GW1--07063_Well Construction - GW1_20231102

WELL CONSTRc'Jaj RECORD(GW-1) Pailtrnal the Only:
I.Well Contractor lidbramtion:.
/
] /£ (' C t
i / l�%2 Yv/ (74 WATER LUNE'S
Well Contractor Name PROM, ...;TO QE$f.Rtri7OM " ""''"""`-` .....
it it.
__
, ft, /f,
NC Weil Contractor{:enifnxtioshlumber _
/ 15.OUTER CASING for ewltt-cased wells OR LINER1f hMe) V
(,r '—.rc 14 ,e r-#.1/.t r✓y FROM TO Mahlftrreik_ THICKNESS MAT!itlA_
Oa itis. �...
Company Name a�
e /1 1cf? I6.tNNERt c4$w pa T11lnING(teathermai.loser!-trap) ,
2.Well C'aristr'uction Permit I*: A {„/r,. CLA 6I�(){N r0 1nAl12tSPZR 7'ttICKNEaS ItFa($�tdL
list all amlirable rye construction y dd OX.WC ,Sate,Variance,ere.). Qb R. r in.teeJsrits-r{�+ at , 4
3.Well Use(check well use): ' IL ft. In.
Water Supply Well: I/.SCRIMS
--__,__��.
CJA r iCUlilital PRoal 10, NAM SLOT SIZE THICKNESS MATEMAL
(:7Municipnl/Public ft. in.
—
❑Geothermal(Heating/Cooling Supply) ORestdential Water Supply((single) - — - --
ft. ft. Its.
❑lnductrial/Commercial ClResidential Water Supply(shared) 1 ` -t&Gil -,
C7lrrigation lJ Wel is> 100,000 GPO :PRoat '�U hiaTEtttlAk` ir:hiPt.n4EMItsrr is
Non-Water Supply Weil: It itsttiutir,-.
°Monitoring Llliatbova
ft. 1
Injection Well:
C]A uifer Bechar a yy''�� ft. n•
q g dF oundwater Remediat ion
ClAquifcr Storage and Recovery CiSalinit Barrier 19.SAND/GRAVEL PACK lit rpplicahk? •
'� FROM ,•,•„ TO ....MATERIAL. - >rhtPLACEM1cNt'ME;THOD ..
.[}Aquifer Test OStormwater Drainage . , ft. ft. w-..-._
• ©Experimental Technology °Subsidtarce Control ft. ft
C}Ocotheanal(Closed Loop) °Tracer • 20.Dit1LLNG LOG(rtta'eltadditiamitabeets ifnscep'i.IY),
iROM TO tit.SoorrrONf voter h°ie"�'
°Geothermal iH+eatingK poling Return) than(explain under#21 Remarks} +we►frl+a;Mr tha+l+r)
L ti. .174,4. 6,+tii/4' raj54.ol ik,CiAl
4.OakWepfr) : Weil IDS I l - -2 7 25 ir. '. . "rtl'40,ft e l Z "paw L
5e.Well Landau: it. n.
N
Afte. 00e)*or"C oberx-CyeriZw,t.Siiee O e v7b i'ililg
ltacllityKYwner'Name Facility ll (if applicably) ft' NOV .J:2 2023
2117 t er r,n.+°' ail✓ d. ft.
�j� t:1i�'t+N✓t�jle �t3'�S"i��'
.._ ft. ft.
Physical Aekiresx.City,and Zip
0A/5l0w 3703ay78)8 .21. _ _.
County Parcel idrnti(e5tion Na.(PIN) //£I`Ttit _
5b.Latitude and longitude iu degrees/minutes/seconds or decimal degrees: e � � /1:t'tw'jt�+�,�l rti+'>`�J A' i �k.
or well field,(Nlc fat/long is sufficient)
22.Certification:
1`l. 11/teit, .N 77 3 .`.d e o w t o._l -9,3
L.is(are)the walk* ISKrmanent or °Temporary Signature otCcrtified Well Cermranor Date _� __..
r� 1h-signing this form.I hereby trim,(•Gild Mr nrl/fs)was(went)constructed in aecw.Iam a with
7.is this a repair to an existing well: °Yes or tI}i�lo 1x4 NC.dr'02C 0100 or 15A Nt:ACWC.11200 Nell,e'wtWAnction Standards and clan*molly
IJ-thix..a repair,jilt attt known well construction infinarotirnt and c:xplan the nation•g/thr 6(1h15 record has been lantfded to the waft owner,
vepou-tinder#21 rxentat*s section or an the bad.of AA form.
23.Site diagram or additional well details:
You may use the hack of this page to provide additional well construction infer
S.Per Geeprobe/DPT or Closed-Loop Geothermal Wells having the same
construction,only 1 GW 1 is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach additional pages if necessary.
drilled:
._. _ .._.___. 24.SUBMITI'Ai,1NSTRUCTIONS
O.Total well depth below land surface: 2 L (ft.) Submit thisG W-i within 30 days of well completionper the following:
For anrhtltk+unit i1w ail depths if different(example-304200'and 2ipi1 MJ� p i,:
1e.Static water level below top of easing: / (ft.) For or Ail Wells; Original Won to Division of Water Resources (DWR),
JJaeterleveit.,abrrxecaxrrsR.ass + information Processing Unit.1617MSC,Raleigh,NC 27699-i617
lt.Borehole diameter: P (in.) .24h For!election Wells:CtSty to DWR;:Uncle round Injection Control(WC)
Program, 1636 MSC,Raleigh,NC27699-1636
12.Well construction method: feel 41 ih/'11t7`Lt 24e.For Water Supply and Open-Loop Geothermal Return Wells:Copy Rothe
(i,e.auger,canny,cable.deer:push,etc.) minty.nwironmental health department ol'the county where installed
_ ___
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPD: Copy to DW .CUPC:,t IA
Permit Program. 161 I MSC,Raleigh,NC 27� R
690-161 I
13a.Yleid-:(gpm) y,,, Method of test: _„_
13b.Disinfection type: __. Amount: ..._-,,,.._...__,__,_.. ...._..

TERRATHERM ISTD Heater Boring Construction Detail Revision#: 0
Release date: 5/12/23
Approved by: SL
Well ID H-27 Date /it), 03 — it _ey�
Oversight ;,. r Job# R23-104
Driller
Constructed
(fill out if
Resign--j 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
Dir ush
, nce
Hollow Stem Auger
Mud Rotary
Other:
Bottom of Heater Can 26'
M
Bottom of Boreho 26'
-f
Post-installation QC(to be performed 24hrs after installation) PID Log:Ma M el:
1)Confirm well is free of grout Design Constructed Time: 6 6 Cs) Reading: 0 . I_ PPM
Depth to bottom of well[ft bTOC; 7R' 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. Time: Reading: PPM
Date Depth to Grout[ft bgs] Notes: