GW1--05142_Well Construction - GW1_20230818

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
I.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES . I •
Well Contractor Name •
FROM TO DESCRIPTION
ft. ft.
I .
A - 2581 ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells)OR-LINER(if ap licable)
GEOLOGIC EXPLORATION FROM TO ' ft. in.DIAMETER THICKNESS I MATERIAL
ft
Company Name 16:INNER'CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#: W RO3001 23 FROM TO DIAMETER THICKNESS - MATERIAL .
List all applicable ire//construction permits(i.e.(//C,County,State,Variance,etc.) 0.0 ft• 75.0 ft• 6.0 Irt• SCH 80 PVC
3.Well Use(check well use): ft. ft. ia•
17.SCREEN
Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑A ricultural _ `� a�S�Munici al/Public 75.0 ft• 190.0 ft' 6.0 tn' .010 SCH 80 SS.
❑Geothermal(. cfatih lin,Si�p�p4y). Residential Water Supply(single) ft ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) ,18.GROUT
❑Irrigation AUG 18 2O`3 ❑Wells> 100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: V 0.0 ft• 65.0 ft. NEAT PORTLAND CEMENT SLURRY(PUMP)
❑Mction irtgtlpf1tR %n 1 '„scooping ❑Recovery ft. ft. J
Injection Well:
ft. . ft.
❑Aquifer Recharge ❑Groundwater Remediation
d 9.SAND/GRAVEL PACK(if applicable)
❑Aquifer Storage and Recovery OSalinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage 70.0 ft• 191:0 ft• 7-35(#2) POUR ..
❑Experimental Technology ❑Subsidence Control ft. ft.
OGeothermal(Closed Loop) ❑Tracer `20.DRILLING LOG.(attach additional sheets if necessary). ..•. .
OGeothermal(Heating/Cooling Return) MOther(explain under#21 Remarks) FROM • TO DESCRIPTION(color,hardness,soil/rock type,grain size,etc.)
0.0 ft• 17.0 ft' RED SILTY CLAY
4.Date Well(s)Completed: 07/25/23 Well ID# EX-68SBR 17.0 ft. 86,0 ft' TAN SILTY SAND
5a.Well Location: 86.0 ft' 92.0 ft• PWR
DUKE ENERGY CAROLINAS MARSHALL STEAM STATION 92.0 ft• 191.0 ft• ROCK
ft. ft.
Facility/Owner Name Facility IDN(if applicable)
8320 NC HIGHWAY 150 SHERRILLS FORD 28673 ft. ft.
ft. ft.
Physical Address,City,and Zip
CATAWBA 461803426350 .21.REMARKS • •
County' Parcel Identification No.(PIN) ... BENTONITE SEAL-65.0=70.0 FEET
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
STAINLESS STEEL SUMP - 190.0- 191.0 FEET
(if well field,one lat/long is sufficient) 22.Certification:
35° 35' 42.37" N 80° 57' S7.29° W n.�.6'w-r--
07/24/23
6.Is(are)the well(s): P9Permanent or OTemporary Signature of Certified Well Contractor Date
By signing this first,I hereby certify that the well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or ONo 15A NCAC 02C.0100 or I5A 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:121 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 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: 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 191'0 (ft.)
For multiple wells list all depths if different(example-3 c@200'and 2 a I00') Submit this GW-1 within 30 days of well completion per the following:
10.Static water level below top of casing: 23.2 (ft) 24a. For All Wells: Original form to Division of Water Resources (DWR),
ifiraterlerel is nbrn•e coring,use"=" Information Processing Unit,1617 MSC,Raleigh,•NC 27699-1617
II.Borehole diameter: 14.0/10.0/6.0 (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/SONIC
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
Permit Program,1611 MSC,Raleigh,NC 27699-1611
13a.Yield(gpm) Method of test:
. 13b.Disinfection type: Amount: .
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-20I8