GW1-2022-07619_Well Construction - GW1_20220817

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
KENNY SARGENT 14:WATERZONEs a
Well Contractor Name FROM TO DESCRIPTION
ft. ft. � '
A - 4226 ft. rt. k
NC Well Contractor Certification Number 15.OUTER'CASING'for multi-cased wells)OR LINE
R if a licable
GEOLOGIC EXPLORATION FROM TO DIAMETER THICKNESS MATERIAL
ft. ft. i in.
Company Name
I&INNER CASING OR'TUBING eothermal closed-loon)
2.Well Construction Permit#• FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction pernntts(i.e.UIC,County,State,Variance,etc.) 0.0 ft- 13.0 ft• 2.0 in. SCH 40 PVC
3.Well Use(check well use): ft. ft. in.
Water Supply Well: 17.SCREEN,
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 13.0 ft• 23.0 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
❑Irrl ation ❑Wells>100,000GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0.0 ff. 7.0 It' PORTIAND BENTONITE SLURRY
OMonitoring ❑Recovery ft. ft.
Injection Well: ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation
A9:SAND/GRAVEL PACK if a"licable'
❑Aquifer Storage and Recovery []Salinity Barrier FROM To MATERIAL EMPLACEMENT METHOD
❑Aquifer Test. ❑StormwaterDrainage 10.0 ft• 25.0 fL 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary)
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❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) I
FROM I TO DESCRIPTION color,havdness soiltroch type,grain siu etc.
0.0 ft. 1.0 ft. ASPHALT/GRAVEL
4.Date Wells)Completed: O6/13/22 Well ID# MW'3 1.0 IL 14.0 ft- BROWN SILTY SANDY CLAY
5a.Well Location: 14.0 1" 19.0 ft- BROWN SANDY SILT/GRAVEL
MGP PLANT 19.0 ft- 25.0 ft-
BROWN SANDY SILT
Facility/Owner Name Facility ID#(if applicable) ft. ft.
161 SOUTH CHARLOTTE STREET ASHEVILLE 28801 ft. ft.
Physical Address,City,and Zip ft. ft.
BUNCOMBE 21.REMARKS',
County Parcel Identification No.(PIN) BENTONITE SEAL-7.0-10.0 FEET
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22.Certification:
350 35' 34.23" N 820 32' 55.02" W /, ,w,a '� 06/21/22
6.Is(are)the well(s): OPermanent or ❑Temporary Signature of Certified Well Contractor
By signing this form,I hereby certify that the (",Ad 0e't¢,Lc 4ns�tDordance with
7.Is this a repair to an existing well: ❑Yes or ONo 15A NCAC 02C.0100 or ISA NCAC 02C.0200 Well Construction Standards and that a copy
/J'this is a repair,fill out known well construction information and explain the nature of the ofthis record has been provided to the trell mvne p ij� �(1��
repair under#21 remarks section or on the back of this form. l�
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 pagel info
construction,only I GW-1 is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also MAgrZZIDGtal pages if necessary.
drilled: 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 23.0 (ft.)
For multiple wells list all depths ifd�erent(example-3@200'and 2@/003 Submit this GW-1 within 30 days of well completion per the following:
10.Static water level below top of casing: 10•0 (ft) 249. For All Wells: Original form to Division of Water Resources (DWR),
If water level is above casing,use"+' Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter: 6.0 (ilt) 24b.For Infection Wells:Copy to DWR,Underground Injection Control(1UC)
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
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FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells roducine'over 100,000 GPD:Copy to DWR,CCPCUA
Permit Program,1611 MSC,Raleigh,NC 27699-1611
13a.Yield(gpm) Method of test:
13b.Disinfection type: Amount:
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Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources) Revised 6-6-2018