GW1-2022-07931_Well Construction - GW1_20220823

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
I.Well Contractor Information: j
BRIAN THOMAS 14.WATER ZONES
FROM TO DESCRIPTION
Well Contractor Name
ft. ft.
A - 2581
NC Well Contractor Certification Number 15.OUTER CASING for rnulti-cased'wells OR LINER if a licable
GEOLOGIC EXPLORATION FROM TO DIAMETER THICKNESS MATERIAL
ft. rt. � in.
C'ompmty Name
16.INNER CASING OR TUBING( e6thermal closed-loot
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS MATERIAL
List till applicable ueN construction permits(Le.(//C.(ounty,State.Variance,el'.) 0.0 ft' 140.0 ft' 6.0 in' SCH 40 PVC
3.Well Use(check well use): ft. R. 1 in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL.
OAgricultural OMunicipal/Public 140.0 ft. 160.0 1" 6.0 in. .010 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) tr. R• in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑lrroauotn ❑Wells> 100.000 GPD FROM 1'0 MATERIAL EMPLACEM ENT METHOD&AMOUNT
Non-Water Supply Well: 0.0 ft• 20.0 ft• AQUA GUARD SLURRY
OMonitoring ORecovery
Injection Well:
ft. fr.
❑Aquifer Recharge ❑Groundwater Remediation
19.SAN DIG RAVEL PACK(if applicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
OAquitcr Test ❑Stormwater Drainage 25.0 ft. 165.0 ft. 20-40 FINE SILICA SAND
❑Expert mental Technology OSubsidence Control ft. ft.
OGeothermal(Closed Loop) 01-racer 20.DRILLING LOG attach additional sheets if necessa •
❑Geothermal(Heating/Cooling Return) OOther(explain under 421 RemarksU FROM TO DESCRIPTION color,hardness,soil/rock type,gmia size,etc.)
0.0 fr 17.0 ft. BROWN SILTY SAND
4.Date Well(s)Completed: 08/08/22 Well ID# EX-59 17.0 ft• 2S.0 ft' TAN SILTY SAND
58.Well Location: 25.0.__ft'_ _40.5
BELEWS CREEK STEAM STATION 40.5 rt• 165.0 ft. ROCK 4 �s 5
Facility/Owner Name Facility ID#(ifapplicable) ft. ft. t
3195 PINE HALL ROAD BELEWS CREEK 27009 ft. ft. ~ J
Phwsical Address.City.and Zip
ft. fr. t?y;C l 't3f C'�w5w 3 Urli4
STOKES 21.REMARKS
County Parcel Identification No.(PIN) BENTONITE SEAL- 20.0-25.0 FEET
SUMP- 1160.0- 161.0 FEET
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if%voil field.one Iat/long is sufficient) 22.Certification:
928370.7122 N 1680778.718 W ow- 08/11/22
6.Is(are)the well(s): OPermanent or OTemporary Signature ofCenified Well Contractor Date
Bt'.ri•Fnin•4!lrl.c Ji,rnt,/herehr e•ertiJj,tha!the use//(sJ u•ac(u'ereJ constructed m acc•nrdonce u'itb
7.Is this a repair to an existing well: ❑1'es or MNo 1 iA NC'A('02C.0100 or IAA NCAU 02C;.0200 Well Can.cnroc'lian.Stnndnrds and that a cups
this is o repair,Jill nut knuu it well construction inliwination and explain the nonin,of the of this record has been prnriclerl to the,cell oirner.
repair wider-2/retnork's section or on this hack of this/in-nr.
23.Site diagram or additional well details:
3.For Geoprobe/DPT or Closed-Loop Geothermal Yells 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.SUBMrr'rAL INSTRUCTIONS
9.Total well depth below land surface: 160.0 (ft)
hin-wwdup/c ire/Is list all depth.,i/'dttlereni(esanip/c-1@,200,and 2 u,/uo') Submit this GW-I within 30 days of well completion per the following:
10.Static water level below to of casino: 57.06 24a. For All Wells: Original form to Division of Water Resources (DWR).
troicr level it a/ cnriw,e.use �" b (ft.) Intonnation Processing Unit,1617 MSC.Raleigh,NC 27699-1617
10.0 24h. For Injection Wells: Copy to IDWR, Underground Injection Control(10C)
I I.Borehole diameter: (in.) Program. 1636 MSC.Raleigh.NC 27699-1636
12.Well construction method: AIR -
24c.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the
(i.e.:wger.ratan-.cable.direct push.etc.) county environmental health department of the county where installed
i
FOR 1YATER SUPPLY WELLS ONLY: 24d. For Water Wells producing over 100,000 GPD:Copy to DWR,CCPCUA
Permit Program, 1611 MSC,Raleigh;NC 27699-161 1
13a.Yield(gpm) Method of test:
i
13b.Disinfection type: Amount:
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018