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HomeMy WebLinkAbout393659_Well Construction - GW1_20110509NON ONRESIDENTIAL WELL CONSTRUCTION RECORD North Carolina Department of Environment and Natural Resources- Division of Water Quality WELL CONTRACTOR CERTIFICATION # 3550 1. WELL CONTRACTOR: JAMES HESS 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 State 28625 Zip Code OTHER ASSOCIATED PERMIT#Qt applicable) SITE WELL ID #(if applicable) AS-1 A 3. WELL USE (Check One Box) Monitoring V Municipal/Public ❑ Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑ IrrigationE Other ❑ (list use) DATE DRILLED 04/04/11 - 04/05/11 4. WELL LOCATION: 130 NORTH SUTHERLAND AVENUE 28110 (Street Name, Numbers, Community, Subdivision, Lot No„ Parcel, Zip Code) CITY: MONROE COUNTY UNION TOPOGRAPHIC / LAND SETTING: (check appropriate box) ❑Slope ❑ Vallev ❑Flat ❑Ridge ❑Other LATITUDE " DMS OR DD LONGITUDE " DMS OR DD Latitude/longitude source: I= PS [(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.) NCDOT FACILITY N/A Facility Name Facility ID# (if applicable) 130 NORTH SUTHERLAND AVENUE Street Address MONROE City or Town NC 28110 State Zip Code NCDOT - PROFESSIONAL SERVICES MGT UNIT Contact Name 4809 BERYL ROAD Mailing Address RALEIGH City or Town ( 919 ) 250-3004 Area code Phone number 6. WELL DETAILS: a. TOTAL DEPTH: 35.0 FEET NC 27606 State Zip Code b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO [if c. WATER LEVEL Below Top of Casing: 10.5 FT. (Use "+" if Above Top of Casing) er6 a a 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 25.0 Ft. 2 INCH SCH 40 PVC Top Bottom Ft. Top Bottom Ft. 8. GROUT: Depth Top 3.0 Bottom 20.0 Top Bottom Top Bottom Material Ft. PORTLAND BENTONITE Ft. Ft. Method SLURRY 9. SCREEN: Depth Diameter Slot Size Material Top 25.0 Bottom 35.0 Ft. 2.0 in. .010 in. PVC Top Bottom Ft. in. in. Top Bottom Ft. in. in. 10. SAND/GRAVEL PACK: Depth Top 23.0 Bottom 35.0 Top Top Bottom Bottom 11. DRILLING LOG Top Bottom 0.0 8.0 29.0 8.0 29.0 35.0 12. REMARKS: BENTONITE SEAL FROM 20 0 TO 23.0 FEET Size Material Ft. 20-40 Ft. Ft. FINE SILICA SAND Formation Description BROWN/RED SILTY CLAY PARTIALLY WEATHERED ROCK GRAY SLATE lt„�snatlo BOG n9 oco I DO 15A R CTED IN ACCORDANCE WITH THAT A COPY OF THIS SIGNATURE OF CERTIFIED WELL CONTRACTOR JAMES HESS PRINTED NAME OF PERSON CONSTRUCTING THE WELL Submit within 30 days ofcompletion to: Division of Water Quality Information Processing, 1617 Mail Service Center,: Raleigh. NC 27699-161, Phone : (919) 807-6300 Form GW-lb Rev. 2/09