414829_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°
Well Contractor (Individual) Name
Ransier Environmental Drilling, Inc.
Well Contractor Company Name
PO Box 923
Street Address
Pinehurst
NC
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)T
3. WELL USE (Check One Box) Monitoring Municipal/Public 0
Industrial/Commercial 0 Agricultural 0 Recovery ❑ Injection 0
Irrigation❑ Other 0 (list use)
DATE DRILLED/25/13
4. WELL LOCATION:
401 Arendell St.
28370
Zip Code
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Morehead City COUNTYCarteret
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
0Slope [Valley V=lat DRidge ❑Other
LATITUDE 34 043 .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)
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
Contact Name
2301-F Crown Point Executive Dr •
State Zip Code
An
d. TOP OF CASING IS -.25 FT. Above Land Surface*
"Top of casing terminated atlor 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):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
• Thickness/
i 7. CASING: Depth Diameter Weight Material
Top -.25 Bottom 30 Ft. 2" Sch 40 PVC
Top 0 Bottom 25 Ft 5" Sch 40 PVC
Top Bottom Ft
8. GROUT: Depth
: Top .5 Bottom 25
Top Bottom
Top Bottom
9. SCREEN: Depth
Bottom 35 Ft 2 in. .010 in. PVC
Top30
• Top
• Top
Material
Ft. portland
Ft
Ft
Method
tremmie
Diameter Slot Size Material
Bottom Ft in. in.
Bottom Ft. in. in.
: 10. SAND/GRAVEL PACK:
Depth
Bottom 35
Top 28
Top
: Top
11. DRILLING LOG
Top Bottom
•
•
Mailing Address
Charlotte NC
City or Town State
( 704 ) 845-4010
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 35
28227
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO $✓
0 / 20
Bottom
Bottom
20 / 23
23 / 35
/
/
/
/
: 12. REMARKS:
Size Material
Ft. Med. Quartz
Ft
Ft
Formation Description
sand
clayey sand
sea shells/sand
5 201:5
WATER QUALITY SECTION
N(.:-r.)FaliATION 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 PROVID D TO THE WELL OWNER.
V
•
SIGNAT'CJRE OF CERTIFIED WELL.I ,
c. WATER LEVEL Below Top of Casing: 18
(Use "+" if Above Top of Casing)
FT.
Bryan Vest
PRINTED NAME OF PERSON CO
Submit within 30 days of completion to: Division of Water oa
1817 Mail Service Center. Raleigh. NC 27699-161, Phone : [phone]
7/1/13
•
t ytiri,
Form d V-1 b
Rev. 2/09