GW1-2022-08669_Well Construction - GW1_20220427

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information: j
KENNY SARGENT 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
fr. ft.
A - 4226
rt. D.
NC Well Connacior Certification Number 15.OUTER CASING for multi-cas d weds OR LINER it a t licable
GEOLOGIC EXPLORATION FROM TO DIAMETER THICKN FSS MATERIAL
Company Name 16.INNER CASING OR TUBING(geothermal closed-loo
2.Will Construction Permit h: FROM TO DIAMETER Til ICKNESS MATERIAL
lav all applicable wee/ronstruction permils(i.e.VIC.('ramie State.l'arionce.etc) 0.0 fr. 18.0 A. 2.0 in' SCH 40 PVC
3.Well Use(check well use): ff. ft. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER I LOTSIZE THICKNESS AfATERIAL
❑Agricultural ❑Municipal/Public 180 r-' 23.0 rt• 2.0 1O' 010 SCH 40 PVC
OGcothcrmal(Ilealing/Coolmg Supply) OResidential Water Supply(single) ft. it.
❑InduslriaUCommercial OResidemial Water Supply(shared) 18.GROUT
❑lrr( ation OWells> 100.000 GPD FROM TO MATERIAL EMPLICEMF.NTMMIOD&AMOUNT
Non-Water Supply Well: 0.0 i+ 11.0 rt• AQUA GUARD SLURRY
091vionitoring ORecovery rr. ft.
Injection Well:
ft. ft.
OAquifer Recharge OGroundwater Remediation
19.SAND/GRAVEL PACK if a licablcl
❑Aquilcr Storage and Recovery ❑SahnityBarrier FROM TO MATERIAL I &1IPLACEMENTMETHOD
❑Aquifer Test ❑Stormwater Drainage 13.0 i+• 26.0 It- 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control ft, a.
❑Geothermal(Closed Loop) OTracer 20.DRILLING LOG attach additional sheets Ii necessary)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under B21 Remarks) FROM TO DESCRIPTION color,hurdness,miVroek rain size.etc.
0.0 i'• 1.0 i'• GRAVEL
4.Date Well(s)Completed: 02/02/22 Well ID# PMW-AS-5D 1.0 r+• 9.() ft. RED SILTY CLAY
5a.Well Location: 9.0 i'• 19.0 it' BROWN SILTY PWR
CLIFFSIDE STEAM STATION 19.0 i' 20.0 I', GRAYROCK9
FaeilitylOw ier Noire Facility IDd(ifappheable) 20.0 i' 24.0 I+ B 1r), .isfi AN T IL ::
573 DUKE POWER ROAD MOORESBORO 28114 24.0 i' 26.0 i' WH K 9
Physical Address,City,and Zip ft. A.
RUTHERFORD 21.REMARKS _. T•-�
County Parcel Identification No.(PIN)
B£NTONITE SEAL-8.0-13.0 FEET/SUIVIF �fhF T IJi�I i
5b.Latitude and longitude in degrees/minules/seconds or decimal degrees:
(dwell field one IaUlong is sufficient) 22.Certificalior u�,�"v"1�
350 12' 53.04" N 810 45' 15.13" W 03/23/22
6.Is(are)the well(s): 18Perm anent or OTemporary Signature ofCcnrfied Well Contractor Dale
By sigriit{y this farm,l herrbycerlify that the ireU(sJ tras(were)constructed in accordance a ith
7.Is this a repair to an existing well: ❑Yes or MNo 1 JA NOW 02C_0100 or/SA NCAC 02C.0200 Well(•vatstruction Sltnetlards and that d cap,
U'this is a repair.fill out ktatrn well construction information and explain tit•nature ofthe ofiltir record has been provided to the well owner.
rrrtair water.21 mmurks section or an the back of this Jinni. -
23.Site diagram or additional well details:
8.For Geoprobe/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 OW-1 is needed. Indicate TOTAL NUMBER of wells (add'See Ovee in Remarks Box).You may also attach additional pages if necessary
drilled 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 26.0 (ft.)
I-or multiple irells list all depilu ifdrfferenr(exonrple-9@200•arrd 2CI0U) Submit this CNN'-]within 30 days of well completion per the following:
10.Static water level below top of casing: 8.57 (it.) 24a, For All Wells: Original form to Division of Water Resources (DWR).
lfunierl,•rdlts obure rusirrg.use"-
Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
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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 ' Iv and O en-Loo Geothermal Return Wells:Copy to the
(i.e auger,rotary,cable,direct push,etc.) county environmental health department o the 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,Raleigh,NC 276 9-16t I
13a.Yield(gpm) Method of test:
tab.Disinfection type: Amount:
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Fonn GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised"-2018