GW1--07043_Well Construction - GW1_20231102

WELL CONS' 'RUC'I ON RECORD t .W s i For lnt�a1 Use only:
I.Well Contractor information:
.. Kc(/y 6A. -
Welt Connector ..a- _14.W,1ITI;R WINKSmrector Name nom To v
ft rt.
•
NC Well Contractor Certification Number R. ft.
e+~ l", tr.� rT CASINO Inc valet-excel+.eUs o
urn u�r MATERIAL
ongiany Name n. ft. la. KNEES
l� I&Whi k
2.Well Construction Permit f J9 cz i,i 6 s".�te FROM,. TO_CARING OR TUDIIMG(geothermal N+uued coop!
Lest all applicable sell construction DIAMETER Tftic�tclvps MATtsRtaL,
(lr,L!lC:, ata�:Slate,Variance err�t ft R. ta.
ee"fii//;,0r 0.-,le de 3.Well Use(check well use): J ft. ht. _.
Water Supply Well: . I7_SCREEN : _ _—
i]Agricn)ttual CltvluuicipallPublic PROM ma_METER Ttit l ' iaahMAt, —
leatinIt h tau
OGeothermal{! g/Cooliug Supply) GlResidentisi Water Supply(single) —
Olnd R'
ustrial/Cominencial
C1Residenttisi Water Supply(shared)
C?lirigation te.GRt1uT
—.
DWells. 100,000GPO PROM v To . IMATERIM CMP(.A terMrrlttlmAAAMOV'tl
Noll-Water Supply Well: it . It
OMonitoeing ecov
Injection Well: OR ft, N, .."1
0Aquifer Recharge dil ndwater Remediation
C}Aquifer Storage and Recovery OSalin ty barrier 13.SAN VIL P At K()I - I
OAquifer Teat °Stormweter Drainage • • tt. • k,
OR'xperimental Technology OSubsidcnce Control R. ft.
OGeotherntal(Closed Loop) °Tracer 20.DRILLING'LOG
feteleketlittkentlettrets E
* ir die Iv , ogoatirT N sIi ,u W**ern.erti. t=,�!± _NOCcwthermai{Iletting 'xrting Return) (explaiunder#2Remarks)s7
4.Date Welke)Completed: Well IiNt _ 6' 0 ,.:%,S .,7�✓.-t-4:+de%t r-a�1. ►14 ta:7..
2`5 n. ,& 4-r41 its er.r 12,.S"ar dlr ram.
WellLocation: h. R.
5n. ---
e.. vas;J7eur c pdverr Si tat-1 L S,/e,s(f I)D x7bYY3'�'Y' et. rt. _ _
PacirtyiChsnerName t:acitityEU(if applicableI It. rt. NOV J 2 .2Q23
2/27 4 j u.v / 1✓,� tiik,tt.s't��vt✓s'/Ie - n: ft.
Physivai Address.City,end Zips 285'Y n. !t, :3:¢:.:,
ON-Sit) 4'J U/3ay78/, 21.REt -_ _�
County Parcel Identification No.(PIN) Fix 'P 4-Pin P . _.
5b.Latitude and longitude in degreea/ndnutesistconds or decimal degrees: S'de,o,,1'f 41 sc e-�i fo � rrvc f raw et j '�
Orwell field.one Iat/long is sutlicient)
3 Y•7 hj/L/C O zx Certification:
-Ii.--- (a.18-a3
6.is(are)the wait): 11114rmastent or C1Temperary Signature of Certified Well Contractor mar
,r+ 8ysigning this i m,I hereby eYyy •that the near)was(Satre)constructed in accordance with
7.Is!hiss repair to as exiadttg well: OYes or n 1.14 NCAC 02C OM tsr ISA MCA('02C.0200 Welt f.'ostirttethm Standards and Mal a cops
(tan Lr a repu/r..f11i asri know,,wall consultation fs/rgyrgdMn turf expiate the nature tithe of this record Oar beets prmiakd r('the well o,aarr.
repair hail-an remarks section or an the betas Of Mis,frrm.
23.Site diagram or additional well details:
R.For Geoprobe/1)I'T or Closed-Loop Geothermal Well.having the same You may use the hack of this page to provide additional well construction info
construction,only I GW-I is needed. Indicate TOTAL NUMBER of wells Odd'See Over in Remarks Box),You may also attach additionsl pages ifnece nary,
drilled:
24.SUBM TTAL RMST.Ri,ICTIONS
S.Total well depth below laud surface: 3 f *.J (ft.)
For neult>ple sells 1!»all/eptho y'dr4ereirr(maniple-31206'anndAiiialy} Submit this CW-i within 30 days of well completion per the following;
10.iSte&wetter level below top of casing: I 24a. Far An Wads: Ori inai form to Division of Water Resources (DWR),
if writer level i,<ahnvr,carter,use"+" (ft`) information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
II,Borehole diameter: 6 (in.) 24b.For Injection Wells:Cary to DWR;Underground Injection Control(lt/C)
Program,1636 MSC Raleigh,NC 27699-1636
12.Weil construction method; /Co test-5400Yt+✓ 24e,for wares Sooty and Open-lArvo trial tr Winkle Copy to the
(te.anger,ina,y,cable ditras push,etc) county enviromnenta1 health department the county Instalted
FOR WATER SUPPLY WELLS ONLY: 7Ad.For Water Wens,produdng a I Grp:Copy to DWR,CCPCUA
13a.Yield tgpm3 Method of t+t t: Permit l'rognun, 1611 MSC,Raleigh, C 1611
13h.Didafectlon type: Amou _,, ,_nts /
Form C,W-i U, .,r.�.:__ri...............

TERRATHERM Temperature and Revision#:_0
Pressure Monitoring Point Release date_5/12/23_
Construction Detail Approved by: SL_
Well ID T-6 Date
Oversight !, xAh \ lob#R23-104
l�Driller rid`/ /0"--
Design Constructed Notes
(fill out if
different)
Pipe Diameter TMP: 1.5" ----------Stick Up(TMP) 30"
PMP: 1" —Stick Up(PMP) 24"
Borehole Diameter: 6"
Ground Surface 0.0'
M_ HT Grout--- J Angle from Horizontal 90"
Casing Material
Carbon Steel
Other: Top of#00 Sand 1'
TMP Pipe Length 33.5' Top of PMP Screen 3'
MN
PMP Riser Length 5'
PMP Screen Length 2' Bags of#00 Sand 2.5
Bottom of PMP Screen 5'
+_Screen Material
Stainless Steel Bottom of#00 Sand 7'
Other:
Bags of Cement 7.75
Slot Size 10 Bags of Silica 2.5
Installation Method Borehole Diameter 6"
Direct Push
Sonic Bottom of TMP Well 31'
Hollow Stem Auger
Mud Rotary
Other:
Bottom of Borehole 31'
Post-Installation QC(to be performed 24hrs after installation) PID Log:Make/Model:
1)Confirm well is free of grout Design Constructed Time: U// ' Reading: ,.C1 PPM
Depth to bottom of TMP[ft bTOC]: 33.5' Time: Reading: PPM
Depth to bottom of PMP[ft bTOC]: 7' Time: Reading: PPM
if greater than or equal to 1ft 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 bgs Notes:
Depth to Grout, Depth to Grout,
Date TMP[ft bgs] PMP[ft bgs]