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Home My WebLink AboutGW1--07076_Well Construction - GW1_20231103 i' I WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only: • I.Well Contra • ctor Information:' j y thl./t(i t tt,-/'v1 W t m lie e r,I y • 14.WATER ZONES I I. Well Contractor Name FROM TO DESCRIPTION v 7 U' fr. ft. NC Well Contractor Certification Number It ft. / 15.OUTER CASING(for multi-cased wells)OR LINER(if ap !liable) 4I-Sc 0.�,d e. 2 r, /l/n/CC7 FROM' {I TO DIAMETER THICKNESS • MATERIAL Company Name ,, J !'t. + ft. in• . 16.INNER CASING OR TUBING(geothermal closed-loop) 2.Well Construction Permit#: , A CLIRC L(4 „�=f d FROM TO DIAMETER .THICKNESS MATERIAL List all applicable well construction lie nits(i.e.'UIC.C'mmty,Stale.Variance,etc.) ft. ' ft. in. • Pe Id 3.Well Use(check well use): � �� ft. ft. In. • -.-- • Water Supply Well: 17.SCREEN DA*icultural • FROM TO .' .DIAMETER' -SLOT SIZE THICKNESS MATERIAL OMunicipal/Public ft. ft, . ' in, OGeothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) , ft. ft.• in. Olndustrial/Comntercial ❑Residential Water Supply(shared) - - 18.GROUT Obrigation °Wells>100,000 GPD FROM ' TO ' MATERIAL' EMPLACEMENT METHOD&AMOUNT Non-Water Supply Well: ft.' ft. ' • °Monitoring ❑Recovery . • ft. ' ft. ' Injection Well: . °Aquifer Recharge GGC,roundwater Remediation Ib ft. ❑Aquifer Storage and Recovery rr •❑Salinity$e er • 19.'SAND/GRAVEL PACK(if applicable) • - . FROM TO MATERIAL • 'EMPLACEMENT METHOD ' °Aquifer Test ❑Stonnwater Drainage, • •• • It' • ft, ' ❑Experimental Technology ❑Subsidence Control ft. ft. . OGeothermal(Closed Loop) °Tracer • 20.DRILLING LOG(attach ndditlonnl sheets if necessary) ' DGeothermal(Heating/Cooling Return) then(explain under#21 Remarks) FROM i TO DESCRIPTION Icotor,hardness,salUrock type,6rarn size,etc.) • ft. .Z S ft. / 4.Date Well(s).Completed:le) '' ell iD#• /-/e.--0/ ft. / -ft: tIr-i v:y ( a.tir•f Z s-al./v A• 5a.Well Location: ft. ft. / • i '�SC' °We-PO�r CJ ver S:,iit uyL S.Ye NO)e zyb y9y`1 q It. •ft. . ,.,v. ..P i - is -77 _I . Facility/Owner Name Facility 1D11(if applicable) . ft. ft ,T� • 2/z7/Je9i+.ve' /31✓6taw.ehsorl✓�ilei 2' "YZ . ft. ft, NOV2��Z;i --- Physical Address,City,and Zip 'it. ft. Dnvslo 1/3 71I3 7818 21.REMARKS i-, :.'.;OCa.„ County Parcel identification No.(PiN) /7/eA' r-`co-,-± (N.'-"i, yeyod cr'•e;e fr ;,70,Coe./( Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: S'tcn, c�Gh LrPSeh n a f r c fo r L'o,v.S1 t W C f'r n a'GIy /CL I lS Of well field,ld one Iat/long is sufficient) 22.Certification 3ir:7 7/ L/G 0 N :77.:.3Ctb / /I 410 --c 1-4:c°/-te2le.er Signnturc ofCcrtic WConrrnctor Date6.Is(are)the well(s): l rmanent or OTemporary 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 NttlVo 15A NCAC 02C.0100 or 15A NCAC 02C'.0200 Well.Construction Standards and that a copy If this is a repair,fill out known well construction infhrnmrior,and explain the nature of the or this record has been provided to the well owner. repair under 021 remarks section or on the hack of this form, 23.Site diagram or additional well details: You may use the back of this page to provide additional well construction info 8.For CeoprobelUPT or Closed-Loop Geothermal Wells having the wine '(add'See Over'in Remarks Box).You may also attach additional pages if necessary. construction,only 1 GW-1 is needed. lndicatc,TOTAL NUMBER of wells drilled; • ° " 24.SUBMITTAL INSTRUCTIONS 9.Total well depth below land surface: "f/- (ft.) • Fa multiple wells list alldepticc i(di(fereut(example-3 rr 200'and 2 re I00� . Submit this GW 1 within 30 days of Well completion per the following: 10.Static water level below top of casing: it (ft) -24a.•For All Wells: Original farm to Division of Water Resources (DWR), If water level is share casing,use"+^ Information Processing Unit,1617,MSC,Raleigh,NC 27699-1617 II.Borehole diameter: (in.) 24b.'For Injection Wells:Copy to DWR,Underground injection Control(IUC) /� ,, Program,1.636 MSC,Raleigh,NC127699-1636 We ll ell construction method: 10 0.--.5.011/1 • • 24e.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the (i.e.auger,rotary,cable,direct push,etc.) county"environmental health department of the county where installed FOR WATER SU P1 LY WELLS ONLY: . i , i 24d.For Water Wells producing over 100,000 GPD: Copy to DWR,CCPC1)A 13a.Yield m Method of test: Permit Program,1611 MSC,Raleigh;NC 27699-1611 (gnu)' '. I I3b.Disinfection type: Amount:, • • • • Form OW-I. North Carolina Department of Environmental Quality-Division of Water Resources Revised 6.6-2018 • I I • I A.,f,i,*TERRATI-IERM , . ISTD Heater,Boring Construction Detail Revision#: 0 C,i,, a vs=on Camay, Release date: 5/12/23_ , • Approved by: si. ,. . Th, Well ID ', 1100113 Date icV"1 fr°2• . , Oversight 't _S Q. ..,S'4‘......... Job#, R23-104 , . Driller I eciletv ' ' /,,.4- Aer/t/ .40... Constructed • (fill out if Design different) Notes -Length of Can Stick-Up(ft)/ Height of Can Stick-up Above 1/2"Thermocouple pipe? rrs4.'":77,,N'Vf:''',), Ground(in) 3.5./30" Thermocouple Length ' 87.67' . ! . -Length of VEVU Stick-Up(ft)/ Height of Riser Stick-Up Above l' Ground(in) 11./6" Ground Surface 0.0' I tz-R i Heater Can Conductive HI-Gmut-- •:-..a;:, =%t'-c:i I Angle from Horizontal 35° Schedule 80 , _ •; --7- ,:_,..i • I Borehole Diameter 7 • ';'-5if.,,•,. 1 .....'" . t•.-7,4';', Top of SOO Sand „3,-- / • tfii•••=• 1 . .,..- t • ,---,•,Li •i-.-,: • Top of Screen ,g. 3 .._ ..: , ' Heater Can Length . 91 ft .4, ! ..,._,A,.,•5 Gal Buckets of Graphite 1 i .. . ....—N Heater Can Diameter 3 in. '-• I' •. Bags of Silica 1.5 ....,...,.,.. Screen Length 4 0 ow- ft 1 , Bags of Cement 4.5 , Riser Length 7 ft ,., 1 .N. I' . . . Screen Diameter 1 in ..I.1 •.1 - Bottom of Screen awl. 1 - - _ •' ' ,. . I II .. '. Installation Method ,;• ,.• • I • • 'e• . — .' •D -ct Push I, • • I 'I :2• , ' Bags of/10050nd , 28 Sonic ,0 low Stem Auger .•, ' ',•:,',`.- Gallons of Crushed ,• Mud/Rotel* 1 ' Limestone 28 Other: ' . , ,, : ; . •: 1 ' - • 1 , ,, 1 l' .. ,..• '.., ,•; Bottom of800 Sand i 76.5!,• i ,;lc-.:. ,L..j.te:•'S I , -tetk4A1 4.4 Bottom of Heater Can 87.5'1 v41;:•.: •,•-•".i:X.?.., , . •,-1,..7,4 FaAtE.,:t . • Bottom of Borehole 87.5'1 1 . . Post-Installation QC(to be performed 24hrs after installation) PID Log:Make/Model: 1)Confirm well is free of grout Design Constructed Time: J 6 v sr) I Reading: ep.0 PPM Depth to bottom of well[ft bTOC: i _ at . Time: pi. 13 0 1 Reading: cp_so .. . PPM If greater than or equal to lft less than designed alert the office Time: 1 2,230 . , Reading: 0.0 PPM 2)Confirm grout plug reaches ground surface Time: f 130 I Reading: 6-1.1, PPM repeat dolly until depth to groui is Oft Time: I Reading: PPM , Date ' Depth to Grout[ft bgs] Note.s: I I ,S 1 eTh, • 1 • , t 1 , , 1 ' '•'if'''.'."„1 • , .