398936_Well Construction - GW1_20111021

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NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2345
1. WELL CONTRACTOR:
MARK GETTYS
Well Contractor (Individual) Name
GEOLOGIC EXPLORATION, INC
Well Contractor Company Name
176 COMMERCE BLVD
Street Address
STATESVILLE NC 28625
City or Town State Zip Code
(704 ) 872-7686
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# N/A
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) AS-3
3. WELL USE (Check One Box) Monitoring d Municipal/Public ❑
Industrial/Commercial ❑ Agricultural 0 Recovery 0 Injection 0
Irrigation❑ Other 0 (list use)
DATE DRILLED 09/27/11
4. WELL LOCATION:
13024 EAST INDEPENDENCE BLVD 28105
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: STALLINGS COUNTY UNION
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley ❑Flat ❑Ridge ❑Other
LATITUDE
LONGITUDE
"DMS OR
" DMS OR
DD
DD
Latitude/longitude source: EGPS [Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
RMR - 2364 N/A
Facility Name Facility ID# (if applicable)
13024 EAST INDEPENDENCE BLVD
Street Address
STALLINGS
City or Town
CONOCO PHILLIPS
NC 28105
State Zip Code
Contact Name
420 SOUTH KEELER AVENUE
Mailing Address
BARTLESVILLE OK 74006
City or Town State Zip Code
( )
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 30.0 FEET
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO d
c. WATER LEVEL Below Top of Casing: 13.0 FT.
(Use "+" if Above Top of Casing)
ervice
398936
d. TOP OF CASING IS 0.0 FT. Above Land Surface*
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): N/A METHOD OF TEST
f. DISINFECTION: Type N/A Amount
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness)
7. CASING: Depth Diameter Weight Material
Top 0.0 Bottom 27.5 Ft. 2 INCH SCH 40 PVC
N/A
N/A
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material
Top 3.0 Bottom 23.0 Ft. PORTLAND BENTONITE
Top Bottom Ft.
Top Bottom Ft.
Method
SLURRY
9. SCREEN: Depth Diameter Slot Size Material
Top 27.5 Bottom 30.0 Ft. 2.0 in. .010 in. PVC
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top 25.0 Bottom 30.0 Ft. 20-40
Top
Top
Bottom
Bottom
11. DRILLING LOG
Top Bottom
0.0 / 5.0
5.0 / 15.0
15.0 / 26.0
26.0 / 30.0
Ft.
Ft.
Material
FINE SILICA SAND
Formation Description
ORANGE SILTY SAND
BROWN SILTY CLAY
TAN SANDY CLAY
BROWN SILTY CLAY
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lnfnr^nali6., roLessi+tg UIIOC
12. REMARKS:
BENTONITE SEAL FROM 23.0 TO 25.0 FEET
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NC 2 WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RE EN PR IDED WELL t\
SIGNATURE OF CERTIFIED WELL CONTRACTOR
''MARK GETTYS
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-lb
Rev. 2/09