406468_Well Construction - GW1_20120820

NONRESIDENTIAL 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. Bridaer
Well Contractor (Individual) Name
Bridaer 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:
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) MW20
3. WELL USE (Check One Box) Monitoring se. Municipal/Public 0
Industrial/Commercial 0 Agricultural 0 Recovery 0 Injection 0
Irrigation❑ Other 0 (list use)
DATE DRILLED 6/21112
4. WELL LOCATION:
East Cascade Road
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Wilmington COUNTY New Hanovo
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope [Walley 0 Flat 0 Ridge ❑ Other
LATITUDE 3 i f ' S741"DMS OR 3X.XXXXXXXXX DD
LONGITUDE45? "° ' 1153P " DMS OR 7X.XXXXXXXXX DD
Latitude/longitude source: ❑GPS :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.)
Coastal Cleaners
Facility Name Facility ID# (if applicable)
DSCA Petitioner #65-0002-East Cascade Rd.
Street Address
Wilmington NC
City or Town State Zip Code
Christoahel Fav-Withers & Ravenel
Contact Name
1410 Commonwealth. Dr . STE 101
Mailing Address
Wilmington NC 28403
City or Town State Zip Code
( 910n 238-0313
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 40
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO pi
c. WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
,
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
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0 Bottom 25 Ft. 1.5 sch40 pvc
: Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material
Top 0 Bottom 23 Ft. neat
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. in.
Top Bottom Ft. in. in.
: 10. SAND/GRAVEL PACK:
Depth Size Material
Top 25 Bottom 40 Ft. med sand
Top
: Top
: 11. DRILLING LOG
Top Bottom
0 / 40
Bottom
Bottom
= 12. REMARKS:
prepack we
Ft.
Ft.
Formation Description
tan & gray sand
A
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WE ONST CTION STANDARDS, AND THAT A COPY OF THIS
: RE • " s AS : ' PRO D D THE WELL OWNER.
• :. 7'5112
. George R. Bridaer
PRINTED NAME OF PERSON CONSTRUCTING TI E IVEt L
TURE OF CERT/74ED WELL CONTRAC �TjRr:: _ ° r`�` _ PATE
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form 6W l b
Rev.`2/09