394262_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
9(10 ) 690-6688
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#MW-14
NC 28327
State Zip Code
OTHER ASSOCIATED PERMIT#(ifapplicable)
SITE WELL ID #(ifapplicable)
3. WELL USE (Check One Box) Monitoring Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection D
Irrigation"! Other ❑ (list use)
DATE DRILLED4/11 /11
4. WELL LOCATION:
4702 Concord Hwy
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Monroe COUNTYUnion
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope DValley Vlat ❑Ridge ['Other
LATITUDE 35 ® 059 .30 " DMS DD
LONGITUDE 80 ®° 31 .49 " 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.)
Fletcher Oil Co.
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 11/
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 Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top -.25 Bottom 3 Ft. 2" Sch 40 PVC
Bottom
Bottom
tdd
F�•i r«
Top Bottom Ft
Top Bottom Ft.
8. GROUT: Depth Material Method
Top .5 Bottom 1 Ft. portland tremmie
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top 3 Bottom 23 Ft. 2 in. .010 in. PVC
Top Bottom Ft. in. in.
Top Bottom Ft. 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
5 /17
17 /23
/
/
/
/
/
12. REMARKS:
red/tan silty clay
weathered granite
granite
MAY
2011
informat;,,0 t'r,,t,essing Unit
DWr�jer,c
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.
SIG
TURE OF CERTIFIED WELL CONTRACTOR
Bryan Vest
5/4/11
DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
later Qualit
919) 807-63(
Form GW-lb
Rev. 2/09