GW1--04400_Well Construction - GW1_20240723

WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
1.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 DIANIFIT:R THICKNESS 1 Mn FERIAE
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(i.e.(/!(',County,State, Variance,etc.) 0.0 ft' 55.5 ft• 2 In' SCH 40 PVC
~
3.Well Use(check well use): 65.5 ft. 70.8 ft• 2 In' SCH 40 PVC
Water Supply Well: 17.SCREEN
FROM T(1 DIAMETER SLOT SIZE THICKNESS MATERIAL.
❑Agricultural OMunicipal/Public 55.5 ft. 65.5 ft. 2 in' 0.010 Inch SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) rt. ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Irrigation ❑Wells> 100,000 GPD FROM TO MATERIAL EMPLA('ESIENT METHOD&AMOt'NT
Non-Water Supply Well: 0.0 ft. 44.3 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 OSalinity Barrier FROM It) MATERAAI. EMIPI.ACEMIENT METHOD
❑Aquifer Test ❑Stormwater Drainage 50.5 ft. 52.5 ft- Secondary Filter(GP#1 I Gravity/Pour
❑Experimental Technology OSubsidence Control 52.5 ft• 71.7 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 Ispe,grain size.etc.)
❑Geothermal(Heating/Cooling Return) DOther(explain under#21 Remarks)
0 ft. 3 ft. Red Sandy Lean Clay
4.Date Well(s)Completed: 6/8/2024 N ell 11). W-1 1 3 ft. 50 ft. Yellow Red Brown Silty Sand
5a.Well Location: 50 f' 55 ft' Brown Poorly Graded Gravel
Belews Creek Steam Station 55 ft* 66 ft. Yellow Red Brown Silty Sand lx+..t.,, !t ..r
Facility/Owner Name Facility ID#(if applicable) 66 ft. 71 7 ft. Rock-Gneiss
3195 Pine Hall Road, Belews Creek, NC 27009 ft. ft. JUL 2 c 2)24
ft. ft. Ir, ::;,ai`c.� ,� s
Physical Address,Cm.and Zip .;-$:fit
Stokes • 21.REMARKS D'L•'.:...'.,:;v.
County Parcel Identification No (PIN) BENTONITE SEAL-44 3 to 50.5 feet
Drilling Log Depths(Except Termination)Approximated to Nearest Foot
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one latllong is sufficient) 22.Certification: ff
36.2668 80.0615 (
WOde U 7-- -.2 '
6.Is(are)the well(s): lPermancni or I eniporary Signature of Certified Well Contractor Date
By signing this form,l hereby certify that the went's)was(were)constructed in accordance with
7.Is this a repair to an existing well: L 1 es or tNo 15A N('AC 02('.0100 or iSA NCA('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 e2I 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-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: 71'7 (ft.)
For multiple wells list all depths if different(example-3 a 200'and 2@!00') Submit this GW-1 within 30 days of well completion per the following:
38.5 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
(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:
13b.Disinfection type: Amount:
Form G W-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018