Loading...
HomeMy WebLinkAboutGW1--07474_Well Construction - GW1_20231120 WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only: 1.Well Contractor Information: Kolby Mitchel Sawyers 1iMMTSR ZOt ' ; ; ., ', FROM TO DESCRIPTION Well Contractor Name ft. ft. II 4471-A ft. ft. NC Well Contractor Certification Number 31SAAPl'EtWAM tG,;{fdr taunt cas4Yt;tvells)tlli+l%t1iEEi{ifap tfcalile) CLYDE SAWYERS&SON WELL&PUMP INC FROM TO DIAMETER THICKNESS MATERIAL +1 ft 140 ft• 6.25 tn' #21 PVC Company Name -, x, 1s INIVERVAsir`s C7r3 T116INdikailf rmalsctoscaliVf s ''' 2.Well Construction Permit#:WP23-096 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: ts?scREENs " ;k; m ,, , i,, 9 FROM TO DIAMETER' SLOT SIZE THICKNESS MATERIAL al'Agricultural DMunicipal/Public ft. ft. in: I INiGeothermal(Heating/Cooling Supply) Residential Water Supply(single) ft. ft. in *iindustrial/Commercial DResidential Water Supply PP Y(shared) 181GROU'C* . ,,, iirrigation FROM TO MMA'I'ERItAI. EhIP1.ACEMEN'r METHOD&AMOUNT Non-Water Supply Well: o ft• 20 ft. Bentonite Pumped W I Monitoring DRecovery ft. ft. Cap Top with Bentomite chips Injection Well: -- - ' ft. tt 'Aquifer Recharge ()Groundwater Remediation 1?SANbIGRAVEOPAMelitaflppllCihIe) ' ° :. ',Aquifer Storage and Recovery ®Salinity Barrier _FROSt TO MATERIAL EMPLACEMENT METHOD RiAquifer Test (3Stonnwater Drainage ft. ft. l tExperimental Technology ®Subsidence Control ft. ft. �!Geothermal(Closed Loop) ®Tracer I20111.ILLt�0E(1GWttac i gditttiona>"sheetsltiiecess`h�- FROM TO DESCRIPTION(color,hardness,soil/rock type.grain size,etc.) al Geothermal(Heating/Cooling Return) Other(explain under#21 Remarks) - - ; 0 ft. 140 ft• OVER BURDEN 4.Date Well(s)Completed: 11-10-2023 Well ID# 140 ft. 485 ft• GRANITE 5a.Well Location: ft ft. , Brent Sanders • v..--- ' Facility/Owner Name Facility ID#(if applicable) ft. ft. n)Ol/ 9 2023 308 Capps Road Pisgah Forest, NC 28768' ft. ft. NOV VV Physical Address,City,and Zip ft. ft. I' Transylvania 8597-95-3725-000 VIIMatilitaiktW4 ' � ; County Parcel identification No.(PiN) this well was self certified 5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: (if well field,one Iatflong is sufficient) 22.Certification: N W 11-12-2023 6.Is(are)the well(s) X Permanent or Temporary Signa e of er ed onh rdor Date By signingdh oral,1 hereby cerrifi'that the well(s)was(were)constructed in accordance 7.Is this a repair to an existing well: ®Yes or EtNo with 154 NCAC 02C.0100 or 15A NCAC 02C'.0200 Well Construction Standards and that a If this is a repair.fill out known well construction infonnation and explain the nature of the copy of this record has been provided to die well 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: 485 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well For multiple wells list all depths ifdifferent(example-3@200'and 2@100') construction to the following: 10.Static water level below top of casing: 70 (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 1 13a.Yield(gpm) 2 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. I I Form OW-1 North Carolina Department of Environmental Quality-Division of Water Resources I Revised 2-22-2016 I