GW1--03364_Well Construction - GW1_20230517

I
WELL CONSTRUCTION RECORD(GW-1) For Internal'Use Only:
I.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
.. FROM TO DESCRIPTION
Well Contractor.Name
fit. 1't.
A - 2581 ft. ft.
NC Well Contractor Certification Number .15.OUTER CASING for multi-cased wells OR LINER if a t dicable)
GEOLOGIC EXPLORATION FROM TO DIAMETER .. THICKNESS MATERIAL
0.0 ft.f 65.0 ft. 6.0 ' i" SCH 80 PVC
Company Name -
16..INNER CASING OR TUBING eathermal closed-loop)
2.WCII COnS1YUCt1"tl Permit#: FROM TO DIAMETER THICKNESS MATERIAL
List all applicable trell construction pernti(s(t.el.-U/C.County,State,Variance,etc.) 0.0 ft' 90.0 ff 2.0 '"• SCH 40 PVC
3.Well Use(check well use): ft. ft. 14•
17.SCREEN '
Water Supply Well: FROM.. TO DIAMETER SLOT SIZE THICKNESS t\IATER A
❑Agricultural• ❑Municipal/Public 90•0 ft- 100.0,ft' 2.0 '"' .010 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft ft. in:
❑Ind ustrial/Commercial ❑Residential Water Supply(shared) IS.-GROUT
❑Irrigation ❑Wells> 100,000 GPD FROM TO MATERIAL EMPLACEMENTMETHOD&ADIOUNT
Non-Water Supply Nell:. 0.0 ft• 65.0 ft• AQUA GUARD SLURRY(PUMP)
®Monitoring ❑Recovery
Injection Well: ft.. ft.
❑Aquifer Recharge ❑GroundAvater Remediation '
19.SAND/GRAVEL PACK if a licalile
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM. TO MATERIAL EhIPLACEi11 EM1T METHOD
❑Aquifer Test' ❑StonmvaterDrainage 88.0 ft• T00.0 ff 7-35(#2) POUR
❑Experimental Technology 0Subsidence Control fL ft.
OGeothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional.sheets if necessary)
FROM TO DESCRIPTION(color,hardness,soilh-ock t c,gnin size,etc.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) 0.O tr. 7 0 tt. RED SILTY CLAY
4.Date Weu(s)Completed- 12/13/22 Well ID# EMP-6BR 70 R: 14.0 ft' BROWN SILTY SAND
ia.Well Location: 14.0 ft. 38.0 ft' TAN/WHITE SILTY SAND
DUKE ENERGY OF THE CAROLINAS ALLEN STEAM PLANT 38:0 ft- 55.0 ft. PWR
Facility/Owner Name Facility ID#(ifapp)icable) 55.0 ft• 100.0. ft. ROCK
253 PLANT ALLEN ROAD BELMONT 28012 ft. tt.
Physical Address,City,and Zip
GASTON 304337 21.REMARKS
Comity Parcel Identification Na.(PIN) BENTONITE SEAL-65.0-88.0 FEET
ib.Latitude and longitude in degrees/tninutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22.Certification:
529578.61033 N 1399702.32288 �� nZ:_lu
04/11/23
6.Is(are)the well(s): OPermanent or ❑Temporary Signature of Certified Well Contractor . Date
By signing this fora,l hereby certify drat the wells)was(were)�gtitF,lK(elYal cbrc9a17cey4t 1h�4 t+r
7.Is this a repair to an existing well: ❑Yes or IENo 15A NCAC 02C.0100 or 15A NCAC 02C.0200 We/1 Constri0iolle5ktuddr,(19�1;Uok�c /'
if this is a repair,Lill out known well construction it ftnnallon and explain the nature of the of this record has been provided to the we/l owner.
repair under r21 remarks section or at the back gfdtis farm. MAY ry
23.Site diagram or additional well details: 1 2�23
8.For Gcoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well construction info
construction,only I GW-1 is needed. Indicate TOTAL NUMBER of wells (add'See Ovee in Remarks Box).You may also attacl�I�ItdTtlitCiafaa�e3fcf pee e.�s .1�GZ
drilled: 24.SUBtNIITTAL'INSTRUCTIONS D"' :Doc'
9.Total well depth below land surface: 100.0 (fit.)
For multiple wells list a//depths ifd erent(example-3 a 200'and 2 100') Submit this GW-1 within 30 days of well completion per the following:
18.02 24a. For All Wells: Original form to Division of Water Resources (DWR),
10.Static water level below top of casing: " (fit.) Information Processing Unit,1617 MSC,Raleigh;.NC 27699-1617
!/'water level is above casing,use•'+
11.Borehole diameter: 6.0 (in.) 24b. For Injection Wells: Copy,to DWR,Underground Injection Control (IUC)
Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: SONIC/AIR
24c:For Water Supply and Open-Loop Geothermal Return Wells:Copy to the
(i.e.auger,rotary,cable,direct push,etc.) ., - county environmental health department of the county where installed
FOR WATER SUPPLY NYGLLS ONLY: 24d.For Water Wells producing over 100.000 GPD:Copy to DWR,CCPCUA "
Permit Program, 1611 MSC,Raleigh;NC 27699-1611
13a.Yield(gpm) Method of test:
13b.Disinfection type: Amount:
Form G W-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018