HomeMy WebLinkAboutGW1--05582_Well Construction - GW1_20240913 I
WELL CONSTRUCTION•RECORD(GW=1) For Internal Use Only: I '
1.Well Contractor-Information; l . . •
Eddie Thomas':(Brian)
14.W ATER ZONES
FROM ' "T
Well Contractor Name' - O, ' . 'DESCRIPTION• "
ft. . . ft:'. 1, I : - -
•
2581 A= • rt rt. '
NC Well Contractor Certification Number
15.OUTER CASING(for multi-cased wells)OR LINER(if ap licable)
Geologic Exploration, Inc. ,,., , , ETEII Tr MATERIAL.FROM TO -D[A,M THICKNESS
, Company Name' ; .. .
• ft fr
16.INNER CASING OR TUBING(geothermal closed-loop)
' 2.Well Construction Permit#E •,FROM ' :-•t '.TO,'' ' .DIAMETER'r•. THICKNESS,:' :MATERIAL'
Listall`a licable'isellconstruction ermits te,UIC CountyState,Variance,etc. �' •.in •
tin v ( ) 0.0 ft.- 72;0 :rt. 2, SCH 40• . PVC"
3.Well Use:(check well use): 92;0: ft '97.3 It. 2 •_ +' i"'. SCH 40 .PVC - ' "
Water Supply Well ' i-17.SCREEN i •
FROM-. .TO - ' -DIAMETER ;.'SLOT SIZE -THICKNESS MATERIAL
DAgricultural- DMunicipal/Public 7 0 ft. 9 0 ft" 2 in. ' C
2. 2 ;. 010 inch SCH, PV
: ❑Geothermal'(Heating/Cooling'Supply)' OResidential Water Supply(single) ft , ' " ft.r, :..in'
❑Industria)/Commercial ❑Residential Water Supply(shared)" • 18 GROUT
' Dlrrigatiori , OWells>100,000 GPD, FROM:,r% ,..TO : MATERIAL -EMPLACEMENT METHOD&AMOUNT
Non-Water Supply'Welli , • - • 0 0 ft. , 59.3 . ft, Portland Bentonite Tremie- ..
lMonitoring • - ORecovery •
ft. ft:
Injection Well; ft • •tt.
❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK Of applicable)"
❑Aquifer.Storage and•Re nity covety ' ❑S4li Barrier ?'FROM`' >: "TO'.' • %MATERIAL,`,' :EMPLACEMENT METHOD, ".r
OAquifer Test" ❑Stormwater Drainage 65:1 ft 68.1 .ft'. Secondary,'Filter(GP#1) Gravity/Pour
OExperimenfa•l Technology . ❑Subsidence Control 68.1 ft• .100.0 :ft• Pnmary Filter-(GP#2) Gravity/Pour' '
' ❑Geothermal(Closed,Loop),;" •OTracer 20.•DRiLLING LOG(attach additional sheets if necessary) - - " .,
•
- " DGeothefmal,(Heating/Cooling-Return) tiddler* explain under
I.Remarks) : - FROM, TO ",•"'DESCRIPTION(color.hardnes':--.tick t'-r--rain siie:'etc.)
..o 0 tt 3 fr Red Lean Clay• „
4.Date Well(s),Completed 08%19/2024 Well ID# VU'2 _ 3 ft 12 ft Red_Brown Yellow Silty Sand
,. : 5a.Well Location: '12• .-:Et.'''' 1'4 ft Red Yellow Sandy Silt , ,
Belews Creek Steam Station ' ' 14 ft 2t ft Red Yellow Browri Silty Sand. �-,
', Facility/Owner•Name -: FacilityIDN(if applicable)' `26 • ft 100.0 ft Rock Sehlst/Gneiss 4 ` 17'„
,,,ft ft ; h
31:95 Pine HaltRoad, •Belews Creek, NC 27b0'9 n
Physical Address;City,avid Zip` ft ft. S r tS' 2024
• .Stokes • -, 21 REMARKS 1
e' i BENTONITE SEAL 59:3 to 65.1$r t( td+2, .y .'
County' !,:. Parcel Idenhfication - l�'f S•vZ,�"
'' r •; :� 1; . `- Drilling Log Depths(Except Terminatlon)-Approximated to'Nearest Foot
Sb Latitude apd longitude in degrees/minutes/seconds or decimal degrees:,•
• (if well field one lat/long is sufficient)
N "' ' 22 Certification ' , .
-3-62820 80 051 .• " I (
G ;
6:Is(are)the well(s): ,l lPermanent or ',❑Temporary Signature of Certified Well Contractor Il, •,, ate"
By signing this form:I hereby certifythat he u ell(s)u•as(ii ere)constructed in accordance Irish
• 7:Is this a repair to an'existing well: ❑Yes or iNo • 15A NCAC 02C.0100 or ISA NCAC O'Ci.0200 Well Construction Standards and that a copy
• If this is.a repair•fill out tenon",well conslruction information and explain the nature of the , of this record has been provided to the well'owner•
repair under. 21 remarks section or om the back of this form. r .
23 Sdiag ite ram;or additional well•details: '
, • 8.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 Remarkspage,',
Box).Y may also attach additional pages if necessary. •
dulled s 24;SUBMITTAL INSTRUCTIONS " '
•
9 Total well depth below land surface 1`00' . . ." ':. .. • •(f"t. '
For multi le,wells list all de ihs i di erenr exam le-3 00'and 2 100'. ) ' Submit this GW-1 within 30 days of well completion per the,following:'
n l if ( n G? @ ) -
85'S ) 24A For All Wells:•Original form to 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.+" • r I , ", -
8 nominal • 24b For Infection Wells Copy toy DWR,Underground Injection Control(IUC)
1,1.Borehole diameter (in.) Program,,"1636.MSC Raleigh NC 27699-.1636
Down The Hole DTH Hammer '. �' •
12.Well 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 Wells producing ti'ver:1002000 GPD: Copy to DWR,CCPCUA
' ' ' 'Permit Program;161'CMSC,Raleigfi;NC 27699.1611 • • - - '
13a.Yield(gpm) . Method of test:
13b.Disinfection type •-. ' Amount
Foirn OW-'1 "'Nori1E Carolina De`piirtmen.t of Eiivironmental Quality-Divisidii'of Water Resduroes - • Revised 6-6=2018 -