WQ0004209_Complete File - Historical_20200929

WATER QUALITY REGIONAL OPERATIONS STAFF REPORT
Date: May 11, 2018 County: Vance
To: WQROS, Central Office Permittee: ST Wooten Corp.
CO Reviewer: Michael Rogers Project Name: ST Wooten Henderson Asphalt Plant
Regional Reviewer: Eric Rice Application No.: WQ0004209
L GENERAL INFORMATION
1. This application is (check all that apply): ❑ New ® Renewal
❑ Minor Modification ❑ Major Modification
Surface Irrigation ❑ Reuse ❑ Recycle ❑ High Rate Infiltration ❑ Evaporation/Infiltration Lagoon
❑ Land Application of Residuals ❑ Attachment B included ❑ 503 regulated ❑ 503 exempt
❑ Distribution of Residuals ❑ Surface Disposal
® Groundwater Remediation ❑ Other Injection Wells (including in situ remediation)
Was a site visit conducted in order to prepare this report? ® Yes or ❑ No.
a. Date of site visit: May 2, 2018
b. Person contacted and contact information: James Washburn (ST Wooten)
c. Site visit conducted by: E. Rice
d. Inspection Report Attached: ❑ Yes or ® No.
IL EVALUATIONAND RECOMMENDATIONS
1. Provide any additional narrative regarding your review of the application: The groundwater remediation
system is non -operational and remains in an inactive condition. There is a comment in B1MS where inactive
status was initiated on February 9, 2012. The current permit does not designate any monitoring wells for
sampling. However, BIMS list the following monitoring wells: MW-1, MW-2, MW-3, MW-4, MW-5, MW-6,
MW-7, MW-8, MW-9, MW-10, MW-I 1, MW-12, MW-13, MW-14, MW-15. In the 1996 permit wells MW-1,
MW-4, MW-7, MW-I 1, MW-12, MW-13, MW-14, MW-15, RW-I and RW-2 are listed under groundwater
monitoring requirements.
For the site inspection, the system appeared to be sealed off consistent with the 2016 inspection. The shed for
the remediation system was locked. The recovery well and/or infiltration gallery shed access was open at the
time of inspection with a nonfunctioning lock. Documentation has been received at RRO that indicates a new
lock has been installed on the shed. Monitoring wells MW-4, MW-6, MW-7, MW-11, MW-12, MW-13, MW-
14, MW-15, MW-18 were inspected. MW-3 could not be located. MW-6 casing was damaged and could not be
capped or locked.
Please be aware that a result of the 2016 inspection and follow up information received was that monitoring
wells MW-1, MW-2 and MW-5 are no longer existing wells in service.
FORM: ST Wooten WQ0004209

1
WATER QUALITY REGIONAL OPERATIONS STAFF REPORT
RRO recommends that the listed monitoring wells in the BIMS database are removed given that they have not
been included in the previous permit. It is also recommended that the permit renewal is held until such time that
documentation is received that details the process to locate MW-3 and documentation that MW-6 has been
either repaired or properly abandoned.
Recommendation. ®Mold, pending reeeipt_o£additional. information. -Documentation o£efforts to
locate MW-3 (and if located, repair or abandon as necessary) and repair or abandonment of MW-6;
RRO will request permittee include CO in the requested document submittal. RRO recommends that the
permit is renewed once the information is received.
❑ Hold, pending review of draft permit by regional office; ❑ Issue upon receipt of needed additional
information; ❑ Issue; ❑ Deny. If deny, please state reasons:
3. Signature of report preparer(s): �.' IF 9L - -
Signature of WQROS supervisor:
Date: 5
FORM: ST Wooten WQ0004209

Rogers, Michael
From: Bolich, Rick
Sent: Friday, May 11, 2018 5:06 PM
To: Rogers, Michael
Cc: Rice, Eric
Subject: WQ0004209 ST Wooten staff report
Attachments: Scanned from 2nd Floor Xerox.pdf
Hi Michael;
The subject staff report is attached. Please let us know if you need anything else or have any questions.
Take Care!
rb

Rogers, Michael
From: Rice, Eric
Sent: Friday, August 31, 2018 3:55 PM
To: Rogers, Michael
Subject: St Wooten map
Attachments: 180831161431_0001.pdf
Michael
Keep in mind this map is probably from the early days of the project and so plume dimensions could vary quite a bit to
current time frame.
Eric Rice
Hydrogeologist
Water Quality Regional Operations
Department of Environmental Quality
919 791 4242 office
[e-mail]
3800 Barrett Drive
1628 Mail Service Center
Raleigh, NC 27699
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.

a

Rogers, Michael
From: Gerald Paul <[e-mail]>
Sent: Friday, August 31, 2018 4:17 PM
To: Rogers, Michael
Cc: [e-mail]; Bolich, Rick; Smith, Danny; Rice, Eric;
[e-mail]; Watts, Debra
Subject: RE: [External] RE: WQ0004209 Notice of Permit Expiration (NOE) - Permit Renewal
Michael,
The gallery appears to be located in an uncontaminated area. The remaining free product plume
(approximately 20' x 50� and only indication of remaining contamination, appears to be trapped in a rock
formation to the east of MW-13. This was previously delineated by AECOM in a 2011 report. Based upon the
last 4-5 annual sampling events, the only detections in our monitoring well network above the 2L Standards
were detected in MW-13 near this delineated free product plume. During the most recent sampling event we
collected a sample of MW-13 with a sheen of free product and only detected two constituents (benzene at 1.2
ug/L and naphthalene at 34 ug/L) above the 2L Standards. We are currently working on a plan to remove the
remaining free product and hopefully close the site.
I will give you a quick call to fill :in the additional details and answer any additional questions that you may
have.
Thanks,
Jerry
Jerry Paul
Senior Project Manager
Raleigh Office — Environmental Group Leader
F
S&ME
amw x;:ar ="
3201 Spring Forest Road
�wiwrs
Raleigh, NC 27616 map
0:919.872.2660
+rs
D: 919:954.6216
M: 919.801.6482
[e-mail]
www.smeinc.com
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From: Rogers, Michael [mailto:[e-mail]]
Sent: Friday, August 31, 2018 2:44 PM
To: Gerald Paul <[e-mail]>
Cc: [e-mail]; Bolich, Rick <[e-mail]>; Smith, Danny <[e-mail]>;
Rice, Eric <[e-mail]>; [e-mail]; Watts, Debra <[e-mail]>
Subject: RE: [External] RE: WQ0004209 Notice of Permit Expiration (NOE) - Permit Renewal

OK, thanks. Question: is the gallery located in a contaminated area or uncontaminated area? Where is the plume
generally located?
From: Gerald Paul [mailto:[e-mail]]
Sent: Friday, August 31, 2018 2:25 PM
To: Rogers, Michael <[e-mail]>
Cc: [e-mail]; Bolich, Rick <[e-mail]>; Smith, Danny <[e-mail]>;
Rice, Eric <[e-mail]>; [e-mail]; Watts, Debra <[e-mail]>
Subject: RE: [External] RE: WQ0004209 Notice of Permit Expiration (NOE) - Permit Renewal
Michael,
Please find the attached site map.
Let me know if you need anything additional from me.
Have a great holiday weekend.
Jerry
Jerry Paul
Senior Project Manager
Raleigh Office — Environmental
Group Leader
'
S&ME
AVWW
3201 Spring Forest Road
�r
Raleigh, NC 27616 map
Isom 1
O: 919.872.2660
D: 919.954.6216
SU;Lt FOR
v RsATILfTy
M:919.801.6482
[e-mail]
www.smeinc.com
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From: Gerald Paul
Sent: Thursday, August 30, 2018 6:06 PM
To: 'Rogers, Michael' <[e-mail]>
Cc: [e-mail]; Bolich, Rick <[e-mail]>; Smith, Danny <[e-mail]>;
Rice, Eric <[e-mail]>; [e-mail]; Watts, Debra <[e-mail]>
Subject: FW: [External] RE: WQ0004209 Notice of Permit Expiration (NOE) - Permit Renewal
Michael,
Absolutely. Would it be ok if I shoot this over to on Tuesday following the Labor Day Holiday? I will be in the
field tomorrow and off on Monday. I will see if I can coordinate with our drafting folks and will possibly send it
to you tomorrow.
Thanks,
2

Jerry
Jerry Paul
Senior Project Manager
Raleigh Office — Environmental
Group Leader
S&ME
ANNIV
3201 Spring Forest Road
air
Raleigh, NC 27616 map
r
0:919.872.2660
D: 919.954.6216
SUILf FOR
veRsarta trr
M:919.801.6482
[e-mail]
www.smeinc.com
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by reply and delete this electronic message and any attachments. Please consider the environment before printing this email.
From: Rogers, Michael[mailto:[e-mail]]
Sent: Thursday, August 30, 2018 4:52 PM
To: Gerald Paul <[e-mail]>
Cc: [e-mail]; Bolich, Rick <[e-mail]>; Smith, Danny <[e-mail]>;
Rice, Eric <[e-mail]>; [e-mail]; Watts, Debra <[e-mail]>
Subject: RE: [External] RE: WQ0004209 Notice of Permit Expiration (NOE) - Permit Renewal
Jerry -
We are on the verge of reissuing the above permit. Please provide an updated site map of the facility showing the
location of all wells and infiltration gallery.
Thanks
From: Rogers, Michael
Sent: Friday, August 10, 2018 3:51 PM
To: 'Gerald Paul' <[e-mail]>
Cc: [e-mail]; Bolich, Rick <[e-mail]>; Smith, Danny <[e-mail]>;
Rice, Eric <[e-mail]>; [e-mail]
Subject: RE: [External] RE: WQ0004209 Notice of Permit Expiration (NOE) - Permit Renewal
Thanks.
From: Gerald Paul [mailto:[e-mail]]
Sent: Wednesday, August 8, 2018 5:04 PM
To: Rogers, Michael <[e-mail]>
Cc: [e-mail]; Bolich, Rick <[e-mail]>; Smith, Danny <[e-mail]>;
Rice, Eric <[e-mail]>; [e-mail]
Subject: RE: [External] RE: WQ0004209 Notice of Permit Expiration (NOE) - Permit Renewal
Mr. Rogers,

Please find the attached letter report to document the abandonment of monitor MW-6. As I had mentioned in
my previous email, monitor well MW-3 was properly abandoned in 2011 following a similar inspection and
request. The attached report includes a copy of our 2011 report for your records to document the
abandonment of MW-3. This report should serve to address all of your concerns associated with the reissue of
NPDES Permit #WQ0004209. Please do not hesitate to call if you have any questions or are in need of
additional information.
Thanks,
Jerry
Jerry Paul
Senior Project Manager
Raleigh Office — Environmental Group Leader
"W S&ME
3201 Spring Forest Road
Raleigh, NC 27616 map
D: 919.954.6216
M: 919.801.6482
8 I t FOR [e-mail]
VIRSATILITY www.smeinc.com
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by reply and delete this electronic message and any attachments. Please consider the environment before printing this email.
From: Rogers, Michael[mailto:[e-mail]]
Sent: Thursday, May 31, 2018 5:50 PM
To: Gerald Paul <[e-mail]>
Cc: [e-mail]; Bolich, Rick <[e-mail]>; Smith, Danny <[e-mail]>;
Rice, Eric <[e-mail]>; [e-mail]; Tom Raymond <[e-mail]>
Subject: RE: [External] RE: WQ0004209 Notice of Permit Expiration (NOE) - Permit Renewal
Thanks.
From: Gerald Paul [mailto:[e-mail]]
Sent: Thursday, May 31, 2018 5:45 PM
To: Rogers, Michael <[e-mail]>
Cc: [e-mail]; Bolich, Rick <[e-mail]>; Smith, Danny <[e-mail]>;
Rice, Eric <[e-mail]>; hank.butts @stwcorp.com; Tom Raymond <[e-mail]>
Subject: [External] RE: WQ0004209 Notice of Permit Expiration (NOE) - Permit Renewal
Mr. Rogers,
Monitor well MW-3 was properly abandoned in 2011 following a similar inspection and request. On September
1, 2011, S&ME's drillers properly abandoned this well in accordance with 15A NCAC 2C .0113 rules. We were
unable to locate MW-6 at the time of the inspection and assumed that it had been abandoned or
destroyed. This was also mentioned in the report. I have attached a copy of the 2011 report and

correspondence letter for your records to document the abandonment of MW-3. S&ME will work with S.T.
Wooten to either repair the damaged well (MW-6) or properly abandon it. I will let you know as we have
completed the work to facilitate the reissue of the permit. Please do not hesitate to call if you have any
questions or are in need of additional information.
Thanks,
Jerry
Jerry Paul
Senior Project Manager
Raleigh Office — Environmental Group Leader
S&ME
3201 Spring Forest Road
Raleigh, NC 27616 map
ANNW
0:919.872.2660
D: 919.954.6216
M: 919.801.6482
[e-mail]
www.smeinc.com
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This electronic message is subject to the terms of use set forth at www.smeinc.com/email. If you received this message in error please advise the sender
by reply and delete this electronic message and any attachments. Please consider the environment before printing this email.
From: Rogers, Michael[mailto:[e-mail]]
Sent: Thursday, May 31, 2018 5:10 PM
To: [e-mail]; Gerald Paul <[e-mail]>; Tom Raymond <[e-mail]>
Cc: [e-mail]; Butch Lawter <[e-mail]>; Bolich, Rick <[e-mail]>; Smith,
Danny <[e-mail]>; Rice, Eric <[e-mail]>
Subject: RE: WQ0004209 Notice of Permit Expiration (NOE) - Permit Renewal
Greetings -
We are nearly there for renewing this permit. However, we have the following comments/requests:
• MW-3 could not be located during the site inspection. Please locate MW-3, and if located, repair or properly
abandon per 15A NCAC 2C .0113. If this monitoring well cannot be located, provide documentation/steps taken
to make good faith effort to locate. You also have the option to install a replacement well.
MW-6 was found to be damaged. Please have well repaired per requirements of 15A NCAC 2C .0108(a), or also
properly abandon or replace.
This is because these wells can be a possible conduit of surface water or other contamination into the aquifer if not
properly constructed and/or sealed off. After receipt of documentation (GW-1 well repair/construction records, GW-30
well abandonment records, photos, etc.), we will reissue permit. You can attach in reply to this email (also provide the
staff at the Raleigh Regional Office above).
If you have any questions, please advise. FYI- I will be on vacation starting Monday. If you have any questions during
the time I am off, please contact Eric Rice in regards to the above comment/requests.
Thank you for your cooperation.

From: Rogers, Michael
Sent: Tuesday, March 27, 2018 3:20 PM
To: [e-mail]
Cc: [e-mail]; Butch Lawter <[e-mail]>; Bolich, Rick <[e-mail]>; Smith,
Danny <[e-mail]>
Subject: WQ0004209 Notice of Permit Expiration (NOE)
Mr. Butts -
Please find attached a Notice of Expiration (NOE) for a groundwater remediation permit issued on February 16, 2012,
and expired on January 31, 2017. It also has annual fees of $1310.00 due April 7, 2018. Also attached are a permit
renewal application, and system closure requirements, if applicable.
If you have any questions, please advise.
Thank you for your cooperation.
Michael Rogers, P.G. (NC and FL)
UIC Program Manager- Hydrogeologist
Water Quality Regional Operations Section (WQROS) - Division of Water Resources
1636 Mail Service Center
Raleigh, NC 27699
919-807-6412

Path: Q:\PROJECTS\2017\4305-17-083\4305-17-083B\NPDES permit.mxd plotted by JVolker 08-31-2018
Lrx`s:�i
e
MW-12
MW-11
MW-15 RW-2
'- RW-1
MULDINU IANKN
NOTES:
* APPROXIMATE LOCATION BASED ON SUBSURFACE ASSESSMENT AND REMEDIAL ACTION PLAN (WESTINGHOUSE
ENVIRONMENTAL SERVICES - SEPT 1998).
GIS BASE LAYERS WERE OBTAINED FROM THE 2017 NCONEMAP.COM AERIAL ORTHOIMAGERY LAYER. THIS MAP IS 0 �,
FOR INFORMATIONAL PURPOSES ONLY. ALL FEATURE LOCATIONS DISPLAYED ARE APPROXIMATED. THEY ARE NOT
BASED ON CIVIL SURVEY INFORMATION, UNLESS STATED OTHERWISE.
SITE MAP
NPDES PERMIT # WQ0004209
' � S.T. WOOTEN ASPHALT PLANT
697 GREYSTONE ROAD
HENDERSON, VANCE COUNTY, NORTH CAROLINA
Zd-
Legend
9 MONITOR WELL
O RECOVERY WELL
® INTERCEPTOR TRENCH/INFILTRATION GALLERY
= SEPARATOR SYSTEM/HOLDING TANKS
SCALE: FIGURE NO.
1"=150'
DATE:
8-31-18
PROJECT NUMBER
4305-17-083B i

Rogers, Michael
From: Gerald Paul <[e-mail]>
Sent: Wednesday, August 8, 2018 5:04 PM
To: Rogers, Michael
Cc: [e-mail]; Bolich, Rick; Smith, Danny; Rice, Eric;
[e-mail]
Subject: RE: [External] RE: WQ0004209 Notice of Permit Expiration (NOE) - Permit Renewal
Attachments: S. T. Wooten Summary of Well Abandonment Report_8-8-2018.pdf
Mr. Rogers,
Please find the attached letter report to document the abandonment of monitor MW-6. As I had mentioned in
my previous email, monitor well MW-3 was properly abandoned in 2011 following a similar inspection and
request. The attached report includes a copy of our 2011 report for your records to document the
abandonment of MW-3. This report should serve to address all of your concerns associated with the reissue of
NPDES Permit #WQ0004209. Please do not hesitate to call if you have any questions or are in need of
additional information.
Thanks,
Jerry
Jerry Paul
Senior Project Manager
Raleigh Office — Environmental Group Leader
S&ME
3201 Spring Forest Road
Raleigh, NC 27616 map
h O: 919.872.2660
D: 919.954.6216
M: 919.801.6482
[e-mail]
www.smeinc.com
Linkedln I Twitter I Facebook
This electronic message is subject to the terms of use set forth at www.smeinc.com/email. If you received this message in error please advise the sender
by reply and delete this electronic message and any attachments. Please consider the environment before printing this email.
From: Rogers, Michael [mailto:[e-mail]]
Sent: Thursday, May 31, 2018 5:50 PM
To: Gerald Paul <[e-mail]>
Cc: [e-mail]; Bolich, Rick <[e-mail]>; Smith, Danny <[e-mail]>;
Rice, Eric <[e-mail]>; hank.butts @stwcorp.com; Tom Raymond <[e-mail]>
Subject: RE: [External] RE: WQ0004209 Notice of Permit Expiration (NOE) - Permit Renewal
Thanks.

From: Gerald Paul [mailto:[e-mail]]
Sent: Thursday, May 31, 2018 5:45 PM
To: Rogers, Michael <michael.ro>[e-mail]>
Cc: [e-mail]; Bolich, Rick <rick.bolich([e-mail]>; Smith, Danny <[e-mail]>;
Rice, Eric <[e-mail]>; [e-mail]; Tom Raymond <[e-mail]>
Subject: [External] RE: WQ0004209 Notice of Permit Expiration (NOE) - Permit Renewal
Mr. Rogers,
Monitor well MW-3 was properly abandoned in 2011 following a similar inspection and request. On September
1, 2011, S&ME's drillers properly abandoned this well in accordance with 15A NCAC 2C .0113 rules. We were
unable to locate MW-6 at the time of the inspection and assumed that it had been abandoned or
destroyed. This was also mentioned in the report. I have attached a copy of the 2011 report and
correspondence letter for your records to document the abandonment of MW-3. S&ME will work with S.T.
Wooten to either repair the damaged well (MW-6) or properly abandon it. I will let you know as we have
completed the work to facilitate the reissue of the permit. Please do not hesitate to call if you have any
questions or are in need of additional information.
Thanks,
Jerry
Jerry Paul
Senior Project Manager
Raleigh Office — Environmental Group Leader
S&ME
�• ' - -- 3201 Spring Forest Road
.� Raleigh, NC 27616 map
0: 919.872.2660
D: 919.954.6216
M: 919.801.6482
[e-mail]
www.smeinc.com
Linkedln I Twitter I Facebook
This electronic message is subject to the terms of use set forth at www.smeinc.com/email. If you received this message in error please advise the sender
by reply and delete this electronic message and any attachments. Please consider the environment before printing this email.
From: Rogers, Michael [mailto:[e-mail]
Sent: Thursday, May 31, 2018 5:10 PM
To: [e-mail]; Gerald Paul <[e-mail]>; Tom Raymond <[e-mail]>
Cc: iames.washburn([e-mail]; Butch Lawter <[e-mail]>; Bolich, Rick <[e-mail]>; Smith,
Danny <danny.smith ncdenr.eov>; Rice, Eric <[e-mail]>
Subject: RE: WQ0004209 Notice of Permit Expiration (NOE) - Permit Renewal
Greetings -
We are nearly there for renewing this permit. However, we have the following comments/requests:

MW-3 could not be located during the site inspection. Please locate MW-3, and if located, repair or properly
abandon per 15A NCAC 2C .0113. If this monitoring well cannot be located, provide documentation/steps taken
to make good faith effort to locate. You also have the option to install a replacement well.
• MW-6 was found to be damaged. Please have well repaired per requirements of 15A NCAC 2C .0108(a), or also
properly abandon or replace.
This is because these wells can be a possible conduit of surface water or other contamination into the aquifer if not
properly constructed and/or sealed off. After receipt of documentation (GW-1 well repair/construction records, GW-30
well abandonment records, photos, etc.), we will reissue permit. You can attach in reply to this email (also provide the
staff at the Raleigh Regional Office above).
If you have any questions, please advise. FYI- I will be on vacation starting Monday. If you have any questions during
the time I am off, please contact Eric Rice in regards to the above comment/requests.
Thank you for your cooperation.
From: Rogers, Michael
Sent: Tuesday, March 27, 2018 3:20 PM
To: [e-mail]
Cc: [e-mail]; Butch Lawter <[e-mail]>; Bolich, Rick <[e-mail]>; Smith,
Danny <[e-mail]>
Subject: WQ0004209 Notice of Permit Expiration (NOE)
Mr. Butts -
Please find attached a Notice of Expiration (NOE) for a groundwater remediation permit issued on February 16, 2012,
and expired on January 31, 2017. It also has annual fees of $1310.00 due April 7, 2018. Also attached are a permit
renewal application, and system closure requirements, if applicable.
If you have any questions, please advise.
Thank you for your cooperation.
Michael Rogers, P.G. (NC and FL)
UIC Program Manager- Hydrogeologist
Water Quality Regional Operations Section (WQROS) - Division of Water Resources
1636 Mail Service Center
Raleigh, NC 27699
919-807-6412

I I I
M
August 8, 2018
North Carolina Department of Environmental Quality
Division of Water Resources
Water Quality Regional Operations Section (WQROS)
1636 Mail Service Center
Raleigh, NC 27699-1628
Attention: Mr. Michael Rogers, P. G (NC and FL) via email: [e-mail]
UIC Program Manager - Hydrogeologist
Reference: Summary of Well Abandonment
S. T. Wooten Henderson Facility
679 Greystone Road
Henderson, Vance County, North Carolina
Permit No. WQ0004209
Incident No. 3412
S&ME Project No. 4305-17-083B
Dear Mr. Rogers:
S&ME, Inc. (S&ME) is submitting the following summary report to document the well abandonment that was
completed at the S. T. Wooten Asphalt Plant in Henderson, Vance County, North Carolina. These services were
performed in general accordance with S&ME proposal number 43-1800592, dated July 18, 2018 to S. T. Wooten.
BACKGROUND
On May, 2, 2018, Mr. Eric Rice with the North Carolina Department of Environmental Quality (NCDEQ), Water
Resources Water Quality Regional Operations Section conducted a compliance inspection of the inactive
groundwater remediation system at the Henderson facility (NPDES Permit #WQ0004209). During the inspection,
several issues were noted with regard to the groundwater monitoring well network and the remediation system.
Monitor well MW-6 was noted to have a damaged protective casing in need of repair or abandonment. Monitor
well MW-3 was noted as missing and could not be located. The inspection also indicated that infiltration gallery
shed was equipped with a non-functioning door lock. This summary report serves as a response to address these
concerns.
Remediation System Building Repairs
Following the inspection, Mr. James Washburn (S. T. Wooten) replaced the security lock and reported the repair to
NCDEQ. According to the May 11, 2018 Site Inspection Report (inspection conducted May 2, 2018),
documentation of the repair to the lock was submitted to the Raleigh Regional Office. A copy of the May 11, 2018
inspection report is included as Attachment I.
S&ME, Inc. 13201 Spring Forest Road I Raleigh, NC 27616 1 p 919.872.2660 1 www.smeinc.com

Summary of Well Abandonment
S. T. Wooten - Henderson Facility
Permit No. WQ0004209
Incident No. 3412
S&ME Project No. 4305-17-083B
Monitor Well Abandonments
As previously indicated in an email correspondence to NCDEQ on May 31, 2018, Monitor well MW-3 was properly
abandoned in 2011 following a similar inspection and request. On September 1, 2011, S&ME's drillers properly
abandoned this well in accordance with 15A NCAC 2C .0113 rules. We were unable to locate MW-6 at the time of
the inspection and assumed that it had been abandoned or destroyed. This was also mentioned in the report. A
copy of the 2011 Summary of Well Abandonment report is included as Attachment II.
On August 2, 2018, S&ME's North Carolina licensed well drillers mobilized to the site and abandoned monitor well
MW-6 in general accordance with North Carolina Administrative Code (NCAC) Title 15A Subchapter 2C Section
.0113 Abandonment of Wells.
The monitor well MW-6 total depth was measured to 49 feet below ground surface (ft. bgs.), plus stick-up
protective casing (1.6 feet). The total footage of the abandoned monitor well was 50.6 feet. Depth to water was
measured to an approximate depth of 26.71 feet below top of casing (ft. BTOC). After measuring the depth to
groundwater and the total depth, the monitor well was abandoned by pouring bentonite chips from the surface
and then hydrated with potable water. The steel protective casing and concrete pad were removed and riser pipe
was cut at approximately two ft. bgs. No additional site restoration was completed. The attached site map
indicates the approximate former monitor well Location (Figure 1). The completed original Well Abandonment
Records are submitted to North Carolina Department of Environmental Quality, Division of Water Resources, as
required by the Rule, as Attachment III. A photographic log of the well abandonment of monitor well MW-6 is
attached as Attachment IV.
CLOSURE
If you have any questions concerning the methods used or the well abandonment forms, please feel free to
contact Gerald Paul at 919-872-2660.
Sincerely,
S&ME, Inc.
Gerald Paul
Thomas Raymond, P.E.
Project Manager Senior Consultant
Cc: Mr. Eric Rice — NCDEQ, Water Quality Program Supervisor
Mr. Danny Smith — NCDEQ, Water Quality Program Supervisor
Mr. Rick Bolich — NCDEQ, Water Quality Program Supervisor
Mr. James Washburn — S. T. Wooten, Environmental Compliance Manager
Attachments: Figure 1— Site Map with Well Location
Attachment I — NCDEQ Site Inspection Report (May 11, 2018)
Attachment II — Summary of Monitor Well Abandonment and Well Repairs (September, 26, 2011)
Attachment III — Well Abandonment Record (NCDEQ Form GW-30)
Attachment IV — Photographic Log
August 8, 2018

Attachment I — NCDEQ Site Inspection Report (May 11, 2018)

WATER QUALITY REGIONAL OPERATIONS STAFF REPORT
Date: May 11, 2018
To: WQROS, Central Office
CO Reviewer: Michael Rogers
Regional Reviewer: Eric Rice
I. GENERAL INFORMATION
1. This application is (check all that apply)
County: Vance
Permittee: ST Wooten Corp.
P ten Henderson Asphalt Plant
Application No.: WQ0004209
❑ New ® Renewal
❑ Minor Modification ❑ Major Modification
Surface Irrigation ❑ Reuse ❑ Recycle ❑ High Rate Infiltration ❑ Evaporation/Infiltration Lagoon
❑ Land Application of Residuals ❑ Attachment B included ❑ 503 regulated ❑ 503 exempt
❑ Distribution of Residuals ❑ Surface Disposal
® Groundwater Remediation ❑ Other Injection Wells (including in situ remediation)
Was a site visit conducted in order to prepare this report? N Yes or LJ No.
a. Date of site visit: May 2, 2018
b. Person contacted and contact information: James Washburn (ST Wooten)
c. Site visit conducted by: E. Rice
d. Inspection Report Attached: ❑ Yes or ® No.
IL EVALUATIONAND RECOMMENDATIONS
1. Provide any additional narrative regarding your review of the application: The groundwater remediation
system is non -operational and remains in an inactive condition. There is a comment in BIMS where inactive
status was initiated on February 9, 2012. The current permit does not designate any monitoring wells for
sampling. However, BIMS list the following monitoring wells: MW-1, MW-2, MW-3, MW-4, MW-5, MW-6,
MW-7, MW-8, MW-9, MW-10, MW-11, MW-12, MW-13, MW-14, MW-15. In the 1996 permit wells MW-1,
MW-4, MW-7, MW-11, MW-12, MW-13, MW-14, MW-15, RW-1 and RW-2 are listed under groundwater
monitoring requirements.
For the site inspection, the system appeared to be sealed off consistent with the 2016 inspection. The shed for
the remediation system was locked. The recovery well and/or infiltration gallery shed access was open at the
time of inspection with a nonfunctioning lock. Documentation has been received at RRO that indicates a new
lock has been installed on the shed. Monitoring wells MW-4, MW-6, MW-7, MW-11, MW-12, MW-13, MW-
14, MW-15, MW-18 were inspected. MW-3 could not be located. MW-6 casing was damaged and could not be
capped or locked.
Please be aware that a result of the 2016 inspection and follow up information received was that monitoring
wells MW-1, MW-2 and MW-5 are no longer existing wells in service.
FORM: ST Wooten WQ0004209

WATER QUALITY REGIONAL OPERATIONS STAFF REPORT
RRO recommends that the listed monitoring wells in the RIMS database are removed given that they have not
been included in the previous permit. It is also recommended that the permit renewal is held until such time that
documentation is received that details the process to locate MW-3 and documentation that MW-6 has been
either repaired or properly abandoned.
2. Recommendation: ® Hold, pending receipt of additional information. Documentation of efforts to
locate MW-3 (and if located, repair or abandon as necessary) and repair or abandonment of MW-6;
RRO will request permittee include CO in the requested document submittal. RRO recommends that the
permit is renewed once the information is received.
❑ Hold, pending review of draft permit by regional office; ❑ Issue upon receipt of needed additional
information; ❑ Issue; ❑ Deny. If deny, please state reasons:
.'1 /) '
3. Signature of report preparer(s):
Signature of WQROS supervisor:
Date:
FORM: ST Wooten WQ0004209 2

Attachment II - Summary of Monitor Well Abandonment and Well
Repairs (September, 26, 2011)

September 26, 2011
North Carolina Department of Environment and Natural Resources
Division of Waste Management
Underground Storage Tank Section
1637 Mail Service Center
Raleigh, North Carolina 27699
Attention: Mr. Eric Rice email: Eric.Rice&ncdenr.gov
Reference: Summary of Monitor Well Abandonment and Well Repairs
697 Greystone Road
Henderson, Vance County, North Carolina
Permit No. WQ0004209
Incident No. 3412
S&ME Project Number 1054-10-116B
Dear Mr. Rice:
S&ME, Inc. (S&ME) is submitting the following summary report for the well
abandonments and repairs that were completed at the S.T. Wooten Asphalt Plant in
Henderson, Vance County, North Carolina. These services were performed in general
accordance with S&ME proposal number P143-11V, dated July 8, 2011 to S.T. Wooten.
BACKGROUND
On July 7, 2011, a representative of the North Carolina Department of Environment and
Natural Resources (NCDENR) Division of Water Quality (DWQ), Aquifer Protection
Section (APS) conducted an annual site inspection of the groundwater remediation
system at the Henderson facility. During the course of the inspection, several issues were
noted with regard to the groundwater monitoring well network and a group of temporary
monitor wells that were installed near the remediation system. On July 21, 2011,
NCDENR issued two separate letters to address the violations that were noted during the
inspection. The first letter was addressed to Mr. R.S. Lawter of S.T. Wooten and the
second letter was addressed directly to the driller (Regional Probing Systems) that
installed the 14 temporary monitor wells (EP-1 though EP-14) in 2008. The first letter
noted the deficiencies that were identified during the inspection with regard to the
existing monitor well network. The first letter also listed the required actions to be taken
to address the deficiencies that were noted with regard to the existing monitor well at the
site.
S&ME, INC. / 3201 Spring Forest Road / Raleigh, INC 27616 / p 919.872.2660 / f 919.876.3958 / www.smeinc.com

Summary of Monitor Well Abandonment/Repairs S&ME Project No. 1054-10-116B
S.T. Wooten Corp. - Greystone Road Asphalt Plant, Henderson, Vance County, NC September 26, 2011
The second letter, which was addressed directly to the driller (Mr. Larry Outten, who is
actually Mr. Larry Opper — Regional Probing Services) of the 14 temporary piezometers,
indicated that the temporary piezometers were not completed as permanent monitor wells
or removed as required following their 2008 installation. The second letter indicated that
if the piezometers were to remain at the site, the piezometers needed to be converted to
permanent groundwater monitor wells. Following the receipt of this letter, Mr. Opper
completed well construction records detailing the installation of the temporary monitor
wells. Copies of the Non -Residential Well Construction Records (NCDENR Form GW-
1 b) are included as an attachment.
Following the receipt of the letters, S. T. Wooten contracted S&ME to address the
violations that were noted during the inspection including the abandonment of the 14
temporary piezometers that were installed by Mr. Opper. This summary report serves as
a response to both letters and to report that the existing monitor well network has been
brought back into compliance with the well construction standards per Chapter 15A of
the North Carolina Administrative Code (15A NCAC) Subchapter 2C-Well Construction
Standards (2C Standards), Section .0108. A site map indicating the current monitor well
network has been included as Figure 1.
The following is a summary of violations that were indicated in the July 21, 2011 letter
that was addressed to Mr. Lawter of S.T. Wooten:
MW-1 Well could not be located. Well may have been destroyed during grading of area.
MW-2 Well could not be located.
MW-3 Well damaged (casing bent at an angle), no well cap present on well and no lock.
MW-4 No lock present, well cap not secure.
MW-5 No lock present.
MW-7 Well could not be located.
MW-11 Well could not be located.
MW-12 No lock present.
MW-13 No lock present.
MW-14 No lock present.
MW-18 Unclear if this well was located
The following is a summary of the required corrective actions that were indicated in the
July 21, 2011 letter that was addressed to Mr. Lawter:
Install locking well caps and/or locks as necessary.
Repair or abandon well MW-3.
Locate wells MW-1, MW-2, MW-7, MW-I I and MW-18. The wells must be
located and an assessment made in regards to compliance with the well
construction rules. If the wells are found to be out of compliance, the wells must
be repaired or properly abandoned.

Summary of Monitor Well Abandonment/Repairs S&ME Project No. 1054-10-116B
S.T. Wooten Corp. - Greystone Road Asphalt Plant, Henderson, Vance County, NC September 26, 2011
FIELD ACTIVITIES
Well Repairs
On September 1, 2011, S&ME personnel, including a North Carolina Licensed Well
Driller visited the site to make all necessary repairs to the wells and to properly abandon
the 14 temporary piezometers.
The following is a summary of the repairs that were completed on September 1, 2011:
MW-1 The well was not located and appears to have been destroyed by construction
activities.
MW-2 The well was not located and appears to have been destroyed by construction
activities.
MW-3 The damaged monitor well was properly abandoned (approximate total depth
of 25 linear feet) on September 1, 2011 by S&ME drillers. The well
abandonment record (NCDENR GW 30) has been submitted to NCDENR and
a copy has been included as an attachment to this summary letter.
MW-4 A new well tag was affixed to the monitor well and a new locking cap and
lock were attached to the two-inch monitor well.
MW-5 The well was not located and appears to have been destroyed by construction
activities.
MW-6 The well was not located and appears to have been destroyed by construction
activities.
MW-7 A new well tag was affixed to the monitor well and a new locking cap and
lock were attached to the two-inch monitor well.
MW-11 A new well tag was affixed to the monitor well and a new locking cap and
lock were attached to the two-inch monitor well.
MW-12 A new well tag was affixed to the monitor well and a new locking cap and
lock were attached to the two-inch monitor well.
MW-13 A new well tag was affixed to the monitor well and a new locking cap and
lock were attached to the two-inch monitor well.
MW-14 A new well tag was affixed to the monitor well and a new locking cap and
lock were attached to the two-inch monitor well.
MW-15 A new well tag was affixed to the monitor well and a new locking cap and
lock were attached to the two-inch monitor well.
MW-18 A new well tag was affixed to the monitor well and a new locking cap and
lock were attached to the two-inch monitor well.
RW-1 A new well tag was affixed to the monitor well and a new locking cap and
lock were attached to the two-inch monitor well.
RW-2 A new well tag was affixed to the monitor well and a new locking cap and
lock were attached to the two-inch monitor well.
Four additional monitor wells were installed on the S.T. Wooten property by others to
investigate groundwater at the site for a possible real estate transaction. The wells remain
at the site and are not part of the S.T. Wooten monitor well network. During the site
visit, S&ME tagged these wells for total well depth, affixed a well tag indicating the total

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SITE FEATURE MAP
ST VVOOTrN ASPHALT PLANT
HENDERSON. NORTH CAROLINA
*S&ME "w '—SEPT. 2D' 1
PlbliR IOS4-10-116B BTR
WVVWSMEINC.COM
B-1702

Summary of Monitor Well Abandonment/Repairs SBME Project No. 1054-10-116B
S.T. Wooten Corp. - Greystone Road Asphalt Plant, Henderson, Vance County, NC September 26. 2011
well depth and installed a new expandable locking cap and lock to each of the four wells.
If these wells serve no purpose to a previous prospective buyer, the wells should be
abandoned in accordance with 15A NCAC 2C .0113(d). The four wells are labeled as
unknown and are also indicated on the attached Figure 1.
Well Abandonments
As previously indicated, the second letter was addressed to Mr. Larry Otten to address 14
temporary piezometers (EP-1 through EP-14) that we located during the site inspection.
On September 1, 2011, S&ME personnel abandoned 14 temporary piezometers (EP-1
through EP-14) and one Type II monitor well (MW-3) in general accordance with the
standards specified in 15A NCAC 2C. In all, approximately 322 linear feet of wells were
properly abandoned (297 linear feet —14 temporary wells and 25 linear feet — MW-3). A
copy of the Non -Residential Monitor Well Construction Records and Well Abandonment
Records are included as attachments to his report.
The wells/temporary piezometers were first disinfected to 100 parts per million
(ppm) chlorine residuals within each well using quantities of a hypochlorite
containing approximately 70 percent available chlorine.
At each location a section of the riser pipe was removed from the well/temporary
piezometer and bentonite pellets were tremied inside of the remaining well pipe to the
ground surface. Each well was checked to confirm that settling did not occur within the
casing. The NCDENR-DWQ required well abandonment records are attached.
CLOSING
If you have any questions concerning the methods used or the well abandonment forms,
please feel free to contact us at [phone].
Sincerely,
S&ME, Inc.
Gerald Paul
Project Manager
Cc: R. S. (Butch) Lawter — S.T. Wooten
M/'Jm_"jP
Tom Raymond, P.E.
Senior Consultant
Attachments: Figure 1 — Site Map with Monitor WeWemporary Piezometer Locations
Photographic log of the well repairs/abandonments
Non -Residential Well Construction Records —NCDENR Form GW-lb
NCDENR Well Abandonment Records — NCDENR Form GW-30

Well Repairs and Abandonments S&ME Project No. 1054-10-116B
S&ME 697 GreystS.T. Wooten Asphalt Plant Taken by: Date Taken
one Road, Henderson, North Carolina
G.P. 9/1/201 t

MW-15 (example of typical repairs) affixed new well
tag to the wells and replace locking caps and locks.
Indicator of monitor well MW-6.
Well Repairs and Abandonments S&ME Project No. 1054-10-116B
S&ME S.T. Wooten, Asphalt Plant Taken by: Date Taken:
697 Greystone Road, Henderson, North Carolina G. P. 9/1/2011
11

mow` ,� �X +�;Nr��t;�✓1;�^
LII,.
,i `liVg C
NX
9 Monitor well MW-3 to be abandoned
(Damaged Protective Casing).
11 RW-2 (example of typical repairs) affixed new well
tag to the wells and replace locking caps and locks.
POW 1 4
Q Location of former monitor well MW-3 that was
abandoned by S&ME on September 1, 2011
(Facing Southeast).
Y.
12 RW-1 (example of typical repairs) affixed new well
tag to the wells and replace locking caps and locks.
Well Repairs and Abandonments S&ME Project No. 1054-10-116B
'!OS&ME S.T. Wooten, Asphalt Plant Taken by: Date Taken:
697 Greystone Road, Henderson, North Carolina G.P. 1 9/1/2011
I

Well Repairs and Abandonments S&ME Project No. 1054-10-116B
*S&ME S.T. Wooten, Asphalt Plant Taken by: Date Taken:
697 Greystone Road, Henderson, North Carolina
G.P. 1 9/1/2011

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3322-A
1. WELL CONTRACTOR:
Lawrence D. Opper
Well Contractor (Individual) Name
Regional Probing Services
Well Contractor Company Name
STREET ADDRESS PO BOX 1161
Wake Forest, NC 27588
City or Town State Zip Code
9( 19 )- 570-5588
Area code- Phone number
2, WELL INFORMATION:
SITE WELL ID #(if applicable) EP-1
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring �a Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation Other ❑ (list use)
DATE DRILLED 6/13/2008
TIME COMPLETED N/A AM ❑ PM ❑
3. WELL LOCATION:
CITY. Henderson COUNTY Vance
Northeast corner of US 1/Highway 158 27536
(Street Name, Numbers, Community, Subdidsion, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope ❑ Valley ❑x Flat ❑ Ridge ❑ Other
(check appropriate box)
LATITUDE 3 N36.36834 May be in degrees,
minutes, seconds or
LONGITUDE W78.35827 in a decimal format
Latitude longitude source: EGPS pTopographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. FACILITY -is the name of the lousiness where the well is located.
FACILITY ID #(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Rd
Henderson , NC
27536
City or Town State
Zip Code
CONTACT PERSON R.S. Lawter
MAILING ADDRESS P.O. Box 2408
Wilson, NC
27894
City or Town State
Zip Code
25� 2 )- 291-5165
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 26'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: NM FT.
(Use "+' if Above Top of Casing)
d. TOP OF CASING IS 1 5 FT. Above Land Surface'
`Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): N/A METHOD OF TEST
f. DISINFECTION: Type NA Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
6. CASING: Thickness/
From 0' Depth Ft. 1Diameter Sceiaht Mat�tial
From To Ft, ti�0 F�/C
From To Ft.
1. GROUT: Depth Material Method
From 0 To 3 Ft. cement pour
From 3' Tom —FL bentonite pour
From To FL .
8. SCREEN: Depth Di�meter Slot Size Material
From 6' To 26' Ft. 1 n. •010 in, PVC
From To Ft. in. in.
From To Ft. in. in.
9. SANDIGRAVEL PACK:
Depth Size Material
From 5' To 26' Ft. #2 Sand
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0-26' Formation Samples not collected.
26' Bedrock- drill refusal encountered
11. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C. WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD BEEN PROVIDED TO THE WELL OWNER.
FG�T—UFTIFIED WELL CONTRACTOR i&T—E
G �wrr►�e� LD. Qn
PRINTED NAME OF PERSON MNSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form GW-1b
1617 Mail Service Center — Raleigh, NC 27699-1617 phone No. [phone] ext 568. Rev. 7/05

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3322-A
1. WELL CONTRACTOR:
Lawrence D. Opper
Well Contractor (Individual) Name
Regional Probing Services
Well Contractor Company Name
STREET ADDRESS PO Box 1161
Wake Forest, NC 27588
City or Town State Zip Code
9( 19 )- 570-5588
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if appimble) EP-2
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring ® Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 6/13/2008
TIME COMPLETED N/A AM ❑ PM ❑
3. WELL LOCATION:
CITY. Henderson COUNTY Vance
Northeast comer of US 1/Highway 158 27536
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope ❑ Valley ® Flat ❑ Ridge ❑ Other
(check appropriate box)
LATITUDE 3 N36.36838 May be in degrees,
minutes, seconds or
LONGITUDE W78.35842 in a decimal format
I.atitude/longitude source: EiGPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID #(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Rd
Henderson , NC 27536
City or Town State Zip Code
CONTACT PERSON R.S. Lawler
MAILING ADDRESS P.O. Box 2408
Wilson, NC 27894
City or Town State Zip Code
25( 2 )- 291-5165
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 2T
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: NM FT
(Use "+° if Above Top of Casing)
d. TOP OF CASING IS 1.5
FT. Above Land Surface`
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): NSA
METHOD OF TEST
f. DISINFECTION: Type NA
Amount
g. WATER ZONES (depth):
From To
From To
From To
Fran To
From To
From To
6. CASING:
Thickness/
Depth
Diameter W Material
1"
From 0' To 7' Ft. PVC
From To Ft.
From To Ft
7. GROUT: Depth
Material Method
From 0 To 3 Ft,
cement pour
From 3' TDB —Ft.
bentonite pour
From . To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 7' To 27' Ft.
1 in. .010 in. PVC
Fran To Ft.
in. in.
Fran To Ft.
in. in.
9. SANDIGRAVEL PACK:
Depth Size Material
From 6' To 27' Ft. #2 Sand
From TC Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0-27' Formation Samples not collected.
27' Bedrodc- drill refusal encountered
11. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECOR ROVDED TO THE WELL OWNER.
iq III
GNATU CERTIFIED WELL CONTRACTOR DATE
J;14wit Ut D .
PRINTED NAME OF PERSONNSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form GW-1b
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext l568. Rev. 7105

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3322-A
1. WELL CONTRACTOR:
Lawrence D. Opper
Well Contractor (Individual) Name
Regional Probing Services
Well Contractor Company Name
STREET ADDRESS PO Box 1161
Wake Forest, NC 27588
City or Town State Zip Code
9( 19 )- 570-5588
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) EP-3
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(ff applicable)
WELL USE (Check Applicable Box) Monitoring xi Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 6/13/2008
TIME COMPLETED NSA AM ❑ PM ❑
3. WELL LOCATION:
CITY: Henderson COUNTY Vance
Northeast corner of US 1/Highway 158 27536
(Street Name, Numbers, Commum-ty, SubdiHsion, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
[]Slope ❑Valley ®Flat ❑Ridge ❑ Other
(check appropriate box). _
LATITUDE 3 N36.36840 Mav be in degrees,
— — minutes, seconds or
LONGITUDE W78.35813 in a decimal format
Latitude/longitude source: giGPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. FACILITY- is the name of the business where the well is Io ted.
FACILITY ID #(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Rd
Henderson , NC 27536
City or Town State Zip Code
CONTACT PERSON R.S. Lawler
MAILING ADDRESS P.O. Box 2408
Wilson, NC 27894
City or Town State Zip Code
( 252 )- 291-5165
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 21'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
C. WATER LEVEL Below Top of Casing: NM FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1.5 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance With 15A NCAC 2C .0118.
e. YIELD (gpm): NSA METHOD OF TEST
f. DISINFECTION: Type NA Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
6. CASING: Thickness/
Depth Diameter W * paterial
From 0' To 6' Ft. V SGGTT I VC:
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 0 To 3 Ft. cement pour
From 3' To -'Ft. bentonite pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 6' To 21' Ft. 1 in. .010 in, PVC
From To Ft. in. in.
From To Ft. in. in.
9. SANDIGRAVEL PACK:
Depth Size Material
From 5' To 21' FL #2 Sand
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0-21' Formation Samples not collected.
21' Bedrock- drill refusal encountered
11. REMARKS:
1 00 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD 8"1? N OVIOED TO THE WELL OWNER.
f
S11115NATUREVIICERTIFIED WELL CONTRACTOR DATE
LAW Q-e�ju D i'K- _
PRINTED NAME OF PERSOqCONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form GW-1b
1617 Mail Service Center— Raleigh . Rev. 7105
, NC 27699-1617 Phone No. [phone] ext 568

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3322-A
1. WELL CONTRACTOR:
Lawrence D. Opper
Weil Contractor (Individual) Name
Regional Probing Services
Well Contractor Company Name
STREET ADDRESS PO BOX 1161
Wake Forest, NC 27588
City or Town State Zip Code
9C 19 )- 570-5588
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicabie) EP-4
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring 91 Municipal/Pubfic ❑
Industriai/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 6/13/2008
TIME COMPLETED NIA AM ❑ PM ❑
3. WELL LOCATION:
CITY: Henderson COUNTY Vance
Northeast comer of US 1/Highway 158 27536
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope ❑ Valley ® Flat ❑ Ridge ❑ Other
(check appropriate box)
LATITUDE 3 _ N36.36W May be in degrees,
minutes, seconds or
LONGITUDE W78.35827 in a decimal format
Latitude/longitude source: giGPS ❑Topographic map
(location of welt must be shown on a USGS topo map and
attached to this form if not using GPS) -
4. FACILITY- is the name of the business where the well is located.
FACILITY ID /(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Rd
Henderson , NC 27536
City or Town State Zip Code
CONTACT PERSON R.S. Lawler
MAILING ADDRESS P.O. Box 2408
Wilson, NC 27894
City or Town State Zip Code
25( 2 )_ 291-5165
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 17'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: NM FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1.5 FT. Above Land Surface'
"Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): N/A METHOD OF TEST
f. DISINFECTION: Type NA Amount
g. WATER ZONES (depth):
From Ta From To
From To From To
From To From To
6. CASING: Thickness/
Depth Diameter Weight Malarial
From 0' To T Ft. 1" sc PVe
From To Ft.
From To Ft.
7, GROUT: Depth Material Method
From 0 To 4 Ft. cement pour
From 3' Tom— Ft. bentonite pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 7' To 17' Ft. 1 in. .010 in. PVC
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 6' To 1T Ft. #2 Sand
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0-17' Formation Samples not collected.
17' Bedrock- drill refusal encountered
11. REMARKS:
O HER CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
tN 2C,
IDW ELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECO D PROVIDED TOTHE WELL OWNER.
�U 1
SI NATUR Iric-1w F CERTIFIED WELL CONTRACTORwe, 1) -19fb�1�
PRINTEDNAME OF PERSON CNNSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form GW-1b
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Ron, 7108

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3322-A
1. WELL CONTRACTOR:
Lawrence D. Opper
Well Contractor (Individual) Name
Regional Probing Services
Well Contractor Company Name
STREET ADDRESS PO Box 1161
Wake Forest, NC 27588
City or Town State Zip Code
9( 19 )- 570-5588
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) EP-5
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring X1 Municipal/Pubtic
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 6113/2008
TIME COMPLETED N/A AM ❑ PM ❑
3. WELL LOCATION:
CITY: Henderson COUNTY Vance
Northeast comer of US 1i1-lighway 158 27536
(Street Name, Numbers, Community, Subdimsion, Lot No.. Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope ❑ Valley p Flat ❑ Ridge ❑ Other
(check appropriate box)
LATITUDE 3 _ N36.36827 May be in degrees,
minutes, seconds or
LONGITUDE W78.35821 in a decimal format
Latitudedongitude source: ®GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID #(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Rd
Henderson , NC
27536
City or Town State
Zip Code
CONTACT PERSON R.S. Lawter
MAILING ADDRESS P.O. Box 2408
Wilson, NC
27894 - -
City or Town State
Zip Code
( 252 )- 291-5165
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 20'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: NM FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1.5 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm). N/A METHOD OF TEST
f. DISINFECTION: Type NA Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
6. CASING: Thickness/
Depth Diameter WI
MatBral
From 0 To 5' Ft. 1" sC FVC:
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 0 To 3 Ft. cement pour
From 3' Tom Ft. bentonite pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 5' To 20' Ft. 1 in. .010 in. PVC
From To Ft. in. in.
From To— Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 4' To 20' Ft. #2 Sand
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0-20' Formation Samples not collected.
20' Bedrock- drill refusal encountered
11. REMARKS:
I DO HE ERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A N C 2C, ELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
N PROVIDED TO THE WELL OWNER.
- !a ll
SIGNATUJEiOF CERTIFIED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON COqSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Farm GW-tb
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. (919) 733-71116 ext 568. Rev. 7105

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3322-A
1. WELL CONTRACTOR:
Lawrence D. Opper
Well Contractor (Individual) Name
Regional Probing Services
Well Contractor Company Name
STREET ADDRESS PO Box 1161
Wake Forest, NC 27588
City or Town State Zip Code
91( 9 )- 570-5588
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID#(Ifapplicable) EP-6
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Boot) Monitoring KI Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 12/20/2007
TIME COMPLETED N/A AM ❑ PM ❑
3. WELL LOCATION:
CITY: Henderson COUNTY Vance
Northeast corner of US 1/Highway 158 27536
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
[]Slope ❑ Valley M Flat ❑ Ridge ❑ Other
(check appropriate box)
LATITUDE 3 N36.36836 May be in degrees,
minutes, seconds or
LONGITUDE W78.35848 in a decimal format
Latitude/longitude source: giGPS ❑ Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. FACILITY- is the name of the business where the well is located -
FACILITY ID #(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Rd
Henderson NC 27536
City or Town State Zip Code
CONTACT PERSON R.S. Lawter
MAILING ADDRESS P.O. Box 2408
Wilson, NC 27894
City or Town Stale Zip Code
25( 2 ).291-5165
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 20'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing.. NM FT.
(Use'+' if Above Top of Casing)
d. TOP OF CASING IS 1.5 FT. Above Land Surface*
`Top of casing terminated allor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): N/A METHOD OF TEST
f. DISINFECTION: Type NA Amount
g. WATER ZONES (depth):
Fran To From Tc
Fran To From To
From Tc From To
6. CASING: Thickness/
Depth Diameter Weight Material
From 0' To 5' Ft. 2- s PVC
From To Ft.
From To Ft.
7. GROAT: Depth Material Method
From 0 To 3 Ft. cement pour
From 3' Toff-- Ft. bentonite pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 5' To 20' Ft. 2 in. •010 in, PVC
From To Ft. in. in.
Fran To Ft. in. in.
9. SANDIGRAVEL PACK:
Depth Size Material
From 4' To 20' Ft. #2 Sand
From : To Ft
From - To Ft.
10. DRILLING LOG
From To Formation Description
0-20' Formation Samples not collected.
20' Bedrock- drill refusal encountered -
11. REMARKS:
I DO HERgDY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
15A N LL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
R ROVIDED TO THE WELL OWNER.
SIGNATURE F CERTIFIED WELL CONTRACTOR T DATE
L-k W L U Ncc L, l
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form GW-lb
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 588. Rev. 7/05

nA
NONRESIDENTIAL WE
North Carolina Department ofEnvironment and Nam
WELL CONTRACTOR CERTIFICATIO
1. WELL CONTRACTOR:
Lawrence D. Opper
Well Contractor (Individual) Name
Regional Probing Services
Well Contractor Company Name
STREETADDRESS PO Box 1161
Wake Forest, NC 27588
City or Town State Zip Code
9( 19 )- 570-5588
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(ifapplicable) EP-7
STATE WELL PERM IT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring ® Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑ 1
Irrigation❑ Other ❑ (list use)
DATE DRILLED 6/13/2008
TIME COMPLETED N/A AM ❑ PM ❑
3. WELL LOCATION:
CITY. Henderson COUNTY Vance
Northeast comer of US 1/Highway 158 27536
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope ❑ Valley Exl Flat ❑ Ridge ❑ Other
(check appropriate box)
LATITUDE j _ N36.36848 May be in degees,
minutes, seconds or
LONGITUDE W78.35833 in a decimal format
iatitudc/longitude source: oGPS CTopographie map
(location of well must be shown on a USGS topic, map and
attached to this form if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID #(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Rd
Henderson , NC 27536
City or Town State Zip Code
CONTACT PERSON R.S. Lawter
MAILING ADDRESS P.O. Box 2408
Wilson, NC 27894
City or Town State Zip Cade
( 252 )- 291-5165
Area code - Phone number
S. WELL DETAILS: -
a. TOTAL DEPTH: 21'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO i79
c. WATER LEVEL Below Top of Casing: NM FT.
(Use "+" if Above Top of Casing)
6.
i
From - 10 - Ft. '"'".'"" F.-
From 3' To-5 Ft. bentonite pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 6' To 21' Ft. 1 in. .010 in. PVC
From To Ft. in. in.
From To Ft. in. in.
9. SANDIGRAVEL PACK:
Depth Size Material
From 5' To 21' Ft. #2 Sand
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0-21, Formation Samples not collected.
21' Bedrock- dell refusal encountered
11. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NC6C,2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECO S N PROVIDED TO THE WELL OWNER.
SI ATURE FICERTIFIED WELL CONTRACTOR DATE
LA w a 1u w ib. cry '—
PRINTED NAME OF PERSON CO RUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, 1617 Mail Service CenterForm GW-tb
— Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev. 7105

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3322-A
1. WELL CONTRACTOR:
Lawrence D. Opper
Well Contractor (Individual) Name
Regional Probing Services
Well Contractor Company Name
STREET ADDRESS PO Box 1161
Wake Forest, NC 27588
City or Town State Zip Code
9( 19 } 570-5588
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) EP-8
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #('If applicable)
WELL USE (Check Applicable Box) Monitoring XT Municipal/Publlt ❑''
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 12/20/2007
TIME COMPLETED N/A AM ❑ PM ❑
3. WELL LOCATION:
CITY: Henderson COUNTY Vance
Northeast comer of US I/Highway 158 27536
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zp Code)
TOPOGRAPHIC / LAND SETTING
❑Slope ❑Valley pFlat ❑Ridge ❑ Other
(check appropriate box)
LATITUDE 3 _ N36.36842 May be in degrees,
minutes, seconds or
LONGITUDE W78.35827 in a decimal format
Latitude/longitude source: RiGPS pTopographic map
(location of welt must be shown on a USGS topo map and
attached to this tbrm i/ not using GPS)
4. FACILITY- is the name or the business where the wea is I«ated.
FACILITY ID #(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Rd
Henderson , NC
27536
City or Town State
Zip Code
CONTACT PERSON R.S. Lawler
MAILING ADDRESS P.O. Box 2408
Wilson, NC
27894
City or Town State
Zip Code
25L 2 ) 291-5165
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 20'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: NM FT.
(Use'+" if Above Top of Casing)
d. TOP OF CASING IS 1.5 FT. Above Land Surface`
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): N/A METHOD OF TEST
f. DISINFECTION: Type NA Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
6. CASING: Thickness/
Depth Diameter Wegrial
From 0' To 5 Ft. 2- Sc l:
From To Ft.
From To FL
7. GROUT: Depth Material Method
From 0 To 3 Ft. cement pour
From 3' —Tom—Ft bentonite pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 5' To 2V Ft. 2 in. -010 in. PVC
From To Ft. in. in.
From To Ft. in. in. -
9. SAND/GRAVEL PACK:
Depth Size Material
From 4' To 20' Ft. #2 Sand
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0-2V Formation Samples not collected.
20' Bedrock- drill refusal encountered
11. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED W ACCORDANCE WrH
15A NCAC 2 , ELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORDH EE �TO THE WELL OWNER.
SIGNATURE OF TIFIED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CO RUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form GW-1b
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev. 7105

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3322-A
1. WELL CONTRACTOR:
Lawrence D. Opper
Well Contractor (Individual) Name
Regional Probing Services
Well Contractor Company Name
STREET ADDRESS PO 13ox 1161
Wake Forest, NC 27588
City or Town State Zip Code
9t 19 )- 570-5588
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) EP-9
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring gl MunicipaUPubitc ❑ -
Industrial/Commercial ❑ Agricuttural ❑ Recovery p Injection El
Irrigation❑ Other ❑ (list use)
DATE DRILLED 6/13/2008
TIME COMPLETED N/A AM ❑ PM ❑
3. WELL LOCATION:
CITY: Henderson COUNTY Vance
Northeast comer of US 1/Highway 158 27536
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope ❑ Valley [4 Flat ❑ Ridge ❑ Other
(check appropriate box)
LATITUDE _ N36.38850 May be in degrees,
minutes, seconds or
LONGITUDE W78.35836 in a decimal format
Latitude/longitude source: RiGPS ❑Topographic map
(bcation of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID #(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Rd
Henderson , NC 27536
City or Town State Zip Code
CONTACT PERSON R.S. Lawler
MAILING ADDRESS P.O. Box 2408
Wilson, NC 27894
City or Town State Zip Code
25( 2 )- 291-5165
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 17'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: NM FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1.5 FT. Move Land Surface`
"Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): N/A METHOD OF TEST
f. DISINFECTION: Type NA Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
6. CASING: Thickness/
Depth Diameter Welaht Material
From 0' To 7' Ft.Ft.-"s FVt;
From To Ft.
From To Ft.
7., GROUT: Depth Material Method
From 0 To 3 Ft. Cement pour
from 3' Tom Ft. bentonite pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From T To 17' Ft. 1 in. •010 in, PVC
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 6' To 1T Ft, #2 Sand
From To Ft.
From-To-ft.
10. DRILLING LOG
From . To Formation Description
0-17' Formation Samples not collected.
17' Bedrock- drip refusal encountered
11. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC NELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RE A 1� OVIDED TO THE WELL OWNER. 14 f)
'%IGNATURET11 CERTIFIED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form GW-tb
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 668. Rev. 7/05

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3322-A
1. WELL CONTRACTOR:
Lawrence D. Opper
Well Contractor (Individual) Name
Regional Probing Services
Well Contractor Company Name
STREET ADDRESS PO Box 1161
Wake Forest, NC 27588
City or Town State Zip Code
9( 19 )- 570-5588
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID#(if applicable) EP-10
STATE WELL PERMIT#(ifapplicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring gi Municipal/Publlc ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation[] Other ❑ (list use)
DATE DRILLED 6/13/2008
TIME COMPLETED NSA AM ❑ PM ❑
3. WELL LOCATION:
CITY: Henderson COUNTY Vance
Northeast comer of US 1/Highway 158 27536
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:"-
❑ Slope D Valley © Flat ❑ Ridge ❑ Other
(check appropriate box)
LATITUDE 3 _ N36.36842 May be in degrees,
minutes, seconds or
LONGITUDE V 78.35823 in a decimal format
Latitude/longitude source: aiGPS ❑Topographic map
(location of we# must be shown on a USGS topo map and
attached to this form if not using GPS)
4, FACILITY- is the name of the business where the well Is located.
FACILITY ID #(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Gre ystone Rd
Henderson , NC 27536
City or Town State Zip Code
CONTACT PERSON R.S. Lawler
MAILING ADDRESS P.O. Box 2408
Wilson, NC 27894
City or Town State Zip Code
( 252 1- 291-5165
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 23'
b. DOES WELL REPLACE EXISTING WELL? YES Q NO g
e. WATER LEVEL Below Top of Casing: NM FT;
(Use'+° if Above Top of Casing)
d. TOP OF CASING IS 1.5 FT. Above Land Surface*
'Top of casing terminated atior below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): NSA METHOD OF TEST
f. DISINFECTION: Type NA Amount
g. WATER ZONES (depth):
From To From To
From To From Tc
From To From To
6. CASING: Thickness/
From 0' Depth
FL 14iameter eeiaht MVateal
SC
From To Ft. t1�U �
From To Ft.
7, GROUT: Depth Material Method
From 0 To 3 Ft, cement pour
From 3' To_— Ft. bentonite pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 8' To 23' Ft. 1 in. .010 in, PVC
From To Ft. in. in.
From Ta Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 7' To 23' Ft. #2 Sand
From To Ft
From To Ft.
10. DRILLING LOG
From To Formation Description
0-23' Formation Samples not collected.
23' Bedrock- drill refusal encountered
11. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECO S BE I OVIDED TO THE WELL OWNER.
--
S19NATURE q CERTIFIED WELL CONTRACTOR DATE
l;AvM�Nc� p,( 11-1,-
P NTED NAME OF PERSON CONtTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form GW-1b
1617 Mail Service Center— Raleigh, NC 27699-1617- -Phone No. [phone] ext 668. Rev. 7/05

',TA
r
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3322-A
1. WELL CONTRACTOR:
Lawrence D. Opper
Well Contractor (Individual) Name
Regional Probing Services
Well Contractor Company Name
STREET ADDRESS PO Box 1161
Wake Forest, NC 27588
City or Town State Zip Code
9t 19 )- 570-5588
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) EP-11
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring x] -Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 6/13/2008
TIME COMPLETED N/A AM ❑ PM
3. WELL LOCATION:
CITY: Henderson COUNTY Vance
Northeast corner of US 1/1-lighway 158 27536
(Street Name, Numbers, Community, SubdiHsion, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING: .
❑ Slope ❑ Valley O Flat ❑ Ridge ❑ Other
(check appropriate box)
LATITUDE 3 N36.36844 May be in degrees,
minutes, seconds or
LONGITUDE W78.35822 in a decimal format
Latitude/longitude source: EGPS [3 Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. FACILITY- is the name of the b"iness where the well Is located.
FACILITY ID #(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Rd
Henderson , NC 27536
City or Town State Zip Code
CONTACT PERSON R.S. Lawter
MAILING ADDRESS P.O. Box 2408
Wilson, NC 27894 -- -
City or Town State Zip Code
( 252 )- 291-5165
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 22'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 3
c, WATER LEVEL Below Top of Casing: NM FT.
(Use "+^ if Above Top of Casing)
d. TOP OF CASING IS 1.5 FT. Above Land Surface'
`Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): NSA METHOD OF TEST
f. DISINFECTION: Type NA Amount
g. WATER ZONES (depth):
From To— From To
From To From To
From To From To
6. CASING: Thickness/
Depth Diameter WW blat�ral
From 0' To 7- Ft. 1" s PVV
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 0 To 3 Ft. cement pour
From 3' To-g� Ft. bentonite pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 7' To 22' Ft. 1 in. .010 in, PVC
From To Ft. in, in.
From To Ft. in. in.
9. SANDIGRAVEL PACK:
Depth Size Material
From 6' To 22' Ft. #2 Sand
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0-22' Formation Samples not collected.
22' Bedrock- drill refusal encountered
11. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2 ELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
REC A VIDED TO THE WELL OWNER.
gligIIt
IGNATURE O ERTIFIED WELL CONTRACTOR DATE
L Aw 2 -bau ,L�Owl
PRINTED NAME OF PERSON CONS UCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form GW-1b
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev. 7/05

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3322-A
1. WELL CONTRACTOR:
Lawrence D. Opper
Well Contractor (Individual) Name
Regional Probing Services
Well Contractor Company Name
STREET ADDRESS PO Box 1161
Wake Forest, NC 27588
City or Town State Zip Code
9( 19 ).570-5588
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) EP-12
STATE WELL PERMIT#(ifapplieable)
DWQ or OTHER PERMIT #(If applicable)
WELL USE (Check Applicable Box) Monitoring @3' Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 6/13/2008
TIME COMPLETED N/A AM ❑ PM ❑
3. WELL LOCATION:
CITY: Henderson COUNTY Vance
Northeast comer of US 1/1-lighway 158 27536
(Street Name, Numbers, Community; Subdivision, La No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope ❑ Valley © Flat ❑ Ridge ❑ Other
(check appropriate box)'
LATITUDE 3 _ N36.36850 May be in degrees,
minutes, seconds or
LONGITUDE W78.35833 in a decimal format
Latitude longitude source: � GPS ❑Topographic map
()ocation of wep must be shown on a USGS fopo map and
attached to this form if not using GPS)
4. FACILITY- is the nme at the business where thawed is located -
FACILITY ID *(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Rd
Henderson , NC 27536
City or Town State Zip Code
CONTACT PERSON R.S. Lawler
MAILING ADDRESS P.O. Box 2408
Wilson, NC 27894
City or Town State Zip Code
252 )- 291-5165
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 20'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: NM FT
(Use'+° it Above Top of Casing)
d. TOP OF CASING IS 1.5 FT. Above Land Surface'
`Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): N/A METHOD OF TEST
f. DISINFECTION: Type NA Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To Fran To
6. CASING: Thickness/
Depth Diameter W PVC
From 0' To 9 7 s ry Ft.
From To FL
From To FL
7. GROUT: Depth Material Method
Fran 01. To 3 Ft, cement pour
Fran 3' To 4' Ft. bentonite pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 5' To 20' Ft 2 in. .010 in. PVC
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 4' To 20' Ft #2 Sand
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0-20' Formation Samples not collected.
20' Bedrock- drill refusal encountered
11. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RE R AM P VIDEDTOTHE WELL OWNER.
Iq
S NATURE 6f tERTIFIED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON C014STRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form GW-1b
1617 Mail Service Center —Raleigh, NC 27699-1617 Phone No. [phone] ext 668. Rev. 7/05

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3322-A
1. WELL CONTRACTOR:
Lawrence D. Opper
Well Contractor (Individual) Name
Regional Probing Services
Well Contractor Company Name
STREET ADDRESS PO Box 1161
Wake Forest, NC 27588
City or Town State Zip Code
9( 19 )- 570-5588
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) EP-14
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring X1 NNni 1pal/PObll
Industriai/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 6/13/2008
TIME COMPLETED N/A AM ❑ PM ❑
3. WELL LOCATION:
CITY: Henderson COUNTY Vance
Northeast comer of US 1/Highway 158 27536
(Street Name, Numbers, Community, -Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope ❑ Valley p Flat []Ridge ❑ Other
(check appropriate box)
LATITUDE 3 N36.36803 May be in degrees,
_ — minutes, seconds or
LONGITUDE W78.35842 in a decimal format
Latitude/longitude source: pGPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. FACILITY- Is the name of the business where the well is located.
FACILITY ID Jiff applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Rd
Henderson , NC 27536
City or Town State Zip Code
CONTACT PERSON R.S. Lawler
MAILING ADDRESS P.O. Box 2408
Wilson, NC 27894
City or Town State Zip Code
25� 2 _)- 291-5165
Area code - Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: 23'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO EN
c. WATER LEVEL Below Top of Casing: NM FT
(Use'+" if Above Top of Casing)
d. TOP OF CASING IS 1.5 FT. Above Land Surface`
"Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): NSA METHOD OF TEST
f. DISINFECTION: Type NA Amount
g. WATER ZONES (depth):
From To From To
From Tc From To
From To From To
6. CASING: Thickness/
Depth
From 0' To 8' Ft. 1Diameter sc Mat�nal
From To Ft. PVI;
From To Ft.
7. GROUT: Depth Material Method
From 0 To 3 Ft. cement pour
From 3' Tom Ft. bentonite pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 8' To 23' Ft. 1 in. •010 in. PVC
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 7' To 23' Ft. #2 Sand
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0-23' Formation Samples not collected.
23' Bedrock- drill refusal encountered
11. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCA ,WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RE
CO H BE PROVIDED TO THE WELL OWNER.
q
SI ATURE CERTIFIED WELL CONTRACTOR IDATE
PRINTED NAME OF PERSON CO TRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form GW-1b
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev. 7/05

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3322-A
1. WELL CONTRACTOR:
Lawrence D. Opper
Well Contractor (Individuap Name
Regional Probing Services
Well Contractor Company Name
STREET ADDRESS PO Box 1161
Wake Forest, NC 27588
City or Town State Zip Code
91( 9 )- 570-5588
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) EP-13
STATE WELL PERMIT#(it applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring 91 Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ❑ (fist use)
DATE DRILLED 6/13/2008
TIME COMPLETED N/A AM ❑ PM ❑
3. WELL LOCATION;
CITY: Henderson COUNTY -Van -
Northeast comer of US 11Highway 158 27536
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zep Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope ❑ Valley pp Flat ❑ Ridge ❑ Other
(check appropriate box)
LATITUDE 3 _ N36.36869 May be in degrees,
minutes, seconds or
LONGITUDE W78.35841 in a decimal format
LatitudeAongitude source: ®GPS ❑Topographic map
(location of we# must be shown on a USGS topo map and
attached to this form if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID #(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Rd
Henderson , NC 27536
City or Town State Zip Code
CONTACT PERSON R.S. Lawler
MAILING ADDRESS P.O. Box 2408
Wilson, NC 27894
City or Town State Zip Code
252 291-5165
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 20'
b. DOES WELL REPLACE EXISTING WELL?, YES El NO
c. WATER LEVEL Below Tap of Casing: NM FT.
(Use'+' if Above Top of Casing)
d. TOP OF CASING IS 1.5 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): NSA METHOD OF TEST
f. DISINFECTION: Type NA Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
S. CASING: Thickness/
From 0' Tot 5Deph.Ft. Der
s �Vuw l
From To Ft. PVC;
From To Ft
7. GROUT: Depth Material Method
From 0 To 3 Ft. cement pour
From 3 Tom— Ft. bentonite pour
From To Ft.
8. SCREEN; Depth Diameter Slot Size Material
From 5' To 20' Ft. 2 in. .010 in, PVC
From To Ft. in. in.
From To Ft. in. in.
9. SANDIGRAVEL PACK:
Depth Size Material
From 4' To 20' Ft. #2 Sand
From To Ft.
From, To FL
10. DRILLING LOG
From To Formation Description
0-20' Formation Samoles not collected.
20' Bedrock- Rill refusal encountered
11. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCA C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
R OS PROVIDED TO THE WELL OWNER.
&16NAT^�pCERTIFIED WELL CONTRACTOR DATE
L�jwll.aw c.cp. may,_
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of. Water Quality within 30 days. Attn: Information Mgt., Form GW-1b.
11617 Mail Service Center— Raleigh, NC 27649-1617 Phone No. [phone] ext 568. Rev..7/05

$rA
1 „
WELL ABANDONMENT RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2907
I. WELL CONTRACTOR:
Thomas Whitehead
Well Contractor (Individual) Name
S&ME, Inc.
Well Contractor Company Name
STREET ADDRESS 3201 Spring Forest Road
Raleigh NC 27616
City or Town State Zip Code
9( 19 ) . 872-2660
Area code - Phone number
2. WELL INFORMATION:
SITE WELL ID # (if applicable) MW-3
STATE WELL PERMIT # (if applicable)
COUNTY WELL PERMIT# (if applicable)
DWQ or OTHER PERMIT # (if applicable)
WELL USE (Check applicable use): A Monitoring ❑ Residential
❑ MunicipattPublic ❑ Industrial/Commereial ❑ Agricultural
❑ Recovery ❑ Injection ❑ Irrigation
❑ Other (list use)
3. WELL LOCATION:
COUNTY Vance QUADRANGLE NAME
NEARESTTOWN: Henderson
697 Greystone Rd, Henderson, NC
(Street/Road Name, Number, Community, Subdivision, Lot No., Parcel. Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope ❑ Valley ❑ Flat ❑ Ridge ❑
(Check appropriate setting)
36.36834 May be in degrees,
LATITUDE minutes, seconds, or in a
LONGITUDE 78.35827 decimal format
Latituddlongitudesource: OGPS ❑Topographictnap
(Location of tve/l must be shown on a USGS topo Wrap and
attached to rho form if not using GPS.)
49. FACILITY- The name ofthe business where the well is located. Complete 4a and4b.
(If a residential well, skip 4a; complete 4b, well owner information only.)
FACILITY ID #(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Rd
Henderson NC 27536
City or Town State Zip Code
4b. CONTACT PERSON/WELL OWNER:
NAME R. , Lawter
STREET ADDRESS PO BOX 2408, Wilson, NC 27894
S. WELL DETAILS:
a. Total Depth: 25 ft Diameter: 2 in.
b. Water Level (Below Measuring Point): 21 ft
Measuring point is ft. above land surface.
6. CASING: Length Diameter
a. Casing Depth (if known): ft. in.
b. Casing Removed: `i IL _ �� in.
7. DISINFECTION: 71%
(Amount of 65%75% calcium hypochlorite used)
S. SEALING MATERIAL:
Nest Cement Sand Cement
Cement lb. Cement lb.
Water. gal. Water gal.
Bentonite
Bentonite 90 lb.
Type: ❑Slurry ®Pellets
Water gal.
Other
Type material
Amount
9. EXPLAIN METHOD OF EMPLACEMENT OF MATERIAL:
Tremmie bentonite chips inside well pine
10. WELL DIAGRAM: Draw a detailed sketch of the well on the back of this
form showing total depth, depth and diameter of screens (if any) remaining
in the well, gravel interval, intervals ofcasing perforations, and depths and
types of fill materials used.
IL DATE WELL ABANDONED 9/1/11
1 DO HEREBY CERTIFY THAT THIS WELL WAS ABANDONED IN ACCORDANCE
WITH 15A NCAC 2C. WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF
THIS RECORD HAS BEEN PROVIDED E WELL OWNER.
L
41Z,r��
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
SIGNATURE OF PRIVATE WELL OWNER ABANDONING THE WELL DATE
(The private well owner must be an individual who pirsonally abandons his/her residential wen
in accordance with 15A NCAC 2C .0113.)
Thomas Whitehead
PRINTED NAME OF PERSON ABANDONING THE WELL
Submit a copy to the owner and the original to the Division of Water Quality within 30 days. Forth GW-30
Attn: Information Management, 1617 Mail Service Center — Raleigh, NC 27699-1617, Phone No. [phone] ext 56& Rev. 5/06

WELL ABANDONMENT RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2907
1. WELL CONTRACTOR:
Thomas Whitehead
Well Contractor (Individual) Name
S&ME, Inc.
Well Contractor Company Name
STREET ADDRESS 3201 Spring Forest Road
Raleigh NC 27616
City or Town State Zip Code
9( 19 ) - 872-2660
Area code - Phone number
2. WELL INFORMATION:
SITE WELL ID # (if applicable) EP-1
STATE WELL PERMIT # (if applicable)
COUNTY WELL PERMIT # (if applicable)
DWQ or OTHER PERMIT # (if applicable)
WELL USE (Check applicable use): ❑ Monitoring ❑ Residential
❑ Municipat/Public ❑ Industriat/Commercial ❑ Agricultural
❑ Recovery ❑ Injection ❑ Irrigation
❑ Other (list use) Temporary Monitor Well
3. WELL LOCATION:
COUNTY Vance QUADRANGLE NAME
NEAREST TOWN: Henderson
697 Greystone Road, Henderson, NC
(Street/Road Name, Number, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
O Slope ❑ Valley ❑ Flat ❑ Ridge ❑ Other
(Check appropriate setting)
LATITUDE N36.36834 May be in degrees,
— minutes, seconds, or in a
LONGITUDE W78.35827 decimal format
Latitude/longitude source: O GPS ❑ Topographic map
(Location of rvel/ must be shown on a USGS topo map and
attached to this form if not using GPS.)
4a. FACILITY- The name of the business where the wea is located. Complete 4a and4b.
(Ifa residential well, skip 4a; complete 4b, well owner information only.)
FACILITY ID #(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Road
Henderson NC 27536
City or Town State Zip Code
4b. CONTACT PERSON/WELL OWNER:
NAME R.S. Lawter
STREET ADDRESS PO BOX 2408, Wilson, NC 27894
S. WELL DETAILS:
a. Total Depth: 26 ft. Diameter: 1 in.
b. Water Level (Below Measuring Point): ft.
Measuring point is 1.5 ft. above land surface.
6. CASING: Length Diameter
a. Casing Depth (if known): ft. in.
b. Casing Removed: — ft. f in.
7. DISINFECTION: 71 %
(Amount of 65% 75% calcium hypochlorite used)
S. SEALING MATERIAL:
Neat Cement Sand Cement
Cement lb. Cement lb.
Water gal. Water gal.
Bentonite
Bentonite 37 lb.
Type:❑Slurry ®Pellets
Water gal.
her
Type material
Amount
9. EXPLAIN METHOD OF EMPLACEMENT OF MATERIAL:
Tremie bentonite chips inside the well pipe
10. WELL DIAGRAM: Draw a detailed sketch of the well on the back of this
form showing total depth, depth and diameter of screens (if any) remaining
in the well, gravel interval, intervals of casing perforations, and depths and
types of fill materials used.
11. DATE WELL ABANDONED 9/1/11
1 DO HEREBY CERTIFY THAT THIS WELL WAS ABANDONED IN ACCORDANCE
WITH 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF
THIS RECo t.2D HAS BEEN PROV � E WELL OWNER
/ 9/23/2011
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
SIGNATURE OF PRIVATE WELL OWNER ABANDONING THE WELL DATE
(The private well owner roust bean individual who personally abandons his/tier residential well
in accordance with 15A NCAC 2C .0113.)
Thomas Whitehead
PRINTED NAME OF PERSON ABANDONING THE WELL
Submit a copy to the owner and the original to the Division of Water Quality within 30 days. Form GW-30
Attn: Information Management, 1617 Mail Service Center — Raleigh, NC 27699-1617, Phone No. [phone] ezt 568. Rev. 5106

WELL ABANDONMENT RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #2907
1. WELL CONTRACTOR:
Thomas Whitehead
Well Contractor (Individual) Name
S&ME, Inc.
Well Contractor Company Name
STREET ADDRESS 3201 Spring Forest Road
Raleigh NC 27616
City or Town State Zip Code
9( 19 ) _ 872-2660
Area code - Phone number
2. WELL INFORMATION:
SITE WELL ID # (if applicable) EP-2
STATE WELL PERMIT # (if applicable)
COUNTY WELL PERMIT # (ifapplicable)
DWQ or OTHER PERMIT # (if applicable)
WELL USE (Check applicable use): ❑ Monitoring ❑ Residential
❑ Municipat/Public ❑ Industrial/Commercial ❑ Agricultural
❑ Recovery ❑ Injection ❑ Irrigation
❑ Other (list use) Temporary Monitor Well
3. WELL LOCATION:
COUNTY Vance QUADRANGLE NAME
NEARESTTOWN: Henderson
697 Greystone Road, Henderson, NC
(Street/Road Nam, Number, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
O Slope ❑ Valley ❑ Flat ❑ Ridge ❑ Other
(Check appropriate setting)
LATITUDE N36.36838 May be in degrees,
minutes, seconds, or in a
LONGITUDE W78.35842 decimal format
Latitude/longitude source: O GPS []Topographic map
(Location of rvell must be shown on a USGS topo map and
attached to this form if not using GPS.)
4a. FACILITY- The name of the business where the well is located. Complete 4a and4b.
(If a residential well, skip 4a; complete 4b, well owner information only.)
FACILITY ID #(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Road
Henderson NC 27536
Cityor Town State Zip Code
4b. CONTACT PERSONAVELL OWNER:
NAME R.S. Lawter
STREET ADDRESS PO BOX 2408, Wilson, NC 27894
6. WELL DETAILS:
a. Total Depth: 27 ft. Diameter: 1 in.
b. Water Level (Below Measuring Point): ft.
Measuring point is 1.5 ft. above land surface.
6. CASING: Length Diameter
a. Casing Depth (if known): ft. in.
b. Casing Removed:— ft. in.
7. DISINFECTION: 71 %
(Amount of 65s/o-75% calcium hypochlorite used)
8. SEALING MATERIAL:
Neat Cement Sand Cement
Cement lb. Cement lb.
Water gal. Water gal.
n onite
Bentonite 37 lb.
Type: ❑Slurry oPellets
Water gal.
Other
Type material
Amount
9. EXPLAIN METHOD OF EMPLACEMENT OF MATERIAL:
Tremie bentonite chips inside the well pine
10. WELL DIAGRAM: Draw a detailed sketch of the well on the back of this
form showing total depth, depth and diameter of screens (if any) remaining
in the well, gravel interval, intervals of casing perforations, and depths and
types of fill materials used.
11. DATE WELL ABANDONED 9/1/11
1 DO HEREBY CERTIFY THAT THIS WELL WAS ABANDONED IN ACCORDANCE
WITH I SA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF
THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
9/23/2011
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
SIGNATURE OF PRIVATE WELL OWNER ABANDONING THE WELL DATE
(The private well owner must be an individual who os[s nally abandons his/her residential well
in accordance with ISA NCAC 2C .0113.)
Thomas Whitehead
PRINTED NAME OF PERSON ABANDONING THE WELL
Submit a copy to the owner and the original to the Division of Water Quality within 30 days. Form GW-30
Ann: Information Management, 1617 Mail Service Center —Raleigh, NC 27699-1617, Phone No. [phone] tit 568. Rev. 5/06

«srnrr
'h, Waal•
1. WELL CONTRACTOR:
WELL ABANDONMENT RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #2907
Thomas Whitehead
Well Contractor (Individual) Name
S&ME, Inc.
Well Contractor Company Name
STREET ADDRESS 3201 Spring Forest Road
Raleigh NC 27616
City or Town State Zip Code
9( 19 1- 872-2660
Area code - Phone number
2. WELL INFORMATION:
SITE WELL ID # (if applicable) EP-3
STATE WELL PERMIT # (if applicable)
COUNTY WELL PERMIT # (if applicable)
DWQ or OTHER PERMIT # (if applicable)
WELL USE (Check applicable use): ❑ Monitoring ❑ Residential
❑ Municipal/Public ❑ industrialtCommercial ❑ Agricultural
❑ Recovery ❑ Injection ❑ Irrigation
❑ Other (list use) Temporary Monitor Well
3. WELL LOCATION:
COUNTY Vance QUADRANGLE NAME
NEAREST TOWN: Henderson
697 Greystone Road, Henderson, NC
(Street/Road Name, Number, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
0 Slope ❑ Valley ❑ Flat ❑ Ridge ❑ Other.
(Check appropriate setting)
LATITUDE N36.36840 May be in degrees,
minutes, seconds, or in a
LONGITUDE W`78.35813 decimal format
Latitudellongitude source: V) GPS ❑ Topographic map
(Location of well must be shown on a USGS topo map and
attached to this form if not using GPS.)
4a. FACILITY- The name ofthe business where the well is located. Complcte 4a and4b.
(If a residential well, skip 4a; complete 4b, well owner information only.)
FACILITY ID #(if applicable)
NAME OF FACILITY S. T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Road
Henderson NC 27536
City or Town State Zip Code
4b. CONTACT PERSONIWELL OWNER:
NAME R.S. Lawler
STREET ADDRESS PO BOX 2408, Wilson, NC 27894
6. WELL DETAILS:
a. Total Depth: 21 R. Diameter: 1 in.
b. Water Level (Below Measuring Point): R.
Measuring point is 1.5 ft above land surface.
6. CASING: Length Diameter
a. Casing Depth (if known): R. in.
b. Casing Removed:— R. in.
7. DISINFECTION: 71 %
(Amount of 65e/.75% calcium hypochlorite used)
8 SEALING MATERIAL:
Neat Cement Sand Cement
Cement lb. Cement lb.
Water gal. Water gal.
Bentonite
Bentonite 25 lb.
Type: [I Slurry ®Pellets
Water gal.
Other
Type material
Amount
9. EXPLAIN METHOD OF EMPLACEMENT OF MATERIAL:
Tremie bentonite chins inside the well pipe
10. WELL DIAGRAM: Draw a detailed sketch of the well on the back of this
form showing total depth, depth and diameter of screens (if any) remaining
in the well, gravel interval, intervals of casing perforations, and depths and
types of fill materials used.
11. DATE WELL ABANDONED 9/1/11
1 DO HEREBY CERTIFY THAT THIS WELL WAS ABANDONED IN ACCORDANCE
WITH 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF
THIS RECORD HAS BEEN PROVID D TO E WELL OWNER.
9/23/2011
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
SIGNATURE OF PRIVATE WELL OWNER ABANDONING THE WELL DATE
(The private well owner must be an individual who pwonafly abandons his/her residential well
in accordance with 15A NCAC 2C .0113.)
Thomas Whitehead
PRINTED NAME OF PERSON ABANDONING THE WELL
Submit a copy to the owner and the original to the Division of Water Quality within 30 days. Form GW-30
Attn: Information Management, 1617 Mail Service Center — Raleigh, NC 27699-1617, Phone No. [phone] ext 568. Rev. 5/06

WELL ABANDONMENT RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #2907
1. WELL CONTRACTOR:
Thomas Whitehead
Well Contractor (Individual) Name
S&ME, Inc.
Well Contractor Company Name
STREET ADDRESS 3201 Spring Forest Road
Raleigh NC 27616
City or Town State Zip Code
9( 19 ) - 872-2660
Area code - Phone number
2. WELL INFORMATION:
SITE WELL ID # (if applicable) EP-4
STATE WELL PERMIT # (if applicable)
COUNTY WELL PERMIT# (ifapplicable)
DWQ or OTHER PERMIT # (if applicable)
WELL USE (Check applicable use): ❑ Monitoring ❑ Residential
❑ Municipal/Public ❑ Industrial/Commercial ❑ Agricultural
❑ Recovery ❑ Injection ❑ Irrigation
❑ Other (list use) Temporary Monitor Well
3. WELL LOCATION:
COUNTY Vance QUADRANGLE NAME
NEAREST TOWN: Henderson
697 Greystone Road, Henderson, NC
(Street/Road Narne, Number, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
2]Slope ❑ Valley [:]Flat ❑ Ridge ❑ Other
(Check appropriate setting)
LATITUDE N36.36846 May be in degrees,
minutes, seconds, or in a
LONGITUDE W78.35827 decimal format
Latitude/longitude source: V]GPS []Topographic map
(Location ofrvel/ must be shown on a USGS topo map and
attached to this form if not using GPS.)
4a. FACILITY- The name of the business where the well is located. Complete 4a and4b.
(Ifa residential well, skip 4a; complete 4b, well owner information only.)
FACILITY ID #(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Road
Henderson NC 27536
City or Town State Zip Code
4b. CONTACT PERSON/WELL OWNER:
NAME R.S. Lawler
STREET ADDRESS PO BOX 2408, Wilson, NC 27894
5. WELL DETAILS:
a. Total Depth: 17 ft. Diameter: 1 in.
b. Water Level (Below Measuring Point): ft.
Measuring point is 1.5 ft. above land surface.
6. CASING: Length Diameter
a. Casing Depth (if known): ft. in.
b. Casing Removed: —'� ft. in.
7. DISINFECTION: 71%
(Amount of 65%75% calcium hypochlorite used)
8. SEALING MATERIAL:
Neat Cement Sand Cement
Cement lb. Cement lb.
Water gal. Water gal.
Bentonite
Bentonite 25 lb.
Type: ❑ Slurry ®Pellets
Water gal.
Other
Type material
Amount
9. EXPLAIN METHOD OF EMPLACEMENT OF MATERIAL:
Tremie bentonite chins inside the well Dine
10. WELL DIAGRAM: Draw a detailed sketch of the well on the back of this
form showing total depth, depth and diameter of screens (if any) remaining
in the well, gravel interval, intervals of casing perforations, and depths and
types of fill materials used.
11. DATE WELL ABANDONED 9/1/11
1 DO HEREBY CERTIFY THAT THIS WELL WAS ABANDONED IN ACCORDANCE
WITH 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF
THIS RECO HAS BEEN PROVIll TO E WELL OWNER.
9/23/2011
CNATURE OF CERTIFIED WELL CONTRACTOR DATE
SIGNATURE OF PRIVATE WELL OWNER ABANDONING THE WELL DATE
(The private well owner runt be an individual who 1mrsonally abandons his/her residential well
in accordance with 15A NCAC 2C .0113.)
Thomas Whitehead
PRINTED NAME OF PERSON ABANDONING THE WELL
Submit a copy to the owner and the original to the Division of Water Quality within 30 days. Form GW-30
Attn: Information Management, 1617 Mail Service Center — Raleigh, NC 27699-1617, Phone No. [phone] eit 568. Rev. 5/06

aa. SWro
WELL ABANDONMENT RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #2907
1. WELL CONTRACTOR:
Thomas Whitehead
Well Contractor (Individual) Name
S&ME, Inc.
Well Contractor Company Name
STREET ADDRESS 3201 Spring Forest Road
Raleigh NC 27616
City or Town State Zip Code
9( 19 ) . 872-2660
Area code - Phone number
2. WELL INFORMATION:
SITE WELL ID # (if applicable) EP-5
STATE WELL PERMIT # (if applicable)
COUNTY WELL PERMIT # (ifapplicable)
DWQ or OTHER PERMIT # (if applicable)
WELL USE (Check applicable use): ❑ Monitoring ❑ Residential
❑ Municipat/Public ❑ Industrial/Commercial ❑ Agricultural
❑ Recovery ❑ Injection ❑ Irrigation
❑ Other (list use) Temporary Monitor Well
3. WELL LOCATION:
COUNTY Vance QUADRANGLE NAME
NEAREST TOWN: Henderson
697 Greystone Road, Henderson, NC
(Street/Road Name, Number, Conununity, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
® Slope ❑ Valley ❑ Flat ❑ Ridge ❑ Other.
(Check appropriate setting)
LATITUDE N36.36827 May be in degrees,
minutes, seconds, or in a
LONGITUDE W78.35821 decimal format
Latitude/longitude source: 0 GPS ❑ Topographic map
(Location of well mast be shown on a USGS topo map and
attached to this form if not using GPS.)
4a. FACILITY- The name of the business where the well is located. Complete 4a and4b.
(If a residential well, skip 4a; complete 4b, well owner information only.)
FACILITY ID #(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Road
Henderson NC 27536
City or Town State Zip Code
4b. CONTACT PERSON/WELL OWNER:
NAME R.S. Lawler
STREET ADDRESS PO BOX 2408, Wilson, NC 27894
5. WELL DETAILS:
a. Total Depth: 20 ft. Diameter: 1 in
b. Water Level (Below Measuring Point): ft.
Measuring point is 1.5 ft. above land surface.
6. CASING: Length Diameter
a. Casing Depth (if known): ft. in.
b. Casing Removed: 3 ft. in.
7. DISINFECTION: 71 %u
(Amount of 65%75%calcium hypochlorite used)
8. SEALING MATERIAL:
Neat Cement Sand Cement
Cement lb. Cement lb.
Water gal. Water gal.
Bentonite
Bentonite 25 lb.
Type: ❑ Slurry WIPellets
Water gal.
Other
Type material
Amount
9. EXPLAIN METHOD OF EMPLACEMENT OF MATERIAL:
Tremie bentonite chips inside the well pipe
10. WELL DIAGRAM: Draw a detailed sketch of the well on the back of this
form showing total depth, depth and diameter of screens (if any) remaining
in the well, gravel interval, intervals of casing perforations, and depths and
types of fill materials used.
11. DATE WELL ABANDONED 9/1/11
1 DO HEREBY CERTIFY THAT THIS WELL WAS ABANDONED IN ACCORDANCE
WITH 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF
THIS RECORD HAS BEEN PROVIDED O THE WELL OWNER.
`✓9/23/2011
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
SIGNATURE OF PRIVATE WELL OWNER ABANDONING THE WELL DATE
(the private well owner moist be an individual who personally abandons his/her residential well
in accordance with 15A NCAC 2C .01 13.)
Thomas Whitehead
PRINTED NAME OF PERSON ABANDONING THE WELL
Submit a copy to the owner and the original to the Division of Water Quality within 30 days. Form GW-30
Attn: Information Management, 1617 Mail Service Center — Raleigh, NC 27699-1617, Phone No. [phone] eat 568. Rev. 5106

WELL ABANDONME]
North Carolina Department of Environment and Natural R
WELL CONTRACTOR CERTIFICATION #',
1. WELL CONTRACTOR:
Thomas Whitehead
Well Contractor (Individual) Name
S&ME, Inc.
Well Contractor Company Name
STREET ADDRESS 3201 Spring Forest Road
Raleigh _ _ NC 27616
City or Town State Zip Code
9( 19 ) - 872-2660
Area code - Phone number
2. WELL INFORMATION:
SITE WELL ID # (if applicable) EP-6
STATE WELL PERMIT # (if applicable)
COUNTY WELL PERMIT # (if applicable)
DWQ or OTHER PERMIT # (if applicable)
WELL USE (Check applicable use): ❑ Monitoring ❑ Residential
❑ Municipat/Public ❑ Industrial/Commercial ❑ Agricultural
❑ Recovery ❑ Injection ❑ Irrigation
❑ Other (list use) Temporary Monitor Well
3. WELL LOCATION:
COUNTY Vance QUADRANGLE NAME
NEAREST TOWN: Henderson
697 Greystone Road, Henderson, NC
(Street/Road Name, Number, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
O Slope ❑ Valley ❑ Flat ❑ Ridge ❑ Other
(Check appropriate setting)
LATITUDE N36.36836 May be in degrees,
minutes, seconds, or in a
LONGITUDE W78.35848 decimal format
Latitude/longitude source: O GPS ❑ Topographic map
(Location of well must be shown on a USGS topo map and
attached to thisform ifnot using GPS.)
4a. FACILITY- -fhe name of the business where the well is located. Complete 4a and4b.
(lfa residential well, skip 4a; complete 4b, well owner information only.)
FACILITY ID #(if applicable)
NAME OF FACO-.rrY S.T. Wooten Asphalt Plant
STREET ADDRESs 697 Greystone Road
Henderson NC 27536
City or Town State
4b. CONTACT PERSON/WELL OWNER:
NAME R.S. Lawter
STREET ADDRESS PO BOX 2408, Wilson, NC 27894
Zip Code
6. WE
a.
b. '
6. C/
a.
b.
7. DI
(/
8. SEALING MATERIAL:
Neat Cement Sand Cement
Cement lb. Cement lb.
Water gal. Water gal.
Bentonite
Bentonite 75 lb.
Type. ❑Slurry 01'ellets
Water gal,
Other
Type material
Amount
9. EXPLAIN METHOD OF EMPLACEMENT OF MATERIAL:
Tremie bentonite chins inside the well pipe
10. WELL DIAGRAM: Draw a detailed sketch of the well on the back of this
form showing total depth, depth and diameter of screens (if any) remaining
in the well, gravel interval, intervals of casing perforations, and depths and
types offill materialsused.
11. DATE WELL ABANDONED 9/1111
1 DO HEREBY CERTIFY THAT THIS WELL WAS ABANDONED IN ACCORDANCE
WITH 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF
THIS RECORD HAS BEEN PROVIDr TO THE WELL OWNER.
9/23/2011
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
SIGNATURE OF PRIVATE WELL OWNER ABANDONING THE WELL DATE
(The private well owner must be an individual who tzsrsonally abandons his/her residential well
in accordance with 15A NCAC 2C .0113.)
Thomas Whitehead
PRINTED NAME OF PERSON ABANDONING THE WELL
Submit a copy to the owner and the original to the Division of Water Quality within 30 days. Form GW-30
Attn: Information Management, 1617 Mail Service Center — Raleigh, NC 27699-1617, Phone No. [phone] eit 568. Rev. 5/06

WELL ABANDONMENT RECORD
North Carolina Deparunent of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #2907
1. WELL CONTRACTOR:
Thomas Whitehead
Well Contractor (Individual) Name
S&ME, Inc.
Well Contractor Company Name
STREET ADDRESS 3201 Spring Forest Road
Raleigh NC 27616
City or Town State Zip Code
9( 19 ) - 872-2660
Area code - Phone number
2. WELL INFORMATION:
SITE WELL ID # (if applicable) EP-7
STATE WELL PERMIT # (if applicable)
COUNTY WELL PERMIT # (if applicable)
DWQ or OTHER PERMIT # (if applicable)
WELL USE (Check applicable use): ❑ Monitoring ❑ Residential
❑ Municipal/Public ❑ Industrial/Commercial ❑ Agricultural
[-)Recovery ❑ Injection ❑ Irrigation
❑ Other (list use) Temporary Monitor Well
3. WELL LOCATION:
COUNTY Vance QUADRANGLE NAME
NEAREST TOWN: Henderson
697 Greystone Road, Henderson, NC
(Street/Road Name, Number, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
O Slope ❑ Valley ❑ Flat ❑ Ridge ❑ Other
(Check appropriate setting)
LATITUDE N36.36848 May be in degrees,
minutes, seconds, or in a
LONGITUDE W78.35833 deci7°al fO11at
Latitudetiongitude source: O GPS ❑ Topographic map
(Location ojrre/l must be shown on a USGS topo map and
attached to this form ijnot using GPS.)
4a. FACILITY- The name of the business where the well is located. Complete 4a and4b.
(If a residential well, skip 4a; complete 4b, well owner information only.)
FACILITY ID #(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Road
Henderson NC 27536
City or Town State Zip Code
4b. CONTACT PERSON/WELL OWNER:
NAME R.S. Lawter
STREET ADDRESS PO BOX 2408, Wilson, NC 27894
5. WELL DETAILS:
a Total Depth: 21 ft. Diameter: 1 in.
b. Water Level (Below Measuring Point): ft.
Measuring point is 1.5 IL above land surface.
6. CASING: Length Diameter
a. Casing Depth (if known): ft. in.
b. Casing Removed:— ft. in.
7. DISINFECTION: 71 %
(Amount of 65%75% calcium hypochlorite used)
8. SEALING MATERIAL:
Neat Cement Sand Cement
Cement lb. Cement lb
Water gal. Water gal.
Bentonite
Bentonite 25 lb.
Type: El Slurry OPellets
Water gal.
Other
Type material
Amount
9. EXPLAIN METHOD OF EMPLACEMENT OF MATERIAL:
Tremie bentonite chips inside the well pipe
10. WELL DIAGRAM: Draw a detailed sketch of the well on the back of this
form showing total depth, depth and diameter of screens (if any) remaining
in the well, gravel interval, intervals of casing perforations, and depths and
types of fill materials used.
11. DATE WELL ABANDONED 9/1/11
1 DO HEREBY CERTIFY THAT THIS WELL WAS ABANDONED IN ACCORDANCE
WITH I5A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF
THIS RECORD HAS BEEN PROVID THE WELL OWNER.
9/23/2011
IGNA RE OF CERTIFIED WELL CONTRACTOR DATE
SIGNATURE OF PRIVATE WELL OWNER ABANDONING THE WELL DATE
(The private well owner must be an individual who px5gaWlyabandons his/her residential well
in accordance with 15A NCAC 2C .0113.)
Thomas Whitehead
PRINTED NAME OF PERSON ABANDONING THE WELL
Submit a copy to the owner and the original to the Division of Water Quality within 30 days. Form GW -30
Attn: Information Management, 1617 Mail Service Center -Raleigh, NC 27699-1617, Phone No. [phone] ext 568. Rev. 5/06

U44nf-
WELL ABANDONMENT RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
1. WELL CONTRACTOR:
Thomas Whitehead
WELL CONTRACTOR CERTIFICATION # 2907
Well Contractor (Individual) Name
S&ME, Inc.
Well Contractor Company Name
STREET ADDRESS 3201 Spring Forest Road
Raleigh NC 27616
City or Town State Zip Code
9( 19 ) - 872-2660
Area code - Phone number
2. WELL INFORMATION:
SITE WELL ID# (ifapplicable) EP-8
STATE WELL PERMIT # (ifapplicable)
COUNTY WELL PERMIT # (ifapplicable)
DWQ or OTHER PERMIT # (ifapplicable)
WELL USE (Check applicable use): ❑ Monitoring ❑ Residential
❑ Munkipal/Public ❑ lndustriaUCommercial ❑ Agricultural
❑ Recovery ❑ Injection ❑ Irrigation
❑ Other (list use) Temporary Monitor Well
3. WELL LOCATION:
COUNTY Vance QUADRANGLE NAME
NEAREST TOWN: Henderson
697 Greystone Road, Henderson, NC
(Street/Road Name, Number, Community, Subdivision, Lot No., Parcel, Tip Code)
TOPOGRAPHIC / LAND SETTING:
Z slope ❑ Valley ❑ Flat ❑ Ridge ❑ Other
(Check appropriate setting)
LATITUDE N36.36842 May be in degrees,
minutes, seconds, or in a
LONGITUDE w18.35827 decimal format
Latitudetlongitude source: JZGPS ❑ Topographic map
(Location of well must be shown on a USGS topo map and
attached to this form if not using GPS.)
49. FACILITY- The name ofthe business where the well is located Complete 4a and4b.
(If a residential well, skip 4a; complete 4b, well owner information only.)
FACILITY 1D #(ifapplicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Road
Henderson NC 27536
City or Town Stale Zip Code
4b. CONTACT PERSON/WELL OWNER:
NAME R.S. Lawler
STREET ADDRESS PO BOX 2408, Wilson, NC 27894
5. WELL DETAILS:
a. Total Depth: 20 ft. Diameter: 2 in.
b. Water Level (Below Measuring Point): ft.
Measuring point is 1.5 ft. above land surface.
6. CASING: Length Diameter
a. Casing Depth (if known): ft. in.
b. Casing Removed: 5 ft. �� in.
7. DISINFECTION: 71 %
(Amount of65a/o-75%calcium hypochlorite used)
8. SEALING MATERIAL:
N mCement Sand Cement
Cement lb. Cement lb.
Water gal. Water gal
Bentonite
Bentonite 75 lb.
Type: El Slurry ®Pellets
Water gal.
Other
Type material
Amount
9. EXPLAIN METHOD OF EMPLACEMENT OF MATERIAL
Tremie bentonite chips inside the well pine
10. WELL DIAGRAM: Draw a detailed sketch of the well on the back of this
form showing total depth, depth and diameter of screens (if any) remaining
in the well, gravel interval, intervals of casing perforations, and depths and
types of fill materials used.
11. DATE WELL ABANDONED 9/1/11
1 DO HEREBY CERTIFY THAT THIS WELL WAS ABANDONED IN ACCORDANCE
WITH 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF
THIS RECORD HAS BEEN PROVIDE TO' EWELL OWNER.
9/23/2011
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
SIGNATURE OF PRIVATE WELL OWNER ABANDONING THE WELL DATE
(The private well owner must be an individual who personally abandons his/her residential well
in accordance with 15A NCAC 2C .0113.)
Thomas Whitehead
PRINTED NAME OF PERSON ABANDONING THE WELL
Submit a copy to the owner and the original to the Division of Water Quality within 30 days. Form GW-30
Attn: Information Management, 1617 Mail Service Center — Raleigh, NC 27699-1617, Phone No. [phone] e:t 568. Rev. 5/06

WELL ABANDONMENT RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #2907
1. WELL CONTRACTOR:
Thomas Whitehead
Well Contractor (Individual) Name
S&ME, Inc.
Well Contractor Company Name
STREET ADDRESS 3201 Spring Forest Road
Raleigh NC 27616
City or Town State Zip Code
s( 19 ) - 872-2660
Area code - Phone number
2. WELL INFORMATION:
SITE WELL ID # (if applicable) EP-9
STATE WELL PERMIT # (if applicable)
COUNTY WELL PERMIT # (if applicable)
DWQ or OTHER PERMIT # (if applicable)
WELL USE (Check applicable use): ❑ Monitoring ❑ Residential
❑ Municipal/Public ❑ Industrial/Commercial ❑ Agricultural
❑ Recovery ❑ Injection ❑ Irrigation
El Other (list use) Temporary Monitor Well
3. WELL LOCATION:
COUNTY Vance QUADRANGLE NAME
NEAREST TOWN: Henderson
697 Greystone Road, Henderson, NC
(Street/Road Name, Number, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING•
91Slope ❑ Valley ❑ Flat ❑ Ridge ❑ Other
(Check appropriate setting)
LATITUDE N36.36850 May be in degrees,
minutes, seconds, or in a
LONGITUDE W78.35836 decimal format
Latitude/longitude source: 0 GPS ❑ Topographic map
(Location of well must be shown on a USGS topo map and
attached to this form tf not using GPS.)
4a. FACILITY- The name of the business where the well is located. Complete 4a and4b.
(If a residential well, skip 4a; complete 4b, well owner inforcration oily.)
FACILITY ID #(ifapplicable)
NAME OF FACa.rrY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Road
Henderson NC 27536
City or Town State Zip Code
4b. CONTACT PERSON/WELL OWNER:
NAME R.S. Lawler
STREET ADDRESS PO BOX 2408, Wilson, NC 27894
S. WELL DETAILS:
a. Total Depth: 17 ft. Diameter: 1 in.
b. Water Level (Below Measuring Point): ft.
Measuring point is 1.5 ft. above land surface.
6. CASING: Length Diameter
a. Casing Depth (if known): ft. in.
b. Casing Removed: ft. �— in.
7. DISINFECTION: 71%
(Amount of 650/05% calcium hypochlorite used)
8. SEALING MATERIAL:
Neat Cement Sand Cement
Cement lb. Cement lb.
Water gal. Water gal.
ntonit
Bentonite 25 lb.
Type: ❑Slurry ®Pellets
Water gal.
Other
Type material
Amount
9. EXPLAIN METHOD OF EMPLACEMENT OF MATERIAL:
Tremie bentonite chips inside the well pipe
10. WELL DIAGRAM: Draw a detailed sketch of the well on the back of this
form showing total depth, depth and diameter of screens (if any) remaining
in the well, gravel interval, intervals of casing perforations, and depths and
types of fill materials used.
11. DATE WELL ABANDONED 9/1/11
I DO HEREBY CERTIFY THAT THIS WELL WAS ABANDONED IN ACCORDANCE
WITH 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF
THIS RECO AS BEEN PROVIDE T THE WELL OWNER.
/ �/ 9/23/2011
S(GNATURE OF CERTIFIED WELL CONTRACTOR DATE
SIGNATURE OF PRIVATE WELL OWNER ABANDONING THE WELL DATE
(The private well owner must be an individual who personally abandons hislher residential well
in accordance with 15A NCAC 2C .0113.)
Thomas Whitehead
PRINTED NAME OF PERSON ABANDONING THE WELL
Submit a copy to the owner and the original to the Division of Water Quality within 30 days. Form GW -30
Attn: Information Management, 1617 Mail Service Center - Raleigh, NC 27699-1617, Phone No. [phone] ext 568. Rev. 5/06

WELL ABANDONMENT RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #2907
1. WELL CONTRACTOR:
Thomas Whitehead
Well Contractor (Individual) Name
S&ME, Inc.
Well Contractor Company Name
STREET ADDRESS 3201 Spring
Forest Road
Raleigh NC
27616
City or Town State
Zip Code
9( 19 ) - 872-2660
Area code - Phone number
2. WELL INFORMATION:
SITE WELL ID # (if applicable)
EP-10
STATE WELL PERMIT # (ifapplicable)
COUNTY WELL PERMIT # (ifapplicable)
DWQ or OTHER PERMIT # (if applicable)
WELL USE (Check applicable use): ❑ Monitoring ❑ Residential
❑ Municipal/Public ❑ Industrial/Commercial ❑ Agricultural
❑ Recovery ❑ Injection ❑ Irrigation
❑ Other (list use) Temporary Monitor Well
3. WELL LOCATION:
COUNTY Vance QUADRANGLE NAME
NEAREST TOWN: Henderson
697 Greystone Road, Henderson, NC
(Street/Road Name, Number, Community, Subdivision, Lot No., Parcel, tip Code)
TOPOGRAPHIC / LAND SETTING:
21Slope ❑ Valley []Flat ❑ Ridge ❑ Other
(Check appropriate setting)
LATITUDE N36.36842 May be in degrees,
minutes, seconds, or in a
LONGITUDE W78.35823 decimal format
Latitude/longitude source: 0 GPS []Topographic map
(Location of weil must be shown on a USGS topo map and
attached to this form ifnot Laing GPS.)
4a. FACILITY- The name of the business where the well is located. Complete 4a andlb.
(If a residential well, skip 4a; complete 4b, well owner information only.)
FACILITY ID #(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Road
Henderson NC 27536
City or Town State Zip Code
4b. CONTACT PERSON/WELL OWNER:
NAME R.S. Lawter
STREET ADDRESS PO BOX 2408, Wilson, NC 27894
6. WELL DETAILS:
a. Total Depth: 23 ft. Diameter: 1 in.
b. Water Level (Below Measuring Point): ft.
Measuring point is 1.5 ft. above land surface.
6. CASING: Length Diameter
a. Casing Depth (if known): ft. in.
b. Casing Removed: 3 ft. �— in.
7. DISINFECTION; 71 %
(Amount of 65%75% calcium hypochlorite used)
8. SEALING MATERIAL:
Neat rement Sand Cement
Cement lb. Cement lb.
Water gal. Water gal.
Bentonite
Bentonite 37 lb.
Type: [I Slurry V]Pellets
Water gal.
Other
Type material
Amount
9. EXPLAIN METHOD OF EMPLACEMENT OF MATERIAL:
Tremie bentonite chips inside the well pipe
10. WELL DIAGRAM: Draw a detailed sketch ofthe well on the back of this
form showing total depth, depth and diameter of screens (if any) remaining
in the well, gravel interval, intervals of casing perforations, and depths and
types of fill materials used.
11. DATE WELL ABANDONED 911111
1 DO HEREBY CERTIFY THAT THIS WELL WAS ABANDONED IN ACCORDANCE
WITH I SA NNNC//CCA��}iC 22C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF
THI�'�'�EEN PROVIDED WELL OWNER_
`✓ 9/23/2011
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE.
SIGNATURE OF PRIVATE WELL OWNER ABANDONING THE WELL DATE
(The private well owner must be an indimridual who DS[i2uUy abandons his/her residential well
in accordance with I SA NCAC 2C .0113.)
Thomas Whitehead
PRINTED NAME OF PERSON ABANDONING THE WELL
Submit a copy to the owner and the original to the Division of Water Quality within 30 days. Form GW -30
Attn: Information Management, 1617 Mail Service Ceuter — Raleigh, NC 27699-1617, Phone No. [phone] ezt 568. Rev. 5/06

WELL ABANDONMENT RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #2907
1. WELL CONTRACTOR:
Thomas Whitehead
Well Contractor (Individual) Name
S&ME, Inc.
Well Contractor Company Name
STREET ADDRESS 3201 Spring Forest Road
Raleigh NC 27616
City or Town State Zip Code
9( 19 ) - 872-2660
Area code - Phone number
2. WELL INFORMATION:
SITE WELL ID # (if applicable) EP-11
STATE WELL PERMIT # (ifapplicable)
COUNTY WELL PERMIT # (if applicable)
DWQ or OTHER PERMIT # (if applicable)
WELL USE (Check applicable use): ❑ Monitoring ❑ Residential
❑ Municipal/Public ❑ Industrial/Commercial ❑ Agricultural
❑ Recovery ❑ Injection ❑ Irrigation
❑ Other (list use) Temporary Monitor Well
3. WELL LOCATION:
COUNTY Vance QUADRANGLE NAME
NEAREST TOWN: Henderson
697 Greystone Road, Henderson, NC
(Street/Road Name, Number, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
0 Slope ❑ Valley ❑ Flat ❑ Ridge ❑ Other.
(Check appropriate setting)
LATITUDE N36.36844 May be in degrees,
minutes, seconds, or in a
LONGITUDE W78.35822 decimal format
Latitude/loogitude source: O GPS ❑ Topographic map
(Location ojwelt must be shown on a USGS topo map and
attached to this form if not using GPS.)
4a. FACILITY- The name ofthe business where the well is located. Complete 4a and4b.
(If a residential well, skip 4a; complete 4b, well owner information only.)
FACILITY ID #(ifapplicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Road
Henderson NC 27536
City or Town State Zip Code
4b. CONTACT PERSON/WELL OWNER:
NAME R.S. Lawter
STREET ADDRESS PO BOX 2408, Wilson, NC 27894
6. WELL DETAILS:
a. Total Depth: 22 ft. Diameter: 1 in.
b. Water Level (Below Measuring Point): ft.
Measuring point is 1.5 ft. above land surface.
6. CASING: Length Diameter
a. Casing Depth (if known): ft. in.
b. Casing Removed:— ft. 1 in.
7. DISINFECTION: 71%
(Amount of 65e/r75% calcium hypochlorite used)
S. SEALING MATERIAL:
Nent Cement Sand Cement
Cement lb. Cement lb.
Water gal. Water gal.
Bentooite
Bentonite 25 Ib.
Type: El Slurry ®Pellets
Water gal.
Other
Type material
Amount
9. EXPLAIN METHOD OF EMPLACEMENT OF MATERIAL:
Tremie bentonite chips inside the well pipe
10. WELL DIAGRAM: Draw a detailed sketch of the well on the back of this
form showing total depth, depth and diameter of screens (if any) remaining
in the well, gravel interval, intervals of casing perforations, and depths and
types of fill materials used.
IL DATE WELL ABANDONED 9/1/11
1 DO HEREBY CERTIFY THAT THIS WELL WAS ABANDONED IN ACCORDANCE
WITH 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF
THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
lit/ 9/23/2011
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
SIGNATURE OF PRIVATE WELL OWNER ABANDONING THE WELL DATE
(The private well owner roust be an individual who personally abandons his/her residential well
in accordance with 15A NCAC 2C .0113.)
Thomas Whitehead
PRINTED NAME OF PERSON ABANDONING THE WELL
Submit a copy to the owner and the original to the Division of Water Quality within 30 days. Form GW -30
Attn: Information Management, 1617 Mail Service Center —Raleigh, NC 27699-1617, Phone No. [phone] ezt 568. Rev. 5/06

WELL ABANDONMENT RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2907
1. WELL CONTRACTOR:
Thomas Whitehead
Well Contractor (Individual) Name
SBME, Inc.
Well Contractor Company Name
STREET ADDRESS 3201 Spring Forest Road
Raleigh NC 27616
City or Town State Zip Code
99 19 ) - 872-2660
Area code - Phone number
2. WELL INFORMATION:
SITE WELL ID # (if applicable) EP-12
STATE WELL PERMIT # (if applicable)
COUNTY WELL PERMIT # (if applicable)
DWQ or OTHER PERMIT # (if applicable)
WELL USE (Check applicable use): ❑ Monitoring ❑ Residential
❑ Municipal/Public ❑ Industrial/Commercial ❑ Agricultural
❑ Recovery ❑ Injection ❑ Irrigation
❑ Other (list use) Temporary Monitor Well
3. WELL LOCATION:
COUNTY Vance QUADRANGLE NAME
NEAREST TOWN: Henderson
697 Greystone Road, Henderson, NC
(Street/Road Name, Number, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
® Slope ❑ Valley ❑ Flat ❑ Ridge ❑
(Check appropriate setting)
LATITUDE N36.36850 May be in degrees,
minutes, seconds, or in a
LONGITUDE W78.35833 decimal format
Latitude/longitude source: V]GPS [:]Topographic map
(Location of well must be shown on a USGS topo map and
attached to this form ifnot using GPS,)
4a. FACILITY- The name of the business where the well is located Complete 4a and4b.
(If a residential well, skip 4a; complete 4b, well owner information only.)
FACILITY ID #(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Road
Henderson NC 27536
City or Town State Zip Code
4b. CONTACT PERSON/WELL OWNER:
NAME R.S. Lawter
STREET ADDRESS PO Box 2408, Wilson, NC 27894
6. WELL DETAILS:
a. Total Depth: 20 ft. Diameter: 2 in.
b. Water Level (Below Measuring Point): ft.
Measuring point is 1.5 ft. above land surface.
6. CASING: Length Diameter
a. Casing Depth (if known): ft. in.
b. Casing Removed: fL �— in.
7. DISINFECTION: 71%
(Amount of65s/o-75%calcium hypochlorite used)
8 SEALING MATERIAL:
Neat Cement Sand Cement
Cement lb. Cement lb
Water gal. Water gal.
Bentonite
Bentonite 75 lb.
Type: ❑ Slurry ®Pellets
Water gal.
Other
Type material
Amount
9. EXPLAIN METHOD OF EMPLACEMENT OF MATERIAL:
Tremie bentonite chips inside the well pipe
10. WELL DIAGRAM: Draw a detailed sketch of the well on the back of this
form showing total depth, depth and diameter of screens (if any) remaining
in the well, gravel interval, intervals of casing perforations, and depths and
types of fill materials used.
11. DATE WELL ABANDONED 9/1/11
1 DO HEREBY CERTIFY THAT THIS WELL WAS ABANDONED IN ACCORDANCE
WITH 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF
THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
`✓ 9/23/2011
SIGNATURE O ERTIFIED WELL CONTRACTOR DATE
SIGNATURE OF PRIVATE WELL OWNER ABANDONING THE WELL DATE
(The private well owner must be an individual who RmQnally abandons lusther residential well
in accordance with 15A NCAC 2C .0113.)
Thomas Whitehead
PRINTED NAME OF PERSON ABANDONING THE WELL
Submit a copy to the owner and the original to the Division of Water Quality within 30 days. Form GW-30
Attn: Information Management, 1617 Mail Service Center — Raleigh, NC 27699-1617, Phone No. [phone] ext 568. Rev. 5/06

WELL ABANDONMENT RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2907
1. WELL CONTRACTOR:
Thomas Whitehead
Well Contractor (individual) Name
S&ME, Inc.
Well Contractor Company Name
STREET ADDRESS 3201 Spring Forest Road
Raleigh NC 27616
City or Town State Zip Code
9( 19 ) - 872-2660
Area code - Phone number
2. WELL INFORMATION:
SITE WELL H) # (if applicable) EP-13
STATE WELL PERMIT # (if applicable)
COUNTY WELL PERMIT # (if applicable)
DWQ or OTHER PERMIT # (if applicable)
WELL USE (Check applicable use): ❑ Monitoring ❑ Residential
❑ Municipal/Public ❑ Industrial/Commercial ❑ Agricultural
❑ Recovery ❑ Injection ❑ Irrigation
❑ Other (list use) Temporary Monitor Well
3. WELL LOCATION:
COUNTY Vance QUADRANGLE NAME
NEAREST TOWN: Henderson
697 Greystone Road, Henderson, NC
(Street/Road Name, Number, Communiry, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
O Slope ❑ Valley ❑ Flat ❑ Ridge ❑ Other
(Check appropriate setting)
LATITUDE N36.36869 May be in degrees,
minutes, seconds, or in a
LONGITUDE W78.35841 decimal format
Latitude/longitude source: 0 GPS ❑ Topographic map
(Location of well must be shown on a USGS topo map and
attached to this form if not using GPS.)
4a. FACILITY- The name of the business where the well is located. Complete 4a and4b.
(If a residential well, skip 4a; complete 4b, well owner information only.)
FACILITY ID #(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Road
Henderson NC 27536
City or Town State Zip Code
4b. CONTACT PERSON/WELL OWNER:
NAME R.S. Lawter
STREET ADDRESS PO BOX 2408, Wilson, NC 27894
S. WELL DETAILS:
a. Total Depth: 20 ft. Diameter: 2 in.
b. Water Level (Below Measuring Point): ft.
Measuring point is 1.5 ft. above land surface.
6. CASING: Length Diameter
a. Casing Depth (if known): ft. in.
b. Casing Removed: 5 ft. in.
7. DISINFECTION: 71 %
(Amount of65a/o-75%calcium hypochlorite used)
8. SEALING MATERIAL:
N at Cement Sand Cement
Cement lb. Cement lb.
Water gal. Water gal
Bentonite
Bentonite 75 lb.
Type: ❑Slurry ®Pellets
Water gal.
Other
Type material
Amount
9. EXPLAIN METHOD OF EMPLACEMENT OF MATERIAL:
Tremie hentonite chips inside the well pine
10. WELL DIAGRAM: Draw a detailed sketch of the well on the back of this
form showing total depth, depth and diameter of screens (if any) remaining
in the well, gravel interval, intervals of casing perforations, and depths and
types of fill materials used.
11. DATE WELL ABANDONED 9/1/11
1 DO HEREBY CERTIFY THAT THIS WELL WAS ABANDONED IN ACCORDANCE
WITH 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF
THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
zy,l 9/23/2011
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
SIGNATURE OF PRIVATE WELL OWNER ABANDONING THE WELL DATE
(The private well owner must be an individual who personally abandons his/her residential well
in accordance with 15A NCAC 2C .0113.)
Thomas Whitehead
PRINTED NAME OF PERSON ABANDONING THE WELL
Submit a copy to the owner and the original to the Division of Water Quality within 30 days. Form GW-30
Attn: Information Management, 1617 Mail Service Center — Raleigh, NC 27699-1617, Phone No. [phone] ext 568. Rev. 5/06

WELL ABANDONMENT RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2907
1. WELL CONTRACTOR:
Thomas Whitehead
Well Contractor (Individual) Name
S&ME, Inc.
Well Contractor Company Name
STREET ADDRESS 3201 Spring Forest Road
Raleigh NC 27616
City or Town State Zip Code
9( 19 ) _ 872-2660
Area code - Phone number
2. WELL INFORMATION:
SITE WELL 1D # (if applicable) EP-14
STATE WELL PERMIT # (if applicable)
COUNTY WELL PERMIT # (if applicable)
DWQ or OTHER PERMIT # (if applicable)
WELL USE (Check applicable use): ❑ Monitoring ❑ Residential
❑ Municipal/Public ❑ lodustriaUCommercial ❑ Agricultural
❑ Recovery ❑ Injection ❑ Irrigation
❑ Other (list use) Temporary Monitor Well
3. WELL LOCATION:
COUNTY Vance QUADRANGLE NAME
NEARESTTOWN: Henderson
697 Greystone Road, Henderson, NC
(Street/Road Name, Number, Conummity, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
O Slope ❑ Valley ❑ Flat ❑ Ridge ❑ Other
(Check appropriate setting)
LATITUDE N36.36803 May be in degrees,
minutes, seconds, or or a
LONGITUDE W78.35842 decimal format
Latitude/longitude source: O GPS ❑ Topographic map
(Location ojwell must be shown on a USGS topo map and
attached to this form it(nor using GPS.)
4a. FACILITY- The name ofthe business where the well is located. Complete 4a and4b.
(If a residential well, skip 4a; complete 4b, well owner information only.)
FACILITY ID #(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Road
Henderson NC 27536
City or Town State Zip Code
4b. CONTACT PERSON/WELL OWNER:
NAME R.S. Lawler
STREET ADDRESS PO BOX 2408, Wilson, NC 27894
6. WELL DETAILS:
a. Total Depth: 23 ft. Diameter: 1 in.
b. Water Level (Below Measuring Point): ft.
Measuring point is 1.5 ft. above land surface.
6. CASING: Length Diameter
a. Casing Depth (if known): ft. in.
b. Casing Removed:— ft —� in.
7. DISINFECTION: 71 %
(Amount of 65a/o-75%calcium hypochlorite used)
8. SEALING MATERIAL:
Neat Comment Sand Cement
Cement lb. Cement lb.
Water gal. Water gal.
Bentonite
Bentonite 37 lb.
Type: El Slurry OPellets
Water gal.
Other
Type material
Amount
9. EXPLAIN METHOD OF EMPLACEMENT OF MATERIAL:
Tremie bentonite chins inside the well pipe
10. WELL DIAGRAM: Draw a detailed sketch of the well on the back of this
form showing total depth, depth and diameter of screens (if any) remaining
in the well, gravel interval, intervals of casing perforations, and depths and
types of fill materials used.
11. DATE WELL ABANDONED 9/1/11
1 DO HEREBY CERTIFY THAT THIS WELL WAS ABANDONED IN ACCORDANCE
WITH 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF
THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
ZZ� AWL—J 9/23/2011
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
SIGNATURE OF PRIVATE WELL OWNER ABANDONING THE WELL DATE
(The private well owner must be an individual who psrsmdb�abandons his/her residential well
in accordance with 15A NCAC 2C .0113.)
Thomas Whitehead
PRINTED NAME OF PERSON ABANDONING THE WELL
Submit a copy to the owner and the original to the Division of Water Quality within 30 days. Form GW -30
Attn: Information Management, 1617 Mail Service Center — Raleigh, NC 27699-1617, Phone No. [phone] ext 568. Rev. 5/06

Attachment III - Well Abandonment Record MNW-6 (NCDEQ Form GW-30)

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Thomas Whitehead
Well Contractor Name (or well owner personally abandoning well on his/her property)
2907-A
NC Well Contractor Certification Number
S&ME, Inc.
Company Name
2. Well Construction Permit #: 90-0121-WM-0023
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.) rjlmown
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
e Monitoring ❑ Recovery
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
OGeothermal (Closed Loop)
❑Geothermal (Heating'Cooling
4. Date well(s) abandoned: 8/2/2018
5a. Well location:
S. T. Wooten
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑ Tracer
❑Other (explain under 7g)
Facility/Owner Name Facility ID# (ifapplicable)
697 Greystone Road
Physical Address, City, and Zip
Vance
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
36.3676 N-78.3589
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only I GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout
a Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
O Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Shury
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
Bentonite 501b. Bags 2.5 Bags
Water 10 Gallons
7g. Provide a brief description of the abandonment procedure:
Pour bentonite chips then hydrate with potable water.
8. Certification:
8/6/2018
Signature of Certified Wel Contractor or Well Owner Date
By signing this form, I hereby certify that the well(s) was (were) abandoned in
accordance with 1 SA NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non-wutersupply wells
ONLY with the same construction/abandonment, you can submit one form.
6a. Well ID#: MW-6
6b. Total well depth: 49.0 (ft.)
6c. Borehole diameter: NA (in.)
6d. Water level below ground surface: 25.1 1 (ft.)
6e. Outer casing length (if known): (ft.)
6f. Inner casing/tubing length (if known): 35.5 (ft.)
6g. Screen length (if known): 15.0 (ft.)
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this forth within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mall Service Center, Raleigh, NC 27699-1636
10c. For Water Suuoly & Injection Wells: In addition to sending the form to the
address(es) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
abandoned.
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22.2016

Attachment IV — Photographic Log

Well Abandonment
S. T. Wooten Asphalt Plant
697 Greystone Road, Henderson, North Carolina
S&ME Project No. 4305-17-083B
t
�
O
Location / Orientation
Facing South
1
Monitor Well MW-6 with damaged protective casing
Remarks
and missing well cap/lock.
c
Location / Orientation
Facing South
2
Remarks
Monitor Well MW-6 properly abandoned.
1

September 26, 2011
North Carolina Department of Environment and Natural Resources
Division of Waste Management
Underground Storage Tank Section
1637 Mail Service Center
Raleigh, North Carolina 27699
Attention: Mr. Eric Rice email: Eric. RiceAncdenr.gov
Reference: Summary of Monitor Well Abandonment and Well Repairs
697 Greystone Road
Henderson, Vance County, North Carolina
Permit No. WQ0004209
Incident No. 3412
S&ME Project Number 1054-10-116B
Dear Mr. Rice:
S&ME, Inc. (S&ME) is submitting the following summary report for the well
abandonments and repairs that were completed at the S.T. Wooten Asphalt Plant in
Henderson, Vance County, North Carolina. These services were performed in general
accordance with S&ME proposal number P143-11 V, dated July 8, 2011 to S.T. Wooten.
BACKGROUND
On July 7, 2011, a representative of the North Carolina Department of Environment and
Natural Resources (NCDENR) Division of Water Quality (DWQ), Aquifer Protection
Section (APS) conducted an annual site inspection of the groundwater remediation
system at the Henderson facility. During the course of the inspection, several issues were
noted with regard to the groundwater monitoring well network and a group of temporary
monitor wells that were installed near the remediation system. On July 21, 2011,
NCDENR issued two separate letters to address the violations that were noted during the
inspection. The first letter was addressed to Mr. R.S. Lawter of S.T. Wooten and the
second letter was addressed directly to the driller (Regional Probing Systems) that
installed the 14 temporary monitor wells (EP-1 though EP-14) in 2008. The first letter
noted the deficiencies that were identified during the inspection with regard to the
existing monitor well network. The first letter also listed the required actions to be taken
to address the deficiencies that were noted with regard to the existing monitor well at the
site.
S&ME, INC. / 3201 Spring Forest Road / Raleigh, NC 27616 / p 919.872,2660 / f 919.876.3958 / www.smeinc.com

Summary of Monitor Well Abandonment/Repairs S&ME Project No. 1054-10-116B
S.T. Wooten Corp. - Greystone Road Asphalt Plant, Henderson, Vance County, NC September 26, 2011
The second letter, which was addressed directly to the driller (Mr. Larry Outten, who is
actually Mr. Larry Opper — Regional Probing Services) of the 14 temporary piezometers,
indicated that the temporary piezometers were not completed as permanent monitor wells
or removed as required following their 2008 installation. The second letter indicated that
if the piezometers were to remain at the site, the piezometers needed to be converted to
permanent groundwater monitor wells. Following the receipt of this letter, Mr. Opper
completed well construction records detailing the installation of the temporary monitor
wells. Copies of the Non -Residential Well Construction Records (NCDENR Form GW-
1 b) are included as an attachment.
Following the receipt of the letters, S. T. Wooten contracted S&ME to address the
violations that were noted during the inspection including the abandonment of the 14
temporary piezometers that were installed by Mr. Opper. This summary report serves as
a response to both letters and to report that the existing monitor well network has been
brought back into compliance with the well construction standards per Chapter 15A of
the North Carolina Administrative Code (15A NCAC) Subchapter 2C-Well Construction
Standards (2C Standards), Section .0108. A site map indicating the current monitor well
network has been included as Figure 1.
The following is a summary of violations that were indicated in the July 21, 2011 letter
that was addressed to Mr. Lawter of S.T. Wooten:
MW-1 Well could not be located. Well may have been destroyed during grading of area.
MW-2 Well could not be located.
MW-3 Well damaged (casing bent at an angle), no well cap present on well and no lock.
MW-4 No lock present, well cap not secure.
MW-5 No lock present.
MW-7 Well could not be located.
MW-11 Well could not be located.
MW-12 No lock present.
MW-13 No lock present.
MW-14 No lock present.
MW-18 Unclear if this well was located
The following is a summary of the required corrective actions that were indicated in the
July 21, 2011 letter that was addressed to Mr. Lawter:
Install locking well caps and/or locks as necessary.
Repair or abandon well MW-3.
Locate wells MW-1, MW-2, MW-7, MW-I I and MW-18. The wells must be
located and an assessment made in regards to compliance with the well
construction rules. If the wells are found to be out of compliance, the wells must
be repaired or properly abandoned.
S&ME, INC. / 3201 Spring Forest Road / Raleigh, NC 27616 / p 919.872.2660 / f 919.876.3958/www.snieinc.com

Summary of Monitor Well Abandonment/Repairs S&ME Project No. 1054-10-116B
S.T. Wooten Corp. - Greystone Road Asphalt Plant, Henderson, Vance County, NC September 26, 2011
FIELD ACTIVITIES
Well Repairs
On September 1, 2011, S&ME personnel, including a North Carolina Licensed Well
Driller visited the site to make all necessary repairs to the wells and to properly abandon
the 14 temporary piezometers.
The following is a summary of the repairs that were completed on September 1, 2011:
MW-1 The well was not located and appears to have been destroyed by construction
activities.
MW-2 The well was not located and appears to have been destroyed by construction
activities.
MW-3 The damaged monitor well was properly abandoned (approximate total depth
of 25 linear feet) on September 1, 2011 by S&ME drillers. The well
abandonment record (NCDENR GW 30) has been submitted to NCDENR and
a copy has been included as an attachment to this summary letter.
MW-4 A new well tag was affixed to the monitor well and a new locking cap and
lock were attached to the two-inch monitor well.
MW-5 The well was not located and appears to have been destroyed by construction
activities.
MW-6 The well was not located and appears to have been destroyed by construction
activities.
MW-7 A new well tag was affixed to the monitor well and a new locking cap and
lock were attached to the two-inch monitor well.
MW-11 A new well tag was affixed to the monitor well and a new locking cap and
lock were attached to the two-inch monitor well.
MW-12 A new well tag was affixed to the monitor well and a new locking cap and
lock were attached to the two-inch monitor well.
MW-13 A new well tag was affixed to the monitor well and a new locking cap and
lock were attached to the two-inch monitor well.
MW-14 A new well tag was affixed to the monitor well and a new locking cap and
lock were attached to the two-inch monitor well.
MW-15 A new well tag was affixed to the monitor well and a new locking cap and
lock were attached to the two-inch monitor well.
MW-18 A new well tag was affixed to the monitor well and a new locking cap and
lock were attached to the two-inch monitor well.
RW-1 A new well tag was affixed to the monitor well and a new locking cap and
lock were attached to the two-inch monitor well.
RW-2 A new well tag was affixed to the monitor well and a new locking cap and
lock were attached to the two-inch monitor well.
Four additional monitor wells were installed on the S.T. Wooten property by others to
investigate groundwater at the site for a possible real estate transaction. The wells remain
at the site and are not part of the S.T. Wooten monitor well network. During the site
visit, S&ME tagged these wells for total well depth, affixed a well tag indicating the total
S&ME, INC. / 3201 Spring Forest Road / Raleigh, NC 27616 / p 919.872.2660 / f 919.876.3958 / www.smeinc.com

Summary of Monitor Well Abandonment/Repairs S&ME Project No. 1054-10-116B
S.T. Wooten Corp. - Greystone Road Asphalt Plant, Henderson, Vance County, NC September 26, 2011
well depth and installed a new expandable locking cap and lock to each of the four wells.
If these wells serve no purpose to a previous prospective buyer, the wells should be
abandoned in accordance with 15A NCAC 2C .0113(d). The four wells are labeled as
unknown and are also indicated on the attached Figure 1.
Well Abandonments
As previously indicated, the second letter was addressed to Mr. Larry Otten to address 14
temporary piezometers (EP-1 through EP-14) that we located during the site inspection.
On September 1, 2011, S&ME personnel abandoned 14 temporary piezometers (EP-1
through EP-14) and one Type II monitor well (MW-3) in general accordance with the
standards specified in 15A NCAC 2C. In all, approximately 322 linear feet of wells were
properly abandoned (297 linear feet — 14 temporary wells and 25 linear feet — MW-3). A
copy of the Non -Residential Monitor Well Construction Records and Well Abandonment
Records are included as attachments to his report.
The wells/temporary piezometers were first disinfected to 100 parts per million (ppm)
chlorine residuals within each well using quantities of a hypochlorite containing
approximately 70 percent available chlorine.
At each location a section of the riser pipe was removed from the well/temporary
piezometer and bentonite pellets were tremied inside of the remaining well pipe to the
ground surface. Each well was checked to confirm that settling did not occur within the
casing. The NCDENR-DWQ required well abandonment records are attached.
CLOSING
If you have any questions concerning the methods used or the well abandonment forms,
please feel free to contact us at [phone].
Sincerely,
S&ME, Inc.
Gerald Paul Tom Raymond, P.E.
Project Manager Senior Consultant
Cc: R. S. (Butch) Lawter — S.T. Wooten
Attachments: Figure 1 — Site Map with Monitor Well/Temporary Piezometer Locations
Photographic log of the well repairs/abandonments
Non -Residential Well Construction Records — NCDENR Form GW-lb
NCDENR Well Abandonment Records — NCDENR Form GW-30
S&ME, INC. / 3201 Spring Forest Road / Raleigh, NC 27616 / p 919.872.2660 / f 919.876.3958 / www.smeinc.com

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MW-12 (example of typical repairs) affixed new well
tag to the wells and replace locking caps and locks.
Well Repairs and Abandonments SBME Project No. 1054-10-116B
ItS&ME S.T. Wooten Asphalt Plant Taken by: Date Taken
697 Greystone Road, Henderson, North Carolina
G.P. 1 9/1/2011
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MW-15 (example of typical repairs) affixed new well
tag to the wells and replace locking caps and locks.
Indicator of monitor well MW-6.
Well Repairs and Abandonments S&ME Project No. 1054-10-116B
*S&ME S.T. Wooten, Asphalt Plant Taken by: Date Taken:
697 Greystone Road, Henderson, North Carolina
G.P. 9/1/2011
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697 Greystone Road, Henderson, North Carolina
G.P. 9/1/2011

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NONRESIDENTIAL � ONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3322-A
1. WELL CONTRACTOR:
Lawrence D. Opper
Well Contractor (Individual) Name
Regional Probing Services
Well Contractor Company Name
STREET ADDRESS PO Box 1161
Wake Forest, NC 27588
City or Town State Zip Cafe
9( 19 )_ 570-5588
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) EP-1
STATE WELL PERMIT#(ifapplicable)
DWQ or OTHER PERMIT #(if applicable)_
WELL USE (Check Applicable Box) Monitoring ® Municipal/Public ❑
Industrial/Commerclal ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 6/13/2008
TIME COMPLETED N/A AM ❑ PM ❑
3. WELL LOCATION:
CITY: Henderson COUNTY Vance
Northeast comer of US 1/Highway 158 27536
(Street Name, Numbers, Community, Subdi%sion, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
[]Slope ❑ Valley p Flat []Ridge ❑ Other
(check appropriate box)
LATITUDE 3 N36.36834 May be in degrees,
minutes, seconds or
LONGITUDE W78.35827 in a decimal format
Latitude/longitude source: pGPS pTopographic map
(location of we# must be shown on a USGS topo map and
attached to this form if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID #(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Rd
Henderson , NC 27536
City or Town State Zip Code
CONTACT PERSON R.S. Lawter
MAILING ADDRESS P.O. Box 2408
Wilson, NC 27894
City or Town State Zip Code
25� 2 )_ 291-5165
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 26'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: NM FT.
(Use "+' if Above Top of Casing)
d. TOP OF CASING IS 1.5 FT. Above Land Surface*
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): N/A METHOD OF TEST
f. DISINFECTION: Type NA Amount
g. WATER ZONES (depth):
From To From Tc
From To Fran To
Fran To From To
6. CASING: Thickness/
From 0' Depth Diameter Ft. 1Diameter sceiaht Material
From To Ft, fr40 PV(:
Fran To FL
7. GROUT: Depth Material Method
From 0 To 3' Ft.cement pour
From 3- Tom Ft. bentonite pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
Fran 6 To 26' Ft. 1 in. .010 in, PVC
From To Ft. in. in.
From To— Ft. in. in.
S. SAND/GRAVEL PACK:
Depth Size Material
From 5' To 26' Ft. #2 Sand
From To Ft.
From To Ft.
10. DRILLING LOG
From To
0-26'
26'
11. REMARKS:
'Formation Description
Formation Samples not collected.
Bedrock- ddll refusal encountered
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
I SA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORDoft BEEN PROVIDED TO THE WELL OWNER.
GNATU F TIRED WELL CONTRACTOR �y A' E
G Awf ILn'Nt L). �A
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form GW-1b
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev. 7105

\w4 NONRESIDENTIAL WELL CONSTRUCTION RECORD
aj4A�'�
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3322-A
1. WELL CONTRACTOR:
Lawrence D. Opper
Well Contractor (individual) Name
Regional Probing Services
Well Contractor Company Name
STREET ADDRESS PO Box 1161
Wake Forest, NC 27588
City or Town State Zip Code
9( 19 )- 570-5588
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID *(if applicable) EP-2
STATE WELL PERMIT#(Happlicable)
DWC1 or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring xi Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 6/13/2008
TIME COMPLETED NSA AM ❑ PM ❑
3. WELL LOCATION:
CITY: Henderson COUNTY Vance
Northeast comer of US 1/Highway 158 27536
(Street Name, Numbers. Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope ❑ Valley ® Flat ❑ Ridge ❑ Other
(check appropriate box)
LATITUDE 3 N36.36838 May be in degrees,
minutes, seconds or
LONGITUDE W78.35842 in a decimal format
Latitude/longitude source: aiGPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID #(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Rd
Henderson , NC 27536
City or Town State Zip Code
CONTACT PERSON R.S. Lawter
MAILING ADDRESS P.O. Box 2408
Wilson, NC 27894
City or Town State Zip Code
25( 2 )- 291-5165
Area code - Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: 2T
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: NM FT
(Use "+' if Above Top of Casing)
d. TOP OF CASING IS 1.5 FT. Above Land Surface'
'Top of casing terminated al/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): N/A METHOD OF TEST
f. DISINFECTION: Type NA Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
6. CASING: Thickness/
Depth Diameter W Material
From 0' To 7' Ft. 1" PVt;
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 0 To 3 Ft. cement pour
From : ' To AT Ft. bentonite pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 7' To 27' Ft. 1 in. .010 in, PVC
From To Ft. in. in.
From Ta Ft. in. in.
9. SANDIGRAVEL PACK:
Depth Size Material
From 6' To 27' Ft. #2 Sand
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0-27' Formation Samples not Collected,
27' Bedreck- drill refusal encountered
11. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECOR ROVIDED TO THE WELL OWNER.
it
q (1
GNATU FFCERTIFIED WELL CONTRACTOR DATE
LIQwI(1 cd D (i
PRINTED NAME OF PERSON NSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form GW-1b
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 668. Rev. 7/05

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3322-A
1. WELL CONTRACTOR:
Lawrence D. Opper
Well Contractor (Individual) Name
Regional Probing Services
Well Contractor Company Name
STREET ADDRESS PO Box 1161
Wake Forest, NC 27588
City or Town State Zip Code
9( 19 f- 570-5588
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) EP-3
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring xi MunicipaUPublic ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 6/13/2008
TIME COMPLETED NSA AM ❑ PM ❑
3. WELL LOCATION:
CITY: Henderson COUNTY -Van -
Northeast comer of US 1/Highway 158 275M
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope ❑ Valley ® Flat ❑ Ridge ❑ Other
(check appropriate box) -
LATITUDE 3 N36.36840 May be in degrees,
minutes, seconds or
LONGITUDE W78.35813 in a decimal format
LatitudeAongitude source: oGPS ❑Topographic map
(location of we# must be shown on a USGS topo map and
attached to this form if not using GPS)
4. FACILITY- is the name of the twsinese where the well is located.
FACILITY ID #(f applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Rd
Henderson , NC 27536
City or Town State Zip Code
CONTACT PERSON R.S. Lawler
MAILING ADDRESS P.O. Box 2408
Wilson, NC 27894
City or Town State Zip Code
25l —)- 291-5165
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 21'
b. DOES WELL REPLACE EXISTING WELL? YES ❑
c. WATER LEVEL Below Top of Casing: NM FT.
(Use "+" if Above Top of Casing)
I• B
d. TOP OF CASING IS 1.5 FT. Above Land Surface"
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): N/A METHOD OF TEST
f. DISINFECTION: Type NA Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From Tc
S. CASING: Thickness/
Depth Diameter Weight Material
From 0' To 6' Ft. 1"
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 0 To 3 Ft. cement pour
From 3' To'�—Ft. bentonite pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 6' To 21' Ft. 1 in. .010 in. PVC
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 5' To 21' Ft. #2 Sand
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0-21 Formation Samples not collected.
21' Bedrock- drill refusal encountered
11. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD -N OVIDED TO THE WELL OWNER.
/
S NATUR CERTIFIED WELL CONTRACTOR_ DATE
LAVj Q-eyU 17
PRINTED NAME OF PERSO ONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form GW-1b
1617 Mail Service Center —Raleigh, NC 27699-1617 Phone No. [phone] ext568. Rev. 7/05

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3322-A
1. WELL CONTRACTOR:
Lawrence D. Opper
Weil Contractor (Individual) Name
Regional Probing Services
Well Contractor Company Name
STREET ADDRESS PO BOX 1161
Wake Forest, NC 27588
City or Town State Zip Code
9( 19 1- 570-5588
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) EP-4
STATE WELL PERMIT#(ifapplicable)
DWQ or OTHER PERMIT #[if applicable)
WELL USE (Check Applicable Box) Monitoring ® Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 6/13/2008
TIME COMPLETED NSA AM ❑ PM ❑
3. WELL LOCATION:
CITY: Henderson COUNTY Vance
Northeast comer of US 1/Highway 158 27536
(Street Name, Numbers, Community, SubdHsion, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope ❑ Valley ©Flat ❑ Ridge ❑ Other
(check appropriate box)
LATITUDE j _ N36-36846 May be in degrees,
minutes, seconds or
LONGITUDE W78.35827 in a decimal format
Latitude longitude source: pGPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. FACILITY- is the name of the business where the well is located. -
FACILITY ID #(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Rd
Henderson , NC 27536
City or Town State Zip Code
CONTACT PERSON R.S. Lawler
MAILING ADDRESS P.O. Box 2408
Wilson, NC 27894
City or Town State Zip Code
25( 2 )- 291-5165
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 17'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 19
c. WATER LEVEL Below Top of Casing: NM FT.
(Use "+° if Above Top of Casing)
d. TOP OF CASING IS 1.5 FT. Above land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): N/A METHOD OF TEST
f. DISINFECTION: Type NA Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
G. CASING: Thickness/
Depth Qiameter We MVeial
From 0' To 7' Ft. 1 sc PVC
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 0 To 4 Ft. cement pour
From 3' To Ft. bentonite pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 7' To 17' Ft. 1 in. .010 m; PVC
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 6' To 17' Ft. #2 Sand
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0-17' Formation Samples not collected.
17' Bedrock- drill refusal encountered
11. REMARKS:
I DO HER CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WRH
ISA N 2C, W ELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECO D PROVIDED TO THE WELL OWNER.
►y 1
SI NATUR F CERTIFIED WELL CONTRACTOR ATE
we N - �
PRINTED NAME OF PERSON C STRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form GW-1b
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev. 7/05

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3322-A
1. WELL CONTRACTOR:
Lawrence D. Opper
Well Contractor (Individual) Name
Regional Probing Services
Well Contractor Company Name
STREET ADDRESS PO Box 1161
Wake Forest, NC 27588
City or Town State Zip Code
91( 9 )- 570-5588
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) EP-5
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring ® -Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 6/13/2008
TIME COMPLETED N/A AM ❑ PM ❑
3. WELL LOCATION:
CITY: Henderson COUNTY -Van -
Northeast comer of US 1/Highway 158 27536
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope ❑ Valley © Flat ❑ Ridge ❑ Other
(check appropriate box)
LATITUDE 3 _ N36.36827 May be in degrees,
minutes, seconds or
LONGITUDE W78.35821 in a decimal format
Latitude/longitude source: ®GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID #(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Rd
Henderson , NC 27536
City or Town State Zip Code
CONTACT PERSON R.S. Lawler
MAILING ADDRESS P.O. Box 2408
Wilson, INC 27894
City or Town State Zip Code
( 252 )- 291-5165
Area code - Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: 20'
b, DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: NM FT.
(Use "+' if Above Top of Casing)
d. TOP OF CASING IS 1.5 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): N/A METHOD OF TEST
f. DISINFECTION: Type NA Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
S. CASING: Thickness/
Depth Diameter W Material
From 0' To 5' Ft. 1" s Oye:
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 0 To 3 Ft. cement pour
From 3' TOE' Ft. bentonite pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 5' To 20' Ft. 1 in. •010 in, PVC
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 4' To 20' Ft. #2 Sand
From To Ft.
From To Ft.
10. DRILLING LOG
From To
0-20'
20'
11. REMARKS:
Formation Description
Formation Samples not Collected.
Bedrock- drill refusal encountered
15A 91 ERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
1N C 2C, ELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
N -awm
TO THE WELL OWNER.
�a l/
SIGNATUFfOF CERTIFIED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON C04STRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form GW-1b
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev. 7/06

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3322-A
1. WELL CONTRACTOR:
Lawrence D. Opper
Well Contractor (Individuaq Name
Regional Probing Services
Well Contractor Company Name
STREET ADDRESS PO Box 1161
Wake Forest, NC 27588
City or Town State Zip Code
9f 19 1.570-5588
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) EP-6
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring C Municipal/15411c; ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 12/20/2007
TIME COMPLETED N/A AM ❑ PM ❑
3. WELL LOCATION:
CITY: Henderson COUNTY Vance
Northeast comer of US 1/Highway 158 27536
(Street Name, Numbers, Community, Subdiuslon, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope ❑ Valley ®Flat ❑ Ridge ❑ Other,
(check appropriate box)
LATITUDE �3 _ N36.36836 May be in degrees,
minutes, seconds or
LONGITUDE W78.35848 in a decimal format
Latitude/longitude source: aiGPS ❑ Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID #(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Rd
Henderson , NC 27536
City or Town State Zip Code
CONTACT PERSON R.S. Lawler
MAILING ADDRESS P.O. Box 2408
Wilson, NC 27894
City or Town State Zip Code
25( 2 )- 291-5165
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 20'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
e. WATER LEVEL Below Top of Casing. NM FT.
(Use "+' if Above Top of Casing)
d. TOP OF CASING IS 1.5 FT. Above Land Surface*
`Top of casing terminated aUor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): N/A METHOD OF TEST
f. DISINFECTION: Type NA Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
6. CASING: Thickness/
Depth Diameter Weight Material
From 0' To 3 Ft. 2" s PVC
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 0 To 3' Ft cement pour
From 3' To 4 Ft. bentonite pour
From To Ft-
8. SCREEN: Depth Diameter Slot Size Material
From 5' To 20' Ft. 2 in. .010 in, PVC
From To Ft. in. in.
From To FL in. in.
9. SANDIGRAVEL PACK:
Depth Size Material
From 4' To 20' Ft. #2 Sand
From To Ft -
From —To— Ft.
10. DRILLING LOG
From To Formation Description
0-20' Formation Samples not collected.
20' Bedrock- drill refusal encountered - -
11. REMARKS:
I DO HEREUY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A N LL CCNSTRUCTK)N STANDARDS, AND THAT A COPY OF THIS
R ROVIDED TO THEWELLOWNER.
SIGNATURE F CERTIFIED WELL CONTRACTOR I DATE
IAAk- NCFI b- 1311
PRINTED NAME OF PERSON COQSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Fonn GW-1b
1617 Mail Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev. 7/05

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3322-A
1. WELL CONTRACTOR:
Lawrence D. Opper
Well Contractor (Individual) Name
Regional Probing Services
Well Contractor Company Name
STREETADDRESS PO Box 1161
Wake Forest, NC 27588
City or Town State Zip Code
(919 )_ 570-5588
Area code- Phone numbs
2. WELL INFORMATION:
SITE WELL ID #(if applicable) EP-7
STATE WELL PERMIT#(itapplicable)
DWQ or OTHER PERMIT *(if applicable)
WELL USE (Check Applicable Box) Monitoring gi Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 6/13/2008
TIME COMPLETED NSA AM ❑ PM ❑
3. WELL LOCATION:
CITY: Henderson COUNTY Vance
Northeast comer of US 1/Highway 158 27536
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope ❑Valley ❑x Flat ❑Ridge ❑ Other
(check appropriate bob
LATITUDE _ N36.36848 May be in degrees,
minutes, seconds or
LONGITUDE W78.35839 in a decimal format
Latitude/longitude source: ®GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. FACILITY- is the name of the business where the wea is located.
FACILITY ID *(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Rd
Henderson , NC 27536
City or Town State Zip Code
CONTACT PERSON R.S. Lawler
MAILING ADDRESS P.O. Box 2408
Wilson, NC 27894
City or Town State Zip Code
( 252 )_ 291-5165
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 21'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Im
c. WATER LEVEL Below Top of Casing: NM FT.
(Use'+' ff Above Top of Casing)
d. TOP OF CASING IS 1.5 FT. Above Land Surface'
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): N/A METHOD OF TEST
f. DISINFECTION: Type NA Amount
g. WATER ZONES (depth):
From To Fran To
From To From To
From To From To
6. CASING: Thickness/
Depth Diameter Weight Material
From 0' To 6' Ft. 1" S PVC
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 01
To 3 Ft. cement pour
From 3' ToTr­ Ft. bentonite pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 6' To 21' Ft. 1 in. .010 in. PVC
From To Ft. in. in.
Fran To Ft. in. in.
9. SANDIGRAVEL PACK:
Depth Size Material
From 5' To 21' Ft. #2 Sand
From To FL
From To Ft.
10. DRILLING LOG
From To Formation Description
0-21' formation Samples not collected.
21' Bedrock- drill refusal encountered
11. REMARKS:
I DO HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
I SA NC612,2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECtl S N ROVIDED TO THE WELL OWNER.
siGINATURE F CERTIFIED WELL CONTRACTOR DATE
LAw
PRINTED NAME OF PERSON CO RUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: information Mgt, Form GW-1b
1617 Mail Service Center — Raleigh, NC 27699-1617 _- Phone No. [phone] ext 568. Rev. 7/05.

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3322-A
1. WELL CONTRACTOR:
Lawrence D. Opper
Well Contractor (Individual) Name
Regional Probing Services
Well Contractor Company Name
STREET ADDRESS PO Box 1161
Wake Forest, NC 27588
City or Town State Zip Code
9l 19 )- 570-5588
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) EP-8
STATE WELL PERMIT#(irapplicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monftodr g Ry Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 12/20/2007
TIME COMPLETED N/A AM ❑ PM ❑
3. WELL LOCATION:
CITY: Henderson COUNTY Vance
Northeast comer of US 1/Highway 158 27536
(Street Name, Numbers, Community, Subdfe4sion, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING.
❑Slope ❑Valley ©Flat []Ridge ❑ Other
(check appropriate box)
LATITUDE 3 _ N36.36842 May be in degrees,
minutes, seconds or
LONGITUDE W78.35827 in a decimal format
Latitude/longitude source: pGPS gTopographic map
(location of we# must be shown on a USGS topo map and
attached to this form if not using GPS)
4. FACILITY- is the name of the business where the wall Is located.
FACILITY ID #(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Rd
Henderson , NC 27536
City or Town State Zip Code
CONTACT PERSON R.S. Lawter
MAILING ADDRESS P.O. Box 2408
Wilson, NC 27894
City or Town State Zip Code
25�2 )_ 291-5165
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 20'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO EN
c. WATER LEVEL Below Top of Casing: NM - FT,
(Use'+" if Above Top of Casing)
d. TOP OF CASING IS 1.5 FT. Above land Surface'
'Top of casing terminated atfor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): N/A METHOD OF TEST
f. DISINFECTION: Type NA Amount
g. WATER ZONES (depth):
From To Fran To
Fran To From To
From To From Tc
6. CASING: Thii�cn�nnlkeW
From 0' DToot5' FL 2Dlameter ScIT40 PVt; al
From Tc Ft.
From To Ft.
7. GROUT: Depth Material Method
From 0 To 3 Ft. cement pour
From 3' Tom— Ft. bentonite pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 5' To 20' Ft. 2 in. .010 in. PVC
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 4' To 20' Ft. #2 Sand
From To Ft. —
From —To— Ft.
10. DRILLING LOG
From To Formation Description
0-20' Formation Sameles not collect
20' Bedrock- drill refusal encountered
11. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED W ACCORDANCE WITH
15A NCAC 2 ELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD H EE DEi TO THE WELL OWNER.
SIGOATURE OF JETRTIFIED WELL CONTRACTOR DATE PRINTED NAME OF PERSON CONISTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Fan, GW-1b
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev. 7/05

1 r ONRESIDENTL4L WELL CONSTRUCTION RECORD
> f.. North Carolina Department of Environment and [Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3322-A
1. WELL CONTRACTOR:
Lawrence D. Opper
Well Contractor (Individual) Name
Regional Probing Services
Well Contractor Company Name
STREET ADDRESS PO Box 1161
Wake Forest, NC 27588
City or Town State Zip Code
9( 19 )_ 570-5588
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #('d applicable) EP-9
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring M MunicipalIPublte ❑ -
IndustriaUCommerciai ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation[] Other ❑ (list use)
DATE DRILLED 6/13/2008
TIME COMPLETED NIA AM ❑ PM ❑
3. WELL LOCATION:
CITY: Henderson COUNTY Vance
Northeast comer of US 1/Highway 158 27536
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING
❑ Slope ❑ Valley p Flat ❑ Ridge O Other_
(check appropriate box)
LATITUDE 3 _ N36.36860 May be in degrees,
minutes, seconds or
LONGITUDE W78.35836 in a decimal format
Latitude/longitude source: RiGPS ❑Topographic map
(location of we# must be shown on a USGS topo map and
attached to this form if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID #(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Rd
Henderson , NC 27536
City or Town State Zip Code
CONTACT PERSON R.S. Lawler
MAILING ADDRESS P.O. Box 2408
Wilson; NC 27894
City or Town State Zip Cade
25( 2 )_ 291-5165
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 17'
b. DOES WELL REPLACE EXISTING WELL? YES El NO 0
c. WATER LEVEL Below Top of Casing: NM FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1,5 FT. Above Land Surface'
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): NSA METHOD OF TEST
f. DISINFECTION: Type NA Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To Frcrrt To
6. CASING: Thickness/
Depth Diameter W Mattyiai
From 0' To 7' Ft. 1" s PVe
From To Ft.
From To Ft
7., GROUT: Depth Material Method
From 0 To 3' Ft cement pour
From 3' Tom -Ft. bentonite pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 7' To 17' FL 1 in. .010 in, PVC
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 6' To 17' Ft. #2 Sand
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0-17' Formation Samples not collected:
17' Bedrock- drill refusal encountered
11. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
t5A NCAC ELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RE A OVIDED TOTHEWELLOWNER. ry
IGNATUR CERTIFIED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form GW-1b
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev. 7/05

i
1. WELL CONTRACTOR:
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3322-A
Lawrence D. Opper
Well Contractor (Individual) Name
Regional Probing Services
Well Contractor Company Name
STREET ADDRESS PO Box 1161
Wake Forest, NC 27588
City or Town State Zip Code
9( 19 )- 570-5588
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) EP-10
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring zi Municipal/Pubfic ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injec6ori p
Irrigation❑ Other ❑ (list use)
DATE DRILLED 6/13/2008
TIME COMPLETED NSA AM ❑ PM ❑
3. WELL LOCATION:
CITY: Henderson COUNTY Vance
Northeast comer of US 1/Highway 158 27536
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING -'
❑ Slope ❑ Valley 0 Flat ❑ Ridge ❑ Other
(check appropriate box)
LATITUDE 3 _ N36.36842 May be in degrees,
minutes, seconds or
LONGITUDE W78.35823 in a decimal format
Latitude/longitude source: RiGPS ❑Topographic map
(location of we# must be shown on a USGS topo map and
attached to this form if not using GPS)
4. FACILITY- is the name of the business where the well Is located.
FACILITY ID #(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Rd
Henderson , NC 27536
City or Town State Zip Code
CONTACT PERSON R.S. Lawler
MAILING ADDRESS P.O. Box 2408
Wilson, NC 27894
City or Town State Zip Code
( 252 ) 291-5165
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 23'
b. DOES WELL REPLACE EXISTING WELL? YES El NO 6
c. WATER LEVEL Below Top of Casing: NM Ff.
(Use'+' if Above Top of Cas(ng)
d. TOP OF CASING IS 1.5 FT. Above Land Surface'
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): NSA METHOD OF TEST
f. DISINFECTION: Type NA Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
S. CASING: Thickness/
Depth 4iameter We MHtQ(Ial
From 0' To 8' Ft. 1' sc PPVe
From Tc Ft.
From To Ft.
7. GROUT: Depth Material Method
From 0 To 3 Ft, cement pour
From 3' To 7' Ft. bentonite pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 8' To 23' Ft. 1 in. •010 in, PVC
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 7' To 23' Ft. #2 Sand
From' To Ft.
From To FL
10. DRILLING LOG
From To Formation Description
0-2T Formation Samples not collected.
23' Bedrock- drill refusal encountered
11. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
1 SA NCAC 2C. WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECO BE OVIDED TO THE WELL OWNER.
SIGNATURE Of CERTIFIED WELL CONTRACTOR DATE
�,N1/NLt$NC� Dr tT1L
PRINTED NAME OF PERSON CONTSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form GW-1b
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 668. Rev. 7/05

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3322-A
1. WELL CONTRACTOR:
Lawrence D. Opper
Well Contractor (Individual) Name
Regional Probing Services
Well Contractor Company Name
STREET ADDRESS PO Box 1161
Wake Forest, NC 27588
City or Town State Zip Code
9( 19 1.570-5588
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) EP-11
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(If applicable)
WELL USE (Check Applicable Box)'Monitoring® -Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 6/1312008
TIME COMPLETED NSA AM ❑ PM ❑
3. WELL LOCATION:
CITY: Henderson COUNTY Vance
Northeast corner of US 1/Highway 168 27536
(Street Name, Numbers, Community, SubdiWsion, Lot No-, Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING: -
❑ Slope []Valley O Flat ❑ Ridge ❑ Other
(check appropriate box)
LATITUDE 3 r N36.36844 May be in degrees,
minutes, seconds or
LONGITUDE W78.35822 in a decimal fonnat
LatitudeAongitude source: giGPS ❑Topographic map
(location of we# must be shown on a USGS topo map and
attached to this form if not using GPS)
4. FACILITY- is the name of the business where the well Is located.
FACILITY ID #(if applicable)
NAME OF FACILITY S-T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Rd
Henderson , INC 27536
City or Town State Zip Code
CONTACT PERSON R.S. Lawler
MAILING ADDRESS P.O. Box 2408
Wilson, NC 27894 ----
City or Tam State Zip Code
25( 2 )_ 291-5165
Area code- Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: 22'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: NM FT.
(Use "+' if Above Top of Casing)
d. TOP OF CASING IS 1.5 FT. Above Land Surface'
"Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): NSA METHOD OF TEST
f. DISINFECTION: Type NA Amount
g. WATER ZONES (depth):
From Tc From To
From To From To
From To From To
6. CASING: Thickness/
Depth Diameter W Material
From 0' To 7' Ft. 1' s PVC:
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 01 To 3 Ft. cement pour
From 3' Tod' Ft. bentonite pour
-From----- Tc Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 7' To 22' Ft. 1 in. .010 in. PVC
From To Ft. in, in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 6' To 22' Ft. #2 Sand
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0-22' Formation Samples not collected.
22' Bedrock- drill refusal encountered
11. REMARKS:
I DO HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2 W ELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
REC 2f AS VIDEO TO THE WELL OWNER.
gh Ir
IGNATURE OPiCtRTIFIED WELL CONTRACTOR DATE
LAW 2 emu= ). 60
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form GW-1b
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 668. Rev. 7105

r�Z y NONRESIDENTIAL ONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3322-A
1. WELL CONTRACTOR:
Lawrence D. Opper
Well Contractor (Individuao Name
Regional Probing Services
Well Contractor Company Name
STREET ADDRESS PO Box 1161
Wake Forest, NC 27588
City or Town State Zip Code
9( 19 )- 570-5588
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) EP-12
STATE WELL PERMIT#(Napplicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring R- Municipal/Public El
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 6/13/2008
TIME COMPLETED N/A AM ❑ PM ❑
3. WELL LOCATION:
CITY: Henderson COUNTY Vance
Northeast comer of US 1/Highway 158 27536
(Street Name, Numbers, Community; Subdhilslon, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope ❑ Valley p Flat ❑ Ridge ❑ Other
(cluck appropriate box)'
LATITUDE 3 _ N36.36850 =,indegrees,LONGITUDE W78.35833
Latitude(longitude source: pGPS ❑Topographic map
(location of we# must be shown on a USGS topo map and
attached to this form it not using GPS)
4. FACILITY- is the name of the business where the well ie Ioaatad.
FACILITY ID #(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Rd
Henderson , NC 27536
City or Town State Zip Code
CONTACT PERSON R.S. Lawler
MAILING ADDRESS P.O. Box 2408
Wilson, NC 27894
City or Town State Zip Code
25(_ 2 )_ 291-5165
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 20'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: NM FT.
(Use';' if Above Top of Casing)
d. TOP OF CASING IS 1.5
FT. Above Land Surface'
'Top of casing terminated aVor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): N/A
METHOD OF TEST
f. DISINFECTION: Type NA
Amount
g. WATER ZONES (depth):
From To
From To
From To
Fran To
Fran To
Fran To
6. CASING:
Thickness/
Depth
Diameter
Weiahf Material
S PVC
From 0'
To 5
Ft. 2-
From
To
FL
From
To
Ft.
7. GROUT:
Depth
Material
Method
'From 01,
To 3
Ft. cement
pour
From 3' -
Tom— Ft. bentonite pour
From
To
Ft.
8. SCREEN:
Depth
Diameter
Slot Size Material
From 5'
To 20'
Ft 2 in.
.010 in. PVC
From
To
Ft in.
in.
From
To
Ft. in,
in.
9. SANDIGRAVEL PACK:
Depth
Size
Material
From 4'
To 20'
Ft. #2
Sand
From -
To
Ft.
From
To
Ft.
10. DRILLING LOG
From To Formation Description
0-20' Formation Samples not collected:
20' Bedrock- drill refusal encountered -
11. REMARKS:
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RE R P VIDED TO THE WELL OWNER.
(q{ I h
S NATURE ERTIFIED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form GW-1b
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 668. Rev. 7105

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3322-A
1. WELL CONTRACTOR:
Lawrence D. Opper
Well Contractor (Individual) Name
Regional Probing Services
Well Contractor Company Name
STREET ADDRESS PO Box 1161
Wake Forest, NC 27588
City or Town State Zip Code
9( 19 )- 570-5588
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) EP-14
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring KI Municipal/Puptic ❑'
Industrial/Commercial ❑ Agricultural ❑ Recovery p Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 6/13/2008
TIME COMPLETED N/A AM ❑ PM ❑
3. WELL LOCATION:
CITY. Henderson COUNTY Vance
Northeast comer of US 1/Highway 158 27536
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope ❑ Valley M Flat ❑ Ridge ❑ Other
(check appropriate box)
LATITUDE 3 ` N36.36803 May be in degrees,
minutes, seconds or
LONGITUDE W78.35842 in a decimal format
Latitude/longitudesource: RiGPS ❑ Topographic map
(location of weft must be shown on a USGS topo map and
attached to this form if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID #(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Rd
Henderson , NC 27536
City or Town State Zip Code
CONTACT PERSON R.S. Lawler
MAILING ADDRESS P-0. Box 2408
Wilson, INC 27894
City or Town State Zip Code
( 252 )- 291-5165
Area code - Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: 23'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NOEN
e. WATER LEVEL Below Top of Casing: NM FT
(Use'+" if Above Top of Casing)
d. TOP OF CASING IS 1.5 FT. Above land Surface'
"Top of casing terminated War below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): N/A METHOD OF TEST
f. DISINFECTION: Type NA Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
6. CASING: Thickness/
From 0' DTepot8, Ft DDiameter scff40 Material
From To Ft. PVt�
From To Ft.
7. GROUT: Depth Material Method
From 01 To 3 Ft. cement pour
From 3' To-7— Ft. bentonite pour
From To--T Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 8' To 23' Ft. 1 in. .010 in. PVC
From To Ft. in. in.
From To Ft, in, in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 7' To 23' Ft. #2 Sand
From Tc Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0-23' Formation Samples not collected.
23' Bedrock- drill refusal encountered
11. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
I SA NCA , WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECOR H BE PROVIDED TO THE WELL OWNER. 14
sicyAATUREbfCFRTlFIED WELL CONTRACTOR l�DATE
PRINTED NAME OF PERSON CO TRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form GW-1b
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev. 7105

j NONRESIDENTIAL NONRESIDENTIAL WELL CONSTRUCTION RECORD
Y
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3322-A
1. WELL CONTRACTOR:
Lawrence D. Opper
Well Contractor (Individual) Name
Regional Probing Services
Well Contractor Company Name
STREET ADDRESS PO Box 1161
Wake Forest, NC 27588
City or Town State Zip Code
9( 19 )_ 570-5588
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) EP-13
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring ® Municipal/Public ❑
Industriai/Commercial ❑ Agricultural ❑ Recovery p Injection ❑
Irrigation❑ Other ❑ (fist use)
DATE DRILLED 6/13/2008
TIME COMPLETED N/A AM ❑ PM ❑
3. WELL LOCATION: --
CITY: Henderson COUNTY Vance
Northeast comer of US 1/1-lighway 158 27536
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope ❑ Valley ❑O Flat ❑ Ridge ❑ Other
(check appropriate box)'
LATITUDE 3 _ N36.36869 May be in degrees,
minutes, seconds or
LONGITUDE W78.35841 in a decimal format
Latitude/longitude source: ®GPS ❑Topographic map
(location of we# must be shown on a USGS topo map and
attached to this form if not using GPS)
4. FACILITY- is the name of the buainess where the well is located.
FACILITY ID #(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Rd
Henderson , NC 27536
City or Town State Zip Code
CONTACT PERSON R.S. Lawler
MAILING ADDRESS P.O. Box 2408
Wilson, NC 27894
City or Town State Zip Code
25L 2 )- 291-5165
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 20'
b. DOES WELL REPLACE EXISTING WELL?. YES:E3, 190
c. WATER LEVEL Below Top of Casing: NM FT.
(Use'+' if Above Top of Casing)
d. TOP OF CASING IS 1.5 FT. Above Land Surface'
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): N/A METHOD OF TEST
f. DISINFECTION: Type NA Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
6. CASING: Thicimess/
epth From 9DTo 5' Ft. 2 iameter sIN �u�
From To Ft.
From To Ft
7. GROUT: Depth Material Method
From 0 To 3 Ft. cement pour
From 3' ToFt. bentonite pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 5' To 20 Ft. 2 in. .010 in, PVC
From To Ft. in, in.
From To Ft. in. in.
9. SANDIGRAVEL PACK:
Depth Size Material
From 4' To 20' Ft. #2 Sand
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0-20' Formation Samples not collected.
20' Bedrock- drill refusal encountered
11. REMARKS:
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCA C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
R O S PROVIDED TOTHEWELLOWNER.
-- 1,f(rt
NATO CERTIFIED WELL CONTRACTOR DATE
LAv'" �
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form GWAb.
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev..7/05

SiAr(
WELL ABANDONMENT RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2907
1. WELL CONTRACTOR:
Thomas Whitehead
Well Contractor (Individual) Name
S&ME, Inc.
Well Contractor Company Name
STREETADDRESS 3201 Spring Forest Road
Raleigh NC 27616
City or Town State Zip Code
9( 19 ) - 872-2660
Area code - Phone number
2. WELL INFORMATION:
SITE WELL ID N (if applicable) MW-3
STATE WELL PERMIT N (if applicable)
COUNTY WELL PERMIT # (if applicable)
DWQ or OTHER PERMIT # (if applicable)
WELL USE (Check applicable use): ,Q Monitoring ❑ Residential
❑ Municipal/Public ❑ Ind ustria I/Commercial ❑ Agricultural
❑ Recovery ❑ Injection ❑ Irrigation
❑ Other (list use)
3. WELL LOCATION:
COUNTY Vance QUADRANGLE NAME
NEAREST TOWN: Henderson
697 Greystone Rd, Henderson, NC
(StrecuRoad Name, Number, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
[--]Slope ❑ Valley ❑ Flat ❑ Ridge ❑ Other
(Check appropriate setting)
LATITUDE 36.36834 May be in degrees,
minutes, seconds, or in a
LONGITUDE 78.35827 decimal format
Latitude/longitude source: ®GPS [-]Topographic map
(Location of tve/l must be shown on a USGS topo map and
attached to this form if not using GPS.)
4a. FACILITY- The name of the business where the well is located. Complete 4a and4b.
(If a residential well, skip 4a; complete 4b, well owner information only.)
FACILITY ID #(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Rd
Henderson NC 27536
City or Town State Zip Code
4b. CONTACT PERSON/WELL OWNER:
NAME R. , Lawler
STREET ADDRESS PO BOX 2408, Wilson, NC 27894
S. WELL DETAILS:
a. Total Depth: 25 ft Diameter: 2 in.
b. Water Level (Below Measuring Point): 21 ft-
Measuring point is ft. above land surface.
6. CASING: Length Diameter
a. Casing Depth (if known): ft, in.
b. Casing Removed: i ft �_ in.
7. DISINFECTION: 71%
(Amount of 65%75% calcium hypochlorite used)
S. SEALING MATERIAL:
Nest Cpmont Sand Cement
Cement lb. Cement lb.
Water gal. Water gal.
Bentonite
Bentonite 90 lb.
Type: ❑Slurry ®Pellets
Water gal.
Other
Type material
Amount
9. EXPLAIN METHOD OF EMPLACEMENT OF MATERIAL:
Tremmie bentonite chips inside well pipe
10. WELL DIAGRAM: Draw a detailed sketch of the well on the back of this
form showing total depth, depth and diameter of screens (if any) remaining
in the well, gravel interval, intervals ofeasing perforations, and depths and
types of fill materials used.
11. DATE WELL ABANDONED 9/1/11
1 DO HEREBY CERTIFY THAT THIS WELL WAS ABANDONED IN ACCORDANCE
WITH 15A NCAC 2C. WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF
THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
SIGNATURE OF PRIVATE WELL OWNER ABANDONING THE WELL DATE
(The private well owner must be an individual who Itmonally abandons his/her residential wen
in accodance with 15A NCAC 2C .0113.)
Thomas Whitehead
PRINTED NAME OF PERSON ABANDONING THE WELL
Submit a copy to the owner and the original to the Division of Water Quality within 30 days. Form OW -30
Attn: Information Management, 1617 Mail Service Center - Raleigh, NC 27699-1617, Phone No. [phone] ext 568. Rev. 5/06

WELL ABANDONMENT RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2907
1. WELL CONTRACTOR:
Thomas Whitehead
Well Contractor (Individual) Name
S&ME, Inc.
Well Contractor Company Name
STREET ADDRESS 3201 Spring Forest Road
Raleigh NC 27616
City or Town State Zip Code
9( 19 ) _ 872-2660
Area code - Phone number
2. WELL INFORMATION:
SITE WELL ID 1$(if applicable) EP-1
STATE WELL PERMIT # (if applicable)
COUNTY WELL PERMIT # (if applicable)
DWQ or OTHER PERMIT # (if applicable)
WELL USE (Check applicable use): ❑ Monitoring ❑ Residential
❑ MunicipaVPublic ❑ Industrial/Commercial ❑ Agricultural
❑ Recovery ❑ Injection ❑ Irrigation
❑ Other (list use) Temporary Monitor Well
3, WELL LOCATION:
COUNTY Vance QUADRANGLE NAME
NEAREST TOWN: Henderson
697 Greystone Road, Henderson, NC
(Street/Road Name, Number, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
Slope ❑ Valley ❑ Flat ❑ Ridge ❑ Other
(Check appropriate setting)
LATITUDE N36.36834 May be in degrees,
minutes, seconds, or in a
LONGITUDE W18.35827 decimal format
Latitude/longitude source: O GPS ❑ Topograpbk map
(Location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4a. FACILITY- The name of the business where the well is located. Complete 4a and4b.
(Ifa residential well, skip 4a; complete 4b, well owner information only.)
FACILITY ID #(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Road
Henderson NC 27536
City or Town State Zip Code
4b. CONTACT PERSONIWELL OWNER:
NAME R.S. Lawter
STREET ADDRESS PO BOX 2408, Wilson, NC 27894
S. WELL DETAILS:
a. Total Depth: 26 ft. Diameter: 1 in.
b. Water Level (Below Measuring Point): ft.
Measuring point is 1.5 ft. above land surface.
6. CASING: Length Diameter
a. Casing Depth (if known): ft. in.
b. Casing Removed:— ft. in.
7. DISINFECTION: 71%
(Amount of 65%75%calcium hypochlorite used)
S. SEALING MATERIAL:
Neat Cement Sand Cement
Cement lb. Cement lb.
Water gal. Water gal.
Bentonite
Bentonite 37 lb.
Type:❑Slurry ®Pellets
Water gal.
Other
Type material
Amount
9. EXPLAIN METHOD OF EMPLACEMENT OF MATERIAL:
Tremie bentonite chips inside the well pipe
10. WELL DIAGRAM: Draw a detailed sketch of the well on the back of this
form showing total depth, depth and diameter of screens (if any) remaining
in the well, gravel interval, intervals of casing perforations, and depths and
types of fill materials used.
11. DATE WELL ABANDONED 9/1/11
1 DO HEREBY CERTIFY THAT THIS WELL WAS ABANDONED IN ACCORDANCE
WITH 15A NNCCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF
THIS ECO AS BEEN P,/.^ROV9iE WELL OWNER
!I9/23/2011
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
SIGNATURE OF PRIVATE WELL OWNER ABANDONING THE WELL DATE
(The private well owner must be an individual who personally abandons his/her residential well
in accordance with 15A NCAC 2C .0113.)
Thomas Whitehead
PRINTED NAME OF PERSON ABANDONING THE WELL
Submit a copy to the owner and the original to the Division of Water Quality within 30 days. Form GW-30
Attn: Information Management, 1617 Mail Service Center — Raleigh, NC 27699-1617, Phone No. [phone] tit 568. Rev. 5/06

WELL ABANDONMENT RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2907
1. WELL CONTRACTOR:
Thomas Whitehead
Well Contractor (Individual) Name
S&ME, Inc.
Well Contractor Company Name
STREET ADDRESS 3201 Spring Forest Road
Raleigh NC 27616
City or Town State Zip Code
9( 19 ) - 872-2660
Area code - Phone number
2. WELL INFORMATION:
SITE WELL ID # (if applicable) EP-2
STATE WELL PERMIT # (if applicable)
COUNTY WELL PERMIT # (if applicable)
DWQ or OTHER PERMIT # (if applicable)
WELL USE (Check applicable use): ❑ Monitoring ❑ Residential
❑ Municipal/Public ❑ Industrial/Commercial ❑ Agricultural
❑ Recovery ❑ Injection ❑ Irrigation
❑ Outer (list use) Temporary Monitor Well
3. WELL LOCATION:
COUNTY Vance QUADRANGLE NAME
NEAREST TOWN: Henderson
697 Greystone Road, Henderson, NC
(Street/Road Nana, Number, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
O Slope ❑ Valley ❑ Flat ❑ Ridge ❑ Other
(Check appropriate setting)
LATITUDE N36.36838 May be in degrees,
minutes, seconds, or in a
LONGITUDE W18.35842 decimal format
Latitude/longitude source: O GPS ❑Topographic map
(Location of well must be shown on a USGS topo map and
attached to this form if not using GPS.)
4a. FACILITY. The name of the business where the well is located. Complete 4a and4b.
(If a residential well, skip 4a; complete 4b, well owner information only.)
FACILITY ID #(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Road
Henderson NC 27536
City or Town State Zip Code
4b. CONTACT PERSON/WELL OWNER:
NAME R.S. Lawter
STREET ADDRESS PO BOX 2408, Wilson, NC 27894
6. WELL DETAILS:
a. Total Depth: 27 R. Diameter: 1 in.
b. Water Level (Below Measuring Point): R.
Measuring point is 1.5 ft above land surface.
6. CASING: Length Diameter
a. Casing Depth (if known): R. in.
b. Casing Removed:— R. in.
7. DISINFECTION: 71 %
(Amount of 65%75% calcium hypochlorite used)
S. SEALING MATERIAL:
Neat Cement Sand Cement
Cement lb. Cement lb.
Water gal. Water gal.
Bentonhe
Bentonite 37 lb.
Type: []Slurry OPellets
Water gal.
Other
Type material
Amount
9. EXPLAIN METHOD OF EMPLACEMENT OF MATERIAL:
Tremie bentonite chips inside the well pipe _
10. WELL DIAGRAM: Draw a detailed sketch of the well on the back of this
form showing total depth, depth and diameter of screens (if any) remaining
in the well, gravel interval, intervals of casing perforations, and depths and
types of fill materials used.
11. DATE WELL ABANDONED 9/1/11
1 DO HEREBY CERTIFY THAT THIS WELL WAS ABANDONED IN ACCORDANCE
WITH ISA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF
THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
G✓� 9/23/2011
SG ATUREOFCERTIFIEDWELLCONTRACTOR DATE
SIGNATURE OF PRIVATE WELL OWNER ABANDONING THE WELL DATE
(The private well owner must be an individual who personally abandons his/her residential well
in accordance with I SA NCAC 2C .01 I3.)
Thomas Whitehead
PRINTED NAME OF PERSON ABANDONING THE WELL
Submit a copy to the owner and the original to the Division of Water Quality within 30 days. Form GW-30
Attn: Information Management, 1617 Mail Service Center —Raleigh, NC 27699-1617, Phone No. [phone] ettt MS. Rev. 5/06

_WELL ABANDONMENT RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2907
1. WELL CONTRACTOR:
Thomas Whitehead
Well Contractor (Individual) Name
S&ME, Inc.
Well Contractor Company Name
STREET ADDRESS 3201 Spring Forest Road
Raleigh NC 27616
City or Town State Zip Code
9( 19 ) - 872-2660
Area code - Phone number
2. WELL INFORMATION:
SITE WELL ID # (if applicable) EP-3
STATE WELL PERMIT # (if applicable)
COUNTY WELL PERMIT # (if applicable)
DWQ or OTHER PERMIT # (if applicable)
WELL USE (Check applicable use): ❑ Monitoring ❑ Residential
❑ Municipal/Public ❑ Industrial/Commercial ❑ Agricultural
❑ Recovery ❑ Injection ❑ Irrigation
❑Other(list use) Temporary Monitor Well
3. WELL LOCATION:
COUNTY Vance QUADRANGLE NAME
NEAREST TOWN: Henderson
697 Greystone Road, Henderson, NC
(Street/Road Name, Number, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
0 Slope ❑ Valley ❑ Flat ❑ Ridge ❑ Other
(Check appropriate setting)
N36.36840 May be in degrees,
LATITUDE minutes, seconds, or in a
LONGITUDE W78.35813 decimal format
Latitude/longitude source: O CPS []Topographic map
(Location of well must be shown an a USGS topo map and
attached to this form if not ruing GPS.)
4a. FACILITY- The name of the business where the well is located. Complete 4a and4b.
(If a residential well, skip 4a; complete 4b, well owner information only.)
FACILITY ID #(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Road
Henderson NC 27536
City or Town State Zip Code
4b. CONTACT PERSON/WELL OWNER:
NAME R.S. Lawler
STREET ADDRESS PO Box 2408, Wilson, NC 27894
S. WELL DETAILS:
a. Total Depth: 21 ft. Diameter: 1 in.
b. Water Level (Below Measuring Point): ft.
Measuring point is 1.5 ft. above land surface.
6. CASING: Length Diameter
a. Casing Depth (if known): ft. in.
b. Casing Removed:— ft. —� in.
7. DISINFECTION: 71 %
(Amount of 65%75% calcium hypochlorite used)
8. SEALING MATERIAL:
Nest Cement Sand Cement
Cement lb, Cement lb.
Water gal. Water gal.
Bentonite
Bentonite 25 lb.
Type: ❑Slurry ®Pellets
Water gal.
Other
Type material
Amount
9. EXPLAIN METHOD OF EMPLACEMENT OF MATERIAL:
Tremie bentonite chips inside the well pipe
10. WELL DIAGRAM: Draw a detailed sketch of the well on the back of this
form showing total depth, depth and diameter of screens (if any) remaining
in the well, gravel interval, intervals of casing perforations, and depths and
types of fill materials used.
11. DATE WELL ABANDONED 9/1/11
1 DO HEREBY CERTIFY THAT THIS WELL WAS ABANDONED IN ACCORDANCE
WITH 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF
THIS RECORD HAS BEEN PROVID D TO E WELL OWNER.
9/23/2011
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
SIGNATURE OF PRIVATE WELL OWNER ABANDONING THE WELL DATE
(The private well owner must be an individual who o >y vn I abandons his/her residential well
in accordance with ISA NCAC 2C .0113.)
Thomas Whitehead
PRINTED NAME OF PERSON ABANDONING THE WELL
Submit a copy to the owner and the original to the Division of Water Quality within 30 days. Form GW-30
Ann: Information Management, 1617 Mail Service Center — Raleigh, NC 27699-1617, Phone No. [phone] tit 568. Rev. 5/06

WELL ABANDONMENT RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #2907
1. WELL CONTRACTOR:
Thomas Whitehead
Well Contractor (Individual) Name
S&ME, Inc.
Well Contractor Company Name
STREET ADDRESS 3201 Spring Forest Road
Raleigh NC 27616
City or Town State Zip Code
9( 19 ) - 872-2660
Area code - Phone number
2. WELL INFORMATION:
SITE WELL ID # (ifapplicable) EP-4
STATE WELL PERMIT # (ifapplicable)
COUNTY WELL PERMIT# (ifapplicable)
DWQ or OTHER PERMIT # (ifapplicable)
WELL USE (Check applicable use): ❑ Monitoring ❑ Residential
❑ Municipal/Public ❑ Ind ustrial/Commercial ❑ Agricultural
❑ Recovery ❑ Injection ❑ Irrigation
❑ other (list use) Temporary Monitor Well
3. WELL LOCATION:
COUNTY Vance QUADRANGLE NAME
NEAREST TOWN: Henderson
697 Greystone Road, Henderson, NC
(Street/Road Name, Number, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
® Slope ❑ Valley ❑ Flat ❑ Ridge ❑ Other
(Check appropriate setting)
LATITUDE N36.36846 May be in degrees,
minutes, seconds, or in a
LONGITUDE W78.35827 decimal format
Latitude/longitude source: O GPS ❑ Topographic map
(Location of well must be shown on a USGS topo map and
attached to this form if not using GPS.)
4a. FACILITY- The name of the business where the well is located. Complete 4a and4b.
(If a residential well, skip 4a: complete 4b, well owner information only.)
FACILITY ID #(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Road
Henderson NC 27536
City or Town State Zip Code
4b. CONTACT PERSONIWELL OWNER:
NAME R.S. Lawter
STREET ADDRESS PO BOX 2408, Wilson, NC 27894
6. WELL DETAILS:
a. Total Depth: 17 ft. Diameter: 1 in.
b. Water Level (Below Measuring Point): ft.
Measuring point is 1.5 ft. above land surface.
6. CASING: Length Diameter
a. Casing Depth (if known): ft. in.
b. Casing Removed: —�� ft. in.
7. DISINFECTION: 71%
(Amount of 65a/o 75% calcium hypochlorite used)
& SEALING MATERIAL:
Neat Cement Sand Cement
Cement lb. Cement lb.
Water gal. Water gal.
Bentonite
Bentonite 25 lb.
Type: ❑ Slurry ®Pellets
Water gal.
Other
Type material
Amount
9. EXPLAIN METHOD OF EMPLACEMENT OF MATERIAL:
Tremie bentonite chips inside the well pipe
10. WELL DIAGRAM: Draw a detailed sketch of the well on the back of this
form showing total depth, depth and diameter of screens (if any) remaining
in the well, gravel interval, intervals of casing perforations, and depths and
types of fill materials used.
11. DATE WELL ABANDONED 9/1/11
1 DO HEREBY CERTIFY THAT THIS WELL WAS ABANDONED IN ACCORDANCE
WITH 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF
THIS REC07 HAS BEEN PROVID TO E WELL OWNER
9/23/2011
GNATURE OF CERTIFIED WELL CONTRACTOR DATE
SIGNATURE OF PRIVATE WELL OWNER ABANDONING THE WELL DATE
(The private well owner muss be an individual who mrsoaal►yabandons his/her residential well
in accordance with 15A NCAC 2C .0113.)
Thomas Whitehead
PRINTED NAME OF PERSON ABANDONING THE WELL
Submit a copy to the owner and the original to the Division of Water Quality within 30 days. Form GW-30
Attn: Information Management, 1617 Mail Service Center — Raleigh, NC 27699-1617, Phone No. [phone] ext 568. Rev. 5/06

WELL ABANDONMENT RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #2907
1. WELL CONTRACTOR:
Thomas Whitehead
Well Contractor (Individual) Name
S&ME, Inc.
Well Contractor Company Name
STREET ADDRESS 3201 Spring Forest Road
Raleigh NC 27616
City or Town State Zip Code
9( 19 ) - 872-2660
Area code - Phone number
2. WELL INFORMATION:
SITE WELL ID # (if applicable) EP-5
STATE WELL PERMIT # (if applicable)
COUNTY WELL PERMIT # (if applicable)
DWQ or OTHER PERMIT # (if applicable)
WELL USE (Check applicable use): ❑ Monitoring ❑ Residential
❑ Municipal/Public ❑ Industrial/Commercial ❑ Agricultural
❑ Recovery ❑ Injection ❑ Irrigation
❑ Other (list use) Temporary Monitor Well
3. WELL LOCATION:
COUNTY Vance QUADRANGLE NAME
NEARESTTOWN: Henderson
697 Greystone Road, Henderson, NC
(Street/Road Name, Number, Comrramity, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
0 Slope ❑ Valley ❑ Flat ❑ Ridge ❑ Other
(Check appropriate setting)
LATITUDE N36.36827 May be in degrees,
minutes, seconds, or in a
LONGITUDE W/8.35821 decimal format
Latitude/longhude source: 21 GPS [:]Topographic map
(Location of well must be shown on a USGS topo map and
attached to this farm if not using GPS.)
4a. FACILITY- The name ofthe business where the well is located. Complete 4a and4b.
(If a residential well, skip 4a; complete 4b, well owner information only.)
FACILITY ID #(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Road
Henderson NC 27536
City or Town State Zip Code
4b. CONTACT PERSON/WELL OWNER:
NAME R.S. Lawter
STREET ADDRESS PO BOX 2408, Wilson, NC 27894
S. WELL DETAILS:
a. Total Depth: 20 ft. Diameter: 1 in
b. Water Level (Below Measuring Point): ft-
Measuring point is 1.5 ft. above land surface.
6. CASING: Length Diameter
a. Casing Depth (if known): ft. in.
b. Casing Removed: 3 ft. in.
7. DISINFECTION: 71 %
(Amount of 650/05% calcium hypochlorite used)
8. SEALING MATERIAL:
Neat Cement Sand Cement
Cement lb. Cement lb.
Water gal. Water gal.
Bentonite
Bentonite 25 lb.
Type: El Slurry OPellets
Water gal.
Other
Type material
Amount
9. EXPLAIN METHOD OF EMPLACEMENT OF MATERIAL:
Tremie bentonite chips inside the well pine
10. WELL DIAGRAM: Draw a detailed sketch of the well on the back of this
form showing total depth, depth and diameter of screens (if any) remaining
in the well, gravel interval, intervals ofcasing perforations, and depths and
types of fill materials used.
11. DATE WELL ABANDONED 9/1/11
1 DO HEREBY CERTIFY THAT THIS WELL WAS ABANDONED IN ACCORDANCE
WITH I SA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF
THIS RECORD HAS BEEN PROVIDED O THE WELL OWNER.
9/23/2011
SJGNATURE OF CERTIFIED WELL CONTRACTOR DATE
SIGNATURE OF PRIVATE WELL OWNER ABANDONING THE WELL DATE
(The private well owner must be an individual who personally abandons his/her residential well
in accordance with 15A NCAC 2C .0113.)
Thomas Whitehead
PRINTED NAME OF PERSON ABANDONING THE WELL
Submit a copy to the owner and the original to the Division of Water Quality within 30 days. Form GW -30
Attn: Information Management, 1617 Mail Service Center —Raleigh, NC 27699-1617, Phone No. [phone] ext 5". Rev. 5/06

WELL ABANDONMENT RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #2907
1. WELL CONTRACTOR:
Thomas Whitehead
Well Contractor (Individual) Name
S&ME, Inc.
Well Contractor Company Name
STREET ADDRESS 3201 Spring Forest Road
Raleigh NC 27616
City or Town State Zip Code
9( 19 ) - 872-2660
Area code - Phone number
2. WELL INFORMATION:
SITE WELL ID # (if applicable) EP-6
STATE WELL PERMIT # (if applicable)
COUNTY WELL PERMIT # (if applicable)
DWQ or OTHER PERMIT # (if applicable)
WELL USE (Check applicable use): ❑ Monitoring ❑ Residential
❑ Municipal/Public ❑ Industrial/Commercial ❑ Agricultural
❑ Recovery ❑ Injection ❑ Irrigation
❑ Other (list use) Temporary Monitor Well
3. WELL LOCATION:
COUNTY Vance QUADRANGLE NAME
NEAREST TOWN: Henderson
697 Greystone Road, Henderson, NC
(Street/Road Name, Number, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
® Slope ❑ Valley ❑ Flat ❑ Ridge ❑
(Check appropriate setting)
LATITUDE N36.36836 May be in degrees,
minutes, seconds, or in a
LONGITUDE W78.35848 decimal format
Latitudellongitude source: O GPS []Topographic map
(Location of well must be shown on a USGS topo map and
attached to this form if not using CPS)
4a. FACILITY- The name of the business where the well is located Complete 4a and4b.
(Ifa residential well, skip 4a; complete 4b, well owner information only.)
FACILITY ID #(if applicable)
NAME OF FACILITY S. T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Road
Henderson NC 27536
City or Town State Zip Code
4b. CONTACT PERSON/WELL OWNER:
NAME R.S. Lawter
STREET ADDRESS PO Box 2408, Wilson, NC 27894
5. WELL DETAILS:
a. Total Depth: 20 ft. Diameter: 2 in.
b. Water Level (Below Measuring Point): ft.
Measuring point is 1.5 ft. above land surface.
6. CASING: Length Diameter
a. Casing Depth (if known): ft. in.
b. Casing Removed: —� ft. —�� in.
7. DISINFECTION: 71 %
(Amount of 65%75% calcium hypochlorite used)
S. SEALING MATERIAL:
Neat Cement Sand Cement
Cement lb. Cement lb.
Water gal. Water gal.
Bentonite
Bentonite 75 lb.
Type: El Slurry V]Pellets
Water gal.
Other
Type material
Amount
9. EXPLAIN METHOD OF EMPLACEMENT OF MATERIAL:
Tremie bentonite chips inside the well pipe
10. WELL DIAGRAM: Draw a detailed sketch of the well on the back of this
form showing total depth, depth and diameter of screens (if any) remaining
in the well, gravel interval, intervals of casing perforations, and depths and
types of fill materials used.
11. DATE WELL ABANDONED 9/1/11
1 DO HEREBY CERTIFY THAT THIS WELL WAS ABANDONED IN ACCORDANCE
WITH 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF
THIS RECORD HAS BEEN
PROVIDr TO THE WELL OWNER.
�./9/23/2011
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
SIGNATURE OF PRIVATE WELL OWNER ABANDONING THE WELL DATE
(Me private well owner must be an individual who txrsonally abandons his/her residential well
in accordance with 15A NCAC 2C .0113.)
Thomas Whitehead
PRINTED NAME OF PERSON ABANDONING THE WELL
Submit a copy to the owner and the original to the Division of Water Quality within 30 days. Form GW -30
Attn: Information Management, 1617 Mail Service Center — Raleigh, NC 27699-1617, Phone No. [phone] ext 568. Rev. 5/06

WELL ABANDONMENT RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #2907
1. WELL CONTRACTOR:
Thomas Whitehead
Well Contractor (Individual) Name
SBtME, Inc.
Well Contractor Company Name
STREET ADDRESS 3201 Spring Forest Road
Raleigh NC 27616
City or Town State Zip Code
9( 19 ) - 872-2660
Area code - Phone number
2. WELL INFORMATION:
SITE WELL 1D # (if applicable) EP-7
STATE WELL PERMIT # (if applicable)
COUNTY WELL PERMIT # (if applicable)
DWQ or OTHER PERMIT # (if applicable)
WELL USE (Check applicable use): ❑ Monitoring ❑ Residential
❑ Municipal/Public ❑ IndustrinUCommercial ❑ Agricultural
❑ Recovery ❑ Injection ❑ Irrigation
❑ Other (list ..),-Temporary Monitor Well
3. WELL LOCATION:
COUNTY Vance QUADRANGLE NAME
NEAREST TOWN: Henderson
697 Greystone Road, Henderson, NC
(Street/Road Name, Number, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
0 Slope ❑ Valley ❑ Flat ❑ Ridge ❑ Other,
(Check appropriate setting)
LATITUDE N36.36848 May be in degrees,
minutes, seconds, or in a
LONGITUDE W78.35833 deC111al fO1m7S
Latitude/longitude source: 0 CPS []Topographic map
(Location oftell must be shown on a USGS topo map and
attached to this form if not using GPS.)
4a. FACILITY- The name of the business where the well is located. Complete 4a and4b.
(I fa residential well, skip 4a; complete 4b, well owner information only.)
FACILITY ID #(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Road
Henderson NC 27536
City or Town State Zip Code
4b. CONTACT PERSON/WELL OWNER:
NAME R.S. Lawter
STREET ADDRESS PO BOX 2408, Wilson, NC 27894
b. WELL DETAILS:
a Total Depth: 21 ft. Diameter: 1 in.
b. Water Level (Below Measuring Point): ft.
Measuring point is 1.5 IL above land surface.
6. CASING: Length Diameter
a. Casing Depth (if known): ft, in.
b. Casing Removed:— ft. �- in.
7. DISINFECTION: 71 %
(Amount of 651/05% calcium hypochlorite used)
8. SEALING MATERIAL:
Neat_ (nit Sand Cement
Cement lb. Cement lb
Water gal. Water gal.
Bentonite
Bentonite 25 lb.
Type: ❑Slurry OPellets
Water gal.
Other
Type material
Amount
9. EXPLAIN METHOD OF EMPLACEMENT OF MATERIAL:
Tremie bentonite Chips inside the well pipe
10. WELL DIAGRAM: Draw a detailed sketch of the well on the back of this
form showing total depth, depth and diameter of screens (if any) remaining
in the well, gravel interval, intervals of casing perforations, and depths and
types of fill materials used.
11. DATE WELL ABANDONED 9/1/11
1 DO HEREBY CERTIFY THAT THIS WELL WAS ABANDONED IN ACCORDANCE
WITH 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF
THIS RECORD HAS BEEN PROV[.�/� I'rr`-THE WELL OWNER.
9/23/2011
�UREERTIFIED WELL CONTRACTOR DATE
SIGNATURE OF PRIVATE WELL OWNER ABANDONING THE WELL DATE
Jbc private well owner mutt be an individual who pw2nall,(y abandons his/her residential well
in accordance with 15A NCAC 2C .0113.)
Thomas Whitehead
PRINTED NAME OF PERSON ABANDONING THE WELL
Submit a copy to the owner and the original to the Division of Water Quality within 30 days. Form GW -30
Attn: Information Management, 1617 Mail Service Center -Raleigh, NC 27699-1617, Phone No. [phone] eut 568. Rev. 5/06

e.. Anti^
- 4
WELL ABANDONMENT RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #2907
1. WELL CONTRACTOR:
Thomas Whitehead
Well Contractor (Individual) Name
S&ME, Inc.
Well Contractor Company Name
STREET ADDRESS 3201 Spring Forest Road
Raleigh NC 27616
City or Town State Zip Code
9( 19 ) - 872-2660
Area code - Phone number
2. WELL INFORMATION:
SITE WELL ID# (ifapplicable) EP-8
STATE WELL PERMIT # (if applicable)
COUNTY WELL PERMIT # (if applicable)
DWQ or OTHER PERMIT # (if applicable)
WELL USE (Check applicable use): ❑ Monitoring ❑ Residential
❑ Municipal/Public ❑ Industrial/Commercial ❑ Agricultural
❑ Recovery ❑ Injection ❑ Irrigation
❑ Other (list use) Temporary Monitor Well
3. WELL LOCATION:
COUNTY Vance QUADRANGLE NAME
NEAREST TOWN: Henderson
697 Greystone Road, Henderson, NC
(Street/Road Name, Number, Community, Subdivision, Lot No., Parcel, tip Code)
TOPOGRAPHIC / LAND SETTING:
®Slope ❑ Valley ❑ Flat ❑ Ridge ❑ Other
(Check appropriate setting)
N36.36842 May be in degrees.
LATITUDE _ minutes, seconds, or in a
LONGITUDE W78.35827 decimal format
Latitude/longitude source: lI GPS ❑ Topographic map
(Location of well must be shown on a USGS topo map and
attached to this form if not using GPS.)
4a. FACILITY- The name of the business where the well is located. Complete 4a and4b.
(If a residential well, skip 4a; complete 4b, well owner information only.)
FACILITY ID #(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Road
Henderson NC 27536
City or Town Stale Zip Code
4b. CONTACT PERSON/WELL OWNER:
NAME R.S. Lawter
STREET ADDRESS PO BOX 2408, Wilson, NC 27894
S. WELL DETAILS:
a. Total Depth: 20 ft. Diameter: 2 in.
b. Water Level (Below Measuring Point): ft.
Measuring point is 1.5 ft. above land surface.
6. CASING: Length Diameter
a. Casing Depth (if known): ft. in.
b. Casing Removed: 5 ft. —� in.
7. DISINFECTION: 71 %
(Amount of65a/o-75%calcium hypochlorite used)
8. SEALING MATERIAL:
N mement Sand Cement
Cement lb. Cement lb.
Water gal. Water gal
Bentonite
Bentonite 75 lb.
Type. ❑ Slurry F11pellets
Water gal.
Other
Type material
Amount
9. EXPLAIN METHOD OF EMPLACEMENT OF MATERIAL:
Tremie hentonit _ chips inside the well pipe
10. WELL DIAGRAM: Draw a detailed sketch of the well on the back of this
form showing total depth, depth and diameter of screens (if any) remaining
in the well, gravel interval, intervals of casing perforations, and depths and
types of ftl I materials used.
11. DATE WELL ABANDONED 9/1/11
I DO HEREBY CERTIFY THAT THIS WELL WAS ABANDONED IN ACCORDANCE
WITH 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF
THIS RECORD HAS BEEN PROVIDE TO E WELLOWNER.
9/23/2011
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
SIGNATURE OF PRIVATE WELL OWNER ABANDONING THE WELL DATE
(The private well owner must be an individual who psrsona ly abandons his/her residential well
in accordance with 15A NCAC 2C .0113.)
Thomas Whitehead
PRINTED NAME OF PERSON ABANDONING THE WELL
Submit a copy to the owner and the original to the Division of Water Quality within 30 days. Form GW -30
Attn: Information Management, 1617 Mail Service Center - Raleigh, NC 27699-1617, Phone No. [phone] eat 568. Rev. 5/06

WELL ABANDONMENT RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #2907
1. WELL CONTRACTOR:
Thomas Whitehead
Well Contractor (individual) Name
S&ME, Inc.
Well Contractor Company Name
STREET ADDRESS 3201 Spring Forest Road
Raleigh NC 27616
City or Town State Zip Code
9( 19 ) _ 872-2660
Area code - Phone number
2. WELL INFORMATION:
SITE WELL ID# (ifapplicabic) EP-9
STATE WELL PERMIT # (if applicable)
COUNTY WELL PERMIT # (if applicable)
DWQ or OTHER PERMIT # (if applicable)
WELL USE (Check applicable use): ❑ Monitoring ❑ Residential
❑ Municipal/Public ❑ Industrial/Commercial ❑ Agricultural
❑ Recovery ❑ Injection ❑ Irrigation
❑ Other (list use) Temporary Monitor Well
3. WELL LOCATION:
COUNTY Vance QUADRANGLE NAME
NEAREST TOWN: Henderson
697 Greystone Road, Henderson, NC
(Street/Road Name, Number, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING-
® Slope []Valley []Flat ❑ Rtdge ❑ Other
(Check appropriate setting)
LATITUDE N36.36850 May be in degrees,
minutes, seconds, or in a
LONGITUDE W78.35836 decimal format
Latitude/longitude source: O GPS ❑ Topographic map
(Location of well must be shown on a USGS topo map and
attached to this form if not using GPS.)
4a. FACILITY- The name ofthe business where the well is located. Complete 4a and4b.
(If a residential well, skip 4a; complete 4b, well owner information only.)
FACILITY ID #(ifapplicabie)
NAME OF FACiLrrY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Road
Henderson NC 27536
City or Town State Zip Code
4b. CONTACT PERSON/WELL OWNER:
NAME R.S. Lawter
STREET ADDRESS PO BOX 2408, Wilson, NC 27894
5. WELL DETAILS:
a. Total Depth: 17 ft. Diameter: 1 in.
b. Water Level (Below Measuring Point): ft.
Measuring point is 1-5 ft. above land surface.
6. CASING: Length Diameter
a. Casing Depth (if known): ft. in.
b. Casing Removed: ft. �— in.
7. DISINFECTION: 71%
(Amount of 651/6-75% calcium hypochlorite used)
8. SEALING MATERIAL:
Neat Cement Sand Cement
Cement lb. Cement lb.
Water gal. Water gal.
Bentonite
Bentonite 25 lb.
Type: [I Slurry V]Pellets
Water gal.
OL1111r.
Type material
Amount
9. EXPLAIN METHOD OF EMPLACEMENT OF MATERIAL:
Tremie bentonite chips inside the well pipe
10. WELL DIAGRAM: Draw a detailed sketch of the well on the back of this
form showing total depth, depth and diameter of screens (if any) remaining
in the well, gravel interval, intervals of casing perforations, and depths and
types of fill materials used.
11. DATE WELL ABANDONED 9/1/11
I DO HEREBY CERTIFY THAT THIS WELL WAS ABANDONED IN ACCORDANCE
WITH 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF
THIS R AS BEEN PROVIDE T THE WELL OWNER.
9/23/2011
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
SIGNATURE OF PRIVATE WELL OWNER ABANDONING THE WELL DATE
(The private well owner must be an individual who pWMuy abandons his/her residential well
in accordance with 15A NCAC 2C .0113.)
Thomas Whitehead
PRINTED NAME OF PERSON ABANDONING THE WELL
Submit a copy to the owner and the original to the Division oI Water Quality within 30 days. Form GW-30
Attn: Information Management, 1617 Mail Service Center — Raleigh, NC 27699-1617, Phone No. [phone] ext 568. Rev. 5/06

WELL ABANDONMENT RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2907
1. WELL CONTRACTOR:
Thomas Whitehead
Well Contractor (Individual) Name
S&ME, Inc.
Well Contractor Company Name
STREET ADDRESS 3201 Spring Forest Road
Raleigh NC 27616
City or Town State Zip Code
9( 19 ) _ 872-2660
Area code - Phone number
2. WELL INFORMATION:
SITE WELL ID # (if applicable) EP-10
STATE WELL PERMIT # (if applicable)
COUNTY WELL PERMIT # (if applicable)
DWQ or OTHER PERMIT # (if applicable)
WELL USE (Check applicable use): ❑ Monitoring ❑ Residential
❑ Municipal/Public ❑ Industrial/Commercial ❑ Agricultural
❑ Recovery ❑ Injection ❑ Irrigation
[]Other (list use) Temporary Monitor Well
3. WELL LOCATION:
COUNTY Vance QUADRANGLE NAME
NEAREST TOWN: Henderson
697 Greystone Road, Henderson, NC
(Street/Road Name, Number, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
IZ Slope ❑ Valley ❑ Flat ❑ Ridge ❑ Other
(Check appropriate setting)
LATITUDE N36.36842 May be in degrees,
minutes, seconds, or in a
LONGITUDE W78.35823 decimal format
Latitude/longitude source: O GPS ❑ Topographic map
(Location of well must be shown on a USGS topo map and
attached to this form ifnot using GPS.)
4a. FACILITY- The name of the business where the well is located. Complete 4a and4b.
(If a residential well, skip 4a; complete 4b, well owner information only.)
FACILITY ID #(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Road
Henderson NC 27536
City or Town State Zip Code
4b. CONTACT PERSON/WELL OWNER:
NAME R.S. (_awter
STREET ADDRESS PO BOX 2408, Wilson, NC 27894
S. WELL DETAILS:
a. Total Depth: 23 ft. Diameter: 1 in.
b. Water Level (Below Measuring Point): ft.
Measuring point is 1.5 ft. above land surface.
6. CASING: Length Diameter
a. Casing Depth (if known): ft. in.
b. Casing Removed: 3 ft. —� in.
7. DISINFECTION: 71 %
(Amount of 65a/r75% calcium hypochlorite used)
8. SEALING MATERIAL:
Neat Cement Sand Cement
Cement lb. Cement lb.
Water gal. Water gal.
ntonite
Bentonite 37 lb.
Type: ❑Slurry OPellets
Water gal.
Other
Type material
Amount
9. EXPLAIN METHOD OF EMPLACEMENT OF MATERIAL:
Tremie bentonite chips inside the well pipe
10. WELL DIAGRAM: Draw a detailed sketch ofthe well on the back of this
forth showing total depth, depth and diameter of screens (if any) remaining
in the well, gravel interval, intervals of casing perforations, and depths and
types of fill materials used.
11. DATE WELL ABANDONED 9/1/11
I DO HEREBY CERTIFY THAT THIS WELL WAS ABANDONED IN ACCORDANCE
WITH 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF
THIS RECORD AS BEEN PROVIDED TO THE WELL OWNER.
9/23/2011
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE.
SIGNATURE OF PRIVATE WELL OWNER ABANDONING THE WELL DATE
(The private well owner must be an inditidual who psrsolt;fy abandons his/her residential well
in accordance with I SA NCAC 2C .0113.)
Thomas Whitehead
PRINTED NAME OF PERSON ABANDONING THE WELL
Submit a copy to the owner and the original to the Division of Water Quality within 30 days. Form GW -30
Attn: Information Management, 1617 Mail Service Center — Raleigh, NC 27699-1617, Phone No. [phone] e:t 568. Rev. 5/06

WELL ABANDONMENT RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #2907
1. WELL CONTRACTOR:
Thomas Whitehead
Well Contractor (Individual) Name
S&ME, Inc.
Well Contractor Company Name
STREET ADDRESS 3201 Spring Forest Road
Raleigh NC 27616
City or Town State Zip Code
9( 19 ) - 872-2660
Area code - Phone number
2. WELL INFORMATION:
SITE WELL ID # (if applicable) EP-11
STATE WELL PERMIT# (ifapplicable)
COUNTY WELL PERMIT # (if applicable)
DWQ or OTHER PERMIT # (if applicable)
WELL USE (Check applicable use): ❑ Monitoring ❑ Residential
❑ Municipal/Public ❑ Industrial/Commercial ❑ Agricultural
❑ Recovery ❑ Injection ❑ Irrigation
❑ Other (list use) Temporary Monitor Well
3. WELL LOCATION:
COUNTY Vance QUADRANGLE NAME
NEAREST TOWN: Henderson
697 Greystone Road, Henderson, NC
(Strect(Road Name, Number, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
0 Slope ❑ Valley ❑ Flat ❑ Ridge ❑ Other_
(Check appropriate setting)
N36.36844 May be in degrees,
LATITUDE minutes, seconds, or in a
LONGITUDE
W78.35822 decimal format
Latitude/longitude source: O GPS ❑ Topographic map
(Location ojwe/i must be shown on a USGS topo map and
attached to this form ijnot using CPS)
49. FACILITY- The name of the business where the well is located. Complete 4a and4b.
(I fa residential well, skip 4a; complete 4b, well owner information only.)
FACILITY ID #(if applicable)
NAME OF FACILITYS•T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Road
Henderson NC 27536
City or Town State Zip Code
4b. CONTACT PERSON/WELL OWNER:
NAME R.S. Lawter
STREET ADDRESS PO BOX 2408, Wilson, NC 27894
S. WELL DETAILS:
a. Total Depth: 22 ft. Diameter: 1 in.
b. Water Level (Below Measuring Point): ft.
Measuring point is 1.5 ft. above land surface.
6. CASING: Length Diameter
a. Casing Depth (if known): ft. in.
b. Casing Removed: ft. 1 in.
7. DISINFECTION: 71%
(Amount of 65%-75% calcium hypochlorite used)
8. SEALING MATERIAL:
Nest Cement Sand Cement
Cement lb, Cement lb.
Water gal. Water gal.
Bentonite
Bentonite 25 lb.
Type: ❑Slurry I]Pelles
Water gal.
Other
Type material
Amount
9. EXPLAIN METHOD OF EMPLACEMENT OF MATERIAL:
Tremie hentcnite chins inside the well pipe
10. WELL DIAGRAM: Draw a detailed sketch of the well on the back of this
form showing total depth, depth and diameter of screens (if any) remaining
in the well, gravel interval, intervals of casing perforations, and depths and
types of fill materials used.
If. DATE WELL ABANDONED 9/1/11
1 DO HEREBY CERTIFY THAT THIS WELL WAS ABANDONED IN ACCORDANCE
WITH I SA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF
THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
:M4= 9/23/2011
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
SIGNATURE OF PRIVATE WELL OWNER ABANDONING THE WELL DATE
(The private well owner must be an individual who personally abandons his/her residential well
in accordance wish 15A NCAC 2C .0113.)
Thomas Whitehead
PRINTED NAME OF PERSON ABANDONING THE WELL
Submit a copy to the owner and the original to the Division of Water Quality within 30 days. Form GW -30
Attn: Information Management, 1617 Mail Service Center —Raleigh, NC 27699-1617, Phone No. (9I9) 733-7015 eret 568. Rev, 5/06

WELL ABANDONMENT RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2907
1. WELL CONTRACTOR:
Thomas Whitehead
Well Contractor (Individual) Name
S&ME, Inc.
Well Contractor Company Name
STREET ADDRESS 3201 Spring Forest Road
Raleigh NC 27616
City or Town State Zip Code
9( 19 ) - 872-2660
Area code - Phone number
2. WELL INFORMATION:
SITE WELL ID # (if applicable) EP-12
STATE WELL PERMIT # (if applicable)
COUNTY WELL PERMIT # (if applicable)
DWQ or OTHER PERMIT # (if applicable)
WELL USE (Check applicable use): ❑ Monitoring ❑ Residential
❑ Municipal/Public ❑ Industrial/Commercial ❑ Agricultural
❑ Recovery ❑ Injection ❑ Irrigation
❑ Other (list use) Temporary Monitor Well
3. WELL LOCATION:
COUNTY Vance QUADRANGLE NAME
NEAREST TOWN: Henderson
697 Greystone Road, Henderson, NC
(Street/Road Name, Number, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
® Slope ❑ Valley []Flat ❑ Ridge ❑ Other
(Check appropriate setting)
LATITUDE N36.36850 May be in degrees,
minutes, seconds, or in a
LONGITUDE W78.35833 decimal format
Latitudellongitude source: 0 GPS ❑ Topographic map
(Location of well must be shown on a USGS ropo map and
attached to this form if not using GPS)
4a. FACILITY- The name of the business where the well is located. Complete 4a and4b.
(If a residential well, skip 4a; complete 4b, well owner information only.)
FACILITY ID #(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Road
Henderson NC 27536
City or Town State Zip Code
4b. CONTACT PERSON/WELL OWNER:
NAME R.S. Lawter
STREET ADDRESS PO Box 2408, Wilson, NC 27894
S. WELL DETAILS:
a. Total Depth: 20 ft. Diameter: 2 in.
b. Water Level (Below Measuring Point): ft.
Measuring point is 1.5 ft. above land surface.
6. CASING: Length Diameter
a. Casing Depth (if known): ft. in.
b. Casing Removed: ft. -� in.
7. DISINFECTION: 71 %
(Amount of65°/P75%calcium hypochlorite used)
8. SEALING MATERIAL:
Neat Cement Send Cement
Cement lb. Cement lb
Water gal. Water gal.
nont
Bentonite 75 lb.
Type: ❑Slurry oPellets
Water gal.
Other
Type material
Amount
9. EXPLAIN METHOD OF EMPLACEMENT OF MATERIAL:
Tremie bentonite chips inside the well pipe
10. WELL DIAGRAM: Draw a detailed sketch of the well on the back of this
form showing total depth, depth and diameter of screens (if any) remaining
in the well, gravel interval, intervals ofeasing perforations, and depths and
types of fill materials used.
11. DATE WELL ABANDONED 9/1/11
1 DO HEREBY CERTIFY THAT THIS WELL WAS ABANDONED IN ACCORDANCE
WITH 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF
THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
'2;�:`✓ 9/23/2011
SIGNATURE OFFCERTIFIED WELL CONTRACTOR DATE
SIGNATURE OF PRIVATE WELL OWNER ABANDONING THE WELL DATE
(The private well owner must be an individual who oersomlly abandons his/her residential well
in accordance with 15A NCAC 2C .0113.)
Thomas Whitehead
PRINTED NAME OF PERSON ABANDONING THE WELL
Submit a copy to the owner and the original to the Division or Water Quality within 30 days. Form GW-30
Attn: Information Management, 1617 Mail Service Center — Raleigh, NC 27699-1617, Phone No. [phone] ext 568. Rev. 5/06

WELL ABANDONMENT RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2907
1. WELL CONTRACTOR:
Thomas Whitehead
Well Contractor (Individual) Name
S&ME, Inc.
Well Contractor Company Name
STREET ADDRESS 3201 Spring Forest Road
Raleigh NC 27616
City or Town State Zip Code
9( 19 ) _ 872-2660
Area code - Phone number
2. WELL INFORMATION.
SITE WELL ID # (ifapplicable) EP-13
STATE WELL PERMIT # (if applicable)
COUNTY WELL PERMIT # (if applicable)
DWQ or OTHER PERMIT # (if applicable)
WELL USE (Check applicable use): ❑ Monitoring ❑ Residential
❑ Municipal/Public ❑ Industrial/Commercial ❑ Agricultural
❑ Recovery ❑ Injection ❑ Irrigation
❑ Other (list use) jemporary Monitor Well
3. WELL LOCATION:
COUNTY Vance QUADRANGLE NAME
NEAREST TOWN: Henderson
697 Greystone Road, Henderson, NC
(Street/Road Name, Number, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
O Slope ❑ Valley ❑ Flat ❑ Ridge ❑ Other
(Check appropriate setting)
LATITUDE N36.36869 May be in degrees,
minutes, seconds, or in a
LONGITUDE W78.35841 decimal format
Latitude/longitude source: O GPS ❑ Topographic map
(Location of rvell must be shown on a USGS topo map and
attached to this form if not using GPS)
4a. FACILITY- The name of the business where the well is located. Complete 4a and4b.
(If a residential well, skip 4a; complete 4b, well owner infommation only.)
FACILITY ID #(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Road
Henderson NC 27536
City or Town State Zip Code
4b. CONTACT PERSON/WELL OWNER:
NAME R.S. Lawter
STREET ADDRESS PO BOX 2408, Wilson, NC 27894
6. WELL DETAILS:
a. Total Depth: 20 ft. Diameter: 2 in.
b. Water Level (Below Measuring Point): ft.
Measuring point is 1.5 ft. above land surface.
6. CASING: Length Diameter
a. Casing Depth (if known): ft. in.
b. Casing Removed: 5 ft. �2 in.
7. DISINFECTION: 71 %
(Amount of 651/05% calcium hypochlorite used)
g. SEALING MATERIAL:
Neat Cement Sand Cement
Cement lb. Cement lb.
Water gal. Water gal
Bentonite
Bentonite 75 lb.
Type: El Slurry ®Pellets
Water gal.
Other
Type material
Amount
9. EXPLAIN METHOD OF EMPLACEMENT OF MATERIAL:
Tremie bentonite chip,, inside the well pine
10. WELL DIAGRAM: Draw a detailed sketch of the well on the back of this
form showing total depth, depth and diameter of screens (if any) remaining
in the well, gravel interval, intervals of casing perforations, and depths and
types of rill materials used.
11. DATE WELL ABANDONED 9/1/11
I DO HEREBY CERTIFY THAT THIS WELL WAS ABANDONED IN ACCORDANCE
WITH 1 SA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF
THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
9/23/2011
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
SIGNATURE OF PRIVATE WELL OWNER ABANDONING THE WELL DATE
(The private well owner must be an individual who personally abandons his/her residential well
in accordance with I SA NCAC 2C .0113.)
Thomas Whitehead
PRINTED NAME OF PERSON ABANDONING THE WELL
Submit a copy to the owner and the original to the Division of Water Quality within 30 days. Form GW-30
Attn: Information Management, 1617 Mail Service Center — Raleigh, NC 27699-1617, Phone No. [phone] ext 565. Rev. 5/06

WELL ABANDONMENT RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #2907
1. WELL CONTRACTOR:
Thomas Whitehead
Well Contractor (Individual) Name
S8tME, Inc.
Well Contractor Company Name
STREET ADDRESS 3201 Spring Forest Road
Raleigh NC 27616
City or Town State Zip Code
9( 19 ) - 872-2660
Area code - Phone number
2. WELL INFORMATION:
SITE WELL ID # (if applicable) EP-14
STATE WELL PERMIT # (if applicable)
COUNTY WELL PERMIT # (if applicable)
DWQ or OTHER PERMIT # (if applicable)
WELL USE (Check applicable use): ❑ Monitoring ❑ Residential
❑ Municipat/Public ❑ Industrial/Commercial ❑ Agricultural
❑ Recovery ❑ Injection ❑ Irrigation
❑ Other (list use) Temporary Monitor Well
3. WELL LOCATION:
COUNTY Vance QUADRANGLE NAME
NEAREST TOWN: Henderson
697 Greystone Road, Henderson, NC
(Street/Road Name, Number, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
O Slope ❑ Valley ❑ Flat ❑ Ridge ❑
(Check appropriate setting)
LATITUDE N36.36803 May be in degrees,
minutes, seconds, or in a
LONGITUDE W78.35842 decimal format
Latitude/longitude source: O GPS ❑ Topographic map
(Location of well must be shown on a USGS topo map and
attached to this form if nor using GPS.)
4a. FACILITY- The name ofthe business where the well is located. Complete 4a and4b.
(If a residential well, skip 4a; complete 4b, well owner information only.)
FACILITY 1D #(if applicable)
NAME OF FACILITY S.T. Wooten Asphalt Plant
STREET ADDRESS 697 Greystone Road
Henderson NC 27536
City or Town State Zip Code
4b. CONTACT PERSONIWELL OWNER:
NAME R.S. Lawter
STREET ADDRESS PO BOX 2408, Wilson, NC 27894
6. WELL DETAILS:
a. Total Depth: 23 ft. Diameter: 1 in.
b. Water Level (Below Measuring Point): ft.
Measuring point is 1.5 ft. above land surface.
6. CASING: Length Diameter
a. Casing Depth (if known): ft. in.
b. Casing Removed: —�� ft. �— in.
7. DISINFECTION: 71%
(Amount of65%75%calcium hypochlorite used)
S. SEALING MATERIAL:
Neat Cement Sand Cement
Cement lb. Cement lb.
Water gal. Water gal.
Bentonite
Bentonite 37 lb.
Type: El Slurry (Pellets
Water gal.
Other
Type material
Amount
9. EXPLAIN METHOD OF EMPLACEMENT OF MATERIAL:
Tremie bentonite chips inside the well pipe
10. WELL DIAGRAM: Draw a detailed sketch of the well on the back of this
form showing total depth, depth and diameter of screens (if any) remaining
in the well, gravel interval, intervals of casing perforations, and depths and
types of fill materials used.
11. DATE WELL ABANDONED 9/1/11
1 DO HEREBY CERTIFY THAT THIS WELL WAS ABANDONED IN ACCORDANCE
WITH 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF
THIS RECORD HAS BEEN PROVIDED TONNE WELL OWNER.
ZZ� lil%t....g 9/23/2011
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
SIGNATURE OF PRIVATE WELL OWNER ABANDONING THE WELL DATE
(The private well owner must be an individual who g4@onab abandons his/her residential well
in accordance with 15A NCAC 2C .0113.)
Thomas Whitehead
PRINTED NAME OF PERSON ABANDONING THE WELL
Submit a copy to the owner and the original to the Division of Water Quality within 30 days. Form GW -30
Attn: Information Management, 1617 Mail Service Center — Raleigh, NC 27699-1617, Phone No. [phone] ext 5M. Rev. 5/06

0, A'
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
July 21, 2011
Larry Outten'
Regional Probing Services
P.O. Box 1161
Wake Forest, N.C. 27588
Re: Piezometers/temporary wells located at S.T. Wooten facility
S. T. Wooten
US 1/Highway 158
Henderson, NC -Vance County
Permit #WQ0004209
Incident#201101458
Dear Mr. Outten:
The Aquifer Protection Section (APS) of the Division of Water Quality (DWQ) is responsible for the
regulation of well construction activities within the State of North Carolina. On July 7, 2011, an annual
site inspection of the groundwater remediation system was conducted at the facility at the above listed
address in Henderson, N.C. In the course of conducting the inspection it was noted that several wells were
not in compliance with the well construction standards per 15A NCAC 02C .0108.
The following listed issues are a summary of the violations noted during the inspection:
The wells designated as piezometers/temporary and installed in 2008 (or possible prior to) were not
properly constructed. Eleven of the wells were located during the inspection. Documentation received
after the inspection from S.T. Wooten Company (7-7-11) indicates there may be as many as sixteen wells
of similar construction at the site. The basic construction of the wells appear to be a one (1) inch casing
rising above grade approximately twenty four inches. An approximately sixteen inch length by four inch
width PVC outer casing ("collar") is installed around the one inch casing. The annular space between the
one inch PVC and outer PVC casing was grouted. Two of the wells inspected (off of the gravel road near
the remediation system) did not have grout installed that extended below the surface grade. Please note
because of varying site conditions each well was not inspected for grouig. These wells did not have tags
installed or locking well caps. Slip caps had been installed with the exception of one well which did not
have a slip cap at the time of inspection and was open to the environment.
In the conversation (7-20-11) between yourself and staff with the Raleigh Regional Office, APS you
were not entirely certain that all of the wells (piezometers/temporary) were installed by you. However you
indicated that a majority of the wells were installed by yourself. In light of this information you are being
directed to repair or abandon the wells in question that were installed by yourself. It will be necessary to
inspect all of these same construction type wells at the site to ensure that were not installed by you and if
so, that the wells are in compliance with the 2C rules. .
Aquifer Protection Section
1628 Mail Service Ccnter. Raleigh, North Carolina 27699-1628
Location: 3800 Barrett Dr.. Raleigh, North Carolina 27609
Phone: [phone] % FAX: [phone] l Customer Service: 1-877.623-6743
(ntemet: www rtmateraualitv.ora
An Equal Opportunity 1, Affirmative Action Employer
Oiie
NhCarohna
Naturally

Larry Outten
Page 2
July 21, 2011
Specific rule violation(s):
1. 15A NCAC 02C .0108 Standards of Construction: Wells Other Than Water Supply
(a) No well shall be located, constructed, operated, or repaired in any manner that may adversely
impact. the quality of groundwater;
(g) The well shall be constructed in such a manner that water or contaminants from the land
surface cannot migrate along the borehole annulus into any packing material or well screen
area
(i) In non -water supply wells, grout shall be placed in the annular space between the outermost
casing and the borehole wall from land surface to the top of the bentonite seal above any well
screen or to the bottom of the casing for open ended wells. The grout shall comply with
paragraph (e) of Rule .0107 of this Section except the upper three feet of grout shall be
concrete or cement grout
(k) All non -water supply wells, including temporary wells, shall be secured with a locking well
cap to ensure against unauthorized access and use
(1) All non -water supply wells shall be equipped with a steel outer casing or flush mount cove,
set in concrete, and other measures sufficient to protect the well from damage by normal site
activities;
(o) Each non -water supply well shall have permanently affixed an identification plate.
(s) Temporary wells and all other non -water supply wells shall be constructed in such a manner
as to preclude the vertical migration of contaminants within and along the borehole channel.
Required Corrective Actions:
1. The wells are required to be completed in such a manner that the wells are in compliance with the
rules or properly abandoned. Any well which can not meet the rule should be abandoned pursuant
to 15A NCAC 2C .0113(d):
a) less than 20 feet in depth and which do not penetrate the water table shall be abandoned by
filling the entire well up to land surface with a grout, dry clay, or material excavated during
the drilling of the well and then compacted in place; and
b) ' greater than 20 feet in depth or that penetrate the water table shall be abandoned by
completely filling with a bentonite or cement-type.grout
• A certified well contractor must be used for all well repair/abandonment activities.
2. Inspect all wells of this type associated with the site and determine if you were the well driller. If
the construction of the wells are in violation of the well construction rules, take the necessary
steps to repair or abandon the additional wells.

Larry Outten
Page 3
July 21, 2011
Please take the corrective action(s) for the above violation(s) as necessary to bring all wells into
compliance. Corrective actions must be taken and reported to the Raleigh Regional Office within 30 days,
from the date of this notice to avoid recommendation of civil penalties for continuing violations.
Please submit the documentation explaining how you brought yourself back into compliance
including the well abandonment records (if applicable) by August 22, 2011.
If you have any questions regarding this matter contact Eric Rice or Jay Zimmerman at (919)
791-4200.
Sincerely,
S. Jay Zimrnerman, L.C.
Environmental Regional Supervisor
Raleigh Regional Office
c: Vance County Health Department
Mark Powers, UST-RRO
RS Lawler, ST Wooten Company, PO Box 2408,
Wilson, NC 27894
file

08/19/2011 15:16 9197887159 NCDWORRO PAGE 02/03
fi '�
ar..^ �rr�a
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Boverty Enves Perdtic Coleen H. Sullins Me I'reemali
Governor Director Seerctaryy
July 21, 2011
R,S, Lawter
S.T. Wooten Corporation
P.O. Box 2408
Wilson, N.C. 27894
Re: Inspection of groundwater remediation system and monitoring wells
S. T. Wooten
US I/Highway 158
Henderson, NC -Vance County
Permit #WQ0004209
Incident #201101457
1027fkri u'_E
The Aquifer Protection Section (APS) of the Division of Water Quality (DWQ) is responsible for the
regulation of well construction activitics within the State of North Carolina. On July 7, 2011, an annual
site inspection of the groundwater remediation system was conducted at the facility at the above listed
address in Henderson, N.C. In the course of conducting the inspection it was noted that several
monitoring wells were not in compliance with the well construction standards per 15A NCAC 02C .0108.
Also, the remedial system was inspected to assess its current status given the system is in an inactive
state.
The following items are a summary of the violations observed:
• MW-1
Well could not be located. Well may have destroyed in recent grading of area.
* MW-2
Well not located.
• MW-3
Well damaged (casing bent at an angle), no well cap present on well, no lock-.
+ MW-4
No lock present, well cap not secure
• MW-5
No lock present.
• MW-7
Well could not be located.
• MW-1 I.
Well could not be located.
0 MW-12
No lock present
• MW-13
No lock present
MW-14
No lock present
MW-18
Unclear if this well was Iocated.
Specific rule violation(s):
1. 15A NCAC 02C .0108 Standards of Construction: Wells Other Than Water Supply
\yu,lcr I'n,tvi;jwn tied,nn
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08/19/2011 15:16 9197887159 NCDWORRO PAGE 03/03
Mr. R.S. Lawter (S_T_ Wooten Corporation)
Page 2
luly21, 2011
0108: (a) No well shall be located, constructed, operated, or repaired in any manner
that may adversely impact the quality of the groundwater
(k) All non -water supply wells, including temporary wells, shall be secure with
a locking well cap to ensure against authorized access and use
Required corrective action for the monitoring wells.
Install locking well caps and/or locks as necessary
Repair or abandon well MW-3
Locate wells MW-1, MW-2, MW-7, MW-11, and PAW-1 S. The wells must be located and
an assessment trade in regards to compliance with the well construction rules. If the
wells arc found to be out of compliance, the wells must be repaired or properly
abandoned. Contact the APS, Raleigh Regional Office to schedule a follow up inspection
on the located wells.
If it becomes necessary to abandon a wcll/s, it shall be abandoned pursuant to 15A NCAC 02C .0113.
The well shall be abandoned by sealing with a cement -grout from the bottom of the well to the top
(tremie). If the cement -trout is to be poured into the well, then the well shall be de -watered prior to
pouring the cement mixture. A certified well contractor must be used for all well repair or abandonment
activities.
Please note that Larry Outten (Regional Probing Services) has been directed to address the improper
construction on all the pixemoters/temporary wells installed around 2008 in the general area located
near the remediation system. Mr. Outten was unsure if every one of the wells was installed by himsef
(Mr. Outten stated the majority were installed by him) and has been directed to inspect and make that
determination. If any number of the wells were not installed by Mr.. Outten, it will be your (S. T. Wooten
Corporation) responsibility to address the non-compliance issues with the well Constructions rules and
submit the necessary documentation associated with the wells repair or abandonment.
Please submit the documentation explaining how you brought yourself back into compliance
including the well abandonment records (if applicable) on or before August 22, 2011.
If you have any questions regarding this matter contact Eric Rice or lay Zimmerman at (919)
791-4200.
cc: rile
Mark Powers RPM, UST Section
Vance County Health Department
Sincerely,
S. Jay Zimmerman, L.G.
Environmental Regional Supervisor

WATER QUALITY REGIONAL OPERATIONS SECTION
APPLICATION REVIEW REQUEST FORM
Date: 4/9/18
To: RRO- WQROS: Danny Smith/Rick Bolich
From: Michael Rogers, WQROS — Animal Feeding Operations and Groundwater Protection Branch
Telephone: [phone] Fax: [phone] E-Mail: [e-mail]
A. Permit Number: WQ9
B. Applicant: S. T. Wooten Corp.
C. Facility Name: S. T. Wooten Henderson Asphalt Plant
D. Application:
Permit Type: Non -Discharge Groundwater Remediation
Project Type: Permit Renewal
E. Comments/Other Information:
❑ I would like to accompany you on a site visit.
Attached, you will find all information submitted in support of the above -referenced application for your
review, comment, and/or action. Within 30 calendar days, please return a completed WOROS Staff
Report.
When you receive this request form, please write your name and dates in the spaces below, make a copy of
this sheet, and return it to the appropriate Central Office Groundwater Protection Branch contact person
listed above.
RO-WOROS Reviewer:
COMMENTS:
Date:
NOTES: If my schedule will allow, I would like to go out on the inspection, if
you elect to conduct one. Thanks for your support.
FORM: WQROS-ARR ver. 092614 Page 1 of 1

Water Resources
Environmental Quality
April 9, 2018
Henry Butts, Jr., V.P.
S.T. Wooten Corp.
3801 Black Creek Road
Wilson, NC 27893
RE: Acknowledgement of Application
Non -Discharge Groundwater Remediation Permit
Permit No. WQ0004209
Vance County
Sent via Email
Dear Mr. Butts:
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
LINDA CULPEPPER
Interim Director
The Water Quality Regional Operations Section (WQROS) acknowledges receipt of your
permit renewal application and supporting documentation received on April 5, 2018, for the above
referenced permit. Your application package has been assigned the number listed above, and the
primary reviewer is Michael Rogers.
Central and Raleigh Regional Office staff will perform a detailed review of the provided
application, and may contact you with a request for additional information. To ensure maximum
efficiency in processing permit applications, the Water Quality Regional Operations Section
(WQROS) requests your assistance in providing a timely and complete response to any additional
information requests.
Please note that processing standard review permit applications may take as long as 60 to
90 days after receipt of a complete application. If you have any questions, please contact Michael
Rogers at 919-807-6412 or [e-mail].
Sincerely,
Jv . Debra J. Watts, Supervisor
Animal Feeding Operations & Groundwater
Protection Branch
Division of Water Resources
cc: Raleigh Regional Office, WQROS
Permit File WQ0004209
!`Nothing Compares'`.
State of North Carolina I Environmental Quality I Division of Water Resources
Water Quality Regional Operations Section
1636 Mail Service Center I Raleigh, North Carolina 27699-1636
919-707-9129

April 3, 2018
North Carolina Department of Environmental Quality
Division of Water Resources
Water Quality Regional Operations Section
1636 Mail Service Center
Raleigh, North Carolina 27699-1636
Attention: Michael Rogers
Hydrogeologist — UIC Program Manager
-PR - S Alt'
dater Qualit',
email: michael.rogers@ncdenr,gov
Reference: Permit Renewal Request — Inactive Groundwater Remediation System
S. T. Wooten Corporation — Henderson Asphalt Plant
697 Greystone Road
Henderson, Vance County, North Carolina
NDPES Permit No. WQ-0004209
NCDEQ Incident No. 3214
Dear Mr. Rogers:
On behalf of the S.T. Wooten, S&ME, Inc. (S&ME) is submitting this letter requesting to continue the non-
operational status of the groundwater remediation system associated with the NDPES permit referenced above.
The groundwater remediation system (pump and treat) has been inactive since June 2008. S&ME is currently
assessing the remaining free product plume (diesel fuel) at the S.T. Wooten Asphalt Plant in Henderson, NC and
will evaluate remedial alternatives. Once the remaining free product has been removed, S&ME will request
closure of the incident and will submit a formal closure plan in accordance with 15A NCAC 02T .1608.
S.T. Wooten would like to keep the NPDES Permit open in the event that the system may serve a purpose in the
future. As such, S.T. Wooten will continue to renew the permit and pay all associated fees to maintain the permit.
By continuing the non -operational status of the permit, S.T. Wooten will continue to omit the monitoring
requirements set forth in the permit as they pertain to the remediation system.
Please call us at [phone] if you have any questions or comments, or if we can be of further assistance.
Sincerely,
S&ME, Inc.
Gerald Paul
Senior Project Manager
ipaulCcbsmeinc.com
Thomas P. Raymond, P.E.
Senior Consultant
[e-mail]
Cc: Mr. Rick Bolich - Assistant Regional Supervisor — NCDEQ Raleigh Regional Office
Mr. James Washburn — Environmental Compliance Manager, S. T. Wooten Corporation
S&ME, Inc. 1 3201 Spring Forest Road j Raleigh, NC 276161 p 919,872,2660 1 w viv.smeinc,corn

North Carolina Department of Environmental Quality - Division of Water Resources (DWR)
Non -Discharge Groundwater Remediation Permit Application Form
THIS APPLICATION PACKAGE WILL NOT BE ACCEPTED UNLESS ALL APPLICABLE ITEMS ARE INCLUDED
APPLICATION INFORMATION
Application Date:
3/29/2018
Application Type:
Renewal
*New Projects — DWR to assign application #
**Renewals/Modifications — Enter Permit #
WQ-0004209
Fee Submitted: (refer to fee schedule at
http://deg. nc.gov/about/divisions/water-
resources/water-resou rces-permits/wastewater-
$1,310 (major)
branch/ground-water-protection/groundwater-
remediation )
*For New Projects: complete this page, signature page, and supply all attachments.
**For Renewals: complete this page and signature page.
**For Modifications: complete this page, signature page, and supply relevant attachments.
Applicant's Name (specify the name of the
municipality, corporation, individual, etc.):
S.T. Wooten Corporation
lop
Owner or Signing Official's Name and Title
(person legally responsible for the facility and
its compliance):
Mr. Henry D. Butts J Jg
Mailing Address:
3801 Black Creek Road, hir S x./c
Telephone Number:
[phone]
Email Address:
Hank. [e-mail]
Facility Name (name of the project site; be
consistent throughout application package):
S.T. Wooten Henderson Asphalt Plant
-
Physical Address:
697 Greystone Road , %1-Le,-N/;>,'X,jL).A%
County:
Vance
Geographic Coordinates:
362 22' 08.29" N, 782 21' 31.37" W
Contact Person (who can answer questions
about application):
James Washburn — Environmental Compliance
Manager
Telephone Number:
[phone]
Email Address:
[e-mail]
>3�
Non -Discharge GW Remediation Application Rev. 3-1-2016 Page 1

ATTACHMENTS
The following shall be included as separate attachments to this application form. Failure to
include the following information as part of the application package will result in the
application package being returned as incomplete.
A. Site Description and Incident Information. As specified in 15A NCAC 02T .1604(a), the
applicant must briefly describe the site, noting pertinent site information including:
(1) Contaminant(s) of concern,
(2) Source(s) and date(s) of the contaminant release,
(3) Remedial actions to date,
(4) Current land use,
(5) Potential receptors, and
(6) Incident number and name of oversight agency.
B. Soils Evaluation. As specified in 15A NCAC 02T .1604(b), for systems with proposed
discharge within seven feet of land surface and above the seasonal high water table, a soil
evaluation of the disposal site shall be provided to the Division by the applicant. If required by
G.S. 89F, a soil scientist shall submit this evaluation. This evaluation shall be presented in a
report that includes the following components:
(1) Field description of soil profile. Based on examinations of excavation pits or
auger borings, the following parameters shall be described by individual
diagnostic horizons to a depth of seven feet below land surface or to bedrock:
(A) Thickness of the horizon;
(B) Texture;
(C) Color and other diagnostic features;
(D) Structure;
(E) Internal drainage;
(F) Depth, thickness, and type of restrictive horizon(s);
(G) pH;
(H) Cation exchange capacity; and
(1) Presence or absence and depth of evidence of any seasonal high water
table.
(2) Recommendations concerning annual and instantaneous loading rates of
liquids, solids, other wastewater constituents and amendments. Annual
hydraulic loading rates shall be based on in -situ measurement of saturated
hydraulic conductivity in the most restrictive horizon.
Non -Discharge GW Remediation Application Rev. 3-1-2016 Page 2

C. Hydrogeologic Evaluation. As specified in 15A NCAC 02T .1604(c), a hydrogeologic
evaluation of the disposal site shall be provided to the Division by the applicant. This
evaluation shall be conducted to a depth that includes the depth of existing contamination and
the total depth of the injection well(s) or infiltration gallery(ies). This evaluation shall be based
on borings for which the numbers, locations, and depths are sufficient to define the
components of the hydrogeologic evaluation. In addition to borings, other techniques may be
used to investigate the subsurface conditions at the site. These techniques may include
geophysical well logs, surface geophysical surveys, and tracer studies. This evaluation shall be
presented in a report that includes the following components:
(1) A description of the regional and local geology and hydrogeology;
(2) A description, based on field observations of the site, of the site topographic
setting, streams, springs and other groundwater discharge features, drainage
features, existing and abandoned wells, rock outcrops, and other features that
may affect the movement of the contaminant plume and treated wastewater;
(3) Changes in lithology underlying the site;
(4) Depth to bedrock and occurrence of any rock outcrops;
(5) The hydraulic conductivity, transmissivity, and storativity (specific yield if
unconfined aquifer) of the affected aquifer(s);
(6) Depth to the seasonal high water table;
(7) A discussion of the relationship between the affected aquifers of the site to
local and regional geologic and hydrogeologic features; and
(8) A discussion of the groundwater flow regime of the site focusing on the
relationship of the plume and remediation system to groundwater receptors,
groundwater discharge features, and groundwater flow media.
D. Demonstration of Hydraulic Control. As specified in 15A NCAC 02T .1604(d), computer
modeling or predictive calculations based on site -specific conditions shall be provided to the
Division by the applicant to demonstrate that operation of the system will not cause or
contribute to:
(1) The migration of contaminants into previously uncontaminated areas, and
(2) A violation of the groundwater standards specified in 15A NCAC 02L .0202 at
the compliance boundary as described in 15A NCAC 02L .0107.
Non -Discharge GW Remediation Application Rev. 3-1-2016 Page 3

E. Maps and Cross -Sections. As specified in 15A NCAC 02T .1604(e), site plans or maps shall be
provided to the Division by the applicant depicting the location, orientation, and relationship of
facility components including:
(1) A scaled map of the site, with site -specific topographic contour intervals and
showing all facility -related structures and fences within the treatment, storage
and disposal areas;
(2) Locations of all test auger borings or inspection pits;
(3) The location of all wells (including usage and construction details if available),
designated wellhead protection areas, streams (ephemeral, intermittent, and
perennial), springs, lakes, ponds, other surface drainage features, and any other
site activities or features that may involve possible exposure to contamination
within 500 feet of all waste treatment, storage, and disposal sites;
(4) Setbacks specified in 15A NCAC 02T .1606,
(5) Delineation of property boundaries, review boundaries, and compliance
boundaries;
(6) The horizontal and vertical extent of the contaminant plume for each of the
contaminants of concern, including isoconcentration lines and plume cross -
sections;
(7) Cross -sections depicting soil and rock layers and features to a depth including
the depth of existing contamination and the total depth of the injection wells or
infiltration galleries; and
(8) Hydrologic features such as potentiometric surface / water table contours and
the direction of groundwater flow.
F. Engineering Design Documents. As specified in 15A NCAC 02T .1604(f), the following
documents shall be provided to the Division by the applicant:
(1) Engineering plans for the entire system, including treatment, storage,
application, and disposal facilities and equipment except those previously
permitted unless they are directly tied into the new units or are critical to the
understanding of the complete process;
(2) Specifications describing materials to be used, methods of construction, and
means for ensuring quality and integrity of the finished product; and
(3) Plans that include construction details of recovery, injection, and monitoring
wells and infiltration galleries.
NOTE: Recovery and monitoring wells shall be constructed in accordance with
the requirements of 15A NCAC 02C .0108. Injection wells shall be constructed
in accordance with the requirements of 15A NCAC 02C .0225(g).
Non -Discharge GW Remediation Application Rev. 3-1-2016 Page 4

G. Operating and Monitoring Plans. As specified in 15A NCAC 02T .1604(g), an operation and
monitoring plan shall be provided to the Division by the applicant. These documents shall be
specific to the site and include:
(1) The operating plan shall include:
(A) The operating schedule including any periodic shut -down times,
(B) Required maintenance activities for all structural and mechanical
elements,
(C) All consumable and waste materials with their intended source and
disposal locations,
(D) Restrictions on access to the site and equipment, and
(E) Provisions to ensure the quality of the treated effluent and hydraulic
control of the system at all times when any portion of the system ceases
to function.
(2) If injection wells are to be used then the operating plan shall also include:
(A) The proposed average and maximum daily rate and quantity of injectant;
(B) The average maximum injection pressure expressed in units of pounds per
square inch (psi); and
(C) The total or estimated total volume to be injected.
(3) The monitoring plan shall be prepared in accordance with 15A NCAC 02T .1607
and include:
(A) The monitoring well(s) that will be sampled,
(B) The constituent(s) for which those samples will be analyzed, and
(C) The schedule for sampling.
H. In Situ Remediation Additives. The following shall be provided to the Division by the
applicant if the remediation system includes additives to promote remediation in situ:
NOTE: Approved injectants can be found online http://deg.nc.gov/about/divisions/water-resources/water-
resources-permits/wastewater-branch/ground-water-protection/ground-water-approved-injectants All
other substances must be reviewed by the Division of Public Health, Department of Health and Human
Services as required by 15A NCAC 02C .0225(a). Contact the UIC Program for more information (Ph# 919-807-
6464).
(1) MSDS, concentration at the point of injection, and percentage if present in a mixture
with other injectants;
(2) A description of the rationale for selecting the injectants and concentrations proposed
for injection, including an explanation or calculations of how the proposed injectant
volumes and concentrations were determined;
(3) A description of the reactions between the injectants and the contaminants present
including specific breakdown products or intermediate compounds that may be formed
by the injection;
(4) A summary of results if modeling or testing was performed to investigate the injectant's
potential or susceptibility for biological, chemical, or physical change in the subsurface;
and
(5) An evaluation concerning the development of byproducts of the injection process,
including increases in the concentrations of naturally occurring substances. Such an
evaluation shall include the identification of the specific byproducts of the injection
process, projected concentrations of byproducts, and areas of migration as determined
through modeling or other predictive calculations.
Non -Discharge GW Remediation Application Rev. 3-1-2016 Page 5

Professional Engineer's Certification:
Name & Lic. No. of Professional Engineer:
Name of Engineering Firm:
Mailing Address:
City:
Telephone Number: (�
Email Address:
State: Zip:
Fax Number:
, attest that this application for
has been reviewed by me and is accurate and complete to the best of my knowledge. I further attest
that to the best of my knowledge the proposed design has been prepared in accordance with the
applicable regulations. Although certain portions of this submittal package may have been developed
by other professionals, inclusion of these materials under my signature and seal signifies that I have
reviewed this material and have judged it to be consistent with the proposed design.
North Carolina Professional Engineer's Seal, Signature, and Date:
Applicant's Certification (signing authority must be in compliance with 15A NCAC 2T .0106(b)
and c I:
T)• !�� � ��' , attest that this application for
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that
if all required parts of this application are not completed and that if all required supporting information
and attachments are noDill d d, this application package will be returned to me as incomplete.
Signature and Title: Y'� Date: A "2 - 10
SEND TWO COPIES OF THE COMPLETE APPLICATION PACKAGE, INCLUDING ALL
SUPPORTING INFORMATION AND MATERIALS, TO THE FOLLOWING ADDRESS:
DIVISION OF WATER RESOURCES — UIC PROGRAM
1636 MAIL SERVICE CENTER
RALEIGH, NORTH CAROLINA 27699-1636
TELEPHONE NUMBER: [phone]
Non -Discharge GW Remediation Application Rev. 3-1-2016 Page 6

Water Resources
Environmental Quality
March 27, 2018
Mr. Hank Butts, Vice President
S. T. Wooten Corp.
3801 Black Creek Rd.
Wilson, NC 27894
Sent as attachment via email w/attachments
Subject: Notice of Expiration (NOE)
S. T. Wooten Corp. — Henderson Site
Permit Number WQ0004209
Groundwater Remediation, Non -Discharge System Permit
Vance County
Dear Mr. Butts:
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
LINDA CULPEPPER
Interim Director
Our records indicate that the above -referenced permit was issued on February 16, 2012, and expired
on January 31, 2017. It also has annual fees of $1310.00 due April 7, 2018.
Permitting Requirements
It is both a condition of your permit and required by 15A NCAC 2T .0109 to request a renewal of your
permit at least 180 calendar days prior to its expiration date. Failure to apply for permit renewal and
continued operation of your facility without an active permit may result in an enforcement action by
the Division of Water Resources (DWR), in accordance with North Carolina General Statute 143-
215.6A to 143-215.6C. To comply with the permit requirements set forth in your permit and 2T .0109,
the Water Quality Regional Operations Section (WQROS) is making the following options available
to you:
1. Permit Renewal (application attached). When you apply for and receive a renewal, operation of
the groundwater remediation system will be permitted to continue. As such, annual fees, all
requirements for sampling and annual reports, and any operation and maintenance specified in
your previous permit will be required.
2. Apply for Permit Renewal with Suspended Actions. Under this option, you must still apply for
a permit renewal. However, you may indicate that operation of the remediation system has been
suspended, but that you desire to maintain the permit should the need arise to restart the system.
As such, operation of the remediation system will be prohibited until such time that a permit
modification is obtained from the Division of Water Resources allowing operation of the system.
Under the "Permit Renewal with Suspended Actions" option, all monitoring and annual reports
will be suspended until otherwise notified. Infiltration galleries will be directed to be winterized
as a permit condition, as well as temporary abandonment of any monitoring wells in accordance
with 15A NCAC 2C .0113(a). Annual fees will still be required, but may be reimbursed under
`Nothing Compares
State of North Carolina I Environmental Quality I Division of Water Resources
Water Quality Regional Operations Section
1636 Mail Service Center I Raleigh, North Carolina 27699-1636
919-707-9129

the NC State Trust Fund as a directed cost. This option allows you to keep your system inactive
until the UST Section once again directs remediation. At that point, you will need to request a
modification to your permit to activate your system.
3. Permit Rescission. To apply for a rescission, you must request that your permit be rescinded in
writing and attach a proposed remediation system closure plan. After receipt of the rescission
request/plan, it will be reviewed by staff. If no further information is required, you will be
directed to close your infiltration gallery/injection wells in accordance with 2T .1608 (a PDF of
this rule is attached). Abandonment of any monitoring wells must be in accordance with 15A
NCAC 2C.0113, and any injection wells will need to be abandoned in accordance to 2C .0240.
If you choose to have your permit rescinded, any reactivation of the subject remediation system
in the future will require a new permit.
Annual Fees Requirement
It is both a condition of your permit and required by 15A NCAC 2T .0105(e)(2) to pay the annual
administering and compliance fees within thirty (30) days of being billed by the Division of Water
Resources. Failure to pay the fee accordingly may result in the Division initiating enforcement actions,
to include the assessment of civil penalties. Civil penalty assessments may be issued of not more that
twenty-five thousand ($25,000) dollars against any "person' who violates or fails to act in accordance
with the terms, conditions, or requirements of a permit under authority of G.S. 143-215.6A.
Please note that each day a violation continues may be considered a separate violation, subject to
additional civil penalties and/or the use of other enforcement mechanisms available to the State.
Therefore, it is imperative that you submit the appropriate fee(s) as requested within thirty (30) days
of receipt of the invoice. According to our records, the following invoice(s) are outstanding:
Invoice Number
ting
Operrad
Perio
Due Date
Outstanding
e
2018PR002429
2018-2019
4-7-2018
$1310.00
Please remit payment made payable to the North Carolina Department of Environmental Quality
(DEQ) in the amount of $1310.00. Please mail this payment to the address below, and let me know
via in reply to this email when payment is made.
Division of Water Resources
Budget Office
Attn: Teresa Revis
1617 Mail Service Center
Raleigh, NC 27699-1617
If you feel this NOE is in error and you have documentation that one or more of the above referenced
fees have already been paid, please send the documentation of payment to the address listed above.

For questions regarding any overdue annual fee, please contact Teresa Revis with the Division's
Budget Office at [phone]. If you have any other questions, please contact me by phone at (919)
807-6412 or by email at [e-mail].
Thank you for your cooperation.
Sincerely,
Michael Rogers, P.G. (NC and FL)
Hydrogeologist
UIC Program Manager
Water Quality Regional Operations Section
Division of Water Resources
Attachment(s) to Email
cc: Danny Smith/Rick Bolich, Raleigh Regional Office
Central Files - Permit No. WQ0004209 w/o attachments
r -_

r
6��
=-'i—
a,
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P.E. Dee Freeman
Governor Director Secretary
February 16, 2012
MR. GEORGE R. STRICKLAND, SENIOR ENGINEER
S.T. WOOTEN CORPORATION
PO BOX 2408
WILSON, NC 27894-2408
Subject: Permit No. WQ0004209
S.T. Wooten Corporation
Groundwater Remediation Facilities
Vance County
Dear Mr. Lawter:
In accordance with the request for a change in status dated August 17, 2011, submitted on your behalf by
Gerald Paul and Thomas P. Raymond of S&ME, Inc., and subsequent application for permit renewal submitted on
February 8, 2012, we are forwarding herewith Permit No. WQ0004209, dated February 16, 2012, to S.T. Wooten
Corporation for the continued permit coverage / renewal of the subject groundwater remediation facility.
This permit shall be effective from the date of issuance until January 31, 2017, shall void Permit No.
WQ0004209 issued May 3, 2006, and shall be subject to the conditions and limitations as specified therein. The
monitoring and reporting requirements for this permit are hereby administratively suspended. Please note that a
written notification must be sent to the Raleigh Regional Office and the Raleigh Central Office at least thirty (30)
days before the remediation system is reactivated (Permit Condition I.1.), and that semiannual inspections are
required (Permit Condition II.1.). After the remediation system is restarted, the monitoring and reporting must be
resumed. Please pay particular attention to the monitoring requirements in this permit. Failure to establish an
adequate system for collecting and maintaining the required operational information will result in future compliance
problems.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the right to
request an adjudicatory hearing upon written request within thirty (30) days following receipt of this permit. This
request must be in the form of a written petition, conforming to Chapter 150B of the North Carolina General
Statutes, and filed with the Office of Administrative Hearings, 6714 Mail Service Center, Raleigh, NC 27699-6714.
Unless such demands are made this permit shall be final and binding.
If you need any additional information concerning this matter, please contact David Goodrich at (919) 807-
6352.
Sincerely,
.for Charles Wakild, P.E.
cc: Wake County Health Department
Raleigh Regional Office, Aquifer Protection Section
Gerald Paul, S&ME, Inc., 3201 Spring Forest Road, Raleigh, NC 27616
APS — Central Files
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 512 N. Salisbury St., Ralegh, North Carolina 27604
Phone: [phone] \ FAX: [phone]
Internet: www rlmateroualitv.om
An Equal Opportunity \ Affirmative Action Employer
NorthCarolina
Naturally

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
GROUNDWATER REMEDIATION PERMIT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as amended,
and other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
S.T. Wooten Corporation
Vance County
FOR THE
continued operation of a 14,400 GPD groundwater remediation facility consisting of a 10-gallon per minute
pump, a 10-gallon per minute oil and water separator, two I0,000-gallon water storage tanks with air diffusion, a
500-gallon oil storage tank, a Feremede/citric acid feed system to assist with the chemical removal of iron to
prevent deposits and stoppages in the line that conveys treated groundwater to the infiltration galleries, a carbon
absorption system, and two infiltration galleries, each 200 square feet in area to serve S.T. Wooten Corporation's
Henderson Hot Mix Plant. The system shall be operated such that there is no discharge of wastes to the surface
waters, pursuant to the application received March 7, 2006, and in conformity with the project plan,
specifications, and other supporting data subsequently filed and approved by the Division and considered a part of
this permit.
This permit shall be effective from the date of issuance until January 31, 2017, shall void Permit No.
WQ0004209 issued May 3, 2006, and shall be subject to the following specified conditions and limitations:
I. PERFORMANCE STANDARDS
1. The Raleigh Regional Office and Raleigh Central Office, Aquifer Protection Section, shall be notified in
writing at least thirty (30) days in advance of restarting operation of the facilities. The notification shall be
sent to:
Raleigh Regional Office, Aquifer Protection Section
1628 Mail Service Center
Raleigh, NC 27688-1628
and to
Aquifer Protection Section, Groundwater Protection Unit
1636 Mail Service Center
Raleigh, NC 27699-1636
Page 2 of 7

The groundwater treatment system shall consistently achieve 15A NCAC 2L Section .0202(g) Class GA
Standards prior to discharge to the infiltration galleries. The treated water discharged into the infiltration
galleries must not cause a violation of Class GA Standards for any constituent beyond the Compliance
Boundary, nor cause the migration of the contamination into unaffected areas. If the treatment system
fails to consistently achieve this standard, additional treatment units or changes in operational needs may
be required.
3. This permit shall become voidable if the soils fail to adequately assimilate the remaining wastes and may
be rescinded unless the facilities are installed, maintained, and operated in a manner, which will protect
the assigned water quality standards of the surface and groundwaters.
4. The issuance of this permit shall not relieve the Permittee of the responsibility for damages to surface or
groundwaters resulting from the operation of this facility.
Any residuals generated from these treatment facilities must be disposed in accordance with General
Statute 143-215.1 and in a manner approved by the Division.
6. Diversion or bypassing of the untreated groundwater from the treatment facilities is prohibited.
II. OPERATION AND MAINTENANCE REOUMEMENTS
The facilities shall be properly maintained and operated as a non -discharge system to prevent the
discharge of any wastewater resulting from the existence or operation of this facility. The groundwater
recovery, treatment and disposal system shall be inspected semiannually. If it is determined that the
system is malfunctioning or leading to the release of wastes to the environment, a threat to human health,
or a nuisance, all repairs should be made as soon as possible and reported to the Raleigh Regional Office
(see Section VI. NONCOMPLIANCE NOTIFICATION). All components of the groundwater
recovery, treatment, and disposal system shall be properly weatherproofed to prevent freezing and failure
of the system.
2. Upon classification of the wastewater treatment and remediation facilities by the Water Pollution Control
System Operators Certification Commission (WPCSOCC), the Permittee shall designate and employ a
certified operator to be in responsible charge (ORC) and one or more certified operator(s) to be back-up
ORC(s) of the facilities in accordance with 15A NCAC 8G .0201. The ORC shall visit the facilities in
accordance with 15A NCAC 8G .0204 or as specified in this permit and shall comply with all other
conditions specified in these rules.
3. The infiltration galleries shall be operated above the water table at all times.
4. If requested by the owner, the Division will consider remote monitoring in lieu of (frequency) physical
inspections, on a case -by -case basis, following at least two years of successful operation.
The Permittee shall maintain an inspection log or summary including at least the date and time of
inspection, observations made, and any maintenance, repairs, or corrective actions taken by the Permittee.
This log of inspections shall be maintained by the Permittee for a period of three years from the date of
the inspection and shall be made available to the Division or other permitting authority, upon request.
6. Any duly authorized officer, employee, or representative of the Division may, upon presentation of
credentials, enter and inspect any property, premises or place on or related to the disposal site or facility at
any reasonable time for the purpose of determining compliance with this permit, may inspect or copy any
records that must be maintained under the terms and conditions of this permit, and may obtain samples of
groundwater, surface water, or leachate.
Page 3 of 7

III. MONITORING REQUIREMENTS
The influent and effluent from the treatment system shall be sampled every month for the parameters
specified below:
pH
Volatile Organic Compounds
2. For Volatile Organic Compounds (VOCs), use only one of the following methods:
a. Standard Method 6230D, Practical Quantitation Limit (PQL) at 0.5 ug/L or less
b. Standard Method 6210D, PQL at 0.5 ug/L or less
c. EPA Method 8021, Low Concentration, PQL at 0.5 ug/L or less
d. EPA Method 8260, Low Concentration, PQL at 0.5 ug/L or less
e. Another method with prior approval by the Aquifer Protection Chief.
Any of the referenced methods used for VOCs must at a minimum, include all the constituents
listed in Table VIII of Standard Method 6230D. Any method used must provide a PQL of 0.5 ug/L or
less, which must be supported by laboratory proficiency studies as required by the DWQ Laboratory
Certification Unit. Any constituents detected above the Method Detection Limit (MDL) but below the
PQL of 0.5 ug/L must be qualified (estimated) and reported.
Any laboratory selected to analyze parameters must be Division of Water Quality certified for those
parameters required.
4. Any additional groundwater quality monitoring, as deemed necessary by the Division, shall be provided.
IV. REPORTING REQUIREMENTS
1. Three (3) copies of the following forms shall be mailed to the address below:
a. GW-59 Groundwater Quality Monitoring: Compliance Report Form
b. GW-59A Compliance Report Form
Mail these documents to the following address: Division of Water Quality
1617 Mail Service Center
Information Processing Unit
Raleigh, NC 27699-1617
Updated blank forms may be downloaded from the Division of Water Quality website at
http://h2o.enr.state.nc.us/ or requested from the address mentioned above.
2. The results of the sampling and analysis must be received on forms GW-59 and GW-59A on or before the
last working day of the month following the sampling month. The data of all groundwater sampling
analyses required by the permit conditions must be reported using the most recent GW-59 and GW-59A
forms along with attached copies of the laboratory analyses.
3. For the initial sampling of the well(s), the Permittee shall submit a copy of the GW-1 form with forms
GW-59 and GW-59A for each well to the address listed above. Initial GW-59 forms that do not include
copies of the GW-1 form may be returned to the Permittee without being processed. Failure to submit
these forms as required by this permit may result in enforcement activities pursuant to NC General
Statutes 143-215.6A.
Page 4 of 7

4. The Permittee shall retain records of all monitoring information, including calibration and maintenance
records, continuous monitoring data and reports required by this permit, for at least 3 years from the date
of the sample measurement, report or application. Records of this monitoring information shall include,
but not be limited to, the following:
a. the date, exact place, and time of sampling or measurements,
b. the individual who performed the sampling or measurements,
c. the date the analyses were performed,
d. the analytical techniques or methods used, and
e. the results of such sampling, measurements, and analyses.
The Permittee shall report to the Raleigh Regional Office (see Section VI. NONCOMPLIANCE
NOTIFICATION) any monitoring or other information which indicates:
a. any contaminant may cause an endangerment to an underground source of drinking water,
b. any noncompliance with a permit condition due to a malfunction of the system, or
c. any cause of fluid migration outside the injection zone or area.
The written submission shall contain a description of the noncompliance and its cause, the period of
noncompliance, including exact dates and times. If the noncompliance is not corrected and is expected to
continue, steps taken or planned to reduce, eliminate, and prevent reoccurrence of the noncompliance
shall be provided to the Regional Office in a timely manner.
6. The Permittee shall submit an annual report summarizing the volume of effluent discharged into the
infiltration galleries and the summary results of related groundwater, influent, and effluent monitoring.
Isoconcentrations (horizontal and vertical direction) and water level contour maps shall be prepared on an
annual basis and submitted with this report. If an annual report containing this information (e.g. corrective
action plan) is required by a regulatory agency, the Permittee may submit two (2) copies of that report in
lieu of the preceding information within thirty days of its publication. The Permittee shall submit this
report to the following addresses: Aquifer Protection Section, Groundwater Protection Unit,1636
Mail Service Center, Raleigh, NC 27699-1636, and to Aquifer Protection Section, Raleigh Regional
Office, 3800 Barrett Drive, Raleigh, NC 27609.
V. NONCOMPLIANCE NOTIFICATION
The Permittee shall report by telephone to the Raleigh Regional Office, telephone number (919) 571-
4700, as soon as possible, but in no case more than 24 hours or on the next working day following the
occurrence or first knowledge of the occurrence of any of the following:
a. Any occurrence at the groundwater remediation facility which results in the treatment of significant
amounts of contaminated groundwaters which are abnormal in quantity or characteristic, such as the
dumping of the contents of a basin or tank, the known passage of a slug of hazardous substance
through the facility, or any other unusual circumstances;
b. Any process unit failure, due to known or unknown reasons, that renders the groundwater treatment
and disposal system incapable of adequate treatment and disposal, such as mechanical or electrical
failures of pumps, aerators, compressors, etc.;
c. Any failure of a pumping station, sewer line, or treatment facility resulting in a by-pass directly to
receiving waters without treatment of all or any portion of the influent to such station or facility; or
d. Any time that self -monitoring information indicates that the groundwater treatment and disposal
system is not in compliance with any specified permit limitations.
Page 5 of 7

2. Occurrences outside normal business hours may also be reported to the Division's Emergency Response
personnel at telephone number [phone] or to the Emergency Management's switchboard at (919)
733-3300. Also, persons reporting such occurrences by telephone shall file a written report within five
(5) days following first knowledge of the occurrence. This report must outline the actions taken or
proposed to be taken to ensure that the problem does not recur.
VI. APPLICABLE BOUNDARIES
1. The COMPLIANCE BOUNDARY for the disposal system is specified by regulations in 15A NCAC 2L,
Groundwater Classifications and Standards. The Compliance Boundary for the disposal system
individually permitted on or after December 30, 1983 is established at either 250 feet from the waste
disposal area, or 50 feet within the property boundary, whichever is closest to the waste disposal area. An
exceedance of Class GA Standards at or beyond the Compliance Boundary is subject to remediation
action according to 15A NCAC 2L .0106(d)(2).
2. The REVIEW BOUNDARY is established around the disposal systems midway between the Compliance
Boundary and the perimeter of the waste disposal area. Any exceedance of Class GA Standards at the
Review Boundary may require action in accordance with 15A NCAC 2L .0106(d)(1).
VII. GENERAL CONDITIONS
Issuance of this permit does not constitute approval for reimbursement from the Leaking Petroleum
Underground Storage Tank Cleanup Fund (15A NCAC 2P) or any other fund. Additionally, the issuance
of this permit does not remove the Permittee's responsibility to comply with the corrective action
requirements of the Division of Waste Management. Furthermore, the Permittee should notify and report
all changes concerning the remedial system to the Division of Waste Management. It is the Permittee's
responsibility to comply with the requirements of all involved agencies.
2. This permit shall become voidable unless the facilities are constructed in accordance with the conditions
of this permit, the approved plans and specifications, and other supporting data.
3. This permit is effective only with respect to the nature and volume of wastes described in the application
and other supporting data.
4. This permit is not transferable. In the event there is a desire for the facilities to change ownership, or
there is a name change of the Permittee, a formal permit request must be submitted to the Division
accompanied by an application fee, documentation from the parties involved, and other supporting
materials as may be appropriate. The approval of this request will be considered on its merits and may or
may not be approved.
5. A set of approved plans and specifications for the subject project must be retained by the Permittee for the
life of this project.
6. Failure to abide by the conditions and limitations contained in this permit may subject the Permittee to an
enforcement action by the Division in accordance with North Carolina General Statute 143-215.6A to
143-215.6C.
7. The annual administering and compliance fee must be paid by the Permittee within thirty (30) days after
being billed by the Division. Failure to pay the fee accordingly may cause the Division to initiate action
to revoke this permit as specified by 15A NCAC 02T .0105 (e).
8. The issuance of this permit does not preclude the Permittee from complying with any and all statutes,
rules, regulations, or ordinances, which may be imposed by other government agencies (local, state, and
federal), which have jurisdiction.
Page 6 of 7

9. Sixty (60) days prior to closure of the infiltration galleries, the Permittee must request a rescission of the
permit from the Division of Water Quality. Guidelines for the closure of the infiltration galleries may be
obtained from http://h2o.enr.state.nc.us/ or requested from the Division of Water Quality.
10. If the Permittee wants to continue operation of this system, at least six (6) months prior to the expiration
of this permit, the Permittee shall request its extension. Upon receipt of the request, the Commission will
review the adequacy of the facilities described therein, and if warranted, will extend the permit for such
period of time and under such conditions and limitations as it may deem appropriate.
Permit issued this the 161 day of February, 2012
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
for Charles Wakild, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission
Permit Number WQ0004209
Page 7 of 7

p�pF W ATFgOG Michael F. Easley, Governor
William G. Ross Jr., Secretary
r- North Carolina Department of Environment and Natural Resources
Q Alan W. Klimek, P.E. Director
Pr Division of Water Quality
May 3, 2006
MR. GEORGE R. STRICKLAND
S.T. WOOTEN CORPORATION
PO BOX 2408
WILSON, NC 27894-2408
Subject: Permit No. WQ0004209
S.T. Wooten Corporation
Groundwater Remediation Facilities
Vance County
Dear Mr. Strickland:
In accordance with your request for renewal received March 7, 2006, we are forwarding herewith Permit
No. WQ0004209, dated May 3, 2006, to S.T. Wooten Corporation for the continued operation of the subject
groundwater remediation facility.
This permit shall be effective from the date of issuance until May 3, 2011, shall void Permit No.
WQ0004209 issued May 14, 2001, and shall be subject to the conditions and limitations as specified therein. Please
pay particular attention to the monitoring requirements in this permit. Failure to establish an adequate system for
collecting and maintaining the required operational information will result in future compliance problems.
In response to your request, the permit has been modified to allow the use of citric acid as an option for iron
control, add diffused aeration as an option to the treatment process, and remove the bag filter from the treatment
process. However, the oil/water separator should remain a part of the treatment process.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the right to
request an adjudicatory hearing upon written request within thirty (30) days following receipt of this permit. This
request must be in the form of a written petition, conforming to Chapter 150B of the North Carolina General
Statutes, and filed with the Office of Administrative Hearings, 6714 Mail Service Center, Raleigh, NC 27699-6714.
Unless such demands are made this permit shall be final and binding.
If you need any additional information concerning this matter, please contact Mike Ranck at (919) 715-
6164.
Sincerely,
Alan W. Klimek, P.E.
cc: Vance County Health Department
Raleigh Regional Office, Aquifer Protection Section
John G. Funk, EarthTech
Technical Assistance and Certification Unit
APS — Central Files
No Carolina
.One
Aquifer Protection Section 1636 Mail Service Center Raleigh, NC 27699-1636 Phone [phone] Customer Service
Internet: http://h2o.enr.state.nc.us 2728 Capital Boulevard Raleigh, NC 27604 FAX [phone]
An Equal Opportunity/Affirmative Action Employer- 50% Recycled/10% Post Consumer Paper

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
GROUNDWATER REMEDIATION PERMIT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as amended,
and other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
S.T. Wooten Corporation
Vance County
FOR THE
continued operation of a 14,400 GPD groundwater remediation facility consisting of a 10-gallon per minute
pump, a 10-gallon per minute oil and water separator, two 10,000-gallon water storage tanks with air diffusion, a
500-gallon oil storage tank, a Feremede/citric acid feed system to assist with the chemical removal of iron to
prevent deposits and stoppages in the line that conveys treated groundwater to the infiltration galleries, a carbon
absorption system, and two infiltration galleries, each 200 square feet in area to serve S.T. Wooten Corporation's
Henderson Hot Mix Plant. The system shall be operatred such that there is no discharge of wastes to the surface
waters, pursuant to the application received March 7, 2006, and in conformity with the project plan,
specifications, and other supporting data subsequently filed and approved by the Division and considered a part of
this permit.
This permit shall be effective from the date of issuance until May 3, 2011, shall void Permit No.
WQ0004209 issued May 14, 2001, and shall be subject to the following specified conditions and limitations:
I. PERFORMANCE STANDARDS
1. The groundwater treatment system shall consistently achieve 15A NCAC 2L Section .0202(g) Class GA
Standards prior to discharge to the infiltration galleries. The treated water discharged into the infiltration
galleries must not cause a violation of Class GA Standards for any constituent beyond the Compliance
Boundary, nor cause the migration of the contamination into unaffected areas. If the treatment system
fails to consistently achieve this standard, additional treatment units or changes in operational needs may
be required.
2. This permit shall become voidable if the soils fail to adequately assimilate the remaining wastes and may
be rescinded unless the facilities are installed, maintained, and operated in a manner, which will protect
the assigned water quality standards of the surface and groundwaters.
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages to surface or
groundwaters resulting from the operation of this facility.
4. Any residuals generated from these treatment facilities must be disposed in accordance with General
Statute 143-215.1 and in a manner approved by the Division.
Page 2 of 6

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross Jr., Secretary
Kerr T. Stevens, Director
May 14, 2001
MR. GEORGE R. STRICKLAND,
S.T. WOOTEN CORPORATION
POST OFFICE BOX 2408
VICE PRESIDENT
WILSON, NORTH CAROLINA 27894-2408
Dear Mr. Strickland:
1 �,TkW,A
IT •
A1 2
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
Subject: Permit No. WQ0004209
S.T. Wooten Corporation
Henderson Hot Mix Plant
Groundwater Remediation Facilities
Vance County
In accordance with your application received on April 4, 2000 as well as the additional information
received on February 14, 2001, we are forwarding herewith Permit No. WQ0004209, dated May 14, 2001, to the
S.T. Wooten Corporation for the continued operation of the subject groundwater remediation facilities. This
permit approves the continued operation of a groundwater remediation system, which was originally installed at
S.T. Wooten Corporation's Henderson Hot Mix Plant following a leaking underground storage tank incident in
1986, for another five-year permit cycle.
This permit shall be effective from the date of issuance until April 30, 2006; shall void Permit No.
WQ0004209, issued on April 12, 1996; and shall be subject to the conditions and limitations as specified
therein.
Please take time to review this permit carefully, as some of the conditions contained therein may have
changed since its last issuance. Of particular interest is the fact that groundwater monitoring is no longer a
requirement of this permit since the groundwater monitoring wells were installed primarily to examine the
pollutant plume and assess the incident rather than to monitor the operation of the infiltration galleries. Note
that the Division of Waste Management's Underground Storage Tank Section may choose to retain the
groundwater monitoring requirements as part of the Corrective Action Plan (CAP). Remember that this permit
governs the activities involving the discharge of effluent into the infiltration galleries alone. It is important,
therefore, that you ensure compliance with the CAP as well as any other requirements of other regulatory
agencies that might be imposed on you with respect to the groundwater remediation activities. Please note other
minor changes that have been made to this permit:
♦ General: The system description of the groundwater remediation process has been amended to
include a FeREMEDE feed system, which the Permittee has added to facilitate the removal of iron
from the treated wastewater in order to prevent deposits to hamper operation of the overall system.
♦ Condition H. 2.: This condition has been amended to reflect the adoption of new rules by the Water
Pollution Control System Operators Certification Commission (WPCSOCC). The referenced
regulation is now 15A NCAC 8G .0202.
♦ Condition III. 2.: Events of non-compliance must now be submitted to the Division of Water
Quality (Division) in written form within five days (i.e., reduced from 15 days) of the event's
occurrence.
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] Fax [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/10% post -consumer paper

♦ Condition IV. 2.: This is a new condition that requires high-water alarms in the two infiltration
galleries that will operate in concert with the groundwater remediation facilities.
♦ Condition IV. 5.: This condition has been amended to reflect the new mailing address for the
Central Office of the Division's Groundwater Section.
♦ Condition IV. 6.: The language in this condition has been modified slightly since the distance
between the property line and the two infiltration galleries is less than 50 feet.
♦ Condition IV. 7.: This is a new condition that reminds the Permittee that compliance with the CAP
is not covered by the conditions of this permit.
♦ Condition VI. 4.: This condition has been amended to reflect the fact that there is no fee associated
with a request to transfer permits.
♦ Condition VI. 8.: This condition has been amended to provide examples of other regulations, which
may be applicable to the permitted activity, that are not under the jurisdiction of this permit.
As always, pay particular attention to the monitoring and reporting requirements contained in this
permit. Failure to establish an adequate system for collecting and maintaining the required operational
information will result in future compliance problems.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the right to
request an adjudicatory hearing upon written request within 30 days following receipt of this permit. This
request must be in the form of a written petition, conforming to Chapter 150B of the North Carolina General
Statutes, and filed with the Office of Administrative Hearings, 6714 Mail Service Center, Raleigh, NC 27699-
6714. Unless such demands are made, this permit shall be final and binding.
If you have questions that are specific to the groundwater requirements contained in this permit, please
contact Mr. Salam Murtada at [phone]. For general information concerning this matter, do not hesitate
to contact Ms. Shannon Mohr Thornburg at [phone], extension 353.
Sincerely,
Kerr T. Stevens
cc: Vance County Health Department
Raleigh Regional Office, Water Quality Section
Raleigh Regional Office, Groundwater Section
Central Office, Groundwater Section
Technical Assistance and Certification Unit
Non -Discharge Compliance/Enforcement Unit

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH
GROUNDWATER REMEDIATION PERMIT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as amended,
and other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
S.T. Wooten Corporation
Vance County
FOR THE
continued operation of a 10-gallon per minute groundwater remediation system that consists of the following
minimum facilities: a 10-gallon per minute pump; a 10-gallon per minute oil and water separator; two 10,000-
gallon water storage tanks; a 500-gallon oil storage tank; a FeREMEDE (i.e., a combination of citric acid and
chelating agents) feed system to assist with the. chemical removal of iron to prevent deposits and stoppages in
the line that conveys treated groundwaterwater to the infiltration galleries; a carbon absorption system; and two
infiltration galleries, each 200 square feet in area to serve S.T. Wooten Corporation's Henderson Hot Mix Plant.
The system shall be operated such that there is no discharge of wastes to surface waters, pursuant to the
application received on April 4, 2000 as well as the additional information received on February 14, 2001, and
in conformity with the project plans, specifications, and other supporting data subsequently filed and approved
by the Department of Environment and Natural Resources and considered a part of this permit.
This permit shall be effective from the date of issuance until April 30, 2006; shall void Permit No.
WQ0004209, issued on April 12, 1996; and shall be subject to the following specified conditions and
limitations:
I. PERFORMANCE STANDARDS
1. This permit shall become voidable if the soils fail to assimilate the wastes adequately and may be
rescinded unless the facilities are installed, maintained, and operated in a manner that will protect
the assigned water quality standards of the surface waters and groundwater.
In the event that the facilities fail to perform satisfactorily, including the creation of nuisance
conditions, the Permittee shall take immediate corrective action, including those actions that may be
required by the Division of Water Quality (Division), such as the construction of additional or
replacement treatment or disposal facilities.
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages to
surface waters or groundwater resulting from the operation of these facilities.

4. Any residuals generated from the facilities shall be disposed in accordance with North Carolina
General Statute § 143-215.1 and in a manner approved by the Division.
5. Diversion or bypassing of untreated groundwater from the facilities shall be prohibited.
II. OPERATION AND MAINTENANCE REQUIREMENTS
1. The facilities shall be properly maintained and operated at all times.
2. Upon classification of the facilities by the Water Pollution Control Systems Operators Certification
Commission (WPCSOCC), the Permittee shall employ a certified operator to be in responsible
charge (ORC) of the facilities. The operator shall hold a certificate of the type and grade at least
equivalent to or greater than the classification assigned to the facilities by the WPCSOCC. The
Permittee shall also employ a certified back-up operator of the appropriate type and grade to comply
with the conditions of 15A NCAC 8G .0202. The ORC of the facilities shall visit Class I facilities
at least weekly and Class H, III, and IV facilities at least daily, excluding weekends and holidays;
shall properly manage and document daily operation and maintenance of the facilities; and shall
comply with all other conditions of 15A NCAC 8G .0202.
The facilities shall be effectively maintained and operated as a non -discharge system to prevent the
discharge of any wastewater resulting from the operation of these facilities.
III. MONITORING AND REPORTING REQUIREMENTS
Any monitoring deemed necessary by the Division to ensure surface water and groundwater
protection shall be established and an acceptable sampling reporting schedule shall be followed.
2. Noncompliance Notification:
The Permittee shall report by telephone to the Raleigh Regional Office, telephone number (919)
571-4700, as soon as possible, but in no case more than 24 hours or on the next working day
following the occurrence or first knowledge of the occurrence of any of the following:
a. Any occurrence at the facilities that results in the treatment of significant amounts of
contaminated groundwater which are abnormal in quantity or characteristic, such as the
dumping of the contents of a basin or tank, the known passage of a slug of hazardous substance
through the facilities, or any other unusual circumstances;
b. Any process unit failure, due to known or unknown reasons, that renders the facilities incapable
of adequate treatment and disposal, such as mechanical or electrical failures of pumps, aerators,
compressors, etc.;
c. Any failure of the facilities resulting in a by-pass directly to receiving waters without treatment
of all or any portion of the influent groundwater; or
d. Any time that self -monitoring information indicates that the facilities are not in compliance with
any specified permit limitations.
Persons reporting such occurrences by telephone shall also file a written report in letter form within
five days following first knowledge of the occurrence. This report must outline the actions taken or
proposed to be taken to ensure that the problem does not recur.
IV. GROUNDWATER REQUIREMENTS
4

1. All components of the groundwater recovery, treatment, and disposal system shall be properly
weatherproofed to prevent freezing and failure of the facilities.
2. The high-water sensors in the two infiltration galleries shall be set to shut down the facilities when
the water level in the infiltration galleries rises to within one vertical foot of the distribution lines.
This shut-off system shall be designed such that the facilities will not operate until the water level in
the infiltration galleries falls to an elevation of at least two vertical feet of the distribution lines.
3. The groundwater recovery, treatment, and disposal system shall be inspected weekly. If it is
determined that the facilities are malfunctioning, all repairs shall be made as soon as possible and
reported to the Groundwater Section of the Raleigh Regional Office at [phone] within 48
hours.
4. The influent and effluent from the groundwater treatment system shall be sampled every month for
the following parameters:
pH
Volatile Organic Compounds - Standard Method 6230 D (Purge and Trap Capillary -Column
Gas Chromatographic Method), "Standard Methods for the Examination of Water and
Wastewater," Most Recent Edition.
5. One copy of the results of the sampling and analysis on Form GW-59 (i.e., "Compliance Monitoring
Report Form") shall be received by the NC Division of Water Quality, Groundwater Section,
Permits and Compliance Unit, 1636 Mail Service Center, Raleigh, NC 27699-1636 on or before the
last working day of the month following the sampling month.
6. The facilities shall consistently achieve Class GA Groundwater Quality Standards, as outlined in
15A NCAC 2L .0202(g), in the effluent prior to discharge into the infiltration galleries. The
effluent discharged into the infiltration galleries shall not violate the Class GA Groundwater Quality
Standards for any constituent beyond the compliance boundary or cause the migration of
contamination into unaffected areas. If the facilities fail to achieve these standards consistently,
additional treatment units or changes in operational methods may be required.
7. The issuance of this permit shall not remove the Permittee's responsibility to comply with the
corrective action requirements stipulated by the Division of Waste Management's
Underground Storage Tank Section.
The COMPLIANCE BOUNDARY for the disposal system is specified by regulations in 15A
NCAC 2L (i.e., Groundwater Classifications and Standards). The Compliance Boundary for
disposal systems constructed after December 31, 1983 is established at either (1) 250 feet from the
waste disposal area, or (2) 50 feet within the property boundary, whichever is closest to the waste
disposal area. An exceedance of Groundwater Quality Standards at or beyond the Compliance
Boundary is subject to immediate remediation action in addition to the penalty provisions applicable
under North Carolina General Statute §143-215.6A(a)(1).
In accordance with 15A NCAC 2L, a REVIEW BOUNDARY is established around the disposal
system midway between the Compliance Boundary and the perimeter of the waste disposal area.
Any exceedance of standards at the Review Boundary shall require remediation action on the part of
the Permittee.
9. Any additional groundwater quality monitoring, as deemed necessary by the Division, shall be
provided.

V. INSPECTIONS
Adequate inspection, maintenance and cleaning shall be provided by the Permittee to ensure proper
operation of the facilities.
2. The Permittee or his designee shall inspect the facilities to prevent malfunctions and deterioration,
operator errors, and discharges which may cause or lead to the release of wastes to the environment,
a threat to human health, or a nuisance. The Permittee shall maintain an inspection log or summary
including at least the date and time of inspection, observations made, and any maintenance, repairs,
or corrective actions taken by the Permittee. This log of inspections shall be maintained by the
Permittee for a period of three years from the date of the inspection and shall be made available to
the Division or other permitting authority, upon request.
Any duly authorized officer, employee, or representative of the Division may, upon presentation of
credentials, enter and inspect any property, premises or place on or related to the facilities at any
reasonable time for the purpose of determining compliance with this permit, may inspect or copy
any records that must be maintained under the terms and conditions of this permit, and may obtain
samples of groundwater, surface water, or leachate.
VI. GENERAL CONDITIONS
Issuance of this permit shall not constitute approval for reimbursement from the Leaking Petroleum
Underground Storage Tank Cleanup Fund established by 15A NCAC 2P.
2. This permit shall become voidable unless the facilities are constructed in accordance with the
conditions of this permit, the approved plans and specifications, and other supporting data.
3. This permit shall only be effective with respect to the nature and volume of wastes described in the
application and other supporting data.
4. This permit shall not be transferable. In the event there is a desire for the facilities to change
ownership or there is a name change of the Permittee, a formal permit request shall be submitted to
the Division accompanied by documentation from the parties involved and other supporting
materials as may be appropriate. The approval of this request shall be considered on its merits and
may or may not be approved.
5. A set of approved plans and specifications for the subject facilities shall be retained by the Permittee
for the life of this facilities.
6. Failure to abide by the conditions and limitations contained in this permit may subject the Permittee
to an enforcement action by the Division in accordance with North Carolina General Statutes § 143-
215.6A through § 143-215.6C.
7. The annual administering and compliance fee shall be paid by the Permittee within 30 days after
being billed by the Division. Failure to pay the fee accordingly may cause the Division to initiate
action to revoke this permit as specified by 15A NCAC 2H .0205 (c)(4).
The issuance of this permit shall not preclude the Permittee from complying with any and all
statutes, rules, regulations, or ordinances that may be imposed by other government agencies (i.e.,
local, state, and federal) which have jurisdiction, including, but not limited to, applicable river
buffer rules in 15A NCAC 2B .0200, erosion and sedimentation control requirements in 15A NCAC
6

Chapter 4 and under the Division's General Permit NCG0100000, and any requirements pertaining
to wetlands under 15A NCAC 2B .0200 and 15A NCAC 211.0500.
9. The Permittee, at least six months prior to the expiration of this permit, shall request its extension.
Upon receipt of the request, the Division shall review the adequacy of the facilities described
therein, and if warranted, shall extend the permit for such period of time and under such conditions
and limitations as it may deem appropriate.
Permit issued this the fourteenth of May, 2001
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
Kerr T. Stevens, Director
Division of Water Quality
By Authority of the Environmental Management Commission
Permit Number WQ0004209