Loading...
HomeMy WebLinkAbout411561_Well Construction - GW1_20130211NONRESIDENTIAL 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 NC 28458 City or Town State Zip Code (910 ) 289-3175 Area code Phone number 2. WELL INFORMATION: WELL CONSTRUCTION PERMIT# OTHER ASSOCIATED PERMIT#(it applicable) SITE WELL ID #(if applicable) 3. WELL USE (Check One Box) Monitoring 0 Municipal/Public 0 Industrial/Commercial 0 Agricultural V Recovery ° Injection ❑ Irrigation° Other ° (list use) DATE DRILLED 1-3-2013 4. WELL LOCATION: HUFFMANTOWN ROAD (Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code) CITY: RICHLANDS couNTYONSLOW TOPOGRAPHIC / LAND SETTING: (check appropriate box) ❑Slope °Valley gliFlat ❑Ridge ❑Other LATITUDE 34 =57 6.6000 "DMS OR 3X.XXXXXXXXX DO LONGITUDE 77 33 29.0000 " DMS OR 7X.XXXXXXXXX DD Latitude/longitude source: IMPS ['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.) A .l HI IFFMAN Facility Name Facility ID# (if applicable) HI IFFMANTOWN ROAD Street Address RICH) ANDS NC 2857- City or Town State Zip Code A ,I HI IFFMAN Contact Name 612 RARREE ROAD Mailing Address RICH) ANDS City or Town NC 28574 State Zip Code t _) Area code Phone number 6. WELL DETAILS: a. TOTAL DEPTH: 305 b. DOES WELL REPLACE EXISTING WELL? YES of NO ❑ c. WATER LEVEL Below Top of Casing: 73 FT. (Use "+" if Above Top of Casing) 411561 U. TOP OF CASING IS 1 5 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): 30 METHOD OF TEST Al R f. DISINFECTION: Type HTH Amount 4 07 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 250 Ft. 4 40 PVC Top 250 Bottom 260 Ft. 4 80 PVC Top Bottom Ft. 8. GROUT: Depth Material Method Top 0 Bottom 20 FL HOLE PLUG POURED Top Bottom Top Bottom Ft. Ft. 9. SCREEN: Depth Diameter Slot Size Material Top 260 Bottom 305 Ft. 4 in. .015 in. PVC Top Bottom Ft. in. in. Top Bottom Ft. in. in. 10. SAND/GRAVEL PACK: Depth Top 250 Bottom 320 Top Bottom Top Bottom 11. DRILLING LOG Top Bottom 150 / 162 162 / 175 175 / 210 210 / 216 216 / 217 217 / 238 238 / 241 241 / 251 251 / 258 258 / 267 267 / 268 12. REMARKS: Size Ft #1 Ft. Ft. ': ormation Processing Unit DWQ/BOG Formation Description �E!,VED FEB 4 5 2013 SAND (MED FIND SAND (FINE) CLAY SAND (FINE) ROCK 6" SAND AND CLAY ROCK 30" SAND (MED FINE) ROCK AND SAND SAND (MED FINE) ROCK 12" I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH`o. 15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COP,Y,'OR THIS' REC9HAS BEEN P VIDE HE TTWE OWNER .40'tD o SIGNATURE OF CERTIFIED WELL t ?, DAVID 1. REGISTER �� PRINTED NAME OF PERSOICONSTRUCTIN�G T E WELL Submit within 30 days of completion to: Division of Water Quality - Information Processing, 1617 Mail Service Center, Raleigh, NC 27699-161, Phone : (919) 807-6300 Form GW-lb Rev. 2/09