GW1--05139_Well Construction - GW1_20230818

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
I.Well Contractor Information: '
BRIAN THOMAS 14.WATER ZONES
FROM •TO. DESCRIPTION
Well Contractor Name
ft. ft.
A - 2581 • •
ft. ft. • 1 •
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#: WR0300123 FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.U/C,Comity,State,Variance,etc.) 0.0 ft. 75.0 ft. 6.0' in' SCH 80 PVC
3.Well Use(check well use): ft. ft. in.
.171 SCWater Supply Well: •FROM REE TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 75.0 ft. 190.0 ft• 6.0 in! .010 SCH 80 SS
❑Geothermal(He ti Cgpji g,Sy ly residential Water Supply(single) tr. ft. in.
❑Industrial/Cot'ii4 c, to�h residential Water Supply(shared) 18.GROUT
❑Irrigation ❑Wells>100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply j{! e�] . 8 ZO23 0.0 ft. 65.0 ft. NEATPORTLANDCEMENT SLURRY(PUMP)
❑Monitoring. Recovery ft. ft.
Injection Welkyt{r„atttift Yrrx:4*0 r4 La"-
ft. ft.
❑Aquifer Recharge [ f0r13 0G ❑Groundwater Remediation
.19.SAND/GRAVEL PACK(if applicable)--
❑Aquifer Storage and Recovery ❑Salinity Barrier • FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑StormwaterDrainage 70.0 ft• 191.0 it. 7-35(#2) • POUR
❑Experimental Technology ❑Subsidence Control ft. ft. ,
❑Geothermal(Closed Loop) ❑Tracer .20.-DRILLING LOG(attach additional sheets if necessary)
OGeothermal(Heating/Cooling Return) lOther(explain under#21 Remarks) •
FROM TO DESCRIPTION(color,hardness,soil/rock type,grain size,eLr.)
0.0 ft• 19.0 ft. RED SILTY CLAY .
4.Date Well(s)Completed: 08/02/23 Well ID# EX-71SBR 19.0 -ft• 31.0 ft. TAN SILTY SAND
5a.Well Location: 31:0 ft. 54.0 ft. BROWN SILTY SAND
DUKE ENERGY CAROLINAS MARSHALL STEAM STATION 54.0 ft• 91.0 ft• PWR
Facility/Owner Name Facility IN(if applicable) 91.0 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-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'-44.06" N 80° 57' 55.32" w �:>-- ► '- 08/08/23
6.Is(are)the well(s): (!Permanent or OTemporary Signature of Certified Well Contractor Date
Hy signing this form,I hereby certify that the well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or ONo 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy
If this is a repair,fill out known well construction itJbrnration and explain the nature of the of this record has been provided to the well owner.
repair under 1/2/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 ifdiJferenl(example-3@200'and 2 ril100') Submit this GW-1 within 30 days of well completion per the following:
44.0 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
!firmer level is above casing,tree"+'•
11.Borehole diameter: 1 4.0/10.0/6.0'(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 GW-I North Carolina Department of Environmental Quality-Division of Water Resources I Revised 6-6-2018