GW1-2023-01898_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:
Lewis LeFever 14.WATER ZONES
FROM TO DESCRIPTION
Well Contractor Name ft.
2480 ft. ft. f
NC Well Contractor Certification Number 15.OUTER CASING(for multi-eased wells)OR LINER if a able)
FROM TO DIMIF,TERI THICKNESS MATERIAI.
Parratt-Wolff, Inc. rt. ft. I Iin.
Company Name 16.DINER CASING OR TUBING(geothermal closed-loop)
FROM I TO DIAMETER' THICKNESS MATERIAI.
2.Well Construction Permit#: 0 ft- 5 ft. 2 in. sch40 pvc
List all applicable well permits(i.e.County.State,Variance,b jection,etc.) ft. fL 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 Coolin Supply) ❑Residential Water SuPP1Y(single) f. f. in.
❑industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
❑Irrigation 1 ft. 3 ft- Bentonite Chil Pour
Non-Water Supply Well: ft. ft. Pour
OMonitoring ❑Recovery
Injection Well:
❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK(ifapplicable
FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage 3 ft. 20 it #1 Sand Tremie
ft. ft.
❑Experimental Technology ❑Subsidence Control 20.DRILLING LOG(attach additional sheets if necessa
❑Geothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION(color,hardness,soil/rock type, min size,etc.)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) ft. ft.
r`
4.Date Well 12-1-22 GW-29
s)Completed: Well ID#
ft. ft.
5a.Well Location:
Duke Energy Cape Fear Plant ft. it. FEB 2
Facility/Owner Name Facility ID#(if applicable) ft. ft. 1
500 C P and L Road Moncure n=r" g`�� ' '��'�" Uril
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 lat/long is sufficient)
35.594833 N -79.048390 a- So, a a-
S are of Certified Well on. ctor Date zu
6.Is(are)the well(s): ZPermanent or ❑Temporary
By signing This,form.I hereby certify that the wells)was(were)constructed in accordance
with 15A NCAC 03C.0100 or 15A NCAC 6C.0200 Nell Construction Standards and that a
7.Is this a repair to an existing well: ❑Yes or F]No copy ofthis record has been provided to the well owner.
If this is a repair,fall ont known well construction information and explain the nature of the
repair under#21 remarks section a•on the back ofthis form. 23.Site diagram or additional well details:
You may use the back of this page toiprovide additional well site details or well
8.Number of wells constructed: 1 construction detajls. You may also attach additional pages if necessary.
For multiple injection a•non-water supply wells ONLY ivith the scone construction,you 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 ifdierent(example-3@22000'and 1@100') construction to the following:
(
10.Static water level below top of casing: 14.25 (f() Division of Water Resources;Information Processing Unit,
if water•level is above casing,use"+" 1617 Mail Service Center,'!Raleigh,NC 27699-1617
1.
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 1
(i.e.auger,rotary,cable•direct push,etc.) I
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 Wells:
Also submit one copy of this form within 30 days of completion of
13b.Disinfection type: Amount: well construction to the county health department of the county where
constructed.
Form GW-I North Carolina Department of Environment and Natural Resources-Division or Water Resource's Revised August 2013