GW1--01935_Well Construction - GW1_20240325

WELL CONSTRUCTION RECORD GW-1) I For Internal Use Only: •
1.Well Contractor Information: It '
Rick Crane 14.WATER ZONES l t
Well Contractor Name FROM TO DESCRIPTION
ft. 1
3073-A ft.
ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING(fur multi-eased wells)OR LINER(if up licable)
Crane Bros Well Drilling, Inc. FROM TO DIAMETER THCKNESS MATERIAL
0 ft. 77 ft. 6.25 ' in, SDR-21 PVC
Company Name `16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#. 0212624-1 FROM _To DIAMETER THICKNESS I MATERIAL
List all applicable well construction permits(i.e.UIC.County.State,Variance,etc.) rt. IL in.
3.Well Use(check well use): ft. ft. in.
Water Supply'Well: 17.SCREEN - -
1111 S FROM TO DIAMETER SLOT SIZE THICKNESS I MATERIAL
❑Agricultural ❑Municipal;Public ft, ft, in.
UGeothennal(Heating/Cooling Supply) L°IResidential Water Supply(single) R, ft. in,
❑lndustrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
fllnigation flWells>100,000 GPT) FROM TO I MATERIAL EMPLACEMENT METHOD 8:AMOUNT
Non-Water Supply Well: 0 _ ft. 77 ~ft henonite pumped---_ -_ ---
❑Mestitoriug ❑Recovery ft. ft.
Injection Well:
ft. ft.
I❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GPAYEL PACK(Ff applicable)
❑Ayuifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
DAgitifer Test UStcuxnwater Drainage ft. ft.
DExperimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG(attach additional sheets if necessary)
FROM TO DESCRIPTION(rotor,hardness,soil/rock type,grain sin,ere.)
['Geothermal(Heating/Cooling Return) ['Other(explain under#21 Remarks)
0 to 77 ft. clay
t 4.Date Well(s)Completed: 03/07/2024 Weil ID# 77 ft. 680 It. granite
5a.Well Location: ft. ft.
Elizabeth Lequire It. ft. ^
It : ;•
Facility/Owner ner Naar Facility 1Dn(if applicable) - ft' u 'E C,.,r'is z kra 6"'� '
33 Soper Road Franklin, NC 28734 ft. ft.
ft. ft. ��� �G2 ^ '
PhysicalpA Address,City,and Zip
Macon 6595708365 21.REMARKS _ trl Gi-m .;^:i '),._... ,.L.
t-� . �:
County Parcel Identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if welt field,one Int/long is sufficient) 22.Ce 'cation: '
35. 11.019 N 83 21.559 w 3/0 3/2024
6.Is(are)the well(s): inPermanent or ❑Temporary Signatu a 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 itNo 15A NCAC 02C.0100 or I5A NCAC 02C.0200 Well Construction Standards and that a copy
Ii tds is a repair,fill oat known :,ell eoastr uctlon information and explain the nature(Oise. of this record has been provided to the well owner-
repair under il2l remark 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'_GCE'-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: 680 (ft.)
For multiple wells list all depths if d fferent(example-3@200'and 2(a)100) Submit this GW-1 within 30 days of well completion per the following:
24a. For All Wells: Original form to Division of Water Resources (DWR),
10.Static water level below top of casing: • (fL) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
Il'Water level is above casing.use"+" i '
24b.For Injection Wells:Copy to DWR,Underground Injection Control(1UC)
11.Borehole diameter 6.25 (in.)
Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: Rotary
24c,For Water Supply and ripen-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
13a.Yield(gpm) 20 Method of test:Air
Permit Program,1611 MSC,Raleigh,NC 27699-1611
113b.Disinfection type: Amount:
Form G W-1 North Carolina Department of Environmental Quality-Division of Water Resources. Revised 6-6-2018