GW1-2023-02574_Well Construction - GW1_20230410

WELL CONSTRUCTION RECORD Far ltdarml use ONLY:
This Conn can U:rtsad fits single or multiple{cells
1.Well Contractor Information:
M WATER-ZONES
Zach Thompson VROM TO DFSCRtIPTION
We)t t ormrsctorlvame R. ft.
4478A ft. ft
NC Well ConuaciorCcnification Number iS:OUTER CASING(roe eituhi4aiwA wills)OR LINER flf a••[lcabk
FROM! I TO I DIAMETER I MICKOWS5 I MATERIAL
SAEDACCO Inc 0 IL. 65 rL 2" im. SCH-40 . I PVC
CauV;uty Name; ICINNER CASING OR 7 UBING •eathermA clasedaoa
FROM TO DEOIETER I THICKNESS I M.111ElUAL
2.Well Construction riarruit#: R. ft,
1.l0 all omilcvibir.m-hpon aUE ff.r.Cowley,Sride,Variawe,11)tBrOCn Orr•.) -
R. ft. ttn.
3,Welt use(check well use): 17:srt1E1 N
--= — -.:
Water Supply Well: - FROM TO DIAMETER sr•OTSin, THICKNESS I NrATRRTAI,
Mgticult u it OhfunicipaMblic 65 ft. 75 R. 2" Im .010 SCH-40 PVC
®Gcothermal(Flcating,'Cooling Supply) ®Residential Water Supply(single) iT. I ft,
®industriallConuncrcial ®Residential Water Supply(sled) Tee GROUT =
FROM TO NIATERMI. EHPtACEMEVTMEf110MAHOUNT
❑lrigation 0 ft. 55 fG Portland Injection
Non-Water Supply Well:
fG tL
PaMonit6ring ❑Recovery
Injecllon Weft: fG rL
0 Aguifcr Recharge QGFoundw:Rcr Reiltediation 19:SANDIGRAVEL PACK tit a dkAtite).
FRONT •r(r MaTRittAL HMPIACr MENT MM11011
❑Aquifer Storage acid Rccovciy ❑Salinity Baiiicr 60 ft, 78.5 ft. Filter Sand #2
❑Aquifer Test ❑Slormwitcr.Uraitnafl
ft. ft:
❑>:xpeiimental Technoto�' ❑Srthsidcncc Canirol
for DRILL111 G1OG(attach additional shcels iritcccssari t
OGeothetntal(Closed Loop) OTrdcer FROM TO DESCRIMON h'obr.hurduca w+il'nrektype,oWn*e.ttr)
OGeothemial(HeatingrCoolineReturn) OOtller(explain under 921 Retuaft) 0 ft. 100 ft, Tan Silty Sand and Saprolite
ft. fL
4.Date NWLI(s)Completed: 3/14/2023 WdtiD#PZ23-06
Sa.Nell I.ocatitrn: fL ft. li 'r _
Duke Energy ft. ft. 1 2h
FacL1ity,0tvncr Numc Facility=-(ifapplixiblc)
253 Plant Allen Rd., Belmont, NC, 28012 .
�'a•,.,L�
Nlical Addt?ss.City.and Zip a3t:REM1fARKS'
Gaston Bentonite Seal from 55+-601 and from 78'-100+
Ccumtl' Parcel 1dr.,dirk ition No,(PIN)
Sb,lAtitude and I ongitndc in dcgrcexlminutcs/xconds or decimal degrees: 22.Certr£tc rtipw
(If yell fntd,pile tablong is cidticicml)
35.1980 N -81.0110 IV /��V 3/18/2023
` lgmture<ar cdtlrkd We Contractor Dale
6.Is(are)the{Sell(S}: EPermanent at L7Temporary Bysfgnbig rhir form,i hereby ceriifr rhau slip mellfsl tsva fxrrc)convinrcred tit mcor&nne•
nirh 1501 A W 02C.01M or 1501 rYCAC 02C..02M)Well Constreacriwr Srarxia nts and r1ma a
7.Lv this•a repair to an a Ming hell: 7Vcc or MNte raps oJdiir rrrnni has fn cn�mvirteal ro thr rn*!1 rnrira r.
!f thbs is a nlvtlr,fill air knfiim Iveff coru7riratan luformadon emd a plaht the moire of rite
rejwir aralcr#21 remarks srcrian or mi die bark of this forirc 23.Site diagram or additional well details:
you may use the back of this page to pro%i additional-well site details or welt
8.Nutnberof wells construeted: 1 coustmc[ioii details. You inay also altaeft additional pages if necessary.
For mailrlrrlelrtfecrlai or Dori-barer suppJr nrlls Or�'LY.ndrh the s+riite tnrrstrucrlar,}'ou cna
submit nn"jann. SUBMITTAL iNSTLiCTiONS
9.Total well depth beto{i land surface. 100 ((t,} 24a. For All NV014: Suhndl this form within 30 days of completion of will
For rnrilriple wells list at depths bf difiveru fcr+mipre-3@200'aiu!2@ lfldl l constmction to the following:
10.Static water level below top of casing: (M) Division of Water R6uurces,Information Prueessing Unit,
if nvirer level Is above casing,rise"+" I617 Mail Sen•ice Ceater,Raleigh,NC 27699-I617
11.Borehole diameter:8" (in) tab.Tnr iiileetion Mth.ONLY: 'In addition to sending the form to ilia address in
24a above.also submit a copy of this faro within 30 days of completion of wall
12.Well construction method:HSA eonstmctiou to the following:
(i.c,auger.story,cable direct push.etc:)
Division of Water Resources,Underground hijeeaion Control Program,
FOR WATER SUPPLY\YELLS ONLY: 1636 Mitt Service Center,Raleigh,NC 27699-1636
13a,Yield(gym) Method of test: 24c.For Water Su6,l &-injeetuan1wcils:
Also submit one cop), of this form within 30 days of completion of
13h.Disinfection type. Amount:. wcli constriction to the coimty lie:ilth dcpanment of the county when:
conMictcd. j
Form MY-t North CarmlinaDep:nmemofEnviron ciaandNaturalResources-Division ofWateritmottces Revised August 2913