WM0100570_Groundwater Well Construction Record_20240224

WELL CONSTRUCTION RECORD (GW-1
1. Well Contractor Information:
John C. Schat,aell
Well Contractor Name
2332-A
NC Well Contractor Certification Number
M&W Drilling, LLC
Company Name WM O1oo5 " 2. Well Construction Permit #: " 7
O
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc)
3. Well Use (check well use):
Water Supply Well:
Agricultural []Municipal/Public
Geothermal (Heating/Cooling Supply) Residential Water Supply (single)
Industrial/Commercial DResidential Water Supply (shared)
Irri ation
Non -Water Supply Well:
X Monitoring []Recovery
Injection Well:
Aquifer Recharge `Groundwater Remediation
Aquifer Storage and Recovery []Salinity Barrier
Aquifer Test 0 Stormwater Drainage
Experimental Technology []Subsidence Control
Geothermal (Closed Loop) []Tracer
Geothermal (Heating/Cooling Return) M Other (explain under #21 Remarks)
4. Date Well(s) Completed: 2/21 /24 Well 1D#MW-4
5a. Well Location:
Casa Terra Properties LLC
Facility/Owner Name Facility ID# (ifapplicable)
936 Tunnel Road, Asheville, NC 28805
Physical Address, City, and Zip
Buncombe 965897168100000
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35035'20.12" N 82030'05.38" W
6. Is(are) the well(s)Permanent or []ITemporary
7. Is this a repair to an existing well: []Yes or []No
If this is a repair, fill out known well construction information and explain the nature of the
repair under #21 remarks section or on the flack of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface: 48 (ft.)
For multiple wells list all depths if d fferent (example- 3@200' and 2@100')
10. Static water level below top of casing:
Ifwater level is above casing, use "+"
11. Borehole diameter: 8.75 (in.)
12. Well construction method: Hollow Stem Auger
(i.e. auger, rotary, cable, direct push, etc.)
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING for multi -eased wells OR LINER if a licable
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING(geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
33 ft-
2 b"
SCh 40
PVC
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
33 ft•
48 ft-
2 in'
1 0.010
SCh 40
PVC
ft.
ft.
in.
18. GROUT
FROM
I TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft.
29 fL
Portland Cement
Mix & Pour (870 Ibs)
29 ft.
31 ft-
Bentonite Chips
Pour 80lbs
ft.
&
19. SAND/GRAVEL PACK ifa licable
FROM
TO
MATERIAL
EMPLACEMENT METHOD
31 ft.
48 ft.
#2 Medium Sand
Pour
ft.
ft.
20. DRILLING LOG attach additional sheets if necessary)
FROM
TO
DESCRIPTION color, hardness, soiltrock type, grain size, etc.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
22. Certif cation:
G U2-24-24
Signature of Certified Well Contractor Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
(ft) Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 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: Amount: 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