GW1--01498_Well Construction - GW1_20240312

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WELL CONSTRUCTION RECORD Far Toupin!Use ONLY: '
This farm can be used lot sitigk or multiple wells.
1.Wcl[Contractor Information:
. LI:WAIT:R•LON ES
Robert Miller',_- - ' FROM ' r TO - '-PESCSIRDON
Well Contractor Name • ft.• ft, i
2675-A .ft.. ft.
•
NCWel1 ConlmctorCcnification Nurdt'er. • =IS:OUTER CASING fforiudll-cisedsd1s)OR-LiNER(if nn ilcabkl:•
FROM •TO • ' DIAMETER• THICKNESS- AIAiERtAL•-- -
SAEDACCO - f6 IL. lit.
Quatrain.[fame I6.-INNER CASING OR TUBING(geothermal dosed-loop) •
-FROM TO ' DIAMETER TUICELNESS MATERIAL
2.Wcit.Construction Pe)mnit it:WI0100704 R. : ft: , .tit. .
f.iu oil appiliciible wolf permits fcc.County;Stain;.Variance.liyect cal efr.:i
.R,. ft, ; ita
3.Well t se(check well use):- . - • ri.SCREEN
Water Supply Weft : • - -- --- - -- FROM.- to .Di%Mr;TSR' SLOT SIZE 1111C1tNMS. MATERIAL,
❑Agricultival ❑Muaieipal Public ft. R, it -
❑Geotheflnal(l3eating'ICooling Supply) ®Residential Water Supply(single) ft ft. in.
©ludustiia-ilComntercial ®Residential Water Supply(shad) .Sac GROUT
FROM TO . MATERIAL EMPLACEMENT AIETUODSAAIOWT
❑Irrigation . . .fr. ' ft.
Woo-Wafer Supply Well:; R. It. ,
❑Monitoring -. ❑Recovery. - ,
Injection Well: ft, • tt.
13AnnifcrRecharge CGGrolundiriter Rentcdinfion t9:sANOIGILAVEL PACK or appliCabter - :;•= -- -
'I.ROM - - 10• MA'rERWr. E1IP1ACEMENT MrTHOn '
13AguifcrStorLgcand Rccovrty P5alinity 6amcr R. ft. -
EIAgriifcrTest- 175tommatcrDraiinagc ft ft..
QRx7tCtipu nfnl T 1LnotPgy ❑SrtbsidctKs C'01Ntpl ,2a;pi{JLLUNG'i:OGranaeli,naditiorftr sticels tf ncccswrvt ' '
• ❑Geotltermal(ClosedLoop) • ❑Tracer •
FROM• TO DESCRIPTION Dolan heMn MI,wirmck7l*ntwirl 4te.dr)
l7Geodtetival(13eatinetCooliue Return) ❑Other(erplait►under#21 Reoiatls) n rt.
4.Date Well(s)Completed:'2/22/24 ,Well pDff H-1 . ft. • ft. • i•) {��~�'R/" ; }� .''
Sa.Wdl Location: .rt. . rL. ' �- • • .MAR 1 2 .2024 . .
Zboyovski Property . . . ft. h, 7r i^��.
FadlitylDir•ncrName . Facility iDk(ifapplkable) . . R: ft. • 1nS ,=t;+_^l: y •;. I�...
• D'4f`vQii5'. =
146 Smokey. Park.Hwy., Asheville, .NC, 28806 ' .
.R. ft. .
•
Elry'Sical Address City.and Zip i21.REMARKS •
Buncombe- • - • Injected 104 gallons of Cool-Ox per boring;
CmistY Nivelkica!lifLCanou No,(MN) 20-33'
5b,latitude acid Longitude in de rees/minutcslscconds or decimal degrees: 22.Cettificatian:
(If Hell field;9ak l W7olig ir'strlrcknl)
N WV , 1 2/28/2024'
Siviuuueofs:rra!a!:owrs•,:.:�..Gs•';� manic
6.Is.(are)the wcll(s}r-t7Perinanent .or• 81Teniporat • .
By,5ignrnb rlris.jotm.1 hereby certify rLar thgn•ellN ism(ptrmJ cnrtrtructed ln,acrotrlanre
iiith I SA NCAC 02C,0100 or ISA NCAC 02d.0200 A'eU Conatrirerion Sraia:fards and that a •
7.Is this a repair to air existing well: DYe-v or 'Ill No rcyirbf riiir recorrl has lh'cn provided ratite urll(+wrier,
If;Nils a repair;fill oar k i6sii well c nastnrctlon lnlbmurriwu and a tplaht the rutrare of rho
repair rnrd'er621 remarle-erciian or on the hart of the form ' 23.Site diagram or additional well details:
You may use the back Of this page.to.provide additional well site details or Well
8.Number of wells constructed: 1 • . " coustmetioitdetails, You-May also auac[raddilionat pages if necessaly.
•For nnilrlple hdecilon or non-water siippWu'tik ONLY with iiic same conatr iflon,yoti a an '
sahwit oneiann. SUBM[TTAi.iNSTUCTIONS. . .
9.Total well depth below hind surface; 33 (ft,) •Iiii. Mir AU Wells: Submit this Toni]within 30 days of completion of well- -
Air mathiple. eflrllsrcoOdepthsifd •i'rem((craotple-i@200'atud.20,100) - - constmction.roiltefollowing; '• ' '
10.Static water level below top of callow • (ft,) Di�•isinn of Water Resorirees,Information Processing Unit,
If n!irer kid is of ore casing.ase"+" 1617 Mall Service Center,Raleigh,NC 27699-1617
11.Borehole-diameter:1.5" . (in.) 24b.For iui[ectior;Wells ONLY: Ili addition to sending the form to the address in
24aaboye.also,submit a copy of this fonu within 30 days of.completion of well
12.Well construction method:DPT . coustnidiau to the following: --
(Le:auger.rotary,Cable.direct gushetc.}- Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: - - 1636 Mad Scrvlce'Center',Raleigh,NC27609-1636
13a Vicki(>ILm) Method of test: 24C,For Water Supply&Injection Wells: . -
Also submit one copy-of this faun within 30•daysofcouipletionof
'13h.Disinfection type: Amount: • well construction to the county health department of the.00unly.Wherc
consinicted. '
Farm GW-I - Nonli Carolina Depyt)itcm.of Em iionnsuu and Natural Renautres-Diviiioa of Walcr Rrxmr .Remised August 1013
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