GW1-2022-00256_Well Construction - GW1_20221222

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
George Bridger 14.WA,I.ERZONES F
Well Contractor Name FROM TO DESC rn0N
2393-A
fL 2
NC Well Contractor Certification Number I&OUTER CASING formoltiaased"wells ORLt1YER d• 'cable
Bridger Drilling Enterprises, Inc. FROM To DIAMEMIR THIC"M MATERIAL
Company Name
0 fL 2 ft- 2 i. in. I SCh 40 PVC
WIVIt7801213 16.INNERCA SING ORTUBING eiitbcrmalelas<d-tau
2.Well Construction Permit il FROM I TO I DIAMMR . I TIUCIrNFSS MATERIAL
List all applicable well construction permits it.e.WC.County.State,Variance,eta) fL % in.
3.Well Use(check well use): tL tL �; I'M
17.SCREEN
Water Supply Well: - FROM TO I DIAMLTER I SLOTSaE TmLTU'rFSS MATERIAL
❑Agricultural ❑MunicipaMblic . R 12 tL 2 in.; .610 sch 40 pVC
[]Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) R• fL in.
❑Industrial/_Cam_mercial ❑Residential,Water Supply(shared)_ I&GROUT - —
❑Irri 'on ❑WcUs>100,000 GPD FROM TO MATERIAL ' ^EMPLACE1fEhT 1fErnOD&A1fOUNT
Noo Water Supply Well: 0 fL .5 IL concrete inplace
Monitoring ❑Recovery .5 fL 1 fL bentonite
Injection Well:' fL M
❑AquiferReebarge ❑GroundwaterRemediation 19 SANDIGRAVELPACK d■ ticabte
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM To MATERIAL EiuPLACEn1ENT Merllon
❑Aquifer Test ❑StormwaterDrainage 1 fL 12 % sand prepack
{ ❑Experimental Technology ❑Subsidence Control ft. %
[]Geothermal(Closed Loop) ❑Tracer 20.DRILLING I OG ■ttacb additional sbeets if necessa
FROM TO DFSCRUMON colon hudam sai0rock iu sRt.eta
OC,cothermal(Healing/Cooling Return) ❑Other(explain undert121 Remarks) 0fL 13 fL Gray and Dark Gray Sand
a.Date Well(s)Co.- eted:12/5/2022 Well roc M W-01 n ft.
fL ft,
Sit.Well Location:.- .
tL
CPI USA North Carolina,LLC
. ft.
Facility/Owner
Name Facility IDll(ifapplicable) ft. -
ft. M
1281 Powerhouse Dr.Southport, NC 28461
_-. 2
Pbysical Address,City,and Zip 21.REMARKS
Brunswick intii;fiaiFstr 1 l�fCc?�i?Yv x.7liRt
countyParcel Identification No.(PIN)
5b.Latitude and longitude in degreedminuteslseconds or decimal degrees:
(ifwen field,one Wong is sutficieat) 22 Certification:
20.97.16 N -92.85.11 w !//f 12/14/2022
Si ep f eertifi Well or Ike
6.h(Mt)thewell(s): "trmanent or ❑Temporary f
s glhis jorm,l hereby cen ifryp lluu ih well(5)was(were)constructed in accordance with
I5 NCAC 02C.0100 or 15A NCAC 02C•.0200 lVell Construction Standards and rhar a copy
7.Is this a repair to an exbting well: ❑Yes or ONo jdris record has been provided io the well ouver.
Ijthrs iso repair,fill out Itnawn well construction irjon anion and explain the nature ojrhe '
repair,mder 021 remarks section or on the backojthisjorm. 23.Site diagram or additional well details:
having the same You may use the back of this page to provide additional well construction info
Geothermal Wells tmv
8.For GeoprobdDPT or Closed-LOOP (add Bee Over'in Remarks Box).You may also attach additional pages if necessary.
construction,only I GW-1 is needed. Indicate TOTAL NUMBER of wells 24.SUBMITTAL INSTRUMONS
drilled:
(ft) Submit this Gw-1 within 30 days of well completion per the following:
9.Total well depth below land surface:'1 to-3 00'and 1@I00� j
For multiple wells list all depths ijdfferent(gyp
(ft.) 24a. For All Wells: Original form to Division of Water Resources (DWR),
10.Static water level below top of easing:6 In Processing Unit,1617 MSC,Raleigh,NC 27699-1617
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ljwaterjowl is above casing.use +" 246.For.Infection Wells:Copy to DWlt Underground Injection Control(IUC)
Program,1636 MSC,Raleigh,NC 27699-.1636 '
11.Borehole diameter.�— I I
direct push z4e.Far Water SDDDIY and Open-Loon Geothermal Return Wells:Copy to the.
I2.Well construction method: 'county environmental heal department of the county where installed
(i.e.auger.rotary.eable;direct posh etc.)
FOR WATER SUPPLY WELLS ONLY: 24d Eor Water wells roduciD "over 100 000 GPD:Copy to DWR,CCPCUA
Permn Program,1611 C,Ralei ,NC 27699-611
Methoii of test.
13a.Yield(gpm)
Amount
13b.Disinfection type:
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Norio Carolina Department orEaviroaroental Quality Division of Water Resources Revised 6-6-2018
Form GW-1