_Well Construction - GW1_20230327 (31)

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
].'Well Contractor Inforination:
BRANDON DOTY
14.WATER ZONES,_
' Well Contractor Name
FROM TO DESCRIPTION _
ft.
A - 4595
ft ft..
NC Well Contractor Certification Number I '
15.-0UTER CASING for mrilh casedi'velI, ,ORLINER(if a` hcable'
GEOLOGIC EXPLORATION FROM TO' DG1M1fETER;- THICKNESS. -" 1fATER 1AL
no
Company Name i .
6:1NNER CASING OR TUBING(geothermal closed loo
1Well Construction Permit#:' : ':.
FROM TO - DIAMETER THICKNESS. 1 MATERIAL
List all applicable well constriiciion permits(i.e.UlC,County,State;Vdnrince,eM.). db it' 4,5".0
ft' 2:0 1O' SCH 40 - 'PVC -
3.Well Use(check welluse): it-
ft ft.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOTSIZE THICKNESS_ MATERIAL
❑Agricultural " OMunicipal/Public" 45.0 iL 55.0 ff 2.0 'in'
.010 SCH 40. PVC
_ _.
❑Geothermal(Heatiiig/Cooling Supply) ❑Residential Water Supply(single) ft. tt: in.
❑Industrial/Commerciaf ;.DResidential Water Supply:(shared) 18.GROUT
❑lrrl anon _ ❑Wells>I00,0KGPD - FROM TO 'MATERIAL. EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well-.' ,0.0"`ft' 38.0 ft•' PORT LAND aENTONITE SLURRY ..
IEMonitoring DRecove'ry ft ft. .
injection Well:. ft. tt.
❑Aquifer Recharge ❑Groundwater Remediation
19..SAND/GRAVEL PACK(if a 'licable
❑Aquifer Storage and Recovery. ❑Salinity Barrier FROM- TO _ MATERIAL EMPLACEMENTMETHOD
❑Aquifer Test ❑StormwaterDrainage ... 43,0 ft. 62,0_ ft• 20-40 .. 'FIN E'SILICA SAND... .
..
❑Ex erimental Technolo ` ❑Subsidence Control ft. ft.
' P gY '
❑Geothetirta](Closed-Loop) ❑Tracer 20.DRILLING'LOG attach additional sheets if necessary)'
FROM TO .DESCRIPTION
color,hardness,soil/rock e;gmin size,etc.) _
❑Geothermal(Heatmg/Cooling;Retum) ❑Other(explain under#21 Remarks)
0.,0..ft. 1.0 ` ft. ASPHALT/GRAVEL.
4.Date Well(s)Completed: -03/07/23 Well ID# CCR-27S 1.0 .ft• .80.0 ,ft BROWN SILT
•
Sa.Well Location:' '
80.0. ft. 108.0 fL, :. BROWN PWR ,
ft.
ALLEN STEAM STATION ft.
Facility/OwnerNariie" Facility iDX(ifapplicable) M
ft ft:
253 PLANT ALLEN ROAD :BELMONT 28012.:
Physical Address,City,and Zip- ft. ft.
GASTON. _.. .21.REMARKS
-.
County Parcel Identification No.(PIN) BENTONITE SEAL-38.0 43.0 FEET`&62.0 108.0 FEET
' Sb.Latitude and longitude igilegrees/InibutesAcco ids or decimal degrees:
(if well field,one IaVlong is sufficient) 22.Certitication:
35° 11' 1.5 83n N . 810 00' 38:65'i . .., w . .
03/15/23
6.Is(arc)the well(,): OPermanent 'or ❑Temporary Signature of.Ceitilied Well Contractor Date
sfining this fornr,1 hereby cerlifj,thai the was(were)constructed: accordance with
7.Is this a repair to.an existing well: ❑Yes or. nNo 15A NC4C 02C.0100 or 15A NCAC 02C'.0200 Well Conslruclion.StandOrtiv and that a copy
1j'this'isa repair,fil/ota known irell construction inform.alion and e.tplain the nature of the gfthii'record has Seen p'rowtiled to the it-ell ou-ne'r.
repair under d21 remarks section or on the back o/this form.
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 info
construction,only FGW-1,is needed. Indicate TOTAL NUMBER of wells (zidd.'See Over'in Remarks Box)."You may also attach additional pages if necessary.
drilled: ..
24.SUBMITTAL_INSTRUCTIONS
9.Tot it well depth below land surface: 55'0 (ft.)
f or nttdtiplewellr list all depths ifrlifjerent(example-3 rt 200'and 2 a 100') Submit this G�V-I;within 30 days of well completion per the following:
40.0., 24a. For All Wells: Original forin to Division of Water Resources (DWR),
10:Static water level below top'of casing: (ft.) Information Processing Unit, 1617 MSC'Raleigh;NC 27699-1617
ifl:ater level is abote c•ai•ing,'tise"+" !
11.Borehole diameter: 6.O (in.) 24b. Foriniection Wells: Copy to,DWR,'Undergr'ound Injection Control(IUC)''
SONIC Program, I636 Iv1SCRaleieh NC 2 7699-1636
12,Well construction method: SONIC
For Water Supply and_Open- o op Geothermal Return Wells:Copy to the
(i.e.auger,rotary,cable,direct push;etc.) county environmental health department of the countywhere installed
FOR WATLR SUPPLY WELLS ONLY: 24d.For Water-,Wells producing over 100,060.GPD: Copy to DWR,.CCPCUA
Permit Proeram,1611 MSC,Raleigh;NC 27699-1611
13a.Yield(gpni) Method of test:'
13b.Disinfection type: Amount:
t
Pptin GW;I North Carolina Department of Environmental Quality-Division of Wi ter-Resources Revised 6-6-2018