HomeMy WebLinkAboutGW1-2022-08244_Well Construction - GW1_20220826 i
WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.N'ATERZONES
Well Contractor Name FROM TO DESCRIPTION
fL fr.
A - 2581 fit. fit.
NC Well Contractor Certification Number 15.OUTER CASING far multi-cased wells)OR LINERlicable)
GEOLOGIC EXPLORATION FROM TO DIAMETER THICKNESS MATERIAL,
fir. fir. in.
Company Name
16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit N: FROM TO DIAMETER THICKNESS MATERIAL
i.st all applicahle,cell cmrsa-uciiort pernril.v(i.e.UIC,County,Slole, Variance,etc.) 0.0 ft. 65.0 ft. 6.0 "' I SCH 40 PVC
3.Well Use(check well use): ft. ft. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public ft, fir, in.
65.0 85.0 6.0 .010 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single)
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Irrigation ❑Wells> 100,000 GPD FROM TO MATERIAL EMPLACEM ENT METHOD&AMOUNT
Non-Water Supply Well: 0.0 f` 20.0 f`• AQUA GUARD SLURRY
InMonitoring ❑Recovery fir. ft.
Injection Well:
fit. ft.
❑Aquifer Recharge ❑Ground%vater Remediation
19.SANDlGRAVEL PACK if a t dicable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENTMETHOD
❑Aquifer"rest ` ❑Stormwater Drainage 25.0 f` 90.0 f`' 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control tr. R.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary)
FROM TO DESCRIPTION color,hardness,soill rock tv e,grain size,etc.)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 921 Remarks)
0.0 f`• 18.0 f`• BROWN SILTY SAND
4.Date Well(s)Completed: 08/1 6/22 Well ID# IW-41 18.0 f` 25.0 f`• TAN SILTY SAND
5a.Well Location: 25.0 ft. 26.0 ft' PWR
BELEWS CREEK STEAM STATION 26.0 f`' 90.0 fit• ROCK
Facility/0,vuer Name Facility 04(ifapplicable) ft. ft.
3195 PINE HALL ROAD BELEWS CREEK 27009 rt. ft.
Physical Address,City,and Zip ft.
STOKES 21.REMARKS
County Parcel Identification No.(PIN) BENTONITE SEAL- 20.0-25.0 FEET
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one lat/long is sufficient) 22.Certification:
928871.0155 N 1681142.424 W !�:/:Sn�_ 0r---
08/22/22
6.Is(arc)the w•ell(s): MPermanent or []Temporary Signature ofCenified Well Contractor Date
Hy signing dris:%rot.l herebr c•crtify Ihnt the yell(.,)wna(here)convls uc(ri/i_,ri nc•c•arrJaneei�'i�ly' �^���
7.Is this a repair to an existing well: ❑Yes or MNo 15A NCIC 02C.0100 or l.iA A'CAC 02C.020o We//Cmrrlrnctlnn sal(dr�/s,r)rull/h rn tsop
//'this is a repair.Jill nut knmrn yell construction inforutnlion and e.vploin the nature(?I-the oJ*11is record has been provided to the yell owner.
repair under is 2/remarkv s•eclion or on the back gf tha Jnrm. AI 1(j 2 G 20��
23.Site diagram or additional well details: ll
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well constRIC6011 itl^fo_r� Or,;Y
construction,only I GW-t is needed. Indicate TOTAL NUMBER ofwells (add'See Over'in Remarks Box).You may also attach additir t�Rag6s it lec.-e� szfrj_
�l JLJlJJ'L7
drilled: 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 85.0 (ft.)
For multiple n•e//s hrst all depths/J'd/JJerenl(erautple-3 200'and 2 r@100') Submit this GW-I within 30 days of well completion per the following:
30.0 24a. For All Wells: Original form to Division of Water Resources (DWR),
1'u0.Static water level below top of casing: (ft.) Information Processing Unit, 1617 MSC,Raleigh,NC 27699-1617
/flrarur lcrc/is abate c•usirrn,use"'"
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 WATER SUPPLY WELLS ONLY: 24d. For Water Wells producing over 100,000 GPD: Copy to DWR,CCPCUA
13a.field(gptn) Method of test: Permit Program, 1611 MSC,Raleigh,NC 27699-161 1
13b.Disinfection type: Amount:
Form GW-I North Carolina Department ofEnvitonntental Quality-Division of Water Resources Revised 6-6-2018