GW1--07040_Well Construction - GW1_20231102

For!Memo Use Only:
I.Well Contractor lnfown);ation:
Well Connector Narftc " - -+"-- _ 14.WA b' ZONES
"' TO pit iN
NC Weil Contractor Certification Number n' n•
4r� J/ it.mina.CAS1NG grit multi.emed walk Olt
Company Name /. ft. (t, 1p
2.Well C'.onrh uetton Permit l#:{F 19 � �1 A 16.INNER!!!CASING OR TOWN I ca ., _
list all applicable nett cons/maim) 7O ttttlMtClda
pth7,t is(i.e.t11C.County,Slate.Yat9uttcr,err tt: ft. in.
3.Well Use(cheek well use): l��'r 9►+•/�fr`:' W,A.:r e
R ft• IS.
Water Supply Well: .17.SCREEN
PROM TO OlatiltITS $1411114t Agriculttnal OMtnricipal/Public R. .taAt7s .
OCreotharnrat(Heating/Cooling Supply) ORestdential Water Supply(single)
CllndovtrieUC+xmtnercial b• fr. ht.Water Supply(shared) -
l7lrrigatiun O Wells> 1(10,t1U0 Cal'() 'Komi
Non-Water Supply Well: R l iXratet+u tiltilt�,4 t p�f►60t1#Aettt rn'
OMonitori _ DReeov
n action r e . ft. `..ft. _-
°Aquifer Recharge tli undwater Itetnedlatiat ft.
17AquifeeStoma and Recovery tip 1tdV 4P C8 ail ,..
Matittity'Sorrier t r<rny'Batat. _.
CJAquifer Test trJ►tft�. M
©Stormwater Drainage - h. rc.
C1Experimental Technology C1Suhsideii Control ,
tt. h, `
C1Geot enna!(Closed Loop) ClTrgcer 20.YNRI'LLINC LOG(attarhaddaional at)iaets If DG othetmal(l'teating/C.'ooling Return) th r(cx lain under#21 Remarks ik� ro -- rtt'ON trofa;tiardaeu,ssWreek a
- r) ) It y-� !. ♦ tppc;�aMa Biel..._...
4.Sate Welke)Congrletedz Wet!its /� " d 2 S iw 4 5 It. ,,tr�yiP'"-`,agist it t el]"c/t�,..v, iii e1ek
Sac Weft 1.,oration: .; .. r A �:r f d+�hr S.
/ ,' + ONellour Ckt:.ver% cyoi 5,•pi .'' /A b 0 xt:y'' f251 rt. h.
Faun ity Owner Name Facility Ills(if applicable) ft. rt. NO I) 2
2132,3
2117 4f.ieuove Aiviik.;.€1-c.siwi;)/e# 2 85-Si '
Physical Address,City,and Zip �t _
Sl01Jt7 1/3` le"f 81 21.REMARKS
ft.ON � v)
County Parcel Identification No.(PIN) kir,17.1-re f t-/4.rot
5b.Latitude and longitude in degreesintinuteslieconds or decimal degrees: see41,tfol..ateot,x etnsi'+L fa)r C_O oval-riot t`s IIt v el t l j j,S
Orwell field,ace atllong is sufficient)
22.Cert(tieatien:
3'1. '11Li00 .N 73i/4(10 _W
6.is(are)the well(s): I t maaent or OTrmpewar Sigta nue of Certified Well Cnatnimor Date -.....
b1•slgntag rakeft,rni.thereby twill),that the neH/.r)was(were)constructed in are011110tre with
7.is this a repair to an existing well: Oyes or IBC. 11.4 NCAC 02C.0100 or 134 NCAC 01C.0200 Wel Construction.Standards and that a von,
i then!r a repair,,fill oat known wall construction htfrtt asmtinc mat crplaim the nature of the ojthts'ecord Ass teen provided to the wall owner•
wens under tt11 enmarkr section or an Hie hack of this form.
23.Site diagram or additional well details:
8,For t eoprobe/fPT or Closed Loop Geothermal wells having the same
may use the hack of this page to provide additional well construction info
construction,only I OW-1 is needed Indicate TOTAL NUMBER of welts ( 'See Over'in Remarks Box),You may also attach additional pages if necessary.
drilled: _. _
24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: y 7 (ft.)
For mint*wells list all depths(different(example 3(rilltk) and Y /ntn Submit this GW 1 within 30 days of well completion per the following:
10.Static water level below top of easing: f (ft) 24a. For AU Welk: Original floes to Divisionof Water Resources (DWR),!fritter level is above coring.rise"+ ' Information Processing Unit,1617 MSC,Raleigh,NC 27699-I617
Ii.Borehole diameter: (in,) 24b. For Infection Wells:Copy to DWR,Underground Injection Control MO
fa-
, Program,'.636 MSC,Raleigh,NC 27699-1636
12.Well construction method: ie�7 C3 i a--5- iv. Lr.
0 a.auger,rotaty cable,diiax>.t push,etc.} 24c.For Water Supplyand Open-L oop f rl'OthermaI Return Weill Copy to the
county environmental ealth depar i ient of the county where installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Welk producing over 100,000 GPD:Copy to DWR,CCPCUA
13u.Yield m Permit Program, 1611 MSC,Raleigh,NC 27699-1611
(gP ) . Method of teat:
tab.Disinfection type: Amount:
Ferro OW-1 wa r

TERRATHERM
ISTD Heater Boring Construction Detail Revision#: 0
° >.•,••� Release date: 5/12/23
Approved by: SL
Well ID H-8 Date 1 s Q
Oversight Job# R23-104
Driller it Y 6 , "
Constructed
(fill out if
Design different) Notes
--Stick Up Height
1/2"Thermocouple pipe? 24"
Thermocouple Length 48.67'
Ground Surface 0.0'
Heater Can Conductive HT Grout— Angle from Horizontal 90°
Schedule 40
Borehole Diameter 6"
Heater Can Length 49 ft 5 Gal Buckets of Graphite 2.5
Bags of Silica - 3.25
Heater Can Diameter 3 in
Bags of Cement 10.75
Installation Method
Direct Push
Sonic
Hollow Stem Auger
Mud Rotary
Other:
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 Time: t Reading: OA... PPM
Depth to bottom of well[ft bTOC, 49' Time: Reading: PPM
if greater than or equal to lit 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 bgsj Notes: