GW1--07075_Well Construction - GW1_20231103

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WELL CONSTRUCTION RECORD(GW-1)
For Internal Use Only:
C. • .II
1:Well Contractor Informntimt: ,•
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W`iii-tt.r1 We.mb•e.r,,l,y I .
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.14.WATER ZONES I..
Well Contractor Name • FROM • .TO !DESCRIPTION
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NC Well Contractor Certification Number, ft. ft.
15;OUTER CASING(for multi-cased wells)OR LINER(if no{{cable)
4.0-5C i,vG(e. /or: //�n/ FROM TO 'DIAMETER - THICKNESS . MATERIAL _
•Company Name 1 ft. ft. in.
R /1 16,iNNERCASING.ORTUBiNG(geothermal closed-loop)
2.Well Construction Permit#: A CL►1 C L A3--f' ' FROM• TO• .DIAMETER THICKNESS •MATEwAL
List all applicable well construction a nits(i.e.'UIC,Couaq',-State.Variance,etc.) ft. ft. in.
3.Well Use(check well use): /'e" r f}�°"A. f f1°-' re.,, .
ft. . • ft.' ' In.
Water Supply Well: 17.SCREEN ,
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❑Agriculhu tI FROM` To DIAMETER . SLOT SIZE THICKNESS • MATERIAL
❑Municipal/Public' 'ft. ft. in.
OGeothennal(Heating/Cooling Supply) Residential Water Supply(single)
rt. ft. in
❑lndustriaVCommercial ❑Residential'Water Supply(shared)
❑irrigation 18.GROUT
CI Wells> 100,000 GPO FROM TO ' . MATERIAL'''-' NT
. EMPLACEMENT METHOD&AMOUNT
Non-•Water Supply Well:. ft.• ft.
❑Monitoring • ❑Recovery .
Injection Well: . ft. ft.
❑Aquifer Recharge l droundwater Remediation ft. ft. •
❑Aquifer Storage and Recovery ❑Salinity Barrier .19.'SAND/GRAVEL PACK(if applicable) •
FROM TO • .MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stonnwater Drainage • , ft• : R. I
❑Experimental Technology ❑Subsidence Conubl ft. ft.
❑Geothermal(Closed Loop) . ❑Tracer • 20.DRILLING LOG(attach additional sheets if necessary)
❑Geothermal(Heating/Cooling Return) Cher(explain under 1121 Remarks) FROM • I -TO DESCRIPTION(color,hardness,sol soli/rock type;grain sizeNete.l
? / 0 ft.
5 ft. el
4.Date Well(s)Completed:/J '4i/3 Well ID# lt& © �Q `+ ft. ft. 3 a�c. ' -i-, .. 9... � `d
/�/�� 5a.Well Location:� .r { :ft. ft.
//LAC.- 0A0e 1'lour 1. er --Cep`&vgg,J o e /i(Ch 0 zyb 451419/ rt, rt. r •'..�.4.."'si.:i .
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,Facility/Owner Name Facility IDli(if applicable) ft. 7t. s _ -
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, usve / /Vft. ft. NEAL t
2/27 Z
t�J t�rR cl i��N✓�`%%} •
2 Via"��
Physical Address,City,and Zip ft. rt. 1 If:J r<<r: ;l r _' :;0 t"t;.i
Oill'SIU(� 21.REMARKS r•. --
�31�13ay78/8 •
County - Parcel Identification No.(PiN) . /Aeezf>?✓ ettA�di e 'k7 f& "X r '1U.�t.,LUC/,I •
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56.Latitude anti longitude in degrees/Iniuutes/seconds or decimal degrees: Set' ���ejxchepn -'(-r.C.fo r c o.M Srrt✓c f;0 tv e-i.f'1'CL i Is-
(if well field,one Iadlong is sufficient) 22.Certification
3i.1.7'Y/4/0.° . N - 77. 3ZG170 W , /
./. .../,4_27' 4 / '--/t23
6.is(are)the wells): rmanent or ❑Temporary Signature of Certified Well Contractor Date
I _ By signing this form,1 hereby cerlily Mitzi the well(s)eras(were)constructed in accordance with
7.Is this a repair to an existing well: !❑Yes or ®'INo 15A NCAC 02C.0/00 or 1SA NCI(02C.0200{Nell Constrnc,ion Standards and f/tat a copy
If this is a repair,fill out known well construction in/w-,,,a Ian and explain the nature of the oft/iis r•ircord has been provided to the well oiwrer.
repair under 1t21 remarks.section or an the hark of this:form. '
• I 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 Remarks Box).You may also ankh 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: ' ' G (ft.)
Far multiple wells list all depths(I-different(example 3,rr 200•and 2 100) Submit this GVV-I within 30 days of well completion per the following:
ft) '24a. For All Wells: Original form to Division of Water Resources (DWR),
10.Static water level below top of,casingt :
If water level is above casing,use••+•• information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
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11.Borehole diameter: 7 (iii) • 24b. For.Iniection Wells:Copy to DWR, Underground Injection Control(IUG)
Program,'1.636 MSC,Raleigh,NC 27699-1636
12.Well construction method: filtl 1-0LSi:W/C
(i.e.auger,rotary,cable,direct push,etc.) 24c.For Water Supply and Open'Loop Geothermal Return Wells:Copy to the
: county environmental health department of the county,where installed
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FOR WATER SUPPLY WELLS ONLY: . .. •
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24d.-For•Water Wails producing over 100,000.GPD: Copy.to DWR,CCPCIIA
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13a.Yield Permit Program,1611 MSC;Raleigh,NC 27699-1611
(gpm) Method of test: . .. .
13b.Disinfection type:, . Amount:
Form OW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018

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ISTD Heater Boring;Construction Detail Revision l;:_o
',„ TERRA THERM ` Release date_5/12/23_•
' Approved by:_SL
,�, Well ID ' HC-01D Date `) '(�`3- a^ 1 °� -r�°�
Th
- Oversight CS/^I '^.--) Job II R23-104
.r \3i,E-i 5 S I A-iir
Driller \—IZ kLi...[ .6).Wlatier`/
Constructed
dii• (fill out if
Design. different) Notes
-Length of Can Stick-Up(ft)/.
. Height of Can Stick-up Above I
1/2"Thermocouple pipe? ;, r" .;; Ground(in) 2.5'/30"
Thermocouple Length 61.75' Length of VEW stick-up(ft)/
Mk)kik t'Lt- -, M A C-3.. Height of Riser stek-Up Above
Ground(In) 0.5'/6"
Ground Surface 0.0'
Heater Can Conductive HT Grout ;_
'''Angle from Horizontal 66"
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Schedule 80 a• F •''
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Borehole Diameter T,'
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_' % Top of f100 Sand 2',
Pia E_ t
.?i Top of Screen 4} `
Heater Can Length 64.5 ft W. PI:i5GalB5ofte
0.75
^ Heater Can Diameter 3 inr �` Bags of Silica 1i 1
Screen Length 10 ft Bags of Cement 3'
- Riser Length ( • ft i r'v 11 7%
Screen Diameter 1 in ' Bottom of Screen 141 1 a+�
i4 4 O i ,,,o
Installation Method ), C
Direct P s A i ! , ,' :1 Bags of#00 Sand 26.5 I(
onic F1 `l'"
ollow Stem Auger • `` ' ff°'�r. Gallons of Crushed
Mud Rotary 1 6.' ,h Limestone 26.5 5,G«i
Other #�;9 "� ;, I
( Bottom of 800 Sand 54.5'
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'Bottom of Heater Can 62'
;' ^ ,„,.,.. r Bottom of Borehole 62'; LE 7i
Post-Installation QC(to be performed 24hrs after Installation) • PM Log:Make/Model:
1)Confirm well is free of grout Design Constructed Time: eV- _ 0 S-6/ S Reading: i 141;0 PPM
Depth to bottoni of well[ft bTOC; i 4 s' • Time: 0.0 I Reading: i;'ify_:,02._. PPM
if greater than or equal to ift less than designed alert the office Time: (j. i:a-r3i , Reading: ©..i 0 e.:) PPM
2)Confirm grout plug reaches ground surface Time: Reading: PPM
repeat dailyuntil depth to grout is Oft, Time: 'i Reading: . PPM
Date Depth to Grout[ft bgs] Notes: ttg..,.�� U - • e'li:1L6
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