GW1-2022-10761_Well Construction - GW1_20221209

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
Robin Webb 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
0 rt• 385 ft.
2418 rt. rt.
i
NC Well Contractor Certification Number 15.OUTER CASING for multi-cased wells OR LINER if a licable
Greene Brothers Well & Pump, WT Inc. FROM TO DIAMETER TRICKINESS MATERIAL
0 rL 80 ft- 6114 in. Bentonite
Company Name
W EL2021-00674 16.INNER CASING OR Tu)31N eothermal closed-loop)
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.UIC,County.State.Variance,etc) ft. ft: in.
3.Well Use(check well use): ft. ft. in.
Water Supply Well: 17.SCREEN
lrp y FROM I TO DIAMETER SLOTSIZE THICKNESS MATERIAL
Agricultural OMunicipal/Public
Geothermal(Heating/Cooling Supply) Residential Water Supply(single) ft. ft. in
Industrial/Commercial [3Residcntial Water Supply(shared) 18.GROUT
_'. Irrigation FROM TO MATERIAL EMPLACEMENT METHOD&AT81OUNT
Non-Water Supply Well: 0 ft. 20 rt• Bentonite
Monitoring !)Recovery
Injection Well:
Aquifer Recharge OGroundwater Remediation
19.SAND/GRAVEL PACK if applicable)
Aquifer Storage and Recovery OSalinity Barrier FROM I TO I MATERIAL F,MPLACEMENT METHOD
Aquifer Test' E)Stormwater Drainage ft. ft.
Experimental Technology OSubsidence Control ft. I rt.
Geothermal(Closed hoop) OTraeer 20.DRELLING LOG attach additional sheets if necessary)
FROM I TO DESCRIPTION(color,hardness,soiltrack type.grain size,etc.
Geothermal(HeatinglCoolirig Return) rtOther(explain under#21 Remarks) 0 ft- 40 ft* Clay
4.Date Well(s)Completed: 11/15/22 Well ID# 40 ft• 405 ft, Granite
5a.Well Location:
Jason Davis/Brad Nash �-
Facility/Owner Name Facility ID#(if applicable) rt. ft. DEC 2022
21 Calabrese Ln. Candler 28715 ft. ft.
Physical Address,City,and Zip ft. ft. DVJQIBC)G
Buncombe 8698-10-7032 21.REMARKS
County Parcel Identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22. ertiliea' n.
35.561 N -82.726 W
v 11/15/22
6.Is(are)the well(s)OPermanent or OTemporary Signature of Certified Well Contractor Date
By signing This form,I hereby certify that the wedl(s)was(were)constricted in accordance
7.Is this a repair to an existing well: nYes or E)No with 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and dml a
ff this 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#11 remarks section a•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 1 GW-1 is needed. Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if necessary.
drilled:-' SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 405 (ft•) 24a. For All Wells: Submit this form within 30 days of completion of well
For mulliple wells list all depths ifdi ferent(example-3Q200'and 20,I00� construction to the following:
10.Static water level below top of casing:40 Division of Water Resources,Information Processing Unit,
If water level is above casing.use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 6 1 A (in.) 24b.For Infection Wells: In addition to sending the form to the address in 24a
Rotary 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.)
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail ServiceMCenter,Raleighr NC 27699-1636
13a.Yield(gpm) 7 Method of test: 2 Hours 24c.For Water Supply&Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b.Disinfection type: HTH Amount: 74 tabs completion of well construction to 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