GW1--05576_Well Construction - GW1_20240913

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only: '
' 1.Well Contractor Information: • '• .
' Eddie Thomas Brian 14.WATER ZONES •
s +
Well Contractor Name FROM TO.. DESCRIPTION' '
ft. ft, I 1
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2581-A ft. 'ft. . , , .
yC,Well'Contractor Certification Number • 15.OUTER CASING'(for multi-cased wells)OR LINER(if ap livable)
Geologic'Expl'oration,, Inc. FROM ', TO ' DIAMETER I THICKNESS • MATERIAL .
ft.•, fit. td.
Company Name. ,
16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#: . • FROM, 'TO:, '' DIAMETER • THICKNESS ' `MATERIAL _
List all applicable well'construction permits(i.e.UIC,County,State,Variance,etc.) 0.0 '- ft.' 135.0 ft-; 2`• •i'"' SCH 40 PVC
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3.Well Use(check well use): • . 155.0;.ft. .160.3, ft- 2 • 'i I•:n., SCH 40 ; PVC
Water Supply Well: 17.SCREEN
• .FROM.' 7., TO .. -DIAMETER SLOT SIZE. THICKNESS MATERIAL '
❑Agricultural ❑Municipal/Ptiblic _ .1,35.0 ft-` 155.0 ft•. 2,- '"'' :0.010 inch SCH 40 PVC '
( g/ g . . Supply(sing fL ft.. in.
• ❑Geothermal Heatin Coolin Supply) ❑R esrdential�Water sin le - •
Olndustrial/Commercial ❑Residential Water'Supply(shared) ' •
GROUT
Olrrigation' _ ❑Wells>100,006GPD .FROM.'' TO. .'-MATERIAL EMPLACEMENT METHOD&AMOUNT
' Non-Water Supply Well , " ' ' A.0 ' ft. , 124.3 ft' Portland Bentonite 'Tremie
• OMonitoring , , ❑Recovery - . • :ft' • fe. ' '
Injection Well:
fit fit II
❑Aquifer Recharge ❑Groundwater Remediation J'' .
19.SAND/GRAVEL PACK(if applicable)
❑Aquifer Storage and Recovery •❑Salinity Barrier , ` -FROM ' r,:TO' . .MATERIAL, , ' - • -EMPLACEMENT METHOD'
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• ❑Aquife?'Test ' •❑Stormwater Drainage'. 131:0 .fit ` 132.9 ft- Secor dary'Filter(GP#1) Gravity/Pour',; -' •
❑Experimental'Technology '❑Subsidence Control 132.9 ft 1.61,0- ft'. •P rimry a Filter,(GP#2) Gravity/Pour ,
. ❑Geothermal(Closed Loop).- ❑Trader 20.DRILLING LOG(attach additional sheets.if necessary)•,' • -
❑Geothermal(Heating/Cooling'Return) ' ❑Other(explain,under#21 Remarks) - FROM r TO •• ,, .. -DESCRIPTION(color,hardiness,soiUrock_, grain'size,etc.)
-, 0 ft, .5 ft . Red Sandy•Silt.
' 4ate Well(s)Completed O7/12/2024 D#Well I DWr'6..D 5 ,. f1,• 39 k Yellow Red Brown Silty,Sand
f f9 t 161;0 t Rock 'Schist/GneissSa Well Location •
y
BelewsCreek'Steam Station II. it: ' i , ..�.,.L.. .�y L . ,
•Facility/Owner Name.': ... ' Facility IDII(if applicable) fit ft
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3,Physical Address,City,and-Zip,195 Pin_a Hall Road, Belews Creek,•NC 27009 `ft 'ft SCI'. 1 ob 2024
ty, p. - - .;,ft fit. • ji Irt1`J:':74:.':.ill ;err{'/ ,-
6i.!.wll'
Stokes'
., 21.REMARKS t?"ili°raw'
County Parcel IdentificationNo (PIN) •BENTONITE SEAL 124,3 to 131';0ft: -'
- Drilling Log Depths(Except Termination)Approximated to NearestFoot
• 5b.Latitude and,longitude m:degrees/minute's/seconds or'decimal degrees:
(tf swell field one lot/long is'sufficient)
.2.Certification ,�
36:2707: , N 80 0542 w , 1/ :
:6;Is(are)the•;well(s): OPermanent. or ❑ empor Tary Signature•of Certified Well Contractor., •'I• ,; . - Date
• ' By sighing this for:in,llrerebycertik7hat theiirel/(s)was(*ere)constructed in accordance with
7,Is this a repair to an existing well: ❑Yes •or lNo 15A NCAC'02C.0l06 or 15A NCAC(12C.0200 Well Constriction Standards and that a copy
If this is a repair;fill oi/i known well construction ii fornmtian and explain the nature Of the of this,'ebord has been piovided'io the Well owner.
' repair under#.21 remarks section or on:the back of this form. . '
23.Site diagram'or additional well details:
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You tray use the back of this page to provide additional well construction info
• construction only I'GW-1•is needed. Indicate TOTAL NUMBER of wells (add'See Ovee in Remarks Box).You play also attach additional pages if necessary.
drilled:1,- _ - 24,SUBMITTAL INSTRUCTIONS'.
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9 Total well depth.below land surface: 61',0. (ft) Submrf this GW4 Within: days:of well completion•per the following: '
For multiple wells hit all depthiuf different(example 3 a 200:and 2@100')
75 g ' 24a. For All.Wells: Original form.ito;Division of Water Resources (DWR)
10.Static'Water level below top of casing: (ft) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
If water level is above'casing,use ,+ - . ' •
I:
. e nominal t0-30 ft) 24b.For,injection.Wells:Copy to DWR,Underground Injection Control(IUC)
1I.Borehole diameter:••s s rota nai{3atsto 61 (in.) Program,_1636 MSC,Raleigh,NC 27699,1636
, -. Down The Hole (DTH) Hammer
We
ll ell construction method, 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 Was'producing over 100,000 GPD: Copy to DWR,CCPCUA -
- , Permit Program; 1611 MSC,Raleigh;NC127699-1611 ' • -
13a.Yield(gpm) • Method of test: '
13b.Disinfection type: .. Amount: ,
- Form OW-1 - -- - ' North Carolina Depaitmedf of Edviroiimental Quality_Division of Water Resources' ' - -- . , -'Revised 6-6-2018 . - '