408596_Well Construction - GW1_20121022

SITE WELL ID #(if applicable)
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
State
OTHER ASSOCIATED PERMIT#(if applicablplr,
28458
Zip Code
2o2
3. WELL USE (Check One Box) Monitori
Industrial/Commercial 0 Agricultural 0 ction 0
Irrigationlj Other ❑ (list use)
DATE DRILLED 10-03-12
4. WELL LOCATION:
RIVER LANDING - SYCAMORE FOREST DR
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: WALLACE COUNTY DUPLIN
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley vfFlat ❑ Ridge ❑ Other
LATITUDE 34 0 45 , 39.5000 " DMS OR 3x.xxxxxxxxx DD
LONGITUDE 77 ° 55 , 31.4000 " 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.)
RIVER LANDING
Facility Name Facility ID# (if applicable)
SYCAMORE FOREST DRIVE
Street Address
WALLACE NC 28466
City or Town State Zip Code
CHRIS HERRING -RIVER LANDING
Contact Name
PO BOX 1139
Mailing Address
WALLACE NC 28466
City or Town State Zip Code
t 3
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 122
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
c. WATER LEVEL Below Top of Casing: 11
(Use "+" if Above Top of Casing)
FT.
408596
: d. 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): 75 METHOD OF TEST AIR
f. DISINFECTION: Type HTH Amount 3 07
: g. WATER ZONES (depth):
: Top Bottom
: Top Bottom
Top Bottom
7. CASING: Depth Diameter
: Top 0 Bottom 112 Ft. 4
Top Bottom Ft.
Top Bottom Ft.
Top . Bottom
Top Bottom
Top Bottom
Thickness/
Weight Material
40 PVC
8. GROUT: Depth Material
Top 0 Bottom 20 Ft. HOLE PLUG
: Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth
Top 112 Bottom 122
: Top Bottom
Top Bottom
10. SAND/GRAVEL PACK:
Depth
: Top 105 Bottom 122
Top
Top
11. DRILLING LOG
: Top Bottom
0 /10
•
10 / 65
Bottom
Bottom
65 / 77
• 77 / 79
•
• 97 / 112
79 / 97
112 / 121
•
121 / 122+
12. REMARKS:
Diameter Slot Size
Ft. 4 in. .015
Ft. in.
Ft. in.
Method
POURED
Material
in. PVC
in.
in.
Size Material
Ft. #2
Ft.
Ft.
Formation Description
SAND
CLAY
SAND AND CLAY
HARD ROCK 30"
SAND AND CLAY
ROCK AND SAND (MED-FINE)
SAND (MED-COARSE)
ROCK AND SAND
. -
•
OCT
2 2 2012
I DO HEREBY CERTIFY THAT THIS WELL WA ®NSTRU&T-E--D.,4N.AC gNCE WITH
• 15A NCA 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECOR H S BEEN , 'OVIDED T E WELL OWNER.
•
_ 10-10-12
SIGNATURE OF CERTIFIED LL CONTRACTOR DATE
DAVID L. REGISTER
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit: within 30 days of completion to: Division of Water Quality - Information Processing
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]s
Form GW-lb
Rev. 2/09