GW1--02119_Well Construction - GW1_20240405

WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
1.Well Contractor Information:
Robin Webb -14.wATERZONES --'. "
Well Contractor Name FROM TO DESCRIPTION
2418 o ft. 305 ft. ZBWa '
rt. .
305 505 ft• i gpm I sosssa 1 gpm
NC Well Contractor Certification Number 15:OUTER CASING(for miilti-cased§wells)OR LINER(if ap.licable), '
Greene Brothers Well &Pump, WT Inc. FROM TO DIAMETER THICKNESS MATERIAL
0 ft. 81 ft. 61/4 in. PVC
Company Name FROM TO TUBING(geothermal closed=loop) _
WEL2023-00542 I6.INNERCASWGORT
2.Well Construction Permit#: DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e. UIC,County,State,Variance,etc.) ft. ft. in.
3.Well Use(check well use): ft. ft. in.
Water Supply Well: FROM TO DIAMETER _ SLOT SIZE THICKNESS MATERIAL
*i Agricultural Di Municipal/Public ft. ft. in.
*Geothermal(Heating/Cooling Supply) .Residential Water Supply(single) ft. ft. in.
l lndustrial/Cotnmercial DResidential Water Supply(shared) g GROUT.
Irrigation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 ft. 20 ft• Bentonite
El Monitoring DRecovery ft. ft.
Injection Well: ft. ft.
*Aquifer Recharge 0 Groundwater Remediation 19.SAND/GRAVEL PACK(if aTElicable)�i Aquifer Storage and Recovery �Salini Salinity FROM TO MATERIAL
EM
PLACEMENT METHOD
*Aquifer Test IStonnwater Drainage ft. ft.
11'Experimental Technology Q0Subsidence Control ft. ft.
Is Geothermal(Closed Loop) Ej Tracer -20.DRILLING LOG(attach:additional sheets if necessary:
FROM TO DESCRIPTION(color,hardness,soil/rock type,grain size,etc.)
ills Geothermal(Heating/Cooling Return) nOther(explain under#21 Remarks) 0 ft. 81 ft* Clay
4.Date Well(s)Completed: 03/05/24 Well ID# 81 ft. 705 ft. Granitel
ft. ft.
5a.Well Location: , z
Maria Ceballos/Sonia Arevalos ft. ft. N'-_' r; '''- It°. .6'"-'
Facility/Owner Name Facility ID#(if applicable) ft. ft.
r es
777 Glenn Bridge Rd. Arden 28704 ft. ft. rtAP� U t 624
Physical Address,City,and Zip ft. ft. }r11�„r�.y; _17•.•.,..,i.2:ur
Buncombe 9633-85-4452 21.REMARKS'. • 1-'++ i5)L ...
County Parcel Identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 2 ertificaIn•
35.443 N -82.564 W
(_i_ 016--) 03/05/24
6.Is(are)the well(s){Permanent or IITemporary Signature o e ,fled Well 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: QIYes or ENo 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 information and explain the nature of the copy of this record has been provided!o the well owner.
repair under#21 remarks section or on the back of this forts.
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 1 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: 705 (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: 30 (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) 4 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: 81' 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