GW1--04403_Well Construction - GW1_20240723

WELL CONSTRUCTION RECORD (CW-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 DIAAIFTER THICKNLSS MATERIAL
ft. ft. in.
Company Name
16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS )IATERIAI.
List all applicable well construction permits(i.e.(11(',County,State, Variance,etc.) 0.0 ft. 66.0 ft. 2 '"' SCH 40 PVC
3.Well Use(check well use): 86.0 ft• 88.3 ft. 2 'n' SCH 40 PVC
Water Supply Well: 17.SCREEN
PP Y FROM To DLS>IFTF:R SLOT SIZE THICKNESS MA ITRLu.
❑Agricultural ❑Municipal/Public 66.0 ft' 86.0 ft' 2 '" 0 010 Inch SCH 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft ft.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
EIrrigation ❑Wells> 100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD& >'IO(NT
Non-Water Supply N1 ell: 0.0 ft. 55.7 ft• Portland Bentonite Tremie
JMonitoring ❑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 MATFRIAI. EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage 61.0 ft. 63.0 ft• Secondary Filter(GP#1) Gravity/Pour
❑Experimental Technology ❑Subsidence Control 63.0 ft. 89 9 ft• Primary Filter(GP#2) Gravity/Pour
OGeothermal(Closed Loop) ❑Tracer 20.DRILLING LOG(attach additional sheets if necessary)
FROM TO DESCRIPTION(color.hardness,soil/rock h.pe,grain sire,etc.i
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#2I Remarks)
0 ft. 3 ft. Red Sandy Silt
4.Date Well(s)Completed: 6/18/2024 Well ID# W-5 3 ft• 36 ft. Brown Yellow Silty Sand IT "_;,- --
Sa.Well Location:
36 ft. 89.9 ft. Rock-Schist t x......' ' a... i/ L
Belews Creek Steam Station ft. ft. JUL 2 i 2024
Facility/Owner Name Facility iD#(if applicable i ft. ft.
lar3195 Pine Hall Road, Belews Creek, NC 27009 ft. ft. D'fd 3t:r.3 •`"` irk
Physical Address,City,and Zip ft. ft.
Stokes 21.REMARKS
County Parcel Identification No.(PINT BENTONITE SEAL-55 7 to 61 0 feet
Drilling Log Depths(Except Termination)Approximated to Nearest Foot
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
i if well field,one lat/long is sufficient) 22.Certification:
36.2806 \ 80.0500 N, /jell% �u'`'`` ? is 32(f
6.Is(are)the well(s): (Permanent or ❑Temporary Signature of Certified Well Contractor Date
By signing this form,l hereby certify that the well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or In No I3A NIA('02('.0100 or 15A N('AC 02C.0200 Well Construction Standards and that a copy
If this is a re/iour,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:1 24.SUBMITTAL INSTRUCTIONS
9.Total well depth bel land surface: 89'9
ow (ft.)
For multiple wells list all depths i1 different(example-3@200'and 2@100') Submit this GW-I within 30 days of well completion per the following:
67.6 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) 241). 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-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018