GW1-2022-02553_Well Construction - GW1_20220410

WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
1.Well Contractor Information:
Robin Webb 14.WATER ZONES '
FROM TO DESCRIPTION
Well Contractor Name
• p fL 165 ft.
2418
ft. tt.
NC Well Contractor Certification Number 15.OUTER CASING for multi cased wells OR LINER �t a" licable
Greene Brothers Well & Pump, WT Inc. FROM TO DIAMETER TffiCKNESS MATERIAL
p ft. 51 n- 61/4 1 in. Steel
Company Name
WEL2021-00551 16.INNER CASING ORTUBING(geothermal closed-too
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.
17.SCREEN_
Water Supply
Well: FROM TO DIAMETER SLOT SIZE THICKI�'ESS MATERIAL
Agricultural DMunicipal(Public ft. ft. in:
Geothermal(Heating/Cooling Supply) OResidential Water Supply(single) fL ft. in•i I
Industrial/Commercial DResidential Water Supply(shared) 18.GROUT .
_ Irrigation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 fL 51 ft. eentonite
_ Monitoring ORecovery ft. R.
Injection Well:
ft. ft.
i_ Aquifer Recharge Groundwater Remediation
19.SAND/GRAVEL PACK(if applicable)
:)Aquifer Storage and Recovery OSalinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
L_ Aquifer Test O Stormwater Drainage ft. ft.
Experimental Technology QlSubsidence Control ft. ft.
Geothermal(Closed Loop) OTracer 20.DRILLING LOG(attach additional sheets if necessary)
__ _ FROM TO DESCRIPTION color,hardness,soiltrack e, in size,etc.
Geothermal(Heating/Cooling Return) Other(explain under#21 Remarks) 0 ft. 81 ft. Clay
4.Date Well(s)Completed:01/13/23 Well ID# 51 ft. 185 ft, Granite
ft.
5a.Well Location:
John(Tony)Cantrell ft. rt. ''z.. _. ` ;- i
i_
Facility/Owner Name Facility ID#(if applicable) ft. ft. APR 0
29 Jim &Clyda Trull Dr. Candler 28715 ft. ft.
Physical Address,City,and Zip ft, %
Buncombe 8698-01-9301 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.Cerfffl !ion:
35.565 N -82.730 W ,��
V 01/13/23
6.Is(are)the well(s)oPermanent or OTemporary Signa of Certified Wcll Contractor Date
By signing this form,I hereby certify that the urll(s)was(were)constructed in accordance
7.Is this a repair to an existing well: DYes or QNo with 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a
If 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#21 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 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: 185 (ft•) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths ifdifferent(example-3@200'and 2@100D construction to the following:
N/A Artesian
10.Static water level below top of casing: (ft) Division of Water Resources,Information Processing Unit,
Ifuater level is above casing,use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 6 1/4 (in.) 24b.For Iniection 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
(i.e.auger,rotary,cable,direct push,etc.)
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mall Service Center,Raleigh,NC 27699-1636
13a.Yield(gpm) 60 Method of test: 2 Hours 24c.For Water Suppiy&Iniectitm 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 33 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