GW1-2023-00638_Well Construction - GW1_20230105

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
NICHOLAS HAYES 14.NVATER ZONES
Well Contractor Name FROM TO DESCRIPTION
ft. ft. i i
A - 4121
ft. '
{
NC Well Contractor Certification Number ft.
15.OUTER CASING for multi-casedrwells IN OR LER if a licable)
GEOLOGIC EXPLORATION FRONT TO DIAMETER. THICKNESS MATERIAL
ft. ft. n,
Company Name
WI0300437 16.INNER CASING OR TUBING eothermal closed-loon)
2.Well Construction Permit#• FROM TO DIAMETER I THICKNESS I NATERIAL
List all applicable trell construction pennits(i.e.UIC,County,State,Marianc•e,etc.) 0.0 ft- 48.0 f`• 6.0 in' SCH 80 PVC
3.Well Use(check well use): fr. fr. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 48.0 f`' 83.0 f`• 6.0 in. .010 SCH 80 SS
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft.
❑Ind ustrial/Commercial ❑Residential Water Supply(shared) 13.GROUT
❑Irri atlon ❑Wells>100,000 GPD FROM TO MATERIAL EMPLACENIENTMETHOD&AMOUNT
Non-Water Supply Well: 0.0 f`• 43.0 f`• NEAT PORTIANDCEMENT SLURRY(PUMP)
❑Monitoring ❑Recovery ft. ft.
Injection Well:
❑Agtlifer Recharge ❑Groundwater Remediation ft. fr.
❑Aquifer Storage and Recovery ❑Salinity Barrier 19.SAND/GRAVEL PACK ifalicableFROM TO MATERIAL ENIPLACENIENTMETHOD
❑Aquifer Test ❑StormwaterDrainage 43.0 ft- 46.0 f`- 16-50,(#1) POUR
Cl Experimental Technology []Subsidence Control 46.0 f`- 84.0 1" 7-35(#2) POUR
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary)
FROM TO DESCRIPTION(color,hardness,soilhack e, gain size,etc.
❑Geothermal(Heating/Cooling Return) (explain under#21 Remarks)
0.0 f`• 55.0 f`• BROWN SANDY SILT
4.Date Wells)Completed: 08/03/22 Well ID# IN-7 55.0 f` 68.0 f" PWR
Sa.Well Location: 68.0 f` 74.0 ft' WEATHERED ROCK
DUKE ENERGY OF THE CAROLINAS MARSHALL STEAM STATION 74.0 ft• 84.0 f`' ROCK
Facility/Owner Name Facility ID#(ifapplicable) ft. ft.
8320 NC HIGHWAY 150 SHERRILLS FORD 28673 ft• ft.
Physical Address,City,and Zip ft. ft.
CATAWBA 461803426350 21.REMARKS
Count)' ***INFILTRATION***
Parcel Identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
STAINLESS STEEL SUMP-83.0-84.0 FEET
(ifwell field,one]at/long is sufficient) 22.Certification:
350 35' 41.82" N 800 57' S6.56" W 08/23/22
6.Is(are)the well(s): OPermanent or ❑Temporary Signature of Certified Well Contractor Date
By signing this form,l hereby certify that the we//(s)was(here)constructer)in accordance rri/h
7.Is this a repair to an existing well: ❑Yes or MNo ISA NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and drat a cope
l f this is a repair,fill oat knoirn well construction iglbrination and explain the nature ofihe of iliis•record has•been proriiled io the well owner.
repair under,t21 renrm•ks section or on the back aJ'lhi Jbrnr.
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 add''jignaLavell construction inib
construction,only I GW-I is needed. Indicate TOTAL NUMBER ofwells (add'See Over in Remarks Box).You may also attar -add�iti0,a a�°es i ne-q*.%il.
drilled: �.Ilm,�:,..��i'..,,s `:r i(.,., •24.SUBMITTAL INSTRUCTIONS �� �f
9.Total well depth below land surface: 84.0 (ft.) JA N ^ 2023
lbr nnr/tiple u•e/%r list a//depths ijc/iJJerent(example-J a 700'and 2@l00') Submit this GW-1 within 30 days of.well completion per the ollowing:
10. 71.2 ) 24a. For All Wells: Original form to Divisic��i4crfF+ a'tF'R�srOuir�c's(D�V��i%a
fwater level it obare casing,use Static water level below top of casing: (ft Information Processing Unit,1617 MSC,Raleigh,NC 2769Pj•�P'�0G
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11.Borehole diameter: 14.0 (in) 24b. For Injection Wells: Copy to DWR,Underground Injection Control (IUC)
Program, 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: AUGER/AIR 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
13a.Yield(gpm) Nlethod of test:
Permit Program, 1611 MSC,Raleigh,NC 27699-1611
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13b.Disinfection type: Amount:
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Fonn G W-I North Carolina Department of Environmental Quality-Division of Water Resources i Revised 6-6-201 S
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