GW1-2023-00626_Well Construction - GW1_20230105

WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
1.Well Contractor Information:
NICHOLAS HAYES 14.WATER ZONES I
Well Contractor Name FROM TO DESCRIPTION
' ft. ft.
A 4121 ft. ft. l
NC Well Contractor Certification Number 15.OUTER CASING for multi-cased rvells OR LiNER if a licable)
GEOLOGIC EXPLORATION FROM TO DWMETERi 1 THICKNESS �IATERIAL
Company Name
0.0 ft. 50.0 f` 8.0 1'in SCH 80 1 PVC
_ ..
16.INNER CASING OR TUBING(geothermal closed-loot')
2.Well Construction Permit#- WR0300123 FROM TO DLINIETER6 THICKNESS MATERIAL
List all applicable it-ell construction permits(i.e.U1C,County,State,ilariance,etc.) ft, ft. Ilin.
3.Well Use(check well use): ft. ft. in.
Water Supply Rt¢II: F7R.OMSCREENTO I DIAMETER 1,SLOTSIZE I THICKNESS I MATERIAL
❑Agricultural ❑Municipal/Public ft. ft. in. ;
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in. i
❑Industrial/Commercial ❑Residential Water Supply(shared) . IS.GROUT !
❑Irrl ation ❑Wells> 100,600GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0.0 f`• 50.0 f`• NEATPORTLANDCEMENT SLURRY
❑Monitoring ❑Recovery
injection Well:
ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK if applicabie
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL', EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Draihage ft. ft.
❑Experimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary)
❑Geothermal(HeatinglCDoling Return) DOther(explain under 921 Remarks) FROM TO DESCRIPTION color,hardness,soil/rock type,ginin sin,etc.)
0.0 f` 30.0 f` BROWN SANDY SILT
4.Date Well(s)Completed: 10/17/22 Nell iD# EX-31 BR 30.0 ft• 40.0 f`- PWR
5a.Well Location: 40.0 f`' 246.0 f`' ROCK
DUKE ENERGY OF THE CAROLINAS MARSHALL STEAM STATI.ON ft. ft.
Facility/Owner Name Facility iD#(if applicable) ft. ft.
8320 NC HIGHWAY 150 SHERRILLS FORD 28673 rt. er:
Physical Address,City,and Zip ft. ft.
CATAWBA 461803426350 21.REMARKS
County Parcel identification No.(PIN) OPEN HOLE
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22.Certification:
350 35' 40.36" 800 57' 56.03", �.;
N W 12/14/22
6.Is(are)the well(s): IMPermanent or ❑Temporary Signature of Certified Well Contractor Date
By signing this form,I hereby certify that the I i elI(s)was(here)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or 15No ijA NCAC 02C.0100 or I5A NCAC 02C.0700 Well Construction StandartG•and that a copy
if Ilds is a repair,fill oul known construction information and explain the nature of the ofthis record has been provided io the wellgn-ner.
repair under�21 remorkv section or on the back of this forum.
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 toyprovide additioqa ell co tri nfo
construction,only 1 GW-I is needed. Indicate TOTAL NUMBER of wells (add'See Over in Remarks Box).You may also attach ar,{Iikig�tal®abs � c sary.
drilled: 24.SUBMITTAL INSTRUCTIONS
2460 ; {n�..;r �;c n ir,' ^c •2��:1?r�L n:t
.
9.Total well depth below land surface: (ft.) r" r
h1or maniple mel/s list all depdts ifdierent(example-JCa200'and 2 rt 100� Submit this GW-I within 30 days of well completion per'-fhi tStldwiifg:
15.4 24a. For All Wells: Original form to,Division of Water Resources (DWR),
t'i Static water level below top of casing: (ft.) Information Processing Unit,1617 MSC'Raleigh,NC 27699-1617
/f w nter level is above casing,use"-" r '
16.0/7.0/12.0 24b.For Injection Wells: Copy to DWR,Underground Injection Control(IUC)
11.Borehole diameter: (in.) Program, 1636 MSC,Raleigh,NC 27699-11636
i..Well construction method AUGER/AIR ROTARY
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: a `
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:
Fonn GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018