GW1--07011_Well Construction - GW1_20231102

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information: I
d i►1 We M i e r I y 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
348 /nt 64 R.
NC Well Contractor Certification Number ft ft.
// �// JJ� 15.OUTER CASING(for multi-cased wells)OR LiNER(if a licable)
CD_+s(:U.6C e. br/ /(/^/Q FROM I TO I DIAMETER j
THICKNESS MATERIAL
Company Name J ft• Inin.
n
16.INNER CASING OR TUBING(geothermal dosed-loop)
2.Well Construction Permit#: A t"Z RC L/-) ,S.•1e FROM TO DIAMETER
List all applicable well construction pe 7s(i.e.UIC,County.State,Variance,etc.) THICKNESS MATE/UALerip.1/4,01 We :v'ete n• ft. in.
3.Well Use(check well use): ft. ft. In
Water Supply Well: 17.SCREEN
DAgriCUhlrral FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
OMunicipal/Public ft. ft, In.
OGeothertnal(Heating/Cooling Supply) OResidential Water Supply(single)
ft. R. In.
❑Industrial/Cominercial ❑Residential Water Supply(shared)
❑Irrigation i 1&GROUT
Wells>100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: ft. ft.
GMonitoring ❑Recovery
Injection Well: //�� n• fL
DAquifer Recharge lti(4 ndwater Remediation ft. ft.
DAquifer Storage and Recovery OSalinity Barrier 19.SAND/GRAVEL PACK(if applicable) .
FROM TO MATERIAL EMPLACEMENT METHOD
DAquifer Test DStormwater Drainage . ft. ft.
❑Experimental Technology OSubsidence Control ft. tt.
•
❑Geothermal(Closed Loop) OTracer 20.DRILLING LOG(attach additional sheets if necessary)
DGeothermal(Heating/Cooling Return) filletcer(explain under#21 Remarks) FROM To DESCRIPTION(color,hardness,soil/rock type,grain size,etc.)
4.Date Well(s)Completed: /I)- '"..23 Well iD# //`/6 0 R• 2 S ft- „..spr/)ad0-e.14 rot 5,1.4eA v&CIe 7
2 S ft. /7) .R 6-pal
c,nr 12_Sati LJC
5n.Well Location: it. ft.
M3C. o,ye.Ji0urCk1o.,t/efs Si vi .1Lsie 4CAazy6Yy4i '1 ft.
Facility/Owner Name Facility iOt(if applicable) ft. ft.
2/2"71JL'u,ve /3/641/irsk.etg.Nti;let 28'5V ( H. ft. v -_
Physical Address.City,and Zip ft, ft. I ..
ON-TiO tL' 4(3 el30 JOg j 8 21.REMARKS
i
County Parcel Identification No.(PiN) e"' '"/*"... C.c,1._ -1 Avs 14-1 / O it/
5b.Latitude and longitude in degrees/nninutes/seconds or decimal degrees: See*. i eA. c�It++Tn e.E t`c fo f-C t[,v.1ror[ i p w et i js
(if well field,one iat/long is suficient) 22.Certification
3 y.7 yl ya o N ' 77, 3 `I 00
W
6.is(are)the well(s): lV rmanent or OTemporary Signature of Certified Well Contractor Date
7.Is this a repair to an existingwell: ❑Yes or By signing this form,l hereby certify that the twills)was(we're)awn-acted tructed in accordance with
P (11VD ISA NCAC 02C.0100 or ISA NCAC 02C.0200 Well Construction Standards and that a color
if this is a repair,fill out known urn construction information and explain the nature of the of this record has been provided to the well owner.
repair under 021 remarks section or on the hack of this form.
23.Site diagram or additional well details:
You may use the back of this page to provide additional well construction info
8.For Geoprobe/DPI or Closed-Loop Geothermal Wells having the same
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:
24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: (ft.)
For multiple wells list all depths ifdijferent(example-.1Q200'and 2Qt!00') Submit this GW-1 within 30 days of well completion per the following:
10.Static water level below top of casing: /t, (ft) 24a. For All Wells: Original form to Division of Water Resources (DWR),
i/water level is above casing,usc"+ information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter: 6 (in.) 241t.For Injection Wells: Copy to DWR, Underground Injection Control(RIC)
1i Program, 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: RO 0.Sa,ryl 24c.For Water Supply and Open-Loop Geothermal Return Wells:Co to the
(i.e.auger,rotary,cable,direct push,etc.) county environmental health department of the county where installed py
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:
Ob.Disinfection type: Amount: i
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Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-t-201 R

140 TERRATHERM ISTD Heater Boring Construction Detail
Revision#: 0
Release date: 5/12/23
Approved by: St.
r S
Well ID H-16 Date ( - t 1 ^ of J
Oversight t L�' 3 Job# R23-104
Driller Constructed
(fill out if
Design different) Notes
--Stick Up Height
1/2"Thermocouple pipe? 24" ZA
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 5 Gal Buckets of Graphite 1.25
Bags of Silica 1.75
Heater Can Diameter 3 in
Bags of Cement 6
Installation Method
Direct Push
Hollow Stern Auger
Mud Rotary
Other:
Bottom of Heater Can 26'
Bottom of Borehole 26' Z(12*
Post-Installation QC(to be performed 24hrs after installation) PID Log:Make/Model:
1)Confirm well is free of grout Design Constructed Time: Reading: PPM
Depth to bottom of well[ft bTOC 711' Time: Reading: PPM
if greater than or equal to lit 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:i R