GW1--04755_Well Construction - GW1_20240812

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WELL CONSTRUCTION RECORD (GW-I) For Internal Use Only:
1.Well Contractor Information:
Ko by Mitchel Sawyers 14.WATER ZONES 1
FROM TO DESCRIPTION
Well Contractor Name ft. ft.
4471-A
ft. ft.
NC Well Contractor Certification Numberv,..ittettottaiNG dor maid-cased wells)OR LINER(If ap icabto
CLYDE SAWYERS& SON WELL&PUMP INC FROM •1'0 DI!ME TER THICKNESS MATERIAI,
+1 it 30 ft, 6.25 in, #21 PVC
Company Name
2024-00265 16,INNER CASING OR TUBING(geotherm al closed-loop)
2.Well Construction Permit#: FROM TO DIAMETER FITICKNESS MATERIAL
List all applicable well construction permits(i.e.UIC',Courtly,State,Variance.etc.) fL ft. in.
3.Well Use(check well use): ft' ft. in.
W k7.SCREEN
•
FROM TO DI AM ETV SiOF SITE )'III(K",I:SS M'St F'.RIM.
Agricultural ®Municipal/Public ft. ft. is.
Geothermal(Heating/Cooling Supply) ©Residential Water Supply(single) ft. ft. in.
Industrial/Commercial OResidential Water Supply(shared) 18.GROUT
ligation FROM ro MA rE RI(I_ F NI PI,1{'E MFNI'SIT"HOn Si%MO(VI _
Non-Water Supply Well: o ft. zo ft. Bentonite Pumped
Monitoring ®Recovery ft. ft. Cap Top with Bentonite chips
Injection Well:
ft. ft.
Aquifer Recharge 0 Groundwater Remediation -
19:.SAND/GRAVEL PACK(if t(pplicablc
Aquifer Storage and Recovery D Salinity Barrier FROM TO M,crERIAL EMPI.AC EMIENT METHOD
Aquifer Test OStomrwater Drainage ft. ft.
JExperimental Technology 0Subsidence Control ft. ft.
pGeothermal(Closed Loop) 0Tracer 20,DIIILL1NG LOG(attach additional sheets if necessary)
FROM TO DESCRIPTION(color,hardness.midi rock type,grain size.etc.)
Geothermal(Heating/Cooling Return) 00ther(explain under#21 Remarks)
0 ft. 30 ft OVER BURDEN
4.Date Well(s)Completed:7-4-2024 Well ID# 30 rt. 485 ft• GRANITE
5a.Well Location: ft ft. 4' .` -.'k-...' +
Brendan Flood ❑. ft AUG 1 2 2024
Facility/Owner Name Facility ID#(if applicable) ft. ft.
585 Laurel Valley Drive Asheville, NC 28805 fr. ft. lr,f.:,:::a.t°'a o-r---4n;;-,, silhit
Physical Address,City,and Zip ft. ft. -CPA -.1'''
Buncombe 977060682200000 L211..REMARKS/� A CERTIFY
T C
County Parcel Identification No.(PIN) V Y FI L. WAS SFLF CERTIFY i
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field.one lat/long is sufficient) 22.Certification:
N W 7-11-2024
6.Is(are)the well(s)0Permanent or ®Temporary Signa coffer ed ontractor Date
By signing th Olin,/hereby certifr that the well(s)was()vere)constructed in accordance
7.Is this a repair to an existing well: 0 Yes or %DNo with 15A NCAC OW.0100 or 15A NCAC(I2C'.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 021 remarks section or on the buck of this form.
23.Site diagram or additional well details:
8.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: 485 (f•) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths ifdiJjerent(example-3@200'and 4-4/0(1') construction to the following:
10.Static water level below top of casing:40 (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: 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) 25 Method of test: RIG 24c.For Water Supply& luiection 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 OW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016