GW1--07087_Well Construction - GW1_20231103

WELL.CONSTRUCTION RECORD(GW-1)
For Internal Use Only: '
1.Well contractor informntioii: i
a%Itat.wi'W;(ob.er I y • • : - -- .: 1 �,i - •
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.it
.14.WATER ZONES • 1 I •
Well Contractor Name .FROM TO . .DESCRIPTION
6 /1 ff. ft. I
NC Well Contractor Certification Number . . . it' ft. 1
•
®® 'IS.OUTER CASING(for niullti-cased wells)OR LINER(if op doable)
�0,.0•SC rVGt e, br1 // %_9 •FROM TO I DIAMETER THICKNESS
p fL ft. Ii Fm S1ATEILIAL
Company Name
A i ' !� /� C•
' 16.INNER CASING OR TUEING.(geothermal closed-loop)
2.Well Construction Permit#:i ym CE t C L A 5 j-e FROM .TO
List all applicable well construction pe nits(i.e.U1C.County,State.Variance,etc.) ';'DIAMETER THICKNESS MATERIAL
ft.. R. ', in.
3.Well Use(check well use): PV r+ 47 iht d-" ,btf e_:le e vie • ft.
-
R. in.
Water Supply Well - -17.SCREEN i,
•
❑Apnicllhltral • FROM • TO . .DIAMETER SLOT SIZE . THICKNESSMATERIAL '
❑Municip5l/Public ft. ft.: • hi. .
❑Geothermal(Heating/Cooling Supply) ❑Residentiat Water Supply f 1
PP Y(single) - •ft.:. -ft'. I In. -
❑Industrial/Cominercial • ❑Residential.Water Supply(shared)
❑]rrigrition ❑Wells>;100,000 GPD 18'GROUT ; _
FROM :. TO ' MATERIAL' EMPLACEMENT METHOD&AMOUNTS
Non-Water Supply Well: ft, ft. .
°Monitoring ❑Recovery '
it
Injection'Well; • • ft.
°Aquifer Recharge �C,roundwater Romediation it' ft.
❑Aquifer Storage and Recovery ❑salinity Barrier 19.SAND/GRAVEL PACK(if applicable) • .'
FROM ' • TO' MATERIAL . EMPLACEMENT METHOD
❑Aquifer Test ❑Stonnwatcr Drainage •. ' - ft. ft: :,
•
•
❑Experimental Technology1
❑Subsidence Control • ft. ft, •
❑Geothermal(Closed Loop) ❑Tracer G a '
20:DRILLING LOG(attach additional Sheets if necessary),. •. -
❑Geothermal(Heating/Cooling Return) then(explain under#21 Remarks) FROM' i,To.. DFSCRIP'IION(color,hardness,snlUrock type,grain size etc.)
4.Date Well(s)Com leted:`L--"t 23 /IC d�. +'�J at�tr-P���t'Lv�3CwAvrQf�[ oC�/
P Well ID# �• �� ft• ft. � y /
/ - S, jp.. l , a Atir.tz-rOt N�Q
5a.Well Location: • ft. ft. /
/Mt_ 0/ye-PP S:1VeR�,,sl S,,ve.Arch0246vying . - • • It. .
Facility/Owner Name Facility 1D11(if applicable) ft �``b• ,�.�. 11 ft. L.
' r I"'F
2 i2.7 Z JevNe /3/✓tQ/rTi.erg.s"0N✓�•liej 284"ye • rt. ft
Physical-Address,City,and Zip ft. . ft. 1 1y O y 2�2� -
O.1/s/0(.0 //31g'I30117818 .21.REMARKS • 1IlfCr-r=':S.,n ;a,•_..,_-:_ •
County //�� 1 �,t,•...: x':1 .: it�/i�:z
Parealdentific:nionNo. PiN //e �tq` ....toi .'— 1 '147' ( e.*i.
See o,z
Sb.Enfilade and longitude in degrees/minutes/seconds or decimal degrees: a,I r�•h.ei,seh'e-/'1'is -r`c.for t^,,,srr -c.f"'intvel fc;i LS
(if well field,one tat/long is sufficient)
22.Certification:
`I,?y/'boo . N ' 7'7.. 364e fop W.
6.ls(are)•the well(s): ibI rmanent or ❑Tem pot , /0 ,-/r--4:-Y
iS gnnture ofCenificd Well Conrnictar
r...."e"."----.
• P ar5' Data
/' By signing tlris form,I hereby certify•that the well(s)was�(u®ere)constructed in accordance with 7.Is this a repair to an existing well: ❑Yes or �7Vo 1SA NCAC C2C.0100 or 15A NCAC Q2C.0200 Web,Cousfrnctiort Standards and that a copy
I(Utis is a repair fill out known well construction infot•ntOtimr and explain the nature of the o/7his record has been provided to lhts a elYo,,nc,.
repair under 1t21 remarks section or on the hack of this torn. ,
23.Site diagram or additional Well details:
S.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page'to provide additional well construction info
construction,only I GW-I is needed. Indicate TOTAL NUMBER of wells •(add'See Over'in Remarks Box).You may also attach additional pages if necessary.
drilled:
y� —2.-,
24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: (� (ft)i i'
a 200•'and 1 a i00� Submit this -1 within 30 days Owe!!completion per.the following:
For multiple wells,list all depths)fdjferent(example-,3
10.Static water level below top of casing: 'H AP , '24a. For All Wells: Original'fort to Division of Water Resources (DWR);
f s - (f�) Information Processing Uilit,'1617IMSC,Raleigh,NC 27699-1617
1 water level is above casing use."+"
7 •
II.Borehole diameter: (in.) I 24b. For injection Wells:Copy'to DWR, Underground Injection Control(IUC •
)
p Program;1.6366 MSC,Raleigh,NC 27699-1636
12.Well construction method: t/1 ei ta..l,?.iv e 1 .i
(i.e.auger,torn 24c.For Water Supply and Open-Loo Geothermal Return Wells:Copy to the
b ry,cable,'direct push,etc.) p I Y,
county environmental health departmentml of the county whereItistalled
FOR WATER SUPPLY WELLS,ONLY:' - . I 24d.For;Water Wells producing Lv r 100,000 GPD:Copy to DWR,CCPCUA
13a.Yield(n m 1 -Permit Program,1611.MSC,Raleigh,NC 27699=1 61 1 ,
bP ) Method of test: . , -
I3b.Disinfection type: • • Amount: - ' I
•
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Form OW-I North Carolina Department of Environmental Quality-Division of Water Resources I Revised 6.6.2018

1
®.TERRAIN' ` ' ' ISTD Heater Boring Construction Detail Revision#:_0
aCren&COmnMy Release date:_5/12/23_
' ; I Approved by: SL
1
'`'� ' I;• I
f I Well ID I , 1 ;HC-04D i', Date (Co — D Q ,3
• Oversight g :-6-3 ZE),!nqi;e1 Job I R23-104
/ I
Driller f L. 4 Fr©in V`r/ , -1/40,.A I
er/
Constructed
(fill out If
Design different) Notes
—Length of Can Stick-Up(ft)/
Height of Can Stick-up Above
1/2"Thermocouple pipe? ‘'' j-`t-' ',; Ground(in) 2.5'/30"
Thermocouple Length ._ 61.75' Length of VEW Stick-Up(ft)/
Height of Riser Stick-Up Above
Ground(in) 0.5'',/6"
Ground Surface 0.0' '
1
-53
Heater Can Conductive HT Grout-- `
'' ?Angle from Horizontal 66`
Schedule 80 V ,y -41
Borehole Diameter T,'
„� a= i;,Top of#00Sand 21
fiteli
i�,ee
, ' ' ® a Top of Screen 4',
1 Mill
i Y
` t' fi' �.f'+ I
Heater Can Length 64 ft ti ` 5 Gal Buckets of Graphite 0.75 1
Heater Can Diameter 3 in i ,-, .4"Bags of Silica 1, 1
Screen Length 10 ft — Bags of Cement 3 I 3
%Riser Length ft ,,
Screen Diameter in 44!1 § 4 Bottom of Screen 14'1 1 Li
Installation Method .„ ?. � i,,`
Direct Push �! s � �
.; . : Bags of#00 Sand 26.5 I
Y y
_.,,,rem `. 1
o low Stem Auger 4 Gallons of Crushed
Mud Rotary ' • ,4' VA?Limestone 26.5 5 '? 't,AK—
Other: rQ
��; Bottom of#00 Sand 54.5',;
L . xa 1: 1
I .`a
;-- .'Bottom of Heater Can 62'
Bottom of Borehole 62 1 6 a.
is v c '
1
Post-Installation QC(to be performed 24hrs after installation) PID Loa:.Make/Model: ,
1)Confirm well is free of grout Design t Constructed .Time: p'o 0 6.-2 p, Reading: ,,,a go Z-PPM
Depth to bottom of well[ft bTOC 64 5' `• ' Time:. ' 1 021r, ' Reading: ,e2,C) PPM
if greater than or equal to 1ft less than designed alert the office . Time: 10 Li t) 1 Reading: ,per ,ppM
2)Confirm grout plug reaches ground surface Time: pq�;a a 'i Reading: i) , �a 9VPPM
repeat daily until depth to grout is Oft. ' Time: 1 Reading: ✓d PPM
Date Depth to Grout[ft bgs] Notes: I Sc,..1.—
I
i 1.i 11