GW1-2023-01900_Well Construction - GW1_20230222

WELL CONSTRUCTION RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: '
Lewis LeFever 14:WATER ZONES I'
FROM TO DESCRIPTION
Well Contractor Name ft. ft.
2480 ft. ft.
NC Well Contactor Certification Number 15.OUTER CASING(for multi-cased wells OR LINER it a licable
FROM TO DIAMETERI THICKNESS MATF.RI,\L
Parratt-Wolff, Inc. ft. ft. tin.
Company Name 16.INNER CASING OR TUBING(geothermal closed-loop)
FROM I TO I DIAMETER:, THICKNESS MATERIAL
2.Well Construction Permit#: 0 It. 5 ft. 2 I' .i" SCh40 PVC
List all applicable well permits(i.e.County.Slate,Variance.injection,etc.) ft. I ft. I in.
3.Well Use(check well use): 17.SCREEN
Water Supply Well: FROM TO DIAMETER, SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 5 tt. 20 it. 2 i" .010 sch40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. fit. in.I
❑industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
❑lrri ation 1 ft. 3 ft* Bentonite Chil Pour
Non-Water Supply Well: fit. R• Pour
OMonitoring ❑Recovery
Injection Well: fit. ft.
❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK if applicable)
FROM TO MATERIAL EJIPLACEIIIENT METHOD
❑Aquifer Storage and Recovery ❑Salinity Barrier 3 tt. 20 f`• #1;Sand Tremie
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology Subsidence Control 20.DRILLING LOG(attach additional sheets if necessary)
❑Geothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION(color,hardness,soil/rock type.grain size,etc.)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) ft. ft.
fit. ft.
4.Date Well(s)Completed: 12-1-22 Well[D#GW-6R
ft. ft.
5a.Well Location: FED 2
fit. ft.
2Duke Energy Cape Fear Plant rt. tt.
L
Facility/Owner Name Facility ID#(if applicable) , ;�Y_
ft. ft. !; lntwn,cli:Ct1 Prrcw­_rog LIni4
500 C P and L Road, Moncure ;. • ti;
ft. tt.
Physical Address,City.and Zip 21.REMARKS
Chatham 2 x 2 Pad
County Parcel Identification No.(PiN) 3,Bollards
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22•Certification: !'
(ifwell field,one lat/long is sufficient)
35.594884 N -79.048274 W ra ' 30 '��-
Sign t reofCertified We Co ct I; Date
6.Is(are)the well(s): ❑O Permanent or ❑Temporary BY signing this form,I hereby certify thai the well(s)was(were)constructed in accordance
with 1 SA NCAC 02C.DI00 or 15A NCACj 02C.0100 Well Construction Standards and that a
7.Is this a repair to an existing well: ❑Yes or E]No copy ofthis record has been provided to the well owner.
lflhis is a repair,fill out known well construction itfornation and explain the nature ofthe
repair under#21 remarks section at•on the back ofthis form. 23.Site diagram or additional well;details:
You may use the back of this page to provide additional well site details or well
S.Number of wells constructed: construction details. You may also attach additional pages if necessary.
For nadtiple injection or non-water supply wells ONLY with the same construction,you can
submit oneform. SUBMITTAL INSTUCTIONS
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9.Total well depth below land surface: 20 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths ifdiiferent(example-3 tt 200'and 2@/00� construction to the following:
10.Static water level below top of casing: 13.92 (ft.) Division of Water Resources,Information Processing Unit,
Ifaater level is above casing.use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
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11.Borehole diameter: 6 (in.) 24b.For[niection Wells ONLY: in addition to sending the form to the address in
24a above, also submit a copy of this'form within 30 days of completion of well
12.Well construction method: HSA construction to the following: j
(i.e.auger,rotary,cable,direct push,etc.)
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
13a.Yield m Method of test: 24c.For Water Supply&Injection Wells:
(gp ) Also submit one copy of this form within 30 days of completion of
13b.Disinfection type: Amount: well construction to the county health department of the county where
constructed.
Form GW-I North Carolina Department of Environinent and Natural Resources-Division of Water Resf out es Revised August 2013
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