411931_Well Construction - GW1_20130304

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1. WELL CONTRACTOR:
DAVID REGISTER
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2314A
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
NC 28458
State Zip Code
411931
: 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): 150 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/
2. WELL INFORMATION: Weight Material
WELL CONSTRUCTION PERMIT# 40 PVC
OTHER ASSOCIATED PERMIT/0 applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigationti Other ❑ (list use)
DATE DRILLED 2-1-2013
4. WELL LOCATION:
7. CASING: Depth Diameter
▪ Top 0 Bottom 150 Ft. 4
: Top Bottom Ft.
Top Bottom Ft.
= 8. GROUT:
• Top 0
Top
Top
9. SCREEN: Depth Diameter Slot Size Material
Method
POURED
Depth Material
Bottom 20 Ft. HOLE PLUG
Bottom Ft.
Bottom Ft.
CORNER OCT GLORY & SUGAR MAPLE : Top 150 Bottom 160 Ft. 4 in. .015 in. PVC
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
Top Bottom Ft. in. in.
CITY: WALLACE COUNTY D U PL I N : Top Bottom Ft. in. in.
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley Flat ❑Ridge DOther
LATITUDE 34 ° 44 , 55.0000 " DMS OR 3x.xxxxxxxxx DD
LONGITUDE 77 56 ' 7.2000 " DMS OR 7x.xxxxxxxxx DD
Latitude/longitude source: rilj3PS ❑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
CORNER OCT_ GLORY
Street Address
WALLACE
City or Town
RIVER LANDING
Facility ID# (if applicable)
& SUGAR MAPLE
NC 28466
State Zip Code
Contact Name
CORNER OCT_ GLORY
Mailing Address
WALLACE
City or Town
& SUGAR MAPLE
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Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 160
NC 28466
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: 8 FT.
(Use "+" if Above Top of Casing)
10. SAND/GRAVEL PACK:
Depth
: Top 145 Bottom 160
• Top
Top
11. DRILLING LOG
: Top Bottom
142 / 145
Bottom
Bottom
Size Material
Ft. #2
Ft.
Ft. FEH 24. 6 ?D3
. WATER QUALITY SECTION
Formatiogi 3N PROCESSING UNIT
SAND AND CLAY
145 / 146 ROCK 3"
146 / SAND
12. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECD HAS BEEF PROVIDED TO THE HELL OWNER.
SI
NATURE OF CERTIFIED WELL CONTRACTOR
2-6-13
DAV I D L. REGISTER 77, ,� r >Z
PRINTED NAME OF PERSON CONST tU���y tN'TH'EEWELL'�
MAR2O13t
Submit within 30 days of completion letion to: Division of Water QualityInformation Processin s Form GW-1
Y P - �� Rev. 2/09
, 1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone] yry_�_�.__