GW1-2022-03910_Well Construction - GW1_20220412

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
KalebT. Hyde 14.WATER ZONES
FROM TO DESCRIPTION
Well Contractor Name 700 ft- $OS ft-
NC ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING for multi-cased wells OR LINER if a ticable
Graham Well Drilling LLC FROM TO DIAMETER THICKNESS MATERIAL
0 ft• 70 ft- 6.25 1n 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 c•onstruclion permits(i.e.U/C.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.
❑Geothenmal(Heating/Cooling Supply) Il Residential Water Supply(single) ft. ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) I&GROUT
❑irri atlon ❑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. bentonit6
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#21 Remarks) FROM TO DESCRIPTION(color,hardness,soiUrock a fain size,etc.)
ft. ft.
4.Date Well(s)Completed: 03/02/2022 well iD# ft. ft.
ft. ft.
5a.Well Location:
Ocona Homeowners Association ft. ft.
Facility/Owner Name Facility ID#(ifapplicable) ft. ft.
Ocona Estates, Bryson City, NC 28713 ft. ft. y y
Physical Address,City,and Zip ft. ft.
21.REMARKS
Swain
County Parcel Identification No.(PIN)
a e v.9_t HlYtd
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: ua°'. ,'' „". ; r ,rSEMNG IM
(if well field,one lat/long is sufficient) 22.Certification:
35 degrees 27' 9 ' N 83 degrees 22' 5" W 3/2/2022
6.Is(are)the well(s)• In Permanent or ❑Temporary Signature of Certified*eProntractor t Date
Rv signing this form,/hereby cer!iO that the ire//(s)was(here)consirucled in accordance with
7.Is this a repair to an existing well: ❑Yes or ONo i5A NCAC:02C.0100 or/SA NCAC 02C 0200 We//Conslruclion Standards and that a copy
/f'ons is a repair,Jill out known well construction information and explain the nature of the o/this record has been provided to the hell owner.
repair under s2/remarks section or on the back of this farm.
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-i is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach additional pages if necessary.
drilled: 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 805 (ft.)
For mulliple wells fist all depths tfdiifPrent(example-3@a 200'and 2 a/00') Submit this GW-1 within 30 days of well completion per the following:
24a. For All Wells: Original form to Division of Water Resources (DWR),
10.Static water level below top of casing: 700 (ft•) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
If water level is above casing,use
6.25 24b. For Infection Wells:Copy to;DWR,Underground injection Control(IUC)
11.Borehole diameter: (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
i
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPD:Copy to DWR,CCPCUA
13a.Yield(gpm) '25 Method of test: air
Permit Program,1611 MSC,Raleigh;NC 27699-161 1
13b.Disinfection type: HTH Amount: 6 oZ I
Form GW-i North Carolina Department of Environmental Quality-Division of Water Resources ! Revised 6-6-2018