GW1-2022-03911_Well Construction - GW1_20220412

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
Kaleb T. Hyde 14.WATER ZONES
FROM TO DESCRIPTION
Well Contractor Name
70 ft. 305 ft.
4436-A
ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING for multi-cased wells OR LINER if a licable
Graham Well Drilling LLC FROM TO DIAMETER THICKNESS MATERIAL
0 ft. 116 ft- 6.25 1188 1 Steel
Company Name
16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.1/1C.County,State, Variance,etc.) 0 ft. ft. in.
3.Well Use(check well use): ft. ft. in.
17.SCREEN
Water Supply Well:
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public ft. ft. in.
❑Geothermal(Heating/Cooling Supply) CJResidential Water Supply(single) ft. ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Irrigation ❑Wells>100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 ft. 17 ft. bentonite
❑Monitoring ❑Recovery 17 ft- 20 ft- bentonite
Injection Well:
ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation
19.-SAND/GRAVEL PACK ifa licable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage ft. ft.
❑Experimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) FROM ft. To ft. DESCRIPTION(color,hardness,soillivck type,grain sin,etc.)
4.Date Well(s)Completed: 03/29/2022 Well ID# ft. ft.
ft. ft.
5a.Well Location:
Great Smoky Mountain Event Park ft. ft.
Facility/Owner Name - Facility ID#(ifapplicable) ft. ft. r _
Hyatt Creek Rd.,Bryson City, NC -28713 f` ft. APR 1
Physical Address,City,and Zip ft. ft.
Swain 21:REMARKS
County I!S;"•�'i4'Y a+�• ^l�1�1 ^lC`'i itJ!`ll\..'`
Parcel Identification No.(PIN) ' t�{�(Y`tf°�"
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one Iat/long is sufficient) 22.Certification:
35 degrees 26' 53" N 83 degrees 23'46" W 1/y 3/29/2022
6.Is(are)the well(s): IlPermanent or ❑Temporary Signature of Certified W,ff Contractor Date
By.signing this form,1 hereby certifp that the well(s)was(mere)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or [!]No 15A NCAC 02C.0100 or 15A NCAC 02C 0200 Well Construction Standards and that a copy
If this is a repair,fill out known well construction in/orntalion and explain the nature gf the of this record has been provided to the we/ owner.
repair under€21 remarks section or on the back gf this.f lrm.
23.Site diagram or additional well details:
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well construction info
construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach additional pages if necessary.
drilled: t 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 305 (ff•) Submit this GW-1 within 30 days of well completion per the following:
For multiple wells list all depths ifdifferent(example-3@200'and 2@I00')
24a. For All Wells: Original form to Division of Water Resources (DWR),
10.Static water level below top of casing: 70 (ft•) Information Processing Unit,1617 M4SC,Raleigh,NC 27699-1617
1f"mater level is above casing,use
11.Borehole diameter: 6.25 (in.) 24b. For Injection Wells: Copy to DWR,Underground Injection Control(IUC)
Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: rotary 24c.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the
(i.e.auger,rotary,cable.direct push,etc.) county environmental health department of the county where installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPD:Copy to DWR,CCPCUA
$ air
Permit Program,1611 MSC,Raleigh';NC 27699-1011
13a.Yield(gpm) Method of test:
13b.Disinfection type: HTH Amount: 12 oZ
i
Fonn GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018