GW1--07020_Well Construction - GW1_20231102

WELL CONSTRUCTION RECORD GW_1
For Internal Use Only:
1.Well Contractor Information:
11-X/ii-ti.M t ,mil er l
Well Contractor Namc 14.WATER ZONES
FROM TO DESCRIPTION
NC Well Contractor Certification Number ft. ft.
IS.OUTER CASING(for multi-cased wells)OR LINER(Ifs feeble)
e0_5.c c.el e br;lb---...9 FROM TO
I DIAMETER THICKNESS 7 MATERIAL
Company Name ft. H. is
2.Well Construction Permit#: A Ce!j C j//y� rr 1 16.INNER CASING OR TUBING(geothermal closed-Ioo�)
J•/-a FROM TO DIAMETER THICKNESS
List all applicable well construction pe nits(i.e.WC,County,State,Variance,etc.) MATERIAL
tt• ft. in.
•
3.Well Use(check well use): Perin,rni�5 id et-' Y e ce
ft. ft. In.
Water Supply Well: 17.SCREEN
°Agricultur'al °Municipal/Public FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
°Geothermal(Heating/Cooling Supply) °Residential Water Su l ft. ft. in.
°Industrial/Commercial y(shale) n rt. In
❑Residential Water Supply(shared)
18.°irrigation ❑Wells>100,000 GPD FROM TO
ROUT ,.
Non-Water Supply Well: MATERIAL EMPLACEMENT METHOD&AMOUNT
ft. ft.
OMonitoting ❑Recovery
Injection Well: /`' ft. rt.
Recharge ( n4water Remediation ft. R.
Krrou
•
❑Aquifer Storage and Recovery ' °Salinity Barrier 19.SAND/GRAVEL PACK(if applicable)
°Aquifer Test FROM I TO MATERIAL EMPLACEMENT METHOD
°Stormwater Drainage . . ft. ft.
❑Experimental Technology °Subsidence Control
ft. ft.
❑Geothermal(Closed Loop) °Tracer
.20.DRILLING LOG(attach additional sheets if necessary)
°Geothermal(Heating/Cooling Return) Cher(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness,soD/reek
l 7 type,grain sire,ate.)
4.Date Well(s)Completed:1' G3 Well no l C t��} H, y2-yS R uh td�P�9~6`S,SQ,. C�Qy
/•Uft* 4-pal u wr t nn /
5a.Well Location: Z-�0./V!JL
`t• ft.
M3C. ONe-hour Cietwerr sc Vs-r-.j_Sye 4re b 0 z76Yyy9y rt. rt.Facility/Owner Name Facility IDN(if applicable) ft. ft. NOV t) 2 2023 --
2/27 Z fe urtee /3/v6 Y drew.`,-Ile 2 85"y/ ft. ft.
Physical Address.City,and Zip rt. ft. •
OA/SID W 43?I/3a y7818 /21.REMARKS
County Parcel Identification No.(PIN) /�eM'tP��a_.+W,- VO�Pv r-[�_Sl r1�ro..G f'i v.ne ide i2
j '
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: 5eeet,1•lt41 e l xche"0-E-i c.for 'tro*tC t"+pro el et j Is
(if well field,one lot/long is sufficient)
/
u '7 L 22.Certification:
e- / I/Ifd0 N 7 ,. 3A,( to
w
��l✓�z' �7 �z�,�n� `U `r�9
fa(are)the wells): rmanent or OTemporary
Signature of Certified Well Contractor � _�
Date
6.
7.Is this a repair to an existing well °Yes or [ By signing Ibis form,Ihereby cm*if)'that the well/.$)was(were)constructed in accordance with
ISA NCAC 02C.0100 or ISA NCAC 02C.0200 Well Construction Standards and that a cops
if this is a repair,,fill out known well construction information and explain the nature of the of this record has been provided to the well owner repair under#11 remarks section or on the hack 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 page to provide additional well construction info
(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
9.Total well depth below land surface: 8.7 .3" (ft.)
For multiple wells list all depths if different(example-3(a3200'and 2QI00') Submit this GW 1 within 30 days of well completion per the following:
10.Static water level below top of casing: �6 (ft) 24a. For MI Wells: Original form to Division of Water Resources (DWR),
II water level iv above casing,use +7 if Processing Unit,1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter: / (in,) 24b.For Injection Wells:Copy to DWR,Underground Injection Control(lUC)
/� a Program, 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: /1 O ia-J d/V i 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:
i
t..;
Form G W-I North Carolina Department of Environmental Quality-Division of Water Resources �.o

400 TERRATHERM ISTD Heater Boring Construction Detail Revision#:_0
��>• Release date:_5/12/23_
Approved by:_SL
Well ID HC-06B Date —1'" / I •'' 43
Oversight 1 t Job# R23-104
Driller & t Fir aft ', ^ .Gv, ere.I r
` Constructed
(fill out If
I Design different) Notes
—Length of Can Stick-Up(ft)/
Height of Can Stick-up Above
1/2"Thermocouple pipe? Ground(in) 31Y/30' 9
Thermocouple Length 87.67' -length of VEW Stick-Up(ft)/
Height of Riser Stick-Up Above
Ground(in) '/
01
Ground Surface 0.0'
ter Can Conductive HT Grout—
ngle from Horizontal 35'
(:Schedule 80
J — •• hole Diameter 7"
Top of#00 Sand 3'
— Top of Screen 5'
Heater Can Length AO ft _- Gal Buckets of Graphite 4117
— i
Heater Can Diameter 3 In — `Bags of Silica iS
Screen Length 17 ft _- Bags of Cement 4.
Riser Length 7 ft —
Screen Diameter 1 in •, om of Screen 22.5'
Installation Method
�Drere Push , of1100Sand 28
Ho ow Stem Auger Gallons of Crushed
Mud Rotary Limestone 28
Other:
Bottom of#I00 Sand 76.5'
Bottom of Heater Can 87.5'
Bottom of Borehole 87.5' "7 5
Post-Installation QC(to be performed 24hrs after installation) MD Log:Make/Model•
1)Confirm well Is free of grout Design Constructed Time: 7 .O Reading: of PPM,
Depth to bottom of well[ft bTOC 91' Time: ,/,,iQ Reading: �. PPM
if greater than or equal to 1ft less than designed alert the office lime: Q Reading: d e0 PPM
2)Confirm grout plug reaches ground surface lime: Reading: PPM
repeat daily until depth to grout is Oft. Time: Reading: PPM
Date Depth to Grout[ft bgs] Notes: