WI0100459_Geothermal Well Construction Record (GW1)_20161109

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I. Well Contractor Information:
Robert Larry Wells
For In I Use ONLY ■
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Well Cantlutor Name
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NC Well Contractor Certification Number RpQla1
AWD Services Inc. West, O"R11W C10T1'I Tift
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DIAMETER[ I THICKrim I HATERIa
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Company Name
2. Well Construction Pcrmtt#: W10100459 �
List all applicable well cons nwilon permirs �.e. County, Sram, trarl mA etc j
3. Well Use (check well use):
16; ICtiA1iY
125M
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350 �
1.25 l'"
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Water Supply Well:
QAg�icultural C7MunicipellPublic
thermal (Heating(Cooling Supply) []Residential Water Supply (Single)
01ndustriallCommercial ❑ Residential Water Supply (shared}
❑Irr' ion
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QMonitpring' QRecovery .
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lnjection Well-
ClAquifer Recharge C}Groundwater Remediation
❑Aquifer Storage and Recovery []Salinity Barrier
[Aquifer Test ❑Stormwater Drainage
LlExperimental Technology ❑Subsidence control
Ddcothwrnal (Closed Loop) ❑Tracer
DGeothermal Head Cooli Raw ❑Other lain under #21 Remarks)
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4. Date Well(s) Completed: 11-8-16 Well1D#
Sa.Well Location:
Linda Burke
FaeflltylOwner Name Facility MN (aapplicable)
87 Graceiyn Road Asheville, NC 2880.4
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Pby4md Address, City, and Zap -
Buncombe 974051139100000
Copy Pamal identification No, (PIN)
Sb. latitude and Longitude in degreeslmtnuteslseconds or decimal degrees:
22. Certilieatton•
(ifwell Sell, sae latlivng is sufficient)
35 37, 29,, N 82 33' 0"
11/09/18
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6. h (are) thewell(s): aermanent or OTemporary
Sigaatvra of Loured Well Colt= r Date
By slOft ihes form, I hereby ceri[jy that the W11(s) was (were) canakwied in accaratrnce
15A NCAC 02C
7. Is this a repair to an existing well: Oyes or do
with .NO or 1SA NGfC 02C ,0200 Well Consimcilon Slaandordt and that a
copy gflhis record has been provided to rho well owner.
Ifihis is o repair, fill out blown well construchon information and explain the nature of&e
repair under 921 remarkr section Aran the back ofihla form.
23. Site diagram or additional well details:
1
You may use the back of this page to provide additional well site details or well
S. Number of wells acted:
construction details. You may also attach additional pages if necessary.
on(
For multiple injection orr namxmler sully wells ONLY with the snare eonabrtchon, you can
submit acre farm•
SUBMITTAL INSTUCHONS
9. Total well depth below land surface: 1 @ 350. (ft)
24a. For All Wells: Submit this fart[( within 34 days of completion of well
For muNlple wells list ail daplhr if&ffetent (example- 3V00'and2®100')
construction to the following:
10. Statte water level below top of casing: NIA (ft,)
Division of Water Quality, Information Procettsing Unit,
{jwater level is above casing, core "+"
1617 Mail Service Center, Raleigh, NC 2709-16I7
11. Borehole diameter: 6.25 (in.)
24b. In e t It : In addition to sending the farm to the address in 24a
rotary
rota
above, also submit a copy of this form within 30 days of completion of well
1x Well construction metLod:
oonstsuction to the following:
(i.e. aWr, rotary, cable, direct posh, eta)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY:
1636 Maii.Service Center, Raleigh, NC 27699-I636
138. Yield (gpm) Method of test:
Z4c. For Water Sullol): ALIAlectign Wells-. In addition to sending the farm to
the address(es) above, also submit.one copy of this fame within 30 days of
13b. Disinfection type: Amount:
completion of well construction to the county health department of the county
where constructed.
Form GW- l Noith Carolina Dopanment of Envimnment and Natures Reso=es - Division of Water Qaality Revised Ian.20U .