GW1-2023-00630_Well Construction - GW1_20230105

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
NICHOLAS HAYES 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
ft. ft. }
A - 4121
ft. fr.
NC Well Contractor Certification Number
15.OUTER CASING for multi-cased wells OR LiNER if a licable)
GEOLOGIC EXPLORATION FROM TO DiAhi ETER THICKNESS h1ATERIAL
ft. ft. in.
Company Name
WI0300437 16.INNER CASING OR TUBING geothermal closed-loODI
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS I MATERIAL
List all applicable hell construction permits(i.e.UC,County.State,Pariance,etc.) 0.0 ft- 42.0 ft• 6.0 in. SCH 80 PVC
3.Well Use(check well use): fr. ft. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 42 0 ft' 122.0 ft- 6.0 'n' .010 SCH 80 SS
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Irrl ation ❑Wel Is> 100,000 GPD FROM - TO _MATERIAL EMPLACEMENTMETHOD&AMOUNT
Non-Water Supply Well: 0.0 1" 370 ft' NEAT PORTLANDCEMENT SLURRY(PUMP)
❑Monitoring ❑Recovery
Injection Well:
❑Aquifer Recharge ❑Groundwater Remediation Pt. ft.
19.SAND/GRAVEL PACK 1'a licable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL Eh1PLACEMENT METHOD
❑Aquifer Test ❑StormwaterDrainage 37.0 ft' 40.0 R. 16-50(#1) POUR
❑Experimental Technology ❑Subsidence Control 40.0 ft- 123.0 fr. 7-35(#2) POUR
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary)
❑Geothermal(Heating/Cooling Return) OOther(explain under 921 Remarks) FROM TO DESCRIPTION color,hardness,soillrock type,whin size,etc)
0.0 ft• 70.0 ft• BROWN SILTY SAND
4.Date Well(s)Completed: 08/10/22 Well ID# .IN-22 70.0 fr• 95.0 ft, PWR
5a.Well Location: 95.0 e. 116.0 fr' WEATHERED ROCK
DUKE ENERGY OF THE CAROLINAS MARSHALL STEAM STATION 116.0 ft 123.0 fr ROCK
Facility/Owner Name Facility ID#(ifapplicable) ft. ft.
8320 NC HIGHWAY 150 SHERRILLS FORD 28673 ft. ft-
Physical Address,City,and Zip ft. ft.
CATAWBA 461803426350 21.REMARKS
County Parcel Identification No.(PIN)
***IN FILTRATION***
>b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
STAINLESS STEEL SUMP- 122.0- 123.0 FEET
(iftvell field,one]at/long is sufficient) 22.Certification: ,
350 35' 40.33' N 800 57' 58.31 i' W ��/ ��� 08/23/22
6.Is(are)the well(s): MPermanent or ❑Temporary Signature of Certified Well Contractor Date
By signing this fornt,t hereby certify that the ire/l(s)tras(here)constructed in accordance tritb
7. Is this a repair to an existing well: ❑Yes or ONo 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Nell Construction Standards and that a copy
lfthisiv a repair,fill out knou•ti yell cott.4lruction injbrtltatiotn and explahn the nantre ofthe of7his record has been provided to the",ell ouvner.
repair under r 21 reinarks section or on the back afl/nis front.
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-I is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach additiVA lvgES i�(teELe��r�.
drilled: 24.SUBMITTAL INSTRUCTIONS VV v
123.0 y>�. lts
9.Total well depth below land surface:- (ft.) lfti°O+is��+t"� '`"^�"' "� f
For multiple wells list all depths iJ'dif)erew(example-3@200'a)n(1 2 a l00') Submit this GW-1 within 30 days of well completion per the',9It6i'@ lgD�_1
10.Static water level below top of casing:
59.1 24a. For All Wells: Original form to Division of Water Resources (DWR),tf crater level is abore casi (ft.)ng,use Information Processing Unit, 1617 MSC,Raleigh,NC 27699-1617
14.0 24b. For Injection Wells: Copy to DWR,Underground Injection Control(IUC)
11.Borehole diameter: (in.) Program, 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: AUGER/AIR ROTARY
24c.For Water Supplv and Oven-L'oob 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 6 1 1
13a.Yield(gpm) Method of test:
r
13b.Disinfection type: Amount:
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources h Revised 6-6-2018