HomeMy WebLinkAboutWI0100434_Geothermal Well Construction Record (GW1)_20160519LL CgMBECTIONAECORD
This form can be used for single of miAtipli we Ig IrI"_ j C �Cr_D
1. Well Contractor Informs 'oa: Division of Water Hosuumes
Robert Larry 111ells
We]I Contractor Name
2693-A
JUL 12 2016
NC Well Contractor Certification u06w
AWD Services IncA1,1P,r C1r rn ifr runt i, rn I Onnrryt]n.
Company Name '
W10100434
2. Well Construction Permit #
l.iarall applicable well construction pain as ri.. 'rznniy..Sofu.
3. Well Use (checkwell use):
Q
Cl Agricultural
i M u m c) pa ul'i r h 1 1.
i Geothermal [Heating/Cooling Supply
-.Rcsident)ar rvaLe.r '111nply isrngiv
0Industrial lCommercial
]Residenne: Nara supply Ishaxo
lrrkbatio[1
.. . - .
Non -Water Supply Well.
❑Monitoring
Kecova:.
—
Inseetion Well:
❑ Aquifer Recharge
Groundwatr. ..noel xuw
DAquffer Storage and ?recovery
Isalinin 8ai: n
f-]Aquifer'Fest
titorrnwatr jra{,laer
0Experlmemai Technology
Subsiden,:- •+nrr
Geothermal (Closed Loop)
'I racer
DGeothermai (FleatinglCooling Return)
uj0lh& (expian, Linder ntl ?renrark7,
-- - ---
5119116
4. Date Well(s) Completed:._..
Well Wk
Sa. Well Location:
Jean Ann Groves & William
J Plante
Facilirylowner Name
FaLwlim ll-rx 1. applicablc'
465 Chunns Cove Rd
Asheville NC 28805
Physical Address, City, and dip
Buncombe
9fi592568299DOQQ
w
County
Parcal lfci oficatrn, \1r i TN
5b. Latitude and Longitude in degrees/min uteslseeonds rrr deelinal degrees:
(if well field, one ladlong is sufficient]
35 36' 37" N 82 31 2 ''
4. Is (are) the well(s): j(Permanent or l'emporar
7. Is this. a repair to an existing well: N e:. o)
if l&' is a repair, flit our known well ennsrn r ion rninrararir.:. ,,... ... r
wpair under R2I remarks .reckon or on the lmck Sri chic liar+;
A. Number of wells constructed: 3 _ __
r ❑r multiple injection or non -wafer supply we& OIVI.)' +riri: !1F, am:-mrrslrerr�llne ,
.rrebmil wre form-
9, Total well depth below land surface: 1 @ 35C 2 @ 260
.._it't.
1% r multiple wells 101 all depths if diffvrP)v :erornplc 3[a Qlr' vrr -'r i rin
10. Static water level below top of casing: N1A... 4l.
ft master level i,s abarre casing, use
11. Borehole diameter: 6.25r lim
III. Well construction method: rotary
(i.e. auger. rotarv, cable, direct push, etc.
POK WAFER SL?PPLY WELLS ONLY
139. Yield (gpm) —.. Metbod nt x,.,.
13b. Disinfection type: Arnoum
Farr �-��--
14. WATER ZONES
FROM .—..... TO .. TIE'ECRIPTIBN .----
Ft- fY.
ft. Fr.
I& OUTER CANING Uar nla
wilt ..
BU1ME'1$R !i9 MATERIAL
_ ,
in.
ft. ft.
16. INNER CASING OR TU
G Naartaai•
' '
"
0M ft. • 260 Ft. 1.25 in.6UH1 1TOE
-.1-_
17. SCREEN
5toM TO ..- DTANIXTER I 11L11T11 TRIC101U1 MATERIAL
ft.
18. GROUT
A"M - . - TO MA'AEMAL mul"c'8M8N1• rd=010) & AM011W
3501t 0 ;t• Thermall Enhanced Pum e
60ft-+ 5-_4_ThermoEnhanced Pump
ft.i�
_
19. SANIVORAVEL PACK ita linable -
SROId TO MATERIAL ....-
....-.....--_—_.. - .-
WFI ACi MEU MErOOD
fc ft.
i
-_... ..-. -
ft. ft.
10-DRiLL7l G LOG airaclr.adiRtionaTalteeh.:
FROM To MYcolor, h2wneas aoillrock Lyfic, zrwix sim etc,
ff. rr.
Ft. It. ---
r[. fr-
21. REMARKS ...._....... .. ..---
__.--lnfarm�ties�i-grit------'
QIL]�
22. t,:ertificatinp
r 5/23/16
Date -- _.......
•ur :+:�}:�� .prl'r s/ was lwerej von.Tlrvlcled in accordance
+irk iA A'r .4r '7 .rd fIG er �>; 1* ii 97,1,':If�ld'iVell r on.Ylruclioa Ylundordr and Arai a
"p1 : c`rhr.• rrri +rn+- h,rrur 12 rvided ro !hc u-e l - rn•rvar•.
23- Site diagram or addltlonai well details:
You mav use thr hack of this page to provide additional well site details or well
.;onshuction detatl�: You mmv also attach additional pages if necessary
SUBMITTAL INSTUCTIONS
Loa. For All Wells- . Submn +.hl, torn) within 30 days of completion of well
'onstruction rn the following
Division of Water Quality, information Processing Unit.
I6I7 Mail Service Center, Raleigh, NC 27699461'7
24b. For Iniection Wells: Ill addition to sending the form to the address in 24a
above also submil a ropy ni' th!c ihrm within 30 days of completion of well
nnsinletmr. )c Follt)winp
Division of Water Quality, Underground injection Control Program,
1636 Mail Service Center. Raleigh, NC 21699-1636
14c. For Water SunniSunniv & in' : In addition to sending the form to
the address[es1 above, also submit one copy of this form within 30 days of
complebtui of ,veil :onstructinr: ro the county health dapartmenE of the count]
where constructed
Form [}w-• \4vri) r.'aroI - !.ANVrTWIs rir-r-!rnp,.:na. !r ci \'atLrgI Hrc.juror: 'r!cisran ofWatr: Quah, RevisAJaii.2013