408530_Well Construction - GW1_20121022

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1. WELL CONTRACTOR:
Lewis LeFever
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2480
Well Contractor (Individual) Name
Parratt-Wolff, Inc.
Well Contractor Company Name
501 Millstone Drive
Street Address
Hillsborough
City or Town
(919 ) 644-2814
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
NC 27278
State Zip Code
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) -3
3. WELL USE (Check One Box) Monitoring C{ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
IrrigationD Other ❑ (list use)
DATE DRILLED 8/13/12
4. WELL LOCATION:
Riverfront Road
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Kure Beach COUNTY New Hanov©
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley grFlat ❑ Ridge ❑ Other
LATITUDE 33 0 58 ' 814.0000 „ DMS OR 3X.XXXXXXXXX DD
LONGITUDE 77 ° 54 ' 821.0000 DMS OR 7X.XXXXXXXXX DD
Latitude/longitude source: ❑GPS 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.)
Fort Fisher Air Force Station
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 ❑ NO ql
c. WATER LEVEL Below Top of Casing: 2.0 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 0 FT. Above Land Surface*
*Top of casing terminated at/or below Iand.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 Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
• Thickness/
7. CASING: Depth Diameter Weight Material
: Top 0 Bottom 3.0 Ft. 1" Sch40 PVC
Ft.
Ft.
Top
Top
Bottom
Bottom
8. GROUT: Depth Material Method
Top 0 Bottom 1.0 Ft. Portland Tremie
Top 1.0 Bottom 2.0 Ft. Bentonite Tremie
Top Bottom Ft.
: 9. SCREEN: Depth Diameter Slot Size Material
Top 3.0 Bottom 8.0 Ft. 1 in. .010 in. PVC
Top Bottom Ft. in. in.
Top Bottom Ft.
in. in.
: 10. SAND/GRAVEL PACK:
Depth Size
Top 2.0 Bottom 8.0 Ft. #1
Top Bottom Ft.
Top Bottom Ft.
: 11. DRILLING LOG
: Top Bottom
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12. REMARKS:
Material
Sand
Formation Description
No samples taken
OCT 72o12
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1 DO HEREBY CERTIFY THAT THIS WELL
• 15A NCAC 2C, WELL CONSTRUCTION STA
RECORD HA, BEEN PROVIDED.. THE WEIR
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OCT 2 2012 ;,4
:=CONSTRUCTED IN ACCORDANCY,{ TH
D 'RDS, AND THAT A COPY OF THISt "
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„.... GNATURf' 9...F°' ERTIFIED WELL CONTRACTOR DATE
Lewis LeFever
•
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 b
Rev. 2/09