411740_Well Construction - GW1_20130208

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
City or Town
(919 ) 644-2814
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
NC
State
27278
Zip Code
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) O B-18B
3. WELL USE (Check One Box) Monitoring ll Municipal/Public ❑
Industrial/Commercial 0 Agricultural ❑ Recovery 0 Injection 0
Irrigation❑ Other ❑ (list use)
DATE DRILLED 12/2-12/3/12
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 0 Ridge ❑ Other
LATITUDE 34 "DMS OR 34.32759559 DD
LONGITUDE 77 " DMS OR 77.92917966 DD
Latitude/longitude source: ❑GPS 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
Castle Havne
City or Town
•
•
•
•
4 1 I 74 0
d. TOP OF CASING 15 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):
i Top N/A Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material.
i Top 0 Bottom 20.5 Ft. 8" Sch40 PVC
Top 0 Bottom 30.0 Ft. 4" Sch40 PVC
Top Bottom Ft.
: 8: GROUT: Depth Material Method
: Top 0 Bottom 20.0 Ft. Portland Tremie
Top 20.0 Bottom 25.0 Ft. Bentonite Tremie
Top Bottom Ft.
i 9. SCREEN: Depth Diameter Slot Size Material
Top 30.0 Bottom 90.0 Ft. 4 in. .020 in. PVC
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
: 10. SAND/GRAVEL PACK:
Depth Size Material
:• Top 25.0 Bottom 90.0 Ft. #2 Sand
Top Bottom Ft.
: Top Bottom Ft.
: 11. DRILLING LOG
Top Bottom Formation Description
5.0 / 9.0' Tan, wet, fine SAND
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: 90.0'
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO Cif
c. WATER LEVEL Below Top of Casing: 5.0
(Use "+" if Above Top of Casing)
FT.
•
17.0 / 21.0 Gray, moist CLAY
30.0 / 34.0 Dark gray, fine SAND
50.0 / 52.0 Dark gray, silty SAND
80.0 / 82.0 ' Dark grav, wet, fine SAND &
/
12. REMARKS:
SILT r,,:73,
..
.%
FE13 0 8
2013
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRIVgDNIA
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND TWAT
• RECORD BEEN PROVID D TO THE WELL OWNER. . /J
z-7
GNATU',. CERTIFIED WELL CONTRACTOR-
= Lewis LeFever
PRINTED NAME OF PERSON CONSTRUCTING'T
Y"!
(/�j �1y
�,+ �T
ANCE WITH
ig Unit
4t
- DATE
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

QMI
III
-P-OXIMATE EXTENT OF TR f:I. FAP.INC
0
RAP'
J
0
7
U
2
LL1G
h-
ZZ
O1
§_Q0
wee
CDIli
Z
S
Jdr PDXSLOI£
Ddr£Oxuats
DdZOXSLOt£
`Jdr-LOXSLOt£
S3�VW1 S431.
VSri'L1 nose50d lE Wd 3Z 11 movsvI atio- t 81.7'•111H11d a13V13111S1O1d — dr113S3OVd 04O31 SNr11 SL'Bt ,GroVOV riM SZ l . mama MAYS I :Irmo" 5%,•roJSLOICumuad- nay.maccooOtL092SLO1C00BOJ-0v3Sf1,t..rams.
.1.1,--dd0•.=Nd.13O)W 1 (dOI Wl N0113d•Yv rid (1dO):Old (do) Ol N3nVN3SOd'1. 3 OVOA J3 dfl -CA1a xv'3St134R) S ,JJ.O