GW1-2023-02570_Well Construction - GW1_20230410

r WELL C01YS'I'RuCTION RECORD FarlracrnalttseQNLY:
This Conn can be used for single or mLddpk wells /
1.Well Contractor Information:
\ 1.1 VATERZONES
Zach Thompson FROM TO MiCRtar'trON
W01colimcturName R. ft,
4478A
NCNcllConuaciorCcnifccationNtunber 1S:OUTERCASMG(for-itatli4d'sctlW tUsl•OR<LINER(it"aNT '"ficaTATETibkl`.
FRO TO ntv%wrER THICKNESS hTAL
SAEDACCO Inc 0 ft. 60 fL 2" in SCH-40 PVC
C6ukp:un)-Naear I6:INNER'CASING ORTUBING cnike_r_mat cfosedaoo ..
FRONT TO DELRIETER TIrI S STATERTAL
2.Well Construction remit R: R, ft, i
Lire e1J alptlirabIC WNIP r WIS(i-e.C01M%S1ate,Variarwe,Ir}'eCdC}err.)
R. ft. �.
I Well l Use(ch"Ic.wdl use): [l:SCREEN
Water Supply Wells FROM TO Dt.-W:TFR SLOT SIM Tilt, INVSs I NIATRRTAT,
❑Agricultural Mfunicipalftblic 60 ft. 70 ft. z" i1a olo sell-4o PVC
13GeothemlaI(liea(ingiCooiing Supply) ❑Residential Water Suppb,(single) fL ft. iR
131_RdustriallConmlcicial QResidenfial Water Supply(shared) FaOGRO`T TO NLATERL%L I EM1[PLACEFTEVTNtEIrtOD&'Ah10u TT
❑]rti'Rtlpn 0 ft. 54.5 M Portland Injection
NonAhlater Supply Well:
Mklonitoring . QRrxovery
Injection Well: fL to,
QAquifcrRccitarge QGrourvdiN lter Rerncdiallon 1%SANDIGRAVEL PACK(if• a aticabte)
FROM 'Tt} NfATY.nr41. KN1PIAC.:1V.NThir:Tu011
❑Aquirkr Storage atidRccovety 175alinityHardcf- 57.5 R. 70 ft. Filter Sand #z
❑AquifcrTW A5tormnatcr Ilatnaoe
R. rL
❑EN�pcdmcutal Tmhttotogy QSnbsidcncc Control
20:DRILLING:LOG(attack additiorial.slicees if necessary
❑G odtemlal(Clased Loop) ❑Trager FRONT TO I'9MCRUPTION(color,h artlnct+.wiVnick h ru,oWy we,ckJ
❑Goofhennal(HeatinglCooliugRelum) ❑0111er(Mlalitt Under 921Retuatts) 0 ft. 70 fL Tan Silty Sand and Saprolite'
70 ft. fL Rock
d.Date Well(s)Completed: 2/20/23 WellIDgPZ23-01
54,WiAI Lticathm: ft, fL
Duke Energy f4 11. APR a. 0 2n �
Facgily,'Qivoct-Nam Factlh)•IDk(ifappli able)
R. ft.
253 Plant Allen Rd., Belmont, NC, 28012
Physical Addt:rss.City.and Zip
'21:REM1tAF{KS
Gaton Bentonite Seal from 54.5e-57.5e
(onWp Marvel lJsnlificallonNo,(PIN)
Sb.I ldhtde and I tingittrde in dttteslminutcslscerinds pr decimal(lcgT ccs: 22.Certification:
(Ifucil nod,one laLhwn$is;urmcktd)
35.19471982 N -81.01366301 W / V ' rr'c' 2/28/2023
naiumufCatilkel a Contractor Date
6.I9(ar'e)the wcll(s)t EPe ntaltent or ❑Temporary •signing thin firm,I herrin.certify rhar rhr ire1J(s;was(wrrei comtrucied hr mwrardancr
nr'th Jyi1 NCr1C rJ;C,(J!(t'9 or J.ft,YCAC p,C,020D It`e•l!Cnrrs(rrctiwr Srdnefards and ds!rra
7.Is thbi a repair to an existing well: l]Yer- or Moo ctrr ojthir cot Val hrsslns.rn(rmrirlt d ra r,N erJl ma,u•r.
If this is a"P41r,fall txrr kr,rivaa xall cwrxstilfolea hiforownlon end eaplaht rho narare of(lie
rrlrairrurdcrA31 rrnaarks irrtiarr gran elm hrxk nfdrisrogue 23.Site di Wam or add Itionat well details:
You may use the back of this page to provide additional Well site details or%veil
S.Number of Wells coustmeted: 1 cousitrdon details. You may also attach additional pages if necessary.
For uml#rleJuAvrlonorarm-ncarer.sup#p -nefff ONLY mirhthesatirecotrstridl&,n,)Vhcan
subadf oar form. SUBNIMA L INSTUC.TfONS
9.Total we11 depth below land surface. 70 24a. For All Wells: Subunit this farm within 30 days of Completion of wtll
For taalrlph*ivellr l rst all depths fJdJfrerov(craeapfe-7 @:0'arul 3@[09 y construction to Ific fpito%ing;
10.Static Water level below top of casing: A) Division of Water Resources,Information Processing Unit,
If ndrer level Is thaw cueing.am"+" 1617 IVUH Senfce Center,ltrldAi,NC 2 7 699-16 17
1.1.Borehole diameter,8" (in.) 24b.Fnr Iniccfinn Wdfv ONLY: in addition to-sending the form to the address in
14aabove. also submit a-copy of this fotut Within 30 days of completion of%e11
12.Well Construction method:HSA construction to the following:
(i.e.auger.((loan•,cable direct push etc:}
Division of Water Resources,Qndet•grouud Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mill Service Center,Raleigh,NC 27699-1636
13a Yield( Tm) hlcthod of test 24c.For Watcr Supply&Injection Wells:
Also stnbmit one copy of this form within 30 days of completion of
13h.Uisinfectian type: Amount: well construction to the county ht:alth depanmetlt of the court},%•here
constmiacd. �
Fenu MI-1, Nonh Carolina Dcpattment of Eneirorutk na and Natural Resources-Division of Rater ftcxaut— Revised August 3v 13