386653_Well Construction - GW1_20100827

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2314A
1 WELL CONTRACTOR
DAVID L 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 ❑
Industnal/Commercial ❑ Agricultural ii Recovery ❑ Injection 0
Irrigation❑ Other 0 (list use)
DATE DRILLED 07/12/2010
4. WELL LOCATION.
605 CYPRESS CREEK ROAD
(Street Name, Numbers, Community, Subdivision, Lot No , Parcel, Zip Code)
CITY WALLACE COUNTY DUPLIN
TOPOGRAPHIC / LAND SETTING (check appropnate box)
❑Slope ❑Valley VfFlat ❑Ridge ❑Other
LATITUDE 34 ° 46 , 52 3000 ^ DMS OR 3x xxxxxxxxx DD
LONGITUDE 77 ° 45 ' 0 8000 ^ DMS OR 7x xxxxxxxxx DD
Latitude/longitude source IMPS I7ropographic 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 )
TIM MARFADY
Facility Name Facility ID# (if applicable)
605 CYPRFSS CRFFK ROAD
Street Address
WA! I ACF NC 28466
City or Town State Zip Code
TIM MARFADY
Contact Name
605 CYPRFSS CRFFK ROAD
Mailing Address
WAI I ACF
City or Town
( 910n 289-1168
Area code Phone number
6 WELL DETAILS.
a. TOTAL DEPTH. 230
NC 28466
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Cif
c. WATER LEVEL Below Top of Casing 25 FT
(Use "+" if Above Top of Casing)
d TOP OF CASING IS 1.5 FT Above Land Surface'
'Top of casing terminated at/or below land surface may require
a vanance in accordance with 15A NCAC 2C 0118
e. YIELD (gpm) 45 METHOD OF TEST AIR
f. DISINFECTION. Type HTH Amount 4 07
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 185 Ft 4 40 PVC
Top Bottom Ft
Top Bottom Ft
8 GROUT Depth
Top 0 Bottom 20
Top Bottom
Top Bottom
- 9. SCREEN: Depth
Material
Ft HOLE PLUG
Ft
Ft
Method
POURED
Diameter Slot Size Material
Top 185 Bottom 230 Ft 4 in 015 in PVC
Top Bottom Ft in in
Top Bottom Ft in in
10. SAND/GRAVEL PACK'
Depth
Top 175 Bottom 240
Top Bottom
Top Bottom
11 DRILLING LOG
Top Bottom
0 /3
_3_/ 15
15 / 16
16 / 80
80 / 135
135 / 180
180 / 186
186 / 235
235 / 238
238 / 240+
12 REMARKS
Size Material
Ft 2 GRAVEL
Ft
Ft
Formation Descnption
SAND AND CLAY
CLAY
ROCK 2"
CLAY & THIN ROCK
CLAY
SAND AND CLAY
SAND
ROCK & SAND
SAND AND CLAY
CLAY
RFCIFIVED
AUG 2 7 2010
I DO HEREBY CERTIFY THAT THIS WELL WAS CiAggriU#0911FAr
15A NCAC 2C WELL CONSTRUCTION STANDARDS, AND TOW
: RECORD n AS BEEN PROVIDED TO TH ELL O
•'.4i. •
nP:Za7
i% VIA
THIS
8/3/10
SIGNATURE OF CERTIFIED WELILCONTRACTOR DATE
DAVID L REGISTER
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion{to: Division -of Water Quality; Information Proceisi4g,
FEB 1�` 2014
1617 Mail Service Center, Raleigh, -NC 27699-161, Phone : [phone]
Form GW-lb
Rev 2/09