GW1-2022-08894_Well Construction - GW1_20220912

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
I.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
Well Contractor Name FROM TO I DESCRIPTION
ft. fr.
A - 2581
ft. rt.
NC Well Contractor Cenificaiion Number IS,OUTER CASING far multi<wed wdb OR LINER if■ litablc
GEOLOGIC EXPLORATION FROM TO DIAM ETF.Ri THICKNESS MATERIAL
rc. rL tM1
Company Name 16.INNER CASING OR TUBING(geothermal closed-too
2.Well Construction Permit b' FROM TO DIAMETER i. THICKNESS MATERIAL
Lrcr all applicable ucll raastruriOn permiu(i.e.I/If C-nat State.I anma c etc 1 0.0 fi. 140.0 G. 6.0 in. SCH 40 PVC
3.Well Use(check well use): ft. (I. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER I ISLOTSIZE THICKNESS INIATFRIAL
❑Agricultural OMunicipal/Public 140.0 r" 160.0 rt' 6.0 1O' '.010 SCH 40 PVC
OGeothermal(Heating/Cooling Supply) OResidential Water Supply(single) n. tt. in.
❑btdustrial/Commercial ❑Residential Water Supply(shared) 19.GROUT
❑Lrrl ation OWells> 100,000 GPD FROM TO MATERIAL; EMPLACEMENT METHODdr ANIOtINT
Non-Water Supply Well: 0.0 r'• 20.0 r' AQUAGUARD SLURRY
INMonitoring ORecovery ft. ft.
Injection Well:
tt, rt.
DAquiter Recharge ❑Groundwater Remediallon
19.SAND/GRAVEL PACK Ifs linable
DAquil'er Storage and Recovery OSalinity Barrier FROM TO MATERIAL. EMPLACEAfENTMETHOD
❑Aquifer Test DStormaater Drainage 25.0 It- 165.0 ft. 20.40 FINE SILICA SAND
❑Experimental Technology OSubsidence Control ft. A.
OGeothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary)
FROM TO DESCRIPTION color,hardness,toillrac4 rain size.at.
DGcolhermal(Heatin Coolie Retum) DOther(explain under#21 Remarks) 00 h. 8.0 r'' BROWN SILTY SAND
4.Date Well(s)Completed: 08/29/22 Well IDH EX-31 8.0 rL 13.0 ft- TAN SILTY SAND
5a.Well Location: 13.0 r'- 32.0 rt' PWR
BELEWS CREEK STEAM STATION 32.0 ft- 165.0 r' ROCK
FacilitylOwnerName Facility 1001ifapplicable) n. R. -.>E._, --�y, _
3195 PINE HALL ROAD BELEWS CREEK 27009 ft. n. -. 4s
Physical Address,City,and Zip ft. ft. F P r�
STOKES IL REMARKS
BENTONTTE SEAL-20.0-2 05T�rPFtas:^rl ?`z.-.�."a:,
County Parcel Identification No(PIN) � UR,
Sh.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
SUMP- 166.0- 161.0 FEET aC
(dwell field,one ladlong is sufficient) 22.Certification:
928907.2305 N 1681333.431 w '" 09/07/22
6.Is(are)the well(s): (Permanent or ❑Temporary Signature orCcrtified well Contractor Date
hl,.ti�aang this jore,,l kereQycertify-flat the i vll(s)near(were)enni,micted in art orikince irnh
7.Is this a repair to an existing well- DYes or MNo ISA N('A('02(' 0100 ar 13A N('AC WV.0200 Hell(bm7rutvion Standards and thr,f o r„pi
lf7hrs r.r a re/x»r,fill aw ktunnt cell t-Iruciiun a fi,nnat w,and eVhri,t rite nature al the a/ilii.r rerant bar bren prarid d is the is oiruer
repimr trader-2!rentarkr sect;ai nr on the hock al this fbrut,
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 ConSlrllCllOn info
construction,only 1 GW-I is needed. Indicate TOTAL.NUMBER of wells (add:See Over in Remarks Box).You may also attach additional pages if ncccssan
drilled: 24.SUBMITTAL INSTRUCTIONS
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9.Total well depth below land surface: 160. (ft.)
I'm wuhtple,relb lit all depths i/di/ferew(example-3 r00t 2W•and 2@10l1.) Submit this GW-I within 30 days of Kell completion per the following:
28.36 24a. For All Wells: Original form t0 Division of Water Resources (DWR),
10.Static wafer level below top of casing: (ft.) Information Processing Unit, 1617 MSC,Raleigh,NC 27699-1 6 1 7
mien lever a olxwe raring.us' -
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11.Borehole diameter: 1 pn) 24b.For Injection Wells: Copy to DWR, Underground lntection Control 011C)
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,rotor),,cable.direct push,etc) county environmental health department o the county where installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100 000 GPD:Copy to DWR.CCPC UA
13a.Yield(gpm) Method of test:
Permit Program,I I I M.y ,Raleigh,N 7 -16l I
13b.Disinfection type: Amount:
Font GW-I North Carolina Department of Erivironmental Quality-Division or Water Resources ` Revised ii-4•Pit a
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