GW1--07082_Well Construction - GW1_20231103

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WELL CONSTRUCTION RECORD(GW_1? •
For Internal Use Only:
1,Well,Contructor Information:
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14.WATER ZONES i
Well Contractor Name •FROM TO _ I DESCRIPTION
3 ea 76 IA ' , , rt. rr.
NC Well Contractor Certification Number •
tt• !t.
15.OUTER CASING(for multi-eased wells)OR LINER(if an Waffle)
`C o1e. bri/l �/�Q
Ls...,s�Ct, FROM.- I �TO' 'DIAMETER ) THICKNESS � MATERIAL
CompnnyName •
H. If ft. ; in. if
A`•
16.INNER CASING OR TUBING(geothermal Nosed-loop)
•2.Well'Construction Permit#:,1r,A (►L e.L FROM ' TO.
,1 'DIAMETER THICKNESS MATERIAL
List all applicable n'ell�corsnvrction pe nuq(i.e.(ic l/1C,ComntY,Std(c,Variance,etc.) .fL' R, ! in. '
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3.Well Use(check well use): Pee^ -.� ,;"6 f` 44.1.6-'i,.e de •ft. ft. • 1. In. _—
• Water Supply Well: ' 17.SCREEN
❑Agriellltltral ❑1Vlitmicipa11P111)11C •
FROM ' TO •• DIAMETER', SLOT SIZE .THICKNESS MATERIAL
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Su . rt' n,' in.
pP1y.(singlc)
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❑Industrial/Commercial uppy(shored)
t•` ff. in. —
❑Residential Water Sl
❑LTigntion • 18.GROUT •
❑Wells> 100,000 GPi) . FROM. ' .TO-' ' MATERIAL' ;EMPLACEMENT METHOD 8:AMOUNT
Non-Water Supply Well: • ' ft. ' ft. •
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❑Monitoring ❑Recovery
Injection Well: ft. ft.
Aquifer Recharge I�firoundwater Remediation !t` ft.
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❑Aquifer Storage and Recovery °Salinity Barrier_ • 19,SAND/GRAVEL PACK(if epplleable)
FROM TO - , MATERIAL EMPLACEMENT METHOD
❑Aquifer Tcst• ❑Stonnwater Drainage ft. ' rt.. '
❑Experimental Technology ❑Subsidence Control • ft. ft.
°Geothermal(Closed Loop) ❑Tracer - 20.DRILLING LOG•(attach additional sheets if necessary) '
❑.Geothermal(Floating/Cooling Return) tier.(explain under#21 Remarks) FROM TO • DESCRIPTION(color,hardness,soil/rock gFe,:grain slzr,ctr:)
4.Date Completed: "'A ''�3 ` (7 ft. ;�S fL •T'; .�Js� � rd+
Well(s) P Well ID#/"�C-4 e,6 C 2 S ft. ,f ar�ct-[
Sa.Well Location: ft. ft. 1
/ 8(1_ OW-Pa-Jr'Jr C!dvieeta S/ rIEWS-5,3le , y
S 59q " ft. . ' ft. -
Facility/OwnerName Facility 1D0(ifapplicnble) • ft• ft
i27Z guNe ,3J✓�fJ-�.test./toiley 2b's'51‘ ft. !t. '+ �"•
Physical Address,City,and Zip ft. ft• - ' • No if 7 •2U23 „
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ON-510t to z/3!ley 3r)I. 78J8 • "21.REMARKS —.1:nit ::%:,1 /
County // f s': :'..:.--,•,_;a. Glt ,, j�(f— .
Parcel Identification No.(OM) lige.er-CAL.:v" ; vey4ki,:v jtJ f,-,,,.i21-6, /
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: Yeea, I h edSchepr►a'--,c.foe a o,,;:srrcr.a-e f'in me.i et;I '
(lewcll field,one Int/long is sufficient) '
i71> 1 �/G 22.Certification:
N �7'7. 3Zie.170 •
6.is(are)the well(s): ( I'ernlanent or ❑Temporary ignnture of edified Well ontmctor, Date
By signing this form,l hereby cerlif•that the ne/i(.$)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or illt1Vo 1SA NC4C.02C.0100 or 1SA NCAC 62C:0200 Well Construction Standards and that a copy
if this ie a Penult.,•fill out known we t/conrn•rrc tior information and explain the stature of the edits record has been provided to the,trel/Dauer,
repair under 112/remarks section Dina the hack of this farm, 1
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:
.�� 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: L •
Par multiple wells list all depths indifferent(example-3@200'mid 2@100') ,(f f� Submit this GW 1�4lthin 30 days of well completion per the following:
10.Static water level below of casing: ',(ft) '24a. For All Wells: Original form to Division.of Water Resources (DWR),
(Twiner level is shave casing,me top - Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter: on.) 24b.For Injection"Wells:Copy to DWR,Underground Injection Control(IUC)
,p �^ Program,'1.636 MSC.Raleigh,NC 27699-1636
12.Well construction method: • tf 10 to-1-.J P>✓OP./\L • •(i.e.auger,rotary,,cable,direct push,etc.) 24e.For'Water Supply.and Open=Loop Geothermal Return Wells:Copy to the •
"• ` county environmental health"departnient of the county where installed
FOR WATER SUPPLY WELLS ONLY: J.
24d.For Water Wells producing over-100,000 GPD:Copy to DWR,CCPCIJA
13a.•Yield m 'I Permit Program,1611 MSC,Raleigh,NC 27699-1611
(gP ) , Method'of test: . 1
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13b.Disinfection type: Aniount: - I i
Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Resised 6-6.2011

TERRATHERM 'ISTD Heater Boring Construction Detail 1 Revision#: 0
®lll� aca,faaoComma, I
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)1 �f // i AReleasedate_5/12/23�` r
/ . / / Approved by:_—SL
in„_ Well ID HG-06C f li�f t t'l �L?Vni 1j 9 1 ..yq
"� l Date -�� �, 3
Oversight to ti 5 If^3 Job# R23-104
Driller C - tf t g—k.1/4/OM. 6Pt/rl,/
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Constructed
' (fill out if
Design different) Notes
—Length of Can Stick-Up(ft)/
G Can Stick-up Above
1/2"Thermocouple pipe? :� � ''�l7' - ° Ground(in) 3'/30"
Thermocouple Length
-Length of VEW Stick-Up(ft)/
Height of Riser Stick-Up Above
Ground(In) 0.5'/6"
Ground Surface 0.0'
Heater Can Conductive HT Grout— -
Schedule 80 # '+Angle from Horizontal Oil
s *
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y ; _ ',,!Borehole Diameter 7
a„ Top of#00 Sand 2',
4.
),44( t x,w Top of Screen 4' 4.
Heater Can Length 79 ft i� s f
*t,4S 5 Gal Buckets of Graphite 0.75
® .y.
ll e
EAI
i l Heater Can.Diameter 3 in `"oi Bags of Silica 1 !,
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Screen Length ` Q ft fi D. Io Bags of Cement 3.5'
Riser Length 1( * .
Screen Diameter 1 in ' '?`' Bottom of Screen 17.5; I-1
Atiji
Installation Method t ,
Direct Push' ),
�- 5 r t, Bags of/I00 Sand 33
OnIC I ai; •
• ow Stem Auger " ,,
3 �", Gallons of Crushed
Mud Rotary
Other: aic ,i"Limestone 33
( g p'
,. Bottom of#00 Sand 67.5', '
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-` Bottom of Heater Can 76'
"- ....,-. Bottom of Borehole 76' ' '
Post-installation QC(to be performed 24hrs after installation) p1D Log:Make/Model:
1)Confirm well Is free of grout . ' Design ' Constructed Time: kip i h (•0.0. Reading: ®•6 PPM
Depth to bottom of,well[ft bTOC ' 7g'
Time: R� 05•�•j' � Reading: ©" ,(� PPM
if greater than or equal to ift less than designed alert the office Time: ,! 'i.t®d g.). i Reading: o'.0 ' PPM
2)Confirm grout plug reaches ground surface Time: 01;H 5- 1 Reading: 0 0 PPM
repeat doily until depth to grout is Oft • Time: \d! i L ' Reading: D ,O PPM
Date Depth to Grout[ft bgs] - Notes: t
iZ".(r 07R1J -345r &V/1 c--:,StlA1/41
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