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Home My WebLink AboutGW1--07034_Well Construction - GW1_20231102 WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only: 1.Well Contractor Information: t)r/ill-o-i)+'1 WtMberIY 14.WATER ZONES Well Contractor Name FROM TO DESCRIPTION 34876A NC Well Contractor Certification Number ft. ft. 15.OUTER CASING(for multi-cased wells)OR LINER Of an Stable)CO.+,f t.Ct,.t�e L r /r/^/Q FROM I TO I DIAMETER THICKNESS MATERIAL Company Name -J it ft. la, A//A teat]. 16.INNER CASING OR TUBING(geothermal closed-loop) 2.Well Construction Permit#:/y 4 �•J FROM TO DIAMETER List all applicable well construction pe nits(i.e.U/C.County,Stale,Variance,etc.) ft. ft. in. THICKNESS MATEWAL 3.Well Use(check well use): Pent",h1i~9 A41°'' r e ee ft. ft. In. Water Supply Well: 17.SCREEN OAgtiCultlrml OM FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL unicipal/Publc ft, h, in. OGeothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑lndustrial/Commercial h' ft. 1n ❑Residential Water Supply(shared) OhTigation Iti GROUT ❑Wells>100,000 GPO FROM TO MATERIAL` EMPLACEMENT METHOD&AMOUNT Non-Water Supply Well: ft. h ❑Monitoring ❑Recovery Injection Well: ft. rt. Recharge IDGrougdwater Remediation ft. ft. ❑Aquifer Storage and Recovery ❑Salinity Barrier 19.SAND/GRAVEL PACK(if applicable) FROM TO MATERIAL EMPLACEMENT METHOD ❑Aquifer Test OStormwater Drainage • ft. ft. ❑Experimental Technology OSubsidence Control ft. H. OGeothermal(Closed Loop) ❑Tracer 20.DRILLING LOG(attach additional sheets if necessary) ❑Geothermal(Heating/Cooling Return) then(explain under#21 Remarks) FT" TO DESCRIPTION(color,hardness mlUroek type,grain she,eu.) J/ 0 ft. Z S. h. 4.Date Well(s)Completed:/`6 -2-3 Well ID# /7-L/( 2 5 f, IL ZeiPCII td' r iee Z o_Arol,a,v, e�C 1 eC�j • fT--rdl ,..)" �2 Saiv[� I ,�p�� So.Well Location: 'ft. ft. 13& Owe J1ouf CI .�Net-Y S c+r&-A- h. ft. ... --y P S-fie yeAdx`16Y�5�9y Facility/Owner Name Facility 1D//(if applicable) ft. ft. N n V J 2 L7023 2/2'7 Zejeu�A.e /31✓t,7�Ta.erssNV 1/et 28.5•Y' ft. - Physical Address.City,and Zip ft. ft. Oaslo 1>v y3 9613d it7818 21.REMARKS County Parcel Identification No.(PiN) /*c teen Co-", i-►7%!yi- 14-pe v C-Xtr �1/o,�s we 1 5b.Latitude and longitude in degrees/atainutes/seconds or decimal degrees: Ste*,1/-al eceXchtivkaSr`c l s r CONS -ran t i o ar el eta;IS (if well field,one IaUtong is sufficient) 22.Certification: 3y.7ylyeo N - 77. 36`d ®0 W 6.is(are)the wells): rmanent or OTemporary Signature of Certified Well Contractor Date By signing this form,1 hereby certify that the well(s)was(were)constructed in accordance with 7.Is this a repair to an existing well: ❑Yes or ( 1Vo I5A NCAC 02C.0100 or 15A NCAC 02C.0T00 Well Construction Standards and that a copy if this is a repair,fill out known well construction nil-carnation and explain the nature of the of this record has been provided to the well owner. repair under#21 r•emor*s section or on the back of this farm. 23.Site diagram or additional well details: You may use the back of this page to provide additional well construction info 8.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-1 is needed. Indicate TOTAL NUMBER of wells drilled: 24.SUBMITTAL INSTRUCTIONS 9.Total well depth below land surface: 3 6 (ft.) For multiple melts list all depths ifdifferehu(example-?(tr�200'and 2@/00� Submit this GW-1 within 30 days of well completion per the following: 10.Static water level below top of casing: 49 (ft) 24a. For All Wells: Original form to Division of Water Resources (DWR), (/runner level is above casing.use"+" information Processing Unit,1617 MSC,Raleigh,NC 27699-1617 11.Borehole diameter: 7 (in.) 24b, For Injection Wells:Copy to DWR,Underground injection Control(IUC) /� C Program, 1636 MSC,Raleigh,NC 27699-1636 /1 12.Well construction method: D t0.. d✓I/I e. (i.e.auger,rotary,cable,direct push,etc.) 24c.For Water Supply and Open-Loop Geothermal Return Wells;Copy to the county environmental health department of the county where installed FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPD:Copy to DWR,CCPCUA 13a.Yield m Permit Program, 1611 MSC,Raleigh,NC 27699-1611 (gP ) Method of test: 13b.Disinfection type: Amount: Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-)nt A TERRATHERM ISTD Heater Boring Construction Detail Revision#^0 Release date:_5/12/23_ Approved by: SL Well ID H-41 Date ' " ) Oversight +.: Job# R23-104 Driller J'rt {J Constructed (fill out if Design different) Notes 1/2"Thermocouple pipe? ISOM --Heater Stick-Up Height ,,a9"- 07 a, Thermocouple Length 37.67' VEW Stick-Up Height /1g Ground Surface 0.0' �� Heater Can Conductive HT Grout-- ogle from Horizontal 90' 'Schedule 80 ' Borehole Diameter 7' Top of IWO Sand 1' ,>Top of Screen 3' Heater Can Length { 38.5 ft 5 Gal Buckets of Graphite ,O:S C Heater Can Diameter '"3 in Bags of Silica 0.75 r Screen Length 10 ft Screen Diamter in 7f Bags of Cement -2:25 [ Bottom of Screen 13'rl Installation Method Direc Push Bags of B00 Sand 10.5 Sonic/ Hollow Stem Auger Gallons of limestone 10.5 Mud Rotary Other: Bottom of#00 Sand 30' Bottom of Heater Can 36' Bottom of Borehole 36' Post-Installation QC(to be performed 24hrs after installation) PID Log:Make/Model: 1)Confirm well is free of grout Design Constructed Time: ' Reading: F) , ) PPM Depth to bottom of well[ft bTOC; 4R c' Time: 8 r Reading: PPM if greater than or equal to 1ft less than designed alert the office Time: Reading: ( ,(J 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: