GW1--07084_Well Construction - GW1_20231103

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' WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only: ' `
' 1.Well Contractor Information: i
,; . .
bi111- PN W i m1 el- 1 y/ t
0 14.WATER ZONES.. I I . __J
Well Contractor Nam? FROM • TO IDESCRiPTiON
3 7 /) f ft ft
NC WellC( / •
onntracto�r Certification Number ft ' ft. J ;
I 1 • ' 15.OUTER CASING(for multi-cased wells)OR LINER(If ap limbic)�,�a;;.0'Lae._,�rl 1/l/^/Cj • FROM •l TO • DIAMETER THICKNESS MATERIAL
• I Company Name . �j ft. it. { in.
/� /► 16.INNER CASING OR TUBING(geothermal dosed-loop)
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2.Well Construction Permit#: CLr t-C L ri �.)Le FROM .TO. ' DIAMETER - THICKNESS • MATERIAL
list all'applicahk Well construction he�fnits'(i.e.U/C County,State,Variance,etc.) ft. ft. in. '
• 3.WellUse(checkwelluse): Perilrf /e o-. re
ft. it. In.
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Water Supply Well: 17.SCREEN • ' '
OAgrlctrltlual _FROM 'TO DIAMETER ' .SLOT SIZE -'THICKNESS MATERIAL
OMtinicipaUPublic ft. - ft. •in.
OGeothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) _
❑lndustrial/Comntercial ft In.
❑Residential Water Supply(shared)
❑hTigation 18.GROUT • •
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.CI Wells>100,000 GPD .FROM •..TO " L MATERIA EMPLACEMENT METHOD&AMOUNT
•Non-Water Supply Well: ft.. ff.'
.DMonitoring. • ;•
ORecovery ft. ft.
Injection Well: ' ' ,
❑Aquifer Recharge teougdwater Remediation • ... it' ft.• `
OAquifer Storage and Recovery OSalinity farrier .19.'SAND/GRAVEL.PACK(if t nlleablc)
FROM' TO MATERIAL EMPLACEMENT METHOD
OAquifer Test OStormwater Drainage - • ft. • it. • '
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❑ExperimentalTechnolo �
Technology OSubsidence Control • • ft. ft, I OGeothermal(Closed Loop) OTracer •' 20.DRILLING LOG(attach additional sheets if necessary)
OGeotliermal(I-leating/Co0ling Return) that•(explain,under#21 Remarks) FROM TO DESCRIPTION(color hardness, grain sizeetc.ji��
0 tt. It d /�
4.Date Wells Com leted: �1' ��' •
,,p¢ S. X7r�r�j¢iac?`` Mil (s,,y ti'(16.7
O P Well ID# •� �" /1 ft. it-
Z /.y�.. . f�1-r`ay l�i�.tit re.--ra.A.Z •
Sa.Well Location: ft. ft.
/3i13C: 0/le /our C� sewer S.e-fat-R)44 Sj1e-i/eh 0 2-`/6 Y4y9 ft. • ft. ' �- _
y
Facility/Owner Name Facility iD11(ifa• pplicable) ft. ft. ' ;' •
2/27 Z ieudve /3itigi i2;ehisoi4.0vie1 2.8' "Y‘ ft. • ft. • NO b' J 2(1z37
Physical Address.City,and ZIP it. it.. I If,,:r.'c ,'a n ;;),-. •
y7g 8 - .,. _ . . )C: (r.-.
ON-1/0 w 2/3 Tel3a / /21/.REMARKS�t. `':: >c.'.�i:;
County 'Parcel identification No.(PiN) ' //ec_ier-Ce4..M-to i w, re Ey to.t;0.v We I(Sb.Latitude and longitude in degreeshninutes/seconds or decimal degrees: sr�@o'f fah e��ch�'n,�'ft'C-/o r eo,vstt-ckC f civel et i;is
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.(if well field,one lat/long is sufficient) i• 22.Certifigat ont
/11.74i1/00 N - '7.7,. 3ZI'd 0 1
6.Is(are)the well(s) wrermanent. or DTemporary•
Signature Decertified Well Contractor; Date �
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By signing this form,.I hereby cer of•Oat the wens)was(were)cbnstr•u led in accordance with
7.Is this a repair to an existing well: DYes or t51210 • 13.4 NC4C 02C.0/00 or 15.4 NCAC 02C..0200 IVeil Construc•Non Sirntdnrds and that gcopy
(Phis is a repair,fill out known well construction information and explain the nature of the of this record has been provided to 1he;nell Davies.
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repair under tt21 remarks.section or an the back of this form. ' .
23.Site diagram or additional well details:
S.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well construction info
construction,only 1 GW-I is needed.'indicate TOTAL NUMBER of wells • (add'See Over'in Remarks Box).You may also attach additional pages if necessary.
drilled:
C 7 Z 24.SUBMITTAL INSTRUCTIONS
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9.Total well depth below land surface: .. . (ft,) 1.
For multiple wells list all depth's"different(example-3@200'and 2C10o' Submit this GVV-i within 30 days of well completion per the following:
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10.Static water level below top of casing: •le 'I(f!I •240. For All Wells: Original form to Division 'of Water Resources (DWR),
((water level is'above casing use'+^ ?, Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
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11.Borehole diameter: / (in.) 1, 24b. For Infection Wells: Copy to.DWR,Underground Injection Control(RUC)% 1 Program,1.636 MSC,•Raleigh,NC•27699-1636
12,Well construction method: /10 c $.pV 1 C ' ! 24e.E'er Watel+Supply.and Open•Loop Geothermal Return-Wells:Copy to the
(i.e•auger,rotary,eabltp,direet push,etc.) ! county environfnental health department of the cowry•dlhere installed
FOR WATER SUPPLY WELLS ONLY: 24d.For`Water Welts pI tiducint;Over 100,000 GPD:Copy to DWR,CCPCIJA
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130.Yield(gpm) Method of test: I; PcrmitProgram,1611 MSC,.Ralcigh,NC 27699-1611 •'
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13b.Disinfection type: Amount: ; i
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Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources 1 Revised 6-6-2018

,i°"-1 TERRATHERM ; i. SIW Boring Construction Detail Revision#: o
0 G]:YaNJ CCm°pry i I -
Release date: 5/12/23
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11' Approved by:
1,
Well ID HC-06A
Date 7 kJ-a
Oversight %jaw .jiteg&Lt,'
Job# R23.104
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Driller o Albd,`y
Design Constructed Notes'
(fill out If
®t j' different)
1/2"Thermocouple pipe? ht' + ;='`3*":, G
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Thermocouple Length 59.17' 1 ---Heater Stick Up Height 30"i. x 2"t
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—SIW Stick Up Height 18"I .:. r Zli
Ground Surface 0.0'
Conductive HT Grout i
1;
Heater Can OP, Angle from Horizontal 78°;
Schedule 80
Heater Can Length 60' 4: %
�. Borehole Diameter 7°
Heater Can Diameter
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SIW .l ,w 5 Gal Buckets of Graphite 2.25
=;1 "• ;.I
Riser Length 51.5 r� ,k t Bags of Silica 3
Screen Length
2 ft :,r' -
Screen Material °" 4.sags of cement 10
Stainless Steel 11,4�'., •.
Fiberglass p4 AV a i
is Top of1100Sand 30' '
Other: i
im g(
SIWSIotSize tx„ '�-,g �G
Screen Diameter
10 4 Jj h Bogs of Sand 7.5
ag fay !
� 32 76 ��
a �r. Gallons of Limestone 7.5
Installation Method 1 7 ey
5yty •
I I 4 tV,; Top of Screen 50.5' I,
1 1
Direct Push' .0 l ?;t,j —riii
Hollow Stem Auger :Ii.t s, r, I,
.. 1,
Mud Rotary, r M f• 1
n i,
Other: 1 i 0,.04 t r` Bottom of Screen 52.5'
t -411
Sa x
°??.r`„`,R, : Bottom of 800 Sand 54.5'" I
a Conductive High Temp Grout a`•
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', Bottom of Borehole 57.5' j
Post-Installation QC(to be performed 24hrs after Installation) PID Log:Make/Model: i
1)Confirm;well Is free of grout; Design Constructed Time: /t8 jrading: I d,u PPM
Depth to bottom of well[ft bTOC]: 6n' Time: D
�, _�,�/!.� Reading: a r PPM
if greater than or equal to 1ftless than designed alert the Office, Time: 15 I r Reading: i' 0 '(, PPM
2)Confirm grout plug reaches ground surface ! Time: Reading: I ! " PPM
repeat daily until depth to grout is Oft I Time: Reading: i ; •
Date; Depth'to Grout[ft bgs] PPM,
i 1 Notes: f •
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