GW1--07038_Well Construction - GW1_20231102

WELL CONSTRUCTION RECORD((GW-I) For Internal Use Only:
I.Well Contractor Information:
14.WATER ZONE$
Weil Contractor Natno
NC Well Contractor Certification Number ft.
�" 13.Ot1TER CASINt:1trit multi eased wells)OR LINER 111
Ls-c)..,S C:G4: g, Jr 1 11'r'✓ FROM _ To._ H4inIrratt _ TNICKNcsa tM l .
Company Name i), la.
IS.INNER C:A.SI YG OR' .._..._ ;. .__-_
2.Well Construedon Permit f}: CLtf -r(BINC UCs�thermpi ctwrrt tan
t� 5.' sum-- tY7 DIAMETER 111IC'KNBSS MATERIAL
Litt allapplicablewellconrtruction)xn la(l.r,:f11C:Carnrt)�,rStair, }ir/awe,ere). It R, in.
3.Well Ilse(check well use): re e.","/ J &0- r e'` - -- --�---
Tt. ln.
Water Supply Well: - t7.SCRM;KN .. __...._._.....-._..__,......,..._
C)ltgricnhanal [7MtmrcigJttllPut)lic t711.1Ls it I)}AMR7'TR Mot-sip 8 rftsesorss asar uAL
to in.
C1Geothcrrraal(NtmttiuglCooling Supply) ClReaidat)tipl Water Supply(single) tt. alall Ils ,
.
Dindustrial/Commercial °Residential Water Supply(shared) -
10,GROUT --^
Olrngation ..."...-.�...-
1Wells S 11)U,t)t)0 GPI) FROM 1�:: 1 irtATER1AL 16MP1y1{RM$PiT R�rllU 8 nMi)tJ�
Non-Water Supply Weft: R rt.
OMonitoring Cilteeovery it; h. ..
'Wertiun Well:
1,7Aa)taiPer RechargeIL rt.
oundwater Remediatirn)
(] 19 SAND/GRAVEL TACK of applicatsle)Aquifer Stomp.and Recovery OSaiinity Barrier
ttat)Nl•, re }tiAT1r.RIA1. P�Nrt4cEtatENT METHOD
. OAgtufx Test fStormwater Drainage - ft.- to
[]Experimental Technology t1Subaidence Control tt
OOeathennal(Closed Loop) OTracer
20.DRILLING LOG(e!tttacanddtilaaal sheets h'eaces;:ra.'L_ .. .
ClGeothermal(Heating/Cooling Return) tcer(explain under#21 Remarks) iatMS To tTwCcxlrrlUNitrrtariw sr,a,►umck , »In c r_k,;y'_
in ft. , , .5 m„7:Z4Pe 6 egifiel 9 ea 1 iii.4Mait A.c'ill
4.Date WelL(li)Completed: Well IO4/ }I -"?.I 2 5 R rbit.
So.Well Location: ''t, tL
/It`le. ONemburCkoiverl Stye
# S./ i+ C` t 47-161 i q e 1 r:.
PasilitylOsvner Name Facility ID"(irsopficable) fl. NC)V >) 4 2023
/31
x f '7 Z eta,�.t ✓t for lip .. 'ilif, 211'4'$1 d ft ft.
Physical Address,City,and Zip Vt ft � - 1 L,f r7t
ON.S'/l LA) "7. ?dri.304/7 J It REMARKS __ __ _ ___ _
'
County Pametidenatclaion No.(PIN)1 ( /
3b.Latitude and longitude In degreesiminuteaiseconds or.decimal dam: sef'o'fte.th.elgc ht. !>-�`t t-1;e C p.sx train fig ivj t•1{A iz:
(it well field,<an'lat/tong is sufficient) 22.Certification:
1.1,_711/ 4/0 a N 7 7 3.ii4r d O ,w
-7______----,_ I6-1S-23
6.ia(are)the welit's): (�rmanent or Crremporary SignatureofCertifiedWell('ant�Contractor pate
/ It'signing this lea-nn•thereby ertli(i•that the nettle)was(mere)constructed in tn.<utrta):re with
7.Is this a repair to an existing welt: °Yes or L!'Na 1.54 NCAC 02C_0100 or 114 NC,4C 02C".0200 Weil Construction Standard&and that a T
Phis Is a repots-jilt out known well construction is f rmattrur and explain the nature of tin- of this r•etord has been provided w,the well owner•.
rrpe/c wider 021+ennuis section or on the back of thisfirn.
23.Site diagram or additional well details:
8.Far Geeprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well construction WO
construction,only I(3W-1 is needed, indicate TOTAL NUMBER of wells (add See Over'in Remarks ilex).You may also attach additional pages trisects/Ivry,
tsry
drilled:___ _.. W,,_ 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below hind surface: S.7 4-rz. (ft.)
For nrnrnpie wells list all deptkr ifd Brent(rtanpft-3(n;200'tied 2Q))lutr) Submit this(:W-1 within 30 days of well completion per the fallowing:
10.Statie water level Maw tap of casing: ±f 9 (ls,) 24m. Ear AN Weds: Ori$iva} form to Division of Water Resources (DWIt),
If urrver truel is above rasing,kw"+" Information Processing Una,1017 MSC,Raleigh,NC 27699-161.7
11.Borehole diameter: t-y (in.) 24h. For lajection Wells:Copy to DWR.,Underground Injection Control(IOC)
¢ Program, 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method:_,_ leo t o-S,Wt < _ .......... 24c.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the
(i e.auger,whiny.,cable,direct pest,,etc.) county environmental hcahh department of the county where ansta test
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wefts praduchjgover 100,000 GPM Copy to OWE,CCPCUA
P
13a.Yield(gpm) Method of teat: cnm1 Program, obi 1 MSC,Raleigh,NC 27699.1611
[Ct)ltinttlon type: Amount: -

-%,,rot TERRATHERM SIW Boring Construction Detail Revision ti: 0
Release date: 5/12/23_
Approved by:
Well ID H-21 Date I/,'U 9 - 69
(,' -
Oversight b Job StR23-104
Driller (t.) _C')0444
Design Constructed Notes
(fill out if
different)
1/2"Thermocouple pipe? y"''r�
Thermocouple Length 58.67' ----Heater Stick Up Height t30" !
---SIW Stick Up Height Q)
Ground Surface 0.0'
Conductive HT Grout /Angle from Horizontal 90"
Heater Can
Schedule 80
Heater Can Length 59.5' Borehole Diameter 7"
Heater Can Diameter 3'
•5 Gal Buckets of Graphite 2.25
SIW
Riser Length ( ft Says of Silica 3
Screen Length ft
Screen Material Bags of Cement 10
Stainless Steel '>
Fiberglass Top of#00 Sand 30'
Other:
SIW Slot Size 10 Bags of Sand 7.5
Screen Diameter 1"
Gallons of Limestone 7.5
1pallaon Method
S.Sofiie-- Top of Screen 50'
Direct Push
Hollow Stem Auger
Mud Rotary
Other: Bottom of Screen 52'
U 1
Bottom of#00 Sand 54' 1
conductive High Temp Grout--
Bottom of Borehole 57'
Post-Installation QC(to be performed 24hrs after Installation) PID Log:My /Model:
1)Confirm well Is free of grout Design Constructed Time: t7 s., Reading: PPM
Depth to bottom of well[ft bTOC): 59 5' Time: tel
t7 , G �, Reading: rj„Di PPM
if greater than or equal to Ift less than designed alert the office Time: 7 , Q S Reading: PPM
2)Confirm grout plug reaches ground surface Time:/3: (s‘ Reading: O. - n PPM
repeat doily until depth to grout is Oft. Time: Reading: PPM
Date Depth to Grout[ft bgs) Notes: