GW1--07065_Well Construction - GW1_20231102

WELL CONSTRLI1 'JO RECORD(QW-I) For internal Use Only: '
I,Writ Contractor lathtri idon:
C v R 44- ie.«Alma ZoIYlrS
Wen Contractor Ptamc PROM TO Oi9l4R PTIOft
—
NC Well Contractor Certification Number n' tt'
IS.O&M EB CASING(far mulq-eased wells OR
Cdk. c c... e. 4r;11''`'... ► TO DIAMETER THICKNESS MATERIAL
Company Name a• ft. }e
A � � } 16.INNER CASING OR tBING 1
2.Well Construction Permit if MOM TO AMICTSIt }
Liar all applicable well eanan'nction s 0.r.UIC,onto:Stale, Krrtame,ere.) ft. R. MA'IItUL
3.Wet Use{check teen use): c'+ •"',w jt! :Y a
ff. ia.
Water Sup
ply Well: �" 17-SCREIN
OAgricnitisral ❑i►turiicipptil/Publin 'mil` TO MAM MAT OHS I. MAT1.RiAl
OGeothennal(Heating/Cooling Supply) °R.esidential Water Supply(single)
C7bxla neL/t oomnercial ft. h' in.
°Residentitsl Water supply(shared) IIL *
ITORStian °Wells:>tit(},090 OPD FROM To `" _
i�
Non-water Supply Well: ft ft.
a+r ttna4 aM C►t al{r n T L, ccv.,T
°Monitoring °Recovery
'It}ectiont*ell: ,,r+�am' tt. }}
°Aquifer Recharge Oi� tindwater Retnediaticns it.~ it
L]Aqui for Storage and Recovery OSa,inity Barrio t9.SCAN vet,PACK sir hie
°Aquifer Test OStonnwater Drainage ft. ft. Mt� 10 014435024atlli
°Experimental Technology C1Subsidinee Control ft. ft.
eseeulratTl
CiGeothetmal(Closed Loop) ciTracer 20.MILLING LOG(*MIA mitilhod r s if � -,
...�
C7Lienthermai(,Ieating/C'ooling Retunt) Vier w ,yry poo �rtioer iumna tries
."" Y`!•""(�J'��in under i1El AeS) � To .. �IV.SCtt•`•.v4•r'R�k"-'++'rr NkfflYRll�MiY�YJA�i'r Oil_.1....
4.Dote Well(s)Completed: Well 11)4 14 -2 6 2s R. it.
Su.Well Location: 6. 2 "
Jr� t . O,veJ�1 our C ,,a,et-s s'iv i S.1c , c b e z76 VIVT ' ft. n
Fay ility/Owner Nana. Facility M it(ifapplicable) n. n
�ey e 131✓ tt:
x� 7t n. ` - 1v©V J 2 2023
Physical Address.City,and Zip ft. It. -, i,;)
lbw /vie 4i. Y113ay7, t8 21.REMA - - J �..i
County Parcel identification No.(PIN) f,tl reef. r
3D.Latitude and longitude in degratsltnittatealscconds or decimal degrees: sett Ae t h:ktet+a-t a.fir ecf.str'vt f"rp av et et ii.
(if wctl field.oat b atnng is sufficient) 22 Certification:
3 .7L1I LID N . 77, 3UC' 00 . w __
6,is(ant)the welkin ei rajai�'_�3..
irs) trmtinent or °T Signature ofccrdtiad Wen Contractor Date
ttl•slg rice r/r i rm;1 twat,cvreg.that the nellta)mts(were)crattttrarted in at'csmlanre with
7.Is this a repair to an existing Well: °Yee or <l O ail n+CAC 02C.dif*r or I SA NCAC 02C.0100 Weit Construction Standar*and that a ropy
Ohl O a repair.till ant known twit alumna.tf m itgvtvmtttni and explain the nature of the o/fhis r ecord hat been.provided tad,well owror.
r'iris under all swoon*.section or nn eke!melt n(rkis form.
23.Site diagram or additional well details:
You may use the beck of this page to provide additional well construction info
ti,For C,toprobe/DI'T or Closed-Loop Geothermal Wells having the same
construction,only I OW-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:
-(B') Submit this GW-I within 30 days
For multiple sells)let all depths il"dallerenn(example-304.200'and Y40I0i7) of well completion per the following:
Ill.Static water level below top of casing: ! 24a, For All Wells: Original from to Division of Water Resources (DWR),
If water level t.i oknve coxing,tat (h`) Information Processing Unit.161 7 MSC,Raleigh,NC 27699-1617
1I.Borehole diameter: V (in,) 24b,For Injection Wells:Copy to DWR, Underground injection Control(RUC)
Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: i 0 t01 e i(l C. 24c.For Water Sup l and Open-t cop Geutl(erate(R Radar,"Welts;C(ix auger,rarely,cable,direct pods,CIO.; Supply p Copy to the
county environmental health department of the county vv{nre(nstaltcd
FOR WATER SUPPLY WELLS ONLY; 2Ad.For Water Welltproduzing ov r I GPD:Copy to DWR,CCPCIIA
Penttit?rowel, 1611 SC,Raleigh,NC 27699-1611
13a.Yield(gpm) Method of test:
`I3b.Disinfection type: Amount: __............... ,
Frame(:W-1

ilk.TERRATHERM ISTD Heater Boring Construction Detail Revision#:__0
Release date:_5/12/23_
Approved by:_SL
ri
Well ID H-26 Date /0 -- 0 3 - g ?
Oversight gJob# R23-104
Driller r
Constructed
a (fill out if
ign different) Notes
1/2"Thermocouple pipe? --Heater Stick-Up Height r----.\Thermocouple Length gry ---VEW Stick-Up Height .\8
Ground Surface 0.0'
Heater Can Conductive HT Grout Pill /
—
- from Horizontal 90°
Schedule 80 pp
&`
R-
i - Borehole Diameter 7"
' Top of J100 Sand 1'
Top of Screen 3'
Heater Can Length 28.57 5 Gal Buckets of Graphite 0.5
Heater Can Diameter 3
Bags of Silica 0.75
Screen Length 10 ft .41
iff
Screen Diamter 3 in RI Bags of Cement 2.25
iiil
W
Bottom of Screen 13'
1
Installation Method
ush Bags of MO Sand 6.5
nic,
'Hollow Stem Auger Gallons of Limestone 6.5
Mud Rotary
Other:
Bottom of II00 Sand 20'
~ Bottom of Heater Can 26'
Bottom of Borehole 26' I
Post-Installation QC(to be performed 24hrs after installation) PIO Log:Make/PA
1)Confirm well Is free of grout Design Constructed Time: / •� Reading: ',‘ 0 PPM
Depth to bottom of well[ft bTOC 7R c' Time: Reading: PPM
if greater than or equal to 1ff 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: