GW1--03021_Well Construction - GW1_20230306

WELL CONSTRUCTION RECORD Far Imcnml Use ONLY:
This farm con be used fm single or ttmhiplc n'clis
1.Well Contractor Information:
14.AVATER TONES
Zach Thompson FRO51 TO I DKsCRIPTu)N
%V01 Coranrcior Nanw ft. ft.
4478-A ft. ft.
NC Wc11 CoMmcrarCcnift,cation Ntutber 15.OUTER CASING troi tooth-caged d'clls OR LINER lif a 'flcabkl-
FROM TD nuxrTER Tfolct tEss MATERTAL
SAEDACCO Inc 0 (L 25 (L 2- in. I SCH-40 PVC
(:dav; Iy Namc M INNER CASING OR TUBING'eadwrreal closed-lon i
FROM TO DLMRIETER TRIMNESS MATERLIL
2.Well Construction FCrrnit 4: ft. ft, in.
List all rj7P rrrhlr w-e)1 paJmita(Ga.Comity.S.,xv,Vorrdtwe,l)'ecdCrb err..)
ft, rut. its
3,Wc1l 135c(checlewdl use): 17:sCttE t n
WaterSuppiy Well: FROM I TO MAtiIF.TFR SLOTSM. T1nCKNFSs I MATERIAL.
Mgriculturul 0M.Unicipal/Pabtic 25 ft. 35 R. 2- k .010 SCH-40 PVC
13Geathemral(Iiea(ingtCooling Supply) ®Residentiat Water Supply(single) ft. ft.
❑IndustriaUContmtcrcial l3Residenrial Wow Supply(shared) FROG.rtRO� TO MATER[AL EMPL%CESISVThiEtttODSAMOUNT
❑hri titian 0 ft. 19 M Portland Injection
Non-AS'ater Supply Welly
®14tonitoring ❑Rccol-cry
R. R.
Injection Well: ft. fL
❑Arplifcr Recharge Q(mundwalcr Rcmcdiation t9:SANDIGRAVEL PACx tit t slicable
FROM TO 31ATt:RE4t. CaMP1AM1V.NTHF:TH0n
❑AquifcrStoragcaudRccovcy Malinity8arda 23 ft. 35 ft. Filter Sand #2
❑Aquifer Test ❑Stortn;rtcr Drl'kmaoc
r1, rL
❑1 cperinicntal Tcchnotogy ❑Sithsidcncc Control
'20:DRILLING LOG latlach addilioaal sheets if acccssmti9
❑Geothemlal(Closed Loop} ❑Tracer FROM I To DESCRIPTION(cobr.harttncsv,v,1'ncekh .-anv,ac/al
❑Geothermal(IleatinelCoolitte Return) 1:30ther(M- laitt under 921 RematW 0 ft. 35 fi. Brown Sand !.,,• ,_.- -.
ft. It.
4.Date,NWH(s)Completed: 2-15-2023 WellID#CLF-23-408 z
R. rL
59.Well Ia►catinn: ft. ft.
Duke Energy It A.
FaciIity;%bvncrNanv-- Factill)•IDM(ifapplimble)
R. A.
8320 NC-150, Sherrills Ford, NC, 28673 ft. fl
Physical Addicss.City.and Zip 2 t.ltEM1fARKS
Catawba Bentonite seal from 19-23'
Caouty Patrol Willifialliou No,(PIN)
Sb.I iltitude and I1.on9itudc in dCgn'es/minutc5/sec0'nds or decimal dCgIVCs: 22.Certification:
(tl�„•n rKw,ulr 1:u.7u�sissitn;ck.t�t) �,�,
35.6165 N 80.9741 W '.r""�� 2/16/2023
Igtutun orccitirEd}Vei Cafluxtar Dale
6.IS(are)the R'CII(s}: EPermanent or ❑Temporary fly signlrrg lhir farm,1 hereby cerrifv char the urdl(si mwx(sure)carymuctrrl is rrcconLmue
u•(rh 15A NOW 02C,0109 or I S t NCAC 02C,O1.00 Rill Consrrt,ir(on Srarriards and rlxrr a
7.Lc this a repair to as exist rig well: t7Ycc or MNo ropy ofthlr record has Fern praridt-4 ra rtia in•N'ou7ser,
lfrbls 14 a repalr,fill cerr.(r,vicar tall cownuMon brfortm0pa and eaplobi the nrrutre of die
rcprirrdirler d021 mnarkvj4crima or an the brup:of this•jorm. 23.Site diagram or additional well details:
You may use t1k bacl,of this paa*e to provide additional well site details or isell
8.Number of wells cousinicted: 1 cous(nlction details. You ma}'ali(1:ittacb udclitiottal pab s if uec t'ssary.
For rnalrlple hVecrlon or anti-roarer supply n-rHs ONLY rrlrh the sanrFCartrtraetimr,$fa Caa
submit one form. SUBMITTAL.INSTUC.TIONS
9.Total well depth below land surface: 35 (ft.) 24a. For All Wells: Submit plus fart within 30 days of completion of 1►'ell
For nmlrlple teells list all tfcpuhT 1f differeou fex4iwjple-3@20'aml 2G_a100) construction to cite foltottingn:
In.Static eater level below top of casing: 5.5 (ft.) Division of Water Resources,Information Processing Unit,
If trdier level is above cuaing;aye"+" 1617 Mail Sen'ice Center,Raleigh,NC 27699-I617
11.Borehole diameter.8.25° (in.) 24b.Fnr Infecfi0n We119 ONLY: In addition to sending the fort to the address in
24a ab&e. also subiltit a copy of this fonn within 30 days of completion of well
12.Well aonstmetion method: HSA construction to the following:
(Le.auger.rmaq•,cable dket push.crc:y
Division of Water Resautce9,Undel blvund injection Control Proerant,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center.Raleigh.NC 27699-1636
I3a,Yield(Ppm) Method of test: 24c.For Water Snliph&11ectfoa Wells:
Also subtisit one copy of this fortis. within 30 days ofcompletionof
13b.Disinfection type. Amount: ectl construction to the cour ty health dcparimcnt cif the county when:
constructed.
Faun GW-1 N-Dnh Carolina Depar mcnt of Enyifonmcm and uautrnJ Resources—Divi;lon of Water Rearm-- Revised Aigust 2013