385472_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-4
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring E Municipal/Public 0
Industrial/Commercial 0 Agricultural ❑ Recovery 0 Injection 0
Irrigation❑ Other 0 (list use)
DATE DRILLED 07/01/10 - 07/02/10
TIME COMPLETED AM ❑ PM ❑
3 WELL LOCATION
CITY ASHEVILLE COUNTY BUNCOMBE
WRIGHT BROTHERS WAY 28732
(Street Name, Numbers Community Subdivision Lot No Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING
❑Slope ❑Valley ❑Flat ❑Ridge ❑ Other
(check appropnate box)
LATITUDE
LONGITUDE
Latitude/longitude source
May be in degrees,
minutes, seconds or
in a decimal format
DGPS ❑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 30 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 El
FT
3 5472
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 Weight Material
From 0 0 To 15 0 Ft 2 INCH SCI�40 PVC
From To Ft
From To Ft
7 GROUT Depth Material Method
From 0 0 To 10 0 Ft Portland bentonite SLURRY
From To Ft
From To Ft
8 SCREEN Depth Diameter Slot Size Material
From 15 0 To 30 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 13 0 To 30 0 Ft 20-40 FINE SILICA SAND
From To Ft
From To Ft
10 DRILLING LOG
From To Formation Description
0 0 3 0 ORANGE ROCKY SANDY CLAY
3 0 10 0 TAN/ORANGE SILTY CLAY
10 0 30 0 TAN/BROWN SANDY CLAY
JUL. 1 4 min
Ir¢_
,•oLik.rt rlSl..t
—• V‘K/•d A(,
11 REMARKS
BENTONITE SEAL FROM 10 0 TO 13 0 FT
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C WELL CONSTRUCTION STAN RDS AND THAT A COPY OF THIS
RECO`D AS EEN PROV e D TO THEW OWNER
i 07/07/10
St;G ATURE eiRCERTIFIED W C RAC DATE
JOHNNY BURR
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn Inforr t4",; a t ,
1617 Mail Service Center — Raleigh, NC 27699-1617 Phone No [phone] ext 5d8
JAN 10 2013
Form GW-lb
Rev 7/05