GW1--05138_Well Construction - GW1_20230818

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
I.Well Contractor Information: .
• BRIAN THOMAS 14.WATER ZONES.
Well Contractor Name FROM TO DESCRIPTION
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 MATERIAL
ft. ft. in.
Company Name 16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit ft: WRO3001 23 FROM TO DIAMETER THICKNESS MATERIAL .
List all applicable well construction pernt;/s(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.
•
17.SCREEN
Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 75.0 ft' 190.0 ft. 6.0 in' .010 SCH 80 SS
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ' ft. in.
❑Industrial/Cot gr{ia1 C.4�1 VV sidential Water Supply(shared) 18.GROUT
❑Irrigation ❑ eIIS>100,000 GPD FROM TO MATERIAL EMPLACEMENT M ETHOD&AMOUNT
Non-Water Supply W I' 20Z3 0.0 ft• 65.0 ft. NEAT PORTLAND CEMENT SLURRY(PUMP)
❑Monitoring AEG 1 ❑Recovery ft. ft.
Injection Well: Vit$
❑Aquifer Rech$tger 'ne,,, �❑Groundwater Remediation ft. ft.
r,)V4 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.
❑Geothermal(Closed Loop) OTracer _20.DRILLING LOG(attach additional sheets if necessary) •
•
OGeothermal(Heating/Cooling Return) EOther(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness,soil/rock type,grain size,etc.)
- 0.0 ft• 18.0 ft. RED SILTY CLAY
4.Date Well(s)Completed: 07/26/2.3 Well ID# EX-72SB R 18.0 ft• 31.0 ft. TAN SILTY SAND
5a.Well Location: 31.0 ft' 60.0 ft' BROWN SILTY SAND
DUKE ENERGY CAROLINAS MARSHALL STEAM STATION 60.0 ft• 106.0 ft• PWR
Facility/Owner Name Facility ID#(if applicable) 106.0 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 • '
BENTONITE SEAL- 65.0-70.0 FEET
County Parcel Identification No.(PIN)
STAINLESS STEEL SUMP- 190.0- 191.0 FEET
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
Orwell field,one lat/long is sufficient) 22.Certification: •
35° 35' 42.29" N 80° 57' S6.31" N „01.----
07/31/23
6.Is(are)the well(s): OPermanent or ❑Temporary Signature of Certified Well Contractor Date
By signing this farm,I hereby certify That the well(,)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or ONo /SA NCAC 02C.0/00 or ISA NCAC 02C.0200 Well Construction Standards and that a rapt,
If this is a repair,Jill out known well construction inJbrtuation and explain the nature of the of this record has been provided to the well owner.
repair under i 2I rentarkr section or on the back of this fro.
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-I 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.)
f•in multiple wells list all depth.?Raffia-en((example-3@2110'and 2 rr/00') Submit this GW-1 within 30 days of well completion per the following:
23.6 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
//l rater level is above casing,use"4-"
I1.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 G W-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6.6-20I8