GW1--04404_Well Construction - GW1_20240723

WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
I.Well Contractor Information:
Eddie Thomas (Brian) 14.NATERZONES
FROM TO DESCRIPTION
Well Contractor Name
ft. ft.
2581-A
ft. It.
NC Well Contractor Certification Number 15.OtTER CASING(for multi-cased wells)OR LINER(if applicable)
Geologic Exploration, Inc. FROM It) DI. NIL I ER THICKNESS I MATERIAL
ft. ft. in. Ir
Company Name 16.INNER CASING OR TUBING(geothermal closed-loop)
Al
2.Well Construction Permit# FlomFlomTO DIAMETER THICKNESS M s r1RI
List all applicable well construction permits 11 e I IC,County,State, Variance,etc.) 0.0 It. 54.0 ft• 2 in' SCH 40 PVC
3.Well Use(check well use): 64.0 ft: 66.3 It. 2 'n SCH 40 PVC
17.SCREEN
Water Supply Well:
PP Y FROM TO DIAMETER SLOT SIZE THICKNESS MATERI%I.
❑Agricultural ❑Municipal/Public 54.0 ft' 64.0 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 1 "It) MATERIAL EMPL ACI:MENT METHOD&AMOUNT
Non-Water Suppl N ell: 0.0 ft• 43 1 ft• Portland Bentonite Tremie
dMonitoring ❑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 M:crERIAL EMPLACEMENT.SIETlIOD
❑Aquifer Test ❑Stormwater Drainage 48.8 ft. 50.5 ft. Secondary Fitter(GP#1) Gravity/Pour
['Experimental Technology ❑Subsidence Control 50 5 ft. 66.8 ft' Primary Filter(GP#2) GraVity/POUF
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG(attach additional sheets if necessary)
❑Geothermal(Heating/Cooling Return) ['Other(explain under#21 Remarks) FROM TO DESCRIPTION(color.hardness,soil/rock type,grain size.etc.)
0 ft. 2 ft. Yellow Red Sandy Silt
4.Date Well(s)Completed: 6/24/2024 Well ID# W-4 2 ft. 36 ft. Yellow Brown Gray Silty Sand
5a.Well Location: 36 ft' 66.8 ft, Rock-Schist r .-.7:..., «' w 1 e---.... ;--..i
Belews Creek Steam Station
(
UL
Facility/Ow DS ner Name Facility I Of applicable) ft. It. L 4
3195 Pine Hall Road, Belews Creek, NC 27009 ft. ft.
0-J0. i:,r. :e:r^sot.,-e Uri
Physical Address,Qn.and:ii, ft. ft. d ;C:...1.(.-,3
Stokes 21.REMARKS
County Parcel Identification No.(PIN) BENTONITE SEAL-43 1 to 48 8 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 lat/long is sufficient i 22.Certification:
36.2811 • 80.0469 C
6.Is(are)the well(s): lPermanent or ❑Temporary Signature of Certified Well Contractor Date
By signing this form.!hereby certi/y that the well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or I'tNo 15A NCA('02C.0100 or 15A N('AC 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,:2 I 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.l"s I RI ( FIO'S
9.Total well depth below land surface: 66'8 (ft.)
/br multiple wells Gat a!1 depths if different(example- a nit and 1Cg?!00') Submit this GW-ll within 30 days of well completion per the following:
60.2 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" "
I I.Borehole diameter: 8 nominal (in ) 24b. For Injection Wells:Copy to DWR, Underground Injection Control(IUC)
Program,1636 MSC,Raleigh.NC 27699-1636
1z.Weu construction method: Down The Hole (DTH) Hammer
24c.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the
lie 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: .'mount:
Form G W-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018