GW1-2022-08566_Well Construction - GW1_20220527

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
NICHOLAS HAYES � �
=14.WATER-ZONES -.
Well Contractor Name FROM TO I DESCRIPTION
ft. ft.
A - 4121 ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING'for mulfi-casedtwells OR LINER if a licable
GEOLOGIC EXPLORATION FROM TO DIAMETER THICKNESS MATERIAL
ft. ft. in
Company Name
16.INNER CASING OR TUBING ieothermal closed-loo
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS I MATERIAL
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.) 0.0 ft. 7.0 ft. 2.0 In' SCH 40 PVC
3.Well Use(check well use): ft. ft in.
17.
Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS I MATERIAL
❑Agricultural ❑Municipal/Public 7.0 ft- 62.0 ft. 2.0 In' .010 SCH 40 PVC
❑Geothennal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft ft in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 1s.GROUT
❑Irri ation ❑Wells>100,000GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0.0 ft• 3.0 ft' PORTLAND BENTONIT E SLURRY
❑Monitoring ❑Recovery ft. ft.
Injection Well: ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation
'.19.SAND/GRAVEL PACK if a Gcable'-"
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑StormwaterDrainage 4.0 It- 62.0 fi 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.'DRILLING LOG ittach additional'sheets if necessary)
❑Geothermal(Heating/Cooling Return) inOther(explain under#21 Remarks) FROM TO DESCRIPTION color,hardness,soillmek type,grain sae,etc.
0.0 It- 20.0 ft• RED CLAY
4.Date Well(s)Completed: 03/01/22 Well ID# OW-7S 20.0 ft. 50.0 ft- SAPROLITE
5a.Well Location: 50.0 u. 61.0 ft• PWR
PIEDMONT LITHIUM 61.0 ft- 62.0 ft- ROCK
Facility/Owner Name Facility ID#(if applicable) ft. ft.
231 HASTINGS ROAD BESSEMER CITY 28016 ft. It.
Physical Address,City,and Zip ft. ft.
GASTON :2r;REMARKS',"`,,',
County Parcel Identification No.(PIN) BENTONIfE SEAL-3.0-4.0 FEET
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
***OBSERVATION***
(if well field,one lat/long is sufficient) 22.Certification:
350 22' 40.61" N 810 16' 56.74" W 1 05/19/22
6.Is(are)the well(s): MPermanent or ❑Temporary Signature of Certified Well Contractor Date
By signing this form,I hereby certify that the wells)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or MNo ISA NCAC 02C.0100 or ISA NCAC'02C.0200 Well Construction Standards and that a copy
Ifthis is a repair,fill out known well construction information and explain the nature of the ofthis 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 w ruction info
construction,only I GW-I is needed. Indicate TOTAL NUMBER of wells (add'See Over in Remarks Box).You may also attach addition s if necessary.
drilled: 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 62'0 MAY 2(ft.) 7 °'0"'
por multiple wells list all depths ijdii ferent(example-3@200'and 2@1001 Submit this GW-1 within 30 days of well completion per the following:
24a. For All Wells: Original form to Division of Water Resources (DWR),
10.Static water level below top of casing: (ft)
If water level is above casing,use"+If Processing Unit,1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter: 8.0 (in.) 24b.For Injection Wells:Copy to DWR,Underground Injection Control(IUC)
Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: AUGER
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 roducin over 100,000 GPD:Copy to DWR,CCPCUA
13a.Yield(gpm) Method of test:
Permit Program,1611 MSC,Raleigh,NC 27699-1 6 1 1
13b.Disinfection type: Amount:
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018