GW1--07077_Well Construction - GW1_20231103

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WELL CONSTRUCTION RECORD(GW-1)
For Internal Use Only: '
1.Well Contractor Information: i
GQJIWtrh (tif,.r-,ber 1. ,
14.WATER ZONES 1 •
Well ContractorName FROM TO . DESCRIPTION
3. '76 A ft. ft.
NC Well Contractor Certification Number ft fit' I
//' 15.OUTER CASING(for multi-cased wells)OR LINER(if op`Ilcahle)
/
I' .o-5C r:s,4 e. ,L r;/(,.N . • FROM TO DIAMETER THICKNESS MATERIAL
Company Name fit. ft. I in. •
/? /1 16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#:F CL I l C L l'I' -FROM ' TO- DIAMETER .THICKNESS • :MATERIAL List all applicable well construction perinite s;(i.e.WC.County.Sidle.-Variance,etc.)„ ft. ft. I. in.
3,Well Use(check well use): Per.%,//I:Ay E4°'; r C''.` ft. -
ft. I In.
Water Supply Well: • 17.SCREEN•
❑A iclllhtral .FROM TO DIAMETER SLOT SiZE THICKNESS MATERIAL
°Municipal/Public fi. ft. I• in,
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(sinblc) rc. rt. I, .In. _
❑Industrial/Coaimercial ❑Residential.Water Supply(shared)
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qhn anon 18.GROUT ;:
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g ❑Wells>100,000 GPD FROM, TO ' - MATERIAL'y, EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: ft..' • ft.
❑Monitoring ❑Recovery . ft. ft. •
Injection Well:_ i
uifer Recharge • fft. ft.❑A
q g It tot dwater Remediation
19.SAND/GRAVEL PACK(if applicable) •
❑Aquifer Storage and Recovery . ❑Salinity Barrier FROM TO' MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stornwater Drainage • - . . ft.' . ft'. i '
❑Experimental Technology ❑Subsidence Control . • ft. ft, i
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG(attach additional sheets if necessary)
• OCieothermal Heatin Coolin Return) `FROM I TO I DESCRIITION(color,hardness Solt/rock( g thcr(explain under#21 Remarks)- type,grain sties etc)
ft. 2.S.-ft.
4.Date Well(s)Completed:/j 4 �� /� .�.r: �b a��e�l��t-� Sia�v,fi CI��/
Well ro# C�-0/ 2 Srt' %D .fit: •f3-r .i 40..t-.fZ-:.5-,A,Lk /.
5a.Well Location: ft. ft.
Ml
e_ 6ye,f7oW^C efs Sydr.,R,v, _ k. 4( oribriy9`/ ft. ft. I-,i'' 'i. r.
Facility/Owner Name Facility iDll(if applicable) ft. fit. !r'.f.-,'t,,.o k,_ i '.c kz-y„_
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2/Z7 Z eu.ve /3/1/4 / ft. ft. 40 173
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Physical Address.City,and Zip • ft. ft.
O,v's/v w y314'l3a y'78i 8 /2211.REMARKS _ I «--,:.t . - -:. -.j t.,.,, .
County tie er- �/ �� �.3i�` 7
Parcel Iiientificaiian No.(PiN) - fiQ1�Io j s/�efire
C�r. at/J ee'tI v,+v wlt'l
•Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: S'ee0'ft tCIt heYI►�-E r e Io r Co.NSrri✓C{itf Pr eI et.;Is
(if well field,one lat/long is sufficient) 22.Certification:
3 ,7 LII 4/c D • N 7.7,. ,3 R� R�0 W / ..r/ � -'-� o -/8'--
6.is(are)the well(s): 11 rmanent 'or ❑Temporary Signature of Certified Well Contract Date
By signing tieforot,I hereby cerlif•hut:the uellIs)was(Were)conso•ucied in accordance with
7.Is this a repair to an existing well: : OYes or .3I1V0 • ISA NCAC 02C.0100 or 1SA-NCAC 02C.0200 Well.Construction Standards and that a color •
/f this is a repair;fill out known well consnuciiorl injormatimr and explain the nature of the alibis record has been provided to the/'aell o,wie, '
repair under 1t11 remarks section or on the hack of this form,
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
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:
I I 24.SUBMITTAL INSTRUCTIONS.
9.Total well depth below land surface:I!. ' , t
(fit:) Submit this GW 1 within 30 des s of well Completionper the following:
For multiple wells list rill depths If different(e aMPle-;3 rr 100'mid 2@100� Y, P
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10.Static water level below top of casing:. / (fit) '24a. For All Wells: Original form to Division of Water Resources (DWR),
(Netter St r'level is water
labove casing,use +^ Information Processing Unit,1617;MSC,Raleigh,NC 27699-1617
11.Borehole diameter: (in.) 24b.For lnlection Wells:Copy to DWR,Underground injection Control(lUC)
f� �^ I Program,1.636.MSC,Raleigh,NC 27699-1636
12.Well construction method: /.1© f0..- �.M/C �: •
(i.e.anger,rotary,cable;direct push,etc.) � 24c:For Water Supply and Opeti-Loop Geothermal Return'Wells:Copy to the
.. '1 ,coiiny..environmental health department of the county where Metalled • •
FOR WATER SUPPLY WELLS ONLY: 24d.For Water.Wells producing,over 100,000 GPD: Copy to DWR,CCPCIIA'
Permit Program,•161 I MSC,Raleigh„NC 27699-1 61 1
13a.Yield(gpm) Method of test: .
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13b.Disinfection type: Amount: _:! j
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Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6.6-2018

TER iiRATHEK INA SIW Boring Construction Detail i Revision#: 0 ttpI
a Ca5.4 0 C.71,Zr,
I Release date: 5/12/23_
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1 , Approved by: SL
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Well ID HC-01A Date 6 fitilt,
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Oversight JiLfF 41.116..4 [lob# R23-104
Driller COey 401t, t.•71. 4//144ee/1 Des gn Constructed Notes
(fill out if
different)
1/2"Thermocouple pipe? ifitilWai i
Thermocouple Length 59.171 —Heater Stick Up Height 30n a 14 1 I
1....11
—--SIW Stick Up Height. (1 / ----.
Ground Surface 0.0' ,
, .,
Conductive HT Grout— :iv:I') ,,,,;44 ,( Angle from Horizontal 78°,
Heater Can ,
Schedule 80 , rt..
,,
Heater Can Length 60' *,A .-*.• .e 'Borehole Diameter 7"I
Heater Can Diameter 3' 41
1 5 Gal Buckets of Graphite 2.25:
VW
Riser Length 51.5 ft -,I; 1,,,;,- fi: Bags of Silica 3
Screen Length 2 ft
%g .4,j
Screen Material ,,
.4 " 1.' Bags of Cement 10
Stainless Steel ,3 '
'&.
Fiberglass Ai: Rf,! 11'4 Top of#00 Sand 30'Other: tg gif i i
, P4 '.'n'
5114/Slot Size 10 Bags of Sand 7.5
Screen Diameter in 64 kw ,•,A I
A kt) .' Gallons of Limestone 7.5
..:.,i
Installation Method ,1 II,i i-4 e
trIP i ; ;.,Iith !If; Ii'!..1 Top of Screen 50.511
, Vi=
Direct Push ''At W-e,—i'P I
;,,i, .:,,,,4, ,A1 I
Hollow Stem Auger n,,,e ;,ft*_.''.71;I ;),. .p.: ',i,;
Mud Rotary
—.g
Other: g :0-: t Bottom of Screen 52.5'
4.. •,: —.r,,
k',L,'v
00 ,Y,''', =,•.,
:- ?,:•4!
\-li
, .=,,,g P..,,-,01,••••',,.JA
.,,kze. Fil•-.4,".4,760,';
Bottom of 800 Sand 54.5' .
Conductive High Temp Grout ;: zch,, I
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" , , I , i.:;) ,:, Bottom of Borehole
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Post-mstaiiation QC(to be performed 24hrs after installation) PID Log:Make/Model:
1)Confirm well is free of grout Design Constructed Time: 7.7 3 0 Reading: 6•4_ PPM
Depth to bottom of well[ft bTOC]: fin' Time: 3 :, CO Reading:"6•CIP PPM
if greater than or equal to Ift less than,designed alert the office Time: (41 . • Reading: 'CLCI PPM
2)Confirm groat plug reaches ground surface ' : ' Time: • ; 0 0 Reading: I 4!" V PPM
repeat daily Until depth to grout is Qft , Time: 0 0 0 Reading: Id. 0 PPM
Date Depth to Grout[ft bgs] ;1 Notes:I
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