GW1--03548_Well Construction - GW1_20240612

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
Kolby Mitchel Sawyers 14.WATER ZONES
FROM TO DESCRIPTION 1
Well Contractor Name ft. ft.
4471-A
ft. ft.
NC Well Contractor Certification Number 15.O(:TER CASING(for multi-cased wells)OR LINER(if ap lkable)
CLYDE SAWYERS&SON WELL&PUMP INC FROM TO DI AMP:PER THICKNESS M iiERIAL
+1 it 182 ft• 8.25 in• #21 PVC
Company Name WEL2023-00448 IC INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#: FROM TO DI. tE rot THICKNESS M.4Tf:RIAL
List all applicable wrll construction permits(i.e.UIC.County.State.Variance.etc.) ft. ft, in.
3.Well Use(check well use): ft. ft. in.
Water Supply Well: 17.SCREEN
ruOM Io DIkMFIFR SI 01,:l/E TInCKNFSs MAI TRIM
_
°Agricultural °Municipal/Public ft. ft. in.
°Geothermal(Heating/Cooling Supply) E3 Residential Water Supply(single) ft. ft. in,
industrial/Commercial °Residential Water Supply(shared) 18.GROUT
I',Irrigation FROM rO MA(I,RI u. 1.met Ac'cnlr\I\II I1101)&5MOt wr
Non-Water Supply Well: o ft. 20 ft• Bentonite Pumped
(2Monitoring °Recovery _ ft ft. Cap Top with Benlomile chips
Injection Well: ft. ft.
°Aquifer Recharge ®Groundwater Remediation
19.SAND/GRAVEL PACK(if applicable)
°Aquifer Storage and Recovery °Salinity Barrier FROM TO .IATERI:y. . EMPLACLMLvr\n,tnot)
['Aquifer Test OStonuwater Drainage ft. ft.
°Experimental Technology 0 Subsidence Control ft. ft.
°Geothermal(Closed Loop) °Tracer ' 20.DRILLING LOG(attach additional sheets if necessary)
FROM TO DESCRIPTION(color,hardness,soihrock type.grain sire,etc.)
°Geothermal(Heating/Cooling Return) ['Other(explain under#21 Remarks) 0 ft 182 ft• OVER BURDEN
3-18-2024 182 R• 605 ft• GRANITE
4.Date Well(s)Completed: Well ID# «,
IL ft. �'l' jl
5a.Well Location: V t`L.'
BOBBY WRIGHT u, ft.
Facility/Owner Name Facility ID#(if applicable)
ft. ft. JUN 1 2 2024
88 REEDS CREEK ROAD FAIRVIEW, NC ft. ft. iriferMIGAieil Pre(4104yt!URI
Physical Address,City,and Zip ft. ft. DlYGI'1041
BUNCOMBE 9677801595 21.REMARKS
County Parcel IdentifiicationNo.(PIN) Well was self certified
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22.Certification:
N W 03/21/2024
6.Is(are)the well(s)IX Permanent or E3Temporary Signs c of C et al ontractor Dale
By signing th wnt,I hereby cer'tiifj'that the well(a)was(were)constructed in acrordarue
7.Is this a repair to an existing well: °Yes or 1cONo with ISA NCAC 02C.0/00 or 1SA NCAC 02C'.0200 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 of this firmer.
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.
dolled' SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 605 (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 2C 10(Y) construction to the following:
10.Static water level below top of casing: 240 (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 Iniection 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) 1.5 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 CiW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016