GW1--03378_Well Construction - GW1_20230517

WELL.CONSTRUCTION RECORD(GW-1) For Internal Use Only:
I.Well Contractor Information:
NICHOLAS HAYES 14.WATER ZONES
FRONT TO DESCRIPTION
Well Contractor Name
ft. ft.
A - 4121
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells OR LINER(if a,ilicable)
GEOLOGIC EXPLORATION FROM TO DL METER .1 ICKNESS I\IATERIAL
Company Name
0.0 ft. 109.0 ft. 8.0 In SCH 80 PVC
16.INNER CASING OR TUBING eothermal closed-loop)
2.Well Construction Permit It: WR0300124 FRONT TO DIAMETER THICKNESS MATERIAL
l.cvr au appheable Lreu eansrrncua„pe,n,ts(i.e.111C,County,State,Variance,etc.) ft. ft.
3.Well Use(check well use): ft. in.
Water Supply Well: 17.SCREEN
FRONT TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public Ift. R. in.
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(Single) ft. ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 13.GROUT.
❑Irrigation ❑Wells> 100,000 GPD FROM TO MATERIAL EMPLACE\IENTNETIIOD R AMOUNT
Non-Water Supply Well: 0.0 ft' 109.0 ft- NEAT PORTLANDCEMENT SLURRY(PUMP)
I!lMonitoring ❑Recovery
Injection Well: ft. ft.
❑Aquifer Recharge ❑Groundwater Remedialion
19.SAND/GRAVEL PACK(if a i ilicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FRONT r0 MATERIAL entPLncenlENr MErBOD
❑Aquifer Test - ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG(attach additional sheets if necessary)
OGeothermal(Heating/Cooling Return) ❑Other(explain under 1121 Remarks) FROM TO DESCRIPTION(color,hardness,soith'ock type,grain size,etc.)
0.0 ft. 20.0 ft- HARD BROWN SILTY ROCK
4.Date Well(s)completed: 03/13/23 Well IDH EX-60 20.0 ft. 25.0 fc WEATHERED ROCK
in.Well Location: 25.0 fL 35.0 fL BROWN SAND
DUKE ENERGY OF THE CAROLINAS ALLEN STEAM STATION 3S.0 FT- 96.0 ft. BROWN SILTY CLAY
Facility/OwnerNamc Facility 1139(il'applicable) 96.0 ft: 98.5 ft. PWR
253 PLANT ALLEN ROAD BELMONT 28012 98.5 ft. 246.0 ft• ROCK
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 tat/long is sufficient) 22.Certification: �C/" /�///` _
350 10' 36.07" N 810 00' 23.16" /�
����rj'� 04/21/23
6.is(are)the well(s): MPermanent or ❑Temporary Signature of Certified Well Contractor Date
By signing This jor n,l hereby certify lha1 the vell(v)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or ITNo 15A NCAC 02C.0100 or 1JA NCAC 02C.0200 I{'ell Con.wz,ctia. tarnfn;df anaarqq ri,iulri
1J'this is a repair,fill ow knout,well Construction information and esnlain the nature of'lhe at this record has been provider/to the yell owner. : '•w u..,s'r�.,,,y ,• � �
repair under::21 remarkv section or on the back of this firm.
23.Site diagram or additional well details: �/( � �n rt�
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional we co 1/stn•ti 7,it �,I[
construction,only I GW-1 is needed. Indicate TOTAL NUMBER of wells (add'See Over in Remarks Box).You may also attach additional pages if necessarv.
drilled: l:f'r<
24.SUBMITTAL INSTRUCTIONS ['Ai.!a.,3'0G
9.Total well depth below land surface: 246.0 (fL)
l•i r,nultiple,tells fist all depth.)'7,J ri%/Jereln(exoniple-3@200'and 2@100') Submit this G1\'-1 within 30 days of well completion per the following:
10.Static water level below top of casing: 17.1 24a. For All Wells: Original form to Division of Water Resources (DWR),
(ft.)If user level is above casing.use Information Processing Unit, 1617 MSC,Raleigh,NC 27699-1617
.. `
16.0/12.0/7.0 24b. For-Injection Wells: Copy to DWR,Underground injection Control (IUC)
i I.Borehole diameter: (in.) 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.Yield(gpm) Dlcthod of test: Permit Program, 1611 MSC,Raleigh,NC 27699-161 1
13b.Disinfection type: Amount:
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018