414472_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
Hillsborouah
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) B-13
3. WELL USE (Check One Box) Monitoring d Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
IrrigationD Other ❑ (list use)
DATE DRILLED 5/6-5/7/13
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 hiFlat ❑ Ridge ❑Other
LATITUDE 34
"DMS OR 34.32493750 DD
LONGITUDE 77 " DMS OR 77.93320298 DD
Latitude/longitude source: DGPS Viopographic 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 Facility ID# (if applicable) 8.0 / 12.0
NC 27278
414472
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 Bottom
Top Bottom
Top
•
7. CASING:
: Top 0
Top 0
Top
8. GROUT:
Top 0
Top 8.0
Top
9. SCREEN:
Bottom
Depth
Top Bottom
Top Bottom
Top Bottom
Thickness/
Diameter Weight Material
Bottom 18.0 Ft. 4" Sch40 PVC
Bottom 20.0 Ft. 1" Sch40 PVC
Bottom
Ft.
Depth Material Method
Bottom 8.0 Ft. Portland Tremie
Bottom 19.0 Ft. Bentonite Tremie
Bottom Ft.
Depth
: Top 20.0 Bottom
Bottom
Bottom
Top
Top
Diameter Slot Size Material
30.0 Ft. 1 in. .010 in. PVC
Ft.
Ft.
: 10. SAND/GRAVEL PACK:
Depth
Bottom
Bottom
Bottom
Top 19.0
Top
: Top
: 11. DRILLING LOG
: Top Bottom
5.0 / 8.0'
in. in.
in. in.
Size
30.0 Ft. #1
3901 Castle Havne Road 20.0 / 24.0
Street Address
Wilminaton NC 28429
City or Town State Zip Code
Contact Name
Mailing Address
City or Town State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 30.0'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO GI
c. WATER LEVEL Below Top of Casing: 8.0 FT.
(Use "+" if Above Top of Casing)
/
/
/
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12. REMARKS:
Ft.
Ft.
Material
Sand
Formation Description
Tan, wet, fine SAND & SILT
Black, wet, fine SAND
Tan, wet, fine SAND
I. ')fl1`_
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C ELL CONSTRUC 40N STANDARDS, AND THAT A COPY OF THIS
RECORD EEN PROVID 0 THE WELL OWNER.
2,/
IGNATURE..► " 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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