GW1-2022-00737_Well Construction - GW1_20220113

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NORTH CAROLINA
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WELL CONSTRUCTION RECORD (GW-1 )
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Form GW-1 Well Construction Electronic Form
North Carolina Department of Environmental Quality
Division of Water Resources
November1
Submission ID#
G W 1-2022-00737
Are you submitting a scanned form?* Yes
No
CONTACT INFORMATION
.......................................................................................................................
Email Address*
Contact Name* haley.thompson@byerswelldrilling
Haley Thompson com
Is this a revision to the form you have previously submitted?*
Yes No
WELL CONSTRUCTION INFORMATION
.................... ................... ................... ................... ............... .......... .................. ................... ................... ................... .....
1.Who is installing these wells?*
Owner Well Contractor
1.Well Contractor Information:
........ ......... ..... ......... ......... ......... ......... ..... .........
Certiticate# Cert Level First Name Last Name Company Name
3131 A LON DILLARD BYERS WELL DRILLING, INC.
2.Well Construction Permit#:
.....................................................................................................
7502086460
List all applicable well construction permits(i.e.Monitoring Wells,UIC,County,CCPCUA,etc.)
What type of well is this?* Injection Well Non-Water Supply Well
Water Supply Well(includes irrigation wells)
3.Water Supply Well* Geothermal (Heating/Cooling Supply) Industrial/Commercial
Irrigation Municipal/Public/Community
Residential Water Supply(single) Residential Water Supply(shared)
Wells> 100,000 GPD
4.Date well was completed and ID#
Date Well Completed* Well ID# Well Yield

12/28/2021 100
(gallons per minute)"
5.Well Location
Facility/Owner Name*
Kevin Storey Facility ID#
(Required) (If applicable)
County* Parcel Identification No.(PIN)
Macon
Physical Address* Street Address
Fulcher Vistas Drive
Address Line 2
City State/Province/Region
Franklin NC
Postal/Zip Code Country
28734 USA
Latitude* 36.0722100000 Longitude*75.2046400000
Decimal degrees Decimal degrees
... ................ ......... ........................... ........................... ......... ......... ......... ...................
6.Is(are)the well(s):* Permanent Temporary
7.Is this a repair to an existing well:* Yes • No
If this is a repair,fill out known well construction information and explain the nature of the
repair under#21 remarks section or on the back of this form.
For multiple Geoprobe/DPT or Closed-Loop Geothermal Wells having the same construction,only 1 GW-1 is needed.
8a.Indicate TOTAL NUMBER of wells drilled: 1
9.Total well depth below land surface: (ft.) 9a.What is the depth of the casing from ground
805 surface?
For multiple wells list all depths if different 30
(example-3@200'and 2@100') in feet
10.Static water level below top of casing: (ft.) 11.Borehole diameter:
140 6.25
If water level is above casing,use"+" in inches
12.Well construction method:
Auger Air Rotary Cable Tool
Direct Push Mud Rotary Rotosonic
Other
13. FOR WATER SUPPLY WELLS ONLY:
13a.Yield(gpm)
100 13a.Method of test:
If applicable Air
13b. Disinfection type:* 13b.Amount:*
Chlorine 20 oz

14.WATER BEARING/FRACTURE ZONES
From To Description
0 220 0.75 GPM
in feet in feet
220 788 30 GPM
in feet in feet
788 795 70 GPM
in feet in feet
795 805 100 GPM
in feet in feet
15.OUTER CASING(for multi-cased wells)OR LINER(if applicable)
From To Diameter Thickness Material
in feet in feet in inches
17.SCREEN
...........................................................................................
From To Diameter Thickness Material
in feet in feet in inches
18.GROUT
........... ................... .... .......
From To Material Emplacment Method&Amount
0.00 20.00 Cement Gravity
in feet in feet
19. SAND/GRAVEL PACK(if applicable)
From To Material Emplacment Method
in feet in feet
20. DRILLING LOG
From To Description(color, hardness,soil/rock type,grain size,etc.)
0.00 20.00 Overburden/Clay
in feet in feet
20.00 795.00 Granite
in feet in feet
795.00 805.00 Granite
in feet in feet
21. Remarks
........... ............ ...............
22.Site diagram or additional well details:
You may upload additional well construction information here.
pdf only

CERTIFICATION INFORMATION
.......................................
* By signing this form, I hereby certify that the well(s)was(were)constructed in accordance with 15A NCAC 02C .0100 or
15A NCAC 02C.0200 Well Construction Standards and that a copy of this record has been provided to the well owner.
23.Certification
le 40
Signature of Certified Well Contractor