GW1--04800_Well Construction - GW1_20240814

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
Kolby Mitchel Sawyers :ir ,N w
FROM TO DESCRIPTION
Well Contractor Name ft. ft.
4471-A
ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased tvellsQOR LINER(if ap' foible)
CLYDE SAWYERS & SON WELL & PUMP INC FROM TO DIANIF FER THICKNESS J M.AIT:RIA1
+1 ft 51 ft. 6.25 In- #21 PVC
Company Name
WP24-002 16.INNER CASING OR TURING IgLothermal closed-loop)
2.Well Construction Permit#:_ PROM To nLvu•rER rutcLNfss MA FERIA!.
List all applicable well construction permits(i.e.UIC,County.State,Variance,etc.) It. Its I"'
3.Well Use(check well use): • ft. ft. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MAIL RI Al
Agricultural OMunicipal/Public ft. ft. in.
Geothermal(Heating/Cooling Supply) l Residential Water Supply(single) ft. ft. in.
Dlndustrial/Commercial DResidential Water Supply(shared) 18.GROUT _
()Irrigation FROM TO MA I'EIt111. F MEI ACEMFN I MT THOU&ANIMAL
Non-Water Supply Well: 0 ft. 20 ft. Bentonite Pumped
()Monitoring ORecovery ft. ft. Cap Top with Bentomite chips
Injection Well: -ft. tt.
()Aquifer Recharge ()Groundwater Remediation - •19.SAND/GRAVEL PACK(if applicable)
OlAquifer Storage and Recovery OSalinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
0Aquifer Test OStormwater Drainage ft. ft.
0 Experimental Technology 0 Subsidence Control ft. ft.
()Geothermal(Closed Loop) OTracer 20.DRILLING LOG(attach additional sheets if necessary)
FROM TO DESCRIPTION(color,hardness,soil/rock type.groin site,etc.)
()Geothermal(Heating/Cooling Return) DOther(explain wider#21 Remarks) 0 ft 51 f4 OVER BURDEN
4.Date Well(s)Completed: 07 31 24 Well ID# 51 ft. 185 ft• GRANITE
ft. ft.
5a.Well Location: _
Steve Monahan It. ft. M,:! 'i 1: L)
Facility/Owner Name Facility ID#(if applicable) ft. ft.
f 1 : 2024
TBD Woodpecker Lane ft. ft.
Physical Address,City,and Zip ft. ft. -
.
Transylvania 8573-36-6856-000 21.REMARKS •
County Parcel Identification No.(PIN) SELF CERTIFY
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
-
(if well field,one lat/long is sufficient) 22.(crtification:
N Vs 07-31-24
6.Is(are)the well(s)OX Permanent or Temporary Sign,,, c o„( CI nlractur Date
By signing th Orin.I hereby certifi•that the wells)was(were)constructed in accordance
7.Is this a repair to an existing well: ©Yes or XONo with ISA NCAC 02C.0100 or ISA NCAC(12C.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 back 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.
dulled. i SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 185 (R•) 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 2(a•10(Y) construction to the following:
10.Static water level below top of casing: 35 (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) 12 Method of test: RIG 24c.For Water Snooty&Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b.Disinfection type: PILLS Amount: 28 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 Reaources 'Revised 2-22-2016