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Home My WebLink AboutGW1--07116_Well Construction - GW1_20231103 • , 1 WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only: 1.Well Contractor Inforinntioii: , ; Well Contractor Name / 14.1VATER ZONES_ FROM ' TO DESCRIPTION f NC Well Contractor Certification Numlier ft. ft• 15.OUTER CASING(for multi-cased wells)OR LINER(if op licahle) On G,. 1 C 0.4it e. 1br"i /1;ys/� FROM ' TO 'DIAMETER _ THICKNESS MATERIAL Company Name ft. 1 ft. in , 2.Well Construction Permit#:N Q CI. (' /� r 16.INNER CASING OR TUBING(geothermal closed-loop) I �/'1 ►1 1•f l 7. d FROM TO DIAMETER THICKNESS MATERIAL List all applicable well construction pe nits(LC.UK',County,Stile,Variance,etc.) ft. • ft. ' in. 3.Well Use(check well use): f e r'.I,i f�°�� ('`l.5- se e. - ft. ft.! in. Water Supply Well: 17.SCREEN ❑Agricultural FROM TO DIAMETER SLOT SIZE - THICKNESS MATERIAL ❑Muuicipal/Public ft. R. ;n. OGeothermal(Heating/Cooling Supply) ❑Residential Water Supply(single). • ft. ft. ❑Industrial/Commercial in. ❑Residential Water Supply(shared) ❑ • b'rigation 18.GROUT - ❑Wells-)-100,000 GPD FROM TO ' .-MATERIAL': EMPLACEMENT METHOD&AMOUNT Non-Water Supply Well: ft. ft. ❑Monitoring ❑Recovery ' Injection Well: //�� ft. ft. . UAquifer Recharge tlaflrottndwater • Rentediation ft' ft. ❑Aquifer Storage and Recovery ❑Salinity Barrier 19.SAND/GRAVEL PACK(if applicable) - FROM To MATERIAL EMPLACEMENT METHOD ❑Aquifer Test ❑Stonnwater Drainage • • • ft. • ft. - ❑Experimental Technology ❑Subsiderice Control ft. ft. OGeothermal(Closed Loop) ❑Tracer .20.DRILLING LOG(attach additional sheets if necessary). Aber(explain under HZ 1 Remarks) FROM I'TO DFSCRII TIUN(color,hardness,soh/rock type,groin she,eu.1-� OGeothermal(Heating/Cooling Return) 19 0 ft' 2.5 ft* e 4.Date Well(s)Completed:f ',9 '1 Well IDti He .C;l�. ft. -:- 7Nr-/j 2(�aP`��G rC�S[°'Ar'��'G 1 r:(�/. /•L� rt. f1-1,6 � u.tir'f Z Sa.w r� I 5a.Well Location: ft. ft. ' / k Of/eourl� Jl16, vetz si .f.,J S,Ie `� S 5J95i rt. ...: = :r „ ;; y, Facility/Owner Name Facility IDII(ifapplicabte) ft. ft. -V - 2.i,z•7j Z uwve /3J✓tQf T�.crJ•a7, lie j 2 8'5'Y' ft, ft. NOV 1) - Physical Address,City,and Zip ft. 1 ... ' , - ONS/t9GIl' • 7j 14'110'17 p f(3 21.REMARKS ' • /� - County Parcel Identification No.(PIN) �j�4a .,`C ot110'Ci)a Try VV��Di" ex- r •t dt.' Well 5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: st!e � e. Sete' a-�-r`c fo I�.C��.v s trf✓C f t0 ry �' �1,j IS' (if well field,one lat/long is sufficient) • 22.Certification: • L7y1 pieb • N ' 77,. 3Zt 7o i , ,,,,,......:7L;(4,44 /0. •"/ar-23 6.Is(are)tthe well(s): likKrmanent or OTemporary Signature of Certified Well Contractor Date By signing thrisform.1 hereby cerlifj.that the well(s)was(were)constructed ill accordance with 7.Is this a repair to an existing well: ❑Yes or NlVo 15A NCAC 02C.0/00 or 15.4 NCAC 02C.0200 Well.Construction Standards and that a cope (Nis le a repair,•Jill out known well construction information and explain the nature of the orth/s record has been provided to t/se wet!owner. repair under 02/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 8.For Ceoprobe/DPT or Closed-Loop Geothermal Wells having the same (add'See Over'in Remarks Box).Youmay also attach additional pages ifttecessaty. construction,only 1 GW-I is needed. Indicate TOTAL NUMBER of wells drilled: �''J' 24.SUBMITTAL INSTRUCTIONS 9.Total well depth below land surface: (ft) Submit this GW 1 within 30 days of Well completion per the following: Far multiple wells list all depths ffdiJJerent(eramrples 3@200'and 2 a 100) 10.Static water level below top of casing: ' /s ft 24a. For AB Wells: Ori�hral form to Division of Water Resources (DWR), If water level is above casing,use +� ( ) . Information Processing Unit,1617IMSC,Raleigh,-NC 27699-1617 11.Borehole diameter: / (in,) 24b.For Injection Wells: Copy to DWR,Underground Injection Control(WC) i - Program, 1636 MSC,Raleigh,NC 27699-1636 12.Well construction method: RC C fa-DOA/Pi r✓ (i.e.anger,rotary,eagle,direct push,etc.) • 24c.For WaterSupply and Open'.'.-Loop Geothermal Return Wells:Copy to the . county environmental health department of.the-county where installed ' FOR WATER SUPPLY WELLS ONLY: i 24d.For Water Wells producing over 100,000 GPD: Copy to DWR,CCPCUA 13a.Yield m I 'Permit Program,1611 MSC,Raleigh,NC 27699-1611 lgp ) Method of test: 13h.Disinfection type: • Amount: -, I Revised 6-6-201 R Form OW-1 North Carolina Department of Environmental Quality-Division of Water Resources ISTD Heater Boring,Construction Detail Revision#:_0 i TERRATHERM Release date:_5/12/23_ ec`'-416.0"0.4, S / Approved b SL Well ID i °HC-02C 1 'Ill '(3. vC�6✓ir(�edDate C IG Oversight A,/i,L 0. 1%0tNU� Job# R23-104 Driller . L t TY 11.4A /(, k)aiid ei-ly I • Constructed (fill out if Design different) Notes —Length of Can Stick-Up(ft)/ Height of Can Stick-up Above 1 1/2"Thermocouple pipe? '• Fq''r`*' ._.- `4. Ground(in) 3'/30" Thermocouple Length 75.92' �C""" -Length of VEW Stick-Up(ft)/ Height of Riser Stick-Up Above ' Ground(in) 0.5'/6" Ground Surface 0.0' ---_-----_ ----.....—......------- ,; Heater Can Conductive HT Grout— F•':;=; --' Angle from Horizontal 48° Schedule 80 F xa1 t, t a NIBorehole DJometer 7"i k. ' Top of#00 Sand 2'1 Z .at. a Top of Screen 4' LA.` t FA Can Length 79 ft 0, )-' [:5GalBucketsofGraphite 0.75 vl 6 '-- Heater Can Diameter 3 in 1, , 7 Bags of Silica 1 17. ram, ' s Screen Length 1e3T ft - Bags of Cement s 3.5 g----- P- It C Riser Length �5. ft r, i ,, „ q I Screen Diameter 1 in " Bottom of Screen 17.5' t.`"` Installation Method • aiw�, Direct Push _ Bags of#00 Sand 33' On $ kbh I +}4 Gallons ofCrushed Hollow Stem Auger Mud Rotary � ,,, Limestone 33 Other: > ' Tv t e( Bottom of#00 Sand 67.5' -Bottom of Heater Can 76' i 4. -6. s Bottom of Borehole 76'1 1 la'' Post-Installation QC(to be performed'24hrs after installation) Pro Loa:Make/Model: 1)Confirm well is free of grout' Design Constructed Time: %Lit:.D Reading: iV' I 0 PPM Depth to bottom of well[ft bTOC. Jg' Time: \"1 (3 1, Reading: 0. Q PPM if greater than or equal to Ift less than designed alert the office Time: Via, Z. f I Reading: 0 ..v PPM 2)Confirm grout plug reaches ground surface Time: 45" r Z.cJ--/ en -0 Reading: 0, f) PPM repeat daily until depth to grout is Oft. Time: 0'605 I Reading: 0 .1 . PPM Date Depth to Grout[ft bgs) Notes: rTh j u ,, o ;:, - a0\ 10 c05 L-t..--4 13O a,1;g,;- �, - c -2-0