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Home My WebLink AboutGW1--07067_Well Construction - GW1_20231103 • WELL CONSTRUCTION RECORD(GW-1) i 11' • . I,, . i 1, For Internal Use Only 1g."Well Contractor Information: ,i ' 14.WATER ZONES I Well Contractor Name ' FROM TO I DESCRIPTION 3 t 76,„ac/tl ft ft. I NC Well Contractor Certification Number ! ft. ft. • 15.OUTER CASING(for multi-cased wells)OR LiNER(if ap licable) CC cH,:ei e. bdr-0 I//,Vry • FROM TO I DIAMETER THICKNESS MATERIAL Company Namcl f ' ;i 1 Ii I R, I in. 16.INNER CASING OR TUBING(geothermal closed-loop) 2.Well Construction Permit#:yA.eEne L A Pit FROM TO 'DIAMETER THICKNESS MATERIAL List all applicable'n�e/i construction penne.s(Le.'U1C.County,State,Variance,etc.) ft, ft. I. In. 3.Well Use(cheek use): er int/A-19 Iti�"°rede • ft. ft. In. Water Supply Well: 17.SCREEN I • °A(picultlrral FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL OMlmicipal/Public ft. ft, in. °Geothermal(Heating/Cooling Supply) °Residential Water Supply(single) - ❑lndustnal/Commercial ft. ft, • I" °Residential Water Supply(shared) °Irrigation • 18.GROUT O Wells>100,000 GPD FROM TO ' MATERIAL'') EMPLACEMENT METHOD&AMOUNT Non-Water Supply Well: .. • ft. R. °Monitoring ' °Recovery Injection Well: • ft• fa ; . °Aquifer Recharge, IIDtirourulwater Remediation tt. R. ' °Aquifer Storage and Recovery °Salinity Barrier • 19.SAND/GRAVEL PACK(If:applicable) • FROM TO MATERIAL EMPLACEMENT METHOD °Aquifer Test OStornwater Drainage • . It. • ft: ❑Experimental Technology °Subsidence Control • ft. ft. I' °Geothermal(Closed Loop) °Tracer I • 20.DRILLING LOG(attach additional sheets if necessary) • ' °Geothermal(Heating/Cooling Return) Cher(explain under#21 Remarks) FROM TO DESCRIPTION lsnior,hardness soNroek type,grain size,eic.j I f ft' 2.5 fL 4.Date Well(s)Completed:/ ,O', 1- Well ID# f7 -3 2 s ft. R, )�p ,(Wei��A''�tire�Q' • - lt�. .4 u wa- s~al./io zi 5a.Well Location: n, ft. 1 Dive 1 ou r C pert-5 , - Facility/OanerName • Facility iO0(if applicable) ft. ft. ,.``"' .::.,i.' 1 1 . • 2127 ZlievAre/3/✓4 2 8' y' ft. ft. N� eti -�. 2 if (]�� Physical Address,City,and Zip -p ft. • ft. 2 J ON-5/0(.0 4/3�I/3D'// t91® 21.REMARKS County Parcel Identification No.(PiN) / er- (�a4' .��.5•f- 1'- ,1g 'I r'2>%t;i Sb.Latitude and longitude indegrees/minutes/seconds or decimal degrees: Seen,t1-64 Gis'eh dzi-i.a�o r C o. .xtr•ca:fi tI aw ei ett,i L$ (if well field,one tat/long is sufficient) 22.Certification: ntanent or °Temporary aturo ofCcnificd Well Contmcttir Date 6.Is(are)the well(s): er Bysigninglldsform,I hereby cerli/j hatthe ne//(s)was(were)constructed in accordance with 7.Is this a repair to an existing well: ! Dyes or &'!Vo • ISANCAC 02C.0100 or 15A NCACO2C.0200►Ve/1 Construction Standards and that a copy Olds is a repafr,•/Ai out known well construction it formation and explain the nature of/he of this record has been provided to th'a e/l owner, repair tinder 021 remarks section or on the back ofthis form. ' 23.Site diagram or additional well details: S.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 I GW-1 is needed. Indicate TOTAL NUMBER of wells •(add'See Over'in Remarks Box).You may also attach additional pages if necessary. drilled: . j r 24.SUBMITTAL INSTRUCTIONS 9.Total_well depth halo*land surface: ' ! • r For multiple wells list all depdrs ifd�erent(eiantple-!3@200'and 22@@1oo') (ft.) Submit this GW-1 within 30 days f well completion per the following: 10.Static water level below top of casing: ®p 1(ft) -24a. For All Wells: Original form to Division of Water Resources (DWR), Ovate,.level is above casing,use '+^ 1 information Processing Unit,1617 MSC,Raleigh,NC 27699-1617 11.Borehole diameter: 6 (in.) 1 • ,; 24b.For Infection Wells:Copy to l:DWR,Underground Injection Control(IUC) Program, 1636 MSC,Raleigh,NC127699-1636 12.Well construction method: eC) f al J ea'� •' 24c,For Water Supply and Open-Loop Geothermal Return Wells:Copy to the (i.e•auger,rotary,icflble,direct push,etc.) I ';I county environmental health department of the county where installed FOR WATER SUPPLY WELLS ONLY: '' ' 't I •i 24d.For Water Wells producing I over 100,000 GPD:Copy to DWR,CCPCIJA j ,,, Permit Program,1611 MSC,Raleigh NC 27699-1611 13a.Yield(gpm) ;Method of test: • �� 13b.Disinfection type: Aniount: •- I li Form GW-I North Carolina Department of Environmental Quality-Division of Water Resmrmes • lat ' ISTD Heater Boring Construction Detail i Revision#: 0 TERRATHERM a caraan cam"; Release date: 5/12/23 Approved by: SL 1 Well.ID Ha Date 7 la, — • Job# R23-104 ' Oversight ' �. ��;/f��' , Driller /�/®/�S'r: G(/r�/M 6lrly q , ( Constructed . I (fill out if Design different) Notes —Stick Up Height 1/2"Thermocouple pipe? P,;.,.��w?r''r., ' 24'J Thermocouple Length f` 67' I' Ground Surface.'_0.0' Heater Can Conductive HT Grout—I• ! ::Angle from Horizontal 90° Schedule 40 d •. , „Borehole Diameter 6" I:• • i 1 — C I i Heater Can Length AO ft. 1 ili • 5 Gal Buckets of Graphite 125 I, I ;.1 • •;Bags of Silica' 1I75 Heater Can Diameter 3 in i •Bags of Cementcr.)i Installation Method .. iPush 1, • Sonic I „ i'• . Hollow Stem Auger • I j Mud Rotary ' ' • i Other' I 1 Bottom of Heater Can 26' e ., , I I z••', I I }.. __, Bottom of Borehole 6' 1, V i. Post-Installation;QC(to be performed 24hrs after Installation) ND Log:Make/Model: 1; 1)Confirm well Is free of grout,' 'I Design ' '' ' Constructed Time: IQ:QQ i Reading: a s Q PPM Depth to bottom of well[ft bTOC 711' ,, Time: i,(!;O 5 1 Reading: 0,,0 PPM if greater:thun'or`equal to'1ft less than designed alert the office Time: 1 Reading: PPM 2)Confirm grout'plug reaches ground surface Time: 1 Reading: PPM repeat`daily,until depth to grout is Oft. I Time: I Reading: PPM Date ,: Depth to Grout[ft bgs] Notes: I • ,. II ' ,1 I I• ' lI •� 1 ,,1 , 1 , I, I,