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