_Well Construction - GW1_20230310 (67)

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
Robin Webb 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
0 rt. 2115 ft. r�
2418
rt. rt.
NC Well Contractor Certification Number 15.OUTER.CASING for multi-cased wells)OR LINER if a licable
Greene Brothers Well & Pump,WT Inc. FROM TO DIAMETER THICKNESS MATERIAL
0 ft. 64 ft. 61/4 in. Steel
Company Name
WEL2022-00610 16.INNER CASING OR TUBING(geothermal closed-too
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 DMunicipal/Public ft. ft. in.
Geothermal(Heating/Cooling Supply) OResidenlial Water Supply(single) ft. ft. to
Industrial/Commercial DResidential Water Supply(shared) 18.GROUT
h-i ation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 ft. 20 it. Bentonite
Monitoring EjRccovery
Injection Well:
ft. ft.
Aquifer Recharge DGroundwater Remediation
19.SAND/GRAVEL PACT{ if applicable)__
Aquifer Storage and Recovery 0Salinity Barrier FROM f TO MATERIAL EMPLACEMENT METHOD
Aquifer Test OStormwater Drainage ft. I
Experimental Technology OSubsidence Control ft. I ft.
Geothermal(Closed Loop) OTracer 20.DRILLING LOG(attach additional sheets if necessary)
Geothermal(Heating/Cooling Return) ! Other(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness.soillrock typF gmin size,etc
0 ft. 64 ft. Clay
4.Date Well(s)Completed: 01/23/23 `,,ell ID# 64 rt• 305 ft• Granite L `?
1, 4
5a:Well Location: "
Walter&Vada Taylor ft. rt. Map , n j ?�
Facility/Owner Name Facility ID#(if applicable) ft. ft.
337 Billy Cove Rd. Candler 28715 ft. ft.
Physical Address,City,and Zip ft. ft.
Buncombe 9605-65-5253000 21•REMARKS
County Parcel Identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 2 erti ation•
35.495 N -82.676 r
01/23/23
6.Is(are)the well(s)OPermanent or OTemporary Signature of Certified Well Contractor Date
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: EjYes or EjNo with 15A NCAC 02C.0100 or 15ANCAC 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 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: 305 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths ifeli ferent(example-3@200'and 2@100D construction to the following:
10.Static water level below top of casing: 15 (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 Iniection 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.)
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
13a.Yield(gpm) 60 Method of test: 2 Hours 24c.For Water Supply&Iniection 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: 56 Tabs completion of well constructiori 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