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Home My WebLink AboutGW1--07015_Well Construction - GW1_20231102 WELL CONSTRUCTION RECORD GW-1 For Internal Use Only: I.Well Contractor Information: Ist):lI;d•-w% ,t i L €r l Well Contractor Name 14•WATER ZONES rJ {� FROM TO DESCRIPTION 7!> /'1 ft. ft. NC Well Contractor Certification Number ft. ft. J r 15.OUTER CASING(for multi-cased wells)OR LINER(if a Reside) >{�Ili.fC CV�e •UI"/ /[/eta FROM I TO DIAMETER I THICKNESS MATERIAL Company Name ft. I it. I in. l 2.Well Construction Permit#: A [ILL'1/� r 16.INNER CASING OR TUBING(geothermal closed-loop) -•t 5:-' FROM TO DIAMETER THICKNESS List all applicable well construction permits(i.e.UIC.County,State,Variance,etc.) n. ft. in MATEWAL PerfiAln IA)0., Y e et 3.Well Use(check well use): ft, ft. In. -" Water Supply Well: 17.SCREEN FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL °A6nicultltral ❑Municipal/Public ❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply ft ft. In. ❑Industrial/Commercial pp y(single) n rt. in ❑Residential Water Supply(shared) ❑peel:anion la.GROUT ❑Wells>100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&A1110UNT- Non-Water Supply Well: ft. R. ❑Monitoring ❑Recovery •Injection Well: /'` ft. rt. Recharge 1 (1 ndwnter Remediation II. rt. • ❑Aquifer Storage and Recovery ❑Salinity Barrier 1 199.M ND/GRAVEL PACK(if applicable) °Aquifer Test TO MATERIAL EMPLACEMENT METHOD °Stormwater Drainage • ft. ft. ❑Experimental Technology ❑Subsidence Control ft. ft. ❑Geothermal(Closed Loop) solUn ❑Tracer 20.DRILLING LOG(attach additional sheets if necessary) ' °Geothermal(Heating/Cooling Return) fill er(explain under#2I Remarks) FROM TO DESCRIPTION(robe,bardaess xk " hyper grain size.etc.) 4.Date Well(s)Completed:/0 '/ `2.3 Well I D# d ft. 2 S. •/te r/):hie./5 r of s� 1 C 1 ec I ._ 9 2s rt. 5a.Well Location: • �/(i`'$u nr Z S ra/t,S. n• ft. /Mc o,ve r�C1J1oua ,efs SyerEwiL Side ,y,'A 0z76Y5199g a. rt. _ Facility/Owner Name Facility ID#(if applicable) ft. ft. 2/'7 teiev e /31 4 t eti50.i v' lieu 2 a'S yG r• rt. NOV J 2 '(123 - Physical Address.City,and Zip ft. ft. ONS10 a' 1/3 del ad 10g18 21.1.REMARKS • County Parcel Identification No.(PIN) / 'Ulf;"l f4.J'.7 L)etj• W if � ut�C 7f'i is../ G 5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: see'*,';��1 edsc.herno.E-t L for Cur s sIrot f-40I"�elLL i is (if well field,one tat/long is sufficient) y. 1 �D D 22.Cert(ficatign: N - 7'7 36d100 ' 6.Is(are)the well(s): Il ermanent or ❑Temporary Signature otCenificd Well ontmctor Date ul u �� 7.Is this a repair to an existing well: DYes or �o By signing this form,I hereby certif•Ih .r)nos(Were)constructed in accordance with ISA NCAC CZC.0100 or ISA NCAC 02C'.0200 Well Construction Standard.,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#21 remarks section or on the bark of this form. 23.Site diagram or additional well details: 8.For Geoprobe/DP1'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-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: (ft.) For multiple well.,list all depth,.if different(example-J@200'and 2@lof7 Submit this GW-1 within 30 days of well completion per the following: 10.Static water level below top of casing: /6 (ft) 24a. For All Wells: Original form to Division of Water Resources (DWR), IJ'rvater level is above casing,use"(' Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617 11.Borehole diameter: t� (In.) 24b. For Injection Wells:Copy to DWR,Underground Injection Control(IIJC) /{� Program,1636 MSC,Raleigh,NC 27699-1636 12.Well construction method: /{[?t0.Saw/4 (i.e.auger,rotary,cable,direct push,etc.) 24c.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the 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: ADiount: i Form OW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6.'01R 111111.0 R Multi-Phase Extraction Well Revision#: 0 TERRATHERM GrrnrYnli•ip-�q Construction Detail Release date:_5/12/23_ Approved by: SL_ Well ID M-9 Date 0 ! 16, '3 JIP Oversight i M t • Job# R23-104 Driller t r b - 5 / 'i" /-'7 (' 7 Design Constructed Notes AO (fill et f Well Diameter different) Borehole Diameter MEE, ----Stick Up Height 36" • Ground Surface 0.0' HT Grout------- Angle from Horizontal 90° Top of#00 Sand 1' Casing Material Carbon Steel __ Top of Screen 3' Other: I —' Riser Length 6 ` Screen Length 47 Bags of#00 Sand 30.75 Bags of Cement 1.25 _ - Bags of Silica 0.5 Screen Material Stainless Steel "—" Borehole Diameter 8" Fiberglass PVC "—"—' Other: Slot Size 10 Bottom of Sand 50' Bottom of Screen 50' lotion Method ` oni HT Grout--- Ho Ow Stem Auger Sump Length 2' Mud Rotary Other: Bottom of Sump ..-----r' Bottom of Borehole 52' Post-Installation QC(to be performed 24hrs after installation) PID Log:Make/Model: 1)Confirm well is free of grout Design Constructed Time: 0'3 " ,'5 Reading: 0- .1. PPM Depth to bottom of well[ft bTOC]: cc' Time: D ," p c. Reading: U- /... PPM if greater than or equal to ift less than designed alert the office Time: Reading: PPM 2)Confirm grout plug reaches ground surface Time: Reading: PPM repeat daily until depth to grout is Oft bgs Time: Reading: PPM Date Depth to Grout[ft bgs] Notes: