GW1--03385_Well Construction - GW1_20230517

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor information:
BRIAN THOMAS l4.WATERzoNEs.
Well-Conti actor Name FROM TO ' . . DESCRIPTION
A - 2581 ft. a.
ft. ft.
NC Well Contractor Certification Number
15.OUTER CASING 11or multi-cased'wells OR LINER if a tlicable)
GEOLOGIC EXPLORATION FR011 TO UTAII ETER THICKNESS MATERL\L
ft. in.
Company Name ft. �
WR0300124 16..INNER CASING OR TUBING eothermal closed-loo 1
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS MATERIAL
l ist all applicable uvll e•anstruction perinhs(i.e.UIC,Couarya State,Variance.etc.) 0.0 ft. 114.0 ft. 6.0 in. SCH 80 PVC
3.Well Use(check well use): ft. ft. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOTSIZE THICKNESS NIATERIAL
❑Agricultural ❑Municipal/Public 114.0 f' 169.0 f' 6.0 "' .010 SCH 80 SS
OGeothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. I ft. in.
❑Industrial/Conintercial ❑Residential Water Supply(shared) 13.GROUT
Olrrigation ❑Wells> 100,000 GPD FRONT TO MATERIAL EMPLACENI ENT II ETIIOD a AMOUN7
Non-Water Supply Well: 0.0 ft- 103.5 ft' NEAT PORTLAND CEMENT SLURRY(PUMP)
OMonitoring ❑Recovery ft. fr.
Injection Well: ft. R.
❑Aquifer Recharge ❑GfOUnciNvater Remediation
K
❑Aquifer Storage and Recovery OSalinity Barrier 19.SAND/GRAVEL PAC (if a s tlicablcFROM TO MATERIAL EMPLACEMENT mcriu D
❑Aquifer Test ❑Stonnwater Drainage 108.5 f' 170.0 f'. 7-35(#2) POUR
❑Experimental Technology ❑Subsidence Control fr. ft.
❑Geothermal(Closed LOOP) OTracer 20:DRILLING LOG attach additional sheers if necessary)
FROM TO DESCRIPTION(color,hardness,soillrock ly re,oraiu size,etc.)
OGeothennal(Heating/Cooling Return) ❑Other(explain under#21 Remarks)
0.0 f' 18.0 f' RED SILTY CLAY
4.Date Well(s)completed: 02/09/23 Well[D# EX-53 18.0 ft- 79.0 ft- BROWN SILTY SAND
5a.Well Location: 79.0 f` 87.0 ft' TAN/WHITE SILTY SAND
DUKE ENERGY OF THE CAROLINAS ALLEN STEAM STATION 87.0 ft- 168.0 ft- PWR
Facility/Owner Name Facility ID;:(irapplicable) 168.0 f'' 188.0 f' ROCK
253 PLANT ALLEN ROAD BELMONT 28012
Physical Address,City,and Zip fL ft.
GASTON 304337 21.REMARKS
County Parcel Identification No.(PIN) BENTONITE SEAL- 103.5-108.5 FEET
ib.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
STAINLESS STEEL SUMP- 169.0- 170.0 FEET
(if well field,one Iat/long is sufficient) 22.Certification:
525085.74830 �, 1400591.47534 W 04/11/23
6.Is(are)the well(s): Permanent or OTemporary Signature of Certified Well Contractor Date
By signing this form,i hereby cer i/y that the a eh'(s)n•as(were)constnrr•d ltt�c•c•a rlr txu�sritir.
7.Is this a repair loan existing well: ❑Yes or MNo ISA A'CAC 02C.0100 or 15A NCAC 02C.0200 Well Cons r(Yi r6nr)ar'r anrfl/u�f ujt�-
/J rhir i.v a repair,fill ota known well construc•han it ftrino6on and explain the ncaure afrhe ofihis record has been provided to the well asrrier. t. ^"
repair under"21 remarks section or on the back ofthis form. 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 addition well construction info
construction,only I GW-I is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach additional��g� jf rt cep )nail
drilled: 24.SUBMITTAL 1NSTRUCTiONS
9.Total well depth belowland surface: 170•0 (ft.)
Par nrmlriple uv//s fist all depths i1(gJercnl(eranglle-J a 200'and 2@100') Submit this GW-I within 30 days of well completion per the following:
10.Static water level below top of casing: 23.25 24a. For All Wells: Original form to Division of Water Resources (DWR),
lJ'u•arerlere/i.c nonce caring,use"-
(ft.) Information Processing Unit, 1617 MSC,Raleigh,NC 27699-1 6 17
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 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 WATER SUPPLY WELLS ONLY: 24d. For Water Wells producing over 100,000 GPD: Copy to DWI',CCPCUA
13a.field(-pill) Method of test: Permit 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