GW1--03395_Well Construction - GW1_20230517

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.-WATERZONES "
.. FROM Well Contractor Name 'r0-- DESCRIPTION
ft. ft. i
A - 2581
fr. tt.
NC Well Connector Certification Number 15.OUTER CASING for multi-cased wells OR LINER if a licable)
GEOLOGIC EXPLORATION _ FROM TO DIAMETER THICKNESS M1IATERIAL
f[. ft. �in.
.. .. ...
Company Name .
16.INNER CASING OR TUBING eother al closed-loop)
2.Well Construction Permit#: W R0300124 FROM TO DIAMETER I THICKNESS T MATERIAL
List all applicable well construction pertnils(i.e.1l1C,County,.State,Variance,etc) 0.0 ft' 83.0 ft. 6.0 Ln' SCH 80 PVC
3.Well Use(check well use): ft. fr. in.
Water Supply Well: 17.SCREEN.'
FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 83.0 ft' 128.0 fr- 6.0 1°' .010 SCH 80 SS
❑Geothermal(Fleating/Cooling Supply) ❑Residential Water Supply(single)
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Irritation ❑Wells> 100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well:, 0,0 ft. 70.0 ft• NEAT.PORTLAND CEMENT SLURRY.(.PUMP)
OMonitoring ❑Recovery'
Injection Well:
ft. ft.
❑Aquificr Recharge ❑Groundwater Remediatfon
19.SAND/GRAVEL PACK ifn licable
❑Aquifer Storage and Recovery ❑Salinity Barrier; FROM TO MATERIAL EMPLACEMENT METHOD
❑AquiferTest ❑StormwaterDrainage 75.0 ft. 129.0 fr' 7-35(#2) POUR
❑Experimenial Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) ❑Tracer _ 20.DRILLING'LOG attach additional sheets if necessary)
FROM• TO DESCRIPTION(color,hanlness,soil/rock type,ginin size,etc.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks)
0.6 fr• 7.0 fr. RED SILTY CLAY
4.Date NVe11(s)Completed: 03/09/23 Well ID# EX-39. 7.0 11. 26.6 fr, BROWN SILTY SAND
ia.Well Location: 26.0 ft' 680 ft' TAN/WHITE SILTY SAND
DUKE ENERGY OF THE.CAROLINAS ALLEN STEAM STATION ' 68.0 fr• 136.0 fr• PWR
FacilityiC%dner Nanie Facility IDN(if applicable) 136.0 fr• 149.0 fr' ROM
253 PLANT ALLEN ROAD BELMONT 28012 a. ft.
Physical Address,City,and zip ft. ft. MAY 2023
GASTON 304337 21.REMARKS
County Parcel Identification No.(PIN) BENTONITE SEAL 70.0: 7 (uT .Ctl sDr^ 9
V
>b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: STAINLESS STEEL SUMP- 128.0- 129.0"Fftr
(if well field,one]at/long is sufficient) 22.Certification:
526685.11446 N 1400502.62106 Wn,h
04/11/23
6.Is(are)the well(s): OPermanent or ❑Temporary Siggature of Certified Well Contractor ,Date
By signing this form,1 hereby certify that the well(s)was(were)constructer(in accordance with
7.Is this a 'repair to an existing well: ❑Yes or 5No' 15A NCAC 01C.0100 or 15A NCAC 01C r0200 Well Construction Siat(dardv and that a copy
if This is a repair,fill out known well construction information and esplaiin the nature of the of this record haY been provided to the well owner.
repair.wider 21 remarks section or an the back of Ibis fornt.
23.Site diagram 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-F is needed. Indicate TOTAL-NUMBER of wells (add'See Ove?in Remarks Box).You may also attach additional pages if necessary.
drilled: 24.SUMMIT-FAL INSTRUCTIONS
9."Total well depth below land surfacer 129.0 (ft.) Submit this GW4 within 30 days of well completion per the following:
l-})r nitdtiple wel/s list all depths ifdifferent(erantple-3@200'and 2 a.100')
10.Static water level below to of casin : 8.8 24a. For All Wells: Original form to Division of Water Resources (DWR),
p 6 (ft.) Information Processing Unit, 1617 MSC,Raleigh,NC 2 769 9-1 61 7
lflrater level is above caving,use
10.0/6.0 24b. For igjection.�Vells: Copy to DWR, Underground Injection Control (IUC)
11.Borehole diameter: (in.) Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: SONIC lac.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the
(i.e.auger,rotary,cable,direct pusli,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 27699-1611
13a.Yield(-pm) Method of test:
13b.Disinfection type: Amount:
Farm GW-1 North Carolina Depattinent of Environmental Quality-Division of Water Resources Revised 6-6-2018
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