GW1--04762_Well Construction - GW1_20230724

WELL CONSTRUCTION RECORD(GW-1) For internal Use Only:
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1.Well ContractOr information:
BRIAN THOMAS I4,WATERZONE3
Well Contractor Name FROM TO' '' - DESCRIPTION I''
ft. n. .
A - 2581 '
NC Well Coniradar Certification Numbber. I5.OUTER CASINO(for multi-cased wells)OR LINER(if ap IIcable)
GEOLOGIC EXPLORATION ' FROM TO•::'- DIAMETER' • THICKNESS MATERIAL •
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0.0. ft• 50.0 ft. -6.0 . .in. SCH 40 PVC
.Company Name -16:INNER CASING OR TUBING(keoihermal closed-loop)-
2:Well Construction Permit#: FROM ' TO- I-DIAMETER THICKNESS MATERIAL
List all opphrohle well construction permits.(ae.rl/C,County.State.Variance.etc.)- - 0.0 ft. 130.0•rt. 2.0 i"' SCH 40 PVC
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3.Well Use(check well.use): ft. " 'ft. in. '
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Water Supply Well: FROaCREEN TO DIAMETER• SLOT SIZE THICKNESS' :MATERIAL
°Agricultural OMunicipal/Public •
130.0 rt' 140,0 f`•. 2.0 '"' .010 --SCH 40 PVC ,
OGeothermal(Heating/Cooling Supply). OResidential Water Supply(single) rt. rt. in. - •
Olndustrial/Commercial OResidential Water Supply(shared) 18.GROUT •
Olt-ligation ❑Wells>100.000 GPD -FROM . TO MATERIAL.. EMPLACEMENT METHOD&AMOUNT
• Non-Water Supply Well:' 3.0 n. 110.0 f'• AQUA GUARD SLURRY
EiMonitoring.- '` ORecovery 0.0 ft.. 50.0 f<• PORTLANDBENTONITE SLURRY
Injection Well:
()Aquifer Recharge OGroundwaterRemediation 00 rf 3,0 •ft• CONCRETE STICKUP PAD -
I9.'SAND/GRAVEL PACK-Of appicrble)
❑Aquifer Storage and Recovery °Salinity Rainer FROM TO MATERIAL ' ENIPLACEMENT METHOD
°'Aquifer Test , OStormwater Drainage 125.0 ft• 140.0; fr• 20-40 . .. FINE SILICA SAND
OExperiinental Technology . . •OSubsidence Control ft '- . D. '
OGeothermal(Closed Loop) ()Tracer . 20.DRILLING LOG(attach additional sheets ifnevessaryL
FROM ' 70 DESCRIPTION(color•hardness,unpack type,truin Bice.elc.)
' °Geothermal(Heating/Cooling Return) °Other(explain under fl21 Remarks).
0.0 fl- 10.0 .rt.' RED SILTY CLAY'
4.Date•WelI(s)'Completed: 05/05/23 _ Well ILOPMW'14BR 10.0 IL 18.0 .ft.: BROWN SILTY SAND
5n.Well Location: 18.0 rl• 37.0 ft' . TAN SILTY SAND' .
BELEWS CREEK STEAM STATION .37.0 '11. 39.0 ft• . . . PWR .
Facility/Owner Name Facility lot(if applicable)' - 39.0 11. 140,0 ft ROCK
3195 PINE HALL ROAD BELEWS CREEK 27009 - ft. rt.
Physical Address,City,and Zip II. n.
STOKES 21.REMARKS .
County• Parcel Idemificalion No.(PIN)• BENTONITE SEAL•- 110.0-125.0 FEET
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: • •
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fitwell field.one lat/long is.sufTcieni) 22,Certification:
36° 16' 53.35" 80° 03' 34.85" w r i •
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. N 07/18/23
6.Is(are)the well(s): L)Permanent or °Temporary Signature of Certified Well Contractor Date
to-signing this form,i hereby certify that the ieell(s)u•o.(were)ca,strueted iri acconlaace u•rih
• 7,Is this a repair to art existing well: O' es or ' e3No 15.4 NCA('0X'.0100 or 15A Ne il('02l'.0200 Well C aiturtrerran StanrlariLr and thou a copy
Oki is a repair•fill out known well cotatrunncti deformation and explain 1/a-nature of the of their record has.heen prarrded to the well owner r
reivir nailer c21 reniorkt secaon(Jr on the back oflh,r Prat. �"�r n
e a moral23.Site diagram or additional well details: Construction 16ra`SD
• 8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page.to,provt moral well construction info
• construction,only I OW-1 is needed indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also altapli di inrkpd 213'Iecessary
drilled. 24.SUBMITTAL INSTRUCTIONS J
140.0 t��Pfr,vsae,:trg unit
9.Total well depth below land surface: (ft.)
i ire multiple wcllslist all depths ifddlerent(example-Jrn:200"and 2Ck IO0) Submit this Gw=1 within 30 days of well I i i e'f'tiorr 'i' ing:
10.St• atic water level below top ofcasing: - 75.58 (ft) 24a. For MI Wells: Original form to Division of Water Resources (DWR).
1/.,at.•rh•rrlirahoreiarn,g.o'er ••' Information Processing Unit.16i7.MSC,Raleigh,NC27699,1617
II.Borehole diameter: 10.0 • - (in.) 24b. For Injection.Wells: Copy to DWR, Underground Injection Control (TUC)
Program, 1636 MSC,Raleigh,NC 27699-1636-
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12,Well construction method: AIR
24e.For Water Supply and Open-Loop Geothermal Ream 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 GPI): Copy to DWR,CCPCI IA
Permit Program.1611 MSC,Raleigh,NC 27699-1411
13a.Yield(gpm) Method of test:
13b.Disinfection type: - Amount:
Form GW-I North Carolina Depantiteut of Environmental Quality-Division of Water Resources Revised o:6-2o i 8