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Home My WebLink AboutGW1-2021-00196_Well Construction - GW1_20210505 a. WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only: 1.Well Contractor Intor lion: %=14::WA1'ER-ZONES. "=;. .. ,.,;�i _� �, ��.� �7,77777 Well Contractor Name ? FROM TO DESCRWRON 22 r p r, v 202 5 ,oft S"' / ft 2 M yJl7� 1v1y1 l?'y, ft. R NC Well Contractor Certification Number 15.iOUTER-CASING formul&4:'sed'we16 ORLINER If - (/ FROM To D THN3INFSS MATERIAL y ft ft in. g G a(Va d Company Name 1&INNER GASING OR TUBING ttiernui dose8-i ,s .,_r.. 2.Well Construction Permit#: I J 7 ! 70 20 FROM TO DIAMETER I TINC 0MS I MATERIAL List all applicable well construction permits(i.e.UIC,County,State,Variance,etc) & R 3.Well Use(check well use): ft ft in. Water Supply Well: FROM TO DIAMETER SLOT SIZE I THICTfl+MS I MATERIAL Agricultural [3Municipal/Public 0 ft. ft. Geothermal(Heating/Cooling Supply) residential Water Supply(single) ft & in. Industrial/Commercial Residential Water Supply(shared) a8.:GROUT >... Irrigation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT Non-Water Supply Well: 6 & 2-0 ft. U Monitoring ORecovery ft ft Injection Well: ft ft Aquifer Recharge 13Groundwater Remediation Aquifer Storage and Recovery 13Salinity Barrier FROM TO MATERIAL I EMPLACEMENT METHOD Aquifer Test []Stonnwater Drainage & ft Experimental Technology D Subsidence Control ft ft _ Geothermal(Closed Loop) Tracer -;20 10D ING LOG fattach idditi nil!sfiei3ts'if Geothermal(Heating/Cooling Return) ,Other(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness,soil/reck im grain sim etc. ft S'o ft 4.Date Well(s)Completed: 21 �(/ Well II)1# ft- 61 ft- 0. 5a.Wellll Location: w ft � — ft61,74 e LI JGG I y(C�r ft ft Facility/Owner Name i Facility ID#(if applicable) ft ft W2��' &u r wade ��esf ft ft Physical Address,City,and Zip & ft 21:REMARKS . �. County Parcel Identification No.(PIN) ardFLI 1 1 P_ 5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: (ifwell field,one lat/long is sufficient) 22.Certificati n: N W l 6.Is(are)the well(s)OPermanent or 13Temporary Signature ofCertified Well Contractor Date By signing this form,I hereby certify that the well(s)was(were)constructed in accordance 7.Is this a repair to an existing well: 13Yes or /2 No with 15A NCAC 02C.0100 oro15A NCAC 02C.0200 Well Construction Standards and that a If this is a repair,fill out known well construction information and explain the nature of the copy of this record has been provided to the well owner. 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 toprovide additional well site details or well construction,only I GW-I is needed. Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if necessary. drilled: SUBMITTAL INSTRUCTIONS 9.Total well depth below land surface: (ft) 24a. For All Wells: Submit this foIin within 30 days of completion of well For multiple wells list all depths ifdifferent(example-3@2000'and 2@1001) construction to the following: f 10.Static water level below top of casing: 6✓ {t ( ) Division of Water Resources,Information Processing Unit, Ifwater level is above casing,use /+ 1617 Mail Service Center,Raleigh,NC 27699-1617 11.Borehole diameter: 6 (in.) 24b.For Iniection Wells: In addition to sending the form to the address in 24a 12.Well construction method, �/ c{(^Y above,also submit one copy of this form within 30 days of completion of well(i.e.auger,rotary,cable,direct push,etc.) construction to the following: Division of Water Resources,Underground Injection Control Program, FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636 13s.Yield(gpm)�< Method of test: 0 i 24c.For Water Supply&Injection Wells: In addition to sending the form to p the address(es) above, also submit one copy of this form within 30 days of 13b.Disinfection type: Amount: D completion of well construction to the county health department of the county where constructed. Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016 WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only: 1.Well Contractor Information: h JOHNNY BURR 14.WATER ZONES Well Contractor Name gam' - ' �; FROM TO DESCRIPTION y rt. ft. A - 3098 p V 21 it. it NC Well Contractor Certification Number `��,y 1 f� J �O 15..OUTER CASING(tor multi-cased wells)OR LINER(if applicable) GEOLOGIC EXPLORATION ,,f,, ,�.-J t:)',�i FROM TO DIAMETER THICKNESS MATERIAL ft. ft. in. Company Name ii1Ui, nnr't;0'il 16.INNER CASING OR TUBING eothermal closed-loo 2.Well Construction Permit#: FROM TO DIAMETER THICKNESS I MATERIAL List all applicable well construction permits(i.e.UIC,County,State,Variance,etc) 0.0 ft. 10.0 ft. 2.0 in. SCH 40 PVC 3.Well Use(check well use): fL ft. in. 17.SCREEN Water Supply Well: FROM TO DIAMETER I SLOT SIZE THICKNESS MATERIAL ❑Agricultural ❑Municipal/Public 10.0 ft' 20.0 ft. 2.0 in., .010 SCH 40 PVC ❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft ft. in.! ❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT. ❑hri ation ❑Wells>100,000 GPD FROM TO MATERIAL. EMPLACEMENT METHOD&AMOUNT Non-Water Supply Well: 0.0 IL 6.0 it' PORTIAND 9ENTONITE SLURRY 19Monitoring ❑Recovery Injection Well: ft. it. ❑Aquifer Recharge. ❑Groundwater Remediation 19.SAND/GRAVEL PACK if a 1icablc ❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD ❑Aquifer Test ❑StormwaterDrainage 8.0 IL 20.0 It 20-40 FINE SILICA SAND ❑Experimental Technology ❑Subsidence Control ❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG'attach additional sheets if necessary) - ❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) FROM TO DESCRIPTIONcolor,hardness s7rock e rain size,etc. 0.0 II• 1.0 It ASPHALT 4.Date Well(s)Completed: 03/31/21 well ID# MW-16R 1.0 II• 7.0 It. RED/ORANGE CLAY 5a.Well Location: 7.0 ft 20.0 It. RED/BROWN SILT SPEEDWAY - 6983 rt. ft Facility/Owner Name Facility ID#(if applicable) 850 CAPITAL BLVD RALEIGH 27603 Physical Address,City,and Zip fL ft. WAKE 21.REMARKS County Parcel Identification No.(PIN) BENTONITESEAL- 6.0-8.0 FEET 5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: (if well field,one)at/long is sufficient) 22.Certification: 350 47' 32.76" N 780 38' 30.01" 04/01/21 6.Is(are)the well(s): NPermanent or ❑Temporary Signature of Certified Well Contractor Date By signing this farm,I hereby certify that the well(s)was(were)constructed in accordance with 7.Is this a repair to an existing well: ❑Yes or l!9No 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy Ifthis 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#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 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: 20.0 (ft.) Submit this GW-1 within 30 days of well completion per the following: For multiple wells list all depths if different(example-3@200'and 2@700� ) 12.0 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 11.Borehole diameter: $.0 (in.) 24b.For Injection Wells: Copy to DWR,Underground Injection Control(IUC) � AUGER Program,1636 MSC,Raleigh,NC 276994636 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 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: Amount: i Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources!. Revised 6-6-2018 WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only: 1.Well Contractor Information: jOHNNY BURR . 14.WATER ZONES Well Contractor Name FROM TO DESCRIPTION �`�k'� A - 3098d � + rt. ra NC Well Contractor Certification Number !s n 2�21 5.OUTER CASING(for multi-cased we0s OR LINER(ir a licsble) GEOLOGIC EXPLORATION �c t,� u l OM TO DIAMETER THICKNESS � MATERIAL 7lnt � � ft. tt. in. Company Name -C:rTC1, �'�'TC.rarY;On 16.INNER CASING OR TUBING eothermal 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. 9.0 ft. 2.0 in. SCH 40 PVC 3.Well Use(check well use): ft ft in. Water Supply Well: M SCREEN FROM TO ]DIAMETER. :SLOT SIZE THICKNESS MATERIAL. ❑Agricultural ❑Municipal/Public 9.0 It' 19.0 ft. 2.6 in., .010'f SCH 40 PVC ❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft ft in.t ❑Industrial/Commercial ❑Residential Water Supply(shared) I 18.GROUT ❑hTi ation. ❑Wells>100,000 GPD, FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT Non-Water Supply Well: 0.0 It• 5.0 It' PORTIAND SENTONITE SLURRY OMonitoring ❑Recovery ft ft Injection Well: - ft. ft ❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK if s 'licable ❑Aquifer Storage and Recovery ❑Salinity Barrier FROM To MATERIAL EMPLACEMENT METHOD ❑Aquifer Test ❑StormwaterDrainage 7.0 IL 19.0 ft. 20-40 FINE SILICA SAND ❑Experimental Technology ❑Subsidence Control ft.. ft. ❑Geothermal(Closed Loop) OTracer 20.DRILLING LOG'attach additional sheets if necessary) FROM TO I DESCREPTION color,hardness soil/rock Type,grain size etc. ❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) 0.0 ft. 1.0 It ASPHALT 4.Date Well(s)Completed: 03/31/21 ileum# MW-17R 1.0 It• 8.0 rt. RED/ORANGE CLAY 5a.Well Location: 8.0 ft- 19.0 ft. RED/BROWN SILT SPEEDWAY - 6983 ft ft Facility/Owner Name Facility ID#(if applicable) 850 CAPITAL BLVD RALEIGH 27603 Physical Address,City,and Zip ft. ft WAKE 21.REMARKS County Parcel Identification No.(PIN) BENTONITE'SEAL- 5.0 7.0 FEET 5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: (if well field,one lat/long is sufficient) 22.Certification: 350 47' 32.76" N 78" 38' 30.01" W ', `� 04/01/21 6.Is(are)the well(s): I!gPermanent 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 T9No 15A NCAC 02C.0100 or ISA NCAC 02C.0200 Well Construction Standards and that a copy Ifthis 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#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 into construction,only 1 GW-I 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: 19.0 (ft.) For multiple wells list all depths if different(example-3@200'and 1@100D Submit this GW-1 within 30 days'vf well completion per the following: 14.0 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 IL Borehole diameter: 8.0 (in.) 24b.For Injection Wells: Copy to DWR,Underground Injection Control(TUC) Program,1636 MSC,Raleigh,NC 27699-1636 12.Well construction method: AUGER 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 13a.Yield(gpm) Method of test: Permit Program,1611 MSC,Raleigh,NC 27699-1611 13b.Disinfection type: Amount: i Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources: Revised 6-6-2018 I i I i 409 Rogers View Court Raleigh,NC 27610 Mid Atlantic office9:9.250.9918 Engineering&Environmental Solutions facsimile 99.250.0950 MAAONLINE.COM April 26, 2021 Division of Water Quality Information Processing Unit 1617 Mail Service Center .Raleigh, NC 27699-1617 Subject: WELL CONSTRUCTION RECORDS SPEEDWAY 6983— CITY OF RALEIGH PROPERTY 1027 N. WEST STREET RALEIGH, NC 27603 (PIN #1704528222) MID-ATLANTIC JOB NO. R0730.33A To Whom It May Concern: On behalf of Speedway LLC, please find the enclosed GW-1 forms for two monitoring wells constructed at this site on April 1, 2021. This work was conducted under NCDEQ Permit WM0501428, issued on March 4, 2021. Thank you. Sincerely, MID-ATLANTIC ASSOCIATES, INC. ova S � Raymond S. Marchant, III, PG Principal Geologist Enclosures: GW-1 forms, MW-16R and MW-17R EXPERIENCED CUSTOMER FOCUSED INNOVATIVE 1 j