GW1--01686_Well Construction - GW1_20240315

WELL CONSTRUCTION RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
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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. j 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#: NIA- ft. ft j in.
List all applicable well permits(i.e.County,State, Variance,Injection,etc.) I
ft ft in.
3.Well Use(check well use): 17.SCREEN
Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
CI Agricultural 0 Municipal/Public 7 ft. 12 ft. 2 j in. Slot.010 Sch.40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. . ft. ' ; in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
❑Irrigation ft. ft. '
Non-Water Supply Well:
®Monitoring ❑Recovery 0 rt. 5 ft. Bent.Pellets Surface Pour
Injection Well: ft. rt. '
o Aquifer Recharge 0 Groundwater Remediation 19.SAND/GRAVEL PACK(if applicable)
FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Storage and Recovery 0 Salinity Barrier
❑Aquifer Test ❑Stomtwater Drainage 5 ft 12 ft Torpedo Sand Surface Pour
ft ft.
❑Experimental Technology O Subsidence Control •
20.DRILLING LOG(attach additional sheets if necessary)
❑Geothermal(Closed Loop) 0 Tracer FROM To DESCRIPTION(color.hardness,soiUrock type,gain size,etc.)
❑Geothermal(Heating/Cooling Return) 0 Other(explain under#21 Remarks) ft. ft ,
4.Date Well(s)Completed: 02/05/24 Well ID#: PZ-G5 •
ft ft. , e�
ft. ft. �O
5a.Well Location: �N
ii p
ft ft
Duke Energy ft �j
Facility/Owner Name Facility RA(if applicable) P`I (...i.7,
ft
1199 Black Jack Church Rd.,Goldsboro,NC 27530 -ft ft. _-• -`t-r. if )-u
Physical Address,City,and Zip .
21.REMARKS MIA 11) I ` <U9M'
WAYNE . .
County Parcel Identification No.(PIN) . , IniiWMZ::z`n Pr•-, ,,n ,
5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: ve vim,
22.Certification:
(if well field,one lat/long is sufficient) 1.'
' !
35.375 N -78.107 W 'ma's- (4 iu,CA, 3/8/2024
Signature of Certified Well Codtfactor Date
6.Is(are)the well(s): I:I Permanent or 0 Temporary By signing this fonn,I hereby certifi Lthat 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 al So 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: 12.0 (ft.) 24a.For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths in d erent(example-3@200'and 2@100) construction to the following:
10.Static water level below top of casing: (B•) 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: 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: 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 Supply&'Infection 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.
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Adapted front 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: CONTRACT NUMBER:
HF Lee - IAB 3 Piezometer
PZ-G5 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
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
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LITHOLOGIC DESCRIPTION o REMARKS
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a o_
U > ? w
in CCw O
0 m I= o
— Brown/gray, clayey, fine-medium SC _ 1
— grain SAND (SC), moist, trace organic _
- material
-i
5
— Gray, fine-medium grain SAND (SP), SP— saturated, trace gravel
— I
10 Gray, fine-coarse grain SAND (SP) Sp— with gravel, saturated
- Boring terminated at 12.0 ft bgs @ _I
- 1515 _j
15 -
-
- I
20 -,
- I
25 —
" WSP USA E&I BORING LOG DESIGNATION
I 5710 Oleander Dr
Suite 110 Page of
Wilmington,NC
28403 I j
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