GW1-2022-08658_Well Construction - GW1_20220427

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
NICHOLAS HAYES 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
A - 4121
NC Well Contractor Cenificatton Number 15.OUTER CASING for multi-cased we1Lt OR LINER if a litable
GEOLOGIC EXPLORATION FROM To DIAMETER 11HCtCtLSS atATERlAL
tt. ft. in.
Company Name
16.INNER CASING OR TUBING fectithermal closed-l000l
2.Well Construction Permit#• FROM To DIAMETER I THICKNESS I MATERIAL
List all applicable well cmcrtrucrion pertnttr(i.e.WC C-aunty.Stare,Variance.ere.) Q,Q R- 18,0 fL 2.0 In- [�� PVC
3.Well Use(check well use): R. ft. io.
17.SCREEN
Wafer Supply Well. FROM TO DIAMETER SLOTSIZE THICKNESS AtATERtAL
❑Agncultural ❑Municipal/Public 18.011. 23.0 ft. 2.0 1O' .010 SCH 40 PVC
OGeothermal(HeatinP,/CoOhng Supply) ❑Residential Wafer Supply(single) R.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑IRigalion ❑Wells>100.000 GPD FROM TO MATERIAL EMPLACEUEN METHOD h AMOUNT
Non-Wafer Supply Well: 0.0 "' 11.0 ft AQUA GUARD SLURRY
IMMonitoring ❑Recovery ft. ft.
Injection Well:
ft. R.
CIAquifer Recharge ❑Groundtivater Remediation
19.SANDIGRAVEL PACK if applicable)
OAquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL I EnIPLACEMENrt11E-f1I0D
❑Aquifer Test OStormvmter Drainage 13.0 tt 26.0 ft• 20-40 FINE SILICA SAND
OExperimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessa
❑Geothermal(Heatin Coolie Return) ❑Other(explain under#21 Remarks) FROM TO DESCRIPTION tobr,hardness,soiVrock minsim.eic.
0.0 It• 8.0 ft• RED CLAY
4.Date Well(s)Completed: 1 2/1 7/21 well ID# PMW-AS-4D 8.0 R, 17.0 f' SAPROLITE
Sa.Well Location; 17.0 ft- 24.0 ft' PWR
CLIFFSIDE STEAM STATION 24.0 1" 26.0 R• Q P r. h
I'miliry.rOwnerName Facility lDX(irapplicable) ft. ft.
573 DUKE POWER ROAD MOORESBORO 28114 ft. ft. APR 2 --
Physical Address.City,and zip ft. rt. �C
RUTHERFORD 21.REMARKs I ii
County Parcel Identification No.(PIN) BENTONITE SEAL•-8.0'123:0'tiEETyt1Mp` �3.04 26.0 FEET
5b.Latilude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one fat/long is suRicicm) 22.Certirrcalion:
35" 12' 48.75" N 810 45' 12,84" W 03/23/22
6.ls(are)the well(s): OPermanent or ❑Temporary Signature ofCcriified Wei)Contractor Date
$p.signing this jorat,l hereby certl/p that the trelf(s)u•as(were)constructed in accordatwe u-idt
7.Is this a repair to an existing well: ❑Yes or MNo 13A NC'il('n1('.U10a nr/5.4 hZ A('DIC.010t7 IYell('onsrntcrimt.titmt lard,rind drat a sort
if this+r o repatr,/ill not kt min tell coastru<vtnn it jarnrainn mxl rzploin the norure aJ tl+r ofthis record liar been prm ided to the ire//atener
repair ender,21 remarks section or on the back ofills/itrm.
23.Site diagram or additional well details:
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells lowing the same You may use the back of this page to provide additional wail construction info
constntet:on,only I GW-I is needed. Indicate TOTAL NUMBER ofwells (add'See Over in Remarks Box).You may also attach additional pages ifnecessan
dolled_ _- -.,_....._.__ _:- 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 26.0 (ft.
1•itr ntahiple wells flit all depihr f rWerent(eranrple•3�t00'mtd 1 t@1oo') ) Submit this GW-1 within 30 days of well completion per the following:
10.Static water level below top of casing: 2.18 (ft-) 24a. For All Wells: Original form to Division of Water Resources (DWR),
1J'u-an•r lore/it aMn•e canng,use"--
Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter: 6.0 (in) 24b. For Injection Wells:Copy to DWR,Underground Injection Control (IUC)
Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: SONIC
24c.For Water Su I and O en-Loo Geolherma]Return Wells:Copy to the
(i.e auger,rotary,cable,direct push,etc) county environmental hea t apartment o t e county where installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells roducin over 100 000 GPD:Copy to DWR,CCPCUA
Permit Program,I I I MSC,Ra eigh,NC 27699-16 1 1
13s.Yield(gpm) Method of test:
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13b.Disinfection type: Amount:
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Fun[OW-1 North Carolina Department of Environmental Quality-Division of Waicr Resrutctes i Revised 6-6-2018