GW1--05571_Well Construction - GW1_20240913

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WELL CONSTRUCTION RECORD(GW-I) For Internal Usd Only:. ... .
.1.Well Contractor Information: ' • . . .. ,
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Eddie Thomas (Brian) .•
. 14.WATER ZONES • ' /' . . ,
FROM' ' ' 'TO ".• - .DESCRIPTION.
i.),,e11 Contractor Name
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2581-A ' , • . •- - , .
' ft.I ' ft.
NC Well Contractor Certification Number ,
15.OUTER CASING(for multi-cased ivells)OR LINER(if op licable)
Geologic Exploration, Inc. FROM - :TO.-.:.' • DIAMETER 1 . THICKNESS - MATERIAL.
''• :.'ft:' ,, ft.
ConipilnyWaine
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. ' 16.INNER CASING OR TUBING(geothermal closed-loop)
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. . 2.Well•Cdtistructioii Pernilt if:. , . . FROM ' .TO ' . ' . DIAMETER ' • THICKNESS MATERIAL
List all applicable;Veil constrhetion'perniits(i.e.U1C,County,State,Variance,etc) ' - :0.C( ft::' 110„0 ft• 2 .' I,!(O• SCH 40 2 ' Pkid.
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3.Well Use well use); , , 130 0 (t• 135 3. ft• 2 , ji'"••• CH 40 PVC. . - ..... -
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• Water
Supply
ell: ' ' , •
• • W FROM, TO ' DIAMETER oSLOT SIZE THICKNESS MATERIAL • ,
CfAgricultural OMunicipal/Publiq •
' . 110.6 ft: 136.0 ft.--12 . ''''' 001Dinch SOITI40 PVC
Odeothermal(Heating/Cooling Supply) OResidential Water Supply(single) ... ft.I , , ft..• . in;. , ': - ' .•: ' .•:. - • ' . , • ,„•
. . 0 Indti4rial/Conimerc ial DResidential Water Supply(shared) • ' •
IS GROUT
' ' I:Irrigation • 0Wells>100,000 GPD FROM ' ' TO' MATERIAL , • EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: .
" 0.-0 f!. 99.7 ft .Portland'BOtonit0 Tremie ' .., . ,•
It Monitoring,: 0Recovery , . .
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Injectinit Well:" " .2 • "'•
, .,. . ft. , ' ft. , . :i" .DAqUifer_Recharge ,OGroundwater Remediation
S SS --•t 9.SAND/GRAVEL PACK(if applicable)
:Aquifer Storage: ,and Recovery DSalinity Barrier ' FROM.' -TO '; -' - MATERIAL , . . EMPLACEMENTMETHOD ,
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:Aquifer Test, ' • • '0Stdmiwater Drainage • 1053, It 107,3't ft• Secondary Filler(GPitil, Gravity/Pour •• ,
DExPerimental Technology OSuhsidence Control • 107.3. 11, 135:6 '..ft• Primary Plitei.'(GP#2) Gravity/Pour ,• • .,
OGeot4ennal(Closed Loop) ElTraCer . , 20.DRILLING LOG(attach additional sheets if necessary)
FROM :: .TO.. ', .:DESCR7TIOl(color.ITrdnessito!lfroek type.igyain size.ete.)
• - ,.. .1:1Gebthermai(Henting/COoling Return), •.OOther(explain under#21 Remarks)
".2.
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., . , .„... , .. .,,, .,.. . .. ., . -- 'ft• 2' " it Red Uear6Clay -.'' '
:' ' •.::- • 07/12/2024• DIN-10
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4.Dale'Well(S)COmpleted:• • • - .,, Well ID# .• . . 2 - ft• .8 ft• Red Brown Yellow Silty Sand
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. .''.. 5a'.Well Location : ' .' , • ' 8' "1(' 14' .1't• Red•YellOw Sandy Silt
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Belews Creek Steam StatIon : 14 ft- 66 ' ft• ReclYellow Brown Silty Sand . •
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Facility/Owner Nan* •" : . - '' • Facility Itli)Of applicable) 66 !!" 135:p' ft kp* .Grielsa ' fit t,.,7 t.,1 ilL., e1, 1--.i j
3195.Pine Hall ROad,.-Belews Creek, NC 27009 . .ft , ft ' • 1 • ,
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Physical Address City and Zip - •'•7: :1,• ••. .: ' - . ft ft SEP 1 20?4
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Stokes -..• --.•' • ._....... • : . ". ,21 RENIARK.S.,, .. . .... -' irift.,....g.........::r:.,, .,,,,:.,......:4.:.,.:,,,f„uak
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County Parcel Identification No (PIN)
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.r,.., ,,. BENTONITE SEAL-99 7 to 105 aft ' OWC140G
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):, '. .':11111frilgtog Depths(Ex Teiiiiieition)Ariormdriliked to Nearest Foot
5b..LatiindenndiOngitydein'degrees/ininnteaisecnnds or decipiat.oegOes: •' ' '• ' -.'"..-:'- .- ' .. • ... . .. ,
(if well vfield,one lei/long is sufficient) r' % 22.Certification:, - • • ."-''ii
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' ••,':': 36.2646, . '- '''• '' .: ' 80.0606'. . . . • . , , . - , - , . ,
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' ''!' '' • -:--,.• • ..,,.. ' .... ' t,,....g.-1.:1..., ,.,.•., .
-• -. I! , . "-.1...0Pff- -,. . I•
6 Is(are)re)the inPerManent or DTemporary'" • ..Signature of CcrtipeclWell Contractor ' Date
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Bysigtiing this forin;ihereby certify thalihdiVell(s);was(were)constructed in accordance ividt' . .
7.Is this a repair to an existing well 1:Y4' or It No • 15A NCAC 02C.0160 or ISA NCAC 02C.0200 Well Construction Standards and that a copy
If this t4 repair fill out known ivell construction information and explain the nature of the of this record has been provided to the well triter.
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repair under#21 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
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canstruction,only I 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' . • -.. ' .. .. - • 'll.
24 SUBMITTAL INSTRUCTIONS"Ii• ' ' : .• ' ..
9.Total well depth below la 135:9 land surface: - -
For multiple ivells list all depths((different(example-'3@,200 an 2@' d' l00'). • (ft) Submit this GW:1 within 30.days of!Ve'll completion per the following:
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• . 24a..For All Wells:..Original_form tb Division of Water Resources (DWR),, , •
• •• .10."'Sintic Water'CVO&lois;top of casing: (ft') Information.Processing Unit,1617 MSC,Raleigh;NC 27699-1617
If water!eye!is above casing.use"+" • t I ' .
'. 8 nomInal(0-69 ft) . • 24b„For•Injection Wells:Copy to DWR,Underground Injection Control (IUC)
11.Borehole diameter: ,4
6.5 seminal(68-135.911) -(in.)
. '' PrOgrani,'1636 MSC Raleigh NC 27699-1636 1 ,
Down The Hole (DTH)'Hammer .. I, 1
12.Well construction method: _ . . ' • 24c.For Water Supply and Open4,odp Geothermal Return Wells:Copy to the
(i.e.auger;retary,•cable,direct push,etc.) county environmental health department of the countyWhere installed
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FOR WATER SUPPLY WELLS ONLY: l'24d.For Water Wells produang over 100,000:GPO: Copy to DWR,CCPCUA '
• Permit PrOgram•1"61-1 MSC;Roleigh,,NG2769941611
I3a.Yield(gpin) , _ _ Method of test: •
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13b.Disinfection type: , , Amount: .
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-' om.i""d‘v-i''•: -• - • Worth Carolina Department of EnVirontrientaNuality-Division'of Water ResOurces • . - Revised 6-6-2018
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