GW1--04760_Well Construction - GW1_20240812

WELL CONSTRUCTION RECORD For Internal Use ONLY:
This form can he used for single or multiple wells
I.Well Contractor Information:
Taylor Ray Boger 14.WATER ZONES
FROM TO DESCRIPTION
Well Contractor Name ft. ft.
4614-A ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells)OR LI.'NER(if applicable)
FROM TO DIAMETER 1NICK NESS MATERIAL
CLYDE SAWYERS & SON WELL & PUMP INC +1 ft• 68 ft• 6 1/8 in* #188 STEEL
Company Name 16,INNER CASING OR TUBING(geothermal closed-104h.
WEL-2023-00508 FROM TO DIAMETER Title KNESS MATERLM.
2.Well Construction Permit ft: ft. ft. in.
List all applicable well permits(i.e.County,Stale.Variance.injection,etc.) ft• ft• in. — _3.Well Use(check well use): 17.SCREEN Water Supply Well FROM 10__- to\MIl ER SLOE SIZE 'I FREENESS MATERIAL —
• ft. D. in.
❑Agricultural ❑Municipal/Public
❑Geothermal(Heating/Cooling Supply) E lResidential Water Supply R. ft. m.
( $� $ PP Y) PP Y
❑Industrial/Commercial ❑Residential Water Supply(shared) I&GROUT
FRe1M TO NIA I ERI U. F.AIPI,AC EMENT METH M&AMOUNT
❑Irrigation 0 ft• 20 ft. Bentonite Pumped
Non-Water Supply Well: -
DMonitoring ❑Recovery ft. ft. Cap Top with Bentonite Chips
injection Well: ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL,PACK(ifappllesble)
FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Storage and Recovery OSalinity Barrier '
ft. ft.
❑AquiferTest ❑Stormwater Drainage
ft. ft.
❑Experimental Technology ❑Subsidence Control
20.DRILLING LOG(attach additional sheets if necessary)
❑Creothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION(color,hardness.ioiVrock type.grain size,etc.)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) 0 ft- 68 ft. OVER BURDEN
6-12-2024 68 ft- 185 ft• GRANITE
4.Date Well(s)Completed: Well 1130 ft. ft. r-- --- - _
Sa Well Location: ft. ft. 6 iG ,....:(....L.! if
WNC DEVELOPING LLC ft. ft. AUG 1 2 2024
Facility/Owner Name Facility ID#(if applicable) ft. ft.
1445 NEWFOUND ROAD LOT 2 LEICESTER, NC ft ft. 11,&,,r.4..e' .1 :nrv,'.,'sr..a
f„..,- .
Physical Address,City.and Zip 21.REMARKS
BUNCOMBE 86894100500000
County Parcel Identification No_(PIN)
Sb.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification:
(if well field,one IaUlong is sufficient)
N W 6-19-2024
Signature of ed ell ntractor Date
6.Is(are)the well(s): ®Permanent or ❑'temporary By signing this form,1 hereby certify that the met/(r)was(were)constructed in accordance
with 15.4 NCAC 02C.0100 or 15,4 NCAC 02C.0200 Well Construction Standards and that a
7.is this a repair to an existing well: ❑Yes or BNo copy of this record has been provided to the well owner.
If this is a repair,fill out known 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: 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
submit one form. SUBMITPAL iNSTUCTIONS
9.Total well depth below land surface: 1 85 (IL) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths if dif ferent(example-3t 200'and 2(w.100) construction to the following:
10.Static water level below top of casing: 30 (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: 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
lie.Yield(gpm) 20 Method of test: RIG 24c.For Water Supply&Injection Wells:
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-I North Carolina Department of Environment and Natural Resources—Division of Water Resources Revised August 2013