385516_Well Construction - GW1_20100715

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3544
1 WELL CONTRACTOR
Joshua Eliingworth
Well Contractor (Individual) Name
Parratt-Wolff, Inc
Well Contractor Company Name
501 Millstone Drive
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
Street Address g WATER ZONES (depth)
Hillsborough NC 27278 Top N/A Bottom Top
City or Town State Zip Code Top Bottom Top
(919 ) 644-2814 Top Bottom Top
Area code Phone number
2 WELL INFORMATION
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) MW-G
3 WELL USE (Check One Box) Monitoring 54 Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 4/26/10
4 WELL LOCATION
10023 North Trvon Street
(Street Name, Numbers Community Subdivision, Lot No , Parcel, Zip Code)
CITY Charlotte COUNTY Mecklenburg
TOPOGRAPHIC / LAND SETTING (check appropriate box)
❑Slope ❑Valley grFlat ❑Ridge ❑Other
LATITUDE 35
° 19 332 0000 " DMS OR 3x XXXXXXXXX DD
LONGITUDE 80 44 ao 0000 " DMS OR 7x xxxxxxxxx DD
Latitude/longitude source OGPS Weropographic 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 )
Fxxon Mobil
Facility Name Facility ID# (if applicable)
10023 North Trvon Street
Street Address
Charlotte NC 28262
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 15.0'
b DOES WELL REPLACE EXISTING WELLS YES ❑ NO qI
c WATER LEVEL Below Top of Casing 13.0
(Use "+" if Above Top of Casing)
FT
N/A
Bottom
Bottom
Bottom
Thickness/
7 CASING Depth Diameter Weight Material
Top 0 Bottom 5 0 Ft 2" Sch40 PVC
Top Bottom Ft
Top Bottom Ft
8 GROUT Depth
Material Method
Top 0 Bottom 1 5 Ft Portland Tremie
Top 1 5
Bottom 3 0 Ft Bentonite Tremie
Top Bottom Ft
9 SCREEN Depth Diameter Slot Size Material
Top 5 0 Bottom 15 0 Ft 2 in 010 in PVC
Top Bottom Ft in in
Top Bottom Ft in in
10 SAND/GRAVEL PACK
Depth
Top 3 0 Bottom
Top Bottom Ft
Top Bottom Ft
11 DRILLING LOG
Top Bottom
Size Material
15 0 Ft #1 Sand
Formation Description
5 0 / 8 0' Gray, moist SAND & CLAY
8 0 / 12 0 Gray, moist SAND & CLAY
12 0 / 16 0 Gray, moist SAND & CLAY
16 0 / 20 0 Gray, moist SAND & CLAY
20 0 / 24 0 Red/gray, wet CLAY, some
/ medium/coarse sand &
/ weatheredrrock nr® r
12 REMARKS
[11_1"'v ,L.LJ
JUL 1 2010
I DO HEREBY CERTIFY THAT THIS WELL0WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, W ONSTRUCTIONISTANDARDSIAND THAT A'COPY OF THIS
CORD HA��/ IDEDS® THE WELL OWNERQ{BOG
ATURE OF CERTIFIED WELL CONTRACTOR DATE
Joshua Ellingworth
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
•s"'-a,a,°Sas9��'a, t "'e �`e�, a y-° �, �,. .T t�e 'tea WY 'Cr" -bttlVe
,iSubmit ifithin g30;days ofacompl`etion>to Division of Water{Quallty � Infgormation Fr.cessing,;
''16117(MauI;S'ery Ed eenter;,Raleigh;:NCR27699-161 Phone._(919) 807-6300�• Oft e® .0
Form GW-lb
Rev 2/09

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