GW1--05671_Well Construction - GW1_20230831

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
Nicholas Moreno :la.WATERZONEs
FROM TO DESCRIPTION
Well Contractor Name
ft. ft. I i
4209-A ft. I fa I
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased.wells)OR LINER(if ap !feeble) •
Keller Industrial FROM TO DIAMETER THICKNESS MATERIAL
ft. ft. in.
Company Name 16.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. 26 ft. 4 hr. Sch 40 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 26 ft. 46 ft. 4 in. 20 Sch 40 PVC
Geothermal(Heating/Cooling Supply) °Residential Water Supply(single) ft f. in.
Industrial/Commercial °Residential Water Supply(shared)
Irrigation FROM . TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: ft. ft.
Monitoring 10 Recovery ft. ft.
Injection Well:
Aquifer Recharge °Groundwater Remediation f I
f
19.SAND/GRAVEL PACK(if applicable) '"
Aquifer Storage and Recovery °Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
Aquifer Test °StormwaterDrainage 0 ft• 46 ft• IA Send ' Treenaile
Experimental Technology °Subsidence Control ft. ft.
Geothermal(Closed Loop) °Tracer 20:-DRILLING LOG(attach additional sheets if necessary) .
Geothermal(Heating/Cooling Return) °Other(explain under#21 Remarks) FROM TO DESCRIP I lON(color,hardness,solUrock type,grain size,etc.)
q tt- 5 it- Data greyest
4.Date Well(s)Completed:8-17-23 Well ID#DW2-10 5 it 10 ft' Redish brown sandy day
5a.Well Location: is ft. 45 ft Dark greyash
Duke Energy 45 f, 46 it Native i•�, (..,E.'t\I h r
Facility/Owner Name Facility ID#(if applicable) ft. ft.
8320 NC 150, Sherrills Ford, 28673 ft. ft. AUG 3 12023
Physical Address,City,and Zip ft. ft. i Irn`crmatiSil f m-7.:if441g 1.111,
Catawba •21.`REMARKS•,,, . .,, Gv1lt O,t8C.IG :?-.
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.Certification:
35.61599 N 80.97861 W
%--- i7•7 fr -7 7
6.Is(are)the well(s)°Permanent or '„�iTemporary gnature o 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 ONo with 1SA NCAC 02C.0100 or 1SA 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 j
9.Total well depth below land surface: 46 (ft..) 24a. For All Wells: Submit thin form within 30 days of completion of well
For multiple wells list all depths if different(example-3@200'and 2@100) construction to the following:
10.Static water level below top of casing: 15.5 (ft.) Division of Water Resources,Information Processing Unit,
If water level is above casing,use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
i
11.Borehole diameter: 8 (in.) i
24b.ForInjection 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:
(Le.auger,rotary,cable,direct push,etc.)
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
13a.Yield(gpm) Method of test: 24c.For Water Supply&Iniectionl 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.
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016