394261_Well Construction - GW1_20110324

NONRESIDENTIAL 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
City or Town
(910 ) 690-6688
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#MW-13
NC 28327
State Zip Code
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Monitoring Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other 0 (list use)
DATE DRILLED4/11 /11
4. WELL LOCATION:
4702 Concord Hwy
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Monroe
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley 'lat ❑Ridge ❑Other
LATITUDE 35 0°59 .30 "DMS DD
LONGITUDE 80 ®° 31.49 " DMS DD
Latitude/longitude source: lijiPS Qropographic 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.)
Fletcher Oil Co.
COUNTYUnIOn
Facility Name
see above
Facility ID# (if applicable)
Street Address
see above
NC
City or Town
Laura Minor
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: 23
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO [�
c. WATER LEVEL Below Top of Casing: 11
(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
Top Bottom Top
Top Bottom Top
7. CASING: Depth Diameter
Top -.25 Bottom 3 Ft. 2"
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material
Top .5 Bottom 1 Ft. portland
Top Bottom Ft.
Top Bottom Ft.
Bottom
Bottom
Bottom
Thickness/
Weight
Material
Sch 40 PVC
9. SCREEN: Depth Diameter Slot Size
Top 3
Top
Top
Bottom 23 Ft. 2
Bottom . Ft.
Bottom Ft.
in.
in.
in.
.010
Method
tremmie
Material
in. PVC
in.
in.
10. SAND/GRAVEL PACK:
Depth Size Material
Top 2 Bottom 23 Ft. Med. Quartz
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom Formation Description
0 / 5 red/tan silty clay
5 / 17 weathered granite
17 / 23 granite
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12. REMARKS:
MAY 2 4 2011
Information Processing unit
DWQ/BOG
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECO$D HAS BEEN PROVIDED TO THE WELL OWNER.
5/4/11
SIGNARIRE OF CERTIFIED WELL CONTRACTOR DATE
Bryan Vest
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
ubmtt.within 30kdays of•completion to Division of'V
�17 Mail Service Center, Raleigh, NG 27699s 161, Phone
Ater Qual
919) 807-63(
rocessinc
Form GW-lb
Rev. 2/09