GW1-2021-07118_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
FROTr To DUMPTION
Well Contractor Name fit Tt
Donald Myles 4525A
n. ft.
NC Well Contractor Certification Number 15,OUTER CASING for multi cased welts OR LINER f a lleable
Cascade Drilling FROM TO I)IN-5N6TER TIIICHNESSI KATER41I.
ft. [L in.
Company Name 16.INNER CASING ORTUSING eothermalclosed-loo
2.Well Construction Permit#• FROM TO DIAME'114t I'HICKNF'$S MA'rrwnl,
List all applicable or11 coostruclion permits(t.c.UX Count,State,Nar'lnuce,eie.) fL n. in.
3.Well Use(check well use): iL ft in.
Water Supply Wc1L 17.SCREEN
PPY FROM 1'O DIAMWITR SI,0r5t%l1 'fillCKAF«SS MATERIAL:
Agricultural [Municipal/Public 97.1 r<• 107.1 ft- 2 In. 0.01 Soh 40 PVC
Geothermal(HeatingfCooling Supply) DResidentiat Water Supply(single) n, rt. In,
Industrial/Commercial [Residential Water Supply(shared) 1&GROUT ("
Irri ration FROM To MATERIAL EMPLACEMENT METHOD&AatOUNT
Non-Water Supply Well: 0 n• 91 r'• Aqua Guard 1 Inch tremle pipe
x Monitoring Recovery n, n, (bentonite)
Injection Well: iG tL
Aquifer Recharge [Groundwater Remediation
19.SAND/GRAVEL PACK f a liable
Aquifer Storage and Recovery [Salinity Barrier FROM To MATERIAL I PhIPLAUNFFNI llff" D
Aquifer Test [StormwaterDrainage 95 rt• 107.4 n #1 Sand Pre-packed screen&
Experimental Technology [Subsidence Control gravity
Geothermal(Closed Loop) [Tracer 20.DRILLING LOG attach additional sheets If necessary)
Geotlicrmal Hcalin Coolin Return Other(explain under#21 Remarks FROM To nitceRlrrtoN color,barrinecs solUraek type, In size,ate.
0 n 40 n Undifferentiated Deposits
4.Dale Well(s)Completed:6-15-21 well ID#CH-NW 40 n. 74 rt• Lower Sands Deposits
5a.Well Location: 74 n• 107.4 n• Castle Ha ne Formation
Duke Energy Brunswick Nuclear ft. n.
Facility/Owner Name Facility IDA(ifapplicnble) tt. ft
8520 River Road SE,Southport,NC 28401 ft. tL
Physical Address,City,and Zip ft. ft. T
Brunswick 20600001 21.REMARKS
County Parcel Identification No.(PIN) Information ,
UVVM
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwoll field,one latilong is sufFicieru) 22.Certification:
330 57'35,81" N 78°00'41.68" W
6.is(nre)the well(s)[X Permanent or [Teltlporary Signature oc citified well Contmeto Date
0p signing this form,1 herclry certify that tire well(i)uvts(rtv'rc)mrisintcred in accordance
7.is this a repair to an existing well: []Yes or %[No iviih 15A NCAC 02C.0100 ar•15A NCAC 02C.0200 Well Constrrtciton Standards and that a
rfthis is a npalr;fill(plot known+cell conslrurfian iglannatiarl ford arplain the nattn•e of the copy ofthis record has bear provided to the(pill owner.
rrpair•under#21 ronrarks section or on Ilse back ofthis form. 23.Site diagram or additional well details:
8.Tor 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-1 is needed. Indicate TOTAL NUMBER of wells construction details, You may also attach additional pages if accessary,
drilled: SUBMITTAL,INSTRUCTIONS
107.4
9.Total:well depth below land surface: (fit•) 24a• For All Wells: Submit this form within 30 days of completion of""ell
Far multiple ivells list all deptIn ifdifferent(erarnple-3 a 00'and 2C100) construction to the following'
10.Static water level below top of casing:14.52 (ft.) Division of Water Resources,Information Processing Unit,
Ifumer level is abm+e 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:
(Le,auger,rotary,cable,direct push,ctc.)
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 SUDDIV&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 die county health department of the county
where constructed.
Torn GW-1 North Cmolinn Department of Environmental Quality-Division of Water Resources Revised 2-22-2016