GW1--06708_Well Construction - GW1_20241108

i
WELL CONSTRUCTION RECORD
For internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: 1
Taylor Ray Boger 4.14 `4itiV`Eli QI ES ,A . 4'.'"IVOr''' ":- :. ' 'INMM
FROM TO DESCRIPTION
Well Contractor Name ft. ft.
4614-A ft. ft. I
NC Well ContractorCertiticationNumber '1S=t)Cl3'ER;G stsl a(foarotC-c ased't�efi`s);Y,}R:IIirER('ifapphcablej ,.,M,,,;',:';`�,
FROST TO DIAMETER THICKNESS MATERIAL
CLYDE SAWYERS & SON WELL & PUMP INC +1 ft 50 ft. 6.25 in. #21 1 PVC
Company Name Tti:ilN1YER C„tfiSl" Crt14tiTCIBTNCrf(KeWtherm Geloi-ettA q -'^
2024-00482 FROM TO DIAMETER THICKNESS MATERIAL
2.Well Construction Permit#: ft. ft. in.
List all applicable well permits(i.e.County,State,Variance.Injection,etc.) ft. ft• in.
3.Well Use(check well use): SIGItEEiN , _WW . s, r'717,Ra;!Qa4rgarik, rti.100,1W
Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public ft tn•
ft. ft. in.(Heating/Cooling Supply) EResidential Water Supply(si le)
•
❑industrial/Commercial ❑Residential Water Supply(shared) 48`0.1ttx t. '`.• � SPA I N:
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
❑Irrigation 0 ft. ft.
Not-Water Supply Well: 20 Bentonite Pumped
❑Monitoring ['Recoveryft. ft. Cap Top with Bentonite Chips
Injection Well: ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation 119:xSAID1{I11A%Y1•i`1'.IC"{tapiilteattlelfgl 'rttMR .r `
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM To MATERIAL EMPLACEMENT METHOD
ft. ft.
❑Aquifer Test , ❑Stormwater Drainage ft. ft.
❑Experimental Technology . ❑Subsidence Control
,70 LtRI1s'l ING''1`0 tlIttac addttiiuitallit eetiifilie car3`) ',
OGeothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION(color,hardness,soil/rock type,gran size,etc.)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) 0 ft' 50 ft. 1 OVER BURDEN
10-11-2024 -
Well ID# 50 ft• 305 ft. ' ,. --GRANITE
4.Date Well(s)Completed: it, ft. r,'4;-.L•, `-' f` ,T
5a.Well Location: fT.
ft.
I`I l)U
ENPLAS AMERICA INC ft. rt. 0 3 2024
Facility/Owner Name Facility ID#(if applicable) ft. ft. Ir,`C:7;7.-,t17--.-: ?'�.0 r,-•^-c7 r i- 77gg..
c. - Wi✓D`.+Y.
230 SARDIS ROAD ASHEVILLE, NC 28806 ft. ft. E.;;;Ca'=4�-,,i
Physical Address,City,and Zip tt2'1 7 t ARirS W ' �, ' INAWM
BUNCOMBE 9627-00-3429 THIS WELL WAS SELF CERTIFIED
County Parcel Identification No.(PIN)
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification
(if well field,one lat/long is sufficient) ,
N Vy % . 10-16-2024
Signature of ed ell C ntractor ` Date
6.Is(are)the well(s): ©Permanent or ❑'Temporary By signing this form,I hereby certfy that'the well(s)was(were)constructed in accordance
with h A NCAC 02C.0I00 or ISA NCAC 02C..0200 Well Construction Standards and that a
7.Is this a repair to an existing well: ❑Yes or 16No 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#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 INSTUCTEONS ;
9.Total well depth below land surface: 305 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths ifdii different(example 2-3Q)200'and 2@100') construction to the following:
10.Static water level below top of casing: 20 (ft) Division of Water Resources ices,Information Processing Unit,
If water level is above casing,use"+" 1617 Mail Service Cent er,Raleigh,NC 27699-1617
11.Borehole diameter: 6•25 (in.) 24b.For injection Wells ONLY: Iri addition to sending the form to die 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: 1
(i.e.auger,rotary,cable,direct push,etc.)
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Celtic'',Raleigh,NC 27699-1636
13a.Yield(gpm) 75 Method of test: RIG 24c.For Water Supply&Injection Wells:
PILLS Also submit one copy of this form Owiihin 30 days of completion of
13b.Disinfection type: Amount: 30 well construction to the county health department of the county where
constructed. I
Form GW-1 North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised August 2013