GW1--02254_Well Construction - GW1_20240409

• , , •
.... • "
1 . .
WELL CONSTRUCTION.RECORD Fut It:titled(he OWN:,. • , .
This(bemoan bc used for single Or multiple'wells•- • .
I ". . .
I.Well Contractor htiormation: . .
'Li.WATER ZONES . .
Chris Huffer . . . • ' FROM TO ' •DPACItiPtION. ' " -
Well ContramorName ' .• .ft: ft, • 1 . . •
" i
4223 A . . . • . :ft. It.
NC Well Connecter Ccrtifichtion Ninth& • . I-
.. . ,16.OUTER CASING(for Inutti-ented-littIst OR LINER(if ifti•ilCiabkli - ' '
. FROST TO •• . • DIASTEIVR i., THICKNESS, MATERIAL
• SAEDACCO • . . • ft,• ft. Is. • '
Compani Name . . 16.INNER CASING OR (geothermal dosed-loop)
. . -BROM 'TO DIANIETER, THICKNESS :MATERIAL
. . . ..--
2.Weil ConStruetion Pei*tri: . : O. . 'ft, 5 ft. 2 . •ht. SCH-40 PVC
.• lio 41.0401karre well penrritifiz,eluoiry;snite,-.VntkuTrr..6fectico,etc:)',
. ht.- ._
3.WelkIrse.(check.well oseR. . • • • t7.:SCREEN . .
-. Niger Suly Weil:pp . FROM. . TO . -DIAMETER SLOT SIM IIIICHNIZS SIATRIDAI.. .
, . ,..
. • • 5 • R. 15 -ft. 2 in ':,010 SCH-40 , PVC
• LIAgticultutal • . . Inhfunidipal/Publie
. •ft. • in
. .
OGeothennat(Ilea.ling/Cooling Supply). CIResidentiat Water SupPly(single) ft
• • " • fli GROUT „
-- . .• •
.131odustiialf.Commacial • I:Residential Water Supply(shared) •
FRI ONI . TO. MATERIAL . I E3WEACE.MEST METHOD&AMOUNT'
- - Elluipation . ' :- . . . . 0- ' it. -1 -11. Portland Pour - •
• 'Non-Water SuPplY,Wen: • •. ..
. .,
Monitoriog R . '- - Io . R.Ottecosety
Injection Well: . . . , . . . . 11.• ft. .
. , .
. . . .
• CIAMtifer Recharge ' OGioundvinki lienediation- 19-MAD/GRAVEL PACK(if applieable) . . -.- .: = .-. - = •
- • . ..-... • , . - .- • "FlIONI- -TO' •. .NIATRIMI: • ' • •• ESIPLACEMENT METI1011 - .
. 13Aiptifer Storage and Itceove CfSnlinity.13tiiii. ci - 3 ft,. 15 It, Sand r • #2 • • • . .
1:1Aqiiifer Test- • . IDStormsvater Draleige'• . " . 1 . •
- --ft It. - •• . . .
IflEVerillictiln.I Technology • 0Subsidenc4ontrol . . .. . - . . .. ,. - • - .
• -20/DRILLING LOG(Mach-additional!Medi if necessaml - •1:30eotItemial(Claied Loop) 1:1Tracer. .FROM• TO • . DESCRIPTION(osbe.hmrdticri.sulumekoncerain sire.dr.)
DGeothennal Mention/Cablitig Return) . 130Iber(explain 6de...fat Remaiks) . - 'f!... , ft.. .
.
. • it.• it..- •
• • • . '
• , •
-1.13aie Welt(s)Completed:.3-20-2024 tept.ft Ift#M41-2 . .
,.
ft. • •h. - - . .
- _
. . . . . . .
Sa.Wt.41 isteation: . .
t .See Gemes Notes - - 17,.72.77.,-,
.., .L,., ...„•L„.i.•
Duke Energy' • - "ft. fl-, r, .
. .
FacflOntnribme Facility ID/,'(iFappliaable) • ' - . ". . • = R. ft. , "• '. AHR.OI 2024 '
900-Power Station St., Whiteville, NC, 28472 • .ft. •
. .
Physical
A0iNi5;CiL'•unit Zip• "-21.1tE111AnKS ' . " • • I i i;,....A,,,-...`..:,. •......,........,, d I
.
. . Columbus . - Bentonite seal from 1,3''
.
- •
•
Coauly • Pliteel Idesinficallou NO,(PIN) • ,
,
. ' .
• .
• •
Sb.il.ittilittle and Longitude in degreciiminutes/Sceands or decinial •
degrees!. 21 Certification . •
OfnUllfoeld,ow tatrlong is stdrieteM) • •• ' .• . ,
•
. . . . . . . .
• N • • • W. - Chns-Ruffer i ' 3/21/2024
• • . . . - Si..:paTtIL4fEeTrtiiie-tiCif&nii3et;ir '' Dale •
6.Is OM the well(s):.loPermanent .or pTemporary :ili#gniatilay-fauff,'I irerchy errs*Mai 14 rreilf.0 MIS(were)corAgruelert Gr coqc!rdralce ' '•
' .
, • nit!,15A AVCAC 02C.0100 or•15,1 NC IC OW.0200 Wel1 Constnieriair Standards and the:a
7.Lsihis a rcpairto anc-kistiog wdh OYes or 1.0No •••refiyOf thir rceonf has Nem irrAwirtat G i dif spirli cnt,:iier, ,
• 1101511a repair:1111par fiathivi well eawiniedaa brformaaan and aplahrthe agrare of rf.le• . - - • , .
• :glair titrdir021 renrarki:irciiirr tit-on the briar-AI drii ferric ' 23.Site diagram'or adiDtlahal well detailsf
- • You ma use the back of this page to preside additional well site details or Well
- •11.Nuntberof wells constnicted: 1 - consttudiaidetaits. You inay alsonnantradditibital pages if necessary.
Foe Analaple1afeeili?a or(mi.-Miter iuppti-ive(fsO.AZYiekh die swae coaiteiredon,you ran • - - . _._ , ..
. submit-one fem. . - • StillIITTALINSTUCTIONS '
. - - •
- - ' •
91.-TOtal well depth below land surface 15 • -- ' (6.) 24a.-Far:MI Wells:•Submit this form OAtilin-30 days of completion of well
. For maid&rvellf list di depths ildUfervir:(exAmpte-30100'&mil@ 100) • construction to the following: • I ' . -• .
10.Static water level below top'of casing:- - ' •01-) • Division of Water Reintiree4,Information Processing Unit,
If writer level is abaee addax we"+" •. .• • 1617 Stall Scniee Center,Raleigh,NC 27699-1017 .
•
. ,
11.Dorchotc diameter:8.25" 'OM) 2.1b.Far inferior;%Yells ONLY: in addition-to sending the form to the address.in
.244aboVe.also.submit a copy of thiS faun within 30 dais'of.completion.of well
12.Well banstruction inelsod:Auger -. . . . . . coustruCtiffil to the following:• I •
, , ••
. •
.
(Lc:auger.rally.table.direct r,ash ctc.} •• • • .
• . . 'Divis19 u of Water Resources,Dnderwound Injection Control Program,
FOR WATER SUPPLY WELLS ONI.Y1 • 1636 Mall Service Cenh.T.Raleigh,NC 27609-1636-
• • • 24e.ear Water:Supply&IojectionlWells:
1341.Yield igloo) - Method attest: •
Also'stink one copy of tins Sinn Within 30‘days Of completion:of
•
. .
•
• 13b.Disinfection-type - • •Amount: - - • well-OonstructiOn Co the county health department of ihe.coloq.where
• _. anstructed. • .
• ihnuGW71. North Carolina Department of&MONISM:Ill and Neutral Resources-Division of Water thistunsas Revised Atg,ust20 LI
. . .
1 •
. , • .