WI0100439_Geothermal Well Construction Record (GW1)_20160603

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CONSTRUCTION " u" °Valor fi cousr.l:s
can be used for single or rhultiole weI x
t. Well Contractor Informati u;
Robert Larry Wells JUL 12 200
Well Contractor Name
2603-A
NC'Well Contractor Certification Nu they GVrltr'r Ou' !itw Rr-ik !lal Operations
AWD Services Inc-..._. ............._....-.-... _ .
Company fame V t p 10 1 00 y 9
2. Well Construction Permit #: V 1 V V �t.i
1Jrr all applicable well corrsfrucNofr permFlr- Ir.c nrenry. 91arc.
3. Well Ilse (check well lose):
❑Agricultural
RGeothermal [lleatingfCoohng Supply:
❑ lndustriallCommerc ial
Non -Water Supply Well:
Injection Well:.
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
Geothermal [Closed Loop]
municipar poill I.
ResidenuE:, Arttu supply •.single
.IResldenim skate: ,Slppl°::Shaug1
�I kecaver .
'Jl,1rVLirlLlWdlcr lism P.Q1a[lfla
1SalItntt 13tfr!ir I`
_ Srorn•lwatel � ir${111iljjt
Snbsldepl', n,, .
: Fraecr 1
,turn) :Jllther (.XpIaiI :aide! ;? fRemarka
4. bate Well(A) Completed: 6/2/l-6 Well lblr
5a. Well Location:
Pearson Alexander
FaoilitylOwner Name Faailir: 10F ,If appttcnbic,
17-Jake Ridge Trail Fletcher NC 28732
Physical Address, City, and Zip
Buncombe
County
9675-•84-5871
Pan-vI Idmil;cyrv, tir�•-'PI'n'
ib. Latitude and Longitude in degrees/min uteslsecond •l 4ecimai degrees
[ifweli field, one latliong is sufficient)
35 30' 2" N 82 2' , 36
6. Is (are) the well(s); XPerrnanent of Terniaw s
?- Is this a repair to an existing well: 'Yes or VIN,
If rhrs is a repair, j711 out known well consimcriorr fo,,,nairw, -o i ,:1-rr •• W." 4"
repair under U21 remarks• seciion at on the- hack .ifeim Zorn
S. Number of wells constructed: 2
l�ar mu1llpfe Ipfecffarr nr non-waier .sulrpl;• well.+ fJN7.Y x•ill: ?h� samr::�nnsrrrrcriurr. ... ..
rubmtl one form. 9.'Total well depth below land surface: 2 (d)Lr .300 €'z
For mulrlple wells 11si all deplhr rf dl fferefn fewamplr 3[u200 rim w ir-
10. Static water level below toll of casing; t'I.
if waver lave/ rr above casing. use "
11. Borehole diameter: �•2�rr lin.; .
12. Well construe tiou method; rotary
rr.e, auger rotary, cable, direct push. etr: ': �•
FOR WATER SU"LV WELLS QNLti
I3n. Yield fgpm) _-- °Method o€
I3b.DWnfectiontype: —_� .._. Arnounl
For ]nternal � �ti,� itl �
14. •WATER ZONES
Flnona_-...__ a'a.
_nes�rrrraiv.
ft.
ft-
f[-
ft.--i- - ...._r_....r_.-._._....�
is. OUTER CASING Par ttrttl&rasid'w
eRs tom:
FROM TU
DLLMYTek MATItRWL
_.
ft.
16. ]ONRA AWR SDIG ORATUMC el' 4 .
FROM _ TO
UiAM�rm
0 ft- 3
0 ft. 1. G 5 in.
ft-
ft. in. •-•--•___�_. �..-
FRdM TO
... DIAMETER SLOTSTHwfams MATERIAL.
---
f[-
ft. in.
ft.
ft
i8. CrItOUT
FROM TO
.. .. MATERIAL EdHPLACFA¢r"MVrMD&AM
•-300'1 f[. Thermal Enhanced Pum e
•--� - �
ft,
St.
�-
19. SANI] G A'VEL PACK
if•a lilealrle . m._
FROM To
MATERIAL 1�pY,pC�ENf MEIrFiOD
R.
ft.
fr.
it.
20. DIULI. YNG LUG
t
sua�l�.sil�' m' eheets.r�, - —
FROM To
_I AFSCRIPTXON color, Iwrdneas 50iVroak yet, grain sire, etc.
ft.
ft.
_... ....._—�.
ft.
---- .... ..... ....
ft. t
ft.
----------- --- --
it.
Ft-
fI ,
ft
ft.�..
>__ lnforrrltaWn.FTONG ss q-L.fn..
_.�-_.
21. REMARKS_....._....�.---
U. f ertificatiort
6/3i 16
.: ,::r .-e:rr� I :ini, :,.. ,:qr�trrla •5vere} cnnsri uclere in trccnrdonee
:rib ? iA :1rr : it :rrUrl err r.sn N( A( 9)r Standards and Thal a
:Vv nl rlhr: . .r: hn.rxrerr prnrrrlrr! r„ rhr Drell n>7•rrer• .
23. Site diagram or additional well details:
You Ina) use EIIc back of this page to provide additional well site details or well
:onstruction derad,q You may also attach additional pages if necessary
SI3Sl1'IITI.AL IiNSTL1CTIONS
Na. For All Wells: Submll ?hrti form wlthm 30 days of completion ❑f well
•anstructinn `r- Phe following
Division of Water Quality, Information Processing Unit.
161'7 Mail Service Center, Raleigh, NC 27699-I6I7
24b- Far I ec6an ,gam: in addition to sending the form Eo the address in 24a
abuvc• also sltbroil r; copy :11 dik ionn within 30 days of completion of well
nnstnlcitOr 17V tofluwjna
1]ivision ni W ater Quality. I inderground Injection Control Program,
i636 Mail Service Center. Raleigh, NC 27699-1636
24t. Eu Water &milv &Joiltrtion Wells: In addition to sending the form to
the addressfes': above- also submit one copy of this form within 30 days of
'ornpletion -„ •-w ,0 :onstraction to the county health department of the county
where :,enstrm:r(-ct
Forin C;W \nrrh [`arulm ::rnannlr•�� Ia.:;;i,,; ,..: WH'�a[urlE lde.=.otv�;r .14V�Slest ofWatV Q1)a9i:y kcevisedlair.2013