GW1-2022-07377_Well Construction - GW1_20220809

i
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 ;15.OUTER CASING for inulti-cased wells OR LINER if a licable
GEOLOGIC EXPLORATION FROM TO DIAMETER THICKNESS MATERIAL
ft. I ft. in.
Company Name
,16.INNER CASING OR TUBING- eothermal closed-loo
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS I MATERIAL
List all applicable well construction permits(i.e.U1C,County,State,Variance,etc.) 0.0 ft. 70.0 fl- 6.0 in. SCH 40 PVC
3.Well Use(check well use): ft. fL 7
Water Supply Well: 17;:SCREEN
FROM TO DIAMETER .SLOTSIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 70.0 ft• 90.0 ft' 6.0 'n'' .010 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. fr.
❑Industrial/Commercial ❑Residential Water Supply(shared) Is.GROUT
❑Irrl atlon ❑Wells>100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0.0 1t• 20.0 ft- AQUA GUARD SLURRY
(EMonitoring ❑Recovery fr. ft.
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 ❑Stormwater Drainage 25.0 ft- 95.0 IL 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control ft. it
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG'attach additional sheets if necessa
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 421 Remarks) FROM To DESCRIPTION(color,hardness,soil/rock q rain size,etc.
0.0 fr• 8.0 ft.
BROWN SILTY SAND
4.Date Well(s)Completed: 07/26/22 Well ID# IW-37 8.0 ft• 15.0 1t• TAN SILTY SAND
5a.Well Location: 15.0 tt' 38.0 tt' PWR
BELEWS CREEK STEAM STATION 38.0 rt• 95.0 rt• ROCK
Facility/Owner Name Facility ID#(if applicable) ft. ft. a / p�
3195 PINE HALL ROAD BELEWS CREEK 27009 ft. ft. '� _�}
Physical Address,City,and Zip ft. ft. AYG
STOKES zLREMARKS c �;
County Parcel Identification No.(PIN) BENTONITE SEAL-20.0-25.0 FEET v+VQ/zj Qq
q u9 Unit
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient)
22.Certification:
928788.3891 N 1681050.393 W %- �` ' 08/01/22
6.Is(are)the well(s): (EPermanent or ❑Temporary Signature of Certified Well Contractor Date
By signing this form,1 hereby certify that the well(s)was(were)constructed in accurdance with
7.Is this a repair to an existing well: ❑Yes or 29No 15A NCAC'02C.0100 or 15A NCAC 02C 10200 Well Construction Standards and that a copy
Ifdtis 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 421 remarks section or on the back afthis 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.)
For muhiple wells list all depths ifdiJferent(example-3 tt 200'and 2@.100') Submit this GW-I within 30 days of well completion per the following:
10.Static water level below top of casing: 34.0 lit) 24a. For All Wells: Original form' to Division of Water Resources (DWR),
/f water level is above casing,use"A." Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
0.0 24b. For Infection Wells:Copy to DWR,Underground injection Control(IUC)
11.Borehole diameter: (in.) Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: AIR
24c.For Water Supply and O en-Loo 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: 1
24d.For Water Wells producing over100,000 GPD:Copy to DWR,CCPCUA
Permit Program,1611 MSC,Raleigh,NC 2 7699-1 61 1
13a.Yield(gpm) Method of test:
f
13b.Disinfection type: Amount:
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018