GW1--06700_Well Construction - GW1_20241108

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WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
1.Well Contractor Information:
Kolby Mitchel Sawyers X1.44WATEIMONDOWK, ••s -t" '' ''„ i,,,'oV -7>;a t;
FROM TO DESCRIPTION i
Well Contractor Name
ft. ft.
4471-A
ft. ft.
NC Well Contractor Certification Number I UU1 CR GASItYG tfOrtn`ultt"easett ells)ZIIt%1;INEltz(tf ajs Ileable)VIMA.4;:' :`
CLYDE SAWYERS & SON WELL & PUMP INC FROM To DIAsi TER THICKNESS J MATERIAL
+1 ft• 120 ft• 6.25 in. #21 PVC
Company Name
W E L2024-0 0463 ��Ic'�l"I�illa.cAslnt;,nrtrgrtlncr{�co'tiaermut:closed-toop),���. .��,��%
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.) ft. ft. in.,
3.Well Use(check well use): fL ft. in.
Water Supply Well :i11M'UREENx ? 4. "• .a , ,-:, ` '01:5; , � s N '
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
Agricultural Municipal/Public ft. ft. in.
Geothermal(Heating/Cooling Supply) }Residential Water Supply(single) ft. ft. in. '
industrial/Commercial ®Residential Water Supply(shared) Nf8;fG1R0`11T.W .• l .)MItiac4151l0
irrigation FROM TO MIA'rh:RIA I. EHPI,ACEM EN'r METHOD&An1OUNT
Non-Water Supply Well: 0 ft. 20 ft. Bentonite Pumped
Monitoring DRecovery ft. ft. Cap Top with Bentomite chips
Injection Well:
ft. ft.
Aquifer Recharge 0Groundwater Remediation •
19.'SAND/G1ZAVEDPAGK(itapPlic>i°bl�< _ ,~ c? Ser4PkeWi OVA
Aquifer Storage and Recovery 0Salinity Barrier FROM TO _ MATERIAL EMPLACEMENT METHOD
Aquifer Test fl Stonnwater Drainage ft. ft.
E .
Experimental Technology ID Subsidence Control ft. ft. ,
Geothermal(Closed Loop) 0Tracer iriti tI)OY;INGJi(?GTtattacli€add)tiorialsheetsifiecassuij) ' ;
Geothermal(Heating/Cooling Return) 0 Other(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness,soil/rock type,grain size,etc.)
0 ft. 120 ft. OVER BURDEN
4,Date Well(s)Completed: 10-15-2024 Well ID# 120 ft. 225 ft• GRANITE
5a.Well Location: ft. ft. t° • . `.r+ .;2- 1
JOE JONES ft. ft. NOV0
Facility/Owner Name Facility lD#(if applicable) ft. ft. NOV8 2024
840 ASBURY ROAD CANDLER, NC 28715 ft. ft. Ir2V.,. ?rCr�.?,„r1= .ii, ,.
Physical Address,City,and Zip ft ft. Vi i.u'' Q it
BUNCOMBE 960789439900 13zt::1tErvtutif Se. ` -- ;:— W1,, 4i, ' - 'NZIMIMEit
County Parcel Identification No.(PIN) WFI I WAS SFI F CERTIFIED
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5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22.Certification: ' •
N W 10-18-2024
6.Is(are)the well(s) X Permanent or OTemporary Signa e of er edth ontractor . ' Date
6y signing th orm.I hereby ceriJj•that the well(s)was(here)constructed in accordance
7.Is this a repair to an existing well: 0Yes or EiNo with 15A NCAC 02C.0100 or 15A NCAC 02C.020I)Well Construction Standards and that a
If this is a repair.Ill out known well construction information 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 buck 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 GW-1 is needed. Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if necessary.
drilled: I SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 225 (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@a,200'and 2(a 100') construction to the following: l
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10.Static water level below top of casing: 20 (ft.) Division of Water Resoulrces,Information Processing Unit,
Ifwater 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 t nter,Raleigh,NC 27699-1636
13a.Yield(gpm) 50 Method of test: RIG 24c.For Water Supply&Injection 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: 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 Resource. Revised 2-22-2016