GW1-2022-09065_Well Construction - GW1_20220923

k
t
WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
I.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES
FROM TO DESCRIPTION
Well Contractor Name
ft. ft.
A - 2581
Y:'k�e•fix•^ Ce.ex] `�// it+�•.L:: fr. ft.
NC Well Contractor Certification Number (� 15.OUTER CASING for mulfl-cased'wtills OR LINER if a tlicable
GEOLOGIC EXPLORATION SF P 2022 FROM TO DIAMETER THICKNESS MATERIAL
ft. fr. in.
Company Name
itl"i:•+�+i�•^�^'� (-', -;,;:.,,?� (:fli1 16.INNER CASING OR TUBING.(geothermal closed-loop)
2.Well COnStrUCflOn Permit#: FROM I TO I DIAMETER THICKNESS MATERIAL
Lai all applicable irel/construction perntits(i.e.(.11C,Couni),State,Variance,e1c.) 0.0 it' 120.0 ft. 6.0 in- SCH 40 PVC
3.Well Use(check well use): fr. ft. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 120.0 t'' 140.0 ft- 6.0 r°' .010 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) tr. fr. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Irrigation ❑Wells> 100,000GPD FROM I TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0.0 t` 20.0 it• AQUA GUARD SLURRY
[5]Vlonitorine ❑Recovery
Injection Well:
ft. fr.
OAquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK ifar licable
❑Aquiter Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL I EMPLACEMENTMETHOD
❑Aquifer Test ❑Stormwater Drainage 25.0 t'• 145.0 t'' 20-40 FINE SILICA SAND
❑ENperimental Technology ❑Subsidence Control R. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary)
FROM TO DESCRIPTION(color,hardness•soil/rook resin size,etc.)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 42I Remarks)
0.0 t'• 7.0 ft. BROWN SILTY SAND
4.Date Well(s)Completed: 09/07/22 Well ID# IW-19 7.0 t'• 11.0 n- TAN SILTY SAND
5a.Well Location: 11.0 it' 45.0 ft' PWR
BELEWS CREEK STEAM STATION 45.0 it• 145.0 t` ROCK
Facility/Owner Nanre Facility ID!((ifapplicable) ft. ft.
3195 PINE HALL ROAD BELEWS CREEK 27009 e. rt.
Physical Address,City,and 7_ip ft. ft
STOKES 21.REMARKS
Count}• Parcel Identification No.(PIN)
BENTONITE SEAL- 20.0-25.0 FEET
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22.Certification:
928934.3309 N 1681444.380 11, P"-
09/12/22
6.Is(are)the well(s): (EPermanent or ❑Temporary Sienature ofCertifred Well Contractor Date
M,.signine ihi.r lorin,I herebP cerlyi-shot die n•e1l(s)urns(were)constructed in urcnrrkurce vab
7.Is this a repair to an existing well: 01''es or MNo /5.4 NCAC WC.0100 or 1 A N('A('!/2('.021)0 IVe//('onsirucuon Slandordv and/hw o rnpi
//this is a repair./ill nut knuinr u'rl/cuusUronion in/irrmation and v.V)hoo the•nalury o/'tile ofilpis record has been provided to dte ire/I owner.
repair rnrder ,21 reruorkv section or on the back n/this/orrtt.
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 sand surface: 2 140.0 (ft.)
l� Submit this GW-I within 30 days of well completion per the following:
itr nndtiple ira//s list all depths i/�diOi�rern(example- i�_!I(1'rutd 2(c.11lll')
10.Static water level below top of casing: 33.73 (ft) 24a. For All Wells: Original form to Division of Water Resources (DWR).
lJlrnrer/eve/is frbnre cn.r/qt,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 (luc)
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,CCPC UA
Permit Program, 1611 MSC,Raleigh.NC 27699-161 1
13a.Yield(gpm) Method of test:
13b.Disinfection type: Amount: p
6
form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018