GW1--04401_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 wens)OR LINER(if ap licable)
Geologic Exploration, Inc. FROM TO DIAMETER THICKNESS 1 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(t.e.(//C,County,State, Variance,etc.) 0.0 ft• 34.0 ft• 2 r"' SCH 40 PVC
3.Well Use(check well use): 44.0 ft. 49.3 ft• 2 in. SCH 40 PVC
Well: 17.SCREEN
Water Supply
FROM _ TO DIAMETER SLOT SIZE tHICKNESS %UTERIAL
❑Agricultural OMunicipal/Public 34.0 ft. 44.0 ft. 2 in' 0 010 Inch SCH 40 PVC
OGeothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft - ft. in T
❑Industrial/Commercial ❑Residential Water Supply(shared) IS,GROUT
❑Irrigation ❑Wells>100.000 GPD FROM TO NE t IERIAI. EMPLACEMENT METHOD&AS1O1 NT
Non-11 ater Supply Well: 0.0 ft• 24.5 ft• Portland Bentonite Tremie
itMonitoring ❑Recovery ft. ft.
Injection Well:
ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL.PACK(if applicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM I0 MA IERIAI. EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage 29.7 ft. 31.0 ft. Secondary Filter(GP#1) Gravity/Pour
❑Experimental Technology ❑Subsidence Control 31.0 ft. 50.7 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 hpe.grain size.etc.)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks)
0 ft. 3 ft• Brown Silty Sand
4.Date Well(s)Completed: 6/15/2024 11 ell 11/# W-10 3 ft. 7 ft• Red Lean Clay
Sa.Well Location: 7 ft. 34 ft. Yellow Brown Silty Sand
Belews Creek Steam Station 34 ft. 41 ft. Brown Silty Sand with Gravel _ _
Facility/Owner Name Facility ID#(if applicable) 41 ft. 50.7 ft. Rock-Gneiss c_"'- . ' k,,E
t ,.ti.�. 6...
3195 Pine Hall Road, Belews Creek, NC 27009 ft. ft.
ft. ft. JUL 2 tr 2024
Physical Address,City,and Zip
Stokes 21.REMARKS ;h`s;:.'4.4'"s1 3,-,-r1Ai:.'ii
Count. Parcel Identification No.(PIN)
BENTONITE SEAL-24.5 to 29 7 feet D'h.C:53Cv
Drilling Log Depths(Except Termination)Approximated to Nearest Foot
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one latilong is sufficient) 22.Certification:
36.2686 80.0574 NY ` ak...-,-
7 1(
6.Is(are)the well(s): iPermanent or ❑Tr"tporar Signature of Certified Well Contractor Date
By signing this form,I hereby certify that the wellls)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or n No /SA N('A('02('.01110 or ISA NCAC OX'.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 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 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: 50.7 (ft)
For multiple wells list all depths if different(example-3a200'and 2 tr 100') Submit this GW-1 within 30 days of well completion per the following:
36.7 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
1/water level is above casing,no'" "
II.Borehole diameter: 8 nominal (in.) 24b. For Injection Wells:Copy to DWR, Underground Injection Control(TUC)
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