WI0700012_Application_20010403

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NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR
INJECTION
Class 51322, 5R21, 5S23, 5T, 5X25, SZ Wells
In Accordance with the provisions of NCAC Title 15A: 02C.0200
Complete application and mail to address on the back page.
TO: DIRECTOR, NORTH CAROLINA DIVISION OF WATER QUALITY
DATE: March 30, 2001
A. PERMIT APPLICANT
Name: PCS Phosphate
Address: PO Box 48/1530 Highway 306 South
City: Aurora State: NC Zip Code: 27806
County: Beaufort Telephone: [phone]
B. PROPERTY OWNER (if different from applicant)
Name: Same as Applicant
Address:
City: State: Zip Code:
County: Telephone:
C. STATUS OF APPLICANT
Private: Commercial: X Federal: State:
County: Municipal: Native American Lands:
D. FACILITY (SITE) DATA
(Fill out ONLY if the Status is Federal, State, County, Municipal or Commercial).
Name of Business or Facility: PCS Phosphate
Address: PO Box 48/1530 Highway 306 South
City: Aurora Zip Code: 27806 County: Beaufort
Telephone: [phone] Contact Person: D. Daniel Winstead III
E. INJECTION PROCEDURE
D
rJ
Provide a detailed description of all planned activities relating to the proposed injection
facility including but not limited to:
(1) construction plans and materials; [not annlicable, already constructed]
(2) operation procedures; and [see Attachment I, Item 1]
(3) a planned injection schedule. [see Attachment I, Item 1]
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F. HYDROGEOLOGIC DESCRIPTION (See Attachment I, Item 2)
SECTION (F) MUST BE ORIGINALLY SEALED AND SIGNED BY A
LICENSED GEOLOGIST
Provide a hydrogeologic description, soils description, and cross section of the subsurface to a
depth that included the known or projected depth of contamination. The number of borings
shall be sufficient to determine the following:
(1) the regional geologic setting;
(2) significant changes in lithology;
(3) the hydraulic conductivity of the saturated zone;
(4) the depth to the mean seasonal high water table; and
(5) a determination of transmissivity and specific yield of the aquifer to be used for
injection (showing calculations).
G. MONITORING PROCEDURE (See Attachment I, Item 3)
Provide plans for proposed location and construction details of groundwater monitoring well
network, including a schedule for sampling and analytical methods. Include any
modeling/testing performed to investigate injectant's potential or susceptibility to change
(biological, chemical or physical) in the subsurface.
H. WELL USE Will the injection well(s) also be used as the supply well(s) for the following?
(1) The injection operation?
(2) Personal consumption?
I. CONSTRUCTION DATA (check one)
YES NO X
YES NO X
X__ EXISTING WELL being proposed for use as an injection well. Provide the
data in (1) through (7) below to the best of your knowledge. Attach a copy
of Form GW-1 (Well Construction Record) if available. (See Attachment II.)
PROPOSED WELL to be constructed for use as an injection well. Provide
the data in (1) through (7) below as PROPOSED construction
specifications. Submit Form GW-1 after construction.
(1) Well Drilling Contractor's Name:
NC Contractor Certification number:
(2) Date to be constructed: Number of borings:
Approximate depth of each boring (feet):
(3) Well casing:
Type: Galvanized steel_ Black steel_ Plastic_ Other (specify)
Casing depth: From to ft. (reference to land surface)
Casing extends above ground inches
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(4) Grout:
Grout type: Cement Bentonite _ Other (specify) ..
Grouted surface and grout depth (reference to land surface):
around closed loop piping; from to (feet).
around well casing; from to (feet).
(5) Screens
Depth: From _ to _ feet below ground surface.
N.C. State Regulations (Title 15A NCAC 2C .0200) require the permittee to make
provisions for monitoring wellhead processes. A faucet on both influent (recovered
groundwater) and effluent (fluid being injected into the well) lines is generally
required.
(6)
(7)
Will there be a faucet on the influent line? yes no
Will there be a faucet on the effluent line? yes_ no
SOURCE WELL CONSTRUCTION INFORMATION (if different from injection
well). Attach a copy of Form GW-1 (Well Construction Record). If Form OW-1 is not
available, provide the data in part G of this application form to the best of your
knowledge. (See Attachment I. Item 4.)
NOTE: THE WELL DRILLING CONTRACTOR CAN SUPPLY THE DATA FOR EITHER EXISTING OR
PROPOSED WELLS IF THIS INFORMATION IS UNAVAILABLE BY OTHER MEANS.
J. OTHER WELL DATA (See Attachment I, Item 5)
Provide a tabulation of data on all wells within Y4 mile of the injection well(s), excepting
water supply wells serving a single-family residence, which penetrate the proposed injection
zone. Such data shall include a description of each well's type, depth, record of abandonment
or completion, and additional information the Director may require.
K. PROPOSED OPERATING DATA
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Injection rate: Average (daily) 19tgallons per minute (gpm)
Injection vohime: Average (daily) 27.400. gallons per. day (gpd)
Injection pressure: Average (daily) N/A winds/square inch (psi)
Injection temperature: Average (January) 69-74° F, Average (July) 69-74° F
Hydraulic capacity of the well: 2tto 4tnnm Der well
Expected lifetime of the injection facility: 20 years
Give a description of how the above data will be measured and controlled: Infection rate
is measured by flow totalizer. Injection rate is controlled by automatic water level controller
set to a selectedstatic water level.
L. INJECTION -RELATED EQUIPMENT (See Attachment L Item 6)
Attach a diagram showing the detailed plans and specifications of the surface and subsurface
construction details of the system.
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M. LOCATION OF WELL(S) (See Attachment I, Item 7)
Attach a scaled, site -specific map(s) showing the location(s) of the following:
(1) the proposed injection walks);
(2) all property boundaries;
(3) the direction and distance from the injection well or well system to two nearby,
permanent reference points (such as roads, streams, and highway intersections);
(4) all buildings within the property boundary;
(5) any other existing or abandoned wells, including water supply and monitoring wells,
within the area of review of the injection well or wells system;
(6) potentiometric surface showing direction of groundwater movement;
(7) any existing sources of' potential or known groundwater conramination, including
waste storage, treatment or disposal systems within the area of review of the injection
well or well system; and
(8) all surface water bodies within the area of review of the injection well or well system.
N. INJECTION FLUID DATA (See Attachment I, Item 8)
(1) Fluid source, if underground, from what depth, formation and type of rock/sediment
unit will the fluid be drawn (e.g., granite, limestone, sand, etc.).
(2) Provide the chemical, physical, biological and radiological characteristics of the fluid
to be injected
O. PERMIT LIST (See Attachment I. Item 9)
Attach a list of all permits or construction approvals that are related to the site, including but
not limited to;
(1) Hazardous Waste Management program permits under RCRA
(2) NC Division of Water Quality Non -Discharge penults
(3) Sewage Treatment and Disposal Permits
(4) Other environmental permits required by state or federal law.
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P. CERTIFICATION
"I hereby certify, under penalty of law, that I have personally examined and am familiar with
the information submitted in this document and all attachments thereto and that, based on my
inquiry of those individuals immediately responsible for obtaining said information, I believe
that the information is true, accurate and complete. I am aware that there are significant
penalties, including the possibility of fines and imprisonment, for submitting false
information I agree to construct, operate, maintain, repair, and if applicable, abandon the
injection well and all related appurtenances in accordance with the approved specifications
and conditions of the Permit."
Q.
y 5' Marta
214 !X ll'G r en 2 v. AC-Cta 6 •
(Sign a of Well Owner or Authorized Agent)
If authorized agent is acting on behalf of the well owner,
please supply a letter signed by the owner
authorizing the above agent.
CONSENT OF PROPERTY OWNER (Owner means any person who holds the fee or other
property rights in the well being constructed. A well is real property and its construction on
land rests ownership in the landowner in the absence of contrary agreement in writing.)
If the property is owned by someone other than the applicant, the property owner hereby
consents to allow the applicant to construct each injection well as outlined in this application
and that it shall be the responsibility of the applicant to ensure that the injection well(s)
conforms to the Well Construction Standards (Title 15A NCAC 2C .0200)
(Signature Of Property Owner If Different From Applicant)
Please return two copies of the completed Application package to:
UIC Program
Groundwater Section
North Carolina DENR-DWQ
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
GW-57 OTH (Jan, 2000) Page 5 of 5

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ATTACHMENT
INFORMATION IN SUPPORT OF APPLICATION
FOR RENEWAL OF PERMIT WI0700012
FOR OPERATION OF INJECTION WELL SYSTEM

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ATTACHMENT I
INFORMATION IN SUPPORT OF APPLICATION
FOR RENEWAL OF PERMIT WI0700012
FOR OPERATION OF INJECTION WELL SYSTEM
ITEM 1: INJECTION PROCEDURE
The tank farm area remedial action system Injection wells have been in operation since March 24,
1992. The injection well system contains seven 4-inch diameter PVC wells generally 49 feet deep
tapping the 17 to 22-foot thick Croatan Formation with its top located 27 to 31 feet below ground
surface. These seven wells are designated CIW-1 through CIW 7 (Croatan Injection Well). The
seven wells are connected by a common 4-inch diameter PVC header pipe at Elevation 4.0 feet
(MSL) connected to a water level control tank near injection well CIW-4. The injection well system
is designed to operate at a water level between 5 and 15 feet (MSL) and at a flow rate up to 40
gal/min. Approximately 33% of the injection water is captured by the Croatan Formation withdrawal
wells and 67% flows radially east, west and south away from the injection wells. The construction
plans and materials and operation procedures were described in the original permit application
submitted on March 7, 1991, and are on file with the Department.
The injection wells are scheduled to continue to operate 24 hours/day, 365 days/year. The
injection of fresh water will continue until the target clean-up values established for the remedial
action are achieved at the withdrawal wells. For the last monitoring period for which data have
been reported (i.e., November 2000; December 2000; and January 2001), the injection rate
averaged 6.2 gal/min. Similar injection rates are projected in the future.
ITEM 2: HYDROGEOLOGIC DESCRIPTION
The tank farm area remedial action system was documented in the Ardaman & Associates, Inc.
Remedial Action System Design report dated July 31, 1990 and approved by the State of North
Carolina Department of Environment, Health and Natural Resources Division of Environmental •
Management - Groundwater Section in their letter of November 26, 1990. Section 2 of this
document should be referred to for details regarding hydrogeologic conditions in the tank farm
area.
ITEM 3: MONITORING PROCEDURE
Monitoring ofthe injection well system will continue in accordance with the performance monitoring
plan already in place as part of the remedial action plan, and the Part V requirements of the
existing injection well permit, WI0700012.
Quarterly reports will continue to be submitted to the Department in the same format as currently
used.
ITEM 4: SOURCE WELL INFORMATION
Water for the injection well system consists of water from the depressurizing well water system
around the mine. The depressurizing wells tap the upper unit of the Castle Hayne limestone with
open hole collection zones within the formation typically extending from 180 to 280feet below land

- PURR 30 2001 3:23PM ,yam.7...AMRM+ASSOCIATES 47 598121 p.9
PCS Phosphate Page 2
File Number. 88-144A
surface. The upper 180 feet of the wells, through the undifferentiated surficial deposits, Croatan
Formation, Yorktown Formation, Pungo River Formation and upper 20 to 30 feet of the Castle
Hayne limestone, are sealed with a grouted steel pipe casing.
The depressurizing well water system consists of numerous operating wells around the mine at any
given time. Water from the wells is discharged into a ditch system from which the water is taken
for the injection wells. The ditch system is scheduled to be replaced by a pipeline system from the
depressurizing wells to the plant.
ITEM 5 - OTHER WELL DATA
The locations of the seven withdrawal wells (CWW-1 through CWW-7) tapping the Croatan
Formation (i.e., the injection zone) are shown on the attached plan and described in detail in the
Remedial Action System' Design report on file with the Department. Well logs for the seven
withdrawal wells are included in Attachment III. The locations of seven wells and piezometers
tapping the Croatan Fomiation used to monitor the performance of the injection well system
(MWTF-1C, MWTF-2C, MWTF-3C, CPZ-1, CPZ-2, CPZ-3 and CPW) are shown on the attached
plan, and the well logs are included in Attachment IV.
ITEM 6: INJECTION -RELATED EQUIPMENT
The layout of the tank farm area remedial action system including the Croatan Formation injection
well system was described in the Remedial Action System Design report and the original permit
application submitted on March 7, 1991, both of which are on file with the Department. The only
significant changes to the system have been: (i) to substitute a multimedia anthracite/sand filter
and an ultraviolet tube light filter for the reverse osmosis unit described in the original permit
application; and (ii) substituting depressurizing well water for water from the FERT-1 well described
in the original permit application.
ITEM 7 - WELL LOCATIONS
A plan showing the locations of the injection wells was presented in the tank farm area Remedial
Action System Design report. A copy of that report is on file with the Department. The attached
figure also depictsthe locations of the seven injection wells , seven withdrawal wells and seven
wells/piezometers used for performance monitoring. The location of other remedial action system
wells in the tank farm area are also shown on the figure.
ITEM 8 - INJECTION FLUID DATA
The injection fluid consists of groundwater from the upper unit of the Castle Hayne limestone.
Wells providing the injection fluid have collection zones tapping the Castle Hayne aquifer between
depths of about 180 to 280 feet below land surface.
Prior to injection, the groundwater is treated by a multimedia anthracite/sand filter and ultraviolet
light filter. The quality of the injection fluid is monitored quarterly and reported to the Department.
The last set of analyses performed on the injection fluid on January 12, 2001 are tabulated below
and compared with the current permit concentration limits.

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PCS Phosphate Page 3
File Number: 88-144A
Parameter
01/12/01
Sample
Permit
Requirement
pH
7.5
6,5-8.5
Temperature (°C)
12.6
<35.5
Total Dissolved Solids (mg/1)
466
<500
Total Organic Carbon (mgll)
6.4
<10
Sulfate, SO4 (mg/I)
28
50
Chloride, CI (mg/1)
11
<55
Fluoride, F (mg/I)
0.54
<1.0
Total Phosphorus, P (mg/1)
0.15
<0.15
Cadmium, Cd (mg/I)
<0.001
<0.005
Chromium, Cr (mg/1)
<0.005
<0.05
Manganese, Mn (mgll)
0.043
<0.05
Total Coliiform Organisms (per 100 ml)
<1
<1
As shown, the constituent concentrations in the injection water are at or below the permit
requirements.
ITEM 9 - PERMITS
The original permit to construct and operate the injection well system was submitted to the North
Carolina Environmental Management Commission Department of Natural Resources and
Community Development (Form GW--57B) on March 7,1991. The permit, 06-0071-W0-0005, was
issued by the Department on December 5,1991. The permit was amended on June 15,1995 (with
the new company name and permit number). An application to renew the original permit was filed
on May 8,1996, and the permit was renewed by the Department on September23, 1997 as Permit
No. WI0700012. The expiration date for the permit is September 30, 2001.
T:Wrojecel1M 9&1HaW!-1 Pennfl Renewatwpa
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3
- SWW-I
cww1
OFFICE
/— CUT—OFF WALL
ma-s Q ASPHALT ROAD cw E
SWWs CWW4 - -
li
S.P.A
PLANT Q
L 1
WATER LEVEL
Lvn I f8)L TANK
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IS TFI
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CLUSTER
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SPZ-6
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LEGEND
SYMBOL DESCRIPTION
PIEZOYETER
• MONITOR WELL
• CONFINED SAND LAYER WITHDRAWAL WELL
• CROATAN FO NATpN WITHORAWAA WELL
• CROATAN FORYAT)OW INJECTION WELL
10. INJECTION WELL NEAD61 PIPE CLEA►LOOT
• WIECTDN WELL IYST[NI WATER LEVEL
CONTROL TANK
LOCATION PLAN FOR TANK FARM
AREA REMEDIAL ACTION SYSTEM
WELLS AND PIEZOMETERS
S31bI3OSSd+NUWE..
Ul
CD
CO

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ATTACHMENT II
INJECTION WELL INSTALLATION RECORDS

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NORTH CAROLINA DEPARTMENTOF ENVIRONMENT, HEALTH AND NATURAL RESOURCES
DIVISION OF ENVIRONMEICAL MANAGEMENT• GROUNDWATER SECTION
0.0. ROk 27OET• RALEIGH. NC M11146e7
PHONE [phone]T4
WELL CONSTRUCTION RECORD
WELL NUMBER CIW-1
DRILLING CONTRACTOR Burnett Contracting and Drilling Co.
STATE WELL CONSTRUGCCCN DRILLER REGISTRATION NUMBER 1275 PERMIT NUMBER: 06 UU71 WI-0238
FOR OFFICE USE ONLY
Quad. No. Serial No
Lat. Long. Pc
Minor Basin
Basin Code
Header Ent.
GW-1 Ent.
1. WELL LOCATION: (Show sketch of the location below)
Aurora, North Carolina
Nearest Town -
;Road, Community, or Subdivision and Lot No.)
2. OWNER Texasqulf Inc.
•ODRESS P.O. Box 48
(Street sir Rote o.:
Aurora, Nortf Carolina 27806
City or Town State Zip Code
3. DATE DRILLED 5-30-91 USE OF WDLL Injection Well
4 TOTAL DtPTH 50.01 CUTTINGS COLLECTEC D yes ••• No
5. DOES WELL REPLACE EXISTING WELL? ❑ Yes r No
6. STATIC WATER LEVEL: 15.8 FT. 0 above 7CP OF CASWG.
® belw
TOP OF CASING IS 1.62 FT ABOVE oLA':O SURFACE.**
T. YIELD Worn): METHOD OF TEST
a. WATER ZONES (depth)-
• cows,: Beaufort
Doom
DRILLING LOG
From' To Formation Oast:notion
SEE ATTACHED SOIL PROFILE
9. CHLORINATION: Type None Amount
to. CASING: Wall Thickness 11 additional soaca is needed use back of Ioml.
Depth Diameter or WelgnIIFt. Material LOCATION SKETCH
=rom 0.0 - To 33.42 Fi 4"' Sch.40 PVC :Show directionand dis: r:e from at least two State Roads,
-ram 47.67 To 49.67Ft 4" Sch.40 PVC* or other map reference :::nts)
SEE ATTACHED WELL LOCATION PLAN
From To Ft
It.GROUT: *TAILPIPE BELOW WELL SCREEN.
Depth Matarlal Method
=•on- O.0 To 27.5 Ft. Neat Cement Tremmis **PRIOR TO CUTTING CASING FOR INSTALLATION
From To Ft. 1N FLUSH MOUNT WELL COVER
12. SCREEN:
Depm Warmer Slat Size Materiel
From 33.42 Ta 47.67Ft. 4" fn.0.035in PVC APPROXIMATE PLANT COORDINATES OF WELL:
From To FL In in.
From To Ft in. in.
:3. GRAVEL PACK:
N 82+96
E 127+63
Depth Size Matafial
From 31.0 To 50.0 Ft. 8/20 Silica Sand
From To Ft.
4. REMARKS Bentonite Seal from 27.5' to 30.5' 20/30 Silica Sand Filter from 30.5' to
31.0' ; Stainless Steel Centralizer at 38.04' and 43.04'.
HEREBY CERTIFY THAT THIS WELL WAS CONSTR TED IN ACCQQQqqqpppQQQRDANCE WITH 15 'CAC 2C. WELL CONSTRUCTION
STANDARDS. AND THAT A COPY OF THIS RECORD H PROVIDED THEW OWNER. 08/05/91
SIGNATURE Of CONTRACTOR OR AGENT DATE
GWt REVISED 2090 Submit anginal to Division 01 Environmental Management and copy to well owner.

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NORTH CAROLINA DEPARTNENTOF ENVIRONMENT. HEALTH AND NATURAL RESOURCES
DwMS IN OF ENVmONMENTAL MANAGEMENT- GROUNDWATER SECTION
P.O. ROE 2T68T • RALEIGH. NC Eral,-Taar
PHONE Ig1an774711
WELL CONSTRUCTION RECORD
WELL NUMBER CIW-2
DRILLING CONTRACTOR Burnett Contracting and Drilling Co.
STATE WELL CONST UTLQJN
DRILLER REGISTRATION NUMBER 1275 PERMIT NUMBER: 05-W71-WI-0238
FOR OFFICE USE ONLY '
Quad. No. Serial No.
Lat Long. Pc
Mbtor Basin
Basin Code
Header Ent
GW-1 Ent.
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Aurora, North Carolina
2. OWNER
ADDRESS
;Road. Community, or Subdivision and Lot No.)
Texasaulf Inc.
3. DATE DRILLED
4. TOTAL DEPTH
P.O. Box 48
(Street or Route No.:
Aurora. North Carolina 27806
City or Town State Zip Code
6-03/6-04-91 USE Or WCLL Injection Well
50.5' CUTTINGS COLLECTS:. ❑ Yes LX) No
5. DOES WELL REPLACE EXISTING WELL? Q Yes L No
16.87 FT n above TOP OF CASING.
2.96 FT ABOVE LAND SURFACE.**
6. STATIC WATER LEVEL -
TOP OF CASING IS
7 YIELD (9omk METHOD OF TEST -
8. WATER ZONES (depth):
9. CHLORINATION: Type None Amount
10. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Maternal
From 0.0 To 34.12 Pt 4" Sch.40 PVC
From 48.38 -ro 50.5 Pt 4" Sch.40 PVC*
From To Ft
1 t. GROUT:
From 0.0
From To Ft'
12. SCREEN:
Depth
To 25.0
,Material Method
FL Neat Cement Tremnie
Depth Diameter Sot Size Material
From 34.12 To 48.38 Ft 4' en. 0.035 in. PVC
From To Ft. in in.
From Td Ft in. in.
13. GRAVEL PACK:
Depth
From 29.5 To 50.5 Ft
From To Ft.
14. REMARKS. Bentonite Seal from 25.0' to 29.0' ; 20/30 Silica Sand Filter from
Size
8/20
• Material
Silica Sand
county:. Beaufort
Depth
DRILLING LOG
From To Formation Description
SEE ATTACHED SOIL PROFILE
If additional space is needed use back at Corm.
LOCATION SKETCH
:Show direction and dis:arse Irom at least two State Roads.
or other map reference :::nts)
SEE ATTACHED WELL LOCATION PLAN
*TAILPIPE BELOW WELL SCREEN
**PRIOR TO CUTTING CASING FOR INSTALLATION
IN FLUSH MOUNT WELL COVER
APPROXIMATE PLANT COORDINATES OF WELL:
N 83+04
E 128+71
29,5'; Stainless Steel Centralizer at 3.75' and 38.75'.
29.0'
to
I DO HEREBY CERTIFY THAT THIS WELL WAS CO UCTED IN CCORDANCE WITH 15 NCAC 2C. WELL CONSTRUCTION
STANDARDS. AND THAT A COPT OF THIS RECORDVEEN PRO ED TG THE WELL OWNER.
GW I REVISED 210
1yt� 08/05/91
SIGNATURE OF CONTRACTOR Oir GENT DATE
Submit original to Division of Environmenml Management and copy la well owner.

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2. OWNER
ADDRESS
3. DATE DRILLED
TOTAL DEPTH
NO1int CAROLINA D®ARTIIENFOF ENVIRONMENT, HEALTH NID NATURAL RESOURCES
oMSmN OF ENVIRONMENTAL MANAGEMENT • GROUNDWATER SECTION
13.O.9OX 27357- RALEIGH. NC .R8114537
PHONE 1e19pt-3Ta1
WELL CONSTRUCTION RECORD
FOR OFFICE USE ONLY
Quad. No. Serial No.
Lat. Long. Pa
Minor Basin
Basin Coda
Header Ent.
GW-1 Ent.
WELL NUMBER CIW-3
DRILLING CONTRACTOR Burnett Contracting and Drilling Co. WELL CONS u
DRILLER REGISTRATION NUMBER 1275 • PERMIT NUMBER: uO-��j� +-1U'0238
i. WELL LOCATION: (Show sketch of the location below)
Neems: Town* Aurora, North Carolina
(Road. Cammumty. or subdWlsion and Lot No.)
Texasqulf Inc.
P.O. Box 48
caveat r Route No.:
Aurora, North Carolina 27806
City or Town State Zip Code
6-05-91 USE OF WELL Injection Well
• county: Beaufort
50:0 CUTTINGS COLLECTS- 0 Yes al] No
5. DOES WELL REPLACE EXISTING WELL? 0 Yes g NO
6. STATIC WATER LEVEL: 16.94 FT. 0 abe TOP OF CASING.
3 belovow
TOP OF CASING IS 2.88 FT ABOVE LA::D SURFACE. **
7. YIELD (gpm) , - METHOD OF TEST
6. WATER ZONES (depth).
9. CHLORINATION:
10. CASING:
=ram
From
From
11. GROUT:
From
From
12. SCREEN:
Type
None
Amount
Wall Thickness
Depth Diameter or Weight/Ft. Matadai
0.0 To 33.04F1 4° SShi41! PVC
47.29 To 49.46F1 4° Sch.40 PVC*
From
From
From
t3. GRAVEL PACK:
To FI.
Depth Material Method
0.0 To 27.0 FL Neat Cement Tremmie
To Ft
Depth Diameter
33.04 To 47.29FI 4°
To Ft.
To Ft.
Slot Site Material
kL 0.035 in. PVC
in. in.
Depth
From To
DRILLING LOG
Formation Descdpdon
. SEE ATTACHED SOIL PROFILE
11 addlponal space is needed use back of form.
LOCATION SKETCH
:Show direction and distant) from et least two State Ronds.
7r other map reference:::nts)
SEE ATTACHED WELL LOCATION PLAN
*TAILPIPE BELOW WELL SCREEN
**PRIOR TO CUTTING CASING FOR INSTALLATION
IN FLUSH MOUNT WELL COVER
APPROXIMATE PLANT COORDINATES OF WELL:
N 83+10
E 129+54
Depth Stle Mamrial
From 30.0 To 49.46F1. 8/20 Silica Sand
From To FL
14. REMARKS. Bentonite Seal from 27.0' to 2g.5' ; 20/30 Silica Sand Filter from 29.5' to
30.0'; Stainless Steel Centralizer at 3 67' and 42 67'.
I DO HEREBY CERTIFY THAT THIS WELL WAS COIN RUCTED IN dC F•ANCE WITH 15 NCAC 2C. WELL CONSTRUCTION
STANDARDS. AND THAT A COPY OF THIS RECO BEEN PRO EDT E WELL OWNER 08/05/91
SIGNATURE OF CONTRACTOR OR AGENT DATE•
Gobi REVISED 2 a0 Submh anginal to Division of Environmental Management and dopy to well away.

• PURR 30 2001 3:31PM -7RMRN+RSSOCIRTES
4- 598121
p. 16
From 30.5
From
14. REMARKS:
2. OWNER
ADDRESS
NORTH cANOLINA DEPARTMENT
ENATURAL NVIRONNENTMAL MANAGEMENT• GRO NDYIATTION
DIVISION OFRESOURCES P.O. SOX VW • RALEIGN. NC :7611.7EE7
PHONE te191775-e711
WELL CONSTRUCTION RECORD
FOR OFFICE USE ONLY
Quad. Na. Serial No.
Lat. Long.
Minor Basin
Basin Code
Header Ent.
Pc
GW-I Ent
WELL NUMBER CIW-4
DRILLING CONTRACTOR Burnett Contracting and Drilling Co.
STATE WELL CONSTRUCTAN
DRILLER REGISTRATION NUMBER
1@75 PERMIT NUMBER: B0-0ur1-WI-0238
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town. Aurora, North Carolina
(Road. Community. or Subdivision and Lot No.)
Texasquif Inc.
P.O. Box 48
Aurora, Notr oaoina 27806
City or Town State Zip Costa
3. DATE DRILLED 6-04/6-05-91 USE OF WELL Injection Well
4 TOTAL DEPTH. 49.5' CUTTINGS COLLECT" ❑Yes Z' No
5. DOES WELL REPLACE EXISTING WELL? 0 Yes E No
6. STATIC WATEP. LEVEL: 17.05 FT ❑ above TOP OF CASING.
\
TOP OF CASING IS 3.0 FT. ABOVE LA.XD SURFACE.**
7. YIELD (gpm): - METHOD OF TEST
Gounly:
Beaufort
Depm
From To
DRILLING LOG
Formation Description
SEE ATTACHED SOIL PROFILE
8. WATER ZONES (depth)'
9. CHLORINATION:
t0. CASING:
Prom
Frain
From
11. GROUT:
From
From
t2. SCREEN:
Type None
Depth
0.0 To 32.83
47.08 : 49.33
C
0.0
Death
TO 27.5
To
Amount
Wall Thickness
Diameter or weight/Ft.
Ft ,A" _ Sch.40
Ft 4" Sch.40
Ft.
Malorial
PVC
PVC*
Materiel Momad
Ft. Neat Cement Trertm!ie
Fi.
Depth Diameter Vol Size material
From 32.83 To 47.08 Ft, 4" !n.0.035 !n. PVC
From To Ft n. in.
From To Ft. In.
13. GRAVEL PACK:
Deem Size Material
To49.5 Ft, 8/20 Silica Sand
To Ft
Bentonite Seal from 27.5' to 30.0' : 20/30
30.5'; Stainless Steel Centralizer at 37.
1 00 HEREBY CERTIFY THAT THIS WELL WAS CONSTR TED IN AC(
STANDARDS. AND THAT A COPY OF THIS RECORD H EN PROVIDEQ
11 additional space is needed use back al form.
LOCATION SKETCH
:Show direction and dialer -Ca Iron at toast two. State Roam
or other mao reference :tints)
SEE ATTACHED -WELL LOCATION PLAN
*TAILPIPE BELOW WELL SCREEN
**PRIOR TO CUTTING CASING'FOR INSTALLATION
IN FLUSH MOUNT WELL COVER .
APPROXIMATE PLANT COORDINATES OF WELL:
N 83+06
E 130+63
GAL REVISED 2/90
Uteet
SIGNATURE OF CONTRACTOR OR AGENT
Submit original to Division of Environmental Management and copy to well owner.
Silica Sand Filter from 30.0' to
6and 42.46'
RDANCE WITH 15 NCAC 2C,.WELL CONSTRUCTION
o TIt WELL OWNER 08705/91
DATE

• MAR 30 2001 3:32PM RMRN+RSSOCIRTES
47"508121
p. 17
NORTH CAROLIIA DEPARTMENT OFENVIIlONMENT, HEALTH AND NATURAL RESOURCES
CNISION OF ENVIRONMENTAL MANAGEMENT• GROUNDWATER SECTION
P.O. BOX WRIT. RALHON, NC 376N•73a7
PHONE WI 17334 I
WELL CONSTRUCTION RECORD
FOR OFFICE USE ONLY
Quad. No. Serial No.
Lat. Lone Po
Minor Basin
Basin Coda
Header Ent. GW-1 Ent
WELL NUMBER CIW-5,
DRILLING ccumAcToR Burnett Contracting and Drilling Co.
STATE WELL CONSTRUCTION
DRILLER REGISTRATION NUMBER 1275 PERMIT NUMBER: 0'T071WI-0238
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town. Aurora. North Carolina
(Road. Community. or Subdivision aria Lot No.)
2. OWNER Texasgulf Inc.
ADDRESS P.O. Box 48
NrCar rRnNao.:
Aurora, 27806
City or Town State Zip Code
3. DATE -•FILLWO 6-06-91 USE OF WELL Injection Wel l
4. TOTAL '=oTH 50.0' CUTTINGS COLLECT:: LI Yes al No
5. DOES WELL REPLACE EXISTING WELLY 0 Yes g No
6. STATIC WATER LEVEL: 17.64 FT ❑ above TCP OF CASING.
3.B below
TOP OF CASING IS 08 FT ABOVE LA'.D SURFACE.**
7. YIELD fOnm1: - METHOD OF TEST -
8. WATER ZONES (depth).
9. CHLORINATION: Type None Amount -
10. CASING: Watt Thickness
DEARDiameter or Waignt/Ft. Material
From 0.0 To 32.96 Ft 4" • Sch.40 PVC
From 47.20 -0 49.33 FI 4" Sch.40 PVC*
Fro.•n To FI
11. GROUT:
From
From
12. SCREEN:
County: Beaufort
DODth DRILLING LOG
From To Formation Deaconon
SEE ATTACHED SOIL PROFILE
11 additional space is needed use back of form.
LOCATION SKETCH
:Show director and distar:e from at least two State Roads.
or other map reference :::nts)
SEE ATTACHED WELL LOCATION PLAN
*TAILPIPE BELOW WELL SCREEN
Depth Material Method
0.0 -026.0 FI. Neat Cement Tremmie
To FI **PRIOR TO CUTTING CASING FOR INSTALLATION
IN FLUSH MOUNT WELL COVER
Depth Diameter Slot Size Material
From 32.96 To 47.20 Ft. 4" in.0.035 tn, PVC
From To Ft. in. in.
From To Ft. In 1. __
13. GRAVEL PACK:
APPROXIMATE PLANT COORDINATES OF WELL:
N 83+09
E 131+60
Depth Size Material
From 29•5 To50.0 Ft. 8/20 Silica Sand
From To Ft
1a REMARKS' Bentonite Seal from 26.0' to 29.0' : 20/30 Silica Sand Filter from 29.0' to
2R '• Stainless Steel Centralizer at 37.58' and 42.58'
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTF CT£D IN C0RO NCE WITH 15 =AC 2C. WELL CONSTRUCTION
STANDARDS. AND THAT A COPY OF THIS RECORD EN PRO TO WELL owe. 08/05/91
SIGNAT PE CONTRACTOR 0 A DATE
Gw.l REVISED 290 Submit original to Division of Environmantat Management and copy 10 weft owner.

•SENT,BY: ; 407 859 8121;
MAR "1 4:02PM; PAGE 2/19
I1ORTN CAROLINA DEPARTMENT OF ENVIRONMENT. HEALTH AIM NATURAL RESOURCES
DIVISION OF ENVIRONMENTAL MANAGQaENT • GROUNDWATER SECTION
e.0.1104 MOT• RAI.EIGLNC r,TAr1.ner
PNONERNEY/S74Y.I
WELL CONSTRUCTION RECORD
WELL NUMBER CIW-6
FOR OFFICE USE ONLY
Mao. No Serial Nc.
Let ' ono Pc
Minor Basin
Basin Code
Header Ent, GW-1 Ent.__
. I
DRILLING CONTRACTOR Burnett Contracting and Drilling Co.
1275 STATE WELL CONSTRUCTION
DRILLER REGISTRATION NUMBER PERMIT NUMBER: 06-0071—WI-0238
I. WELL LOCATION: (Show sketan Of tho laCation below)
Nearest Town. Aurora, North Carolina county Beaufort
;Road, Community. or Subdivision and Lot NO.)
2. OWNER Texasqulf Inc.
ADDRESS P.O. Box 48
(Street r Rot NO.:Aurora, North CYaro'lina 27806
City or Town State Zip Code
DATE DRILLED 6-06-91 USE 0= W=LL Injection Well
TOTAL DEPTH 48,0CUTTINGS CCLLECTE: ❑ Yes tE No
5 DOES WELL REPLACE EXISTING WELL? W Yes £ NO
6. STATIC WATER LEVEL: FT C above TOP OF CASING.
TOP OF CASING IS 2.54 below
FT. ABOVE LA::O SURFACE**
7. YIELD (gOml: METHOD OF TEST
6. WATER ZONES (depmY
9. CHLORINATION: Type None Amount
10. CASING:
Welt Thickness
Depth Diameter or Weight/Pt. Material LOC =,T)ON SKETCH
From 0.0 To 31.33 Ft 4" Srh. 40 PVC :Show diraehon and dlatar.^e note et least two State Roeoa.
From 45.58 Tp 47.75 Ft 4" SCh.40 PVC* or other mao reference :::his)
SEE ATTACHED WELL LOCATION PLAN
From To Ft
: I, GROUT: *TAILPIPE BELOW WELL SCREEN
Depth Metenai Metnod
From 0.0 To 24.0 Ft Neat Cement Tremmie **PRIOR TO CUTTING CASING FOR INSTALLATION
From To Ft IN FLUSH MOUNT WELL COVER
Depth DRILLING LOG
From To Formation Description
SEE ATTACHED SOIL PROFILE
If additional space is neeoeo use beck of form.
12. SCREEN:
Depth Diameter Slot size Materiel
From 31.33 To 45.58 Ft. 4a in 0.035 in. PVC APPROXIMATE PLANT COORDINATES OF WELL:
From To Ft. irk in. N 82+74
From To FI N. m. E 132+44
IS. GRAVEL PACK:
Depth Size Malarial
From 27.75 To 48.0 FI. 8/2D Silica Sand
From To FI.
IA REMARKS' Bentonite Seal from 24.0' to 27.0': 20L30_Silica Sand_ Filter from 27.0' to
27.75r• Stainless Steel Centralizer at 5.96' and•40.96'
I DO HERESY CdhTIFY THAT THIS WELL WAS CONSTRUCTED I AC4OROANCE WITH 15 NCAC 2C. WELL CONSTRUCTION
STANDARDS. AND THAT A COPY OF THIS RECORQ N,},4 BEEN PR EOIf0 THE WELL OWNER.
GW.1 RE1fISED 290
08/05/91
SIGNATURE OF CONTRACTOR OR AGENT DATE
Submit original to Division of Environmental Management and copy to well owaef.

'SENT,BY: ;
407 859 8121;
MAR4., "1 4:02PM; PAGE 3/19
NORUl CAROLNA OEPARTNENT OF ENVINONMENT,NEALTN AFO NATURAL RESOURCES
DIVISION OF ENVIHONIrENTAL MANAGSMENT. OROUNOwATER SECTOR
P.O. nox 27187- RAI.EIGH. HC :Mn-0NT
PHONE 01T9)713.e741
WELL CONSTRUCTION RECORD
WELL NUMBER CIW-7
DRILLING CONTRACTOR Burnett Contracting and Drilling Co.
1275 STATE WELL CONS UGT[�j�1
DRILLER REGISTRATION NUMBER PERMIT NUMBER: 0 -0071-WI-0238
FOR OFRCE USE ONLY
Ouad. No Serial Nc.
Lat Long Pc
Minot Basin
Basin Code
Header Ent GW-1 Ent.
1. WELL LOCATION; (Show sketch CI Me IoWOdon below)
Nearest Town: Aurora, North Carolina
(ROad, COmmomty. Or SUDOWision and Lot No.)
2. OWNER Texasoulf Inc.
ADDRESS P.O. Box 48
Aurora, North Ceet arolina
27806
City or Town State Zit Code
3. DATE ORILLcD 6-07-91 USE OF WELL Injection Wel l
4. TOTAL DEPTH 48.0 CUTTINGS COLLECTS- L . Yes E No
5. DOES WELL REPLACE EXISTING WELL? 0 Yes E No
6. STATIC WATER LEVEL:
TOP OF CASING I5 3.33
FT ❑ above TOP OF CASING.
09 below
FT ABOVE LA:.] SURFACE.**
7. YIELD room): METHOD OF TEST
8. WATER ZONES (deem)•
9. CHLORINATION: Type None
10. CASING
Amount
Well ThiekneRsa
Depth Diameter or we;gnitFt.
=rem 0.0 To 31,0 Et " 4 Sch.4D
45.25 to 47.75ot 4" Sch.40
From
Prom
11. GROUT:
To
Depth
From 0.0 To
From To
12. SCREEN:
Ft.
Material
PVC
PVC*
Material Meihod
25.5-rt. Neat Cement Tr!,mnie
Ft.
Oepm Diameter 5:ot Size Material
From 31.0 To 45.25Ft 4" in, 0.035 in PVC
From To_ FI. in. in.
-ram To Ft in, ,;r<
13. GRAVEL PACK:
Depth
From 28.5 To 48.0 Ft
cram To FI
Size Material
8/20 Silica Sand
County: Beaufort
Depth DRILLING LOG
From To Formation Description
SEE ATTACHED SOIL PROFILE
/
11 additional space is needed mu back Ot torm.
LOCATION SKETCH
:Show direction anddisle-:e from al leas) two State Roads,
or other map tolerance a:;n:s)
SEE ATTACHED WELL LOCATION PLAN
*TAILPIPE BELOW WELL SCREEN
**PRIOR TO CUTTING CASING FOR'INSTALLATION
IN FLUSH MOUNT WELL COVER
APPROXIMATE PLANT COORDINATES OF WELL;
N 82+67
E 133+29
14 semen- Bentonite Seal from 25.5' to 28.0' % 20/30 Silica Sand Filter from 28.0' to
2100 HEREBY GEATIFY THAT THISSWELLL WAS COU T$pry$JlCTEO IN t AtORIDDNCE d WIITH 215 �NCAC 2C. WELL CONSTRUCTION
STANDARDS. AND THAT A COPY OF THIS FECORmtdtSIBEEN PRO V TO WELL OWNER.
08/05/9.1
G'Na REvtSEO2E90
SIGNALURE OF CONTRACTOR l5R AE3EN* DATE
Submit original to Division al Environmental Management and dopy to web Owner.

•9ENT,8Y:
407 850 8121;
MAR-£(" "1 4:03PM; PAGE 4/19
ATTACHMENT III
WITHDRAWAL WELL INSTALLATION RECORDS

'SENT,RY:
407 A59 B121;
MAR-t ''I 4:03PM; PAGE 5/19
NORTH CAROLINA DEPARTMENT OF ENVIRONMENT, IMAM AND NATURAL RESOURCES
DIVISION OP ENVIRONMENTAL MANAGEMENT -GROUNDWATER SECTION
P.O. BOX 2759T • RALEIGH. NC :7511.7607
PHONE (9I9)771.7211
WELL CONSTRUCTION RECORD
WELL NUMBER CWW-1
DRILLING CONTRACTOR Ardaman & Associates, Inc.
DRILLER REGISTRATION NUMBER 1019
FOR OFFICE USE ONLY 1
Quad No serial NO.
Lat Long. Pc
Minor Basin
Basin Code
Header Erd OW-1 Ent
STATE WELL CONSu01-WR-D226
PERMIT NUMBER: 06007
1. WELL LOCATION; (Show sketch of the location below)
Nearest Town Aurora, North Carolina
(Road. Community, or Subdivision and Lot NO.)
2. OWNER Texasgulf Inc.
ADDRESS P.O. Box 48
(Street or Route No.1
Aurora, North Carolina 27806
county: Beaufort
Depth DRILLING LOG
From To Formation Description
SEE ATTACHED SOIL PROFILE
City or Town State Zip Code
3. DATE fRILLFD 6-12-91 USE OF WELL Recovery Well
4. TOTAL DEPTH 55. Q' CUTTINGS COLLECTED :J Yes El No
5. DOES '+ELL REPLACE EXISTING WELL? 0 Yes E No
6. STATIC WATER LEVEL: 13.3E FT. ❑ above TOP OF CASING,
belowLA
TOP OF CASING IS 2.25 FT. ABOVE ND SURFACE.**
7. YIELD Wm): - METHOD OF TEST
- WATER ZONES (deDtN'
9. CHLORINATION: Typo None Amount
10, CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0.0 To 33.27 Ft, 4" Sch.40 PPC
From 52.68 To 54.85 Ft 4" Sch.40 PVC*
Frorn To Ft
11. GROUT:
D60m Material Method
II addltlonal space :s neededuse back of form.
LOCATION SKETCH
:Snow direction and dime- :e from at least two State Roads,
or other map reference :::nts)
SEE ATTACHED WELL LOCATION PLAN
*TAILPIPE BELOW WELL SCREEN
From 0.0 To24.5 Ft Neat Cement Tremmie **PRIOR TO CUTTING CASING FOR INSTALLATION
From To Ft.
12. SCREEN;
Depth Diameter Stot Size material
From 33.27 To 52.68 Ft. 4" in.0.035 in. PVC
From To_ Ft. In. in,
From To Ft. in in.
13. GRAVEL PACK:
IN SERVICE BOX
WELL LOCATION: N 87t51.85
E 127+65.85
ELEVATION OF TOP OF CASING: 10.60' (MSL)
Depth Size Material
From 28.5 To55.0 Ft. 8/20 Silica Sand
From To Ft
,.REMARKS- Bentonite Seal from 24.5' to 27.5' ; 20L30 Silica Sand Filter from 27.5' to
28.5'• Stainless Steel Centralizer at 37.89', 42.93' and 48.02'.
I DO HEREBY CERTIFY THAT THIS WELL WAS CO TRUCTED I ACC• -DANCE WITH 15 ::CAC 2C, WELL CONSTRUCTION
STANDARDS. AND THAT A COPY OF THIS RECORQF S BEEN PRO DED L THE WELL OWNER.
07/19/91
eat
SIGNATURE OF CONTRACTOR •R AGENT DATE
CW-1 REVISED 2190 Submit original to Division 01 Environmental mznagement and copy to well owner.

•SENT,BY: ;
407 859 8121;
MAR -<'A ";1 4:00PM; PAGE 6/19
2. OWNER
ADDRESS
NORTH CAROLINA DEPARTMENT OF ENVIRONMENT, REALM AND NATURAL RESOURCES
DIVISION OF ENVInONMENTAL MANAGEMENT- GROUNOWATER 5ECn0H
P,O. PDX 276e7 . RALEIG)H, NC Arai I.1ae7
PHONE Iafel7aa-2Z1
WELL CONSTRUCTION RECORD
WELL NUMBER CWW-2
DRILLING CONTRACTOR Ardaman & Associates, Inc.
DRILLER REGISTRATION NUMBER 1019
FOR OFFICE USE ONLY
Quad. N0. serial Mc.
Lat. Long. Pc...�
Minor Basin
Basin Code
Header Ent
GW-1 Ent.
STATE WELL CONSu171 WR-D226
PERMIT NUMBER: 0600
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town' Aurora, North Carolina
(Road. Community. or Subdivision and Lot No,)
Texasqulf Inc.
P.O. Box 48
(St lot or Ro No.)
Aurora, Nortff CarolIina 27806
City or Town State Zip Code
3. DATE DRILL°D 6-12/6-13-91 USE OF WELL Recovery Well
4. TOTAL DEPTH 52.151 CUTTINGS COLLECTED D Yes r' No
5. DOES WELL REPLACE EXISTING WELL? ❑ Yes E No
S. STATIC WATEP. LEVEL: 13.67 FT ® above TOP OF CASING.
TOP OF CASING IS
7. YIELD (gem): METHOD OF TEST
WATER ZONES (depth].
county Beaufort
Depth
DRILLING LOG
From To Formation Deseription
SEE ATTACHED SOIL PROFILE
9. CHLORINATION:
10. CASING:
3.0 FT. ABOVE LowAND SURFACE**
Type None Amount
Wall Thickness
Depth Diameter or Weight/Ft. (Material
From 0.0 To 30.57 Ft 4" Sch.40 PVC
From 49.82 To 52.15 Ft 4" Sch.40 PVC*
From To Ft
11. GROUT: •
Depth Material
From 0.0 To 21.5 F1 Neat Cement
From
12. SCREEN:
From 30.57
To Ft.
Depth
TO 49.82
From To,
Ft
Ft.
Method
Trettmi e
Diameter Stot Size material
4" In.0.035 in. PVC
itt (n.
From_ To Ft. in. In.
13. GRAVEL PACK:
Depth Size Material
F(OM 25-5 Tp52.15 Ft. 8/20 Silica Sand
From
REMARKS:
11 additional space is needed use back o1 form,
LOCATION SKETCH
(Show direction end disteroe from a1 least two Stale Roaos,
or other map reference ;;inta)
SEE ATTACHED WELL LOCATION PLAN
*TAILPIPE BELOW WELL SCREEN
**PRIOR TO CUTTING CASING FOR INSTALLATION
IN SERVICE BOX
WELL LOCATION: N 87+58.03
E 128+54.32
ELEVATION OF TOP OF CASING: 10.23' (MSL)
To Ft.
Bentonite Seal from 21.5' to 25.0' ; 20/30 Silica Sand Filter
25.5' : Stainless Steel Centralizer at 35.20' and 45.20'.
I DO HEREBY CERTIFY THAT THIS WELL WAS 0 STRUCTEACC; RDANCE WITH 15 NCAC 2C.
STANDARDS, AND THAT A COPY OF THIS nee BEEN P/IDED I A THE WELL OWNER.
GWI REVISED2/90
SIGNATURE OF CONTRACTOR eR AGENT
Submit original to Division Of Environmental Management
from
25.0' to
WELL CONSTRUCTION
07/19/91
DATE
and copy to welt owner.

•8ENT,BY: ;
407 859 8121;
MAR-^/" "1 4:03PM; PAGE 7/19
GW1 REVISED 2190
NORTH CAROLINA DEPARTMENT OF ENVIRONMENT, HEALTH AND NATURAL RESOURCES
DIVISION OF ENVIRONMENTAL MANAGEMENT• ORDUNuwATER SECTION
P.D. e0X 27687 • RAI.EIGH, NC nsti•Tea7
PHONEIBISPTa.3Ya1
WELL CONSTRUCTION RECORD
WELL NUMBER CWW-3
DRILLING CONTRACTOR Ardaman & Associates, Inc.
DRILLER REGISTRATION NUMBER 1019
FOR OFFICE USE ONLY
Cued. No. Soria' NO.
Let Long. Pc
Minor Basin
Basin Code
Header Ent. OW-1 Ent.
STATE WELL. CONSTRUMN
06-0071 WR-0226
PERMIT NUMBER
1. WELL LOCATION: (Show sketch of m0 !Deakin be!cvr)
Nearest Town: Aurora, North Carolina
(Road. Community, or Subdivision and Lot No.)
2. OWNER Texasgulf Inc.
ADDRESS P.O. Box 48
(Str et or RO I No..
Aurora, North Carolina 27806
City or Town State Zio code
3. DATE DRILLED 6-13-91 USE OF WELL Recovery Well
4. TOTAL DEPTH 53.0' CUTTINGS COLLECT!3 G Yes M No
5. DOES WELL REPLACE EXISTING WELL? ❑ Yes & NO
6. STATIC WATER LEVEL: 14.20 FT, O above TOP OF CASINO.
TOP OF CASING IS
3.08 FT A OVE Lr.ND SURFACE.**
7. YIELD (9pm): - METHOD OF TEST
WATER ZONES (depth).
9. CHLORINATION:
10. CASING:
Type None Amount
Well Thickness
Depth Diameter or weight/Ft. Malarial
From 0.0 To 36.42Ft 4" Sch 40 PVC
From 50.67 To 53.0 Ft 4" Sch.40 PVC*
Rom To Ft
county: Beaufort
Oepth DRILLING LOG
Formation Description
From To
SEE ATTACHED SOIL PROFILE
II additional space is needed use back of form.
LOCATION SKETCH
:Show direction and dlscar:e from at least two`State Roads.
or other map reference :::nts)
SEE ATTACHED WELL LOCATION PLAN
11. GROUT: *TAILPIPE BELOW WELL SCREEN
Depth Materiai Method
FrOm 0.0 To 28.0 FI. Neat Cement Tretlmlie **PRIOR TO CUTTING CASING FOR INSTALLATION
From To F(. IN SERVICE BOX
12. SCREEN:
DOOM Diameter S!ol Size Materiel
From 36.42 To 50.67Ft. 4" in.0.035 in. PVC WELL LOCATION: N 87+55.61
E 129+65.64
From- Ta Ft. in. in.
From To Ft in in ELEVATION OF TOP OF CASING: 9.95' (MSL)
13. GRAVEL PACK:
Depth Size Material
From 31.75 To 53.Q_Ft. 8/20 ' Silica Sand
From To Ft.
REMARKS. Bentonite Seal from 28.0' to 31.0' i 20/30 Silica Sand Filter from 31.0' to
31.75'; Stainless Steel Centralizer at 41.04' and 46.04'.
1 DO HEREBY CERTIFY THAT THIS WELL WAS C TRUCTED I ACC!RDANCE WITH 15 NCAC 2C. WELL CONSTRUCTION
STANDARDS. AND THAT A COPY OF THIS RECO S BEEN IDEO +• THE WELL OWNER,
-.ow% P 07/19/91
SIGNATURE OF CONTRACTOR • R AGENT DATE
Submit original to Division of Environmental Management and Copy to well owner.

•SENT, BY:
407 859 8121;
MAR-' "1 4:04PM; PAGE 8/19
GW-I REVISED2'90
2. OWNER
ADDRESS
NORni CAROLINA DEPARTMENT OP ENVIRONMENT. HEALTH AND NATURAL RESOURCES
DIVISION DP ENVIRONMENTAL MANAGEMENT • GROUNDWATER SECTION
PA. PDX 276a7 • PALEISH. NC ^.7e11.7t87
PHONE I919)77}a221
WELL CONSTRUCTION RECORD
FOR OFFICE USE ONLY
Quad No Seral No.
Lat. long. Pc
Minor Saab
Basin Code
Header Ent. 1 GW-1 Ent.
WELL NUMBER CWW-4
DRILLING CONTRACTOR Ardaman & Associates, Inc. STATE WELL CONSTRUCTION
GRILLER REGISTRATION NUMBER
1019 PERMIT NUMBER. O6-0071-WR-0226
I. WELL LOCATION: (Shcw sketch of the location below)
Nearest Town. Aurora, North Carolina county, Beaufort
Depth DRILLING LOG
From To Formation Description
(Road. Community, or Subdivision and Lot No.)
Texasaulf Inc.
P.O. Box 48
Aurora, North
Cro N
27806
City or Town State Zip Cade
3. DATE DRILLED
6-11-91 USE Or WELL Recovery Well
4. TOTAL DEPTH 53.0' CUTTINGS COLLECTED G Yes rj No
5. DOES WELL REPLACE EXISTING WELL? 0 Yes Ili No
6. STATIC WATER LEVEL: 14.22 FT. D above TOP OF CASING,
2.75 gl below
TOP OF CASING IS FT ABOVE LAND SURFACE**
7. YIELD (gpm)• - METHOD OF TEST -
^ WATER ZONES (depth):
SEE ATTACHED SOIL PROFILE
9. CHLORINATION: Type None Amount
10. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material.
From 0.0 To 41.67Ft 4" Sch.40 .140
From 50.92 Tp 52.92Ft 4" Sch.40 PVC*
From _ To Ft
i1.GROUT: *TAILPIPE BELOW WELL SCREEN
Depth Material Method
From 0.0 TO 34.0 Ft. Neat Cement Tremmie **PRIOR
CCUTTING CASING FOR INSTALLATION
X
From To ' FL
12. SCREEN:
II additional space 15 needed use book of form.
Depth Diameter skitsize Materiel
From 41.67 To 50.92Ft 4" in.0.035 in. PVC
From To - Ft. in.
From To Ft in. m. -
13. GRAVEL PACK:
LOCATION SKETCH
;Show direction and dista is from at least two State Road^.,
or other Mao reference ;WIC
SEE ATTACHED WELL LOCATION PLAN
WELL LOCATION: N 87+62.10
E 130+84.77
ELEVATION OF TOP OF CASING: 10.73' (MSL)
Depth Site Material
From 37.5 To 53.0 FI. 8/20 Silica Sand
From To Ft
.REMARKS. Bentonite Seal from 34.0' to 37-0' : .O/30 Silica Sand Filter from 37.0' to
3g77 51• Stainless Steel Centralizer at 46.29'
I DO HEREBY CERTIFY THAT THIS WELL WAS STRUCTEo ACC RDANCE WITH 15 NCAC 2C. WELL CONSTRUCTION
STANDARDS. AND THAT A COPY OF THIS RECO AS BEEN PFigVI ELL OWNER. 07/19/91
SIGNATLME OFCONTRACTOR AGENT DATE
Suhmit original to Division of Environmental Management and Copy to well owner.

•SENT,BY: ;
407 850 8121;
MAR -FT 4:04PM; PAGE 0/19
• 2. OWNER
ADDRESS
NORTH CAROLINA IMPARTMENT OF ENVIRONMENT, NEALIH ARO NATURAL R6SOURCEZ
DIVISION OF ENVIRONMENTAL MANAdEMENT• GROUNDWATER SECTION
P.O. P.O% 276aT. RALEIGH, NC ^.761r•T697
PHONE [phone]
WELL CONSTRUCTION RECORD
WELL NUMBER CWW-5
DRILLING CONTRACTOR Ardaman & Associates, Inc.
DRILLER REGISTRATION NUMBER 1019
FOR OFFICE USE ONLY
Quad. No. Serial N-
Let Long. Pc
Minor Basin
Basin Code
Header Ent. Gw-1 Ent.
IN
PERMIT NUMBER. WELL 06uUU71-WR-0226
1. WELL LOCATION: (Snow sketch of the location below)
Nearest Town• Aurora, North Carolina
(Reed. Community, Of subdivision and Lot No.)
Texasqulf Inc.
P.O. Box 48
(Street or Rot No.:
Aurora, North Carolina 27806
cminty:. Beaufort
Depth
DRILLING LOG
From To Formation Descriohon
SEE ATTACHED SOIL PROFILE
City or Town State Zip Code
3. DATE DRILLED 6-11-91 USE.OF WELL Recovery Well
4. TOTAL DEPTH 53.17I 'CUTTINGS COLLECT:_:-. LJ Yes in No
5. DOES WELL REPLACE EXISTING WELL? 0 Yes E No 6. STATIC WATER LEVEL: 14.90 FT ❑ shove TOP OF CASING,
2.58 (8 below
TOP OF CASING IS FT ABOVE LAMD SURFACE.**
7. YIELD :Wm): -
METHOD OF TEST
wATER ZONES (depth):
9. CHLORINATION: Typo None Amount 10. CASING:
Wall Thickness
Depth Diameter or weight/Ft. Materiel
From 0.0 To 41.75Ft. 4" Sch.40 PVC
From 51.08 To 53.17Ft 4" Sch.40 PVC*
From TO FI
it GROUT:
From 0.0
From
12. SCREEN:
Depth
To 35.0 Ft.
To Pt.
Material Method
Neat Cement Tremmie
Depth Diameter Slot Size Materiel
From 41.75 To 51,08Ft 4" in.0.035 in. PVC
To Ft. in. in.
To Ft in in.
From
From
13. GRAVEL PACK:
Depth
Size Material
II additional spate :s needed use back of form.
LOC=TION SKETCH
(Show direction and "istaree from at least two State Roads,
or ether map reference ee:nts)
SEE ATTACHED WELL LOCATION PLAN
*TAILPIPE BELOW WELL SCREEN
**PRIOR TO CUTTING CASING FOR INSTALLATION
IN SERVICE BOX
WELL LOCATION: N 87+61.37
E 131+46.35
ELEVATION OF TOP OF CASING: 10.74' (MSL)
From 38.0 To 53.17Ft. 8/20 Silica Sand
From To - Ft.
,.REMARKS: Bentonite Seal from 35.0' to 37.5' ; 20/30 Silica Sand Filter from 37.5' to
38.0'; Stainless Steel Centralizer at 46.42'
I DO HEREBY CERTIFY THAT THIS WELL WAS CO !ROOTED 11 ACC•RDANCE WITH 15 CAC 2C. WELL CONSTRUCTION
STANDARDS. AND THAT A COPY OF THIS REC R S BEEN P DEED 0 THE WELL OWNER
07/19/91
SIGNATURE OF CONTRACTQR •R AGENT DATE
Gw•1 RLLISED2/90 Submll original to Division of Environmental Management and Copy to well owner.

•SENT, BY:
407 859 8121;
MAR-2' ^1 4:04PM; PAGE 10/19
GWI REVISED 2190
NORTH cARouN► DEPARTMENT OF ENVIRONMENT, t1EALT14 AND NATURAL RESOURCES
ONISX1N OF ENVIRONMENTAL MANAGEMENT• GROUND WATER SECTION
P.O. PDX 2 F417 . RAL€IAK, NC z7611.7W7
PNONE(919paaaft
WELL CONSTRUCTION RECORD
WELL NUMBER CWW-6
DRILLING CONTRACTOR Ardaman & Associates, Inc.
DRILLER REGISTRATION NUMBER 1019
1
FOR OFFICE USE ONLY
clued. No. Serial No.
Lat. Long. - Pc
Minor Basin
Basin Coda
Header Ent. GW-1 Ent.
STATE WELL CONSTRUCTIION
PERMIT NUMBER: 06- 071-WR-0226
I. WELL LOCATION: (Show sketch 01 the locadon below)
Nearest Town. Aurora, North Carolina
(Road. Community. or Subdivision and Lot NO.)
2. OWNER Texasqulf Inc.
P.O. Box 48 SEE ATTACHED SQIL PROFILE
ADORERS (Street or Rote No.)
Aurora, North Carolina 27606
City or Town Siete WellZiP e
3. DATE DRILLED 6-10-91 USE OF WELL Recovery
4. TOTAL DEPTH 53.0' CUTTINGS COLLECTED G Yes 11. No
5. DOES WELL REPLACE EXISTING WELL? 0 Yes E No
6. STATIC WATER LEVEL:, 14.82 FT. ® be1O S TOP OF CASING,
TOP OF CASING IS 2.92_ FT. ABOVE I.M D SURFACE.**
county Beaufort
Depth GRILLING LOG
From To FOrnation Description
7. YIELD (;pm): -
WATER ZONES (depth'
METHOD OF TEST -
9. CHLORINATION: Type None Amount -
10. CASING: Waa Thickness
Depth Diameter or Weight/Ft. Material
From 0.0 To 36.62 P1 4" Sch.40 PVC
From 50.88 T. 52.96 Ft 4" Sch.40 PVC*
From To F1•
it, GROUT:
Depth Material Memcd
From 0.0 To 31.5 FL Neat Cement Treffeni e
From To F1.
12. SCREEN;
Depth Diameter 5101 Size material
From 36.62 To 50.88 Ft 4" ;, 0.035 in. PVC
From To. Ft. in in.
From To Ft. In in. -
13. GRAVEL PACK:
If addleonal space is needed use back of form.
LOCATION SKETCH
(Show direction auto distance IrOm at least two State Roads,
or other map reterenee D Dints)
SEE ATTACHED WELL LOCATION PLAN
*TAILPIPE BELOW WELL SCREEN
**PRIOR TO CUTTING CASING FOR INSTALLATION
IN SERVICE BOX
WELL LOCATION: N 87+64.69
E 132+53.89
ELEVATION OF TOP OF CASING: 9.92' (MSL)
Depth Size Material
From 35.0 To53.0 Ft. 8/20 Silica Sand
From, To Ft.
REMARKS: Bentonite Seal from 31.51 to _34.5' ; 20L30 Silica Sand Filter from 34.5' to
35.0'• Stainless Steel Centralizer at 46.25' an 5'
I DO HEREBY CERTIFY THAT THIS WEU. WAS q�{�1 STRUCTEDD,I ACC-ROANC f 15 sNCAQ 2C, WELD CONSTRUCTION
STANDARDS. AND THAT A COPY OF THIS RECQRWJ9A>a BEEN •ry�•D •THE WELL OWNER. 07/19/91
SIGNATURE OF CONTRACTOR OR AGENT DATE
Submit original 10 Division of Environmental Management ano Copy to well owner.

'SENT, BY: ;
407 85D 8121;
MAR --`1 4:05PM; PAGE 11/10
GW t REVISED 2/90
2. OWNER
ADDRESS
NORTH CANOUNA DEPARTMENT OF ENVIRONMENT. neALTN Alto NATURAL RESOURCES
DIVISION OF ENVIRONMENTAL MANAGEMENT • GROUNDWATER SECTION
P.O. SOX 2Teet• RALEIOH. NO t751I4fieT
PHONE (919)T33447t
WELL CONSTRUCTION RECORD
WELL NUMBER CWW-7
DRILLING CONTRACTOR Ardaman & Associates, Inc.
DRILLER REGISTRATION NUMBER 1019
FOR OFFICE USE ONLY
(Ned. No. Serial Ne.
Lat. Long. Pe
Minor Basin
Basin Code
Header Ent.
GW-1 Ent.
STATE WELL CONSTRUCT(ON WR-0226
PERMIT NUMBER: 6UUUn1
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Aurora, North Carolina
(Road, -Community. or Subdivision and Lot No.)
Texasqulf Inc.
P.O. Box 48
(Street pr Rote No.)
Aurora, North Carolina 27806
City or Town State Zip Code _
3. DATE DRILLED 6-7/6-8-91 USE OF WELL Recovery Well
4. TOTAL DEPTH 53.01 CUTTINGS COLLECTED' GJ Yes 'LM No
5. DOES WELL REPLACE EXISTING WELL? 0 Yes E No
6. STATIC WATER LEVEL; 13.66 FT. Q above TOP OF CASING.
II bebw
TOP OF CASING IS�FT. ABOVE LAUD SURFACE.**
7. YIELD (gpm): -
" 'VATER ZONES (depth):
METHOD OF TEST
9. CHLORINATION: Type None Amount
10. CASING: Well Thickness
Depth Diameter or Weight/Ft. Material
0.0 To36.58 Ft 4" Sch.40 PVC
50.83 T053,0 F1 4" Sch.40 PVC*
From
From
county: Beaufort
Depth
From TO
DRILLING LOG
Formation Descripnon
SEE ATTACHED SOIL PROFILE
If additional space is needed use back of form.
LOCATION SKETCH
(Show direction end oistarce from at least two State Roads.
or other map reterence :=rots)
SEE ATTACHED WELL LOCATION PLAN
From _ To Ft
11.GROUT: *TAILPIPE BELOW WELL SCREEN
Depth Material Method
From 0.0 To31.75 Ft. Neat Cement' Trenenie. **IRIORRTOCCUTTING CASING FOR INSTALLATION
IFrom To Ft.
12. SCREEN:
Depth Diameter Slot Size Material
From 36.58 TO50.83 FI 4" in0.035 in. PVC WELL LOCATION: N +62.97
E 133+55.827
Fram To Ft. in. in.
From TO Ft. in- -In ELEVATION OF TOP OF CASING: 9.95' (MSL)
13. GRAVEL PACK:
Frain 35.25
Depth " Size Material
To53.0 Ft. 8/20 Silica Sand
From To FI.
REMARKS: Bentonite Seal from 31 T5,'t9 34.51 20/30 Silica Sand Filter from 34.5' to
35.2511Stainless Steel Centralizer at 46:21' and 41.21'.
I D0 HEREBY CERTIFY THAT THIS WELL WAS CON RUCTED IN A CORD CE WITH 15 NCAC 2C. WELL CONSTRUCTION
STANDARDS. AND THAT A COPY OF THIS REC JE BEEN PRO TO WELL�OWNER. 07/19/91
SIGNATURE OF CONTRACTOR OR A NT DATE
Submit original to Division of Environmental Management and copy 10 well owner.

•SENT, BY: ;
407 859 8121;
MAR-a"--"1 4:05PM; PAGE 12/19
ATTACHMENT V
OTHER WELL INSTALLATION RECORDS

.SENT, BY: ;
407 850 8121;
MAP -€"-"1 4:05PM; PAGE 13/19
2. OWNER
ADDRESS
NOR711 caaap=A OEPABThC r or NATURAL RtaOU = A/O WMWTY ovvactw ►
mom of tir.so1SRAL MANACOeHfT - w nnwaTm szCIICN
P.O. SOX Reee7 - nAutiO14N.G. 27e11. F70E (Ole) 733-60821
WELL CONSTRUCTION RECORD
WELL NUMBER MWTF1-C
DRILUNG CONTRACTOR Ardaman & Associates, Inc.
DRILLER REGISTRATION NUMBER 1019
FOR OFFICE USE ONLY
Quad. Na. Serial Nu.
Lat. Lone. Po --
Minor Satin
ealdn Code
Header Ent GW-1 Ent.
STATE WELL CONSTRUCTION
PERMIT NUMBER: 06-0071-WM-0156
1. WELL LOCATION: (Show sketch of mo location below)
Nearest Town. Aurora, North Carolina CO1IttI Beaufort
(Road. Community, or Subdivision and Lot No.)
Texasgulf Inc.
Depth DRILLING LOG
From To Formation Description
P.O. Box 48 SEE ATTACHED BORING LOG
Aurora, NorttNLarolina Na•) 27806
City or Town State Zip Code
3. DATE DRILLED 10-26-88 USE OF WELL Monitoring
4. TOTAL DEPTH 42.01 CUTTINGS COLLECTED 0 Yes • No
5. DOES WELL REPLACE EXISTING WELL? ❑ Yee . No
5. STATIC WATER LEVEL: 14.65* FT El above TOP OF CASING.
TOP OF CASING IS nit* IN
ABOVE beLAND SURFACE.
7. YIELD Wpm): X METHOD OF TEST X
S. WATER ZONES (depth)• X
9. CHLORINATION: Type None Amount X
O. CASING:
Was Thickness
Depth Diameter or Weight/FL. Material
From 0.0 To 38.7 Ft 2" Sch 40 PVC
From TO Ft
From To Ft.
t. GROUT:
From
From
t2. SCREEN:
If additional Space is needed use beck o1 form.
LOCATION SKETCH
(Show direction and elstance from at least two State Roads,
or other map reference points)
SEE ATTACHED MONITOR WELL LOCATION PLAN
Depth Material Method
0.0 To 34.1 Ft_ Neat Cement Trennlie *Static water level on 12-07-88
To Ft. **Monitor well in leak resistant steel
manhole
Depth Diameter Slot Sixe Material
From 38.7 To 40.7 Ft. 2 in. 0.01 in. PVC
NOTE; Total depth of well, and the casing,
From To Ft in in. grout, screen, gravel pack and bentonite
From ,To Ft. M in. seal depths are referenced from the top of
I3.GRAVEL PACK: the PVC well casing in the steel manhole.
From
From
4. REMARKS:
Depth Size Material
36.3 To 42.0 Ft 8/16 Silica Sand
TO Ft.-
Bentonite seal from 34.3 to 36.3 feet
'TOO HEREBY 'CERTIFY THAT THIS WELL WAS CONS
STANDARDS. AND THAT A COPY OF THIS RECORD
GW-1 Revised 111R4
CTED IN AC RDANCE WITH IS NCAC 2C, WELL CONSTRUCTION
TWO 0 WELL OWNER
i23- 12-27-88
SIGNATURE OF CONTRACTOR OR I(GENT GATE
Submit original to Division 01 Envirnnn►nrsr , ...w... -n.-1 ..nnu tin well n.-n•r

•SENT, 8Y: ; 407 859 8121 ;
NORTH OAROUNA DEpARn eo OF NMWAL tit:BOtallla AND cotton manioc
DIMON OP elvmnit&NTAL Man - GROU OWAI'FA SEcnen
P.O. BOX 27ee7 - RMOGOUI.C. 27611. MOMS (018) 733-e083
WELL CONSTRUCTION RECORD
NELL NUMBER MWTF2-C
DRILLING CONTRACTOR Ardaman & Associates, Inc.
7RILLER REGISTRATION NUMBER 1019
MAR-S" "1 4:06PM; PAGE 14l19
FOR OFFICE USE ONLY
Quad No. Serial No.
Let Long. pc
Mirror Basin
Basin Coda
Header Ent GW-1 Ent.
STATE WELL CONSTRUCTION
PERMIT NUMBER; 06-0071-WM-0156
WELL LOCATION: (Stow seethe of the location below)
Nearest Town- Aurora, North Carolina County:
(Road. Community. or Subdivision and Lot No.)
, OWNER
ADDRESS
Texasqulf Inc.
Depth _ DRILLING LOG
From To Formation Daecnptlon
P.O. Box 48 SEE ATTACHED BORING LOG
Aurora, Naraktarolina Np') 27806
City or Town Slaw Zip Code
DATE DRILLED 10-22-88 USE OF WELL Moni.torinq
. TOTAL DEPTH 42.5' CUTTINGS COLLECTED D Yea No
. DOES WELL REPLACE EXISTING WELL? ❑ Yes • No
STATIC WATER LEVEL: 16.03* FT O above TOP OF CASING,
3.23 II below
TOP OF CASING IS FT ABOVE LAND SURFACE.
YIELD (gpml• X METHOD OF TEST X
. WATER ZONES (depth): X
. CHLORINATION: Type None Amount
L CASING:
X
Wall Thickness 11 additional apace is needed use back of form.
Depth Diameter or Wepht/Ft. Motorist
From 0.0 To 39.7 Ft 2" Sch 40 PVC
(Show direction and distance from at least two State Roads.
From To Ft Or other map reference points)
From To Ft SEE ATTACHED MONITOR WELL LOCATION PLAN
. GROUT:
Depth Material Method
From 0.0 To 36.0 Ft Neat Cement Tremmie *Static water level on 11-30-88
From To Ft.
I SCREEN:
Depth Diameter Slot Size Material
From 39.7 To 41.7 FL 2 in. 0.01 M. PVC
From To Ft in in.
From To Ft. in. in.
I. GRAVEL PACK:
Depth Size
Material
From 38.0 To 42.5 pt. 8/16 Silica Sand
From To Ft.
I. REMARKS. Bentonite seal from 36.3 to 38.0 feet
—roc) HEREBY -CERTIFY TRAT THIS WELL WAS CONS
STANDARDS, AND THAT A COPY OF THIS RECORD
LOCATION SKETCH
TED IN ACCJJROANCE WITH 15 NCAC 2C, WELL CONSTRUCTION
PROVIDED OWELL OWNER.
• TbYJ� 12-27-88
IW-1 Reeilted IIIRA
SIGNATURE OF CONTRACTOR OR A
Snhmn !molest to Ilivicinn of PMtrr-.•..•••••-. ,.
DATE
r.-...-mil -.so. -. •...-... -..�.

'SENT, BY: ;
407 859 8121;
MAR-C" 1'1 4:O6PM; PAGE 15/19
• NORTH CAROtau IWPARTIOWY OF mann tRnwi 1031 MO CO►aa.tTY bt:vaontetr
_ DEMON OF SAL MANAAFMNU • PRoUNDMA,m SECTION
P.O. sox 27ae7-RALE161ULC. 27011. Plat fatal 739.eoes
WELL CONSTRUCTION RECORD
WELL NUMBER MWTF3-C '
DRILLING CONTRACTOR Ardaman & Associates, Inc.
DRILLER REGISTRATION NUMBER 1019
FOR OFFICE USE ONLY
quad No, Serial No.
Lat. L0pg. Pc
Minor Basin
BOOM Cod.
Header Ent OW-1 Ent,
STATE WELL CONSTRUCTION
PERMIT NUMBER: 06-00714M-0156
.. WELL LOCATION: (Show Match of the toeation below)
Nearo5I Town:
Aurora, North Carolina
(Road. Community, der Subdivision and Lot No.)
• OWNER Texasgulf Inc.
County: Beaufort
Depth DRILLING LOG
From To Formation Desdfpttnn
ADDRESS P.O. Box 48 SEE ATTACHE! BORING LOG
Aurora, Nortlfitriarol t nee N0') 27806
City or Town Stale Zip Code
. DATE DRILLED 10-24-88 USE OF WELL Monitoring
. TOTAL DEPTH 47.71 CUTTINGS COLLECTED ❑ Yes • No
• DOES WELL REPLACE EXISTING WELL? 0 Yes t No
. STATIC WATER LEVEL: 14.58* FT. 0 above TOP OF CASING.
TOP OF CASING 15 1) ■ VEow
F7 ABOVE LAND SURFACE.
. YIELD (gpm): X METHOD OF TEST X
. WATER ZONES (depth)* X
- CHLORINATION: Type None Amount
). CASING:
x
Well Thickness
Depth Diameter or Weight/Ft. Material
From 0.0 T.44.7 Ft 2n Sch 40 PVC
From To Ft.
From To Ft.
1. GROUT:
From 0.0
Rom
2. SCREEN:
II additional space is needed use back of term,
LOCATION SKET,pH
(Show direction and distance tram at least two State Roads,
der other map reference Points)
SEE ATTACHED MONITOR WELL LOCATION PLAN
Depth Material Method
To 41.8 Ft. Neat Cement Tremmie *Static water level on 12-07-88
To Ft. '*Monitor well in leak resistant steel
manhole
Depth Diameter Slot Size Matenal
From 44,7 To 46.7 FL 2 im 0.01 in. PVC
Fram ro Ft n in. NOTE: Total depth of well, and the casing,
From, To Ft, in, grout, screen, gravel pack and bentonite
seal depths are referenced from the top of
).GRAVEL PACK: the PVC well casing in the steel manhole.
Depth Size Material
From 43.5 To 47.7 Ft. 8/16 Silica Sand
From To Ft -
I. REMARKS. Bentonite seal from 42.1 to 43.5 feet
TDO HEREBY CERTIFY TAT THIS WELL WAS COryyTgUCTED IN A COR NCE WITH 15 NCAC 2C. WELL C0NsTRUCTiON
STANDARDS AND THAT A COPY OF TH15 RECOj E� F PROVi . TOT WELL OWNER
iW-1 Revised 11/81
• 12-27-88
SIGNATURE OF CONTRACTOR OR AGENT DATE
Submit ori°inaf to Division of Envlmnm•n,.r ...- ,....•...•... .., ....,,-.,.•.r

GENT, BY: ;
407 859 8121;
MAR- r'' t,I 4:O6PM;
PAGE 16/19
F r=m
From
1. GROUT:
NORTH CAROLINA OEEPANTMENT OF ENVIRONMENT• HEALTH ANO NATURAL RESOURCES
DIVISION OF ENVIRONMENTAL MANAGEMENT • GROUNDWATER SECTION
P.O. BOX U6a7- RALEIGH. NC 276114667
PHONE (919)733•3I2f
WELL CONSTRUCTION RECORD
PIEZOMETER CPZ-1
DRILLING CONTRACTOR Ardaman & Associates, Inc.
DRILLER REGISTRATION NUMBER 1019
FOR OFFICE USE ONLY
Cued. NO. Sariel No.
Lat. Lang. Pc
Minor Basin
Basin Code
Header Ent
GW-1 Ent.
STATE WELL CONSTRUCTION
PERMIT NUMBER: 06-0071-WM-0237
i. WELL LOCATION: (Show sketch of the locadon below]
Nearest Town: Aurora
Texasqulf Phosphate Operations
(Road. Community, or Subdivision and Lot No.)
2. OWNER Texasqulf Inc.
ADDRESS P.O. Box 48
(Street Route N
Aurora, North Carolina 27806
county: Beaufort
Depth
DRILLING LOG
From To Formation Description
SEE LOG FOR NEARBY BORING TF-102
Clay or Town state Zio Code
3. DATE GRILLED 06/29/91 USE OF WELL Monitor*
4. TOTAL DEPTH 45.0 CUTTINGS COLLECTED ❑ Yes al No
5. DOES WELL REPLACE EXISTING WELL? 0 Yes Iaa NO
5. STATIC WATER LEVEL: 9.95 FT. 0 above !CP OF CASING.
below
TOP OF CASING IS -0.32 FT. A OVE LAND SURFACE**
7. YIELD (gpm)- - METHOD OF TEST -
8. WATER ZONES (depth): -
9. CHLORINATION: Type
10. CASING:
None
Amount -
wait Thickness
Depth Diameter or weipnVFt. Material
From 0.32 -0 34.0 ,Ft 2" Sch 40 PVC
-0 Ft
-0 Ft.
Depth Matenal MOIOd
From 0.5 To 28.0 Ft. Neat Cement Tremmle
From To Ft
12. SCREEN:
From 34.0
From
From
13. GRAVEL PACK:
From
II additional soace is needed Use back of form,
LOCATION SKETCH
(Show direction ano distance from al least two State Rocas.
or other map reference coitus)
SEE ATTACHED WELL LOCATION PLAN
*Piezometers are used to monitor water
level only.
**Piezometers are installed in flush mount
well covers
Deem Diameter Slot Site Material
To 43.0 Ft 2 4n,0.020in. PVC PIEZOMETER LOCATION: N 86+64.91
E 126+49.92
To Ft. in. in.
Pt :n in.
Deptm Size Material
32.0 TO 45.0 Ft, 8/20 , Silica Sand
TOP OF CASING EL. 10.51 ft (MSL)
From To FI
14 RE)MARKS.Bentonite seal from 28.0' to 32.0'; 1 stainless steel centralizer on well screen.
DO HEREBY CERTIFY THAT THIS WELL WAS C N RUCTED IN A COP NCE WITH 15 NCAC 2C. WELL CONSTRUCTION
STANDARDS. AND THAT A COPY OF THIS RECCRQ BEEN PROVI TO TE WELL OWNER.
08/05/91
SIGNATURE OF CONTRACTOR t)R AGENi DATE
n..��..-•.-.�-1 .- rli.....w.. w/ .. sash a -w en wall nwrler.

.BENT; BY: ;
407 850 8121;
MAR "'1 4:06PM; PAGE 17/10
2. OWNER
ADDRESS
NOnTH CAPOLWA DEPARTMENT OF ENVIRONMENT. HEWN ANO NATURAL RESOURCES
otv15ION OF ENVIRONMENTAL MANAGEMENT -GROUNDWATER SECTION
P.O. BOX 279E7 • RALEIGl+. NC 27e11•Ts8T
PHONE [phone]Zr
WELL CONSTRUCTION RECORD
PIEZOMETER CP2-2
DRILLING CONTRACTOR Ardaman & Associates. Inc.
DRILLER REGISTRATION NUMBER 1019
Serial No.
Lora.
1 Cued. No.
Lat.
Minor Basin
Basin Code
Header Ent.
FOR OFFICE USE ONLY
Pc
GW-1 Ent.
STATE WELL CONSTRUCTION PERMIT NUMBER: 06-0071-WM-0237
t_ WELL LOCATION: (Show sketch of the Iocalon below)
Nearest Town. Aurora
Texasaulf Phosphate Operations
(Road. Community. or Subdivision and Lot No.)
Texasqulf Inc.
P.O. Box 48
Aurora, Nort¢aarOiin2N8 6
3. DATE DRILLED
4. TOTAL DEPTH
City or Town State Zip Coda
66/30/91 USE OF WELL Monitor*
40.0 CUTTINGS COLLECTED D Yes aa No
5. DOES WELL REPLACE EXISTING WELL? 0 Yes alti NO
a. STATIC WATER LEVEL: 9.90 e•T, rJ above TOP OF CASING.
TOP Or CASING IS -0.23 FT AGOVE beloLwAND SURFACE*
7. YIELD (gem):
METHOD OF TEST
8. WATER ZONES (depth):
9. CHLORINATION: Type None Amount -
tG. CASING: watt Thickness
Depth Diameter or Weight/Ft. Material
From 0.23 To 30.0 Ft 2" Sch 40 PVC
From 7o Ft
From -o Ft.
11. GROUT:
Depth Matenat Magma
From 0.5 To 24,0 Ft. Neat Cement Tremmie
From To Ft
12. SCREEN:
Depth Diameter SIOt Sin Material
From 30.0 To 39.0 Ft. 2 ;n. 0.020 in. PVC
From To FL in. in.
From To FL 'n trt.
13. GRAVEL PACK:
From
From
14. REMARKS.
County: Beaufort
Depth
From To
DRILLING LOG
Formation Description
SEE LOG FOR NEARBY BORING TF-2
I1 additional space i3 fleeciest use buck of form,
LOCATION SKETCH
(Show oirection and distance from at least two State Roaos,
or other map reference points)
SEE ATTACHED WELL LOCATION PLAN
*Piezometers are used to monitor water
level only.
**Piezometers are installed in flush mount
well covers
PIEZOMETER LOCATION: N 88+26.79
E 128+97.44
TOP OF CASING EL. 10.25' (MSL)
Depth Sin Material
26.5 To 40.0 Ft, 8/20 Silica Sand
To Ft
Bentonite seal from 24.0' to 26.5'; 1 stainless steel centralizer on well screen.
I D0 HEREBY CERTIFY THAT THIS WELL WAS C. .TRUCTED IN COR ANCE WITH 15 NCAC 20. WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS REC^A BEEN PRO TO WELL OWNER. 0$/05/91
ra
SIGNATURE OF CONTRACTOR OR A OATE
...-. _..A ..r.......wall nwn r.

SEN , BY: ;
407 859 8121;
MAR Ir—t,1 4:07PM; PAGE 18/19
NORTH CAROLINA DEPARTMENT OF ENVIRONMENT, }IEALTN AND NAWEAL RESOURCES
amSmM OF ENVIRONMENTAL MANAGEMENT•GR0UNOWATER SECTION
P.O. BOX VS87 • RALEIGH, NC 7.7611.76a7
PHONE [phone]
WELL CONSTRUCTION RECORD
PIEZOMETER CPZ-3
DRILLING CONTRACTOR Ardaman & Associates, Inc.
DRILLER REGISTRATION NUMBER 1019
Cued No.
Lat.
Minor Basin
Basin Code
Header Ent.
FOR OFFICE USE ONLY
Serial No.
Long. Pc
GW-1 Ent.
STATE WELL CONSTRUCTION PERMIT NUMBER: 06-0071-WM-0237
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town* Aurora ' county: Beaufort
Texasgplf Phosphate Operations
(Road, Community, or Subdivision and Lot Na.)
Depth DRILLING LOG
From To Formation Description
2. OWNER Texasoulf Inc.
P.O. Box 48 SEE LOG FOR NEARBY BORING TF-103
ADDRESS
Aurora, Nortcro'R06
City or Town State Zip Code
3. DATE DRILLED 08/22/91 USE OF W'LL Monitor*
4. TOTAL DEPTH 41.0 CUTTINGS COLLECTED LJ Yes ix No
5. DOES WELL REPLACE EXISTING WELL? 0 Yes al No
8. STATIC WATER LEVEL: 11.49 FT. 0 above T OP OF CASINO.
El below
TOP OF CASING 15 -0.26 FT ABOVE LAND SURFACE**
7. YIELD (Qom): -
METHOD OF TEST
8. WATER ZONES (Depth) -
9. CHLORINATION: Type None Amount -
10. CASINO:
Wall Thickness
Depth Diameter or Wetgnt/Ft, Material
From 0.26 To 31.0 Ft 2" Sch 40 PVC
From 'o Ft
From '•o Ft
11. GROUT:
Depth Material Method
Fram 0.5 To 27.5 Ft. Neat Cement Tremmie
Fram
12. SCREEN'
To Ft.
Depth Diameter Slot Size Material
Fram 31.0 To 40.0 Fi. 2 in. O'.020In, PVC
From To FI. in. in. ___
From To Ft 'n in.
13. GRAVEL PACK:
II additional space is needed Use back of form.
LOCATION SKETCH
;Show direction ana distance from at least two State Roads.
Or other map reference oointe)
SEE ATTACHED WELL LOCATION PLAN
*Piezometers are used to monitor water
level only.
**Piezometers are installed in flush mount
well covers
Depth Size Material
From 30.0 TQ 41.0 Ft. 800 Silica Sand
From To Ft._
14. REMARKS: Bentonite seal from 27.5' to 30.0'; 1 st�a_i,UCTED IN�n'less steel centralizer on well screen.
I DO HEREBY STANDARDS. ANDRTH TTIFY TA COPY OF THIS RECOR C.
RF BEENwPRt/v�yED TO CCO ANCE WELL OWNER.CAC 2C. WELOL$C/23 9RUCTON
hlr
SIGNATURE OF CONTRACTOR OR LFENT DATE
............. stall tutorial'.

•SENT4 BY:
407 959 8121;
MAR-: 1 4:07PM; PAGE 19/19
MOTH Cana n®AmatOP MAIM& REIOUNOIM ANDCOMaMIY pa%esOFl W
DNa11OiOF ENVPROMMITM M1N.teeee17-ORaOAAVAT tr aacleptt
PA ep* etea- RMOIMC 27e11. PIOL-btni t31-1K01
WELL. CONSTRUCTION RECORD
CELLNO. CPW
MILLING CONTRACTOR Ardaman & Associates. Inc.
)HILLER REGISTRATION NUMBER 1019
FOR OFFICE USE ONLY
Coed N0. Serial Na
LaL Loop. Pc
Minor Saris
Benin Coda
tloed.r tad QW-1 Ent.
STATE WELL CONSTRUCTION
PERMIT NUMBER: 06-0071-WG-0194
WELL LOCATION: (Show sketch of the location balow)
Near.et To.m• Aurora. North Carolina
(Road. Community. or Subdtyiston and Lot No.]
OWNER Texasoulf Inc.
ADDRESS P.O. Box 48
t ix Aurora, Northt6treeCarolina27806
DATE DRILLED
City or Town State zip Cade
Test Well
05-24-90 USE OF WELL
TOTAL DEPTH 55.0' CUTTINGS COLLECTED ❑ Yen M No
DOES WELL REPLACE EXISTING WELL? ❑ Yea III No
STATIC WATER LEVEL: 13.21 FT. it baTOP OF CASING.
TOP OF CASING IS 3.46 FT ABOVEbort LAND SURFACE.
YIELD (gpmk X METHOD OF TEST
WATER ZONES (deot* X
X
CHLORINATION: Type None Amount
. CASING:
From
Fran
From
. GROUT:
From
From
. SCREEN:
Depth Diameter
0.0 To 36.95 Ft. 2e
51.95 To 53.95F1 2"
To Ft
Wall Thickness
or Weight/Ft. Malone,
Sch 40 PVC
Sch 40 PVC*
Depth Material
0.0 To 34.24 Ft. Neat Cement
To Ft
Method
Tremmie
Depth Diameter SW Size Material
From 36.95 to 51.95 Ft. 2 its 0.02 in. PVC
Frain To Ft. In. In.
From To FL M. h
GRAVEL PACK:
Depth
Size Material
Count. Beaufort
Depth DRILLING LOG
Fran To Formation Deeatption
SEE ATTACHED BORING LOG
If additional apace is needed use bads of form.
LOCATION SKETCH
(Show dir.cdon and distance (ram at Meet two State Roads.
or other map reference points)
SEE ATTACHED MONITOR WELL LOCATION PLAN
*2'-long sump below screen section
From 36.5 To 55.0Ft 4/20 Silica Sand
From To Ft.
REMARKS Sand from 34.24' to 35.54' and bentonite seal
centralizer on well screen.
t DO HEREBY CERTIFY THAT THIS WELL WAS CONS TED IN
STANDARDS. AU4 THAT A COPY OF THIS
from 35.54' to 36.5'; 1 stainless steel
Of1DANCE WITH 16 NCAC 2C. WELL CONSTRUCTION
NIL OWNER.
7/16/90
SIGNATUREOF CONIRAOTOR OR A JT DATE

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL FOR INJECTION
(NON -HEAT PUMP SYSTEM)
This is not the proper form for injection wells to be used in a closed -loop groundwater remediation
system. Wells of this type require a separate
Groundwater Remediation Permit Application.
Class 5 Wells
TO: DIRECTOR, NORTH CAROLINA DIVISION OF ENVIRONMENTAL MANAGEMENT
DATE: `578 - , 19 Re"
In accordance with the provisions of Article 7, Chapter 87; Article 21, Chapter 143; and regulations pursuant
thereto, APPLICATION is hereby made for a PERMIT to 'construct and/or use an injection well or well system
as described below and in any accompanying data submitted as part of this APPLICATION.
Please type or print clearly.
A. PERMIT APPLICANT
Name: Pes PAospAeole Company, rnc.
Address: y.0. Box 448 nto w/ty 306 AinAny
City: if / eat/ / NC Zip code: a 1806
County: BEauFo27-
Telephone: (9/q) 3 za - 4r///
B. STATUS OF APPLICANT
Federal State Private X
Public Commercial Other
Native American Lands
C. PROPERTY OWNER (if different from applicant)
Name: Sane as 19 A.
Address:
City:
County:
Telephone:
D. FACILITY (SITE) DATA
Name of Business or Facility PC S Pliospha- Ieornpetn %e.
Address: P.0. Pox rfB N9Aua y 306 °.-4L
City: Anna- Zip code: a7B06
County: ,etarrf'ort
Telephone: (q/q) 32Z — ti///
Contact Person: Lion attab onsERv'-
E. INJECTION PROCEDURE (Briefly describe how the injection well(s) will be used.)
1/sed'fo svirbi, reslt wafer ,.t +It grovnJ for9rovadwa+er re...edlnflon. Waite -from ike frcr'/1:y3
Veoressue..af! /,Je/I wafer system is 'Sa 'l+er'I'Iten d's...fec.j-eeQ
we* Okay/clef ike wo.ter ike... -Plows fn+o a wafer level eon+rol tank- ,'ad yravri^1 feeds
4krov5tn a kea4tr pipe +Inaf' suypl4 s eat.h well• There art seven (9) Injec.hon wefts,
F. WELL USE Will the injection well(s) also be used as the supply well(s) for either of the following:
Zip code:
(a)
(b)
The injection operation? YES
Your personal consumption? YES
NO X
NO X
GW-57N (October 1994) Page 1 of 4

G. CONSTRUCTION DATA (check one)
EXISTING WELL being proposed for use as an injection well. Provide the data }
in (1) through (7) below to the best of your lmowledge. Attach a copy of 1
Porm GW-1 (Wei1 Construction Record) if available. (6W` �ormc s. o.deed)
PROPOSED WELL to be constructed for vse as an injection well. Provide the
data in (I) through (7) below as PROPOSED construction specifications. Submit
Form GW-1 after construction.
NOTE: THE WELL DRILLING CONTRACTOR CAN SUPPLY THE DATA FOR EITHER EXISTING OR
PROPOSED WELLS IF THIS INFORMATION IS UNAVAILABLE BY OTHER MEANS.
(1) Well Drilling Contractor's Name; See orf,: ra,l Appl 'ca kor jk {ed povernst, 1, 199 f ai a cd.
NC Driller Registration number:
(2) Date to be constructed: Approximate depth:
(3) Well'casing:
(a) Type: Galvanized steel Black steel Plastic Other(specify)
(b) Inside diameter: inches; Wall thickness inches or schedule r
(c) Casing depth: From to ft (reference to land surface)
(d) Casing extending above ground inches (must be at least 12 inches)
(4) Cement group
(a) Around inner or "primary' casing: From to ft. (must be from the land
surface to the point of injection)
(b) Around outer (pit) casing, if presenc From to ft.
Screens (if applicable):
(a) Type: Inner diameter. inches
(b) Depth: From 10 feet below land surface
(6) Gravel (if applicable): From to feet below land surface
(7) N.C. State Rezulations (Tide 15A NCAC 2C Section .0200) require the permittee to make
provisions for monitoring wellhead processes. A faucet on both influent (recovered groundwater)
and effluent (water being injected into the well) lines is generally required- Will there be a faucet
on:
(5)
(a) the influent line? yes_Xno_ (b) the effluent line? yes x no
H. PROPOSED OPERAT tNG DATA
(a) Injection rate: Average (daily) I q.3 gallons per minute (gm)
How will the rate be measured? Orffiu rhe+cr
(b) Injection volume: Average (daily)a 1.2 kgallons per day (gpd)
How will the volume be measured? L tli s<r -Prom orr41'cc ,.ne k r
(c) Injection pressure: Average (daily) NA pounds/square inch (psi) (6retvaii Feed)
How will the pressure be measured?
(d) Injection temperature: Annual Average AMaIEMaegrees F
How was this determined?
(e) Hydraulic capacity of well(S) (°-)
(f) Expected lifetime of injection facility a 0 vears
GW-57N (October 1994) Page 2 of 4

I. INJECTION FLUID DATA
(1) Fluid source. If underground, from what depth, formation and type of rock/sediment unit will the
fluid be drawn (e.g., granite, limestone, sand, etc.).
Depth: 0200 t+ Formation: CAsn.e• ijA4Q6 Rock/sediment unit binEsto.i6
(a) SOURCE WELL CONSTRUCTION INFORMATION (if different from injection well). •
Attach a copy of Form GW-1 (Well Construction R"cord) If Form GW-1 is not available,
provide the data in part G (1) through (7) of this application form to the best of your
knowledge.
(2) Chemical Analysis of Source Water. The following chemical characteristics MUST accompany this
application:
pH ; Total hardness - ppm (parts per million or mg/1); Iron ppm;
Chloride ppm; Nitrate ppm; Coliform bacteria counts/100 nil.
Substances added to injected fluid. Some substances may be added to (1) enhance in -situ treatment
of contaminated soil and/or groundwater and (2) improve well operation. Only substances that can
be demonstrated to have advantages that outweigh disadvantages will be considered.
Will any substances be added to the effluent? No If yes, provide a detailed description of
these substances, including quantity and schedule of substances to be added- Eoidemiologic data
should be submitted to aid evaluation. Provide copies of published reports or pilot studies that
justify the type, quantity and schedule of additivies proposed.
(3)
J. INJECTION -RELATED EQUIPMENT
Attach a diagram showing the engineering layout of the (1) injection equipment, and (2) exterior
piping/tubing associated with the injection operation. Describe the method for determining mechanciai
integrity of the injection well over a five (5) year period.
K. TOPOGRAPHIC MAP
Attach a scaled topographic map which extends one mile beyond the property boundaries of the facility
and indicates the location of the facility.
L. HYDROGEOLOGIC MAPS AND CROSS SECTIONS
Attach scaled maps and cross sections indicating the vertical and lateral limits of all underground
sources of drinking water within 3,000 ft. Include their position relative to the injection formation,
and the direction to water which may be affected by the proposed injection.
M. LOCATION OF WELL(S)
Attach a detailed, scaled map of the site of the facility, showing the location of and distances between the
proposed wells(s) (source wells and injection wells) and any waste (including hazardous waste) treatment,
storage or disposal facilities; buildings; property boundaries; surface water bodies; and any other potential
source of groundwater contamination. Additionally, indicate on the map the direction and distance to
existing wells (injectidn wells, water supply wells, dry wells, abandoned wells) located within 1,500 feet of
the proposed injection well(s). Include with the map a description of each existing well, incorporating type,
construction information, date drilled, and depth. Indicate on the map at least two nearby reference points
such as roads, road intersections, streams, etc., and identify them by US, NC or SR (county secondary
roads) numbers or name. Label all features clearly. Include a north arrow on the map to indicate orientation.
GW-57N (October 1994) Page 3 of 4

.
N. HYDRAULIC CONTROL
Attach calculations/models which demonstrate the expected changes in pressure, foutnation fluid
displacement and direction of movement of the injected fluid. Describe any plans tco monitor fluid
movement. It contaminants are present, the operation of an injection well must notresult in the migration
of a contaminant off property boundaries.
O. CONTINGENCY PLANS
Attach a brief plan to address emergency control methods that will be utilized in case of an injection well
failure or loss of power so as to prevent the discharge of fluids outside the injectioazone area.
P. CERTIFICATION
"I hereby certify, under penalty of law, that I have personally examined and am familiar with the
information submitted in this document and all attachments thereto and that, bawl -Lion my inquiry of those
individuals immediately responsible for obtaining said informational believe that tte information is true,
accurate and complete. I am aware that there are significant penalties, including the possibility of fines and
imprisonment, for submitting false information. I agree to construct, operate, maintain, repair, and I agree
to, if applicable, abandon the injection well and all related appurtenances in acco -•r ce with the approved
pt,el
specifications and conditions of the Permit"
(Signature of Applican t Authorized Agent)
PLEASE SUPPLY ALEII at.SIGNED BY THE OWNER
AUTHORIZING THE ABOVE AGENT, IFAUTHORILED AGENT IS SIGNER.
Q. CONSENT OF PROPERTY OWNER (Owner means any person who holds the fete or other property rights
in the well being constructed. A well is real property and its construction on land mats ownership in the
land owner in the absence of contrary agreement in writing).
If the property is owned by someone other than the applicant, the property owner hereby consents to allow
the applicant CO construct each injection well as outlined in this applicanon•and that it shall be the
responsibility of the applicant to ensure that each injection well conforms to the Viwell Construction
Standards (Title 15A NCAC 2C .0200)
Name of Property Owner (Print):
Mailing Address:
(Signature of Property Owner if Different From Applicant)
Please return the completed application package to:
UIC Program
DEM/Groundwater Section
P.O. Box 29535
Raleigh, NC 27626-0535
(telephone: [phone])
GW-57N (October 1994) Page 4 of 4