GW1-2022-07981_Well Construction - GW1_20220826

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
Well Contractor Nanta FROM TO I DESCRIPTION
ft. ft.
A - 2581
fr. it.
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells)OR LINER if a disable)
GEOLOGIC EXPLORATION FROM TO DIAMETER THICKNESS M RI ATEAL
ft. ft. in.
Company Name
16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS MATERIAL
Litt all applicable well construction permits(i.e.(11C,County,S•tatc,I'arianc•e,etc.) 0.0 ft. 140.0 ft' 6.0 1°' I 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 ❑Municipal/Pubiic 140.0 ft]160.0 ft' 6.0 1O' .010 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) fr. I in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑lrrl ation ❑Wells> 100.000 GPD FROM I TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0.0 ft• 20.0 f` AQUA GUARD SLURRY
INMonitoring ❑Recovery
Injection Well:
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK(ita l licablc
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑StormwaterDrainage 25.0 ft. 165.0 fry 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control R. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary)
FROM TO DESCRIPTION(color,hardness,soit/rnck type, rain size.etc.)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks)
0.0 ft- 8.0 ft- RED SILTY CLAY
4.Date Well(s)Completed: 08/19/22 Well ID# EX-55 8.0 ft 18.0 fry BROWN SILTY SAND
6a.Well Location: 18.0 ft 25.0 fr. TAN SILTY SAND
BELEWS CREEK STEAM STATION 25.0 ft. 34.0 ft. PWR
Facility/Owner Name Facility ID#(ifappticable) 34.0 fry 165.0 f` ROCK
3195 PINE HALL ROAD BELEWS CREEK 27009
Physical Address,City,and Zip ft. ft.
STOKES 21.REMARKS
County Parcel Identification No.(PIN) BENTONITE SEAL- 20.0-25.0 FEET
ib.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
SUMP- 160.0- 161.0 FEET
(if well field,one lat/long is sufficient) 22.Certification:
928981.7463 N 1681153.734 W � -- �'�''" 08 22
G.Is(are)the well(s): OPermanent or ❑Temporary Signature ofCenified Well Contractorie;^-
Bp.signing this,fnrin,l herehl'ceriify that the well(s)was(were)cowtruci ed in accordance with
7.Is this it repair to an existing well: ❑Yes or [TNo 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Cotrrirucvion S'tmrdafJd Er,j/tl)iit c•o/�o�2
Y'dars is a repair,fill out known well consa•ticuon hybrnrnion and explain the nature of the ql ihis record has been provided to the well owner. I llJ J Cd
repair under 21 reiunrks section or on the back of7his•Jorm. s��ir 0 Until
23.Site diagram or additional well details: Ithvi„;rj C..1 . r•'-°s`'"
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well constr&ttt9ii2i`rij�,PG'
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 INSTRUCTION'S
9.Total well depth below land surface: 160.0 (ft.)
Vor nnhiple,re//c list all depths iJ dt1feretn(erantp/e-�ct 200'and 2 a.100') Submit this GN1'-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).
Iflrn/cr lorel is above cns'iag,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 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(gpnl) Method of test: Penn it Program, 1611 MSC,Raleigh,NC 27699-16 1 1
13b.Disinfection type: Amount:
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018