GW1-2022-09325_Well Construction - GW1_20221007

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
380 ft- 755 ft.
4436-A ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING for mulfi-cased wells OR LINER if a livable
Graham Well Drilling LLC FROM TO DIAMETER THICKNESS MATERIAL
0 ft• 42 ft- 6.25 in SDR21 I PVC
Company Name 16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS MATERIAL
List a//applicable rrell construction permits(i.e. U/C,County,Siale,Variance,etc.) 0 ft. ft. in.
3.Well Use(check well use): ft.-- in.
17.SCREEN
Water Supply Well: FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public ft. ft. in.
❑Geothermal(Heating/Cooling Supply) In Residential Water Supply(single) ft. ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT k
❑irrl ation ❑Wells>100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 ft. 17 ft. bentonitei
❑Monitoring ❑Recovery 17 ft. 20 ft. bentonite
Injection Well: ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK if applicable)
❑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 421 Remarks) FROM To rt. DESCRIPTION(color,hardness,soillrock e, min size,etc)
ft.
4.Date Well(s)Completed: 09/23/2022 Well ID# ft. ft.
ft. ft.
5a.Well Location:
John R. Edwards Construction ft. fr.
Facility/Owner Name Facility ID#(ifapplicable) ft. ft.
Sawmill Creek, Walnut Cove, Bryson City, NC 28713 ft. ft. OCT 0 1
ZUZZ
Physical Address,City,and Zip ft. ft. -
Swain 2L REMARKS -
County Parcel Identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field one hit/long is sufficient) 22.Certification:
35 degrees 20' 44" N 83 degrees 28' 10" W A-a" / 9/23/2022
6.Is(are)the well(s): InPermanent or ❑Temporary Signature of Certified w Contractor Dare
By.signing this form,I hereby cert�that the we//(s)u•as(mere)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or (INo 15A NCAC 02C.0100 or 15A NCAC 02C.0100 Well Conslruclion Slandards and that a copy
if this is a repair,Jill out known well construction ittlbrmation and explain the nature of the of this record has been provided to the well omner.
repair under=11 remarks.section or on the back o/'this form.
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: 755 (ft•) Submit this GW-1 within 30 days of well completion per the following:
!br multiple welds list all depths iif'diereni(example-3 a@200'and 2@a 100')
24a. For All Wells: Original form to Division of Water Resources (DWR),
10.Static water level below top of casing: 380 (ft.) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
1llrater level it above casing,use "
24b. For Injection Wells:Copy to DWR,Underground Injection Control(IUC)
11.Borehole diameter: 6.25 (in.) 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) 1 Method of test: air
Permit Program, 161 1 MSC,Raleigh,NC 27699-161 1
13b.Disinfection type: HTH Amount: 18 oZ
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018