GW1--04894_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 NES t
Austin Fowler FROM TO DESCRIPTION
Well Contractor Name ft. R
4366A ft. ft.,
NC Well Contractor Certification Number 15.INNER CASING OR TUBING(geothermal closed-loop)
I KuAl II DIAMI(II(R TI IlCKNIiSS MATERIAL
CATLIN Engineers and Scientists 0 rt. 10 ft. 2 in. Sch.40 PVC
Company Name Itt.OUTER CASING(for multi-cased wells)OR LINER(if applicable)
I itt1Al Ill,A011 II It II II(K N.!NN V AI!NI AI
2.Well Construction Permit#: N/A ft. ft
List all applicable well permits(i.e.County.State. I ariance,Injection,etc.) It. ft.ft. in.
3.Well Use(check well use): 17.SCREEN
Water Supply Well: IHuAI I() III VA IIIIIt N1O1'1/I 1111(.tiVINS NINIF.121AI
❑Agricultural ❑Municipal/Public 10 ft. 20 ft. 2 in. Slot 010 Sch. 40 PVC
❑Geothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) ft. ft. in.
0 Industrial/Commercial 0 Residential Water Supply(shared) 18.GROUT
I ItuNI TO ALV1l It'tI 1 V11 1(1 Nil NI All IllttII A. AAlin AI
0 Irrigation
ft. ft.
Non-Water Supply Well:
®Monitoring ❑Recovery 0 ft. 5 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 0 Salinity Barrier FROM a `EMPLACEMENT METHOD
❑Aquifer Test ❑StormwaterDrainage 5 ft. 20 ft. #2 Medium Sand Surface Pour
❑Experimental Technology SubsidenceControl ft. ft.
❑ -
20.DRILLING LOG(attach additional sheets if necessary)
0 Geothermal(Closed Loop) ❑Tracer I-ROM f TO DI SCRIP I ION(color.hardness.soil rock Lure.grain slue.etcI
0 Geothermal(Heating/Cooling Return) 0 Other(explain under#21 Remarks) a. ft.
4.Date Well(s)Completed: 07/30/24 Vs ell I D#: PZ-DI ft. ft. �G tO
Ift. ft. `
Sa.Well Location:
t. ft. pgpikA
Duke Enemy
Facility/Owner Name Facility ID#(if applicable) ft i 'll jG ? 8 2024
Duke Weatherspoon, Lumberton, NC 28358 It.
ft. It 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.(ertilication:
(if well field,one lat/long is sufficient)
34.592364 N -78.971181 w � 8/20/2024
Signature ofCetified Well Contractor Datc
6.Is(are)the well(s): Oa Permanent or ❑7 emporan 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: Oyes 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@i00) construction to the following:
10.Static water level below top of casing: 7.7 (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 Study&Injection 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 GW-1 North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised 2-22-2016

ENVIRONMENTAL,CIVILWELL I_OG CATLIN
GEOTECHNICAL
Wimirglon.Raleigh.Washington.
" 10n 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-DI
NORTHING: 3829710 EASTING: 686060 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: 7.7 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 L SOIL AND ROCK WELL
DEPTH 0.5ft 0.5ft 0.5ft 0.5ft (PPm) LAB. S G DEPTH DESCRIPTION DETAIL
0.0 Land Surface o.o
0.0 ,rIf (SC)-Tan,medium grained,well graded,Clayey SAND. 0.0
0
— M —
3.0 - 3.0 •
M (SC)-Gray,medium grained,well graded Clayey SAND. •
4.0— PAa.0 -- —
(SP)-Tan,medium grtained,well graded,SAND with
trace Clay - a • 5.0
N
- - v/
10.0
N — Sat. —
a -
a
-
a - -
i.
pU
- - oa
'oa
qW VCO
W
Y
O — —
rn
a
C,
C
20 0 „::_ 20.0 20.0 20.0
R BORING TERMINATED AT DEPTH 20.0 ft
c
z -
a - -
;�;i Bentonite Pellets `#2 Medium Sand