GW1-2022-01317_Well Construction - GW1_20220124

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
Anthony Convery 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
4343 ft. ft.
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NC Well Contractor Certification Number ft. ft.15.OUTER CASING for multi-eased wells OR LINER if a licahle
Parratt-Wolff, Inc. FROM TO DIAMETER THICKNESS MATERIAL
ft. ft. in.
Company Name .
16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#: FROM TO DIAMETER 'THICKNESS MATERIAL
List all applicahle well construction permits(i.e.I/1C,County,State,Variance,etc.) 0 ft. 4 ft. 2 in. sch40 PVC
3.Well Use(check well use): ft. ft. ! in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 4 ft' 14 ft' 2 in. .010 sch40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. 4 ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Irri ation ❑Wells>100,000 GPD FROM TO MATERIAL EMPL.ACEMENTMETHOD&AMOUNT
Non-Water Supply Well: 0 ft. 1 ft- Portland Cement Poured
OMonitoring ❑Recovery 1 ft. 2 ft. Bentonite6ips Poured
Injection Well: ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation
SAND/GRAVEL PACK if.a licahle
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM I TO MATERIAL. EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage 2 ft 14 ft. #1 Sand; Poured
❑Experimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) ❑Tracer <20.DRILLING LOG attach additional"sheets if necessary)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) FROM TO DESCRIPTION color,hwdness,soil/mck type,gimin size,etc.
ft. ft.
4.Date Well(s)Completed: 12-9-21 Well ID# MW-8
5a.Well Location: ft. ft.
Silverline Plastics Corporation ft. ft.
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Facility/Owner Name Facility ID#(if applicable)
ft. ft.
950 Riverside Drive, Asheville, NC 28804 ft. ft.
Physical Address,City,and Zip ft. ft.
Buncombe 21.REMARKS
County Parcel Identification No.(PIN) 8"Flush mount
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
2'x 2'Concrete Pad
(if well field,one Iat/long is sufficient) 22.Certification:
35.624373 N -82.579867 W
6.Is(are)the well(s): In Permanent or ❑Temporary Signature ofCertified Wet ontractor Date
By signing this form,l herehy eerli&that the me a'(mere)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or MNo 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Coarnrttchon S'mudurds and thin a copy
I/'this is a repair/ill out known well construction in/ormolion and explain the nature ofthe cif this record has been prorided to the well,owner.
repair under=21 remarks.seclion or on the back q/this/orm.
23.Site diagram or additional well details:
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well construction info
construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You'may also attach additional pages if necessary.
drilled: 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 14
Pbr mullip/e melts/i.+v all depilt.s i/'diflerenl(example-3 cl200'and 2 ct 100') Submit this GW-1 within 30 days of well completion per the following:
24a. For All Wells: Original form!to Division of Water Resources (DWR),
10.Static water level below top of casing: (ft.) Information Processing Unit, 1617 MSC,Raleigh,NC 27699-1617
if water le re/is above casing,use
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11.Borehole diameter: 2 (in.) 24b. For Injection Wells: Copy to DWR,Underground Injection Control(IUC)
Program, 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: Auger
24c.For Water Supply and Open-Loon Geothermal Return Wells:Copy to the
(i.e.auger,rotary,cable,direct push,etc.) county environmental health department"of the county where installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing ov r100,000 GPD: Copy to DWR,CCPCUA
13a.Yield(gpm) Method of test:
Permit Program,1611 MSC,Raleigh,E NC 27699-1611
13b.Disinfection type: Amount:
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018