GW1--05909_Well Construction - GW1_20241001

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
KENNY SARGENT 14.WATER ZONES
FROM TO DESCRIPTION
Well Contractor Name
ft. ft.
A - 4226 ft. ' ft.
NC Well Contractor Certification Number IS.OUTER CASING(for multi-cased wells)OR LINER(if ap licable)
GEOLOGIC EXPLORATION FROM TO DIAMETER THICKNESS MATERIAL
0.0 ft* 44.0 ft. 6.0 in. SCH 40 PVC
Company Name
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,State,Variance,etc.) 0.0 ft. 52.0 ft. 2.0 'n' SCH 40 PVC
3.Well Use(check well use): ft. R. in.
17.SCREEN
Water Supply Well:
PP Y FROM TO _ DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 52.0 ft. 62.0 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
❑Irrigation ❑Wells>100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0.0 ft. 10.0 ft PORTLAND BENTONRE SLURRY
OMonitoring ❑Recovery 0.0 ft. 44.0 ft. PORTLAND BENTONITE SLURRY
Injection Well:
ft. ft.
0 Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK(if applicable)
❑Aquifer Storage and Recovery OSalinity Barrier FROM TO MATERIAL _EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage 50.0 ft. 64.0 ft. 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control n. ft.
OGeothermal(Closed Loop) ❑Tracer 20.DRILLING LOG(attach additional sheets if necessary)
OGeothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness,soil/rock type,grain size,etc.)
0.0 ft. 25.0 ft- BROWN SILTY CLAY
4.Date Well(s)Completed: 03/07/24 Well ID# CPA-7D 25.0 I'L 32.0 ft BROWN SILT
5a.Well Location: 32.0 ft' 62.0 ft' BROWN SILTY PWR
ASHEVILLE STEAM PLANT 62.0 n• 64.0 ft Roc!< , , . 4 '* ,,M p
Facility/Owner Name Facility ID#(if applicable) ft. ft.
52 NEW ROCKWOOD ROAD ARDEN 28704 ft. ft. OCT U 1 ZOZ4
Physical Address,City,and Zip ft. ft lr f+t: 'i.i.e a a•rr.y4 1 t M
BUNCOMBE 21.REMARKS OWCs40G
County Parcel Identification No.(PIN) BENTONITE SEAL- 10.0-50.0 FEET
***U-PACK SCREEN***
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one Ia0long is sufficient) 22.Certification:35° 27' 48.99" N 82° 32' 05.93" W u'1r1A44w 04/19/24
6.Is(are)the well(s): EMPermanent or ❑Temporary Signature of Certified Well Contractor Date
By signing this form,I hereby certify that the well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or ONo ISA NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy
If this is a repair,Jill out known well construction information and explain the nature of the 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:
You may use the back of this page to provide additional well construction info
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach additional pages if necessary.
drilled: 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 62.0 (ft.)
For multiple wells list all depths if different(example-3@200'and 2(4)100') Submit this GW-I within 30 days of well completion per the following:
18.62 24a. For All Wells: Original form to Division of Water Resources (DWR),
10.Static water level below top of casing: (fL) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
If water level is above casing.use"*"
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 Open-Loop 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 producing over 100,000 GPD:Copy to DWR,CCPCUA
Permit Program,1611 MSC,Raleigh,NC 27699-1611
13a.Yield(gpm)_, . Method of test:
13b.Disinfection t pe: Amount:
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018