GW1--03394_Well Construction - GW1_20230517

WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.WATERZONES -
Well Contractor Name FROM TO DESCRIPTION
A - 2581 ft. ft.
fr. fr.
NC Well Contractor Certification Number 15.OUTER CASING for multi-cased%yells)OR LINER if al) licable
GEOLOGIC EXPLORATION FROM TO DIAMETER I THICKNESS MATERIAL
ft. ft. in.
Company Na me
W R0300124 16.INNER CASING OR TUBING eothermal closed-loo t
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS I NATERIAL
List all applicable well construction perntils(i.e.1/1C,County,Slate.Variance,etc.) 0.0 R. 70.0 rt. 6.0 in. SCH 80 PVC
3.Well Use(check well use): fr. ft. in.
17.
Water Supply Well: FRO M SCREEN
TO DIAMETER SLOTSIZE I THICKNESS MATERIAL
❑Agricultural ❑Mgnicipal/Public 70.0 ft• 100.0 ft' 6.0 in- .010 SCH 80 SS
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. fr. in.
❑Ind ustrial/Commercial DResidential Water Supply(shared) 18.GROUT
❑Irrigation ❑Wells> 100,000 GPD FROM TO MATERIAL EpIPLACEMENT NTEl'HOD&AMOUNT
Non-Water Supply Well: 0.0 ft. 60.0 ft' NEAT PO RTLAND CEMENT SLURRY(PUMP)
OMonitoring ❑Recovery
Injection Well: ft. fr.
❑Aquifer Recharge ❑GroUndwdter Remedialion
❑Aquifer Storage and Recovery ❑Salinity Barrier 19.SAND/GRAVEL PACK ifa t tlicableFROM. TO MATERIAL I ENIPLACENIENT nIETIM
❑Aquifer Test ❑Storm\vater Drainage 65.0 ft• 101.0 ft. 7-35(42) POUR
❑Experimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessar
FRONI TO DESCRIP'r10N(color,hardness,soil/rock t le, rain size,etc.
❑Geothermal(FlealinPJCooling Return) ❑Other(explain under#21 Remarks)
- 0.0 ft• 13.0 ft• RED SILTY CLAY
4.Daten'ell(s)Completed: 02/01/23 Well ID# EX-40 13.0 ft• 51.0 ft• BROWN SILTY SAND
5a.Well Location: 51.0 rr. 94.0 ft. TAN/WHITE SILTY SAND
DUKE ENERGY OF THE CAROLINAS ALLEN STEAM STATION 94..0 ft• 100.0 ft• PWR
F tit r-v
Facility/Owner Name Facility IDP(irapplicable) 100.0 ft. 109.0 ft. ROCK -t:y.�k- �,. .'�; ' a
253 PLANT ALLEN ROAD BELMONT 28012 ft. ft.
Physical Address,City,and Zip ft. ft. Iff 2023
GASTON 304337 .21.REtNIARKS
BENTONITE SEAL- 60.0-65.0 FEET lJl
County Parcel Identification No.(PIN) Ri+ ' t, OG
56.Latitude and longitude in degrees/minutes/seconds or decimal degrees: STAINLESS STEEL SUMP - 100.0- 101.0 FEET
(if well field,one lat/long is sufficient)
22.Certification:
526455.21916 N 1400492.09603 NV ��- Gv r 04/11/23
6.Is(are)the well(s): OPermanent or ❑Temporary Signature of Certified Well Contractor Date
By signing this farm,1 herebt•certify that the me/1(s)Bras 6rere)constructed in accordance wilh
7.Is this a repair to an existing well: ❑Yes or ONo 15A NCAC 02C.0100 or 15A NCAC 02C.0200 IVcIl Cot)strticiioii Slati(lai-r/r and thal a c•oln-
if this is a repair.Jill oul known well construction infbnnalion and explain the nature ql'i/ne of dais record has beeii ptnricier/io the tee//ou,)ier.
repair under a'21 retuarks.rection or oil the back ofthisJbrm.
23.Site diagram or additional well details:
3.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.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 101.0 (ft.)
hbr nnd h liple tre//s list all depths iI di//erenl(example-3 rt200'atitl2@/00') Submit this GW-1 within 30 days of well completion per the following:
10.Static water level below top of casing:
5.13 24a. For All Wells: Original form to Division of Water Resources (DWR),
(ft.) Information Processing Unit, 1617 MSC,Raleigh,NC 2 7699-1 6 1 7
1f water level is abore casing,use
10.0/6.0 24b. For Injection Wells: Copy to DWR,Underground Injection Control(IUC)
I1.Borehole diameter: (in.) Program, 1636 MSC,Raleigh,NC 2 769 9-1 63 6
12.Well construction method: SONIC
24c.For Water Supply and Open-Loon Geothermal Return n'ells:Co to the
(i.e.auger,rotary,cable,direct push,etc.) county environmental health department of the county Where installed Copy
FOR n'ATER SUPPLY WELLS ONLY: 24d. For Water Wells producing over 100,000 GPD: Copy to DWR,CCPCUA
13a.Yield(gpnn) Method of test: Permit Program, 1611 INISC,Raleigh,NC 27699-1 6 1 1
13b.Disinfection type: Amount:
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018