GW1--06035_Well Construction - GW1_20230920

WELL CONSTRUCTION RECORD
For Internal Use ONLY:
This form can be used for single or multiple wells
1.WellContractor Information: '
GARRETT COLLIN BANKS :AC VVATER ZONES. 1:,4. .-
FROM TO DESCRIPTION
Well Contractor Name ft. ft.
4519-A ft. ft. i
NC Well Contractor Certification Number "W'':OUTER°CASING(for niniti cnsedVvells)OR LINER(if tipsltesble) ., , •
FROM TO DIAMETER THICKNESS MATERIAL
CLYDE SAWYERS & SON WELL & PUMP INC +1 ft• 107 ft• 6 1/4 ; in' -#21 PVC
Company Name I6.INNER,CASINGIOR TUBING(geothermal closed loop)E':>`'°n ,
2022-00134 FROM TO _ DIAMETER THICKNESS MATERIAL
2.Well Construction Permit#: ft. ft. i in.
List all applicable well permits(i.e.County.State,Variance.Injection,etc.) ft. ft. in. -
3.Well Use(check well use):
Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS : MATERIAL
ft. ft. in.
❑Agricultural ❑Municipal/Public
OGeothermal(Heating/Cooling Supply) ©Residential Water Supply(single) ft. ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18•-GROUT a ',
FROM TO MATERIAL' EMPLACEMENT METHOD&AMOUNT
❑Irrigation 0 ft• 20 ft' Bentonite Pumped
Non-Water Supply Well: ft. It.
❑Monitoring ❑Recovery Cap Top with Bentonite Chips
Injection Well: ft. f.
❑Aquifer Recharge ' ❑Groundwater Remediation 19 SAND/GRAVEL PACK,(if applicable)` •, ,
FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Storage and Recovery 0 Salinity Barrier ft. ft.
❑Aquifer Test ❑Stormwater Drainage ft. ft.
El Experimental Technology ❑Subsidence Control 20.DRILLING LOG,(attach additional'Sheets if necessary) -
OGeothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION(color.hardness,soil/rock type.grain size,etc.)
OGeothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) 0 ft• 107 It. OVER BURDEN
08/25/2023 107 ft• 245 ft• GRANITE
4.Date Well(s)Completed: Well ID#
ft. ft.
5a.Well Location: ft. ft. 7.r -� ` r e—J,,
Big Hills Coast. LLC ft. ft.
� C.
k ,
Facility/Owner Name Facility ID#(if applicable) ej€Fp 2 '' 2023
ft. ft.
41 Bridge Way Dr., Candler, 28715 ft. ft. infvi'ri cj? l[3 s J? uf
Physical Address,City,and Zip
21,.-REMARKS -.__. _. ?,�a- •. .`c� ,
Buncombe 86986859140000
County Parcel Identification No.(PIN) '
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification: 6 '
(if well field,one Iatnong is sufficient)
N Nt 09/18/2023
Signature of Cerlt Well Contractor 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 accordance
with 15A 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 ENo 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 sane construction,you can
submit one form. SUBMITTAL iNSTUCTIONS
9.Total well depth below land surface: 245 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list al/depths if different(example-3l200'and 2C100) construction to the following:
Division of Water Resources,Information Processing Unit,
10.Static water level below top of casing: 20 (f()
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 ONLY: lMaddition 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.) I
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: 25 well construction to the county health department of the county where
constructed.
Form GW-I North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised August 2013