GW1--06816_Well Construction - GW1_20241114

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only: i
1.Well Contractor Information:
1
Kaleb T. Hyde 14.WATER ZONES I
FROM TO DESCRIPTION
Well Contractor Name
300 ft• 655 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• 42 it 6.25 ' in• SDR21 PVC
Company Name 16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#: FROM TO . DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(ie.UIC,County,State,Variance,etc) 0 ft. ft. in.
3.Well Use(check well use): ft. ft. in.
17.SCREEN
Water Supply Well:
FROM TO DIAMETER • SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public ft. ft. in.,
❑Geothermal(Heating/Cooling Supply) ciResidential Water Supply(single) ft. ft. in.i
❑Industrial/Commercial Residential Water Supply(shared)
18.GROUT .. .
❑Irrigation ❑Wells>100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 ft. 17 ft• bentonite
❑Monitoring ❑Recovery 17 ft• 20 ft• bentonite
Injection Well: -
ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation •
19.SAND/GRAVEL D/GRAVEL PACK(if applicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FRori _ TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑StormwaterDrainage ft. ft.
❑Experimental Technology ❑Subsidence Control ft. ft. i
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG(attach additional sheets if necessary).
❑ FROM TO DESCRIPTION(color,hardness,soiUtrock type,grain size,etc.)
Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks)
ft. ft. 1 •
4.Date Well(s)Completed: 10/31/2024 Well ID# ft. ft. !
ft. ft. I'
5a.Well Location: - i
Paula Hoelle ft. ft. ,�- .7-- ,-,-,._ _
Facility/Or ner'Name _- . _ _ .__. -Facility.ID#(if applicable) ft. ft. . '�;,a,,-,:1 btu'.a „3 f,
1135 TimberEstates Road, Bryson City, NC 28713 ft. ft. NOV ,
ft. x L024
Physical Address,City,and Zip , - .ft. ,
Swain - 2I.REMARKS - - F -n 7:-.,.-Yam,::..•: L.:, :
County Parcel Identification No.(PIN) fit' '" '-' _
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22.Certification: 1
35 degrees 21' 18" N 83 degrees 25' 13" W , 10/31/2024
6.Is(are)the well(s): lPermanent or ❑Temporary Signature of Certified II Contractor Date
1'
By signing this form,I hereby certifr that'the well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or [No 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 tinder."•2l remarks section or on the back of this Jornr.
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: I 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 655 (ft.) I '
For multiple wells list all depths iifdii different(example-3(4200'and 2Ca/00� Submit this GW-1 within 30 days of well completion per the following:
24a. For All Wells: Original,form to Division of Water Resources (DWR),
10.Static water level below top of casing: 300 (ft.) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
If stater level is above casing use"r
11.Borehole diameter: 6.25 (in.) 24b.For Injection Wells:Copy to DWR,Underground Injection Control(IUC)
Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: rotary 24c.For Water Supply and OpenLoop 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 prodOcingJover'100,000 GPD:Copy to DWR,CCPCUA
1 air
Permit Program,1611 MSC,Raleigh,NC 27699-1611
13a.Yield(gpm) Method of test:
13b.Disinfection type: HTH Amount: 15oz
, I '
Fonn GW-1 North Carolina Department of Environmental Quality-Division of Water Resource I , Revised 6-6-2018