GW1--07070_Well Construction - GW1_20231103

WELL CONSTRUCTION RECORD(GW-1)
For Internal Use Only ''
1.Well Contractor Information: I
lad"i/t ct-tiA id;0112,el- 1 i 1
p 14.WATER ZONES • I
Well Contractor Name FROM TO I DESCRIPTION
.8,7 r!A, ft. rt.
NC Well Contractor Certification Number ft •
ft,
! ' 15.OUTER CASING(for multi-cased welts)OR LINER(if ap licable)
(:,tp,..-S C it.Cl e. br,./d A/q FROM I TO ' DIAMETER THICKNESS MATERIAL
Company Name • ft. + R 1 .. . in. !
2.Well Construction Permit#:/lr [1 L�'► j =�f 16.INNER CASING OR TUBING(Reothermnl closed-loop)
FROM • T0.' DIAMETER • THICKNESS. 'MATERIAL
list all opplicahle well construction pe nits(i.e.'UIC Comer,Stole,Parlance,etc) ft. I. `1, in,' '
3.Well Use(check well use): Per.0,/71 041 W e--;Y e cQ • _
ft, ft, .! in,
WaterSupply Well: - 17.SCREEN.
OAgricultitral .FROM : TO : DIAMETER' SLOT SIZE THICKNESS MATERIAL,
OMunicipal/Public ft. rt. ; in:
❑Geotheal(Heating/Cooling Supply) • ❑Residential Water Supply(single) •
rm
ft. • .ft. In
❑Industrial/Comtnercial OResidential'Water Supply(shared) '
C1lrngation IS.GROUT _ •
❑Wells> 100,000 GPD FROM TO ' . MATERIAL'. EMPLACEMENT METHOD&AMOUNT Non-Water Supply Well: ft. ft:
❑Monitoring _ ❑Recovery It. ft. i`
Injection Well:
❑Aquifer Recharge ll3water Remediation ft ft.
�round
❑Aquifer Storage and Recovery19.SAND/GRAVEL PACK(if applicable)• ••
OStilinlly$orrice • .FROM . ' TO '• . MATERIAL EMPLACEMENT METHOD . •
[Aquifer Test OStonnwater Drainage -ft. 11. '
•
OExperimenlal Technology ❑Subsidence COMM] ft. IL
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG(attach additional sheets if necessary)
❑Geothermal(Heating/Cooling Return) that'(eXplain under#21 Remarks) [ROM1t' TO DESCRIPTION(color.hardness,sail/rock type,train stzc,etc.)_
,1 0 ft. -.S ft. y, q
4.Date Well(s)Completed:/0 `- --23Well ID# /I> 0 12.4 2 S fr. -
7d •ft' 6-1'r 1 4.n S�a
r12_ .ivd..
Sa.Well Location: • ft. ft.
/Mkt owe)1 our(4 leatver- 5vg-R.4-j'e yycb 0 216 ii/yiq ft. . ft. ' , t-'• R�-c �,
Facility/Ownerner Name Facility ID!!(if applicable) ft. ft. - ,,.,
2/27 Z jeudve 33/v rrw.€Y .50,4 lIe, eS '"V fr. • fr: A10 V J ZL)13
physical Address,City,and Zip ft. I .2 'ft. .1
1 Iri;;,;}^r.�;,,,-, ;a,.... -'
•
OIvSiO UI t 21.REMARKS �,�; ,•^, -
�/31�13G.y7g18. j/ _
County ParcelldentificationNo.(PIN) // %�e�cGk-w'w ,/ �` `, q
t;,� x Kee a�E�i1^ee.L'T6 v.-' Wes'r.I
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: geed,I i.,ch ads h ►O' i-r'a ro r C owstr'& f;tt Ar el et i I.s-
(ifwell field,one lat/long is sufficient) 22.Certification:
1.
6.is(are)the well(s): digrmanent or OTemporary igndturc of Certified Wc1l Contactor Date
By signing this farm,t hereby certify that the well(s)was(were)constructed in nccorrlwice with
7.Is this a repair to an existing well: ❑Yes or 11t1Vo ISA NCAC 02C.0100 or 154 NCAC 112C.0100 Well.Construction Standards and that a cope
ifdrds is a repair,fill out knmrn well construction infa•nration and e.Vilain the nature oft/te (Phis'record!Whiten provided io f/a ire!!owner,
repair under NI reworks,seclian mr an the hack of this/orm.
23.Site diagram or additional well details: ...
You may use the back of this page to provide additional well conShvction info
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells '(add'See Over'in Remarks Box).You may also attach additional pages if necessary.
drilled: ' � 24.SUBMITTAL INSTRUCTIONS
['
9.Total well depth below land surface: ..-C '7_. ^. ft• j
For mu/tiple welds list all depths ildifferent(example-3@100'and 1@100� ( ) Submit this GW-1'Within 30 days!of well completion per the following:
10.Static water level!below top of casing: (ft,) "24a. For All Wells: Original form to Division of Water Resources (DWR),
((water level is above casing,use••+`^� Information Processing Unit,I617;MSC,Raleigh,NC 27699-1617
11.Borehole diameter: / (ity,) 24b.For Injection Wells: Copy to DWR,Underground Injection Control(RUC)
Program,1.636-MSC;Raleigh,NC 27699-1636
12.Well construction metlmrl: ® �..5-e✓V'14 .24c.For Water Supply.and OpenLLeop Geothermal Return Wells:Copy to the
(i.e.auger,rotary,cable;diseet push,arc.) county environmental health depaitment of the county where installed
FOR WATER SUPPLY WELLS ONLY: 24d.For-Water-Wells producing over 100,000 GPD:Copy to DWR,CCPCi1A
13a.Yield m .Permit Program,1611.MSC,Raleigh,NC 27699-1611
(gP )• Method of test:
I3b.Disinfection type: Amount: _ ,
l
Form OW-I North Carolina Department of Environniental Quality-Division of Water Resources) - Revised 6-6.2018
I

k ISTD Heater BoringConstruction Detail Revision#: 1
z;io TERRATHERM —
°�"Y"c Release date_6/14/23_
Approved by:
1 1 •
Well ID HG02A Date b" 1 S —0
Oversight ' , J , ✓".. / / Job ftR23-104
Driller Cote A..., I /'/ i A160/17,
/ Constructed
(fill out if
Design different) Notes
—Length of Can Stick-Up(ft)/
Height of Can Stick-up Above
1/2"Thermocouple pipe? STA., off' j Ground(In) 2.5'/30" a<<
Thermocouple Length 57.17' Length of VEW Stick-Up(ft)/
Height of Riser Stick-Up Above 1 im
' "Ground(In) 0.5'/6" O
Ground Surface 0.0' ,
Heater Can Conductive HT Grout ,, ,;;, _
'? ; }x Angle from Horizontal 78°
Schedule 80 ; + ' f '
11 _ 1 Borehole Diameter 7"
2 •
Top of#00 Sand 1'
fi
' .. Top of Screen 3'
ii A rw
Heater Can Length 60 ft ,t• I : 1 5 Gal Buckets of Graphite 0.5
Heater Can Diameter 3 in k ,`,4 Bags of Slllca 0.75 !
Screen Length 10 ft 1,71
'• Bags of Cement 2.75 •
Riser Length 4.5 ft
• Screen Diameter 1 in 1 , 'r, , Bottom of Screen 13',
Installation Method i ��
Direct Push hiill �� ;Bags of#00Sand 19,
a
Sonic
Hol ow Stem Auger �R w� Gallons of Crushed
Mud Rotary , ,•l ;° "��Limestone 19
Other: 0 I
sA ';')vA Bottom of I100 Sand 50.5'
'° C y.4.' Bottom of Heater Can 57.5',
r*r xk3S{;7x
,, ::-.:.,I, :,, Bottom of Borehole 57.5'
Post-Installation QC(to be performed 24hrs after installation) PIE)Log:Make/Model:
1)Confirm well is free of grout Design Constructed Time: Pi: ; Reading: b16 PPM
Depth to,bottom of well[ft bTOC; 6n' Time: / S 30 I Reading: ,1 (a PPM
if greater than or equal to 1ft less than designed alert the office Time: .,i# I Reading: .aeQ PPM
2)Confirm grout plug reaches ground surface Time: `r00 4 ,Reading: 40 PPM ._
repeat daily until depth to grout is Oft Time: I Reading: PPM
. Date Depth to Grout[ft bgs] Notes:
st (---)
1