GW1--03381_Well Construction - GW1_20230517

WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
1.Well Contractor information:
BRIAN THOMAS 14.WATER ZONES
Well Contractor Name FROM TO I DESCRIPTION
A - 2581
ft. ft.
NC Well Contractor Certification Number
15rOUTER CASING(for multi-cased wells)OR LINER(if ayl pHEabIfe
GEOLOGIC EXPLORATION FROM TO DIAM1 ETER THICKNESS p1ATER1:\L
r7. tr. 1n.
Company Name
W R0300124 16.INNER CASING OR TUNING geothermal closed-loo p
2.Well Construction Permit#: FRO\I TO DIAMETER I THICKNESS MATERIAL
List al!applicable well consiruc•tion permits(i.e.CRC,Coi nq,,Suae,Variance,elc•) 0.0 ft-_ 121.5 ft- 6.0 in' SCH 80 PVC
3.Well Use(check well use): ft. ft. in.
Witter Supply Well: 17.SCREEN '
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 121.5 f' 176.5 ft' 6.0 . ill.
.010 SCH 80 SS
❑Geothermal(Fleating/Cooling Supply) ❑Residential Water Supply(single) ft. fr. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT.
❑Irrigation ❑Wells> 100,000GPD FROM f0 MATERIAL EMIPLACEMENTMIETHOD R AMIOUN"I'
Non-Witter Supply Well: 0.0 f'• 109.0 f'• NEAT PORTLAND CEMENT SLURRY(PUMP)
OMonitoring ❑Recovery tt. fr.
Injection Well:
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK(if a p plicable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL I EMIPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage 114.0 f'• 177.5 ff 7-35(#2) POUR
❑Experimental Technology ❑Subsidence Control ft. 1t.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if oecessa
FROM TO DESCRIPTION(color,hardness,soil/rock t pep rain size,etc.)
❑Geothermal(Ffeating/Coolin,Retum) ❑Other(explain under#21 Remarks)
0.0 f' 18.0 fr RED SILTY CLAY
4.Date Well(s)Completed: 01/16/23 Well ID# EX-57 18.0 tr. 70.0 f' BROWN SILTY SAND
5a.Well Location: 70.0 f' 140.0 ft' TAN/WHITE SILTY SAND
DUKE ENERGY OF THE CAROLINAS ALLEN STEAM STATION 140.0 f' 176.5 ft. PWR
Facility/Opener Name Facility ID"(irapplicable) 176.5 ft' 189.0 ft• ROCK
253 PLANT ALLEN ROAD BELMONT 28012 ft. rr.
Physical Address.City,and Zip ft. rt.
GASTON 304337 21.REpNIARKS
County Parcel identificalion No.(PIN) BENTONITE SEAL•- 109.0- 114.0 FEET
ib.Latitude and longitude in degrees/minutes/seconds or decimal degrees: STAINLESS STEEL SUMP- 176.5- 177.5 FEET
(if,vell field,one tat/long is sufficient) 22.Certification: ��
524679.21227 N I400500.28869 NY .'.._ nL7_ Cj1ti,,,-
04/11/23
6.is(are)the well(s): OPermancnt or ❑Temporary Signature of Certified Well Contractor Date
Hy signing this form,l hereby c'erliJy dial the well()n'as(were)conxiriicied in aecorclnuce with
7. Is this a repair to an existing well: ❑Yes or ONo I5A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Conevruclion&Wlo!.;l(t(¢al tll(t/
U'ihi.v is a repair,fill nut known well comiruclion h!1hrmation and evploin the nature ofthe ofihis record has been provicled io the well owner. -
repair under=21 reumt•k.c sec•iian or on the back nf7his form. _
23.Site diagram or additional well details:
3.For Geoprobc/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional MAy nsirUgioq Ri3
construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach additional pages if necessar\
drilled:
24.SUBMITTAL INS7-RUCTIONS 1'f
177.5 C:'1 u!L'�L.
9.Total well depth below land surface: (ft.)
I-armxlliple wells list all(lepihs i(clijpreni(example-3@200'and 2 m100') Submit this G�1'-1 within 30 days of well completion per the following:
6.05 24a. For All Wells: Original form to Division of Water Resources (DWR),
l/t
/iinier level is nbure casing,use"� 5 Static water revel below top of casing: (ft.) Information Processing Unit, 1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter: 14.0/10.0/6.0 (in) 24b. For 1hjection Wells: Copy to DWR, Underground injection Control (IUC)
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,cable,direct push,etc.) county environmental health department of the county where installed
FOR 1VATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPD: Copy to DWR,CCPCUA
13a.Yield(gpm) Method of test: Permit Program, 1611 NISC,Raleigh,NC 27699-161 1
13b.Disinfection type: Amount:
Forin GW-I North Carolina Department ofEnvironniental Quality-Division of Water Resources Revised 6-6-2018