GW1-2022-10598_Well Construction - GW1_20221122

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
I.Well Contractor Information:
BRIAN THOMAS >a.WATER ZONES
k t
Well Contractor Name FROM TO DESCRIPTION
A - 2581 ft. a.
ft. ft.
NC Well Contractor Certification Nwnber 15.OUTER CASING for multi-cased wells OR.LINER if a -licable
GEOLOGIC EXPLORATION FROM TO DIAMETER THICKNESS MATERIAL
ft. ft. 'in.
Company Name
16.INNER CASING OR TUBING. eothermal closed-loop)
2.Well Construction Permit#• FROM TO DIAMETER THICKNESS MATERIAL
l,i.si all opplic•able well consiritcliort permits(i.e.UIC•.Coumv.State,Varimrc•e,etc.) 0.0 ft- 135.0 ft• 6.0 in. SCH 40 PVC
3.Well Use(check well use): ft. ft. in.
Water Supply Well: FROM TODIAMETER I SLOT SIZE I THICKNESS I MATERIAL
❑Agricultural ❑Municipal/Public 135.0 fL 155.0 ft- 6.0 in.
O10 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in;
❑industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑lrrl atlon ❑Wel Is> 100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD B AMOLINT
Non-Water Supply Well: 0.0 ft• 20.0 ft-" AQUA GUARD SLURRY
OMonitoring . ❑Recovery' ft. ft.
Injection Well:
ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK if a ilicable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO I MATERIAL I EMPLACEMENT METHOD
❑Aquifer Test ❑Stonmvater Drainage 25.0 ft- 160.0 ft. 20-46 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary)
❑Geothermal(HeatingJCooling Return) ❑Other(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness,soilhrockty te, rain size,etc.
0.0 ft. 8.0 ft• RED SILTY CLAY
4.Date Well(s)Completed: 11/01/22 Well 1D# EX-76 8.0 ft- 14.0 ft- BROWN SILTY SAND
5a.Well Location: 14.0 ft• 24.0 ft' TAN SILTY SAND
BELEWS CREEK STEAM STATION 24.0 ft• 71.0 ft- PWRIBM _
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Facility/Owner Name - Facility IDk(ifapplicable) 71.0 ft- 160.0 ft- ROCK
3195 PINE HALL ROAD BELEWS CREEK 27009 ft. ft.
Physical Address,City,and Zip ft. ft. N 0 V 2 2
STOKES 21.REMARKS
Ung
Couniy' Parcel Identification No.(PIN) BENTONITE SEAL 20.0-25.0 F
SUMP- 155.0- 156.0 FEET
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(i(well field,one latlong is sufficient) 22:Certification: �
929313.12 N 1682305.3 W !_efts... 11/07/22
6.Is(are)the well(s): MPermanent or ❑Temporary Signature of Certified Well Contractor Date
By signing,thia_/inin,I hereby c•ertJy that the tre//(s)rros(here)constructed in are•ordmut with
7.Is this a repair to an existing well: Oyes or ONO 15.4 NCAC 01C.0100 or ISA NCAC 02C.0100 Well Construction.Sianelards and that a cop}'
ll this is a repair,Jill our known Krell construction information and explain the nature of the oJ7hi.s record has bean provided to the well owner.
repair under s11 rernarks section or on the back uJ'1his Jornh.
23.Site diagram or additional well details:
8.For Geoprobe/DPI'or Closed-Loop Geothermal Wells having the same You may use the back of this page'�to provide additional well construction 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 necessary.
drilled: 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 155.0 (ft.)
I•Ar tnithiple u•e//s list all depths ifdiOirent(esang)le-3@200'and Ica l00') Submit this GW-1 within 30 days of well completion per the following:
10.Static water level below top of casing: 74.7 (ft) 24a. For All Wells: Original forth to Division of Water Resources (DWR),
{/tuner level is above cncing.use Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter: 10.0 (in) 24b. For Injection Wells: Copy to iDWR, Underground Injection Control(IUC)
Program, 1636 MSC,Raleigh,NC 27699-1636
1.e AIR
Well construction method: 24c.For Water Supply and Open-Hoop 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: county
For Water Wells producing oiter 100,000 GPD:Copy to DWR,CCPCUA
Permit Program,1611 MSC,Raleigh;NC 27699-161 I
13a.Yield(gpm) Method of test: i
13b.Disinfection type: Amount: R
!Vr{.
Form GW-I North Carolina Department of Environinental Quality-Division of Water Resources E Revised 6-6-2018
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