GW1--07323_Well Construction - GW1_20231113

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
Kaleb T. Hyde 14.WATER ZONES I I
Well Contractor Name FROM TO DESCRIPTION
250 ft. 705 it ,
4436-A ft. ft. i
NC Well Contractor Certification Number 15.OUTER CASING.(for multi-cased wells)OR LINER(if ap licable)
Graham Well Drilling LLC FROM TO DIAMETER THICKNESS MATERIAL
0 ft 168 it 6.25 in' SDR21 PVC
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.U1C,County,State, Variance,etc.) 0 ft. ft. i in.
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3.Well Use(check well use): ft. ft. in.
17.SCREEN
Water Supply Well: I:
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public ft. ft. in.
OGeothermal(Heating/Cooling Supply) Inesidential 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(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)
FROM TO DESCRIPTION(color,hardness,soil/rock type,grain size,etc.)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) ft. ft.
4.Date Well(s)Completed: 10/20/2023 Well ID# ft. ft.
5a.Well Location: ft. ft.
Brent Aubrey ft. ft. L t:-,4-Y- /n.T. !
Facility/Owner Name Facility ID#(if applicable) ft. ft. ' NOV
Fontana Lake Estates,Smoky Mnt View,Bryson City, NC 28713 ft. ft. 1 = 2023
Physical Address,City,and Zip ft. ft. 11,i ;' '. .1 1, __::;- i�t
Swain 21.REMARKS !J'*'', .:7 si:1
County Parcel Identification No.(PiN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22.Certification: •
35 degrees 23' 26" N 83 degrees 33' 53" W li � �/ 10/20/2023
6.Is(are)the well(s): I�Permanent or ❑Temporary Signature of Certified Wyt Contractor Date
By signing this form,I hereby certt&that the wells)eras(were)constructed in accordance with
7.is this a repair to an existing well: ❑Yes or MNo 15.4 NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy
'phis is a repair,fill out known well construction information and explain the nature of the of this record has been provided to the well owner.
repair under#21 remarks section or on the back of 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: 705 (ft.)
For multiple wells list all depths if different(example-3@200'and 2 a 100) Submit this GW-1 within 30 days of swell completion per the following:
250 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
If water 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
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FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPD:Copy to DWR,CCPCUA
13a.Yield(gpm) 2 Method of test: air
Permit Program,1611 MSC,Raleigh,NO27699-161 I
13b.Disinfection type: HTH Amount: 21 oz
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018