GW1-2022-08246_Well Construction - GW1_20220907

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
I.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
FROM TO DESCRIPTION
Well Contractor Name fr. ft. f
A - 2581 ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING for multi-cased+Sells OR LINER if a t licable)
GEOLOGIC EXPLORATION FROM TO DIAMETER THICKNESS PATERIAL
Company Name
16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit 4: FROM TO DIAMETER THICKNESS MATERIAL
List oll applicable well cnncn•uclion perrrtils(i.e. (fl(',(:bunly,State,Variance,etc-.) 0.0 ft. 140.0 ft• 6.0 in. SCH 40 PVC
3.Well Use(check well use): ft. I ft. in.
17.SCREEN
Water Supph'Well:
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 140.0 ft• 160.0 ft- 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
❑irri ation ❑Wells> 100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0.0 ft- 20.0 ft- AQUA GUARD SLURRY
OMonitoring ❑Recovery ft. ft.
Injection Nell:
fr. fr.
❑.Aquifer Recharge ❑Gro(md\+ater Remediation
` 19.SAND/GRAVEL PACK(ifa licable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAU EMPLACEMENTMETHOD
❑Aquifer Test ❑Stormwater Drainage 25.0 ft- 165.0 ft• 20-40 FINE SILICA SAND
❑E-xperimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) ❑l racer 20.DRILLING LOG attach additional'sheets if necessary)
FROM TO DESCRIPTION color,hardness,soil/rock e, rain Size,etc.)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks)
0.0 ft- 7.0 ft• BROWN SILTY SAND
4.Date Well(s)Completed: 08/24/22 Well ID# EX-27 7.0 ft. 190 ft- TAN SILTY SAND
5a.Well Location: 19.0 ft• 31.0 ft- PWR R 7
BELEWS CREEK STEAM STATION 31.0 ft- 165.0 ft'
Facility/Owner Name Facility[DO(ifapplicable) ft. ft. 'a•1� -
319S PINE HALL ROAD BELEWS CREEK 27009 ft. ft. Sr
Physical Address.City.and Zip ft. ft. .r•+,;1 ;^�C`J
STOKES 21.REMARKS 4 Ji rvs�;uly
County P 'cel Identification No.(PIN) BENTONITE SEAL 20.0-25.0 FEET
m
Sb.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:928884.2275 N 1681313.081 W 2- n;-, 08/29/22
6.ls(are)the well(s): OflPermanent or ❑Temporary Signature ofCenified Well Contractor Date
HT signing this fin-to,l hereby certl(i;//in/dreg rrell(s)vas(vent euraclrrteted in accor(knrce will,
7.Is this a repair to an existing well: ❑Yes or MNp /SA uvCA('0?('.0/rAl a, /i,4 AY 4('o?('.1�200 1Ve//('unstnicliun.Sandorrlc and lhm n cupr
ifthis is a repair.fill out known ire/I c•onsinavion itlhrnrtzllon and explain the nature ufthe ofilus record has been provided w the well miner
repair under`2/remarks section or on the back ofthis/grin.
23.Site diagram or additional well details:
3.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well construction into
construction.onh' 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.SUBIIMITTAL INSTRUCTIONS'
9.Total well depth below land surface: 160.0 (ft.)
Pirr nntlliple❑�el/s list all depths/fdlffcrent(¢sample-B a 200'and 2 tc l00') Submit this G\Y-1 within 30 days ofiwell completion per the follo+ving:
24.0 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
lJ'u•nter level 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 Supply and Open-Loon 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.CCPCII.A
Permit Program, 1611 MSC,Raleigh,NC 27699-1 61 1
13a.field(gpm) Method of test:
13b.Disinfection type: Amount:
i!
I
Form G W-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018