GW1-2022-08896_Well Construction - GW1_20220912

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only: j
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I.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
FROM TO DESCRIPTION
Well Contractor Name
h. h.
A - 2581
fr. ft.
NC Well Contractor Cenification Number 15.OUTER CASING for multi-cased welts OR LINER Ua livable
GEOLOGIC EXPLORATION FROM TO DIAM1I ErER THICKNESS M1tATERIAI.
Company Name 16,INNER CASING OR TUBING eothermal closed-loop)
2.Well Construction Permit k: FROM I TO DIAMETER!. THICKNESS MATERIAL
List all npplicable well cannsirrrrtian perntils(i.e.(/I('.(bray.State Var+ance.etc.) 0.0 f'' 70.0 ft. 6.0 m. SCH 40 PVC
3.Well Use(check well use): ft. I ft. In.
Water Su It•Well: 17.SCREEN
PP FROM I TO DIAMETER SLOTSIZE THICKNESS MATERIAL
OAericullural OMunicipat'Pubhc 70.0 tt' 90.0 tL 6.0 in. -.010 SCH 40 PVC
❑Geothermal(Healinra/Cooling Supply) OResidennal Water Supply(single) fr. p, in.
Olndustrial/Commercia) ❑Residential Water Supply(shared) 18.GROUT
Oirrigation OWells> 100000 GPD FROM TO MATERIAL EMPLACEMENT RIETHOD&AMOUNT
Non-Water Supply Well: 0.0 f'• 20.0 f• AQUA GUARD SLURRY
dMonitoring ❑Recovery ft. ft.
Injection Well:
h. h.
OAquiter Recharge OGroundwater Remediation
19.SAND/GRAVEL PACK if applicable)
OAqurter Storage and Recovery OSalmity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test OStormurater Drainage 25.0 ft. 95.0 ft. 20-40 FINE SILICA SAND
OFxperimental Technology ❑Subsidence Control ft, ft.
OGeothermal(Closed Loop) OTracer 20.DRILLING LOG adach additionalsheea ifnecesse
OGcothermal(HeatingJCooling Return) OOther(ex lain under#21 Remarks) FROM TO DESCRIPTION(color,timidness.wiVnKk twin rim.etc.
0.0 f' 9.0 f• BROWN SILTY SAND
4.Date Wells)Completed: 09/01/22 Well IDN IW-17 9.0 f'• 15.0 ft. TAN SILTY SAND
Sa.Well Location: 15.0 f'' 39.0 tt' PWR
BELEWS CREEK STEAM STATION 39.0 h 950 f' ROCK
Facility/Owner Name Facility IDM(ifapplicabte) fi. ft. Y
3195 PINE HALL ROAD BELEWS CREEK 27009 A. fL 44F `
Physical Address,City,and Zip ft. ft ( 1 2022
STOKES It.REMARKS Ll�
County Parcel Identification No.(PIN)
BENTONITE SEAL•- 20.0-25.0 FEEIn 3fta:y C-1 Pf c• - mg UnI
J.. '0
5b.Latitude and longitude in degrees/niinutes/seconds or decimal degrees:
(ifwell field,one lat/long is su0'icieni) 22.Certification: �
928895.7726 N 1681399,364 w �2 r-%;'- " 09/07/22
6.Is(are)the well(s): OPermanent or OTemporary Signature ofCenified Well Contractor Date
Hi•slpning ins Jrrrnh,l henby certyj•that the irellf)n-as(uere)cansrrnrtrd in arror(bence irrrlr
7.Is this a repair to an existing well: OYes or MNo /3A N('AC•(1?( 1/1g11 nr/SA N( ll'!11('.!1?n0 11'rll('uns+rtn hoer J7andanlr a+u/dear o ra/n
ly On,is a rrpair•fill vm kronen well rnnvrmwon n Jarmatum and expla o the noire al Me a/this recont has been provided w the well(itrnc•r.
repoir under 21 remarks section ur on the back(f this fiirnr.
23.Site diagram or additional well details:
8.For Geoprobr/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 vvells (add'See Over'in Remarks Box) You may also attach additional pages if necessan
drilled. 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 90.0 (ft.)
l-iirna+ll;�fr yell,lwall depilts JdtJjirem(cran+rde-3Ci21N)'and 204q,10!') Submit this CW-1 within 30 days of well completion per the following:
31.48 24m. For All Wells: Original form (o Division of Water Resources (DWR).
l0.Static eater level below top of casing: (ff•) Intorniatton Processing Unit, 1617 MSC,Raleigh,NC 2 7699-1 61 7
q\rrr.•:•r err.!a nbarr:'e+eutl t+sr" i
11.Borehole diameter: 10.0 (in.) 24b. For Injection Wells:Copy to DWR, Underground Injection Control(IUC)
Program.1636 MSC,Raleigh,NC 2 7699-1 63 6
12.Well construction method: AIR
24c.For Water Su I and O n-Loo Geothermal Return Wells:Copy to the
(i e.auger,rotary,cable,direct push.etc.) county environments heahh epartmenI 0 the county where.InSla ed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells roduein over 100 000 GPD: Copy to DWR.CCPCUA
138.field(gpm) Method of test: Permit Program,1611 MSC,Raleigh,NC 2 7699-161 1
13b.Disinfection type: Amount: r
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Form G W-I Nonh Carolina Department or Environmental Quality-Division of Water Resources I' Revised 6-6.2018
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