GW1-2022-08895_Well Construction - GW1_20220912

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information: i
t
BRIAN THOMAS 14.WATER ZONES
FROM TO DESCRIPTION
Well Contractor Name
ft. R. i
A - 2S81
NC Well Contractor Certification Number 15.OUTER CASING for multi-case L Yells OR LINER if a licable
GEOLOGIC EXPLORATION FROM TO DIAMETER THICKNESS MATERIAL
ft. I ft. I I; in.
Company Name
16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#' FROM TO DIAMETER THICKNESS MATERIAL
Lisi all applicable yell construction peratits(i.e.WC,Counl',Stale, Variance.erc.) 0.0 ft• 120.0 fL 6.0 i"' SCH 40 PVC
3.Well Use(check well use): ft. ft. in.
17.SCREEN
Water Supply Well: FROM I TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 120.0 ft' 140.0 rt 6.0 in_
.010 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. fL in.:
❑Industrial/Com mere ial ❑Residential Water Supply(shared) 18.GROUT
❑Irrieation ❑Wel Is> 100,000 GPD FROM I TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0.0 ft- 20.0 ft- AQUA GUARD SLURRY
INMonitoring ❑Recovery ft. ft.
Injection Well: R, ft.
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK ifa tlicable
❑Aquifer Storage and Recovery ❑Salinily Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stormw•ater Drainage 25.0 ft 145.0 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,sail/crock q rain size,etc.)
0.0 ft. 7.0 rL BROWN SILTY SAND
4.Date Well(s)Completed: 09/02/22 Well ID# IW-18 7.0 IL 15.0 1` TAN SILTY SAND
ia.Well Location:
15.0 ft' 44.0 ft. PWR
BELEWS CREEK STEAM STATION 44.0 rt 145.0 ft• ROCK
PacilitylOwnerName Facility ID4 ft. ft.
(rfa pplicable)
3195 PINE HALL ROAD BELEWS CREEK 27009 D. rL k. f a` ;' ,`
Physical Address,City.and Zip ft. ft. F P j i
STOKES 21.REMARKS
BENTONITE SEAL- 20.0 25.0 F fl - ins.„�
County Parcel Identification No.(PIN) / uf'"
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field•one tat/long is sufficient) 22.Certification:
928913.4451 N 1681421.336 W -- 09/07/22
6.Is(are)the well(s): eflPernmaent or 01'emporary Signature of Certified Well Contractor Date
lir.ci,�nin,�dti.c fin-nt./hereAr eeriifv lltcndte vell(v)ryas(u*ere)cuttctrteted in accordiutcr vidt
7.Is this a repair to an existing well: ❑Yes of (5No /9.4 NC,4('02C.0100 or 15.4 NC'AC 02C.0200 Well('unciruc/iun J'tnndards and thul a copy
l this is a repair.fill out knmrn well construction imj)rntalion and explain the nature ol'the I#this record has been provided t)the hell owner.
repair under i.`2l remarks section or on lire hack q/this f irtit.
23.Site diagram or additional well details:
8.For Geoprobc/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well construction into
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.)
Por muhiple wells list all depths ijd/#&rcni(example-3 ct,200'mud 2@100') Submit this GW-1 within 30 days of well completion per the following:
30.8 24a. For All Wells: Original foam to to Division of Water Resources (DWR).
10.Static water level below top of casing: (ft.) Information Processing Unit; 1617 MSC,Raleigh,NC 27699-1617
if\roar 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 i
24c.For Water Supply and Open!Loop Geothermal Return Yells:Copy to the
(i.e.auger.rotmy,cable,direct push•etc.) county environmental health department of the county where installed
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FOR WATER SUPPLY WELLS ONLY: 24d. For Water Wells producinQlover 100,000 GPD:Copy to DWR.CCPCUA
Permit Program, 161 I MSC,Raleigh,NC 27699-I61
13a.Yield(gpm) Method of test:
13b.Disinfection type: Amount:
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Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2013
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