GW1--07068_Well Construction - GW1_20231103

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WELL CONSTRUCTION RECORD(GW-1)
For Internal Use Only: •
1.Well Contractor Information:. . ' 1 '
I6+/ryy �lfd yrtgM26f° � I
• 14.WATER ZONES I
Well Contractor Name FROM TO I DESCRIPTION
3$ll 6 , , •
ft. ft,
NC Well Contractor Certification Number' i ft. It.
N Is.OUTER CASING(for multi-cased wells)OR LiNER(if ap usable)
6�+ C Ca. e I' P �8d A� FROM f TO ( DIAMETER THICKNESS g MATERIAL
Company Name' h it f R• I In. I lu
2.Well Construction Permit#: �� g 16.INNER CASING OR TUBING(geothermal closed-loop)
Y/ a L.A Si) e FROM TO DIAMETER THICKNESS MATERIAL
List all applicable"well constructionpe nits(i.e.U/C County State.Variance,° e etc.), ft ft. in.
3.Well Use(case➢]weU use): Pe�``� // �� i1°`•
I ft. ft. In.
Water Supply Well: 17.SCREEN
OA(p!iculttral •;OMu nicipal/Public FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
ft• ft.°Geothermal in.
(Heating/Cooling Supply) °Residential Water Supply(single)
❑Industrial/Con mercial • °Residential Water Supply(shared) ft. ft In.
❑hTigation la GROUT
❑Wells>100,000 GPD FROM TO ' •
Non-Water Supply Well: MATERIAL' EMPLACEMENT METHOD d AMOUNT
ft. ft. , •
°Monitoring ❑Recovery
Injection Well: , ft• ft.
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°Aquifer Recharge 1194 gdwater Remediation tt. ft.
°Aquifer Storage and Recovery ❑Salinity Barrier •
19•SANTI/GRAVEL PACK(if applicable) .
°Aquifer Test ?oM To MATERIAL EMPLACEMENT METHOD
❑Stormwater Drainage . . n. R.
°Experimental Technology °Subsidence Control .
ft. ft.
OGeothetrr,al(Closed Loop) OTrncet
°Geothermal(Heating/Cooling Return) Cher(explain under#21 Remarks) 20 DRILLING LOG(attach additional sheets if necessary)
ES
IRON I TO DESCRIPTION?color,hardness,solorock type,grain stze,etc)
ft. li2. ft
4.Date Wells)Completed: J d Well iD# ��` r - 2 ft. ft' �°17,„e'iprd1 e 4.
, lleie/.5re�t g A fir eidt.7
So.Well Location: ® r 1 nr si ou- c���
'ft. g,
0/Ye/lour Cieeviiel Siv ;1/6Q.-SeeWeb a ry6?WV/ ft. R. I k' -''
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Facility/Owner Name Facility IDN(if applicable) ft• ft,•
r�•'=r, n ,i
.2iZ•7tejenmee /3/V,2 T e asstiwilee 28.�"V‘ ft. ft. NOv n
Physical Address,City,and Zip 2023
Ins:;,;� � ;a.._ _
�jl j 1 /31 s1 7i i®p 21.REMARKS ;-'
County Parcel Identification No.(PiN) 71e er- CCti_r>V I�N jiq !44r'DoV-
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: gee.,y f AGh e is,k eh'C.fo t- ...ctr DdZ ft'O w di eta i
(if well field,one lat/long is sufficient)
22.Certification: I
6.Is are the welts (4/,/,711--.
� ��� 1v ,g-2( ) O: ermanent of °Temporary Sc of Certified Wc11 Contractor t1 Dote
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7.Is this a repair to an existingwell:. °Yes o1, By signing ikisform,'hereby cerli/j that the well(s)was(were)constructed in accordance with
0:11' 15A NCAC 02C.0100 or 1SA NCAC 02C.0200 Well Construction Standards and that a copy
If this is a repair,ftllont known Well construction h foiination aid explain the name of the of this record has been provided to the well owner.
repair under 021 renia ks section or on the back of this form. ,
23.Site diagram or additional.well details: -- •
8.For Geoprobe/olq'or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well const action info
construction,only,1 GW-I is needed. Indicate1TOTAL NUMBER of wells• ; i, '(add'See Over'in Remarks Box).You may also attach additional pages if necessary.
drilled:
: I o'j, i 24.SUBMITTAL INSTRUCTIONS
9.Total Well depths below land surface: ' I 1!i 17'1 1
For anitiple wells list dil'depths ifd�erent(example!,3Q200,and 2C1007 , i(f 1., Submit this GW-1 within 30 days of well completion per the following:
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10.Static water level below top of casing: •24a. For AU Wells: Original�fiirm to Division of Water Resources (DWR),
if hater level is above casing,use"+" , ' I '(111!)' Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
&],•Borehole diameter's r3 I i 24b.For Infection Wells:Copy to DWR,Underground Injection Control(IUC)
(hi:); ',
� Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: ©�10 t �0Aei I
(i.e.Well 7otary,cable,direerpush,ere.):' , : 24e.For Water Supply and Open=Loop Geothermal Return Wells:Copy to the
county environmental health department of the county where installed
FOR WATER SUPPLY WELLS ONLY: i , n 24d.For Water Wells producing over 100,000 GPD:Copy to DWR,CCPCl1A
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13a.Yield'(gpin) ' Method'of.testi Permit Program,1611 MSC,Raleigh,NC 27699-1611
I3b.Disinfection type Amount: ; J-
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Rim GW-I. ' North Carolina Department of finVironnrntalQuality-DivisionofWaterResourdes Re.;.,dt•r_lma

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l TERRATHERIVI ' '` ISTD Heater Boring,Construction Detail Revision#: 0
a08�"""" Release date: 5/12/23
i' •1, ,1' , - I I I Approved by: SL
ti,, Well ID t ' .H-21 1 I ; .Date ,Ri/
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Oversight I ' ��',i7 • . Job# R23-104
Driller, Vag • /N. %/1)`Pr/>/ y
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Constructed
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Design different) Notes
'1 1 ' 'I ,;,- -Stick Up Height
1/2"Thermocouplepipe?., L'"')•`!i,C' I/24"
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Thermocouple Length • �67,'•
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Ground Surface' 0.O' I '
Heater Can ' Conductive HT Grout— :'',Angle from Horizontal '90"
r. 0
Schedule s
• Borehole Diameter '6"
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Heater Can Length A. ft i . 5 Gal Buckets of Graphite 2.5 S
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,Bags of Silica 3.25.
Heater Can Diameter 3 in
( � Bags of Cement 10.75
Je,
Installation Method 1 + , P Dire Push ttt {
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Sonic' 11 ,I ,1 I, I ;,i
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• I :i:
o ow Stem Auger, ;
Mud''Rotary' I' l ; '
Other: . I
• Bottom of Heater Can 47'
I 1 ,, :a1 II
J , , ,' } Bottom of Borehole 4T
Post-Installation„QC.(to be performed 24hrs after installation) PID Log:Make/Model:
1)Confirm well is free of grout;;, II ' Design. I', ' Constructed Time: 5ff.7 0 i ' Reading: en PPM
• ;Depth to bottom of'well[ft bToc: I 49' !
� , ; ' Time: 1.10 Reading: �e� PPM
if greater than'or'equal to1fl•less than designed alert the office Time: I' Reading: PPM
2)Confirm grout'plug reaches ground surface Time: I : Reading: PPM
repeat daily until depth to grout is Oft Time:
' Reading: PPM
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Date ,„ " ., Depth to Grout[ft bgs] i Notes: '
,:# ,
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