GW1--06499_Well Construction - GW1_20241101

WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only: '
1.Well Contractor Information: j
Rick Crane , 14.WATER ZONES .
Well Contractor Name FROM TO DESCRIPTION
3073-A ft. ft.
_ ft. ft.
NC Well Contractor Certification Number .15.OUTER CASING(for multi-cased wells)OR LINER(if ap licable)
Crane Bros. Well Drilling, Inc. FROM TO DIAMETER THICKNESS MATERIAL
0 ft. 100 ft. 6.25 I SDR 21 PVC
Company Name 16:INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#: 2023-24931-9-12991 FROM . TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.) ft. ft. in.
3.Well Use(check well use): it ft. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public ft. ft. in.
❑Geothermal(Heating/Cooling Supply) l lResidential Water Supply(single) ft. ft is
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT -
❑hrigation ❑Wells>100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 ft. 20 It Benonite pumped
❑Monitoring ❑Recovery ft. ft.
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.
i
OGeothermal(Closed Loop) ❑Tracer .20.DRILLING LOG(attach additional sheets if necessary). -
OGeothermal(Heating/Cooling Return) ['Other(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness,soiurock type,grain size,etc.)
0 ft. 100 ft* clay '
4.Date Well(s)Completed: 05-30-2024 Well ID# 100 ft. 1005 ft• granite �r�- 4
5a.Well Location: ft. ft. -"' "- x ; ' v,: 3s::i
Terry Potts/Curtis Weaver ft. ft. NOV 0 1 2024
Facility/Owner Name Facility ID#(if applicable) ft. ft. '
Wild River Rd. Cashiers, NC ft. ft. °.r
Physical Address,City,and Zip ft. ft.
Jackson 7561-89-5568 `21.REMARKS.r- .
County Parcel Identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22.Certi tion:
N W 1 10/22/2024
6.Is(are)the well(s): CJPermanent or ❑Temporary Signature o Certified Well Contractor' Date
By signing this form,I hereby cert(j that the well(s)was(were)constructed in accordance with ' -
7.Is this a repair to an existing well: ❑Yes or ONo ISA 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:
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 if necessary.
drilled: 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 1005 (ft.)
For multiple wells list all depths if diy'ferenr(example-3@200'and 2@100') Submit this GW-1 within 30 days of well completion per the following:
`20 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"+"
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
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPD:Copy to DWR,CCPCUA
Permit Program,1611 MSC,Raleigh,NC 27699-1611
13a.Yield(gpm) 3 Method of test:Air
13b.Disinfection type: Sterilene Amount: - - _
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018