414467_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 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) WT-23A
3. WELL USE (Check One Box) Monitoring Municipal/Public 0
Industrial/Commercial ❑ Agricultural ❑ Recovery 0 Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 4/29/13
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 UfFlat ❑ Ridge ❑Other
LATITUDE 34 " DMS OR 34.32517230 DD
LONGITUDE 77 " DMS OR 77.94065684 DD
Latitude/longitude source: DGPS 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.)
General Electric
Facility Name
3901 Castle Havne Road
Street Address
Wilminaton
Facility ID# (if applicable)
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: 22.0'
b. DOES WELL REPLACE EXISTING WELL? YES O NO qI
c. WATER LEVEL Below Top of Casing: 0
(Use "+" if Above Top of Casing)
FT.
414467
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 Bottom Top Bottom
▪ Top Bottom Top Bottom
Thickness/
:7. CASING: Depth Diameter Weight Material
: Top 0 Bottom 12.0 Ft. 2" Sch40 PVC
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material
Top 0 Bottom 7.0 Ft. Portland
Method
Tremie
Top 7.0 Bottom 10.0 Ft. Bentonite Tremie
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top 12.0 Bottom 22.0 Ft. 2 in. .010 in. PVC
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
: 10. SAND/GRAVEL PACK:
Depth Size Material
: Top 10.0 Bottom 22.0 Ft. #1 Sand
Top Bottom Ft.
▪ Top Bottom Ft.
11. DRILLING LOG
Top
Bottom
/
fs � it,
4��/
�e�av ^� 'lit dry' 0`b
i �'
/ 0
/ JUL 0 01 '0
Formation Description
No samples taken
: 12. REMARKS:
WATER QUMM (TV SF TI I
INFORMATION PROCESSING UNIT
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUC ION STANDARDS, AND THAT A COPY OF THIS
• RECORD BEEN PROVIDED1 O THE WELL OWNER.
•
IGNATURERTIFIED WELL CONTRACTOR
Lewis LeFever
DATE
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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