GW1--07013_Well Construction - GW1_20231102

WELL CONSTRUCTION RECORD(GW-1)
f For Internal Use Only:
I.Well Contractor Information: 11 I
tdt/1t(.1.-/ \ At Mber I Y 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION -
3 / 6 Ait. ft.
NC Well Contractor Certification Number ft. ft.
K. /
G�.1 C c e br, it,,,NC
FROM I TO I DIAMETER I THICKNESS 4j15.OUTER CASING(for multi-cased wells)OR LiNER(If ap Ilcahle) -MATERIAL
Company Name Jft• ft. III. I
2.Well Construction Permit#:�/�e 16.INNER CASING OR TUBING(geothermal closed-loop)
' s/,7 CI I1 Lii S•he FROM TO DIAMETER THICKNESS MATERIAL
List all applicable hell construction pe nits(i.e.II/C.County,Slate, Variance,etc) ft.
ft. in.
3.Well Use(check well use): �6'-."'r/`fi.4✓-r W 6-;re,e
ft. ft. in.
Water Supply Well: 17.SCREEN
❑AgrlCllltural FROM To DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Municipal/Public ft. ft. in.
OGeothermal(Heating/Cooling Supply) ❑Residential Water Supply(single)
❑Industrial/Commercial ft. R. in. -
❑Residential Water Supply(shared)
ClhTigation 18.GROUT
Wells> 100,000 GPO FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: ft. ft.
❑Monitoring ❑Recovery
Injection Well: //�� ft. ft.
DAquifer Recharge IL 1 ndwater Rertediation ft. ft.
19.SAND/GRAVEL PACK(if applicable)
DAquifer Storage and Recovery OSalinity Barrier FROM TO MATERIAL
DAquiter Test EMPLACEMENT METHOD
OStomnvatcr Drainage R. ft.
❑Experimental Technology ❑Subsidence Control ft. ft.
OGeothermal(Closed Loop) DTraccr 20.DRILLING LOG(attach additional sheets if necessary)
DGeothermal(Heating/Cooling Return) then(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness,soil/rock type,grain sim_etc,)�
o ft.
Z S ir. �-^
y, -1L,'7t�r1)S,fyeI3 t-C�,-0-A4 4-c I Ay
4.Date Well(s)Completed:/O_.j 2 3 Well iD# /1 A '-0 2 ft. 7 •Q ft,
6-roll& �r-1 SC-Af 4t
5a.Well Location: fr. ft.
Mi.e Civ`J1v:irCJe wisp).-R,,,,i-S•le /ytheZ16Y5"y9y ft. ft. •
Facility/Owner Name Facility MDh(if applicable) ft. ft. ---
21'Z7 Z�eud.e lie, 2 8.5'5‘ NOV ii Ara
Physical Address,City,and Zip rt. rt.
0/V-/0 co 1/3 d l3a y 7818 21.REMARKS County Parcel Identification No.(PIN) /e"tp✓ Ca-.vLou' Kyle"-L /re•e ,•` `tie(/
Sb.Latitude and longitude indegrees/minutes/seconds or decimal degrees: se� ►eixc•�►ernoi-t'a ►o f'C e.�'Srr•�[�bow el t''tct i i.S
(ifwcll field,one Iat/long is sufficient)
3 y �/ /G 22.Certification:
' '7.7, 3d.Ii 00
w 4.2,..7",„......z. Azesdc& /0 ._,e-2,3
6.is(are)the well(s): rmanent or DTemporary ignnrure o Well Contractor Date
�• By signing this form,I hereby certify that the wrills)was(were)constructed in accordance with 7.Is this a repair to an existing well: 0 Yes or �1Vo I5A NCAC 02C.0/00 or/SA NCAC 02C•.0200 Wet/Con truction Standard,and that a copy
If this is a repair•fill out known well construction ialot•ntation and explain the stature of th o/This record has been provided to the well asw,er.
repair under/121 remarks section or in,the hack al this form.
23.Site diagram or additional well details:
You may use the back of this page to provide additional well construction info
S.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
(add'See Over'in Remarks Box).You may also attach additional pages if necessity.
construction,only I GW-I is needed. indicate TOTAL NUMBER of wells
drilled:
�j 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: / (ft.)
For mah pie wells lust a/i depth,i/'dr//Crew(example-3@200'and 221 (00� Submit this GW-1 within 30 days of well completion per the following:
10.Static water level below top of casing: IV (f 24a. For All Wells: Original form to Division of Water Resources (DWR),
Ifwaxer level is above casing,use + t) Information Processing Unit, 1617 MSC,Raleigh,NC 27699-1617
II.Borehole diameter: 7 (in.) 24b. For Injection Wells: Copy to DWR, Underground Injection Control(IUC)
�J Program, 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: hi\O fa_S owr.0
(i.e.auger,rotary,cable,direct push,etc.) 24c.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the
county environmental health department of the county where installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPD: Copy to DWR,CCPCIIA
13a.Yield m Permit Program, 1611 MSC,Raleigh,NC 27699-1611
(gP ) Method of test:
13b.Disinfection type: Amount: i
Form OW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-20 l i

o ISTD Heater Boring Construction Detail Revision 0: 0
TERRATHERM Release date: 5/12/23
Approved by: St
• Well ID HA-02 Date / J
Oversight c_ / Job it R23-104
Driller �$ [i't l[ i�. LLt.' le,4'
Constricted
(fill out If
Design different) Notes
1/2"Thermocouple pipet Heater Stick-Up Height 30"
Thermocouple Length 31.25'
---VEW Stick-Up Height 18"
IIMI
Ground Surface 0.0' ------------------------ - --------w
Heater Can Conductive HT Grout—
Angle from Horizontal 62'
Schedule 80
Borehole Diameter 7"
-T Top of AIObStald 1'
_- Top of Screen 4.5'
Heater Can Length 32 ft z 5 Gal Budgets of Graphite 0.5
Heater Can Diameter 3 in _
Bops of SIBoa 0.75
IIScreen Length 10 ft
Screen Diamter 3 in Bags of Cement 2.75
li
Bottom of Screen 14.5'
installation Method
Direct Push Bogs of isVJO Sand 75
Sonic
Hollow Stem Auger Gallons of Umestone 7.5
Mud Rotary
Other: Bottom of BOO Sand 22.5'
Bottom of Heater Can 29.5'
Bottom of Borehole 29.5' '1,5'
Post-ins 1.)Canitallation no well Is QC(to beperformed 24hrs after Installation) MD Log:Make/Model: dh PPM f_ree of f Reading:
'g:
grout De Constructed Time: ;$A O $o
Read PPM
Depth to trottunr of well ift bTOC ._.__ a?' Time: ng:
CJ
iReading: PPM
if wane,HUM or equal to lit less than drslpned alert the office Time: Reading: PPM2)Confine grout plug readies ground surface Time: EJ
repeat Burly until depth to drool is UJt.
Time: Reading: PPM
Dare Depth to Grout III btsi Notes:
i _ _
I0~ erdn