GW1--05678_Well Construction - GW1_20230831

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
Nicholas Moreno '14.WATER-ZONES ..'- !. ,".
FROM TO DESCRIPTION
Well Contractor Name ft. ft.
4209-A ft. ft I 1
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells)OR LINER(if ap livable)
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 h• 27 ft• 2 in. 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 OMunicipal/Public 27 ft 47 ft 2 in. .20 Sch 40 PVC
Geothermal(Heating/Cooling Supply) E3Residential Water Supply(single) ft ft. in.
Industrial/Commercial nResidential Water Supply(shared)
Irrigation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: ft. ft.
Monitoring DRecovery ft ft. I
Injection Well: tft. 1 1 ft
Aquifer Recharge OGroundwater Remediation
19.SAND/GRAVEL PACK(if applicable). .'
Aquifer Storage and Recovery 0Salinity Barrier FROM I TO I MATERIAL EMPLACEMENT METHOD
Aquifer Test E2StormwaterDrainage o ft• 47 ft• IA Send Trerrrnie
Experimental Technology D Subsidence Control ft. ft.
Geothermal(Closed Loop) niTracer 20.DRILLING LOG(attach additional sheets if necessary) .
FROM TO DESCRIPTION(color,hardness,so0/rock type,grain size,etc.)
_ Geothermal(Heating/Cooling Return) nOther(explain under#21 Remarks) o ft. 5 R• Days grey ash
4.Date Well(s)Completed:8-2-23 Well ID#DOW-2 5 it. 10 ft' Redish brown sandy clay
5a.Well Location: to ft• 45 ft Dark grey ash -' 1;y. /1"I'•"a
Duke Energy-. 45 ft 47 >t• Native , ti'.Z..r�: i,! .L.
Facility/Owner Name Facility ID#(if applicable) ft. ft. A U G .l 1 7 itt123
8320 NC 150, Sherrills Ford, 28673 ft ft. [
Physical Address,City,and Zip ft. I ft. I D:Or On
Catawba 21.REMARKS
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.Certifies
35.61599 N 80.97861 w
F 20 -z3
6.Is(are)the well(s)DPermanent or EtTemporary S. tore 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: JYes or jNo with ISA NCAC 02C.0100 or 15A 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 ifdifferent(example-3@200'and 2@100) construction to the following:
10.Static water level below top of easing: 15.3 (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 IniecHon 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 ;
(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
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13a.Yield(gpm) Method of test: 24c.For Water Supply&Inieetion 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!td the county health department of the county
• where constructed. 1
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Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources', Revised 2-22-2016