GW1-2022-10667_Well Construction - GW1_20221128

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
BRIAN THOMAS 14.WATER TONES
Well Conrimetor Name FROM TO DESCRIPTION
A - 2581
It. It.
NC Well ContraclorCmificaion Number NOVIS,OUTERCASING formulti-cued wells)OR LINER iIa kabta
GEOLOGIC EXPLORATION NOV 2 8 202Z FROM TO DIAMETER THICKNESS MATERIAL
h. ft.
Nance n
!D{uPA'i:KJ-1 ?C':96M1] Ur r 16.INNER CASING OR TUBING eorhermaleloeed-too
2.Well Construction Permit k: r„},ram/6� FROM TO DI'MrrER THICKNESSI MATERIAL
/,iv all app/iraMe well aonnrurrion prmrits(.e.UIC.Coumy State,Variamn,arc.) 0.0 R• 125.0 IL 6.0 r"' SCH 40 PVC
3.Well Use(check well use): h. ft !n
Water Supply Well: 17.SCREEN
MOM I TO I DIAmE s1ATsIZE TIMInKNESS MATERIAL
❑Agricultural OMunicipal/Public 125.0R' 145.0 IL 6.0 rn .010 SCH 40 PVC
OGeothermal(Heating Cooling Supply) OResidential Water Supply(single) n. I h. I Io
Dlndustrial/Commercial DResidential Water Supply(shared) I&GROUT
❑Irrl ation DWells> 100000 GPD FROM TO MATERIAL EMPLACEMENT METHOD 6 AMOUNT
Non-Water Supply Well: 0.0 R• 20.0 D' AQUA GUARD SLURRY
ElMoniloring ORecovery, h. ft.
Injection Well:
h. R.
DAquiter Recharge OGroundwater Remedialion
19.SANDIGRAVEL PACK(if IkaWe
❑Aquifer Storage and Recovery OSalinity Bartier FROM TO MATERIAL EMPLACEMEM MErH00
❑Aquifer Test OStormwater Drainage 25.0 R• 150.0 a. 20-40 FINE SILICA SAND
OExpenmental Technology OSubsidence Control rL R
OGeothermal(Closed Loop) OTrxcer 20.DRILLING TOG intbch additional sh"is ifnecessa
OGeotherial(Heming/Cooling Return) DOdler(explain under k21 Remarks) PROM TO DFSCRIPTIONColor,hamnam,ru1/ne4ya size.err.
0.0 h' 13.0 a BROWN SILTY SAND
4.Date Well(s)Completed: 1 1/08/22 Well[Do EX-80 13.0 R' 23.0 It TAN SILTY SAND
5a.Well Location: 23.0 R, 71.0 R' PWR
BELEWS CREEK STEAM STATION 71.0 R' 150.0 R' ROCK
Facility/owner Name Facility ID4(ifapplicabk) R, ft
3195 PINE HALL ROAD BELEWS CREEK 27009 R. rL
Physical Address,City,and Zip h. ft
STOKES 21.REMARKS
Cowry Parcel Idemificetion No.(PIN) BENTONITE SEAL- 20.0-25.0 FEET
Sb.Latitude and longitude in degrees/minutes/mconds or decimal degrees: SUMP- 145.0- 146.0 FEET
(ifwell field,we Ia llong is so fici,m) 22.Certification:
929271.60 N 1682522.24 W �- 0 r- 11/14/22
6.Is(are)the well(s): 19Permanent or OTempocary Signature ol'Cenified Well Contractor Data
Sysigning tMs form,/hereby certify 1hal the sell(s)was(were)corntrunedm accordance with
7.Is this a repair to an existing well: OYes or MNo ISA NG/C 02C.0100 or ISA NCAC 02C.0200 Well Conrtrucllon SmtdaA*and lbat a copy
lJthv u a repair,fill out kmmvn well comouc0on information mod explain the nature of the ofther record has been provided to the yell owner.
repair under<21 remarb.secdoo(iron the back ofthis form.
23.Site diagram or additional well details:
8.For Geoprobe/DPf 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 Uvel in Remarks Box).You may also attach additional pages If necessary.
drilled: 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 145.0 (fi)
For aulup/e wells Netall depths fdifferent(example-3(a1200'eud 2@100) Submit This GW-1 within 30 days of will completion per the following:
10.Static water level below top of casing: 99.0 (a) 24e. For All Wells: Original form to Division of Water Resources (DWR),
fwmrr keel is above rasing,care Information Processing Unit,1617 MSC,Raleigh,INC 27699-1617
11.Borehole diameter: 10.0 (in.) 24b. For Infection Well a:Copy to DWR,Underground Injection Control (TUC)
Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: AIR 24c.For Wafer Su I and O n-Loo Gtothermal Return Wells:Copy to the
(i.e.auger,rusty,cable,direct peak act county environmental health apartment o t e county ere insta
FOR WATER SUPPLY WELLS ONLY: 24d. For Water Wells rodurin over 100 000 GPD:Copy to DWR,CCPCUA
Permit Program,I I I MSC,Raleigh,NC 276 9-1611
13a.Yield(gpm) Method of teat:
13b,Disinfection type: Amount:
Tam GW-1 North Carolina Depanment of Environmental Quality-Division of Water Resources Revised"-2019