WI0400551_Well Construction Record(s) (GW-1)_20240122

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
A - 2581 rt. rt
NC Well Contractor r-erti fication Number 15.OUTER CASING for multi-cased welh OR LINER if■ 1ltabk
GEOLOGIC EXPLORATION FROM To DIAMETER THICKNESS MATERIAL
ft. fL in.
Company Name
16.INNER CASING OR TUBING eothermal closed-too
2.Well Construction Permit N: FROM TO I DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(Le.UIC,County,Stare. Variance,etc.) 0.0 Q• 80.0 n• 6.0 itl SCH 40 PVC
3.Well Use(check well use): ft. ft- ln.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 80.0 iL 100.0 0' 6.0 In• .010 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft In.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
Olrri ation OWel Is>100000 GPD FROM TO MATERIAL EMPLACEMENTMETHOD&AMOUNT
Non-Water Supply Well: 0.0 IL 20.0 ft. AQUA GUARD SLURRY
MMonitoring ❑Recovery R. %
Injection Well: ft fL
❑Aquifer Recharge OGroundwater Remediation
I%SAND/GRAVELPACK 1fa lieable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENrmETHOD
❑Aquifer Test ❑Stormwater Drainage 25.0 1t• 105.0 R 20-40 FINE SILICA SAND
❑Experimental Technology OSubsidence Control rt. fL
❑Geothermal(Closed Loop) OTracer 20.DRILLING LOG fattitch additional sheets if nectuaa
❑Geothermal(Heating/Cooling Return) ❑Other(ex lain under 421 Remarks) FROM TO DFSCRHMOn color,haraa wiuroct type,Irsin size etc.
0.0 h 8.0 't RED SILTY CLAY
4.Date Well(s)Completed: 07/12/22 'Well][DO IW-1 8.0 TM 21.0 1t BROWN SILTY SAND
5s.Well Location: 21.0 1" 35.0 fL TAN SILTY SAND
BELEWS CREEK STEAM STATION 35.0 ft 540 fL PWR
Facility/Owner Name Facility IDH(if applicable) 54.0 ft• 105.0 fL ROCK
3195 PINE HALL ROAD BELEWS CREEK 27009 1t. fL
Physical Address.Cay,and Lip ft. 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:
(if well field,one Iatilong is sufficient) 22.Certification:
928049.9669 N _ 1681183.996 W �n/_ fir- 07/18/22
6.Is(are)the well(s): "Permanent or ❑Temporary Signature of Certified Well Contractor Date
By signing this form,I hereby cerr fy thar the well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: OYes or Ls1No 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy
If this it a repair,fill out brown well construction information and explain the nature of the of this record has been provided to the well owner.
repair under h21 remarks section or on the back of This 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 info
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
9.Total well depth below land surface: 100•0 (ft.)
ror multiple wells list all depths ifdfffereat(example 3 200'and 2@10i0) Submit this GW-1 within 30 days of well completion per the following:
10.Static water level below top of casing: 36•0 (ft) 24a. For All Wells: Original form to Division of Water Resources (DWR),
fwater level is above casing,use "+^ Information Processing Unit,1617 MSC,Raleigh,NC 2 7699-1 6 1 7
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-Loup Geothermal Return Wails:Copy to the
(i.e auger,rotary,cable,direct push,etc.)
county-environmentalea apartment of the county ere costa
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing aver l00 GPD:Copy to DWR,CCPCUA
13s.Yield(gpm) Method of test:
Permit Program, 11 MSC,Raleigh, 7000 I
13b.Disinfection type: Amount:
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6.2018

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
ft. ft.
A - 2581 ft. ft
NC Well Contractor Cenification Number 15.OUTER CASING for multi cased wells OR LAVER if a licable
GEOLOGIC EXPLORATION FROM TO DIAMETER 1 ESS MA UL
R. D 1n
Company Name 16.INNER CASING OR TUBING eothernud closed-lao
2,Well Construction Permit N: FROM TO DIAMETER I THICKNESS I MATERIAL
List all applicable well consiruction permits 0.e.UIC,County,State,Yarionce,etc.) 0.0 R. 90.0 q. 6.0 in. SCH 40 PVC
3.Well Use(check well use): ft. I (L
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 90.0 ft. 110.0 D' 6.0 10 1 .010 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. t°
❑Industrial/Commercial ❑Residential Water Supply(shared) 19.GROUT
01tr1 tion ❑Wel Is>100000 GPD FROM TO MATERIAL EMPLACEMENTME'fHOD&AMOUNT
Non-Water Supply Well: 0.0 % 20.0 IL AQUA GUARD SLURRY
09Monitoring ❑Recovery ft. Ir.
Injection Well:
ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK Ita livable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL I EMPLACEMENTMET1100
❑Aquifer Test ❑Stormwater Drainage 25.0 ft- 115.0 ft- 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control It. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG rattasch additional sheets If necessa
❑Geothermal(Heating/Cooling Return) ❑Other(explain under N21 Remarks FROM TO DESCRIPTION eobr,hsrdn mwrock rym tritin size,etc.
0.0 B• 17.0 fr- BROWN SILTY SAND
4.Date Well(s)Completed: 07/12/22 Well IDN IW-2 17.0 ft• 25.0 fr- TAN SILTY SAND
5a.Well Location: 25.0 ft' 55.0 ft' PWR
BELEWS CREEK STEAM STATION 55.0 fr• 115.0 fL ROCK
Facility/Owner Name Facility IDk(ifapplicable) A, ft.
3195 PINE HALL ROAD BELEWS CREEK 27009 IL B.
Physical Address,City,and Zip B- B'
STOKES 21.REMARKS
County Parcel Identification No.(P[N) BENTONITE SEAL-20.0-25.0 FEET
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwcll field,one Wilting is sufficient) 22.Certification:
928105.6623 N 1681165.239 W � 0--r-- 07/18/22
6.Is(are)the well(s): MPermanenl or ❑Temporary Signature of Certified Well Contrador Date
Bysigning this farm,l hereby certify that the weli(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or MNo 15A NCAC 02C 0l00 or 15A NCAC 02C.0200 Well Construction Standards and that a copy
if this,r a repair,fid an k,anrn well construction information and explain the nature ofthe ofthis recordhas beenprovided to the well owner.
repair under#21 remarks section or on the back of rhis farm.
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 info
construction,only l GW-1 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: 110.0 (ft.)
I or multiple wells list all depths jdifferent(example-3@200'and 2@100) Submit this GW-1 within 30 days of web completion per the following:
10.Static water level below top of casing: 44.0 (ft) 24a. For All Wells: Original form to Division of Water Resources (DWR),
,f water level is abm a casing use--r, Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
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 Su 1 and O n-Lon Geothermal Return Wells:Copy to the
(i.e.auger,rotary,cable,direct push,etc.)
county envlronmenta ea apartment o e county where installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells roduc'a over 100 000 GPD:Copy to DWR,CCPCUA
13a.Yield(gpm) Method of test: Permit ogntm, I Iv1 ,Ra et 7
999-1611
13b.Disinfection type, Amount:
Form OW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised"-2013

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14,WATER ZONES
Well(.ontsa:tor Name FROM TO DESCREMON
ft. ft.
A - 2581
rt. R.
NC Well G,ntractor Certification Number 15.OUTER CASING for tnulti-cased wells OR LINER 1fa Neabir
GEOLOGIC EXPLORATION PRUM To DIAMETER TH1CgVE89 MATERIAL
ft. it in
Company Name
16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS MATERIAL
Lisi all applicable well construction permits(i.e.f71C,County,State.Variance,etc.) 0.0 ft, 90.0 f6 6.0 IO' SCH 40 PVC
3.Well Use(check well use): ft. ft. In.
Water Supply Well: 17.SCREEN
PROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public Tr ft. In. O10 SCH40 PVC
90.0 110.0 6.0
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) fL ft. in.
Olndustriali'Commercial ❑Residential Water Supply(shared) f8.GROUT
❑Irri ation ❑Wells>100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0.0 it• 20.0 it AQUA GUARD SLURRY
MMonitoring ❑Recovery ft. fa
Injection Well:
ft. fL
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK If■ hirable
[JAquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENTMETHOD
❑Aquifer Test ❑Stormwater Drainage 25.0 ft. 1150 ft, 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sherd if nttema
OGeothermal(Heat in Cool ing Return) OOther(explain under#21 Remarks) FROM TO DESCRDvnON color,h miltrock tyM rain stir etc.
0.0 ft- 13.0 ft, BROWN SILTY SAND
4.Date Well(s)Completed: 06/23/22 Well ID# IW-3 13.0 ft- 25.0 ft, TAN SILTY SAND
5a.Well Location: 25.0 rr' 50.0 ft PWR
BELEWS CREEK STEAM STATION 50.0 ft 115.0 IL ROCK
Facilityl0wner Name Facility[DO(ifapplicable) ft. ft.
3195 PINE HALL ROAD BELEWS CREEK 27009 ft. ft.
Physical Address,City,and Zip ft. fl.
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:
(ifwall field,one laulong is sufficient) 22.Certification,
928175.2816 N 1681142.195 W / 017--
06/27/22
6.Is(are)the well(s): TlPermanent or ❑Temporary Signature ofCertified Well Contractor Date
By signing this form,I hereby certify that the welks.was(were)constructed in accordan.a with
7.Is this a repair to an existing well: OYes Or ENO 15A NCAC 02C 0100 or 15A NCAC 02C.0200 Well Construction Standards and that a mpi
ifthis itt a repair,f;i..ul brown u,ed construction information and explain the nature of the ofihis record has been provided to the well owner
repair under tt2;remarks section.it on the back ofthis form.
23.Site diagram or additional well details:
S.For Geoprobe/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 1 GW-I is needed Ind irate TOTAL NUMBER of we:is (add'See Over'DI Remarks Box).You may also attach additional pages if necessary
drilled: 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 110.0 (ft))
F"r multiple M elis Jul aL depths 0 drr&"m(example-3@200'and 2@100') Submit this GW-1 within 30 days of well completion per the following:
107.0 24a. For All Wells: Original form to Division of Water Resources (DWR)
10,Static water level below top of casing: (170 Information Processing Unit,1617 MSC-Raleigh,NC 27699-1617
jwarer level is a.r ��car,n�,usr " "
11.Borehole diameter: 10•0 (in.) 24b. For Injection Wells:Copy to DWR,Underground Injection Control(IL C)
Program, 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: AIR 24c.For Water Supely and Open-Loop Geothermal Return Wells:Copy to the
(i.e.auger,rotary,cable,direct push,etc.) county environmental healthdepartment ofthe county where col;]
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100 000 GPD:Copy to DWR,CCPCUA
Permit Program,I 1 I a ei ,
13a.Yield(gpm) Method of test:
13b.Disinfection type: Amount:
Form GW-I North Carolina Department of Envuoimentat Quality-Division of Water Resources Rev,sed 6-6-2018

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
Well Contractor No= FROM TO DESCRIPTION
R. ft.
A - 2581
ft. rL
NC Well Contractor Certification Number 15.OUTER CASING for multi-cased wells OR LINER if a Ifcable
GEOLOGIC EXPLORATION FROM To DIAMETER THICKNESS MATERIAL
rr. rL in,
Company Name
16,INNER CASING OR TUBING eothermal closed-loop)
2.Well Construction Permit dd: FROM To DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(.e.UIC,County,Stole,Variance,etc) 0.0 n• 80.0 R 6.0 in. SCH 40 PVC
3.Well Use(check well use): ft. ft. im
17.SCREEN
Water Supply Well: FROM TO DIAMETER SLOTSIZE I THICKNESS J MATERIAL
❑Agricultural ❑Municipal/Public 80.0"' 100.0 ft' 6.0 1"
.010 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) El Residential Water Supply(single) ft ft. in.
❑Ind ustrial/Commercial ❑Residential Water Supply(shared) 18,GROUT
❑Irrl lion ❑Wells> IOOOOOGPD FROM I TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Nan-Water Supply Well: 00 ft• 20.0 ft- AQUA GUARD SLURRY
IJMonitoring ❑Recovery ft. ft.
Injection Well:
❑Aquifer Recharge ❑Groundwater Remediation 19 SAND/GRAVEL PACK if a liable
QAquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL I EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage 25.0 It• 105.0 IL 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control ft, ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 421 Remarks FROM TO DESCRIPTION color,ntrdn soil/rock JyK Irsin site etc.
0.0 It. 8.0 IL RED SILTY CLAY
4.Date Well(s)Completed: 06/21/22 Well IDN I`W-4 8.0 ft- 31.0 It• BROWN SILTY SAND
5a.Well Location: 31.0 ft' 40.0 n' TAN SILTY SAND
BELEWS CREEK STEAM STATION 40.0 ft• 69.5 ft- PWR
Facility/Owner Name Facility]DO(ifapplicable) 69.5 It' 105.0 fL ROCK
3195 PINE HALL ROAD BELEWS CREEK 27009 ft. ft
Physical Address,City,and Zip ft, ft.
STOKES 21.REMARKS
County Parcel Identification No.(PIN) BENTONITE SEAL•- 20.0-25.0 FEET
5b.Latitude and longitude in degrecs/minutes/seconds or decimal degrees:
(ifwell field,one Iatllong is sufficient) 22.Certification:
928244.9008 N 1681162.559 W � � _ 011- 06/27/22
6.Is(are)the well(s): OPermanent or ❑Temporary Signature ofCertified Well Contractor Date
By signing this form,I hereby cert!&that the well(st was(were)constrveted in accordance with
7.Is this a repair to an existing well: ❑Yes or TlNo l5A NCAC 02C.0100 or 15A NCAC 02r 0200 Well Construction Standards and that a copy
lfthis is a repair,fill out known well construction information and explain the nature of the ofthis record has been provided to the well owner
repair under#21 remarks section or on the back of this 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 info
construction,only I GW-I is needed. Indicate TOTAL NUMBER of wells (add'See Ovet in Remarks Box).You may also attach additional pages ifnecessary
drilled: 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 100.0 (ft)
For multiple wells list all depds ifd�ereni(example-3 200'and 2@100) Submit this GW-1 within 30 days of well completion per the following-
For
Static water level below top of casing: 60.0 (ft) 24a. For All Wells: Original form to Division of Water Resources (DWR),
!f water level is above casing,use"+"
Information Processing Unit, 1617 MSC,Raleigh,NC 2 7699-1 6 1 7
11.Borehole diameter: 10•0 (in.) 24b. For Injection Wells:Copy to DWR,Underground Injection Control(IUC)
Program, 1636 MSC,Raleigh,NC 27649-1636
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 environment. eat epairti t o e county ere insta e
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells roducin over]00 Q00 GPD: Copy to DWR,CCPCUA
139.Yield(gpm) Method of test: Permit Program, I] M Ra ei ,N 7 -1611
13b.Disinfection type: Amount:
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6.6.2018

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
Well Contractor Name FROM TO DESC7tUMON
ft. R
A - 2581
ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING for multb "A wells OR LINER if a Ilcable
GEOLOGIC EXPLORATION FROM TO DIAMETER THICKNESS MATERIAL
fr. fr. in.
Company Name 16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit H: FROM TO DIAMETER THICIQVESS MATERIAL
List all applicable well construction permits ri.e. U1C,County,Stale,Variance,etc) 0-0 ft. 95-0 ft- 6.0 ln. SCH 40 PVC
3.Well Use(check well use):
ft. rL to
17.SCREEN
Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL,
❑Agricultural ❑Municipal/Public 95.0 ft' 115.0 R 6.0 1d 010 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) El Residential Water Supply(single) & ft. to
❑Industrial/Commercial ❑Residential Water Supply(shared) I&GROUT
❑Irrl atlon ❑Wells>100000 GPD FROM I TO MATERIAL FM PLACEM ENT M LTHO D&AM OUNF
Non-Water Supply Well: 0.0 fl. 20.0 1L AQUA GUARD SLURRY
IJMonitoring ❑Recovery ft. tt
Injection Well:
ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation
❑A uifer Storage and Recovery ❑Salini Barrier FROM
SANDlCRTO PACK MAif applicable)
q g �' ty FROM TO MATERIAL EMPLACEM ENi MEIIrOn
❑Aquifer Test ❑Stormwater Drainage 25.0 rr. 120.0 r` 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets If necessary)
❑Geothermal(Heat in Cool ing Retum ❑Other ex lain under k21 Remarks) FROM TO DESCRIPTION color,bards soil/mck type,train size etc.
0.0 fr. 8.0 fl. RED SILTY CLAY
4,Date Well(s)Completed: 06/21/22 Well IDfI IW-5 8.0 rt• 22.0 rt BROWN SILTY SAND
5a.Well Location: 22.0 r`. 30.0 fL TAN SILTY SAND
BELEWS CREEK STEAM STATION 30.0 r` 70.0 rr PWR
Facility/Owner Name Facility ID#(ifapplicable) 70.0 n' 120.0 r`. ROCK
3195 PINE HALL ROAD BELEWS CREEK 27009 ft. R•
Physical Address.City,and Zip ft. ft.
STOKES 21.REMARKS
County Parcel Identification No.(PIN) BENTONIfE SEAL-20.0-25.0 FEET
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one ladlong is sufficient) 22.Certification:
928334.8702 N 1681195.250 W f:zf > % ow- 06/27/22
6.Is(are)the well(s): Permanent or ❑Temporary Signature ofCcrtitied Well ContrWor Date
By signing this form,1 hereby certt&that the wells)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or MNo 1SA NCAC 01C.0100 or 1SA NCAC 02C.0100 Well Construction Standards and that a copy
Ifthis is a repair fill out known well construction Information and explain the nature of the of this record has been provided to the well owner.
repair under 21 remarks section or on the back of this form.
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 Ovee in Remarks Box).You may also attach additional pages if necessaq-
drilled 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 110.0 (ft.)
for muWple wells list al,depths lfdifferenl(example-Ja200'and 2@100) Submit this CW-1 within 30 days of well completion per the following:
10.Static water level below top of casing: 54.0 IfL) 24a. For All Wells: Original form to Division of Water Resources (DWR),
,f warer lev,l,s above casing,me"�" Information Processing Unit,1617 MSC,Raleigh,NC 2 7699-1 6 1 7
11.Borehole diameter: 10•0 (in,) 24b. For Injection Wells: Copy to DWR,Underground Injection Control(IUC)
Program, 1636 MSC,Raleigh,NC 27699-1636
l2.Well construction method: AIR 24c.For Water Su ! and O n-Lao Geotherme[Return Wells:Copy to the
(i.e.auger,rotary,cable,direct push,etc.) county environments ea epartment 0 e county where installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells roducin over]00 000 GPD:Copy to DWR,CCPCUA
Permit Program,t 1 l M Ra er 7 -I ]1
13s.Yield(gpm) Method of test:
13b.Disinfection type: Amount:
Form G W-1 North Carolina Department of Enviroitmental Quality-Division of Water Resources Revised 6-6-2018

WELL CONSTRUCTION RECORD(GW-I) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
Well Contractor Name FROM TO DESCRIMON
ft. ft:
A - 2581
ff. rL
NC Well Contractor Certification Number 15.OUTER CASING for multi-cased wells OR LINER ifa ]Icable
GEOLOGIC EXPLORATION FROM To DIAMETER THICIQV ESS MATERIAL
ft. fL in
Company Name
16.INNER CASING OR TUBING eathermai closed-lou
2.Well Construction Permit FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.UIC,Counry,State,Variance,etc.) 0.0 ft• 80.0 n• 6.0 in. SCH 40 PVC
3.Well Use(check well use): n• n• im
Water Supply Well: 17,SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑MunicipaVPublic 8001L 100.0 It' 6.0 l°' .010 SCH40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft ft. 1>ti
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Irrl atiOn ❑We11s> IOOOOO GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0.0 fL 20.0 fL AQUA GUARD SLURRY
19Monitoring ❑Recovery ft. M
Injection Well: ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK ifa licable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL I EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage 25.0 n• 105.0 fL 20-40 J FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control ft. ft
OGeothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if neceasa
©Geothermal(Heating/Cooling Return) ❑Other(explain under 421 Remarks FROM TO DESCRIPTION color,hardness,wivrock type,itmin sire etc.
0.0 ft 11.0 IL BROWN SILTY SAND
4.Date Well(s)Completed: 06/20/22 Well IDN AA/-6 11.0 ft 25.0 ft TAN SILTY SAND
Sa.Well Location: 25.0 ff 55.0 ft. PWR
BELEWS CREEK STEAM STATION 55.0 ° 105.0 h- ROCK
Facility/Owner Name Facility[DO(ifapplicable) ft. ft.
3195 PINE HALL ROAD BELEWS CREEK 27009 ft. ft.
Physical Address,City,and Zip
ft. 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:
(ifwcll field,one lat/long is sufficient) 22.Certification:
928407.1671 N 1681237.587 W �/_ 017- 06/27/22
6.Is(are)the well(s): (EPermanent or ❑Temporary Signature ofCcrtified Well Contractor Dale
By signing this form,l hereby terrify that the well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or MNo 15A NCAC 02C.0100 or 15A NCAC 02C 0200 Well Construction Standards and that a copy
if this is a repair,fill our known well constructlon information and explain the nature of the of this record hat been provided to the welt owner
repair under 021 remarks section or on the back of this 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 additions) well construction Info
construction,only I GW-t 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: 100.0 (ft.)For multiple wells list all depths ifdifferem(example-3@200'and 2@I001 Submit this GW-I within 30 days of well completion per the Following:
89•Q 24a. For All Wells: Original form to Division of Water Resources (DWR),
f Stalk water level below top of casing: (ft.) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
dJwarer level is above casing,use"�"
11.Borehole digmeler: 10.0 (in) 24b. For Injection Wells: Copy to DWR,Underground injection Control(IUC)
Program,1636 MSC,Raleigh,NC 27699-1636
l2.Well construction method: AIR 24c.For Water Supply and Open-Loop Geothermal Return We[Is:Copy to the
direct
(i.e.auger,rotary,cable,dirt push,etc.) county environments ea department o e county ere insta e
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells roducin over 100 000 GPD:Copy to DWR,CCPCUA
Permit Program, 111 M Ra el ,N27699l I l
13s.Yield(gpm) Method of test:
13b.Disinfection type: Amount:
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6.2018

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14,WATER ZONES
Well Contractor Name FROM ft. TO
m TO DESCRT[ON
A - 2581
n. R.
NC Well Contractor Certification Number 15.OUTER CASING for mu[tl cued welb OR LINER ira Ilcable
GEOLOGIC EXPLORATION PROM TO DIAMETER r7tIC10VEss MATERIAL
R. fit in.
Company Name
16.INNER CASING OR TUBING oWltermal closed-loop)
2.Well Construction Permit#: PROM TO DIAMETER THICKNESS I MATERIAL
List all applicable well construction permits(i.e.U1C,County,State,Variance,etc) 0.0 ft. 80.0 fit- 6.0 In. SCH 40 PVC
3.Well Use(check well use): n. fL in.
17.SCREEN
Water Supply Well: FROM TO DIAMETER I SLOTSIZe THICKNESS I MATERIAL
❑Agricultural ❑Municipal/Public 80.0 R• 100.0 ft' 6.0 Ir` 010 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) rt- tc. in
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑lirl atlon ❑Wells>100000 GPD FROM TO MATERIAL EMPLACEMENT METHOD 6 AMOUNT
Non-Water Supply Well: 0.0 ft. 20.0 fit AQUA GUARD SLURRY
®Monitoring ❑Recovery ft. n-
Injection Well:
n
❑Aquiter Recharge ❑Groundwater Remediation
19.SANDlGRAVEL PACK if a Ilcable
El Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL I EMPI ACPJNENTMETHOD
[]Aquifer Test ❑$tormwater Drainage 25.0 fit• 105.0 fit 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control rL R
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG tattakch addttioaal sheet:if necessa
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) PROM TO DPSCRIVT70N color,hardnemsoillrock tyM trainxbae etc.
0.0 fit• 16.0 fL BROWN SILTY SAND
4.Date Well(s)Completed: 06/29/22 Well ID# IW-7 16.0 n 27.0 fL TAN SILTY SAND
So.Well Location: 27.0 t1, 55.0 fL PWR
BELEWS CREEK STEAM STATION 55.0 ft- 105.0 IL ROCK
FacilitylOwnerName Facility lD#(ifnpplicable) R. ft.
3195 PINE HALL ROAD BELEWS CREEK 27009 n• ft.
Physical Address,City,and Zip
rt. R.
STOKES 21.REMARKS
County Parcel Identification No.(PIN) BENTONITE SEAL 20.0-25.0 FEET
5b.Latitude and longitude in degrces/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22.Certification:
928339.6901 N 1680854.412 W - ''`^ 07/06/22
6.Is(are)the well(s): MPermanent or ❑Temporary Signature ofCcrtificd Well Contractor Date
fly signing this form,1 hereby terrify that the well(s)was(were)constructed to accordance with
7,Is this a repair to an existing well: ❑Yes or 19No !SA NCAC 02C.0100 or!SA NCAC 02C.0200 Well Construefron Standards and that a can"
1f this is a repair,fill out known well construction informatitm am,d rs;-,'ain the naturr of the c fthis record has been provided to the well owner.
repair under e21 remarks section or on the back ofthis 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 info
construction,only I GW-1 is needed. Indicate TOTAL NI IMBER of wells (add See Over'in Remarks Box).You may also attach additional pages if necessay
drilled: 24,SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 100.0 (fit
For nruitiple a ells list alp depdrr ifdierern(example-3 a 00'and 2Q(007 ) Submit this GW-1 within 30 days of well completion per the following:
10.Static water level below top of casing: 32.0 {ft.) 24a. For All Wells: Onginal form to Division of Water Resources (DWR),
1,water level is abore casing,use"+„ Information Processing Unit,1617 MSC,Raleigh,NC 27699-1 6 1 7
11.Borehole diameter:
10.0 (in.) 24b.For Infection Wells:Copy to DWR,Underground Injection Control(IUC)
-
AIR Program, 1636 MSC,Raleigh,NC 27699-1636
i.e Well construction method: 24c.For Water Su I and O n-Loo Geothermal Return Wells:Copy to the
(i.e.auger,rotary,cable,direct push etc.)
county envtronmenta eat apartment o e cotmty ere tnsla e
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over l00 000 GPD:Copy to DWR,CCPCUA
13a.Yield(gpm) Method of test:
Permit Program, I ,Raleigh, 7 •l 11
13b.Disinfection type: Amount:
Form GW-1 North Carolina Department of Environmental Quality-Division o r Wwcr Resources Revised 66-2018

WELL CONSTRUCTION RECORD GW-1 For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14,WATER ZONES
Well Contractor Name FROM TO DESCREMON
A - 2581
R. fL
NC Well Contractor Certification Number 15.OUTER CASING for multi cased wells OR LDVER If a licable
GEOLOGIC EXPLORATION FROM TO DIAM= THICKNI55 MATERIAL
R. fL in.
Company Name
16.INNER CASING OR TUBING eothermal closed-too
2,Well Construction Permit N: FROM TO I DIAMETER I THICKNESS I MATERIAL
List all applicable well construction permits(i.e. FfIC,County,State.Variance,eic) 0.0 rt. 90.0 fL 6.0 i° SCH 40 PVC
3.Well Use(check well use): R. ft. is
Water Supply Well: 17.SCREENFROM TO DIAMETER SL.OTSIZE THICKNESS MATERIAL
❑Agricultural GMunicipaliPublic 90 0 fL 110.0 R. 6.0 I°- .010 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) fL ft is
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Ifrl atlon ❑Wells> 100000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-water Supply Well: 0.0 R- 20.0 R- AQUA GUARD SLURRY
EMonitoring ❑Recovery R. R.
Injection Well:
ft. fL
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK ira lkable
❑Aquifer Storage and Recovery ❑Salinity Burner FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage 25.0 R• 115.0 fL 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control R. fL
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necema
❑Geothermal Heal inglCoolin Return []Other(explain under N21 Remarks mom TO DESCRIPTION color,hardn sowroc4 IyM train gize,etc.
0.0 n 8.0 It. BROWN SILTY SAND
4.Date Well(s)Completed: 07/08/22 Well IDN IW-8 8.0 15.0 fL TAN SILTY SAND
5a.Well Location: 15.0 ft. 57.0 iL PWR
BELEWS CREEK STEAM STATION 57.0 ft 115.0 fL ROCK
Facility/Owner Name Facility[DR(ifaWlicable) R. ft.
3195 PINE HALL ROAD BELEWS CREEK 27009 fr. fL
Physical Address,City,and Zip
n. R.
STOKES 21.REMARKS
County Parse!ldenlificatian Na.(PIN)
BENTONITE SEAL--20.0-25.0 FEET
Sb.Latitude and longitude in degrtts/minutes/seconds or decimal degrees:
(ifwell field,one lat/long is sufficient) 22.Certification: � �
928409.3093 N 1680938.550 W / _ 011- 07/18/22
6.Is(are)the well(s): OPermatient or ❑Temporary Signature ofCerti&ed Well Contractor Date
By signing this farm,1 hereby certify thal the well(s)was(were)construciod in accordance wuh
7.Is this a repair to an existing well: ❑Yes or ONo 1SA NCAC 02C.0100 or 15A NCAC 02C 0200 Well Construction Standards and that a copy
If flits is a repair,fill ow known well construction information andexplain the nature ofthe ofthis record has been provided to the well owner.
repair under=21 remarks section or on the back ofthis 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.nfo
construction,only I GW-I is needed. Indicate TOTAL NUMBER of wells (add'See Ovee in Remarks Box).You may also attach additional pages ifnecessary
drilled- 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 110.0 (fL)
For mulriple wells list all depths ifdifferent(example-J(200'and 2Q100� Submit this GW-1 within 30 days of well completion per the following:
91.5 ) 24a. For All Wells: Original form to Division of Water Resources (DWR1
f Static water level below top of casing: (ft. Information Processin Unit,1617 MSC,Uci NC 27699-1 6 1 7
lfwater Jere!is above coxing,use"+" g ��
11.Borehole diameter: 10•0 (in) 24b. For Injection Wells: Copy to DWR,Underground In,ection Control(11;C)
Program,1636 MSC,Raleigh,NC 27699-1636
12.
(i.c.e.auger,rotary,cable,direct push,etc.)Will construction method: AIR 24c,For Water Su 1 and O n-Lon Geothermal Return Wells:Copy to the
county environments health department ofthe county where installU
FOR WATER SUPPLY WELLS ONLY: 24d. For Water Wells roducin over]00 000 GPD: Copy to DWR,CCPCUA
13a.Yield(gpm) Method of test: Permit Program, Ra ei i 11
13b.Disinfection type: Amount:
Form OW-I North Carolina Department of Environrnental Quality-Division of Water Resources Revised t.-�,20l8

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
ft. ft.
A - 2581
ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING for rou]N-Cared wells)OR LINER if a Iltable
GEOLOGIC EXPLORATION FROM To DIAMETER THIC[Q�lFSS MATERIAL
rr. rr. 1a
Company Name
16.INNER CASING OR TUBING eorherma[closed-too
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS I MATERIAL
List all applicable well conrtrreclion pernNts(i.e. U1C.County,State,Variance,etc.) 0.0 fr. 95.0 fr• 6.0 In. SCH 40 PVC
3.Well Use(check well use): ft. ft, in.
17.SCREEN
Water Supply Well:
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
DAgricultllral OMunicipaUPublic 95.0 fr• 115.0 fr' 6.0 In 010 SCH 40 PVC
OGeothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. In
❑IndustriaUCommercial ❑Residential Water Supply(shared) 18.GROUT
❑Irri ation ❑Wel Is> 100000 GPD FROM TO MATERIAL EMPLACEAirNr METHOD&AMOUYr
Non-Water Supply Well: 0.0 TM 20.0 f1- AQUA GUARD SLURRY
©Monitoring ❑Recovery fr. ft.
injection Well:
ff. fr.
❑Aquifer Recharge DGroundwater Remediation
19.SAND/GRAVEL PACK If a Ilcable
❑Aquifer Storage and Recovery DSalinity Barrier FROM TO MATERIAL EMPLACEMENTMETHOD
DAquifer Test OStormwater Drainage 25.0 ft- 120.0 fr' 20-40 FINE SILICA SAND
❑Experimental Technology OSubsidence Control ft. ft
❑Geothermal(Closed Loop) 01'mcer 20.DRILLING LOG attach additional sheets If nccessa
❑Geothermal(Ileatin Coolin Return) ❑Other(explain under 421 Remarks) FROM TO DESCRIPTION ealor,bardnesig,mivruek type,grain sizt etc.
0.0 fr. 8.0 rL RED SILTY CLAY
4.Dale Well(s)Completed: 06/1 7/22 Well iD# IW-9 8.0 rr. 25.0 rL BROWN SILTY SAND
5a.Well Location: 25.0 D' 71.0 rl' PWR
BELEWS CREEK STEAM STATION 71.0 "' 120.0 "' ROCK
Facility/Owner Name Facility iDd(if¢pplicable)
ft. ft.
3195 PINE HALL ROAD BELEWS CREEK 27009 °• ft.
Physical Address,City,and Zip fr. fit.
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:
928497.6721 N 1681034.477 W �%- Gut- 06/24/22
6.Is(are)the well(s): OPermanent or OTemporary Signature ofCemfied Well Contractor Date
By signing this form,1 hereby terrify that the well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or MN0 JSA NC4C 01C.0100 or 1SA NCAC 01C.0100 Well Construction Standards and that a copy
If this is a repair fill our known well construction information and explain the nature of the of this record has been provided go the well owner.
r,pair under 021 remarks section or on the back of this farms
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 Info
construction,only 1 GW-I is needed Indicate TOTAL NUMBER of wells (add'See Ovee In Remarks Box).You may also attach additional pages if necessary
drilled: 24,SUBMITTAI.INSTRUCTIONS
9.Total well depth below land surface: 115.0 (ft.)
For multiple wells list all depths ifdiorent(exumple-3 a 00'and 1©100') Submit this GW-1 within 30 days of well completion per the following:
62.0 24a. For All Wells: Original form to Division of Water Resources (DWR),
10.Static water level below top of casing: (ft.) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
lfunrer level is ab.,ve rasing,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 Su I and O en-Loa Geothermal Return Wells:Copy to the
(i.e.auger,rotary,cable,direct push,etc) county envtronmenta hea th department of the county where Insta e
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over I00
13a.yield(gpm) Method of tell: 000 GPD:Copy to DWR,CCPCUA
Permit Program, 1611 MSC,Raleigh,NC 276 9-1 l l
13b.Disinfection type: Amount:
Form GNr-1 North Carolina Department of Environmenrnl Quality-Division of Water Resources Revised 6.6-2018

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
A - 2581 rL rL
NC Well Contractor Certification Number 15.OUTER CASING for multi-cased wells OR LINER €f ap Iicable
GEOLOGIC EXPLORATION FROM To DUMETER THICKN FSS M TERIAL
ft. fL in.
Company Name
16.INNER CASING OR TUBINGfiteothernialclosed-looDI
2.Well Construction Permit H: FROM TO DIAMETER TMICKNESS MATERIAL
List all applicable well construction permhs Ox.UIC,County,Slate, Variance.etc) 0.0 ft. 95.0 (L 6.0 in. SCH 40 PVC
3.Well Use(check well use): ft. f6 in.
Water Supply Well: 17.SCREEN
FROM To DIAMETER SLOTSIZE THICK NESS MATERIAL
❑Agricultural ❑Municipal/Public 95.0 f`' 115.0 f`' 6.0 7°' 030 SCH40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) fL ft in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Irrl alien ❑Wells> 100000GPD FROM TO MATERIAL EMPLACEMENrMETHOD&AMOUNT
Non-Water Supply Well: 0.0 ft• 20.0 f`• AQUA GUARD SLURRY
OMonitoring ❑Recovery ft. ft.
Injection Well:
ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation 19.
❑A uifer Storage and Recovery ❑Salinit Barrier FROM DlCRAVEL PACK MA 1€cable
q g ry Y FROM TO MATERIAL Eh1PUCEMENT METHOD
❑Aquifer Test OStormwater Drainage 25.0 ft• 120.0 f`' 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets If necessa
❑Geothermal(Il tin Coolin Return) ❑Other(explain under#21 Remarks) FROM TO DESCRIPTION color,hardn solurock rain size arc.
0.0 It. 8.0 fL RED SILTY CLAY
4.Date Well(s)Completed: 06/1 6/22 Well ID4 IW-1 0 8.0 ft. 24.0 ft. BROWN SILTY SAND
5a.Well Location: 24.0 f`' 45.0 fL TAN SILTY SAND
BELEWS CREEK STEAM STATION 45.0 ft' 63.0 f" PWR
Facility/Owner Name Facility[DR(ifapplicable) 63.0 fL 120.0 (`' ROCK
3195 PINE HALL ROAD BELEWS CREEK 27009 f`. f`•
Physical Address,C'in,and Zip ft, ft.
STOKES 21.REMARKS
County Parcel IdcnnficnttonNu IPIN)
BENTONITE SEAL- 20.0-25.0 FEET
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(.(well field,one lat/long n;efficient) 22,Certification:
928563.0071 N 1681095.571 W � - 0-y - 06/24/22
6.Blare)the well(s): M Permanent or ❑Temporary Signalure of Certified Well Contractor Date
By signing this form,1 hereby terrify that the well(s)was(were)constructed in accordance reilh
7.Is this R repair to an existing well: ❑Yes or ONo 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Srondardr and that a copy
If rhi,is a repair,fit!out lu-,well const�aeon information and explain the nature of the oflhis record has been provided io the well owner.
rr pw r u,,der#21 remarks-uon or on lhr to ck of thts 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 info
construction,only I GW-I is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach additional pages Ifnecessary
drilled 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 115.0 (ft)
r or n,ujaple wells!,stall depdts ifdijJerenr(example•3 a200'and 2@100) Submit this GW-1 within 30 days of well completion per the following:
56.0 24a, For All Wells: Original form to Division of Water Resources (DWR),
feareerr level Static 10. v e!!s ole��a casing.use water level below top of casing: (ft.) Information Processing Unit,1617 MSC,Raleigh,NC 2 7699-1 6 1 7
,
11.Borehole diameter: 10.0 (in,) 24b. For Iniection 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 apartment o e county ere costa e
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wdls roductn over 100 000 CPD:Copy to DWR,CCPCr.IA
Penmtt Program,1 11 M ,Ra et ,N 27699-I 11
13a.Yield(gpm) Method of test:
13b.Disinfection type: Amount:
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1,Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
A - 2581 ft. ft-
h. ft.
NC Well Contractor Certification Number IS.OUTER CASING for mu1H-cased wells OR LINER i[a Ilcable
GEOLOGIC EXPLORATION FROM To DIAMETER THICIQVEl MATERUL
- h. fL its
Company Name
16.INNER CASING OR TUBING fueotherimat closed-loon)
2.Well Construction Permit N: FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.UIC,County,Stare,Variance,etc.) 0.0 ft. 90.0 ft. 6.0 In. SCH 40 PVC
3.Well Use(check well use): h. I ft. is
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
❑Agricultural ❑MunicipaUPublic 90.0 f4 110.0 fr• 6.0 Its- .010 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) fL I h. Ia
0 Ind ustrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Irrl atlon ❑Wel Is> 100000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0.0 h• 20.0 f0 AQUA GUARD SLURRY
[EMonitoring ❑Recovery
Injection Well;
fr. h.
❑Aquifer Recharge ❑Groundwater Remediation
19.SANDIGRAVF,L PACK if a licable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO I MATERIAL I EMPLACEMEtfI'METHOD
❑Aquifer Test ❑Stormwater Drainage 25.0 h, 110.0 ft- 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control ft. f
❑Geothermal(Closed Loop) OTracer 20.DRILLING LOG attach additional aheeb if necessary)
OGeothermal(Hewing/Cooling Return) ❑Other(explain tinder#21 Remarks) FROM TO DESCRIPTION color,hardness,soilf o r•aia err.
0.0 h• 7.0 ft- RED SILTY CLAY
4.Dare Well(s)Completed: 06/01/22 Well ID# IW-11 7.0 ft- 19.0 fl- BROWN SILTY SAND
5a.Well Location: 19.0 ft. 29.0 h' TAN SILTY SAND
BELEWS CREEK STEAM STATION 29.0 1` 41.0 ft, PWR
Facility/Owner Name Facility IDk(if applicable) 41.0 f- 110.0 fL ROCK
3195 PINE HALL ROAD BELEWS CREEK 27009 ft. fL
Physical Addle;;,City,and Zip ft. fL
STOKES 21.REMARKS
Courty Parcel Identification No(PIN) BENTONITE SEAL•-20.0-25.0 FEET
5b.Latitude and longitude in degrees/minutWseconds or decimal degrees:
ifwe.l field,one iw.Ion?is sufTic eni) 22.Certification: � �
928622.9867 N 1681199.537 W ��1•_ Gly- 06/09/22
6.Is(are)the well(s): MPermanent or ❑Temporary Signature ofCcnified Well Contractor Date
By signing this form,thereby cerrlfy that the well(s)was(were)constructed in accordance wide
7.Is this a repair to an existing well: ❑Yes or MNo 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy
if this�s a repair,fill out known well construction information and explain the nature of the of this record hat been provided io the well owner.
repair under 21 remarks section or on the back of this 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 info
construction,only l GW-1 is needed. Indicate TOTAL NUMBER of wells (add See Ovet in Remarks Box).You may also attach additional pages if necessary
drilled. 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 110.0 (ft.)
i•'or nutitiple)Wls nsl all J.pths ifdierent(exaniple-3,1200 and 2Q100) Submit this GW-1 within 30 days of well completion per the following:
10.Static water level below top of casing: 91.5 {ft.) 24a. For All Wells: Original form to Division of Water Resources (DWR),
jirar-r level�s ahoi*casing,use "+" information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
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 Su i and O en to Geothermal Relurn Wells:Copy to the
(i e.auger,rotary,cable,duect push,etc.)
county environmenla eat epartment o e county ere costa e
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100 000 GPD:Copy to DWR,CCPCUA
Permit
13s.Yield(gpm) Method of test: Program, 1611 MSC,Raleigh,N 7 1 11
13b.Disinfection type: Amount:
Form GW-I North Carolina Departmeni of Environmental Quality-Division of WBICT Resources Revised 6-6-2018

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTIONft. rL
A - 2581
ft. rr.
NC Well Contractor Certification Number IS.OUTER CASING for multi cased welb OR LINER if a llcabie
GEOLOGIC EXPLORATION FROM To DIAM LTER TxICKNF$S MATERIAL
ft. ft. is
Company Name
16.INNER CASING OR TUBING eothermal closed-loan)
2.Well Construction Permit N: FROM TO DIAMETER THICKNESS MATERIAL
List all applicable we//construction permits(i e. UIC,County,Stale, Variance etc.) 0,0 ft• 90.0 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 90.0 rt 1110.0
ft. 6.0 in. .010 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) fr. ft. In.
Olndustrial/Commercial ❑Residential Water Supply(shared) lg,GROUT
Dirrl ation ❑Wells> 100,000 GPD FROM TO MATERIAL EMPLACEMEPrr METHOD&AMOUrvT
Non-Water Supply Well: 0.0 tr. 20.0 ft, AQUA GUARD SLURRY
MMonitoring []Recovery rt. rt
Injection Well:
ft. ft.
DAquifer Recharge ❑Groundwater Remedianon
19.SAND/GRAVEL PACK if a Ilcable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL I FMPIACEMENTMETHOD
❑Aquifer Test ❑Stormwater Drainage 25.0 rL 110.0 ft. 20-40 FINE SILICA SAND
❑Experimental Technology OSubsidence Control ft. ft.
Li Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additani l sheets Ifnecessa
tyM
r•ala etc.
nGeothermal(Heatine'Coolin Return) TO DESMPnONcolor hRrdn wi0toek) DOther(ex lain under#21Remarks) 00 R• 5.0 ft. RED SILTY CLAY
4.Date Well(s)Completed: 06/03/22 Well IDN IW-12 S.0 ft, 18.0 ft- BROWN SILTY SAND
Sa.Well Location: 18.0 ft. 31.0 ft, TAN SILTY SAND
BELEWS CREEK STEAM STATION 310 ft• 43.0 ft. PWR
i-acility/Owner Name Facility IDN(ifapplicable) 430 ft. 110.0 ft. ROCK
319S PINE HALL ROAD BELEWS CREEK 27009 R. ft.
Physical:\ddress,City,and Zip ft. 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 f.rtd,one lat long is sufficient) 22.Certification:
928693.8768 N 1681258.956 W �ZESn.;-_ 0k
06/09/22
6.Is(are)the well(s): IMPermanent or ❑Temporary Signature of Certified Well Contractor Date
By signing this form,1 hereby certify that the wetl(s)was(were)comtrucled in accordance with
7.Is this a repair to an existing well: OYes or MNo 154 NCAC 01C.0100 or 15A NCAC 01C.0200 Well Construction Standards and that a copy
Ifthis is a repair,fill out known well construction infornunion and explain the nature ofthe oftha record has been provided to the well owner.
repair under 411 reniarkr.section or on the back ofthis 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 info
construction,only I GW-I is needed. Indicate TOTAL NUMBER of wells (add'Sce Over in Remarks Box).You may also attach additional pages ifnecessary
drilled' 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 110.0 (ft
Submit this GW-1 within 30 days ofwell coin r the following:
1•bruurltiplew,llr!Est:rlldeptiuifdi;(ferenl(example-3i�_5_00'antlli_ii100) y completion per g'
10.Static water level below top orcasing: 53.5 (fL) 24a. For All Wells: Original form to Division of Water Resources (DWR),
,fwawr level isab-'e caring,use"+ Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
10.0 24b. For Injection Wells:Copy to DWR,Underground Injection Control(IUC)
I1.Borehole diameter: (in.) Program, 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: AIR
24c.For Water Su I and O n-Lao Geothermal Return Wells:Copy to the
(i.e.auger,rolary,cable,direct push,cic.)
county environmental eat apartment o e county ere installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over]00 000 GPD:Copy to DWR CCPCUA
13a.Yield(gpm) Method of test: Permit Program, 1611 MSC,Raleigh,N 7 -1 1
13b.Disinfection type: Amount:
Form GW-1 North Carolina Department of Environmental Quality-Division of Wafer Resources Revised 6-6-2018

WELL CONSTRUCTION RECORD(GW-11 For Internal Use Only:
I.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTIONft. f6
A - 2581
ft. fL
NC Well Contractor Certification Number 15.OUTER CASING for multi-cased wens OR LINER if a Ile&ble
GEOLOGIC EXPLORATION 7��ftt!
DIAMETER TH CKN ESS MATERIAL
rL la
Company Name
16.INNER CASING OR TUBING fizecithermal closed-loo
2.Well Construction Permit N: FROM TO DIAMETER THICKNESSI MATERIAL
I.tsi all applicable well construction permits(r.e.UlC,County,State, Variance,etc) 0.0 ft. 120.0 ft. 6.0 ln. SCH 40 PVC
3.Well Use(check well use): ft. ft. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLYr SIZE THICKNESS MATERIAL
DAgricultural ❑MunicipallPublic 120.0 fL 140.0 f' 6.0 ia- .010 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) OResidential Water Supply(single) M R la
Olndustrial/Commercial DResidential Water Supply(shared) 18.GROUT
Diffi ation ❑Wells> 100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0.0 ft• 30.0 ft- AQUA GUARD SLURRY
OMonitoring DRecovery ft. ft.
Injection Well:
ft. ft.
❑Aquifer Recharge CGroundwater Remediation
I9,SAND/GRAVEL PACK if a livable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL I EMPLACEMENTMETHOD
❑Aquifer Test ❑Stormwater Drainage 35.0 ft• 140.0 fL 20-40 FINE SILICA SAND
❑Experimental"Technology ❑Subsidence Control ft. ft.
DGeothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional aheets if necessa
DGeothermal(Heat in Cocl in&Retum) DOther(explain under 421 Remarks FROM TO DESCRIPTION color,hud mll/ro k JyK grain etc.
0.0 ft. 11.0 fL RED SILTY CLAY
4.Dale Wells)Completed: 06/02/22 Well ID.Y IW-13 11.0 rL 24.0 f'- BROWN SILTY SAND
5a.Well Location: 24.0 1" 30.0 ft' TAN SILTY SAND
BELEWS CREEK STEAM STATION 30.0 ft• 61.0 ft. PWR
Facility/OwncrName Facility IDk(ifapplicable) 61.0 ft• 140,0 fL ROCK
3195 PINE HALL ROAD BELEWS CREEK 27009 ft. ft.
Physical Address,City,and Zip R. fi.
STOKES 21.REMARKS
-aunty Parcel Identification No.(PIN)
BENTONITE SEAL--30.0-35.0 FEET
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22.Certification:
928758.1407 N 1681293.790 W !�ESIrtz;.. Gw-
06/09/22
6.Is(are)the well(s): OPermanent or ❑Temporary Signature ofCerti6ed Well Contractor Date
By signing ihis farm,l hereby cerrt&that the well(s)was(were)construcred in accordance svirh
7,Is this a repair to an existing well: ❑Yes or ONo 15A NCAC 02C 0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy
lfihis is a repair,fill out known well construction inforntailon and explain the nature ofthe ofrhis record has been provided to the well owner.
repair under 021 remarks.section or on the back ofihls form.
23.Site diagram or additional well details:
S.For Geoprobe/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-l is needed. Indicate TOTAL NUMBER ofwells (add'See Ovee in Remarks Box).You may also attach additional pages if necessary
drilled: 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 140.0 (ft.
!•ornndnple wells list all depths ifdifferent(example-3 200'and 1i._a,100'} ) Submit this GW-1 within 30 days of well completion per the following;
10.Static water level below top of casing: 50.5 (ft) 24a. For All Wells: Original form to Division of Water Resources (DWR),
.fivater level is above casing,use.,," Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter: 10•0 (in.) 24b. For Injection Wells: Copy to DWR,Underground Injection Control(IUC)
Program, 1636 MSC,Raleigh,NC 2 7699-1 636
12.Well construction method: R 24c.For Water Su I and O en-Loa Geothermal Return Wells:Copy to the
(i.e.auger,rotary,cable,direct push,etc.) county environmenaa eat epartment ot the county where costa e
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells V roducin over 100 000 GPD: Copy to DWR,CCPCUA
Permit Program, ,Ra elg ,N
13a.Yield(gpm) Method of test:
CM
13b.Disinfection type; Amount:
Form GW-1 North Carolina Department of Environmental Quality-Division of Watcr Resources Revised 6-6.2018

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
PTI
Well Contractor Name FROM IM DESCRI ON
ft. fr.
A - 2581
NC Well Contractor r:ertification Number 15.OUTER CASING for multi cased wells OR LINER if a licable
GEOLOGIC EXPLORATION FROM TO DIAMETER THLCIOVESS MATERIAL
rt. rL is
Company Name 16.INNER CASING OR TUBING eothermal closed-loo
2.Well Construction Permit 0: FR0:11 TO DIAMETER THICKNESS MATERIAL
List all applicable well comiruciton permits(i.e.UIC,County,State, Variance,etc.) 0.0 ft• 120.0 ft• 6.0 "' I SCH 40 PVC
3.Well Use(check well use):
ft. ft. in.
Water Supply Well: 17.SCREENFROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 120.0"' 140.0 ft. 6.0 Iri. .010 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) OResidential Water Supply(single) ft. R. try
Olndustrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑lrrl alion ❑Wells> 100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0.0 f' 250 ft. AQUA GUARD SLURRY
MMonitoring ❑Recovery ft. R.
Injection Well:
ft. fr.
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK If■ livable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL I EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage 30.0 ft. 145.0 ft. 20-40 FINE SILICA SAND
El Experimental Technology ❑Subsidence Control R. ft,
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets If necessary)
FROM TO DESCRIPTION color,hardness,wiUruk rain size etc.
[]Geothermal(Heat m Coohn Return) ❑Other(explain under N21 Remarks)
0.0 R• 18.0 f' RED SILTY CLAY
4,Date Well(s)Completed: 06/1 3/22 Well ID# IW-14 18.0 ft• 27.0 ft' BROWN SILTY SAND
Sa.Well Location:
27.0 ft' 62.0 ft' TAN SILTY SAND
BELEWS CREEK STEAM STATION 62.0 ft. 650 ft' PWR
Facility/OWneT Name Facility ID#(if applicable) 65.0 ft- 145.0 ft- ROCK
3195 PINE HALL ROAD BELEWS CREEK 27009 ft. ft.
Physical Address,City,and Zip ft. ft.
STOKES 21.REMARKS
County Parcel Identificmion No.(PIN)
BENTONITE SEAL- 25.0-30.0 FEET
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one latflong is sufficient) 22.Certification:
928823.4757 N 1681306.652 W -- '`"" 06/24/22
6.Is(are)the well(s): ©Permanent or ❑Temporary Signature ofCenified Well Contractor Date
By signing This form,1 hereby certify that the well(s)was(were)constructed in accordance%ith
7.Is this a repair to an existing well: ❑Yes or ©No 15A NCAC 01C.0100 or 15A NCAC 02C 0200 Well Construction Standards and that a,opy
1f+his is a repair•fill our knou n well construction informaiton aml explain the nature of the of this record has been provided to the well owner
repair under#21 remarks section or on the back of this 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 info
construction,only I GW-1 is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach additional pages ifnecessary
drilled: 24.SUBMITTAL INSTRUCPIONS
9.Total well depth below land surface: 140.0 {ft.)
For multiple ivells list all depilis ifdrffereni(example-3 200'and 1©100') Submit this GW-1 within 30 days of well completion per the following-
For
24a, For All Wells: Original form to Division of Water Resources (DWR),
10.Stalk water level below top of casing: {ft.)IJ n•arerlere!is shove casing,use"+" Information Processing Unit, 1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter: 10.0 (in.) 24b.For Infection 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 We[Is:Copy to the
(i.e.auger,rotary,cable,direct push,etc.) county environmental eat department o e county ere i_ e
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells rodurin over 100 000 GPD:Copy to DWR,CCPCUA
Permit Program,] I I MSC,Ra ei ,N 27699-I 11
138.Yield(gpm) Method of test:
13b.Disinfection type: Amount:
Form G W-I North Carolina Department of Environmental Quality-Division of Water F r:r umc c Revised t,t 211 16

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
I.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
FROM TO DESCRIPTION
Well Contractor Nanu ft. fl.
A - 2581
ft. ft.
NC Well Contractor Certification Number IS.OUTER CASING for multi-cased wells OR LINER If a llcable
GEOLOGIC EXPLORATION FROM TO DIAMETER THICIINEss MATERIAL
ft. ft. is
Company Name
16,INNER CASING OR TUBING eotherrael closed-too
2.Well Construction Permil#: FROM TO I DIAMETER I THICKNESS MATERIAL
List all applrcable well rnn.ciruciian permits(i.e. 111C,County,Stare.Variance,ere) 0.0 ft. 120.0 fL 6.0 in' SCH 40 PVC
3.Well Use(check well use): ft. ft. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑MunicipaUPublic 120.0"' 140.0 ft• 6.0 I° .010 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) []Residential Water Supply(single) ft. ft. In
❑Ind uslrial/Com mere ial ❑Residential Water Supply(shared) 18.GROAT
❑Irri ation ❑Wells>100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD dr AMOUNT
Non-Water Supply Well; 0.0 ft. 25.0 ft• AQUA GUARD SLURRY
OMonitoring ❑Recovery
-Jeelion Well:
ft.
❑Aquifer Recharge ❑Groundwater Remediauon
14.SANDlGRAVEI.PAC K Ifs licable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL I EMPLACEMENT METHOD
❑Aquifer Test OStormwater Drainage 30.0 ft• 145.0 ft• 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control ft. rL
❑Geothermal(Closed Loop) OTracer 20.DRILLING LOG attach additional sheets if necasa
❑Geothermal(Heat in Cool ing Return) ❑Other(explain under#21 Remarks) FROM TO DESCRIPTION color hardu millmk tym tMin etc
0.0 ft. 12.0 ft- RED SILTY CLAY
4.Date Well(s)Completed: 06/09/22 Well ID# IW-1 5 12.0 ft• 23.0 ft. BROWN SILTY SAND
Sa.Well Location: 23.0 ft• 48.0 ft• TAN SILTY SAND
BELEWS CREEK STEAM STATION 48.0 ft• 63.0 ft• PWR
Facility/Owner Name Facility IDS(if applicable) 63.0 ff 145.0 ff ROCK
3195 PINE HALL ROAD BELEWS CREEK 27009 ft. ft
Physical Address,City,and Zip ft. ff.
STOKES 21.REMARKS
County Parcel Identification No.(PIN)
BENTONTTE SEAL-25.0-30.0 FEET
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one iaUlong is sufficient) 22.Certification- � _
928856.1431 N 1681338.806 �W �/ - 0'r' 06/17/22
6.ls(are)the we[I(s); OPermanent or ❑Temporary SignaturaofCcrtified Well Contractor Date
By signing this form,I hereby certify that the weil(s)was(were)cotutrucred lit accordance with
7.Is this a repair to an existing well: OYes or l!5No 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Conslructron Standards and that a copy
If this is a repair,fill out known we/1 caatruction information and explain the nature of the afthrs record has been provided to the well owner.
repai.wider 021 remarks section or on the back ofthis form.
23.Site diagram or additional well details:
8.For GeoproWDPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well construction info
a�nstrucnon,only I GW-1 is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach additional pages if necessary
gilled: 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 140.0 (ft.)
I oraulriple welis list all depths rfdrfferent(example-3 200'and 2Q100') Submit this GW-1 within 30 days of well completion per the following:
45•0 ) 24%. For All Wells: Original form to Division of Water Resources (DWR),
f Static water level below top of casing: (ft. Information ProcessingUnit, 1617 MSC,Raleigh,NC 27699-1617
.fu•ater level is abase casing,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.Weil construction method: AIR
24c.For Water Supply and Open-Lon Geothermal Return Wells:Copy to the
(i e.auger,rotary,cable,dwect push etc.) county environments cat department o t e county ere installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100 000 GPD:Copy to DWR,CCPCUA
Permit rogram,I 11 MSC,Raleigh, 7 I
13a.Yield(gpm) Method of test:
13b.Disinfection type: Amount:
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1,Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
A - 2581 ft. fL
ft. R.
NC Well Contractor Certification Number 15.OUTER CASING for maid-cored wells OR LINER If a licable
GEOLOGIC EXPLORATION FROM TO DIAMETER THICKNESS MATERIAL
ft. TL in
Company Name
16.INNER CASING OR" BING ecithermal closed-loo
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS I MATERIAL
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.) 0.0 ft. 120.0 fL 6.0 in. SCI..I 40 PVC
3.Well Use(check well use): ft. fr. In
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 120.0 ft. 140.0 B. 6.0 In• .010 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
111rrl atlOn ❑Wells> 100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOl1NT
Non-Water Supply Well: 0.0 " 25.0 f` AQUA GUARD SLURRY
©Monitoring ❑Recovery ft. ft.
Injection Well:
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK Ira licable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL I EMPLACEMENT METHOD
OAquifer Test ❑StormwaterDrainage 30.0 ft• 145.0 ft' 20-40 FINESILICASAND
❑Experimental Technology ❑Subsidence Control ft. fL
DGeolhermal(Closed loop) ❑Tracer 20.DRILLING LOG attach additional sheets ifnecessa
FROM TO DESCRIPTION color,hardness,soli/rock t rain rue etc.
❑Geothermal{Hearin Conlin Return) []Other(explain under#21 Remarks)
0.0 ft- 17.0 ft- RED SILTY CLAY
4.Date Well(s)Completed: 06/08/22 Well ID# IW-1 6 17.0 fL 27.0 ft. BROWN SILTY SAND
5a.Well Location: 27.0 ft' 41.0 1" TAN SILTY SAND
BELEWS CREEK STEAM STATION 41.0 ft 67.0 1` PWR
Facility/Owner Name Facility ID#(if applicable) 67.0 ft. 145.0 ft. ROCK
3195 PINE HALL ROAD BELEWS CREEK 27009 ft. IL
Physical Address,City,and Zip ft. ft.
STOKES 21.REMARKS
County Parcel Identification No.(PIN) BENTONITE SEAL 25.0-30.0 FEET
5b.Latitude and longitude in degree Vininutes/seconds or decimal degrees:
(if well field one Iavlong is sufficient) 22.Certification:
928880.2421 N 1681370.425 Wes%- T`" 06/17/22
6.Is(are)the well(s): fBPermanent or OTemporary Signature of Certified Well Contractor Date
By signing This form,I hereby certt&that the well(s)was(were)constructed in accordance with
7.is this a repair to an existing well: ❑Yes or IENo 15A NCAC 02C 0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy
If dirs is a repair,fill our known well construction information and explain the nature of the afthis record has been provided to the well owner.
repair under 21 remarks section or on the back of this form.
23.Site diagram or additional well details:
8.For Geoprobe/DPI'or Closed-Loop Geothermal Wells having the same You inay use the back of this page to provide additional well construction info
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
9,Total well depth below land surface: 140.0 (ft.)
For multiple wells list all depths if different(example-31t 00'and 2@100� Submit this GW-1 within 30 days of well completion per the following:
10.Static water level below top of casing: 43.0 (ft) 24a. For All Wells: Original form to Division of Water Resources (DWR),
If water level is above casing,rise-+ Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter: 10.0 (in) 24b. For injection Wells: Copy to DWR,Underground Injection Control(IUC)
Program, 1636 MSC,Raleigh,NC 27699-1636
I2.Well construction method: AIR 24c.For Water Su 1 and Open-Loop Geothermal Return Wells:Copy to the
(i.e.eager,rotary,cable,direct push,etc.) county environmentshealth depanmentofthe county ere ins
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells rod over 100 000 GPD:Copy to DWR,CCPCUA
Permit Program, I I I M ei 7699-1611
139.Yield(gpm) Method of test:
13b.Disinfection type: Amount:
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
Well Contractor Name FROM TO D[SCRImON
h. fi
A - 2581
h. n.
NC Well Contractor Cenificat on Number 13.OUTER CASING ifor ME Le walks OR LINER If a liable
GEOLOGIC EXPLORATION FROM TD DIAMETER THltxtrTss MATERIAL
Company Not" t6.INNERCASINGORTUBING hernial closed-loasil
2.Well Conslruclion Permit N: FROM To DIAMETER THICKNESS MATERIAL
1.ice all applicable cell comire CIum!merits li.e.WC,Cotimy,Slate itariamo,ere.J 0.0 h• 70.0 n, 6.0 i"" SCH 40 PVC
3.Well Use(check well use): n. Is.
N'aterSupply Well: 17.SCREEN
FROM 70 DIAMETER SLOTSIZE THICKNESS MATERIAL
OAgricultural OMunKipal Public 70.0 II• 90.0 rL 6.0 i"' .010 SCH 40 PVC
OGecahermal(Ilealing/Cooling Supply) C)Residemial Water Supply(single) rt. ft In.
o(ndustrial/Commercial OResidential Water Supply(shared) I&GROUT
Dirrigation OWells> 100000GPD FROM TO MATERIAL EMPLACEMENT METHOD A AMOUNT
Non•WaterSupply Well: 0.0 n' 20.0 h' AQUA GUARD SLURRY
amonitoring ORecovery rI. ft,
Injection Well:
R. ft.
OAquilrr Recharge OGroundwater Remediation
19.SANDICRAYEL PACK if a eaWe
OAgmfer Storage and Recovery OSahnny Barrier FROM TO MATERIAL EMnACEMENTMETHOD
❑Aquifer Teu oStorinwater Drainage 25.0 fl• 95.0 h 20.40 FINE SILICA SAND
oExperimcnW Techn0ogy oSubsidence Control R. n-
oGerithermal(Closed Loop) OTracer 20.DRILLING LOG ■leach additional sheets if eecessa
OGeOlhcnnal ileatin Coolin Return) OOlher(explain under#21 Remarks) FROM TODPS[RIITION carat kananess raiYraeY Tin dv,ae.
0.0 ft• 9.0 h' BROWN SILTY SAND
4.Dale Well(s)Completed: 09/01/22 Well IDq IW-17 9.0 n 150 fe TAN SILTY SAND
58.Well Location: 15.0 fI 39.0 fr' PWR
BELEWS CREEK STEAM STATION 39.0 h 950 fl• ROCK
Facility/Owner Naine Facilay IDN(i(applKabki rt. h.
3195 PINE HALL ROAD BELEWS CREEK 27009 n• fl.
Physical Address,Ciiy,and Zip A. ft.
STOKES 21.REMARKS
Vou ity Parcel Identification No.(PIN) BENTONITE SEAL-•20.0-25.0 FEET
Sb,Latitude and longitude In degrees/minutes/seconds or decimal degrees:
(if well fitld,one tatilong is suffocient) 22.Certification;
928895.7726 N 1681399.364 Wes%-�"'`� 09/07/22
6.Is(are)the well(s): ®Permanent or OTemporary Signature ofCenified Wall Conlraetor Date
)(r wjAwng drolorm.1 hereb),vervifj•thin the ir0r4 t+us hi ere)rrnnrrrn irTNrr anarrAiner irirh
7.Is this to repair to an existing well: oYes or MNo 13A N('AC OA VI(A)m 13A N('A('02C.0200 Will Ctnislrrrcarm Sootxlrrr<h ural ilia'a r,Va
1 aw r,a repair,fill out kmmw well r'rNt.raia•NMi Ir fnnrrarurn uMl exrlaar Me nature of Uie rf etas re,wnl has berg pravuh•J w the null fill-Mr.
repair Mn1er ?!reamrli,,rs'inn iu•ran the bock rf'rliu friar
23.Site diagram or additional well detain:
9.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well construction inl'u
construction,only I GW-I is needed. Indicate TOTAL NUMBER ofvtclls OW'Sce Over in Remarks Box) You may also attach additional pages if necessan
drilled. 24.SUBMITTAL INSTRUMONS
9.Total well depth below land surface: 90.0 ft.)
Yur n:•d,'r1r wells by rill iA•-1wia f rlUennt/eruaiple.Ir@r 21N1•a+a12�rlllllf) Submit this GWI within 30 days of well completion per the following:
31,48 24n. For All Wells: Original I'Drin to Division of Water Resources (DWR)
Sl ei water level below,�a aMxr nrrury!me-p l casing: (ft.) Information Processing Unit,1617 MSC,Raleigh,NC 27699-16 1 7
1/'u�rrf t:er
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
24e,For Wafer Su I and O n-Lao Geothermal Return Wells:Copy to the
6 e.auger,rotary,cable,d'veet push,etc.) county en rinienta a t epanmtnt 0 l e t0untywhere installed
FOR WATER SUPPLY WELLS ONLY: 24d,For Water Wells roduci over 100 000 GPD:Copy to DWR.CCPCUA
l3a.Yield(gpm) Method of test: Permll rogram, 611 a eig ,
13b.Disinfection type: Amount:
form G W-1 Nonb Carolina Depaninent of Eiinranmenlnl Qualiiy•Division of Water Resources Revised 6-6-2018

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
FROM TO DESCRIPTION
Well Contractor Name
h. ft.
A - 2581 ft. h.
NC Well Contractor Certification Number I5.OUTER CASING far multi-eased wells OR LINER if a licable
GEOLOGIC EXPLORATION FROM TO DUM ETER THICKNESS MATERIAL
Company Name 16,INNER CASING OR TUBING eothermal closed-loo
2.Will Construction Permit#: FROM TO DIAMETER THICKNESS MATERIAL
List all applicable tr•ell construcron permlls(l.e.UIC,Coiaoo,,Stare,Variance,etc.) 0.0 ft- 120.0 ft. 6.0 in. SCH 40 PVC
3.Well Use(check well use): h. ft. in.
Water Supply Well: 17.SCREEN
PPY FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
❑Agricultural OMunicipal.Public 120.0 h• 140.0 ft' 6.0 1 ' 1 .010 SCH 40 PVC
OGeothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft ft. in.
&industrial/Commercial &Residential Water Supply(shared) IS.GROUT
Oirrigation ❑Wells> 100900GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0.0 ft- 20.0 IL AQUA GUARD SLURRY
&Monitoring ❑Recovery tt. h.
Injection Well: ft. h.
&Aquifer Recharge &Groundwater Remedialion
19.SAND/GRAVEL PACK if a licable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMP[ACEME T METHOD
OAquif!r Test ❑Storinwater Drainage 25.0 ft- 145.0 ft- 20-40 FINE SILICA SAND
❑Experimental Technology OSubsidence Control it. h•
❑Geothermal(Closed Loop) ❑Tracer 22.DRILLING LOG attach additional sheets if necessary)
OGcolhermal(Heating/Cooling Return) 001hcr(explain under#21 Remarks) FROM TO DESCRIPTION color,hardness,soiUmcM type,gnin sire,etc.
0.0 h 7.0 fa BROWN SILTY SAND
4.Dale Well(s)Completed: 09/02/22 Well ID# IW-18 7.0 it- 15.0 ft, TAN SILTY SAND
Sa.Well Location:
15.0 ft' 44.0 ft• PWR
BELEWS CREEK STEAM STATION 44.0 h 145.0 ft• ROCK
Facility/Owner Natne Facility IDO(ifopplicable) h• ft.
3195 PINE HALL ROAD BELEWS CREEK 27009 ft. ft.
Physical Address,City,and Zip ft, ft.
STOKES 21.REMARKS
County Parcel;dentificalPon Nm(PIN) BENTONITE SEAL•-20.0-25.0 FEET
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one tattlong is sufficient) 22.Certification:
928913.4451 N 1681421.336 W !:21r-- 0-y- 09/07/22
6.Is(nre)the well(s): &Permanent or &Temporary Signature of Certified Well Contractor Date
By signing this farm,1 herebr ccrlifj,Arai are hello)iras(ware)cons wricied in occ ordance iivth
7.Is this a repair to an existing well; Oyes or laJNo l5A N('A('02(' 0/00 ar 15A NCAC 02('.o200 Well(bnvrut tim Slaix/aretr and rhai it ruin
if this is a repair fill oti1 kwartr well ciravruclron irr imuriaon and explain iln nature rf the eJ this record lair been provided it)1he to-ell oirner.
re pair iarder 21 remarks.section or air the back of This 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 info
construction,only 1 GW-I is needed Indicate TOTAL NUMBER ofwells (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: 140.0 (fl.)
Submit this GW-1 within 30 days of well completion per the following:
!•iir nmhiple e•ells list a!f ileprhs rf'dtoerenr(example.3 @200 and 2!f_M00')
10.Static water level below top of casing: 30.8 (ft) 24s. For All Wells: Original form to Division of Water Resources (DWR).
ir'uaierlevel is above caving.oxv Information Processing knit,1617 MSC,Raleigh,NC 27699-1617
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-Loo Geothermal Return Yells: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(gpm) Method of test: Permit Program, 1611 MSC,Raleigh,NC 27699-1611
13b.Disinfection type: Amount:
Form GW-I North Carolina Department of Environinental Quality-Division of Water Resources Revised 6-6-2018

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.WATERZONES
Well Contractor Name FROM TO I DESCRIPTION
A - 2581
ft. fr.
NC Well ContracioF Certification Number IS.OUTER CASING for multi-cased wells OR LINER if a licable
GEOLOGIC EXPLORATION FROM TO DIAMETER THICKNESS MATERIAL
h. fr. in.
Company Name
16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS I MATERIAL
List all applrcable well consrruclion permits ri.e.171C.Counly,Stare, Variance,etc) 0.0 Ir. 120.0 If 6.0 in. SCH 40 PVC
3.Well Use(check well use): ft. ft. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
i lAericullural OMumcipal,,Public 120.0It' 140.0 ft' 6.0 in. .010 SCH 40 PVC
itSeolhermal(Heating/Cooling Supply) OResidenlial Water Supply(single) ft. h,
_Industrial/Commercial OResidential Water Supply(shared) 18.GROUT
(Arri ation OWells> 100,000GPD FROM TO MATERIAL EMPLACEMENT MLTIIOD&AMOUNT
Non-Water Supply Well: 0.0 fr. 20.0 ft. AQUA GUARD SLURRY
(NMonitoring ❑Recovery h. it.
Injection Well:
h. ft.
GAquifer Recharge OGroundwater Remediation
19.SAND/GRAVEL PACK if■ licable
❑Aquifer Storage and Recovery OSatintty Barrier FROM TO MATERIAL EMPIACEMENTMLTHOD
❑Aquifer Test OStonmvaler Drainage 25.0 R- 145.0 IG 20-40 FINE SILICA SAND
DExperimental Technology OSubsidence Control ft. I ft.
❑Geothermal(Closed Loop) O"rracer 20.DRILLING LOG attach additional sheep if n"essa
DGeothermal(HeatinglCooling Return) ❑Other(explain under#21 Remarks) FROM To DESCRIPTION color,Hardness,soiltrock lypt,train size,etc.
0.0 h• 7.0 h- BROWN SILTY SAND
4.Date Well(s)Completed: 09/07/22 Well ID# IW-19 7.0 ft- 11.0 ft- TAN SILTY SAND
5a.Well Location: 11.0 ft. 45.0 ft' PWR
BELEWS CREEK STEAM STATION 45.0 ft. 145.0 f- ROCK
Facility/Owner Name Facility IDJJ(if applicable) h• ff.
3195 PINE HALL ROAD BELEWS CREEK 27009 ff. ft.
Physical Address,City and Zip h, ft.
STOKES 21.REMARKS
Couiiq' Parcel Identification No.(PIN)
BENTONITE SEAL-20.0-25.0 FEET
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one billong is sufficient) 22.Certification:
928934.3309 N 1681444.380 W 09/12/22
6.Is(are)the well(s): OPermanent or ❑Temporary Signature of Certified Well Contractor Date
Hi'si1!ninA lhic fiinr4 1 herebr ceri fV llnn the irellO lows(irere)convnrctrd m rxrorehrne r,nrA
7.Is this a repair to an existing well: Ol'es or MNo 15.4 N('AC D2C.o100 or 15A NC.if'02('-421N1 Well('onstrarNon JYandanl.caH1 rJHn o,.y+r
1J this is a relwir,fill ons knoirn yell canutrm-lira;nyornialion and dq+lain Me rranne rJ the of'thi%rec'onlllax been provided!o the we11 envier.
relrilr inuler z 21 renwrkr.reclirnr or art die bock of this fin'n!.
23.Site diagram or additional well derails:
8.For Ceoprobe/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 wells (add'See Over'in Remarks Box).You may also attach additional pages if necessar%
drilled: 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 140.0 (ft.)
Mir innhiple ire/Is list all depdis y dgjireni(example-d a 200'arnl2©100) Submit this GW-I within 30 days of well completion per the following:
10.Static water level below top of casing: 33.73 (ft.
ft) 24a• For All Wells: Original form to Division of Water Resources (DWR).
1J'rraler live/is ahore caring,irse"," Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter: 10.0 (in) 24b. For Injection Wells:Copy to DWR,Underground Injection Control(LIC)
Program, 1636 MSC,Raleigh,NC 27699-1636
12.1Vell construction method: AIR
24c.For Water Supply and Open-Loop Geothermal Return Wells:Copy In the
(i.e.auger,rotery,cable,direct push,etc.) county environmental health department of-the county where installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water 11'ells roducin over 100,000 CPD:Copy to DWR,CCPCUA
Permit Program, 16 A M ,Ra eig ,NC 27699-1611
13a.field(gpm) Method of test:
13b.Disinfection hype: Amount:
Fonn GW-I North Carolina Department of Environnientat Quality-Division of Water Resources Revised 6-6-20 8

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
ft. ft.
A - 2581
NC Well Contractor Certification Number 15.OUTER CASING for mulIMaedwORLNR i fMaAbl
GEOLOGIC EXPLORATION THICE T ERIAL
Company Name
16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit q: FROM TO DIAMETER THICKNESS MATERIAL
Lisi all applicable well construction perrrirrs(r.e.UIC,County,Stare.Variance etc.) 0.0 ft- 120.0 ft' 6.0 in' SCH 40 PVC
3.Well Use(check well use): ft. ft. in
Water Supply Well: 17.SCREEN
PROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 120.0 ft 140.0 ft• 6.0 In. .010 SCH 40 PVC
[]Geothermal(I leating/Cooling Supply) ❑Residential Water Supply(single) R. ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Irrl ation ❑Wells> 100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0.0 ft• 25.0 fL AQUA GUARD SLURRY
19Monitoring ❑Recovery
Injection Well:
❑Aquifer Recharge ❑Groundwater Remediation R R
19.SAND/GRAVEL PACK Ifs Ifcable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM To MATERIAL I EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage 30.0 f° 145.0 fl• 20-40 FINE SILICA SAND
DExperimenlalTechnology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessa
FROM TO DESCRIPTION color,hardne wilhock rain tic.
❑Geolhertnal(Healin Conlin Return) DOther(explain under k2 i Remarks)
0.0 fr• 6.0 ft• RED SILTY CLAY
4.Dale Well(s)Completed: 06/08/22 Well IDN IW-20 6.0 ft• 17.0 ft. BROWN SILTY SAND
5a.Well Location: 17.0 ft• 28.0 ft' TAN SILTY SAND
BELEWS CREEK STEAM STATION 28.0 n 62.0 ft• PWR
Facility/Owner Name Facility IDN(ifapplicable) 62.0 ft' 145.0 ft. ROCK
3195 PINE HALL ROAD BELEWS CREEK 27009 ft. rr.
Physical Address,City,and Zip ft. ft-
STOKES 21.REMARKS
County Parcel Identification No.(PIN) BENTONITE SEAL-25.0-30.0 FEET
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifweli field,one hit/long is sufficient) 22.Certification:
928866.3182 N 1681529.054 W -` - '''"' 06/17/22
6.Is(are)the well(s): CEPernianent or ❑Temporary Signature ofCenified Wetl Contractor Date
By signing this form,l hereby certtry that the well(s)eras(were)constructed in accordance ivith
7.Is this a repair to an existing well: a Yes or MNo 15A NCAr'02C 0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy
rr7hm f,a repair fill our known ve'i construction urfarniarion and-rplam the nature of1h. ofrhis"cord has been provided to The irell owner.
rec,ri,nder 21remarkssecemi..r.m the back ofrhisfurm.
23.Site diagram or additional well details:
S.For Geoprobe/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-l 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: 140.0 (ft.)
.,-or midriple wells list all deptlu ifdl,8erent(example-3@200'and 2 lo0� Submit this GW-1 within 30 days of well completion per the following:
37.0 24s. For All Wells: Original form to Division of Water Resources (DWR),
17 ouler let
el
Stalet rl is above,.sing,use water level below top of casing: {it.) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter: 10.0 (in) 24b. For Injection Wells:Copy to DWR,Underground Injection Control(IUC)
Program, 1636 MSC,Raleigh,NC 27699-1636
l2.Well construction method: AIR 24c.For Water Su I and O n-Lao Geothermal Return Wells:Copy to the
{i.e auger,rotary,cable,direct porch,etc.) county environments eat epartment o e county where installeT
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells roduciD over l00 000 GPD:Copy to DWR,CCPCUA
13a.Yield(gpm) Method of test: Permit Program,1611 M et 7 -I I
13b.Disinfection type: Amount:
Form GW-1 North Carolina Department of Hnvtronmerild Quality-Division of Water Resources Revised 6-6-2018

WELL CONSTRUCTION RECORD GW-1 For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
Well Contractor Name FROM To DESCRFMONfi ft
A - 2581
ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING far multi-cased wells OR LINER if a licable
GEOLOGIC EXPLORATION FROM TO DIAMETER THICKNESS MATERIAL
fo.
Company Name
16,INNER CASING OR TUBING eothermal closed-loo
2.Well Construction Permit#: FROM TD DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(r.e.UIC,County,Slate, Variance,ere.) 0.0 ff• 120.0 rL 6.0 In' SCH 40 PVC
3.Well Use(check well use): ft. ft. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SI.OTSIZE THICKNESS MATERIAL
OAgricullural ❑Municipal/Public 120.0 f`' 140.0 f`' 6.0 in. .010 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in.
❑Industrial./Commercial ❑Residential Water Supply(shared) 18.GROUT
❑lrrl ation OWells> 100000 GPD FROM I TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0.0 R. 25.0 f`• AQUA GUARD SLURRY
©Monitoring ❑Recovery ft. ft.
Injection Well:
ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK Iry licable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL I EMPLACEMEN*r NIETHOD
❑Aquifer Test ❑Stormwater Drainage 30.0 f`• 145.0 f` 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary)
❑Geothermal(Heatin Coolin Return) ❑Other(explain under 421 Remarks) FROM TO DESCRIP77ION color,luirdnep,wivrock type,Irmin size,etc.
0.0 D• 6.0 r`• RED SILTY CLAY
4.Date Well(s)Completed: 06/07/22 Well IDN IW-21 b.0 ft- 16.0 ft- BROWN SILTY SAND
5n.Well Location: 16.0 f` 30.0 ft. TAN SILTY SAND
BELEWS CREEK STEAM STATION 30.0 R 63.0 ft. PWR
Facility/Owner Name Facility ID#(ifapplicable) 63.0 f`• 145.0 "' ROCK
3195 PINE HALL ROAD BELEWS CREEK 27009 ft. ft.
Physical Address,City,and Zip ft. ft.
STOKES 21.REMARKS
County Parcel Identification No.(PIN) BENTONITE SEAL-25.0-30.0 FEET
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one Iaillong is sufficient) 22.Certification:
928885.0619 N 1681544.595 W �;�, �jlk,,--
06/17/22
6.Is(are)the well(s)• MPermanent or ❑Temporary Signature ofCcrtificd Well Contractor Date
Bysigning thisJorni.I herehycerrify that the wells)was(were)constructed in accordance a-irh
7.Is this a repair to an existing well: []Yes or MNo 15A NCAC 02C.0100 or 15A NCAC 02C_.0200 well Construction Standards and that a copy
If this is a repair,fill out known well construction information and explain the nature of the ofilus record has been provided to the well owner.
repair under 421 remarks section or on the back oJThis farm.
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 info
construction,only I GW-1 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: 140.0 (ft.)
hbrrnultiple wells list all depths rfdieretn(example-3Q200'and 2@100') Submit this GW-1 within 30 days of well completion per the following:
10.Static water level below top of casing: 37.0 (ft.) Information
For All Wells: Original form to Division of Water Resources (DWR),
li"waterlove/is above casing,use'•+" Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
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 Su 1 and O n-Loo Geothermal Return Wells:Copy to the
(i.e.auger,ro(ary,cable,direct push,etc.) county envtronmeW. eat epartmenl o t e county where installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 1119
00 000 GPD: Copy to DWR,CCPCUA
13a.field(gpm) Method of test:
Permit Program,1611 MSC,Raleigh, -1 1 I
13b.Disinfection type: Amount:
Form OW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6.2D18

WELL CONSTI UCTION RECORD(II For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTIONft R
A - 2581
rt. rr.
NC Well Contractor Certification Number IS.OUTER CASING for multi-eased wells OR LINER If a licab e
GEOLOGIC EXPLORATION ERonr To DIAMETER THICIOfES3 MATERIAL
ft. fL In.
Company Nana
16.INNER CASING OR TUBING eothermat closed-too
1.Well Construction Permit 4: FROM 710 DIAMETER THICKNESS I MATERIAL
List all applicable Nell construction permits(t.e.UIC,County,Stale.Variance,etc) 0.0 fr. 120.0 ft- 6.0 1- SCH 40 PVC
3.Well Use(check well use): ft. fr. in.
17.
Water Supply Well: FROMREE TO DIAMETER SL.OTSIZE THICKNESS MATERIAL
❑Agricultural OMunicipaUPublic 120.0 ft. 140.0 It- 6.0 In. .010 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) fl. ft In.
❑Ind ustrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Irri ation ❑Wells> 100000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0.0 ft- 25.0 IL AQUA GUARD SLURRY
(Monitoring ❑Recovery ft. ft.
Injection Well:
❑Aquifer Recharge OGroundwater Remedtation
19.SAND fr.
ICRAVEL PACK if applicablel
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage 30.0 ft• 145.0 ft' 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control ft. iL
❑Geothermal(Closed Loop) OTracer 20.DRILLING LOG attach additional sheers If necessary)
❑Geothermal(lleatin Conlin Retum) ❑Other(ex lain under N21 Remarks FROM TO DESCRIPTION color,hardo mill c r rain rtc
0.0 ft- 7.0 f- RED SILTY CLAY
4.Date Well(s)Completed: 06/07/22 well ID4 IW-22 7.0 ft, 11.0 ft- BROWN SILTY SAND
5a.Well Location: 11.0 ft' 23.0 ft' TAN SILTY SAND
BELEWS CREEK STEAM STATION 23.0 ft• 62.0 ft• PWR
Facility/Owner Name Facility ID4(ifapplicable) 62.0 ft• 145.0 ft- ROCK
3195 PINE HALL ROAD BELEWS CREEK 27009 rr. fr.
Physical Address,City,and Zip ft. ft
STOKES 21.REMARKS
County Parcel Identification Na (PIN)
BENTONIfE SEAL- 25.0-30.0 FEET
5b.Latitude and longitude in degrces/minutes/seconds or decimal degrees:
(if well field,one la✓long is sufTScimu) 22.Certification:
928904.8766 N 1681566.032 W �%-ow- 06/17/22
6.Is(are)the well(s): MPermanent or ❑Temporary Signature ofCcrtified Well Contractor Date
By signing this form,I hereby certt&that the well(s)war(were)consiructed to accordance with
7.Is this a repair to an existing well: ❑Yes or MNo ISA NCAC 02C.0100 or 13A NCAC 02C.0200 Well Construction Standards and that a copy
If this is a repair,fil/out knoirn hell construction information and explain the nature of the ofthis record has been provided to the well owner.
repair under 021 remarks section or on the back ofthis 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 Info
construction,only I GW-I is needed Indicate TOTAL NUMBER of wel Is (add'See Ove?in Remarks Box).You may also attach additional pages if necessary
drilled: 24.SUBMITTAL,INSTRUCTIONS
9.Total well depth below land surface: 140.0 (ft.)
hor multiple ivells list all depths ifdtfferem;example-3@200'and Za 1000 Submit this GW-1 within 30 days of well completion per the fallowing:
10.Static water level below top ofcasing: 30.0 (ft.) 249. For All Wells: Original form to Division of Water Resources (DWR),
/jwater level is above casing,tine"
Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
10.0 24b. For Injection Wells: Copy to DWR,Underground Injection Control(IUC)
I1.Borehole diameter: (in.) Program, 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: AIR
24c.For Water Su 1 and O en-Loo Geothermal Return We[Is:Copy to the
(i.e,auger,rotary,cable,direct push,etc county envlromnenta eat apartment o e county w ere costa e
FOR WATER SUPPLY WELLS ONLY: 24cL For Water Wells producing over 100 000 GPD:Copy to DWR,CCPCUA
13a.Yield(gpm) Method of test:
Permit rogmm, 1611 MSC,Raleigh,N 27 -1 I I
13b.Disinfection type: Amount:
Fonn ow-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14,WATER 70NES
FROM TO DESCRIPTION
Well Contractor Name h.
A - 2581 ft.
n. h.
NC Well Contractor Certification Number IS,OUTER CASING for mWH cased wells OR LINER If■ lkable
GEOLOGIC EXPLORATION FROM To DIAMETER TIHCIUi ass MATERIAL
h. ft In
Company Name
16.INNER CASING OR TUBING(geothermal closed-loo
2.Well Construction Permit 4: FROM TO I DIAMETER I THICKNESS I MATERIAL
List all applicable well caiwrucrron parades(i.e. U1C,County.Stare.Variance,etc) 0.0 ft. 120.0 fi. 6.0 1n• I SCH 40 PVC
3,Well Use(check well use): ft. ft.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑MunicipaVPublic 120.0 ft 140.0 R' b.0 in 010 SCH 40 PVC
❑Geothermal(HeatingfCoolingSupply) ❑Residential Water Supply(single) ft. ft. la.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Irri ation ❑Wel Is> 100,000 GPD FROM TO MATERIAL EMPLACEMENTMLTHOD&AMOUNT
Non-Water Supply Well: 0.0 f'• 250 ft- AQUA GUARD SLURRY
©Monitoring ❑Recovery ft. ft.
Injection Well:
h. ft.
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PAC K Ifs Iicable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL I EMPIACFm ENTMErHOD
❑Aquifer Test ❑Stormwater Drainage 30.0 f'• 145.0 ft 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG sthch additional sbeed if neceaaa
❑Geolhermal(Heating/Cooling Return) ❑Other(explain under 921 Remarks) FROM TO DESCRIPTION cobs hardnen,sonliwk ripe,grain rke etc.
0.0 f' 5.0 ft- RED SILTY CLAY
4.Date Well(s)Completed: 06/06/22 Well ID# IW-23 5.0 ft- 10.0 f'' BROWN SILTY SAND
5.4.Well Location: 10.0 ft. 18.0 ft. TAN SILTY SAND
BELEWS CREEK STEAM STATION 18.0 f' 67.0 f• PWR
Facility/Owner Name Facility ID#(ifapplicable) 67.0 f'' 145.0 ft ROCK
3195 PINE HALL ROAD BELEWS CREEK 27009 ft. ft.
Physical Address,(Ay w,d Zip ft. ft
STOKES 21.REMARKS
County Parcel Identification No.(PIN) BENTONITE SEAL-25.0-30.0 FEET
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
iifwell field,one lat'lo(ip is sufficient) 22.Certification:
928919.3360 N 1681581.573 Wna;, �j ►.r--
06/17/22
6.Is(are)the well(s): IBPermanent or ❑Temporary Stgnaturc ofCcrtiftcd Well Contractor date
By signing thu form,1 hereby terrify that the wells)was(were)constructed in accordance with
7.Is this a repair to an existing well: t]Yes or ONo 15A NCAC Ol" 0100 or ISA NCAC 02C.0200 Well Construction Standards and that a copy
f tin.¢,�a repair Jill out known cell construction rnlor malhn and-rplain the natarr, ofrhe ofth:s record has been provided to the well owner.
repair ender 21 reararks.section ar on the bark ofihs Jorm
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 info
construction,only I GW-1 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
0
9.Total well depth below tend surface: 140. (ft) Submit this GW-1 within 30 days of well completion r the following:
!-or rv,l rple wt 1l�1,s cull t prlu ifdrjjerent(example-3W00'and Z,100') Y P lx
28.0 24a, For All Wells: Original form to Division of Water Resources (DWR),
I0.Static water level below top of casing: (ft.)!f warm level is above caring,use" " Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter- 10.0_ (in) 24b. For Infection Wells: Copy to DWR,Underground Injection Control(IUC)
Program, 1636 MSC,Raleigh,NC 27694-1636
i.e Well construction method, AIR 24c.For Water Su I and O n-Lao Geothermal Return Wells:Copy to the
(i.e.auger,rotary,cable,direct push,ac) county environments ea t apartment o e county where installed
FOR WATER SUPPLY WELLS ONLY: 24d. For Water Wells producing over l00 000 GPD:Copy to DWR,CCPCUA
13a.Yield(gpm) Method of test:
Permit Program,1611 ,Raleigh, 7 1 I 1
13b.Disinfection type: Amount:
Form 6 W-I North Carolina Department of Envronrnenial Quality-Division of Water Resources Revised 6-6-2018

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.WATER 70NES
Well Contractor Name FROM TO DESCRIPTION
ft. h.
A - 2581
NC Well ContractorCenification Number IS.OUTER CASING ffor multi-cued wells OR LINER ifa Iicable
GEOLOGIC EXPLORATION FROM TO DIAMETER THICKNFSS MATERIAL
in.
Company Narne
16.INNER CASING OR TUBING(geothermal closed-loo
2.Well Construction Permit#: FROM TO I DIAMETER I THICKNESS I MATERIAL
List off applicable well courrrrrcuon permits(r.e.(IV.Comply.idle.Irariarice,etc/ 0.0 h. 120.0 ft- 6.0 In. SCH 40 PVC
3.Well Use(check well use): ft. ft.
Water Supply Well. 17.SCREEN
FROM TO DIAMETER I SLOTSIVE I THICKNESS MATERIAL
❑Agricultural OMunicipalrPubllc 120.0 f'' 140.0 f'' 6.0 '"' 010 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) OResidentral Water Supply(single) ft, ft.
❑industrial/Commercial OResidential Water Supply(shared) 18.GROUT
Olrri alion OWel1S> 100,OWGPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOtiNF
Non-Water Supply Well: 00 f• 20.0 " AQUA GUARD SLURRY
OMonitoring 0Recovery to. h.
Injection Well:
h
OAquil'er Recharge OGroundwater Remediation
OA uifer Storage and Recovery OSalmit Barrier 19.SAND/GRAVEL PACK if a litable
qY FROM TO MATERIAL I EMPLACEM ENT ML-r110D
0Aquifer Test ❑Storm%%aler Drainage 25.0 f'• 145.0 f'' 20-40 FINE SILICA SAND
❑Experimental Technology OSubsidence Control A. ft.
OGeothenrial(Closed Loop) OTracer 20.DRILLING LOG atmch additional sheets ifnecessa
OGeothermal(Heat in Coolin Return) ❑Other(explainunder#2i Remarks) FROM TO DESCRIPTION color,hardnemI*iurockt "in Sim,tic.
0.0 ft- 7.0 ft- BROWN SILTY SAND
4.Date Well(s)Completed: 09/14/22 Well ID# IW-24 7.0 ft- 17.0 f'• TAN SILTY SAND
Sa.Well Location: 17.0 ft' 36.5 1" PWR
BELEWS CREEK STEAM STATION 36.5 f' 145.0 ft- ROCK
Facility/Owner Name Facility ID!!(ifapphcable) h. ft.
3195 PINE HALL ROAD BELEWS CREEK 27009 ft. "'
Physical Address.City,and Zip ft. ft.
STOKES 21.REMARKS
County Parcel Identification No.(PIN)
BENTON]TE SEAL•-20.0-25.0 FEET
Sb.Latilude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22.Certification-
928903.2700 N 1681165.708 Nr 09/19/22
6.Is(are)the well(s): OPermanent or 01'emporary Signature ofCenified Well Contractor Date
)iv ogaaig!leis Jbnn.l herehr certib chat she irel/(rf true(+ren)enru(nutrd it;urrnnkun a.nib
7.Is this a repair to an existing well: Oyes or ONo liA Nr il('!)2('.olOo ar!iA NCA('1)2f g2110 IVrI!('rnasrn chars.tirurnlardr urn(rhur a nyn
1J'tlu,rr a mpwrr,Jill ma krrvnrn ireff ernrctrneriun rnlarrreurrarr unel esphms ilk'rrarnre it/The of rhrs reeurtl hits been praride d lei the it rll airnrr
repair umler 21 remarks secsrrrn ar an/lie back(f'thes Jarnr.
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 ink)
construction,only 1 GW-I is needed. Indicate TOTAL NUMBER of wells (add'See Over in Remarks Box).You may also attach additional pages ifnecessan
drilled: 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 140.0 (ft.)
Far nudirple irells lit all depths ifdrjlireni(example-,ie2on'orrd 2 a 1W) Submit this GW-1 within 30 days of well completion per the following:
10.Static water level below top of casing: 31.29 (ft) 24s. For All Wells: Original form to Division of Water Resources (DWR)
11 timer level rs ahore casing.use- " Information Processing Unit,1617 MSC,Raleigh,NC 2 7699-16 17
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 Su I and Open-Loop Geothermal Return Wells:Copy to the
(i.e.auger,rosary,cable,direct push,etc.) county envtronmenla eallh department of the county where installed
FOR WATER SUPPLY WELLS ONLY: 24d. For Water Wells producing over 100 V GPD:Copy to DWR.CCPCI iA
Permit Program.1611 MSC,Raleigh,NC 76 1
13a.field(gpm) Method of Zest: -16
13b.Disinfection type: Amount:
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6.20I8

WELL CONSTRUCTION RECORDSGW-1) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
FRO\I TO DESCRIPTION
Well Contractor Name ft ft
A - 2581
NC Well Contractor Certification Number 15,OUTER CASING for mat@-cased welt OR LINER if a licable
GEOLOGIC EXPLORATION FROM TO DIAMETER THICKNESS MATERIAL
ft. ft. In
Company Name
16.INNER CASING OR TUBING(geothermal dosed-too
2.Well Construction Permit N: FROM TO DIAMETER THICKNESS MATERIAL
Lire of/applicable•well couvirrnvian perahc(i.e I4•.Cname) 14me.Variance.etc) Q.0 ft. 90.0 ft. 6.0 in. SCH 40 PVC
3.Well Use(check well use): ft. ft. in.
Wafer Supply Well: 17.SCREEN
FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
❑Agricultural ❑Mumcipal.Tubhc 90.0 ft. 110.0 rL 6.0 In. .010 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) ORestdenual Water Supply(single) ft ft in.
Olndustnal/Commercial ❑Residential Water Supply(shared) IS.GROUT
❑lrrl ation DWells? 100,000GPD FROM I TO MATERIAL EMPLACEMENT METHOD&AMOi N-I'
Non-Water Supply Well: 0.0 e' 20.0 rt. AQUA GUARD SLURRY
OMonitoring ❑Recovery ft. ft.
Injection Well:
❑Aquifer Recharge DGroundwater Remediation
19.SAND/GRAVEL PACK ifa licable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL I EMPLACEMENT METHOD
❑AquiterTest ❑StormwaterDrainage 25.0 ft- 115.0 ft- 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control ft. I ft.
❑Geothermal(Closed Loop) OTracer 20.DRILLING LOG atta h additional sheets irnecessa
OGeolhermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) FROM TO DESCRIPTION color,hardness,wilfrock 1 rain sire etc.
0.0 ft. 7.0 ft. RED SILTY CLAY
4.Dale Well(s)completed: 09/14/22 Weu IDa IW-25 7.0 ft 16,0 ft' BROWN SILTY SAND
Sa.Well Location: 16.0 ft' 20.0 ft' TAN SILTY SAND
BELEWS CREEK STEAM STATION 20.0 a• 31.0 ft• PWR
Facility/Owner Name Facility IDII(if applicable) 31.0 ft. 115.0 ft. ROCK
3195 PINE HALL ROAD BELEWS CREEK 27009 ft. ft.
Physical Address,City,and Zip ft. ft.
STOKES 21.REMARKS
Courtly Pnrcet Identification No.(PIN) BENTONITE SEAL•-20.0-25.0 FEET
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one Iatilong is suflicieni) 22.Cerlifcation:
928927.9045 N 1681192.503 W o'" 09/19/22
6.Is(are)the well(s): (Permanent or ❑Temporary Signature of Certified Well Contractor Date
By signing This form.J hereby certify Arai dre im/Ift)was(were)c•anstnaved a ac•eortkac a with
7.Is this a repair to an existing well: ❑Yes or MNo 15A N(A('02(' 0100 ar 15A NCAC 02C.0200 Well Conrrrucriarr Srorulard,and that a ci In
if a rep,ur.fill Out kn,nrn well ciursrrtierian infbi anon and,:/Naar the nature of 1he of'ihis record hors been pr•trided u)Ifte well awner.
repair under ?i rernnrkr ere•uon nr un rlh•back i f rJrir forne
23.Site diagram or additional well details:
8.For Geoprobe/DPT or Closed-Loop Geothermal 11 ells 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 wells (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: 110.0 (fl.)
i•,-r uwbrple.allc list all dcluhs if'di#erent h iamI4-3a:200 and her lW') Submit this GW-I within 30 days of well completion per the following:
29•67 24a. For All Wells: Original form to Division of Water Resources (DWR).
10.Static water level below top of casing: (ft.) Information Processing Unit, 1617 MSC,Raleigh,NC 27699.1617
q unrer l;rri,.uhnre casnrl; tare�.
11.Borehole diameter: 10•0 (in,) 24b. For lnjection Wells:Copy to DWR, Underground Injection Control 0UC)
Program, 1636 MSC,Raleigh,NC 27699-1636
12.well construction method: AIR 24c.For 11'ater Su I and O en-Loo Geothermal Return 1Yells:Copy to the
(ix auger.rotary.cable,direct push,etc) county environmental ealth epartmenl of the county where insfa ed
FOR WATER St PPLY WELLS ONLY: 24d. For Water Wells producing over 100 000 GPD: Copy to DWR.CCPCI. A
13a.Yield(gpm) Method of test: Permit Program, 1611 MSC,Raleigh, C 7 l 1
13h.Disinfection type: Amount:
Fonn GW.I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-201 B

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
Wei.Contractor Name FROM R. TO DFSCRIPTION
R.
A 2581 ft. ft.
NC Well Connaciar Certification Number IS.OUTER CASING for mold-cored wells OR LINER if a liable
GEOLOGIC EXPLORATION FROM TO DIAMETER THICKNESS MATERIAL
n. n. ln.
Company Name 16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#' FROM TO DIAMETER I THICKNESS MATERIAL
l.ml all applicable well canriraetton Immuls(t e.!//(;Couny'•State,Variance,etc) 0.0 ft• 120.0 fl' 6.0 in' SCH 40 PVC
3,Well Use(check well use): ft• ft' in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
OAgr[cultural OMunicipal/Public 120.0 f• 140.0 ft 6.0 in- .010 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) OResidential Water Supply(single) n ft in.
0Industrial/Commercial ❑Residential Water Supply(shared) IR,GROVT
Oirrigation ❑Wel Is> 100,000 GPD FROM I To MATERIAL EMPLACEMENT METHOD&AMOL Nr
Non-Water Supply Well: 0.0 ft• 20.0 ft- AQUA GUARD SLURRY
09Monitoring ❑Recovery fr. ft.
Injection Well:
R. ft.
OAquiter Recharge ❑Groundwater Remedtation
19.SAND/GRAVEL PACK ifa Ilcable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL I EMPLACEMENT aIMIOD
DAquifer Test ❑Slormwater Drainage 25.0 ft- 145.0 ft' 20-40 FINE SILICA SAND
OExperimental Technology ❑Subsidence Control n• ft.
❑Geothermal(Closed Loop) OTracer 26.DRILLING LOG attachadditional sheets if necessary)
❑Geothermal(Heating/Cooling Return) OOther(explain under#21 Remarks) FROM
n• TS 0 ft. BROWN SILTY SAND DESCRIPTION `B rain sim,etc.
0
4.Date Well(s)Completed: 09/13/22 Well ID# IW-26 5.0 n 19.0 fr• TAN SILTY SAND
Sa.1Ve11 Location:
19.0 f0 21.0 fr' PWR
BELEWS CREEK STEAM STATION 21.0 ft• 1450 f• ROCK
Facility/Owner Natne Facility ID#(ifopplicable) R. ft.
3195 PINE HALL ROAD BELEWS CREEK 27009 ft. ft.
Physical Address,City,and Zip ft. ft.
STOKES 21.REMARKS
County Parcel Identification No.(P.N) BENTONTTE SEAL-20.0-25.0 FEET
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
i if well field,one laVlong is sufficient) 22.Certification:
928957.8943 N 1681230.017 W f: G'y- 09/19/22
6.Is(are)the well(s): TPermanent or ❑Temporary Signature ofCeriifted Well Contractor Date
l)j'srknargrbee fiirni,llterchviceraJ)diet the the/l{s)was(irere)ranctrnered nr.rrrar:/im r rrlr
7.Is this a repair to an existing well: [-.Yes or MNo 15A N(4,1 02C 0100 or ISA N(Al 02('.1111N1 Nell('onsirtreiinit.Ytatulard+and ilurl,,,•itpt
,f'ihis is it repair,fill nor ktunrir tell cnnsvna tine,nJornration and rxlilonr Ilse nature of dre nl this rrcan!leas brenptvn'nlcd ro die cell oevrer.
repair render 1l rranrrkr.ruc nun ar nn the brnk ref deieJarrn
23.Site diagram or additional well details:
9.For Geoprobe/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 1 GW-I is needed Indicate TOTAL NUMBER of wells (add'See Over in Remarks Box).You may also attach additional pages if necesser%
drilled 24.SUBMITTAL INSTRUCTIONS
0
9.Total well depth below land surface: 140. (ft.) Submit this GW-I within 30 days of wet]completion per the following:
irr multiply irell.s hsi all depihs if'diflerew(example-3C(b,2 1'anti a IIF!')
l0.Static water level below top of casing: 20.09 (ft-) 24a. For All Wells: Original form to Division of Water Resources (DWR).
�Ji.attaticer isahrele el being use•• Information Processing I init, 1617MSC,Raleigh,NC 27699-1617
1 I.Borehole diameter: 10.0 (in) 24L For Injection Wells:Copy to DWR,Underground Injection Control (It IC)
Program, 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: AIR 24c.For Wafer Su I and O en-Lo0 Geothermal Return Wells:Copy to the
(re.auger,rosary,cable,dire`[push,etc) county environmental ealih department o t e county where installed
FOR WATER St,PPLY WELLS ONLY: 24d. For Wafer Wells roducin over 100000 GPD: Copy to DWR.CCPCI�A
Permit Program, A,I M C,Raleigh,NC 27699-1611
13a.Yield(gpm) Method of lest:
13b.Disinfection type: Amount:
Form GW-I North Carolina Department of Environmental Quality•Division of Water Resources Re+ised 6.6.2018

WELL CONSTRUCTION RECORD GW-I For Internal Use Only:
I.Well Conlractor Information:
BRIAN THOMAS 14.WATER ZONES
FROM TO DESCRIPTION
We]Contractor Nsn•e ft. fi
A - 2581
n. n.
NC Well Conrractrr("cri fic2tion Nunber IS.OUTER CASING for multi-cased wells OR LINER if■ [icable
GEOLOGIC EXPLORATION FROM TO DIAMETER THICKNESS MATERIAL
ft. ft. ia.
Company Name 16.INNER CASING OR TUDING(geothermal closed-too
2.Well Construction Permit hl: FROM TO DIAMETER THICKNESS MATERIAL
i;.,r nil apphcahle ire!!canstrue Tian prrnrirs{i.r 11!(:(boom.,kare I nrianee rrc J 0,0 n• 90.0 n 6.0 In- SCH 40 PVC
3.Well Use(check well use): ft. ft. in.
17.SCREEN
Water Supply Well: FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
❑Agricullural OMunicipal/Public 90.0 f�• 110.0 f' 6.0 1 ' .010 SCH 40 PVC
OGeothenmal(Heating/Cooling Supply) ❑Residential Water Supply(single) n n in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Irri atiOn ❑Wells>100,000GPD FROM I TO MATERIAL EhtPLACEMENTMETHOD&AMOUNT
Non-Water Supply Well: 0.0 n• 20.0 ft- AQUA GUARD SLURRY
19Monitonng 0Recovery
Injection Well:
R. R.
❑Aquifer Recharge ❑Groundwater Remediation
19.SANDlCRAVEL PACK ifs lieahle
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO I MATERIAL I EMPLACEMENTMETHOD
❑Aquifer Test ❑Stormwaler Drainage 25.0 n• 115.0 tr• 20-40 FINE SILICA SAND
OExperimental Technology ❑Subsidence Control ft. a.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) FROM To DESCRIPTION color,hardness,soiltirtx1s;type.iti-ain size.etc.
0.0 ft- 8.0 n• BROWN SILTY SAND
4.Date Well(s)Completed: 09/14/22 WeII IDN IW-27 8.0 ft• 18.0 fL TAN SILTY SAND
Sa.Well Location: 18.0 ft. 24.0 ft. PWR
BELEWS CREEK STEAM STATION 24.0 ft- 115.0 n• ROCK
Facility/Owner Namc Facility[Do(if applicable) n. ft.
3195 PINE HALL ROAD BELEWS CREEK 27009 ft. ft.
Physical Address,City,and Zip ft. 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:
f if well field,one tattlong is sufficient) 22.Certification:
928985.7420 N 1681255.205 W 09/19/22
6.Is(are)the well(s): BPermanent or ❑Temporary Signature of Certified Well Contractor Date
Hy signing rhis)orm,11terehycera)y dwi the wettl(c)ryas(here)conciracaal in crecareharee uvh
7.Is this a repair to an existing well: ❑Yes or MNo 15A N(.4('f)2(' 0100 or 15A N(AC 02C.0200 Well(brisiriwiirm Stamlardc and their it ra/ri
,I'rhis is a repair,fill out known hell cmisrruc Pion injornralion and e.rplain die nature of the (if this record lws been provided ai,the hell owner.
repair mrdrr :!rxnrarkc serrimr ar mr lire hack of dos farm
23.Site diagram or additional well details:
8.For Ceoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well construction mlo
construction,only I GW-I is needed Indicate TOTAL NUMBER of wells (add'See Over in Remarks Box) You may also attach additional pages d•nccessan
drilled. 24.St BMITTAL INSTRUCTIONS
9.Total well depth below land surface: 110.0 (ft.)
i lrrnndtiple hells list all depths iirl!#erem(extuni le-3gt,.TIk and 2a lim.) Submit This CN'-1 within 30 days of well completion per the following:
36.25 24a. For All Wells: Original form to Division of Water Resources (DWR).
10.Static water level below top of casing: (ft.) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
f irahrlcrc!is above casing.use..
11.Borehole diameter: 10.0 (in) 24b. For Infection 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 Supply and Open-Looe Geothermal Return Wells:Copy to the
(i.e.auger,rotary,cable,direct push,etc) county environmental health department of the county w ere Installed
FOR WATER SUPPLY WELLS ONLY: 24d,For Water Wells producing over 100,000 GPD: Copy to DWR,CCPCUA
13s.Yield(gpm) Method of test: Penn it Program, 1611 MSC,Raleigh,NC 2 7699-1 6 1 1
13b.Disinfection type: Amount:
Form GW-I North Carolina Depannienl orEnvrronmental Quality-Division of Water Resources Revised 6-6-2018

WELL CONSTRUCTION RECORD For Internal Use ONLY
This form can be used for single or multiple wells
1.Well Contractor Information:
BRIAN THOMAS 14.WATERZONES
FROM m DESCRIPTION
Well Contractor Name ft. ft.
A - 2581 ft. tt.
NC Well Contractor Certification Number IS.OUTER CASING for T!!I cased wells OR LINER if a licable
PROM TO DIAMETER THECKNE$$ MATERIAL
GEOLOGIC EXPLORATION, INC ft. ft. is
Company Name 16.INNER CASING OR TUBING eothermal closed-loop)
FROM TO DIAMETER THICKNESS MATERIAL
2.Well Construction Permit#: 0.0 ft' 148.0 R' 6.0 1°' SCH 80 PVC
1.isr all applicable 112•Il construction pernitts(i.e.Couny,Score,Variance,en.J
ff. ft.
3.Well Use(check well use): 17.SCREEN
Witter Supply Well: PROM TO DIAMETER SLOTSIZE I THICKNESS I MATERIAL
❑Agricultural ❑Municipal/Public 148.0 f'' 168.0 f` 6.0 rn .020 SCH 80 SS
❑Geothermal(Heating/Coohng Supply) ❑Residential Water Supply(single) ff' ft. ie
Olndustnal/Commercial []Residential Water Supply(shared) Ili•GROUT
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Dirrigation
20 f' 20.0 f' vpgrUWDaEN70NRE SLURRY
Non-Water Supply Well:
OMomtoring ORecovery I+• fr.
Injection Well: ft. ft.
❑Aquifer Recharge OGroundwater Remediation 19.SANDiGRAVEL PACK orapplicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑StormwaterDrainage 30.0 ft- 172.0 ft. 20-40 FINE SILICA SAND
❑Experimental Technology ❑SubsidCnCC Control 20.DRILLING LOG lattagch additional sheets if necessary)
❑Geothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION rolur,herdn ess,soiVrxk typl,grain size.err.
❑Geothermal(Heating/Cooling Return) OOther(explain under#21 Remarks) 0.0 fr 1&0 I'L TAN SILTY SAND
4.Date Well(s)Completed:
11/16/20 Well IDN IW-28 16.0 f' 23.0 iL BROWN SILTY SAND
23.0 ft- 35.0 ft- PWR
Sa.Well Location: 35.0 ft' 172.0 n ROCK
BELEWS CREEK STEAM STATION D. n.
Facility/Owner Name Facduv ID#(ifapplicable)
319S PINE HALL ROAD BELEWS CREEK 27009 f< ft
fr. fr.
Physical address,City,and Zip 21.REMARKS
STOKES BENTONrrE SEAL-20.0-30.0 FT (WIRE WRAPPED SCREEN)
Countv Parcel Identification No(PINJ
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification:
(if well field,one laVlong is sufficient)
360 17' 31.79" N 800 03' 50.88" W _ � 12/15/20
Signature of Certified Well Contractor Date
6.Is(are)the well(s): oPermanent or OTemporary
By signing this form,1 hereby c•rrlify that the ue!!(s)n•as(here)canrrrucred in aa'ordance
tvnh 15A NCAC 01C 0100 or 15A NCAC 01C.0100 Well Ctnistruclion Sraulardr anrl than a
7.Is this a repair to an existing well: OYes or ElNo copy afthis record has been provided to the well owner
lfdnix is a repair,fill out knairn hell construction lirforrianon and explain the nature ofihe
repair under-21 remarks.cecuan or an the hack afthis forru. 23,Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
S.Number of wells constructed: 1 construction details. You may also attach additional pages if necessary
l itr andriple ityection or nan•irarer snpply irells ONLY iriih the sane construction,am can
suhtniianefinnr. SUBMITTAL INSTUCTiONS
9.Total well depth below land surface: 168.0 (ft.) 24a. For All Wells: Submit (his form within 30 days of completion of icell
har nni tiple hell list all depths I dWerem(example-3 rt 200 and 21ir100') construction to the following:
10.Static water level below lop of casing: 31.0 (ft) Division of Water Quality,Information Processing Unit,
iJ'iiater level is abore casing,are ' " 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 6.0/12.0 (in.) 24b. For Infection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12.Well construction method: AIR construction to the following:
(i.e.anger,rotary•cable,direct push,etc)
Division of Water Quality,Underground injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
13a.Yield(gpm) Method of lest: 24c.For Water Supply&Injection Wells: In addition to sending the form to
- the address(es) above, also submit one copy of this form within 30 days of
13b.Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-1 North Carolina Department of Emironment and Natural Resources Division of Water Quality Revised Jan.2U 0,

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
ft. It
A - 2581
NC Well Comracl Certificati m Number 15.OUTER CASING for muttl-cased well OR LINER if a labia
GEOLOGIC EXPLORATION FROM Tn DIAMETER THICKNESS MATERIAL
ft. rt. in.
Company Name
16.INNER CASING OR TiIBING teeetbermall d -loo
2.Well Construction Permit H: FROM TO DIAMETER THICKNESS I MATERIAL
List all applicable well construction permits Q.e.UIC,County,Stale, Variance,etc.) 0.0 R• 64.0 n- 6.0 ID SCH 40 1 PVC
3.Well Use(check well use): h• ft {tl
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 64 0 fL 84.0 ft 6.0 Ia .010 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in
❑Ind ustrial/Commercial Cl Residential Water Supply(shared) 18.GROUT
❑lrri ation ❑Wells>100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOIIN7
Non-Water Supply Well: 0.0 n• 20.0 IL AQUA GUARD SLURRY
i9Monitoring ❑Recovery ft. ft.
Injection Well:
ft. ft
El Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK If a Ilcable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL I EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage 25.0 ft- 89.0 ft• 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control ft. ft
[]Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets If neccssa
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 421 Remarks)' FROM TO DESCRI]MON color,bards -Rtmc4 type,smin etc.
0.0 ft• 21,0 ft BROWN SILTY SAND
4.Date Well(s)Completed: 07/06/22 Well IDq IW-29 21.0 f" 35.0 fL TAN SILTY SAND
Sa.Well Location: 35.0 n' 47,0 n- PWR
BELEWS CREEK STEAM STATION 47.0 ft- 89.0 ft ROCK
Facility/Owner Name Facility lDH(ifapplicable) ft. ft
3195 PINE HALL ROAD BELEWS CREEK 27009 ft. It
Phys LAI Addre»,City,and lip ft. ft
STOKES 21.REMARKS
County Parcel Identification No.(PIN) SENTONITE SEAL-20.0-25.0 FEET
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwefl field,one IaUlong is sufficient) 22.Certification:
928518.8093 N 1680688.193 W4% fir-" 07/18/22
6.Is(are)the well(s): IalPermanent or ❑Temporary Signatureol'Certified Well Contractor Date
By signing(his form,I hereby cert!&Boar the wells)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or LINO 15A NCAC 01C.0100 or 15A NCAC 02C.0100 Well Construction Standards and that a„+pi
if this is a repotr,fell out known well construction informoo,w and explmn the nature of the ofihis record has been provided to the well owner.
repair under till remarks section or on the ba.k,f this f rm
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 info
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
9.Total well depth below land surface: 84.0 (ft)
for m0iple wdfs list all depths if'different(example-3@200'and 1Q100) ) Submit this GW-1 within 30 days of well completion per the following:
10.Static water level below top of casing: 47.0 (ft) 24a. For All Wells: Original form to Division of Water Resources (DWR),
.'f x�mrr level a above caring,use "'"
Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter: 10.0 (in) 24b. For Injection Wells:Copy to DWR,Underground Injection Control(IUC)
AIR Program, 1636 MSC,Raleigh,NC 27699-1636
i.e Well construction method: 24c.For Water Su ! and Open-Loop Geothermal Return Wells:Copy to the
(i.e.auger,rotary,cable,dvccl posh,etc.)
county envtronmenaa health department ofthe county where installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100 OUO GPD:Copy to DWR,CCPCUA
Permit Program, MSC,Raleigh, -1 I 1
13a.Yield(gpm) Method of test:
13L Disinfection type: Amount:
Form G W-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2:i IS

WELL CONSTRUCTION RECORD For Internal Use ONLY
This form can be used for single or multiple wells
I.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
FROM TO DESCRIPTION
Nell Contractor Name ft. ft.
A - 2581 n. ft.
NC Well Contractor Certification Number IS.OUTER CASING Ifor T!lti cased wells OR LINER if go Ucable
FRUM TO DIAMETER THICKNESS MATERIAL
GEOLOGIC EXPLORATION, INC rt. rr. is
Company Name 16.INNER CASING OR TUBING(geothermal closed-too
FROM TO DIAMETER THICKNESS MATERIAL
2.Well Construction Permit#: 0.0 rr. 149.0 R' 6.0 in. SCH 80 PVC
List all applicable it-ell conitraction permits(i.e Couny-.Stare,Variance,ere.)
ft. R. is
3.Well Use(check well use): 17,SCREEN
Water Supply Well: FROM TO DIAMETER I SLOTSIZE I THICKNESS MATERIAL
OAgncultural OMunicrpal/Public 149.0 n' 169.0 n 6.0 in. .020 SCH 80 SS
OGeolhermal(Hea(ing/Cooling Supply) ❑Residential Water Supply(single)
01ndustnal/Commercial 0Residential Water Supply(shared) 13.GROUT
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
❑I 20 ft. 200 ft' KMANDSENTONRE SLURRY
Nonni Iron-Wafer Supply Well: R. ft.
OMonitormg ❑Recovery
Injection Well:
❑Aquifer Recharge OGroundwaler Remedial ion 19,SANDIGRAVEL PACK ire licable
FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Storage and Recovery ❑Salinity Barrier 30.0 ft• 174.0 n' 20-40 FINE SILICA SAND
❑Aquifer Test ❑Stormwater Drainage
R. H.
❑Experimental Technology ❑Subsidence Control
20.DRILLING LOG attach additional sheets if necessa
❑Geothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION color,bardoess soi0rock rain sire,ter.
❑Geothermal(Heat in Coohn Return) OUther(ex lam under#21 Remarks) 0.0 ft. 16.0 ti• TAN SILTY SAND
4.Date Well(s)Completed:
11/18/20 Well IDIt IW-30 16.0 ft, 21.0 R• BROWN SILTY SAND
21.0 ft. 34.0 ft, PWR
So.Well Location: 34.0 ft• 174.0 D' ROCK
BELEWS CREEK STEAM STATION r�. n.
Faeilnv 0waer Name Facility iDd(,fappl,cable) ft it
3195 PINE HALL ROAD BELEWS CREEK 27009
ft. R.
Physical Address,City,and Zip 21.REMARKS
STOKES BENTONITE SEAL-20.0-30.0 FT (WIRE WRAPPED SCREEN)
County Parcel Identification\o-(PIN)
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification:
(,fwell field,one Iatllong is sutric,cnt)
36° 17' 31.79" N 80° 03' 50,88" \\, �1`'I 12/15/20
Signature ofCert,fred Well Contractor Date
6.Is(are)the well(s): OPermanent or OTemporary y signing J fy () (were)H .a nrrr this arnr,1 hereby cirri that the+cells u•as +rrrr cnnsrrucred in accanlanrr
,rich 13A NCAC 02C 0100 or 1 SA N(AC 02(' 0200 Well Convirucrion Standards and that a
7.Is this a repair to an existing well: ElYes or DNo copy of tins record has beeir provided to the irell otener
If this is it repair,fill out known sell construction inJnrmalion and explain tire nature aJ the
relxur under--21 renrarks aec•rion or on fire back ry this farm. 23,Site diagram or additional well details:
You may use the back of this page to provide additional we:I site details or «ell
8.Number of welts constructed: 1 construction details You may also attach additional pages if necessary
tar mub.ple byecncm or iron-water supply wells ONLY it-rib ilk same construction for con
,ubnntrnteform SUBMITTAL INSTUC'TIONS
9.Total well depth below land surface: 169.0 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
1-i,r rnrdiiple,•ells lot all depths if diJJerern(example-3 rt 200'an!1(4( 0tr) construction to the following:
10.Static water level below top of casing: 31.0 (ft) Division of Water Quality,Information Processing Unit,
if fiat.tie,.!is above caving.use•��" 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 6.0/12.0 (in) 24b. For Infection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of wril
12.Well construction method: AIR construction to the following:
0 a auger,rotary,cable,direct push,etc)
Division of Water Quality,Underground injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
13a.l ield(gpm) Method or test: 24c.For Water Supply&Injection Wells: In addition to sending the form to
- the address(es) above, also submit one copy of this form within 30 day-, of
13b.Disinfection type: Amount completion of well construction to the county health department of the county
where constructed
Form GW-I North Carolina Department of Environment and Natural Resources-Division of Water Vualiy Res iced lira 2013

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
ft. ft.
A - 2581
NC Well Contractor Certification Number 15.OUTER CASING for multi-cased wells OR LINER ifs licsble
GEOLOGIC EXPLORATION FROM TO DIAMETER THICKNESS MATERIAL
It. ft. in.
Company Name
16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#: WI0400551/WV0400056 FROM I TO I DIAMETER I THICKNESS MATERIAL
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.) 0.0 ft. 147.0 it' 1 6.0 t"' I SCH 80 1 PVC
3.Well Use(check well use): ft. I ft. I in.
Water Supply Well: 17.SCREENFROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 147.0 ft. 167.0 r" 6.0 in. .020 SCH 80 SS
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Irrl ation ❑Wells>100,000 GPD FROM I TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 2.0 ft. 20.0 ft' PORTIANDBENTONITE SLURRY
❑Monitoring ❑Recovery ft. ft.
Injection Well:
ft. ft.
❑Aquifer Recharge 15Groundwater Remediation
19.SAND/GRAVEL PACK if a livable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑StormwaterDrainage 30.0 ft- 172.0 ft- 20-40 FINESILICASAND
❑Experimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary)
❑Geothermal(HeatinglCooling Return) ❑Other(explain under#21 Remarks) FROM TO DESCRIPTION color,hardness,soil/rock type,grain size,etc.
0.0 ft- 17.0 fit- TAN SILTY SAND
4.Date Well(s)Completed: 1 1/18/20 Well ID# IW-31 17.0 ft• 21.0 ft• BROWN SILTY SAND
5a.Well Location: 21.0 it' 26.0 PWR
BELEWS CREEK STEAM STATION 26.0 it• 172.0 n• ROCK
Facility/Owner Name Facility ID#(if applicable) ft. ft.
3195 PINE HALL ROAD BELEWS CREEK 27009 ft. ft.
Physical Address,City,and Zip ft. ft.
STOKES 21.REMARKS
County Parcel Identification No.(PIN) BENTONITE SEAL-20.0-30.0 FT(WIRE WRAPPED SCREEN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one lat/long is sufficient) 22.Certification:
360 17' 31.79" N 800 03' 50.88" W �,;" ,,_-
12/31/2020
6.Is(are)the well(s)• 091'ermanent or ❑Temporary Signature of Certified Well Contractor Date
By signing this form,1 hereby certify that the well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or INNo 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy
If this is a repair,fill out known well construction information and explain the nature of the ofthis record has been provided to the well owner.
repair under#21 remarks section or on the back ofthis 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 info
construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells (add'See Ovee in Remarks Box).You may also attach additional pages if necessary.
drilled: 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 167.0 (ft.)
For multiple wells list all depths ifdii ferem(example-3@200'and 2@100') Submit this GW-1 within 30 days of well completion per the following:
31.0 24a. For All Wells: Original form to Division of Water Resources (DWR),
If water level is above casing,use"+
f Static water level below top of casing: (ft.) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
"
11.Borehole diameter: 6.0/12.0 (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.Yield(gpm) Method of test: Permit Program,1611 MSC,Raleigh,NC 27699-1611
13b.Disinfection type: Amount:
Form G W-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018

WELL CONSTRUCTION RECORD(GW_11 For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
Well Contractor Name
FROM TO I DESCRIPTION
A - 2581 ft. IL
ft. it.
NC Well Contractor Certification Number 15.OUTER CASING form b
ETETH MT N
IALGEOLOGIC EXPLORATION R
ft. ft. iR
Company Name
16.INNER CASING OR TUBING eothermal closed-loo
2.Well Construction Permit#: FROM TO I DIAMETER I TIIICKNESS IMATERIAL
List all applicable hell construction permits(i.e.UIC,County,State,Vartwrce,eic) 0.0 ft- 85.0 IL 6.0 la SCH 40 PVC
3.Well Use(check well use): ft. ft. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE THICI04 ESS MATERIAL
DAgricultural ❑MunicipaUPublic 85.0 it. 105.0 it. 6.0 I°' .010 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. n• in.
Dlndustrial/Commercial ❑Residential Water Supply(shared) 18.GROAT
01rTigation OWells> 1000OOGPD FROM TO MATERIAL Em PLAcEm ENTMETHOD h AMOUNT
Non-Water Supply Well: 0.0 it• 20.0 ft- AQUA GUARD SLURRY
MMonitoring DRecovery ft. ft.
Injection Well: It. ft.
DAquifer Recharge ❑Groundwater Remediation
19.SANDIGRAVEL PACK If a licable
DAquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLA CEMENTMETHOD
❑Aquifer'rest DStotmwater Drainage 25.0 it. 110.0 ft. 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control ft. it.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necesaa
❑Geothermal(Heat in Cool ing Return) ❑Other(explain under#21 Remarks) FROM To DESCRIPTION color,bardness,saivrock CyM grain size etc.
0.0 n 17.0 it RED SILTY CLAY
4.Date Well(s)Completed: 07/05/22 Well ID# IW-32 17.0 n 20.0 it BROWNJAN SILTY SAND
5a.Well Location: 20.0 n' 57.0 it PWR
BELEWS CREEK STEAM STATION 57.0 ir• 110.0 it ROCK
Facility/Owner Name Facility lD#(ifappbcable) ft. rL
3195 PINE HALL ROAD BELEWS CREEK 27009 ft. fI
Physical Address,City,and Zip ft. ft
STOKES 21.REMARKS
County Parcel Identification No.(PIN) BENTONITE SEAL-20.0-25.0 FEET
5b.Latitude and longitude in degrees/niinutes/seconds or decimal degrees:
(ifwell field one Iat/long is sufficient) 22.Certification:
928583.3851 N 1680790.317 W �e/ _ 0'r - 07/18/22
6.Is(are)the well(s): 19Permanent or ❑Temporary Signature of Certified Well Contractor Date
BY signing this form,1 hereby certify that the well(s)was(were)comiructed in accordance with
7.Is this a repair to an existing well: ❑Yes or ONo 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy
If ibis is a repair,ft11 out known well construction information and explain the nature oJ'the ofthis record has been provided to the well owner
repair under e21 remarks section or on the back of this farm.
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 info
construction,only 1 G W-I is needed. Indicate TOTAL NUMBER of wells (acid'See Over'in Remarks Box).You may also attach additional pages if necessary
drilled: 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 105.0 (ft.)
/'or multiple wells list all depths ifdrfferent(example-3@200'and 2@1003 Submit this GW-1 within 30 days of well completion per the following:
51.0 24m. For All Wells: Original form to Division of Water Resources (DWR),
f voter level is above casing,use"+"Stalk water Ievel below fop of casing: (f-) Information Processing Unit, 1617 MSC,Raleigh,NC 27699-1617
If
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 0 n-Lon Geothermal Return Wells:Copy to the
(i.e.auger,rotary,cable,direct push,dc.) county environments eat epartment o e county wfiere installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over]00 000 GE): Copy to DWR,CCPCUA
Permit Program,l M Ra el 7 -1 I I
13a.Yield(gpm) Method of test:
13b.Disinfection type: Amount:
Form GW-1 Nonh Carolina Department of Enviroitrnental Quality-Division of Waler Resources Revised 6-6-2019

WELL CONSTRUCTION RECORD r7a
I Use ONLY.
This form can be used for single or multiple welts
I.Well Contractor Information:
BRIAN THOMAS 14.WATERZONES
FROM TO DESCRIPTION
Well Contractor Name ft. R.
A - 2581 ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING for multi caned wells OR LINER if a lieoble
FROM To DIAMETER THICKNESS MATERIAL
GEOLOGIC EXPLORATION, INC h. I rt. I in.
Company Name 16.INNER CASING OR TUBING(geothermal clmed4tio
FROM TO DIAMETER THICKNESS MATERIAL
2.Well Construction Permit N: 0.0 ft. 149.0 ft. 6.0 '"' SCH 80 PVC
List at/applicable irell construction pernniis(P.a('non)',Srate flariance,etc)
ft. R. iri.
3.Well Use(check well use): 17.SCREEN
Water Supply Well: FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
❑Agruultural ❑Municipal;Public 149D ft' 169.0 fL 6.0 "' .020 SCH 80 SS
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) R. I R. im
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Dirrigation
Non-Water Supply Well: 20 f0' 20.0 R' FORTIANDBENTONRE SLURRY
❑Monitoring ❑Recovery R. R
Injection Well: ft. R.
❑Aquifer Recharge laGroundwater Remediation 19.SANDIGRAVEL PACKS lif applicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO I MATERIAL I EMPLACEMENTMEI'HOD
❑Aquifer Test OStormwater Drainage 30.0 ft 174.0 ft- 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control fr R
20.DRILLING LOG attach additional sheers if necessary)
❑Geothermal(Closed Loop) OTracer FROM TO DESCRIPTION color,hardnM soillrotk type,crain fin,etc.
❑Geothermal(Heat mg/Cool m Return) DUther(explain under#21 Remarks) 0.0 R• 17.0 It. TAN SILTY SAND
4.Date Well(s)Completed:
11/18/20 WeI11Dq IW-33 17.0 ft. 24.0 R• BROWN SILTY SAND
24.0 R 38.0 fr- PWR
5a.Well Location: 38.0 R 174.0 R' ROCK
BELEWS CREEK STEAM STATION
R. R.
Faciliry Owner Name Facility ID*(ifappficable) ft R
3195 PINE HALL ROAD BELEWS CREEK 27009
R. ft.
Physical Address,City,and Zip
21.REMARKS
STOKES BENTONITE SEAL-20.0-30.0 FT (WIRE WRAPPED SCREEN)
County Parcelldenbf:anon No.(PIN)
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification:
(ifwell field,one laillong is sufficient)
36o 17' 31.79" N 80° 03' 50.88" \\, 12/15/20
Signature of Certified Well Contractor Date
6.Is(are)the well(s): OPermanent or ❑Temporary gJr signing dric Jarnn.1 hereby cerrif),flint the u•e/ifc)irar there)cansirnc•ied m actanluin r
with 15A N(AC 02C 0100 or 15A W AC 02(- 0200 Well('oRstraction.Amulardi ai)ll shut it
7.Is this a repair to an existing well: Oyes or EINo cop),ojihis record hac been prorided to the well ou•rier
If ilim is a repair,Jill ow known rreU constriction infinrnwnair and explain dre naitire of'me
repair canter,21 renrarki section ar on the back cq'ihis%aria 23.Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
8.Number of wells constructed: 1 construction details You may also attach additional pages if necessary.
1 iir nredliple,njecuon ar man.n•:nrr supply wells ONLY o•nh 11re same construction.you can
.vuboi+one•farm. SUBMITTAL iNSTL_f CTI ONS
9.Total well depth below land surface. 169.0 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of+vc:I
1 iir oalnple ire/Li list ail depth,it different(example-J a200'arrd 2,,Ii 1/0'I construction to the following
10.Static water level below top of casing: 31.0 (ft.) Division of Water Quality,Information Processing Unit,
1(,iaar!reel rr above casing.ii,e'• - 1617 Mail Service Center,Raleigh,NC 276994617
11.Borehole diameter: 6.0/12.0 (in.) 24b. For lniection Wells: In addition to sending the form to the address in 241
above, also submit a copy of this form within 30 days of completion of well
12.Well construction method: AIR construction to the following.
(i.e.auger,rotary,cable,direct push,etc)
Division of Water Quality,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY. 1636 Mail Service Center,Raleigh,NC 27699-1636
13a.Yield(gpm) Method of test: 24c.For Water Suably&Injection Wells: In addition to sending the form to
the address(es) above, a:so submit one copy of this form within 30 days of
13b.Disinfection type: Amount: completion of well construction to the county health department of the county
- where constructed
Form GW-1 North Carolina Department of Environment and Nalrual Resources Division or water Quality Revised Jan ?01?

WELL CONSTRUCTION RECORD(GW-I) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
Well Contracts\ame FROM TO DESCRIPTION
[t. fL
A - 2581
rt. ft.
NC Well Contractor Certification Number IS.OUTER CASING 11or multi cased welts OR LINER If a ]kable
GEOLOGIC EXPLORATION FROM To DIAMLTCR THICKNsss MATERIAL
re. tL in.
Company Name 16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit u: FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(t.e.UIC.County,State,Variance,etc) 0,0 ft- 65.0 ft- 6.0 I° I SCH 40 PVC
3.Well Use(check well use): It. ft in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 65.0 ft- 85.0 ft' 6.0 ln. .010 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) It. ft. fa
❑IndustriaUCommercial ❑Residential Water Supply(shared) 19.GROUT
❑lrrl atlon ❑Wells> IDO,WO GPD FROM I TO MATERIAL EMPLACEMENT METHOD&AMOIM
Non-Water Supply Well: 0.0 ft• 20.0 fL AQUA GUARD SLURRY
©Monitoring ❑Recovery O. It.
Injection Well:
fr. ft.
❑Aquifer Recharge ❑Groundwater Remediation
19,SANDJCRAVEL PACK if applicable)
❑Aquifer Storage and Recovery OSalinity Barrier FROM To MATERIAL EMPLACEMENT METHOD
El Aquifer Test ❑Stonnwater Drainage 25.0 ft- 105.0 fL 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control ft. fL
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG Which additional sheets if necessary)
❑Geothermal(Heat in Cool ing Return) ❑Other(explain under 421 Remarks) FROM TO DESCRIPTION color,haviftiess,wiliroe4 tyM grain siz,,etc-
0.0 ft. 8.0 fL BROWN SILTY SAND
4,Date Well(s)completed: 07/14/22 Well IDt# IW-34 8.0 ft- 25.0 fL TAN SILTY SAND
5a.Well Location: 25.0 f- 63.0 f" PWR
BELEWS CREEK STEAM STATION 63.0 fL 105.0 fL ROCK
Facility/Owner Name Facility 1D#(ifapplicable) ft. fL
3195 PINE HALL ROAD BELEWS CREEK 27009 ft. fL
Physical Address.Cin,and Zip ft. ft.
STOKES21.REMARKS
COUP'y Parcel Identification No.(PIN) BENTONITE SEAL-•20.0-25.0 FEET
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(dwell field, ne[at long is<u'fi.icnt;i 22.Certification:
928638.0444 N 1680868.251 W Ow- 07/18/22
6.Is(are)the well(s): OPermanent or OTemporary Signature ofCenified Well Contractor Date
Bysigningthis form,I herebycertlfy(bar the wells)was(were)construcled in accordance with
7.Is this a repair to an existing well: ❑Yes or RINo 15A NCAC 02C.0100 or 15A NCAC 02C 0200 Well Construction Standards and that a copy
lfthis rs a repair,fill out known well construction information and explain the nature of the afthls record has been provided To the well owner,
repair under 021 remarks section or on The back ofihts form.
23.Site diagram or additional well details:
8.For Geoprobe/DPT or Closed-Loop Geolhermal Wells having the same You may use the back of this page to provide additional well c:onstructi-_n info
construction,only I GW-I is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box) You may also attach additional pages i f ncces,.0
drilled: 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 85.0 00
i ormwiiple wells list all depths tfdii Brent(example-3@200'and 2Q100) Submit ibis GW-1 within 30 days of well completion per the following:
DRY 24a. For All Wells: Original form to Division of Water Resources (DWR),
fwater level it above casting,use"
10.Static water level below top, casing: ((L) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter: 10.0 (in) 24b. For Injection Wells:Copy to DWR,Underground Injection Control(IUC)
AIR Program, 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: 24c.For Water Su I and O n-Loo Geothermal Return Wells:Copy to the
(i.c,auger,rotary,cable,direct push,etc.) county environments eat apartment on
e county ere installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over l00I III GPD: Copy to DWR,CCPCUA
Permit Program,1611 M Raleigh, 7
13a.Yield(gpm) Method of test: I
13b.Disinfection type: Amount:
Form GW-1 North Carolina Department ofEnvironnientat Quality-Division of Water Resources Revised,-. a 18

WELL L CONSTRUCTION RECORD For Internal Use ONLY
This form can be used for single or multiple wells
I.Well Contractor information:
BRIAN THOMAS 14.WATERZONES
FROM TO DESCRIPTION
Well Contractor Name ft. R.
A - 2581 ft. ft.
NC Welt Contractor Certification Number IS.OUTER CASING for mnitiKaard wells OR LINER ifa Hcabk
FROM TO DIAMETER THICKNFS4 MATERIAL
GEOLOGIC EXPLORATION, INC o. ft. in.
Company Name 16.INNER CASING OR TUBING iffetitbermal elesed-Itio
FROM TO DIAMETER THICKNESS I MATERIAL
2.Well Construction Permit k: 0.0 R' 139.0 R' 6.0 1D SCH 80 PVC
List all applicable well construction permits(i.a County.State,Variance etc)
fr. ft. in.
3.Well Use(check well use): 17.SCREEN
Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
OAgricultural ❑Municipal/Public 139.0 h' 159.0 n' 6.0 in. .020 SCH 80 SS
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) f, I ft.
❑Industrial/Commercial OResidenttai Water Supply(shared) I&GROUT
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
C31rrigation 2.0 R• 20.0 R' "ILMDOINIONITE SLURRY
Non-Water Supply Well:
R n
❑Monitoring ❑Recovery
Injection Well: R. ft.
❑Aquifer Recharge ®Groundwater Remediation 19.SANDIGRAVEL PACK(if applicable)
❑Aquifer Storage and Recovery OSalinity Barrier FROM TO MATERIAL I
EMPLACEMENTME HOD
❑Aquifer Test ❑Stormwater Drainage 30.0 ft' 159.0 n' 20-40 FINE SILICA SAND
❑Experimental Technology OSubsidence Control
20.DRILLING LOG attach additional sheets if necessary)
❑Geothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION trolar,hardness,willreck type,grain sire,etc.
❑Geothermal(HeatinglCooling Return ❑Other(explain under#21 Remarks 0.0 I'L 14.0 R. TAN SILTY SAND
11/09/20 IW-35 14.0 21.0 R- BROWN SILTY SAND
4.Date Well(s)Completed: yYell IDq 21.0 ft• 38.0 ti PWR
52.Well Location: 38.0 n 175.0 ft• ROCK
BELEWS CREEK STEAM STATION rr R
Facility'Owner Namc Facility I DO(if applicable)
ft. R.
3195 PINE HALL ROAD BELEWS CREEK 27009 ft. R.
Physical Address,City,and Zip 21.REMARKS
STOKES BENTONITE SEAL-20.0-30.0 FT (WIRE WRAPPED SCREEN)
County Parcel Identification No (PIN)
5b.Latitude and Longitude in degrees/minules/seconds or decimal degrees: 22•Certification:
(if well field,one latllong is sufficient)
360 17' 31.79" N 800 03' 50.88" W _ 11/11/20
Signature of Certified Well Contractor Date
6.is(are)the well(s): UlPermanent or ❑Temporary By signing this form.I hereby certify that the irell(s)was(irere)constructed in accordance
with I SA N(AC 02C 0100 or I JA NCAC 02C 0200 Well Construction Standards and that a
7.Is this a repair to an existing well: ❑Yes or ElNo copy oftlris record has been provided to the hell owner
If this is a repair,fill out known well construction information and explain the nature of the
repair under:21 remarks section or on the back of ilns form 23.Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
8.Number of wells constructed: 1 construction details. You may also attach additional pages if necessary
Far multiple injection or non-irater supply irells ONLY irirh the same construction.you can
submit one form. SUBMITTAL INSTUCTIONS
9.Total well depth below land surface: 159.0 (It.) 24a. For All Wells: Submit this form within 30 days of completion of well
For mtilripde irells list all depths tf dtifferent(exanyde-3@200'and 2qt l00') construction to the following
10.Static water level below top of casing: 31.0 ln) Division of Water Quality,Information Processing Unit,
If Hater level is above casing use•' 1617 Mail Service Center,Raleigh,NC 2 7699-1 6 1 7
11.Borehole diameter: 6.0/12.0 (in.) 24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12.Well construction method: AIR construction to the following
(i.e auger,rotary,cable,direct push,etc)
Division of Water Quality,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
13a.Yield(gpm) Method of test: 24c.For Water Supply&injection Wells: In addition to sending the form to
the address(es) above. also submit one copy of this form within 30 days of
13b.Disinfection type: Amount: completion of wel; construction to the county health department of the county
where constructed
Form GW-I North Carolina Department of Environrnenl and Natural Resources-Division of Water Quality Revised Jan 2013

WELL CONSTRUCTION RECORD GW-1 For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
ft. ft.
A - 2581
ft. rt
NC Well Contractor Certification Number I&OUTER CASING for multitased well OA LINER If a Ilcable
GEOLOGIC EXPLORATION PROM TO DIAMETER THICIQJFss MATERIAL
R. ft. is
Company Name
16.INNER CASING OR TUBING eotbermal cloud-loo
2.Well Construction Permit q: FROM TO I DIAMETER ICIUtESS MATERIAL
List all applicable well construction permits(r.e.UIC.County,State, Variance,etc.) 0.0 ft, 65.0 fL 6.0 tn' SCH 40 PVC
3.Well Use(check well use): ft, IL In.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 65.0 R' 85.0 R• 6.0 in. 010 SCH 40 PVC
ft. r'
❑Geothermal(I leating/Cooling Supply) ❑Residential Water Supply(single)
❑industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT I in
❑Irri ation ❑Wells>100000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0.0 ft. 20.0 fL AQUA GUARD SLURRY
15Monitoring ❑Recovery R. fL
Injection Well:
R. fL
❑Aquifer Recharge ❑Groundwater Remediation
19.SANDIGRAVEL PACK if a Ikablc
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage 25.0 ft. 88.0 R' 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control ft. R.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional abetts if necessary)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks FROM TO DESCRUrnON mbr ba roivmxk rain rim etc.
0.0 R- 17.0 n BROWN SILTY SAND
4.Date Well(s)Completed: 07/1 5/22 Well IDP IW-36 17.0 R• 30.0 fL TAN SILTY SAND
5a.Well Location: 30.0 rt 62.0 R' PWR
BELEWS CREEK STEAM STATION 62.0 rt. 880 ft. ROCK
Facility/Owner Name Facility lDH(if applicable) ft. rt.
3195 PINE HALL ROAD BELEWS CREEK 27009 ft. fL
Physical Address,City,and Zip It. ft.
STOKES 21.REMARKS
County Parcel Identification No.(PIN) BENTONITE SEAL-20.0-25.0 FEET
5b.Latitude and longitude in degrees/tninutes/seconds or decimal degrees:
(if well field,one Iattiong is sufficient) 22.Certification: � �
928697.9889 N 1680941.041 W / - GV-7- 07/18/22
6.ls(are)the well(s): (91'trmanent or ❑Temporary Signature ofCertiscd Well Contractor Date
By signing this form,l hereby cert6(y rhos the well(s)was(were)co siructed in accordance with
7.Is this a repair to an existing well: ❑Yes or ONo IJA NC4C 02C.0100 or ISA NCAC 02C.0200 Well Construction Standards and that a copy
If this is a repair.Jill out known well construction infornuulon and explain the mature of the of this record has been provided to the well owner.
repair under#21 remarks.section or on the back of this form.
23.Site diagram or additional well details:
8.For Gcoprobe/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-1 is needed. Indicate TOTAL NUMBER of weils (add'See Over in Remarks Box).You may also attach additional pages if necessary
drilled: 24.SUBMITTAL INSTRUCTIONS
9.Total we]!depth below land surface: 85.0 (ft
For multiple wells list all depths ifdii ferenr(example-3@200'gird 2Q100} ) Submit this GW-1 within 30 days of well completion per the following:
10.Static water level below top of casing: 50.0 (ft.) 24a, For All Wells: Original form to Division of Water Resources (DWR)
lfwaier level is above casing,use"+" Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
10.0 24b. For Injectian Wells:Copy to DWR,Underground Injection Control (IUC)
11,Borehole diameter: (in.) Program, 1636 MSC,Raleigh,NC 27699-1636
12.
(i.e.auger,rotary,cable,direct push,etc.)Well construction method: AIR 24c.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the
.e
county environments eat epartment o e county ere costa
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells Producing over[00 000 GPD:Copy to DWR,CCPCUA
13a.Yield(gpm) Method of test:
Permit Program,1 , ,Ra ei 7 -I ]
13b.Disinfection type: Amount:
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018

WELL CONSTRUCTION RECORD GW-I For Internal Use Only:
I.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
A - 2581 rt. It
n. ft.NC Well Contracts Certification Number 15,OUTER CASING for tnulti•cued weth OR LINER if a lcable
GEOLOGIC EXPLORATION PROM TO DIAMETER THICKNESS MATEAUL
Company Name
16.INNER CASING OR TUBING eothermal closed-l000l
2.Well Construction Permit 0: FROM I TO DIAMETER THICKNESS I MATERIAL
List all applicable hell construction permits(i.e. UIC.County,State,Variance,etc.) 0.0 ft. 70.0 rL 6.0 " SCH 40 PVC
3.Well Use(check well use): n• ft. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑MunicipallPublic 70.0 h• 90.0 R' 6.0 in. .010 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) fL rt in.
❑industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Irri atlon ❑Wells>100000 GPD FROM I TO MATERIAL EMPLACP.MENr METHOD&AMOUNT
Non-Water Supply Well: 0.0 ft' 20.0 It- AQUA GUARD SLURRY
LalMonitoring ❑Recovery ft. ft
injection Well: ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK if a lieable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage 25.0 fL 95.0 1` 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control ft. h
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary)
❑Geothermal(Heat in Cool ing Return) ❑Other(explain under tl21 Remarks) FROM TO DESCRIPTION color,hardn soiurnck type,grain sae ck,
0.0 ft• 8.0 rt• BROWN SILTY SAND
3.Date Well(s)Completed: 07/26/22 Well IUit IW-37 8.0 tt 15.0 It TAN SILTY SAND
5a,Well Location: 15.0 If 38.0 fL PWR
BELEWS CREEK STEAM STATION 38.0 ft• 95.0 It ROCK
Facility/Owner Name Facility lDM(ifapplicable) ft. ft.
3195 PINE HALL ROAD BELEWS CREEK 27009 n• ft
Physical Address,City,and Zip h• ft.
STOKES 21.REMARKS
County Parcel Identification No.(PIN) BENTONIfE SEAL-- 20.0-25.0 FEET
5b.Latitude and longitude in degreeVminules/secouds or decimal degrees:
(ifwcll ficld,one lat/long is sufficient) 22.Certillcation- � �
928788.3891 N 1681050.393 W �/ _ 011 - 08/01/22
6.ls(ere)the well(s): (JPtrmatxat or ❑Temporary Signature ofCcrtified Well Contractor Dale
By signing this form,I hereby cert&that the wells)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or MNo ISA NCAC 02C.0100 or ISA NCAC 01C.0100 Well Construction Standards and that a copy
If this is a repair,fill out knui n it-ell construction information and explain the nature of the of this record bas been provided to the well owner.
repair under 021 remarks section or on the back of This 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 info
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
9,Total well depth below land surface: 90.0 (ft.)
Far multiple wells list all depths iftli ferent(example-3 a 00'and 2Q100') Submit this GW-1 within 30 days of well completion per the following:
10.Static water level below top of casing: 34.0 (ft.) 24a. For All Wells: Original form to Division of Water Resources (DWR),
!f i+mter level is above eosing,sae"+"
Information Processing Unit,1617 MSC,Raleigh,NC 2 7699-1 6 1 7
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 O n-I o Geothermal Relurn Wells:Copy to the
(i.e.auger,rotary,cable,direct push.etc.) county environmental healthdepartment ol the county where costa e
FOR WATER SUPPLY WELLS ONLY: 24d. For Water Wells Urciducing over]00 000 GPD:Copy to DWR,CCPCUA
Permit Program, 1611 Raleigh,N 111
13a.Yield(gpm) Method of test:
13b.Disinfection type: Amount:
Form GW-I North Carolina Dcpartment of Environmental Quality-Division of Watcr Resources Revised 6-6-201 a

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
Well Contractor Name FROM TO I DESCRIPTION
ft. ft.
A - 2581 ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING for multi-cased wells OR 1,NER if a licable
GEOLOGIC EXPLORATION FROM TO DIAMETER THICKNESS MATERIAL
ft. rt. in.
Company Name
WI0400551/WV0400056 16.INNER CASING OR TUBING eothermal closed-loop)
2.Well Construction Permit#: FROM I TO I DIAMETER THICKNESS I MATERIAL
List all applicable well construction permits(i.e.UlC,County,State,Variance,etc.) 0.0 ft. 1145.0 ft- 1 6.0 t"' SCH 80 PVC
3.Well Use(check well use): ft. I ft. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 145.0 ft- 165.0 ft• 6.0 in. .020 SCH 80 SS
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Irrl atlon ❑Wells>100,000 GPD FROM I TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 20 ft- 200 rt• PORTLANDBENTONITE SLURRY
❑Monitoring ❑Recovery ft. ft.
Injection Well: ft. ft.
❑Aquifer Recharge Groundwater Remediation
19.SAND/GRAVEL PACK if a licable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑StormwaterDrainage 30.0 ft- 170.0 ft. 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control ft. it.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) FROM TO DESCRIPTION color,hardness,soil/mck type,grain size,etc.
0.0 B- 17.0 ft. TAN SILTY SAND
4.Date Well(s)Completed: 1 2/22/20 Well ID# IW-38 17.0 ft- 21.0 ft. BROWN SILTY SAND
5a.Well Location: 21.0 rt' 32.0 rt. PWR
BELEWS CREEK STEAM STATION 32.0 ft• 170.0 ft- ROCK
Facility/Owner Name Facility ID#(if applicable) ft. ft.
3195 PINE HALL ROAD BELEWS CREEK 27009 ft. ft.
Physical Address,City,and Zip
ft. ft.
STOKES 21.REMARKS
County Parcel Identification No.(PIN) BENTONITE SEAL- 20.0-30.0 FT(WIRE WRAPPED SCREEN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lattlong is sufficient) 22.Certification:
360 17' 31.79" N 800 03' 50.88" W � 0.1 12/31/2020
6.Is(are)the well(s): OPermanent or ❑Temporary Signature ofCertified Well Contractor Date
By signing this form,l hereby certify that the ire//(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or MNo 15A NCAC 02C.0100 or 15A NCAC 01C.0200 Well Construction Standards•and that a copy
/f this is a repair,fill out known well construction information and explain the nature of the ofthis record has been provided to the well owner.
repair under#21 remarks.section or on the back of this farm.
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 info
construction,only 1 GW-1 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: 165.0 (ft.)
For multiple wells list all depths iJ'dii ferent(example-3@200'and 1@100') Submit this GW-1 within 30 days of well completion per the following:
10.Static water level below top of casing: 31.0 (ft) 249. For All Wells: Original form to Division of Water Resources (DWR),
if water level is above casing,use"+•' Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter: 6.0/12.0 (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.Yield(gpm) Method of test: Permit Program,1611 MSC,Raleigh,NC 27699-1611
13b.Disinfection type: Amount:
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTIONft. ft.
A - 2581
ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING for multi-cased wells OR Puma
a licable
GEOLOGIC EXPLORATION FROM To DIAMETER TBICKNESS MATERIAL
ft. ft. in.
Company Name
16.INNER CASING OR TUBING eothermal closed-Im
2.Well Construction Permit#: WI0400551/WV0400056 FROM TO DIAMETER THICKNESS I MATERIAL
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.) 0.0 ft. 148.0 ff 1 6.0 t"' SCH 80 PVC
3.Well Use(check well use): ft. I ft. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 148.0 ft' 168.0 ft' 6.0 in. .020 SCH 80 SS
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. I ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Uri ation ❑Wells>100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 2.0 ft- 20.0 ft' PORTLANDBENTONITE SLURRY
❑Monitoring ❑Recovery ft. ft.
Injection Well: ft. ft.
❑Aquifer Recharge OGroundwater Remediation
19.SAND/GRAVEL PACK if applicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL I EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage 30.0 ft- 173.0 ft. 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 421 Remarks) FROM TO DESCRIPTION color,hardness,soiUrock type,grain size,etc.
0.0 It- 14.0 ft. TAN SILTY SAND
4.Date Well(s)Completed: 1 2/23/20 Well ID# IW-39 14.0 ft. 21.0 ft- BROWN SILTY SAND
5a.Well Location: 21.0 ft. 33.0 It. PWR
BELEWS CREEK STEAM STATION 33.0 ft• 173.0 ft. ROCK
Facility/Owner Name Facility ID#(ifapplicable) ft. ft.
3195 PINE HALL ROAD BELEWS CREEK 27009 ft. ft.
Physical Address,City,and Zip ft. ft.
STOKES 21.REMARKS
County Parcel Identification No.(PIN) BENTONITE SEAL-20.0-30.0 FT(WIRE WRAPPED SCREEN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one lat/long is sufficient) 22.Certification:
360 17' 31.79" N 800 03' 50.88" W �n..•..00-- 12/31/2020
6.Is(are)the well(s)' OPermanent or ❑Temporary Signature ofCertified Well Contractor Date
By.signing this form,1 hereby certify that the svell(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or l!9No 15A NCAC 02C.0100 or 15A NCAC 01C.0200 Well Construction Standards and that a copy
1J'this it a repair,fill out known well construction information and explain the nature of the of this record has been provided to the well owner.
repair under#21 remarks section or on the back ofthis 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 info
construction,only 1 GW-1 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: 168.0 (ft.)
For multiple wells list all depths ifdierent(example-3@200'and 2@/00') Submit this GW-1 within 30 days of well completion per the following:
31.0 249. For All Wells: Original form to Division of Water Resources (DWR),
/f ioarer level is above casing,use"+"
f Static water level below top of casing: (ft.) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter: 6.0/12.0 (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.Yield(gpm) Method of test: Permit Program,1611 MSC,Raleigh,NC 27699-1611
13b.Disinfection type: Amount:
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018

WELL CONSTRUCTION.RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
Well Contractor Name FROM TO I DESCRIPTION
ft. fr.
A - 2581
rr. re.
NC Well Contractor Certification Number IS.OUTER CASING for could-cued wells OR LINER if a Ilcable
GEOLOGIC EXPLORATION FROM TO DIAMETER THICKNESS MATERIAL
h. rt. in.
Company Name
16.INNER CASING OR TUBING eothermal closed-loop)
2.Well Construction Permit N: FROM TO I DIAMETER THICKNESS I MATERIAL
List all applicable mell consiruction pernrits(i.e.(11C.Caunrle Stale,Variance,etc) 0.0 It. 70.0 ft. 6.0 in. SCH 40 TPVC
3.Well Use(check well use): h. R. In.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER I SLOTS17E I THICKNESS I MATERIAL
OAgricullural OMunicipal/Public 70.0 ft• 90.0 A' 6.0 in.
.010 1 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) 0Residential Water Supply(single) ft.
Olnduslrial/Commercial ❑Residential Water Supply(shared) 13.GROUT
Oirrigation ❑Wells> 100,000GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0.0 ft• 20.0 f`• AQUA GUARD SLURRY
[!§Moniloring ❑Recovery e, R.
Injection Well:
OAquifer Recharge OGroundwater Remediation
19.SANDIGRAVEL PACK(irsoplicablel
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL i EMPLACEMENTMrriioo
OAquifer Test OSIOrmwater Drainage 25.0 f` 95.0 �' 20-40 FINE SILICA SAND
❑Experimental Technology OSubsidence Control
OGeolhermal(Closed Loop) ❑Tracer 20.DRILLING LOG ar(aeb additional sheets if necessary)
❑Geothermal(Heating/Cooling Return) OOther(explain under 421 Remarks) FROM TO DESCRIPTION color,hardness,saWrork type,amin size,etc.
0.0 f• 8.0 ft, RED SILTY CLAY
4.Date Well(s)Completed: 08/16/22 Well IDa IW-40 8.0 rt 18.0 f`- BROWN SILTY SAND
5a.Well Location: 18.0 f` 30.0 R' TAN SILTY SAND
BELEWS CREEK STEAM STATION 30.0 f` 34.0 f` PWR
Facility/Owner Name Facility IDH(ifapplicable) 34.0 ft. 95.0 fr• ROCK
3195 PINE HALL ROAD BELEWS CREEK 27009 ft. ft•
Physical Address,City,and Zip ft. ft.
STOKES 21.REMARKS
Courtly Parcel Identification No.(PIN)
BENTONITE SEAL-20.0-25.0 FEET
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(i(well field,one tatilong is sufficient) 22.Certification:
928826.6180 N 1681098.495 W � 0.7 - 08/22/22
6.Is(are)the well(s): (!Permanent or OTemporary Signature of Certified Well Contractor Date
By signing flits form.1 herchi terrify drat the ur/l(s)mu(mere)canslrucled ire uc'cardinece mah
7.Is this a repair to an existing well: ❑Yes or ONo 13A NCAC 021 0100 or 13A N('A('()1( U2lNI lVelJ(onarroc firut.17andnrdr sent rh<ef a a'upi
J th.s is a repair,fro oar ktto,rn we/1 ransimcfian m0mrarion and c cplain the natnrr,f'dm c+f(hit record leas Arc n prorided ro the mill nmiter
repair render 21 rrnnukr secann ar on site back i jrhis fount.
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 info
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 necessa.-�
drilled' 24.SUBMITTAL INSTRUCTIONS
9,Total well depth below land surface: 90.0 (ft.)
lnr nntll0k mcQs �r,anoMc- Submit this CN-I within 30 days of well completion per the following:
59.0 24m. For All Wells: Original form to Division of Water Resources (DWR).
10.Static water level below lop of casing:l,flran'.tare!I,nna,•<,'a.,n,r.apt.. .. (ft.) Information Processing Unit, 1617 MSC,Raleigh,NC 27699 617
�
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 Sil t and O en-Loo Geothermal Return Wells:Copy to the
(i.e.auger,rotary,cable.direct push,etc.) county envvonmenta ,obit department o the county where costa led
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over
13a.Yield(gpm) Method of test: 100 000 GPD:Copy to DWR.CCI'CUA
Permit Program, 1611 MSC,Raleigh,NC 27699-tb1 I
13b.Disinfection type: Amount:
Form GW-1 Nonh Carolina Department of Environinemal Quality-Division of Water Resources Revsed 6L,30l9

WELL CONSTRUCTION RECORD(GW-11 For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
Well Conireclor Name FROM TO DESCRIPTION
h. h.
A - 2581
h. n.
NC Well Contractor Certification Number 15.OUTER CASING for could-eased wells OR LINER ifa Ilcable
GEOLOGIC EXPLORATION FROM TO DIAMETER THICKNESS MATERIAL
n. rr. in.
Company Name
16,INNER CASING OR TUBING eothermal closed-too
2.Will Construction Permit#: FROM TO DIAMETER THICKNESS I MATERIAL
Liar all applicable well c'onrinrcimn prrrnils(i.e IW',County.State,Variance.etc) 0.0 h• 65.0 ft, 6.0 In- SCH 40 PVC
3.Well Use(check well use): h. n. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOTSIZE I THICKNESS MATERIAL
❑Agricultural OMunicipal Public 65.0 h' 85.0 ft' 6.0 in' 010 4t�L
PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft• h. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) I&GROUT
❑1t71 ation ❑Wells>100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOt NT
Non-Water Supply Well: 0.0 ft- 20.0 ft- AQUA GUARD SLURRY
&Monitoring ❑Recovery ft. h.
Injection Well:
n h
OAquiter Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK ifa licable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwaler Drainage 25.0 ft- 90.0 ft- 20-40 FINE SILICA SAND
OExpenmental Technology OSubsidence Control h. n.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 1121 Remarks) FROM TO DESCRIPTION color,hardam,soil/retk type,train sim,err.
0.0 fL 18.0 A. BROWN SILTY SAND
4.Dale Well(s)Completed: 08/16/22 Well ID# 1W-41 18.0 ft. 25.0 ft- TAN SILTY SAND
5a.Well Location: 25.0 f• 26.0 ft' PWR
BELEWS CREEK STEAM STATION 260 fl' 90.0 ft, ROCK
FacilityJOwnerName Facdn)1130(ifapplicable) ft. A.
3195 PINE HALL ROAD BELEWS CREEK 27009 h• ft.
Physical Address,City,acid Zip ft. 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:
(if well field,one tai/long is sufficient) 22.Certification:
928871.0155 N 1681142.424 W �'^�`"' 08/22/22
6.Is(are)the well(s): &Permanent or ❑Temporary Signature of Certified Well Contractor Date
b),signing thhform,l hereby certify that the well(sJ was(were)consrnreied in uccardani a ith
7.Is this a repair to an existing well- OYes or &No 15A N1:4('02(' 0100 or 1SA N('A( f/2/ 0200 Well Constna Lion 1'1ardards and tlrat a cola
#this is a repair.Jill nut known well construction nijbrnration and ecplanr the nature oy'the af'this record has been provided da the well owner
repair wider"21 renrarkr sernan fir on rise back oJ'rldv Jarnr.
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 info
construction,only 1 GW-I is needed. Indicate TOTAL NUMBER of wells (add'See Ovef in Remarks Box) You may also attach additional pages if necessarx
drilled: 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 85.0 (ft.)
1-ar nnihiple rrellr ho all depths iJ';h&rero(erample-J a 200'and 2 a 100') Submit this GW-I within 30 days of well completion per the following:
10.Static water level below lop of casing: 30.0 (ft) 24a. For All Wells: Original form to Division of Water Resources (DWR)
!J wafer level is ulxn'r casing,use** "
Information Processing Unit, 1617 MSC,Raleigh,NC 27699-1617
10.0 24b. For Injection Wells:Copy to DWR, Underground Injection Control (IUC)
I.Borehole diameter. (in.) Program, 1636 MSC,Raleigh,NC 27699.1636
12.Well construction method: AIR 24c.For Water Su I and O n-Loo Geothermal Return Wells:Copy to the
(i.e.auger,ro[ary,cable,direct push,etc.) County environmenta eat apartment o t e county ere costal ed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells roducin over I00 Q00 GPD: Copy to DWR.CCPCUA
13a.Yield(gpm) Method of test- Permu Program, 1611 MSC,Raleig , C 76 -1611
13b.Disinfection type: Amount:
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6.2018

WELL CONSTRUCTION RECORD GW-1 For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
A - 2581 ft. rL
R. R.
NC Well Contractor Certification Number 15.OUTER CASING for mull-cased wellisl OR LINER if a livable
GEOLOGIC EXPLORATION PROM TO n1AMT fER THICKNESS MATERIAL
fG tt. la
Company Name
16,INNER CASING OR aothermal closed-l000li
2.Well Construction Permit N: FROM TO DIAMETER THICKNESS MATERIAL
List of/applicable well construction permits p.e.U1C,County,Stare,Variance,arc) 0.0 ft. 70.0 fL 6.0 In I SCH 40 EPVLC
3.Well Use(check well use): R. fL in.
Water Supply Well: 17.SCREEN
FROM TO DIAM EI'ER SLoTSIZE THICKNESS MATERIAL
DAgricultura] ❑Municipal/Public 70 0 ft 90.0 fL fi.0 I°' .010 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) OResidential Water Supply(single) R. n- is
Dlndustrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Irri ation DWells>100000GPD FROM TO MATERIAL FM PLACEMENT METHOD&AM011rrr
Non-Water Supply Well: 0.0 fL 20.0 ft. AQUA GUARD SLURRY
MMonitoring ❑Recovery ft. tr.
Injection Well:
El Aquifer Recharge ❑Groundwater Remediation fL fL Cl 19,SAND/GRAVEL PACK(if applicable)
Aquifer Storage and Recovery DSalinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage 25.0 R, 95.0 ft- 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control fL ft.
❑Geothermal(Closed Loop) ❑Tracer 20,DRILLING LOG attach additional sheets If neceasa
DGeothermal(HeatinglCooling Return) ❑Other(explain under 421 Remarks) FROM TO DESCRIPTION mlor,bards soil/mik type, raln ere.
0.0 ft. 11.0 f6 BROWN SILTY SAND
4.Date Well(s)Completed: 07/1 1/22 Well IINY IW-42 11.0 ft. 20.0 ft. TAN SILTY SAND
Sa.Well Location: 20.0 1" 50.0 ft- PWR
BELEWS CREEK STEAM STATION 50.0 ft- 95.0 ft- ROCK
Facility/Owner Name Facility IDN(ifapplicable) ft. ft.
3195 PINE HALL ROAD BELEWS CREEK 27009 M ft.
Physical Address,City,and Zip R. ft.
STOKES 21.REMARKS
County Parcel Identification No.(PIN)
BENTONIfE SEAL-20.0-25.0 FEET
5b.Latitude and longitude in degrees/minutes/scconds or decimal degrees:
(ifwcll field,one lat/long is sufficient) 22.Certification: �
927959.5753 N 1681138.248 µ, !::/S - Gv-'- 07/18/22
6.Is(are)the well(s): MPermanent or ❑Temporary Signature ofCenified Well Contractor Date
Hy signing thin form,l hereby terrify that the well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or MNo 1SA NCAC 02C.0100 or 15A NCAC 02C.0200 Well Castrrtetion Standards and that a copy
lfthu is a repair,fill out known well construction information and explain the nature of the ofthis record has been provided to the well owner.
repair under 021 remarks section or on the back of this farm.
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 info
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
9.Total well depth below land surface: 90.0 (ft.)
F r cow:uple wr,7,!�,i all depths ifdifferent(example-3;❑200'and 2®100� Submit this GW-1 within 30 days of well completion per the following:
10.Static water level below top of casing: 27.0 (ft) 24a, For All Wells: Original form to Division of Water Resources (DWR),
if water level is above casing,usr 1�1•• Information Processing Unit,1617 MSC,Raleigh,NC 2 7699-1 6 1 7
11.Borehole diameter: 10.0 (in) 24b.For Injection Wells: Copy to DWR,Underground Injection Control (TUC)
Program,1636 MSC,Raleigh,NC 27699-1636
i..Well construction method: AIR 24c.For Water Su i and Open-Loop Geothermal Return Wells:Copy to the
(i.e.auger,rotary,cable,direct push,etc.) county environments health department of the county where costa e
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells roducin over]00 000 GPD: Copy to DWR,CCPCUA
Permit Program, Ra et ,N 7 I I I
13a.Yield(gpm) Method of test:
13b.Disinfection type: Amount:
Form GW-1 North Carolina Department of EnvuonmenW Quality-Division of Water Resources Revised 6-6-2018

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only;
1.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
Well Contractor Name FROM ft. TO ft. DESCRIPTION
A - 2581 ft. Ift
NC Well Contractor Certification Number 15,OUTER CASING for multi-cased wens OR LINER if a licable
GEOLOGIC EXPLORATION FROM To DIAMETER THICKNESS MATERIAL
ft. tr. la
Company Name
16.INNER CASING OR TUBING fizeulhcrmxl closed-too
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS I MATERIAL
List all applicable well construcron permits(te i+h:', .'otimy State,Variance,etc) 0.0 ft. 70.0 rL 6.0 ]- SCH 40 PVC
3.Well Use(check well use): ft. ft. in.
17.SCREEN
Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
OAgricultural ❑MunicipallPublic 70.0 fL 90.0 ft' 6.0 In. .010 SCH 40 PVC
❑Geothermal(Healing/Cool ng Supply) ❑Residential Water Supply(single) ft. ft, 1n
❑IndustriaUCommercial ❑Residential Water Supply(shared) 18.GROUT
❑IRI ation ❑Wells>100000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0.0 ft- 20.0 ft- AQUA GUARD SLURRY
[MMonitoring ❑Recovery ft. fL
Injection Well:
❑Aquifer Recharge ❑Groundwater Remedtation
19,SANDD ft./GRAVEL PACK if a Ilcable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM I TO I MATERIAL EVIPLACFMENT METHOD
❑Aquifer Test ❑StormwaterDrainage 25.0 ft, 95.0 fL 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control ft. M
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necmx
❑Geothermal (Heating/Cooling Return ❑Other(explain under#21 Remarks) FROM TO DESCRIPTION eobr herd solVrock tyM grain size etc.
0.0 ft. 10.0 M TAN SILTY SAND
4,Date Well(s)Completed: 06/21/22 Well ID# IW-43 70.0 tL 60.0 ft- PWR
59.Well Location: 60.0 ft- 95.0 ft- ROCK
BELEWS CREEK STEAM STATION ft. ft.
Facility/Owner Name Facility ID#(ifapplicablc) ft. ft
3195 PINE HALL ROAD BELEWS CREEK 27009 fL ft.
Physical Address,City,and iip
It. ft.
STOKES 21.REMARKS
C.,cnty Parcel Identification No(PIN) BENTONITE SEAL--20.0-25.0 FEET
5b.Latitude and longitude in degrees/rninutes/seconds or decimal degrees:
(ifwell Geld,one lath g is sufficient; 22.Certification:
928296.8442 N 1681176.174 W 06/27/22
6.Is(are)the well(s): oPermanent or OTemporary Signature ofCertiSed Well Contractor Date
By signing this form,I hereby cerrlfy that the wells)was(were)constructed In accordance with
7.Is this a repair to an existing well: ❑Yes or L'JNo ISA NCAC 02C.0100 or I5A NCAC 02C.0200 Well Construction Standards and chat o copy
if rhir is a repair,fill out known well construction information and explain the nature of the of this record has been provided to the well owner.
n•pa,under#21 remarks section or on the back of this 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 info
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
dr'.1ed: 24.SUBMITTAL INSTRUCTIONS
9,Total well depth below land surface: 90.0 (ft.)
J or m.lriple wells list all depths if different(example-3Q200'and 2Qa 100) Submit this GW-1 within 30 days of well completion per the following:
52.0 24a. For All Wells: Original form to Division of Water Resources (DWR),
1 Stalk water level below top of rasing: (ft') Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
,fu-airrlevel i,aAo�r casing,usr"+"
11.Borehole diameter: 10.0 (in,) 24b. For Injection Wells:Copy to DWR, Underground Injection Control(IUC)
AIR Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: 24c.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the
(i.e.auger,rotary,cable,direct push,etc.)
county environmen }lea t epariment o e county where installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells roducin over 100 000 GPD: Copy to DWR,CCPCUA
13a.Yield(gpm) Method of test: Permit Program, I 1 I M Ra clg ,N 7 1611
13b.Disinfection type: Amount:
Form G W-1 North Carolina Department of Environmental Quality-Division of Waler Resources Revised 6-6.2018

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
Well Contractor Name FROM ft. ft.TO DESCRIPTION
A - 2581
ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING for multi cased wells OR LINER ifs licsble
GEOLOGIC EXPLORATION FROM TO DIAMETER THICKNESS MATERIAL
ft. ft. in.
Company Name
16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#: WI0400551/WV0400056 FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.U1C,County,State,Variance,etc) 0.0 ft. 145.0 ft. 6.0 in. SCH 80 PVC
3.Well Use(check well use): ft. ft. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 145.0 ft. 165.0 ft' 6.0 in. .020 SCH 80 SS
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Irri ation ❑Wells>100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 2.0 I't. 20.0 ft' PORTLANDBENTONITE SLURRY
❑Monitoring ❑Recovery ft. ft.
Injection Well:
ft. ft.
❑Aquifer Recharge 15Groundwater Remediation
19.SAND/GRAVEL PACK if applicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test OStotmwater Drainage 30.0 ft. 170.0 ft. 20-40 FINE SILICA SAND
CI Experimental Technology OSubsidence Control ft. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) FROM TO DESCRIPTION color,hardness,soil/rock type,gmin sin,etc.
0.0 ft- 13.0 ft. TAN SILTY SAND
4.Date Well(s)Completed: 12/28/20 Well ID# IW-44 13.0 ft. 18.0 ft. BROWN SILTY SAND
5a.Well Location: 18.0 ft' 32.0 ft' PWR
BELEWS CREEK STEAM STATION 32.0 ft. 170.0 ft. ROCK
Facility/Owner Name Facility ID#(if applicable) ft. ft.
3195 PINE HALL ROAD BELEWS CREEK 27009 ft. ft.
Physical Address,City,and Zip
ft. ft.
STOKES 2L REMARKS
County Parcel Identification No.(PIN) BENTONIfE SEAL-20.0-30.0 FT(WIRE WRAPPED SCREEN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22.Certification:
360 17' 31.79" N 800 03' 50.88" W �fi_ 0.1 1/13/2021
6.Is(are)the well(s): IMPermanent or ❑Temporary Signature of Certified Well Contractor Date
By signing this form,I hereby certify that the ire//(s)was(mere)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or IJNo 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy
1f this is a repair,fill out known well construction information and explain the nature of the ofthis record has been provided to the well owner.
repair under#21 remarks section or on the back ofthis 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 info
construction,only 1 GW-I is needed. Indicate TOTAL NUMBER ofwells (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: 165.0 (ft.)
For multiple wells list all depths;fdiJferem(example-3@200'and 1@100') Submit this GW-I within 30 days of well completion per the following:
31.0 24a. For All Wells: Original form to Division of Water Resources (DWR),
10.Static water level below top of casing: (ft•) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
ff wooer level is above casing,use" "
11.Borehole diameter: 6.0/12.0 (in) 24b.For Infection 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.Yield(gpm) Method of test:
Permit Program,1611 MSC,Raleigh,NC 27699-1611
13b.Disinfection type: Amount:
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
A - 2581 ft. ft.
ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING for multi-cased wells OT vaT RIALGEOLOGIC EXPLORATION FROM DIAMETER RRa MA
ft. ft. in.
Company Name
16.INNER CASING OR TUBING eothermal closed-100
2.Well Construction Permit#: WI0400551/WV0400056 FROM TO DIAMETER THICKNESS I MATERIAL
List all applicable ivell construction permits(i.e.U1C,County,State,Variance,etc) 0.0 ft. 148.0 ft. 6.0 in. SCH 80 PVC
3.Well Use(check well use): ft. ft. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 148.0 fa 168.0 fL 6.0 in. .020 SCH 80 SS
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Irri ation ❑Wells>100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 2.0 ft- 20.0 ft' PORTLAND BENTONITE SLURRY
❑Monitoring ❑Recovery ft. ft.
Injection Well: ft. ft.
❑Aquifer Recharge OGroundwater Remediation
19.SAND/GRAVEL PACK if a livable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO I MATERIAL I EMPLACEMENT METHOD
❑Aquifer Test ❑StormwaterDrainage 30.0 ft. 173.0 ft. 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) FROM TO DESCRIPTION color,hardness,soil/Fwk type,grain size,etc.
0.0 ft. 17.0 It- TAN SILTY SAND
4.Date Wells)Completed: 12/21/20 Well ID# IW-45 17.0 ft. 29.0 ft- BROWN SILTY SAND
5a.Well Location: 29.0 ft' 39.0 ft' PWR
BELEWS CREEK STEAM STATION 39.0 ff 173.0 ft ROCK
Facility/Owner Name Facility ID#(if applicable) ft. ft.
3195 PINE HALL ROAD BELEWS CREEK 27009 ft. ft.
Physical Address,City,and Zip ft. ft.
STOKES 21.REMARKS
County Parcel Identification No.(PIN) BENTONIfE SEAL-20.0-30.0 FT(WIRE WRAPPED SCREEN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22.Certification:
360 17' 31.79" N 800 03' 50.88" W 12/31/2020
6.Is(are)the well(s): OPermanent or ❑Temporary Signature of Certified Well Contractor Date
By signing this form,1 hereby certl&that the well(s)tvas 6vere)constructed in accordance ivhh
7.Is this a repair to an existing well: ❑Yes or I!9No 15A NCAC 01C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy
if this is a repair,fill out known ivel/construction information and explain the nature of the ofihis record has been provided to the wve//owner.
repair under#21 remarks section or on the back ofthis 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 info
construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER ofwelis (add'See Ovef in Remarks Box).You may also attach additional pages ifnecessary.
drilled: 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 168.0 (ft.)
For multiple wells list all depths ifdierent(example-3@200'and 1@100') Submit this GW-1 within 30 days of well completion per the following:
10.Static water level below top of casing: 31.0 (ft.) 24a. For All Wells: Original form to Division of Water Resources (DWR),
1f water level is above casing,use"+" Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter: 6.0/12.0 (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 100,00'GPD:Copy to DWR,CCPCUA
1
13a.Yield(gpm) Method of test: Permit Program,1611 MSC,Raleigh,NC 27699- 611
13b.Disinfection type: Amount:
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
FROMI DESCRIPTION
Well Contraclor Name
(i. fL
A - 2581
ft. fL
NC Well Contractor Certification Number 15.OUTER CASING for multi cwed welly OR LINER 1f a llcable
GEOLOGIC EXPLORATION PROM TO DIAMETER THI FSS MATERIAL
fL fL 1R
Company Name 16.INNER CASING OR TUBING Iteothertnal closed-loop)
2.Well Construction Permit N: FROM TO I DIAMErER I THICTUfESS MATERIAL
List all applicable well construction permits O.e.UIC.County,Stale,Variance,ere.) 0.0 ft. 85.0 fL 6.0 In- SCH 40 PVC
3.Well Use(check well use): ft. ft. I�
Water Supply Well: 17.SCREEN
PPY FROM I TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑MunicipaUPublic 85.0 n- 105.0 ft' 6.0 'a' .010 SCH 40 PVC
OGeothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) rt. I ft, la
❑IndUSlrlal/COmmercial ©Residential Water Supply(shared) 10,GROUT
❑Irri ation ❑Wells>100000 GPD FROM I TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0.0 ft- 20.0 n AQUA GUARD SLURRY
LSMonitoring ❑Recovery ft. ft.
Injection Well: ft fL
❑Aquifer Recharge OGroundwater Remediation
19,SAND/GRAVEL PACK if applicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL I EMPLACEMENTMErHOD
❑Aquifer Test ❑StormwaterDrainage 25.0 ft- 110.0 fL 20-40 FINESILICASAND
❑Experimental Technology ❑Subsidence Control rL fL
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG Mach additional sbeets If necessary)
FROM TO DESCRIPTION
❑Geothermal Heatin Coolin Retum) ❑Other(explain under N2] Remarks color,hatdn solvrocY nin aim,etc
0.0 fL 18.0 fL BROWN SILTY SAND
4.Date Well(s)Completed: 06/28/22 Well IDtt IW-46 18.0 ft• 37.0 ft TAN SILTY SAND
Sa.Well Location:
37.0 ft- 53.0 ft' PWR
BELEWS CREEK STEAM STATION 53.0 fL 110.0 fL ROCK
Facility/Owner Name Facility ID#(if applicable) ft, ft.
3195 PINE HALL ROAD BELEWS CREEK 27009 ft. °'
Physical Address.City,and Zip ft. ft.
STOKES 21.REMARKS
County Parcel Identification No.(PIN) BENTONITE SEAL 20.0-25.0 FEET
5b.Latilude and longitude in degrees/minuies/seconds or decimal degrees:
(if well field one InVIong is sufficient) 22.Certification:
928300.9055 N 1680928.532 W ��-011- 07/06/22
6.Is(are)the well(s): 15Permanent or ❑Temporary Signature of Certified Well Contractor Date
By signing this form,1 hereby cert!&that the well(s)was(were)construc ed in accordance with
7.Is this a repair to an existing well: ❑Yes or ONo 15A NCAC 02C 0100 or 15A NCAC 01C.0100 Well Construction Standards and that a copy
lfthis is a repair,fl!out known well construction information and esplaln the nature of the of this record has been provided to the well owner.
repair under 921 remarks section or on the back ofthis 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 info
construction,only I GW-I is needed. Indicate TOTAL NUMBER of wells (add'See Ovee in Remarks Box) You may also attach additional pages if necessary
drilled' 24.SUBMITTAL INSTRUCTIONS
0
9.Total well depth below land surface: 105. (ft') Submit this GW-1 within 30 days of well completion per the following:
"or multiple wrl,s list all depths lfdt,(jerent(example-3 n,100 and 2w_'100)
51.0 249. For All Wells: Onginal form to Division of Water Resources (DWR),
If Static water levrl below top of casing: (ft} Information Processing Unit, 1611 MSC,Raleigh,NC 27699-Ir.17
,fwarerleveluabovecasing,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 Supely and Open-Loop Geothermal Return Wells:Copy to the
(i.e.auger,rotary,cable,direct push,etc.) county environments ea apartment o e county where installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wills roducin over 100,000 GPD:Copy to DWR,CCPCUA
Permit Program,] I I M et 7 1 I I
13a.Yield(gpm) Method of test:
131L Disinfection type: Amount:
Form OW-I North Carolina Departinent ofEnvironmenial Quality-Division of Water Resources Revised 6-6.2019

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
L Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
FROM TO DESCRIPTION
Well Contractor Name
ft. (t.
A - 2581 ft. rL
NC Well Contractor Certification Number 15.OUTER CASING for multi cased wet" OR LINER "a Ileable
GEOLOGIC EXPLORATION FROM �+ TII CI 11 MATERIAL
R. tt In
Company Name 16.INNER CASING OR TUBING eothermal dosed-loo
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits 0.e.U1C.County,State,Mmiance,etc.) 0.0 fL 85.0 ft' 6.0 in' SCH 40 PVC
3.Well Use(check well use): iL ft. in.
Water Supply Well: 17.SCREEN
PPy FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
DAgricultural ❑Municipal/Public 85.0 rL 105.0 ft' 6.0 i- 1 .010 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) fL ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Irri ation DWells> 100000GPD FROM TO MATERIAL EMPLACEMEW METHOD&AMOUNT'
Non-Water Supply Well: 0.0 ft• 20.0 fL AQUA GUARD SLURRY
15Monitoring ORecovery ft. ft.
Injection Well:
iI. fL
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK If a Heable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL I EMPLACEMENT METHOD
❑Aquifer Test ❑StormwaterDrainage 25.0 ft- 110.0 fL 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control ft. fL
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets it necessary)
❑Geothermal(Heatin Cool ing Return) ❑Other(explain under#21 Remarks FROM TO DESCRIPTION frolor,hardness,seivrock CyM zrain tic.
0.0 ft- 17.0 f BROWN SILTY SAND
4.Date Well(s)Completed: 06/28/22 Well ID# IW-47 17.0 h• 33.0 fL TAN SILTY SAND
Sa.Well Location:
33.0 ft' 52.0 rL PWR
BELEWS CREEK STEAM STATION 52.0 B 110.0 fL ROCK
Facility/Owner Name Facility 1Dk(ifapplicable) ft. fL
319S PINE HALL ROAD BELEWS CREEK 27009 D• It.
Physical Address,City,and Zip ft. fL
STOKES 21.REMARKS
County Parcel Identification No.(PIN) BENTONITE SEAL- 20.0-25.0 FEET
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one lat/long is sufficient) 22.Certification: �
928370.4822 N 1680898.227 W !:7/ ow- 07/06/22
6.Is(are)the well(s): MPermanenl or ❑Temporary Signature ofCcrtificd Well Contractor Date
By signing this form,1 hereby certt&that the well(s)was(were)constructed in accordance with
7.is this a repair to an existing well: ❑Yea or ONo 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Consfruclion Standards and that a copy
lfthis is a repair,JRl out known well cotslruclion mformoon and explain the nature of the ofthis record has been provided to the well owner.
repair under 021 remarks section or on the back of this 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 mfD
construction,only I GW-I is needed. Indicate TOTAL NUMBER of wells (add'See Ove?in Remarks Box).You may also attach additional pages if necessary
drilled: 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 105.0 (ft.)
Tor multiple wells list at/depths ifdtereni(example-3Q200'and 2@100) Submit this GW-1 within 30 days of well completion per the following:
46.0 24a. For All Wells: Original form to Division of Water Resources (DWR),
10.Static water level below top. casing: (ft) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
!fuarerleve!is above casing,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 SuRply and Opcn-Loop Geothermal Return Wells:Copy to the
(i.e.auger,rotary,cable,direct push,etc.) county envlronmente ea department o e county ere Insta
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100'0'GPD:Copy to DWR,CCPCUA
Permit Program, I ,Raleigh, 7 11
13a.Yield(gpm) Method of test:
13b.Disinfection type: Amount:
Fomr GW-1 North Caroluia Department of Environmental Quality-Division of Water Resources Revised 6-6-2018

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
Well Contractor Name FROM TO I DESCRIPTION
ft. ft.
A - 2581 ft. ft.
NC Well Contractor Certification Number 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(geothermal closed-loop)
2.Well Construction Permit#: WI0400551/WV0400056 FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.I11C,County,State,Variance,etc.) 0.0 ft. 145.0 ft. 6.0 in- SCH 80 PVC
3.Well Use(check well use): ft. ft. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 145.0 ft. 165.0 ft. 6.0 in.
.020 SCH 80 SS
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Irri ation ❑Wells>100,000 GPD FROM I TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 2.0 l" 20.0 n' PORTIANDBENTONUE SLURRY
❑Monitoring ❑Recovery ft. ft.
Injection Well: ft. ft.
❑Aquifer Recharge Groundwater Remediation
19.SAND/GRAVEL PACK if a licable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑StormwaterDrainage 30.0 ft. 170.0 ft. 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) FROM TO DESCRIPTION color,hardness,soil/rock type,amin size,etc.
0.0 ft. 13.0 ft. TAN SILTY SAND
4.Date Well(s)Completed: 12/29/20 Well ID# IW-48 13.0 ft. 20.0 ft. BROWN SILTY SAND
5a.Well Location: 20.0 ft' 33.0 fl' PWR
BELEWS CREEK STEAM STATION 33.0 ft• 170.0 ft. ROCK
Facility/Owner Name Facility ID#(ifapplicable)
rt. ft.
3195 PINE HALL ROAD BELEWS CREEK 27009 ft. ft.
Physical Address,City,and Zip ft. ft.
STOKES 21.REMARKS
County Parcel Identification No.(PIN) BENTONIfE SEAL-20.0-30.0 FT(WIRE WRAPPED SCREEN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one Iat/long is sufficient) 22.Certification:
360 17' 31.79" N 800 03' 50.88" W es,;,,t ,,._-
1/13/2021
6.Is(are)the well(s): OPermanent or ❑Temporary Signature ofCertified Well Contractor Date
By signing this form,I hereby certify that the well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or ONo 15A NCAC 01C.0100 or 15A NCAC 01C.0200 Well Construction Standards and that a copy
/f this is a repair,fill out known well construction information and explain the nature of the of this record has been provided to the well owner.
repair under#21 remarks section or on the back of this 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 info
construction,only 1 GW-1 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: 165.0 (ft.)
For multiple we/Is list all depths iftli ferent(example-3@200'and 2@100') Submit this GW-1 within 30 days of well completion per the following:
31.0 24a. For All Wells: Original form to Division of Water Resources (DWR),
/f water level is above casing,use"+"
f Static water level below top of casing: (ft.) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter: 6.0/12.0 (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.Yield(gpm) Method of test: Permit Program,1611 MSC,Raleigh,NC 27699-1 6 1 1
13b.Disinfection type: Amount:
Form G W-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14,WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
ft. ft.
A - 2581
NC Well Contractor Certification Number 15.OUTER CASING for multt-cased wells OR LINER if a Iiceble
GEOLOGIC EXPLORATION FROM To DIAMETER THICKNESS MATERIAL
ft. fL in.
Company Name
16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#. FROM TO DIAMETER THICKNESS I MATERIAL
Liss all oppItcoble well construction permits(i.e.UIC,County,Stare,Variance,etc.) 0.0 fi• 95.0 fi- 6.0 In. SCH 40 PVC
3.Well Use(check well use): s, ft, in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER I SLOTSIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 95.0 fa 115.0 ft. 6.0 in' .010 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. R. is
❑industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
Olrri ation ❑Wel Is>100000 GPD FROM TO MATERIAL r,MPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0.0 ft- 200 ft. AQUA GUARD SLURRY
19Monitoring ❑Recovery ft. fL
Injection Well: ft fL
❑Aquifer Recharge ❑Groundwater Remedialion
19.SAND/GRAVEL PACK if a Iiceble
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage 25.0 f'• 120.0 fL 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed loop) 01•racer 20.DRILLING LOG attach additional sheets if necessa
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 421 Remarks) FROM TO DESCRIPTION color,h"ness roil/mck type,grain t o etc.
0.0 ft. 7,0 ft. RED SILTY CLAY
4.Dale Well(s)Completed: 06/1 7/22 WeII IDM IW-49 7.0 ft• 23.0 fL BROWN SILTY SAND
5a.Well Location: 23.0 ft• 25.0 ft. TAN SILTY SAND
BELEWS CREEK STEAM STATION 25.0 ft. 70.0 ft- PWR
FacililylOwner Name Facility IDN(if applicable) 70.0 ft, 120.0 fi' ROCK
3195 PINE HALL ROAD BELEWS CREEK 27009 ft. fL
Physical Address,City,and Zip ft. fL
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:
(if well field,one Ial/long is sufficient) 22.Certification:
928457.8037 N 1680984.722 W ow- 06/24/22
6.Is(are)the w'ell(s): OPermanent or ❑Temporary Signature ofCcrtified Well Contractor Date
By signing this form,1 hereby cert�that the well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or [5No 15A NCAC`02C.0100 or 15A NCAC 02C.0200 Well Comrruction Standards and that a copy
If this is a repair.Jill out known well construction Information and explain the nature of the of this record has been provided to the well owner.
repair under#21 reworks section or on the back oJ'this farm.
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 info
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
9.Total well depth below land surface: 115.0 (ft.)
1'or tnuhiple wells list all depths tfdWerent(example-3 a 200'and 2@100� Submit this GW-1 within 30 days of well completion per the following:
10.Static water level below top of casing: 77.0 (ft 24a. For All Wells: Original form to Division of Water Resources (DWR),
Ifnuterlevells above casing,use••+" Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter: 10.0 (in.) 24b. For Injection Wells:Copy to DWR,Underground Injection Control(IUC)
Program, 1636 MSC,Raleigh,NC 27699-1636
12.11'ell construction method: AIR
24c.For Water Supely and Open-Loop Geothermal Return Wells:Copy to the
(i.e.auger,rotary,cable,direct push,etc.) county environmental healthdepartment o t e county ere msta e
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100
13a.Yield(gpm) Method of test: "0 GPD:Copy to DWR,CCPCUA
Permit Program,111 MSC,Raleigh,N 27 9-
13b.Disinfection type: Amount:
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
ft. ft.
A - 2581
ft. ft.
NC Well Contractor Certification Number 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#: WI0400551/WV0400056 FROM I TO DIAMETER I THICKNESS MATERIAL
List all applicable well construction permits(i.e.U/C,County,State,Variance,etc.) O.0 ft 144.0 fl- 6.0 1O' SCH 80 PVC
3.Well Use(check well use): ft. ft. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 144.0 ft. 164.0 ft. 6.0 in. .020 SCH 80 SS
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Irrl ation ❑Wel Is>100,000 GPD FROM I TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 2.0 ft. 20.0 ft' PORTLANDaENTONITE SLURRY
❑Monitoring ❑Recovery H. ft.
Injection Well: ft. ft.
❑Aquifer Recharge CDGroundwater Remediation
19.SAND/GRAVEL PACK if applicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL I EMPLACEMENT METHOD
❑Aquifer Test ❑StormwaterDrainage 30.0 ft. 169.0 ft. 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary)
FROM TO DESCRIPTION color,hardness,soil/mck rain size,etc.
❑Geothermal(}teating/Cooling Return) ❑Other(explain under#21 Remarks) 0.0 ft. 16.0 ft. TAN SILTY SAND
4.Date Well(s)Completed: 12/30/20 Well ID# IW-51 16.0 ft. 23.0 ft. BROWN SILTY SAND
5a.Well Location: 23.0 ft- 36.0 ft' PWR
BELEWS CREEK STEAM STATION 36.0 ft• 169.0 ft. ROCK
Facility/Owner Name Facility ID#(if applicable) ft. ft.
3195 PINE HALL ROAD BELEWS CREEK 27009 ft. ft.
Physical Address,City,and Zip ft. ft.
STOKES 21.REMARKS
County Parcel Identification No.(PIN) BENTONITE SEAL-20.0-30.0 FT(WIRE WRAPPED SCREEN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22.Certification:
360 17' 31.79" N 800 03' 50.88" W cL.- fir-- 1/13/2021
6.Is(are)the well(s): OPermanent or ❑Temporary Signature ofCertified Well Contractor Date
By signing this form,1 hereby term that the rvell(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or IJNo 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy
/fthis is a repair,fill out known well construction information and explain the nature of the of this record has been provided to the well owner.
repair under#1/remarks section or on the back ofthis 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 info
construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells (add'See Ovet'in Remarks Box).You may also attach additional pages if necessary.
drilled: 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 164.0 (ft.)
For multiple wells list all depths ifdii ferent(example-3@200'and 2@100') Submit this GW-1 within 30 days of well completion per the following:
31.0 24a. For All Wells: Original form to Division of Water Resources (DWR),
f Static water level below top of casing: (ft.) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1 6 1 7
/fwater level is above casing,use"+"
11.Borehole diameter: 6.0/12.0 (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
Permit Program,1611 MSC,Raleigh,NC 27699-1611
13a.Yield(gpm) Method of test:
13b.Disinfection type: Amount:
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018

WELL CONSTRUCTION RECORD GW-1 For Internal Use Only:
I.WeII Contractor Information:
BRIAN THOMAS 14.WATER ZONES
FROM TO DESCRIPTION
Well Contractor Name ft. ft.
A - 2581
R, fL
NC Well Contractor Certification Number IS.OUTER CASING for multi-cased wells OR LINER if a Ilcable
GEOLOGIC EXPLORATION FROM TO DIAMETER THIClOVESS MATERIAL
rt. rL in.
Company Name
16,INNER CASING OR TUBING eothermal closed-looril
2.Well Construction Permit 4: FROM I TO DIAMETER THICKNESS I MATERIAL
List all applicable well ronsirvction permits(i.e.U1C,County,State, Variance,etc.) 0.0 O• 90.0 rt• 6.0 is SCH 40 PVC
3.Well Use(check well use): ft. R Io-
Water Supply Well: 17.SCREEN
PROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 90•0 ft. 110.0 ft. 6.0 in. _010 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. to
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Irrl ation ❑Wells> 100000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNr
Non-Water Supply Well: 0.0 ft• 20.0 rL AQUA GUARD SLURRY
LSMonitoring ❑Recovery fL fL
Injection Well: ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK ifa Ilcable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test CIStormwater Drainage 25.0 ft- 110.0 rt• 20-40 FINE SILICA SAND
❑Experimental Technology []Subsidence Control ft. ft.
❑Geothermal(Closed Loop) 111'racer 20.DRILLING LOG attach additional sheets If necema
❑Geothermal(Healin Coolin Return) ❑Other(explain under#21 Remarks) FROM TO DESCRIPTION color,hardn wilhock tym rota etc.
0.0 ft• 8.0 IL RED SILTY CLAY
4.Date Well(s)Completed: 06/01/22 Well ID# IW-52 80 ft- 19.0 fL BROWN SILTY SAND
Sa.Well Location: 19.0 R• 27.0 ft' TAN SILTY SAND
BELEWS CREEK STEAM STATION 27.0 rt• 41.0 fL PWR
Facility/Owner Name Facility ID#(ifapplicable) 41.0 rt' 110.0 fL ROCK
3195 PINE HALL ROAD BELEWS CREEK 27009 ff. ft.
Physical Address,City,and Zip ft. 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:
(if well field,one Iatflong is sufficient) 22.Certification:
928657.3600 N 1681230.529 W 011- 06/09/22
6.Is(are)the well(s): E91'ermenent or QTemporary
Signature ofCcrtified Well Contractor Date
By signing lhtt fornt,l hereby certify that the well(s)was(were)conitrucred in accordance with
7.Is this a repair to an existing well: ❑Yes or TINo 15A NC-AC 02C 0100 or 15A NCAC 02C.0200 Well Construction Siandords and Our a c,py
1f this is a repair fill out known well consirucilon information and explain the nature of the ofthis record lies been provided to the well owner.
repair under,21 remarks section or on the back ofthis 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 info
construction,only l GW-1 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: 110.0 {ft.
ror multiple wells list all depths fdifferent(example-3(200'and 2 r@100) ) Submit this GW-I within 30 days of well completion per the following:
10.Static water level below top of casing: 51.5 (it) 24a. For All Wells: Onginal form to Division of Water Resources (DWR),
1f water Ievel is above caring,use"+"
Information Processing Unit, 1617 MSC,Raleigh,NC 27699-1617
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 24r.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the
(i.e.auger,rotary,cable,direct push,etc.) county environmental department o e county ere msta e
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over]00 000 GPD: Copy to DWR,CCPCUA
1 I
13a.Yield(gpm) Method of lest: Permit Program,1611 MSC,Raleigh,N -
13b.Disinfection type: Amount:
Form G W-l North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-20I8

WELL CONSTRUCTION RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
FROM TO I DESCRIPTION
Well Contractor Name ft. ft.
A - 2581 ft. fr.
NC Well Contractor Certification Number 15.OUTER CASING for multi-cased wells OR LINER if a Rcable
FROM I TO DIAMETER T THICKNESS MATERIAL
GEOLOGIC EXPLORATION, INC ft. & in.
Company Name 16.INNER CASING OR TUBING eothermal closed-loop)
FROM I TO I DIAMETER THICKNESS MATERIAL
2.Well Construction Permit#: 0.0 It- 120.0 fr. 6.0 in. SCH 80 PVC
List all applicable well construction permits(i.e.County,State,Variance,etc.)
130.0 ft 150.0 It 6.0 1O SCH 80 PVC
3.Well Use(check well use): 17.SCREEN
Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 120.0 ft. 130.0 1" 6.0 in. .020 SCH 80 SS
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 150.0 ft- 170.0 ft. 6.0 in. .020 SCH 80 SS
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
❑Irrl ation 2.0 ft. 20.0 It' PORTLANDaENTONRE SLURRY
Non-Water Supply Well: ft. ft.
❑Monitoring ❑Recovery
Injection Well: ft. ft.
❑Aquifer Recharge ©Groundwater Remediation 19.SAND/GRAVEL PACK if applicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
)
❑Aquifer Test ❑StormwaterDrainage 30.0 ft- 175.0 fr• 20-40 FINE SILICA SAND
ft. ft.
❑Experimental Technology OSubsidence Control
20.DRILLING LOG attach additional sheets if necessary)
❑Geothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION color,hardness soillreck rain sin,etc.
❑Geothermal(Heating/Coolin Return ❑Other(explain under#21 Remarks 0.0 ft- 17.0 ft- TAN SILTY SAND
4.Date Well(s)Completed: Well ID#
12/09/20 IW-53 17.0 ft- 24.0 ft- BROWN SILTY SAND
24.0 ft. 37.0 ft. PWR
5a.Well Location:
BELEWS CREEK STEAM STATION 37.0 ft 0 ft- ROCK 175.
ft. fr.
Facility/Owner Name Facility ID#(ifapplicable) ft. ft.
3195 PINE HALL ROAD BELEWS CREEK 27009 ft. ft.
Physical Address,City,and Zip 21.REMARKS
STOKES BENTONITE SEAL-20.0-30.0 FT (WIRE WRAPPED SCREEN)
County Parcel Identification No.(PIN)
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification:
(if well field,one lat/long is sufficient)
360 17' 31.79" N 800 03' 50.88" N, 12/15/20
Signature of Certified Well Contractor Date
6.Is(are)the well(s): OPermanent or OTemporary By signing this form,I hereby certify that the ivell(s)ivas(were)constructed in accordance
with 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a
7.Is this a repair to an existing well: ❑Yes or ONo copy of this record has been provided to the well owner.
1f this is a repair,fill out knoum well construction information and explain the nature of the
repair under#21 remarks section or on the back of this form. 23.Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
8.Number of wells constructed: 1 construction details. You may also attach additional pages if necessary.
For multiple injection or non-woler supply wells ONLY with the same construction,you can
submit one form. SUBMITTAL INSTUCTIONS
9.Total well depth below land surface: 170.0 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths ifdifferent(example-3@200'and 2@100') construction to the following:
10.Static water level below top of casing: 31.0 (ft) Division of Water Quality,Information Processing Unit,
If water level is above casing,use"-" 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 6.0/12.0 (in) 24b.For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12.Well construction method: AIR construction to the following:
(i.e.auger,rotary,cable,direct push,etc.)
Division of Water Quality,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
13a.Yield(gpm) Method of test: 24c.For Water Suooly&Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b.Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-I North Carolina Department of Environment and Natural Resources-Division of Water Quality Revised Jan.2013

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
ft. ft.
A - 2581
ft. It.
NC Well Contractor Certification Number 15.OUTER CASING for multi-cased wells OR LINER if a liceble
GEOLOGIC EXPLORATION FROM TO DIAMETER THICKNESS MATERIAL
ft. ft. in.
Company Name 16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#: WI04005 51/WV0400056 FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.U1C,County,State,Variance,etc) 0.0 It. 144.0 ft' 6.0 in. SCH 80 PVC
3.Well Use(check well use): ft. ft. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 144.0 ft. 164.0 ft. 6.0 in. .020 SCH 80 SS
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Irrigation ❑Welis>100,000 GPD FROM I TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 2.0 f` 20.0 ft' PORTLANDaENTONUE SLURRY
❑Monitoring ❑Recovery ft. ft.
Injection Well:
ft. ft.
❑Aquifer Recharge OGroundwater Remediation
19.SAND/GRAVEL PACK ifa licsble
❑Aquifer Storage and Recovery ❑Sal inity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑StormwaterDrainage 30.0 ft- 168.0 ft' 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) FROM TO DESCRIPTION color,hardness,soitimck type,grain size,etc.
0.0 ft- 14.0 It- TAN SILTY SAND
4.Date Well(s)Completed: 12/31/20 Well ID# IW-54 14.0 ft- 24.0 ft' BROWN SILTY SAND
5a.Well Location: 24.0 ft- 37.0 ft. PWR
BELEWS CREEK STEAM STATION 37.0 ft- 168.0 ft- ROCK
Facility/Owner Name Facility ID#(if applicable) ft. ft.
3195 PINE HALL ROAD BELEWS CREEK 27009 ft. ft.
Physical Address,City,and Zip ft. ft.
STOKES 21.REMARKS
County Parcel Identification No.(PIN) BENTONITE SEAL-20.0-30.0 FT(WIRE WRAPPED SCREEN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one]at/long is sufficient) 22.Certification'
360 17' 31.79" N 800 03' 50.88" W -,,. ,,.-
1/13/2021
6.Is(are)the well(s): OPermanent or ❑Temporary Signature ofCertified Well Contractor Date
By signing this form,I hereby certify that the well(s)was(were)constructed in accordance ivith
7.Is this a repair to an existing well: ❑Yes or ONO 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy
1f this is a repair,fill out known well construction information and explain the nature of the ofthis record has been provided to the well owner.
repair under#21 remarks section or on the back of this 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 info
construction,only I GW-1 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: 164.0 (ft.)
For multiple wells list all depths ifdii ferent(example-3@200'and 1@100') Submit this GW-1 within 30 days of well completion per the following:
31.0 24a. For All Wells: Original form to Division of Water Resources (DWR),
10.Static water level below top of casing: (ft.) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
Ifwater level is above casing,use"+"
11.Borehole diameter' 6.0/12.0 (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
Permit Program,1611 MSC,Raleigh,NC 27699-1611
13a.Yield(gpm) Method of test:
13b.Disinfection type: Amount:
Form G W-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018

WELL CONSTRUCTION RECORD GW-1 For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.WATER TONES
Well Contractor Name PROM 7'O DESCR►MON
A - 2581 rr. IL
rI. ft.NC Well Contractor Certification Number
15.OUTER CASING for ma1N-cased wel6 OR LINER If a livable
GEOLOGIC EXPLORATION FROar To DIAMETER nitcravess MATERIAL
R. iL fiL
Company Name
16.INNER CASING OR TUBING eothermal closed-loonl
2.Well Construefion Permit#: FROM TO DIAMETER THICKNESS MATERIAL
l.iv all applicable well construction permdrs(i.e.UiC,County,Stare,Variance,etc) 0.0 ft. 50.0 ft. 6.0 in' SCH 40 PVC
3.Well Use(check well use): ft. ft. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
❑Agricultural DMunicipal/Public 50.0 tr 70.0 it' 6.0 ID 010 SCH 40 PVC
❑Geothermal(I leating/Cooling Supply) ❑Residential Water Supply(single) ft. R. In.
❑Industrial/Commercial DResidential Water Supply(shared) 18.GROUT
01rn atlon ❑Wells> 100000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0.0 n• 20.0 fa AQUA GUARD SLURRY
MMonitoring ❑Recovery ft. fL
Injection Well:
❑Aquifer Recharge ❑Groundwater Remediation R. ft.
19.SANDIGRAVEL PACK ira livable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
DAquitcr Test ❑Stormwater Drainage 25.0 R' 72.0 it• 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control ft. ri
❑Geothermal(Closed Loop) OTracer 20.DRILLING LOG attach additional sheets if necessary)
❑Geothermal( feat in Cool ing Return) DOther(explain under#21 Remarks) FROM TO DESCRIVnON color,hardnM millmit tyM train size,etc.
0.0 °• 16.0 ir• BROWN SILTY SAND
4.Dale Well(s)Completed: 07/28/22 Well ID# IW-55 16.0 h• 28.0 it. TAN SILTY SAND
5a.Well Location: 28.0 ir• 45.0 i' PWR
BELEWS CREEK STEAM STATION 45.0 R 72.0 ft- ROCK
Facility/Owner Name Facility ID#(ifapplicablo) ft. ft.
3195 PINE HALL ROAD BELEWS CREEK 27009 ft. fL
Physical Address,City,and Zip ft. 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:
(if well field,one lat/long is sufficient) 22.Cerlifteation:
928752.7070 N 1681224.372 W _
08/01/22
6.Blare)the well(s): ITPermanent or ❑Temporary Signature of Certified Well Contractor Date
By signing IhLT form,/hereby certify that the,vell(s)war(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or ONO 15A NC4C 02C.0100 or 15A NCAC 02C.0200 lYeti Consirue ian.Standards and that a copy
If this is a repair,fill out known well construction inOrmarlon and explain the nature of the of this record lays been provided to the well owner.
repair under#21 remarks section or an the back ofdtis form.
23.Site diagram or additional well details:
8.For Geoprobe/DP7'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-1 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: 70.0 (ft.)
1•or multiple wells/Ar all depths ifd fferent(example-3@200'and 2@100) ( Submit this GW-1 within 30 days of well completion per the following:
10.Static water level below top of casing: 30.0 fL 24a, For All Wells: Original form to Division of Water Resources (DWR),
If water level is abore casing,use"+'• ( ) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter: 10•0 (in) 24b. For Injection Wells:Copy to DWR,Underground Injection Control(IUC)
Program, 1636 MSC,Raleigh,NC 27699-1636
.e Well construction method: AIR 24c.For Water Supply and Open-Loop Geothermal Return\Yells:Copy to the
(i.e.auger,rotary,cable,direct push,arc.) county environments eat department o e county ere inl e
FOR WATER SUPPLY WELLS ONLY: 24d. For Water Wells producing
(gP ) Method of test: over l00 000 GPD: Copy to DWR,CCPCUA
13s.Yield m Permit Program,1611 Raleigh,N 7 I
13b.Disinfection type: Amount:
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
ft. ft.
A - 2581 ft. ft.
NC Well Contractor Certification Number 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(geothermal closed-loop)
2.Well Construction Permit#: WI0400551/WV0400056 FROM TO DIAMETER I THICKNESS I MATERIAL
List all applicable ivell construction permits(i.e.UIC,County,State,Variance,etc.) 0.0 ft- 146.0 ft. 6.0 r"' I SCH 80 PVC
3.Well Use(check well use): ft. ft. in.
17.SCREEN
Water Supply Well:
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 146.0 ft' 166.0 ft' 6.0 in.
.020 SCH 80 SS
❑Geothermal(Heating/Cooling Supply) OResidential Water Supply(single) ft. ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Irrl ation ❑Wells>100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 2.0 ft- 20.0 ft' PORTLAND BENTONITE SLURRY
❑Monitoring ❑Recovery ft. ft.
Injection Well: ft. ft.
❑Aquifer Recharge I'DGroundwater Remediation
19.SAND/GRAVEL PACK if applicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage 30.0 ft- 170.0 ft. 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 421 Remarks) FROM TO DESCRIPTION color,hardness,soil/rock type,grain size,etc.
0.0 ft- 13.0 ft. TAN SILTY SAND
4.Date Well(s)Completed: 01/07/21 well ID# IW-59 13.0 ft- 22.0 I'L BROWN SILTY SAND
5a.Well Location: 22.0 It' 34.0 It' PWR
BELEWS CREEK STEAM STATION 34.0 ft 170.0 ft. ROCK
Facility/Owner Name Facility ID#(ifapplicable)
ft. ft.
3195 PINE HALL ROAD BELEWS CREEK 27009 ft. ft.
Physical Address,City,and Zip ft. ft.
STOKES 21.REMARKS
County Parcel Identification No.(PIN) BENTONITE SEAL-20.0-30.0 FT(WIRE WRAPPED SCREEN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one ladlong is sufficient) 22.Certification:
360 17' 31.79" N 800 03' 50.88" W !�21n:;_Gar-- 1/13/2021
6.Is(are)the well(s): 091'ermanent or ❑Temporary Signature ofCertified Well Contractor Date
By signing this form,I hereby certify that the rvell(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or MNo 15A NCAC 02C.0100 or 15A NCAC 02C.0100 Well Construction Standards and that a copy
If this is a repair,fill out known well construction information and explain the nature of the ofthis record has been provided to the well owner.
repair under#21 remarks section or on the back of this 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 info
construction,only 1 GW-1 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: 166.0 (ft.)
For multiple wells list all depths ifdi/jerent(example-3@200'and 1@I00') Submit this GW-1 within 30 days of well completion per the following:
31.0 24a. For All Wells: Original form to Division of Water Resources (DWR),
!f water/evel is above casing,use"+"
f' Static water level below top of casing: (ft.) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter: 6.0/12.0 (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.Yield(gpm) Method of test: Permit Program,1611 MSC,Raleigh,NC 27699-1611
13b.Disinfection type: Amount:
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018

WELL CONSTRUCTION RECORD For Internal Use ONLY
This form c&n be ased for suittle or multiple wells
1.Well Contractor Information:
BRIAN THOMAS 14,WATER ZONES
FROM TO DESCRIPTION
Well Cortrucle Name ft. R.
A - 2581 ft.
NC Wel:Contrtsctor Certificariun Number 15.OUTER CASING for multi-cased wells OR LINER if a livable
FROM TO DIAMETER THICKNESS MATERIAL
GEOLOGIC EXPLORATION, INC rt. n. in
Company Name 16.INNER CASING OR TUBING fteothermal closed-loo
FROM TO I DIAMETER I THICKNESS riATERIAu
2.Well Construe lion Permit N: 0.0 ft. 145.0 ft- 6.0 'a 5CH 80 PVC
Lest all applicable well construction peronts(i.e (bunt,3-,,Srale.Variance,err.)
ft, ft. in,
3.Well Use(check well use): 17.SCREEN
Witter Supply Well: FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
OAgncultural OMunicipal/Public 145.0 ft' 165.0 ft. 6.0 in. .020 SCH 80 SS
OGeolhermal(Heating/Cool ing SuPPIY} ❑Residential Water SuPPIY(single) f. ft. in.
❑lndustrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
FROM TO MATERIAL EMPLACEMENTMETHOD&AMOUNT
Dirrl atton 2.0 ft. 20.0 It. PORTILM10IENTONUE SLURRY
Non-Water Supply Well:
❑Monitoring ORecovery
Injeclion Well: ft. ft.
❑Aquifer Recharge ®Groundwater Remediation 19.SAND/GRAVEL PACK ira livable
FROM TO MATERIAL EMPLACEMENT METHOD
❑Aqurtcr Storage and Recovery ❑Salinity,Barrier 30.0 ft• 170.0 ft• 20-40 FINE SILICA SAND
❑Aquifer Test OStormwater Drainage R. ft.
DExperrmental Technology ❑Subsidence Control
20.DRILLING LOG attach additional sheens if aeeessa
❑Geothermal(Closed Loop) OTracer FROM TO DESCRIPTION color,hardness,wiVmk type,grain size,etc.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under N21 Remarks) 0.0 ft• 12.0 R• TAN SILTY SAND
4.Date Well(s)Completed:
12/03/20 Well 1DN IW-62 12.0 ft- 23.0 ft- BROWN SILTY SAND
23.0 ft• 36.0 rL PWR
Sa.Well Location: 36.0 f' 170.0 ft. ROCK
BELEWS CREEK STEAM STATION
Facility/Owner Name Facility IDN(if applicable)
3195 PINE HALL ROAD BELEWS CREEK 27009 ft. ft.
Physical Address,City,and Zip ZI.REMARKS
STOKES BENTONITE SEAL-20.0-30.0 FT (WIRE WRAPPED SCREEN)
County Parcel Identification No.(PIN)
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification:
(if well field,one latilong is sufficient)
360 17' 31.79" N 800 03' 50.88" W _ � ''`- 12/15/20
Signature of Certified Well Coriiraelor Date
6.Is(are)the well(s): OPermanent or OTemporary Ry signing ilus forme I hereby certify that the weA(s)eras(here)consrrucied in accorckrnce
iriih 15A N<AC 02C 0100 or 1SA N(AC 02C.0200 Well Construction.Srandardv and that a
7.Is this a repair to an existing well: ❑Yes or ®No cagy of this record leas been provided to the well owner
if ilus is a repair,fill our known ue11 ctntsrrrecrion iglbratatian and explain dre nature of the
repair under-21 renwrks secnair or an the back afthis form. 23.Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
S.Number of wells constructed: 1 construction details. You may also attach additional pages tf necessa fy
1•ar nuilriple urjeernmr or non-itmer.supply irells ON1.V iriih the some construction.put can
suburil oneform. SUBMITTAL INSTUCTIONS
9.Total well depth below land surface: 165.0 (ft.) 24o. For All Wells: Submit this form within 30 days of completion of well
h,w inuhiple hells lisi all depths ifdi,(lrretn feraniple-31iQ200'aul2@lW'► construction to the following:
10.Static water level below top of casing: 31.0 (ft) Division of Water Quality,Information Processing Unit,
if crater fro-el is abore casing use" - 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 6.0/12.0 (in.} 24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12.Well construction method: AIR construction to the following:
p,e.auger,rotary,cable direct push,etc)
Division of Water Quality,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
13m.field(gpm) Method of test: 24c.For Water SuDDIy&Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 clays of
13b.Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form CW-I North Carolina Department of Environment and Natural Resources-Division of Water Quality Revised Ian 2013

WELL CONSTRUCTION RECORD r7a
IUseONLY
This form can be used for single or multiple wells
1.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
FROM TO DESCRIPTION
Well Contractor Name ft. n.
A - 2581 ft. n.
NC Well Contractor Certification Number 15,OUTER CASING for multi-cased wells OR LINER if a Gcable
FROM TO DIAMETER THICKNESS M1UTERIAL
GEOLOGIC EXPLORATION, INC n. n. I in.
Company Name 16.INNER CASING OR TUBING fueethermal closed-loon)
FROM TO DIAMETER I THICKNESS MATERIAL
2.Well Construction Permit#: 0.0 ft' 145.0 f" 6.0 i"' I SCH 80 PVC
!•ire all applicable well construction permrirs(i.e.(betray,Stare,I'ariance,etc)
n. n. ;n.
3.Well Use(check well use): t7,SCREEN
Water Supply Well: FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
OAgncullural ❑Municipal/Public 145.0 ft' 165.0 ft' 6.0 in. .020 SCH 80 SS
❑Geothermal(Heat m Coul m&Supply) ❑Residential Water SuPPIY(single) ft• ft.
01ndustrial/Commercial OResidenttal Water Supply(shared) 18.GROUT
FROM TO MATERIAL EMPLACEMENTMETHOD&AMOUNT
❑ aeon 2.0 te. 20.0 ft' PoaluikostkroWN SLURRY
Non-Water Supply Well: n. ft,❑Mondoring ❑Recovery
Injection Well: R. ft.
❑Aquifer Recharge OGroundwater Remediation 19.SAND/GRAVEL PACK: ifs Iicable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM To MATERIAL I EMPLACEMENTAIETHOD
❑Aquifer Test ❑Stormwater Drainage 30.0 n• 170.0 ft' 20-40 FINE SILICA SAND
❑Experimental Technology OSubsidence Control
20.DRILLING LOG attach odditfonal aheeb if necessary)
❑Geothermal(Closed Loop) ❑Tracer FROM I TO DESCRIPTION color,bardne "illmlittype,grain size,e1r.
❑Geothermal(Realm Cuolin Return) ❑Usher(explain under#21 Remarks) 0.0 ft' 13.0 n• TAN SILTY SAND
d.Date Well(s)Completed:
12/02/20 Well ID# IW-63 13.0 ft- 23.0 n. BROWN SILTY SAND
23.0 ft- 38.0 n• PWR
5a.Well Location: 38.0 ft- 170.0 ft. ROCK
BELEWS CREEK STEAM STATION
Facility/Owner Name Facility IDN(if-applicable) ft. n.
3195 PINE HALL ROAD BELEWS CREEK 27009 n, R.
Physical Address,City,and Zip
21.REMARKS
STOKES BENTONIfE SEAL-20.0-30.0 FT (WIRE WRAPPED SCREEN)
County Parcel Identification No.(PIN)
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification'
(if well field,one latdlong is sufficient)
360 17' 31,79" N 800 03' 50.88" W 12/15/20
Signature of Certified Well Contractor Date
6.Is(are)the wctl(s): OPermanent or ❑Temporary } R i (
H•si inn this f arnr,1 hereby•ceNi7 that the nil!s)kac Terre eonclrudeJ in nrcnrtkraer
with 15A NCAC 02(' 0100 or 15A N(AC 02C.0200 Well(omirriction Stoodartlr and that u
7.Is this a repair to an existing well: ❑Yes or allo copy i fthis record has been provided to the urll owner.
If this is a repair•fill nur knmrn well construction information and explain the nature ofthe
repair under 21 renrarkc section or on the back rJ This form. 23.Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
1�ir- Number of wells constructed: 1 r nrulrrplr ur/retimr or Tenn-u•atrr supply u•rlLc ONLY rvirh the same crmstrucrion.you can construction details You may also attach additional pages if necessary
subnrironefttio SUBMITTAL INSTUCTIONS
9.Total well depth below land surface: 165.0 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
1-or minhiple welly list all depths if differeru(example-3@2W'ark12(@100') construction to the following.
10.Static water level below top of casing: 31.0 (ft.) Division of WaferQuality,Information Processing Unit,
If+rarer leri l it abort facing,use•' " 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 6.0/12.0 (in.) 24b.For Injection Wells: In addition to sending the form to the address in 24a
12.Well construction method: AIR above, also submit a copy of this form within 30 days of completion of well
construction to the following.
p c auger,rotary,cable,direct push,etc)
Division of Water Quality,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
13a.Yield(gpm) Method of test: 24c.For Water Supply&Injection Well • In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b.Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed
Form G W.I North Carolina Department of Environment avid Natural Resources Division of Waler Quality Revised Jan.2011

WELL CONSTRUCTION RECORD For laternal Use ONLY.
This form can be used for single or multiple wells
1.Well Contractor Information:
BRIAN THOMAS 14,WATER ZONES
FROM TO DESCRIPTION
Well Contractor Name n. R.
A - 2581 ft. ft.
NC We] Coatiuwtor Certeficarime Number IS.OUTER CASING rar multi-cased wells)
elt OR L[NER if a licable
FROM TO DIAML"rER THICKNESS MATERIAL
GEOLOGIC EXPLORATION, INC ft. rie. in
Company Name 16.INNER CASING OR TUBING(geothermal closed-loose)
FROM TO DIAMETER I THICKNESS I MATERIAL
2.Well Construction Permit N: 0.0 "' 145 0 ft' 6.0 1- 1 SCH 80 1 PVC
Uss all applicable well cansiractstin perturts(i.e.Countj Store,Variance.et(J
h. O, in.
3.Well Use(check well use): 17.SCREEN
Water Supply Well: FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
❑Agricultural OMumcipal/Pubhc 145.0 t'' 165.0 t'' 6.0 'a' .020 SCH 80 SS
❑Geothermal(Heating/Coohng Supply) OResidential Water Supply(single) ' ft. in'
❑industrial/Commercial ❑Residential Water Supply(shared) 19.GROUT
FROM TO MATERIAL E14 PLACEMENT METHOD&AMo-URF
Oirrigation 20 O, 200 ft' oonrciwosrnronnr SLURRY
Non-Water Supply Weil:
❑Monitoring ❑Recovery
lnjeclion Well:
❑Aquifer Recharge ❑Groundwater Remediation 19.SANDIGRAVEL PACK ifs ticable
❑Aqurfer Storage and Recovery OSaLnity Sorrier FROM TO 1 MATERIAL EMPLACEMENT111ETHOD
OAquifer Test ❑Slormwater Drainage 30.0 tt 170.0 R' 20-40 FINE SILICA SAND
h. n.
❑Experimental Technology ❑Subsidence Control
20.DRILLING LOG attach additional sheet if necessa
❑Geothermal(Closed Leap) ❑Tracer FROM I TO DESCRIPTION color,hardness,wivrock tysie,grain sire,etc.
❑Geothermal(Heatin Coul Ing Return) ❑Other(explain under 421 Remarks) 0.0 h• 12.0 n TAN SILTY SAND
4.Date Well(s)Completed:
12/02/20 Well 1Dl! IW-65 12.0 n 23.0 R BROWN SILTY SAND
23.0 t'' 38.0 n PWR
Sa.Well Location: 38.0 tt 170.0 h' ROCK
BELEWS CREEK STEAM STATION
Faca:in/Owner Name Facility IDN(al'applicable)
3195 PINE HALL ROAD BELEWS CREEK 27009
Phyteea Address,City,and Zip
21.REMARKS
STOKES SENTONITE SEAL-20.0-30.0 FT (WIRE WRAPPED SCREEN)
County Parcel Identification No (PIN)
Sb.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification:
(ifwell l'ierd,one latllong is sufficient)
360 17' 31.79" N 800 03' 50.88" �` 12/15/20
Signature ofCenified Well Contractor Dare w_
6.Is(are)the well(s). OPermemenl or ❑Temporary cretin this arm,I hereh carte shot the wells iron were constructed nt actordance
NJ' i� x ! r h' ll (� 1
ivith 1SA N('AC 02C 0100 or 13A N('A('02('.0200{Yell('atrlruetian Soatalards n)kl iiiai a
7.Is this a repair to an existing well: 01'es or ElNo copy tifilsis record hat been provided so else well owner
JJ'das is a repair,fill out known hell constrac0oir infbrinaeion senrl explaor she nature qj tire
repair antler 21 rernarks sertian or an the hack ofthis farm. 23,Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
8.Number of wells constructed: 1 construction details You may also attach additional pages if necessary
ben-nathipb iryer9lon or rare wahr supply hells ONLY with she same construction,)Wei can
suhmrtanefririn. SUBMITTAL 1NSTUCTIONS
9.Total well depth below land surface: 165.0 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
I-or nadnMe ii ehs live all depth,fdr1lercen(exanyNv-3 a 200'and 2 a/Oil') construction to the followi ig.
10.Static water level below lop of casing: 31.0 (ft.) Division of Wafer Quality,Information Processing Unit,
1f ivater level is obiwe casing,env- " 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 6-0/12.0 (in.) 24b. For Injection Wells: In addition to sending the form to the address in 24a
12.Well construction method: AIR above, also submit a copy of this form wtthin 30 days of completion of well
construction to the fo.lowing
O.e auger,rotary,cable,direct push,etc)
Division of Water Quality,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
13a.1 field(gpm) Method of test: 24c.For Water Supply&lnWtion Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b.Disinfection type:- _ Amount: completion of well construction to the county health department of the county
where constructed
Form GW-I North Carolina Department of Hnveronmeni and Natural Resources Division of Waler Quality Reyesed Jan 2013

WELL CONSTRUCTION RECORD For Internal Use ONLY
This form can be used for single or multiple wells
1.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
FROM TO DESCRIPTION
Well Contractor Name ft. n,
A - 2581 n, n.
NC Well Contractor Certification Number 15.OUTER CASING for
FRUM TO muDlttwa els ORR a leabte
METER MATERIAL
GEOLOGIC EXPLORATION, INC rt. a, I in.
Company Name 16.INNER CASING OR TUBING eothermal closed40011111
FROM TO I DIAMETER I THICKNESS MATERIAL
2.Well Construction Permit#: 0.0 ft. 147,0 n' 6.0 i" SCH 80 PVC
List all applicable+cell cortcrruciian permits(ix.('aunt}.Stale.Variance.vie.) fL ft. in.
3.Well Use(check well use): 17.SCREEN
Water Supply Well: FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
OAgncultural ❑Municipal/Public 147.0 "' 167.0 ft. 6.0 'n' .020 SCH 80 SS
❑Geothermal Heaton Coolie Supply) ❑Residential Water Supply(single) ft, n. is
( P>< 8 PP Y) AP Y( g
❑lndus(nal/Commercial OResidential Water Supply(shared) 18.GROUT
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well:
2.0 ft. 20.0 O' e0arta E)SENEONITE SLURRY
Non- fr. R.
OMonitonng ❑Recovery
Injection Well: ft. h.
❑Aquifer Recharge OGroundwater Remediation 19.SANDIGRAVEL PACK if applicublel
FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Storage and Recovery ❑Salinity Berner 30.0 f6 173.0 ft- 20-40 FINE SILICA SAND
❑Aquifer Test OStormwater Drainage ft
❑Experimental Technology ❑Subsiclence Control 20.DRILLING LOG attach additional sheets if necessary)
❑Geothermal(Closed Loop) ❑Tracer FROM TO DESCRIPTION color,hardness,soil/wit IyM timin sat,<fc.
❑Geothermal(Heaton Coolie Return) OUlher(explain under#21 Remarks) 0.0 ft, 22.0 ft- TAN SILTY SAND
J.Date N1'ell(s)Completed:
12/01/20 Well 1D4 IW-67 22.0 n. 30.0 n BROWN SILTY SAND
30.0 n 41.0 n PWR
5a.Well Location: 41.0 f' 173.0 n ROCK
BELEWS CREEK STEAM STATION
Fac;:ity'Owaer%amc Facility ID#(ifappl,cable)
3195 PINE HALL ROAD BELEWS CREEK 27009 rl. ft.
Physical Address,City,and Zip
21.REMARKS
STOKES BENTONITE SEAL-20.0 30.0 FT (WIRE WRAPPED SCREEN)
Count% Parcel Identification No.(PIN)
Sb.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification:
(if well field one Iaillong,s sutTicienul
36° 17' 31.79" N 800 03' 50.88" W 12/15/20
Signature of Certified Well Contractor Dale
6.Is(are)the weil(s): OPermanent or OTemporary Y x f y fY (j ( /
8 signing�this orm,1 beech�tern that the rcell.r +ear rrer constructed nr occordnnrr
trilh 15A N('AC 02C 0100 or 15A N(A('02C 0200 Well Constractiou Siandards and drat o
7.Is this a repair to an existing well: ❑Yes or EINo cagy ufthis record hat been previrled to the+cell owner
ty this is a repair fill aW knoirn well consirucrran urforniotion and exlihwa the nature of the
repair tunler 21 reniarks sectirur or air the lack r ftWs farm. 23,Site diagram or additional well details:
You may use the back of this page to provide additional well site details or we.I
8.Number of wells constructed: 1 construction details. You may also attach additional pages if necessary
Por nwhiple injection or nan-+rarer supply+vells ONLY trirh the same construction,Yuri can
.vibmil oneJorm SUBMITTAL INSTUCTlONS
9.Total well depth below land surface: 167.0 (ft.) 24s. For All Wells: Submit this form within 30 days of completion of well
her inrdnple+rells i'is1 oil depths iJ iliJjerein(example 3@200'and 2©100') construction to the following
10.Static water level below top of casing: 31.0 (ft) Division of Water Quality,Information Processing Unit,
IJ troier level is above caring.use" " 1617,Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter. 6.0/12.0 (in) 24b. For Injection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of w'e.l
12.Well construction method: AIR construction to the fuLowmg
p e auger rotary,cable,direct push,etc)
Division of Water Quality,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
13n.Yield(gpm) Method of test: 24c.For Water Supply&lniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b.Disinfection type: Amount completion of well construction to the county health department of the county
where constructed.
Form GWA North Carolina Department of Environment and Natural Resources-Division of Water Quality Revised Jan 20.;

WELL CONSTRUCTION RECORD For Internal Use ONLY
This form can be used for single of muhrple wells
1.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
FROM TO DESCRIPTION
Well Contractor Name ft. ft.
A - 2581 ft. n.
NC Well Contractor Cerlificalion Number IS.OUTER CASING for multi eased wells OR LINER it a livable
PROM TO DIAMETER THICKNP$$ MATERIAL
GEOLOGIC EXPLORATION, INC ft, in
Company Name 16.INNER CASING OR TUBING Imeothermall clo3ed-l000l
FROM TO DIAMETER THICKNESS MATERIAL
2.Well Construction Permit q: 0.0 "' 147.0 It- 6.0 In. SCH 80 PVC
List all applicable well construction permits(i.e.Caumv,State,Variance,etc) ft. ft. in.
3.Well Use(check well use): 17.SCREEN
Water Supply Well: FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 147.0 ft' 167.0 ft' 6.0 .020 SCH 80 SS
❑Geothermal(Heat ing/Cool Ing Supply) ©Residential Water Supply(single) ft. ft. in
[ Industrial/Commercial ❑Residential Water Supply(shared) IS.GROUT
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Olrri anon 2.0 0• 20.0 ft. PearWroSENlonnr SLURRY
Non-Water Supply Well:
❑Monilonng ORecovery fr. ft.
Injection Well: 0 rT
❑Aquifer Recharge OGroundwater Remediation 19.SANDIGRAVEL PACK if a livable
❑Aquifer Storage and Recovery OSalmity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Storm+valer Drainage
30.0 n 172.0 It 20-40 FINE SILICA SAND
ft. fr.
❑Experimental Technology ❑Subsidence Control
20.DRILLING LOG attach additional sheets if necestia
❑Geothermal(Closed Loop) OTracer FROM TO DESCRIPTION color hardn soiPrack lypr,grain size err.
OGcothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) 0.0 ft. 16.0 R• TAN SILTY SAND
10/15/20 IW-68 160 i' 58.0 It- BROWN SILTY SAND
4.Date Well(s)Completed: Well 1Dq 58.0 ft• 66.0 it• PWR
5a.Well Location: 66.0 i< 172.0 4• ROCK
BELEWS CREEK STEAM STATION
Facility/owner Name Facility ID#(dapplicable)
ft. ft.
3195 PINE HALL ROAD BELEWS CREEK 27009 ft. D.
Physical Address,City,and Zip 21.REMARKS
STOKES BENTONITE SEAL-20.0-30.0 FT (WIRE WRAPPED SCREEN)
Countv Parcel Identification No (PIN)
Sb.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification:
(if well field.one lot/long is sufficient)
36° 17' 31.79" N 800 03' 50.88" W `� 10/23/20
Signature of Certified Well Contractor Date
6.Is(are)the well(s): OPermonent or OTemporary By signing this form,1 hereby certify that rise ireR(s)was(irere)constructed in accorrhnrce
with 1 SA NC AC 02C 0/00 or 15A NCAC 02C 0200 Well Construction Standards and that u
7.Is this a repair to an existing well: ❑Yes or ONo copy ofrhis record leas been provided to the irell otrner
lJ tits is a repair,fill our known trell construction information and explain the nature of the
repair under#21 rensorks section or an the back afthis farm. 23.Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
8.Number of wells constructed: 1 construction details You may also attach additional pages if necessary
Por multiple injection or ton-iraer.supply irelts ON1,Y with the same construction.Jrou can
submttanefornn. SUBMITTAL INS'TUC'TlONS
9.Total well depth below land surface: 167.0 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
I ar multiple irelh hst all depths ifili Brent(exannple-3 tr 00'am12©100') construction to the following:
10.Static water level below top of casing: 34.0 (ft) Division of Water Quality,Information Processing Unit,
If eater level is above casing,use•• - 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 6.0/12.0 (in) 24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12.Well construction method: AIR construction to the following:
(ix auger,rotary,cable,direct push,etc)
Division of Water Quality,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
13a.Yield(gpm) Method of test: 24c.For Water Supply&Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b.Disinfection type: _ Amount: completion of well construction to the county health department of the county
%%here constructed
Form GW-1 North Carolina Department of Environmeni and Natural Resources-Division of Water Quality Revised Jan.2013

WELL CONSTRUCTION RECORD For Internal Use ONLY
This form can be used for single or mulliple wells
I.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
FROM TO DESCRIPTION
Well Contractor Name n. ft.
A - 2581 n. n.
NC Well Contractor Certification Number IS.OUTER CASING Ifor multi-cased wells OR LINER ifs lieable
FItUM TO DIAMETER THICKNESS MATERIAL
GEOLOGIC EXPLORATION, INC ft. rt. is
Company Name 16,INNER CASING OR TUBING eothermal dosed-loop)
FROM TO DIAMETER I THICKNESS MATERIAL
2.Well Construction Permit#: 0.0 D' 150.0 n. 6.0 i°' SCH 80 PVC
Livi all applicable roll constrw'tion pernlilc(i.e Ci muJ:Stale•Variance•erc) n O. is
3.Well Use(check well use): 17.SCREEN
Water Supply Well: FROM TO DL IETER SLOTSIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 150.0 n' 170.0 f'• 6.0 in. .020 SCH 80 SS
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) n. ft. in.
❑Industrial/CommercPal DRestdential Water Supply(shared) IS,GROUT
FROM TO MATERIAL EMPLACEMENT METHUD&AMOUNT
❑Ern ition
2•0 ft. 200 ft. pORTW/DaEN1ONnE SLURRY
Non-Water Supply Well:
n. n.
❑Monnonng ❑Recovery
Injection Well: ft. to.
❑Aquiter Recharge ❑Groundwater Remediation 19.SANDIGRAVEL PACK If a lieable
FROM TO MATERIAL EMPLACEMENTMETHOD
OAquifer Storage and Recovery OSalinity Barrier 30.0 r'• 175.0 f'• 20-40 FINE SILICA SAND
❑Aquifer Test OStormwater Drainage ft. n.
❑Expenmental Technology OSubsidence Control
20.DRILLING LOG attach additional sheed if necessary)
❑Geothermal(Closed Loop) OTracer -mom- TO DESCRIPTION ciiJitr.hardness,3oiYmk type,limia sir,etc.
❑Geothermal(Heat m Cool ing Return) ❑Ocher ex lam under#21 Remarks) 0.0 It. 25.0 rl• TAN SILTY SAND
11/25/20 IW-69 25.0 n 33.0 D BROWN SILTY SAND
4.Date Wells)Completed: Well 1Dp
33.0 f' 51.0 r' PWR
Sa.Well Location: 51.0 r' 175.0 f' ROCK
BELEWS CREEK STEAM STATION
FaciliiylOw•ner Name Facility IDO(ifapplicable)
n. R.
3195 PINE HALL ROAD BELEWS CREEK 27009
ft. ft.
Physical Address,City,and Zip 21.REMARKS
STOKES BENTONrfE SEAL•-20.0-30.0 FT (WIRE WRAPPED SCREEN)
County Parcel Identification No.(PIN)
Sb.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22•Certification:
(dwell field one IaUlong is sufficient)
360 17' 31.79" N 800 03' 50.88" , 12/15/20
Signature of Certified Well Contractor Dale
6.Is(are)the well(s): OPermanent or ❑Temporary By signing this form,1 hereby ceni/j-that dre wel(s)was(were)constructed in ac orilano
will)15A N(AC 01(' 0100 or ISA NCAC 01C 0200 Well Catairuction Slawlards and tint a
7,Is this a repair to an existing well: ❑Yes or ONo copy of this record has beeir prowled to dre ivell rnr•ner
1f ibis rs a repair,Jill our kienru well construction information and explain the nantre of dw
repair render=21 remarks section or on dre back of dris jiirni. 23.Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
8.Number of wells constructed: 1 construction details You may also attach additional pages if necessary
1•br multiple ollecrion or wen-waler suppl)wells ONLY with the same construction.yore can
subruir one front. SUBMITTAL.INSTUCTIONS
9.Total well depth below land surface: 170.0 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
For iwrhiple trells list all depths rf'difjereirl(example-3@100'aml 2yi;l00') construction to the following:
10.Static water level below top ofcasing: 31.0 (ft.) Division of Water Quality,Information Processing Unit,
Iftiaier lerelisaboi•e c•avorg,rise.. " 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 6.0/12.0 (in) 24b. For Infection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of will
12.Well construction method: AIR construction to the following:
(i.e auger rotary,cable,direct push,etc)
Division of Water Quality,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
13a.Yield(gpm) Method of test: 24c.For Water Supply&ln•ection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b.Disinfection type. Amount: completion of well construction to the county health department of the county
where constructed
Form GW-1 North Carolina Department of Environment and Natural Resources Division of Waler Quality Revised Jan 201 i

WELL CONSTRUCTION RECORD For Internal t'se ONLY
This form can be used for single or multiple wells
1.Well Contractor Information:
BRIAN THOMAS 14,WATER ZONES
FROM TO DESCRIPTION
Well Contractor Name 0. ft.
A - 2581 ft. ft.
NC Well Contractor Cemfieauon Number IS.OUTER CASING for muttPc2 ed wells OR LINER if a Ucable
FROM TO DIAMETER THICKNF$$ MATERIAL
GEOLOGIC EXPLORATION, INC n. ft. is
Company Name 16.INNER CASING OR TVBING eothermal Nosed-too
FROM TO DIAMETER I THICKNESS I MATERIAL
2.Well Construction Permit#: 0.0 f'• 150.0 "' 6.0 'n I SCH 80 PVC
I isiall applicable well canstructionpermUs(i.e.(•orrnty.Slate.I'arrance,etc)
R. ft. is
3.Well Use(check well use): 17.SCREEN
Water Supply Well: FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
OAgrtcultural OMuincipallPublic 150.0 fr' 170.0 fr. 6.0 in' .020 SCH 80 SS
OGeothermal(Heating/Cooling Supply) OResidential Water Supply(single) ft. ft. rn
❑Industrial/Commercial OResidential Water Supply(shared) 18.GROUT
FROM TO MATERIAL EMPLACEMENT METHOD AMOUNT
Non-Water Supply Well:❑ 2.0 fi- 20.0 ft' PORTUNDBENTONRE SLURRY
G. tr.
❑Monitoring ❑Recovery
Injection Well: ft. ft.
❑Aquifer Recharge OC;roundwater Remediabon 19.SAND/GRAVEL PACK if applicablel
FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Storage and Recovery ❑Salinity Barney 30.0 fr• 175.0 fr• 20-40 FINE SILICA SAND
OAqulfer Test ❑Stormwater Drainage fL R,
❑Experimental Technology ❑Subsidence Control
20.DRILLING LOC atfoch additional sheets if ntcessa
❑Geothermal(Closed Loop) ❑Tracer FROM 710 DESCRIPTION color,hardam milfrock tyn,anin sizei etc.
❑Geothermal(Healing/Cooling Return) OOther(explain under#21 Remarks) 0.0 fr• 28.0 n TAN SILTY SAND
J.pate Well(s)Completed:
i 1/24/20 Well Ip# IW-70 28.0 fr• 37.0 R BROWN SILTY SAND
37.0 R. 68.0 tr. PWR
Sa.Well Location: 68.0 fr• 175.0 fr• ROCK
BELEWS CREEK STEAM STATION 8 R
Facibty'Owner Name Facility ID#(ifapplicable) R R
3195 PINE HALL ROAD BELEWS CREEK 27009 ft ft
Physical AJdre,s,Cit_v,anti Lp 21.REMARKS
STOKES BENTONITE SEAL 20.0 30.0 FT (WIRE WRAPPED SCREEN)
County Parcel Identification No.(PIN)
%.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22•Certification:
(d well field,one tat/long is sufficient)
360 17' 31.79" N 800 03' 50.88" W �`'� '`^ 12/15/20
SignaturaofCertified Well Contractor Date
6.Is(are)the well(s): OPermanent or ❑Temporary
Hy signing this Joan,1!hereby versify rlrar the nrell(s)trac(it-ere)can.errnned to nrrnrtbnre
inch 13A NCAC-02C 0100 or 15A NCAC 02('.0200{Yell Construction Standards and 11101 a
7.Is this it repair to an existing well: ❑Yes or ElNo copy aJ this record has been provider/to the tr•ell oirner
1J ibis is a repoir.Jill ova knnvn irell consirncrion hi/brotamrn oinl explain the nature of the
repair under-21 renrarkr s'ectrm or on the back r fthic Jnrar. 23,Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
8.Number of wells constructed: 1 construction details You may also attach additional pages if necessary
hor uodalVe Ur/ertiarr ar non-i,arer.ntpplr irellc ONLY iruh the same concrrifedi i.y nt con
submironeJorrn. SUBMITTAL INSTUCTIONS
9.Total well depth below land surface: 170.0 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
bar nwhiple hells list all depths rJ'drJJerew(example-3«200'antl2Q100') construction to the following:
10.Static water level below top of casing: 31.0 (ft.) Division of Water Quality,Information Processing Unit,
ifiraterlevel is above casing.tee 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 6.0/12,0 (in) 24b. For IMection Wells: In addition to sending the form to the address In 24a
above, also submit a copy of this form within 30 days of completion of well
12.Well construction method: AIR construction to the following:
(re auger rotary,cable,direct push,etc)
Division of Water Quality,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
13a.Yield(gpm) Method of test: 24c.For Water Supply&Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b.Disinfection type: _ Amount: completion of vvii construction to the county health department of the county
where constructed
Form G W-I North Carolina Department of Environment and Natural Resources-Division of Water Quality Revised tan 2013

WELL CONSTRUCTION RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
FROM TO DESCRIPTION
Well Contractor Name ft. I ft.
A - 2581 ft. I it.
NC Well Contractor Certification Number 15.OUTER CASING for muttitc d wells OR LINER it a (cable
FROM TO DIAMETER THICKNESS MATERIAL
GEOLOGIC EXPLORATION, INC ft. & in.
Company Name 16.INNER CASING OR TUBING eothermal closed-loop)
FROM TO DIAMETER THICKNESS MATERIAL
2.Well Construction Permit#: 0.0 ft. 63.0 ft. 6.0 in. SCH 80 PVC
List all applicable well construction permits(i.e.County,State,Variance,etc.)
73.0 ft• 148.0 fr. 6.0 in. SCH 80 PVC
3.Well Use(check well use): 17.SCREEN
Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 63.0 1" 73.0 ft. 6.0 in. .020 SCH 80 SS
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 148.0 ft. 168.0 ft. 6.0 'n .020 SCH 80 SS
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
FROM I TO MATERIAL EMPLACEMENT METHOD&AMOUNT
❑Irri ation
Non-Water Supply Well: 2.0 f ZOO It' DORTLAND BENTONRE SLURRY
ft.. ft.
❑Monitoring ❑Recovery
Injection Well: ft. ft.
❑Aquifer Recharge ©Groundwater Remediation 19.SAND/GRAVEL PACK if a pi0icable
FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Storage and Recovery ❑Salinity Barrier 30.0 ft- 183.0 ft. 20-40 FINE SILICA SAND
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control ft. ft.
20.DRILLING LOG attach additional sheets if necessary)
❑Geothermal(Closed Loop) OTracer FROM TO DESCRIPTION color,hardness,soilirock type,gritin size,etc.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) 0.0 ft. 27.0 ft. TAN SILTY SAND
4.Date Well(s)Completed: WeII ID#
11/23/20 IW-71 27.0 ft. 36.0 ft. BROWN SILTY SAND
36.0 " 68.0 1' PWR
5a.Well Location: 68.0 ft. 183.0 ft. ROCK
BELEWS CREEK STEAM STATION ft. ft.
Facility/Owner Name Facility ID#(if applicable)
ft. ft.
3195 PINE HALL ROAD BELEWS CREEK 27009
ft. ft.
Physical Address,City,and Zip 21.REMARKS
STOKES BENTONITE SEAL-20.0-30.0 FT (WIRE WRAPPED SCREEN)
County Parcel Identification No.(PIN)
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification:
(if well field,one lat/long is sufficient)
360 17' 31.79" N 800 03' 50.88" W 12/15/20
Signature of Certified Well Contractor Date
6.Is(are)the well(s): ©Permanent or ❑Temporary
By.signing this form,1 hereby certify that the well(.$)was(were)constructed in accordance
with 15A NCAC 02C.0100 or I5A NCAC 02C.0200 Well Construction Standards and that a
7.Is this a repair to an existing well: ❑Yes or [?]No copy of this record has been provided to the well owner.
If this is a repair,fill out known well construction information and explain the nature of the
repair under#21 remarks.section or on the back of this form. 23.Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
8.Number of wells constructed: 1 construction details. You may also attach additional pages if necessary.
For multiple injection or non-water supply wells ONLY with the same construction,you can
submit one farm. SUBMITTAL INSTUCTIONS
9.Total well 0 depth below land surface: 168.
p (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths ifdiJferent(example-3@200'and 251005 construction to the following:
10.Static water level below top of casing: 31.0 (ft) Division of Water Quality,Information Processing Unit,
Ifwater level is above casing,use " 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 6.0/12.0 (in) 24b.For Infection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12.Well construction method: AIR construction to the following:
(i.e.auger,rotary,cable,direct push,etc.)
Division of Water Quality,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
13a.Yield(gpm) Method of test: 24c.For Water Supply&Infection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b.Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-I North Carolina Department of Environment and Natural Resources-Division of Water Quality Revised Jan.2013

WELL CONSTRUCTION RECORD For Internal Use ONLY
This form can be used for single or multiple wells
1.Well Contractor Information:
BRIAN THOMAS 14.WATERZONES
FROM To DESCRIPTION
Wet)Contractor Name ft. ft.
A - 2581 1
1,. R.
NC Well Contractor Certification Number 15,OUTER CASING for multi-eased wells OR LINER if a tteoDle
FROM TO DIAMETER THICKNESg MATERIAL
GEOLOGIC EXPLORATION, INC rr, 0. 1 in
Company Name 16.INNER CASING OR TUBING fteotherional closed-too
FROM TO DIAMETER THICKNESS I MATERIAL
2.Well Construction Permit#: 0.0 f'. 1 55.0 ft-_[b.0 in' SCH 80 PVC
List all applicable to-ell construction pernniu(i.e.0ninly,Stare,Variance,etc)
65.0 it- 1 755.0 f• 1 6.0 SCH 80 PVC
3.Well Use(check well use): 17.SCREEN
Water Supply Well: FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
[]Agricultural Oivlunicipali'Public 55.0 It- 65.0 ft' 6.0 "` .020 SCH 80 SS
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 155.0 ft' 175.0 ft' 6.0 "` .020 SCH 80 SS
❑industrial/Commercial ❑Residential Water Supply(shared) 1g-GROUT
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
01irigation 2.0 fL 20.0 ft' PWLMosrNTONne SLURRY
Non-Water Supply Well:
ft.❑Monitoring ORecovefy n.
Injection Well:
❑Aquifer Recharge ®Groundwater Remediation 19.SAND/GRAVEL PACK if applicable)
OAquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL I EMPLACEMENTb1ETHOD
❑Aquifer Test OStormwater Drainage 30.0 ft- 180.0 ft- 20-40 FINE SILICA SAND
ft. It.
❑Experimental Technology ❑Subsidence Control
20.DRILLING LOG attach additional sheet if necessary)
❑Geothermal(Closed Loop) OTraCef FROM TO DESCRIPTION color,bossiness,soillroek type,grain size,ett.
OGeothermal(Heat in Cool ing Return ❑Other(explain under l/21 Remarks) 00 ft- 15.0 fr• TAN SILTY SAND
4.Date Well(s)Completed: Well IDN
10/19/20 IW-72 15.0 ft, 57.0 ft- BROWN SILTY SAND
57.0 ft- 65.0 ft- PWR
52,Well Location: 65.0 ft' 180.0 "' ROCK
BELEWS CREEK STEAM STATION
e. rt.
Facility'Uwner Name Facility 1D#(if applicable)
ft
3195 PINE HALL ROAD BELEWS CREEK 27009 ft
ft. ft.
Physical Address,City,and Zip 21.REMARKS
STOKES BENTONIfE SEAL 20.0-30.0 FT (WIRE WRAPPED SCREEN)
County Parcel Identification No (PIN)
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Cerliftcation:
(if well field,one Iaviong is sufficient)
360 17' 31.79" N 80° 03' 50.88" W 10/23/20
Signature ofCeRified Well Contractor Date
6.Is(are)the welt(s): G]Permanenl or OTemporary By signing this form,1 hereby certify that the i ell(.$)was luvrel constructed in accordance
will)15A NCAC 02•.0100 or 15A NGAC 02C 0200 Well Construrarm Standards and that a
7.is this a repair to an existing well: ❑Yes or ONO copy ofihis reivrd haw been provided to the cell owner
h,thus is a repair,fill out known well construction information and explain the nature of the
repair under 21 remarks section or on the back ofthis form! 23.Site diagram or additional well details:
You may use the back of this page to provide additional well site details or Wei:
8.Number of wells constructed: 1 construction details You may also attach additional pages if necessary
hor multiple injection or non-ii ater stipply irells ONh.Y with the same canstruction,ova can
subnutoneJornt. SUBMITTAL INSTUCTIONS
9.Total well depth below land surface: 175.0 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
1-or multiple wells list all depllts ifdiJferent fexaniple.3a,*200'and 2©100') construction to the following
10.Static water level below top of casing: 35.0 (ft.) Division of Water Quality,Information Processing Unit,
Ifuvter level is above casing,use"+- 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 6.0/12.0 (in.) 24b. For lnjection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12.Well construction method: AIR construction to the following
0.e auger,rotary,cable,direct push,etc.)
Division of Water Quality,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
139.Yield(gpm) Method of test: 24c.For Water Supply&Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b.Disinfection type: Amount: complet:on of well construction to the county health department of the county
where constructed
Form GW-I North Carolina Department of Environment and Natural Resources Division of Water Quality Revised)ra M