GW1--02982_Well Construction - GW1_20240513

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WELL CONSTRUCTION RECORD For Internal Use ONLY:
This form can be used for single or multiple wells t
1.Well Contractor Information:
Taylor Ray Boger I1ovikTftwzo>uys 0i 41 ; 5;
FROM TO DESCRIPTION
Well Contractor Name ft. ft.
4614—A ft. ft. I, '
NC Well Contractor Certification Number `1S OUTER`RAStNG(far'm©ltt-casi�d(s'ells);OR 1MNER(tf flick abtej ,i-. `��
FROM TO DIAMETER THICKNESS MATERIAL
CLYDE SAWYERS & SON WELL & PUMP INC +1 tt• 53 It 6.25 ; in. #21 1 PVC
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Company Name fb INNElt�'CASTNGORT ISING(geoitierinaletused-toop ' -' ` . '
2021-00580 FROM TO DIAMETER THICKNESS MATERIAL
2.Well Construction Permit#: ft. ft. in.
List all applicable well permits(i.e.County,State,Variance,Injection,etc.)
ft, ft. ; in.
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3.Well Use(check well use): ,1.7, SCREEN,:I , . " ti-Vati r i,k. .a.' IO P
Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
ft. ft. in.
❑Agricultural ❑Municipal/Public ,
ft. ft. in.
❑Geothermal(Heating/Cooling Supply) OResidential Water Supply(sin le)
❑Tndustrial/Commercial ❑Residential Water Supply(shared) :18.,GROVTx �' 'k _ `4 .z.� '"A`':'ue ' 0
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
❑Irrigation 0 ft' 20 ft. Bentonite Pumped
Non-Water Supply Well:
❑Monitoring ❑Recovery ft. ft. Cap Top with Bentonite Chips
• Injection Well: ft. ft.
❑Aquifer Recharge ❑GroundwaterRemediation *19'S MIIGRAY;Ef;'1!ACIC;(ifupjiltca)le), ;": °•. M 'AV
FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Storage and Recovery ❑Salinity Barrier ft. ft.
0 Aquifer Test ❑Stormwater Drainage ft. ft.
❑Experimental Technology ❑Subsidence Control
*20 11t1LEINGILTI (a[tiCh addttio taYsheetiif necessary)iVA MI .
❑Geothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION(color,hardness soiVroch type.grain size.etc.)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) 0 ft. 53 ft. i OVER BURDEN
2-26-2024 53 ft• 805 ft GRANITE
4.Date Well(s)Completed: Well ID# '
ft. ft.
5a.Well Location:
ft. ft.
Theodore C Rhoadesft. ft. I '" �'"'� r".L_`'
Facility/Owner Name Facility ID#(if applicable)
`t' `t' MAY 1 2024
92 Running Ridge Road Asheville, NC 28804 ft. ft. -
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Physical Address.City,and Zip 2T,gRE114ATOW,c 7 ., 14 ,I(tsL; rs,r:.;t ,P , VA ;t+sr'�o-I . tx
Buncombe 9731420564 use s''�0
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 �r � 2-27-2024
Signature of ed ell ntracto`r Date
6.Is(are)the well(s): ®Permanent or ❑Temporary By signing this form,I hereby certibt that the nell(s)was(were)constructed in accordance
with 15.4 NCAC 02C.0100 or 15.1 NCAG 02C.0200 Well Construction Standards and that a
7.is this a repair to an existing well: ❑Yes or o No copy of this record has been provided to the well owner.
If this is a repair,fill out knower well construction information and explain the nature of the
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: 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 I!
submit one form. SUBMITTAL INSTUCTIONS
9.Total well depth below land surface: 805 (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:
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10.Static water level below top of casing: 260 (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: 6.25 (in.) 24b.For Injection Wells ONLY:I in addition to sending the form to the address in
ROTARY 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) 3 RIG 24c.For Water Supply&Injection Wells:
Method of test:
PILLS Also submit one copy of this fo 'within 30 days of completion of
13b.Disinfection type: Amount: 35 well construction to the county h Ith department of the county where
constructed.
Form GW-1 North Carolina Department of Environment and Natural Resources—Division of Water Resources Revised August 2013