GW1--07059_Well Construction - GW1_20231102

WEL CONSTRUCTION RE con)(GW-!l For Internal Use Only:
I.Well contrector information:
--_, j I i r l,;1I4j 4-i 14.WATER ZONES --
well C:onttretor Nattac vnOM To nzseRlrrittS
NC Well Contractor Certification Number ft' ft,
Cf _15,OUTER CASING _or-multi-c*ud was OR
A.,..rC 1�4 t br�') // ,, Nr.OM TO ntAM[' J t� •t
itir:r«t�ae:-:�
Company Maine i rt. L__ �if. In
2.well CSaMtttretioa Permit# j 16.1NNI1R CASING OR S(geothermalcl )
/ire all applicable hell construction `'riFROM TO Ttt1L 4N 8 #iA t bltrAl
s(i.r.UIC:Cora, .dale, FaNarnae,.rr,t R• ft la.,,�,t ,wit
3.Well Use(check well use): ref- .Vt. O AI a`` I' eat
IL ft. IL
Water Supply Well:
17.8C'RILIIA 1 _ ,
PROM C11'griculttual C7Mtu►icipal/.'ubtie , tO ,DIAM it tIt ft, ha
4.Ot eigte t fta MA t,
OGeothennal(Heating/Cooling Supply) ()Residential Water Supply 9(single) ;" ft " - ,la. ,
Dlndustrial/Commercial ()Residential Water Soppy(shared) —.
Cllrrigation 1S,",ill 37
C7Wplla> IootWO GPIJ Motu 7v AinuAt MPt.tiC RtIiN7 Ir[lTlt<?Df AMOUNT��
Non-Water Supply Well: ft. ft.
°Monitoring ft°Recov
Injection Well: ,.r✓am' ft. `I
°Aquifer Recharge 1111 vundwatcr Retncdiatior: ft, ft.
❑Aquifer Storage and Recovery OSalinity harrier 1 PACK(H,,,I k)
(?Aquifer Test 'f MKI11O0'
DSion:maim Drainage , ft. it.
°Experimental Technology °Subsidence Control fi. ft,
CJGeothetmal(Closed Loop) OTsacer 20.DRILLING LOG(attach ndddlwud
'
°Gieothennal )least _� tiMKttn " �petso char) :...... .____.ti._.._
{ ng/C'ortling Return) 4t,� e7'{exp}oin under#21 Remarks) � �r�It rs.y,�,w+reM, awr..R ter�ri+.t.,�a�.)
4.Date Well(a)Completed: Well Itni I1 - 31 2 S y- �r t
� .ETA .� ,LT'"rf'd'�,!��t Wit` �.»�a�Jar.f3C.
ia.Well Location: !r. rt.
r.
iii3e. OA�J1ovl"C e Stier 4 s/le .44k o 2-76Y*9q ,t. f' -
tavilitylOw•nerNante Family 104 fir applicable i ft• ft. ..........
ter.i- 7 e+t� �r NOV J 2 2n?3.. .�_ ___ - _...�
2 7 4e 'lave 131✓1/10 stAr sir j, ile0 2e7 ft./Z
Physical Address,City,and Zip ft.
tJ/VSlob • 2!3 ( /30/ !8/8 21.RREMA
County Parcel Identification No:(PIN) XI ri) 1.4 /....4 n
its.Latitude and longitude in degrees/minutecleecnnds or decimal degrees: See44, ed�rCati1 -t -I.i.:rO+v'8tr.►>(t W Sf etai ii
(if well field,one bt/tong it eulacient) 22.Certffieatfon;
341.7 r eo N -77 . 6dµ .°r W
6.Ia(err)the well();]: dl! rnnanent or Cl I ertlporar v Signature of Certified Well Coatirnar pate
/ It),signing*Islam I hereby eer tifj,that the well(s)nut(eery)consttvcted in avcurnitrtrry with
7.is this a repair to an existing well: DYea or t�"19n 11A 1✓CAC 02C 0100 or ISA AK AC MC.t2d9 Well.Cbnrtniction Standar&and that a Off
it this is a reputr,fll mu known well reartm'tian bgroratation awl esplaw the nature of the of this record Ras been provided to Me Nell outer.
repair under#21 mutate,section or on the hail.of this Toro
23.Site diagram or additional well details:
You may use the back of this page to provide additional well construction info
II.For Geoprabeli7PT or Closed-Loop Geothermal Welk teeing the same
construction only I Gt4V-1 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: S '7 ft
Far multipleice//s slat all*Ms it different(morph.-3(c#On'ajrttY(p1txY) ( ) Submit this(W I within 30 days of well completion per the following:
18.State water level below top of easing: /Q (It) 24a. For All Welk: Original form to Division of Water BecoUrcca (DWR),
11.waterer level is above coxing,use"+' lnfbrtttatioi:Processing Unit,1617 MSC,Raleigh,NC 27699-1617
IL Borehole diameter' Q (in,) 24b.For Injection.WO:Copy to DWR,Underground Injection Control(11JC)
Program, 1636 MSC,Raleigh,NC 27699-1636
12.Weil construction method: 11 o r P i 4 24e.For Water Supply end Open-I Geothermal Jtetarr wax;:Co r to the
(i.e.aartger,rotary,cable,direetposh,etc.) county environmental ihcSIth Aparmrentt of the county wv e insti 1k4 1 y
FOR WATER SUPPLY WELLS ONLY: 24d.pot Water Wells produsifigp ikQil5 CPU:Copy to 11WR,(( Ct/A
Pcnni ogrtttn, 1611 MSC,1tntcngh, 7699-16i i
13a.Yield(gust) - Method of test: , _
13h.Disinfection type: Amount:._ .,......__._ _ .-._

•
100 TERRATHERM ISTD Heater Boring Construction Detail Revision it 0
HER Release date: 5/12/23
Approved by: SL
Well ID H-31 Date Q 9—1 d r-�•
- Oversight R+- ©J + lob ft R23-104
Driller 12.41-1t4—
Constructed
(fill out if
Design different) Notes
—Stick Up Height
1/2"Thermocouple pipe? 24"
Thermocouple Length 58.67'
Ground Surface 0.0'
Heater Can Conductive HT Grout— •ngle from Horizontal 90°
Borehole Diameter 6"
•
Heater Can Length 59 ft 5 Gal Buckets of Graphite 3
Bags of Silica 4
Heater Can Diameter 3 i
Bags of Cement 13
Installation Method
Direct Push
Hollow Stem Auger
Mud Rotary
Other:
Bottom of Heater Can 57'
Bottom of Borehole 57'
Post-Installation QC(to be performed 24hrs after installation) PID Log:Make/Model:
1)Confirm well is free of grout Design Constructed Time: 'f ° Reading: f" PPM
Depth to bottom of well(ft bTOC c4' Time: !" c-•p C Reading: Q ti ,4 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 bgsj Notes: