GW1--07012_Well Construction - GW1_20231102

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
I.'�Well Contractor Information:
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14.WATER ZONES
Well Contractor Name / FROM TO DESCRIPTION
3876A R.
NC Well Contractor Certification Number it ft.
e 15.OUTER CASING(for multi-cased wells)OR LINER(if a able)
(�,/l�,,f C G,� . br/ lb",J FROM TO i DIAMETER i THICKNESS MATERIAL _
Company Name ft. I ft. ia,
/�
16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#: /9 CLRC L#1 S,he FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well contraction pe its(i.e.UIC County.State,Variance,etc.) R. ft. in.
3.Well Use(check well use): Perin.i/71 ' W d`' V e d
ft. ft. In.
Water Supply Well: 17.SCREEN
❑Agricuh teal FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Municipal/Public ft, R. In.
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single)
❑Industrial/Commercial R R. I"'
❑Residential Water Supply(shared)
❑]rrigation 1&GROUT
❑Wells>100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: ft. ft.
❑Monitoring ❑Recovery
Injection Well: ft. ft.
❑Aquifer Recharge 1116<ndwater Remediation It R,
❑Aquifer Storage and Recovery OSalinity Barrier 19.SAND/GRAVEL PACK(if applicable)
FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stotmwater Drainage • ft. • ft.
❑Experimental Technology ❑Subsidence Control R. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG(attach additional sheets If necessary)
❑Geothermal(Heating/Cooling Return) theFROM To DFSCRIP170N(color,hardness,wlVrork type,grain sire.me.)
/ y [ �/ 0 " 2.S ft.4.Date Well(s)Completed: /tQ ' •-2-3 Well ID# lT-// - r��t lie Ig~C1 Srn`�y'jj L jd`/
2 S R, /.U .it 6-pal k u nr 4 Z.S�d�./v et f
5n.Well Location: R. R. /
Mot onferJ1ourCi,,,erxs`P4t- t LS e .Yena2.6V/99g R. rt.
•
Facility/Owner Name Facility IDe(if applicable) ft, ft. NO V 1/] 2 2023
2127 Ze ev�e / /vI Y etcsowW/Je) 23.5.ye ft. R. `i
Physical Address,City,and Zip ft. ft.
ONSIo lid #3 e/3D%'7 818 21.REMARKS1] /County Parcel Identification No.(PiN) 11tse'� greet Al., (.U z' YO-P e r'LX/r7r-GT d,._CO e/1
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: gee*, eisch�n 0-1,`c for a e9�s1 r'e#1 1-4 N el ei. 1 tS_
(if well field,one tat/long is sufficient) 22.Certification:
3y.711l1/e0 N 77, 3gcl00 W N�.� -a`s ' -�
IU's 3
6.is(are)the well(s): ilif(rmanent or ❑Temporary Signature of Certified Well Contractor f_ Darts
By signing this form,1 hereby certif•that the nr//(s)was(were)constructed in accordance with
7.is this a repair to an existing well: ❑Yes or II<Vo 1SA NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a cola
If this is a repair,Jill out known well construction info•nmtion and explain the nature of the of this record has been provided to the urnl owner.
repair under 1t21 remarks section or are 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/DPT or Closed-Loop Geothermal Wells having the same
(add'See Over'in Remarks Box).You may also attach additional pages if necessary.
construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:
/ 24.SUBMITTAL INSTRUCTIONS
a9.Total well depth below land surface: [s (ft.)
For multiple wells lase all depths if different(example-3@200'and 2 aQ1110) Submit this GW 1 within 30 days of well completion per the following:
10.Static water level below top of casing: AP ft) 24a. For All Wells: Original form to Division of Water Resources (DWR),
if water level is above casing,use•'+" ( information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
II.Borehole diameter: 7) (in.) 24b. For Infection Wells: Copy to DWR,Underground Injection Control(IUC)
Program, 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: RO t0..5-GtrY/L
(i.e,auger,rotary,cable,direct push,etc.) 24e.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the
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 27699-161 1
(gP ) Method of test:
13b.Disinfection type: Amount: -
Form OW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6.6-201 R

;.TERRATHERM ISTD Heater Boring Construction Detail Revision#:_0
Release date:_5/12/23_
Approved by: SL
Well ID H-14 Date 7 f t .--.'S.Q} 3
Oversight pi-/�.j y/f�
Job# R23-104
Driller f, DAIS I G).id,,.zA'Y iy
( Constructed
(tilt out if
Design different) Notes
1/2"Thermocouple pipe? ---Heater Stick-Up Height aa.'j
Thermocouple Length .67'
---VEW Stick-Up Height .48w- len
Ground Surface 0.0'
Heater Can Conductive HTGrout—
Angle from Horizontal 90"
Sche file 80 ' it 0 a
is ' y '
Y'Borehole Diameter 7"
r°. .f
° To
p� of Ai00 Sand 1'
`' Top of Screen 3'
Heater Can Length 28.5 ft
��-5 ���;5 Gal Buckets of Graphite 0.5
Heater Can Diameter 3 in —
Screen Length 10 ft ``' Bags of Silica 0.75
Screen Diamter rs•"-f in Bags of Cement 2.25 41,
k t. Bottom
of Screen 13'
s , lcr
Installation Method E
Sonic
f T ,Bags ofNO0Sand 6.5
Hollow Stem Auger ''' ' Y
? t,Gallons of Limestone 6.5
Mud Rotary -1.;
Other:
; ' ;,
'Y xninY` Bottom of MO Sand 20'
Bottom of Heater Can 26'
Bottom of Borehole 26' 4
Post-Installation QC(to be performed 24hrs after installation) PID Log;Make/Model:
1)Confirm well is free of grout Design constructed Time: J ,„y(J Reading: O, PPM
Depth to bottom of well[ft bTOC: 7a S' Time: a; /5' Reading: a . PPM
if greater than or equal to 1ft 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:
R eel/i