GW1-2023-00648_Well Construction - GW1_20230105

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTIONft. ft.
A - 2581
NC Well Contractor Certification Number 15.OUTER CASING for multi-eased wells OR LINER if a 9icable
GEOLOGIC EXPLORATION FROM TO DIAMETER THICKNESS L11.&.IAL
0.0 ft. 14.0 ft. 6.0 i" SCH 80 PVC
Company Name
16.INNER CASING OR TUBING(geothermal closed-log
2.Well Construction Permit#: WR0300123 FROM TO DIAMETER THICKNESS MATERIAL
List all applicable ivell construction permits(i.e.U/C,County,Slate,Variance,etc.) 0.0 ft• 144.0 ft. 14.0 '"' SCH 40 PVC
3.Well Use(check well use): fr. ft. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public ft. ft. in.
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Irri ation ❑Wells>100,000 GPD FROM TO MATERIAL E\IPLACEAIENTMETHODBADIOUNT
Non-Water Supply Well: 0.0 ft. 144.0 ft. NEAT PORTLAND CEMENT SLURRY
❑Monitoring ❑Recovery 0.0 ft. 14.0 ft. CONCRETE SLURRY
Injection Well: ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK if a tlicable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑StormwaterDrainage ft. ft.
❑Experimental Technology ❑Subsidence Control ft. I fr.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary)
❑Geothermal(Heating/Cooling Return) IJOther(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness,soil/rock type,ginin size,etc.
0.0 ft• 14.0 ft• BROWN SILTY SAND/COBBLES
4.Date Well(s)Completed: 1 2/02/22 Well ID# EX-55BR 14.0 ft• 144.0 ft• BROWN SANDY SILT/ROCK FRAGMENTS
5a.Well Location: 144.0 fL 231.0 BEDROCK
DUKE ENERGY OF THE CAROLINAS MARSHALL STEAM STATION
Facility/Owner Name Facility ID9(ifapplicable) ft. fr.
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) -OPEN HOLE-
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22.Certification:
350 35' 42.35" N 800 57' 53.58" W f:2 12/14/22
6.Is(are)the well(s): MPermanent or ❑Temporary Signature of Certified Well Contractor Date
By signing this•form,l hereby certify that the trei/(Y)iras(were)constructed in accordance frith
7.Is this a repair to an existing well: ❑Yes or ITNo 15A NCAC 02C.0100 or I5A NCAC 02C.0200 Well Construction S'landardv and that a copy
1 Ihis is a repair,Jill out knon•n nrell construction in orutalion and explain the native o the of this record lrav been provided to the trel!o atw. ?, 1
repair under k2l remarks section or on the back ofthis fora.
23.Site diagram or additional well'de
S.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page'to provt ��d. on � }}{{ ��struction info
construction,only I GW-i is needed. Indicate TOTAL NUMBER of\vells (add'See Ovel in Remarks Box).You may allUct�d It hl ages if necessary.
drilled: 24.SUBMITTAL INSTRUCTIONS
fi5'Liii�'��v:=1 Ufia
9.Total well depth below land surface: 231.0 (1t) r;tNa"BO•:
For multiple ire/Is list al/depths tf'diereni(example-J rt 200'and 2 a 100') Submit this GW-1 within 30 days of well comP(elEon per tfie following:
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 MSC,Raleigh,NC 27699-1617
If ureter level is above casing,use
11.Borehole diameter: (in.)
16.0/10.0/5.0 24b. For Injection Wells: Copy to DWR,Underground Injection Control(IUC)
Program, 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: SONIC/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 ofthe 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 27699-1 61 1
13a.Yield(gpm) Method of test:
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13b.Disinfection type: Amount:
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018
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