406490_Well Construction - GW1_20120820

]VONREsJDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2393-A
1. WELL CONTRACTOR:
George R. Bridger
Well Contractor (Individual) Name
Bridger Drilling Entrp., Inc. dba Carolina Drilling
Well Contractor Company Name
114 Chimney Lane
Street Address
Wilmington NC 28409
City or Town State Zip Code
(910 ) 799-0493
Area code Phone number
2. WELL INFORMATION:
e. n ;'
d. TOP OF CASING IS (-) 0.1 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
Diameter
WELL CONSTRUCTION PERMIT# : Top 0 Bottom 25 Ft. 1.5
OTHER ASSOCIATED PERMIT#(if applicable) : Top Bottom Ft.
SITE WELL ID #(if applicable) MW2 ; Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring 11 Municipal/Public ❑
Industrial/Commercial 0 Agricultural ❑ Recovery 0 Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 6/21/12
4. WELL LOCATION:
Mockingbird Road
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Wilmington COUNTY New Hanove
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley ❑ Flat ❑ Ridge ❑ Other
LATITUDE a65174/f ' W� ' DMS OR 3X.XXXXXXX)0( DD
LONGITUDE_° 3 18.17 7 " DMS OR 7X.XXXXXXXXX DD
Latitude/longitude source: ❑GPS Agtgpographic map
(location of well must be shown on a USGS topo map andaitached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Coastal Cleaners
Facility Name Facility ID# (if applicable)
DSCA Petitioner #05-0002-Mockingbird Road
Street Address
Wilmington NC
City or Town State Zip Code
Christopher Fav-Withers & Ravenel
Contact Name
1410 CommonweaIth Dr_ STE 101
Mailing Address
Wilmington NC 28403
City or Town State Zip Code
( 9 1 0 238-0313
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 40
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO gI
c. WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
7. CASING: Depth
8. GROUT:
Top 0
Depth Material
Bottom 23 Ft. neat
Thickness/
Weight Material
sch40 pvc
Top Bottom Ft.
Top Bottom Ft.
Method
in place
9. SCREEN: Depth Diameter Slot Size Material
: Top 25 Bottom 40 Ft. 1.5 in. 010 in. , pvc
Top Bottom Ft. in.
i Top Bottom Ft. in.
: 10. SAND/GRAVEL PACK:
Depth Size Material
Top 25 Bottom 40 Ft. med sand
Top Bottom Ft.
: Top Bottom Ft.
: 11. DRILLING LOG
Top Bottom Formation Description
•
" / 40 tan & gray sand
/
/
12. REMARKS:
prepack wei
fuJ
1 DO HEREBY CERTIFY THAT THIS
• 15A NCAC 2C, WELL ' T STRUC
: RECORD HAS BEE - ' OVIDE
URE OF CER IFIE
eorge R. Bridger
PRINTED NAME OF PERSON CONSTRUCTMG TH,F WELL,
LL WAS CONSTRUCTED IN ACCORDANCE WITH
STANDARDS, AND THAT A COPY OF THIS
WELL OWNER.
715/12
ELL CONTRACTOR= DATE
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service'Center, Raleigh, NC 27699-161, Phone : [phone]
r :Form GW-1 b
Rev. 2/09