GW1--07018_Well Construction - GW1_20231102

WELL CONSTRUCTION RECORD(GW_1)
For Internal Use Only:
I.Well Contractor Information: I
WW1 a M tti/'mber I Y
Well Contractor Name 14.WATER ZONES
FROM TO DESCRIPTION
3 t8 / 6 A ft.
7
NC Well Contractor Certification Number ft ft.
2. 15.OUTER CASING(for multi-cased wells)OR LINER(if ap Ilcahie)
(s'6�-J.0 tOC4 e r // "s FROM I TO DIAMETER THICKNESS MATERIAL.
Company Name ft.
I( ft. in
e ����1('1/� 16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#: /1 5: e FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction pe nits(i.e.U!C.County,State, Variance,ekt) ft. R. in.
3.Well Use(check well use): Per.4,,/1i.3 Gtf o"; re et _
ft. ft. In.
Water Supply Well: 17.SCREEN
CJAgricultural FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Municipal/Public ft. ft. in.
OGeothermal(Heating/Cooling Supply) OResidential Water Supply(single)
❑Industrial/Commercial ft. R. in. -
❑Residential Water Supply(shared)
Ohrigation 18.GROUT •
❑Wells> 100,000 GPO FROM TO ' MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: ft. ft.
❑Monitoring ❑Recovery
Injection Well: //'� ft. R.
OAquifer Recharge �C,roundwater Remediation ft. ft.
L7Aquifer Storage and Recovery ❑Salinity Barrier 19.SAND/GRAVEL PACK(if applicable)
FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stonnwater Drainage • ft. ft.
❑Experimental Technology ❑Subsidence Control
ft. ft
OGeothermal(Closed Loop) ❑Tracer 20.DRILLING LOG(attach additional sheets if necessary)
OGeothermal(Heating/Cooling Return) Cher(explain under#21 Remarks) FROM TO DFSCRII TION(color,hardness,soil/rock - -
s e / type,grain sire,ete.)
/ ��jj /( /� 0 ft 2.S. ft' •�-- as C _t
4.Date Well(s)Completed: to"-O"23 //O c%L _ ,�(•y'l�c'' t P� t'�` �i►�v U•C�dC`.
Well iD# -S it. 'Q R. G n /
/`cal a.,•.r'fZ Sot�,,ix
5a.Well Location: ft. ft.
/3& o,ve)1 our C'cowefs Sl yr{u vel( S'ie y Y V9y _
/' ityMO( pl 6 v NOV J 2023
Facility/CrunerName CncililylDJl(ifappliLcablc) ft. ft.
212.7 Z f jev,ve /314/J-0,eh-50/4✓, i/e, 2 8.5 7 6 fL R. _-----
Physical Address,City,and Zip ft. ft. '-
O.vs/v w '/3 Yd l3PY7818 21.REMAARKS ---
County Parcel identification No.(PIN) /Jee:�,, 'P.Cei..ry (,I/i'4j V1/4/3ur ytros-. e�C /€0
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: st!e�I f t�Gh presch�'l�+,.*- c fo r�e,a.�Srror(f i n iv r•11 /q,1 IS
(if well field,one lat/long is sufficient)
22.Certification:
3L r7y/ 4/4o N 77, .3d1Z170 ,�/� i „/„... � C)
W / f -2
6.Is(are)the well(s): [lrmanent or ❑Temporal y tgnaturc of Certified Well Contractor Date
By signing this form,l hereby certify that the.,neli(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: DYes or M1Vo 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy
If this is a repair,fill out known uw!l construction information and explain the natureof the of this record has been prattled to the well owner.
repair under till remarks section or em the hack of this form.
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 1 GW-I is needed. Indicate TOTAL NUMBER of wells (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: 76 - S (ft.)
For multiple wells list all depths irdt/fere,n(example-3@200•and 2@lll0� Submit this CW-1 within 30 days of well completion per the following:
10.Static water level below top of casing: /t' 24a. For All Wells: Original form to Division of Water Resources (DWR),
if water level iv above casing,use"+" (IL) Information Processing Unit, 1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter: (in.) 24b. For Injection Wells:Copy to DWR,Underground Injection Control(IUC)
/� { �^ Program, 1636 MSC,Raleigh,NC 27699-1636
Le.Well construction method: /\O 10.J A/V, L 24c.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 SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPD: Copy to DWR,CCPCUA
13a.Yield m Permit Program,1611 MSC,Raleigh,NC 27699-1 61 1
(gP ) Method of test:
13b.Disinfection type: Amount:
i
Form GW-I North Carolina Department of Environmental QualityDivision of Water Resources Revised 6-6-2t11A

A
• 440 TERRATHERM ISTD Heater Boring Construction Detail Revision#: 1
Release date:_6/14/23_
Approved by:
Well ID HC-06E
Date 6• 5-r��
Oversight of /c't�q� Job B R23.104
Driller 1 • ✓
ZYAk/,V /4,l"beil7
Constructed
(MI out If
Design different) Notes
Length of icUp(ft)/
Height of Ca Can n SticSt k-uk-p Above
1/2"Thermocouple pipe? Ground(In) 5'/30"
Thermocouple Length 77.29'
1 -Length of VEW Stick-Up(n)/
Height of Riser Stick-Up Above
Ground(in) 1.5'/6",
Ground Surface 0.0'
Heater Can Conductive HT Grout—
lefrom Horizontal 22'
Schedule 80
Borehole Diameter 7"
Top of N00 Sand 21.5'
Top of Screen 26.5'
a
Heater Can Length I It 5 Gal Buckets of Graphite 2.5
r-„, Heater Can Diameter 3 in Huffs of Mica 3.5
Screen Length /0 '- ft Bags of Cement 11
Riser Length 29 ft
Screen Diameter 1 in Bottom of Screen '34Y1 it
Installation Method
Direct Push Bags of#00Sand 15
Sonic
Hollow Stem Auger Gallons of Crushed,
Mud Rotary limestone 15
Other:
Bottom of MOO,and 61.5'
Bottom of Heater Can 76.5'
Bottom of Borehole 76.5'
Post-Installation QC(to be performed 24hrs after Installation) PMD Lo¢Make/Model:
1)Confirm well is free of grout Design Constructed Time:Sol;_jD Reading: 40,0 PPM
Depth to bottom of well[ft bTOC; RI S' Time: _e Q /Y� Reading: �-O PPM
if greater than or equal to eft less than designed alert the office Time:,,,.3©�� Reading:i7.11 PPM
2)Confirm grout plug reaches ground surface Time:3;.�p Reading:0,0 PPM
repeat doily until depth to grout is Oft. Time: Reading: PPM
Date Depth to Grout[ft bgsj Notes: