GW1-2021-05999_Well Construction - GW1_20211008

WELL,CONSTRUCTION RECORD(GW-I) For Internal Use Only:
1.Well Contractor Information:
Kaleb T. Hyde
14.WATER ZONE
Well Conlrnclnr Name FROM '1'0 DhSCI(IP970N
4436-A 905 ft• 905 rr.
ft. rr.
N('Well('on111100r('erlification Nunther
(5.OUTER CASING for multi-cased wells OR LINF,R(if it t tli'all
Graham Well Drilling LLC FROM f0 DIAiMEXER fHICKNI•:SS MATr•,RIAL,
C'onilmny Nintc 0 ft• 68 I't. 6.25 in. SDR21 PVC
16.INNER CASING OR TUBING 'cothermal closed-Inn
2.Well Constr action Permit#: FROM To n1AM E'tF,R 'rnICKNE S MATERIAh
Lie?all applicahle irr//cans/ruclu"I per)n,1a(1.r.(1/(,(unnrr.h7nlr. 6lvinncr, 0 fr• ft. in. -
3.Well l Ise(check well use):
Water Supply Well: 17.SCREEN
CAgI'ICI11tURtl r PI20M TO DIAMETER! SI,O'1' F. 'I'll ICENPSS MATERIAL
❑Municipal/I ublic ft. SIZE n. in:
OOcothermal 0-10illing/("001111g SuPPIy) 19Rosicicntial Water Supply(single)
fr• fl. ini
❑Industrial/Commercial ❑Rcsidenlial Water Supply(share(l)
IA.G I.
C:Ilrrigati°n LlWclls Ro UT` 100,000 GPD FROM TO
MATERIAL 1•:MPI,A('EMI?NT METHOD&AMO(INT
Non-Water Supply Well: 0 rr. 17 ft.
❑Monitoring EIRecovcry
Injection Well: 17 ft- 20 fr.
❑Aquifer Recharge ❑Groundwater Remedialion ft. ft.
❑Aquilcr StotnLc and Rcr.Ovr 19.SAND/GRAVEL PACK ifa))licablc Recovery ❑Salinity Barrier FROM TO
MA"rl;lilA1• 1•;M11PLA('EMENTm rnoD
❑Aquiler'I'est ❑Slormwater Drainage
❑Ii..Nperimcntal'I'cchnology ❑SubsidenccC'0nlrol n.
1-16colhermal(Closed I,00p) 1-1117acer
20.DRILLING LOG attach additional sheets if ncccssa
❑(icoth0nnal(Ilaning/(:'oolingRcwrn) CIOIh r(explainun<Icrft2l Rcnwrks) FROM 1'0 DESCRIVI...N(rntnr,hm'dnnss,son/rnckt c, ra;ns;c,erc.)
ft• ft.
4.Date Well(s)Completed: 09/09/2021 Well m# e. ft.
5a.Well I,ocatimr: ft. ft.
Robert Kerbs e ft.
Facility/Owner Name Facility II)//(ifappliuble) ft. ft.
Fox Run Ridge, Bryson City, NC 28713 I'I
ft. fr.
Physical Address.('ily.and lip ft.
ft.
Swain information Prooessin Unit
21.REMARKS
(`OOpty Parcel Idenliticalion No.(PIN) _ -
Sb.latitude and longitude in degreeshninutes/seconds or decimal degrees:
(it well field,one Int/long is sufficient)
35 degrees 24' 0" N 83 degrees 27' 3g° 2z.Certification:
w &a" YY� 9/9/2021
G.Is(are)the well(s): P1Permanent or ❑'Temporary• Sil;nnaue of(cuthc9pell contractor Dam
lit si,rfni1w Ihi.s Jirrrn,l hereho ecrlilj,1hnr nc,;l rr//(il uvtc carte)cnna Iruc/cr/in ncc•orrinnc'c mil/i
7.Is this a repair to an existing well: IJ I- n
Ycs or No l,i,q N('.4('02( .("oO I('nr 15A NC 02('./j7!/0 We//!'unsnvr/inn.\>rrndrnr/c rare/drat n enpt
l/7/ris is a rrpnir.fill n,n luruu n moll ran.crrneriun inJirrnrurinn nnrl e.tplrrin rhr nrrnrrr n/'(hr /7Li.e rrr nrrl lrn.c hero pro"Wer/rn Ih<•urll utruer.repair under ii2/rrnmrlcs'.raclinn n1'on the buck o%dria,/or•nr.
23.Site diagra in or additional well details:
8.For Geoprobe/DIRT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well construction info
construction,Only I GW-1 is needed. Indicate TOTAL NUM13FR ol'wells (add'Sec Over,in Remarks Taos).You may drilled: r also attach additional pages il'necc nary.
24.SUBMITTAL►NSTRIICTIONS
9.Total well depth below land surface: 905 (ft.)
hi)r Ilndlip/e ur//c/61,11/depths i/d(/)irr„r ir.rnrnp/c-I(n)2011•an 2z(1,Inu') Submit this CW-1 within 30 days of well completion per the following:
10.Static water level below top of casing: 905 (ft.) 24a. For All Wells: Original forin Ib Division of Water Resources (DWR),
//1"werks,e/i "hnrccasinrC.1/se Infr or
Processing Unit. 1617 MS('IL Raleigh,NC 27699-1617
9
11.Roreholediameter.: 6.25 (in.) 241). For Injection Wells:COPY to DWR, Underground Injection Control(IIIC)
Program- 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: rotary i
(i.c.auger,rotary.rabic,direct push.cm.) 24c.I%D7•Water SupPly and Open-Loop Geothermal Return Wells Copy to the
c0unly ulvlronntun,tl health depatunentot the county where Installed
FOR WATER SIiPPLI'WI?I,I,S ONLY: f
24d. For Water Wells Producing over 100 000 GPD Copy to DWR,CC'PCt1A
13a.Yield m o test
: rnul I rogrant 1611 MSC,Ralclgh.N('27699-I(il 1
(gP ? Method t
I
13b.Disinfection type: HTH 0 1
A InO tm t
Form(.iW-I North Carolina Depnontem of I(nvironntcnlal Qualily-Division of Water Resources I,
aovis«I 6-6-20 1 s
f