GW1--03314_Well Construction - GW1_20240603

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
Rick Crane 14.WATER ZONES
FROM I TO 1 DESCRIPTION ,
1 eii i'murat:ior Nu,TK
ft. ft.
3073-A
ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells)OR LINER(if a bk)
FROM TO DIAMETER THICKNESS MATERIAL
Crane Bros. Well Drilling _ I :_ I.. .. I__
Company Name
0 " IOU �t).L�t '; 'S0R2l PVC
011320 P 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.U1C,County,State,Variance,etc.) ft. ft. 1n.
i,Well tier:(rhos*well rise)?rise)? ft.
t in
t i i
Water Su 17.SCREEN
Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public ft. ft. in.
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft, ft. in.
r'I-ducti'.al!r£.mmcrcis! flR.esid e'atial Water Supply(shared) • - •
is.GROUT
❑Irrigation ❑Wells>100,000 GPO FROM 10 MA I ERIAL 1 EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 ft' 20 It benonite pumped
❑Monitoring ORecovery ft. ft.
Injection Well:
R. h_
❑Aquifer Recharge fiGroundwater Rernediation 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.
❑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,4ardoess,soil/rock type,grain size,eta)
5/9/2024 ° ft' 60 ft. clay
4.Date Well(s)Completed: Well ID# 60 ft- 855 ft• granite
Sa Well Location: ft. ,,. 11 .. M• -�, _ 1
— C ` i
Macon County/Wesley's Park it. ft.
Facility/Owner Name Facility ID#(if applicable) ft ft it I V (/ : 2624
Main Street, Franklin NC: 28734 ft. , ft. .
Physical Address,City,and Zip It• ft.
Macon 6595314313 21.REMARKS
County Parcel Identification No.(PIN)
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: i '
(if well field,one IaVlong is sufficient) 22. cation:
35 18 6583 N 83 37.346 w 5/28/2024
6.Is(are)the well(s): !!Permanent or DTemporary Signat of Certified Well Contractor Date
By signing this form,'hereby certify that the well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: DYes or C5No 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#21 remarks section or on the back of this form.
23.Site diagram or additional well details:
........ ac bu n vi°.1.•i:;-..6, ;.. • µu,:i=:..•..1?h
R.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
YUu auuJ +.t_� Fe:a�� aJ tiveaut 'ill;:iiFauui:utii5 uai(i
constriction,only I GW-1 is needed. Indicate TOTAL NUMBER of wells (add'Sec Over'in Remarks Box).You may also attach additional pages if necessary.
drilled: 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 855 (ft.) Submit this G W-1 within 30 days of well completionper the following:
For.muNple wells!in all depths Ifdttr rent!example-30200'and 2n tturt Y P
24a. For All Wells: Original form to Division of Water Resources (DWR),
10.Static water level below top of casing: 6 (ft) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
If water level is above casing.use"+"
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
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
fnfl Air Permit Program.1611 MSC.Raleigh.NC 27699-1 61 1
i ia.Yield(gpni) Y Menton of test: ' '
13b.Disinfection type: Sterilene Amount: