GW1-2022-09088_Well Construction - GW1_20220926

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
I.Well Contractor Information:
BRIAN THOMAS 14.WATER ZONES I
FROM TO DESCRIPTION
Well Contractor Name
ft. ft. f
A - 2581
fr. ft. { �
NC Well Contractor Certification Number l(� 1.5.OUTER CASING for multi-c ised wells OR LINER if a licable)
`�,y,�•C ° s' !"'-�+ FROM TO DIAMETER THICKNESS MATERIAL
GEOLOGIC EXPLORATION n.^ -� iE:>�?� ft. I a•
Company Name J) r C'_n
,j �n 16.INNER CASING OR TUBING t eothermal closed-loop
2.WPII Construction Permit# 2_ FROM TO DIAMETER THICKNESS MATERIAL
1.is1 all nppltcable wc•//c'nnstrnrrion permits'(i.e. (ll.�iCmmq�,J'Ip/�.yl;arinnc•e,etc.J 0.0 ft. 90•0 ft. 6.0 in. 5CH 40 PVC
3.Well Use(check well use): �t''s'u v-. lJr,„ ft. ft. in.
17.SCREEN
Water Supply Well:
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 90.0 ft. 110.0 fr 6.0 in. .010 SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) OResidential Water Supply(single) ft, ft. in.
❑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 fL AQUA GUARD SLURRY
(TMonitoring ❑Recovery fr. ft.
Injection Well:
ft. ft.
❑Aquifer Recharge OGmundwater Remediation
19.SAND/GRAVEL PACK ifa licable
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquiler Test OStonmvater Drainage 25.0 ft- 115.0 It- 20-40; FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets ifnecessa
FROM TO DESCRIPTION color,hardness,soil/rock t rain sitx,etc.)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks)
0.0 It. 7.0 ft RED SILTY CLAY
4.Date Well(s)Completed: 09/14/22 Well ID# IW-25 7.0 ft• 16.0 ft BROWN SILTY SAND
5a.Well Location: 16.0 ft• 20.0 ft' TAN SILTY SAND
BELEWS CREEK STEAM STATION 20.0 ft 31.0 fr PWR
Facility/Owner Name Facility ID9(ifapplicable) 31.0 ft' 115.0 ft' ROCK
3195 PINE HALL ROAD BELEWS CREEK 27009
Physical Address.Ciro,and Zip
STOKES 21.REMARKS
County Parcel Identification No.(PIN)
BENTONITE SEAL- 20.0-25.0 FEET
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one W/long is sufficient) 22.Certification:
928927.9045 N 1681192.503 kY 09/19/22
6.Is(are)the well(s): MPermanent or ❑Temporary Signature of Certified Well Contractor Date
By signing this%nrnr,1 herebt•ceriyj'that the weI1(s)urns(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or MNo I?4 NCAC 01C.11100 or l5A NCAC 01(';0100 IFe/I Canrtructinn Standords nrrd dray n cart
If this is a repair,till out known well construction itilbrrnalion and esploin the tonne ol7ire gfdri.s record has been provided to the well owner.
repair under/i21 rernorla section or on the•back q rhi.r/ornr.
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 iolil
construction,only I GW-I is needed. Indicate TOTAL NUMBER ofwells (add'See Over'in Remarks Box).You may also attach additional pages if necessar\.
drilled: 24.SUBMITTAL INSTRUCfIONS
9.Total well depth below land surface: 110.0
(ft.)
I-or trra0iple we//s list all depths 1%diljerent(example-3 200•and 2@100') Submit this G\V-1 within 30 days of well completion per the following:
29.67 24a. For All Wells: Original form to Division of Water Resources (DWR).
I Static water level below top of casing: (ft.) Information Processing Unit, MSC.Raleigh,NC 2 7699-1 6 1 7
ll wamr Icrcl is abate cnrirrt;,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
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12.Well construction method: AIR 24c.For Water Su Iv te and O en-Ioo Geothermal Return Wells:Copy to the
(i.e.auger,rotary,cable,direct push.etc.) county environmental alth department of the county where installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPD:Copy to DWR,CCPCUA
Permit Program, 1611 MSC,Raleigh',NC 27699-1611
13a.Yield(gpm) Method of test:
13b.Disinfection type: Amount:
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Form GN'-I North Carolina Department of Environmental Quality-Division of Water Resources '� Revised 6-6-2018
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