386839_Well Construction - GW1_20100101

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3098
1 WELL CONTRACTOR
JOHNNY BURR
Well Contractor (Individual) Name
GEOLOGIC EXPLORATION, INC
Well Contractor Company Name
STREET ADDRESS 176 COMMERCE BLVD
STATESVILLE NC 28625
City or Town State
( 704 )_ 872-7686
Zip Code
Area code- Phone number
2 WELL INFORMATION
SITE WELL ID #(if applicable) CB-8
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring E Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection E
Irrigation❑ Other ❑ (list use)
DATE DRILLED 08/17/10
❑ PM ❑
BUNCOMBE
TIME COMPLETED AM
3 WELL LOCATION
CITY ARDEN COUNTY
200 CP&L DRIVE 28704
(Street Name, Numbers, Community, Subdivision Lot No Parcel Zip Code)
TOPOGRAPHIC / LAND SETTING
❑Slope ❑Valley ❑Fiat ❑Ridge ❑ Other
(check appropnate box)
LATITUDE
May be in degrees,
minutes, seconds or
in a decimal format
LONGITUDE
Latitude/longitude source ❑GPS ❑Topographic
(location of well must be shown on a USGS
attached to this form if not using GPS)
4 FACILITY- is the name of the business where the well is located
FACILITY ID #(if applicable)
map
topo map and
575
NAME OF FACILITY PROGRESS ENERGY
STREET ADDRESS 200 CP&L DRIVE
ARDEN NC 28704
City or Town State Zip Code
CONTACT PERSON PROGRESS ENERGY
MAILING ADDRESS 200 CP&L DRIVE
ARDEN NC 28704
City or Town State
( )-
Zip Code
YES ❑ NO
0 FT
Area code - Phone number
5 WELL DETAILS
a TOTAL DEPTH 57 0 FEET
b DOES WELL REPLACE EXISTING WELL?
c WATER LEVEL Below Top of Casing 18
(Use "+" if Above Top of Casing)
d TOP OF CASING IS 3 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 N/A
g WATER ZONES (depth)
From To From To
From- To From To
From To From To
6 CASING Thickness/
Depth Diameter W iCH ht Material
From 0 0 To 47 0 Ft 2 INCH 54o PVC
From To Ft
From To Ft
7 GROUT Depth Matenal Method
From 0 0 To 39 5 Ft Portland bentonite SLURRY
From To Ft
From To Ft
8 SCREEN Depth Diameter Slot Size Material
From 47 0 To 57 0 Ft 2 0 in 010 in PVC
From To Ft in in
From To Ft in in
9 SAND/GRAVEL PACK
Depth Size Material
From 43 5 To 57 0 Ft 20-40 FINE SILICA SAND
From To Ft
From To Ft
10 DRILLING LOG
From To Formation Description
0 0 3 0 RED/ORANGE CLAY
3 0 34 0 BROWN/TAN SILT
34 0 40 0 BROWN/GRAY PARTIAL WEATHER ROCK
40 0 57 0 GRAY HARD ROCK
1i
Irfforma 6 2010
11 REMARKS tfon ,�
BENTONITE SEAL FROM 39 5 TO 43 5 FT Off'✓Q/R�SIng (hut
I DO HEREBY CERTIFY THAT THIS WELL WAS C!�r -TRUCTED IN ACCORDANCE WITH
15A NCAC 2 ELL ONSTRUC ON STAND • 'L 5;. AND THATA COPY OF THIS
RECORD H• E ,"-• r.,. OTHE W•,(a Ei
� 08/25/10
SIGN ,/o/RE OF C "TIFIED WELL CONTRACTOR DATE
JOHNNY BURR
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days Attn Information Mgt ,
1617 Mail Service Center — Raleigh, NC 27699-1617 Phone No [phone] ext 568
Form GW-lb
Rev 7/05

-
Y.,