WI0100494_Well Construction Record (GW1)_20180611

WELL CONSTRUCTION RECORD
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1. Well Contractor Information:
Robert Larry Wells
Well Conhaow Nmm
2603-A
NC Well Conen. OndfiaeEon Number � 9018
AWD Services Inc. /l)
WID100494
2Well CM troMe. Permit#:
Les all Nheable welfromowU*n,e mltr (I.e. Ca.M Slam. Porlarce, a j
3. Well Use (clock well see):
Water Supply Welk "
Zltuml 09u ncipaVPublic
h'snual Supply) OResidential Water Supply (single)
Olnduddel/Comen,.ed OResidential Water Supply(shsred)
eulmemw wen;
OAquifer, Recher,
pGroundwater Remedus'.
OAgdifer Storage. and Recovery
Ogsivlty Gamer
OAqudlar Tat
OStarmwatrr Drainage
➢3 penewival Technology
eGeot
OSubeidence Crend
thermal (Closed loop)
Ohacer
4. Date Well(,) Completed; 08/Oit1fl Well D2#
So. Well 3joca9on:
'
SRZ Proparlas LLC (Sergio Zyman)
Fnciliw/ —Name -
Feoiuh AbNufawlimble)
214 Folkestone Lana Aden, NC 28704
Phyawel Addmae; Ciw, aM Zip
Buncombe
- 98340119e8
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Pmvel ldcndfloti No.(PM)
Far Internal Osa ONLY:.
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45499
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5b. Latitude end Longitude In degreu/ndnutedeeeonds or deal=] degrees:
(1fwe11 field one loUlone naufficiset)
22: CertlSea9os
36.480975000 ' 82.593288000
N
Forour {Ce .W.d . Date
6. G (are) the weil(e): LrPermMMt or OTe e,wrar,
By Agnfg rnmfoem l dareby Or* 'hat I& neli() itwruJ romoue/ d in aaommce
wlra lie NCAC 02C 0100 or IM NCAC 02C.02M Well im' Mowwen SmM s eud ehn a
1.Iathlearepairmaveris9ugwell: OYes or c
ropy oflh/rmrordhov (nenprvnlhdm;IM well m.Mr
j/Ms isar� flldul Mavxi wll e/nsc /Mon: flanmrdeWbmfhenamm aJ'Oo
repair undo xTl rL wanan metank ofwie hwnn.
23. Seto diagram orMiliflooal wslleirbeai
7 -
You may use the be& of this page to provide aldirouni wail site details or well
S. Number ofwdis constructed:
conehuctiondetaile. You mayalso aauohadMoned pages ifneceaeaty.. .
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.SUBMITTAL INSTUCYIONS
9. Total well depth below, land mrfaee: 2@275' 3Q300' 2O350' (ft)
24a Her All
wet6;: 9ubmrt this fame within 30.days 04 mmpledon N' well.
Formu)npls wefle llemll hP/Feld(I(renl(xample�3(j]00`oM2�100)
conetm6➢onto
thefollowing
Ill. SYafle water level below mpofeatlng: NIA in)
DirlewlofWater QuaDty{]uformedonProrard,
unit,
rywalerlevebr above mehig, ux^+"
1617:Mail Serolp, Came,
Raleigh, NC 276994617 '
el. Borehole diameter 6.25 (in.)
241sFar, lnhe0on Wells: In addition w 4endiag the form to the addmu in 24a
rotaryabove
also su8eit a popy of this form within30 days of oompledon of well
12. Well sonstruflem meMod:.
wnemmHonlo the frilowing'
(i.a. auger, mtury, eeRq direatpueb, apJ
Distdon ofWans .eRty, Undergrount Injection Central program,
FOR WATRR SUPPLY WELLS ONLY:
106 MFA SeMae Ceutmg R lelg%NC 27699-1636.
13a.Yleld(gpm) Methodaftmh
2de. For Wghr Sudnb&Iuleetl !,Y' p Ineddnlon tosending(he done, to
Me Md."(.$) above, also 6ppnl[ ono o py of thisto. witMn 30 days of
13p DbmfiMdM type: Amouol:
completion of well wvlumion to the county haeltb department of the county,
wherdrarMtrvcted.
Farm GW-1 NoM Carufwa Depuonevto{5nvirunmenrWNmnel Reacur<a-DiviswnafWara QWiH sevuedlae.2013