GW1--04835_Well Construction - GW1_20240814

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WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
1.Well Contractor Information:
•
Kolby Mitchel Sawyers 14.WATERZONES 1
FROM TO DESCRIPTION
Well Contractor Name -
4471-A ft. ft.
ft. ft.
NC Well Contractor Certification Number
15.OUTER CASING(for multi-eased wells)OR LINER(if ap kable)
CLYDE SAWYERS&SON WELL&PUMP INC FKUNI 1 TO urs MI:MK THICKNESS M.4lERIAI,
+1 ft. 60 ft. 6.25 in. #21 Pvc
Company Name
SW22-0295 16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#: FROM TO DI:AME TER THICKNESS MATERIAL
List all applicable well construction permits/i.e.NC,County,State.Variance,etc.) It. ft. In.
3.Well Use(check well use): ft. u. in.
17.SCREEN
Water Supply Well:
1
FROM T SL l U DI UT /IC_ 1 lilt KNESS MATERI%I.
°Agricultural ®Municipal/Public ft. ft. in.
()Geothermal(Heating/Cooling Supply) ©Residential Water Supply(single) ft. ft. in.
°industrial/Commercial °Residential Water Supply(shared) IS.GROUT
("Irrigation - FROM rO NI A r1.Rl4I FSIPl ACFAO;vr atr WOO&AMUrNI
Non-Water Supply Well: o ft. 20 ft. Bentonite Pumped
°Monitoring ORecovety ft. ft. Cap Top with Bentomite chips
Injection Well:
ft. ft.
OAquiter Recharge Groundwater Remediation
19.SAND/GRAVEL PACK(if applicable)
Aquifer Storage and Recovery E3 Salinity Barrier FROM fo MATERIAL EMPLACEMENT METHOD
Aquifer Test OStorntwater Drainage ft. ft.
°Experimental Technology °Subsidence Control ft. ft.
°Geothermal(Closed Loop) °Tracer 20.DRILLING LOG(attach additional sheets if necessary)
°Geothermal(Heating/Cooling Return) °Other(explain under#21 Remarks) FROM TO DESCRIP'r1UNS rotor,hardness,soil/rock type.grain size.de.)
0 B. 60 ft. OVER BURDEN
4.Date Well(s)Completed:7-12-2024 Well iD# 60 ft 325 f+ GRANITE i 3 1_�^
�. _-l . 1! _ea-)
ft. ft. �'
5a.Well Location:
ft. AUG2024
SARAH EDWARDS ft. 1
Facility/Owner Name Facility ID#(if applicable) ft. ft. Ir.f f 7.-4.i."CI -r,^.may.--.1 ij41;
1507 GOOSE CREEK ROAD MARION, NC 28752 ft. ft. DhC„tGv
Physical Address,City,and Zip ft. ft.
MCDOWELL 21•REMARKS
County Parcel Identification No.MIN) WELL WAS_SELF CERTIFIED
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field.one lat/long is sufficient) 22.Certification:
N W 7-15-2024
6.Ware)the well(s)I% Permanent or ®Temporary Signa e of ter ed ontractor Date
By signing th brit.1 hereby certifi'that the well/0 seas(were)constructed in accordance
7.is this a repair to an existing well: (3 Yes or %ONo with 15.4:VCAC 02C.0/Of)or 15A 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 021 remarks section or on the hack of this farm.
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: 325 (ft.) 24a. kor All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths if different(example-3@200'and=(ii 100') construction to the following:
10.Static water level below top of casing: 50 (ft.) Division of Water Resources,information Processing Unit,
limiter 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) 8 Method of test: RIG 24c.For Water Supply&lniection Wells: In addition to sending the form to
PILLS the address(es) above, also submit one copy of this fonn within 30 days of
13b.Disinfection type: Amount: 30 completion of well construction to the county health department of the county
where constructed.
Form(iW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016