GW1--04355_Well Construction - GW1_20230707

WELL CONTRUCTION-RECORD For Irtornal tkcpNLY:.
'5.Thfs:form can by tiscd rill singlo.or Inultipk trolls• ' .
L•Witt.Contratto I'Information: - . •
.... .'14.1VATER-71)NES.. • -. • ' . . - - .- . •.
Stefan Smith • StOSI • TO '•DI:SCRIP:NON '
Wo11 Contractor N:inio, • ft. • ft.
' - •
ft, ff,
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3576-A
'."1&-.OUTER'CASING‘ifdriiiIiItiztif411176-kilsfrOR LINER:tifaii'llelible):,.'.-:,
NC Well Contractor OzOificalion Nunilet •
FROM - 'I TO ' DIA5GETEIt THICKNESS NIATEMAL .
SAEDACCO Inc 0 (I, I 20 -ft. -2" ' ; In. SCH-40 PVC ' •
Conigany:tom t6.--INNERACASING'OR,••11181NqOguilli2iltutl cbiiStfil4t:III .L.-.•_,-. "
FROM TO • • DULIEETER . THICKNESS MATERIAL
.'Welf"ConStructinti Permit Ili • ft. ' ft,• fa:
Litt off applkitbfe well piTheitz(L..County..po.y!,Viniatier,fiziecp0;err.) ft
. ft. - . 41. • .. .. . .. .. .
•3„.'WO lit (elietarydl use)l . ..17."SCIIEEN - . . . . • . . .
' Waf,Cr Smutty%Veil: - EttOSI 10 WASH:rt.:It St,OTSIZZ IIIICHN['SS I SIATIKtfat,-
20 Ft. 40 It• 2" it, .010 ' SCHr 40 PVC
. °Agricultural LAItinicipal/Public
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°Gel:dem:al(lleatingCooling.Supply) - 1:3Residentia1.Watir Supply(single) . . .11" 11' in
,718Z GROUT.-• -• • .-..... .-7,":,*
El Industriaittpinntorcial . ORcsidential Water Supply(slciretl) '
F8051 - :Tiii . • IVIATERRL ENIPLA-CF,NtE.-NT StEIWOD&AMOUNT
• Clkfisstion . . . Q. :ft.• 16 ft.,- Portland, Pour
Non;Water Supply W . . 'ell: - - • . • ' . . . .
ft, ' • ft,
• RIDAnnitoring IStocol'ory • ' • . • .. _ .._
Injection Well: • . . ft. ft.
..............—.1_...._0.3tquifcf Rochargi. • • • DOrpuii4water Rciucdivlion . -.1VSA.NIVGILAVELPACKtif:Atfilii..ahIW : -',,-. -7-,-:-c•-::----:..-, .., ,--•-:•• ...-''--
. •••PROM 10 • NIASEEtrA I. • -ENIPIACEAIENT IJI-3110D - •
'' " '' • •"
• . 0 Annitcr:Sa.gc awl RtctAtty PSalinity Banici. 18 .ft. 40 ft. sand 2 -.
CI Aquifcr Tcst. OStotniwator Prainago
o o: S o '•• . h.. . jt. '
JEVrintonal Thuting DubOconr tntral . OGItfOdd tliifalihiliif tCiSta-611,
29:,ORTLINGL t7to
. • - "
. . . . •Eictutitennal(closed Limp) . 6trai:.er — MOAT ' I TO • DESCRIPTION tottor.hardscsatimit 4yitc.g.risiii
. . . . . . . . _ .
EIGeothennal Mean:WO:ding Retool) clothe,(ex:phiin underp2 I.kenadis) 0 .ft.. 30 ' ft, .silt to clayed silt
. . • . .. 30 ft. -40 ft. silt/possible PWR •
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. . . 4.Date Well(s).completed:' 672-23 Welt INI0-5 . . . . . ft. rt.
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S.Well Location.:
•1I.' ft, '
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• --.., ”......
Shell•Gas Station . _ • rt.. It.' . , , .---t.r.--F• • •
.4 __.9
Faciliir'thvtxr Name Facility itg,!(if applitble) --., 7-.-.........t-....,,,,$_. ol•,., , - .
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171 Weaver Blvd., Weaverville, NC, 28787 , ft. ft' . . ,- " • ' JUL 0 7 2023:
• •phystomoit7s,.tity.-.1„iti, • -21 RENIA'R.tis . .. . , . •,• .. . . .
•
Buncombe . Bentonite seal from 16-18'irliCI-Filali-C II ;"'r,7-,:r,-m,.4.,• UntA,
. • Dt.,),0;n1::::::
County P4tcc1kkolification No;(PIN)
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5h..1.0tifit detitill 1,onOutle in dcgreesiniinutes/seennds or florin:al degree* .22.Certification:- ,
Or lieu 11414,pi!e 1:411p4 itt•solficignit
ii7.fieid
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35.704485 1(4, 82.569434 %V krill - . 6/5/2023
• . . .Sign? of Co..Nd Well Contractor • Date
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G.Is(are)the•Iv. 11(s)t X1Perntaitent or OTemporary
hy Ni.gmbre,driiirmr4.1 liereby eedify Oar*verb)hy.•04rtzi!eurgitiglexl iira :ordrivcr
. . . OA FM NPIE 02C AVM or ISA AretC a2C;020a Wea Coto-J..41(0n Statxtorris'opitt gm a .
7.4 this a repair to an o.iistinglyclii ElVes or pm) "ntivofillis imoryi/.0.,i4-br,5•4 provided r c!.dm%wit'owner,
//Mess:kg(Oak,fill 4N4r lovii.ii we/I C61.13711117fielt1 likfilren471INI am/f.;.yl.epir the,.torare claw
iipair roe 021'rellittrAw Aftliara or imi the hark of this form. 23:Site diagi•ant or,additional wOo details:
You may,use the back of this page toinovide-additional well site details,or Well
8.Nuattberof Wells constructed: 1 - . constniction delaits. You inay illsa•atladt idditional pages if nixessary:
For fritalziple hdeer/oil iir owl-wirer Elipi* reify- ONLY ONLY with rhe.saw construi.flott,yon eon . , . - .
sa6nth Lihe form. • SUBMITTAL INSTUCTIONS '
0.,.Total Well depth belt*hunt stiff:ice: - - •- .. • (ft„)' .24a. Far All Wells: SOhntit this form within 30 days'of completiOn of well
For itushilik ii7eitslisr id!rktubs fick6i.roir tre,rowipie.--3%290'dttil;@l4h)) 'cOnarliCtitut to the folloning: •
In.Static,water leVet held*top of easing: • . . (111.) Division of-Water Resources,Inforifilithin Pincessing Ilitit,
//MVO kVid ii ilbutT tAISIWS,ilSe"t" • • 1617MaiL.Serviee Center,Raleigh,NC.27699-16 i7
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II,Borehole diameter:8-25" . (in.) •24b.For fp.fsefitut Weill ONLY In addition to sending the form to the address in
• 24aabrive_also submit a.copy of this feint within 30 days of completion of Well.
12.Well construction method: HSA • witstnichan In•the followinel.
(i.e.*gar,rotary.cahle,direct gush.clef .
•. . . Division of WaterItesourceS,Undergound Injection Control,Program,
. FOR WATER SUPPLY WELLS ONLY: • " 1636 Mail Service Center,Raleigh,NC 27699-1636
24e.For Water Soupy&tojectiOn.Wats:.
/301,•Vieltl'(ttifilt) Mediod of test: - .. - •
• . Also submit'one'Copy of this-jinni Witbin.30.:days of etunPletiOnof . . •
13h.Disinfection type: Amount: well conStruction to the county health department of Me coimty where-
-. . constricted, 1 I I I
Fii nu GW-1 NoniCarelina Npanment.of Ent-IMMO:1K and Natural RCMit•CCS-Division of WaiciFtirsatrcm. Raised August 2013
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