414470_Well Construction - GW1_20130701

NON RESIDENTIAL 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
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-1 1
3. WELL USE (Check One Box) Monitoring C5 Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
IrrigationD Other ❑ (list use)
DATE DRILLED 5/8-5/9/13
4. WELL LOCATION:
3901 Castle Havne Road
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Wilminaton COUNTY New Hanov©
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley ritFlat ❑ Ridge ❑ Other
LATITUDE 34 "DMS OR 34.32421980 DD
LONGITUDE 77 ° " DMS OR 77.93706536 DD
Latitude/longitude source: ['CPS Vropographic 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 CAI
c. WATER LEVEL Below Top of Casing: 5.0
(Use "+" if Above Top of Casing)
FT.
414470
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):
i Top N/A Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0 Bottom 18.0 Ft. 4" Sch40 PVC
Top 0 Bottom 20.0 Ft. 1" Sch40 PVC
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom 9.0 Ft. Portland Tremie
Top 9.0 Bottom 18.0 Ft. Bentonite Tremie
Top Bottom Ft.
▪ 9. SCREEN: . Depth Diameter Slot Size Material
Top 20.0 Bottom 30.0 Ft. 1 in. .010 in. PVC
Top Bottom Ft.
Top Bottom Ft.
in. in.
in. in.
: 10. SAND/GRAVEL PACK:
Depth Size
: Top 18.0 Bottom 30.0 Ft. #1
Top Bottom Ft.
Top Bottom Ft.
: 11. DRILLING LOG
: Top Bottom
5.0 / 8.0'
•
•
•
•
•
•
8.0 / 12.0
12.0
20.0
24.0
/ 16.0
/ 24.0
/ 28.0
/
/
/
1• 2. REMARKS:
Material
Sand
Formation Description
Black/gray, wet, fine SAND
Gray, wet, fine SAND & CLAY:
some silt
Gray, wet CLAY
Tan, wet, fine SAND
Gray, wet CLAY & SILT
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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 BEEN PROVIDTO THE WELL OWNER.
•
IGNATUR`E- CERTIFIED WELL 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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