GW1--04378_Well Construction - GW1_20240723

WELL CONSTRUCTION RECORD(GW-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 TO DIAMETER THICKNESS g MATERIAL
ft. ft. in.
Company Name
16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#: FROM TO DIAME FER THICKNESS M ATERI11.
List all applicable well construction permits(i.e t 11('.County.State. I artance.etc) 0.0 ft. 44.0 It. 2 i"' SC H 40 PVC
3.Well Else(check well use): 59.0 ft. 64.3 ft• 2 '"' SCH 40 PVC
17.SCREEN
Water Supply Well:
PPYFROM TO DI(METER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 44.0 ft' 59.0 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.GROUT
❑Irrigation ❑Wells> 100,000 GPD FROM TO MATERIAL F\IPLACEMF:\I METHOD& \MOuNT
Non-Water Supply Well: 0.0 ft• 34.9 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 MIATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage 40.6 It, 41.7 ft. Secondary Filter(GP#1) Gravity/Pour
❑E4erimental Technology OSubsidence Control 41.7 ft' 66.0 ft. Primary Filter(GP#2) Gravity/Pour
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG(attach additional sheets if necessary)
FROM TO DESCRIPTION(color.hardness,soil/rock type.grain size,etc.)
OGeothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks)
0 ft. 7 ft• Red Brown Sandy Silt
4.Date Well(s)Completed: 6/13/2024 Well ID# W-6 7 ft. 59 ft• Yellow Brown Silty Sand with Gravel
5a.Well Location: 59 ft' 66.0 t• Rock Gneiss- � -.,. ..,.
Belews Creek Steam Station ft. ft. -•• VE D
Facility'.Ossner Name Facility ID#(if applicable) ft. ft, JIJL -(, 4
3195 Pine Hall Road, Belews Creek, NC 27009 ft. ft. 2
Physical Address,Cits.and tip
ft. ft. Irr{Gr::,ir.i 17;1 !.r f7 ;,,.$Uf it
Stokes 21.REMARKS D '
County Parcel Identification No.(PIN) BENTONITE SEAL-34 9 to 40 6 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 latllong is sufficient) 22.Certification:
36.2705 N 80.0586 w �tr ��Lt� I S 2
6.Is(are)the well(s): Permanent or ❑Temporary Signature of Certified Well Contractor Date
By signing this form,I hereby certify that the well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or nNo I SA NCAC 02('.0100 or/SA NCAC 02C.0200 Well Construction Standards and that a copy
I/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 hack 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:t 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 66'0 (ft.)
For multiple wells list all depths if different(example-3 2f)0'and 2 ih!(lll') Submit this GW-1 within 30 days of well completion per the following:
top of casing: 47.7 (ft) Information
For All Wells: Original form to Division of Water Resources (DWR).
10.Static water level .a e Information Processing Unit, 1617 MSC,Raleigh,NC 27699-1617
If water level is shove c below
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
(i a auger,rotary',cable,direct push,etc) county environmental health department of the county where installed
FOR WATER SUPPLY WELLS ON IA: 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 G W-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018