408939_Well Construction - GW1_20121105

N ._ % ESIDENTIAL 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#Of applicable.)
SITE WELL ID #(if applicable) WW-16
3. WELL USE (Check One Box) Monitoring L' Municipal/Public 0
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection 0
IrrigationD Other ❑ (list use)
DATE DRILLED 9/25-9/29/12
: d. TOP OF CASING 1S 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 12.0 Ft. 8" Sch40 PVC
Top 0 Bottom 50.0 Ft. 4" Sch40 PVC
Top Bottom Ft.
▪ 8. GROUT:
: Top 0
:Top 44.0
Top
Depth
Bottom 44.0
Material.
Ft. Portland
Method
Tremie
Bottom 48.0 Ft. Bentonite Tremie
Bottom Ft.
4. WELL LOCATION: : 9. SCREEN: Depth
3901 Castle Havne Road Top 50.0 Bottom 90.0 Ft. 4 in. .020 in. PVC
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code) Top Bottom Ft. in. in.
CITY: Wilmington COUNTY New Hanova : Top Bottom Ft. in.
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope [Valley FiFlat ❑ Ridge ❑ Other
LATITUDE 34 " DMS OR 34.33067887 DD
LONGITUDE 77 ° ' " DMS OR 77.93426513 DD
Latitude/longitude.source ❑GPS Vropographic 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)
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: 92.0'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
c. WATER LEVEL Below Top of Casing: 5.0
(Use "+" if Above Top of Casing)
FT.
• 10. SAND/GRAVEL PACK:
Depth
: Top 48.0 Bottom 92.0
Top Bottom Ft.
: Top Bottom Ft.
•
: ▪ 11. DRILLING LOG
Top Bottom
Diameter Slot Size Material
Size
Ft. #2
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
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4.0 / 8.0'
8.0
0 5 2012
Sand
Formation Description
White/light brown, wet, medium/
fine SAND: little silt
/ 10.0 Gray, wet CLAY
Gray, wet, dense CLAY: little
silt
/ 16.0 Tan, wet, fine SAND
Light gray, wet, fine SAND: trace
silt
/ 44.0 Gray, wet, fine SAND: some silt
/ 56.0 Gray, wet, fine SAND & GRAVEL
/ some silt
10.0 / 12.0
14.0
16.0
/ 20.0
40.0
52.0
: 12. REMARKS:
•
: I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTR GT, EL N *CCSRDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, 'MAT . COPY OF THIS ‘,2.' ' ` '
• RECORD BEEN PROVIDED ' HE WELL OWNE -ery
IGNATURE CERTIFIED WELL CO1ACTb DATE
: Lewis LeFever
i PRINTED NAME OF PERSON CONSTRUCTING THE WELL
•
Submit within 30 days of completion to: Division.oWater Quality - Information Processing,
1617 Mail Service. Center, Raleigh, NC 27699-161, Phone `[phone]
Form GW-1 b
Rev. 2/09

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