414474_Well Construction - GW1_20130701

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
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) D-25
3. WELL USE (Check One Box) Monitoring Ni Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery 0 Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 5/7-5/8/13
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 Wi(Flat ❑ Ridge ❑Other
LATITUDE 34 "DMS OR 34.32550457 DD
LONGITUDE 77 " DMS OR 77.93045639 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
Wilminaton
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: 40.0'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
c. WATER LEVEL Below Top of Casing: 5.0
(Use "+" if Above Top of Casing)
FT.
414474
: d. TOP OF CASING IS 0 FT. Above Land Surface`
*Top of casing terminated atlor 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
7. CASING: Depth
Diameter
: Top 0 Bottom 13.0 Ft. 4"
Top 0 Bottom 30.0 Ft. 1"
Top Bottom Ft.
▪ 8. GROUT: Depth Material
: Top 0 Bottom 26.0 Ft. Portland
Top 26.0 Bottom 28.0 Ft. Bentonite
Bottom
Thickness/
Weight
Sch40
Material
PVC
Sch40 PVC
Top Bottom Ft.
▪ 9. SCREEN: Depth
Top 30.0 Bottom
Top Bottom
Top Bottom
Method
Tremie
Tremie
Diameter Slot Size Material
40.0 Ft. 1 in. .010 in. PVC
: 10. SAND/GRAVEL PACK:
Depth
: Top 28.0 Bottom 40.0
Top Bottom
Ft. in. in.
Ft. in. in.
Size Material
Ft. #1 Sand
Ft.
Top Bottom Ft.
: 11. DRILLING LOG
: Top Bottom
4.0 / 8.0'
8.0
16.0
Formation Description
Brown, wet, fine SAND; trace
silt
/ 12.0 Gray, wet CLAY&SILT
/ 20.0 Gray, wet, fine SAND
/
/
: 12. REMARKS:
JUN 2 5 2013
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C,.,y,VELL CONSTRICTION STANDARDS, AND THAT A COPY OF THIS
• RECORD HBEEN PROVIDI=D TO THE WELL OWNER.
-
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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