GW1--03368_Well Construction - GW1_20230517

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Inforration:
BRIAN THOMAS 14.WATER ZONES
Well Contractor Name
FROM TO DESCRIPTION
Pt. ft.
A - 2581
ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells)OR LINER if a licable)
GEOLOGIC EXPLORATION FROM To DIAMETER THICKNESS 1.xrERIAL
fit. D. in.
Company Name
WR0300124 16.INNER CASING OR TUBING eothermal closed-loon)
2.WCII Construction Permit#: FROM TO DIAMETER THICKNESS MATERIAL
list all applicable❑•e!l cnnsYrttctiot+pertniiv(i.e.WC,Coantl'..Shine,trarianc•e,etc.) 0.0 fr. 44.0 ft. 6.0 in. SCH 80 PVC
3.Well Use(check well use): tr. ft. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOTSIZE I THICKNESS I MATERIAL
❑Agricultural ❑Municipal/Public 44.0 fL 59.0 ft. 6.0 in. .010 SCH 80 SS
❑Geothermal(HeatinJCooling Supply) ❑Residential Water Supply(single) tr. fr. in.
❑industrial/Commercial ❑Residential Water SupPly(shared) 18.GROUT
❑Irrigation ❑Wells> 100,000 GPD FROM TO MATERIAL EMPLACEMENTAIETHOD&AMOUNT
Non-Water Supply Well: 0.0 ft' 340 ft. NEAT PORTLAND CEMENT SLURRY(PUMP)
C9Monitoring ❑Recovery ft. fir.
Injection Well: ft. ft.
❑Aquifer Recharge ❑GroundN ater Remediation
19.SAND/GRAVEL PACK(if a l licable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO I MATERIAL I EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage 39.0 f' 60.0 ft. 7-35(#2) POUR
❑Experimental Technology ❑Subsidence Control it. fit.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG(attach additional sheets if necessary
❑Geothermal(I leatinJCooling Return) ❑Other(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness.soil/rock tv,c, ,:d„size.etc.)
0.0 ft• 7.0 ft• RED SILTY CLAY
4.Date 11'ell(s)Completed: 12/08/22 Well ID# EX-73 7.0 ft. 14.0 1" BROWN SILTY SAND
ia.Well Location: 14.0 ft• 38.0 ft' TAN/WHITE SILTY SAND
DUKE ENERGY OF THE CAROLINAS ALLEN STEAM STATION 38.0 ft• 59.0 ft. PWR
Facility/Owner Name Facility IDS(ifapplicable) 59.0 ft• 69.0 ft• ROCK
253 PLANT ALLEN ROAD BELMONT 28012
Physical Address,City,and Zip
GASTON 304337 21.REMARKS
County Parcel Identification No.(PIN)
BENTONITE SEAL-34.0-39.0 FEET
gib.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
STAINLESS STEEL SUMP- 59.0-60.0 FEET
(ifwell field,one kit/long is sufficient) 22.Certification:
529543.95346 N 1399639.70978 NY 04/11/23
6.Is(are)the well(s): ®Permanent or ❑Temporary Signature of Certified Well Contractor Date
By signing this fbon,I hereby certify that the,re//(v)was(were)cog&uered in accordnnc•e•i'ah
7.Is this a repair to an existing well: ❑Yes or ONo 15A A'CAC 02C.0100 or l5A NCAI'02C.0200 I1lcll Convtractio t.$tii,tth'r rrjrl.tGrn n cnpr
f p f l ofthis record has'been provided to the well otrner. 'a -"d Y 7hir ie'n re air, tll otit knutrn,Tell cnnsvruction i,forutntion mal e.rpinin the nnn,re of the
repair router-2l remarks section or on the bock of this jarnr. �-
�.y . .�V �.. ..
23.Site diagram or additional well details: q�/
S.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional wel'Iydnstuctm}1�}i��jj
construction,only I GW-I is needed. Indicate TOTAL NUMBER of wells (add'SCC Over'in Remarks Box).You may also attach ac(clitional pages if nechsS'�F-
drilled:
24.SUBMITTAL INSTRUCTIONS f�,?=' ^'•
9.Total well depth below land surface: 60.0 (ft.)
I•br i n llip/c a eAv list all depths ifd f!renl(example-3@200'and?tt 100) Submit this CW-1 within 30 days of well completion per the following:
10.Static water level below to of casing: 17.4 24a. For All Wells: Original form to Division of Water Resources (DWR),
p (ft.)lJlrntcr Jerel is above casing,use"=" -
Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
1.Borehole diameter:
14.0/10.0/6.0 24b. For Injection Wells: Copy to DWR, Underground Infection Control (IUC)
(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:Copy to the
(i.e.auger,rotary,cahle,direct push,etc.) county environmental health department Of the county where installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPD: Copy to DWR,CCPCUA
13a.Yield(gpnl) Method of test:
Permit Program, 161 1 MSC,Raleigh,NC 27699-161 1
13b.Disinfection type: Amount:
Form G W-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018