GW1--07113_Well Construction - GW1_20231103

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P
WELL CONSTRUCTION RECORD(GW-1)
( For Internal Use Only':
1.Well Contractor Information: .I I I
WWI-et-MI 9dtsllboer11 y ;
14.WATER ZONES I
Well Contractor Name FROM TO I DESCRIPTION
S ag 76 ,4 i ft. fr. I
NC Well Contractor Certification Number ft• ft, j
1 15.OUTER CASING(for multi-cased wells)OR LINER(Bap neable)
4 0, c Cp,ei e. Dr;It,per FROM TO 'DIAMETER THICKNESS MATERIAL
Company Name ft. I R. I 1 In,
1
2.Well Construction Permit#: Q� ��tAt►�„[A gilt FROM
INNER CASING OR TUBING(geothermal closed-loop)
FROM TO .DIAMETER THICKNESS MATERIAL
List all applicable well construction pe n Is(i.e.WC.
County,State,Variance,etc.) ft. fit in.
3.Well Use(check well use): el9"'�i e o y Id�-°r e
ft. ft. In.
Water Supply Well: 17.SCREEN •
°Agticultlrral FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Mimicipal/Public ft. ft. in.
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) .
❑Industrial/Commercial ft' e, to
❑ResideritialWaterSupply(shared)
°}rrigation IS.GROUT
°Wells>100,000 GPD FROM TO ' MATERIAL.'' EMPLACEMENT METHOD 3 AMOUNT
Non-Water Supply Well: it. ft.
❑Monitoring ❑Recovery '
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Injection Well: ft, ft.°Aquifer Recharge • trdGroundwater Remediation .. tt. ft. •
DAquifer Storage and Recovery OSalinity Barrier 19.SAND/GRAVEL PACK(if•applicable) .• FROM TO MATERIAL EMPLACEMENT METHOD
°Aquifer Test °Stormwater Drainage • • • • ft. • ft.
•
DExperimental Technology ❑Subsidence Control ' ft. ft. '
•
°Geothermal(Closed Loop) OTracer • 20.DRILLING LOG(attach additional sheets if necessary) - •
°Geothermal(Heating/Cooling Return) keret.(explain under 1/21 Remarks) - FROM TO DESCRIPTIONZm1or,hardness,soli/rock type,grain size,etc.) --
4.Date Well(s)Completed:/e)_�3,"'� /]t `b . R, 2.5 -, % �J ttJ A. t"LI Yeti,4r, ca-chi
V4rellIDll
5a.Well Location:
It. ft.
� y��,�.r�Z -sra�.e�
ave I/our Clig.t ect s°��et•R,,,,E i� e ,i( b 0 vie 'iev9ie ft. rt.
Facility/Owner Name Facility iDS(if applicable) ft. ft' . `•6' 4 , -
•
2 d Z7 l eu,A.e 13, iai,X:erso.i Ile) 2:.�"v( ft. ft. ; NO v 0 ....
Physical Address,City,and Zip it. • ft.
Istr„ L 206
ON-5/0 1083 21.REMARKS }..;
/
County ParcelldentificationNo.(PiN) / 'e4P:ter t��vt/, S g���W f Yi/1 i
5b,Latitude and longitude in degrees/minutes/seconds or decimal degrees: gee dt,�a,c'i el sch 'o-'�"t`c.►o r e oX.Strarg'C f a e av e)et.e p.s
(if well field,one Int/long is sufficient)
Y N B ®� 22.Certification:
Ai N a 77. 36U1 00
6.h(are)the well(s): rmanent or ❑Temporary ignature /;(4':/j4b.
of Certified Wcl Contractor Date
Bj'signing thisform,I hereby certify that the ivellls)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or N9Yo 1SANCAC 02C.0100 or 1SA NCAC 02C.0200 Well Construction Standards and that a copy
Ifl/tr is a repair,fill out kirown well construction information and explain the nature oftbe of this record has been provided to the well onmer.
repair under#21 remarks section or on the back 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 prise to 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
9.Total well depth below land surface: 3 ©'
(ft.)' Submit this GW l within 30 dais
For multiple mils list all depths if different(example=3@200'and 2(aQ/005 ys of well completion per the following:
10.Static water level below top of casing: �,9 ft) '24a. For All Wells: Original form to Division of Water Resources (DWR),
If water level is above casing,rise"+"
( Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
;
I1.Borehole diameter: (itt.) ' ;•1 24b.For Infection Wells:Copy to DWR,Underground Injection Control(IUC)
l� .5�•
U .I Program,1.636 MSC,Raleigh,N027699-1636
K2.Well construction method: go n- 1, .1 4 1
(i.e,auger,rotary,cable,direct push,ere.) 24e.For Water Supply and ODelnLoop Geothermal Return Wells:Copy to the
county environmental health department-Of the county where installed
FOR WATER SUPPLY WELLS ONLY: 1, 24d.For Water Wells producing over 100,000 GPD:Copy to DWR,CCPCUA
13a,Yield m Permit Program,.1611 MSC,RalcighJ NC 27699-1611
(gP ) Method of test: .
13b.Disinfection type: Amount: 1 , I i .
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••Form OW-I NorthCarolinaDepartmentofEnvironmentalQuality-DivisionofWaterResource� i • Revised 6-6-2018

i4510 s
TERRATHERM ISTD Heater Boring Construction Detail j Revision#: 0
"u ,b,a�vry Release date: 5/12/23
' • Approved by: SL
Well ID H-35 Date 7-9?3 'e?3
_ Oversight d ,,�,fh-',/* ' ibIsi1t,
R23-104
Driller P o aorS ��/M:eb rr/`-
Constructed
(fill out If
Design different) Notes
--Stick Up Height ;w,,,�
1/2"Thermocouple pipe? up i .-24 'f
Thermocouple Length 37.67'
•
Ground Surface 0.0'
t
Heater Can Conductive HT Grout—
[,,. , •'!Angle from Horizontal j 90°
Schedule 40
Borehole Diameter 1,6"
, I
Heater Can Length 38 ft 'i. ' I t; Seal Buckets of Graphite 1.75
i,
,Bags of Silica .2.5 w'
Heater Can Diameter 3 in : '1 I'
Bags of Cement 8.25 �d
Installation Method ' [
ect Push r
! }. I
w Stem Auger s" i
Mud Rotary I, .'.,a; .I } ;!.:i is
Other:
' i ;:I Bottom of Heater Can 36•
'I I I
II! , , .11 f
!
' ' Bottom of Borehole 6'
Post-Installation QC(to be performed 24hrs after installation) PID Log:Make/Model: •
1)Confirm well is free of grout Design , ;Constructed Time: Er o !' Reading: e. 6 PPM
Depth to bottom of well[ft bTOC: , 4R' I Time: f 1,,,E i Reading: D i PPM
if greater than or equal to'1ft less than designed alert the office Time: i�'j,j 1' Reading: d,Ii PPM
2)Confirm'g•rout plug reaches ground surface Time: I' ,Reading: PPM
repeat daily until depth to grout is Oft. Time: I ' Reading: , PPM
Date Depth to Grout.[ft bgs] Notes: I •
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