GW1-2022-08245_Well Construction - GW1_20220907

WELL CONSTRUCTION RECORD(GW-1) For internal Use Oniy:
1.Well Contractor Information: 1
BRIAN THOMAS 14.WATER ZONES
Well Contractor Namc FROM TO DESCRIPTION
h. ft.
A - 2581
NC Well Contractor Certification Number IS.OUTER
h. CASINmd b OT L bTT 'for DIAMTwelRHI a livA RfALGEOLOGIC EXPLORATION FROM O
rt.
Company Name
16,INNER CASING OR TUBING eothermtd closed-too
2.Well Construction Permit#: FROM I TO I DIAMETER I THICKNESS I MATERIAL
List nil applicable well construction permits(i.e,UIC,('moor,.titafr.Variance,etc) 0.0 ft. 115.0 rL 6.0 In. SCH 40 PVC
3.Well Use(check well use): R. ft,
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
OAgricultural ❑Municipal/Pubic 115.0 rt' 135.0 fit' 6.0 1O' i010 SCH 40 PVC
OGeothermal(Heating/Cooling Supply) OResidential Water Supply(single) ft. ft. in•
Olndustrial/Commercial DResidentiai Water Supply(shared) 18.GROUT
Olrrigalion ❑Wells>100000GPD FROM TO MATERIAL EMPLACEMENT METHOD A AMOUNr
Non-Water Supply Well: 0,0 f' 20.0 h• AQUA GUARD SLURRY
MMonitoring ❑Recovery h. ft.
Injection Well:
fit. h.
❑Aquifer Recharge OGroundwaier Remediation
f 19.SAND/GRAVEL PACK if a IfeaDle
❑Aquifer Storage and Recovery OSaltnuy Barrier FROM TO I MATERIAL EMPLACE M EKTaIETHOD
OAquifer Test ,r OStormwaler Drainage 25.0 rt• 140.0 rt' 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control fit. fir.
I
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG tattaeh additional sheetsifneceua
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) FROM TO DESCRIPTION color,haWnem miun ick type,Itmin eiu,era.
0.0 rt 8.0 f RED SILTY CLAY
4.Dale Well(s)Completed: 08/24/22 Well IDN EX-20 8.0 r' 18.0 fl BROWN SILTY SAND
SA.Well Location: 18.0 25.0 fL TAN SILTY SAND
BELEWS CREEK STEAM STATION 25.0 rt• 41.0 rt• PWR
Facility/Owner Name Facility ID#(ifapplicable) 41.0 IL 140.0 ROCK + a•'`�"�'
3195 PINE HALL ROAD BELEWS CREEK 27009 D• ft. -__P 0ZQ22
Physical Address.City.and Zip h. ft.
STOKES 2L REMARKS
• Ut
CountyParcel Identification No.(PIN)
BENTONITE SEAL-20.0-25.0 FEET :`•":�;s
Sb.Latitude and longitude indegrees/minutes seconds or decimal degrees:
SUMP-- 135.0- 136.0 FEET
(ifwell field,one IaVlong is sufficient) 22.Certification:
928807.8844 N 1681228.010 , -- O ',- 08/29/22
6.Is(are)the well(s): (Permanent or ❑Temporary Signature orCenifed Well Contractor Daic
HpsijmiuA Ibis fnrnq/!n•reht cart fy dwt the uW1(s),ras(++'ere j cnrtslnrrhd in nccanbtnc c halo
7.Is this a repair to an existing well: ❑Yes or fNo ISA NUAC UA nlno or ISA NCAC 02C.0200 1*//Como rsitun 4-hint.nerd than u c wi
iJdos is it repair.fill our kriinsw hell cansirucrinin information and e.cploin ilnr nowre r I the ifdtii reeord!ins been prnrided to rite it-ell nirner
relernr under 21 rrmorkr.rectian nr on the/rock rJ71nc form.
23.Site diagram or additional well details:
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well construction inlir
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 I
9.Total well depth below land surface; 135. (ft.)
/•ur nudnple welts li.sra//depihs iftlilirent(esmnple-3rt�1 wowl2@1W) Submit this G1V-1 within 30 days of well completion per the following:
39.0 24a. For All Wells: Original form to Division of Water Resources (DWR).
10.Static water level below lap of casing: (ft') Information Processing Unit,1617 MSC,Raleigh,NC 27699.1617
if+rurrr le+•e!is obnrr eaclrtX,,rcr"' i
I,
(I.Borehole diameter: 10.0 (in.) 24b. For Injection Wells: Copy to DWR,Underground Injection Control(IUC)
Program, 1636 MSC,Raleigh,NC 276919-1636
12.Well construction method: AIR 1
Nc.For Water Su I and O en-Loo Geothermal Return 1Vells:Copy to the
(i.e.auger,rotary,cable,direct push,etc.) county environmental healt department o the county where utsta led
FOR WATER SUPPLY WELLS ONLY: 24d.For Water 1Vells rod over' 100 000 GPD:Copy to DWR,CCPCLIA
Permit Program,lbl I M Ra etg ,NC 27699-Ibl I
13a.Yield(gpm) Method of lest:
13b.Disinfection type: Amount:
Foim GN'-I North Carolina Deparnnem of Emironnnental Gualit)•Division of Water Rc�wtees Reciscd 6-6.2018
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