GW1--07017_Well Construction - GW1_20231102

WELL CONSTRUCTION RECORD GW-1
I For Internal Use Only:
1.Well Contractor Information:
tlX1Ii6-tvx lttuber 1
Well Contractor Namc 14.WATER ZONES
FROM TO DESCRIPTION
3876A ft. n.
NC Well Contractor Certification Number n• ft.
IS.OUTER CASING(for multl-cased wells)OR LINER(if ap likable)
(2.n�.1•C a.c,(e. br-/ f ri i✓D FROM I TO ) DIAMETER THICKNESS MATERIAL
Company Name J ft. n, )n
2.Well Construction Permit# A ('.'ERC j /� ['�,[ 16.INNER CASING OR TURING(geothermal closed-loop)
it 5:Ice FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction pe its(i.e.UIC.County,State,Variance,etc.) It. ft. in.
Per-0,
3.Well Use(check well use): /r Ai°`' i'e
ft. ft. In.
Water Supply Well: 17.SCREEN
❑Agricuhttral FROM TO DIAMETER SLOT SIZE TNICKNE35 MATERIAL
❑Municipal/Public rt, It.OGeothermal(Heating/Cooling Supply) ❑Residential Water Supply(single)
❑Industrial/Commercial n• n. In.
❑Residential Water Supply(shared)
IS.GROUT
❑hTigation
❑Wells> 100,000 GPO FROM TO
Non-Water Supply Well: MATERIAL EMPLACEMENT METHOD&AMUUNTV
n. ft.
❑Monitoring ❑Recovery
Injection Well: /'� , ft. ft.
Recharge uidlt'dwater Remediation ft. ft.
❑Aquifer Storage and Recovery ❑Salinity Barrier 19.SAND/GRAVEL PACK(If applicable)
FROM I TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test OStormwater Drainage • • ft. • ft.
❑Experimental Technology OSubsidence Control
ft. ft.
•
OGeothermal(Closed Loop) ❑Tracer
20,DRILLING LOG(attach additional sheets If necessary)
OGeothermal(Heating/Cooling Return) then(explain under#21 Remarks) FROM TO DFSCRIPTtUN(color,hordes raturoek
�y� •• hardness, h'Fe,grain saes,eta.)
4.Date Well(s)Completed: 0 Well iD# / /— R• Z S. ft.
"F'"` r�j td�Pi 5 rc / ,(a tt 1aC7
fl �� �� 2 S n, 1d f' f,-j .,C „rk-z sati I
5a,Well Location: n. ft.
mac. oive J our C'�wers S` ei- , ,lC S--� 1( sy'eb a i''b yyvl°y ft. rt. -
Facility/Owner Name Facility ID#(if applicable) ft. rt.
2/2.7 Z,cu,Are i31� /3;enso/v✓,-i/e f 285 yed n• tl ',
Physical Address,City,and Zip ft. ft.
t/N-1s/0 to y j 9d13d y•7813 21.REMARKS County Parcel identification No.(PiN) "V//a " 1
44...se r a,, toe
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: St'.ect,fzt4 e/tctierne-'E-t`e for CtwArsr(f i o ft,el eta i is
Orwell field,one lalloog is sufficient)
y. �1�Q j / f 22,Certification: 1
6.Is(are)the well(s): Icrmanent or ❑Temporary >naEH lure ofCertifiedZeWell Contractor �^�r� )(✓ -��f `213
�' Date
7.Is this a repair to an existing well: OYea or �O By signing this form,I hereby certij•that the twills)was(were)constructed in accordance with
if C this is a repuir,,Jill out known well construction iyfouation and explain the nature of the of h record hasO100 bee provided to th or ISA NCACa tell o700 Well Construction Standards and that a corm
repair under lt2/remarks section or an the hark of this forni.
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 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:
2 2 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: (ft.)
For multiple we/Ls list all depths if different(example-3@200'and 2@/00� Submit this GW 1 within 30 days of well completion per the following:
10.Static water level below top of casing: /(P (ft.) 24a. For All Wells: Original form to Division of Water Resources (DWR),
If water level is above casing,use'+v If Processing Untt,1617 MSC,Raleigh,NC 27699-1617
11,Borehole diameter: 8 (in.) 24b.For Infection Wells:Copy to DWR, Underground injection Control(IIIC)
Program, 1636 MSC,Raleigh,NC 27699-1636
/�
12.Well construction method: /1 0 fa .040 C
(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
Permit Program,1611 MSC,Raleigh,NC 27699-1611
13a.Yield(gpm) Method of test:
13b.Disinfection type: ADiount:
Revmed 6-r,-mist
Form OW-I North Camlina Department of Environmental Quality-Division of Water Resources

obi TERRATHERM Multi-Phase Extraction Well Revision U.
,rwr�r,.•,., Release date:_5/.12/23_
Construction Detail
Approved by. St..._--.
Well ID M-5 Date ^1 9 V 3�VV!
Oversight :$4
Vid
lob it R23-104
Driller ('G __.__ i er iy
Design Constructed Notes
(fill out if
Well Diameter 4" different)
Borehole Diameter 8" Stick Up Height
Ground Surface 0.0'
HT Grout
Angle from Horizontal 90'
Top ofiY00Sand 1'
C ngMateral
Carbon Steel T•_-,, op of Screen 3'
Riser Length 6 ft
Screen Length 17 ft Bogs of NO0 Sand 12 s'Q
Rags of Cement 25 1..�5
_, Bags of Silica
Screen Material
Stainless Steel Borehole Diameter 8"
Fiberglass
PVC -----
Other:
Slot Size 1(1 " Bottom of Sand 20'
Bottom of Screen 20'
I • •tion Method 111
Soni HT Grout---
Hollow Stem Auger Sump Length 2'
Mud Rotary
Other: Bottom of Sump 22'1
Bottom of Borehole
dr
Post-Installation QC(to be performed 24hrs after installation) PID Log:Make/Model:
1)Confirm well is free of grout Design Constructed Time: 7 3t03.. Reading: (3,e PPM
Depth to bottom of well]ft bTOC1: 75' Time: a _ )11A Reading: O PPM
if greater than or equal to 1ft less than designed alert the office Time: 4; dam Reading: 1. 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:
r " �q