395409_Well Construction - GW1_20110624

NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3580
1. WELL CONTRACTOR:
Bryan Vest
Well Contractor (Individual) Name
Ransier Environmental Drilling, Inc.
Well Contractor Company Name
1 Piney Point
Street Address
Whispering Pines
NC 28327
City or Town
(910 ) 690-6688
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#TW-1
State Zip Code
OTHER ASSOCIATED PERMIT#(ifapplicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Monitoring Municipal/Public 0
Industrial/Commercial 0 Agricultural ❑ Recovery 0 Injection 0
Irrigation❑ Other 0 (list use)
DATE DRILLED5/24/11
4. WELL LOCATION:
13801 Providence Road
(Street Name, Numbers,Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Weddington COUNTYUnion
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley What ❑Ridge ❑Other
LATITUDE 35 ®'59 .30 • "DMS DD
LONGITUDE 80 ®° 31 ,49 "DMS DD
Latitude/longitude source: R 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.)
Brewer-Hendly Oil Company
Facility Name
see above
Facility ID# (if applicable)
Street Address
see above
City or Town
Laura Minor
NC
State
Zip Code
Contact Name
410 E. Franklin Street
Mailing Address
Monroe NC 28112
City or Town State Zip Code
( 704 ) . 289-5881
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 45
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO (JV
c. WATER LEVEL Below Top of Casing: 28
(Use "+" if Above Top of Casing)
FT.
d. TOP OF CASING IS 2.5 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):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top -.25 Bottom 40 Ft. 2" Sch 40 PVC
Top 0 Bottom 35 Ft. 5" Sch 40 PVC
Top Bottom Ft.
8. GROUT: Depth Material
Top .5 Bottom 35 Ft. portland
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth
Bottom 45
Top Bottom
Top Bottom
Top 40
Method
tremmie
Diameter Slot Size
Ft.2 in. .010 in.
Ft. in:. in.
Ft. in. in.
Material
PVC
•
10: SAND/GRAVEL . EL PACK:
Depth .. _ Size ._.. Material.
Top 38 Bottom 45 Ft. Med. Quartz
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 /35
35 /45
/
/
/
/
Formation Description
brown/gray silty sand
as above with rock frags
/ ri-Q AL-)\/cn
/
/ JUN 2 4 2011
12. REMARKS:
Information Processinc
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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.
6/8/11
IGN URE OF CERTIFIED WELL CONTRACTOR DATE
Bryan Vest
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
i ''Submit withinr30 days of.completion to jDivision of
1617 Mail Sernce Center, Raleigh, NC 27699 161, Phone
titer Qualtfj,
919) 80T-6300
Form GW-lb
Rev. 2/09