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HomeMy WebLinkAbout393379_Well Construction - GW1_20110419NONRESIDENTIAL 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. Wet Contractor Company Name 1 Piney Point Street Address Whispering Pines NC 28327 City or Town State Zip Code (910 ) 690-6688 Area code Phone number 2. WELL INFORMATION: WELL CONSTRUCTION PERMIT#MW-6 OTHER ASSOCIATED PERMIT#(if applicable) SITE WELL ID #(tf applicable) 3. WELL USE (Check One Box) Monitoring Municipal/Public ❑ Industrial/Commercial 0 Agricultural 0 Recovery 0 Injection 0 Irrigation❑ Other ❑ (list use) DATE DRILLED2/24/11 4. WELL LOCATION: 3813 Hwy 74 (Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code) CITY: Wingate COUNTYUnion TOPOGRAPHIC / LAND SETTING: (check appropriate box) ❑Slope ❑ Valley VVlat ❑ Ridge ❑ Other LATITUDE 34 0°58 ,55 "DMS DD LONGITUDE 80 ®° 27.31 "DMS DD Latitude/longitude source: 12PS [(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.) Sandy's Cleaners Facility Name see above Facility ID# (if applicable) Street Address see above NC City or Town Kristin Beckwith State Zip Code Contact Name PO Box 16265 Mailing Address Greensboro NC 27416 City or Town State Zip Code (336 ) 335-3174 Area code Phone number 6. WELL DETAILS: a. TOTAL DEPTH: 19 b. DOES WELL REPLACE EXISTING WELI ? YES n NO V c. WATER LEVEL Below Top of Casing: 11 (Use "+" if Above Top of Casing) FT. 3 ;.f.:) 7 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): Top Bottom Top Bottom Top Bottom Top Bottom Top Bottom Top Bottom Thickness/ 7. CASING: Depth Diameter Weight Material Top -.25 Bottom 4 Ft. 2" Sch 40 PVC Top Bottom Ft. Top Bottom Ft. 8. GROUT: Depth Material Top .5 Bottom 1 Ft. portland Top Bottom Ft. Top Bottom Ft. Method tremmie 9. SCREEN: Depth Diameter Slot Size Material Top 4 Bottom 19 Ft. 2 in. .010 in. PVC Top Bottom Ft. in. in. Top Bottom Ft. in. in. 10. SAND/GRAVEL PACK: Depth Size Material Top 3 Bottom 19 Ft. Med. Quartz Top Bottom Ft. Top Bottom Ft. 11. DRILLING LOG Top Bottom Formation Description 0 / 8 Red silty clay 8 / 18 weathered rock 18 / 19 rock / / 12. REMARKS: 2011 Infor71ie3boo Pioces4kn.-. e • I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECQRD HAS BEEN PROVIDED TO THE WELL OWNER. 3/4/11 IGN Kt OF CERTIFIED WELL CONTRACTOR DATE E Bryan Vest PRINTED NAME OF PERSON CONSTRUCTING THE WELL ubm'rViithin' 30 bays of completion to Divlslon,of 17 Mall Service Center, Raleigh NC 27699 181, one,. Form GW-lb Rev. 2/09