GW1-2023-00641_Well Construction - GW1_20230105

i.
WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only: f(
1.Well Contractor Information:
I {
NICHOLAS HAYES 14.WATERZONES {
FROM TO DESCRIPTION
Well Contractor Name } !
A - 4121 ft. ft. r
NC Well Contractor Certification Number 15.OUTER CASING Qfor multi-cased wells OR LINER(if a livable)
GEOLOGIC EXPLORATION FROM TO DIAMETER THICKNESS hATERIAL
ft. ft. I in.
Company Name
WI0300437 16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#: FROM TO DIAMETER _I THICKNESS I MATERIAL
List all applicable well construction permits(i.e.(11C.County.State,flariance,etc.) 0.0 ft- 40.0 ft. 6.0 t• in. SCH 80 PVC
3.Well Use(check well use): ft. ft. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 40.0 ft' 100.0 ft' 6.0 1O' .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 ❑Wells>100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0.0 ft. 35.0 ft' NEAT PORTLAND CEMENT SLURRY(PUMP)
❑Monitoring ❑Recovery ft. ft.
injection Well: ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK if a livable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL I EMPLACEMENTMETHOD
❑Aquifer Test ❑Stormwater Drainage 35.0 "- 38.0 ft, 16-50(#1) POUR
❑Experimental Technology ❑Subsidence Control 38.0 ft- 101.0 ft. 7-35,(#2) POUR
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets ifnecessa
❑Geothermal(Heating/Co_oli_ng Return) IJOIher(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness,soil/rock e,chain size,etc.)
0.0 ft. 65.0 ft.
BROWN SILTY SAND
4.Date Well(s)Completed: 07/26/22 WeII ID# IN-2 65•0 ft. 80.0 ft. PWR
5a.Well Location: 80.0 ft. 100.0 ft. WEATHERED ROCK
DUKE ENERGY OF THE CAROLINAS MARSHALL STEAM STATION 100.0 ft- 101.0 ft` ROCK
Facility/Owner Name Facility ID#(ifapplicable) f[. ft.
8320 NC HIGHWAY 150 SHERRILLS FORD 28673
Physical Address,City,and Zip ft. ft.
CATAWBA 461803426350 21•1EINIARKs
County Parcel Identification No.(PiN) -INFILTRATION***
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: STAINLESS STEEL SUMP- 100.0- 101.0 FEET
(if well field,one]at/long is sufficient) 22.Certification: -
350 35' 40.54" N 800 57' 57.99" W 08/23/22
6.Is(are)the well(s): IMPermanent or ❑Temporary Signature of Certified Well Contractor Date
Hy signing this forte,1 hereby certify drat fire u'ell(s)was(were)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 c•olm
/fthis is a repair,Jill out known well construction inlormation and explain the nature of file ofthis record has been prorided to the hell owner.
repair under"21 remarks section or an the back oJ7his form.
23.Site diagram or additional well details,--
You
S.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same may use the back of this page to prowde additional-+yell c6nstruetSOn info
construction,Only I GW-I is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach additional Pages if necessary.
drilled: 24.SUBMITTAL INSTRUCTIONS JAN Q v 29L3
101.0
9.Total well depth below land surface: (ft.) a�--- +:�� fir^ u';'
I-loraultrple wells'list all depths ifdiJfereni(example-3@200'and 2 a 100') Submit this GW-1 within 30 days of weifCbtltpY�-t r Q,Jjp�'r5,tili'-Tp[lo<c�ng:
'l.ti�+J�
10.Static water level below top of casing: 64•0 (ft) 24a. For All Wells: Original form to Division of Water Resources (DWR).
1/lrarer lore/is abate caving,ere' Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
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 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
Permit Program, 1611 MSC,Raleigh;NC 27699-161 1
13a.Yield(gpm) Method of test:
i
13b.Disinfection type: Amount: {
II
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources I Revised 6-6-2018
i
j,
t '
1