GW1-2022-08660_Well Construction - GW1_20220427

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
NICHOLAS HAYES 14.WATER70NES
Well Contractor Name FROM TO I DESCRIPTION
A - 4121 rt. ft.
ft. Pt.
NC Well Cortractos Certification Number 15.OUTER CASING for rould-cued welb OR LINER i!a livable
GEOLOGIC EXPLORATION FROM TO DIAMETER TH,CKIYFSS M1IATERIAL
" ft. ft.
is
Company Nome
16.INNER CASING OR TUBING fizeolliermal closed-loan)
2.Well Construction Permit N: FROM I DIAbtBTER THICKNESS MATERIAL
1.61 all applicable well ratstructrmr permits r•e,UIC,Cnmuv.Store,Variance,ere) 0.0 (L 40.0 it• 2.0 '^' $CH 40 PVC
3.Well Use(check well use): ft. It. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural OMunicrpal/Public 40.0 r'' 45.0 f' 2.0 In. .010 SCH 40 PVC
❑Geothermal(Healing/Cooling Supply) ❑Residential Water Supply(single) It. !r. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
Oirrigation OWells>I00,0W GPD FROM TO MATERIAL E5IPLACEMEN75IL7HOD&AMOUN7
Non-Water Supply Well, 0.0 i' 33.0 fL AQUA GUARD SLURRY
INMonitoring ❑Recovery ft. ft.
Injection Well:
❑Aquifer Recharge OGround%aler Remediation
19.SAND/GRAVEL PACK if a livable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENTSIETHOD
OAquifer Test ❑Stormwater Drainage 35.0 fl• 48.0 f'. 20-40 FINE SILICA SAND
OExperimental Technology ❑Subsidence Control it. R•
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sleets if necessory
❑Geothermal(Htalin Co01in Return) OOther(explain under p21 Remarks) FROM TO DESCRIPTION color,hardness soitl o k ruin site.etc.
0.0 f'• 7.0 ir• RED CLAY
4.Date Well(s)Completed: 12/10/21 well IDq PMW-AS-3D 7.0 n. 34.0 f' SAPROLITE
Se.Well Location: 34.0 ft- 47.0 ft' P R_ _
CLIFFSIDE STEAM STATION 47.0 f1• 48,0 f'' ��'r OGi1c" 'i
Facility/Owner Name Facility IDH(ifappliwble) ft. ft.
7 ft. ft.
5 3 DUKE POWER ROAD MOORESBORO 28114
Physical Address,City,and Zip It. ft. .., i- r'a'
RUTHERFORD 21.REMARKS _ ",,
Court BENTONITE SEAL-•30.0-35.t)rF'�E'I` 1 'P�'45 0-48.0 FEET
County Parcel Identification No.(PIN)
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifw•ca field.one laUlongissufficient) 22.Cerlifitalion: 1��
350 12' 48.10" N 810 45' 12.58" W 03/23/22
6.Is(are)the welt(s): OPermanent or OTemporary Signature ofCerlified Well Contractor Date
Hy signing this junn.I hereby cerr f y that the u•ell(s)u•a.s(it-ere)construcled in accordance with
7.Is this a repair to an existing well: Oyes or MNo 15A NC AC 02C.0/00 or 134 NCAC 03C.0200 Well Cnnsrruciion Standards and that a copy
ifilin A a repair,JN!out known"•ell construction iajarnrarion and explain the nature of die ojfhts record hat been provided to than%tell oti•ner.
repair corder x21 remarks section or on the hock ofihis fornr.
23.Site diagram or additional well details:
8.For Geoprobe/Di11'or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well construction info
construction,only I GW 1 is needed. indicate TOTAL NUMBER of wells (add'Sec Ovee in Remarks Box).You may also attach additional pages if necessary
drilled: 24.SUBMITTAL INSTRUCTION'S
9.Total well depth below land surface: 48.0 (ft.)
n p l 11 (example. @2 Ci ) Submit this GW-i within 30 days of well completion r the following:
!•irr nrrrlri le hells hrr nil de !!cs i dt rrnf exam e•1 r fX)'and I t !00' Y P Ix g
10.Slavic water level below top or casing: 27.64 IfL) 24a. For All Wells: Original form to Division of Water Resources (DWR),
lfrrmer level is above casing,use"-•• 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
24e.For Water Su iv and O en-Lao s Geothermal Return\Veils:Copy to the
(i.e.auger,rotaq•,cable,direct push,etc) county envvonmenlal eat epartment o the county where irlsta ed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells roducin over 100 000 GPD:Copy to DWR,CCPCUA
M C,Raleigh,NC 7 )9-161 I
13a.Yield(gpm) Method of test: Permit Program,1611
13b.Disinfeclion type: Amount:
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Form G W-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6•6-2018