GW1--03396_Well Construction - GW1_20230517

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
BRIAN.THOMAS -La.WATER ZONES
Well,Contractor.Name FROM T0. DESCRIPTION
A - 2581
NC Well Contractor Certification Number .15:OUTER CASING(for mdrelsOLNERR
D \ IETE ICKNf a licaAblcEGEOLOGIC EXPLORATION FROM ESS M1IT)
RL\L
Corripany Name
WR03001.24 16.INNER CASING OR TUNING eothermal closed-loo
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS I MATERIAL
List all applicable well construction permits(l.e.UIC,County,State,Variance,etc.) 0.0 ft' 102.0 ft- 6.0 rn' SCH 80 PVC
3.Wcll,Use(check well use): tr. fr. in.
17.SCREEN
Water Supply Well: FROM. TO DIAMETER SLOTSIZE THICKNESS MATERIAL
❑Agricultural ❑Miinicipal/Public 102.0 R' 147.0 ft- 6.0 ' in. .010 SCH 80 SS
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. tr. in.
❑I ndustrial/Commercial ❑Residential WaterSupply(shared) 18.GROUT
❑Irrl ation ❑Wells> 100,000GPD FROM TO MATERIAL EMPLACEMENT MMIOD&ADIOUNT
Non-Water Supply Well:. 0.0 ft- 920 ft' NEATPnRTLANDCEMENT SLURRY(P(JMP)-
PflMonitoring. ❑Recovery fr. ft.
Injection Well:
❑Aquifer Recharge ❑Groundwater Remediation
19.-SAND/GRAVEL PACK(ifar licable
❑Aquifer Storage and Recovery" ❑Salinity Barrier 'FROM TO I MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwaier Drainage 97.0 " ft- .148.0 ft• 7=3S'(42) - POUR
❑Experimental,Technology ❑Subsidence Control ft: H.
❑Geothermal(Closed Loop) "" ❑Tracer - -20.DRILLING LOG attach additional sheets ifireceim
OGeothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) FROM TO DESCRIPTION color,hardness,soiVrock t ie, rain size,etc.
0.0."ft. 7.0 ft. RED SILi`Y CLAY
4.Date Well(s)Completed: 02/27/23 Well ID# EX-38 7.0 fr• 23.0 ft. BROWN SILTY SAND
5a.Well Location: 2310 ff 119.0 ft' TAN/WHITE SILTY SAND
DUKE ENERGY OF THE CAROLINAS ALLEN STEAM STATION 119.0 ft• 147.0 ft• PWR
Facility/Osviier Name Facility ID#(ifapplicable) 147.0 ft- 159.0 f- ROCK "a
253 PLANT ALLEN ROAD :BELMONT 28012 ti tr. 23
Physical Address,City,and Zip ft. ft.
GASTON 304337 .21..REDIARKs
County Parcel Identification No.(PiN) BENTONITE SEAL.-92.0-97.0 FEET
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
STAINLESS,STEEL SUMP- 147.0- 148.0 FEET
(if well field,one lat/long is sufficient) 22..Certification:
526885.41118 N 1400520.72407 W !:21 sn:a_ 04/11/23
6.IS(are)the well(s): 191"ermanent or ❑Temporary Signature of Certified Well Contractor Date
Hy signing Ihis farm,1 hereby certify that the ureills)was(here)consvnicted in accordance with
7.Is this a repair to an existing well: ❑Yes or [5No 15A NCAC 02C.0/00 or ISA NCAC 02C.0100 We11 Construction Standards and that a copy
if Ihis is a repair,fill our known a-ell construction a f miatiwr and explain the nature of the ofthis record has been provided to the well owner.
repair under rill remarks section or on the back oy'Ihts font.
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-1 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
0 -
9.Total well depth below land surface: 148. (ft.)
(or nudtiple hells list all depths ifdiifferent lexample-3 n 100'and 1 a 100') Submit this GW-1 within 30 days of well completion per the following:
10.Static water level below top of casing: 6•5 Ift) 24f• For All Wells: Original form Jo Division of Water.Resources (DWR),
/Jlroter lorel is above casing,use,.+••
information Processing Unit, 1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter: 1 0.0/6.0. ' (in.) 24b. For Injection Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: SONIC
lac:For Water Supply and Open-Loon Geothermal Return.Wells:Copy to the
(i.e.auger,rotary,cable,direct push,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(gpm) Method of test:
I.
13b.Disinfection type: Amount:
I
FornL GW-I North Carolina Department of Environmental Quality-Division of WaterResources Revised 6-6-2018