WI0100470_Geothermal Well Construction Record (GW1)_20170406

Austin Deveb
WELL COMIRUCHON RECC far rapunal vsa.ONLY
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Th�s form cart by used &r aiagle crmulti-
1, Well Contractor Information: R EC 1"' ]V E - -
D'Ivislan of Watet fiesourCese
Well-CoafracwName ft. ft.
2603-A MAY 4 . 207 f ft.
NC W191 Contractor Certi$oatioe Numbs ER
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AIIVD Services Inc, I Water Quality l3egional [JperaYlons ft•'
CoutipauyName _ AsheV e r�glorra Ic� . --.
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2. Well ConstruclionPermlt#: W10100470. _.. FROM
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Do all appilcablewit conslraanan permile O.e. Cow*, Stare, Variance, eteaft.
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3. Well Use (eheckwell use), 17. �11U•r.;
..... - .Fry ...,..
RAgricultural ❑Municipallpublic
Wdeothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
DIndustriallCommercial liResidential Water Supply (shared)
❑ ion
ft.
to
To
MATEM
ft:
ft.
Thorn
Noxt-Water Supply Well:
MIAcnitoring . ❑Recovery
n,
ft.
Injection Well.
f7Aquifer Recharge ❑Gromdwater Remediativn
[]Aquifer Storage and Recovery ❑Salinity Barrier
[]Aquifer Test ❑6tormwater Drainage,
❑EVerim=W Technology CSubsidence Control
06othermal (Closed Loop) ❑Tracer
QGeothermal astir Caoii Return ❑Other lain under #21 Remarks)k
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ft.
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FROM
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4. Date Well(s) Completed: 3/29/17 Well ID
5%. Well Lacation:
Creiahton A Kato Kr ov-Hoken
Faai]ieylf}lvearblamp Facility Z9 (ifapplleable)
226 Tulip Poplar Trail Asheville, NC 28804
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ft
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Phy deal Aadre d
443 125
In.
a 6a. City, an Zip
Buncombe
972172OZ22QQ060
Ccuety Parcel Ideadficadon No. (PtN)
5IL Latitude and Longitude in degrees/minuteslaeconds or decimal degrees:
22, CertiRea
(iftvall field. one S Maq is sufficient) Elev. 2154'
rr F pt W
4106117
6. lls (are) the well(s): Armanent or ❑Temponry
Date
1iy tllgW this 1 hereby Cart[ That the U(v) was (were) caaSovvied to acro�nca,
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with 13A NC 4C 0 C .01or MA NCAC 02C,0200 Well Construction Samdards and rhos: a
7. Is this a repalr.to an existing well: ❑Yes or l ie
copy of this mwrdhae been praWaled to the weA owner.
If thts.9 a repair, fill owANO son well consartce'an Lsformation aced sapialp Me wt me of the
repair &niter NJ remarks section or as the Lack ofthlsfamr..
23. Site diagram or additional Well details:
3
You may use the back of this page. to provide additional well site details or well
S. Number of wells contracted:
construction details. You may also attach additional pages if necessary.
Far multiple injection or non -water xgF13y wells ONLY with life Sam crw AWc*k you oar+
sm6mll one farm.
SUBM ITAL IINSTUCTIQNS
9. Total well.&&* below land aurfaee: 3 A, 200' (&)
24s. For All -Wells: Submit this fond within 30 days of completion of well
For mulllple wells Ilsrall depths Ifdiftetsne (example- 3@200'and2@10u)
construction to the.following
10. Static water level below top of casing: NIA (i,)
l7ivisian of Water Quality, Inform itioa Processing Unit,
#'water level is above cwsft area "+"
1617 Mail Service.CeMer, Raleigh, NC 276994617
11. Boreboie diameter: 6.25 (in.)
24b. For Iniedion Wells: In additionto sending. the form to the address in 24a
rotary
above, also submit a copy of this f6ini. within 30 days of rampletion of well
II Well coastructlon method:
construction to the fallmMnS
(ta. auger, eatery, cable, dinxt push, ato.)
Division of Water Quality, Underground Injeetinn Control Program,
FOR WATER SUPPLY WELLS ONLY:
16M Mail Service Center,.Rallgigh, NC 276994.636.
13a. Yield (Sam) NIA Method of test: f A _
24e Mter Wells, addition to sending the form to
__
the addiess(es) above, also submit,one copy of this farm within 30.days of
I& Disiafectioa NIA Amaan,: NIA
completion of well construction to the county. health department of the county
where constructed.
Form GW-1 North Catolian I)qw-twor of8nvirenment.and Natural Raaomees --Division of Water quality Revisad ran, 2013