GW1--04664_Well Construction - GW1_20240809

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
Justin Marlowe I4.NNNIE:RZONES
Well Contractor Name IRON] TO DESCRIPTION
4452-A N/A ft. N/A ft. N/A
ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells)OR LINER(if ap licable)
Pheom Geotech FROM TO DIAMETER THICKNESS MATERIAL
N/A ft. N/A ft. N/A N/A N/A
Company Name 16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#: Not Applicable FROM to DIAMETER THICKNESS MATERIAL.
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.) N/A ft- N/A ft. N/A in- N/A N/A
3.Well Use(check well use): ft. ft. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE 1111(KNISS MATERIAL
❑Agricultural ❑Municipal/Public 24.0 ft. 34.0 ft. 2.0 in' 0.010 sch. 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Irrigation ❑Wells>100,000 GPD FROM TO MATERIAL I NI PLACEMENT NI 111OD&AMOUNT
Non-Water Supply Well: 0.0 ft. 20.0 ft. neat cement grout pour-25 gallons
l9Monitoring ❑Recovery 20.0 ft. 22.0 ft• bentonite pellets pour-20 pounds
Injection Well:
ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK(if applicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage 22.0 ft. 34.3 ft. no.2 filter sand pour
❑Experimental Technology ❑Subsidence Control ft. ft
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG(attach additional sheen if necessary)
OGeothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness soil/rock type,grain sine,etc.)
0.0 ft' 15.0 ft' Sandy Silt(ML)-brownish red,non-plastic,fine
4.Date Well(s)Completed: 6/26/2024 Well ID# CLF22-306R it. ft to medium sand,micaceous[Residual]
5a.Well Location: 15.0 ft. 29.0 f` Silt(ML)-brown to yellowish brown,non-
Duke Energy Carolinas Not Applicable ft. ft. plastic,few fine sand,micaceous[Saprolitej
Facility/Owner Name Facility ID#(if applicable) 29.0 h' 34.3 ft. Silty Sand(SM)-yellowish brown, pale red,
8320 NC Hwy 150, Terrell, NC 28673 ft. ft. white,fine to coarse, non-plastic fines,
Physical Address,City,and Zip rt ft micaceous[Partially Weathered Rock]
Catawba 461803426350 21.REMARKS
County Parcel Identification No.(PIN)
L
5b.Latitude and longitude io degrees/minutes/seconds or decimal degrees:
(dwell field,one lat/long is sufficient) 22.Certification: A Ub t, b O
35.616154 „ -80.972432 W
S;gmtme of Certified W etc Coatrac r v Wel0114Qt 3
6.Is(are)the well(s): MPermanent or ❑Temporary GIo
By signing this form,I hereby certify that the well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or elNo ISA NCAC 02C.0100 or ISA 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#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 construction info
construction,only 1 GW-I is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach additional pages if necessary.
drilled:Not Applicable 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: ` '0 (ft) per on Submit this GW-1 within 30 days of well completion the follow
For multiple wells list all depths if different(example-3@200'and 2@I00') y p ing:
2g g 24a. For All Wells: Original form to Division of Water Resources (DWR),
10.Static water level below top of casing: (ft) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
If water level is above casing,use"+"
24b.For Injection Wells:Copy to DWR,Underground Injection Control(IUC)
11.Borehole diameter: 7.0 I I
er Program,1636 MSC,Raleigh,NC 27699-1636
Hollow Stem Au
12.Well construction method: g 24c.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the
(i.e.auger,rotary,cable,direct push,etc.) countyenvironmental health dep
artment 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) 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

II=\ r
III
Monitoring Well Construction Form
( i
S&ME Project: Marshall Well Replacements Project Number: 21,110007, Ph.02
Driller/Company:Justin Marlowe/Phenom Geotech Well Installation Method:Hollow Stem Augers WELL NO.
Drill Rig:Mobile B-57(tracked) Borehole Diameter(in.):7.0 CLF22-306R
Start Date:6/26/24 Northing(ft):685002.97 Reference Point for Measurements:Below Ground Surface(BGS)
Completion Date:6/26/24 Easting(ft): 1413817.98 Depth to Water(ft.BGS):22.9 Date:6/27/24
Height of casing stick-up above ground surface(ft): 4.0 DEPTH
Height of concrete pad above ground surface(in): 2.0 (in feet)
Concrete pad thickness(in): 4.0
A
Ground Surface(Elevation 814.4') 0
Protective Surface Casing
Size(in): 4 x 4
Type: Steel
Bottom of Protective Surface Casing 1.0
Backfill Material )' < Riser Casing
Type: neat cement grout Type: sch.40 PVC
Dia(in): 2
Top of Annular Seal 20.0
Annular Seal >
11
Type: bentonite pelletsII_ Top of Filter P ck 22.0
Top of Screen 24.0
Screen Type
Dia (in): 2 < Filter Pack
Type: sch.40 PVC(pre-packed) Type: no.2 filter sand
Slot(in): 0.010
Bottom of Screen 34.0
Bottom of Sump 34.3
I Bottom of Hole 34.3