GW1-2022-08659_Well Construction - GW1_20220427

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
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I.Well Contractor Information:
NICHOLAS HAYES 14.WATER ZONES
Well Contractor Name FROM toI DESCRIPTION
A -4121 r,. ft.
NC Well Contractor Certification Number 15.OUTER CASING for mu11t-emed wells OR LINER if a lieabte
GEOLOGIC EXPLORATION FROS1 TO DIA11-. ER 771[CKN FSS MATERIAL
ft. 2 is
Company Name
16.INNER CASING OR rUBiNC Neothermal closed-loan)
2.Well Construction Permit N: FROM TO DIAhIF rFR I THICKNFSS MATERIAL
Lhail applicable well construction perridis(i•e U1C.Couttty.Stare,Ilarionce.ere.) 0.0 ft' 5.0 fi' 2.0 In, SCH 40 PVC
3.Well Use(check well use): rL tr. in.
Water Supply Well: 17.SCREEN
FROM TO DIAM1f ETER SLOT SIZE THICKNESS _MATERIAL
❑Agricultural ❑Municipal/Public 5.0 "' 10.0 n• 1 2.0 in. .010 SCH 40 PVC
OGeothermal(Heating/Cooling Supply) OResidential Water Supply(single) ft. ft. in.
Olndusirial/Cominercial ❑Residential Water Supply(shared) I&GROUT
❑irri alion ❑Wel Is>100.000 GPD FROM TO MATERIAL. F.MPLACEMENTMETHOD&AMOUNT
Non-Water Supply Well: 0.0 n' 3.0 f• AQUA GUARD SLURRY
fflMonitoring ORecovery rt. ft.
Injection Well:
❑Aquifer Recharge ❑Groundwater Remediation
19,SAND/GRAVEL PACK if a licable
❑Aquifer Storage and Recovery ❑Salinity,Barrier FROM TO MATERIAL I EMPIACEMENrhimoo,
OAquifer Test ❑Stormwater Drainage 3.0 D 13.0 h. 20-40 J FINE SILICA SAND
OExperimental Technology ❑Subsidence Control fr. 6.
❑Geothermal(Closed Loop) OTracer 20.DRILLING LOG attach additional sheets Itnecessa
❑Geothermal(HeatingtCooling Return) ❑Other(explain under#21 Remarks) FROM TO DFSCRIPrr[ON color,hardness,wflho k typ.Itriti.sru,etc.
0.0 n• 8.0 n• RED CLAY
4.Date Well(s)Completed: 12/17/21 Well ID# PMW-AS-45 8.0 rt. 13.0 fr• SAPROLITE
Sa.Well Location: ft. fr. IVC
CLIFFSIDE STEAM STATION ff. n.
Facility/Owner Nattic Facility iDN(if applicable) ft. rt. ArR 2d I 20a
573 DUKE POWER ROAD MOORESBORO 28114 D. ft.
Physical Address.City,and Zip ft. ft. h, rnslil.
RUTHERFORD 21.REMARKS �,r v=rt' „�'
County Parcel Identification No.(PIN) I BENTONITE SEAL•-2.0-3.0 FEET/SUMP- 10.0-13.0 FEET
5b,Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(i(svell field,one IaUlong is sufficient) 22.Certification: /�� - _,��
350 12'49.02" N 81 a 45' 12.80" W (%,//Q'��'� 03/23/22
6.Is(are)the well(s): MPermanent or ❑Temporary Signature of Certified Well Contractor Dale
H)•signing this form.I herehy certify that ilir u•ell(s)was 6rere)constructer)in accordance rrnh
7.Is this a repair to an existing well: ❑Yes or MNo /SA NCAC 02C.0100 or 13A NCAC 02t•.0200 Iffell Construction Standards and bras a cope
ff'tiris A a repair.fill out known trell canstrtnvion ii forniadon and explain the nature of the ofiltis record has beenpearided to tire well ou9ier.
repair under.21 renrarkv section or an the tack of this forni.
23.Site diagram or additional well details:
S.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well construction into
construction,only I GW-I is needed Indicate TOTAL NUMBER of wells (add'See Over in Remarks Box).You may also attach additional pages if necessan
drilled: 24,SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 13.0 (ft.)
I•nr nnrhiple irelLr list a//depths if idi&rent(example-Irr`,D200'and10,100') Submit this GW-1 within 30 days of well completion per the following:
10. 5.31 24a. For All (Yells: Original form to Division of Water Resources (DWR),
tru•nrrr In•rl is short casing,use"•"Static water level below top of casing: (fL) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
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6.0 24b. For Injection Wells:Copy to DWR,Underground injection Control(IUC)
1 I.Borehole diameter: (in.) Program, 1636 MSC,Raleigh,NC 27699-1636
12.11'ell construction method: SONIC
24c.For Water Su i And U n-Loo Geothermal Return Wells:Copy to the
(i.e.auger,rotary,cable•direct push,eic.) county environments heath department o 1 e county ere installed
FOR WATER SUPPLY WELLS ONLY: 24d.For WRler Wells roducin over 100 000 GPD:Copy to DWR,CCPCUA
Permit Program,1 I I M Ra cig ,NC 27699-I 1 I
13a.Yield(gpm) Method of test:
13b.Disinfection type: Amount:
Fomi GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018