WI0100479_Geothermal Well Construction Record (GW1)_20170427

WELL CONSTRUMON RECORD For1n)arnatllse.QNLr: .
This form can he used for single or mu tipleweifa._....... ...........
1. Well Contractor Information Envision of Water F{:oS(][}rco3`,
Robert Larry We! s FROM -'M
�. • ft.
Well Contractor Name M hl n Y 2 4 rCtn 17 '
2603-A U �. f`
Is .alrli eCASINUflai•.=
NC Well Contractor Certification Num er FROM -ru
AWD Services Inc. water ouality Hegloi wl opz.°raflons ft' fr.
Company Name _....- 1 tavi e eginrtal •...5e;t RM �" GQif
2.Well CoastructlnnPermlt#: W10100479 A FROM
ft• 300ft.
List all applicable well construction permits p.e. County, scare, variance, etc.) ft, ft
3. Well Use (check well use): ,I7.:SCREFN
FROM I TO 1
Water Supply Weft: ft. fG
❑Agricultural E7MunicipallPuhfic
ft. fr.
gbeothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial ❑Residential Water Supply (shared) 1E,
aROM •ro
r1irri tion-300ft' 0 ft,
Noa-Water Supply Well:
❑Monitoring ❑Recovery
it ft.
Injection W
[]Aquifer Recharge ❑F
Groundwater Remediation FROM O1GRAt+1$L':IIACi
FROM TO
rlAquifer Storage and Recovery []Salinity Harrier ir, ft.
❑Aquifer Test ❑Stortnwater Drainage g ft
MExperimental Technology ❑Subsidence Control 201D I1tV IaiR ' a
gi6cothermal (Closed Loop) oTracer FROM TO
❑Geothermal iieatingCooli Return) ❑Other lain under #21 Remarks
ft. fL
ft
4126/17
4. bate Wallis) Completed: Well IID# fr. ft,
Sa. Well LocadoIV. ft ft'
Virginia G Hunneke rL
Faeffity/OwnerNarne Facility MA (if applicable) EREMO
�
34 Bee Balm Way Asheville, NC 28804 fL
Physical Address, City, and Zip -'
Buncombe 972172775700000
C—W Parcel Identification No. (PIN)
5L Latitude and Longitude in degrecslnduateslseconds or decimal degrees' 22• Certiftcatio
(ifwell field, one latliongis sufficient) Elev.2585
35 39' 16" N 82 35' 3411
�Cmifw
6. Is (are) the well(O S(Fermanent or []Temporary
7. Is this a repair to as existing well: l7Yes . or &KO
if this is a repair, flll nut known well consmtciton information and "plate the oalure of the
repair under 421 remarks section or on the hark of thlsfonn.
S. Number of wells construeted:
For muhiple btfecilon or non water supply wells ONLY with 'be same aonetruettavr, }rou can
submit onefarm. 2 @ 300r
9. Total well depth below land surface: tJ (ft.)
For mulliple wells list all depths ttroarenr (example- 3@200' end 2@100')
10. Static water level below top of casing: N/A (ft)
dfwaler level is above casing use "4'
11.13urehole diameter- 6.25 (in,)
12. Well construction method: rotary
(i.e, auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
139. Yield (gpm) N/A Method of test:
1 13b.'Disinfection type: I; ;hletqAmount: 2 —
44372
�tlitit'L'hbt.d s si `b ':
67�R TaICKNE$S M
5 SM311
to.
at SLoTSIZF :...THICHM
in.
in.
L EMPI�t nfexrn
ermal Pump
4/27/17
u4m
By signing this form, l hereby terrify that the wsll(s) was (were) eonsiructed in accord2nce
with 15A NCAC 02C •also or ISA NCAC 02C ,0200 Well Canslructton Standards and that a
copy of this record has been provided to lh8 Nell oxnat:
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBSi4f3'ITAL 1NSTUCTIONS
24a. For All Wells: Submit this farm within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b, For Ini ctlon Wells- In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Underground injection Controi Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
74c, For Water l 'o W lls• In addition to sending the form to
the addresses) above, also submit.one copy of this fort within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW-1 North Carolina Department ofSnvi—at and Naturat Resources—❑ivision of Water Quality Revised Jan. 2013