386840_Well Construction - GW1_20100101

NON RESIDENTIAL 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) CB-4B
STATE WELL PERMIT#Of applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring ® Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 08/16/10 - 08/17/10
TIME COMPLETED AM ❑ PM ❑
3 WELL LOCATION
CITY ARDEN
200 CP&L DRIVE 28704
COUNTY BUNCOMBE
(Street Name, Numbers Community, Subdivision, Lot No , Parcel Zip Code)
TOPOGRAPHIC / LAND SETTING
❑Slope ❑ Valiey ❑Flat ❑ Ridge ❑ Other
(check appropnate box)
LATITUDE
LONGITUDE
Latitude/longitude source
May be in degrees,
minutes, seconds or
in a decimal format
❑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 loQa1 , -)5
FACILITY FACILITY ID #(if applicable)
NAME OF FACILITY PROGRESS ENERGY
STREET ADDRESS 200 CP&L DRIVE
ARDEN NC
28704
City or Town State
CONTACT PERSON PROGRESS ENERGY
Zip Code
MAILING ADDRESS 200 CP&L DRIVE
ARDEN NC
28704
City or Town State
( )-
Area code - Phone number
5 WELL DETAILS
a TOTAL DEPTH 39 0 FEET
Zip Code
b DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c WATER LEVEL Below Top of Casing 18 0 FT
(Use "+" if Above Top of Casing)
G40
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 acdordance 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 29 0 Ft 2 INCH sui-rau PVC
From 0 0 To 20 0 Ft 4 INCH SCH 40 PVC
From To Ft
7 GROUT Depth Material Method
From 0 0 To 25 0 Ft Portland bentonite SLURRY
From 0 0 To 20 0 Ft Portland bentonite SLURRY
From To Ft
8 SCREEN Depth Diameter Slot Size Material
From 29 0 To 39 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 27 0 To 39 0 Ft 20-40 FINE SILICA SAND
From To Ft
From To Ft
10 DRILLING LOG
From To Formation Description
0 0 20 0 BROWN/ORANGE SILTY CLAY
20 0 31 0 GRAY PARTIALLY WEATHERED ROCK
31 0 39 0 GRAY HARD ROCK
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11 REMARKS /11atr
BENTONITE SEAL FROM 25 0 TO 27 0 FT DIA,Q� srny
Unit
I DO HERE: CERTIFY THAT THIS WELL WA t•NSTRUCTED IN ACCORDANCE WITH
15A NCA 1 1, W L CONST' CTION STAN'1S AND THAT A COPY OF THIS
00/
RECORD 1 ::_. ,....:.,,r, D TO THE s 0/04
`/
' '/ I/ V 08/25/10
Ste • TURE OF ERTIFIED 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

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