414331_Well Construction - GW1_20130722

1. WELL CONTRACTOR:
Bryan Vest
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 358°
: d. TOP OF CASING IS -.25 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): METHOD OF TEST
: f. DISINFECTION: Type Amount
: g. WATER ZONES (depth):
NC 28370 •
Top Bottom Top Bottom
City or Town State Zip Code • Top Bottom Top Bottom
(910 ) 690-6688 : Top Bottom Top Bottom
Area code Phone number
Well Contractor (Individual) Name
Ransier Environmental Drilling, Inc.
Well Contractor Company Name
PO Box 923
Street Address
Pinehurst
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(rf applicable)
SITE WELL ID #(if applicable)MW
3. WELL USE (Check One Box) Monitoring Municipal/Public 0
Industrial/Commercial 0 Agricultural 0 Recovery 0 Injection 0
Irrigation❑ Other 0 (list use)
DATE DRILLED6/24/1 3
4. WELL LOCATION:
401 Arendell St.
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Morehead City COUNTYCarteret
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley lielat ❑Ridge ❑Other
LATITUDE 34 :t' F .43 ,15 "DMS DD
LONGITUDE 76 0 ° 42.25 "DMS DD
Latitude/longitude source: 3PS [Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS) : 11. DRILLING LOG
5. FACILITY (Name of the business where the well is located.) : Top Bottom Formation Description
Wilco -Hess 0 / 12 sand
Thickness/
7. CASING: Depth Diameter Weight Material
Top -.25
Bottom 2 Ft 2 Sch 40 PVC
Top Bottom Ft
Top Bottom Ft
8. GROUT: Depth Material Method
: Top 0 Bottom 1 Ft portland tremmie
Top Bottom Ft
Top Bottom Ft
9. SCREEN: Depth Diameter Slot Size Material
: Top 2 Bottom 12 Ft. 2 in. .010 in. PVC
Top Bottom Ft in. in.
Top Bottom Ft in. in.
: 10. SAND/GRAVEL PACK:
Depth Size Material
Top 1.5 Bottom 12 Ft Med. Quartz
Facility Name
see above
Facility ID# (if applicable)
Street Address
see above
NC
City or Town
Nicole Long
State Zip Code
Contact Name
2301-F Crown Point Executive Dr
Mailing Address
Charlotte NC 28227
City or Town State Zip Code
(704 ) 845-4010
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 12
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO pBI
c. WATER LEVEL Below Top of Casing: 3
(Use "+" if Above Top of Casing)
FT.
: Top Bottom Ft.
Top Bottom Ft.
1
1
1
/
1
/
/
/
/
/
12. REMARKS:
I_R QUALITY SECTION
!NICK-ATKA PROCESSING UNIT
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
• RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
.
7/1 /13
SIGNATURE OF CERTIFIED WELL 00TRaA TC d--- 14EL,
Bryan Vest
PRINTED NAME OF PERSON CON
c.6teTrA L8i
Submit within 30 days of completion to: Division oWater Quality - information Process n, .
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form G v-1 b
Rev. 2/09-