GW1--03551_Well Construction - GW1_20240612

WELL CONSTRUCTION RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information:
Taylor RayBoger14.WATER ZONES
Y FROM To DESCRIPTION
Well Contractor Name ft. ft.
4614-A ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells)OR LINER(if applicable)
FROM TO DIAMETER THU KNE.SS MATERIAl.
CLYDE SAWYERS & SON WELL & PUMP INC +1 ft. 66 ft• 6.25 in• #21 PVC
Company Name 16.INNER CASING OR TUBING(geothermal closed-loop)
WEL 2022-00306 FROM TO DIAMETER THICKNESS MAI ERR!
2.Well Construction Permit#: ft. ft. in.
List all applicable Hell permits(i.e.Counry.State.Variance.Injection,etc.) tt ft in.
3.Well Use(check well use): 17.SCREEN
Water Supply Well: FROM TO DIAMElER SLOT SIZE TIDCKNESS MATERIM. _
ft. ft. in.
❑Agricultural ❑Municipal/Public
OGeothennal(Heating/Cooling Supply) ElResidential Water Supply(single) ft. ft. in. —
❑LndustriaVComrnercial °Residetttiat Water Supply(shared) Ill.GROUT
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
❑irrigation 0 it. 20 ft. Bentonite Pumped
Non-Water Supply Well:
DMonitoring ❑Recovery ft. ft. Cap Top with Bentonite Chips
Injection Well: • ft. ft.
°Aquifer Recharge °Groundwater Remediation 19.SAND/GRAVEL PACK(if applicable)
FROM TO MATERIAI. EMPLACEMENT METHOD
❑Aquifer Storage and Recovery ❑Salinity Barrier ft. ft.
°Aquifer Test °Stormwater Drainage
ft. ft. •
°Experimental Technology °Subsidence Control
20.DRILLING LOG(attach additional sheets if necessary)
°Geothermal(Closed Loop) °Tracer FROM 1 c) DESCRIP no\(color.hardness.moil/rack qpe.gran‘in...cur)
°Geothermal(Heating/Cooling Return) °Other(explain under#21 Remarks) 0 ft- 66 ft. OVER BURDEN
03-20-24 66 ft• 705 ft• .GRANITE
4.Date Well(s)Completed: Well ID# ft. ft.
5a.Well Location: ft. ft. ,, " •
Stephan Huffaker ``"Lr -- �.#
ft. ft.
Facility/Owner Name Facility!DO(if applicable) J U N 1 2 2024
ft. ft.
58 Candyland Court, Candler
ft. ft.
rn�'�-
Physical Address.C ilc.and/yl ._, i•
21.REMARKS
BUNCOMBE 8684581556
County Parcel Identification No.(PIN)
Sb.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification:
(if well field,one lot/long is sufficient)
N M, pi 04-19-2024
Signature of ed Well ntractor Date
6.is(are)the well(s): aPetmanent or OTemporary By signing this form.I hereby certify that the Hell(s)was(were)constructed in accordance
with 15A NCAC 02C.0100 or ISA NC.4C 02C..0200 Well Construction Standards and that a
7.Is this a repair to an existing well: DYes or ENo copy of this record has been provided to the well owner.
If this is a repair,fill out known well construction information and explain the nature of the
repair under 1(21 remarks section or on the back of this form. 23.Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
8.Number of wells constructed: 1 construction details. You may also attach additional pages if necessary.
For multiple injection or non-water supply wells ONLY with the same construction.you can
submit one form. SUBMITTAL INSTUCTIONS
9.Total well depth below land surface: 705 (ft) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths if different(example-3ia3200'and 2(i;100') constniction to the following:
10.Static water level below top of casing: 200 (ft) Division of Water Resources,Information Processing Unit,
If water level is above casing,use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
it.Borehole diameter: 6'26 (in.) 24b.For Injection Welt ONLY: In addition to sending the form to the address in
ROTARY 24a above, also submit a 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) 8 RIG 24c.For Water Supply&Injection Wells:
Method of test:
PILLS Also submit one copy of this form within 30 days of completion of
13b.Disinfection type: Amount 35 well construction to the county health department of the county where
constructed.
Form GW-1 North Carolina Department of Environment and Natural Resources—Division of Water Resources Revised August 2013