GW1-2021-07115_Well Construction - GW1_20211006

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• WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
Cascade Drilling 14.WATER ZONES
most TO DESCRIPTION
WellConhncturName ft. ft.
Donald Myles 4525A
rt. n.
NC Well ContmctorCertiticallon Number 15.OUTER CASING for tnultl-cased wells OR LINER f a lieahlc
Cascade Drilling FROM TO 1_11 RTER THICKNESS MATERIAL
n. n lal.
Company Name 16.INNER CASINGORTUDING cothermnlelosed-loop)
2.Well Construction Permit# FROM I To I DIAMKIxR I THICKNESS I MATERIAL
List all applicable well constmVion permits(i.e.UIC,County State,r'nr lance.etc.) ft. ft. in.
3.Well Use(check well use): fl. ft, in.
Water SD Well: 17.SCREEN
Supply FROM 1 11'O nIAMF"rtm star ,Smr, THICKNESS MAWWAI.
Agricultural DMunicipal/Public 136.En• 156.6n• 2 in' 0.01 Sch40 PVC
Geothermal(Heating/Cooling Supply) DResidential Water Supply(single)
Industrial/Commercial [Residential Water Supply(shared) Is.GROUT
_11tTlization PROM I TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply well: 0 fl• 129 rt• Aqua Guard 1 inch tremie pipe
x Monitoring DRecovery n• ft- (bentonite)
Injection Well: ft. ft.
Aquifer Recharge Groundwater Remediation
19.SAND/GRAVEL PACK f a Ilcablc
Aquifer Storage and Recovery Dsalinity Barrier PROM TO MATERIAL I EMPLACF.MRNTMETROD
Aquifer Test DStormwaterDrainage 132 D• 156.9 n• #1 Sand Pre-packed screen&
Experimental Technology DSubsidence Control n• I fL I gravity
Geothermal(Closed Loop) DTracer 20.DRILLING LOG attach additional sheets if necessary)
FROM TO DESCRIPTION
Geothermal(Heating/Cooling Coolin Return Other(explain under#21 Remarks color,hardne soll/mckt In size cto
0 IL 40 r Undifferentiated Deposits
4.Date Well(s)Completed:6-16-21 well ID# PO-NW 40 a. 74 Tt Lower Sands Deposits
5a.Well Location: 74 R• 113 R• Castle Ha ne Formation
Duke Energy Brunswick Nuclear 113 R• 156 c IL Peedee Formation
Facility/Owner Name Facility to#(ifapplicable) fa ft.
8520 River Road SE,Southport,NC 28401 ft. rL
Physical Address,City,and Zip
n.
Brunswick 20600001 21.REMARKS n(�
County PnmelIdentification No.(PIN) " '
Sb,Latitude and longitude in degrees/minutes/seconds or decimal degrees: PrOmessing
(ifweil field,one latliong is sufficient) 22.Certification: �I✓=l �'9 1n pWR SgCl10n
33'57'35.97" N 78"00'41.47" W
6.Is(are)the well(s)OPermanent or Temporary Si a 6rCcnifcd well Contractor rate
By signing this form.I hereby eerier!lint the ivell(s)was(were)consintered in accarlrnrce
7.Is this a repair to an existing well: Dyes or %ONO afth 15A NC.4C 02C.01110 ar 15d NCAC 02C.0200 Nell Construction Standards and that a
111bir is a relmin fill ant knotwI uvil constnirtion infunnation mal explobi the nature of the copy of this record has been provided to the,well mwaer.
repair under1121 remarks section or on the backofthisforn, 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 1 GW-I is needed. Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if necessary.
drilled: SUBMITTAL INSTRUCTIONS
ft.l.well depth below land surface: 156.9
9.Total
P ( ) 24a. For All Wells: Submit this form within 30 days of completion of well
Far nmltiple bells luau all depllas Jfdi,Qcrent(example-3Q200'mad 2@1190� construction to the following:
10.Static water level below top of casing:14.35 (ft.) Division of Water Resources,Information Processing Unit,
if utttm•level Is abtrve casing•use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter:6 (in.) 24b.For Iniection_W_el_ls: In addition to sending the form to the address in 2411
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
13a.Yield(gpm) Method of test: 24c.For Water Supply&Injection Wells: In addition to sending the form to
the address(es) above, also submit one 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.
P
Fonn G W-1 North Carolina Department of Environmental Quality-Division of Water Resources Revisal 2-22-2016