GW1-2023-00647_Well Construction - GW1_20230105

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only: f
1.Well Contractor Information: JI
KENNY SARGENT
14.WATER ZONES {
Well Contractor Name - FROM TO DESCRIPTION
ft. ft. 11
A - 4226 et. ft. 1 1
NC Well Contractor Certification Number '' '
/^ /�T� 15.'OUTER CASING for-multi-cased'rvells OR LINER if a licable'
GEOLOGIC EXPLORATION FROM TO DIAMETER THICKNESS hATERIAL
ft. ft. tin.
Company Name it
16.INNER CASING OR TUBING: cothermal closed-loon)
2.Well Construction Permit# FROM TO DIAMETER_ . THICKNESS I MATERIAL
Lint all applicable well construction permits(i.e.UIC,County,State,Variance,eic.) 0.0 ft' 1$.0 ft• 2.0 'In' SCH 40 PVC
3.Well Use(check well use): ft. ft. in.
_
Water Supply Well: 17.SCREEN
FROM TO DIAMETER' SLOTSIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 18.0 f" 28.0 ft. 2.0 in, .010 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. I ft.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT.
❑Irrl alion ❑Wells>100,600GPD _ FROM TO MATERIAL-- EMPLACEMENT-METHOD B•AMOUNT
Non.-Water Supply Well: 0•0 ft' 11.0 ft- NEAT PORTfANDCEMENT SLURRY
1!5M.onitoring ❑Recovery ft. ft.
Injection Well:
❑Aquifer Recharge ❑Groundwater Remediation +'
19.SAND/GRAVEL PACK ifa licable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL I EMPLACEMENTMEfHOD
❑Aquifer Test ❑Stormwater Drainage 16.0 ft- 28.0 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) 00ther(explain under 421 Remarks). FROM TO- _ DESCRIPTION color,hardness,soil/rock type,gmin size,etc.
_ 0.0 ft. 1.0 ft. GRAVEL
4.Date Wells)Complet 08
ed: /11/22 Well ID# EMP75S 1.0 ft. 9.0 � ft• BROWN SIL1Y CLAY
5a.Well Location: 9.0 f�' 28.0 ff BROWN SILT
DUKE ENERGY OF THE CAROLINAS MARSHALL STEAM STATION
Facility/Owner Name Facility ID#(if applicable)
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)
BENTONIfE SEAL- 11.0-16.0 FEET
•
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one fat/long is sufficient) 22.Certification:
350 35' 43.52" N 800 57' 54.54" W
08/23/22
6.Is(are)the well(s): OPermanent or ❑Temporary Signature of Certified Well Contractor i, Date
By signing this form,I hereby certify that the treil(s)eras(u,ere).constructed in accordance nri'ih
7.Is this a repair to an existing well: ❑Yes or MNo 15A NCAC 02C.0106 or 15A NCAC 02C:020f.&�-WehkGoosrructlov Standards and that a copy
1J'th/s is a repair,fill out known well construction information and explain the nature of the ojthis record has beenprovided to the nrel/on�i"er
repair under 421 remarks section or an dre back ojthis jornn. �`r'�^-f E,r'' 4•r,+•„,'
23.Site diagram or additional well,details•
8.ForIGeoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provJAaWd#nP struction info
construction,only I GW-1 is needed. Indicate TOTAL NUMBER&wells (add'See Over in Remarks Box).You may also attach additional p ges if necessary.
drilled: 'ttl7iaai?s. <:?7 �r".a.'^r^j ,.
24.SUBMITTAL INSTRUCTIONS : � . Ur.7
0
9.Total well depth below land surface: 28. ft.
For multiple wells Itsr all depths ijdi{Jerent(exannple-J rt 00'and 2@/00') ( ) Submit this GW-I within 30 days of well completion per the following:
1,
10.Static water level below top of casing: 23•0 (ft) 24a. For All Wells: Original form to Division Of Water Resources (DWR),
If water level is above casing,use"+" Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter: 6.0 (in) 24b.For Injection Wells: Copy to DWR,Underground Injection Control(IUC)
Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: SONIC a 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 o e 100,000 GPD:Copy to DWR,CCPCUA
13a.Yield(gpm) Method.of test: Permit Program, 1611 MSC,Raleigh;NC 27699-1 6 1 1
13b.Disinfection type: Amount:
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018