411737_Well Construction - GW1_20130218

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1. WELL CONTRACTOR:
Lewis LeFever
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2480
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#
NC
State
27278
Zip Code
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) WW-16
3. WELL USE (Check One Box) 'Monitoring vd Municipal/Public 0
Industrial/Commercial 0 Agricultural 0 Recovery 0 Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 12/10-12/12/12
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 DOther
_ „ DMS OR 34.33041308 DD
LATITUDE 34
LONGITUDE 77 " DMS OR 77.93424367 DD
Latitude/longitude source: ❑GPS QrTopographic 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
Castle Havne
City or Town
Facility ID# (if applicable)
41_1737
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.
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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 12.0 Ft. 12" Sch40 B I P
Top 0 Bottom 55.0 Ft. 6" Sch40 SS
Top Bottom Ft.
8. GROUT: Depth Material Method
: Top 0 Bottom 27.0 Ft. Portland Tremie
Top 27.0 Bottom 30.0 Ft. Bentonite Tremie
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
: Top 55.0 Bottom 80.0 Ft. 6 in. .015 in. SS
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
: 10. SAND/GRAVEL PACK:
Depth
Top 30.0 Bottom 88.0
Size Material
Ft. #1 Sand
Top Bottom Ft.
: Top Bottom Ft.
: 11. DRILLING LOG
: Top Bottom
/
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: 88.0'
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO Gi
c. WATER LEVEL Below Top of Casing: 5.0
(Use "+" if Above Top of Casing)
FT.
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: 12. REMARKS:
atiea su.0 - .
Formation Description
No samples taken
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20/3
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Proc.,�� �ti .wit
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 H :EEN PROVIDED T.`THE WELL OWNER.
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ATURE ► ERTIFIED 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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