386802_Well Construction - GW1_20100827

"A4
1 WELL CONTRACTOR
K Tv Colwell
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3229
Well Contractor (Individual) Name
Withers & Ravenel, Inc
Well Contractor Company Name
111 MacKenan Drive
Street Address
Cart/
City or Town
(919 ) 460-6006
Area code Phone number
2 WELL INFORMATION
WELL CONSTRUCTION PERMIT#
State Zip Code
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) MW-20
3 WELL USE (Check One Box) Monitoring I( Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 7/26/2010
4 WELL LOCATION
Old Rosemary Road 28458
(Street Name, Numbers, Community Subdivision Lot No Parcel Zip Code)
CITY Rose Hill COUNTY Duolin
TOPOGRAPHIC / LAND SETTING (check appropriate box)
❑ Slope ❑ Valley elat ❑ Ridge ❑ Other
LATITUDE 36
" DMS OR 34 808668 DD
LONGITUDE 75 " DMS OR 78 025289 DD
Latitude/longitude source ❑3PS Vropographic 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# Of applicable)
Old Rosemary Road (NCSR 11481
Street Address
Rose Hill
n� City or Town
' Katie Elmer
Contact Name
PO BOX 856
NC 98458
State Zip Code
Mailing Address
Warsaw NC 28398
City or Town State Zip Code
( 910,b 293-5245
Area code Phone number
6 WELL DETAILS
a TOTAL DEPTH 11.0'
b DOES WELL REPLACE EXISTING WELL' YES 0 NO qI
c WATER LEVEL Below Top of Casing 5.38 FT
(Use "+" if Above Top of Casing)
10 SAND/GRAVEL PACK
Depth
Top 1 5' Bottom
Top Bottom
Top Bottom Ft
11 DRILLING LOG
Top Bottom
0 / 4"
4" / 2 0'
/
2 0' / 7 0'
7 0' / 10 0'
100' / 11 0'
12 REMARKS
3268O2
d TOP OF CASING IS 0.0 FT Above Land Surface*
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C 0118
e YIELD (gpm)
f DISINFECTION Type Amount
g WATER ZONES (depth)
METHOD OF TEST
NC 27511 Top Bottom Top
Top Bottom Top
Top Bottom Top
Bottom
Bottom
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
Top 0 0' Bottom 1 0'
Top 1 0' Bottom 1 5'
Top Bottom Ft
9 SCREEN Depth
Top 2 0' Bottom
Top Bottom Ft
Top Bottom Ft
Material
Ft Portland Pour
Method
Ft Bentonite Pour
Diameter Slot Size Material
11 0' Ft 2" in 0 010 in PVC
in in
in In
Size Material
11 0' Ft #2 Sand
Ft
Formation Description
ABC Stone
SM, Silty Sand, brown to dark
brown. low plasticity. some
organics
Same as above except with
some plasticity, red. light brown.
gray,
SM with clay, slight plasticity.
gray & light brown
SP. gray & dark gray.
nonplastic
t'ECEIVED
AUG 272010
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C WELL CONSTRUCTION STANDARDS ANDfn-NTAIMY105 THIS
RECORD BEEN PROVIDED TO T"
LL OWNER rOce SHlg ()tilt
c6� /0
DATE
SIGNATURE OF CERTIFIED ELL CONTRACTOR
K. Ty Colwell/Justin Fabriziani
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
tc
Sutiml�t "w��ithin`°30,,days of completion to-Dliilision of Water Quality - Informatton4Pro sing,
16177 MaihService,Center, Raleigh, NC 276997161, Plone [phone]
q.q
Form GW-1 b
Rev 2/09

WITHERS 4SC- RAVENEL
ENGINEERS I PLANNERS I SURVEYORS
1 U 1 Mackerun Drive Cary, Noah Carolina 27511 Irk 919-469.3340 www.wlth,,.,...arel.mm License No. CO1132
GENERAL LOCATION MAP
MW-20
OLD ROSEMARY ROAD
ROSE HILL, NORTH CAROLINA
USGS ROSEHILL, NC
7.5 min. Quadrangle
DRAWN BY:
KTC
SCALE
1'-1000'
APPROVED BY:
DATE
RTC
8/11/10
FIGURE NO.
1
JOB NO:
02050270.01