_Well Construction - GW1_20230310 (66)

WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
1.Well Contractor Information:
Robin Webb 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
2418
0 ft, 380 ft, a spm
-
NC Well Contractor Certification Number ft. rt.
15.OUTER CASING(for multi cased wells OR LINER if a licable)
Greene Brothers Well &Pump, WT Inc. FROM TO DIAhETER THICKNESS MATERIAL
0 tt. 1 28 ft. 1 6 114, : in. Steel
Company Name
VVEL2021-604 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.) ft. ft. in.
3.Well Use(check well use): ft. ft. in,
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
Agricultural E]Municipal/Public ft. ft. in.
Geothermal(Heating/Cooling Supply) OResidential Water Supply(single) ft. ft. in.
AIndustrial/Commercial DResidential Water Supply(shared) 18.GROUT
firigation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 ft. 20 ft. Bentonite
_.Monitoring ORccovery ft. ft.
Injection Well:
it, ft.
Aquifer Recharge OGroundwater Remediation
19.SAND/GRAVEL PACK if applicable)
Aquifer Storage and Recovery DSalinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
Aquifer Test DStormwater Drainage ft. tt.
Experimental Technology [I Subsidence Control ft. ft.
Geothermal(Closed Loop) DTracer 20.DRILL]NG LOG(attach additional sheets if necessary)-.
FROM TO DESCRIPTION color,hardness,saillrock t e, rain size,etc.
BGeothermal(Heating/Cooling Return) i Other(explain under#21 Remarks)
0 ft. 28 tt. Clay
4.Date Well(s)Completed: 01/18/23 Well 1D# 28 ft. 405 ft* Granite -=
�..
5a.Well Location: ft. ft.
Erin Reagan ft. ft. M A , 7 2023
Facility/Owner Name Facility ID#(ifapplicable) ft. ft.
325 Big Cove Rd. Candler 28715
Physical Address,City,and Zip ft. ft.
Buncombe 8697-09-5668 21.REMARKS
County Parcel Identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one lat/long is sufficient) 22. er ftcation
35.560 N -82.731 �,
01/18/23
6.Is(are)the well(s)OPermanent or OTemporary lguatuie of Certified Well 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 drat a
#-tins is a repair,fill out known well construction information and explain the nature of the copy of tins record has been provided to the well owner.
repair under#21 reunarkv section or on the back of this form.
23.Site diagram or additional well details:
S.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: 405 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths if d fferent(example-3@200'and 2@100D construction to the following:
10.Static water level below top of casing: 5 (ft.) Division of Water Resources,Information Processing Unit,
ifwater 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 pushy etc.)
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
13a.Yield(gpm) 6 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: 74 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