WI0100443_Geothermal Well Construction Record (GW1)_20160712

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I - 'Well ('ontractor Information:
AUG 23 2016
Robert Larry Wells
well CuntmctorNamc
inJr r?l C�Il.:llity
2603—►q
Ileginnitf C7pe ral
VC Wall i ontrsator (e iflcatiori NtimUcr
ffice
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AW❑ Services Inc
"ompan�• -Nome
W10100443
Z. well Construction Permit #'
n colt applicable well rnnxlrucria prrmu-.
!v
3. Well Use (cheek well use)
Agricultural
Municipal/Publ is
Geothermal (HeatinglCooling Supple
JRezidential Water Supply [single
-1 Ind ustriaA'omnlerujai
Residential Water Supply [shared
Non -Water Supply W ell:
hrionitor mg
l Recnv ei
Injection Well:
❑Aquifer Recharge
(;Tou[jdwatei Remediatior
7Aquifer Storage and Recoven
5aiirury Barrlet
]Aquifer lest
Stormwater Drainage
_JExpenrnental Technology
:Subsidence i.:ontml
RGeothermal (Closed i.00p)
.l acer
"]Geothermal (HeatingfCooling Return]
AOt-h r {explain under #21 Ream K:
4. bate W ell(s) Completed: 7/0.7 r 1 6 W ell (b# ._
Sa. W ell "cation:
Robert Farouharson _
.'aciVitylDwner Name Facty iD lifapplicable)
27 Corkscrew Way Sylva. NC 28779
Physi❑ai \ddTcss, City. and Zip
.Jackson 7682W 10-3824
.J— Parcel Identification No [PIN'
County
Sb. Latitude and Longitude in degreeslminuteslseeands or decimal degrees
if well field, one latllong is sufGrient )
35 22' 13" „ 83_ 5` 24"
h. is (AreI the wells}: 'permanent nr ITemporar-,
y. is this a repair to an existing Weil: iY e. of O(No
if this +• a repalr,. fi)1 ou+ known well «arrarnrcrroro +glorrrrafo), .rnri axpiain Nre 'Amxw 4f e"..
epair under fI? 1 remarks xeciion or "n 111n Back ,r; Mo., lorfK
S. Number of Wells constructed: J
or nrulripfe inJe0h9r; or nnrt-worer.supply i+'e119 MV1.Y M•I1h the same crons'trrrcdor. yut:
;ubm+r pine k:rm
200'
9. fatal well depth below land surface. ilt
�nr maltipin '.veils Ifsr all depths rjdif%renr •irrrrr*plc .3(c�7C10'rrnr12�100",
NIA
to. Stxtir water level below top of casing:
+f Mbler irval Is above casing. use - -
i 1. Borehole diameter: 6.25
12. Well construction method:--
e auger rotary, cabie. direct push- ctc
FUR WATER 8[3PPL•Y WELLS ONi
l3a- Yield (gpm) Method of test: _
13b. Disinfection type:
Fr.
in,
SCitEEiy_.
r+ROnr
OlAhtli:'rER_T SLp7'SIZE 1t1ICKNESB N
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-ti __-I MATERIAL-._-- EMpLACElH6Pi1 MMX001
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07/12/16
•,�n:ra : �l'ral Toniracioi Date
rcrehr :Terri/,i• rha7 rile :,eljp) were (M'ere) coeisrrwied M accordo++ci
!00 nr : �A .Ail •A! • a-,'r 0200 Well C:am1mcriar SOOn&Irlis and rhnl
cqv prrn Idel fn 61• +•: [dl nM'ner-
i Sity •.liaterxtt::ir additional well details:
ck of this page to provide additional well site details of well
you rna7 also attach additional pages if necessary
itiFilllk I I •k, INSTUCTIONS
4n.- Vol •N6 yy�; Subinir znrs foci" within 30 days Of Completion of Weli
`�ilowin-
ii*• itituu of Water duality. information Processing Unit,
i tiliaii Service Center. Raleigh, NC27699-1617
•.1h. k'er .tn ectiou ils: h: add�tlor, ro sending the form to the address in 24a
..I eop� .tt rhls Form within 30 days of completion of %yell
.. ��Ilo�viits:
61i.lryleir, r water Quality- Uaderground Injeetion Con tral Program,
r,.iG i7Ail Service Center, Raleigh, NC 27699.1636
ar 4:. Vaare! .v 1 jigtMen Wells: in addition to sending the form to
o hovL alsr! suhmit one copy of this form within 30 days or
anstn;r:uon In thi .:ounty health department of the county
•-omi [,W -North ( arohnd iepartment of Fmriromnv ,; niv • ision nr W atcr flualit,. Revised im, 2013