GW1--06152_Well Construction - GW1_20230922

WELL-CONSTRUCTION RECORD(G d-1) I For internal Use Only:
I..Vel?C Imo.ontractor ormation; I
Rick Crane 14:WATER ZONES: -- - = . - -
Well Contractor Name FROM 70 DESCRIPTION I I
ft, ft, • I
3073-A
i to I ft. ` I I
NC Well.Contractor Certification Number '15:OUTER CASING(for inuRGcused wells)OR LINER(If lip livable) .
Crane Bros. Well Drilling, Inc. FROM TO DIAMETER THICKNESS MATERIAL
0 ft• 59 ft- 6.25 In- SDR-21 IPVC
Company Name
t 16.INNER:CASING OR TUHING-(centherm,nl clnscd:innp) -
9.EUe16.C"netr,tt.4t�n Permit�- 2� `- �� 1 FROM TO i DIAMETER I '1'RICKi,ESs I MATERIAL
Li.:l all applicable mill tanulraciion yermiis(La.EEC,Count, Slain,Variance;elc;) - ft. ft- in. I
-3.Well Use(check well use): ft, tt In.
- -- 17.SCREEN - ..
I Water Supply Well: FROM i TO DIAMETER SLOT SIZE TRICE:.NESS MATEP.LiL
.UAolieuiniral UA4iuucipal/Rthiie i ft 1 it In I,
❑Geothermal(Heating/Cooling Supply) liReccidential Water Supply(single) i ft, ft. in: 1 -
❑lndustrial/Commercial ❑Residential Water Supply(shared)
18.GROUT
❑Irrigation ❑Wells.>100,000GPD • FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non Wnter Supply Welt: 0 ft. 20 It• benonite punnped
❑Monitorne ❑Recovery ft. U.
Injection Well: ft. ft 'I I
❑Aquifer Recharge ❑Groundwatcr Remcdiation
19.SAND/GRAVEL PACK(if applicable)-
❑Aquifer Storage and Recovery ❑Salinity Burner FROM TO MATERIAL I EMPLACEMENT METHOD
❑Aquifer Test ❑StonnwaterDrainage ft. R. Ill
❑rxperilnentai'fechnology CI_Subsidence.Control ft. ft. I
❑Geothermal(Closed Loop) ['Tracer20:DRILLiNG-LOG(attae6;additional'sheets.if necessary) ' '- -- - '
❑Geothermal(Heating/Cooling Return) ❑Other(explain under/121 Remarks) FROM TO DESCRIPTION(color,loudness,roalrocYty„e Mtn d>x,etc.)
0 ft- 59 ft- clay I `
4.Date Well(s)Completed:07/27/2023 Well ID# - - 59 it• 380 ft- granite
"Sit Well Location: It. I ft.
Richard Dorsett `` " [ti ta a-" 'i f b
Facility/Owner Name Facility Mt/(if applicable) ft. ft.
147 Saldeer Mtn. Rd. Franklin, NC.28734 ft. ft. SEP 2 2 211Z3
Physical Address.City,and Zip. ft.. ft }rttpr,rtra;;nqm ;Or.,.—;3.,P g t n
Macon 6577371366 --21-REMARKS . D`Y ,�=- -
County Parcel Identification No.(PIN)
5b.Latitude and longitude in&:Free/minutes/seconds or deetma.dcgrem
Of well field.one lattlong-is sufficient) 22.• -[cation: 1
35 25.341 N 83 27:131 W 9/20/2023
6.Is(are)the well(s): CIPermanent or ❑Temporary Signal of Certified Well Contractor Date
•
Ilr.slllning this form,1 hereby rerfilsjr that the.,argil(:)war(Karr.:)ramrhr-i nd in arr ant:men with
7.is this a repair to an estatiuRwell: UVe: or tNo 15A NCAC 02C-.0/0Uor 15:1'NCaC.02C.0200 Well Constrv.^tion•)imALvr/,-laud that a copy
If this is a repaint!!!out known well construction information and explain the nature of the of this record has been provided to the well caner. I I
repalrunder#21 remarks section or on the back of this form. 23.Site diagram or additionulmvcli details:
R,For GeoprnbeJDYF or Closed-Loop Geothermal Wells having the came You may use the back of this page to provide additional well construction info
construction,only.1 G1V-1 is needed Indicate TOTAL NUMBER of walls (add'See Over'in Remarks Bo tj.You may also atachadditional pages if necessary.
drilled: 24.SUBMITTAL INSTRUCTIONS
9 Total well depth below land surface:380 (ft.) Submit this GW-1 within 30 days of well completion per the following:
For multiple wells list all depths((different(example-3@200'and 2(a)i00)
24a. For All Wells: Original form to Division,}of Water Resources (DWR),
Y(1,Static:sake level helots hip of easing:80 ((I) information Processing Unit,161 t Iv15G,Raleigh,NC 27699-1617
If wooer level is.cello e cmin..g..use i'r 1
6.25 2db.For injection Wells:Copy to DWR,Underground injection Control(lUC)
11:Borehole diameter: (In.) Program,.1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: Rota'7te
24c.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the
0,e.toyer,ratan•,cable,dir.et punt,,era,) county environmental health department of the county:inhere installed
FOR WATER SUPPLY WELLS ONLY: AA 24d.For Water Wells producing over MORNGPD:Copy-to DWR,-CCPCUA
13a.Yield .20 Method Dftesh Air Petmmf Program,1611-MSC,Raleigh,NC 27699-16111
13b.Disinfection type:Sterilene Amount:_
Form GW-i North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018:
1