GW1--04896_Well Construction - GW1_20240828

WELL CONSTRUCTION RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information:
14.WATER ZONES AF IV
Austin Fowler IRO,, lu DESCRII'IION
Well Contractor Name ft. ft.
4366A ft. ft.
NC Well Contractor Certification Number 15.INNER CASING OR TUBING(geothermal dosed-loop)
I R(111 1(1 DI-1!.11 II It I)11(kVI tiff A1111RIAI
CATLIN Engineers and Scientists 0 ft. 10 ft. 2 Sch.40 PVC
Company Name 16.OUTER CASING(for multi-cased wells)OR LINER(if applicable)
IR(IAI I() III A'•11 II Ii 11IR KVI.> RI 111 RIA1
2.Well Construction Permit#: N/A
ft. ft.
List all applicable well permits(i.e.County,State, Variance,Injection,etc.)
-
ft. ft. in.
3.Well Use(check well use):
17.SCREEN
Water Supply Well: fRC111 lU DI AAII I-� .I I ii.1/1 1111(1.A1.. AI A1I RI El
❑Agricultural ❑Municipal/Public 10 rt. 20 ft. 2 Slot 010 Sch. 40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in.
❑Industrial/Commercial 0 Residential Water Supply(shared) Ig.GROUT
I RuV IO 1IA 1121A1 11Ill A(I.A11AI All 111(ID,1.55u1'V"I
0 irrigation
ft. ft.
Non-Water Supply Well:
®Monitoring ❑Recovery 1 ft. 8 ft. Bent.Chips Surface Pour
Injection Well: ft. ft.
0 Aquifer Recharge 0 Groundwater Remediation 19.SAND/GRAVEL PACK(if applicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier "\1 MA hLRIAL PI NE VI\ \II I(IU
❑AquiferTest ❑StormwaterDrainage 8 ft. 20 ft. #2 Medium Sand Surface Pour
rt. rt.
0 Experimental Technology 0 Subsidence Control
20.DRILLING LOG{attach additional sheets if necessary)
0 Geothermal(Closed Loop) ❑Tracer I ImV I(' oL/,cRII'I1Uy(color.hardness.soil.rock I.N.own size.el,❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) ft. ft.
4.Date Well(s)Completed: 07/30/24 Well ID#: PZ-D2 u n' sets:,
h. ft.
5a.Well Location: -
ft. ft. pgrikA
Duke Enerpv ft. P‘11
Facility/Owner Name Facility ID#(if applicable)
ft.
Duke Weatherspoon,Lumberton,NC 28358 -
ft. ft.7
Physical Address.City,and Zip
21.REMARKS
ROBESON
County Parcel Identification No.(PIN)
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification:
(if well field.one lat/long is sufficient) -
34.591243 N -78.970151 w 8/20/2024
Signature of Certified Well Contractor Date
6.Is(are)the well(s): ®Permanent or 0 Temporary By signing this form,1 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
7.Is this a repair to an existing well: D Yes or ®No this record has been provided to the well owner.
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. 23.Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
8.Number of wells constructed: 1 construction details. You may also attach additional pages if necessary.
For multiple injection or non-water supply wells ONLY with the same construction.you SUBMITTAL INSTRUCTIONS
can submit one form.
9.Total well depth below land surface: 20.0 (ft.) 24a.For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths in different(example-3@200'and 2@100) construction to the following:
10.Static water level below top of casing: 5.4 (ft.) Division of Water Resources,Information Processing Unit,
If water level is above casing,use"- 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 4.25 (in.) 24b.For Injection Wells ONLY: In addition to sending the form to the
address in 24a above,also submit a copy of this form within 30 days of
12.Well construction method: HSA completion of well 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 Smoak&Liectio.Weis:
Also submit one copy of this form within 30 days of completion of well
13b.Disinfection type: Amount: construction to the county health department of the county where constructed.
Adapted from Form G W-1 North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised 2-22-2016

ENVIRONMENTAL,CIVILWEI. I. I_OG CATLIN
GEOTECHNICAL
WInnoton.Rale/P.Wash,9ton,
cna`tes`on Engineers and Scientists
224079 SHEET 1 OF 1
PROJECT NO.: 224079 STATE: NC COUNTY: ROBESON LOCATION: Lumberton
PROJECT: Duke Weatherspoon 1979 PZ Install LOGGED BY: Carolyn Smillie WELL ID:
DRILLER: Austin Fowler PZ-D2
NORTHING: 3829588 EASTING: 686157 CREW: Logan Hamilton
SYSTEM: NCSP NAD 83 (m) DRILL MACHINE: CAT1303 CME-550 93%03/05/2024 T.O.C.ELEV.:
VERT.DATUM: NAVD88 (USft) ,METHOD: HSA 0 HOUR DTW: 5.4 TOTAL DEPTH: 20.0
START DATE: 7/30/24 END DATE: 7/30/24 24 HOUR DTW: NM WELL DEPTH: 20.0
BLOW COUNT OVA o a SOIL AND ROCK WELL
DEPTH 0.5ft 0.5ft 0.5ft 0.5ft (PPm) S G DEPTH DESCRIPTION DETAIL
3.9
0.0 Land Surface o.o
0.0 (ML)-ASH
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(MLS)-Black,Sandy SILT with Organics
I — of-:::
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VY — —
O _
N -
z 20.0 • 20.0 20.0 = 20.0
z BORING TERMINATED AT DEPTH 20.0 ft
c - -
cc
z - -
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a -
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Bentonite Pellets 0#2 Medium Sand