GW1--00896_Well Construction - GW1_20240205

WELL CONSTRUCTION RECORD (GW-1) For Internal'Use Only:
1.Well Contractor Information:
Travis Greene 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
0 ft. 165 ft. 7gpm .
4238
ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased;'wells)iOR LINER`(if ap licable)
Greene Brothers Well &Pump, WT Inc. FROM TO DIAMETER, THICKNESS MATERIAL
0 ft. 92 ft. 61/4 I tn. Steel
Company Name
W E L.2 023-00305 -.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. 1 in.
3.Well Use(check well use): ft. ft. in.
17.SCREEN
Water Supply Well: FROM TO DIAMETER i SLOT SIZE THICKNESS MATERIAL
Agricultural DMunicipal/Public ft. ft. in.I
Geothermal(Heating/Cooling Supply) DResidential Water Supply(single) ft. ft. in. i I
industrial/Commercial Residential Water Supply(shared)
18.GROUT
Irrigation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 it. 20 ft. Bentonite
Monitoring
ft. 1 ft.
Injection Well:
1Ej ft. ft.
Aquifer Recharge Groundwater Remediation 19.SAND/GRAVEL PACK(if applicable)
Aquifer Storage and Recovery Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
Aquifer TestIStormwater Drainage ft. ft.
Experimental Technology Subsidence Control ft. ft.
Geothermal(Closed Loop) Tracer 20.DRILLINGLOG(attach additional'sheets,ifnecessary) '
FROM TO DESCRIPTION(color,hardness,soil/rock type,grain size,etc.)
Geothermal(Heating/Cooling Return) Other(explain under#21 Remarks) 0 ft. 92 ft. Clay
4.Date Well(s)Completed: 11/20/23 Well ID# 92 ft. 205 ft' Granite
5a.Well Location: ft. ft. ,dry `: F
Steven Rowlinson ft. ft. ,4,„,,,, :. ii-2 .i..
Facility/Owner Name Facility ID#(if applicable) ft. ft. r C d 0 5 l Q?Q
231 Bull Creek Rd. Asheville 28805 ft. ft. Irk, ,r_alip:.) ;Di
Physical Address,City,and Zip ft. ft. ��kdE,lii5 1 4UIN-4
Buncombe 9760-88-0270
21C'REMARKS
County Parcel Identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: I
(if well field,one lat/long is sufficient) 22.Certification: '
35.647 N -82.474 �,
.- 11/27/23
6.Is(are)the well(s)JPermanent orO(Temporary Sign tore of Certified Well Contractor Date
By signing this form,I hereby certi&that the well(s)was(were)constructed in accordance
7.Is this a repair to an existing well: jYes or ONo with 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a
If this is a repair,fill out known well construction i formation 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 sameYou 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 I
9.Total well depth below land surface: 205 (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: ,
10.Static water level below top of casing: 20 (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 Infection Wells: In addition to sending the form to the address in 24a
Rotary above, also submit one copy of this forin 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) 9 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: 36 tabs completion of well construction to the county health department of the county
where constructed. ,
i
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources ; Revised 2-22-2016