398938_Well Construction - GW1_20111021

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
City or Town
( 704 ) 872-7686
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# N/A
NC 28625
State Zip Code
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) AS-5
3. WELL USE (Check One Box) Monitoring d Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation Other ❑ (list use)
DATE DRILLED 09/26/11
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 DOther
LATITUDE " DMS OR DD
LONGITUDE " DMS OR DD
Latitude/longitude source: [PPS aopographic 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
City or Town
OK 74006
State Zip Code
( )
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 25.0 FEET
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO pi
c. WATER LEVEL Below Top of Casing: 13.0 FT.
(Use "+" if Above Top of Casing)
ervlce
f completion to Divisionao
aleighNC 27699 161, PhonE
3 0 e '. to 8
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 N/A
f. DISINFECTION: Type N/A Amount N/A
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 22.5 Ft. 2 INCH SCH 40 PVC
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth
Top 3.0 Bottom 18.0 Ft.
Top Bottom Ft.
Top Bottom Ft.
Material
PORTLAND BENTONITE
Method
SLURRY
9. SCREEN: Depth Diameter Slot Size Material
Top 22.5 Bottom 25.0 Ft. 2.0 in. .010 in. PVC
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
Top 20.0 Bottom 25.0 Ft. 20-40
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0.0
5.0
15.0
5.0
15.0
25.0
FINE SILICA SAND
Formation Description
ORANGE SILTY SAND
BROWN/TAN SILTY CLAY
POWDER SILT/WHITE ROCK
PECCIVPD
UL 1 2 1 201t
Iatformatio . ^,Uutssi-ny unit
�11nr� er.
+.sr uQ�j
12. REMARKS:
BENTONITE SEAL FROM 18.0 TO 20.0 FEET
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A N C , WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
EEN PROVIDE gTOTHE WELACIWNER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR
MARK GETTYS
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
8O76
Form GW-lb
Rev. 2/09

/1'24-