GW1--07033_Well Construction - GW1_20231102

WELL CONSTRUCTION RECORD(GW_I
For Internal Use Only:
1.Well Contractor Information:
t"t/+t cLM WI illiz.e r I Y 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
3$ 7 6 A It. ft.
NC Well Contractor Certification Number ft ft.
15.OUTER CASING(for multi-cased wells)OR LINER if a licable
�j 0_3-C Z't,(i e bro./1t^/dJ FROM I TO I DIAMETER I THICKNESS MATERIAL.
Company Name fr• ft. in if
2.Well Construction Permit#: 16.INNER CASING OR TUBING(geothermal closed-loop)
/A CIICL4 5,.fe FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction pe nits(i.e.U/C•.County.State, Variance,etc.) ft. ft. in.
t
Per
3.Well Use(check well use): u,,//i.�-9 �es ; v.e
ft. ft. In.
Water Supply Well: 17.SCREEN
❑Agri CldtnfAl FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
OMunicipal/Public it, fl, in.
❑Geothermal(Heating/Cooling Supply) OResidential Water Supply(single)
ft. fr. In.
❑Industrial/Commercial
❑Residential Water Supply(shared) 18.GROUT
❑Irrigation ❑Wells> 100,000 GPO FROM TO •
Non-Water Supply Well: ft. ft.
MATERIAL EMPLACEMENT METHOD&AMOLI,YT
❑Monitoring ❑Recovery
Injection Well: /� ft. R.
°Aquifer Recharge tDf roundwater Rerediation ft. ft. --
❑Aquifer Storage and Recovery DSalinity Barrier 19.SAND/GRAVEL PACK(if applicable)
FROM TO MATERIAL EMPLACEMENT METHOD
DAquifer Test ❑Stormwater Drainage • • ft. ft.
❑Experimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG(attach additional sheets if necessary) I
L°Geothermal(Heating/Cooling pR�eturn) tier(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness,snlVrock type,grain size:etc.) _.
4.Date Well(s)Com Completed: r� "v� ''2� 0 k ZS ft T-fi.r1)fi e..i5r0,1IrLAfit�C'j•dl
P 1 O Well iD# li 413 2 5 H• 1.7) ft. -t - a
I'6+� t .�.tir fZ SU�/V LQ
Sa.Well Location: ft, ft. /
/3& ON`Jiv'JrCJ jel- S:net-R.1-Sie N'ebez16Sevv9y ft. ft.
Facility/Owner Name Facility IDN(if applicable) ft. ft.
.z.7Z�euNe /51�1 3 28.s'ye ft.2i
^u V 2 2R23
Physical Address.City,and Zip ft. ft.
ON-5/0W Ii3 U/3a1/78)3 21.REMARKS T County Parcel identification No.(PiN) hiee--fe1•` e�.,,y 7-.,�...54-,!(A./'I c eV
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: Stems 1 l e�h p+J�Seh@rn,2 E r C.10 r Co.�'Srrt✓Z f+n AC elefct I Ls,
(if well field,one!Wong is sufficient) 22.Certification;
3'1 7`lI i/d o N - '7-7,. 3 /Igo W it././7!" --c /te,•ri. ) l©_ 1-'23
6.is(are)the well(s): rmanent or OTemporaty Signature of Certified Well Contractor Date
By signing this form,Iltereby certify that the twills)was(were)cunsnveved in accordance with
7.Is this a repair to an existing well: ❑Yes or Q1Vo 1SA NCAC 02C.0100 or ISA NCAC 02C.0200 Well Construction Standards and that a copy
Olds c is a repair,fill out knotty;well construction information and explain the nature of the oJ'this record has been provided to the well owner.
repair under 1121 remarks section or on the hack of this(oral.
23.Site diagram or additional well details:
You may use the back of this page to provide additional well construction info
R.For Geoprobe/DPI'or Closed-Loop Geothermal Wells having the same
(add'See Over'in Remarks Box).You may also attach additional pages if necessary.
construction,only I GW-I is needed. indicate TOTAL NUMBER of wells
drilled:
24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 36
Fat'multiple ire/!s list all depths ifdi(Ierenr(example-3 a 100'and 2@/00� (ft.) Submit this GW-1 within 30 days of well completion per the following:
10.Static water level below top of casing: /� 24a. For All Wells: Original form to Division of Water Resources (DWR),
If water level A.above casing,use"+" (It') Information Processing Unit, 1617 MSC,Raleigh,NC 27699-1617
11,Borehole diameter: CJ (ill,) 24b. For Injection Wells:Copy to DWR,Underground injection Control(IUC)
/� Program, 1636 MSC,Raleigh,NC 27699-1636
/1
12.Well construction method: O fe�Sc,i1/ie.
(Le.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,CCPCiJA
13a.Yield m Permit Program, 1611 MSC,Raleigh,NC 27699-1 61 1
(gP ) Method of test:
13b.Disinfection type: Amount: I
Form G W-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018

40 IERRATHERM ISTD Heater Boring Construction Detail Revision II: 0
Release date: 5/12/23
Approved by: SL
r -\
Well ID H-43 Date 7"/ c5
iir
Oversight Job II R23-304
Driller _ r r uLr 1! I,4+/GAG`' Constructed
/ (fIII out if
Design different) Notes
—Stick Up Height
1/2"Thermocouple pipe? 24"
Wal
Thermocouple Length 37.67'
Ground Surface 0.0'
Heater Con Conductive HT Grout--- •ngle from Horizontal 90'
•
Schedule 40 i
' Borehole Diameter 6"
Heater Can Length 38 ft 5 Gal Buckets of Graphite 1.75
Bags of Silica 2.5
Heater Can Diameter 3 in
Bags of Cement 8.25
Installation Method '
Direct Push
Sonic
Hollow Stem Auger
Mud Rotary
Other: '
Bottom of Heater Can 36'
$ Bottom of Borehole 36' i
Post-Installation QC(to be performed 24hrs after installation) PlO Log:Make/Model:
1)Confirm well is free of grout Design Constructed Time: 7 � Reading: opPPM
Depth to bottom of well lft bTOC IN _ Time: (_ uU Reading: (7,2!'la PPM
if greater thou or equal to]ft less than designed alert the office Tine: 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 bp) Notes:
1