GW1--07030_Well Construction - GW1_20231102

WELL CONSTRUCTION RECORD(GW-1
For Internal Use Only:
1.Well Contractor Information: I
WriflaM WtmherIY 14.WATER ZONES
Well Contractor Name
FROM TO DESCRIPTION
3 O '7t>' A ft. R.
NC Well Contractor Certification Number rt. R.
15.OUTER CASING(for multi-cased wells)OR LINER(if ay Ilcahle)
C —,XC Cu.C./e Br; lr)"� FROM I TO I DIAMETER THICKNESS MATERIAL
Company Name fit ft. in.
� 16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#: /�A f.Cf/{( L.A 5:1—a FROM TO DIAMETER THICKNESS _ MATERIAL
List all applicable well construction pe nits(i.e.LI/C.County.State,Variance,etc.) rt. ft. in.
3.Well Use(check well use): Per-ft,r/f/�S ido-.' r e 4e ---_
ft. ft. In.
Water Supply Well: 17.SCREEN
❑A1,rictllfmtral FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Municipal/Public ft. R. in.
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single)
ft. R. In.
❑lndustriai/Cornmercial ❑Residential Water Supply(shared)
18.GROUT
❑h'ligahon —
❑Wells>100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: ft. ft.
❑Monitoring ❑Recovery
Injection Well: /�` ft. n
❑Aquifer Recharge iroundwater Remediation ft. ft.
❑Aquifer Storage and Recove 19.SAND/GRAVEL PACK(if applicable)
ry ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage • ft• It.
❑Experimental Technology ❑Subsidence Control ft.
it.
❑Geothermal(Closed Loop) OTracer 20.DRILLING LOG(attach additional sheets if necessary) •
❑Geothermal(Heating/Cooling Return) then(explain under#21 Remarks) FROM TO DESCRIPTION(cobq hardness salPrork type,grain size,etc.)
�j A d f. 2 S fit. • s
4.Date Well(s)Completed: /l`""' '23
r L L/ y^ - -''fie�J aoOt°` 9 r'�` 3(t�vi E4 a /dCy
P Well iD# !�, / 2 S tt' /.b .R' 6-pal a u af"t s Q /
1 Z a�/V
Sa.Well Location: ft. ft.
/3BC' Orn-j1ourC verS slue 4. $Je /ycAezyby9y9'y ft. ft. -
Facility/(Tuner Name Facility lot(if applicable) ft. ft.
2/2'7 t Jev,.e ,314j,j e1-cse r✓,-i/e) 2 8.s•'V6 n' ft. N!i V 2023 _ —
Physical Address,City,and Zip ft. I ft.
Ones/o LA) 1/3�Td°/,3a 117818 21.REMARKS --
County Parcel Identification No.(PiN) //5eS1e r („^e4,-, to/ *Tied,A.%...Zrf 11 is'•I/ £A. ��
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: gee*,I,,�/��l priQsche I+ .Ft c.10r C o..SIroot t ifl tv el a to i t'S
(if well field,one latilong is sufficient) 22.Certifieationa
w
.fe� I:aft ,�fr irk 36.is(are)the well(s): ufYermanent or ❑Temporary ignature of Certified Well Contractor ate
By signing this form 1 hereby calif•that the well(s)H s(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or O'1Vo 1SA NCAC 02C.0/00 or ISA NCAC 02C 0200 Well Construction Standards and that a copy
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 101 remarks section or on 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
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
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:
S 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: (ft.)
For multiple wells list all depths if different(example-3(3200'and 2 rr l00') Submit this GW-i within 30 days of well completion per the following:
10.Static water level below top of casing: /(f(fit) 24a. For All Wells: Original form to Division of Water Resources (DWR),
limner level is above casing,use"+ Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter: 7 (in.) 24b. For Injection Wells:Copy to DWR,Underground Injection Control(1UC)
�J Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: /1 D fa_�O.^/l L 24c.For Water Supplyand Open-Loop Geothermal Return Wells:Copy to the
(i.e.auger,rotary,cable,direct push,etc.)
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,CCPC11A
130.Yield m Permit Program, 1611 MSC,Raleigh,NC 27699-1611
(gP ) Method of test:
13b.Disinfection type: Amount: - i
Form OW-I North Carolina Department of Environmental QualityDivision of Water Resources- Revised 6.6-1.0I8

A, + TERRATHERM SIW Boring Construction Detail Revision 4: 0
Release date:_5/12/23_
Approved by: SL
Well ID H-44
Date 69;/,--D-'*��
Oversight /�... R-04A742,1
y� ���A ^� Job q R23-104
Driller /«..^ r,/L`rr Design Constructed Notes
/��
(MI out if
./ different)
di
1/2"Thermocouple pipe?
Thermocouple Length ---Heater Stick Up Height 30"
I
—SIW Stick Up Heig 18"
Ground Surface 0.0' _ ••''
_ Conductive HT Grout ,Angle from Horizontal 90"
Heater Can
Schedule 80
Heater Can Length AM. Borehole Diameter 7"
Heater Can Diameter Allitgillir
1111111
SIW Gal Buckets of Graphite 2.25
Riser LengthAO Bogs
Screen Length of Silica 3
Screen Material �� Bags of Cement io
Stainless Steel {
Fiberglass
Other: Top of 1I00Sand 30'
SIW Slot Size SO Bags of Sand
Screen Diameter 7.5
1"
j Gallons of Limestone 7.5
Iron Method
Boni '--
! 'Direct Push Top of Screen 50'
Hollow Stem Auger
Mud Rotary
Other:
Bottom of Screen 52'
111
Bottom of P00 Sand 54'
Conductive High Temp Grout---
v , Bottom of Borehole 57'
Post-Installation QCJto be performed 24hrs after Installation) PID Log:Make ode?:
1)Confirm well is free of grout Design Constructed Time: /��y L,'`` 0 Reading: ii '- in PPM
Depth to bottom of well[ft bTOC]: 59 5' lime: //i V Reading: 0 t PPM
if greater than or equal to 1ft 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 Time: Reading: PPM
Date Depth to Grout[ft bgs] Notes:
I
i+/4