GW1-2021-07116_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
FROM TO DGSCnIPTtOt\
Well Contractor Name
rt. rt.
Donald Myles 4525A
n. rr.
NC Well Contractor Certification Number 15.OUTER CASING for multi-cased rMis OR LINER f a
Cascade Drilling FaO DTE Ess lMC RL4L
rt K
rt. in.
Company Name 16.INNER CASING OR TUBING eothermal closed-loop)
2.Well Construction Permit#• FROM 'ro I DIAMETER I 'rnlCKr rss MATrIt1AL
List all applicable well constntdion permits(Le,Ulr,County,State,Fardance,etc) A. ft. In.
3.Well Use(check well use): rt. n. ta•
Water Supply Well: 17.SCREEN
PP S` I+ttOa1 '1'O UTAME'rER .SI,O'I'St%A: 'I'nICKAESS MATtSR1A1,
Agricultural 0Municipal/public 146,7ft• 166.7n• 2 In. 0.01 Sch 40 PVC
Geothermal(Heating/Cooling Supply) DResidential Water Supply(single)
:)Industrial/Commercial Residential Water Supply(shared) 18.GROUT
_11hriention FRO1s1 I TO MATERIAL EMPLACEVENr METITOU s Anlourrr
Non-Water Supply well: 0 ft- 139 ft- Aqua Guard 1 inch tremie pipe
x Monitoring DRecovery ft. n- (bentonite)
Injection Well: ft. ft.
Aquifer Recharge Groundwater Remediation
19.SAND/GRANGE PACK f applicable)
Aquifer Storage and Recovery OSolinity Barrier FROM To I h1ATr,RIAL FatpLACEIVIENT MT.TIIOD
Aquifer Test DStormwaterDrainage 142 rt- 167 rt• #1 Sande, Pre-packed screen&
Experimental Technology QSubsidence Control 11• rt gravity
Geothermal(Closed Loop) QTraccr 20.DRILLING LOG attach additional sheets if necessa '
Geothermal eatin Coolin Return Other(explain under#21 Rcmarks FROM TO DESCRtPTIOn color,h"rd"exc,calthrock type, Io slze,Cie.).
0 fL 46.5 rt• Undifferentiated Deposits
4.Dale Well(s)Completed:7-14-21 Well ID# PD-E 46.5 ft• 72.5 " Lower Sands Deposits
So.Well Location: 72,5 rt 99 rt. Castle Mayne Formation
Duke Energy Brunswick Nuclear 99 rt• 112 n Peedee'Confining Unit
facility/Owner Name Facility IDM(ifopplicablc) 112 rt• 167 ft• Peedee Formation
8520 River Road SE,Southport,NC 28401 ft. rt.
Physical Address,City,unit Zip ft. rt.
Brunswick 20600001 21.REMARKS
County Paled Identification No.(PIN) `'I
in 5b.Latitude and longitude in degrees/minutes/secondsUnit
or decimal degrees: ��rr 1i1f0Iin
(ifwcll Gcid,one Lidlong is sufficient) 22.Certification: YS2T� pWR Sect+on
330 57'31.16" N 78°00'26.74" W f
6.Is(are)the well(s)OX Permanent or []Temporary S-'fgaaturc o enified well Contractor Date
0y signing thia,fornr,1 hereby certify tint the wcil(s)nvrs(were)ronatntcred in accordmtce
7.Is this a repair to an existing well: []Yes or [ INo with 15A NCAC 02C.0100 or ISA NCAC 02C.021N1 i'ell Consrnrc0on Stnndardr and that a
Ifdris 6v a repair,fill uat knaimr iveli eumtrnrtion Itefbrnrathm and eapluin the nature-r fthe copy of this record has beat provided to the aril owner.
irpair under 021 snarls section cr on the back of tills form.
23.Site diagram or additional well details:
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the sume 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 pubes if necessary.
drilled: SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 167 (ft.) 24a, For All Wells: Submit this form within 30 days of completion of well
For nadtiple nrlls list all depths{fdrarent(esanrple-3Q200'and 2@100) construction to the following:
10.Static water level below top of casing:11.65 (ft-) Division of Water Resources,Information Processing Unit,
If ureter level is ahave trishAg,Use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter:6 (in.) 24b.For Injection 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 Ilse 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 8c 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 the county health department of the county
where constructed.
form GW-1 North Carolinn Department of Environmental Quality-Division of Water Resources Revised 2-22-2016