GW1--05162_Well Construction - GW1_20230818

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
I.Well Contractor Information: •
BRIAN THOMAS 14.WATERZONES
Well Contractor Name FROM TO ' DESCRIPTION
ft. ft.
A - 2581
ft. ft. • '
NC Well Contractor Certification Number '15.OUTER CASING(for multi-cased wells)OR LINER(if ap !Kahle)
GEOLOGIC EXPLORATION • FROM TO, - DIAMETER THICKNESS I MATERIAL
ft. ft. in.
Company Name
16.INNER CASING-OR TUBING(geothermal closed-loop)
2.Well Construction Permit#: WR03001 23 FROM TO DIAMETER THICKNESS MATERIAL
/.ist all applicable'veil construction permits(i.e.U/C,County,State,Variance,etc.) 0.0 ft• 75.0 ft• 6.0 in' SCH 80 PVC"
3.Well Use(check well use): ft. ft. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS , MATERIAL
❑Agricultural ❑Municipal/Public .75.0 ft• 190.0 ft' 6.0 tn' .010 SCH 80 SS
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT -
❑Irrigation 1)v(-CC L i' �e�lls> 100,000 GPD FROM- TO MATERIAL EMPLACEMENT METHOD&AMOUNT
• Non-Water Supply ..' l'� � 0.0 ft. 65.0 ft NEATPORTIANDCEMENT SLURRY(PUMP)
❑Monitoring AUG rU 1 Y eY 0 2O2 Jl=7Recovery ft. ft.
Injection Well:' f s ft. ft.
❑Aquifer Rechargge� � OG,r_otE idwater Remediation
{i rPC?ftiatD?roc Uflf '19.SAND/GRAVEL PACK(if applicable)
❑Aquifer Storage and Reccemr � Cj Salinity 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.
OGeothenmal(Closed Loop) ❑Tracer 20.DRILLING LOG(attach additional'sheets if necessary)
OGeothermal(Heating/Cooling Return) OOther(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness,soil/rock type,grain size,etc.)
• 0.0 ft• 8.0 ft• RED SILTY CLAY
4.Date Well(s)Completed: 08/02/23 Well ID# EX-74SBR 8.0 ft• 13.0 - ft' TAN SILTY SAND
Sa.Well Location: 13.0 ft• 27.0 ft' BROWN SILTY SAND
DUKE ENERGY CAROLINAS MARSHALL STEAM STATION 27.0 ft• 65.0 ft. • PWR •
Facility/Owner Name Facility ID#(if applicable) 65.0 ft. 191.0 ft' ROCK
8320 NC HIGHWAY 150 SHERRILLS FORD 28673 ft. • ft.ft. ft.iPhysical Address,City,and Zip-
CATAWBA 461803426350 •21.REMARKS . . .
County Parcel Identification No.(PIN) BENTONITE SEAL-65.0-70.0 FEET
5b.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' 44.21" N 80° 57' 55.03" w -OW-- 08/08/23
6.1s(are)the well(s): OPermanent or ❑Temporary Signature of Certified Well Contractor Date
By signing this forms,I hereby certify that the well(s)was(were)constritcied in accordance with
7.Is this a repair to an existing well: ❑Yes or ONo I5A NCAC 02C.0100 or/5A NCAC 02C.0200 Well Construction Standards and that a copy
!phis is a repair,fill out known well construction inJbrmation and explain the nature of the of this record has been provided to the well owner.
repair under#21 remarks section or on the hack 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 toprovide additional well construction info
construction,only 1 GW-1 is heeded. 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-5 tt 200'and 2 cu/00') Submit this GW-1 within 30 days of well completion per the following:
10.Static water level below top of casing: • 19.0 (ft) 24a. For All Wells: Original form to Division of Water Resources (DWR),
Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
Twofer level is above casing,use
11.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 27699-1 61 1
I3a.Yield(gpm) Method of test:
13b.Disinfection type: Amount:
•
Form G W-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018