GW1--06691_Well Construction - GW1_20241108

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WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
1.Well Contractor Information:
Kolby Mitchel Sawyers
r,1.4AVaTEIMcirrcSMA MW_, '04;ve.qc.AWIfA M
FROM ' TO DESCRIPTION
Well Contractor Name ft. ft.
4471-A
ft. ft.
II
NC Well Contractor Certification Number ✓1S;(I(}thR';Ca SlttitCrifait,Uiiiltt'cas¢i1:ivilli1)eDINEIt(it p'yti'1itlte) a NW:4
CLYDE SAWYERS & SON WELL & PUMP INC FROM TO DIAMETER THICKNESS I MATERIAL
+1 ft• 80 ft. 6.25 ' in. #21 PVC
Company Name K.
WEL2023-00376 .a1 �iNNElt.cA5Katit ittitllNc:(t eo e,tnateiosed toopgl� .. ...r
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.) ft. ft. in.
3.Well Use(check well use): ft. ft. in.
Water Supply Well: l :S`eRgENAYr, " ��, "w ,
PP FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
I!j
Agricultural �ATunicipal/Public ft. ft. in.
Geothermal(Heating/Cooling Supply) El Residential Water Supply(single) ft. ft. in.
industrial/Commercial
Non-Water Supply Well:
Residential Water Supply(shared) 18:GRpUTw � x
/irrigation FROM TO MATERIALEMPLACEMENT METHOD&AMOUNT
0 ft. 20 ft. Bentonite Pumped
Monitoring
Injection Well:
Aquifer Recharge
Recovery ft ft. Cap Top with Bentomite chips
ft. ft.
Groundwater Remediation
19`SAND`iGRAVEOBSBIKA f nRj3lir'altl ri gilr" 1': •'+, ''
Aquifer Storage and Recovery Salinity Barrier IROM TO MATERIAL EMPLACEMENT METHOD
Aquifer Test [3Stonnwater Drainage ft. ft,
Experimental Technology Subsidence Control ft. ft.
Geothermal(Closed Loop) ®Tracer 2ll RILIANGIOG{at'aetiaiidi iiiiii Leers ilnecessat•jj R
FROM TO DESCRIPTION(color.hardness,soil/rock type,grain size,etc.)
DGeothermal(Heating/Cooling Return) ®Other(explain under#2I Remarks) 0 ft. 80 ft. OVER BURDEN
9-20-2024
4.Date Well(s)Completed: Well ID# 80 ft. 385 ft. GRANITE e•-7.7,-- :,,:;--�,, �
5a.Well Location: ft. ft. ., �,,•1,.:,; 'Vy L_,1.)
OSWALDO VARGAS ft. ft. NOV 0 8 2024
Facility/Owner Name Facility ID#(if applicable) ft. ft.
221 JD TRAIL CANDLER, NC 28715 ft. ft. , ir=:,,;r 1. " /'7^^.51.:--aJ i..:`
Physical Address,City,and Zip ft. ft.
BUNCOMBE 96161167250000 elaituwAittcsttgatfIKW.Ja
County Parcel Identification No.(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 9-25-2024
6.Is(are)the well(s) X Permanent or Temporary Signa a of el ed1➢t onlraclor Date
By signing th. Orin,/hereby certify that the well(s)ryas(were)constructed in accordance
7.Is this a repair to an existing well: 0Yes or ONo with ISA NCAC 02C.0101)or ISA 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 form.
23.Site diagram or additional well details:
8.For Ceoprobe/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: r SUBMITTAL INSTRUCTIONS :
9.Total well depth below land surface: 385 (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 c@200'and 2(4)/00') construction to the following: j
40
10.Static water level below top of casing: (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) 15 Method of test: RIG 24c.For Water Supply&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: 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