GW1--03383_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 DESCRIPTION
ft. �
A - 2581 1
ft.
ft. ft.
NC Well Contractor Cedification Number 15.OUTER CASING(for multi-cased wells)OR LINER if apt ilicable)
GEOLOGIC EXPLORATION FROM ro DIAMETER THICKNESS MATERI:L
rt. ft. in.
Company Name
W RO3OO124 16.INNER CASING OR TUBING geothermal closed-loo t
2.Well Construction Permit#: FROM I TO I DIAMETER THICKNESS I 1ATERIAL
List a//applicable trel/constructio,L permits(i.e.UIC,County'State,Variance,etc.) 0.0 ft- 142.0 ft. 6.0 in' SCH 80 PVC
3.Well Use(check well use): R. I ft. I in.
Water SIIppI)'Well: FRSCREEN; TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 142.0 ft• 207.0 ft. 6.0 in- .010 SCH 80 SS
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT.
❑Irrigation ❑Wells> 100,000 GPD FROM TO MATERIAL ENIPLACEMENTMETHOD 3 AMOUNT
Non-Water Supply Well: 0.0 ft• 123.0 ft' NEAT PORTLAND CEMENT SLURRY(PUMP)
®Monitoring ❑Recovery fr. ft.
Injection Well:
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK(if a T tlicablc
❑Agllller SlOragC and Recovery ❑$a1llllt)'Barrier FROM TO MATERIAL EMPI,ACEDIENTMETHOD
❑Aquifer Test ❑Storinwater Drainage 138.0 ft. 208.0 ft. 7-35(#2) POUR
❑Experimental Technology ❑Subsidence Control
❑Geothermal(Closed Loop) ❑Tracer .20.DRILLING LOG attach additional sheets if necessary)
FROM TO DESCRIPTION(color,hardness,soil/rock Type, rein sixe.etc.)
❑Geothermal(I-feating/Cooling Return) ❑Other(explain under#21 Remarks)
0.0 ft• 21.0 ft• RED SILTY CLAY
4.Date Well(s)Completed: 02/21/23 Well ID# EX-56 21.0 fr. 47 0 ft• BROWN SILTY SAND
ia.Well Location: 47.0 ft' 69.0 ft. TAN/WHITE SILTY SAND
DUKE ENERGY OF THE CAROLINAS ALLEN STEAM STATION 69.0 ft. 207.0 ft. PWR
facility/Owner NLanie Facility ID,'(ifapplicable) 207.0 ft. 224.0 ft. ROCK
253 PLANT ALLEN ROAD BELMONT 28012
Physical Address,City, ft. ft.
Y y,and Zip
GASTON 304337 21:REMARKS
County Parcel Identification No.(PIN) BENTONITE SEAL•-• 123.0-138.0 FEET
ib.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
STAINLESS STEEL SUMP -207.0-208.0 FEET
(ifwell field,one hat/long is sufficient) 22.Certification:
524810.71352 N 1400509.72649 \�, )n, 04/11/23
6.Is(are)the well(s): MPermanent or ❑Temporary Signature of Certified Well Contractor Date
By signing this'Jornt,l hereby certfy that the Lrell(i)uns(°oer ?tn$7f71c <7Nt a,'�rn,c�2 nor/,t>i
7.Is this a repair to an existing well: ❑Yes or InNo 15A NC'AC 02C.0100 or 15A NCAC'02C.0200)t'el/Cou.crrlfcti,,Sra, la,ff �iTdbhr
!l this is a repair,fill mu knotrn well construction it formation and etplain the nature of the oJ7hi.v record has been provided to the well owner.
repair under=2/retnarks section or on the back oftlils fbrnt. MAY 1 7 2023
23.Site diagram or additional well details:
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well construction into
construction,only I GW-1 is needed. Indicate TOTAL NUMBER ofwells (add'See Over'in Remarks Box).You may also atta��ivl�i}ional.ppgo�rtfrKeti�ynr�'l t i
drilled:
24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 208.0 (ft.)
hor n,u/liple,re/ev list all depths i/"diJJere,n(ecnn,p/c-3 u 200'and 2 !00') Submit this GW-1 within 30 days of well completion per the following:
4.33 24a. For All Wells: Original form to Division of Water Resources (DWR),
If'unter level is above 10.Static water below lop of casing: (ft.) Information Processing Unit, 1611 MSC,Raleigh,NC 2 7699-1 6 1 7
c eaasing,use"��" •-
11.Borehole diameter: 10.0/6.0 (in.) 24b. For Injection Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: SONIC
24c.For Water Supph'and Open-Loop Geothermal Return Wells:Copy to the
(i.e.auger,Total),,cable,direct push,etc.) county environmental health department of the county where installed
FOR WATER SUI'PLl'WELLS ONLY: 24d.For Water Wells producing over 100,000 GPD: Copy to DWR,CCPCUA
13a.Yield(-put) Method of test: - Penns Program, 1611 MSC,Raleigh,NC 27699-161 1
13b.Disinfection type: Amount:
Form G W-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018