GW1-2023-00644_Well Construction - GW1_20230105

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
NICHOLAS HAYES 14.WATERZONES r i
Well Contractor Name. FROM TO DESCRIPTION
ft. ft.
A - 4121 ft. ft. d i
NC Well Contractor Certification Number 15.OUTER CASING for multi-cased wells)OR LINER if a Iicable)
GEOLOGIC EXPLORATION FROM TO DIAMETER t THICKNESS MATERIAL
ft. ft. I'in.
Company Name -I
16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#: WR0300123 FROM TO DIAMETER THICKNESS MATERIAL
Lich all applicable well cons[rttctiatt permits(i.e.UIC,County,State,Variance,etc.) 0.0 ft. 40.0 ft. 6.0 in' SCH 80 PVC
3.Well Use(check well use): ft. ft. i in,
Water Supply Well: 17.SCREEN
FROM TO DIAMETER •SLOTSIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 40.0 fL 180.0 ft• 6.0 in. 010 SCH 80 SS
❑Geothermal(Ileating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. I..
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Irrigation ❑Wells>100,000 GPD FROM TO MATERIAL EMPLACEMENTMErHOD&AMOUNT
Non-Water Supply Well: 0.0 ft- 33.0 ft' NEAT PORTLANDICEMENT SLURRY
❑Monitoring ❑Recovery ft. ft.
Injection Well:
ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation
19.SANDIG RAVEL PACK(if applicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL' EMPLACEMENT METHOD
❑Aquifer Test ❑StormwaterDrainage 38.0 fL 181.0 ft• 20-40 FINE SILICA SAND
OExperimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach a dditionali"sheets if necessary)
❑Geothermal(Heating/Cool i ng Return) In Other(explain under#21 Remarks) FROM TO DESCRIPTION color:harJness,soil/rock e, rnin size,etc.)
0.0 ft- 60.0 ft. j' BROWN SANDY SILT
4.Date Well(s)Completed: 09/08/22 Well ID# EX-23SBR 60.0 ft. 72.0 ft. PWR
5a.Well Location: 72.0 ft. 181.6 It. jr ROCK
DUKE ENERGY OF THE CAROLINAS MARSHALL STEAM STATION ft. ft.
Facility/Owner Name Facility lD#(if applicable) ft. ft. j
8320 NC HIGHWAY 1.50 SHERRILLS FORD 28673 ft. ft.
Physical Address,City,and Zipft. ft.
CATAWBA 461803426350 21.REMARKS -
County Parcel Identification No.(PIN) BENTONITE SEAL-33.0-38.0 FEET
STAINLESS STEEL SUMP- 180.0- 181.0 FEET
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one latlong is sufficient) 22.Certification:
350 35' 39.97" N 800 57' 55.24" W 12/14/22
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Signature of Certified Well Contractor Dar,
6.Is(are)the well(s): TPermanent or ❑Temporary r N ;-� � --
By.sil nittg lhiv jbrnt,1 hereb),cerl yy that the u,�l(A )�as[tt_erd)oFns,{nic�'erhip gC dance with
7.Is this a repair to an existing well: ❑Yes or ONo 15A NCAC 02C.0100 or 15A NCAC 02C., 6)Ae� Consiruction Standards and that a copy
If this is a repair,fill out known uve/l construction hJorphation and explain the nature of the ofthis record has been provided to the trel/�otoner. r 20
repair under-21 remarks section or on the back of this form. J A N 0 t, 2�]JJ
23.Site diagram or additional well details:
S.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page t' de.addiyignpl,wel(.;FRr*yhktibn info
construction,only I GW-I is needed. Indicate TOTAL NUMBER ofwells (add'See Ovee in Remarks Box).You >S �alsto-attar ad�latiogat;pages ifnecessary.
drilled: 24.SUBMITTAL INSTRUCTIONS;
1.
9.Total well depth below land surface: 181.0 (ft.) Submit this GW-1 within 30 days of well completion per the following:
1--or tntdfhple trews list an depths ifdifferew(example-3@200'mn12 t@100�
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41.5 24a. For All Wells: Original forml�tol Division of Water. Resources (DWR),
10.Static water level below top of casing: (ft.) Information Processing Unit,1617 MSC Raleigh,NC 27699-1617
If Crater level it above casing,use•r
14.0/10.0 24b.For Injection Wells: Copy to DWR,Underground Injection Control(IUC)
11.Borehole diameter: (in.) Program, 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: AUGER/AIR ROTARY J j
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 i100,000 GPD:Copy to DWR,CCPCUA
13a.Yield(gpm) Method of test: Permit Program, 1611 MSC,Raleigh,NC 27699-1611
13b.Disinfection type: Amount:
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018