GW1-2022-08664_Well Construction - GW1_20220427

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
NICHOLAS HAYES 14.WATER ZONES i
Well Contractor Name FROM TO DESCRIPTION
ft. ft.
A - 4121
ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING for multi-cased wells OR LINER if a licable
GEOLOGIC EXPLORATION FROM TO DIAMETER THICKNESS �IATERIAL
te. ft. in.
Company Name
16.INNER CASING OR TUBING eothermal closed-loop)
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS MATERIAL
List all applicable n•ell conslruc•linn permits(i.e.WC.County.Stale,I'ariance,etc.) 0.0 ft. 8.0 ft- 6.0 in' .188 STAINLESS STEEL
3.Well Use(check well use): ft. ft. in.
Water Supply Nltell: 17.SCREEN
FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public $0 f' 68.0 R. 6.0 in- .010 .188 STAINLESS STEEL
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in,
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Irrigation ❑Wells>100,000 GPD FROM I TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0.0 ft. 1.0 ft' AQUA GUARD SLURRY
❑Monitoring ❑Recovery ft. ft.
Injection Well:
ft. ft.
❑Aquifer Recharge OGroundwater Retnediation
19.SAND/GRAVEL PACK if a licable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑StormwaterDrainage 5.0 " 69.0 R' 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary)
FROM TO DESCRIPTION color,hardness,soil/rock type,grain size,etc.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 921 Remarks)
0.0 ft• 5.0 R. RED CLAY
4.Date Well(s)Completed: 01/27/22 Well ID# EX-AS-7 5.0 ft• 29.0 tt• SAPROLITE
5a.Well Location: 29.0 ft' 48.0 fc' PWR
CLIFFSIDE STEAM STATION 48.0 ft. 69.0 ft. ROCK
Facility/Owner Name Facility IDtf(ifapplicable) R. ft.
573 DUKE POWER ROAD MOORESBORO 28114 +f' fr.Physical Address,City,and Zip ft. APR 2 7
RUTHERFORD 21.REMARKS I
County Parcel Identification No.(PIN) BENTONITE SEAL- 1.0-5.0 FEET/SU;P �i$i07r69 0 FEET
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifsvell field,one let/long is sufficient) 22.Certification:
350 12' 52.S9" N 810 45' 13.87" W
03/23/22
6.ls(are)the well(s): (EPermanent or ❑Temporary Signature of Certified Well Contractor Date
By signing this jbi-in,1 hereby c•erli&that the me0(,)u•as(were)constructed in accordance wilh
7.Is this a repair to an existing well: ❑Yes or MN'o 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Slandords and that a copy
/f this is a repair,fill oul known u•e//construction information and explain the nature q/7he of this record has been provided to the trell corner.
repair under"21 remarks section at-all 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 construction into
construction,only I GW-I is needed. Indicate TOTAL NUMBER of wells (add'Sec Over'in Remarks Box).You may also attach additional pages if necessary.
drilled: 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 69.0 (ft.)
hor aedliple wells list all depths ifdifjerent(example-3 a 200'and 2 rt 100') Submit this GW-1 within 30 days o6 well completion per the following:
10.13 24a. For All Wells: Original form to Division of Water Resources (DWR),
10.Static water level below top of casing: (ft.) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
1%un/m•lere/is above casing,use••+,.
11.Borehole diameter: 16.0/6.0 (in) 24b. For Injection Wells:Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: SONIC/AUGER/AIR
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 producing over 100,000 GPD:Copy to DWR,CCPCUA
Permit Program, 1611 MSC,Raleigh,NC 27699-161 1
13a.Yield(gpm) Method of test:
13b.Disinfection type: Amount:
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018