GW1--01898_Well Construction - GW1_20240325

WELL CONSTRUCTION RECORD(GW-i For Internal Use Only: '
1.Well Contractor Information:
Rick Crane I4.,WATERZONES -- I ' - - - -
Well Contractor Name FROM TO DESCRIPTION
f4 ft.
3073-A ft. f<.
NC Well Contractor Certification Number 15.OUTER CASING(fur multi-cased wells)OR LINER(if an ticable)
Crane Bros Well Drilling, Inc. FROM TO DIAMETER THICKNESS MATERIAL
Company Name 0 ft. 77 iL 6.25 in' SDR-21 PVC
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.VIC,County,State,Variance,etc.) n. rt. M.
3.Well Use(check well use): ft. fa in.
Wilt-Cr Supply Well: 17.SCREEN . - - - . _ -
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Muricipal/Public it, ft. in.
UGeothermal(Heating/Cooling Supply) tJResidential Water Supply(single) R. R. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18:GROUT -. . -_ -
fllrrigation flWells?100,000 GPO FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 — ft' 20 It benonite pumped 1
❑Monitoring ❑Recovery ft. ft.
Injection Well:
ft. H.
DAquifer Recharge ❑Groundwater Remediation -19.SAND/GRAVEL PACK(If applicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO O MATERIAL EMPLACEMENT METHOD
DAquiifer Test ❑Stormwater Drainage • ft. ft.
❑Experimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) 0Tracer 20.DRILLING LOG(attach additional sheets if necessary)- -
OGeothermal Meeting/Cooling Return) ❑Other(explain under#21 Remarks) FROM TO DESCRIPTION tester,hardness,aoi0roc type,grain size,etc.)
0 ft. 77 ft. day
4.Date Well(s) 02/27/2024 Completed: Well no 77 t1' 405 ft- granite .---. n. ,;,�
ft. ft. ve h..,<L r L.)L.)v.,
5a.Well Location: _
Ray Stevens/Heather Stillwell f ft MAR 2 �� 2024
Facility./Owner Name J^ Facility ID#(if applicable) ft. ft
75 Sweet Apple Cove Rd. Bryson City NC ft. ft. Infs.; l: :'n,. ...-,mf. Lir1N
Physical Address,City,and Zip ft. ft.
Swain ,21.REMARKS - -
County Parcel Identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: ,
(if well field,one lot/long is sufficient) 22.Certification: '
35 25.207 33 21.747 I .
N �3' .,e . �°/ � ' 3!7 3/2024
6.Is(are)the well(s): l lPermanent or ❑Temporary Sigoo ore of Certified Well Contractor Date
By signing this form,I hereby certiry that the well(s)was(were)constnacted in accordance with
7.Is this a repair to an existing well: ❑Yes or lNo 15A NCAC 02C.0100 or 151 NCAC 02C.0200 Well Construction Standards and that a copy
Olds is a repair,fill out knots.t welLea structiondr formation and explain the nature of the ^i this record has been provided to the well otatter•
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 Oven in Remarks Box).You may also attach additional pages if necessary.
drilled:- - - - 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface:405 (ft) Submit this GW-1 within 30 days of well completion per the following:
For multiple wells list all depths if different(example-36200'and 2@100)
10.Static water level below top of casing: �� (ft') 24a. For All Wells: Original form to Division of Water Resources (DWR),
If water l vel is abase be,use"+" Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
24b.For Injection Wells:Copy to DWR,Underground Injection Control(IUC)
11.Borehole diameter 6.25 (ill.)
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
(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
Permit Program,1611 MSC,Raleigh,NC 27699-1611
13a.Yield(gpm) 12 Method of test:Air
13b.Disinfection type: Amount:
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources, Revised 6-6-201S