406301_Well Construction - GW1_20120820

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2480 1 ri 301.
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) I W-2
3. WELL USE (Check One Box) Monitoring d Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 5/29/12
4. WELL LOCATION:
Riverfront Road
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Kure Beach COUNTY New Hanov©
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑ Valley Flat ❑ Ridge DOther
LATITUDE 33
LONGITUDE 77
58
54
814.0000
821.0000
" DMS OR 3X.XXXXXXXXX DD
" DMS OR 7x.xxxxxxxxx DD
Latitude/longitude source: ❑GPS VTopographic 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.)
Fort Fisher Air Force Station
Facility Name Facility ID# (if applicable)
Riverfront Road
Street Address
Kure Beach
City or Town
NC 28449
State Zip Code
Contact Name
Mailing Address
City or Town State Zip Code
( )
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 8.0
b. DOES WELL REPLACE EXISTING WELL? YES O NO 51
c. WATER LEVEL Below Top of Casing: 0
(Use "+" if Above Top of Casing)
FT.
..........................
•
Top 0
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): NIA METHOD OF TEST N/A
f. DISINFECTION: Type N/A Amount N/A
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
Bottom 5.0 Ft. 4" Sch40 PVC
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth
Top 0
Material
Bottom 0.5 Ft. Portland
Top 0.5 Bottom 2.5 Ft. Bentonite
Top Bottom
Ft.
Method
Tremie
Tremie
9. SCREEN: Depth Diameter Slot Size Material
Top 3.0 Bottom 8.0 Ft. 4 in. .020 in. PVC
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
: 10. SAND/GRAVEL PACK:
• Depth Size Material
: Top 2.5 Bottom 8.0 Ft. #2 Sand
Top
Top
: 11. DRILLING LOG
: Top Bottom
Bottom
Bottom
12. REMARKS:
Ft.
Ft.
Formation Description
No samples taken
2C\%
M+'
l DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
• RECORD HA BEEN PROVIDED TO THE WELL OWNER.
•
iri'ERTIFIED WELL CONTRACTOR
Lewis LeFever
---2,57-(0._
DATE
PRINTED NAME OF PERSON CONSTRUCTING THEW.ELL,
•
Submit within 30 days of completion to: Division of Water Quality -
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Information Processing,
AUG 7 rern
W-1 b_