GW1--07037_Well Construction - GW1_20231102

WELL CONSTRUC ION RCORD CW Al For Intern]Use
Only: -
I I.Well Contractor information:
--____,,t Q 'Xitiri G an r 14.WATER ZONE _
,,:. Well Contractor came `snow TO
� 0 /� ft. f DESCRIPTION
NC Well Contractor Certification Number ft. It.
15.OUTER CASING ter multi-cased wells OR LINER kable
LF L*—.�sw :w e Dr,11)r/ ,...0. ETE
TO MAMR THICKNESS MATERIAL �`-
Company Name f. fa.
2.Well Construction Permit H yA 16.INNER CASING OR TUBING(taathsratttl closed-final►}l_lit oa applicable wail UK Ca L.6 s:fe PROM TO DIAMEri R TM/0MM MATERIAL -'construrtio»p tic..WC emfv,Sate,i'aritrtoc,erc.J ft, ft. in.
3.Well Use(checkt eelin r%/i r►r3 W O..%r t<'dE _ i
well nee): ft. ft.
Water Supply Well: la.
1 T.JsICRCIiAI _
OAgriculttua) PROM TO .: DIAMET0ft mot ma , THIC KNEMS KATEN1AI,`
❑Municipal/Public R. n In.
°Geothermal(Nesting/Cooling Supply) °Residential Water Supply(single)
OhuinsrriaUCamtncroial ft. fir. Ia ` _._
OResidential Waster Supply(shared)
❑Irrigation f&GROUT
O Wells> 100,000 GPI) FROM TO MATERIAL .MPLAC'_MENT it1ETHoa d ahsou-pit
Non-Water Supply Well: ft. ft.
°Monitoring °Recovery
injection Well: W_d. R.
°Aquifer Recharge tlindwater Rernedietion IL ft.
C'aou
;i. C1Ayuifer Storage and Recovery 19.SANDrGRAVEL PACK(ifatrpheabie)
look OA u °Salinity Barrier FROM To MATERIAL
Obu,• q fifer Teat ©Stormwater DrainagetfitILALEME3YI METfIOD
ft. ft.
�I,';1i: °Experimental Technology °Subsidence Control 4•!.:, ft. ft.
N; OGeothtarnal(Closed Loop) OTtnt cr t
_�,✓ 20.DRILLING LOG Wrath addnfaaal sherds If mammary)C1C,cothetmal(Heatinglt tooling Return) t)yCltticr(explain under#21 Remarks)
FRLJM TO »scRurnoN(case;)m,dses,sawn ham,gr in the.c o
ft.r 4.Date Welt(s)Completed: Well ID# /1 .1 y or R. 2 s ft... i'lb.�1y t,iiieiIroi stt..rv, si1..C1sK`_
2 5 7, ) . 4-rtr7 ate,ear-t 2.S0.4v tit
—-
So.Well Location: A. It
f & Di*e 11 o ur C;e Srt iers org,t , ;-/e . C h 0 Z76 Viil ft. R. .__
Facility/Ownet Name Facility 1Dt(if applicable) ft. ft.
xf77Zfieumei3/✓t1ij-ultj.s5,.ii;i/e1 2 ?$V( n ft. NOV t12 ZOZ.
Physical Address,City,and Zip ft. p, __ _...._._..
ON_5/0 W #3 Y1�130l 7813 21.REMARKS - -
County Parcel Identification No.(PTN) c lt}�LL/ ` ,{
fib.Latitude and longitude hi degrees/mintlteslseconda or decimal degrees: sewt►°`� Celt cite." -'4"i C. Ist"Cp.�.ftrosr�f,pn.,�i e7,.j j„S.
(if well fxid,one fat/tong is swflictent) 22.Certification:
141.7it/y00 N • 77r. 3t ti or) w •
6.!Ohre)the well(s): 1 1 rmrarpt or °7 emporal y Signature of Certified Well Contractor Data
�' try signing thisfrm.I hereby cer/fr that Me wets)was(iar)cronstr arced in accordance with
!i!, 7.Is this a repair to as existing well: °Yes or Q1Va lSd NC lC 02C0704 or IBA NC IC 02C.t)lltl)Well,Coa:traction Staednrde and that a corn
If Mir Is a repair, oat broww nail cbattrurf wr' t r L. rn{otawtirrn and explaut tte nature of tin, o/fits r coca has bttH Pr01 ¢a to the well°"".
�jil repow tinder A11 remark,sacuten or on the hark of this form
23.Site diagram or additional well details:8.For GeoprabeJDPT or Closed-1 cop Geothermal Wells having the same You may use the hack of this page to provide additional well construction infra
q.,'G construction,only I GW-I is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks(sox).You may also attach additional pages if necessary.
' drilled:
w — 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: ,5- 1 e'S.-2-
For twxhmjtlr wells lift nut dapihc it'dmlj rer„/.io f/e-3(r:7ao and<l%mtm) (ft) Submit this(:W--1 within 30 days of well completion per the following:
/Pe 24a. For Ali Wells: Original form to Division of Water Resources (DWR),
10.Static water level below top of-casing: (R)
If wow level is ahnve marl,.tut."+"�r) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
I I.Borehole diameter: G! tin.) 24b. For Infection Wells:Copy to DWR, Underground injection Control(IUC)
f t Program,1636 MSC,Raleigh,NC 2 7699-1 63 6
12.Wert construction method: 11 el el-..et.r1f i
ii.e auger,rotary.cahla dirsn t Wwi, ow.) 24e.For WaterSnnply and Open-Loop Geothermal Return Wells:Copy to the
county environmental health department of the county where installed
FOR WATER SUPPLY WELLS ONLY: 24tt.For Water Wells producing over 106,000 GPO: Copy to DWR,CCPCIIA
I3a.Yield m Permit Program. 1611 MSC,Raleigh,NC 27699-1611
l8P ) Method of test:
Oh.Disinfection type: Amount:
Penn OW-1 6..I r. .::.....Y.._._..... . — ..

SIW BoringConstruction Detail Revision If: 0
TERRATHERM —
Release date:_5/12/23_
Approved by: SL_�
well to _ H-24 Date q--0 - 3
Oversight Job# R23-104
Driller Design Constructed Notes
(fill out if
different)
1/2"Thermocouple pipe? ; '^;'] y !�
Thermocouple Length 58.67' Heater Stick Up Height 30"
----SIW Stick Up Height 1.8"
Ground Surface 0.0'
Conductive HT Grout—_--- Angle from Horizontal 90"_
Heater can
Schedule 80
Heater Can Length 59.5' Borehole Diameter 7"
Heater Can Diameter 3'
5 Gal Buckets of Graphite 2.25
SIW
Riser Length 51..5 ft Bops of Silica 3
Screen Length 2 ft
Screen Material Bags of Cement 10
Stainless Steel
Fiberglass Top of N00 Sand 30'
Other:
SIW Slot Size 10 Bags of Sand 7.5
Screen Diameter :I."
Gallons of Limestone 7.5
Installation Method
Sonic Top of Screen 50'
Direct Push
Hollow Stem Auger
Mud Rotary
Other: Bottom of Screen 52'
ll
Bottom of//00 Sand 54'
Conductive High Temp Grout ---- '
4 . Bottom of Borehole 57'
Post-Installation QC(to he performed 24hrs after installation) PIA Log:Make/Model:
1)confirm well is free of grout Design Constructed Time: I; /S Reading: s PPM
Depth to bottom of well[ft hTOC): S9 5' Time: 3; z O Reading: 3 i PPM
if greater than or equal to lit less than designed alert the office Time: Reading: PPM
2)Confirm grout plug reaches ground surface Time: Reading: PPM
repeat daily until depth to grout is Oft. Time: Reading: PPM
Date Depth to Grout[ft bgsj Notes: