GW1--07026_Well Construction - GW1_20231102

WELL CONSTRUCTION RECORD(GW-1)
I For Internal Use Only:
1.Well Contractor Information: i
(at);/fit a w‘ Ai,M6er 1 Y
14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
3876A ft.
NC Well Contractor Certification Number ft. ft.
15.OUTER CASING(for multi-eased wells)OR LINER if a Iicahle
G .. C ci-d e b r2 /`Z n/� FROM TO DIAMETER THICKNESS NIATEIt1AL.
Company Name It. ft, in.
2.Well Construction Permit#:Nr,, . neat L/n� `` 16.INNER CASING OR TUBING(geothermal closed-loop)
rl ,71'JLe FROM TO DIAMETER THICKNESS MATERIAL
List all applicable,well construction pe nits(i.e.UIC.County.Stale, Variance,etc.) -ft. ft. in,
3.Well Use(check well use): Per�t�/�3 �o`; Ye ��__._
ft. R. in.
Water Supply Well: 17.SCREEN
❑Agricultural FROM TO DIAMETER SLOT 512E THICKNESS MATERIAL
°Municipal/Public ft. ft. in.
°Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single)
°Industrial/Comn)ercial ft. IL In,
❑Residential Water Supply(shared)
°hrigation 18.GROUT
°Wells> 100,000 GPD FROM TO ' MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: ft. R.
❑Monitoring °Recovery
Injection Well: //�� ft. ft. - -
°Aquifer Recharge IBC;roundwater Remediation ft' ft.
°Aquifer Storage and Recovery OSalinity Barrier 19.SAND/GRAVEL PACK(if applicable)
FROM TO MATERIAL EMPLACEMENT METHOD
°Aquifer Test OStonnwater 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) Ihor(explain under#21 Remarks) FROM TO DF.SCRII TTON(color,hardness,toll/rock type,grain size,et,..)
ft"
Z S ft. 7-J A {�p
4.Date Well(s)Completed:/O ._ Z3V -�^� r/)ea®�°"4/t'o• 0-Ae �L itlC`/
P Well ID# 2 5 ft. v IL 6-1` •• B� :r.f Z sa.nr el ,
5a.Well Location: ft. ft. /
Me_ 0t%4.41u tr Ciemeeli slue ,4 Si '• 44 1)d 246 yyy9y ft. ft. -
Facility/Owner Name Facility ID//(if applicable) ft. ft. 7
2 i Z 7 q ieur.e /3/✓IS1f 3-a eh-_,,,,,✓-i/e 2 O.S ' ft. ft. N O V 1I 2 ?Ill �II
Physical Address,City,and Zip ft• ft•
ON-510 W 1/3 7e/3a 1 7 818 21.REMARKS County Parcel Identification No.(PIN) Vol'0 r- `-Lk'trams 1*..14)4 I
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: yeect,tf„.heixchein.1-t ‘ for co-Srr•r✓e t inNd E'1u.i 1S
Orwell field,one lat/iong is sufficient)
y. 1/ /G O 7 `E` w 22.Certification�
1 N ' / 7 3 tJ 4 r"Q /�i�26,, ,�.. i ` .: r,''� , / /U 7 �j"-/3
6.Is(are)the wells); rmanent or °Temporary Signature of Certified Well Contractor / Date
L.
By signing this form,I hereby cerlily that the;mil/slims(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or M/t1 ISA NCAC 02C.0/00 or ISA NCAC 02C.0200 Well Construction Standards and that a copy
IOW is a repuir,.fill out known well cons:nicht»,inWhinratimr and explain Mc nature oftlte o/this record has been provided to the well onvter
repair under 82/remarks section or an 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
S.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
construction,only I GW-I is needed. indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach additional pages if necessary.
drilled:
24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: / 2 (ft-)
For am/tiple wells list all depths if different(example-3@200'and 2 a/tkr) Submit this GW-1 within 30 days of well completion per the following:
10.Static water level below top of casing: /cp (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 27699-16 1 7
11,Borehole diameter: G✓ (in.) 24b. For Injection Wells: Copy to DWR,Underground Injection Control(IUC)
/� C Program, 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: /1 O tcLl_J d",V i C.
(i.e linger,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
13a.Yield m Permit Program, 1611 MSC,Raleigh,NC 27699-1611
(gP ) Method of test:
13b.Disinfection type: Amount:
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6.6-20l t

TERRATHERM VEW Boring Construction Detail Revision I1:_1_
Release date:_6/27/23_
Approved by: EH
,' WelllD V-2 i
Date -�- Z 3
Oversight _i� N kit..)a —
/% Job M R23-104
t'
Driller e—• '�Z,irw—L e , 1 • ((JJ�%IN k efr A/
Constructed 1
(fin out if j
Design different) Notes
s
---VEW Stick-Up Height 18"
2,14 al j4 1
Ground Surface 0.0' ;
it
conductive HrGrout_
I i
Angle from Horizontal 22'
Borehole Diameter 6"
1
Top of#00 Sand 13.5' /3 1
,
Top of Screen 26.5'
t
t
‘ S Gal Buckets of Graphite 1 S
Riser to
ft s Bags of Silko 1.25 1
Screenlength 15 ft x
Screen Diamter 1 in Bags of Cement 4 •
IP
c
s Bags of#00 Sand 9.5 1 c)
MtstaAbEloe,Method - Gallons of Limestone 9.5 2_ c. ,
_Direct h --
•
oilow Stem Auger -
Mud Rotary
•
Other:
Bottom of Sand and Screen 41.5'
a
Bottom of Borehole 41.5' if 1"I A`
Post-installation QC(to be performed 24hrs after Installation) PID Log:Make/Model:
1)Confirm well is free of grout Design Constructed Time:_ c.Qt) Reading: Q.p PPM
Depth to bottom of well ift bTOC 41 ft . lime: s pD Readin
g: p. Q PPM
if greater than or equal to 1ft less than designed alert the office Time: •;Qp Reading: p.0 PPM
2)Confirm pout plug reaches ground surface Time: Reading: PPM
repeat daily until depth to grout is Oft. Time: Reading: PPM
Date Depth to Grout ift lags) Notes: ,3 c -IcEttt .).r Z
1-8 ,
Str-^''.