GW1--01685_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 ft ft
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. ! 2 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 ft ft. ! 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 ❑Municipal/Public 7 ft. 12 ft. 2' in. Slot.010 Sch.40 PVC
o 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
❑Irrigation I
Non-Water Supply Well: ft. ft.
®Monitoring ❑Recovery 0 ft. 5 ft Bent.Pellets Surface Pour
Injection Well: ft. _ it .
❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK(if applicable)
❑Aquifer Storage and Recovery 0 Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑StornrwaterDrainage 5 ft 12 ft. j Torpedo Sand Surface Pour
❑Experimental Technology 0 Subsidence Control ft ft.
20.DRILLING LOG(attach additional sheets if necessary)
❑Geothermal(Closed Loop) 0 Tracer FROM TO DESCRIPTION(color,hardness,sotVrock type,main size,etc.)
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) it. it.
4.Date Well(s)Completed: 02/05/24 Well ID#: PZ-C2 ft rt rt e�
5a.Well Location: �O
ft. ft G�
Duke Energy •
ft � P
Facility/Owner Name Facility ID#(if applicable) Pi‘
ft
1199 Black Jack Church Rd.,Goldsboro,NC 27530 ft. ft , e"°.,-,
jti j '
Physical Address,City,and Zip 1 h nn
WAYNE 21.REMAItKS l.�!,11 1 L 4UZ4
County Parcel Identification No.(PIN) Ift+Lrrr t' 1 Pt-^;y;h>? a I fA
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: D"Ct,'li'G, -
(if well field,one lat/long is sufficient) 22.Certification:
35.373 N. -78.109 w / rim y L'4Lctt 3/8/2024
Signature of Certified Well-Contractor Date
6.Is(are)the well(s): ®Permanent or 0 Temporary By signing this forml hereby certify;that the well(s)was(were)constructed in accordance with
1SA NCAC 02C.0100 or 1SA NCAC 02C.0200 Well Construction Standards and that a copy of
7.Is this a repair to an existing well: O Yes or ONo 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 I
can submit one form. SUBMITTAL INSTRUCTIONS
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
11.Borehole diameter: 8.25 (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,dired 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 front Form GW-1 North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised 2-22-2016

•
BORING NUMBER: PROJECT NAME: HF Lee - IAB 3 Piezometer CONTRACT NUMBER:
PZ-C2 CLIENT: Duke Energy PROJECT LOCATION: Goldsboro, NC
START DATE/TIME:2/5/24 COMPLETION DATE/TIME: 2/5/24 BLDG/SITE: HF Leel.
DRILLING CNTRCTR: Catlin DRILLER: Jason Williams LOCATION SKETCH I
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
J
w
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a LITHOLOGIC DESCRIPTION Q
0 REMARKS
m w
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0 U j 00 w
bi 2 w 0
0 D 0 z I a.
- Brown/tan, fine-medium grain SAND SP
— (SP), wet, trace organic material
- l
5 - Brown/tan/gray, fine-medium grain SP -
- SAND (SP), saturated
•
10
•
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— Boring terminated at 12.0 ft bgs @
- 1405
15 — —-I
20 —1
— - -I
25
I UVSP USAF&I57 BORING LOG DESIGNATION!
Sute10�lOnderDr 1 1
Wilmington,NC
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