389578_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#(if applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public 0
Industrial/Commercial ❑ Agricultural ke Recovery ❑ 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 DuDlin
TOPOGRAPHIC / LAND SETTING (check appropnate box)
❑Slope ❑Valley elat ❑Ridge DOther
LATITUDE 35 ° 3 4 7000 ^ DMS OR 3X XXXXXXXXX DD
LONGITUDE 77 58 27 9000 „ DMS OR 7x XXXXXXXXX DD
Latitude/longitude source IMPS propographic 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 )
Flwood Garner
Facility Name Facility ID# (if applicable)
Summerlins X-Roads Veaches Mill Rd
Street Address
Kenansville NC 28349
City or Town State Zip Code
Flwood Garnder
Contact Name
412 Franklin St PO Box 1124
Mailing Address
Kenansville NC 98349
City or Town State Zip Code
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Area code Phone number
6 WELL DETAILS
a TOTAL DEPTH 300
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Get
c. WATER LEVEL Below Top of Casing 36 FT
(Use "+" if Above Top of Casing)
G r�
9 5 if 4a
: 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) 150 METHOD OF TEST AIR
f. DISINFECTION' Type HTH
Amount
5 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 RA_ 0 PVC
Top 250 Bottom 280 Ft 4 80 pvc
Top Bottom Ft
8 GROUT Depth Material
Top 0 Bottom 20 Ft hole plug
Top Bottom Ft
Top Bottom Ft
9. SCREEN Depth Diameter
Top 280 Bottom 300 Ft in
Top Bottom Ft in
Top Bottom Ft in
10 SAND/GRAVEL PACK
Depth
Top 270 Bottom
Top Bottom
Top Bottom
Method
poured
Slot Size
015 in
in
in
Material
PVC
Size Material
305 Ftt02' s ir" i GRAVEL
Fty s a--''''
Rtv342010
11 DRILLING LOG (Jnit
Top Bottom InformationFPdt l� scnption
DWQ/B
sand
0 / 10
10 / 25
25/ 42
42 / 70
70/95
95 / 188
188 / 216
216 / 223
223 / 241
241 / 250
250 /305+
12. REMARKS:
sand and clay
clay
sand and clay
rock 3'
sand and clay
sand
clay
sand medium coarse
clay
sand medium coarse
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A N 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECS BEEN PR % IDED THE WEL WNER
If i4 11 /23/10
S ATURE OF CERTIFIED WALL CQINTRACTOR DATE
DAVID L REGISTER
PRINTED NAME OF PERSON CONSTRUCTG� T�1LWELL
m�°,af
Submit within 30 days of completion to: Division of Water Quality - Information Processing, OCT 2 4 ?Q brm GW-1b
ev 2/09
1617 Mail•Service Center, Raleigh, NC 27699-161; Phone • (919)_807-6300