411939_Well Construction - GW1_20130304

Latitude/longitude source: ❑GPS ViTopographic 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
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2480
1. WELL CONTRACTOR:
Lewis Le Feve r
Well Contractor (Individual) Name
Parratt-Wolff, Inc.
Well Contractor Company Name
501 Millstone Drive
Street Address
Hillsborough NC 27278 : Top 20.5 Bottom 88.0 Top Bottom
411939
9
d. TOP OF CASING IS 2.0 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): 30 METHOD OF TEST Pump
City or Town
State Zip Code
f. DISINFECTION: Type N/A . Amount
g. WATER ZONES (depth):
Top Bottom Top Bottom
(919 ) 644-2814 : Top Bottom Top Bottom
Area code Phone number Thickness/
2. WELL INFORMATION: : 7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# WS0800931 : Top 0 Bottom 12.0 Ft. 12" Sch40 BIP
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) WVV-16
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial d Agricultural ❑ Recovery ❑ Injection ❑
IrrigationD Other ❑ (list use)
DATE DRILLED 12/10-12/12/12
4. WELL LOCATION:
3901 Castle Havne Road : Top 55.0 Bottom 80.0
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
Top 0 Bottom 55.0 Ft. 6"
Top Bottom Ft.
Sch40 SS
8. GROUT: Depth Material Method
Top 0 Bottom 27.0 Ft. Portland Tremie
Top 27.0 Bottom 30.0 Ft. Bentonite Tremie
Top Bottom Ft.
CITY: Wilminaton couNTY New Hanove
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑Valley dFlat ❑ Ridge ❑ Other
LATITUDE 34 "DMS OR 34.33041308 DD
LONGITUDE 77 " DMS OR 77.93424367 DD
: 11. DRILLING LOG
Top Bottom
• 4.0 / 8.0'
Facility Name •
3901 Castle Havne Road
9. SCREEN: Depth
Top . Bottom
Top Bottom
Diameter Slot Size Material
Ft. 6 in. .015 in. SS
Ft. in. in.
Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
Top 30.0 Bottom 88.0 Ft. #1 Sand
Street Address
Castle Havne
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: 88.0'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
c. WATER LEVEL Below Top of Casing: 20.5
(Use "+" if Above Top of Casing)
FT.
Top Bottom
Top Bottom
8.0
10.0
/ 10.0
/ 12.0
14.0
/ 16.0
16.0 / 20.0
40.0 / 44.0
52.0 / 56.0
12. REMARKS:
Ft.
Ft.
FEB 2
WATER QUALITY SECTION
IN,FORMATION PROCESSING UNIT
ormation Description
White/light brown, wet, medium/
fine SAND; little silt
Gray. wet CLAY
Gray. wet, dense CLAY; little
silt
Tan, wet, fine SAND
Light pray, wet, fine SAND; trace
silt
Gray, wet, fine SAND; some silt
Gray, wet, fine SAND & GRAVEL
some silt
•
-u0J.
I DO HEREBY
15A NCAC�
RECORD •
ERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
BEEN PROVIDED TO THE WELL SWNER.
SIGNA �� ' E OF C ' TIFI
;4-
WELL CONTRACTOR
Lewis LeFever
= PRINTED NAME OF PERSON COSTI fi C `OCG"THE WELL
DATE
•
3;r
Submit within 30 days of completion to: Division of Water Quality - Information Processipq
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
AR2Ol3 •1 .',
Form GW-1 b
Rev. 2/60

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