GW1--07098_Well Construction - GW1_20231103

1
, I
WELL CONSTRUCTION RECORD(GW-1)•' For Internal Use Only":
' I.Well Contractor Information: ,'
•
1C✓t8.1 6 dd. :W; YlbbeC°'Bq� i
• WeIi Contractor Namc Q 14.WATER ZONES I'
FROM TO i DESCRIPTION
' $ ® 6 ft. (r,
NC Well Contractor Certification Number ft• ft. I -- -
p p p 15.OUTER CASING(for multi-eased wells)OR LINER(Crap licahle)
$�•oL,i-C Llv�.e. brl`I /h N� FROM + TO 'DIAMETER THICKNESS MATERIAL
Company Name ft. I R. 11 , Ia. I 1 a
i
2.Well Construction Permit#: C��� e 16.INNER CASING OR TUBING(geothermal closed-loop)
List all applicable well construction pe nits(i.e.UIC Coung�,Slate,Variance,etc) FROM TO DIAMETER in THICKNESS MATERIALft. ft.
3.Well Use(check well use): Pee-min/A.-0 in A.-.-0 `V e 1' '
ft. ft. • in.
•
Water Supply Well: 17.SCREEN ,
°AIFiCUltlual OM FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
unicipal/Public ft. ft, I in.
°Geothermal'(Heating/Cooling Supply) ['Residential Water Supply(single) '' •
OlndustrieUCommercial n' h In
°Residential Water Supply(shared)
Obligation 1&GROUT ;r • . _
❑Wells>100,000 GPD FROM TO ' MATERIAL'' EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: ft. ft.
°Monitoring ['Recovery •Injection Well: ft. ft. I
DAquifer Recharge ltilOrourrdwater Remediation n• R. .
❑Aquifer Storage and Recovery ['Salinity Barrier 19.SAND/GRAVEL PACK(if applicable)
• FROM TO MATERIAL EMPLACEMENT METHOD
°Aquifer Test ❑Stonnwater Drainage • • . It. • (t;
❑Experimental Technology °Subsidence Control
OGeothermal(Closed Loop) °Tracer • 20.DRILLING LOG(attach additional sheets If necessary) •
°Geothermal(Heating/Cooling Return) then(explain under#21 Remarks) • FR" TO DESCRIPTION imtor,hardness soli/rock type,main sire,etc)
0 ft. 2.S (L
4.Date Well(s)Completed:/O"- •'2>3 Well ID# - .6-:e • �����a���,ryc"A°' e'Aa`®�
ft. ,ft. �f°rl,1��.c gar 1?..SraL�o Etc N
Sa.Well Location: h. R. I
�NJ4.- OMart�Dcjl ie e �a ErY�3lN,yL S� Ie ft. ft. "-�•. i 1 - ,.-,
,°cho2.ybvily9�
--
Facility/Ownerpro�,r.r g..... .c q"-.-'�
Name Facility i M(if applicable) ft. ft.
2iz7 Z eu.ve 131✓6,71f�cY55,ej wile, 285V' ft. ft. NCV 2023
Physical Address,City,and Zip /� / /� p ff. • ft, in;:;r!& P,
ON-5/0 iAD 4/3 U/3t�% 8)® 21.REMARKS ,-`;l 2 (fir i
fly L �,+ a d vl
County Parcel Identification No.(PiN) s '���A���"�/]pt s e�X "-y_(� d,r/ J e//
Sb.Latitude and longitude indegrees/minutes/seconds or decimal degrees: 5ee•a,t/ )1 eiZch arts L for e,v rv.$trcrpf ti p w•o e°f d a s
(if well field,one lat/loag is sufficient)
• �1 ®� ^•y f 22.Certification:.17 r
6.is(are)the well(s): l rmanent or OTemporary Signature of Certified Well Contractor Date
y
Bj'signing th/sfornr,Thereby ceril&l)at!re xell(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or t)17Vo 15A NCAC 02C.0100 or 154 NCAC 02C.0200 Well Contraction Standards and that a copy
phis'IS a repair,fill Out known well construction it formation and explain the tat re of the of this record has been provided to theme osvnea
repair trader tt21 rrwumks section or on the back of this form I
23.Site diagram or additional well details:
8.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
(add'See Over'in Remarks Box).You may also attach additional pages if trecesseay.
construction,only 1 OW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:
24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: • P 3 (ft.) I
Submit this GW-I within 30 days of well completion per the following:
For nndtiple wear list all depths ifd jerent(example-3@200'and 2Cifly)
��10.Static water level below top of casing: (ft.) '24a. For AU Wells: Original fop) to Division of Water Resources (DWR),
If waterlevel is above casing,rise'+ infonnation Processing Unit,1617'MSC,Raleigh,NC 27699-1617
11.Borehole diameter: , (in,) 24b.For Infection Wells:Copy to T)WR,Underground Injection Control(IUC)
,�p Program,1.636 MSC,Raleigh,NC 27699-1636
6�
12.Weil construction method: 27 1-04.•.J EWi '
(i.e.auger,rotary,cable,direct push,etc.) 24e.For Water Supply and Open:Loop Geothermal Refill n Wells:Copy to the
county environmental health department of the county where installed
FOR WATER SUPPLY WELLS ONLY: • '
24d.For Water Wells producing lover 100.000 GPD:Copy to DWR,CCPCIJA •
13a.Yield(gpm) Permit Program,1611 MSC,Raleigh,NC 27699-1611
Method of test: I
. I
I
I3b.Disinfection type: Aniount: - I
•
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2011

, I I
, I
" 'I TERRATHERM Multi-Phase.Extraction Well Revision#: 0
• °cruc,tmcarrrmv Construction Detail Release date:_5/12/23_
�7d1°' D A_ '�� Approved by: SL_
Well ID M-2 .t'r 1/`1 e5 . Ve/ i+j.42 f' Date 7-tA 3°-02 3 Th
Oversight
i2-•,44,/7,:ri��� //� /� ,] Job# R23-104
Driller • '.g 0 a�-4,01-AY.."0/�.42•�I.�Pr1"/ I
/� ! Design Constructed Notes
I. I (fill out if .
Well Diameter • 4" different)
Borehole Diameter alVir -------Stick Up Height 48"
I
H '
Ground Surface 0.0' -�--. ,I HT Grout--------- ,
Angle from Horizontal 38°
4 r G it tt''
0 fir Top of#00 Sand 14' .
• 'Cai
Cng-Meal k -
•
.49 bon Ste — Top of Screen 16'
Other L .e3
Riser Length 20 f ^k r _ , 7'r
t 1
Screen Length 65 t - ti_ "--t Bags of#00 Sand 2 r
KiAi
! #4 Bags of Cement 6.5
}'' t._
t, :Bags of Silica 21
�1 .......1-,,,?ti
i- •_
Screen. m.,,:'
Stainless Steel 4 x . �r Borehole Diameter -8",' //�`�}
�. R '
Fiberglass _' _ 61114
`r. PVC VAW,,, .
s' _. i;
Other 5f ._. " .
O ,,kid; ,I
•
Slot Size 10 v43- ` ;,�4 ' • 81'1;
��s Bottom of Sand
, i Bottom of Screen 81'!; '
ronMethodi i�_� I
Soni , HT Grout -, ay a.,a 1 .
hollow Stem Auger ' a„ ;Sump Length 2' I,
Mud Rotary. ; - ;,
Other: 11
Bottom of Sump 83'
j
' ;�L.,4 . i Bottom of Borehole
•
Post-Installation QC(to be performed 24hrs after Installation) P,ID Log:Make/Model: I,
•
1)Confirm well is free of grout ; Design Constructed Time: lobo Reading:! 0, 0 PPM
Depth to bottom of well[ft'bTOC): _fir___ Time: 130 Reading:;, R d.. 0 PPM
'if greater than or equal to Ift less than designed alert the office Time: ;(31 Reading:I 1 Q ,0 PPM
2)Confirm grout plug reaches ground surface Time: }'C.OO Reading:I { 0,0 PPM
repeat daily,until depth to grout is Oft bgs Time: Reading:I I ; PPM
Date, Depth to Grout[ft bgs] Notes: I • ` r
' : ' 1 n
---,, •
,
i ,