GW1-2023-02581_Well Construction - GW1_20230410

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WELL CONSTRUCTION RECORD For t uemal Use ONLY:
This form can be used for single or mW ipk%sells
➢.Well Contractor Ltformalion:
t-1.WATER ZONFS
Zach Thompson FRONT TO 0t•SCRIP11ON
Well CorwrclurN'ante R. ft,
4478A ft. ft
NC Well Cowacror Ccnifiention Nwober IS:OUTER CASING for'PTMtll=cised4cl1sl'OR LIINER fif s• tkabk .
FRONT TO DLU IETER Tti MNESS. I NTATEntAL
SAEDACCO Inc 0 ft. 1 63 fL 2" in: I SCH-40 PVC
Comp;up•Nance 16ANNER CASING OR TUBING f eoiberuA cksLil400 '
FRONT TO DrMIFTER TtnCKNESS I NTAItUt.
2.Wc1➢Construction Permit#: ft. ft. in
Mr at aiv rable weUpennits(r%Cbunry,Stp:rr,Yariarso,IryB[DCet C1r..J
ft. ft. tt4
3.Well Use(chgcl.vvell use): M SCREEN
Water Supply Well:
- - - FROM TO DrA,ltri.TF,R St.OT81"'. TtIICTcNM I MATFAW,
Mg culturll ONfunicipaliPub)ic 63 ft. 73 ft. 2" Ire• .010 SCH-40 PVC
®Geothermal(➢3eatingtooling Supply) ®Residential Water Supply(s[Dgle) fL fL
❑IudustriallContmcrcial []Residential Water Suppb•(shared) IS.-GROUT
FRONT TD NTATERtAL ENIPLtCENTENT VE•rf1OD&AMOUNT
❑Iri ation 0 ft. 54 (L Portland Injection
Non-Water Supply WCR:.
fL
ohfonitoring []Recovery
Injection WeLI: rL fp
Q Aquifer Red,arge .116muridwalcr8cmcdiation "MSANDIGRAVEL,PACK(if r rlieslAe)+
FRONT TO NIATRIU.M. RNIPI�(F{IE:VTHtFnOh
❑AgnifcrSiorngcandRecovery l7SalinityHarricr 58 R. 73 ft. Filter Sand #2
❑AgnifcrTest 05fomiwatcr Drrin,'roc
R. ft.
❑Experimcntal Twhaotogy Mnbsidcncc Conttol
20 DRILLIl1GILOGialurchaddltionnlshcetsifhcccssaril
❑Geodwnnal(Closed Loop) ❑Tracer .FRONT TO DrsCRWROX(ma,harduca wwntektr n r5rucit.)
❑Grothem ai(Heatine-Cooliu_e Muni) ❑0ther(explaiu under 421 Retuarf s) a M 73 fL Tan Silty Sand and Saprolite
73 fL % Rock
4.DatcWe11(s)Completed: 3/6/2023 WeilID#PZ23-13 -'- -
ft. ft.
54.Well[.ocatfttn: fL fL
Duke Energy ft fL
FacilitylOicncrName Facility IDN(ifapplicable) R. R,
253 Plant Allen Rd., Belmont, NC, 28012 ft,
Plnsieal Address.City.and Zip -,2 t.RERtAH S'
Gaston Bentonite Seal from 541-58'
Coutliv Parcel ltknlifrcilion No,(PIN)
56.Latitude and Longitude in ftmes/minuteslscconds or decimal degrees: 22.Certification:
(irucu field,pore 1,11rlong ig atnickrrt)
35.1935 N -81.0098 W /rLbI1i 3/18/2023
ernWru ofcatiried welfconvaetat Dale
6.I5(are)the w•ell(s): MPermanent or ❑Temporaiy.. IN aigvring rhir farm,1 hereby rerlify rhal the nzille i war(Krml ewaslr icierl irr rtcrvrdxmcv
teirh JS,t NC.1C t72C,(i1Atl a•IBA 1VCAC(J3C,(l:p{7{{'rlJ Corrsrrrctiorr Srdrrsicrrds avrd rbwrl a
7.Lv this a repair to an existing well: E]Vcs or ®ND cry afrfilr reconi leas lhca pmvided ro dw ui-11 moier,
if ibes h a"Pair,fall cerr owed w Ivell ewumict(oa hrformrriorrmrd expidin the narare of die
repair under 921 rernarkr srcliam or ovv the hart:afthh form 23.Site dinl;ram or additional well details:
You may use the back of this page to provide additional well site details or avell
S.)lumberof wells constructed: 1 construction details. You may also attach additional pages if necessary.
For rtrn4*lyderrion or am-ti+orer sup#,v wells ONLY idih the sirme e4wstrimdoat,yoi,can
.suipmlt rum farm. .G 1BMI TA .INST T .TIONS
9.Total well depth below land surface: 73 (ft.) 24a. For Ali Wells: Submit Ilds farm within M days of conip[asion of well
For rtruldph,ivellslistaNdepffirlfdiferew(exaajpfe-3@ 00'deul2@100) con5inictiantodwfb(lotviag:
10.Static Nvater level Maw top of cminw. (B,) Division of Water Resources,Information Processing Unit,
if seater level is above Lvising,ace"+" 1617 hail Sert•ice Center,R:ticigty NC 27699-1617
11.Borehole diameter.8" (in.) tab.FOIE 11ILMIian Wclis ONLY: In addition to sending the form to the address in
24a above,also submit a copy of this fotui within 30 days of completion of well
12.Well construction method: HSA construction to the following.
(Le.auger.nx*,cables dirt:ct ptsslL etc.)
Division of Water Resources,Underground Injection Control Programs,
1636 Mull&rviceCentcr,Ralef
FOR WATER SUPPLY WELLS ONLY: , Raleigh,NC 27699-1636� >;
13-. Yield ftm) 14lcthad of test: 24c.For Water Supply Br[njcctirrn Wells:
Also submit one copy of this fama within, 30 daysofcompletionof
13h.Disinfection 1hpet Amount- cecll construction to the catmn•6.Ith department of tim counh,where
constnlctcd.
Fame GW-t North Carolina Dep utmem of Endroruncra and Mitural Resources-Division of Rrotcr R i dou Revised Atgust-V 13