GW1--04364_Well Construction - GW1_20240723

WLLL CONS 1KU( IIUN KLUUKD ((.W-1) 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) J
Geologic Exploration, Inc. FROM TO DIA ME TER THICKNESS I NIATERI•\t.
ft. ft. in.
Company Name
16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#: FROM TO DIANIEI'ER THICKNESSMATERIAL
list all applicable well construction permits tt: l 1(.,Counts.State, Variance,etc.) 0.0 ft• 42.0 ft. 2 in' SCH 40 PVC
^
3.Well('se(check well use): 57.0 N. 62.3 ft• 2 'n. SCH 40 PVC
Water Supply Well: 17,SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS NIA IERI:11.
❑Agricultural ❑Municipal/Public 42.0 ft. 57.0 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) IS.GROUT
❑Irrigation ❑Wells> 100,000 GPD FROM TO MATERIAL ENIPI.\C E)IEN1 NIETIIOD& %MOT NI
Non-Water Supply Well: 0.0 ft• 32.8 ft- Portland Bentonite Tremie
nMonitoring ❑Recovery ft. ft.
Injection Well: ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK(if applicable)
❑Aquifer Storage and Recovery OSalinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage 37.9 ft• 39.0 ft. Secondary Fitter(GP#1) Gravity/Pour
❑Experimental Technology ❑Subsidence Control 39.0 ft• 63.4 ft• Primary Filter(GP#2) Gravity/Pour
❑Geothermal(Closed Loop) OTracer 20.DRILLING LOG(attach additional sheets if necessary)
FROM 1 TO 1 DESCRIPTION(color,hardness,soil/rock tspe.grain siie.etc.)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks)
0 ft. 8 ft• Red Brown Silt
4.Date Well(s)Completed: 6/1 1/2024 Well ID# W-14 8 ft. 13 ft• Yellow Brown Silty Sand
Sa.Well Location: 13 ft' 14 ft• Yellow Red Sandy Silt
Belews Creek Steam Station 14 ft• 43 ft. Yellow Red Brown Silty ," w? �• j},�!�^�
. .r. _ V 1...�J. ..
Facility Owner Name Facility ID#(if applicable) 43 ft• 63.4 ft• Rock-Schist
3195 Pine Hall Road, Belews Creek, NC 27009 ft. ft. JUL 2 20Z4
Physical.Address.Cit .and Zip ft. ft. A-rr 1�►J<
Stokes 21.REMARKSIE'(a' -4i�\' , a
D(M'?.ir.l v
County Parcel Identification No (PIN)
BENTONITE SEAL-32.8 to 37.9 feet
Drilling Log Depths(Except Termination)Approximated to Nearest Foot
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one latilong is sufficient) 22.Certification:
36.2636 80.0644 7-11. a _l 2 (/
6.Is(are)the well(s): nPermanent or ❑Temporary Signature of Certified Well Contractor Date
By signing this form,/hereby certify that the well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑l es or n No I5A NC A('02C.0 WO or 15A NCAC 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'2/remarks section or on the hack of this form
23.Site diagram or additional well details:
8.For Geoprobe/DPT or Closed-l.00p Geothermal Wells having the same You may use the back of this page to provide additional well construction info
construction,only I GW-I is needed. Indicate TOTAl.NUMBER of wells (add'See Over'in Remarks Box).You may also attach additional pages if necessary.
drilled:1 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 63'4 (ft.)
For multiple wells list all depths if different(example"3�100'and 2Qa 10t1') Submit this GW'-I within 30 days of well completion per the following:
10.Static water level top of casing: 42 9 (fit) 24a. For All Wells: Original form to Division of Water Resources (DWR).
1 If-water level is above casing,below use" Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
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
lie 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.l ield(gpm) Method of test:
13b.Disinfection hype: Amount:
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018