GW1--00891_Well Construction - GW1_20240205

WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
1.Well Contractor Information:
Travis Greene ,
14.WATER ZONES ' •,- `
We11Con[ractorName FROM TO DESCRIPTION
0 ft. 165 ft. 30gpm i
4238 -
ft. ft.
NC Well Contractor Certification Number
,15.OUTER CASING(for mull-rated'wells)ORLINER`(if ap licable)
Greene Brothers Well &Pump, WT Inc. FROM TO DIAMETER THICKNESS MATERIAL
0 ft. 24 ft. 61/4 I I in. PVC
Company Name
WEL2021-00582 ,g16.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,State, Variance,etc.) ft. ft. i in.
3.Well Use(check well use): ft. ft. in.
17.`SCREEN "•rt
Water Supply Well: FROM TO DIAMETER' SLOT SIZE THICKNESS MATERIAL
W Agricultural DMunicipal/Public ft. ft. in:
I I
a Geothermal(Heating/Cooling Supply) xDResidential Water Supply(single) ft ft. in.l
WI Industrial/Commercial DResidential Water Supply(shared) 18,GROUT
JIrrigation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: o ft. 20 ft• Bentonite
SIMonitoring DI Recovery ft. ft.
Injection Well: ft. ft.
mlAquifer Recharge 0Groundwater Remediation '
19.SAND/GRAVEL PACK(if applicable) '
*'Aquifer Storage and Recovery DlSalinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
"'Aquifer Test DStonnwater Drainage ft. ft.
El I Experimental Technology DSubsidence Control ft. ft.
*Geothermal(Closed Loop) D Tracer 20.DRILLING LOG(attach additional sheets if necessary) '-
FROM TO DESCRIPTION(color,hardness,soil/rock type,grain size,etc.)
III Geothermal(Heating/Cooling Return) DI Other(explain under#21 Remarks) 0 ft. 24 ft. Clay I
4.Date Well(s) 11/20/23
Completed: Well ID# 24 ft. 185 ft' Granite '0..,
5a.Well Location: ft. ft. . i (l,A'_': •.
Janet Mills/Barry Kelling ft. ft.
l'�a " J Z0 Facility/Owner Name Facility ID/1(if applicable) ft. ft. 24
398 Old Farm School Rd.Asheville 28805 ft. ft. inx;,yir:il:^n h,-,,,,�
Physical Address,City,and Zip ft. ft. i°`v 6,Y J G ."1
Buncombe 9669-94-0295
County Parcel Identification No.(PIN) i
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: I
(if well field,one lat/long is sufficient) 22.Certification: '
35.607 N -82.468 W
11/20/23 J ,• -_
6.Is(are)the well(s)0Permanent or DTemporary Signature of Certified Well Contractor Date
LJ By signing this form,I hereby certify that the well(s)was(were)constructed in accordance
7.Is this a repair to an existing well: DYes or ONo 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 Gcoprobe/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 if different(example-3@200'and 2@100') construction to the following: •
•
10.Static water level below top of casing: 40 (ft.) 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 1/4 (in.) 24b.For Injection 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.) I
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
13a.Yield(gpm) 30 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: 33 tabs ( completion of well construction to thebu cnty health department of the county
I.
where constructed.
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources I Revised 2-22-2016