GW1--07086_Well Construction - GW1_20231103

WELL CONSTRUCTION RECORD(GW-1) '
For Internal Use Only:
I.Well Contractor Information: I
LUii1.16-m War bet ity R , .
14.WATER ZONES i
Well Contractor NameFROM TO - !DESCRIPTION
S,`76 /► ft. ft. I ,
NC Well Contractor Certification Number ft. ft.
'Or; IS,OUTER CASING(for mtitti•eased wells)OR LINER(Kan !feeble) •
(�I?�.1'Ct� (1(e• �/ / l;�_9 FROM TO .. DIAMETER THICKNESS MATERIAL
Company Name. , 1 1't• ft. 1 in.
16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#: A CL''l t'L/ S FROM • TO
DIAMETER THICKNESS MATERIAL..
List a!l'npplicahle well construction perSnils(i.e.U/C County,State.Variairce,etc.) • ft. ft. ', in.
3.Well Use(check well use): Per''<i A-9 t+0 e-;tr e _-___
fL ft. In.
Water Supply Well: 17.SCREEN •
❑Agricult tral '-FROM • TO . '.DIAMETER SLOT:SIZE"• THICKNESS MATERIAL
❑Municipal/Pirblic • ft. fr. 1 ' in,
❑Geothermal(Heating/Cooling Supply) ❑Residential:Water Supply(single) ,- ' - '
❑Industrm uu
l/Conercial ft, fr: I"• -
[Residential Water Supply(shared) ls.GROUT
ghrigtition ClWells> 100,000 GPD FROM TO • • ' ' M
MATERIAL,` EMPLACEMENTn1ETHUD&Ah1UUN7-
Non-Watel'Supply Well:
ft. ft.
❑Monitoring DReeovety . •
Injection Well: • • It. ft.
❑Aquifer Recharge //�� • ft. ' ft. ! -
11146 undwater Remediation
19:$AND/GRAVEL PACK(if appllcable) ••
❑Aquifer Storage and Recove
rY ❑Salinity Barrier • .,mom ,TO • MATERIAL-
❑Aquifer Test ❑S EMPLACEMENT METHOD
tonnwater Drainage ft. • ft.
'❑Experimental Technology ❑Subsidence Control ft. ft. . .
❑Geothermal(Closed Loop) ❑Tracer ' 20.DRILLING LOG(attach additional sheets if necessary)
❑Geothermal(Heating/Coohng Return) (11 i(explain wider#2I Remarks) FROM - TO DESCRIPTION(color,heMness;salt/rock type,grain size,,etch_
4.Date Well(s)Com toted:J� ' _• 1C-- .j - '�k oaten fro .a.Aht d-C 01
P Well ID# 2 ft, .7:- ft. l' A i
/.%� . (rNrX-!6tu.sr'tZ Slaty
5a.Well Location: ft. /
/i& O,v`)lourelawer1 S'o�of 4 Slit' ./1/eb ez16�/Sly9q -• It. ft. i. �r
paeility/(honer Name Facility IDf/(if applicable) ft. it,' t F •� -
2%2,7 eu,n.t° l3Ji/rQf r/rT_cJ;�':9�11/� r/e} 2 c5's'Yz • ft. ft. , 1` 1 ............Physical Address.City,and Zip ft, ft.•
��10 Y 1/ n 2�2 J
On,rs/oLL. 2/3�6'/3ay78)3 21.REMARKS' '. lr;;;r?. c'-;) P,•- ..c__ ,
County / • p/ ac _r ..�. .. ,:
Parcel Identification No.(PiN) t/e� �Cer-it.,W� 1r`"O e� �' LA-- /
t� r L= ��'CCfs 7)�y -�L �1
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: she 6''i h e�S�h@pt+a�-t .re r'C a.v'Srrt'c f-s tt w E'Ica i is-
(if wcll field,one ladloug is sufli iient) 22.Certification:.
3`i:P1/ 4/.o 0 • N - 7.7,,3 Z G U d o . W 4,(...„../ 7/.---...i7c3.g f e
6.is(are)the.well(sj: • rmanent or ❑Temporary Signature Of Certified Well Contnictor,' Date
By signing tdsfarm,1 hereby certify that the well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or VIVO 15A NC/IC 02C.0100 or. NC AC 01C.Q200 Well Consnmtion Standards and that a copy -
If this is a repair fill out known well cons/1 ucdo,,lalbrataiion and ierplant the nature of/he ol'this record has been provided to the,u ell owner.
repair ande'r 021 remarks section or on the hack of this form.
23.Site diagram'or additional well details: .
Yon 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 attach'additional pages ifnecessay.
construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:
' 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface; 4;
(ft.) Submit this GW-1 within 30 days of well completion per the following:
Far multipk wilily list all depths i/•diOereru(eraniple-3 cei 100 t and,2pa 100)
10.Static water level below top of casing: �Q '24a. For.All Wells: Original fort to Division of Water Resources (DWR),
limiter level is above casing,use"+^ (ft.) information Processing Unit,1617,MS ( )C,Raleigh,NC 27699-.1617
IL Borehole diameter:, (in.) • 24b.For Infection Wells:Copy to DWR, Underground Injection Control(IUC)
,p Program,1.63E MSC,Raleigh,NC 27699-1636
12.Well construction method: D fc�.J5 ✓Y;I For Water 24e. . r Sen1Lo Geo
1\ thermal.Return Wells:Copy to the
aug
er,ger,rotary,cable,direct push,etc.) upply.and Op o P.
I county environmental health:depart=ment of the county where installed
FOR WATER'SUPPLY WELLS ONLY: -24d,For-Water Wells producing over_100,000 GPD:-Copy to DWR;CCPCIIA
13u.Yiel""d PermitProgram,1611 MSC;Raleigh,NC 27699-1611-
(gpm. ): Method of test: .
j .
13b.Disinfection type: Aniount: - . i
•
•
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources ' Revised 6-6-2018
t

I
M.S.�'� TERRATHERM S,, ISTD Heater Boring Construction Detail Revision It_0
a Cazcar14,Comm, Release date_5/12/23_
" i Approved by: SL
r_ T}" Well ID 1: HC-05D , I' Date 1 ;
i
Oversight ..�2��L7"VG Job�# R23-104
ice {
;
• cDriller � A-2k-) \ 4 �di. er �/
i' Constructed
j (fill out if
Design different) Notes
-Length of Can Stick-Up(ft)/
Height of Can Stick-up Above i
1/2 Thermocouple pipe? 'ili;µ.^No ,,,, Ground(in) 2.51/30
Thermocouple Length 61.75' -Length of VEW Stick-Up(ft)/
Height of Riser Stick-Up Above
1 1 Ground(In) 0.511 6"
Ground Surface 0.0' 1 '
ilh',,,. 6 t i
n A
Heater Con : Conductive HT Grout z�r` 1
e ei Angle from Horizontal 66°
Schedule 80 2 ` iai '':1 i;,r
�IBorehole Diameter 7"
m[: - h!
":1z: 11 Top of#00Sand 2'
w=r y Top of Screen !4'/
�rF, 1
Heater Can Length 64.5 ft 4 i _ , 5 Gal Buckets of Graphite 0.75 1' t G Pam - i•
Heater Can Diameter 3 int�;Bags of Silica 11
Screen Length 1,0
ft R '....F. ,;Bags of Cement 3!' 3'
Riser Length 5.5 ft a l
Screen Diameter 1 in ; w;BottomofScreen '14 ,
Installation Method ? �,, l � J1
Direct Push x .I I'
4 I I 74 . a ;�4; Bags of it00Sand 20
Hollow Stem Auger ,J °^" ,, Gallons of Crushed ' � L
Mud:Rotary. , l' ° Limestone 20� g SU/G..t`-rL'J-�
Other: . . +':. Y
r '
fir " ,."' ` a' Bottom of Il00Sand 54.5'
, £fix,
: i
F , s S P, Bottom of Heater Can . 62'I
Ps- a n�E ',,ref 1
I ; .;,,, " 1 ir Bottom of Borehole 62
I1
Pest-Installation C;C(to be performed 24hrs after installation) MD Log:Make/Models
1)Confirm well.is free of grout. , . .Design Constructed Time: ' .�4'S I. Reading: , ) .a PPM
Depth to bottom of well[ft bTOC s4•5' Time: 013 1 0 I Reading: ..©. PPM
if greater than or equal to Ift less than designed alert the office Time: C'Q.c.3cv 1 Reading: 7. 0 PPM
2)Confirm grout plug reaches ground surface Time: 0 o(, 2„c I Reading: Q r-, PPM
repeat daily until depth to grout is Oft. . ; Time: r.,,a1c-( if., I Reading: ��-G PPM
Date Depth to Grout[ft bgs] Notes: `
1 I 'j
- 1 t. a '
{n,