GW1--06713_Well Construction - GW1_20241108

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WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only: ,
1.Well Contractor Information:
I
Kolby Mitchel Sawyers 14 ATERzONES ' MMV ,, ,n
FROM TO DESCRIPTION I
\Vell Contractor Name ft. ft.
4471-A
ft. ft. I
NC Well Contractor Certification Number glWotlEgleGAS16101ftiiiititilii4iiWtViet~EINERFOrtirliallife0M as
CLYDE SAWYERS & SON WELL & PUMP INC FROM '1'0 DIAMETER THICKNESS MAATERIAI,
+1 ft. 64 ft. 6.25 in. #21 PVC
Company Name •" a
WEL2021-00123 � ASINER,Cu•gilW)R.TUBtt\G<i ca(ticraraliiiiii 140-6WIPMMI • u
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): ft. ft. in.
t ater Su ly Well t7`5GR-OR °".
pp FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
Agriculturalh4unicipal/Public ft. ft in.
Geothermal(Heating/Cooling Supply) EaResidential Water Supply(single) ft. ft.
industrial/Commercial Residential Water Supply(shared) *18:GR4U7 � ,,� � �yx
irrigation FROM TO MATERIAL EMPI,ACP.MENTMETIIOD&ASIOUN'1'
Non-Water Supply Well: 0 fL 20 ft. Bentonite Pumped
Monitoring Recovery ft. ft. Cap Top with Bentomite chips
Injection Well:
ft. ft.
Aquifer Recharge ®Groundwater Remediation
EI A S/GitivET�PAcKAi tiii$H b1�1 o. „:q-CT
Aquifer Storage and Recovery ®salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
Aquifer Test OStonnwater Drainage ft ft.
BExperimental Technology Subsidence Control ft. ft.
Geothermal(Closed Loop) Tracer ZODRILTNGzECtG(aiiacliaddifiaiialheets iCriiecessarjW >aR
Geothermal(Heating/Cooling Return) Other(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness,soil/rock type.grain size.etc.)
0 ft 64 ft.
OVER BURDEN
4.Date Well(s)Completed:9-19-2024 Well ID# 64 ft 305 ft GRANITE
5a.Well Location: ft. ft. 4 .ta,.,a.,t:is i"a 4 j
JAMES SANDUSKY PARRIS ft. ft.
Facility/Owner Name Facility ID#(if applicable)
ft. ft. NOV 0 8 2024
25 MORSE DRIVE ASHEVILLE, NC 28806 ft. ft. lfi<:,, -...-. :3,,,.,;: 1, ,;
Physical Address,City,and Zip
ft. ft. {s':vi-.;'.I(3
BUNCOMBE 1.21 RE;4fARKS' avX r.o°r• a s h. s . .
County Parcel Identification No.(PIN) WFLI WAS SFI F CFRTIFIFn
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
Orwell field,one lat/long is sufficient) 22.Certification:
N N' • 10-7-2024
6.ls(are)the well(s)�I% Permanent or OTemporary Signa a of er ed onhador Date
By signing th brut,1 hereby cerrj.that the well(s)was(were)constructed in accordance
7.Is this a repair to an existing well: 0. Yes or 0No with 15.4 NCAC 02C.0100 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#21 remarks section or on the back 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 1 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: 305 (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@200'and 2 cg l00') construction to the following:
10.Static water level below top of casing: 60 (ft.) Division of Water Resources,information Processing Unit,
If water level is above casing,use"+•' 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 6.25 rn.
( ) 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: 1
(i.e.auger.rotary,cable,direct push,etc.) I ,
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
the address(es) above, also submit one copy of this form within 30 days of
13b.Disinfection type: PILLS Amount: 30 completion of well construction to the county health department of the county
where constructed.
Form OW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016