GW1--03539_Well Construction - GW1_20240612

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WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
1.Well Contractor Information:
Kolby Mitchel Sawyers 14.WATER ZONES
Well Contractor Name
FROM TO DESCRII'TIUN
ft. ft.
4471-A
ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased rrclis)OR LINER(if ap Kahle)
CLYDE SAWYERS&SON WELL&PUMP INC FROM 1'0 DIAMEtER THICKNESS MAItRIAL
+1 f• 170 ft. 6.25 in. #21 PVC
Company Name
WEL2024-00 05 16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#: a FROM To DIAMETER THICKNESS MATERIAL
List as applicable well construction permits(i.e.UIC.County,State, Variance,etc.) ft. IL in.
3.Well Use(check well use): ft. ft. in.
Water Supply Well: t7.SCREEN
FROM Io DI vMFTFR_ 51 ott_NUE TIn(KNISS vI1TLRt S,
()Agricultural ®Municipal/Public H. It. in.
Geothermal(Heating/Cooling Supply) ©Residential Water Supply(single) It. ft. in.
Industrial/Commercial °Residential Water Supply(shared) 18.GROUT
DIrrigation ream ro NI rI F.Rt a F\IPt,uT MF rI 'It rHon&AMOUNT
Non-Water Supply Well: 0 ft. 20 ft. Bentonite Pumped
Monitoring ()Recovery ft. ft. Cap Top with Bentomite chips
Injection Well: --
ft. ft.
°Aquifer Recharge ()Groundwater Remediation —
19.SAND/GRAVEL PACK(it'applicable)
()Aquifer Storage and Recovery ()Salinity Barrier FROM 'CO MATERIAL F:NH'I.A(EMEN 1 AIL IHOD
()Aquifer Test °Stonnwater Drainage ft. ft.
pExperimental Technology ()Subsidence Control ft. ft.
Geothermal(Closed Loop) 0 Tracer 2(L DRILLING LOG(attach additional sheets if necessary)
FROM TO DESCRIPTION(color,hardness,soil/rock type.grain size,etc.)
()Geothermal(Heating/Cooling Return) °Other(explain under#21 Remarks) 0 ft 170 ft• OVER BURDEN
3-25-2024 170 ft. 265 ft• GRANITE pt.. • . �^"4.Date Well(s)Completed: Well ID# ft. ft. ("'''���..* �E�„�
5a.Well Location: "'�
Charles McMahan Living Trust r• ft. JUN 1 2 2024
Facility/Owner Name Facility ID#(if applicable) ft. ft.
585 Christian Creek Road Swannanoa, NC ft. ft. lailiri E+' P'r.r.,aItip•ii Unit
MCI SCGI
Physical Address,City,and Zip ft. ft.
Buncombe 967893867900000 21.REMARKS
County Parcel Identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22.Certification:
N W 03/25/2024
6.Is(are)the well(s)0Permanent or ()Temporary Sig of(cr cd onlracmr Date
By signing th arm.I hereby(ertifj'that the weals)was(were)constructed in accordance
7.Is this a repair to an existing well: ()Yes or EDNo with ISA NCAC 02C.0I00 or ISA NCAC 02C'.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 well owner.
repair under#21 remarks section or on the hack of this form.
23.Site diagram or additional well details:
R.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: 265 (ft.) 24a. For AU Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths if different(example-3(0200'and 4000') construction to the following:
10.Static water level below top of casing: 50 (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
13a.Yield(gpm) 10 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
I3b.Disinfection type: Amount: �' completion of well construction to the county health department of the county
where constructed.
Form OW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016