GW1-2021-07112_Well Construction - GW1_20211006

Prir)t Form
WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
Cascade Drilling 14.WATER ZONES
FROM I To I DESCRIPTION
Well Contractor Nnme ft. ft.
Donald Myles 4525A
n. R.
NC Weli Contractor Cenitication Number IS.OUTER CASING for multi-cased wells)OR LINER if a livable
Cascade Drilling FROM To Dt METER nucxNEss MATElL1AL
(t. R. in.
CompanyNntrn 16.INNER CASING ORTUBING closed-100PY
2.Well Construction Permit#: FROM 1'0 DIAMK'PKR '1111CKNESS MATERAAI,
List all applicable lirl/coustrtiction permits(i.e.UIC,County.State,Variance,etc.) rt. ft. in.
3.Well Use(check well use): ft. R' ra.
Water Su 17.SCREEN
Supply Well: FROM 1'O DIAMitTeR S101'st%k: I'111CKVKSS htA'not[Al,
Agricultural DMunicipal/Public 26 rt. 36 n• 2 In. 0.01 Sch 40 PVC
Geothermal(Heating/Cooling Supply) ©lRtsidcnlial Water Supply(single) ft. ft. in.
Industrial/Cominerciai DResidential Water Supply(shared) 18.GROUT
Irrl ation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-water supply well: 0 ft- 74 ft. Aqua Guard 1 inch tremie pipe
x Monitoriug DRecovery ft. ft- (bentonite)
Injection Well:
R. CG
Aquifer Recharge []Groundwater Remediation
19.SAND/GRAVEL PACK(IfnpPlienbic
Aquifer Storage and Recovery DSalinity Barrier FRObr TO MATERIAL EnIPI.ACEMEN I MI:THOn
Aquifer Test QStotmwaterDrainage 23.7 ft. 36.3 ft. #1 Sand Pre-packed screen&
Experimental Technology OSubsidence Control R. ft. gravity
Geothermal(Closed Loop) QTracer 20.DRILLING LOG attach additional sheets If necessary)
FROM TO DESCRIPTION color,hardn soilimck t, min SIZE,do.
treodtcrmal He
alin Coolin Return Other ex lain under Remarks
0 ft- 36.3 IL Undifferentiated Deposits
4.Date Well(s)Completed:6-29-21 Well iD# SHOW it. rt.
Sa,Well Location: ff ft.
Duke Energy Brunswick Nuclear ft. ft.
Facility/Owner Name Facility ID0(ifapplicable)
8520 River Road SE,Southport,NC 28401 tt. ft. OCT U 6 2021
Physical Address,City,and Zip R' ft. egging Unit
Brunswick 20600001 21.RE-MARIcs inlarmatioll
DVVK z5ecllull
County Parcel Identification No.(PIN)
5b.Latitude and longitude In degrees/minutes/seconds or decimal degrees:
(ifwell Geld,one lat/tong is sufficient) 22.Certification:
33°57'23.32" N 78°00'43.10" W
6.Is(are)the well(s)Ox Permanent or DTemporary Sig/ure of/Ccnined Well Contractor lets of
By signing rhis.(orm,l herch),call'that the uvIl(s)nm(were)constructed in aceordmtce
7.Is this a repair to an existing well: ©Yes or [DNo with 15A NCAC 02C.0100 at-15A NCAC 02C.0200 Well Construction Standards and that a
gilds is a repair,fill ant known hell eonstr urttan infunnation and elplafn the ntamr of the copy of this record has been provided to the i elf oivner.
repair under it2l remarks section or on the back af0ifsform. 23.Site diagram or additional well details:
S.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 ncccssary.
drilled: SUBMITTAL INSTRUCTIONS
9.Total well depth belmv land surface:36.3 (R.)p 24a. For All Wells; Submit lhig form within 30 days of completion of Kell
For nmlliple walls list all deplls)fdf(lwent(erantple-3Q200'and 2@100) construction to the following'
10.Static water level below top of easing:12.43 (ft.) Division of Water Resources,Information Processing Unit,
lfllrner level is above cusb1:.(A.Va"+" 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
13a.Yield(gpm) Method of test: 24c,For Water Supply&Injection'Wells: In addition to sending the fort 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.
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-241 G