GW1--07089_Well Construction - GW1_20231103

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WELL CONSTRUCTION RECORD(GW-1) i
For Internal Use Only:'
1.Well Contractor Information:.
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ti) ei-' ifro‘ Wi.A14.e,r,1 y .
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• 14.WATER ZONES• I I . •
Well Contractor Name I ' :FROM TO. . . IDESCRIPTION ' '. ' . •
A : . . .
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NC Well COhtractor Certification Number ' •' ' .: ft, •i i i . 15.OUTER CASING(for mtiltgeased wells)OR LINER(if ap Ileahle)
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e J.C.C:+i...41e. br;/1)",_9 . .. . FROM .TO ' . DIAMETER . THICKNESS •: MATERIAL •
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Company Name • . • . iii. -
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•2 16.INNER CASING OR TUBING(geothermal closed-loop)
.Well Construction Permit#1/A.tefle•Lil 3";}-e - •FROM .TO • : •DIAMETER THICKNESS 'MATERIAL
Lis f all'applieable well construction pe Os(i.e.1.11C,County.Slate.Variance,etc.), • ft. . ft. I in.
Pe r'.41 1 14-1 io-;freze , . . . .
3.Well Use(Cheek well use): • ft. : ft. . ' In. •.
Water'Supply Well:, ' . 17.SCREEN : I •
°Agricultural OMuiticipal/Pnblic 'FROMft TO • DIAMETER -SLOT SIZE ,THICKNESS -MATERIAL
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°Geothermal(Heating/Cooling Supply) °Residential Water Supply(single) •
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• ft. ' ' ft. ' •in. .
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OlndOtrial/Conimercial ' °Residential 1.'Water Supply(shared) 18.GROUT . *
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" .'°Irrigation . . . ' ', OWells••1.06,000.GPD ' . , •• FROM „ -TO '• • .' • MATERIAL' EMPLACEMENT METHOD&AMOUrFI:-
Non-Water:Supply Well: • ' ' ft. _ '. ft.' 1 -: . . ' •
°Monitoring °Recovery . ' . •
ft. • ft, • .
Injection Well:
... • •
• ' ft .
ClAquifer Recharge ' tilerO:ndwater Remediation ' •. ft.
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19.SAND/GRAVEL PACKlif applicable) •
°Aquifer.storage and Recovery ' °Salinity Barrier • mom• •. TO _ ' •MATERIAL. EMPLACEMENT METHOD •DAquifer;Test OStonnwater Drainage • . . , • . •ft. • • ' ff. ' - ,
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0 Experimental Technology CISobsidence Control • • ft. ft, . . •
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°Geothermal(Closed Loop) - OTracer • • 20.DRILLING LOG(attach - .additional sheets if nicesiary) . • • : ' .
FROMf'TO. . ... I DESCRIPTION co/or,hardn6s,soil/reek type,grain size.etc3-
°Geothermal(Heating/Cooling Return) • tlii‘er(explain under#21 Remarks)
. „ r,• • a ft' 2.S- I.L-.7;1/71e•6(at?i 1 MI_.'11x.14 d•clA7 4.Date Well(s)Completed:/d"3-2-'3 Well ID# :.117ei -°•-•-)I- 2 s it
ft• .:/..6•.
5a.Well Location: ' . ft. ,' ft. , •
. . f'-'71 7-----,-, --...
NO V .3 ‘) 2023
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/Y3e_ °Nell.,Clavvers S:ferEmit.5;le /Yeb e 2.Y6 ia/V9g.• ft. rt. , r..gz L.,1:1! ' .
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Fa e i I i ty/Own er Name, . Facility ID//(if applicable) ' : ' ft. ' IL • -r,
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••ft: ft.
2/2'7 Zjeudve /3/14,ei iTo.e/I-50144'lle., ..2 3'.5'VZ .
Physieal'Address,City,and Zip it; ft. Int-CT.r,-;17471 %,..-.-.77:::-,'-1 i P
Oev_ilow 4/391/3010 818 21.REMARKS '
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,_,. , .-,, ::_.,!....q.,:i • . -
County , Parcel Identification No.(PIN). t, Nees f-ee-Co...:...se i.,..4,77-.. yer,,,,,-cieb.. allia.„... Wei/
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• • gee.a,ffe.e... A&exche..."'d..11`c foe-e 0,.. -itec t;t1=veleta;is
5b.Latitude and kingitude in degrees/minutes/seconds or decimal degrees:
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(if well field,one lat/long is sufficient)
• 22.Certification:
lii.7 ill li e 0 . N 77 3d 1/0
/O.
y,,,,,
Igna .Date '
6.Is(are)the well(s): ditcrmanent or DTemporary (turc'of Certified Well Contractor'
( /Ay signing thisform,I hereby certflj•that the li,11(.' was(were)constructed in accordance with
7.Is this a repair to an existing Weil: . Dyes or NI< ' 15A NCAC 02C.01.00 or 15A AlCAC 02C.qo Well.Construction Sumilards•and that a copy
if/his Is a rFpitir,fill on:known wall eonstimc:tion infOrmation and explain the nature of the ' of this record has been provided to illewell owner.
repair under 021 remarks section or on the hack of this form.
23.Site diagram or additional well details: •
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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:
SUBMITTAL INSTRUCTIONS •
9.Total well depth below land surface:.. ' ' 24. UB
7‘ S.-.- . . -„.. ., .
. (ft. 1
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For multiple wells flit all depths trdUkrent(erampk-3@200 and 2©100) ' - ), Submit this GW1 within 30 days of well completion per the following:
' ., /8! .. , '24a. For All'Wells:-Original fomi to Division of Res ,
If
10.Static wlater bove level below top of casing:
t'it'i Information Prodessing Unit;16171MSC,Raleigh,NC 2Water.769.9-1ources (DWR)
617 , •
• .water leve is a casing,use"+"
11.Borehole diameter: 7 • -on.). - - 24b.ForIniection Wells:Copy to DWR, Underground Injection Control(lUC)
' Progrant,*1.636 MSC,Raleigh„NC,37699-1636 .
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12:Well construction method: . le0,fc.1....,..)de,eV/ . • . 24c.For Water Supply and Open Loop Geothermal Return Wells:Copy to the
(i.e.auger,rotaiy.cable,direct push,me) . '
. . . .. '. ' county environmental health.department of the county where installed'
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FOR WATER SUPPLY WELLS ONLY:: • .
.• '' I- 24d.For Water Wells prOducing,over 100,000 GPD: Copy to DWR,CCPCUA
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: ' ,. Permit Program,1611MSC,Raleigh,NC 27699-1611 -
13a.Yield(gp.m) • - Method of teat: . • . . . • .
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13b.Disinfection type:- - Amount: - .
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Form OW-1 North Carolina Department of firri,ironntental Quality-Division of Water Resources . Revised 6-6-2018
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Revision#: D —
- , ISTD Heater Boring Construction Detail Release date_5/12/23_
z 3 TERRATHERM
nG :�s ,. I Approved by: SL
HC-03E Date
Well ID
• n
� Job# R23-104
Oversight �(� ,
Driller 1 1 G , �• ,A+." rr!y
/�/� I Constructed
I (fill out if
Design different) Notes
—Length of Can Stick-Up(ft)/ I,
Height of Can Stick-up Above
.+ r Ground(In) 5'/30"
1/2 Thermocouple pipe? ..4,01`b t'„i:.
Thermocouple Length 77.29' -Length of VEW Stick-Up(ft)/ I'
Height of Riser Stick-Up Above i �y e
Ground(in) 1.5'%6" As
Ground Surface. 0.0' ...._
Heater Can . Conductive HT Grout— :i _ 1
rys i gd Angle from Horizontal 22
Schedule 80 7 1 S
,O, �'
.;i : :;
y n 7 Borehole Diameter 7'
� 1 jv ri*
`°? ,-Sit
Top of#00 Sand 241'
I VIP
' dViFi
E -e, Top of Screen 2615' 0615
Heater Can Length 81.5 ft �*'4 ' 5 Gal Buckets of Graphite 2.75
3 in or.' . Bags of Silica 3.75
`'*\ Heater Can Diameter - ,
kv'rU. -r v. I,
ti
9 Nib ft t, F Bags of Cement 12
Screen Length /p x �'1,
Riser Length 29 ft �Fw4;'1 Z - r_ . 12 91
Screen Diameter 1 in ' ', 'Bottom of Screen 34:5 0
Installation Method s 1 ,# „ :
$ s
Direct Push I •. r (ti Bags of 800 Sand 14
Sonic tl°,, ' 1,
Hollow Stem Auger I r: �,,'fi4 '.Gallons of Crushed 1
Mud Rotary zi Limestone 14
Other: t 4 Bottom of#00 Sand 61!5'
f :x'rr' ii Bottom of Heater Can 76'5'
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Kf ,,: s Bottom of Borehole 76:5'
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Post-Installation QC(to be performed 24hrs after Installation) PlD Log:Make/Model:
1)Confirm;well Is free of grout Design Constructed Time: . 0 0 0 tO Reading: PPM
Depth'to bottom of well[ft bTOC: 'R1 c' , Time: I ; Reading: PPM
if greater than or equal to'1ft less than designed alert the office ,Time: I I Reading: PPM
2)Confirm'grout plug reaches ground surface Time: I I Reading: PPM
repeat daily until depth to grout is Oft Time: ! Reading: PPM
Date ' ' ' Depth to Grout[ft bgs] Notes:
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