GW1 - Duplin 2018

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:
RECEIVED
EN
DEC 1 7 2018
WELL CONSTRUCTION PERMIT# Plater Quality Regional
OTHER ASSOCIATED PERMIT#(if applicabqperations Section
SITE WELL ID Cif applicable) #4
Wilrnington Regional Office
3. WELL USE (Check One Box) Monitoring 0 Municipal/Public 0
Industrial/Commercial 0 Agricultural Ii Recovery 0 Injection ❑
Irrigation❑ Other 0 (list use)
DATE DRILLED 10/15/2018
4. WELL LOCATION:
FOUNTAINTOWN ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: BEULAVILLE COUNTY DUPLIN
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley VrFlat ❑Ridge ❑Other
LATITUDE • ' " DMS OR N34.858672
LONGITUDE " DMS OR W77.674678
Latitude/longitude source: UfGPS ❑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.)
DD
DD
Facility Name Facility ID# (if applicable)
F011NTAINTOWN ROAD
Street Address
BFUI AVII I F
City or Town
JUSTIN FDWARDS
NC 78518
State Zip Code
Contact Name
507 CFDAR FORK CHURCH ROAD
Mailing Address
BFtJI AVII I F I\IC
City or Town State
( ) 271-1079
Area code Phone number
6. WELL DETAILS:
28518
Zip Code
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): 15 METHOD OF TEST AIR
f. DISINFECTION: Type HTH Amount 4 07
g. WATER ZONES (depth):
Top Bottom Top
Top Bottom Top
Top Bottom Top
7. CASING: Depth Diameter
Top 0 Bottom 230 Ft. 4
Top Bottom Ft.
Top Bottom Ft.
Bottom
Bottom
Bottom
Thickness/
Weight Material
40 PVC
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 230 Bottom 260 Ft. 4 in. .016 in. PVC
Top Bottom Ft. in. in.
Top Bottom Ft.
in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top 220 Bottom 265 Ft. #1
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 /10
10 /45
45 / 62
62 / 68
68 / 77
77 / 120
120 / 160
160 / 201
201 / 205
205 / 222
222 /265+
12. REMARKS:
Material
GRAVEL
Formation Description
SAND AND CLAY
SOFT CLAY
ROCK AND MARL
ROCK
MARL
CLAY
SAND AND CLAY
CLAY
ROCK
SAND AND CLAY
ROCK AND MED FINE SAND
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
5A N C 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
a. TOTAL DEPTH: 260 V EC R HAS BEEN VIDETHE WEL WNER.
b. DOES WELL REPLACE EXISTING WELL? YES ,tld e� 11 /A
�'' SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 47 FT. DAVID L REGISTER
(Use "+" if Above Top of Casing) 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:
RECEIWNC
DEC 1 7 �018
WELL CONSTRUCTION PERMIT# Water Q. tlity o. ,,;_ _
OTHER ASSOCIATED PERMIT#(ir applicab Operations Section
iniil;n on ,eg!ona! Office
SITE WELL ID #(if applicable) #3
3. WELL USE (Check One Box) Monitoring 0 Municipal/Public 0
Industrial/Commercial ❑ Agricultural t ' Recovery ❑ Injection 0
IrrigationD Other 0 (list use)
DATE DRILLED 10/13/2018
4. WELL LOCATION:
FOUNTAINTOWN ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: BEULAVILLE COUNTY DUPLIN
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley iiifFlat ❑Ridge ❑Other
LATITUDE "DMS OR N34.858605 DD
LONGITUDE " DMS OR W77.674779 DD
Latitude/longitude source: VPS DTopographic 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.)
JUSTIN FDWARD.S
Facility Name
FOUNTAINTOWN ROAD
Street Address
RFUI AVII I F
City or Town
JUSTIN FDWARDS
Facility ID# (if applicable)
NC 28518
State Zip Code
Contact Name
507 CFDAR FORK CHURCH ROAD
Mailing Address
RFIJI AVII I F NC
City or Town State
( ) 271-1079
Area code Phone number
6. WELL DETAILS:
28518
ode
a. TOTAL DEPTH: 260 � Gn�^�,4
b. DOES WELL REPLACE EXISTING WE.L14W O RIO L�
c. WATER LEVEL Below Top of Casing: 47 FT.
(Use "+" if Above Top of Casing)
45R149
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): 15 METHOD OF TEST AIR
f. DISINFECTION: Type HTH Amount 4 07
g. WATER ZONES (depth):
Top Bottom Top
Top Bottom Top
Top Bottom Top
Bottom
Bottom
Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0 Bottom 230 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
Top 230 Bottom 260 Ft. 4
Top Bottom Ft.
Top Bottom Ft.
10. SAND/GRAVEL PACK:
Depth
Top 220 Bottom 265
Diameter Slot Size Material
in. .016 in. PVC
in. in.
in. in.
Size
Ft. #1
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 /10
10 / 45
45 / 62
62 / 68
68 / 77
77 / 120
120 / 160
160 / 201
201 / 205
205 / 222
222 /265+
12. REMARKS:
Material
GRAVEL
Formation Description
SAND AND CLAY
SOFT CLAY
ROCK AND MARL
ROCK
MARL
CLAY
SAND AND CLAY
CLAY
ROCK
SAND AND CLAY
ROCK AND MED FINE SAND
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 PROVIDE TO THE YELL OWNER.
S GNI J ('LLer
ATURE OF CERTIFIED WELL LCONTRACTOR
DAVID L. REGISTER
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
o,l
11/30/18
DATE
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
'm "" • �`` 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
RECEIVFIV CBEI OW88
City or Town State Zip Code
(910 ) 289-3175 DEC 1 2018
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# Water Quality Regional
OTHER ASSOCIATED PERMIT#(if a lic Operations Ser;aI O I
( pP \ ?le27?fGn i +onal Office
SITE WELL ID #(if applicable) #2
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public 0
Industrial/Commercial ❑ Agricultural ' Recovery 0 Injection ❑
Irrigation0 Other 0 (list use)
DATE DRILLED 10/1 1 /2018
4. WELL LOCATION:
FOUNTAINTOWN ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: BEULAVILLE COUNTY DUPLIN
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley WfFlat ❑ Ridge ❑Other
LATITUDE "DMS OR N34.858663 DD
LONGITUDE " DMS OR W77.674631 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.)
JUSTIN FDWARDS
Facility Name
FOUNTAINTOWN ROAD
Street Address
BFUI AVII I F
City or Town
JUSTIN FDWARDS
Contact Name
507 CFDAR FORK CHURCH ROAD
Mailing Address
BFUI AVII I F NC
City or Town
State
,e_‘
271-1079
Phone number Rem riQ4A
Area code
6. WELL DETAILS:
Facility ID# (if applicable)
NC 78518
State Zip Code
a. TOTAL DEPTH: 260 c,;
b. DOES WELL REPLACE EXISTING Out r YE5zu NO 14.
c. WATER LEVEL Below Top of Casing: 47 FT.
(Use "+" if Above Top of Casing)
o
450148
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): 15 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 230 Ft. 4 40 PVC
Top Bottom
Top Bottom
Ft.
Ft.
8. GROUT: Depth Material
Top 0 Bottom 20 Ft: HOLE PLUG
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth
Top 230 Bottom 260
Top Bottom
Top Bottom
Method
POURED
Diameter Slot Size Material
Ft. 4 in. .016 in. PVC
Ft. in. in.
Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top 220 Bottom 265 Ft. #1
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 /10
10 / 45
45 / 62
62 / 68
68 / 77
77 /120
120 / 160
160 / 201
201 / 205 •
205 / 222
222 /265+
12. REMARKS:
Material
GRAVEL
Formation Description
SAND AND CLAY
SOFT CLAY
ROCK AND MARL
ROCK
MARL
CLAY
SAND AND CLAY
CLAY
ROCK
SAND AND CLAY
ROCK AND MEDFINE SAND
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
REC HAS BEEN ROVIDD TO THE vy LL OWNER.
( 11/30/18
SIGNATURE OF CERTIFIED ElJe CONTRACTOR DATE
DAVID I , RFGISTFR
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-1b
Rev. 2/09

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality + 4 i
WELL CONTRACTOR CERTIFICATION # 2314A 45F [�
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
REffivtgrofftlf
(910 ) 289-3175
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
DEC 172018
OTHER ASSOCIATED PERMIT#(if applicable) Operations Section
SITE WELL ID *Of applicable) #1 Wilmington Regional Office
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial D Agricultural i Recovery ❑ Injection ❑
Irrigation❑ Other D (list use)
DATE DRILLED 10/08/2018
4. WELL LOCATION:
FOUNTAINTOWN ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: BEULAVILLE couNTYDUPLIN
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
ID Slope DValley elat ❑Ridge ❑Other
LATITUDE " DMS OR N34.858586 DD
LONGITUDE " DMS OR W77.674667 DD
Latitude/longitude source: VGPS Qropographic 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.)
JUSTIN FDWARDS
Facility Name
FOUNTAINTOWN ROAD
Street Address
BFIJI AVII I E
City or Town
JUSTIN FDWARDS
Contact Name
Facility ID# (if applicable)
NC 28518
State Zip Code
Mailing Address
BFUI AVII 1 F
City or Town
( ) 271-1079
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 260
NC
State
CJv
b. DOES WELL REPLACE EXISTING WELL? YES
c. WATER LEVEL Below Top of Casing: 47
(Use "+" if Above Top of Casing)
FT.
d. TOP OF CASING IS 1.5 FT. Above Land Surface*
„Top of casing terminated aUor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 15 METHOD OF TEST AIR
f. DISINFECTION: Type HTH Amount 4 (77
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 230 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.
9. SCREEN: Depth Diameter
Method
POURED
Slot Size Material
Top 230 Bottom 260 Ft. 4 in. .016 in. PVC
Top Bottom_ Ft.
Top Bottom Ft.
in. in.
in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top 220 Bottom 265 Ft. #1
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 /10
10 / 45
45 / 62
62 / 68
68 / 77
77 /120
120 / 160
160 / 201
201 / 205
205 / 222
222 /265+
12. REMARKS:
Material
GRAVEL
Formation Description
SAND AND CLAY
SOFT CLAY
ROCK AND MARL
ROCK
MARL
CLAY
SAND AND CLAY
C LAY
ROCK
SAND AND CLAY
ROCK AND MED FINE SAND
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECO D AS BEEN Pf OVIDTO THE W&LL OWNER.
ice°% 11/30/18
SIGNATURE OF CERTIFIED WELL; ONTRACTOR DATE
DAVID L. REGISTER
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
L Le'L
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-1 b
Rev. 2/09

'. ax
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 RECEIVEti DEt$M
(910 ) 289-3175
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
DEC T 7 2018
OTHER ASSOCIATED PERMIT#(if applicabl'ater Quality Regional
Operations Section
( )
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 152
SITE WELL ID #(if applicable)
ffice
3. WELL USE (Check One Box) Monitoring 0 Municipal/Public ❑
Industrial/Commercial ❑ Agricultural 0 Recovery ❑ Injection 0
IrrigationL ' Other ❑ (list use)
DATE DRILLED 1 1 /16/2018
4. WELL LOCATION:
STERLING DRIVE - RIVER LANDING
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: WALLACE COUNTY DUPLIN
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope DValley VFlat ❑Ridge ❑Other
LATITUDE "DMS OR N34.769297 DD
LONGITUDE " DMS OR W77.951138 DD
Latitude/longitude source: V PS ❑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
STFRI ING DRIVF
Street Address
WAI I ACF
City or Town
RIVFR LANDING
Contact Name
PO BOX 1139
Mailing Address
Facility ID# (if applicable)
NC 28466
State Zip Code
WAI 1 ACF NC 2R46
City or Town State Zip C
CSC
Qc
('
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NOV
c. WATER LEVEL Below Top of Casing: 39 FT.
(Use "+" if Above Top of Casing)
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2314A
4500
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): 35 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 132 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 132 Bottom 152 Ft. 4 in. .018 in. PVC
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
Top 130 Bottom 152 Ft. #2 GRAVEL
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 /15
15 /30
30 / 43
43 / 90
90 / 104
104 / 110
110 / 129
129 / 136
/ 150
/ 152+
REMA.xRKS:
4W`
Formation Description
CLAY
SAND
SAND AND CLAY
CLAY
SAND AND CLAY
ROCK AND SAND
SAND (MED)
ROCK AND SAND
SAND (MED)
ROCK AND SAND
HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
S BEEN PR MED TQ THE WELL i'WNER.
xta 11/30/1 8
SIGNATURE OF CERTIFIED WELL C j' TRACTOR 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

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department ofEnvirontnent and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIF ION # 2314A
RECEIVED/NCDENR/D
1. WELL CONTRACTOR:
DAVID L REGISTER
Well Contractor (Individual) Name
REGISTER WELL CO.. INC.
Well Contractor Company Name
721 WEST CHARLTY ROAD
Street Address
ROSE HILL
City or Town
( 910 ) 289-3175
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
DEC 1 7 2018
Water Quality Regional
Operations Section
Wilmington Regional Office
NC 28458
State Zip Code
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check Applicable Box): Residential Water Supply Ctli
DATE DRILLED 10/30/2018
TIME COMPLETED AM 0 PM ❑
4. WELL LOCATION:
CITY: ALBERTSON COUNTY DUPLIN
WASHBOARD ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope O Valley 2rFlat ❑Ridge ❑ Other
LATITUDE " DMS OR N35.121739 DD
LONGITUDE " DMS OR W77.886558 DD
Latitude/longitude source: I PS [(Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. WELL OWNER
JOHNNY SUMMERLIN
Owner Name
400 NORBERT WILSON STREET
Street Address
MT. OLIVE
City or Town
( ) 289-0255
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 190
NC 28365
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IV
c. WATER LEVEL Below Top of Casing: 47 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): 35 METHOD OF TEST Al R
f. DISINFECTION: Type HTH Amount 4 OZ
Top 160
g. WATER ZONES (depth):
Top Bottom
Top Bottom
Top Bottom
45A 145
Top Bottom
Top Bottom
Top Bottom
Thickness/
Diameter Weight
Ft. 4 .40
Ft.
Ft.
7. CASING: Depth
Top 0 Bottom 170
Top Bottom
Top Bottom
8. GROUT: Depth
Top 0 Bottom 20
Top Bottom
Top Bottom
Material
Ft. HOLE PLUG
Ft.
Ft.
Material
PVC
Method
POURED
9. SCREEN: Depth Diameter Slot Size Material
Top 170 Bottom 190 Ft.4 in, .024 in. PVC
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Bottom
Size Material
193 Ft. #2 GRAVEL
Top Bottom
Top Bottom
11. DRILLING LOG
Top Bottom
0 /20
Ft.
Ft.
20 /35
35 /47
47 /80
80
115
142
Formation Description
SAND
SAND AND CLAY
CLAY
SAND AND CLAY
/115 SAND (MED)
/ 142 SAND AND CLAY
/ 144 ROCK 24"
144 /192 SAND (MED)
192 / 193+ SAND & CLAY
/
12. REMARKS:
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
PR DED TO THE WELL OWN
twt,li
11/30/18
SIGNATURE OF CERTIFIED WEL 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-la
Rev. 2/09

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Justin Radford
Well Contractor Name RECEIVED/NGUhNR/DWR
3270
NC Well Contractor Certification Number
Geological Resources, Inc.
DEC 172018
4
Water Quality Regional
Operations Section
List all applicable well construction permW �ilhl llf�o�il!% S#ii$ l fykl fbride, etc.)
Company Name
2. Well Construction Permit #:
3. Well Use (check well use):
Water Supply Well:
Agricultural
DGeothermal (Heating/Cooling Supply)
Dhldustrial/Commercial
IlInigation
IDMunicipaVPublic
DResidential Water Supply (single)
QResidential Water Supply (shared)
Non -Water Supply Well:
Monitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
QGeothermal (Heating/Cooling Return)
QRecovery
QGroundwater Remediation
Salinity Barrier
fStormwater Drainage
Subsidence Control
Tracer
[Other (explain under #21 Remarks)
4. Date Well(s) Completed: 10/16/18 Well m# MIN-3
5a. Well Location:
Friendly Mart #1 0-016703
Facility/Owner Name Facility iD# (if applicable)
103 East Center Street, Faison 28341
Physical Address, City, and Zip
Duplin 245900885314
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.116407 N 78.135576
W
6. Is(are) the well(s)JPermanent or DITemporary
7. Is this a repair to an existing well: QYes or EiNo
If this is a repair, fill out known well construction information and explain the nature of the
repair under #21 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface: 13 (ft.)
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing: 5.02
If water level is above casing, use "+"
11. Borehole diameter: 6" (in.)
12. Well construction method: Direct Push
(ft.)
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
136. Disinfection type: Amount:
For Internal Use Only:
t
14. WATER ZONES
FROM
TO
DESCRIPTION
5or
ft.
15. OUTER
CASING (for
multl-cased wells) OR LINER (If applicable)
FROM
TO
DIAMETER
THICKNESS I MATERIAL
ft.
ft.
in.
Ij
16. INNER
CASING OR TUBING
(geothermal
closed -loop)
FROM
TO .
DIAMETER
THICKNESS
MATERIAL,
0 ft.
3 . ft.
2• ln.
Sched 40
PVC
ft.
ft.
in.
-
17. SCREEN
--
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
3 ft.
13 ft.
2" In.
0.010
Sched 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft.
0.5 ft•
cement
pour
0.5 ft.
1 ft.
bentonite
pour
ft.
ft.
19. SAND/GRAVEL
PACK
(If applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
1 ft.
13 ft.
#2 Gravel Pack
Pour
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
0 ft.
13 ft.
direct push - no cuttings retained
ft.
ft.
ft.
ft.
-
ft.
ft.
ft.
ft.
ft.
ft.
11
ft.
ft.
U;v..'
21. REMARKS \ ), v
22. Certification:
21c6
Signature of Certified Well Contractor
11/16/18
Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with ISA NCAC 02C.0100 or 154 NCAC 02C.0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW-1
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Justin Radford
Well Contractor Name
3270
2
NC Well Contractor Certification Number RECEIWED/NCDENR/
Geological Resources, Inc.
Company Name
DEC 172018
2. Well Construction Permit #:
List all applicable well construction permits (i.e. U1C, County,, State, Variance, etc.)
Water Quality Regional
3. Well Use (check well use): Operations Section
Water Supply Well: bKltin+l;lun Re,iultdl OfiICC
El Agricultural DMunicipal/Public
QGeothermal (Heating/Cooling Supply) QResidential Water Supply (single)
Industrial/Commercial DResidential Water Supply (shared)
(' Irrigation
Non -Water Supply Well:
Monitoring
DRecovery
Injection Well:
Aquifer Recharge
QlAquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
QGroundwater Remediation
QSalinity Barrier
Stormwater Drainage
Subsidence Control
QTracer
nGeothennal (Heating/Cooling Return) Other (explain under #21 Remarks)
4. Date Well(s) Completed: 1 0/1 6/1 8 Well ID# M\N-2
5a. Well Location:
Friendly Mart #1 0-016703
Facility/Owner Name Facility ID# (if applicable)
103 East Center Street, Faison 28341
Physical Address, City, and Zip
Duplin 245900885314
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.116407 N 78.135576
W
6. Is(are) the well(s)0Permanent or QTemporary
7. Is this a repair to an existing well: (jYes or EgNo
If this is a repair, fill out known well construction information and explain the nature of the
repair under #21 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface:
For multiple wells list all depths if different (example- 3@200' and 2Q100)
10. Static water level below top of casing: 6.13
If water level is above casing, use "+"
u
11. Borehole diameter: 6
12
(ft.)
(ft.)
12. Well construction method: Hand Auger/Direct Push
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
For Internal Use Only:
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER Of a llcable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
In.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL -
0 ft.
2 ft.
2• is
Sched 40
PVC
ft.
ft.
in.
17. SCREEN -
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
2 ft•
12 ft'
2' in.0.010
Sched40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft'
0.5 ft•
cement
_
pour
0.5 ft•
1 ft•
bentonite
pour
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
1 ft.
12 ft.
#2 Gravel Pack
Pour
ft.
ft.
20. DRILLING LOG (attach
additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, solFrock type, grain size, etc.)
0 ft•
0.5 ft•
concrete
0.5 ft•
3 ft•
brown fine sand
3 ft.
72 `t•
direct push - no cuttings retained
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
V ? E�
22. Certification:.,
bx
Signature of Certified Well Contractor
11/16/18
Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C.0100 or 1SA NCAC 02C.0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699 -1617
24b. For Infection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW-1
North Carolina Department of Environmental Quality - Division of Water Resources
Revised 2-22-2016

d.
e.
f.
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 23I4A
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#
RECEIVED/NCDENR/DWR g
Top
Top
Top
OCT 02 2018
WATER ZONES (depth):
4542a7
Bottom Top
Bottom Top
Bottom Top
Bottom
Bottom
Bottom
Water Quality Regional p Thickness/
7. CASING: De th DiameterWeight
Wilmington Regional Offic 'P 0 Bottom 200 Ft. 2
NC 28458 Top Bottom Ft.
State Zip Code
Top Bottom Ft.
Opel atiuiis SeCtiOn
OTHER ASSOCIATED PERMIT#Qf applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check Applicable Box): Residential Water Supply t(
DATE DRILLED 09-05-2018
TIME COMPLETED AM ❑ PM ❑
4. WELL LOCATION:
CITY: MAGNOLIA COUNTYDUPLIN
795 HAMILTON ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley 6'FIat ❑Ridge ❑ Other
LATITUDE
LONGITUDE '
Latitude/longitude source: W&PS
(location of well must be shown on
this form if not using GPS)
" DMS OR N34.881525 DD
" DMS OR W77.998953 DD
❑topographic map
a USGS topo map andattached to
5. WELL OWNER
JOSE HENRY FUNES RODRIQUEZ
Owner Name
795 HAMILTON ROAD
Street Address
MAGNOLIA NC 28453
City or Town
State Zip Code
( ) 214-2512
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 215
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IV
c. WATER LEVEL Below Top of Casing: 25
(Use "+" if Above Top of Casing)
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.
YIELD (gpm): 30 METHOD OF TEST AIR
DISINFECTION: Type HTH Amount 4 OZ
FT.
Material
.40 PVC
8. GROUT: Depth Material
Top 0 Bottom 20 Ft. HOLE PLUG
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter
Top 200 Bottom 215 Ft,2
Top Bottom Ft.
Top Bottom Ft.
in.
in.
in.
10. SAND/GRAVEL PACK:
Depth Size
Top 195 Bottom 220 Ft. #2
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 /10
10 /30
30 /60
60 /65
65 /72
72 / 73
73 /133
133 /134
134 /151
151 /153
153 /181
181 /182
182 /216
216 /220+
12. REMARKS:
Method
POURED
Slot Size Material
.015 in. PVC
in.
in.
Material
GRAVEL
Formation Description
& CC Li-
CLAY
SANDSAND & CLAYAY
ROCK & CLAY
SAND & CLAY
ROCK 2"
SAND & CLAY
ROCK 18" R
SAND & CLAY ��Q1$
ROCK 18" 5EP
CLAY pr�r;'g/" to L"..
ROCK 2"�a�lpvdOirC`-
SAND (MED)
SAND & CLAY
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 WE OWNE
,�/�a,c. L- �` iiC j tl It/Akef 9-10-18
SI NATURE OF CERTIFIED WELL NTRACTOR DATE
DAVID L REGISTER
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1R17 Mail Rarvira ranfar Ralainh Nr 97RQq-1R1 Phnnn • /QAQ1 Rr17-AVAA
Form GW-la

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTI TION # 2314A
RECEIVED/NCDENR/DWR
1. WELL CONTRACTOR:
DAVID LREGISTER
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# WI 8-096B
OCT 02 2018
Water Quality Regional
Operations Section
Wilmington Regional Office
NC 28458
State Zip Code
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(ifapplicable)
3. WELL USE (Check Applicable Box): Residential Water Supply Gi
DATE DRILLED 08-14-2018
TIME COMPLETED AM ❑ PM ❑
4. WELL LOCATION:
CITY: SUMMERLINS X-RDS COUNTYDUPLIN
SUMMERLINS X-RDS
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code).
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑Valley fi(Flat ❑ Ridge ❑Other
LATITUDE "DMS OR N35.094266 DD
LONGITUDE " DMS OR W77.970254 DD
Latitude/longitude source: (PS Dfopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. WELL OWNER
G & B BUILDERS
Owner Name
1603 S HOLLYBROOK RD.
Street Address
WENDELL NC 27591
City or Town State Zip Code
(919 ) 795-8635
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 210
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO d
c. WATER LEVEL Below Top of Casing: 30 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): 50 METHOD OF TEST Al R
f. DISINFECTION: Type HTH Amount 4 OZ
g. WATER ZONES (depth):
Top Bottom
Top Bottom
Top Bottom
7. CASING: Depth Diameter
Top 0 Bottom 190 Ft. 4
Top Bottom Ft.
Top Bottom Ft.
:15.3493
Top Bottom
Top Bottom
Top Bottom
Thickness/
Weight Material
.40 PVC
8. GROUT: Depth Material Method
Top O Bottom 20 Ft. HOLE PLUG POURED
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top 190 Bottom 210 Ft.4 in. .016 in. PVC
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top 180 Bottom 215 Ft. #2
Top Bottom
Top Bottom
11. DRILLING LOG
Top Bottom
0 /30
30 /88
88 /124
124 /125
125 /134
134 /135
135 /210
210 /215+
12. REMARKS:
Ft.
Ft.
Material
GRAVEL
Formation Description
SAND
SAND AND CLAY
SAND (MED)
ROCK 12"
SAND (MED)
ROCK 6"
SAND (MED)
CLAY
SEP 0 6 2018
krfofiTitAtion Pre: ,L `Y•. :
cy G/t4 G13
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
PRO ED TO THE WELL OWNER.
SIGNATURE OF CERTIFIED WF
DAVID L REGISTER
L11 08-30-2018
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-la
Rev. 2/09

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
Lawrence D. Opper
RECEIVED/NCDENR/DWP
Well Contractor Nalne
NC3322-A
NC Well Contractor Certification Number
Regional Probing Services
Company Name
2. Well Construction Permit #:
List all applicable a ell canstrac liun permits (i.e. Connie, State. Parlance'. etc.)
SEP 0 4 ?..013
3. Well Use (check well use):
Water Quality Regional
Operations Section
Wilmington Regional Offi
Water Supply Well:
❑ Agricultural
❑ Geothermal (Heating/Cooling Supply)
Industrial/Commercial
❑ irrigation
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
❑O Monitoring ❑Recovery
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑ Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
❑Groundwater Remediation
❑ Salinity Barrier
❑ Stormwater Drainage
❑ Subsidence Control
❑Tracer
❑other (explain under #2 1 Remarks)
For Internal Usc ONLY:
4. Date Well(s) Completed: 7/16/2018 Well ID=MW-25, MW-14R
5. Well Location:
Pantry 3197
Facility/Owner Name facility I04I (it applicable)
1330 N. Norwood Street, Wallace
Physical Address, City. and Zip
Dublin
County Parcel identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
34.751126 N 77.998059 W
6. Is (are) the well(s): OPcrmanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ONo
/J'Ihis is a repair, fill out known ire/1 comu'uc Lion urfiu,ualion and explain the nature nfthe
repair under 21 renurrks.ceenton or on the back of this prin.
8. Number of wells constructed: 2
i•or multiple injection or non -Crater supply wells ONLY with the .same construction. you can
submit one fiu'nt.
9. Total well depth below land surface: 12
Par multiple m'e/ls list all depths ifdiffirent (example- 3(0200' and 2@l0Ort
10. Static water level below lop of casing: -4
!Prater level is chore casing, use "
11. Borehole diameter: 4.25 (in.)
12. Well construction method: Auger -DP
(i.e. auger, rotary, cable, direct push. etc.)
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
I5. OUTER C:ASiNG (for multi -cased wells) OR LINER (if ap Hcable)
FROM PTO
DIAMETER
THICKNESS MATERIAL
ft. ft.
�16,
in.
INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft'
2 it'
2 in'
sch 40
PVC
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SITE
THICKNESS
MATERIAL
2 ft•
12 ft.
2 in.
.010
sch40
PVC
ft.
ft.
in.
18. GROUT
PROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft'
1 ft'
cement grout
pour
1 n.
1.5 ft•
bentonite
pour
O.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
1.5 ft.
12 ft.
#2 sand
pour
ft.
ft.
20. DRILLING
LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soiVrock type, grain size, etc.)
0 ft•
12 ft.
Silty Sand
rt.
re.
ft.
ft.
ft.
ft.
ft.
ft.
e.
ft.
ft.
ft.
:L\u G % 4, 2018
21. REMARKS
22. Ce ti("
•atio": Lawrence
er
Signalur o Certified Well C'ontractor
Ug i 4Jy signed by larnencc flee,
PN. <n=law,ems o,Per. o=Regional
P.obiM Service, ou.
mat=ran,e+.eganab,obing.<o,n
<=U5
Dale'10; BAB. I) 70 53.8 -0e00'
8/4/2018
Dale
fir .signing this farm. I hereby certijj' Thal the men(o) m'as (mere) constructed in accordance
attic 15A ;VI ',I( 02('.01100 or I5A N('A(02('.0200 Weil ('nnstruction Standards and thin
crept' of this record has been provided to the well owner
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
24. Submittal Instructions:
(ft) 24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
(ft.)
13. FOR WATER SUPPLY WELLS ONLY:
I3a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
Division of Water Quality, information Processing Unit,
1617 Mil Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Geothermal Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well constniclion to the county health department of the county
where constructed.
Fcrm GW-1
North Carolina Department of Emitonment and Natural Resources - Division of Water Quality Revised Jan. 2013

— -
1. WELL CONTRACTOR:
DAVID L_REG LSTER
Well Contractor (Individual) Name
REGISTER WELL CO.. INC.
Well Contractor Company Name
721 WEST (;�-(ARITY ROAD
Street Address
ROSE HILL
City or Town
( 910) 289-3175
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#450
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Qualit
WELL CONTRACTOR CEEIVED RI, itifeON # 2314A
JUL 2 3 2018
Water Cluaitty Rgional
Operations Section
wi+Ttington p4onal Off ce 7. CASING: Depth
Top 0 Bottom 235
Top Bottom
Top Bottom
NC 28458
State Zip Code
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID Cif applicable)
3. WELL USE (Check Applicable Box): Residential Water Supply I�
DATE DRILLED 06-19-2018
TIME COMPLETED AM ❑ PM ❑
4. WELL LOCATION:
CITY: TEACHEY couNTY DUPLIN
ESTHER TEACHEY LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley [tFlat ❑Ridge ❑Other
LATITUDE "DMS OR N34.768048 DD
LONGITUDE " DMS OR W78.027765 DD
Latitude/longitude source: IMPS ['Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. WELL OWNER
ROSA PACHECO
Owner Name
ESTHER TEACHEY LANE
Street Address
TEACHEY NC 28464
City or Town State Zip Code
(910 ) 271-4427
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 255
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO I '
c. WATER LEVEL Below Top of Casing: 38 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 Al R
f. DISINFECTION: Type HTH Amount 3 OZ
g. WATER ZONES (depth):
Top Bottom Top
Top Bottom Top
Top Bottom Top
Bottom
Bottom
Bottom
Thickness/
Diameter Weight Material
Ft. 2 .40 PVC
Ft.
Ft.
8. GROUT: Depth Material
Top 0 Bottom 20 Ft. HOLE PLUG
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter
Top 235 Bottom 255 Ft2 in.
Top Bottom Ft. in.
Top Bottom Ft. in.
10. SAND/GRAVEL PACK:
Depth
Top 220 Bottom 260
Top Bottom
Method
POURED
Slot Size Material
.015 in. PVC
in.
in.
Size Material
Ft. #2 GRAVEL
Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 /15
15 /25
25 /54
54 /57
57 /71
71 /75
75 /87
87 /88
88 /148
148 /160
160 /176
176 /177
177 /190
190 /213
12. REMARKS:
Formation Description
CLAY EE_ a� y {,
SAND AND CLAR `.: �. .n•, s " L. L.,
CLAY
ROCK AND CLAY JUL 1 9 2018
SAND AND CLAY
ROCK AND SANI' m3,•sc::-i t r .; =:.2 UY
CLAY D,f. G: O%
ROCK 4"
SAND AND CLAY
ROCK AND SAND
SAND (MED FINE)
ROCK 4"
SAND AND CLAY
CLAY
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.
6-28-18
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
DAVID L REGISTER
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality -
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Information Processing,
Form GW-la
Rev. 2/09

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2314A
RECEIVED /NCDENR/DWR
1. WELL CONTRACTOR:
DAVID L REGISTER
Well Contractor (Individual) Name
REGISTER WELL CO.. INC.
Well Contractor Company Name
JUL 23 1018
Water Quality Regional
721 WEST C_HARJTY ROAD Operations Section
Street Address Wilmington Regional Uttice
ROSFi-IILL 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 Applicable Box): Residential Water Supply I!tr
DATE DRILLED 06-21-2018
TIME COMPLETED AM ❑ PM ❑
4. WELL LOCATION:
CITY: TIN CITY
HWY 11
COUNTY DUPLIN
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑Valley IiFlat ❑ Ridge ❑Other
LATITUDE " DMS OR N34.728377 DD
LONGITUDE " DMS OR W77.979267 DD
Latitude/longitude source: l iPS Ofopographic map
(location of well must be shown on a USGS fopo map andattached to
this form if not using GPS)
5. WELL OWNER
IRA WADE
Owner Name
1355 N NORWOOD ST.. PO BOX 276
Street Address
WALLACE NC 28466
City or Town State Zip Code
(910 ) 271-8158
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 255
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO lr
c. WATER LEVEL Below Top of Casing: 29 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): 25 METHOD OF TEST AIR
f. DISINFECTION: Type HTH Amount 3 OZ
4 S28O9
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 240 Ft. 2 .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 240 Bottom 255 Ft2 in. .015 in. PVC
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
Top 230 Bottom 260 Ft. #2 GRAVEL
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
180 /195
195 /230
230 /241
241 /242
242 /255
255 /260+
/
/
12. REMARKS:
Formation Description
SAND AND CLAY
CLAY
SAND (MED)
ROCK 14"
SAND (MED)
SAND AND CLAY
JUL 1 9 2018
intt}rraaAtoci Pr?Y:g'.tt.a j �ifasi
CMG.
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 TyE WELL OWNE6i►
SIGNAT� OF CERTIFIED WELL OR DATE
DAVID L REGISTER
6-28-18
� r
NTRACT
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-la
Rev. 2/09

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department ofrrEnvironment
RRand Natural Resources- Division of Water Quality
WELL CON 4 En�1E7:R�)�I��ITION # 2314A
1. WELL CONTRACTOR:
DAVID LL RE_GISTER
Well Contractor (Individual) Name
REGISTER WELL. CO.. INC.
Well Contractor Company Name
721 WEST CI- RITY ROAD
JUL 23 2018
Water Quality Regional
Operations Section
Wilmington Regional Office
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 Applicable Box): Residential Water Supply Vir
DATE DRILLED 06-21-2018
TIME COMPLETED AM ❑ PM E
4. WELL LOCATION:
CITY: TIN CITY
HWY 11
COUNTY DUPLIN
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley VFlat
LATITUDE
LONGITUDE
❑Ridge ❑Other
° DMS OR N34.728377 DD
" DMS OR W77.979267 DD
Latitude/longitude source: 3PS ❑Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. WELL OWNER
IRA WADE
Owner Name
1355 N NORWOOD ST,. PO BOX 276
Street Address
WALLACE NC 28466
City or Town State Zip Code
(910 ) 271-8158
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 255
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO d
c. WATER LEVEL Below Top of Casing: 29 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): 25 METHOD OF TEST AIR
f. DISINFECTION: Type HTH Amount 3 OZ
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
7. CASING: Depth Diameter
Top 0 Bottom 240 Ft. 2
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth
Top 0 Bottom 20
Top Bottom
Top Bottom
Thickness/
Weight Material
.40 PVC
Material
Ft. HOLE PLUG
Ft.
Ft.
Method
POURED
9. SCREEN: Depth Diameter Slot Size
Top 240 Bottom 255 Ft.2 in. .015 in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Material
PVC
10. SAND/GRAVEL PACK:
Depth Size
Top 230 Bottom 260 Ft. #2
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 /17
17 /38
38 /67
67 /75
75 /88
88 /95
95 /110
110 /120
120 /145
145 /155
155 /156
156 /172
172 /173
173 /180
12. REMARKS:
Material
GRAVEL
Formation Description
CLAY
SAND AND CLAY
CLAY
ROCK AND SAND
CLAY
SAND
ROCK AND SAND
SAND AND CLAY
CLAY
SAND
ROCK 2"
SAND (MED) ;C....� .:y. �
ROCK 3"���
SAND (FINE) la,
F're�cy'�T�`i
.; ri
lil$l`%P i a`: cioni , 3.r:.
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.
6-28-18
SIGNATURE OF CERTIFIED WELL 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-la
Rev. 2/09

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
[phone]
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# 450
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check Applicable Box): Residential Water Supply RI
DATE DRILLED 06-19-2018
TIME COMPLETED
4. WELL LOCATION:
CITY: TEACHEY COUNTY DUPLIN
ESTHER TEACHEY LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope ❑Valley I'Flat ❑Ridge
LATITUDE
LONGITUDE
AM ❑ PM ❑
(check appropriate box)
❑Other
"DMS OR N34.768048 DD
" DMS OR W78.027765 DD
Latitude/longitude source: t 3PS ['topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
6. WELL OWNER
ROSA PACHECO
Owner Name
ESTHER TEACHEY LANE
Street Address
TEACHEY NC 28464
City or Town State Zip Code
(910 ) 271-4427
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 255
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO d
c. WATER LEVEL Below Top of Casing: 38 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 3 OZ
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2314A
RECEIVED/MEN/MR
JUL 23 2618
g. WATER ZONES (depth):
Top Bottom Top
Top Bottom Top
Top Bottom Top
Water QualityOporatlnnc SPcRegionatll
oli 7. CASING: Depth
Wilmington Regional (lop 0 Bottom 235 Ft. 2
NC 28458 Top Bottom Ft.
State Zip Code
Top Bottom Ft.
o2$01
Bottom
Bottom
Bottom
Thickness/
Diameter Weight Material
.40 PVC
8. GROUT: Depth Material Method
Top O Bottom 20 Ft. HOLE PLUG POURED
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
235 Bottom 255 FL2 in. .015 in. PVC
Bottom Ft. in. in.
Bottom Ft. in. in.
Top
Top
Top
10. SAND/GRAVEL PACK:
Depth
Bottom 260
Size Material
Top 220 Ft. #2 GRAVEL
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top
213
230
231
Bottom Formation Description
/230 SAND (FINE)
/231 ROCK 6"
/260+ SAND (MED FINE)
12. REMARKS:
JUL 9 ZOIB
tfl4l'KC':i=tiifrl i'' S?aRreS j t 1iai
DWCOOG
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 TWEL . OWNER.
6-28-18
SIGNATU/�RvE OF CERTIFIED WELL 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-la
Rev. 2/09

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality 51 1 6
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#Qf applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural 0 Recovery 0 Injection ❑
IrrigationEl Other 0 (list use)
DATE DRILLED 04-23-2018
4. WELL LOCATION:
NORTH DUPLIN SCHOOL ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: CALYPSO COUNTY DUPLIN
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley urFlat ❑Ridge ❑Other
LATITUDE " DMS OR N35.139432 DD
LONGITUDE "DMS OR W78.089540 DD
Latitude/longitude source: 3PS Qropographic 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.)
CARROI I COTTI F
Facility Name Facility ID# (if applicable)
NORTH CUP! IN SCHOOL ROAD
Street Address
CAI YPSO NC
City or Town State Zip Code
CARROI I COTTI F
Contact Name
501 S. HARDING DRIVF APT 701
Mailing Address
(COI DSBORO NC 97530
City or Town State Zip Code
( )
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 125
b. DOES WELL REPLACE EXISTING WELL? YES ❑
c. WATER LEVEL Below Top of Casing: 39
(Use "+" if Above Top of Casing)
NO Gil
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 85 Ft. 4 .40 PVC
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth
Top 0 Bottom 20
Top Bottom
Top Bottom
Material Method
Ft. HOLE PLUG POURED
Ft.
Ft.
9. SCREEN: Depth Diameter Slot Size
Top 85 Bottom 125 Ft. 4
Top Bottom Ft.
Top Bottom Ft.
Material
in. .016 in. PVC
in. in.
in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top 75 Bottom 140 Ft. #2
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 42
42 / 81
11 /120
120 /140+
—TECTREVEDENR/DWR�tn?,
Material
GRAVEL
Formation Description
CLAY
SAND AND CLAY
SAND (MED COARSE)
SAND (FINE)
—ZUN 1 8 2018
%
cal
---1Cfer Qudlily Regional
12. REMti0nS Section
Wilmington Regional Office
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCA WELL CON TRUCTION STANDARDS, AND THAT A COPY OF THIS
RECOR HA BEEN PR it3ED TO Tk1E WELL 0ER.
ZIA" c5 6-1-18
.
SIGNATU
RE OF CER IF WELL CON ACTOR 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

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
For Internal Use ONLY:
1. Well Contractor Information:
�✓'art1- bei/
RECEIUEi?/NCDENR/DW.,NELi. ABANDONMENT DETAILS
Well Contractor Name (or well owner personally abandoning welliJrhlrelprjperyi'),13
32 -,4 LL UU
NC Well Contractor Certification Number • Water Quality Regional
trc £iZpu1D 5EgO t C�$Opecrations Section
OGl(minf utr R,l,aionaI Uttice
Company Name
7a. Number of wells being abandoned: 1
Pm- multiple rnlection or non -crater supply wells (hVLY with the same
construction abandonment, you can submit me !Orin
7b. Approximate volume of water remaining in well(s): —( (gal.)
2. Well Construction Permit 4:
A14
list all applicable well permits (te County ,Slate. Variance, Injection. etc) if known
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothennal (Heating/Cooling Supply)
❑Industrial/Commercial
❑Irrigation
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
' Monitoring
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
❑Recovery
❑Groundwater Remediation
❑Salinity Barrier
❑ Stormwater Drainage
❑Subsidence Control
❑Tracer
❑ Other (explain under 7g)
4. Dale well(s) abandoned: ,6 I ai ' ,20 I S
5a. Well location:
-U(Coe 11 Pro i`es 0 •-0000aItoq-so
Facility/Owner Name Facility ID!' (if applicable)
1330 Mrtti Nov woos(
Physical Address, City. and Zip
tin
County Parcel Identification No. (PIN)
33o16)oo11 OT72
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field. one lat/long is sufficient)
34,75IIzs N -7`19SCo82 W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Atmch well construction record(s) if aradable. For multiple injection or non -water supply
wells ONLY with the same construction abandonment you Carr submit one fora.
6a. Well iD#:
6b. Total well depth: / i ("W Cf A C
6c. Borehole diameter: 02 if (i ) JrU N 0
5 2018
°rlOort-laiiofi I�roc.... I)att.
6d. 'Water level below ground surface:
6e. Outer casing length (if known):
Of. inner casing/tubing length (if known):
fig. Screen length (if known):
Form GW-30
101
(ft.)
(ft.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout
O Sand Cement Grout
0 Concrete Grout
❑ Specialty Grout
O Bentonite Slurry
l;(r,Bentonite Chips or Pellets
0 Dry Clay
0 Drill Cuttings
❑ Gravel
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
< Ibibs of Qe.siv$fe C.14q's•
7g. Provide a brief description of the abandonment procedure:
S !ow 1 POIW I evl#oYl 1' !-e C.-6r? s its to t/Je.i l .
While- �'-1/I. KS & 6(1.519tog .
8. Certification:
Signature of Certified Well Contractor or Well Owner
Date
By signing this form, 1 hereby certi5 that the well(s) was (were) abandoned in
accordance with ISA NCAC 02C.0100 or 2C.0200 Well Consn•uction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagrain or additional well details:
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
IOa. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Infection Wells: in addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Supply & infection Wells: In addition to sending the forin to
the address(es) above. also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
where abandoned.
North Carolina Department of Environment and Natural Resources - Division of Water Resources Revised August 2013

8. Number of wells constructed:
WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
I. Well Contractor Information:
Joseph V Thigpen
Well Contractor Name
2631A
NC Well Contractor Certification Number
Thigpen Well Drilling
Company Name ,trr'' (''�
2. Well Construction Permit #: ✓" % b i 0 !%V� J
List all applicable well construction permits (t. e. County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
gricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑lrrigation
❑MunicipaVPublic
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
❑Monitoring
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed:
5. /Well Location:
MJi-
Facility/Owner Name
❑Recovery
FROM
For Internal Use ONLY:
450604
14. WATER ZONES
FROM
TO
DESCRIPTION
ft
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if applicable)
DIAMETER
FROM
TO
/ y5'
THICKNESS
ft. ti v
16. INNER CASING OR TUBING (geothermal dosed -loop)
THICKNESS MATERIAL
ft.
TO
ft.
DIAMETER
in.
is
MATERIAL ,
ft.
ft.
itt
17.SCREEN
FROM TO ter-'
ft. ft.
DIAMETER
is
SLOT SIZE
did
THICKNESS
MATERIAL
is
18. GROUT
FROM
d ft
TO
47 0 rt.
MATERIAL
EMPLACEMENT METHOD & AMOUNT
ft
ft
❑Groundwater Remediation
❑Salinity Barrier
❑Stomlwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 Remarks)
_ IT
Y90A.-
Facility ID# (if applicable)
Physical Address, City, and Zip
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
3a) $ N 7) . �O W
6. Is (are) the well(s): ElP rmanent or OTemporary
7. Is this a repair to an existing well: ❑Yes or 3
If this is a repair, fill out known well construction information and explain the nature ofthe
repair under 1121 remarks section or on the back of this form.
y
For multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
9. Total well depth below land surface:
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing:
If water level is above casing us
11. Borehole diameter: (in.)
12. Well construction method: / Cf^I�-
(i.e. auger, rotary, cable, direct push, etc.)
(ft)
(ft.)
13. FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) .� Method of test:A
13b. Disinfection type:L�/v�4-� Amount: a�
Fomi GW-1
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
ft
ft
TO
ft.
MATERIAL
q rc-v�e.i
EMPLACEMENT METHOD
20. DRILLING LOG (attach additional sheets ifnecessary
TO DESCRIPTION (color, hardness, soil/rock type, grain size, etc)
FROM
ft.
ft.
ge-erft.
ft.
//,j (' ft.
ft.
ft
'7 y ft.
8 C/ ft.
/ Lid it.
ft.
ft.
R E C E e V_.
21: REMARKS
22. Certi
tion:
true ofCerti CyyWell C(ontractotf7'
140,rtilfiti0r1 Proce: i`c-i(Sg lli
LA 0
Date
signing this form, I hereby certtfy that the well(s) was (were) constructed in accordance
with 15A NCAC 02C.0100 or 15,4 NCAC 02C .0200 Well Construction Standards and thot a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
24. Submittal Instructions:
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
construction to the following:
North Carolina Department of Environment and Natural Resources - Division of Water Quality
RECEIVED/NCDENR/DWR
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636 gg
24c. For Water Supply & Geothermal Wells: In 9Q9i'iPnJ cti lnldte form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed. Water Quality Regional
Operations Section
Wilmington Regionladv4ife. 2013
tr:

2. Well Construction Permit #: 1/4J.5.0. Cf/ /
List all applicable well construction permits (i.e. County, Stare, Variance, etc)
3. Well Use (check well use):
WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
Joseph V Thigpen
Well Contractor Name
2631 A
NC Well Contractor Certification Number
Thigpen Well Drilling
Company Name
For internal Use ONLY:
45002
14. WATER ZONES
FROM
ft.
TO
ft.
DESCRIPTION
15.OUTER CASING (for multi -cased wells) OR LINER (if applicable)
DIAMETER
FROM
TO
/ 6S'ft
THICKNESS
ft V in. t j d)
16.1NNER CASING OR TUBING (geothermal closed -loop)'.
FROM
TO
DIAMETER
THICKNESS
MA'I�RIAL
MATERIAL
ft.
ft.
is
ft.
ft.
in_
17. SCREEN
Waterei uIturay Well:
IWllU7al
❑Geothermal (Heating/Cooling Supply)
❑Industrial/Commercial
❑Irrigation
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
❑Monitoring
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Recovery
FROM
TO
iC
ft.
ft
DIAMETER
1.1
in.
in.
SLOT SIZE
THICKNESS
y�
18. GROUT
FRO
ft
rt.
TO
t ft
ft
MATERIAL
EMPLACEMENT METHOD & AMOUNT
OGroundwater Remediation
❑Salinity Barrier
❑Storm water Drainage
❑Subsidence Control
❑Tracer
❑Geothermal (Heating/Cooling Return) ❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: SI -/ )
5. Well Location:
Facility/Owner Name
Facili IDII (if applicable)
6�1 d Q 4 t . �-i� i�� l�
Phy al Adddre;s, City. and Zip
/.\^\
County V Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if welt field, one lat/long is sufficient)
3f/3 Nt7T(-T
6. Is (are) the well(s): (anent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes orO
If this is a repair, fill out known well construction information and explain the nature oldie
repair under 1121 remarks section or on the back of this form.
8. Number of wells constructed:
For multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
For multiple wells list all depths ifdifferene (example- 3 200' and 2@100') (ft.)
9. Total well depth below land surface:
10. Static water level below top of casing:
If water level is above casing use
11. Borehole diameter: t% (in.)
12. Well construction method:
117
Y/ e'L��
(i.e. auger, rotary, cable, direct push, etc.)
(ft)
13. FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) ° Method of test: A
13b. Disinfection type: 1/ /UG` e"` Amount: cle" .2"-e
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)'
FROM
ft
TO
t70
ft.
MATERIAL
EMPLACEMENT METHOD
• 20. DRILLING LOG (attach additionat'sheets
TO DESCCRIPTIOr, hardness, soil/rock type, grain size, etc.)
Ls
FROM
d ft
1,), fL
led ft.
/03 ft*/
e tt.
itrit
ed ft.
I (ez3 ft
ft
if:REMARKS
22. Ce [cation:
01-e
tractor
in•
J)/r-
Date
By signing this form, 1 hereby certify that the well(s) was (were) constructed in accordance
with ISA NCAC 02C .0100 or 15.4 NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
24. Submittal Instructions:
24a. For Ali Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For injection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
construction to the following'
Water Quality Regional
North Carolina Department of Environment and Natural Resources - Division of Water Quality operations Section an. 2013
Wilmington Regional�ff#
RECEIVED/NCDENR/DWR
Division of Water Quality, Underground njection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Geothermal Wells: 4 laistilitik k s t the form to
the address(es) above, also submit one copy is arm wi in 30 days of
completion of well construction to the county health department of the county
where constructed.
Fomr GW-1

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
Joseph V Thigpen
Well Contractor Name
2631A
NC Well Contractor Certification NnmhPe
Thigpen WeII Drilling
Company Name
2. Well Construction Permit #: (�l/5 U O / 3
List all applicable well construction permits (Le. County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
grtcultura!
❑Geothermal (Heating/Cooling Supply)
❑Industrial/Commercial
Dlrrigation
OMunicipaUPublic
OResidential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
❑Monitoring ❑Recovery
Injection Well:
DAquifer Recharge
OAquifer Storage and Recovery
DAquifer Test
❑Experimental Technology
❑Geotherma!(Closed Loop)
DGroundwater Remediation
DSalinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
OGeothermal (Heating/Cooling Return) ❑Other (explain under #2I Remarks)
4. Date Well(s) Completed:
5 Well Location:
�r SC/ /--- 1" IvideS.
Facility/ er Name Facility ID# (if applicable)
Physicals, City, and Zip
J/� n
County U Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
6. Is (are) the well(s): L+ rmanent or DTemporary
1. Is this a repair to an existing well: Dyes or ft7Aicr-
If this is a repair, fill out known well construction information and explain the nature of the
repair under 421 remarks section or on the back o this form.
8. Number of wells constructed:
For multiple injection or non -water supply wells ONLY with the same contraction, you can
submit one form.
9. Total well depth below land surface: EJ (fL)
For multiple wells list all depths ifd fferenl (example- 3@200' and 2@100')
W
10. Static water level below top of casing:
lfwater level is above casing care
11. Borehole diameter:
(in.)
12. Well construction method: 1 C' 1' "
(i.e. auger, rotary, cable, direct push, etc.)
(n)
13. FOR WATER SUPPLY WELLS ONLY:
13a.
Yield
reld m
(gP ) /� ,/ Method of test.
13b. Disinfection type:(/✓ /o'C✓ 1- Amount: ���--
For Internal Use ONLY:
14. WATER ZONES
FROM TO
DES r pT[
j�S-flu �`
C
ft ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if ap iicable)
0
TO
DIAMETER
THICKNESS MA�T{f/�R�E,A/L
. , ft
I
I fL
a i in.
Lif�
{' L
16. INNER CASING OR TUBCNG(geothermal
dosed -loop)' . .. .
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft
in.
ft.
ft.
in.
17.SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
l gSh. _2o
11 in.
d/ C
if CI
PI/
ft
ft
in.
18. GROUT :.:'. - ..
FROM
yAf ATERIAL
EMPLACEMENT METHOD & AMOUNT
ft
� ft .Yei-'i.4h
L�
@___
ft.
f.
ft.
fL
-.19. SAND/GRAVEL PACK (ifappiicable)' :., . t
FROM
TO
MATERIAL
EMPLACEMENT METHOD
iIGift.aa)
I
[�' ft
�r�-.-f
ft
ft
-20.`DRILLING. LOG (attaeliiddiliooal'sbeetsifutieSsary):ir>: ;....
FROM TO
DESCRIPTION (co r, hardness. soittroek type. grain size, etc.)
j fi. rft
1 ft. j j. ft
�l
)/)'t /(yft.
Lift 123
C.--'i
/.)3ft!tsc-ft
X
I" rt
/ if
5
21..REMARIGS .. . .. . ; ' i I f •
,:. y; : •. .
2018
A 1')iA.-
.... h`Sri Q 1
22. Certi
tion:
lure of Ce
ed Well Contra
Date
By signing this form, 1 hereby certij, that the well(s) was (were) constructed in accordance
with 1 SA NCAC 02C .0100 or ISA NCAC 02C .0200 Well Construction Standords and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
24. Submittal Instructions:
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
e Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
2413. For Iniection Welts; In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Undergroun ��� vR
1636 Mail Service Center, Rale s . rt
24c. For Water SonpIy & Geothermal Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30b,Y s of
completion of well construction to the county healtlJJNrtr4er1o2itt3jounty
where constructed.
Form GW.1 North Carolina Department of Environment and Natural Resources - Division of Water Quality
Water Quality Region®d. 2013
Operations Section
Wilmington Regional Office

No
North C
Carolina
RESIDENTIAL WELL CONSTRUCTION RECORD (�
D S ent of Environment and Natural Resources- Division of Water Quality ,� 5 /
•,Y p ,,- WELL CONTRJOR CERTIFICATION # 2314A
1. WELL CONTRACTOR:4 - �'O
DAVID L REGIST' '' (3- o
Well Contractor (Individual)C
`�
WELL
REGISTER
Well Contractor Company Nam2N
721 WEST CHARITY
Street Address
ROSE HILL
City or Town
(910 ) 289-3175
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) #1
NC 28458
State Zip Code
3. WELL USE (Check One Box) Monitoring 0 Municipal/Public 0
Industrial/Commercial 0 Agricultural Recovery ❑ Injection 0
Irrigation❑ Other ❑ (list use)
DATE DRILLED 05-02-2018
4. WELL LOCATION:
WARDS BRIDGE ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: KENANSVILLE COUNTY DUPLIN
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley !Alai ❑Ridge ❑Other
LATITUDE " DMS OR N35.015601 DD
LONGITUDE " DMS OR W77.986982 DD
Latitude/longitude source: V PS Jropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
6. FACILITY (Name of the business where the well is located.)
STAN DRALJGHN
Facility Name
WARDS BRIDGF ROAD
Street Address
KFNANSVII I F
City or Town
STAN DRAUGHN
Facility ID# (if applicable)
NC 98349
State Zip Code
Contact Name
185 N COUNTRY CI UB DRIVF
Mailing Address
KFNANSVII I F
City or Town
NC 28349
State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 275
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO Cit
c. WATER LEVEL Below Top of Casing: 45 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): 25 METHOD OF TEST AIR
f. DISINFECTION: Type HTH Amount 4 07
g. WATER ZONES (depth):
Top Bottom
Top Bottom
Top Bottom
7. CASING: Depth Diameter
Top 0 Bottom 205 Ft. 4
Top Bottom Ft.
Top Bottom Ft.
Top Bottom
Top Bottom
Top Bottom
Thickness/
Weight Material
.40 PVC
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 205 Bottom 225 Ft. 4 in. .016 in. PVC
Top Bottom Ft. in. in.
Top Bottom Ft.
in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top 195 Bottom 237 Ft. #2
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 43
43 / 95
95 / 115
115 / 116
116 / 126
126 / 127
127 / 135
135 / 136
136 / 200
200 / 225
225 /237+
12. REMARKS:
Material
GRAVEL
Formation Description
A D
SAND (MED) Os
ROCK 12" ceS`��`�
SAND (FINE)
ROCK 10"
SAND (MED FINE)
SAND (MED)
SAND (MED FINE)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
REC D S BEEN PVIDEO T, THE WE fI WNER.
CAA`
SIGNATURE OF CERTIFIED WELL CO TRACTOR
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

NON 1 SIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Depart
„tip _ WEI4 COPSRACtift CERTIFICATION #
_of Environment and Natural Resources- Division of Water Quality
1. WELL CONTRACTOR: 6" '3 , O ��
DAVID L REGISTER ��`°'wQ�
Well Contractor (Individual) Name? �Q3 cc:,REGISTER WELL CO,. *44- co
Well Contractor Company Name o n:5.
721 WEST CHARITY ROP
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) #2
3. WELL USE (Check One Box) Monitoring 0 Municipal/Public 0
Industrial/Commercial 0 Agricultural li ' Recovery 0 Injection ❑
Irrigation❑ Other 0 (list use)
DATE DRILLED 05-03-2018
4. WELL LOCATION:
WARDS BRIDGE ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: KENANSVILLE COUNTY DUPLIN
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley Flat ❑Ridge ❑Other
LATITUDE "DMS OR N35.015494 DD
LONGITUDE " DMS OR W77.986968 DD
Latitude/longitude source: IMPS (]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.)
STAN DRAUGHN
Facility Name
WARDS RRIDGF ROAD
Street Address
KFNANSVII I F
City or Town
STAN DRALJGHN
Contact Name
185 N COUNTRY CI UB DRIVF
Mailing Address
KFNANSVIL I F
City or Town
Facility ID# (if applicable)
NC 28349
State Zip Code
NC 78349
State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 225
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO q/
c. WATER LEVEL Below Top of Casing: 45
(Use "+" if Above Top of Casing)
FT.
2314A
•150399
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): 25 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 205 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 205 Bottom 225 Ft. 4 in.
Top Bottom Ft. in.
Top Bottom Ft. in.
10. SAND/GRAVEL PACK:
Depth
Top 195 Bottom 230
Size
Ft. #2
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 43
43 / 95
95 / 126
126 / 128
128 / 200
200 / 225
225 /230+
12. REMARKS:
Slot Size Material
.016 in. PVC
in.
in.
Material
GRAVEL
Formation Description
SAND
SAND AND CLAY
SAND (MED)
ROCK AND SAND
SAND (MED FINE)
SAND (MED)
, ,(,3t 0 OG
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCA C. WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECOR H S BEEN PRO OED T HEW OWNER.
/���� fatly 5-22-18
SIGNATURE OF CERTIFIED WELL t1 NTRACTOR 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-1b
Rev. 2/09

1. WELL CONTRACTOR:
DAVID L REGISTER,-;4.,
Well Contractor (Individual) Nar0
REGISTER WELL COS
Well Contractor Company Name a
721 WEST CHARITY RO
Street Address
ROSE HILL
City or Town
(910 ) 289-3175
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Departi�9f� �t of Environment and Natural Resources- Division of Water Quality
WELL CONTRA R CERTIFICATION # 2314A
�G F
2.) O
„'c'>NC 28458
State Zip Code
co
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Monitoring 0 Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery 0 Injection 0
Irrigation) Other 0 (list use)
DATE DRILLED 05-15-2018
4. WELL LOCATION:
THE VINEYARD —RIVER LANDING
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: WALLACE COUNTY DUPLIN
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley WrFlat ❑Ridge ❑Other
LATITUDE " DMS OR N34.769040 DD
LONGITUDE " DMS OR W77.949210 DD
Latitude/longitude source: 3PS ❑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 1 ANDING
Facility Name
THE VINFYARD
Street Address
WAI [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: 158
Facility ID# (if applicable)
NC 2R4F6
State Zip Code
NC 2R4AF
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO 51
c. WATER LEVEL Below Top of Casing: 43 FT.
(Use "+" if Above Top of Casing)
Top Bottom
Top Bottom
450341
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 TEST Al R
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 138 Ft. 4 .40 PVC
Ft.
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 138 Bottom 158 Ft. 4 in. .016 in. PVC
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Top 130 Bottom 160 Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 /8
8 /30
30 / 98
98 / 110
110 / 111
111 / 127
127 / 140
140 / 151
151 / 158
158 /160+
12. REMARKS:
Size Material
#2 GRAVEL
Formation Description
CLAY
SAND
CLAY
SAND
ROCK 6"
SAND (MED)
ROCK AND SAND ,*
SAND (MED) Ma
ROCK AND SAND SAND ycR`$‘
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
REC9 HAS BEENOVIDE)ITO THE WELL OWNER.
SIGNATURE OF CERTIFIED WELL NTTRAC OR
DAVID L. REGISTER
5-22-18
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

NON IDENTL4L WELL CONSTRUCTION RECORD
North Carolina De artment epvironment and Natural Resources- Division of Water Quality
W LI ONT STOR
1
° `0r
61`
DAVID L REGISTER °°lo��%q�%_ bl�
•
r .,f
TIFICATION # 2314A
•
WELL CONTRACTOR:
Well Contractor (Individual) Name 'pro sS "Po
REGISTER WELL CO„ INCI9O; et6
Well Contractor Company Name di 4 "9i
721 WEST CHARITY ROAD on
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 0 Municipal/Public ❑
Industrial/Commercial 0 Agricultural 0 Recovery 0 Injection 0
Irrigationd Other 0 (list use)
DATE DRILLED 05-14-2018
4. WELL LOCATION:
BLUE SCOTTS CT.. RIVER LANDING
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: WALLACE COUNTY DUPLIN
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley WiFlat ❑Ridge ❑Other
LATITUDE " DMS OR N34.762562 DD
LONGITUDE " DMS OR W77.938967 DD
Latitude/longitude source: 3PS (]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
Rl 11F SCOTTS CT
Street Address
WAI 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)
( )
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 190
b. DOES WELL REPLACE EXISTING WELL?
NC 28466
State Zip Code
NC 28466
State Zip Code
YES ❑ NO qI
c. WATER LEVEL Below Top of Casing: 34 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 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
7. CASING: Depth Diameter
Top 0 Bottom 170 Ft. 4
Top Bottom Ft.
Top Bottom Ft.
Thickness/
Weight Material
.016 PVC
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
Top 170 Bottom 190 Ft. 4 in. .016 in,
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top 165 Bottom 195 Ft. #2
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 60
60 /75
75 / 95
95 / 102
102 / 105
105 / 120
120 / 124
124 / 131
131 / 138
138 / 147
147 / 165
12. REMARKS:
Material
GRAVEL
Material
PVC
Formation Description
CLAY
SAND AND CLAY
CLAY
SAND (MED)
ROCK AND SAND ��� 0ytpt'
SAND AND CLAY w 0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NC2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECO S BEEN PI $ VIDEO/ 0 THE WELD. WNER.
SIGNATURE OF CERTIFIED WELL Cs' TRACT.R
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]
5-22-18
DATE
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 NC 28458
City or Town State Zip Code
(910 ) 289-3175
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# JV//// FQ�ry C4F/(A/
OTHER ASSOCIATED PERMIT#(if applicable) � D�A
2
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Mont ltf )) 't jpal/Public 0
Industrial/Commercial ❑ Agricultural 1i v tion 0
Irrigationd Other 0 (list use) O�tio ( W
DATE DRILLED 05-14-2018 ClcO
4. WELL LOCATION:
BLUE SCOTTS CT.. RIVER LANDING
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: WALLACE COUNTY DUPLIN
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley VrFlat ❑Ridge DOther
LATITUDE "DMS OR N34.762562 DD
LONGITUDE • " DMS OR W77.938967 DD
Latitude/longitude source: I, PS DTopographic 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 I ANDING •
Facility Name Facility ID# (if applicable)
BI 11F SCOTTS CT
Street Address
WAI ACF
City or Town
RIVFR 1 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 98466
State Zip Code
NC 98466
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 5Ir
c. WATER LEVEL Below Top of Casing: 34 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 TEST AIR
f. DISINFECTION: Type HTH Amount 4 07
g. WATER ZONES (depth):
Top Bottom Top
Top Bottom Top
Top Bottom Top
Bottom
Bottom
Bottom
Thickness/
7. CASING: Depth Diameter Weight
Top 0 Bottom 170 Ft. 4 .016
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material
Top 0 Bottom 20 Ft. HOLE PLUG
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth
Top 170 Bottom 190 Ft. 4 in. .016 in. PVC
Material
PVC
Method
POURED
Diameter Slot Size Material
Top Bottom Ft.
Top Bottom Ft.
in. in.
in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top 165 Bottom 195 Ft. #2
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 60
60 / 75
75 /95
95 / 102
102 / 105
105 / 120
120 / 124
124 / 131
131 / 138
138 / 147
147 / 165
12. REMARKS:
Material
GRAVEL
Formation Description
CLAY
SAND AND CLAY
CLAY
FLO
SAND (MED) Ptr;c
ROCK AND SAND 0c a" al$�
SAND AND CLAY 1 C �
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
REC i S BE tN PHUVIDEO THE WELIltQWNER.
a-t'
5-22-18
SIGNATURE OF CERTIFIED WELL Cc TRACTOR 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

McCALL
BROTHERS
INC.
Founded 1938
PO BOX 668710 • CHARLOTTE, NC 28266-8710 • TELEPHONE [phone] • FAX [phone]
LETTER OF TRANSMITTAL
TO: Division of Water Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
GENTLEMEN/LADIES:
RECEIVED/NCDENR/DWR
JUN 0 2 2018
Water Quality Regional
Operations Section
WiImingtop, kern. a 1,Rffid2017
REF: Well Construction Records (WCR)
Well Abandonment Records (WAR)
We are sending you the following:
X Attached Well Construction Records - Well Abandonment Records
QTY
WCR/
CITY
COUNTY
ADDRESS
CUSTOMER
1
WCR
GASTONIA
GASTON
119 AKINBAC ROAD
STEVE MCGIRT
DEPt7PF.
1/1)
1ft/
l
il

NONR
North Carolina Departmeri
WELL CONTRACTO
IDENTIAL WELL CONSTRUCTION RECORD
nvironment and Natural Resources- Division of Water Quality
RTIFICATION # 2314A
1. WELL CONTRI
ACTOR: sb
DAVID L REGISTER �3 °° o Fy
Well Contractor (Individual) Name cO,tj ("d 9 c.1
REGISTER WELL CO„ IN6�°�9' o� -xis
Well Contractor Company Name co S
721 ee1t AddressWEST CHARITY ROAD S°o°'o°dam
ROSE HILL
1C 28458
City or Town date 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 0 Municipal/Public 0
Industrial/Commercial 0 Agricultural ❑ Recovery 0 Injection 0
Irrigationtii( Other 0 (list use)
DATE DRILLED 05-14-2018
4. WELL LOCATION:
BLUE SCOTTS CT.. RIVER LANDING
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: WALLACE COUNTY DUPLIN
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley QrFlat ❑Ridge ❑Other
LATITUDE ° " DMS OR N34.762562 DD
LONGITUDE " DMS OR W77.938967 DD
Latitude/longitude source: 3PS DTopographic 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 1 ANDING
Facility Name
RI lJF SCOTTS CT
Street Address
WALI ACE
City or Town
RIVFR I ANDING
Contact Name
PO RC)X 1139
Mailing Address
WAl L ACF
City or Town
Facility ID# (if applicable)
NC 2R4fi
State Zip Code
NC 2R466t
State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 190
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO 51
c. WATER LEVEL Below Top of Casing: 34 FT.
(Use "+" if Above Top of Casing)
}50395,
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 TEST AI R
f. DISINFECTION: Type HTH Amount 4n7
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 .016 PVC
Top Bottom Ft.
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 170 Bottom 190 Ft. 4 in.
Top Bottom Ft. in.
Top Bottom Ft. in.
10. SAND/GRAVEL PACK:
Depth
Top 165 Bottom 195 Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
165 / 180
180 / 181
181 / 191
191 /195+
/
12. REMARKS:
Size
#2
Method
POURED
Slot Size Material
016 in. PVC
in.
in.
Material
GRAVEL
Formation Description
SAND (MED) 0 c
ROCK 6"
SAND (MED) , -
SAND AND CLAY
1 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.
SIGNATURE OF CERTIFIED WELL CONTRACTOR 5 DATE 5
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

1. WELL CONTRACTOR: •a�� �o
DAVID L REGISTER '1��o,Q L Fyn,
Well Contractor (Individual) Name o p'9-i cb v4-
REGISTER WELL CO_ INc t.s
Well Contractor Company Name 0•
721 WEST CHARITY ROAD °��
Street Address
ROSE HILL ANC 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 0 Municipal/Public 0
Industrial/Commercial 0 Agricultural 0 Recovery 0 Injection 0
Irrigationti Other ❑ (list use)
DATE DRILLED 05-10-2018
4. WELL LOCATION:
RED FOX RUN - RIVER LANDING
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: WALLACE COUNTY DUPLIN
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope OValley prFlat ❑Ridge ❑Other
LATITUDE "DMS OR N34.753793 DD
LONGITUDE " DMS OR W77.930482 DD
Latitude/longitude source: 3PS DTopographic 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 1 ANDING
Facility Name
RFD FOX RUN
Street Address
WAI I ACF
City or Town
RIVFR I ANDING
Facility ID# (if applicable)
NC 28466
State Zip Code
Contact Name
PC) ROX 1139
Mailing Address
WAI I ACF
City or Town
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 160
NC 28466
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO gif
c. WATER LEVEL Below Top of Casing: 16
(Use "+" if Above Top of Casing)
FT.
NON R,1i IDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department b nvironment and Natural Resources- Division of Water Quality
WELL CONTRAbTOR1RTIFICATION # 23144
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 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 140 Ft. 4 40 PVC
Top
Top
Bottom
Bottom
Ft.
Ft.
8. GROUT: Depth Material
Top 0 Bottom 20 Ft. HOLE PLUG
Top
Top
Bottom
Bottom
Ft.
Ft.
9. SCREEN: Depth Diameter
Top 140 Bottom 160 Ft. 4 in.
Top
Top
Bottom
Bottom
10. SAND/GRAVEL PACK:
Depth
Top 135 Bottom 160
Ft.
Ft.
in.
in.
Size
Ft. #2
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 /15
15 / 70
70 / 82
82 / 84
84 / 98
98 /112
112 / 125
125 / 128
128 /160+
12. REMARKS:
Method
POURED
Slot Size Material
.016 in. PVC
in.
in.
Material
GRAVEL
Formation Description
SAND AND CLAY
CLAY
450394
.;zis
ROCK AND
SAND (FINE)
ROCK AND SAND ,p^Qpa�
SAND (MED)"° `
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NC 2C, WELL CONSTRUCTION ST ' DARDS, AND THAT A COPY OF THIS
REC. S BEEN PROVI i .0 TO THE LL OWNER.
5-22-18
SIGNATURE OF CERTIFIED WEL ! ONTRACTOR 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 V • F.' L !D #(if applicable)
3. WELL USE (Check One Box) Monitoring 0 Municipal/Public 0
Industrial/Commercial 0 Agriculturb
Irrigationli Other 0 (list use)
DATE DRILLED 04-12-2018
4. WELL LOCATION:
HWY 11
Recovery 0 Injection 0
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
clrV: WALLACE COUNTY DUPLIN
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley Ig(Flat ❑Ridge ❑Other
LATITUDE • " DMS OR N34.734033 DD
LONGITUDE ° " DMS OR W77.980949 DD
Latitude/longitude source: QI3PS Dropographic map
(location of well must be shown on a USGS topo map andaftached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
WAI I ACF FI FMFNTARY
Facility Name
HWY 11
Street Address
WAI LACF
City or Town
CHRIS HFRRING
Contact Name
Facility ID# (if applicable)
NC 2R466
State Zip Code
Mailing Address
ROSF HII L
City or Town
NC 28458
State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 293
b. DOES WELL REPLACE EXISTING WELL? YES ❑
c. WATER LEVEL Below Top of Casing: 36
(Use "+" if Above Top of Casing)
NO GI
FT.
45039?
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 250 Ft. 4 40 PVC
Top 250 Bottom 273 Ft. 4 80 PVC
Top Bottom Ft.
8. GROUT: Depth
Top 0 Bottom 20
Top Bottom
Top Bottom
9. SCREEN: Depth
Top 273 Bottom 293
Top Bottom
Top Bottom
Material
Ft. HOLE PLUG
Ft.
Ft.
Method
POURED
Diameter Slot Size
Ft. 4 in. .016 in.
Ft. in. in.
Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Top 260 Bottom 300 Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
Size
#2
Material
PVC
Material
GRAVEL
Formation Description
170 / 177 ROCK AND SAND
177 / 220 SAND (VERY FINE)
220 / 242 CLAY
242 / 245 SAND (MED)
245 /254 CLAY
254 / 300+
/_RFCFIVFD/NCD
12. REMARKS:
4.1
JUN 0 2 2f11R
Water Quality Regional
ul HEREBY Ig�I Operations1perySection
15AONCAC 2C, WELL CO CTIO TANDARDS, AND THAtnelr DT A COPYIN OFTHIS
E WITH
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
5-22-18
SIGNATURE OF CERTIFIED WELL 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 Departmet Environment and Natural Resources- Division of Water Quality
:;49..w-.0•' WELL CONTRACTO ERTIFICATION #
O
1. WELL CONTRACTOR: ' ��/ �L
DAVID L REGISTER tom, ,1. �'a
1.
Well Contractor (Individual) Name (5- Q .
REGISTER WELL CO„ IN .* c-, IS
Well Contractor Company Name S
721 WEST CHARITY ROAD q cc,k
Street Address 'd, o
ROSE HILL o b 28458
City or Town (tate 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 0 Municipal/Public ❑
Industrial/Commercial 0 Agricultural ❑ Recovery Infection 0
Irrigationii Other ❑ (list use)
DATE DRILLED 04-12-2018
4. WELL LOCATION:
HWY 11
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: WALLACE COUNTY DUPLIN
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley p"Fiat ❑Ridge ❑Other
LATITUDE " DMS OR N34.734033 DD
LONGITUDE
Latitude/longitude source: 3PS ❑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.)
" DMS OR W77.980949 DD
WALL ACF FI FMFNTARY
Facility Name
HWY 11
Street Address
WAI I ACF
City or Town
CHRIS HFRRING
Contact Name
Facility ID# (if applicable)
NC 284866
State Zip Code
Mailing Address
ROSF HII I
City or Town
NC 28458
State Zip Code
( )
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 293
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO q/
c. WATER LEVEL Below Top of Casing: 36 FT.
(Use "+" if Above Top of Casing)
2314A
45011
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
g. WATER ZONES (depth):
Top Bottom Top
Top Bottom Top
Top Bottom Top
7. CASING: Depth Diameter
Top 0 Bottom 250 Ft. 4
Top 250 Bottom 273 Ft. 4
Top Bottom Ft.
8. GROUT: Depth
Top 0 Bottom 20
Top Bottom
Top Bottom
Amount 4 07
Bottom
Bottom
Bottom
Thickness/
Weight Material
40 PVC
80 PVC
Material
Ft. HOLE PLUG
Ft.
Ft.
Method
POURED
9. SCREEN: Depth Diameter Slot Size
Top 273 Bottom 293 Ft. 4 in. ,016 in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Top 260 Bottom 300 Ft.
Top Bottom Ft.
Size
#2
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 /5
Material
PVC
Material
GRAVEL
Formation Description
SAND AND CLAY
5 / 66 CLAY
66 / 67 ROCK 6"
67 / 79 SAND AND CLAY
79 / 83 SAND AND ROCK
83 / 110 SAND AND CLAY
110 / 120 ROCK AND SAND
120 / 143 SAND AND CLAY
143 / 144 ROCK 10"
144 / 163 SAND AND CLAY
163 / 170 SAND (MED}
12. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECHAS BEEN PRpVIDED T/Q THE WEWNER.
SIGNATURE CERTIFIED WELL C
L• -L'� 5 22-18
NTRACTOR 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

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Departr pt of Environment and Natural Resources- Division of Water Quality
r ap•' WELL CONTRACTCERTIFICATION # 2314A
1. WELL CONTRACTOR: �G� /y00
DAVID LREGISTER i %Q ©Fy
Well Contractor (Individual) Name a a?...)... O
REGISTER WELL CO.,INY:,) s od �7'
Street Address
ROSE HILL `(`) NC
City or Town State
( 910 ) 289-3175
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# 28450
Well Contractor Company Name u9ado
721 WEST CHARITY ROAD dam%�
28458
Zip Code
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check Applicable Box): Residential Water Supply NI'
DATE DRILLED 05-22-2018
TIME COMPLETED AM ❑ PM 0
4. WELL LOCATION:
CITY: ROSE HILL
FUSSELL ROAD
COUNTY DUPLIN
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley !'Flat ❑ Ridge ❑ Other
LATITUDE "DMS OR N34.776535 DD
LONGITUDE " DMS OR W78.094713 DD
Latitude/longitude source: RhPS []Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. WELL OWNER
WILLIAM BILLY THOMAS
Owner Name
995 S HOLLY SHELTER ESTATES
Street Address
ROCKY POINT NC 28457
City or Town State Zip Code
( ) 470-9773
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 200
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO (qf
c. WATER LEVEL Below Top of Casing: 22 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 3 OZ
450380
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
7. CASING: Depth Diameter
Top 0 Bottom 185 Ft, 2
Top Bottom Ft.
Top Bottom Ft.
Thickness)
Weight Material
.40 PVC
8. GROUT: Depth Material
Top 0 Bottom 20 Ft. HOLE PLUG
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth
Top 185 Bottom 200
Top Bottom
Top Bottom
10. SAND/GRAVEL PACK:
Depth
Top 180 Bottom 208
Top
Top
Bottom
Bottom
11. DRILLING LOG
Top Bottom
0 /22
22 /67
67 /70
70 /80
80
160
180
200
Method
POURED
Diameter Slot Size Material
Ft.2 in. .016 in. PVC
Ft. in. in.
Ft. in. in.
Size Material
Ft. #2 GRAVEL
Ft.
Ft.
Formation Description
CLAY
SAND AND CLAY
ROCK AND SAND
CLAY
/160 SAND AND CLAY
/180 CLAY
/200 SAND MED
/208+ CLAY
/
12. REMARKS:
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
PROVJ D TO THE WELL OWNE
U7.I/
5-22-18
SIGNATURE OF CERTIFIED WELL ONTRACTOR 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-la
Rev. 2/09

12. Well construction method:
(Le. auger, rotary, cable, direct push, etc.)
. Well Contractor Information.:
Arthur Wayne Cannady
Well Contractor Name
2125-A
RECEIVED/NCDENR/DWR
NC Well Contractor Certification Number
Cannady Brothers Weil Drilling, 1nRPR 21 2t118
Company Name
2. Well Construction Permit #: 99/ ecia r Jl i;aiity �8 lona!
List all applicable well construction permits (i.e. UIC, Couxy, ofje, It oyis``�ion
Wilmington Regional Office
3. Well Use (check well use):
Water Supply Well:
Agricultural DMunicipal/Public
Geothermal (Heating/Cooling Supply) esidential Water Supply (single)
Industrial/Commercial DResidential Water Supply (shared)
Irrigation
1 Non -Water Supply Well:
nMonitoring
Injection Well:
nAquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
DRecovery
Groundwater Remediation
Salinity Barrier
oStormwater Drainage
Subsidence Control
Tracer
(Other (explain under #21 Remarks)
4. Date Well(s) Completed: a 1 ~ JErWell ID#
5a. Well Location:
'-1L.
Facility/Owner Name
.2 (c_S
physical Address, City, and Zip
County
Facility ID# (if applicable)
/PO54e Jul M
(thgl,
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one latflong is sufficient)
3 y v s 6,/ a. 09 N 7 S 7' 3. 1.f W
6. Is(are) the well(s)0?ermanent or ElTemporary
7. Is this a repair to an existing well: es or ElNo
If thins a repair, fill our known well construction informationand erplain Nye nature of the
repair under #21 remarks section or on the back of this font'.
S. For GeoprobelDPT or Closed -Loop Geothermal Wells having the same
construction, only I GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface: / C/
For multiple wells list all depths if different (example- 3!'j200' and 2@100')
n
10. Stave water level below top of casing:
If tearer level is above casing. use "-
11.Borehole diameter: .5 `/-/! (v't.)
a�
(fL)
(ft)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) / / L Method of test: All
13b. Disinfection type: � Amount:
/- Pr '
14. WATER ZONES
1
FROM
TO
1
DESCRIPTION
rift-
/ 5 P
i'•
cur.)-m-t. 4 f v J 1.2
j sue! ft.1 / s'c
f`.
c o t~ `a-t
15.OUTER CASING (for
multi -cased wells) OR LINER (if applicable)
FROM TO
I
DIAMETER
THICKNESS 1 MATERIAL
- v ft. I i 9
2.t. in.
24.46
ipJ v
16. INNER CASING OR
TUBING Geothermal closed -loop)
FROM 1 TO
1 DIAMETER THICKNESS
MATERIAL
ft. I
'Iri.
in. I
ft. I
lt•
in. I
17. SCREEN
FROM 1 TO
IDIAMETER
SLOT SIZE
THICKNESS
MATERIAL
0 ft. I
ft.
1 in.
176 ft.
V ft..
AI, in.
61 .
;e1-.tf6
pot;
13. GROU£
FROM
TO 1
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft.
I a6 t.
14g49 I
t>t 2a.4-b
ft.
t.
ft.
1
t.
[
.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
15 ft.
/ () It.
&4 t, II/ 0Purl%
.
ft.
I't.
20. DRILLiNG LOG (attach additional sheets if necessary)
FROM
TO 1_
DESCRIPTION (color. hardness. soiUroeb type. min size. etc.)
eta tl ft.
1p
1.
i3 R vwr. s rti c.., s. IS sr F /6 0 5 t".D
7 7 eft.
'1 7
.t.
1 gso / 66 . (6 t
7 r y ft,
-.t et I
A-
tt s o,...� ! (o ! - / 0cu. ,,,,,,
ft.
4 I '
ft.
,, 12u c 1(
/01 ft.
lt, .--) I
ft.
C -... a....1
,+,I•L
! I 9 eft.
! 56 I
rt.
co 0.„,.S �-G
/56- ft.
ftY
Vt.
itac'L
'}'.
2I. REMARKS I
RE' ' :- t
k ,
'APR182018
1
22. Certification:
SSwature of Certified W 1 Contractor
lt?'vi 1_r�i: f'1 P
t ,
/Date
Be signing this form• l 1 rebr certify tbar the well(s) was (were) cotstrac;ed in accordance
with ISA NCAC 02C .011 s or I SA NCAC 02C .0200 Well Cotsmtction Standards and that a
copy of this record has b F: n provided to the well owner_
23. Site diagram or a
You may use the bac
construction details.
SUBNIITTALINSTI
24a. For All Wells:)
construction to the fo
Division o
1617
24b. For In'ection ti
above, also submit o
constructimin the fo
Division of Wate
1636
24c. For Water Su
the address(es) abovl
completion of well c
where constructed. I
ditional well details:
of this page to provide additional well site details or well
ou may also attach additional pages if necessary.
UCTIONS
Submit this form within 30 days of completion of well
owing:
ater Resources, Information Processing Unit,
Service Center, Raleigh, NC 27699- 1 617
ells: In addition to sending the form to the address in 24a
e copy of this form within 30 days of completion of well
owing:
Resources, Underground Injection Control Program,
it Service Center, Raleigh, NC 27699-1636
Iv & Injection Wells: In addition to sending the form to
, also submit one copy of this form within 30 days of
nstruction to the county health department of the county

This form can be used for single or multiple wells
1. 1Ve11 Contractor Information:
Jonathan Kamionka
WELL CONSTRUCTION RECORD
3. O
cia
•-
Well Contractor Name
3465-A
O t37
XI -
0' ro �o
NC Well Contractor Certification Number A' mo
0 0'
Bill's Well Drilling Co o g
t7
CD
2. Well Construction Permit #: WS0801008; CU3294
Company Name
m
v
List all applicable well permits (Le. Counq,, Stare, Variance, Infection. etc.)
3. Well Use (check well use):
For Internal Use ONLY:
448785
14, WATER ZONES
FROM
TO
95 ft.
155 ft.
ft.
ft.
DESCRIPTION
15. OUTER CASING (for multi -cased wells) OR LINER (if applicable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
H.
rt.
In,
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM TO
DIAMETER
THICKNESS
MATERIAL
+1
ft.
95
ft.
6-1/8 in -
SDR21
PVC
155 ft.
160 fr'
6-1/8
in.
SDR21
PVC
17. SCREEN
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ In du st ria UCom m erc ial
Ellrrigation
Non -Water Supply Well:
❑Monitoring
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Recovery
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Geothermal (Closed Loop) ❑Tracer
❑Geothermal (Heating/Cooling Return) ❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: 10-4-17 Well ID#
5a. Well Location:
University of Mount Olive
Facility/Owner Name Facility lD# (if applicable)
408 Garner Chapel Rd, Mt Olive, NC
Physical Address, City, and Zip
Duplin
350100056273
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field. one lat/long is sufficient)
35.10471 N 7 73 9 3'/
6. Is (are) the well(s): OPermanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ONo
If this is a repair, fill out known IvaN construction information and explain the nature of the
repair under 421 remarks section or on the back of this form.
8. Number of wells constructed: 1
For multiple injection or non -water supply wells ONLY with the same construction, you can
submit one firm.
9. Total well depth below land surface: 160
For multiple wells list all depths ifdijferent (example- 3 a 200' and 2®100)
(ft.)
10. Static water level below top of casing: 35.6 (ft.)
;firmer level is above casing, use "- "
11. Borehole diameter: 12
12. Well construction method: mud rotary
(i.e. auger, rotary, cable. direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 167 Method of test: pumping
13b. Disinfection type: HTH Amount: 1 cup
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
95 ft*
155 ft.
6-1/8
.032
SDR21
PVC
ft.
ft.
in.
1S. GROUT
FROM
0
ft.
TO
85
ft.
MATERIAL
Bentonite
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
pumped
EMPLACEMENT METHOD
85 n.
160
ft.
#3 gravel
ft.
ft.
poured
20. DRILLING LOG (attach additional sheets if necessary)
FROM
ft.
TO
ft.
DESCRIPTION (color. hardness. solltroek type. Rraie size, ea.)
See attached
ft.
ft.
fr.
fr.
ft.
ft.
fr.
ft.
ft.
ft.
e.
21. REMARKS
ft.
APR
,1
22. Certifica on:
10-4-17
Si' ture ofCertifi s Well Contractor Date
By signing this form, 1 hereby certify that the well(s) was (were) constructed in accordance
with 1 SA NCAC 02C .0100 ar 1 sA NCAC 02C _0200 fret! Construction Standards and that a
copy of this record has been prorlded to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Welis: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For litiection Welis ONLY: In addition to sending the form to the address in
24a above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Welis:
Also submit one copy of this form within 30 days of completion of
well construction to the county health department of the county where
constructed.
Form G W-1 North Carolina Department of Environment and Natural Resources - Division of Water Resources Revised August 2013

Pumping Test - Well
Pumping Test Record We
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APR 2 1 2018
Water Quality Regional
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Wilmington Regional Office
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SPECIFIC CAPACITY:
a_
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WELL YIELD:
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PUMPING WATER LEVEL:
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CHLORINATION:
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10. TIME AND DATE:
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WATER LEVEL MEASURING DEVICE:
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Wilmington Regional Office
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92.6418
92.2103
92.5781 -
92.3957
92.3126
93.0537
92.7614
93.0247
92.5057
92.8372
92.5606
93.2724
92.798
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41.6476
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39.8339
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39.3782
10/20/2017 I 3:18 PM 39.2608
12:28 AM
1:28 AM
2:28 AM
3:28 AM
4:28 AM
5:28 AM
6:28 AM
7:28 AM
8:28 AM
9:28 AM
10:28 AM
a
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12:28 PM
1:28 PM
1:33 PM
1:38 PM
1:43 PM
1:48PM
1:53 PM
1:58 PM
2:03 PM
2:08 PM
2:13 PM 1
2:18 PM
2:23 PM
2:28 PM
2:38 PM
2:48 PM
2:58 PM
3:08 PM
+�.
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10/20/2017
10/20/2017
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10/20/2017
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10/20/2017
10/20/2017
10/20/2017
10/20/2017
10/20/2017
10/20/2017
Jonathan Kamionka - 3465-A

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
'o
ocoro
1. Well Contractor Information:
Jonathan Kamionka
rrf
C")
art
m
>vJ
Well Contractor Name
3465-A
NC Well Contractor Certification Number
Bill's Well Drilling Co
Company Name
2. WellConstruction Permit tv: WS0801008; CU3294
C7
t=,
rn
List all applicable well permits (i.e. County, Slate, Variance, Injection, ek.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑Industrial/Commercial
Irrigation
Non -Water Supply Well:
❑Monitoring
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Recovery
❑Groundwater Remediation
❑Salinity Barrier
OStormwater Drainage
❑Subsidence Control
❑Tracer
❑Geothermal (Heating/Cooling Retum) ❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: 10-10-17 Well 1DN UCF
5a. Well Location:
University of Mount Olive
Facility/Owner Name Facility ID#F (if applicable)
408 Garner Chapel Rd, Mt Olive, NC
Physical Address, City, and Zip
Duplin
350100056273
County Parcel Identification No. (PiN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35. /(2Li90 N -77, g9 380
6. Is (are) the well(s): OPermanent or ❑Temporary
7. is this a repair to an existing well: ❑Yes or ElNo
if this is a repair, fill out known well construction information and explain the nature of the
repair under 821 remarks section or on the back of this form.
8. Number of wells constructed: 1
For multiple itycctlon or non -water. supply wells ONLY with the some construction, you can
submit one form.
9. Total well depth below land surface: 345
For multiple wells list all depths if different (example- 3 rt 200' and 241100')
10. Static water level below top of casing: 41.6
If water level is above casing. use "+ "
11. Borehole diameter: 16
12. Well construction method: mud
(in.)
rotary
(ft.)
(ft.)
(i.e. auger, rotary, cable. direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 290 Method of test: pumping
13b. Disinfection type: HTH Amount: 2 CUPS
Form GW-1
For Internal Use ONLY: • 487 4
14. WATER ZONES
FROM
TO
DESCRIPTION
240 rt.
255 ft.
275-295
320 ft.
340 a
15. OUTER
CASING (for multi -cased wells) OR LINER (i_f apklicable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft,
55 - ft.
12 in.
sch40
PVC
16. INNER
CASING OR TUBING
(geothermal clooeddoop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
fe
in.
SEE
ATTACHED
ft.
It
6 in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
ft.
ft.
in.
SEE
ATTACHED
ft.
ft,
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT MEfI OD & AMOUNT
0 ft'
55 ft•
bentonite
pumped
0 ft
220 ft,
bentonite
pumped
ft.
ft.
19. SAND/GRAVEL PACK
Of applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
220 ft-
345 ft.
#3 gravel
poured
ft.
ft.
20. DRILLING
LOG (attach
additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soiVreck type, grain sire, eta)
ft.
ft.
See attached
ft.
ft.
ft.
rt.
ft.
ft,
ft.
rt.
f _.` err l
ff.
ff.
...'t :fi.- e�
f
ft.
APR ) 6 2B'8
zl.RE 11t.
22. Certificalion:
urc of Certified Well Contractor
10-10-17
Date
By signing this form, 1 hereby certify that the irell(s) was (were) constructed in accordance
with 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Canstrmctlor Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMiTTALINSTUCTiONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
2411 For infection Wells ONLY: in addition to sending the form to the address in
24a above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells:
Also submit one copy of this form within 30 days of completion of
well construction to the county health department of the county where
constructed.
North Carolina Department of Environment and Natural Resources -Division of Water Resources Revised August 2013

RECEIVED/NCDENR/DWR
Pumping Test - Well
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ilmington Regional Office
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TIME AND DATE:
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Jonathan Kamionka - 3465-A

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# 18-008
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check Applicable Box): Residential Water Supply lkf
DATE DRILLED 02-22-2018
TIME COMPLETED AM ❑ PM ❑
4. WELL LOCATION:
CITY: KENANSVILLE COUNTY DUPLIN
597 NC HWY 24 & 50
(Street Name, Numbers, Community. Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ID Valley IiFlat ❑Ridge ❑Other
LATITUDE
LONGITUDE °
" DMS OR 34.972591 DD
" DMS OR 78.008850 DD
Latitude/longitude source: I PS ['Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. WELL OWNER
KYLE PHILLIPS
Owner Name
597 NC HWY 24 & 50
Street Address
KENANSVILLE NC 28349
City or Town State Zip Code
( )
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 250
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IV
c. WATER LEVEL Below Top of Casing: 48 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): 35 METHOD OF TEST Al R
f. DISINFECTION: Type HTH Amount 4 OZ
g. WATER ZONES (depth):
Top Bottom
Top Bottom
Top Bottom
447875
Top Bottom
Top Bottom
Top Bottom
Thickness!
Diameter Weight Material
Ft. 4 .40 PVC
7, CASING: Depth
Top 0 Bottom 230
Top Bottom
Top Bottom
8. GROUT: Depth
Top 0 Bottom 20
Top Bottom
Top Bottom
Ft.
Ft.
Material Method
Ft. HOLE PLUG POURED
Ft.
Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top 230 Bottom 250
Top
Top
Bottom
Bottom
10. SAND/GRAVEL PACK:
Depth
Top 220 Bottom 260
Top
Top
Ft.4 in. .015 in. PVC
Ft. in. in.
Ft. in. in.
Size
Ft. #2
Bottom Ft.
Bottom Ft.
11. DRILLING LOG
Top Bottom
127 /145
Material
GRAVEL
Formation De ripttan
SAND AND CLA(oc
145 /158 CLAY 3
158 /250 SAND (MED) o
250 /260+ SAND AND CLAM
o' .
m(11:1
/
12. REMARKS:
n�o
S,..rC�a
w,
MAR 7 1 Z013
C
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 OOWWNER.
cO-i��' ill 3 8 2018
SIGNATURE OF CERTIFIED Wd_L CONTRACTOR DATE
DAVID L REGISTER
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
dMa/HN3aoN/a3A13338
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-la
Rev. 2/09

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
City or Town
( 910) 289-3175
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# 18-008
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check Applicable Box): Residential Water Supply ltll
DATE DRILLED 02-22-2018
TIME COMPLETED AM ❑ PM D
4. WELL LOCATION:
CITY: KENANSVILLE COUNTY DUPLIN
Street Address
ROSE HILL NC 28458
State Zip Code
597 NC HWY 24 & 50
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope DValley 'Flat ❑Ridge DOther
LATITUDE " DMS OR 34.972591
LONGITUDE " DMS OR 78.008850
Latitude/longitude source: [PS [Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. WELL OWNER
KYLE PHILLIPS
Owner Name
597 NC HWY 24 & 50
DD
DD
Street Address
KENANSVILLE NC 28349
City or Town State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 250
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO V
c. WATER LEVEL Below Top of Casing: 48 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): 35 METHOD OF TEST Al R
f. DISINFECTION: Type HTH Amount 4 OZ
g. WATER ZONES (depth):
Top Bottom
Top Bottom
Top Bottom
7. CASING: Depth
Top 0 Bottom 230
Top Bottom
Top Bottom
.147873
Top Bottom
Top Bottom
Top Bottom
Thickness/
Diameter Weight Material
Ft.4 .40 PVC
Ft.
Ft.
8. GROUT: Depth Material
Top 0 Bottom 20 Ft. HOLE PLUG
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth
Top 230 Bottom 250
Top
Top
Bottom
Bottom
10. SAND/GRAVEL PACK:
Depth
Top 220 Bottom 260
Top
Top
Method
POURED
Diameter Slot Size Material
Ft.4 in. .015 in. PVC
Ft. in. in.
Ft. in. in.
Size
Ft. #2
Bottom Ft.
Bottom Ft.
11. DRILLING LOG
Top Bottom
0 /15
15 /35
35 /50
50 /55
55 /65
65 /76
76 /78
78 /88
88 /90
90 /108
108 /118
118 /119
119 /126
126 /127
12. REMARKS:
Ma
GRA
l
o a) 0
3 = c
o cu tv�
rn
m �'0
Formation Desaiiii&i
CLAY —
SAND AND CLAY
CLAY
SAND
CLAY
SAND AND CLAY
ROCK 18" ;s
SAND ig
rjtas v rk ,
ROCK 24"
SAND AND CLAY
SAND (MED)
ROCK 4"
SAND (MED)
ROCK 6"
00
1Ma/bN3a3N/a3A13338
C E VE
MAR 2 ° 2018
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
PRO DED TO THE WELL OWNER.
dCL✓c,GL {^ ` �i 3-8-2018
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
DAVID L REGISTER
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality -
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Information Processing,
Form GW-la
Rev. 2/09

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2314A
RECEIVED/NCDENR/DWR
1. WELL CONTRACTOR:
DAVID L REGISTER
Well Contractor (Individual) Name
REGISTER WELL Ca. 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#
FEB 2 6 2018
Water Quality Regional
Operations Section
Wilmington Regional Office
NC 28458
State Zip Code
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check Applicable Box): Residential Water Supply Gd.
DATE DRILLED 02-05-2018
TIME COMPLETED AM ❑ PM 0
4. WELL LOCATION:
CITY: TEACHEY COUNTY DUPLIN
MATTHEWS FARM LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley I 'Flat ❑Ridge ❑Other
LATITUDE " DMS OR 34.782938 DD
LONGITUDE " DMS OR 78.047386 DD
Latitude/longitude source: F 3PS °Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. WELL OWNER
BILLY ENGLISH
Owner Name
MATTHEWS FARM LANE
Street Address
TEACHEY NC 28464
City or Town State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 260
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO d
c. WATER LEVEL Below Top of Casing: 23 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 3 OZ
g. WATER ZONES (depth):
Top Bottom Top
Top Bottom Top
Top Bottom Top
7. CASING: Depth Diameter
Top 0 Bottom 240 Ft. 2
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth
Top 0 Bottom 20
Top Bottom
Top Bottom
446077
Bottom
Bottom
Bottom
Thickness/
Weight Material
.40 PVC
Material
Ft. HOLE PLUG
Ft.
Ft.
9. SCREEN: Depth Diameter Slot Size
Top 240 Bottom 260 Ft.2
Top Bottom Ft.
Top Bottom Ft. in.
10. SAND/GRAVEL PACK:
Depth Size
Top 230 Bottom 265 Ft. #2
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 /10
10 /35
35 /56
56 /61
61 /72
72 /73
73 /90
90 /125
125 /146
146 /150
150 /170
170 /172
172 /198
198 /220
12. REMARKS:
Method
POURED
Material
in. .016 in. PVC
in. in.
in.
Material
GRAVEL
Formation Description
SAND AND CLAY
CLAY
SAND AND CLAY
ROCK AND SAND
SAND
ROCK 6"
CLAY
SAND AND CLAY
SAND (MED)
SAND AND CLAY
SAND (MED)
ROCK 24"
CLAY
SAND (MED)
p r
Val 9 a°1#6
a
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
PRODDED TO THE WELL OWNER.
at" % 2-13-18
SIGNATURE OF CERTIFIED WELL NTRACTOR 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-la
Rev. 2/09

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#
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2314A
RECEIVED/NCDENR/DWR
FEB 2 6 2018
Water Quality Regional
Oppratiaas.Sestien
Wilmington Regional Offic
NC 28458
State Zip Code
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check Applicable Box): Residential Water Supply IV
DATE DRILLED 02-05-2018
TIME COMPLETED AM 0 PM 0
4. WELL LOCATION:
CITY: TEACHEY
MATTHEWS FARM LANE
COUNTY DUPLIN
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
Ei Slope ❑ Valley afFlat ❑ Ridge ❑Other
LATITUDE
LONGITUDE
" DMS OR 34.782938 DD
" DMS OR 78.047386 DD
Latitude/longitude source: GI PS DTopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. WELL OWNER
BILLY ENGLISH
Owner Name
MATTHEWS FARM LANE
Street Address
TEACHEY
City or Town
NC 28464
State Zip Code
( )
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 260
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Cc
c. WATER LEVEL Below Top of Casing: 23 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 3 OZ
4460'76
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
7. CASING: Depth Diameter
Top 0 Bottom 240 Ft. 2
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth
Top 0 Bottom 20
Top Bottom
Top Bottom
9. SCREEN: Depth
Top 240 Bottom 260 Ft.2
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Thickness/
Weight Material
.40 PVC
Material
Ft. HOLE PLUG
Ft.
Ft.
Method
POURED
Diameter Slot Size Material
in. .016 in. PVC
10. SAND/GRAVEL PACK:
Depth Size
Top 230 Bottom 265 Ft. #2
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
220 /229
229 /261
261 /265+
12. REMARKS:
Material
GRAVEL
Formation Description
CLAY
SAND (MED)
SAND AND CLAY
FEB 9 2Oiu
,PZn:xC5ot1 r' •
r r:.`, C iGSArtyCIMU1 Yll i
--
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
PROJl1pED TO THE WELL OWN
SIGNATURE OF CERTIFIED WELL
DAVID L REGISTER
t/I%e2'1 2-13-18
NTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality -
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Information Processing,
Form GW-la
Rev. 2/09

WELL CONSTRUCTION RECORD
For Internal Use ONLY:
This form can be used for single or multiple wells
1. Well Contractor Information:
Joseph V Thigpen
Well Contractor Name
2631A
NC Well Contractor Certification Number
Thigpen Well Drilling
Company Name
2. Well Construction Permit tl: ✓ e fit`) /dc,2 9
List all applicable well construction permits (i.e. County, State, Variance, etc)
3. Well Use (check well use):
Water Supply Well:
111 cultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑Irrigation
❑ Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
❑Monitoring ❑Recovery
Injection Well:
❑Aquifer Recharge
DAquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
OGeothermal (Heating/Cooling Return)
❑Groundwater Remediation
❑ Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
['Other (explain under #21 Remarks)
446444
4. Date Well(s) Completed: / / ! - /
5. Well Location:
t 4-�
Facility/Owner Name Facility ID# (if applicable)
' 2 5
Physical Address, City, and Zip
14 61.4
County tr Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient) �j
s y, 9c5 N . W
6. Is (are) the well(s): Pligrmanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or Ymo
If this is a repair, fill out known well construction information and explain the nature oldie
repair under #21 remarks section or on the back of this form.
8. Number of wells constructed: If
For multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form. ` C�
9. Total well depth below land surface: /
For multiple wells list all depths ifdWerenl (example- 3 200' and 2 a 100)
10. Static water level below top of casing:
lfwaler level is above casing use ' '
11. Borehole diameter: `f' tV (in.)
12. Well construction method: l'4/•} G -11
(i.e. auger, rotary, cable, direct push, etc.) I
1--f
(ft.)
(ft.)
13. FOR WATER SUPPLY WELLS ONLY: /�
13a. Yield (gpm) r I Method of test: /t r �✓
13b. Disinfection type: t"/' !a )ri-- e Amount: .7 �'z--
14. WATER ZONES
FROM
TO
DESCRIPTION
/ s'
) ss
5e-�e-/
ft,
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if applicable)
4ROM
TO
DIAMETER
DIAMETER
THICKNESS
MATERIAL
'T f ft.
/�Tt.
1Y)
in.
Lf V
Ovc
16. INNER
CASING OR TUBING
(geothermal dosed -loop) -
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
is
ft.
ft.
in.
17. SCREEN
•
FROM
TOC
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
/ ft.
/ D' cam'
i fin.
oyse.
c'
g vL
ft,
ft.
in.
:18. GROUT
:
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
U fL;%f
ft.
lJ
6ej ',i, .�
ac $
ft.
ft.
/�/C�
I✓-e Y-- (/i�
ft.
ft.
7
:19. SAND/GRAVEL PACK
(if applicable) , ` - - "
FROM
TO
MATERIAL
EMPLACEMENT METHOD
%0
/ c0ft.
t�
/k'S'
0,Ai-a-cr-9'-/
ft.
ft.
,f
20. DRILLING
LOG (attach additional'sheets if necessary)' - ...-
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain Use, etc.)
/ % ft.
/ 5/ ft.
S if,, L tli
/ Li ft.
t s ft.
gt-e,ce,C__
I C ft.
/ ifaft.
C-/
(1 / CI ft
j � 2._ ft.
�iC/
1 y)-CL
/ (POE
t--1 /So---1 F:.,_ ._� :� ...,..
/CC) fL
/4 s 1t,
5 .i-e_ J 2018
% (p r'�ft.
t r s'ri:
c40 .`
..c _-�
21:•RE.MARKS t. , . .-,.
.
;.
...g
22. Cerfcation:
DENR/DWR
nature offied Well1Contractor Date
By signing this form, 1 hereb certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C.01FE lSAAC �p0200 Well Construction Standards and that a
copy of this record has been provr e o t jI owner.
23. Site diagram or additional well details:
You may use thettiateafkItialtiellegiromi# additional well site details or well
construction des
.Dg1��lditional pages if necessary.
Wilmington Regional Office
24. Submittal Instruch ns:
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells: to addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Geothermal Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW l
North Carolina Department of Environment and Natural Resources- Division of Water Quality Revised Jan. 2013

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department ofEnvironment 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 0 Recovery ❑ Injection ❑
Irrigationl' Other ❑ (list use)
DATE DRILLED 12-18-2017
4. WELL LOCATION:
RIVER LANDING -SYCAMORE LAKES
(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 " DMS OR 34.762790 DD
LONGITUDE " DMS OR 77.930783 DD
Latitude/longitude source: VGPS 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 Facility ID# (if applicable)
SYCAMORF I AKFS
Street Address
WAI L ACF
City or Town
RIVFR I ANDING
Contact Name
PC) BOX 1139
Mailing Address
WAI l ACF
City or Town
NC 28466
State Zip Code
NC 28466
State Zip Code
( )
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 153
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
c. WATER LEVEL Below Top of Casing: 27 FT.
(Use "+" if Above Top of Casing)
446382
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(100) 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
Top 0 Bottom 20 Ft. HOLE PLUG
Top Bottom Ft.
Top Bottom Ft.
Method
POURED__,-_-
9. SCREEN: Depth Diameter Slot Size Materi:.,l
Top 133 Bottom 153 Ft. 4 in. .016 in. PVC
Top Bottom Ft. in. in. _
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Top 125 Bottom 153
Top
Top
Bottom
Bottom
11. DRILLING LOG
Top Bottom
128 Rtrii3�
134 `4
145 / 153
153 / 68
o5
Size
Ft. #2
Ft.
Ft.
EfIN
2018
Material
GRAVEL
Formation Descrip4i N 1 1 20 i j
SAND (FINE i'tatfon PrcC <<sr;:rg
SAND (MED) DWGN30 ,
D (MED FINE)
K
R
i'VOr6t nualily
-a�--- rSniOnal
I �lonal pace
12. REMARKS:
2ul
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE lVi rt ;
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECOR S BEEN PROVIDED TO THE WE L OWNER.
cu-f Lr 4 • c�:011___ 12-21-
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
DAVIDJ RFGISTFR
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-1
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 0
Industrial/Commercial 0 Agricultural 0 Recovery 0 Injection ❑
IrrigationNr Other 0 (list use)
DATE DRILLED 12-14-2017
4. WELL LOCATION:
CHARITY ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: ROSE HILL COUNTY DUPLIN
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley VrFlat ❑Ridge ❑Other
LATITUDE "DMS OR 34.822548 DD
LONGITUDE " DMS OR 77.955448 DD
Latitude/longitude source: IMPS Ofopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
6, FACILITY (Name of the business where the well is located.
ROUSFRROTHFRS
Facility Name
CHARITY ROAD
Street Address
ROSF Hil L
City or Town
OWFN ROUSF
Contact Name
1528 W CHARITY ROAD
Mailing Address
ROSF HII I
City or Town
Facility ID# (if applicable)
NC 28458
State Zip Code
NC 78458
State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 290
b. DOES WELL REPLACE EXISTING WELL? YES IV NO 0
c. WATER LEVEL Below Top of Casing: 42 FT.
(Use "+" if Above Top of Casing)
446381
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(150) 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 250 Ft. 4 40 PVC
Top 250 Bottom 270 Ft. 4 80 PVC
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
To270 � �trN�R .016 in., PVC
TopBottom ¢
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACXar : 2018
Depth Size MaterialTop �-*�
Top 260w//rnn Q R ,€t' na GRAVELE��E \i ,�
j'f0i7S - -
Top Bottom I e$IC1i�. Dice �1•
11. DRILLING LOG
Top Bottom
192 / 215
215 / 237
237 / 246
246 / 247
247 / 254
254 / 255
255 / 258
258 / 261
261 / 277
277 / 278
278 / 290
12. REMARKS:
Formation Descop'pt
tr OT
SAND AND CLAY
CLAY
SAND AND CLAY
ROCK 10"
SAND (FINE)
ROCK 2"
SAND (MED)
ROCK 30"
SAND (MED FINE)
ROCK 8"
JAN I Z418
SAND (MED)
iJ qti 11�C�1'r-;
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 PROVIDED T THEE WF OWNER.
7�P.f �'�-c 12-21-17
SIGNATURE OF CERTIFIED WELL 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
v46929
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(100) METHOD OF TEST AIR
f. DISINFECTION: Type HTH Amount 4 07
Street Address g. WATER ZONES (depth):
ROSE HILL NC 28458 Top Bottom Top Bottom
City or Town State Zip Code Top Bottom Top Bottom
(910 ) 289-3175 Top Bottom Top Bottom
Area code Phone number ,�t
2. WELL INFORMATION: RfCE`�tD'NC�£�RIDr,�7. CASING: Depth Diameter ThW fight
icWELL CONSTRUCTION PERMIT# +L Top 0 Bottom 133 Ft. 4 40
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Monitoring ❑ Municip`aIl/Publi� j`i� Reg!f? �tioo GROUT: Depth
Industrial/Commercial 0 Agricultural 0 Recovery p I � jaj1t Re t��a<C �� Bottom ottom 20
irrigational Other 0 (list use) W 1n p
DATE DRILLED 12-18-2017 Top Bottom
JAN 6 mB TTop Bottom Ft.
Bottom Ft.
4. WELL LOCATION:
RIVER LANDING -SYCAMORE LAKES
(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 34.762790 DD
LONGITUDE "DMS OR 77.930783 DD
Latitude/longitude source: VGPS Dfopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
6. FACILITY (Name of the business where the well is located.)
RIVFR I ANDING
Facility Name
SYCAMORF I AKFS
Street Address
WAI 1 ACF
City or Town
RIVFR I ANDING
Contact Name
PO BOX 1139
Mailing Address
WAI I ACF
City or Town
Facility ID# (if applicable)
NC 28466
State Zip Code
NC 28466
State Zip Code
( )
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 153
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IV
c. WATER LEVEL Below Top of Casing: 27 FT.
(Use "+" if Above Top of Casing)
Ft.
Ft.
Ft.
Material
HOLE PLUG
9. SCREEN: Depth Diameter
Top 133 Bottom 153
Top
Top
Bottom
Bottom
10. SAND/GRAVEL PACK:
Depth
Top 125 Bottom 153
Material
PVC
Method
POURED
Slot Size Material
Ft. 4 in. .016 in. PVC
Ft. in. in.
Ft. in. in.
Size Material
Ft. #2 GRAVEL
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 /18
18 / 83
83 / 87
87 / 90
90 / 96
96 / 105
105 / 113
113 / 121
121 / 122
123 / 125
125 / 128
12. REMARKS:
R E C ,8V E D
Formation Descripti)-0 1
AND iota PreCl' ` g tom.
CLAY
SAN D
ROCK 30"
SAND (MED)
SAND AND CLAY
ROCK AND SAND
SAND (MED FINE)
ROCK 10"
SAND (MED)
ROCK AND SAND
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE Win
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD H • - : EEN PROVIQ D TO THE z ELL OWNER.
i-�
SIGNA URE OF CERTIFIE I W ONTRACTOR DATE
DAVID L. REGISTER
12-21-17
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
6Ota
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GIN i b
Rev. 2/09

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
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 Applicable Box): Residential Water Supply Gtr
DATE DRILLED 10-31-2017
TIME COMPLETED AM 0 PM 0
4. WELL LOCATION:
CITY: ROSE HILL COUNTY DUPLIN
NASH JOHNSON POND ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley I'Flat ❑Ridge ❑Other
LATITUDE " DMS OR 34.865194 DD
LONGITUDE " DMS OR 78.057838 DD
Latitude/longitude source: i PS Dfopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. WELL OWNER
NASH JULIAN JOHNSON
Owner Name
NASH LJOHNSON POND ROAD
Street Address
ROSE HILL NC 28458
City or Town State Zip Code
(— )
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:150
b. DOES WELL REPLACE EXISTING WELL?
YES ❑ NO IRr
c. WATER LEVEL Below Top of Casing: 31 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): 35 METHOD OF TEST AIR
f. DISINFECTION: Type HTH Amount 4 OZ
131 /132
.146528
g. WATER ZONES (depth):
Top J f ttt�n6 7(l18 Top Bottom
Top Bottom Top Bottom
Top Waler 11a��alTop Bottom
q�l tjn Regiontions l Section I e
7. CASI 1��rcfieter
OperTop 0 Bottom 205 Ft. 4
Top Bottom Ft.
Top Bottom Ft.
Thickness/
Weight Material
.40 PVC
8. GROUT: Depth Material
Top 0 Bottom 20 Ft. HOLE PLUG
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size
Top 205 Bottom 225 Ft.4 in. .016
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Method
POURED
10. SAND/GRAVEL PACK:
Depth
Top 195 Bottom 233
Top Bottom
Top Bottom
11. DRILLING LOG
Top Bottom
0 /10
10 /33
33 /58
58 /65
65 /73
73 /74
74 /103
Material
in. PVC
Size Material
Ft. #2 GRAVEL
Ft.
Ft.
Formation Description
SAND AND CLAY
CLAY
SAND (MED)
CLAY
SAND AND CLAY
ROCK 12"
SAND AND CLAY
103 /131 SAND (MED)
132 /160
ROCK 6"
SAND (MED)
160 /165 SAND AND CLAY
165 /171
171 /172
172 /173
12. REMARKS:
C LAY
SAND
ROCK 6"
if
;A rr
,i.N1I2018
I DO HEREBY CERTIFY THAT TH S WELL WAS CONSTRUCTED II,'
ACCORDANCE WITH 15A NCI emisT4wRipm
STANDARDS, AND THAT A COPY OF TI$t/aiD FlAS BEEN
PROV ED TO Tp WELL OWN
GLLA-L. / 4,1.1-1 12-21-17
SIGNATURE OF CERTIFIED WELLONTRACTOR 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 GtV-la
Rev. 2101.

RESIDENTIAL WELL CONSTRUCTION RECORD 11
North Carolina Department of Environment and Natural Resources- Division of Water Quality146926
WELL CONTRWIRCOMENRAWHON # 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#
JAN 1 6 ?018
Water Quality Regional
' Operations Stilton
Wilmington Regional Office Thickness/
7. CASING: Depth Diameter Weight Material
Top 0 Bottom 205 Ft. 4 .40 PVC
NC 28458 Top Bottom Ft.
State Zip Code Top Bottom Ft.
WATER ZONES (depth):
Bottom Top Bottom_
Bottom Top
Top
Bottom
Bottom
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check Applicable Box): Residential Water Supply C�
DATE DRILLED 10-31-2017
TIME COMPLETED AM El PM 0
4. WELL LOCATION:
CITY: ROSE HILL COUNTY DUPLIN
NASH JOHNSON POND ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Scope ❑Valley 6/(Flat ❑Ridge ❑Other
LATITUDE " DMS OR 34.865194 DD
LONGITUDE " DMS OR 78.057838 DO
Latitude/longitude source: 4FaPS propographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. WELL OWNER
NASH JULIAN JOHNSON
Owner Name
NASH JOHNSON POND ROAD
Street Address
ROSE HILL NC 28458
City or Town State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 150
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO d
c. WATER LEVEL Below Top of Casing: 31 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 2G .0118.
e. YIELD (gpm): 35 METHOD OF TEST Al R
f. DISINFECTION: Type HTH Amount 4 OZ
9.
Top
Top
Top
Bottom
8. GROUT: Depth Material
Top 0 Bottom 20 Ft. HOLE PLUG
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter
Top 205
Top Bottom
Top Bottom
Method
POURED
Slot Size Material
Bottom 225 Ft.4 in. .016 in. PVC
—
Ft. in. in. _—
Ft. in. in.
10. SAND/GRAVEL PACK:
Top 195
Depth Size Material
Bottom 233 Ft. #2 GRAVEL
Top Bottom
Top Bottom
11. DRILLING LOG
Top Bottom
173 /186
Ft.
Ft.
186 /199
Formation Description
SAND AND CLAY
SAND (MED)
199 /201 SAND AND CLAY
201 /225 SAND (MED)
225 /233+ SAND AND CLAY
/
/
/
/
/
12. REMARKS:
JAN ;1 1: 201:1
Ittbmation Prc Lr l Sit'1ri
D tCr/l=.0 f
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
PROVED TO TF{E WELL OWNE
1i,9 f
SIGNATURE OF CERTIFIED WELL ONTRACTOR
DAVID L REGISTER
12-21-17
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-la
Rev. 2/09

kb
•
1. WELL CONTRACTOR:
DAVID L REGISTER
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2314A
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#
NCSta
446025
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(100) METHOD OF TEST AIR
f. DISINFECTION: Type HTH Amount 4 07
g. WATER ZONES (depth):
28458 Top Bottom Top Bottom
Top Bottom Top Bottom
RECEIVED/NCDNRIBWR-- Bottom Top Bottom
Zip Code
7. CASING: Depth
N_6i 1O
OTHER ASSOCIATED PERMIT#(if applicable) Top
SITE WELL ID #(if applicable) Water Quality8gional
3. WELL USE (Check One Box) Monitoring 0 Municipal/Pu Operations action p
De th
wtillington RP> o� r ®(fife
Industrial/Commercial ❑ Agricultural 0 Recovery 0 Injection ❑ Top 0 Bottom 20
Diameter
Bottom 115 Ft. 4
Bottom Ft.
Bottom Ft.
Irrigationtg" Other ❑ (list use)
DATE DRILLED 12-19-2017
4. WELL LOCATION:
RIVER LANDING -MAPLE CREEK
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: WALLACE COUNTY DUPLIN
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope [Valley Flat ❑Ridge DOther
LATITUDE " DMS OR 34.751503 DD
LONGITUDE " DMS OR 77.931567 DD
Latitude/longitude source: VOPS ['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.)
RIVER I ANDING
Facility Name
MAPI F CRFFK
Street Address
WAI 1 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: 135 Precossing
b. DOES WELL REPLACE EXISTING WELL? YESQT VVV
c. WATER LEVEL Below Top of Casing: 12 FT.
Facility ID# (if applicable)
Top Bottom
Top Bottom
Thickness/
Weight Material
40 PVC
Material
Ft. HOLE PLUG
Ft.
Ft.
Method
POURED
9. SCREEN: Depth Diameter Slot Size Material
Top 115 Bottom 135 Ft. 4 in. .016 in. PVC
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Top 110 Bottom 135 Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
Material
GRAVEL
Formation Description
0 / 9 SAND
9 /11
11 / 12
12 / 77
NC 28466 77 / 81
State Zip Code
CLAY
ROCK 8"
CLAY
SAND (MED)
81 / 88 ROCK AND SAND
88 / 99
99 / 110
110 / 118
118 / 134
NC 28466 134 / 135+
If StateC, o, 4 12 REMARKS:
F ECE
I\
(Use "+" if Above Top of Casing)
JAN ..1 201;
Size
#2
SAND (MED)
ROCK AND SAND
SAND AND CLAY
SAND (MED)
ROCK
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONST UCTION STANDARDS, AND THAT A COPY OF THIS
RECORD BEEN PROV D TO TH WELL O ER.
) 4i 12-21-''. 7
SIGNATURE OF CERTIFIED WELL CON ACTOR DATE
DAVID I _RF.GJSTER
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 GVtV-1b
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 0 Municipal/Public ❑
Industrial/Commercial ❑ Agricultural 0 Recovery 0 Injection 0
Irrigationli Other 0 (list use)
DATE DRILLED 12-14-2017
4. WELL LOCATION:
CHARITY ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: ROSE HILL COUNTY DUPLIN
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley VFlat ❑Ridge ❑Other
LATITUDE "DMS OR 34.822548 DD
LONGITUDE ° " DMS OR 77.955448 DD
Latitude/longitude source: VGPS DTopographic 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.)
ROUSE BROTHERS
Facility Name
CHARLTYROAD
Street Address
ROSF HIl I
City or Town
OWFN ROUSF
Contact Name
1526 W CHARITY ROAD
Mailing Address
ROSE Hll L
City or Town
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 290
Facility ID# (if applicable)
NC 28458
State Zip Code
NC 28458
State Zip Code
RECEN
JAN 1 1 2018
information Pro:;:-....,>:;:K
b. DOES WELL REPLACE EXISTING WELL? YM/astO.❑
c. WATER LEVEL Below Top of Casing: 42 FT.
(Use "+" if Above Top of Casing)
-146924
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(150) 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 250 Ft. 4 40 PVC
Top 250 Bottom 270 Ft. 4 80 PVC
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 270 Bottom 290 Ft. 4 in. .016 in. PVC
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
Top 260 Bottom 300 Ft. #2 GRAVEL
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom Formation Description
290 / 300+ SAND AND CLAY
I
12. REMARKS:
JAN 1 6 2018
Water Quality Regional
OWllm nngtontons R gSection
ur al Office
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECO AS BEEN Pf VIDED T THE WEOWNER.
SIGNATURE OF CERTIFIED WELL OieNTRACTOR 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 GVN- i I;
Rev. 2/09

( )
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 290
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 0 Municipal/Public ❑
Industrial/Commercial 0 Agricultural 0 Recovery 0 Injection 0
Irrigation[' Other 0 (list use)
DATE DRILLED 12-14-2017
4. WELL LOCATION:
CHARITY ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: ROSE HILL COUNTY DUPLIN
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley tiFlat ❑Ridge ❑Other
LATITUDE "DMS OR 34.822548 DD
LONGITUDE
" DMS OR 77.955448 DD
Latitude/longitude source: I,%13PS 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.)
ROUSE RROTHFRS
Facility Name
CHARITY ROAD
Street Address
ROSE HII I
City or Town
OWFN ROUSF
Contact Name
1528 111/ CHARITY ROAD
Facility ID# (if applicable)
NC 28458
State Zi Code
RECEIVED/NCDENR/DvNR
Mailing Address JAN 1 6 2018
ROSE HII I NC 28458
Z
City or Town )SatRe i011I
1�Code
Water Qua I y g
Operations Section
Wilmington Regional Office
b. DOES WELL REPLACE EXISTING WELL? YES GI/ NO ❑
c. WATER LEVEL Below Top of Casing: 42 FT.
(Use "+" if Above Top of Casing)
r44692.3
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(150) METHOD OF TEST Al R
f. DISINFECTION: Type HTH Amount 4 07
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
Depth Diameter Weight
Bottom 250 Ft. 4 40
Bottom 270 Ft. 4 80
Top Bottom Ft.
7. CASING:
Top 0
Top 250
8. GROUT: Depth
Top 0 Bottom 20
Top Bottom
Top Bottom
Material
PVC
PVC
Material Method
Ft. HOLE PLUG POURED
Ft.
Ft.
9. SCREEN: Depth Diameter
Top 270 Bottom 290
Top
Top
Bottom
Bottom
10. SAND/GRAVEL PACK:
Depth
Top 260 Bottom 300
Top
Top
Bottom
Bottom
11. DRILLING LOG
Top Bottom
192 / 215
215 / 237
237 / 246
246 / 247
247 / 254
254 / 255
255 / 258
258 / 261
261 / 277
277 / 278
278 / 290
12. REMARKS:
Slot Size Material
Ft. 4 in. .016 in. PVC
Ft. in. in.
Ft. in. in.
Size Material
Ft. #2 GRAVE
'j
Ft. R EEC / tP••
Ft.
JAN Q18
Formation Descpp'pdo�ttRCSft PrOCf
Si'S1at�rt
SAND AND CLAY
CLAY
SAND AND CLAY
ROCK 10"
SAND (FINE)
ROCK 2"
SAND (MED)
ROCK 30"
SAND (MED FINE)
ROCK 8"
SAND (MED)
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 AS BEEN PROVIDED T THE WP OWNER.
/I.A.'t-0-1 12-21-17
SIGNATURE OF CERTIFIED WELL 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-1b
Rev. 2/09

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
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 Applicable Box): Residential Water Supply Sir
DATE DRILLED 11 -28-2017
TIME COMPLETED AM 0 PM ❑
4. WELL LOCATION:
CITY: ROSE HILL COUNTY DUPLIN
852 BRICES STORE ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
CI Slope ❑Valley G'Flat ❑Ridge ❑Other
LATITUDE
° "DMS OR 34.823069 DD
LONGITUDE " DMS OR -78.067097 DD
Latitude/longitude source: (tPS DTopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. WELL OWNER
DWIGHT DAVIS
Owner Name
852 BRICES STORE ROAD
Street Address
ROSE HILL
City or Town
( ) 789-2293
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 150
NC 28458
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES Cl NO tit'
c. WATER LEVEL Below Top of Casing: 22 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): 150 METHOD OF TEST AIR
f. DISINFECTION: Type HTH Amount 3 OZ
g. WATER ZONES (depth):
Top Bottom Top
Top Bottom Top
Top Bottom Top
7. CASING: Depth Diameter
Top 0 Bottom 130 Ft. 2
Top Bottom Ft.
Top Bottom Ft.
to
•446'616
Bottom
Bottom
Bottom
Thickness/
Weight Material
.40 PVC
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
Top 130 Bottom 150 Ft2 in. .016 in.
Material
PVC
Top Bottom Ft. in. in.
Top t3ottom Ft. in. in.
Top 120
Top Bottom Ft.
Top Bottom Ft.
10. SAND/GRAVEL PACK:
Depth Size
Bottom 150 Ft. #2
11. DRILLING LOG
Top Bottom
0 /15
15 /45
45 /83
83 /85
85 /117
117 /150+
/
/ e,/,iic-i drat
12. REMARKS: CAN CV
JAN o 6 2018
Material
GRAVEL
Formation Description
SAND AND CLAY
CLAY
SAND AND CLAY
ROCK 24"
CLAY
SAND (MED)
201E
RECFIVED/NCDENR,D R
I DO HEREBY CERITIOI
AS CONSTRUCTED IN
ACCORDANCE INT l • t ONSTRUCTION
STANDARDS, AND THA C CPIECORD HAS BEEN
PROVIDED TO THE WELL OWNER.
iZ ;Az ✓ .i�% i 12-19 2017
SIGNATURE OF CERTIFIED WELL CON tRACTOR DATE
DAVID L REGISTER
PRINTED NAME OF PERSON CONSTRUCTING HE WELL
Submit within 30 days of completion to: Division of Water Quality -
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Information Processing,
Form GIN -la
Rev. 2/09