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Home My WebLink AboutGW1--07056_Well Construction - GW1_20231102 WELL CONSTRUCT ON RECO ' For internal Use Only: I.Well Contractor information: t(i (,' A iv - _ ---M.3�hTF,It 7CtNFS wetl C'oaoatxor Name - iRdM1i _.. ,_TO riCRIPTION --- 3O ,. t it. ri, NC Well Connector Certification?srrmbcr ft. ft 15.t)VTER CASING_fnr multi-eased well) OR LINER fif lNOM ... c em,poay Nam L r7tOlri otAmErER THICKNESS MATERIAL___17, ft in. Z.Well (� I6.INNER C".A.SING t)R 1111RtNGAgeesthermal closed-logy .. �."'W_ VW_�CWIstnietiorPermit#:iyA cot4 6 ; er _To nIAMEISR IMC10E:SLS MATERJAty List all applicable well eotottrtcttan per n. �(�rs, (i.e..UJC County,Stale,Variance,ere.), rt. • __ ` cheek wen one): -- _ _.______..._.._. 3.Well Use n. r!. in. Supply Weil: 17.SC'T REN _ -.. l7 icuieattel FR -4__ To nrAMCTfta SLOT SIZE THICKNESS--..........-____..........- --- Wider MATlr-RIA).- ry OM unicipaliPublic Ft, rt, in, DOcothennal(Heating/Cooling Supply) QResidential Water Supply(single) - °htdustrinUCommercinl °Residential Water Supply(recta PP. tled) _ _ 1R.GROUT _._.....,...._ Ohrication DI/Veils> 100,000 GPI) room iv Pion-Water Supply Well: - - MATERIAL; p1ilPtAehtP1 MfTlf(Ip3 tni<iu -ft. ft ❑Monitoring ❑Recovery __ __ _.- ttjeetion Well: ._.. t!. ft. C7Ayuifer Recharge EL n. —- g ervundwiuer Retnedie +tion _ °Ayuifrr Storage and Recovery OSalinity Barrier , 19•SAND/GRAVEL PACK(il-wxTpiical ) PROM TO MATERIAL eel Pt�ctnraNr METHOD 1lAyurfer Test OStormwater Drainage ft. ft.. . lExperimental Technology OSubsidtnce Control ft. h. °Geothermal(Closed Loop) °Trac:er r---__. 0 21).DRILLING LOG(*tomb additional sheets ` s}erlIf n ecesaory) - ors arriON(mbr,htrdness,tolunx4r rc,t;+r.,�.t:LOCieothertnal Heating/Cooling Return) •her(explain under l2l Remelts) ra(MTn a.11)ate Weli(i)Completed: Well Tll1t �� -j y +�0 ft* . " S" ' 1 acr.�'1)ale / i.CI 50.Well Location: te It — —w /e Orve.J'sw,tr e er%Ssrtt mist- t�',t. I! j}0 silt if ir R FrivilitylOtener Name Paeility t Me It•vdran ft. ft. , a 1f..... let 2147 t t) e /3/VVri J etc ,,✓>•j. /,. 2t.5'y‘ ft. ft. NOV J 2 2023 ___...,. Physical Address,City,and Zip ft; ft. Cranny Parcel identification No.(PiN) f 0X _ _ _. 5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: gee.4, A e+t Ac-h_° "r t (-foe co,,v,�tr"a�►JC tit,w>el t`tot r S (it'well field,one tat/long is sullietent) 22.Certification: W --,�--_--- _ I c Its 23 6.is(are)the well(s)t lW rmanent or OTempaorary Signature of Certified Well Contra tnr Date .is this aHy signing this form.t hereby ectlifj that the neeilto)was(nekav)e'on.soireted in accarr/cnn•r%vats repair to an existing well: CD Yes or tileVr, 114 NCAC 62C. 0100 or lid Wale MC.0100 Well Cbhstnrrtion Standar*aid that a cop it this is a reptitr,"till Out know,,nWil(onsntaaian itifininattan and t'.rplaat the nature of the, of this record has hues,pra,.9ded ro the,met mrwer. repair under 021+errant,section or an the bat*of this fitiar 23.Site diagram or additional well details: You may use the back of this page to provide additional well construction info ' tl.For(:eoprobeiDYT'or Closed-Loop Geothermal Wells having the same construction only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells (add'See Over in Remarks Box).You may also attach additional page if necessary, drilled: 24.SUBMITTAL INSTRLtCTiONS 9.Total well depth below land surface: /_ 1 't' .2 For natlttple neat Ito all deptks ifdii rent(examipl (i(20a"am It 10s1a» (0) Submit this C;W-1 within 30 days of well completion per the following: W.Stadc water level below top of caning: '( ) 24a. For All Wells: Original form to Division of Water Resources (DWR). if denser level is above,casing,asc„+ (N information Processing I1ntt1617 MSC,Raleigh,NC 27699-I ti l 7 11,Borehole diameter! g (in.) 24b.For Inlet**,Ws11s:Copy to DWR,Underground Injection Control.(10C) t Program,1636 MSC,Raleigh,NC 27699-1636 12.Well construction method: i f Gl l9 rVt t '""'""_ 24e.For Water SupplyaridWells;Open-Loop Geothermal Return ells.Copy to the (i:e.auger,feisty,cable,dim.,yeah,*KO county environmental ealth department of the county where installed FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPO: Copy to DWR.CCPCt1A 13a.Yield m permit Program, 1611 MSC,Raleigh,NC 21 9-1611 (gP ) Method of test: 13h.Disinfection type: Amount: Form OW-I •- .. '0,4 TERRATHERM SIW Boring Construction Detail Revision#: 0 Release date:_5/12/23_ Approved by: SL Well ID 14-34 Date 'Q `p<a "a"S Oversight tb 1 '1 Job# R23-104 ' Driller i_' i.,A Ill'/(Y Gal r 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 111,Angie from Horizontal 90° Heater Can Schedule 80 Heater Can Length 59.5' Borehole Diameter 7" Heater Can Diameter 3' Gal Buckets of Graphite 1a5 1/.Q SIW Riser Length 51.5 ft Bogs of Silica k ti Screen Length 2 ft Screen Material Bags of Cement / 3 Stainless Steel Fiberglass Top of#00 Sand 30' Other: SIW Slot Size 10 Bags of Sand 7.5 1 Screen Diameter 1" Gallons of Umestone 7.5 Installation Method Sonic Top of Screen 50' Direct Push Hollow Stem Auger Mud Rotary Other: Bottom of Screen 52' U Bottom of 800 Sand 54' Conductive High Temp Grout - t a 6 1 ,�, `0' Bottom of Borehole 57' Post-Installation QC(to be performed 24hrs after installation) BID Log:Make/Model: 1)Confirm well is free of grout Design Constructed Time: 1 ! :3,0 Reading: (�.('1 PPM �' Depth to bottom of well[ft bTOC]: FA c' —Time. t�� -pp ,C, if greater than or equal to Ift less than designed alert the office Time: ° Reading: Q, 0 PPM e V G 2)Confirm grout plug reaches ground surface Time. 0 Reading: 8)6 ( PPM repeat daily until depth to grout is Oft. Time: Reading: y 1 PPM Date Depth to Grout[ft bgs) Notes: