GW1--03373_Well Construction - GW1_20230517

WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
1.Well Contractor Information:
NICHOLAS HAYES 14.RATER ZONES
Well Contractor Name
FROM TO DESCRIPTION
ft. ft.
A - 4121
NC Well Contractor Cenificmion Number 15.OUTER CASING for multi-cased wells)OR LINER(if a rlicable)
GEOLOGIC EXPLORATION FROM TO DIAMETER THICKNESS MATERIAL
Company Name
0.0 ft. 188.0 ft. 8.0 in SCH 80 PVC
-
W R0300124 16.INNER CASING OR TUBING 2cothermal closed-loo+
2.Well Construction Permit#: FROM TO DIAMETER I THICKNESS MATERIAL
List all applicable well con.siruetion permits(i.e.(11C.Cotemr,State,Variance,etc.) ft. f[. ia.
3.Well Use(check well use):
Water Supply Well: 17.SCREEN
FROM TO DIAMETER I SLOTSIZE THICKNESS I MATERIAL
❑Agricultural ❑MLmicipal/Public ft. R. in.
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single)
❑lndristrial/Commercial ❑Residential WaterSLlpply(Shared) 18.GROUT
❑Irrigation ❑Wells> 100,000 GPD FROM TO MATERIAL EMPLACENIENT METHOD S AMOUNT
Non-Water Supply Well: 0.0 ft• 188.0 ft' NEATPO.RTLANDCEMENT SLURRY(PUMP)
EMonitoring ❑Recovery ft. fr.
Injection Well: ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK ifa+ licable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT iurnOD
❑Aquifer Test ❑Stormwater Drainage fr. ft
❑Experimental Technology ❑Subsidence Control
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG.attach additional sheets if necessary
FROM TO DESCRIPTION(color,hardness,soilhock type,brain size,Oc.l
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 921 Remarks)
0.0 ft- 25.0 ft- RED CLAY
4.Date Well(s)Completed: 03/24/23 Well lD# EX-66 25.0 ft. 128.0 ft. RED SILTY SANDY CLAY
5a.Well Location: 128.0 ft. 178.0 ft. PWR
DUKE ENERGY OF THE CAROLINAS ALLEN STEAM STATION 178.0 ft• 246.0 ft• ROCK
Facility/Owner Name Facility IDk(if applicable) ft. ft.
253 PLANT ALLEN ROAD BELMONT 28012 ft. ft.
Physical Address,City,and Zip ft. ft.
GASTON 304337 21.REMARKS
County Parcel Identification No.(PIN) OPEN HOLE
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22.Certification:
525224.54268 N 1400536.17681 W lleI `' 7� 04/11/23
6.Is(are)the well(s): ®Permanent or ❑Temporary Signature of Certified Well Contractor Date
Hy signurg this fbr+n,1 hereby c•ertJy that the well(s)u•arl�.n.•,Erel,Qns cte,(/IQn gc•corelafice with
7.Is this a repair to an existing well: ❑Yes or MNo l3A NCAC 02C.t110U or 1 iA NCAC.'01C.0100 H e//Cly slrr'u tiod Stim7h+rtic ru+fjil}q{cf of r
!J this is a repair,fill nut known well construction i+(Jnrnathm and e.rploin the nature of the oJihis record has been provided ra the well oua+ar. V
repair tattler�21 remarks section or on the back oJ'#ds fLrn+. y
23.Site diagram or additional well details: ��AV
8.For Gcoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional we I c nStrU o I into
construction,only 1 GW-I is needed Indicate TOTAL NUMBER of wells (add'See Over'in Remarks_Box).You may also attach additional pages if necessF n.
drilled: Inr 1 :.:,:': :::•: :J l.f
24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: . 246.0 (ft.)
Fier multiple wel/s list qli depihs if different(exmnple-3 n 200'and 1GJ100') Submit this GW-I within 30 days of well completion per the following:
10. 15.3 24a. For All Wells: Original form to Division of Water Resources (DWR),
lflrnter level is ahnm casing,use"�"Static water level below toil of casing: (ft.) information Processing Unit, 1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter: 12.0/7.0 (in) 24b. For Injection Wells: Copy to DWR,Underground Injection Control(lUC)
Program, 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: ROTARY/AIR
24c.For Water Supply and Open-Loop Geothermal Return:Wells:Copy to the
(i.e.auger,rotary,cable,direct push,ere.) county environmental health department of the county where installed
FOR WATER SUPPLY WELLS ONLY: 24d. For Water Wells producing over 100,000 GPD: Copy to DWR,CCPCUA
13a.Yield(gpm) Method of test: Perin it Program, 1611 MSC,Raleigh,NC 27699-1611
13b.Disinfection type: Amount:
Fonn GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018