GW1--05908_Well Construction - GW1_20241001

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
KENNY SARGENT 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
ft. ft.
A - 4226
ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells)OR LINER(if ap licable)
GEOLOGIC EXPLORATION FROM TO DIAMETER THICKNESS MATERIAL
0.0 ft. 71.0 ft. 6.0 1n- SCH 40 PVC
Company Name
16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS MATERI U I.
List all applicable well construction permits(i.e.U/C,County,State.Variance,etc.) ft. ft. in.
3.Well Use(check well use): ft. ft. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural OMunicipal/Public ft. ft. in.
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑irrigation ❑Wells>100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0.0 ft' 71.0 ft PORTLANDBENTONITE SLURRY
RIMonitoring ❑Recovery ft. ft.
Injection Well: '
ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK(if applicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test OStormwater Drainage ft. ft.
❑Experimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) OTracer 20.DRILLING LOG(attach additional sheets if necessary)
OGeothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness soil/rock type,grain size,etc.)
0.0 ft- 25.0 ft' BROWN SILTY CLAY
4.Date Well(s)Completed: 02/29/24 Well ID# CPA-7BR 25.0 ft• 32.0 R• BROWN SILT
5a.Well Location:
32.0 ft. 64.0 ft. BROWN PWR
ASHEVILLE STEAM PLANT 64.0 ft• 137.0 it GRAY ROCK
Facility/Owner Name Facility ID#(if applicable) ft. ft.
52 NEW ROCKWOOD ROAD ARDEN 28704 ft. ft.
Physical Address.City,and Zip ft. ft. i •t :F ` .' t f 7:
BUNCOMBE 21.REMARKS ''�� '
County Parcel Identification No.(PIN) OPEN HOLE O v 1 20 4_,...
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: If 3:'.:kn-.r.• s,, Nr,,g2rr4s(h:t
(if well field,one lat/long is sufficient) 22.Certification: CoNCet:.-'9
35° 27' 49.55" N 82° 32' 05.44" W 6e1 , 04/19/24
6.Is(are)the well(s): MPermanent or ❑Temporary Signature of Certified Well Contractor Date
By signing this form,I hereby certify that the well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or RINo ISA NCAC 02C.0100 or/SA NCAC 02C.0200 Well Construction Standards and that a copy
If this is a repair,Jill out known well construction information and explain the nature of the 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 construction info
construction,only I GW-1 is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach additional pages if necessary.
drilled: 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: (ft.) Submit this GW-1 within 30 days of well completion per the following:
For multiple wells list all depths iifdifferent(example-3Q200'and 2@100)
37.19 24a. For All Wells: Original form to Division of Water Resources (DWR),
10.Static water level below top of casing: 01) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
If stater level is above casing,use" '
11.Borehole diameter: 6.0 (in.) 24b. For Injection Wells:Copy to DWR,Underground Injection Control(IUC)
Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: SONIC
24c.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the
(i.e.auger,rotary,cable,direct push,etc.) county environmental health department of the county where installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPD:Copy to DWR,CCPCUA
Permit Program,1611 MSC,Raleigh,NC 27699-1611
13a.Yield(gpm) Method of test:
13b.Disinfection type: Amount:
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018