GW1--01682_Well Construction - GW1_20240315

WELL CONSTRUCTION RECORD For Internal Use ONLY: •
This form can be used for single or multiple wells
1.Well Contractor Information: .
14.WATER ZONES
T. Jason White FROM TO- • DESCRIPTION.
Well Contractor Name ft. ft.
3323A f1• rt
NC Well Contractor Certification Number 15.INNER CASING OR TUBING(geothermal closed-loop)
FROM TO DIAMETER THICKNESS MATERIAL.
CATLIN Engineers and Scientists 0 ft. 7 ft. 12 in. Sch.40 PVC
Company Name 16.OUTER CASING(for multi-cased wells)OR LINER(if applicable)
FROM TO . DIAMETER THICKNESS MATERIAL
2.Well Construction Permit#: N/A- it, rt in.
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: FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural 0 Municipal/Public 7 rt. 12 rt. 2 in. Slot.010 _ Sch.40 PVC
0 Geothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) ft. ft. I in.
0 Industrial/Commercial 0 Residential Water Supply(shared) 18.GROUT
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
0 Irrigation
Non-Water Supply Well: ft. ft.
®Monitoring ❑Recovery 0 ft. 5 ft. Bent.Pellets Surface Pour
Injection Well: ft. ft. , I .
❑Aquifer Recharge 0 Groundwater Remediation 19.SAND/GRAVEL PACK(if applicable)
0 Aquifer-Storage and Recovery 0 Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD!
❑Aquifer Test 0 Stomrwater Drainage 5 rt 12 rt. Torpedo Sand Surface Pour
ID Experimental Technology 0 Subsidence Control it tL
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20.DRILLING LOG(attach additional sheets if necessary)
❑Geothermal(Closed Loop) 0 Tracer FROM TO DESCRIPTION(color,hardness,soil/rock type,Brain size.etc.)
❑Geothermal(Heating/Cooling Return)' 0 Other(explain under#21 Remarks) ft. ft. . I
4.Date Well(s)Completed: 02/05/24 Well ID#: PZ-G9 ft ft øc)
ft. . ft.
Sa.Well Location: C�
rt ft.
Duke Energy rt .� -
Facility/Owner Name Facility ID#(if applicable) - v: e T� / :f▪ Sr i
ft. p
1199 Black Jack Church Rd.,Goldsboro,NC 27530 MAR r /B A
Physical Address,City,and Zip ft. ft • V 1
21.REMARKS
WAYNE Inicor,:r.;i.n,�•,.•_,.,-
County Parcel Identification No.(PIN) tiWrt_,•30c;• 'ro -'
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification:
(if well field,one lat/long is sufficient)
35.375 N -78.105 w .J
(�'=� 4; ` 1 3/8/2024
Signature of Certified Wcll.Corltractor' Date
6.Is(are)the well(s): ®Permanent or O Temporary By signing this form,I hereby certify that the well(s)war(were)constructed in accordance with
ISA NCAC 02C.0100 or ISA NCAC 02C:0200 Well Construction Standards and that a copy of
7.Is this a repair to an existing well: Cl 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.
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9.Total well depth below land surface:__ 12.0 (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: (ft.) Division of Water Resources,Information Processing Unit,
Ifwater level is above casing,use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
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11.Borehole diameter: 8.25 - (in.) 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
12.Well construction method: NSA 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 Supply&Injection Wells:
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 GW-1 North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised 2-22-2016
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BORING NUMBER: PROJECT NAME: HF Lee - IAB 3 Piezometer CONTRACT NUMBER:
PZ-G9 CLIENT: Duke Energy PROJECT LOCATION: Goldsboro, NC
START DATE/TIME:2/6/24 COMPLETION DATE/TIME: 2/6/24 • BLDG/SITE: HF Lee'
DRILLING CNTRCTR: Catlin DRILLER: Jason Williams LOCATION SKETCH I it
DRILLING METHOD: HSA BORING DIAMETER(in): 4-inches
EQUIPMENT: Mobile Drill B-57 - Unit 22111
DEPTH TO WATER(feet bgs): TOTAL DEPTH(feet bgs): 12.0
LOGGED BY: Holly Jones
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LITHOLOGIC DESCRIPTION m z REMARKS
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— Light brown/tan, clayey, fine-medium SC _
— grain SAND (SC), moist, trace organic _
— material
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— Brown/tan, clayey, fine-medium grain SC
— SAND (SC), wet •
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- Brown/tan, clayey, fine-medium grain SC
— SAND (SC), saturated
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— Boring terminated at 12.0 ft bgs @
- 0955.
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" I W10USAOlead BORING LOG DESIGNATION
57 Oleander Dr 1
Suite 110
Wilmington,NC Page of
28403
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