GW1--03374_Well Construction - GW1_20230517

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor information: C
NICHOLAS HAYES 14.WATER ZONES
Well Contractor Naine FROM T0: DESCRIPTION
A - 4121 fi. rr.
t3. rr. I
NC Well Contractor Certification Number
15.-OUTER CASING for multi-cased wells oR LiNER'if a litable,-
GEOLOGIC EXPLORATION FROM TO IADIETF -THICKNESS MATERIAL
Conipany Name
0.0 ft.- 177.0 ft- 8.0 i" SCH 80 PVC
W R0300124 16.INNER CASING OR TUBING. cothermal closed-loon), -
2.Well Construction Permit#: FROM TO DIAMETER I THICKNESS I MATERIAL
List all applicable well construction pertnits(i.e.U1C,County.State,Variance,etc.) ft. ft: in.
3.Well Use_(check well use): H. It. in.
Water Supply Well: 17.SCREEN
FR01U TO DIAMETER SLOT SIZE THICKNESS AIATERI,AL
❑Agricultural ❑Municipal/PUbliC ft. ft. in..
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) tr tt in.
❑Ind.ustrial/Commercial ❑Residential Water Supply(shared), 18.GROUT
❑irrl ation _ - ❑Wells> 100,000 GPD FROM . TO MATERIAL EMPLACEM ENT M ETHOD&AAfOUNT
Non-Water Supply Well: 0.0 ft- 177.0 ft. NEATPORTfANDCEMENT SLURRY
.(PUMP)
iEMonitoring ❑Recovery• ft. ft.
Injection Well:
,
OAgitifer Recharge OGroundwater Remediation ft. ft.
19.-SAND/GRAVEL PACK if a llicable'-
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM To I MATERIAL EDIPLACENIENT METHOD
❑AgitiferTest ❑Stormwatef.Drainage
❑Experimental Technology ❑Subsidence Control ft. ft.
❑Geotherinal.(CloseId Loop) ❑Tracer 20.DRILLING LOG attach additional sheets ir'necessa
FROM TO DESCRIPTION(color,hardness,soiltrack type, mitt size,etc.)
OGeothermal(Heating/Cooling Return) OOther(explain under#21 Remarks) -
0.0 ..ft• 87.0 ft•" RED CLAYEY SANDY SILT
4.Date Well(s)Completed: 03/24/23 Well ID# EX-65 87.0 rt. 168.0 ft- PWR
5a.Well Location: 168.0 ft. 246.0 ff ROCK
DUKE ENERGY OF THE CAROLINAS ALLEN STEAM STATION
Facility/Owner Name Facility 104(ifapplicable), ft. ft. - -
253 PLANT ALLEN ROAD BELMONT 28012 a. H.
Physical Address,City,and Zip ft. ft.
GASTON 304337 21;REMARKS
County Parcel Identification No.(PIN) OPEN HOLE
ib.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one[at/long is suflicieni) 22.Certification:
525224.54268 N 1400536.17681 W 04/11/23:
� . ..
6.Blare)the well(s): MPermatient or ❑Temporary Signature of Certified Well Contractor Date
By.signing this form,1 hereby certify that the4rell(s)was(here)constructed in accordance with
7.Is this a repair to an'existing well: ❑Yes or MNo I5A NCAC 01C.0100 or 15A NCAC 02C,0200 Well Construction Stan tle riA and that a copy
J'this is a repair,fill out knatrn well consa•ucuon hnforntation and explain the nature ofthe ofthis record has been provided to the nrell owner.
repair under r:21.remarks section or on the back ofthis form, 23.Site diagram or additional well details:
S.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page_to,provide additional we IAAc tr ction t Po
construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells (add'See Ove> in Remarks Box).Youmay also attach adElitionitllesf nc�ce3
drilled: 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: (ft.) t �a!•� ;OL;
hor nnt/tiple wells list all depilts ifdiffereni(example-3@200'and 2 a 100') Submit this.GW=1 within 30 days of well completion per the fotffiLiflg.
18.85 24a. For All Wells: Original form to Division of Water. Resources (DWR),
10,Static water level below top of casing: (ft.) lnformation Processing Unit,1617 MSC,Raleigh,NC 27699-1617
tf❑•aer level is above casing.use"+"
1 2.0/7.0 24b. For Iniection Wells: Copy to DWR, Underground Iniection Control (IUC)
1.Borehole diameter: (in.) Program, 1636 MSC,Raleigh,NC 27699-1636'
12.Well construction method: ROTARY/AIR
24c.For Water Supply and Open-Loon 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 WELLS ONLY: 24d.For Water Wells producing over 100,000 GPD: Copy to DWR,CCPCUA
13a.field(gpm) Method of test:
Permit Program, 1611 MSC,Raleigh,NC 27699-1 6 1 1
.
13b.Disinfection type: Amount:
Form G W-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018
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