GW1-2022-09591_Well Construction - GW1_20221021

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
I.Well Contractor Information:
)OHNNY BURR t
14.WATER ZONES 1
Well Contractor Name FROM TO DESCRIPTION
A - 3098
rt. ft. 4
NC Well Contractor Certification Number 15.OUTER CASING for multi-cased wells OR LINER if a tlicable
GEOLOGIC EXPLORATION FROM TO. DIAMETER i THICKNESS MATERIAL
0.0 ft• 55.0 ft• 6.0 " SCH 80 PVC
Company Name '
16.INNER CASING OR TUBING(geothermal closed-loop)
2.WCII Construction Permit#: FROM TO I DIAMETER THICKNESS - MATERIAL
I.isi all applicable nrll enttstnrctinn perntiec(i.e.(llC,C'nunlp,5'tate.Pitriance,err.) 0.0 ft. 63.0 ft. 2.0 1' I SCH 40 PVC
3.Well Use(check well use): fr. e, in.
Water Supply Well: FH SCREEN
TO DIAMETER { SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 63.0 ft. 73.0 ft' 2.0 in. 1 .010 SCH 40 PVC
❑Gcothennal(Fleating/Cooling Supply) ❑Residential Water Supply(single) H fr in. 1
❑Ind ustrial/Commercial ❑Residential Water Supply shared i
PP y(shared) I8.GROUT
❑Irrl anon ❑Wells> 100,000GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0.0 fL 52.0 ft• AQUA GUARD SLURRY
Monitoring ❑Recovery 0.0 fry 55.0 ft. CEMENT GROUT SLURRY
Injection Well:
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK if a t licable _
❑Aquifer Storage and Recovery ❑Salllllly Barrier FROM TU MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage 60.0 ft• 73.0 ft' 1 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control ft. m
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary)
FROM TO DESCRIPTION color,hardness;soil/rock lv e, r-ain si-,etc.)
❑Gcothennal(Heating/Cooline Return) ❑Other(explain under#21 Remarks)
0.0 fL 7.0 fL BROWN CLAYEY SANDY SILT
4.Date\fell(s)Completed: 09/08/22 Well ID# CCR-27BR 7.0 1- 29.0 ft. BROWN PWR
5a.Well Location: 73.0 ft' 6RAY ROCK
BUCK STEAM STATION ft. ft.
Facility/Owner Nance Facility IDk(ifapplicable) ft. ft.
1 S55 DUKEVILLE ROAD SALISBURY 28146 f. ft.
Physical Address,City,and Zip ft. ft.
ROWAN 21.REMARKS
County Parcel Identification No.(PIN) BENTONITE SEAL- 52.0-60.0 FEET
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one tat/lone is sufficient) 22.Certification:
350 42' 43.25" N, 800 22' 05.31" \�; �� 10/10/22
6.Is(are)the well(s): OflPermanent or ❑Temporary Signature ofCenified Well Contractor Date
H,si,ning dti.s arm•l hereby cerli&that the we!l s u i rn. 'p''''r t t ee rids
7.Is this a repair to an existing well: ❑1'es or ONo I5�1 NCA('02(!.01l1d or/iA NCAC'02C? 200 We/ ,. 11ry�fiLwlJt t., nt� opr
Ifdtis is a repair,Jill ow known we//construction inf n-ntallon and explain the nature of the nfthis record has been provided to the well corner.
repair under e'2l remarks.secdan or an the hock n/.this.1brm. O C T 2 1 2022
23.Site diagram or additional well details:
8.For Geoprobe/DPI'or Closed-Loop Geothermal fells having the same You may use the back of this page to provide additional well construction inJit
construction,only I GW-I is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may al KetdGl7Fidliifrh(�a 1 r)
drilled: DVIOAX
24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 73'0 (ft.)
l-or nndople u•e/ls lest al/depths ifdilferent(example- 304,,200'and?valu0,) Submit this GW-I within 30 days of well completion per the following:
2.0 24a. For All Wells: Original font to Division of Water ResOUrCCS (DWR),
10.Static water level below top of casing: (ft.) Information Processing Unit,1617 MSC.Raleigh,NC 27699-1617
l/uoter/ere/is above casing.use•
11.Borehole diameter: 8.0/6.0/7.875 (in) 24b. For Iniection Wells: Copy to DWR, Underground Injection Control(IUC)
Program; 1636 MSC,Raleigh,NC 27,699-1636
12.Well construction method: AUGER/AIR P
24c.For Water Soppy and Open-L'oo'p 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 oiicer 100,000 GPD: Copy to DWR,CCPCUA
Penn it Program, 1611 MSC,RaleighlNC 27699-1611
13a.field(gpm) Method of test:
i
13b.Disinfection hype: Amount: l
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resoui'ces Revised 6-6-20I S
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