The URL can be used to link to this page

Home My WebLink AboutGW1--07095_Well Construction - GW1_20231103 . WELL CONSTRUCTION RECORD GW-1 • For Internal Use Only'. 1.Well Contractor Information: it ii/i-4....pp ./�Isillile.r•:f I I 1 Well Contractor Name d4.WATER ZONES I ! FROM TO I IDESCRIPTION 3$76 A • ft. Ft.I NC Well ContractorCertifieation Number ft. ft.I 1 •• IS.OUTER CASING(for'multi-cased wells)OR LINER(if ap liable) C7f}�+�•C Cu.�e. br iii ",...9 FROM TO � ft. 1� DI AMETER I THICKNESS MATERIALCompany Name ft. i in. 2.Well Construction Permit#: 4� �L�e 16.INNER CASING OR TUBING(geothermal closed-loop) fll S'- e FROM TO DIAMETER THICKNESS MATERIAL List all applicable well construction pe its(i.e.WC.Como%State,Variance,etc) H. ft. in. 3.Well Use(checkwelluse): /Ped�+r i.01. We-:rec I. ft. ft. In. Water Supply Well: 17.SCREEN ❑AgC1CUltliral OMunicipal/Public FROM TO DIAMETER SLOT SIZE THICKNESS MIATERIAL ❑Geothermal(Heating/Cooling Supply) OResidential Water Su l' ft. ft. in. PP Y(single) tt. it. In.OIndustrial/Cominercial • ❑Residential Water Supply(shared) ❑irrigation IS.GROUT ❑Wells>100,000 GPD FROM TO ' MATERIAL'' EMPLACEMENT METHOD&AMOUNT Non-Water Supply Well: ft. ft. ['Monitoring ['Recovery • Injection Well: • /�° ft. it °Aquifer Recharge groundwater Remediation • ft. ft • • ❑Aguifer Storage and Recovery ❑Salinity Barrier 19.SAND/GRAVEL PACK(if applicable)• FROM TO MATERIAL EMPLACEMENT METHOD ❑Aquifer Test ❑Storinwater Drainage .. It • ft. ❑Experimental Technology ❑Subsidence Control . ft. ft OGeothermal(Closed Loop) ❑Tracer • 20.DRILLING LOG(attach additional sheets if necessary) •❑Geothermal(Heating/Cooling Return) then(explain under#21 Remarks) FR I TO DESCRIPTION?color,hardness,snit/rock type,grain size.atc.l 4.Date Well(s)Completed:� '; /y� _ % ft. 2.S ,./4 4/oilrol 571,w/cir ciev Well ID# / / t2 • 2 S ft. r • l�r �ku;4r12 Sa_�eQ Sa.Well Location: �g / y��y .t. ft. 4 OWe-Bat�1^C1t af�.��PNf 6tjv ..J,•7`t'� s f 3/1 ,/+ ft. ft. 1 y' , Facility/OwgerName Facility 11O//(if applicable) ft. ft.• A• 2/x•�z !u.ve /311/t t.C c.s ,1V.Vie! 285'9'‘ ft. rt. NOV i 2023 __ Physical Address,City,and Zip it. • ft "''cr,,: ^•,;3,.,,, .a ON-5/0(�, y3 T e/304/7g18 21.REMARKS r•: . ; County Parcel Identification No. PiN o h'ili.e `/44�3 • / Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: gee 6,ff6 as'che'.drnia-•*-t`c�o r-a 0,vsI'r ss-eiteO iw of I ye t c Ls (if well Sold,one Iat/long is sufficient) ti. G A�� 22.Certification: I N. "77 .361I ®p . , 6.is(are)the well(s): Permanent or DTemporary ignature of Certified Well Contractor Date erm By signing Ibisfornr,i hereby certify that the ue/l(s)was(were)constructed in accordance with 7.Is this a repair to an existing well: I OYes or MIl • 1SA NCAC 02C.0100 or ISA NCAC 02C.0200 Well Construction Standards and that a cop, If this is a repair,fill out known well construction it formation and explain the nature of the ofthis record has been provided to the,nell owner. repair wider t111 remarks section or on the hack 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: -, (ft.) For ntnbiple wells list all depots ifdillirem(example-3@200•and 2@10i') Submit this GW-1 within 30 days of well completion per the following: 10.Static water level below top of casing: �Ilp (ft.) '24a. For All Wells: Original form to Division of Water Resources (DWR), If water level is above casing,use + information Processing Unit,1617lMSC,Raleigh,NC 27699-1617 1I,Borehole diameter: d ' fin.) 24b.For Injection Wells:Copy tI fin.) DWR,Underground Injection Control(lUC) J �• , Program, 1636 MSC,Raleigh,NC 27699-1636 12.Well construction method: �® f 0.. OK'd ! ' (i.e.auger,rotary,cable,dtre'et gash etc.) 24c.For Water Supply and Open'-'Loop Geothermal Return Wells:Copy to the I ;county environmental health department of the county where installed FOR WATER SUPPLY WELLS ONLY: ' 24d.For Water Wells producing over ver 100,000 GPD:Copy to DWR,CCPCUA 13a.Yield(gpm) Method of test: Permit Program,1611 MSC,Raleigh,NC 27699-1611 13b.Disinfection type:, I Amount: - • • Form GW-I , North Carolina Department of Environmental Quality-Division of Water Resources Rev-iced 6.6•M 1 R , 00 TERRATHERM; Multi-Phase Extraction Well • Revision#:_0 in GrIwitln CwrR?nY Construction Detail Release date:_5/12/23_ ' Approved by:_SL_ Well ID .M-6 . , Date 7— a-3-ca3.. ( -1 Oversight 1 . /�/ >': Job i R23-104 /' { , Driller , .Fr.�Ci,-.1. / ��h P,l/ D I ign Constructed Notes . I (fill out if Well Diameter ' 4" different) Borehole Diameter ' Mir;I ------Stick Up Height 36" ,— OF Ground Surface 0.0' j , HT Grout-'--' ., 1 , Angle from Horizontal 90° • ' x ?'`gam I:WAV, Top of#00 Sand 1' sin e(ial • {y , Carbon Stee ,,,Ii `2a Top of Screen 3' Other: = a_._ .r r -,.� t. ,li,� II 4.4 Wilt • Riser Length ' 6 ft '•-'° IL "a=. i. - + ` Screen Length ' 27 ft >;� _ x "��,�Bags of 1100 Sand 18:25 /�" ' _ x„.„. ' Bags of Cement 1. t , ,: -,; Bags of Silica 0.5 1 S n I s fia-- , I▪ r`;I tainlessSteel �;I„3 ._ ',��YNz Borehole Diameter Fiberglass *�"} , rw'` ' rTh ---� r r. .�. x# PVC a �� a, ' str. . w II Other -� . :. L1 11 Faa f, �q Slot Size 10 .�.f1ZT Bottom of Sand 30' i,4 3-.— •i �;��.__ h;,;" Bottom of Screen 30'! Installation Method ct Sonic HT Grout 1i,]�1`'1 ''Y1;,: ! '.!Id Hollow Stem Auger istt 11lit�• i 1�:, Sump Length 2' Mud Rotary iv"1 I' T; I, Other: ;,„ �" Bottom of Sump 32'Ii • ,.,• I ,I ' .,Bottom of Borehole I Post-Installation QC(to be p`erformed'24hrs after installation) PID Log:Make/Model: 1)Confirm well is free of grout Design Constructed Time: 9 j•QG Reading:) ®,6 PPM Depth to bottom of well[ft bTOC]: �5_ Time: 9; 0 Reading:; •! () •D PPM if greater than or equal to lft less than designed alert the office Time: 1 O?6,b Reading:1 16 •0 PPM 2)Confirm grout plug reaches ground surface i Time: /t}•; 6 Reading:I I 1:).0 : PPM repeat daily until depth to grout is Oft bgs Time: Reading:I I PPM Date 1 Depth to Grout[ft bgs] ++ Notes: - I I 1 I 'I li in , • I I i ; ,