GW1--07049_Well Construction - GW1_20231102

WELL CONSTRI,JC'TJON RECORD(GM_l1 For Internal Use Only: .
1.Well Contractor Information:
k£'/l 61L;441- i4.WATIR ZONES ---
Welt Contractor NUM PROM I TO DESCRIPTION -' -
- 7 .70 'a n ft. -
NC Well Contractor Certifa:ation Number ft. ft'
Ia.OD TER CAOI i(for ataltt,eaeaad wellsZOlt 1491112
Le -i2,•, C 4*-101
e I)r!lli ily } ( FRDM TO atAMEttit MATERIALCompany Name "/ ft, ft. !a
2,Well Construction Pernik#.r rlA lr �+ 1441VNRRCASINO OR JTt1.RING(geothermal 1 elosed4onts)
y r�]7 �7 f e TO DIAMETER THICKI# MATERIAL ~
List all appthYtbk awl, .atruellan / s(Le UDC., ntt+,Stab, Variance,eq., ft. ft, In.
3.Willi Use(ehesk well use): d J►.•/Tf+ i W e.;Y c°'c il.
R. in.
Water Supply Wen: . 17.1ilCitLitNl - ----
OAgriCltittrrsi [1Mnnicipalfiubtit: Plod ft TO . DI.U11VItt)t nor stzs TltIC'Itt MATERIAL
OClcothermal()leating/Cooling Supply) °Residential Water Supply(single)
°bdustrial/Cortunercial It" '
LJRtsidtmtial Water Supply(shared} Is,�QIl_1' .._
Irrigation C7 Wells,› 100,000 CZPC) MOM. To , Ili/Amu,' nt i(.ionot(t
Non-Water Supply Well: it. it. >� atuoUyT-,
OMonitoring °Recov 117 ft. ._.+__.__
Injection Weil:
QAquifer Rectal a ,,�•� ri. ft,
S all�C`roundwater Retnediation
W❑Aquifer Storage and Recovery ' ' °Salinity Barrier 19,SAN VE4 PACE iiii k iilitial})
°Aquifer Test OStortnwater Drainage it. h.
°Experimental Technology CISubsidence Ctntroi $. ft.
OGeothetmal(Closed Loop) °Tracer ' 20.WOUND LIND,LOG(seta baddawpd,heeO Haasce*err)
MAT DGeothennal(lleating/C:oolingReturn) 4+ iexplsnunder021Remarks) To (sets,b.rdae,s,row,.d,eft,;, i:, �,s.j �
L IL 2,S. ft. ., ,del`le 4 Alb kg t"'ol lifs..vl t�". „
4.Date Well(s)Completed: Well IIIld1 fl - /)-- 2 S n rh . tr
"' -ral 4.,ter-12_. .1,‘,..I,..
5a,Well Location: -1t. R. I
Mk rive lour("kit/vet-1 iyer-1j4 5,1e M b 0 276 r/i/l q f' ft.
Facility/OwnerName Facility Ills(ifapplioable) ff. r
212.1 L etJ,a.e° Al✓dij;s.rrs,,N✓d:fie,0..:2 4"y '...., ft, NOV 1) 2 2021
Physirad Addicas.City,and Zip ,( y� Q O. ft. --- _I
. I7 7 21.RFM �.. •'[
QAi-5 lo w ! /30 �► ARx :__ •
County Parcel Identification No.(PIN) 1.x r'R.ii-c_/-.till,/ tnf C 1/ `` #
Sit Latitude and longitude in degreea/tMnutesiseconds or decimal degrees: se 1 e4I> ir t"he E r c.for f?�`o iS�ri►E f 0 n+td tr 7Q)�S
tifweft field,one latltong is sufficient) 22.Cetrtftleadess:
3 y.7111 ya o _ N t 77,. .E 6 CI oo W �L_.-_______-- 114 ' 3
6.is(are)the welf(s): lI 1 rmanent or ()Temporary Signature ate/11Scd Well Contra for Date
,�' Ely sianbtg this fern,I hereby(eritfj•that the natl.)ocr(avers)sn»strurted in(local/owe whit
7.Is this a repair to an existing well: °Yes or il1Vo 1 i4 NCAC 02C.0100 or 1.11 NCAC 02C.0200 WN{(onstru tiort Standards and that v ceps
(/`this i.e a repair,,fill out known aria cwnartn+tfwr u$irawerirnand explain the nature of the of'A/O record has been Provided to the arll owner.
repair Nude,-1121 arman*e ssetion or an the book ofthft firm.
23.Site diagram or additional well details: ,
K.For Ceoprobe'DPT or Closed-Loop Geothermal Welk having the same You may use the k of this page to provide additional well conshvctian info
construction,only 1 GW-I is needed. Indicate TOTAL NUMBER of wells ( Over in Remarks Box).You may also attach additional pages if necessary,
drilled:
_.� _ ...__ __...___.._ 24.sUBR 1'ITAI.+IN$TRpCTIONS
9. multi well depth below land surface: (R') Submit this GW-1 within ail days of well completionper the following:
For pada*wells lin all depths it dillerout(example-3( 200'end 40Y P
IR shade water level below top of casing: lie I) 24a. For All Wens. Original form to Division of Water Resources (DWR),
(
if water keel is abavr easing,ruse"+^ Information Processing Unn,1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter: la ( ,) 24b.for Injectiog Wells:Copy to DWR,Underground Injection Control(It/C)
if
t� �•' Program,1.636 MSC,Raleigh,NC 27699-1636
12.Well construction method: o. J lsr4t 1 24c.For Water Sully and Often-Loop GeothermalRetarn Wet Copyto the
(i.e.auger,rotary,cable,direct push,etc.) County environmental health department of the county where hest&led
-
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells prodpcipp.over 100,000 GP1l:Copy to DWR.CCT'Ct1A
13a.Yield(gpm) MetMrd of test Permit Program, 1611 MSC,Raleigh,NC 27694-1611
13b.Disinfection type: Amount: /
P,rrrh tilts_/ 10...I.r,,,.�.-I:..,.IN ............ .,,.. .. .. ..

•
Revision a: 0Multi-Phase Extraction Well
NO TERRATHERM Construction Detail Release date:_5/12/23_
Approved by:_SL_
Well ID M-12 Date 1 Qt‘..---1 .R
Oversight • gCL-‘A Job# R23-104
Driller _...VC A G
Aft Design Constructed Notes
ti (fill out f
Well Diameter ) different)
Borehole Diameter Stick Up Height 362
W
Ground Surface 0.0'
HT Grout-------
- Angle from Horizontal 90°
Top of#00 Sand 1'
Casing Material
Carbon Steel _ Top of Screen 3'
Other:
...„."
•
Riser Length 6 ft
Screen Length 17 ft ___ Bags of#00 Sand 12
_ _ Bags of Cement 1.25
• •
�` •-.MN" Bags of Silica 0.5
Screen Material
Stainless Steel __ _ Borehole Diameter 8"Fiberglass
PVC ----�
Other:
Slot Size 10 Bottom of Sand 20'
_ Bottom of Screen 20'
Inst lation Method °
o is HT Grout---
low Stem Auger Sump Length
Mud Rotary
Other: Bottom of Sump 22'
Bottom of Borehole 22'
Post-Installation QC(to be performed 24hrs after installation) PID Log:M ke/Model: /'f
1)Confirm well is free of grout Design Constructed Time: . d Reading: O -t".) PPM
Depth to bottom of well[ft bTOCJ: 2S' Time: Reading: PPM
if greater than or equal to ift 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 Time: Reading: PPM
Date Depth to Grout[ft bgs) Notes: