GW1--07079_Well Construction - GW1_20231103

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
I.Well Contractor Information: t
;%/I Ot-h'\'14)d mkaQr 1
14.WATER ZONES' I I
a Well Contractornt Name •
FROM TO DESCRIPTION
7 U ff. fG
ft. rt. f
NC Well Contractor Number 15.OUTER CASING(for multi-eased wells)OR LINER(Nap licahle)'.
C0-5C tL(C e. Dr/ ///,,, FROM TO. DIAMETER • THICKNESS MATERIAL,
Company Name J ff. ft in.
16.INNER CASING OR TUBING(geothermal closed-loop) •
2.Well Construction Permit#:NIA CL'I f/�d L II 5 Jae FROM TO • DIAMETER - THICKNESS. _MATERIAL
List all applicable well construction pe nits(i.e._UIC,Garish•,Stale,Variance,etc.)) ft. ft i• - in.
erft,i fr A. id.6-%Yet,
3.Well Use(check well use): • ft: ft.• In.` -
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Water Supply Well: ..17.SCREEN r
•❑A iLliltltTAl FROM .TO . DIAMETER SLOT SIZE . THICKNESS MATERIAL
g ❑Municipal/Public ft. • -ft., in; • • •
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single)
ft, ft, r in.
❑lndustrial/Commercial ❑Residential Water Supply(shared)
18.GROUT
°irrigation . . • 0Wells>:100,000GPO FROM TO.' MATERIAL" EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: . ft. ft. . ;
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❑Motiitoritig '°Recovery ft. • ft. •
Injection Well: •
ft. • ft.❑A uiferRechm a ronclwater Remediation
.
❑Aquifer Storage and Recovery ❑Salinity Barrier 19:SAND/GRAVEL PACK(if applicable) • '
FROM' .TO ' -• MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stennwater Drainage • • • • ft. • R:•
-
. ❑Experimental Technology ❑Subsidence Control ft.` • ft. { •
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG(attach additional sheets if necessary)
[7Cieothermal(Heating/Cooling Return) FROM I TO DESCRIPTION -.
( g/ g Cher(explain finder#21 Remarks) type,whin ai=�•ets.j
0 ft. 2.S ft. ,,,%.7/prij I;lp14@411-6 *,,Ati deo/
4.Date Well(s)Completed/ '- 2 3 Well ID# /T-- "^ ,r
5a.Well Location: ft. it.
/3.841OiveJ7 our Ctleoiver Sier 01-iVe ly CI)0216Yyy9y' rt. I, 1,` ... ;• T .
Fability/Owner Name FacilityMY.(if applicable) ft. ft. " `, •''...:'I_ 5 r ;i
2/x'72.fewv.e /3144J'v�.etc :,N V.''de. 2e.6-"ye.. ft. - ft. I NOV J 2�23
Physical Address.City,and Zip ft. ft.
ON. /o Ct.P • . c .21:REMARKS _ • _-.._', °:`^-::'.'1(?t:
County . . . Parcel Identification No.(PIN) • / esc cer : ✓,. .;.,._fip--7/er,,`'1 e -„J !
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: see41r ft Cz�sehdrAi.�-r C fo r e��.M.Srr4►•t f;ff,v.e1 eta;it
(if well field,one Ia lloug'is sufficient) 22.Certification: i
• : • W .4.00(•dX-j.°1./e.,,r4L/.. /4 /6-At-2-3
•6.is(are)thewell(s}: d rmanent or ❑Temporary Signature ofCcnificd Well Contractor Date
By signing this form,!hereby certrj•that the well(s)was(were)consa•ucied in accordance with
7.Is this a repair to an existing well:, Oyes or iStl 1SA NCAC 02C.0100 or iSA NCAC 02C.0200 Well Conslractiot,Standards and that a copy
((this is a repair fill out known well construction in/brrnation and explain the nature of thie of this record has Geeti provided to the'well ouster.
repair under 112l 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 Ceoprobe/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: ' - it.
For multiple wells lisra/l depths ifdiQerenl(exasnple113@100'and 220100) ) Submit this GW-1 within 30 daysof well completion per the following:
10.Static water level below top of casing: '1 /p •. .1 '24a. For All Wells: Original form to Division of•Water Resources (DWR),
qt.) Information Processing Ovate,.level is above casing,use"+^ Unit, 16171MSC,Raleigh,NC 27699-16,l.7
11.Borehole diameter: (in.) II ' 24b.For Injection Wells: Copy to DWR,-Underground Injection Control(JUC)
�^ 'i Program;•1636 MSC,Raleigh;NC 27699-1636
IL Well construction'method: .Id to-:...Jd✓IfIs.0 • i . • • i .
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(i.e.auger,rotary,cnlile,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
FOR WATERnSUPPLY WELLS ONLY: 24d.For Water Wells•producing over 100,000 GPD:'Copy.to DWR,CC:PCIJA
13a.Yield m • Permit Program,-1611 MSC,Raleigh,NC 27699-1611 - -
(gP ) Method of test .. r. •
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13b.Disinfection type: - Amount: _ ' ! .
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Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resourcesi ; Revised 6.6-2n 18

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*40 ' . ,. ISTD Heater Boring Construction Detail Revision#: 0
TERRA 0.0,, Release date: 5/12/23
:
, Approved by: SL
Well ID 1 • H-36 ,1 Date 7-' —
Oversight , ��1�,�,,,,e J}bI# R23-104
Driller .' , be/11 ./ •WiMAer/-f j
I ` Constructed
;I (fill out If
Design different) Notes
—Stick Up Height '`
1/2"Thermocouple pipe? 4 '.,.'.(1 o-}' ,. ,; 124" ,a•Lj
Thermocouple Length 37.67'
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Ground Surface 0.0' - ----�- 1
Heater Can Conductive HT Grout— :r Angle from Horizontal !90°
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Schedule 40 '
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,i, r 'Borehole Diameter 6" , ' '
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Heater Can Length 38 ft I ;, ' '5 Gal Buckets of Graphite 1.75 1
l 'Bags of Silica 2.5 Q
(-' Heater Can Diameter 3 in • , '• ') +,
:Bags of Cement 8.25 4
Installation Method !
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Direct Push I. I
Sonic
Hollow Stern Auger, ffili
Mud Rotary 'i. . I :.r.
Other: ! ,• t I
. •• 1 Bottom of Heater Can 36'
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'' L. _; j Bottom of Borehole 36' j=i
Post-Installatidn QC(to be performed 24hrs'after installation) P!D Log:Make/Model:
1)Confirm well is free of grout , Design `Constructed Time: 7 r ej • I Reading: ®'-a PPM
Depth to bottomwof well[ft bTOC RR' Time: : SO Reading: a.,(rV PPM
if greater than or equal to ift less than designed alert the office , , Time: 'l/3 ! , Reading: e 'r 0 PPM
2)Confirm grout plug reaches ground surface Time: j 8 !t Q M, i Reading: 0 c0 PPM
repeat daily until depth to grout is Oft. Time: I Reading: PPM
Date Depth to Grout[ft bgs] Notes: tr / li , .
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