GW1--05575_Well Construction - GW1_20240913

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only: I '
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1.Well Contractor Information: I
Eddie Thomas (Brian) Lt.WATER ZONES
Well Contractor Name . .FROM 'TO: . . DESCRIPTION
' ft. ft. 1
2581-A ft. ft.
I .i .
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells)OR LINER(if ap licable)
Geologic Exploration, Inc. FROM TO DIAMETER ' THICKNESS .' MATERIAL
- ft. ft. i`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.U/C,County.State,Variance,etc) 0.0 ft• 170.0 ft• 2 • in' SCH 40 PVC
3.Well Use(check well use): 190.0 ft• 195.3 fa 2 , 'n', SCH 40 PVC • .
Water Supply Well: 17.SCREEN
pp y FROM TO , DIAMETER SLOT SIZE THICKNESS • MATERIAL
❑Agricultural ❑Municipal/Public ', 170.011 190.0 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) Is.GROUT
❑Irrigation ❑Wells>100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0.0 ft• 159.3 ft• Portland Bentonite Tremie
nMonitoriiig EJRecovery ft. ft. . .' ,
Injection Well: .
ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation - -
19.SAND/GRAVEL PACK(if applicable)
DAquifer Storage and Recovery ❑Salinity Barrier ..FROM TO MATERIAL' • EMPLACEMENT METHOD _"
❑Aquifer Test • ❑Stormwater Drainage 164,9 ft• ,166.4 • ft• Secondary Filter(GP#1) Gravity/Pour ,
❑Experimental Technology []Subsidence Control 166.4 ft• 195.8 ,ft• Primary Filter(GP#2) Gravity/Pour ,
❑Geothermal(Closed Loci)) ❑Tracer . 20.DRiLLiNG'LOG(attach additional sheets if necessary)
FROM .. TO ' DESCRIPTION(color,hardness,soil/rock type,grain size,etc.)
❑Geothermal(Heating/Cooling Return)_ '[]Other(explain under#21.Remarks) •
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0 ft. 4, ft• 'Brown.Red Sandy Silt , ,
- 4.Date•Well(s)Completed: 07/03I2024 Well ID# DW.S • 4 ft• 30 ' ft• Red Brown Gray Silty Sand '
5a.Well Location: 30 ft• 195.8 'ft• Rock-Gneiss ' ,
Belews Creek Steam Station ft. ft. . i.4 .� _
Facility/Owner Name Facility ID#(if applicable) • ft.' ft. I `�f = � .=y ,
3195 Pine,Hall Road, Belevirs Creek, NC 27009 ft. ft. SEA a® (°°°�
Physical Address,City,and Zip ' ' ft. . ft. . �OLT
Stokes 21.REMARKS ,ir,`z • ^ti a -v.•-,y UN,
County. :'' Parcel Identification No.(PIN) '
• BENTONITE SEAL-159 3 to 164 9 ft DV CI _vie
Drilling Log Depths(Except Termination)Approximated to Nearest Foot
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
. - (if well field,one lat/long is sufficient) . 22.Certification: t
36.2723 N •80.0568 ' W i.„ :• .�C.- .•
`( G'I
•
6.Is(are)the"well(s): i lPermanene or ❑Temporary SignattireofCertifiied Well Contractor'' ate
By signing this fortn,L hereby certify that the well(s)was(x•ere)-constructed in accordance with
7.is this a repair to an existing well: ❑Yes or IJNo 15A NCAC 02C.0100 or i5A NCAC 02C.f1200 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,t 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
construction,only 1 GW-1 isneeded. Indicate'TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach additional pages if necessary.
drilled:1 ' ' 24.SUBMITTAL INSTRUCTIONS
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9.Total well depth below land surface: 195.8. (ft.) •
Submit this GW-1 within 30 days of well completion per the following: .
For multiple smells list all depths if different(example-3 , 00'and 2@100')
-'.69.8 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• .
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a nominal(o-a6o) 24b. For Injection Wells: Copy to pWR,Underground Injection Control(IUC)
1 I.Borehole diameter: ss nommar(aatss.a e> (in.) Program,1636 MSC,Raleigh,NC 27699-1636
Down The Hole (DTH) Hammer 'I.
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12.Well construction method: 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 • '
l FOR WATER SUPPLY WELLS ONLY:
24d.For Water Wells producing over,L00,000 GPD: Copy to DWR,CCPCUA
Permit Program,1611 MSC,Raleigh,NC 27699-1611
13a.Yield(gpm) Method of test:
13ti.Disinfection type:. Amount: ,
Form GW-1 North Carolina D"epartinent of Envirotimenial Quality-Division of Water Resources Revised 6-6-2018 '
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