GW1--05137_Well Construction - GW1_20230818

WELL-CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
BR'IAN THOMAS 14.WATER ZONES
. FROM -TO DESCRIPTION
Well Contractor Name
ft. ft.
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 1 MATERIAL
fr, ft. in.
Company Name
16.INNER CASIN,C:OR TUBING(geothermal closed-loop).
2.Well Construction Permit#: W R0300123 FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.U/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
FROM TO DIAMETER SLOT SIZE THICKNESS 'MATERIAL
• loAgricultural ❑Municipal/Public 75.0 ft. 190.0 ft* 6.0 in* .010 SCH 80 SS
OGeothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in.
❑Industrial/Commerci r s :'' ji^ y ❑'exid tal Water Supply(shared) 18•GROUT
❑Irrigation Y-o` •
6 'ri l s 00,000 GPD FROM. TO MATERIAL EMPLACEMENT METHOD&AMOUNT
• NEAT PORTLAND CEMENT
Non-Water g apply Well: Ant,I� 1 8 �a„ ry 0.0 tt• 60.0 ft. SLURRY(PUMP) •
❑Monitorin HU t11,LCtycove ft. ft.
Injection Well: •' .
❑Aquifer Recharge fY1�F5Ptr"26rfl Pir9C ft. • ft.
�E�6later Remediation
DWQl- ' • '19.:SAND/GRAVEL PACK(if applicable)
❑Aquifer Storage and Recovery uSalinity Barrier FROM TO , MATERIAL EMPLACEMENT METHOD '
OAquifer Test ❑Stormwater Drainage 70.0 ft 191.0, ft 7-35(#2) POUR
❑Experimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) ❑Tracer 20i DRILLING LOG(attach.additional sheets if necessary) . -
FROM TO . DESCRIPTION(color,hardness,soil/rock type,grain size,etc.)
❑Geothermal(Heating/Cooling Return) Mother(explain under#21 Remarks)
0.0 ft. 23.0 ft RED SILTY CLAY
4.Date Well(s)Completed: 07/27/23 Well ID# EX-73SBR 23.0 ft• 37.0 ft• TAN SILTY SAND
5a.Well Location: 37.0 ft '67.0 ft BROWN SILTY SAND
DUKE ENERGY CAROLINAS MARSHALLSTEAM STATION 67.0 ft. 115.0 ft* PWR
Facility/Owner Name - Facility IN(if applicable) 115.0 ft. 191.0 ft ROCK
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 60.0 70.0 FEET
STAINLESS STEEL SUMP- 190.0- 191.0 FEET
5b.Latitude and longitude in degrees/minutes/seconds Or decimal degrees:
(if well field,one lat/long is"sufficient) 22.Certification: ,
35° 35' 42.18" N 80° 57' 56.44" • w -Our-- 07/31/23
6.Is(are)the well(s): 21Permanent or ❑Temporary Signature of Certified Well Contractor Date
Hy signing this form,/hereby certify that the we//(s)was(were)consirucied in accordance with
7.Is this a repair to an existing well: ❑Yes or l5No /5A NCAC 02C.0/00 or ISA NCAC 02C.0200 Well Construction Standards-and that a copy
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;/21 remarks section or on the back of this form.
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 I 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/2liffereni(example-3 ct200'and 2 cr I00') Submit this GW-1 within 30 days of well completion per the following:
19.4 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 water level is above 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 Rettirn 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:
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Fonts GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018