GW1--01178_Well Construction - GW1_20240219

' PI iris Firm
WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only: i
1.Well Contractor Information:
Kolby Mitchel Sawyers R<xeirt sre RmAi:�ec
•>4:va'Ioo "': o @_. Ncw
FROM TO DESCRIPTION I
Well Contractor Name ft. ft.
4471-A
ft. ft. I 1
NC Well Contractor Certification Number 15:UU'LER' ASI O(f6"r'inultl.easeilil[¢11i5).ilR LINER+{iF`up ticgbte ,'_ n;c-.
CLYDE SAWYERS&SON WELL&PUMP INC FROM •1'0 DIAMETER': i THICKNESS MATERIAL
+1 ft. 160 ft• 6.25 1in #21 PVC
Company Name FROM TO DIAMETER;
.. x x., v4 ri.i
We12021-00434 � �.�,in talifusod loap) e `�,� w,.;��"<�-��,rx
2.Well Construction Permit#: ft. ft. THICKNESS MATERIAL
I .t1NNER CA$ISGt)Tt=TCJBInG{Qco)tern
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)
3.Well Use(check well use): ft. ft. :in.
Water Supply Well: t7SCIFFtUN ,fi .. z'asp . ,t .tis„ its
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
Agricultural Municipal/Public ft. ft. in.
Geothermal(Heating/Cooling Supply) EiResidential Water Supply(single) ��1 ft. ft. in•
Industrial/Commercial
Irrigation
Non-Water Supply Well:
DResidential Water Supply(shared) .
8GR1)11T�,rt,�.�`"�� �t�°wS,�„s��?�°�< •s,.- ,, t��"'�s,E,s x�av �,O.vs��z
FROM 1'O MATERl.4l. EMP1,ACEM[:N'r METHOD&AMOUNT
p ft. 20 ft. eentonite Pumped
Monitoring
Injection Well:
Recnvety ft. ft. Cap Top with Bentomite chips
ft. ft.
Aquifer Recharge Groundwater Remediation
+19).SANA/GRAVEVP CI (it applicalil),`� ��`Nr MUUW is ,m A4
Aquifer Storage and Recovery Salinity Barrier FROMTo MATERIAL EMPLACEMENT METHOD
Aquifer Test DStonuwater Drainage ft. ft.
Experimental Technology Subsidence Control ft. ft.
BGeothermal(Closed Loop) 0Tracer ..2b lift#liLING.7IOGIEiiriach"iiidltioiiatslie¢teifn"ecessnij3a, MM. °
FROM TO DESCRIPTION(color.hardness,soil/rock type,gram size.etc.)
Geothermal(Heating/Cooling Return) 0Other(explain under#21 Remarks)
0 ft. 160 ft• OVER BURDEN
4.Date Well(s)Completed:2-5-2024 Well ID# 160 ft• 480 ft' GRANITE
ft. ft. r
5a.Well Location: [- a
Big Hills Construction LLC ft. ft. i ti '���, � ,
ft. ,
Facility/Owner Name Facility ID#(if applicable) ft. f.E
Stone Ridge Sub Lot 29 Candler, NC 28715 ft. ft. e�z4
Physical Address,City,and Zip ft ft. ! tti%t t"7i.7c{ 11 n t.yrik
Buncombe 8698792530000 RItlitEMARKS Xitgriiin:ilaniinTISMIVArit0C,WW.MairiniN
County Parcel identification No.(PiN) •
•
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one latllong is sufficient) 22.Certification:
N W 2-9-2024
6.Is(are)the well(s) Permanent or OTemporary Signs a of er ed� untnrctnr Date
%
By signing dr.fawn,1 hereby coll. &that the wells)was(were)constructed in accordance
7.Is this a repair to an existing well: 0Yes or ONo with 15,4 NCAC 02C.01I10 or 15A NCAC(12C'.0200 Well Construction Standards and that a
if this is a repair.fill out known well construction information and explain the nature of the copy of this record has been provided to the i tell owner.
repair under#21 remarks section or on the back tf this firm. i
23.Site diagram or additional well details:
II.For Ceoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page toiprovide 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 1
9.Total well depth below land surface: 480 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths if difibrent(example-3 a@200'and 2 ,100') construction to the following:
I.
10.Static water level below top of casing: 60 (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
i.
13a.Yield(gpm) 10 Method of test: RIG 24c.For Water Supply&lniection,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 thte county health department of the county
where constructed. l
Form C W-1 North Carolina Department of Environmental Quality-Division of Water Resources i Revised 2-22-2016