GW1--07103_Well Construction - GW1_20231103

WELL CONSTRUCTION RECORD'{GW-1) 1 I
For Internal Use Only: •
1.Well Contractor Information:
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t /!/It rs•-/+;L W d mbet?). i 1
Well Contractor Naito 14•WATER ZONES l i •
FROM ,TO : DESCRIPTION
,O 76 A ft: fk
NC Well Contractor Certification Number., , ft. ft. I
(�� • 15.OUTER CASING(for multi-eased wells)OR LINER(if ap Ileahle)
c JC0,41 e. /1 r,./ 0 .FROM . TO ' ,�
ice! C� I DIAMETER THICKNESS MATERIAL
Company Name , J ft. + • ft �' !n. •
n c ,
2.Well Consti action Permit#:N�1 Ca t:L►9 �=jC 16;INNER CASING OR TUBING(geothermal closed-loop)
FROM TO ;DIAMETER .. . THICKNESS. - MATERIAL
.i'
List all applicable well construction permits(i.e.UK;Count!•,State,Variance,etc) t . R. � • in.
3.Well Use(check well use): Per'l%/14,or/� Ai a-' Y e ce f .
ft, ft, 1 ' In.
Water Supply Well: 17:SCREEN I.
°AgrlCltltltral FROM '•' TO. DIAMETER' SLOT SIZE THICKNESS MATERIAL
OMunieipal/Pnblic ft,' ft, ' 'in,
°Geothermal(Heating/Cooling Supply) DResidential Water Supply(single)
❑IndustnaVCommercial ft, ' n•' - • in.
t7Residential,Water Supply(shared) 18 GROUT°Irrigation •
`D Wells> 100;000 GPD • ,FROM. `• ,TO '• MATERIAL!' •EMPLACEMENT'METHOD&AMOUN7
Non-Water Supply Well: ' it. ft.
• ❑Monitoring • ' . , ❑Recovery
Injection Well: ft: ft.. •
°Aquifer Recharge , r16 Groundwater Remediation ft. [t.
ch
°Aquifer Storage and Recovery ❑Salinity Barrier •
. 19.SAND/GRAVEL PACK(ifiuppllcable)' •• •FROM To MATERIAL EMPLACEMENT METHOD
°Aquifer Test DStonnwater Drainage • ff• ft.
DExperimental Technology OSubsidence Control • 'ft, ft. • i`°Geothermal(Closed Loop) °Tracer - 20.-DRILLING LOG(attach additional sheets if necessary)
°Geothermal(Heating/Cooling Return). . then(explain under#21 Remarks) FROM I.TO. . ►'DESCRIPTION(color Hardness,salt/reek type,prom xhc,etch
ft. • ft.
4.Date Wells Com Ieted: '�'� ft; 2.5.
S. ,v/ ter)eije/5 mi.*/3ra..vi tk'C.16. '
() p Well1D#, C--d 2_0 2 S ' ft, ,r ,, .•. • r
So.Well Location: • fr. ft.i '1 e 41
©/v o!-IrCJwers SLPv,-Rmig-S•,'e /Y'cb'e2.y6y4'VJy ft• ri• 'I, _ .:,.
Facitity/Owner Name Facility UM(if applicable) ft. ft. --
2127:Z:Vev,.e 131✓ .1J;.cl;_YoNtel.iteI 2 es've ft. ft. P10V t1 t Z023
Physical Address.City,and Zip ft. ft.
4/3?6/3ay78i3 . 21.REMARKS •:,:
1 tr-w County Parcel identification No.(PIN) Meet -e r C"_ 1 „V' or -.E Xfr s.ef p,c�ttlt•
00..av (rJi rMo �(
5b,Latitude and longitude in degrees/minutes/seconds or decimal degrees: See %. Ciisch�r►b f t c fo r-c ows Jr'wC f iO rir e'et i LS
(if well field,one tat/long is sufficient) 22.Cettifieatipn:
3`1.7'YI 4/00 N " '77,. 3ZII I'0 • , w 4,,,,,,# _...7 r,d,,,,il • /.'' ,/s-,2.3
,,--. .- "-
6.is(are)tthe well(s): 11?1 rmanent or °Temporary Signature of Certified Well Contractor Date
•
By signing this form,I hereby certif•drat the ne/I(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: °Yes or Litt 1SA NC4C 02C.0100 or ISA NCAC 02C.g200 Well Construction Standards and that a cop/f this isa repair,fill out kmm�a well eonstvclinninjornreuon and explain/he nature ofthe • of thisrecord has been p, t a/edto.the1pe/Io11910!.
repair under 1121 remarks section or an the hark of this farm.
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
6
(ft.) I'
9.Total well depth below land surface:
For multiple hells/lst all depths((different(example?3Q200'orid�1e100� Submit this GW-1 within 30 days of well completion per the,following:
/6"
• ,,
10.Static water level below top of casing: , , "24a. For AB-Wells: Original form to Division.of Water Resources (DWR),
/jhintrr'level it above casing,use^+�► )
Information Processing Unit,1617'MSC,Raleigh,NC 27699-1617
11,Borehole diameter: / (in:) 24b.For Infection Wells:Copy to DWR,Underground Injection Control(IUC)
I Program; 1.636 MSC,.Raleigh,NC 27699-1636
12.Well construction method: rt t7 f0.Sd,rlrrl C 24c•For Water Supply and Open iLoop Geothermal Return Wells:Copy to the
(i.e.auger,rotary,calilo;direct push,ere.) I• 1 Y,.
county ensironmental"health department of the county.where'installed
FOR WATER SUPPLY WELLS ONLY: 24d..For Water.Wells producing over 100,000 GPD:Copy to DWR,CCPCtJA
13a.Yield, m ,0 Permit Program,'1611 MSC;Raleigh,NC 27699-1611 •
(gP ) Method of test:
13b.Disinfection type: ' ' . Amount: 7 0 , / .
•
Form GIN-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised t-6.201 R

I,
` TERRATHERM ISTD Heater Boring Construction Detail j Revision#: 0
aCum,C<mcw.y
Release date:_5/12/23_
Approved by: SL
,
1 '?
Well ID HC-O2D Datel �. / 0' '�
Oversight ;6aV�5 Job# R23-104
Driller I D r\� l/G�.h%AID{r l�
Constructed
(fill out if
Design different) Notes
-Length of Can Stick-Up(ft)/ I,
Height of Can Stick-up Above ,
1/2"Thermocouple pipe? t ;T.! ' Ground(in) 2.5' 30"
Thermocouple Length 61.75' 1,
-Length of VEW Stick-Up(ft)/ ;
Height of Riser Stick-Up Above
Ground(in) 0.5V 6"
Ground Surface 0.0'
..--r .-HeaterCan Conductive HT Grout— .,n ,.r i
.'r r'`~ c i T Angle from Horizontal 66°
CSchedule 80 r , i. i `.< ,co
/ �"°: Borehole Diameter 7" —7•
' off,„
`�_ATop of#00 Sand 2'
t
ft
us.
. ',Top of Screen 4', 1 ro
h i
Heater Can Length ft
f= ,l,^Al 5 Gal Buckets of Graphite 0.75 1
Th Heater Can Diameter 3 in •. ._.: Bags of Silica 1 �i ' if
!! Screen Length 10 ft - Bags of Cement 3 ,
Riser Length le ft a
Screen DiameterTF Li 1 in Wt H",Bottom of Screen 14';'
' J•Y
Installation Method ' ipY,44 II
DireG. Push' �a, Bagsii00Sand
onic ... F�,
g of 26.5', \ 1
Hollow Stem Auger `�'�"
Mud RotaryfY;, Gallons of Crushed I'
� li Limestone 26.5 5...% St f tACE,15
Other:
Bottomo
I ii f#00 Sand 54.5' '
,
,f•' m
i .Bottom of Heater Can 62' 1I'
i • ) :? Bottom of Borehol 62' I` of/ kr a
Post-Installation QC(to be performed 24hrs after installation) PIP Log:Make/Model: 1 ,
1)Confirm well is free of grout Design ' Constructed Time: l��1JfD I Reading: ,e9 PPM
Depth to bottom of well[ft bTOC ' G4.5' Time: 1 at 3 0 j Reading: 44., 0 PPM
if greater than or equal to 1ft less than designed alert the office Time: i iA; dam, { Reading: 0, PPM
2)Confirm grout plug reaches ground surface lime: !Reading: PPM
repeat daily until depth to grout is Oft. Time: Reading: PPM
Date r Depth to Grout[ft bgs) Notes: i
1 1
I
I 4 '
I i; I