406302_Well Construction - GW1_20120820

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 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) IW-3
3. WELL USE (Check One Box) Monitoring CS Municipal/Public ❑
Industrial/Commercial 0 Agricultural 0 Recovery 0 Injection 0
Irrigation❑ Other ❑ (list use)
DATE DRILLED 5/29/12
4. WELL LOCATION:
Riverfront Road
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Kure Beach
302
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 N/A
g. WATER ZONES (depth):
: Top N/A
Top
Top
7. CASING: Depth
: Top 0 Bottom 5.0
Top Bottom
Top Bottom
8. GROUT:
: Top 0
Top 0.5
Top
9. SCREEN: Depth
: Top 3.0
Top
COUNTY New Hanov© : Top
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley 'Flat ❑Ridge ❑Other
LATITUDE 33 ° 58 ' 814.0000 °DMS OR 3X.XXXXXXXXX DD
LONGITUDE 77 54 ' 821.0000 " DMS OR 7X.XXXXXXXXX DD
Latitude/longitude source: ❑GPS VITopographic 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.)
Fort Fisher Air Force Station
Bottom Top Bottom
Bottom Top Bottom
Bottom Top Bottom
Thickness/
Diameter Weight Material
Ft. 4" Sch40 PVC
Ft.
Ft.
Depth Material
Bottom 0.5 Ft. Portland
Method
Tremie
Bottom 2.5 Ft. Bentonite Tremie
Bottom Ft.
Diameter Slot Size Material
Bottom 8.0 Ft. 4 in. .020 in. PVC
Bottom Ft. in. in.
Bottom Ft. in. in.
: 10. SAND/GRAVEL PACK:
Depth
Top 2.5 Bottom
Top
Top
: 11. DRILLING LOG
: Top Bottom
Size Material
8.0 Ft. #2 Sand
Bottom Ft.
Bottom Ft.
Facility Name Facility ID# (if applicable) /
Riverfront Road
Street Address
:
Kure Beach
City or Town
NC 28449
State Zip Code
Contact Name
Mailing Address
City or Town State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 8.0
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO qr
c. WATER LEVEL Below Top of Casing: 0
(Use "+" if Above Top of Casing)
FT.
12. REMARKS:
Formation Description
No samples taken
jUN 2, ZVI
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD H= EEN PROVIDED 0 THE WELL OWNER.
-075:-/a..
• = �A UR - • ERT FI D WELL CONTRACTOR DATE
: Lewis LeFever
PRINTED NAME OF PERSON CONSTRUCTING -THE -WELL
Submit within 30 days of completion to: Division of Water Quality Information Processin
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
AUG 2 0;41?
Rev. 2/09