GW1-2023-00977_Well Construction - GW1_20230118

WELL CONSTRUCTION RECORD(CM-1) For internal Use Only:
1.Well Contractor Information:
Rick Crane 14.WATER ZONES.
Well Contractor Name FROM TO DESCRIPTION
ft. ft.
Crane Bros.Well Drilling
ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING for multi-cased wells OR LINER if a llcsble -
3073-A FROM TO DIAMETER THICKNESS MATERIAL
Company Name 0 it- 144 fl- 16.25 1n SDR-21 JPVC
2022-23517-9-12190 16.INNER CASING OR TUBING eothermal closed-loo .
2.Well Construction Permit#: FROM TO I DIAMETER I THICKNESS I MATERIAL
List all applicable tivell consauction permits(i.e.UIC,County,State,Variance,etc.) It. ft. I in.
3.Well Use(check well use): ft. ft I in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑MunicipaMblic ft. It. in.
❑Geothermal(Heating/Cooling Supply) 19Residential Water Supply(single) ft. fL in.
❑1ndustrial/Commercial ❑Residential Water Supply(shared) 18:GROUT.
Ofixigation ❑Wells>100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 rt 20 fL Benonite Pumped
❑Monitoring ❑Recovery ft. ft.
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. It.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets If necessary)
❑Geothermal(HeatingrCooling Return) ❑Other(explain under#21 Remarks)J
FROM TO DESCRIPTION mlor,hardness,sultrock type,grain size eta
0 ft. 44 ft. clay
4.Date We0(s)Completed: 10-14-22 Well ID# 44 rt• 305 rt• granite -- �a
5a.Well Location: i L-
John Sullivan ft. ft.
Facility/Owner Name Facility ID#(if applicable) ft. ft.
125 Stone Cliffs Ln ft. ft. II'160matiarl Pray zeWrg M
Physical Address,City,and Zip ft. fr.
Cashiers NC 7564-49-8219 21.REMARKS
County�Q c ly �u/` PmcelldentificationNo.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22.C 'tification:
N w 1/12/2023
6.Is(are)the well(s): InPermanent or ❑Temporary Signattlre of Certified Well Contractor Date
By signing this form,I hereby certify that the rrell(s)it=(were)constructed in accordance ivith
7.Is this a repair to an existing well: ❑Yes or ItNo 15A NCAC 01C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy
If this is a repair,Jill out A-milm tvell construction information and explain the nature of die of this record has been provided to the ivell owner.
repair tinder#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 GNV-1 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:305 (R') Submit this GW-1 within 30 days of well completion per the following:
For multiple veils list all depths ifdifferenr(example-3@200'and 2@100')
10.Static water level below top of casing:20 (ft) 24a. For All Wells: Original form to Division of Water Resources (DWR),
Iftmter level is above casing,rise"+" Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter:6.25 (in,) 24b.For Injection Wells:Copy to DWR,Underground Injection Control(IUC)
12.Well construction method: Rota') Program,1636 MSC,Raleigh,NC 27699-1636
24c.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the
(i.e.auger,rotary,cable,direct pusb,etc.) county environments eat department o the county where installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPD:Copy to DWR,CCPCUA
13a.Yield(gum) Method of test: I r
20 - Permit Program,1611 MSC,Raleigh,NC 27699-1611
13b.Disinfection type: Sterllene Amount:
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6.6-2018