414466_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) FW-14B
3. WELL USE (Check One Box) Monitoring d Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
IrrigationD Other ❑ (list use)
DATE DRILLED 4/25-4/26/13
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 -Flat ❑ Ridge ❑ Other
LATITUDE 34 0 "DMS OR 34.32316540 DD
LONGITUDE 77 " DMS OR 77.93411493 DD
Latitude/longitude source: ❑GPS it 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
Facility ID# (if applicable)
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: 40.0'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qi
c. WATER LEVEL Below Top of Casing: 0
(Use "+" if Above Top of Casing)
FT.
414466
: 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.
i e. YIELD (gpm): N/A METHOD OF TEST N/A
f. DISINFECTION: Type N/A Amount
g. WATER ZONES (depth):
i Top N/A Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
. Thickness/
7. CASING: Depth Diameter Weight Material
: Top 0 Bottom 16.0 Ft. 4" Sch40 PVC
Top 0 Bottom 30.0 Ft. 2" Sch40 PVC
Top Bottom Ft.
8. GROUT: Depth Material Method
: Top 0 Bottom 25.0 Ft. Portland Tremie
Top 25.0 Bottom 28.0 Ft. Bentonite Tremie
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top 30.0 Bottom 40.0 Ft. 2 in. .010 in. PVC
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
: 10. SAND/GRAVEL PACK:
Depth Size Material
: Top 28.0 Bottom 40.0 Ft. #1 Sand
Top Bottom Ft.
Top Bottom Ft.
: 11. DRILLING LOG
: Top Bottom Formation Description
7.0 / 8.0' Tan, wet, fine/medium SAND
•
•
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/
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12. REMARKS:
". ...ram
JUL 1 ?91,1 9 2nn
s .t. .0 Lm ( sEC T Inidf
n-------€i FORMATI:0N PROCESSING UNR
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I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD H : EEN PROVIDED HE WELL OWNER.
GNATURERTIFIED 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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