408232_Well Construction - GW1_20121001

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2314A
1. WELL CONTRACTOR:
DAVID REGISTER
Well Contractor (Individual) Name
REGISTER WELL CO„ INC.
Well Contractor Company Name
721 WEST CHARITY ROAD
Street Address
ROSE HILL
City or Town
910 ) 289-3175
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
NC 28458
State Zip Code
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID *Of applicable)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public 0
Industrial/Commercial 0 Agricultural 0 Recovery 0 Injection 0
Irrigation❑ Other I '(list use) RUN PLANT
DATE DRILLED 9-11-2012
4. WELL LOCATION:
469 YELLOWCUT ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
OR
"32
d. TOP OF CASING IS 2.0 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): 300 METHOD OF TEST AIR
f. DISINFECTION: Type HTH Amount 4 OZ
: 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 200 Ft. 6 S-10 SS
: Top Bottom Ft.
Top Bottom Ft
8. GROUT: Depth
Top 0 Bottom 20
Top
Top
Bottom
Bottom
Material
Ft. HOLE PLUG
Ft.
Ft
9. SCREEN: Depth Diameter
Top 200 Bottom 250 Ft. 6
Top
CITY: ROSE HILL CouNTYDUPLIN Top
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
DSlope CI Valley Flat ❑Ridge ❑Other
LATITUDE 34 050 ' 12.4000 "DMS OR 3X.XXXXXXXXX DD
LONGITUDE 82 ° 2 ' 14.7000 DMS OR 7X.XXXXXXXXX DD
Latitude/longitude source: j3PS ❑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.)
VA11 EY PROTFINS
Facility Name Facility ID# (if applicable)
46.9Y.F.1 1 OWCUT ROAD
Street Address
RASE Hit [ C 28458
City or Town State Zip Code
VALLEY PROTEINS
Contact Name
..69 YELLOWCUT ROAD
Mailing Address
ROSE lii I I NC 28458
City or Town State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 251
b. DOES WELL REPLACE EXISTING WELL? YES ❑
NO q�
c. WATER LEVEL Below Top of Casing: 37 FT.
(Use "+" if Above Top of Casing)
Bottom
Bottom
Ft,
Ft.
Method
POURED
Slot Size Material
in. .020 in. SS
in. in.
in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top 190 Bottom 260 Ft. #2
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
: Top Bottom
161' 1 162
162 /165
165 / 171
171 / 180
180 / 182
182 / 184
184 / 237
237 / 253
253 / 258
258 / 259
259 / 265
1▪ 2. REMARKS:
Material
Formation Description
SAND (MED)
ROCK 30"
SAND (MED)
CLAY
ROCK 28"
SAND AND CLAY
SAND (MED)
SAND(MED) W/CLAY STRKS
CLAY
ROCK 16"
SAND ANDFY,
, 2012
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTR1 CTEDrLN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, ANDT IAT=A ( OF TI L:S�;-6S'z; j. i Li = '
• RECOR ► , S BEEN
PR DED TO 1IE WELL OWNER.•
SIGNATURE OF CERTIFIED WALL CONTRACTOR DATE
DAVID L REGISTER
PRINTED NAME OF PERSON CON=11II
Submit within 30 days of completion to: Division of Water Quality information Processin
1617 Mail Service Center, Raleigh, NC 27699-1.61, Phone.: [phone]
1,717
THE >' ELL•
OCT 0 i 2032Gwilo
Rev. 2/09t.4