GW1--01936_Well Construction - GW1_20240325

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
Rick Crane 14.WATER ZONES- _ -- .. .. =i ; -
FROM TO DESCRIPTION
Well Contractor Name
ft. ft.
3073-A ft. ft.
NC Well Contractor Certification Number !`15.OUTER CASING(for multi-cased Wells)OR LINER(if up livable)
Crane Bros Well Drilling, Inc. FROM TO DIAMETER TIIICKNESS MATERIAL
0 ft. 44 it. 6.25 ! lit SDR-21 PVC
Company Name 16.INNER CASING OR TUBING(geothermal closed-loan)
2.well Construction Permit.#: 08 ��_t-n FROM I TO I DIAMETER THICKNESS MATERIAL -
List all applicable well construction permits(ie.UIG County.State,Variance.etc.) n• IL I in.
ii 3.Well Use(check well use): ft. fL in.
t Walter Supply Well: •17.SCREEN -- -
pp y FROM TO DIAMETER SLOT SIZE THICKNESS I MATERIAL
❑Agricultural ❑Municipal/Public it. it. . in.
UGeothermal(Heating/Cooling Supply) IJResidential Water Supply(single) R n ;n,
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT .`. . _ . -
I f-Ordgation r1Well'>100,000 GPD _FROM _ TO _-_-_-MATERIAL- - EMPLACEMENT METHOD&AMOUNT_
Non-Water Supply Well: 0 ft. 20 rt. benonite pumped
-- - `�-
°Monitoring ❑Recovery ft. ft.
Injection Well: ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation
I 19.SAND/GRAVEL PACK(if applicable) _
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
•°Aquifer Test DStormwater Drainage ft, ft
❑Experimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG(attach additionat'sheets if necessary).- -
FROM TO DESCRIPTION(color,hardness,soit/rock Inir,grain size,etc.)
❑Geothermal(Ileating/Cooling Return) ❑Other(explain under#21 Remarks) 0 ft' 44 ft. clay
4.Date weu(s)Completed: 02/29/2024 Well ID# 44 ft. 305 ft. granite
Sa.Well Location: ft ft.
Tucker Smith ft. ft.
Facility/Owner Name facility ID#(if applicable)--- - t. if. I:^^.7 -, r. R
340 Ruby Mine Road, Franklin, NC 28734 ft. ft. a s �,,e E.;,` it a: )
Physical Address,City,and Zip ft. it. MAR 2 ;; C(j2,
Macon 6598413770 21.REMARKS_- - -.
lfliG Pi, ii a 'ern..-
County Parcel Identification No.(PiN) -s.:'" "'?3 1%RIt
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one l nt/long is sufficient) 22.Ce •'nation:
35 1.6.137 Ai 22.552 �^
N w -sue - U� J 37i 3/2024
6.Is(are)the well(s): IJPermanent or ❑Temporary 5ignnt of Certified Well Contractor Date
By signing this form,I hereby cerli/)that the wells)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or ONo 1SA NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy
I(this is a repair,Jill oat known well construction information and explain the nature of the of this record has been provided to the well mane-*
repair under 1121 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-1 is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach additional pages if neee saiy.
drilled: 24.SUBMITTAL INSTRUCTIONS
305 1
9.Total well depth below land surface: (ft.) Submit this GW-1 within 30 days of well completion per the following:
For multiple wells list all depths if different(example-3Q200'and 2@)100)
10.Static water level below top of casing:4 V (ft.) 24a. For All Wells: Original form to Division of Water Resources (DWR),
If miter level is above a casing,use op 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 (in.)
Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: Rotary
24e.For Water Supply and Open-i oop 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
13b.Disinfection type: Amount:
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018-