GW1--06710_Well Construction - GW1_20241108

WELL CONSTRUCTION RECORD For internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: - ---
14.
Taylor Ray Boger - FROM TODESCRIPTION , __
Well Contractor Name ft. ft.
4614-A ft. ' ft.
NC Well Contractor Certification Number :.15.OUTER CASING(for niutti-casedweUS)';OR LINER(ifappirldbie) 'r , .,
FROM TO DIAMETER THICKNESS MATERIAL
CLYDE SAWYERS & SON WELL & PUMP INC +1 ft- 97 ft- 6.25 in• #21 PVC
Company Name 16.INNERCASIN�G ORTURING"(geothermalclosed-loop)y.� , ,
W E L 2024-00431 FROM TO DIAMETER THICKNESS MATERIAL ___
2.Well Construction Permit it: ft. ft. in.
List all applicable well permits(ie.County,State.Variance.Injection,etc.) ft. ft. in.
3.Well Use(check well use): ,17:SCREEN " .;. - , ,'.
° ,._.,
Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public ft. ft in.
❑Geothermal(Heating/Cooling Supply) l7Residential Water Supply(single) ft. ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) .18•GROUT = i _:-° . .
FROM _ TO MATERIAL EMPLACEMENT METHOD&AMOUNT
0 Irrigation 0 ft. 20 ft- Bentonite Pumped
Non-Water Supply Well: ft. ft. Cap Top with Bentonite Chips
❑Monitoring ❑Recovery _ ,
Injection Well: ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK'(if applicab t) - '- ''- `,
FROM _ TO MATERIAL. EMPLACEMENT METHOD
❑Aquifer Storage and Recovery 0 Salinity Barrier ft. ft.
❑Aquifer Test ❑Stormwater Drainage ft. ft.
❑Experimental Technology 0 Subsidence Control
20.DRILLING;LOG,(attacli additional sheets if necessary) ^- s ''", '', b t.. .
OGeothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION(color,hardness,soil/rock type,grain size,etc)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) 0 ft- 97 ft. OVER BURDEN
10-09-2024 97 ft. 165 ft. GRANITE
4.Date Wells)Completed: Well ID#
ft. ft. —
5a.Well Location: ft. ft. �T C. ,.tv ` %f•,a,_:Li
SETH SOLESBEE ft. ft. A
Facility/Owner Name FacilitylD#(ifapplicable) - NOV 0 8 2024
ft. ft.7 ALPHA DRIVE
ft. R. I lfi:nc,:a.t.. , 'r-.re;}:sj .%r"s'!i`.
Physical Address,City,and Zip
ASHEVILLE 9626-92 9203 THIS WELL WAS SELF CERTIFIED
County Parcel Identification No.(PIN)
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification:
(if well field,one hat/long is sufficient)
N `,it 10-09-2024
Signature of ted Well ntractor Date
6.is(are)the well(s): OPermanent or OTemporary By signing this form,I hereby certify that the well(s)was(were)constructed in accordance
with 15.4 NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a
7.Is this a repair to an existing well: ❑Yes or ElNo 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. SUBMITTAL INSTUCTIONS
9.Total well depth below land surface: 1 65 (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 2@100) construction to the following:
10.Static water level below top of casing: 20 (ft.) Division of Water Resources,Information Processing Unit,
If water level is above casing,use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
1'1.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.) 1
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
30 RIG 24c.For Water Supply&Injection Wells:
13a.Yield(gpm) Method of test:
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-1 North Carolina Department of Environment and Natural Resources—Division of Water Resources Revised August 2013
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