414471_Well Construction - GW1_20130701

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
Hillsborouah
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) B-12
3. WELL USE (Check One Box) Monitoring d Municipal/Public 0
Industrial/Commercial ❑ Agricultural ❑ Recovery 0 Injection 0
Irrigation❑ Other ❑ (list use)
DATE DRILLED 5/9-5/10/13
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 ❑Valley RiFlat ❑ Ridge ❑Other
LATITUDE 34 "DMS OR 34.32518559 DD
LONGITUDE 77 " DMS OR 77.93542385 DD
Latitude/longitude source: ❑GPS Q 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
3901 Castle Havne Road
Facility ID# (if applicable)
Street Address
Wilminaton NC 28429
City or Town State Zip Code
Contact Name
Mailing Address
City or Town State Zip Code
( )
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 30.0'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
c. WATER LEVEL Below Top of Casing: 5.0
(Use "+" if Above Top of Casing)
FT.
414471
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
g. WATER ZONES (depth):
Top N/A Bottom Top
Top Bottom Top
Top Bottom Top
Thickness/
▪ 7. CASING: Depth Diameter Weight
Top 0 Bottom 17.0 Ft. 4" Sch40
Amount
Bottom
Bottom
Bottom
Material
PVC
Top 0 Bottom 20.0 Ft. 1" Sch40 PVC
Top Bottom Ft.
8. GROUT: Depth Material
: Top 0 Bottom 6.0 Ft. Portland
Top 6.0 Bottom 18.0 Ft. Bentonite
Top Bottom . Ft.
Method
Tremie
Tremie
9. SCREEN: Depth Diameter Slot Size Material
▪ Top 20.0 Bottom 30.0 Ft. 1 in. .010 in. PVC
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
: 10. SAND/GRAVEL PACK:
: Top 18.0
Top
▪ Top
: 11. DRILLING LOG
: Top Bottom
8.0 / 12.0'
Depth
Bottom 30.0 Ft.
Bottom Ft.
Bottom Ft.
12.0 / 16.0
16.0 / 20.0
24.0 / 28.0
/
/
12. REMARKS:
Size
#1
Material
Sand
Formation Description
Brown, wet, fine SAND; some
silt
Brown, wet, fine SAND & SILT
Gray, wet CLAY & SILT
Tan, wet, fine SAND; trace silt
YO QRMATI0N PROCESSING UNIT
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRTION STANDARDS, AND THAT A COPY OF THIS
RECORD H $ EN PROVID O THE WELL OWNER.
•
NATURED
CERTIFIED WELL CONTRACTOR
CONTRACTOR
Lewis LeFever
DATE
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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