GW1-2022-04432_Well Construction - GW1_20220511

w
®,
NORTH CAROLINA
ilk
WELL CONSTRUCTION RECORD (GW-1 )
EnvfronmertmfQua(Iry
Form GW-1 Well Construction Electronic Form
North Carolina Department of Environmental Quality
Division of Water Resources
November1
Submission ID#
GW 1-2022-04432
Are you submitting a scanned form?* Yes
• No
CONTACT INFORMATION
.......................................................................................................................
Contact Name* Email Address*
Ben Maser [e-mail]
Is this a revision to the form you have previously submitted?*
Yes No
WELL CONSTRUCTION INFORMATION
........................................................................................................................................................................................................................................................................................................................................................................................................................................................
1.Who is installing these wells?*
Owner Well Contractor
1.Well Contractor Information:
Certiticate# Cert Level First Name Last Name Company Name
2393 A GEORGE BRIDGER BRIDGER DRILLING ENTRP INC,dba
CAROLINA
2.Well Construction Permit#:
...............
W M0801183
List all applicable well construction permits(i.e.Monitoring Wells,UIC-Underground Injection Control,CCPCUA-Central Coastal Plain Capacity Use Area,County,
etc.)
What type of well is this?* Injection Well Non-Water Supply Well
Water Supply Well(includes irrigation wells)
3.Non-Water Supply Well* Monitoring
Recovery
4.Date well was completed and ID#
......... ......... ......... ......... ..... .........
Date Well Completed* Well ID# Well Yield
4/12/2022 TW-SB-101 (gallons per minute)"
4/12/2022 TW-SB-118 (gallons per minute)"

4/12/2022 TW-SB-122 (gallons per minute)"
4/12/2022 TW-SB-124 (gallons per minute)"
4/12/2022 TW-02-R1 (gallons per minute)"
4/12/2022 TW-02A (gallons per minute)"
4/12/2022 TW-02B (gallons per minute)"
5.Well Location
Facility/Owner Name*
Duke Energy Progress Inc. Facility ID#
(Required) (If applicable)
County* Parcel Identification No. (PIN)
Brunswick 209716928511
Physical Address* Street Address
1281 Powerhouse Dr
Address Line 2
City State/Province/Region
Southport NC
Postal/Zip Code Country
28461 United States of America
Latitude* -78.0124250000 Longitude*33.9468470000
Decimal degrees Decimal degrees
......... ......... ......... ......... ..... ...
6.Is(are)the well(s):* Permanent Temporary
7.Is this a repair to an existing well:* Yes • No
If this is a repair,fill out known well construction information and explain the nature of the
repair under#21 remarks section or on the back of this form.
For multiple Geoprobe/DPT or Closed-Loop Geothermal Wells having the same construction,only 1 GW-1 is needed.
8a.Indicate TOTAL NUMBER of wells drilled: 7
9.Total well depth below land surface: (ft.) 9a.What is the depth of the casing from ground
14 surface?
For multiple wells list all depths if different 5
(example-3@200'and 2@100') in feet
10.Static water level below top of casing: (ft.) 11.Borehole diameter:
8 2
If water level is above casing,use"+" in inches
12.Well construction method:
Auger Air Rotary Cable Tool
Direct Push Mud Rotary Rotosonic
Other
14.WATER BEARING/FRACTURE ZONES
From To Description

in feet in feet
15.OUTER CASING(for multi-cased wells)OR LINER(if applicable)
From To Diameter Thickness Material
0.00 4.00 0.75 SCH 40 PVC
in feet in feet in inches
17.SCREEN
From To Diameter Thickness Material
4.00 14.00 0.75 SCH 40 PVC
in feet in feet in inches
18.GROUT
From To Material Emplacment Method&Amount
3.00 0.00
in feet in feet
19. SAND/GRAVEL PACK(if applicable)
From To Material Emplacment Method
14.00 3.00 Sand In Place
in feet in feet
20. DRILLING LOG
From To Description(color, hardness,soil/rock type,grain size,etc.)
0.00 4.00 Dark Brown,Silty Sand
in feet in feet
4.00 5.00 Light Gray Clay
in feet in feet
5.00 6.50 Dark Brown,silty sand
in feet in feet
6.50 9.50 Gray, Fine Sand
in feet in feet
9.50 14.00 Gray&Brown Fine Sand
in feet in feet
21. Remarks
22.Site diagram or additional well details:
You may upload additional well construction information here.
pdf only
CERTIFICATION INFORMATION

* By signing this form, I hereby certify that the well(s)was(were)constructed in accordance with 15A NCAC 02C.0100 or
15A NCAC 02C.0200 Well Construction Standards and that a copy of this record has been provided to the well owner.
23.Certification r
Signature of Certified Well Contractor