GW1--04954_Well Construction - GW1_20230807

WELL.CONSTRUCTION RECORD (,...,LeFor Il;ternal Uso ONLY:
This-form cam be used for single or muliiple wells
I.Well.Contractor Information: \\J`
't.t..WATIiRzONFS
Brian Ewing FfUW1. TO DESCRt14111N
' Well Cor aractor Marne ft: ft, ' i •
4240-B ft. ft.
NC Well Contractor Ccnifte,tiorvNunilct 'IS:OUTER CASING(for`inrihI;eisicdlicpsiORLiNER111'siittica6kl
FROM' Tel nr.vatETER THICKNESS sIAiERIAt.
SAEDACCO ft. fL' ]a
CeurpourNanw•. IN.INNER CASING OR 77.IBING'4�cntber ma ckucd-IdiLe)"..,- . .. -•.- •
FROM . TO OFAMETER THICKNESS MATERIAL
2.WdI Consttwction Permit#: 0• ft. 3 ft. 2 .n. SCH-40 PVC
iisrafl applied*well pemTOe(Li..County.SJrr!e.r•nriarse,(rydb'C;a,,...J 6.
•
3,Well Use(Check well tisej: • • ;t7.st;RelN
Water Supply%Velh IrRltst ' TO ntAMFTKR Sr.OTS1731 . T1lICKNIIS I MATnnrAI.
tJtlgrictlltura@ o titiiciplUl'twic 3 ft. 13 ft. 2 in, .010 sCH-40 PVC
DGeotlrcrral(HLeatingICooling Supply} CiResideiltial-Water Supply(single) fi. R: in, 1
•
• ©IudustriaUConlntcrcial °Residential Watee.Suppii•(shared) "I,' OUT :: • , :- - U
M To- MATEItLVL I EMPIACThIC\TM6itIOD&AMOUNT
❑Irrigation' 0 ft. 2 ft. PORTLAND , POURED
Noll-Water Supply Well: ft.- (I . •
RIafonitoring DReciwcry .
Injection Well: rt. •ft.
DiigisiferRecharga °GroundRaterRC1ncdiati00 `191SAND;f:IfAYEL.PACKfir omit icat)to • • --" -
-PROS! TO - NI ATI:Rr41. -F.SIPIACEVENt•11.1 VINO II
°A heifer Storage and Recov?try' . °S linty Balmier 2,5 ft. 13 fl. FILTER SAND #.2
. . ❑Aquifer Test - ❑Storniwatcr Drtinago ft. ft,
❑LW«ritucn(nl'fcclmology' fSuhsidcncc,Cotdrul
. :,2n;DRILLING4:OG`fottaed'additiontll sheets`if it-ee.:Scar-f
OGeotlrennnl(Closed Limp) °Trager - FROM 1 To DRicurrrmxfwbr.bntdnc.a. master. ..in sv,:.c[c.l
❑Geoclietnlal(lilearine/Coolinc Return) ❑Oilier(explain under#21 Remarks) 0 - ft. 5 ft. FILL', GRAVEL ROCK SILT SAND
5 it. 13 it. MOIST TO WET SILT/ CLAY
4.Date Well(s)Completed: 6-28-23 Well iDNMW-1RA ft. ft. '
•
5a.Well L i Itilin: .ft. ft.
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Shell Gas Station ' ft.- ft.
. .
Facially;ClnncrNatoc Facilill 1Dk{if3pplrablc). R rt -
202 NC-9, .Black Mountain; NC, 28711 ft, fl,. ;,r r r a C ,'
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Phi sr al rlddrest.City..and 111
nd Zip 21:REMARKS . -'
Buncombe 1 BENTONTIE SEAL 2-2.5' • AUG 0 7_ 2023
County Parcel Irkaditvc iiun Na.(PIN)
I it• ADre.. /r:@
' Ste.i.;ttitudc and 1.ongituile in degrees/minutcsisccottds or decimal degrees: .22.CCreifcation: D ICEloc;
(it a ell f4W,Urs:lot 1oug ix srdlici<la)
IVW Brian E i erg ... 7/1 2/2023_v-
.Sigmtum afCertifiedWell Caitractar Dale
6.is(are)the Well(s): KiPennauent ,or ❑Temhoraty By sfgnhrg this faine,-i irereb)•...edify that the weflfs'J was(v,,en)a' ihreted it,oxen-lance
with 15A NCAC 02C,O100 or 1 SA NCAC 02C.0200 Welt Cwutrrirriou Sraodaois anti r1u r a
7.Is this a repair_toallculstln,well: °Ve or pNo ropy of this ieeort1leisbcnproririrdMJhe Well owl er.
. If Jlrls R.a reu air.fill(RJr krona writ cvnoJnt;laa isf'reoarhsi earl.i tpfahi the armor,'of rile
rival,ruttier p i rcmarts•srrtfon or iv,the hank arthir fora:. ' - . '23.Site diagrantor additional well details:
You may.use the back of this page to provide'additional well site details or Well
S.Number of wells constructed: 1 • - - •cotistiuction details, You may also attack additional pages if necessan.
Fur,nrlrl c.ird trlon uraon-nvr;rr sipplr wvcfls 19,14.I'with the sarrrrarlrsiruiriorl,you con �T
sahoritnne farm. SLII3b1ITTAL iNST1ICfIONS -
9.Total Well depth below laud stirfacei 13. ((1.) 24a. For All Wells: Submit this form within 30 days'of completion of well
For in+rltlpfciri'its list lift deprhsrfdlfliYenr(c.rompre-se213O'ruat2@tarr6 construction to the following:
• 10.Static water level below top of easiuyi • ((11.) Division of Water Resources,Information Processing Unit,
if wale,level it above casing,rue"+" - 1617 IFLial cin ice Center,Raleigh,NC 27699-1617
I1.rtnrcllote diameter 8.25" (in,) 241.For dejection Nally ONLY: hi 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
• 12.Well construction method:BORED - coistnictimr to the following'. -
. (i.e.anger,rotary,cable=direct push.etc.;
- Division of Water Reseurces,!UutIerrroat,d Injection Control Ptrograut, .
FOR WATER SUPPLY WELLS ONLY:. . 1636 Mail Service Center.Raleigh,NC 27699-1636
I3:I Yield(gpm) 24e For Water Suphlv..Kc Injection.Were:
Method arrest: •
Also subniit one copy of this form Within 30 days ofconipletionof
13b.Disinfection,type: Amount: well constnlction to the county health department of the county where
constricted.
Form OW-1, NonlrCarolina Department of Eut•ilutunenl and Natural Resources-Divi;Ion of Water Regret Revised August 1013