GW1-2022-04982_Well Construction - GW1_20220516

•��u��vlvaAxcv�,1t1v1v1CL+L;C➢1� tiW—1 For lnterntilUseOnly:
1.Well Contractor Information:
James Hall
14.WATER ZONES .
Well Contractor Name Mom TO DL;SCRIPTIOn
3224A fr• tt,
ir.INC Well Contractor Certification Number ft. '
Cascade Drilling tS,OUTER CASING for multi-cased wens OR LINER if a licable
FROM TO DIAhrZ ER I THICKPfFSS MATh1trAL
Company Name ir• ft. ;n,
Mecklenburg County: #70002996 16.INNER CASINGORTURING oothermniclasetl-too
pj
2,Well Construction Permit#: NCDEQ: #WM0301193 raonr 'ro MAMlSrnR THICKNESS M&FRIA1,
List all applicable well constr•:rettoo permits(i.e.UN,,County,State,Yarlauoe,cic.) ft. ft. in.
3.Well Use(chcclt well use): ft. ft. in.
UA
Well: 17.SCREEN:
FROM 1'O DIAMir•1•F:It SLOTSVF; 'I'MCKNESS MATERIA1,
Municipal/Public
•leating/Cooling Supply) ®lResidentiat Water Supply(single) 20t0 sch.im
mercial Residential Water Supply(shared) IS.GROUT
VROM TO MATERIAL EMPLACEMENT NIETIIOD do ANTODPiT
Non for Supply Well; y it. ft. bent rout tremmle
i s
r
ring E3Rccovery ft. it.
InjectionWell:
Rechar+e it• ft.
b oGroundwater Remediation
Storage and Recover 19,SAND/GRAVEL PACK if a licable
Y E3Salinity Bar ier IF ROTH TO MATEnL1T, i n7PI ACEMF,NT IVIETtrOD
Test [3Stormwater Drainage ft. 1i tp
trernmle
Experimental TechncIogy ©ISubsidence Control it. R.
mal(Closed Loop) [3Traeer 20.DRILLING LOG attach additional sheets Irnecessalnal Ilcating/Coolin Return) Other(explain under'#21 Renlnr[s FRORI TO DCSCRIPTTOK color,hardnass,sotllrock tV a rnin site,eta
4,Date Well(s)Completed: ` � Well ID# �'O(/
Sa.Well Location: ft. ft.
Duke Energy rr. rt. t�(31
.r
Facility/Owner Name Facility 1Drt(if applicable) ft, ft.
13733 Lancaster Hy. Pineville NC
Physical Address,City,and Zip ft. it. Intotimiattan r5ct;tim{tt9 ►lit
r- fit. 2I.REMARKS
County Parcel Identification No.(P1N)
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/(ong is sufficient) 22.Certifieatio
w.
N W 4-13-22
6.Is(are)the`Yells Permanent or emporary Signaturo led Well Contractor Date
11y signing thts_/brm,/hereby certify that the tvell(r)was(were)Coueancted in accordance
7.is this a repair to an existing well: E3Yes or XBNo with 1Sd NCIC 02C.0100 ar 15d NCXC 02C.0200 Rrell Constrrtedon Standards and Mai a
If/his is a repair,fill out known well construction inforaurfion and erplafa the nnnnr gfthc copy ofthis•record has been provided to Nin well owner,
repah'under#21 remarks section or on the back g1'rhisfarin.
23.Site diagram or additional well details:
8.For Gcoprobc/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well site details or well
construction,only 1 GW-1 is needed. indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if necessary.
drilled:
r SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: —(ft-) 24a. For All Wells: Submit this form within 30 days of completion of well
Isar Ntttblpkt wells list all depths if dflfarent(eeaatple-3@200'and 2@100) construction to the following'
10.Static water level below top of casing: (ft.) Division of Water Resources,Information Processing Unit-,
If water/eves is above casing,n8e"+^ 1617 Mai!Service Center,Ralei !1 NC 27699-1617
g �
11.Bol'e!►ole diarneter: 6 inch
24b.For Injection Wells: In addition to sending the form to the address in 24a
I2.Well construction method: Sonic above, also submit one copy of this form'within 30 days of completion of Fvell
(i.e.auger,rotary,cable,direct push,etc.) construction)to the following:
FOR WATER SUPPLY WELLS ONLY: Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
13a.Yield(gpnr) Method of test: 24c.For Water Supply&Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 clays Pf
13b.Disinfection type: Amount: completion of well construction to tho county health department of the county
where constructed.