GW1--05646_Well Construction - GW1_20230831

11
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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information: 1 ,
Nicholas Moreno N14.WATER:ZONEs 14-,,;z: , ,,,€ ., ..
Well Contractor Name FROM TO DESCRIPTION
ft. ft. l
4209-A rt. I It 4
NC Well Contractor Certification Number 15.-OUTER CASING(for multi-cased wells)'OR LINER(If upp'litable)
Keller Industrial FROM TO DIAMETER THICKNESS I MATERIAL
ft. ft. in. )II
Company Name 16 INNERCASINGOR TUBING'(geothehnal:closed loop)-"i
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.) 0 ft- 27 ft• 4 in. Sch 40 we
3.Well Use(check well use): ft. ft. in.
Water Supply Well: 47.SCREEN',.... . .,. ,;, . . ,
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
Agricultural °Municipal/Public 27 ft. 47 ft. 4 1O' 20 sch 40 Pvc
Geothermal(Heating/Cooling Supply) °Residential Water Supply(single) ft. ft. in;
Industrial/Commercial Residential Water Supply(shared) ` `
1;IB GROUT ;ice„ ..tee: . a .N ,
Irrigation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: ft. ft.
°Monitoring E3Recovery ft. ft.
Injection Well: ft I ft.
Aquifer Recharge Groundwater Remediation L
19.SAND/GRAVEL PACK(If applicable)',,,. ,--- - "'
.'.na
Aquifer Storage and Recovery �ISalinity Barrier FROM I TO MATERIAL. I EMPLACEMENT METHOD
F�v
DAquifer Test oStormsaterDrainage a ft• 1 47 ft- P4 Send i Trenwnie
°Experimental Technology °Subsidence Control ft. ft. ,
°Geothermal(Closed Loop) *Tracer --20.-DRILLING LOG(attach additional sheets-ifhecessary)'- f..•,_ r_:
FROM I TO DESCRIPTION(color,hardness,soil/rock type,grain size,etc.)
Geothermal(Heating/Cooling Return) nOther(explain under#21 Remarks)
t) ft. 5 f.t. Dark grey ash
4.Date Well(s)Completed:8-2-23 Well ID#DWI-13 5 •ft. 10 it
pRedish brown sandy clay
5a.Well Location: ,a ft. fL Dark grey ash
Duke Energy 45 a 47 ft- Naove
Facility/Owner Name Facility ID#(if applicable) ft. ft. C"):rz(--�,K f+ . ¢
8320 NC 150, Sherrills Ford, 28673 ft. ft. ►`' "�N.,�--I 'I C.._a •
Physical Address,City,and Zip R. I ft. I A U G 3 1 2023
Catawba 21:'RE14fARK5 " .
Infor ra l:n?rtv. rapt tin.
County Parcel Identification No.(PIN) 1:7.:i..;j:;ta.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22.Certification:
35.61599 N 80.97861 R, .�
7.7C/-2-7
6.Is(are)the well(s)lPermanent or EiTemporary Si cure of Certified Well Contractor Date
By signing this form,I hereby certify that the well(s)was(were)constructed in accordance
7.Is this a repair to an existing well: DYes or EiNo with ISA NCAC 02C.0100 or ISA NCAC 02C.0200 Well Construction Standards and that a
If this is a repair,fill out known well construction information and explain the nature of the Copy of this record has been provided to the well owner.
repair under#21 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 site details or well
construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if necessary.
drilled: SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 47 (ft) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths if different(example-3@200'and 2@I00') construction to the following: ', '
10.Static water level below top of casing: 15.1 (ft.) Division of Water Resources,Information Processing Unit,
If water level is above casing,use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 8 (in.) 24b.For Injection Wells: In addition to sending the form to the address in 24a
Rotary above,also submit one copy of this form within 30 days of completion of well
12.Well construction method: construction to the following:
(i.e.auger,rotary,cable,direct push,etc.)
l Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
13a.Yield(gpm) _ Method of test: 24a For Water Supply&Iniectil ni Wells: In addition to sending the form to ,
the address(es) above, also submit one copy of this form within 30 days of
13b.Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016 .