GW1--07114_Well Construction - GW1_20231103

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WELL CONSTRUCTION RECORD(GW-1)
I, ;;.'' • ;I. For Internal Use Only:
I.Well Contractor Information:'
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Well Contractor Name 14•WATER ZONES I I
FROM. TO ft. DESCRIPTION •
NC Well Contractor Certification Number Pt Pt.
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ry 15.OUTER CASING(for multi-cased wells)OR LINER(If au Ilcable)
e•v,.JC cu.4 /J�®e. ,K�r® /K®,• , FROM I TO DIAMETER THICKNESS MATERIAL
Compa Nei ny nc' j', ft. H. I
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tL I? 16.INNER CASING OR TURING(geothermal closed-toot) •
2.Well Construction Permit#: A �1-e. FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction pe nits(i.e.WC.County.Stale,Variance,etc.) ff. ft. in.
3.Well.Use(check well use): /l/Ateva Id ft. ft. In.
Water Supply Well: 17.SCREEN
❑Agricultl1ral FROM • TO DIAMETER SLOT SIZE THICKNESS MATERIAL
OMunicipal/Public ft. ft. In.
°Geothermal(Heating/Cooling Supply) °Residential Water Supply(single)
❑IndustrtaliComrnercial ft n• In
°Residential Water Supply(shared)
°Irrigation I&GROUT
❑Wells>`100,000 GPD FROM TO • MATERIAL" EMPLACEMENT METHOD d AMOUNT
Non-Water Supply Well: .
ft, ft. i
°Monitoring °Recovery •-
Injection •
Well: ft. ft. ••
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°Aquifer Recharge iroundwater Remediation - - . it. ft.
°Aquifer Storage and Recovery ❑Salinity Barrier .19•SAND/GRAVEL PACK(ifmpplIcoble) •
°Aquifer Test FROM To MATERIAL EMPLACEMENT METHODOstotmwater Drainage ft. • it.
❑Experimental Technology °Subsidence Control .
Pt• •
ft.
°Geothermal(Closed Loop) OTracer ..
°Geothermal(Heating/Cooling Return) ' (her(explain under#21 Remarks) FR.DRILLING LOG(attach additional sheets If necessary)
FROM TO DESCRIPTION'Roter,hardness,Mere&type,grata size.me.)
4.Date Well(s)Completed:/a'. —�i ✓`0 0 ft, f L ' �)�d�iN tit � t�° bra sewQ 6�t'r��da�
Well ID# 2 ft. •�-•�• ) •f• I'
5a.Well Location: ft. ft.
S ri T 1 aye-Hour C/ errx-r,,Pisr'r�4P1••.S' e 4/eh 0 246 if9��4/ ft. ft. a� �1, :. .r•r'�:
9 +, Ci;t~-i ,
Facility/Owner Name Facility iD#(ifapplicable) ft. ft. '
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�023fLa dZ7 qt le ®3di/tij 0��,etisivil?ilea �� �� ft In ci: __Physical Address,City,and Zip . --
ONi tiLd' 3 51/ Cl 6 81 21.REMARKS ,.��.County , . Parcel Identification No.(PIN) #eek->�e r't�et..V t A.
+ e yr CxfP6+ +1 eta,
G 6,IJE'I1 .
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: ��� ��� �a-�'r`C ivs� �a�Sd r�aC Noas•diet ��
(if well field,one lat/tong is sufficient) j
V e,� 22.Certification:
N: 7. 3S1 61 ®.0 w /
� �G J�J '__?„24,4_,. /d*-fey-2,3
6.Is(are)the well(s): rmanent' or °Temporary Signature of Certified Well Contractor Date
II_ By signing this form,1 hereby cer/ifj•that7ke walks)urns(were)constructed in accordance with
"7.is this a;repair to an existing well: i ❑Yes or ''( poi - 1SANCAC 02C.0100 or 1SA NCAC 02C.0200 We/Construction Standards and that a copy
Phis is a repair;fill out known ulell cbnsrrzrNiou i,formation that explain the nature of the ! oft/is record has been provided to tbu a e//owner.
repair under-#21 i•en,nrks section br on the back of this farm. ,
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' 23.Site diagram or additional welt details: -
8.For Gebprobe%DPT or Closed-Loop'Geothermal Wells having the same You may use the back of this page to provide additional Well coast action info
construction,only 1 GW-I is needed.•Indicate TOTAL NUMBER of wells II i '(add'See Over'in Remarks Box).You may also attach additional pages if necessary.
drilled:
24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: • I '
For multiple weA.v 1trt;nll depths efd(jere,it(ecan,ple-3@200'and 2@/00) •(f tl) Submit this CVV I within 30 days of well completion per the following:
10.Static water level below top of casing: / (ft:
'24a. For All Wells: Original forth to Division of Water Resources (DWR),
• if water level.,is abavg,casing,use^+^ ? Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
- II.Boreholedianieter:' j' 7 `(in,) I �'.; 24b.For Infection Wells:Copy to DWR, Underground Injection Control(IUC)
i, g • ' Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: / 6 P r;IL:�.0i-e . .e,, 1 C''
(i.e.anger,rotary,cable,direct push,ere.) ; 24e.For Water Supply and Open-Loop Geothermal Return Wells:Copy to tile
' , county environmental health department of the county where installed
• FOR WATER SUPPLY WELLS ONLY: ,
- '244.For Water Wells pi oducingl over 100,000 GPD:Copy to DWR,CCPCUA
13a:Yield(gpm) Method of test: i i;; f Permit Program,1611 MSC,Raleigh;NC 27699-1611
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13b.Disinfection type: • I ; Amount:' Ii ; I L•
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Form GW-1 North Carolina Department ofEnvirbnnieptal Quality-Division of Water Resources n u �_�m a

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�'�4TERRAITHERM i s " , ISTD Heater BoringiConstruction Detail Revision#:_0
°cancai C.00V-nr !
Release date:_5/12/23_
Approved by: SL .
I 1 Well ID '' ' H=19 r Date 7-�3-a .
Oversight) II `Oe r�, � S, ' Job# R23-104
Driller, �e� IV)%e /�
i
` Constructed
' ! (fill out If
Design different) Notes
1/2"'Thermocouple pipe?1 ^',''� ri „,3 —Heater Stick-Up Height 30"'
Thermocouple Length 48.67'
—VEW Stick-Up Height 18"'
Ground Surface 0.0' '
eat Can • .Conductive HTGrout— >x a' I
j
,, sra` Angle from Horizontal 90°1
Schedule SO % , •
Borehole Diameter 7" '
_'] Top of SOO Sand 1'
,,f v `, RM
Iv
x'-147 *Top of Screen 3'
40 4Heater Can Length ft •.,- ' 5 Gal Buckets of GraphIte 0.5 I
Heater Can Diameter in I :=story. I
r.o;1v � ,`; Bags of Silica 0.75
Screen Length 10 ft =z ^i-1k ,�
Screen Diamter �M in ,Dtf:' ,-r„s Bags of Cement . 2.75
�a • Bottom of Screen 13'
Installation Method Ae,
ttp4
Die ush ' M Sags of MO Sand 14.5
Soni,
Hollow Stem Auger ` t �.l ,Gallons of Limestone 14.5{ ft el
Mud Rotary ' .r •'fi
4.
Other: '' 45 ,
' Bottom of MO Sand 40'
lcl
'�'r Bottom of Heater Can 47'
P., ,,ems ,7W
,i }. *', ', Bottom of Borehole ,
Post-Installation QC(to be performed 24hrs after Installation) PID Log:Make/Model:
1)Confirm well is free of grout Design Constructed Time: ,J'V;e/D ' Reading: ep, 0 PPM
Depth to bottom of well[ft bTOC: 49 5' Time: /GA;f) 1 Reading: 2.6, PPM
if greater,than or equal to lft less than designed alert the office Time: 1.5.a raf 1 Reading: e2,0 PPM
2)Confirm grout plug reaches ground surface Time: Reading: PPM
repeat daily until depth to grout is Oft. Time: Reading: PPM
Date, • • Depth to Grout[ft bgs] ' ' Notes:
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