GW1-2023-02582_Well Construction - GW1_20230410

WELL CONSTRUCTION RECORD For hint nil Use ONLY:
This form can be used for single or mullipk ivctls
1.Well Contractorluformation:
iJ.tYA?ER'ZONES
Zach Thompson FROM TO 11MCIRPTION,
Uroll CoivingotN'ame
4478A
NC Well ConnaearCertification Nmrh& tS.OUTER CASING(rdr mu[1i ea d r�effsY OR LINER llfu'`licabkY.
FROM To n1AMETEII THWKNE51 AIATERIAL
SASDACCO Inc 0 tL 37 fL 2" in. SCH-40 PVC
CovV.-uq•Name I6JNNER CASING OR.TL'BiNG ,paihcrmai cloccd-look
FROM TO DUMETER THICKNESS hL4TERIAL
2.Wc1I Construction Permit#: R. R, ni
lest uT1 rjp�lit-rrbfe irc!lprrrisiM fi_a.Cauruy,Stu.c,Vonore,1r fa daz eit-1
ft. it. in.
3,Wei Use(chocl:w•ell use): 17:SCREEN
Water Supply Well: FROMI TO I at METFtr I 81.OTS17i I TIRCHNISS I MATHm u.
C1Agrt utmrafl �114f1IDIc1pa11Ptd19iC 37 ft. 1 47 R. 2" 1% 010 SCH-40 PVC
®Geothermal(HealiliWCooGag Supply} 011esidential Water Supply(single) fL fL
®hidustriaVConmtcrciat l7Residential Water Supp4,(shared) tee GROUT -
FROM TO ItIATMA EMPLWEFIENTINMR100.SAAIOLNT
❑ItTi afian 0 ft. 27 R. Portland Injection
Non-Water Supply Well:
rt. (t.
MNfOnitoring I-Mccovery
Inject Ion Well:
0Aquitcri1ccltarge QGroundvs-atcrRcutcdiadon 1s:SANDIGRAVEL PACK(if
uriltubtc►'t
FROM MATFnrSL H\IP1.AC1:iti:VTMt:TlIOn
17Atjaifcr Storagc and Recovery []Salinity garner 32 R. 47 ft. Filter Sand #2
❑AquifcrTest ❑SlOrmwatcr l)riukigp
R. ft:
❑t:rperinicnial Tcchnology 13Snbsidcncc Conitol
20i DRiL
LING,WGfanach addhional''-dwits i0cccssun•1
❑Geotltennal(Closed Coop} OTricer FROM TO nFSLRAPTIO\(,nbr,hnrdnccr�,i1'nrcktr x.' n wc.rlr.1
DGvrothenual(FIcatinalCooliug Return) L7Otlter(explain.under fill Rewa&) 0 tL 47 R Tan Silty Sand and Saprolite
47 ft, fL Rock . . ,.
4.Date Well(s)Completed: 2/21/2023 WatIED#PZ23-02
sa.Well I.orathin: ft. tL APR
(Z3
Duke Energy fi ft. In
Factlity,'4ivocrNaivc FiclitylDS((fapplicablc) R, ft.
253 Plant Allen Rd., Belmont,. NC, 28012 ft. ft.
Pigskal Address City.and Zip d2L REMARKS
Gaston Bentonite Seal from 27'-32'
Ccnuily 1}arcc]1J,,nlff�canon.Na,(PIN}
5b.F Atitude and Longitude in(!4t!rfies4minutc9seconds or decimal degt•ces: 22.Certification:
(It,,itll ficW,ciic IaU70ug is gu(iiciC.nl}
35.1142 N -81.0048 W 2/28/2023
tuWrcarceiti l Contactor Dale
6,b(are)the well(s): MPermattent or 17Temporary Ht signing this far m..l hereby cerfify char flie iiell(sl wvx(virre)conxfnrcfed ire avearrianc r
with 15,6Vck 02C.O!(►)at,15A NCAC 02C.0200 elide Constructiar Starkiards wid dw a
7.Is they a repair tit an ex sting well: ElVes or ®ND coVy af(Adr record has fiwen pruritic•ptibe srrlf mmer,
If this is o reyglr,fitt Ott ku(;w(ivelf cofwnfedoa hifor(oari eve and explain the trarare of flea
repair under 021 remarks srciian or oii die bark 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.Numberof wells constructed: 1 consimCtion deiails. You may also:ttlaelt adu&6onal pages if necessatp-
For mulrllli Injew1o)i or onui-imfer suppiy n•elrs OXLY m1(h r1a&7R(C forPStri([11an,you can
sudmif Clio form. SCTDRf[TTAL.iNSTCiCTiONS
9.Total well depth below land surface. 47 (fl,) 24a. Stir All Wells: Subinit iltis form within 30 days of completiou of well
Fnr)ffnlalpioirclislfst Off dCPYhsffdigi•rM&.Irro!ok•-J@20'a(ul2@fM- } construction tolhcfollonina:
10.Static crater level below Kip of rasing: ((Y,) Division of Water Resources,InGirmation Processing Unit,
if nbter level 6 above casing,use"+ 1617 Mait Service Center,R•ilcigh,NC 27699-1617
11.Borehole diameter.8" (in) 24b.For is .Inn Walla ONLY: in addition to sending the fomi to ilia address in
24aabove.also submit a copy of this foau within 30 days of completion of well
12,Well Construction method:HSA constructionl to ilia following_
(i.e.auger.-rotar}•,cable.direct push etc:} Division of Water Resource's,Underground Injeclion Control Program,
FOR NVATER SUPPLY WELLS ONLY: 1636 Mail Service Center.Raleigh,NC 2 7699-1636
13a,Vicld(gpni) Method of test• 24c.For Water Supply&Injcetion Wells:
Also submit one copy of this form within 30 days of Completion of
13h.M.4infectian type: Amount: well consiniction to the coinny Itc;ilth department of tine County where
constricted. f I
Fonn GeV-t NonhCarolina Mpaumnt of Environurni and Natural Resources—DivWon of Waicr RmcL1 Revised august`013