GW1--01899_Well Construction - GW1_20240325

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information: l._- 7.. ~- '1 t"7,-,
Rick Crane � r �� 5 a:G:,F .-14.WATER ZONES i T - -
Well Contractor Name MAR 2 t` 2024 FROM ft. TO ft
• DESC I 770N
3073-A R� ^ ft. , ft.
NC Well Contractor Certification Number Dkiii0i.30G15.OUTER CASINO(for multi-cased wells)OR LINER if tip livable)
Crane Bros Well Drilling, Inc. FROM TO DIAMETER THICKNESS MATERIAL
0 rt. 44 It. 6.25 in' SDR-21 PVC
Company Name
16.INNER CASING OR TUBING(geothermal closed-loop) -
2.Well Construction Permit#: FROM TO I DIAMETER l THICKNESS MATERIAL - -
1County.S - n. rL in.
List all applicable well contraction permits(i.e.UIC, fate,I arianre,etc.)
3.Well Use(check well use): ft. ft. in.
Water Supply`Ala: 17.SCREEN
FROM TO DIAMETER. SLOT SIZE THICKNESS MATERIAL
❑Agricultural °Municipal/Public ft, ft, in.
UGeothernial(Heating/Cooling Supply) L°IResidential Water Supply(single) ft. fr. ;n•
❑industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT- _ . - - - - -
lTrrig ttion flVltells>100,000 GPi) _mom__ TO_ ___MATERIAL _ EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 ft. 20 benonite pumped__-�---�v-
❑Monitoring °Recovery ft. ft.
Injection Well: It. It.
°Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK{if applicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM M TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑StomiwaterDrainage ft. ft.
❑Experimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) °Tracer 20.-DRiLLiNG LOG(attach additional sheets if necessary) - -
_FROM
TO DESCRIPTION(color,hardness,sod/rock type,grain size,de.)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks)
Q fL 44 ft. clay
4.Date Well(s)Completed: 02/08/2024 Well ID# 44 ft. 505 tt• granite
ft. ft.
5a.Well Location:
Robert Bolton __ _ ft.
Facility/Owner Name Facility ID#(if applicable)
-___ ft. ft i
527 Brush Creek Road, Bryson City, NC ft. ft.
Physical Address,City,and Zip rt. ft.
Swain 21:_REMARKS . -
County Parcel identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimaldegrees: - -- - • -
(if well field,one 1st/long is sufficient)' 22. rtification:
35 19.224 N 83 29.879 W 2 ,--e ; J 3/13/2024
6.Is(are)the well(s): liPermanent or OTemporary Sign ture of Certified Well 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: DYes or ONo ISA NCAC 02C.0100 or ISA NCAC 02C.0200 Well Construction Standards and that a copy
If this is a roe-atr,fill out knoiei-i well construction information and erplain 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
in Remarks Box).You may also attach additional pages if
(add'See
construction,only 1(1W-1 is needed. Indicate TOTAL NUMBER of wells Ova? iieci5nuy.
drilled: 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 505 (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 a@ 100')
r60 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• i
11.Borehole diameter:6.25 (in) 24b.For Injection Wells:Copy,.to DWR,Underground Injection Control(TUC)
Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: Rotary
24e.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the
(i.e.auger,rotary,cable,direct push,etc.) ' county environments 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)5 Method of test:Air
Permit Program,1611 MSC,Raleigh,NC 27699-1611
13b.Disinfection type: Amount:
Form OW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018