GW1--06019_Well Construction - GW1_20230920

L fr(hit Form'''
WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
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1.Well Contractor Information: I •
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Kolby Mitchel Sawyers a lliWATLDI Ng$,A t <. ,;~
FROM TO DESCRIPTION
Well Contractor Name ft. ft.
4471-A ft. ft.
NC Well Contractor Certification Number 46'0DIECti CAS;ja;focauuliglasett et)s} aINEtt°ri ji (iiitilti)..'` .
CLYDE SAWYERS&SON WELL&PUMP INC FROM '1'0 DIAMETER THICKNESS M.ATERAAI.
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ft ft, 61/8 ' 1O #188 Steel
Company Name �.Y�...
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2021-00578 IVINNER eiGDIt2Tuslnc{i eotlferm;il tAed loon)' : •
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.UIC,County,Slate,Variance,etc.) ft. ft. in. ,
3.Well Use(check well use): ft. it. in.
? 5CRE1rN cuI,ice` ".1-: � `.s
Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
*I Agricultural Municipal/Public ft. ft. in.
*Geothermal(Heating/Cooling Supply) gResidential Water Supply(single) - ft.; ft. in. —
jMiindustrial/Commercial E3Residential Water Supply(shared) Ofx OROD. ,. , l V ' ' 0,1k'
'Irrigation FROM TO MATERIAL. EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: o ft. 20 ft, Bentonite ' Pumped
**Monitoring pRecovery ft. ft. Cap Top with Bentomite chips
Injection Well:
ft. ft.
j 'Aquifer Recharge ®Groundwater Remediation
01911SAN INGRA'NELPAF.IVOi nFiDlfiklif
**Aquifer Storage and Recovery ®Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
alIAquifer Test DStonnwater Drainage ft. ft. I
%iExperimental Technology ()Subsidence Control ft. ft.
I Geothermal(Closed Loop) ()Tracer 441):Dlt1LT:iNCLOD;(attaelt"addifio aV's"]teefs`if`necasst;r}j'
FROM TO DESCRIPTION(color,hardness,soil/rock type,grain size,etc.)
MU Geothermal(Heating/Cooling Return) E3Other(explain under#21 Remarks)
0 ft• 36 ft OVER BURDEN
4.Date Well(s)Completed:4-28-2023 Well ID# 36 ft 165 ft.
pGRANITE
ft. ft.
5a.Well Location:
Patrick A Hunt ft. ft.
Ems^ 7", ai' i. I T.
Facility/Owner Name Facility ID#(if applicable) ft. ft. 4 1e b�IL......r �t.L.� 3
252&254 Shope Creek Road Asheville, NC 28805 ft. ft. SEP 1 9 7n73
Physical Address,City,and Zip ft. ft.
�2L'IREMAU `E r � 'lt'ittgirt ; , "L �` ..
Buncombe 977045091700000 �'„ � �
County Parcel Identification No.(PiN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: —
(if well field,one fat/long is sufficient) 22.Certification:
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�� 05-15-2023
6.Is(are)the well(s) Permanent or Temporary Signa a of er edonvclor Date
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By signing th fern:,I hereby cerrifj'that the well(s)was(were)constructed in accordance
7.Is this a repair to an existing well: 0 Yes or x No with 15,4 NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a
!/'this is a repair.fill out known well construction information and explain rite nature of the copy of this record has been provided to thew•ell 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.
drilled:' SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 165 (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'rend 2 @/00') construction to the following: i
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
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11.Borehole diameter: 625 (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.)
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Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
13a.Yield(gpm) 100 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: 25 completion of well construction to thie county health department of the county
where constructed.
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016