380990_Well Construction - GW1_20100101

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2580
1 WELL CONTRACTOR
JASON MANTAK
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 ® Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 01/29/10
TIME COMPLETED AM ❑ PM ❑
3 WELL LOCATION
CITY ENKA COUNTY BUNCOMBE
1301 SAND HILL ROAD 28728
(Street Name Numbers, Community Subdivision, Lot No , Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING
❑Slope ❑Valley ❑ Flat DRidge ❑ Other
(check appropnate box)
LATITUDE
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal tormat
Latitude/longitude source ID GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form rf not using GPS)
4 FACILITY- is the name of the business where the well is located
FACILITY ID #(if applicable)
NAME OF FACILITY BASF
STREET ADDRESS 1301 SAND HILL ROAD
ENKA
NC 28728
City or Town State Zip Code
CONTACT PERSON BASF
MAILING ADDRESS 1301 SAND HILL ROAD
ENKA NC 28728
City or Town State
( )-
Area code - Phone number
5 WELL DETAILS
a TOTAL DEPTH
33 0 FEET
Zip Code
b DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
c WATER LEVEL Below Top of Casing 23 0 FT
(Use "+" if Above Top of Casing)
d TOP OF CASING IS 2 0 FT Above Land Surface'
*Top of casing terminated at/or below land surface may require
a vanance 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 iq ht Material
From 0 0 To 23 0 Ft 2 INCH Scii40 PVC
From To Ft
From To Ft
7 GROUT Depth Material Method
From 0 0 To 14 0 Ft Portland bentonite SLURRY
From To Ft
From To Ft
8 SCREEN Depth Diameter Slot Size Material
From 23 0 To 33 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 18 0 To 33 0 Ft 20-40 FINE SILICA SAND
From To Ft
From To Ft
10 DRILLING LOG
From To Formation Description
00 70 RED CLAY
7 0 23 0 BROWN SANDY CLAY/WEATHER ROCK LAYERS
23 0 26 0 GRAY WEATHERED ROCK
26 0 35 0 GRAY ROCK
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11 REMARKS
BENTONITE SEAL FROM 14 0 TO 18 0 FT
1 DO HEREBY , RTIFY THAT THIS ELL W • ' STRUCTED IN ACCORDANCE WITH
15A NCAC 2 t, ELL CONSTRUC 1 N ST. •: • ' DS AND THAT A COPY OF THIS
RECORD HA i i., N PROVI. ' • 1 ). OWNER
02/02/10
SIGNAT 1 OF CERTIFIED WELL CONTRACTOR DATE
JASOMANTAK
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days Attn Information Mgt ,T,lv ,i
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No [phone] ext 568 FEB 0 k 2013
Form GW-lb
Rev 7/05

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