GW1--03400_Well Construction - GW1_20230517

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
L Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
for. ft.
A - 2581
ft. ft.
NC Well Contractor Certification Number
15.OUTER CASING for multi-cased wells)OR LINER if a ilicable'
GEOLOGIC EXPLORATION FROM TO- DIAMETER THICKNESS MATERIAL
in.
Company Name
W R0300124 16.INNER CASING OR TUIIINC eothermal closed-loo s
2.Well Construction Permit#: FROM TO DIAMETER I THICKNESS I MATERIAL
List all applicable u•e/l construction permits(i.e.U/C,County,State,Variance,etc) Q•Q ft. 81.0 ft. 6•0 in. SCH 80 'PVC
3.Well Use(check well use): ft. ft. in.
Water Supply Well: 17.SCREEN ..:
❑Agricultural ❑Municipal/Public
FROM TO DIAMETER SLOTSIZE I THICKNESS MATERIAL
$1.0 It. 116.0 ff 6,Q '"' .010 SCH 80 SS
❑Geothermal(Fleating/Cooling Supply) ❑Residential Water Supply(single) ft. f"ft. in.
❑Industrial/Conunercial ❑Residential WaterSupply(shared) 18.GROUT
❑Irri ation ❑Wells> 100,000 GPD FROM TO m vrER1AL EMPLACEMENT METHOD&AMOUNT
1-Water Supply Well: 0.0 ft. 71.0 ft' NEAT PORTrAND CEMENT SLURRY(PUMP)
OMonitorina ❑Recovery for. et.
Injection Well:
ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK if applicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑StormvaterDrainage 76.0 It- 118.0 ft• 7-35(#2) POUR
❑Experimental Technology ❑Subsidence Control for. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) FROM TO DESCRIPTION color,hardness,sos7hock type,grain size,etc.)
0.0 ft- 14.0 1" RED SILTY CLAY
4.Date NVell(s)Completed: 12/30/22. Well ID# EX-24 14.0 ft- 36.0 ft- BROWN SILTY SAND
5a.Well Location: 36.0 ft. 89.0 ft' TAN/WHITE SILTY SAND
DUKE ENERGY OF THE CAROLINAS ALLEN STEAM STATION 89.0 ft- 116.0 ft. PWR
Facility/Owner Name Facility ID#(if applicable) 116.0 ft 129.0 ft• ROCK y
253 PLANT ALLEN ROAD BELMONT 28012 ft. ft. - K-.r o .'
Physical Address,City,and Zip ft. ft. MAY 7 20213
GASTON 304337 21.REMARKS
County_ Parcel Identification No.(PIN) BENTONITE SEAL-71.0-76.0 ljr.:
Sb.Latitude and longitude in degrees/minutes/seconds or decinial degrees:
STAINLESS STEEL SUMP- 116.0- 117.0
(if well field,one]at/long is sufficient) 22.Certification:
528589.01569 N 1400145.73473 W ,__
04/11/23
6.Is(are)the well(s): (EPermanent or ❑Temporary Signature of Certified Well Contractor Date
By signing this form,l hereby cenify_that lhd well(s)Bras(u^ere)coalgtrucie(i in accot•dance with
7.Is this a repair to an existing well: ❑Yes or MNo ISA NCAC 02C.0100 at-15A NCAC 02C.0200 Well Construction Stat elards and that a cops
{f this is a repair,fill ota known swell construction i formation and explain the nature of the ofdlis record has been provider/to the well owner.
repair under:21 remarks section or on the back of this form.
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-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: . 117.0 ft.)Far multiple n•el/s'list all t/eplhs i/t1 f/erenl(example-3@200'and 2@100') ( Submit this GW-1 within 30 days of well completion per the following:
10.Static water level belnxv top of casing: 8•59 (ft) 24a, For All Wells: Original form to Division of Water Resources (DWR),
Ifsrater level is above casing,use"r'. Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter: (in.)
14.0/10.0/6.0 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 Supply and Open-LOOD Geothermal Return Wells:Copy to the
(i.e.auger,tnrtp cable,direct push.etc.) county environmental health department of the county where installed
FOR WATER SUPPLY WELLS ONLY: 24d. For Water Wells ProducinE over 100 000 GPD:Copy to DWR,CCPCUA
Permit Program, 1611 MSC,Raleigh,NC 27699-1611
13a.Yield(gpm) Method of test:
13b.Disinfection type: Amount:
Form GN'-I North Carolina Deportment of Environmental Quality-Division of Water Resources Revised 6-6-2018