GW1--03312_Well Construction - GW1_20240603

WELL CONSTRUCTION STRUT 1ION RECORD(GW'-i) For Internal Use Only: I
1.Well Contractor information:
Rick Crane 14.WATER ZONES
FROM I TO I DFCt'.RIPTION
well I.inniracior Name '
ft. ft.
3073-A ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells)OR LiNER(if a cabk)
FROM TO DIAMETER THICKNESS MATERIAL
Crane Bros. Well Drilling :_ I I-. ...:U IaU 'r' ID,L:`� in* i5U1K21 iP'VL
Company Name
010823—I' 16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.UIC,County,State, Variance,etc.) ft. ft. in.
i.\V^!!fief.lrhrrlr weft nsrl ft. ft. in.
Water Supply Well: 17'SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public ft. ft. in.
❑Geothermal(Heating/Cooling Supply) ItResidential Water Supply(single) tL ft. in.
• ^.rnili:trial/C mmerci_l flPc:id_ntial Water Supply!:hared) .
—_.. Supply. :.... 18.GROUT
❑Irrigation ❑Wells>100,000 GPD FROM 10 MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 ft. 20 rt. benonite pumpe
❑Monitoring ❑Recovery ft. ft.
Injection Well: •
❑Aquifer Recharge ❑Groundwater Remediation i i i
19.SAND/GRAVEL PACK(if applicable)
❑Aquifer Storage and Recovery OSalinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage ft. ft.
❑Experimental Technology ❑Subsidence Control ft. ft
1 '
•
❑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,soil/rock type,grain size,etc.)
0 ft' 90 ft. clay
4.Date Well(s)Completed: 3/18/2024 Well ID# 90 ft. 305 ft. granite
rt. it.
Sit.Well Location:
Rita Byrd ft ft. ------- -------------
Facility/Owner Name Facility ID#(if applicable) ft ft.
17F5 N. _inns Cr. Rfi, Franklin; NC 28734
N
Physical Address,City,and Zip ft• ft' ii toG tl't
Macon 6562715245 21.REMARKS
County Parcel Identification No.(PIN) _,, --,
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: i
(if well field,one lat/long is sufficient) 22.Certification:
35 06.14 N 83 27.72 w 5/29/2024
5_Is(are)the t•c'r(-): !�'P^rmanent or ❑T=:r:;:orar~• Sianattve 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 tn No 1 SA NCAC 02C.0100 or 1 SA 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#21 remarks section or on the back of this form.
23.Site diagram or additional well details:
You itiU usu the cuc'k of this :.. - •ae additional well....-...:_...::..
8.For(:eoprobeiDPT or Closed-Loop Geothermal Wells having the same s r•�•a= ��P•o*t4•-�...u.,:,�:u: :u'�u��•-..'rt mac'
construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach additional pages if necessary.
dulled: 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 305 (ft.) Submit this GW-1 within 30 days of well completionper the following:
Far-„tyrle wells l et all deaths lraraerew xamnle-:i 17n0•and 2n 11W) Y P
Staop of casing: 100 (ft) 24a. For All Wells: Original form to Division of Water Resources (DWR),
10. atic water level below t tlevel is above casing,use op" Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
If
11.Borehole diameter 6.25 on.) 24b.For Injection Wells:Copy to DWR,Underground Injection Control(IUC)
Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: notary
24c.For Water Supply 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
I FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPD:Copy to DWR,CCPCUA
7n Air Permit Program. 1611 MSC.Raleigh.NC 27699-1611
' his.Yield(gpnl) '' Method of test: ' -
13b.Disinfection type: Sterilene Amount:
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