GW1--07044_Well Construction - GW1_20231102

WELL CONS RUCTION RECORD CW-iFii,,tl,' � For Internal y;
„i�'� � Use can!n,0i,�,!, L Well Contractor Inforamtlon:
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li i-,. _ c �r - _ 14.WATER 7.UNES
p.l. Wen Contractor Name
DESCRIPTION
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NC Well Contractor Certification Number 11111111111161
) IS.OUTER CASING for mai-awed wells OR LI
�.c�C...:€ NER L' J�1J�/ FROM ininTp � �'. able
" ,� TltlC MATERIAL
Company Nameit
ion
2.Well Construction Permit#: t L' (t' 16.INNER CASING OR TUBING ._,.
l.tl S nom To tmitcJ+wed-0:
Lill all applicable wYeeonslruciion ports is(i.c.WC,COMllip,State. Voriupne,err) tt. D[AMErEa r' '« ' MATERIAL
Pe ell' r ,,t t7 A R• la
3.Well Use(check well use): !' °"'�'�'
IL R. In.
...___
Water Supply Well:
17.BCREKN _
FROM
°Agricultual ❑MtwicipaUPublic ft.
TO ft. 1 011AM67tttt t SLOT SIZE rtitctcivasa MATERIALOGeothermal(1leating/Cooling Supply) OResidentiat Water Supply(single)
Olndnm'iaVCommeacial N• fr. to __ ....__._..
❑Residential Water Supply(shared)
GP
❑litigation L7 Wel is 100,000 GPI) I&GROUT _ _.�_.......
Non-Water Supply Well: t�cmi To MATERIAL giMP1•A Mt;1vT METHOD&aaiuvyi
OMonitoring ❑R.ecovery
;jy Injection Well: ,. in tM. fc _.._..
°Aquifer Recharge taifavundwater Reediation f1. N.
iii!i4. DAqui for Storage and Recovery 19.SANIUGItAttga PACK(ifs applicable) .
Nla : OSaiinity Barrier room TO
;l !'ly! °Aquifer Test MATERIAL t7�Mt'LACEMigVT ME�7iOo
i.. OStormwater Drainage it. • ft.
I,, DExi erimental Technology CiSubsidertce Control
W iiii OGeothemtal(Closed Loop) OTtaci r
OGc othetmal pleating/Cooling Return) grvinor(explain ]o DRILLING LOG(attach additional sheets>f • _
{ plain underf121 Remarks) rRo)►t To
t)F.SCIt1PfIt�)v t7)
_ /�'} ft. •� ft•• ..1,,.,. ,,( , 'fCiUylMtt tlPe.$ria else.etc_}.. ..
J!nfi sat 4 tt. •�A/ 4�OIa< 4 f
4.Date Well(s)Completed: Well DV l . n t E' ro .sri..A.I i
Sa.Well Location: �rd4�� r`r �-h
ir. 7L 1
t tf3C,_ Otvrv.f-�o ur C e aterS syor fuvat j',/e .4(60 0z•/+ Y*941 fl` n. __ ....
Facility/Owner Name Facility ID*(ifataplicabk) n• r 7t
2 f'2'7 Z>jt�t},+'re 13t✓t{t j4 rr..rto.v✓--llE'y 28.s"y ft. NOV J 2 2023 -----
Physn:ai Address,City,and Zip
O.v s!v w
7.3 76/301(78!$ 21•REMARKS _—
County Parcel tdentifrcaiicai No.(PIN) • ' i� I- .i P 1
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: see*,I ff eischerit s-'f"i t:for eo a.3'frez f;p,v J eta i jS
Of well field,one lat/long is sufficient)
22.Certification:
. y.?y/yo o N " .77, 3AII 00
6.la(are)the weli(s): ll rmanent or °Temporan Signorine of Cettiticd Well Contractor tc ^)D l{�—
Date
7,is this a repair to an existingwell: °Yes or !i)'J1gning this ltaai.1 hereby eeraj•that the ar/lfr)was(ware)aoeuirrtried in acwillo ,'with
1`' �l�o 114 NCAC d1C,OltNl or)3A NCACOJC.i1101)Well Contraction Standards nut Ilan a role
$t Oki,iv a rupair,, f out;mown aril CUpslme' a,I*Mannino mitt explain the aafMre of MI, ojthi.r record flat been provided to tko mall oust'''.
o" repair antler ar21 twra the tactic*or nn boric o(rkts jornr.
7 u:u:.' 23.Site diagram or additional well details:
;i,,, S.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the hack of this page to provide additional welt construction info
• :l,4.. construction,only I GW-i 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: r)rl '1 (ft.)
,r,''i" F'or multiple wtli.Y bcr all iarthc il'.Htjr r,u(example-36200'ur.,,;;welt?) Submit this CW-f within 30 days or well completion
°i' l P per the following:
10.Static water level below top of casing: /( (R) 24a. For All Wells: Original form to Division of Water Resources (DWR),
1faalrerlevel <ahn,.ernrtr,g.Mrc"+" information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
1
I I.Borehole diameter: L1 tin.) 24b. For Infection Wells:Copy to DWR, Underground Injection Control(11)C)
�• Program,1636 MSC,Raleigh,NC 27699-1630
12.Well construction method: c, f11-)oovi C
(le auger,rosary,cable direct push etc.) 24e.ForWaterSa ly and Open-Loop G�Retara Wells:Copy to the
county environmental health department of the county where instaltcti
FOR WATER SUPPLY WELLS ONLY:
24d.For Water Wells,producing over 100 000 OPD:Copy to DWR,CCPCI IA
13a.Yield(gpm) Method of test: Permit Program, 1611 MSC,Rafcrg}t,NC 2'699-1611
13b.Disinfection type: Aatouat:
Form GW-i

Ifs Temperature Temperature and Revision#: o
,., ; ,�
Pressure Monitoring Point Release date:_5/12/23_
Construction Detail Approved by: SL�
Well ID T- �"-`•
g Date 10 . 2 -a 3
Oversight j •• k Job#R23-104
Driller WEE 4-
Design Constructed Notes
(fill out if
different)
Pipe Diameter TMP: 1.5" ------Stick Up(TMP 30"
PMP: 1" —Stick Up(PMP)) 24"
Borehole Diameter: 6"
Ground Surface 0.0'
HT Grout- — Mgle from Horizontal 90°
Casing Material
Carbon Steel
Other: Top of#00 Sand 1'
—
TMP Pipe Length 23.5' ..
Top of PMP Screen 3'
PMP Riser Length 5' --
PMP Screen Length 2' :" Bags of#00 Sand 2.5
Bottom of PMP Screen 5'
Screen Material
Stainless Steel Bottom of#00 Sand 7'
Other:
Bags of Cement 4.75
Slot Size 10 Bags of Silica 1.5
installation Method Borehole Diameter 6"
Direct Push
Sonic Bottom of TMP Well 21'
Hollow Stem Auger
Mud Rotary
Other:
Bottom of Borehole 21'
Post-Installation QC(to be performed 24hrs after installation) PID Log:Make/Model:
1)Confirm well is free of grout Design Constructed Time: p Reading: (� - PPM
Depth to bottom of TMP[ft bTOC]: 23.5' Time: Reading: PPM
Depth to bottom of PMP[ft bTOC]: 7' Time: Reading: PPM
if greater than or equal to 1ft 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 bgs Notes:
Depth to Grout, Depth to Grout,
Date TMP[ft bgs] PMP[ft bgs]