GW1--01186_Well Construction - GW1_20240219

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WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
1.Well Contractor Information:
1 1
Kolby Mitchel Sawyers li ,«-ATERZONEM ;' : x r... y F :<_. ;
Well Contractor Name FROM ft. TO ft. DESCRIPTION
4471-A - 1
ft. ft. I i
NC Well Contractor Certification Number t5,QU SIf GASiaa(formutii_cuseilai ii Olt INkitlifi 1lcdYsle) x <<.
CLYDE SAWYERS&SON WELL&PUMP INC FROM TO DIAMETER I . THICKNESS MATERIAL
+1 ft. 114 11 6.25 II ni #21 PVC
Company Name 2021-00435 x ��
IM INNER,CASII tr i( illeBIil1G``(cak4orniiiretoscd loop)k:. � �'w ,
2.Well Construction Permit#: FROM TO DIAMETER i THICKNESS MATERIAL
List all applicable well construction pennits(i.e.U1C,Courant State.Variance,etc.) ft ft. in.
3.Well Use(check well use): ft ft. in•
1!Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
Agricultural Municipal/Public ft. ft. in.
Geothermal(Heating/Cooling Supply) DResidential Water Supply(single)industrial/Commercial
ft• ft. in.
Residential Water Supply(shared) e
t8.1GROUTk� S�.,��. ?kr�` ,.�.s�c`�:���r"��si`�,��er�` `n�`�:,��"�<
'Irrigation FROM TO MATERIAL N:hI EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 it 20 ft' Bentonite Pumped
Monitoring Recovery ft ft. Cap Top with Bentomite chips
Injection Well:
,
ft. ft.
Aquifer Recharge Groundwater Remediation
L SAND/GRAVEL.BACK(if appliiaiblc)WAMWMC C §=404 ` irg
Aquifer Storage and Recovery Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
Aquifer Test OStormwater Drainage ft. ft.
Experimental Technology DSubsidence Control ft. ft.
plGeothermal(Closed Loop) ®Tracer 21MDRLCTil1s1G% `(tG,faitacii ailtllhut al sheets ifi icessary). . MA
FROM TO DESCRIPTION(color,honlness,soil/rock type.grain size,etc.)
OGeothermal(Heating/Cooling Return) 00ther(explain under#21 Remarks)
0 ft• 114 ft• OVER BURDEN
4.Date Well(s)Completed:2-7-2024 ft. ft.Well ID# 114 245 GRANITE �, , v
5a.Well Location: ft. ft. i C '( tz E E'•-
BIG HILLS CONSTRUCTION ft. ft. ))qq
Facility/Owner Name Facility ID#(if applicable) ft. ft. F�f7 ��L`F
STONE RIDGE SUB LOT 28 CANDLER, NC 28715 ft. ft. tqoariaach Pf.;,, 2 umk
Physical Address,City,and Zip
ft. ft. oWQ/BOG
2LAREM IRKS: 4 't�'rc, �6 ns :�'' h vM
BUNCOMBE 869879248100000 ,
County - Parcel identification No.(PiN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one Iat/long is sufficient) 22.Certification:
N W
2-9-2024
6.Is(are)the well(s) X Permanent or Tembra p ry Signa e of er ed onhaetor Date
i
By signing 1h 'brim,I hereby certify that the wells)was(were)constructed in accordance
7.Is this a repair to an existing well: 0Yes or finNo with 15,4 NCAC 02C.0100 or 1SA NCAC 02C.020t)Well Construction Standards and that a
If this is a repair.fill out knot,a well construction information nation and explain the nature of the copy of this record has been provided to die.hell owner.
repair under#21 remarks section or on the back of this form.
23.Site diagram or additional well details:
3.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 assay also attach additional pages if necessary.
drilled:' SUBMITTAL INSTRUCTIONS
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 all depths ifdi/ferent(example-3@200'and 2 g/O0') construction to the following: 1
i
10.Static water level below top of casing:20 (ft.) Division of Water Resources;information Processing Unit,
If water level is above casing,anse"+" 1617 Mail Service Center;Raleigh,NC 27699-1617
11.Borehole diameter: 6.25 (in.) 24b.For Infection 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.) i
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center;Raleigh,NC 2 7699-1 63 6
I
13a.Yield(gpm) 30 Method of test: RIG 24c.For Water Supply&Injection!Wells: In addition to sending the form to
the address(es) above, also submit dne,copy of this form within 30 days of
13b.Disinfection type: PILLS Amount: 25 completion of well construction to the county health department of the county
where constructed,
I
Form OW-1 North Carolina Department of Environmental Quality-Division of Water Resources I Revised 2-22-2016