GW1--07060_Well Construction - GW1_20231102

For Internal Use Only:I.Well Contractor Information:
WeilC'otarrn nor Nmnc ld W R 7ANE3
rrto$ TO onsaurnots ._.
NC well contractor Certification Number ft
G,t 1 r )J.v 15.13 CASINO
ND{tar ent wells)OR IOW 9t able)
IA.,. C Cw /i t3 DOCK NATO' ML
Company Name16.1N.✓ - ft. ff. la.
1,Well Construction Permit J#: 1/� C1 j r7 .�'.,7c FROM 1 CARING OR,. i
1Sa jjj W�sd4son)
List all appltcwhlc well constru.j r per, 7Nft2ClY 6 iNA76lttgt —"""'^
its(i.e WC.C Hta:Slate,YAMtTIaM.Mt'.) ft, it, ill.
3.Well Use(check well use): ee . ,f" &�.:}r e, i
��� IL R. la.
Water Supply Well: i IT.SCREEN
°Agricultural C1Munieipallpubik MOM mjNgrY�t $rAR a12 6lAttRr+�.
°Geothemail(Heating/Cooling rt. R. in.giCooliug Supply) CTReatderrtial Water Supply(single) ""' -
OlndostrieUCwutnercial R' tr. hi
°Residential Water Supply(shared)
Qlrrigstion C)Weiis . 100 r 2O GRgUI .
WQGPD mom TO
Non-Water Supply`Well: ft. n . +y," >MTLA rttE{rr( rt4Da,opener
0Mottitorittg °Recove
Injeetiop Wel)� ft. ft
°Aquifer Recharge l ndwarer Remediation h. ft a�qp
°Aquifer Storage and Recovery °Saliniity Harriet 1 FRS AMPMCiIC-ttwspiit }
°Aquifer Test gt rANtF�^ ti irei
°3tomiwater Drainage . it. tt.
°Experimental Technology °Subsidence Control ft.
ft.
°Geothonual(Closed Loop) °Tracer 20.DRILLING LOG,plumb addilisaaf*tits If v
°Geothern)al(Heating/Cooling ReturnMist to irrwctgrritoN a es a •-----._-_----.
13 ) her(explain tinder N21 Remarks) S. {satyr,birdie*.witMeae4 tpeasaja ter.ws:)4.Date Well(s)Completed: / t fr. 2.r2 R. . r--.,>ve-.6 tile4ro ? try ti cio.`y
Well IDS /7--.3 0 2 S .t' �- ^ft. t' .{ n J
i• LT"r `� u M1 t - ex weft
/+ �p� �yiu.Well Location:
n. � _� ..
7 J2�G WtYt'v 10 L+1"CAS:041/erl SoprFtwit.s4te NC1307-76Y 9 rt. ft
fauilityro nerName Facility lb*(if applicable) ft. rt.
x/ 7 x e� e �3l✓¢��,7�.ct� t�,ti �1e� ft' ft. " NOV J 2A23--. __
Physical Address,City,and Zip ft. ., R.
IV /v Di ��rr f h{ ^� J 21.REMARKS — _ ._—.._-
V
County Parcel Identification No.(PIN) .2'f T'f7,y /7I rr t r
5b.Latitude and longitude In degreesiminutes&aeconds or decimal degrees: ge�'g_i1Le"1 tizt-t C.fo r C o,w,l't r .t t e p rr 5J e ,i ii_
(if well field.one tat/tong is sufficient) 22.CertUleatlan:
' ^7 /i�/� N " 77, 3d 1,1,4'p W
it rmanent or °Temporary al
Signaiarc of citified Well Contras/sir Date
6.Is(ate)the well(s)t l l�'+) �
/ di'signing title jOin.I hereby certif.that the nett't)neat(Imre)C•wtrtnrwd in tieWnimrre WA7.is this a repair'to an existing well: °Yes or Q7Vo Lift NCAC 02t'0100 or 15A NCe1C 02C.0101)Weil C-bnstnsutou Slaw/omit and dear a color
(f th1.t is a repute,:jyl hint known well conanrtM+on iiiiirratrnlotr and explain the nature actin. of hti record has been prodded to the is ll owenr.
,e(,wr nmler#21 rrmat*e racoon or an Ike harm of ibis,form.
23.Site diagram or additional weldetais:
Ii.For C,eoprobelDPT or Chisel-Loop Geothermal Wale having the same You may use the back of this page to provide additional well construction in6
construction only l GW 1 is needed: Indicate TOTAL NUMBER of walla (add'See Over in Remarks Box).You may also attach additional pages if necessary.
drilled:
_ — 24.SUIIMI'JTAL.INSTRUCTIONS
9.Total well depth below land surface: f 7 1 J {ft.)
For multiple veldt lint all depths it element(example-34200'and 20)1ntr) Submit this CW-1 within 30 days of well completion per the following:
10.Statte water level below top of casing) /Q (f.) Zia. For All Wei: Original from to Division of Water Resources (DWR),
1j water level it shove,easing.ass"+ Information Processing Unit,1617 MSC,Raleigh,NC 2 7699-1 6 1 7
il.Borehole diameter: 3 . (M) 24b.For Infection Wells:Copy to DWR,Underground Injection Control(MC)
Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: o too_.,-'#Y i t~
I t a.auger,rotary,cable,direct push,etc.) 24e-for Water 3Npp) ahh tcpar t oo�r Gedtti county
Isere i Wsita:Copy to the
county envircmmental health department of the county where installed
FOR WATER SUPPLY WEU.S ONLY: 24d.For Water Wells producing over 3110,000 GPD: Copy to DWR,CC PC11A
13a.Yleid to Permit Program, ((i 11 MSC,Raleigh,NC 27699-1611
gip ) . Method of teat:
yt3b.Disinfection type: _ Amount:, ___
Form OW-!

TERRATHERM ISTD Heater Boring Construction Detail Revision#_0
Release date:_5/12/23_
Approved by:_SL
Well ID H-30 q—a6 2 3
,/\ Date
Oversight `�, �,-, Job# R23 104
Driller ° j-
• i�runfi
Constructed
(fill out if
Design different) Notes
1/2"Thermocouple pipe? ---Heater Stick-Up Height 30"
Thermocouple Length 58.6i7
--VEW Stick-Up Height 18"
Ground Surface 0.0'
Heater Can Conductive HT Grout—
Schedule 80 d nglefrom Horizontal 90°
y 1
Borehole Diameter 7"
Top of#00 Sand 1'
Top of Screen 3'
Heater Can Length 59.5 ft 5 Gal Buckets of Graphite 0.5
Heater Can Diameter 3 in
Bags of Silica 0.75
Screen Length 10 ft
..-. Screen Diamter 3 in , Bags of Cement 2.75
Bottom of Screen 13'
Installation Method
t.
Direct Push Bags of#00 Sand 18.5
Sonic
Hollow Stem Auger Gallons of Umestone 18.5
Mud Rotary
Other:
Bottom of#00 Sand 50'
Bottom of Heater Can 57'
Bottom of Borehole 57'
Post-Installation QC(to be performed 24hrs after installation) PM Log:Make/Model: _
1)Confirm well is free of grout Design Constructed Time: :0n Di-
De
pth � Reading: �.r� PPM q d �car
Depth to bottom of well[ft bTOC, co S' Time: 71 iot u Reading: ppM
If greater than or equal to ift less than designed alert the office Time:"--- ----- Reaa ng -pppl-"-----* r�
2)Confirm grout plug reaches ground surface Time: Reading: lei t PPM if 9 ",)i ••6
repeat daily until depth to grout Is Oft. Time: �'. Reading: V E 0} PPM /
Date Depth to Grout[ft bgsj Notes: 0