389579_Well Construction - GW1_20101130

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#(rf applicable)
SITE WELL ID #(if applicable)
3 WELL USE (Check One Box) Monitoring 0 Municipal/Public 0
Industrial/Commercial 0 Agricultural Recovery 0 Injection 0
Irngation❑ Other 0 (list use)
DATE DRILLED 10/21/10
4. WELL LOCATION:
Summerlins X-Roads. Veaches Mill road
(Street Name, Numbers, Community, Subdivision, Lot No , Parcel, Zip Code)
CITY Kenansville COUNTY Dublin
TOPOGRAPHIC / LAND SETTING (check appropriate box)
❑Slope ❑Valley elat ❑Ridge ❑Other
LATITUDE 35 0 3 5 2000 " DMS OR 3x XXXXXXXXX DD
LONGITUDE 77 ° 58 27 5000 " DMS OR 7x XXXXXXXXX DD
Latitude/longitude source IXPS Dropographic 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 )
Flwond Garner
Facility Name Facility ID# (if applicable)
Summerlins X-Rnads Veaches Mill Rd
Street Address
Kenansville
City or Town
Flwnnd Garnder
Contact Name
412 Franklin St PO Box 1124
NC 2R34c)
State Zip Code
Mailing Address
'\ Kenansville
City or Town
ry
Area code Phone number
6. WELL DETAILS
a TOTAL DEPTH 300
NC
State
2R349
3,)
wi
C 8 )
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 Al R
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 250 Ft 4 40 PVC
Top 250 Bottom 280 Ft 4 80 pvc
Bottom Ft
Top
8 GROUT Depth
Top 0 Bottom 20
Material
Ft hole plug
Top Bottom Ft
Top Bottom Ft
9 SCREEN• Depth Diameter
. Top 280 Bottom 300
Top Bottom
Top Bottom
10 SAND/GRAVEL PACK:
Depth
Top 270 Bottom 305
Method
poured
Slot Size Material
Ft in 015 in PVC
Ft in in
Ft in in
Size
Ft 2
Top Bottom Ft
Top Bottom Ft
11 DRILLING LOG
Top Bottom
0 / 10
10 / 25
25 / 42
42 / 70
70 / 95
95 / 188
188 / 216
216 / 223
223 / 241
241 / 250
250 / 305+
Zip Code 12 REMARKS*
b DOES WELL REPLACE EXISTING WELL? YES ❑ NO Gil
c WATER LEVEL Below Top of Casing 36 FT
(Use "+" if Above Top of Casing)
Material
GRAVEL
Formation Descnption
sand
sand and clay
clay
sand and clay
rock 3'
sand and clay
sand
clay
sand_meditym°coa
� cla " r r,
l'sanv dlu �rrse
N�
in§©�mab1Otljt��'jj{y�n
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 S BEEN PRO IDED THE WEygOWN R
bAtiStn 11/23/10
SIGNATURE OF CERTIFIED WELL CQNTRACTOR DATE
DAVID L REGISTER
PRINTED NAME OF PERSON CONSTRUCTII
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
s
unit
4 Raw -lb
Rev 2/09