GW1--03387_Well Construction - GW1_20230517

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS' 14.WATERZONES
Well Contractor Name FROM To. DESCRIPTION -
rt. ft. i
A - 2581
rt. rt.
NC Well Contractor Certification Number "15.OUTER CASING for multi=ti:iscd wells OR LINER' if a licable
GEOLOGIC EXPLORATION FROM TO. DIAAf ETF:R THICKNESS "'ATER1AL
ft. fr. ;n,
Company Name 16.INNER CASING OR TUNING geothermal closed-fool)
2.Well Construction Permit#: WR0300124 FROM TO I DIAMETER THICKNESS MATERIAL
Lisl all applicable trell carstructior perttits(i.e.UIC.County,Slate,Variance,etc.) 0.0 rt' 88.0 ft. 1 6.0 t"• SCH 80 PVC
3.Well Use(check well use): n. tt. in.
Water Supply Well: 17.SCREEN
❑Agriculhtral ❑Municipal%Public
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
88.0 rt' 128.0 rt . 6.0 t"' .010 SCH 80 SS
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single)
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
Olrrigation ❑Wells> 10.0,000 GPD FROM TO MATERIAL E\IPLACEM ENT M ETHOD&AMOUNT
Non-Water Supply Well: 0.0 ft. 79.0 rr. NEATPORTLANDCEMENT SLURRY(PUMP)
ITMonitoring ❑Recovery
Injection Well:
rt. rt.
❑Aquiter Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK if ri i licable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑StormwaterDrainage 83.0 rt• 129.0 rr' 7-35(#2) POUR'
❑Experimental Technology OSubsidence Control R. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG'attach additional sheets if nee es
FROM TO DESCRIPTION(color,hardness,soilh-ock type;grain size,etc.)
❑Geothermal(1-leating/Cooling Return) ❑Other(explain under 921 Remarks)
0.0 ft. 13.0 rL RED SILTY CLAY
4.Date Well(s)Completed: 02/06/23 Well ID# EX-50 13.0 ft- 58.0 rc. BROWN SILTY SAND
5a.Well Locution: 58.0 ft. 129.0 ft' TAN/WHITE SI.LTY SAND
DUKE ENERGY OF THE CAROLINAS ALLEN STEAM STATION 129.0 rt. 139.0 rt. ROCK
Facility/Owner Name Facility IDii(ifapplicable) ft. ft.
253 PLANT ALLEN ROAD BELMONT 28012
Physical Address,City,and Zip ft. ft.
GASTON 304337 '21.REMARKS
County Parcel Identification No.(PIN) BENTONITE SEAL-76.0-83.0 FEET
STAINLESS STEEL SUMP- 128.0- 129.0 FEET
ib.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one]at/long is sufficient) 22.Certification:
525224.54268 N 1400536.17681 W !:2Sn,;7
04/11/23 .
6.Is(are)the well(s): MPermanent or ❑Temporary Signature ofCenified Well Contractor Date
ie
By signing dris Joan,!hereby certify that the mell(s)was(u e �J.�oTlsrrrtt•ced r r_cc r%lnfc
.L �4 t( �e`.
7.Is this a repair to an existing well: ❑1'es or �No 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Consixi0ir�1> �+uJrirfi+.1141 tho"d,�tp ;
ljdris is a repair,fill out known well construction information and explain the nature ojlhe "jrhis record has been provided to the well owner. y
repair roofer.'-.'21 remarks.section or on the back of this fornr' MAY 1 7 20 23
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 info
construction,only 1 GW-I is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also atth[1f3iFtifrci{k3f�Tris'if#ie�i`JrLL
drilled:
24.SUMMITTAL INSTRUCTIONS
9.Total well depth below land surface: 130.0 (ft.)
For nudtiple ire/Ls list all depths y'different(example-9 a 200'and 2 a 100') Submit this GW-I within 30 days of well completion per the following:
10.Static water level below top of casing: 14.2 (ft) 24a. For All Wells: Original font to Division of Water Resources (DWR),
I%u•nreT level is above casing,use" "
Information Processing Unit, 1617 MSC,Raleigh,NC 27699-1617
=
11.Borehole diameter: 14.0/10.0/6.0 (ltt) 24b. For Injection Wells: Copy to DWR,Underground Injection Control(IUC)
Program, 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: AUGER/SONIC
24c.For Water Supplv and Open-Loop Geothermal Return II ells:Copy to the
(i.e.auger,rotary,cable,direct push,etc.) county environmental health department of the county where installed
FOR WATER SUPPLY WELLS ONLI'i 24d. For Water Wells producing over 100,000 GPD: Copy to DWR,CCPCUA
13a.Yield(-pm) Method of test: Permit Program, 1611 MSC,Raleigh,NC 27699-16 1 1
13b.Disinfection type: Amount:
Form GW-I North Carolina Department of Environniental Quality-Division of Water Resources Revised 6-6.2018