414460_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
City or Town
(919 ) 644-2814
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) FW-12A
3. WELL USE (Check One Box) Monitoring d Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
IrrigationD Other ❑ (list use)
DATE DRILLED 4/24-4/27/13
4. WELL LOCATION:
3901 Castle Havne Road
NC 27278
State Zip Code
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Wilmington COUNTY New Hanove
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley RiFlat ❑ Ridge ❑ Other
LATITUDE 34 "DMS OR 34.32207332 DD
LONGITUDE 77 " DMS OR 77.9327791 U DD
Latitude/longitude source: ❑GPS Viropographic 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)
414460
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
Top Bottom Top
Top Bottom Top
7. CASING: Depth
Top 0 Bottom 6.0
Top Bottom
Top Bottom
8. GROUT: Depth
Top 0 Bottom 2.0
Diameter
Ft. 2"
Ft.
Ft.
Material
Ft. Portland
Bottom
Bottom
Bottom
Thickness/
Weight Material
Sch40 PVC
Top 2.0 Bottom 4.0 Ft. Bentonite
Top Bottom Ft.
Method
Tremie
Tremie
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
Top Bottom Ft.
Material
Sand
: Top Bottom Ft.
: ▪ 11. DRILLING LOG
: Top Bottom Formation Description
/ No samples taken
Street Address•
/
Wilmington NC 28429 /
City or Town State Zip Code •/
/
Contact Name •/ - r
— P1 i`ti e i
sr r (—
Mailing Address
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 ❑ NO qI
c. WATER LEVEL Below Top of Casing: 8.0
(Use "+" if Above Top of Casing)
FT.
:n ? '(J ,14 6)
ram. ' �'f C rrE f FT
_t n; t•,
•
JUL 2013 !,
• [3l
1▪ 2. REMARKS:
•
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 ,IAAt BEEN PROVID. I TO THE WELL OWNER.
IGNATUR= 0• CERTIFIED WELL CONTRACTOR DATE
Lewis LeFever
4 2I 43
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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