GW1-2022-09029_Well Construction - GW1_20220923

WELL CONSTRUCTION RECORD (GW-1) For internal Use Only:
1.We 1 Contractor information:
9O 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
,' ..-�;,.� ft. ft. �
sC Well Contractor Certification Number F �. ,n1 15.OUTER CASING for multi-cased wells OR LINER if a licable
Cascade Drilling, LP 2`2- FROM TO DIAMETER THICKNESS MATERIAL
ft. ft. in.
Company Name Irli:;i:�" ; =a i.?:v3• ;C'.a r:i:
�;• 16.INNER CASING OR TUBING' eothermal closed-loop)
2.Well Construction Permit#:
FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.UIC.County.State. Variance,etc.) ft. ft. in•
3.Well Use(check well use): ft. rt. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public ft. tt. in.
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) tt. ft. in.
❑industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑irri ation ❑Wells> 100,000GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: /03 rt. O tt.
❑Monitoring ❑Recovery
injection Well:
ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK if applicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑StormwaterDrainage
❑Experimental Technology ❑Subsidence Control
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary)
❑Geothermal(Heating/Cooling Return)
TO DESCRIPTION(color,hardness,soil/mck type,grain size,etc.)) ❑Other(explain under#21 Remarks) ft. ft.
4.Date Well(s)Completed.�_'-'-�"� Well iD# P z tt. tt. Ye Cep
Sa.Well Location:
rt. rt.
Duke Energy
bility/Owner Name Facility iD#(if applicable)
ft. ft.
306 Dunnaway Road, Semora, NC 27343 ft. ft.
Physical Address,City,and Zip ft. ft.
Gaston 21.REMARKS
County Parcel identification No.(PiN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one]at/long is sufficient) 22.Certification•
N W
6.Is(are)the well(S): ❑Permanent or -Memporary Signature of Certified Well Contract Date
By signing thisJorm.1 herebv certiJi�that the well(s)was(were)constructed in accordance with
7.is this a repair to an existing well: ❑Yes or In No 15A NCAC 01C.0100 or 15A NCAC 01C.0100 Well Construction Standards and that a copy
IJ'this is a repair,Jill out known well construction information and explain the nature oJ'the of this record has been provided to the well owner.
repair under#21 remarks section or on the back at this Jorm.
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-1 is needed. indicate TOTAL NUMBER of wells (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: (ft.) Submit this GW-i within 30 days of well completion per the following: -
For multiple wells list all depths ifdiJferent(example-3@200'and 1@100')
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
lt'water level is above casing,use
11.Borehole diameter: (in,) 24b. For injection Wells: Copy i to DWR,Underground Injection Control(IUC)
Program, 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: iG 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
it
)R WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPD: Copy to DWR,CCPCUA
Permit Program,1611 MSC,Raleigh,NC 27699-1611
13a.Yield(gpm) Method of test:
13b.Disinfection type: Amount:
Fonn GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018
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