385474_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 Zip Code
( 704 )_ 872-7686
Area code- Phone number
2 WELL INFORMATION
SITE WELL ID #(if applicable) MW-7
STATE WELL PERMIT#Of applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring ® Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery 0 Injection 0
Irrigation❑ Other ❑ (list use)
DATE DRILLED 07/01/10 - 07/02/10
TIME COMPLETED AM ❑ PM ❑
3 WELL LOCATION
CITY ASHEVILLE
WRIGHT BROTHERS WAY 28732
COUNTY BUNCOMBE
(Street Name, Numbers, Community Subdivision, Lot No , Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING
❑ Slope ❑Valley ❑ Flat ❑Ridge 0 Other
(check appropnate box)
LATITUDE
LONGITUDE
May be in degrees,
minutes, seconds or
in a decunal format
Latitude/longitude source ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
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)
NAME OF FACILITY ASHEVILLE AIRPORT
STREET ADDRESS WRIGHT BROTHERS WAY
ASHEVILLE
NC 28732
City or Town State Zip Code
CONTACT PERSON ASHEVILLE REGIONAL AIRPORT
MAILING ADDRESS
61 TERMINAL DRIVE
FLETCHER NC
28732
City or Town State
)-
Area code - Phone number
5 WELL DETAILS
a TOTAL DEPTH 25 0 FEET
b DOES WELL REPLACE EXISTING WELL?
c WATER LEVEL Below Top of Casing 15 0
(Use "+" if Above Top of Casing)
Zip Code
YES ❑ NO
FT
5474
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
g WATER ZONES (depth)
From To
From To
From To
6 CASING
From 0 0
From
From
Depth
To 15 0
7 GROUT
From 0 0
From
From
To
To
Depth
To 10 0
To
To
Amount
From
From
From
Ft 2IINCHer
Ft
Ft
To
N/A
To
To
Thickness/
1CI-Y40 Material
Material
Ft Portland bentonite
Ft
Ft
Method
SLURRY
8 SCREEN Depth Diameter Slot Size
From 15 0 To 25 0 Ft 2 0 in 010 in
From To Ft in
From To Ft in
9 SAND/GRAVEL PACK
Depth
From 13 0 To
From To
From To
10 DRILLING LOG
From To
00 30
25 0
in
in
Material
PVC
Size Material
Ft 20-40 FINE SILICA SAND
Ft
Ft
Formation Description
ORANGE ROCKY SANDY CLAY
3 0 10 0 TAN/ORANGE SILTY CLAY
100 250
TAN/BROWN SANDY CLAY
rcU.., t r_..
JUL 1 2 2010
Intormatior 1-'rot. ,sisig iJnit
6J YV%..,I
11 REMARKS
BENTONITE SEAL FROM 10 0 TO 13 0 FT
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCC 2 WELL CONSTRUCTION ST' NIARDS AND THAT A COPY OF THIS
REC,IS♦J�q'�`aAFFN�gpVIDED TO TH _;,,' L OWNER
fGNATURE`( r CERTIFIED W
JOHNNY BURR
L d TRA OR
07/07/10
DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn Info
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No [phone] ext 568
JAN 10 2013
Form GW-lb
Rev 7/05