GW1--03544_Well Construction - GW1_20240612

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WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
1.Well Contractor Information:
Kolby Mitchel Sawyers _f4.WATER ZONES';
[Rom IO DESCRIPTION
Well Contractor Name ft. ft.
4471-A
it. ft.
NC St ell Contractor Certification Number 15.OUTER CASING(for multi-cased wells)OR LINER(if apRlicable)
CLYDE SAWYERS & SON WELL & PUMP INC FROM TO DIM TER THICKNESS I MATERIAL
+1 ft 150 ft. 6.25 in. #21 PVC
Company Name
WEL2023-00449 16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#: FROM To DIAMErEK THICKNESS MATERIAL
List all applicable well construction permits tie.UIC,Count'',Starr i,riance,etc.) ft. ft. in.
3.Well Use(check well use): fL ft. in.
Water.Supply Well: t?.SCREEN
PROM io DI It MF:'IER _SI.01"17F TIIICKN!:SS MAIERI Al
Agricultural ®Municipal/Public fI. II. in.
Geothermal(Heating/Cooling Supply) l3 Residential Water Supply(single) fr - tt in.
Industrial/Commercial °Residential Water Supply(shared) 18.GROUT
Irrigation FROM TO NI%TERIAI. F MP!ACIMEN I All IHOD S AtIOCNI
Non-Water Supply Well: o ft. 150 ft• Bentonite Pumped
Monitoring ®Recovery ft. ft. Cap Top with Bentomite chips
Injection Well:
ft. It.
Aquifer Recharge ®Groundwater Remediation
I'4.SAND/GRAVEL PACK(if applicabkL
Aquifer Storage and Recovery ®Salinity Barrier )Ru>1 _ To M CIERfu. EMPI.,(UHLN I\ILl HOD
Aquifer Test ®Stonnwater Drainage ft. ft.
Experimental Technology ©Subsidence Control ft. ft.
Geothermal(Closed Loop) ®Tracer 20.DRILLING LOG(attach additional sheets if necessary)
Geothermal(Heating/Cooling Return) ®Other(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness,soil/rock type.grain sin`,etc.)
0 ft. 135 ft OVER BURDEN
4.Date Well(s)Completed:3-11-2024 Well ID# 135 ft 405 ft• GRANITE
5a.Well Location: ft ft.
2020 BUILDERS LLC ft. ft. ram.•,„.'„,/
Facility/Owner Name Facility ID#(if applicable)
et. ft. � L i�Y
835 GARREN CREEK ROAD FLETCHER, NC 28730 ft. ft. JUN 1 2 2024
Physical Address,City,and Zip ft. ft.
BUNCOMBE 060578182300000 21.REMARKS 1feG:. ''>ntil ' ..:-. ;1.ia
County Parcel Identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lot/long is sufficient) 22.Certification:
N W 4-3-2024
6.Is(are)the well(s)0Permanent or ®Temporary Signa a of Cer ed ontractor Date
By signing th orm,1 hereby certiJi,that the wens)was(were)constructed in accordance
7.Is this a repair to an existing well: ©Yes or [3 No with 15,4 NCAC 02C.010N1 or 15A NCAC 02C.0201)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 to the well owner.
repair under#21 remarks section or on the hack t f this firm.
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: ' SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 405 (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 q,200'and 2(i-100') construction to the following:
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
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.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) 5 Method of test: RIG 24c.For Water Supply&Injection Wells: In addition to sending the form to
PILLS the address(es) above, also submit one copy of this form within 30 days of
13b.Disinfection type: Amount: 35 completion of well construction to the county health department of the county
where constructed.
Form(1W-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016