GW1--05857_Well Construction - GW1_20230912

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only: I,
1.Well Contractor Information: 1
Kaleb T. Hyde 14.WATER ZONES. . I
FROM TO DESCRIPTION
Well Contractor Name -
45 ft• 305 ft• I
4436-A ft. ft. 1 '
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells)OR LINER(if ap livable)
Graham Well Drilling LLC FROM TO DIAMETER I THICKNESS MATERIAL
0 ft. 59 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.U/C,County,Stale,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) nResidential Water Supply(single) ft. ft. in. ,
❑industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT _ i.
❑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 OSubsidence Control ft. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG(attach additional sheets if necessary)
❑ FROM TO DESCRIPTION(color,hardness,soil/rock type,grain size,etc.)
Geothermal(Heating/Cooling Return) DOther(explain under#21 Remarks)
ft. ft.
4.Date Well(s)Completed: 08/18/2023 Well ID# ft. ft.
ft. ft. 1
5a.Well Location:
M.Wiggins Builders/Sampson Job ft. ft.
ft. ft. � ,I`' t w i S $ r
Facility/Owner Name Facility IDI/(if applicable) C'�+.r: V E[I
SEP 1 2
Fontana Lake Estates/Alarka Point, Bryson City, NC 28713 ft. ft. q
Physical Address,City,and Zip ft. ft ZQLJ
Swain 21.REMARKS it in*.-.ra.A,:,,^A Prr.,:w,•`Y:,.g(r'r:
County Parcel Identification No.(PIN) lNv1 +
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: .
(if well field,one lat/long is sufficient) 22.Certification: '
35 degrees 23' 36" N 83 degrees 33' 15" N !i_ /I� / i' 8/18/2023
6.Is(are)the well(s): CIPermanent or ❑Temporary Signature of Certifi ell Contractor Date
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By signing thisJbrm,I hereby certify that)he,well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or ONo 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 nrel/owner
repair under it21 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 I GW-i 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: 305 (ft.) Submit this GW-1 within 30 days of well completion per the following:
For multiple wells list all depths tfdii jerent(example-3@200'and 2@I00)
24a. For All Wells: Original form to Division of Water Resources (DWR),
10.Static water level below top of casing: 45 (ft) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
If water 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 37699-1636
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 producingtover 100,000 GPD:Copy to DWR,CCPCUA
Permit Program,1611 MSC,Raleigh,iNC 27699-1 6 1 1
13a.Yield(gpm) 40 Method of test: air i
13b.Disinfection type: HTH Amount: 12 oz I
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Form GW-i North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018