WI0400176_Application_20130408

License No. C-0281
CIVILISANITARYIENVIRONMENTAL ENGINEERS
Municipal
Services
SITE PLANNING ISUBDIVISIONS
March 22, 2012
Mr. Michael Rogers, P.G.
Aquifer Protection Section
NC DENR — Division of Water Quality
1636 Mail Service Center
Raleigh, NC 27699-1636
Engineering
Company, P.A.
SUBSURFACE UTILITY ENGINEERING (SUE)
Pam-1 T-
l.r�ti�a'
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Subject: Documentation Required for Section VIII of the
Injection Well Permit Renewal with Modification for
Surry County Closed C&D Over MSW Landfill - Mt. Airy
SWS Permit 486-02
UIC Permit No. WI0400176 (Issued 5/6/11)
MESCO # G12181.0
Dear Mr. Rogers:
Please add the enclosed documentation to the subject Application for Permit Renewal with
Modification which was submitted January 30, 2012.
Should you have any questions or need additional information, please contact me at (919) 772-
5393 or mdurway6d)mesco.com. Thank you for your assistance.
Sincerely,
MUNICIPAL ENGINEERING SERVICV
:?
SEAL
0875
D. Mark Durwa L.G.
Geologist Y� , '.�R °'Ovnc'�� RECEIVED'DENRIDWO
cc: Dennis Bledsoe, Surry County Director of Public Works
APR 4 8 2013
Aquifer Protection Section
PO Box 97. Garner, North Carolina 27529 [phone]
PO Box 349, Boone, NC 28607 [phone]

MUNICIPAL ENGINEERING SERVICES COMPANY, P.A.
PG Bar 97 Garner, NC 27529
Tel [phone]
March 23, 2013
Re: Documentation for Section V111 of the
In'ection Well Permit Renewal with Modification for
Surry County Closed C&D Over MSW Landfill - Mt. Airy
SWS Permit #86-02
UIC Permit No. W 10400176 (Issued 5/6/11)
MESCO # G 12181.0
VIIl. Attachments
1. INJECTION ZONE
Injection of EOS Pro and water, or other approved injectant, will be done through six existing 2"
diameter wells ranging in depth from 40 to 70 ft and completed with either a 10 or 15 ft 0.010
slot screen. The shallowest depth of injection will be 30 ft bls in IW I and the deepest will be 70
ft bls in IW2. GW 1 well logs, referenced in Section VIII.2(G), include depths and screen
intervals for each of the landfill injection and monitoring wells.
Injectant and chase water will be emplaced by gravity flow or other low pressure means of
injection. Based on the deepest well depth (70 t), and the injectant's density (approximately
equal to water), the calculated maximum injection pressure by gravity flow will be
approximately 30 psi at 70 ft, assuming 1 psi per 2.31 ft of water column.
Based on the aquifer's average effective porosity of 15 percent, the immediate post -injection
radius of influence for 500 gallons of injectant and chase water through a 10-ft section of screen
will be just under 4 ft, assuming equal injectant distribution. At a more conservative average
effective porosity of 10 percent, the immediate radius of influence would be about 5 ft.
Injectant will spread over time through the saprolite-bedrock aquifer due to groundwater flow
and dispersion. With average hydraulic conductivity of 6.93 x 10-4 cm/see and average gradient
of 0.155, average seepage velocity through the aquifer is estimated to be approximately 2 ft/day,
assuming effective porosity of 15%. Given this flow rate, the average travel time from injection
wells to monitoring wells at the landfill is approximately 5.1 months. Taking into consideration
the delaying effects of retardation due to adsorption, the true travel rate of contaminants and
injectant is expected to be even lower.
Based on product literature (attached), EOS Pro can last three to five years in the aquifer.
RECEIVEDIDENRIM
APR 0 8 2013
Aquifer Protection Section

2. HYDROGEOLOGIC EVALUATION
(A) Regional and local geology and hydrology
The Surry closed landfill is a 23 acre site located in the western NC piedmont at 237 Landfill
Road about five miles south of downtown Mt Airy. Landfill elevation ranges from about 1000 ft
above sea level along the north side of the property to 950 ft along Stoney Creek to the south.
Unnamed creeks bound the east and west sides of the landfill and flow generally south to Stoney
Creek. Stoney Creek flows southeasterly between the closed C&D landfill and the active
Subtitle D landfill before discharging into the Ararat River.
Landfill location, topography, and wells are shown on the attached maps. Groundwater flow at
the site is generally toward Stoney Creek which borders the landfill to the south, and to two
smaller unnamed creeks which border the southern portion of the landfill to the southeast and
southwest.
Groundwater at the site occurs under unconfined conditions within a schist and gneiss saprolite-
bedrock aquifer system. Comparisons of groundwater elevations from site monitoring wells
indicate that the saprolite and upper fractured bedrock are hydraulically connected..
Depth to groundwater varies widely at the landfill. During the October 2012 monitoring event,
groundwater depth ranged from 4.01 ft below land surface in well MW-22 to 52.95 ft in well
MW-15.
(B) Changes in lithology underlying the facility_
Wells MW-1, IW-2, MW-9, MW-13, MW-18, MW-19, and MW-21 through MW-23 are
screened exclusively in saprolite. Wells MW-3RS, IW4, IW-5, MW-G, MW-11, MW-12S,
MW-14 through MW-17, and MW-20 are screened in bedrock. Wells MW-7 and MW-8 are
screened in saprolite and bedrock. Variations in the schist -gneiss lithology are shown on the
GW1 well logs referenced in Section VIII.2(G).
(C) Depth to bedrock
During the installation of wells, depth to bedrock varied from several feet to approximately 45 ft
bls.
(D) Depth to mean seasonal high water table
Depth to mean seasonal high water table is equal to or greater than 5 ft below the base of the
landfill, based on pre -construction landfill borings. During the spring monitoring event, depth to
mean seasonal high water table has historically varied from less than a foot below Iand surface to
over 50 ft bls, based on water level measurements in wells. During the most recent monitoring
event in October 2012, water levels in the six existing injection wells ranged from approximately
22 to 42 ft bls, as shown on the attached well data summary table.
(E) Hydraulic conductivity, transmissiylty, etc. of the injection zone
Hydraulic conductivity, k, was determined by slug test following well installation. Well
installation dates, k values, and other data are provided in the attached well data summary table.

As previously indicated in Section VI1I.1, average hydraulic conductivity for the landfill wells is
approximately 6.93 x 104 cm/sec or 2 ftld.
Transmissivity, T, for the aquifer was calculated using the formula T = kb, where b is aquifer
thickness. As thickness of the saprolite-bedrock aquifer varies, an arbitrary value of 15 ft
(typical screen length) was chosen, yielding an average value for T of 30 ft2/d or about 224
gpolft. During the initial injection event in October 2012, the rates of injection by gravity flow
in wells IW4 and IW6 were approximately 10 gpm in each well. Each of these wells is
completed with 15 ft of 0.010 slot Schedule 40 PVC screen. Based on these injection rates
aquifer transmissivity is calculated to be over four times higher (960 gpolft) than when using
slug test data.
Aquifer storativity at the landfill is assumed to fall within the standard range for unconfined
aquifers of 0.02 to 0.3 (Fetter, Applied Hydrogeology, third edition, p 118).
(F) Rate and direction of groundwater flow
As indicated in Section VIILI, average seepage velocity through the aquifer is estimated to be
approximately 2 ft/day. Contouring of groundwater levels as measured in the landfill injection
and monitoring wells confirms that the direction of groundwater flow at the landfill is generally
to the south toward Stoney Creek and the two smaller unnamed creeks to the southeast and
southwest.
(G) Lithostratigraphic and hydrostratigraphic logs of wells
GW 1 well logs are attached.
3. INJECTANT INFORMATION
Injectant currently used is listed below:
EOS Pro {EOS Remediation, LLCM
B-12 vitamin supplement
Sodium bromide tracer
(A) MSDS sheets and product data are attached. Injection has been performed at the landfill
since 2011 in accordance with a Corrective Action Plan approved by the NC Solid Waste
Section. Injection is done using a solution of 10% EOS Pro and 90% water, B-12 vitamin
supplement (16 oz per 55 gal drum EOS Pro), and NaBr tracer (at concentration of 100 mg/kg).
EOS Pro, water, and B-12 are mixed and injected in accordance with manufacturer guidelines.
(B) Makeup water is to be obtained from Stoney Creek or other source following pre -testing
for Appendix I VOCs.
(C) EOS Pro was selected for injection in order to enhance degradation of chlorinated
hydrocarbons downgradient of the landfill. An initial injection quantity of 250 gallons of
injectant followed by 250 gallons of chase water was set for each well. Based on the screen
length in each well, the immediate radius of influence around each well following injection is 5

ft, after which injectant spreading should occur by groundwater flow and dispersion. To date
injection has been performed at 6 injection wells and injection monitoring has been performed in
downgradient monitoring wells on a regular basis in accordance with NC Solid Waste Section
requirements. Re -injection is scheduled to recur as -needed to control contaminant levels and to
meet state requirements. Based on product data from the manufacturer, EOS Pro should last
from three to five years in the aquifer.
(D) Dechlorination of chlorinated hydrocarbons is expected to be in the order of-
perchloroethylene, trichloroethylene, 1,2-trans/cis-dichloroethylene, vinyl chloride, ethene.
(E) Preliminary modeling was not performed.
(F) No byproducts are known.
4. INJECTION PROCEDURE
Injection details are provided on the attached table "Well Injection Plan for Surry Closed
Landfill".
5. FRACTURING PLAN
Not Applicable
6_ WELL CONSTRUCTION DETAILS
Well details are provided on the attached table "Injection and Monitoring Wells for Surry
Closed Landfill".
7. MONITORING PLAN
Primary target contaminants include: perchloroethylene, tichloroethylene, 1,2 trans/cis-
dichloroethene and vinyl chloride. Parameters that may indicate degradation is occurring include
dissolved oxygen, volatile fatty acids, etc. Monitoring wells that will be used to monitor
injection events are listed on the attached table "Injection and Monitoring Wells for Surry Closed
Landfill". Monitoring is to be conducted on a semi-annual basis.
8. WELL DATA TABULATION
Existing and/or abandoned wells within the injection well area at Surry Closed Landfill
are listed on the attached table "Well Data Summary".
9. MAPS AND CROSS -SECTIONS
Maps and cross -sections are attached. No other known or potential groundwater
contaminant sources have been identified within the vicinity of Surry Closed Landfill.

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Certified by Date
Prepared by D. Mark Durway, LG
Municipal Engineering Services Company, P.A. - Garner, NC (C-0281)
March 23, 2013
RECENEDIDENRINQ
APR o 8 2013
Aquifer Protection Section

APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR INJECTION
In Situ Groundwater Remediation i Tracer Injection
VM. ATTACHMENTS — provide the following information in separate attachments. The attachments should be
clearly identified and presented in the order below to expedite review of the permit application package.
1. INJECTION ZONE — Specify the horizontal and vertical portion of the subsurface within which the proposed injection
activity will take place and beyond which no violations of groundwater quality standards shall result from the injection as
determined by an approved monitoring plan. The determination shall be based on the hydraulic properties of the specified
zone. Provide any supporting documentation in a separate attachment.
2. HYDROGEOLOGIC EVALUATION -- Provide a hydrogeologic evaluation of the injection zone that includes all of
the following:
(A) Regional and local geology and hydrology;
(B) Changes in Iiihology underlying the facility;
(C) Depth to bedrock;
(D) Depth to the mean seasonal high water table;
(E) Hydraulic conductivity, transmissivity, and storativity, of the injection zone based on tests of site -specific
material, including a description of the test(s) used to determine these parameters;
(F) Rate and direction of groundwater flow as determined by predictive calculations or computer modeling; and
(G) Lithostratigraphic and hydrostratigraphic logs of any existing test and injection wells.
3. INJECTANT INFORMATION — List each injectant in the space below and provide the following information for each
injectant. NOTE: Approved injectants can he found online at http:'I ortal.ncdenr.orglweblx•glapslgL4,pro. All other substances
must be reviewed by the Division of Public Health, Department of Health and Human Services. Contact the UIC Program for
more information (Ph# 919-807-6496).
EOS Pro (soybean -based emulsion) and water (mixed 1:9)
B-12 vitamin supplement
NaBr tracer G 00 m"a in solution?
(A) MSDS, concentration at the point of injection, and percentage if present in a mixture with other injectants;
(B) The source of fluids used to dilute, carry, or otherwise distribute the injectant throughout the injection zone. If
any well within the area of review of the injection facility is to be used as the fluid source. then the following
information shall be submitted: location/ID number, depth of source, formation, rock/sediment type, and a
chemical analysis of the water from the source well. including analyses for all contaminants suspected or
historically recognized in soil or groundwater on the site;
(C) 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:
(D) 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;
(E) 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
(F) 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.
4. INJECTION PROCEDURE — Submit a table with a detailed description of the proposed injection procedure that
includes the following.
(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.
RECOVER ENRIDWO
APR 08 2013
Revised 101$12012 UIC-51/5T Aquffer Protection Se t101PJage 3 of 5

Well Injection Plan for 5urry Closed Landfill
Injection Well Permit Renewal with Modification
SWS Landfill Permit 86-02
UIC Permit No. WI0400176
Injection is to be performed using up to 250 gallons UIC-approved injectant per well followed by an additional
250 gallons of clear water to flush injectant through the filter pack and into the formation. Lesser quantities may be used
depending on well capacity. Injection water is to be obtained from Stoney Creek or other source following pre -testing for Appendix I VGCs.
Proposed average
Proposed maximum
Average
Estimated total
Injection Injection
daily rate and qty of
daily rate and qty of
maximum
volume to be injected
Well Frequency
iniectant per well
iniectant oer well
iniection pressure
per well
Iniectant
IW 1 annually or as
1 to 10 gpm
10 gpm
30 psi
500 gal
EOS Pro,
required by 5W5
500 gal max
500 gal max
(250 gal 1:9 EQ5 Pro
water,
and water with 8 ox
vitamin B12,
vitamin B12 chased
and
with 250 gal clear
sodium bromide
water to flush
(tracer)
injectant into
formation)
IW2
(former MW2)
IW3
(former MW3RS)
IW4 POP,
(former MW4)
IW5
(former MW5)
IW6
(former MW8)
IW 7' P. 11,
(proposed)
Notes:
SWS=NC Solid Waste Section
'IW7, MW25, MW26, and MW27 to be installed if required by SWS
sodium bromide tracer concentration=1000 mg/I
m
m
m
Monitoring Wells
and
Proximitv to Injection Well
MW17 MW19 MW22
330' W 450' SE 200' S
MW12S
MW13
MW18
200' E
300' S
450' SE
MW3R
MW16
SO'SE
100' SW
MW14
MW21
MW23
150' S
200' SE
680' 5
MW15
MW19
--
300' S
850' S
MW7
MW9
MW20
320' S
330' W
380' W
MW25
MW26
MW27
(proposed)
(proposed)
(proposed)
Prepared by D. Mark Durway, LG
Municipal Engineering Services Co, PA (C-0281) - Garner, NC
March 23, 2013

Injection and Monitoring Wells for Surry Closed Landfill
Six permanent 2" 5ch 40 PVC wells are used for injection. Each is terminated with either 10 or
15 ft of 0.010 slot screen. Wells are grouted to approximately 1 to 2 ft above screen top.
GWl forms for each well are included with the Section VIII documentation package.
Monitoring Wells
Injection
Total
Screen Interval (ft)
Screen
and
Well
Depth ft
Top
, Bottom
Length ft
Proximity to Injection Well
IW1
40
30
40
10
MW17
MW19
MW22
(former MW1)
330' W
450' SE
200' S
IW2
70
60
70
10
MW12S
MW13
MW18
(former MW2)
200' E
300' S
450' SE
IW3
52
37
52
15
MW313
MW16
--
(former MW3115)
50' SE
100' SW
IW4
55
40
55
15
MW14
MW21
MW23
(former MW4)
150' S
200' SE
680' S
IW5
63
48
63
15
MW15
MW19
(former MW5)
300' S
850' S
IW6
54
39
54
15
MW7
MW9
MW20
(former MW8)
320' S
330' W
380' W
IW7*
pending
pending
pending
pending
MW25
MW26
MW27
(proposed)
(proposed)
(proposed)
(proposed)
Notes:
SW5=NC Solid Waste Section
IW7, MW25, MW26, and MW27 to be installed if required by SW5
Injection Well Permit Renewal with Modification
SWS Landfill Permit 86-02
UIC Permit No. WI0400176
Prepared by D. Mark Durway, LG
Municipal Engineering Services Co, PA (C-0281).- Garner, NC
March 23, 2013

WELL DATA SUMMARY
Well
Installed
LS
Elevation
TOG
Elevation
Well
Diam
Boring
Diam
Top
Screen
Bottom
Screen
Top
Bedrock
K
(cmisec)
n
I_ithology
WL
WE
Elevation
Northing
Fasting
IW-1
11/28/89
1133.15
1134.35
2
6
30
40
4.30E-05
15
-
22.48
1111.87
982415,3900
1538683.5600
IW-2
11/28/89
1068,36
1068.86
2
6
60
70
-
4.30E-05
15
-
39.92
1028.94
981188,9200
1538522.6400
MW-3R
9127194
1015.00
1017.50
2
6
86
101
1002
2.40E-08
5
Schist
40.13
977.37
980800.7900
1537523,9900
1W-3
5/17/01
1018.24
1020.57
2
6
37
52
1004
2.40E-05
5
Schist
31.1
989.47
980774.6600
1537562.0900
IW-4
8/30194
1025.06
1026.26
2
6
40
55
1020
1.10E-04
5
Schist
34.22
992.04
980773,3700
1538343.9200
IW-5
8/27194
1077.78
1080.18
2
6
48
63
1062
1.50E-05
5
Schist
40.61
1039.57
980752.5000
1537979.7100
MW-6
917194
1065.61
1067.67
2
6
15
30
1050
1.90E-05
15
Schist
22.29
1045,38
981781,4700
1537810.6400
MW-7
8/23194
1071,50
1073.50
2
6
8
23
1053
8.10E-04
15
Schist
11.86
1061.64
982146.6600
1537917.8200
IW-6
8/16/94
1086.45
1088.45
2
6
39
54
1041
4.40E-04
15
Schist
41.52
1046.93
982450,8900
1538023.2100
MW-9
8122/94
1092.07
1094,07
2
8
29
44
-
1.70E-04
15
Sdy sit
33.11
1060.96
982459,9300
1537691.5700
MW-11
8/15194
1150,40
1151.80
2
6
25
40
1132
3.10E-04
5
Schist
20.64
1131.16
983287,9100
1538278.0400
MW-12S
5/31/01
1023.25
1025.80
2
6
-
-
-
3
13.7
1012.1
981225,2500
1538712,1200
MW-12D
5/30/01
1023,75
1027.05
2
6
90
100
-
1.30E-06
5
Schist
-
-
981232.6200
1538705.7100
MW-13
5/30/06
1005,75
1008.48
2
7.75
21
36
962
2,06E-04
23
Slty sd
25.09
983.39
980896,6851
1538645,3057
MW-14
5/30/06
1016.11
1018.80
2
7.75
33
48
1012
7.45E-03
3
Schist
34.41
984.39
980620.7382
1538330.1252
MW-15
6/22/06
1073,23
1075,96
2
7.75
42
57
1045
7.21E-05
3
Schist
52.95
1023.01
980455.7576
1537966,3428
MW-16
6/21/06
996.67
999.54
2
T75
21
36
988
2.82E-05
3
Schist
25.47
974.07
980732,6585
1537485.4425
MW-17
611107
962.26
965.43
2
5.5
5
15
962
2.94E-04
3
Schist
8.04
957.39
980378.3804
1537362.2222
MW-18
611107
-
-
2
7.75
-
-
-
2.04E-03
15
Slty sd
5.91
977.09
-
-
MW-19
611t07
942.97
946.27
2
T75
7
17
926
1.10E-03
3
PWR
10.77
935.5
979885.7429
1537930.9885
MW-20
611107
1079.12
4082.19
2
5.5
11
26
1072
1.92E-04
3
Gneiss
19.39
1062.8
982364.4458
1537648.3166
MW-21
611107
962.22
965.36
2
7.5
5
15
952
1.28E-03
3
Schist
5.56
959.8
980599.6655
1538483.3653
MW-22
611107
950.23
953.40
2
5.5
6
16
936
9.88E-04
15
Sdy sit
4.01
949.39
980145,1343
1537605.0256
MW-23
611107
952.09
955.31
2
7.75
7
17
-
3.04E-04
15
Sdy sit
7.06
948.25
980097.0793
1538346.6748
6.93E-04 = avg hydraulic conductivity (k) = 1.96 ftld
NOTES:
1. Well and boring diameter in inches. Other units in feet. 6. PWR = partially weathered rock
2. LS = land surface; TOC � top of casing 7. IW = injection well
3. hydraulic gradient (dhldl) and water levels (WL) are from October 2012 sampling event
4. Screen top and bottom = below land surface (bls)
5. n = effective porosity
Surry Closed Landfill. Mt. Airy

w x+vc.
1 ■ ONRESIDENTIAL WELL CONSTRUCHON RECORD
..- . north Carolina nI ofEnvixonmeat and Natural x Division of water Quality
r WELL CONTRACTBR CER7TFICA-HoN # 2663
i- WELL CONTRACTOR:
Derry HUnetiCutt
Well Contractor (Individual) Name
De s Well Drillin Inc.
Well Contractor Company Name
44283-8 NC 24127173
Street Address
Albemarle NC 28001
City or Town State Zip Code
704--) 982-9070
Area code Phone number
2. WELL INFORMATION -
WELL CONSTRUCTION PERMIT#
= d. TOP OF CASING Is 3.00 FT. Above Land Surface'
'Top of casing terminated atlor below land surface may require
a vadanoe in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): na METHOD] OF TEST
L DISINFECTION: Type
Amount, nA
9. WATER ZONES (depth):
= Top_ 75'(?) 8Mm-7r{7j_
Top
Bottom
Top Rotlom
Top
Bottom
Top Sotbrn
Top
Bottom
•
Thickness)
T. CASING: Depth Dipanter
Weight Material
Top ++-3•OQ- Botlom 61.40 FL_2L_ sch 40 PVC
OTHER ASSOCIATED PERMIT#(l applicable} W IQ400176 : Top Bottom FL
SITE WELL !D #(d applicable, I W-1 :Top Bottom Ft
3. WELL USE (Check One Box) Monitoring LT MunlcipailPublic ❑
IndustriaVCommemal ❑ Agricultural 0 Recovery ❑ Injection I(
Irrigation❑ Other ❑ (list use)
DATE DRILLED 1012$111
4. WELL LOCATION:
419 Landfill Road
(Streot Name. Numbers, Community. SubdrorAon, Lot No -.Parcel. Zip Code)
CITY: Ararat COUNTY SUrrV
TOPOGRAPHIC 1 LAND SETTING: (check appropriate box)
[]Slope[]Valley ❑Flat ZRidge ❑Other
K(XWrCD 36_--XAOkA AAAA^ ^n"l CL R OR 3&4Pg@4AAAA CC
iUV14Fl$TCD�5 --AnnnAAnnnnnnnr CL ROR 80A7Tg3AAAA CO
Latitudenongitude source: 03PS CWopographlc map
(7ocation of well must be shown on a USGS logo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is {opted.]
Sum Co_ CloSpiri M.SWLF
Facillty Name Facility ID# Cif applicable)
419 Landfill Roars
Street Address
Ararat NC 27007
City or Town State Pip Code
Contact Name
PCB Box 1.542
Mailing Address
_Mount Aim NC 27030
City or Town state Zip Code
r 336401-8376
Area code Phone number
8. GROUr. Depth Material Method
Top 5^7.00 Bottom 60.00 FL Bent. Chips Grays
Top Bottom 57.00 Ft. Neat Cement Trem'se
Top Bottom FL
9. SCREEN: Depth Dfameter Slot Size Material
Top fit Bottom 81.4OFt 2 in. 0.02 in- PVC
= Top Bottom Ft. in- in- Nigh Flow
Top Bottom Ft in. in. _ 1 18"spacing
10. SANDIGRAVEL PACK:
Depth size Material
Top 60.00 Bottom 84.00 Fi_#3 Filter Sand
Ton Bottom Ft
Top Bottom Ft.
t 1- DRILLING LOG
fop Bottom
0 1 41.00
41.00 143.00
43.00 147.00
47___-00 1 84.00
63 163.51)
70 .1 70.50
75 _137
AD 180.50
12. REMARKS:
Formation Description
r ■ RLe 11MIARMAS
Fracture _
Fracture
Fracture
6. WELL DETAILS. - 100 HEREBY CERTIFY THAT THIS wow WAS CONSTRUCTED IN ACCORDANCE WITH
uA 2C, WELL CONSTR1fCi1
9
N ANDAPDSI. AND THAT A CO OF THIS
a. TOTAL DEPTH: 81.401 sus a E wEU
CMEFL
b. DOES WELL REPLACE ExiSTING WELL? YES ❑ NO a/ F CERTIFIED CO CTOR DATE
c. WATER LEVEL Below Top of Casing: _ 53-04 R�FT. VrPA
Day L Fluneucutt
(Use.+' if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Fort GW-1b
Submit within 30 days of completion to: Division of Water Quality - information Processing, Rev. 1l08
1617 Mail Service Center, Raleigh, NC 27699461, Phone. [phone]

w 1
N. C. Deparemene of Hum:n Resources
Division of Hesith Services
WELL COMPLETION RECORD
COMPL= ALL INFORMATION REQUESTED BELOW FOR EACH WELL INSTALLED, AND RFrjRN FORM TO THE N.C.
DEPARTMENT OF HUMAN RESOURCES, SOLID AND HAZARDOUS WASTE ]MANAGEMENT BRANCH.
P.O. BOX 209I, RALEIGH, N.C. 27602
NAME OF SITE l PERMIT NO-
S 61 e r2 -r G>a � �{ t `?
ADDRESS: OWNER (print]:
�� L1. 1 7 L lJp�i�rJ N . C. -7GI ��r/e,le-t -tc N T"Y
❑RILLiNG CONTRACTOR.- j] RFGLSTRA-nON NO.: 7I
NZ VV,//7 #/", i� M-I -J&7-Z -r ti---- J, wS E r-' 1
Casing Type: - j 4- -- dia.
-2-Lin.
Grout Depth:
from �to _ ft. -dia.
in.
Casing Depth: from to �- ft. - dia.
2 .. in.
Sentonite Seal:
from 2-9 to ft. - dia.
G in.
Scretn Type: t- dia.
-` in.
Sand/Gravel PK:
from j; 0_ to ft. - dia.
in.
Scrttrt Depth:00 from to --�4` ft. - dia.
A " in.
Tpnl Well Depth:
from to ft. - dia.
in.
i
Static Warer Level: fees from tap of
casing
Date Measured — /____
Yield (gpm): Method of Testing
Casing is / feet above land surface
DRILLING LOG
DEPTH
FROM TO FORMATION DESCRIPTION
r4-
REMARKS:
LOCATION 5KETCH J
(show distance to num6cred roads. ar ether map reference points)
DATE.- 1 r- -2- K - S SIGNATURE f w" U7=7 �t '� ��- .. Q �� W-1-7 •r^ - Sc�.
Sntld & Haard. Wrwe i.fv.ernen[ &.nth

tAW 2-
' WELL COMPLETION RECORD
AFLETE ALL INFORMATION REQUESTED BELOW FCR EACH WELL INSTALLED. AND RETURN FORM TO THE N-C.
kRTMENT OF HUMAN RESOURCES, SOLID AND HAZARDOUS WASTE MANAGEMENT BRANCH.
BOX 2091. RALEIGH, N.0 27602
AE OF SITE: PERMIT NO.:
5Gr iZ rr 7 r 1V a �. G L -'
)RjES& / OWNER (print): �
J � . ' / � �r 1C �4 1 JCtJ 1 �` � ]a (7 �[ + fL 1 L -r LL c r r N f `7'
LUNG CONTRACTM- REGISTRATION NO..
+g Typr. dla- 2: in. Grout Depth: from a to � It. - dia. in.
+g Depth: from �� to ft - dis. � in. Brnvonkc Scat: from 3 to L in.
�' ft. •dia
n Type: v_ e'-- r dia. ;6- in. Sand/Gravel PK: from - &Q-_ to :2 ��' fs. • dia. 4 in.
!n Depth_00')from 60 rO r? ft. • dia. —42 In. Total WO Depth. from.4 to _Z_7 Ft. • dia. in.
c Water Level: yf-0 — feet from top of casing Date MCASurcd _ /_ /—
i (gpm): f Method of Testing a--4- casinQ is / ' feet abovr hmd surfa{c
(show distance to numbered roads, or other map reference points)
MARKS:
ITEr I I — SIGNATURE r`�C <f �.il�J`^•-- �u�`
d a< Hmrdnr Vvrr i.Sr.s+�s.0 ard� !�[ C-^w ��'� f•iC � `�� ��i � N

H U) '3
Division of Health Services
' WELL COMPLETION RECORD
/'J� 7 /7 IrZ Y �I.IEiL 7
-)M PLETE ALL INFORMATION REQUESTED BELO W FOR EACH WELL INSTALLED. AND RMRN FORM Tip THE ?4.C.
jEPARTMENT OF HUMAN RESOURCES. SOLID AND HAZARDOUS WASTE MANAGEMENT BRANCH,
P. O. BOX 2091, RALFIGH, N.C. 27602
NAME OFF SITE: PERMITNO- '7
} dr 12 je r r T rV 7' n L L T -L
ADDRESS: OWNER Wr4
�L 7
) C --2 ?a 1 7 �Gr rLrt7 �r nr T'
DRILLING CONTRACTOR: - REGISTRATION NO.;
using Type.
G dia_
1
in.
Grout Depth: from () so "? fr. - dia. �in.
asing Depth:
from ro !CO ft. - din.
�
1 In.
Bentonitc Scat- from to /Sa ft. - dia. tom- in.
icrecn Type:+
icrecn Depth:6o`)
L. dia
from ,o �] to &9' ft. - dia.
ixe
I in.
5artd/Grsvd P1C from sa fc - dia 1n a in.
Toni Well Depth: from Qto _14_P ft. - dia. /" in.
3r2dc Watcr Lzvcl '3y Peer from top of casing Date'Mcwured — /—
Yield (gpm): ��/ Method of Testing: A 14 - Casing is — J— feet above land surface
DRILLING LOG
OEP- H
FROM TO FORMATION DESCRIPTION
REMARKS:
LOCATION SKETCH
{show distance to numbered reads, or other trap reference points)
.]ATl~: 1 � ` � �Y � �_ SIGNATURE:
ielJ 6 li.urda.� W...r >,Aws+.Y.+x Dr.nch

North Carolina - Department of Environment, Health, and Natural kesources
NyWon of Environmental Management - Groundwater Section
P.O. Box 29535 - Raleigh, N.C. 27626-0535
Phone [phone]
FOR OFRCE USE ONLY
QUAD. NO. SERIAL NO,
Lit Lora. RO
Minor Basin
WELL CONSTRUCTION[ RECORD Basin code
DRILLING CONTRACTOR: GAi Consultants I Header Ent GW-1 EnL
STATE WELL CONSTRUCTION
DRILLER REGISTRATION NUMBER: 446 PERMIT NUMBER: N/A
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Mt. Airy County-_ Surry
SR 2015
(Road, Community, or Subdivision and Lot No.)
DE PTH
2.
OWNER Surry County Attn: Jerry Snow
From TO
ADDRESS PO Box 706
0 — 13
(Streat or Route No.)
Dobson NC 27017
16 —
Ciry or Town Stale Zip Code13
3.
DATE DRILLED 9-27-94 USE OF WELL Monitoring
4,
TOTAL DEPTH 103'
5.
CUTTINGS COLLECTED YES ❑ NO®
16 — 30.7
6.
DOES WELL REPLACE EXISTING WELL? YES 0 NO❑
7.
STATIC WATER LEVEL Below Top of Casing: *7Q,5 FT.
{Use ': li Above Top of Casift
30.7 _ 102
8.
TOP OF CASING 1S 2-5 FT- Above Land Surface'
• Casing Terminated &Vor below tend surfaes is Illegal unless a vsrianra is Issued
In
aeeordanes with 15A )CAC 2C .0118
N A
9_
YIELD [wwmj. METHOD OF TEST
10,
WATER ZONES (depth): 85 to 102 ft
DRILLING LOG
Formation Description
Red clay
Extremely weathered
schist
Slightly weathered
schist
Schist
11_ CHLORINATION: Type N/A Amount It additional space is needed use hack of form
12. CASING:
Wall Thickneaa
LOCATION SKETCH
t2.5 Depth85
Diameter or WeighVFL
AMaterw
(Show direction and distance from at least two State
From To
FL 2" Sch
40 PVC
Roads, or other map raference paints)
From To
Ft.
From To
Ft.
SR 2015
13. GROUT:
Depth
Material
Method
From 0 To 80
Ft.
neat cement
grout
■t
From 80 To 82.6
Ft
bentonite
pellets _
1
14. SCREEW
Depth Diameter Slot Size
Material
3R
From $16;_To 1O1 Ft
2
in. -010
in. PVC
From To FL
in.
in.
From To Ft._
in.
in.
15, SANDIGRAVEL PACK:
Depth
Size
Material
From . $2-6 To 102
Ft.
silica
From TD Ft.
1�. REMARKS: Monitoring Well 3R
N -(---
Water first encountered at: 85 to 95 ft
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WFTH 15A NCAC 2C, WFLL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATUR OF CONTRACTOR OR AGENT , uXTE
r, rw;,,,,,,..r A►wna..w— w n

M'Li 3F's
MONITORING WELL
�►r•o� Z uJ 3}
RAWNSAWMAR
now
CONSTRUCTION LOG ENGINEERING, INC
PROJECT: Mt Airy Water Quality Assessment MONITORING WELL ID: MW-3RS
LOCATION: Mt. Airy, NC !� CONSTRUCTION DATE 5/17/2001
STAND PIPE CONSTRUCTION
GEOLOGIC UN
MEASURING POINT ELEVATION 1020.57 it AMSL
PAD DIMENSIONS 3 fjjLx 3 fset _
GROUND SURFACE ELEVATION 1018.24 ftJ AMSL
BOREHOLE DIAMETER -9 inche§,to 14 feet below grade
4 inches from 14 feet to bottom
ANNULAR SPACE SEAL
TYPE OF SEAL ole P Cement
Tre i routed
RISER TYPE PVC
RISER DIAMETER 2-imhes
TOP OF FILTER PACK SEAL
ELEVATION 988.57 ft AMS_L
DEPTH 32 feet
FILTER PACK SEAL TYPE hur 4 8 i ch chi
TOP OF FILTER PACK
ELEVATION 985.57 ft AM L
DEPTH 35 f HE
FILTER PACK TYPE 93 graded well sand
FILTER PACK SOURCE QSI
TOP OF SCREEN
ELEVATION
983. 7 ft AM r
DEPTH
�7 f 15 Se r
SCREEN TYPE
PVC
SCREEN DIAMETER inches
SLOT SIZE
0A10 inch
BOTTOM OF SCREEN
ELEVATION 968.57 ft AMSSL,
DEPTH 5�.feet
BOTTOM OF BOREHOLE
ELEVATION 96B.57 ft AM&
DEPTH 52 f et

lt-x L.J `j
Norih Carolina - Department of Environmiint, Heatih, and Natural Resources
Division of Environmental Management - Groundwater Secticn
P.O. Box 29535 - Raleigh, N.C. 27625-0535
Phu na [919} 733.3221
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: GAI Consultants
DRILLER REGISTRATION NUMBER: 445
now 'L w Li)
FOR OFFICE USE ONLY
QUAD_ NO. _ _ SERMA.L NO..
tat Long. RO
Misr Basin
Basin Cade
Header Ent GW-1 Errs
STATE WELL. CONSTRUCTION N/A
PERMIT NUMBER-
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Mount Airy County: Surry
SR 2015
(Road, Community, or Subdivision and Lot No,) DEPTH DRILLING LOG
2, OWNER Surry County _ From To Formation description
ADDRESS a°x 705 0 - 5 Sandy silt with
gSlreet or Route No.) trace Clay
DolDson NC 27017
City or Town State Lo Code
3. DATE DRILLED 8-30-94 USE OF WELL Monitoring 5 - 55.4 Gray garnet mica
4. TOTAL DEPTH 55.4' schist with quartz
5. CUTTINGS COLLECTED YES ',__� NOFx_j veins
& DOES WELL REPLACE EXISTING WELL? YES � NOF7x
7. STATIC WATER LEVEL Below Top of Casing: 35 FT.
{Use' if Above Top of Casing]
& TOP OF CASING IS 2 FT. Above Land Surface'
Casing Terminated atlor below land surface is illegal unless a variance is issued
in accordance with 15A NCAC 2C .0118
9. YIELD (gpm):—METHOD OF TEST
10. WATER ZONES (depth): 45 to 55.4 ft
11. CHLORINATION: Type ,Amount If additional space is needed use back of form
12. CASING:
Depth
From +2 To
From To
From —To
13. GROUT:
Depth Material Method
From O To 38 Ft, Cement Grout N N
From 38 To - �9 Ft. Bentonite Pellet
14. SCREEN: (15')
❑epih Diameter Slot Size Material
From 40-41To 55-4 Ft 2 in. .Old in. PVC
From To Ft. in. in,
From To fit. in, in.
i5. SANDIGRAVEL PACK:
Depth Sze Material
From 39 To 56.4 Ft. 2 Sand
From To Ft. N e
16. REMARKS: Monitor inq Well 4 Water first encountered at 46 ft
Wall Thickness
Diameter or Weight/FL Material
Ft 2" Sch 40 PVC
Ft.
FL
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
SR 2015
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C. WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATUR F CONTRACTOR CA AGENT DATE
;w.� RFV 4+51 SttRmit' trial to Division of Envtror7wrilal Manaaemenl and copy in well owner

]_kLi 5-
North Carolina - Depanmern of Environment. Health. and Natural Resources
Division of Errvironrrlental Management - Groundwater Section
P.D. Box 29535 - Raleigh, N.C. 27626.0535
Phone [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: GAI Consultants
�+r,aw i W 5)
FOR OFFICE USE ONLY
OGAD. NO, SERIAL NO.
Lat Long, RR
Minor RUM
8334 code
4ieadw Ent GW-1 Ent.
STATE WELL CONSTRUCTION
DRILLER REGISTRATION NUMBER: 445 PERMfT NUMBER: NSA
1. WELL LOCATION: [Show sketch of the location below]
Nearest Town: Mount Airy Counrf: Surry
SR 2015
(Road, Community, or Subdivision and Lot No.) DEPTH DRILLING LOG
2. OWNER Starry County
PC) Box 7l� From To Formation ❑esaipuon
ADDRESS 0 - 5 Red clay
IStreet or Houle W.)
Dobson NC 27017
5 - 16 ?an sandy silt
Ciry or Town state Zio code
3. DATE DRILLED 8-27-94 USE OF WELL Monitoring
4. TOTAL DEPTH � •.7 15 -- �- 7 Gray garnet mica
5. CUTTINGS COLLECTED YES ❑ NOIJ_x schist with granite
6. DOES WELL REPLACE EXISTING WELL? YES C NO[7x intrusions
7. STATIC WATER LEVEL Below Tap of Casing: 39.5 FT.
(Use': if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
Casing Terminated aVor below land surface is inagai unless it variance Is issued
in accordance with 75A NCAC 2C .011e
9. YIELD (gpm): METRO❑ OF TEST
10. WATER ZONES (depth): 51 to 54.7 ft
I. CHLORINATION: Type Amcunt If additional space is needed use back of form
12. CASING:
Depth Diarreter
211
From +2 Tu —4 I Ft.
From To Ft,
From To Ft.
13. GROUT:
Wall Thickness LOCATION SKETCH
or weighc'Ft- Material (Show direction and distance Irom at least two State
SCh 40 PVC Roacs. cr other map reference permtsl
SR 2015
Depth Material Methoo {
From 0 To 45 Ft. Cement Grout `1
From 45 To 46 Ft, Bentonite Pellet '
14- SCREEN: t15plh
0
Diameter Slot Size Material
From 48 To E3 Ft 2 in. -010 in. PVC Mw r:
From -To Ft, in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 46 To 64.7 Ft. 2 Sand
From TO Ft. N
16. REMARKS: Monitoring Weil 5 - Water first encountered
I DO HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH t 5A NCAC 2C, WELL
CONSTRUCTION STANCARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL UWNER.
SiGNAT E OF CONTAACTOA G7 AGENT DA
GM REV S91 Sui Qno,nat to :1 iv isron of Ettvero r me vial ki a n acerne nl and caov to well owne•

M Uj 6
North Carolina - Deparlmern of Envrrannietn. Health, and Nalwal Resources FOR OFFICE USE ONLY
Division of Envirflnmentai Management - Groundwater Section
P.O. Box 29535 - Ralergh.N.G.27626.0535 a 5EAIALHO.
Phone [phone] Lat Long, FID
Minor Basin
WELL. CONSTRUCTION RECORD 6coda
DRILLING CONTRACTOR: CAI Consultants peader EM Gw-1 GV.
STATE WELL CONSTRUCTION
DRILLER REGISTRATION NUMBER: 446 PERMIT NUMBER: NSA
1.
WELL LOCATION: (Shaw sketch of the location belord)
Nearest Town: Mount Airy _ Cnurny:
Surry
SR 2015
(Road, Community, or Suodrvision and Lot No.)
DEPTH
DRILLING LOG
2.
OWNER Surg County _
From To
Fermaeon Description
ADDRESS 10 Box 706
❑ - 15.5
Brown to tan sandy
tSlreetOf ROUM NO-)
Dobson NC 27017
silt with trace clay
3.
City or Tcxr Stan 7io Code
DATE DRILLED 9-7-94 WELL Monitoring
15.5 - 3D.7
Gray garnet mica
4.
USE OF
TOTAL DEPTH 30. 7
schist With granite
5.
CUTTINGS COLLECTED YES 71 NOFT
intrusions .5-1'
6.
DOES WELL REPLACE EXISTING WELL? YES � NOr_x_
thick
7.
STATIC WATER LEVEL Below Top of Casi ng: 2 5 FT -
(Use % if Above Top of Casirg)
S.
TOP OF CASING IS 2 FT. Abase Land Surface'
Casing
Termineied auor below land surface is illegal unless a variance is issued
in
secordanee with 15A NCAC 2C .0118
9.
YIELD (gpm):.r METHOD OFTF;
10.
WATER ZONES (depth): 20.55 to 30.7 It
.1. CHLORINATION: Type
12- CASING:
Deoih Diameter
From +2 To 14.7 Ft. 2 r
From To Ft,
From To Ft.
13. GROUT:
_ Amount 11 additional space is needed use back cf form
Wall Tiickness LOCATION SKETCH
of weti �r pvrrkal {Show direction and distance from at;east two State
S h 4
Reacs. i:;r Other map reference Famtz}
Depth Material
From ❑ To 12 Ft. Cement
From 12 To 13 Ft- Bentoni to
14. SCREEN -
SR 2❑15
Method
Grout ti
Pellet ,
Depth Diameter Slot Size Material
From 14.7 To 29.7 Ft 2 in. 010 in. PVC
From —To—FL— in, in.
From To Ft. in. — in.
15. SAND/GRAVEL PACK:
Depth Size
From 13--o To 30.7 Ft. 2
From To FL.
16. REMARKS: Monitoring well 6
Material
Sand
N 4--
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH-1SANCAC 2C- WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
%/fc
SiGNATUPj_ OF C:ONTAACTOR Ca AGENT - �t rE
3W• t REV 9191 Sufi met or Cinsi to ti4rs. rt 01 E2 inn For r7i Wn ear l.tr n averne rt ano coo :J we 11 .rwnc­

North Carolina - Department of Ervwronment, Health. and Natural Resources FOR OFFICE USE oNLY
Divisian of EmoronmenW Managemord - Groundwater Section ❑UAp SEAIALNo
P.O_ Box 29535 . Raleigh. N.C. 27626.0535
Phone [phone] L&L Long. AD
mkwr Bait
WELL CONSTRUCTION RECORD leas.! Case
SRiLLING CONTRACTOR: GAI Consultants Header Ent. GW-1 Ertl
STATE WELL CONSTRUCTION
❑KILLER REGISTRATION NUMBER: 446 PERMIT NUMBER' NSA
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Mount Airy County-, Surry
SR 2015
(Road. Community, or Suodivision and Lot No DEPTH DRILLING LOG
2. OWNER Surry County
Froen Formation Aesenpdon
PO Box 706 ADDRESS _ 0 — 45 Tan to brown sandy
(Strew or Route No.) silt
Dobson NC 27017
City or Town State 2io Code
3. DATE DRILLED B-16-94 USE OF WELL Monitoring 45 — 55.3 Gray schist
4. TOTAL DEPTH 55.3
5. CUTTINGS COLLECTED YES NO J
5. DOES WELL REPLACE EXISTING WELL? YES C N0
7. STATIC WATER LEVEL Below Top of Casing: 41.1.1 FT.
(Ilse': it Above Top of Casing)
8. TOP OF CASING IS 2.3 FT. Above Land Surface -
Casing Terminated aVor below land surface is illegal unless a variance is issued
In accordance with 15A NCAC 2C .13118
9. YIELD (gpm):_METHOD OF TEST
16. WATER ZONES idepth): 3a.8 to 55.3 ft
' 1. CHLORINATION: Type Amount 11 additional space is needed use back ct farm
2. CASING:
Wall Thickness LOCATION SKETCH
+23 ❑epth3g Diameter or weight;FL Material (Show direction and distance from at least two State
From To Ft, 2' Sch 46 PVC Roscs, cr other map reference points)
From Ta Ft.
From —To Ft. SR 2015
13. GROUT!
Depth Material Method
From -_ To 36 Ft. Cemerit Grout
From 36 To 37 Ft. BentOnite Pellet ,
0/14. SCREEN: (15') fW 8
Depth Diameter Slot Size Material
From 39 To 54 Ft 2 in. -012 -n, PVC
From T❑ Ft. in. in.
From To Ft. in, in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 37 To 55.3 Ft. 2 Sand
Prom To Ft. N f
16. REMARKS: Monitoring Well 8
100 HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
Vk4l lo 11p If"
SIGNAIUR ri CF CONTRACTOR CAG2NT D.;rE
uW t REV ?97 ��_m t nil r. =rv-aon of & +� u mn:a+!!anaoer^rr• ,�aC�c: +_ vrr,

�A LX) C i
North Carolina - Department of ErivironmoM, Health. and Natural Resources
Oivision of Environmental Manage mertt - Groundwater Section
p_O. Box 29535 - Raleigh, N.C. 27626-0535
Phone [phone]
WELL CONSTRUCTION RECORD
"RILLING CONTRACTOR: GAI Consultants
FGA OFFICE USE ONLY
Q=. NO. SERIAL NO.
l aL L-V• f40
Minor Basin
Basin Cade
V&adar Era ew-1 Env
STATE WELL CONSTRUCTION
DRILLER REGISTRATION NUMBER: 446 PERMIT NUMBER: N/A
1. WELL LOCATION: [Show sketch of the location below]
Nearest Town:Mount Airy _— County: Surry
SR 2015
(plead, Community, or Subdivision and Lot No.)
2. OWNER Surry CountY
ADDRESS PO Box 706
(Street or Route nto.j
Dobson NC 27017
City or Town State Zio Code
3. DATE DRILLED 8-22-94 USE OF WELL Monitoring
4. TOTAL DEPTH 43.8
5. CUTTINGS COLLECTED YES ❑ NO C
6. DOES WELL REPLACE EXISTING WELL? YES (� NOF_X
7. STATIC WATER LEVEL Below Top of Casing: 3"5 7 FT.
(Use'i if Above Top of Casing)
S. TOP OF CASWG IS 2 3 FT. Above Land Surface'
'Casing Terminated avor below land surtace is illegal unless a variance is issued
In accordance with 15A NCAC ZC A118
9. YIELD [gpm): METHOD OF TEST
10. WATER ZONES (depth): TA-4—to 43_9 ft
`i. CHLORINATION: Type
Amount
CASING:
Weill Thickness
+2 ,3
Depth 28. S
at
Diameter or w ghat. PVC
From
To Ft.
From
To Ft.
From
To Ft.
13. GROUT:
Depth
Material Method
From 0
To 25.5 Ft.
Gent Grout
From 25.5
To 215• 5 Ft.
Bentoni to Pellet
14- SCREEN:
DEPTH DRILLING LOG
From To Formation Description
D - 43.8 Brown to tan sand
silt
If additional space is needed use bark of form
LOCATION SKETCH
(Show direction and distance from ai least two State
Roans, or other map reference pcmis)
sR 2015
1
Depth Diameter Slot Size Material MW 9
From 28-8T❑ 13-6 Ft 2 in. •Olo in. PVC
'40-
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 2_6 5 To 43.8 Ft, 2 Sand
From To Ft. N 4—
16. REMARKS: Monitoring Well 9
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC "cC. WELL
CONSTRUCTION STANGAR[OS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OtVNEA.
11 -
r�
SIGNATURE CONTRACTOR rR AGENT �A
Gw-1 REV 991 �+t c '- at t� ^i •S,�r a E v ro- ^en; anaQQmnr ; zr+a c=ov :_ :•en :N�e

KLJ tl
North Carotina - Dapan mem of Environment. Health, and Naturai Resaurces
Division of Environmental Martagemem - Cuoundwater Section
P.O. Box 29535 • Rai aigh. N.C. 27626-0535
Phone [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: GAI Consultants
DRILLER REGISTRATION NUMBER: 446
FOR OFFICE USE ONLY
QUAD. NO. SERIAL NO.
[at [.Ong. RO
Wrix Basin
ft— rl-d.
Header Ent Caw-1 Etc
STATE WELL CONSTRUCTION NSA
PERMIT NUMBER:
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Mount Airy_ _ County:
Surry
SR 2015
(Road. Cammun[sy. or Sutdmsion and Lot No.;
DEPTH
DRILLING LOG
2. OWNER : uU- County
From 7o
Fnrmaapn Description
PO $O% 7❑6
ADDRESS _
❑ - 17-5
Red to brown sandy
t5veei Of Route No,;
Silt with trace clay
Dobson NC 27017
City or Town Slate zip Code
3. DATE DRILLED 8-15-94 USE OF WELL Monitoring
17.5 - 41
Gray garnet mica
4. TOTAL DEPTH 411
schist
5. CUTTINGS COLLECTED YES;17 NOFT
S. DOES WELL REPLACE EXISTING WELL? YES C NOR
7. STATIC WATER LEVEL Below Top of Casing: 20.92 FT.
(Use' -:'if Above Top of Casing)
S. TOP OF CASING iS 1-5 FT. Above Land Surface'
' Casing Torminared auor below land surface is illegal uniess a variance I Issued
In accordance with ISA NCAC 2C .011a
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth}: 36 to 41 ft
11. CHLORINATION: Type Amount If additional space is needed use bark of form
2. CASING.
Walf Thickness
Depth
Diameter or rvS Weight' t. a[eriai
From *1.5
To 25
Ft,
2" Sch 4� PVC
From
To
Ft.
—
From
To
Ft.
13. GROUT:
Depth
Material Method
From 0
To 22
Ft.
Cement Grout
From 22
To 23
Ft.
Bentonite Pellet
14. SCREEN:
LOCATION SKETCH _
{Show direction and distance from at laast two State
Roads, cr other, map reference points)
SR 2015
MW 11~
�t
Depth Diameter Slot Size Material
From 25 To 40 Ft 2 in. .010 in PVC
From To Ft. in. in.
From_To Fr. in. in.
15. SANDIGRAVEL PACK:
Depth Size Material
From 23 To 41 Ft. 2 Sand
From To Ft. N
1E. REMARKS: Monitoring Well 11 Water first encountered at 36 ft
I DO HEREBY CERTIFe THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C. WELL
CONSTRUCTION STANCAROS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL aNNER.
r, /r
Vkbj
-�Xxkz' Lc Q I
S16NA7uF F CONTRACTOR CR AGENT aTE
GW-1 REV 991;a.r�-

-`ALJ
MONITORING WELL
CONSTRUCTION LOG
PROJECT: Mt Airy Water Quality Assessment
LOCATION: ML Airy, NC
GEOLOGIC UN
ENGINEER3NG, *NC
MONITORING WELL 10: MW-12S
CONSTRUCTION DATE: S13112DD1
STAND PIPE CONSTRUCTION
MEASURING POINT ELEVATION 10 0 ft AMS
PAD DIMENSIONS 3feet N 33 feet
GROUND SURFACE ELEVATION 1023-25 ft A 5
BOREHOLE DIAMETER 9_inches to 5 feet below orade
-LiD.qh2r, from 5 IU5 to hattom _
ANNULAR SPACE SEAL
TYPE OF SEAL Ejoanokg EodanclC meQj
RISER TYPE PV
RISER DIAMETER � Inches
TOP OF FILTER PACK SEAL
ELEVATION j-lQI7.25ftAMSL
DEPTH
FILTER PACK SEAL P h r 8 in. c' s
TOP OF FILTER PACK
ELEVATION 1 14, ft MSL
DEPTH 9 feel
FILTER PACK TYPE jt raded well sand
FILTER PACK SOURCE O51 -r
TOP OF SCREEN
ELEVATION 012AMSL
DEPTH 11 feet
SCREEN TYPE VC
SCREEN DIAMETER legs
SLOT SIZE D.010 inh
BOTTOM OF SCREEN
ELEVATION -j2.25 ft AMSSL
DEPTH 51 f2et
BOTTOM OF SCREHOLE
ELEVATION 972.25 ft AMSL
DEPTH 51 feet

Muj i7- p
MONITORING WELL
CONSTRUCTION LOG
PROJECT: Mt._Airy Water_ QuaiLty Assessment
LOCATION: Mt. Airy, NC
GEOLOGIC UNITS
ENGINEERING, INC.
MONITORING WELL 11): MW-120
CONSTRUCTION DATE: 5/30/2001
STAND PIPE CONSTRUCTION
MEASURING POINT ELEVATION ] L95 ft AMSL _
PAD DIMENSIONS 3 feet x 3 feet
GROUND SURFACE ELEVATION 1023.75 ft AMSL
BOREHOLE DIAMETER 9 inches to 5 feet belowgrade
4 inches from 5 feet to bottom
ANNULAR SPACE SEAL
TYPE OF SEAL Roanoke P land Cement
Tremie flrouted
RISER TYPE PVC
RISER DIAMETER 2 inched
TOP OF FILTER PACK SEAL
ELEVATION 932.75 AMSL
DEPTH 84 feet
FILTER PACK SEALTYP—E hu'r Plua 3!8 inch chins
XZTOP OF FILTER PACK
ELEVATION 9Q6.65 ft AMSL _T
DEPTH 87,10 feet
FILTER PACK TYPE #3-orao&d well sand
FILTER PACK SOURCE _?sl
— TOP OF SCREEN
ELEVATION} ft AMSL
DEPTH 90 feet
SCREEN TYPE PVC
SCREEN DIAMETER _2 inches
SLOT SIZE O7 O 10 inch
BOTTOM OF SCREEN
ELEVATIONMj5A AMSL
D EPTH 100 teat
LE, —BOTTOM OF BOREHOLE
ELEVATION! 923.75 ft AMSL
DEPTH 1 m Feet _ �"

Surry County Closed, Mt. Airy
Drilling contractor: Derry's Well Drilling
D6111 rig & method. 7.75* OD HSA
Logged by: I Plohl
Date started: 5/30/2006
Date ended: 5/30/2006
Completion depth: 44.00 ft
Stickup height: 2.73 ft
LOG OF BORING: MW-13
Project No. G06061
Surface elevation: 1005.75 ft (MSL)
Top of pipe elevation: 1 D08A8 ft (MSL)
Depth to water (TOB): 32.00 ft
Depth to water (24hrs): 24.17 It
—
Z.
W
CL -6
d)
Well Diagram
E
EDescription
of Material & Remarks
o
W
>,
N
(n Co
r1L
Saprolite - Silty Sand
5
E
L)
rK
ty
15
20
--x
1W
-4
k
0
330
O
Water observed while drilling
C;
6
35
40
Auger Refusal - Top of Competent Rock 961.75 ft. amsl.
45
Boring terminated at 44.0 feet
Municipal Engineering Services Company, P.A.
Operation)Construction Managers Civil/San" Engineers Environmental Studies Page 1 of 1
PO Sax 97, Gamer, North Caraina 075291919) 772-5393PO H<w 349. Some, Noah Caroins 28607(826) 267-1767 1

NONIwESIDENTL4L WELL CONSTRUCnON RECORD tAW.
Nortb Carolina Department of Enwonment and Natural Re zu res- Divism of Watts Quality
WELL CONTRACTOR CERTIFICATION # 260
1. WELL CONTRACTOR -
Derry Huneycutt
Wei Contractor (IndMduat) Name
Derry's Well06ing
Wed Contrwor Company Name
STREET ADDRESS 44283-A NC 24(27R3
Albemarle NC 28002
City or Town State Zip Code
70�___�- 9B2.3❑7❑
Area code- Phone number
2. WELL INFORMATION -
SITE WELL ID Se applicable)
STATE WELL PERMITikif appfinble)
DWO or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) MoMonng p MunidpaVPublir 0
IndustriallCommercial p Agriaitturai D Recovery ❑ Injection L
Irrigation© CM)er ❑ pist use]
DATE DRILLED 5I30f06
TIME COMPLETED 2:30 AM Q PM p
3. WELL LOCATION:
CITY: Ararat COUNTY NC
419 Landes Road 27007
{Strut Nrnme Nurnbem, Community, Subdusmn, Lot Ha, Parcel, Zip Code)
TOPOGRAPHIC HAND SETTING:
■ Slope ❑ Valley ❑ Flat ❑ Ridge L7 Ot w
{check awopnale brA
LATCTUDE 6 &C. 7A 3k May be irf degrom
minLlt� socands or
LONGITUDE SC b` q,S29 { in a dimirml Torrnaz
LatitudeRongitudesourrc: 4@15PS pTopogmphic map
{bcabon of weg must be shown on a USGS topo map and
affached )o this farm it not using GAS}
A. FACILITY- is sx �- or eb nrr--- m - eb wrl is km.
FACILITY 10 $(If applicable)
NAME OF FACILITY Suety Go. Closed Landfill
STREET ADDRESS 419 Landfill Road
Araml NC 27D07
City or Town Stale Zip Code
CONTACT PERSON Mr, Jerry Snow
MAILING ADDRESS PO BOX 1542
Mount Airy NC 27030
City or Town State Zip Code
( 336 )- 401-8376
Area code - Phone number
S. WELL DETAILS:
Ia. TOTAL DEPTH: 35.7V
b. DOES WELL REPLACE EXISTING WELL? YES Cl NO Ei
c. WATER LEVEL Below Top of Casing: 26-90 FT,
(Use' -'If Above Top of GasRq)
S. TOP OF CASING IS 3.00 FT. Above Land Surface'
'Top bl casing terminated Wor below land surface may require
a variance in accordance with 15A NCAC 2C .011 B.
at. YIELD (gpmy na METHOD 6F TEST na
f. DISINFECTION: Type ns Amount na
g. WATER PONES (depth)
Frwn Tc From To
Fr rn To From To
From To Frort_Ta
& CASING: ThKAcress/
From 0 � h0.78 FL iameler Wnpx Mir.1
From Tc FL
from To Ft.
T. GROUT: Depth Material Method
From ❑ To 16.5 FL Neal Cement Tremie
Fran 1 Ta_W5 FL w" s" °" a ff' Pour
From 35.78 To 44 FL Neat Cement Tremb
3. SCREEN: Depth Dwrieter Slat Size Material
From 2❑-78 To 35.78 FL2' in. 0-10 in- PVC
Fran To FL in, in.
From Ta Ft. in, In,
9. SANDIGRAVEL PACK:
Depth Size material
Fran 19,S To �.78 FL #2 Filter Sand
Fran Ta Ft`
From To Ft-
10. DRILLING LOG
From To Formation Description
❑ 44 �N�1c�,ht
11. REMARKS'
MW-13 Installed as Type 11 MW Ior aw-loring down9mdont of closed MSWLF
I DO HEREBY C THAT WELL WAS CONMUCTEO IN ACCORANJCE WTrK
1 U NCAC 21c tt ON STAMMPZ09, ANZ THAT A COPY OF THIS
RE E 0THE WELL OWNEFL
711*6
SIGNATUPIEOFCER IED WELL CONTRACTOR DATE
t
PRIN TECFNAME OF W& CONSTRUCTING THE WF..LL
Submit the original to the DiVISiOnI of Water Quality within 30 days. Attn: Information MgL, Form GW-lb
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev. 7r05

Surry County Closed, Mt.
Drilling contractor: Derry's Well Drilling Date started: 5/30/2006
Drill rig & method: 7.75' OD HSA16" OD DTH Date ended: 5/30/2006
Logged by: J. Pfohl Completion depth: 48.00 ft
Stickup height. 2.69 ft
LOG OF BORING: MW-14
Project No. G06061.0
Surface elevation: 1016.11 ft (MSL)
Top of pipe elevation: 101$.80 ft (MSL)
Depth to water (T013): 38.00 ft
Depth to water (24hrs): 38.50 ft
_
a
❑
-_-
n
r
d
ca a
E
E
Description of Material & Remarks
Well Diagram
N
sR
�.1
5
7p
c
15
20
25
30
35
40
45
50
-
Saprolite - Silty Sand1/01
----------------------------------------------------
Auger Refusal - Top of Competent Rack 1012.1 1 ft amsl
Schist, tan interiayered with saprolite, highly fractured.
Gneiss- gray moderatley hard
----------------------------------------------------
Schist - brown, fractured
----------------------------------------------------
Gneiss
Suhlst - brown, dry
---------------------------- ------------------------
Gneiss
----------------------------------------------------
Schist
Groundwater observed - solvent odor
--------------------------------------------------
Gneiss
C7
to
v
[]
0
c
m
m�x
Il
a
N
N
:..
-
Cj
i
a
a
n
d
N
O
N
V)
N
0
6
a
Boring terminated at 48.0 feet
Municipal Engineering Services Company, P.A.
Operation/Construction Managers Civil/Santary EngineersEnvironmental Studies Page 1 of 1
PO Sax 97. Gamer, North Garoina 27529{919) 772-5393PO Box 349, Boone, North Carofina '8607(828) 2624767

NONRESIDENTIAL WELL CON STRLUM0N RECORD /Aw . 1
NorW Carolina Depaim erA of Envarmtnent and Nenval Resourus- ❑nzsion of Water Quality
WELL CONTRACTOR CERTIFICATION # 2663
1. WELL CONTRACTOR:
Derry Huneycutt
Well Contractor (Individual] Name
Derry's Well Drilling
Wei Contractor Company Name
STREET ADDRESS 44283-ANC 24127f73
Albemarle NC 2800]2
City or Town Stale Zip Code
7�r 982-W70
Area code- Phone number
7- WELL IMF �RMATIONr
SITE WE 1D #(H applicable)
STATE WILL PERMITV app&,Abl.�
DWQ or O HER PERMIT #(if applicable]
WELL USE ( heck Applicable Box) Monnoring e7 MunigpallPubAc ❑
lndustriallC mercW 0 Agricultural ❑ Recovery ❑ Injedion q
Irllgatian> Otlux ❑ (Rst use)
DATE imt O 513=6
TIME CO PLETED 6:30 AM l7 PM ID
3, WELL LO�ATIOW
CfTY: A I COUNTY NC
419 Landrk Road 27007
(Street e, Numbesa, Community, Su6dvirlon, Lot Ala. Parcel. Zip Code)
TOPOG HlC 1 LAND SETTING:
p Slope ❑ ey it Flat ❑ Ridge [IOther
[ eat approp fete ba4
I,ATITUD� gyp+ �6 o3.t"�lS Mir be in degtoes,
rnunytcs, axcorlds or
LONGITUDE ijo a 4,14 S in a dcaural format
latitude)]' gite source: 4BGPS ❑Topographic map
Ibcatb 1 of wet must be shown on a USG topo map and
attach d to this farm I nW using GPS]
t FACILITY is pie name ar the baainma wham the war is Ivcaied.
FACILITY ID Kd applicable]_
NAME OF!FACILITY Sury Co. Closed Landiil
STREET �DDR£SS 419Landfill Road
Ararat NC 27007
City or Town Slate Zip Code
CONTACT PERSON Mr• .ferry Snow
MAILING ADDRESS PO Box 1542
Mount A! NC 27030
City Town State Zip Coda
33{ 6 1 _ 401-8376
Area code. Phone number
i
5, WELL DETAILS:
a. TOTA DEPTH: 48.03'
h- DOESMIELL REPLACE EMSTING WELL? YES[) N0
c. WATER LEVEL Below Top of Casing: 41.19 FT.
(Use'+' it AhoA Tap of Casing)
d. TOP OF CASING IS 3-00 FT. Above Land Surface
'Top of casing terminated Wor below land surface may require
avanarce in accordance with i5A NCAC 2C .0113,
a, YIELD (gpm); r'a METHOD OF TEST rra
1, DISINFECTION: Type na Amount na
g. WATER ZONES (depth):
Frcm38.18 To From To
From To From To
From To From To
$. CASING: Thiickfitn��eW
From 0 Depth 3.03 FL r arrieter WS,gQZ PVCnai
From To Ft.
Fran To Ft
T. GROUT: Depth Mat" Method
From 0 To 29-5 Ft Neal Cement Tremble
From 29.5 Tom Ft. tieaaye cnw Pour
From To Ft
B_ SCREEN: Depth Diameter Slot Size Material
Frain 33.03 To 48.03 FLT in. 010 in. PVC
From To R in. in.
From To Ft in- in.
S. SANDIGRAVEL PACK:
Depth Size Material
From 32 Tc 48.03 Ft 7 Filter Sand
From To Ft
From To Ft,
10. DRILLING LOG
From To
0 6
Formation Description
2sil —_
PWR L� Rock
11. REMARKS:
MW-14 lnctalled as type 11 M W tar monilodng downgrndierd of chord MSWLF
10011EREBY FY THAT THIS L Z CONSTRUCTED IN ACCORDANCE WrH
5U WCAC 20 LLF
U TAN[YiR0.S, ANO THAT A COPY OF TMS
REpORO EN E W ELL OWN
EN
71IM6
SI 0 IF D WELL CONTRACTOR DATE
PRINTED NAME 0
Submit the original to the Minion of Water Quality within 30 days. Attn:lnformatlon Mgt, Form GW.tb
1617 Mail Service Center —Raleigh. NC 27699.1617 Phone No. [phone] ext 560. Rev- 7105

LOG OF BORING: MW-15
Surry County Closed, Mt. Airy
Project No. 006061.0
Drilling contractor. Derry's Well Drilling
Date started:
6/22/2006
Surface elevation:
1073,23 ft (MSL)
Drill rig & method: 7.75' OD HSA/4" OD DTH
Hate ended:
6/22/2006
Top of pipe elevation:
1075.96 ft (MSL)
Logged by: J. Pfohl
Completion depth:
57.00 ft
Depth to water (TDB):
49.50 h
Stickup height:
2.73 ft
Depth to water (24hrs):
49.74 ft
---
„
Well
Diagram
_
v
=
a
a
r=
E
Description of Material 8 Remarks
❑
IL
rn
o a
0 rn
vl�
rn
Saprolite - Silty Sand
-
a
5
-
10
t5-------------•--------------------•----•-----•------
PW R - Hard Drilling
o
d
w
20
m
U
�
U
d
V
25
N
Auger Refusal -Top of Competent Rock 1045.23 ft amsi - Schist
30
35
40
m
`o
c
45
d
m
Q
5II----------------------------------------------------
a
a
a
�
Highly weathered rock
s
N
55
Returned to competent rock
LM
4
O
Boring terminated at 57.0 feet
so
Municipal Engineering Services Company, P.A.
Operation/Construction Managers CiviuSanitary EngineersErnrironmental Studies Page i of 1
PO Box 97. Gamer" North Camifia 27529I9i9J 772.5393PQ Bar 349. Some, NWh Carolina 29607[6251252-1767

NONRESIDENTIAL WELL CONSTRICTION RECORD
Norffi Carolms Department ofFaviroament and Natural Resources- Divivon of Water Quality
WELL CONTRACTOR CF-RT7k'ICATION N 2663
1, WELL
Pdihaduefj Name
Derry's
STREET DDRESS 44283-A NC 24)27173
Albema a NC 28002
ty or town smote zip cede
7O4 982-3070
Area Phone Umber
Z WELL IN ❑RMATION:
SITE w LL In C{dappFcaMe1
STATE ELL PERM ITkrrappccadel
DWp or THER PERAAIT #(if appli el
WELL USE Check Wiic" Box] Moniiaing p Munk•JilairPubec ❑
IndustriaYC mercial ❑ Agricultural CI Recovery Q In)ecd C7
Irrigation Other (list use)
DATE D LLED 8[ZM6
TIME COI APLETED 8,30 AAA ❑ PM E
3. WELL L ATION:
CITY: Arkral_ — -- — COUNTY NC _
4.
419 LaW4 Road 27007
(Street C Numbers. Carnmurrty. Subdlumon, LO Na-, Parcef, Zip Code)
TOP[3G HIC r LAND SETTING:
Slope 11vailley ❑ Ftaf C IRkige ❑ Other
elk appropriate box)
LATITUfli( OI . �$ May be in degrees,
minutes, stands or
LONGITU E 24 3 11.7 } in a docinml foram
L.atitudell ngitude source: rGPS ❑Topographic map
flocaria of wet rnLosr be shown on a LISGS repo map and
attach to this Aorta+ enal using GPS)
-r= Tf�►_ V;90]71
g.. n . of me eu.aK.a where rna w.s W Iar: -
*{if applicable}
Co. Closed Larwrio
STREET DRESS 419 Landnl Road
Ararat NC 27007
City or Town State Zip Code
CC) NTAci PERSON Mr. Jerry Snow
MAILING ODRESS PO8ax 1542
Mount Air INC 27030
City oi� Town Stale Zip Code
33L� 8 11 401-8376
Area code Phone number
L WELL DETr4ILS:
a. TOTAL PITH: 56,98'
b. DOES 1rLL REPLACE EXISTING WELL? YES ❑ NO @
r- WATER LEVEL Below Top of Casing: 52.47 FT.
{Use'•' 0 Above Top of Casing)
MW-15
ai TOP OF CASING IS 3.00 FT. Abate Land Surface -
'Top of casing terrrwLwed avor below, lend surface may require
a valance in accordance with 15A NCAC 2C .01Ia.
e. Y1ELa (9 Pint) METHOD OF TEST na
f. DISINFECTION: Type na Amount rIa
9. WATER ZONES {Ceptily
From 49,47 To From To
From TO From To,_
Frost Ta From To
L CASING: Thkimessr
From 0 Depth
41,98 FL 2' ulrrteler WU9ht PVC
From To FL 4U
From Tc Ft,
7. GROUT: Depth Material Method
From 0 To 37.5 FL Ness Cemenl Tremie
Fromm To= Ft o- Pow
From To Ft.
a. SCREEN: Depth Diameter Slot Size AAatedw
From 41.98 To 58.98 Ftf ih. 9,10 in. PVC
From TO In.
From To Ft eh. in,
9. SANDIGRAVEL PACK:
Depth Size Material
From 40.38 Tc 56.98 FL #2 Filter Sand
Fran To Ft.
From Td Ft
10, DRILLING LOG
From To Formation Description
0 28 Sol
28 56.99 Rack
11. REMARKS:
MW.15 Inrmlied as typo 11 µW for monilpnng dnwngradlent of aosed MSWL.r
100 R15EACNQMGREC EWWEA$ GAER.a
C1EQ H ACCORWNCE wTi*
GTHAT A COPY OF Tas
711ap
SIG OF CERTI D WELL CONTRACTOR DATE
ell
P RI NTJO NAME 09 PERSON CONSTRUCTING THE WELL
Submit the Original to the Division of Water Quality within 30 days. Attn: Informti aon Mgt, Form GW-lb
1S17 Mail Se ; ice Center- Raleigh, NC 27699-1617' Phone No. [phone] ext 568. Rev, 7l05

LOG OF BORING: MW-16
Surry County Closed. Mt. Airy Project No. G06061.0
Drilling contractor: Derry's Well Drilling
Date started:
6/21,2006
Surface elevation: 996.67 ft (MSL)
Drill rig & method: 7-75" 00 HSA14" OD DTH
Date ended:
6121/2006
Tap of pipe elevation: 999.54 ft (MSL)
Logged by: J. Pfohl
Completion depth:
36.28 tt
Depth to water (T06)-
Stickup height:
2.87 ft
Depth to water (24hrs): 26-94 ft
--
m
Well Diagram
_
v
C
R
R O
E
Description of Material & Remarks
om
can
c°n 0
`e
n
Y
Saprolite Silty Sand
5
a
j 14
10
Auoer Refusal - Top of Competent Rock 987.67111 amsl
f �
Gneiss/Schist
U a
N
20
C
C
25
C
yv
N
7
= a
a c
a �
m �N
30
�
LO
a
35
Boring terminated at 36.3 feet
40
45
Municipal Engineering Services Company, P.A.
OperabonlConstruction Managers CiviVSanitary Engineers Environmental Studies Rage 1 of 1
PC Box 97, Garner, North Caro►na 27529(919) 772.5393PO Box 349, Bome. North Carolina 28607{828J 262-1767

fA W
� I—
NaN.RESrDEN—ML WELL CONMUCT10N RECORD] �j
North Carolina Departmicut of Environment and Natund Resouresa- Division of WxW Quality
WELL CONTRACTOR CERTIFICATION N 2663
1. WELL CONTRACTOR:
Derry Huneyarit
Wei Contractor (Individual) Name
Derry's Well Drilitng
Wed Contractor Gompeny Name
STREET ADDRE55 4.4283-ANC 24/27173
Albemarle NC 28rM2
CW or Town State ZIP Cade
70t 4 � 9e2-3070
Area code- Phone number
I WELL INFORMATION:
SITE WELL ID tyr appkc oe)
STATE WELL PERMIT#Cif applicable}
DWO or OTHER PERMIT A(6 applicable)
WELL USE (Check Applicable $oxj Moniloring El MuracipallPublic ❑
IndustdailCommarcial C Agncultural C Recovery ❑ Injection 0
Irrigation❑ Other ❑ (Nst use)
DATE DRILLED P121106
TIME COMPLETED 8:15 AM 9 ?MID
3. WELL LOCATION:
CITY' Ararat COUNTY NC
419 LandfiiN taped 27D07
(Stream Name, Numbers, Cwvnu ty, Subdi ivon, Lot No-. Paw-M. Tip Con-1
TOPOGRAPHIC ILANE) SETTING,
*Slope 45Valiey 0FW QRiNe ❑ father
(check apprbpri ale box)
LATITUDE _ fir ,� ,04. CI"kQ ( May tes in degrxs
mitnrtrs, seconds or
LONGJUOE %0 n w decimal format
LatitudeliDrigi(ude Source: AwC'TPS ❑Topographic map
I4Carlon orwed must be shown on a tJSGS lope map and
arlached to this farm divot using GPS)
4. FACILITY -Is M ram. a N. nnai... wears i" ww i. v eakd.
FACILITY ID $(if applicable] _�� _
NAME OF FACILITY Surry Co. Closed Landin
STREET ADDRESS 419 LariaM Road
Ararat NC 27007
City or Town State Zip Code
CONTACT PERSON Mr. Jerry $now
MAILING ADDRESS PO Sax 1542
FAbunl NC 27030
City or Town State Zip Code
336 J.401-8375
Area code - Phone nurnber
L WELL DETAILS:
a. TOTAL DEPTH: 36.28-
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO H
c WATER LEVEL Below Top of Casing: 26.94 Fr -
(Use'+' if Above Top of Casing)
d. TOP OF CASING 15 3.00
FT- Above Land Surface'
'Top of casing terminated aVor below land surface may require
a variance in accordance wily 1 SA NCAC 2C .DI18,
e. YIELD Igpml: na
METHOD OF TEST na
f. DISINFECTION: Type ea
Amount r>a
9. WATER ZONES (depth);
Fromm-94 To
From To
From To
From To
Fmr Tp
From Tp
6 CASING:
Thicknes5J
Depth
7 iamew 1VAV Maa?lat
From 0
1 8
FL GC
From
To
Ft
From
To
Ft,
7. GROIN:
Depth
Material Method
From D
To 18.25
FL Neat Cement Tremie
FrprrL 112 To=Ft "a•-_ rc'" Pour
From
To
Ft
a, SCREEN:
Depth
Diameter
Slot Size Manna
From 2128
To— 3&.28
FL2- in.
0.10 In. PVC
From
To
Ft. in,
in.
From
To
Ft in,
in,
A SANUIGRAVEL PACK:
Depth
Size
Material
From 20.5
To 36-28
FL #2
FAter Sand
From
To
Ft.
From
To
FL
1D. DRILLING LOG
From To Formation Desenplion
0 9 Soil
2 35.28 Rode Gnsars
11. FtEMARK S.,
MW-16 Instal Had as type D PAW for munilzring downgradienl of dosed MSWLF
100 HEAE., YTHAT OS,TAVCTEQ IN ACCcRDANCE Wrni
ISA.,r =c 'L
AHD THAT A caP Of T1.$
RECNO EN A ea 'HELL EFL
7l11D6
SIGNATVE OF CERTIFI ELL CONTRACTOR DATE
■
PRINTS N E OF ERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality w-tthin 30 days. Attu: Information Mgt, Form GW-lb
1617 Mal Service Center —Raleigh. NC 27699-1617 Phone No. [phone] ext 568. Rev- 7M5

Surry County, Mt. Airy Closed
Drilling contractor: Derry's Well Drilling
Drill rig & method: 5.5" DTH
Logged by-. J. Pfohl
Date started: 611/2007
Date ended: 6/1/2007
Completion depth: 15.32 ft
Stickup height: 3.17 fi
LOG OF BORING: MW-17
Project No. G07063.0
Surfaoe elevation: 962.26 tt (MSL)
Top of pipe elevation: 965.43 ft (MSL)
Depth to water (TOB): 9.46 f1
Depth to water (24hrs): 8.83 ft
Y
(D
Well Diagram
L
a
9
ao
E
?
Q
Description of Material & Remarks
CU
d
.� nch co
[ij
y
a
Gniess; grey, competent
a R
L7
0
5
P1 CL
C fA
�
m
0.
_ a
b
N
R � N
-
1Q
n v
o
v'i c
� U
_ q
N
c�1
Boring terminated at 15.3 feet
20
25
30
35
40
45
Municipal Engineering Services Company, P.A.
Operation/Construction Managers CiviVSanhary Engineers Environmental Studies page 1 of 1
PO Bar 97,, Gamey Noah Caraina 27528(919) 772-5393PC Box 349, BomL. Non Garokna 28607(828) 262-1767

NONRESIDENTIAL NTIAL WELL CONSTRUCTION RLCCRD
North Carolina Department of Environment and Nab" Resources- Division of Water Quality
WELL CONTRACTOR CERTInCATION # 2663
1. WELL CONTRACTOR:
Derry Huneycutt
Well Contractor (individual) Name
Derry's well Drilling Inc.
Well Contractor Company Name
STREET ADDRESS 44283-A NC 24/27/73
Albemade NC 28002
City or Town State Zip Code
7{ _ 04 982-9070
Area code- Phone number
2 WELL INFORMATION:
SITE WELL ID wit applcable) MW-17
WELL CONSTRUCTION PERMlTt(p applicable).
OTHER ASSOCIATED PERMIT #(if applicable)
3. WELL USE (Check Applicable Box) Monitoringd Municipal/PubAcC
IndustrlallCommerdall] AghcutturalC Recove ya InjectionO
IrAgation[I Othern (list use)
DATE DRILLED 6/1107
TIME COMPLETED 9.30 AMR PM❑
4. WELL LOCATION;
CITY: Ararat COUNTY NC
419 Landfill Rd. 470 7
(Sheet Narne, numbers, Community. Subdivision, Lot No.. Parcel, Zip CodaI
TOPOGRAPHIC I LAND SETTING.
Q Slope ■ Valley 0 Flat 17 Ridge a Other
(check appropriate box) May be in degas,
LATITUDE 36.4338922 minutes, seconds or
LONGITUDE 80.572245 in a decimal formal
Latitudcllongitude source: 1 GPS 0 Topographic map
(lok:ah'on of well must be shown on a USGS Icpo map and
attached to thrs form If not using GPS)
S. FACILITY- is Ina name or a* b-"sa worries me wet Is ip w.
FACILITY tD it(if applicable) -
NAME OF FACILITY Surry Co. Closed MSWLF
STREET A0DRE55 419 Landfill Rd.
Ararat NC 27007
City or Town State Zip Code
CONTACT PERSON Mr- Jerry Snow _
MAILING ADDRESS PC) Sox 1542
Mount Airy NC 27030
City or Town State Zip Code
(336 i,401-8376
Area code - Phone number
G. WELL DETAILS:
a. TOTAL DEPTH: 15.32
b. DOES WELL REPLACE EXISTING WELL? YESD NON
c. WATER LEVEL Below Top of Casing: 8.83 FT.
(Use '+' if Above Top of Casing)
d. TOP OF CASING 15
3.00 FT. Above Land Surface'
'Top of casing terminated atlor below land surface may require
a variance in accordance with 15A NCAC ZC .pi 1 B.
e. YIELD (gpm): na METHOD OF TEST na
f. DISINFECTION: Type na Amount na
S. WATER ZONES (depth):
Fmrk 10 To 10.5 From To
From To From To
From To From To
7. CASING: Thickness!
Depth Narmler We Mat Mat�ria]
From 0 To 5.32 Ft; 2 32 F W
From To Ft -
Fro mTo Ft
S. GROUT: Depth Material Method
From 0 To 3 Ft. Neat Cement Pour
From 3 To 5.10 Ft. 318' Sent. Chips Pour
From To Ft
9. SCREEN: Depth Diameter Slot Size Material
From 5.32 Tn 15.32 Ft. 2 in. 0.01 in. PVC
From To Ft. in. in.
From To Ft. in. In.
1 D. SAN DIG RAVEL PAC K:
Depth Size Material
Frorr5. 10 TOIL- 12 Ft. #2
From To Ft.
From To Ft.
11.0RILLING LOG
From To Formation Description
Q !S•3 �acj _; G� Gn<L
12. REMARKS:
MIAI_37 Installed as yps 11 MW fr.r
HnWpgF2,j0ant of CIGS r AACIAfI t=
I DO HEREBY CE TkAT THIS 1NEL AS CO'NS7RLICTED IN ALCORDANCE 1MTH
15A NCAC 2G L C 11C ON TANDAROS, AND THAT A COPY OF THIS _
RECORD cN PR Ea T E WELL OW
g a�
SIGN R VOF CERTIPIEG AELLCONTRACTOR DATE
jU Prru L . fl eNCam #
PRINTED WJAE OF PERSON C STRUCTING THE WELL
Submit the original to the Division of Water Duality within 30 days. Attn: Information Mgt, Form GW-1 b
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No, [phone] ext 568: Rev. 3i07

LOG OF BORING: MW-18
Surry County, Mt. Airy Closed Project No. G07061.0
Drilling contractor: Derry's Well Drilling Date started: 6/1/2007 Surface elevation:
Drill rig & method: 7.75 CD HSA wl SS Date ended- 6/1/2007 Top of pipe elevation:
Logged by: J. Pfohl Completion depth: 18.15 ft Depth to water (TOB): 10.18 ft
Stickup height: Depth to water (24hrs): 5.88 ft
V
L
o
a
N
iv o
E
N C ]
m
E
cn
Description of Material & Remarks
Well Diagram
1
Silty Sand; Dario brown with red clay nodules. micaceous, moist
C
O
Silty SandlSapralite; moderate brown, few angular schist fragments,
a
5
dense relic structure, micaceous, moist
2
C N
agno
:::::
,::
Silty SandlSaprolite; dark brown, angular schist fragments, defined relic
structure, micaceous, moist
&
10
a
F s
say
Silty Sand/Saprolite; same as above with more schist fragments, slightly
N
weathered rock, wet
o
t 5
V
N
Baring terminated at 18.1 feet
20
25
313
35
40
45
Municipal Engineering Services Company, P.A.
Qperation/Construcion Managers CiviVSanitary Engineers Environmental Studies Page 1 of 1
PO Box 97, Gamer, Nalh Carafna 27529 [phone]PC Box 349, Boone, Nor?h Carolina 28607(829) 262- r 767

NON RESIDENTL4 L WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2663
1. WELL CONTRACTOR:
Derry Huneycutt
Well Contractor (Individual) Name
Derry's Well Drilling Inc.
Well Contactor Company Name
STREET ADDRESS 44283-A NC 24/27/73
Albemarle NC 28002
City or Town State Zip Cade
7704-982-9070
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(If appticabie) MW-18
WELL CONSTRUCTION PERMIT#fttapprrcable)
OTHER ASSOCIATED PERMIT #(if applicable)
3. WELL USE (Check Applicable Box) Monitoring Municipal/PublicO
IndusidattCommercial❑ Agricultural] Recoveryl3 Injection❑
Irrigatforfl Otherl3 (list use)
DATE DRILLED 611107
TIME COMPLETED 1:20 AMU PM!
4. WELL LOCATION:
CITY: Ararat COUNTY NC
419 Landfill Rd. a700 7
(Street Name, Numbers. Community, Sut+divlsion, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
0 Slope 0 Valley [3 Flat El Ridge Q Other
(check appropriate box)
May be in defiers,
LATITUDE 36.433015639 minutes, semnds or
LONGITUDE 80.572032 in n decimal format
Latitude/longitude source: a GPS 0 Topographic map
(Ioca6orr of well must he shown on a LISGS topo map and
attached to this form if not using GPS]
S. FACILITY- la 4w name of the buNneas wtwrf the w Ir is iorared
FACILITY tD #(if applicable)
NAME OF FACILITY_Sugy Co. Closed MSWLF
STREET ADDRESS 419 Landfill Rd.
Ararat NC 27007
City or Town State Zip Cade
CONTACT PERSON Mr. Jerry Snow
MAILING ADDRESS PC BOX 1542
Mount Airy NC 27030
City or Town Stale lip Code
�335 j401-8376
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 18.15
b. DOES WELL REPLACE EXISTING WELL? YE50 NOB
c. WATER LEVEL Below Top of Casing: 9.98 FT.
(Use "+' if Above Top of Casing)
d. TOP OF CASING is 3.00 Fr. Above Land Surface'
*Top of casing terminated allor below land surface may require
a variance in accordance with 15A NCAC 2C .611 fl.
e. YIELD (gpm): na METHOD OF TEST na
f. DISINFECTION,. Typo na Amount na
g. WATER ZONES (depth):
From 6.98 To 18.15 From To
From To From To
From To From To
T CASING: Thldmessf
Depth iameter Weight Material
From 0 To 8.15 Ft
From To Ft.
From To Ft
S. GROUT: Depth Material Method
From 0 To 5 FL Neat Cement Tremie
From 5 To 7 FL 318" Bent. Chi Pour
From To Ft.
S. SCREEN: Depth Diameter Slot Size Material
Frain 8.15 Ta 18.15 FL 2 in. 0.01 in. PVC
From To Ft in. in.
From To FL in. in.
1G. SAHDIGRAVEL PACK:
Depth Size Material
Frain 7 To IB IS FL #2 FilteFSand
From To Ft.
From 7o FL
11.DRILLING LOG
From To Formation Description
O 3.S Sr S l
3.5-'ta-1� b
12. REMARKS:
d ownnrorl'opl of nrnSCH K4SIA71 C
I DO HEREeY C FY THAT THIS W WAS CONSTRUCTED W ACCOROANCE WITH
11.1 NCAC zC R STANDARDS, A TRAT A COPY OF THIS
RECORD EN P DE T E WELL OWN
-as-
SIGKFAtURPFCERTI IEO LL CONTRACTOR DATE
_Derrq L • HU -n ec�f
PRINTED N E OF PERSON CD 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.31Q7

LOG OF BORING: MW-19
Surry County, Mt. Airy Closed. Project No. G07063.0
Drilling contractor. Derry's Well DnIfing
Date started:
6/112007
Surface elevation:
942.97 If (MSL)
Drill rig & method; 7.75 HSA w/SS, 5.5 DTH
Date ended:
6/1/2007
Top of pipe elevation:
946.27 It (MSL)
Logged by: J. Pfohl
Completion depth:
17.10 ft
Depth to water (TOB):
10,03 ft
Stickup height:
130 It
Depth to water (24hrs):
9-57 ft
Well Diagram
w
CL
CL
L
_
R P
0
R
E
Description of Material & Remarks
0-
Q (!] n
Vo
V
�
2t
Sandy Silt: dark brown, with few black root fragments, high organic
content, micaceous, moist
� v
CL
a
4' 6
F4,
O t
HSA Refusal on Rock seam (begin DTH)
P
50l3
PW R; moderately weathered rock, schist, brown, micaceous, dry
"' x
10
- s
a u7
a �
5012
NO Recovery - PW R, moderately weathered rock, brown, schist
c�
a
TCP O1= COMPETENT ROCK = 925.89 It amsl
Boring terminated at 17.1 feet
20
25
30
35
40
45
Municipal Engineering Services Company, P.A.
Operation/Construction Managers CiviVSanitary EngineersEnvironmental Studies Page 1 of 1
Piz Bur 97, Garner, North %aroina 27529 [phone]PO Say 349, Some, North Carohna 28607 (828) 262.1 767

Y � = NONIRESIDENTLAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION n 2663
�q
1. WELL CONTRACTOR:
Derry Huneycutt
Weil Contractor (Individual) Name
Derry's Weil Drilling Inc,
Well Contractor Company Narne
STREFT ADDRESS 44283-A NC 24/27/73
Albemarle NC 28002
City or Town State Zip Code
70L 4982-9070
Area coce- Phone number
2, WELL INFORMATION:
SITE WELL ID #{If applicable) MW-19
WELL CONSTRUCTION PER MITNIif appllrat>ie)
OTHER ASSOCIATED f ERMJT u(ii applicable)
3. WELL USE (Check Applicable Box) MortitolinglE MunicipallPublic❑
Industrial/Commercial❑ Agricullura[0 Recovery[] injectionQ
Irrigatlorill Other❑ (46t uSe)
DATE DRILLED 6/1/07
TIME COMPLETED 11:50 AM■ PM11
4. WELL LOCATION:
CITY: Ararat COUNTY NC
419 Landfill Rd- ; 7 a0
(Stye& Name, Numbers. Commu6iy, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
0 Slope 9 Valley 0 Fiat 17 Ridge 0 Other
(check appropriate box)
May be in degrcrs,
LATITUDE 36-433015639 minutes. seconds W
LONGITUDE 80.572032 in a decimal format-
Latitude/longitude source: N CPS 0 Topographic map
(location of well most be shown on a USGS topo map and
attached to this form if not using GPS)
S. FA Ci UTY- is ch a name w Iha ;uwtasa where u,a —ii w mcs lwa.
FACILITY ID S(if applicable)
NAME OF FACILITY Sur Co. Closed AISWLF
STREET ADDRESS 419 Landfill Rd.
Ararat NC 27007
City or Town State Zip Code
CONTACT PERSON Mr. Jerry Snow
MAILING ADDRESS PC Box 1542
Mount Airy _ NC _ 27030
City or Town State Zip Code Y
3336 �_401-8376
Area code - Phone number
S. WELL DETAILS:
a- TOTAL DEPTH_ 17.10
b. ODE WELL REPLACE EXISTING WELL? YESQ NON
c. WATER LEVEL Below Top of Casing: 9-57 FT -
(Lis a '+' if Above Top of Casing)
d. TOP OF CASING IS 3.00 FT, Above Land Surface'
"Top of casing terminated al/or below land sur:ace may require
a variance in accordance with 15A NCAC 2C .011a-
e. YIELD Igpm), n2 MET?iOD OF TEST na
1. DISINFECTION: Type r)a Amount na
g. WATER ZONES (depth):
From 10 To 17A 0 From To
From Tv From To
From To From To
7. CASING: Thickness/
Depth lameter Weight Material
From 0 To 7.10 Ft- 2 bk :nr+v I-VU
From To Ft.
From Tv Ft
—
0. GROUT: Depth Material Method
From 0 To 4 Fl, Neat Cement Tremie
From 4 To 6 Ft- 3/8" Dent, Chips Pour
From —To Ft- f
9. SCREEN_ Depth Diameter Slot Size Material
From 7-10 To 17.10 Ft- 2 l" 0.01 in. PVC
From To FI- in. in.
From To Ft. in. in,
10. SANDIG RAVEL PACK:
Depth Site Material
From 6 To 174 Ft. #2 {,iltef sand`
From To Ft. —
From -To- FI-
11.DRLLLING LOG
From To Formation Qescription
a 4 s i
G_-� C.9
12. REMARKS:
L W-4 ❑ iRst"ll ed @6 type11 NIW f . m n�}rtr�nr. -
r'o1A,Qgi:2dae-61_ofslr.sQd UStnn F
OOHEREeY [FY TW.7 TH:S LL WAS CONSTRUCTED INACCORDMCE WITH
15A uCAC LL iP R! T1 N S7AN0ARoS. ANP THAT A COPY r]f TH IIS
RECORD EN ❑ THE WELL ❑
SIGN U OF R IFIE ELL CONTRACTOR GATE
PRINTED N E OF PERSON CONVJUCTING 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 27609.1617 Phone No. [phone] ext 568, Rev. 3/07

LOG OF BORING: MW-20
Surry County, Mt. Airy Closed Project No. G07061.0
Drilling contractor: Derry's Well drilling Date started: 611 /2007 Surface elevation: 1079.12 ft (MSL)
Drill rig & method: 5.5 DTH w/SS Date ended. 6/112007 Top of pipe elevation: 1082.19 n (MSL)
Logged by: J. Pfohl Completion depth: 25.64 ft Depth to water jTOSj: 20.93 ft
Stickup height: 3.07 ft Depth to water (24hrs): 19.53 ft
n
m
CL ,
m
Well Diagram
a
F
� E
E
Description of Material & Remarks
m
O
m
(n
cn
m
n
a
1
Silty Sand with Clay; red -brown, moderately cohesive, moist
ears
Silty Sand/Saprolite; dense angular rock fragments, few black silt
5
partings, micaceous, dry
HSA Refusal - TOP OF COMPETENT ROCIC = 1072. i2 ft amsl
o N
Gneiss grey competent, no evident fractures
m
10
15
groundwater encountered
a
a
a a
m
ffj G
20
o
e
i _ _ N
25
Boring terminated at 25.6 feet
30
35
40
45
Municipal Engineering Services Company, P.A.
Operation/Construction Managers Civil/Sanitary SngineersBnvironmental Studies Rage i of 1
PA Bar 97,, Gamer, NcHh Carvina 27529 [phone]PQ Sox 349, home, Nodh Carona 29607(828) 262-1767

N4NRESIDEN7YAL WELL CONSTRUCT ON RECORD
North Carolina Deparurient of Environment and Natural Resources- Division of Water Quality C�u
WELL CONTRACTOR C$RTiiFICATION # 2663
1, WELL CONTRACTOR:
Deny Huneycutt
Well Contracor (Individual) Name
Derry's Well Drilling Inc.
Well Contractor Company Name
STREET ADDRESS 44283-A NC 24127f73
Albemarle NC 28002
City or Town State Zip Code
Tt 04 }-982-9070
Area code- Phone number
Z WELL INFORMATION-
S I TE WELL ID #{rf applirable) MW-20
WELL CONSTRUCTION PERMiTIKK applicable)
OTHER ASSOCIATED PERMIT #{if applicable}
3. WELL USE (Check Applicable Box) Monitoring) MunicipaVPublici7
Ind ustriaUCommercialD AgriculturalCI Recovefyp Injection0
IrrigationD OtherD {list use)
DATE DRILLED 611107
TIME COMPLETEV 10:30 AMD PM❑
4. WELL LOCATION:
CITY: Ararat COUNTY NC
419 Landfill Rd. � 7 no
(Sueet Name. Numbers, ComrnuMy, Subdivisinn, Lot No., Parcel, Tip Code)
TOPOGRAPHIC 1 LAND SETTING:
0 Slope ■ Valtey 0 Flat 0 Ridge D Other
(check appropriate bold May be in degrees,
LATITUDE 36-4326887 minutes. seconds or
LONGIfUCIE 80.56910777 in a decimal fonnat
Latitude/longitude source: ■ GPS 0 Topographic map
potation of well must he shown on a USGS Iopo map and
attached to this form if not using GPS)
5. FACILITY- Is am Hems of Va business when the wee fs iecu
FACILITY ID *(if applicable)
NAME OF FACILITY Sllrry CO. Closed MSWLF
STREET ADDRESS 419 Landfill Rd.
Ararat NC 27007
City or Town Slate Zip Code
CONTACT PERSON Mr. Jerry Snow
MAILING ADDRESS PO Box 1542
_Mount Airy _ NC _27030 _
City or Town" State Zip Code
336 1.401-8376
Area code - Phone number
S. WELL DETAILS:
a. TOTAL. DEPTH: 25.64
b. DOES WELL REPLACE EXISTING WELL? YES13 NOM
c. WATER LEVEL Below Top of Casing: 19.53 FT_
(Use 'f' If Above Top of Casing)
d. TOP OF CASING IS 3.00 FT. Above Land Surface'
'Top of rasing terminated atlor below land surface may require
- a variance In accordance with 15A NCAC 2C 0118.
s. YIELD (gpm): na METHOD OF TEST na
f. DISINFECTION: Type na Amount na
9. WATER ZONES (depth):
From 17 To 17.5 From TO
From To From To
From To From To
7. CASING: Thickness/
Depth iameler Weight Material
From 0 To 10.64 FL 2 I--yu
From To Ft.
From To Ft.
8. GROUT: Depth Material Method
From 0 To 7 FL Neat Cement Tremie
From 7 To 9.5 Ft, 318" Bent, Chi?S Pour
From To Ft.
9. SCREEN: Depth Diameter Slot Size Material
From 10+64 To 25.64 Ft. 2 in. 0.01 in, PVC
From To FL en. in.
From To Ft in. in,
14. SAND/GRAVEL PACK:
Depth Size Material
From 9. S To 39. Ft. #2 ftE�
From To Ft.
From To Ft.
Il.DRILLING LOG
From T6 Formation Description
d '4 S:
7 1S.L r
12. REMARKS:
MkAl 20 Jnstal(ad as type II r11W for ixinni r •--
downgcadient of -I -sad DWI F
100 HERESY CE THAT THIS WAS CONSTRI. CTE0 IN AOCORphNCE WITH
15A NCAC 27C, r-oky STANDAA DS, AND THAT A COPY OF THIS
RECORD H DE E WELL PWNE I
SIGN UR F C I IE LL CONTRACTOR DATE
PRINTED QME OF PERSON C TRUCTiNG THE WELL
Submit the original to the Division of Water- Quality Within 30 days. Attn: Information Mgt, Form DW-1b
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev. 3107

LOG OF BORING: MW-21
Surry County, Mt. Airy Closed Project No. G07053.0
Drilling contractor: Derry's Well Drilling Date started: 61112007 Surface elevation: 962.22 ft (MSL)
Drill rig & method: 7.5 OD HSA w/SS, 5.5 DTH Date ended: 6/1/2007 Top of pipe elevation: 965,36 ft (MSL)
Logged by: J. Pfohl Completion depth: 15.41 ft Depth to water (TOB): 6.23 tt
Stickup height: 3.i4 ft Depth to water [24hrs): 6.10 ft
o
m
Well Diagram
a
H
r E
E
Description of Material & Remarks
Y
r
cn
M
14
=
Silty Sand; dark brown, micaceous, high organic content, few angular
schist fragments, moist
v
m a
5
HSA Refusal on rock seam
C �
O =y
N
---------------------------------------------------
—
a
as
Sandy SiItlSaprolite; relict structure, wet, almost PW R
N
TOP OF COMPETENT ROCK = 952.22 ft ams]
y u
N
JT
+� (L
V
1 s
large fracture - water encountered
w
Boring terminated at 15.4 feet
20
25
30
35
40
45
Municipal Engineering Services Company, P.A.
Operation/Construction Managers Civil/SaniEary EngineersEraironmental Studies Page i of 1
PO Box 87, Gamer, Np7h Caroina 27528 {8T8) 772-5393PQ Box 349, 8oarie, North CarnYna 286a7 (828)2E2-1 ib 7

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Departmen[ of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION 4 2663
1. WELL CONTRACTOR:
Derry Huneycutt
Well Contractor (Individual) Name
Derry's Well Drilling ins.
Welt Contractor Company Name
STREETADDRESS 44283-ANC 24/27173
Albemarle NC 28002
City or Town State Zip Code
7i 04 ]_982-9070
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID e<irapplirabie} MW-21
WELL CONSTRUCTION PERMITS(ir applicable)
OTHER ASS 0CIATE1) PERMIT #(if applicable)
3. WELL USE (Check Applicable Box) Monitoring[] MunlclpallPuhlicfl
tndustriallCommercial❑ Agricultural❑ Recovery[] Injectionl]
laigationg Otheill (list use)
DATE DRILLED 6/1107
TIME COMPLETED 3:30 AM❑ PMO
4, WELL LOCATION:
CITy: Ararat COUNTY NC
419 Landfill Rd. 27007
[Street Name, Numbers, Community, Subdvision, Lot No,, Parcel, `up Code)
TOPOGRAPHIC l LANE) SETTING--
0 Slope ■ Valley R Flat 0 Ridge 11 Other
{check appropriate box]
May 6e in degret:s.
LATITUDE 36.434277833 minutes. seconds or
LQNGiTUOE
80 568596 in a dt•.cimat format
— —
Latitude/longitude source: G GPS 0 Topographic map
(location of well must be shown on a USGS ropo map and
attached to [his form if nor using GPS}
5. FACILITY- a the tar ar the bum"sa vAare the � F is tocatva.
FACILITY IO #(if applicable)
NAME OF FACILITY SUr_ry Co._ Closed MS_VJ_LF
STREET ADDRESS 419 Landfill Rd.
Ararat NC 27007
City or Town Slate Zip Code
CONTACT PERSON Mr- Jerry Snow
MAILING ADDRESS PO BOX 1542
Mount Airy NC 27030
City or Town Slate Zip Code
336-401-8376
Area code • Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 15.41
b. DO ES WELL REPLACE EXISTING WELL? YES❑ NOD
o. WATER LEVEL Below Top of Casing: 6.10 FT.
(Use '•- if Above Top of Casing)
d. TOP OF CASING IS 3.00 FT. Above Land Surface'
"Top of casing terminated allor below land surface may require
a variance in accordance with 15A NCAC 2C ,0118.
a, YIELD tgpml: na METHOD OF TEST na
f. DISINFECTION: Type na Amount na
g. WATER ZONES (depth):
From 6 To 6.50 From To
From To From To
From To From To
7, CASING; Thickness)
Depth Diameter Weight Material
From 0 To 5.41 Ft. / sun-ry rVU
From To Ft.
From To Ft.
8. GROUT: Depth Material Method
From 0 To 3 Ft_ Neat Cement Tremie
From 3 To 5 Ft, 318" Bent. Chi Pour
From To Fi-
g. SCREEN: Depth Diameter Slot Size Material
From 5.41 To 15.41 Ft. 2 in. 0,01 in• PVC
From To Ft. in. in,
From To- Ft - in. in.
IO. SANDlGRAVE L PACK:
Depth Size Mate ial
From 5 70 ISM I Ft, #2 F,irtepSaid
From iS.+�l l To-_L�L_ Ft. r;llnr
From To Ft.
11-DRILLING LOG
From To Formation Description
sd r
10 14t CIO _ us e'
12+ RE MARKS:
MlAl l 1.,r+1 r+a-49da; YPG tI MW i0r rrsanitaring-
9
DO htERERY r FY HA THt vVAS CON STA LiCirtD IN ACCOR DA1.rCE wt711
t SA MCAw 2C co . Rll S7AH(]kRn5. Flt+a THAT A COPY QF 7rir5
REC�REN P ❑ � THE WELL ME
Ily Z_07
S[GOF CERT 'Wr�E��L`LL CONTRACTOR DATE
{ T
PRI )ff r\i OF PER P c0 RUG rIN[a THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form GW-10
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev. 3107

LOG OF BORING: MW-22
Surry County, Mt. Airy Closed Project No. G47063.0
❑riIIing contractor: ❑erry's Welt Drilling Date started: 6/1/2007 Surface elevation: 950.23 ft (MSL)
Drill rig & method: 5.5 CD DTH Date ended: 6/1/2007 Top of pipe elevation; 953.40 ft (MSL)
Logged by, I Pfohl Completion depth: 16.04 ft Depth to water JOB): 4.63 ft
Stickup height: 3-17 fit Depth to water (24hrs): 4.60 ft
W
Diagram
V
a
-aWell
Description of Material & Remarks
Q
�
a
�°n
�'
Q
23
Sandy Silt; dark brown, few black root fragments, high organic content,
micaceous, moist
v
5b14
___
Sandy 5iltl5aprolite; moderately brown, dense, several angular rock
m
5
fragments, moist, heavily weathered rock
a
sa
Sandy Silt; same as above, wet
s
10
Q
n a
y d
N i
a
5013
_ _
TOP OF COMPETENT ROCK = 936 23 ft amsl: moderately weathered
0
15
gneiss, wet
Boring terminated at 16.13 feet
20
25
30
35
40
45
Municipal Engineering Services Company, P.A.
OperationiConstrudon Managers CiviVSanilary E ng i n eers E nv i ro nmen tal Studies Page 1 of t
PO Box 37, Gamer, North GaroAna 27529(919) 772.5393PQ Box 349, Boone, North Carolina 28607(828) 262-1787

NoNRESMENTIAi WELL, CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2663
1. WELL CONTRACTOR:
Derry Huneycutt
Well Contractor (individual} Name
Derry's Well Drilling Inc.
Well Contractor Company (dame
STREETADaRess 44283-ANC 24127/73
Albemarle NC 28002
City or Town State Zip Code
T0L 4 )-982-9D7g
Area code- Phone number
2. WELL INFORMATION:
SITE WELL M Oft appRrable) MW-22
AFFLL CONSTRUCTION PERMITWappucabley
OTHER ASSOCIATED PERMIT #(if applicable)
9. WELL USE (Check Applicable Box) Monilor(ngO Municipal/Public,0
IndustriallCommercial❑ Agricultural❑ Recovery[[ Injection❑
IrrigationD Other[[ (list use)
DATE DRILLED 611/07
TIME COMPLETED 2:00 AM❑ PMQ
i. WELL LOCATION:
CITY; Ararat COUNTY NC
419 Landfill Rd. 27007
(Street Name, Numbers, Community, Subdivision, Lot No,, Parcel, £Ep Code)
TOPOGRAPHIC 1 LAND SETTING:
13 Slope ■ Valley 11 Flat ❑ Ridge D other
(chock appropriate boxy May kind
LATITUDE 36,435334111 minutes, seconds or
LONGITUDE 80-567269 1 in a decimal Formal
Latitudellongitude source: III GPS 0 Topographic map
pocafion of well must be shown on a USGS f0po map and
attached to this ibrm if not using GPS)
S. FACILITY- It Ilra narri. of the bush" wtwm the wall is located.
FACILITY ID *(If
NAME OF FACILITY Surry Co. Closed MSWLP
STREET ADDRESS 419 Landfill Rd.
Ararat NC
27007
City or Town State
Zip Code
CONTACT PERSON. Mr. Jew Snow_
MAILING ADDRESS PG Box 1542
Mount Airy NC
27030
City or Town State
Zip Code
(336 )-401-8376
Area code - Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: 16.04
b. DOES WELL REPLACE EXISTING WELL? YES[[ N00
c, WATER LEVEL Below Top of Casing: 4•60 FT.
(Use "+' if AhD a Top of Casing)
d+ TOP OF CASING is 3.00 FT. Above Land Surface
`Top of casing terminated atror below land surface may require
a variance In accordance with ISA NCAC 2C .O118.
e. YIELD (gpm): na METHOD OF TEST na
f, DISINFECTION: Type na Amount na
g. WATER ZONES (depth):
From 1.60 To >16.04 From To
From TO From To
From To From TO
7. CASING: Thickness!
Depth Diameter Weight material
From D To 6.04 Ft c sL;rl.+y rvu
From To Ft.
From To Ft.
8. GROUT: Depth Material Method
From 6 To 3' Fl. Neat Cement Tremie
From 3 To 5 FL 3/8" Bent Chi Pour
From _To Ft.
9. SCREEN: Daplh Diameter Slot Size Material
Frorr,6.04 To 16+04 Ft.2 in. 0.01 in+ PVC
From To Ft In. in.
Fron-L_ To Ft. in. in.
10. SAND/GRAVEL PACK,
Depth Size Material
From 5 ToJL&.�_ Ft #2
From To FL
From To Ft
II.DRILLING LOG
From To Forman n Descripption
0 3.S 5 lc vu
12. REMARKS:
WA49 Installed a a II 5ArA1 f„r manofr,.in„
dai�ingrzdiQnt of ciased MSNILF .—
I DD HEREBY IFY THA T S LL WAS CONSTRUCrEO IN ACCORDANCE MTN
ISA NC./ALL LL CD R N $TANWD AND THAT A COPY OF THIS
RL,cM tl EEN P THE ER,
SIGNATU OF CERTIFI WELL CONTRACTOR DATE
9 cu
PRINTED . E OF PERSON C N TRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Farm GW-1b
1617 Mail Service Center— Raleigh, NC 27699.1617 Phone No. [phone] ext 568, Rev.3107

LOG OF BORING: MW-23
Surry County, Mt. Airy Closed
Project No. G07053.0
Drilling contractor: Derry's Well Drilling
Dale started:
6/112007
Surface elevation: 952.09 ft (MSL)
Drill rig & method: 7.75 OD HSA w/SS
Date ended:
6/1/2007
Top of pipe elevation: 955.31 ft (MSL)
Logged by: I Plohl
Completion depth:
17.10 ft
Depth to water (T08): 8.19 ft
Stickup height:
3,22 fit
Depth to water (24hrs): 8,16 ft
v
a
p
a
F-
CL
m _
aQ
F- E
0 w
d
E
rn
Description of Material & Remarks
Well Diagram
a
=
�o
Sandy Silt with clay; red -brown, relict structure, organic debris, moist
a
� U
33
Sandy Silt; dark brown, few balck organic silt nodules, micaceous, moist
d a
5
i
C �
d
35
Sandy Silt; same as above, wet
d
10
4 N
41
Sandy Silt; moderate brown, few angular schist fragments, micaceous,
a
we[
15
Boring terminated at 17.1 feet
20
25
30
35
40
45
Municipal Engineering Services Company, P.A.
OperationlConstruction Managers CivillSan'rtary EngineersEnvironmental Studies Page 1 of 1
Pp Box 97. Gamer, Noih Garolna 27529 [phone]PO Bar 349, SAOne, NoHh Carolina 28607(828) 252- 1767

stiff,.
NONRESIDENTIAL WELL CONSTRUCTION RECORD
W
North Carolina Department of Environment and Natural Resources- -Division of Water Quality
z�,,,• WELL CONTRACTOR CERTIFICATION # 2663
1. WELL CONTRACTOR:
Derry Huneycutt
Well Contractor (Individual) Name
Derry's Well Driiling Inc.
Well Contraclor Company Name
STREETADDRESS 44283-ANC 24/27/73
Albemarle NC 28002
City or Town Stale Zip Code
704 ]_ 982-9070
Area code- Phone number
2, WELL INFORMATION:
SITE WELL la #(d applicabte) MW-23
WELL CONSTRUCTION PERMITffi(ir appicatwe)
OTHER ASSOCIATED PERMIT *(if applicable)
3. WELL USE (Check Applicable Box) Moniloringil MunicipatlPublic❑
lndustriaVCommerraalQ Agrnculturalf) Recoveryp Injection0
IrrigationQ Otherfl {list use}
DATE DRILLED 611/07
TIME COMPLETED 4.20 AMC] PMQ
4. WELL LOCATION:
CITY: Ararat COUNTY NC
419 Landfill Rd. 27007
(Street Name, Numbers. Community, Subalmsion, Let No-, Parcel, 23p Code)
TOPOGRAPHIC 1 LAND SETTING:
0 Slope A Valley ❑ Flat 11 Ridge d Other
(Check appropriate box) may
36.439015556 min be sdegrees,
LATITUDE _ _ minulea• seconds or
LONGITUDE 80-571788 in a decimal formal
Latitude/longitude source: 0 GPS ❑ Topographic map
(location of well must be shown on a USGS tope map and
attached to this farm if not using GPS}
S. FAC ILTTY- rc ure name or Ire arstness where me wait is tocated
FACILITY 1D #(if applicable)
NAME OF FACILITY SUrry Ca. Closed MSWLF
STREETAODRE55 419 Landfill Rd.
Ararat NC 27007
City or Town Slate Zip Code
CONTACTPERSON Mr..IORy Sr1OW
MAILING ADDRESS PO BOX 1542
Mount Airy NC 27030_
City or Town State Zip Code
336 - 401-8376
Area code - Phone number
6. WELL DETAILS:
a- TOTAL DEPTH( 17.10
b. DOES WELL REPLACE EXISTING WELLT YES NOd
c. WATER LEVEL Below Top of Casing: 8.16 FT -
(Use -+' if Above Top of Casing)
d. TOP OF CASING IS 3.00 FT. Above Land Surface'
'Top of casing terminated at/Dr below land surface may require
a variance in accordance with 15A NCAC 2C ,011 a.
e. YIELD (gpmy na METHOD OF TEST na
U DISINFECTION: Type na Amount na
g. WATER ZONES {depth}:
From 5-16 To 17,10 From To
From To From To
From To Frflm To
7. CASING: Thickness)
Depth iameler Weight Material
From 0 To 7.1 C Ft. st:n•+U 11V U
From To- Ft.
From To Ft.
8. GROUT: Depth Material Method
From C To 4 FI. Neat Cement Trernie
From To 5-05 Ft. 3/8" Beni. Chrtf Pour
From To Ft.
9. SCREEN: Depth Diameter Slot Size Material
From 7.10 To 17A 0 Ft.- 2 in, 0.01 in- PVC
From To Ft- in. in -
From To Ft- ir% in-
10. SANDIGRAVE!_ PACK:
Depth Size Material
From 6, 05 To 17.10 Ft. 92 -pd"eft "bRd
From To Ft -
From To Ft.
11.DRILLING LOG
From To Formation Description
0 3,S S r
12. REMARKS:
XAN-2T, , I.,{{e po n new &OF
I CYINIC22
IFY THA 7041S WR9 t:',?rJ$7 CTEl7 IN ACCURDMCC WITH
SALL C R STrWp 21 C THAT ACOPY❑FTHIS
REN P �7 YH W ynnj((-- yy--��77 --
a
SI(G` AATUU1 OF C RT1F WELL CONTRACTOR DATE
1 }f'_t 1 -L l L • _ n e
PR
NTEO AE ❑F PERSON NSTRUCTING THE WELL
Submit the original to the Division of Water Ouality within 30 days. Attn: Information Mgt-, Form GW-1b
1617 Mail Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev- W7

SO pro
Experience you can rely on, Products you can trust 141
EQS Remediabon, LLC
EOS PRo
PRODUCT INFORMATION SHEET
Emulsified Oils Family
EOS PRO (formerly 598542) is a nutrient -enriched, DoD-validated, food -grade oil/water emulsion
designed to quickly stimulate microbial activity while providing long-term nourishment to enhance
anaerobic bioremediation of chlorinated solvents, nitrates, perchlorate, energetics, acid mine
drainage, and other recalcitrant chemicals in contaminated groundwater. EOS PRo can also be
used to reduce redox sensitive metals and radionuclides. The negative surface charges on the
droplets combined with small droplet size promote effective transport in the subsurface.
EOS PRo benefits:
Description
• Includes biostimulating vitamins and nutrients
Rapidly -biodegradable substrates to jump start" bacterial growth
■ Slow release biodegradable substrates to promote long-term biological activity
• Small oil droplet size
• Negative surface charge
• Neutral pH
■ Extensive third party validation
EOS PRo incorporates the proven patented EOS® technologies that clients have trusted for more
than a decade. Made in the USA with US farmed soybean oil,
Oil Emulsion Concentrate: EOS PRo Typical
Refined and Bleached US Soybean Oil (% by wt.) 59.8
Rapidly Biodegradable Soluble Substrate (% by wt.) 4
Chemical &
Other Organics (emulsifiers, food additives, etc.) (% by wt.) 10
Physical
Specific Gravity 0,96 - 0.98
Properties
pH (Standard Units) 6.0 - 7.0
Median Oil Droplet Size (microns) 1.0
Organic Carbon (% by wt.) 74
Mass of Hydrogen Produced (lbs. H2 per lb. EOS PRo) 0.25
Packaging
Shipped in 55-gallon drums, 275-gallon IBC totes or bulk tankers (40,000 lbs.)
EOS PRo is shipped as a ready -to -use concentrated emulsion that can be diluted with water in the
field to prepare a high quality suspension for easy injection. EOS PRo has a low viscosity and can
be distributed with commonly available pumps or continuous metering with a diluter (e.g.,
Handling &
DosatronTm). Dilution ratios for EOS PRo commonly range from 4.1 to 20:1 (water: EOS PRO)
Storage
depending on site conditions. EOS PRo injections should be followed with additional chase water
to maximize distribution of EOS PRo into the formation.
For best performance, use EOS PRo within 60 days of delivery and store at a temperature
between 407 (4°C) to 1007 (38'C).
Phone: [phone]
Web: www.eosremediat on.com Copyright@ 2012, EOS Remedie ion, LLC Rev. 06.19.2012

L+�
a
Science Lab -com
Chemicals & Laboratory Equipment
Material Safety Data Sheet
Cyanocobalamin MSDS
I Section 1: Chemical Product and Company Identification
Product Name: Cyanocobalamin
Catalog Codes: SLC5008, SLC2218
CAS#: 68-19-9
RTECS: GL7030000
TSCA: TSCA 8[b) inventory: Cyanocobalamin
CI#: Not available.
Synonym: Vitamin B12; Cobinamide, cyanide
phosphate T-ester with 5,6-dimethyl-l-alpha-
Dribofuranosylbenzimidazole, inner salt
Chemical Formula: C63H88CoN14014P
Contact Information:
Sciencelab.com, Inc.
14025 Smith Rd.
Houston, Texas 77396
US Sales. 1-800-901-7247
International Sales: 1-281-441-4400
Order Online: Sciencel-ab.com
CHEMTREC (24HR Emergency Telephone], call:
1-800-424-9300
International CHEMTREC, call: 1-703-527-3887
For non -emergency assistance, call: 1-2814414400
Section 2: Composition and Information on Ingredients
Composition:
Name CAS # % by Weight
Cyanocobalamin 68-19-9 100
Toxicological Data on Ingredients: Cyanocobalamin LD50: Not available. LC50: Not available.
Section 3: Hazards identification
Potential Acute Health Effects:
Very hazardous in case of ingestion. Hazardous in case of skin contact (irritant), of eye contact (irritant), of inhalation. Slightly
hazardous in case of skin contact tpermeatorj.
Potential Chronic Health Effects:
CARCINOGENIC EFFECTS: Not available. MUTAGENIC EFFECTS: Not available. TERATOGENIC EFFECTS: Not available.
DEVELOPMENTAL TOXICITY: Not available. The substance is toxic to lungs, mucous membranes. Repeated or prolonged
exposure to the substance can produce target organs damage.
I Section 4: First Aid Measures I
Eye Contact:
Check for and remove any contact lenses. Immediately flush eyes with running water for at least 15 minutes, keeping eyelids
open. Cold water may be used. Do not use an eye ointment. Seek medical attention.

Skin Contact:
After contact with skin, wash immediately with plenty of water. Gently and thoroughly wash the contaminated skin with running
water and non-abrasive soap. Be particularly careful to clean folds, crevices, creases and groin. Cold water may be used.
Cover the irritated skin with an emollient. If irritation persists, seek medical attention. Wash contaminated clothing before
reusing.
Serious Skin Contact:
Wash with a disinfectant soap and cover the contaminated skin with an anti -bacterial cream. Seek medical attention.
Inhalation: Allow the victim to rest in a well ventilated area. Seek immediate medical attention,
Serious Inhalation: Not available.
Ingestion:
❑o not induce vomiting. Loosen tight clothing such as a collar, tie, belt or waistband. If the victim is not breathing, perform
mouth-to-mouth resuscitation. Seek immediate medical attention.
Serious Ingestion: Not available
I Section 5: Fire and Explosion Data
Flammability of the Product: May be combustible at high temperature.
Auto -Ignition Temperature: Not available.
Flash Points: Not available.
Flammable Limits: Not available.
Products of Combustion: These products are carbon oxides (CO, CO2), nitrogen oxides (NO, NO2.,.). Some metallic oxides.
Fire Hazards in Presence of Various Substances: Not available.
Explosion Hazards in Presence of Various Substances:
Risks of explosion of the product in presence of mechanical impact: Not available. Risks of explosion of the product in
presence of static discharge: Not available.
Fire Fighting Media and Instructions:
SMALL FIRE: Use DRY chemical powder. LARGE FIRE: Use water spray, fog or foam. ❑o not use water jet.
Special Remarks on Fire Hazards: Not available.
Special Remarks on Explosion Hazards: Not available.
Section 6: Accidental Release Measures
Small Spill:
Use appropriate tools to put the spilled solid in a convenient waste disposal container. Finish cleaning by spreading water on
the contaminated surface and dispose of according to local and regional authority requirements.
Large Spill:
Use a shovel to put the material into a convenient waste disposal container. Finish cleaning by spreading water on the
contaminated surface and allow to evacuate through the sanitary system.
Section 7: Handling and Storage j
Precautions:
Keep away from heat. Keep away from sources of ignition. Empty containers pose a fire risk, evaporate the residue under
a fume hood. Ground all equipment containing material. Do not breathe dust. Wear suitable protective clothing In case of
insufficient ventilation, wear suitable respiratory equipment If you feel unwell, seek medical attention and show the label when
possible. Avoid contact with skin and eyes
p. 2

Storage:
Keep container dry. Keep in a cool place. Ground all equipment containing material. steep container tightly closed. Keep in a
cool, well -ventilated place. Combustible materials should be stored away from extreme heat and away from strong oxidizing
agents.
I Section 8: Exposure Controls/Personal Protection
Engineering Controls:
Use process enclosures, local exhaust ventilation, or other engineering controls to keep airborne levels below recommended
exposure limits. If user operations generate dust, fume or mist, use ventilation to keep exposure to airborne contaminants
below the exposure limit.
Personal Protection:
Splash goggles. Lab coat. Dust respirator. Be sure to use an approvedlcertified respirator or equivalent. Gloves.
Personal Protection in Case of a Large Spill:
Splash goggles. Full suit. Dust respirator. Boots. Gloves. A self contained breathing apparatus should be used to avoid
inhalation of the product. Suggested protective clothing might not be sufficient; consult a specialist BEFORE handling this
product.
Exposure Limits: Not available
Section 9: Phvsical and Chemical Properties
Physical state and appearance: Solid.
Odor: Not available.
Taste: Not available.
Molecular Weight: 1355.39 glmole
Color: Not available.
pH j1 % soInlwaterj: Not available.
Boiling Point: Decomposes.
Melting Point: 1i72.5'C (216.5`F)
Critical Temperature: Not available.
Specific Gravity: Not available.
Vapor Pressure: Not applicable.
Vapor Density: Not available.
Volatility: Not available.
Odor Threshold: Not available.
WaterlOil Dist. Coeff.: Not available.
lonicity (in Water): Not available.
Dispersion Properties. See solubility in water.
Solubility: Partially soluble in cold water.
Section 10: Stability and Reactivity Data
stability: The product is stable.
p. 3

Instability Temperature: Not available -
Conditions of Instability: Not available.
Incompatibility with various substances: Not available.
Corrosivity: Non -corrosive in presence of glass.
Special Remarks on Reactivity: Not available.
Special Remarks on Corrosivity: Not available.
Polymerization: No -
Section 11: Toxicological Information
Routes of Entry: Eye contact- Inhalation. Ingestion.
Toxicity to Animals:
LD50: Not available. LC50: Not available.
Chronic Effects on Humans: The substance is toxic to lungs, mucous membranes.
Other Toxic Effects on Humans:
Very hazardous in case of ingestion. Hazardous in case of skin contact (irritant), of inhalation- Slightly hazardous in case of
skin contact (permeator).
Special Remarks on Toxicity to Animals: Not available -
Special Remarks on Chronic Effects on Humans: Not available.
Special Remarks on other Toxic Effects on Humans: Not available_
Section 12: Ecological Information I
Ecotoxicity: Not available.
BOD5 and COD: Not available.
Products of Biodegradation:
Possibly hazardous short term degradation products are not likely- However, long term degradation products may arise.
Toxicity of the Products of Biodegradation: The products of degradation are more toxic.
Special Remarks on the Products of Biodegradation: Not available.
Section 13: Disposal Considerations
Waste Disposal:
Section 14: Transport Information
DOT Classification: Not a DOT controlled material (United States).
Identification: Not applicable.
Special Provisions for Transport: Not applicable.
Section 15: Other Regulatory Information
p- 4

Federal and State Regulations: TSCA 8(b) inventory: Cyanocobalamin
Other Regulations: OSHA: Hazardous by definition of Hazard Communication Standard (29 CIF 1910.1200).
Other Classifications:
WHMIS (Canada): CLASS D-2A: Material causing other toxic effects (VERY TOXIC).
❑SCL (EEC): R36138- Irritating to eyes and skin.
HMIS (U.S.A.):
Health Hazard. 2
Fire Hazard: 1
Reactivity: 0
Personal Protection: E
National Fire Protection Association (U.S.A.):
Health: 2
Flammability: 1
Reactivity: 0
Specific hazard:
Protective Equipment:
Gloves. Lab coat. Dust respirator. Be sure to use an approvedlcertified respirator or equivalent. Wear appropriate respirator
when ventilation is inadequate. Splash goggles.
Section 16: Otter Information
References: Not available.
Other Special Considerations: Not available
Created: 10/10/2005 08:17 PM
Last Updated: 06i0912012 12 00 PM
The information above is believed to be accurate and represents the best information currently available to us. However, we
make no warranty of merchantability or any other warranty, express or implied, with respect to such information. and we assume
no liability resulting from its use. Users should make their awn investigations to determine the suitability of the information for
their particular purposes. In no event shall ScienceLab. com be liable for any claims, losses, or damages of any third party or for
lost profits or any special, indirect, incidental. consequential or exemplary damages. howsoever arising, even if ScienceLab.com
has been advised of the possibility of such damages.
P. 5

N o. Br -
Science Uh.com
Chemicals & Laboratory Equipment
Material Safety Data Sheet
Sodium bromide MSDS
Section 1: Chemical Product and Company Identification
Product Name: Sodium bromide
Catalog Codes: SLS3820, SLS1600
CAS#: 7647-15-6
RTECS: VZ3150000
TSCA: TSCA 8(b) inventory: Sodium bromide
CI#: Not available.
Synonym: Bromide salt of sodium
Chemical Name. Sodium Bromide
Chemical Formula: NaBr
Contact Information:
Sciencelab.com, Inc.
14025 Smith Rd,
Houston, Texas 77396
US Sales: 1-800-901-7247
International Sales- 1-281-441-4400
Order Online: ScienceLab.com
CHEMTREC (24HR Emergency Telephone), call:
1-800-424-9300
International CHEMTREC, call: 1-703-527-3887
For non -emergency assistance, call: 1-281-441-4400
Section 2: Composition and Information on Ingredients
Composition:
Name CAS # % by Weight
Sodium bromide 7647-15-6 100
Toxicological Data on Ingredients: Sodium bromide: ORAL {LU50): Acute: 3500 mglkg [Rat]. 7000 mg/kg [Mouse].
! Section 3: Hazards Identification
Potential Acute Health Effects.
Hazardous in case of eye contact (irritant), of ingestion, of inhalation. Slightly hazardous in case of skin contact (ir(tant).
Potential Chronic Health Effects:
CARCINOGENIC EFFECTS: Not available. MUTAGENiC EFFECTS: Not available. TERATOGENIC EFFECTS; Not available -
DEVELOPMENTAL TOXICITY: Not available. Repeated or prolonged exposure is not known to aggravate medical condition.
I Section 4: First Aid Measures I
Eye Contact:
Check for and remove any contact lenses. In case of contact, immediately flush eyes with plenty of water for at least 15
minutes. Cold water may be used. Get medical attention.
Skin Contact:

Wash with soap and water. Cover the irritated skin with an emollient. Get medical attention if irritation develops. Cold water
may be used.
Serious Skin Contact: Not available.
Inhalation:
If inhaled, remove to fresh air. If not breathing, give artificial respiration. If breathing is difficult, give oxygen- Get medical
attention.
Serious Inhalation: Not available.
Ingestion:
Do NOT induce vomiting unless directed to do so by medical personnel. Never give anything by mouth to an unconscious
person. Loosen tight clothing such as a collar, tie, belt or waistband. Get medical attention if symptoms appear.
Serious Ingestion: Not available.
Section 5: Fire and Explosion Data
Flammability of the Product: Non-flammable.
Auto -Ignition Temperature: Not applicable.
Flash Points: Not applicable.
Flammable Limits: Not applicable.
Products of Combustion: Not available.
Fire Hazards in Presence of Various Substances: Not applicable.
Explosion Hazards in Presence of Various Substances:
Risks of explosion of the product in presence of mechanical impact: Not available. Risks of explosion of the product in
presence of static discharge: Not available.
Fire Fighting Media and Instructions: Not applicable.
Special Remarks on Fire Hazards: Not available.
Special Remarks on Explosion Hazards. Not available.
I Section 6: Accidental Release Measures I
Small Spill:
Use appropriate tools to put the spilled solid in a convenient waste disposal container. Finish cleaning by spreading water on
the contaminated surface and dispose of according to local and regional authority requirements.
Large Spill:
Use a shovel to put the material into a convenient waste disposal container. Finish cleaning by spreading water on the
contaminated surface and allow to evacuate through the sanitary system.
Section 7: Handling and Storage
Precautions:
Do not ingest. D❑ not breathe dust. Avoid contact with eyes. Wear suitable protective clothing. In case of insufficient
ventilation, wear suitable respiratory equipment. If ingested, seek medical advice immediately and show the container or the
label. Keep away from incompatibles such as oxidizing agents, acids.
Storage: Keep container tightly closed. Keep container in a coal, well -ventilated area. Do not store above 250C (77`F).
Section 8: Exposure Controls/Personal Protection
W

Engineering Controls:
Use process enclosures, local exhaust ventilation, or other engineering controls to keep airborne levels below recommended
exposure limits. If user operations generate dust, fume or mist, use ventilation to keep exposure to airborne contaminants
below the exposure limit.
Personal Protection:
Splash goggles. Lab coat. Dust respirator. Be sure to use an approved/certified respirator or equivalent. Gloves.
Personal Protection in Case of a Large Spill:
Splash goggles. Full suit. Dust respirator. Boots. Gloves. A self contained breathing apparatus should be used to avoid
inhalation of the product. Suggested protective clothing might not be sufficient: consult a specialist BEFORE handling this
product.
Exposure Limits: Not available.
Section 9: Phvsical and Chemical Properties I
Physical state and appearance: Solid.
Odor: Not available.
Taste: Not available.
Molecular Weight: 102.91 glmole
Color: Not available.
pH (1% solnfwater): 6.5-8.0
Boiling Point: 1390°C (2534°F)
Melting Point: 755'C (1391 `F)
Critical Temperature: Not available.
Specific Gravity: 3.21 (Water = 1)
Vapor Pressure: Not applicable.
Vapor Density: Not available.
Volatility: Not available.
Odor Threshold: Not available.
Water/Oil Dist. Coeff.: Not available.
conicity (in Water): Not available.
Dispersion Properties: See solubility in water, methanol.
Solubility:
Easily soluble in cold water, hot water. Soluble in methanol. 1 g dissolves in 1.1 ml of water. 1 g dissolves in about 16 ml of
alcohol. 1 g dissolves in 6 ml of methanol
Section 10: Stability and Reactivity Data j
Stability: The product is stable.
Instability Temperature: Not available.
Conditions of Instability: Incompatible materials, moisture
Incompatibility with various substances: Reactive with oxidizing agents, acids.
p. 3

Corrosivity: Non -corrosive in presence of glass.
Special Remarks on Reactivity:
Absorbs moisture from the air but is not deliquescent. Hygroscopic. Also incompatible with alkaloidal and heavy metal salts,
and Bromine Triflucride.
Special Remarks on Corrosivity: Not available.
Polymerization: Will not occur.
Section 11: Toxicological Information
Routes of Entry: Inhalation. Ingestion.
Toxicity to Animals: Acute oral toxicity (LD50): 3500 mg/kg [Rat]
Chronic Effects on Humans. Not available.
Other Toxic Effects on Humans:
Hazardous in case of ingestion, of inhalation. Slightly hazardous in case of skin contact (irritant).
Special Remarks on Toxicity to Animals: Not available.
Special Remarks on Chronic Effects on Humans:
May cause adverse reproductive effects (male and female effects on fertility and effects on newborns and fetotoxicity) based
on animal data Human: passes the placental harrier, detected in maternal milk.
Special Remarks on other Toxic Effects on Humans:
Acute Potential Health Effects: Skin: May cause mild skin irritation. Eyes: Causes eye irritation. Inhalation: May cause
respiratory tract irritation. Ingestion: May cause gastrointestinal tract irritation with nausea and vomiting, abdominal pain,
constipation. Bromide poisoning following acute ingestion is more rare and may affect the central nervous system (CNS
depression - somnolence, confusion, ataxia, coma and other symptoms similar to chronic ingestion), cardiovascular system
{hypotension, tachycardia}, kidneys {acute renal failure, urinary incontinence], and respiration {acute respiratory distress
syndrome}. It may also cause eye disturbances such as mydriasis and nystagmus, disturbances of apparent color of objects,
blurring or indistinctness of vision, apparent movement or wiggling and change in apparent size of objects, large pupils,
subnormal reaction to light, diplopia, and photophobia. Chronic Potential Health Effects: Skin: Prolonged or repeated skin
contact may cause skin rashes. Eyes: Prolonged or repeated eye contact may cause blepharitis, and conjunctivitis. Prolonged
or repeated ingestion may cause skin rashes (bromoderma, acne, pyoderma gangrenosum, erythema multiforme), affect the
liver, endocrine system (thyroid), metabolism(anorexia), blood, vision (visual disturbances, permanently decreased vision
and may produce a toxic syndrome, "Bromism" which may be characterized by behavior/central nervous symptoms such
CNS depression, irritability, headache, confusion, slurred speech, memory loss, lethargy, ataxia, tremor, agitation, delusion,
disoriented, paranoia, aggressiveness, hallucinations, mania, fatigue, seizure, neuropathy, muscle weakness, coma. Also, in
individuals with chronic bromism, the tongue may have a coated or furred appearance.
I Section 12: Ecological Information !
Ecotoxicity: Not available.
BOD5 and COD: Not available.
Products of Biodegradation:
Possibly hazardous short term degradation products are not likely. However, long term degradation products may arise.
Toxicity of the Products of Biodegradation: The product itself and its products of degradation are not toxic.
Special Remarks on the Products of Biodegradation: Not available.
Section 13: Disposal Considerations
Waste Disposal:
p. 4

Waste must be disposed of in accordance with federal, state and local environmental control regulations.
Section 14: Transport Information
DOT Classification: Not a DOT controlled material (United States).
Identification: Not applicable.
Special Provisions for Transport: Not applicable.
Section t 5: Other Regulatory Information I
Federal and State Regulations: TSCA 8(b) inventory: Sodium bromide
Other Regulations: EINECS: This product is on the European Inventory of Existing Commercial Chemical Substances.
Other Classifications:
WHMIS (Canada): Not controlled under WHMIS (Canada).
DSCL (EEC):
R36- Irritating to eyes. S2- Keep out of the reach of children. S24i25- Avoid contact with skin and eyes. S46- if swallowed,
seek medical advice immediately and show this container or label.
HMIS (U.S.A.):
Health Hazard: 2
Fire Hazard: 0
Reactivity: 0
Personal Protection: E
National Fire Protection Association (U.S.A.):
Health: 2
Flammability: 0
Reactivity: 0
Specific hazard:
Protective Equipment:
Gloves. Lab coat. Dust respirator. Be sure to use an approved/certified respirator or equivalent. Splash goggles.
f Section 16: Other Information
References. Not available.
Other Special Considerations: Not available
Created: 10110/2005 08:26 PM
Last Updated: 06/09/2012 12,00 PM
The information above is believed to be accurate and represents the best information currently available to us. However, we
make no warranty of merchantability or any other warranty, express or implied, with respect to such information, and we assume
no liability resulting from its use. Users should make their own investigations to determine the suitability of the information for
their particular purposes. In no event shall ScienceLab.com be liable for any claims, losses, or damages of any third party or for
lost profits or any special., indirect, incidental, consequential or exemplary damages, howsoever arising, even if Sciencel- ab. com
has been advised of the possibility of such damages.
P. 5

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