381260_Well Construction - GW1_20100225

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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 Eister
Well Contractor (Individual) Name
Brldaer Drlllina Enterprises. Inc
Well Contractor Company Name
114 Chimney Lane
Street Address
Wilminaton
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 1 Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ 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)
crry Wallace COUNTY Duplin
TOPOGRAPHIC / LAND SETTING (check appropriate box)
❑ Slope ❑Valley ❑ Flat ❑ Ridge ['Other
LATITUDE 34
LONGITUDE 77
" 44 967 0000 " DMS OR 3x xxxxxxxxx DD
" 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 Rahway 50
Street Address
Wallace NC 98408
City or Town State Zip Code
Daua Haaaett
��11,�,, Contact Name
JJ PQBIx15104
Mailing Address
Wllminatan NC 28408
/\ / City or Town State Zip Code
( 910h 397-0808
Area code Phone number
6 WELL DETAILS
a TOTAL DEPTH 12
b DOES WELL REPLACE EXISTING WELL? YES ❑ NO q/
c WATER LEVEL Below Top of Casing 2 FT
(Use "+" if Above Top of Casing)
Suq it within 30 d ys of omplet on to.Division oflWater Quality - Information processing,,)
:°,1617 Mad Service"Center; Raleigh,Aq,27699,161; Phone .U(919),807-6300,
d TOP OF CASING IS -3'i 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 NA Amount
g WATER ZONES (depth)
NC 28409 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
Top 2 Bottom 12 Ft 2 in
Top Bottom Ft in
Top Bottom Ft in
10 SAND/GRAVEL PACK
Depth Size
Top 1 5 Bottom 12 Ft #2
Top Bottom Ft
Top Bottom Ft
Slot Size Material
0 10 in pvc
in
In
Material
torpedo
11 DRILLING LOG
Top Bottom Formation Description
tan sand
12 REMARKS
gray clay
"D 2 5 2010
Ir.f
rrocessina Unit
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C WELL CONSTRUCTION STANDARDS AND THAT A COPY OF THIS
REC HAS BEEN ROVIDED TO THE WELL O�R J
� e � �, -, g Ib
SIGNATURE OF CERTIFIED ELL CONTRACTOR DATE
Gerald R. Ester
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Rev 2/09 / •
OCT 2J2013