GW1--02256_Well Construction - GW1_20240409

i
•
' WELL CONSTRUCi'EON RECORD Forh[cne1Usc•UNLY
This feitne=b:mot for Singleor tmr tipk wells•,
1.Well Cortricterinforntation:
II;WATER ZONES .
Chris Ruffer .. _ Int031 ' TO PMCRIPr1ON
Well CotnractorNante• • R. .R. _ I
4223 A A. ft. ft, �;
AS
NC�YclfContraclorCcnifinitioaNniclicr OUTER CASING(tormnhl-ristdwcts}'ORLiNER(Irap ticabk)• '
. . . - PROM' TO DIAMETER,. • TmCKNESS• - MATERIAL
SAEDACCO ft. ft. hi:
Conrpwj MomT6.iN.�7ER CASING OR TUBING Isinibcrmral eMscd lonpt. .
PROM • TO- DL'METhR. THICKNESS •MATERIAL
. . 2,Weil Construction Peiutit d: . ... 0 ft .5 ft: 2 6L. SCH-40 PVC '
List(zll apyilkni,1e well pemrf..(i:r.away:SPAT,.rade:ace,Infect ri,err..). .'
• . 3.Well.tlsc(checkil cil tice}.; • Tx'sc'Hti E N
'Water SuppWW Well: PttOM. . TO' •DIAMETER I SLOT SIFE 1 IICKNIi55: I''MATKRtAL •
l7Agticul(tttal . . . CJMunicipaliPtfbiiC 5 • ft. 15 ft. 2 ill, :`010 SCH-40 PVC
CIGeothcfmal(1eating,'CaoliogSupply) CiResidentia(Water Supply(single) rt. rt., in
( lndustiiall/Conmtcrcial ©Residential Water'Suppiy.(shared) - t8cGR0[1T
FROAr TO . . .AL►TERiAL. .. 'I EAIPLACEUENTME -OD
' Olrtieatidn • . • . 0 ft. 1 ' ft. Portland Pour ' ' '
'Non-Water Sutiply:Well: . .
®Monitoring • i7Recorety ' . R. ft.. I
Injection Well:, . . R. tG . . .
• ' clAgaiferR echarge . UGruutidAaicr Rentcdiation- L9.S►NWGIL►VEL•PACK fit upplleahlur , . _ ' - '
'FROM. ' TO ' .. NIATRRRIAL ' •EMPLACEMENTMFCTII0II • _ ' •
PAgnifcrStorlgc and Beeifveiy °Salinity Isom(, • 3 ft..- 15 ft. Sand #2
i7AqufcrTcst. ' .. t]S1vrm`tatci•i?rttno�e it. it.
• AExpcdmcntal Technology 17Sabsidcncc Conft it
-lei DRILLING'LOG(anoch addition-at sheets if accessarvI
- OGeotLennil(ClosedLoop) . 17Tricer. .FROM to DESCRIPTION(obi:hardneti:wn'nr t(Intr:cn+nuie.(tea
• OGeotltennal(Beating/team Relate) Dallier(explain udder.al Rettimhs) , • :ft.• eG-
(L fL
.
4.Date Weil®Completed:'3-20-2024 .Well il)ffMW-3 .�{ • -:
• .tt. PI. • i` ;, 17 ,.
54:Well Ltrcatiou: _ft. See Gem! Notes , O^^^p-p„°�(_,t`V�}('.
•
Duke Energy . ft. fL i, •' Ar i\ O t7 2074
Facility/thus:rNante Facility IDk(if applicable) R. ft. .. . .
i ,.
• 900 Power Station St., Whiteville, NC,. 28472 . . . ft, rt. i ntl..,e•.4.:--,. `• ,,x,°: u:..ri
• .. . DWG/15 OG�
Pity-ical et#g-r cit}•.and Zrp '.It.REMARK'S . •
Columbus Bentonite seal from 1-3', •
County farce]ldentifteatiun No.(PIN}
Sti.►attitiide Wad Longitude in-degreeshninuteStsccontli or dccirnal tiegIvxs: 21'Ccrtiiicadon:
(lfucll(old,otrc L.I/lo g Is strflieicid}
. l� NY �lr�:S RU@r 3/21/2024
. Sigaaturcofcenified Well Coatracior . Date
6.IS.(WO tltetiv ell(s):.xlPeiwanent or fTeurporat7
'By signing this fumy;i hereby certify rhos the nell(s)Kvs(nrieJ Lyn:gnu:1rd brcreconluncr
Will 15A NCAC 02C.0100 or ISA NCAC 02C.0200 Melt Construction Srarkfirrds and OW a
7.is this a repair to an eci%tingmwell; Dies• or Ni,V - rolirofrhIr woof has Oar iirayide4 tar6e:10,ilowirer,
if this'ir o iepalr:fill prat krouii well must merlon brfarrnarion and cipiahr the snare of the '
- repairwolcr021 irmarLsxectian.arim the bawl of this knit. 23.Site tllygram'or additional well details:• .
You may use the back of this page to provide additional well site details or.Well
- 8.Numb erof*ells constructed: 1 . • . . . l Otlsttuctioli details. You may also attach additional pages if necessary.
' • For siwlrl pie lake Ion or non-crater ssspph wells ONLY with the same cansrructiarr,yair ecur .
subniregefona:' - ' SUBMITTALiNSTUCTIONS
•
9.Totalweltdepth below land strtfriec 15 (fr.) 21a. For All Wells: Submit this fann Within 30 days'of completion of(Yell
For rntAtrplc ii ellslisr all depths if difikrtnt(maniple-3@200°and 2@/00) Construction to tltc following: '
10.Static water level below top of casing: . •(ft.) - Division of Water Recut ross,Information Processing Unit,
.Ifuwret level lsebore cumin;:use"+" 1617 Mail Service Ccnter,Ralctg NC 27699=16L7
Il.Borehole diameter:8°25" . •(in.) 21h.Far Weellon Wells ONLY: In addition to sending the form to the address in
24aabot'e.also submit a copy_ of thus'' 'farm within 30 days'of completion.of Well
Auger . . •construction to the follosiin
12.Well oonctitnctlou iRethodcg
(Lc:auger:mealy,cable.direct risk cm., , •
Division of Water Resources,Underground Injection-Control Program,
FOR WATER SUPPLY WILLIS ONLY: -1636 Mail Senicc Cef fair,Raleigh,NC 27699,1636 • '
•l3a idd lie.For Water Supple&Injection Wells:
(gpm) Method of test:_ Also submit one CO3}I of this him(Within 30,days of completion of
-113b.Disinfection type: .Amount: - . well.constmcrion to the county health,department of the.county.where •
- consmtcted. i •
• i
FonnG►V-t 'North Care linaD, rtnremofEnvironmentantiNaturalResources—DivisionofWaterRietram. ResisedAugust:W13