GW1--06818_Well Construction - GW1_20241114

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
Kaleb T. Hyde 14.WATER ZONES' 1
Well Contractor Name FROM TO DESCRIPTION
350 ft. 705 ft.
. 4436-A ft. ft.
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 ft• 6.25 ,I 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(i.e.U1C,County,State,Variance,etc.) 0 ft. ft. . in.
3.Well Use(check well use): 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) CiResidential Water Supply(single) ft. ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT i.
❑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 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)
OGeothermal(Heating/Cooling Return) DOther(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness,soil/rock type grain size,etc.)
ft. ft.
i.
4.Date Well(s)Completed: 10/17/2024 Well ID# fr. ft
5a.Well Location: ft. ft.
•Joe Perkins ft. ft. ;/-,,.. -,
Facility/Owner Name Facility 1D#(if applicable) ft. ft. •;'
Fontana Ridge Rd. Bryson City, NC 28713 ft. ft. Noli 3 �;'''
Physical Address,City,and Zip ft. ft. 1 ( ,
Swain 21.REMARKS �� _
County Parcel Identification No.(PiN) t`r `'' .
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: I'
(if well field,one lat/long is sufficient) 22.Certification:
35 degrees 25' 56" N 83 degrees 29' 42" W
/ ¢� ) 10/17/2024
6.Is(are)the well(s): Permanent or ❑Temporary Signature of Certified W Contractor 1 Date
By signing this form,l hereby certify that th'e wells)was(mere)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or ONo ISA NCAC 02C.0/00 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-I 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: 705 (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@l00')
350 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"+" 1
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 Open-L000p 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
13a.Yield(gpm) 1 _ Method of test: air
Permit Program,1611 MSC,Raleigh,NC 27699-1611
13b.Disinfection type: HTH Amount: 15 OZ
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018