GW1--01897_Well Construction - GW1_20240325

WELL CONSTRUCTION RECORD(GW-1j For Internal Use Only:
L Well Contractor Information:
Rick Crane •14.WATER ZONES_. : -
FROM TO DESCRIPTION I
Well Contractor Name ft. ft.
3073-A ft ft
(
NC Well Contractor Certification Number '15.OUTER CASING(for multi-cased welts)OR LINER.(if ap^ticuble)-
Crane Bros Well Drilling, Inc. FROM TO DIAMETER TIHCKNESS MATERIAL
Company Name 0 R• 26 IL 6.25; in. SDR-21 PVC
16.INNER CASING OR TUBING(geothermal closed4o0p) - -
2.Well Construction Permit#: FROM I TO DIAMETER THICKNESS MATERIAL
List all applicable well construction p_r„tits(i.e.LUC,County.State,Variance,etc.) n. It. in.
3.Well Use(check well use): ft. ft in.
Water Supply Well: 17.'SCREEN -- -• _
pp FROM TO I DIAMETER SLOT SIZE -THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public ri, ft, in.
1
UGeothermal(Heating/Cooling Supply) itResidential Water Supply(single) ft. ft in.
❑Industrial/Commercial ❑Residential Water Supply(shared) •18:GROUT -, ` -
flirrigatian flWells>100,000 OPT) _FROM___..TO____MATERIAL_MATERIAL_u_ EMPLACE A OI EMPLACEMENT METHOD ANNT
Non-Water Supply Well: 0 ft' 20 ft benonite pumped - --
OMonitoring ❑Recovery ft. ft.
Injection Well:
IL ft
❑Aquifer Recharge ❑Groundwater Remediation
-19.SAND/GRAVEL PACK(If applicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO I MATERIAL EMPLACEMENT METHOD
-Aquifer Test DStorinwaterDrainagge ft. ft.
❑Experimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) ❑Tracer -20.DRILLING LOG(attach additional sheets if necessary) - -- . -
❑Geothermal(Heating/Cooling Return) DOther(explain under#21-Remarks) FROM TO DESCRIPTION(color,hardness,soli/rocktype,grain size,etc,)
0 fa 26 ft. I clay
4.Date Wells)Completed: 2/22/2024 Well ID# 24 ft. 860 ft• granite
5n.Well Location: ft ft.
Warren Miles Morrow ft. ft. '
Facility/Owner Name� A� -� Facility ID# if applicable) ft. ft . `t g„L e tc 7 �l ,•
y t)' ( pp ) wY 7�i
Bryson City, NC ft. ft. AanR 2 E 2024
Physical Address,City,and Zip ft ft t
Swain 21.REMARKS . - . ' ., If iirF Z n?!+-;:^.:Fva;•_,t n,N.
C.M(0130(4,
County Parcel Identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one 1nt/long is sufficient) 22. cation:
N W 3/13/2024
6.Is(are)the well(s): l lPermanent or ❑Temporary Signar of Certified Well Contractor Date
By signing this farm,I hereby certify that the well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or INo 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy
I%this is a repair,fill eat blUitit well construction it forrnatiau and exidaeri the nature oldie of this record has been provided to the well ouster.
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 OW-I 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: 860 (ft.) Submit this GW-1 within 30 days of well completion per the following:
For multiple wells llst all depths ifdifferent(example-3@200'and 2@100')
24a. For All Wells: Original form to Division of Water Resources (DWR),
e
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:Cop !to DWR,Underground Injection Control(TUC)
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 Wens:Copy to the
(i.e.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
13a.Yield(gpm)30 Method of test:Air
Permit Program,1611 MSC,Raleigh,NC 27699-1611
13b.Disinfection type: Amount:
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources. Revised.6-6-2018.