GW1-2023-00632_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. ft. ti
NC Well Contractor Certification Number 15.OUTER CASING for inulti-cased avells .OR LINER if a licable
GEOLOGIC EXPLORATION FROM fO DIAMETER THICKNESS MATERIAL
ft. ft. in.
Company Name
16.INNER CASING OR, BING eoihermal closed-loop)
2.Well Construction Permit#: WR0300123 FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.U/C,County,Stale,Variance,etc.) 0.0 ft. 37.0 ft- 6.0 i,t"• SCH 80 PVC
3.Well Use(check well use): ft. ft.
17.SCREEN
Water Supply Well;
FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 37 ft• 177.0 ft• 6 in• 010 SCH 80 SS
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft, I ft. in.
❑industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT'
❑lrrl ation ❑Wells>I00,000',GPD FROM TO MATERIAL' EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0.0 ft- 30.0 ft' NEAT PORTLAND'CEMENT SLURRY
❑Monitoring ❑Recovery ft. ft.
Injection Well:
ft. ft. �
❑Aquifer Recharge ❑Groundwater Remediation
19,SAND/GRAVEL PACK(if applicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL' EMPLACEME\T METHOD
❑Aquifer Test ❑Stormwater Drainage 35.0 ft- 180.0 ft- 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence.Control ft. ft.
❑Geothermal(Closed Loop) ❑Tracer 20:DRILLING LOG attach additional sheets if necessary
❑Geothermal(Heating/Cooling Return) CJOther(explain under 921 Remarks) FROM TO DESCRIPTION(color,hardness,soillrock e, nin size,etc.)
0.0 ft- 60.0 ft- BROWN SANDY SILT
4.Date Well(s)Completed: 09/12/22 Well ID# EX-24SBR 60.0 ft• 70.0 ft PWR
5a.Well Location: 70.0 ft. 79.0 ft. i• WEATHERED ROCK
DUKE ENERGY OF THE CAROLINAS MARSHALL STEAM STATION 79.0 ft- 179.0 ft• I, ROCK
Facility/Owner Name Facility 1Dk(if applicable) 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) BENTONITE SEAL-30.0-35.0 FEET
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: STAINLESS STEEL SUMP 177.0-178.0 FEET
(if well field,one lat/long is sufficient) 22.Certification:
35o 35' 39.60" N 80o 57' 55.43 W
6.Is(are)the well(s): ITPermanent or ❑Temporary Signature of Certified Well Contractor it Date
By signing this form,1 hereby certify that 1hellre//(s)was 61,ere)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or MNo 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy
If this is a repair,fill out known hell construction information and explain the nature of the ofthis record has been provided to the well orrne�t _
repair under 421 remarks section or on the back ofthis faro. F, '• d n" ,y�'t
23.Site diagram or additional well details:'.L��a,7 I(-i V
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
(adti'See Ovel'in Remarks Box).You may also ��'I�a ItCon " if necessary.
construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells i 'l��
drilled: 24.SUBMITTAL INSTRUCTIONS
1 78.0 (1rc+Di�Yr�Uil P fccr:*n ng Uri",;
9.Total well depth below land surface: (ft.) +I rEr f /r.
!or nudli le wells list all depths i elt erenr exam le-3 00'and 2 1p0' Submit this G�)'-1 within 30 days of well compleHon�rer3Fh allowing:
P P f .f ( P � � ) I,
34.6 24a. For All Wells: Original form 'to iDivision 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' . I• i
11.Borehole diameter: 14.0/1 0.0 (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 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: 24d.For Water Wells producing ove`L00,000 GPD:Copy to DWR,CCPCUA
13a.Yield(gpm) Method of test: Permit Program,1611 MSC,Raleigh,NCj27699-161 i
13b.Disinfection type: Amount:
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018