GW1-2023-01897_Well Construction - GW1_20230222

WELL CONSTRUCTION RECORD For Internal Use ONLY:
This form can be used for single or multiple wells ;
1.Well Contractor Information:
Levels LeFever 14.WATER ZONES
FROM TO DESCRIPTION
Well Contractor Name f[. ft.
1
2480
NC Well Contractor Certification Number 15.OUTER CASING(for multi-eased wells)OR LINER if a Ilcable)
FROM TO DIAMETER THICKNESS MATERIAL
Parratt-Wolff, Inc. rt. ft. ►in.
Company Name 16.INNER CASING OR TUBING(geothermal closed-loop)
FROM I TO I DIAMETER I THICKNESS MATERIAL
2.Well Construction Permit#: 0 ft. 5 ft. 2 in' I SCh40 PVC
List all applicable hell permits ri.e.County,State.Varianca b jection.etc.) ft. ft. in.
3.Well Use(check well.use): 17.SCREEN
Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 5 ft. 20 ft- 2 in. .010 sch40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) I&GROUT
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
❑Irri ation 1 ft. 3 ft. Bentonite Chil Pour
Non-Water Supply Well:
Pour
OMonitoring ❑Recovery
Injection Well:
❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK if applicable)
FROM TO MATERIAL EMPLACEMENT METHOD
[]Aquifer Storage and Recovery []Salinity Barrier
3 rr• 20 rt• #1 Sand Tremie
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control
20.DRILLING LOG(attach additional sheets if necessary)
❑Geothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION(color,hardness,solUmck type.grain size,etc.)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) ft. ft.
ft. ft.
4.Date Well(s)Completed: 12-1-22 Well ID#GW-30 _ �! -
ft. ft. 4uv'7 I i
v'
5a.Well Location: ft. ft. I
Duke Energy Cape Fear Plant rt. FEB ft. 2 v 20023
Facility/Owner Name Facility ID#(if applicable)
500 C P and L Road Moncure ft. ft. Ins„�;:;t:j^;) CeL.• ��,n Unit
rt. ft. ua>�ttt✓
Physical Address,City,and Zip
21.REMARKS
Chatham 2 x 2 Pad
County Parcel Identification No.(PIN) 3-Bollards
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification:
(if well field,one Iat/long is sufficient)
35.594458 N -79.048132 / a. Sp. a.W _=2 !=�
Sig tureofCertifi ell 'ontmctor Date
6.Is(are)the well(s): 2Permanent or ❑Temporary By signing this,Jornt,I here)'certify that the well(s)was(were)constructed in accordance
with 15A NCAC 02C.0100 or I5A NCAC 02C.0200 Well Construction Standards and that a
7.Is this a repair to an existing well: ❑Yes or ONo copy ofthis record has been provided to the well owner.
If this is a repair,(r11 out known well construction information and explain the nature of the.
repair under#21 remarks section or on the back of this form. 23.Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
8.Number of wells constructed: 1 construction details. You may also attach additional pages if necessary.
For muthiple injection or non-water supply wells ONLY with the saute construction,rots can
submit one form. SUBMITTAL INSTUCTIONS
9.Total well depth below land surface: 20 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths ifdiifferent(example-3@2200'and 2@100') construction to the following:
10.Static water level below top of casing: 14.84 (ft) Division of Water Resources,Information Processing Unit,
lfwater level is above casing.use"+" 1617 Mail Service Center;Raleigh,NC 27699-1617
i
11.Borehole diameter: 6 (in.) 24b.For Infection Wells ONLY: In addition to sending the form to the address'in
24a above, also submit a copy of this form within 30 days of completion of well
12.Well construction method: HSA construction to the following:
(i.e.auger,rotary,cable•direct push,etc.) j
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center;Raleigh,NC 27699-1636
13a.Yield(gpm) Method of test:
24c.For Water Supply&injection Rtells:
Also submit one copy of this fore within 30 days of completion of
13b.Disinfection type: Amount: well construction to the county health department of the county where
constructed. I
Form GW-i North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised August 2013