408940_Well Construction - GW1_20121105

ITSN ESI/4) xr NTIAL WELL CONST UCT1ON RECO ' D
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL C ��� NTRA.CTO CE '; TI FICATI ON # 2480
1. WELL CONTRACTOR:
Lewis LeFever
Well Contractor (Individual) Name
Parratt-Wolff, Inc.
Well Contractor Company Name
501 Millstone Drive
Street Address
Hillsborough NC 27278
City or Town State Zip Code
(919 ) 644-2814
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) WW-17
3. WELL USE (Check One Box) Monitoring rif Municipal/Public ❑
Industrial/Commercial 0 Agricultural 0 Recovery ❑ Injection ❑
Irrigationp Other 0 (list use)
DATE DRILLED 9/29-10/ 10/ 12
4. WELL LOCATION:
3901 Castle Havne Road
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Wilmington COUNTY New Hanove
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley iifFlat ❑ Ridge ❑ Other
LATITUDE 34 "DMS OR 34.32961568 DD
LONGITUDE 77 " DMS OR 77.93327808 DD
Latitude/longitude source: COPS 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.)
General Electric
Facility Name Facility ID# (if applicable)
3901 Castle Havne Road
Street Address
Castle Havne
City or Town
NC 28429
State Zip Code
Contact Name
Mailing Address
City or Town State Zip Code
)
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 92.0'
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
c. WATER LEVEL Below Top of Casing: 5.0 FT.
(Use "+" if Above Top of Casing)
\f`6V
408940
: d. TOP OF CASING IS 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): N/A METHOD OF TEST N/A
f. DISINFECTION: Type N/A Amount
: g. WATER ZONES (depth):
: Top N/A Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
• Thickness/
7. CASING: Depth Diameter Weight Material
i Top 0 Bottom 16.0 Ft. 8" Sch40 PVC
Top 0 Bottom 50.0 Ft. 4" Sch40 PVC
Top Bottom Ft.
8. GROUT: Depth Material
Top 0 Bottom 43.0 Ft. Portland
Top 43.0 Bottom 47.0 Ft. Bentonite Tremie
Top Bottom Ft.
Method
Tremie
9. SCREEN: Depth Diameter Slot Size Material
Top 50.0 Bottom 90.0 , Ft. 4 in. .020 in. PVC
Top Bottom
Top Bottom
: 10. SAND/GRAVEL PACK:
Depth Size Material"
: Top 47.0Bottom 92.0 Ft. #2 Sand
NOV 05 2612
Ft. in. in.
Ft. in. in.
Top Bottom Ft.
Top Bottom Ft.
: 11. DRILLING LOG "°--�---
Formation Description
•
•
••
•
Top Bottom
4.0 / 8.0'
12.0 / 16.0
20.0 / 24.0
48.0 / 52.0
•
/
12. REMARKS:
Tan, wet, fine SAND; some silt
Gray, wet CLAY & SILT
Tan, wet, fine SAND & SILT
Gray, wet SILT; some fine/
coarse sand & gravel
iG
f y
CA
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTER 'A bRB ,m kWITHy
15A NCAC 2 , WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
• RECORD 1 S BEEN PROVI' . D TO THE WELL OWNER.
IGNATU • F CERTIFIED WELL CONTRACTOR
DATE
Lewis LeFever
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
•
Subm�# w�th�n :30 444y$,:0-fl completionDWater:Quality Information Processing,
1617 _Mail Service Center, •Raleigh, NC::"27699-161, Phone .: [phone]
Form GW-1 b
Rev. 2/09

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