GW1--04365_Well Construction - GW1_20240723

WELL cUNsIKUC:I ION KEC;UKU (UW-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 IS.OUTER CASING(for multi-cased wells)OR LINER(if ap licable)
Geologic Exploration, Inc. FROM It) DIAMETER THICKNESS I MATER!M.
ft. ft. in. Ir
Company Name
16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit# FROM TO DI%METER THICKNESS NENTERI N
List all applicable well construction permits(i.e.(/IC,County,State, Variance,etc.) 0.0 ft• 44.0 ft. 2 t"' SCH 40 PVC
3.Well Use(check well use): 54.0 ft. 59.3 ft. 2 i"' SCH 40 PVC
17.SCREEN
Water Supply Well:
PP Y FROM TO DIAMETER SLOT SIZE THICKNESS NENTERI NI.
❑Agricultural ❑Municipal/Public 44.0 ft' 54.0 ft* 2 t"' 0.010 Inch SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Irrigation ❑Wells> 100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD\ tMOI NT
Non-Water Supply Well: 0 0 ft. 36.8 ft- Portland Bentonite Tremie
)Monitoring ❑Recovery ft. ft.
Injection Well:
ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK(if applicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO NIA-FERIAE EMPLACEMENT METHOD
EAquifer Test ❑Stormwater Drainage 40.2 ft. 41.4 ft. Secondary Filter(GP#1) Gravity/Pour
'Fxperimental Technology ❑Subsidence Control 41.4 ft. 61.1 IL Primary Filter(GP#2) Gravity/Pour
J(ieothermal(Closed Loop) ❑Tracer 20.DRILLING LOG(attach additional sheets if necessary)
FROM TO DESCRIPTION(color,hardness,soil/rock hpe,grain size.etc.)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks)
0 ft. 3 ft. Red Sandy Silt
4.Date Well(s)Completed: 6/26/2024 Yell lD# W-13 3 ft. 41 ft• Yellow Red Brown Silty Sand
5a.Well Location: 41 ft* 49 ft. Brown Gray Silty Sand with Gravel
Belews Creek Steam Station 49 ft• 61.1 ft• Rock-Gneiss ^ -- " .+ . i V �-
B' _:...;..ri..,
Facility/Owner Name Facility ID#(if applicable) ft. ft. I'. L
3195 Pine Hall Road, Belews Creek, NC 27009 ft. ft. JUL 2 ; Z0!4
Physical Address,City,and Zip ft. ft. Irk t,i'r,, ,'"',Ff.;i,-1(kd
Stokes 21.RENIARKS Fp/;,' t,:
County Parcel Identification No (PIN) BENTONITE SEAL-36 8 to 40 2 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 lat/long is sufficient) 22.Certification:
36.2652 N 80.0620 w' %'i C�� �_ 7)5T2 I
6.Is(are)the well(s): LPermanent or ❑Temporary Si�gnaattuurre�ofCertified Well Contractor Date
By signing this firm,l hereby certify that the well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or IatNo ISA NC'A('02('.0I00 or ISA NCA('02C.0200 Well Construction Standards and that a copy
if this is a repair,Jill 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 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.SL'BMIITTAL INSTRUCTIONS
9.Total well depth below land surface: 61.1 (ft.)
Submit this GW-1 within 30 days of well completion per the following:
For multiple wells list all depths if different(example-3 a 100'and 1(a 100')
10.Static water level below top of casing: 56.7 (ft.) 24a. For All Wells: Original form to Division of Water Resources (DWR),
Information Processing Unit, 1617 MSC,Raleigh,NC 27699-1617
!I water level is above casing.use"
II.Borehole diameter: 8 nominal (ill ) 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
(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 GPD: Copy to DWR,CCPCUA
Permit Program, 1611 MSC.Raleigh,NC 27699-1611
13a.Yield(gpm) Method of test:
13h.Disinfection type: Amount:
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018