GW1--03398_Well Construction - GW1_20230517

WELL CONSTRUCTION RECORD(GW4) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.wATERZONES 1
Well Contmctof Name FROM TO DESCRIPTION
ft. ft.
A - 2581
NC Well Contractor Certification Number
15.OUTER CASING for multi-cased we11s OR LINER(if a licable
GEOLOGIC EXPLORATION FROM TO DIAMETER THICKNESS �tATERIAL
:in.
Company Name
W R03001 24 16.INNER CASING OR TUBING cotherma]closed-loop)
2.Well Construction Permit#° FROM TO DIAMETER THICKNESS MATERIAL
List all applicable we/l construction permits(i.e.UIC,County,Slate,Variance,etc.) .0.0 t`• 82.0 fr- 6.0 r"' _SCH 80 PVC
3.Well Use(check well use): ir. tr. in.
Water Supply Well: A7.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS 1ATERIAL
❑Agricultural ❑Municipal/Public 82 0 it. 117.0 fr• 6.0. in' .010 SCH$0 SS
OGeothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. - fr. in.
❑Ind ustrial/Cominercial OResidential Water Supply(shared) All.GROUT-
. ❑Irrigation ❑Wel Is> 100,000 GPD .FROM TO MATERIAL EMPLACEMENTMETHOD&AMOUNT
Non-Water Supply Well:, 00 ft- 72.0 ft- NEAT PORTLAND CEMENT SLURRY(PUMP)
OMonitoring ❑Recovery
Injection Well:
❑Aquifer Recharge ❑Groundwater Rem fr: ft.
ediation
19:SAND/GRAVEL PACK if li i olicable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM 't0 I MATERIAL I EMPL,\CENIE\TMLTIIOD
❑Aquifer Test ❑Stormwater Drainage -7TO fr• 1.18.0 t` 7=35(#2) POUR
❑Experimental Technology ❑Subsidence Control
❑Geothermal(Closed Loop) ❑Tracer .20.DRILLING LOG attach additional sheets if necessary)
❑Geothermal(Heati ng/Cooling Return) ❑Other(explain under#21 Remarks) FROM To DESCRIPTION coloq harJness,sou/rock c, rain size,etc.
0.0 fr• 12.0 tr, RED SILTY CLAY.
4.Date Well(s)Completed: 2/1 6/?? WelliD# EX=26 12.0 ff. _ 31.0 _ tr BROWN SILTY SAND
5a.Well Location: 31.0 f`• 90.0 f`- TAN/WHITE SILTY SAND
DUKE ENERGY OF THE CAROLINAS ALLEN STEAM STATION 99.0 f`- 117.0 ft• PWR .,
Facility/OwnerNarpe Facility IDlt(ifapplicable) 117.0 ft- 129.0- f`• ROCK s. 0U fLy 147"M'
253 PLANT ALLEN ROAD BELMONT 28012 ft- ft.
Physical Address,City,and Zip ft. ft. MA 3
GASTON 304337 21.'REMARKs Ur:
County Parcel Identification No.(PIN) BENTONITE SEAL_72,0-77.0 FEET CIV4140,f3
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: STAINLESS STEEL SUMP 117.0- 118.0 FEET
(if well field,one Iatlong is sufficient) :22.Certification:
528601.76276 N .1400340.39774 . Wt�:h. -- 04/11/23
6.is(are)the well(s): OI'ermanent or ❑Temporary Signature of Certified Well Contractor Date
By signing this forin,1 hereby certify that the ire//(s)was(were)construcved in accordance with
7.Is this a repair to an existing well: ❑Yes or (5No 15A NCAC 01C.0100 or 13A NCAC.02C.0200 Well Coihsiruc7ion Sidndarrls anti ilia/a copy
IJ7hic is a repair,fill out known well coin.Ttruclion iglbrination and explain the nature ofihe ofibis record has been provided to the well owner.
repair under r2l remarks section or on the back of this fora.
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 1 GW-1 is heeded. 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: 118.0 ft.
har inahip/e wells list all depiks ifdtffereni(exam aple-3 2a0'and 2 a 100') ( ) Submit this GW-1 within 30 days of well completion per the following:
10.Static water level below top of casing: 9•96 (ft) 24a. For All Wells: Original form. to Division of Water Resources (DWR),
1J'irater level is above casing, Information Processing Unit, 1617 MSC,Raleigh,NC 27699-1617
11.Borehole tianieter: 14.0/10.0/6.0_ (in) 24b. For Injection Wells: Copy to DWR,Underground Injection Control(IUC)
Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: AUGER/AIR/SONIC
24c.For Water Snpply a1110 pen-Loon Geothermal Return Wells:Copy to the
(i.e.auger,rotary,cable,direct push,etc.) comity environmental health department of the county where installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,0"GPD:Copy to DWR,CCPCUA
Permit Program, 1611 MSC,Raleigh,NC 27699-161 1
13a.Yield(gpm) Method of test:
13b.Disinfection type: Amount:
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6.6-2018
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