WI0100449_Geothermal Well Construction Record (GW1)_20161109

L Well Contractor Information
Robert Larry Wei _ 2016
Well Cooftota:r Name
2603 A
NC well cantraotor cadoa Water OtIallty Ra9lonal ply�ons
AIIVD Services fnc, Mhf,OIP 115. nnl Offlc �
�,,.._..r.
Compaq Name
z. well Canstm tw, permit #: 1M 0100449
Lrsl all appha:a5le-11eanstracnonpemarrs Aff Comm State. Yvrtansa sraj
3. Well use (check. well use):
DAgricultural
M&cthermat (k1eating(Cooling Supply)
Cludusk'i"ammercial
[]Aquifer Recharge
OAquifer Storage and Recovery
❑Aquifer Test
C Bgmrimerual Technology
S&Othemai (Closed Loop)
17MunicipaLftbUe
[Residential Water Supply (single)
[Residential Water Supply (shared)
C
❑Ciroundwatar Remediation
0Salinity Harrier
❑Stormwater Drainage
Cl3ubsidencs Control
l7Trooer
+4. Date Wells) Completed. 11/3/16 Weil IfAalt
Sa. Well Laeetlon:
Thomas & Jenny CraWford
FwwtyA>WRWName F-MW U-V (ifapplicablo
474 Chunns.gay& Rd Asheyille,.NC 2Sgo,-9;
ftatutl Addmsa, QW, and Zip
Buncombe
County
965926117700000
Parse] Identiawtioa No. (PIN)
Sb, latitude and Longitude in degrees/minutesheeonds or decimal degrees -
(if -U iixeld, am tatllong is anmeiee)
36 36' 43" 82 al' 3 W
6. Is (are) the well(s): WWmaneat or OTemporary
11
7. D this a repair to an exiisftwe]l: UYes . or M(N
Ifrh►a rs arepdrr, fig Ourhwww M11cwtsrracrron i4bmealron and explarn the native ofrhe
rePut" vmd:r OV reosarirs secdm or on rho &q"d of (hisform.
L Number of wells constructed: 2
For nndOk rafae Mm or non-wa►ersupply wells ONLY wilh the MW sansbsewim. you can
submit ow Torsi.
9. Total well depot below land surface: 2 0 300' M)
l+arwrhrplr,sellslist all *pl&yawaw rent (exasrple 3®200'and2@1005
10. Static water level below top of casing. NIA A)
11.Borehole .aiameter: 6.25 (in-)
12. Well eonslrucdon method: rotary
(Le. sugar. rotary, as* dimeetpush, em.)
rr Ianrnel Uwe ONLY:
440150
(�; � � ��x 1 ..,,
..- _. .:-
a.• .:fin: a::- •'r'�'
jA
27. OHM
34mb m of Lmt&d Well Cootmcaor Data
ei +►AS fo+�tl I hereby -no than the wells) ►vas (were) cawo=red in Mwr*nce
wlrh !SA NCAC 03C+0100 or 15.4 MAC OxC.OP00 Well Comslarm"lorr Srandbrdsand Char d
copy of ft Pwrdhas BeeFmvltttd $c the wet owner.
23. Site diagram or additional well details;
You may use the bads of this page to provide additional well site details or well
cansiruction details. You may also attach additional pages if necessary,
MMMI TPAL INSTUCTIONS
242. EU-611 Wells: Submit this farm within 30 shays of completion of well
construction to the following;
Division of Water Quxllty, information Processing Unit,
1617 Mail Service Center, lialeigh, NC 2709-1617
24b. For Imfeatiom Artist in addition to sa3ding the form to the address in 24a
above, also submit a copy of this fonts within 30 days of completion of well
construu6onto the following:
Division of We ter Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELTS ONLY. 1636 Matt Service Center, Ralsi86, NC 27699-1636
13a. Yield (gpm) Method of test: 24e. EML)hter &Apply & Inisba VVdkLjP addition to sending the form to
the address(es) abvvb, also submit.one copy of this form within 30 days of
13b. Disinfcrtion type. Amount: completion of well construction to the county health department of the courtly
where constructed.
I'oVM OW-1 Nord: Camii-Departs" of 8nviroament and Nanual Resoorm — Division of Water Quality Revised Jan. 2013