GW1--07354_Well Construction - GW1_20231113

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WELL CONSTRUCTION RECORD(GW-1) For Internal Usb Only:
1.Well Contractor Information:
Robin Webb `44..WATERZONES
Well Contractor Name FROM TO DESCRIPTION •
2418 0 ft. 305 ft. .caw„
305 ft. 345 ft•• ss spm I I
NC Well Contractor Certification Number
,'35:OUTER CASING(for-Multi-cased wells)OR LINER(if ap licable)
Greene Brothers Well &Pump, WT Inc. FROM TO DIAMETER THICKNESS MATERIAL
Company Name 0 ft. 108 ft 61/4 in. Steel
J C H_023W .T 16.INNER CASING ORUBING.(geothermal closed-loop) " - '
2.Well Construction Permit#: Ll G 11 V FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(Le.UIC,County,State,Variance,etc.) ft. ft. i in.
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3.Well Use(check well use): ft. ft. �, • in.
Water Supply Well:
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
*Agricultural . °Municipal/Public ft. ft. in.t
'*Geothermal(Heating/Cooling Supply) 1X Residential Water Supply(single) ft ft. hi.
MI Industrial/Commercial °Residential Water Supply(shared) •
n1Irrigation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: o ft- 20 .ft• Bentonite
MI Monitoring ORecovery ft ft.'
Injection Well: ft. ft.
all Aquifer Recharge °Groundwater Remediation 19.SAND/GRAVEL PACK(if applicable)
*Aquifer Storage and Recovery L°Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
®I Aquifer Test I°' StormwaterDrainage ft. ft. - j.
*Experimental Technology °Subsidence Control ft. ft. I i
Al I 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)
0 ft- 106 ft. Clay I' 1
4.Date Well(s)Completed: 09/22/23 Well ID# 108 ft 365 ft' Granite
5a.Well Location: ft. ft.
•.
Robert Lizzolft ft.
= •,_ -
_I, n es ft:',..-- �,,,r
Facility/Owner Name Facility ID# ft. ft.(if applicable) `
211 Davey Crockett Dr. Maggie Valley 28751 I V ft. ft. 2023
Physical Address,City,and Zip ft ft. 0-i f c m .;.^1 ),--. ,,,_..
Haywood 7676-63-2594 21.REMARKS:: >..,- ,<,.' -'a,a.
County Parcel Identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: ' r
(if well field,one lat/long is sufficient) 22.Ce . .lion:
35.503 N -83.113 w ; h /�
q 1 (,. 09/22/23
6.Is(are)the�well(s)JPermanent or Temporary Signatu ofC d�$ed Vie ontractor Date
OTemporary
signing this form,I hereby ceN.&that the well(s)was(were)constructed in accordance
7.Is this a repair to an existing well: °Yes or DINo with I5A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a
If this is a repair,fill out known well construction information and explain the nature of the copy of this record has been provided to the well owner.
repair under#21 remarks.section or on the back of this form.
r 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 site details or well
construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if necessary.
drilled:r SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 365 (ft-) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths if different(example-3@200'and 2@I00) construction to the following:
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10.Static water level below top of casing: 120 (ft.) Division of Water Resources,Information Processing Unit,
If water level is above casing,use"+" . 1617 Mail Service Center,Raleigh,NC 27699-1617
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11.Borehole diameter: 6 1/4 (in.) 24b.For Injection Wells: In addition to sending the form to the address in 24a
Rotary • above,also submit one copy of this form within 30 days of completion of well
12.Well construction method: - - - - - construction to the following:
(i.e.auger,rotary,cable,direct push,etc.) ,
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
13a.Yield(gpm) 10 Method of test: 2 hours 24c.For Water Supply&Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b.Disinfection type: HTH Amount: 67 tabs completion of well construction to the county health department of the county
where constructed. i
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources ' Revised 2-22-2016
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