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Home My WebLink AboutWI0600068_Well Records_20111108erg SCArt r,� NONRESIDENTIAL WELL CONSTRUCTION RECORD North Carolina Department of Environment and Natural Resources- Division of Water Quality WELL CONTRACTOR CERTIFICATION # 2579 1. WELL CONTRACTOR: DANNY SUMMERS 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 70{ 4 ) 872-7686 ,Area code Phone number 2. WELL INFORMATION: WELL CONSTRUCTION PERMIT# N/A OTHER ASSOCIATED PERMIT#(if applicable) SITE WELL ID #(if applicable) MW-26 3. WELL USE (Check One Box) Monitoring d Municipal/Public ❑ Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑ Irrigation❑ Other ❑ (list use) DATE DRILLED 11/03/11 4. WELL LOCATION: 3060 OWEN DRIVE 28306 (Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code) CITY:FAYETTEVILLE COUNTY CUMBERLAND TOPOGRAPHIC / LAND SETTING: (check appropriate box) ❑Slope ❑Valley ❑Flat ❑Ridge ❑Other LATITUDE _°_' " DMS OR DD LONGITUDE _°_' " DMS OR DO Latitude/longitude source: BPS 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.) SMITTYS CLEANERS N/A Facility Name Facility ID# (if applicable) 3060 OWEN DRIVE Street Address FAYETTEVILLE NC 28306 City or Town State Zip Code NCDENR .Contact Name 401 OBERLIN ROAD Mailing Address RALEIGH NC 27605 City or Town State Zip Code U Area code Phone number 6. WELL DETAILS: a. TOTAL DEPTH: 20.0 FEET b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO p( c. WATER LEVEL Below Top of Casing: 7.0 FT. (Use "+" if Above Top of Casing) 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 5.0 Ft. 1 INCH SCH 40 PVC Top Bottom Ft. Top Bottom Ft. 8. GROUT: Depth Material Method Top 0.0 Bottom 3.0 Ft. PORTIANDBENTONITE SLURRY Top Bottom Ft. Top Bottom Ft. 9. SCREEN: Depth Diameter Slot Size Material Top 5.0 Bottom 20.0 Ft. 1.0 in. .010 in. PVC v Top Bottom Ft. in. in.. Top Bottom - Ft.-- ---- 10. SAND/GRAVEL PACK: Depth Size Material Top 4.0 Bottom 20.0 Ft. 20-40 FINE SILICA SAND Top Bottom Ft. Top Bottom Ft. 11. DRILLING LOG Top Bottom Formation Description 0.0 / 10.0 BROWN/TAN SAND 10.0 / 20.0 BROWN SANDY CLAY 1 12. REMARKS: BENTONITE SEAL FROM 3.0 TO 4,0 FEET I D EREBY CERTIF HAT THIS WELL S CONSTRUCTED IN ACCORDANCE WITH 1 AC 2C, WELL STRUCTION ST DARDS, AND THAT A COPY OF THIS CO D HAS BEEN VI�TO TH ELL OWNER. 11 /08/11 SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE DANNY SUMMERS PRINTED NAME OF PERSON CONSTRUCTING THE WELL Form GW-1 b Rev. 2/09 bFNR-F�;Y�?tFI�LLc AC OFFICE NONRESIDENTIAL WELL CONSTRUCTION RECORD North Carolina Department of Environment and Natural Resources- Division of Water Quality WELL CONTRACTOR CERTIFICATION # 2579 1. WELL CONTRACTOR: DANNY SUMMERS 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 70( 4 ) 872-7686 Area code Phone number 2 WELL INF d. TOP OF CASING IS 0.0 FT. Above Land Surface' `Top of casing terminated attor 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 NIA g. WATER ZONES (depth): Top Bottom Top Bottom Top Bottom Top Bottom Top Bottom Top Bottom Thickness/ ORMATION: : 7. CASING: Depth Diameter Weight Material WELL CONSTRUCTION PERMIT# N/A :Top 0.0 Bottom 5.0 Ft. 1 INCH SCH 40 PVC OTHER ASSOCIATED PERMIT#(if applicable) : Top Bottom Ft. SITE WELL ID #(if applicable) MW-27 : Top Bottom Ft. 3. WELL USE (Check One Box) Monitoring V Municipal/Public ❑ : 8. GROUT: Depth Material Method Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑ Top 0.0 Bottom 3.0 Ft. PORTLANOBENTONITE SLURRY Irrigation❑ Other ❑ (list use) : Top Bottom Ft. DATE DRILLED 11/03/11 : Top Bottom Ft. 4. WELL LOCATION: : 9. SCREEN: Depth Diameter Slot Size Material 3060 OWEN DRIVE 28306 :Top 5.0 Bottom 20.0 Ft. 1.0 in. 010 in. PVC ,(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code) Top Bottom Ft. in. in. CITY: FAYETTEVILLE K `` _` W r - = — -COUNTY=CUAhBERLAND. — — —' Top -- _= =-- Bottom" - ` Ft. in. in. TOPOGRAPHIC / LAND SETTING: (check appropriate box) ❑Slope ❑Valley ❑Flat ❑Ridge ❑Other 10. SAND/GRAVEL PACK: LATITUDE _° " DMS OR DD Depth Size Material — LONGITUDE " : Top 4.0 Bottom 20.0 Ft. 20-40 FINE SILICA SAND _°_' DMS OR DD : Top Bottom Ft. Latitude/longitude source: BPS aopographic map : Top Bottom Ft. (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.) 11. DRILLING LOG Top Bottom Formation Description SMITTYS CLEANERS N/A Facility Name Facility ID# (if applicable) 3060 OWEN DRIVE Street Address FAYETTEVILLE NC 28306 City or Town State Zip Code NCDENR . Contact Name 401 OBERLIN ROAD Mailing Address RALEIGH NC 27605 City or Town State . Zip Code U Area code Phone number 6. WELL DETAILS: a. TOTAL DEPTH: 20.0 FEET b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0/ c. WATER LEVEL Below Top of Casing: 7.0 FT. (Use "+" if Above Top of Casing) 0.0 / 10.0 10.0 / 20.0 BROWNITAN SAND BROWN SANDY CLAY �NOV _=ZIP 12. REMARKS: 5ENTONITE SEALFROM 3.0 TO 4.0 FEET I DO HEREBY CERTIFY THAT THIS WELL AS CONSTRUCTED IN ACCORDANCE WITH • 1 CAC 2C, WELLSTRUCTION S DARDS, AND THAT A COPY OF THIS .0 RD HAS BEEYOOQO� VI DTO THE- ELL OWNER. 11 /08/11 NATUR F CERTIFIED WELL CONTRACTOR DATE DANNY SUMMERS PRINTED NAME OF PERSON CONSTRUCTING THE WELL Form GW-lb Rev. 2/09 N10V 2 12011 9ENR-FAYETTEMLLE RECITAL OFFICE �~ SrArp� L '~ `' ?' NONRESIDENTIAL WELL CONSTRUCTION RECORD F C y' North Carolina Department of Environment and Natural Resources- Division of Water Quality WELL CONTRACTOR CERTIFICATION # 2579 1. WELL CONTRACTOR: : d. TOP OF CASING IS 0.0 FT. Above Land Surface' DANNY SUMMERS `Top of casing terminated atlor below land surface may require Well Contractor (Individual) Name a variance in accordance With 15A NCAC 2C .0118. GEOLOGIC EXPLORATION, INC : e. YIELD (gpm): NIA METHOD OF TEST N/A Well Contractor Company Name 176 COMMERCE BLVD f. DISINFECTION: Type N/A Amount N/A Street Address STATESVILLE NC 28625 City or Town State Zip Code 70( 4 ) 872-7686 Area code Phone number 2. WELL INFORMATION: WELL CONSTRUCTION PERMIT# N/A OTHER ASSOCIATED PERMIT#(if applicable) SITE WELL ID #(if applicable) MW-28 3. WELL USE (Check One Box) Monitoring W Municipal/Public ❑ Ind ustrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑ Irrigation❑ Other ❑ (list use) DATE DRILLED 11/03/11 4. WELL LOCATION: 3060 OWEN DRIVE 28306 (Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code) ___ I _CITY 'FAYE-T_TEVILLE----- - - COUNTY CUMBERLAND TOPOGRAPHIC / LAND SETTING: (check appropriate box) ❑Slope []Valley []Flat ❑Ridge ❑Other LATITUDE _°_' " DMS OR DD LONGITUDE _°_' " DMS OR DC Latitude/longitude source: BPS QTopographic 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.) SMITTYS CLEANERS N/A Facility Name Facility ID# (if applicable) 3060 OWEN DRIVE Street Address FAYETTEVILLE NC 28306 City or Town State Zip Code NCDENR Contact Name 401 OBERLIN ROAD Mailing Address RALEIGH NC 27605 City or Town State Zip Code U Area code. Phone number 6. WELL DETAILS: a. TOTAL DEPTH: 20.0 FEET b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO p� c. WATER LEVEL Below Top of Casing: 7.0 FT. (Use "+" if Above Top of Casing) 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 5.0 Ft. 1 INCH SCH 40 PVC Top Bottom Ft. Top Bottom Ft. 8. GROUT: Depth Material Method Top 0.0 Bottom 3.0 Ft. PORTLANDBEWONITE SLURRY Top Bottom Ft. Top Bottom Ft. 9. SCREEN: Depth Diameter Slot Size Material Top 5.0 Bottom 20.0 Ft. 1.0 in. .010 in. PVC Top Bottom Ft. in. in. - --•--= Top Bottom - Ft� = In - <. m-- 10. SAND/GRAVEL PACK: Depth Size : Top 4.0 Bottom 20.0 Ft. 20-40 Top Bottom Ft. Top Bottom Ft. 11. DRILLING LOG : Top Bottom 0.0 / 10.0 10.0 / 20.0 Material FINE SILICA SAND Formation Description BROWN/TAN SAND BROWN SANDY CLAY _ . r.... `1 O V I� � 12. REMARKS: SENTONITE SEAL FROM 3.0 TO 4.0 FEET I DO HEREBY CERTIFY THAT THIS WELL S CONSTRUCTED IN ACCORDANCE WITH 1 ^AC 2C, WELL STRUCTION ST DARDS, AND THAT A COPY OF THIS CO D HAS BEEN VID�p TO THE ELL OWNER. SI NATURE OF CERTIFIED WELL CONTRACTOR DATE DANNY SUMMERS PRINTED NAME OF PERSON CONSTRUCTING THE WELL ter Quality `Information Processing; : Form :.. ,. :.:. Rev.2/09/09 !T-- E [E- N,GV 2 12011 DEUR-FAYE TEMLLE REMINAL DFROE WELL No�hCum�mDepu�mvn of Environment �d NaturNONRESIDENTIAL CONSTRtJCTION RECORD al xo D�b�oofTvu�rOuub� WELL CONTRACTOR CERTIFICATION # 2579 � 1.WELL CONTRACTOR: - DANNYGUMK4ERG '� TOP FT. Above Land Surface* � °'^°=°�'" vv*|non�u�xUnuwu ~ ��"�ou � ''~- casing ~-~ ~`~~~~~ land surface may require . uvanance inocoorua��m1u�wC�C2C�o110 � GE Well Contractor Company Name �o. YIELD (ypm):N/A METHOD or TEST N/A 176 COMMERCE BLVD r om/wpsonow: mnvunt-_1N/8--_-- ~^~~~~~== �q. WATER ZONES (denm): -''--'--- =C 28625 �Top_ Bottom Top BottomCit ' or Town State Zip Code � Top Bottom Top Bottom /04 8/2'7686 � Top_ Bottom Top_ Bottom �_______ Area code Phone number �INFORMATION: � Thickness[ :zoAo/ma: Depth Diameter ' Weight '----- Material WELL CnwS7nuCT0w NA\ pEnM ' �Top 0.L_Bottom _�0__Ft. _1 INCH_ SCH 40 PVC�____ OTHER ASSOCIATED psnw|n*(itapplicable) �Top_ Bottom pt`______ SITE WELL m#(n"nm/"ameMVV-28 Top_ Bottom n`_______ »' WELL USE (Check One Box) Monitoring VMuni mpu»pummo o. GROUT: oenm Material Method Ind vnmavoummooia/o Agricultural El Recovery oInjection TuP__2.0L_ov««n3.0-_n. PORTLAND BENTONITE -5LJR��---- »noaoono Other o(list use) Top_ oomvn______Ft. __________ DATE DRILLED 11/03/11 Top_ aomvm n`___________ 4.WELL LooAnow: � �9.ocnssm: oenm Diameter Slot Size Material 3050OVVEN -'`''^ ^~~~" �Top 1~0--n� in. ��C_____TOPOGRAPHIC , unity, Subdivision, Lot No., Parcel, Zip Code) _�0avuon��mbe—rsComm _�. -Jl10' I LAND SETTING: (check appropriate box) SMITTYS CLEANERS N/A Facility Name Facility ID# (if applicable) Street Address City or Town State Zip Code NCDENR Contact Name 401 OBERLIN ROAD Mailing Address City or Town State Zip Code Area code Phone number 6. WELL DETAILS: a. TOTAL DEPTH:— 20.0 FEET b. DOES WELL REPLACE EXISTING WELL? YES [I wo5/ c WATER LEVEL Below Top mCasing: 7 oRovvwnAwSawo BROWN SANDY CLAY 12. REMARKS: /ooHEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION STADARDS, AND THAT A COPY OF THIS R7D HAS BEEN 7VIDED TO TH:PLL OWNER. 11/08/11 DATE —DANNY SUMMERS PRINTED NAME OF PERSON CONSTRUCTING THE WELL Form eW-1» ~� g k:f� C NOV ? 12011 DENR -FAYET TEVILLE REGIC,%AL OFRCE