The URL can be used to link to this page

Home My WebLink AboutGW1--01533_Well Construction - GW1_20240312 Print Form 1 WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only: 1.Well Contractor Information: Austin Fowler 14.WATERZONES FROM TO DESCRIPTION Well Contractor Name ft. ft. 4366-A ft. ft. NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells).OR LINER(if ap licable) __ CATLIN Engineers and Scientists FROM TO DIAMETER' THICKNESS MATERIAL ft. ft. i in. Company Name N/A .16.INNER CASING OR TUBING(geothermal closed-loop) 2.Well Construction Permit#: N/A FROM TO DIAMETER THICKNESS MATERIAL List all applicable well construction permits(i.e,UIC,County,State,Variance,etc.) -3.72 ft. 30 ft. 2 'n. 0.010 PVC 3.Well Use(check well use): ft. ft. in. Water Su I Well: 17.SCREEN PP Y FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL %Agricultural 0Municipal/Public • 30 ft. 40 ft. 2 in. 0.010 0.010 PVC *-Geothermal(Heating/Cooling Supply) DResidential Water Supply(single) ft. • ft. in. %Industrial/Commercial D Residential Water Supply(shared) 18:GROUT .. !P'I Irrigation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT Non-Water Supply Well: 1.5 ft. 28 ft. Bent. Chips Surface Pour ®'Monitoring DRecovery ft. ft. Injection Well: ft. ft. • *Aquifer Recharge DGroundwater Remediation 19:SAND/GRAV.EL PACK(if applicable) RI Aquifer Storage and Recovery D1Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD III Aquifer Test DStormwater Drainage 28 ft• 40 ft. #2 Medium Sand Surface Pour ®,Experimental Technology DSubsidence Control ft. ft. %Geothennal(Closed Loop) DTracer 20.DRILLING LOG(attach additional sheets if necessary) I Geothennal(Heating/Cooling Return) DI Other(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness,soil/rock type,grain size,etc.) ft. ft. 4.Date Well(s)Completed:2-14-2024 Well ID#C-32R ft. ft. ft. ft. 5a.Well Location: • Geosyntec ft. ft. SEE ATTACHED Facility/Owner Name Facility ID#(ifapplicable) ft. ft. r? r 100 Farmers Chemical Road, Winton, 27986 ft. ft. ' '"� ,L'L t- V x--L.• Physical Address,City,and Zip ft. ft. MAR 1 2 ?OM Hertford 21.REMARKS - _' - County Parcel Identification No.(PIN) Inter rhokt .;1 tPr-,..—. 7a:::,i Iii;i Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: (if well field,one lat/long is sufficient) L Certification: (�v//V/1 ,r F. 36.371308 -76,859757 N . W 2-28-2024 6.Is(are)the well(s){Permanent or QlTemporary Signature of Certified Well Contractor Date By signing this form,I hereby certify that the well(s)was(were)constructed in accordance , 7.Is this a repair to an existing well: DYes or DNo with 15A NCAC 02C.0100 or 1SA NCAC 02C.0200 Well Construction Standards and that a If this is a repair,fill out Anolln well construction information and explain the stature of the copy of this record has been provided to the well owner. repair under#2I remarks section or on the back of this form. 23.Site diagram or additional well details: You may use the back of this page to provide additional well site details or well 8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if necessary. drilled: SUBMITTAL INSTRUCTIONS 9.Total well depth below land surface: 40 (ft.) 24a. For All Wells: Submit this fonn within 3Q days of completion of well For multiple wells list all depths if different(example-3@200'and 2 a.100) construction to the following: . 10.Static water level below top of casing: (ft.) Division of Water Resources,Information Processing Unit, If water level is above casing,use"-•' 1617 Mail Service Center,Raleigh,NC 27699-1617 11.Borehole diameter:6 (in.) 24b.For Injection Wells: In addition to sending the form to the address in 24a above,also submit one copy of this fonn within 30 days of completion of well 12.Well construction method: HSA construction to the following: i (i.e.auger,rotary,cable,direct push,etc.) ' Division of Water Resources;Underground Injection Control Program, FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636 13a.Yield(gpm) Method of test: 24c.For Water Supply&Injection Wells: In addition to sending the form to the address(es) above, also submit one copy of this form within 30 days of 13b.Disinfection type: - Amount: completion of well construction Ito the county health department of the county where constructed. i i Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016 WELL CONSTRUCTION DIAGRAM - EPA TYPE II WELL (STICK-UP) JOB NAME: C.1:: Wilatx4SINL (] eosyritec '> JOB NO.: (;4 75(c,co _3 g C � consultants DATE/TIME: 2f!`j Z /1200 WELL NO.: , WELL LOCATION: iicfr it fe6fl.U,[ lyd FIELD REP: f3NorCram R.str LAP) L GROUND SURFACE ELEVATION: (ft,ms1) BENTONITETYPE: N IAL CHIPS —ON tD —Kelm TOP OF SCREEN ELEVATION: (ft,nisi) MANUFACTURER: tWdigs)c'wLr BOTTOM OF WELL ELEVATION: (ft,msl) CEMENT TYPE: III tali S-raENE`m NORTHING: ' EASTING: CEMENT MANUFACTURER: 'te SCREEN MATERIAL: PVC SAND PACK TYPE AND SIZE: 1Npp I SCREEN MANUFACTURER: 5I(vM,ttt.Er IMI)fikQ7G SAND MANUFACTURER: AS I RISER MATERIAL: Ni,. DRILLING CONTRACTOR: CTWN RISER MANUFACTURER: 51LVE(L Lit,,E EMU Vott AMOUNT BENTONITE USED: = I bags 6t1bs RISER DIAMETER: 2- (in) Length: '33,12. (ft) AMOUNT CEMENT USED: (p bagss"L Ibs SCREEN DIAMETER: Z (in) Length: lb (ft) AMOUNT SAND USED: ; t() bagslCE,61bs. BOREHOLE DIAMETER: it [2 (in) STATIC WATER: 'gli depth from TOC DRILLING TECHNIQUE: 14 S R Size: `i 'Ai (in) ENCOUNTERED WATER: '2.0 1:31 depth from ground WELL DIAGRAM Protective Pipe Stick-up Height PVC Pipe Ground Surface 3,71 (L xw xi+) Z04. .Z.. 11N•$ Dimensions of Concrete Pad r III El . R ` _ Length Of Riser ' I1t�.CO_ 26. Depth To Top Of Bentonite Total Depth Of • Depth To Bottom Well : : Depth To Top Of Sand Of Hole yQ iIi S _: vl • C zrf ILLS r — Length Of Screen e =e = itci Length Of Bottom Cap 40 (dr25%-i) } Length Of Sand Base -IN(t-� .yiv. . Cement/Bentonite Grout • Sand Pack 44# Neat Concrete Bentonite MI Bottom Cap QA/QC INSTALLED BY: Awl fd1NLE12 OBSERVED BY: ' AJNlJ-cJ j�e'.77 DATE: CHECKED BY: DATE: Geosyntec Consultants Geosyntec Boring Log consultants DRILLING CO.: ()IT NJ . SITE: CF NITRUL•ivN Bolting fi ID: C-3 Z.R DRILLER: �'1A EC ., Sheet: i of V 5711J PROJ TNO 4N 7'�Gtr. /07`t7 i DRILLING METHOD: i4c,A. DATE STARTED: Z 14 14 Borehole Location Sketch Map/Reference RIG: CME y 13 DATE FINISHED:Z/14I Zy x•ftwocw.vo C 3L BITDiAMETER/TYPE: 4t/2I Aukt 2 SUPERVISOR: ,(4volitlo 'gar t..mLL__? SAMPLE METHOD: LATtINt PHOTO TAKEN: 'IBS 0 -(-33 MIMMIIIIIMIMIIIIIIMIIIM Lithology Log Depth USCS/Rock Run Reg SPT/ Notes/Sample ID/Water ft(bls) Time Level [Secondary/PRIMARY soil type,color,moisture,trace content, _ Type (No.) (N RQD density/consistency,plasticity,grain size] 6.5- 0.s P N.40_ 02.67AN1t--5-Cr2 s.<t,.,/ems, e0 ko-Z4J SAND4 CORN (A./iv? Ca), (1Nr613) ' 1.I(4H713Qt31niNi P4015T-VR.`7, 5 '7, HEW1.,r4 CL S — 5 =- G'c45- i74414 rI(All ..-V)5 - . CLljyEy 5AND C5p.-SC), Boa-, Sot2i p . meolVMS tNDi 151-PR4/ SOF-1-Lmeie, SP-SC e w14e-cquM 91149-B71ciiy1 f iclu jOut41. r egovr i _ SRIZ b .� ip � �• ..--- iLEP) ?cola,/ Sow-reo 11LolvNi se S i l'Zi C ic-t /3) c.7 't3Fi'wr1 Moo Cnn)Liiii-7 Groot/ Lcfir5E1 1O 51, law- t 1 (vcN-pr,Aszu., 'T42(KE3 e USN. - 5ANb csr) Peanut Se¢Zeo Meotvwt Or* i S 1,5 ^7 pQSS FtlrE S J ) 60'tt;.Ui3)U wer B(-tw►", Mio 11.41t l,ct 1.-ces4Je, HO1S r -20 - Zl9 Lbc -- Sflly) (SO Pc )'(.S-? ftlk-reOW7vl .47,,za ilt•ro i.I�HT ?)11.1 0514 yll, IA1, Mot51, 5 P 4.-- r.clsi- gv ._ 30 �golO i NCE2 .iMa 5tr'og-ftur+NJ, '7i, ini-17LASt1 - • < ` 3e .7, ` sa...seN S -L�iY tTY C SP-SC) •1 % % ttif�-tt �vR/LtiO S� SC 3S-- 3c -- 10iS - �1N*-I-leptmwt 5 IUD, Viol'5-1-vimI ti • %We 7 SO-au tow,tit01 OA 9iAitICI y,( 116-17►uMkati-LOW ' i._ 40 - ip20- AND ouvECdZ %4 C6�1 4/I) /. 3V.L bYs� 43- Li -- cPositoi Uh,l . [4i) tI litc w rrk VOA- _ _ .. , yce ' s Ft we-MLv1un'! 5flnop, wt:J, t->ut% C(i -. ; _.- tt5 --i 3d 0. et1t,-ricczyi CNS) 1-t O i:ra ll, S°?"l. t. s aA Filex _ 6cREHci.e -real moo) h7 'is* '3-s 11.-4,,....` - 2-i -7y ,It, t ocr..I'il5a;lp mais1r¢Is CarrtEuf BSc-t V t c e i' + Cp,5 R-fU2A-r,to j . Z Suf-i:(._ t,..}ie(L