GW1-2022-08242_Well Construction - GW1_20220907

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS
14.WATER ZONES I
FROM TO DESCRIPTION
Well Contractor Name ft ft
A - 2581 fr. e.
NC Well Conh'actor Certification Number 15.OUTER CASING for multi-cased wells OR LINER if a lieable
GEOLOGIC EXPLORATION FROM TO DIAMETER THICKNESS MATERIAL
ft. ft. in.
Company Name
16.INNER CASING OR TUBING(geothermal closed-loo
2.Well Construction Permit#: FROM TO DIAMETER I THICKNESS I MATERIAL
l.i.vi all applicable hell cnnviruc•iinn permits(i.e. WC,County.Slate, Variance.etc'.) 0.0 f'• 140.0 ft- 6.0 ''in. SCH 40 PVC
3.Well Use(check well use): fr. ft, in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 140.0"' 160.0 ft- 6.0 in.
.010 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Irrl ation ❑Wells> 100,000 GPD FROM 7'D MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 00 ft- 20.0 ft• AQUA GUARD SLURRY
MMonitoring ❑Recovery
Injection Well: ft. h.
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK if a r rlicable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM I TO MATERIAL I EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage 25.0 ft• 165.0 ft• 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary)
FROM TO DESCRIPTION color,hairiness•soillrock type, rein sim,etr.i
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks)
0.0 f' 8.0 ft• RED SILTY CLAY
4.Date Well(s)Completed: 08/24/22 Well ID# EX-24 80 R• 180 f' BROWN SILTY SAND
5a.Well Location: 18.0 f'' 25.0 fr' TAN SILTY SA ;,t
BELEWS CREEK STEAM STATION 25.0 f' 41.0 f' PWR Q22
Facility/Owner Name Facility IDk(ifapplicable) 41.0 f'• 165.0 ft• ROCK f U)Zt
3195 PINE HALL ROAD BELEWS CREEK 27009 ft.
Physical Address,City,and Zip ft. Jyr'71u
STOKES 21.REMARKS
County Parcel Identification No.(PIN) BENTONITE SEAL- 20.0-25.0 FEET
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
SUMP- 160.0- 161.0 FEET
(if well field.one la(/Iong is sufficient) 22.Certification:
928854.8905 N 1681277.385 W !:2Sn;;_ 0,- -"'- 08/29/22
6.Is(are)the well(s): 29Permanent or ❑Temporary Signature ofCenified Well Contractor Date
By signing this(in-in,l hereby cerigJ,that the❑'ell(s)tros(were)constructed in accordance with
7.Is this a repair to an existing well: 01'es or TINo /iA NCAC 02C.0100 or 15A N(:.4C 02C l0200 Well Consiruc•iian Siandards and than a copy
l%this is a repair,fill nut known ire0 construction in/nrinutirnr and explain the nature of7he of thi.v record has been provided to the u'el/ou-ner.
repair under='21 remarks.section or nit the back ojihis Joan. �.
23.Site diagram or additional well details:
3.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: 160.0
I•or nuhiple tre/lv list all depths it(hIftrent(eranple-3 a 20n'and 2 100') Submit this GW-1 within 30 days of well completion per the following:
10.Static water level below top of casing: 32•0 (ft) 24a• For All Wells: Original form to Division of Water Resources (DWR).
ll�trnter level is nhure caring;,use"-
Information Processing Unit, 1617 MSC i ,Raleigh,NC 27699-1617
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 of the county where installed
FOR 11'A'fER SUPPLY WELLS ONLI': 24d. For Water Wells producing aver 100,000 GPD: Copy to DWR.CCPCUA
13a.field(gpnl) 1lethod of test:
Permit Program, 1611 MSC,Raleigh;NC 27699-16 1 1
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i
13b.Disinfection type: Amount:
I
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018
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