GW1-2021-02972_Well Construction - GW1_20210512

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WELL CONSTRUCTION R�CO:ItD ,�` For Troerml Usc ONLY:
This Conn can be used for On&cc multipk wCus
1.Well Contractor information:
.0-AVAT13tZONES
Zach Thompson FROM Ttt IDFSCRIptTQ
%'Ot Goiilrnclor Nm w
ft. fL
4478A
NC Well Conlmcior Con ifxmtionNinber '15.OUTER CASING, rhreiilh'Fe4kil-''eR_ RLINTRfif-WoOlkabM..
FROM - TO DSANTETF,R TWC-K 4En MATERIAL.
SARDACCO Inc 0 ft, 75- fL 2" 1in. SCH-40 PVC
(:6fa sisq.Name T61A R :ASIXG ORIT 1BIP1G' '-eaW dood4on
FROM TO I DIAMETER TifICRNESS MATERIAL
2,Well!Construction Permit k: ft, ft. I ilk.
List all.rplrfirnhlr Teal!prrinirs 0-e-Cmrnh,:Sear.Madame-1njWdcn rlr.j
R. fL tat,
3.Wert Use(cheek well use): akktW
Witter Supply Well: 1110M TO PtAKF'rPlt; SUIT S1U� T`uT(%Nr-s I MATKRiAI,
04fietdtural 75' ft. 851 fL 2" in,' 0.010 SCH-40 PVC
❑Geothenmtl(Heatit%tooliilgSuppty) ❑R.esidential Water Suppb,(single) R'
17lndustrial/Conimercial OResidcmial Water Supph'(shmed) 18 CROUI
FROM TO MATERML I EMPLACVMr;1TMLMl0D&Arl0lT t
OlnigaWn 0 ft. 71' fL Portland Injection
Non-water Supply Well:
fL IL
wmanitorin 1311move '
injection well: R, %
O.AgniferRecharge DGrtmndnnterRcinlcdiation 19.` AND,lORA4e!' X (;f: narite"
raon Tn InIATFatnt,__ t
i]Aquifcr Storage find Recevcq ❑Salinity Barrier 73- ft, 85- ft. Filtered Sand2
❑Aquifer Test 05 m 1omatcr Dmirtpgc R. ft
❑15..VeTimcnial Tcchnoloq 11$11bsid=c C'otdtal .
20.''DJtTL!I1NGL4DG faltach rid4litionii.1 ali d0f:kccwn
❑Geotltermal(Closed Loop) ❑Tracer Fmo.I To PYSCRmnoN(*bur.bRran snri»�trr n*t.Hr:1
u'C . r Under(Heatiuootins Return) ❑Other( aitder 92.1 Retnae s) ft. fL
fL ft
4.Date Wel1(s)Coniplctt:d: 4/19/2021 Well ID#Mta-15
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ft,
&L Well L.Ileation: ft. tt
Swannanoa Pre-Regulatory LF fL fL Y 2 2021
FkrIhy)Gvvncr Nnroc Facility iD✓r(Kapplicable)
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51 Mountain Ridge Dr., Swannanoa, NC, 28778 ft. ft. Intorn MccessiAg
P1tS6ca1 A;itdress Cah•.and Zip Pori r
'2L-ItF:MAtt[t5
Buncombe Bentonite Seal from 711=73,
Conroy Parcel Ideniir=t;on No,(PIN)
5b,Latitude and Longitude in dcgrecs/minute0sm.nds or Vlocimal duress: 12.Certification:
flt%i ell acid,one l;w7oi ;x siditelc/d)
35.595952 N -82.386142 W 4/19/2021
/nature afCen trod Wd Comractar Dale
6.IS(are)the well(/): xPermanent or ❑Temporary Br•signing this form,1 hcreJn-erriify f)!dLr file nrllfs')WUS f k-err)emuimeird by oveor&mlre
kith 1,54 NCAC 02C.01(k)or l SA NCAC n2C,0200 Well Coirserrrcrfon Standards caul r)Nrr o
7.h-thin a repair to an existing well. ❑Ycc or NNo r„rrl nl fhir rrrlriYl lT;c lrervr priayirkd to thr�i+lt lrµitrr,
if this!s n replrlr,fill lRrr lnV+irrf wet!cnvurnrcttrJri l�rfornxrrlr+n arld e_cpf�ln rltr n�rrMre,rjthr
repeir e"dlcrA71 rmarks•.erefion or on fire bra-4-c!fthis form. 23.Site diagram or additional well details:
You may use The back of this page-to provide additional well Site details or%veil
8.Number of Wells constructed: 1 construction details. You ilia),also attach additional pages if necessary.
For multiple InfemkNi a Nem-ulna rmpply wr(lr ONLY trirh the mme ronstracrimi.}m Carr
.=15vnif one form. SUBAIMAL INSTUCTIONS
9.Total well depth below land surface: 85 qt.) 24a. Fbr All Wells: Submit !Iris;foot Within 3(1 days of completion of well
For itwerip)rwrtlrliarrt71.!rlubsfld( rvn+(C.rrma)vte-.l@;0f'a>rd2cm/4Q'1 construction to the foftowing:
10.Static water level below top of rasing: ((y,) Division of Water Ration rtes,Information Protessiug Unit,
lf+rrr)ar k•vel is d&ve[r siyy;eisr"4 1617 Mail Service Ccntcr,Riticegh,NC 27699-1617
11.Bnrehole diameters 8.25. (in,) 24b.jute[iliMflon Mlb ONLY: itn addition to sending the form to Ale addtess in
24aabove. also submit a copy of this form tritbin 70 days 8f completion of Well
12.Well corictructlon method: Bored construction to it Following:
(i.e.migr,rolaq.csbk.dines push ctc.1
Dlyision of Water Resour'ces,1Uadergr6imd Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Cenier,Raleigh.NC 27699-1636
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13a.Yield(gpm) Method of test: 24c-For Water Supply&lnlccthm.Wells:
Also submit one cop} of this fort Within'30 days of completion of
13b.DisinfMion type: Amount: well consinaction to the county health depaitment of the cotutly n•bm
r-onctnretod.
FomiGW-1 Ntonln Carolina 13,1mienlofEtwimmacni and Wtita:lRewumes-Dl% ton or'RralerRlaou%M Rc+•ised.4vgusty01.1