GW1-2022-09140_Well Construction - GW1_20220930

WELL CONSTRUCTION RECORD � For internal Use ONLY:
nis renn can be used for sinFk or multiple wells
I.Well Contractor Information:
1-3.WATER ZONES,
Scott Hunt Jr. FROM I DFSCRIF"M
Wail Ctit>zr:tanr N,nne
h, h.
u. h.
4561-A
NC Well Contranor Cenifnation Nunilbcr 13.OUTF.R CASING-foririuhi-casedwens'OR LISTER if an inable
FROM TO I mAMi,TF.R TNICKNFSS MATERIAL
SAEDACCO Inc 0 ft. 35 It. 2" in. SCH-40 PVC
Company Name M.INNER CASING'OR TUBING ileotbennat ebscddot+pj.
FROM TO DLA�IFTER THICKNESS MATERIAL
2.WdI Construction Permit
Lin ill applirithlr utlf prnniri(i:r.C.rtenh•.51rnr..1rriarrrr.Trq`Eroari rtt.3 ft. h. ,in•
3.Well Ilse(check well use,): 17.SCRi:EN
Water Supply Well: FROM TO r DIANIETFR SLOTS171, TIIICKNINS I MATFRIAI:
L7Agricultural G.Municiptil/liublic 35 ft. 40 ft. 2" in, 0
10 SCE-40 PVC
1343cothemtal(Ncatiriptooling Supply) 01tesident4al Water Supph•)single)
01)dustrilKontmercial 011csidential Water Supph•(shared) 1R+GROUT TO MATFRUl, P.AIPLACFMCYTMETHOU A AMOUNT
DlrfiLpation 0 ft. 31 ft. Portland Tremie
Non-Water Supply Well:
h. h.
OivlanitorinG ORccatrrg
injection Well:
QAquifcrRccharge OGroundwitcrRcntcdiation 19.SANDIGRAVEL PACK`rit iiitatfle
FROM TOI MATRRt-%L F.MPI.AMIENTMYrHOn
OAquifcrStoragc and Recovery ❑Salinitl•1lafricr 33 fL 1 40 h. Filter Sand #2
ClAgoifcr Tcs1 Dstormwatcr fhuinasc
h. rt.
OE\perimcntnl Tochnology ❑Suhsidcnec Comm1
10 DRtl:11rG LOG(a(tub additibrial KAiets if e►cccaxan
OGeothernwl(Closed Loop) oTracet FROM TO UPMRIPTION ftobr,httrVnrtr w tt'nWk Upt.griiii s're,ok j
OGeoihenttal 1Tlcatint lCooline Return) mother(explain under A21 Remarks) see gho s log ft.
ft. ft.
4.Date Well(s)Completed: 8/23/22 Well iD#AS-2
ft. ft. q. r
x.
5a.Well Lticath)n: ft. ft. • '� v s ! - '
Duke Energy h ft' SF. 2(j��
FacI tt:�'Ott'ncr Flamm Facility 1DK(if applimblc) fl. ft. l�
8320 NC-150, Sherrills Ford, NC, 28673 Illf-
ft. h,
u• n
�t�ti+ s •
Physical Address.City-.and Zip 21 RCMARKS'
Catawba Bentonite seal from 31-33,
CaatlM Pattel id-ni iry-ition No.(1,11N)
5h.l:atitudc and Longitude in degtreslminutcslsccrindr or decimal degrees: 22.Certification:
(if bell field,one hu lotV is std'tici;nn
N W 9/18/2022
Sigrouir of Ccnlfied Well Conimnor Dalc r ,
6.is(are)thewell(s)t 2iPerinanent or oTemporary M srgrtint this Conn,I heed'.11 errtify Mar thr"r/l(.0 tiros{rate)ix-aviturted hr tee orrlUnee
ii*h 15A NCAC 02C.01M fir ISA A10W RFC AM nell Crnrstrartion standards rumIlyet a
7.Is this a repair to an existing{Yell: ®Yeti tr ENo tnp)'pjtltix rrrnnl has Men iN2+rjrfrd In7hr sn ll rnrnrr,
lfthis is a cola'lir,fill oir fnhun troll nmonwilaa infumxrrkm and et'plala the mvrate of the
,rlmirroalrrA21 rrn+orAtr sre�ian or tut the beak nfthle form. 23.Site diagram or additional well details:
you may use d�back of this pale to provide additional well L site details or well
8.Number of wells constructed: 1 construction details: You may also attach additional pabves if necessary.
For nwhiple iri/eerimt eN arm-warm supl#wells OA9.Y i+•ifh'the same consfruetiotr,cot,COP '
.tatimit mir fare,+. SU M ITTA LKSTUCTIONS
9.Total well depth below land surface: 40 (ft.) 24a. For All Wells: Subnut this form wilhin'3(1 days of completion of well
For,natltiple tCH11 list all dr/ulrs 11 dlfti re+v(earmny,IC•30200'axtfl 20Iffl') construction to the foltoNting:
10.Static water level below tarp of casing: (ly,) Division of Water Resources,Information Processin8 Unit,
lft+YNer level is above rrsirt•Y.use 1617 Mail Service!'Centcr,Raleigh.NC 27699-1617
11.Borehole di'ametcr:8.25" (ia) 24b.,For hikction 3yd1c ONLI': To addition to sendioR the forte to the addw in
24a above. also submil a copy of this foln) within 30 days of Completion of well
12.%Veil comstruction method: HSA Construction to the following'.
(i.c.auger.roury,cable.dieted push ctc:)
Division of Rater Resourccs,`Underground injection Control Program,
FOR WATER SUPPLi'WELLS ONLY 163611feil Service Center.Raleigh;\C 27699-1630
t3a Yield(gpru). Method of test. 24c.For Water Supph'elk injection Wells
Also submit one cop)'of this form within 10 days of completion of
13h.i)ixinfation type-___ Amount:
well construction to the tountN"health dcpanmcrit of the cmtnh•.w•itcre
constructed.
Fann OW-I l�nnh Calafirta Dcyannx tit or Em rotunctu grid V:nural Resources-Dit'sion of 1\'flair Re5otrtes Revised:August 2013