GW1--07039_Well Construction - GW1_20231102

.WElLL CON TRACTION REC D(GW .,
=� For ltztcrtie use Only:
I.Well Contractor Information:
Well Contractor Name al TO
_ DESCRIPTION �....-_
.7, J _ Is, n. _..._
N/t'.`.Well Contractor
//Ce tiflcation Number • ft. __.
Gr tit., -C Le ch,a pr; h,v3 IS.OUTER IElR CASING or a►atti aa.d well 17R
11B1C ATERIEL
Company Name ti. R.
2.Well CbnstrucNoa Permit#t i�A C� �rt` `�a 16. NNRR NG D 7URING lamtherteal eluaeA-Ioop}
List all applicable well ronctruettem perm is(r.c WC:County.Stale, faience,el,) Fltui►t R. 7 0 tNAaterxta 1NeCtG1Y 6 Ara ltxRlAL
3.Wen Use(ditch well use): ft. ha
l�a. 1't'At
Water Supply Well: 17. IEN __
C1Agtculttata) C7Munit ptillPublt� .1;n" i , LC' i. k lea o. r nille
lieatin It t"
OGeothermal
( giCooling Supply) IMuniaattiel Wafer Supply(single)
°IndustrialCorntncrcht! ft. la
['3Residerttial Water Supply(shared)
L71►rigatian actt4ll't
D Wells y 100,000 GpD oat M,k'l aw. am )
Nan-water Supply Well: n. tt PL MisN!a+t 7(qtt u
OMonitoriug
Injection Well: _ C1Recovery
0Aquifer Recharge adwatar Reinediation
rt> e. _ ._._— _
ClAquifer Storage and Recovery OSahnity Barrier PROM "" • Y 'PACK(H blsj �
L?Aquifer Test M S.2.4t i' •aft ,
C}Stonnwater Drainage . n. k,
IIIIIIIIIIIIIIIIII
DExperimental Technology OSubsidence Control
tt. ft.
C IGeothermal(Closed Loop) (°Tracer 20,DRILLING LOG(attach addMMard aitaets if
ClGcnthemial(Heating/Cooling C'ooli Return) Tl
type,ENO
r!£ q'(explain Under Wl l Remarks)
�� ... To 1YFSCAtt'ITUn teator,aanater,,aYtroefi tytu; r:c'.}
4.�.�Well(i)Completed: Well ID# _9 ... 0 25 r 77)5 IL .ph.,4 d�o#d t e-DI. �n©.,4ts l :
So.Well Location: 4 l.`s ttir ��`A" L1`
_. dh*r,jibi r Ci p�irtrl aye I�. -s,;/e, 44-h 0 z76 y'Ty '7 n• ft. "
Me-
paeility/AanerNa Faeilitytl)V(if appliawbk) It. ft. _
nm
2117 t>4trr-e. r31r41 r,,err arg1,-ile� 2t5'. Y' ft " ft.
NOV J 2.2073
Phystusl Milieu,City.sad Zip It. >t qyy y_ _._w.
t+ NslOW
County Parcet Identification No.(PIN) l "c T"�'D__ II-c'i'r`
3b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: s'� !r 04A e°+tl ,'t•, ►e„lt►e-i'r'�f r C04!",illrfn f limo,01 et i LS.
(if well field,and iat/}orgt is suffietent)
yy 22.Certification:
34.7111 96 O N . '77, 3 d&d 00 W 1
b.I err theweU s e - /0 -'Q, 3
(}. t rsnanent or OTe earl Signature of Well Contractor Date
7,l t this a repair Bp signing Parietal,l hereby vet*.Mai Me nets)war(were)con,ttneud in me titam•e with
to an exis ing well: Dyes or till l.14 NCAC 02C.ditto IV I SA NCAC OJC.012011 Weil(Water:ai ,Standards and Mar a colic
I/}his.is a repair,fill out known call rnnswiallrnt inforinanan and curtain the nature of the of tits record aas helm provided ro the well owner,
?VOW under 01I rwm,n-kr section or nn thehatA grins Arm.
23.Site diagram or additional well details:
8.For Geoprobe/DP'I'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
construction,only I GW-1 is needed. Indicate'TOTAL NUMBER of wells
drilled:_
f/ 24.SUBMITTAL INSTRUCTIONS
4•Total well depth below land surface: �7 7 'f' 1 (ft•)
For multiple nails lief all MOLTU"diffarerrr fe ttatole-3(r>2200'and J(t llttr)" Submit this GW-1 within 30 days of well completion per the following:
18.Static water level below top of casing: /f ( ) 24a. For All Wells: Oripinai foam to Division of Water Resources (DWR),
if water-level is above twang,arc"+ Infonnation Processing Unit,1617 MSC,Raleigh,NC 27699-1617
IL Borehole diameter: (in,) 24b.For Inlectioie.Wells:Copy to DWR,Underground injection Control(1(JC)
Program, 1636 MSC,Raleigh,NC 2 7699-1 63 6
12.Well construction method: 43„ fa..SPA'J C.
ji.e.sugar,rotary.delft,duce,push,etc.) 24e.For WilierentalSoppily and t t•• ip gentperntal. Isere i Wells;Copy to the
county environmental health department of the county where inatatied
FOR WATER SUPPLY WELLS ONLY:
2.4d.For Witter Wells produthmover 10,14000 CPD: Copy to OWE,CCPC1)A
13a.Yield(gig) Method of test Permit Program, 1611 MSC,Raleigh,NC27699-16 11
tab.Disinfection type: M iniunt:

TERRATHERM ISTD Heater Boring Construction Detail Revision 8:_0
"' Release date:_5/12/23_
Approved by:_SL
Well ID H-9 Date 3 1,-a 3
Oversight a Job It R23-104
Driller K£if %iif/14—
Constructed
(fill out if
Design different) Notes
iaisa.
1/2"Thermocouple pipe? ----Heater Stick-Up Height 30"
Thermocouple Length
VEW Stick-Up Height 18"
Ground Surface 0.0'
Heater Can Conductive HT Grout—
le from Horizontal 90"
Schedule 80 ^ i
Borehole Diameter 7"
Top of 1100 Sand 1'
Top of Screen 3'
Heater Can Length 49.5 ft - S Gal Buckets ofGraphite 0.5
Heater Can Diameter 3 in ra—,
';Bags of Silica 0.75
Screen Length 10 ft
Screen Diamter 3 in Bags of Cement 2.75
Bottom of Screen 13'
Installation Method
Direct Push Bags of#00 Sand
Sonic 6
Hollow Stem Auger Gallons of Limestone 14.5
Mud Rotary
Other:
Bottom of#00 Sand 40'
Bottom of Heater Can 47'
Bottom of Borehole 47'
Post-Installation QC(to be performed 24hrs after installation) PID Log:Make/Model:
1)Confirm well is free of grout Design Constructed lime: C A Reading: () PPM
Depth to bottom of well[ft bTOC; 49 S' Time: Reading: PPM
if greater than or equal to Sft 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: