414464_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) FW-13A
3. WELL USE (Check One Box) Monitoring d Municipal/Public 0
Industrial/Commercial ❑ Agricultural 0 Recovery ❑ Injection ❑
Irrigation❑ Other 0 (list use)
DATE DRILLED 4/25/13
4. WELL LOCATION:
3901 Castle Havne Road
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Wilminaton COUNTY New Hanovli
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley Flat ❑ Ridge ❑ Other
LATITUDE 34 "DMS OR 34.32393184 DD
LONGITUDE 77 " DMS OR 77.93390572 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
Street Address ••
Wilminaton NC 28429••
City or Town State Zip Code ••
•
•
Contact Name ••
•
Mailing Address /
414464
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 6.0 Ft. 2" Sch40 PVC
Top ' Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
: Top 0 Bottom 2.0 Ft. Portland Tremie
Top 2.0 Bottom 4.0 Ft. Bentonite Tremie
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top 6.0 Bottom 16.0 Ft. 2 in. .010 in. PVC
Top Bottom Ft. in. in.
▪ Top Bottom Ft. in. in.
: 10. SAND/GRAVEL PACK:
Depth Size
Top 4.0 Bottom 16.0 Ft. #1
Material
Sand
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom Formation Description
/ No samples taken
Facility ID# (if applicable) /
/
/
City or Town
State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 16.0'
b. DOES WELL REPLACE EXISTING WELL? YES ❑
c. WATER LEVEL Below Top of Casing: 6.0
(Use "+" if Above Top of Casing)
NO qI
FT.
: 12. REMARKS:
itr— VP VP' N.. 0'
JUL I 2013
O..
ii i
25 2 1
17
AiA P Ol 1P L1 Y SECTION
I,N;v,7°)RMATIC)N PR0CESSW0 UN1 i
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 PROVIDES To THE WELL OWNER.
IGNATURECERTIFIED WELL CONTRACTOR
Lewis LeFever
Z.- —21 -13
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-1b
Rev. 2/09

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