414468_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 27278
State Zip Code
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) WT-23B
3. WELL USE (Check One Box) Monitoring d Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 4/28/13
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)
DSlope DValley Flat ❑ Ridge DOther
LATITUDE 34 0 "DMS OR 34.32518559 DD
LONGITUDE 77 " DMS OR 77.94060319 DD
Latitude/longitude source: ❑GPS 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
( )
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 35.0'
b. DOES WELL REPLACE EXISTING WELL?
State Zip Code
YES ❑ NO Ni
c. WATER LEVEL Below Top of Casing: 0
(Use "+" if Above Top of Casing)
FT.
414468
: 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
7. CASING: Depth
Top
Top
Top
Bottom
Bottom
Bottom
Thickness/
Diameter Weight Material
Top 0 Bottom 25.0 Ft. 2" Sch40 PVC
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
: Top 0 Bottom 20.0 Ft. Portland Tremie
Top 20.0 Bottom 23.0 Ft. Bentonite Tremie
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top 25.0 Bottom 35.0 Ft. 2 in. .010 in. PVC
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
: 10. SAND/GRAVEL PACK:
Depth Size Material
: Top 23.0 Bottom 35.0 Ft. #1 Sand
Top . Bottom
Top Bottom
11. DRILLING LOG
: Top Bottom
8.0 / 12.0'
/
Ft.
Ft.
Formation Description
Tan, wet, fine/medium SAND;
some silt
s''''' t
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ii 2 5.9 2 0 1 3
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a - 4 k 'moo r
v . {WATER QUA Hai �' Sail ION
li IIVORflils:SIS/L2R9 GaiSSING UNIT
BY:---
12. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, ELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD H .,1:EEN PROVIDE D.1t THE WELL OWNER.
GNATURE
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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