GW1--05577_Well Construction - GW1_20240913

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
Eddie Thomas (Brian) 14.WATER ZONES ,
Well Contractor Name FROM TO DESCRIPTION
ft. ft.
2581-A e. ft. I
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells)OR LINER(if ap licable)
Geologic Exploration, Inc. FROM TO DIAMETER I THICKNESS MATERIAL
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.UIC,County,State,Variance,etc.) 0.0 ft• 117.0 ft• 2 •n' SCH 40 PVC
3.Well Use(check well use): 137.0_ft• 142.3 ft.. 2 •n•
' SCH 40 PVC
Water Su 1 Well: • 17.SCREEN
pP y .FROM • TO '."DIAMETER SLOT SIZE THICKNESS •MATERIAL _
❑Agricultural ❑Municipal/Public 117.0 ft' 137.0 ft• 2 '•n'• 0.010 inch SCH 40 PVC
•
OGeothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) • fit. ft. in. '
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Irrigation ❑Wells>100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0.0, ft. .103.7 ft., Portland Bentonite Tremie
OMonitoring ❑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 .,MATERIAL' - -EMPLACEMENT METHOD
: ❑Aquifer Test clStormwater Drainage 111.9'ft• 114.1 ft• Secondary Filter(GP#1) Gravity/Pour
' ❑Experimental Technology OStibsidence Control 114.1 ft• 143.8 ft• Primary Filter(GP#2) Gravity/Pour ,
❑Geothermal(Closed Loop) ❑Tracer ' , 20.DRILLING LOG(attach additional sheets if necessary)
.FROM '. TO -- ' DESCRIPTION(color,hardness,soiilrock type,grain size,etc.)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) -••
•• 0 ft• 6 ft• Red Silty
4,Date Neils)Completed: 08/19/2024 Well ID# • ..4 6 ft• 11 ft• Red Brown Sandi Silt • '
Sa.Well Location:•
11 ft•, 68:. ,- ft' Multicolored Silty Sand '
•
Belews Creek Steam Station 68 .ft• : 143.8 ft• Rock-Gneiss I Schist ;-, ,�•_,; ,
Facility/Owner Name • Facility ID#(if applicable) ft. ft. . A ,k,.e L.s; ; '1.s:l
3195 Pine Hall Road, Belevirs,Creek; NC 27009 ft. ft. ;SEP `' (J
Physical Address,City,and Zip • ' ft. ft. �'+��
I. Stokes 21.REMARKS • ' Iflfyi .,i ?r.r.t..:_ u
nX
BENTONITE SEAL-103.7 to 111.9 ft D"A CAA s
County Parcel IdentificatiOnNo.(PIN) -
Drilling Log'Depths(Except Termination)Approximated 4o Nearest Foot „
• 5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
- ' (if well field,one lat/long is sufficient) ' ' '22.Certification: - • ' "
36.2806 N 80:0483 w r 1 -( 1
6.Is(are)the well(s): InPermanent 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 •ItNo !SA NCAC 02C.0100 or!SA NCAC 02C.0200 Vell Construction Standards and drat a copy
If this is a repair;fill out known well construction it formation and explain the nature of the of this record has been provided to the well lowner-
repair under ff.?!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 is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box.You may also attach additional pages if necessary.
drilled: _ 24,-SUBMITTAL INSTRUCTIONS,"
9.Total well depth below land surface: 143.8 (ft.) Submit this GW-1 within 30 days of well completionper the following:
For multiple wells list all depi/ts if different(example-3t200'and 2@!00') y p
'67,6 ' - • 24a. For. AU 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"+"
a nominal(0-7 ft) 24b.For Injection Wells: Copy to DWR,Underground,Injection Control(IUC)
p5
11.Borehole diameter: 6.5 nominal 143.e a) (in.) Program,1636 MSC;Raleigh,NC 27699-1636
12.Well construction method: DoWn The Hole (DTH) Hammer ' ' i
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 Pregram,.16 h1"MSC,-Raleigh,NC'27699-1611 '
13a.Yield(gpm) Method of test: •
I
13b.Disinfection type: Amount:
•
' • Form GW-1 • North Carolina Department of Environmental Quality-Di'isieii of Water Resources i Revised 6-6-2018