GW1-2021-07119_Well Construction - GW1_20211006

Print Form
WELL CONSTRUCTION RECORD(GA-1) For Internal Use Only:
1.%Veil Contractor Information:
Cascade Drilling 14.WATER ZONES
PROsi TO I DG ctuirnON
Well Lontracior Name
rt. rt.
Donald Myles 4525A
a. B.
NC Well Conlmctor Certification Number iS.OUTER CASING for mult!•cosed wells OR LINER f a livable
Cascade Drilling FROM To DLUNkR TIILCKNFSS MATEt114L
rt. ft. irt.
Coinpany Name 16.INNER CASING OR TUBING(geothermal closed-loo
2.Well Construction Permit#• FROM •ro DIAMIN'Kit THICKNrM MAWMIAI,
List all applicable m-11 construction permits(i.e.UIC,Count);State,Variance.etc.) ft. ft. In.
3.Well Use(check well use):
Water Supply Well: 17.SCREEN
PPY FROM •110 DtANIFTER Si.o,rsvx THICKVKSs MATKRIAL
Agricultural [:)Municipal/Public 47.6 ft. 57.6 ft- 2 in. 0.01 Sch 40 PVC
Geothermal(Neating/Cooling Supply) Residential Water Supply(single) R, n, in.
Industrial/Commercial []Residential Water Supply(shared) 19.GROUT d
Irri ntion PROM TO MATERIAL EMPLACUMENT METHOD&AMOUNT
Non-Water supply well: 0 ft- 44 ft• Aqua Guard 1 inch tremie pipe
X Monitoring Recovery f<• ft. (bentonite)
Injection Well: ft. ft.
Aquifer Recharge Groundwater Remediation
19.SAND/GRAVEL PACK if n Iicablo
Aquifer Storage and Recovery Salinity Barrier FROM To MATERIAL, FAMI.ACEMM MF.TtrOD
Aquifer Test []StotmwaterDrainage 46 ft. 57.9 ft. #1 Sand Pre-packed screen&
Experimental Technology Subsidence Control ff. R. gravity
Geothermal(Closed Loop) DTmcvr 20.DRILLING LOG attach additionai shects If necessary) i
Geothermal Heating/Coolin Return Other CX lain under#21 Remarks FROM TO MCRIPTION color,hnrdnecs,safilm ry e, rain size.ete.
0 ft. 40 ft- Undifferentiated Deposits
4,Date Well(s)Completed:7-1-21 Well ID# IS-tN 40 fit• 57•9 ft. Lower Sands Deposits
So,Well Location:
rt. ft.
Duke Energy Brunswick Nuclear
Facility/Owner Name Facility IDA(if applicable) ft. ft.
oaarziNIFM
8520 River Road SE,Southport,NC 28401 ft. ft.
Physical Address,City,and Zip ft. B.
Brunswick 20600001 21.REMARKS2-021
1.
County parcel Identification No.(PIN) ht4MFP`1RfiQA REC'nasSMQ Unit
Sb.Latitude and longitude In degrees/minutes/seconds or decimal degrees: R SectiOn
(if well field,one IaUlong is sufficient) 22.Certification:
33o 57'27.38" N 78°00'43.96" W
6.Is(are)the wells) Permanent or Temporary Signature of CcrIi1TM Well Contractor Date
fly sigaDtg this fomt,1 hereby certify that the wcl/(s)was(were)cmrsmteted in accordance
7.Is this a repair to an existing well: []Yes or Q%INo uidi 15A NCAC 02C.0100 or 15A NCAC 01C.0100 Melt Construction Standards and that a
Ifthis is a repair•fill ant known ivvll mmiracdan infunnation and arplain the natury oflhe cop)'of this record has beenprovided to the nrll owner.
repair under#21 remarks section or on die back gftlhis form.
23.Site diagram or Additional well details:
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having ilia 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 ifnoocssary.
drilled: SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 57'9 (ft.
P ) 24a.For All Wells: Submit this form within 30 days of completion of iye11
For nndtiple wells 0.st aQ depths#'diperent(erswpple-3@200'and 2@J 00) construction to the following:
10.Static water level below top of casing:15.25 (ft.) Division of Water Resources,Information Processing Unit,
ff itwer level/Y abave easing rise"+" 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.anger,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
I
13a.Yield(gpm) Method of test:. 24c.For Water Supply&Iniection'Wells: In addition to sending the fori 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.
Fonn cw-1 North Carolina Department ofEnvironntentnl Quality-Division of Water Resources Revised 2-22-2016