GW1--04758_Well Construction - GW1_20230724

-WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only: ; •
1.Well Contractor lnfarntalion: . I
BRIAN THOINAS 14.WATER ZONES ..
Well Contractor Name FROA. " TO DESCRIPTION
ft. ft.
A - 2581 . .
ft. ft.
NC Well Contractor Certification Number 15,OUTER CASING(for multi-cased wells)OR LINER(if op licabte) ..
GEOLOGIC EXPLORATION FROM TO.: DIAMETER THICKNESS MATERIAL • •
0.0 fl• 59.0 ft' 6,0 in• SCH 40 PVC'
Company Name 16.INNER CASING ORTURING(geothermal closed-loop)
2.Well Construction Permit#: FROM . TO DIAMETER THICKNESS MATERIAL. . .
List all applicable well construction permits(i.e:.l/I('•('°un(}.State.l'arinnee•etc) 0.0 rt. 140.0 ft. 2.0 in. SCH 40 PVC _
3.Well Use(check well use): ft. ft. in.
. Water Supply Well: . 17.-SCREEN -
'FROM .. TO DIAMETER SLOT SIZE THICKNESS. MATERIAL
°Agricultural DMtiriicipal/Public 140.0 ft' 150.0 R'. 2.0 in' .010 SCH 40 PVC
°Geothermal(Healing/Cooling Supply) ❑Residential Water Supply(single) ft. re. in.
❑lnditstrial/Commercial ❑Residential Water Supply(shared) •I .GROUT
. ❑Irrigation - ❑Wells>100,000GPD FROM . TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well 3:0 rt• 115.0. ft• AQUA GUARD SLURRY
CrJMonitonng- ❑Recovery . 0.0 f6 S9.O costisNotnenoalE SLURRY
Injection Well:
❑Aquifer Recharge ❑Groundwater•Remediation 0.0 ft. 3.0 rt CONCRETE STICKUP PAD
19.SAND/GRAVEL PACK(if applicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM. TO MATERIAL EMPLACEMENT METHOD
°Aquifer Test • . OStormwater Drainage 130,0 ft. 150.0 'fr. 20-40 FINE SILICA SAND ,
°Experimental Technology °Subsidence Control ft.• • -ft. '
°Geothermal(Closed Loop) OTracer 20.DRILLING LOG(attach additional sheets if necessary) •• •
°Geothermal(Heating/Cooling Return) ❑Other(explain.under#21 Remarks} FROM • TO DESCRIPTION(rotor,tr.rdntss soiurnek'gpe;grain size.etc.)
0,0 ft• 4.0 ft• RED SILTY CLAY
4.Date Wells)Completed: 05/10/23 Well ID# Pn11W-SBR(r) 4.0 ft,• 10.0 ft' BROWN SILTY SAND
5a_Well Location: 10.0..IL 15.0 f' TAN SILTY SAND
BELEWS CREEK STEAM STATION 15.0 ft• 54.0 It• PWR ' .
Facility/Owner Name Facility IN(ifapplicable) 54.0 ff. 150.0 II' ROCK
3195 PINE HALL ROAD BELEWS CREEK 27009 ft, I ' fr.
Physical Address.City.and Zip fi• ft.
STOKES • ••21.REMARKS .
County Parcel Identification No.(PIN) BENTONITE SEAL- 115.0-130.0 FEET
Sb,Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one at/long is sufficient) 22.Certification: •
36° 16' 52.17" N 80° 03' 33.56" ,, - "' 07/18/23
6.Is(are)the well(s): C)Permanetit or ❑Temporary Signature of Certified Well Contractor Date
Hy xig,aag this Jixm,I hereby earth•that the reel/(s)was(were)constructed it:accordance wait
7.Is this a repair to an existing well: Oyes or MNo • 13AN('A('02('.OHM nr15AN(;IC VC'.0200I (`l/Jsrgcti�, ire c. tme
!J leis is a repair,Jill out known well consln,ction It forntarion end explain the nature iv'the njehis record has been provided in the+1c•/1 owner .e
C.
Li
repair mule,x2l remarks section or on the bark of rds fern 23.Site diagram or Additional will details:
S.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide ad ttlon'si>0 sng j czt 2ua:tion info
construction,only I GW-I is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box) You may also at tdit'iona1 pages if necessary
drilled: 24.SUBMITTAL INSTRUC)`IONS ^ti Pr^"'�`r'9 Uls
ik
Inforl +�
9.Total well depth below land surface: 150.0 (ft.) DWQrSOG
I ire multiple+culls list all.depths ijdl)irent(example-1 rc 200'and 2 ru ltw') Submit this GW1 within 30 days of well completion per the following:
79.46 242. For All Wells: Original form to Division of Water Resources (DWR),
10.Static water level below top of casing: (CI') Information Processing Unit, 1617 MSC,Raleigh,NC 27699-1617 . •
JjwateP level it abase casing,nye"+-
10.0 24b, For Injection Wells:Copy to DWR, Underground Injection Control (IUC)
11.Borehole diameter: (in.) Program, 1636 MSC;Raleigh,NC 27699.1636
12.Well construction method: AIR
24c:For Water Supply 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
Permit Program,1611 MSC,Raleigh,NC 27699-161 I
13a.Yield(gpm) Method of lest:
13b.Disinfection type: • Amount:
Form OW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised(r U•20 i 5