414473_Well Construction - GW1_20130701

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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
State
27278
Zip Code
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) D-24
3. WELL USE (Check One Box) Monitoring CI Municipal/Public 0
Industrial/Commercial 0 Agricultural ❑ Recovery 0 Injection 0
Irrigation❑ Other ❑ (list use)
DATE DRILLED 4/30-5/1/13
4. WELL LOCATION:
3901 Castle Havne Road
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip. Code)
CITY: Wilminaton COUNTY New Hanove
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope :Walley Flat ❑ Ridge ❑ Other
LATITUDE 34 "DMS OR 34.32255401 DD
LONGITUDE 77 " DMS OR 77.93058514 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.)
General Electric
Facility Name Facility ID# (if applicable)
3901 Castle Havne Road
Street Address
Wilminaton NC 28429
City or Town
State Zip Code
Contact Name
Mailing Address
City or Town
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 32.0'
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES 0
c. WATER LEVEL Below Top of Casing: 8.0
(Use "+" if Above Top of Casing)
NO qI
FT.
/114473
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
: Top 0 Bottom 20.0 Ft. 4" Sch40 PVC
Top 0 Bottom 22.0 Ft. 1" Sch40 PVC
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom 11.0 Ft. Portland Tremie
Top 11.0 Bottom 20.5 Ft. Bentonite Tremie
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size
Top 22.0 Bottom 32.0
Top Bottom
T▪ op Bottom
Material
Ft. 1 in. .010 in. PVC
Ft. in. in.
Ft. in. in.
: 10. SAND/GRAVEL PACK:
Depth Size
: Top 20.5 Bottom 32.0 Ft. #1
Top Bottom Ft.
▪ Top Bottom Ft.
: 11. DRILLING LOG
: Top Bottom
8.0 / 12.0'
12.0 / 16.0
20.0 / 24.0
/
/
/
12. REMARKS:
Material
Sand
Formation Description
Gray, wet CLAY; trace fine
sand
Brown, wet, fine SAND
Dark gray, wet CLAY & SILT
5
AlL 1 14332 vA
WATER .SECTION
BY:------INFMTATION PROCESSING UNI I
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C ELL CONSTRUQTION STANDARDS, AND THAT A COPY OF THIS
• RECORD . • EEN PROVID OSHE WELL OWNER.
•
IGNATURE
-2/-/c3
CERTIFIED 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

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