GW1-2023-00640_Well Construction - GW1_20230105

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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
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells)OR LINER if a licable
GEOLOGIC EXPLORATION FROM TO DIANIETERi THICKNESS MATERIAL
ft. f[. j ih.
Company Name
WIO3OO437 16.INNER CASING OR TUBING(geothermal closed-loon)
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS I MATERIAL
Lisi all applicable well consirucrion permit[(i.e.(1/C,Coumy.Stale,Mariance,etc.) 0.0 ft. 40.0 ft• 6.0 ' in' SCH 80 PVC
3.Well Use(check well use): ft. ft. in.
Water Supply Well: 17.SCREEN
OA-ricultural OMunicipal/PublicFROM TO DIAMETER THIC
KNESS CKNESS i•IATERL L
40.0 ft' 80.0 ft' 6.0 in.
010 SCH 80 SS
DGeothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) fr. fr. in.
❑Ind ustrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑irri ation 0Wells>100,000 GPD FROM TO MATERIAL EMPLACEA(ENTAILTHOD d AMOUNT
Non-Water Supply Well: 0.0 ft. 35.0 ft' NEAT PORTLAND CEMENT SLURRY(PUMP)
❑Monitoring ❑Recovery
Injection Well: ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK ifa licable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT NIETHOD
❑Aquifer Test ❑Stormwater Drainage 35.0 ft• 38.0 ft• 16-50(#1) POUR
❑Experimental Technology ❑Subsidence Control 38.0 ft. 81.0 ft. 7-35(#2) POUR
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary)
❑Geothermal(Heating/Cooling Return) InOther(explain under 921 Remarks) FROM TO DESCRIPTION(color,hardness,soil/rock type,grain size.etc.)
0.0 ft• 60.0 ft• BROWN SILTY SAND
4.Date Well(s)Completed: 07/26/22 Well ID# IN-3 60.0 fc• 70.0 ft. PWR
ia.Well Location: 70.0 t3. 80.0 ft. WEATHERED ROCK
DUKE ENERGY OF THE CAROLINAS MARSHALL STEAM STATION 80.0 ft• 81.0 ft• 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) '**INFILTRATION`..
ib.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
STAINLESS STEEL SUMP-80.0-81.0 FEET
(if well field,one lat/long is sufficient) 22.Certification:
350 35' 40.33" N 800 57' S8.17" W 08/23/22
6.is(are)the well(s): [EPermanent or []Temporary Signature of Certified Well Contractor Date
By signing this form,i hereby certlyy that the ire//(s)Lras(were)construcled in ac•c•ordanc•e with
7.Is this a repair to an existing well: ❑Yes or MNo 15A NCAC 01C.0100 or JSA NCAC 01C:0100 Well Construction S'tandardv and than a corer
lJ7his is a repair,fill oul known irell construction information and explain the nature of the ofthis record has been provic%d to the well owner.
repair under"11 remarks-section or on the back of'this forni.
23.Site diagram or additional well details:
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same YOUmay use the back of this page to provide additional well construction info
construction,only I GW-1 is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach at�f^cTl£1on pasi:Lffi�desaf}:� �•:
drilled: 24.SUBMITTAL INSTRUCTIONS n
9.Total well depth below land surface: 81.0 (ft.) J�U 202J
har withiple ire//.[list all depilts ifdfjerent(exantp/e-3«1!1!J'and 1 at/00') Submit this GW-1 within 30 days of well completion per a foll lvittg:
67.0 24a. For All Wells: Original form'to Division Q(j� tof 25D1ilCes (.p 5 f2�•Uria
fi Static water level below top of casing: (ft.) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1(Dqy;C bQ1;OG
IJ'uater level is above caving,use"+"
11.Borehole diameter: 14.0 (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 Supplv 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
Permit Program, 1611 MSC,Raleigh,NC 27699-161 1
13a.Yield(gpm) Method of test:
13b.Disinfection type: Amount: {,
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Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018
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