GW1-2022-09063_Well Construction - GW1_20220923

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS G,, 14.WATER ZONES
FROM TO DESCRIPTION
Well Contractor Name --' '''cky t ft. ft
A - 2581
2Q22
NC Well Contractor Certification Number Sr p -d 15.OUTER CASING for multi-cased-wells OR LINER if a licable)
GEOLOGIC EXPLORATION -s>�r,, FROM TO DIAMETER THICKNESS MATERIAL
fr. ft. in.
Company Name _ `':' 1,:,:��
` t6.INNER CASING OR TUBING: eothermal closed-loop)
2.Well Construction Permit#: FROM TO DIAMETER. THICKNESS MATERIAL
Lut all applicable yell c•on truc ion permits(i.e. (l/(.'.CnuntY,State. Variance.etc.) 0.0 ft. 140.0 lit. 6.0 in. SCH 40 PVC
3.Well Use(check well use): ft. ft. in.
17.SCREEN
Water Supply Well:
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 140.0 ft• 160.0 ft' 6.0 1O' .010 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft.
❑industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Irrigation ❑Wells> 100,000GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0.0 ft. 20.0 rL AQUA GUARD SLURRY
OMonitoring ❑Recovery ft. ft.
Injection Well:
ft. lit.
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK if a licable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Storimwater Drainage 25.0 ft. 165.0 lit' 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary
FROM TO DESCRIPTION(color,hardness,soiltrock •te, rain size,etc.)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks)
0.0 lit• 8.0 lit• RED SILTY CLAY
4.Date Well(s)Completed: 09/07/22 Well ID# EX-50 8.0 ft. 18.0 lit. BROWN SILTY SAND
5a.Well Location: 18.0 rt. 30.0 ft' TAN SILTY SAND
BELEWS CREEK STEAM STATION 30.0 lit 44.0 lit• PWR
Facility/Owner Name Facility[DO(ifapplicable) 44.0 lit• 165.0 lit• ROCK
3195 PINE HALL ROAD BELEWS CREEK 27009 ft. ft.
Physical Address.City,and Zip ft. ft.
STOKES 21.REMARKS
County Parcel Idcntificatiou No.(PIN) BENTONITE SEAL- 20.0-25.0 FEET
SUMP- 160.0- 161.0 FEET
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22.Certification:
928880.2271 N 1681471.546 N, �;�, -
09/12/22
6.Is(are)the well(s): OPermanent or ❑Temporary Signature of Certified Well Contractor Date
Hy signing this/brin,l herehv serf fi,that the tee//(s)was(were)constructed in ct ordance,voh
7.Is this a repair to an existing well: ❑Yes or MNo I5A N(:AC 02C.010t1 or 15A NCA('02C.0200 Well Construction Standards and trot a co/ry
l/'dus is a repair,/ill out kno,rtr,cell construclion inlortnation and explain the ncoure q/the al'this record has been provided to the,cell mi ner.
repair under all 1votarks section or art the hack a/'this jn•nt.
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: 160.0 (ft.)
I•'or multiple wel/c list all deptt.s i/dt/jcrettt(example-3t 200'and 2 a,100') Submit this G%V-1 within 30 days of well completion per the following:
38.79 24a. For All Wells: Original form to Division of Water Resources (DWR).
10.Static water level below top of casing: Information Processing Unit, 1617 MSC,Raleigh,NC 27699-1617
lhruter lerel is obove casin•Q,use
11.Borehole diameter: 10.0 (in) 24b. For Injection Wells:Copy tojDWR, Underground h>_jection Control (IUC)
Program, 1636 MSC,Raleigh.NC 27699-1636
12.Well construction method: AIR 24c.For Water Supph•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(gpm) Method of test:
Permit Program, 1611 MSC,Raleigh',NC 2 7699-161 1
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13b.Disinfection type: Amount:
Form GW-I North Carolina Deportment of Environmental Quality-Division of Water Resources Revised 6-6-2013
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