GW1--03543_Well Construction - GW1_20240612

WELL CONSTRUCTION RECORD(GW-I) For Internal Use Only:
1.Well Contractor Information:
Kolby Mitchel Sawyers 14.WATER ZONES
Well Contractor Name FROM It) DE5CRIFIION
ft. ft.
4471-A
ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells)OR LINER(if ap hcable)
CLYDE SAWYERS& SON WELL&PUMP INC FROG 1<) DIAMF:EF:R r1111 K\I SS MATERIAI
+1 ft. 102 ft. 6.25 In. #21 PVC
Company Name
WEL2022-00336 16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#: r•Hu>I n) ms�If:n;R rluclars5 M crF:Rfnt.
List all applicable well construction permits(i.e. UDC,County,State,Variance,etc.) ft. ft. in.
3.Well Use(check well use): n. ft. in.
Water Supply Well: 17.SCREEN
FROM tO MAW-.lFR _ SLO I-Si/t/_ "I IIIC'K\FSS MA 1FRI M.
©Agricultural DMunicipal/Public ft. ft. in.
©Geothermal(Heating/Cooling Supply) %Resi den dal Water Supply(single) ft. ft. ill.
DIndustrial/Commercial ()Residential Water Supply(shared) Ia.GROUT
()Irrigation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: a ft. 20 ft• Bentonite Pumped
®Monitoring ()Recovery ft ft. Cap Top with Bentomite chips
Injection Well:
ft. ft.
Aquifer Recharge ()Groundwater Remediation
1$,SAND/GRAVEL PACK(if applicable)
0 Aquifer Storage and Recovery ()Salinity Barrier FROM TO M VI L.1tiAI. EMPLACEMENT METHOD
0 Aquifer Test DStormwater Drainage ft. 11.
0 Experimental Technology ()Subsidence Control ft. ft.
0 Geothermal(Closed Loop) ()Tracer 20.DRILLING LOG(attach additional sheets if necessary)
FROM TO DESCRIPTION feeler,hardness,soil/rock I,pe,grain size,etc.)
0 Geo t h e rm a 1(Heating/Cooling Return) ()Other(explain under#21 Remarks) 0 ft• 102 ft. OVER BURDEN
4.Date Well(s)Completed: 04-12-2024 Well ID# 102 ft. 265 fL GRANITE
5a.Well Location: ft. ft. --�1 - 1.'
ENGLISH DREWS ft. ft. 1`�t...:l r , �E�,.r
Facility/Owner Name Facility lD#(if applicable) ft. ft JUN 1 2 2024
186 DAVIDSON ROAD SWANNANOA, NC ft. ft.
Physicalft. ft. 114.17tn f't ' '�y
Address,City,and Zip
lfLi _
BUNCOMBE 96892331120000 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 4-25-2024
6.Is(are)the well(s) Permanent or ()Temporary Si of e ed ntractor Date
X
By,signing th arm.I hereby cenif)'that the welt."s)was(were)constructed in accordance
7.Is this a repair to an existing well: ()Yes or DNn with 15.4 NCAC 02C.0100 or I.SA NCAC 02C.0200 Well Construction Standards and that a
If this is a repair.Jill out known well construction inJormatiort 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 back of this form.
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 OW-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 (Ct.) 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 2ta)100) construction to the following:
10.Static water level below top of casing:40 (ft.) Division of Water Resources,Information Processing Unit,
If water level is above easing.use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
I I.Borehole diameter: 6"25 (in.)
24b.For lnjection 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) 5 Method of test: RIG 24c.For Water Supply&iniection 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: 15 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