GW1--02624_Well Construction - GW1_20240501

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Weil Contractor Information:
Michael Coleman 14.WATER ZONES. • • - . ,.I -..
Well Contractor Name FROM TO DFSCRIPTTONi •
2992-A ft. ft. I.
it. it. I
NC Well Contractor Certification Number 1S.OUTER CASING(for multi-cased Welt)OR LINER(If ap�ble) - '
Cascade Drilling ' FROM TO DIAMETER THICKNESS MATERIAL
o ft. 53 'in stool
Company Name 16.INNER CASING OR TUBING(geothermal closed-loop) . -
2.Well Construction Permit i9: FROM TO , DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.WC,County.State.Variance.eta) .ft. ft. iIn.
3.Well Use(cheek well use): ft. R. In.
Water Supply Well: .r 17.SCREEN ,
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
gricultural • QMunicipal/Public 53 ft. 55 ft. 1 in. 0.010 as
Geothermal(Heating/Cooling Supply) OResidential Water Supply(single) ft R. to '
Industrial/Commercial OResichintial Water Supply(shared) =1S:GROUT -
Irrigation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 ft. 51 !t cement I tremie pipe
- - Monitoring ---- -==_-----• -----Recovery -- - - -it. - _ -tt.- -- I I -- • - - - ..
Injection Well:
Aquifer Recharge xOGroundwater Remediation
'19.SAND/GRAVEL PACK(if applicable)
Aquifer Storage and Recovery Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
Aquifer Test QStomtwater Drainage 51 rt- 55 ft. #00 send , Sonic
Experimental Technology QSubsidence Control ft. R.
Geothermal(Closed Loop) OTracer '20.DRILLING LOG(attach additional sheets If necessary)
Geothermal(Heating/Cooling Return) }Other(explain under#21 Remarks) FROM TO DESCRIPTION[corer.hardem,rotthotk type,o.fo the.ees) /
4.Date Weli(s)Completed:4/3/2024 Well ID#SB-04 iL R ��ft. i 1'�qQ
5a.Well Location: ft.
R.
.1Z CCgc�,--e-sA'a0ve, -s A /tJC 2e,Z Y57yy. ft. R. I; , _,. :.
Facility/Owner Name Facility ID#(if applicable) ft. R• ji i. ;'
3 6 .t., . . i i."-..1 t
'vz7?..:7i�..� 37i�� ,r, 1-,,,.X��2.,Fsyts , ' MAY v 1 f
Physical Address,City,and Zip n' 2u24
_,1-/ y79,6 y : RS 1,,,:,..,...„,' ::. ._.r
CountyParcel Identification No.(PIN) On sitA gAn hiltC e ` Y .R
soil description [�.�°r:.>�;�.�-
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one Iat/long is sufficient) 22.Certification: i`
3y 7y/Sv N c,77..36C" Ye �,y i .
4/17/2024
6.Is(are)the wel(s)DPermanent or Temporary
signature of Certified Wel Contractor Dare
By signing this form.I hereby cent)"that the well(s)was(were)constructed in accordance
7.Is this a repair to an existing wells DYes or allo with ISA NCAC 02C.0100 or ISA NCAC 02C.0200 Well Constriction Sicndar.s and that a --
If this is a repair,fellow brown well construction information and explain the nature of the copy of this record has been provided to the well owner.
repair under tl2!remarks section or on the back of this form. 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 site details or well
construction,only I GW-1 is needed. Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if necessary.
drilled: SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 55 (W -24a. For All'Wells: Submit this form within 30 days of completion of well
For multiple wells list all depth Ifdierent(example-3Q200'and 2@l00') construction to the following:
10.Static water level below top of casing: (ft.) Division of Water Resources,Information Processing Unit,
Ifwater level is above casing.use"+" 1617 Mail Service Center,Raleigh,NC 27699.1617
11.Borehole diameter: 6 (in.) 24b.For Infection Wells: In addition to sending the form to the address in 24a
Sonic above,also submit one copy of this form within 30 days of completion of well
12.Well construction method: construction to the following: .
• (i.e.auger,rotary,cable,direct push,etc)
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
( I
13a.Yield(gpm) Method of test: 24c.For Water SuDDIV&Infection Wells: In addition to sending the form to
the address(es) above, also submit lone copy of this form within 30 days of
13b.Disinfection type: Amount: completion of well construction to the county health department of the county
. where constructed.
Form GW I North Carolina Department of Environmental Quality-Division of Water Resources Revised 2.22-2016

r TERRATHERM SIW Boring Construction Detail Revision#: _0
Release date_5/12/23_
Approved by: SL_
. Well ID SB-04 Date
Oversight Job# R23-104
/
Driller "i e-vU' 7er✓ �, -L_/' , — 6,4,.,�(2...,,,,-, Design Constructed Notes
(fill out if
different)
—SIW Stick Up Height 18"
Cover Surface 1.0'
Ground Surfaee-0.0.-»---��-- =_ ; _ _�
Grout r s T ---- — `I
Borehole Diameter 6"
3..n:I I,..iV.rA., , ./ 7
Riser 1"CS
•
Riser Length 55.5 ft �''' 1 •Bags of Cement 14.25
Screen Length 2 Jt
r.Screen Material SS 1 ' 0, l Bags of Silica 4.75 1
SIW Slot Size 10 ]
Screen Diameter 2" Bags of Sand 2
V ,
Installation Method
Sonic z
Direct Push t sr l,.-y
I Hollow Stem Auger k r
Mud Rotary 5 t ,% ;''.
Other: Top of POD Sand 51'
Top of Screen 53'
•__-- __.._._____ _ PM MO
Bottom of MO Sand 55' ____T
and Screen
F..,
I Bottom of Borehole 55' J
Post-Installation QC(to be performed 24hrs after installation) PlD Log:Make/Model:
1)Confirm well Is free of grout Design Constructed Time: Reading: PPM
Depth to bottom of well[ft bTOC]: 57 5 Time: Reading: PPM
if greater than or equal to 1ft less than designed alert the office Time: Reading: 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:
L