GW1 - New Hanover Dec-Nov 2017

Water Resources
Environmental Quality
ock
Graham & Maeomie Mosley
2137 Auburn Ln
Wilmington, NC 28405
December 13, 2017
Re: Issuance of Injection Well Permit
Permit No. WI0800014
Geothermal Heating/Cooling Water Return Well
New Hanover County
ROY COOPER
Governor
4 MICHAEL S. REGAN
44.° Secretary
41, LINDA CULPEPPER
®<`? • le Interim Director
oo /2 3
N
Dear Mr. and Mrs. Mosley:
In accordance with your permit renewal application received on September 5, 2017, I am forwarding
Permit No. WI0800014 for the continued operation of geothermal heating/cooling water return well(s)
located at the above referenced address. This permit shall be effective December 13,2017, until
November 30, 2022, and shall be subject to the conditions and limitations stated therein.
Please Note:
• Samples from the influent and effluent sampling ports of your geothermal well system
were collected on November 30, 2017. Laboratory analytical results will be forwarded to
you when it becomes available.
In order to continue uninterrupted legal use of this well for the stated purpose, you should submit an
application to renew the permit 120 days prior to its expiration date. As indicated in the permit, this
permit is not transferable to any person without prior notice to, and approval by, the Director of the
Division of Water Resources. If you have any questions regarding your permit or the Underground
Injection Control Program please call me at [phone].
Best Regards,
astlieb
Shristi Shrestha
Underground Injection Control (UIC)- Hydrogeologist
Division of Water Resources, NCDEQ
Water Quality Regional Operations Sectiopct,„Noth,nq Compares:-._.
State of North Carolina I Environmental Quality I Division of Water Resources
Water Quality Regional Operations Section
1636 Mail Service Center I Raleigh, North Carolina 27699-1636
919-707-9129

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENTAL QUALITY
RALEIGH, NORTH CAROLINA
PERMIT FOR THE USE OF A WELL FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87; Article 21, Chapter 143; and other applicable
Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Graham & Maeomie Mosley
FOR THE CONTINUED OPERATION OF ONE (1) GEOTHERMAL HEATING/COOLING WATER
RETURN WELL(S), defined in Title 15A North Carolina Administrative Code 02C .0224(a), which will be used
for the injection of heat pump effluent. The injection well(s) located at 2137 Aurburn Ln, Wilmington, New
Hanover County, NC 28405 will be operated in accordance with the application submitted September 5, 2017,
and in conformity with the specifications and supporting data, all of which are filed with the Department of
Environmental Quality and are considered a part of this permit.
This permit is for continued operation of an injection well shall be in compliance with Title 15A North Carolina
Administrative Code 2C .0100 and .0200, and any other Laws, Rules, and Regulations pertaining to well
construction and use.
This permit shall be effective, unless revoked, from the date of its issuance until November 30, 2022, and shall
be subject to the specified conditions and limitations set forth in this permit.
Permit issued this the 13th day of December 2017.
„ uo*.
For Linda Culpepper
Interim Director, Division of Water Resources
By Authority of the Environmental Management Commission.
Permit #WI0800014
UIC/5A7
ver. 11/15/2015
Page 1 of 5

7. A completed Well Construction Record (Form GW-1) shall be submitted as described in Part V.5 of this
permit.
PART III — OPERATION AND USE CONDITIONS
1. The Permittee shall comply with the conditions of this permit and properly operate and maintain the
injection facility in compliance with the conditions of this permit and the rules of 15A NCAC 02C .0200,
even if compliance requires a reduction or elimination of the permitted activity [15A NCAC 02C .0211(j)].
2. The issuance of this permit shall not relieve the Permittee of the responsibility for damages to surface water
or groundwater resulting from the operation of this facility. In the event that the facility fails to perform
satisfactorily, including the creation of nuisance conditions or failure of the injection zone to adequately
assimilate the injected fluid, the Permittee shall take immediate corrective actions that may be required,
such as the repair, modification, or abandonment of the injection facility [15A NCAC 02C .0206].
PART IV — INSPECTIONS [15A NCAC 02C .0211(k)]
1. Any duly authorized officer, employee, or representative of the Division of Water Resources (DWR) may,
upon presentation of credentials, enter and inspect any property, premises, or place on or related to the
injection facility at any reasonable time for the purpose of determining compliance with this permit, may
inspect or copy any records that must be maintained under the terms and conditions of this permit, and may
obtain samples of groundwater, surface water, or injection fluids.
2. DWR representatives shall have reasonable access for purposes of inspection, observation, and sampling
associated with injection and any related facilities as provided for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary samples of the injection facility's activities.
PART V — MONITORING AND REPORTING REQUIREMENTS
1. Records of well construction, repair, or abandonment shall be submitted within 30 days of completion of
such activities. Copies of such records shall be retained on -site and available for inspection [15A NCAC
02C .0224(0(2), (4)].
2. Monitoring of any well may be required to ensure protection of the groundwater resources of the State and
compliance with the groundwater quality standards specified in 15A NCAC 02L [15A NCAC 02C
.022401)1
3. The Permittee shall report any monitoring or other information that indicates noncompliance with a specific
permit condition, that a contaminant may cause a violation of applicable groundwater quality standards, or
that a malfunction of the injection system may cause the injected fluids to migrate outside the approved
injection zone or area. As specified in rule 15A NCAC 02C .0211(r), noncompliance notification shall be
as follows:
(A) Oral notification shall be given within 24 hours of the occurrence, or first knowledge of the
occurrence, to the Wilmington Regional Office, telephone number 910-796-7215.
(B) Written notification shall be made within five days of the occurrence and submitted to the addresses
in Item #5 below.
Permit #WI08000 14
UIC/5A7
ver. 11/15/2015
Page 3 of 5

(D) Each well shall be completely filled with cement grout, which shall be introduced into the
well through a pipe which extends to the bottom of the well and is raised as the well is
filled.
(E) In those cases when a subsurface cavity has been created as a result of the injection
operations, each well shall be abandoned in such a manner that will prevent the movement
of fluids into or between underground sources of drinking water.
(F)
The Permittee shall submit a Well Abandonment Record (Form GW-30) as specified in
15A NCAC 2C .02240)(4) within 30 days of completion of abandonment.
5. The written documentation required in Part VII (4)(F) shall be submitted to the addresses specified in Part
V.5 above.
Permit#WI0800014
UIC/5A7
ver. 11/15/2015
Page 5 of 5

WELL ABANDONMENT RECORD
North Carolina Department of Environment and Natural .Resources- rvnisiWa on of ter Quality
WELL. CONTRACTOR CERTIFICATION # 1L-1 i t A
1. WELL CONTRACTOR:
C gs
WContractor (1rQiiv ua) Name
elS n} Vl� Inc
14
WpJI Conterra..ctttor Company Narne� , �
Street fAAddddr s I OM
City or Town / / State Zip, Code
;-2j1- (En
Area code Phone number
( tC
2. WELL INFORMATION:
SITE WELL ID # (if applicable)
STATE WELL PERMIT # (if applicable)
COUNTY WELL PERMIT # (if applicable)
DWQ or OTHER PERMIT # (if applicable)
WELL USE (Check applicable use): Monitoring Residential
M unicipal/Public Industrial/Commercial a Agricultural
Recovery ' Injection . irrigation
'.Other /list user.
meivin®
3. WELL LOCATION: Q �°1
COUNTY �G`NUADRANGIE ME
NEAREST TOWN. CO(l`t()a
(Street/Road Name, Number, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHC / LAN ' SETTING:
Slope : i Valley � Ridge Other
(Check appropriate setting)
LATITUDE 36
LONGITUDE 75 '
VMS OR 3X.XXXXXXXXX)D
"DMS OR 7X.XXXXXXXXXID
Latitude/longitude source: [GPS [Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
4a. FACILITY- The name of the business where the well is located. Complete 4a.
(If a residential well, skip 4a; complete 4b, well owner information only.)
FACILITY ID # (if applicable)
NAME OF FACILITY
STREET ADDRESS
City or Town Stale Zip Code
4b.NCONTACT PERSON/WEL I,-f-1 n�ki(3j`��
\JT yl(` C \y t1' '1 4 or k
5. WELL DETAILS:
,
a.Total Depth 4ic ft. Diameter: 1 /i
b. Water Level (Below Measuring Point): ` �' ft.
Measuring point is _ LJ ft. above land surface.
6. CASING: Length Diameter
' Ie�
a. Casing Depth (if known):
b. Casing Removed: /� ft in.
7. DISINFECTION: 1 I b .
(Amount of 65%75% calcium hypochlorite used)
8. SEALING MATERIAL:
Neat Cement Sand Cement
Cement Ib. Cement Ib.
Water gal. WaterRECyy^'°�'
A
Bentonite gc) Ib.
DEC � � 2017
Bentonite
®GpYC�,B, Type:' . furry Lr' ii ts.
&aeSg
DgaLi rsatioVdt2/�
WR
Other
DEGyz ae
may-
Amount
wOater Quality Re
Wilmiperations SECeg�iona/
9. 'E'XPL pjp pF EMPLACEMENTQFJv1ATE_RIAL
e\j.e S fit, Y �'
A Vel Gi �
10. WELL DIAGRAM Draw a detailed sketch of thee° on the back of this,.
form showing total depth, depth and diameter of screens (if any) ;ernaining
in the well, gravel interval, intervals of casing perforations, and depths and
. types of fill materialsised
11. DATE WELL ABANDONED
DO HEREBY CERTIFY THAT THIS WELL WAS ABANDONED IN ACCORDANCE
WITH 15A NC C 2 ELL CONSTRUCTION STANDAR,PS;.ANDTHAT A COPY OF
THIS REC EE VIDEO TO T�BLt0VNNER.
SIGNATURE OF CE
IFIBD WELL CONTRACTOR
I 1�7
DATE
SIGNATURE OF PRIVATE WELL OWNER ABANDONING THE WELL DATE
(The p vete wet owner must be an individual wpersonalllebandons his/her residential well
in acco\' with l5w_ A NCA� 20. 73.)
PRINTED NAME OF PERSON ABANDONING TH E LL
,n t''sh Salu , o(
Submit a copy to the owner and the original to: Division of Water Quality - Information Processing,
1817 Map Service Center, Raleigh, NC 27699-1617, Phone : [phone]
Form GW-30
Rev. 5/10
STREET ADDRESS

WELL CONSTRUCTION RECORD (GW-11
1. Well Contractor Information:
Donald Cummings
Well Contractor Name
2412-A
NC Well Contactor Certification Number
Applied Resource Management, P.C.
Company Name
2. Well Construction Permit#:
List all applicable well construction permits (Ie. UJC, County, State, Variance, etc)
3. Well Use (check well use):
N/A
Water Supply Well:
Agricultural
Geothermal (Heating/Coaling Supply)
Industrial/Commercial
x Irrigation
Non -Water Supply Well:
�. Monitoring
fMunicipal/Public
()Residential Water Supply (single)
()Residential Water Supply (shared)
Recovery
Injection Well:
Aquifer Recharge
Ire Aquifer Storage and RecoveryAquifer Test
. Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
['Groundwater Remediation
()Salinity Barrier
oStormwater Drainage
['Subsidence Control
(Tracer
(Other (explain under N21 Remarks)
4. Date Well(s) Completed: 11 /20/17 Well mrl N/A
5a. Well Location:
City of Wilmington N/A
Facility/Owner Name Facility IDk (if applicable)
Green Field Lake Park, Wilmington, NC 28402
Physical Address, City, and hip
New Hanover
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lallong is sufficient) N 77 56 32.3
34 12 54.4
6. Is(are) the well(s)$Permanent or OTemporary
7. Is this a repair to an existing well: []Yes or ®x No
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 thisfarnr.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled: I
R05417-017-001-000
w
For Internal Use Only:
446032
14.WATER ZONES
FROM
TO
DESCRIPTION
ft.
R
:15::OUTER CASING (for mul6Kaseidwells) OR LINER (if appliOble)
THICKNESS i MATERIAL
R R
FROM
0
TO
80
DIAMETER
4
in.
SCH40 PVC
16. INNER CASING. OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
R.
R
in.
ft.
in.
17. SCREEN.
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
80 R•
100 R•
4
A
.020
SCH40
PVC
ft.
R
in.
I& GROUT
FROM
0
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
24 ft-
Grout
Poured
9. Total well depth below land surface: 100 (ft.)
For multiple wells list all depths if different (example- 3@200' and 2@l001)
10. Static water level below top of casing: 1 1 (ft.)
If water level is above casing, use "+"
11. Borehole diameter: 0-100/8" (in,)
12. Well construction method: Mud Rotary
(i.e. auger, rotary, cable, direct push, etc.)
70 tL
75 f'-
Bentonite
Poured
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
75 R,
100 it.
Course
Poured
-.:20. DRILLING LOG (attach additional sheets if necessary)
DESCRIPTION (color, hardness, ma/rock type, grain she, etc.)
FROM
0
R.
TO
60
Sandy clay to clay
60 a.
110 "'
110 h•
225 R.
ft.
Limestone to cemented sands
Clay (some mud rock to 135')
R.
fL
ft.
ft.
ft.
ft.
21. REMARKS
DEC 0`a`2017
''tl4grrnw5iOr1 PtCCCS5"tIg
22. Certification:tir�
Ce
R�L C) AA
Signature of Certified Well Contractor Date
By signing this form, 1 hereby certify, that the well(s) was (were) constmcted in accordance
with 15A NCAC 02C .0100 or ISA NCAC 02C .0200 Well Construction Standards and that a
copy 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 well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following: RECEIVED/NCDENR/DWR
Division of Water Resources, Information Processing Unit,
1617 Mail Service Cgtit rs Raleigh,
N'C727699-1617
24b. For Iniection Wells: In additUSi to sending gi form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following: Water Quality Regional
aP' Pf,}rr7rdlthW lsion Control Program,
Division of Water it Service
Id �,ty
1636 Mail Service I g, o¢0lll01f161t9-1636
24c. For Water SHOWY & Infection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
11/29/17
FOR WATER SUPPLY WELLS ONLY:
Method of test: Airlift
13a. Yield (gpm) 80
13b. Disinfection type: HTH Amount: 3%@10g
Form GW-I
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

Print Form
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Terry White, Jr
Well Contractor Name
3287-B
NC Well Contractor Certification Number
IET
Company Name
2 Well Construction Permit #:
List all applicable well construction permits (Le. UIC, Conn0), State, Variance, etc.)
3. Well Use (check well use):
ater supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Ilrilation
Non -Water Supply Well:
Monitoring
ejection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heatin /Coolie_ Retu
4. Date Well(*) Completed: 11 /06/17 Well tint M W-8
ElMunicipal/Public
DResidential Water Supply (single)
Residential Water Supply (shared)
Groundwater Remediation
Salinity Barrier
DStormwater Drainage
()Subsidence Control
DTmcer
* Other (explain under #21 Remarks)
5a. Well Location:
Modern Laundry
Facility/Owner Name Facility ID# (if applicable)
3607 Oleander Dr, Wilmington 28403
Physical Address, City, and Zip
New Hanover
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
34 12 58.43 N 77 54 11.05
6. Istare) the well(s)Permanent or E3Temporary
7. Is this a repair to an existing well: DYes or No
If this is a repair. fill out known well construction reformation and explain the nature ofth
repair under421 remarks section or on the back of this faun.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
constmotion, only 1 GW-I is needed. Indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface: 15.
For multiple wells list all depths if different (example- 3(4200' and 2@100')
10. Static water level below top of casing: 7
If water level is above casing. use "+"
11. Borehole diameter: 8.5 (in.)
auger
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
For Internal Use Only:
"if 2
14WATER ZONES:
FROM
TO
DESCRIPTION
7 ft.
15 ft.
sand
ft.
ft.
15. OUTER CA4iNG.(for
muhi-cased wells) 'OR- LINER (fan Usable)
FROM
TO
DIAMETER
THICKNESS 4 MATERIAL
ft.
ft.
in.
16. INNER
CASING OR T[IBING (geofhering dated -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft
5 ft.
2 in'
Sch40
PVC
ft.
ft
in.
17.SCRREN `.;
'...
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
5 R•
15 f
2 ir`
0.010
SCh40
PVC
ft.
ft
in.
IS.::.GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft
1 ft
concrete
pour
1 D.
3 rt
bentonite
pour
ft
ft
'19,SAND/GRAYEL
PACK
(if applicable)
FROM
TO TO
MATERT AI
EMPLACEMENT METHOD
3 1t.
-15 ft.
#2 silica sand
pour through augers
ft
ft.
20. DRILLINGLOG
(atta
h additional sheets if:new eery) "..
FROM
TO
DESCRIPTION (color, hardness, sell/rock type, grain size, etc)
ft.
ft
See Consultant's Log
ft.
ft
ft.
rt
ft.
f.
f.
R'i re
ft
ft.
7
ft.
ft
f�OV 2017
21: REMARKS' 4
IRYY:rtavtl l
22. Certification:
W �"�%T(.C4��4
- "Lan' 2725-A for Terry white
Signature o i .ratified Well Contractor Date
By signing this faint I hereby tern»' that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or ISA NCAC 02C .0200 Well Construction Standards and that a
e copy of this record has been provided to the well owner.
23. Site diagrams or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may Mao attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
(ft) 24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
(➢) Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this for anitkiivDflvd®6'dis9 w iSeti of well
construction to the following: GIrK �6!/�tllwe.ItlBi���®fit
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Rat ,LNC((t7699rLLk36
24c. For Water Supply & Iniection Wells: In additionlvitoseen�� //ding the form to
the address(es) above, also submit one coy of this form . within 30 days of
completion of well construction to the co aleQnall yi41ugiSn¢ll the county
where constructed. perations Section
Wilmington Regional Office
onmental Quality - Division of Water Resources Revised 2-22-2016
11/19/17
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
Form GW-1
North Carolina Department of Env

Pflnt Farm
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Terry White, Jr
Well Contractor Name
3287-B
NC Well Contractor Certification Number
IET
Company Name
2. Well Construction Permit #:
List all applicable well canstnm#on pemrits 6.e. UIQ County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
Agricultural
'Geothermal (Heating/Cooling Supply)
�Industrial/Commercial
In'igation
E3Municipal/Public
Residential Water Supply (single)
Residential Water Supply (shared)
Non -Water Supply Well:
Monitoring Recovery
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
'Geothermal (Heating/Cooling Return)
▪ Groundwater Remediation
Salinity Barrier •
EIStormwater Drainage
❑ Subsidence Control
DTmcer
Other (explain under 521 Remarks).
4. Date Well(s) Completed: 11/06/17
5a. Well Location:
Modem Laundry
Well ID# M W 7
Facility/Owner Name Facility ID# (if applicable)
3607 Oleander Dr, Wilmington 28403
Physical Address, City, and Zip
New Hanover
County
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
34 12 58.64 N 77 54 10.27
For Intemal Use Only:
(Mrs -
Parcel ldentification No. (PIN)
6. Is(are) the well(s)OPermanent or ElTemporary
7. Is this a repair to an existing wen: Dyes or No
If this is a repair, fill out known well consMation mfommtion and explain the nature of the
repair under #21r'emarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface: 15
For multiple wells list all depths ifdifferent (example- 3Qa 200' and2@100)
10. Static water level below top of casing: 7 (It.)
If water level is above casing, use "+"
11. Borehole diameter: 8.5 (in.)
auger
12. Well construction method:
(i.e. auger; rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm)
Method of test:
13b. Disinfection type:
Amount:
North Carolina Department of En
onmental Quality - Division of Water Resources
14. WATER ZONES:
FROM
7
TO
DESCRIPTION
ft.
15 ft.
sand
ft.
ft.
sad wells) OR'LINER (if ap
15. OUTER CASING Der multita
DIAMETER
FROM
TO
THICKNESS
MATERIAL
ft.
in.
16. INNER CASING ORT
FROM
0 ft.
TO
5
ft.
tS
ethtrmardosed-loop)
MATERIAL
DIAMETER
2
in.
THICKNESS
Sch40
PVC
ft.
ft.
in.
17.SCREEN
FROM
5
ft.
TO
15 ft.
DIAMETER
2 m.
SLOT SIZE
0.010
THICKNESS
Sch40
MATERIAL
PVC
ft.
ft.
in.
FROM
0 ft
TO
1 ft.
MATERIAL
concrete
EMPLACEMENT METHOD & AMOUNT
pour
1
ft.
3 ft.
ft.
bentonite
pour
9 NDIG
FROM
3 ft.
PACK Of applicable)
TO
15 ft
MATER .1
#2 silica sand
EMPLACEMENT METHOD
pour through augers
fL
ft.
FROM
ft.
GLOG(atto h additional sheets ifnecessary)
DESCRIPTION (color, hardness, soil/rock type, grain sloe, etc.)
TO
ft.
See Consultants Log
ft.
ft.
ft.
ft.
ft.
f4
ft.
ft.
fL
21. REMARKS <..
ft.
V%`'2017
22. Certification:
w7114,2-
/r,7na- 2725-A for Terry White
Signature o ettiricd Well Contractor Date
By signing this form, I hereby certify that the we/l(s) was (were) constructed in accordance
with ISA 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.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
(ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mall Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sendingthe form to the address in 24a
above, also submit one Dopy of this form within 30 days of completion of well
construction to the following:
11/19/17
RECEIVED/NCDENR/DWR
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Ralei€�thCNC�277%699-116336
17
24c. For Water Supply & Iniection Wells: Dun addition t2§emaing the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the c health 4attment of the county
�1vate uall e�gional
where °mils u°tea. Operations Section
Wilmington Regional LFeg2.22-2016
Form GW-1

Print Form
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Terry White, Jr
Well Contractor Name
3287-B
NC Well Contractor Certification Number
IET
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. VIC, County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
DAgricultural
Geothermal (Heating/Cooling supply)
RIndustrial/C ommercial
Irrigation
Non -Water Supply Well:
Monitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
0Municipal/Public
Residential Water Supply (single)
['Residential Water Supply (shared)
['Recovery
['Groundwater Remediation
Salinity Barrier
DStonnwater Drainage
['Subsidence Control
['Tracer
',Other (explain under #21 Remarks)
4. Date Well(s) Completed: 1 1 /06/17
5a. Well Location:
Modem Laundry
Well ID# MW-6
Facility/Owner Name Facility ID# (if applicable)
3607 Oleander Dr, Wilmington 28403
Physical Address, City, and Zip
New Hanover
County Parcel IdentificationNo. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one latllong is sufficient)
34 12 57.71 N 77 54 10.67
6. Is(are) the well(s)OPermanent or Eiremporary
7. Is this a repair to an existing well: QYes or No
If this is a repair, fill out known well construction information and explain the nature of the
repair under 021 remarks section or on the back of this faint
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled;
9. Total well depth below land surface: 15
For multiple wells list all depths ifci cliff 3@200' and2@100')
For Ititamal Use Only' c/'q(a
rr
14-WATER ZONES
FROM
TO
DESCRIPTION
7 tl•
-15 ft.
sand
ft.
ft.
15. OUTER CASING (for
muid-eased wells) OR LINER (if a Usable)
FROM
TO
DIAMETER
THICKNESS MATERIAL
ft.
ft.
in.
16. INNER.CASINGOR
TUBING' (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 tt.
5 H.
2 In.
Sch40
PVC
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
5 ft
15 ft,
2 'm'
0.010
Sch40
PVC
ft.
ft.
in.
FROM
TO
MATERrm
EMPLACEMENT METHOD & AMOUNT
0 D
1 ft.
concrete
pour
1 ft
3 ft
bentonite
pour
ft
ft
19:. SAND/GRAVEL
PACK
(ifapplicubie)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
3 ft•
15 ft
#2 silica sand
pour through augers
f.
20.-DRILLIN
GLOB (arts
liadditionat sheetsniece soty)FROM
TO
DESCRIPTION (color, her nos, soiVroek type, grain size, etc.)
ft
ft.
See Consultants Log
ft.
ft
ft.
ft
ft
ft.
ft
ft
iL
ft.
C- d
S
ft.
it.
r4
21. REMARKS.,_: NOV ref s,"a r;
inxar=
(B.)
10. Static water level below top of casing: 7 (ft)
If water level is above casing, use "+"
11. Borehole diameter: 8.5 (in.)
auger
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
22. Certification:
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
136. Disinfection type: Amount:
Form GW-1
North Carolina Department of E
2725-A for Terry White
Signature q' eddied Well Contractor
By signing this farm, ;hereby cerify 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.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
246. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
11/19/17
Date
RECEIVED/NCDENR/DWR
Division of Water Resources, Underground Injection Control Program,
1636 Mall Service Center, Raleigh, N,f9gCl ++2yy76,,9(9n�-�177636
24c. For Water Supply & Iniection Wells: Tn�ad2Y i n k{/sbading the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the ryry alth, department of the county
where constructed.
yvazer uality Regional
Operations Section
ronmental Quality -Division of Water Resources Wilmington Regional Q a€hdz-22-zole

WELL CONSTRUCTION RECORD (GW-11
1. Well Contractor Information:
Donald Cummings
Well Contractor Name
2412-A
NC Well Contractor Certification Number
Applied Resource Management, P.C.
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (Le. 17IC, County, State, Variance, etc)
3. Well Use (check well use):
WP0291566
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
DMunicipaUPublic
XOResidential Water Supply (single)
DResidenfial Water Supply (shared)
Non -Water Supply Well:
Monitoring ®Recovery
Injection Well:
Aquifer Recharge - OGroundwaterRemediation
Aquifer Storage and Recovery DSalinity Barrier
Aquifer Test DStormwater Drainage
Experimental Technology DSubsidenceControl
Geothermal (Closed Loop) OTracer
Geothermal (Heating/Cooling Retum) flOther (explain under #21 Remarks)
4. Date Well(s) Completed: 1 1/3/17 Well ID# N/A
5a. Well Location:
Andy Simmons N/A
Facility/Owner Name Facility mg (if applicable)
2613 Middle Sound Loop Rd, Wilmington, NC 28405
Physical Address, City, and Zip
New Hanover R05100-006-013-000
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(Swell field, one lationg is sufficient)
34 15 07.6 N 77 47 23.8
W
6. Is(are) the well(s) xPermanent or DTemporary
7. Is this a repair to an existing well: ()Yes or 0No
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 fonn.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled: t
9. Total well depth below land surface: 180
For multiple wells list all depths if different (example- 3@200' and 2@1001)
10. Static water level below top of casing: 17
(ft.)
(ft.)
For Internal Use Only: e4L ise ,�® ,f
14. WATER ZONESFROM
TO
DESCRIPTION
ft.
fL
n
ft.
15. OUTER CASING (formalti-eased
wells) OR LINER .(if a ble)
FROM
TO
DIAMETER
THICKNESS MATERIAL
(PVC
0 ft
160 It
in•
SCH40
16. INNER
CASING OR TUBING
(geothermal closed loop) . .
FROM
TO
DIAMETER
THICKNESS
MATERIAL
150 ft
160 ft
2 in'
SCH40
PVC
ft.
ft.
in.
17.SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
160 ft
180 ft
2 1"
.020
SCH40
PVC
ft
ft
in.
18. GROUT '.`.._
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft'
30 ft•
Bentonite
Poured
ft.
ft.
f
19.SAND/GRAVEL
PACK
(if applicable) _.
FROM
TO
MATERIAL
EMPLACEMENT METHOD
It
ft
ft
R.
20. DRILLING
LOG (attach
additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, son/rock type, grain size, etc)
0 ft*
60 ft
Sandy clay to clay
60 ft
120 ft.
Limestone
120 D•
155 ft•
Clay with mudrock
155 ft.
180 ft•
Sandstone
ft.
It.
ft.
ft
NOV %, r 2017
21. REMARKS
0 - 105/8" 65-180/6" ,,.-,t znon "rncsx es.rig UM.
If water level is above casing, use "*"
11. Borehole diameter: See RemaQg(tn.)
12. Well construction method: Mud Rotary
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a..Yield (gpm) 60@1001 Method of test: Airlift
13b. Disinfection type: HTH Amount: 3%@10g
22. Certifica 'on:
Signe a of Certified Well Contractor
11/14/17
Date
By signing this farm. 1 hereby cart fy 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.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additionalpages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center,grpa���RpaIIlleeigiggg��h, NC 27699-1617p�61I�I
24b. For Iniection Wells: In additS M1N�H O o` inddress in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Under DE Cd inje tion Auntrol Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Su
the address(es) above, also submit, pp
completion of well construction to IN
where constructed.
& Iniectif on�t'fr. .ahPeng%
hbing the form to
ig 30 days of
of the county
Form GW-1
North Carolina Department of Environmental Quality - Division of Water Resources
Revised 2-22-2016

rint,For.
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Terry White, Jr
Well Contractor Name
3287-B
NC Well Contractor Certification Number
IET
Company Name
2. Well Construction Permit #:
List all applicable well constnection pe
3, Well Use (check well use):
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
hri:ation
Non -Water Supply Well:
;f Monitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
erimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
(i.e. UIC, County, State, Variance, etc)
0Municipal/Public
Residential Water Supply (single)
DResidential Water Supply (shared)
DGroundwater Remediation
0Sahnity Barrier
DStormwater Drainage
['Subsidence Control
DTmcer
Other (ex Main under #21 Remarks)
4. Date Well(s) Completed: 1 1 /06/17 Well ID# M W-5
5a. Well Location:
Modern Laundry
Facility/OxmerName Facility m# (if applicable)
3607 Oleander Dr, Wilmington 28403
Physical Address, City, and Zip
New Hanover
County
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one hit/long is sufficient) 34 12 56.06 N 77 54 10.65
Parcel Identification No. (PIN)
6. Is(are) the well(s)OPermanent or Temporary
7. Is this a repair to an existing well: ()Yes or No
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.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface: 15
For multiple wells list all depths if different (example- 3@200' and2@100)
10. Static water level below top of casing: 7
If waterlevel is above casing, use "+"
11. Borehole diameter: 8-5 (in.)
auger
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
(ft.)
For Internal Use Only: Li rs 1
n
14. WATER ZONES( -
FROM
TO
DESCRIPTION
7 D.
15 tt
sand
ft.
ft
15.OUTER CASING (for
multi -eased w4h)ORLINER .(if applicable)
FROM
TO
DIAMETER
THICKNESS MATERIAL
ft.
ft.
in.
1
16. INNER
CASING. OR TURING,(geothermal closed loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft
5 ft.
2 in
Sch40
PVC
ft
ft
m.
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
5 ft
15 ft.
2 in
0.010
Sch40
PVC
ft.
ft.
is
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0
1 ft
concrete
pour
1 ft.
3 ft
bentonite
pour
ft
ft
I9LSAND/GRAYELPACKOfapplicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
3 ft
15 it
#2 silica sand
pour through augers
ft
ft.
20. DRILLING
LOG (aua
hadditionnl she if note sary) - '-
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size etc)
a.
ft
See Consultant's Log
ft
ft
ft.
ft.
R,
ft.
ft.
D.
,^ r ', r 1,,y` 1�
ft^�..
G9"°,y
R.
ft
KQV 9).1 v1
tl
2ii REMARKS i�W
..< 1 1 p S 41_:.'-1t% .i1
22. Certification:
w711,1-14- /yam 2725-A for Terry White
Signature o cttdmd Well Contractor Date
By signing this four, 1 hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy of 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 well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
11/19/17
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method attest:
13b. Disinfection type: Amount:
24b. For Iniection Wells: In additio
above, also submit one copy of' this
construction to the following:
Division of Water Resources, UndergrreqmqppddriInke I}I J / of Program,
1636 Mail Service Center, Rhl h, 1WC t76RY IF636
�Rt}itditireason iofn 24a
ffii�6"��i�well
24c. For Water Sunni, & Iniection Wells: In addition to sending the form to
the address(es) above, also submit oneW rttbi 9le5inHP 30 days of
completion of well construction to the co itlkl gkaLtitt ptFt of the county
where constructed. Wilmington Regional Office
Form GW-1
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

w
For multiple wells list all depths ifdierent (example- 3@200' and 2@1001) „r':'F_.c`C
—v,I )(st UBron to the following:
10. Static water level below top of casing: (ft)
If water level is above casing, use"t' J�
11. Borehole diameter: `See RemaTr3(in.)
12. Well construction method: Mud Rotary
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 60 Method of test: Airlift
13b. Disinfection type: HTH Amount: 3%@109
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Donald Cummings
Well Contractor Name
2412-A
NC Well Contractor Certification Number
Applied Resource Management, P.C.
Company Name
2. Well Construction Permit ft:
WP0291569
List all applicable well construction permits (i.e. (AC, County, Stale, Variance, etc)
3. Well Use (check well use):
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
�Industrial/Commercial
Irrigation
Non -Water Supply Well:
Monitoring
@Municipal/Public
@Residential Water Supply (single)
@Residential Water Supply (shared)
@Recovery
Injection Welk
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
}Geothermal (Heating/Cooling Retum)
4. Date Well(s) Completed: 11/7/17
5a. Well Location:
S & W Builders
@Groundwater Remediation
()Salinity Barrier
@Stormwater Drainage
@Subsidence Control
@Tracer
@Other (explain under #21'Remarks)
Wen ID# N/A
N/A
Facility/Owner Name Facility DP (if applicable)
1211 Hellene Drive, Wilmington, NC 28409
Physical Address, City, and Zip
New Hanover R04400-003-165-000
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one latfiong is sufficient)
34 16 26.18 N 77 47 30.01
w
6. Is(are) the well(s)K Permanent or @Temporary
7. Is this a repair to an existing well: @Yes or t. No
Ifthis is a repair, fill out known well construction information and explain the nature of the
repair under 121 remarks section or on the back of this form.
"° §
8. For 6eaprob , 1 fl or Closed -Loop eglIn Geothermal Wells having the ep>Y es�„
construction, only 1 GW-1 is needed Indicate TOTAL NUMBER of wells
For Internal Use Only:
14. WATER ZONES ,
FROM
TO
DESCRIPTION
ft.
ft.
ft.H.
15. OUT CASING (for
mdti-cased wells) OR LINER (if a cable)
FROM
TO
DIAMETER
THICKNESS MATERIAL
0 h•
44 ft.
6 i"'
SCH40 PVC
16.. INNER
CASING OR TUBING
(geothermal el -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft'
50 ft
4 in•
SCH40
PVC
ft
ft.
in.
-:17. SCREEN-.;
FROM
TO
DIAMETER
SL
MOT SIZE
THICKNESS
MATT?RWL
fL
ft
io.
It.
ft
ID.
18 GROUT
FROM
TO
MATERIAL
EMPLACEMENT METH OD & AMOUNT
0 ft.
44 ft
Bentonite
Poured
ft.
ft
ft
t f
19. SAND/GRAVEL
PACK
(if applicable) -
FROM
TO
MATERIAL
EMPL. CEMENT METHOD
ft.
ft
ft.
ft
20. DRILLING
LOG tetfacll
additional sheets if necessary)
FROM
TO
DESCRIPTION (calor, hardness, soil/rock type, grain at, eta))
0 rt•
30 'H•
Sands/some-clays' -
30 ft•
35' ft.
Clays •
35 ft.
38 rt•
Sandiorange weathered limestone
38 ft
60 n•
Limestone (voids at 40' and 46')
ft.
ft.
ft.
(t.
ft..
I
2L REMARKS -
0-44/10" 44-60/6"
22.Ceei cation:
11/14/17
Signature of Certified Well Contractor: ... Date
By signing Ibis form, I hereby cen(i that the wells) +f (were) constructed in accordance
with 15A NCAC 02C .0100 or I5A NCAC 02C .0200 Well Construction 5tanderde and that a
copy of this record has been provided to the well owner.
r Site gaitTalikor additional well details:
bL3titay tine theback of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
drilled: t NOV PSI 11/3WAL INSTRUCTIONS
9. Total ell depth below land surface: 60 (ft.) Submit this form within 30 days of completion of well
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617 - 24b. For Iniection Wells: In add' IMEIONDIR/OVIIRaddress in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following. .C[ II��..:
Division of Water Resources, Undeai�kohnOl[fkL ln7erdi@44k'ontrol Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water SuDDIv & InieetionftWtsllsQijgtl rl({'egj finding the form to
the address(es) above, also submit oi@panati st6ec 6ti within 30 days of
completion of well construction tWli1/401a1g41111waspopeet of the county
where constructed.
Form GW-1
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

es'
WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
I. Well Contractor Information:
'Tames Mat Tr.
Well Contractor Name
3»a7A
NC Well Contractor Certification Number
Cascade Drilling, L.P.
Company Name
2. Well Construction Permit tl:
List all applicable well permits p.c. County, State
3. Web Use (check well use):
arlance, hyaena
eta./
Water Supply Well:
❑ Agricultural
OGeothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑Irrigation
❑Municipal/Public
❑ Residential Water Supply (single)
❑ Residential Water Supply (shared)
Non -Water Supply Web:
G9 Monitoring ❑Recovery
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑ Experimental Technology
❑ Geothermal (Closed Loop)
O Geothermal (Heating/Cooling Return)
❑Groundwater Remediation
❑Salinity Barrier
❑ Stormwater Drainage
❑ Subsidence Control
❑Tracer
❑Other (explain under ft21 Remarks)
4. Date Well(s) Completed: ®/J lig Well IDk 1�' tag
5a. Well Location:
Duke Energy/Plant Sutton
Facility/Owner Name
801 Sutton Stearn Plant Road, Wilmington, NC 28401
Facility IDN (if applicable)
Physical Address, City, and Zip
New Hanover County
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
N W
6. Is (are) the well(s): OPermanent or 1511 porary
7. Is this a repair to an existing well: Oyes or ONo If this is a repair, till can known well construction in/hrratian and explain the nature of Me
repair under 2/ remarks .seerimn or on the hackk of MA. form.
S. Number of wells constructed: /
hint multiple injection or nun-wawr supply wells ONLY with the same construction, pm can
.submit one firm.
9. Total well depth below land surface: .
For multiple walls list all depths if'Vixen, (example- 3@200' and 2@/00)
10. Static water level below top of casing:
If water fatal is above casing, use ", "
11. Borehole diameter: b (in.)
12. Well construction method: /OM 6
(i.e. auger, rotary, cable, direct push, etc.)
(ft.)
(ft.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
For Internal Use ONLY: 446767
' TER ZONIiS
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
tc. otrtt`R CA81140 (far o9uthc-
tl spells) i 21401 RPPtietAbin)
FROM
TO
DIAMETER THICKNESS MATERIAL
ft
ft.
in.
10, INNER
CASING Ott tUkiNG°faro
terms) ctospd-)Qnp) .....
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
ft.
ft.
in.
t7:SCREEdN
FROM
TO
SLOT SIZE
THICKNESS
MATERIAL
n ft.fA
7
I ft
..�DDIIAMETER
ifs m.
s�
I o! ®
ate *®
We-
h.
ft
in.
ItGRUUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
ft.-
n. ft.
19-SAND/GRAYt L PACK
Of riPVtie96le)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
eq R.
1 ft
fate l
ft.
ft.
20. DRILLING
LOG (a#taf
h,ad4Hiogal attests itneceaaary)
FROM
TO
DESCRIPTION (eetor, hardness, soil/rock type, grain sire, etc.)
ft.
ft.
ft.
H.
ft.
ft.
ft.
D.
ft.
ft.
ft.
if.
it
f� p g °-�
RF
rfe(s"�,"&\iFDa,
24'-REMARI(S ..
NOV ! $ 2097
22. Certification:
Information Prot
OWC,MOCi
nnactat
Untt
ga9v7
By signing this prin. 1 hereby certify that the me//Gs1 was (mere) constructed in accordance
with ISA NCIAC 02C .0100 or /SA NCAC 02e .0200 Weil Construction Smmdards arrd that a
eons aphis record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this pace . wAdgtgddrt(q gl a® •tRdetails or well
construction details. You may alse,'kj_ (((��kk�lb�h���9++ g$$s''r`iYnecessary.
SUBMITTAL INSTUCTIONS ts��fp� 99((�� 77
24a. For All Wells: Submit this f'orn{v' {in6bWd2N�1' completion of well
construction to the following:
Division of Water Resoureseiss lg tCr4 jjprjgEgQP636ig Unit,
1617 Mail Service Cent �e Na 9J342%ll617
24b, For Iniection Wells ONLY: Wi UdItn Q9 J R8141DNaheioll ()tflC2
g m [o the address in
24a above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply Sr Injection Wells:
Also submit one copy of this form within 30 days of completion of
well construction to the county health department of the county where
constructed
Farm GW-I
Noah Carolina Department of Environment a
d Natural Resources— Division of Water Resources Revised August 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
I. Well Contractor Information:
zrames Ncu t 5re
Well Contractor Name
3aavi
NC Well Contractor Cenification Number
Cascade Drilling, L.P.
For Internal Use ONLY:
446i6r
4, WATERZONES
FROM
ft.
TO
ft.
DESCRIPTION
R.
ft.
it,£ OUTER CAS/ND (for <a
FROM TO
ft.
DIAMETER
in.
Company Name
2. Well Construction Permit it:
List all applicable well permits (i.e. Coutuy Smte, Variance, Injection, etc)
3. Well Use (check well use):
Water Supply Well:
°Agricultural
o Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑Irrigation
❑ Municipal/Public
❑ Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
Monitoring - ❑Recovery
Injection Well:
❑ Aquifer Recharge
❑Aquifer Storage and. Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑ Geothermal (Heating/Cooling Return)
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑ Subsidence Control
°Tracer
❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: 2 fa / rR Well IDk / 2t9 L_ r7,5
5a. Well Location:
Duke Energy/Plant Sutton
Facility/Owner Name Facility ID# (if applicable)
801 Sutton Steam Plant Road, Wilmington, NC 28401
Physical Address, City, and Zip
New Hanover County
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
Of well field, one lat/long is sufficient)
N w
6. Is (are) the well(s): °Permanent or I7rfemporary
7. Is this a repair to an existing well: °Yes or El No
lithir is a repair, Jill out known well construction information and explain the nature of the
repair under ::21 remarks section or an the back of this/arm.
8. Number of wells constructed:
!fir multiple tn/ection or non -water supply wells ONLY with the same construction, yrnt can
submit one Imo. 9. Total well depth below land surface: Id
For multiple wells list all depths ifdiffarent (example- 3@200' and 2©100')
10. Static water level below top of casing:
If water level is above easing, use /
1 I. Borehole diameter: 4(in)
504/C
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
(ft.)
(ft.)
FOR WATER SUPPLY WELLS ONLY:
I3a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
FROM
IER CASR3ao
ft.
TO
ft.
DIAMETER
in
THICKNESS
THIESS I MATERIAL
IgsRdrloop)
THICKNESS 1 MATERIAL
ft.
in.
17.SCREEN
FROM
TO
ea ft.
ft.
d ft.
°ROUT
FROM
ft.
TO
ft.
DIAMETER
in.
SLOT SIZE
rdlD
THICKNESS
sc40
MATERIAL
Pit
MATERIAL
EMPLACEMENT METHOD &AMOUNT
ft.
ft.
1 SAND 1
ft.
ft.
9. AYELP
FROM
ft. . ft.
ft.
zo.orucu
PROM
ft.
TO
AC (if
H.
MATERIAL
j4na'
EMPLACEMENT METHOD
Li
TO
9f.Sts
DESCRIPTION (color, hardness, soil/rook type, grain size, et
ft.
h.
ft.
ft.
fr.
ft.
ft.
fl.
ft.
qmx
R.
It.
NOV 2017
inforrnegion Processing Unit
DWCYBOG
22. Certification:
S igI
1 o for Date
By .signing this form, 1 hereby certijj, that the well(,) uns (were) constructed in accordance
aids lid Wi'AIT 02C .0100 br hid NCAC 02C .0200 Well Construction Standurdc and that a
copy of this record has been provided m the wet/ owner.
23. Site diagram or additional well details
You may use the back of this page to provl0�ooii t luQlt',Mi Num well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
7
24a. For All Wells: Submit this form within 300 days of c m�pletion of well
construction to the following:
Division of Water Resources, InfOP rmINiitEsali lD6i�l
1617 Mail Service Center, Raw liN@S4 $Bftlon
I rnington Regional Office
24b. For Infection Wells ONLY: In addition to sending the form to the address in
24a above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells:
Also submit one copy of this form within 30 days of completion of
well construction to the county health department of the county where
constructed
Farm GW-I
North Carolina Department of Environment a d Natural Resonmes— Division of'Water Resources Revised August 2013

r ;tilt Anna
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Donald Cummings
Well Contractor Name
2412-A
NC Well Contractor Certification Number
Applied Resource Management, P.C.
Company Name
2. Well Construction Permit#:
List all applicable well construction permits (Le. (AC, County. State, Variance, eta)
3. Well Use (check well use):
N/A
Water Supply Well:
Agricultural DMunicipal/Public
Geothermal (Heating/Cooling Supply) Residential Water Supply (single)
Industrial/Commercial DResidential Water Supply (shared)
- Irrigation
Non -Water Supply Well:
Monitoring
Recovery
Injection Welt:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Retum)
4. Date Well(s) Completed: 11/3/17
5a. Well Location:
Toledo Carolina
Groundwater Remediation
Salinity Barrier
oStormwater Drainage
QSubsidence Control
fTracer
(Other (explain under #21 Remarks)
Well ID# N/A
N/A
Facility/Owner Name Facility ID# (if applicable)
2915 Blue Clay Road, Castle Hayne NC 28429
Physical Address, City, and Zip
New Hanover
R03312-003-031-000
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one tat/long is sufficient)
34 17 30.55 N 77 54 35.01
6. Is(are) the well(s) x Permanent or DTemporary
7. le this a repair to an existing well: ()Yes or ©x No
If this is a repair, fill out known well construction information and explain the nature of the
repair under a1/ remarks section or on the back of this form.
S. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled: 1
9. Total well depth below land surface: 13
For multiple wells list all depths if different (example- 3@200' and 2@100')
W
(ft.)
10. Static water level below top of casing: 4' 51 (ft.)
If water level is above casing, use "+"
$ n
11. Borehole diameter: (in.)
12. Well construction method: Mud Rotary
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) N/A Method of test: N/A
13b. Disinfection type: N/A Amount: N/A
1-
For Internal Use Only:
446736
14. WATER ZONES:;
FROM
TO
DESCRIPTION
ft.
H.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (ifa ble)
FROM
TO
DIAMETER
THICKNESS MATERIAL
0 ft.
3 ft.
2 i°-
SCH40 PVC
16. INNER
CAShNG.OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft
fL
in.
ft.
ft.
is
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
3 fL
13 ft-
2 ia-
.010
SCH40
PVC
ft
ft.
in.
1E. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0.1 ft'
0.3 ft-
Grout
Poured
.3 fL
1.5 ft-
Bentonite
Poured
rt.
ft.
19.SANDIGRAVEL
PACK
(if applicable) -- - -.
FROM
TO
MATERIAL
EMPLACEMENT METHOD
1.5 IL
1.5 sL
Coarse
Poured
ft.
ft.
20. DRILLING
LOG (attach
additional sheers if necessary)
FROM
TO
DESCRIPTION Dolor. hardnessrsoiamrk type, grain svq etc.)
ft.
ft.
See Attached
ft.
ft.
ft.
ft.
ft.
ft.
RECEIVE
ft.
ft.
ft.
ft.
NOV 1 4 2097
ft.
ft.
2L REMARKS - - information f rocat'a[TS) Ut , '.
Dwo,e c)G
22. t ertifiication:
citified Well Contractor
11/3/17
Date
By signing this form, 1 hereby cart fy that the *Wks) was (were) consiruded in accordance
with I5A 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.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS RECEIVE®/NCpEPd /
24a. For All Wells: Submit this form within 30 days of co�fPJWJ of well
construction to the following:
Division of Water Resources, Info (t fioW' fir c011ug Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to E
above, also submit one copy of this ft
construction to the following:
it {(pry 9 the address in 24a
(i7 llerid g5,Ayj, oif3�tletion of well
.on
Pam.-,.'., - . , r.
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW-1
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

TOLEDO CAROLINA
2915 BLUE CLAY ROAD
WILMINGTON, NC
MW-18R
Drilled by: Applied Resource Management, P.C.
Logged by: J. Zuncich
Date: 11/03/17
0-10
Medium gray to brown orange, clean backfill sand material.
Moderate
Grab
10 -13
Medium gray, silty clay changing to slightly clayey fine sands.
Minor hydrocarbon odor present.
High
HP
HP - Hydraulic Push

11.5' Sand
MWR-1 8R
Locking Well Cap
Steel Manhole ___ 0.3' Concrete/Grout Crown
Ground Surface
1.2' Bentonite
1
%
3' Riser
•_.•••
_•••
.,.,. --,••❖•,
,.,.,.:_i,.,•; ,
••'•'•—'••••••
Groundwater 2S*
•••Table hN••,,•
,•,•1--II••••••
•••,••_1••• •.i
.,.,.i- ,,.11 ,•.i
•.i-•••
►••••• *••••••
i•�•�•� ::::::•.
C.,.,•1-e,•,•,*
•••••�'••••••
• • • - 1 . • •
� •••••• • I ••••••
!•••••' • _1 •••••
•••••� -C••••••
f•-0I-4•••.
I•41•••.•-�•�••*••I
•0•9•� _••••••'
1•• ••• - I•• •••
�•
t•••••�••,--a••••••'
•••••••i
• • • • • 0 • 4
10' Screen
13' Total Depth