GW1--04764_Well Construction - GW1_20240812

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WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
1.Well Contractor Information:
Kolby Mitchel Sawyers 14.WATER ZO IE$
FROM TO DESCRIPTION _ _ _
Well Contractor Name __ft, ft.
4471-A - -{
ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING(far mild-cased wells)OR LINER If a livable
CLYDE SAWYERS & SON WELL&PUMP INC FRO\I To IIIAISIE:TER THICKNESS MATERIA1
+1 ft. 108 ft• 6.25 in- #21 PVC
Company Name
WEL2023-00521 lb,INNER CASING OR TUBING(geothermal clowd-Ioapi
2.Well Construction Permit#: ERONI TO DIAME FER THICKNESS MATERIAL
List all applicable led!!constructee,,permits(i.e.LlIC.County,State. Variance.etc.) ft. ft. in.
ft. ft. in.
3.Well Use(check well use):
Water Supply Well: )9.SCRF,EN
',Rom ro DI\MFI E'R Slur stir. THICKNESS FSS M'uTt RI u.
Agricultural ®Municipal/Public ft, ft. in.
Geothermal(Heating/Cooling Supply) ()Residential Water Supply(single)
Industrial/Commercial
Irrigation
Non-Water Supply Well:
ft. It. in.
OResidenlial Water Supply(shared) 18.GROUT
FlomFlom 'I t) \I,1 fFRI 11. I'NI PIArt-AWN T\1F1110D&AMOON'I'
0 it 20 ft. Bentonite Pumped
Monitoring ®Recoveryy ft. ft. Cap Top with Bentomite chips
Injection Well:
ft. ft.
Aquifer Recharge ®Groundwater Remediation
1 19.SAND/GRAVEL PACK(if applicable)
Aquifer Storage and Recovery ®Salinity Barrier FROM ro MATERIALEMPLACEMENT METHOD
Aquifer Test ®Stonuwater Drainage ft, ft.
8Experimental Technology ©Subsidence Control ft. ft.
Geothermal(Closed Loop) OTracer 20.DRILLING LOG(attach additional sheets if necessary)
Geothermal(Heating/Cooling Return) OOther(explain under#21 Remarks) FROM TO DESCRIPTION(color.hardness.swtirock type.grain Size,etc.)
0 ft. tpg ft. OVERBURDEN
6-10-2024 108 ft 305 ft• GRANITE s t
4.Date Well(s)Completed: Well iD# 1 1
ft. ft.
5a.Well Location:
BIG HILLS CONSTRUCTION ft. ft. AUG 1 2 2024
Facility/Owner Name Facility I (if applicable) ft. ft.
UN
STONE RIDGE SUBDIVISION LOT 50 CANDLER, NC 28715 rt. ft.
Physical Address,City,and Zip ft. ft.
BUNCOMBE 8698588965 21.REMARKS
County Parcel Identification No.(PIN) THIS WFI I WAS SFLF CFRTIFIFD
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat./long is sufficient) 22.Certification:
N W 6-11-2024
6.Is(are)the well(s)I% Permanent or r3Temporary Signa e of C er ed antractor Date
By signing th .arm,/hereby vertu•that the wellls)Ilws(were)constructed in accordance
7.Is this a repair to an existing well: 0 Yes or %@No with 15A NCAC 02C.01t10 or ISA NCAC 02C.020N/Well Construction Standards and that a
ifdais+s a repair.fill out known well construction inJiinnation and explain the nature oft e copy of this record has been provided to the well owner.
repair under el remarks section or on the hack oft is firm.
23.Site diagram or additional well details:
R.For Ceoprobe/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: 305 (ft.) 24a.IFor All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths if different(example-30200'and 4a:100') construction to the following:
10.Static water level below top of casing:40 (ft.) Division of Water Resources,information Processing Unit,
1/waler)evel is above casing,use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
I1.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) 8 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: 30 completion of well construction to the county health department of the county
where constructed.
Form CiW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016