GW1--03390_Well Construction - GW1_20230517

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
I.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
Well Connector Name FROMI TO DESCRIPTION
ft. ft.
A - 2581 1
rt. rt.
NC Well Connector Certification Number 15.OUTER CASING(for multi-cased wells)OR LINER if a dicable)
GEOLOGIC EXPLORATION FROM TO DIAMETER THICKNESS ML\TERIAL
ft. �ft. in.
Company Name .
16.,INNER CASING OR TUBING geothermal closed-loop)
2.Well Construction Permit#: WR0300124 FROM TO DIAMETER THICKNESS ML\TERIAL
list oil applicable melt construction permits(i.e.UIC,County,State,Variance,etc_) 0•0 fL 79.0 ft. 6.0 in. SCH 80 PVC
3.Well Use(check well use): ft. ft. in.
17.SCREEN
Water Supply Well:
FROM TO DIAMETER SLOTSIZE THICKNESS NMTERIAL
❑Agricultural ❑Municipal/Public 79•0 "' 114.0ft• 6.0 in' .010 SCH80 SS
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Irrigation ❑Wells> 100,000 GPD FROM TO MATERIAL EMIPLACEMI ENT METHOD&AMIOUNT
Non-Water Supply Well: 0.0 ft• 67.0 ft' NEAT PORTIANDCEMENT SLURRY(PUMP)
nMonitoring ❑Recovery
Injection Well:
rt. tt.
❑Aquifer Recharge ❑Groundwater Relnediation
19.SAND/GRAVEL PACK if applicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM 7'D MATERIAL EMIPLACEMENTMIETHOD
❑Aquifer Test ❑StormwaterDrainage 74.8 ft- 115.0 ft- 7-35(#2) POUR
❑Experimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary)
FROM TO DESCRIPTION color,hardness,soil/rock Type,grain size,etc.)
❑Geothermal(lieating/Cooling Return) ❑Other(explain under#21 Remarks)
0.0 ft• 14.0 fr, RED SILTY CLAY
4.Date\Yell(s)Completed: 02/01/Z3 Well ID# EX-43 14.0 ft- 56:0 ft- BROWN SILTY SAND
5a.Well Location: 56.0 ft. 79.0 rr. TAN/WHITE SILTY SAND
DUKE ENERGY OF THE CAROLINAS ALLEN STEAM STATION 79.0 fr• 114.0 ft• PWR
Facilip'/Owner Name Facility IDl(if applicable) 114.0 ft• 115.0 e• ROCK
253 PLANT ALLEN ROAD BELMONT 28012 ft. ft.
Physical:Address,City,and Zip ft. ft. MAY 7 20 3
GASTON 304337 21.REMARKS
Count}' Parcel Identification No.(PIN) BENTONITE SEAL-' 67.0-74.8 �7 rl„
STAINLESS STEEL SUMP - 114.0- 115.0 FEET
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lallong is sufficient) 22.Certification:
35o 10' 42.10" N 81 a 00' 23.40" , !.2/SnL;7- 6)t r- 04/21/23
6.Is(are)the well(s): Permanent or ❑Temporary Signature of Certified Well Contractor Date
Hy signing lhiv jbrm,l hereby ceriVy that the meil(s)was(mere)constructed in ace'at'dame'e mith
7.Is this a repair to:in existing well: ❑Yes of MNo I5A AtCAC 02C.a100 or 15A NCAC 02C.0200{Veil Convirncliort Stancletrely and Ilia/a copy
U ihis i.v o repair,fill out know n me•ll construction ii formation and e-rplain the tiatnre oj'ihe ofthis record liav been provided io die hell oii'tter.
repair under=21 rewarkv section or on the back oj'thiy Jnrnt.
23.Site diagram or additional well details:
S.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 1 GW-1 is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach additional pages if necessary.
drilled: 24.SUBMIT•l-AL INSTRUCTIONS
9.'rotal weii depth below land surface: 115.0 (ft.)
I•itr multiple hells list all depths ifdiJ7erent(e.rmmple-3@200'aml2a 100') Submit this GW-1 within 30 flays of well completion per the following:
10.55 24a. For All Wells: Original form to Division of Water Resources (DWR),
i Static water revel below top of casing: ((ft.) Information Processing Unit, 1617 MSC,Raleigh,NC 27699-1 6 1 7
Ifntver level is nbore casing,ore.'- `
11.Borehole diameter: 6.0/1 O.O (in) 24b. For Injection Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 PASC,Raleigh,NC 27699-1636
12.Well construction method: SONIC
24c.For Water Soppy and Open-Loop Geothermal Return Wells:Copy to the
(i.e.auger,rotary,cable,direct push,etc.) county environmental hearth 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(gent) Nlethad of test: `
Permit Program,1611 MSC,Raleigh,NC 27699-1 61 1
13b.Disinfection type: Amount:
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018