411744_Well Construction - GW1_20130218

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1. WELL CONTRACTOR:
Lewis LeFever
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2480
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) O B-16
3. WELL USE (Check One Box) Monitoring d Municipal/Public ❑
Industrial/Commercial- ❑ Agricultural ❑ Recovery ❑ Injection ❑
IrrigationD Other ❑ (list use)
DATE DRILLED 9/25-9/29/12
4. WELL LOCATION:
3901 Castle Havne Road
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Wilminaton COUNTY New Hanov©
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope D Valley rgrFlat ❑ Ridge ❑ Other
LATITUDE 34 "DMS OR 34.33067887 DD
LONGITUDE 77 " DMS OR 77.93426513 DD
Latitude/longitude source: EJGPS Q1Topographic 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
Castle Havne
City or Town
State Zip Code •
•
Contact Name
Mailing Address
(
City or Town
)
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 92.0'
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑
0
c. WATER LEVEL Below Top of Casing: 5.0
(Use "+" if Above Top of Casing)
5it
FT.
•
•
•
•
Facility ID# (if applicable)
- "`
• d. TOP OF CASING IS 0 FT. Above Land Surface"4 4 4
*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
Top Bottom Top
▪ Top Bottom Top
7. CASING: Depth
: Top 0 Bottom 12.0 Ft. 8"
Top 0 Bottom 50.0 Ft. 4"
Top Bottom Ft.
8. GROUT: Depth Material
: Top 0 Bottom 44.0 Ft. Portland
Top 44.0 Bottom 48.0 Ft. Bentonite Tremie
Top • Bottom Ft.
Bottom
Bottom
Bottom
Thickness/
Diameter Weight Material
Sch40 PVC
Sch40 PVC
Method
Tremie
▪ 9. SCREEN: Depth Diameter Slot Size Material
Top 50.0 Bottom 90.0 Ft. 4 in. .020 in. PVC
Top Bottom Ft. in.
Top Bottom Ft. in.
: • 10. SAND/GRAVEL PACK:
Depth Size
Top 48.0 Bottom 92.0 Ft. #2
Top Bottom Ft.
Top Bottom Ft.
: 11. DRILLING LOG
Top Bottom
4.0 / 8.0'
8.0 / 10.0
10.0 / 12.0
NC 28429 : /
14.0 / 16.0
16.0 / 20.0
/
40.0 / 44.0
52.0 / 56.0
in.
in.
Material
Sand -
P-..E9 o 20/3
„a
Formation Description'in ProC
White/lightaSsing brown, wet, and fs
n;°,
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
: 12. REMARKS:
Corrected wel -previously WW-
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 BEEN PROVIDE TO THE WELL OWNER.
• 3
GNATUCERTIFIED WELLCONTRACTOR.?: _PATE
Lewis LeFever
PRINTED NAME OF PERSON CONSTRUWG �H� �E,V�l,�
1
Submit within 30 days of completion to: Division of Water Quality Information Processin
1 617 Mail Service Center, Raleigh, NC 27699-161, Phone [phone]
Form GW-1 b
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