GW1-2022-10597_Well Construction - GW1_20221122

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WELL.CONSTRUCTION RECORD(GW-1) For Internal Use Only:
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1.Well Contractor Information:
BRIAN THOMAS
14.WATER ZONES p 1.
Well Contractor Name FROM - TO I DESCRIPTION
A - 2581 rt. ft.
ft. rt.
NC Well Contractor Certification Number
15.OUTER CASING for multi-cased
h. ft• wellsO f a tbe
GEOLOGIC EXPLORATION FROM
AME THNNE lcMAT ERIAL
Company Name
16.INNER CASING OR TUBING geothermal closed-loo
2.Well Construction Permit#: FROM TO I DIAMETER I THICKNESS I MATERIAL
List all applicable it construction penuitr(.e.Ul(',Cnttnm.,Sate,Variance,etc) 0.0 fL 120.0 ft• 6.0 in. SCH 40 PVC
3.Well Use(check well use): ft. ft. in.
Water Supply\VC1I: FR.OSCREEN
❑Agricultural ❑Municipal/Public TO DIAMETER- SLOT SIZE I THICKNESS I MATERIAL
120.0 fr' 140.0 ff 6.0 t"• .010 SCH 40 1 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) it ft. in.
❑Industrial/Commercial OResidential Water Supply(shared) 18.GROUT.
❑Jrri ation ❑Wells> 100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOtfNT
Non-Water Supply Well: 0.0 ft- 20.0 rt• AQUA GUARD SLURRY.
IMMonitoring ❑Recovery
Injection Well:
ft. fr. i
❑Aquifer Recharge ❑Groundwater Retnediation
❑Aquifer Storage and Recovery ❑Salinity Barrier 19.SAND/GRAVEL PACK ifa licableFROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Storm%vater Drainage 25.0 fL 150.0 ft 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control
❑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,soil/rack type, ruin size:etc.
0.0 ft- 12.0 f- BROWN SILTY SAND
4.Date Well(s)Completed: 10/31/22 Well ID# EX-77 12.0 ft. 28.0 n- TAN SILTY SAND
5a.Well Location: 28.0 ft' 74.0 f" PWR
BELEWS CREEK STEAM STATION 74.0 ft• 150.0 ft. ROCI`�, ,-
Facility/Owner Name Facility IDt!(if applicable) ft. ft.
3195 PINE HALL ROAD BELEWS CREEK 27009 a. ft.
Physical.Address,City,and Zip ft. ft.
nts UP,aS
STOKES 21.REMARKS Y' r.�..
County Parcel Identification No.(PIN) BENTONITE SEAL-20.0-25.0 FEET
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
SUMP- 140.0- 141.0 FEET
(ifwell field,one lat/long is sufficient) 22.Certification:
929290.07 N 1682368.71 W 2Sr1z;_ Gw' 11/07/22
6.Is(are)the well(s): OPermanent or ❑Temporary Signature ofCertifted Well Contractor Date
Hv signing ilurs.1brin,l herehv-certi.j'that the:,ir/I(cJ u•as(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or �No 15A NCAC 02C•.0100 or 15.4 NCAC 02C.0200 Well Consirucuon.Standards and drat a copy
!%/his is a repair/ill not knotin well construction inlitrmotion and explain the•nature a17he gJthis record has been provided in the well owner.
repair under a 2l remarks.section or on the hark o/'this tiro.
23,Site diagram or additional wellidetails:
S.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 1 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.SUBMITTAL INSTRUCTIONS
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9.Total well depth below land surface: 140. (ft.)
Submit this GW-I within 30 days of well completion per the following:
(•itr multiple u'clLr list all depths ifdi/jerent(excimple-3@200'mrd?ct 10(1') y p p g
10.Static water level below top of casing: 48.0 (ft) 24a. For All Wells: Original form to Division of Water Resources (DWR),
{J,rarcr/ewel is oho,e casing.use + Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
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11.Borehole diameter: 10.0 (in) 24b. For Infection 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
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FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPD: Copy to DWR,CCPCUA
Permit Program,1611 MSC,Raleigh]NC 27699-1 61 1
13a.Yield(gpm) Method of test:
13b.Disinfection type: Amount: `E
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Fonn GW-I North Carolina Department of Environmental Qualiy-Division of Water Resources Revised 6-6-20I S