GW1--01312_Well Construction - GW1_20240229

WELL CONSTRUCTION RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information:
Kevin White 14.WATER ZONES
FROM TO DESCRIPTION
Well Contractor Name 134 fL 142 ft- I Wet
2973 -- -ft. " ft.
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells)OR LINER(if ap licable)
FROM TO DIAMETER THICKNESS MATERIAL
Parratt-Wolff, Inc. o ft. 75 ft. 6.0 in. Sch.40 Galv. Steel
Company Name 16.INNER CASING OR TUBING(geothermal closed-loop)
FROM TO DIAMETER THICKNESS MATERIAL
2.Well Construction Permit#: 0 ft* 132 ft- 2 in' sch40 pvc
List al/applicable well permits(i.e.County,State,Variance,Injection,etc.) ft. ft. in.
3.Well Use(check well use): 17.SCREEN
Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 132 ff. 142 ft. 2 in. .010 sch40 pvc
ft. ft. in.
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(sin le)
❑Industrial/Commercial 0 Residential Water Supply(shared) 1S,GROUT
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
❑Irrigation 0 ft. 126 ft Portland Cem Tremie
Non-Water Supply Well: ft.-- - R.-
❑Monitoring ❑Recovery -126 129- - Bentonite-Chil-Poured-"- - -
Injection Well: 147 f`• 186 ft. Bentonite Chi!Poured
❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK(if applicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
129 ft• 147 _ ft, #1 Sand Tremie
❑Aquifer Test ❑Stormwater Drainage ft. ft.
❑Experimental Technology ❑Subsidence Control
20.DRILLING LOG(attach additional sheets if necessary)
❑Geothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION(color,hardness,soil/rock type,grain size,etc.)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#2I Remarks) ft. ft.
1/11/24 BI39-BW5 ft. ft.
4.Date Well(s)Completed: Well ID# ft. ft. r' ^'` /�'
���,+If_/\/ '''r)
5a.Well Location: ' ft. ft. �`
Chemtronics ft. ft. FLU 2 a 2U24
Facility/Owner Name Facility ID#(if applicable) ft. ' ft. �,�
Information: . 4irdeR _1}
180 Old Bee Trap Road, Swannanoa ft. ft. INJ01306
Physical Address,City,and Zip
21.REMARKS
Buncumbe
' 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:
'35.623709 N -85.432954 W 1,„) ( s ( - 3p- a 4-/
Sigifattgb of Certified Well Contractor Date
6.is(are)the well(s): ❑Permanent or ❑Temporary By signing this form,i hereby certn5,that the well(s)was(were)constructed in accordance
with i5A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a
7.Is this a repair to an existing well: ❑Yes or IBNo copy of th is record has been provided to the well owner.
If this is a repair,fill out known well construction information and explain the nature oldie
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.Number of wells constructed: 1 construction details. You may also attach additional pages if necessary.
For multiple injection or non-water supply wells ONLY with the same construction,you can
submit one form. SUBMITTAL INSTUCTIONS
9.Total well depth below land surface: 147 (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: 134 (ft.) Division of Water Resources,Information Processing Unit,
If water level is above casing,use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
1I.Borehole diameter: 1 0 (in.) 24b. For Injection Wells ONLY: In addition to sending the form to the address in
HSA/8"Air Hammer/5 7/8 Air Hammer 24a above, also submit a 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) Method of test: 24c.For Water Supply&Injection Wells:
Also submit one copy of this form within 30 days of completion of
13b.Disinfection type: Amount: well construction to the county health department of the county where
constructed.
Fonn GW-I North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised August 2013