GW1--02987_Well Construction - GW1_20240513

WELL CONSTRUCTION RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information:
Derrick Heath Sawyers s I4:WATER ZONES. �A `E,- r. , .-
FROM TO DESCRIPTION
Well Contractor Name ft. fL I ,
2436-A ft. fL , '
NC Well Contractor Certification Number -15:OUTER4CASING(fo`r-multi-cased wells)OR LINER(rapplicahlej' '-.Iv,
FROM TO DIAMETER THICKNESS MATERIAL
CLYDE SAWYERS & SON WELL & PUMP INC +1 ft• 140 ft• 6.25 'in. #21 l PVC
Company Name ,16AINNER;CASING ORTURING"(geotherinal clOSed loop}„a ,"'<r',
2024-00021 FROM TO DIAMETER THICKNESS MATERIAL
2.Well Construction Permit#: ft. ft. I in,
List all applicable well permits(i.e.County,State,Variance.Infection,etc) ft. ft. in.
3.Well Use(check well use): 4t7:SCREEN,v. , ;
Water Supply Well: FROM TO DIAMETER 'SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public ft. ft. in.
❑Geothermal(Heating/Cooling Supply) O.Residential Water Supply(single) ft. ft. in.
❑lndustriallCommercial ❑Residential Water Supply(shared) 18rGROUT._,:.Y ,' _ �;'
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
❑Irrigation 0 ft. ft
Non-Water Supply Well: 20 Bentonite Pumped
ft. ft. Cap Top with Bentonite Chips
OMonitoring ❑Recovery
Injection Well: ft. ft.
I
❑Aquifer Recharge ❑Groundwater Remedialion •19rSANRIGRAVEL;PACK(ifappllcabl6N. '•` -'3,,6 _: II 1 .°A'.,,,-
FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Storage and Recovery ❑Salinity Barrier ft H
❑Aquifer Test ❑Stormwater Drainage
ft. ft.
❑Experimental Technology ❑Subsidence Control
=20,.DRILLING[OG(at(acb additicnialriateetk if necessary):.' k, -,
❑Geothermal(Closed Loop) OTracer FROM TO DESCRIPTION(color,hardness soil/rock type,Frain size,etc.) \
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) 0 ft• 140 ft I' OVER BURDEN
4.Date Well(s)Completed: 03-1 1-24 Well ID# 140 ft 205 ft TMGRANITE
5a.Well Location: ft. ft.
McMaster Holdings, LLC ft. ft. MAY 1 2024
Facility/Owner Name Facility ID#(if applicable) ft. ft.
248 Luther Rd 1. tri5,,,.::,,,-;,r:i P-rr vv-.-t t: N'
ft. ft. I. '
�Ats C)v
Physical Address,City,and Zip
Buncombe 86878423890000
County Parcel Identification No.(PIN)
I
Sb.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: i•
22.Certification:
(if well field,one laulong is sufficient)
N
W
Ue041163 ,
03-11-2024
Signature of Certified l Contmcto Date —
6.Is(are)the well(s): OPermanent or ❑Temporary By signing this form,1 hereby cer(tt&that the well(s)was(were)constructed in accordance
with 15A 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 IJNo copy of this record has been provided to the well owner.
If this is a repair,fill out knonn well construction information and explain the unsure 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: 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 I'submit one fora. SUBMITTAL INSTUCTIONS
i.
9.Total well depth below land surface: 205 (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 2ca 100) construction to the following:
10.Static water level below top of casing: 20 (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.Iti 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: l
(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
RIG 24c.For Water Supply&Injectiol Wells:
13a.Yield(gpm) 15 Method of test:
PILLS Also submit one copy of this form;within 30 days of completion of
13b.Disinfection type: Amount: 20 well construction to the county health department of the county where
constructed.
Form GW-1 North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised August 2013