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HomeMy WebLinkAboutGW1--03514_Well Construction - GW1_20230519 WELL CONSTRUCTION RECORD For Internal Use ONLY: This form can be used for single or multiple wells 1.Well Contractor Information: A7'I;R+Z,E)1 GARRETT COLLIN BANKS 14R FROM TO DESCRIPTION Well Contractor Name ft. ft. 4519-A NC Well Contractor Certification Number S.tS..OfS GER:C`A511Y ,fot4mNti cast d ii e0s.01tt MER if u" IiEelite .,. FROM TO DIAMETER THICKNESS MATF.RTAL CLYDE SAWYERS & SON WELL & PUMP INC +1 ec. 115 ft• 6 1/4 in. #21 PVC Company Name 16:lNVE1iGASf1YOR,T.lIB1N(: �eoitietviute3vsed ttia" s � 2023-00139 FROM TO DIAMETER THICKNESS MATERIAL 2.Well Construction Permit#: ft. ft. in. List all applicable well permits(i.e.County,State,Variance,Injection,etc.) ft ft in 3.Well Use(check well use): A11ACaR9rN 1ra%_WWN W� Water Supply Well: FROM TO DIAMETER, SLOT SIZE THICKNESS MATERIAL ft. ft.❑Agricultural ❑Municipal/Public in. ❑Geothermal (Heating/Cooling Supply) OResidential Water Supply(sin(single) ft. ft. in. ❑IndustriaUCommercial ❑Residential Water Supply(shared) FROM TO MATF.RTAL EMPLACEMENT METHOD&AMOUNT ❑hri ation 0 ft. 20 ft- Bentonite Pumped Non-Water Supply Well: ❑Monitoring ❑Recovery rt. ft. Cap Top with Bentonite Chips Injection Well: ❑Aquifer Recharge ❑Groundwater Remediation1?SA?3DIGC1ilV ,PAFHif ❑Aquifer Storage and Recovery El Salinity Barrier FROM TO AMTERIAL EMPLACEMENT METHOD ❑Aquifer Test ❑Stormwater Drainage ft. ft. ❑Experimental Technology ❑Subsidence Control x2U'1tf211y1:INti<T:t�t:4aftaeli�addfhunai'�shee4s i£iieeess>iry..�'�����n.:: ❑Geothermal(Closed Loop) []Tracer FROM TO DESCRIPTION color,hardness,so!Vmck type,gmin size,etc.) ❑Geothermal (Heating/Cooling Return) ❑Other(explain under#21 Remarks) 0 ft 115 ft OVER BURDEN 4-14-2023 115 ft- 405 ft. GRANITE 4.Date Well(s)Completed: Well ID# ft. ft. 3 k._ ,rj Sa.Well Location: ft. ft. ice.6. ' • 1--` ,, Seth Solesbee ft. ft, Facility/Owner Name Facility ID#(ifapplicable) —ft MAY' I Q . ft. 518 Pole Creasman Road Asheville, NC 28806 ft. ft. In r��,= �ter:zi-,w!>j Ura Physical Address,City,and Zip Ys Y, P 7Z.1 -IIENI'IRKSe . ' � f `�&T.V kV`-`°` '. x4 W"W"1 04 Buncombe 96264165140000 This well was self certified County Parcel ldenlification No.(PIN) 5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22•Certification: (if we0 field,one lat/long is sufficient) N �� (715 4-20-2023 Signature of CerU Well Ccntractor Date 6.Is(are)the well(s): OPermanent or ❑Temporary By signing this form,I hereby certify that the well(s)was(were)constructed in acenrdanre with 15A NCAC 02C.0100 or 15A NCAC 02C.0200 41 ell Construction Standards mid that a 7.Is this a repair to an e)dsting well: ❑Yes or E]No copy ofthis record has been provided to the well owner. If this is a repair•fill out known weft construction information and explain the nature of the repair[order#21 remarb,section or on the back gj'lhis form. 23.Site diagram or additional well details: You may use the back of this page to provide additional well site details or well S.Number of wells constructed: 1 construction details. You may also attach additional pages ifnecessary. For multiple injection or non-water supply wells ONLY with the saute construction,you can .submit one form. SUBMITTAL INSTUCTIONS 9.Total well depth below land surface: 405 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well For multiple wells list all depths iif'diJferew(example-3 di 00'ant[ (w 2100') construction to the following: 10.Static water level below top of casing: V 0 (ft.) Division of Water Resources,Information Processing Unit, IJ'water level is above casing.use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617 11.Borehole diameter: 6.25 (in.) 24b.For Iniection 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.) DiAsion of Water Resources;Underground Injection Control Program, FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636 13a.Yield(gpm) 5 Method of test: RIG 24c.For Water Supply sr Injection Wells: PILLS Also submit one copy of this form within 30 days of completion of 13b.Disinfection type: Amount: 35 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