GW1 - Duplin Dec-Nov 2017

.NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # (NCWC) 3470-A
1. WELL CONTRACTOR:
William M Wiaains
Well Contractor (Individual) Name
Mid -Atlantic Drilling, Inc.
Well Contractor Company Name
PO Box 315
Street Address
Carolina Beach NC 28428
City or Town State Zip Code
(910 ) 458-5020
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) CP-1
3. WELL USE (Check One Box) Monitoring tilt' Municipal/Public ❑
Industrial/Commercial 0 Agricultural 0 Recovery 0 Injection 0
Irrigation❑ Other 0 (list use)
DATE DRILLED 11 /29/2017
4. WELL LOCATION:
1628 Garner Chapel Road
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Mt. Olive couNTY Duplin
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
riiSlope ❑Valley ❑ Flat ❑ Ridge ❑Other
LATITUDE 35
LONGITUDE 77
10 ' 13.0700 " DMS OR
55 45.4700 " DMS OR
DD
DD
Latitude/longitude source: IDGPS Topographic 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.)
Butterball. I 1 C
Facility Name Facility ID# (if applicable)
1628 Carner Chanel Road
Street Address
Mt. Olive
City or Town
Josh Batchlor
Contact Name
1628 Garner Chanel Road
Mailing Address
Mt_ Olive
City or Town
( 91913 658-6743
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 24
NC 28365
State Zip Code
NC 28365
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
c. WATER LEVEL Below Top of Casing: 20.05 FT.
(Use "+" if Above Top of Casing)
446294
d. TOP OF CASING IS 3.11 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
Top Bottom Top
Top Bottom Top
7. CASING: Depth Diameter
Top +3.11 Bottom 14 Ft. 2 in
Top Bottom Ft.
Top Bottom Ft.
Bottom
Bottom
Bottom
Thickness/
Weight
Material
sch40 PVC
8. GROUT: Depth Material Method
Top 0 Bottom 0.5 Ft. Concrete Hand Mixed
Top 0.5 Bottom 12 Ft. Bentonite
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top 14 Bottom 24 Ft. 2 in. in. PVC
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
Top 12 Bottom 24 Ft. #2 Well Sand
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom Formation Description
12 Reddish brown, slightly clayey,
/ medium sand
/ 16 Gray. sliahtiv clavev. fine and
/ medium sand
16 l/ CDEN Gray, medium sand with clay
� O/Nf; i,' <e {
ECEI`/ ED
DEC 1 8 2017 DEC 1 A 2017
WatQualii l,,t+=rmatton r rope• '''9 unt
12. RE
er
erationS Secttiion)al p;Np1t OG
tgton Regional 0ft,e
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 H • 5 BEEN PROVIDED TO THE WELL OW R.
SIGNATURE •FCER
FIED ELL
/2/7/ 7
TOR DATE
William M Wiggins
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GW-lb
Rev. 2/09

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # (NCWC) 3470-A
1. WELL CONTRACTOR:
William M Wiaains
Well Contractor (Individual) Name
Mid -Atlantic Drilling, Inc.
Well Contractor Company Name
PO Box 315
Street Address
Carolina Beach NC 28428
City or Town State Zip Code
(910 ) 458-5020
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) CP-2
3. WELL USE (Check One Box) Monitoring el Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 1 1 /17/2017
4. WELL LOCATION:
1628 Garner Chapel Road
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Mt. Olive COUNTY Dublin
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
vlSlope ❑Valley ❑ Flat ❑Ridge ❑ Other
LATITUDE 35
LONGITUDE 77 ° 56 • 8.1600 " DMS OR
�9 16.1900 "DMSOR
DD
DD
Latitude/longitude source: OGPS Topographic 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.)
Butterball. l I C.
Facility Name
1628 Carner Chanel Road
Street Address
Mt. Olive
City or Town
Josh Batchlor
Contact Name
1628 Garner Chanel Road
Mailing Address
Mt, Olive
City or Town
( 9196 658-6743
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 16
Facility ID# (if applicable)
NC 28365
State Zip Code
NC 28365
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO G
c. WATER LEVEL Below Top of Casing: 12.41 FT.
(Use "+" if Above Top of Casing)
446285
d. TOP OF CASING IS 2.94 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
Top Bottom Top
Top Bottom Top
7. CASING: Depth
Top +2.94 Bottom 6
Top Bottom Ft.
Bottom
Bottom
Bottom
Thickness/
Diameter Weight Material
Ft. 2 in sch40 PVC
Top Bottom Ft.
8. GROUT: Depth
Top 0 Bottom 0.5
Material Method
Ft. Concrete Hand Mixed
Top 0.5 Bottom 4 Ft. Bentonite
Top Bottom Ft.
9. SCREEN: Depth
Top 6 Bottom 16
Top Bottom
Top Bottom
10. SAND/GRAVEL PACK:
Depth
Top 4 Bottom 16
Top Bottom
Top Bottom
11. DRILLING LOG
Top Bottom
0 /5
12
/
Diameter Slot Size Material
Ft. 2 in. in. PVC
Ft. in. in.
Ft. in. in.
Size Material
Ft. #2 Well Sand
Ft.
Ft.
Formation Description
Tannish brown. fine and medium
sand
Reddish brown. fine and medium
sand
iittetaet046,00441 4 2°17
AFC 18 , .-moo,' t' r vi
12. REMARKS:
OWQ/' rci
o,,/ H.141 t1
/Irn/nbio t/°ns SReg/ooa
nR e l
I DO HEREBY CERTIFY THAT THIS WELL Se
IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDA THAT A COPY OF THIS
RECORD HAS BEEN P. IED TO THE WELLo .CB
SIc i4 ERTIFI
T TOR
DATE
William M Wiggins
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GW-lb
Rev. 2/09

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # (NCWC) 3470-A
1. WELL CONTRACTOR:
William M Wiggins
Well Contractor (Individual) Name
Mid -Atlantic Drilling, Inc.
Well Contractor Company Name
PO Box 315
Street Address
Carolina Beach NC 28428
City or Town State Zip Code
(910 ) 458-5020
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) CP-4
3. WELL USE (Check One Box) Monitoring IV Municipal/Public ❑
Industrial/Commercial 0 Agricultural 0 Recovery ❑ Injection 0
Irrigation❑ Other ❑ (list use)
DATE DRILLED 1 1 /17/2017
4. WELL LOCATION:
1628 Garner Chanel Road
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Mt. Olive COUNTY Dublin
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
LlSiope ❑Valley ❑ Flat DRidge ❑ Other
LATITUDE 35 ° 9 ' 32.7500 " DMS OR DD
LONGITUDE 77 ° 54 ' 47.5200 " DMS OR
DD
Latitude/longitude source: BPS topographic 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.)
Butterball. I I C.
Facility Name Facility ID# (if applicable)
1698 Garner Chanel Road
Street Address
Mt. Olive
City or Town
Josh Batchlor
Contact Name
1628 Garner Chanel Road
Mailing Address
Mt. Olive
City or Town
( 919, 658-6743
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 14
NC
State
28366
Zip Code 110
"r
a
.146284
d. TOP OF CASING IS 3 05 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
Top Bottom Top
Top Bottom Top
7. CASING: Depth
Top +3.05 Bottom 4
Top Bottom Ft.
Top Bottom Ft.
Bottom
Bottom
Bottom
Thickness/
Diameter Weight Material
Ft. 2 in sch40 PVC
8. GROUT: Depth
Top 0 Bottom 0.5
Material Method
Ft. Concrete Hand Mixed
Top 0.5 Bottom 2 Ft. Bentonite
Top Bottom Ft.
9. SCREEN: Depth
Top 4 Bottom 14
Diameter Slot Size Material
Ft. 2 in. in. PVC
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top 2 Bottom 14 Ft. #2
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 /5
_5____/ 14
NC 28366
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ltlr
c. WATER LEVEL Below Top of Casing: 10.05 FT.
(Use "+" if Above Top of Casing)
%to
Material
Well Sand
Formation Description
Gray,lightley clayey fine and
medium sand
Gray. fine and medium sand
,
n ;
a\
h�t��ty SecX1on ,eP
ion
12. EOM • Rsa1
Information
r)WO/0
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
REC''0 HAS = EN PROVIDED 1 H WELL 0 N R
/2/717
DATE
William M Wiggins
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GW-lb
Rev. 2/09

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # (NCWC) 3470-A
1. WELL CONTRACTOR:
William M Wiggins
Well Contractor (Individual) Name
Mid -Atlantic Drilling, Inc.
Well Contractor Company Name
PO Box 315
Street Address
Carolina Beach NC 28428
City or Town State Zip Code
(910 ) 458-5020
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) CP-3
3. WELL USE (Check One Box) Monitoring i3t Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other 0 (list use)
DATE DRILLED 11 /29/2017
4. WELL LOCATION:
1628 Garner Chapel Road
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Mt. Olive couNTY Duolin
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
'Slope ❑ Valley ❑ Flat ❑ Ridge ❑ Other
LATITUDE 35 ° 9 40.3200 "DMS OR
LONGITUDE 77 ° 55 0.8800 " DMS OR
Latitude/longitude source: JGPS Topographic 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.)
Butterball. l I C.
Facility Name
1628 Carner Chanel Road
Street Address
Mt. Olive
City or Town
Josh Batchlor
Contact Name
1628 Garner Chanel Road
Mailing Address
Mt Olive
City or Town
( 919.6 658-6743
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 20
DD
DD
Facility ID# (if applicable)
NC 28365
State Zip Code
NC 28365
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
c. WATER LEVEL Below Top of Casing: 16.40 FT.
(Use "+" if Above Top of Casing)
446283
d. TOP OF CASING IS 2.79 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
g. WATER ZONES (depth):
Top Bottom Top
Top Bottom Top
Top Bottom Top
7. CASING: Depth Diameter
Top +2.79 Bottom 10 Ft. 2 in
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth
Top 0 Bottom 0.5
Amount
Bottom
Bottom
Bottom
Thickness/
Weight Material
sch40 PVC
Material Method
Ft. Concrete Hand Mixed
Top 0.5 Bottom 8 Ft. Bentonite
Top Bottom Ft.
9. SCREEN: Depth Diameter
Top 10 Bottom 20 Ft. 2 in.
Top Bottom Ft. in.
Top Bottom Ft. in.
10. SAND/GRAVEL PACK:
Depth Size
Top 8 Bottom 20 Ft. #2
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 10
10 / 15
15 / 20
/
12. REMARKS:
Slot Size Material
in. PVC
in.
in.
Material
Well Sand
Formation Description
Reddish brown. slightly clayey
medium sand
Tannish brown. slightly clayey
fine and medium sand
Brown. fine and medium sand
!ECkFVF J C D D V E r;
Bi C
Water Q
I DO HEREBY CERTIFY TH HIS�Ierk
15A NCAC 2C, WELL CONS I py$
RECORD HAS EE PROV
RfiYinoi7
PrOC :rSir,9 V(�li
.55A1("SI C:7("e
GV = , - • IN ACCORDANCE WITH
T A COPY OF THIS
/2/7//2
DATE
William M Wiggins
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GW-lb
Rev. 2/09

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 ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigationtj Other ❑ (list use)
DATE DRILLED 09-26-2017
4. WELL LOCATION:
RIVER LANDING
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: WALLACE COUNTY DUPLIN
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley VFlat ❑Ridge ❑Other
LATITUDE "DMS OR 34.763043 DD
LONGITUDE " DMS OR-77,928657 DD
Latitude/longitude source: UtPS 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.)
RIVFR I ANDING
Facility Name
WFST WINDING WAY
Street Address
WAl I ACF
City or Town
RIVFR I ANDING
Contact Name
PO ROX 1139
Mailing Address
WAI I ACF
City or Town
Facility ID# (if applicable)
NC 2846E
State Zip Code
NC 2846E
State Zip Code
( )
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 140
b. DOES WELL REPLACE EXISTING WELL? YES ❑
c. WATER LEVEL Below Top of Casing: 24
(Use "+" if Above Top of Casing)
NO LV'
FT.
Li*" '111
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): 50 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 120 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
Top 120 Bottom 140
Top
Top
Bottom
Bottom
10. SAND/GRAVEL PACK:
Depth
Top 115 Bottom 141
Top Bottom
Top Bottom
Slot Size Material
Ft. 4 in. .016 in. PVC
Ft. in. in.
Ft. in. in.
Size Material
Ft. #2 GRAVEL
Ft.
Ft.
11. DRILLING LOG
Top Bottom Formation Description
120 / 125 ROCK AND SAND
140 / 141+ CLAY
125 / 140 SAND (MED)
RECEIVED/NCDENR/DWR
I NOV 2 7 2i11,...
12. REMARKS:
NOV
2 n 2C)i;
1 D,
Water Quality Regional
Operatmns Sec�t,�i1orp�,O HEREBY CERTIFY THAT THIS WELL WwI� EFtegieitaker� WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, A D THAT A COPY OF THIS
RECORD HAS BEEN PROVI ED TO THE WELL OWNER.
SIGNATURE OF CERTIFIED
10-5-17
LL CONTRACTOR DATE
DAVID L. REGISTER
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GW-lb
Rev. 2/09

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 ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
IrrigationL' Other ❑ (list use)
DATE DRILLED 08-22-2017
4. WELL LOCATION:
RIVER LANDING
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: WALLACE COUNTY DUPLIN
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley elat ❑ Ridge ❑ Other
LATITUDE
LONGITUDE
" DMS OR 34.739543 DD
° " DMS OR -77.934746 DD
Latitude/longitude source: BPS Ofopographic 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.)
RIVER 1 ANDINLG
Facility Name Facility ID# (if applicable)
Street Address
WAI I ACF
City or Town
RIVER I ANDING
Contact Name
Ply BOX 113.9
Mailing Address
WAI I ACF
City or Town
NC 28468
State Zip Code
NC 28466
State Zip Code
( )
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 190
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO g/
c. WATER LEVEL Below Top of Casing: 19
(Use "+" if Above Top of Casing)
FT.
u16( 47164-
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): 50 METHOD OF TEST AIR
f. DISINFECTION: Type HTH Amount 4 (')7
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
7. CASING: Depth
Top 0 Bottom 170
Top Bottom
Top Bottom
8. GROUT: Depth
Top 0
Top
Top
Bottom 20
Bottom
Bottom
Thickness/
Diameter Weight Material
Ft. 4 40 PVC
Ft.
Ft.
Material
Ft. HOLE PLUG
Ft.
Ft.
Method
POURED
9. SCREEN: Depth Diameter Slot Size Material
Top 170 Bottom 190 Ft. 4 in. .016 in. PVC
Top
Top
Bottom Ft.
Bottom Ft.
10. SAND/GRAVEL PACK:
Depth
Top 165 Bottom 193
Top
Top
in. in.
in. in.
Size
Ft. #2
Bottom Ft.
Bottom Ft.
11. DRILLING LOG
Top Bottom
155 / 162
162 / 172
172 / 183
183 / 184
184 / 191
191 / 194
12. REMARKS:
Material
GRAVEL
Formation Description
SAND (MED)
SAND AND CLA' ! _ •
SAND (MED)
ROCK 10" NOV' 0 2017
SAND (MED)
SAND AND
kkCEIVED/NCDENR/DWR
NOV 2 7 2017
I DO HEREBY CERTIFY THAT THIS WELL WAS CONST
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AN
RECTO HAS BEE PROVUJED TO TJ1E WELL OW
SIGNATURE OF CERTIFIED
DAVID L. REGISTER
Wilmington Re ional Office
LL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GW-lb
Rev. 2/09

.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 ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigationij Other ❑ (list use)
DATE DRILLED 09-26-2017
4. WELL LOCATION:
RIVER LANDING
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: WALLACE COUNTY DUPLIN
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley VFlat ❑Ridge ❑Other
LATITUDE " DMS OR 34.763043 DD
LONGITUDE " DMS OR -77.928657 DD
Latitude/longitude source: Qi3PS [Topographic 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.)
RIVFR I ANDING
Facility Name
WFST W Nausta WAY
Street Address
WAI I ACF
City or Town
RIVFR I ANDING
Contact Name
PO BOX1139
Mailing Address
WAI LACF
City or Town
Facility ID# (if applicable)
( )
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 140
b. DOES WELL REPLACE EXISTING WELL?
c. WATER LEVEL Below Top of Casing: 24
(Use "+" if Above Top of Casing)
NC 28466
State Zip Code
NC 28466
State Zip Code
YES ❑ NO II/
FT.
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): 50 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 120 Ft. 4 40 PVC
Top
Top
Bottom Ft.
Bottom Ft.
8. GROUT: Depth Material
Top 0 Bottom 20 Ft. HOLE PLUG
Top Bottom Ft.
Top Bottom Ft.
Method
POURED
9. SCREEN: Depth Diameter Slot Size Material
Top 120 Bottom 140 Ft. 4 in. .016 in. PVC
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEI :'ACK:
Derr Size Material
Top 115 Bottom 141 Ft. #2 GRAVEL
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 20
20 / 75
75 / 76
76 / 82
82 / 84
84 / 95
95 / 100
100 / 108
108 / 117
117 / 118
118 / 120
12. REMARKS:
Formation Description;
SAND AND CLAY
CLAY
ROCK 2"
SAND AND CLAY
ROCK 24"'.
SAND
CLAY
ROCK AND SAND
SAND (MED)
ROCK 6"
SAND (COARSE)
NOVA dl 2017
RECEIVED/NCDENR/DWR
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 HAS BEEN PROVIDED TO THE WELL OWNER.
NOV 2 7 W5-17
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
DAVID L REGISTER Water Quality Regional
PRINTED NAME OF PERSON CONSTRUuCIPcift.�filon
in Wilmon �egt I Office
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GW-lb
Rev. 2/09

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
\• WELL CONTRACTOR CERTIFICATION # 2314A
sroo
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 NC 28458
City or Town State Zip Code
(910 ) 289-3175
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(ifapplicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
IrrigationTi Other ❑ (list use)
DATE DRILLED 08-22-2017
4. WELL LOCATION:
RIVER LANDING
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: WALLACE COUNTY DUPLIN
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley Flat ❑Ridge ❑Other
LATITUDE " DMS OR 34.739543 DD
LONGITUDE " DMS OR -77.934746 DD
Latitude/longitude source: VGPS [Topographic 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.)
RIVFR I ANDING
Facility Name Facility ID# (if applicable)
Street Address
WAI I ACF
City or Town
RIVFR I ANDING
Contact Name
PO BOX 1139
Mailing Address
WAI I ACF
City or Town
( )
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 190
NC 7646E
State Zip Code
NC 28466
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO al
c. WATER LEVEL Below Top of Casing: 19 FT.
(Use "+" if Above Top of Casing)
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
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): 50 METHOD OF TEST Al R
f. DISINFECTION: Type HTH
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 170 Ft. 4 40 PVC
Top Bottom Ft.
Top Bottom Ft.
Amount 4 07
8. GROUT: Depth Material
Top 0 Bottom 20 Ft. HOLE PLUG
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size
Top 170 Bottom 190 Ft. 4 in.
Top
Top
Bottom
Bottom
Ft. in.
Ft. in.
10. SAND/GRAVEL PACK:
Depth
Top 165 Bottom 193
Top Bottom
Top Bottom
11. DRILLING LOG
Top Bottom
/ 11
18
18 / 40
40 / 75
7_/ 85
85 / 88
88 / 98
98 / 130
130 / 135
135 / 152
152 / 155
12. REMARKS:
Method
POURED
Material
.016 in. PVC
in.
in.
Size Material
Ft. #2 GRAVEL
Ft.
Ft.
Formation DescrpiprN s e " r :L
CLAY NOV f_g
SAND ,�011
CLAY
SAND AND
s.�
SAND
ROCK AND SAND
SAND (MED)
ROCK AND SAND
SAND (MED)
SAND AND CLAY
ROCK AND SAND
I DO HEREBY CERTIFY THAT THIS RCCWPSLVNORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
N 0 V 27 ?Q17_ 10-5-17
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
DAVID L. REGISTE
PRINTED NAME OF PERSON
all Rp3gionaI
atg-IWELL
Wilmington Regional Office
Form GW-lb
Rev. 2/09

NON RESIDENTIAL 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 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 0 Recovery ❑ Injection ❑
Irrigationci Other ❑ (list use)
DATE DRILLED 08-21-2017
4. WELL LOCATION:
RIVER LANDING
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: WALLACE COUNTY DUPLIN
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley Utlat ❑Ridge ❑Other
LATITUDE rr DMS OR 34.758294 DD
LONGITUDE "DMS OR -77.946659 DD
Latitude/longitude source: UPS ❑Topographic 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.)
RIVFR I ANDING
Facility Name
RII I Y FI OYD HOMF
Street Address
Facility ID# (if applicable)
City or Town State Zip Code
RIVFR l ANDING
Contact Name
PO ROX 1139
Mailing Address
WAI I ACF NC 28488
City or Town State Zip Code
( )
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 145
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO aV
c. WATER LEVEL Below Top of Casing: 32 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 variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 30 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 133 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 133 Bottom 145 Ft. 4 in. .016 in. PVC
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Size Material
Top 125 Bottom 157 Ft. #2 GRAVEL.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom Formation Description
145 / 153 CLAY
153 / 157+ SAND AND CLAY
/
R
12. REMARKS:
Water Quality
Iuuuualliity Regional
I DO HEREBY CERTIFY THAT THIS WELL Fri AtIl RDANCE WITH
15A NCAC 2C, WELL CONSTRUCTIONVO 100THIS
REC D HAS BEE PROVI ED TO T E WELLLNNER.
. 10-5-17
SIGNATURE OF CERTIFIED
DAVID L. REGISTER
LL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GW-lb
Rev. 2/09

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
( 91 0 ) 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 ❑
Industrial/Commercial 0 Agricultural 0 Recovery ❑ Injection ❑
Irrigationlj Other ❑ (list use)
DATE DRILLED 08-21-2017
4. WELL LOCATION:
RIVER LANDING
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: WALLACE COUNTY DUPLIN
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑ Valley hiFlat ❑Ridge ❑Other
LATITUDE " DMS OR 34.758294 DD
LONGITUDE " DMS OR -77.946659 DD
Latitude/longitude source: VGPS Qfopographic 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.)
RIVFR I ANDING
Facility Name
RII I Y FLOYD HOMF
Street Address
WAI l ACF
City or Town
RIVFR 1 ANDING
Contact Name
PC) BOX 1139
Mailing Address
WAI I ACF
City or Town
Facility ID# (if applicable)
( )
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 145
b. DOES WELL REPLACE EXISTING WELL?
NC. 28466
State Zip Code
NC 28466
State Zip Code
YES ❑ NO El
c. WATER LEVEL Below Top of Casing: 32
(Use "+" if Above Top of Casing)
FT.
r-f Olt
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): 30 METHOD OF TEST AIR
f. DISINFECTION: Type HTH Amount 4 07
g. WATER ZONES (depth):
Top Bottom
Top Bottom
Top Bottom
7. CASING: Depth
Top 0 Bottom 133
Top Bottom
Top Bottom
8. GROUT: Depth
Top 0 Bottom 20
Top Bottom
Top Bottom
Top Bottom
Top Bottom
Top Bottom
Thickness/
Diameter Weight Material
Ft. 4 40 PVC
Ft.
Ft.
Material Method
Ft. HOLE PLUG POURED
Ft.
Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top 133 Bottom 145 Ft. 4 in. .016 in. PVC
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top 125 Bottom 157 Ft. #2
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 20
20 / 25
25 / 48
48 / 95
95 / 100
100 / 103
103 / 116
116 / 119
119 / 128
128 / 133
133 / 145
12. REMARKS:
Material
GRAVEL
Formation Dessrtpt ol•k,, ,,
CLAY
SAND
CLAY
SAND AND�bLAY
SAND
ROCK 32"
SAND (MED)
CLAY
ROCK, SAND AND CLAY
CLAY
SAND (MED)
RECEIVED/NCDENR/DWR
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION R CORD HAS BEEN PROVIDED TO THMAL �(JSNERNC �� IT A COPY OF THIS
I 10-5-17
SIGNATURE OF CERTIFIEI FLV ',iRTMata1 DATE
DAVID L. RFGIST— u')erations Section
PRINTED NAME OF PERATT vklfKtksFtA TH�IELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GW-lb
Rev. 2/09

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality •4 6 4 0
, 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 State Zip Code
(910 ) 289-3175
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
NC 28458
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public 0
Industrial/Commercial ❑ Agricultural ❑ Recovery 0 Injection ❑
Irrigation(i Other ❑ (list use)
DATE DRILLED 09-25-2017
4. WELL LOCATION:
ELWYN G. MURRAY ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: ROSE HILL COUNTY DUPLIN
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley Q'Flat ❑Ridge ❑Other
LATITUDE "DMS OR 34.829326
DD
LONGITUDE " DMS OR -78.013334 DD
Latitude/longitude source: 3PS 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.)
DUSTIN JACKSON
Facility Name
Ft WYN G MURRAY ROAD
Street Address
ROSF HIL I
City or Town
DUSTIN JACKSON
Contact Name
FI WYN G MURRAY ROAD
Mailing Address
ROSF HII I
City or Town
( )
Area code Phone number
6. WELL DETAILS:
Facility ID# (if applicable)
NC 28458
State Zip Code
NCB, 2R4 8
8tOte S • ljsci
NOV g 2017
information Proc":S`^9, Unit
a. TOTAL DEPTH: 125 WKS uC
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO E/
c. WATER LEVEL Below Top of Casing: 35 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 variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 20 METHOD OF TESTAR
f. DISINFECTION: Type HTH 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 Bottom 105 Ft. 4 40 PVC
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material
Top 0 Bottom 20 Ft. HOLE PLUG
Top Bottom Ft.
Top Bottom Ft.
Method
POURED
9. SCREEN: Depth Diameter Slot Size Material
Top 105 Bottom 125 Ft. 4 in. .015 in. PVC
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Top 100 Bottom 126
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 20
20 / 62
Size
Ft. #2
Material
GRAVEL
Formation Description
SAND
CLAY
62 / 78 SAND
78 / 82
82 / 98
98 / 103
103 / 125
125 /126+
/
12. REMARKS:
ROCK AND SAND
SAND (MED)
ROCK AND SAND
SAND (MED)
CLAY
NOV 20 2011
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARQN, TkWT�,;OORHI
Ye 7Si
REC DHAS BE PROVI DTOTHE LLO htU ‘Y tC• Ofld
• 1,, tions Section
SIGNATURE OF CERTIFIED WELL ONTRACTTOR IOI 1DATEe7
E
DAVID L. REGISTFR
PRINTED NAME OF PERSON CONSTRUCTING•THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GW-lb
Rev. 2/09