GW1--05652_Well Construction - GW1_20230831

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractorinformation:
Nicholas Moreno 'T4.WATER ZONES -
FROM TO DESCRIPTION
Well Contractor Name ft ft
4209-A 1
ft1 ft
NC Well Contractor Certification Number °15.OUTER CASING(for multi-cased wells)OR LINER(if ap limbic) .._•
Keller Industrial FROM TO DIAMETER'. THICKNESS 1 MATERIAL
ft. ft 1 in.
Company Name
I6.INNER CASING OR TUBING(geothermal closed-loop) - ,
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.) 0 ft. 27 ft• 4 in' Sch 40 avc
3.Well Use(check well use): ft. ft. in.
Water Supply Well: FROMREE TO .= DIAMETER SLOT SIZE THICKNESS MATERIAL
Agricultural °Municipal/Public 27 ft 47 ft 4 in. .20 Sch 40 PVC
Geothermal(Heating/Cooling Supply) (°Residential Water Supply(single) ft ft. in.
Industrial/Commercial a Residential Water Supply(shared) 1S.GROUT i
Irrigation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: ft. ft.
Monitoring °Recovery ft. ft.
Injection Well:
ft 1 ft. I ,
Aquifer Recharge °Groundwater Remediation
19."SAND/GRAVEL PACK(if applicable) ' '
Aquifer Storage and Recovery °Salinity Bather FROM TO MATERIAL EMPLACEMENT METHOD
Aquifer Test °StotmwaterDrainage 0 ft. 47 ft IA Sand Tremme
Experimental Technology °Subsidence Control ft. ft.
Geothermal(Closed Loop) °Tracer 20.DRILLING LOG(attach additional sheets if necessary)• "; ''
FROM TO DESCRIPTION(color,hardness,soil/rock type,grain size,etc.)
Geothermal(Heating/Cooling Return) nOther(explain under#21 Remarks)
'0 tt• 5 it. Dafg grey esn
4.Date Well(s)Completed:7-31-23 Well ID#DW 1-19 5 ft. 10 ft Radish brown sandy clay
5a.Well Location: ro ft, 45 ft* Dark grey ash
Duke Energy 45 ft. 47 ft- Native 47- ; r.a
Facility/Owner Name Facility ID#(if applicable) ft. ft. ° '`4"' i V�3-I.,'
8320 NC 150, Sherrills Ford,28673 ft. ft. AUG 3 1 21173
Physical Address,City,and Zip tt. ft.
Catawba 21.REMARKS•:_' - Ilti +rc . -71 71 .r, iwr. 3r)
County Parcel Identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22.Certificatio
35.61599 N 80.97861 W
6.Is(are)the well(s)rPermanent or IMITemporary ture of Certified Well Contractor Date
By signing this form,I hereby certify that the well(s)was(were)constructed in accordance
7.Is this a repair to an existing well: DYes or EllNo with 15A NCAC 02C.0100 or ISA NCAC 02C.0200 Well Construction Standards and that a
If this is a repair,fill out known well construction information and explain the nature of the copy 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 site details or well
construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if necessary.
drilled: SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 47 (ft-) 24a. For All Wells: Submit this; form within 30 days of completion of well
For multiple wells list all depths ifdif erent(example-3@200'and 2@100) construction to the following:
10.Static water level below top of casing: 14.6 (ft.) Division of Water Resources,Information Processing Unit,
If water level is above casing,use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 8 (in.) 24b.For Injection Wells: In addition to sending the form to the address in 24a
Rotary above,also submit one copy of this form within 30 days of completion of well
12.Well construction method: construction to the following: :
(i.e.auger,rotary,cable,direct push,etc.)
i
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: I 1636 Mail Service Center,Raleigh,NC 27699-1636
13a.Yield(gpm) Method of test: 24c.For Water Supply&Infection'Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b.Disinfection type: Amount: completion of well construction to the county health department of the county ,
where constructed. I
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016