GW1-2022-08802_Well Construction - GW1_20220909

WELL CONSTRUCTION RECORD(GW-I) Por Internal Use Only:
1.Well Contractor Information:
i
Kaleb T. Hyde 14.WATER 7.ONES
FROM .11O DESCRIPTION
Well('onunaetor Name 75 ft- 255 ft.
4436-A ft. ft.
N('Well('ontractoi Certification Number I5.OUTER CASING: for multi-cased wells OR LINER if a licable
Graham Well Drilling LLC PROM TO DIAMETER Ill
ICKNIiSS MA'fERIAI.
0 fl 114 ft 6.25 i" SDR21 PVC
Company Name 16.INNER CASING OR TUBING(geothermal closed-loop)
2.WCII Construction Permit#: FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well caavirm ion prrniils(.e.!UU,County,,\Yule, Kirialle",rlc) 0 ft.
3.Well Ilse(cheel(well use): ff. ft. in.
17.SCREEN
Water Supply Well: FROM TO DIAMETER SLOTSI7,E TIIICKNESS MATERIAL
❑Agricultural ❑M till icipal/Public ft. ft. in.
❑Gcothennal(Heating/Cooling Supply) I'IResidential Water Supply(Single) ft. ft. is
Cllndustrial/Commercial f7Residenlial Water Supply(shared) 18.C Rol II'
❑irrigation ❑Wel IS> 100,000(_iPD FROM TO MATERIAL. EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 ft' 17 ft bentonite
❑Monit:oring ❑Recovery 17 ft• 20 ft- bentonite
Injection Well: ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation
l9.SAND/GRAVEL PACK(if applicable)
❑Ag(IIIer Storage and Recovery- ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENTMF,THOD
ClAquiler Test ❑Stormwatcr Drainage ft. ft.
❑l',xpefimenttd l'cchnology ❑Subsidence Control ft. ft.
C(icothcrmal(Closed Loop) CI fraccl 20.DRILLING LOG attach additionalshects if necessary)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 1121 Remarks) FROM r0 ft. DESCRIP'1'ION(colm•,haWness,sail/mch( c, ratasi ,oc.)
ft.
4.Date Wcll(s)Completed: 08/01/2022 Well HU
5a.Well I.,ocation: � (f"
Alisha Kirkland ft. ft.
Facifiiy/Owner Namc Facility IM/(ifappliwhle) ft. ft.
Laurel Lane, Bryson City, NC 28713 fi. ft.
Physical Address,City.and Zip In7�i Fi i.�++0,'1 r 1^ •*�,i.::� nit
Swain 21.REMARKS
Cooney Parcel Identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well lield,one lal/long is sufficient) 22.Certification:
35 degrees 26' 40" N 83 degrees 25' 16" W K " 8/1/2022
6.Is(are)the well(s): nPermanent or Cfremporary Signature ofCtlnified VI Conlraclor Date
Rv signing llris fiwtn,1 hereh.v cerlifji iha1 the rve//O was(uvrreJ concrrucied in nec•nrr/nnr.•e with
7.Is this a repair to an existing well: ❑Yes or nNo 15A N!'AC 02C.0100 or 1 in NCAC 02C.0200 Well Cnnstmelion Rlnndarr6 and Thai a cnpv
1/71iie is rr repair,/ill out knomn rve/1 consirur•lion in/in-walinn and explain der millre')l the n/7his record hots been provided to the❑ad/corner.
repair niter i�21 remarks sec•lion or on the hack g1'111i.v 1brnt.
23.Site diagram or additional well details:
R.For Gcoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the hack of this page to provide additional well construction into
COI15lIl1CL011,only 1 GW-I is needed. Indicatc'I'O"fAl.NUMRIiR of wells (add'Sec Over'in Remarks Box).You may also attach additional pages if necessary.
drilled: t 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 255 (ft.)
Por nudii le we/Lv hsl al/rlc uhs i ,h erenl rxanr /a-.i ri),..0lI'and 2(r1100, Submit this GW-➢within 30 days of well completion per the following:
p l III ( p (.' )
24a. For All Wells: Original form to Division of Water Resources (DWR),
10.Static water level below top of casing: 75 (W) Intonrlation Processing Unit, 1617 MSC,Raleigh,NC 27699-1617
l/tenter hwv/is whom casing;,use
6.25 24h. For Injection Wells:Copy to DWR,Underground Injection Control(IIIC)
I1.Borehole diameter: (in.) Program, 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: rotary
24c.For Water Supply and Opcn-'Loop Geothermal Return Wells:Copy to the
(i.e.auger.rotmy,crbte,direct push.elc.) county environnientnl health deparlinew of the county where installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPD:Copy to DWR,CCPCIIA
13a.Yield(gpm) 20 Method of test: ale
Permit Program, 161 1 MSC,Ralcigh,NC 2 7699-1 61 1
131).Disinfection type: HTH Amount: 9 oZ
Form GW-I North Carolina Departmeni of Environmental Quality-Division of Water Resources' Revised 6-6-2018