GW1-2022-07608_Well Construction - GW1_20220817

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information: j
KENNY SARGENT 14.WATER ZONEs.
Well Contractor Name FROM TO DESCRIPTION
rt. ft.
A - 4226
fr. fr. i
NC Well Contractor Certification Number 15.'OUTER CASING for multi-cmediwells OR LINER a licable
GEOLOGIC EXPLORATION FROM TO DIAMETER THICKNESS MATERIAL
ft. ft. in.
i
Company Name 16.INNER CASING'OR:TUBING eotbermal 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. 11.0 ft. 2.0 1 'n• SCH 40 PVC
3.Well Use(check well use): ft. fr. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 11.0 ft' 21.0 It- 2.0 . "' .010 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) _18.GROUT
❑Irri ation ❑Wells>100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0.0 It' 5.0 ft' PORTLANDBENTONITE SLURRY
TMonitoring ❑Recovery ft. ft.
Injection Well:
ft. tL
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK if a licable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENTMNTHOD
❑Aquifer Test ❑Stormwater Drainage 8.0 It- 23.0 ft' 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control fr. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) FROM TO DESCRIPTION color,hiuAness soi0rroek type,gimin sin,etc.
0.0 ft• 1.0 ft' ASPHALT/GRAVEL
4.Date Well(s)Completed: 06/13/22 Well ID# MW-2 1.0 fL 14.0 fL BROWN SILTY SANDY CLAY
5a.Well Location: 14.0 It' 23.0 ft' BROWN SANDY SILT
MGP PLANT ft. ft.
Facility/Owner Name Facility ID#(if applicable) ft. ft. 'b s
161 SOUTH CHARLOTTE STREET ASHEVILLE 28801 fr. ft.fr. ft. AUG ,
'
Physical Address,City,and Zip
BUNCOMBE :21.REMARKS', a
County Parcel Identification No.(PIN)
BENTONITE SEAL-5.0-80WUSOG
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: ��_ j_
(ifwell field,one ladlong is sufficient) 22.Certification: �,��rV"t,'1 'C✓J"`'^'"
350 35' 34.38" N 82e 32' 55.04" W 1; �. �° 06/21/22
6.Is(are)the well(s): I51'ermanent or ❑Temporary Signature of Certified Well Contractor Date
By signing this form,]hereby certify thal the well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or INNo 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy
Ijthis is a repair,Jill out known well construction information and explain the nature of the of this record has been provided to the uvell owner.
repair under#21 remarks section or on the back ofthis 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 construction info
construction,only 1 GW-I is needed. Indicate TOTAL NUMBER of wel Is (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: 21.0 (ft.)
For multiple wells list all depths ifdiperenr(example-3@200'and 1 t@100') Submit this GW-1 within 30 days of well completion per the following:
10.0 24a. For All Wells: Original form to Division of Water Resources (DWR),
If Static water level below top of casing: (ft.) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
!ju•ater 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,NC27699-1636
12.Well construction method: SONIC 24c.For Water Supply and Open-Loop Geothermal Return s:Copy to the
(i.e.auger,rotary,cable,direct push,etc.) county environmental health deparItment of the county where in
(i.e.
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing,over 100,000 GPD: Copy to DWR,CCPCUA
13a.Yield(gpm) Method of test: Permit Program,1611 MSC,Raleigh;NC 27699-1611
13b.Disinfection type: Amount:
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018