GW1--07050_Well Construction - GW1_20231102

WELL QNSTRUCT'ION RECO JCy fr,WryIA
For Internal Use only:
I.Welt Contractor Information:
_ k f'If Y 6kit M— __ .
Welt C'onnacror Name rt -. W.WATER ZONNS
mow To _ ousceti%rtort -
g 230 Ah.
NC Well Contractor Certification Number ft, ft.
ill.Ott t.A rec)far annii-eared wells OR j-DiEtlfi/ ),
G'.�..1-c Ca t e l rf t,v- . mom i
TOillamtren
Company Name h M+l17it1iiL
M.
�+ ,� 16.INNER CASING OR TUBING t> t'ttrsl
2.Well Construction Permit tl: s �!
List ail � � n �••r7 ,7•'/-� MOT T33, IN B1'ER
applicable well colour talon (i.r.WC.Cattotn Stale,Yar'ance,err.) ft. (t, to M,tfiptA4
3.Well Use(cluck well use): " a-"r""' dt)e..r tit P. s ,..
itrt. In.
Water Supply Well: 17.SCREEN 1
ViOhl TO AUMI T slorsl rtitrxtat;ys Ma ""i
DAgriettltuai QMunicipal/Pubiie
°Geothermal(Heating/Cooling.Supply) DResidential Water Supply(single) Pi It Supply) ft. i is
M.
°IndustrialCommercial OResidential Water Supply(shared)
t3irrigaticrn la moo. i
ID_Wells> 100,000 GPI) Atom ,TO 4 rtrttat, eM ENT MttTUOP&,ul10VNr!'
Non-Water Supply Well: ft. h
OMonitoring °Recovery b .___.__--_._._.____.i
Injection Well: tit.
°Aquifer Recharge dit"�ndwater Retnediation 11' e
C7Agwfer Storage and Recovery CiSa1mity Barrier 19.SAND/CRAWL WL PACK tit ties)
FROM TO tiHlrtr►S iYt l rr Ma[11EIOB
OAquifor Test OSton water Drainage ft. rt.
°Experimental Technology ClSubsidtntce Control tit. ft. "
OGeothennal(Closed Loop) °Tracer ' 20.U11ILLiltC LOG tauter h sddtt mad sheets W seee sexy)
C}Gewthermal{Heating/(haling Realm) t)jis(ex(lain under#21 Remarks) mew T o' t' (e.kr,baie.�,ratawck hpawsla.t e.Hc.1
4,Date Well(s)Completed: Well Ind ` _ �`/ L IL..
2,5 tit. ,, -ri 4 egae l rah.a'A d ti'C/6,` 1
! tit. It .LT'r41 0r�r tZ Spry[
Sn,Well Location:+ it. It.
l
!,& Otrejleur^Cleoiiers S�fdeR-01551e +/i+1hDVI JY' 99 h' n' 1 ._� .
Facility/OwnerName Facility IDa(if applicable) ft. ft. _
x f t tt e itr 1, �t �10 t) 2 ZOZ3 .�_
Physical Athrsas,Cary,and Zip 3 Mt.. h — _._
ON-510aJ 4'J 7tA//3Di78 3 2i.REMjjARtB _'
County Parcel Edentifie inn No.(RN) /- -tt/Z ir __
3b.Latitude and longitude in degreo�Nmdnutes seconds or decimal degrees: Se L"g*r rtit d1*.. r ►deft' �m/ t+�' r i► s it,�v t` t i 5
(if wcll Read,one latllong is sufficient) 23,Certification:
341.7111 °o N - 77 , ddU00 w
.1 .2-.•-- (6 -ii.03
6.is(are)the weil(s): 11ii�errnaaent or OTemperery Signature of Certified Well Contractor Itarc
/' byat$ning th a aux I herein,co*that the weals)was(snarl consirrarad in oriwxtmrre with
7,is this a repair to an existing well: Oyes or t11RlYo 114 AtCACIVC.0/00 or 13.4 NC4C 02C.1)201)Well Contraction Standards and that a aria,
It this it a ttrptir,,(NI sat known ew]/coawwrtiaw agktraratka,anti explain the nature of the 0Jthts record 114r beta provided ro the itch'o;mee.
repair trader 021+rmants section or on the back*irks form.
23,Site diagram or additional well details:
You may use the back of this page to provide additional well conatrconstructionloft,
11.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
construction,only 1 OW-1 is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach additional pages ifneccwaaty.
drilled:___ ___�___...— 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: .1 Ci
Par andtyde walls no all depths it difereta(esttrmpk-3412tIR'aad2( 1 oo) -at) Submit this C.W-D within 30 days of well completion per the following:10.Stelae water level•below top incasing: /8 IL) 24a. For All Wells: O ig)inal hour to Division of Watt-7 Resources (DWR),
(
if wetter level is above casing.use"+'. Information ProcessingUnit,1617 MSC,Raleigh,NC 27699-2617
IL Borehole diameter: (in,) 24b. For Injection Wells:Copy to DWR, Underground Injection Control(IUC)
�°• Program, 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: if� J fa- ItNi L 24c.For Witter Setrloy and Loop caMhertniti Return Weill:Copy 0 e auger,rotary.cable,duvet push,etc.) county environmental health department of the county'sere installers to the
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Well/ppreducin*over J100t000 GPD:Copy to DWR,CL,C11A
I crtnit Program, 1611 MSC,Raleigh:NC 27699-1611
13a.Yield(glint) Method of test:
Oh.Disinfection type: Atrtiount:,.. Y _ ,
ra,rr„C,w.r

1400 TERRATHERM ISTD Heater Boring Construction Detail Revision#: 0
Release date: 5/12/23
Approved by: SL
Well ID H-51 Date /
Oversight ,7 _ A Job# R23-104
Driller rrr1 e ,� `+
Constructed
(fill out if
Design---different) Notes
--Stick Up Height
1/2"Thermocouple pipe? 24"
Thermocouple Length 27.67'
Ground Surface 0.0'
Heater Can Conductive HT Grout-- Angle from Horizontal 90°
Schedule 40
Borehole Diameter 6"
Heater Can Length 28 ft S Gal Buckets of Graphite 1.25
Bags of Silica 1.75
Heater Can Diameter 3 in
Bags of Cement 6
Installation Method
Direct Push
,
'lc-Hollow Stern Auger
Mud Rotary
Other:
Bottom of Heater Can 26'
~ I
Bottom of Boreh a 26'
Post-Installation QC(to be performed 24hrs after installation) PM Log:Mak el:
1)Confirm well is free of grout Design Constructed Time: I Reading: 0 4^ 0 PPM
Depth to bottom of well[ft bTOC 7R' Time: Reading: PPM
if greater than or equal to Ift 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 bgs] Notes: