GW1--04363_Well Construction - GW1_20240723

WELL CONSTRUCTION RECORD ((:N\-I) For Internal Use Only:
I.Well Contractor Information:
Eddie Thomas (Brian) 14.WATER ZONES
------ - - -- ---- FROM TO DESCRIPTION
Well Contractor Name
ft. ft.
2581-A
ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells)OR LINER(if ap licable)
Geologic Exploration, Inc. FROSt TO DIAMETER THICKNESS I MATERIAL
ft. ft. in.
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 tie. (I/('.County.Slaty. romance,etc.) 0.0 ft. 45.0 ft. 2 i"' SCH 40 PVC
3.Well l'se(check well use): 60.0 ft. 65.3 ft. 2 in SCH 40 PVC
Water Supply Well: 17.SCREEN
pp FROM TO DIAMETER SLOT SIZE 1'IIICKNESS MATF:RI Si.
°Agricultural ❑Municipal/Public 45.0 ft' 60.0 ft. 2 in' 0.010 Inch SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. . in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.CROFT
❑Irrigation ❑Wells> 100,000 GPD FROM TO NI AVER' EMI.WE%I F S I METHOD A S.\IOt NT
Non-Water Supply Well: 0.0 ft. 35 5 ft. Portland Bentonite Tremie
lMonitoring ❑Recovery ft. ft.
Injection Well:
ft. ft.
°Aquifer Recharge ❑Groundwater Remediation -
19.SAND/GR.%VF:I.PA('K(if applicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM IO SI%tERI+.1. EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage 41.3 ft. 42.4 ft. Secondary F Iter(GP#1) GraVlty/POUT
❑Experimental Technology ❑Subsidence Control 42.4 ft. 66.4 ft. Primary Filter(GP#2) Gravity/Pour
❑Geothermal(Closed Loop) OTracer 20.DRILLING LOG(attach additional sheets if necessary)
FROM TO DESCRIPTION(color.hardness,soil'rock type.grain size.etc.)
°Geothermal(Heating/Cooling.Return) ❑Other(explain under#21 Remarks)
0 ft. 5 ft. Red Silt with Sand
4.Date Well(s)Completed: 6/14/2024 Well ID# W 7 5 ft. 61 ft. Yellow Red Brown Silty Sand
5a.Well Location: 61 ft' 66.4 ft' Rock-Schist
Belews Creek Steam Station ft. ft. ;-- �' ; , /
Facility Owner Name Facility IDe(if applicable) ft. ft.
3195 Pine Hall Road, Belews Creek, NC 27009 ft. ft. JUL 2 t 2014
Physical Address.City.and Zip ft. ft. Itr3:.''�,- :3-:--,;r;:-„
fir:
Stokes 21.REMARKS DI.(:_;t._
County Parcel Identification No.(PIN) BENTONITE SEAL-35 5 to 41 3 feet
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: Drilling Log Depths (Except Termination)Approximated to Nearest Foot
(if well field,one lat/long is sufficient
22.Certification: ,
36.2706 80.0568 W.
_../1443 0
I). Is(are)the well(s): lPermanent or ❑•Temporary Signature of Certified Well Contractor Date
By signing this form,I hereby cent*that the well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or ONo I SA NC AC 02('.0/00 or 1SA N('AC 02C.0200 Well Construction Standards and that a copy
If this is a repair,fill out known well construction information and explain the nature of the of this record has been provided to 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 may use the back of this page to provide additional well construction info
construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach additional pages if necessary.
drilled:I 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 66.4 (ft.) Submit this GW-1 within 30 days of well completion per the following:
For multiple wells list all depths if different(example-3@200'and 2@ 1 00')
37.1 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"
II.Borehole diameter: 8 nominal (in.) 24b. For Injection Wells:Copy to DWR, Underground Injection Control(IUC)
Program, 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: Down The Hole (DTH) Hammer
24c.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the
ti a 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 27699-1611
13a.Yield(gpm) Method of test:
13b.Disinfection type: Amount:
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018