GW1--04358_Well Construction - GW1_20230707

• WELL.CONSTRUCTION RECORD For lrrernal Use ONLY:.
This form can be ascd foi single or tnultipk welts
1.Well.Contrattor Ltformation:
;t4: AXERZONiS
Stefan Smith ROM in DFiiCRiPTlON
«•oll Coritnactor Nam:, ft. II. . '
1 I
3576A ft, rt.. I
NC Won Contractor Certification Nutrlrct TS::OMITER CASING'Ifirri iitll i=casied rscOsl'OR LINER fit appticabkl'.
FRO\I TO DT-•METtiR MICtiNESS MATERIAL
SAEDACCO Inc • .ft, - ft. , In.
Cautp;ut]Hance. -Ili:INNER CASING OR=TUBING.IrL'ni,ei'rnal c olds-loop)'.'- - _
. FROM TO . DIAMETER TIiICKNE.SS TIATEItiAL
2.Well Construction Permit 0: • ft, ft. ..,ht.
iirratt applicable weft ptimits(he.County.:Stuar,1cirimse,1100;ear.J ,,
0.. ft. Ca.
3.Well tie(check well rise): • .17:SCREEN • .
Water-Supply-Well: PROMTO Dl.fE:Tr;R sr.OTSIZE THICKNESS i MATERIAL,
CIAgiicultuial . DlMtitiicipaliPublic ft. Ft. in
I�lGeotliennat(Heating1Cooling Suppi)) - .DResiidential\Pater Sup*(single) �t' .ft, •
i°' I
®ltidustriallConmlen ial ©Residential Wnter.Suppl (slctlyd) ;:cpcROUT`: .•....- :I. .
FROSI TQ_ . MATERiAL -EMPLACEMENT.METHOD&A:SIOR`T
El Irrigation • . . ft.. fl.•
Ncrn-AVatcr Sum l}SVtK: rt. . rt. . . 99 . .
5dlbf4ni(nring 1]Receveiy __ 1 n_
inject ion Well: ft. ft.
ClAgnifcr Recharge gGroui dw-tter Renicdiation 4t9:SANDJ(RAVELPACK9if agrliltcabItlY!' - •:. _
• -ERO.t 7O - M TRntst. • •R5iPLfCE MENT�l Limon❑Aquifer Storage aril Rccoitty OSalinityr Barrie ft. ft.
❑ATlnilerTest. ❑SlttirntaterDrainage • 6 ft.
❑Expetimeolal Teclmotnrt• 'DSithsidcnce Conant .
-..20:DRILLING4LOGYaliacl addllionalshcets if necessary')
fGeoodtemtal(Closed Loup) ❑Tracer FROM TO DESCRIPTION roar.u,rrvncw,s;rurnara rti-.vpin w":.cei
❑Gtotltennal(Heating Cuoliog Return) ❑Odter(explain under-12I Retuaths) 0 .fy 10 ft, Silt L and gravel
ft._ ft.
. 4.Date Well.(s).Completed: 12 June 23 WellillfiTMW-1 °�'� '` "�"
It. ' rt 'a L.N.'l,,,a L:'.; -L
is Well Location: .ft. IL JULI I 7 2[�23
_ .
Factlitp,'ClnrtcrNaruc Facility ID.(ifappli:irble). ft,_ t ; f k.,1 r'rr•,:,r,y7 )ir
144 Tunnel Rd., Asheville, NC, 28805 . ft. ft D4ri` j'� -
Ptnsieal Addiesn.City:and Zip . :I L REMARKS- ' . .
Buncombe 'Used SP-22 water sampling tools for 3 grab
Comb.- Panc]hiclitificailonNo,(PIN) samples
5h.-I.4ttifudeand lmngituile in dcgnes/minutes/seconds nr decimal cfegeeci: 22.Ccr1iticatione
(ito ell fiCld,Pip:Iat.1out;i;;gid]]cieru)
•
35.590819 N 82.529824 •
W i n � 6/16/2023
Signal; c.lied Well Canttactar Dale
G.iS(are)the tt'elI(S): L]Pl'rllf3ttent tlr $ITetttpOrat Y m•.signing Air furia;.1 hereby certify rlaru the we'llss)trri (Men)Oi 0yanreed hi,:.'crc*71c.r
Writ'I 5A,VC1C 02C.0100 or 154 NC4C 02C,0200 Wei!Cpnimirarc,r Stanrtarris mid Omer it
7.Lsthu,areliairttrancristingr{'elli OWN or No t'o,7r.'ofrlrfsrveirrlhhsbee.'prarididroih.'trullcholer,
if rh(s:ls o rpcTh'.fall oor.Sio;wr a•et!romyracrloii hgiurnrrlcvt.Trial e i hIn the wrote of die
• 'lip*rar,•Icr 021'rernark,'.scerliur,or ill ahe bruk of this form. 23:Site diagram or additional well details:
You may use the bacd of this page to.pros'idc•additional well site details.or Well
•
8.Number of wells constructed: 1 • consituctiott details. You Islay also attach additional pages if ttecessan-
For,autrlple lrt eerlon err eirm-over supply trelds ONLY u'ldr rlir.saeae coustrurriou,Ant cars
. saver o w form. SUBMITTAL iNSTI_ICTIONS
9.Total Welt depth below laud surface; 10 (t11.). 24a. Fur Alt Wells( Submit this form within 30 days of completion of well
For ntarhiplei.,elirlisr all depths(fdI4i'rem(e,r4rn,pfe-.? 200•and.2nstoo) consinuction to the following: -
10.Static water Iei•el pduw top of casing (ft.) Division of•Water Resources,Information Processing Unit,
1/uniee kin.?Is above cusi7ar:are•'+'• 1617 Mail Service Center,Raleigh,NC 2 7 699-16 17
11.Borehole diameter.2.25•" (in.) 211.1•nr Iniecflon W'glh ONLY: in addition to-sending the fort to the address in
24aabove,also submit a-copy of this funs ivitbia 30 days'of completion of Well •
12.Well oonstrttctiou method:DPT eoustmcUon to-the following:•
(Le.aiiger,rotary,cable.direct rusit:etc.)
Division of Water Resources,Underground Injection Control Program, ,
FOR WATER SUPPLY WELLS ONLY 1636 Mail Service Center.Raleigh,NC 27699-163G
13ak>!'idd(j linl) Method of test: lie.For Water5ulipl:it Injection.Wefts:
• Also submit•one cops' of this fort Within 30.days ofcompletionof .
136.Disinfection type: Amount: well constmction.to the county health department of die.coimiy where
cousin:etc:I
Font;Gw-1 MonhCatoltlta Departmetir.of Eocitaautrm and Natural Resources-Division of WaterRtxotrcn Revised August2i113