414830_Well Construction - GW1_20130722

NONRESIJENTIAL WELL CONS'TRUC'TION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 358°
1. WELL CONTRACTOR:
Bryan Vest
Well Contractor (Individual) Name
Ransier Environmental Drilling, Inc.
Well Contractor Company Name
PO Box 923
Street Address
Pinehurst
NC 28370
Zip Code
City or Town State
(910 ) 690-6688
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT# if applicable)
SITE WELL ID #(if applicable)M
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 DRILLED/24/13
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)
0Slope D Valley gelat ❑Ridge ❑ Other
LATITUDE 34 0 043 ' 15 "DMS DD
LONGITUDE 76 0 ° 42' 25 "DMS DD
Latitude/longitude source: OPS ['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.)
Wilco -Hess
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 gbol
c. WATER LEVEL Below Top of Casing: 3
(Use "+" if Above Top of Casing)
FT.
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 (g pm):
METHOD OF TEST
f. DISINFECTION: Type Amount
: g. WATER ZONES (depth):
i Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
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
Top 0 Bottom 1 Ft. Portland
Top Bottom r Ft.
Top Bottom Ft
•
Method
tremmie
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
Top Bottom Ft
Top Bottom Ft.
: 11. DRILLING LOG
Top Bottom
0 /12
•
/
1
1
/
/
1
/
12. REMARKS:
Formation Description
sand
52013
WATER QUALITY SECTION •
1NFORWAMU PROCESSING UNIT
I 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.
SIGN ' URE OF CERTIFIED WELL
Bryan Vest
PRINTED NAME OF PERSON CON
7/1 /13
{�,yV�.tY t �c, r,, �"DATE ;
Submit within 30 days of completion to: Division of Water Quality
1617 Mail Service Center. Raleiah. NC 27699-161, Phone : [phone]
Information Processing, Rev. 2/09