GW1--01496_Well Construction - GW1_20240312

WELL CONSTRUCTION RECORD
Fur!Neural DSC ONLY':
This form can biased fur single or nrnitipte cells• - '
I.Well Contractor Information:
.IJ.WevI1RZONES 1
Robert Miller . - _ FROM TO • DESCRIPTION
Well Co inalothanre: • ft. ft. . i
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2675-A ft. ft.
NC Well Conlmciar Certification Nuldlcr t15:Of17'ERCASiNG-Ont.:Ruthlcasede"clls).OftLINER(ifan ticsbk): .
FR051 •TO • DIAMETER. TRIMNESS• • MATERIAL .
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SAEDACCO (L fG. lo.
Company Nome. : 16.'iNNER CASING Olt TUBING lgeatbcrmat elascdaoap).• '
- •FROM To DIM1IETER. TRIMNESS - MATERIAL
2.WcllConstnuction Perirtit#:N10100704 , _ • " •f. , ft, irl. -
Lw or/ we/4E1 inn(Li.County.Slam,.Variance.forectiat ere)
. •ft.• f.' in.
3.WcilUae(ehecl:well usej: I7:SCREEN •
SS'atcrSupltly Well: . ' - - - — FROM I TO . .•D(AMRP:it SLOT Sin. TIl1CRY(Es MATERIAL.
OAF/cultural al t'Jhfunicipafi•P(lblic• ft. •ft;
OGeotlicmtal(Heating/Cooling Supply) ®Residential Water Supply(single) fG ft. Ia.
0iudustrial/Coniniercial ©Residential Water Supplystrafed -ill.GROUT . --: ." _ : --
( ) ' PROM TO Af\TER[U E AC MET METHODRAMOUNT
Olaf atian ft. ft. '
Non-Water Supply Well:
• OMonitoring - Oltccovety. rt.; to
InjectionWel ft.' ft.
❑Aquifer Rcchuge s ' llG'roundwaicrIcnicdiation <19,SANDJGRAVEL PACK(if applicable) - _ - - -
' - 'G'rrO51 • ' TO' -• ;1IATERIai( RMPI.%CpMENTMrruO11 • •
17Aqu;fcr.Stotagc and Recovcty 17Salinity Hamel_ • R. ft.
❑AguifcrTest s ❑Stottm�atcri)rsiga&• ft., ft..
AExpcifmcnlalTocitnologp ❑5Db5hdCncC(`atitrol 20;DRILLING LOGYai(ach.additional sheets'if -
' OGeothennal(Closed Loop) - •' Effacer - .FROM•• TO DESCRIPTION((obr.luudnetij wR'niek lyoc fen we.Ht.)
OGcodtettnal(Morita/Cooling Return) .•Clother(explaiet.under 821 Reuintis) • �..' 1: *1 ,:7 r
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rt:. ft: I
4.Date Wells)Completed:'2/22/24 well m�s-1 - B-5 ' - -
n. ft. i MAR J. 2 C(Z4
So.Will Location: ft. ft, 1.
?r
Zboyovski Property ft, . ft ' if{1�;; l$ii+l: x ;r.1�7.?1
- Facility,Ylimer14orc. FatallyiDA(ifappiiable) n R .,
146 Smokey Park-Hwy., Asheville, NC, 28806 ' . " ,ft. it. .
Plrssical•Addiess.City.and Zip- z31:REMARKS' .
Buncombe Injected 104 gallons of Cool-Ox per boring; .
Com* Panel tdentifcairooNo.(PIN) 20-33' i •
Sli.isttitude acid Longitude in:!egt'ses/minutes/Secrands ay decimal degrees: 22.C_crtnf ienthm:
(if cell field,orre.1fI11orig to sidficienl) j
N W . • 2/28/2024
$1g6t1t1iCOrC:(1 ti`r •-;r?5.'.cs:i' Dire
6.Is(rare)the\u'ell(s): aPeitnaucnt .or'' Z]TenlpoCiltti 11j•srgnrng This fo:m,'1 hereby certify rho tau ircil(s)was(Isrm.,cvrxrrruered in acrordancr
frith FM NCAC 02C.0100 or ISA NOW.02C.0209 We Constricrlar Starlciarcls and th,u a
7.Is this a repair to an ex vtins;well: DYai or l lNn ce>,lin ofelkr recordhtrs liricri panmded ro dre'nrld turner.
ifito's'ir o repair.fill nut limn i ietll-crosuirerloa:brfomur8orr and ciplabr rile aerare of the
repairriiuier.21 remarks seci(on or on du bail of Or form. 23.Shp diagra W or additional ss chi derails:
You may use the back of this page to;pro\ide additional well site details of.uell
8.Nuinlier of wells cousinicted: 5 • • • • • eousttuetfoti delaifs. You may also attaclludditional pages if ticeessa,y.
For innhlple bl/eeiionor Dirt-irarer si,ppli•wells ONLY with the same corrstrudtorr,you ear)
submit one fora. ' SUBMITTAL INSTIJCTiONS "
9.Total well depth below land surface; 33 . ' (ft.) 24a. Par All Wells; Submit this-fume within 30 days of completion of well
For malriplc Kt./if list all Arks ifdifeu•nt lexamnle-3E100'orut.2@WO) constroction to-tire following:
10.Static water level below top of casing: {!1(,) Division of Water Restat ccs Information Processing Unit,
If wake.level Is abase rasing;use"+" 1517 Alan Service Center,RLticfgh,NC 27699-1617•
11.Borehole diameter:1.5"-- - (in,) 24b.For Infection?(Yells ONLY: in/addition to sending the form to the address in
24a above.also submit a copy of this fonu within 30 days of completion of well
. 12.Well contraction method:DPT cons1nic11 it to the following:
(it:auger.rotary,cable,direct push.etc.,
Division of Water Resources;Underground Injection Control Program;
FOR WATER SUPPLY WELLS ONLY: 1636 AIIN Service Cent'crrRaleigh,NC 27699-1636
13,r Yield tRpm) Method'of test: • 24c.For Water Supply&Injectton Wells,
Also submit one copy-of'this form-Within 30,days of completion.of
13h.Disinfection type: Amount: ruck construction to the county health department of(tie.colunh'.where
constructed.
FortGW-I North Carolina Eh:artrrremofPireiroitnuuandNatui lResources-Divisionof\PalerRerarro RevisedAugust2013
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