386804_Well Construction - GW1_20100827

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3229
r
1 WELL CONTRACTOR
K Tv Colwell
Well Contractor (Individual) Name
Withers & Ravenel, Inc
Well Contractor Company Name
111 MacKenan Drive
Street Address
Cary
City or Town
(919 ) 460-6006
Area code Phone number
2 WELL INFORMATION
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) MW-22
3 WELL USE (Check One Box) Monitoring NI Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 7/26/2010
4 WELL LOCATION
Old Rosemary Road 28458
State Zip Code
(Street Name Numbers Community, Subdivision Lot No Parcel, Zip Code)
CITY Rose Hill
TOPOGRAPHIC / LAND SETTING
❑ Siope ❑Valley elat ❑ Ridge
LATITUDE 36
COUNTY DuDlln
(check appropriate box)
❑Other
" DMS OR 34 808619 DD
LONGITUDE 75 " DMS OR 78 024712 DD
Latitude/longitude source D3PS VTopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5 FACILITY (Name of the business where the well is located )
Murphy Farms. Inc.
Facility Name Facility ID# (if applicable) 4" / 10 0'
Old Rosemary Road (NCSR 11481
\\V. Street Address
^" \ Rose Hill NC 28458 10 0' / 11 0'
``/ City or Town State Zip Code
Katie Elmer
d TOP OF CASING IS 0.0 FT Above Land u face*
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C 0118
e YIELD (gpm)
f DISINFECTION Type
g WATER ZONES (depth)
NC 27511 Top
Top
Top
METHOD OF TEST
Amount
Bottom Top Bottom
Bottom Top Bottom
Bottom Top Bottom
Thickness/
7 CASING Depth Diameter Weight Material
Top 0 0' Bottom 2 0' Ft 2" Sch 4C PVC
Top Bottom Ft
Top Bottom Ft
8 GROUT Depth Material Method
Top 0 0' Bottom 1 0' Ft Portland Pour
Top 1 0' Bottom 1 5' Ft Bentonite Pour
Top
Bottom
Ft
9 SCREEN Depth Diameter Slot Size Material
Top 2 0' Bottom 11 0' Ft 2" in 0 010 in PVC
Top Bottom Ft in in
Top Bottom Ft in in
10 SAND/GRAVEL PACK
Depth Size Material
Top 1 5' Bottom 11 0' Ft #2 Sand
Top Bottom Ft
Top Bottom Ft
11 DRILLING LOG
Top Bottom
0 /4"
/
Contact Name
PO BOX 856
Mailing Address
Warsaw NC 28398
City or Town State Zip Code
( 910a 293-5245
Area code Phone number
6 WELL DETAILS
a TOTAL DEPTH 11.01
b DOES WELL REPLACE EXISTING WELL? YES ❑ NO q/
c WATER LEVEL Below Top of Casing 5.09
(Use "+" if Above Top of Casing)
FT
/
/
12 REMARKS
Formation Description
ABC Stone
Sandy Clayey Silt, light brown &
gold. med - high plasticity, fine to
medium
SP, gray, fine to medium,
nonplastic
201G
re'>r natDIt`c,�LjUGs1ng n,t
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C WELL CONSTRUCTION ANDARDS AND THAT A COPY OF THIS
RECORD AS BEEN PROVIDED T WELL OWNER
84040/0
E OF CERTIFJ D WELL CONTRACTOR DATE
K Ty Colwell/Justin Fabriziani
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
<= Form GW-1b
''Sub'initwithin 30 days'ofricompletion to Division of WateVQuaIity - -dnformation Processing`; ' 0 ev 2/og
17; Mail Service Center,„ wRale gh;i-NC- 27699-161, Phone 04 0,�(919 807=6300 OC 1 ?+ Q»

WITHERS ck RAVENEL
ENGINEERS I PLANNERS I SURVEYORS
111 MacKenan Drive Cary, North Carolina 27511 lol: 919469-3340 www.withersrarionel.com License No. C.0632
GENERAL LOCATION MAP
MI►-22
OW ROSEMARY ROAD
ROSE HELL, NORTH CAROLINA
USGS ROSEHILL, NC
7.5 min. Quadrangle
DRAM BY:
KTC
APPROVED BY:
KTC
SCALE:
1--1000•
DATE
8/11/10
FtGURE NO.
1
JOB N0:
02050270.01