GW1--03369_Well Construction - GW1_20230517

WELL CONSTRUCTION RECORD(GW-1) For Internal Use,Only:
1.Well Contractor Information:
NICHOLAS HAYES fa.wATERzoNEs
Well Contractor Name FROM TO DESCRIPTION _
A - 4121
NC Well Contractor Certification Number
15.OUTER CASING for multi-eased wells OR LINER if a Tlicable)
GEOLOGIC EXPLORATION [ FROM ITO D1An1ETeR TIncKNEss PATERIAL
Company Name
0.0 tt• 187.0 tr• 8.0 i" SCH 80 PVC
W RO300124 16.INNER CASING OR TUBING(geothermal closed-loot
2.Well Construction Permit#: _ FROM TO DIAMETER THICKNESS MATER1AL
List al/applicable well construction permits(i.e.U1C,County,State,Variance,etc.) rt. ft. in.
3.Well Use(check well use): ft. ft.
Water supply Well; 17.FROM SCREEN
❑Agricultural ❑Municipal/Public TO DIAMETER SLOTSIZE THICKNESS. MATERIAL
ft.
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in.'
❑Industrial/Commercial OResidential Water Supply('shared) 18.GROUT
❑Irri ation .. ❑We]Is> 100,000 GPD FR09f - 'TO' MATERIAL EMPLACEMENTMETHOD R AMOUNT
Non-Water Supply Well; 0.0 ft- 187.0 ft- NEATPORTLANDCEMENT SLURRY(PUMP)
Mfvlonitoring ❑Recovery:
Injection Well:
fr: ff.
❑Aquifer Recharge ❑Groundwater Remediaiion
19:SAND/GRAVEL PACK if a licable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO I MATERIAL I EMPLACEMENTNI91MOD
❑Aquifer Test ❑Stormvater Drainage
❑Experimental Technology ❑Subsidence Control
❑Geodlermal(Closed Loop) ❑Tracer 20.DRILLING.LOG lattach additional sheets if necessary)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) FROM- TO DESCRIPTION color,hardness,soil/rock type,grain size,etc.)
0.0 tr 140.0 tr RED SANDY SILTY CLAY
4.Date Wells)Completed: 03/30/23 W ell ID# EX-69 140.0 ft- 116.5, ft- PWR "
Sa.Well Location: 176.5 tr• 238.0 fr• ROCK
DUKE ENERGY OF THE.CAROLINAS ALLEN STEAM STATION rr. ft.
Facility/Owner Name Facility i69(inapplicable) rt. ft.
253 PLANT ALLEN ROAD BELMONT 28012
Physical Address,City,and Zili
GASTON 304337 21.REMARKS
County Parcel Identification No.(PIN) OPEN HOLE
Sb.Latitude andlongitude in degrees/minutes/seconds or decimal degrees:
(iftvell Field,one IaUlong is sufficient) 22.Certification:
524810.71352 N 1400509.72649 W '' r'
04/13/23
6.Is(are)the well(s): OPermanent or: OTemporary Signature of Certified Well Contractor Date
by signing this form,/hereby certify that I&well(s)was tivere)construcled in accordance with
7. Is this a repair to an existing well: ❑Yes or nNo 15A NCAC 02C.0100 or ISA NCAC 02C.0200 1{'ell Construction S9andarr6'and that a copy
If llds is.a repair,fill ant known❑'el1 consiruction in/orination and explain the nature of the ofdris record has.been provider(to the well owner.
y Y...repair ender r2l reutarks section or on the back aJ this form.
23.Site diagram or additional well details: '�••�' • ' L ?.
You May use the back of this page to provide additional wel ruction nfo
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same Y P g
construction,only I GW-I is needed. Indicate TOTAL NUMBER of wells (add,See Over'in Remarks Box).You may also attach additiona�s i�n�es41)q�
drilled: L UULL
24.SUBMITTAL INSTRUCTIONS
0
9.Total well depth below land surface: 232. (ft.) i.r•-,.�' '«:1�3 L.tr;:i
por multiple wells lisl all depths ifdifferent(example-3C200'and 2 rt 100') - Submit this GW-1 within 30 days Of well completion per the fo71dt4 rd`�L�
10.Static water level below top of casing: 17 (ft) 24a. For All Wells: Original form to Division of Water Resources (DWR),
//baler level is abore caving,use"F" Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
IL Borehole diameter: 12.0/7.0 24b. For Injection Wells: Copy to DWR,Underground Injection Control(IUC)
(in.)
Program, 1636 MSC,Raleigh,NC 27699-1636
I2.Well construction method: ROTARY/AIR
24c.For Water Supply and Open-Loon Geothermal Return Wells:Copy to the
(i.e.auger,rotary,cable,direct posh,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
Permit Program, 1611 MSC,Raleigh,NC 27699-1611
13a.Yield(gpm) Method of test:
13b.Disinfection type: Amount:
Form 0W-I North Carolina Department of Environmental Quality-Division of Water Resources I Revised 6-6-2018