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Home My WebLink AboutGW1--07054_Well Construction - GW1_20231102 WEAL CONSTRUCTION RECO W 1 For Internal 'se Only: I.Well Contractor Information: /t t �y .__ r l�� 6 A.3 ✓1 y 14.WATER ZONES Well Contractor Nam c -FROM i0 UESCRtTT1pN .) J l ii ft. R. NC Well Contractor Certification Number H• ft. l5,GuTER CASING(for null-cased wells)OR LINER Of obit tiu.r Es'••'rC Ch- l r f INAMEi6R MATERIAL 110"!' Company Name r i!,�/t FROM R• 70 i THICKNESS ) ,,/ la. t 16.INNER CASING OR TUBING(remberatrt closet! ii: 2.Well Construction Permit#• A CLOG.L.6 , ;f e FROM TO DIAMETER '1 !¢1 List all applicable well constatchan pt ..rs Mr.111C.County.State,YaNmtcc,etc.),, ft. R, TNIG7CN�1t MATERIAL i PeriPt,/Iia✓5 W a..:Y•e a 3.Well Use(check well use): ft. . �- 1s ft. in. I; Water Supply Weft: 11.SCREEN OAgricu]Uual ❑MnnicipallPubli+ FROM T( DIAMETER _ SLOT SIZE TII)acro1 , MATERIAL mal(Heating/Coolingit. ft to °Geother Supply) C7Raidetnial Water Supply(single) ft. R. at.. _........_.__. °IndustrialCommercial ❑Residential Water Supply(shared) °hrigation IL GROUT ---_.. °Wells 100,000 GPD FROM TO MATERIAL EMPLACI MENT METHOD a AMuvyi Non-Water Supply Well: if, R °Monitoring ❑Recovery Injection Well: �,.^�un R' fc °Aquifer Recharge Uit`avdwater Remediation ft. ft,� °Aquifer Storage and Recovery ❑Salfimity Barnet19.SAND/GRAVEL PACK(If appiip►k) FROM Ter MATERIAL I EMPLACEMENT METHOD - °Aquifer Test OStormwater Drainage , A. • tr. °Experimental Technology °Subsidence Control tt. ft. °Geothermal(Closed Loop) °T�rac^er 20.DRILLING LOG(attach sddideasl sheets If meow)) • - OCeothertnal(Heating/Cooling Return) tyDtIIef(explain under/#21 Rtnnarks) Moat TO DEScalrnON(too r kW/elk N1Utaek IT-Pet e�►t• ,aic.i_�,, 4.Date Well(s)Completed: Well ID# 1 If 4 2 pZ} ft' -1.�7� �R�Ot'��rofT t,V.i�t� C.� So.Well Location: ft. ft ---- ferny D,ve.}pour>v ieya,,veil Sbprf 4 S./e . t))eV76(9Yl�' rt. n. ._.__ ,.I' fiAcility/thrrRrNantc Facility lt)s(if appiicsbk) ft. n NOV 2 11,�� - -.__._._ a .2 12.7 Z��JL"tv,,rr�° 131✓t��,7�a.etc..ToN✓-ilk'j 2�5 S•'Ei' ft. ft. I Physitnai Address.City,and Zap ft. g j y, "'" tJNile111 '/.3 71/30 y7,S'il(4 21.REMARKS County Parcel Identification No.(PIN) r, 3b.Latitude and longitude hi demos/minutes/seconds ees/ndnateslseconds or decimal degrees: seta. .A el sch..fie+-*r c. fo r�e.o,.,.5rre c f a,v g ts1a.;i,s (if well field,one 1atAong is suf icicat) 22.Certification: 3t1.7111 lye t N ` .77, 361I00 W -;7.-------- Q ('��7 Yermanent or °Temporan' Signature ofCt Certified Well Contractor Data6.Is(are)the well(s): 111 I�^ -' He stewing this s-m.1 hereby certify that the nails)war(acre)constntried in at•conlauce with 7.Is this a repair to an existing well: °Yes or tiltl I SA NCAC 02C 0100 or 13A NCAC 02C.0200 Well(:ansintcrion Stasda,th and Mar a cop' if1his is a repair,Jilt ate ittoaw 11w11 coastnwyiaw nsfarstrrrioa and explain Me nantrr of the ofthis record has been provided so the nrll onaer. repair wader$121 rvma,*e section or an the hash of this Coral. 23.She diagram or additional well details: ' 1.For C.eoprobeJl3l'T or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well construction info (add'See Over in Remarks Box),You may also attach additional pages if necessary, construction,only i OW-1 is needed, Indicate TOTAL NUMBER of wells drilled: 24.SUBMITTAL INS£RUCTIONS 9.Total well depth below Wad surface: .5-7 tt S 2 For multiple wens list all d.Prhs il,,tp re,,,(.a.,ple-ara,.ton'and 20100) (R') Submit this CW-1 within 30 days of well completion per the following: 10.Stake water level belowtop of casing: f 24a. For AI) Wells: Original form to Division of Water Resourc: (DWR), (R) Information Processing Unit,1617 MSC.Raleigh,NC 27699-1617 ,i!;;� If tower level it shave caeiug,tar"+" I I.Borehole diameter: tt 24b. For Infection Wells:CopyI ;; t (in.) to DWR, Underground Injection Control iIUC) �nii!r< Program,1636 MSC,Raleigh,NC 27699-1636 i. !t, ' 12.Well construction method:• L'7 ttx._.51)1V t 4 i (i.e.auger,rotary.cable.direct push,etc.; - 24c.For Water Supply ant!Ojetr Loup Geothermal Return Wells;Copy to the county environmental health department of the county where installed ill FOR WATER SUPPLY WELLS ONLY: li:, 24d.For Water Wells producing over 100,000 GPD: Copy to DWR,CCPCUTA t' " l 13s.Yield(gpm) Method of test Permit'Program, 1611 MSC,Raleigh,NC 27ti49•S61 t • !13h.Disinfection type: Amount: - Form OW-1 14400 TERRATHERM SIW Boring Construction Detail Revision#: 0 Releasedate_5/12/23_ Approved by: SL • Well ID M-46 Date (a, ~ Oversight V' BC4tA3111 Job# R23-104 Driller Ke 117 (71-0 f)'+ Design Constructed Notes (fill out if different) 1/2"Thermocouple pipe? Thermocouple Length 58.67' --Heater Stick Up Height 30" SIW Stick Up Height 18" Ground Surface 0.0' ___ Conductive HT Grout Angle from Horizontal 90° Heater Can Schedule 80 Heater Can Length 59.5' Borehole Diameter 7" Heater Can Diameter 3' 5 Gal Buckets of Graphite 2.25 SIW Riser Length 51.5 ft Bags of Mika 3 Screen Length 2 ft Screen Material Bags of Cement 10 Stainless Steel Fiberglass Top of#00 Sand 30' Other: SIW Slot Size 10 Bags of Sand 7.5 Screen Diameter 1" Gallons of Limestone 7.5 Installation Method Sonic Top of Screen 50' Direct Push Hollow Stem Auger Mud Rotary Other: Bottom of Screen 52' Bottom of#00 Sand 54' Conductive High Temp Grout Bottom of Borehole 57' Post-Installation QC(to be performed 24hrs after Installation) PID Log:Make/Model: (7 1)Confirm well is free of grout Design Constructed Time: ''"4 t 4 C Reading: j?t PPM (D Depth to bottom of well[ft bTOC]: sq s' Time: "—"Readtn I)I , j 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. Time: Reading: PPM Date Depth to Grout[ft bgs] Notes: