GW1--07115_Well Construction - GW1_20231103

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WELL CONSTRUCTION RECORD(GW-1) I.
, For internal Use Only:
1.Well Contl'actor Information:' I
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t ql,t ct-pv\, W Mber•It y I i i .
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14.WATER ZONES I '
Well Contractor Nome FROM TO DESCRIPTION •
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3g 76 A. . .. ft. ft.
NC Well Contractor Certification Number ft ft. •
/ '4 I •
15.OUTER CASING(for:multi-cased wells)OR LINER Wan llcahle)
(may fl'id C.'c •e bri // ""2 ' •' FROM ., ,TO DIAMETER THICKNESS. . .'MATERIAL,
Company Name;I ft. ft. I in. ..
M P 16.INNER CASING OR TUBING(geothermal closed-loop) 'Well Constr
2. uction Permit#'Iy/A L l e L t"I.S=/-/ "e FROM . TO. -DIAMETER : 'THICKNESS. MATERIAL
! List all applicable well construction pe nits(i.e.'U/C,Cauttti..State,Variance,_etc) • ' ft. ft. 'i • 'in.
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3.Well Usc1(chcckwell use): Pr'.i't;ff 649 a."el- Ye ce _
B. ft. in.
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Water Supply,Well: , 17.SCREEN .
❑A�*1'I¢Ilitllral ' FROM • 'TO. DIAMETER- :SLOT SIZE THICKNESS' •• :MATERIAI:°MunrctpallPwtblic ft. ft. ;n.
°Geothermal(Heating/Cooling Supply) . °Residential Water Supply(single) • -
ft. ft. in.
Oindustrial/Comniercial, , DResidential Water Supply(shared) .
°b'rigation 111.GROUT , •O Wells>_100,000 GPD ..FROM TO • ,MATERIAL'' EMPLACEMENT METHOD&AMOUNT
. Non-Water Supply Well: ft. ' ft. ,
O'vionitoring OItecover .
Injection Well: Y ' ft. ft.. I
❑Aquifer Recharge • ' itiGroundwater'Remediation ft. ft. I
OAqui far Storage and Recovery19.SAND/GRAVEL PACK(if appncable)
°Salinity Barrier FROM TO.' MATERIAL EMPLACEMENT METHOD
°Aquifer Test DStonnivater Drainage • • ft. • ft:. '
❑Experimental Technology °Subsidence Control ft, ft, ! • •
❑Geothermal(Closed Loop) OTracer • • 20.DRILLING LOG(attach additional sheets if necessary) ' '
°Geothermal(Heating/Cooling.Return) ther'(explainunder1121Remarks) FROM TO DESCRIPTIONtrotor,hardness,solUrocNrypeerolnsizc,�u.l _
0 ft. 2.S ft. '7' r�j¢
4.Date Well(s)Completed: ��-3-2-3 Well ID# 1 /7 G+ ` ,f 1p�c'12� -6i-Areq L.9._ i d'C�r:C`y
Sa.Well Location. fr.
ft.
/ & °Nano. rC�ers-5 fo+F L$le' v9-y- c -w L. b* . 4-3
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Facility/Owner Name. Facility lt)11(if applicable) ft. ft: V
2 i271gietwe 1311/tQf t w,etc.50.Nt/�•lie, ,2 8'6'.y('•
rt. i, NOV a� •L 2[1��
Physical Address;.City,and Zip ft. 'ft. I l fhC, _,. 1 r .
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©NS1U(� 4/3.1473.0 y:7818 . 21.REMARKS i os r E
County Parcel Identification No.(PIN / e E'Z" CtA rvC+ti6 y. y�" Lrp-��!t
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I. f. �.z 1/L1G�DoV�iTc'd' ft.
Sb.Latitude and longitude in degrees/minutes/seconds'or'declmaldagrees: 5,e64t,1 r�.h eiscli i.c ro r C owSrric fit,A.'El et i iS
(if well field,one lai/long is sufficient 22.CerHGeation:
3y.7`flyoo N -77,. 3ZGigp w /b/
ermanenl or OTeniporary 4'i .• /12.-'/,--23
Signature ofCertified Well Contnrctorr Date
6.is(are)the well(s): [
Bj'signing lhisform,I hereby certify that the well(s)was(were)constructed in accw•dmrce wills
7.Is this.a repair to.an existing well: ❑Yes of &Vo 15A NCAC 02C.0)00 or 15A NC.AC 02C.o200 Well Coa.Nracrio,Standards and that a copy
If this is a repair,fill out known well construction infora:orlon and erlilaln the nature of the of ibis record/tes been provided to ihelrrel/owner.
repair ruiner 1121 remarks section or on the hack of!Iris teen:, '
• 1 i 23.Site diagram or additional well ails:
S.For Geoprobe/DPI'or Closed-Loop'Geothermal Wells having the same You may use the back of this pagedet to provide additional well construction info
construction,only 1 GW-I is needed..Indicate TOTAL NUMBER of wells •(add'See Over in Remarks Box).Yottmay also attach additional pages if necessary.
drilled: 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 2
Formultiple wells list all depths ifditrerent(ecainnle-"3 a 200'and 2 a 100 j �f t) Submit this GW-1 within 30 days of well completion per the following:
10.Static water level below top of casing: Q 24a. For All Wells: Original form to Division of Water Resources (DWR),
If Water level is above casing,use"+" (ft) information Processing.Unit,1617:MSC,Raleigh;NC 27699-1617
11.Borehole diameter: 7 , (in,) 1 ,' 24b.For Injection Wells:Copy to DWR;Underground Injection Control(1UC)
I , , Program, 1.636 MSC,Raleigh,NC 27699-1636
12.Well construction method: R© .5�^ . r'1
� c 24c.For Water Supply.and Open-{oop Geothermal Return Wells;Copy to the '
(i,e,auger,rotary,cable,direct push,etc.)' ,,.county environmental health department`of the-county Where instailed
FOR WATER SUPPLY WELLS ONLY: ' I
i j,' ! 24d..For Water Wells producing,over 100,000.GPD: Copy to DWR,CCPCUA
'Permit Pro ram 1611 MSC,Ralei'� NC 27699-1611
• , 13a.Yield(gpm) . . Method of test: !I.
g '
13b.Disinfection type: Aniount: 1 ' 17. J
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Form OW-1 North Carolina Department ofEnvirorimental Quality-Division of Water Resources Revised 6-6 2018

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TERRATHERM ' ISTD Heater Boring Construction Detail Revision#1_0
° '' '� Y Release date: 5/12/23_
' Approved by: Sl_
r Well ID H-17 Date, f-/o^ as
Oversight ',/ ,'.? Job# R23-104
Driller f� / pv,M 4 o-t y
(. i' Constructed
G (fill out if
Design, different) Notes
1/2"Thermocouple pipe? ' —Heater Stick-Up Height 30"i 0
Thermocouple Length 27.67' I /
' '--VEW Stick-Up Height 18" /b
Ground Surface 0.0' 1
Heater Can Conductive HTGrout , ' ry
7r" •<t Angle from Horizontal 90°
Schedule 80 � I
'•,,,V vl__,6.g l'6!
12 Borehole Diameter 7" j'
r
,, et-
y ,Top of MD Sand 1' i'
q*41
'r:� Top of Screen 3' I
oil 1
Heater Can Length 28.5 ft tZ. 5 Gal Buckets of Graphite 0.5 ! '/B'ri.4
Heater Can Diameter 3 in a' = �'
,
, -�1,*,Bags of Silica 0.75
Screen Length 10 ft 6, ;4 war''
a ,
Screen Diamter 3 in 1 r ' Bags of Cement 2.25 11
L.
w
,, -A,
� Bottom of Screen 13' /ft
Installation Method A.
Direct Push I " 'a.r4:r• Bags of#DOSand 6.5 6x ,d4
Sonic f 'y .
Hollow Stem Auger r„ . Gallons of Limestone 6.5 ,3
Mud Rotary 4• i,•
Other: r
r ;�1,'Bottom of MO Sand 20'
eta , r,-FU'(Bottom of Heater Can 26' I,
t il• f os � Bottom of Borehole 26' ' 26'
Post-Installation QC(to be performed 24hrs after installation) PID Log:Make/Model: 1,,
1)Confirm well is free of grout Design Constructed Time: f ,;3 0 Reading: D-6 PPM
Depth to bottom of well[ft bTOC: 7S 5' Time: I : 30 Reading: D4 a PPM
if greater than or equal to 1ft less than designed alert the office Time: 7 t,3D Reading: p,0 PPM
2)Confirm grout plug reaches ground surface Time: cf"; 30 Reading: z9,0 PPM
repeat daily1untll,depth to grout is Oft Time: Reading: PPM
Date . • Depth to Grout[ft bgs] Notes:
(' 1 bbb
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