411926_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 NC 28458
City or Town State Zip Code
(910 ) 289-3175
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigationii Other ❑ (list use)
DATE DRILLED 2-5-2013
4. WELL LOCATION:
CELLAR WAY (VINEYARDS) LOT#87
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
411926
: 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 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 142 Ft. 4 40 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 Material
Top 142 Bottom 152 Ft. 4 in. .015 in. PVC
Top
CITY: WALLACE COUNTY DUPLIN Top
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
DSlope ❑Valley FitFlat ❑ Ridge ❑Other
LATITUDE 34 46 20.3000 " DMS OR 3x.xxxxxxxxx DD
LONGITUDE 77 ° 57 , 4.4000 " DMS OR 7x.xxxxxxxxx DD
Latitude/longitude source: [WISPS ['Topographic map
(location of well must be shown on a USGS topo map andaitached 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)
CELLAR WAY (VINEYARDS) LOT#87
Street Address
WALLACE NC 28466
City or Town State Zip Code
RIVER LANDING
Contact Name
CELLAR WAY (VINFYARDS) 1 C)T#87
Mailing Address
WALLACE NC
City or Town State
Area code Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: 152
b. DOES WELL REPLACE EXISTING WELL? YES ❑.
c. WATER LEVEL Below Top of Casing: 38
(Use "+" if Above Top of Casing)
28466
Zip Code
NO qI
FT.
Bottom Ft. in. in.
Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
Top 135 Bottom 152 Ft. #2
Top Bottom Ft.
Top Bottom Ft.
WATER. UUALi l / SECTION
11.. DRILLING LOG INFORMATION PROCESSING UNIT
: Top Bottom Formation Description
F:. 5 9013
•
0 / 10 CLAY
10 / 26 SAND
26 / 27 SOFT ROCK 12"
27 / 80 CLAY
80 / 89 SAND
89 / 96 CLAY
96 / 104 SAND
104 / 106 HARD ROCK 24"
106 / 119 SAND (MED)
119 / 125 SAND AND CLAY
125 / 130 ROCK AND 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
• RECOR HAS BEEN PROVIDED TO THE WW1 OWNER.
•
' CiA)-("{- A • *-6-,--t--1.--i
r�
. SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
2-6-13
: DAVID L. REGISTER _- r7,k,s ...
PRINTED NAME OF PERSON CON& RljpTiI G H WELL';
Submit within 30 days of completion to: Division of Water Quality - Information Processing,,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
MAR 0 g9,13G.,,,
Rev. 2/09 ::'