GW1-2021-00864_Well Construction - GW1_20210404

•WELL CONSTRUCTION RECORD For iltsnlafVscONLY:
This famcan be awd fat single or MWti*wcIls
1.Well Contractor information:
24..1'ATER ZONES
Zach Thompson MOM I TO OMSCRIP"OR
Well Contraclar Naunc R. fl.
2 ft.
4478A
NC Well ConnamrCen)1'IeslionNu rfacr t f.O[TIFR CA4 Q rntittT�easrdiiell O1L1 T1YSR 'a ticab
FROM I TO DIAMETER TIM'K M I MATERIAL
SAEDACCO Inc 0 rt 1 5' tt. 2° Jn. Schedule OPVC
Caolp6mlyName tti # N 1; 1T8 G „" rl'etet dt
FROM TO K"MTRR 71nCKNTS3 I MAITRIAL
2.Well COnstrn noon Permit#: ft. A. ka-
Litt all appliraNe,urllperridis(i e..Cowity,SAM,Variawe If&rVkrl r1r.)
p: fl. iie.
3.WdI Use(chock well as*
Water Supply Well, (PROM TO ptAHrF,TIR VAT So vs. 4AIT91A1:
OAglicultural OmunicipaVPublic 5' R. 15' ft2° la., 0.010 Schedule OPVC
®Geothermal(HeatingfCooling Supple) OResidential Water Supple'(single) A. ft. in
Olndustrial/Commercial ORe sidential Water Supple,(strand) Is;GR0117
FROM To MATERU rpMr-MM AWMOD R AMOLM
Olririgafion 0 fL 3' h. Portland C tection
Non-Water Supply Well:
A. ri:
Mmonitorin ORCCMT
Tn ertloo Well: fL fl:
OAquifcrRcchargc OGroundlt:i ter Remediation i .SAN6 , LPL A
F'R M TR AIARIAI F.htt 9A .. I;NY 41T D
mquifer Storage and Recovery OSaunityBarrier 4' fl. 15' fi. Filtered Sand #2
OAquiief Test OStomm•IrtcrDruiupgc ft, ft.
OF-Npclimcntnl Te chnolaZy OSubsidmc Golarot
.: Rut.L'ft���]AG•ieltxq�dd3ltnnliishe�Nsttncceasir ""
OGeotherrivil(Closed Loop) 13Tnicer PROA1 TO DrrACRrrMN obur.borin OWM'k "PIMC110
oGeotherrual(HeatinglCoq&Retum) OOther tea iu under 921 Remarks h^ (L
ft. (l.
4.Date Welt(s)Completed: 3/18/21 WellID#Tw-4R
ft. tt: F+
1.
IL ft.
Dynamite Roasting Company (L (i. �l_,��r►(n�
FacitiiplM mr Namic Facility TD#(if applicable)
fT. f4.
2744 US Hwy 70, Swannanoa, NC, 28778 ft. ft. ProGeS
2t-it At . jWfvi9f3'a40
Pfisirsil Add/ess City.and Zip G{;O
Buncombe Bentonite seal from 3'-4'
cortrkv NredIdefflit OonNo:MN)
5h.Latitude and Longitmdc in degrecs/minureslseconds or decimal degrees 22,Certification:
(if%to yield,oar 4 T41 is st nkkra)
35.601028 i` -82.368277 W 3/18/2021
siganim OrOwitiad Well C.ontmclor � Daft
6.is(are)the 1\e11(S): $!#/eYrilanent or 07cmporYty It iign tg i1y fo"m I hrmby ernah thai the urlks)war tower.)eirwimered in mrvardd ner
ndth 154 NCAC 02C.t)100 or JM NCA C 02C 42M R oU Comtmakm 5tratnlard5 turd that a
7.Is this a repair to all existing well: 01'es or MNo copy afthit rMord Am Oem pn+rlrkd ro the WHI meter,
If Alt h a repair.fill our l wkvr well eossrnrctfan"cR/arns<rtlan treat a kplakr the Harare nf At
repair wider/rmarb veaim or on the baari'of th)s fora 23.Site diagram or additional well defaitR:
You tea}use tile-ba&-of this page to provide additional well site details or well
S.Number of wells constructed: 1 construction details: You may also aftach additional pages if necessary.
For otcalfiple Inferikui oe,Hart-nutter sample wvellt ONI Y'n-tth dm tome eansgmrtlaa,viw esrav S nn1l tZ Ai iN i t j
submit tine form
9.Ttltaln-eltdepth Mow laedsurracc: 15 (ft,) 24a. Pnr A Welfs; Stlbttdt tllis form Within 30 dgvs of completion of moll
For nwlrWr uvItir her of)depAs ff dtlferrnl termrrpfe-MOO'ead 2d 1W) constntc6on to the follonitW.
10.Static water I"TI below top of casing (ft.) Division of Water Resources,Information Processing Unit,
If vtwrr teal Is above c©alra;.ate`4" 1617 Anil Service Center,Italciph,NC 276994617
i 1.13orellnlC dlemCter 8° (ill.) 24b.For InhT on Webs ONLY: In addition to sending the form to the address in
243 above. also srtbatit a copy of this foml Within 30 da)'s of complexion of%vell
12.tVell censtrnctlon method: Bored construction to the Mowing:
(i.e.aqw.turn,caable,tiled push etc) Division of WaterResmreds,Underground Injection Control Program,
FOR WATER SUPPLYWRLLS ONLY: 163E Mail St"rice Center,Ralelo.NC 276"4636
13a.Yield(gpm) Method of test Zoe.For Water Sugol&tnjoetibui ells:
Also submit one copy of this forts ►slth'tn 30 days of completion of
13b.Disinfection type: Anunuat +vrll construction to the county he dlb dep<artmcut of the count),where
constructed.
Fenn GW»t Noah Carolm Dgmunmtaf Emianmcn►and Natural Rcsoumu-Division ofWateritMa rm, Rcvlwd Aiglest 2013
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