GW1--07362_Well Construction - GW1_20231113

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
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1.Well Contractor Information:
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Travis Greene 14.WATER ZONES. ":
FROM TO DESCRIPTION I
Well Contractor Name 0 ft. 185 tt. i„
4238 ft. ft.
NC Well Contractor Certification Number 15:OUTER CASING(for multi-cased wells)OR LINER(if ap licable)
Greene Brothers Well &Pump, WT Inc. FROM TO DIAMETER, THICKNESS MATERIAL o 11- 116 ft* 6 1/4 !in' Steel o
Company Name 16.INNER CASING OR TUBING(geothermal closed-loop) '
WEL2023-00326 FROM TO DIAMETER' THICKNESS MATERIAL
2.Well Construction Permit#: ft. it. �in•
List all applicable well construction permits(i.e.UIC,Count:State,Variance.etc.)
ft. ft. ,in.
3.Well Use(check well use):
437.SCREEN . ' -
Water Supply Well: FROM TO DIAMETER ' SLOT SIZE' THICKNESS MATERIAL
III Agricultural • DMunicipal/Public ft. ft. in.
IN Geothermal(Heating/Cooling Supply) DResidential Water Supply(single) fL ft in.
*Industrial/Commercial _Residential Water Supply(shared) '18.GROUT ,
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
hrigation •
Non-Water Supply Well: o ft. 20 ft• Bentonite
111iMonitoring DRecovery ft. ft.
Injection Well: ft. ft.
*i Aquifer Recharge Groundwater Remediation 19.SAND/GRAVEL PACK(if applicable)
*Aquifer Storage and Recovery 0Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
MI Aquifer Test EStormwater Drainage ft. ft.
*Experimental Technology D Subsidence Control 1.' ft. • ft.
li Geothermal(Closed Loop) Tracer 20:DRILLING LOG(attach additional sheets if necessary) .
FROM TO DESCRIPTION(color,hardness,soil/rock type,grain size,etc.)
MI Geothermal(Heating/Cooling Return) DOther(explain under#21 Remarks) a ft. 116 ft. Clay
4.Date Well(s)Completed: 10/03/23 Well ID# 116 it225 ft. 'Granite ,
ft.
5a.Well Location: / ' ft. . r-, �- � r
ft. t ' J r 1
(Permit-Tommy Plemmons)Hunter Bowman
Facility/Owner Name Facility ID#(if applicable) ft. ft. NO V I 4:
699 Reeves Cove Rd. Candler 28715 ft. ft. ZOL.i
ft. ft. inv,:::., .. �n P.—
Physical Address,City,and Zip , i t,-
Buncomb 9605-97-4804 "21.REMARKS
County Parcel Identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one let/long is sufficient) ( 22.Certification:
35.503 N -82.664 W � � _ �
�� � y 10/03/23
Signature ot&hied Well' ontrac(:or Date
6.Is(are)the well(s)JPermanent or OTemporary
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: IjYes or XjNo with 1SA NCAC 02C.0100 or 15A NCAC 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:
You may use the back of this page to provide additional well site details or well
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
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 I'
9.Total well depth below land surface: 225 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths if different(example-3@200'and 2@100') construction to the following: I I
1ft. Division of Water Resources,Information Processing Unit,
If0. ter level is above level below top of casing:60 ( ) 1617 Mail Service Center,Raleigh,NC 27699-1617
u�ater is casing,use"+"
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
(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
2 hours
Method of test: 24c.For Water Supply&Injection Wells: In addition to sending the form to
13a.Yield(gpm) 10 the address(es) above, also submit I one copy of this form within 30 days of
42 tabs
Amount: completion of well construction to the county health department of the county
13b.Disinfection type: HTH where constructed.
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1 Revised 2-22-2016 r
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources