GW1--07325_Well Construction - GW1_20231113

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
f
Kaleb T. Hyde 14.WATER ZONES i -
Well Contractor Name FROM TO DESCRIPTION
90 ft. 355 ft.
4436-A
ft. ft.
I
NC Well Contractor Certification Number 15.OUTER CASING(for multi-casedwells)OR LINER(if ap licable)
Graham Well Drilling LLC FROM TO DIAMETER THICKNESS MATERIAL
0 ft. 94 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.(I1C,County,State,Variance,etc.) 0 ft. ft. ! in.
3.Well Use(check well use): ft. ft. in.
Water Supply Well: 17.SCREEN
FROM TO _ DIAMETER, SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public ft. ft. in.I
❑Geothermal(Heating/Cooling Supply) OResidential Water Supply(single) ft. ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑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 ❑Subsidence Control ft. ft.
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❑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) ['Other(explain under#21 Remarks) ft. tt.
4.Date Well(s)Completed: 10/31/2023 Well ID# ft. ft.
• ft. ft.
5a.Well Location:
'F6ntana Lake Builders/Steven Skahill Job ' ft. ft.
Facility/OwnerName•••,i : ' ' FacilityIDii(if applicable) ., ,^�.t._3 k. ...is u.r✓ i'
. ,._.
Fontana Lake Estates,Lakeside Point, Bryson City, NC 28713 fr. ft. i NOV
,
Physical Address,City,'and Zip' . ' • ft.' " ' ' ' ft. ' ••- • ' .. 'N O V 1 .S 2023
Swain .21.REMARKS. .. _ . .
11:, ... ...:t . . .. .--� t�,,.1
County Parcel Identification No.(PIN) t',•:`:i' •'i>
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22.Certification:
35 degrees 23'43" N 83 degrees 34' 18" w 7t^et0a.6 Yy 10/31/2023
6.Is(are)the well(s): nPermanent or ❑Temporary Signature of Certified W/Contractor Date
By signing this form,I hereby certify that the 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 due of this record has been provided to the well owner.
repair under tt2I 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 GW-1 is needed. Indicate TOTAL NUMBER of wells (add'See Over'.in Remarks Box).You may also attach additional pages if necessary.
drilled: 1 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 355 (ft.) Submit this GW-1 within 30 days of well completion per the following:
For multiple wells list all depths if different(example-3(a 200'and 2@/00) 1
90 24a. For All Wells: Original form to Division of Water Resources (DWR),
10.Static water level below top of casing: • (ft') Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
If water level is above casing,use"+" 1
6.25- 24b.For Injection Wells:Copy to IWR,Underground Injection Control(IUC)
11.Borehole diameter: (in.) Program, 1636 MSC,Raleigh,NC 27699-1636
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12.Well construction'method: rotary24c.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
6 .' Method of test: air
Permit Program,1611 MSC,Raleigh,NC 27699-1611
13a.'Yield(gpm)
13b.Disinfection type: HTH Amount: 12 oz ' I _ .
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018