GW1--07024_Well Construction - GW1_20231102

WELL CONSTRUCTION RECORD GW-1
For Internal Use Only:
1.Well Contractor Information:
t.AX%Ii -/v% tt mbaer I
14.WATER ZONES
Well Contractor Name
�r FROM TO DESCRIPTION
g / �� ft. ft.
NC Well Contractor Certification Number h. ft.
r IS•OUTER CASING(for multi-cased wells)OR LINER(if a Ilcable)
C Ct. ��^1 /l s ^/� FROM I TO I DIAMETER THICKNESS MATERIAL.
Company Name T' it. ft.
2.Well Construction Permit#:Jr`A newel-/] ` 16.INNER CASING OR TUBING(geothermal closed-loop)
e t ,7'Va FROM TO DIAMETER THICKNESS MATEWAt
List all applicable well construction p^e/nits(i.e.WC Court State,Variance,etc.) ft. ft. in.
3.Well Use(check well use): " erg r l;41 a1 te- Y e ee,
It ft. In.
Water Supply Well: 17.SCREEN
17Agricultltral OMunicipal/Pubfic FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
°Geothermal(Heating/CoolingSupply) DResidential Water Supply(single) ft ft.
in
PpY) PPY( 8 )
❑lndustrial/Cominercial R• ft. In.
°Residential Water Supply(shared)
❑Im.ation IS.GROUT _
°Wells>100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT-
Non-Water Supply Well:
ft. ft.
OMonitoring ❑Recovery
Injection Well: /`' ft. rt.
Recharge tlieLidwater Remediation ft' R'
•
❑Aquifer Storage and Recovery OSalinity Barrier 19.SAND/GRAVEL PACK(if applicable)
°Aquifer Test FROM TO MATERIALEMPLACEMENT METHOD
OStormwater 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) then(explain under#21 Remarks) FROM TO
DESCRIPTION(color,aaNae wlUrock
type,groin sin.etc.)
v y-� �
4.Date Well(s)Completed: 1� -p-�3 yell no NC `Q yQ ft* -yS '�x°�rr�j td���9~�`� «d L1QY
Sa.Well Location: ,'U • G-rtiy a.,ar 1Z sale I
D. ft.
Mae. O,re.liour ClemwerS STVCR vI.S Ie Nebo 2.16Y64/9y ft. ft.
Facility/Owner Name Facility IOU(if applicable) ft. fL --
p L,/ r� ,-.LJ
2/Z'7 t eev.ve 1311/6 X.C�.S'DNVd i/e, 2 t7.� 7 G R.
Physical Address.City,and Zip ft• ft. -
ON-5/0 to 113?I/301 7813 21..REMARKS —
County Parcel Identification No.(PIN) him/r"r" pi 1A I/.y� ��
Steect, �1 elsehern o•
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: •f-r•a fo r C n,,,.i ret f4 N el eta i is
(if well field,one Iat/long is sufficient)
/` �/�0 ` f 22.Certification:t�,J'�-
N ' 77. 3db Er f90 W � v '��� r� ?3
6.Is(are)the well(s): t t rmanent or DTempora tsgnaturc of Certified Well Contractor✓ ��
Date
7.Is this a repair to an existing well: °Yes or By signing this form,1 hereby certif•that the twills)was(were)constructed in accordance with
1 SA NCAC 02C.0100 or I SA NCAC 02C.0200 Well Consn'iction Standards and that a copy
If this is a repair,fill out known„e l coma—fiction information and explain the nature of the of this record has been provided to the ne/l ouster.
repair under#21 remarks section or on the hark 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
(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:
y 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: g S (ft.)
For multiple welly list all depths ifdiferent(example-3Q200'and 2 it 101Y) Submit this GW 1 within 30 days of well completion per the following:
10.Static water level below top of casing: ie 24a. For AU Wells: Original form to Division of Water Resources DWR,
II water level is above casing,use`^+�" (ft.) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617 (DWR)
11.Borehole diameter: / (ill,) 24b. For injection Wells:Copy to DWR, Underground Injection Control(1IJC)
a Program, 1636 MSC,Raleigh,NC 27699-1636
Na.,Well construction method: /1 O t J iwi e.
(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,CCPCIIA
Permit Program, 1611 MSC,Raleigh,NC 27699-1611
13a.Yield(gpm) Method of test:
13b.Disinfection type: Amount:
i
R.,,,, .,t4_4.into
Form OW-I North Camlina Department of Environmental
Quality
-Division of\VaterResources

, t' TERRATHERM ISTD Heater Boring Construction Detail Revision#:_0
Release date:_5/12/23_
Approved by:_SL
Well ID HC-04B / ''Date 9-
Oversight n A 4.10' ' Job# R23-104
Driller 005"''�tL/1 */"://-e -!if/i 447.60 e-Iy
Constructed
(fill out if
Design different) Notes
C--' —Length of Can Stick-Up(ft)/
Height of Can Stick-up Above
1/2"Thermocouple pipe? 1111Mill Ground(in) 3.5'/30" ?t 6
Thermocouple Length 87.67' -Length of VEW Stick-Up(ft)/
Height of Riser Stick-Up Above
Ground(in) 1'/6"
Ground Surface 0.0'
Heater Can Conductive HT Grout IF
—
r- i Angle from Horizontal 35°
,( hedule 80 -:1 ' .�
I;
'
'',.Borehole Diameter 7"
,<; , _ia, !Top of POO Sand 3'
•1 ,1 if, Top of Screen 5'
P;
Heater Can Length 91 ft r 1 , 1, .5 Gol Buckets of Graphite 1
"""� Heater Can Diameter 3 in �� ' " ofSgka 1.5
_ '
Screen Length 17.5 ft t+,1,Bags of Cement 4.5
Riser Length 7 ft �s ' '
tt ,
Screen Diameter 1 in ' °'Bottom of Screen 22.5'
Installation Method , 4)! P4�� ''
Direct Push x;1 • "R U Bags of#00Sand 28
ISonic ,!°! „,
Hollow Stem Auger fit' 1 , ,
n 1 Gallons of Crushed
Mud Rotary '' . s Lune 28
Other: g;.'
' l(:�i ' Bottom of POOSand 76.5'
bs '
Bottom of Heater Can 87.5'
Bottom of Borehole 87.5' ' 7.`)
Post-Installation QC(to be performed 24hrs after Installation) PID Log:Make Model:
1)Confirm well Is free of grout Design Constructed Time: '�'c') Reading: 5,�9, PPM
Depth to bottom of well[ft bTOC QV Time: � iJ' Reading: L�''r PPM
if greater than or equal to ift less than designed alert the office Time: iV i t Reading: (7, PPM
2)Confirm grout plug reaches ground surface Time: it ir.° Reading: © PPM
repeat dolly until depth to grout is Oft. Time: Reading: PPM
Date Depth to Grout[ft bgs] Notes: