GW1--07046_Well Construction - GW1_20231102

WELL CONSTRUCTION RECORD rr;al ..
For Inteniai Use Only:
1.Weil Contractor Ildbrmation;
1 ll- �'a'a Ai-
"_ter it
Well Contractor Pixrno _FRO 'fir
tldtllCRtt`1'H1N .
NC Well Contractor Certifn Certification Number b' .
L 3 tr C� i// 15.OUTER CASING Mirmuld-cared OR LINER#N bkl
m DIAMETER 1110t.N6B8 MantuaCompany Nameft. rt. Ia.
2.Well Construction Permit yel_CgLiCk.41,Le......._____ 1d.INNER CASING OR TUBING(t eadier aft ekeed-kmrLire all applicable well construction p p.e,U/C.Contitt glair,Parlance,err.) M ft. R, Duman 1 iicw( MAT R At
3.Well Use(check well use): ` erg,,ff f' id a-Y r e 4E
fl. Jet ....
Water Supply Well: 17.SCREEN y
OAgr)cultnurtl ❑Tviunicipal/Pub6c PkOMI ,RIAM ltlA slued It tuhsilnA ''_
°Geothermal(Heating/Cooling Supply) °Residential Water Supply rt
vPP y(single) —p), rr ter r .,
°Industrial/Commercial DResidential Water Sunni),(shared) , 1S O�tOUx Obligation =—•::
C1 Wells.3 1 oPp7 robot. 'to htAT*RIA1.' tM
Pion-Water Supply Well: ft. rt. >h t1 ►tl I�t ft`A�trtiwv t'
°Monitoring °Recov -
Injection Weil; ,,�rfkd ft. ft. .___.__.1
fJAyuifcr Recharge tstitrouwakcr Reinediatiorr _q. ,r
°Aquifer Storage and Recovery USalinityBarrier 194SAND/GRAttr Sp.
Farm ,: 1+a. �averr ,c ,IN ,(ram
QAquifer Test OStonnwater Drainage . ft. ft
°Experimental Technology °Subsidence Control ft. ft.
°Geothermal(Closed Loop) °Tracer 20.DRILLING LOG *torch additional • —"""
_�,,�✓ l�etaas to erot*eesear>t
C]Geothetrnal(l icatingK:oolimg Return) t�Oth (explain under t021 Remarks) urss7ttrtros Wart leri*ets,eaBn o&7 ,anus 4,a 4 _ .r
4.Date Wells)Completed: Well[DO !y1 / 0 It Z 5 k i``,b.110.�q f"a i..iilaw t 4 c iatV_.
2 S 7 .!! -. I L i sir-l z..Sallie•r?t.. T
/�,�p,��� So.Well location: r roily ff. R !
1 Ji 3e. Oftoe1l owe C eel$ 'Q L/-•5•/c 1�''Cb 0 Z'fo! ►7 1 C N. ft,
Facility/Owner Name Facility ID*(irapplitnlbie) b• h
2 x t rlo. i31✓1 j.7"� x>o t<; /t' 'yG ft.
ft. NOV Asi 9, 2a23__ _�......
Physioel Address,City.and Zip ft, ft.
Oros/0 a) 4ij 9i/30Y7$,8 21-REMARKS �___
County Parcel identification No.(PIN) £lr'T(•Z/l-C r•T'0,r' W Et II�^
3b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: Seen. teloc jtt io. a f'i't:!e r eeof„'tr+h[6D iv j 1.�degrees/minutes/seconds
(if well field,one tetilong is sufitcient) 23 Certifi anion
3'L 7 j"/0'0 N ` 77, 3 6`4' 00 w
6.is(are)the wsU(s)r i1ttcrwndnsnt or UTstnperary sip...ofer:milied Well Contractor Two
r✓ by signing this fanu 1 hereby to l fr'that the nellls){roes flexed')4o nstrrn tad in accordance Kith
7.Is this a repair to an existing well: 0 Yee or l' 'R< 114 NCAC 02C_Ol ikl or 134 NOW I12C•.11209 Wll,Contraction Slairdnrttc and Owl a cq(1,
Ohs is a repair,fill out know;awll ecentructiba fhfstarmton and espkanr the nature of the ojrhis record has been prmided so the urll pager
repair under#21 remarks section or an die back ofthis form.
23.Site diagram or additional well details: '
You may use the back of this page to provide additional well construction info
8,For Ceoprobe/DPT or Closed-Loop Geothermal Wells having the same
construction,wily I OW-1 is needed Indicate TOTAL NUMBER of wells (a 'S Over' Remarks Box). i ou may slap attach additional pages if necessary.
drilled:
24.SUBMITTAL INSTRUCTIONS
9.Total well depth below lead surface: 3 2 (ft.)
Formulttpie malls lief all depths it different(*.tempi;-31 2(k1'and 24101r) Submit this oW-1.within 30 days of well completion per the following:
10.Static water level below top of easing: /` (N l un, For All Welts: Original farm to Division of Water Resource (DWP),
11 mailer level is above casing,use"+^ InformationProcessing Unit,1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter: (,) (In.) 24b.For Intettlpn Wolfs:Copy to OWL Underground Injection Control(11JC)
, 1 J Program. 163E MSC,Raleigh,NC 27699-1636
12.Well construction method: :/t t� tat--5.'5 'i:. 24e For Wr► r
(r,e.*Orr.rotary,cable,direct push,etc.) county environmena Supply lth de:a o department a i Return Wells:Copy to the
thhe county where installed
FOR WATER SUPPLY WISI.LS ONLY; 2Ad.For Water WAR producing over 100 0e0 GPD: Copy to DWR,CCPC(JA
(gpm) Method oftest:
I3a.YieldPermit Program, 1t 11 MSC,Raleigh,NC'27'609-1611
[13h,Disinfection type: .� _ Atrununt:___ _. ._ _ ._ w

Multi-Phase Extraction Well Revision#:_0
two TERRATHERM Construction Detail Release date:_5/12/23_
Approved by:_SL_
Well ID M-15 Date $-30 g.5
Oversight lob# R23-104
Driller 1�
Design Constructed Notes
(fill out if
Well Diameter 4" different)
Borehole Diameter 8" Stick Up Height 36"
Ground Surface 0.0'
HT Grout --
Angle from Horizontal 90"
Top of 1100 Sand 1'
Casing Material
Carbon Steel __ Top of Screen 3'
•
Other:
Riser Length 6 ft
•Screen Length 27 ft • Bags of#00 Sand 18.25
_ _• Bags of Cement 1.25
Bags of Silica 0.5
Screen Material •_ ^_
Stainless Steel • Borehole Diameter 8"
Fiberglass
PVC •—_-___•
Other:
Slot Size 10 Bottom of Sand 30'
Bottom of Screen 30'
In iatio Method
I' onic HT Grout--
Hollow Stem Auger Sump Length 2'
Mud Rotary
Other: Bottom of Sump 32'
Bottom of Borehole 32'
Post-Installation QC(to be performed 24hrs after installation) PID Log:Make Model:
1)Confirm well is free of grout Design Constructed Time: 11'S) Reading: CL-5` PPM
Depth to bottom of well[ft bTOC]: _35'_ 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 doily until depth to grout is Oft bgs Time: Reading: PPM
Date Depth to Grout[ft bgs] Notes: