GW1--04402_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 a licable
Geologic Exploration. Inc. FROM TO DIAMETER THICKNESS NIATERI.\I.
ft. k, 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.(/l('.County,State. Variance,et.) 0.0 fit• 21.0 fit• 2 'n' SCH 40 PVC
3.Well Use(check well use): 31.0 fit• 36.3 fit• 2 'n' SCH 40 PVC
N Act'Supply Well: 17.SCREEN
FROM TO D1.VHETER SLOT SIZE THICKNESS NIATERTU.
❑Agricultural ❑Municipal/Public 21.0 ft• 31.0 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. ENIPLUF.\IF:\I NIEI111111A s\lorsI
Non-Water Supply Well: 0.0 ft. 11 6 ft. Portland Bentonite Tremie
[Monitoring ❑Recovery ft. ft.
Injection Well: ft. ft.
JAquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK(if applicable)
❑Aquifer Storage and Recovery OSalinity Barrier FROM To NI\FERI St. EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage 17 5 ft. 18.6 ft Secondary Filter(GP#1) Gravity/Pour
❑Experimental Technology ❑Subsidence Control 18.6 ft. 38.0 ft. Primary Filter(GP#2) Gravity/Pour
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG(attach additional sheets if necessary)
FROM I TO I DESCRIPTION(color.hardness,soil/rock tope.grain size.etc.)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks)
0 ft. 3 fit• Red Sandy Silt
4,Date Well(s)Completed: 6/26/2024 Well ID# W-8 3 ft. 27 fit• Multicolored Silty Sand
5a.Well Location: 27 ft. 38.0 ft Rock-Gneiss
Belews Creek Steam Station ft. ft. _
ijFacihh Owner Name Facility ID ;`#(if applicable) ft. ft. '' ' `'..*Tl 1.� ,
3195 Pine Hall Road, Belews Creek, NC 27009 ft. ft.
ft. ft. J U L 2 J. 2024
Physical Address,City,and Zip
Stokes 21.REMARKS tr.i::' -.yt' ` a•r"a '-a JAR
County Parcel Identification No.(PIN) BENTONITE SEAL- 11 6 to 17.5 feet DI,',"::,3'2,21
Drilling Log Depths(Except Termination)Approximated to Nearest Foot
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: Approximated_
to
well field,one lat/long is sufficient) 22.Certification:36.2693 N 80.0557 W 62k-'---_-_.- c-�_ - 1/
6.Is(are)the well(s): nPermanent 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 liNo 114 NCA('02('.0100 or ISA MAC'02C.020 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 all 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-1 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: 38 0 (ft.)
For multiple wells list all depths if different(example-3@a 200'and 2@100')
Submit this GW-1 within 30 days of well completion per the following:
28.5 24a. For All Wells: Original form to Division of Water Resources (DWR),
10.Static water level below top of casing: (fit•) Information Processing Unit, 1617 MSC.Raleigh,NC 27699-1617
II water level is above casing,use"• '•
11.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
13a.l"field Permit Program. 1611 MSC,Raleigh,NC 27699-1611
(gpm) Method of test:
13b.Disinfection type: Amount:
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018