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Home My WebLink AboutGW1--02625_Well Construction - GW1_20240501 PrintFORII - WELL CONSTRUCTION RECORD 1GW-1) For Internal Use Only: F 1.Well Contractor Information: I i. Michael Coleman Welt Contractor Name ft.FROM , TO DESCRIPTION 2 ft. I'992-A ft. ft. u ; NC Well Contractor Certification Number 'I&OUTER CASING(for multltased wells)OR LINER Of a.pplii.cabale) Cascade Drilling FROM TO DIAMETER THICKNESS 1 MATERIAL 0 ft. 53 ft. lu. (steel Company Name /� ;16.INNER CASING OR TUBING(geothermal riaaed409)'' 2.Well Construction Permit# /4 (_P�✓l/4., f�� MOM TO DIAMETER THICKNESS MATERIAL List all applicable well construction /is(+.e,(/IC.Cowry.&ate,Variance.eta) lL ft. in. 3.Well Use(check well use): ft' In. Water Supply Well: FROMREgN TO DIAMETER SLOT SIZE THICKNEss MATERIAL Agricultural °Municipal/Public 63 it. 55 D. 1 in. 0.010 ss Geothermal(Heating/Cooling Supply) ['Residential Water Supply(single) fL it. in. industrial/Commercial DResidential Water Supply(shared) t 1&GROUT. ." Irrigation FROM TO MATERIAL ' EMPLACEMENT METHOD Fe AMOUNT Non-Water Supply Well: o n- 51 ft cement ' tremia pipe Monitoring — ------_°Recovery-- --- — ---;-'--,,-----ft..- . --ft. - H. -_.--- _ - -.- --- — Injection Well: r ft. ft. Aquifer Recharge �)t Groundwater Remediation 14.SAND/GRAVEL PACK(H applicable) Aquifer Storage and Recovery ['Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD Aquifer Test DStormwater Drainage 51 ft- 55 ft. #00 send Sonic Experimental Technology ['Subsidence Control ft. ft. Geothermal(Closed Loop) ['Tracer ;.20.DRILLING LOG(attach additional sleets If necessary) - -- - Geothermal(Heating/Cooling Return) father(explain under#21 Remarks) FROM TO DESCRIPTION(nobs hardness,tolVreck typo train the,etc.) 4/3/2024 S-2(SB-06) CV ft'' 2 5 n' - i 'P'�,�� 9r%y See.�d* --7 4.Date Well(s)Completed: WeilLW/ f-� 5a.Well Location: " I 9� ft. � �� Facility/Owner Name Facility ID#t(if applicable) ft. ft. i -?L.r i/r1 "'?ft ,-. /s�'C � ��/� r�w�-i.7P. / 28�s/f - ft. ' MAY t 2G%% Physical Address,City,and Zip h' ft. ? t F� ,._ 21.REMARKS 1 i. �,•, :?:. : r„:9.•1. County Parcel Identification No.(PIN) On sites gpo has soil descriptinn sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: (if well field,one Iat/ong is sufficient) 22.Certification: ' 3 Y. -7 y/c 6 N 077,E 66 cv w �,,e 1--- 4/17/2024 6.Is(are)the well(s)I]Permanent or ['Temporary Signature of Certified Well Contractor I Date By signing this form.I hereby certifr that the well(s)was(were)constructed in accordance 7.is this a repair to an existing well: OYes 'or x)No• with ISA NCAC 02C.0100 or ISA NCAC 02C.0200 Well Construction Sranderdsand that a If this It a repair.fill out known well construction information and explain the nature of the copy of this record has been provided to the well owner. repair under#11 remarks section or on the back 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 site details or well construction,only I GW-1 is needed. Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if necessary. drilled: SUBMITTAL INSTRUCTIONS 9.Total well depth below land surface: 55 (ft-) 24a. For All Wells: Submit this form within-30 days of completion of well For multiple wells list all depths ifdtgerent(example.3@200'and 21l]i J00') construction to the following: j' I. 10.Stolle water level below top of casing: (ft.) Division of Water Resources,Information Processing Unit, If water level is above casing,use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617 11.Borehole diameter: 6 (in.) 24b.For infection Wells: In addition to sending the form to the address in 24a Sonic above,also submit one copy of this form within 30 days of completion of well 12.Well construction method: construction to the following: (i.e.auger,rotary,cable,direct push,etc.) P Division of Water Resources,Underground Injection Control Program, FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636 i' 1 13a.Yield(gpm) Method of test:- 24c.For Water Sunsiv Sc infection Wells: In addition to sending the form to the address(es) above, also submit one copy of this form within 30 days of 13b.Disinfection type: Amount: completion of well construction to the county health department of the county where constructed. Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016 040- TERRATHERM SIW Boring Construction Detail Revision#:_0 "�""` Release date_04/02/24_ Approved by:_DS/EH Well ID S-2(SB-06) Date Oversight �,�1 Job# R23-104 Driller- rp df1 'rt�� G/+hw�..7 rr 4e' C�le,",d,N.e Design Constructed Notes [fill out if different) 1 --SIW Stick Up Height 18" Cover Surface 1.0' 1 Ground Surface 0A' . I Grout =ice` - —_ ___ k. ', '' i , i Borehole Diameter 6' r, NW Riser i"CS r k Riser Length 55.5 ft ? ! i, }-'.Bags of Cement 1450 4 !! Screen Length 2 ft r ). .',i ` Screen Material SS . s. ',. Bags of Silica - 4.75 SIW Slot Size 10 , Screen Diameter 2" � Bogs of Sand 2.0 f Installation Method • { 'Sonic , Direct Push <, Hollow Stem Auger Mud Rotary ;;' Other: Top of#00Sand 51 • Top of Screen 53 ..N ---- —--- - - --— --- - --- Bottanrof BOO Sand'-�"55=--- - - — — — and Screen Bottom of Borehole 55 Post-Installation QC(to be performed 24hrs after Installation) PRD Log:Make/Model: 1)Confirm well is free of grout Design Constructed Time: Reading: PPM Depth to bottom of well[ft bTOCJ: a7 a Time: Reading: 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. Time: Reading: PPM Date Depth to Grout[ft bgs) Notes: