GW1-2022-07624_Well Construction - GW1_20220817

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
KENNY SARGENT 14.WATER'ZONES,
- t.
Well Contractor Name FROM TO DESCRIPTION
A - 4226 ft. It.
ft. ft.
NC Well Contractor Certification Number
15.OUTER CASING foP multi-cased wells OR LINER if a'rlicable
GEOLOGIC EXPLORATION FROM TO DIAMETER THICKNESS MATERIAL
ft. ft. in.
Company Name
<.16.INNER CASING OR TUNING eothermatclo§ed-loo - .-
2.Well Construction Permit#: FROM I TO I DIAMETER THICKNESS MATERIAL
List all applicable ivell construction permits C1.e.UIC,County,State,Variance,etc.) 0.0 ft. 8.0 ft. 2.0 in. SCH 40 PVC
3.Well Use(check well use): ft. ft. in.
17 SCREEN c,.
Water Supply Well: FROM TO DIAMETER SLOTSIZE THICIQNFSS MATERIAL
❑Agricultural ❑Municipal/Public 8.0 ft' 18.0 ft' 2.0 in' .010 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Irri ation ❑Wells>100,000GPD FROM TO MATERIAL EMPLACEMENPMETHOD&AMOUNT
Non-Water Supply Well: 0.0 ft. 3.0 ft' PORTLANDBENTONRE SLURRY
OMonitoring ❑Recovery ft. ft.
Injection Well: ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation
,19.'SAND/GRAV,ELPACK(if a livable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL I EMPLACEMENT AfETHOD
❑Aquifer Test ❑StormwaterDrainage 6.0 ft. 20.0 ft. 20-4t) FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) []Tracer 20.DRILLINGLOG'attach additional sheets ifnecessarv'
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness,soil/rock type,gmin size,etc.
0.0 ft. 1.0 ft. ASPHALT/GRAVEL
4.Date Well(s)Completed: 06/14/22 Well ID# MW-5 1.0 ft. 13.0 ft. BROWN SILTY SANDY CLAY
5a.Well Location: 13.0 ft' 20.0 ft' BROWN SANDY SILT
MGP PLANT ft. ft.
Facility/Owner Name Facility ID#(if applicable) ft. ft.
161 SOUTH CHARLOTTE STREET ASHEVILLE 28801 ft. ft.
Physical Address,City,acid Zip ft. ft.
BUNCOMBE 2LREMARKS
County Parcel Identification No.(PIN) BENTONITE SEAL.-3.0-6.0 FEET
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one IaUlong is sufficient) 22.Certification: y�� ^'i� �"
350 35' 34.95" N 820 32' 55.58" W 06/21/22
6.Is(are)the well(s)• MPermanent or ❑Temporary Signature of Certified Well Contractor Date
By signing this form,I hereby certify that the irell(s)was(�)I�cou ru cr o qTr
7.Is this a repair to an existing well: ❑Yes or ONo 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Co sr t4t�t9nn r dv#sa 1hEaa bj
IJ'rltis A a repair,Jill our known well construction information and explain the nature of the of this record has been provided to the well owner.
repair under 921 remarks section or on the back ofthis form. A U r ? � 2022
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) (QW@li`g0h§1'PRW--Ci&g i
drilled: t*'NQ/80G
24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 18.0 (ft.)
For multiple wells list all depths ifd fferent(example-3@200'and 1@100') Submit this GW-1 within 30 days of well completion per the following:
10.Static water level below top of casing: 10.0 (ft) 24a. For All Wells: Original form to Division of Water Resources (DWR),
!J'warer level is shove casing,use"+"
Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter: 6.0 (in,) 24b.For Injection Wells:Copy to DWR,Underground Injection Control(IUC)
Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: SONIC
24c.For Water Supply and OpeniLoop 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 producinglover 100,000 GPD: Copy to DWR,CCPCUA
Permit Program,1611 MSC,Raleigh,NC 27699-1611
13a.Yield(gpm) Method of test:
13b.Disinfection type: Amount:
Fort GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018
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