411738_Well Construction - GW1_20130208

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
411738
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
Street Address : g. WATER ZONES (depth):
Hillsborough NC 27278 : Top N/A Bottom Top Bottom
City or Town State Zip Code i Top Bottom Top Bottom
(919 ) 644-2814 : Top Bottom Top Bottom
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) WW-18
3. WELL USE (Check One Box) Monitorin
g C� Municipal/Public 0
Industrial/Commercial 0 Agricultural ❑ Recovery 0 Injection 0
Irrigation❑ Other 0 (list use)
DATE DRILLED 1 /14-1 /17/13
4. WELL LOCATION:
3901 Castle Havne Road
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Wilmington couNTY New HanoVe
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑Valley Flat ❑ Ridge ❑Other
LATITUDE 34 " DMS OR 34.32773736 DD
LONGITUDE 77 " DMS OR 77.92864322 DD
Latitude/longitude source: ❑GPS Viopographic 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: 105.0'
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO qI
c. WATER LEVEL Below Top of Casing: 0
(Use "+" if Above Top of Casing)
FT.
: 10. SAND/GRAVEL PACK:
Depth
: Top 30.0 Bottom
Top Bottom
Top Bottom
: 11. DRILLING LOG
: Top Bottom
/
/
1▪ 2. REMARKS:
• Thickness/
7. CASING: Depth Diameter Weight Material
Top 0 Bottom 16.5 Ft. 12" Sch40 BIP
Top 0 Bottom 65.0 Ft. 6" Sch40 SS
Top Bottom Ft.
8. GROUT: Depth Material
:• Top 0 Bottom 25.0 Ft. Portland
Top 25.0 Bottom 30.0 Ft. Bentonite Tremie
Top Bottom Ft.
Method
Tremie
9. SCREEN: Depth Diameter Slot Size Material
:• Top 65.0 Bottom 105.0 Ft. 6 in. .015 in. SS
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Size
105.0 Ft. #1
Ft.
Ft.
Material
Sand
Formation Description
-No samples taken
FEB i 2Gia
kor—
U Q/BOG
•
•
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 J S BEEN PROVIDED TO THE WELL OWNER.
GNATU"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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