411741_Well Construction - GW1_20130218

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) OB-17B
3. WELL USE (Check One Box) Monitoring C{ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
IrrigationD Other ❑ (list use)
DATE DRILLED 11 /27-11 /28/12
4. WELL LOCATION:
3901 Castle Havne Road
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Wilmington COUNTY New Hanov©
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley EgrFlat ❑ Ridge ❑ Other
LATITUDE 34 0 "DMS OR 34.32878285 DD
LONGITUDE 77 " DMS OR 77.93237686 DD
Latitude/longitude source: ❑GPS VfTopographic 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 Facility ID# (if applicable)
3901 Castle Havne Road
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: 90.0'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
c. WATER LEVEL Below Top of Casing: 5.0
(Use "+" if Above Top of Casing)
FT.
411741
: 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 16.0 Ft. 8" Sch40 PVC
Top 0 Bottom 50.0 Ft. 4" Sch40 PVC
Top Bottom Ft.
8. GROUT: Depth
: Top 0 Bottom 38.0
Material
Ft. Portland
Method
Tremie
Top 38.0 Bottom 41.0 Ft. Bentonite Tremie
Top
Bottom Ft.
: 9. SCREEN: Depth Diameter Slot Size Material
: Top 50.0 Bottom 90.0 Ft. 4 in. .020 in. PVC
i Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
: 10. SAND/GRAVEL PACK:
Depth • Size Material
Top 41.0 Bottom 90.0 Ft. #2 Sand
Top Bottom Ft.
: Top Bottom Ft.
: ▪ 11. DRILLING LOG
Top Bottom Formation Description
•
•
•
/
5.0 / 7.0'
9.0
/ 13.0
13.0 / 17.0
40.0 / 42.0
/
: 12. REMARKS:
•
Tan, wet, fine SAND: some silt
Gray, moist CLAY & SILT
Gray, moist CLAY & SILT; trace
fine sand
Gray; wet, fine SAND; trace silt
-Et3 0 8
2013
p reces
: 1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTR �: � C 'W1' `H
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THA
• RECORD H EEN PROVIDE? TO THE WELL OWNER.
OF THIS
51' :if.3
NATUR F CERTIFIED WELL CONTRACTOR DATE. -
Lewis LeFever
PRINTED NAME OF PERSON CONSTRUCTIN�TH B �WEL,�8O�3
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
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