GW1--05578_Well Construction - GW1_20240913

' WELL CONSTRUCTION RECORD(GW-1) - For Internal Use Only:
J.Well Contractor information: ' • '
Eddie Thomas (Brian) . ' •14.WATER ZONES
Well Contrnctor Name' - •
FROM ,,, • 2 TO DESCRIPTION' .. . ... -•
R ft.
• 2581-A fr.
NC Well.Contractor•Certification Number . 15.OUTER CASING(for multi-cased wells)OR LINER(if ap licable)
FROM , TO -DIAMETERI I THICKNESS ' MATERIAL
Geologic Exploration, Inc. ".-
ft;
Company Name I. .I.
r . ' 16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#• .. • FROM. • TO :-• DIAMETER` '!• THICKNESS" 'MATERIAL ,
List all applicable nell construction permits(i.e.UIC,County,State,Variance,etc.) :CO..0ft 170,0 ft- 2''' 1O•• SCH 40 PVC
3.Well Use:(check well use)• 190 0.'ft 195:3 ft• 2 ;''n'. SCH 40 PVC ' ' ; •
-
Water SupPy 1 Well: • 17.SCREEN
' 'FROM " TO'-::- DIAMETER :' SLOT SIZE THICKNESS , MATERIAL'
❑Agricultural. OMunicipal/Public ,170.0 ff 190'.0 ft, '2 ,,0.010•inch SCH 40 • . PVC.
❑Geothermal•(Heating/Cooling Supply) OResidential Water Supply(single)., •.ft:" ft. - in . .
Dlndustrial/Commercial OResidential Water Supply(shared) 18.GROUT •
Olrrigation DWells>100,000 GPD • FROM TO-: MATERIAL EMPLACEMENT METHOD&AMOUNT
•
Non-.Water Supply Well:' 0,0, ft• 158,5' ft• Portland.Bentonite Tremie', - .
':ClMonitoring. ❑Recovery. ft. ' f• t.' •,
' Injection Well:
ft. it. .iF
OAquifer Recharge', OGroundwater,Remediation .
OF applicable)
• ❑Aquifer Storage and Recovery_ ❑Salinity Barrier FROM T".TO 's MATERIAL' ' EMPLACEMENT.METHOD ,
, DAquiferTest ❑StormwaterDrainage :164:4 ft• ' 166.3 ft, SecondaryiFilter(GP#1) Gravity/Pour
❑Experimental Technology ❑Subsidence Control 166:3 -ft 195:9. . ft' Pnmary Filter(GP#2) Gravity/Pouf'. '
❑Geothermal(Closed Loop) ❑Tracer ' 20:DRILLING.LOG(attach additional sheets if necessary) • '
' •
.FROM-' "TO-' • ',DESCRIPTION(color;hardness,sail/rock type,grain sire,etc.)
❑Geothermal(Heating/Cooling Return), . OOther:(explain under#21 Remarks) f
0 t 3,: ft. Red Lean•Clay
08/13%2024', D.W 3 ' .. ft fi.
: • • '4.Date Well(s)Completed. • r Well ID# 3 . 16 . Yellow Red Sandy Silt,
.5a.'Well Location: , - •, - 16•• ft " 49 _ft,. Yellow,Brown Gray Silty Sand -
Belews Creek Steam Station 49 rt 195.9 ft Rock Gneiss f i' —'
Facility/Owner Name Facility (if applicable)" ft. • ft. • a..'L.,"L y�'.a'
.- gym
3195 Pine Hall Road; Belews-Creek,NC 27009 ' ft ft.
,Physical Address,City,•and Zip • ft ft.; t� .20C '
.Stokes • • , 21 REMARKS
fik lIi i t nil 3.:-.,�.
County ,„ Parcel ldentificahon No:•(PIN) BENTONITE SEAL ..158.5 to 164 4�it`1 La'BOG am`
. Drllling.Log'Depths(Except Termination)Approximated to Nearest Foot
Sb:Latitude and longitude:in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/loog is suffeient) • - • •.• ' . 22.Certification ' T.'
'. 36'2810 '-•.N 80 0523-' ' " . W', • //}�
Signatureiof Certified:Well Contractor' r,• Date '
6.Is(are)the well(s): m InPeranent or .OTem
, porary j+
By sighing this form 7 hereby certifr!Partin!well(s)'it,as(were)constructed in accordance with.
, 7.Is;this a repair to an existing well: DYes or 0No i5A NCAC 02C.0100 or 15A NCAC.02C::0200 1'ell Construction Standards and that a copy
If!his is a repair,fill outknotirn well construction information and explain the nature of the of this record has been provided to the arell owner.'
repair under i121 remarks section or on the back of this form. - . "'. 1' - - '
23 Site diagram or additional wellidetailss`•• ;
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to.provide additional well constructioh'info
construction,only 1'GW-1.:is needed. Indicate-TOTAL NUMBER of wells (add'See Oyer''in Remarks Box) You`may also attach additional pages if necessary
drilled: 24:SUBMITTAL INSTRUCTIONS ,•
• 9.Total well'depth below land surface: 195,9
Forin-dnpM wells list all depths ifdieerent(example- tt 3 200'and 2@100') Submit this GW-1 within 30 days of well completion per the following: .
24a. or All Wells: Ori oral for I�-.to Division•of Water Resources DWR
10.Static water level below top of casing: (ft.) Tor Information Processing Unit, 1617 MSC,Raleigh,NC 27699-1617
Ifwater•.level is above casing,use"+" �'
a nominal(0;50 it) ., 241i. For Injection-Wells: Copy toIDWR,Underground Injection Control-(IUC)
ll.BoreholediaMeter: s5 nominal(50-195.9a) 1 in Program,1636 MSC Raleigh NC 27699 1636 ''
'' `Down The Hole (DTH) Hammer - ' ': it, -' "
12.Well construction method 24c.For Water Supply,and Open-Loop Geothermal Return Wells:Copy to the
(i.e.auger ramry,cable directpush 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
• - ° PermitPrograin;1;6f1 MSC;Raleigh;NC'27699-1611 ' -
13a.Yield(gpm) ,Method of test: • i
,13b.Disinfection type: Amount:. - • '
Flinty GW-1 ' - "' ' North Carolina Depaifin enrol'Envirei iiiental9Zuality'DiSision of Water Resodices - - . - Revised 6:6 2018 '