411940_Well Construction - GW1_20130304

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# WS0800931
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) WW-17
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial C( Agricultural ❑ Recovery ❑ Injection ❑
IrrigationD Other ❑ (list use)
DATE DRILLED 12/13-12/16/12
4. WELL LOCATION:
3901 Castle Havne Road
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
. 1 1
d. TOP OF CASING IS 2.0 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): 10 METHOD OF TEST Pump
f. DISINFECTION: Type N/A Amount
: g. WATER ZONES (depth):
: Top 20.9 Bottom 108.0 Top
Top Bottom Top
Top Bottom, Top
Thickness/
7. CASING: Depth Diameter Weight Material
: Top 0 Bottom 18.0 Ft. 12" Sch40 BIP
Bottom
Bottom
Bottom
Top 0 Bottom 65.0 Ft. 6" Sch40 SS
Top Bottom Ft.
8. GROUT:
: Top 0
Top 27.0
Depth Material
Bottom 27.0 Ft. Portland
Method
Tremie
Bottom 30.0 Ft. Bentonite Tremie
Top Bottom Ft.
9. SCREEN:
Depth Diameter Slot Size Material
Top 65.0 Bottom 105.0Ft. 6 in. .015 in. SS
Top Bottom Ft. in. in.
CITY: Wilmington COUNTY New Hanove : Top Bottom Ft. in. in.
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley itFlat ❑ Ridge ❑ Other
LATITUDE 34 "DMS OR 34.32885373 DD
LONGITUDE 77 " DMS OR 77.93231248 DD
Latitude/longitude source: DGPS Topographic 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
Castle Havne
City or Town
NC 28429
State Zip Code
Contact Name
Mailing Address
City or Town State Zip Code
( )
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 108.0'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qi
c. WATER LEVEL Below Top of. Casing: 20.9
(Use "+" if Above Top of Casing)
FT.
: 10. SAND/GRAVEL PACK:
Depth Size Material
:• Top 30.0 Bottom 108.0 Ft. #1 Sand
Top Bottom Ft.
Top Bottom Ft.
: 11. DRILLING LOG
: Top Bottom
•
•
•
•
WATER QUALITY SECTION
itigARMATLONEMESSING UNIT
4.0 / 8.0' Tan, wet, fine SAND: some silt
12.0 / 16.0 Gray, wet CLAY & SILT
20.0
/ 24.0 Tan, wet, fine SAND & SILT
48.0 . / 52.0 Gray, wet SILT: some fine/
/ coarse sand & gravel
12. REMARKS:
.v -
•
I DO HEREBY ERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC ' , WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
• RECORD ,rS BEEN PRO DED TO THE WELL OWNER.
LI al 1-3
• SI N RE OF CERTIFI WELL CONTRACTOR D4TE.
•Le is LeFever
PRINTED NAME OF PERSON CONSTI& CTING THE WELL
MAR 042013
4
Submit within 30 days of completion to: Division of Water Quality- Information Processing,Form GW-1b=�
Y p PIftl _. �ma
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

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