GW1-2023-02579_Well Construction - GW1_20230410

I
WELL C®NSTRucrioN RECORD ForimcrnaluseONLY:
TVs Conn can be used Car single or n,nitiplc wells
1.Well Contractor Information:
t.l.%l ATE R.ZONES
Zach Thompson FROM To 11MCHIPTION
Well ContractotMow
4478A ft. fL
NC Well ContraciorCenifi ation Mother A&OUTER CASING(14r;m1II-rryrd wcn0 O&LiNER(if a' f cable
FROST To Dri11iF, Mt TFIICRNE3I STATERTAL
SAEDACCO Inc 0 fL 79 ft 2" in SCE-40 I PVC
Cdn gia.ny Nan,C 16.INNER CASING OR TURING eoihermal ck,sed4oa'
FRONT To DLMETSR THICKNESS \lATEn1A1
2,Well ConstructEral Pctmit#: R. ft, ur.
i ire coil apprL'eablC Kp)!pencils fLr..CmrNv,State.,Variarwe. [ __ F-11
R, ft. in
3.Well Use(eheck-%vell use): M SCREEN
Water Supply Well:
- - --- --- -- - - FROM TO I DiASIETF,R SLOTSIM THICHMSS I SIATRRiAL
CIAgr(cultural ohflmicipat/Nblic 79 ft, 89 R. 2" in. .010 SCH-40 PVC
MmheTmal(I3eatin lCooliug Supply) ❑Residential Water Suppb,(single) ft. I fL in,
©indusirial/Commerciai ©Residential Water Suppb, (slated) cRo G.r�r OUT TO .rATeRLv 6S[PLIt ENlCVT SlEi!!OD s ASiO[INT
Elk—ligation 0 ft. 70 fL Portland Injection
Hon-Water Supply Well:
fL ft
0010onitoring .[]Recovery
Inject[on Well: fl. R.
13A0uifer ROCharge. 015rotlndttatcr Remcdiation t9:S.UVDIGRAVEL PACK(if ,rlicable)-
FROM 'M %IATIMM, [iMl'1��(ayrt:RT HITripll
MAgltifcr Storagc and Recovery ❑Salinity Hartief 74 R, 89 R. Filter Sand #2
❑AquifcrTcst ❑StormlvatcrDminago R. ft,
❑Experimcnial Technology 08nbsidcncc Contra(
III.,DRILLING LOG(attach addhionnlshceta if necesmn'I
❑Gesttluenrml(ClusedLoop) ❑TrlCrr .FROST I To DESCRtPTtO\mbrtbardncn,wi3'r+,akty ,t.radcl
❑Geothenlial(IleatinglCuolingRetum) Miller(el\plain under#21Retuarks) 0 fL 89 rl. Tan Silty Sand and Saprolite
89 ft. fL Rock
4.Date Wells)Completed: 3/9/2023 WC11 iDIIPZ23-10
$a.Well Location: ft.
Duke Energy ft. FL AF�k
Facility,ChcncrNamc Fact1h)-IDkfifapplinblc) R. ft.
253 Plant Allen Rd., Belmont,. NC, 28012 ft fL i
Pits si;al Address City.and Zip -.21.RE6LUtKS
Gaston Bentonite Seal from 701-74'
Coauty Parcel ldinlifiic,111onNo.(PIN)
fib,Latitude and Longitude in dcgnes/minutes/seconds or decimal degrees: 22.Certification:
(11`mall field,orre labloug Is sallieienl)
35.1979 N -81.0128 3/18/2023
gruturr ofCcitiftcd Wd Commaor Dale
6.Is(are)the well(s)- mPennanent or ❑TemporaPy lb•sigidng eh::r ,fur+rr,f herebr•corrifr dear fhe❑efl(sl r+-as(%rrvJ conic rcred irr fxwonlmrce
rt'irh I'M NCAC 02C.01M or 1 s,t NCAC 0k.0200 Welf Cousfracria,Srarkfards and 11rTr a
7.is this a repair to an existing well- ElVes or ®No cn)vrnfflur rronihaslxiu r,mrirtrd ureh sn11 mc,r,•r.
If rhls is a repulr.fN char krnirw x ellcarur�irctfoa brforrnar on m,d e'spbbi rhv r,arr,re ojdip
repair rurder#21 rrmrtrdv src,imr or rm flip Lael of r/th farnL 23.Site diagram or additi0nal well details:
You may use the back of this page to provide additional%cell site details or well
8.Number of wells constructed: 1 consimetion details. You[tray also attach adrGtlotlal pabes if tiLvessaty.
For ruulrl)r!e ir�krrlon or ara'I-+rarer suppJr'n•etls MVLV.iNrh din s,Tme conserlatiorp}•oa eaa
supmRane form. -CE1n11ftTTAL fNS'➢'tTCTTONS
9.Total well depllt below Lund surfaei: 89 24a. For All Wells: Suborn this form within 30 days of completion of well
For,nalrlple wells lin alddrprhs ifdif erenr(e.wiplc-1ra,200'arur 2@11.19) construction to,the following:
10.Static%cater level below top of casinla (ft.) DivErfon of Water Resources,laformation Processing Unit,
11 irony r level 8 above cask;,'use"}^ 1617 Mail Senice Center,ItAcigh,NC 27699-1617
11.Borehole diameter.8" (in.) 24b.Fnr iitleeflon A,M4 ONLY: in addition to sending fire form to the address in
24a above,also submit a Copy of this fortil within 30 days of completion of well
12,Well constructiou method: HSA COtlsfmCtion t0 the following:
(ix`.,anger.rurau?•,cable direct push c[c.)
Division of Water Resources,Uudergt'omtd Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Sen9ce Confer,Raleigh,NC 27699-1636
13;r,Yicld(gym) 'Method of test: 24c.For Water Supply.INection WON-
Also submit on., copy Of this fa rill within 30 days of completion of
13h.11isinfleedi n h-pe: Amount: w'cll consimction to the county lrc ith department of the county w•herc
constnictcd.
Forni GtV-1 Nonh Camllm Depanssln of Environnicni and,(atonal Resources—Dtyi;lonof WslctFuror¢ RevIsed August2013