GW1--02486_Well Construction - GW1_20240423

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
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1.Well Contractor Information: i
Kaleb T. Hyde 14.WATER ZONES I
Well Contractor Name FROM TO DESCRIPTION
75 ft. 355 ft. I
4436-A ft. ft. I •
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells)OR LINER(if ap licable)
Graham Well Drilling LLC FROM TO DIAMETER ' THICKNESS MATERIAL
0 ft. 118 ft• 6.25 in. SDR21 PVC
Company Name 16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#: FROM TO DIAMETRIC , THICKNESS MATERIAL -
List all applicable well construction permits(i.e.UIC,Comity,State,Variance,etc.) 0 ft. ft. I hi.
3.Well Use(check well use): ft. ft. irt.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public ft. ft. in.
❑Geothermal(Heating/Cooling Supply) OResidential Water Supply(single) ft. ft. in. '
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT 11
❑irrigation ❑Wells>100,000 GPD FROM TO MATERIAL . EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 ft' 17 ft' bentonite
❑Monitoring Recovery -1.7 .-ft• -20 - ft• bentonite
Injection Well:
ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK(if applicable)
❑Aquifer Storage and Recovery -❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage ft. ft.
❑Experimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG(attach additional sheets if necessary)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness,soilhrocktype grain size,etc.)
ft. ft.
4.Date Well(s)Completed: 03/26/2024 Well ID# ft. ft.
5a.Well Location: ft. ft.
Casey Davis :,.
Facility/Owner Name Facility ID#(if applicable) ft. ft. APR 2 I. 7.024
Josh Ledford Rd, Bryson City, NC 28713 B. ft.
Physical Address,City,and Zip ft. ft. i. c 1frJ.- To. •P-:,�...14:,7 3 .S r"
1`�
Swain 21.REMARKS . 1 . R:`i;Ca 2, iv
County Parcel Identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: '
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(if well field,one latllong is sufficient) 22.Certification:
35 degrees 24' 3" N 83 degrees 31' 28" W /<ale 1/. 3/26/2024
6.Is(are)the well(s): l lPermanent or ❑Temporary Signature of Certified W of ontractor i Date
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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 ONo 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy
If this is a repair,fill out known well construction information and explain the nature of the of this record has been provided to the well owner. -
repair under 1121 remarks section or on the back of this jbrm. -
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 I GW-1 is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach additional pages if necessary.
drilled: t 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 355 (ft.) Submit this GW-1 within 30 days of well completion per the following:
For multiple wells list all depths ifd�erent(example-3 ,200'and 2@100') 1,
75 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"+"
6.25 24b.For Injection Wells:Copy toi DWR,Underground Injection Control(IUC)
11.Borehole diameter: (in.) 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 departiperit of the county where installed
FOR WATER SUPPLY WELLS ONLY:
24d.For Water Wells producing I over 100,000 GPD:Copy to DWR,CCPCUA
12 air
Permit Program, 1611 MSC,Raleigh,NC 27699-1611
13a.Yield(gpm) Method of test:
13b.Disinfection type: HTH Amount: 12 oz 1
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Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources• Revised 6-6-2018
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