GW1--07231_Well Construction - GW1_20231108

V L CONSTRUCTION RECORD ` �. For trrcnuIUcONLY:
Tiia,foto can lt-c mod for single or multiple wells ` {1`V f'
1.Well Contractor Information: \(
-4.1A,ATER_ZONES: '' -• ..
Stefan Smith FROM 1 TO nFaCrttPtiOn -
Well Contractor l:ame ft, fit. i r
3576A f. I. ft.
NC«'ellCaruracI Ccnifcationivrnrircr ::15OUTERCASING(Air 'OR'mnlll=casedvills) LINERtitaprllcabte)•. .
FROM I TO ' I DIAMETER THICKNESS MMATFRTA1.
SAEDACCO 0 It.I 15 ft. 2 in. SCH 4 0• . PVC
GmupuryNaurc -..16:iiiNERCAS1NGORTUBM.l3;coihiiiirialstttsct14000, , .. . - -
JFROM 70 DIAMETER • Tt11CA'NISS MATERIAL -
2.Well Constr uetion•Pcr'wit#: n, ft, .'hr.
Ild ail applicable'Tell permits fi_e.County.Siv,:Variance,f,,Jecdrei etc i
fit, fit. -in.
3.Wei! (cheer.wc11 use): 17:>S(;Rr tY:
Water Supply Well: FRO51 l TO 1 DIAMETER 1 SLOT5i%k; VIICK+dsS 11IATERIAt. •
0Aglfcultutal DMunicipalPublic 15 it, J 25 ft; 3 2 ill. 010 SCH 90 PVC
• ©Geothemlal(HeatingfCooting Supply) °Residential Water Supply(single) R.J II in. '
©hldustdal(Cantmcrcial ®Residential Water Supply(shared) :., - - - c tFR8OGM OIT TO sv - ,. E _P _
MTtsntat EMPLACEMENT 110D&ANIOUNi'
0Irrigation . . 0 fL 11 It. Portland Pour
Non-Water Supply`Nell: • • .
rt, rt,
IliMonitodng Dltecoven• . -- •-- - - -
•Injection Welt: It. O.
DAquifcr Recharge • DCitlnndtlhtcr Rcmediatioa 1tl sANDJCRAVEL AC_K of aP ille aI :)':=.=•-= =-: '-- - _
• FROM 1 To. : MATERIAL • 1.NIPIACE:MOM MI7IIO1I
DAgaifcr.Storagc and Rccoven' Daealinity Ranier' 13 ft. 127 fit., sand , #2
DAquifer Test . DStortm liter Drainage fit, !I fit..
08Verintcnial Technology. °Subsidence Control
20..DRiLLING'LOt fnitach'ndiliiionnl shcets'il inceessnr-)'
CGeotiteruial(ClosedELoup) DTraeer FROM io Dt.cltrptIoxrdvknrrerGnet,:t q'nrekt)ra.�dn iredra
OGeodtelwal(FleatinUCuolIug Return) D0lbet(explain under#2i Remarks) 0 ft. 27 ft.. Silt I. -
ft. I ft. C'";L.. -> --
4:DateVVell(s)Completed: 10-11-23 WellID#MW12 h I rT. � FJ''�� .�
Sa.Well Ldreatlnn; ft. •ft.• NO J S 20,
3
. iL It.
lr
Faclily.ThsnerNarns. Faciliy-1Dk(if agpliciblcl _ - tt' 'te r .�.
1920 Four Seasons Blvd. , Hendersonville, NC, 28792 R, rt. " �-�`�
. Pltysicul Address.Cit;,and_Zip .211.RE6tARi:S-. •- _ .
Henderson 1 2 'foot bentonite seal from 11 to 13'. .
Coudul Panel 1dtuIift.,1ti(n No.(PIN) I
5h, ititude and Longitude
I- ngitude lit degr'ces/nlinutss/sccrinds or ileciand degrees: 22,Cer'tilicatinn:
(If cell h eW;one iub7par�Is talneiont)
35.3374'44 N 82.444357 NV _ s" 1. 10/16/2023
Siernt orCc:lied Well Contractor Date
6.Is(are)the wcll(s): SPerrnanent or CTelnporary ! ,
Hy signing ihtr form,1 ircrebr•certify than rlir relics)was(Krrei cwarrnrcred in acrorerram
with 15,1 NC 1C 02C,O!(kr or 154 A'CAC:02C,0200)1!Cousnsirrinn Srnndurds and snot a
•7.Is this a repair to an existing well:. • IJYon or B Nn t'ipy of chic woof tar.c lrrea provided to.61:uril Diener.
If this is a repair,fill our n,urn welt twuslnellominforraorka:and explain Me nararc piffle
repair ruder 0l21remarks acerb*or an the ben(of tilts f ur. 23.Site diali•anioradditional.w•elldetails;
• You may use the blielc of this page'to provide additional well site details or Well
8.Number of wells constructed: 1 cotlstluction details. You may also attach additional pages if necessary.
• For multiple otter:ion er non-uwrer supply wells ONI.Y with the saute construction,t+nn eno -
srabniiroue farm. SUBMITTAL TAL iNSTLTCTJONS
9.Total Well depth below land surface: 5 (fit.) 24a. Purr All-Wells: Submit this foam within 30 days of completion of well
For Multiple-icelk US;deli depths ifdifii'rrnr(nwntple-YO'200'and 20lilin construction to the following:
.
10.Static water levet belowtop of casing: . (It) Division of Water Resuui,rc'cs;Information liiucesshnt Unit,
1f miler level is share easing;arc'"4-" 1617 Mail Se'viee Center,Raleigh,NC 27699-1617
11,Borehole di:wieter:8 (to,) 2.1b.Foe bi,icrtTor .11s ONLY: 1n addition to sending the form to the addrus in
24a above.also submit a copy of this form within 30 days of completion of well
12.Well construction method: HSA cousimction to the following:
(i.c.auger.rotary,-cable,direct past.ctc.l
Division of Water Resources,Utidergr'ouod Injection:Control Program, •
FOR WATER SUPPLY WELLS ONLY: I636 Mail Service CeInter,Raleigh.NC 27699-1636
13;t Yield.(lgiur) Method of test: 24k.For Water Supply&Injcrtiou Wells:
- Also submit one copy of this forth Within .330 days of completion of
13b.Disinfection type: Amount: well construction to the county lie:Itli department of the county widen
constucted.
Form GW-t North Carohna Dcgorrmcnt of Euvironntnu and;`'ants!Resources-Dici;ion of Water Resources Revised August 2013
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