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HomeMy WebLinkAbout381260_Well Construction - GW1_20100225.1. Are 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