GW1--01941_Well Construction - GW1_20240325

i
WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
1.Well Contractor Information:
Rick Crane 14.WATERZONES ' S • • -
FROM TO DESCRIPTION
Well Contractor Name ft. ft.
3073-A
ft. ft.
l
NC Well Contractor Certification Number "15..O11TER CASING(fur multi-cus.d'wells)OR LINER(if aF livable) i
Crane Bros Well Drilling, Inc. FROM TO DIAMETER THICKNESS MATERIAL
0 ft• 157 ft• 6.25 in. SDR-21 PVC
Company Name
ry9, 523-p 16.I ilEP.CASINGORTUEING,(geothermalclosed-loop)
2.Well Constr ncflon Permit ii: �J`J FROM TO DIAMETER I THICKNESS I-MATERIAL
List all applicable well construction permits(i.e.VIC.Count:State,Variance,etc.) H. II. in. }
3.Well Use(check well use): ft it. in.
Water Supply Al•'\WI1: 17.SCREEN • {I
- FROM TO DIAMETER SLOT SIZE I THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public A. ft. in.
UGeothermal(Heating/Cooling Supply) IJResidential Wager Supply(single) fL n, in.
❑lndustrial/Commercial ❑Residential Water Supply(shared) 18.GROUT - . . - _ -
flirrigattion flWells>1(.]0,000 GPI) FROM TO_ __MATERIAL_ _ EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 - ft. 20 20� •ft. benonite_ pumped -._ _A._.M i
❑Monitoring ❑Recoveiy ft. ft.
Injection Well: ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK(If applicable)
❑Aquifer Storage and Recovery OSalinity Barrier FROM ' TO MATERIAL EMPLACEMENT METHOD
UAatiifer Test ❑Stormwater Drainage ft. ft.
❑Experimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRiLLiNG.LOG"(attach additional sheets if necessary) - ' -
FROM TO DESCRIPTION(cola:.hardness.soOrark hl,r,grain sip,etc.) (
❑Geothermal(Heating/Cooling Return) DOther(explain under#21 Remarks) 0 ft. 157 ft. 'play
4.Date Well(s)Completed: 12/22/2023 Well m# 157 ft. 855 ft. granite
ft. ft.
5a.Well Location: '
Berg-Homes LLC fL. ft. _ r °,g °�
,-,k.,.,• i
Facility/OwnerName� - Facility lD#(if applicable) ft. ft. MAR M 2 ` (�zl�
Endoda Road, Franklin, NC 28734 ft. ft. AR
Physical Address,City,and Zip D. It lni'C:;743.izm r",^5„4:?.:74z 1 1,,k.
Macon 6563050444 21.REMARKS.. - - ' • G:e 1Y 0{3 ' .
County Parcel Identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal'degrees:
(if well field,one gat/long is sufficient) 22 ertification•
35 08.375 N 83 29.041 :r i 3/13/2024
, i' , -
. 6..Is(are)the well(s): t lPermanent or .❑Temporary Si afore 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: ❑Yes or InJNo 15,4 NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy
Ij thts is a repair,,fill oat krtu:wt well eon:vincttu»ittfor lotion and wtplaiu the nature citje of this record has been provided to the well answer.
repair under#21 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 1 GW-1 is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach additional pages ifnecematy.
drilled: • 24.SUBMITTAL INSTRUCTIONS
9.Totai well depth below land surface: 855 (ft.) Submit this GW-1 within 30 days of well completion per the following:
For multiple wells list all depths if different(example-3®200'and 2na 100)
10.5tatic level lop of casing: 10n at) 24a. For All Wells: Original form to Division of Water Resources (DWR),
10.wateraticel water above casing,below op" Information Processing Unit,161,7 MSC,Raleigh,NC'27699-1617
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 construction method: 7 24e.For Water Simply 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
13a.Yield(gpm) 20 Method of test:Air
Permit Program,1611 MSC,Raleigh,NC 27699-1611
13b.Disinfection type:'Sterilene Amount:
Form G W-I North Carolina Department of Environmental Quality-Division of Water Resources' Revised 6-6-2018