GW1-2023-00633_Well Construction - GW1_20230105

WELL CONSTRUCTION RECORD(GW-i) For internal Use Only:
1.Well Contractor information:
NICHOLAS HAYES 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
A - 4121 rt. ft.
ft. ft. {
NC Well Contractor Certification Number 1
15.OUTER CASING for multi-casea wells OR LINER if a licable
GEOLOGIC EXPLORATION FROM TO DIAMETER THICKNESS M1IATERIAL
Company Name
WI0300437 16.INNER CASING OR TUBING eothermal closed-loon)
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well consn'uction permits(i.e.UIC,County,State,flariance,etc.) 0.0 ft. 43.0 ft.: 6.0 in. SCH 80 PVC
3.Well Use(check well use): ft. ft. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER', SLOTSIZE I-THICKNESS DATERIAL
❑Agricultural ❑Municipal/Public 43.0 ft' 73.0 ft' 6.0 in-' .010 SCH 80 SS
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. et. in.
❑Ind ustrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
01rr1 ation ❑Wells> 100,000 GPD FROM TO MATERIAL EMPLACEMEW51ETHOD&AMOUNT
Non-Water Supply Well:. 0.0 ft. 38.0 ft' NEAT PORTLAND CEMENT SLURRY(PUMP)
❑Monitoring ❑Recovery ft. ft.
Injection Well:
❑Aquifer Recharge ❑Groundwater Remediation ft. ft.
19.SAND/GRAVEL PACK ifa licable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT M1IETHOD
❑Aquifer Test ❑StormwaterDrainage 38.0 ft' 41.0 ft. 16-50(#1) POUR
❑Experimental Technology ❑Subsidence Control 41.0 ft. 74.0 ft. 7-35:(#2) POUR
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary)
❑Geothermal(Heating/Cooling Return) f10ther(explain under#21 Remarks) FROM TO DESCRIPTION color,hardness,son/rock type,ginin size,etc.
0.0 ft' 55.0 ft- BROWN SILTY SAND
4.Date Well(s)Completed: 08/08/22 Well ID# IN-20 55.0 ft- 65.0 ft. PWR
5a.Well Location: 65.0 fL 69.0 ff WEATHERED ROCK
DUKE ENERGY OF THE CAROLINAS MARSHALL STEAM STATION 69.0 ft. 74.0 ft. ROCK
Facility/Owner Name - Facility[D#(ifapplicable) ft. ft.
8320 NC HIGHWAY 150 SHERRILLS FORD 28673
Physical Address,City,and Zip ft. ft.
CATAWBA 461803426350 21.REMARKS
County Parcel Identification No.(PIN) * *INFILTRATION-
ib.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
STAINLESS STEEL SUMP-73.0-74.0 FEET
(if well field,one]at/long is sufficient) 22.Certification: -
350 35' 40.36" N 800 57' 58.21" W 1461 A7` 08/23/22
6.is(are)the well(s): INPermanent or ❑Temporary Signature ofCertified Well Contractor I Date
by signing this ftrut,/hereby certify that the Irell(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or ONo 15A NCAC 02C.0100 or 15.4 NCAC 02C X200 Well Construction Standarch and that a capl,
/)'this is a repair,fill out known well construction iglbrtnation and explain the nature of the of this record itas been provided io the well owner.
repair tinder=21 rentarkv section or on the back of thix Jornt.
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 eonstructioii-info=--
construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also at&l addit(onaJ ages iTtie ess rv;
'a � ..
drilled: 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 74.0 (ft) JAIL Q 2023
For multiple wellx list all depths ifdiJJerent(exam a(example-3 100'and 2@100') Submit this GW-I within 30 days of well completion per the following:
10.Static water level below top of casing: 58.0 (ft) 24a. For All Wells: Original form'to Divisito�ii'c)N l i�eS,RespJ`sn�
lfwaterlevel is above caring,use
information Processing Unit,1617 MSC;Raleigh,NC 27694_9iet
11.Borehole diameter.
14.0 24b. For Injection Wells: Copy to DWR, Underground injection Control (IUC)
(in.) Program, 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: AUGER/AIR ROTARY �
24c.For Water Supply and Open-Loon 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 900,000 GPD:Copy to DWR,CCPCUA
Permit Program, 1611 MSC,Raleigh,NC 27699-1611
13a.Yield(-,pm) Method of test:
13b.Disinfection type: Amount: '
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources I Revised 6-6-2018
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