GW1--02963_Well Construction - GW1_20240513

. '
WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
1.Well Contractor Information:
KolbyMitchel Sawyers
••' 1Q.kNVAlA%RrlJtll\GSOf4.7�uhYt�i�3Elg�W"N4 AWAV.MERVWX011 kP.
FROM TO DESCRIPTION
Well Contractor Name ft. ft. f
4471-A -
ft. ft. I'
NC Well Contractor Certification Number 111S,.iOti.TE(t;C'ASiN(r(foMmltlti costal velfsTORS INER"(iFapp Ileahte)MAf'i
CLYDE SAWYERS &SON WELL & PUMP INC FROM 'to DIAMETER 'THICKNESS MATERIAL
+1 ft 63 ft. 6.25 ! in• #21 PVC
Company Name �,
OSS-2023-1579 t16:i14YER CASINO�MBONGrOi tltaraia[cioscd=loop)- • .V.`1WAVI.
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS MATERIAL
List all applicable bell construction permits(i.e.UiC,County,State,Variance,etc.) ft. ft. in.
3.Well Use(check well use): ft ft. in.
Water Supply Well: f1,7 SCI;EENNE :+ . - ti � r ' :1>��-K ii.;• x
FROM TO DIAMETER. SLOT SIZE THICKNESS MATERIAL _
Agricultural Municipal/Public ia
ft. ft. in.,
Geothermal(Heating/Cooling Supply) l Residential Water Supply(single)industrial/Commercial
lrrigation
Non-Water Supply Well:
ft. ft. in.
QResidential Water Supply(shared) 18:G[ZOUT. � €.'. xry # yy sr
FROM ToM1IA"1'ERIA 1. EMPLACEMENT METHOD&AMOUNT
ft 20 ft. Bentonite Pumped
Monitoring
Injection Well:
Recovery rt ft. Cap Top with Bentomile chips
0 ft. ft.Aquifer Recharge Groundwater Remediation
,�19�AN1?/GIit1YEL"yP'1GK
Aquifer Storage and Recovery ID Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
Aquifer Test ®StonnwaterDrainage ft. fr.
Experimental Technology Subsidence Control ft. ft.
Geothermal(Closed Loop) ®Tracer ,20AItIT;LI1:Vt7„T:C►G daft'aclicadditianalsheets ifnecessairj). " ��'..;
0Geothermal(Heating/Cooling Return) ®Other(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness,soil rock type.Ream size etc.)
o ft. 63 ft. OVER BURDEN
4.Date Wells)Completed:2-22-2024 Well ID# 63 ft 605 ft• GRANITE
5a.Well Location: ft. ft• FT; "• ',- :• ;
BIG OAK BUILDERS LLC ft. ft. ` a° `�'m,�i,ia �::;L
Facility/Owner Name Facility ID#(if applicable) ft. ft• MAY 1 = ?f1?4
37 TUPPER LANE HENDERSONVILLE, NC 28792 ft. ft.
ft ft. !r,`.,.,,,.:i..
_. ?-�:�-°;,j,', L :t
Physical Address,City,and Zip DWCItili0
Henderson 9690824893 2f:REiVIUK I IX, f.`;UM � x" . Kt7
County Parcel identification No.(PiN) Well was self certified
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22.Certification:
N W 2-28-2024
6.Is(are)the well(s) Permanent or DTemporary Sigma a of er ed onhanor Date
X
By signing t/r 'arm,1 hereby co.*that the well(s)was(were)constructed in ace•ordance
7.Is this a repair to an existing well: 0Yes or 3No with 15A,VCAC 02C.0100 or 15A NCAC(I2C.02(10 Well Construction Standards and that a
Ijthis is a repair.fill out known well construction information and explain the nature of the copy of this record has been provided to the mall owner.
repair under till remarks section or on the back if this firm.
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 I GW-1 is needed. Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if necessary.
drilled: ' SUBMITTAL INSTRUCTIONS
depth below land surface: 605'
9.Total well 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'and 2@100) construction to the following: i'
10.Static water level below top of casing: 170 (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.) i
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
it
13a.Yield(gpm) 1 Method of test: RIG 24c.For Water Supply&Injection Wells: In addition to sending the form to
PILLS the address(es) above, also submit 'one copy of this form within 30 days of
13b.Disinfection type: Amount: 35 completion of well construction to rite county health department of the county
- where constructed.
Form(1W-i North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016