GW1--03386_Well Construction - GW1_20230517

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WELL CONSTRUCTION.RECORD(GW71) For Internal Use Only:
1.Well Contractor Information- I
BRIAN THOMAS
14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
A - 2581
ft. ft.
NC Well Contractor Certification Number
IS.-OUTER CASING(for multi-cased'wclls)OR LINER if a ilicable)
GEOLOGIC EXPLORATION FROM TO, DIAMETER THICKNESS MATERIAL
ft. fr. in.
Company Name
W R03001 24 16.INNER CASING OR TUBING geothermal closed-loot)
2.WCII CODStrUCtlOn Permit#: FROM TO DIAMETER THICKNESS .. ANIATERIAL
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.) 0.0 ft. 98.0 ft. 6.0 in.. SCH 80 PVC
3.Well Use(check well use): ft• fr. in.
Water Supply Well: - - F SCREEN FROM TO DIAMETER I SLOTSIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public ft. fr. in.
58.0 138.0 6.0,:,. 010 SCH'80 SS
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single)
❑lhdustrial/Commercial ❑Residential Water Supply(shared) IS.GROUT
❑Irrl ation ❑Wei Is> 100,000 GPD FROM E88.O '
'MATERIAL EMPLACEMENT METHOD&AMOUNT '
Noll-Water Supply Well: ' Q•O ft. NEATPORTIANDCEMENT SLUftRY'(P•UMP)
INMonitoring. ❑Recovery ftInjection Well; ti.
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK ifa licable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑StorimvaterDrainage 93.0 ft• 139.0 fL 7=35"(#2) POUR
❑Experimental.Technology OSubsidence Control ft. fr.
OGeothermal(Closed Loop) ❑Tracer 20:DRILLING LOG attach additionnI sheets if necessary)
❑Geothermal(Heat i rig/Cool ing Return) ❑Other(explain under#21 Remarks) FROM' TO DESCRIPTION color,hardness;suith-ock type,grain size,etc.)
0.0 ft. 18.0 ftRED SILTY CLAY
4.Date Well(s)Completed: 02/07/23 Well ID# EX-51 _ 18 D tr. 71.0 . ft- BROWN SILTY SAND
ia.Well Location: 71.0 ft- 125.0 ft' TAN)WHITE SILTY SAND
DUKE ENERGY OF THE CAROLINAS ALLEN STEAM STATION 125.0 fr• 145.5 ft• PWR
FaciligdOwnerNanie Facility lD#(ifapplicable) 145.5 ft• 158.0 ft- ROCK
253 PLANT ALLEN ROAD B.ELMONT 28012
Physical Address,City,and Zip ft. ft.
GASTON 304337 21..REMARKS
County Parcel Identification No.(PIN) BENTONITE SEAL-88.0-93.0 FEET
ib.Latitude and longitude in degrees/minutes/seconds or.decimal degrees: STAINLESS STEEL SUMP_ 138.0 139.0 FEET
(if well field,one Iatlong is sufficient)
22.Certification:
525158,20921 N 1400576.89306 w
04/11./23
signature of Certifie Well Contractor
m m d Date" F4. •i. �'},. ?
6.Is(are)the vvell(s): INPeranent or OTeporary i 4 D4
6 ace
By signing this forms,1 hereby eerlo,lhdt the ire/l(s)n•ar(were)constructed At accordnnee with
7.Is this a repair to an existing well: ❑Yes or Mo LiA NCAC 02C.0100 or 15A NCAC 02C.0100 Well Construction S!t cly., ,d
1f this is a repair,Ji//out known we/1 construction i/fortnation and explain the nature of the ofttis record has been provided to the well owner. H I
repair under=21 rentarks section or on the back ofihis•form.
23.Site diagram or additional well details: c._..- ,•.),��r "4�>a:�7 BEM
S.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additidtfell ci7nts(r� ;�agl> l�
construction,only I GW-1 is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach additional pages I necessary.
drilled:
24.SUBMITTAL INSTRUCTIONS
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9.Total well depth below land surface: 139. (ft.)
1--or multiple wells fist all depths ifclierent(example-3C200'and 2 a 100') Submit,this GW-I within 30 days of well completion per the following:
10.Static water level below top of casing: 25.06 ft 24a. For All Wells: Original form.to Division of Water Resources (DWR),
Ifirater/erel is above coxing,use"+" ( ) Information Processing Unit,1611 MSC,Raleigh,NC 27699-1617
IL Borehole diameter: 1 0.0/6.0 (in) 24b. For Injection Wells: Copy to DWR, Underground Injection Control(IUC)
Program, 1636 MSC,Raleigh,NC 27,699-1636
12:Well construction method: SONIC
24c..For Water Supplv and Open-Loon Geothermal Retur.n:Wclls Copy to the
(i.e.auger,rotary,cable,direct push,etc.) county env irom nental health department of the county where installed
FOR WATER SUPPLY WELLS ONLY:. 244. For Water Wells producing.over it 100,000 GPD
13a.field(-pm) : Copy to DWR,CCPCUA
Perm Program,1611 MSC,Raleigh 27699-161 I
Method of test:
13b.Disinfection type: Amount:
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Form G W-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018
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