386801_Well Construction - GW1_20100827

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NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3229
1 WELL CONTRACTOR
K Tv Colwell
Well Contractor (Individual) Name
Withers & Ravenel, Inc
Well Contractor Company Name
111 MacKenan Drive
Street Address
Cary NC 27511
City or Town State Zip Code
9( 19 ) 460-6006
Area code Phone number
2 WELL INFORMATION
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) MW-19
3 WELL USE (Check One Box) Monitoring j Municipal/Public ❑
Industrial/Commercial D Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 7/26/2010
4 WELL LOCATION
Old Rosemary Road 28458
(Street Name, Numbers, Community, Subdivision Lot No Parcel, Zip Code)
CITY Rose Hill COUNTY Duplin
TOPOGRAPHIC / LAND SETTING (check appropriate box)
❑Slope ❑Valley Flat ❑Ridge ❑Other
LATITUDE 36 "DMS OR 34 808809 DD
LONGITUDE 75 " DMS OR 78 025053 DD
Latitude/longitude source DGPS VIopographic 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 )
Murphy Farms. Inc.
Facility Name Facility ID# (if applicable)
Old Rosemary Road (NCSR 11481
Street Address
a� Rose Hill NC 28458
Zip Code
Cityor Town State
Katie Elmer
Contact Name
PO BOX 856
Mailing Address
Warsaw NC 28398
City or Town State Zip Code
( 910 {i 293-5245
Area code Phone number
6 WELL DETAILS
a TOTAL DEPTH 10.5'
b DOES WELL REPLACE EXISTING WELL? YES ❑
c WATER LEVEL Below Top of Casing 5.05
(Use "+" if Above Top of Casing)
NOL/
FT
10 SAND/GRAVEL PACK
Depth
Top 1 75 Bottom
Top Bottom Ft
Top Bottom Ft
11 DRILLING LOG
Top Bottom
0 / 4"
4" / 10 5'
/
/
/
12 REMARKS
38C8O1
d TOP OF CASING IS 0.0 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) METHOD OF TEST
f DISINFECTION Type Amount
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 0 Bottom 2 5 Ft 2" Sch 4C PVC
Top Bottom Ft
Top Bottom Ft
8 GROUT Depth Material
Top 0 0 Bottom 1 0 Ft Portland
Top 1 0 Bottom 1 75 Ft Bentonite
Top Bottom Ft
Method
Pour
Pour
9 SCREEN Depth Diameter Slot Size Material
Top 2 5 Bottom 10 5' Ft 2" in 0 010m PVC
Top Bottom Ft in in
Top Bottom Ft in in
Size Material
10 5' Ft #2 Sand
Formation Description
ABC Stone
SP, Poorly graded Sand, mid to
light Brown, non plastic
RE -OE -WED
AUG 2 7 2010
Information PIO.essing Unit
PWQ/DO0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C WELL CONSTRUCTION STANDARDS AND THAT A COPY OF THIS
RECORD AS BEEN PROVIDED TO THE WELL OWNER
NATURR OF CERTIFIE
8/2040IV
ELL CONTRACTOR DATE
K. Ty Colwell/Justin Fabriziani
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submil-kwithin 30{days of completion to DiVision`of Water Quality -
161,7 MaihService-Center, Raleigh, NC 27699-161; Phone (91,9) 807-6300
Information -Processing,
(' Lf 1 Form GW 1b
Rev 2/09

WITHERS & RAVENEL
ENGINEERS I PLANNERS I SURVEYORS
111 A1ad(enan Orive Cary, Noth Carolina 27511 1d: 919-469.3340 www.withersrarenel.com License No. C-0032
GENERAL LOCATION MAP
11W-19
OLD ROSEMARY ROAD
ROSE HILL, NORTH CAROLINA
USGS ROSEHILL, NC
7.5 min. Quadrangle
DRAM er:
KTC
APPROVED B?
KTC
1e=1000'
DATE:
8/11/10
FlGl3RE NO.
1
JOB NO:
02050270.01