GW1--03392_Well Construction - GW1_20230517

WELL.CONSTRUCTION.RECORD(GW 1) - For Internal_Use Only:
1.Well Contractor Information:
BRIAN THOIMAS 14.WATER ZONES
Well Contractor Name
FROM TO DESCRIPTION
ft. ft. i
A - 2581
NC Well Connactor Certification Number -'15:OUTER CASIN ulti CASING(for m =cased'wells R O LINER(if a Iicable
GEOLOGIC EXPLORATION.- FROM TO DIAM1tETER THICKNESS. MATERIAL
.... .. .- ft.
Company Name-
W RO3OO124 16.INNER CASING OR TUBING oeotherrnal closed-loop)
2.Well Construction Permit#' FROM TO DIAMETER THICKNESS "MATERIAL
List all applicable well construction permits(i.e.U1C,County,State,Variance,etc.) 0.0 ft. 110.0 ft. 6.0 tn- SCH 80 1.
PVC
3.Well Use(check well use): R. ft. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal%Public 110.0 f`' 150.0 ft' 6.0 'n' .010 SCH 80 SS
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft, in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑lrrl ation ❑Wen Is'>I00;000 GPD FROM TO _ 'MATERIAL EMPLACEM ENT AIETH OD&AMOUNT
Non-Water SupplyWcll:;. 00 ft- 88.9 ft- NEATP6FuANDCEMENT SLURRY(PUMP)
29Monitoring ORecovery ft. ft.
injection Well: ft. ft.
❑Aquifer Recharge OGroun&ater Remediation
19.SAND/GRAVEL PACK 1'a licable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL I EMPLACEMENT METHOD
❑Aquifer Test ❑Stonmvater Drainage 94.7 ft• 151:6 fl- 7-35(#2) POUR"
❑Experimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) ❑Tracer 20:DRILLING LOC attach additional sheets if necessary
FROM TO DESCRIPTION color,hardness,soil/rock t y 0e, ,min size,etc)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks)
0.0 f` 1.3.0 f` RED SILTY CLAY.
4.Date Well(s)Completed: / /23 Well iD# EX-41 13•0 ft- 51.0 f` BROWN SILTY SAND ..
5a.Nell Location: 51.Q f` 129.0 f`' TAN/WHITE SILTY SAND
DUKE ENERGY OF THE CAROLINAS ALLEN STEAM STATION 129:0 ft- 150.0 ft7 PWR
Facility/Owner Name Facility ID#(rf applicable) 150.0 f`• 159.0 ft
253. PLANT ALLEN ROAD -BELMONT 280.12 rt. rt. ,s�•,:�• s t�° ;-"
Physical Address,City;and Zip=
ft. ft.
GASTON 304337 '21•REMARKS - -
BENT0NITE SEAL-88.9.-94.7 EET•-, ;q�.F,r .�=F ;;;, Una
Comity Parcel Identification No.(PIN) ,,. 3
STAINLESS STEEL SUMP- 150.0-151.0 FEE_:=;Qr'n'J'u
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one lat/I6ng is sufficient) 22.Certification:
526300.1541.9 N 1400502.49850 w jk.r--
04/11/23 ,
6.IS(arc)the well(s): Permanent or ❑Temporary Signature of Certified Well Contractor Date
Hy signing this form,1 hereby certify,that the we/!(s)was(were)consiructed inacc•ordance with
7:Is this a repair to an existing well: ❑YCS Or MNo 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction S.landards and that a cop,
IJ'ihis is a repair,Jill oul known well construction itilbrniation and explain the nature iifthe ofthis record has beenprorided to due ire/l orner.
repair under'2/reivarks section or on the back ofthis form.
23.Site diagram or additional well details:
8.For Gcoprobe/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 I GW-1 is needed. indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach additional pages if necessary.
drilled: 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface:' 1 51.0 (ft.)
For multiple hells list all depth's ifdiJferetu(eraniple-3@200'and?@100') Submit this GW-1 within 30 days of well completion per the following:
8.64 24a. For All Wells: Original form to Division of Wafer,Resources (DWR).
10:Static water level below top of casing: (ft.)
/Jlrn/er/ere/is above casing,use Information Processing Unit, 1617 MSC,•Raleigh,NC 27699-1617
"�•' .
10.0/6.0 24b. For Infection Wells: Copy to DWR, Underground Injection Control(IUC)
11.Borehole diameter: - (fit•) 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 DWR,CCPCUA
13a.Yield(gpm) Method of test:
Permit Program, 1611 MSC,Raleigh,NC 27699-1611
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13b.Disinfection type: Amount:
- ..
Forni G W-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018