GW1--01193_Well Construction - GW1_20240219

' , F iii t Eormy ..w
WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only: .
1.Well Contractor Information:
Kolby Mitchel Sawyers .4?;WATER=ZOlNES .: 04,W I; .1 :4`, . ...
FROM TO DESCRIPTION
Well Contractor Name ft. ft.
4471-A
ft. ft.
NC Well Contractor Certification Number
t15.,Ul1TERtCaSItITGffor,mult7 cflst:clRvellsAR<tIhERWa"[i ticablc)` '.v_ 4."
CLYDE SAWYERS&SON WELL & PUMP INC FROM TO DIAMETER t THICKNESS mA ERIAt•
+1 ft 50 ft. 6.25 !' 1° #21 PVC
Company Name
2023-00519 r6,IINNER CASING-ORTUBINC(gedlhdimnId osed-lou , ,`u �' „ F,'<. ..., ;*
2.Well Construction Permit#: FROM TO 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. fin.
t,7 SGRLEiY�• .i.; � k... `. a :,.
11 Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
Agricultural Municipal/Public ft. ft. in.
Geothermal(Heating/Cooling Supply) Residential Water Supply(single) ft. ft. in.
industrial/CommercialResidential Water Supply(shared) st8:GROUT � 5 , a<� �av ,.
irrigation FROMTO SIATItIs I.At. , EMPLACEMENTMETHOD&ASIOUNT
Non-Water Supply Well: 0 ft. 20 ft• Bentonite l' Pumped
Monitoring Recovery ft. ft.
Cap Top with Bentomite chips
Injection Well:
ft. ft, i
Aquifer Recharge Groundwater Remediation
19`SAND/GRAVEE-PACK'(if appliaab(#).� ems, 1.vtL Sri: ' `Y .a,.r..:�s/
Aquifer Storage and Recovery 0 Salinity Barrier FROM TO MATERIAL EMPLACEMENT Aquifer Test 0Stonuwater Drainage ft. ft.
Experimental Technology Subsidence Control ft. ft.
(Geothermal(Closed Loop) E3 Tracer 2111TRIDIdNGiL`0`6;{aitacl"addthonall`sheets'iF:necessatY)s v� W
FROM TO DESCRIPTION(color,hardness,soil/rock type,grain size,etc.)
Geothermal(Heating/Cooling Return) E3 Other(explain under#21 Remarks)
0 ft. 50 ft• OVER BURDEN
4.Date Well(s)Completed:12-13-2023 Well iD# 50 ft 425 ft' GRANITE' '
ft. ft.
5a.Well Location:
Brett Sister ft. ft. r--i ,.,.r to ,"
Facility/Owner Name Facility ID#(if applicable) ft. ft. $E
99 Bear Woods Trail Asheville, NC 28805 ft. ft. i btl7 1 91024
Physical Address,City,and Zip ft. ft.
Buncombe 976044340100000 521,REvt= ICSI i"W li ry L ` Fes, '.tn,wir 20;,,,,M1.r l: .
Cttv'0.130C
County Parcel identification No.(PiN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
Orwell field,one lat/long is sufficient) 22.Certification:
N W 12-15-2023
6.1s(are)the well(s) X Permanent or ['Temporary Sigma a of er ed antrrctor Date
By signing fit form,I hereby tel that the well(s)was(were)consn•trcred in accordance
7.Is this a repair to an existing well: D Yes or ElNo with 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a
If this is a repair..frll out known well construction information and explain the nature of the copy of this record has been provided to the'ls ell owner.
repair under#21 remarks section or on the back of this farm. i
23.Site diagram or additional well details:
R.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:1 SUBMITTAL INSTRUCTIONS '
9.Total well depth below land surface: 425 (ft) 24a. For All Wells: Submit this fortis within 30 days of completion of well
For multiple wells list all depths if dierent(example-3@,200'and 2 tc l o(1') construction to the following: I
10.Static water level below top of casing: 60 (ft.) Division of Water Resources,information Processing Unit,
If water level is above casing,use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
` i
11.Borehole diameter: 6.25 (in.) 24b.For Infection 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
(i.e.auger,rotary,cable,direct push,etc.) i ,
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center;Raleigh,NC 27699-1636 . .
13a.Yield(gpnl) 10 Method of test: RIG 24c.For Water Supply&Injection Wells: In addition to sending the form to
the address(es) above, also submit Onel copy of this form within 30 days of
13b.Disinfection type: PILLS Amount: 35 completion of well construction to the county health department of the county
where constructed.
I ,
Form OW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016
4i