GW1-2021-01202_Well Construction - GW1_20210209

WELL.CONSTRUCTION RECORD
\� For Irrtcnml use arlrv:
This form can be used for singlcor mnitift wells
1.Well Contractor Information:
ALWATE920NES
Dylan Fierst FROM '"I I RF CRtVt1e)11,
U101 Conlrnclor N�mc fi. fL
4507-A
NC Well Contractor Cenitleation Nimber yS-01CfFR CASf�7G ffnr niutiT used vre{Is OR I.iPTER di1 a' fieahle -
FRONT TO 014METER TMC.kVE55 MATERIAL
SAEDACCO inc 0 fL 10' fL 2" In. SCE-40 PVC
Cofdpan Nana> 16.-INNTIt CA41N 'OR TUBING' 'er thervital elosedaati'
FROM TO 6[A.. TER THICKNESS MATCRI.U.
2,Wdl Consttlrction Pct•mit a: ft. iL is
List 4711,rq ,rable.dell l pernrlrs Coirmy,5kr ,r,lrnrinrxr,frfttlrn em:J
3.It 71[1sa(cf dp •ell use!,17 SC,Itk rK '` t s
Water Supply°W01: FROM TO PrANMTHR y70rSIM. I 'MCKINTts I MATFRIAl,
CSAgTkulttllal MMunicipat ttblic 10' ft, 251 A, 2" in, .010 SCH-40 ( PVC
OGeotficnwi(HeititSICaolln Supply) OResidenta eater Supply h(snSle� f. ru
fL '
0tridustti lllCoomcrcial OResidential Water Sapp!)'(skated) 183CROIF17..
FROM TO MATERUL EMPtAcrM&NT MLTHoD&Amo0NT
DIrfigation 0 R, 61 ft Portland Ce"atred
Non-Witter Supply Well:
fL ft.
®lvlouitorin ❑Rtxa1Y '
injection Well: R- (L
CIAqu'rfer RCcharge ❑CroundRhtcr Rcnicdiotion '19:S, Il 'ItA)FEl1 ACti,t. 'rt'acatok)
_ _ tATBattt, a�ai±l�rt'►mr_�r Mt;TttQii _
❑AquifcrStortgcaWRccctmiy ❑SalinityBarricr 8' R. 25' R, FnILTER SAND 20/30
❑Aquifer Test ❑Stoninmicr Drkir47gc ft. fL
❑E.eperimcntal Tcchnolo�g 08absidcnec Control
20.'.DRHAJKG LOG7aitack additional F"N*if nccesta-M
❑Geotftetrital()Closed Loop) ❑Tracer FRONT TO DUCRFMON tanbr;nartincs+Tq UatiM41i n tic,ek.1
❑Geo€bemral(Heatinefooline Retum) ❑Other(eniain under 9211ketnaft) 0 f(. 251 tL
fL ft.
A.Date Well(S)Completed: 12/30/2020 Wdl ID#KW-1
ft, fL
5a.!bell L cati m: ft. ft
Eddie Johnson's Texaco fL fi
FadityJt weer Name Factlity iM(Kappli:.dble)
fi. fL
784 Haywood Rd., Asheville, NC, 28806 R ft.
PhFOW Address_City.and Zip -21 R NIAltlM$
Buncombe Bentonite seal from 6-8'
t frnrrrl' Panel Wour=0on.Na,(PIN)
:ab,Latitude and L ongitudc in dcgr ecs/minutalseconds or ticcinvol dcgives: 22.Ccrtification:
(If%iell tkld,one latll*agi4 41rffitt<ra)
N W 1/15/2021
Si d�arCantrwd Well Contractor Date
6.IS(are)the well(3): XPerm luent or .❑Temporary 1 r Signing lklr furor.1 lrereby cerjv ditu Me nrld{al want.(were..)erryiraered La mvo.Rkmre
w1rh 154 NC,4C 02C,01(k)or 154 XCAC 02C.0"00 Well cowman.?StAndods and than a
7,l_c this a repair to an existing well: ElYcti or E No rOfy of rhir record Ape bcev Rmrirk4l ro i .%rlf vOier,
lfrhfs'LT a e-gvir,fill ratlletwu7naavfon brfoMWfi or imel exlefnin Me Iarrnre of(fir
rearle amler 021 remcirks.ret_tiam arc an flit,bra-k r.f this farm. .,,.�23.Site diflt*ram Or additional e'tII/IetaiL4:
RECEV P L) ck tin You may use the baof Ws page to provide additional e l site details or well
8.Number of wells constructed: 1 v construction details. You ulay also attach additional pages if imessaty.
For msdrilele MAvikm m non wer sapclJy wells ONLY rrirb Me r4rrt2e�[{gSMArfflMr.p"hln
=Nnittwic form. r t� X 9 2021 suBmi7"PAL.INS`I'UC.TiONS
9.Total well depth below land stlrface: 25 q;) 24p. For All Wellx; Subndi this form.nithin 30 days of completion of well
For iffWriple ovi-110f.ir P11 depi-hy ifelWrim;(e.y4mipte-J@ p1MV411 7a-M r roces.s!rIg kia6rtructiontoIhc:following:
10.Static ester level below top of casing (ft,) Div loon of WaterRevourcew information Prticessing Unit,
if mates level is.rhos casing,ass"a" 1617 NbAl Service Center,Raleigh,NC 2 7699-1617
11.Horebole diameter.8.25" teal 24b.For in lion Wc1(S ONLY: in addition to sendipg the foml to live address in
24a abme. also submit a copy of this form within 30 days of completion of%tell
12,Well construction method: 4.25" ESA constmctian to tile follovrike':
(i.e.anger.rotary,cable direct pasti c1c.)
Dl1•islon of Water Resources,Underground infection Contl+ol Pmgranv,
FOR.WATER SUPPLY ATLLS ONLY: 1636 Dtait Service Center:Raleigh,NC 276"4636
11%l'idd(gpm) Method of tit 24c-For Water Supply&'injection Wcrly:
Also submii one cap, of this fort!! within 30 days of completion of
13b.bisinfuction type. __ __ _ _.__._ Amount:__.. _ well constmctifln to the county health dcpsam of of the tautly where
constructed.
Fornv GkV-I Nonni Carolhia Dcpadnt<ni of Em•irortnscm and Nntaral Resoaroes-Mis Ion of'AlwerRenoutm Rcviscd Avg ut?a13