GW1--03367_Well Construction - GW1_20230517

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
I.Well Contractor Information:
NICHOLAS HAYES 14.WATER ZONES
Well Contractor Name FROM To. DESCRIPTION
ft. ft. i
A - 4121
ft. ft:
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells)OR LINER'if a dicablej
GEOLOGIC EXPLORATION FROM TO DIAMETER THICKNESS MATERIAL
ft. ft. .
Company Nvpe
W R0300124 16.INNER CASING OR TUBING acothermal closed-loon)
2.Well Construction Permit#: FROM 'to DIAMETER THICKNESS MATERIAL
List all applicable u•eh'c•ansiniction permits(i.e.(//C.County,State,Varimte•e,etc.) 0.0 ft- 44.0 ft- 6.0 in' SCH 80 PVC
3.Well Use(check well use): ft. fr. in.
Water Supply Well: 17.FROMSCREENTO DIAMETER SLOTSIZE I THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 44.0 ft• 59.0 f`• 6.0 1p' .010 SCH 80 SS
❑Geothermal(Heat ing/Cool i ng Supply) ❑Residential Water Supply(single)
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Irrigation ❑Wells> 100.000 GPD FROM 'to DATERIAL ENIPLACEMENTMETHOD&AMOUNT
Non-Witter Supply Well. 0.0 1" 34.0 ft' NEAT PORTLANDCEMENT SLURRY(PUMP)
®Monitoring ❑Recovery
Injection Well:
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK if a r tlicable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACENIENTNMETHOD
❑Aquifer Test ❑St6nnwater Drainage 39.0 ft. 60.0 ft. 7=35(#2) POUR
❑Experimental Technology ❑Subsidence Control fr. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary)
❑Geothermal(Heatin--/Cooling Return) ❑Other(explain under#21 Remarks) FROM TO DESCRIPTION color,Hardness,soillrocic type.ginin sae,ete.
0.0 ft• 40.0 f` BROWN CLAYEY SILT
4.Date Well(s)Completed: 12/13/2.2 well ID# EX-74 40.0 fr. 59.0 ft• PWR
ia.Well Location: 59.0 f` 79.0 ft' ROCK
DUKE ENERGY OF THE CAROLINAS ALLEN STEAM STATION ft. ft.
Facility/Owner Name Facility I Drr(ifapplicable) ft. ft.
253 PLANT ALLEN ROAD BELMONT 28012 e. ft.
Physical Address,City,and Zip ft. ft.
GASTON 304337 21.REMARKS
County Parcel Identification No.(PIN) BENTONITE SEAL-34.0-39.0 FEET
ib.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
STAINLESS STEEL SUMP-59.0-60.0 FEET
(ifwell field,one lat/long is sufficient) 22.Certification: -
529604.24341 1 1399788.63100 W ieG1" 04/11/23
6.Is(are)the well(s): Permanent or ❑Temporary Signature of Certified Well Contractor Date
By signing this form,1 hereby certify that the ire/I(s)u•as(were)c YeJi-14�hiaccordamce with
7.Is this a repair to an existing well: ❑Yes or MNo 45A NCAC 01C.0100 at LiA NC 02C.0200{Nell Con.slructis)r�tajldartls do I tIrll a cry?+:. �
!/'this'is a repair,fill oar known ire/1 construction h#brmaiion and explain the nature of the of this record has been provirtec/to the well orrrrer. °'�--ti..n f...b t' ''j+<„L r
repair under=11 remarks section or on the back of•tliis faun.
23.Site diagram or additional well details: MAY r7 9/�
8.For Gcoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well consIll.1 $012,e23
construction,only1 GW-1 is needed. Indicate TOTAL NUMBER of wells (add'See Over in Remarks Box).You may also attach dditi nal ages if necessan'-
drilled: tin:� ',1
24.SUBIMITTAL INSTRUCTIONS t..:;;''��.•�r•}i�y •
9.Total well depth below land surface: 60.0 (ft.)
l•or nitiluple ire/is list al/depths ifdifJerew(exaniple-3 a200'and 2 a 100') Submit this GW-1 within 30 days of well completion per the following:
16.4 24a. For All Wells: Original form to Division of Water Resources (DWR).
If u
f'i•mer level is above casing.use"T Static water level below top of casing: (ft.) Information Processing Unit, 1617 MSC,Raleigh,NC 27699-1617
14.0/10.0/6.0 24b. For Injection Wells: Copy to DWR,Underground Injection Control(IUC)
I1.Borehole diameter: (in.) Program, 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: AUGER/AIR/SONIC
24c.For Water Supply and Open-Loop Geothermal Return Wells:Co to the
(i.e,auger,rotary,cable,direct push,etc.) county environmental health department of the county where installed Copy
FOR WATER SUPPLY WELLS ONLY: 24d. For Water Wells producing over 100,000 GPD: Copy to DWR,CCPCUA
13a.field(gpnM) Method of test Perntt Program, 1611 MSC,Raleigh,NC 27699-1 6 1 1
136.Disinfection type: Amount:
Form G W-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018 -