GW1--03376_Well Construction - GW1_20230517

WELL CONSTRUCTION RECORD(GW-1) For internal Use Only:
I.Well Contractor Information:
NICHOLAS HAYES i4.NVATERZONES
Well Contractor Name FROM TO DESCRIPTION
A - 4121
ft. ft.
NC well Contractor Cenification Number 15.OUTER CASING(for multi-cased wells)OR LINER(if a t licable)
GEOLOGIC EXPLORATION FROM I TO IDIAMETER THICKNESS 11:1TERIAL
Company Name 0.0 • 139.0 ft• 8.0 i° SCH 80 PVC
WR0300124 .16.INNER CASING OR TUBING(geothermal closed-loot)
2.Wcll Construction Pel•mit#: FROM TO DIAMETER THICKNESS MATERIAL
List all app/ic•able well constractian peratits(i.e.111C•,County,Slate,Variance,etc.) ft. ft. in.
3.Well Use(check well use): ft. (r, in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public fr. ft. in.
❑Geothermal(Heat ing/Gooling Supply) ❑Residential Water Supply(single) ft ft in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑]rrigafion ❑Wells>100,000 GPD FROM 1'O MATERIAL EMPLACEMENTMETHOD S ANIOUNr
Non-Water Supply Well: 0.0 f` 139.0 f` NEA1P0R11NDCE.EN1 SLURRY(PUMP)
MMonitoring ❑Recovery
Injection Well:
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK(if a s licable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL ENIPLACEMEKr iNtETn OD
❑Aquifer Test ❑Stormxvater Drainage fL ft.
❑Experimental Technology OSubsidence Control ft. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG(attach additional sheets if necessan
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) FROM To DESCRIPTION eoto,,naraness,sou/root type,g,hinsizgetc.)
0.0 f` 30.0 ft.
` RED CLAY
4.Date Well(s)Completed: 03/14/23 Well ID# EX-62 30.0 ft• 129.0 f` BROWN SANDY SILT
.);I.Well Location: 129.0 f` 246.0 f`' ROCK
DUKE ENERGY OF THE CAROLINAS ALLEN STEAM STATION
Facility/Owner Name Facility ID#(ifapplicable) 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
ib.Latitude and longitude in degrees/minutes/seconds or tlecinial degrees:
(if well Field,one tat/long is sufficient) 22.Certification:
525224.54268 N 1400536.17681 W � '' 04/11/23
6.Is(are)the well(s): ENPerinanent or ❑Temporary Signature of Certified well Contractor Date
By signing this fi/rtn,I hereby cerlij,that the wel/(s)Was(were)comiracted in accordance frith _
7.Is this a repair to an existing well: ❑Yes or MNo 15A NCAC 02C•.0100 or 15A NCAC 02C'.0200 We//Cnnstructia/'Fy�St in(Ipr/)n/,(I /iq!q Cps 1}�„t "i
If lhir is o repair,fill ont known,roll construction i/Jbrnration nn<I explain the nature nf[!ve gfthis record has been provided io the ire/l owner. $ :,%:'i,.;? ..,y E;%
repair under 21 remarkr section or on the back(if this form.
23.Site diagram or additional well details: MAY t7 7(�
8.For Geoprobe/DPT'or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well constrli.` inV- 23
construction,only I GW-I is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach additional pages if necessary.
drilled: lnl oun%. :^.,U �T ,x;'7:'••7:.Ga
24.SUBtVII•Cfr1L INSTRUCTIONS
246.0
'J.Total well depth below land surface: (ft.)
blur multiple ire//s 11V an dep[hs tfdyferent(example-;a 200'and 2@1 100') Submit this GWA within 30 days of well completion per the following:
17.7 24a. For All Wells: Original form to Division of Water Resources (DWR).
IU.Static water level below top of casing: (FL) Information Processing Unit, 1617 MSC,Raleigh,NC 27699-1617
IJ'irater level is abore cavil¢;,use-
11.Borehole diameter: 16.0/12.0/7.0 (in) 24b. For Injection Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: AUGER/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 WELLS ONLY: 24d.For Water Wells producing over 100,000 GPD:Copy to DWR,CCPCUA
13a.field(-pill) N9ethod of test: itog Perm Program, 1611 MSC,Raleigh,NC 27699-1611
13b.Disinfection type: Amount:
Form GW-I North Carolina Deparunent or Environmental Quality-Division of Water Resources Revised 6-6-2018