411928_Well Construction - GW1_20130304

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 28458
State Zip Code
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public 0
Industrial/Commercial 0 Agricultural ❑ Recovery 0 Injection 0
Irrigationd Other 0 (list use)
DATE DRILLED 2-4-2013
4. WELL LOCATION:
SOUTHERN MAGNOLIA LN.. LOT#414
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: WALLACE COUNTY DUPLIN
TOPOGRAPHIC / LAND SETTING (check appropriate box)
❑Slope ❑ Valley lifFlat ❑Ridge ❑Other
LATITUDE 34 0 46 , 26.5000 " DMS OR 3X.XXXXXXXXX DD
LONGITUDE 77 0 56 , 25.7000 " DMS OR 7X.XXXXXXXXX DD
Latitude/longitude source: 6713PS ❑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)
SOUTHERN MAGNOLIA LANE
Street Address
WALLACE
City or Town
RIVER LANDING
NC 28466
State Zip Code
Contact Name
SOl JTHFR1NI MAG N O1 1A1 A-N F I OT#414
Mailing Address
WA L LAC E
City or Town
NC 28466
State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 180
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
c. WATER LEVEL Below Top of Casing: 19 FT.
(Use "+" if Above Top of Casing)
Top
• Top
11. DRILLING LOG
: Top Bottom
• 0 /10
411928
: 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/
7. CASING: Depth Diameter Weight Material
: Top 0 Bottom 170 Ft. 4 .015 PVC
: 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
Top 170 Bottom 180 Ft. 4 in. .015
Top Bottom Ft. in. in.
= Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top 160 Bottom 180 Ft. #2
Bottom Ft.
Bottom Ft.
Material
in. PVC
10 / 20
20 / 80
80 / 89
89 /92
92 / 102
102 / 109
1 9 / 115
11 / 132
: 132 / 136
136 / 140
12. REMARKS:
Material
FEB
WATER OU,UAtUTV SECTION
BNFORIVIATION PROCESSING UNIT
Formation Description
SAND AND CLAY
SAND
CLAY
SAND
ROCK AND SAND
SAND (MED)
SAND AND CLAY
ROCK AND SAND
SAND (MED FINE)
ROCK AND SAND
SAND AND CLAY
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A N 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
• RECAS BEEN fl OVIDED j 0 THE WJ.L OVI(NER.
2-6-13
SIGNATURE OF CERTIFIED WELL GONTRACTOR DATE
DAVID L. REGISTER
PRINTED NAME OF PERSON CONSTRUOTINh-THE WELLr'
Submit within 30 days of completion to: Division of Water Quality - Information Processing;
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
MAR 9 4Failaw_i'.
RV:.
Rev. 2/09 „�_