414469_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
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) B-10
3. WELL USE (Check One Box) Monitoring Cl/ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
IrrigationD Other ❑ (list use)
DATE DRILLED 4/27-4/30/13
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 RfFlat ❑ Ridge ❑ Other
LATITUDE 34 "DMS OR 34.32355260 DD
: Top 0
LONGITUDE 77 " DMS OR 77.93850302 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.)
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: 35.0'
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO qi
c. WATER LEVEL Below Top of Casing: 8.0
(Use "+" if Above Top of Casing)
FT.
•
Top 18.0
414469
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
i Top 0 Bottom 24.0 Ft. 4" Sch40 PVC
: Top 0 Bottom 25.0 Ft. 1" Sch40 PVC
Top Bottom Ft.
8. GROUT: Depth Method
Tremie
Material
Bottom 18.0 Ft. Portland
Bottom 24.0 Ft. Bentonite Tremie
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top 25.0 Bottom 35.0 Ft. 1 in. .010 in. PVC
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
Top 24.0 Bottom 35.0 Ft. #1 Sand
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
Formation Description
8.0 / 12.0 Tan, wet, fine/medium SAND
/
12. REMARKS:
JUN LU 1.
I DO HEREBY CERTIFY THAT THIS W Lr CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD • BEEN PROVIBED TO THE WELL OWNER.
IGNATU• F 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

LL,,
SE I
p
E
t
,
, a
0
0
0
a
e,concot c xLOc I
CY, Cl;02/.. ,zotto,imr%Lot,coonctoptlyA.,asnove..„,fordAr..m.z..:0A
1-SIVIeSCA.CAE rue z. QOM, :CMLIC), - ,C11.2530,'