GW1--07045_Well Construction - GW1_20231102

WELL 'ONSTRUC ".CON CO Cvw-1
For Internal Use only: -_ `w
I.Well Contractor information:
well Coarsen.Namr
rs pn951 _To �, fp;4cRttet 1N ----
_ ' :�''7y!o -/1 �• .
NC WdFCvnhnct ►Gdtification Nomber ft. - __
6" d } 13.D CASING(t'nr Mudd-cared we-0AD*L -_._
as.k..rc Ce,. S 4r it l Aeit —atom ti4METitRt Ii11C'1(NE4S TM.RIAt..
Company Name !a.
2.Well Construction Permit N: ia.INN SING OR BCNc(gentdermatNero ed-inop)
List all oreaitru well t'Daxtl7mit f yA ar Cn,*i 5"�,. _ FROM TO. DIAMETER THIC OESS SuiERIAt
{{�at UK.Caatt ly,SW Parlance,erc,! fa,. ft,, le.
e ire
3.Well Use(check well use); ee^04,...
J hai 0..;r
R. IC in.
Water 9u - }�._.....
pP1Y Weii: 19.5CitERdY
FRoln_ ,Tip . DIAMETER SLOT SIZE THICKNESS MATERIAL
°Agricultural DMunicipal/pyhBq
OGeothennal(fleeting/Coolingft.` In,
Supply) C3Resideniioi Water Supply(single) e
tihtdustriatICommercial R' l4i
[_1Residt:rttiid Water Supply(shafted) •
OhriIaate _ °Wells.> 100000(Wi) MOM TO -MA'SERIAt • _.
Non-Water Supply Well: Ea11tZMENT ME)Hqp&nntoUt�T .
ft. ft.
°Monitoring °Recovery !t
njerhun el: __..
°Aquifer Rechaage t> oundwater Reined/talon
°Aquifer Storage and Recovery i]Salinity)tarries 19.SAND/GRAVEL L P Of j
FROM ._.._W TO hiA YMPLACEMENT METi OD '
°Aquifer Test DStormwater Drainage ft. ft,
°Experimental Technology °Subsidence Control _ _ _ rt. ft. _ _
°Geothermal(Closed Loop) LITracer 20.DRILLING_ taftealn aidHtonal sheets aoeetuaryj .
DCeothermal lieatin:Cooli .,Return) then(explain under#21Remarks) rates m utsclurrHav(relnr, I", tm,'flivnchtper,retaape,n )
0 f' , 5 ft. t �••b If _-,x-C L..►, C
lil-
t Date Weft(s)Completed: Well Ilifl• . ,. 16 ft,
,�p1,,;� Sa.Weil Location: R: rt
1 . Ome-nessar Ckg,seerl St ei- il-..5 . ,
rt. rt.
Facility/Ow•nerName Facility ION(iiappiicablei ft, it.
Phyritvi Address. h. .r. i, ..
C�ity.:and Zip
0IV 5/0IV 4i 7‘i,3Py"73J3 21.,REMARIQI
County Parcel identifiemtion No.(PIN) till r - I''PIP {
5b.Latitude and longitude in delta eestatiuuteslseeonda or decimal degrees: geto` .`c_fof`c. ', t of fittiv l eto. Ls.,
tit well field,arc Iat/long a somea nt) 22.Certification:
3y.71//Ile a N ' 77, 3611 dC ,w
6.Is(are)the well(s): 1Wrmanent or []Temporary' Signature of Certified Weil CttMtstelor Date
NI• th slgning r r`prat./hereby:whi 'that the ne/Ifc)nrrs(were)cnttrirvcttrl in acovilau•e with
7.Is this*repair to an existing well: Ines or _�7Ro iSA NCAC OK.0100 or 13.4 NCAC 1IIC.0200 Well Cunatrxction Standards and than a ropy
U"the it a rxltulr,Jllt Oh known well connrin'9ian infin nation and explain the stature glair g this recorrtAaa Inure pr undue to the Wail awater.
repair under 0'1 trmarks sec-non or on the bath efOMr forest.
23.Site diagram or additional well details:
g,For CeoproheJDIPT or Closed-Loop p Geothermal Wells having the same You may use,the back of this page to provide additional well construction intD
construction,randy I t`r'4V-1 is needed. indicate TOTAL.NUMBER of wells (add'See Over'in Remarks Box),You may also attach additional pages ifn aty.
drilled:
24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 41/ ' 3 _(ft.)
Paraudtfple with Itnall deptkx if different(example-3(03200 and l{ intr) Submit this("+W--1 within 30 days of well completion per the following;
it Stadia water level below top of casing: �//a 24a, For All Wells: Original form to Division of Water Resourcac (DWR).
l� arrtkvrti.<abortca.ning.axe +( Of') Information Processing Una fhl7 MSC,Raleigh,NC`27690-1h12
1L Borehole diameter L" , 24b. For Injection Wells:Copy to DWR;Underground injection Control(IOC)
,�J { Program. 1636 MSC,Raleigh,NC27699-1636
12.Weil construction method: t, l+A....J+ 'i'Yrt 4.. - 24c.For Water Supplyand Open-Loop Geothermal Return Wells:Co it,the
(Le.oaget,rotary,cable.duvet push,ere.) -
coWattyenvironmental health department of the county where installed
FOR WATER SUPPLY WELLS ONLY; 24d.For Water Wells radnclpg over 100 uoo CPU: I.c,py to()Wit.((PC tlrt
I3a.. Yield to Permit i ogrant. 1611 MSC,Raleigh,N 2 699-161 I
Wpm) of lest:
13b,disinfection type: Amount: .._ ..............._........__...........__.
T'rs-n (;13;.4 rUwwt.na...tL..ram_.....____....-.- . ._ ..

r► Revision#:_0
TE,FWHERM Temperature and
"` Pressure Monitoring Point Release date_5/12/23_
Approved by:_SL
Construction Detail 6
Well ID T-4 Date — a —* 3
Oversight RI PA PP S Job#R23-104
Driller
Design Constructed Notes
(fill out if
different)
Pipe Diameter TMP: / 1.5" - Stick Up(TMP) 30"
PMP: 1" --Stick Up(PMP) 24"
Borehole Diameter: 6"
Ground Surface 0.0'
HT Grout— Angle from Horizontal 90"
Casing Material
Carbon Steel
Other: Top of#00 Sand 1'
TMP Pipe Lengt 43.5' Top of PMP Screen 3'
PMP Riser Len th 5'
PMP Screen Len h 2' Bags of#00 Sand 2.5
Bottom of PMP Screen 5'
Screen-Materiel
Stginless Ste'e1 Bottom of#00 Sand 7'
Other:
Bags of Cement 10.5
Slot Size 10 Bags of Silica 3.25
Installation Method Borehole Diameter 6"
Direct Push
Sohic Bottom of TMP Well 41'
Hollow Stem Auger
Mud Rotary
Other:
Bottom of Borehole 41'
Post-Installation QC(to be performed 24hrs after installation) PIO Log:Make/Model:
(1)Confirm well is free of grout Design Constructed Time: (.14 V Reading: Q, • PPM
Depth to bottom of IMP[ft bTOCi: 43.5' Time: /y: "3 S Reading: © , PPM
Depth to bottom of PMP[ft bTOC]: 7' 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 bgs Notes:
Depth to Grout, Depth to Grout,
Date TMP[ft bgs] PMP[ft bgs]