GW1--00108_Well Construction - GW1_20231228

-=WELL.CONSTRUC'RON RECORD
For heenul Use t)NLV:
This Ramon be nsil for single or multiple welts'
. • 1.Wd6.Cantraetopinforuratiott:
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-Ali-WATER ZONES .
Chris Ruffer SNOM. ' 10 DFSCnlPT11)N '
WWI Contractor isms R: R.
9223-A ft, fr.
NC Well ComtactarCcnifr�lion Number ;tS.OtJCER CASING(Cai�iisntti eiv'ii*cltsy0R LINER'(i AW'Ilcibk
ROM • 'I TO DIAMETER THICKNESS MATENtAL
SAEDACCO .(4_I • fr. I, ID.
CampaarNamc. :I6 INNEN-CASiNG Olt'•TttBINGAiwi6crros}cWsed.lanpj`'',:'-._-:-'-
FROM TO DIAMETER T ICI{.NESS MATERIAL
2.WclC Construction Permit cnit#; 0 ft. 45 ft. 2 1 'hit. SCH-40 Steel
Liar all as li,-dble we'll permits(ix.County.Sru:r.,Vnriarxe.ode dial err..,' '
It.. it, Etc.
3.Welti3se(kli,eeltwell use).: • .t7:SCREEN ' ' • . .
EVucerSupply�i'cll: '• FROM TO rn.%METER SLOT SPX THICKNESS , MATERIAL
OAgl(cultutal ElMilliicipatllrub!ic, •45 R. 55 ft. 2 in ,010 SCH-40 Steel
13Geothetnral(iileatingtCooling'Supply) ®Residential Water Suppl}•(single) R. ft iiz
•❑tndusttiallcontmercril � DResideutiat WaterSuppl}•(slau�ed) 'tS GRRCIUT..•-.. -:' :. - . -,
FROM TO. MATERIAL EMPLACEMENT METHOD&AMOUNT
❑frrigntion - . 0 .ft. 38 .ft, • Portland Pour
Neu=Water Supply WO: .
•18Monitnring Allccnrery, ,. ft. ft •, _ - .-- _ .. •
Injection Welt: R. f4.
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ClAintifcc Recharge ClUtotRdRaterliietrtediation AsAANnIGII,WELPACIZlitatriatiatiter= • _ - ` - •-
'FROM • 1h ' MATERIAL - EMPLACEMENT HLTUOD
CIAgilifcr:Stofagc and itecovety DSalinity Harrie' 43 R. '55 ft. Sand; #2 •
❑AgnifcrTcst. DStotimtateenntiriage -
tt,. ft.
DHylctfmcntalTechnolom' 17Sitbsideocc'Cotttrel
:.2t1 DfttLttNatOG fsltach aditiiionsl sheds if iecerss in.,f _
DGendfennal(Closed Loop) DTlacer FROM • 110 DI-SCRIPTiONfobr.hm4m.ti,sonsi pc praie.ini:Rc.)
DGeotltennal(Flcatink/Cooliug Return) ❑Oilier(e 1plkiu under.#21 Retuatis) .t4. t4
IL. • ' fL i
4.Date Wiell(s).completed: 12-12-2023%Volt ID#C55A1R - - --
ft- See Gets'a Notes,
Sal,Wdl Locating: .(4 ft.
Brunswick Nuclear Plant . . ft, ft, i
Flethiy/OuncrNartec . . Facility IDL(tfappticnble) R. a. �p t l k--
Power Plant'Rd., Southport,.NC,.28461 ft.' ft. ''
Ph sir:al:Addri ss.City.and kip ;zt:_itt nl tiRns DEC 2,6 2C0
Brunswick -Bentonite seal from 38'-43' ..
County Parcel Identification Nu.(PIN) e- .:`•-,�cv:: i p;;1,
Sh,.i ittitucte and Longitude in ttegrteslminuteslscconds ar ciccinutl((eg ets: 22,Certification:
(ifeteft 014,ore lautot is sedficiant) hh R- {� 1�
N W 1't1IS �I.III1 ' 12/13/2023
• Signior.;ofCcrtilled Well Contfactor Date
6:Ira(are)the.well(s)r I0Pevrnaitent or DTeinporat;T '
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By signing drir fair„14ereby errrif:flyer ihr ne11fs)WILY frtirrXl aytrinrered in acecirrh lix
1i'irh 15;t JVCAC 02C.0109 or 1SA NOW 02C.0200 Wd1 C oastrn anon Stomicrrris and:bar a
7.Iis this a repair Lu an csisting well: X1%'cv or CI No 'f[fm,4rfhif word ht,s teem provided(.Ysbe well Meaer.
if Ih&s:ls a rnp air.f ll am 4n01.4/well ears ns-?ion hrfdrmatlon and e.4(iiahr the nature of the '
relu:ir ruder&21 re/mid*maim or ivi the ball of this form. 23:Site di grant or additional«'et0 details: •
You may use the back of this page'to provide•additional well site details:ordell
S.Nmuber-of Wells eoustrtieted: 1 sconsuuction details. You may also attach additional pages if Recess:my.
For uunlrlple iriJecrlon ornmI-wooer supply u'e'Ns O,VLY with the.srrnrecunstrucfeon,you sane
¶OFruuf vne form. - SI TBNIltI'AL iNSTUCTIONS
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9.Total Well depth below laird stirface 55 ((1.) 21a. For All Welts: Submit this form within 30 days of completion of welt
FornrniripkirellslisfalldeptsifellSirrrnr(example-3@240'anr(.2@100) consinittionto Rho Cottonin-,r.: i
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10.St-atic water le%'d below top of casing: 25 (U,) Uivisiuu of Water Resources,Information Processing Unit,
limiter ler4 Ls ahore Leung.LW"t" ' tGt7 RLtil S&ieccCcnter.Raleigh,NC 27699-I617
la,Borehfile diameter,6.. . (in.) 34b.ForIlijection Wells ONLY: hi addition to•sending.the foci to the address in.
24a above,also submit a copy of this fann within 10'days'of.completion of nell.
12.Nell construction method: sonic construction to the follotving:• -
(Ic.angel;rotary,cable,direct pnst�etc.}- i -
Division of Wafer*sou rces,'Underground Unjctylon Control Program,
FOR WATER SUPPLY WELLS ONLY:' 1636 M til Service!I Center,Raleigh,NC 2769941636
t3a,1�cld(dim) Ccflrod of test: 2 te,For Water Supply&Injection WelL
Also submit one copy of this Conn Within 30 days of completion of
flab.Disinfection type: Amount: ' well constmction to the county deportment of the county where
constructed.
Fono GtV-t NoahCamlina Depanrneul of EFl{-Icon melt and Natural Resources-Division of Water R oper Rei;ised Augur*1013