GW1--07677_Well Construction - GW1_20231122

• • '• ,
' . , ' ' : •:, ,':-,•-;.•':. ,,: '_',.•-‘,'•':::••;-'.):-•'::-::: '":."J :,i'" •• • ' Z.
sb
,•.—--, ., LL,CONSTRUCTION RECORD_(GW-41; ' .`',' ;For Internal Use clAly:',..7.;.';.:'2,IY.t re,7'" ' -,, .,,. ,'• .-tp.-•
1,-Well Contractot Information
-.,- c , to,
, - , --ifbiA5e/ ,et.rovk-ey. . 04:.'39:ATERZONEgg,'1..it'.. .r..--::.i---',".1.7_. . . _ ... _=....i.-r3",eM-i .....
,
, -_ - - _ . . , .._TRord _ ',TO 1, r r,.. ._ •nESCRIP--TroN r
'.-' '',,'-`..-:•776111COntitetorNani: - . . ft. li` •ib'•' ft.; .:„ -.1' ,..'..:.:-•:..-n" ' - .
' • ' IDS .1 .-''".
' "-- -. " ' .'0.1)4 ( •' . ft.,', 1::'..".':; St...• - ','-I'''.-.' r-:'''-:'11;'''-'-'''.:'4''''''' ' ' ..
NC Well Con or CertificatiotiNuniber. -.- - - • .-. -' "- .
ilSt01:1TERCASING(failiiiffilti;elikedVells)!ORIZTERlifili'lfellili1)=P.ilnfat:::
. • ",' , Yedkih.Welt Company, Inc.. ' ' , :PRONE- TO •- ' .DIA1E17,R.. .'. .THICKNESS,, .., MATZOIAL.
+1'- ft• 1,,,,q ' 6..1.1S,' 101?-..,0 v:!'..'.Y,(10 C
binapanyNaiiie, .__. .. . _. _ . .,
1•16:IREIRt,CASINGONTEIBINGAilitliEffilid:eltifek480)=7_' ..—,...-1,-",-C.:14.,:
. . ,-,• . .
2.Well Ctinstettellotioarrat#: c,C,S<1 i__bfti,)' _ _ . . , „ . ..FRoM• . _'TO.'. DIAKETRR,,, THICHHESS,,,''. MATERIAL
,..... r _ -: ,..,. - . ... , .
al ea applieablemeit eonstillencinperitits Le. , aCeunsji Stritei Wiriaiick eta) ' ,:._. ft.: ' '-::: . A• : -1.,'T• .•• --, '., ;',,• ' ';,..'_•,.--•_., -
:',.•.... 3,Well Use(cheek iiielliiie): ft:• , _. ,ft. ;.' ". ;.' - in.
. . -.-..-- ., ,... • ._ - : , - -• ' ,IW.,T.CtiMft.H 21:- _;.:.--:: :.: -..::
. :WitellSigiplY W elli$ , •
•„?... . . '''.num :TO: . DIAME- TER, SLOT SI= THICKNESS, .MATERIAL
ClAttidultitral ElbeInnitipal/Pnblie
CICreotberrnal(Heatiiig/CoOliiig,Stifiply), .1Eleiticiezidal Water supply(single). . . •
• ...-• •,-..•..„ - • . • .
,...;,•: - ClInclustiial/Corintterefal Okesidential Water Supply(shared): '.•,,"---—•. ...:....-.. ___!_-___-........2"_____'..."_;_-__ _
• ;,i3.11:-..GROUE...._ ' !.....____ _ ____,
,,,-- ' Oltrigatitat,_"VVVVV I3Wells 5.100,000 GPD._ ._ . _I L FROM VV TO. ',MATERIAL _ EMPLACEMENT METHOD&AMOUNT
NOWAIRter Supply Well f: ft- --, -. ft. , :-' '' . -i - - , , 1 .,,,,''
- _C› ' ' 2,fr_to. Be.irtair.ic(4./.5. /7-lyc).14e i, Pio.,-e..,..
,.. . .,
' - ligeiiitdring,, DRecoyery , ft. ,,_
'',' ft. /1"-'''',5.61-L:. i.945
Injection Well ft ft . -
'.- • 1 _ i:
itiAcItiferket.harge, EIGteundwater Retaediation ,,,.....
- "- -
'419..SANDIGRAVE1 i PACIC(ifilifilfeaVe)i:`,1:::::::::::;-:-..- 7------7-7.-----:=7,1::::7 • ..
0A4iiiferStoragetOadRec'every OSalitlity_Barriet . FROM. To: 'MATERIAL . • ,.EMPLACEMENT METHOD.
..., ,
ClAciaifer Test ostorm'waterDrainage ft. ,.
•,'-', • 1 • . ,. ,_
•''.''''' ' ' ,DExperiniental Technology. CIStititideticeCeaitrol i
. . , . , .. - - • .., . , • ,_
, . .
','"':•.',„' ,_ "°Geothermal,(Closed totrp), Otte& ;r2IfIDRIUMIGI;OG:(ii,ft;thi."-.ii:dfd, 1611Aflieitilf:e&S 1111..)7.7....7.:::„.1., :,.. -_-11,...,, .'...r,..
-— ... •„FROM _ :TOL__ _ , •DESCRLPTION:(=lot,hardness,silIkaek type,grain,size,.ett.)
,':•:-"' ...EIGe.l.titlietuial.(fleatin gigsr e'- '),-, DOtliet(eitolainundes#21 Reinatics); i, 4.„, ..„...„... ,,,. , .,
Da:ONOII'starrecv5 .•, ... „...,, .„1, „.1 a_ --- 'L ./_E.? -. I? . ,,
6'I 4- 1-6,65e 1iis'-''s-e...-•' '' -''''''''
, / x, ' ' ft. ft. ;' . 0 .. .• / •-• - 1. it_,ii
-:-•,-;. 4,Date Well(s),Completed - ' ,:.:c.;,.._ Well Thitinif1P4__62_9'04-''' _ _ -10' ' /L-jir to. ' 4.0-6,-ey-I dtirip;S•v..' '..)ar 74-
..„... , .. - .
. •1)-1-11:F-i-hOn ..SA- 9.Si' 0497 i - ' . ' . .. .-.'. - . r,..-- - .•: •
- .' (11——44-1 %NG(1 g -- ,- -- , 1 cft,) , ti A 6. . , . .. .
Se.,Well Location. .,,.,.1,,, e,. .5,
Wail' ( , , .
ft.. !329 ft. - :: ,. °A, ..,,
: al .._ ..fq dot ok CP•tV -• 11 fs%-J.-'irt Ir-s)
.•' .• FacilitylditkiN- -, FddilftSODItlit iff)1511-cab10' ' ft.
•,. ,
- "--- — , 4 - ft.,
, 3 S El1a,-it) hal e ti <& -..11.":...,•-,-;. iA
EissiCalAddiess tity-andZik t ft ii.,....r,......,..1.p, -.-...-.
Z",•••',-3,•..Y.,i2•'.':';',-'1'-,-• .- ?. '
f°0 Vt'2
2
IFICIA/OLV-2_17.1:-.:
County Parcel ideatifidatiotiNO:(PIN) . .______ . _,..„ .. . ... . - . _
i'..',"•'..-• ;c7,-..3,,,t-:,
. . 5b.Latitude and Eingitddein'degrees/minutes/se tends'or decnn ,degrees., _ .. . . ._ , ,„ _.• ,.,,, ,.,.
!...•:,-.':- • (if field, Istaringlisinteient), -' 22.Certific:ton:
,,..... .
r .
-•- /
36., 2.„r:r 91_ _N ..k67-; *S. 9,..rq, 3
reP - Si 1,.- --•feetti4ecINV enctInteaetor' - , - - -.. . ' -' : . Date--..•.!:- ;,,,'...
:.''';'''.; . ',• 6,1,s- (are):the well(s) Of erman- ent' Or DT-mil porary , .- .
..:
gthieftitei;.There0 cer4f9 giaiihe7well(s)was Construction7fStandards and that I copy
• '',','..'",'•', If aft,'is or-epaft jiff ciiitte,iowiiVill etinstitction,Thformizttoil eferf explain the nature eftlie• of Mg'retoittlirs5e611 provided to the well exiiier.
repair under#21 teriiirfrateetion•or einthebatkefthisforht
23.Site diagrain,cir additionallieli,defailii, .. -,- '---:;„.-:,„''.. -"• .. '
•'..;.;.... ' .. ,. .
You may use the back of this page to additional'well construction info
.
8:For Gecipttibe/OPT or Closed-Loop Geothermal Wells having the Sallie You' (add'See oVer'in Remarks Bok).Yon May also attach arlditiOnafpaicailne6eiaai3i.
.f,•'; ..,..' eMistritctiOn.,.ofily 1 ovi4 id needed Indicate NUMBER of*elle. .
• - :, ... ,,_ ,,• .
chilled._ . _. _.._ ii__ : . .___ . . f. 2:--.-- -.'"''' ' -: -''-' ‘-'::r%:.:7,-.',:'.:,',.-.;:-:: ,''-'•• •
' 24.SUBMITTAL INSTRUCTIONS -- - - •-;"•-:'-•'..,,-.-r.-'-,-- .. .
. .
' . • , ,
9.Totalwell depth below surface -__ _ __ -3 :).-___ ___ __ (ft.):
•'' • • For imultiple wells list all 411a if different(example=3@200'atid'2®190') Submit this GW 1 within 30 days of Well,'.ZonfipleftOnier the iiloyein gi--•-:-. ,.
,...„- ,/,' , • , ". '`. , •':,-,:',.•'..- '...,,"'...,....'::.!!,": '.; -',." ; "-::' . -: . •
,. 24a. For_All Wells: Original',feria'.to;Division of Mater-.ReSourOel,(UWE),
::,:• 10,,Stade water level /0 below top,of casing ._________ 4d (ft.), Infokaation,Rroaaisinaunit;1617..hac;Raleigh,NC 7'699L1617
ifiveter:laiier it above casing;itit"-P!' •- -- ' ' . ' ' '-j,---- '• '-•-.'t-'1 -;'''..-'...,.%c_';','':::'''..,_-','-,,';'-':': ': : .'„ - ,
„
,... . 24b,letit listeetien,TWells:_Colifto"DWR.,.Thid,dtgrifinarl-Injection Control(IUC)
)Bit Off'6. 612- '-
.,,,,.4. .. 11.Borehole diameter _ .. -1 _. __ _.(MO i ,,,_,,i__ _„ ___._ _
PrograM,1036,MSCi Raleigh,N2627699-1036' •:-.';',,',- ' • , •
'R.
12.Well colistenctiollmethtid; -l'f 4' : 4ve V - 346.FotWatei:SaPnlyandiJneii-Loon.GeOtheinial Retain Wells:Copy to the
.•:,.).,:,. (ie.,angiiirotait cable;direct jiish,,etc) /.' cOuntydnyirtairnentalbealth department bfthed4un:15i-;0,,tdrd installed
FOR WATER SUPPLY WELLS ONLY: '''''•-',--s,
,
'-. 24d:For Water'Wells producing GPDf:COpy,to MR,CCPCUA
• . ii . . .. . ,
4A,,: i_,.-- . . . "Pemnt Progrard;1611 MSC Raleigh'1%1C 27699=16111474. ,
-1.
Od:.Yield(gpm) _, -5 (D., Alithed of testr.::If.77'4 '. __. . ___ •- ' - . ' ', .• . --.'-,.,' 'f.,•-...1`.."- .. , /-1,,p-4;A:- 2.0)' Ca..tS 37.V, \
-1'' '' • - - - - - -'-." . - , Date'Site Visited 'D.'7-01-1"---??3,f";"
•'``L" • ' - 70%,fitl$ ,i'L" ,- 6:2' -'' : :Visited'13 •:-; ( 3134:'4".•'
4.31i*,Disinfection typet: Amount:. _ _ , ,_,,., , ,Site x.. ..- , ,,.....,..•., - ,,. .., ,,, . p pg.- dtitt, .
—.--, - - - ,.., '• ' --,:: ',:•':,;-'..-",'-','''-1-,--';-..`1;"•;,.---:-:,f*.r-,i'•:.!',-.-.-:: - ' . i : 7 -A. • .'il
,.,. -• ' ;,,,,-;..,,,, ,•,..:•- :-•-•.:,-....,,,, ,..ic,ri.- , .. • si::::.F.,-,.....•__%_ 0:it.i./4. -.N.01"• ,/, '
..•,,../
%retina Department OfEnvironmenialQeality,blvision of Water Rescitird44,,••.--, . , Revised 6-6-2018-.'-,`
,",tr4•",,' _ -..-' ' ' ' ' .
• ' -:' '•
. „-.