HomeMy WebLinkAboutGW1--07102_Well Construction - GW1_20231103 . 1
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WELL CONSTRUCTION RECORD(GW-1)
1 I For Internal Use Only:
1.'Well Contractor Information:
•1 6%IIct;/vN W&./YJ1•er I y . .
Well Contractor Name. WATER ZONES 1 I
FROM TO" I DESCRIPTION
NC Well Contractor Certification Number ' ft ft.
I. i
/ I/0 15.OUTER CASING(tor multi cased wells)OR LINER(Nan !feeble)
0. dL T C icGC f,�"I.l�J�✓ FROM 1 TO !DIAMETER .`�•THICKNESS 4I MATERIAL ,
Company Name ft. rt. .l' I in.
2.Well Construction Permit' �.1/ ,Q [I�/�� /� 16:INNER CASING OR TUBING(geothermal closed-loop) . -
//7 /1 Z rl -Ae .FROM TO . DIAMETER THICKNESS MATERIAL
List all applicable Well coasn'trction lie urGs(Le..1//C,CO,,,sjt,State;Variance,ere.) ft:
ft. I ! . in.
3.Well Use(check well use): Pert.;//, AY 6a a ; lee _
ft. ft, In.
Water Supply Well: . • ..17.SCREEN' i •
❑Agricultltral ❑M FROM =TO " DIAMETER SLOT SiZE THICKNESS MATERIAL'
•
unicipal/Public ft, ft, , tn•
OGeothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) .
❑Industrial/Conunercial ft a: ln. •
Residential Water.Supply(shared)
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❑Irrigation 18.GROUT ,
OWells>100,000•GPO FROM. TO .• MATERIAL''' EMPLACEMENT METHOD&AMOUNT7
Non-Water Supply Well: ft.• •ft. .i , -
• ❑Monitoring • ❑Recovery
Injection Well: . , ft. ft.• +
°Aquifer Recharge lil3GroundwaterRemediation ft. ft.
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❑Aquifer-Storage and Recovery ❑SAlinity Barrier' • 19.SAND/GRAVEL PACK(ifuppllcable) • • .
FROM •• TO M1IATERiAL EMPLACEMENT METHOD
❑Aquifer Test OStonnwater Drainage .. ft. - ft:
❑Experimental.Technology ❑Subsidence Control ft. ft. .
❑Geothermal(Closed Loop) ❑Tracer • 20.DRILLING LOG(attach additional sheets if necessary) '
❑Geothermal(Heating/Cooling Return) tier(explain under#21 Remarks) FROM TO DFSCRIPTION'(coioq Hardness,colt-rock reps,grain srze.crr.i_
ft. ft. -— -
�j �+ t,• .ZS - iP.'hed®ekgrolsoi.:.rt►Q c�hc7
4.Date Well(s)Completed:/0—✓,) 2-3 Well II)#f f C 0 2 L•'
..7.-7) _ft. frr• y stir fZ S"aw
Sa,Well Location: ft. ft. "
/�L/e_ vnvc:}it,urelavvers S��c�t uv,�'SVt'' SeitY9y ft. • - rt, ..
Facility/Owner Name Facility iDi!(ifapplieable) ft. it. "' '''''.:;•
•2ix'7Z ,gvAreAlvdjTip.tYsoNt6viei •
2 - V ft. tr. NOV 2Q23
Physical Address,City,and Zip ' ft. ft•-
ONslo(�.a • . A1.114,1.30y•78)8. 21 , _ ,,._�= — .
REMARKS
County •1 -7...
iff!oz-a.ef-e',a. +'v
1, • Parcel Identifcntion.No.(PIN) � � �GtJ/�/tj ���►c i"�y1 fy.pc,;(`r.7.4., GL7(?I'
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: Sn!e ,f' aG}I ed�'eht�rna.•f•'t`-e fo.t'C[,,,sttc d f e0 Ar el eta its(ifwcll field,one lot/longis sufficient) I.
L u 7 22.Certif'cation:
I 9.0
N 77. 36td•tfU vl,
6.Is(are)the.well(s): tlrmanent or ❑Tempot•ary Signature ofCertified ell Con)rnotor' Date
By signing thisfornr,I hereby cc,lily t1 r (s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or 51‘ - 1SA NCAC 02C.0100 or RSA NCAC 02C.0200 Well.Construction Standards and that a color '
Olds is a renal);fill known well construction info,ntatio,and explain the nature of the of this record has been provided to the ire//owner.
repair wider(121 remarks section or air'tieback of ibis fdmnt. •
• 23.Site diagram or additional well details:
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well construction info
construction,only I GW-1 is needed. Indicate:TOTAL NUMBER dwells •(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: • I ,/ b.• ' ft•
For multiple wells list all depths i[di(ferent(exa,rple I3 rr 200'dnrl2C100' ( ) Submit this GV1'-1 within 30 days of well completion per the following:
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10.Static water top of casing: ,, •24a. For All Wells: Original fo�rl to Division of Water Resources (DWR),
/f water tic is above level below use"+ ( ) information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter: . on.) •
24b.For.Iniectton Wells:Copy t i DWR,Undergraiirid Injection Control(RUC)
Program, 1.63E MSC,Raleigh,NC 276
1299-1636 •
.,Well construction method: h:1 d.�0.;J .!UI`C
.huger,rotary,cable;direct push,etc:) • •• 24c:For Water Supply rind Open-Loop Geothermal Return Wells:Copy to the
c•
ounty•environmental health department-of the county Where-installed
FOR WATER SUPPLY WILLS ONLY:• • . 'I 24d.For Water Wells Producing:over 100,000 GPD: Copy to DWR,CCPCUA
•13a.Yield(gpm) Method of.tesf: Permit Program;'1611 MSC,Raleigh,NC 27699,1611
13b.Disinfection type: Amount: - 4 I
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Form OW-1 North Carolina Department of Environmental Quality-Division of Water Resources
Revised fi-1.O I R
`' I51 D Heater Boring Construction Detail Revision#:_i
•TERRATHERM Release date: 6/14/23_
°�" """�M' Approved by:
5 Well ID !HC-02E Date ' 4 n
�`� Job#I R23-104
Oversight 1 t3 2 L 01 �'
Driller ‘„#/e , i I 1
L, J O � NI r ;4)a le �- j
/ Constructed
(fill out if
Design different) Notes
Length of Can Stick-Up(ft)/ j,
Height of Can Stick-up Above
1/2"Thermocouple pipe? 'wad rP*R r' Ground(in) 5'/30"
Thermocouple Length 77.29' -Length of VEW Stick-Up(ft)/ I'
Height of Riser Stick-Up Above
Ground(in) 1.5'/6" 0 In
Ground Surface,MO' ------- I,
Heater Can Conductive HT Grout `.% a•" '
', • .ngle from Horizontal 22°
t
Schedule 80 'Y
(f) `, '�y'.Borehole Diameter 7"
f
rt
, _46 Top of#00 Sand 21.5'
F _ `- Top of Screen 24 5 p t.t
Heater Can Length 81.5 ft
',1,;‘A 5 Gal Buckets of Graphite 2.75
'�"'� Heater Can Diameter 3 in =L.� � _�`� Bags of Silica 3.75
Screen Length i/a OP ft r � Bags of Cement 12
Riser Length 29 ft ,k
P..'A ( `
Screen Diameter 1 in r s 1 Bottom of Screen a4:9' 319.s
Installation Method I ' '4t:
Direct Push , Bagsof1100Sand 14
Ho ow Stem Auger ;1'- ' Gallons of Crushed
Mud Rotary tc. �� t Limestone 14
Other:, t ., ,,�% ,
r fC Bottom of#00 Sand 61.5'
ti ?Bottom of Heater Can 76.5'
N
:A, t l 1 ` Bottom of Borehole
Post-Installation QC(to be performed 24hrs after installation) PID Log:Make/Model:
1)Confirm well is free of grout Design I Constructed Time: oQ ;fl d7 ! I Reading: f)a O PPM EP ' c
Depth to bottom of well[ft bTOC R1 R1 Time: Q -, I I Reading: c)'' , 0 PPM
if greater than or equal to 1ft less than designed alert the office Time: 0 LI ( I Reading: Q. ,Cj PPM
2)Confirm grout plug reaches ground surface Time: ;,Q5 1 1 Reading: , d.j PPM""'" r
Notes:
repeat daily until depth to grout is Oft. I Time: I D: I.- 1 I Reading: 6'ti ILO PPM /,--7-
Date ` ,Depth to Grout[ft bgs]; ) S : I
t I of