GW1-2021-07120_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
FR05f TO DM- R1PTION
Well Contractor Name n, fA
Donald Myles 4525A
n. Irt.
NC Well Contractor Certification Number 15.OUTER CASING for muiti-eased wells OR L1N&R f a licable
Cascade Drilling FROM TO DLIMETER' T1nCKNESS MATERLII,
n. I in.
Company Name 16.INNER CASINGORTUBING cotharmalclosed-loo
2.Well Construction Permit# FROM I to I DIAMETRIt I TaICKN►ss I MAnaRIAI,
List all applicable civil construction permits(t.e.U1C,Counj%Stare,1 arlaace,eta) R• R. in.
3.Well Use(cheep well use): rt. R. In
Water Supply Well: 17.SCREEN
PPY 17tOM 'l'0 UTAMICI'RH SIA'I'SI%It 'fHICKVF.SS M1tA'rldK1Al,
Agricultural OMunicipal/Public 45.3 ft- 50.3 rt. 2 131' 0.01 Sch 40 PVC
Geothermal(Heating/Cooling Supply) ORtsidentiai Water Supply(single) ft. ft. In.
Industrial/Commercial [Residential Water Supply(sbared) I8.GROUT
-litigation M- Oaf I TO MATERIAL EMPLACEMENT METHOD R AMOUNT
Non-Water Supply Well: 0 n• 30 n• Aqua Guard 1 inch trernle pipe
x Monitoring DRecovery ft. n• (bentonite)
Injection Well: ft. tL
Aquifer Recharge []Groundwater Remediation
19.SAND/GRAVEL PACK if applicable)
Aquifer Storage and Recovery OSahaity Barrier FROM TO MATERIAL EbIPI.ACEMENP METHOD
Aquifer Test OStortwaterDminage 39.5 ri 50.6 r< #1 Sand Pre-packed screen 8t
Experimental Technology []Subsidence Control I gravity
Geothermal(Closed Loop) []Tracer 20.DRILLING LOG attach additional sheets if necessa •
Geothermal (Heating/Cooling Return) Other(explain under#21 Remarks) FROM TO DRSCRIPTIOK color,brdit as,salllrmk type.gruln it eta
0 n• 33.6 n- Undifferentiated Deposits
4.Date Well(s)Completed:5-20-21 Well ID# IS-SE 33.6 it. 50.6 n- Lower Sands Deposits
ft. A.
5n.Well Location:
Duke Energy Brunswick Nuclear a. n.
pocility/Owner Nnme Facility 1D#(ifopplicnble) ft. n.
8520 River Road SE,Southport,NC 28401 rt. n.
n.
Physics]Address,City,,and Zip '
Brunswick 20600001 21.REMARKS
County Parcel Identification No.(PIN)
InformaMin ii(nn
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwoll field,one lottlong is sufficient) 22.Certification:
33°57'25.35" iv 78°00'25.48" W
6.Is(are)the well(s)O% Permanent or Temporary Sig um o[ cniG/ed Well Contractor Date
By signing this form,I hereby eertffy[liar the weli(,t)Ives(were)caltsirtiered in accordance
7.Is this a repair to an existing well: Oyes or MNo with 15A NCAC 02C.0100 or 1SA NCAC 02C.0200 Hell Constniction Standards and that a
if thls Is a m2air,fill out latmv»well roustr 1010n it fornnedon and explain the nature t f the copy of dais record has been provided to the mll owier.
repair under#21 remark section or oil 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 1 GW-1 is needed Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if accessary.
drilled: SUBMITTAL INSTRUCTIONS
9.Total well depth below Eared surface: 50.6 (ft-) 24a, For All Wells: Subunit this form within 30 days of completion of well
For ainhiple xeiir list all depths tt0l(erent(eraniple-3@260'and 2�1001 construction to the following:
10.Static water level below top of casing:16.29 (ft.) Division of Water Resources,Information Processing Unit,
#'miter 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
13n.Yield(gpm) Method of test: 24c.For Water Supply&Infection Wells: In addition to sending the fort to
the address(cs) above, also subunit 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.
porm CW-I North Carolina Department of Environmental Quality.Division of Water Resources Revised 2-22-2016