GW1-2022-01706_Well Construction - GW1_20220131

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
FROM TO DESCRIPTION
Well Contractor Name ft. ft.
A - 2581
NC Well Contractor Certification Number 15.OUTER CASING for multi-cased wells O LINER Na rlicat"
GEOLOGIC EXPLORATION FROM TO DIAMETER R THICKNESS MATERIAL
ft. ft. ;n.
Company Name
16.INNER CASING OR TUBING eothermal closed-loo
2.Well Construction Permit#: FROM I TO DIAMETER F THICKNESS I MATERIAL
1-istall applicable well c•onsiruc•tion permits(i.e.111C,Coun/v,State.Marianc•e.etc.) 0.0 ft. 50.0 ft. 2.0 in SCH 40 PVC
3.Well Use(check well use): ft. fr. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOTSIZE THICKNESS 117ATERIAL
OAgricultural ❑Municipal/Public 50.0 fr' 60.0 rt• 2.0 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 atlon ❑Wells> 100,000 GPD FROM TO MATERIAL EMPLACEMENTMETHOD&AMOUNT
Non-Water Supply Well: 0.0 ft- 36.5 ft- AQUA GUARD SLURRY
INMonitoring ❑Recovery ft. ft.
Injection Well: ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK if a ticable
OAquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL I EMPLACEMENTMETHOD
❑Aquifer Test ❑Stonnwater Drainage 44.5 ft- 64.0 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 sin,etc.)
0.0 rt• 10.0 rr• BROWN SILTY SANDY CLAY
4.Date Well(s)Competed: 10/04/21 Well ID# CCR-5DA 10.0 fr, 21.0 rr• BROWN SILTY SAND
5a.Well Location: 21.0 tt' 43.0 ft' DARK BROWN SILTY`S'AND. rj
BELEWS CREEK STEAM STATION 43.0 rt• 64.0 ft- PWR
Facility/Owner Name Facility ID4(ifapplicable) ft. ft. JAN 31 202?
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-36.5-44.5 FEET
***U-PACK SCREEN***
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one[at/long is sufficient) 22.Certification:
360 29' 71.48" N 800 07' 70.20" %V �n;;_ (j�,.r---
11/22/21
6.Is(are)the well(s): ITPermanent or ❑Temporary Signature of Certified Well Contractor Date
Qv signing This fitrtn,1 hereby certify that the a ell(s)was(here)ennrtrvcted in ace orclnnce with
7.Is this a repair to an existing well: ❑Yes or C9No 15A NCAC 02(7.0100 or l5A NCAC 02('.0200{{ell Cbnriruc•tioii Standards and that o copr
/f lhis is a repair./ill out known we//construction infirniati"n and explain the nature of the of this record has been provided to the well owner.
repair under r.2/remarks section or on the back of'this fbrni.
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: 60.0 (ft.)
kar nwhiple wells list all depths//i/ifJerew(Crumple-3 a 200'and 2@100') Submit this GWA within 30 days of well completion per the following:
10.Static water level below top of casing: 41.0 (ft) 24a. For All Wells: Original form to Division of Water Resources (DWR).
/flrnier/etr/is nbnre casing,use"-
Infonmation Processing Unit, 1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter: 6.0 (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.field(gpm) Method of test:
Permit Program,1611 MSC,Raleigh,lNC 27699-1611
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13b.Disinfection type: Amount:
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Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018
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