GW1-2023-00672_Well Construction - GW1_20230105

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information: i
BRIAN THOMAS 14.WATER ZONES r
Well Contractor Name FROM TO DESCRIPTION
ft. y
A - 2581 fr.
ft. ft.
I.NC Well Contractor Certification Number 15.OUTER CASING for multi-cased wells OR LINER if a tlicable
GEOLOGIC EXPLORATION FROM TO DIAMETER THICKNESS MATERIAL
Company Name
0.0 ft. 1 159.0 ft. 6.0 in I SCH 80 PVC
16.INNER CASING OR TUBING eothermal closed-loon)
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.UiC,County,State,Variance,etc.) 0.0 ft' 166.0 ft. 2.0 in. SCH 40 PVC
3.Well Use(check well use): ft. ft.
Water Supply Well: FROM
TO DIAMETER SLOTSIZE- THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 166.0 e, 176.0 ft' 2.0 1n. .010 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. fr. in:
❑Industrial/Commercial ❑Residential Water Supply(shared) '
18.GROUT
❑Irri ation ❑Wells>100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: ft. ft.
PP y 0.0 141.0 NEAT PORTLAND CEMENT SLURRY
OMonitoring ❑Recovery 0.0 ft' 159.0 ft' NEAT PORTLAND CEMENT SLURRY
Injection Well: ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK(if applicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM _ TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑StormwaterDrainage 164.0 ft• 179.0 ft. 20-40 FINE SILICA SAND
❑Experimental Technology OSubsidence Control ft. ft.
OGeothermal(Closed Loop) ❑Tracer 20.'DRiLLiNG LOG attach additional sheets if necessary)
FROM TO DESCRIPTION(color,hardness,soithwk type,grain size,etc.)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks)
0.0 ft• 75.0 ft• BROWN SANDY SILT
4.Date Weu(s)Completed: 11/30/22 WeI1ID# EMP-6BR 750 ft. 99.0 fr. BROWN PWR
5a.Well Location: 99.0 fr. 102.0 fL ROCK
DUKE ENERGY OF THE CAROLINAS MARSHALL STEAM STATION 102.0 ft. 132.0 ft- PWR
Facility/Owner Name Facility ID#(if applicable) 132.0 ft. 149.0 f` WEATHERED ROCK
8320 NC HIGHWAY 150 SHERRILLS FORD 28673 149.0 ft• 176.0 fc. ROCK
Physical Address,City,and Zip
CATAWBA 461803426350 21.REMARKS .
County Parcel Identification No.(PIN) BENTONITE SEAL-141.0-164.0 FEET
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22.Certification:
350 35' 42,22" N, 800 57' 54.29" w --- 12/13/22
6.is(are)the well(s): 11flPermanent or ❑Temporary Signature of Certified Well Contractor Date
By signing this•form,I hereby certify that the well(s)was(were)consiructed in accordance with
7.Is this a repair to an existing well: DYes or MIND 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy
!f this•is a repair,fill out known well construction it formation and explain the nature of the ofthis record has been provided to the well owner.
repair under,21 remarks section or on the back of this fornn.
23.Site diagram or additional well details:
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide-additional,v,vela,GMSt(:us Lion info
construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells (add'See Ovee in Remarks Box).You may als.'a taeh'a6ditittnal aces if DeRessan.
drilled: 24.SUBMITTAL ILN'STRUCTIONS
9.Total well depth below land surface: 176.0 (ft.) JAN 0 5z 2023
Farmultiple wells list all depths fdiiferent(example-3@200'and 2 a 100') Submit this GW-1 within 30 days of well completion per the following:
10.Static water level below top of casing: 21.8 (ft) 24a. For All Wells: Original fonri to Division of�Water.,Rd O&c8 t(DWR),
Information Processing Unit,1617 MSC,Raleigh,NC�7$�l-t1�1T
If water level is above casing,use"+" i
14.0/10.0/5.0 tab. For Injection Wells: Copy toDWR,Underground Injection Control(IUC)
11.Borehole diameter: (in.) Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: AUGER/AIR
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
i
FOR WATER SUPPLY WELLS ONLY:
24d.For Water Wells producing over,100,000 GPD: Copy to DWR,CCPCUA
Permit Program,1611 MSC,Raleigh;NC 27699-1611
13a.Yield(gpm) Method of test: ¢
13b.Disinfection type: Amount:
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Form GW-I North Carolina Department of Environmental Quality-Division orWater Resources $ Revised 6-6-2018
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