GW1-2022-10706_Well Construction - GW1_20221205

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only: i
1.Well Contractor Information:
JeffreyGrant
lA.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
4328-B ft. ft. j
ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING for multi-cased wells OR LINER if a licable
JG Drilling,LLC FROM TO DIAMETER THICKNESS MATERIAL
ft. ft. in.
Company Name
WM O 1000530 16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.UIC,County,Stare,Variance,etc.) 0 ft. 16 ft• 1.25' i" .25 Steel
3.Well Use(check well use): ft. ft. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
Agricultural Municipal/Public 16 & 20 ft• .75 in' .006 1 .25 SS
Geothermal(Heating/Cooling Supply) Residential Water Supply(single) ft. ft. in.
Industrial/Commercial Residential Water Supply(shared) 18.GROUT
Irrigation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: ft. ft.
X Monitoring - ,_ =Recovery -- - ft. _ ft.. _-
Injection Well:
ft. ft.
Aquifer Recharge Groundwater Remediation 19.SAND/GRAVEL PACK(if applicable)
Aquifer Storage and Recovery nSalinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
Aquifer Test nStormwater Drainage ft. ft.
Experimental Technology Subsidence Control ft. ft.
Geothermal(Closed Loop) MiTracer 20.DRILLING LOG attach additional sheets if necessary)
FROM TO DESCRIPTION(color,hardness,soiltrock type, rain size,etc.)
Geothermal(Heating/Cooling Return) Other(explain under#21 Remarks) ft. ft.
4.Date Well(s)Completed:1 1-14-22 Well ID#GW 2 ft ft.
5a.Well Location:
ft. ft. ,, .. ..., r.., tt.•a a � .,,..,
3-7
Winter Bell Comapny ft. ft.
Facility/Owner Name Facility ID#(if applicable) ft. ft.
17 Truckers Place, Asheville, 28805 ft. ft.
Physical Address,City,and Zip ft. ft.
Buncombe 965863432 21.REMARKS
County Parcel Identification No.(PIN) Tempffary we!'.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22.Certification:
35.577350 N 82.510519 W ,
11-14-22
6.Is(are)the well(s)E3Permanent or ElTemporary Signa of CeWted VII C66tractor Date
By signing this fonn,1 hereby certify that the well(s)was(were)constructed in accordance
7.Is this a repair to an existing well: nYes or JqNo with 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a
/,jthis is a repair,fill out known well construction information and explain the nature of the copy of this record has been provided to the well owner.
repair under 921 remarks section or on the back of this form.
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 site details or well
construction,only I GW-I is needed. Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if necessary.
drilled:OnR SUBMITTAL INSTRUCTIONS,
9.Total well depth below land surface: 20 (ft•) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths ijdierent(example-3«200'and 2 a 100') construction to the following:
10.Static water level below top of casing: 16.78 (ft.) Division of Water Resources,Information Processing Unit,
lfwater level is above casing,use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
n
11.Borehole diameter:2.25 (in.) 24b.For Iniection Wells: In addition to sending the form to the address in 24a
Direct Push above,also submit one copy of this form within 30 days of completion of well
12.Well construction method: construction to the following:
(i.e.auger,rotary,cable,direct push,etc.)
I
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
i
13a.Yield(gpm) Method of test: 24c. For Water Supply&Iniection Wells: In addition to sending the form to
the address(es) above, also submit lone copy of this form within 30 days of
13b.Disinfection type: Amount: completion of well construction t1 the county health department of the county
where constructed.
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016