381261_Well Construction - GW1_20100225

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2394
1 WELL CONTRACTOR
Gerald R Ester
Well Contractor (Individual) Name
Bndaer Drilling Enterprises. Inc
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)
3 WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irngation❑ Other ❑ (list use)
DATE DRILLED 2/2/10
4 WELL LOCATION
5489 NC Hiahwav 50
(Street Name, Numbers, Community Subdivision Lot No , Parcel Zip Code)
CITY Wallace COUNTY DuDlln
TOPOGRAPHIC / LAND SETTING (check appropnate box)
DSlope ❑Valley jplat ❑Ridge ❑Other
LATITUDE 34 0 44 967 0000 DMS OR 3x xxxxxxxxx DD
LONGITUDE 77 0 46 590 0000 " DMS OR 7x xxxxxxxxx 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 )
Barbara's Grocery & Grill
Facility Name Facility ID# (if applicable)
5489 S NC Hiahwav 50
Street Address
Wallace
City or Town
Douai Hamlett
Contact Name
PO Box 15104
NC. 98466
State Zip Code
Mailing Address
Wilmington
City or Town
(7j (910n 397-0808
Area code Phone number
6 WELL DETAILS
a TOTAL DEPTH 12
NC 28408
State Zip Code
b DOES WELL REPLACE EXISTING WELL? YES ❑ NO qji
c WATER LEVEL Below Top of casing A, FT
(Use "+" if Above Top of Casing)
)G C 1• r.,
d TOP OF CASING IS 3" 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) N/A METHOD OF TEST
f DISINFECTION Type N/A 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 2 Ft 2 sch40 pvc
Top Bottom Ft
Top Bottom Ft
8 GROUT Depth Material Method
Top 0 Bottom 1 Ft neat in place
Top Bottom Ft
Top Bottom Ft
9 SCREEN Depth Diameter Slot Size Material
Top 2 Bottom 12 Ft 2 in 0 10 in pvc
Top Bottom Ft in in
Top Bottom Ft in in
10 SAND/GRAVEL PACK
Depth Size Material
Top 1 5 Bottom 12 Ft #2 torpedo
Top Bottom Ft
Top Bottom Ft
11 DRILLING LOG
Top Bottom Formation Description
0-10 / tan sand
10-12 / aray clay
/
12 REMARKS
rAEL..1—#1/C'r
r~" 95 20-1c
iritormation
DWQ/6OGJ
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C WELL CONSTRUCTION STANDARDS AND THAT A COPY OF THIS
RE D HAS N PkVIDEDTO HE WELL OWNER
SIGNATURE OF CERTIFIED WELL CONTRACTOR
VC-6g o /q, l�(S L-
P NTED NAME OF PERSON CONSTRUCTING THE WELL
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,,Submit within,30 days'of completion to•`DivisionnoffWater Quality- -Information Processing,' t Rev 2/09
, 6 - '�1617 MaiII Service Center, Raleigh,-161, Phone [phone], fig= ,, a,
_,�. �s. � w - � .! OCT 2 3 2013