GW1-2023-00636_Well Construction - GW1_20230105

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
NICHOLAS HAYES 14.WATERZONES t i.
Well Contractor Name FROM TO- DESCRIPTION
1 C
A 4121 ft. rt. I
NC Well Contractor Certification Number 15.OUTER CASING for multi-cased wells OR LINER(if a licable
GEOLOGIC EXPLORATION FROM - TO DIAMETER! TWO
MATERIAL
in.
Company Name
WI0300437 16.INNER CASING OR TUBING cothermaI closed-loo
2.Well Construction Permit 9: FROM TO: DIAMETER THICKNESS MATERIAL
List all applicable wel/construction permits(i.e.UIC.County,State,Variance,etc.) 0.0 f`• 35.0 ft- 6.0 II 1O' SCH 80 PVC
3.Well Use(check well use): fr. ft. in.
Water Supply Well: 17.SCREEN
FROh1 TO DIAMETER' SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 35.0"' 65.0 f1' 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
❑lrri ation ❑Wel Is>100,000 GPD FROM TO MATERIAL EIIIPLACEMENTMETHOD&AMOUNT
Non-Water Supply Well: 0.0 ft- 29.0 ft' NEAT PORTLAND CEMENT SLURRY(PUMP)
❑Monitoring ❑Recovery ft. ft.
Injection Well: ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation
❑Aquifer Storage and Recovery ❑ 19.SAND/GRAVEL PACK if alicableSalinity Barrier FROM TO MATERIAL EMPLACEb1ENT AfETHOD
❑Aquifer Test ❑Stormwater Drainage 29.0 ft' 32.0 f1• 16-50(#1) POUR
❑Experimental Technology ❑Subsidence Control 32.0 ft- 66.0 ft• 1-35(#2) POUR
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary
❑Geothermal(Heating%Cooling Return) 110ther(explain under 921 Remarks) FROM TO DESCRIPTION color,hardness,souhwk type,gmi.size,etc.)
0.0 ft, 55.0 ft- BROWN SANDY SILT
4.Date Well(s)Completed: 08/02/22 Well ID# IN-15 55.0 ft- 64.0 f`• PWR
5a.Well Location: 64.0 ft• 66:0 ft• ROCK
DUKE ENERGY OF THE CAROLINAS MARSHALL STEAM STATION ft. fr.
Facility/Owner Name Facility ID#(ifapplicable) ft. ft.
8320 NC HIGHWAY 150 SHERRILLS FORD 28673 ft. ft.
Physical Address,City,and Zip ft, ft.
i'.
CATAWBA 461803426350 21.REM RKS
County Parcel Identification No.(PIN) 'INFILTRATION***
Sb.Latitude and longitude in degrees/mifiutes/seconds or decimal degrees:
STAINLESS STEEL.'SUMP-65.0-66.0 FEET
(if well field,one Iadlongis sufficient) 22.Certification:
350 35' 41.53" N 800 57' 56:71 W 081/23/22
6.Is(are)the well(s): OPermanent or ❑Temporary - Signature of Certified Well Contractor Date
lIji,signing tins form,I hereby cerfijy that(he well(s)tray(here)constructed in accordanceu'ith
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
1J'this is a repair,fill out knotrn tre/1 construction It formation and explain the nature of the gr1his record has been provided to the trell ou ner.
repair under=21 remarks section or or the back oftnis forty. i.
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�io'provide additional well construction info
construction,only I GW-I is needed. Indicate TOTAL NUMBER of wells (add'See Oveth in Remarks Box).You may also attach additional pages if necessary.
drilled:
24.SUBMITTAL INSTRUCCIONS�':'? "� '
9.Total well depth below land surface: (ft.) Submit this GW-1 within 30 days of well p 4plioo-pof�heufollowing:
For nn ltiple trells list all depths ifd�erenl(example-9«200'and 2@100') A Y ,� LL [[.�7
51.3 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 tG-Ra4 1 NCB 699� r
Ifn•atei•level ir above casing,use'-.
I r�W' ur��
14.0 24b. For Injection Wells: Copy to DWR,UttdCfgriluna"Injection Control(fUC),
11.Borehole diameter: (in.) Program, 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: AUGER/AIR ROTARY I
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 over 100,000 GPD: Copy to DWR,CCPCUA
13a.field(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