GW1-2022-07933_Well Construction - GW1_20220823

• WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES f l
FROM TO DESCRIPTION
Well Contractor Name ft. ft. I,
A - 2581
NC Well Contractor Cenificatiur Number 15.OUTER CASING for mutri-cased.wells)OR LINER if a„livable
GEOLOGIC EXPLORATION FROM TO DIAMETER THICKNESS I MATERIAL
ft. ft. in.
Company Name
16.INNER CASING OR TUBING eothermal closed-loo'
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS MATERIAL
l.i.0 nll npplicahle ur//concnvcrinn permits/i.e. UIC.Counlr.Seale.IOriance,ere.) 0.0 ft. 140.0 ft. 6.0 in. SCH 40 PVC
ft. ft. in.
3.Well Use(check well use): i
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
❑Agricultural OMunicipal/Public 140.0 ft' 160.0 fr. 6.0 in.
_010 SCH 40 PVC
OGeothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) fl ft in.
❑Industrial/Commercial OResidential Water Supply(shared) 18.GROUT
Olrri ation ❑Wel Is> 100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0.0 rt• 20.0 rt• AQUA GUARD SLURRY
(EMonitoring ❑Recovery
Injection Well:
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK if a t livable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENTMETHOD
❑Aquifer Test OStorm%vater Drainage 25.0 rt• 165.0 rt• 20-40:1 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control ft. ft.
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❑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,wilh•ock type. rain siu,etc.)
0.0 rt• 11.0 rt• RED SILTY CLAY
4.Date Well(s)Completed: 08/10/22 Well ID# EX-71 11.0 r' 22.0 rL BROWN SILTY SAND
Sa.Well Location: 22.0 rt. 35.0 rf TAN SILTY SAND
BELEWS CREEK STEAM STATION 35.0 rt• 55.0 rt PWR
Facility/Owner Name Facility ID9(ifapplicable) 55.0 rt• 165.0 ft. ROCK
3195 PINE HALL ROAD BELEWS CREEK 27009
Physical Address.City,and Zip ft. ft.
STOKES 21.REMARKS
County Parcel Identification No.(PIN) BENTONITE SEAL-20.0-25.0 FEET
ib.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
SUMP - 160.0- 161.0 FEET
(if well field.one]at/long is sufficient) 22.Certification:
928739.3563 N 1680875.428 w -
,
•' 9 ;x 11/22
G.Is(are)the w•ell(s): EPermanent or ❑Tcmporar-y
Signature of Certified Well Contractor L_ fate
t
Hv slvnhnc dric forge.l herelty ceMli,thin the ere/44r�it•a.,�i rery1)V tiered in accordance u-nh
7. Is this a repair to an existing well: ❑Yes or ONo /JA N(•A('IVC r/l00 w /5.4 NU AC 02('i0 ip�,)�,}}t;,n tn,„,n Slond,��rd shot a copy
ll Ibis i o repair,fill mn Anoii n n ell construction mfi nuolhm mid e rph,m the nmm'e al the, nl d i,,rc,,rd ha,hewn prg ided w rh a ell mrrrer v
repair under adl rc•nn,r6s,eeriun ur on tlrc hacA'nJ,hes lbrnr. 3C
this 23.Site diagram or additional we�l(tf'ePAi s `
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of' is page to provide additional well construction inft)
construction,only I GW-I is needed. Indicate TOTAL NUMBER ofwells (add'See Over'in Remarks Box).You'mav also attach additional pages if necessary.
drilled: 24.SUBMITTAL INSTRUCTIONS
9."total well depth below land surface: 1 60.0 (ft.)
hi,r untltip/c n ellr list all depths il'ditli ren,/e.rample-J nt200'and 2 a/00') Submit this GYM'-1 within 30 days of well completion per the following:
10.Static water level below top of casing: 54.1 7 (ft) 24a• For All 1Vells: Original firm' to Division of Water Resources (DWR).
Information Processing Unit. 1617 MSG,Raleigh,NC 27699-1617
ira ter k eel rs above ca.cin,Q '.use- i.
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11.Borehole diameter: 10.0 (in) 24b. For Injection Wells: Copy to DWR, Underground Injection Control (IUC)
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.auger,rotary.cable,direct push,etc.) county environmental health department ofthe county where installed
FOR WATER SUPPLY YY'ELLS ONLY: 24d. For Water Wells producing over:100,000 GPD: Copy to DWR CCPCUA
13a.Yield(gpm) Method of test: Permit Program. 1611 MSC.Raleigh,NC 27699-161 1
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13b.Disinfection type: Amount:
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Foam GW-I North Carolina Department of Envirortnental Quality-Division of\Vater Resources Revised 6-6-2018
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