408941_Well Construction - GW1_20121105

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1. WELL CONTRACTOR:
Lewis LeFever
N r '- ESQ.° ENTIAL WELL CONST UCTION RECO
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2480
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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) WW-1.8
3. WELL USE (Check One Box) Monitoring it Municipal/Public 0
Industrial/Commercial 0 Agricultural 0 Recovery 0 Injection ❑
Irrigation❑ Other 0 (list use)
DATE DRILLED 9/26/12
4. WELL LOCATION:
3901 Castle Havne Road
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Wilminaton COUNTY New Hanove
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley Flat 0 Ridge ❑ Other
LATITUDE 34 ° "DMS OR 34.32653237 DD
LONGITUDE 77 ° " DMS OR 77.92774200 DD
Latitude/longitude source:. ❑GPS 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
Street Address
Castle Havne
City or Town
Facility ID# (if applicable)
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
Top
Top
▪ 7. CASING:
Top 0
Top 0
Top
Bottom Top Bottom
Bottom Top Bottom
Bottom Top Bottom
Thickness/
Depth Diameter Weight Material
Bottom 16.5 Ft. 8" Sch40 PVC
Bottom 50.0 Ft. 4" Sch40 PVC
Bottom Ft.
8. GROUT: Depth
: Top 0 Bottom 44.0
Top 44.0 Bottom 47.0
Material
Ft. Portland
Method
Tremie
Ft. Bentonite Tremie
Top Bottom Ft.
9. SCREEN: Depth
Top 50.0 Bottom 90.0
Top Bottom
Top Bottom
: 10. SAND/GRAVEL PACK:
Depth
Bottom
Top 47.0
Top
Top
Diameter Slot Size Material
Ft. 4 in. .020 in. PVC
Ft. in. in.
Ft. in. in.
92.0 Ft.
Bottom
Bottom
• 11. DRILLING LOG
Top Bottom
4.0 / 8.0'
Size
#2
Ft.
Ft.
Material
Sand
1\1°V 0 5 202
Formatbra Description
XSAN&traceSUt
Tan, wet, fi
12.0 / 16.0 Gray, wet CLAY &SILT
/
NC 28429 20.0 / 24.0 Gray, wet, fine SAND: some silt
State Zip Code /
Contact Name
Mailing Address
City or Town State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 92.0'
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
c. WATER LEVEL Below Top of Casing: 4.0 FT.
(Use "+" if Above Top of Casing)
•
•
58.0 / 60.0 Gray, wet SILT: some fine/
/
coarse sand & aravel
84.0 / 86.0 Gray, .wet,SILT-�,a
/ coarse �,:����. a -bra
12. REMARKS:
c\gi
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND TI`C
RECORD H £j= EEN PROVIDED . THE WELL OWNER.
/1? ---24‘.--/(=_
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CERTIFIED WELL CONTRACTOR DATE
Lewis LeFever
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
•
Submit mit within 30 days of completion to: Division of Water Quality Information Processing
1617 Mail Service Center, Raleigh, NC 27699-161, Phone . (919) _807-6300
Form GW-1 b
Rev. 2/09

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