GW1--04357_Well Construction - GW1_20230707

WELL.CONSTRUCTION RECORD For Internal trsc.DNLY,
' This.form can.be•owil fret single or multiple wells.
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1.Well•Contrnetor Information:- • . . . . •
-L TER.ZON ES • -. • - .. - '
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Stefan Smith. : FROSI - TO DTSCIOPTION
Well Cotintoor Name ' ft; it'
. , 11. . IL.
3576A
','15.,OUTER'CASING'(finqiiii111.;eakdriittISV•ORLINERlif ini`illeablel',. ,:..... • . .
NC Well Contractor Certification Nuirhm
FROM . . TO OTAMETER 11111CNNESS- _ MATEMAL
SAEDACCO Inc , 0. it. M. •
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Company-Nome. • :-,16'.1NNER.CASING•011-,TBRING.t.iiklitliiintatebui.cil-lon'i .`_ •-
IIIIIR1111111 TO DIAAITTER TIIIUNNTS4 iniViBign.
2:Well:Construction Permit#: , R. ft.• , ."hi-
Lif r ira apAio:ible Ise;11Prayei: (ix.County,qtale,Varionre,freall64 074.
rt.•. ft. i'.•
• . - •- .
3..NYell Use-(ehecl:Weil lisp): -rit.SCREEN . •. - , . . , .. . .
. ntosi 10 otaAtErra st,Or Silt TO ICKN F7S5 1 NIATI70.11.I,
Water Supply Well:
It. ft. - in.
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011igticulturat ElMtitticipalintblic . • •
.
fi. . in,
1:1GeOtherthal(Heatingtooling Supply)' .1:1Residentiat•.Water Supply(single) • . '
•71 ....,
ClindustrialiConintercinl OResidential Water Supply(shared) -FR051.OUT- .70 . .,-mATERtAL
ENIPLACEM=METTIOD&AMOUNT
I:Irrigation . . . ft, ' •
. . , .
lino-Wafer Supply NVell: • . ft. ' - •- - •
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lahlonitOrittg 1:1Rrxoyety ,__. _• , - ...._, . __ • -
• Ittjedion Well: ft. ft,
°Aquifer Recharge • flantindwatcr Reincthation - .js2sii.rholc,t1AvELTACICtitaittaieunter- . ---'--------.7777:•"-....
. .. .• - ... . • , . •FROM 10 MATT.Rrii I. , .P.:OPIACTMENT Mt.:TOOU -
clAnitiferS.Ithagc and Reetively ElSalifiity Barrier.
°Aquifer Test. ' 1:1Stthintwatce pthinnge . . .
. fi.. ft.'
13V:eperipuentnlTo.-.:hordogy. 13Sithsidcocc Control
• . ',:;20'.iDRILLINIGIOUrritipaWadilliiiinitt itikeislf iteecSmi-vr ' . . •.. . •
Ecrenthemed(Closed Loup) LITEMer - . FROM'.- TO . DESCItIPTION(016r.bzirdigeti,vi.niiteti trrpc..oritin!..ii.hz,del
0Grothental(HeutingCoollugReLutn) Obilier(eSplaitt muter 1,E211 Retuatii.$) 0 .14 15 ft, Silt and gravel • . .
. •
It ft.
-i..Dato wiaaw.conipl'eled! •1 June.'23 Well 166Prmw3 . I 'ft: ft.
5a,Well Locution: .ft. ft. ,
..., '.',-- .... ...
• . . ' tt.- ' r..7 ...-„.fr -`t j_ ,,6 /..,-.,r......7,q1
Facilityk[Inner Now Facilk ID g OfappiSmble) • . -,..„ •
ft. R.:
144 Tunnel Rd., Asheville, NC, 28805 . . ft.. ft,. JUL :0 '7 1023
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. 0 ILI.t.ido Attd.:55,citY:..0 ziP ' REMARKS• • •• • .• ,' I nfc;•,-4-..,--,..'i:,•-i•`,),...-..7-7.„,,:•::..-a un.....t.. .
BUncombe .Used SP-22 water sampling tools- 1517.1digeg
Comity • . Parcel Idoitirdion No;(PIN} samples
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541-Ptitudennit Lthightitle in degivesiminutesisterintis or deviant'degiecs: .
22.CM-111166m:
OS.tteit r.w.td,pike 14104 is.suttlele30 • . .. •• . . .35.590819 N 82.529829 W A'.,,..- 7 e446,,,(d.
• ,... 6/16/2023
.Sgn ' of Cc..tied
Wel Contractor Date
6.1s(pre)theUell(s): I:Permanent .or XITentpnrary .. . . . . . . .., . . .
• Ay.1*ning a*Ptur,,1 irereby certifr Atli At!,weit(s)Px.tx fyiire.,1 a.m.yrnKsed Ire.Aconirilice
TOiril 15.1 NOW 02C.0100 or 1.5it•JVCetc OW,07a0 Weil cossenwriny graradirds tyid gma a
7.Is this.o.repair-to an existing well: ElVes Or RINo 4.'4,Pir•0..f riliy ie.roirl 11,4 heen poi ided fei JI'M Sltirn oiulier,
1/tiVSiiiI7 re;edir.fill-or Art01171 WO' bCieciti hrrilaTiNt iTlitit**11 due;wave of rile
iiliceir radar#2 I reenclai'sergen or imi the&IA of this.form. 23:Site diagram or.addltional well derails:
• 'son thay.use the back of this page Co provide.additiorMI well site details or Well
fl.Manlier of wells ronstrueted: 1 . .
. comnuction details. You may also•attah addition*pi.iges if ill:Coss:try.
For mutripre htjecr1Ou or of!fl-warer supply ivils ONLY Mai rito.sattr• qoanstruilion,yott nut
sobna.une form. ' SLIIINIrrrAL rSTsTucTtON§'
9..Totiii Well depth hap*land stitfacei 15 • Inf.) its _For All Wells:: Submit this font'within SO days'of cOmptetieo of well
For;Tula*ii:,etIsl isr 01 depths if elWereni fenrimpre-3@20fr ard.:@ Min construction to the following:
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pi:Static water level helow.top.of easing,. -• . (it.) Division of'Wtiter ReSon reels.'Inforniatitth Processing;Unit
'if wiime kid is illwre ciisteag;its +" i017 PriaiL.Si:.rvicg,Cciiiir,Raleigh,NC 27699-1617
II,Borehole diameter:2•25" 24b:For tribmion'Wilic ONLY: 16-addition to-sending the feint to the address i
. n 24a above,also submit a-copy of this forth within 30•days of.coulpletion of Rill
it Well'constrnction method: DPT •construction to-Ike fbllowing
. (Lc.pitiTi-,loony,cable,'direct push.coil . •
Division Of Water Resources,Fude
' rgyound Itijeetion Control.PrOgrato,
FOR WATER SUPPLY WELLS ONLY 1636 Mull Service,Center.Raleigh,NC 27699-1636
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24c..For Ile'uter Supply&Injection Wells:
Bp.Yield(ginn) Method of test ,.. . •
Also submit'one'copy of tins,fOrtn Within :30'.days of cOmpletiott of
.
, well-conStniction to the county hcrilth department of the..coOnly where' '
13h.Disinfection type: Amount:
constructed,
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Form GW-L Nook Corolina Department of Euviroturcto and Natural Resources-Divii leo of Water Flantron Revised August 2013
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