MO-9324_40784_CA_CAP_20220117

100 East Ruffin Street, Mebane, North Carolina 27302
Telephone [phone] ·Facsimile [phone]
www.terraquestpc.com

CORRECTIVE ACTION PLAN
FEASIBILITY STUDY

PERTH MINI MART
818 PERTH ROAD
TROUTMAN, IREDELL COUNTY, NORTH CAROLINA

Latitude: 35.684542° N Longitude: -80.895851° W

Release Information:
Date Release Discovered: November 30, 2017 (Lab Confirmed)
Estimated Release Quantity: Unknown
Release Cause/Source: Gasoline Underground Storage Tank System
Previous USTs (release source): 2, 6,000-gallon gas, 1, 4,000-gallon gas, 1, 2,000-gallon non-
ethanol gas (formerly held diesel)
Current (not leaking) USTs: 2, 12,000-gallon gas (compartmentalized)
Current (not leaking) AST: 1,2,000-gallon diesel
NCDEQ-DWM UST Release Incident Number: 40784
Risk Ranking Classification: High
Land-Use Classification: Residential

Facility ID: 00-0-0000024524

Property Owner & UST Owner/Operator:

Madhukunj, LLC
135 Corona Circle
Mooresville, NC 28117

Terraquest Project No. 08217

January 17, 2022

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 i Troutman, Iredell County, NC
EXECUTIVE SUMMARY

Terraquest Environmental Consultants, P.C. has completed a CAP Feasibility Study for the release
incident at the Perth Mini Mart property located in Troutman, Iredell County, North Carolina. This
work is related to a release from a previous gasoline UST system. The NCDWM-UST requested the
work that included pilot testing, calculations, and considerations of active and passive remedial
methods.

In consideration of the contamination present and treatment methods investigated, Terraquest
recommends SVE and air sparging as active treatment methods for the Perth Mini Mart release
incident. Both methods proved practical during pilot testing. Terraquest roughly estimates that 3-
4 years of operating an SVE and air sparge remediation system followed by a year of monitored
natural attenuation could allow closure of this site in 2028 at a cost of $525,000. If the NCDWM-
UST agrees, the next step is to generate a CAP Corrective Action Design Report.

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 ii Troutman, Iredell County, NC
TABLE OF CONTENTS

EXECUTIVE SUMMARY ..................................................................................................................... i
1.0 INTRODUCTION ................................................................................................................... 1
2.0 UPDATE OF SITE HISTORY AND SOURCE CHARACTERIZATION ........................................... 1
2.1 UST Owner ...................................................................................................................... 1
2.2 Tank and Release Information ........................................................................................ 1
2.3 Receptor Information ..................................................................................................... 4
2.4 Regional Geology and Hydrogeology .............................................................................. 5
2.5 Site Geology and Hydrogeology ...................................................................................... 7
3.0 UPDDATE OF SITE ASSESSMENT INFORMATION .............................................................. 13
3.1 Soil Assessment ............................................................................................................. 13
3.2 Groundwater Assessment ............................................................................................. 14
3.1.1 Monitoring Well Network ......................................................................................... 14
3.1.2 Groundwater Sampling ............................................................................................. 14
3.3 Free Product Assessment and Recovery ....................................................................... 16
3.3.1 Discovery ................................................................................................................... 16
3.3.2 Free product pictures ................................................................................................ 16
3.3.3 Historic product presence ......................................................................................... 18
3.3.4 Recovery events ........................................................................................................ 18
3.3.5 Free product delineation .......................................................................................... 18
3.3.6 Product locations and water table fluctuations ....................................................... 20
3.3.7 Free product evaluation............................................................................................ 21
4.0 OBJECTIVES FOR CORRECTIVE ACTION AT THE SITE ......................................................... 22
5.0 COMPREHENSIVE EVALUATION OF REMEDIAL ACTIONS ................................................. 22
5.1 Considered Remedial Methods .................................................................................... 22
5.2 Pilot Testing................................................................................................................... 24
5.2.1 SVE Pilot Test ............................................................................................................ 25
5.2.2 Air Sparge Pilot Test .................................................................................................. 31
5.3 Chosen Remedial Methods ........................................................................................... 36
5.4 Contaminant Mass Removal Estimates ........................................................................ 36
5.5 Remedial System Operation and Maintenance Plan .................................................... 41
5.6 Monitoring Plan ............................................................................................................ 42
5.7 Remedial Schedule ........................................................................................................ 43
5.8 Rough Cost Estimate ..................................................................................................... 44
6.0 CONCLUSIONS / RECOMMENDATIONS ............................................................................ 45
7.0 LIMITATIONS ..................................................................................................................... 45
CERTIFICATION .............................................................................................................................. 46
REFERENCES .................................................................................................................................. 47

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 iii Troutman, Iredell County, NC
TABLE OF CONTENTS (continued)

TABLES

1. Site History (UST/AST System Information)
2. Surrounding Property Owner Information
3. Water Supply Well Information
4. Monitoring Well Construction Information
5. Corrective Action Costs

FIGURES

1. Site Location Map
2. Site Vicinity Map
3. Site Layout Map
4. Potentiometric Surface Map (11/23/21)
5. Proposed SVE Layout
6. Proposed Air Sparge Layout

APPENDICES

A. Technical Methods/Standard Procedures
B. Chronological Site History
C. Historical Groundwater Elevation Data
D. Well Construction Records
E. SVE Pilot Test Report
F. Air Sparge Pilot Test Report
ENVIRONMENTAL ACRONYMS

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 iv Troutman, Iredell County, NC
2L Standard Groundwater Standards Title 15A NCAC 2L
0.0202(g)
2B Standard Surface Water Standards Title 15A NCAC 2B
AFVR Aggressive Fluid-Vapor Recovery
AST Aboveground Storage Tank
BGL Below Ground Level
BTEX Benzene, toluene, ethylbenzene, xylenes
C&D Construction and Demolition
CAP Corrective Action Plan
CAPR Corrective Action Performance Report
CADR Corrective Action Design Report
CSA Comprehensive Site Assessment
DPE Dual-phase Extraction
EPA Environmental Protection Agency
ePATA Electronic Pre-Approval Task Authorization
EPH Extractable Petroleum Hydrocarbons
ESA Environmental Site Assessment
GCL Gross Contamination Level
LEL Lower Explosive Limit
LSA Limited Site Assessment
IPE di-Isopropyl Ether
ISCO In-situ Chemical Oxidation
MADEP Massachusetts Department of Environmental
Protection
MDL Method Detection Limit
MNA Monitored Natural Attenuation
MMPE Mobile Multi Phase Extraction
MSCC Maximum Soil Contaminant
Concentration
MSL Mean Sea Level
MSW Municipal Solid Waste
MTBE Methyl tertiary-Butyl Ether
NC North Carolina
NCAC NC Administrative Code
NCDENR NC Department of Environment and Natural
Resources
NCDEQ NC Department of Environmental
Quality
NCDOT NC Department of Transportation
NCDWM-SW NC Division of Waste Management’s Solid
Waste Section
NCDWM-UST NC Division of Waste Management’s UST
Section
NCDWQ NC Division of Water Quality
NFA No Further Action
NORR Notice of Regulatory Requirements
NORP Notice of Residual Petroleum
NOV Notice of Violation
NPDES National Pollutant Discharge
Elimination System
OVM Organic Vapor Meter
PID Photoionization Detector
PLC Programmable Logic Controller
POE Point of Entry (water treatment system)
POTW Publicly Owned Treatment Works
RBCA Risk Based Corrective Action
RDL Reporting Detection Limit
RP Responsible Party
SCFM Standard Cubic Feet per Minute
SVE Soil Vapor Extraction
STF Leaking UST State Trust Fund
STG Soil to Groundwater
TA Task Authorization
TCC Target Cleanup Concentrations
Terraquest Terraquest Environmental Consultants,
P.C.
TPH Total Petroleum Hydrocarbon
UST Underground Storage Tank
VADEQ Virginia Department of Environmental Quality
VOA Volatile Organic Analysis
VOC Volatile Organic Compound
VPH Volatile Petroleum Hydrocarbons
XP Explosion Proof

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 1 Troutman, Iredell County, NC
1.0 INTRODUCTION

On behalf of Madhukunj, LLC, Terraquest Environmental Consultants, P.C. is reporting results of
a Corrective Action Feasibility Study for the release incident at the Perth Mini Mart facility located
at 818 Perth Road, Troutman, Iredell County, NC. This work was requested by the NCDWM-UST
and costs were pre-approved on ePATA 40784-014.

The site location and surrounding cultural features are depicted in Figure 1. The site vicinity is
depicted in Figure 2. The site layout and monitoring well network are depicted in Figure 3.
Technical methods and standard procedure generally used by Terraquest personnel are outlined
in Appendix A and a chronological history of site events is provided in Appendix B.

2.0 UPDATE OF SITE HISTORY AND SOURCE CHARACTERIZATION

2.1 UST Owner:
The USTs are owned by Madhukunj, LLC.

2.2 Tank and Release Information:
According to the NC UST Database Records, two 6,000-gallon gasoline, one 4,000-gallon gasoline,
and one 2,000-gallon diesel USTs were installed at the site on March 4, 1980. Note that the
2,000-gallon diesel UST was converted to non-ethanol gasoline in 2018. A 2,000-gallon diesel
AST is also present onsite. The installation date of that tank is unknown. All USTs were closed
via excavation and removal in February 2019 as previously reported. Following closure, two new
12,000-gallon, gasoline, compartmentalized USTs were installed. A site history of the USTs and
AST on the property is included as Table 1. Previous tank locations are shown on Figure 3.

In 2017, the UST owner noted inventory record discrepancies based upon ATG reading for UST
T3, the 4,000-gallon gasoline tank. In response, the UST owner submitted an UST-17A UST
Suspected Release 24-Hour Notice Form. The date and nature of the release is unknown but

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 2 Troutman, Iredell County, NC
inventory records show a shortage of approximately 300-400 gallons. Based on the lab results
of soil samples from beneath the other two gas USTs in the T3 basin, a release occurred from
those tanks also.

Terraquest is not aware of any AST release incidents.

The site and several properties in the area are commercial in nature with the remaining majority
used as residential as shown here:
SITE

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 3 Troutman, Iredell County, NC
The closest residence is located approximately 330 feet north of the release area. There are no
places of public assembly within 1,500 feet. Land use in the vicinity of the site is highway business
and residential. The site and properties to the east are zoned Highway Business (HB). Most of
the remaining properties are zoned Residential (RS). Zoning classifications of the site and
surrounding properties are depicted on Figure 2 and below as taken from Iredell County’s GIS
online system at https://iredell.connectgis.com.

Environmental assessment activities were previously detailed in a Site Check Report, LSA Report,
and CSA Report sent to the NCDWM-UST.

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 4 Troutman, Iredell County, NC
2.3 Receptor Information

As part of the LSA and to determine the risk classification of the site, Terraquest personnel
previously performed a reconnaissance of properties within a 1,500-foot radius of the source
area. The reconnaissance effort consisted of obtaining tax department and local zoning
information on properties and conducting door-to-door visits of certain properties within 1,500
feet of the source area, in addition to collecting other pertinent information from the appropriate
local and state officials.

Terraquest personnel inspected all properties within 1,500 feet of the site and attempted to
contact all the property owners within 1,000 feet in person. Property owners within a 500 -foot
radius were questioned, if available, as to the source of their water and if any water supply wells
were located on their property. If owners/occupants were not home, a survey form was left at
their residence or forwarded to the property owners through the mail. In all cases, Terraquest
also conducted a visual survey of the property. Table 2 lists the names and addresses of
surrounding property owners. Note that the PIN Numbers presented in Table 2 correspond with
those shown in Figure 2.

Terraquest contacted the Town of Troutman’s Public Works Department to inquire about the
Town’s water supply system. Terraquest was put into contact with West Consultants, PLLC, who
maintains and operates the municipal supply system. Todd Poteet of West Consultants, PLLC,
verified water lines are available along Perth Rd. and Autumn Leaf Rd.; however, not along
Weddington Ln. Furthermore, since the subject area is not located within the jurisdictional
boundary of the Town of Troutman, property owners are not required to connect to the
municipal water supply system. Most are not interested in doing so as they would be annexed
into Troutman and its associated taxes.

Through the reconnaissance efforts, a total of thirty-three water supply wells were identified
within 1,500 feet or the source area. Of those identified wells, nineteen are sole source water

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 5 Troutman, Iredell County, NC
supply wells located within 1,000 feet. One additional active water supply well is located on the
site within 250 feet of the source area. That well is used to fill minnow tanks at the store. Water
supply well information is listed in Table 3. Supply well locations are depicted on Figure 2.

As part of the reconnaissance effort, Terraquest also searched for any surface water bodies
within a 500-foot radius of the site. An unnamed tributary of Big Branch originates off the
western property boundary of the site and is located within 500 feet of the source area. The NC
Division of Water Quality (DWQ) classifies Big Branch as a Water Supply-IV “Waters used as
sources of water supply for drinking, culinary, or food processing purposes.” The unnamed
tributary of Big Branch is depicted on Figure 2.

2.4 Regional Geology and Hydrogeology

The site is in the Piedmont Physiographic Region of North Carolina. According to the Geologic
Map of North Carolina (Brown, et al, 1985), the site is in the Charlotte Belt and is underlain by
mafic metavolcanic bedrock lithologies. On a regional scale, the Piedmont is characterized by
land with moderate relief and some areas of low relief hills and valleys.

Groundwater in the region is part of the Catawba River Basin. Regionally, groundwater flows to
the southwest and feeds into Big Branch Creek and ultimately Lake Norman. Big Branch Creek is
listed as a Water Supply IV surface water body at https://deq.nc.gov/about/divisions/water-
resources/planning/classification-standards/classifications#DWRPrimaryClassification which
classifies surface water bodies with a WSIV classification as “sources of water supply for drinking,
culinary, or food processing.”

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 6 Troutman, Iredell County, NC
The site’s location in reference to nearby water bodies as provided by the NCDEQ at
https://ncdenr.maps.arcgis.com/apps/webappviewer/index.html?id=6e125ad7628f494694e25
9c80dd64265 follows:

SITE
SITE

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 7 Troutman, Iredell County, NC
2.5 Site Geology and Hydrogeology

ENCOUNTERED LITHOLOGY
The following lithologies were encountered at the site during the installation of soil borings and
the monitoring well network:

0 – 63’ BGL SILT (CL)
Mostly soft to medium-stiff (generally increasing consolidation with depth),
micaceous, red to brown to tan, with trace clay and characteristics of saprolite in
areas.

63-70’ BGL SAPROLITE
Mostly tan/brown heavily-weathered rock.

The drilling locations of the monitoring wells used to describe the lithology are depicted on Figure
3. Geologic cross sections of the site are based upon the soil boring logs are as follows:

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 8 Troutman, Iredell County, NC

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 9 Troutman, Iredell County, NC

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 10 Troutman, Iredell County, NC
Depth-to-water measurements have been collected from the monitoring wells during various
stages of the assessment to estimate the direction of groundwater flow. Groundwater elevation
measurements were reduced to a common datum by surveying the relative elevation of the top
of the casing for each monitoring well. The water table elevation data as measured on November
23, 2021 was used to create a potentiometric surface map which illustrates the interpreted
direction and gradient of groundwater flow that is generally to the west, southwest. Recent
groundwater elevation data and monitoring well construction information is provided in Table 4.
Historical groundwater elevation data is provided in Appendix C.

The groundwater elevation measurements from April 30, 2019 reveal that the hydraulic head
within the shallow phreatic aquifer ranged from a relative value of 66.61 at monitoring well MW5
to 67.91 at MW4. In conjunction with other site measurements, the results indicate flow in the
phreatic aquifer in a south/southwest direction under an average hydraulic gradient of
approximately 0.02.

Water level data from the Type III monitoring well (MW11) and the interpreted groundwater
elevation in the phreatic aquifer in the vicinity of the Type III well (based on MW5) were used to
determine if a vertical head gradient existed in the phreatic aquifer. The vertical head gradient
was calculated using the following equation and groundwater elevation data collected on April
30, 2019: Vg =�ℎ𝑝𝑝ℎ𝑟𝑟𝑟𝑟𝑟𝑟𝑟𝑟𝑟𝑟𝑟𝑟−ℎ𝑀𝑀𝑀𝑀11�𝐷𝐷

where:

Vg = Vertical head gradient
Hphreatic = Water elevation in the shallow aquifer = 66.61’
HMW= Water elevation in deep well MW11 = 66.85’
D = The difference in elevation between the shallow water table and the
middle of the well screen in MW11 = (66.61 – 29.3) = 37.31’

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 11 Troutman, Iredell County, NC
Vertical head gradient:
𝑉𝑉𝑔𝑔=66.61 −66.8537.31

= -0.0064

The head gradient suggests a value very near zero indicating that it is transition zone between a
recharge and discharge area. This seems reasonable as the site is located near Lake Norman
where local groundwater and surface water are discharging to.

To provide preliminary estimates of hydraulic conductivity (K) and groundwater flow velocity (v)
for the phreatic aquifer, Terraquest personnel performed slug tests on monitoring wells MW3,
MW5, and MW7 on December 3, 2018 as part of the CSA.

The preliminary hydraulic conductivity estimates range from 0.176 to 0.427 feet per day. Using
an average hydraulic conductivity value of 0.336 feet/day, an average groundwater seepage
velocity was determined to be 16.35 feet per year. An effective porosity of 15 percent was
chosen based on published values of effective porosity for silt with the value skewed toward silty
sands based on a silt range of 3-19 percent and a silty sand range of fine to silty sand of 10-28
percent (Sanders, 1998). An average hydraulic gradient as measured on December 3, 2018 across
the site was used.

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 12 Troutman, Iredell County, NC
2.6 Local Topography
The local topography is characterized by gently rolling, well rounded hills and long low ridges with
a few hundred feet of elevation difference between the hills and valleys. The majority of the
surrounding 1,000 feet of the site is mapped at approximately 800-900 feet above sea level. Local
topography is depicted in Figure 1.

2.7 Land Cover/Surface Drainage
The release area is currently overlain by asphalt as shown below. The property slopes to the
west, southwest behind the store where there are grass/gravel areas that precipitation can
infiltrate the ground.

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 13 Troutman, Iredell County, NC
3.0 UPDDATE OF SITE ASSESSMENT INFORMATION
3.1 Soil Assessment

Through the 2017 Site Check, 2018 LSA, the 2019 UST closure, the 2019 over-excavation, and the
CSA, a total of fifty-seven samples were collected to delineate the extent of soil contamination.

The area of STG MSCC violation is generally centered on the UST basin with a smaller area around
the northern dispenser island. The volume of contamination is a sum of these two areas. With
an average depth to water of 31 feet in monitoring wells near the UST basin in April 2019, the
calculated tonnage at the site includes 1,220 tons near the basin and 15 tons at the northern
dispenser area. The area is shown here:

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 14 Troutman, Iredell County, NC
Note that Terraquest had discussions with the NCDWM-UST in 2019 prior to and during the UST
closure regarding further excavation of contaminated soil as it was exposed and readily available
to dig out. Ultimately, the Trust Fund did not authorize additional excavation. The RP chose to
dig out an additional 94.66 tons in the southwest direction from the UST basin as it extended
away in the direction where over six feet of product has been gauged. The limits of excavation
in the sloping direction of product flow were all still above the STG MSCCs including some
material that could have been excavated that was above the Residential MSCCs. Again,
Terraquest’s request to dig this material out was denied.

3.2 Groundwater Assessment

3.1.1 Monitoring Well Network

Throughout various phases of assessment, a total of seventeen monitoring wells have been
installed to delineate groundwater quality. Those wells include sixteen Type II wells and one
Type III telescoping deep well. The well locations are shown on Figure 3, their construction is
detailed on Table 4.

3.1.2 Groundwater Sampling

The latest groundwater monitoring event was conducted on September 23, 2020 when
Terraquest personnel sampled monitoring wells MW1, MW3-15, and MW17. Monitoring wells
MW2 and MW16 contained free product and were not sampled. Prior to sampling, Terraquest
field personnel purged at least three well volumes of water from each well using a new disposable
bailer that was then used to retrieve a representative sample. Upon collection, samples were
placed on ice pending transit to an NC-certified laboratory for analysis. All wells were sampled
for 6200B targeting VOCs found in the subject contaminant, gasoline. At the request of the Trust
Fund, all wells were also sampled for 625 targeting SVOCs.

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 15 Troutman, Iredell County, NC
The analytical results of the sampling events reveal an oval-shaped plume that begins at the
northern dispenser island UST basin and extends downgradient past monitoring wells MW12 and
MW13. The 2L Standard violation plume, applicable to this High Risk site, measures 180 feet long
by 100 feet across at the widest point and covers an area of 13,600 square feet. That is an
increase in size from the 2018/2019 CSA data where the 2L Standard violation plume covered
11,300 square feet. The increase is due to the appearance of 2L Standard violation in monitoring
wells MW10 and MW12 and the increase in contaminant concentration in monitoring well MW7.

Further details of the results follow:
Free product: MW2 (4.12’)
MW16 (0.05’)
>GCL: MW3, MW5, MW15, MW17
> 2L Standards: MW1, MW4, MW6, MW7, MW8, MW10-13
<2L Standards: MW9, MW14

MW15 and 17 have
since had free product
present

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 16 Troutman, Iredell County, NC
3.3 Free Product Assessment and Recovery

3.3.1 Discovery:
Prior to developing monitoring wells MW2 – MW4 on June 19, 2018, monitoring wells were
visually checked for the presence of free product with a bailer prior to their development. At
that time, free product was observed in monitoring well MW2. Product was subsequently
discovered in monitoring well MW16 on September 23, 2020, monitoring well MW17 on March
22, 2021, and in soil vapor extraction (SVE) well SVE3 on November 22, 2021.

3.3.2 Free product pictures

MW2 10/7/19:
MW2 7/24/19:

MW2 4/22/19:

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 17 Troutman, Iredell County, NC
Free product pictures continued:

MW16 9/23/20
DTW 29.15’
MW16 11/23/21
DTW 34.82’

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 18 Troutman, Iredell County, NC
3.3.3 Historic product presence:

MW2 7.05 feet in October 2018 prior to MMPE
5.63 feet two months after MMPE in December 2018
4.11 feet in April 2019 before MMPE and following a one-foot water table increase
0.05-foot thickness following the April 2019 MMPE
0.18 feet four days after April 2019 MMPE and rising
4.12-foot product thickness on September 23, 2020
3.08-foot product thickness on March 22, 2021 prior to MMPE
No product on April 21, 2021, a month after MMPE
4.2-foot thickness prior to air sparge pilot test on November 23, 2021
MW15 3-foot thickness prior to air sparge pilot test on November 23, 2021
MW16 0.05-foot product thickness on September 23, 2020
2.85-foot product thickness on March 22, 2021 prior to MMPE
1.49-foot product thickness on April 21, 2021, a month after MMPE
MW17 0.12-foot product thickness on March 22, 2021
0.05-foot product thickness on April 21, 2021, a month after MMPE
SVE3 0.1-foot thickness prior to pilot test start

Historical groundwater elevations and product thicknesses are detailed in Appendix C.

3.3.4 Recovery events:
MMPE events have been conducted for this release incident as authorized on ePATAs 40784-002,
-007, and -013. All the events were five days in length. MMPE services were provided by Zava
Industrial, Inc. for the October 2018 event and by EarthX, Inc. for the April 2019 and March 2021
events. The October 2018 event was successful in removing 4,041 gallons of liquid, the April
2019 event recovered 3,461 gallons, and the March 2021 event recovered 4,679 gallons.
Emissions of 56.86 gallons, 64.23 gallons, and 20.72 gallons were reported for the three events,
respectively. Additional MMPE events were denied by the NCDWM-UST.

3.3.5 Free product delineation:
Following a high-resolution study conducted in June 2020 by Dakota Technologies Company, LLC,
additional monitoring wells MW15, MW16, and MW17 were installed by an NC-licensed driller
on September 22-23, 2020 at previously selected locations validated by the high-res data. Their

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 19 Troutman, Iredell County, NC
locations around MW2 are shown on the enclosed Figure 3. Table 4 shows well construction
details. The screen intervals were extended above the water table on all three wells to capture
the product at shallower depths in accordance with typical well construction policy.

The high-resolution study identified higher concentrations within the analyzed area as follows:

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 20 Troutman, Iredell County, NC
3.3.6 Product locations and water table fluctuations:
As apparent from water table fluctuations and data from the high resolution study, several areas
of free product are present vertically at the site. Greater product thicknesses were noted when
the water table is lower. The majority of free-phase product is located 30 to 40 feet BGL.
Supporting information is as follows:

Date
MW2 Free
Product
Thickness
(feet)
Groundwater
Elevation
(feet)
6/25/2018 6.25 61.95
10/22/2018 7.05 62.60
12/3/2018 5.63 63.68
4/22/2019 4.11 66.83
7/24/2019 2.85 67.06
9/23/2020 4.12 67.11
3/22/2021 3.08 69.56
9/23/2021 4.2 66.08
0
1
2
3
4
5
6
7
8
60.00 62.00 64.00 66.00 68.00 70.00
MW2 Free Product Thickness (feet)

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 21 Troutman, Iredell County, NC
3.3.7 Free product evaluation:
On September 23, 2020, Terraquest personnel used a disposable bailer to remove product from
monitoring well MW2 and subsequently record the rate of its return as requested by the
NCDWM-UST. Personnel bailed product from an initial thickness of 4.12 feet at static conditions
to a thickness of 0.25 feet that repeatedly showed up through several bails. As product was
bailed from the well, it was temporarily placed into a 5-gallon bucket at the well. When that
bucket filled, the contents were transferred to a transport can during which time the well would
fill back up with 6-8" of product. Complete removal of the product was not possible. In total,
over six gallons of product were removed through the efforts and later disposed of offsite in an
environmentally-sound manner. In summary, those efforts amount to a six-gallon recovery via
hand bailing in half an hour. Following the half-hour of bailing, the rate of return was recorded
for two hours following the bailing as detailed in tabular and graphical form:

Time
Top of
Casing
Elevation
(feet)
Depth to
Product from
Top of Casing
(feet)
Depth to
Water from
Top of Casing
(feet)
Free
Product
Thickness
(feet)
Groundwater
Elevation (feet)Comments
Type II Groundwater Monitoring Well
9:15:00 AM 97.83 28.58 32.70 4.12 68.14
9:45:00 AM 97.83 29.83 30.08 0.25 67.93
9:50:00 AM 97.83 29.69 30.00 0.31 68.06
9:55:00 AM 97.83 29.65 30.00 0.35 68.09
10:00:00 AM 97.83 29.66 30.05 0.39 68.06
10:05:00 AM 97.83 29.63 30.02 0.39 68.09
10:10:00 AM 97.83 29.60 29.97 0.37 68.13
10:15:00 AM 97.83 29.58 29.95 0.37 68.15
10:20:00 AM 97.83 29.55 29.94 0.39 68.17
10:25:00 AM 97.83 29.55 29.94 0.39 68.17
10:30:00 AM 97.83 29.55 29.95 0.40 68.17
10:35:00 AM 97.83 29.55 29.94 0.39 68.17
10:40:00 AM 97.83 29.55 29.95 0.40 68.17
10:45:00 AM 97.83 29.55 29.95 0.40 68.17
10:50:00 AM 97.83 29.55 29.94 0.39 68.17
10:55:00 AM 97.83 29.54 29.95 0.41 68.18
11:00:00 AM 97.83 29.54 29.95 0.41 68.18
11:05:00 AM 97.83 29.53 29.94 0.41 68.19
11:10:00 AM 97.83 29.52 29.94 0.42 68.20
11:15:00 AM 97.83 29.52 29.93 0.41 68.20
11:20:00 AM 97.83 29.51 29.93 0.42 68.21
11:25:00 AM 97.83 29.50 29.92 0.42 68.22
11:30:00 AM 97.83 29.50 29.92 0.42 68.22
11:35:00 AM 97.83 29.50 29.92 0.42 68.22
11:40:00 AM 97.83 29.49 29.92 0.43 68.22
11:45:00 AM 97.83 29.48 29.91 0.43 68.23
11:50:00 AM 97.83 29.48 29.90 0.42 68.24
11:55:00 AM 97.83 29.48 29.90 0.42 68.24
12:00:00 PM 97.83 29.48 29.90 0.42 68.24
Product removed from well with disposable bailer for half an hour. Could not remove product to a thickness less than 3". Removed product was placed into a 5-gallon bucket. When that
bucket was transferred to a transport can, the well would fill back up with 6-8" of product. Complete removal of the product was not possible.
0.23
0.28
0.33
0.38
0.43
0.48
9:45:00 AM9:50:00 AM9:55:00 AM10:00:00 AM10:05:00 AM10:10:00 AM10:15:00 AM10:20:00 AM10:25:00 AM10:30:00 AM10:35:00 AM10:40:00 AM10:45:00 AM10:50:00 AM10:55:00 AM11:00:00 AM11:05:00 AM11:10:00 AM11:15:00 AM11:20:00 AM11:25:00 AM11:30:00 AM11:35:00 AM11:40:00 AM11:45:00 AM11:50:00 AM11:55:00 AM12:00:00 PMFree Product Thickness (feet)
Free Product Thickness (feet)

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 22 Troutman, Iredell County, NC
4.0 OBJECTIVES FOR CORRECTIVE ACTION AT THE SITE

With the absence of a municipal water supply source along Waddington Lane and the current
lack of a requirement to annex their properties and pay taxes, this release incident is ranked a
High Risk due to the reliance on water supply wells. Without an alternate water source, there is
no way to downgrade the risk. The cleanup objectives are the STG MSCCs for soil and the 2L
Standards for groundwater. The corrective actions proposed herein are structured to meet those
standards as the objective. Note that once free product and GCL violations are removed, it may
be possible to conduct groundwater modeling to calculate alternate cleanup standards that are
above the 2L Standards but do not threaten receptors.

5.0 COMPREHENSIVE EVALUATION OF REMEDIAL ACTIONS

5.1 Considered Remedial Methods
Remedial actions that have been considered for this release incident include excavation, MMPE,
passive and active product bailers, natural attenuation, in-situ blending/injection, pump and
treat, dual-phase extraction, soil vapor extraction (SVE), and air sparging. Each of the methods
has positive and negative features that are discussed here:

Excavation
Following removal of the UST system, Terraquest requested pre-approval of costs necessary to
excavate contaminated soil. This request was denied. The method has the benefit of immediate
removal of the source zone but can be costly. The current presence of a new UST system would
require removal and replacement costs that negate this as a valid method.

MMPE
Mobile Multi-Phase Extraction (MMPE) events have been performed at this site with success.
However, the cost associated with the events becomes prohibitive in comparison to other
remedial options due to the volume of product remaining.

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 23 Troutman, Iredell County, NC
Product Bailers
Product bailers could aid in removal of some product at the site however, they are limited in their
radius of effectiveness and require constant maintenance/adjustments to perform well. The
bailers would not treat the dissolved-phase contamination.

Natural Attenuation
Natural attenuation of the release incident would take a very long time and gives no protection
to sensitive receptors. The presence of several feet of product would likely take decades to
abate. If other methods can remove most of the contaminant mass, a short-period of monitored
natural attenuation would be a good way to verify that the plume is stable or degrading and allow
site closure.

In-Situ Blending/Injection
In-situ chemical oxidation of free-phase petroleum is, comparably, not the most effective means
of removal. The injectants used offer the ability to treat in place without having to remove and
dispose of contaminants. While this is beneficial and overcomes the increased cost of this
method in many hazardous waste incidents, this release incident is not hazardous. Blending is
not an option without first removal of the current UST system, a cost that would remove this as
an option. The effectiveness of oxidant injection varies based on the lithologic heterogeneities
and BOD, COD of the aquifer. The large presence of free product negates this method as the best
choice.

Pump and Treat and Dual-Phase Extraction
Pump and treat and dual-phase extraction systems would effectively remove free product and
dissolved-phase groundwater contamination. These methods are generally costly as they have
multiple equipment components and require a large amount of maintenance and adjustments
to operate well. The lack of any discharge options for the treated water is problematic as is the
high capital and operations costs. While the methods provide hydrodynamic control of the area
that offers protection to sensitive receptors, they are more costly than other options.

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 24 Troutman, Iredell County, NC
Soil Vapor Extraction
Soil vapor extraction (SVE) applies a vacuum to the vadose zone soil to remove VOCs that are
then emitted to the atmosphere. The method is also capable of recovering liberated sparge
vapors. The method is lower in cost than other active methods and generally operates well with
little down time. Recovered vapors would require treatment prior to exhaust to eliminate the
VOCs and ensure emissions requirements are met. The method is limited by the permeability of
the soil matrix.

Air Sparging
Air sparging uses compressed air applied to the aquifer to liberate dissolved-phase contaminants
that can then be exhausted to the atmosphere. Compared to the other active methods, air
sparging is a lower-cost option. Air sparge systems generally run well with little down time. The
effectiveness of this method is limited by hydrogeologic heterogeneities and lower permeable
aquifer material.

5.2 Pilot Testing

Following discussion, agreement, and pre-approval of costs from the NCDWM-UST, Terraquest
personnel installed wells and conducted SVE and air sparge pilot testing in November 2021.

On November 16-17, 2021, Terraquest personnel supervised the installation of SVE pilot test
wells SVE1, SVE2, and SVE3 and air sparge pilot test well AS1 at the locations shown on the
attached Figure 3. SVE wells SVE1 and SVE2 were installed near the former UST basin to
investigate SVE response for contaminated soil in that area. SVE well SVE3 was installed within
the free product plume as was air sparge well AS1, at the request of the NCDWM-UST, to
investigate free product recovery and air sparge effectiveness. All wells were installed using a
Geoprobe Model 7822DT operated by an NC-licensed driller.

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 25 Troutman, Iredell County, NC
The SVE wells were constructed of 20 feet of 2”-diameter, Schedule 40 PVC casing attached to
15 feet of 2”-diameter, Schedule 40 PVC screen with a 0.010” slot size for a total well depth of
35 feet. This screen interval takes into consideration the prior depth of excavation, the location
of the wells in relation to the source area, and the depth to water. The air sparge well AS1 was
constructed of 55 feet of 1”-diameter, Schedule 40 PVC casing attached to 5 feet of 1”-diameter,
Schedule 40 PVC screen with a 0.010” slot size for a total well depth of 60 feet. This screen
opening forces the introduced air to spread throughout the aquifer where it can provide
treatment. The wells were surveyed into the network following installation. Well construction
information is further detailed in Table 4 and the well records are provided in Appendix D.

SVE and air sparge pilot testing is detailed in reports provided in Appendices E and F. The tests
and results are summarized hereinafter.

5.2.1 SVE Pilot Test
Terraquest performed one true SVE test within the vadose zone near the former UST basin where
the largest contaminated soil mass exists (SVE1) and a second test above the free product area
during the air sparge test (SVE3). The tests were conducted on November 22 and 23, 2021,
respectively. Testing at SVE1 was the chief set of tests with SVE3 conducted to verify those results
by ensuring radius of influence was about the same, and to collect information for the sparge
test that was conducted at the same time.

The basic test procedure consisted of applying a vacuum to the extraction well while monitoring
pressure response at other points of varying distance and direction from the extraction point.
Vacuum pressure and air flow at the extraction well were also monitored. A GAST regenerative
blower with a 1.5 hp electric motor was used to create the vacuum. Various pressure and flow
gauges were also used. The blower and gauges were connected with air-tight seals to the various
points to minimize leakage and, thus, systematic error.

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 26 Troutman, Iredell County, NC
Two types of SVE tests were conducted at SVE1:

The first type of test conducted was an air permeability test that typically lasts for
approximately 10 minutes. Vacuum was applied to the extraction well and the pressure
responses in various observation points were recorded with time. The data is used to
calculate the vadose zone permeability to air flow (intrinsic permeability).

Terraquest personnel conducted three air permeability tests on November
22, 2021. Tests were conducted using SVE1 as the extraction well, while
SVE2, SVE3, and MW1 were observed in each of the respective tests.

The second type of test performed was a steady state test. These last from approximately
1 hour to several or more days, depending on the objectives of the test, the scale of the
project, and other cost justification factors. Two or more tests may be conducted at
various extraction well flow rates. A relationship between applied vacuum and vapor flow
yield is developed from these tests. This relationship is used for blower selection in the
design of the full-scale system. Data from these tests can also be used to calculate
intrinsic permeability.

For the steady state test on SVE1, Terraquest applied a vacuum of -22 inches
of water for a half-hour, -40 inches of water for a half-hour, -60 inches of
water for a half-hour, and -70 inches of water for the last half-hour.

Similarly, the steady state test using SVE3 as the extraction point while
monitoring wells MW1, MW2, MW16, and MW17 was run at progressive
dilutions of -22 inches of water for a half-hour, -40 inches of water for a
half-hour, and -80 inches of water for a half-hour.

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 27 Troutman, Iredell County, NC
Air Permeability
Terraquest used US EPA’s (1993) Hyperventilate program to evaluate the air permeability test
data. Hyperventilate uses the transient pressure response in the observation point to calculate
an air permeability value using a theoretical relationship developed by Johnson, et al (1990a).
Hyperventilate results are attached in Appendix E.

The estimated value of intrinsic permeability (k) for varying soil lithologies ranges from 10-1
(clayey silts) to 105 darcy (gravel) as shown in Appendix E’s Help-page 13 that supports page 8 of
the Hyperventilate analysis. Terraquest chose to enter a darcy value range from 0.25 to 1 as it
most accurately represented the flow ranges that were observed during the pilot tests.

Radius of Extraction Well Influence
The ROI was determined based upon data from the steady state test. A rule-of-thumb
recommended by U.S. EPA (1995) is that the ROI will be the distance at which a vacuum of 0.1
inches of water is yielded. To determine this distance, Terraquest plotted vacuum pressure
versus distance as shown in the graph that follows. When determining the point at which 0.1
inches of water is yielded, a straight-line relationship was drawn from the extraction point
through the observation points in a best-fit manner. The graph shows a corresponding x-axis
crossing of 23.5 feet. A 20-foot radius is chosen as a conservative estimate of influence that
allows for some site heterogeneities.

(graph on next page)

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 28 Troutman, Iredell County, NC

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 29 Troutman, Iredell County, NC
Number of Extraction Wells
Hyperventilate was used to calculate the number of extraction wells by examining the site’s
permeability, critical volume of air, extraction well efficiency, contaminant radius from extraction
well, contaminant concentration, radius of influence, and required cleanup time. The following
values were constant throughout the calculations: (see card SD2 and 3)

• permeability (k) of 0.25 to 1 darcy (previously discussed),
• critical volume of air of 146.71 L/g (see card SD7),
• extraction well efficiency of 30 percent (see card H29)
• Average contamination concentration across subject area of 2,325 mg/kg (previously
discussed),
• Radius of test influence of 20 feet,
• Cleanup time of three years (used as a rough estimate).

The required number of wells calculated by Hyperventilate ranged from 1 to 11 based on area
and critical volume calculations. The data does not consider site heterogeneities, the
requirement of the SVE system to recover free-phase product and sparge vapors and is a rather
large range. Site structures, cost, and installation feasibility must also be accounted for.

In consideration of the aforementioned items, Terraquest recommends the use of ten SVE wells
at the locations shown on the next page and on Figure 5. This includes use of the existing SVE1,
SVE2, and SVE3 and the installation of seven new SVE wells.

SVE Pilot Test Conclusions
Based on the pilot test conducted by Terraquest personnel, the site is acceptable for SVE as a
remedial method. SVE is recommended to remediate soil and remove free product and sparge
exhaust vapors. Ten dedicated SVE wells are recommended.

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 30 Troutman, Iredell County, NC

10 wells total
3 existing
7 new

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 31 Troutman, Iredell County, NC
5.2.2 Air Sparge Pilot Test
The test procedure consists of applying air pressure to the sparging well while monitoring air flow
at this point and changes in product/groundwater levels in nearby wells. During the air sparge
test conducted on November 23, 2021, air was introduced into AS1 while measurements were
collected from observation points MW1, MW2, MW15, MW16, and MW17.

Air was supplied to the injection point from a portable, electric, oil-less air compressor powered
by a portable electrical generator brought onsite for the test. The compressor output was
connected to the injection point through a series of hoses, pipes, and fittings. Air flow into the
injection point was measured with an adjustable flow meter. A static pressure gauge was
installed downstream of the flow control valve. The change in depth to product and water in the
observation points was measured using a Solinst Model 122 Interface Meter.

The test consists of several stages in which a constant flow is applied, while the air pressure and
water levels are measured. After groundwater mounding stabilizes, the flow is stepped up and
held constant for another stage. The number of stages depends on the rate at which responses
occur.

During the November 23, 2021 test, a total of three different flow rates were applied to the air
sparge well. Flows of 1.0, 1.5, and 2.0 standard cubic feet per minute were all applied. Those
flow intervals were provided for 1 hour, 1.5 hours, and 1.5 hours, respectively. That is, 1.0 scfm
was applied for the first 60 minutes, 1.5 scfm was applied from 60 to 180 minutes, and 2.0 scfm
was applied from 180 minutes until test conclusion at 270 minutes. Measurements are provided
in Appendix F.

The three main objectives of data analysis are to determine whether air sparging is suitable for
the site, determine a reasonable radius of influence for an air sparge well, and establish data for
equipment selection in the design of a full-scale system.

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 32 Troutman, Iredell County, NC
Suitability
The responses observed during the test indicate air sparging would be suitable for the site. Air
was injected into the subsurface and flow was maintained. Some sites have had poorly installed
air sparge wells where the screens are cemented or the lithology is too tight and air will not enter
the saturated zone at all. This was not the case at the subject facility. The injection was made
with a standard electrical air compressor suitable for short-term testing and flowable air was
maintained without a large amount of pressure. Flowable pressure for the test was less than 20
psi and a larger spike for breakthrough pressure was not observed. While some breakthrough
pressure exists, it was obviously within the limits of the operating equipment and was short-lived
enough that field personnel did not see it.

Radius of Influence
Determining the radius of influence involves a study of the influence observed in the wells
monitored during the pilot test. As the remedial method of air sparging is the mechanical
stripping of contaminants from the dissolved phase into a liberated waste air stream, the extent
of that effect is what is searched for. Air sparging also acts as a remedial method by increased
the amount of oxygen dissolved in the surrounding aquifer and that should be analyzed too.
However, the presence of free product prevented field measurement of DO with routine
equipment and this data was not obtained.

Prior to and throughout the test, the depth to water was measured in surrounding wells. As the
test progressed, the water table was mounded by the applied air as seen at observations wells
by a rise in the water table. In a fully evolved test with a sufficiently low air flow, the water levels
will subside to near static levels after some period of time as the mounding is spread across the
aquifer. When this drop occurs, the air flow rate is typically increased to the next step.

The measured data is summarized in Appendix F and in less detail below in this text. These graphs
show the mounding and subsequent stabilization of groundwater during each flow increase. The
stabilization is slight and is realized by a tapering of water mounding in some cases. The evidence

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 33 Troutman, Iredell County, NC
of these water level stabilizations is an important result, since it indicates that low flow sparging
can be performed without causing sustained high water levels. These measurements also are
indicative of the radius of influence of the air sparge well. The following results were observed:

Well identification
Radial distance (feet) from
injection point Largest mounding (feet)
AS1 0: injection here
MW2 5 1.49
MW17 5 2.01
MW15 15 2.07
MW16 16 0.94
MW1 22 1.06
MW3 34 0.24

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 34 Troutman, Iredell County, NC

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 35 Troutman, Iredell County, NC
Calculating the radius of influence should take into account multiple factors to provide a
scientifically-reasonable value with some conservative allotment. The radius is subject to
hydrogeology and isn’t as simple as a straight-line graph. The data indicates mounding as far
away as 34 feet. The goal is to calculate a ROI that provides air sparging to all areas without
creating service gaps. The size, shape, and placement of the free product and dissolved-phase
plume onsite where the sparging would occur also needs consideration. In consideration of all
these factors, 20 feet is recommended as a working radius of influence. A total of seven air
sparge wells is recommended and includes the existing well and six new sparge wells. Terraquest
proposes the well placement as shown on Figure 6 and as follows that considers site layout,
remedial goals, free product, GCLs, and radius of influence:

7 wells total
1 existing
6 new

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 36 Troutman, Iredell County, NC
Design data
The air sparge test achieved sustained flow up to 2 scfm at a pressure between 12 and 17 psi.
Equipment should be sized for a flow demand of 7 wells at a flow rate up to 4 scfm each for a
total of 28 scfm with some extra to allow for an increase in sparging as needed. Pressure over
17 psi was not observed but could have happened briefly as breakthrough was occurring. Air
sparge breakthrough is typically 1 psi for every 2.3 feet of head (US EPA 1995). With a head of
55 – 32.13 = 22.87 feet, the entry pressure required is estimated at 9.94 psi. The lithology
accounts for some of the additional pressure required. Overall, the flow and pressure is within
the range of typical air sparge systems.

Air Sparge Pilot Test Conclusions
Based on the pilot test conducted by Terraquest personnel, the site is acceptable for air sparging
as a remedial method. Seven dedicated SVE wells are recommended.

5.3 Chosen Remedial Methods
Based on the factors discussed, Terraquest chooses SVE and air sparging as the remedial methods
for this site.

5.4 Contaminant Mass Removal Estimates
While the exact time required to remediate the free and dissolved-phase contamination is
unknown, pilot test data can be used with previous assessment data to provide a very rough
estimation. Essentially, the metrics involved are the starting mass of product, the starting mass
of dissolved-phase contamination, and the removal rate of the system. The largest problem with
these calculations is that early operation of a system releases untethered contamination VERY
easily whereas later operation of a system requires the rise and fall of the aquifer and the release
of contaminants bound up in pore spaces to provide MUCH slower remediation. Some sort of
reasonable multiplier or logarithmic decline in recoverability must be used to provide a realistic
cleanup time.

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 37 Troutman, Iredell County, NC

CONTAMINANT MASS:
Soil contaminant mass:
Based on a known mass of contaminated soil and known mass of smear zone, a mass of
contaminant can be estimated using the known contaminant/mass values from laboratory
results. Using an average contamination value of 2,325 mg/kg from assessment results and the
previously stated 1,220 tons + 15 tons = 1,270 tons of contaminated soil/smear zone, the
following calculations yield a soil contamination mass of 5,893 pounds.

2,325 mg/kg x (1,270 tons x (907.185 kg / 1 US ton)) =
2,325 mg/kg x (1,152,125 kg) = 2,678,690,625 mg of contamination
2,678,690,625 mg / 1,000,000 mg/kg = 2,679 kg
2,679 kg x 2.2 pounds/kg = 5,893 pounds

Free-phase product mass:
325 ft2 x 2.5-foot average product thickness = 812.5 ft3 x 7.48 gal/ft3 x 6.25 lbs/gal =
37,984 pounds

Dissolved-phase contaminant mass (GCL violation):
3,300 ft2 x (10 feet beyond bottom of 50 foot wells – DTW 32’ = 60-32=28) = 92,400 ft3 x 28.3
L/ft3 = 2,616,476.6 L of GCL water. Average GCL violation wells on 9/2020 = 72,730 ug/L.
2,616,476.6 L of GCL water x 72,730 ug/L x 2.20462e-9 ug/lbs =
419.5 pounds.

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 38 Troutman, Iredell County, NC
INITIAL REMOVAL RATE:
SVE removal rate:
In addition to the mass removal estimates provided in the Hyperventilate analysis, Terraquest
also collected an air sample from the SVE pilot test exhaust stream that also requires
consideration toward mass removal. During the SVE pilot test, Terraquest personnel filled a 1L
Tedlar bag with a representative air sample from the exhaust stack. The results of lab analysis
listed a TPH concentration of 5,070,000 parts per billion by volume (ppbv). Operational SVE
system generally have exhaust readings in the 10,000-100.000 ppbv, so >5,000,000 is significant.
Using published blower performance curves and the time of operation, the following 22.56
pounds / 3 hours removal rate is calculated:

minutes
bump test 15
air permeability test 1 15
air permeability test 2 15
air permeability test 3 15
steady state test 120
180
SVE: this model produces (scfm flow rate):100 scfm
TPH concentration of vapors at stack:5,070,000 ppbv
Volume of air removed is (flow in cubic feet per minute) x length of testing (in minutes)18,000 ft3
Volume of gasoline vapor removed is equal to air volume removed muliplied by the TPH concentration.
Vol. air removed (ft3) x [TPH concentration of vapor (ft3 gasoline vapor/1E+09 ft3 air)]91 ft3 gasoline vapor
Conversions:1 ft3 vapor equals 7.48 gal.
1 gal. equal 3.78 liters
ft3 gasoline vapor x 7.48 gal./ft3 x 3.78 liters/gal. equals liters gasoline vapors.2,580 liters gasoline
vapor
Conversions:
Therefore:89 g/mole x (1mole/22.4 liters) equals:3.97 g/liter
Amount of Contaminant Removed
gasoline vapor (liters) x (3.97 g/liter) x (1 lb/454 g) equals lbs. vapor 22.56 lb of gasoline
At standard temperature and pressure, there are 22.4 liters of gasoline vapor per mole of gasoline. The molecular weight of carbon in gasoline is 89
g/mole.

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 39 Troutman, Iredell County, NC
SVE removal rate continued:
Disregarding all other factors, mathematically, the removal rate of the pilot test would indicate
that at 22.56 pounds / 3 hours, the 5,893 pounds of soil contamination would be gone after 784
hours of SVE system operation. That is, after 33 days. This value isn’t close to a realistic cleanup
time. Generally, there is a logarithmic decline in contamination recovery following evacuation of
readily accessible pore-space contamination. Heterogeneities, bound particles, and recalcitrant
contaminants along with rising and falling water table elevations will affect treatment. A more
likely time frame is 2-3 years. These calculations rely solely on true soil contamination. The larger
driving force at the Perth Mini Mart will be free product and GCL violations.

air sparge removal rate discussed on next page

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 40 Troutman, Iredell County, NC
INITIAL REMOVAL RATE (continued):
Sparge removal rate:
An SVE unit was operated during part of the air sparge test to retrieve a representative sample
of the air sparge exhaust. As shown in the attached analytical report, that sample had a reported
concentration of 10,100,000 parts per billion by volume of Total Petroleum Hydrocarbons as
Gasoline Range Organics. Using the following calculations, the removal rate during the test was:
67.42 pounds/4.5 hours

Expanding the initial removal rate against the mass of contaminant calculates as follows:
37,984 pounds + 419.5 pounds = 38,403.5 pounds / (67.42 pounds/4.5 hours) = 2,563 hours / 24
hours/day = 107 days.

So, if a treatment system were installed that had removal rates like those of the pilot test, the
contaminant mass would be removed in 107 days. However, this does not account for water
OPERATING PERIOD:START: 11/23/21 11:37 AM END:11/23/21 4:07 PM
AIR SPARGE CALCULATIONS (via SVE sample recovery)
SVE: this model produces (scfm flow rate):100 scfm
TPH concentration of vapors at stack:10,100,000 ppbv
Volume of air removed in ft3 equals (flow)(1,440 min/d)(time in period)27,000 ft3
Volume of gasoline vapor removed is equal to air volume removed muliplied by the TPH concentration.
Vol. air removed (ft 3) x [TPH concentration of vapor (ft3 gasoline vapor/1E+09 ft3 air)]273 ft3 gasoline vapor
Conversions:1 ft3 vapor equals 7.48 gal.
1 gal. equal 3.78 liters
ft3 gasoline vapor x 7.48 gal./ft3 x 3.78 liters/gal. equals liters gasoline vapors.7,710 liters gasoline
vapor
Conversions:
Therefore:89 g/mole x (1mole/22.4 liters) equals:3.97 g/liter
Amount of Contaminant Removed
gasoline vapor (liters) x (3.97 g/liter) x (1 lb/454 g) equals lbs. vapor 67.42 lb of gasoline
At standard temperature and pressure, there are 22.4 liters of gasoline vapor per mole of gasoline. The molecular weight of carbon in gasoline
is 89 g/mole.

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 41 Troutman, Iredell County, NC
table fluctuations, lithology heterogeneities, or compounds more recalcitrant to air stripping. It
also ignores the readily available contamination that is liberated by a virgin pilot test. At some
point, air sparge liberation at similar sites has shown a drastic reduction in contaminant recovery
as the system run time increases. Having several feet of free product available for removal may
allow the “early and productive” stages of the sparge system to last longer than sites treating
dissolved-phase contamination alone. All of this is to say that the site will not be rid of product
and GCL violations in 107 days. A 4-5 times factor should be applied along with a year or two of
time to allow for water table fluctuations that may trap product/GCL violations from treatment.

Several years of treatment are anticipated to remove contamination to levels where natural
attenuation can take over and the threat to sensitive receptors is lessened. Further refinement
of treatment time will be understood as the system is operated.

5.5 Remedial System Operation and Maintenance Plan
Terraquest proposes two, 8-hour visits per month to perform system O&M activities. Those
activities will include maintenance as recommended by the manufacturer and the collection of
data as is helpful to this investigation. In addition to an overall system check, equipment
temperatures and run hours will be inspected/adjusted/recorded. An overall check for air, water,
and lubricant leaks should be conducted. The system’s heater and exhaust fan should be
inspected/adjusted/setting recorded. The pressures and flows of the SVE and air sparge system
and lines to wells will be inspected/adjusted/recorded. The load and unload pressures of the
sparge compressor should be verified and recorded. The system’s logic controller should be
inspected. System valves including, ball valves and solenoid valves, and floats will be checked for
proper operation and serviced as needed. System alarms should be operationally verified along
with the variable frequency device for the SVE, pressure relief valves, system lights, hand-off-
auto switches, contacts, and overloads. Sight tubes should be inspected/cleaned/replaced across
the system. The volts and amps across the system will be recorded. The belts and impellers will
be inspected/adjusted/replaced as needed. System moisture will be dealt with along with
automatic knockouts and filters, drums, systems thereto. Aftercoolers will be cleaned and

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 42 Troutman, Iredell County, NC
adjusted as necessary. Pre-intake and air intake filters will be inspected/cleaned/replaced as
needed. Lubricants and associated filters and separator elements will be maintained along with
any scavenge lines, orifices, and filters. Downstream discharge coalescing filters and associated
media and regulators will be inspected/cleaned/replaced. Flows, pressures, and operation of any
associated product drum and/or oxidizer and appurtenances will be collected.

5.6 Monitoring Plan
Terraquest recommends quarterly sampling of the entire monitoring well network following
system startup to measure treatment and plume migration. During those events, free product
thickness measurements should be collected, and dissolved-phase contamination will be
investigated by lab analysis of VOCs via 6200B samples. Contaminant recovery and treatment
system operation should be investigated through monthly collection of air samples from the SVE
system’s exhaust stack and lab analysis per method EPA18 targeting BTEX, MTBE, and TPH.

Following the first year of operation, semi-annual monitoring events may be sufficient.
Additional data collection may be required as treatment unfolds to better understand the
geochemistry and ensure that contamination is removed in the most cost-effective manner.
Knowing the aquifer’s pH, conductivity, dissolved-oxygen, and the amount of sulfates and
nitrates will help steer the need for any additional treatments.

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 43 Troutman, Iredell County, NC
5.7 Remedial Schedule

Following submittal of this report, the following schedule is anticipated:

• one month is anticipated for the NCDWM-UST to review it and respond,
• one week is anticipated for pre-approval of the Corrective Action Design Report (CADR),
• three months are anticipated to design the system and acquire bids and the RP’s
authorization for system placement,
• one month is anticipated for the NCDWM-UST to review the CADR and respond,
• one week is anticipated for pre-approval of the Record of Decision (ROD),
• one month is anticipated to write the ROD and submit it,
• one month is anticipated for the NCDWM-UST to review the ROD and respond,
• one month is anticipated for all parties to meet and sign the ROD,
• one week is anticipated for pre-approval of the system costs and supervised installation,
• three months are anticipated for construction of the system,
• three months are anticipated for installation, inspection approval, utility construction and
activation,
• one month is anticipated to schedule system startup.

A total time of 15 months and three weeks are anticipated until the treatment system will be
turned on.

Following system activation, Terraquest expects the majority of free product will be removed
within the first year of system operation with another year to get it down to small pockets and
water-table fluctuation trapped areas. The surrounding dissolved-phase contaminant plume will
be reduced during these first several years of operation and another year or two will likely be
needed to get concentrations below the GCLs and close enough to the 2L Standards to suspend

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 44 Troutman, Iredell County, NC
system operation and monitor natural attenuation. Following a year of monitored natural
attenuation, it may be possible to reduce the risk ranking of this site and move toward closure.

In total, it will take 16 months to activate the system, 3-4 years of operation to remove the bulk
of the contamination, and another year to monitor natural attenuation and close the incident.
Without any alterations or delays to this schedule, a Notice of No Further Action could be release
in May 2028. While it is possible that this could be accomplished quicker, experience has shown
that it will most likely take longer.

5.8 Rough Cost Estimate
The supervised installation and operation of an SVE and air sparge treatment system with one
year of monitored natural attenuation is expected to roughly cost $525,000. Costs are estimated
on Table 5.

This cost includes $7,000 for CADR, ROD, and public notification, $39,000 for remedial well
installation, $145,000 for system installation, $259,000 for system O&M, $64,000 for
groundwater monitoring, and $10,800 for public notice, NORP, and monitoring well
abandonment toward closure as follows:

CADR
ROD
Remedial well install
Supervised treatment system installation
Annual sampling:
Sytem operations and maintenance (O&M):
Closure:
523,767.50$
38,914.50$
144,476.00$
64,035.00$
258,542.00$
10,800.00$
5,500.00$
1,500.00$

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 45 Troutman, Iredell County, NC
6.0 CONCLUSIONS / RECOMMENDATIONS

In consideration of the contamination present and treatment methods investigated, Terraquest
recommends SVE and air sparging as active treatment methods for the Perth Mini Mart release
incident. Both methods proved practical during pilot testing. Terraquest roughly estimates that
3-4 years of operating an SVE and air sparge remediation system followed by a year of monitored
natural attenuation could allow closure of this site in 2028 at a cost of $525,000. If the NCDWM-
UST agrees, the next step is to generate a CAP Corrective Action Design Report.

7.0 LIMITATIONS

This report is limited to the investigation of petroleum-type compounds, and does not imply that
other unforeseen adverse impacts to the environment are not present at the facility. In addition,
subsurface heterogeneities not identified during the current study may influence the migration
of groundwater or contaminants in unpredicted ways. The limited amount of sampling and
testing conducted during this study cannot practically reveal all subsurface heterogeneities.
Furthermore, the subsurface conditions, particularly groundwater flow, elevations, and water
quality may very through time. The opinions and conclusions arrived at in this report are in
accordance with industry-accepted geologic and hydrogeologic practices at this time and
location. No warranty is implied or intended.

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 46 Troutman, Iredell County, NC
CERTIFICATION
1 Enter the date the Corrective Action Plan was due. 2/28/2022 Will this Corrective Action Plan
Feasibility Study be submitted after the established due date?
YES NO
2 Was any recommended information from the above template missing from this report? YES NO
(IF the answer to question #1 or# 2 is “YES”, please replace this note with additional information in this cell to explain what was missing and why.)
3 Are there any known or suspected factors that could prohibit risk reclassification and the use of
monitored natural attenuation to risk-based cleanup standards following the completion of two
years of active remediation under the proposed strategy?
YES NO
(IF the answer to question #3 is “YES”, please replace this note with a short description of the possible reason(s), and outline proposed remedies. Greater detail should be provided in the report text above.)
4 Does any potential continuing source for the known contamination onsite remain (e.g., an existing,
operating system onsite where a leaking component directly responsible for the discovered release
has not been found and repaired/replaced, etc.)?
YES NO X
5 Does any known or suspected source zone soil contamination or free product remain outside of the
assessed area that could inhibit the effectiveness of the proposed strategy?
YES NO X
6 Since release discovery, has there been any unexpected increase in contaminant mass sufficient to
suggest a potential new release from a separate onsite or offsite source?
YES NO X
(IF the answer to any question from #4 - #6 is “YES”, replace this note with a short description of any recommended actions to address, assess, or clean up any
other known, suspected, or potential source. Greater detail should be provided in the report text above.) 6 Certification:
I, Michael J. Brown, a Licensed Geologist and I, John S. Haselow, a Licensed Engineer in the State of North
Carolina for TERRAQUEST ENVIRONMENTAL CONSULTANTS, P.C. do certify that the information contained in
this report is correct and accurate to the best of my knowledge. All work was performed under my direct
supervision. My seal and signature are affixed below. Additional seals and/or signatures are also listed.

Terraquest Environmental Consultants, P.C. is licensed to practice geology and engineering in North Carolina.
The geology certification number of the corporation is C-291. The engineering certification number of the
corporation is C-4634. Engineering is practiced out of the Cary, NC office.

TERRAQUEST ENVIRONMENTAL CONSULTANTS, P.C.

Ryan D. Kerins Michael J. Brown, P.G. John Haselow, PhD, PE
Project Manager President Senior Engineer

CAP Feasibility Report Perth Mini Mart By: Terraquest Environmental Consultants, P.C. 818 Perth Road
Date: January 17, 2022 47 Troutman, Iredell County, NC
REFERENCES

Brown, et al., 1985. Geologic Map of North Carolina, North Carolina. Department of Natural
Resources and Community Development, 1:500,000 scale.

Johnson, P.C., M. Kemblowski, and J. Colthart. 1990a. Quantitative analysis for the cleanup of
hydrocarbon-contaminated soils by in-situ soil venting. Ground Water, Vol.28, No.3, pp
413-429.

Johnson, P.C., C.C. Stanley, M.W. Kemblowski, D.L. Beyers, and J.D. Colthart. 1990b. A practical
approach to the design, operation, and monitoring of in situ soil-venting systems.
Ground Water Monitoring Review (GWMR), Spring Issue, pp. 159-178.

Sanders, Laura L. 1998. A Manual of Field Hydrogeology. Upper Saddle River, New Jersey: Prentice
Hall Inc.: 196.

U.S. EPA. 1995. How to evaluate alternative cleanup technologies for underground storage tank
sites. Solid Waste and Emergency Response 5403W. Document Number 510-B-95-007.

U.S. EPA. 1993. HyperVentilate: a software guidance system created for vapor extraction sites.
Solid Waste and Emergency Response OS-420WF. Document Number 510-F-93-001.

TABLES

Table 1
Date: 12/6/21 Facility ID No: 0-0024524
Capacity
UST Product (Gallons)Release Discovered
T1 Gasoline 6,000 3/4/80 2/25/19 Yes
T2 Gasoline 6,000 3/4/80 2/25/19 Yes
T3 Gasoline 4,000 3/4/80 2/25/19 Yes
T4 Non-ethanol gasoline*2,000 3/4/80 2/19/19 No
AST1 Diesel 2,000 unknown Active No
T5**Gasoline 12,000 2/27/19 Active No
T6**Gasoline 12,000 2/27/19 Active No
Notes:
1. Information obtained from the North Carolina UST Database Records and field observations.
2. * Tank T4 held diesel fuel until its conversion to non-ethanol gasoline in 2018.
3. ** Tanks are compartmentalized.
4. Tanks T1-T4 were of single-walled steel construction. T5 and T6 are double-walled fiberglass.
Active USTs/AST
SITE HISTORY (UST/AST SYSTEM INFORMATION)
Incident Name: Perth Mini Mart Incident No. 40784
Date Installed Date Closed
Closed USTs
Table 2
Date: 12/6/21 Facility ID: 0-0024524
Tax Parcel Number
(PIN Number)Property Owner Property Owner Address Property Address
Pennell, Gary & Sherry PO Box 712 131 Weddington LaneTroutman, NC 28166 Troutman, NC 28166
Tsitouris, Steve & Michael 569 Autumn Leaf Road 569 Autumn Leaf Road
Troutman, NC 28166 Troutman, NC 28166
Grant, Nancy & Jeffrey 782 Perth Road 782 Perth Road
Troutman, NC 28166 Troutman, NC 28166
TCJ Development, LLC PO Box 3395 803 Perth Road
Mooresville, NC 28117 Troutman, NC 28166
Thompson, Wayne PO Box 886 858 Perth Road
Troutman, NC 28166 Troutman, NC 28166
Madhukunj, LLC 135 Corona Circle 818 Perth Road
Mooresville, NC 28115 Troutman, NC 28166
Notes:
1. Information gathered from field interviews and Iredell County Geographic Information System.
2. Last 4 digits of MAP ID numbers correspond with those displayed on Figure 2.
SURROUNDING PROPERTY OWNERS
Incident Name: Perth Mini Mart Incident No.: 40784
SITE
4730-63-9494
4730-69-9930
4730-79-2085
4730-79-2769
4730-79-4509
4731-50-7091
Table 3
Date: 12/7/21 Facility ID: 0-0024524
Well Depth Type Casing Depth Screen Interval Distance from SourceWell ID No. Well Owner/Address Well Address Well Use (feet BGS)of Well (feet BGS)(feet BGS)Area of Release (feet)Madhukunj, LLC
WSW1 135 Corona Circle 818 Perth Road Active 170 Drilled 95 95-170 107
Mooresville, NC 28115 Troutman, NC 28166 (minnow tank in store)
Tsitouris, Steve & Michael
WSW2 569 Autumn Leaf Road 569 Autumn Leaf Road Secondary Source uknown Drilled uknown uknown 447
Troutman, NC 28166 Troutman, NC 28166
TCJ Development
WSW3 PO Box 3395 562 Autumn Leaf Road Inactive uknown Drilled uknown uknown 464Mooresville, NC 28117 Troutman, NC 28166Pennell, Gary & Sherry
WSW4 PO Box 712 117 Weddington Lane Sole Source unknown Drilled uknown uknown 384
Troutman, NC 28166 Troutman, NC 28166
Upright, Renny & Debbie
WSW5 547 Autumn Leaf Road 547 Autumn Leaf Road Sole Source uknown Drilled uknown uknown 614
Troutman, NC 28166 Troutman, NC 28166
TCJ DevelopmentWSW6PO Box 3395 795 Perth Road Sole Source uknown Drilled uknown uknown 541Mooresville, NC 28117 Troutman, NC 28166
Grant, Nancy & Jeffrey
WSW7 782 Perth Road 782 Perth Road Sole Source uknown Drilled uknown uknown 582
Troutman, NC 28166 Troutman, NC 28166
Pennell, Gary & Sherry
WSW8 PO Box 712 131 Weddington Lane Sole Source 90 Drilled unknown unknown 534
Troutman, NC 28166 Troutman, NC 28166Thompson, K. WayneWSW9PO Box 886 858 Perth Road Sole Source 300 Drilled unknown unknown 679
Troutman, NC 28166 Troutman, NC 28166
Thompson, Tommy
WSW10 855 Perth Road 105 Spicewood Circle Sole Source unknown Drilled unknown unknown 595
Troutman, NC 28166 Troutman, NC 28166
Geiger, Lee
WSW11 533 Autumn Leaf Road 533 Autumn Leaf Road Sole Source unknown Drilled unknown unknown 923Troutman, NC 28166 Troutman, NC 28166TCJ DevelopmentWSW12PO Box 3395 532 Autumn Leaf Road Sole Source unknown Drilled unknown unknown 1000
Mooresville, NC 28117 Troutman, NC 28166
Brown, Gertrude P Heirs
WSW13 9117 J Ruth Street 785 Perth Road Sole Source unknown Drilled unknown unknown 1148
Mount Pleasant, NC 28124 Troutman, NC 28166
Weber, Glenn & Rozelle
WSW14 765 Perth Road 765 Perth Road Sole Source unknown Drilled unknown unknown 1267Troutman, NC 28166 Troutman, NC 28166Weber, Glenn & Rozelle
WSW15 765 Perth Road 765 Perth Road Inactive unknown Bored unknown unknown 1192
Troutman, NC 28166 Troutman, NC 28166
Cowan, Hugh
WSW16 755 Perth Road 755 Perth Road Sole Source unknown Drilled unknown unknown 1322
Troutman, NC 28166 Troutman, NC 28166 2-inch
Cowan, HughWSW17755 Perth Road 755 Perth Road Inactive unknown Bored unknown unknown 1313Troutman, NC 28166 Troutman, NC 28166
Weber, Glenn & Rozelle
WSW18 765 Perth Road 106 Weddington Lane Inactive unknown Drilled unknown unknown 1098
Troutman, NC 28166 Troutman, NC 28166 2-inch
Wagner, Betty etal
WSW19 2795 Westonridge Dr.129 Weddington Lane Sole Source unknown Drilled unknown unknown 659
Cincinnati, OH 45239 Troutman, NC 28166Wagner, Betty & MichaelWSW20PO Box 464 120 Weddington Lane Sole Source unknown Drilled unknown unknown 916Troutman, NC 28166 Troutman, NC 28166
Guentner, Gregory & Julie
WSW21 397 Isle of Pines Road 146 Weddington Lane Sole Source unknown Drilled unknown unknown 833
Mooresville, NC 28115 Troutman, NC 28166 2-inch
Coffey, Robert & Rebecca
WSW22 PO Box 1094 165 Weddington Lane Sole Source unknown Drilled unknown unknown 826
Troutman, NC 28166 Troutman, NC 28166American IRA, LLCWSW23242 Templeton Road 104 Spicewood Circle Sole Source unknown Drilled unknown unknown 814
Mooresville, NC 28117 Troutman, NC 28166
Haynes, Larry
WSW24 118 Spicewood Circle 118 Spicewood Circle Sole Source unknown Drilled unknown unknown 893
Troutman, NC 28166 Troutman, NC 28166
Neel, Henry
WSW25 PO Box 245 123 Spicewood Circle Sole Source unknown Drilled unknown unknown 731Troutman, NC 28166 Troutman, NC 28166Sherrill, Shirley
WSW26 PO Box 73 129 Spicewood Circle Sole Source unknown Drilled unknown unknown 780
Troutman, NC 28166 Troutman, NC 28166
Phelps, Gary
WSW27 147 Spicewood Circle 147 Spicewood Circle Sole Source unknown Drilled unknown unknown 830
Troutman, NC 28166 Troutman, NC 28166
Shoemaker, Nancy
WSW28 151 Spicewood Circle 151 Spicewood Circle Sole Source unknown Drilled unknown unknown 880Troutman, NC 28166 Troutman, NC 28166Davis, Shelly
WSW29 153 Spicewood Circle 153 Spicewood Circle Sole Source unknown Drilled unknown unknown 1,131
Troutman, NC 28166 Troutman, NC 28166
Gilleland, Marilyn
WSW30 294 Spicewood Circle 294 Spicewood Circle Sole Source unknown Drilled unknown unknown 1,019
Troutman, NC 28166 Troutman, NC 28166
Sparrow, WarnerWSW31104 Nutmeg Lane 104 Nutmeg Lane Sole Source unknown Drilled unknown unknown 1,088Troutman, NC 28166 Troutman, NC 28166
Wilcox, Robert
WSW32 138 Spicewood Circle 138 Spicewood Circle Sole Source unknown Drilled unknown unknown 1,050
Troutman, NC 28166 Troutman, NC 28166
Wittie, Richard
WSW33 171 Spicewood Circle 171 Spicewood Circle Sole Source unknown Drilled unknown unknown 1,475
Troutman, NC 28166 Troutman, NC 28166Notes:1. "BGS" = feet below ground surface, .
2. Information obtained from Terraquest field interviews & Iredell County GIS
3. Well ID numbers are displayed on Figure 2.
WATER SUPPLY WELL INFORMATION
Incident Name: Perth Mini Mart Incident No.: 40784
Table 4
Date: 1/13/22 Facility ID: 0-0024524
Well ID Date Installed
Date Water
Level
Measured
Screened Interval (x
to y feet BGS)
Bottom of Well
(feet BGS)
Top of
Casing
Elevation
(feet)
Depth to Water
from Top of
Casing (feet)
Free
Product
Thickness
(feet)
Groundwater
Elevation (feet)CommentsMW11/16/18 11/23/21 30-50 50 98.78 32.13 0 66.65 Type II Groundwater Monitoring Well
MW2 6/18/18 11/23/21 30-50 50 97.83 34.82 4.2 66.08 Type II Groundwater Monitoring Well
MW3 6/18/18 11/23/21 30-50 50 98.54 31.57 0 66.97 Type II Groundwater Monitoring Well
MW4 6/19/18 -30-50 50 99.68 ---Type II Groundwater Monitoring Well
MW5 11/26/18 -30-50 50 96.31 ---Type II Groundwater Monitoring WellMW611/26/18 -30-50 50 97.53 ---Type II Groundwater Monitoring WellMW711/26/18 -30-50 50 99.37 ---Type II Groundwater Monitoring WellMW811/27/18 -30-50 50 98.72 ---Type II Groundwater Monitoring WellMW911/27/18 -30-40 40 89.72 ---Type II Groundwater Monitoring WellMW1011/28/18 -30-40 40 90.75 ---Type II Groundwater Monitoring Well
MW11 11/28/18 -OC: 55 IC: 65 65-70 70 96.80 ---Type III vertical delineation well
MW12 4/29/19 -25-40 40 94.74 ---Type II Groundwater Monitoring Well
MW13 4/29/19 -25-40 40 94.30 ---Type II Groundwater Monitoring Well
MW14 4/30/19 -25-40 40 96.30 ---Type II Groundwater Monitoring WellMW159/22/20 11/23/21 25-45 45 97.25 34.05 3 65.39 Type II Groundwater Monitoring WellMW169/22/20 11/23/21 25-45 45 97.38 34.82 4.82 66.08 Type II Groundwater Monitoring WellMW179/22/20 11/23/21 20-45 45 98.41 32.05 0.05 66.40 Type II Groundwater Monitoring WellAS111/16/21 11/23/21 55-60 60 98.06 31.72 0 66.34 1"-diameter air sparge well
SVE1 11/16/21 11/23/21 20-35 35 98.34 31.70 0 66.64 2"-diameter SVE well
SVE2 11/16/21 11/23/21 20-35 35 97.96 31.39 0 66.57 2"-diameter SVE well
SVE3 11/16/21 11/23/21 20-35 35 97.99 31.26 0.1 66.80 2"-diameter SVE well
Notes:1. "BGS" = below ground surface 2. "-" information not available3. The groundwater elevations for monitoring wells with free product was corrected as follows: [Top of Casing Elevation - Depth to Water] + [Free Product Thickness x 0.7305]
MONITORING WELL CONSTRUCTION INFORMATIONIncident Name: Peth Mini Mart Incident No.: 40784
Well Casing Depth (feet
BGS)3030
30
30
30
30
30303030
25
25
25
2525205520
20
20
Page 1 of 2
Table 5Date: 1/17/22 Facility ID: 0-0024524
Task Description Unit Rate Subtotal TF Lab #Comments
CADR
6.066 Corrective Action Design Report 1 report x 5,000.00$ =5,000.00$ 6.082 Public notice 1 notice x 500.00$ =500.00$
ROD
6.067 Corrective Action Record of Decision 1 report x 1,000.00$ =1,000.00$
6.082 Public notice 1 notice x 500.00$ =500.00$
Remedial well install
3.060 Utility clearance 1 locate x 750.00$ =750.00$
3.101 Drilling supervision 605 feet x 12.50$ =7,562.50$
3.112 1-inch well 360 feet x 40.00$ =14,400.00$ 6 new sparge wells (60')3.113 2-inch well 245 feet x 50.00$ =12,250.00$ 7 new SVE wells (35')
3.351 Well surveying 13 wells x 80.00$ =1,040.00$ 3.398 Drill rig MOBE 1 MOBE x 350.00$ =350.00$
3.500 Drill crew per diem (Driller 1)4 per diem x 151.00$ =604.00$
3.500 Drill crew per diem (Driller 2)4 per diem x 151.00$ =604.00$ 8.055 Injection notice of intent 1 notice x 500.00$ =500.00$
12.030 Consultant per diem 4 per diem x 151.00$ =604.00$ 12.050 Consultant MOBE 1 MOBE x 250.00$ =250.00$
38,914.50$ Supervised treatment system installation
7.065 Cost for multi-tech remediation system 1 system x 85,000.00$ =85,000.00$ Estimated - requires bidding
7.081 Remediation system installation inspection 32 hours x 93.00$ =2,976.00$ 3-week install: 8M,4F,4M,4F,4M,8F. 7.100 Cost for remediation system installation 1 installation x 55,000.00$ =55,000.00$ Estimated - requires bidding
12.050 Consultant MOBE 6 MOBE x 250.00$ =1,500.00$ 3-week install: Monday and Friday visits. 144,476.00$
Annual sampling:once per year:
4.031 Cost for sampling well 17 wells x 110.00$ = 1,870.00$ MW1-17 (product at $50 if present)4.090 Cost for analytical 17 samples x 62.00$ = 1,054.00$ 272 6200B
4.091 Sample shipping 1 fee x 85.00$ = 85.00$ s/h Shipping
6.091 Monitoring Report 1 report x 900.00$ =900.00$ once per year 3,909.00$
4.031 Cost for sampling well 17 wells x 110.00$ = 1,870.00$ MW1-17 (product at $50 if present)4.090 Cost for analytical 17 samples x 62.00$ = 1,054.00$ 272 6200B
4.091 Sample shipping 1 fee x 85.00$ = 85.00$ s/h Shipping
6.090 Monitoring Report 1 report x 1,800.00$ =1,800.00$ 4,809.00$
12,627.00$ 1.5 years until system is installed then
16,536.00$ 1 year of operation with quarterly sampling
26,154.00$ 3 years of system operation8,718.00$ 1 year of natural attenuation
TOTAL 64,035.00$
Units
Incident Name: Peth Mini Mart Incident No.: 40784CORRECTIVE ACTION COSTS
Page 2 of 2
Table 5Date: 1/17/22 Facility ID: 0-0024524
Task Description Unit Rate Subtotal TF Lab #CommentsUnits
Incident Name: Peth Mini Mart Incident No.: 40784CORRECTIVE ACTION COSTS
First quarter of O&M:
4.090 Cost for analytical 3 samples x 142.00$ = 426.00$ 880 3 months x EPA18 BTEX+TPH air samples
4.091 Sample shipping 3 fees x 85.00$ = 255.00$ s/h Shipping6.105 Corrective Action Performance Report 1 report x 2,000.00$ =2,000.00$
7.201 Cost for scheduled maintenance 72 hours x 93.00$ =6,696.00$ Eight hour field visits (2/first week of operation, 1/weeks 2,3,4, and 2/months 2 and 3)7.250 System parts 3 months parts x 250.00$ =750.00$ Miscellaneous system parts
7.260 Operating Utilities 3 months utilities x 1,530.00$ =4,590.00$ Estimate power $1,500/month, remote telemetry $30/month
7.260 Propane - usage 90 days x 200.00$ =18,000.00$ Oxidizer propane use. 12.050 Travel for 7.081 9 MOBE x 250.00$ =2,250.00$ Travel for 7.201
34,967.00$
Quarters 2,3,4
4.090 Cost for analytical 3 samples x 142.00$ = 426.00$ 880 3 months x EPA18 BTEX+TPH air samples
4.091 Sample shipping 3 fees x 85.00$ = 255.00$ s/h Shipping6.106 Corrective Action Performance Report 1 report x 1,000.00$ =1,000.00$
7.201 Cost for scheduled maintenance 48 hours x 93.00$ =4,464.00$ 8-hour visits twice per month of quarter. 7.250 System parts 3 months parts x 250.00$ =750.00$ Miscellaneous system parts
7.260 Operating Utilities 3 months utilities x 1,530.00$ =4,590.00$ Estimate power $1,500/month, remote telemetry $30/month
7.260 Propane - usage 90 days x 200.00$ =18,000.00$ Oxidizer propane use. 12.050 Travel for 7.081 6 MOBE x 250.00$ =1,500.00$ Travel for 7.201
30,985.00$
Routine quarter after 1st year of operation - assume oxidizer no longer needed
4.090 Cost for analytical 3 samples x 142.00$ = 426.00$ 880 3 months x EPA18 BTEX+TPH air samples
4.091 Sample shipping 3 fees x 85.00$ = 255.00$ s/h Shipping6.106 Corrective Action Performance Report 1 report x 1,000.00$ =1,000.00$
7.201 Cost for scheduled maintenance 48 hours x 93.00$ =4,464.00$ 8-hour visits twice per month of quarter. 7.250 System parts 3 months parts x 250.00$ =750.00$ Miscellaneous system parts
7.260 Operating Utilities 3 months utilities x 830.00$ =2,490.00$ Estimate power $800/month, remote telemetry $30/month
12.050 Travel for 7.081 6 MOBE x 250.00$ =1,500.00$ Travel for 7.20110,885.00$
127,922.00$ First year cost
130,620.00$ Three subsequent years
TOTAL 258,542.00$ Closure:
3.399 Monitoring well abandonment 1575 feet x 6.00$ =9,450.00$
3.398 Drill rig MOBE 1 MOBE x 350.00$ =350.00$
6.174 NORP 1 notice x 500.00$ =500.00$
6.082 Public notice 1 notice x 500.00$ =500.00$ 10,800.00$
CADR 5,500.00$
ROD 1,500.00$ Remedial well install 38,914.50$
Supervised treatment system installation 144,476.00$
Annual sampling:64,035.00$
Sytem operations and maintenance (O&M):258,542.00$
Closure:10,800.00$ 523,767.50$

FIGURES

ONSULTANTS, P.C.CENVIRONMENTAL
ENVIRONMENTAL CONSULTANTS, P.C.
ENVIRONMENTAL CONSULTANTS, P.C.
ENVIRONMENTAL CONSULTANTS, P.C.

APPENDIX A

Page 1 of 8 
 TECHNICAL METHODS/STANDARD PROCEDURES 

Equipment Decontamination 

All soil sampling equipment utilized during site assessment activities is decontaminated according 
to standard and accepted protocol.  Cleaning solutions range from clean potable water to acidic 
solutions or organic solvents depending on the contaminants present at the site.  Equipment 
utilized at sites, such as hand augers, contaminated with petroleum hydrocarbons, is generally 
decontaminated with a low‐sudsing detergent such as Luiquinox® and triple rinsed with distilled 
water.  Larger equipment, such as drill rigs and associated tools, is steam cleaned.  All 
decontamination procedures are completed within an established decontamination area which is 
located away from the active study area.  Frequency of equipment decontamination depends on 
the nature of work being performed, but in no case is decontamination performed less frequently 
than once per test (i.e., soil boring, well installation, sample collection, etc.).  Equipment blanks are 
collected as a quality control measure when required by job specifications. 

Soil Boring Installation 

Soil borings are completed using hand‐operated sampling tools, truck‐mounted drills, or 
Geoprobe® drilling rigs depending on the depth of sample collection and other site‐specific 
conditions.  Hand operated stainless‐steel bucket augers are utilized to collect soil samples at 
regular intervals to determine site stratigraphy and to test for the presence of volatile organic 
compounds.  Samples retrieved from the hand auger are necessarily disturbed during the augering 
process, but can provide accurate information on soil type and contaminant concentrations when 
properly interpreted.  Soil samples from hand augered borings are generally retrieved at one to 
two foot intervals. 

Truck‐mounted or Geoprobe® drilling equipment is often utilized when sample retrieval depths 
exceed twenty feet or subsurface conditions prevent utilization of hand augers (i.e., buried rocks, 
wood, bricks or other materials occur in the subsurface).  Truck‐mounted drilling rigs usually 
retrieve soil via a hollow‐stem auger/split spoon collection method.  Geoprobe® rigs usually employ 
a Macro‐Core® tube retrieval system.   

Hollow stem augers provide relatively undisturbed 2‐foot cores of soil samples.  Soil samples are 
generally collected at five foot intervals utilizing standard penetration test procedures as defined 
by the American Society for Testing and Materials (ASTM) or are pushed to the desired depth using 
the head of the drill rig.  The standard penetration test involves driving a 2" outside diameter by 1‐
3/8" inside diameter split‐spoon sampler a minimum distance of one foot with a 340‐lb. slide 
hammer falling a distance of 30 inches.   

A Geoprobe® rig is a hydraulically‐powered soil probing machine.  The probe utilizes static force 
and percussion to advance a small diameter sampling device into the subsurface.  The sampling 
apparatus provides relatively undisturbed 5‐foot cores of soil samples.  Soil samples are collected 
Page 2 of 8 
continuously.  The Macro‐Core® tube contains an inserted poly‐vinyl chloride (PVC) liner which 
retains the soil sample as the tube is driven into the ground.  The Macro‐Core® tube is 
decontaminated between each 5‐foot sample interval in a soil boring using a Liquinox and tap‐
water mixture.  A new PVC liner is used to collect soil from each sample interval in a soil boring.    

Soil samples retrieved from the hollow‐stem augers or Geoprobe are then carefully described 
according to the Unified Soil Classification System.  Soil descriptions are recorded on a soil 
boring log. 

Soil Sampling 

Soils to be analyzed by a North Carolina‐certified laboratory are prepared according to the specified 
analytical method.  Initially, soil samples are removed from the ground using either a hand auger, 
backhoe bucket, spilt spoon auger, or a Macro‐Core® sampling tube.  During the removal, care is 
taken to keep the disturbance of the soil structure to a minimum to reduce the loss of 
contaminants.  Once removed, the samples are placed in the proper sample container for the 
specified analytical method.  For samples collected for the MADEP VPH and EPA Method 8260, a 
TerraCore® sampler is used to collect one 5‐gram allotment of soil.  The allotment is placed in 
methanol‐preserved 40 mL vials.  Also, one 5‐gram allotment of soil is placed into sodium bisulfate‐
preserved 40 mL vials (one 5‐gram allotment per vial, 2 vials per sample) for the 8260 low 
concentration method.  A 250‐mL glass jar of the sampled soil is also collected to provide moisture 
content information.  Soils sampled for MADEP EPH, EPA Method 8270 and TPH 5030 and 3550 are 
placed in a 250‐mL glass jar (for MADEP EPH analysis an amber jar is required).  TPH 5030 samples 
are preserved in methanol similar to the 8260 analysis.  Field personnel wear new, disposable 
nitrile gloves during the collection of each sample.  

The soil samples are labeled with the sample location, sample identification, date and time of 
collection, and the analytical method.  The samples are placed on ice, sent to a laboratory, and 
analyzed before the expiration of an analytical method’s prescribed holding time.  Chain‐of‐custody 
documentation is maintained for each sample collected in the field. 

If the soil is being sampled for volatile or semi‐volatile compounds, a portion of the collected soil is 
placed in a sealable bag and screened for volatile organic vapors.  Head screening procedures are 
described in the following paragraph.  

Headspace Screening 

Collected soil samples are routinely tested for the presence of volatile organic compounds (VOCs).  
After retrieval from the ground, a portion of a soil sample is placed in a sealable plastic bag.  The 
soil samples are then set aside for approximately five minutes so that volatile constituents present 
in the sample can reach equilibrium concentrations with headspace gases in the bag.  Once a 
suitable time period has passed, the probe of the sampling instrument, typically an Organic Vapor 
Monitor (OVM) or a Photo Ionization Detector (PID), is inserted into the bag and the relative 
concentration of total VOCs is measured and permanently recorded in a field note book.  VOC 
Page 3 of 8 
concentrations are measured using either a Thermo Electron Corp. Innova Series catalytic OVM or 
an Ion Science PhoCheck PID.  Both the OVM and PID instrumentation are periodically calibrated 
according to the manufacturer’s recommended procedures. 

The OVM and PID are qualitative tools employed to detect and estimate the concentration of 
organic or hydrocarbon vapors.  A thin probe is inserted through a small break in the seal of a 
bagged soil sample.  For the OVM, an air sample from the headspace of the bag is drawn through 
the probe into an internal chamber where the vapors are catalyzed.  The concentration of the VOCs 
is registered on a digital scale in parts per million (ppm).  For the PID, an air sample from the 
headspace of the bag is drawn across the face of a lamp causing the sample to emit photons, the 
presence of which are converted into a VOC ppm reading that is displayed.  Oxygen levels are field 
calibrated prior to each use.  VOC calibration occurs periodically depending upon use by using a 
span gas of known concentration in a process recommended by the manufacturer.   

Well Installation/Construction 

Monitoring wells are installed using hand‐operated sampling tools, a truck‐mounted drill rig, or a 
Geoprobe drilling rig depending on the depth of well and other site‐specific conditions. All 
monitoring wells are installed according to the requirements of 15A NCAC 2C‐Well Construction 
Standards.  Specifically, individual monitoring wells are constructed of 2‐inch diameter, schedule 40 
PVC casing riser and screen.  The screen interval is generally 10 to 15 feet of machine slotted PVC 
with a slot size of 0.010".  Only flush threaded joints are used.  The annulus space around the 
screen is filled with washed filter pack No. 2 sand.  The filter pack extends one to two feet above 
the top of the screen.  A one to two foot‐thick bentonite pellet seal is then placed above the filter 
pack.  The remainder of the well annulus is completely filled with a Portland (Type I/II) cement 
grout mixture.  A protective outer steel manhole, locking cap, and concrete pad is installed for each 
well. 

Type II Monitoring Well Construction  

Single‐cased monitoring wells are generally used in delineation of groundwater quality within the 
surficial aquifer.  The wells are constructed of 2‐inch diameter, schedule 40 PVC casing and screen.  
The screen interval is generally 10 to 15 feet of machine slotted PVC with a slot size of 0.010".  Only 
flush threaded joints are used.  The annulus space around the screen is filled with washed filter 
pack No. 2 sand.  The filter pack extends one to two feet above the top of the screen.  A one to two 
foot‐thick bentonite pellet seal is then placed above the filter pack.  The remainder of the well 
annulus is completely filled with a Portland (Type I/II) cement grout mixture.  A protective outer 
steel manhole, locking cap, and concrete pad are installed for each well. 

Type III Monitoring Well Construction 

Double‐cased monitoring wells are used in the delineation of groundwater quality within a deeper 
portion of the surficial aquifer or an additional aquifer (e.g. aquitard, bedrock).  A four to six‐inch 
outer casing is installed through the surficial aquifer until a sufficient depth or until the deeper 
Page 4 of 8 
aquifer is encountered.  The casing is secured with a Portland‐grout collar that is tremmied into the 
annular spaced from the bottom of the bore hole to the surface.  Once the grout has sufficiently 
cured, the bore hole is continued through the bottom of the outer casing to a depth approximately 
15 ‐ 20 feet beneath the outer casing.  The inner casing is constructed of 2‐inch diameter, schedule 
40 PVC casing riser and screen.  The screen interval is generally 5 to 10 feet of machine slotted PVC 
with a slot size of 0.010".  Only flush threaded joints are used.  The annulus space around the 
screen is filled with washed filter pack No. 2 sand.  The filter pack extends one to two feet above 
the top of the screen.  A one to two foot‐thick bentonite pellet seal is then placed above the filter 
pack.  The remainder of the well annulus is completely filled with the same Portland grout mixture 
used in the outer casing.  A protective outer steel manhole, locking cap, and concrete pad are 
installed for each well. 

Well Development 

Following installation of each well, surging and pumping or bailing techniques will be used to 
remove fines from the screened interval.  Groundwater is removed from each well until clear water 
is retrieved or a noticeable reduction in the amount of silt is achieved.  Purged groundwater is 
disposed of in an environmentally safe manner. 

Groundwater Sampling 

Petroleum Sites 

Groundwater samples are collected from temporary or permanent monitoring wells according to 
established sampling protocol.  When multiple monitoring wells or sampling points are sampled, 
sampling is completed beginning with the least contaminated well to the most contaminated well, 
if it is known.  When permanent monitoring wells for petroleum sites are sampled, the well is 
purged of a minimum of three well‐bore volumes prior to sample collection in order to assure that 
sampled water is representative of aquifer conditions.  In temporary wells, the first water which 
migrates into the open borehole is sampled.  Samples from both temporary and permanent 
monitoring wells are collected using individually wrapped disposable polyethylene bailers by field 
personnel wearing disposable nitrile gloves.  Only one well is sampled with a given bailer in order to 
prevent sample cross‐contamination.  During both well purging and sampling, proper protective 
clothing and equipment is used and is dependent upon the type and level of contaminants present. 
Also, field personnel change gloves between different samples to reduce the chance of cross‐
contamination. Water samples are transferred from the bailer to laboratory‐prepared sampling 
containers using slow emptying devices to reduce the chance of contamination loss through 
volatilization.  Preservatives, such as acids, are provided by the laboratory in pre‐prepared 
containers in which collected samples are placed if in‐field preservation is necessary.  The samples 
are labeled with the project name, project number, sample identification, required analysis, and 
date and time of collection.  The samples are placed on ice, shipped to a certified laboratory, and 
analyzed before the expiration of an analytical method’s prescribed holding time.  Chain‐of‐custody 
documentation is maintained for each sample collected in the field.   

Page 5 of 8 

Other Groundwater Sampling Protocols 

When required by state or federal regulations, low‐flow groundwater sampling procedures are 
instituted.  Groundwater samples collected in low‐flow situations are collected using a peristaltic 
pump. A peristaltic pump is a type of positive displacement pump. The fluid is contained within a 
flexible tube fitted inside a circular pump casing.  A rotor with a number of rollers attached to the 
external circumference compresses the flexible tube. As the rotor turns, the part of tube under 
compression closes thus forcing the fluid to be pumped to move through the tube.  Groundwater 
parameters such as water level drawdown, pH, conductivity, dissolved oxygen (DO) and turbidity. 
Pumping rate, drawdown, and the time or volume required to obtain stabilization of parameter 
readings can be used as a future guide to purge the well. Measurements are collected at a pre‐
pumping established interval (typically five to ten minutes). Once all or a majority of the 
parameters have stabilized for three successive readings, stabilization has been achieved. In lieu of 
measuring all five parameters, a minimum subset would include pH, conductivity, and turbidity or 
DO. Three successive readings should be within ± 0.1 for pH, ± 3% for conductivity, and ± 10% for 
turbidity and DO.  

Upon parameter stabilization, sampling is initiated. Sampling flow rate is maintained at the estab‐
lished purge rate or is adjusted slightly to minimize aeration, bubble formation, turbulent filling of 
sample bottles, or loss of volatiles due to extended residence time in tubing. The same device used 
for purging is used to collect the groundwater sample. Generally, volatile parameters are sampled 
first. The sequence in which samples for inorganic parameters are collected is not determined 
unless filtered (dissolved) samples are collected. Preservatives, such as acids, are provided by the 
laboratory in pre‐prepared containers in which collected samples are placed if in‐field preservation 
is necessary.  The samples are labeled with the project name, project number, sample 
identification, required analysis, and date and time of collection.  The samples are placed on ice, 
shipped to a certified laboratory, and analyzed before the expiration of an analytical method’s 
prescribed holding time.  Chain‐of‐custody documentation is maintained for each sample collected 
in the field.   

During both well purging and sampling, proper protective clothing and equipment is used and is 
dependent upon the type and level of contaminants present.   Also, field personnel change gloves 
between different monitoring wells or sampling points to reduce the chance of cross‐
contamination.  When multiple monitoring wells or sampling points are sampled, sampling is 
completed beginning with the least contaminated well to the most contaminated well, if it is 
known. 

Stockpile Sampling 

The number of composite samples collected from a stockpile or a total quantity of excavated soil is 
based upon the cubic yardage.  One composite sample is collected for every 100 cubic yards of 
contaminated soil excavated.  The volume of a stockpile or total quantity of excavated soil is 
calculated by approximating the general geometry of a stockpile or estimating the capacity of the 
Page 6 of 8 
dump trucks used for hauling.  If a stockpile is sampled, a grid pattern is laid out on the stockpile, 
dividing the stockpile into segments of approximately 200 cubic yards.  Two soil borings are 
advanced within a grid and three soil samples are collected from each soil boring at various depths. 
 The six soil samples are mixed into a composite sample by a trained TerraQuest technician.  If truck 
loads are sampled, an aliquot sample is collected from the hauling trucks at a frequency based 
upon the capacity of the hauling trucks.   

Aliquots are gently mixed into a composite sample by a trained TerraQuest technician. Every effort 
is made to minimize the loss of contaminants through volatilization.  The composited soil samples 
are jarred in the appropriate laboratory‐prepared containers, labeled with the sample location, 
sample identification, date of collection, time of collection, the analytical method, and the 
preservative.  The samples are placed on ice, shipped to a laboratory, and analyzed before the 
expiration of an analytical method’s prescribed holding time.  Chain‐of‐custody documentation is 
maintained for each sample collected in the field. 

Surface Water Sampling 

Surface water samples, specifically samples from creeks or streams, are collected from a 
moving/flowing portion of the creek or stream to ensure that stagnant water is not collected.  Field 
personnel are careful to collect samples from flowing areas that are not so turbulent as to cause a 
loss of volatile contaminants which might have been contained in the creek’s/stream’s water.  
Samples are collected by field personnel wearing disposable nitrile gloves.  Field personnel change 
gloves between different locations to reduce the chance of cross‐contamination.  Samples are 
collected directly from the appropriate creek or stream location and placed into the appropriate 
laboratory‐prepared containers.  Preservatives, such as acids, are provided by the laboratory in pre‐
prepared containers in which collected samples are placed if in‐field preservation is necessary. The 
samples are labeled with the project name, project number, sample identification, required 
analysis, and date and time of collection.  The samples are cooled on ice to approximately four 
degrees centigrade, shipped to a certified laboratory, and analyzed before the expiration of an 
analytical method’s prescribed holding time.  Chain‐of‐custody documentation is maintained for 
each sample collected in the field.    

Potable Well Sampling 

Groundwater samples from potable wells are collected from sampling points, typically spigots, 
located in the closest proximity to the potable well pump house as possible.  Prior to sample 
collection, the water is run for a sufficient amount of time to purge the bladder tank and assure 
that sampled water is representative of aquifer conditions.  Once purged, the flow rate is reduced 
and samples are placed in the appropriate laboratory prepared containers with the appropriate 
acid preservatives added if preservation of the sample is necessary.  The samples are labeled with 
the project name, project number, sample identification, required analysis, and date and time of 
collection.  The samples are placed on ice, shipped to a laboratory, and analyzed before the 
expiration of an analytical method’s prescribed holding time.  Chain‐of‐custody documentation is 
maintained for each sample collected in the field.  
Page 7 of 8 
Public Water Supply Line Sampling 

Groundwater samples from public water supply lines are collected from sampling points, typically 
spigots.  To sample the spigot, the flow rate is reduced and samples are placed in the appropriate 
laboratory prepared containers.  The samples are labeled with the sample location, sample 
identification, date of collection, time of collection, and required analytical method.  The samples 
are placed on ice, shipped to a laboratory, and analyzed before the expiration of an analytical 
method’s prescribed holding time.  Chain‐of‐custody documentation is maintained for each sample 
collected in the field.  

Air Sampling 

Air samples are collected with the aide of a manually operated MityVac® pump manufactured by 
Pristech, Inc.  The air sampling process begins by connecting a length of rubber hose from the 
MityVac® pump to the port to be sampled, or by hanging the hose inside of an emissions stack in 
such a manner as to ensure no outside air causes dilution.  Another length of hose is fixed to the 
outlet port of the pump and is connected to a new Tedlar bag.  Once the pump is hooked up, a 
valve on the Tedlar collection bag is opened and air is manually forced into the bag by the pumping 
action of sampling personnel.   

Field Measurements 

Field measurements taken to determine the pH, conductivity, temperature, and dissolved oxygen 
concentration of a particular groundwater sample are taken directly after a particular monitoring 
well has been adequately purged.  This ensures that the groundwater parameter data collected is 
representative of the aquifer conditions at a given location.  Once purging of the monitoring well is 
complete, the decontaminated probe head and cord of the appropriate unit is lowered into the 
required monitoring well.  If the depth to water in a specific monitoring well is greater than the 
length of cord for a particular unit, a new, disposable bailer is slowly lowered into the appropriate 
monitoring well and a representative groundwater sample is retrieved.  A slow pouring device is 
fitted onto the end of the disposable bailer and the sample is slowly poured into a new, disposable 
plastic cup.  Groundwater parameter data are then collected from the groundwater in the cup 
using the required unit.   

For pH, conductivity, and temperature, a Hanna Instruments Model 991300 portable meter is 
utilized.  This unit is periodically calibrated and maintained in accordance with the unit’s operations 
manual by field personnel.  Prior to data collection, the unit is properly decontaminated to prevent 
cross‐contamination.  The unit is decontaminated between each sample.  The procedure used for 
sample measurement involves lowering the meter’s probe into the new, disposable cup containing 
the groundwater sample to be measured and slowly stirring the probe to force groundwater across 
the probe’s membrane.  The measurements displayed by the meter are then recorded.   

For dissolved oxygen concentration measurements, a YSI® Model 55 Handheld Dissolved Oxygen 
System is utilized.  This unit is periodically calibrated and maintained in accordance with the unit’s 
Page 8 of 8 
operations manual by field personnel.  Prior to data collection, the unit is properly decontaminated 
to prevent cross‐contamination.  The unit is decontaminated between each sample.  The procedure 
used for sample measurement involves adjusting the unit for the correct altitude where the 
sampling will take place and adjusting the reported units desired.  Once this is done, the unit’s 
probe is inserted into the groundwater sample to be measured and the probe is slowly stirred to 
force the groundwater across the probe’s membrane.  The measurements displayed by the unit are 
then recorded.   

For turbidity measurements, a Hach 2100P Portable Turbidity meter or equal equivalent is utilized.  
The unit is calibrated prior to use in accordance with the unit’s operations manual by field 
personnel.  Groundwater samples are collected in glass containers for measurement by the 
instrument.  The glass containers are washed with bottled‐water between each measurement 
collection.  Once the sample is collected and inserted into the instrument, the measurements 
displayed by the instrument are then recorded.   

APPENDIX B

Perth Mini Mart (#40784)
Chronological Site History
Terraquest Environmental Consultants, P.C.
Page 1 of 3

CHRONOLOGICAL SITE HISTORY

Perth Mini Mart
818 Perth Road, Troutman, NC
Facility ID#: 00-0-0000024524
NCDWM UST Incident No.: 40784
Terraquest Project No.: 08217

March 4, 1980 According to the North Carolina UST Database Records, two 6,000-
gallon gasoline, one 4,000-gallon gasoline, and one 2,000-gallon diesel
USTs were installed at the site.

November 16, 2017 Terraquest personnel mobilized to the Perth Mini Mart facility to
conduct a limited scope site check. The UST owner had recently noted
inventory record discrepancies based upon ATG reading for UST T3. To
investigate these irregularities, the UST owner had a tank tightness test
completed on this UST which resulted in failure. In response, the UST
owner submitted an UST-17A UST Suspected Release 24-Hour Notice
Form. A site check was then required to investigate a potential release
of petroleum.

Soil quality was assessed through the advancement of four soil borings
(B1 – B4) around the suspect UST. Samples from the B1(18-20), B2(8-
10), B3(8-10), and B4(13-15) were submitted for laboratory analysis
per EPA Method 8015 utilizing the 5030-extraction method for
gasoline range organics (GRO). Analytical results of the collected soil
samples revealed detectable concentrations of TPH GRO in each
sample; however, only the B1(18-20) sample contained a TPH GRO
concentration (497 ug/kg) above the 100 mg/kg action limit.

December 8, 2017 Terraquest submitted a copy of the Site Check Report Letter and UST-
61 24 Hour Release Reporting Form were submitted to the NCDWM-
UST. Three soil samples were collected from the MW1 soil boring at
the 10-12 ft. BGL, 20-22 ft. BGL, and 30-32 ft. BGL intervals.

December 19, 2017 The NCDWM-UST issued an NORR that confirmed receipt of the Site
Check Report and requested the completion of an LSA.

January 16, 2018 Terraquest personnel supervised the installation of one Type II
groundwater monitoring well (MW1) as part of a Phase I LSA in the
vicinity of the previous B1 soil boring.

Perth Mini Mart (#40784)
Chronological Site History
Terraquest Environmental Consultants, P.C.
Page 2 of 3
January 22, 2018 Terraquest personnel collected a groundwater sample from
monitoring well MW1 after gauging the well for free product using an
oil/water interface probe that did not detect any measurable amount
of free product. Prior to groundwater sample collection, Terraquest
gauged 6.25 feet of free product in monitoring well MW2. No
additional wells contained free product on this date. Groundwater
samples were collected from monitoring wells MW3 and MW4.

March 19, 2018 The NCDWM-UST LUST Trust Fund issued a correspondence regarding
the Commercial State Trust Fund Eligibility Application. The release
incident was found conditionally eligible following a $20,000
deductible that was noted as having been met.

June 18-19, 2018 Terraquest personnel supervised the installation of three additional
monitoring wells (MW2 – MW4) as part of the Phase II LSA.

August 3, 2018 Terraquest submitted an LSA Report (Phase I & II) to the NCDWM-UST.

August 6, 2018 Terraquest requested pre-approval of costs necessary to complete a
CSA.

September 6, 2018 Terraquest requested pre-approval of costs necessary to conduct free
product recovery via MMPE.

September 11, 2018 The NCDWM-UST grants pre-approval of costs for free product
recovery via MMPE.

October 3, 2018 The NCWM-UST grants pre-approval of costs for CSA activities.

October 22-26, 2018 Terraquest supervised an MMPE event at the site. A total of 4, 041
gallons of a free product/contaminated groundwater mixture were
recovered.

November 26-28, 2018 Terraquest personnel supervised the installation of groundwater
monitoring wells MW5-MW11. These wells were installed as part of
the CSA. Monitoring wells MW5-MW10 are Type II wells installed for
horizontal assessment while monitoring well MW11 is a Type III well
installed for vertical delineation of contamination. Soil borings

December 3, 2018 As part of the CSA, Terraquest personnel sampled monitoring wells
MW1 – MW11 and surveyed the casing elevations of recently installed
wells MW5-MW11. Slug tests were conducted on monitoring wells
MW3, MW5, and MW7.

Perth Mini Mart (#40784)
Chronological Site History
Terraquest Environmental Consultants, P.C.
Page 3 of 3

October 7-11, 2019 Terraquest supervised an MMPE event at the site. Free product was
removed from monitoring well MW2. A total of 3,027 gallons of
contaminated groundwater was removed. Emissions stack
calculations indicate the exhaust of 20.57 gallons of petroleum.

June 1, 2, and 3, 2020 Terraquest supervised a high-resolution study conducted by Dakota
Technologies Company, LLC. The study was requested by the NCDWM-
UST to identify the location of free product and involved the advancement
of ten borings that were analyzed using an Ultra-Violet Optical Screening
Tool (UVOST).

September 22-23, 2020 Terraquest supervised the installation of three free product monitoring
wells, MW15, MW16, and MW17. A free product evaluation was
performed on monitoring well MW2. Groundwater monitoring wells
without free product were sampled and sent off for VOC analysis.
While there were no indications of a release from the diesel AST, STF
demanded that 625 analysis be performed on all wells at the site at a
cost exceeding $3,000 to rule out a release.

March 22-26, 2021 Terraquest supervised an MMPE event at the site. Free product was
removed from monitoring wells MW2, MW16, and MW17. A total of
4,679 gallons of contaminated groundwater was removed. Emissions
stack calculations indicate the exhaust of 20.72 gallons of petroleum.

April 21, 2021 Terraquest personnel gauged monitoring wells and found free product
in MW16 (1.49’) and MW17 (0.05’).

November 16-17, 2021 Terraquest supervised the installation of pilot test wells SVE1, SVE2,
SVE3, and AS1.

November 22-23, 2021 Terraquest conducted SVE and air sparge pilot tests.

APPENDIX C

Well ID
Top of Casing
Elevation
(feet)
Depth to
Water from Top
of Casing
(feet)
Free Product
Thickness
(feet)
Groundwater
Elevation
(feet)
Depth to
Water from Top
of Casing
(feet)
Free Product
Thickness
(feet)
Groundwater
Elevation
(feet)
Depth to
Water from Top
of Casing
(feet)
Free Product
Thickness
(feet)
Groundwater
Elevation
(feet)
Depth to
Water from Top
of Casing
(feet)
Free Product
Thickness
(feet)
Groundwater
Elevation
(feet)
Depth to
Water from Top
of Casing
(feet)
Free Product
Thickness
(feet)
Groundwater
Elevation
(feet)
Depth to
Water from Top
of Casing
(feet)
Free Product
Thickness
(feet)
Groundwater
Elevation
(feet)MW1 98.78 38.60 0 60.18 36.43 0 62.35 35.74 0 63.04 34.59 0 64.19 31.50 0 67.28 31.25 0 67.53
MW2 97.83 ---40.45 6.25 61.95 40.38 7.05 62.60 38.26 5.63 63.68 34.00 4.11 66.83 30.90 0.18 67.06MW398.54 ---36.28 0 62.26 35.59 0 62.95 34.62 0 63.92 31.47 0 67.07 31.30 0 67.24MW499.68 ---37.02 0 62.66 36.3 0 63.38 35.11 0 64.57 ---31.77 0 67.91MW596.31 ---------32.95 0 63.36 ---29.70 0 66.61MW697.53 ---------34.23 0 63.30 ---29.89 0 67.64
MW7 99.37 ---------35.00 0 64.37 ---31.52 0 67.85MW898.72 ---------35.19 0 63.53 ---31.79 0 66.93MW989.72 ---------25.64 0 64.08 ---22.42 0 67.30MW1090.75 ---------26.95 0 63.80 ---23.80 0 66.95MW1196.80 ---------33.22 0 63.58 ---29.95 0 66.85
MW12 94.74 ---------------25.37 0 69.37MW1394.30 ---------------22.95 0 71.35MW1496.30 ---------------29.89 0 66.41Average shallow DTW:38.60 36.58 35.88 32.70 31.49 28.47
Well ID
Top of
Casing Elevation
(feet)
Depth to
Water
from Top of Casing
(feet)
Free
Product Thickness
(feet)
Groundwater Elevation
(feet)
Depth to
Water
from Top of Casing
(feet)
Free
Product Thickness
(feet)
Groundwater Elevation
(feet)
Depth to
Water
from Top of Casing
(feet)
Free
Product Thickness
(feet)
Groundwater Elevation
(feet)
Depth to
Water
from Top of Casing
(feet)
Free
Product Thickness
(feet)
Groundwater Elevation
(feet)
Depth to
Water
from Top of Casing
(feet)
Free
Product Thickness
(feet)
Groundwater Elevation
(feet)
Depth to
Water
from Top of Casing
(feet)
Free
Product Thickness
(feet)
Groundwater Elevation
(feet)
MW1 98.78 ---30.20 -68.58 ---------32.13 0 66.65MW297.83 32.8 2.85 67.11 32.70 4.12 68.14 30.12 3.08 69.96 28.80 0 69.03 27.45 0 70.38 34.82 4.2 66.08MW398.54 ---29.73 -68.81 ------------MW4 99.68 ---30.50 -69.18 ------------
MW5 96.31 ---28.08 -68.23 ------------
MW6 97.53 ---29.05 -68.48 ------------MW7 99.37 ---29.93 -69.44 ------------MW8 98.72 ---29.82 -68.9 ------------MW9 89.72 ---21.45 -68.27 ------------
MW10 90.75 ---22.76 -67.99 ------------
MW11 96.80 ---28.96 -67.84 ------------MW12 94.74 ---26.73 -68.01 ------------MW13 94.30 ---26.57 -67.73 ------------MW14 96.30 ---27.84 -68.46 ------------
MW15 97.25 ---29.07 -68.18 27.3 0 69.95 27.59 0 69.66 27.00 0 70.25 34.05 3 65.39
MW16 97.38 ---29.15 0.05 68.26 29.58 2.85 69.881925 27.74 0 69.64 28.22 1.49 70.248445 34.82 4.82 66.08MW1798.41 ---30.05 -68.36 29.25 0.12 69.24766 28.59 0.1 69.89305 27.92 0.05 70.526525 32.05 0.05 66.40AS198.06 ---------------31.72 0 66.34Average shallow DTW:27.98 29.06 28.18 27.65 33.27
Notes:
1. "BGS" = below ground surface
7/24/2019 9/23/2020 3/22/2021 3/26/2021 4/21/2021 9/23/2021
4/30/2019
HISTORICAL GROUNDWATER ELEVATION DATAIncident Name: Peth Mini Mart Incident No.: 407841/22/2018 6/25/2018 12/3/201810/22/2018 4/22/2019

APPENDIX D

:(//&216758&7,215(&25'
7KLVIRUPFDQEHXVHGIRUVLQJOHRUPXOWLSOHZHOOV
)RUP*:  1RUWK&DUROLQD'HSDUWPHQWRI(QYLURQPHQWDQG1DWXUDO5HVRXUFHV±'LYLVLRQRI:DWHUResources 5HYLVHG$ugust
:HOO&RQWUDFWRU,QIRUPDWLRQ
:HOO&RQWUDFWRU1DPH
1&:HOO&RQWUDFWRU&HUWLILFDWLRQ1XPEHU
&RPSDQ\1DPH
:HOO&RQVWUXFWLRQ3HUPLW
List all applicable well permits (i.e. County, State, Variance, Injection, etc.)
:HOO8VH FKHFNZHOOXVH
:DWHU6XSSO\:HOO
Ƒ$JULFXOWXUDO Ƒ0XQLFLSDO3XEOLF
Ƒ*HRWKHUPDO+HDWLQJ&RROLQJ6XSSO\Ƒ5HVLGHQWLDO:DWHU6XSSO\ VLQJOH
Ƒ,QGXVWULDO&RPPHUFLDO Ƒ5HVLGHQWLDO:DWHU6XSSO\ VKDUHG
Ƒ,UULJDWLRQ
1RQ:DWHU6XSSO\:HOO
Ƒ0RQLWRULQJ Ƒ5HFRYHU\
,QMHFWLRQ :HOO
Ƒ$TXLIHU5HFKDUJH Ƒ*URXQGZDWHU5HPHGLDWLRQ
Ƒ$TXLIHU6WRUDJHDQG5HFRYHU\Ƒ6DOLQLW\%DUULHU
Ƒ$TXLIHU7HVW Ƒ6WRUPZDWHU'UDLQDJH
Ƒ([SHULPHQWDO7HFKQRORJ\Ƒ6XEVLGHQFH&RQWURO
Ƒ*HRWKHUPDO&ORVHG/RRSƑ7UDFHU
Ƒ*HRWKHUPDO+HDWLQJ&RROLQJ5HWXUQƑ2WKHUH[SODLQXQGHU5HPDUNV
'DWH:HOOV&RPSOHWHGBBBBBBBBBBBB:HOO,'BBBBBBBBBBBBBBBBBBBBBB
D:HOO/RFDWLRQ

)DFLOLW\2ZQHU 1DPH )DFLOLW\,'LIDSSOLFDEOH

3K\VLFDO$GGUHVV&LW\DQG=LS

&RXQW\ 3DUFHO,GHQWLILFDWLRQ1R3,1
E/DWLWXGHDQG/RQJLWXGHLQGHJUHHVPLQXWHVVHFRQGVRUGHFLPDOGHJUHHV
LIZHOOILHOGRQHODWORQJLVVXIILFLHQW
1 :
,V DUHWKHZHOOVƑ3HUPDQHQWRUƑ7HPSRUDU\
,VWKLVDUHSDLUWRDQH[LVWLQJZHOOƑ<HVRUƑ1R
If this is a repair, fill out known well construction information and explain the nature of the repair under #21 remarks section or on the back of this form.
 1XPEHURIZHOOVFRQVWUXFWHG 
For multiple injection or non-water supply wells ONLY with the same construction, you can
submit one form.
7RWDOZHOOGHSWK EHORZODQG VXUIDFH  IW
For multiple wells list all depths if different (example- 3@200’ and 2@100ƍ
6WDWLFZDWHUOHYHOEHORZWRSRIFDVLQJ IWIf water level is above casing, use “+”
%RUHKROHGLDPHWHU LQ
:HOOFRQVWUXFWLRQPHWKRG  
LHDXJHUURWDU\FDEOHGLUHFWSXVKHWF
)25:$7(56833/<:(//621/<
D<LHOGJSP0HWKRGRIWHVW
E'LVLQIHFWLRQW\SH$PRXQW
:$7(5=21(6
)520 72 '(6&5,37,21
IWIW
IWIW
287(5&$6,1* IRUPXOWLFDVHGZHOOV25/,1(5LIDSSOLFDEOH
)520 72 ',$0(7(5 7+,&.1(66 0$7(5,$/
IWIWLQ
,11(5&$6,1* 2578%,1* JHRWKHUPDOFORVHGORRS
)520 72 ',$0(7(5 7+,&.1(66 0$7(5,$/
IWIWLQ
IWIWLQ
6&5((1
)520 72 ',$0(7(5 6/27 6,=( 7+,&.1(66 0$7(5,$/
IWIWLQ
IWIWLQ
*5287
)520 72 0$7(5,$/ (03/$&(0(170(7+2' $02817
IWIW
IWIW
IWIW
6$1'*5$9(/3$&.LIDSSOLFDEOH
)520 72 0$7(5,$/ (03/$&(0(170(7+2'
IWIW
IWIW
'5,//,1*/2* DWWDFKDGGLWLRQDOVKHHWVLIQHFHVVDU\
)520 72 '(6&5,37,21 FRORUKDUGQHVVVRLOURFNW\SHJUDLQVL]HHWF
IWIW
IWIW
IWIW
IWIW
IWIW
IWIW
IWIW
5(0$5.6
&HUWLILFDWLRQ
6LJQDWXUHRI&HUWLILHG:HOO&RQWUDFWRU 'DWH
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
6LWHGLDJUDPRUDGGLWLRQDOZHOOGHWDLOV
<RXPD\XVHWKHEDFNRI WKLVSDJHWRSURYLGHDGGLWLRQDOZHOOVLWHGHWDLOVRUZHOOFRQVWUXFWLRQGHWDLOV<RXPD\DOVRDWWDFKDGGLWLRQDO SDJHVLIQHFHVVDU\
68%0,77$/,1678&7,216
D )RU $OO :HOOV 6XEPLWWKLVIRUPZLWKLQGD\VRIFRPSOHWLRQRIZHOO
FRQVWUXFWLRQ WRWKHIROORZLQJ
'LYLVLRQRI:DWHU5HVRXUFHV,QIRUPDWLRQ3URFHVVLQJ 8QLW
0DLO6HUYLFH&HQWHU5DOHLJK1&
E)RU,QMHFWLRQ:HOOV21/<,QDGGLWLRQWRVHQGLQJWKHIRUPWRWKHDGGUHVVLQ
DDERYHDOVRVXEPLWDFRS\RI WKLVIRUP ZLWKLQGD\VRIFRPSOHWLRQRI ZHOO
FRQVWUXFWLRQWRWKHIROORZLQJ
'LYLVLRQRI:DWHU5HVRXUFHV8QGHUJURXQG,QMHFWLRQ&RQWURO3URJUDP
 0DLO6HUYLFH&HQWHU5DOHLJK1&
F)RU:DWHU6XSSO\ ,QMHFWLRQ :HOOV
$OVR VXEPLW RQH FRS\ RI WKLV IRUP ZLWKLQGD\V RIFRPSOHWLRQRI
ZHOOFRQVWUXFWLRQWRWKHFRXQW\KHDOWKGHSDUWPHQWRIWKHFRXQW\ZKHUH
FRQVWUXFWHG
)RU,QWHUQDO8VH21/<
_______________
Jonathan R. Grubbs
3001
Terraquest Environmental Consultants, P.C.
✔
11/16/2021 AS1
Perth Mini Mart 00-0-24524
818 Perth Rd.
Iredell 4730-50-7091
35.648900 -80.895787
✔
✔
1
60
N/A
8.25
Hollow Stem Auger
55'60'.010 Sch. 40 PVC
0 51 Portland Pour
51 53 Bentonite Pour
53 60 No. 2 Sand Pour
0 0.5 Asphalt
0.5 35 Silt
Digitally signed by Jonathan Grubbs
DN: cn=Jonathan Grubbs, o=Terraquest
Environmental Consultants, P.C., ou,
email=[e-mail], c=US
Date: 2021.11.17 16:27:34 -05'00'
:(//&216758&7,215(&25'
7KLVIRUPFDQEHXVHGIRUVLQJOHRUPXOWLSOHZHOOV
)RUP*:  1RUWK&DUROLQD'HSDUWPHQWRI(QYLURQPHQWDQG1DWXUDO5HVRXUFHV±'LYLVLRQRI:DWHUResources 5HYLVHG$ugust
:HOO&RQWUDFWRU,QIRUPDWLRQ
:HOO&RQWUDFWRU1DPH
1&:HOO&RQWUDFWRU&HUWLILFDWLRQ1XPEHU
&RPSDQ\1DPH
:HOO&RQVWUXFWLRQ3HUPLW
List all applicable well permits (i.e. County, State, Variance, Injection, etc.)
:HOO8VH FKHFNZHOOXVH
:DWHU6XSSO\:HOO
Ƒ$JULFXOWXUDO Ƒ0XQLFLSDO3XEOLF
Ƒ*HRWKHUPDO+HDWLQJ&RROLQJ6XSSO\Ƒ5HVLGHQWLDO:DWHU6XSSO\ VLQJOH
Ƒ,QGXVWULDO&RPPHUFLDO Ƒ5HVLGHQWLDO:DWHU6XSSO\ VKDUHG
Ƒ,UULJDWLRQ
1RQ:DWHU6XSSO\:HOO
Ƒ0RQLWRULQJ Ƒ5HFRYHU\
,QMHFWLRQ :HOO
Ƒ$TXLIHU5HFKDUJH Ƒ*URXQGZDWHU5HPHGLDWLRQ
Ƒ$TXLIHU6WRUDJHDQG5HFRYHU\Ƒ6DOLQLW\%DUULHU
Ƒ$TXLIHU7HVW Ƒ6WRUPZDWHU'UDLQDJH
Ƒ([SHULPHQWDO7HFKQRORJ\Ƒ6XEVLGHQFH&RQWURO
Ƒ*HRWKHUPDO&ORVHG/RRSƑ7UDFHU
Ƒ*HRWKHUPDO+HDWLQJ&RROLQJ5HWXUQƑ2WKHUH[SODLQXQGHU5HPDUNV
'DWH:HOOV&RPSOHWHGBBBBBBBBBBBB:HOO,'BBBBBBBBBBBBBBBBBBBBBB
D:HOO/RFDWLRQ

)DFLOLW\2ZQHU 1DPH )DFLOLW\,'LIDSSOLFDEOH

3K\VLFDO$GGUHVV&LW\DQG=LS

&RXQW\ 3DUFHO,GHQWLILFDWLRQ1R3,1
E/DWLWXGHDQG/RQJLWXGHLQGHJUHHVPLQXWHVVHFRQGVRUGHFLPDOGHJUHHV
LIZHOOILHOGRQHODWORQJLVVXIILFLHQW
1 :
,V DUHWKHZHOOVƑ3HUPDQHQWRUƑ7HPSRUDU\
,VWKLVDUHSDLUWRDQH[LVWLQJZHOOƑ<HVRUƑ1R
If this is a repair, fill out known well construction information and explain the nature of the repair under #21 remarks section or on the back of this form.
 1XPEHURIZHOOVFRQVWUXFWHG 
For multiple injection or non-water supply wells ONLY with the same construction, you can
submit one form.
7RWDOZHOOGHSWK EHORZODQG VXUIDFH  IW
For multiple wells list all depths if different (example- 3@200’ and 2@100ƍ
6WDWLFZDWHUOHYHOEHORZWRSRIFDVLQJ IWIf water level is above casing, use “+”
%RUHKROHGLDPHWHU LQ
:HOOFRQVWUXFWLRQPHWKRG  
LHDXJHUURWDU\FDEOHGLUHFWSXVKHWF
)25:$7(56833/<:(//621/<
D<LHOGJSP0HWKRGRIWHVW
E'LVLQIHFWLRQW\SH$PRXQW
:$7(5=21(6
)520 72 '(6&5,37,21
IWIW
IWIW
287(5&$6,1* IRUPXOWLFDVHGZHOOV25/,1(5LIDSSOLFDEOH
)520 72 ',$0(7(5 7+,&.1(66 0$7(5,$/
IWIWLQ
,11(5&$6,1* 2578%,1* JHRWKHUPDOFORVHGORRS
)520 72 ',$0(7(5 7+,&.1(66 0$7(5,$/
IWIWLQ
IWIWLQ
6&5((1
)520 72 ',$0(7(5 6/27 6,=( 7+,&.1(66 0$7(5,$/
IWIWLQ
IWIWLQ
*5287
)520 72 0$7(5,$/ (03/$&(0(170(7+2' $02817
IWIW
IWIW
IWIW
6$1'*5$9(/3$&.LIDSSOLFDEOH
)520 72 0$7(5,$/ (03/$&(0(170(7+2'
IWIW
IWIW
'5,//,1*/2* DWWDFKDGGLWLRQDOVKHHWVLIQHFHVVDU\
)520 72 '(6&5,37,21 FRORUKDUGQHVVVRLOURFNW\SHJUDLQVL]HHWF
IWIW
IWIW
IWIW
IWIW
IWIW
IWIW
IWIW
5(0$5.6
&HUWLILFDWLRQ
6LJQDWXUHRI&HUWLILHG:HOO&RQWUDFWRU 'DWH
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
6LWHGLDJUDPRUDGGLWLRQDOZHOOGHWDLOV
<RXPD\XVHWKHEDFNRI WKLVSDJHWRSURYLGHDGGLWLRQDOZHOOVLWHGHWDLOVRUZHOOFRQVWUXFWLRQGHWDLOV<RXPD\DOVRDWWDFKDGGLWLRQDO SDJHVLIQHFHVVDU\
68%0,77$/,1678&7,216
D )RU $OO :HOOV 6XEPLWWKLVIRUPZLWKLQGD\VRIFRPSOHWLRQRIZHOO
FRQVWUXFWLRQ WRWKHIROORZLQJ
'LYLVLRQRI:DWHU5HVRXUFHV,QIRUPDWLRQ3URFHVVLQJ 8QLW
0DLO6HUYLFH&HQWHU5DOHLJK1&
E)RU,QMHFWLRQ:HOOV21/<,QDGGLWLRQWRVHQGLQJWKHIRUPWRWKHDGGUHVVLQ
DDERYHDOVRVXEPLWDFRS\RI WKLVIRUP ZLWKLQGD\VRIFRPSOHWLRQRI ZHOO
FRQVWUXFWLRQWRWKHIROORZLQJ
'LYLVLRQRI:DWHU5HVRXUFHV8QGHUJURXQG,QMHFWLRQ&RQWURO3URJUDP
 0DLO6HUYLFH&HQWHU5DOHLJK1&
F)RU:DWHU6XSSO\ ,QMHFWLRQ :HOOV
$OVR VXEPLW RQH FRS\ RI WKLV IRUP ZLWKLQGD\V RIFRPSOHWLRQRI
ZHOOFRQVWUXFWLRQWRWKHFRXQW\KHDOWKGHSDUWPHQWRIWKHFRXQW\ZKHUH
FRQVWUXFWHG
)RU,QWHUQDO8VH21/<
_______________
Jonathan R. Grubbs
3001
Terraquest Environmental Consultants, P.C.
✔
11/16/2021 SVE1,SVE2
Perth Mini Mart 00-0-24524
818 Perth Rd.
Iredell 4730-50-7091
35.648900 -80.895787
✔
✔
2
35
N/A
6.25
Solid Stem Auger
20'35'.010 Sch. 40 PVC
0 16 Portland Pour
16 18 Bentonite Pour
18 35 No. 2 Sand Pour
0 0.5 Top Soil
0.5 35 Silt
Digitally signed by Jonathan Grubbs
DN: cn=Jonathan Grubbs, o=Terraquest
Environmental Consultants, P.C., ou,
email=[e-mail], c=US
Date: 2021.11.17 16:27:34 -05'00'
:(//&216758&7,215(&25'
7KLVIRUPFDQEHXVHGIRUVLQJOHRUPXOWLSOHZHOOV
)RUP*:  1RUWK&DUROLQD'HSDUWPHQWRI(QYLURQPHQWDQG1DWXUDO5HVRXUFHV±'LYLVLRQRI:DWHUResources 5HYLVHG$ugust
:HOO&RQWUDFWRU,QIRUPDWLRQ
:HOO&RQWUDFWRU1DPH
1&:HOO&RQWUDFWRU&HUWLILFDWLRQ1XPEHU
&RPSDQ\1DPH
:HOO&RQVWUXFWLRQ3HUPLW
List all applicable well permits (i.e. County, State, Variance, Injection, etc.)
:HOO8VH FKHFNZHOOXVH
:DWHU6XSSO\:HOO
Ƒ$JULFXOWXUDO Ƒ0XQLFLSDO3XEOLF
Ƒ*HRWKHUPDO+HDWLQJ&RROLQJ6XSSO\Ƒ5HVLGHQWLDO:DWHU6XSSO\ VLQJOH
Ƒ,QGXVWULDO&RPPHUFLDO Ƒ5HVLGHQWLDO:DWHU6XSSO\ VKDUHG
Ƒ,UULJDWLRQ
1RQ:DWHU6XSSO\:HOO
Ƒ0RQLWRULQJ Ƒ5HFRYHU\
,QMHFWLRQ :HOO
Ƒ$TXLIHU5HFKDUJH Ƒ*URXQGZDWHU5HPHGLDWLRQ
Ƒ$TXLIHU6WRUDJHDQG5HFRYHU\Ƒ6DOLQLW\%DUULHU
Ƒ$TXLIHU7HVW Ƒ6WRUPZDWHU'UDLQDJH
Ƒ([SHULPHQWDO7HFKQRORJ\Ƒ6XEVLGHQFH&RQWURO
Ƒ*HRWKHUPDO&ORVHG/RRSƑ7UDFHU
Ƒ*HRWKHUPDO+HDWLQJ&RROLQJ5HWXUQƑ2WKHUH[SODLQXQGHU5HPDUNV
'DWH:HOOV&RPSOHWHGBBBBBBBBBBBB:HOO,'BBBBBBBBBBBBBBBBBBBBBB
D:HOO/RFDWLRQ

)DFLOLW\2ZQHU 1DPH )DFLOLW\,'LIDSSOLFDEOH

3K\VLFDO$GGUHVV&LW\DQG=LS

&RXQW\ 3DUFHO,GHQWLILFDWLRQ1R3,1
E/DWLWXGHDQG/RQJLWXGHLQGHJUHHVPLQXWHVVHFRQGVRUGHFLPDOGHJUHHV
LIZHOOILHOGRQHODWORQJLVVXIILFLHQW
1 :
,V DUHWKHZHOOVƑ3HUPDQHQWRUƑ7HPSRUDU\
,VWKLVDUHSDLUWRDQH[LVWLQJZHOOƑ<HVRUƑ1R
If this is a repair, fill out known well construction information and explain the nature of the repair under #21 remarks section or on the back of this form.
 1XPEHURIZHOOVFRQVWUXFWHG 
For multiple injection or non-water supply wells ONLY with the same construction, you can
submit one form.
7RWDOZHOOGHSWK EHORZODQG VXUIDFH  IW
For multiple wells list all depths if different (example- 3@200’ and 2@100ƍ
6WDWLFZDWHUOHYHOEHORZWRSRIFDVLQJ IWIf water level is above casing, use “+”
%RUHKROHGLDPHWHU LQ
:HOOFRQVWUXFWLRQPHWKRG  
LHDXJHUURWDU\FDEOHGLUHFWSXVKHWF
)25:$7(56833/<:(//621/<
D<LHOGJSP0HWKRGRIWHVW
E'LVLQIHFWLRQW\SH$PRXQW
:$7(5=21(6
)520 72 '(6&5,37,21
IWIW
IWIW
287(5&$6,1* IRUPXOWLFDVHGZHOOV25/,1(5LIDSSOLFDEOH
)520 72 ',$0(7(5 7+,&.1(66 0$7(5,$/
IWIWLQ
,11(5&$6,1* 2578%,1* JHRWKHUPDOFORVHGORRS
)520 72 ',$0(7(5 7+,&.1(66 0$7(5,$/
IWIWLQ
IWIWLQ
6&5((1
)520 72 ',$0(7(5 6/27 6,=( 7+,&.1(66 0$7(5,$/
IWIWLQ
IWIWLQ
*5287
)520 72 0$7(5,$/ (03/$&(0(170(7+2' $02817
IWIW
IWIW
IWIW
6$1'*5$9(/3$&.LIDSSOLFDEOH
)520 72 0$7(5,$/ (03/$&(0(170(7+2'
IWIW
IWIW
'5,//,1*/2* DWWDFKDGGLWLRQDOVKHHWVLIQHFHVVDU\
)520 72 '(6&5,37,21 FRORUKDUGQHVVVRLOURFNW\SHJUDLQVL]HHWF
IWIW
IWIW
IWIW
IWIW
IWIW
IWIW
IWIW
5(0$5.6
&HUWLILFDWLRQ
6LJQDWXUHRI&HUWLILHG:HOO&RQWUDFWRU 'DWH
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
6LWHGLDJUDPRUDGGLWLRQDOZHOOGHWDLOV
<RXPD\XVHWKHEDFNRI WKLVSDJHWRSURYLGHDGGLWLRQDOZHOOVLWHGHWDLOVRUZHOOFRQVWUXFWLRQGHWDLOV<RXPD\DOVRDWWDFKDGGLWLRQDO SDJHVLIQHFHVVDU\
68%0,77$/,1678&7,216
D )RU $OO :HOOV 6XEPLWWKLVIRUPZLWKLQGD\VRIFRPSOHWLRQRIZHOO
FRQVWUXFWLRQ WRWKHIROORZLQJ
'LYLVLRQRI:DWHU5HVRXUFHV,QIRUPDWLRQ3URFHVVLQJ 8QLW
0DLO6HUYLFH&HQWHU5DOHLJK1&
E)RU,QMHFWLRQ:HOOV21/<,QDGGLWLRQWRVHQGLQJWKHIRUPWRWKHDGGUHVVLQ
DDERYHDOVRVXEPLWDFRS\RI WKLVIRUP ZLWKLQGD\VRIFRPSOHWLRQRI ZHOO
FRQVWUXFWLRQWRWKHIROORZLQJ
'LYLVLRQRI:DWHU5HVRXUFHV8QGHUJURXQG,QMHFWLRQ&RQWURO3URJUDP
 0DLO6HUYLFH&HQWHU5DOHLJK1&
F)RU:DWHU6XSSO\ ,QMHFWLRQ :HOOV
$OVR VXEPLW RQH FRS\ RI WKLV IRUP ZLWKLQGD\V RIFRPSOHWLRQRI
ZHOOFRQVWUXFWLRQWRWKHFRXQW\KHDOWKGHSDUWPHQWRIWKHFRXQW\ZKHUH
FRQVWUXFWHG
)RU,QWHUQDO8VH21/<
_______________
Jonathan R. Grubbs
3001
Terraquest Environmental Consultants, P.C.
✔
11/16/2021 SVE3
Perth Mini Mart 00-0-24524
818 Perth Rd.
Iredell 4730-50-7091
35.648900 -80.895787
✔
✔
1
35
N/A
6.25
Solid Stem Auger
20'35'.010 Sch. 40 PVC
0 16 Portland Pour
16 18 Bentonite Pour
18 35 No. 2 Sand Pour
0 0.5 Asphalt
0.5 35 Silt
Digitally signed by Jonathan Grubbs
DN: cn=Jonathan Grubbs, o=Terraquest
Environmental Consultants, P.C., ou,
email=[e-mail], c=US
Date: 2021.11.17 16:27:34 -05'00'

APPENDIX E

Soil Vapor Extraction Pilot Test Report
For: Perth Mini Mart, 818 Perth Road, Troutman, Iredell County, NC
Prepared by: Terraquest Environmental Consultants, P.C.
Test Date: 11/22-23-21
Report Prepared: 12/23/21

Soil Vapor Extraction Pilot Test Report

1
Perth Mini Mart – Madhukunj, LLC
818 Perth Road, Troutman, Iredell County, NC
NCDEQ-DWM UST Release Incident Number: 40784
Terraquest Project No. 08217
Facility ID: 00-0-0000024524
Latitude: 35.684542° N Longitude: -80.895851° W
Release Cause/Source: Gasoline Underground Storage Tank System
Release USTs (removed): 2, 6,000-gallon and 1, 4,000-gallon gas, 1, 2,000-gallon gas (formerly
diesel)
Risk Ranking Classification: High
Land-Use Classification: Residential

Property Owner & UST Owner/Operator:
Madhukunj, LLC
135 Corona Circle
Mooresville, NC 28117

INTRODUCTION

Terraquest Environmental Consultants, P.C. has performed a soil vapor extraction pilot test at
the Perth Mini Mart release incident located in Troutman, Iredell County, North Carolina. The
site’s location, vicinity, and layout are depicted on Figures 1, 2, and 3. The test reveals how the
subsurface responds to vapor extraction. Data is used to evaluate the suitability of the site for
SVE and to design a full-scale SVE system.

On November 22-23, 2021, Terraquest performed SVE testing using SVE pilot test wells SVE1,
SVE2, SVE3, and monitoring wells MW1, MW2, and MW16. SVE1 and SVE3 were used as the
extraction wells and the other wells were monitored for influence.

Terraquest personnel supervised the construction of SVE wells SVE1, SVE2, and SVE3 on
November 16, 2021. The wells were installed in preparation for the pilot test. Monitoring wells
MW1, MW2, and MW16 were installed as part of previous assessment activities.

Soil Vapor Extraction Pilot Test Report
For: Perth Mini Mart, 818 Perth Road, Troutman, Iredell County, NC
Prepared by: Terraquest Environmental Consultants, P.C.
Test Date: 11/22-23-21
Report Prepared: 12/23/21

2

The new wells were installed by an NC-licensed driller operating a Geoprobe model 7822 drilling
unit that turned solid-stem augers. Wells SVE1, SVE2, and SVE3 were constructed of twenty feet
of 2”-diameter PVC casing attached to fifteen feet of 2”-diameter screen with a 0.010” slot size
for a total well depth of thirty-five feet. A sand gravel pack was placed around the screened
section of each point. This section was isolated from the surface by bentonite and grout seals.
Well construction records are attached.

Site Hydrogeology

The site is located in the Piedmont Physiographic Region of North Carolina. According to the
Geologic Map of North Carolina (Brown, et al, 1985), the site is located in the Charlotte Belt and
is underlain by mafic metavolcanic bedrock lithologies. On a regional scale, the Piedmont is
characterized by land with moderate relief and some areas of low relief hills and valleys.

Groundwater in the region is part of the Catawba River Basin. Regionally, groundwater flows to
the southwest and feeds into Big Branch Creek and ultimately Lake Norman. Big Branch Creek is
listed as a Water Supply IV surface water body at https://deq.nc.gov/about/divisions/water-
resources/planning/classification-standards/classifications#DWRPrimaryClassification which
classifies surface water bodies with a WSIV classification as “sources of water supply for drinking,
culinary, or food processing.”

Soil Vapor Extraction Pilot Test Report
For: Perth Mini Mart, 818 Perth Road, Troutman, Iredell County, NC
Prepared by: Terraquest Environmental Consultants, P.C.
Test Date: 11/22-23-21
Report Prepared: 12/23/21

3
The following lithologies were encountered at the site during the installation of soil borings and
the monitoring well network:

0 – 63’ BGL SILT (CL)
Mostly soft to medium-stiff (generally increasing consolidation
with depth), micaceous, red to brown to tan silt with trace clay
and characteristics of saprolite in areas.

63-70’ BGL SAPROLITE
Mostly tan/brown heavily-weathered rock.

(Available soil boring logs and well construction records are attached to this report)

Geological cross sections of the subject area follow:

Soil Vapor Extraction Pilot Test Report
For: Perth Mini Mart, 818 Perth Road, Troutman, Iredell County, NC
Prepared by: Terraquest Environmental Consultants, P.C.
Test Date: 11/22-23-21
Report Prepared: 12/23/21

4

Soil Vapor Extraction Pilot Test Report
For: Perth Mini Mart, 818 Perth Road, Troutman, Iredell County, NC
Prepared by: Terraquest Environmental Consultants, P.C.
Test Date: 11/22-23-21
Report Prepared: 12/23/21

5

Soil Vapor Extraction Pilot Test Report
For: Perth Mini Mart, 818 Perth Road, Troutman, Iredell County, NC
Prepared by: Terraquest Environmental Consultants, P.C.
Test Date: 11/22-23-21
Report Prepared: 12/23/21

6
The phreatic aquifer at the site ranges from 21 to 40 feet BGL with an average depth to water in
the Type II wells since 2018 of 32 feet BGL. (Notably, free-phase product is present in multiple
wells with historical thicknesses as great as 7 feet.) As part of the CSA, the groundwater elevation
measurements reveal that the hydraulic head within the shallow phreatic aquifer ranged from a
relative value of approximately 66.61 at monitoring well MW5 to 67.91 at MW4 as measured on
April 30, 2019. In conjunction with other site measurements, the results indicate flow in the
phreatic aquifer in a south/southwest direction under an average hydraulic gradient of
approximately 0.02.

Groundwater elevation data collected on November 23, 2021 prior to testing is listed in Table 1
along with well construction information. The potentiometric surface on that date is displayed
below and indicates a west/southwest groundwater flow direction.

Soil Vapor Extraction Pilot Test Report
For: Perth Mini Mart, 818 Perth Road, Troutman, Iredell County, NC
Prepared by: Terraquest Environmental Consultants, P.C.
Test Date: 11/22-23-21
Report Prepared: 12/23/21

7
General applicability based on soil type and contamination (gasoline at this release incident):

The following chart presented as Exhibit II-4 from the EPA publication entitled “How to evaluate
alternative cleanup technologies for underground storage tank sites,” depicts the ranges of
intrinsic permeability for various soil types and the effectiveness of SVE on those soils
contaminated with various petroleum products. Based on permeability and the contaminants,
the site is generally suitable for implementation of SVE.

US EPA. 1995. How to evaluate alternative cleanup technologies for underground storage tank sites.
Solid Waste and Emergency Response 5403W. Document Number 510-B-95-007.

Soil Vapor Extraction Pilot Test Report
For: Perth Mini Mart, 818 Perth Road, Troutman, Iredell County, NC
Prepared by: Terraquest Environmental Consultants, P.C.
Test Date: 11/22-23-21
Report Prepared: 12/23/21

8
Subject Soil Contamination

Through the 2017 Site Check, 2018 LSA, the 2019 UST closure, the 2019 over-excavation, and the
CSA, a total of fifty-seven samples were collected to delineate the extent of soil contamination.

The area of STG MSCC violation is generally centered on the UST basin with a smaller area around
the northern dispenser island. The volume of contamination is a sum of these two areas. With
an average depth to water of 31 feet in monitoring wells near the UST basin in April 2019, the
calculated tonnage at the site includes 1,220 tons near the basin and 15 tons at the northern
dispenser area. This volume accounts for the previously excavated area. The area is shown here:

Soil Vapor Extraction Pilot Test Report
For: Perth Mini Mart, 818 Perth Road, Troutman, Iredell County, NC
Prepared by: Terraquest Environmental Consultants, P.C.
Test Date: 11/22-23-21
Report Prepared: 12/23/21

9
Soil Mass Calculations:

Knowing the contaminant mass allows an understanding of remediation progress based on
removal rates. The mass is calculated here.

Based on a known mass of contaminated soil and known mass of smear zone, a mass of
contaminant can be estimated using the known contaminant/mass values from laboratory
results. Using an average contamination value of 2,325 mg/kg from assessment results and the
previously stated 1,220 tons + 15 tons = 1,270 tons of contaminated soil/smear zone, the
following calculations yield a soil contamination mass of 5,893 pounds.

2,325 mg/kg x (1,270 tons x (907.185 kg / 1 US ton)) =
2,325 mg/kg x (1,152,125 kg) = 2,678,690,625 mg of contamination
2,678,690,625 mg / 1,000,000 mg/kg = 2,679 kg
2,679 kg x 2.2 pounds/kg = 5,893 pounds

GENERAL PROCEDURES

Terraquest performed one true SVE test within the vadose zone near the former UST basin where
the largest contaminated soil mass exists (SVE1) and a second test above the free product area
during the air sparge test (SVE3). The tests were conducted on November 22 and 23, 2021,
respectively. Testing at SVE1 was the chief set of tests with SVE3 conducted to verify those
results, i.e. radius of influence about the same, and to collect information for the sparge test that
was conducted at the same time.

The basic test procedure consisted of applying a vacuum to the extraction well while monitoring
pressure response at other points of varying distance and direction from the extraction point.

Soil Vapor Extraction Pilot Test Report
For: Perth Mini Mart, 818 Perth Road, Troutman, Iredell County, NC
Prepared by: Terraquest Environmental Consultants, P.C.
Test Date: 11/22-23-21
Report Prepared: 12/23/21

10
Vacuum pressure and air flow at the extraction well were also monitored. A GAST regenerative
blower with a 1.5 hp electric motor was used to create the vacuum. Various pressure and flow
gauges were also used. The blower and gauges were connected with air-tight seals to the various
points to minimize leakage and, thus, systematic error.

Two types of SVE tests were conducted at SVE1. The first type of test conducted was an air
permeability test that typically lasts for approximately 10 minutes. Vacuum was applied to the
extraction well and the pressure responses in various observation points were recorded with
time. The data is used to calculate the vadose zone permeability to air flow (intrinsic
permeability).

The second type of test performed was a steady state test. These last from approximately 1 hour
to several or more days, depending on the objectives of the test, the scale of the project, and
other cost justification factors. Two or more tests may be conducted at various extraction well
flow rates. A relationship between applied vacuum and vapor flow yield is developed from these
tests. This relationship is used for blower selection in the design of the full-scale system. Data
from these tests can also be used to calculate intrinsic permeability.

For tests of sufficient length, it may also be possible to establish VOC mass removal rates by
measuring the steady state vapor concentrations in the off gas. To achieve steady state, at least
one pore volume of vapor must first be removed. It is not usually possible during the test to
know exactly when this occurs. One indication is a leveling of vapor concentrations after a
significant decline. This change occurs as all stagnant air is purged from the capture zone.

Soil Vapor Extraction Pilot Test Report
For: Perth Mini Mart, 818 Perth Road, Troutman, Iredell County, NC
Prepared by: Terraquest Environmental Consultants, P.C.
Test Date: 11/22-23-21
Report Prepared: 12/23/21

11
SPECIFIC PROCEDURES AND RESULTS

Terraquest personnel conducted three air permeability tests on November 22, 2021. Tests were
conducted using SVE1 as the extraction well, while SVE2, SVE3, and MW1 were observed in each
of the respective tests. Information regarding the wells is as follows:

Well identification
Radial distance
(feet) from extract
point
Screened interval
(feet) Total depth (feet)
Well diameter
(inches)
SVE1 0: extraction here 20-35 35 2
MW1 11 30-50 50 2
SVE2 7 20-35 35 2
SVE3 21 20-35 35 2

The air permeability tests were conducted for fifteen minutes each. During the tests, magnehelic
gauges were used to measure the vacuum influence at the observation well. The field results for
these tests are included in SVE-Table 1. As shown on that table, influence was seen at all
observation points.

After the air permeability data was collected, the system was turned off and allowed to
equilibrate prior to conducting the steady state test. The steady state test consisted of four short-
term (30 minutes) tests that were conducted one after another using various extraction well
vacuum pressures to assess the vadose zone response. The primary objective of these tests was
to establish a relationship between vapor flow and applied vacuum. SVE1 was used as the
extraction point for the November 22 test and SVE3 was the extraction point for the November
23, 2021 test. The monitoring results are attached as SVE-Table 2.

Soil Vapor Extraction Pilot Test Report
For: Perth Mini Mart, 818 Perth Road, Troutman, Iredell County, NC
Prepared by: Terraquest Environmental Consultants, P.C.
Test Date: 11/22-23-21
Report Prepared: 12/23/21

12
For the steady state test on SVE1, Terraquest applied a vacuum of -22 inches of water for a half-
hour, -40 inches of water for a half-hour, -60 inches of water for a half-hour, and -70 inches of
water for the last half-hour. Vacuum was controlled via a dilution valve.

Similarly, the steady state test using SVE3 as the extraction point while monitoring wells MW1,
MW2, MW16, and MW17 was run at progressive dilutions of -22 inches of water for a half-hour,
-40 inches of water for a half-hour, and -80 inches of water for a half-hour. The results are shown
in SVE-Table 2.

Pore volume:

From Equation (18) in Johnson et al (1990b), the estimated time to remove one pore volume (Tp)
is estimated by:

Where:
EA = air filled void fraction of soil matrix
R = radius of zone of contamination (feet)
H = thickness of zone of venting (feet)
Q = air flow rate (cubic feet per minute)
Data from the SVE1 steady state test was used to estimate Tp. With the variables assigned as
follows:

EA = 0.15 (based on an average effective porosity published by Sanders, 1998)
R = 44 feet
H = 11.7 feet (SVE1 dtw on 11/22 31.7 feet. screen 20-31.7 = 11.7 feet)
Q = 8 cubic feet per minute (average)

Q
HRE=T Ap
2π

Soil Vapor Extraction Pilot Test Report
For: Perth Mini Mart, 818 Perth Road, Troutman, Iredell County, NC
Prepared by: Terraquest Environmental Consultants, P.C.
Test Date: 11/22-23-21
Report Prepared: 12/23/21

13

An estimated time to remove one pore volume of contamination is calculated to be:

(0.15 x 3.14 x 44^2 x 11.7) / 8 = 1,334 minutes (~22 hours)

Since the SVE steady state test did not run for that long, it is unlikely that a full pore volume was
removed. As shown on SVE-Table 2, VOC concentrations were noted throughout the entire test.

DATA ANALYSIS

Air Permeability:
Terraquest used US EPA’s (1993) Hyperventilate program to evaluate the air permeability test
data. Hyperventilate uses the transient pressure response in the observation point to calculate
an air permeability value using a theoretical relationship developed by Johnson, et al (1990a).
Hyperventilate results are attached at the end of this appendix report.

The estimated value of intrinsic permeability (k) for varying soil lithologies ranges from 10-1
(clayey silts) to 105 darcy (gravel) as shown on Help-page 13 that supports page 8 of the attached
Hyperventilate analysis. Terraquest chose to enter a darcy value range from 0.25 to 1 as it most
accurately represented the flow ranges that were observed during the pilot tests.

Radius of Extraction Well Influence:
The ROI was determined based upon data from the steady state test. A rule-of-thumb
recommended by U.S. EPA (1995) is that the ROI will be the distance at which a vacuum of 0.1
inches of water is yielded. To determine this distance, Terraquest plotted vacuum pressure
versus distance. This graph has been included. When determining the point at which 0.1 inches
of water is yielded, a straight-line relationship was drawn from the extraction point through the
observation points in a best-fit manner. The graph shows a corresponding x-axis crossing of 23.5

Soil Vapor Extraction Pilot Test Report
For: Perth Mini Mart, 818 Perth Road, Troutman, Iredell County, NC
Prepared by: Terraquest Environmental Consultants, P.C.
Test Date: 11/22-23-21
Report Prepared: 12/23/21

14
feet. A 20 foot radius is chosen as a conservative estimate of influence that allows for some site
heterogeneities.

Number of Extraction Wells:
Hyperventilate was used to calculate the number of extraction wells by examining the site’s
permeability, critical volume of air, extraction well efficiency, contaminant radius from extraction
well, contaminant concentration, radius of influence, and required cleanup time. The following
values were constant throughout the calculations: (see card SD2 and 3)

• permeability (k) of 0.25 to 1 darcy (previously discussed),
• critical volume of air of 146.71 L/g (see card SD7),
• extraction well efficiency of 30 percent (see card H29)
• Average contamination concentration across subject area of 2,325 mg/kg (previously
discussed),
• Radius of test influence of 20 feet,
• Cleanup time of three years.

The required number of wells calculated by Hyperventilate ranged from 1 to 11 based on area
and critical volume calculations. The data does not consider site heterogeneities, the
requirement of the SVE system to recover free-phase product and sparge vapors and is a rather
large range. Site structures and installation feasibility must also be accounted for.

In consideration of the aforementioned items, Terraquest recommends the installation of ten
SVE wells at the locations shown on the next page and on Figure 4.

Soil Vapor Extraction Pilot Test Report
For: Perth Mini Mart, 818 Perth Road, Troutman, Iredell County, NC
Prepared by: Terraquest Environmental Consultants, P.C.
Test Date: 11/22-23-21
Report Prepared: 12/23/21

15

Soil Vapor Extraction Pilot Test Report
For: Perth Mini Mart, 818 Perth Road, Troutman, Iredell County, NC
Prepared by: Terraquest Environmental Consultants, P.C.
Test Date: 11/22-23-21
Report Prepared: 12/23/21

16
CONTAMINANT MASS REMOVAL

In addition to the mass removal estimates provided in the Hyperventilate analysis, Terraquest
also collected an air sample from the SVE pilot test exhaust stream that also requires
consideration toward mass removal.

During the SVE pilot test, Terraquest personnel filled a 1L Tedlar bag with a representative air
sample from the exhaust stack. As shown in the attached analytical report, the results of lab
analysis listed a TPH concentration of 5,070,000 parts per billion by volume (ppbv). Operational
SVE system generally have exhaust readings in the 10,000-100.000 ppbv, so >5,000,000 is
significant. Using published blower performance curves and the time of operation, the following
22.56 pounds / 3 hours removal rate is calculated:

minutes
bump test 15
air permeability test 1 15
air permeability test 1 15
air permeability test 1 15
steady state test 120
180
SVE: this model produces (scfm flow rate):100 scfm
TPH concentration of vapors at stack:5,070,000 ppbv
Volume of air removed is (flow in cubic feet per minute) x length of testing (in minutes)18,000 ft3
Volume of gasoline vapor removed is equal to air volume removed muliplied by the TPH concentration.
Vol. air removed (ft 3) x [TPH concentration of vapor (ft 3 gasoline vapor/1E+09 ft 3 air)]91 ft3 gasoline vapor
Conversions:1 ft3 vapor equals 7.48 gal.
1 gal. equal 3.78 liters
ft 3 gasoline vapor x 7.48 gal./ft 3 x 3.78 liters/gal. equals liters gasoline vapors.2,580 liters gasoline
vapor
Conversions:
Therefore:89 g/mole x (1mole/22.4 liters) equals:3.97 g/liter
Amount of Contaminant Removed
gasoline vapor (liters) x (3.97 g/liter) x (1 lb/454 g) equals lbs. vapor 22.56 lb of gasoline
At standard temperature and pressure, there are 22.4 liters of gasoline vapor per mole of gasoline. The molecular weight of carbon in gasoline is 89
g/mole.

Soil Vapor Extraction Pilot Test Report
For: Perth Mini Mart, 818 Perth Road, Troutman, Iredell County, NC
Prepared by: Terraquest Environmental Consultants, P.C.
Test Date: 11/22-23-21
Report Prepared: 12/23/21

17
Disregarding all other factors, mathematically, the removal rate of the pilot test would indicate
that at 22.56 pounds / 3 hours, the 5,893 pounds of soil contamination would be gone after 784
hours of SVE system operation. That is, after 33 days. This value isn’t close to a realistic cleanup
time. Generally, there is a logarithmic decline in contamination recovery following evacuation of
readily accessible pore-space contamination. Heterogeneities, bound particles, and recalcitrant
contaminants along with rising and falling water table elevations will affect treatment. A more
likely time frame is 2-3 years. These calculations rely solely on true soil contamination. The larger
driving force at the Perth Mini Mart will be free product and GCL violations.

CONCLUSIONS

Based on the pilot test conducted by Terraquest personnel, the site is acceptable for SVE as a
remedial method. SVE is recommended to remediate soil, and remove free product and sparge
exhaust vapors. Ten dedicated SVE wells are recommended.

Soil Vapor Extraction Pilot Test Report
For: Perth Mini Mart, 818 Perth Road, Troutman, Iredell County, NC
Prepared by: Terraquest Environmental Consultants, P.C.
Test Date: 11/22-23-21
Report Prepared: 12/23/21

18
REFERENCES

Brown, et al., 1985. Geologic Map of North Carolina, North Carolina. Department of Natural
Resources and Community Development, 1:500,000 scale.

Johnson, P.C., M. Kemblowski, and J. Colthart. 1990a. Quantitative analysis for the cleanup of
hydrocarbon-contaminated soils by in-situ soil venting. Ground Water, Vol.28, No.3, pp
413-429.

Johnson, P.C., C.C. Stanley, M.W. Kemblowski, D.L. Beyers, and J.D. Colthart. 1990b. A practical
approach to the design, operation, and monitoring of in situ soil-venting systems.
Ground Water Monitoring Review (GWMR), Spring Issue, pp. 159-178.

Sanders, Laura L. 1998. A Manual of Field Hydrogeology. Upper Saddle River, New Jersey: Prentice
Hall Inc.: 196.

U.S. EPA. 1995. How to evaluate alternative cleanup technologies for underground storage tank
sites. Solid Waste and Emergency Response 5403W. Document Number 510-B-95-007.

U.S. EPA. 1993. HyperVentilate: a software guidance system created for vapor extraction sites.
Solid Waste and Emergency Response OS-420WF. Document Number 510-F-93-001.

TABLES AND GRAPHS 

SOIL VAPOR EXTRACTION TEST 
Page 1 of 3
SVE-Table 1Date: 12/21/21 Facility ID: 0-0024524
Extraction Well Extraction Well Extraction Well ObservationTimeTimeVacuumFlowVOC reading Vacuum(seconds)(minutes and seconds)(inches of water)(standard cubic feet/minute)(ppm via PID)(inches of water)
EXTRACTION WELL: SVE1 OBSERVATION WELL:SVE2
30 0:30 55 15 >5,000 2.80
60 1:00 55 15 >5,000 3.80
90 1:30 55 15 >5,000 4.00
120 2:00 55 15 >5,000 4.20
180 3:00 55 15 >5,000 4.30
240 4:00 55 15 >5,000 4.40
270 4:30 55 15 >5,000 4.50
300 5:00 55 15 >5,000 4.60
360 6:00 55 15 >5,000 4.70
420 7:00 55 15 >5,000 4.70
480 8:00 55 15 >5,000 4.70
540 9:00 55 15 >5,000 4.70
600 10:00 55 15 >5,000 4.70
660 11:00 55 15 >5,000 4.70
720 12:00 55 15 4,050 4.70
780 13:00 55 15 4,050 4.70
840 14:00 55 15 4,050 4.70
900 15:00 55 15 4,050 4.70
AIR PERMEABILITY TESTS
Incident Name: Peth Mini Mart Incident No.: 40784
Page 2 of 3
SVE-Table 1Date: 12/21/21 Facility ID: 0-0024524
Extraction Well Extraction Well Extraction Well ObservationTimeTimeVacuumFlowVOC reading Vacuum(seconds)(minutes and seconds)(inches of water)(standard cubic feet/minute)(ppm via PID)(inches of water)
AIR PERMEABILITY TESTS
Incident Name: Peth Mini Mart Incident No.: 40784
EXTRACTION WELL: SVE1 OBSERVATION WELL:MW1
30 0:30 54 15 >5,000 2.40
60 1:00 54 15 >5,000 3.20
90 1:30 54 15 >5,000 3.90
120 2:00 55 15 >5,000 4.20
180 3:00 55 15 >5,000 4.60
240 4:00 55 15 >5,000 4.80
270 4:30 55 15 >5,000 5.10
300 5:00 55 15 >5,000 5.20
360 6:00 55 15 >5,000 5.20
420 7:00 55 15 >5,000 5.40
480 8:00 55 15 >5,000 5.40
540 9:00 55 15 >5,000 5.40
600 10:00 55 15 >5,000 5.40
660 11:00 55 15 >5,000 5.40
720 12:00 55 15 >5,000 5.40
780 13:00 55 15 >5,000 5.40
840 14:00 55 15 >5,000 5.40
900 15:00 55 15 >5,000 5.40
Page 3 of 3
SVE-Table 1Date: 12/21/21 Facility ID: 0-0024524
Extraction Well Extraction Well Extraction Well ObservationTimeTimeVacuumFlowVOC reading Vacuum(seconds)(minutes and seconds)(inches of water)(standard cubic feet/minute)(ppm via PID)(inches of water)
AIR PERMEABILITY TESTS
Incident Name: Peth Mini Mart Incident No.: 40784
EXTRACTION WELL: SVE1 OBSERVATION WELL:SVE3
30 0:30 55 15 3,200 2.40
60 1:00 55 15 3,200 3.20
90 1:30 55 15 3,200 3.90
120 2:00 55 15 3,200 4.20
180 3:00 55 15 3,200 4.60
240 4:00 55 15 3,200 4.80
270 4:30 55 15 3,200 5.10
300 5:00 55 15 3,040 5.20
360 6:00 55 15 3,040 5.20
420 7:00 55 15 3,040 5.40
480 8:00 55 15 2,643 5.40
540 9:00 55 15 2,643 5.40
600 10:00 55 15 2,643 5.40
660 11:00 55 15 2,643 5.40
720 12:00 55 15 2,879 5.40
780 13:00 55 15 2,879 5.40
840 14:00 55 15 2,879 5.40
900 15:00 55 15 2,380 5.40
Page 1 of 2
SVE-Table 2Date: 12/21/21 Extraction Well: SVE1 Extraction Well: SVE1 PID (ppm) Well: MW1 Well: SVE2 Well: SVE3Time Vacuum Flow VOCs Vacuum Vacuum Vacuum
(minutes)(inches of water)(standard cubic feet/minute)at extraction well (inches of water)(inches of water)(inches of water)
0 16 5.4 1188 0.11 1.25 0.40
5 17 5.4 1180 1.70 1.55 0.20
10 17 5.4 1148 1.99 1.67 0.20
15 18 5.4 1111 2.00 1.75 0.25
20 18 5.6 1100 2.00 1.77 0.25
30 18 5.6 1080 2.00 1.77 0.25
40 29 8.0 1526 3.00 2.80 0.35
50 29 8.0 1600 3.00 2.80 0.35
60 29 8.0 1560 3.00 2.80 0.30
70 40 11.0 2,125 4.00 3.60 0.48
80 39 10.5 1,988 4.10 3.80 0.53
90 40 10.5 1,986 4.20 3.70 0.55
100 44 11.0 2,257 4.50 3.90 0.55
110 44 11.0 1,906 4.50 3.90 0.53
120 44 11.0 1,790 4.50 3.90 0.55
Distance from extraction well in feet:
Dilution valve open. 60 inches of water pressure at extraction blower
Dilution valve closed. 70 inches of water pressure at extraction blower
Dilution valve open. 40 inches of water pressure at extraction blower
STEADY STATE TEST RESULTSIncident Name: Peth Mini Mart Incident No.: 40784
Dilution valve open. 22 inches of water pressure at extraction blower
Page 2 of 2
SVE-Table 2Date: 12/21/21 STEADY STATE TEST RESULTSIncident Name: Peth Mini Mart Incident No.: 40784Extraction Well: SVE3 Extraction Well: SVE3 PID (ppm) Well: MW2 Well: MW1 Well: MW16 Well: MW17Time Vacuum Flow VOCs Vacuum Vacuum Vacuum Vacuum
(minutes)(inches of water)(standard cubic feet/minute)at extraction well (inches of water)(inches of water)(inches of water)(inches of water)
0 20 8.0 1642 0.90 0.00 0.65 0.50
5 20 8.0 1756 1.00 0.00 0.75 1.00
20 20 7.0 1740 1.00 0.00 0.75 1.00
30 20 8.0 1710 0.50 0.00 0.75 1.00
40 32 13.0 1661 0.60 0.00 1.00 1.90
50 34 13.0 1576 0.65 0.00 1.00 2.00
70 55 22.0 1,035 1.85 0.50 1.80 3.40
80 54 20.0 1,187 1.75 0.25 2.00 3.90
90 54 20.0 1,572 2.00 0.25 2.00 3.90
Distance from extraction well in feet:
Dilution valve open. 22 inches of water pressure at extraction blower
Dilution valve open. 40 inches of water pressure at extraction blower
Dilution valve closed. 80 inches of water pressure at extraction blower
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
4.00
4.50
0 5 10 15 20 25Vacuum Pressure (inches of water)Distance (feet)
Perth Mini MartSVE PILOT TEST DATA EVALUATIONVacuum Pressure Versus Distance
observation wells
Linear (observation wells)

FIGURES

SOIL VAPOR EXTRACTION TEST
ONSULTANTS, P.C.CENVIRONMENTAL
ENVIRONMENTAL CONSULTANTS, P.C.
ENVIRONMENTAL CONSULTANTS, P.C.

HYPERVENTILATE RESULTS

SOIL VAPOR EXTRACTION TEST

WELL RECORDS

SOIL VAPOR EXTRACTION TEST

SSSS521ENVIRONNEN1ALCONSUirANTS,P,C,BORING LOGCont''a''t"i" TfirraqiiRstFqiiipment- OfinPrnhR 7fi??nTnriller'WBR SnrrellsDatnStarfpri- 11-1R-17Date Finishpri- 11-1R-17I nggeri hy .Inrdan I BrswBoring Number:B1BlowCountsOVM(ppm)209581610204152,197284337196473DepthFeet20253035LithologyDescriptionAsphaltSilt(ML)Medium stiff reddish-orange silt, with trace clay and fine sand. Soilsare dry.Silt(ML)Soft brownish-orange, micaceous silt, with trace fine sand. Soils aredry.Silt (ML)Soft orange/brown/black micaceous silt, with trace fine sand andincreasing amounts of saprolite with depth. Soils contain a minuteamount of moisture beginning at 28 feet BGL.Probe refusal at 38 feet BGL.Boring Terminated at 38 feet BGL.Scale as shown: Hatch pattern denotes soil sample depth;Solid denotes lab sample depth; Lithology hatch pattern legend is attached;NA - Not Applicable; BGL - Below GroundlevelSite:Perth Mini Mart818 Perth RoadTroutman, NCClient:MadnuKunj, LLC135 Coron'a CircleMooresville, NCProject No.:08217Page
^-SSSllJ^SsiENVIRONNEHTAI CONSULTANTS, P.C,IBORING LOGf:nnfraft"r" TfirraqilfistFqnipmBnf nsnPrnhs 7fi??nTDrillorWBK KnrrfillRnato Starteri • 11-1R-17Da+B Finiahpri- 11-1R-17I nggnri hy .Inrrlan I BrswBoring Number:B2d)Q.Ero\v>BlowCountsJ_OVM(ppm)675170147DepthFeetLithologyDescription1015AsphaltSilt (ML)Medium stiff reddish-orange silt, with trace clay and fine sand. Soilsare dry.Silt (ML)Soft brownish-orange, micaceous silt, with trace fine sand andsaprolite. Soils are dry.Boring Terminated at 15 feet BGL.Scale as shown: Hatch pattern denotes soil sample depth;Solid denotes lab sample depth; Lithology hatch pattern legend is attached;NA - Not Applicable; BGL - Below GroundlevelSite:Perth Mini Mart818 Perth RoadTroutman, NCClient:Madhukunj, LLC135 Corona CircleMooresville, NCProject No.:08217Page
ENVUtONHENTAL CONSULTANTS, MjBORING LOGCnntrpntnr- TfirraqiifistEquipment- PSRnPrnhfi 7a?9DTDrillBr-WBS RnrrfillsDate Startnri- 11-1R-17Date FinishRri: 11-16-17I nrjfjpri hy .Inrdan I srBWBoring Number:B3d)a.EroIwBlowCounts±OVM(ppm)1715 —I435315DepthFeetLithologyDescription1015AsphaltSilt (ML)Medium stiff reddish-orange slit, with trace day and fine sand. Soilsare dry.Silt (ML)Soft brownish-orange, micaceous silt, with trace fine sand andsaprolite. Soils are dry.Boring Terminated at 15 feet BGL.Scale as shown: Hatch pattern denotes soil sample depth;Solid denotes lab sample depth; Lithology hatch pattern legend is attached;NA - Not Applicable; BGL - Below GroundlevelSite:Perth Mini Mart818 Perth RoadTroutman, NCClient:Madhukunj, LLC135 Corona CircleMooresville, NCProject No.:08217Page
ENWRONHENTAl CONSULTANTS, P,C,BORING LOGCnntrac-tnr- TfirraqiiRRtEquipment- ("SfsnPrnhB 7S77DTnriller;WfiK RnrrfillsHate Started- 11-16-17Rate Finished- 11-1R-17I nggori hy .Inrrian I BrswBoring Number:B4BlowCountsOVM(ppm)3645 —I190382DepthFeetLithologyDescription1015AsphaltSilt (ML)Medium stiff reddish-orange silt, with trace clay and fine sand. Soilsare dry.Silt (ML)Soft brownish-orange, micaceous silt, with trace fine sand andsaprolite. Soils are dry.Boring Terminated at 15 feet BGL.Scale as shown: Hatch pattern denotes soil sample depth;Solid denotes lab sample depth; Lithology hatch pattern legend is attached;NA - Not Applicable; BGL - Below GroundlevelSite:Perth Mini Mart818 Perth RoadTroutman, NCClient:Madhukunj, LLC135 Corona CircleMooresville, NCProject No.:08217Page
TERRAauestlailiiiENVIROHMEHTAI. CONSULTANTS, P,C,1BORING LOGCnntrar-fnr' TprraniifiRfFqnipmsnt- OsnPrnhB 7R9?nTPriller-WRS RnrrfijlRDateSfartpri- 11/7fi/1Rriatn FinishBri- 11/9R/1RLogged by .Inrrlan l RrswBoring Number:B5BlowCountsovn/i(ppm)10898.1163014581065DepthFeetLithology1520 —|25 —|30\S:SS:S:£:g:S:g:£\'•v.'s-v/s-v.s-v.-s'.'^>.^'::::^. .^•i=^..^c^. /^^isfSi^iIS -0 o -0. S -0. S -Q o•^.'^'^.'^•^.'^^^.'^^^ss^ss^[g^.'g^.'g-V.g:'3:gis^s^s^s^^V.S-V.g-V.g^^t^:^-=>.'/i».'^».'^<?iDescriptionAsphaltSilt (ML)Mostly soft, red, micaceous siltwith trace claySilt (ML)Mostly medium stiff, red/brown, micaceous silt, with trace fine sandand trace clay.SILT (ML)Mostly medium-stiff, red/brown, micaceous siltwith little sand andtrace clay. Characteristic of saprolite.Increasing consolidation more like saprolite.Boring terminated at 30' BGL.Scale as shown: Hatch pattern denotes soil sample depth;Solid denotes lab sample depth; Lithology hatch pattern legend is attached;NA - Not Applicable; BGL - Below GroundlevelSite:Perth Mini Mart818 Perth RoadTroutman, NCClient:Madhukunj, LLC135 Corona CircleMooresville, NCProject No.:08217Page
fe^ssssaENVmONBENTAL CONSULTANTS, P,C,BORING LOGCnntranfnr- TsrraqilRRtFqiiipmfnt- OBnPrnhB 7fi?7nTDriller:WBK RnrrsJs-DateStarteri- 11/9R/1Rnato Finiaheri- 11/7R/1RI ngged hy .Inrrian I prswBoring Number:B6<ua.(0|(0BlowCountsOVM(ppm)75.55 —I285.510312940222240650DepthFeet15Lithology20 —|25 —|'s^.^-ssl. /;;=;>. /;';::::>.&~'fa-'f;o-''f;o;f^KV.SV.&O.&V.S:t^>. ^•=:>. .^csk. ./;'=:^. /^^[^V..<^,-U..'a,'V^ ,'^'V. .<:DescriptionAsphaltSilt (ML)Mostly soft, red, micaceous silt with trace claySilt (ML)Mostly medium stiff, red/brown, micaceous silt, with trace fine sandand trace clay.SILT (ML)Mostly medium-stiff, brown/tan, micaceous siltwith little sand andtrace clay. Characteristic of saprolite.Two-inch thick saprolite band with white silt/sand characteristics @22' BGL.SILT(MLTMostly medium-stiff, brown, micaceous siltwith saprolite.Refusal at 28' BGL.Scale as shown: Hatch pattern denotes soil sample depth;Solid denotes lab sample depth; Lithology hatch pattern legend is attached;NA - Not Applicable; BGL - Below Groundleve!Site:Perth Mini Mart818 Perth RoadTroutman, NCClient:MadhuKunj, LLC135 Corona CircleMooresville, NCProject No.:08217Page
S=rtS3S1_EHVIRONNENTAlCONSUlTANTS,P,C,lBORING LOGCnntractpr' TfirraqiiRstFqnipmont- OsnPrnhfi 7R?7nTDrillpr-WPR c;nrrplkDate Startori- 11/7R/-1RDate Finishnri- 11/?fi/1Ra9&?ri h\j,lnrrf?m I ftmwBoring Number:B7Q.EmIwBlowCountsOVM(ppm)75.55285.510312940222240650DepthFeetLithologyDescription15 —I20 —|25 —]30AsphaltSilt (ML)Mostly soft, tan/red silt with little clay and trace sand.Silt (ML)Mostly medium stiff, reddish-tan silt, with few fine-grained sand andfew saprolite.SILT (ML)Mostly soft, red/tan, silt with trace clay and fine-grained sand andincreasing characteristic of saprolite.SILT (ML)Mostly medium-stiff, red/tan, micaceous silt with trace fine-grainedsand. Characteristics of saprolite.SILT (ML)Mostly soft, brown, micaceous siltwith saprolite. Few clay presentfrom 25-30' BGL.Boring terminated 30 feet BGL.Scale as shown: Hatch pattern denotes soil sample depth;Solid denotes lab sample depth; Lithology hatch pattern legend is attached;NA - Not Applicable; BGL - Below GroundlevelSite:Perth Mini Mart818 Perth RoadTroutman, NCClient:Madhukunj, LLC135 Corona CircleMooresville, NCProject No.:08217Page
fe=SsS53&ENyiROHBENTAlCONSUI.TANTS,P,C,lBORING LOGCnntrgffnr- TerraqilRstFqnipment- RRnPrnhs 7R9?nTnrillerWRK RnrrfillsDatoStartnri- 11/?fi/1Rnato FinishBri- •11/7R/18nggsri hy .Inrdan I fimwBoring Number:B7a.(0|(0BlowCountsOVM(ppm)254.4450.010 —|1216818.615151355DepthFeetLithology152025 —|30DescriptionAsphaltSilt (ML)Mostly soft, tan/red silt with little clay and trace sand.Silt (ML)Mostly medium stiff, reddish-tan silt, with few fine-grained sand andfew saprolite.SILT (ML)Mostly soft, red/tan, siltwith trace clay and fine-grained sand andincreasing characteristic of saprolite.SILT (ML)Mostly medium-stiff, red/tan, micaceous siltwith trace fine-grainedsand. Characteristics ofsaprolite.SILT (ML)Mostly soft, brown, micaceous silt with saprolite. Few clay presentfrom 25-30' BGL.Boring terminated 30 feet BGL.Scale as shown: Hatch pattern denotes soil sample depth;Solid denotes lab sample depth; Lithology hatch pattern legend is attached;NA - Not Applicable; BGL - Below GroundlevelSite:Perth Mini Mart818 Perth RoadTroutman, NCClient:Madhukunj, LLC135 Corona CircleMooresville, NCProject No.:08217Page
ENVIBONKENTAI. CONSULTANTS, P,C,BORING LOGf:nntr?ftnr' TBrraqupRtFqiiipmnnf RfinPrnhp 7R77DTnrillor-WRS RnrmllRn^te Started- 11/?R/1RDgte Fim<?h<?f<- 11/?R/1RI nrjgeri by" .Inrrian I srfiwBoring Number:B8BlowCountsOVM(ppm)44.45 —I62.1104797301027188.2DepthFeetLithology152025 —|30DescriptionAsphaltSilt (ML)Mostly soft, red, micaceous silt with trace claySilt (ML)Mostly soft, red/tan silt with trace sand and saprolite.S1LT (ML)Mostly medium-stiff, red/tan silt with few clay and trace sand.Saprolitic in nature.SILT (ML)^ Mostly soft, tan, micaceous silt with trace sand.SILT (ML)Mostly soft, brown, micaceous siltwith saprolite.Boring terminated 30' BGL.Scale as shown: Hatch pattern denotes soil sample depth;Solid denotes lab sample depth; Lithology hatch pattern legend is attached;NA - Not Applicable; BGL - Below GroundlevelSite:Perth Mini Mart818 Perth RoadTroutman, NCClient:Madhukunj, LLC135 Corona CircleMooresville, NCProject No.:08217Page
TERRAcEHVIBONNENTAI COHSDLTAmS, P,C,BORING LOG/MONITORING WELL INSTALLATION DETAILRnntrantnr- TfirraqilfistDrill lUlpthnri-Hnllnw Stfim AngfrPrillerWPR Rnrrsllsnate Started- -1/1R/1Rnato Finished- 1/1R/1RI nggsri hy .Inrrian I RrewBoring Number:MW1BlowCountsCompletionOVM(ppm)DepthFeet1030.62,250±1,7841,347253035404550pthologi5 -^15 —|20 —|DescriptionAsphaltSilt (ML)Medium stiff reddish-orange silt, with trace clay and finesand. Soils are dry.Silt (ML)Soft brownish-orange, micaceous silt, with trace fine sand.Soils are dry.Slit (ML)Soft orange/brown/black micaceous silt, with trace fine sandand increasing amounts of saprolite with depth. Soils aremoist at 40 feet BGLSilt (ML)Soft olive/brown micaceous silt, with trace clay. Soils aresaturated.Well Completed at 50 feet BGL.Scale as shown; Hatch pattern denotes soil sample depth;Solid denotes lab sample depth; Lithology hatch pattern legend is attached;Well Construction2" diameter Sch. 40 PVC; .010" slotted screenSand: no. 2 sand; Grout: poured portland; Bentonite: poured pelletsFinished with 8"-diameter metal bolt down manhole.NA - Not Applicable; BGL - Below Ground LevelSite:Perth Mini Mart818 Perth RoadTroutman, NCClient:Madhukunj, LLC135 Corona CircleMooresville, NCProject No.:08217
TERRAcENV]RONNEHTAI.CONSI)ITANTS,PABORING LOG/MONITORING WELL INSTALLATION DETAILCnntractnr- TRrraqilpstnrill Msthnri-Hnllnw Stem AugsrnrillerWRR KnrrpllsnateRtf-tori- R/1S/1Rnato FiniahBri- R/1S/1RI nggori hy .Inrrian I BmwBoring Number:MW2a.E(0I coBlowCountsCompletionOVM(ppm)5 -^1015 —[20 —I±J_DepthFeet^.ithologi25 —|30 —|35 —|4045 —|50DescriptionAsphaltSilt (ML)Medium stiff reddish-orange silt, with trace clay and finesand. Soils are dry.Silt (ML)Soft brownish-orange, micaceous silt, with trace fine sand.Soils are dry.Silt (ML)Soft orange/brown/black micaceous silt, with trace fine sandand increasing amounts of saprolite with depth. Soils containa strong petroleum odor, with free product saturationbeginning at 33 feet BGL.Silt (ML)Soft olive/brown micaceous silt, with trace clay. Soils aresaturated and contain a strong petroleum odor.Well Completed at 50 feet BGL.Scale as shown; Hatch pattern denotes soil sample depth;Solid denotes lab sample depth; Lithology hatch pattern legend is attached;Well Construction2" diameter Sch. 40 PVC; .010" slotted screenSand: no. 2 sand; Grout: poured portland; Bentonite: poured pelletsFinished with 8"-diameter metal bolt down manhole.NA - Not Applicable; BGL - Below Ground LevelSite:Perth Mini Mart818 Perth RoadTroutman, NCClient:Madhukunj, LLC135 Corona CircleMooresville, NCProject No.:08217Page
TERRAcENVlBONNENTAlCOHSULrAinS, P.C.IBORING LOG/MONITORING WELL INSTALLATION DETAILCnntrar-fnr- TfirraqiiBstDrill Mothnri-Hnllnw Rtsm AnnRrDriller-WBR RnrmllKDfltp Startnri- fi/1R/1RDat? Finishpri- R/1R/1Rnggsri hy .Inrrfan I fimwBoring Number:MW3BlowCountsCompletionOVM(ppm)15 —I1015 —I20 —|DepthFeet50f-ithology25 —|30 —|354045 —|DescriptionAsphaltSilt (ML)Medium stiff reddish-orange silt, with trace clay and finesand. Soils are dry.Silt (ML)Soft brownish-orange, micaceous silt, with trace fine sand.Soils are dry.Silt (ML)Soft orange/brown/black micaceous silt, with trace fine sandand increasing amounts of saprolite with depth. Soils aremoist at 40 feet BGLSilt (ML)Soft olive/brown micaceous silt, with trace clay. Soils aresaturated.Well Completed at 50 feet BGL.Scale as shown; Hatch pattern denotes soil sample depth;Solid denotes lab sample depth; Lithology hatch pattern legend is attached;Well Construction2" diameter Sch. 40 PVC; .010" slotted screenSand: no. 2 sand; Grout: poured portland; Bentonite: poured pelletsFinished with 8"-diameter metal bolt down manhole.NA - Not Applicable; BGL - Below Ground LevelSite:Perth Mini Mart818 Perth RoadTroutman, NCClient:Madhukunj, LLC135 Coron'a CircleMooresville, NCProject No.:08217Page
TERRAcuestENVIBONMENULCOHSULTANIS.P.C.IBORING LOG/MONITORING WELL INSTALLATION DETAILCnntr9rt"r' TBrraqiifistnrill |U|fithO(l-HnllnwRtRm AugsrDrillerWfiR Rnn.milsDate Startori- R/19/1SDate Finisheri: fi/19/18I nrjgnri hy .Inrdan I BmwBoring Number:MW4BlowCountsCompletionOVM(ppm)5 —I1015 —|20 —|1DepthFeetMthologv25 —|3035 —|4045 —\50DescriptionAsphaltSilt (ML)Medium stiff reddish-orange silt, with trace clay and finesand. Soils are dry.Silt (ML)Soft brownish-orange, micaceous silt, with trace fine sand.Soils are dry.Silt (ML)Soft orange/brown/black micaceous silt, with trace fine sandand increasing amounts of saprolite with depth. Soils aremoist at 40 feet BGL.Silt (ML)Soft olive/brown micaceous silt, with trace clay. Soils aresaturated.Well Completed at 50 feet BGL.Scale as shown; Hatch pattern denotes soil sample depth;Solid denotes lab sample depth; Lithology hatch pattern legend is attached;Well Construction2" diameter Sch. 40 PVC; .010" slotted screenSand: no. 2 sand; Grout: poured portland; Bentonite: poured pelletsFinished with 8"-diameter metal bolt down manhole.NA - Not Applicable; BGL - Below Ground LevelSite:Perth Mini Mart818 Perth RoadTroutman, NCClient:Madhukunj, LLC135 Corona CircleMooresville, NCProject No.:08217Pane
TERRAciuestENVIBONNENTAI CONSULTANTS, P.C.IBORING LOG/MONITORING WELL INSTALLATION DETAILf:nntrar-tnr- TRrraqilRfitDrill lUIcthnri-Hnllnw KfRm AliqftrDrillerWRR RnrmllsnatBSfarteri- 11/?fi/1RDat? FJnishBri- 11/99/-1RI nrjgeri hy .Inrdan I erewBoring Number:MW5BlowCountsCompletionOVM(ppm)J_DepthFeetf-itholog^5 —I10 —|152025 —1303540 —|45 —|50DescriptionAsphaltSilt (ML)Mostly soft, red, micaceous siltwith trace clay.SILT (ML)Mostly medium-stiff, tan, micaceous silt.Silt (ML)Mostly soft, tan/gray, micaceous silt, with trace saprolite.Scale as shown; Hatch pattern denotes soil sample depth;Solid denotes lab sample depth; Lithology hatch pattern legend is attached;Well Construction2" diameter Sch. 40 PVC; .010" slotted screenSand: no. 2 sand; Grout: poured portland; Bentonite: poured pelletsFinished with 8"-diameter metal bolt down manhole.NA - Not Applicable; BGL - Below Ground LevelSite:Perth Mini Mart818 Perth RoadTroutman, NCClient:Madhukunj, LLC135 Corona CircleMooresville, NCProject No.:08217
TERRAcEHVIRONUENTAI CONSULTANTS, P,C,BORING LOG/MONITORING WELL INSTALLATION DETAILCnntractnr- TRrraqnfistDrill MBthnri-Hnllnw Stfim AiigprDrillor;WRR RnrrRltePafo St?rtorl- 11/9R/1SPgfe Finishnri- 11,99/1 R! ngrjcri hy .Inrdan I fimwBoring Number:MW6<uQ.E(01(0BlowCountsCompletionOVM(ppm)DepthFeet1-ithologyl5 —I10 —|152025 —|303540 —]45 —|50DescriptionAsphaltSilt (ML)Mostly soft, red, micaceous siltwith trace clay.SILT(ML)Mostly medium-stiff, tan, micaceous silt.Silt (ML)Mostly soft, tan/gray, micaceous silt, with trace saprolite.Scale as shown; Hatch pattern denotes soil sample depth;Solid denotes lab sample depth; Lithology hatch pattern legend is attached;Well Construction2" diameter Sch. 40 PVC; .010" slotted screenSand: no. 2 sand; Grout: poured portland; Bentonite: poured pelletsFinished with 8"-diameter metal bolt down manhole.NA - Not Applicable; BGL - Below Ground LevelSite:Perth Mini Mart818 Perth RoadTroutman, NCClient:Madhukunj, LLC135 Corona CircleMooresville, NCProject No.:08217Page
TERRAcENVIBONNENTAt CONSULTANTS. RC.l-Contrar-tnr- TnrraqiiRstBORING LOG/MONITORING WELL INSTALLATION DETAILDrill IVIpfhnri-Hnllnw Rtam AugfilLnrillnrWRR RnrrpHDate Starfnri- H/7fi/lRnato Finished- 11,99/1 R(LhBoring Number:MW7BlowCountsCompletionOVM(pprn^DepthFeetUthologDescription5 —I10 —|152025 —|303540 —145 —|50sphaltSilt (ML)Mostly soft, red, micaceous siltwith trace clay.SILT (ML)"Mostly medium-stiff, tan, micaceous silt.Silt (ML)Mostly soft, tan/gray, micaceous silt, with trace saprolite.Scale as shown; Hatch pattern denotes soil sample depth;Solid denotes lab sample depth; Lithology hatch pattern legend is attached;Well Construction2" diameter Sch. 40 PVC; .010" slotted screenSand: no. 2 sand; Grout: poured portland; Bentonite: poured pelletsFinished with 8"-diameter metal bolt down manhole.NA - Not Applicable; BGL - Below Ground LevelSite:Perth Mini Mart818 Perth RoadTroutman, NCClient:Madhukunj, LLC135 Coron'a CircleMooresville, NCProject No.:08217Page
TERRAcENVIBONBENTAI CONSULTANTS, P.C.IBORING LOG/MONITORING WELL INSTALLATION DETAILCnntrar.tor- TftrraqufiRtDrill MBthnri-HnllnwRtem Aiigsr.DrillBrWRR Rnrmllsnato Started: 11/?fi/1Rnato Finished: 11/29/1RI nggnri hy .Inrrian I srfiwBoring Number:MW8BlowCountsCompletionOVM(ppm)5 —I10 —|DepthFeetf-itholog^152025303540 —|45 —|50DescriptionAsphaltSilt (ML)Mostly soft, red, micaceous siltwith trace clay.SILT (ML)Mostly medium-stiff, tan, micaceous silt.Silt (ML)Mostly soft, tan/gray, micaceous silt, with trace saprolite.Scale as shown; Hatch pattern denotes soil sample depth;Solid denotes lab sample depth; Lithology hatch pattern legend is attached;Well Construction2" diameter Sch. 40 PVC; .010" slotted screenSand: no. 2 sand; Grout: poured portland; Bentonite: poured pelletsFinished with 8"-diameter metal bolt down manhole.NA - Not Applicable; BGL - Below Ground LevelSite:Perth Mini Mart818 Perth RoadTroutman, NCClient:Madhukunj, LLC135 Corona CircleMooresville, NCProject No.:08217
TERRAcENVIBONHENTAL CONSULTANTS, P,C,1BORING LOG/MONITORING WELL INSTALLATION DETAILCnnfractfu" TfirrsdURstPrjll Mnthnri-Hnllnw Stem AngsrDrillBrWss Snrrellsnato Sta rtsri • 11 /?fi/1 Rnato Finiahnri- 11/99/1Rloggori hy .Inrdan I BmwBoring Number:MW9BlowCountsCompletionOVM(ppm)DepthFeet1-itholog^510 —|15 —|20 —|25 —|303540DescriptionAsphaltSilt(ML)Mostly soft, red, micaceous siltwith trace clay.SILT (ML)Mostly medium-stiff, tan, micaceous silt.Silt (ML)Mostly soft, tan/gray, micaceous silt, with trace saprolite.Scale as shown; Hatch pattern denotes soil sample depth;Solid denotes lab sample depth; Lithology hatch pattern legend is attached;Well Construction2" diameter Sch. 40 PVC; .010" slotted screenSand: no. 2 sand; Grout: poured portiand; Bentonite: poured pelletsFinished with 8"-diameter metal bolt down manhole.NA - Not Applicable; BGL - Below Ground LevelSite:Perth Mini Mart818 Perth RoadTroutman, NCClient:Madhukunj, LLC135 Corona CircleMooresville, NCProject No.:08217
TERRAcEHVHONHEHTAI CONSULTANTS, P.C,BORING LOG/MONITORING WELL INSTALLATION DETAILRnntrartor; TfirraqiiRstnrill wiBthnd-Hnllnw Stem AugfirnrillprWRR RnrmlknafP SfarW- 11/9fi/1ROatfi Finished- 11/?9/18I nggori hy .Inrrfan I BrswBoring Number:MW10BlowCountsCompletionOVM(ppm)5 —I±DepthFeet^.itholog^10 —|15 —\20 —|25 —|303540DescriptionAsphaltSilt (ML)Mostly soft, red, micaceous silt with trace clay.SILT (ML)Mostly medium-stiff, tan, micaceous silt.Silt (ML)Mostly soft, tan/gray, micaceous silt, with trace saprolite.Scale as shown; Hatch pattern denotes soil sample depth;Solid denotes lab sample depth; Lithology hatch pattern legend is attached;Well Construction2" diameter Sch. 40 PVC; .010" slotted screenSand: no. 2 sand; Grout: poured portland; Bentonite: poured pelletsFinished with 8"-diameter metal bolt down manhole.NA - Not Applicable; BGL - Below Ground LevelSite:Perth Mini Mart818 Perth RoadTroutman, NCClient:Madhukunj, LLC135 Corona CircleMooresville, NCProject No.:08217Pac
TERRAcENVIRONMENTAL CONSULTANTS, P.C,BORING LOG/MONITORING WELL INSTALLATION DETAILContrar.fnr: RFDIDrill IUlBthnri-AugF>r/IVIiiri RotaryItullfitRryan Vf^stnato Started: 11/?7/1Rnato Finisheri- 11/?8/19I nggnd hy .InrdflP I firfiWBoring Number:MW11BlowCountsNANANANANANANACompletionOVM(Ppm)NA5 —I10NA15NANANANA \—DepthFeet6070|-itholog\20 —|2530 —I35 —|40 —|45 —|50 —|55 —|NA h— 65 —j'Sy?S:SS:c.Kv&vSv.•s^s^s^DescriptionAsphalt/gravelSilt (ML)Red, brown, clayey-silt.SILT (ML)Tan, sandy-silt.Silt (ML)Brown silt.SaproliteTan/brown weathered rock.Boring terminated 70 feet BGL.Scale as shown; Hatch pattern denotes soil sample depth;Solid denotes lab sample depth; Lithology hatch pattern legend is attached;Well ConstructionOuter casing: 5" dia. sch 40 PVCInner casing: 2" dia. sch. 40 PVC; .01" slotted screenSand: no. 2 sand; Grout: poured portland; Bentonite: poured pelletsManhole: flush 8" diameter steelNA - Not Applicable; BGL - Below Ground LevelSite:Perth Mini Mart818 Perth RoadTroutman, NCClient:Madhukunj, LLC135 Corona CircleMooresville, NCProject No.:08217Page
WELL CONSTRUCTION RECORDThis form can be used for single or multiple wel!s1. Well Contractor Information:Wesley J. SorrellsWell Contractor Name3577JlTerraquest Environmental Consultants,Company Name2. Well Construction Permit #:List all applicable well permits (t e. County, State,3. Well Use (check well use):Water Supply Well:D AgriculturalDGeothermal (Heating/Cooling Supply)D Industrial/CommercialDIrrigationNon-Water Supply Well:(3 MonitoringInjection Well:DAquifer RechargeDAquifer Storage and RecoveryDAquifer TestDExperimental TechnologyDGeothermal (Closed Loop)DGeothermal (Heating/Cooling Return)4. Date Well(s) Completed:5a. Well Location:Perth Mini MartFaciIity/Owner Name818 Perth Rd.Physical Address, City, and ZipIredellCountyConsultants, P.C., Variance, Injection, etc.)D Munic ipal/Publ icDResidentiaI Water Supply (single)DResidential Water Supply (shared)DRecoveryDGroundwater RemediationDSalinity BarrierDStormwater DrainageD Subsidence ControlDTracerD Other (explain under #21 Remarks)WellID#MW100-0-24524Facility IDS (if applicable)4730-50-7091Parcel Identification No. (PIN);or Internal Use ONLY:14. WATER ZONESFROMftftTOft.ft.DESCRIPTION15. OUTER CASmG (for multi-cased wells) OR LINER (ifapplicaNe)FROMftTOft.DIAMETERin.-HICKNESSMATERIAL16. INNER CASING OR TUBING (geothermal dosed-loop)FROMftftTO17. SCREENFROM50 ft-Ft.ft.Ft.18. GROUTFROM)26ftftft0) ft-ft.TO?628ft.ft.ft.ft.ft.DIAMETERin.in.-HICKNESSMATERIALDIAMETERin.in.SLOT SIZE.010THICKNESSSch.40MATERIALPVCMATERIALPortlandBentoniteEMPLACEMENT METHOD & AMOUNTPourPour19. SAND/GRAVEL PACK (if applicable)FROM?8ftftro.0ft.ft.MATERIALNo. 2 SandMFLACEMENT METHODPour20. DRILLING LOG (attach additional sheets if necessary)FROM)).5ftftftft.ft.ft,ft.ro.5iO21. REMARKSft.ft.ft.ft.ft.ft.ft.DESCRIPTION (color, hardness, soil/rnck type, grain size, etc.)AsphaltSilt5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:(if well field, one lat/long is sufficient)35.648900-80.895787_wDate6. Is (are) the well(s): EPennanent or DTemporary7.Is this a repair to an existing well: DYes or 17INoIf this is a repair, fill out hiowfj well construction information and explain the nature of therepair under ff-21 remarks section or on the back of this form.8. Number of wells constructed:For multiple injection or non-water supply wells ONL Y with the same construction, you cansubmit one form.22. Certification:Signature of Certified Well ContractorBy signmg this form, I hereby certify that the well(s} was (were) constructed in accordancewith ISA NCAC 02C .0100 or ISA NCAC 02C .0200 Well Conslruclion Standards and thai acopy of this record has been provided to the well owner.23. Site diagram or additional well details:You may use the back of this page to provide additional well site details or wellconstruction details. You may also attach additional pages if necessary.SUBMITTAL INSTUCTIONS509. Total well depth below land surface:For multiple wells list aU depths if different (example- 3@200' and 2@100')10. Static water level below top of casing: """If water fevel is above casing, use "+ "-(ft.). (ft.)II. Borehole diameter: "".(in.)12. Well construction method:(i.e. auger, rotai-y, cable, direct push, etc.). Hollow Stem AugerFOR WATER SUPPLY WELLS ONLY:13a. Yield (gpm) _ Method of test:13b. Disinfection type; _ Amount:24a. For All Wells: Submit this form within 30 days of completion of wellconstruction to the following:Division of Water Resources, Information Processing Unit,1617 Mail Service Center, Raleigh, NC 27699-161724b. For Injection Wells ONLY: In addition to sending the form to the address in24a above, also submit a copy of this form within 30 days of completion of wellconstmction to the following:Division of Water Resources, Underground Injection Control Program,1636 Mail Service Center, Raleigh, NC 27699-163624c. For Water Supply & Injection Wells:Also submit one copy of this form within 30 days of completion ofwell construction to the county health department of the county whereconstructed.FomiGW-1North Carolina Department of Environment and Natural Resources — Division of Water ResourcesRevised August 2013
WELL CONSTRUCTION RECORDThis form can be used for single or multiple wells1. Well Contractor Information:WesleyJ. SorrellsWell Contractor Name3577>r (JeiliticatiiTerraquest EnvironmentalCompany Name2. Well Construction Permit #:List all applicable well permits (i.e. County, State,3. Well Use (check well use):Water Supply Well:DAgriculturalDGeothermal (Heating/Cooling Supply)DIndustrial/CommercialDIrrigationNon-Water Supply Well:BMonitoringInjection Well;DAquifer RechargedAquifer Storage and RecoveryDAquifer TestD Experimental TechnologyDGeothermal (Closed Loop)DGeothermal (Heating/Cooling Return)4. Date Well(s) Completed:5a. Well Location:Perth Mini MartFacility/Owner Name818 Perth Rd.Physical Address, City, and ZipIredellCountyConsultants, P.C., Variance, Injection, etc.)DMunicipal/PublicDResidential Water Supply (single)D Residential Water Supply (shared)DRecoveryDGroundwater RemediationDSalinity BarrierDStormwater DrainageDSubsidence ControlDTracera Other (explain under #21 Remarks)wen wu MW2,MW3,MW400-0-24524Facility IDS (if applicable)4730-50-7091Parcel Identification No. (PIN)''or Inteirnal Use ONLY:14. WATER ZONESFROMftftTOft.ft.15. OUTER CASING (for iFROMftTOft.DESCRIPTIONmulti-cased wells) OR UNER (ifappUcable)DIAMETERin.•HICKNESSMATERIAL16. INNER CASING OR TUBING (geothermal closed-loop)FROMftftTO17. SCREENFROM30ft.ft.3) ft-ft.18. GROTJTFROM)'6ftft.ft,TO?6?8ft.ft.ft.ft.ft.DIAMETERin.in.•HICKNESSMATERIALDIAMETERIB.in.SLOT SIZE.010THICKNESSSch. 40MATERIALPVCMATERIALPortlandBentoniteEMPLACEMENT METHOD & AMOUNTPourPour19. SAND/GRAVEL PACK (if applicable)FROM'8ft,ft,ro0ft.ft.20. DRILLING LOG (attacFROM)).5ft.ft.ft,ft,ft,ft,ft,ro.5iO21. REMARKSft.ft.ft.ft.ft.ft.ft.MATERIALNo. 2 Sand;MFLACEMENT METHODPourtth additional sheets if necessary)DESCRIPTION (color, hardness, soil/rock type, gi-ain size, etc.)AsphaltSilt5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:(if well field, one lab/iong is sufficient)35.648900-80.895787_wCigitifiysgr^db/VfesteyScniTT.i i^SQTTEBiO K ^ITO 1^.Date6. Is (are) the well(s): [aPermanent or DTemporary7. Is this a repair to an existing well: DYes or ENoIf this is a repair, fill out known well comtrucfion information and explam the nature of therepair under ij-21 remarks section or on the back of this form.38. Number of wells constructed:For multiple injection or non-wafer supply wells ONL Y with the same construction, you cansubmit one form.22. Certification:Signature of Certified Well ContractorBy signing this form, I hereby certify that the well(s) was (were) constructed in accordancewith ISA NCAC 02C .0100 or t5A NCAC 03C .0200 Well Construction Standards and that acopy of this record has been provided to the well owner.23. Site diagram or additional well details:You may use the back of this page to provide additional well site details or wellconstruction details. You may also attach additional pages if necessary.SUBMITTAL INSTUCTIONS509. Total well depth below land surface:For multiple wells list all depths if different (example- 3@200' and 2@IOO'}^(ft.) 24a. For All Wells: Submit this form within 30 days of completion of wellconstruction to the following:10. Static water level below top of casing:If water level is above casing, use "+11. Borehole diameter: ^-25. 40.25,36.28,37.02.(ft.).(in.)12. Well construction method: HollOW Stem Auger(i.e. auger, rotai-y, cable, direct push, etc.)FOR WATER SUPPLY WELLS ONLY:13a. Yield (gpm) _ Method of test:13b. Disiufection type: _ Amount:Division of Water Resources, Information Processing Unit,1617 Mail Service Center, Raleigh, NC 27699-161724b. For Injection Wells ONLY: In addition to sending the form to the address in24a above, also submit a copy of this form within 30 days of completion of wellconstruction to the following:Division of Water Resources, Underground Injection Control Program,1636 Mail Service Center, Raleigh, NC 27699-163624c. For Water Supply & Injection Wells:Also submit one copy of this form within 30 days of completion ofwell construction to the county health department of the county whereconstructed.Form GW-1North Carolina Department of Environment and Natural Resources - Division of Water ResourcesRevised August 2013
WELL CONSTRUCTION RECORDThis form can be used for single or multiple wells1. Well Contractor Information:Wesley J. SorrellsWell Contractor Name3577NC Well Contractor Certification NumberTerraquest Environmental Consultants, P.C.Company Name2. Well Construction Permit #:Usl all applicable well permits (i.e. County, State, Variance^ Injection, etc.)3. Well Use (check well use):Water Supply Well:DAgricultural DMunicipal/PublicdGeothermal (Heating/Cooling Supply) DResidential Water Supply (single)alndustrial/Commereial DResidential Water Supply (shared)a IrrigationNon-Water Supply Well:BMonitoring QRecoveiyInjection Well:DAquifer Recharge DGroundwater RemediationDAquifer Storage and Recovery DSalinity BarrierdAquifer Test DStormwater DrainageDExperimental Technology DSubsidence ControlDGeothermal (Closed Loop) DTracerDGeothermal (Heating/Cooling Return) DOther (explain under #21 Remarks)4. Da.e WeII(s) Con.pleted. 11/26/18 ^,, ^ MW5,MW6,MW75a. Well Location:Perth Mini Mart 00-0-24524Facility/Owner Name Facility IDS (if applicable)818 Perth Rd.Physical Address, City, and ZipIredell 4730-50-7091County Parcel Identification No. (PIN);or Internal Use ONLY:14. WATER ZONESFROMft.ft.TOft.ft.DESCRIPTION15. OUTER CASING (for multi-cased wells) OR LINER (if applicable)FROMft.FROMft.ft.TOft.K. INNER CASING OR TUBING (geISJNG OR TTOft.ft.DIAMETERin,THICKNESSJBING (geothermal closed-Iooii)DIAMETERin.in.THICKNESSMATERIALMATERIAL17. SCREENFROM30 ft-ft.0) ft-ft.DIAMETERin.in.SLOT SIZE.010THICKNESSSch. 40MATERIALPVC18. GROBTFROM3 ft-26 ft-ft.TO76 ft-28 ft-ft.MATERIALPortlandBentoniteEMPLACEMENT METHOD & AMOUNTPourPour19. SAND/GRAVEL PACK (if applicable)FROM28 ft-ft.TO,0 ft-ft.MATERIALNo. 2 SandiMPLACEMENT METHODPour20. DRILLING LOG (attach additional sheets if necessary)FROM3 ft-3.5 ft-ft.ft.ft.ft.ft.TO.5 ft-iO ft-ft.ft.ft.ft.ft.DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)AsphaltSilt21. REMARKS5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:(if well field, one lat/long is sufficient)35.648900-80.895787_wD^itaS/ itgred by V/i lisy SorrEa:6TMiW^cn.Sl056.S3^iaxOT\c»USDate6. Is (are) the well(s): EPermanent or DTemporary7. Is this a repair to an existing well: DYes or 171NoIf this is a repair, fill out known well construction information and explain the nature of therepair under #21 remarks section or on the back of this form.38. Number of wells constructed:For multiple injection or non-water supply wells ONLY with the same construe fioit, you cansubmit one form.22. Certification:•/1Signature of Certified Well ContractorBy sigmng this form, I hereby certify that the well(s) was (were) constructed in accordancewith ISA NCAC 02C .0100 or ISA NCAC 02C .0200 Well Construction Standards and that acopy of this record has been provided to {he well owner.23. Site diagram or additional well details:You may use the back of this page to provide additional well site details or wellconstruction details. You may also attach additional pages if necessary.SUBMITTAL DMSTUCTIONS509. Total well depth below land surface:For multiple wells list all depths if different (example- 3@200' and 2@l00')„. 32.95,34.23,35.00-(ft-)10. Static water level below top of casing:If water level is above casing, use "+11. Borehole diameter: "".(ft.).(in.)12. Well construction method: HollOW Stem Auger(i.e. auger, rotary, cable, direct push, etc.)FOR WATER SUPPLY WELLS ONLY:13a. Yield (gpm) _ Method of test:13b. Disinfection type: _ Amount:24a. For All Wells: Submit this form within 30 days of completion of wellconstruction to the following:Division of Water Resources, Information Processing Unit,1617 Mail Service Center, Raleigh, NC 27699-161724b. For Injection Wells ONLY; In addition to sending the form to the address in24a above, also submit a copy of this form within 30 days of completion of wellconstruction to the following:Division of Water Resources, Underground Injection Control Program,1636 Mail Service Center, Raleigh, NC 27699-163624c. For Water Supply & Injection Wells:Also submit one copy of this form within 30 days of completion ofwell construction to the county health department of the county whereconstructed.Form GW-1North Carolina Department of Environment and Natural Resources - Division of Water ResourcesRevised August 2013
WELL CONSTRUCTION RECORDThis form can be used for single or multiple wel!s1. Well Contractor Information:Wesley J. SorrellsWell Contractor Name3577NC Well Conb'actor Certification NumberTerraquest Environmental Consultants, P.C.Company Name2. Well Construction Permit #:List all applicable well permits (i.e. Conntyi, State, Variance, Injection, etc.)3. Well Use (check well use):Water Supply Well:DAgricultural DMunicipal/PublicDGeothermal (Heating/Cooling Supply) DResidential Water Supply (single)DIndustrial/Commercial DResidential Water Supply (shared)DIn'igationNon-Water Supply Well:BMonitoring DRecoveryInjection Well:DAquifer Recharge dGroundwater RemediationDAquifer Storage and Recovery dSalinity BarrierOAquifer Test DStormwater DrainageDExperimental Technology DSubsidence ControlDGeothermal (Closed Loop) DTracerDGeothermal (Heating/Cooling RetuiTi) DOther (explain under #21 Remarks)4. Date Well(s) Completed: ' '"-" lu Well ID#_5a. Well Location;Perth Mini Mart 00-0-24524Facility/Owner Name Facility ID# (if applicable)818 Perth Rd.Physical Address, City, and Zipiredell 4730-50-7091County Parcel Identification No. (PIN);or Internal Use ONLY:14. WATER ZONESFROMft.ft.TOft.ft.DESCRIPTION15. OUTER CASING (for multi-cased wells) OR LINER (ifapplicalile)FROMft.TOft.DIAMETERin.THICKNESSMATERIAL16. INNER CASING OR TUBING (geotliermal dosed-loop)FROMft.ft.TOft.ft.DIAMETERin.in.THICKNESSMATERIAL17. SCREENFROM30 ft-ft.0) ft-ft.DIAMETERin.in.SLOT SIZE.010THICKNESSSch. 40MATERIALPVC18. GROUTFROM3 ft-26 ft-ft.TO26 ft-28 ft-ft.MATERIALPortlandBentoniteEMPLACEMENT METHOD & AMOUNTPourPour19. SAND/GRAVEL PACK (if applicable)FROM?8 ^ft.TO,0 ft-ft.MATERIALNo.2 SandiMFLACEMENT METHODPour20. DRILLING LOG (attach additional sheets if necessary)FROM3 ft-D.5 ft-ft.ft.ft.ft.ft.TO.5 ^iO ft-ft.ft.ft.ft.ft.DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)AsphaltSilt21. REMARKS5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:(if well field, one lat/long is sufficient)22. Certification:35.648900-80.895787_wDigits'!-/ ttgn^d ly
/ Wsri?/ SorreiKtmi»=w^fSTea-aS^§yna!iicsn, c=USSignature of Certified Well Conb-actorDate6. Is (are) the well(s): BPermanent or DTemporary7. Is this a repair to an existing well: DYes or ElNoIf this is a repair, fifl out hwwn well constmcfion information and explain the nature of therepair wider ii2! remark's section or on the back of this form.8. Number of wells constructed:For multiple injection or non-water supply wells ONLY with the same construction, you cansubmit one form.By signing this form, I hereby certify that {he well(s) was (were) constructed m accordancewill] 15A NCAC 02C .0100 or ISA NCAC 02C .0200 Well Construction Standards and thai acopy of this record has been provided to the well owner.23. Site diagram or additional well details;You may use the back of this page to provide additional well site details or wellconstruction details. You may also attach additional pages if necessary.SUBMITTAL INSTUCTIONS509. Total well depth below land surface:For multiple wells list all depths if different (example- 3@200' and 3@]00'')10. Static water level below top of casing: """If water hvel is above casing, use "+.(ft.) 24a. For All Wells: Submit this form within 30 days of completion of wellconstruction to the following:.(ft.)11. Borehole diameter: _8-25.(in.)12. Well construction method:(i.e. auger, rotary, cable, direct push, etc.). Hollow Stem AugerFOR WATER SUPPLY WELLS ONLY:13a. Yield (gpm) _ Method of test:13b. Disiufection type: _ Amount:Division of Water Resources, Information Processing Unit,1617 Mail Service Center, Raleigh, NC 27699-161724b. For Injection Wells ONLY: In addition to sending the form to the address in24a above, also submit a copy of this form within 30 days of completion of wellconstruction to the following:Division of Water Resources, Underground Injection Control Program,1636 Mail Service Center, Raleigh, NC 27699-163624e. For Water Supply & Injection Wells:Also submit one copy of this form within 30 days of completion ofwell construction to the county health department of the county whereconstructed.FonnGW-1North Carolina Department of Environment and Natural Resources - Division of Water ResourcesRevised August 2013
WELL CONSTRUCTION RECORDThis form can be used for single or multiple wells1. Well Contractor Information:Wesley J. SorrellsWell Contractor Name3577NC Well Contractor Certification NumberTerraquest Environmental Consultants, P.C.Company Name2. Well Construction Permit ff:List all applicable well permits (i.e. County, State, Variance, Injection, etc.)3. Well Use (check well use):Water Supply Well:DAgricultural DMunicipal/PublicDGeothermal (Heating/Cooling Supply) DResidential Water Supply (single)dIndustrial/Commercial DResidential Water Supply (shared)a IrrigationNon-Water Supply Well:BMonitoring DRecoveryTlnjection Well:DAquifer Recharge DGroundvvater RemediationdAquifer Storage and Recovery DSalinity BarrierDAquifer Test DStormwater DrainageDExperimental Technology DSubsidence ControlDGeothermal (Closed Loop) DTracerDGeothermal (Heating/Cooling Return) aOther (explain under #21 Remarks)4. Date Well(s) Completed: ' '"-" '" Well ID#_5a. Well Location:Perth Mini Mart 00-0-24524Facillty/Owner Name Facility ID# (if applicable)818 Perth Rd.Physical Address, City, and ZipIredell 4730-50-7091County Parcel Identification No. (PIN):or Internal Use ONLY:14. WATER ZONESFROMft.ft.TOft.ft.DESCRIPTIONIS. OUTER CASING (for multi-cased wells) OR LINER (if applicable)FROMft.TOft.DIAMETERin.THICKNESSMATERIAL16. INNER CASING OR TUBING (geothennal closed-laop)FROMft.ft.TOft.ft.DIAMETERin.in.THICKNESSMATERIAL17. SCREENFROM?o ft-ft.0) ft-ft.DIAMETERin.in.SLOT SIZE.010THICKNESSSch. 40MATERIALPVC1S.GROUTFROM) ft-16 ft-ft.TO16 ft-18 ft-ft.MATERIALPortlandBentoniteEMPLACEMENT METHOD & AMOUNTPourPour19. SAND/GRAVEL PACK (if applicable)FROM18 ft-ft.TO[0 {t-ft.MATERIALNo. 2 Sand3MPLACEMENT METHODPour20. DRILLING LOG (attach additional sheets if necessary)FROM) ft-).5 ft-ft.ft.ft.ft.ft.TOi.5 ^w {t-ft.ft.ft.ft.ft.DESCRIPTION (color, hardness, soil/rock type, arain size, etc.)GravelSilt21. REMARKS5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:(if well field, one lat/long is sufficient)22. Certification:35.648900-80.895787_w^Di^tiff/ slgnsd
by Wsit-y SotreSsDf£ CBSW&I"/ Sotreasi. o, cu,Emi3s-(i^u3rriai0563gmia£UT\ c:Signature of Certified Well ContractorDate6. Is (are) the well(s): caPermanent or DTemporary7.Is this a repair to an existing well: DYes or IZlNoIf this is a repair, fill out known well construction mfop'mation and explam the nature of therepair wider #27 remarks section or on the back of this form.8. Number of wells constructed:For multiple injection or non-waler supply wells ONL Y with the same construction, you cansubmit one form.9. Total well depth below laud surface: '" _(ft.)For multiple veils list all depths if different (example- 3@200' and2@ll)l)')25.64By signing fhfs form, 1 hereby certify that the wefl{s) was (were) constructed in accordanceU77/1 ISA NCAC 02C .0100 or ISA NCAC 02C .0200 Well Conslruclion Slandards and thai acopy offhis record has been provided to the well owner.23. Site diagram or additional well details:You may use the back of this page to provide additional well site details or wellconstruction details. You may also attach additional pages if necessary.SUBMITTAL INSTUCTIONS10. Static water level below top of casing:If water level is above casing, use +11. Borehole diameter: "•'.(ft.).(in.)12. Well construction method: HollOW Stem Auger(i.e. auger, rotaiy, cable, direct push, etc.)FOR WATER SUPPLY WELLS ONLY:13a. Yield (gpm) _ Method of test:13b. Disinfection type: _ Amount:24a. For All Wells; Submit this form within 30 days of completion of wellconstruction to the following:Division of Water Resources, Information Processing Unit,1617 Mail Service Center, Raleigh, NC 27699-161724b. For Injection Wells ONLY: In addition to sending the form to the address in24a above, also submit a copy of this form within 30 days of completion of wellconstruction to the following:Division of Water Resources, Underground Injection Control Program,1636 Mail Service Center, Raleigh, NC 27699-163624c. For Water Supply & Injection Wells:Also submit one copy of this form within 30 days of completion ofwell construction to the county health department of the county whereconstructed.Form GW-1North Carolina Department of Environment and Natural Resources ~ Division of Water ResourcesRevised August 2013
WELL CONSTRUCTION RECORDThis form can be used for single or multiple wells1. Well Contractor Information:WesleyJ. SorrellsWell Contractor Name3577NC Well Contractor Certification NumberTerraquest Environmental Consultants, P.C.Company Name2. Well Construction Permit #:Lisf all applicable well permits fi.e. County, State,3. Well Use (check well use):Water Supply Well:CIAgriculturalDGeothermal (Heating/Cooling Supply)aindustrial/Commercialdln'igationNon-Water Supply Well:EIMonitoringInjection Well:DAquifer RechargeDAquifer Storage and RecoveryDAquifer TestDExperimental TechnologyOGeothermal (Closed Loop)DGeothermal (Heating/Cooling Return)4. Date Well(s) Completed:5a. Well Location:Perth Mini MartFacility/Owner Name818 Perth Rd.Physical Address, City, and ZipIredellCountyVariance, Injection, etc.)D Munic ipal/Publ icDResidential Water Supply (single)DResidential Water Supply (shared)DRecoveryCIGroundwater RemediationDSalinity BarrierDStormwater DrainageDSubsidence ControlDTracerDOther (explain under #21 Remarks)We,,m#MW1000-0-24524Facility 1D# (if applicable)4730-50-7091Parcel Identification No. (PIN);or Internal Use ONLY:14. WATER ZONESFROMFROMftftTEftTOft.ft.DESCRIPTION15. OUTER CASING (foASING (for multi-cased wells) OR LINER (ifappUcable)TOft.DIAMETERID.'HICKNESSMATERIAL16. INNER CASING OR TUBING (geothermal doscd-loop)FROMftftTO17. SCREENFROM?o ft-Ft.ft.Ft.18. GROUTFROM)16ftftft.0) ft-ft.TO1618ft.ft.ft.ft.ft.DIAMETERin.in.•HICKNESSMATERIALDIAMETERin.in.SLOT SIZE.010THICKNESSSch. 40MATERIALPVCMATERIALPortlandBentoniteEMPLACEMENT METHOD & AMOUNTPourPour19. SAND/GRAVEL PACK (if applicable)FROM18FROM)).5ft,ft,20.DMLLINGLOG(i!ajft,ft,ft,ft,ft,ft.ft,ro0ft.ft.}LOG(attairo.5[021. REMARKSft.ft.ft.ft.ft.ft.ft.MATERIALNo.2 SandMPLACEMENT METHODPouri additional slieets if necessary)DESCRIPTION (color, hardness, soil/rock type, erain sia;, etc.)GravelSilt5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:(if well field, one lat/loug is sufficient)35.648900-80.895787_wDigteByrig.nEdbyWeslF/Son'aSsWt cr^weri"/ Sotrsfli. o. ou.smaftswtsctTeaiQSeayna'Lccm. c;te£:20ia.12D5 HW3S-05WDate6. Is (are) the well(s): E3Permanent or DTemporary7.Is this a repair to an existing well: ClYes or ENoIf this is a repair, fill out hwwn well construction informafson and explain the nature of therepair under #2/ remarks section or on the hack of this form.8. Number of wells constructed:For multiple injection or non-water supply wells ONLY with the same co/istrncfion, you cansubmit one form.22. Certification:Signature of Certified Well ContractorBy signing f his form, I hereby certify that the welf(s) was (were) constructed in accordancewith 15A NCAC 02C .0100 or ISA NCAC 03C .9300 Well Conslruclion Standards and that acopy of this record has been provided to the well ownef:23. Site diagram or additional well details:You may use the back of this page to provide additional well site details or wellconstruction details. You may also attach additional pages if necessary.SUBMITTAL INSTUCTIONS409. Total well depth below laud surface:For multiple wells fis! all depths if different (example- 3@200' and 2@100')10. Static water level below top of casing: '-""If water level is above casing, use "+ ".... 8.25.(ft.) 24a. For All Wells: Submit this form within 30 days of completion of wellconstruction to the following:.(ft.).("1.)11. Borehole diameter:12. Well construction method: HollOW Stem Auger(i.e. auger, rotaiy, cable, direct push, etc.)FOR WATER SUPPLY WELLS ONLY:13a. Yield (gpm) _ Method of test:13b. Disinfection type: _ Amount:Division of Water Resources, Information Processing Unit,1617 Mail Service Center, Raleigh, NC 27699-161724b. For Injection Wells ONLY: In addition to sending the form to the address in24a above, also submit a copy of this form within 30 days of completion of wellconstruction to the following:Division of Water Resources, Underground Injection Control Program,1636 Mail Service Center, Raleigh, NC 27699-163624c. For Water Supply & Injection Wells:Also submit one copy of this form within 30 days of completion ofwell construction to the county health department of the county whereconstructed.Form GW-1North Carolina Department of Environment and Natural Resources - Division of Water ResourcesRevised August 2013
WELL CONSTRUCTION RECORDThis form can be used for single or multiple wells1. Well Contractor Information:Bryan L VestWell Contractor Name3580-ANC Well Contractor Certification NumberRansier Environmental Drilling Inc (REDI)Company Name2. Well Construction Permit #:List all applicable well permits (i.e. County, State, Variance, Injection, etc.)3. Well Use (check well use):Water Supply Well:CIAgricultural DMunicipal/PublicCIGeothermal (Heating/Cooling Supply) DResidential Water Supply (single)aindustrial/Commercial DResidential Water Supply (shared)DIrrigationNon-Water Supply Well:EIMonitoring DRecoveryInjection Well:DAquifer Recharge DGroundwater RemediationDAquifer Storage and Recovery DSalinity BarrierDAquifer Test DStormwater DrainageDExperimental Technology DSubsidence ControlDGeothermal (Closed Loop) DTracerCIGeothermal (Heating/Cooling Return) DOther (explain under #21 Remarks)4. Date Well(s) Completed: 11/28/2018^,, ^ MW-115a. Well Location;Perth Mini Mart 06-6-00000^l{^'2.1^Facility/Owner Name Facility ID# (if applicable)818 Perth Rd, Troutman, NC 28166Physical Address, City, and ZipIredellCounty Parcel Identification No. (PIN);or Internal Use ONLY:14. WATER ZONESFROMft.ft.TOft.ft.DESCRIPTION15. OUTER CASING (for multi-cased wells) OR LINER (ifappliuible)FROM3 ft-TO55 ft-DIAMETER5 in-THICKNESSSCH40MATERIALPVC16. INNER CASING OR TUBING (geothermal closed-Ioop)FROM3 ft-ft.TO65 ft-ft.DIAMETERin.in.THICKNESSSCH40MATERIALPVC17. SCREENFROM35 ft-ft.TO70 ft-ft.DIAMETER2 in-in.SLOT SIZE0.010THICKNESSSCH40MATERIALPVC18. GROUTFROM).5 ft-31 ft-ft.TO61 ft-63 ft-ft.MATERIALCementBentoniteEMPLACEMENT METHOD & AMOUNTPourPour19. SAND/GRAVEL PACK (if applicable)FROM33 ft-ft.TO70 ft-ft.MATERIAL#3 GraveliMPLACEMENT METHODPour20. DRILLING LOG (attach additional sheets if necessary)FROM) ft-3.5 ft-13 ft-18 ft-33 ft-ft.ft.TO0.5 ft-13 ft-18 ft-63 ft-70 ft-ft.ft.DESCRIPTION (colors hardness, soil/rock typCi grain size, etc.)Asphalt/GravelRed/Brown Clayey SiltTan Sandy SiltBrown SiltTan/Brown Saprolite(Weathered Rock)21. REMARKSFinished with Flush Mount Cover5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:(if well field, one laflong is sufficient)22. Certification:35°41'3.4380°53'45.32"-w0^/0^' /-^ l^<L<£t~6. Is (are) the well(s): [aPermanent or DTemporary7. Is this a repair to an existing well: DYes or ENoIf this is a repair, fill out known well construction information and explain the nature of therepair wider ^21 remarks section or on the back of this form.8. Number of wells constructed:For multiple mjection or non-water supply wells ONLY with the swne coHStriiction, you cansubmit one form.12/5/2018Signal of Certified Well ContractorDateBy signing this form, I hereby certify that fhe well(s) was {were} constructed m accordancev'ilh ISA NCAC 02C .0100 or ISA NCAC 02C .0200 Well Consnvclion Standards and thai acopy of this record has been provided to fhe well owner.23. Site diagram or additional well details:You may use the back of this page to provide additional well site details or wellconstmction details. You may also attach additional pages if necessary.SUBMITTAL INSTUCTIONS709. Total well depth below land surface;For multiple wells lisl all depths if different (example- 3@200' and 2@100')10. Static water level below top of casing:If water level is above casing, use "+ "-(ft.).(ft.)11. Borehole diameter: 8 OUter/SJnner (,„.12. Well construction method:(i.e. auger, rotaiy, cable, direct push, etc.)'.). Auger/Mud RotaryFOR WATER SUPPLY WELLS ONLY:13a. Yield (gpm) _ Metliod of test:13b. Disiilfection type: _ Amount;24a. For All Wells: Submit this form within 30 days of completion of wellconstruction to the following:Division of Water Resources, Information Processing Unit,1617 Mail Service Center, Raleigh, NC 27699-161724b. For Injection Wells ONLY: In addition to sending the form to the address in24a above, also submit a copy of this form \vithin 30 days of completion of wellconstruction to the following:Division of Water Resources, Underground Injection Control Program,1636 Mail Service Center, Raleigh, NC 27699-163624c. For Water Supply & Injection Wells:Also submit one copy of this form within 30 days of completion ofwell construction to the county health department of the county whereconstructed.Foml GW-1North Carolina Department of Environment and Natural Resources ~- Division of Water ResourcesRevised August 2013
WELL CONSTRUCTION RECORD fGW-1)1. Well Contractor Information:Jonathan R. GrubbsWell Contractor Name3001For Internal Use Only:NC Well Contractor Certification NumberTerraquest Environmental Consultants, P.C.Company Name2. Well Construction Permit #:List all applicable well comtmction permits (i.e. UIC, Cowity, State, Variance, etc.)3. Well Use (check well use):Water Supply Well:(Agricultural OMumcipa?ublicGeothennal (Heating/Cooling Supply) QResidential Water Supply (single)IIndustrial/Commercial [^Residential Water Supply (shared)I Irrigation14. WATER ZONESFROMft.ft.TOft.ft.DESCRIPTION15. OUTER CASING (for multi-cased wells) OR LINER (if applicable)FROMft.TOft.DIAMETERTHICKNESSMATERIAL16. INNER CASING OR TUBING (geothermal dosed-Ioop)FROMft.ft.TOft.ft.DIAMETERTHICKNESS17. SCREENFROM25ft.ft.40ft.ft.DIAMETER I SLOT SIZE.010THICKNESSsch40MATERIALPVC18. GROTJTFROMTOEMPLACEMENT METHOD & AMOUNTNon-Water Supply Well:|X( Monitoringft.21 ft-n RecoveryPortlandpourInjection Well:lAquifer RechargelAquifer Storage and RecoverylAquifer TestlExperimental TechnologyIGeothermal (Closed Loop)21ft.23ft.BentonitepourQOroundvvater RemediationQSalinity BarrierQStormwater DrainageQSubsidence ControlF'tTracerft.ft.19. SAND/GRAVEL PACK (if applicable)FROM23ft.ft.TO40ft.ft.MATERIALNo. 2 sandEMPLACEMENT METHODpour20. DRILLING LOG (attach additional sheets if necessary)IGeothermal (Heating/Cooling Return) QOther (explain under #21 Remarks)FROM I TO4. Date Well(s) Completed:5a. Well Location:Perth Mini MartFacility/Owner Name4/30/19Well ID#MW12.MW130 ft-ft.ft.0-00-0000024524Facility ID# (if applicable)ft.ft.818 Perth Rd, Troutman, NC 28166ft.Physical Address, City, and ZipIredellCountyft.4730-50-7091Parcel Identification No. (PIN)40 «•DESCRIPTION (color, hardness, soil/rock type, grain sue, etc.)SILT21. REMARKSSb. Latitude and longitude in degrees/minutes/seconds or decimal degrees:(if well field, one lat/long is sufficient)35.684229-80.896042w6. Is(are) the w'ell(s){7j]Permanent or QTemporary7. Is this a repair to an existing well: QYes or R?INOIf this is a repair, fill out known well construction mfonnation and explain the nature of therepair under #21 remark section or on the back of this form.8. For Geoprobe/DPT or Closed-Loop Geothermal Wells having the sameconstruction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wellsdrilled:_409. Total well depth below land surface:For multiple wells list all depths if different (example- 3@200' anti 2@!00<)25.37.22.9510. Static water level below top of casing: —"'" ' 'If water level is above casing, use ttjr "-(ft.).(ft.)11. Borehole diameter:. 8.25. (in.)12. Well construction method:(Le. auger, rotary, cable, direct push, etc.)Hollow stem augerFOR WATER SUPPLY WELLS ONLY:13a. Yield (gpm)_ Method of test:13b. Disinfection type: _ Amount:22. Certification:Digitally signed by Jonathan GrubbsDN: cn=Jonathan Grubbs, o=TerraquestEnvironmental Consultants, P.C., ou,—-efnail'"jrgrubbs@^rr8que9tpc:corrt; c-U-SDate: 2019.05.2^C40:21 -04'00'By signing this form, I hereby certify that the well(s) was (were) constructed in accordancewith ISA NCAC 02C .0100 or ISA NCAC 02C .0200 Veil Construction Standards and that acopy of this record has been provided to the well owner.23. Site diagram or additional well details:You may use the back of this page to provide additional well site details or wellconstmction details. You may also attach additional pages if necessary.SUBMITTAL INSTRUCTIONS24a. For All Wells: Submit this form within 30 days of completion of wellconstruction to the following:Division of Water Resources, Information Processing Unit,1617 Mail Service Center, Raleigh, NC 27699-161724b. For Injection Wells: In addition to sending the form to the address in 24aabove, also submit one copy of this form within 30 days of completion of wellconstmction to the following:Division ofWater Resources, Underground Injection Control Program,1636 Mail Service Center, Raleigh, NC 27699-163624c. For Water Supply & Injection Wells: In addition to sending the fomi tothe address(es) above, also submit one copy of this form within 30 days ofcompletion of well construction to the county health department of the countywhere constructed.FormGW-1North Carolina Department of Environmental Quality - Division of Water ResourcesRevised 2-22-2016
WELL CONSTRUCTION RECORD (GW-1)I. Well Contractor Information;Jonathan R. GrubbsWell Contractor Name3001For Internal Use Only:NC Well Contractor Certification NumberTerraquest Environmental Consultants, P.C.WM0301001Company Name2. Well Construction Permit #:List all applicable well constniction permits (f.e. UIC, County, State, Variance, etc.)3. Well Use (check well use):Water Supply Well:QAgricultural Q Municipal/PublicQOeothennal (Heating/Cooling Supply) QResidential Water Supply (single)Qlndustrial/Commercial QResidential Water Supply (shared)l} Irrigation14. WATER ZONESFROMft.ft.TOft.ft.DESCRIPTION15. OUTER CASING (for multi-cased wells) OR UNER (if applicable)ft.ft.THICKNESS16. INNER CASmG OR TUBING (geothermal dosed-loop)ft.ft.ft.ft.in.THICKNESSMATERIAL17. SCREENFROM25ft.ft.40ft.ft.DIAMETER I SLOT SIZE I THICKNESS I MATERIAL.010sch40PVC18. GROUTFROMEMPLACEMENT METHOD & AMOUNTNon-Wafer Supply Well:J?| Monitoring0ft.n Recovery21 ft-PortlandpourInjection Well:QAquifer RechargelAquifer Storage and RecoverylAquifer TestI Experimental TechnologyIGeothermal (Closed Loop)21 ft-23ft.BentonitepourQGroundwater RemediationQlSalinity BarrierQStormwater DrainageQSubsidence ControlITracerft.ft.19. SAND/GRAVEL PACK (if applicable)PROM I TO23 «•ft.40ft.ft.MATERIALNo. 2 sandEMPLACEMENT METHODpourM. DRILLING LOG (attach additional sheets if necessary)iGeothermal (Heating/Cooling Return) QOther (explain under #21 Remarks)FROM I TO4/30/19Well ID#MW140ft.0-00-00000245244. Date Well(s) Completed:5a. Well Location:Perth Mini MartFaciIity/Owner Name Facility IDS (if applicable)569 Autumn Leaf Rd, Troutman, NC 28166Physical Address, City, and ZipIredellft.ft.ft.ft.ft.ft.County4730792085.000Parcel Identification No. (PW)40 ft-DESCRIPTION (color, hnrdncss, soil/rock type, erain size, etc.)SILT21. REMARKS5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:(if well field, one lat/Iong is sufficient)35.684111-80.895728_w6. Is(are) the well(s)^]]Permanent or QTemporary7. Is this a repair to an existing well: QYes or p}NoIf this is a repair, fill out hwvn well construction mformation and explain the nature of therepair under lf21 remarks section or on the back of this form.8. For Geoprobe/DPT or Closed-Loop Geothermal Wells having the sameconstruction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wellsdrilled:_.409. Total well depth below land surface;For multiple wells list all depths if different (example- 3@200' and 2@100')10. Static water level below top of casing: ~ " 'If water level is above casing, use "+ "_(ft.).(ft.)11. Borehole diameter:.8.25. (in.)12. Well construction method:(i.e. auger, rotary, cable, direct push, etc.)Hollow stem augerFOR WATER SUPPLY WELLS ONLY:13a. Yield (gpm) _ Method of test:13b. Disinfection type: _ Amount:22. Certification: _. ... .Digitally signed by Jonathan GrubbsDN: cn^Jonathan Grubbs, o=TerraquestEnvironmental Consultants, P.C., ou,—[e-mail], c-USDate: 2019.05.2?flS°36:45-04'00'By sigfwig this fonn, I hereby certify that the well(s) was (were) constructed m accordancewith ISA NCAC 02C .0100 or ISA NCAC 02C .0200 Well Construction Standards and that acopy of this record has been provided to the well owner.23. Site diagram or additional well details:You may use the back of this page to provide additional well site details or wellconstruction details. You may also attach additional pages if necessary.SUBMITTAL INSTRUCTIONS24a. For All Wells: Submit this form within 30 days of completion of wellconstruction to the following:Division of Water Resources, Information Processing Unit,1617 Mail Service Center, Raleigh, NC 27699-161724b. For Injection Wells: In addition to sending the form to the address in 24aabove, also submit one copy of this form within 30 days of completion of wellconstruction to the following:Division of Water Resources, Underground Injection Control Program,1636 Mail Service Center, Raleigh, NC 27699-163624c. For Water Supply & Injection Wells: In addition to sending the form tothe address(es) above, also submit one copy of this form within 30 days ofcompletion of well construction to the county health department of the countywhere constructed.Form GW-1North Carolina Department of Environmental Quality " Division of Water ResourcesRevised 2-22-2016
:(//&216758&7,215(&25'
7KLVIRUPFDQEHXVHGIRUVLQJOHRUPXOWLSOHZHOOV
)RUP*:  1RUWK&DUROLQD'HSDUWPHQWRI(QYLURQPHQWDQG1DWXUDO5HVRXUFHV±'LYLVLRQRI:DWHUResources 5HYLVHG$ugust
:HOO&RQWUDFWRU,QIRUPDWLRQ
:HOO&RQWUDFWRU1DPH
1&:HOO&RQWUDFWRU&HUWLILFDWLRQ1XPEHU
&RPSDQ\1DPH
:HOO&RQVWUXFWLRQ3HUPLW
List all applicable well permits (i.e. County, State, Variance, Injection, etc.)
:HOO8VH FKHFNZHOOXVH
:DWHU6XSSO\:HOO
Ƒ$JULFXOWXUDO Ƒ0XQLFLSDO3XEOLF
Ƒ*HRWKHUPDO+HDWLQJ&RROLQJ6XSSO\Ƒ5HVLGHQWLDO:DWHU6XSSO\ VLQJOH
Ƒ,QGXVWULDO&RPPHUFLDO Ƒ5HVLGHQWLDO:DWHU6XSSO\ VKDUHG
Ƒ,UULJDWLRQ
1RQ:DWHU6XSSO\:HOO
Ƒ0RQLWRULQJ Ƒ5HFRYHU\
,QMHFWLRQ :HOO
Ƒ$TXLIHU5HFKDUJH Ƒ*URXQGZDWHU5HPHGLDWLRQ
Ƒ$TXLIHU6WRUDJHDQG5HFRYHU\Ƒ6DOLQLW\%DUULHU
Ƒ$TXLIHU7HVW Ƒ6WRUPZDWHU'UDLQDJH
Ƒ([SHULPHQWDO7HFKQRORJ\Ƒ6XEVLGHQFH&RQWURO
Ƒ*HRWKHUPDO&ORVHG/RRSƑ7UDFHU
Ƒ*HRWKHUPDO+HDWLQJ&RROLQJ5HWXUQƑ2WKHUH[SODLQXQGHU5HPDUNV
'DWH:HOOV&RPSOHWHGBBBBBBBBBBBB:HOO,'BBBBBBBBBBBBBBBBBBBBBB
D:HOO/RFDWLRQ

)DFLOLW\2ZQHU 1DPH )DFLOLW\,'LIDSSOLFDEOH

3K\VLFDO$GGUHVV&LW\DQG=LS

&RXQW\ 3DUFHO,GHQWLILFDWLRQ1R3,1
E/DWLWXGHDQG/RQJLWXGHLQGHJUHHVPLQXWHVVHFRQGVRUGHFLPDOGHJUHHV
LIZHOOILHOGRQHODWORQJLVVXIILFLHQW
1 :
,V DUHWKHZHOOVƑ3HUPDQHQWRUƑ7HPSRUDU\
,VWKLVDUHSDLUWRDQH[LVWLQJZHOOƑ<HVRUƑ1R
If this is a repair, fill out known well construction information and explain the nature of the repair under #21 remarks section or on the back of this form.
 1XPEHURIZHOOVFRQVWUXFWHG 
For multiple injection or non-water supply wells ONLY with the same construction, you can
submit one form.
7RWDOZHOOGHSWK EHORZODQG VXUIDFH  IW
For multiple wells list all depths if different (example- 3@200’ and 2@100ƍ
6WDWLFZDWHUOHYHOEHORZWRSRIFDVLQJ IWIf water level is above casing, use “+”
%RUHKROHGLDPHWHU LQ
:HOOFRQVWUXFWLRQPHWKRG  
LHDXJHUURWDU\FDEOHGLUHFWSXVKHWF
)25:$7(56833/<:(//621/<
D<LHOGJSP0HWKRGRIWHVW
E'LVLQIHFWLRQW\SH$PRXQW
:$7(5=21(6
)520 72 '(6&5,37,21
IWIW
IWIW
287(5&$6,1* IRUPXOWLFDVHGZHOOV25/,1(5LIDSSOLFDEOH
)520 72 ',$0(7(5 7+,&.1(66 0$7(5,$/
IWIWLQ
,11(5&$6,1* 2578%,1* JHRWKHUPDOFORVHGORRS
)520 72 ',$0(7(5 7+,&.1(66 0$7(5,$/
IWIWLQ
IWIWLQ
6&5((1
)520 72 ',$0(7(5 6/27 6,=( 7+,&.1(66 0$7(5,$/
IWIWLQ
IWIWLQ
*5287
)520 72 0$7(5,$/ (03/$&(0(170(7+2' $02817
IWIW
IWIW
IWIW
6$1'*5$9(/3$&.LIDSSOLFDEOH
)520 72 0$7(5,$/ (03/$&(0(170(7+2'
IWIW
IWIW
'5,//,1*/2* DWWDFKDGGLWLRQDOVKHHWVLIQHFHVVDU\
)520 72 '(6&5,37,21 FRORUKDUGQHVVVRLOURFNW\SHJUDLQVL]HHWF
IWIW
IWIW
IWIW
IWIW
IWIW
IWIW
IWIW
5(0$5.6
&HUWLILFDWLRQ
6LJQDWXUHRI&HUWLILHG:HOO&RQWUDFWRU 'DWH
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
6LWHGLDJUDPRUDGGLWLRQDOZHOOGHWDLOV
<RXPD\XVHWKHEDFNRI WKLVSDJHWRSURYLGHDGGLWLRQDOZHOOVLWHGHWDLOVRUZHOOFRQVWUXFWLRQGHWDLOV<RXPD\DOVRDWWDFKDGGLWLRQDO SDJHVLIQHFHVVDU\
68%0,77$/,1678&7,216
D )RU $OO :HOOV 6XEPLWWKLVIRUPZLWKLQGD\VRIFRPSOHWLRQRIZHOO
FRQVWUXFWLRQ WRWKHIROORZLQJ
'LYLVLRQRI:DWHU5HVRXUFHV,QIRUPDWLRQ3URFHVVLQJ 8QLW
0DLO6HUYLFH&HQWHU5DOHLJK1&
E)RU,QMHFWLRQ:HOOV21/<,QDGGLWLRQWRVHQGLQJWKHIRUPWRWKHDGGUHVVLQ
DDERYHDOVRVXEPLWDFRS\RI WKLVIRUP ZLWKLQGD\VRIFRPSOHWLRQRI ZHOO
FRQVWUXFWLRQWRWKHIROORZLQJ
'LYLVLRQRI:DWHU5HVRXUFHV8QGHUJURXQG,QMHFWLRQ&RQWURO3URJUDP
 0DLO6HUYLFH&HQWHU5DOHLJK1&
F)RU:DWHU6XSSO\ ,QMHFWLRQ :HOOV
$OVR VXEPLW RQH FRS\ RI WKLV IRUP ZLWKLQGD\V RIFRPSOHWLRQRI
ZHOOFRQVWUXFWLRQWRWKHFRXQW\KHDOWKGHSDUWPHQWRIWKHFRXQW\ZKHUH
FRQVWUXFWHG
)RU,QWHUQDO8VH21/<
_______________
Jonathan R. Grubbs
3001
Terraquest Environmental Consultants, P.C.
✔
9/22/2020 MW15,MW16
Perth Mini Mart 00-0-24524
818 Perth Rd.
Iredell 4730-50-7091
35.648900 -80.895787
✔
✔
2
45
29.07,29.15
8.25
Hollow Stem Auger
25'45 .010 Sch. 40 PVC
0 21 Portland Pour
21 23 Bentonite Pour
23 45 No. 2 Sand Pour
0 0.5 Asphalt
0.5 45 Silt
Digitally signed by Jonathan Grubbs
DN: cn=Jonathan Grubbs, o=Terraquest
Environmental Consultants, P.C., ou,
email=[e-mail], c=US
Date: 2020.09.25 10:12:17 -04'00'
:(//&216758&7,215(&25'
7KLVIRUPFDQEHXVHGIRUVLQJOHRUPXOWLSOHZHOOV
)RUP*:  1RUWK&DUROLQD'HSDUWPHQWRI(QYLURQPHQWDQG1DWXUDO5HVRXUFHV±'LYLVLRQRI:DWHUResources 5HYLVHG$ugust
:HOO&RQWUDFWRU,QIRUPDWLRQ
:HOO&RQWUDFWRU1DPH
1&:HOO&RQWUDFWRU&HUWLILFDWLRQ1XPEHU
&RPSDQ\1DPH
:HOO&RQVWUXFWLRQ3HUPLW
List all applicable well permits (i.e. County, State, Variance, Injection, etc.)
:HOO8VH FKHFNZHOOXVH
:DWHU6XSSO\:HOO
Ƒ$JULFXOWXUDO Ƒ0XQLFLSDO3XEOLF
Ƒ*HRWKHUPDO+HDWLQJ&RROLQJ6XSSO\Ƒ5HVLGHQWLDO:DWHU6XSSO\ VLQJOH
Ƒ,QGXVWULDO&RPPHUFLDO Ƒ5HVLGHQWLDO:DWHU6XSSO\ VKDUHG
Ƒ,UULJDWLRQ
1RQ:DWHU6XSSO\:HOO
Ƒ0RQLWRULQJ Ƒ5HFRYHU\
,QMHFWLRQ :HOO
Ƒ$TXLIHU5HFKDUJH Ƒ*URXQGZDWHU5HPHGLDWLRQ
Ƒ$TXLIHU6WRUDJHDQG5HFRYHU\Ƒ6DOLQLW\%DUULHU
Ƒ$TXLIHU7HVW Ƒ6WRUPZDWHU'UDLQDJH
Ƒ([SHULPHQWDO7HFKQRORJ\Ƒ6XEVLGHQFH&RQWURO
Ƒ*HRWKHUPDO&ORVHG/RRSƑ7UDFHU
Ƒ*HRWKHUPDO+HDWLQJ&RROLQJ5HWXUQƑ2WKHUH[SODLQXQGHU5HPDUNV
'DWH:HOOV&RPSOHWHGBBBBBBBBBBBB:HOO,'BBBBBBBBBBBBBBBBBBBBBB
D:HOO/RFDWLRQ

)DFLOLW\2ZQHU 1DPH )DFLOLW\,'LIDSSOLFDEOH

3K\VLFDO$GGUHVV&LW\DQG=LS

&RXQW\ 3DUFHO,GHQWLILFDWLRQ1R3,1
E/DWLWXGHDQG/RQJLWXGHLQGHJUHHVPLQXWHVVHFRQGVRUGHFLPDOGHJUHHV
LIZHOOILHOGRQHODWORQJLVVXIILFLHQW
1 :
,V DUHWKHZHOOVƑ3HUPDQHQWRUƑ7HPSRUDU\
,VWKLVDUHSDLUWRDQH[LVWLQJZHOOƑ<HVRUƑ1R
If this is a repair, fill out known well construction information and explain the nature of the repair under #21 remarks section or on the back of this form.
 1XPEHURIZHOOVFRQVWUXFWHG 
For multiple injection or non-water supply wells ONLY with the same construction, you can
submit one form.
7RWDOZHOOGHSWK EHORZODQG VXUIDFH  IW
For multiple wells list all depths if different (example- 3@200’ and 2@100ƍ
6WDWLFZDWHUOHYHOEHORZWRSRIFDVLQJ IWIf water level is above casing, use “+”
%RUHKROHGLDPHWHU LQ
:HOOFRQVWUXFWLRQPHWKRG  
LHDXJHUURWDU\FDEOHGLUHFWSXVKHWF
)25:$7(56833/<:(//621/<
D<LHOGJSP0HWKRGRIWHVW
E'LVLQIHFWLRQW\SH$PRXQW
:$7(5=21(6
)520 72 '(6&5,37,21
IWIW
IWIW
287(5&$6,1* IRUPXOWLFDVHGZHOOV25/,1(5LIDSSOLFDEOH
)520 72 ',$0(7(5 7+,&.1(66 0$7(5,$/
IWIWLQ
,11(5&$6,1* 2578%,1* JHRWKHUPDOFORVHGORRS
)520 72 ',$0(7(5 7+,&.1(66 0$7(5,$/
IWIWLQ
IWIWLQ
6&5((1
)520 72 ',$0(7(5 6/27 6,=( 7+,&.1(66 0$7(5,$/
IWIWLQ
IWIWLQ
*5287
)520 72 0$7(5,$/ (03/$&(0(170(7+2' $02817
IWIW
IWIW
IWIW
6$1'*5$9(/3$&.LIDSSOLFDEOH
)520 72 0$7(5,$/ (03/$&(0(170(7+2'
IWIW
IWIW
'5,//,1*/2* DWWDFKDGGLWLRQDOVKHHWVLIQHFHVVDU\
)520 72 '(6&5,37,21 FRORUKDUGQHVVVRLOURFNW\SHJUDLQVL]HHWF
IWIW
IWIW
IWIW
IWIW
IWIW
IWIW
IWIW
5(0$5.6
&HUWLILFDWLRQ
6LJQDWXUHRI&HUWLILHG:HOO&RQWUDFWRU 'DWH
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
6LWHGLDJUDPRUDGGLWLRQDOZHOOGHWDLOV
<RXPD\XVHWKHEDFNRI WKLVSDJHWRSURYLGHDGGLWLRQDOZHOOVLWHGHWDLOVRUZHOOFRQVWUXFWLRQGHWDLOV<RXPD\DOVRDWWDFKDGGLWLRQDO SDJHVLIQHFHVVDU\
68%0,77$/,1678&7,216
D )RU $OO :HOOV 6XEPLWWKLVIRUPZLWKLQGD\VRIFRPSOHWLRQRIZHOO
FRQVWUXFWLRQ WRWKHIROORZLQJ
'LYLVLRQRI:DWHU5HVRXUFHV,QIRUPDWLRQ3URFHVVLQJ 8QLW
0DLO6HUYLFH&HQWHU5DOHLJK1&
E)RU,QMHFWLRQ:HOOV21/<,QDGGLWLRQWRVHQGLQJWKHIRUPWRWKHDGGUHVVLQ
DDERYHDOVRVXEPLWDFRS\RI WKLVIRUP ZLWKLQGD\VRIFRPSOHWLRQRI ZHOO
FRQVWUXFWLRQWRWKHIROORZLQJ
'LYLVLRQRI:DWHU5HVRXUFHV8QGHUJURXQG,QMHFWLRQ&RQWURO3URJUDP
 0DLO6HUYLFH&HQWHU5DOHLJK1&
F)RU:DWHU6XSSO\ ,QMHFWLRQ :HOOV
$OVR VXEPLW RQH FRS\ RI WKLV IRUP ZLWKLQGD\V RIFRPSOHWLRQRI
ZHOOFRQVWUXFWLRQWRWKHFRXQW\KHDOWKGHSDUWPHQWRIWKHFRXQW\ZKHUH
FRQVWUXFWHG
)RU,QWHUQDO8VH21/<
_______________
Jonathan R. Grubbs
3001
Terraquest Environmental Consultants, P.C.
✔
9/22/2020 MW17
Perth Mini Mart 00-0-24524
818 Perth Rd.
Iredell 4730-50-7091
35.648900 -80.895787
✔
✔
1
45
30.05
8.25
Hollow Stem Auger
20'45 .010 Sch. 40 PVC
0 16 Portland Pour
16 18 Bentonite Pour
18 45 No. 2 Sand Pour
0 0.5 Asphalt
0.5 45 Silt
Digitally signed by Jonathan Grubbs
DN: cn=Jonathan Grubbs, o=Terraquest
Environmental Consultants, P.C., ou,
email=[e-mail], c=US
Date: 2020.09.25 10:12:17 -04'00'
:(//&216758&7,215(&25'
7KLVIRUPFDQEHXVHGIRUVLQJOHRUPXOWLSOHZHOOV
)RUP*:  1RUWK&DUROLQD'HSDUWPHQWRI(QYLURQPHQWDQG1DWXUDO5HVRXUFHV±'LYLVLRQRI:DWHUResources 5HYLVHG$ugust
:HOO&RQWUDFWRU,QIRUPDWLRQ
:HOO&RQWUDFWRU1DPH
1&:HOO&RQWUDFWRU&HUWLILFDWLRQ1XPEHU
&RPSDQ\1DPH
:HOO&RQVWUXFWLRQ3HUPLW
List all applicable well permits (i.e. County, State, Variance, Injection, etc.)
:HOO8VH FKHFNZHOOXVH
:DWHU6XSSO\:HOO
Ƒ$JULFXOWXUDO Ƒ0XQLFLSDO3XEOLF
Ƒ*HRWKHUPDO+HDWLQJ&RROLQJ6XSSO\Ƒ5HVLGHQWLDO:DWHU6XSSO\ VLQJOH
Ƒ,QGXVWULDO&RPPHUFLDO Ƒ5HVLGHQWLDO:DWHU6XSSO\ VKDUHG
Ƒ,UULJDWLRQ
1RQ:DWHU6XSSO\:HOO
Ƒ0RQLWRULQJ Ƒ5HFRYHU\
,QMHFWLRQ :HOO
Ƒ$TXLIHU5HFKDUJH Ƒ*URXQGZDWHU5HPHGLDWLRQ
Ƒ$TXLIHU6WRUDJHDQG5HFRYHU\Ƒ6DOLQLW\%DUULHU
Ƒ$TXLIHU7HVW Ƒ6WRUPZDWHU'UDLQDJH
Ƒ([SHULPHQWDO7HFKQRORJ\Ƒ6XEVLGHQFH&RQWURO
Ƒ*HRWKHUPDO&ORVHG/RRSƑ7UDFHU
Ƒ*HRWKHUPDO+HDWLQJ&RROLQJ5HWXUQƑ2WKHUH[SODLQXQGHU5HPDUNV
'DWH:HOOV&RPSOHWHGBBBBBBBBBBBB:HOO,'BBBBBBBBBBBBBBBBBBBBBB
D:HOO/RFDWLRQ

)DFLOLW\2ZQHU 1DPH )DFLOLW\,'LIDSSOLFDEOH

3K\VLFDO$GGUHVV&LW\DQG=LS

&RXQW\ 3DUFHO,GHQWLILFDWLRQ1R3,1
E/DWLWXGHDQG/RQJLWXGHLQGHJUHHVPLQXWHVVHFRQGVRUGHFLPDOGHJUHHV
LIZHOOILHOGRQHODWORQJLVVXIILFLHQW
1 :
,V DUHWKHZHOOVƑ3HUPDQHQWRUƑ7HPSRUDU\
,VWKLVDUHSDLUWRDQH[LVWLQJZHOOƑ<HVRUƑ1R
If this is a repair, fill out known well construction information and explain the nature of the repair under #21 remarks section or on the back of this form.
 1XPEHURIZHOOVFRQVWUXFWHG 
For multiple injection or non-water supply wells ONLY with the same construction, you can
submit one form.
7RWDOZHOOGHSWK EHORZODQG VXUIDFH  IW
For multiple wells list all depths if different (example- 3@200’ and 2@100ƍ
6WDWLFZDWHUOHYHOEHORZWRSRIFDVLQJ IWIf water level is above casing, use “+”
%RUHKROHGLDPHWHU LQ
:HOOFRQVWUXFWLRQPHWKRG  
LHDXJHUURWDU\FDEOHGLUHFWSXVKHWF
)25:$7(56833/<:(//621/<
D<LHOGJSP0HWKRGRIWHVW
E'LVLQIHFWLRQW\SH$PRXQW
:$7(5=21(6
)520 72 '(6&5,37,21
IWIW
IWIW
287(5&$6,1* IRUPXOWLFDVHGZHOOV25/,1(5LIDSSOLFDEOH
)520 72 ',$0(7(5 7+,&.1(66 0$7(5,$/
IWIWLQ
,11(5&$6,1* 2578%,1* JHRWKHUPDOFORVHGORRS
)520 72 ',$0(7(5 7+,&.1(66 0$7(5,$/
IWIWLQ
IWIWLQ
6&5((1
)520 72 ',$0(7(5 6/27 6,=( 7+,&.1(66 0$7(5,$/
IWIWLQ
IWIWLQ
*5287
)520 72 0$7(5,$/ (03/$&(0(170(7+2' $02817
IWIW
IWIW
IWIW
6$1'*5$9(/3$&.LIDSSOLFDEOH
)520 72 0$7(5,$/ (03/$&(0(170(7+2'
IWIW
IWIW
'5,//,1*/2* DWWDFKDGGLWLRQDOVKHHWVLIQHFHVVDU\
)520 72 '(6&5,37,21 FRORUKDUGQHVVVRLOURFNW\SHJUDLQVL]HHWF
IWIW
IWIW
IWIW
IWIW
IWIW
IWIW
IWIW
5(0$5.6
&HUWLILFDWLRQ
6LJQDWXUHRI&HUWLILHG:HOO&RQWUDFWRU 'DWH
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
6LWHGLDJUDPRUDGGLWLRQDOZHOOGHWDLOV
<RXPD\XVHWKHEDFNRI WKLVSDJHWRSURYLGHDGGLWLRQDOZHOOVLWHGHWDLOVRUZHOOFRQVWUXFWLRQGHWDLOV<RXPD\DOVRDWWDFKDGGLWLRQDO SDJHVLIQHFHVVDU\
68%0,77$/,1678&7,216
D )RU $OO :HOOV 6XEPLWWKLVIRUPZLWKLQGD\VRIFRPSOHWLRQRIZHOO
FRQVWUXFWLRQ WRWKHIROORZLQJ
'LYLVLRQRI:DWHU5HVRXUFHV,QIRUPDWLRQ3URFHVVLQJ 8QLW
0DLO6HUYLFH&HQWHU5DOHLJK1&
E)RU,QMHFWLRQ:HOOV21/<,QDGGLWLRQWRVHQGLQJWKHIRUPWRWKHDGGUHVVLQ
DDERYHDOVRVXEPLWDFRS\RI WKLVIRUP ZLWKLQGD\VRIFRPSOHWLRQRI ZHOO
FRQVWUXFWLRQWRWKHIROORZLQJ
'LYLVLRQRI:DWHU5HVRXUFHV8QGHUJURXQG,QMHFWLRQ&RQWURO3URJUDP
 0DLO6HUYLFH&HQWHU5DOHLJK1&
F)RU:DWHU6XSSO\ ,QMHFWLRQ :HOOV
$OVR VXEPLW RQH FRS\ RI WKLV IRUP ZLWKLQGD\V RIFRPSOHWLRQRI
ZHOOFRQVWUXFWLRQWRWKHFRXQW\KHDOWKGHSDUWPHQWRIWKHFRXQW\ZKHUH
FRQVWUXFWHG
)RU,QWHUQDO8VH21/<
_______________
Jonathan R. Grubbs
3001
Terraquest Environmental Consultants, P.C.
✔
11/16/2021 ASP1
Perth Mini Mart 00-0-24524
818 Perth Rd.
Iredell 4730-50-7091
35.648900 -80.895787
✔
✔
1
60
N/A
8.25
Hollow Stem Auger
55'60'.010 Sch. 40 PVC
0 51 Portland Pour
51 53 Bentonite Pour
53 60 No. 2 Sand Pour
0 0.5 Asphalt
0.5 35 Silt
Digitally signed by Jonathan Grubbs
DN: cn=Jonathan Grubbs, o=Terraquest
Environmental Consultants, P.C., ou,
email=[e-mail], c=US
Date: 2021.11.17 16:27:34 -05'00'
:(//&216758&7,215(&25'
7KLVIRUPFDQEHXVHGIRUVLQJOHRUPXOWLSOHZHOOV
)RUP*:  1RUWK&DUROLQD'HSDUWPHQWRI(QYLURQPHQWDQG1DWXUDO5HVRXUFHV±'LYLVLRQRI:DWHUResources 5HYLVHG$ugust
:HOO&RQWUDFWRU,QIRUPDWLRQ
:HOO&RQWUDFWRU1DPH
1&:HOO&RQWUDFWRU&HUWLILFDWLRQ1XPEHU
&RPSDQ\1DPH
:HOO&RQVWUXFWLRQ3HUPLW
List all applicable well permits (i.e. County, State, Variance, Injection, etc.)
:HOO8VH FKHFNZHOOXVH
:DWHU6XSSO\:HOO
Ƒ$JULFXOWXUDO Ƒ0XQLFLSDO3XEOLF
Ƒ*HRWKHUPDO+HDWLQJ&RROLQJ6XSSO\Ƒ5HVLGHQWLDO:DWHU6XSSO\ VLQJOH
Ƒ,QGXVWULDO&RPPHUFLDO Ƒ5HVLGHQWLDO:DWHU6XSSO\ VKDUHG
Ƒ,UULJDWLRQ
1RQ:DWHU6XSSO\:HOO
Ƒ0RQLWRULQJ Ƒ5HFRYHU\
,QMHFWLRQ :HOO
Ƒ$TXLIHU5HFKDUJH Ƒ*URXQGZDWHU5HPHGLDWLRQ
Ƒ$TXLIHU6WRUDJHDQG5HFRYHU\Ƒ6DOLQLW\%DUULHU
Ƒ$TXLIHU7HVW Ƒ6WRUPZDWHU'UDLQDJH
Ƒ([SHULPHQWDO7HFKQRORJ\Ƒ6XEVLGHQFH&RQWURO
Ƒ*HRWKHUPDO&ORVHG/RRSƑ7UDFHU
Ƒ*HRWKHUPDO+HDWLQJ&RROLQJ5HWXUQƑ2WKHUH[SODLQXQGHU5HPDUNV
'DWH:HOOV&RPSOHWHGBBBBBBBBBBBB:HOO,'BBBBBBBBBBBBBBBBBBBBBB
D:HOO/RFDWLRQ

)DFLOLW\2ZQHU 1DPH )DFLOLW\,'LIDSSOLFDEOH

3K\VLFDO$GGUHVV&LW\DQG=LS

&RXQW\ 3DUFHO,GHQWLILFDWLRQ1R3,1
E/DWLWXGHDQG/RQJLWXGHLQGHJUHHVPLQXWHVVHFRQGVRUGHFLPDOGHJUHHV
LIZHOOILHOGRQHODWORQJLVVXIILFLHQW
1 :
,V DUHWKHZHOOVƑ3HUPDQHQWRUƑ7HPSRUDU\
,VWKLVDUHSDLUWRDQH[LVWLQJZHOOƑ<HVRUƑ1R
If this is a repair, fill out known well construction information and explain the nature of the repair under #21 remarks section or on the back of this form.
 1XPEHURIZHOOVFRQVWUXFWHG 
For multiple injection or non-water supply wells ONLY with the same construction, you can
submit one form.
7RWDOZHOOGHSWK EHORZODQG VXUIDFH  IW
For multiple wells list all depths if different (example- 3@200’ and 2@100ƍ
6WDWLFZDWHUOHYHOEHORZWRSRIFDVLQJ IWIf water level is above casing, use “+”
%RUHKROHGLDPHWHU LQ
:HOOFRQVWUXFWLRQPHWKRG  
LHDXJHUURWDU\FDEOHGLUHFWSXVKHWF
)25:$7(56833/<:(//621/<
D<LHOGJSP0HWKRGRIWHVW
E'LVLQIHFWLRQW\SH$PRXQW
:$7(5=21(6
)520 72 '(6&5,37,21
IWIW
IWIW
287(5&$6,1* IRUPXOWLFDVHGZHOOV25/,1(5LIDSSOLFDEOH
)520 72 ',$0(7(5 7+,&.1(66 0$7(5,$/
IWIWLQ
,11(5&$6,1* 2578%,1* JHRWKHUPDOFORVHGORRS
)520 72 ',$0(7(5 7+,&.1(66 0$7(5,$/
IWIWLQ
IWIWLQ
6&5((1
)520 72 ',$0(7(5 6/27 6,=( 7+,&.1(66 0$7(5,$/
IWIWLQ
IWIWLQ
*5287
)520 72 0$7(5,$/ (03/$&(0(170(7+2' $02817
IWIW
IWIW
IWIW
6$1'*5$9(/3$&.LIDSSOLFDEOH
)520 72 0$7(5,$/ (03/$&(0(170(7+2'
IWIW
IWIW
'5,//,1*/2* DWWDFKDGGLWLRQDOVKHHWVLIQHFHVVDU\
)520 72 '(6&5,37,21 FRORUKDUGQHVVVRLOURFNW\SHJUDLQVL]HHWF
IWIW
IWIW
IWIW
IWIW
IWIW
IWIW
IWIW
5(0$5.6
&HUWLILFDWLRQ
6LJQDWXUHRI&HUWLILHG:HOO&RQWUDFWRU 'DWH
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
6LWHGLDJUDPRUDGGLWLRQDOZHOOGHWDLOV
<RXPD\XVHWKHEDFNRI WKLVSDJHWRSURYLGHDGGLWLRQDOZHOOVLWHGHWDLOVRUZHOOFRQVWUXFWLRQGHWDLOV<RXPD\DOVRDWWDFKDGGLWLRQDO SDJHVLIQHFHVVDU\
68%0,77$/,1678&7,216
D )RU $OO :HOOV 6XEPLWWKLVIRUPZLWKLQGD\VRIFRPSOHWLRQRIZHOO
FRQVWUXFWLRQ WRWKHIROORZLQJ
'LYLVLRQRI:DWHU5HVRXUFHV,QIRUPDWLRQ3URFHVVLQJ 8QLW
0DLO6HUYLFH&HQWHU5DOHLJK1&
E)RU,QMHFWLRQ:HOOV21/<,QDGGLWLRQWRVHQGLQJWKHIRUPWRWKHDGGUHVVLQ
DDERYHDOVRVXEPLWDFRS\RI WKLVIRUP ZLWKLQGD\VRIFRPSOHWLRQRI ZHOO
FRQVWUXFWLRQWRWKHIROORZLQJ
'LYLVLRQRI:DWHU5HVRXUFHV8QGHUJURXQG,QMHFWLRQ&RQWURO3URJUDP
 0DLO6HUYLFH&HQWHU5DOHLJK1&
F)RU:DWHU6XSSO\ ,QMHFWLRQ :HOOV
$OVR VXEPLW RQH FRS\ RI WKLV IRUP ZLWKLQGD\V RIFRPSOHWLRQRI
ZHOOFRQVWUXFWLRQWRWKHFRXQW\KHDOWKGHSDUWPHQWRIWKHFRXQW\ZKHUH
FRQVWUXFWHG
)RU,QWHUQDO8VH21/<
_______________
Jonathan R. Grubbs
3001
Terraquest Environmental Consultants, P.C.
✔
11/16/2021 SVE1,SVE2
Perth Mini Mart 00-0-24524
818 Perth Rd.
Iredell 4730-50-7091
35.648900 -80.895787
✔
✔
2
35
N/A
6.25
Solid Stem Auger
20'35'.010 Sch. 40 PVC
0 16 Portland Pour
16 18 Bentonite Pour
18 35 No. 2 Sand Pour
0 0.5 Top Soil
0.5 35 Silt
Digitally signed by Jonathan Grubbs
DN: cn=Jonathan Grubbs, o=Terraquest
Environmental Consultants, P.C., ou,
email=[e-mail], c=US
Date: 2021.11.17 16:27:34 -05'00'
:(//&216758&7,215(&25'
7KLVIRUPFDQEHXVHGIRUVLQJOHRUPXOWLSOHZHOOV
)RUP*:  1RUWK&DUROLQD'HSDUWPHQWRI(QYLURQPHQWDQG1DWXUDO5HVRXUFHV±'LYLVLRQRI:DWHUResources 5HYLVHG$ugust
:HOO&RQWUDFWRU,QIRUPDWLRQ
:HOO&RQWUDFWRU1DPH
1&:HOO&RQWUDFWRU&HUWLILFDWLRQ1XPEHU
&RPSDQ\1DPH
:HOO&RQVWUXFWLRQ3HUPLW
List all applicable well permits (i.e. County, State, Variance, Injection, etc.)
:HOO8VH FKHFNZHOOXVH
:DWHU6XSSO\:HOO
Ƒ$JULFXOWXUDO Ƒ0XQLFLSDO3XEOLF
Ƒ*HRWKHUPDO+HDWLQJ&RROLQJ6XSSO\Ƒ5HVLGHQWLDO:DWHU6XSSO\ VLQJOH
Ƒ,QGXVWULDO&RPPHUFLDO Ƒ5HVLGHQWLDO:DWHU6XSSO\ VKDUHG
Ƒ,UULJDWLRQ
1RQ:DWHU6XSSO\:HOO
Ƒ0RQLWRULQJ Ƒ5HFRYHU\
,QMHFWLRQ :HOO
Ƒ$TXLIHU5HFKDUJH Ƒ*URXQGZDWHU5HPHGLDWLRQ
Ƒ$TXLIHU6WRUDJHDQG5HFRYHU\Ƒ6DOLQLW\%DUULHU
Ƒ$TXLIHU7HVW Ƒ6WRUPZDWHU'UDLQDJH
Ƒ([SHULPHQWDO7HFKQRORJ\Ƒ6XEVLGHQFH&RQWURO
Ƒ*HRWKHUPDO&ORVHG/RRSƑ7UDFHU
Ƒ*HRWKHUPDO+HDWLQJ&RROLQJ5HWXUQƑ2WKHUH[SODLQXQGHU5HPDUNV
'DWH:HOOV&RPSOHWHGBBBBBBBBBBBB:HOO,'BBBBBBBBBBBBBBBBBBBBBB
D:HOO/RFDWLRQ

)DFLOLW\2ZQHU 1DPH )DFLOLW\,'LIDSSOLFDEOH

3K\VLFDO$GGUHVV&LW\DQG=LS

&RXQW\ 3DUFHO,GHQWLILFDWLRQ1R3,1
E/DWLWXGHDQG/RQJLWXGHLQGHJUHHVPLQXWHVVHFRQGVRUGHFLPDOGHJUHHV
LIZHOOILHOGRQHODWORQJLVVXIILFLHQW
1 :
,V DUHWKHZHOOVƑ3HUPDQHQWRUƑ7HPSRUDU\
,VWKLVDUHSDLUWRDQH[LVWLQJZHOOƑ<HVRUƑ1R
If this is a repair, fill out known well construction information and explain the nature of the repair under #21 remarks section or on the back of this form.
 1XPEHURIZHOOVFRQVWUXFWHG 
For multiple injection or non-water supply wells ONLY with the same construction, you can
submit one form.
7RWDOZHOOGHSWK EHORZODQG VXUIDFH  IW
For multiple wells list all depths if different (example- 3@200’ and 2@100ƍ
6WDWLFZDWHUOHYHOEHORZWRSRIFDVLQJ IWIf water level is above casing, use “+”
%RUHKROHGLDPHWHU LQ
:HOOFRQVWUXFWLRQPHWKRG  
LHDXJHUURWDU\FDEOHGLUHFWSXVKHWF
)25:$7(56833/<:(//621/<
D<LHOGJSP0HWKRGRIWHVW
E'LVLQIHFWLRQW\SH$PRXQW
:$7(5=21(6
)520 72 '(6&5,37,21
IWIW
IWIW
287(5&$6,1* IRUPXOWLFDVHGZHOOV25/,1(5LIDSSOLFDEOH
)520 72 ',$0(7(5 7+,&.1(66 0$7(5,$/
IWIWLQ
,11(5&$6,1* 2578%,1* JHRWKHUPDOFORVHGORRS
)520 72 ',$0(7(5 7+,&.1(66 0$7(5,$/
IWIWLQ
IWIWLQ
6&5((1
)520 72 ',$0(7(5 6/27 6,=( 7+,&.1(66 0$7(5,$/
IWIWLQ
IWIWLQ
*5287
)520 72 0$7(5,$/ (03/$&(0(170(7+2' $02817
IWIW
IWIW
IWIW
6$1'*5$9(/3$&.LIDSSOLFDEOH
)520 72 0$7(5,$/ (03/$&(0(170(7+2'
IWIW
IWIW
'5,//,1*/2* DWWDFKDGGLWLRQDOVKHHWVLIQHFHVVDU\
)520 72 '(6&5,37,21 FRORUKDUGQHVVVRLOURFNW\SHJUDLQVL]HHWF
IWIW
IWIW
IWIW
IWIW
IWIW
IWIW
IWIW
5(0$5.6
&HUWLILFDWLRQ
6LJQDWXUHRI&HUWLILHG:HOO&RQWUDFWRU 'DWH
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
6LWHGLDJUDPRUDGGLWLRQDOZHOOGHWDLOV
<RXPD\XVHWKHEDFNRI WKLVSDJHWRSURYLGHDGGLWLRQDOZHOOVLWHGHWDLOVRUZHOOFRQVWUXFWLRQGHWDLOV<RXPD\DOVRDWWDFKDGGLWLRQDO SDJHVLIQHFHVVDU\
68%0,77$/,1678&7,216
D )RU $OO :HOOV 6XEPLWWKLVIRUPZLWKLQGD\VRIFRPSOHWLRQRIZHOO
FRQVWUXFWLRQ WRWKHIROORZLQJ
'LYLVLRQRI:DWHU5HVRXUFHV,QIRUPDWLRQ3URFHVVLQJ 8QLW
0DLO6HUYLFH&HQWHU5DOHLJK1&
E)RU,QMHFWLRQ:HOOV21/<,QDGGLWLRQWRVHQGLQJWKHIRUPWRWKHDGGUHVVLQ
DDERYHDOVRVXEPLWDFRS\RI WKLVIRUP ZLWKLQGD\VRIFRPSOHWLRQRI ZHOO
FRQVWUXFWLRQWRWKHIROORZLQJ
'LYLVLRQRI:DWHU5HVRXUFHV8QGHUJURXQG,QMHFWLRQ&RQWURO3URJUDP
 0DLO6HUYLFH&HQWHU5DOHLJK1&
F)RU:DWHU6XSSO\ ,QMHFWLRQ :HOOV
$OVR VXEPLW RQH FRS\ RI WKLV IRUP ZLWKLQGD\V RIFRPSOHWLRQRI
ZHOOFRQVWUXFWLRQWRWKHFRXQW\KHDOWKGHSDUWPHQWRIWKHFRXQW\ZKHUH
FRQVWUXFWHG
)RU,QWHUQDO8VH21/<
_______________
Jonathan R. Grubbs
3001
Terraquest Environmental Consultants, P.C.
✔
11/16/2021 SVE3
Perth Mini Mart 00-0-24524
818 Perth Rd.
Iredell 4730-50-7091
35.648900 -80.895787
✔
✔
1
35
N/A
6.25
Solid Stem Auger
20'35'.010 Sch. 40 PVC
0 16 Portland Pour
16 18 Bentonite Pour
18 35 No. 2 Sand Pour
0 0.5 Asphalt
0.5 35 Silt
Digitally signed by Jonathan Grubbs
DN: cn=Jonathan Grubbs, o=Terraquest
Environmental Consultants, P.C., ou,
email=[e-mail], c=US
Date: 2021.11.17 16:27:34 -05'00'

AIR SAMPLE LAB REPORT

SOIL VAPOR EXTRACTION TEST

ANALYTICAL REPORT
Eurofins TestAmerica, Pensacola
3355 McLemore Drive
Pensacola, FL 32514
Tel: [phone]
Laboratory Job ID: 400-211729-1
Client Project/Site: Perth Mini Mart
For:
Terraquest Environmental Consultants, PC
100 E. Ruffin Street
Mebane, North Carolina 27302
Attn: Ryan Kerins
Authorized for release by:
12/3/2021 6:48:33 PM
Chad Bechtold, Project Manager
[phone]
[e-mail]
The test results in this report meet all 2003 NELAC, 2009 TNI, and 2016 TNI requirements for
accredited parameters, exceptions are noted in this report. This report may not be reproduced
except in full, and with written approval from the laboratory. For questions please contact the
Project Manager at the e-mail address or telephone number listed on this page.
This report has been electronically signed and authorized by the signatory. Electronic signature is
intended to be the legally binding equivalent of a traditionally handwritten signature.
Results relate only to the items tested and the sample(s) as received by the laboratory.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Table of Contents
Client: Terraquest Environmental Consultants, PC
Project/Site: Perth Mini Mart
Laboratory Job ID: 400-211729-1
Page 2 of 15 Eurofins TestAmerica, Pensacola12/3/2021
Cover Page . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
Table of Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
Case Narrative . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
Detection Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
Sample Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
Client Sample Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Surrogate Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
QC Association . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
QC Sample Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
Chronicle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11
Method Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
Certification Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
Chain of Custody . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14
Receipt Checklists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Case Narrative
Client: Terraquest Environmental Consultants, PC Job ID: 400-211729-1
Project/Site: Perth Mini Mart
Job ID: 400-211729-1
Laboratory: Eurofins TestAmerica, Pensacola
Narrative
Job Narrative
400-211729-1
Comments
No additional comments.
Receipt
The sample was received on 11/24/2021 9:39 AM. Unless otherwise noted below, the sample arrived in good condition. The temperature
of the cooler at receipt was 17.4º C. Thermal preservation is not used for air samples.
GC VOA
Method EPA-18: The following sample was diluted to bring the concentration of target analytes within the calibration range: SVE
(400-211729-1). Elevated reporting limits (RLs) are provided.
No additional analytical or quality issues were noted, other than those described above or in the Definitions/Glossary page.
Eurofins TestAmerica, PensacolaPage 3 of 15 12/3/2021
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Detection Summary
Job ID: 400-211729-1Client: Terraquest Environmental Consultants, PC
Project/Site: Perth Mini Mart
Client Sample ID: SVE Lab Sample ID: 400-211729-1
Benzene
RL
626 ppb v/v
MDL
250
Analyte Result Qualifier Unit Dil Fac D Method Prep Type
Total/NA274400EPA-18
Toluene 2650 ppb v/v520 Total/NA282600EPA-18
Ethylbenzene 461 ppb v/v249 Total/NA23940EPA-18
m-Xylene & p-Xylene 2300 ppb v/v461 Total/NA211600EPA-18
o-Xylene 2300 ppb v/v318 Total/NA22550EPA-18
Xylenes, Total 2300 ppb v/v737 Total/NA214100EPA-18
Gasoline Range Organics
(GRO)-C6-C10
672000 ppb v/v336000 Total/NA27.55070000 EPA-18
Eurofins TestAmerica, Pensacola
This Detection Summary does not include radiochemical test results.
Page 4 of 15 12/3/2021
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Sample Summary
Client: Terraquest Environmental Consultants, PC Job ID: 400-211729-1
Project/Site: Perth Mini Mart
Lab Sample ID Client Sample ID Matrix Collected Received
400-211729-1 SVE Air - Tedlar Bag 11/22/21 16:34 11/24/21 09:39
Eurofins TestAmerica, PensacolaPage 5 of 15 12/3/2021
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Client Sample Results
Job ID: 400-211729-1Client: Terraquest Environmental Consultants, PC
Project/Site: Perth Mini Mart
Lab Sample ID: 400-211729-1Client Sample ID: SVE
Matrix: Air - Tedlar BagDate Collected: 11/22/21 16:34
Date Received: 11/24/21 09:39
Method: EPA-18 - Volatile Organic Compounds
RL MDL
Benzene 74400 626 250 ppb v/v 11/26/21 17:19 2
Analyte Dil FacAnalyzedPreparedUnitDResultQualifier
2650 520 ppb v/v 11/26/21 17:19 2Toluene82600
461 249 ppb v/v 11/26/21 17:19 2Ethylbenzene3940
2300 461 ppb v/v 11/26/21 17:19 2m-Xylene & p-Xylene 11600
2300 318 ppb v/v 11/26/21 17:19 2o-Xylene 2550
2300 737 ppb v/v 11/26/21 17:19 2Xylenes, Total 14100
2770 999 ppb v/v 11/26/21 17:19 2Methyl tert-butyl ether 999 U
672000 336000 ppb v/v 11/29/21 18:11 27.5Gasoline Range Organics
(GRO)-C6-C10
5070000
a,a,a-Trifluorotoluene (fid)91 67-139 11/29/21 18:11 27.5
Surrogate Dil FacAnalyzedPreparedQualifierLimits%Recovery
a,a,a-Trifluorotoluene (pid)103 11/26/21 17:19 276-127
Eurofins TestAmerica, Pensacola
Page 6 of 15 12/3/2021
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Definitions/Glossary
Job ID: 400-211729-1Client: Terraquest Environmental Consultants, PC
Project/Site: Perth Mini Mart
Qualifiers
Air - GC VOA
Qualifier Description
U Indicates the analyte was analyzed for but not detected.
Qualifier
Glossary
These commonly used abbreviations may or may not be present in this report.
¤Listed under the "D" column to designate that the result is reported on a dry weight basis
Abbreviation
%R Percent Recovery
CFL Contains Free Liquid
CFU Colony Forming Unit
CNF Contains No Free Liquid
DER Duplicate Error Ratio (normalized absolute difference)
Dil Fac Dilution Factor
DL Detection Limit (DoD/DOE)
DL, RA, RE, IN Indicates a Dilution, Re-analysis, Re-extraction, or additional Initial metals/anion analysis of the sample
DLC Decision Level Concentration (Radiochemistry)
EDL Estimated Detection Limit (Dioxin)
LOD Limit of Detection (DoD/DOE)
LOQ Limit of Quantitation (DoD/DOE)
MCL EPA recommended "Maximum Contaminant Level"
MDA Minimum Detectable Activity (Radiochemistry)
MDC Minimum Detectable Concentration (Radiochemistry)
MDL Method Detection Limit
ML Minimum Level (Dioxin)
MPN Most Probable Number
MQL Method Quantitation Limit
NC Not Calculated
ND Not Detected at the reporting limit (or MDL or EDL if shown)
NEG Negative / Absent
POS Positive / Present
PQL Practical Quantitation Limit
PRES Presumptive
QC Quality Control
RER Relative Error Ratio (Radiochemistry)
RL Reporting Limit or Requested Limit (Radiochemistry)
RPD Relative Percent Difference, a measure of the relative difference between two points
TEF Toxicity Equivalent Factor (Dioxin)
TEQ Toxicity Equivalent Quotient (Dioxin)
TNTC Too Numerous To Count
Eurofins TestAmerica, Pensacola
Page 7 of 15 12/3/2021
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Surrogate Summary
Job ID: 400-211729-1Client: Terraquest Environmental Consultants, PC
Project/Site: Perth Mini Mart
Method: EPA-18 - Volatile Organic Compounds
Prep Type: Total/NAMatrix: Air - Tedlar Bag
Lab Sample ID Client Sample ID (76-127)
TFT-P
103400-211729-1
Percent Surrogate Recovery (Acceptance Limits)
SVE
Surrogate Legend
TFT-P = a,a,a-Trifluorotoluene (pid)
Method: EPA-18 - Volatile Organic Compounds
Prep Type: Total/NAMatrix: Air - Tedlar Bag
Lab Sample ID Client Sample ID (67-139)
TFT-F
91400-211729-1
Percent Surrogate Recovery (Acceptance Limits)
SVE
90LCS 400-557593/1002 Lab Control Sample
90MB 400-557593/3 Method Blank
Surrogate Legend
TFT-F = a,a,a-Trifluorotoluene (fid)
Eurofins TestAmerica, Pensacola
Page 8 of 15 12/3/2021
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
QC Association Summary
Job ID: 400-211729-1Client: Terraquest Environmental Consultants, PC
Project/Site: Perth Mini Mart
Air - GC VOA
Analysis Batch: 557404
Lab Sample ID Client Sample ID Prep Type Matrix Method Prep Batch
Air - Tedlar Bag EPA-18400-211729-1 SVE Total/NA
Analysis Batch: 557593
Lab Sample ID Client Sample ID Prep Type Matrix Method Prep Batch
Air - Tedlar Bag EPA-18400-211729-1 SVE Total/NA
Air - Tedlar Bag EPA-18MB 400-557593/3 Method Blank Total/NA
Air - Tedlar Bag EPA-18LCS 400-557593/1002 Lab Control Sample Total/NA
Eurofins TestAmerica, Pensacola
Page 9 of 15 12/3/2021
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
QC Sample Results
Job ID: 400-211729-1Client: Terraquest Environmental Consultants, PC
Project/Site: Perth Mini Mart
Method: EPA-18 - Volatile Organic Compounds
Client Sample ID: Method BlankLab Sample ID: MB 400-557593/3
Matrix: Air - Tedlar Bag Prep Type: Total/NA
Analysis Batch: 557593
RL MDL
Gasoline Range Organics
(GRO)-C6-C10
12200 U 24500 12200 ppb v/v 11/29/21 11:34 1
MB MB
Analyte Dil FacAnalyzedPreparedDUnitResultQualifier
a,a,a-Trifluorotoluene (fid)90 67-139 11/29/21 11:34 1
MB MB
Surrogate Dil FacPreparedAnalyzedQualifierLimits%Recovery
Client Sample ID: Lab Control SampleLab Sample ID: LCS 400-557593/1002
Matrix: Air - Tedlar Bag Prep Type: Total/NA
Analysis Batch: 557593
Gasoline Range Organics
(GRO)-C6-C10
196000 175400 ppb v/v 90 85 -115
Analyte
LCS LCS
DUnitResultQualifier %Rec
Spike
Added
%Rec.
Limits
a,a,a-Trifluorotoluene (fid)67 -139
Surrogate
90
LCS LCS
Qualifier Limits%Recovery
Eurofins TestAmerica, Pensacola
Page 10 of 15 12/3/2021
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Lab Chronicle
Client: Terraquest Environmental Consultants, PC Job ID: 400-211729-1
Project/Site: Perth Mini Mart
Client Sample ID: SVE Lab Sample ID: 400-211729-1
Matrix: Air - Tedlar BagDate Collected: 11/22/21 16:34
Date Received: 11/24/21 09:39
Analysis EPA-18 NTH11/26/21 17:192 TAL PEN557404
Type
Batch
Method
Batch
Prep Type LabAnalystRun
Prepared
or Analyzed
Initial
Amount Amount
Final Batch
NumberFactor
Dil
Total/NA 5 mL 5 mL
Analysis EPA-18 27.5 557593 11/29/21 18:11 NTH TAL PENTotal/NA 5 mL 5 mL
Client Sample ID: Method Blank Lab Sample ID: MB 400-557593/3
Matrix: Air - Tedlar BagDate Collected: N/A
Date Received: N/A
Analysis EPA-18 NTH11/29/21 11:341 TAL PEN557593
Type
Batch
Method
Batch
Prep Type LabAnalystRun
Prepared
or Analyzed
Initial
Amount Amount
Final Batch
NumberFactor
Dil
Total/NA 5 mL 5 mL
Client Sample ID: Lab Control Sample Lab Sample ID: LCS 400-557593/1002
Matrix: Air - Tedlar BagDate Collected: N/A
Date Received: N/A
Analysis EPA-18 NTH11/29/21 11:061 TAL PEN557593
Type
Batch
Method
Batch
Prep Type LabAnalystRun
Prepared
or Analyzed
Initial
Amount Amount
Final Batch
NumberFactor
Dil
Total/NA 5 mL 5 mL
Laboratory References:
TAL PEN = Eurofins TestAmerica, Pensacola, 3355 McLemore Drive, Pensacola, FL 32514, TEL [phone]
Eurofins TestAmerica, Pensacola
Page 11 of 15 12/3/2021
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Method Summary
Job ID: 400-211729-1Client: Terraquest Environmental Consultants, PC
Project/Site: Perth Mini Mart
Method Method Description LaboratoryProtocol
EPAEPA-18 Volatile Organic Compounds TAL PEN
Protocol References:
EPA = US Environmental Protection Agency
Laboratory References:
TAL PEN = Eurofins TestAmerica, Pensacola, 3355 McLemore Drive, Pensacola, FL 32514, TEL [phone]
Eurofins TestAmerica, Pensacola
Page 12 of 15 12/3/2021
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Accreditation/Certification Summary
Client: Terraquest Environmental Consultants, PC Job ID: 400-211729-1
Project/Site: Perth Mini Mart
Laboratory: Eurofins TestAmerica, Pensacola
Unless otherwise noted, all analytes for this laboratory were covered under each accreditation/certification below.
Authority Program Identification Number Expiration Date
North Carolina (WW/SW)State 314 12-31-21
The following analytes are included in this report, but the laboratory is not certified by the governing authority. This list may include analytes for which
the agency does not offer certification.
Analysis Method Prep Method Matrix Analyte
EPA-18 Air - Tedlar Bag Benzene
EPA-18 Air - Tedlar Bag Ethylbenzene
EPA-18 Air - Tedlar Bag Gasoline Range Organics (GRO)-C6-C10
EPA-18 Air - Tedlar Bag Methyl tert-butyl ether
EPA-18 Air - Tedlar Bag m-Xylene & p-Xylene
EPA-18 Air - Tedlar Bag o-Xylene
EPA-18 Air - Tedlar Bag Toluene
EPA-18 Air - Tedlar Bag Xylenes, Total
Eurofins TestAmerica, Pensacola
Page 13 of 15 12/3/2021
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Page 14 of 15 12/3/2021
1234567
8
9
10
11
12
13
14
15
Login Sample Receipt Checklist
Client: Terraquest Environmental Consultants, PC Job Number: 400-211729-1
Login Number: 211729
Question Answer Comment
Creator: Whitley, Adrian
List Source: Eurofins TestAmerica, Pensacola
List Number: 1
N/ARadioactivity wasn't checked or is </= background as measured by a survey
meter.
N/AThe cooler's custody seal, if present, is intact.
N/ASample custody seals, if present, are intact.
TrueThe cooler or samples do not appear to have been compromised or
tampered with.
TrueSamples were received on ice.
TrueCooler Temperature is acceptable.
TrueCooler Temperature is recorded.17.4°C IR9
TrueCOC is present.
TrueCOC is filled out in ink and legible.
TrueCOC is filled out with all pertinent information.
TrueIs the Field Sampler's name present on COC?
TrueThere are no discrepancies between the containers received and the COC.
TrueSamples are received within Holding Time (excluding tests with immediate
HTs)
TrueSample containers have legible labels.
TrueContainers are not broken or leaking.
TrueSample collection date/times are provided.
TrueAppropriate sample containers are used.
TrueSample bottles are completely filled.
N/ASample Preservation Verified.
TrueThere is sufficient vol. for all requested analyses, incl. any requested
MS/MSDs
N/AContainers requiring zero headspace have no headspace or bubble is
<6mm (1/4").
TrueMultiphasic samples are not present.
TrueSamples do not require splitting or compositing.
N/AResidual Chlorine Checked.
Eurofins TestAmerica, Pensacola
Page 15 of 15 12/3/2021
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

APPENDIX F

Air Sparge Pilot Test Report
Perth Mini Mart – Madhukunj, LLC, Troutman, Iredell County, NC
Prepared by: Terraquest Environmental Consultants, P.C.
Test Dates: 11/23/21
Report Prepared: 12/20/21

1

Perth Mini Mart – Madhukunj, LLC
818 Perth Road, Troutman, Iredell County, NC
NCDEQ-DWM UST Release Incident Number: 40784
Terraquest Project No. 08217
Facility ID: 00-0-0000024524
Latitude: 35.684542° N Longitude: -80.895851° W
Release Cause/Source: Gasoline Underground Storage Tank System
Release USTs (removed): 2, 6,000-gallon and 1, 4,000-gallon gas, 1, 2,000-gallon gas (formerly
diesel)
Risk Ranking Classification: High
Land-Use Classification: Residential

Property Owner & UST Owner/Operator:
Madhukunj, LLC
135 Corona Circle
Mooresville, NC 28117

INTRODUCTION

On November 23, 2021, Terraquest Environmental Consultants, P.C. performed an air sparge
pilot test for the Perth Mini Mart release incident located in Troutman, Iredell County, North
Carolina. The site’s location, vicinity, and layout are depicted on Figures 1, 2, and 3.

Air sparging is an in-situ method of groundwater remediation, in which compressed air is injected
into the aquifer via wells screened in the saturated zone. The compressed air is entrained as
small air bubbles and air streams which rise through the pore network in the soil structure and
fractures of saprolite. Volatile organic compounds dissolved in the water column or adsorbed to
soil particles will, depending on subsurface conditions and properties of the target compounds,
volatilize in the air stream. The entrained air eventually emerges to the vadose zone, where the
load of organic gases is released to the soil vapor domain. In aquifers with concentrations of
dissolved oxygen that have been lowered through natural aerobic degradation of the
Air Sparge Pilot Test Report

Air Sparge Pilot Test Report
Perth Mini Mart – Madhukunj, LLC, Troutman, Iredell County, NC
Prepared by: Terraquest Environmental Consultants, P.C.
Test Dates: 11/23/21
Report Prepared: 12/20/21

2
hydrocarbon contaminants, the injection of air can replenish the dissolved oxygen and accelerate
the rate of biodegradation.

As part of the remedial action toward closure for this site, Terraquest identified air sparging as a
potentially viable groundwater remediation method. This test was conducted within the area of
free product as requested by the NCDWM-UST.

The purpose of the pilot tests was to confirm the subsurface would be agreeable to the method,
to provide information for well spacing requirements, and provide system performance
requirements for an onsite system. Contaminant recovery rates for early operation of a sparge
system can also be understood via pilot testing.

The tests revealed how the subsurface responds to injection of air bubbles within the aquifer.
Data was collected for air injection pressure, air injection flow, and changes in free
product/groundwater levels.

Site Hydrogeology

The site is located in the Piedmont Physiographic Region of North Carolina. According to the
Geologic Map of North Carolina (Brown, et al, 1985), the site is located in the Charlotte Belt and
is underlain by mafic metavolcanic bedrock lithologies. On a regional scale, the Piedmont is
characterized by land with moderate relief and some areas of low relief hills and valleys.

Groundwater in the region is part of the Catawba River Basin. Regionally, groundwater flows to
the southwest and feeds into Big Branch Creek and ultimately Lake Norman. Big Branch Creek is
listed as a Water Supply IV surface water body at https://deq.nc.gov/about/divisions/water-
resources/planning/classification-standards/classifications#DWRPrimaryClassification which

Air Sparge Pilot Test Report
Perth Mini Mart – Madhukunj, LLC, Troutman, Iredell County, NC
Prepared by: Terraquest Environmental Consultants, P.C.
Test Dates: 11/23/21
Report Prepared: 12/20/21

3
classifies surface water bodies with a WSIV classification as “sources of water supply for drinking,
culinary, or food processing.”

The following lithologies were encountered at the site during the installation of soil borings and
the monitoring well network:

0 – 63’ BGL SILT (CL)
Mostly soft to medium-stiff (generally increasing consolidation
with depth), micaceous, red to brown to tan, with trace clay and
characteristics of saprolite in areas.

63-70’ BGL SAPROLITE
Mostly tan/brown heavily-weathered rock.

(Available soil boring logs and well construction records are attached to this report)

Geological cross sections of the subject area follow:

Air Sparge Pilot Test Report
Perth Mini Mart – Madhukunj, LLC, Troutman, Iredell County, NC
Prepared by: Terraquest Environmental Consultants, P.C.
Test Dates: 11/23/21
Report Prepared: 12/20/21

4

Air Sparge Pilot Test Report
Perth Mini Mart – Madhukunj, LLC, Troutman, Iredell County, NC
Prepared by: Terraquest Environmental Consultants, P.C.
Test Dates: 11/23/21
Report Prepared: 12/20/21

5

Air Sparge Pilot Test Report
Perth Mini Mart – Madhukunj, LLC, Troutman, Iredell County, NC
Prepared by: Terraquest Environmental Consultants, P.C.
Test Dates: 11/23/21
Report Prepared: 12/20/21

6
The phreatic aquifer at the site ranges from 21 to 40 feet BGL with an average depth to water in
the Type II wells since 2018 of 32 feet BGL. (Notably, free-phase product is present in multiple
wells with historical thicknesses as great as 7 feet.) As part of the CSA, the groundwater elevation
measurements reveal that the hydraulic head within the shallow phreatic aquifer ranged from a
relative value of approximately 66.61 at monitoring well MW5 to 67.91 at MW4 as measured on
April 30, 2019. In conjunction with other site measurements, the results indicate flow in the
phreatic aquifer in a south/southwest direction under an average hydraulic gradient of
approximately 0.02.

Groundwater elevation data collected on November 23, 2021 prior to testing is listed in Table 1
along with well construction information. The potentiometric surface on that date is displayed
below and indicates a west/southwest groundwater flow direction.

Air Sparge Pilot Test Report
Perth Mini Mart – Madhukunj, LLC, Troutman, Iredell County, NC
Prepared by: Terraquest Environmental Consultants, P.C.
Test Dates: 11/23/21
Report Prepared: 12/20/21

7
The target free product and groundwater contaminant plumes are shown here:

Air Sparge Pilot Test Report
Perth Mini Mart – Madhukunj, LLC, Troutman, Iredell County, NC
Prepared by: Terraquest Environmental Consultants, P.C.
Test Dates: 11/23/21
Report Prepared: 12/20/21

8
Based on the previous hydrogeologic descriptions alone, the phreatic aquifer at the site is a
reasonable candidate for air sparging. The amount of clay and consolidation will play a large role
in the effectiveness of sparging.

Well Installation and Layout

In addition to the existing monitoring well network, an air sparge well was installed in anticipation
of the subject air sparge test.

Terraquest personnel supervised the installation of air sparge well AS1 on November 16, 2021.
Well AS1 was installed using a Geoprobe Model 7728DT drilling rig operated by an NC-Licensed
driller. The well was constructed of 55 feet of 1”-diameter PVC casing attached to 5 feet of 1”-
diamter PVC screen for a total well depth of 60 feet. Table 1 and the attached well record provide
further details. The well was placed within the free product plume at the direction of the
NCDWM-UST. Monitoring wells MW1, MW2, MW15, MW16, and MW17 were installed as part
of previous assessment efforts and were used as observation points for this ai sparge test.
Additional summary of the wells as it relates to testing follows:

Well
identification
Radial distance
(feet) from
injection point
Screened
interval (feet)
Total depth
(feet)
Well diameter
(inches)
AS1 0: injection here 55-60 60 1
MW2 5 30-50 50 2
MW17 5 20-45 45 2
MW15 15 25-45 45 2
MW16 16 25-45 45 2
MW1 22 30-50 50 2

Air Sparge Pilot Test Report
Perth Mini Mart – Madhukunj, LLC, Troutman, Iredell County, NC
Prepared by: Terraquest Environmental Consultants, P.C.
Test Dates: 11/23/21
Report Prepared: 12/20/21

9
Equipment and Connections

Air was supplied to the injection point from a portable, electric, oil-less air compressor powered
by a portable electrical generator brought onsite for the test. The compressor output was
connected to the injection point through a series of hoses, pipes, and fittings. Air flow into the
injection point was measured with an adjustable flow meter. A static pressure gauge was
installed downstream of the flow control valve. The change in depth to product and water in the
observation points was measured using a Solinst Model 122 Interface Meter.

GENERAL PROCEDURES

The test procedure consists of applying air pressure to the sparging well while monitoring air flow
at this point and changes in product/groundwater levels in nearby wells. During the air sparge
test conducted on November 23, 2021, air was introduced into AS1 while measurements were
collected from observation points MW1, MW2, MW15, MW16, and MW17.

The test consists of several stages in which a constant flow is applied, while the air pressure and
water levels are measured. After groundwater mounding stabilizes, the flow is stepped up and
held constant for another stage. The number of stages depends on the rate at which responses
occur.

During the November 23, 2021 test, a total of three different flow rates were applied to the air
sparge well. Flows of 1.0, 1.5, and 2.0 standard cubic feet per minute were all applied. Those
flow intervals were provided for 1 hour, 1.5 hours, and 1.5 hours, respectively. That is, 1.0 scfm
was applied for the first 60 minutes, 1.5 scfm was applied from 60 to 180 minutes, and 2.0 scfm
was applied from 180 minutes until test conclusion at 270 minutes. Measurements recorded
during these stages are presented on Table 2.

Air Sparge Pilot Test Report
Perth Mini Mart – Madhukunj, LLC, Troutman, Iredell County, NC
Prepared by: Terraquest Environmental Consultants, P.C.
Test Dates: 11/23/21
Report Prepared: 12/20/21

10
MEASUREMENTS AND RESULTS

The three main objectives of data analysis are to determine whether air sparging is suitable for
the site, determine a reasonable radius of influence for an air sparge well, and establish data for
equipment selection in the design of a full-scale system.

Suitability
The responses observed during the test indicate air sparging would be suitable for the site. Air
was injected into the subsurface and flow was maintained. Some sites have had poorly installed
air sparge wells where the screens are cemented or the lithology is too tight and air will not enter
the saturated zone at all. This was not the case at the subject facility. The injection was made
with a standard electrical air compressor suitable for short-term testing and flowable air was
maintained without a large amount of pressure. Flowable pressure for the test was less than 20
psi and a larger spike for breakthrough pressure was not observed. While some breakthrough
pressure exists, it was obviously within the limits of the operating equipment and was short-lived
enough that field personnel did not see it.

There are other general conditions that contribute to AS effectiveness. These are discussed in
US EPA (1995), and some are listed and addressed below.

• Basements, subsurface utilities, etc. - Air sparging has the potential to exhaust elevated
concentrations of VOCs to the vadose zone, where they could accumulate in basements,
sewers, crawl spaces, etc. Implementation of AS should consider this possibility. At this site,
no basements are known to exist nor are there any building crawl spaces as structures appear
of slab construction. As the majority of the subject area is covered in asphalt or concrete, air
sparge off-gassing could migrate along utility pathways if not collected by a vacuum recovery
system. Regulation of the sparge rate and placement of the injection points are additional
controls.

Air Sparge Pilot Test Report
Perth Mini Mart – Madhukunj, LLC, Troutman, Iredell County, NC
Prepared by: Terraquest Environmental Consultants, P.C.
Test Dates: 11/23/21
Report Prepared: 12/20/21

11
• Unconfined or Confined Aquifer - Air sparging is generally not recommended for confined
aquifers. The target zone at this site would be in the unconfined aquifer, so this factor should
not be prohibitive.

• Type of Contamination - Gasoline is the contaminant at this site. Of the common petroleum
fuels, gasoline is the most amenable to remediation by sparging. That is shown on the
following exhibit from the EPA’s 1995 guidance document (US EPA 1995):

• Soil Type - If the stratigraphy is comprised of tight soils or large amounts of clay, then sparging
is not likely to be effective. However, while some clay was logged at this site, the
US EPA. 1995. How to evaluate alternative cleanup technologies for underground storage tank sites. Solid Waste and
Emergency Response 5403W. Document Number 510-B-95-007.

Air Sparge Pilot Test Report
Perth Mini Mart – Madhukunj, LLC, Troutman, Iredell County, NC
Prepared by: Terraquest Environmental Consultants, P.C.
Test Dates: 11/23/21
Report Prepared: 12/20/21

12
predominant soil matrix within the saturated zone is silt. This was confirmed by the low
pressure needed to maintain injection flow and by the response at surrounding wells.

Radius of Influence
Determining the radius of influence involves a study of the influence observed in the wells
monitored during the pilot test. As the remedial method of air sparging is the mechanical
stripping of contaminants from the dissolved phase into a liberated waste air stream, the extent
of that effect is what is searched for. Air sparging also acts as a remedial method by increased
the amount of oxygen dissolved in the surrounding aquifer and that should be analyzed too.
However, the presence of free product prevented field measurement of DO with routine
equipment and this data was not obtained.

Prior to and throughout the test, the depth to water was measured in surrounding wells. As the
test progressed, the water table was mounded by the applied air as seen at observations wells
by a rise in the water table. In a fully evolved test with a sufficiently low air flow, the water levels
will subside to near static levels after some period of time as the mounding is spread across the
aquifer. When this drop occurs, the air flow rate is typically increased to the next step.

The measured data is summarized on the attached Table 2 and a graph of the depth to water
versus time for each of the wells monitored is also provided at the end of this sparge report.
These graphs show the mounding and subsequent stabilization of groundwater during each flow
increase. The stabilization is slight and is realized by a tapering of water mounding in some cases.
The evidence of these water level stabilizations is an important result, since it indicates that low
flow sparging can be performed without causing sustained high water levels. These
measurements also are indicative of the radius of influence of the air sparge well. The following
results were observed:

Air Sparge Pilot Test Report
Perth Mini Mart – Madhukunj, LLC, Troutman, Iredell County, NC
Prepared by: Terraquest Environmental Consultants, P.C.
Test Dates: 11/23/21
Report Prepared: 12/20/21

13

Well identification
Radial distance (feet) from
injection point Largest mounding (feet)
AS1 0: injection here
MW2 5 1.49
MW17 5 2.01
MW15 15 2.07
MW16 16 0.94
MW1 22 1.06
MW3 34 0.24

Air Sparge Pilot Test Report
Perth Mini Mart – Madhukunj, LLC, Troutman, Iredell County, NC
Prepared by: Terraquest Environmental Consultants, P.C.
Test Dates: 11/23/21
Report Prepared: 12/20/21

14
Calculating the radius of influence should take into account multiple factors to provide a
scientifically-reasonable value with some conservative allotment. The radius is subject to
hydrogeology and isn’t as simple as a straight-line graph. The data indicates mounding as far
away as 34 feet. The goal is to calculate a ROI that provides air sparging to all areas without
creating service gaps. The size, shape, and placement of the free product and dissolved-phase
plume onsite where the sparging would occur also needs consideration.

In consideration of all these factors, 20 feet is recommended as a working radius of influence and
the following well placement is proposed that considers site layout, remedial goals, free product,
GCLs, and radius of influence: (see attached Figure 4 also)

Air Sparge Pilot Test Report
Perth Mini Mart – Madhukunj, LLC, Troutman, Iredell County, NC
Prepared by: Terraquest Environmental Consultants, P.C.
Test Dates: 11/23/21
Report Prepared: 12/20/21

15
Design data
The air sparge test achieved sustained flow up to 2 scfm at a pressure between 12 and 17 psi.
Equipment should be sized for a flow demand of 7 wells at a flow rate up to 4 scfm each for a
total of 28 scfm with some extra to allow for an increase in sparging as needed. Pressure over
17 psi was not observed but could have happened briefly as breakthrough was occurring. Air
sparge breakthrough is typically 1 psi for every 2.3 feet of head (US EPA 1995). With a head of
55 – 32.13 = 22.87 feet, the entry pressure required is estimated at 9.94 psi. The lithology
accounts for some of the additional pressure required. Overall, the flow and pressure is within
the range of typical air sparge systems.

Contaminant Mass
While the exact time required to remediate the free and dissolved-phase contamination is
unknown, pilot test data can be used with previous assessment data to provide a rough
estimation. Essentially, the metrics involved are the starting mass of product, the starting mass
of dissolved-phase contamination, and the removal rate of the system. The largest problem with
these calculations is that early operation of a system releases untethered contamination VERY
easily whereas later operation of a system requires the rise and fall of the aquifer and the release
of contaminants bound up in pore spaces to provide MUCH slower remediation. Some sort of
reasonable multiplier or logarithmic decline in recoverability must be used to provide a realistic
cleanup time. With that in mind, the following is presented:

Free-phase product mass:
325 ft2 x 2.5 foot average product thickness = 812.5 ft3 x 7.48 gal/ft3 x 6.25 lbs/gal =
37,984 pounds

Air Sparge Pilot Test Report
Perth Mini Mart – Madhukunj, LLC, Troutman, Iredell County, NC
Prepared by: Terraquest Environmental Consultants, P.C.
Test Dates: 11/23/21
Report Prepared: 12/20/21

16
Dissolved-phase contaminant mass (GCL violation):
3,300 ft2 x (10 feet beyond bottom of 50 foot wells – DTW 32’ = 60-32=28) = 92,400 ft3 x 28.3
L/ft3 = 2,616,476.6 L of GCL water. Average GCL violation wells on 9/2020 = 72,730 ug/L.
2,616,476.6 L of GCL water x 72,730 ug/L x 2.20462e-9 ug/lbs =
419.5 pounds.

Initial removal rate:
A Soil Vapor Extraction (SVE) unit was operated during part of the air sparge test to retrieve a
representative sample of the air sparge exhaust. As shown in the attached analytical report, that
sample had a reported concentration of 10,100,000 parts per billion by volume of Total
Petroleum Hydrocarbons as Gasoline Range Organics. Using the following calculations, the
removal rate during the test was:
67.42 pounds/4.5 hours

OPERATING PERIOD:START: 11/23/21 11:37 AM END:11/23/21 4:07 PM
AIR SPARGE CALCULATIONS (via SVE sample recovery)
SVE: this model produces (scfm flow rate):100 scfm
TPH concentration of vapors at stack:10,100,000 ppbv
Volume of air removed in ft3 equals (flow)(1,440 min/d)(time in period)27,000 ft3
Volume of gasoline vapor removed is equal to air volume removed muliplied by the TPH concentration.
Vol. air removed (ft 3) x [TPH concentration of vapor (ft3 gasoline vapor/1E+09 ft3 air)]273 ft3 gasoline vapor
Conversions:1 ft3 vapor equals 7.48 gal.
1 gal. equal 3.78 liters
ft3 gasoline vapor x 7.48 gal./ft3 x 3.78 liters/gal. equals liters gasoline vapors.7,710 liters gasoline
vapor
Conversions:
Therefore:89 g/mole x (1mole/22.4 liters) equals:3.97 g/liter
Amount of Contaminant Removed
gasoline vapor (liters) x (3.97 g/liter) x (1 lb/454 g) equals lbs. vapor 67.42 lb of gasoline
At standard temperature and pressure, there are 22.4 liters of gasoline vapor per mole of gasoline. The molecular weight of carbon in gasoline
is 89 g/mole.

Air Sparge Pilot Test Report
Perth Mini Mart – Madhukunj, LLC, Troutman, Iredell County, NC
Prepared by: Terraquest Environmental Consultants, P.C.
Test Dates: 11/23/21
Report Prepared: 12/20/21

17

Expanding the initial removal rate against the mass of contaminant calculates as follows:
37,984 pounds + 419.5 pounds = 38,403.5 pounds / (67.42 pounds/4.5 hours) = 2,563 hours / 24
hours/day = 107 days.

So, if a treatment system were installed that had removal rates like those of the pilot test, the
contaminant mass would be removed in 107 days. However, this does not account for water
table fluctuations, lithology heterogeneities, or compounds more recalcitrant to air stripping. It
also ignores the readily available contamination that is liberated by a virgin pilot test. At some
point, air sparge liberation at similar sites has shown a drastic reduction in contaminant recovery
as the system run time increases. Having several feet of free product available for removal may
allow the “early and productive” stages of the sparge system to last longer than sites treating
dissolved-phase contamination alone. All of this is to say that the site will not be rid of product
and GCL violations in 107 days. A 4-5 times factor should be applied along with a year or two of
time to allow for water table fluctuations that may trap product/GCL violations from treatment.

The longer portion of treatment may not be the product removal but the remediation of the
dissolved-phase contamination. The recovery rate of the GCL violations was not investigated
during the pilot test as the NCDWM-UST directed the placement of the air sparge well into the
free product plume.

Several years of treatment are anticipated to remove product and GCL violations. Further
refinement of treatment time will be understood as the system is operated or by conducting a
level of research and pilot testing of length that exceeds the scope of work for NCDWM-UST RRD
pilot testing.

Air Sparge Pilot Test Report
Perth Mini Mart – Madhukunj, LLC, Troutman, Iredell County, NC
Prepared by: Terraquest Environmental Consultants, P.C.
Test Dates: 11/23/21
Report Prepared: 12/20/21

18

CONCLUSIONS AND RECOMMENDATIONS

A November 23, 2021 air sparge pilot test conducted for the release incident at the Perth Mini
Mart indicates favorable remedial response from the subsurface. Air sparging was conducted at
flows and pressures of typical systems, influence was observed at surrounding wells, and
recovery of the sparge exhaust had reported contamination therein. Overall, air sparging
appears to be a viable option for treatment and is recommended.

Note that the presence of free product and concentration noted in the exhaust stack indicates
that stack treatment via thermal oxidation will be required to ensure emissions do not exceed
permissible limits.

Air Sparge Pilot Test Report
Perth Mini Mart – Madhukunj, LLC, Troutman, Iredell County, NC
Prepared by: Terraquest Environmental Consultants, P.C.
Test Dates: 11/23/21
Report Prepared: 12/20/21

19
REFERENCE

Brown, et al., 1985. Geologic Map of North Carolina, North Carolina. Department of Natural
Resources and Community Development, 1:500,000 scale.

US EPA. 1995. How to evaluate alternative cleanup technologies for underground storage tank
sites. Solid Waste and Emergency Response 5403W. Document Number 510-B-95-007.

TABLES

AIR SPARGE TEST
Table 1
Date: 12/16/21 Facility ID: 0-0024524
Well ID Date Installed
Date Water
Level
Measured
Screened Interval (x
to y feet BGS)
Bottom of Well
(feet BGS)
Top of
Casing
Elevation
(feet)
Depth to Water
from Top of
Casing (feet)
Free
Product
Thickness
(feet)
Groundwater
Elevation (feet)CommentsMW11/16/18 11/23/21 30-50 50 98.78 32.13 0 66.65 Type II Groundwater Monitoring Well
MW2 6/18/18 11/23/21 30-50 50 97.83 34.82 4.2 66.08 Type II Groundwater Monitoring Well
MW3 6/18/18 11/23/21 30-50 50 98.54 31.57 0 66.97 Type II Groundwater Monitoring Well
MW4 6/19/18 -30-50 50 99.68 ---Type II Groundwater Monitoring Well
MW5 11/26/18 -30-50 50 96.31 ---Type II Groundwater Monitoring WellMW611/26/18 -30-50 50 97.53 ---Type II Groundwater Monitoring WellMW711/26/18 -30-50 50 99.37 ---Type II Groundwater Monitoring WellMW811/27/18 -30-50 50 98.72 ---Type II Groundwater Monitoring WellMW911/27/18 -30-40 40 89.72 ---Type II Groundwater Monitoring WellMW1011/28/18 -30-40 40 90.75 ---Type II Groundwater Monitoring Well
MW11 11/28/18 -OC: 55 IC: 65 65-70 70 96.80 ---Type III vertical delineation well
MW12 4/29/19 -25-40 40 94.74 ---Type II Groundwater Monitoring Well
MW13 4/29/19 -25-40 40 94.30 ---Type II Groundwater Monitoring Well
MW14 4/30/19 -25-40 40 96.30 ---Type II Groundwater Monitoring WellMW159/22/20 11/23/21 25-45 45 97.25 34.05 3 65.39 Type II Groundwater Monitoring WellMW169/22/20 11/23/21 25-45 45 97.38 34.82 4.82 66.08 Type II Groundwater Monitoring WellMW179/22/20 11/23/21 20-45 45 98.41 32.05 0.05 66.40 Type II Groundwater Monitoring WellAS111/16/21 11/23/21 55-60 60 98.06 31.72 0 66.34 1"-diameter air sparge well
SVE1 11/16/21 11/23/21 20-35 35 98.34 31.70 0 66.64 2"-diameter SVE well
SVE2 11/16/21 11/23/21 20-35 35 97.96 31.39 0 66.57 2"-diameter SVE well
SVE3 11/16/21 11/23/21 20-35 35 97.99 31.26 0.1 66.80 2"-diameter SVE well
Notes:1. "BGS" = below ground surface 2. "-" information not available3. The groundwater elevations for monitoring wells with free product was corrected as follows: [Top of Casing Elevation - Depth to Water] + [Free Product Thickness x 0.7305]
MONITORING WELL CONSTRUCTION INFORMATIONIncident Name: Peth Mini Mart Incident No.: 40784
Well Casing Depth (feet
BGS)3030
30
30
30
30
30303030
25
25
25
2525205520
20
20
Actual Elapsed Injection Point: AS1
Time Time Pressure Flow DTW Groundwater DTW DTP Prod Thick Groundwater DTW DTP Prod Thick Groundwater DTW DTP Prod Thick Groundwater DTW DTP Prod Thick Groundwater DTW DTP Prod Thick Groundwater
(min)hour min minutes (psig)(scfm)(ft)Elevation (ft)(ft)(ft)(ft)Elevation (ft)(ft)(ft)(ft)Elevation (ft)(ft)(ft)(ft)Elevation (ft)(ft)(ft)(ft)Elevation (ft)(ft)(ft)(ft)Elevation (ft)
11:37:00 AM 0 0 0 0 0.0 32.13 66.65 34.82 30.62 4.20 66.08 31.57 0 66.97 34.05 31.05 3.00 65.39 34.82 30.00 4.82 66.08 32.05 32.00 0.05 66.40
11:42:00 AM 0 5 5 17 1.0 31.96 66.82 32.72 29.35 3.37 67.57 31.55 0 66.99 30.49 30.49 0 66.76 34.75 29.73 5.02 66.30 30.33 0 68.08
11:57:00 AM 0 20 20 14 1.0 31.75 67.03 32.96 29.51 3.45 67.39 31.48 0 67.06 30.45 0 66.80 33.55 29.68 3.87 66.66 30.22 0 68.19
12:07:00 PM 0 30 30 12 1.0 31.68 67.10 33.12 29.65 3.47 67.24 31.47 0 67.07 30.41 0 66.84 33.50 29.67 3.83 66.68 30.36 0 68.05
12:17:00 PM 0 40 40 12 1.0 31.62 67.16 33.36 29.84 3.52 67.04 31.45 0 67.09 30.44 0 66.81 33.58 29.72 3.86 66.62 30.57 0 67.84
12:27:00 PM 0 50 50 17 1.0 31.61 67.17 33.40 29.94 3.46 66.96 31.44 0 67.10 30.44 0 66.81 33.60 29.74 3.86 66.60 30.75 0 67.66
12:37:00 PM 0 60 60 17 1.0 31.60 67.18 33.40 29.94 3.46 66.96 31.44 0 67.10 30.43 0 66.82 33.59 29.74 3.85 66.60 30.75 0 67.66
12:47:00 PM 1 10 70 17 1.0 31.56 67.22 33.40 29.95 3.45 66.95 31.42 0 67.12 30.41 0 66.84 33.54 29.74 3.80 66.62 30.77 0 67.64
12:57:00 PM 1 20 80 11 1.0 31.55 67.23 33.54 30.02 3.52 66.86 31.42 0 67.12 30.43 0 66.82 33.58 29.75 3.83 66.60 30.88 0 67.53
1:07:00 PM 1 30 90 12 1.0 31.54 67.24 33.20 30.00 3.20 66.97 31.40 0 67.14 30.43 0 66.82 33.58 29.75 3.83 66.60 30.80 0 67.61
1:17:00 PM 1 40 100 14 1.0 31.53 67.25 33.17 29.87 3.30 67.07 31.40 0 67.14 30.37 0 66.88 33.44 29.71 3.73 66.66 30.76 0 67.65
1:27:00 PM 1 50 110 14 1.0 31.54 67.24 33.16 29.86 3.30 67.08 31.39 0 67.15 30.30 0 66.95 33.41 29.68 3.73 66.69 30.73 0 67.68
1:37:00 PM 2 0 120 14 1.5 31.53 67.25 33.10 29.82 3.28 67.13 31.38 0 67.16 30.15 0 67.10 33.20 29.65 3.55 66.77 30.52 0 67.89
1:52:00 PM 2 15 135 14 1.5 31.36 67.42 32.95 29.70 3.25 67.25 31.38 0 67.16 30.12 0 67.13 33.25 29.62 3.63 66.78 30.44 0 67.97
2:07:00 PM 2 30 150 14 1.5 31.33 67.45 32.95 29.70 3.25 67.25 31.37 0 67.17 30.11 0 67.14 33.26 29.62 3.64 66.78 30.44 0 67.97
2:22:00 PM 2 45 165 14 1.5 31.30 67.48 32.98 29.73 3.25 67.22 31.38 0 67.16 30.06 0 67.19 33.26 29.58 3.68 66.81 30.48 0 67.93
2:37:00 PM 3 0 180 14 1.5 31.28 67.50 33.04 29.76 3.28 67.19 31.36 0 67.18 30.07 0 67.18 33.26 29.60 3.66 66.79 30.58 0 67.83
2:52:00 PM 3 15 195 14 1.5 31.24 67.54 33.01 29.74 3.27 67.21 31.55 0 66.99 30.00 0 67.25 33.21 29.57 3.64 66.83 30.48 0 67.93
3:07:00 PM 3 30 210 15 2.0 31.20 67.58 33.02 29.75 3.27 67.20 31.35 0 67.19 29.90 0 67.35 33.10 29.55 3.55 66.87 30.30 0 68.11
3:22:00 PM 3 45 225 15 2.0 31.14 67.64 32.56 29.42 3.14 67.56 31.34 0 67.20 29.84 0 67.41 33.00 29.46 3.54 66.97 30.07 0 68.34
3:37:00 PM 4 0 240 15 2.0 31.10 67.68 32.59 29.45 3.14 67.53 31.35 0 67.19 29.80 0 67.45 33.00 29.45 3.55 66.97 30.05 0 68.36
3:52:00 PM 4 15 255 15 2.0 31.08 67.70 32.40 29.86 2.54 67.29 31.33 0 67.21 29.80 0 67.45 33.00 29.38 3.62 67.02 30.13 0 68.28
4:07:00 PM 4 30 270 15 2.0 31.07 67.71 32.4 29.86 2.54 67.29 31.33 0 67.21 29.79 0 67.46 33 29.38 3.62 67.02 30 0 68.41
TEST HALTED
4:27:00 PM 4 50 290 2.0 31.52 67.26 34.83 31.40 3.43 65.51 31.42 0 67.12 30.87 0 66.38 34.28 30.07 4.21 66.18 32.35 0 66.06
Note:
The groundwater elevations for monitoring wells with free product was corrected as follows: [Top of Casing Elevation - Depth to Water] + [Free Product Thickness x 0.7305]
Highest groundwater elevation: 67.71 67.57 67.21 67.46 67.02 68.41
Difference from static level: 1.06 1.49 0.24 2.07 0.94 2.01
Observation Well : MW17
Time
Table 2 BIOSPARGING TEST DATA TABLE
Test Date: 11/23/21 Incident Name: Peth Mini Mart Incident No.: 40784
Elapsed Observation Well : MW1 Observation Well : MW2 Observation Well : MW15 Observation Well : MW16Observation Well : MW3
0.0
0.5
1.0
1.5
2.0
2.5
65.00
65.50
66.00
66.50
67.00
67.50
68.00
68.50
69.00
0 50 100 150 200 250 300Groundwater Elevation (feet)Elapsed Time (Minutes)
Flow Rate vs. Groundwater Elevation (Injection Point: AS1)
MW1 MW2 MW15 MW16 MW17 Flow Rate

FIGURES

AIR SPARGE TEST
ONSULTANTS, P.C.CENVIRONMENTAL
ENVIRONMENTAL CONSULTANTS, P.C.
ENVIRONMENTAL CONSULTANTS, P.C.

WELL RECORDS

SOIL VAPOR EXTRACTION TEST

SSSS521ENVIRONNEN1ALCONSUirANTS,P,C,BORING LOGCont''a''t"i" TfirraqiiRstFqiiipment- OfinPrnhR 7fi??nTnriller'WBR SnrrellsDatnStarfpri- 11-1R-17Date Finishpri- 11-1R-17I nggeri hy .Inrdan I BrswBoring Number:B1BlowCountsOVM(ppm)209581610204152,197284337196473DepthFeet20253035LithologyDescriptionAsphaltSilt(ML)Medium stiff reddish-orange silt, with trace clay and fine sand. Soilsare dry.Silt(ML)Soft brownish-orange, micaceous silt, with trace fine sand. Soils aredry.Silt (ML)Soft orange/brown/black micaceous silt, with trace fine sand andincreasing amounts of saprolite with depth. Soils contain a minuteamount of moisture beginning at 28 feet BGL.Probe refusal at 38 feet BGL.Boring Terminated at 38 feet BGL.Scale as shown: Hatch pattern denotes soil sample depth;Solid denotes lab sample depth; Lithology hatch pattern legend is attached;NA - Not Applicable; BGL - Below GroundlevelSite:Perth Mini Mart818 Perth RoadTroutman, NCClient:MadnuKunj, LLC135 Coron'a CircleMooresville, NCProject No.:08217Page
^-SSSllJ^SsiENVIRONNEHTAI CONSULTANTS, P.C,IBORING LOGf:nnfraft"r" TfirraqilfistFqnipmBnf nsnPrnhs 7fi??nTDrillorWBK KnrrfillRnato Starteri • 11-1R-17Da+B Finiahpri- 11-1R-17I nggnri hy .Inrrlan I BrswBoring Number:B2d)Q.Ero\v>BlowCountsJ_OVM(ppm)675170147DepthFeetLithologyDescription1015AsphaltSilt (ML)Medium stiff reddish-orange silt, with trace clay and fine sand. Soilsare dry.Silt (ML)Soft brownish-orange, micaceous silt, with trace fine sand andsaprolite. Soils are dry.Boring Terminated at 15 feet BGL.Scale as shown: Hatch pattern denotes soil sample depth;Solid denotes lab sample depth; Lithology hatch pattern legend is attached;NA - Not Applicable; BGL - Below GroundlevelSite:Perth Mini Mart818 Perth RoadTroutman, NCClient:Madhukunj, LLC135 Corona CircleMooresville, NCProject No.:08217Page
ENVUtONHENTAL CONSULTANTS, MjBORING LOGCnntrpntnr- TfirraqiifistEquipment- PSRnPrnhfi 7a?9DTDrillBr-WBS RnrrfillsDate Startnri- 11-1R-17Date FinishRri: 11-16-17I nrjfjpri hy .Inrdan I srBWBoring Number:B3d)a.EroIwBlowCounts±OVM(ppm)1715 —I435315DepthFeetLithologyDescription1015AsphaltSilt (ML)Medium stiff reddish-orange slit, with trace day and fine sand. Soilsare dry.Silt (ML)Soft brownish-orange, micaceous silt, with trace fine sand andsaprolite. Soils are dry.Boring Terminated at 15 feet BGL.Scale as shown: Hatch pattern denotes soil sample depth;Solid denotes lab sample depth; Lithology hatch pattern legend is attached;NA - Not Applicable; BGL - Below GroundlevelSite:Perth Mini Mart818 Perth RoadTroutman, NCClient:Madhukunj, LLC135 Corona CircleMooresville, NCProject No.:08217Page
ENWRONHENTAl CONSULTANTS, P,C,BORING LOGCnntrac-tnr- TfirraqiiRRtEquipment- ("SfsnPrnhB 7S77DTnriller;WfiK RnrrfillsHate Started- 11-16-17Rate Finished- 11-1R-17I nggori hy .Inrrian I BrswBoring Number:B4BlowCountsOVM(ppm)3645 —I190382DepthFeetLithologyDescription1015AsphaltSilt (ML)Medium stiff reddish-orange silt, with trace clay and fine sand. Soilsare dry.Silt (ML)Soft brownish-orange, micaceous silt, with trace fine sand andsaprolite. Soils are dry.Boring Terminated at 15 feet BGL.Scale as shown: Hatch pattern denotes soil sample depth;Solid denotes lab sample depth; Lithology hatch pattern legend is attached;NA - Not Applicable; BGL - Below GroundlevelSite:Perth Mini Mart818 Perth RoadTroutman, NCClient:Madhukunj, LLC135 Corona CircleMooresville, NCProject No.:08217Page
TERRAauestlailiiiENVIROHMEHTAI. CONSULTANTS, P,C,1BORING LOGCnntrar-fnr' TprraniifiRfFqnipmsnt- OsnPrnhB 7R9?nTPriller-WRS RnrrfijlRDateSfartpri- 11/7fi/1Rriatn FinishBri- 11/9R/1RLogged by .Inrrlan l RrswBoring Number:B5BlowCountsovn/i(ppm)10898.1163014581065DepthFeetLithology1520 —|25 —|30\S:SS:S:£:g:S:g:£\'•v.'s-v/s-v.s-v.-s'.'^>.^'::::^. .^•i=^..^c^. /^^isfSi^iIS -0 o -0. S -0. S -Q o•^.'^'^.'^•^.'^^^.'^^^ss^ss^[g^.'g^.'g-V.g:'3:gis^s^s^s^^V.S-V.g-V.g^^t^:^-=>.'/i».'^».'^<?iDescriptionAsphaltSilt (ML)Mostly soft, red, micaceous siltwith trace claySilt (ML)Mostly medium stiff, red/brown, micaceous silt, with trace fine sandand trace clay.SILT (ML)Mostly medium-stiff, red/brown, micaceous siltwith little sand andtrace clay. Characteristic of saprolite.Increasing consolidation more like saprolite.Boring terminated at 30' BGL.Scale as shown: Hatch pattern denotes soil sample depth;Solid denotes lab sample depth; Lithology hatch pattern legend is attached;NA - Not Applicable; BGL - Below GroundlevelSite:Perth Mini Mart818 Perth RoadTroutman, NCClient:Madhukunj, LLC135 Corona CircleMooresville, NCProject No.:08217Page
fe^ssssaENVmONBENTAL CONSULTANTS, P,C,BORING LOGCnntranfnr- TsrraqilRRtFqiiipmfnt- OBnPrnhB 7fi?7nTDriller:WBK RnrrsJs-DateStarteri- 11/9R/1Rnato Finiaheri- 11/7R/1RI ngged hy .Inrrian I prswBoring Number:B6<ua.(0|(0BlowCountsOVM(ppm)75.55 —I285.510312940222240650DepthFeet15Lithology20 —|25 —|'s^.^-ssl. /;;=;>. /;';::::>.&~'fa-'f;o-''f;o;f^KV.SV.&O.&V.S:t^>. ^•=:>. .^csk. ./;'=:^. /^^[^V..<^,-U..'a,'V^ ,'^'V. .<:DescriptionAsphaltSilt (ML)Mostly soft, red, micaceous silt with trace claySilt (ML)Mostly medium stiff, red/brown, micaceous silt, with trace fine sandand trace clay.SILT (ML)Mostly medium-stiff, brown/tan, micaceous siltwith little sand andtrace clay. Characteristic of saprolite.Two-inch thick saprolite band with white silt/sand characteristics @22' BGL.SILT(MLTMostly medium-stiff, brown, micaceous siltwith saprolite.Refusal at 28' BGL.Scale as shown: Hatch pattern denotes soil sample depth;Solid denotes lab sample depth; Lithology hatch pattern legend is attached;NA - Not Applicable; BGL - Below Groundleve!Site:Perth Mini Mart818 Perth RoadTroutman, NCClient:MadhuKunj, LLC135 Corona CircleMooresville, NCProject No.:08217Page
S=rtS3S1_EHVIRONNENTAlCONSUlTANTS,P,C,lBORING LOGCnntractpr' TfirraqiiRstFqnipmont- OsnPrnhfi 7R?7nTDrillpr-WPR c;nrrplkDate Startori- 11/7R/-1RDate Finishnri- 11/?fi/1Ra9&?ri h\j,lnrrf?m I ftmwBoring Number:B7Q.EmIwBlowCountsOVM(ppm)75.55285.510312940222240650DepthFeetLithologyDescription15 —I20 —|25 —]30AsphaltSilt (ML)Mostly soft, tan/red silt with little clay and trace sand.Silt (ML)Mostly medium stiff, reddish-tan silt, with few fine-grained sand andfew saprolite.SILT (ML)Mostly soft, red/tan, silt with trace clay and fine-grained sand andincreasing characteristic of saprolite.SILT (ML)Mostly medium-stiff, red/tan, micaceous silt with trace fine-grainedsand. Characteristics of saprolite.SILT (ML)Mostly soft, brown, micaceous siltwith saprolite. Few clay presentfrom 25-30' BGL.Boring terminated 30 feet BGL.Scale as shown: Hatch pattern denotes soil sample depth;Solid denotes lab sample depth; Lithology hatch pattern legend is attached;NA - Not Applicable; BGL - Below GroundlevelSite:Perth Mini Mart818 Perth RoadTroutman, NCClient:Madhukunj, LLC135 Corona CircleMooresville, NCProject No.:08217Page
fe=SsS53&ENyiROHBENTAlCONSUI.TANTS,P,C,lBORING LOGCnntrgffnr- TerraqilRstFqnipment- RRnPrnhs 7R9?nTnrillerWRK RnrrfillsDatoStartnri- 11/?fi/1Rnato FinishBri- •11/7R/18nggsri hy .Inrdan I fimwBoring Number:B7a.(0|(0BlowCountsOVM(ppm)254.4450.010 —|1216818.615151355DepthFeetLithology152025 —|30DescriptionAsphaltSilt (ML)Mostly soft, tan/red silt with little clay and trace sand.Silt (ML)Mostly medium stiff, reddish-tan silt, with few fine-grained sand andfew saprolite.SILT (ML)Mostly soft, red/tan, siltwith trace clay and fine-grained sand andincreasing characteristic of saprolite.SILT (ML)Mostly medium-stiff, red/tan, micaceous siltwith trace fine-grainedsand. Characteristics ofsaprolite.SILT (ML)Mostly soft, brown, micaceous silt with saprolite. Few clay presentfrom 25-30' BGL.Boring terminated 30 feet BGL.Scale as shown: Hatch pattern denotes soil sample depth;Solid denotes lab sample depth; Lithology hatch pattern legend is attached;NA - Not Applicable; BGL - Below GroundlevelSite:Perth Mini Mart818 Perth RoadTroutman, NCClient:Madhukunj, LLC135 Corona CircleMooresville, NCProject No.:08217Page
ENVIBONKENTAI. CONSULTANTS, P,C,BORING LOGf:nntr?ftnr' TBrraqupRtFqiiipmnnf RfinPrnhp 7R77DTnrillor-WRS RnrmllRn^te Started- 11/?R/1RDgte Fim<?h<?f<- 11/?R/1RI nrjgeri by" .Inrrian I srfiwBoring Number:B8BlowCountsOVM(ppm)44.45 —I62.1104797301027188.2DepthFeetLithology152025 —|30DescriptionAsphaltSilt (ML)Mostly soft, red, micaceous silt with trace claySilt (ML)Mostly soft, red/tan silt with trace sand and saprolite.S1LT (ML)Mostly medium-stiff, red/tan silt with few clay and trace sand.Saprolitic in nature.SILT (ML)^ Mostly soft, tan, micaceous silt with trace sand.SILT (ML)Mostly soft, brown, micaceous siltwith saprolite.Boring terminated 30' BGL.Scale as shown: Hatch pattern denotes soil sample depth;Solid denotes lab sample depth; Lithology hatch pattern legend is attached;NA - Not Applicable; BGL - Below GroundlevelSite:Perth Mini Mart818 Perth RoadTroutman, NCClient:Madhukunj, LLC135 Corona CircleMooresville, NCProject No.:08217Page
TERRAcEHVIBONNENTAI COHSDLTAmS, P,C,BORING LOG/MONITORING WELL INSTALLATION DETAILRnntrantnr- TfirraqilfistDrill lUlpthnri-Hnllnw Stfim AngfrPrillerWPR Rnrrsllsnate Started- -1/1R/1Rnato Finished- 1/1R/1RI nggsri hy .Inrrian I RrewBoring Number:MW1BlowCountsCompletionOVM(ppm)DepthFeet1030.62,250±1,7841,347253035404550pthologi5 -^15 —|20 —|DescriptionAsphaltSilt (ML)Medium stiff reddish-orange silt, with trace clay and finesand. Soils are dry.Silt (ML)Soft brownish-orange, micaceous silt, with trace fine sand.Soils are dry.Slit (ML)Soft orange/brown/black micaceous silt, with trace fine sandand increasing amounts of saprolite with depth. Soils aremoist at 40 feet BGLSilt (ML)Soft olive/brown micaceous silt, with trace clay. Soils aresaturated.Well Completed at 50 feet BGL.Scale as shown; Hatch pattern denotes soil sample depth;Solid denotes lab sample depth; Lithology hatch pattern legend is attached;Well Construction2" diameter Sch. 40 PVC; .010" slotted screenSand: no. 2 sand; Grout: poured portland; Bentonite: poured pelletsFinished with 8"-diameter metal bolt down manhole.NA - Not Applicable; BGL - Below Ground LevelSite:Perth Mini Mart818 Perth RoadTroutman, NCClient:Madhukunj, LLC135 Corona CircleMooresville, NCProject No.:08217
TERRAcENV]RONNEHTAI.CONSI)ITANTS,PABORING LOG/MONITORING WELL INSTALLATION DETAILCnntractnr- TRrraqilpstnrill Msthnri-Hnllnw Stem AugsrnrillerWRR KnrrpllsnateRtf-tori- R/1S/1Rnato FiniahBri- R/1S/1RI nggori hy .Inrrian I BmwBoring Number:MW2a.E(0I coBlowCountsCompletionOVM(ppm)5 -^1015 —[20 —I±J_DepthFeet^.ithologi25 —|30 —|35 —|4045 —|50DescriptionAsphaltSilt (ML)Medium stiff reddish-orange silt, with trace clay and finesand. Soils are dry.Silt (ML)Soft brownish-orange, micaceous silt, with trace fine sand.Soils are dry.Silt (ML)Soft orange/brown/black micaceous silt, with trace fine sandand increasing amounts of saprolite with depth. Soils containa strong petroleum odor, with free product saturationbeginning at 33 feet BGL.Silt (ML)Soft olive/brown micaceous silt, with trace clay. Soils aresaturated and contain a strong petroleum odor.Well Completed at 50 feet BGL.Scale as shown; Hatch pattern denotes soil sample depth;Solid denotes lab sample depth; Lithology hatch pattern legend is attached;Well Construction2" diameter Sch. 40 PVC; .010" slotted screenSand: no. 2 sand; Grout: poured portland; Bentonite: poured pelletsFinished with 8"-diameter metal bolt down manhole.NA - Not Applicable; BGL - Below Ground LevelSite:Perth Mini Mart818 Perth RoadTroutman, NCClient:Madhukunj, LLC135 Corona CircleMooresville, NCProject No.:08217Page
TERRAcENVlBONNENTAlCOHSULrAinS, P.C.IBORING LOG/MONITORING WELL INSTALLATION DETAILCnntrar-fnr- TfirraqiiBstDrill Mothnri-Hnllnw Rtsm AnnRrDriller-WBR RnrmllKDfltp Startnri- fi/1R/1RDat? Finishpri- R/1R/1Rnggsri hy .Inrrfan I fimwBoring Number:MW3BlowCountsCompletionOVM(ppm)15 —I1015 —I20 —|DepthFeet50f-ithology25 —|30 —|354045 —|DescriptionAsphaltSilt (ML)Medium stiff reddish-orange silt, with trace clay and finesand. Soils are dry.Silt (ML)Soft brownish-orange, micaceous silt, with trace fine sand.Soils are dry.Silt (ML)Soft orange/brown/black micaceous silt, with trace fine sandand increasing amounts of saprolite with depth. Soils aremoist at 40 feet BGLSilt (ML)Soft olive/brown micaceous silt, with trace clay. Soils aresaturated.Well Completed at 50 feet BGL.Scale as shown; Hatch pattern denotes soil sample depth;Solid denotes lab sample depth; Lithology hatch pattern legend is attached;Well Construction2" diameter Sch. 40 PVC; .010" slotted screenSand: no. 2 sand; Grout: poured portland; Bentonite: poured pelletsFinished with 8"-diameter metal bolt down manhole.NA - Not Applicable; BGL - Below Ground LevelSite:Perth Mini Mart818 Perth RoadTroutman, NCClient:Madhukunj, LLC135 Coron'a CircleMooresville, NCProject No.:08217Page
TERRAcuestENVIBONMENULCOHSULTANIS.P.C.IBORING LOG/MONITORING WELL INSTALLATION DETAILCnntr9rt"r' TBrraqiifistnrill |U|fithO(l-HnllnwRtRm AugsrDrillerWfiR Rnn.milsDate Startori- R/19/1SDate Finisheri: fi/19/18I nrjgnri hy .Inrdan I BmwBoring Number:MW4BlowCountsCompletionOVM(ppm)5 —I1015 —|20 —|1DepthFeetMthologv25 —|3035 —|4045 —\50DescriptionAsphaltSilt (ML)Medium stiff reddish-orange silt, with trace clay and finesand. Soils are dry.Silt (ML)Soft brownish-orange, micaceous silt, with trace fine sand.Soils are dry.Silt (ML)Soft orange/brown/black micaceous silt, with trace fine sandand increasing amounts of saprolite with depth. Soils aremoist at 40 feet BGL.Silt (ML)Soft olive/brown micaceous silt, with trace clay. Soils aresaturated.Well Completed at 50 feet BGL.Scale as shown; Hatch pattern denotes soil sample depth;Solid denotes lab sample depth; Lithology hatch pattern legend is attached;Well Construction2" diameter Sch. 40 PVC; .010" slotted screenSand: no. 2 sand; Grout: poured portland; Bentonite: poured pelletsFinished with 8"-diameter metal bolt down manhole.NA - Not Applicable; BGL - Below Ground LevelSite:Perth Mini Mart818 Perth RoadTroutman, NCClient:Madhukunj, LLC135 Corona CircleMooresville, NCProject No.:08217Pane
TERRAciuestENVIBONNENTAI CONSULTANTS, P.C.IBORING LOG/MONITORING WELL INSTALLATION DETAILf:nntrar-tnr- TRrraqilRfitDrill lUIcthnri-Hnllnw KfRm AliqftrDrillerWRR RnrmllsnatBSfarteri- 11/?fi/1RDat? FJnishBri- 11/99/-1RI nrjgeri hy .Inrdan I erewBoring Number:MW5BlowCountsCompletionOVM(ppm)J_DepthFeetf-itholog^5 —I10 —|152025 —1303540 —|45 —|50DescriptionAsphaltSilt (ML)Mostly soft, red, micaceous siltwith trace clay.SILT (ML)Mostly medium-stiff, tan, micaceous silt.Silt (ML)Mostly soft, tan/gray, micaceous silt, with trace saprolite.Scale as shown; Hatch pattern denotes soil sample depth;Solid denotes lab sample depth; Lithology hatch pattern legend is attached;Well Construction2" diameter Sch. 40 PVC; .010" slotted screenSand: no. 2 sand; Grout: poured portland; Bentonite: poured pelletsFinished with 8"-diameter metal bolt down manhole.NA - Not Applicable; BGL - Below Ground LevelSite:Perth Mini Mart818 Perth RoadTroutman, NCClient:Madhukunj, LLC135 Corona CircleMooresville, NCProject No.:08217
TERRAcEHVIRONUENTAI CONSULTANTS, P,C,BORING LOG/MONITORING WELL INSTALLATION DETAILCnntractnr- TRrraqnfistDrill MBthnri-Hnllnw Stfim AiigprDrillor;WRR RnrrRltePafo St?rtorl- 11/9R/1SPgfe Finishnri- 11,99/1 R! ngrjcri hy .Inrdan I fimwBoring Number:MW6<uQ.E(01(0BlowCountsCompletionOVM(ppm)DepthFeet1-ithologyl5 —I10 —|152025 —|303540 —]45 —|50DescriptionAsphaltSilt (ML)Mostly soft, red, micaceous siltwith trace clay.SILT(ML)Mostly medium-stiff, tan, micaceous silt.Silt (ML)Mostly soft, tan/gray, micaceous silt, with trace saprolite.Scale as shown; Hatch pattern denotes soil sample depth;Solid denotes lab sample depth; Lithology hatch pattern legend is attached;Well Construction2" diameter Sch. 40 PVC; .010" slotted screenSand: no. 2 sand; Grout: poured portland; Bentonite: poured pelletsFinished with 8"-diameter metal bolt down manhole.NA - Not Applicable; BGL - Below Ground LevelSite:Perth Mini Mart818 Perth RoadTroutman, NCClient:Madhukunj, LLC135 Corona CircleMooresville, NCProject No.:08217Page
TERRAcENVIBONNENTAt CONSULTANTS. RC.l-Contrar-tnr- TnrraqiiRstBORING LOG/MONITORING WELL INSTALLATION DETAILDrill IVIpfhnri-Hnllnw Rtam AugfilLnrillnrWRR RnrrpHDate Starfnri- H/7fi/lRnato Finished- 11,99/1 R(LhBoring Number:MW7BlowCountsCompletionOVM(pprn^DepthFeetUthologDescription5 —I10 —|152025 —|303540 —145 —|50sphaltSilt (ML)Mostly soft, red, micaceous siltwith trace clay.SILT (ML)"Mostly medium-stiff, tan, micaceous silt.Silt (ML)Mostly soft, tan/gray, micaceous silt, with trace saprolite.Scale as shown; Hatch pattern denotes soil sample depth;Solid denotes lab sample depth; Lithology hatch pattern legend is attached;Well Construction2" diameter Sch. 40 PVC; .010" slotted screenSand: no. 2 sand; Grout: poured portland; Bentonite: poured pelletsFinished with 8"-diameter metal bolt down manhole.NA - Not Applicable; BGL - Below Ground LevelSite:Perth Mini Mart818 Perth RoadTroutman, NCClient:Madhukunj, LLC135 Coron'a CircleMooresville, NCProject No.:08217Page
TERRAcENVIBONBENTAI CONSULTANTS, P.C.IBORING LOG/MONITORING WELL INSTALLATION DETAILCnntrar.tor- TftrraqufiRtDrill MBthnri-HnllnwRtem Aiigsr.DrillBrWRR Rnrmllsnato Started: 11/?fi/1Rnato Finished: 11/29/1RI nggnri hy .Inrrian I srfiwBoring Number:MW8BlowCountsCompletionOVM(ppm)5 —I10 —|DepthFeetf-itholog^152025303540 —|45 —|50DescriptionAsphaltSilt (ML)Mostly soft, red, micaceous siltwith trace clay.SILT (ML)Mostly medium-stiff, tan, micaceous silt.Silt (ML)Mostly soft, tan/gray, micaceous silt, with trace saprolite.Scale as shown; Hatch pattern denotes soil sample depth;Solid denotes lab sample depth; Lithology hatch pattern legend is attached;Well Construction2" diameter Sch. 40 PVC; .010" slotted screenSand: no. 2 sand; Grout: poured portland; Bentonite: poured pelletsFinished with 8"-diameter metal bolt down manhole.NA - Not Applicable; BGL - Below Ground LevelSite:Perth Mini Mart818 Perth RoadTroutman, NCClient:Madhukunj, LLC135 Corona CircleMooresville, NCProject No.:08217
TERRAcENVIBONHENTAL CONSULTANTS, P,C,1BORING LOG/MONITORING WELL INSTALLATION DETAILCnnfractfu" TfirrsdURstPrjll Mnthnri-Hnllnw Stem AngsrDrillBrWss Snrrellsnato Sta rtsri • 11 /?fi/1 Rnato Finiahnri- 11/99/1Rloggori hy .Inrdan I BmwBoring Number:MW9BlowCountsCompletionOVM(ppm)DepthFeet1-itholog^510 —|15 —|20 —|25 —|303540DescriptionAsphaltSilt(ML)Mostly soft, red, micaceous siltwith trace clay.SILT (ML)Mostly medium-stiff, tan, micaceous silt.Silt (ML)Mostly soft, tan/gray, micaceous silt, with trace saprolite.Scale as shown; Hatch pattern denotes soil sample depth;Solid denotes lab sample depth; Lithology hatch pattern legend is attached;Well Construction2" diameter Sch. 40 PVC; .010" slotted screenSand: no. 2 sand; Grout: poured portiand; Bentonite: poured pelletsFinished with 8"-diameter metal bolt down manhole.NA - Not Applicable; BGL - Below Ground LevelSite:Perth Mini Mart818 Perth RoadTroutman, NCClient:Madhukunj, LLC135 Corona CircleMooresville, NCProject No.:08217
TERRAcEHVHONHEHTAI CONSULTANTS, P.C,BORING LOG/MONITORING WELL INSTALLATION DETAILRnntrartor; TfirraqiiRstnrill wiBthnd-Hnllnw Stem AugfirnrillprWRR RnrmlknafP SfarW- 11/9fi/1ROatfi Finished- 11/?9/18I nggori hy .Inrrfan I BrswBoring Number:MW10BlowCountsCompletionOVM(ppm)5 —I±DepthFeet^.itholog^10 —|15 —\20 —|25 —|303540DescriptionAsphaltSilt (ML)Mostly soft, red, micaceous silt with trace clay.SILT (ML)Mostly medium-stiff, tan, micaceous silt.Silt (ML)Mostly soft, tan/gray, micaceous silt, with trace saprolite.Scale as shown; Hatch pattern denotes soil sample depth;Solid denotes lab sample depth; Lithology hatch pattern legend is attached;Well Construction2" diameter Sch. 40 PVC; .010" slotted screenSand: no. 2 sand; Grout: poured portland; Bentonite: poured pelletsFinished with 8"-diameter metal bolt down manhole.NA - Not Applicable; BGL - Below Ground LevelSite:Perth Mini Mart818 Perth RoadTroutman, NCClient:Madhukunj, LLC135 Corona CircleMooresville, NCProject No.:08217Pac
TERRAcENVIRONMENTAL CONSULTANTS, P.C,BORING LOG/MONITORING WELL INSTALLATION DETAILContrar.fnr: RFDIDrill IUlBthnri-AugF>r/IVIiiri RotaryItullfitRryan Vf^stnato Started: 11/?7/1Rnato Finisheri- 11/?8/19I nggnd hy .InrdflP I firfiWBoring Number:MW11BlowCountsNANANANANANANACompletionOVM(Ppm)NA5 —I10NA15NANANANA \—DepthFeet6070|-itholog\20 —|2530 —I35 —|40 —|45 —|50 —|55 —|NA h— 65 —j'Sy?S:SS:c.Kv&vSv.•s^s^s^DescriptionAsphalt/gravelSilt (ML)Red, brown, clayey-silt.SILT (ML)Tan, sandy-silt.Silt (ML)Brown silt.SaproliteTan/brown weathered rock.Boring terminated 70 feet BGL.Scale as shown; Hatch pattern denotes soil sample depth;Solid denotes lab sample depth; Lithology hatch pattern legend is attached;Well ConstructionOuter casing: 5" dia. sch 40 PVCInner casing: 2" dia. sch. 40 PVC; .01" slotted screenSand: no. 2 sand; Grout: poured portland; Bentonite: poured pelletsManhole: flush 8" diameter steelNA - Not Applicable; BGL - Below Ground LevelSite:Perth Mini Mart818 Perth RoadTroutman, NCClient:Madhukunj, LLC135 Corona CircleMooresville, NCProject No.:08217Page
WELL CONSTRUCTION RECORDThis form can be used for single or multiple wel!s1. Well Contractor Information:Wesley J. SorrellsWell Contractor Name3577JlTerraquest Environmental Consultants,Company Name2. Well Construction Permit #:List all applicable well permits (t e. County, State,3. Well Use (check well use):Water Supply Well:D AgriculturalDGeothermal (Heating/Cooling Supply)D Industrial/CommercialDIrrigationNon-Water Supply Well:(3 MonitoringInjection Well:DAquifer RechargeDAquifer Storage and RecoveryDAquifer TestDExperimental TechnologyDGeothermal (Closed Loop)DGeothermal (Heating/Cooling Return)4. Date Well(s) Completed:5a. Well Location:Perth Mini MartFaciIity/Owner Name818 Perth Rd.Physical Address, City, and ZipIredellCountyConsultants, P.C., Variance, Injection, etc.)D Munic ipal/Publ icDResidentiaI Water Supply (single)DResidential Water Supply (shared)DRecoveryDGroundwater RemediationDSalinity BarrierDStormwater DrainageD Subsidence ControlDTracerD Other (explain under #21 Remarks)WellID#MW100-0-24524Facility IDS (if applicable)4730-50-7091Parcel Identification No. (PIN);or Internal Use ONLY:14. WATER ZONESFROMftftTOft.ft.DESCRIPTION15. OUTER CASmG (for multi-cased wells) OR LINER (ifapplicaNe)FROMftTOft.DIAMETERin.-HICKNESSMATERIAL16. INNER CASING OR TUBING (geothermal dosed-loop)FROMftftTO17. SCREENFROM50 ft-Ft.ft.Ft.18. GROUTFROM)26ftftft0) ft-ft.TO?628ft.ft.ft.ft.ft.DIAMETERin.in.-HICKNESSMATERIALDIAMETERin.in.SLOT SIZE.010THICKNESSSch.40MATERIALPVCMATERIALPortlandBentoniteEMPLACEMENT METHOD & AMOUNTPourPour19. SAND/GRAVEL PACK (if applicable)FROM?8ftftro.0ft.ft.MATERIALNo. 2 SandMFLACEMENT METHODPour20. DRILLING LOG (attach additional sheets if necessary)FROM)).5ftftftft.ft.ft,ft.ro.5iO21. REMARKSft.ft.ft.ft.ft.ft.ft.DESCRIPTION (color, hardness, soil/rnck type, grain size, etc.)AsphaltSilt5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:(if well field, one lat/long is sufficient)35.648900-80.895787_wDate6. Is (are) the well(s): EPennanent or DTemporary7.Is this a repair to an existing well: DYes or 17INoIf this is a repair, fill out hiowfj well construction information and explain the nature of therepair under ff-21 remarks section or on the back of this form.8. Number of wells constructed:For multiple injection or non-water supply wells ONL Y with the same construction, you cansubmit one form.22. Certification:Signature of Certified Well ContractorBy signmg this form, I hereby certify that the well(s} was (were) constructed in accordancewith ISA NCAC 02C .0100 or ISA NCAC 02C .0200 Well Conslruclion Standards and thai acopy of this record has been provided to the well owner.23. Site diagram or additional well details:You may use the back of this page to provide additional well site details or wellconstruction details. You may also attach additional pages if necessary.SUBMITTAL INSTUCTIONS509. Total well depth below land surface:For multiple wells list aU depths if different (example- 3@200' and 2@100')10. Static water level below top of casing: """If water fevel is above casing, use "+ "-(ft.). (ft.)II. Borehole diameter: "".(in.)12. Well construction method:(i.e. auger, rotai-y, cable, direct push, etc.). Hollow Stem AugerFOR WATER SUPPLY WELLS ONLY:13a. Yield (gpm) _ Method of test:13b. Disinfection type; _ Amount:24a. For All Wells: Submit this form within 30 days of completion of wellconstruction to the following:Division of Water Resources, Information Processing Unit,1617 Mail Service Center, Raleigh, NC 27699-161724b. For Injection Wells ONLY: In addition to sending the form to the address in24a above, also submit a copy of this form within 30 days of completion of wellconstmction to the following:Division of Water Resources, Underground Injection Control Program,1636 Mail Service Center, Raleigh, NC 27699-163624c. For Water Supply & Injection Wells:Also submit one copy of this form within 30 days of completion ofwell construction to the county health department of the county whereconstructed.FomiGW-1North Carolina Department of Environment and Natural Resources — Division of Water ResourcesRevised August 2013
WELL CONSTRUCTION RECORDThis form can be used for single or multiple wells1. Well Contractor Information:WesleyJ. SorrellsWell Contractor Name3577>r (JeiliticatiiTerraquest EnvironmentalCompany Name2. Well Construction Permit #:List all applicable well permits (i.e. County, State,3. Well Use (check well use):Water Supply Well:DAgriculturalDGeothermal (Heating/Cooling Supply)DIndustrial/CommercialDIrrigationNon-Water Supply Well:BMonitoringInjection Well;DAquifer RechargedAquifer Storage and RecoveryDAquifer TestD Experimental TechnologyDGeothermal (Closed Loop)DGeothermal (Heating/Cooling Return)4. Date Well(s) Completed:5a. Well Location:Perth Mini MartFacility/Owner Name818 Perth Rd.Physical Address, City, and ZipIredellCountyConsultants, P.C., Variance, Injection, etc.)DMunicipal/PublicDResidential Water Supply (single)D Residential Water Supply (shared)DRecoveryDGroundwater RemediationDSalinity BarrierDStormwater DrainageDSubsidence ControlDTracera Other (explain under #21 Remarks)wen wu MW2,MW3,MW400-0-24524Facility IDS (if applicable)4730-50-7091Parcel Identification No. (PIN)''or Inteirnal Use ONLY:14. WATER ZONESFROMftftTOft.ft.15. OUTER CASING (for iFROMftTOft.DESCRIPTIONmulti-cased wells) OR UNER (ifappUcable)DIAMETERin.•HICKNESSMATERIAL16. INNER CASING OR TUBING (geothermal closed-loop)FROMftftTO17. SCREENFROM30ft.ft.3) ft-ft.18. GROTJTFROM)'6ftft.ft,TO?6?8ft.ft.ft.ft.ft.DIAMETERin.in.•HICKNESSMATERIALDIAMETERIB.in.SLOT SIZE.010THICKNESSSch. 40MATERIALPVCMATERIALPortlandBentoniteEMPLACEMENT METHOD & AMOUNTPourPour19. SAND/GRAVEL PACK (if applicable)FROM'8ft,ft,ro0ft.ft.20. DRILLING LOG (attacFROM)).5ft.ft.ft,ft,ft,ft,ft,ro.5iO21. REMARKSft.ft.ft.ft.ft.ft.ft.MATERIALNo. 2 Sand;MFLACEMENT METHODPourtth additional sheets if necessary)DESCRIPTION (color, hardness, soil/rock type, gi-ain size, etc.)AsphaltSilt5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:(if well field, one lab/iong is sufficient)35.648900-80.895787_wCigitifiysgr^db/VfesteyScniTT.i i^SQTTEBiO K ^ITO 1^.Date6. Is (are) the well(s): [aPermanent or DTemporary7. Is this a repair to an existing well: DYes or ENoIf this is a repair, fill out known well comtrucfion information and explam the nature of therepair under ij-21 remarks section or on the back of this form.38. Number of wells constructed:For multiple injection or non-wafer supply wells ONL Y with the same construction, you cansubmit one form.22. Certification:Signature of Certified Well ContractorBy signing this form, I hereby certify that the well(s) was (were) constructed in accordancewith ISA NCAC 02C .0100 or t5A NCAC 03C .0200 Well Construction Standards and that acopy of this record has been provided to the well owner.23. Site diagram or additional well details:You may use the back of this page to provide additional well site details or wellconstruction details. You may also attach additional pages if necessary.SUBMITTAL INSTUCTIONS509. Total well depth below land surface:For multiple wells list all depths if different (example- 3@200' and 2@IOO'}^(ft.) 24a. For All Wells: Submit this form within 30 days of completion of wellconstruction to the following:10. Static water level below top of casing:If water level is above casing, use "+11. Borehole diameter: ^-25. 40.25,36.28,37.02.(ft.).(in.)12. Well construction method: HollOW Stem Auger(i.e. auger, rotai-y, cable, direct push, etc.)FOR WATER SUPPLY WELLS ONLY:13a. Yield (gpm) _ Method of test:13b. Disiufection type: _ Amount:Division of Water Resources, Information Processing Unit,1617 Mail Service Center, Raleigh, NC 27699-161724b. For Injection Wells ONLY: In addition to sending the form to the address in24a above, also submit a copy of this form within 30 days of completion of wellconstruction to the following:Division of Water Resources, Underground Injection Control Program,1636 Mail Service Center, Raleigh, NC 27699-163624c. For Water Supply & Injection Wells:Also submit one copy of this form within 30 days of completion ofwell construction to the county health department of the county whereconstructed.Form GW-1North Carolina Department of Environment and Natural Resources - Division of Water ResourcesRevised August 2013
WELL CONSTRUCTION RECORDThis form can be used for single or multiple wells1. Well Contractor Information:Wesley J. SorrellsWell Contractor Name3577NC Well Contractor Certification NumberTerraquest Environmental Consultants, P.C.Company Name2. Well Construction Permit #:Usl all applicable well permits (i.e. County, State, Variance^ Injection, etc.)3. Well Use (check well use):Water Supply Well:DAgricultural DMunicipal/PublicdGeothermal (Heating/Cooling Supply) DResidential Water Supply (single)alndustrial/Commereial DResidential Water Supply (shared)a IrrigationNon-Water Supply Well:BMonitoring QRecoveiyInjection Well:DAquifer Recharge DGroundwater RemediationDAquifer Storage and Recovery DSalinity BarrierdAquifer Test DStormwater DrainageDExperimental Technology DSubsidence ControlDGeothermal (Closed Loop) DTracerDGeothermal (Heating/Cooling Return) DOther (explain under #21 Remarks)4. Da.e WeII(s) Con.pleted. 11/26/18 ^,, ^ MW5,MW6,MW75a. Well Location:Perth Mini Mart 00-0-24524Facility/Owner Name Facility IDS (if applicable)818 Perth Rd.Physical Address, City, and ZipIredell 4730-50-7091County Parcel Identification No. (PIN);or Internal Use ONLY:14. WATER ZONESFROMft.ft.TOft.ft.DESCRIPTION15. OUTER CASING (for multi-cased wells) OR LINER (if applicable)FROMft.FROMft.ft.TOft.K. INNER CASING OR TUBING (geISJNG OR TTOft.ft.DIAMETERin,THICKNESSJBING (geothermal closed-Iooii)DIAMETERin.in.THICKNESSMATERIALMATERIAL17. SCREENFROM30 ft-ft.0) ft-ft.DIAMETERin.in.SLOT SIZE.010THICKNESSSch. 40MATERIALPVC18. GROBTFROM3 ft-26 ft-ft.TO76 ft-28 ft-ft.MATERIALPortlandBentoniteEMPLACEMENT METHOD & AMOUNTPourPour19. SAND/GRAVEL PACK (if applicable)FROM28 ft-ft.TO,0 ft-ft.MATERIALNo. 2 SandiMPLACEMENT METHODPour20. DRILLING LOG (attach additional sheets if necessary)FROM3 ft-3.5 ft-ft.ft.ft.ft.ft.TO.5 ft-iO ft-ft.ft.ft.ft.ft.DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)AsphaltSilt21. REMARKS5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:(if well field, one lat/long is sufficient)35.648900-80.895787_wD^itaS/ itgred by V/i lisy SorrEa:6TMiW^cn.Sl056.S3^iaxOT\c»USDate6. Is (are) the well(s): EPermanent or DTemporary7. Is this a repair to an existing well: DYes or 171NoIf this is a repair, fill out known well construction information and explain the nature of therepair under #21 remarks section or on the back of this form.38. Number of wells constructed:For multiple injection or non-water supply wells ONLY with the same construe fioit, you cansubmit one form.22. Certification:•/1Signature of Certified Well ContractorBy sigmng this form, I hereby certify that the well(s) was (were) constructed in accordancewith ISA NCAC 02C .0100 or ISA NCAC 02C .0200 Well Construction Standards and that acopy of this record has been provided to {he well owner.23. Site diagram or additional well details:You may use the back of this page to provide additional well site details or wellconstruction details. You may also attach additional pages if necessary.SUBMITTAL DMSTUCTIONS509. Total well depth below land surface:For multiple wells list all depths if different (example- 3@200' and 2@l00')„. 32.95,34.23,35.00-(ft-)10. Static water level below top of casing:If water level is above casing, use "+11. Borehole diameter: "".(ft.).(in.)12. Well construction method: HollOW Stem Auger(i.e. auger, rotary, cable, direct push, etc.)FOR WATER SUPPLY WELLS ONLY:13a. Yield (gpm) _ Method of test:13b. Disinfection type: _ Amount:24a. For All Wells: Submit this form within 30 days of completion of wellconstruction to the following:Division of Water Resources, Information Processing Unit,1617 Mail Service Center, Raleigh, NC 27699-161724b. For Injection Wells ONLY; In addition to sending the form to the address in24a above, also submit a copy of this form within 30 days of completion of wellconstruction to the following:Division of Water Resources, Underground Injection Control Program,1636 Mail Service Center, Raleigh, NC 27699-163624c. For Water Supply & Injection Wells:Also submit one copy of this form within 30 days of completion ofwell construction to the county health department of the county whereconstructed.Form GW-1North Carolina Department of Environment and Natural Resources - Division of Water ResourcesRevised August 2013
WELL CONSTRUCTION RECORDThis form can be used for single or multiple wel!s1. Well Contractor Information:Wesley J. SorrellsWell Contractor Name3577NC Well Conb'actor Certification NumberTerraquest Environmental Consultants, P.C.Company Name2. Well Construction Permit #:List all applicable well permits (i.e. Conntyi, State, Variance, Injection, etc.)3. Well Use (check well use):Water Supply Well:DAgricultural DMunicipal/PublicDGeothermal (Heating/Cooling Supply) DResidential Water Supply (single)DIndustrial/Commercial DResidential Water Supply (shared)DIn'igationNon-Water Supply Well:BMonitoring DRecoveryInjection Well:DAquifer Recharge dGroundwater RemediationDAquifer Storage and Recovery dSalinity BarrierOAquifer Test DStormwater DrainageDExperimental Technology DSubsidence ControlDGeothermal (Closed Loop) DTracerDGeothermal (Heating/Cooling RetuiTi) DOther (explain under #21 Remarks)4. Date Well(s) Completed: ' '"-" lu Well ID#_5a. Well Location;Perth Mini Mart 00-0-24524Facility/Owner Name Facility ID# (if applicable)818 Perth Rd.Physical Address, City, and Zipiredell 4730-50-7091County Parcel Identification No. (PIN);or Internal Use ONLY:14. WATER ZONESFROMft.ft.TOft.ft.DESCRIPTION15. OUTER CASING (for multi-cased wells) OR LINER (ifapplicalile)FROMft.TOft.DIAMETERin.THICKNESSMATERIAL16. INNER CASING OR TUBING (geotliermal dosed-loop)FROMft.ft.TOft.ft.DIAMETERin.in.THICKNESSMATERIAL17. SCREENFROM30 ft-ft.0) ft-ft.DIAMETERin.in.SLOT SIZE.010THICKNESSSch. 40MATERIALPVC18. GROUTFROM3 ft-26 ft-ft.TO26 ft-28 ft-ft.MATERIALPortlandBentoniteEMPLACEMENT METHOD & AMOUNTPourPour19. SAND/GRAVEL PACK (if applicable)FROM?8 ^ft.TO,0 ft-ft.MATERIALNo.2 SandiMFLACEMENT METHODPour20. DRILLING LOG (attach additional sheets if necessary)FROM3 ft-D.5 ft-ft.ft.ft.ft.ft.TO.5 ^iO ft-ft.ft.ft.ft.ft.DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)AsphaltSilt21. REMARKS5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:(if well field, one lat/long is sufficient)22. Certification:35.648900-80.895787_wDigits'!-/ ttgn^d ly
/ Wsri?/ SorreiKtmi»=w^fSTea-aS^§yna!iicsn, c=USSignature of Certified Well Conb-actorDate6. Is (are) the well(s): BPermanent or DTemporary7. Is this a repair to an existing well: DYes or ElNoIf this is a repair, fifl out hwwn well constmcfion information and explain the nature of therepair wider ii2! remark's section or on the back of this form.8. Number of wells constructed:For multiple injection or non-water supply wells ONLY with the same construction, you cansubmit one form.By signing this form, I hereby certify that {he well(s) was (were) constructed m accordancewill] 15A NCAC 02C .0100 or ISA NCAC 02C .0200 Well Construction Standards and thai acopy of this record has been provided to the well owner.23. Site diagram or additional well details;You may use the back of this page to provide additional well site details or wellconstruction details. You may also attach additional pages if necessary.SUBMITTAL INSTUCTIONS509. Total well depth below land surface:For multiple wells list all depths if different (example- 3@200' and 3@]00'')10. Static water level below top of casing: """If water hvel is above casing, use "+.(ft.) 24a. For All Wells: Submit this form within 30 days of completion of wellconstruction to the following:.(ft.)11. Borehole diameter: _8-25.(in.)12. Well construction method:(i.e. auger, rotary, cable, direct push, etc.). Hollow Stem AugerFOR WATER SUPPLY WELLS ONLY:13a. Yield (gpm) _ Method of test:13b. Disiufection type: _ Amount:Division of Water Resources, Information Processing Unit,1617 Mail Service Center, Raleigh, NC 27699-161724b. For Injection Wells ONLY: In addition to sending the form to the address in24a above, also submit a copy of this form within 30 days of completion of wellconstruction to the following:Division of Water Resources, Underground Injection Control Program,1636 Mail Service Center, Raleigh, NC 27699-163624e. For Water Supply & Injection Wells:Also submit one copy of this form within 30 days of completion ofwell construction to the county health department of the county whereconstructed.FonnGW-1North Carolina Department of Environment and Natural Resources - Division of Water ResourcesRevised August 2013
WELL CONSTRUCTION RECORDThis form can be used for single or multiple wells1. Well Contractor Information:Wesley J. SorrellsWell Contractor Name3577NC Well Contractor Certification NumberTerraquest Environmental Consultants, P.C.Company Name2. Well Construction Permit ff:List all applicable well permits (i.e. County, State, Variance, Injection, etc.)3. Well Use (check well use):Water Supply Well:DAgricultural DMunicipal/PublicDGeothermal (Heating/Cooling Supply) DResidential Water Supply (single)dIndustrial/Commercial DResidential Water Supply (shared)a IrrigationNon-Water Supply Well:BMonitoring DRecoveryTlnjection Well:DAquifer Recharge DGroundvvater RemediationdAquifer Storage and Recovery DSalinity BarrierDAquifer Test DStormwater DrainageDExperimental Technology DSubsidence ControlDGeothermal (Closed Loop) DTracerDGeothermal (Heating/Cooling Return) aOther (explain under #21 Remarks)4. Date Well(s) Completed: ' '"-" '" Well ID#_5a. Well Location:Perth Mini Mart 00-0-24524Facillty/Owner Name Facility ID# (if applicable)818 Perth Rd.Physical Address, City, and ZipIredell 4730-50-7091County Parcel Identification No. (PIN):or Internal Use ONLY:14. WATER ZONESFROMft.ft.TOft.ft.DESCRIPTIONIS. OUTER CASING (for multi-cased wells) OR LINER (if applicable)FROMft.TOft.DIAMETERin.THICKNESSMATERIAL16. INNER CASING OR TUBING (geothennal closed-laop)FROMft.ft.TOft.ft.DIAMETERin.in.THICKNESSMATERIAL17. SCREENFROM?o ft-ft.0) ft-ft.DIAMETERin.in.SLOT SIZE.010THICKNESSSch. 40MATERIALPVC1S.GROUTFROM) ft-16 ft-ft.TO16 ft-18 ft-ft.MATERIALPortlandBentoniteEMPLACEMENT METHOD & AMOUNTPourPour19. SAND/GRAVEL PACK (if applicable)FROM18 ft-ft.TO[0 {t-ft.MATERIALNo. 2 Sand3MPLACEMENT METHODPour20. DRILLING LOG (attach additional sheets if necessary)FROM) ft-).5 ft-ft.ft.ft.ft.ft.TOi.5 ^w {t-ft.ft.ft.ft.ft.DESCRIPTION (color, hardness, soil/rock type, arain size, etc.)GravelSilt21. REMARKS5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:(if well field, one lat/long is sufficient)22. Certification:35.648900-80.895787_w^Di^tiff/ slgnsd
by Wsit-y SotreSsDf£ CBSW&I"/ Sotreasi. o, cu,Emi3s-(i^u3rriai0563gmia£UT\ c:Signature of Certified Well ContractorDate6. Is (are) the well(s): caPermanent or DTemporary7.Is this a repair to an existing well: DYes or IZlNoIf this is a repair, fill out known well construction mfop'mation and explam the nature of therepair wider #27 remarks section or on the back of this form.8. Number of wells constructed:For multiple injection or non-waler supply wells ONL Y with the same construction, you cansubmit one form.9. Total well depth below laud surface: '" _(ft.)For multiple veils list all depths if different (example- 3@200' and2@ll)l)')25.64By signing fhfs form, 1 hereby certify that the wefl{s) was (were) constructed in accordanceU77/1 ISA NCAC 02C .0100 or ISA NCAC 02C .0200 Well Conslruclion Slandards and thai acopy offhis record has been provided to the well owner.23. Site diagram or additional well details:You may use the back of this page to provide additional well site details or wellconstruction details. You may also attach additional pages if necessary.SUBMITTAL INSTUCTIONS10. Static water level below top of casing:If water level is above casing, use +11. Borehole diameter: "•'.(ft.).(in.)12. Well construction method: HollOW Stem Auger(i.e. auger, rotaiy, cable, direct push, etc.)FOR WATER SUPPLY WELLS ONLY:13a. Yield (gpm) _ Method of test:13b. Disinfection type: _ Amount:24a. For All Wells; Submit this form within 30 days of completion of wellconstruction to the following:Division of Water Resources, Information Processing Unit,1617 Mail Service Center, Raleigh, NC 27699-161724b. For Injection Wells ONLY: In addition to sending the form to the address in24a above, also submit a copy of this form within 30 days of completion of wellconstruction to the following:Division of Water Resources, Underground Injection Control Program,1636 Mail Service Center, Raleigh, NC 27699-163624c. For Water Supply & Injection Wells:Also submit one copy of this form within 30 days of completion ofwell construction to the county health department of the county whereconstructed.Form GW-1North Carolina Department of Environment and Natural Resources ~ Division of Water ResourcesRevised August 2013
WELL CONSTRUCTION RECORDThis form can be used for single or multiple wells1. Well Contractor Information:WesleyJ. SorrellsWell Contractor Name3577NC Well Contractor Certification NumberTerraquest Environmental Consultants, P.C.Company Name2. Well Construction Permit #:Lisf all applicable well permits fi.e. County, State,3. Well Use (check well use):Water Supply Well:CIAgriculturalDGeothermal (Heating/Cooling Supply)aindustrial/Commercialdln'igationNon-Water Supply Well:EIMonitoringInjection Well:DAquifer RechargeDAquifer Storage and RecoveryDAquifer TestDExperimental TechnologyOGeothermal (Closed Loop)DGeothermal (Heating/Cooling Return)4. Date Well(s) Completed:5a. Well Location:Perth Mini MartFacility/Owner Name818 Perth Rd.Physical Address, City, and ZipIredellCountyVariance, Injection, etc.)D Munic ipal/Publ icDResidential Water Supply (single)DResidential Water Supply (shared)DRecoveryCIGroundwater RemediationDSalinity BarrierDStormwater DrainageDSubsidence ControlDTracerDOther (explain under #21 Remarks)We,,m#MW1000-0-24524Facility 1D# (if applicable)4730-50-7091Parcel Identification No. (PIN);or Internal Use ONLY:14. WATER ZONESFROMFROMftftTEftTOft.ft.DESCRIPTION15. OUTER CASING (foASING (for multi-cased wells) OR LINER (ifappUcable)TOft.DIAMETERID.'HICKNESSMATERIAL16. INNER CASING OR TUBING (geothermal doscd-loop)FROMftftTO17. SCREENFROM?o ft-Ft.ft.Ft.18. GROUTFROM)16ftftft.0) ft-ft.TO1618ft.ft.ft.ft.ft.DIAMETERin.in.•HICKNESSMATERIALDIAMETERin.in.SLOT SIZE.010THICKNESSSch. 40MATERIALPVCMATERIALPortlandBentoniteEMPLACEMENT METHOD & AMOUNTPourPour19. SAND/GRAVEL PACK (if applicable)FROM18FROM)).5ft,ft,20.DMLLINGLOG(i!ajft,ft,ft,ft,ft,ft.ft,ro0ft.ft.}LOG(attairo.5[021. REMARKSft.ft.ft.ft.ft.ft.ft.MATERIALNo.2 SandMPLACEMENT METHODPouri additional slieets if necessary)DESCRIPTION (color, hardness, soil/rock type, erain sia;, etc.)GravelSilt5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:(if well field, one lat/loug is sufficient)35.648900-80.895787_wDigteByrig.nEdbyWeslF/Son'aSsWt cr^weri"/ Sotrsfli. o. ou.smaftswtsctTeaiQSeayna'Lccm. c;te£:20ia.12D5 HW3S-05WDate6. Is (are) the well(s): E3Permanent or DTemporary7.Is this a repair to an existing well: ClYes or ENoIf this is a repair, fill out hwwn well construction informafson and explain the nature of therepair under #2/ remarks section or on the hack of this form.8. Number of wells constructed:For multiple injection or non-water supply wells ONLY with the same co/istrncfion, you cansubmit one form.22. Certification:Signature of Certified Well ContractorBy signing f his form, I hereby certify that the welf(s) was (were) constructed in accordancewith 15A NCAC 02C .0100 or ISA NCAC 03C .9300 Well Conslruclion Standards and that acopy of this record has been provided to the well ownef:23. Site diagram or additional well details:You may use the back of this page to provide additional well site details or wellconstruction details. You may also attach additional pages if necessary.SUBMITTAL INSTUCTIONS409. Total well depth below laud surface:For multiple wells fis! all depths if different (example- 3@200' and 2@100')10. Static water level below top of casing: '-""If water level is above casing, use "+ ".... 8.25.(ft.) 24a. For All Wells: Submit this form within 30 days of completion of wellconstruction to the following:.(ft.).("1.)11. Borehole diameter:12. Well construction method: HollOW Stem Auger(i.e. auger, rotaiy, cable, direct push, etc.)FOR WATER SUPPLY WELLS ONLY:13a. Yield (gpm) _ Method of test:13b. Disinfection type: _ Amount:Division of Water Resources, Information Processing Unit,1617 Mail Service Center, Raleigh, NC 27699-161724b. For Injection Wells ONLY: In addition to sending the form to the address in24a above, also submit a copy of this form within 30 days of completion of wellconstruction to the following:Division of Water Resources, Underground Injection Control Program,1636 Mail Service Center, Raleigh, NC 27699-163624c. For Water Supply & Injection Wells:Also submit one copy of this form within 30 days of completion ofwell construction to the county health department of the county whereconstructed.Form GW-1North Carolina Department of Environment and Natural Resources - Division of Water ResourcesRevised August 2013
WELL CONSTRUCTION RECORDThis form can be used for single or multiple wells1. Well Contractor Information:Bryan L VestWell Contractor Name3580-ANC Well Contractor Certification NumberRansier Environmental Drilling Inc (REDI)Company Name2. Well Construction Permit #:List all applicable well permits (i.e. County, State, Variance, Injection, etc.)3. Well Use (check well use):Water Supply Well:CIAgricultural DMunicipal/PublicCIGeothermal (Heating/Cooling Supply) DResidential Water Supply (single)aindustrial/Commercial DResidential Water Supply (shared)DIrrigationNon-Water Supply Well:EIMonitoring DRecoveryInjection Well:DAquifer Recharge DGroundwater RemediationDAquifer Storage and Recovery DSalinity BarrierDAquifer Test DStormwater DrainageDExperimental Technology DSubsidence ControlDGeothermal (Closed Loop) DTracerCIGeothermal (Heating/Cooling Return) DOther (explain under #21 Remarks)4. Date Well(s) Completed: 11/28/2018^,, ^ MW-115a. Well Location;Perth Mini Mart 06-6-00000^l{^'2.1^Facility/Owner Name Facility ID# (if applicable)818 Perth Rd, Troutman, NC 28166Physical Address, City, and ZipIredellCounty Parcel Identification No. (PIN);or Internal Use ONLY:14. WATER ZONESFROMft.ft.TOft.ft.DESCRIPTION15. OUTER CASING (for multi-cased wells) OR LINER (ifappliuible)FROM3 ft-TO55 ft-DIAMETER5 in-THICKNESSSCH40MATERIALPVC16. INNER CASING OR TUBING (geothermal closed-Ioop)FROM3 ft-ft.TO65 ft-ft.DIAMETERin.in.THICKNESSSCH40MATERIALPVC17. SCREENFROM35 ft-ft.TO70 ft-ft.DIAMETER2 in-in.SLOT SIZE0.010THICKNESSSCH40MATERIALPVC18. GROUTFROM).5 ft-31 ft-ft.TO61 ft-63 ft-ft.MATERIALCementBentoniteEMPLACEMENT METHOD & AMOUNTPourPour19. SAND/GRAVEL PACK (if applicable)FROM33 ft-ft.TO70 ft-ft.MATERIAL#3 GraveliMPLACEMENT METHODPour20. DRILLING LOG (attach additional sheets if necessary)FROM) ft-3.5 ft-13 ft-18 ft-33 ft-ft.ft.TO0.5 ft-13 ft-18 ft-63 ft-70 ft-ft.ft.DESCRIPTION (colors hardness, soil/rock typCi grain size, etc.)Asphalt/GravelRed/Brown Clayey SiltTan Sandy SiltBrown SiltTan/Brown Saprolite(Weathered Rock)21. REMARKSFinished with Flush Mount Cover5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:(if well field, one laflong is sufficient)22. Certification:35°41'3.4380°53'45.32"-w0^/0^' /-^ l^<L<£t~6. Is (are) the well(s): [aPermanent or DTemporary7. Is this a repair to an existing well: DYes or ENoIf this is a repair, fill out known well construction information and explain the nature of therepair wider ^21 remarks section or on the back of this form.8. Number of wells constructed:For multiple mjection or non-water supply wells ONLY with the swne coHStriiction, you cansubmit one form.12/5/2018Signal of Certified Well ContractorDateBy signing this form, I hereby certify that fhe well(s) was {were} constructed m accordancev'ilh ISA NCAC 02C .0100 or ISA NCAC 02C .0200 Well Consnvclion Standards and thai acopy of this record has been provided to fhe well owner.23. Site diagram or additional well details:You may use the back of this page to provide additional well site details or wellconstmction details. You may also attach additional pages if necessary.SUBMITTAL INSTUCTIONS709. Total well depth below land surface;For multiple wells lisl all depths if different (example- 3@200' and 2@100')10. Static water level below top of casing:If water level is above casing, use "+ "-(ft.).(ft.)11. Borehole diameter: 8 OUter/SJnner (,„.12. Well construction method:(i.e. auger, rotaiy, cable, direct push, etc.)'.). Auger/Mud RotaryFOR WATER SUPPLY WELLS ONLY:13a. Yield (gpm) _ Metliod of test:13b. Disiilfection type: _ Amount;24a. For All Wells: Submit this form within 30 days of completion of wellconstruction to the following:Division of Water Resources, Information Processing Unit,1617 Mail Service Center, Raleigh, NC 27699-161724b. For Injection Wells ONLY: In addition to sending the form to the address in24a above, also submit a copy of this form \vithin 30 days of completion of wellconstruction to the following:Division of Water Resources, Underground Injection Control Program,1636 Mail Service Center, Raleigh, NC 27699-163624c. For Water Supply & Injection Wells:Also submit one copy of this form within 30 days of completion ofwell construction to the county health department of the county whereconstructed.Foml GW-1North Carolina Department of Environment and Natural Resources ~- Division of Water ResourcesRevised August 2013
WELL CONSTRUCTION RECORD fGW-1)1. Well Contractor Information:Jonathan R. GrubbsWell Contractor Name3001For Internal Use Only:NC Well Contractor Certification NumberTerraquest Environmental Consultants, P.C.Company Name2. Well Construction Permit #:List all applicable well comtmction permits (i.e. UIC, Cowity, State, Variance, etc.)3. Well Use (check well use):Water Supply Well:(Agricultural OMumcipa?ublicGeothennal (Heating/Cooling Supply) QResidential Water Supply (single)IIndustrial/Commercial [^Residential Water Supply (shared)I Irrigation14. WATER ZONESFROMft.ft.TOft.ft.DESCRIPTION15. OUTER CASING (for multi-cased wells) OR LINER (if applicable)FROMft.TOft.DIAMETERTHICKNESSMATERIAL16. INNER CASING OR TUBING (geothermal dosed-Ioop)FROMft.ft.TOft.ft.DIAMETERTHICKNESS17. SCREENFROM25ft.ft.40ft.ft.DIAMETER I SLOT SIZE.010THICKNESSsch40MATERIALPVC18. GROTJTFROMTOEMPLACEMENT METHOD & AMOUNTNon-Water Supply Well:|X( Monitoringft.21 ft-n RecoveryPortlandpourInjection Well:lAquifer RechargelAquifer Storage and RecoverylAquifer TestlExperimental TechnologyIGeothermal (Closed Loop)21ft.23ft.BentonitepourQOroundvvater RemediationQSalinity BarrierQStormwater DrainageQSubsidence ControlF'tTracerft.ft.19. SAND/GRAVEL PACK (if applicable)FROM23ft.ft.TO40ft.ft.MATERIALNo. 2 sandEMPLACEMENT METHODpour20. DRILLING LOG (attach additional sheets if necessary)IGeothermal (Heating/Cooling Return) QOther (explain under #21 Remarks)FROM I TO4. Date Well(s) Completed:5a. Well Location:Perth Mini MartFacility/Owner Name4/30/19Well ID#MW12.MW130 ft-ft.ft.0-00-0000024524Facility ID# (if applicable)ft.ft.818 Perth Rd, Troutman, NC 28166ft.Physical Address, City, and ZipIredellCountyft.4730-50-7091Parcel Identification No. (PIN)40 «•DESCRIPTION (color, hardness, soil/rock type, grain sue, etc.)SILT21. REMARKSSb. Latitude and longitude in degrees/minutes/seconds or decimal degrees:(if well field, one lat/long is sufficient)35.684229-80.896042w6. Is(are) the w'ell(s){7j]Permanent or QTemporary7. Is this a repair to an existing well: QYes or R?INOIf this is a repair, fill out known well construction mfonnation and explain the nature of therepair under #21 remark section or on the back of this form.8. For Geoprobe/DPT or Closed-Loop Geothermal Wells having the sameconstruction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wellsdrilled:_409. Total well depth below land surface:For multiple wells list all depths if different (example- 3@200' anti 2@!00<)25.37.22.9510. Static water level below top of casing: —"'" ' 'If water level is above casing, use ttjr "-(ft.).(ft.)11. Borehole diameter:. 8.25. (in.)12. Well construction method:(Le. auger, rotary, cable, direct push, etc.)Hollow stem augerFOR WATER SUPPLY WELLS ONLY:13a. Yield (gpm)_ Method of test:13b. Disinfection type: _ Amount:22. Certification:Digitally signed by Jonathan GrubbsDN: cn=Jonathan Grubbs, o=TerraquestEnvironmental Consultants, P.C., ou,—-efnail'"jrgrubbs@^rr8que9tpc:corrt; c-U-SDate: 2019.05.2^C40:21 -04'00'By signing this form, I hereby certify that the well(s) was (were) constructed in accordancewith ISA NCAC 02C .0100 or ISA NCAC 02C .0200 Veil Construction Standards and that acopy of this record has been provided to the well owner.23. Site diagram or additional well details:You may use the back of this page to provide additional well site details or wellconstmction details. You may also attach additional pages if necessary.SUBMITTAL INSTRUCTIONS24a. For All Wells: Submit this form within 30 days of completion of wellconstruction to the following:Division of Water Resources, Information Processing Unit,1617 Mail Service Center, Raleigh, NC 27699-161724b. For Injection Wells: In addition to sending the form to the address in 24aabove, also submit one copy of this form within 30 days of completion of wellconstmction to the following:Division ofWater Resources, Underground Injection Control Program,1636 Mail Service Center, Raleigh, NC 27699-163624c. For Water Supply & Injection Wells: In addition to sending the fomi tothe address(es) above, also submit one copy of this form within 30 days ofcompletion of well construction to the county health department of the countywhere constructed.FormGW-1North Carolina Department of Environmental Quality - Division of Water ResourcesRevised 2-22-2016
WELL CONSTRUCTION RECORD (GW-1)I. Well Contractor Information;Jonathan R. GrubbsWell Contractor Name3001For Internal Use Only:NC Well Contractor Certification NumberTerraquest Environmental Consultants, P.C.WM0301001Company Name2. Well Construction Permit #:List all applicable well constniction permits (f.e. UIC, County, State, Variance, etc.)3. Well Use (check well use):Water Supply Well:QAgricultural Q Municipal/PublicQOeothennal (Heating/Cooling Supply) QResidential Water Supply (single)Qlndustrial/Commercial QResidential Water Supply (shared)l} Irrigation14. WATER ZONESFROMft.ft.TOft.ft.DESCRIPTION15. OUTER CASING (for multi-cased wells) OR UNER (if applicable)ft.ft.THICKNESS16. INNER CASmG OR TUBING (geothermal dosed-loop)ft.ft.ft.ft.in.THICKNESSMATERIAL17. SCREENFROM25ft.ft.40ft.ft.DIAMETER I SLOT SIZE I THICKNESS I MATERIAL.010sch40PVC18. GROUTFROMEMPLACEMENT METHOD & AMOUNTNon-Wafer Supply Well:J?| Monitoring0ft.n Recovery21 ft-PortlandpourInjection Well:QAquifer RechargelAquifer Storage and RecoverylAquifer TestI Experimental TechnologyIGeothermal (Closed Loop)21 ft-23ft.BentonitepourQGroundwater RemediationQlSalinity BarrierQStormwater DrainageQSubsidence ControlITracerft.ft.19. SAND/GRAVEL PACK (if applicable)PROM I TO23 «•ft.40ft.ft.MATERIALNo. 2 sandEMPLACEMENT METHODpourM. DRILLING LOG (attach additional sheets if necessary)iGeothermal (Heating/Cooling Return) QOther (explain under #21 Remarks)FROM I TO4/30/19Well ID#MW140ft.0-00-00000245244. Date Well(s) Completed:5a. Well Location:Perth Mini MartFaciIity/Owner Name Facility IDS (if applicable)569 Autumn Leaf Rd, Troutman, NC 28166Physical Address, City, and ZipIredellft.ft.ft.ft.ft.ft.County4730792085.000Parcel Identification No. (PW)40 ft-DESCRIPTION (color, hnrdncss, soil/rock type, erain size, etc.)SILT21. REMARKS5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:(if well field, one lat/Iong is sufficient)35.684111-80.895728_w6. Is(are) the well(s)^]]Permanent or QTemporary7. Is this a repair to an existing well: QYes or p}NoIf this is a repair, fill out hwvn well construction mformation and explain the nature of therepair under lf21 remarks section or on the back of this form.8. For Geoprobe/DPT or Closed-Loop Geothermal Wells having the sameconstruction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wellsdrilled:_.409. Total well depth below land surface;For multiple wells list all depths if different (example- 3@200' and 2@100')10. Static water level below top of casing: ~ " 'If water level is above casing, use "+ "_(ft.).(ft.)11. Borehole diameter:.8.25. (in.)12. Well construction method:(i.e. auger, rotary, cable, direct push, etc.)Hollow stem augerFOR WATER SUPPLY WELLS ONLY:13a. Yield (gpm) _ Method of test:13b. Disinfection type: _ Amount:22. Certification: _. ... .Digitally signed by Jonathan GrubbsDN: cn^Jonathan Grubbs, o=TerraquestEnvironmental Consultants, P.C., ou,—[e-mail], c-USDate: 2019.05.2?flS°36:45-04'00'By sigfwig this fonn, I hereby certify that the well(s) was (were) constructed m accordancewith ISA NCAC 02C .0100 or ISA NCAC 02C .0200 Well Construction Standards and that acopy of this record has been provided to the well owner.23. Site diagram or additional well details:You may use the back of this page to provide additional well site details or wellconstruction details. You may also attach additional pages if necessary.SUBMITTAL INSTRUCTIONS24a. For All Wells: Submit this form within 30 days of completion of wellconstruction to the following:Division of Water Resources, Information Processing Unit,1617 Mail Service Center, Raleigh, NC 27699-161724b. For Injection Wells: In addition to sending the form to the address in 24aabove, also submit one copy of this form within 30 days of completion of wellconstruction to the following:Division of Water Resources, Underground Injection Control Program,1636 Mail Service Center, Raleigh, NC 27699-163624c. For Water Supply & Injection Wells: In addition to sending the form tothe address(es) above, also submit one copy of this form within 30 days ofcompletion of well construction to the county health department of the countywhere constructed.Form GW-1North Carolina Department of Environmental Quality " Division of Water ResourcesRevised 2-22-2016
:(//&216758&7,215(&25'
7KLVIRUPFDQEHXVHGIRUVLQJOHRUPXOWLSOHZHOOV
)RUP*:  1RUWK&DUROLQD'HSDUWPHQWRI(QYLURQPHQWDQG1DWXUDO5HVRXUFHV±'LYLVLRQRI:DWHUResources 5HYLVHG$ugust
:HOO&RQWUDFWRU,QIRUPDWLRQ
:HOO&RQWUDFWRU1DPH
1&:HOO&RQWUDFWRU&HUWLILFDWLRQ1XPEHU
&RPSDQ\1DPH
:HOO&RQVWUXFWLRQ3HUPLW
List all applicable well permits (i.e. County, State, Variance, Injection, etc.)
:HOO8VH FKHFNZHOOXVH
:DWHU6XSSO\:HOO
Ƒ$JULFXOWXUDO Ƒ0XQLFLSDO3XEOLF
Ƒ*HRWKHUPDO+HDWLQJ&RROLQJ6XSSO\Ƒ5HVLGHQWLDO:DWHU6XSSO\ VLQJOH
Ƒ,QGXVWULDO&RPPHUFLDO Ƒ5HVLGHQWLDO:DWHU6XSSO\ VKDUHG
Ƒ,UULJDWLRQ
1RQ:DWHU6XSSO\:HOO
Ƒ0RQLWRULQJ Ƒ5HFRYHU\
,QMHFWLRQ :HOO
Ƒ$TXLIHU5HFKDUJH Ƒ*URXQGZDWHU5HPHGLDWLRQ
Ƒ$TXLIHU6WRUDJHDQG5HFRYHU\Ƒ6DOLQLW\%DUULHU
Ƒ$TXLIHU7HVW Ƒ6WRUPZDWHU'UDLQDJH
Ƒ([SHULPHQWDO7HFKQRORJ\Ƒ6XEVLGHQFH&RQWURO
Ƒ*HRWKHUPDO&ORVHG/RRSƑ7UDFHU
Ƒ*HRWKHUPDO+HDWLQJ&RROLQJ5HWXUQƑ2WKHUH[SODLQXQGHU5HPDUNV
'DWH:HOOV&RPSOHWHGBBBBBBBBBBBB:HOO,'BBBBBBBBBBBBBBBBBBBBBB
D:HOO/RFDWLRQ

)DFLOLW\2ZQHU 1DPH )DFLOLW\,'LIDSSOLFDEOH

3K\VLFDO$GGUHVV&LW\DQG=LS

&RXQW\ 3DUFHO,GHQWLILFDWLRQ1R3,1
E/DWLWXGHDQG/RQJLWXGHLQGHJUHHVPLQXWHVVHFRQGVRUGHFLPDOGHJUHHV
LIZHOOILHOGRQHODWORQJLVVXIILFLHQW
1 :
,V DUHWKHZHOOVƑ3HUPDQHQWRUƑ7HPSRUDU\
,VWKLVDUHSDLUWRDQH[LVWLQJZHOOƑ<HVRUƑ1R
If this is a repair, fill out known well construction information and explain the nature of the repair under #21 remarks section or on the back of this form.
 1XPEHURIZHOOVFRQVWUXFWHG 
For multiple injection or non-water supply wells ONLY with the same construction, you can
submit one form.
7RWDOZHOOGHSWK EHORZODQG VXUIDFH  IW
For multiple wells list all depths if different (example- 3@200’ and 2@100ƍ
6WDWLFZDWHUOHYHOEHORZWRSRIFDVLQJ IWIf water level is above casing, use “+”
%RUHKROHGLDPHWHU LQ
:HOOFRQVWUXFWLRQPHWKRG  
LHDXJHUURWDU\FDEOHGLUHFWSXVKHWF
)25:$7(56833/<:(//621/<
D<LHOGJSP0HWKRGRIWHVW
E'LVLQIHFWLRQW\SH$PRXQW
:$7(5=21(6
)520 72 '(6&5,37,21
IWIW
IWIW
287(5&$6,1* IRUPXOWLFDVHGZHOOV25/,1(5LIDSSOLFDEOH
)520 72 ',$0(7(5 7+,&.1(66 0$7(5,$/
IWIWLQ
,11(5&$6,1* 2578%,1* JHRWKHUPDOFORVHGORRS
)520 72 ',$0(7(5 7+,&.1(66 0$7(5,$/
IWIWLQ
IWIWLQ
6&5((1
)520 72 ',$0(7(5 6/27 6,=( 7+,&.1(66 0$7(5,$/
IWIWLQ
IWIWLQ
*5287
)520 72 0$7(5,$/ (03/$&(0(170(7+2' $02817
IWIW
IWIW
IWIW
6$1'*5$9(/3$&.LIDSSOLFDEOH
)520 72 0$7(5,$/ (03/$&(0(170(7+2'
IWIW
IWIW
'5,//,1*/2* DWWDFKDGGLWLRQDOVKHHWVLIQHFHVVDU\
)520 72 '(6&5,37,21 FRORUKDUGQHVVVRLOURFNW\SHJUDLQVL]HHWF
IWIW
IWIW
IWIW
IWIW
IWIW
IWIW
IWIW
5(0$5.6
&HUWLILFDWLRQ
6LJQDWXUHRI&HUWLILHG:HOO&RQWUDFWRU 'DWH
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
6LWHGLDJUDPRUDGGLWLRQDOZHOOGHWDLOV
<RXPD\XVHWKHEDFNRI WKLVSDJHWRSURYLGHDGGLWLRQDOZHOOVLWHGHWDLOVRUZHOOFRQVWUXFWLRQGHWDLOV<RXPD\DOVRDWWDFKDGGLWLRQDO SDJHVLIQHFHVVDU\
68%0,77$/,1678&7,216
D )RU $OO :HOOV 6XEPLWWKLVIRUPZLWKLQGD\VRIFRPSOHWLRQRIZHOO
FRQVWUXFWLRQ WRWKHIROORZLQJ
'LYLVLRQRI:DWHU5HVRXUFHV,QIRUPDWLRQ3URFHVVLQJ 8QLW
0DLO6HUYLFH&HQWHU5DOHLJK1&
E)RU,QMHFWLRQ:HOOV21/<,QDGGLWLRQWRVHQGLQJWKHIRUPWRWKHDGGUHVVLQ
DDERYHDOVRVXEPLWDFRS\RI WKLVIRUP ZLWKLQGD\VRIFRPSOHWLRQRI ZHOO
FRQVWUXFWLRQWRWKHIROORZLQJ
'LYLVLRQRI:DWHU5HVRXUFHV8QGHUJURXQG,QMHFWLRQ&RQWURO3URJUDP
 0DLO6HUYLFH&HQWHU5DOHLJK1&
F)RU:DWHU6XSSO\ ,QMHFWLRQ :HOOV
$OVR VXEPLW RQH FRS\ RI WKLV IRUP ZLWKLQGD\V RIFRPSOHWLRQRI
ZHOOFRQVWUXFWLRQWRWKHFRXQW\KHDOWKGHSDUWPHQWRIWKHFRXQW\ZKHUH
FRQVWUXFWHG
)RU,QWHUQDO8VH21/<
_______________
Jonathan R. Grubbs
3001
Terraquest Environmental Consultants, P.C.
✔
9/22/2020 MW15,MW16
Perth Mini Mart 00-0-24524
818 Perth Rd.
Iredell 4730-50-7091
35.648900 -80.895787
✔
✔
2
45
29.07,29.15
8.25
Hollow Stem Auger
25'45 .010 Sch. 40 PVC
0 21 Portland Pour
21 23 Bentonite Pour
23 45 No. 2 Sand Pour
0 0.5 Asphalt
0.5 45 Silt
Digitally signed by Jonathan Grubbs
DN: cn=Jonathan Grubbs, o=Terraquest
Environmental Consultants, P.C., ou,
email=[e-mail], c=US
Date: 2020.09.25 10:12:17 -04'00'
:(//&216758&7,215(&25'
7KLVIRUPFDQEHXVHGIRUVLQJOHRUPXOWLSOHZHOOV
)RUP*:  1RUWK&DUROLQD'HSDUWPHQWRI(QYLURQPHQWDQG1DWXUDO5HVRXUFHV±'LYLVLRQRI:DWHUResources 5HYLVHG$ugust
:HOO&RQWUDFWRU,QIRUPDWLRQ
:HOO&RQWUDFWRU1DPH
1&:HOO&RQWUDFWRU&HUWLILFDWLRQ1XPEHU
&RPSDQ\1DPH
:HOO&RQVWUXFWLRQ3HUPLW
List all applicable well permits (i.e. County, State, Variance, Injection, etc.)
:HOO8VH FKHFNZHOOXVH
:DWHU6XSSO\:HOO
Ƒ$JULFXOWXUDO Ƒ0XQLFLSDO3XEOLF
Ƒ*HRWKHUPDO+HDWLQJ&RROLQJ6XSSO\Ƒ5HVLGHQWLDO:DWHU6XSSO\ VLQJOH
Ƒ,QGXVWULDO&RPPHUFLDO Ƒ5HVLGHQWLDO:DWHU6XSSO\ VKDUHG
Ƒ,UULJDWLRQ
1RQ:DWHU6XSSO\:HOO
Ƒ0RQLWRULQJ Ƒ5HFRYHU\
,QMHFWLRQ :HOO
Ƒ$TXLIHU5HFKDUJH Ƒ*URXQGZDWHU5HPHGLDWLRQ
Ƒ$TXLIHU6WRUDJHDQG5HFRYHU\Ƒ6DOLQLW\%DUULHU
Ƒ$TXLIHU7HVW Ƒ6WRUPZDWHU'UDLQDJH
Ƒ([SHULPHQWDO7HFKQRORJ\Ƒ6XEVLGHQFH&RQWURO
Ƒ*HRWKHUPDO&ORVHG/RRSƑ7UDFHU
Ƒ*HRWKHUPDO+HDWLQJ&RROLQJ5HWXUQƑ2WKHUH[SODLQXQGHU5HPDUNV
'DWH:HOOV&RPSOHWHGBBBBBBBBBBBB:HOO,'BBBBBBBBBBBBBBBBBBBBBB
D:HOO/RFDWLRQ

)DFLOLW\2ZQHU 1DPH )DFLOLW\,'LIDSSOLFDEOH

3K\VLFDO$GGUHVV&LW\DQG=LS

&RXQW\ 3DUFHO,GHQWLILFDWLRQ1R3,1
E/DWLWXGHDQG/RQJLWXGHLQGHJUHHVPLQXWHVVHFRQGVRUGHFLPDOGHJUHHV
LIZHOOILHOGRQHODWORQJLVVXIILFLHQW
1 :
,V DUHWKHZHOOVƑ3HUPDQHQWRUƑ7HPSRUDU\
,VWKLVDUHSDLUWRDQH[LVWLQJZHOOƑ<HVRUƑ1R
If this is a repair, fill out known well construction information and explain the nature of the repair under #21 remarks section or on the back of this form.
 1XPEHURIZHOOVFRQVWUXFWHG 
For multiple injection or non-water supply wells ONLY with the same construction, you can
submit one form.
7RWDOZHOOGHSWK EHORZODQG VXUIDFH  IW
For multiple wells list all depths if different (example- 3@200’ and 2@100ƍ
6WDWLFZDWHUOHYHOEHORZWRSRIFDVLQJ IWIf water level is above casing, use “+”
%RUHKROHGLDPHWHU LQ
:HOOFRQVWUXFWLRQPHWKRG  
LHDXJHUURWDU\FDEOHGLUHFWSXVKHWF
)25:$7(56833/<:(//621/<
D<LHOGJSP0HWKRGRIWHVW
E'LVLQIHFWLRQW\SH$PRXQW
:$7(5=21(6
)520 72 '(6&5,37,21
IWIW
IWIW
287(5&$6,1* IRUPXOWLFDVHGZHOOV25/,1(5LIDSSOLFDEOH
)520 72 ',$0(7(5 7+,&.1(66 0$7(5,$/
IWIWLQ
,11(5&$6,1* 2578%,1* JHRWKHUPDOFORVHGORRS
)520 72 ',$0(7(5 7+,&.1(66 0$7(5,$/
IWIWLQ
IWIWLQ
6&5((1
)520 72 ',$0(7(5 6/27 6,=( 7+,&.1(66 0$7(5,$/
IWIWLQ
IWIWLQ
*5287
)520 72 0$7(5,$/ (03/$&(0(170(7+2' $02817
IWIW
IWIW
IWIW
6$1'*5$9(/3$&.LIDSSOLFDEOH
)520 72 0$7(5,$/ (03/$&(0(170(7+2'
IWIW
IWIW
'5,//,1*/2* DWWDFKDGGLWLRQDOVKHHWVLIQHFHVVDU\
)520 72 '(6&5,37,21 FRORUKDUGQHVVVRLOURFNW\SHJUDLQVL]HHWF
IWIW
IWIW
IWIW
IWIW
IWIW
IWIW
IWIW
5(0$5.6
&HUWLILFDWLRQ
6LJQDWXUHRI&HUWLILHG:HOO&RQWUDFWRU 'DWH
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
6LWHGLDJUDPRUDGGLWLRQDOZHOOGHWDLOV
<RXPD\XVHWKHEDFNRI WKLVSDJHWRSURYLGHDGGLWLRQDOZHOOVLWHGHWDLOVRUZHOOFRQVWUXFWLRQGHWDLOV<RXPD\DOVRDWWDFKDGGLWLRQDO SDJHVLIQHFHVVDU\
68%0,77$/,1678&7,216
D )RU $OO :HOOV 6XEPLWWKLVIRUPZLWKLQGD\VRIFRPSOHWLRQRIZHOO
FRQVWUXFWLRQ WRWKHIROORZLQJ
'LYLVLRQRI:DWHU5HVRXUFHV,QIRUPDWLRQ3URFHVVLQJ 8QLW
0DLO6HUYLFH&HQWHU5DOHLJK1&
E)RU,QMHFWLRQ:HOOV21/<,QDGGLWLRQWRVHQGLQJWKHIRUPWRWKHDGGUHVVLQ
DDERYHDOVRVXEPLWDFRS\RI WKLVIRUP ZLWKLQGD\VRIFRPSOHWLRQRI ZHOO
FRQVWUXFWLRQWRWKHIROORZLQJ
'LYLVLRQRI:DWHU5HVRXUFHV8QGHUJURXQG,QMHFWLRQ&RQWURO3URJUDP
 0DLO6HUYLFH&HQWHU5DOHLJK1&
F)RU:DWHU6XSSO\ ,QMHFWLRQ :HOOV
$OVR VXEPLW RQH FRS\ RI WKLV IRUP ZLWKLQGD\V RIFRPSOHWLRQRI
ZHOOFRQVWUXFWLRQWRWKHFRXQW\KHDOWKGHSDUWPHQWRIWKHFRXQW\ZKHUH
FRQVWUXFWHG
)RU,QWHUQDO8VH21/<
_______________
Jonathan R. Grubbs
3001
Terraquest Environmental Consultants, P.C.
✔
9/22/2020 MW17
Perth Mini Mart 00-0-24524
818 Perth Rd.
Iredell 4730-50-7091
35.648900 -80.895787
✔
✔
1
45
30.05
8.25
Hollow Stem Auger
20'45 .010 Sch. 40 PVC
0 16 Portland Pour
16 18 Bentonite Pour
18 45 No. 2 Sand Pour
0 0.5 Asphalt
0.5 45 Silt
Digitally signed by Jonathan Grubbs
DN: cn=Jonathan Grubbs, o=Terraquest
Environmental Consultants, P.C., ou,
email=[e-mail], c=US
Date: 2020.09.25 10:12:17 -04'00'
:(//&216758&7,215(&25'
7KLVIRUPFDQEHXVHGIRUVLQJOHRUPXOWLSOHZHOOV
)RUP*:  1RUWK&DUROLQD'HSDUWPHQWRI(QYLURQPHQWDQG1DWXUDO5HVRXUFHV±'LYLVLRQRI:DWHUResources 5HYLVHG$ugust
:HOO&RQWUDFWRU,QIRUPDWLRQ
:HOO&RQWUDFWRU1DPH
1&:HOO&RQWUDFWRU&HUWLILFDWLRQ1XPEHU
&RPSDQ\1DPH
:HOO&RQVWUXFWLRQ3HUPLW
List all applicable well permits (i.e. County, State, Variance, Injection, etc.)
:HOO8VH FKHFNZHOOXVH
:DWHU6XSSO\:HOO
Ƒ$JULFXOWXUDO Ƒ0XQLFLSDO3XEOLF
Ƒ*HRWKHUPDO+HDWLQJ&RROLQJ6XSSO\Ƒ5HVLGHQWLDO:DWHU6XSSO\ VLQJOH
Ƒ,QGXVWULDO&RPPHUFLDO Ƒ5HVLGHQWLDO:DWHU6XSSO\ VKDUHG
Ƒ,UULJDWLRQ
1RQ:DWHU6XSSO\:HOO
Ƒ0RQLWRULQJ Ƒ5HFRYHU\
,QMHFWLRQ :HOO
Ƒ$TXLIHU5HFKDUJH Ƒ*URXQGZDWHU5HPHGLDWLRQ
Ƒ$TXLIHU6WRUDJHDQG5HFRYHU\Ƒ6DOLQLW\%DUULHU
Ƒ$TXLIHU7HVW Ƒ6WRUPZDWHU'UDLQDJH
Ƒ([SHULPHQWDO7HFKQRORJ\Ƒ6XEVLGHQFH&RQWURO
Ƒ*HRWKHUPDO&ORVHG/RRSƑ7UDFHU
Ƒ*HRWKHUPDO+HDWLQJ&RROLQJ5HWXUQƑ2WKHUH[SODLQXQGHU5HPDUNV
'DWH:HOOV&RPSOHWHGBBBBBBBBBBBB:HOO,'BBBBBBBBBBBBBBBBBBBBBB
D:HOO/RFDWLRQ

)DFLOLW\2ZQHU 1DPH )DFLOLW\,'LIDSSOLFDEOH

3K\VLFDO$GGUHVV&LW\DQG=LS

&RXQW\ 3DUFHO,GHQWLILFDWLRQ1R3,1
E/DWLWXGHDQG/RQJLWXGHLQGHJUHHVPLQXWHVVHFRQGVRUGHFLPDOGHJUHHV
LIZHOOILHOGRQHODWORQJLVVXIILFLHQW
1 :
,V DUHWKHZHOOVƑ3HUPDQHQWRUƑ7HPSRUDU\
,VWKLVDUHSDLUWRDQH[LVWLQJZHOOƑ<HVRUƑ1R
If this is a repair, fill out known well construction information and explain the nature of the repair under #21 remarks section or on the back of this form.
 1XPEHURIZHOOVFRQVWUXFWHG 
For multiple injection or non-water supply wells ONLY with the same construction, you can
submit one form.
7RWDOZHOOGHSWK EHORZODQG VXUIDFH  IW
For multiple wells list all depths if different (example- 3@200’ and 2@100ƍ
6WDWLFZDWHUOHYHOEHORZWRSRIFDVLQJ IWIf water level is above casing, use “+”
%RUHKROHGLDPHWHU LQ
:HOOFRQVWUXFWLRQPHWKRG  
LHDXJHUURWDU\FDEOHGLUHFWSXVKHWF
)25:$7(56833/<:(//621/<
D<LHOGJSP0HWKRGRIWHVW
E'LVLQIHFWLRQW\SH$PRXQW
:$7(5=21(6
)520 72 '(6&5,37,21
IWIW
IWIW
287(5&$6,1* IRUPXOWLFDVHGZHOOV25/,1(5LIDSSOLFDEOH
)520 72 ',$0(7(5 7+,&.1(66 0$7(5,$/
IWIWLQ
,11(5&$6,1* 2578%,1* JHRWKHUPDOFORVHGORRS
)520 72 ',$0(7(5 7+,&.1(66 0$7(5,$/
IWIWLQ
IWIWLQ
6&5((1
)520 72 ',$0(7(5 6/27 6,=( 7+,&.1(66 0$7(5,$/
IWIWLQ
IWIWLQ
*5287
)520 72 0$7(5,$/ (03/$&(0(170(7+2' $02817
IWIW
IWIW
IWIW
6$1'*5$9(/3$&.LIDSSOLFDEOH
)520 72 0$7(5,$/ (03/$&(0(170(7+2'
IWIW
IWIW
'5,//,1*/2* DWWDFKDGGLWLRQDOVKHHWVLIQHFHVVDU\
)520 72 '(6&5,37,21 FRORUKDUGQHVVVRLOURFNW\SHJUDLQVL]HHWF
IWIW
IWIW
IWIW
IWIW
IWIW
IWIW
IWIW
5(0$5.6
&HUWLILFDWLRQ
6LJQDWXUHRI&HUWLILHG:HOO&RQWUDFWRU 'DWH
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
6LWHGLDJUDPRUDGGLWLRQDOZHOOGHWDLOV
<RXPD\XVHWKHEDFNRI WKLVSDJHWRSURYLGHDGGLWLRQDOZHOOVLWHGHWDLOVRUZHOOFRQVWUXFWLRQGHWDLOV<RXPD\DOVRDWWDFKDGGLWLRQDO SDJHVLIQHFHVVDU\
68%0,77$/,1678&7,216
D )RU $OO :HOOV 6XEPLWWKLVIRUPZLWKLQGD\VRIFRPSOHWLRQRIZHOO
FRQVWUXFWLRQ WRWKHIROORZLQJ
'LYLVLRQRI:DWHU5HVRXUFHV,QIRUPDWLRQ3URFHVVLQJ 8QLW
0DLO6HUYLFH&HQWHU5DOHLJK1&
E)RU,QMHFWLRQ:HOOV21/<,QDGGLWLRQWRVHQGLQJWKHIRUPWRWKHDGGUHVVLQ
DDERYHDOVRVXEPLWDFRS\RI WKLVIRUP ZLWKLQGD\VRIFRPSOHWLRQRI ZHOO
FRQVWUXFWLRQWRWKHIROORZLQJ
'LYLVLRQRI:DWHU5HVRXUFHV8QGHUJURXQG,QMHFWLRQ&RQWURO3URJUDP
 0DLO6HUYLFH&HQWHU5DOHLJK1&
F)RU:DWHU6XSSO\ ,QMHFWLRQ :HOOV
$OVR VXEPLW RQH FRS\ RI WKLV IRUP ZLWKLQGD\V RIFRPSOHWLRQRI
ZHOOFRQVWUXFWLRQWRWKHFRXQW\KHDOWKGHSDUWPHQWRIWKHFRXQW\ZKHUH
FRQVWUXFWHG
)RU,QWHUQDO8VH21/<
_______________
Jonathan R. Grubbs
3001
Terraquest Environmental Consultants, P.C.
✔
11/16/2021 ASP1
Perth Mini Mart 00-0-24524
818 Perth Rd.
Iredell 4730-50-7091
35.648900 -80.895787
✔
✔
1
60
N/A
8.25
Hollow Stem Auger
55'60'.010 Sch. 40 PVC
0 51 Portland Pour
51 53 Bentonite Pour
53 60 No. 2 Sand Pour
0 0.5 Asphalt
0.5 35 Silt
Digitally signed by Jonathan Grubbs
DN: cn=Jonathan Grubbs, o=Terraquest
Environmental Consultants, P.C., ou,
email=[e-mail], c=US
Date: 2021.11.17 16:27:34 -05'00'
:(//&216758&7,215(&25'
7KLVIRUPFDQEHXVHGIRUVLQJOHRUPXOWLSOHZHOOV
)RUP*:  1RUWK&DUROLQD'HSDUWPHQWRI(QYLURQPHQWDQG1DWXUDO5HVRXUFHV±'LYLVLRQRI:DWHUResources 5HYLVHG$ugust
:HOO&RQWUDFWRU,QIRUPDWLRQ
:HOO&RQWUDFWRU1DPH
1&:HOO&RQWUDFWRU&HUWLILFDWLRQ1XPEHU
&RPSDQ\1DPH
:HOO&RQVWUXFWLRQ3HUPLW
List all applicable well permits (i.e. County, State, Variance, Injection, etc.)
:HOO8VH FKHFNZHOOXVH
:DWHU6XSSO\:HOO
Ƒ$JULFXOWXUDO Ƒ0XQLFLSDO3XEOLF
Ƒ*HRWKHUPDO+HDWLQJ&RROLQJ6XSSO\Ƒ5HVLGHQWLDO:DWHU6XSSO\ VLQJOH
Ƒ,QGXVWULDO&RPPHUFLDO Ƒ5HVLGHQWLDO:DWHU6XSSO\ VKDUHG
Ƒ,UULJDWLRQ
1RQ:DWHU6XSSO\:HOO
Ƒ0RQLWRULQJ Ƒ5HFRYHU\
,QMHFWLRQ :HOO
Ƒ$TXLIHU5HFKDUJH Ƒ*URXQGZDWHU5HPHGLDWLRQ
Ƒ$TXLIHU6WRUDJHDQG5HFRYHU\Ƒ6DOLQLW\%DUULHU
Ƒ$TXLIHU7HVW Ƒ6WRUPZDWHU'UDLQDJH
Ƒ([SHULPHQWDO7HFKQRORJ\Ƒ6XEVLGHQFH&RQWURO
Ƒ*HRWKHUPDO&ORVHG/RRSƑ7UDFHU
Ƒ*HRWKHUPDO+HDWLQJ&RROLQJ5HWXUQƑ2WKHUH[SODLQXQGHU5HPDUNV
'DWH:HOOV&RPSOHWHGBBBBBBBBBBBB:HOO,'BBBBBBBBBBBBBBBBBBBBBB
D:HOO/RFDWLRQ

)DFLOLW\2ZQHU 1DPH )DFLOLW\,'LIDSSOLFDEOH

3K\VLFDO$GGUHVV&LW\DQG=LS

&RXQW\ 3DUFHO,GHQWLILFDWLRQ1R3,1
E/DWLWXGHDQG/RQJLWXGHLQGHJUHHVPLQXWHVVHFRQGVRUGHFLPDOGHJUHHV
LIZHOOILHOGRQHODWORQJLVVXIILFLHQW
1 :
,V DUHWKHZHOOVƑ3HUPDQHQWRUƑ7HPSRUDU\
,VWKLVDUHSDLUWRDQH[LVWLQJZHOOƑ<HVRUƑ1R
If this is a repair, fill out known well construction information and explain the nature of the repair under #21 remarks section or on the back of this form.
 1XPEHURIZHOOVFRQVWUXFWHG 
For multiple injection or non-water supply wells ONLY with the same construction, you can
submit one form.
7RWDOZHOOGHSWK EHORZODQG VXUIDFH  IW
For multiple wells list all depths if different (example- 3@200’ and 2@100ƍ
6WDWLFZDWHUOHYHOEHORZWRSRIFDVLQJ IWIf water level is above casing, use “+”
%RUHKROHGLDPHWHU LQ
:HOOFRQVWUXFWLRQPHWKRG  
LHDXJHUURWDU\FDEOHGLUHFWSXVKHWF
)25:$7(56833/<:(//621/<
D<LHOGJSP0HWKRGRIWHVW
E'LVLQIHFWLRQW\SH$PRXQW
:$7(5=21(6
)520 72 '(6&5,37,21
IWIW
IWIW
287(5&$6,1* IRUPXOWLFDVHGZHOOV25/,1(5LIDSSOLFDEOH
)520 72 ',$0(7(5 7+,&.1(66 0$7(5,$/
IWIWLQ
,11(5&$6,1* 2578%,1* JHRWKHUPDOFORVHGORRS
)520 72 ',$0(7(5 7+,&.1(66 0$7(5,$/
IWIWLQ
IWIWLQ
6&5((1
)520 72 ',$0(7(5 6/27 6,=( 7+,&.1(66 0$7(5,$/
IWIWLQ
IWIWLQ
*5287
)520 72 0$7(5,$/ (03/$&(0(170(7+2' $02817
IWIW
IWIW
IWIW
6$1'*5$9(/3$&.LIDSSOLFDEOH
)520 72 0$7(5,$/ (03/$&(0(170(7+2'
IWIW
IWIW
'5,//,1*/2* DWWDFKDGGLWLRQDOVKHHWVLIQHFHVVDU\
)520 72 '(6&5,37,21 FRORUKDUGQHVVVRLOURFNW\SHJUDLQVL]HHWF
IWIW
IWIW
IWIW
IWIW
IWIW
IWIW
IWIW
5(0$5.6
&HUWLILFDWLRQ
6LJQDWXUHRI&HUWLILHG:HOO&RQWUDFWRU 'DWH
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
6LWHGLDJUDPRUDGGLWLRQDOZHOOGHWDLOV
<RXPD\XVHWKHEDFNRI WKLVSDJHWRSURYLGHDGGLWLRQDOZHOOVLWHGHWDLOVRUZHOOFRQVWUXFWLRQGHWDLOV<RXPD\DOVRDWWDFKDGGLWLRQDO SDJHVLIQHFHVVDU\
68%0,77$/,1678&7,216
D )RU $OO :HOOV 6XEPLWWKLVIRUPZLWKLQGD\VRIFRPSOHWLRQRIZHOO
FRQVWUXFWLRQ WRWKHIROORZLQJ
'LYLVLRQRI:DWHU5HVRXUFHV,QIRUPDWLRQ3URFHVVLQJ 8QLW
0DLO6HUYLFH&HQWHU5DOHLJK1&
E)RU,QMHFWLRQ:HOOV21/<,QDGGLWLRQWRVHQGLQJWKHIRUPWRWKHDGGUHVVLQ
DDERYHDOVRVXEPLWDFRS\RI WKLVIRUP ZLWKLQGD\VRIFRPSOHWLRQRI ZHOO
FRQVWUXFWLRQWRWKHIROORZLQJ
'LYLVLRQRI:DWHU5HVRXUFHV8QGHUJURXQG,QMHFWLRQ&RQWURO3URJUDP
 0DLO6HUYLFH&HQWHU5DOHLJK1&
F)RU:DWHU6XSSO\ ,QMHFWLRQ :HOOV
$OVR VXEPLW RQH FRS\ RI WKLV IRUP ZLWKLQGD\V RIFRPSOHWLRQRI
ZHOOFRQVWUXFWLRQWRWKHFRXQW\KHDOWKGHSDUWPHQWRIWKHFRXQW\ZKHUH
FRQVWUXFWHG
)RU,QWHUQDO8VH21/<
_______________
Jonathan R. Grubbs
3001
Terraquest Environmental Consultants, P.C.
✔
11/16/2021 SVE1,SVE2
Perth Mini Mart 00-0-24524
818 Perth Rd.
Iredell 4730-50-7091
35.648900 -80.895787
✔
✔
2
35
N/A
6.25
Solid Stem Auger
20'35'.010 Sch. 40 PVC
0 16 Portland Pour
16 18 Bentonite Pour
18 35 No. 2 Sand Pour
0 0.5 Top Soil
0.5 35 Silt
Digitally signed by Jonathan Grubbs
DN: cn=Jonathan Grubbs, o=Terraquest
Environmental Consultants, P.C., ou,
email=[e-mail], c=US
Date: 2021.11.17 16:27:34 -05'00'
:(//&216758&7,215(&25'
7KLVIRUPFDQEHXVHGIRUVLQJOHRUPXOWLSOHZHOOV
)RUP*:  1RUWK&DUROLQD'HSDUWPHQWRI(QYLURQPHQWDQG1DWXUDO5HVRXUFHV±'LYLVLRQRI:DWHUResources 5HYLVHG$ugust
:HOO&RQWUDFWRU,QIRUPDWLRQ
:HOO&RQWUDFWRU1DPH
1&:HOO&RQWUDFWRU&HUWLILFDWLRQ1XPEHU
&RPSDQ\1DPH
:HOO&RQVWUXFWLRQ3HUPLW
List all applicable well permits (i.e. County, State, Variance, Injection, etc.)
:HOO8VH FKHFNZHOOXVH
:DWHU6XSSO\:HOO
Ƒ$JULFXOWXUDO Ƒ0XQLFLSDO3XEOLF
Ƒ*HRWKHUPDO+HDWLQJ&RROLQJ6XSSO\Ƒ5HVLGHQWLDO:DWHU6XSSO\ VLQJOH
Ƒ,QGXVWULDO&RPPHUFLDO Ƒ5HVLGHQWLDO:DWHU6XSSO\ VKDUHG
Ƒ,UULJDWLRQ
1RQ:DWHU6XSSO\:HOO
Ƒ0RQLWRULQJ Ƒ5HFRYHU\
,QMHFWLRQ :HOO
Ƒ$TXLIHU5HFKDUJH Ƒ*URXQGZDWHU5HPHGLDWLRQ
Ƒ$TXLIHU6WRUDJHDQG5HFRYHU\Ƒ6DOLQLW\%DUULHU
Ƒ$TXLIHU7HVW Ƒ6WRUPZDWHU'UDLQDJH
Ƒ([SHULPHQWDO7HFKQRORJ\Ƒ6XEVLGHQFH&RQWURO
Ƒ*HRWKHUPDO&ORVHG/RRSƑ7UDFHU
Ƒ*HRWKHUPDO+HDWLQJ&RROLQJ5HWXUQƑ2WKHUH[SODLQXQGHU5HPDUNV
'DWH:HOOV&RPSOHWHGBBBBBBBBBBBB:HOO,'BBBBBBBBBBBBBBBBBBBBBB
D:HOO/RFDWLRQ

)DFLOLW\2ZQHU 1DPH )DFLOLW\,'LIDSSOLFDEOH

3K\VLFDO$GGUHVV&LW\DQG=LS

&RXQW\ 3DUFHO,GHQWLILFDWLRQ1R3,1
E/DWLWXGHDQG/RQJLWXGHLQGHJUHHVPLQXWHVVHFRQGVRUGHFLPDOGHJUHHV
LIZHOOILHOGRQHODWORQJLVVXIILFLHQW
1 :
,V DUHWKHZHOOVƑ3HUPDQHQWRUƑ7HPSRUDU\
,VWKLVDUHSDLUWRDQH[LVWLQJZHOOƑ<HVRUƑ1R
If this is a repair, fill out known well construction information and explain the nature of the repair under #21 remarks section or on the back of this form.
 1XPEHURIZHOOVFRQVWUXFWHG 
For multiple injection or non-water supply wells ONLY with the same construction, you can
submit one form.
7RWDOZHOOGHSWK EHORZODQG VXUIDFH  IW
For multiple wells list all depths if different (example- 3@200’ and 2@100ƍ
6WDWLFZDWHUOHYHOEHORZWRSRIFDVLQJ IWIf water level is above casing, use “+”
%RUHKROHGLDPHWHU LQ
:HOOFRQVWUXFWLRQPHWKRG  
LHDXJHUURWDU\FDEOHGLUHFWSXVKHWF
)25:$7(56833/<:(//621/<
D<LHOGJSP0HWKRGRIWHVW
E'LVLQIHFWLRQW\SH$PRXQW
:$7(5=21(6
)520 72 '(6&5,37,21
IWIW
IWIW
287(5&$6,1* IRUPXOWLFDVHGZHOOV25/,1(5LIDSSOLFDEOH
)520 72 ',$0(7(5 7+,&.1(66 0$7(5,$/
IWIWLQ
,11(5&$6,1* 2578%,1* JHRWKHUPDOFORVHGORRS
)520 72 ',$0(7(5 7+,&.1(66 0$7(5,$/
IWIWLQ
IWIWLQ
6&5((1
)520 72 ',$0(7(5 6/27 6,=( 7+,&.1(66 0$7(5,$/
IWIWLQ
IWIWLQ
*5287
)520 72 0$7(5,$/ (03/$&(0(170(7+2' $02817
IWIW
IWIW
IWIW
6$1'*5$9(/3$&.LIDSSOLFDEOH
)520 72 0$7(5,$/ (03/$&(0(170(7+2'
IWIW
IWIW
'5,//,1*/2* DWWDFKDGGLWLRQDOVKHHWVLIQHFHVVDU\
)520 72 '(6&5,37,21 FRORUKDUGQHVVVRLOURFNW\SHJUDLQVL]HHWF
IWIW
IWIW
IWIW
IWIW
IWIW
IWIW
IWIW
5(0$5.6
&HUWLILFDWLRQ
6LJQDWXUHRI&HUWLILHG:HOO&RQWUDFWRU 'DWH
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
6LWHGLDJUDPRUDGGLWLRQDOZHOOGHWDLOV
<RXPD\XVHWKHEDFNRI WKLVSDJHWRSURYLGHDGGLWLRQDOZHOOVLWHGHWDLOVRUZHOOFRQVWUXFWLRQGHWDLOV<RXPD\DOVRDWWDFKDGGLWLRQDO SDJHVLIQHFHVVDU\
68%0,77$/,1678&7,216
D )RU $OO :HOOV 6XEPLWWKLVIRUPZLWKLQGD\VRIFRPSOHWLRQRIZHOO
FRQVWUXFWLRQ WRWKHIROORZLQJ
'LYLVLRQRI:DWHU5HVRXUFHV,QIRUPDWLRQ3URFHVVLQJ 8QLW
0DLO6HUYLFH&HQWHU5DOHLJK1&
E)RU,QMHFWLRQ:HOOV21/<,QDGGLWLRQWRVHQGLQJWKHIRUPWRWKHDGGUHVVLQ
DDERYHDOVRVXEPLWDFRS\RI WKLVIRUP ZLWKLQGD\VRIFRPSOHWLRQRI ZHOO
FRQVWUXFWLRQWRWKHIROORZLQJ
'LYLVLRQRI:DWHU5HVRXUFHV8QGHUJURXQG,QMHFWLRQ&RQWURO3URJUDP
 0DLO6HUYLFH&HQWHU5DOHLJK1&
F)RU:DWHU6XSSO\ ,QMHFWLRQ :HOOV
$OVR VXEPLW RQH FRS\ RI WKLV IRUP ZLWKLQGD\V RIFRPSOHWLRQRI
ZHOOFRQVWUXFWLRQWRWKHFRXQW\KHDOWKGHSDUWPHQWRIWKHFRXQW\ZKHUH
FRQVWUXFWHG
)RU,QWHUQDO8VH21/<
_______________
Jonathan R. Grubbs
3001
Terraquest Environmental Consultants, P.C.
✔
11/16/2021 SVE3
Perth Mini Mart 00-0-24524
818 Perth Rd.
Iredell 4730-50-7091
35.648900 -80.895787
✔
✔
1
35
N/A
6.25
Solid Stem Auger
20'35'.010 Sch. 40 PVC
0 16 Portland Pour
16 18 Bentonite Pour
18 35 No. 2 Sand Pour
0 0.5 Asphalt
0.5 35 Silt
Digitally signed by Jonathan Grubbs
DN: cn=Jonathan Grubbs, o=Terraquest
Environmental Consultants, P.C., ou,
email=[e-mail], c=US
Date: 2021.11.17 16:27:34 -05'00'

AIR SAMPLE LAB REPORT

AIR SPARGE TEST

ANALYTICAL REPORT
Eurofins TestAmerica, Pensacola
3355 McLemore Drive
Pensacola, FL 32514
Tel: [phone]
Laboratory Job ID: 400-211765-1
Client Project/Site: Perth
For:
Terraquest Environmental Consultants, PC
100 E. Ruffin Street
Mebane, North Carolina 27302
Attn: Ryan Kerins
Authorized for release by:
12/3/2021 6:50:14 PM
Chad Bechtold, Project Manager
[phone]
[e-mail]
The test results in this report meet all 2003 NELAC, 2009 TNI, and 2016 TNI requirements for
accredited parameters, exceptions are noted in this report. This report may not be reproduced
except in full, and with written approval from the laboratory. For questions please contact the
Project Manager at the e-mail address or telephone number listed on this page.
This report has been electronically signed and authorized by the signatory. Electronic signature is
intended to be the legally binding equivalent of a traditionally handwritten signature.
Results relate only to the items tested and the sample(s) as received by the laboratory.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Table of Contents
Client: Terraquest Environmental Consultants, PC
Project/Site: Perth
Laboratory Job ID: 400-211765-1
Page 2 of 16 Eurofins TestAmerica, Pensacola12/3/2021
Cover Page . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
Table of Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
Case Narrative . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
Detection Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
Sample Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
Client Sample Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Surrogate Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
QC Association . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
QC Sample Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
Chronicle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
Method Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
Certification Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14
Chain of Custody . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15
Receipt Checklists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Case Narrative
Client: Terraquest Environmental Consultants, PC Job ID: 400-211765-1
Project/Site: Perth
Job ID: 400-211765-1
Laboratory: Eurofins TestAmerica, Pensacola
Narrative
Job Narrative
400-211765-1
Comments
No additional comments.
Receipt
The sample was received on 11/26/2021 9:20 AM. Unless otherwise noted below, the sample arrived in good condition. The temperature
of the cooler at receipt was 15.8º C. Thermal preservation is not used for air samples.
GC VOA
Method EPA-18: The following sample was diluted to bring the concentration of target analytes within the calibration range: SVE Stack
(400-211765-1). Elevated reporting limits (RLs) are provided.
Method EPA-18: Surrogate recovery for the following sample was outside control limits: SVE Stack (400-211765-1). Evidence of matrix
interference is present.
No additional analytical or quality issues were noted, other than those described above or in the Definitions/Glossary page.
Eurofins TestAmerica, PensacolaPage 3 of 16 12/3/2021
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Detection Summary
Job ID: 400-211765-1Client: Terraquest Environmental Consultants, PC
Project/Site: Perth
Client Sample ID: SVE Stack Lab Sample ID: 400-211765-1
Benzene
RL
313 ppb v/v
MDL
125
Analyte Result Qualifier Unit Dil Fac D Method Prep Type
Total/NA191200EPA-18
Toluene 36500 ppb v/v7150 Total/NA27.5145000 EPA-18
Ethylbenzene 230 ppb v/v124 Total/NA14040EPA-18
m-Xylene & p-Xylene 1150 ppb v/v230 Total/NA111700EPA-18
o-Xylene 1150 ppb v/v159 Total/NA12790EPA-18
Xylenes, Total 1150 ppb v/v368 Total/NA114500EPA-18
Gasoline Range Organics
(GRO)-C6-C10
672000 ppb v/v336000 Total/NA27.510100000 EPA-18
Eurofins TestAmerica, Pensacola
This Detection Summary does not include radiochemical test results.
Page 4 of 16 12/3/2021
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Sample Summary
Client: Terraquest Environmental Consultants, PC Job ID: 400-211765-1
Project/Site: Perth
Lab Sample ID Client Sample ID Matrix Collected Received
400-211765-1 SVE Stack Air - Tedlar Bag 11/23/21 16:13 11/26/21 09:20
Eurofins TestAmerica, PensacolaPage 5 of 16 12/3/2021
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Client Sample Results
Job ID: 400-211765-1Client: Terraquest Environmental Consultants, PC
Project/Site: Perth
Lab Sample ID: 400-211765-1Client Sample ID: SVE Stack
Matrix: Air - Tedlar BagDate Collected: 11/23/21 16:13
Date Received: 11/26/21 09:20
Method: EPA-18 - Volatile Organic Compounds
RL MDL
Benzene 91200 313 125 ppb v/v 11/26/21 16:31 1
Analyte Dil FacAnalyzedPreparedUnitDResultQualifier
36500 7150 ppb v/v 11/29/21 18:40 27.5Toluene145000
230 124 ppb v/v 11/26/21 16:31 1Ethylbenzene4040
1150 230 ppb v/v 11/26/21 16:31 1m-Xylene & p-Xylene 11700
1150 159 ppb v/v 11/26/21 16:31 1o-Xylene 2790
1150 368 ppb v/v 11/26/21 16:31 1Xylenes, Total 14500
1390 499 ppb v/v 11/26/21 16:31 1Methyl tert-butyl ether 499 U
672000 336000 ppb v/v 11/29/21 18:40 27.5Gasoline Range Organics
(GRO)-C6-C10
10100000
a,a,a-Trifluorotoluene (fid)91 67-139 11/29/21 18:40 27.5
Surrogate Dil FacAnalyzedPreparedQualifierLimits%Recovery
a,a,a-Trifluorotoluene (pid)179 S1+11/26/21 16:31 176-127
a,a,a-Trifluorotoluene (pid)93 11/29/21 18:40 27.576-127
Eurofins TestAmerica, Pensacola
Page 6 of 16 12/3/2021
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Definitions/Glossary
Job ID: 400-211765-1Client: Terraquest Environmental Consultants, PC
Project/Site: Perth
Qualifiers
Air - GC VOA
Qualifier Description
S1+Surrogate recovery exceeds control limits, high biased.
Qualifier
U Indicates the analyte was analyzed for but not detected.
Glossary
These commonly used abbreviations may or may not be present in this report.
¤Listed under the "D" column to designate that the result is reported on a dry weight basis
Abbreviation
%R Percent Recovery
CFL Contains Free Liquid
CFU Colony Forming Unit
CNF Contains No Free Liquid
DER Duplicate Error Ratio (normalized absolute difference)
Dil Fac Dilution Factor
DL Detection Limit (DoD/DOE)
DL, RA, RE, IN Indicates a Dilution, Re-analysis, Re-extraction, or additional Initial metals/anion analysis of the sample
DLC Decision Level Concentration (Radiochemistry)
EDL Estimated Detection Limit (Dioxin)
LOD Limit of Detection (DoD/DOE)
LOQ Limit of Quantitation (DoD/DOE)
MCL EPA recommended "Maximum Contaminant Level"
MDA Minimum Detectable Activity (Radiochemistry)
MDC Minimum Detectable Concentration (Radiochemistry)
MDL Method Detection Limit
ML Minimum Level (Dioxin)
MPN Most Probable Number
MQL Method Quantitation Limit
NC Not Calculated
ND Not Detected at the reporting limit (or MDL or EDL if shown)
NEG Negative / Absent
POS Positive / Present
PQL Practical Quantitation Limit
PRES Presumptive
QC Quality Control
RER Relative Error Ratio (Radiochemistry)
RL Reporting Limit or Requested Limit (Radiochemistry)
RPD Relative Percent Difference, a measure of the relative difference between two points
TEF Toxicity Equivalent Factor (Dioxin)
TEQ Toxicity Equivalent Quotient (Dioxin)
TNTC Too Numerous To Count
Eurofins TestAmerica, Pensacola
Page 7 of 16 12/3/2021
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Surrogate Summary
Job ID: 400-211765-1Client: Terraquest Environmental Consultants, PC
Project/Site: Perth
Method: EPA-18 - Volatile Organic Compounds
Prep Type: Total/NAMatrix: Air - Tedlar Bag
Lab Sample ID Client Sample ID (67-139)(76-127)
TFT-F TFT-P
179 S1+400-211765-1
Percent Surrogate Recovery (Acceptance Limits)
SVE Stack
91 93400-211765-1 SVE Stack
92LCS 400-557404/1002 Lab Control Sample
90 90LCS 400-557593/1002 Lab Control Sample
93MB 400-557404/3 Method Blank
90 89MB 400-557593/3 Method Blank
Surrogate Legend
TFT-F = a,a,a-Trifluorotoluene (fid)
TFT-P = a,a,a-Trifluorotoluene (pid)
Eurofins TestAmerica, Pensacola
Page 8 of 16 12/3/2021
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
QC Association Summary
Job ID: 400-211765-1Client: Terraquest Environmental Consultants, PC
Project/Site: Perth
Air - GC VOA
Analysis Batch: 557404
Lab Sample ID Client Sample ID Prep Type Matrix Method Prep Batch
Air - Tedlar Bag EPA-18400-211765-1 SVE Stack Total/NA
Air - Tedlar Bag EPA-18MB 400-557404/3 Method Blank Total/NA
Air - Tedlar Bag EPA-18LCS 400-557404/1002 Lab Control Sample Total/NA
Analysis Batch: 557593
Lab Sample ID Client Sample ID Prep Type Matrix Method Prep Batch
Air - Tedlar Bag EPA-18400-211765-1 SVE Stack Total/NA
Air - Tedlar Bag EPA-18MB 400-557593/3 Method Blank Total/NA
Air - Tedlar Bag EPA-18LCS 400-557593/1002 Lab Control Sample Total/NA
Eurofins TestAmerica, Pensacola
Page 9 of 16 12/3/2021
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
QC Sample Results
Job ID: 400-211765-1Client: Terraquest Environmental Consultants, PC
Project/Site: Perth
Method: EPA-18 - Volatile Organic Compounds
Client Sample ID: Method BlankLab Sample ID: MB 400-557404/3
Matrix: Air - Tedlar Bag Prep Type: Total/NA
Analysis Batch: 557404
RL MDL
Benzene 125 U 313 125 ppb v/v 11/26/21 13:23 1
MB MB
Analyte Dil FacAnalyzedPreparedDUnitResultQualifier
260 U 2601330 ppb v/v 11/26/21 13:23 1Toluene
124 U 124230 ppb v/v 11/26/21 13:23 1Ethylbenzene
230 U 2301150 ppb v/v 11/26/21 13:23 1m-Xylene & p-Xylene
159 U 1591150 ppb v/v 11/26/21 13:23 1o-Xylene
368 U 3681150 ppb v/v 11/26/21 13:23 1Xylenes, Total
499 U 4991390 ppb v/v 11/26/21 13:23 1Methyl tert-butyl ether
a,a,a-Trifluorotoluene (pid)93 76-127 11/26/21 13:23 1
MB MB
Surrogate Dil FacPreparedAnalyzedQualifierLimits%Recovery
Client Sample ID: Lab Control SampleLab Sample ID: LCS 400-557404/1002
Matrix: Air - Tedlar Bag Prep Type: Total/NA
Analysis Batch: 557404
Benzene 15700 14910 ppb v/v 95 85 -115
Analyte
LCS LCS
DUnitResultQualifier %Rec
Spike
Added
%Rec.
Limits
Toluene 13300 12680 ppb v/v 96 85 -115
Ethylbenzene 11500 11080 ppb v/v 96 85 -115
m-Xylene & p-Xylene 23000 22680 ppb v/v 98 85 -115
o-Xylene 11500 10980 ppb v/v 95 85 -115
Xylenes, Total 34500 33670 ppb v/v 97 85 -115
Methyl tert-butyl ether 27700 26410 ppb v/v 95 85 -115
a,a,a-Trifluorotoluene (pid)76 -127
Surrogate
92
LCS LCS
Qualifier Limits%Recovery
Client Sample ID: Method BlankLab Sample ID: MB 400-557593/3
Matrix: Air - Tedlar Bag Prep Type: Total/NA
Analysis Batch: 557593
RL MDL
Toluene 260 U 1330 260 ppb v/v 11/29/21 11:34 1
MB MB
Analyte Dil FacAnalyzedPreparedDUnitResultQualifier
12200 U 1220024500 ppb v/v 11/29/21 11:34 1Gasoline Range Organics
(GRO)-C6-C10
a,a,a-Trifluorotoluene (fid)90 67-139 11/29/21 11:34 1
MB MB
Surrogate Dil FacPreparedAnalyzedQualifierLimits%Recovery
89 11/29/21 11:34 1a,a,a-Trifluorotoluene (pid)76-127
Client Sample ID: Lab Control SampleLab Sample ID: LCS 400-557593/1002
Matrix: Air - Tedlar Bag Prep Type: Total/NA
Analysis Batch: 557593
Toluene 13300 12190 ppb v/v 92 85 -115
Analyte
LCS LCS
DUnitResultQualifier %Rec
Spike
Added
%Rec.
Limits
Gasoline Range Organics
(GRO)-C6-C10
196000 175400 ppb v/v 90 85 -115
Eurofins TestAmerica, Pensacola
Page 10 of 16 12/3/2021
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
QC Sample Results
Job ID: 400-211765-1Client: Terraquest Environmental Consultants, PC
Project/Site: Perth
Method: EPA-18 - Volatile Organic Compounds (Continued)
Client Sample ID: Lab Control SampleLab Sample ID: LCS 400-557593/1002
Matrix: Air - Tedlar Bag Prep Type: Total/NA
Analysis Batch: 557593
a,a,a-Trifluorotoluene (fid)67 -139
Surrogate
90
LCS LCS
Qualifier Limits%Recovery
90a,a,a-Trifluorotoluene (pid)76 -127
Eurofins TestAmerica, Pensacola
Page 11 of 16 12/3/2021
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Lab Chronicle
Client: Terraquest Environmental Consultants, PC Job ID: 400-211765-1
Project/Site: Perth
Client Sample ID: SVE Stack Lab Sample ID: 400-211765-1
Matrix: Air - Tedlar BagDate Collected: 11/23/21 16:13
Date Received: 11/26/21 09:20
Analysis EPA-18 NTH11/26/21 16:311 TAL PEN557404
Type
Batch
Method
Batch
Prep Type LabAnalystRun
Prepared
or Analyzed
Initial
Amount Amount
Final Batch
NumberFactor
Dil
Total/NA 5 mL 5 mL
Analysis EPA-18 27.5 557593 11/29/21 18:40 NTH TAL PENTotal/NA 5 mL 5 mL
Client Sample ID: Method Blank Lab Sample ID: MB 400-557404/3
Matrix: Air - Tedlar BagDate Collected: N/A
Date Received: N/A
Analysis EPA-18 NTH11/26/21 13:231 TAL PEN557404
Type
Batch
Method
Batch
Prep Type LabAnalystRun
Prepared
or Analyzed
Initial
Amount Amount
Final Batch
NumberFactor
Dil
Total/NA 5 mL 5 mL
Client Sample ID: Method Blank Lab Sample ID: MB 400-557593/3
Matrix: Air - Tedlar BagDate Collected: N/A
Date Received: N/A
Analysis EPA-18 NTH11/29/21 11:341 TAL PEN557593
Type
Batch
Method
Batch
Prep Type LabAnalystRun
Prepared
or Analyzed
Initial
Amount Amount
Final Batch
NumberFactor
Dil
Total/NA 5 mL 5 mL
Client Sample ID: Lab Control Sample Lab Sample ID: LCS 400-557404/1002
Matrix: Air - Tedlar BagDate Collected: N/A
Date Received: N/A
Analysis EPA-18 NTH11/26/21 12:541 TAL PEN557404
Type
Batch
Method
Batch
Prep Type LabAnalystRun
Prepared
or Analyzed
Initial
Amount Amount
Final Batch
NumberFactor
Dil
Total/NA 5 mL 5 mL
Client Sample ID: Lab Control Sample Lab Sample ID: LCS 400-557593/1002
Matrix: Air - Tedlar BagDate Collected: N/A
Date Received: N/A
Analysis EPA-18 NTH11/29/21 11:061 TAL PEN557593
Type
Batch
Method
Batch
Prep Type LabAnalystRun
Prepared
or Analyzed
Initial
Amount Amount
Final Batch
NumberFactor
Dil
Total/NA 5 mL 5 mL
Laboratory References:
TAL PEN = Eurofins TestAmerica, Pensacola, 3355 McLemore Drive, Pensacola, FL 32514, TEL [phone]
Eurofins TestAmerica, Pensacola
Page 12 of 16 12/3/2021
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Method Summary
Job ID: 400-211765-1Client: Terraquest Environmental Consultants, PC
Project/Site: Perth
Method Method Description LaboratoryProtocol
EPAEPA-18 Volatile Organic Compounds TAL PEN
Protocol References:
EPA = US Environmental Protection Agency
Laboratory References:
TAL PEN = Eurofins TestAmerica, Pensacola, 3355 McLemore Drive, Pensacola, FL 32514, TEL [phone]
Eurofins TestAmerica, Pensacola
Page 13 of 16 12/3/2021
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Accreditation/Certification Summary
Client: Terraquest Environmental Consultants, PC Job ID: 400-211765-1
Project/Site: Perth
Laboratory: Eurofins TestAmerica, Pensacola
Unless otherwise noted, all analytes for this laboratory were covered under each accreditation/certification below.
Authority Program Identification Number Expiration Date
North Carolina (WW/SW)State 314 12-31-21
The following analytes are included in this report, but the laboratory is not certified by the governing authority. This list may include analytes for which
the agency does not offer certification.
Analysis Method Prep Method Matrix Analyte
EPA-18 Air - Tedlar Bag Benzene
EPA-18 Air - Tedlar Bag Ethylbenzene
EPA-18 Air - Tedlar Bag Gasoline Range Organics (GRO)-C6-C10
EPA-18 Air - Tedlar Bag Methyl tert-butyl ether
EPA-18 Air - Tedlar Bag m-Xylene & p-Xylene
EPA-18 Air - Tedlar Bag o-Xylene
EPA-18 Air - Tedlar Bag Toluene
EPA-18 Air - Tedlar Bag Xylenes, Total
Eurofins TestAmerica, Pensacola
Page 14 of 16 12/3/2021
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Page 15 of 16 12/3/2021
1234567
8
9
10
11
12
13
14
15
Login Sample Receipt Checklist
Client: Terraquest Environmental Consultants, PC Job Number: 400-211765-1
Login Number: 211765
Question Answer Comment
Creator: Roberts, Alexis J
List Source: Eurofins TestAmerica, Pensacola
List Number: 1
N/ARadioactivity wasn't checked or is </= background as measured by a survey
meter.
N/AThe cooler's custody seal, if present, is intact.
N/ASample custody seals, if present, are intact.
TrueThe cooler or samples do not appear to have been compromised or
tampered with.
FalseSamples were received on ice.Thermal preservation not required.
TrueCooler Temperature is acceptable.
TrueCooler Temperature is recorded.15.8°C IR8
TrueCOC is present.
TrueCOC is filled out in ink and legible.
TrueCOC is filled out with all pertinent information.
TrueIs the Field Sampler's name present on COC?
TrueThere are no discrepancies between the containers received and the COC.
TrueSamples are received within Holding Time (excluding tests with immediate
HTs)
TrueSample containers have legible labels.
TrueContainers are not broken or leaking.
TrueSample collection date/times are provided.
TrueAppropriate sample containers are used.
TrueSample bottles are completely filled.
N/ASample Preservation Verified.
TrueThere is sufficient vol. for all requested analyses, incl. any requested
MS/MSDs
N/AContainers requiring zero headspace have no headspace or bubble is
<6mm (1/4").
TrueMultiphasic samples are not present.
TrueSamples do not require splitting or compositing.
N/AResidual Chlorine Checked.
Eurofins TestAmerica, Pensacola
Page 16 of 16 12/3/2021
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15