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Home My WebLink AboutGW1--07031_Well Construction - GW1_20231102 WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only: 1.Well Contractor Information: blXii1a-.M.0t111 er1�/ t W.WATER ZONES Well Contractor Name FROM TO DESCRIPTION 3 8 76 A H. H. NC Well Contractor Certification Number ft. ft, IS.OUTER CASING(for multi-eased wells)OR LINER(if a (cable) C a•�'C t1.ei e ,)r/ it,s/_9 FROM 1 I TO I DIAMETER THICKNESS MATERIAL. Company Name IL H. ht. I n/jA ��,L n 16.INNER CASING OR TUBING(geothermal closed-loop) 2.Well Construction Permit#:rrs�n( # 'S f e FROM TO DIAMETER List all applicable well construction pe its(i.e.UK'.County,Slate,Variance,etc.) ft. ft. in. THICKNESS MATERIAL 3.Well Use(check well use): Pe efts/ /.•1 id B`: r e etc.), _ it ft. In. Water Supply Well: 17.SCREEN ❑Agricultlual FROM TO DIAMETER SLOT SIZE THICKNE,cs MATERIAL OMunicipal/Public ft. D. In. ❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑lndustrial/Commercial H• H. In. ❑Residential Water Supply(shared) 1&GROUT❑irrigation ❑Wells>100,000 GPD FROM TO MATERIAL' EMPLACEMENT METHOD&AMOUNT Non-Water Supply Well: ft. ft. ❑Monitoring °Recovery • Injection Well: ft. ft. ❑Aquifer Recharge i i ougdwnter Remediation H. ft. ❑Aquifer Storage and Recovery OSalinity Barrier 19.SAND/GRAVEL PACK(if applicable) FROM TO MATERIAL EMPLACEMENT METHOD ❑Aquifer Test OStormwater Drainage • ft. ft. ❑Experimental Technology °Subsidence Control ft. ft. ❑Geothermal(Closed Loop) °Tracer 20.DRILLING LOG(attach additional sheets if necessary) °Geothermal(Heating/Cooling Return) they FROM TO under#21 Remarks) FRO TO DESCRIPTION(color,hardness,soWrock type,grain she,etc.j^ yy�� (� D tl. 2 S H ,11"44 td®-e4 r of siwvd d-c1 ooi 4.Date Well(s)Completed:/ti q) -- Well ID# 7 II 5a.Well Location: H, H. - Me. ®,veJ1ourCj%,ens Siei-Ri,,J S'ie .4(cb 0vyg99Y IL H Facility/Owner Name Facility lOt(if applicable) ft. ft. N O V J G 20 Z 3 _- 2 12:7 Zieus.e i31$14T rrt5,,4✓.-,/e1 2S'S y‘ ft. ft. -- Physical Address.City,and Zip H. ft. ' ON-3 10 U.) 2/3 91/301178I 8 21.REMARKS - County Parcel Identification No. PiN T r..pc:..v'Eitr•e ooteA PrfsSor- /5 f 5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: Stet° 1,0'lf'4 eitch'ei't'r o.'f-i c.for e a..sfrohC 1'+a AS rJ heir,i IS (if well field,one Iat/long is sufficient) �7 f 22.Certification: 3`I- / l /L,,0 N ' 77, 3 `6 Oo W 6.is(are)the well(s): rmanent or ❑Temporary Signature of Certified Well Contractor L�� Date By signing this form,1 hereby certi�•that the we//(s)was(were)constructed in accordance with 7.Is this a repair to an existing well: ❑Yes or [I 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy If this is a repair,/ill out known well construction information and explain the nature of the of this record has been provided to the ue/l otHrer.. repair under R21 remarks section or on the hark of this form. 23.Site diagram or additional well details: You may use the back of this page to provide additional well construction info R.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same (add'See Over'in Remarks Box).You may also attach additional pages if necessary. construction,only 1 GW-I is needed. Indicate TOTAL NUMBER of wells drilled: / 24.SUBMITTAL INSTRUCTIONS 9.Total well depth below land surface: (ft.) For multiple sells list all depths if different(example-9ta3100'and 2Q)100) Submit this GW-1 within 30 days of well completion per the following: 10.Static water level below top of casing: /6' (ff) 24a. For All Wells: Original form to Division of Water Resources (DWR), (J wafer level is above casing,use"+" Information Processing Unit, 1617 MSC,Raleigh,NC 27699-1617 11.Borehole diameter: v (in.) 24b.For Injection Wells:Copy to DWR,Underground Injection Control(RUC) �1 Program,1636 MSC,Raleigh,NC 27699-1636 12.Well construction method: /1 O fa_�zdY'i L 24e.For Water Supply and Open-Loop Geothermal Return Wells:Copyto the (i.e.auger,rotary,cable,direct push,etc.) county environmental department l health of the county where installed FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPD:Copy to DWR,CCPCIJA 13a.Yield m Pcrmit Program, 161 I MSC,Raleigh,NC 27699-1611 lgP ) Method of test: 13b.Disinfection type: ADiount: - Revised t-r-ant s Form OW-I North Carolina Department of Environmental Quality-Division of Water Resources TERRATHERM Temperature and Revision n__0____ Pressure Monitoring Point Release date-_5/12/23_. Construction Detail Approved by_ _St__ _ Well ID T-1 l�0 i t r I"l // Date -7 "t 9' - J 3 Oversight 0/,t !T�e} Pe"-44 lob/t R23-104 Drille • r_ _ k 0,..).livi, be4-I / / Design Constructed Notes (fill out if different) Pipe Diameter TMP 1.5" ------Stick Up(TMP) 4101_ PMP 1" --Stick Up(PMP) 30" Borehole Diameter: 6" Ground Surface 0.0' — 2ngl,fron,HT Grout Homan 4100' Carbon S r: Top of#00 Sand 3' r TMP Pipe Length 84.5' _ Top of PMP Screen 5' PMP Riser Length 7.5'PMP Screen Length 'Siil► � — . Bags of#00 Sand �Z 75-- 3 Bottom of PMP Screen ifs n 8 Screen Material Stainless Steel \ Bottom of#00 Sand 10' (I, Other: '` Bags of Cement 1 a. Slot Sire 10 ' *w Bags of Silica •&9c 3 Installation Method Borehole Diameter 6" s. •ct Push Son • Bottom of TMP Well 81' "allow Stem Auger Mud Rotary Other: Bottom of Borehole n .0, Post-Installation QC(to be performed 24hrs after installation) PM Log:Make/Model: I1)Confirm well is free of grout Design Constructed Time: 7 r f Q avll _Reading: �. PPM Depth to bottom of TMP ift bTOCJ: 845' Time: tj;SQ �j.^ Reading: �,() PPM Depth to bottom of PMP ift bTOC): 10.5' Time: q;00 ate+ Reading: e,0 PPM if greater than or equal to 1ft less than designed alert the office Time: Reading: PPM 2)Confirm grout plug reaches ground surface Time: Reading: PPM repeat doily until depth to grout is Oft bgs Notes: . Depth to Grout, Depth to Grout, . Date IMP ift bgs) PMP ift bgs) t.