GW1--03388_Well Construction - GW1_20230517

WELL CONSTRUCTION RECORD(GW-1) For Internal. Se Only:
I.Well Contractor information:
KENNY SARGENT 14.WATER ZONES
• FROM TO: DESCRIPTION
Well Connector Name ft. ft.
A - 422.6 "
NC Well Contractor Certification Number - 15.OUTER CASING(for multi-cased wells)OR LINER(if a licable
GEOLOGIC EXPLORATION FROM DIAMETER THICKNESS M1tATERIAL
ft. ft. in.
Conipany Nan ie
16.INNER CASING-OR TUNING eothermal closed-loop)
2.Well Construction Permit 0: WR03001 24 FROM TO DIAMETER I THICKNESS I MATERIAL
List all applicable well consiruction permits(i.e.UIC,County,State,Variance,etc.) .0..0. ft- 74.0 ft, 6.0 in. SCH 80 PVC
3.Well Use(check well use): ft. ft. in.
Water Supply 1VCII: 17.FROM SCREENTO DIAMETER SLOT SIZE I THICKNESS INIATERIAL
CAgricultural ❑Municipal/Public 74 R. 99.0 R. 6 0 fin• Ol O SCH 80 SS
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single)
❑industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT_ - _
_❑Irri'ation ❑Wells> 100,000 GPD FROM TO MATERIAL ENIPL\CEMENT METHOD&AMOUNT
Non-Water Supply Well: Q,Q It• 64.2 it• NEATP°RTtANDCEMENT SLURRY(PUMP)
©Monitoring ❑Recovery
Injection Well: fr. ft.
❑Aquifer,Recharge ❑Groundwater Remediation
19:SAND/GRAVEL'PACK'ita licable
❑Aquifer Storage and Recovery ❑Salinity Barrier. •FROM TO MATERIAL EMPLACEMENTMETHOD
❑Aquifer Test ❑Stormwater Drainage . . 69.5 ft 100.0 IL 7-35(#2) POUR
❑Experimelital Technology ❑Subsidence Control ty ft.
❑Geotlermal(Closed.Loop) ❑Tracer 20.DRILLING LOG-(attach additional sheets if necessa
FROM TO DESCRIPTION(color,hardness,soitrock type. rein size,e(c.)
OGeothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks)
0.0- It• 20.0 if BROWN SILT/ROCK FRAGMENTS
a.Date Well(s)Completed: 02/06/23 Well iD4 EX-48 . 20•0 fl• 25.0 ft• WEATHERED ROCK
ia.Well Location: 25.0 It• 35.0 if BROWN SAND
DUKE ENERGY OF THE:CAROLINAS ALLEN STEAM STATION 35.0 It• 96.0 ft- BROWN SILTY CLAY
Facility/Owner Naine Facility lD/:(ifapplicable) -96.0 it• 98.5- If PWR
253 PLANT ALLEN ROAD .BELMONT 28012 98.5 ft. 100.0' it• ROCK
Physical Address,City,and Zip: - - rt. ft.
GASTON 304337 '21.REMARKS
County -, Parcel Identification No.(PIN) BENTONITE SEAL- 64.2 69.5 FEET
5b.Latitude and longitude in degrees/miotaCS/seconds or decimal degrees:
STAINLESS STEEL SUMP-99.0:100:0 FEET
(ifwell field,one]at/long is sufficient) 22.Certification: /1
35.0 10' 36.07n n 810 00' 23.10". w 04/21/23.
6.Is(are)the\i•ell(s): INPermanent or ❑Temporary Signature ofCettified Well Contractor Date
by signing this Jbrtn,l hereby certify that the a e//(s)was(were)constructed iu accordance with
7.is this a repair to an existing well: 01'es or ONo I5A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction.Slandardr and that a copy
/J'Ihis is a repair.Jill out known well consiritciioh information and explain the nature oflhe ofthis record has been provided to the irel/,owner.
repair under=31 remarks section or on the back oJ•ttis Joint. "`�•' 9
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 aEh.ai well construction info
construction,only I GW-I is needed. Indicate TOTAL NUMBER of wells (adrl'See Over in Remarks Box).You may also attach� 1�� n p s'f(�e�e�ssary.
drilled: _ "�^'I � � `u��
24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 100.0 ft. r,,.ri^�?r --:5T,`+'3 Un
( ) Submit this GW-I within 30 days of well corn leiioil 'etrt ii�yv�•iwt
l•nr nndtiple sire/Ls list/aN rlepllrs ijd�eretit(ermnple-3@200'mtd 2 ct!00') �� �� � Y� p-,,,���-
10.Static water level below top of casing: (ft-)(ft) 24a• For All Wells: Original form.to Division of Water:Resources (DWR),
"
-information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
If water lure/is above casing,use"+
11.Borehole diameter: 6.0/10.0 24b. Fm•Injection Wells: Copy to DWR, Underground Injection Control (JUC)
(in.) Program, 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: SONIC I'
24c.For Water Supply and:Open-Loon Geothermal Return Welk: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 DWR,CCPCUA
Permit Program, 1611 MSC,Raleigh,NC 27699-1611
13a.field(gpnr) Method of test:,
13b.Disinfection type: Amount:
Fonn G W-I North Carolina Department of Environmental Quality'-Division of Water Resources �' Revised 6-6-2018