GW1--07324_Well Construction - GW1_20231113

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
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1.Well Contractor Information:
Kaleb T. Hyde 14.WATER ONES l i Z
FROM TO DESCRIPTION
Well Contractor Name
250 ft• 605 ft•
4436-A '
ft. ft.
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. 105 ft• 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.(11C,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) dResidential 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) OTracer 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: 10/26/2023 Well ID# ft. ft.
5a.Well Location: ft. ft. ,
Fontana Lake Builders/Breaux Job ft. ft.
ft. ft. ' 'e' .S'..';L_,i. L r
Facility/Owner Name Facility iD#(if applicable) •-.�„,�,.,
Fontana Lake Estates,Smoky Mountain View,Bryson City,NC 28713 ft. ft. NOV 1 L 2021
Physical Address,City,and Zip ft. ft. I v `t
Swain 21.REMARKS iitavr ., i_Sti`i'£r"--°-. -.2 !.,;._._
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' 24" N 83 degrees 33'49" W
K2A �/ ! 10/26/2023
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6.Is(are)the well(s): EPermanent or ❑Temporary Signature of Certified e t ontracror Date
By signing this form,I hereby certify that the we//(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: :Yes or INo 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 information and explain the nature of the _ of this record has been provided to the well owner.
repair tinder 121 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: I 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 605 (ft.)
Submit this GW-1 within 30 days of well completion per the following:
For multiple wells list all depths if different(example-3 a 200'and 2Q100)
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"+" 1
6.25 24b.For Injection Wells:Copy to DWR,Underground Injection Control(IUC)
11.Borehole diameter: (in.) Program,1636 MSC,Raleigh,NC 276199-1636
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
12 air Permit Program,1611 MSC,Raleigh,NO 27699-1611
13a.Yield(gpm) Method of test:
13b.Disinfection type: HTH Amount: 15 oz
Form GW-i North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018