GW1--05136_Well Construction - GW1_20230818

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information: .
BRIAN THOMAS 14.WATER ZONES " '
•
FROM TO • DESCRIPTION
Well Contractor Name ft. ft. 1
A - 2581 ft. ft. .NC Well Contractor Certification Number 15.-OUTER CASING(for multi-cased wells)OR LINER(if ap licable)
GEOLOGIC EXPLORATION FROM TO .' DIAMETER THICKNESS MATERIAL
ft. ft. in.
Company Name
.16.INNER CASING OR TUBING(geothermal closed-loop)
W R0300123 •
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS .MATERIAL
List all applicable well construction permits(i.e.f//C,County,State,Variance,etc.) 0.0 ft• 75.0 ft* 6.0 in. SCH 80 PVC
3.Well Use(check well use): • ft. ft. in.
Water Supply Well:
17:SCREEN
f•a 'w � FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
OAgricultural i. E p,f cipal/Public ft- ft. in.
75.0 190,0 6.0 .010 SCH 80 SS '
❑Geothermal(Heating/Cooling Supplyij ❑Residential Water Supply(single) ft. ' -ft. in. •
❑Industrial/Commercialp+U G 1 L0Z_Residential Water Supply(shared) 18."GROUT "
❑Irrigation ,�}-T �(@A*> 100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supllljrj�7 ]Pf;tt r1L4voa•• L ft. ft• NEAT PORTLAND CEMENT
DWQ/SD�s 0.0 65.0 SLURRY(FUME)
❑Monitoring . ❑Recovery •
ft. ft.
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 ❑Stormwater Drainage 70.0 ft' 191.0. ft. 7-35(#2) POUR
❑Experimental Technology ❑Subsidence Control ft. . ft.
OGeothermal(Closed Loop) OTracer ,20.DRILLING LOG(attach additional-sheets if necessary`) •
FROM TO • DESCRIPTION(color,hardness,soil/rock type,grain size,etc.)
❑Geothermal(Heating/Cooling Return) lOther(explain under 421 Remarks)
0.0' et• 7.0 ft' RED SILTY CLAY
4.Date Well(s)Completed: 07/18/23 Well ID# EX 67SB R 7.0 ft. 71.0 ft' TAN SILTY SAND
5a.Well Location: 71.0 ft- 88.0 ft' . PWR
DUKE ENERGY CAROLINAS MARSHALL STEAM STATION 88.0 ft. 191.0 ft' ROCK .
Facility/Owner Name Facility ID#(if applicable) ft. ft.
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) BENTONITE SEAL-65.0-70.0 FEET
•
STAINLESS STEEL SUMP,- 190.0- 191,0 FEET
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22.Certification:
35° 35'.41.49" N 80° 57' 57.17" w ,•,,6 wJ
07/24/23
6.Is(are)the well(s): OPermanent or ❑Temporary Signature of Certified Well Contractor Date
By signing this form,!hereby certify that the.well(h)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or 21No 15A NCAC 02C.0/00 or/5A NCAC 02C.0200 Well Construction Standards and that a cow
If this is a repair,fill out known well construction information and explain the nature of the of this record has been provided to the well owner.
repair under t12/remarks section or on the back ofthis farm.
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 well construction info
construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach additional pages if necessary.
drilled: 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 191•0 (ft.)
For multiple wells list all depths i/'different(example-3@200'and 2 a/00') Submit this GW-I within 30 days of well completion per the following:
27.1 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
//'water level is'ahove casing,use"+"
11.Borehole diameter: 14.0/10.0/6,0 (in.) 24b. For Injection Wells: Copy to DWR,Underground Injection Control(IUC)
Program, 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: AUGER/AIR/SONIC
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 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:
Form OW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018