GW1--00323_Well Construction - GW1_20240112

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only: {
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1.Well Contractor Information:
Rick Crane 14.WATER ZONES t : -
Well Contractor Name FROM TO DESCRIPTION
ft. ft. 1
3073-A ft. ft. 1
NC Well Contractor Certification Number 15.OUTER-CASING(for Multi-cased wells)OR LINER(i ap'licable) -
Crane Bros. Well Drilling, Inc. FROM TO ' DIAMETER THICKNESS MATERIAL
Company Name 0 ft. 50 it. 6.25 ; in SDR-21 PVC
2019-15932-9-1 2065 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.UIC,County,State,Variance,etc.) ft. It I in.
3.Well Use(check well use): ft. ft. in.
Water Supply Well: 17.FROM SCREENTO „ DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public ft. ft. in.
❑Geothermal(Heating/Cooling Supply) I!1Residential 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. 20 ft. 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. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG(attach additional'sheets if necessary): -
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness solUrock type,pule size,etc.)
0 ft. 50 It. Clay
4.Date Well(s)Completed: 12/08/2023 Well ID# 50 ft. 555 ft. granite
5a.Well Location: ft. ft. ,u_r, ss-.,
Garnet Ridge Properties ft. ft. ',...,Li VCi
Facility/Owner Name Facility ID#(if applicable) ft. ft. JAN 1 ?024
Pumpkintown Road Sylva NC 28779 ft. ft.
ft. ft. :lu ..
li if..,,r�c xi::it P!cn.x.s,3 GM
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Physical Address,City,and Zip D ;'(iur ul
Jackson 7527-65-1271 .21.REMARKS' - -- -
County Parcel Identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22.A;tuition:35 15.520 N 83 15.601 w � 1/3/2024
6.Is(are)the well(s): liPermanent or OTemporary Sign: ;i of Certified Well Contractor Date
By signing this form,Thereby certify that the well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or eiNo ISA 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 well owner.
repair under#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 GW-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: 555 (ft) Submit this GW-1 within 30 days of well completion per the following:
For multiple wells list all depths if different(example-3@200'and 2@100')
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"+"
24b.For Injection Wells: Copy to DWR,Underground Injection Control(IUC)
11.Borehole diameter: 6.25 (in.)
Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: Rotary 24c.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the
(Le.auger,rotary,cable,direct push,etc.) county environmental health department of the county where installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPD:Copy to DWR,CCPCUA
Permit Program,1611 MSC,Raleigh,NC 27699-1611
13a.Yield(gpm) 30 ' Method of test:Air
13b.Disinfection type: Sterilene Amount:
Form OW-1 North Carolina Department of Environmental Quality-Division of Water Resource? Revised 6-6-2018