GW1-2022-08215_Well Construction - GW1_20220505

WELL CONSTRUCTION RECORD(CW-1) For Internal Use Only:
1.Well Contractor Information:
Kaleb T. Hyde 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
500 ft- 805 ft.
4436-A ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING for multi-cased wells OR LINER if a Iicable
Graham Well Drilling LLC FROM TO DIAMETER THICKNESS MATERIAL
0 ft- 50 n- 6.25 in SDR21 PVC
Company Name 16.INNER CASING OR TUBING eothermal closed-loo
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction pernui.v(i.e.(l/(.',Coumj,Slate, Variance,etc.) 0 ft. fL in.
3.Well Use(check well use): ft. ft. in.
17.SCREEN
Water Supply Well:
FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public ft. ft. in.
❑Geothermal(Heating/Cooling Supply) CJResidential Water Supply(single) ft. ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT i
❑Irri atlon ❑Wells> 100,000 GPD FROM I TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 ft• 17 ft- bentonite
❑Monitoring ❑Recovery 17 ft- 20 fir- bentonite
Injection Well:
ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK if a licablc
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL. I EMPLACEMENT METHOD
❑Aquifer Test ❑StormwaterDrainage 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 ft. To ft. DESCRIPTION(color,hardness,soiVrack type,grain sire,etc.)
4.Date Well(s)Completed: 04/7/2022 well ID# ft. ft.
5a.Well Location: ft. ft.
Smoky Mountain Cabin Builders
ft. ft.
Facility/Owner Name Facility ID#(if applicable)
ft. ft.
Alarka Highlands, Equestrian Drive, Bryson City, NC 28713 ft. ft.
Physical Address,City,and Zip ft. ft. - `j
Swain 21.REMARKS �1
County Parcel Identification No.(PIN) -?
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one]at/long is sufficient) 22.Certification:
35 degrees 21' 59" N 83 degrees 22' 46" W :t� ;.+ ' il
7`//2022
6.Is(are)the well(s): [lPermanent or ❑Temporary Signature of Certified We ontractor Date
By signing This firm,l hereby certify that ih�e we//(+)way(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or MNo 15A NCAC 02C.0100 or 15A NCAC 02C!0200 Well Consiruction Standards and that a copy
if this is a repair,fill out known well construction iglbrtnation and explain the nature of the of this record has been provided to the well owner.
repair under t`21 remarks.section or on the back o,f 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: 805 (ft.) Submit this GW-1 within 30 days of well completion per the following:
For multiple welly list all depths ifdifjereni(example-3@200'and 2@100')
10. 500 24a. For All Wells: Original form to Division of Water Resources (DWR),
Static water level below top of casing: (f<) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
1/fbaler 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-hoop 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, 1611 MSC,Raleigh;NC 27699-1 61 1
13b.Disinfection type: HTH Amount: 150Z
i
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018