GW1--03384_Well Construction - GW1_20230517

WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS Ia.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
ft. ft.
A - 2581
rt. ft.
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells)OR LINER if a,aicable)
GEOLOGIC EXPLORATION FROM To DIAMETER THL.LI NEss AfATERI:\L
ft. ft.
Company Naine
WR0300124 16.INNER CASING ORTUBING eothermalclosed-loo,)
2.Well Construction Permit#: FROM TO DIAMETER TIIICKN I MATERIAL
Lict all applicable well cons'trtictiolr pernrilc(i.e.UIC,County, gale,Variance,eic) 0.0 ft. 119.0 ft• 6.0 1°' SCH 80 PVC
3.Well Use(check well use): ft. ft. in.
Water Supply Well: F7R.M1'REENaO DIAMETER SLOT SIZE THICKNESS MATERh\L
❑Agricultural ❑Municipal/Public 119.0 f`- 179.0 f` 6.0 in;
.010 SCH 80 SS
❑Geothermal(Fleating/Cooling Supply) ❑Residential Water Supply(single)
❑Ind ustrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Irrigation ❑Wells> 100,000 GPD FROM TO MATERIAL ENIPLACEN ENT METHOD&AMOUNT
NOn-Water Supply Well. 0.0 ft- 107.0 ft- NEAT PORTLAND CEMENT SLURRY(PUMP)
[EMonitoring ❑Recovery rt. ft.
Injection Well:
ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK if a,placable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL E\1PLACE\IENT iNIETHOD
❑Aquifer Test ❑Storm\vater Drainage 113.0' f` 180.0 f`. 7-35(#2) POUR
❑Experimental Technology ❑Subsidence Control rt. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary)
FROM TO DESCRIPTION(color,hardness,soil/rock type,°rain size,etc.)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks)
0.0_ f`• 13.0 f` RED SILTY CLAY
4.Date Well(s)Complete(]: 02/20/23 Well ID# EX-54 13.0 f` 32.0 f` BROWN SILTY SAND
i:t.Well Location: 32.0 f`, 128.0 ft. TAN/WHITE SILTY SAND
DUKE ENERGY OF THE CAROLINAS ALLEN STEAM STATION 128.0 f` 178.0 f` PWR
Facility/Owner Name Facility ID9(if applicable) 178.0 f`' 188.0 f`• ROCK
253 PLANT ALLEN ROAD BELMONT 28012 rt. ft.
Physical Address,City,and Zip
rt. ft.
GASTON 304337 21.REMARKS
County Parcel Identification No.(PIN) BENTONITE SEAL-- 107.0-113.0 FEET
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
STAINLESS STEEL SUMP- 179.0- 180.0 FEET
(if well field,one Iat/long is sufficient) 22.Certification:
525020.85177 N 1400586.66834 !::/:Sn.„ 01,r--
04/11/23
6.ls(are)the well(s): ©Permanent or ❑Temporary Signature of Certified Well Contractor Date
Rv signing this.jnrnt,l hereby certify that the trell(s)was(trereJ�c�,,o?Lc yy�utr�rrarilm c}k trh '.
7.Is this a repair to an existing well: ❑1'es or �Np 15A NCAC 02C.0100 or/jA NCAC 02C.0200 Oe//Consi nc(ji- Stauellrr g anti Nn,�r c1,pP
lj this is a repair,fill out knout it ell conrreucdon irrfiu'n,aliarr and et'plahr the nature of 1he ojlhic record hac been prorirlerl to the ire//owner.
repair under::21 reotorkc s'eciion or on the back of this Jirr•m' MAY 1 7 2023
23.Site diagram or additional well details:
YOU may use the back of this page to provide additional well Constriction into
S.For Ceoprobc/DP"f or Closed-Loop Geothermal Wells bovine the same � •.�t�fi^
attach hpp�l: s rFneC€g:itt.
construction,only I GW=1 is needed. Indicate TOTAL NUMBER Of w (add'See Over'in Remarks Box).You may also
ells I drilled: ,�..;
r,%',, U
24.SUBA91T7•AL INSTRUCTIONS
9.Total well depth below land surface: 180.0 (ft.)
For ninhiple ire/Lc list all depths ifdij7erent(example-3@200'and 2 rt 100') Submit this GW-1 within 30 days of well completion per the following:
10.Static water level below top of casing: 15.65 24a. For All Wells: Original form to Division of Water Resources (DWR),
if]titer level is above casing,ace"+
(ft.) Information Processing Unit, 1617 MSC,Raleigh,NC 27699-1617
"
11.Borehole diameter: 10.0/6.0 (in) 24b. For Injection Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: SONIC
24c.For Water Supplv 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(gyro) Method of test:
Permit Program, 1611 MSC,Raleigh,NC 27699-1611
.
13b.Disinfection type: Amount:
Fonn GW-I North Carolina Department or Environmental Quality-Division of Water Resources Revised 6-6-2018