GW1-2022-06701_Well Construction - GW1_20220712

WELL CONSTRUCTION RECORD(6W-1) For Internal Use Only:
1.Well Contractor Information:
Kaleb T. Hyde 14.WATER ZONES
FROM TO DESCRIPTION
Well Contractor Name
240 ft. 505 ft.
4436-A ft. ft. !
NC Well Contractor Certification Number I5._OUTER.CASiNG:for mulfi-cased wells OR tiNER'ifa licable
Graham Well Drilling LLC FROM TO DIAMETER THICKNESS MATERIAL
0 ft• 124 ft- 6.25 in. 188 Steel
Company Name I&INNER CASING OR TUBING,geothermal closed-loo
2.Well Construction Permit#: FROM TO DIAMETER - THICKNESS MATERIAL
List all applicable ivell construction permits(1.e.UIC,County,Stale,Variance,etc.) 0 ft. ft. I 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) IlResidential Water Supply(single) ft. ft. in.!
❑Industrial/Commercial ❑Residential Water Supply(shared) 18,.GROIJT l
❑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.if a `teablc
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM I I TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stonnwater Drainage ft. fr.
❑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) I FROM ft. ft.To DESCRIPTION(color,hardness,sou/mck type rain sin,etc.)
4.Date Well(s)Completed: 06/13/22 well ID# ft. ft.
ft. ft.
5a.Well Location:
Swain County TDA/Smoky Mtn Event Park ft. ft.
Facility/Owner Name Facility ID#(if applicable)
ft. ft.
Hyatt Creek, Bryson City, NC 28713 ft. ft.
Physical Address,City,and Zip ft. ft.
Swain .21.REMARKS
County Parcel Identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: JU
(if well field,one ha/long is sufficient) 22.Certification:
35 degrees 26' 53" N 83 degrees 23" 46" W `,m 6/13/2022
6.Is(are)the well(s): nPermanent or ❑Temporary Signature of Certified ell Contractor I `�) 1te
By signing this form,I hereby certify that the ivell(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or nNo 15A NCAC 02C.0100 or 15A NCAC 026.0200 Well Construction Standards and that a copy
Ifthis is a repair,fill out knoivn well construction information and explain the nature ofthe ofthis record has been provided to the ivell owner.
repair under#21 remarks.section or on the back of this fbrnt.
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 OveP in Remarks Box):You may also attach additional pages if necessary.
drilled: t 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 505 (ft') Submit this GW-1 within 30 days of well completion per the following:
For,multiple spells list all depths tfdierent(example-3@200'and 2@100')
240 24a. For All Wells: Original form to Division of Water Resources (DWR),
10.Static water level below top of casing: (ft') Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
/fivater level is above casing,use"+"
11.Borehole diameter: 6.25 (in.) 24b.For Injection Wells:Copy to1DWR,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
13a.Yield(gpm) '25 Method of test: air
Permit Program,1611 MSC,Raleigh,NC 27699-1611
13b.Disinfection type: HTH Amount: 12 oZ
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018