GW1-2022-08656_Well Construction - GW1_20220427

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only: i
1.Well Contractor Information:
NICHOLAS HAYES 14.WATERZONES
Well Contractor Name FROM TO DESCRIPTION
ft. h.
A - 4121
a. ft.
NC Well Contractor Certification Number 15.OUTER CASING for multboased vtells OR LINER if a llcable
GEOLOGIC EXPLORATION FROM TO DIAMETER THtCI(NFSS MATERIAL
it. ft. In.
Company Name
16.INNER CASING OR TUBING lizerilhermal closed-lonni
2.Well Construction Permit FROM TO DIAb=ER THICKNESS MATERIAL
Liu all applicable ire//construction hermits(.e.(AC.CannlP..S'tate.Variance.err) 0.0 h• 45.0 ft. 2.0 in- SCH 40 PVC
3.Well Use(check well use): ft. It. In.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOTSIZ11 T111CK11 11.ATF.RIAL
❑Agricultural ❑Municipal/Public 45.0 f' 55.0 it. 2.0 '� .010 SCH 40 PVC
OGeothermal(Ileating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in.
❑Industrial/Commercial OResidential Water Supply(shared) 18-GROUT
❑)rrl ation ❑Wells>100,000 GPD FROM TO MATERIAL £MPLACEMENTMErHOo&AMOUNT
Non-Water Supply Well: 0.0 ft- 38.0 fL AQUA GUARD SLURRY
I9Monitoring ORecovery ft. ft.
injection Well: ft. R.
DAquifer Recharge ❑Groundwater Remediation
19.SANDIGRAVEL PACK if a licable
OAquifer Storage and Recovery DSalinily Barrier FROM TO MATERIAL E.MPLACEMENTAf ETHOD
❑Aquiter Test DStormwater Drainage 43.0 ft. 58.0 it- 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control ft. R.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessa
❑Geothermal(Heat in Cool ing Return) QOlher(explain under 421 Remarks) FROM TO DESCRIPTION icolor,hardness,toi0rork type,it"in Stu etc.
0.0 ft, 4.0 ft• RED CLAY
4.Date Well(s)Completed: 12/07/21 Well ID# PMW-AS-1 D 4.0 ft. 56.0 0- SAPROLITE
5a,Well Location: 56.0 f• 58.0 Ire FAIR
CLIFFSIDE STEAM STATION n. ft.
Facility/OwnerNaime Faciliq•IDO(ifapplicable) ft. ft.
573 DUKE POWER ROAD MOORESBORO 28114 ft. ft. 91 :
Physical Address.City,and Zip ft. ft.
RUTHERFORD 21.REIIIARKS
County Parcel Identification No.(PIN) BENTONT(E SEAL -38.0-43.0 FEET/SUMPu5,5.QF$$.0 FEET
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: �L s.n•:,, ti I(ifwen field,one Iatilong is sufficient) 22.Certification:
350 12' 47.83" N 810 45' 12.47" W 03/23/22
6.Is(are)the well(s): OPermanent or DTemporary Signature of Certified Well Contractor Date
fly signing this form,1 hereby certiyj,dear the well(T)irm(here)canrtrarred in accortlanre with
7.Is this a repair to an existing well: OYes or ONo 1Srr NC'.t('02('.0100 or lSA N(AC'01C.0100{Fell Consrrnction b7annlards and tliat a rap}'
lfthis t.s a reptar,fill aim knairn yell construction it formation and explain the nature of the ofthis record Inn been provided to the ire//nutter.
re/.nir anler:11 remar.Es section ar air the bock of thi.T 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 1 GW-I is needed Indicate TOTAL NUMBER of%yells (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: 58.0 (ft.)
F- mnhiple ivellr list all depths fdWerent(example-3 200'ond 2C(jIu17 Submit this GW-1 within 30 days of well completion per the following:
10.Static water level below top of casing:. 20.02 (ft) 24a. For All Wells: Original form to Division of Water Resources (DWR),
f-mire/erel is ahare raTi,rg.se••••' Information Processing Unit, 1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter: 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: SONIC
24c.For Water Su ! and 0 n-Lou Geothermal Return Wells:Copy to the
(i c.auger,rosary,cable,direct push,etc) county environmental heat epartment o t e county where installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells rW2cin over 100 000 GPD:Copy to DWR,CCPCUA
13a.Yield(gpm) Method of test:
Permit Program,1 ,1
MSC,Ra etg ,NC 27699-1611
13b.Disinfection type: Amount:
Form OW-1 North Carolina Department of Envirenmcmal Quality-Division of Water Resources i Revised 6-6-201 S