GW1--03542_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
1,120AI l0 DESCRIPTION __
Well Contractor Name ft. ft.
4471-A
It. li.
N. v.ell Contractor Certification Number 15,OL;'f ER CASING(for multi-cased wells)OR LINER(if an Rabk) -,
CLYDE SAWYERS & SON WELL & PUMP INC FROM TO Di AMP:I ER THICKNESS I M.4'TN:RIAI.
+1 ft- 120 ft• 6.25 in- #21 PVC
Company Name
WEL2024-00058 IC INNER CASING OR WRING(geothermal closed-loop)
2.Well Construction Permit#: FROM TO DIANE I ER THICKNESS MA I LR44L
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.) ft. It. in.
3.Well Use(check well use): It. ft. in.
Water Supply Well: 13:4' .'i R (;
FROM TO DIAMN'.1'N'R SLOT SIZE TItICKNTSS MAII RIM
Agricultural 0Municipal/Public ft. ft. in.
Geothermal(Heating/Cooling Supply) 12 Residential Water Supply(single) ft. fr, in.
Industrial/Commercial ©Residential Water Supply(shared) 18.GROUT
Irrigation _ _ PROM '(O �11A I'N.RI 11 FM1I PI.A('F.MNINT M1I1'1'110D&ADIOUN'1
Non-Water Supply Well: 0 ft. 20 1't. Bentonite Pumped
MonitoringRecovery ft. ft. Cap lop with Bentomite chips
Injection Well:
ft. ft.
Aquifer Recharge 0Groundwater Remediation
19.SAND/GRAVEL PACK(if applicable)
Aquifer Storage and Recovery ®Salinity Bather 1'B0?I 1(r M\rER1AL FMI'I nCLM1IEa M1 1111111
Aquifer Test ®Stomfwater Drainage tt. ft.
Experimental Technology 0Subsidence Control r ft. ft. '
Geothermal(Closed Loop) OTracer 20.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 It. 120 ft. OVER BURDEN
3-28-2024 120 ft 365 ft GRANITE 4.Date Well(s)Completed: Well iD# 7 R" `
5a.Well Location: ft ft. Rv„`1/4.,L.. , E�.i
CARTER HOMES OF WNC LLC rt. ft.
Facility/Owner Name IarHE, II)#(if applicable)
ft. ft. JUN 12 2024
106 LADY BUG LANE FLETCHER, NC 28732 ft. ft. info: ea?r4-.-yw,;..•,4 UP.:
IiC
Physical Address,City,and Zip ft. ft. atrCd +o
BUNCOMBE 967501656700000 21.REMARKS
County Parcel Identification No.(PIN) WF LI WAS SFLF__CFRTIFIFD
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field.one Iat/long is sufficient) 22.Certification:
N W" 04/02/2024
6.Is(are)the well(s)DX Permanent or ®Temporary Sig of c d ontractor Date
By signing th onn,i hereby cer'tifj'that the welllsl was(were)constructed in accordance
7.Is this a repair to an existing well: Yes or °No with 1SA NCAC 02C.0/00 or ISA NC'AC.'02C'.020t1 Well Consnvction Standards and that a
If this is a repair.fill out knonn well construction information and explain the nature of the copy of this record has been provided to the styli owner.
repair under f121 remarks section or on the back of this form.
23.Site diagram or additional well details:
S.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: 365 (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@/00') construction to the following:
10.Static water level below top of casing:80 (ft.) Division of Water Resources,information Processing Unit,
If water level is above casing,use"+ 1617 Mail Service Center,Raleigh,NC 27699-1617
II.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.)
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
13a.Yield(gpm) 4 Method of test: RIG 24c.For Water Supply&Infection 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 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