408231_Well Construction - GW1_20121001

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
T
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 #(if applicable)
3. WELL USE (Check One Box) Monitoring 0 Municipal/Public 0
Industrial/Commercial 0 Agricultural 0 Recovery 0 injection 0
Irrigation❑ Other ((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)
CITY: ROSE HILL CouNTYDUPLIN
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑ Valley Flat ❑Ridge ❑Other
LATITUDE 34 0 50 ' 12.4000 " DMS OR 3X.XXXXXXXXX DD
LONGITUDE 82 ° 2 ' 14.7000 " DMS OR 7X.XX:XXXXXXX DD
Latitude/longitude source: Q 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.)
VALLEY PROTEINS
Facility Name Facility ID# (if applicable)
469 YELLOWCUT ROAD
Street Address
ROSE HII I
City or Town
VAI LEY PROTEINS
Contact Name
469X9 I OWCuT ROAD
Mailing Address
ROSE H11 I
City or Town
t }
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 251
NC 28458
State Zip Code
NC 28458
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO q�
c. WATER LEVEL Below Top of Casing: _ 37
(Use "+" if Above Top of Casing)
FT.
4QS0 f
: 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
Thickness/
7. CASING: Depth Diameter Weight Material
Top
Top
Top
Bottom
Bottom
Bottom
Top 0 Bottom 200 Ft. 6 S-10 SS
: Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom 20 Ft. HOLE PLUG POURED
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top 200 Bottom 250 Ft. 6 in. .020 in. SS
Top Bottom Ft.
Top Bottom Ft.
10. SAND/GRAVEL PACK:
: Depth
Top 190 Bottom 260 Ft.
Top Bottom _ Ft.
in. in.
in. in.
Size Material
#2
Top Bottom Ft.
11. DRILLING LOG
: Top Bottom Formation Description
▪ 80 / 81 ROCK 2"
•
CLAY
•
ROCK 2"
CLAY
SAND AND CLAY
SAND AND CLAY
SAND (MED)
SAND AND
SAND (MED) tT--Ifsf , .• -7;';
ROCK 4"
SEP 2 0 2012
•
81 / 85
85 / 86
86 /96
96 / 100
100 / 111
111 / 120
120 / 150
150 / 158
158 / 160
160 / 161
12. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCOFt3A'iV xllfi'-i.j.
- 15A NCA, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
: RECORBEEN PRO IDED TO TH WELL OWNER.
_ 9-11-12
= SIG MATURE OF CERTIFIED WE L CONTRACTOR DATE
DAVID L..REGISTER
PRINTED NAME OF PERSON COG.
Submit within 30 days of completion toDivision of Water Quail
1617 Mai( Service Center, 'Raleigh, ..NC 27,699-161., Phone [phone]
OCT
i G-
Rev. 2/09