GW1--07057_Well Construction - GW1_20231102

'' ' Gt 1VSTRUCTi(D RECORD clew t>,
For Internal Use Only: '
1.Wen Contractor lnMrtnation:
_-_,I lY G /L 4^? 7 14.wkrta zolvtt#Well Contractor Name „
m
PROM TO u►49tttTID*t
NC Well Contractor Certification Number f''
115.OUTER CASING(raw maple ara(t was 04141011
Co,.rc r. t e 4r~;�if; -irtttxtt pIAINlETBR ar
_ _ Ttl1CItNGdO MATtbtllitL
Company Name fr. IL i IL
2,Well Construction Permit#: 16.(NNE CASING OR il'40 t elanad-lese1
List all yA ct 4 e s.►7 fe X7tUM TO, tNAMR1 } . '1'�tuAt
applicable welt p is(i.r.WC Carintx State, 1`aNanee,ere.) rt. R, tn. .._
3.Well Use(cheek well use): r e r ,f °"." W° ;r to mE
ft, 1st.
Water Supply Well: 17.SCREEN • -``
°Agricultual OMunicipal/Publir FROM TO Dimino sun tits Tilicsa , 1MATr1Uht,
OGeothcrrrtal(Pleating/Cooling n` h' tn.
( g/Cooling Supply) °Residential Water Supply(single) --
Clbtda atriaUC:omtnewcial ft. _ a. to
IlResidential Water Supply(shared)
Clkrrigatiun ill.CPtOU'C -•
°Wells> 100,000Geo MOM To ataTerttat,' ai4PI.ACri1.14721, rvittooaAt►fouv'1��
Nett-Water Supply Well: ft. tt.
OMonitoring Okecovery
Injection Well: ft. ft. _._I
°Aquifer Recharge dli ndwxter Retnediation p' fr. _.
DAqul let Storage and Recovery C)Salinity Drtrrier :RAN VRt:PANIC(t(a I�wyk) ;�,�`.,,,�'
QAquifer Test CiStormwatet Drainage rt.' To k, atA tM/Lul+eat1"tpC non'
0 Experimental Technology CISubsidertceConttoi ' ft. ft.
COCieothtomal(Closed Loop) t_aTtreccer 20.DAII:L.INO LOG attach jt
OGcotherrnal(lieating/C'ooling Room) 4tti r(explain under ll2l Remarks) Flynn To fir^-t7� ,. / mek Amiss �ur.).•_..-.
4.Date Well(s)Completed; Well Il)NY lµ '33 d 2*5 f•` ,i asiA i q,-..,, ,t&4:1.
5n.Well Location: ft. ft.�� (] / ,gyp / �/ ft _fr
Facility/(bane Name Facility ID"(ifaPelicable) ft' ft. I'i V V 2 21,23—
W
x /2 7 t)eei,.e 1 I✓11,ro,.cot..foci✓,"ile/. 2 83-Ye' ~. ft.
Physical Address,City,end Zip 11,' 7 rt. R
N.s/0 Ltd73%e13D y78/3 I221 REMARKS A __
V
County Parcel Identification No.(PIN) 3 TD II L4 rrit 4- 4i((f
_
3b,Latitude and longitude to degrees/minutes/seconds or decimal degrees: Seem,. Jieot,&li k...ft(..Ii f` „Q,v,,v,irOr frOwdetaiii
Of welt frcld,one tedlong is sufficient) 22.Certification:
341.711117106 . N - 77 3 1'I80 W
16_63- 3
6.Is(are)the well(s)t LM4ermanent or CITemparary Signature of Certified Well Contractor - Date
,r itprignieg A/r firm I herebyce+ti/j that the nd11f.*),t (weer:)a /$trnwtvrl in'Wiwi/nitre with
7.Is this a repair to an existing well; D Yes or �fto I.14 NCAC 02C.0100 or 114 NCAC 02C.0200 wt/i G'vmrrncrio r Standards aru/Oat a eopr
If Mis is a repair,,fill out known well conxtniekrut infarwtatton and explain the iralNr e(of tilts of this recoril Ass been p oc/ded It'Mr well ouster•,
rrpwir under#2l remarks see0o01 or on the hock of thus form.
23.Site diagram or additional well details:
R,For Ceoprobe/DP7 or t osed-Loop Geothermal Wolfe having the same You may use the beck of this page to provide additional well construction info
construction,telly I C W-1 is needed. Indicate TOTAL NUMBER of wells (add'See over"in Remarks Box).You may also attach additional(rages if necessary.
drilled:
`- — 24.SUDMITFAL,INSTRUCTIONS
9.Total well depth below land surface: S-7 4- 13
Far mid*mils list all depths it diflrreu,(rxan0-3 'endY lrxy) (R.) Submit this C:W-1 within 30 days of well completion per the following:10.Static water level below top of casing: /Qp( (B.) 240. For MI Wells Original form to Division of Water Resources (DWR),
/frimer level 1sahayr e,sing,UAW"+.. Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter: e (110 24b.For Injection Wells:Copy to DWR,Underground Injection Control(IIIC)
�• Program, 1636 MSC,Raleigh,NC 2 7699-1 63 6
U.Well cor tGtl
grtrtan method; t .J i1r'1`a4 24e For Water Supply anti Opety-Lotto Gegtlio mai•Rtetur Willa:Co to the
0 e•auger,rotary,cable direct pink ore:; county environmental health department of the county where installed Wy
FOR WATER ll R SUPPLY WELLS ONLY: 24d.For Water Wells praduting over LlOPSO GPD:Copy to OWE,CCPCUA
Permit Program, 1611 MSC,kaletg)t,Nor"27699-1611
13a.Yield(gpm) - Method of test:_
13b.Disinfection type: Amount:_ ,_ ,
FormGW-I ., r.._.,:_.......-

TERRATHERM ISTD Heater Boring Construction Detail Revision#:_0
" + Release date:_5/12/23_
Approved^'e by:_SL
Well ID H-33 ` Date "1 � J - ( 3
Oversight e I)Q�t� Job# R23-104
Driller ( /S (It
Constructed
(fill out if
Design different) Notes
1/2"Thermocouple pipe? —Heater Stick-Up Height 30"
Thermocouple Length 58.67'
VEW Stick-Up Height 18"
Ground Surface 0.0'
Heater Can Conductive HT Grout
Angle from Horizontal 90"
Schedule 80
2 Borehole Diameter 7"
;# ' Top of#00 Sand 1'
N. Top of Screen 3'
Heater Can Length 59.5 ft 5 Gal Buckets of Graphite 0.5
Heater Can Diameter 3 in
-Zr Bogs of Silica 0.75
Screen Length 10 ft
Screen Diamter 3 in tiok Bags of Cement 2.75
1-1
Bottom of Screen 13'
Installation Method
Direct Push Bags of1100Sand 1o6 30
Sonic
Hollow Stem Auger Gallons of Limestone 18.5
Mud Rotary
Other:
Bottom of#00 Sand 50'
Bottom of Heater Con 57'
Bottom of Borehole 57'
Post-installation QC(to be performed 24hrs after installation) PIO Log:Make/Model:
1)Confirm well is free of grout Design Constructed Time: g ' 1 1/i j Reading: t, L i PPM
Depth to bottom of well[ft bTOC cQ_S' Time: Reading: PPM
if greater than or equal to lft 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. lime: Reading: PPM
Date Depth to Grout[ft bgs] Notes: