NC0003433_Cape Fear AMEC PZ Records CHATH-076_20150902

December 7, 2015
Mr. Dade Smith
Program Manager
Duke Energy
526 South Church Street
Charlotte, North Carolina 28202
Submitted by email: [e-mail]
Subject: Record of Piezometer Installation
Cape Fear Steam Station 1963 Ash Pond
State Dam ID CHATH-076
Chatham County, North Carolina
AMEC Project No.: 7810-14-0154
Mr. Smith,
As part of the Reconstituted Design project for Cape Fear Steam Station (Cape Fear),
AMEC installed a total of four new piezometers in the existing 1953 Ash Pond (CHATH-
075), Details regarding the piezometer installation are attached including a location plan, a
summary table, field installation records, and well construction records, The
piezometers constructed in CHATH-076 were completed on December 18, 2014.
The piezometers were constructed in accordance with the requirements of '15A NCAC
Subchapter 2C — Well Construction Standards by a certified well driller licensed in the State of
North Carolina under the supervision of the Professional Engineer (PE) licensed in the state of
North Carolina whose seal is attached to this letter, Details of the piezometers installed are
attached and include field installation records reviewed by the Engineer of Record (EQR) and
well construction records prepared by the certified driller. The field installation records are
summarized in Table 1. The work was completed in accordance with approved work plans and
piezometer installations were completed with a standard of care commensurate with accepted
industry standards and in a manner that did not alter the existing function or stability of the darn
structure.
The piezometers were installed to provide data to be used during the Reconstituted Design but
are also intended for long term data collection by Duke Energy. AMEC will collect monthly
readings in the piezometers until March of 2015 at which time responsibility for obtaining the
readings will be transferred to Duke Energy personnel as a part of their plant specific
instrumentation monitoring program. Additional readings between the normal scheduled
frequency may be taken as deemed necessary to support data collection needs. Duke Energy
shall maintain a record of the readings as part of their dam monitoring program that will be
available to the Division of Energy, Mineral, and Land Resources upon request.
Correspondence.
Amnec Faster Wheeler Environment &ffirrtstiucazre. Inc,
2801 Ynrkmont Road, Suitc 100
Clzariotte, Aloilh C'aeolina 282tk8
Tel (704) 357-$500
Fax (704) 35{i 4638
Liecnsum NC Engineering F-1253 NC Geology C-`?47

Record of PiezometerInslaffa@m—CHATH-070
December 6,20/5
Page 2
Sinnemly,
AMEG Environment & Infrastructure, Inc.
�3,
R. Bradford Tripp, P.E.
EOR- Project Engineer
Cape Fear Steam 3tatior;
Piezonnekar Location P/an, Figure
Summary of Piaoomstonn Installed in 1956Aeh Pond, Table 1
Typical PiezorDeter'F|a|d Installation Record, CHATH-076-P1OD
Well Construction Rnmnnd' CHATH-078-P10O
Typical Piezonnetar-F|e|d Installation Record. CHATH-076-P1D1
Well Construction Record, CH/\TH'076-P101
Typical Piozometer-FieW|neta>laUon Record, CHATH-076'P102
VVeUConuhocbon Reourd, CHATH-076-P102
Typical Piezorneter- Field Installation Raoonj' CHATH-070-P103
Well Construction Record, CHATH-076'P1O3

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TYPICAL PIEZOMETER -FIELD INSTALLATION RECORD (FLUSH MOUNT)
JOB NAME Cape Fear Phase 2 Reconstitution of Ash Pond AMEC NUMBER 7810-14-0154
PIEZOMETER NO CHATH-076-P100 INSTALLATION DATE 12118/2014
LOCATIow NORTHING: 669,219.2' FASTING: 1,984,742.7' GROUND ELEV: 169.09'
AMEC FIELD REPRESENTATIVE B. Mabie DRILLER/ CONTRACTOR Mid -Atlantic Dril
GRANULAR BACKFILL MATERIAL GP #2 (Quartz Sand) DRILLING TECHNIQUE Hollow Stem Au
SCREEN MATERIAL 2" I.D. Flush Joint Slotted PVC (Sch. 40) BOREHOLE DIAMETER 8" Nominal
SLOT SIZE 0.020" Machine Cut REFERENCE POINT** ELEVATION"
RISER MATERIAL _ 2" I.D. Flush Joint Solid PVC (Soh, 40) LOCK TYPEIKEY CODE Dolphin 1600
' Preliminary -Final iocatfon/elevation to be determined by As -Built Survey NOTE: NOT TO SCALE, ALL DEPTHS RECORDED
•- Reference point is notch Gut in the tap of PVC casing ARE RELATIVE TO EXISTING GROUND SURFACE
WELL CAP AT TIME OF INSTALLATION
BOLTED FLUSH MOUNT COVER
(approx. 1' BELOW GRADE)
CONCRETE PAD
(2'X2'X6")
GROUND
GROUT
TOTAL DEPTH
OF PIEZOMETER
DEPTH TO TOP OF RISER
LENGTH OF RISER/
SOLID SECTION
- 35.0 FEET
BENTONITE SEAL
= 18.0 FEET
- 25.0 FEET
BENTONITE SEAL {Min. 3 feet}
DEPTH TOP OF
STABILIZED WATER
LEVEL AFTER
DEPTH TO TOP OF
SCREEN SECTION
DEVELOPMENT
GRANULAR MATERIAL
= 25.0 FEET
- N/A FEET
BELOW TOP OF
- 23.0 FEET
STICKUP
SCREEN
LENGTH OF SCREEN/
SLOTTED SECTION
MEASURED ON
- N/A DATE
GRANULAR BACKFILL
= 10.0 FEET
CENTERING DEVICES INSTALLED
(APPROXIMATE DEPTHS)
DEPTH BOTTOM OF
- N/A
SCREEN SECTION
= 35.0 FEET
:}
�%ASUMP/CAP
2
f"VNGTHOF SUMP & CAP
EAL
BOTTOM
OF PIEZOMETER.
amen
r •
� r
•e •
�Q. ira • �,�� , -
•D k1
Site Manager Review'+ A.rA�` Date: t 1-1
AMEC Well Installation Recora Rev 0

WELL CONSTRUCTION RE,COR )
Tllis farm can be used fur single or multiple wells
1. Well Contractor Information:
Witham J. Mable
Well CoatraetorNanlo
3137A
NC Wed? CCouttaetor Certification Number
AMEC
ConSpony Name
2, Well Construction Permit 11:
List all applicable weff perarlts f1e. Conno,. Stale, lrarlauce, Irl/oolfarl, elcj
3. Well Use (Check well use):
Water Supply Well:
❑Agricultural
00eothermal (Healing/Cooling Supply)
❑Industria IlConimerci a I
Non-Wnter Supply Well:
@Monitoring
[]Aquifer Recharge
©Aquifer Storage and Recovery
Cl Aquifcr Test
❑Experimental Technology
❑Geothermol (Closed Loopy
Meothertnal (Heating/Cooling Return)
❑14itmicipallPublic
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Recovery
130rouudwater Remediation
❑Salinity harrier
L IStonnwater Drainage
❑Subsidence Control
oTracer
❑Outer (explain under #21 1
4. Date Well(s) Completed; 12118/2014Well ID11 CHATH-076-P100
5a. Well Location. -
DUKE ENERGY - CAFE FEAR STEAM STATISM
raoilitylownerNome t� I Facility IDII (if applicable)
500 CP&L ROAD, MONCURE, NC 27559
Phyaicnt Address, City, nod Zip -
CHATHAM
Cowily Parcel Ideotificaticn No. (PIN)
5b. Lntitude and Longitude in tlegrce4ftnlnulcsfsccontls or decimal degrees:
(if well field, one ladlong is safficlent)
350 35' 19.60" N 79c 03' 04.75" �Y
6- Is (arc) the well(s). 1OPermnneni or 17Temporaty
7, Is this a repnir to an existing well. ❑Yes or ENO
DRY Is a repafr,Jlff oil known reel1 aaustrllcilorl lrrforn+uilon and erplalu the rinha•e of the
r vpair under #21 remarks seclton or oa the back oftFtls form.
8. Yumher of wells constructed: 1
For ouldliple livecilou or non-witler supply watts ONLY with the same cooslrherlou, you cau
sabodl arse form.
9. Total well depth below land surface: 35.0 (ft.)
For nudliple "tells 141 all depths lfdeer'uul (example- 3&J00'awl 3Q1(if1')
16, Static water level below top of easing; NIA (ft.)
�f•swaar level Is above casing, use "f "
1L Borehole dintuetev: 8 (in.)
I2.1{'cli const-ttetion nictlindt AUGER
(i.e. auger, ratory, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY;
l3aa, Yield (gpm) Method of test:
13b, Disinfection type: Amount:
For Internoi Use ONLY,
-i. %% k.r I- Ft 7CtVuti
ft.I
ft.
fL
it.
FROM
TO I DIAMH
0.0 ft.
25.0 rt. 2
11I6: INNlit• G AS fm -0 It-rttpl c tQ
FROYr Ti} f}tAh1ET"
ft,
�fnl—
;9"VTOMV`L�ft.
I+Imhr
TO
I DIAMETLn
25.0 ft.
35.0 ft,
2
Pt,I
ft.
I Ill.
�R.i:f afif�fir.SL[c'I
1TfICa{NFSti tw1,1'rf•:fiaAl
In SCH 40 PVC
ac'rrSina rin�2el•l�wt171 _ � '
"tYI]t-li Yk:Sti ,51A"I'I(lt1,41.
111,
lit. I
I
st,trrSIZE TnzcrcNms h1ATERLa1.
0.02 SCH 40 PVC
0.0 ft. 18.0 It, Cement
ft. ft.
ft, ft.
FRoht TO ntnTs:trly. -
23.0 ft' 35.0 [t' Quartz Sand
ft, ft.
ft, ft.
ft, ft•
ft. ft.
ft. ft,
ft. fL
ft,,
ft. fT.
BENTONITE SEAL FROM 18.0 TO 23.0 FEET
22, Certification;
Igo c of Certified W'el a ran Delo
By stgalog this form, I h y CO.16(y lllal the lvell(sj was (Nero) cortsh•ucled In accgtrlaace
with 15A 1VCAC 03C .0100 or 15A MCA 02C.0200 Pell Consirtletia# Sta+idtrrds clyd liral d
copy oflhfs record has been provided to the well oswier.
23, Site dingram or additional well details:
You cony use the back of this page to provide additional well site details of well
constructions details. You may also attach additional pages if necessary,
SUBMITTAL INSTUCI"IONS
24a. For All Wells: Submit this farm within 30 days of completion of woll
construction to the following;
Division of Witter Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b, For Inleglon Wells ONLY: In nddition to sending the farm to the address in
24aabove, also submit a copy of this form within 30 days of completion of well
construction to the fallowing:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Sueply & Injection Wells:
Also submit one copy of this form within 30 days of completion of
well consti nction to tho county health department of the county where
constructed.
Form GW-t North Carolina Department of fsnvirontnent and Nntarol Resotircus — Diyisiolt of Walor Itesoltrees Revised August 2013

TYPICAL PIEZOMETER -FIELD INSTALLATION RECORD (FLUSH MOUNT)
JOB NAME Cape Fear Phase 2 Reconstitution of Ash Pond AMEC NUMBER 7810-14-0154
PIEZOMETER NO CHATH-076-P101 INSTALLATION DATE 12/17/2014
LOCATION` NORTHING: 869,225.3' EASTiNG: 1,984,797.3' GROUND ELEV: 194,87'
AMEC FIELD REPRESENTATIVE K. Charles -Smith DRILLER/ CONTRACTOR SAEDACCO
GRANULAR BACKFILL MATERIAL GP #2 (Quartz Sand) DRILLING TECHNIQUE Hollow Stem
SCREEN MATERIAL 2" I.D. Flush Joint Slotted PVC (Sch. 40 BOREHOLE DIAMETER 8" Nominal
SLOT SIZE 0.020" Machine Cut REFERENCE POINT" ELEVATION"
RISER MATERIAL 2" I.D. Flush Joint Solid PVC Sch, 40 LOCK TYPEIKEY CODE Dolphin 1600
` Preliminary -Final locationtelevation to be determined by As -Built Survey
" Reference point is notch cut in the top of PVC casing
WELL CAP %
BOLTED FLUSH MOUNT COVER
(approx. 1' BELOW GRADE)
CONCRETE PAD
(2'X2'X6") -..
GROUT
DEPTH TO TOP OF RISER
BENTONITE SEAL
= GROUND SURFACE
BENTONITE SEAL (Min. 3 feet)
DEPTH TO TOP OF
GRANULAR MATERIAL
W 3.0 FEET
SCREEN
GRANULAR BACKFILL
CENTERING DEVICES INSTALLED
(APPROXIMATE DEPTHS)
N/A
�ajll?
NOTE: NOT TO SCALE, ALL DEPTHS RECORDED
ARE RELATIVE TO EXISTING GROUND SURFACE
AT TIME OF INSTALLATION
LENGTH OF RISER/
SOLID SECTION
5.0 FEET
DEPTH TOP OF
SCREEN SECTION
- 5.0 FEET
LENGTH OF SCREEN/
SLOTTED SECTION
10.0 FEET
DEPTH BOTTOM OF
SCREEN SECTION
15.0 FEET
;St A +
* �CZNGTH OF SUMP & CAP
SUMP/CAP A.
,�, • , ...�� , ,�,, ;' 0.2 FEET
GROUND
TOTAL DEPTH
OF PIEZOMETER
15.0 FEET
STABILIZED WATER
LEVEL AFTER
DEVELOPMENT
N/A FEET
BELOW TOP OF
STICKUP
MEASURED ON
N/A DATE
StAL BOTTOM OF PIEZOMETER
r - _
i-,,tp, Grr��E�,�'
m'
Site Manager Review °I Date:
AWo Well laslalfalmn Racara; Rev 0

WELL CONSTRUCTION RECORD
This form can be used for tingle or mulliple wells
l or IWemal Use ONLY:
1.1Well Contractor Information:
Randy D. Hoffman
Well Conuador Nantc
3476
NC Well Coniractor Certirwation Numhcr
SAEDACCO
company Namc
2. Well Construction Permit #:
List all alrplirohlr 11 e!/per rout {i.e, Cotat(V• Slone, Irariaace, ltjection, ere d
3. Well Use (check well use):
Witter supply Well;
U Agricultural
❑Greothermai (Heating/Cooling Supply)
❑ industrial/Commercial
❑ in i gat ion
Nan -Water Supply Well:
❑Municipalr'l"ublis
OResidential Water Supply (single)
[]Residential Water Supply (shared)
DRecovery
Injection Well:
❑Aquifer Recharge
ElGroundwater Remedintion
0AgItiFer,Slorage and Recovery
❑Salinity Barrier
UAquifer Test
❑Stormwwater Drainage
DExperimentai Technology
❑.Subsidence Control
[)Geothermal (Closed Loop)
O'fracer
DGeothermal (Healin /Cooling Return)
❑other (explain under 42t Remarks)
4. Date Well(s) Completed: 1' 2117f2014 Well
6a. well Location:
DUKE ENERGY - CAPE FEAR STEAM STATION
CHATH-076-Pl01
I .m I ity/Owner Name Facility IM (ifapplicable)
500 CP&L ROAD, MONCURE, NC 27559
i1bysical Address, City, and Gip
CHATHAM
cun,tty
Parcel Ideal icauou No. (PFY)
Sh. Latitude and Longitude in degreeslmilluteslsmonds or decimal degree
(ifwcll field, one Iailong isiti icient)
350 35' 19.66"' N 790 03' 04.49"
6. Is (are) the well(s): OPermanenl or ❑TemporaD
14. WA'I Elt IONFS
FROM TO
DFSL'RIPTIfIN
ft. ft.
it. rt.
15,0LTERC.ASMU fairaetulticased»ells)ORLINEtt (if !2
UrAble
FROM
"S'O
DIA31ET£R
THICKNESS
LMATERIAL
0.0 It
5.0 ft.
2 In.
SCH 40
PVC
16.]NNERCASLNGORIUBINGI eNhcrn"tttetawed-too #
FROM TO
nIAw1E1'FIt
rulCr.:NESS
PIATERIAL
ft. ft.
in.
ft. ft,
ln.
t7. s
ty
FRO]t
.110
DIAME1En
SLOTSI%E 71tt(:-hNF.SS
11ATX1UAL
5.0 fl'
15.0 ft.
2 in.
0.01 SCH 40
PVC
ft,
it.
In.
IS. GROUTH
FROM
TO
MATERIAL
EPLACENIENT METHOD & ASti]tIYT
ft.
it.
ft.
ft,
ft,
ft.
14.ltAl►[li .[ fL{'Vi't- 1"a(_ h iiri licable)
FROM TO MAI'ERIAI. 'E:IIPLACF.111ENr)-IL-Y110D -
3.0 ft'
15.0 ft.
Quartz Sand
ft.
fI.
20. DkILLING LOG (aa2cb addifipp[t"lfsecb tf aeeeawxry
FROAS
7'O
DESCRIPTION color, hardnest,>Wift ck type, rain sire, etc.}
ft.
R.
ft.
ft.
ft,
ft.
ft.
ft.
ft.
ft.
ft.
ft.
Ft.
ft.
2L REfYiUMS
BENTONITE SEAL FROM 0.0 TO 3.0 FEET
s' 22. Certification:
;7 4a -fait 12-17-2014
�W Signature ol'Cenified Well Contractor malt _
7. Is this a repair to an existing well: ❑Yes or E]No
If big is a repair, fill Writ known 1veli cnastr•acfiaa It!/ormaliaa (left/s•.rPhlin the el ollre af0m.
repair aexler #21 rrnrar eCr .rertialr or oo Nee h el- afthis forte.
&. Number of wells constructed: 1
Far nrrrlrilrle irrjccti,;wr r,r utv"-xtNc r,rr,p ph- n ells ONL F,ridt Ole sarrte ronserileteoer, tau call
subli it alle form.
9. Total well depth below land surface: 15.0
Far aurleliVe kv I& list d/ of rda II'diMr eat (,mirrtple- 3Cd 2f1R'rnrd 2Ca400'1
10. Static water level below top of casing: N/A
!J %weer lessl is show raving, Ilse "+
11. Borehole diameter: 8
12. Well construction method: AUGER
(i.e. auger, rotary, cattle, direct paste. ctc.i
(ft.)
1i1' signing Ak far`a1, T hereAv certiJr time the 11 '11e.4J wrcr (i"r:r•e) tolltrlwled i+r aerardarre-c
with 15.4 A'C.4C 02C.0100 or JSA A'C'AC e/2C ./12110 lull Carrsirtwtion Standurds and drat a
cops- of ih a recur d has he'eu provided In rite itvll o"r,wr.
23. Site diagram or additional well details:
You may use the back of this page to provide additional wvell site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this forth within 30 days of completion of well
constntctioll to the following:
Division of Water Resources, lnformation Processing Unit,
1617 Mall Service Center, Raleigh, NC 27699-161.7
24b. For Infection 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 completion of well
construction to the following:
Division Of Water Resources, Underground Injection Control program
FOR WATER SUPPLY WELLS ONLY: 1636 flail Service Center, Raleigh, NC 27699-1636
132. Yield (gptn) Method of test:
24c. For )Water Supply & injection Wells:
Also submit one copy of this fami within 30 days of completion of
13b. Disinfection type: Amount: well construction to the county health department of the county )where
constructed.
Fnrm GW- I Nonh Carolina Department nl' Environment and NaturOi Resources - Division aM'ater Resources Rovised August 2013

TYPICAL PIEZOMETER-FIELD INSTALLATION RECORD (FLUSH MOUNT)
JOB NAME Cape Fear Phase 2 Reconstitution of Ash Pond AMEC NUMBER 7810-14-0154
PIEZOMETER NO CHATH-076-P102 INSTALLATION DATE 12/18/2014
LOCATION- NORTHING: 668,705.0' FASTING: 1,984,823.8' GROUND ELEV: 195,26'
AMEC FIELD REPRESENTATIVE B. Mabie DRILLER/ CONTRACTOR Mid -Atlantic Dril
GRANULAR BACKFILL MATERIAL GP #2 (Quartz Sand) DRILLING TECHNIQUE Hollow Stem Au
SCREEN MATERIAL 2" I.D. Flush Joint Slotted PVC (Sch. 40) BOREHOLE DIAMETER 8" Nominal
SLOT SIZE 0.020" Machine Cut REFERENCE POINT" ELEVATION'
RISER MATERIAL 2" I.D. Flush Joint Solid PVC Sch, 40 LOCKTYPE/KEY CODE Dolphin 1600
Preliminary -Final locationlelevation to be determined by As -Built Survey
Reference point is notch cut in the top of PVC casing
WELL CAP ti
BOLTED FLUSH MOUNT COVER
(approx. 1' BELOW GRADE)
CONCRETE PAD
(2'X2'X6" )
DEPTH TO TOP OF
BENTONITE SEAL.
- 18.0 FEET
GROUT
NOTE: NOT TO SCALE, ALL DEPTHS RECORDED
ARE RELATIVE TO EXISTING GROUND SURFACE
AT TIME OF INSTALLATION
RISER LENGTH OF RISER/
SOLID SECTION
25.0 FEET
BENTONITE SEAL (Min. 3 feet)
DEPTH TO TOP OF
GRANULAR MATERIAL
= 23.0 FEET
SCREEN
GRANULAR BACKFILL
CENTERING DEVICES INSTALLED
(APPROXIMATE DEPTHS)
- NIA
SUMP/CAP'-
i
i
ame
= 039171
Site Manager Review
DEPTH TOP OF
SCREEN SECTION
25.0 FEET
LENGTH OF SCREEN/
SLOTTED SECTION
- 10.0 FEET
GROUND
TOTAL DEPTH
OF PIEZOMETER
35.0 FEET
STABILIZED WATER
LEVEL AFTER
DEVELOPMENT
N/A FEET
BELOW TOP OF
STICKUP
MEASURED ON
NIA DATE
DEPTH BOTTOM OF
SCREEN SECTION
35.0 FEET
►1,ENGTH OF SUMP & CAP
'�•Ai
BOTTOM OF PdEZOMETER
AMEC_WO insfallaWn Recard, Rev 0

WE, CONSTRUCTION RECORD
This farm call be used for single or nwiliple wells
1. Well Contractor Informartion,
William J. Mabie
Well Caulmolor Name,
3137A
NC Nell Contractor Certification Number
AMEC
Company Nome,
2. Well Cnnstrtic lioa Perm It ll:
IIst all oppllcable well permils (l e. Comply, State, lrar'lance, 111/eC1'ltlf), efc)
3. Well Use (c11eel( wedl rise):
Witter Supply Well:
❑Agricultural
❑ccotherrnal (Heating/Cooling Supply)
❑ 1n d ust rial/Comniercia I
even -Water supply Well:
Injection Well:
❑Aquifer Recharge
❑Aquifer Slorage and Recovery
❑Aquifer Test
OExperimcntai Technology
[]Geothermal (Closed Loop)
❑Geotherral (Healing/Cooling
❑ivlunicipaUPubilc
I7Residential Water Supply (single)
CIResidential Water Supply (shared)
❑Groundwater Remodiation
❑Salinity Barrier
OStormwater Drainage
13Subsidence Control
OTracer
❑Other (explain lender 921 F
4. Date Well(s) Completed: 12/1812014Well ID# CHATH-076-P102
Sa. Well Locrilion:
DUKE ENERGY - CAPE FEAR STEAM sTAT[oN
FaciiiwowuarName
r� Facility R)d (if applicable)
500 CP&L ROAD, MONCURE, NC 27559
Physical Address, City, and Zip
CHATHAM
County Parcel ldenlification No. (PtN)
fill. Latitude and Longitude in degreeslminuteslseconds or decimal degrees:
(if well field, one Ill/long is swriiciont)
350 35° 14.52" N 790 03" 03.76" �v
6. Is (nre) the well(s): OPerrunnent or []Temporary
7. Is this a repair to nn existing well; t]Ycs or RNo
lffhls is a repair, Jill atu knows well cansinrcllon lnforwutilon and esplah; the naeure of lire
repafr rardcr N21 r-sararks secefort or on lire back oflh is jor'ra.
S. Number- of wells constructed: 1
Formuldple ittlectloa or )ton-lvatersfrpply insets ONLY ivith the srrrne colfsrrfrelion, you call
Submit ogle faun.
9. Total well depth below land surface: 35 (ft.)
P'ar mulilple x'afls list all depths If diffvent (avanVle- 3@200' anef 2 r@1017)
10. Static water level below top creasing: NIA (n,)
If water level is elbove casing, rue " +"
II. Borehole diameter: 0 (in.)
12. Well construction methrld: AUGER
(Le. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONL Y:
1311, Yicid (gpm) Method of tcst:
13b. Disinfection type: Amount:
For internal Use ar,1I.Y:
ft. I ft.
ft. j ft.
0.0 ft. 25.0 rt. 2 In. SCH 40 PVC
lah%''AtE t3 C7 S t7A [Rt L'I0Si:¢I40 " 2 -.' , —_ _
FROM 7IllCIC�FS9 L11ATERIAL
ft. ff. in.
fl, fi. in.
lrR[],ll 'ru nfAi4ri:�IER 'eWI SILL TIUCt ES;s 6TA11MAL
25,0 ft 35.0 ft. 2 Sn. 0,02 SCH 40 PVC
ft. I ft. ia.
r I - --Affiiia
0.0 ft' 18,0 fr. Cement slurry
ft. ft,
rnpt4t To MATERIAL errtr>vics,'tl�n
T. ft 35.0 ft' Quartz Sand
ft, I ft.
SENTONITE SEAL FROM 18.0 TO 23.0 FEET
22. Cerlifientdon:
A J
Sig stare of Corti Red I on racior Date
9y signing thlsfoa7n, aafdlav cerlfy that life well(s) was (were) cn1
1
sa7rcled lit acearrirarca
W11h ISA NC.4C 02C.0100 or 13A NCAC 02C.0200 Well Cansimiclloll Sfandmrfs and thud a
copy odds record has be m provided to fire )veil oavfaer.
23, Site diagram or additional well details:
You may use the back of this page to provi(le additional well site details or well
consiruct"ton details. You may also attach additional pages ifnecessary.
SUBMITTAL rNSTUCTiONS
24n. For Ail 'Wells: Submit this form within 30 days of completion of well
construction to the fofiowing:
Division of Water Resources, Infortuntion Processing Unit,
1617 Mnli Service Center, Ralcigh, NC 27499-1617
24b. Tor fnieetion Wells ONLY: In addition to sending lire farm to the address in
24a above, also submit a copy of this form within 30 (lays of compleliara of well
construction to Site following:
Division of Water Resources, Underground Injection Control Progrnmt,
1636 Mail Service Center, Raleigh, NC 27599-1636
24c. For Water Supply & Injection Wells:
Also submit one copy of this form within 30 Stays of completion of
wail construction to the county health department of the county where
constructed.
Foau OV-1 North Carolina Deporf)uent of tinviroltmerit read Naluml Resources —Division of Waler Resources Reviser) August 2013

TYPICAL PIEZOMETER -FIELD INSTALLATION RECORD (FLUSH MOUNT)
JOB NAME Cape Fear Phase 2 Reconstitution of Ash Pond AMEC NUMBER 7810-14-0154
PIEZOMETER NO CHATH-076-P103 INSTALLATION DATE 1211712014
LOCATION* NORTHING. 668,699.0' EASTING: 1,984,763.2' GROUND ELEV: 167.07'
AMEC FIELD REPRESENTATIVE K. Charles -Smith DRILLER/ CONTRACTOR SAEDACCO
GRANULAR BACKFILL MATERIAL GP #2 {Quartz Sand) DRILLING TECHNIQUE Holln- Stem
SCREEN MATERIAL 211 J.D. Flush Joint Slotted PVC (Sch. 40) BOREHOLE DIAMETER 8" Nominal
SLOT SIZE 0.020" Machine Cut REFERENCE POINT** ELEVATION`
RISER MATERIAL 2" I.D. Flush Joint Solid PVC (Sch. 40) LOCK TYPEXEY CODE Dolphin 1600
Preliminary -Final locationtelevation to be determined by As -Built Surrey
Reference point is notch cut in the top of PVC casing
WELL CAP
BOLTED FLUSH MOUNT COVER
(approx. V BELOW GRADE)
CONCRETE PAD
(2'X2'X6")
GROUT
DEPTH TO TOP OF
BENTONiTE SEAL -
= GROUND SURFACE
BENTONITE SEAL (Min. 3 feet)
DEPTH TO TOP OF
GRANULAR MATERIAL
3.0 FEET
SCREEN
GRANULAR BACKFILLto
CENTERING DEVICES INSTALLED
(APPROXIMATE DEPTHS)
- NIA
s ii[�4'r
r
NOTE: NOT TO SCALE, ALL DEPTHS RECORDED
ARE RELATIVE TO EXISTING GROUND SURFACE
AT TIME OF INSTALLATION
LENGTH OF RISER/
SOLID SECTION
5.0 FEET
DEPTH TOP OF
SCREEN SECTION
5.0 FEET
LENGTH OF SCREEN/
SLOTTED SECTION
10.0 FEET
DEPTH BOTTOM OF
SCREEN SECTION
- 15.0 FEET
CA * !61,1GTH OF SUMP & CAP
�. 'E_y
rSsS .2 FEET
SUMP/CAP
;
GROUND
TOTAL DEPTH
OF PIEZOMETER
- 15.0 FEET
STABILIZED WATER
LEVEL AFTER
DEVELOPMENT
- NIA FEET
BELOW TOP OF
STICKUP
MEASURED ON
NIA DATE
SEAL BOTTOM OF PIEZOMETER
ameco
DAF(
Site Manager Review . Date:_,(
AMEC Warr InslaNalion Record, Rev 0

WELL CONSTRUCTION RECORD
This form can lie used for siuglc or nmhiple welt+
For Internal tlsc ONLY:
1. Well Contractor Information:
Randy D. Hoffman
Well Contractor haute
3476
NC Weil Contractor Ceni[ication Number
SAEDACCO
Company Name
2. Well Construction Permit #:
L/ri all applk•ahle hill pernshx (i:e_ C'ougv. State. Variance„ h jecliolr, elr.)
3. Well Use (check well use):
Water supply Well:
❑Agricultural
❑Geothermal (I-leating/Cooling Supply)
11Indust ria I/Com mere i al
❑N[unicipsl/Public
❑Residential Water Supply (single)
[]Residential Water Supply (shared)
Non -Water Supply Well:
O hfoniloring
(DRerovery
Injection Well:
❑Aquifer Recharge
[']Groundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
DAquifer Test
0Stonmvater Drainage
[]Experimental Technology
❑Subsidence Control
❑Geathernial (Clostsi loop)
❑,tracer
❑Geothermal (I-Icaling/Cool'tne Retum)
❑OLher (exnlain under #21 Remarks)
4. Date Well(s) Completed: 112/17/2014Well ID# CHATH-076-P103
5n. Well Location:
DUKE ENERGY- CAPE FEAR STEAM STATION
Facility/Owner Name Facility 1DP (ifapplicabte)
500 CP&L ROAD, MONCURE, NC 27559
Physical Address, City, and Zip
CHATHAM
County Parcel Ideulification No- (PIN)
51). Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field., one latiiong is sUdlicient)
353 35' 14.46" 79a 93' 44.49" w
6. Is (are) the well(s): 21'ern4inent or ElTemporary
7. is this a repair to an existing well: 01'es or 9No
Iftlus ia• a mpair, fill urrr known 4vell ernist rrrl&n+ ln(nr+r+arhns alyd explain the 1"oure of aiv
rrintir wakr V J remarks tertian or on the hark ajthls Jiar rrt-
8. Number of wells constructed: 1
For malliple injecitinr or as++-wtltrr slrlrplr wel/s ON/ Y with thr sairre construction, yam crux
Submit one aria_
9. Total well depth below land surf -Lee: 15.0
For multiple wells list all depths iffqffcjent Ieva+nple• 304200'aud-Mil 1901
10. Static water level below top of easing: NIA
if never Niel is ahuve rasing, toe "+'
11. Borehole diameter: 8
12.1Vell construction metbod: AUGER
I i.e. auger, rotary, cable, direct push, etc.)
(ft.)
I'll. %% ATER ZCLNES
FROM
TO DESCRIPTION
it.
ft.
ft..
ft.
I5� OUTER CAST %k; for to ald-cased wettsI OR LLSElt if ■
kratlte
�Rosi
ro
DIAMETER THICKNESS
MATERIAL
0.0 ft.
5.0 rt.
12 in. I SCIi 40
PVC
t6, 1 % N F R C4UNG OR TUBING t eatherwitt closed-loo i
FROM
10
DIAMETER I THICKNESS
MATERLkL
ft.
ft.
in.
_
ft.
ft.
in.
17. SCREEN
FROM
to I
ut,ksi E;tF.ttf
3i.orsirE
TIOCKNI:SS
.NLV TE.RIAI.
5.0 ft.
15.0 ft'
2 in.
0.01
SCH 40
PVC
n.
ft.
in.
IS. GROL7
FROM
To
MATERIAL
EMPLACEMENT METHOD &.r,MOVI T
ft.
ft.
ft.
ft,
ft.
ft.
19 SALN lC:RAVIL PACK fit'applHiczabiel
FR04t
TO
MATERIAL
BNIPLACEAIENr}IETliDO
3.0 ft.
15.0 rL
I Quartz Sand
fr.
I ft.
20. irft11A4T1G 1JX; (iinatb iddiluunal sheets If necessary-)
FROM
TO
OVSCRI.PTION eotur, hardness, wittrock tw e, grain ti- ete.I
ft.
It.
fL
ft.
ft.
n,
fI.
fi.
ft.
ft,
ft.
ft.
fr.
ft.
2I _ RE'1Lt,Rt�S _
BENTONITE SEAL FROM 0.0 TO 3.0 FEET
22. Certificrtian:
Randy qa#artaa 12-17-2014
Signature nrcerilied Well Contractor Dale
Br signing this farm, I het-6'v rerq that the arllYx) iiVs ,(Isere) rournvtered to foveor'rhnice
With 15.4 NCAC 02C -n1t10 ur 19.t r1VAC 01C .Q34f1 1 Nil C+nsfr'uellou Stauthrrtls and that n
copy ofthis reem-d has been provideel to the ur//Osman
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages ifnecessary,
SUBMITTAL INSTUCTIONS
24s. For All Wells: Submit this foray within 30 days or completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Al2il Service Center, Raleigh, NC 27199-1617
24b. For [n"ection iYelIs ONLY: In addition to sending the form to the address in
24a above, also submit a copy of this form Within 30 days of completion of well
cons"ction to [lie fallowing:
Division of Water Resources, Underground Injection Control Program,
FOR WA'['rR SUPPLY WELLS ONLY: 1636 iilail Service Center, Raleigh, NC 27699-1636
13a, field (glrltt) Method of test:
24c. For Water Supply & In'cerinn Wells:
Also submit one copy of this; form within 30 days of completion of
13b. Disinfection type: Amount: ~veil constntclion to the county health department of the county where
constructed.
Form OW-1 North Carolina Departmew of Environment and Natural Resources - Division of Water Resources Revised August 2013