GW1--07363_Well Construction - GW1_20231113

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
I.Well Contractor Information:
ii
Travis Greene "14..WATERZONES
Well Contractor Name FROM TO DESCRIPTION
0 ft• 160 II' soap.
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
0 ft• 82 ft. 61/4 I: ill- PVC .
Company Name •
16.INNER CASING OR TIMING(geothermal closed-loop).' - _
2.Well Construction Permit#:WEL2022-00605 FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.UIC,Count,State,Variance,etc.) ft. ft. 1 in.
3.Well Use(check well use): ft. ft. I, in.
Water Supply Well
• FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
,Agricultural OMunicipal/Public ft. ft. ' in.
i Geothermal� (Heating/Cooling Supply) DResidential Water Supply(single) ft. ft. i�•
NI Industrial/Cotmnercial OResidential Water Supply(shared) 18:GROUT
I Irrigation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 ft• 20 ft. Bentonite .
IiMonitoring ORecovery ft. ft.
Injection Well:
ft. ft-
*1Aquifer Recharge 0 Groundwater Remediation -
'19.SAND/GRAVEL PACK(if applicable)
*Aquifer Storage and Recovery L0ISalinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
NI Aquifer Test EtStormwater Drainage ft. ft. I,
*Experimental Technology OSubsidence Control ft. ft.
*1 Geothermal(Closed Loop) Tracer 20.DRILLING LOG(attach additional sheets if necessary)_-j', . . ..
FROM TO DESCRIPTION(color,hardness,soiVroch type,grain size,etc.)
11 Geothermal(Heating/Cooling Return) [30ther(explain under#21 Remarks) 0 ft• 62 ff• Clay
09/27/23 62 ft• 165 ft' Granite) '
4.Date Well(s)Completed: Well ID#
5a.Well Location: ft. ft.
Andrew Davis ft. ft. , ' . _ ,--
Facility/Owner Name Facility ID#(if applicable) ft. ft. , l':,°; ';t,,, ,;1.:1c,' s,, ,.!_.
69 Laurel Cove Rd. Candler ft. ft. I' , NOV 1 3 2023
Physical Address,City,and Zip ft. ft
•
Buncombe 8696-92-3323 2r:REMARKS'_ - , r� . :'
County Parcel Identification No.(PIN) '
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: � 1
(if well field,one lat/long is sufficient) 22.Certification:
35.513 N -82.699 w
09/27/23
6.Is(are)the wells) Permanent or [jTemporary Sis�re o tertif ell)Contractor Date
By signing this form,I hereby cert fy that the well(s)was(were)constructed in accordance
7.Is this a repair to an existing well: LJYes or XONo with ISA NCAC 02C.0100 or ISA 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:
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 I 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: 165 (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@I00' construction to the following:
10.Static water level below top of casing: 06 (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 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 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) 30 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: 29 tabs completion of well construction to the county health department of the county
where constructed. I,
1
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resourcels I Revised 2-22-2016