GW1--07078_Well Construction - GW1_20231103

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WELL CONSTRUCTION RECORD(GW-1)
For Internal Use Only:
I.Well Contractor Information:
LIP,t o-M• W i(f9la•er i D
•14.WATER ZONES j
Well nt 6Contracctor Name FROM' TO . DESCRIPTION -
ft. ft. d v /
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NC Well Contractor Certification Number ft ft. J
JJ//
15.OUTER CASING(for,multi-cased wells)OR LINER(if ap llcable)
C 4%..SC t:tr�I'e. br/ J/,' '' FROM • TO
DIAMETER .THICKNESS • � MATERIALCompany Name ft } Ct• in:
A 16.INNER CASING OR TUBING(geothermal closed-loop) •
2.Well Construction Permit#:I r A Czf e.j.,/I ,�. ee . FROM To
List allapplicahle well construction permits(i.e.U1C.County,Skate,Variance,etc.) ft. ft. DIAMETER THICKNESS1CKNESS •MATERIAL _
in.
3.Well Use(check well use): PerIAin d✓� id e"%lr e.
ft. • ft. in.
Water Supply Well: • 17.SCREEN.
OAgr'Icllltltral FROM •' TO ' DIAMETER:..-SLOT SIZE. :THICKNESS MATERIAL
❑Municipal/Public ft. ft. • 'in. . "
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single)
ft, ft. •in,
❑IndustriaUCommercial ❑Residential.Water Supply(shared) ,
❑hrigation �
❑Wells>100,000 GPD FROM TO.• • MATERIAL': EMPLACEMENT METHOD&AMOUNTS
Non-Water Supply Well: ft. ' ft.
OMonitoring ❑Recovery '
Injection Well: ft. ft.
❑Aquifer Recharge roundwaterReinedintion ff ft.
❑AquiferStorage and Recovery ❑Salinity Barrier 19.SAND/GRAVEL PACK(if appile:M e) '•• FROM c TO MATERIAL EMPLACEMENT METHOD❑Aquifer Test ❑Stonnwater Drainage • . .. •' ft. • ft. • i
❑Experimental Technology ❑Subsidence Control ft ft.
❑Geothermal(Closed Loop) ❑Tracer • 20.DRILLING LOC(attach ridditlonal sheeti if necessary)
❑Geothermal(Heating/C:ooling Return) . ther(eXplain under#21 Remarks) FROM- I TO DESCRIPTION(color,hardness,soli/rock type,grain slxc,�t�.)
i� II. Z Sft- . is id "-'�.
4.Date Well(s) �-19- ��Completed:� .� WellID# • '�-� •tt. -:�•
5a.Well Location: ff. :ft.
i& o,r_J1 v tn Cie .very S. of •vi_,j•;le Y 99'� ft. ft. _" -
Facility/Owner Name 'Facility 1D0(iftipplicable) . ft. ft -
. ''.v'x. ! F,` t
2 i27«�eu.n.e '31✓ j();e1-.sow✓•lie} 28�"5iZ rt. ft. NOV ,)
2023•
Physical Address.City,and Zip ft. • ft. -
Dlv.IL) 113lel3ay73J8 21.REMARKS if ,,,
,�s ,"1( -+
County y ��� ; "
Parcel identification No.(PiN) /lee•l ems. cot..., ..,4,;,_"'fin-j9�-6 O..v •
Sb.Latitude and longitude in,degrees/minutes/seconds or decimal degrees: se& I fah p�s�rl►'e e^d-�i G-fo r C��.v Srrri.e +21 iv )C 1 11
(if well field,one IaVlong is sufficient) 22.Certification
.3j1y7y1 lie 0 N -'7.7,. 3 6 IIc7a
w "� ? . ...,� . /�-4 -23
6.is(are)the well(s): rmanent or OTemporary tgnature ofCertified Well Contractor; Date
t
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By signing this farm,1 hereby certify thatthe tie/l(s)was(were)constructed in accordance with '
7.Is this a repair to an existing well: 'El Yes or &1Vo 1SANCAC 01C.0100 or 1SA NCAC 01C.0100 IVell Construction Standards and that a cola'
/jthis is a tenon;fill out known well construction info nation and explain the nature of the o/1his record has been provided to the hell oitwer.
repair tinder 1121 remarks section or on the hack of this.form.
• 23.Site diagram or additional well details:
8.For Geoprobe/DPT or Closed-Loop,Geothermal Wells having the same You may use the back of this page tb provide additional well construction info
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.SUBMITTAL INSTRUCTIONS
6 9.Total well depth below land surface: 2. . '
(ft.)
For multiple wells list all depths?Td1 in-en((example-,3 r©200'and 2 a 100') Submit this GW 1 within 30 days of well completion-per the following:
i
10.Static,water levehbelow top of casing: /t� ft •24a. For All Wells: Original foi-n to Division of Water Resources (DWR),
If water level is above casing,use ^ ( ) Information Processing Unit,1617 MSC,Raleigh,NC 27699-I617
II.Borehole diameter: 6 (in.) 24b. For Injection Wells:Copy to DWR, Underground Injection Control(fUC)
�J Program,1.636 MSC,Raleigh,NC 27699-1636
12.Well construction method: I!f, 1-cL Sc,✓1f,L I rotary,cable,di 24c.For Water.Supply and Open Loop Geothermal Return Wells:'Copy to the
(i.e.auger, rcet posh;sic) • county environmental health'department of the county where installed
FOR WATER SUPPLY WELLS,ONLY: • 24d.For Water Wells producing Over 100,000 GPD:Copy to DWR,CCPCUA
13a.Yield m Permit Program,1611 MSC;Raleigh,NC 27699-1611
(gp )• Method of test: .
13b.Disinfection type: Amount: - I .
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Form OW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6.6.2018

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TERRATHERM 1 ISTD Heater Boring Construction Detail Revision#: 0
PCseadPC.p"
I; Ip, , 1 I Release date: 5112/23
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Approved by: SL
I i Well ID H-47 Date 7�' ®� '
Job#Oversight / ' R23-104
Driller ' ee/71
I Constructed
(fill out if
Design different) Notes
Alga -Stick Up Height
1/2"Thermocouple pipe? ,`^;inn r I;24" a i"
Thermocouple Length .67' ;
1'
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Ground Surface 0:0'
ill
Heater Can Conductive HT Grout I ' Angle from Horizontal 190°
Schedule 40
i 0
Borehole Diameter j 6"
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Heater Can Length 28 ft ° , 5 Gal Buckets of Graphite 1.25
,l
'Bags of Silica 1.75
Heater Can Diameter 3 in In
n 1. ;Bags of Cement ',6
M
;,
Installation Method? p.•,, I,
Direct Push
Hollow Stem Auger , ; ,
Mud Rotary
Other:. 1" . I; '
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I ' Bottom of Heater Can 26'
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, ;, . Bottom of Borehole 26' i��s
Post-Installation QC(to be performed 24hrs after installation) PID Log:Make/Model:
1)Confirm well is free of grout Design Constructed Time: 7:de Reading: 670 PPM
Depth to bottom of well[ft bTOC; PR' Time: ',°.3''3' Reading: 0,6' PPM
if greater than or equal to ift less than designed alert,the.office Time: q a 5`7 i Reading: 0,0 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:
0�rnI ' ,Wb ,
f ,
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