GW1--07071_Well Construction - GW1_20231103

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WELL CONSTRUCTION RECORD(GW-1)
For Internal Use Only:
I.�)Well Contractor Information: •
11 /,i-d-py. ilii.t er' 1
14,WATER ZONES l
Well Contractor Nitrite ' ' FROM TO DESCRIPTION
. �!7�Arr. rr.
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ft, ft.NC Well Contractor Certification Number
15.OUTER CASING(for multi-cased wells)OR LINER(if hp [Kahle)
(,:i .s$C CL,4:1 e. /I ,-':_9. .FROM-f �^/ l[/ TO. (1DIAMETF•It' THICKNESS .MATERIAL
Company Name v . .ft. ft. • M. !
2.Well Consh action Permit#:N/� C EI j L -�L�v 16.INNER CASING OR TUBING(geothermal closed-loop)
FROM TO- DIAMETER THICKNESS MATERIAL
List all'applicable well construction pe nits(Le UlC.County,Slate,Variance,etc.) ft, ft. in, '
3.Well Use(check well use): Per.),t/`f i A.9 40 a'' Y e 6e.
-ft. ft. In.
Water Supply Well: 17.SCREEN . I
l lAgrieultltral FROM• TO DIAMETER. SLOT SIZE THICKNESS • MATERIAL
OMunicipal/Public ft. rt: in.
❑Geothermal(Heating/Cooling Supply) ,OResidential Water Supply(single)
❑IndustriaUCommercial ft. fr. I. in.
❑Residential W• ater Supply(shared)
IS:GROUT ;i_ , , .
❑Wells> 100,000 GPD FROM ' TO ' MATERIAL' •EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well:
❑Monitoring ❑Recovery
Injection Well: ft. ft.
OAquiferRecharge th roundwaterRemediation ft. ft. -1 - • •
❑Aquifer Storage and Recovery ❑Salinity Battier • 19,:SAND/GRAVEL PACK HI applicable) . -
FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stonnwater,Drainage • . . . rt. • rt:
❑Experimental:Technology ❑Subsidence Conu•ol ft. ft.
OGeothelmal(Closed Loop) OTracer 20.DRILLING LOG(attach additional'sheets if necessary) ,
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❑Geothermal(I-leating/Cooling Return) •then(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness,sol0rock type,grain s{xe,etc.1,�
4.Date Wells Com Ieted: !1 I ,Felli e h edit- � re,/Sfw.v1 t4•C:t 6.7
() P Well ID# / I C ,C. 2a 2 S ft• fi, f A /
5a.Weli Location: 1
ft: It.
'ALL avc, ,v i 1 le t=- ',:?-; ; _
J'�t�ur C �I�s'���t-zf'vv,Q..:�•i�t' 1� �6 y�y��1 ft. ft. �•'''-'•'�.,�r�;, `� ';�`-'
Facility/Owner Name Facility ID//(if applicable). ft• ft. NOVa ;•
ft. • ft. III/V
2iz.74 et;eve &lice fJe;ersye,",v.,•.1/ei 28' "YZ •
Phyran!Address,City,and Zip ft, ft. I ,.,:,,-•:._:'.,:, - - -
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©N-Si l CO • 4i314'13e'178)8 , 2211:REMARKS'. • . . •
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County' Parcel Identifiication No.(PIN). /lee lhf l• c ...n/L+J; 'j�L� VCa j�e.t- j(f re al tiv&el
5b.Latitude and longitudeindegrees/minutes/seconds or decimal degrees: She �GIieASeti�'If►a r e fore��srrw-cf+t1A+� It ai�S
(if well field,one lat/long is sufficient)
1�/G 17 '� 22.Certification: -N
6.is(are the wells: llrman ' 1Alf........(//0-1/,/,‘,
„4,5",...-2..3
f
O ent or ❑Teo ora Certified Well Con
' � P � Date
Hp signing this form,I herebj•certifs.that the we (.$)was(were)constructed in accordance w'irh
7.Is this a repair to an existing well: ' ❑Yes or &I • ISA NCAC 02C.0100 or/SA NCAC 02C.0200 ifel!Constr•,rction Standards and that a copy
If this is a repair fill out known well cen.d1,uc/ion inlormatio,,arid explain the nanny of the q/Yhis record has been provided to the well ownen
repair under#21 remarks'see ion or nit the hack of this fora:.
23.Site diagram or additional well details:
You may use the back of this page to provide additional well construction info
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
(add'See Over'in Reinaiks Box).You may also attach additional pages if necessary.
construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:
24.SUBMITTAL INSTRUCTIONS.
9.Total well depth below land surface: j 1
For multiple wells lie,all rlepthc ifdilferent(example-3@200'and 2©100') (f t) 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),
lJ'tcal level is above casing,rose information'Processing Unit,1.617!MSC,Raleigh,NC 27699-I617
11.Borehole diameter: 7 . . (ill,) 24b.For Injection Wells: Copy to DWR,Underground Injection Control(IUC)
Program,1.636 MSC,Raleigh,NC 27699,163E
12.Well construction!Method: Rt0 te4-5.✓1/i.4.
(i.e.Huger,rotary,cable,direct push,etc.) 24c.For.Water Supply and'Open-'Loop Geothermal Return Wells:•Copyto the
county environmental health department of the county where installed
FOR WATER SUPPLY WELLS ONLY: • '..' f i
• • 24d.For Water Wells producing over 100,000 GPD:Copy to DWR,CCPCIJA
(gP ) Method of "Permit Program,1611 MSC,Raleigh,NC 27699-161.1
13a.Yield m •
test
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13b.Disinfection type: Aniount:
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Form OW-I North Carolina Department of Environmental Quality-Division of Water Resources . Revised 6.6-2018

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s,3%t :TERRe4THERM ISTD'Heater Boring`Construction Detail Revision#:_0
a c.f.11c*rr r Release date:_5/12/23_
Approved by: St
Well ID HC-028 Date ', t�- e9 — 5
Oversight ' I SA;tn,.fi Job# R23-104
Driller ,Ca/` N •k/Al.
464/
/ Constructed
( (fill out if
Design different) Notes
-Length of Can Stick-Up(ft)/
Height of Can Stick-up Above '
1/2"Thermocouple pipe? Ground(in) 3.5'/30" Z•
486.
Thermocouple Length 87.67' -Le of VEW Stick-Up(R)/
Height of Riser Stick-Up Above !
i Ground(in) 1'/16" Z.
Ground Surface_0.0' _ _ ____' _ _ a
HeaterCan ��_.._ Conductive NTGrout i, � �i"� �~� I
Angle from Horizontal 35°
Schedule 80 of . '
f
7�" 03,01
• _'v.Borehole Diameter 7'
0 "c,'• .
430 _ , Top of#00 Sand 3'
ttr
�� Rt,-0-r
Top of Screen 5'
=
Heater Can Length 91 ft 5 Gal Buckets of Graphite 11
Heater Can Diameter 3 in r Bags of Silica 1.5
Screen Length 17.5 ft jai Bags of Cement 4.5
Riser Length 7 ft e r,..k_t* {
Screen Diameter 1 in '3� y h Bottom of Screen 22.5'
r p s
Installation Method ,} `t
CC Push 5,e, ;."1
i,. Bags of#00 Sand 28 IIII
Sonic hi 4. 4
l�If ,4. Gallons of Crushed
ow Stem Auger
Mud Rotary' �t., Limestone 28
w is ] F
Other: .+ c, °
zit*,Bottom of#00 Sand 76.5'
e'/'; k`$ k,4'Bottom of Heater Can 87.5'
- f e.1 r. Bottom of Borehole 87.5'
Post-Installation QC(to be performed 24hrs after installation) AID Log:Make/Modeh
1)Confirm well is free of grout Design Constructed Time: ,/Z fora Reading: 0,0 PPM
Depth to bottom of well[ft bTOC: ea' Time: g f<ro Reading: 064 PPM
if greater then or equal to ift less than designed alert the office Time: Z t..O Reading: Q,p PPM
2)Confirm grout plug reaches ground surface Time: -g stso) Reading: mio PPM
repeat daily until depth to grout is Oft. Time: Y:clh, Reading: 0.0 PPM
Date! Depth to Grout[ft bgs] Notes:
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(PM i