GW1-2022-03574_Well Construction - GW1_20220328

WELL.CONSTRUCTION RECORD Fa;hactawl Use ONLY-
IIL%thrmcant>w owd free single nr maitiDtc rxals
1.WAI Crintmtor€ulor mation;
Stefan Smith FROM to ut�tiGrtttaYYt Y
3576A
CSC Well Campicmar Coil ifaoationHomber
FROM
M tRt FrF.�ti1F`iGR 'tnDt'ttt�FSS AYAi'GflrAt.
0 fL 57 ft. 2" is. SCH-40 PVC
SAEDACCO Inc
FROM M istti tt3R 7frICKPtBSS MA L
IF
2.Well Censtspction Pemnit#
UE1,rraarpplknhle'tu'lltrt'J itr fi-e.Cimmy-
jerilani1f./ n `.
�. 1L
3.Well title(eh"k well orie); ,
'ltatcrSupph'welt
To VRA,rV€r SLOT.fi17"i 111tY+C fifiS MA9 ttl,
OAgricUltural OMinicipaliPubliC 57 A- 67 2" in 010 SCH-40 PVC
OC koilteirtrai(Elemin'Coolinp Suppiyl 01kesidenlial Wata StIpph'(cingic)
ft, fL irt,
MIndus"Wcotttnterciul rlR£siftrl al Wamr Stlpph-('sk1w)
FROM TO !iurett tau_ . , nttataan&AMa., .,
dltti W,U 0 tt. 53 tt• Portalnd Tremie
Non eater Sopplc Welt:
Injectio63A4trrlitorfnG Qltcco�'cry ,
tr Welk
tAgniferRccltart;€ rC)mtuadtsnterRetrdifttitm
FRO. trn�r tt t rttitrr Ar tart Year tr
C7Attzt cr Strnnc and Rcco ery l7Salinity Ramcr 55 rr_ 68 fL sand 2
OAgn)fer TeM M,iatormwater ilea nW
fL ft.
ClExp¢titttcrttal Tcclmo og:, ❑SuWdcncc Coutntt tidaiat�ibeiiiig t
Mxodknnil(closed Loop) t-7Tm r mom I io 4MICRIffOX(4L*kf-,#iRrd#ktthtVIIMK44YPtVO Seft '
DGwiltemtal Oleatin }•Ctiolin g Return) ❑01her 4egbiu uinler#21 Rttuaft) 0 (L 27 tt, Sandy silt
27 ft 42 (L Silty-clay
#.Date Wi`tF(8)C9ltlplettd; 3-9-2022 ttRedt)D$MW-15 42 ft. 68 ft PWR
5a.Well Location: ( ft.
r
NC DENR R. fl
FaclTvIpOn'mrlVo Facitli-iDk(if Mplirabtio ft.
27 Loop Rd., Arden, NC, 28704 ft. ft
Pltysa.:al Address.Citg.:tnd Zip t A
Buncombe Two foot bentonite seal from 53-55,
(:(MM! tMvd)aeidirb:+yaon No.(PIN)
Sb.Latitude and 1400ttrdc in dt ellrninutcat>Bonds or dccianttl depus; 2L C-ertilecatirrn:
fifxsla r�td,mic l;;a'ttai�}s Rrdt3a:4:itlt
35.451916 N 82.530181 3/8/2022
Si�ttsi afCe.Jftatl id4cit(Jantctcwr Dwe
6.Fb tare)the well(s): xPertnanent or oTemporary IN sigrtinv Jhi .Avrrm I h w4 v certify fhat Aw ueltfai mw f4vwrl c¢rirtrurttti!tr,uxviidsm.v
jv,44 4 Sh:k 4C t)xC,0fM or l fy NC,4C aX.0200 tKeft co"'ertt f*'oii smwlaErfls tvid slwr 41
7.CC this a repair to an exWeV well: M1 L.1"i or KNip ۥ'Vynf Ails a?uwn'l Maras brem privri x4 to ftW'.V11 awRrr.
tf M6 ix rt mplir.fill4vt$r owm weft Cow txo fmo,'tfri.WwPiui eerier expWar Of ruirrirc rJ(the
re,air order A'_'f revjard:v aft aiaro or ran the bail of Mis fiwar. 23,Site dhkgr am or additional well details.
You may use the bask of this pap to prottck addifionttl%vA site dwils or ice]!
8.antler of Wells consam ned; 1 construction ddails. You ails t'also:ttl=teh�ditiorgl pages if era e9surt.
Frrr tiitJfitjrl:irr4Eti rMrt r r r,�ti-iJ'ait4 r rry1x7 i:'c 1Fs tlNLY'n sr4 rlir aware aYJtrs#lrCtldti.�4fN s aW C IBIFI 41 il«7 ttC'FION"!
su$vrrSr on fcnr:r_ ► .
9.Total Fell depili D&w land surface: 67 (ft.l 24a For All Wellsa Subnaii albs forth svitliin 30 dmys of eompledon of well
For malri'(e Well'hho 4104 urns if d*?,rn#ti rcwvfe'-,01-.70.4'mn'204{hl A Ctlwnlction to llr fbft1'tingf-
its.Static Water level below trip of casin8,: (B,) IHvisi to of Water Resource!.ihformataon PraeeWng Unit,
If ves k+Fct Jv tdjvve s:rlun?,aw i' 1617 Mad Service Center.Ralah0v.NC 2 769 9-16 17
i,Brtrehole diameter:6" (m;) 24h.Fi r IniucNan WeI1c ONLY; lot addition to sending doe fami to tt. address In
2sa above. also submit a cop :of this fora! within 30 dues of completion of sett
111►rell tottsttuction m-thod. Sonic rannstnrctios to the f4110v Ug,.
i4.c.mWr.rmfy,cable.dim a plods cwti i
Aivisinn of Water Rt=sonr+ces.Utt+ict^la'annd Injection Control Program,
FOR WATER SUPPLY WEL IS ON1LV: 16336 Malt Service Center.Raleigh.NC 2 i6".1636
13a.Weld tttpm) Method of teat:. 24c.For Water Sa rls d&Ipjection Wells.
AlSo Submit am caps' of this faster within 39a &Ws of completion of
13b.Risinfeetiuu type:_ ._ _w W,._ Amount:_ well constnioian to the J:ottr YI} health delmamcut of the (;,m",wl=.
.. __ cont=tnicted
Fnriu Gt1°-1 Noah C&-a1uta L%zq snit=of Envimtwe:in aid Natural Resr w=s-tl i slurs mS>Yaler t$�otre� rte�isd�tryJ3E 3+413