GW1-2023-00651_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
Well Contractor Name FROM TO DESCRIPTION
ft. ft. I
A - 4121 ft. ft.
NC Well Contractor Certification Number 15.OUTER.CASING for multi-cased wells OR LINER if a licable
GEOLOGIC EXPLORATION FROM TO DIAMETER I THICKNESS MATERIAL
0.0 ft 50.0 ft• 8.0 1.i" SCH 80 PVC
Company Name
16.INNER CASING OR TUBING eo'thermal closed-loop)
2.Well Construction Permit#: WR0300123 FROM TO DIAMETER THICKNESS MATERIAL
List all applicable ire/l construction permits r.e.U/C.County,State,I'ariance,etc.) ft. ft. iri.
P in.
3.Well Use(check well use): ft fr. I
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public ft. ft. in.
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in.
Olndustrial/Commercial ❑Residential Water Supply(shared)
18.CROUT -
❑Irri ation ❑Wel Is> 100,000 GPD FROM TO MATERIAL EMPLACEMENTMECHOD&AMOUNT
Non-Water Supply Well: 0.0 ft- 50.0 ft' NEAT PORTrAND',CEMENT SLURRY
❑Monitoring ❑Recovery ft. fr.
Injection Well:
ft. ft. i
❑Aquifer Recharge ❑Groundwater Remediation
• 19.SAND/GRAVEL PACK if a licable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO I MATERIAL I EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage ft. fr.
❑Experimental Technology OSubsidence Control ft. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLiNG LOG attach additional sheets if necessary)
❑Geothermal(Heating/Cooling Return) CJOther(explain under 421 Remarks) FROM TO DESCRIPTION color,hardness,soil/mck e,flrnin size,etc.)
0.0 ft• 25.0 ft- BROWN SANDY SILT
4.DateWell(s)Completed: 10/1 9/22 Well ID# EX-34BR 25•0 rt. 40.0 fr PWR
5a.Well Location: 40.0 ft• 250.0 ft' ROCK
DUKE ENERGY OF THE CAROLINAS MARSHALL STEAM STATION ft. ft.
Facility/Owner Name Facility ID#(if applicable)
8320 NC HIGHWAY 150 SHERRILLS FORD 28673
Physical Address,City,and Zip ft. fr.
CATAWBA 461803426350 21.REMARKS
County Parcel Identification No.(PIN) OPEN HOLE
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one lat/long is sufficient) 22.Certification: i
350 35' 40.68" N 800 57' 54.79" W 12/14/22
6.Is(are)the well(s): OPermanent or ❑Temporary Signature of Certified Well Contractor Date
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By sighing this farm,!hereby certify that dre srell(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or ONo 15A NCAC 02C.0/00 or 15A NCAC 02C''0200 IYe//Consrru n,S�onda�ds hn k!lrrr c?tp/
l p �• f p 1 o this record has been provided to the well'ou-ner. ,( 'i1� `" '• `
I'lhi.r is a rc air, tll out known well construction in orointion and ex loin the nature o dre f Q
repair under»2/remarks secviat or on the back oflhis jor»t.
23.Site diagram or additional well details: nn
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additidibiN je&tr�irsli2 info
construction,only I GW-1 is needed. indicate TOTAL NUMBER of wells (add'See Over in Remarks Box).You'may also attach a ditiona pages if necessary
drilled:
24.SUBMITTAL INSTRUCTIONS `n;C;'t• a 3'• '
9.Total well depth below land surface: _ 250.0 (ft) Submit this GW-1 within 30 days of well completion per the following:
For nurltiple wells list all depths lfdi,Jferent(example-3@200'and 2 tt l00')
10.Static water level below top of casing: 9.9 (ft) 24a. For All Wells: Original form,to Division of Water Resources (DWR),
Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
1f water level is above casing,rise"T
11.Borehole diameter•. 16.0/7.0/12.0 (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
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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 6 1 1
13a.Yield(gpm) Method of test: li i
13b.Disinfection type: Amount:
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018