GW1--07016_Well Construction - GW1_20231102

WELL CONSTRUCTION RECORD GW-1
For Internal Use Only:
1.Well Contractor Information:
(Nc
) 1lid`•-M tjjr Alk r I
Well Contractor Name 14.WATER ZONES
FROM TO DESCRIPTION
3. 76 � ff.
NC Well Contractor Certification Number ft. ft.
/ IS.OUTER CASING(for multi-cased wells)OR LINER(if ap Beattie)
e"i�..rC ct.,1 e. br^i /1;,�� FROM 1 TO DIAMETER THICKNESS
1 MATERIAL
Company Name /+ n tt ft in I
2.Well Construction Permit#: A `LRC jr/� 16.INNER CASING OR TUBING(geothermal closed-loop)
,l �Yf e FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction pe nits(i.c.U1C.County,Slate,Variance,etc.J ft• ft. in.
3.Well Use(check well use): Peri),in �, ✓,t1 e-e r e ce
ft, ft. In.
Water Supply Well: 17.SCREEN
DAgricultural FROM TO DIAMETER SLOT SIZE 7TICKNESS MATERIAL
OMunicipal/Public ft.
n' in.OGeothermal(Heating/Cooling Supply) ❑Residential Water Supply(sin le)❑lndustrieUComtnercial ft. ft. In.
❑Residential Water Supply(shared)
Olrrigation 18.GROUT
❑Wells>100,000 GPD FROM TO
Non-Water Supply Well: MATERIAL EMPLACEMENT METHOD&AMOUNT
ft. ft.
❑Monitoring ❑Recovery
Injection Well: ft. ft.
OAquifer Recharge i111(1/`�',tdwater Rentediation ft. R.
DAquifer Storage and Recovery ❑Salinity Barrier 19.SAND/GRAVEL PACK(if applicable) .
FROM TO MATERIAL EMPLACEMENT METHOD
DAquifer Test OStormwater Drainage • ft.
ft.
❑Experimental Technology ❑Subsidence Control
ft. ft.
OGeothermal(Closed Loop) ❑Tracer
20.DRILLING LOG(attach additional sheets if necessary)
OGeothermal(Heating/Cooling Return) they(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness,wtUrock
( type,grain size.me)
� B. Z S ft.
4.Date Well(s)Completed: /°_ -�3 Well ID# r/J t�A*19�4`r� ►� lac"f 5 ' y-� R, 6- I f
5a.Well Location: G ,'U ' �T �d� u e r f Z j�a/y
R. ft.
/i& o,ve}iour Ciee4verr syveR,4_S.* .4(0 a 2-Y6 S14/619y It• rt.
Facility/Owner Name Facility ID!!(if applicable) ft. ft.
2 1.27 Z J€vAre /3/✓r�l j►; eY.stvnf✓/Ile, 2 8.5"y4e ft.
ft. NOV 12(� s --
Physical Address,City,and Zip ft. R. 2v
©A/31O a) 1/3 7d/30/78,3 22�✓1...REMARKS 1
County Parcel Identification No.(PIN) '' O/fi--I1AA-s f- L x.fr6-c7�c 0e✓ tCJe.//
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: Seen,ti-.4.41e,:eScht!./'no-• ,'L for et►e,.Sfrorc t+t)rodetails_
(if well field,one lat/long is sufficient)
y. �1�Q D 22.Certification: -
N � 77 .�d d d Od W
6.is(are)the well(s): tbrmanent or ❑Temporary Signature of Certified Well Contractor
Date
By signing ibis form.1 hereby certify that the'mills)was(were)canstrac ted in accordance with
7.Is this a repair to an existing well: ❑Yes or EP 1SA NCAC 02C.0100 or 1SA NCAC 02C.0200 Well Construction Standards and that a cop'
If thky is a repah;.fll out known well corrstrucliort information and explain the nature of the of this record has been provided to the well owner.
repair under#2/remmirs section or on the hack of this form.
23.Site diagram or additional well details:
R.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-1 is needed. indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach additional pages if necessary.
drilled:
J 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: Sir r S (ft.)
For multiple wells list all depths ifdifferenl(example-3Q200•and 2@c 100') Submit this GW-1 within 30 days of well completion per the following:
10.Static water level below top of casing: /A7 (ft) 24a. 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
24b.For Injection Wells: Copy to DWR,Underground Injection Control(IIJC)
I1.Borehole diameter: 8 (in.)
Program, 1636 MSC,Raleigh,NC 27699-1636
/�
12.Well construction method: /1 O f0.._5-PrIfi
(i.e.auger,rotary,cable,direct push,etc.) 24c.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(gem) Method of test: Permit Program, 1611 MSC,Raleigh,NC 27699-1611
13b.Disinfection type: Amount:
i
n
Form(W-I North Carolina Department of Environmental Quality-Division of Water Resources a F-i.,n Is

' Multi-Phase Extraction Well Revision#:_0
��TERRATHERM
Construction Detail Release date:_5/12/23_
Approved by: SL_
,
Well ID g_:1147/7M-8 1 Date 4 !_ ,/6` -'0-3
Oversight / lob# R23 104
Driller ! T �#`-',,"� .¢„.( 2M%G1y Design Constructed Notes
(fill out if
Well Diameter 4" different)
IIMMIlr
Borehole Diameter 8" -----Stick Up Height 36" 2y},
Ground Surface 0.0'
- ------ -------
HT Grout---------
III
Angle from Horizontal 90°
Top of#00 Sand 1'
Casing Material ___
-Carbon Steel _ __ Top of Screen 3'
Other: °
.Riser Length 6 ft _ _
Screen Length 47 ._-_. Bogs of#00 Sand 30.75
Bags of Cement 1.25
Bags of Silica 0.5
Screen Material —
_
Stainless Steel ,_-_° Borehole Diameter 8"
-Fiberglass - -
o_......
PVC
Other:
• - :Slot Size 10 Bottom of Sand 50'
___- Bottom of Screen 50'
Installation Method _ _-
Sonic HT Grout
Hollow Stem Auger Sump Length 2'
Mud Rotary
Other: Bottom of Sump 52'
Bottom of Borehole 52' ,S P b1/
Post-Installation QC(to be performed 24hrs after installation) PID Log:Make/Model:
1)Confirm well is free of grout Design Constructed Time: I I) : ` 0 Reading: 0. PPM
Depth to bottom of well[ft bTOC]: SS, /Time: ! l5 Reading: /0 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 bgs Time: Reading: PPM
Date Depth to Grout[ft bgs] Notes: