GW1--03389_Well Construction - GW1_20230517

WELL CONSTRUCTION.RECORD(GW-1) For Internal Use Only:
I:Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES ".
Well Contractor Name - FROM .. TO::" DESCRIPTION
ft. ft.
A - 2581
NC Well Contractor Certification Number IS.-OUTER CASING(for multi cased wells)OR LINER if a licable
GEOLOGIC EXPLORATION.. FROM TO DIAMETER THICKNESS MATERIAL
ft. ft. in.
Company Nmne . ._ ... � .. -
16.INNER CASING OR TUBING geothermal closed-loo
2.Well Construction Permit#: WR0300124 FROM TO DIAMETER THICKNESS MATERIAL
l,isr all applicable well construction permits(i.e.UIC,County,Slate, Variance,etc) .6.0 ft- 65.0 ft- 6.0 in. SCH 80 IL PVC
3.Well Use(check well use) ft.
:
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 65.0 ft' 85.0 ft- 6.0 'in, O10 SCH'80 SS
( g/ Supply) Supply(single) ft. ft. in.
❑Geothermal Heatin Cooling Su I ❑Residential Water Su I "
❑Industrial/Commercial ❑Residential WatecSupply(shared) 18.GROUT
❑Irrigation ❑We]Is> 100,000 GPD FROAI TO MATERIAL EM PLACEM ENT M ETIIOD&M%IOUNT
Non-Water Supply Well: :0:0 ft• 55.0 ft' NEATPORTLANDCEMENT SLURRY(PUMP)
OMonitoring ❑Recovery
Injection Well:
q g❑A wfer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK ifi licable
❑Aquifer Storage and Recovery ❑Salinity Barrier 'FROM I TO MATERIAL EMPLACEMENT METHOD
OAquifer Test ❑StortnwaterDrainage 60.0 ft. 86.0 ft- 7-35(#2) POUR
❑Experimental Technology ❑Subsidence Control fr. ..ft.
❑Geothermal(Closed Loop) ❑Tracer -20.DRILLING LOG attach-additional sheets if necessa'
.FROM TO DESCRIPTION color,hardness,soil/mck type.1"in size,etc.)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks)
0.0. fr. 7.0 ft RED SILTY CLAY'.
4.Date Wcll(s)Completed: 01./05/23 Well ID# EX-47 7.0 ft- 18.0 ft• BROWN SILTY SAND
5a,Well Locution: 18,0 ft' 85.0 tt, TANJ1 MfE SILTY SAND
DUKE ENERGY OF THE CAROLINAS ALLEN STEAM STATION 85.0 ft- 95.0 ft. ROCK ,
Facility/Owner Name Facility ID#(ifapplicable)
253. PLANT ALLEN ROAD: BELMONT 2801-2MAY
ft. ft.
2023
Physical Address,Citv,.and,Zip
- -
GASTON 304337 21.REMARKs ,_<.. v; , UI
County Parcel Identification No.(PIN) BENTONITE SEAL 55.0-60.0 FEET
STAINLESS STEEL SUMP-85.0-86.0.FEET
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one]at/long is.sufficient) 22.Certification:
525368.36786 N 1400492.29950 W !:21 Snzi„ Gly--
04/11/23
6.Is(are)the well(s): MPermanent or ❑Temporary Signature of Certified Well Contractor Date
Hy signing this form,I hereby.certify that the we/l(s)was(were)cotavructe</in accordance with
7.is this a repair to an existing well: ❑Yes or ONo 1SA NCAC 01C.0100 or l.iA NCAC 01C.0200 Well Construction Standards and that a copy
it'll is is a repair.Jill out known well construction information and explain the nature oJ'dre of this record has been provider/to the well owner.
repair antler�21 remarks section or on the back of this form.
23.Site diagr:llil or additional well details:
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You.may use the back of this page to provide additional well construction info
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: 24.SUBNin'TAL INSTRUCTIONS
9.Total well depth below land surface: 86.0 (f')
l�or ruuhiple,srelis list till depths ifdgJereni(erample-3 rr 200'and 1Q100') Submit this GW-1 within 30 days of well completion per the following:
10.Static water level below top of casing: 15.0. 24a, For All Wells: Original form to Division of Water-Resources (DWR),
!/'water level is above casing,use"+" (ff) Information Processing Unit,1617 MSC,Raleigh„NC 27699-1617
14.0/10.0/6. 24b. For Injection.Wells: Copy to DWR,Underground Injection Control (lUC)
I I.Borehole diameter: 0' (in.) Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method` AUGER/AIR/SONIC
24c.For Water Supplv and Opcn-Loop Geothermal Return Wells:Copy to the
(i.e.auger,rotary;cable,direct piish,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-
Permit Program, 1611 MSC,Raleigh;NC 27699-1 61 1
13a.Yield(gpm) Method of test:
13b..Disinfection type: Amount:
Form GW-I North Carolina DeparttY nent of Environmental Quality-Division of Water Resources Revised 6-6-2018