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Home My WebLink AboutGW1--06722_Well Construction - GW1_20241112 • t; , • • . .. p • WELL CONSTRUCTION RECORD For Internal Use ONLY: , ,. ,,.. • . This form can be used for single or multiple wells I. ' ,'• , . .• '`. • 1.Well Contractor Information: . , ! ' " • ' . „•- Derrick Heath Sawyers. 744mATERIon$mm=m-4.:00:?-wnwRolguinR., • ,.w..,. ; _ .,.. .FROM TO DESCRIPTION . Well Contractor Name ft. .. ' ' •2436A .• ft. ft. 1 I g t 6 i'.0.01%itt ASO(akibiligikliaitifilliMittiNgttlieliii irklibleViM ::i NC Well Contractor Certification Number FROM TO DIAMETER THICKNESS MATERIAL .To... . ' * . CLYDE SAWYERS &SON WELL & PUMP INC +1 rt. 27 . ft. 6.25 I '1". #21 . . PVC Company Name .INNER CAINa(irtiitG(,Oillibillnit tote11460) FROM '1'0 DIAMETER THICKNESS MATERIAL •-, ' ' 2.Well Construction Permit#: 404062-2 ft. ft. in. List all applicable well permits(i.e.County,Slate.Variance,in/action,etc.) • • ft. ft. in. 3.Well Use(check well use): AVSCREEN. R.M",!•ftWimmi.p4WREMwi,x5W... -., n*::,.ww-,• : • . Water Supply Well: FROM ' TO DIAMETER SLOT SIZE THICKNESS MATERIAL ft. ft. in. DAgricultural • 0Municipal/Public. . ft.OGeothermal(Heating/Cooling Supply) EIResidential Water Supply(single) ft. in. Q Industrial/commeidial I:Residential Water Supply(shared) '-',,vR18;16:"G4TROUTNI.itrTN!..IX,K.....M.M...?",:ky•MMI--.M4•M?..42.i.IM,". .=!OVAXM". ni ATEF IA L EMPLACEMENT METP101)&AMOUNT' • . • ' . OTrrigation• ,,, .. .: . 0 ft. 20 ft• BentOnite Pumped •. . .,.. -, • . '• ." Non-Water Supply 11 " . • , ' ' !'•"fi,`''. - ' !..' 1' -"'We ' - - : ' ''::- " • : '• '-: -` ' ft, • •- '-:Al. :-.-" • -,, ; Cap Top With Bentonite Chips :-. - 0Monitoring ' .. ° .•ORecovery ..- •. .. ..• . •-. . . .. . . . .. Injection Well: '' 0Aquifer Recharge OGroundwater Remediation IWSANO/GRAYtriF•AC-1(410iiiiiliaile)R•MMZVA•V•Mai",,,MMUVRIN FROPI TO MATERIAL EMPLACEMENT METHOD .i. '. . .1:Aquifer Storage'and Recovery 0 Salinity Barrier ft. ft. .• . , ElAquifer Test OStomiwater Drainage ft. ft. .. • 0Experirnental Technology 0 Subsidence Control • •, -.,.:2.(10)1/.1ttiliOl'itialiiiiailitiliii'aNii-MiCaidirV)WIMMRWOMM. OGeothemial(Closed Loop) , OTracer FROM TO DESCRIPTION(color,hardness,sail/rock type.grain size,etc.) OGeothermal(Heating/Cooling Return) - 00ther(explain under#21 Remarks) 0 ft- 27 - ft. OVER BURDEN , . - • ID# •' ' '. 7 -':-' - 08-12-2024 27 :• ft• 525. .ft• -; . GRANITE . 4.Date Well(s)Completed: Well . . - . • ' ft. : It. • '" r7.. 7'", ._-., ._. • . . . 5a.'Well Location: ..:, • ft. ft. -, V .k...,„::.i!, - ..,:;. , r.----- • Vincent Reeelli: ....:..• : • .. . : - •• - :. - ------,“...: p. ,.„,e..., --,.., ft. . ft. ' :' •NO V p• Facility/Owner Name: • Facility ID#(if applicable) ' ft. ft. .. .4 ‘024 Old Murray Rd, Mars Hill - • ft, ' ft.' ;1'''..":F,-ii":!..F..-•,, 7), . ! ' ,-.".. ' • - !.. Physical Address,City,and Zip . .:71111'11ERIARKS?F,MMWMIMMAM-!,•00441:Mii.Yiit5311.•RaM"•-",.MI: Madison , 9850-92-3969 WELL WASSELF 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 W qeolks ,. , . 09-252024:.:. Signature of ertified Well Conti-acto . . Date ' . , • - • • 6.Is(are).the Weil(s): OPerminent or.. OTemporary .•-7, • • - By signing this fimm,1 here'hy cerib5, •'that the Well(s)uses(were)<was-traded in us, With 1 A NCAC,B2c 7,0100 or 1_511NCAC pc.000 Well c7oh.h.yelion'Standards ancLtilat:O-. , . 7.Is this a repair to an existing well: 0Yes or t No'''' •. . .. 2 '. .'copy 4thisi-ei.M1r1 has:,.becn;nrosideiliO;he;well dwme?. -'' ' • .= ., . •• '' - ...' ' ': •• .1f this is a repair fill out known well construction information and explain the nature of the ' _ ' ,!,--- ...,...:•,•-• • i : I' :. 1- '‘ - .- :' ; ' - • ,.-•• '' . '..-'. repait-'under#21 remarks sectionor on the back of this farm: ' ' ' , 23.Site diagranior additional well details:'--' i .' .1. ,,...,• ., „• ,'',':, ,,,,, ,.„ 1 You may use the back of this page to provide additional well site cietairs or well' 8.Number of wells constructed: - construction details. You may alst)attach additional pages if neceisary. • • - For multiple injection or non-water supply wells ONLY with the sine construction.you can . submit one form. , • SUBMITTAL INSTUCTIONS • • 9.Total well depth below land surface: 525 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well , For multiple Wells list all depths fiftlfifbrent(example-30.3200'and 2(q,..;1001 construction to the following: -, I. •11 ., ,,. . 10.Static water level below top of casing: 20 , (ft.) Division of Water ReSonrces,Information Processing Unit, . . If muter level is above casing.use"+" • ' 1617 Mail Service renter,Raleigh,NC 27699-1617 • ' 11.Borehole diameter: 6.25 , (in.) ' -' . 24b.For Injec ' : - • - • ' tion Wells ONLY: In addition to sending the form to the address in • ' , . : '-' .• ' ROTARY 24a above, alio submit a copy Of this form within 30 daya'of completion of well • , • . 12.Well coistrnetion method: - ' •• " , construction to the following: 1! .: .. , , (i.c.sager,rotary,Cable,direct push,etc.) •. • . .' - 1 •, . . „ ,. Division of ater Resources,Undergrpund Injection Control Program, .. . . W • • FOR WATER SUPPLY WELLS ONLY:- , • 1636 Mail Service'center,Raleigh,NC 27699-1636 . . - . RIG • ' . • ;• 24c.For Water Supply&Injection Wells: • ' ..i '.• 13a.yiell(gpin) Method of test: • , ,- Aro submit one copy of this fOrrn within 30 days of completion of PILLS well construction to the county belth departfnent of the'county where • • 13b.Disinfection type: •: Amount: 35 . ' • ..? :; constructed. . .. .,. . • . • .. , . Form GW-1 • • •, , • North Carolina Department of Environment and Natural Resources—Divisiod of Water Resources ,' • Revised August 2013 , . • . • .. , ., : .. - . . . . . . • • • : . : : 1 ' ' . ' . . • ' . ,,, . . • . . . , . "