GW1 - Onslow July-May 2017

NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2314A
1. WELL CONTRACTOR:
DAVID L REGISTER
Well Contractor (Individual) Name
REGISTER WELL CO.. INC.
Well Contractor Company Name
721 WEST CHARITY ROAD
Street Address
ROSE HILL
City or Town
(910 ) 289-3175
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT*
State
445357
: d. TOP OF CASING IS 1.5 FT. Above Land Surface*
*Top of casing terminated at/or below land surface may require
• a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 50 METHOD OF TEST AIR
• f. DISINFECTION: Type HTH Amount 4 07
: g. WATER ZONES (depth):
NO 28458 : Top Bottom Top Bottom
:• Top Bottom Top Bottom
Top Bottom Top Bottom
•
Zip Code
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Monitoring 0 Municipal/Public 0
Industrial/Commercial 0 Agricultural 0 Recovery 0 Injection 0
Irrigation[i Other 0 (list use)
DATE DRILLED 06-29-2017
4. WELL LOCATION:
HWY 24
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: RICHLANDS- coUNTY ONSLOW
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
0Slope ['Walley EifFlat 0 Ridge 00ther
LATITUDE • ° " DMS OR 34.905335 DD
LONGITUDE " DMS OR -77.561942 DD
Latitude/longitude source: 3PS Dtropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
S. FACILITY (Name of the business where the well is located.)
1 IRFRTY ACADEMY
Facility Name
HWY 24
Street Address
RIC,HI ANDS
City or Town
LI ERTY ACADEMY
Contact Name
sp.
Facility ID# (if applicable)
NC 28574
State Zip Code
Mailing Address
City or Town
( )
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 300
State Zip Code
JUL 2 7 2017
b. DOES WELL REPLACE EXISTING vvg447,_ YES la NO Gi
c. WATER LEVEL Below Top of Casing: f I FT.
(Use "+" if Above Top of Casing)
7. CASING: Depth
Thickness/
Diameter Weight Material
: Top 0 Bottom 240 Ft. 4 40 PVC
Top Bottom Ft.
:• Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom 20 Ft HOLE PLUG POURED
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
:• Top 240 Bottom 300 Ft. 4 in. .016 in. PVC
••• Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
: 10. SAND/GRAVEL PACK:
Depth Size Material
: Top 230 Bottom 317 Ft. #1 GRAVEL
Top Bottom Ft.
Top Bottom Ft.
: 11. DRILLING LOG
: Top Bottom
• • 224 / 227
•
•
227 / 233
233 / 239
239 / 244
244 / 247
247 / 255
255 / 256
256 / 260
260 / 261
261 / 264
Formation Description
ROCK 30"
SAND (MED)
SAND AND CLAY
SAND (FINE)
ROCK 30"
SAND (MED FINE)
ROCK 15"
SAND (MED FINE)
ROCK 4"
SAND (MED)
264 / 268 ROCK AND SAND
: 12. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCA 2C, WELL CONSTRUCT111' (Sir *if OF THIS
• RECO AS BEEN P VIDED
• eLLAC4
SIGNATURE OF CERTIFIED WE CO TRACTOR
• „
DAVID L. REGISTEiLit._ 31 2017-‹
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Water Quality Regional
Operations Section
Submit within 30 days of completion to: Division of VVater Quality - Information Pro.
Wi cy Regional Office Form GW-lb
Rev. 2/09
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
7-20-17
DATE

NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2314A
I. WELL CONTRACTOR:
DAVID L REGISTER
Well Contractor (Individual) Name
REGISTER WELL CO.. INC.
Well Contractor Company Name
721 WEST CHARITY ROAD
Street Address
ROSE HILL
City or Town
(910 ) 289-3175
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
NC 28458
State Zip Code
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Monitoring E Municipal/Public EI
Industrial/Commercial D Agricultural 0 Recovery D Injection El
Irrigatiod Other El (list use)
DATE DRILLED 06-29-2017
4. WELL LOCATION:
WY 24
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: RICHLANDS COUNTY ONSLOW
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
CISlope OValley rFlat El Ridge 00ther
LATITUDE 0 " DMS oR 34.905335 DD
LONGITUDE " DMS OR -77.561942 DD
Latitude/longitude source: aGPS CliTopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
LIBERTY ACADEMY
Facility Name
HWY 74
Street Address
RICH' ANDS
City or Town
LIRFRTY ACADFMY
Contact Name
Facility ID# (if applicable)
NC 28574
State Zip Code
Mailing Address
City or Town
)
Area code Phone number
6. WELL DETAILS:
State Zip Code
JUL 2 7 2017
a. TOTAL DEPTH: 300
U
b. DOES WELL REPLACE EXISTING WELL? VSA
c. WATER LEVEL Below Top of Casing: 77
(Use "+" if Above Top of Casing)
FT.
.145356
: d. TOP OF CASING IS 1.5 FT. Above Land Surface*
*Top of casing terminated at/or below land surface may require
• a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 50 METHOD OF TEST AIR
f. DISINFECTION: Type HTH Amount 4 07
:. g. WATER ZONES (depth):
: Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
Diameter Weight Material
:• Top 0 Bottom 240 Ft. 4 40 PVC
:* Top Bottom Ft.
Top Bottom Ft.
7. CASING: Depth
8. GROUT: Depth
Material Method
Top 0 Bottom 20 Ft. HOLE PLUG POURED
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size
Top 240 Bottom 300 Ft. 4 in. .016
Top Bottom Ft. in.
Top Bottom Ft. in.
: 10. SAND/GRAVEL PACK:
Depth
: Top 230 Bottom 317 Ft.
Top Bottom Ft.
Top Bottom Ft.
: 11. DRILLING LOG
: Top Bottom
0 / 19
19 / 40
40 / 50
50 / 61
61 / 62
62 / 77
77 / 105
Size
#1
Material
in. PVC
in.
in.
Material
GRAVEL
Formation Description
CLAY
SAND
SAND AND CLAY
CLAY
ROCK 3"
CLAY
ROCK AND SAND
105 / 145 CLAY
145 / 165 SAND AND CLAY
165 / 216 CLAY
216 / 224 SAND AND CLAY
12. REMARKS:
RECEIVED/NCIDENR/OVIN
: I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS .AND THAT A2C67,( OF THIS
• RECO"a HAS BE2OVI DE TO THE L W...7 R. 3 1
a _.
DAVID L. REGISTF •
SIGNATURE OF CERTIFIED WRuEL topNerTrauiRtuAioaCnTlisty0sRRecegtiinonn7a2D9i.E17
4r (
PRINTED NAME OF PERSON CY011Agittgefiltiegraai/Mbe
•
Submit Within 30 days of completion to: Division of Water Quality Information Processing,
1617 Mall Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GW-1 b
Rev. 2/09

c. WATER LEVEL Below Top of Casing: 77 FT.
(Use "+" if Above Top of Casing)
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2314A
1. WELL CONTRACTOR:
DAVID L REGISTER
Well Contractor (Individual) Name
REGISTER WELL CO„ INC.
Well Contractor Company Name
721 WEST CHARITY ROAD
Street Address
ROSE HILL
City or Town
(910 ) 289-3175
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
NC
State
28458
Zip Code
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Monitoring 0 Municipal/Public 0
Industrial/Commercial 0 Agricultural 0 Recovery 0 Injection 0
IrrigationCi Other 0 (list use)
DATE DRILLED 06-29-2017
4. WELL LOCATION:
HWY 24
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: RICHLANDS COUNTY ONSLOW
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ['Valley iiifFlat ❑Ridge ❑Other
LATITUDE "DMS OR 34.905335 DD
LONGITUDE " DMS OR -77.561942 DD
Latitude/longitude source: VGPS ❑Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
I RF RTY ACADEMY
Facility Name
HWY 94
Street Address
Facility ID# (if applicable)
City or Town
Li IE RTY ACADEMY
Contact Name
State
Zip Code
Mailing Address
City or Town
)
Area code Phone number
6. ':i'YELL DETAILS:
4453t
: d. TOP OF CASING IS 1.5 FT. Above Land Surface*
*Top of casing terminated at/or below land surface may require
•
:• a variance in accordance with 15A NCAC 2C .0118.
: e. YIELD (gpm): 50 METHOD OF TEST AIR
• f. DISINFECTION: Type HTH Amount 4 07
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
: Top 0 Bottom 240 Ft. 4 40 PVC
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth
Top 0 Bottom 20
Top Bottom
Top Bottom
Material
Ft. HOLE PLUG
Ft.
Ft.
Method
POURED
9. SCREEN: Depth Diameter Slot Size Material
Top 240 Bottom 300 Ft. 4 in. .016 in. PVC
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
: Top 230 Bottom 317
Top Bottom
Top Bottom
11. DRILLING LOG
: Top Bottom
•
• 268
•
•
•
•
•
277
280
288
289
298
299
302
310
311
317
Size
Ft. #1
Ft.
Ft.
Material
GRAVEL
Formation Description
/ 277 SAND (MED FINE)
/ 280 ROCK AND $AN D
/ 288 SAND (MED FINE)
/ 289 ROCK 6"
/ 298 SAND (MED FINE)
/ 299 ROCK 18"
/ 302 SAND (FINE)
/ 310 SAND AND CLAY
/ 311 ROCK 3" '
/ 317 SAND (VERY FINE)
/ ROCK
State nLip Co o. .� T,,
12. REMARKS.
JUL.., . RECEIVED/NCIDEN WITH
2017 . I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCOR
: 15A NC L_ 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
a. TOTAL DEPTH: 300 {.••s`1 REC�-' AS BEEN P' �VIDED T THE WEL OWNER.
b. DOES WELL REPLACE EXISTING WELL? YES-0— 'NO - bilitO 1 •_ 2O12O-i7
• SIGNATURE OF CERTIFIED WELL TRACTOR DATE
DAVID L. REGISTER Water Quality Regional
PRINTED NAME OF PERSON CONSTRUMiti0111560ffibh
WWilmington Regional Office
Submit within 30 days of completion to: Division of Water Quality Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GW-lb
Rev. 2/09

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1, Well Contractor Information:
Jeffery A. Stewart
Well Contractor Name
(NCWC) 2540-A
NC Well Contractor Certification Number
Mid -Atlantic Drilling, INC
Company Name
2 Well Construction Permit #:
0.0 ft-
List all applicable well permits (i.e. County, State, Variance, Injections, etc.)
3. Well Use (check well use):
Water Supply Well:
CI Agricultural
❑Geothermal (Heating/Cooling Supply)
D Industrial/Commercial
D irrigation
Non -Water Supply Wen:
©Monitoring
Injection Well:
❑Aquifer Recharge
ClAquifer Storage and Recovery
°Aquifer Test
❑Experimental Technology
°Geothermal (Closed Loop)
DGeothermal Heatin: Coolin: Return
4. Date Well(s) Completed: • 6/15/201
❑Municipal/Public
°Residential Water Supply (single)
°Residential Water Supply (shared)
❑Recovery
❑Groundwater Remediation
°Salinity Barrier
Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other ex . lain under #21 Remarks)
7wen ID# UST-FC39-TW12
5a. Well Location:
Commanding General USMC NA
Facility/Owner Name Facility 1Dl# (if applicable)
Sneads
FerryRd. Camp Lejeune, NC, 28547
Physical Address, City, and Zip
Onslow County
County
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(dwell field, one lat/long is sufficient)
No Coordinates No Coordinates w
N
NA
For Internal Use ONLY:
452oo
14. WATER ZONES
FROM TO
2.10 ft. 11.3
ft.
ft.
ft.
DESCRIPTION
Water level collected at 24 hrs.
15� OUTER CASING (for multi -cased wells) OR LINER (if applicable)
FROM TO DIAMETER THICKNESS MATERIAL
NA ft, NA in. NA NA
NA ft.
16. INNER GAS1NG OR TUBING :eothermal closed -loop)
FROM TO DIAMETER THICKNESS
Sch 40
11.3 ft.
Parcel Identification No. (PIN)
ft.
ft.
1
in.
MATERIAL
PVC
17. SCREEN,
6. Is (are) the well(s): ❑Permanent or (Temporary
7. Is this a repair to an existing well: ❑Yes or E]No
If this is a repair, fill out known well construction information and explain the nature of the
repair under i/21 remarks section or on the back of this form.
s constructed: 1
S. Number of well
For multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
11
9. Total well depth below land surface:
For multiple wells list all depths if different (example- 3@200' and 2@100')
2.10
10. Static water level below top of casing:
If water level is above casing use "+"
11. Borehole diameter: 2 (in.)
° Direct push technology
12. Well construction method: (i.e. auger, rotary, cable, direct push, etc.)
0.0 ft. 0.65
0.65 ft. 11.3
20. DRILLING. LOG
0.0 ft.
TO
9.0
TO
11.3 ft.
ft.
DIAMETER
1
in.
SLOT TS SIZE
.010
19. SAND/GRAVEL PACK (if applicable)
FROM 1 TO MATERIAL
ft.
Hole Plug 3/8" Chips
THICKNESS MATERIAL
Sch 40
PVC
EMPLACEMENT METHOD
Hand pour
ft.
# Filter Sand
Hand pour
attach additional sheets' if necessa
DESCRIPTION (color, hardness? soil/rock tape, grain size, etc.)
ft.
9.0 ft.
ft.
(ft.)
ft.
ft.
12.0
ft.
ft.
ft.
ft.
Clayey sand, SC, tan/gray, dry to moist
Sandy, gray, saturated
(ft.)
ft.
ft.
ft.
ft.
0 20
21. REMARKS`
22. Certification:
Signa f ifeed Contractor Date
By signing this form, 1 hereby certify that the well(,) was (were) constructed in accordance
with 1 SA 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 wen details: well site details or well
You may use the back of this page to provide additional
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS.
24a. For All Wells:; this form within 30 days of completion of well
nstruetio to the foil ��' v�d��
Division of Water Resources, Information Processing Unit,
1617 Mail Serv}}' Center, Raleigh, NC 27699-1617
JUL
gtQa
in
• tdfilto sending the form to the address
24b. For Injection Wells ONLY°
24a above, also submit a copy of this form within 30 days of completion of well
construction to the follo�4lje r uali ,r Regional
Division of Waj ; ��0 ;; bowl Injection Control Program,
Mali ' 1. _ 19 i C 27699-1636
� 636 M �
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.
FOR WATER SUPPLY WELLS ONLY:
Method of test:
Amount:
13a. Yield (gpm)
13b. Disinfection type:
Form GW-1
North Carolina Department of Environment and Natural Resources - Division of Water Resources
Revised. August 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
Jeffery A. Stewart
Well Contractor Name
(NCWC) 2544-A
NC Well Contractor Certification Number
Mid -Atlantic Drilling, INC
Company Name
2. Well Construction Permit #: _
List all applicable well permits (►.e. County, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
(Geothermal (Heating/Cooling Supply)
❑Industrial/Commercial
°Irrigation
Non -Water Supply Well:
RIMonitoring
Injection Well:
OAquifer Recharge
O Aquifer Storage and Recovery
❑Aquifer Test
°Experimental Technology
❑Geothermal (Closed Loop)
°Geothermal (Heating/Cooling Return)
DMunicipal/Public
°Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Recovery
°Groundwater Remediation.
°Salinity Barrier
DStormwater Drainage
DSubsidence Control
❑Tracer
❑Other (explain under #21 Remarks)
For Internal Use ONLY:
6/16/2017,�,ell YD# UST-FC39-TW15
4. Date Well(s) Completed:
5a. Well Location:
Commanding General LUSMC NA
Facility/Owner Name Facility ID# (if applicable)
Sneads FerryRd. Camp Lejeune, NC, 28547
Physical Address, City, and Zip
Onsiow County
County
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
a Coordinates No Coordinates
N N
NA
FROM
14. WATER ONES
TO DESCRIPTION
445199
1.94 ft.
FROM
ft.
6.5 ft.
ft.
Water level collected at 24 hrs.
1S O TER CASING (for multi -cased wells) OR LINER (if applicable)
THICKNESS T MATERIAL
TO
NA ft. f NA
ft.
DIAMETER
NA
in.
NA
NA
16. INNER C; CASING OR TUBING ;(geothermal closed -loop)
FROM TO DIAMETER THICKNESS
0.0 ft. 6.5 ft- 1 in. Sch 40
in.
ft.
ft.
MATERIAL
Parcel Identification No_ (PIN)
6. Is (are) the well(s): °Permanent or {.Temporary
7. Is this a repair to an existing well: (Yes or CINo
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. Number of wells constructed: •-----�-
For multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
1 depth below land surface: 6
9. 'Total weip
(ft.)
For multiple wells list all depths if different (example- 3@200' 200' and 2@100')
topof casing: 1 ' 94 (ft.)
10. Static water level below
If water level is above casing, use "+ "
11. Borehole diameter: 2 (in.)
17.SCREEN
FROM TO
1.5 ft. 6.5 ft.
DIAMETER
in.
ft.
18. GROUT
FROM TO
NA ft.
NA
ft.
ft.
in.
MATERIAL
NA
SLOT SIZE
.010
ft.
ft.
PVC
THICKNESS
Sch 40
MATERIAL
PVC
EMPLACEMENT METHOD & AMOUNT
NA
ft. ft.
1Y. an..t.,.,,ti
x i•,-• _ •_"-,,_,
TO
__ - -
MATERIAL
EMPLACEMENT METHODFROM
Hand Pour
0.0
ft.
Q.755
ft'
Hole Plug 3/8" Chips
0.75
ft-
6.5
ft.
# Filter Sand
Hand Pour
20.'DRI.LLING LOG
FROM
0.0 ft.
TO
8.0
attach additional sheets rf necessur
DESCRIPTION (color,- hardness, soil/rock type, grain size, etc.)
ft.
Clayey sand,SC, tan, dry to saturated
ft.
ft.
Direct Push Technology
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
ft.
ft.
ft. ft.
ft. ft.
ft.
ft.
ft.
ft.
21. REMARKS
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
Amount: _
13b. Disinfection type:
Form GW-1
22. Certification:
Signa
By signing this for»:, 1 hereby certify that the well(s) was (were) constructed in accordance
with 154 NCAC 02C .0100 or /5A 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: site details or well
You may use the back of this page to provide additional wel
l. construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
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
MN/; 7 �WRo the address in
24b. For Infection Wells ONLY:
24a above, also submit a copy of this form within 30 days of completion of well
construction to the following:
<`t iti
JUL 2 0 2017
•
icwia,a
1111111
ied W Contractor Date
• • • nde JUL2 rn cum ontrol Program,
Division of Water Resources, U rg
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection NOkiiiter Quality Regional
Also submit one copy of this forrcoyi.t eSe r tion of
the countyn 1 e here
well construction to h
constructed.
North Carolina Department of Environment and Natural Resources - Division of Water Resources
Revised August 2013

WELL CONSTRUCTION RECORD
Thus form can be used for single or multiple wells
1. Well Contractor Information:
Jeffery A. Stewart
Well Contractor Name
(NCWC) 2540-A
NC Well Contractor Certification Number
Mid -Atlantic Drilling, INC
Company Name
2. Well Construction Permit #: _' a Variance, Injection, etc.)
List all applicable well permits (i.e. County, State, 1
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
°Geothermal (Heating/Cooling Supply)
❑Industrial/Commercial
❑Irrigation
Non -Water Supply Well:
E?iMonitoring
°Municipal/Public
°Residential Water Supply (single)
°Residential Water Supply (shared)
For Internal Use ONLY:
445198
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
°Aquifer Test
°Experimental Technology
❑Geothermal (Closed Loop)
°Geothermal (Heatin Cooling Return
❑Recovery
14 WATER ZONES FROM TO DESCRIPTION
Water level collected at 24 hrs.
1.94 ft.
NA
ft.
6.5 ft.
ft.
15. OUTER CASING (for nndti-cased;wells) OR LINER (if applicable)
FROM TO DIAMETER I THICKNESS MATERIAL
ft. NA f NA NA NA
16. INNER CASING OR TUBING
FROM" TO DIAMETERTHICKNESS
0.0 ft. 6.5 ft' 1 in* Sch 40
in.
❑Groundwater Remediation.
❑Salinity Barrier
°Stormwater Drainage
°Subsidence Control
❑Tracer
°Other ex • lain under #21 Remarks)
6/16/2017,�,el1ID# UST-FC39-TVIl15
4. Date Well(s) Completed.
53. Well Location:
Commanding General USMG NA
Facility/Owner Name Facility ID# (if applicable)
FerryRd.Camp Lejeune,
Sneads NC, 28547 - --
Physical Address, City, and Zip
Onslow County
County
NA
ft.
ft.
eothermal` closed -loop)
MATERIAL
PVC
17.SCREEN'
FROM
Parcel Identification No. (PIN)
513. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(dwell field, one lat/long is sufficient)
No Coordinates No Coordinates
N
6. Is (are) the well(s): °Permanent or [Temporary
7. Is this a repair to an existing well: °Yes or E3No
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.
Number of welts constructed:
8. can
For multiple injection or non -water supply wells ONLY with the sante construction, you
submit one form.
(ft.)
below land surface:-
6.5
9. Total well. depth
For multiple wells list all depths if different (example- 3@200' and 2(c"�.100')
1.94 (ft.)10. Static water level below top of casing:
If water level is above casing use "+"
11. Borehole diameter: 2 �.,...... (in.)
Direct Push Technology
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
1.5 ft'
TO
6.5
ft.
DIAMETER
1
SLOT SIZE
THICKNESS
MATERIAL
in.
.010
Sch 40
PVC
ft.
ft.
18. GROUT
FROM
NA
ft..
ft.
ft.
TO
NA ft'
ft.
ft.
in.
'MATERIAL
NA
EMPLACEMENT METHOD & AMOUNT
NA
19. SAND/GRAVEL PACK (if applicable)
FROM TO MATERIAL
0.0 ft. 0.75
0.75 ft- 6.5
20. DRILLING LOG (attach additional sheets if necessary) size, etc.)
DESCRIPTION (color, hardness, soil/rock type, grain
EMPLACEMENT METHOD
Hand Pour
Hand Pour
FROM TO
0.0 ft- 8.0
ft.
ft.
ft.
Hole Plug 3/8" Chips
# Filter Sand
Clayey sand,SC, tan, dry to saturated
ft. ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21.. REMARKS
TUJL
2017
22. Certification:
Signa of " ied / 11 Contractor
By signing si in this form, I hereby certify that the well(.) was (were) constructed in�accordanaccordance
with 1.5A. 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 ofthis page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the followi f''ECEIVEDMCDENR/p Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection
Wells ONL4 n a o O1 riding 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 followinaer QUaj j�� �,
Hal
Y g
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type:... Amount:
Form GW-1
e
Date
Division of Water son Rll • is 4:lection Control Program,
1636 Mail ran ti e a - j - .Z 699-1636
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.
North Carolina Department of Environment and Natural Resources - Division of Water Resources
Revised August 2013

WELL CONSTRUCTION RECORD
This form can be used for single of multiple wells
1. Well Contractor Information:
Jeffery A. Stewart
Well Contractor Name
(NCWC) 2540-A
NC Well Contractor Certification Number
Mid -Atlantic Drilling, INC
Company Name
2. Well Construction Permit #:
List all applicable well permits (i.e. County, State, Variance, Injection, etc.)
3. Well Use (check well use):
For Internal Use ONLY:
Water Supply Well:
❑Agricultural
DGeothermal (Heating/Cooling Supply)
D Industrial/Commercial
Dim ation
Non -Water Supply Well:
L Monitoring
Injection Well:
DAquifer Recharge
['Aquifer Storage and Recovery
['Aquifer Test
DExperirnental Technology
['Geothermal (Closed Loop)
['Geothermal (Heating/Cooling Return)
4. Date W ell(s) Completed: 6/15/201
5a. Well Location:
Commanding General USMC NA
ClMunicipal/Public
[Residential Water Supply (single)
[Residential Water Supply (shared)
['Recovery
°Groundwater. Remediation
['Salinity Barrier.
O Stormwater Drainage
❑Subsidence Control
[Tracer
['Other (explain under #21 Remarks)
?well ID# UST-FC39-TW13
Facility/Owner Name Facility ID* (if applicable)
Sneads
FerryRd. Camp Lejeune, NC, 28547
Physical Address, City, and Zip
Onslow County
NA
Parcel Identification No. (PIN)
County
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
Na Coordinates No Coordinates
N
FROM
2.05 ft.
445197
14. WATER ZONES DESCRIPTION
aN ~-"
ft. Water level collected at 24 hrs.
11.3
ft. ft.
15. OUTER CASING (for multi -cased wells) OR LINER(if applicable FROM TO DIAMETER THICKNESS MATERIAL.
NA ft. NA ft. NA in. NA
16. INNER CASING `OR TUDiNG geothermal closed -loop)
FROM TO ,_.,. DIAMETER THICKNESS
Sch 40
0.0 ft
ft.
11.3 ft.
1
in.
NA
MATERIAL
PVC
ft.
in.
l7. SCREEN
FROM
1.3
ft.
TO
11
.3 ft.
6. Is (are) the well(s): ❑Permanent or [Temporary
7. Is this a repair to an existing well: ❑Yes or EiNo
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.
Number of wells constructed:
8. you can
For multiple injection or non -water supply wells ONLY with the same construction,
submit one fnrrn.
ft.
18. GROUT
NA ft.
ft.
ft.
DIAMETER
1
TO
NA ft.
ft.
SLOT SIZE
THICKNESS
MATERIAL
in.
MATERIAL
NA
ft.
SAND/GRAVEL PACK Of applicable_
I9. EMPLACEMENT METHOD#�.r.
FROM TO MATERIAL
0.0 ft 0.65 ft. Hole Plug 3/8" Chips
0.65 ft. 11.3 ft. # 2 Filter Sand
2� Q� DRILLING LOG (attach additional sheets if necessary) �...�....
FROM TO DESCRIPTION color hardness soiUrock ,ii e , size, etc.
0.0 ft. Clayey sand, SC, trace organics, gray, dry to saturated.
Silty sand,trace silt,trace clay,dark,saturated
.010
Sch 40
PVC
EMPLACEMENT METHOD & AMOUNT
NA
8.0 ft.
ft.
8.0
12.0
ft.
ft.
ft.
ft.
ft. ft.
Hand Pour
Hand Pour
11.3 (ft.)
9. Total well depth below land surface: 3 2vU' and 2(�100')
For multiple wells list all depths if diff rent (example-
2.05 (ft.)
10. Static water level below top of casing:
If water level is above casing, use
11. Borehole diameter: 2 (in.)
Direct Push Technology
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
Amount:
13b. Disinfection type:
Form GW-1
ft. ft.
ft. ft.
ft. ft.
21. REMARKS
JU1 2 0 2017
22. Certification:
` A-J.itukhvd, .1 1 % ‘ 1 ii
. Signa i' of ertified W 1!, Contractor Date
ed in
By signing this form, 1 hereby certify that the well (s) was (were) const Stands sand that accordance
with 1 SA NCAC 02C .0100 or 1 SA NCAC 02C .0200 Well Construction
a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details: well site details or well
You may use the back of this page to provide additional
P�
construction details. You may also a ' /itional pages if necessary.
SUBMITTAL INSTUCTIONS %CD
R//� etion of well
24a. For All Wells: Submit this form
Uwithin 30 days of.+
L
construction to the following: Division'' nn
of Water R ources, Informatlo�( ' ocessing Unit,
1617 Mail Service aktyrsleigh, NC 27699-1617
Wells O ' '�� i f 1 �
24b. For Iniection ����' ng the form to the address in
yVel / . ays of completion of well
.�� y� (�j da
24a above, also submit a copy of ,•l �>7
construction to the following: na/ �e
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.
North Carolina Department of Environment and Natural Resources Division of Water Resources
Revised. August 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
Jeffery A. Stewart
Well Contractor Name
(NCWC) 2540-A
NC Well Contractor Certification Number
Mid -Atlantic Drilling, INC
Company Name
2. Well Construction Permit #:
List all applicable well permits (i.e. County, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
D Geothermal (Heating/Cooling Supply)
°Industrial/Commercial
❑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)
4.Date We(ll s) Completed: 6/15/201
5a. Well Location:
Commanding General USMC
7 Well ID#
NA
°Municipal/Public
°Residential Water Supply (single)
°Residential Water Supply (shared)
°Recovery
°Groundwater Remediation.
❑Salinity Barrier
D Stormwater Drainage
❑Subsidence Control
°Tracer
°Other (explain under #21 Remarks)
UST-FC39-TW10
14. WATER ZONES
FROM TO
2.26 ft. 11.2
ft.
Facility/Owner Name Facility ID# (if applicable)
Ferry RdCamp Lejeune, NC, 28547
SneadsrY .
Physical Address, City, and Zip
Onslow County
County
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
No Coordinates N No Coordinates
NA
15. OUTER CASING
FROM TO
NA
ft.
NA
DESCRIPTION
Water level collected at 24 hrs.
ft.
for multi -cased wells OR LINER if a licable
DIAMETER THICKNESS MATERIAL
ft.
NA
in.
NA
NA
O.�J
ft. ft* 1 in
16. INNER CASING OR TUBING (geothermal closed -loop)*
FROM TO DIAMETER THICKNESS
11.2 Sch 40
ft. ft.
Parcel Identification No. (PIN)
6. Is (are) the well(s): ❑Permanent or OTemporary
7. Is this a repair to an existing well: °Yes or 1JNo
If this is a repair, fill out known well construction information and explain the nature of the
repair under 421 remarks section or on the back of this form.
S. Number of wells constructed:
For multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
9. Total well depth below land surface: 11.2
For multiple wells list all depths if different (example- 3@200' and 2@100')
2.26
10. Static water level below top of casing: .
If water level is above casing, use "4-"
1:1. Borehole diameter:
(in.)
12. Well construction method: Direct Push
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm)
13b. Disinfection type: Amount:
20. DRILLING LOG (attach additional sheets ifnecessaryt
DESCRIPTION toyor, hardness, soil/rock type,_grain size, etc.)
0 ft. 7 ft Clayey Sand ,SC, Tan to Brown, Dry to Moist, few organic
Course Sand,SW, Trace Fines, light tan, saturated
TO
7
(ft.)
(ft.)
17. SCREEN
FROM
TO
DIAMETER
1.2 ft.
11.2
ft.
in.
SLOT SIZE
.010
MATERIAL
THICKNESS
Sch 40
PVC
MATERIAL
PVC
ft.
ft.
in.
18.GROUT.
FROM
NA
ft.
TO 1 MATERIAL
NA ft.
NA
ft.
ft.
EMPLACEMENT METHOD & AMOUNT
NA
fir
ft.
19. SAND/GRAVELPACIK (if applicable)
FROM TO MATERIAL
0.0 ft° 0.6 ft. Hole Plug 3/8" Chips
0.6 ft.
ft.
ft.
ft.
ft.
8
ft.
12
ft.
Sand,SW, Tan, Saturated
ft.
ft.
ft.
ft.
ft.
ft.
21 REMARKS
•
Jul 2 o 2017
22. Certification:
Sign e o Certified j ell Contractor Date
By signing this form, 1 hereby certify that the well(s) was (were) constructed in accordance
with I SA 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: well site details or well
You may use the back of this page to provide additional
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS.
24a. For .All Wells: Submit
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Cei LR#i4h,1699-1617
24b. For Injection Wells ONLY: In addition to sending the form to the address in
rnl within 30 days of completion of well
24a above, also submit a copy ����,. �Uali� Regjarlal
construction to the following: pperations Section
Division of Water ResoMigPiNiiirkblegitiRjhSifittgontrol 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.
Method of test: -
10.2
ft.
# 2 Filter Sand
EMPLACEMENT METHOD
Hand Pour
Hand Pour
FROM
WED/WC
7
mpletion of well
Form GW-1
North Carolina Department of Environment and Natural Resources - Division of Water Resources
Revised August 2013.

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
Jeffery A. Stewart
Well Contractor Name
(NCWC) 2540-A
NC Well Contractor Certification Number
Mid -Atlantic Drilling, INC
Company Name
2. Well Construction Permit #: Variance, Injection, etc.)
List all applicable well permits (Le. County, State
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑Industrial/Commercial
❑Irrigation
°Municipal/Publ.ic
°Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
OMonitoring.
Injection Well:
❑Aquifer Recharge
°Aquifer Storage and Recovery
°Aquifer Test
°Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heatin: Coolin:. Return
°Recovery
°Groundwater Remediation
°Salinity Barrier
❑ Stormwater Drainage
❑Subsidence Control
❑Tracer
°Other ex u lain under 421 Remarks)
UST
6I � �%2o i 7'W Well ID#,`FC39-•TW 11
4. Date Well(s) Completed.
For Internal Use ONLY:
5a. Well Location:
Commanding General USMC NA
Fttcility/Owner Name
Facility ID# (if applicable)
Sneads
FerryRd. Camp Lejeune, NC, 28547
Physical Address, City, and Zip
Onslow County NA
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
No Coo
rdinates No Coordinates
�
w
6. Is (are) the well(s): GPermanent or OTemporary
7. Is this a repair to an existing well: DYes or EINo
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.
S. Number of wells construc
ted: 1
For multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
• (ft.)
below land surface: 1 1 0
9. Total well depth
For multiple wells list all depths if different (example- 3@200' 200' and 2@ter 100')
10. Static water level below top of casing: 2.94•
If water level is above casing, use "4- "
44519
14. WATER ZONES
FROM - TO DESCRIPTION
1.73 11.0 Depth of water level collected at 24 hrs.
ft. ft.
15. OUTER CASING (for muiti-cased well) OR LINER (if applicable) RIAI
FROM TO DIAMETER THICKNESS
NA ft. NA ft in.
16. INNER CASING OR TUBING .(geothermal closed -loop)
FROM TO DIAMETER THICKNESS MATERIAL
Sch 40 PVC
0.0 ft.
ft.
11.0
ft.
ft.
1
in.
in.
17. SCREEN
FROM TO
1.0 ft.
11.o ft
DIAMETER:
1 in.
ft.
ft.
in.
SLOT SIZE
.010
THICKNESS
Sch 40
MATERIAL
PVC
18,: GROUT
FROM
NA
ft.
ft.
ft.
TO
NA ft*
ft.
ft.
MATERIAL
19. SAND/GRAVEL PACK (if applicable)
MATERIAL
FROM TO
0.0 ft. 0.5
0.5 ft.
11.0
20. DRILLING LOG
FROM TO
ft.
ft.
8.0 ft
ft. 12.0 ft.
EMPLACEMENT METHOD & AMOUNT
EMPLACEMENT METHOD
Hole Plug 3/8" Chips
# 2 Filter Sand
attach additional sheets if necessa
DESCRIPTION (color, hardness, soil/rock type, grant size, etc.)
Clayey Sand,SC dark, trace fines, moist
Hand Pour
Hand Pour
11. Borehole diameter: 2 (in.)
Direct Push Technology
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
(ft)
ft. ft.
Fine silty sand, dark, saturated
ft. ft.
ft. ft.
ft.
ft.
21. REMARKS
ft.
ft.
•
L13
R WATER SUPPLY WELLS ONLY:
a. Yield (gpm) Method of test:
b. Disinfection type: Amount:
22. Certification:
Signa of '- ified ;•'' 1 Contractor
By signing this form, I hereby certify that the well(s) was (were) constructed in' accordance
with 1SA 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: • well site details or well
You may use the back of this page to provide additional
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
f Water .r' �,.►.; " '.t., �'' wiling Unit,
Division o q-617
1617 Mail Service Center, Raleigh, NC 2 69
24b. For In'ection Wells ONLY: dition to sending the form to the address in
Y(tl7
24a above, also submit a copy of t n hi day s of completion of well
construction to the following:
Division of Water Resource-;� U do Control Program,
1636 Mail Service Cirf. C 1Q1'l
4-1636
24c. For Water Su l & In•e� Regional Office
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.
I YWS'I1 �4 �y Y1 1 's�v�• 1
Date
North Carolina Department of Environment and Natural Resources - Division of Water Resources
Revised. August 2013
Form GW-1

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
Jeffery A. Stewart
Well Contractor Name
(NCWC) 2540-A
NC Well Contractor Certification Number
Mid -Atlantic Drilling, INC
Company Name
2. Well Construction Permit #:
List all applicable well permits (i.e. County, State, Variance, Injection, etc)
3. Well Use (check well use):
For Internal Use ONLY:
445194
14'WATER ZONES
FROM TO
2.4
ft.
DESCRIPTION
11.5
ft.
Water level collected at 24 hrs.
ft.
ft.
15. TERCASING for multi -cased wells OR LINERif`a licable
FROM TO DIAMETER THICKNESS MATERIAL
NA ft. NA ft- NA in. NA
NA
16. INNER CASING OR TUBING Geothermal closed400p)
FROM
0.0 ft.
TO
11.5 ft.
DIAMETER
in.
THICKNESS
Sch 40
MATERIAL
PVC
ft.
ft.
in.
Water Supply Well:
DAgricultural
DGeothermal (Heating/Cooling Supply)
❑Industrial/Commercial
❑I.rrigation
Non -Water Supply Well:
C Monitoring
Injection Well:
D Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
D Geothermal (Closed Loop)
DMunicipal/Publ.ic
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
DRecovery
DGroundwater :Remediation
DSalinity Barrier
DStormwater Drainage
❑Subsidence Control
[Tracer
D Geothermal Heatin : C oolin : Return D Other ex • lain under #21 Remarks)
6/15/2017,,e11 m#�-FC39-TWo8R
4. Date Well(s) Completed:
5a. Well Location:
Commanding General USMC NA
Facility/Owner Name Facility 1D4 (if applicable)
Sneads Ferry Rd. Camp Lejeune, NC, 28547
Physical Address, City, and Zip
Onslow County NA
County
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
Parcel Identification No. (PIN)
No Coordinates N No Coordinates
W
6. Is (are) the well(s): [Permanent or t 1Temporary
7. Is this a repair to an existing well: Dyes or t1No
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 q f this form.
S. Number of wells constructed: _._._.._
For multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
9. Total well depth below land surface: 11.5
For multiple wells list all depths if different (example- 3@200' and 2(000')
(ft.)
10. Static water level below top of casing: 2.4 (ft)
If water level is above casing, use "÷ "
0
11. Borehole diameter: .._ (in.)
Well construction method: Direct Push Technology
12.
(i.e. auger, rotary, cable, direct push, etc.)
0.0
8.0
FROM
0.0 ft'
0.75 ft-
17. SCREEN
FROM TO
1.5 ft- 11.5.ft.
ft. ft.
18. GROUT
FROM TO
NA
ft.
DIAMETER SLOT SIZE
in.
in.
.010
THICKNESS
Sch 40
MATERIAL
PVC
NA ft'
MATERIAL
NA
EMPLACEMENT METHOD & AMOUNT
NA
ft.
ft,
ft. ft.
19, SAND/GRAVEL PACK (if applicable)
MATERIAL [ EMPLACEMENT METHOD
TO
0.75
11.5
ft.
ft.
Hole Plug 3/8" Chips 1 Hand Pour
# 2 Filter Sand
Hand Pour
20,: DRILLING LOG (attach.additional sheets if necessa
FROM TO DESCRIPTION (color, hardness, soil/rock type, wain size,
8.0
ft.
ft.
12.0
ft.
ft.
etc.)
Clayey sand, SC, gray, dry to saturated, backfii
Clayey sand, SC, gray, trace silt, saturated
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
�'�?�Y�rf; %'Y��'�, 3::'�jI'4 lea n•. �q�+,:z.c�.' Si�`c' t, ti
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
22. Certification:
Signa of ertified 11. Contractor
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 1 5A. 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.
'ram -�tia R.:�--`t,,,•
Atit'""ildd 11"Iti
Date
SUBMITTAL INSTUCT ' IVED CDEN /D R
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Reklotirce2 4f$on Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. ��j i$ipgthe form to the address in
For Infection Wells O�er� �� �a s of completion of well
24a above, also submit a copy'efi . Y P
construction to the followiVr
imington Regional Office
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.
Form GW-1
North Carolina Department of Environment and Natural Resources Division of Water Resources Revised August 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
For Internal. Use ONLY:
1. Well Contractor Information:
Jeffery A. Stewart
Well Contractor Name
(NCWC) 2544-A
NC Well Contractor Certification Number
Mid -Atlantic Drilling, INC
Company Name
2. Well Construction Permit #:
List all applicable well permits (i.e. County, State, Variance, Injection, etc)
3. Well Use (check well use):
Water Supply Well:
O Agricultural
DGeothennal (Heating/Cooling Supply)
❑Industrial/Commercial
❑Irrigation
OMunicipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
Z Monitoring
ORecovery
Injection Well:
:Aquifer Recharge
:Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Groundwater Remediation
:Salinity Barrier
❑ Stormwater Drainage
:Subsidence Control
:Tracer
:Geothermal eatiin Coolie Return DOther (ex lain under #21 Remarks)
4. Date Well(s) Completed: 6/15/2017Well ID# UST-FC39-TVVO4R
5a. Well Location:
Commanding General USMC NA
Facility/Owner Naane Facility ID## (if applicable)
Sneads Ferry Rd. Camp Lejeune, NC, 28547
Physical Address, City, and Zip
Onslow County NA
County Parcel Identification No..(PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
No Coordinates N No Coordinates
6. Is (are) the well(s): ©Permanent or (@Temporary
w
7. Is this a repair to an existing well: :Yes or C?JNo
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 farm.
8. Number of wells constructed:
For multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
9. Total well depth below land surface: 11.25 (ft.)
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing: 2.86
If water level is above casing, use
11. Borehole diameter: 2 (in.)
12. Well construction method: Direct Push Technology
(i.e. auger, rotary, cable, direct push, etc.)
(ft.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
14. WATER ZONES
FROM I TO l DESCRIPTION
2.85 ft.
11.25
ft.
Depth of water collected at 24hrs
ft.
ft.
15. • OUTER CASING (for multi -eased wells) OR LINER (if applicable)
.FROM TO DIAMETER THICKNESS MATERIAL
NA ft-
NA
ft.
NA
NA
NA
16. INNER CASING OR TUBING (geothermalclosed-loop)
FROM . TO DIAMETER THICKNESS
MATERIAL
0.0
ft.
11.25 ft.
1
in.
Sch 40
PVC
ft.
ft.
17. SCREEN.
FROM
1.25ft.
TO
DIAMETER
11.25 ft. 1
in.
SLOT SIZE
.010
THICKNESS
Sch 40
MATERIAL
PVC
ft.
ft.
in.
18. GROUT
FROM [ TO
NA ft-
NA
ft.
MATERIAL
NA
EMPLACEMENT METHOD & AMOUNT
NA
ft.
ft.
ft.
ft.
FROM
19. SAND/GRAVEL PACK (if applicable)
TO MATERIAL
EMPLACEMENT METHOD
0.0
ft.
0.625 ft.
Hole Plug 3/8" Chips
Hand Pour
ft.
ft.
# 2 Filter Sand
Hand Pour
20. DRILLING LOG ;(attach ;,additional sheets :if,necessary)
FROM TO DESCRIPTION cobr, hardness) soilfrock type, grain sizee,
0.0 ft- 8.0 ft. Clayey Sand, SC, tan/gray, trace silt, moist at 5'.
8.0
ft.
12.0 ft.
Sand, SW, gray, trace silt, saturated
ft.
ft.
ft.
ft.
ft.
ft.
\j::
r. •--
ft.
ft.
ft
ft.
.,i.:Yi6. •a ::.::,•
JUL 2 0 2017
21. REMARKS
• .i •'ifo ii.atifo3
22. Certification:
Signa o • ified j 1 Contractor
ki 11
Date
By signing this form, 1 hereby certify that the well(s) was (were) constructed in accordance
with 1 SA 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 INS
/NCOEp4R/DWR
24a. For All Wells: Submit this foam within 30 days of completion of well
construction to the following:
Division of Wa%lR2orc information Processing Unit,
g
1617 Mail Service Center, Raleigh, NC 27699-1617
RIMitiklilftitiftto sending the form to the address in
24a above, also s • j 1-Ve61416111glgt&Offh within 30 days of completion of well
construction to the on Regional Office
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Infection 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.
24b. For Injection
Form GW-1
North Carolina Department of Environment and Natural Resources - Division of Water Resources Revised August 2013

WELL CONSTRUCTION RECORD
For Internal Use ONLY:
This form can be used for single or multiple wells
1. Well Contractor Information:
Jeffery A. Stewart
Well Contractor Name
(NCWC) 2540-A
NC Well Contractor Certification Number
Mid -Atlantic Drilling, INC
Company Name
2, Well Construction Permit #:
List all applicable well permits (i.e. County, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
D Industrial/Commercial
Dlrrigation
Non Water Supply Well:
ZiMonitoring
DMunicipal/Publ.ic
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
ORecovery
Injection Well:
DAquifer Recharge
DAquifer Storage and Recovery
❑Aquifer Test
❑ Experimental Technology
DGeothermal (Closed Loop)
DGeothermal (Heating/Cooling Return)
4. Date Well(s) PCom leted: 6/15/201
DGroundwater Remediation
❑Salinity Barrier
D Stormwater Drainage
DSubsidence Control
DTracer
DOther (explain under #21 Remarks)
7 Well _ ' UST-FC39-TWO3R
5a. Well Location:
Commanding General USMC NA
Facility/Owner Name Facility .ID#' (if applicable)
Sneads Ferry Rd. Camp Lejeune, NC, 28547
Physical Address, City, and Zip
Onslow County
NA
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
No Coordinates N No Coordinates
6. Is (are) the well(s): ❑Permanent or OTemporary
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 firm:
8. Number of wells constructed: 1 �,.�..
For multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
9. Total well depth below land surface: 11.45 (ft.)
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below topof casing: 2.57
g (ft.)
If water level is above casing, use "-,- "
11. Borehole diameter: 2
12. Well construction method: Direct push technology
(i.e. auger, rotary, cable, direct push, etc.)
14519i
14. WATER ZONES
FROM
2.57
ft.
ft.
TO
"11.45
ft.
DESCRIPTION
Water level collected at 24 hrs.
15. OUTER CASING (for multi -cased wells) OR LINER (if applicable)
FROM
NA ft.
TO
NA ft
DIAMETER
NA in.
THICKNESS
NA
MATERIAL
NA
16. INNER CASING OR TUBING (geothermal: closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0.0 ft. 11.45 ft•
ft. ft.
1
in.
Sch 40
PVC
17. SCREEN
FROM TO
1.45 ft 11.45 ft
ft. ft.
DIAMETER
1 in.
in.
SLOT SIZE
.010
THICKNESS
Sch 40
MATERIAL
PVC
IS. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
NA ft.
NA ft.
NA
NA
ft.
ft.
ft.
ft.
19. SAND/GRAVEL: PACK :(if applicable)
FROM TO MATERIAL
EMPLACEMENT METHOD
0.0 ft.
0.725 ft.
Hole Plug 3/8" Chips
Hand Pour
ft.
ft.
# Filter Sand
Hand Pour
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount: +,
20. DRILLING LOG .(attach additional sheets if necessa
FROM TO.
DESCRIPTION color, hardness, soil/rock type, grain size, etc.)
0.0 ft. 5.0
ft.
Clayey sand, SC, dry, fill sand
5.0 ft. 6.0
ft.
Silty clay, tan/gray, moist
6.0
ft.
12.0 ft
Clayey sand, SC, tan/gray, trace silt, moist -saturated.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft,
J ti
,%.
21. REMARKS
JUL
2017
22. Certification:
Signa ► o' f e ifled d f 1 Contractor
1 %kW)
Date
By signing this form, 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 diagr CEA/
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 INSTJallaNi 2017
24a. For All Wells: Submit this form within 30 days of completion of well
WR
construction to theratt&Atelity Regional
0 • titOn SPct
nj nformation Processing Unit,
1'7- en' e i h NC 27699-1617
24b. Fo,,,_ r pj''eetion 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.
Form GW-1
North Carolina Department of Environment and Natural Resources - Division of Water Resources
Revised August 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
Jeffery A. Stewart
Well Contractor Name
(NCWC) 2540-A
NC Well Contractor Certification Number
Mid -Atlantic Drilling, INC
Company Name
2. Well Construction Permit #:
List all applicable well permits (i.e. County, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
0Agricultural
DGeothermal (Heating/Cooling Supply)
D Industrial/Commercial
❑Irrigation
Non -Water Supply Well:
ElMonitoring
Injection Well:
0Aquifer Recharge
❑ Aquifer Storage and Recovery
DAquifer Test
DExperimental Technology
DMunicipal/Public
❑Residential Water Supply (single)
DResidential Water Supply (shared)
DRecovery
For Internal Use ONLY:
A45189
14. WATER ZONES
FROM TO
2.98 ft.
11.3
ft.
DESCRIPTION
Water levels collected at 0 hrs
ft.
ft.
0Groundwater Remediation
OSalinity Barrier
❑ Stormwater Drainage
❑Subsidence Control
FROM
0.0
15.;OUTER CASING (for multi -cased wells) OR LINER (if`applicable)
FROM TO DIAMETER THICKNESS 1 MATERIAL
NA
ft.
NA ft.
NA
in.
NA
NA
16. INNER CASING OR TUBING (geothermal closed -loop)
THICKNESS
ft.
ft.
TO
DIAMETER
MATERIAL
11.3 ft. 1
ft.
tin.
in.
Sch 40
Pvc
DGeothermal (Closed Loop) ❑Tracer
ClGeothermal (Heating/Cooling Return) DOther (explain under 421 Remarks)
6I162O 17 UST-FC39-TW16
4. Date. W ell(s) Completed: Well ID#
5a. Well Location:
Commanding General USMC NA
��-
Facility/Owner Name FacilityID# if applicable)
)
Sneads Ferry Rd. Camp Lejeune, NC, 28547
Physical Address, City, and Zip
Onslow County
NA
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
No Coordinates N No Coordinates
6. Is (are) the well(s): DPermanent or [aTemporary
7. Is this a repair to an existing well: ❑Yes or E 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 farm.
8. Number o we
ns ells constructed:
For multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
9P
. Total well depth below land surface: 11.3 (ft.)
For multiple wells list all depths if different (example- 3 u(�200' and 2@100')
10. Sttic water level below topof casing: 2.98 (ft)
Sa
If water level is above casing, use "+"
11. Borehole diameter: 2 (in.)
Direct Push Technology
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
17. SCREEN
FROM TO
1.3
ft.
11.3 ft.
DIAMETER
in.
SLOT SIZE
.010
THICKNESS
Sch 40
MATERIAL
PVC
ft.
ft.
in.
18. GROUT
FROM TO . MATERIAL EMPLACEMENT METHOD & AMOUNT
NA ft• NA ft: NA NA
ft.
ft.
ft.
ft.
19. SAND/GRAVEL. PACK (if applicable)
FROM TO MATERIAL
0.0
ft.
0.65 . ft• Hole Plug 3/8" Chips
EMPLACEMENT METHOD
Hand Pour
0.65 ft• 11.3
20 DRILLING LOG
FROM
0.0 ft.
TO
1.0
ft.
# 2 Filter Sand
Hand Pour
attach additional sheets if new
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
Clayey Sand, SC, gray/brown, dry
ft.
1.0 ft.
6.0 ft. 12.0 ft;
6.0
ft.
Course sand, gravel, backfill, gray/brown, dry to moist
Clayey sand, SC, brown/gray, moist to saturated.
ft.
ft.
ft.
ft.
}•
ft.
ft.
ft.
ft.
21. REMARKS
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
22. Certification:
'I t (1'1
Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 1 SA. NCAC 02C .0100 or 1 SA 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 INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
fo
lfik
Division of Water Resources, n
1617 Mail Service Center, Raleigh, NC 27699-1
1nit,
24b. For Infection Wells ONLY: In adJi t e di• -1,!,,
. the form to the address in
submit a copyof this form within I 1I.,? of completion of well
24a above, also
construction to the following:
Division of Water Resources, n e wr�itj:ztr6o1 Program,
Service 3,
1636 Mail �'� •
Ihggof -� .
24c. For Water Supply & Injection Wells:
glnrral Office
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 Environment and Natural Resources - Division of Water Resources Revised August 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
Donald Cummings
i�l%ell Contractor Narne
2412-A
NC Well Contractor Certification Number
Applied Resource Management, P.C.
Company Name
2. Well Construction Permit #:����6-�0325
List all applicable well construction permits• (i.e. (. ountt ; State, Variance, Etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
OGeothermal (Heating/Cooling Supply)
DIndustrial/Cornn�ercial
Dlrri:ation
Non -Water Supply Well:
❑Monitoring
Injection Well:
❑Municipal/Public
JResidential Water Supply (single)
DResidential Water Supply (shared)
❑Recovery
DAquifer Recharge
DAquifer Storage and Recovery
❑Aquifer Test
DExperimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
4. Date Wells) Conmpleted:2/2/17
❑Groundwater Remediation
OSalinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 Remarks)
Well I.D# N/A
5a. Well Location:
Steven Swed berg N/A
Facility/Owner NameFacility ID# (if applicable)
179 Angel's Haven Lane, Richlands NC
Physical Address, City, and Zip
Onslow 160917
CountyParcel Identification No. (PIN)
51b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwell fieldo
ne lat/long is sufficient)
34 54 19.E77 37 34.E
6. Is (are) the well(s): QPermanent or ❑Temporal ;y
7. Is this a repair to an existing well: Oyes or ONo
If this is a repairfll out known well construction it formation and explain t
repair under r21 remarks section or on the back o f this form:
S. Number of wells constructed:
f
9 p
100 FPS
8479
1
1U0 or 15A 11 C AC 02C 0.00 Ifi'ell Construction Standards and that a
Iaen i�r�po t ,�V�f te dia
gram or additional well details:
You may use the back of this page to provide, additional. well -.site details
�) or well
w
For Internal Use ONLY:
DESCRIPTION
44184'7
111111311111111111111111111111111111111111111111
15.OUTER CASING (fort multi -cased wells OR LINER (if a , licable
FROM TO DIAMETER
SCH40
16.1N] ER CASLNG OR TUBLNG .eothermal closed-loo
FROM TO DIAMETER
FROM
DIAMETER
MATERIAL
Bentonite
Bentonite
19. SAND/GRAVEL PACK (if. a , licable)
FROM TO
MATERIAL
MATERIAL
MATERIAL
SCH4O
EMPLACEMEtiT ME'i�HIOD & AMOI,T'T
Poured
Poured
• EMPLACE? 'T;METHOD
Poured
20. DRILLING LOG (attach additional sheets if.neccssa •
FROM TO DESCRIPTION (color, hardness, soi /rock • e, Grain size, etc.
Sands
Sandy clay to clay with shells
Clay with shell some limestone
22. Certification:
Sign. tune of Certified Well Contractor
Date
1, :r c i s form, I hereby certify that the 3ell(s) was (were constrt
� ---t1r- tctSAC 02C.0r eel m accordance
copy ofthis record has been provided to the well owner,
For multiple injection or non -water supply tiw'ells O_NLI' with the sage cot struction,lsubmit oneortrt.
SUBMITTAL INSTUCTIONS
surface:
. Total well de th below land su :For multiple wells list all. depths if d erent (example- 3@'00' and 2@100')
10. Static water level below top of casing:
Ifwater level is above casing, use "-"
11. Borehole diameter:$
37
(in.)
12. Well construction method: Mud Rotary
(i.e. auger, rotary, cable, direct push, etc.)
�''(!jro�ryssi,"emu details. You may a
(ft.)
(ft.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpni) 40 Method : Airliftof #est. 13b. Disinfection type: HTHAmount: 39__@:LOg___
Form GW-1
24a. ForWells Submit this fo constru11
g
r p wit n 0 T of completion of
- - l
we
ction to the following: L £U
Division of Water Quality, Information -Processing Unit,
1617 Mail Service G for bi y e I RA41617
24b.
For_Iniection 1� ells: In i i0oer ti; ns , ection
above, also submit a copy of ' rs���rg rthi'� �• � a`� �e address in 24a
ndays of
construction to the following: completion of well
Division of Water Quality, Underground Injection Control
Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supple Infection Wells: In addition to sending the fo
the address(es) above, also submit one co rm to
completion of well construction to the county health s form within 30 days of
where constructed. department of the county
North Carolina Department of Environment and Natural Resources - Division of Water Quality
t
•
TY
obwraty.
Revised Jan. 2013
CCE

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2314A
1. WELL CONTRACTOR:
DAVID L REGISTER
Well Contractor (Individual) Name
REGISTER WELL CO.. INC.
Well Contractor Company Name
721 WEST CHARITY ROAD
Street Address
ROSE HILL
City or Town
( 910) 289-3175
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT*
NC
State
28458
Zip Code
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check Applicable Box): Residential Water Supply Vf
DATE DRILLED 06-20-2017
TIME COMPLETED AM El PM
4. WELL LOCATION:
CITY: HOLLY RIDGE COUNTY ONSLOW
640 HOLLY RIDGE ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
El Slope [Walley VFlat DRidge ElOther
LATITUDE • "DMS OR 34.488864 DD
LONGITUDE • -
" DMS OR -77.526073 DD
Latitude/longitude source: WiGPS aopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. WELL OWNER
GUY ROYAL
Owner Name
PO BOX 2717
Street Address
SURF CITY
City or Town
(910 ) 470-3737
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 165
NC 28365
State Zip Code :
b. DOES WELL REPLACE EXISTING WELL? YES D NO Pf
c. WATER LEVEL Below Top of Casing: 19 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1.5 FT. Above Land Surface*
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 150 METHOD OF TEST AIR
f. DISINFECTION: Type HTH Amount 3 OZ
g. WATER ZONES (depth):
• Top Bottom Top
• Top Bottom Top
• • Top Bottom Top.
7. CASING: Depth Diameter
Top 0 Bottom 145 Ft. 4
Top Bottom Ft.
Top Bottom Ft.
444802
Bottom
Bottom
Bottom
Thickness/
Weight
Material
.40 PVC
8. GROUT: Depth Material
Top 0 Bottom 20 Ft. HOLE PLUG
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter
Top 145 Bottom 165 Ft.4
Top Bottom Ft.
Top Bottom Ft.
10. SAND/GRAVEL PACK:
Depth
Top 140 Bottom 169
Method
POURED
Slot Size Material
in. .016 in. PVC
in. in.
in. in.
Size
Ft. #2
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 30
30 /40
40 /60
60 / 100
100 /141
141 /146
146 /163
163 /165
165 /169
169 /
12. REMARKS:
Material
GRAVEL
Formation Description
SAND (FINE)
SAND AND CLAY
SAND AND MARL
SAND (FINE)
ROCK AND SAND
HARD ROCK 5'
MARL
ROCK 20"
MARL
ROCK
PEr F\ bfF'
4 '7
JUL 0 3 2017
nlorroation Pro'cw,aing Unit
OWCIISOG
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
PRIFAED TO T WE LOW R.
/frr CZAd ED/N
SIGNATURE OF CERTIFIED WELL'
!Pi 11-
ONTRACTOR DATE
DAVID L REGISTER
PRINTED NAME OF PERSON CONSTRUCTIIZIIHEVU 017
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Water Quality p? • 0 4w-1 a
1617 final! service Center, Raleigh, NC 27699-161, Phone [phone] vviimOinpgteroatnioRnesSgio6digna 100Wff019ce

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
John Salmon
For Internal Use Only:
t'11111'i.Vil11
444801
Well Contractor Name
3497-A
NC Well Contractor Certification Number
Applied Resource Management, P.C.
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.)
3. Well Use (check well use):
N/A
Water Supply Well:
(Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
Non -Water Supply Well:
Monitoring
Injection Well:
DMunicipaupubljc
DResidential Water Supply (single)
...Residential Water Supply (shared)
ORecovery
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
4. Date Wells) Completed: 06/28/1
5a. Well Location:
Will Farley
Groundwater Remediation
Salinity Barrier
Stormwater Drainage
DSubsidence Control
QTracer
(Other (explain under #21 Remarks)
7
Well ID# NIA
N/A
Facility/Owner Name Facility 1D# (if applicable)
310 Bond Lane, Sneads Ferry, NC 28460
Physical Address, City, and Zip
Onslow 778-40
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lot/long is sufficient)
34 32 32536 N 77 22 38 6339
W
6. Is(are) the welI(s)JPermanent or QTemporary
7. Is this a repair to an existing well: ,:(Yes orONo
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: 1
9. Total well depth below land surface: 20
For multiple wells list all depths if dferent (example- 3@200' and 2 a 100')
10. Static water level below top of casing:
If water level is above casing, use "+ "
12
11. Borehole diameter: 7 7/8 (in.)
12. Well construction method: Mud Rotary
(i.e. auger, rotary, cable, direct push, etc.)
(ft.)
(ft.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 100
Method of test: Airlift
13b. Disinfection type: H TH Amount: 3 %@ 1 Og
14. WATER ZONES .
FROM TO DESCRLPTION
15.OUTER CASING (for multi -cased wells) OR LINER (if ap livable)
FROM TO DIAMETER THICKNESS MATERIAL
0 ft' 100 ft. 4 in* SCH40 PVC
16. INNER CASING OR TUBING (geothermal closed -loop):
FROM DIAMETER THICKNESS
ft.
ft.
TO
ft.
ft.
17. SCREEN
FROM
100 ft.
ft.
ft.
ft.
ft.
ft.
TO
TO DIAMETER
120 ft- 4
18: GROUT
FROM
0 ft.
ft.
ft.
TO
100
ft ft.
ft.
ft.
ft.
in.
in.
MATERIAL
M.
in.
SLOT SIZE
.010
Bentonite
19. SAND/GRAVEL PACK (if applicable)
TO
FROM
100 ft-
ft.
120 ft.
ft.
MATERLAL
Coarse
MATERIAL
ra�crn�rEss
THICKNESS
MATE
RIAL
SCN40 PVC
EMPLACEMENT METHOD & AMOUNT
Poured
EMPLACEMENT METHOD
Poured
20 DRILLING LOG (attach: additional :sheets if necessary)
FROM DESCRIPTION (color, hardness, sot frock . . type, grain size, etc.)
Yellow sand
0 ft.
10 ft.
30 ft..
40
60
90
ft.
ft.
ft.
ft.
TO
10 ft.
30 ft-
40 ft.
60 ft.
90
ft.
120 ft.
_` 2L REMARK';
ft.
Clay
Clay shells
Rock clay layers
Limestone and shells
Limestone
JUL @ 3 2017
22Certification:
e o Certified %i ` 'on s . etor Date
By mg 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.
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. Youmay also attach additional pages necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of
construction to the following: p well
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. l .1 h11:
For Infection Wells: In additl, ►,, u ,. _, r ress 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, Program,
UndergInR of3� �o77
�eiltrol
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection \% II rI :'tamingthe
the address(es) above, also submit one ratif is ' �; ; form t o
completion of well construction to tl�lid�(�Glthin 30 days of
where constructed. b the county
WOOriiati,60 Pt` tul U ice'
DWOIROG
6/28/17
Form GW-1
North Carolina Department of Environmental Quality - Division of Water Resources
Revised 2-22-2016

Print Form ' 1
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Pvk t
Well Contractor Name
NC Well Contractor Certification Number
/4560Cict e-S
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UK', County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
Agricultural 0 M un icipal/Publ ic
Geothermal (Heating/Cooling Supply) EiResidential Water Supply (single)
Industrial/Commercial DiResidential Water Supply (shared) 1_:Irrigation
on -Water Supply Well:
Monitoring 0 Recovery
jection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return
£Groundwater Remediation
..�.'� 1 Sai inity Barrier
Stonnwater Drainage
DSubsidence Control
DTracer
[30ther (explain under #21 Remarks)
4. Date Well(s) Completed: j'R'/ '1. 1 Well ID# l'" I ih)U
/
5 Well Location: rr�� '''']]
\. V �J 1 d ,� - !� I Ooo ,0 006 6 )J 3 o
Facility/Owner Name Facility JD# (if applicable)
� e � ki '; -cji5jytditte Pc,
aniatogilki,
Physical Address, Citit and Zip
Oyi1oW
County Parcel identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
/1,21q N 7° ;II 9 )-1'4 w
6. Is(are) the well(s)
Al
Permanent or DITemporary
7. Is this a repair to an existing well: Yes or No
If ibis is a repair, Jill out known well construction information c n . explain the nature of the
repair under 121 remarks section or on the back ()phis 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:
For multiple swells list all depths ifdifferent (example- 3@2 )0' and 2:4100')
10. Static water level below top of casing:
if water level is above casing, use
11. Borehole diameter: a (in.)
12. Well construction method: 444 WI) fi 14
(i.e. auger, rotary, cable, direct push, etc.)
(ft.)
(ft.)
For Internal Use Only:
444632
. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OU'I'ER CASING (foe multi -cased wells) .OR:.LINER .(if ap tlicable)
THICKNESS MATERIAL
FROM
ft.
TO
ft.
DIAMETER
in.
16. INNER ER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
ft.
ft.
in.
1`1. SC:i1XEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
6,5- ft
ft.
5 ft.
in.
b���
5th 'to
ft.
in.
RC1
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT .
5 ft.
ft.
6),(9 ft. ei,n-c-M-))
ft.
14-aed, Pok„re.,ce
ft.
ft.
1`9 SAND/GRAVEL, PACK Of applrable)
FROM..
TO
MATERIAL
:.EMPLACEMENT METHOD
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
ft.
ft.
'7,
0 ft.
ft.
AA�
. QRILL[NG LOG '(attach additional sheets if'necessary)
FROM
TO
43 ft.
ft.
ft.
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
cIe$1( (M2i-E) �r 51;" GA -a--
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
R r
�' J 18J
ft.
21 MAR:
ft.
JUM S 6 2017
tnforpnrti fl P
lN '..:.ti!' 3' rxr
22. Certification:
Signature of Certified Well Contractor
Date
By signing this form, 1 hereby certify that the well(,) was (were) constructed in accordance
with 15A NC,4C 02C' .0100 or 15.4 N(.'AC 02(' .0200 Well Construction Standards and that a
copy of this record has been provided to the !veil 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 alsi es if necessary.
SUBMITTAL INSTRUCTIONS
GBENR/DWR
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following: JUL 0.3 2017
Division of Water Resources, information Processing Unit,
1617 Mail Serviceater, Raleigh, NC 27699-1617
water
Quality 1�
24b. For Injection Wells: In additic(r�Of � e address in 24a
above, also submit one copy oMJ 1 J- tIQ'completion of well
construction to the following: il to eglonal Office
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells: In addition to sending the fonm 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

rent Form
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 #:
N/A
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc)
3. Well Use (check well use):
Water. Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
k Irrigation
DMunicipal/Public
DResidential 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
0Salinity Barrier
Stormwater Drainage
DSubsidence Control
DTracer
Other (explain under #21 Remarks)
4. Date Wells) Completed: 06/15/17 Well ID# N/A
5a. Well Location:
Christine Bernardi
N/A
Facility/Owner Name Facility ID# (if applicable)
106 Chariot Lane, Maysville, NC 28555
Physical Address, City, and Zip
Onslow
County
023124
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lattlong is sufficient)
34 53 17.4 N 77 14 09.2
6. Is(are) the well(s)C.Permanent or DTemporary
7. Is this a repair to an existing well: EYes or 0No
If this 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 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: 60 (ft.)
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing: 2 (ft.)
If water level is above casing, use "
11. Borehole diameter: 8 (in.)
12. Well construction method: Mud Rotary
(i.e. auger, rotary, cable, direct push, etc.)
For Internal Use Only:
444612
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER`(if applicable)
FROM
TO
DIAMETER
THICKNESS f MATERIAL
0
ft.
40 ft.
4
in.
SCH40
PVC
FROM
1.6..INNER CASING OR TUBING (geothermal closed=loop}
THICKNESS
TO
DIAMETER
MATERIAL
ft.
ft.
in.
ft.
ft.
in.
17:.SCREEh[ :.
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
40 ft-
60 ft.
4
in
.010
SCH40
PVC
ft.
ft.
in.
GROUT.
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0
ft.
23 ft.
Grout
Poured
33 ft•
35 ft-
Bentonite
Poured
ft.
ft.
19. SAND/GRAVEL PACK .(if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
35 ft-
60 ft.
Coarse
Poured
ft.
ft.
20..DRILLING 'LOG (attach' additional sheets if necessary
FROM •
0 ft.
TO
15 ft-
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
Sands to clayey sands
15 ft.
20 ft.
Sandy clay
20 ft:
62 ft.
Sand limestone
62 ft.
ft.
Limestone clay (sandy)
ft.
ft.
ft.
ft.
1
—r%
ft.
1. REMARKS
ft.
Fnformat on V:
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 60 Method of test: Airlift
13b. Disinfection type: HTH Amount: 3 %@ 1 Og
Form GW-1
Signature of Certified Well Contractor
06/22/17
Date
By signing this form, 1 hereby cent that the well(s) was Twere) constructed in accordance
with 15A NCAC 02C .0100 or 1 SA 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 Al1.Wells: Submit this
construction to the following:
Division of Water Resources, Infprwati Womsing Unit,
1617 Mail Service Center, Ramo, a760-1417
24b. For Infection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this foWat �,
iiadai y pinion of well
construction to the following: Operations Section
Division of Water Resources, Uali il�j a aiafil?agram,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
of well
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WE :CONSTRUCTIONRECO
1031 (.1 iitracti r ut trii i.ti irt:
Michael Wilson."
3351. A
NC- `We11 r ` #Amide t iikation Number
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q U I. CONSTRUCTION .R STR TI N EC I) ii farm cmt flit: en Im o11.t '`' r,`:ads ..
Op' Well Comm -tut r InfOr41041i0t
Michael Wilson
E .17oizruripr
3351 'A
C .%Veil Contractor 'eri[.f" = itx;m
SAEDACCO Inc
2. .:1t ` ` .l � ru t kn Permit :
}t. eli lernyf l fie colimry, 3i la"f ' .l ci,
Cx'rif ..1Iussj;•
...: •..F 3 1 •�fc ! S'C�x+ :. LiMM' tl i icip#1lt P 1 4c
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i ticr
OtAipg Reim
bite Conkpleteo
Well Location:
DSCA
.•
7fl 37 mt r:Mitt.t r.,o
idc314. ' i :!
5/8/2017 wat U" ,a4W-2
4clitly:C11%rer Nave
955 Lejeune Blvd.
.. t:,:iii
. ►r. tit .I (it ;TOO
Jacksonville, '..NC . 28540 Onslow .Co,
CO, ,. iir
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VE .-
%"..#l.+ 1si t 7 ir4.14 11-4 Ni tle 1 lit-r /t
L. 'CH CMiltrittlkirr i<Fi l tl� tt�
Michael Wilson
NSTF
ON'RECORD
W dI Ct.:41= ''»r; iriw.2
3351 'A
NCk'".lCti
SAEDACCO ' Inc
I+a9++S�Axcrrh^4fG*Y2xc
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4t #' i1.:} � I :co ipktc4 :5/8/2017.
DSCA
vift
t BUM: _1.
955 . Lejeune Blvd. Jacksonville,': NC 28540 Onslow Co,
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rint Form
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Jeffrey A Stewart
Well Contractor Name
(NCWC) 2540-A
NC Well Contractor Certification Number
Mid -Atlantic Drilling, Inc.
Company Name
2. Well Construction Permit #:
List all applicable Iva construction permits (i.e. UIC, County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
DMunicipallPublic
OResidential Water Supply (single)
DResidential 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)
OGroundwater Remediation
'Salinity Barrier
DStormwater Drainage
DSubsidence Control
[Tracer
EllOther (explain under #21 Remarks)
4. Date Well(s) Completed: 4/18/2017 Well IID# l R02-G W15
5a, Well Location:
Commanding General USMC
Facility/Owner Name Facility ID# (if applicable)
IR02 Holcomb Blvd, Camp Lejeune, NC, 28547
Physical Address, City, -and Zip
Onslow NA
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
34.719697 N-77.342669
W
6. Is(are) the wells) JPermanent or DTemporary
7. Is this a repair to an existing well: DYes or3No
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: 001
9. Total well depth below land surface: 13.0 (ft.)
For multiple wells list all depths ifdifferent (example- 3@200' and 20.100')
10. Static water level below top of casing: 2.53 (ft)
If water level is above casing, use "+" .
11. Borehole diameter: 4 0"(in.)
12. Well construction method: H o l l Ow 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
For Internal Use Only:
444312
14. WATER ZONES
FROM
TO
DESCRIPTION
3.91 ft.
13.0 ft•
Depth of water in well 24hrs after well installed.
ft.
ft.
154 OUTER CASING (for
multi -cased wells) OR LINER (if apphcableZ
FROM
TO
DIAMETER
THICKNESS
MATERIAL`
0.0 it
3.0 ft•
6 in*
Unkown
PVC
16. DINER
CASING OR TUBING
.eothermal closed-loo
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0,0 ft.
13.0 ft.
2 in.
Sch 40
PVC
ft.
ft.
in.
17�` SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
3.0 ft•
13.0 ft•
2 i>i,
.010
Sch 40
PVC
ft.
ft.
in.
18 GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0.0 ft.
3.0 ft•
Cement/Bentonite Mix
Hand pour(Outer Casing)
0,0 ft.
0.74 ft.
Cement/Bentonite Mix
Hand pour (Inner Casing)
ft.
ft.
19 SAND/GRAVEL PACK
(if applicable)"
FROM
TO
MATERIAL
EMPLACEMENT METHOD
1.5 ft.
13.0 ft.
#2 Filter Sand
Hand pour
ft.
ft.
20.>DRILLING'
LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soilrock type, grain size, etc.)
0, 0 ft•
2.0 ft.
Silty Sand(SM), black, few organics, dry to Sandy Clay(CL), gray, dry, Redox
2.0 ft.
3.0 ft.
Sandy Clay(CL) tan to gray, slightly moist, few organics, SC,VC,VS
3.0 ft.
7.0 ft.
Sandy Clay(C1), dark tan, saturated, to Silty Sand(SM) trace clay,darktan,
7.0 ft.
9.0 ft.
Silty Sand(SM),trace clay, dark gray, saturated
9,0 ft.
11.0 ft.
Silty Clay(CL), dark gray, saturated.
11 lift
1341i ft.
Silty Clay(CL), trace sands, dark gray,
ft•
1t•
r , -, ,
21. REMARKS. n {
JUN
0 8 2017
22.
tion:
e Contractor
'r.i'a•;-stir ,d.•
Date
signing t is form, 1 hereby (.'ertifil that the well(s) was (were) constructed in accordance
with 1SA NC'AC 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 pageto 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, Rale h NC
. EIVE INc® l
24b. For Injection Wells: In addit sending the form g rm to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
JUN 192017.
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
tof
24c. For Water Supply & Injection V s t erl Re "�ni:ng the form to
9Pa 'Om the county
e8ri
the address(es) above, also submit one �►,19r� . 'a• 30 days of
completion of well construction to tWl o
where constructed.
Form GW-1
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:
Jeffrey A Stewart
Well Contractor Name
(NCWC) 2540-A
NC Well Contractor Certification Number
Mid -Atlantic Drilling, Inc.
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
DMunicipalWPubiic
OResidential Water Supply (single)
EResidential Water Supply (shared)
Non -Water Supply Well:
Monitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
1
Recovery
DGroundwater Remediation.
Dsalinit' Barrier
DStormwater Drainage
D Subsidence Control
DTracer
Geothermal (Heating/Cooling .Return) DOther (explain under #21 Remarks)
4. Date Well(s) Completed: 4/18/2017 Well ID# I R02-GW14
5a. Well Location:
Commanding General USMC
Facility/Owner Name Facility ID# (if applicable)
IR02 Water Plant RD, Camp Lejeune, NC, 28547
Physical Address, City, and Zip
Onslow NA
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
34.718398 N-77.34147
W
6. Is(are) the wells) Permanent or DTemporary
7. Is this a repair to an existing well: OYes orNo
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: 001
9. Total well depth below land surface: 14.0.
For multiple wells list all depths if different (example- 3@200' and 2 er..100)
(ft.)
10. Static water level below top of casing: 3• 28'
(ft.)
If water level is above casing, use "+ "
11. Borehole diameter: 40" (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:
For Internal Use Only:
14. WATER ZONES z` " 'A` �.
FROM
TO
DESCRIPTION
3.54 f•
14.0 ft
Depth of water in well 24hrs after well installed.
ft.
ft.
15. ' OUTER
CASING (for multi -cased wells) OR LINER(if ap ` licable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0.0 It.
4.0 ft.
6 in"
Unknown
Grout
16. INNER CASING OR TUBING
(geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0.0 ft.
14.0 ft.
2 in.
Sch 40
PVC
ft.
ft.
un.
'
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
4.0 ft.
14.0 ft•
2 in"
.010
.
Sch 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0.0 f •
4.0 ft.
Cemen/Bentonite Mix
Hand Pour (Outer Casing)
0.0 ft.
1.0 ft.
Cement/Bentonite Mix
Hand Pour (Inner Casing)
ft.
ft.
19. SAND/GRAVEL PACK
(if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
2.0 ft•
14.0 ft.
# 2 Filter Sand
Hand Pour
ft.
ft.
20. DRILLING
LOG (attach
additional sheets` if. necessary)
FROM -
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
0.0 ft.
2.0 ft•
Slightly Silty Sand(SM),some Clay (SP) loose, dry, tan, some organics, gravel 2 1'bgs, bum
2.0 ft•
4.0 ft.
Silty Sand, some Clay(SM), dark gray to gray,wet at 3.5' bgs, loose, SC, NP
4,0 ft•
10.0 ft•
(SM) Same as above
10.0 ft•
14.0 ft.
Silty Clay (Ct.) trace sand, dark gray, saturated, SC,MP, VS
ft.
ft.
ft.
ft.
ft.
ft.
''',- -
21. REMARKSJIA
I ) 8 2017
22. Ce
d el Contractor
By signing this form, 1 hereby cert jy that the well(s) was (were) constructed in accordance
with 1SA NCAC 02C .0100 or 1SA 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 attachadditional 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 R:��
1617 Mail Service
OEM nag Unit,
enter, Ra eigh, NC 2 699-1617
24b. For Injection Wells: In addition to sending. the form to the address in 24a
above, also submit one copy of this gurwitiy t .4 of completion of well
construction to the following:
Division of Water Resources, rlg n' ?ntrol Program,
1636 Mail Service ;'
Ora iAF'M,-1636
24c. For Water Supply &InigeNlittafikl l !. J * WniCitficaiding 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

Print Form
WELL CONSTRUCTION RECORD (OW-1)
1. Well Contractor Information:
Jeffrev A Stewart
Well Contractor Name
(NCWC) 254OA
NC Well Contractor Certification Number
Mid -Atlantic Drilling, Inc.
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIG, County, State, Variance, etc:)
3. Well Use (check well use):
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Irri ' ation
DMunicipalJPublic
DResidential Water Supply (single)
DResidential Water Supply (shared)
Non -Water Supply Well:
Monitoring
DRecovery
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heatin: Coolin:.Return)
Groundwater Remediation
()Salinity Barrier
Dstormwater Drainage
Subsidence Control
Tracer
Other , ex )lain under #21 Remarks)
4. Date Well(s) Completed:
Well ID# 1 R02-GW13
5a. Well Location:
Commanding General USMC
Facility/Owner Name Facility ID# (if applicable)
IR02 Water Plant RD, Camp
Lejeune, NC, 28547
Physical Address, City, and Zip
Onslow
County
NA
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
34.717371 47.340635
NW
6. Is(are) the well(s)Permanent or DiTemporary
7. Is this a repair to an existing well: DYes or EgNo
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: 001
9. Total well depth below land surface: i. 5'
For multiple wells list all depths if different (example- 3@200' and 2e,,100`)
(ft)
10. Static water level below top of casing: .5 ft,
( )
If water level is above casing, use "-i-"
11. Borehole diameter: 4.0" (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:
For Internal Use Only:
444310
14. WATER ZONES
FROM
TO
DESCRIPTION
1.51 ft.
12.5 ft•
Depth of water in well 24hrs after well installed.
ft.
ft.
15.'OUTER CASINGJfor multi -used wells) OR LINER if a licablel
FROM TO
DIAMETER
THICKNESS
MATERIAL
0.0 ft. J2.5 ft.
6 in.
Unkown
Grout
16. INNER CASING OR TUBING
(geothermal. closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0.0 ft'
12.5 ft.
2 in'
Sch 40
PVC
ft.
ft.
'
iln.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
2.5 ft.
12.5 ft•
2 in'
0.010
Sch 40
PVC
ft. ft.
in,
18 GROUT
FROM
TO
_
MATERIAL
I EMPLACEMENT METHOD & AMOUNT
0.0 ft•
2.5 ft.
CementlBentonite Mix
Hand Pour (outer casing)
0.0 ft-
r 0.75 ft.
Cementeentonite Iwix
Hand Pour (inner casing)
ft.
ft.
19 SAND/GRAVEL
PACK
of applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
1.5 ft.
12.5 ft.
# 2 Filter Sand
Hand Pour
ft.
ft.
20,<DRILLING
LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, rain size, etc.)
0. 0 ft-
1.8 ft•
(SM)Dark brown,gray,some organics, moist to Tan, Clayey Sand(SC), most,very loose
1,.8 ft.
2.5 ft'
Same as above to Sandy Clay(CL), redox, gray, moist, loose
2.5 ft.4
.5 ft
Silty clay(CL) with sand to sightly Clayey Samd(SC), tan, saturated
4.5 ft.
6.5 ft.
Fine Sand(SP), little fines, saturated, tannishf gray, NC,NP, Looser
6,5 ft.
8,5 ft.
Fine Silty Sand, (SM) little clay, saturated, dark gray, NC,NP,Loose
8.5 ft•
12,E ft.
Silty clay(CL), saturated, dark gray,SC, MP, VS
ft.
ft.
21 REMARKS --
i
t a ,r 1 fi
22. C
S''.' re
tification:
'fi=r ell
•
d as
~:.Y. � � �. • 1 "]-. '`i "ter;"
ontracto Date
dl 7
By signing this form, 1 hereby cer7) that the well(s) was (were) constructed in accordance
with l SA NCAC 02C .0100 or 1SA 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,
IP)WR
24b. 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:
1617 Mail Service Ce ct ; in
JUN 192017
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27 99-1636,
Water Quality Ieglona
24c. For Water Snook ,sr .Injection We p get ding the form to
the address(es) above, also submit 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

For multiple wells list all depths if different (example- 3@200' and 2@100)
10. Static water level below topof casing: 1 ' 00
ng• (ft.)
1f water level is above casing, use "+"
11. Borehole diameter:
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor :information:
Jeffrey A Stewart
Well Contractor Name
(NCWC) 254OA
NC Well Contractor Certification Number
Mid -Atlantic Drilling, Inc.
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
Non -Water Supply Well:
Monitoring
Injection Well:
DMunicipal/Public
DResidentia! Water Supply (single)
DResidential Water Supply (shared)
Recovery
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
OGroundwater Remediation
DISalinity Barrier
Dstormwater Drainage
Subsidence Control
Tracer
flOther(explain under#21 Remarks)
4. Date Well(s) Completed: 4/12/2017 Well ID#UST FC39-TU1/09
5a. Well Location:
Commanding General USMC
Facility/Owner Name Facility ID# (if applicable)
Sneads FerryRd, Camp Lejeune, NC, 28547
Physical Address, City, and Zip
Onslow
NA
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
No Coordinates No Coordinates
. N
6. Is(are) the well(s)fPermanent orDTemporary
7. Is this a repair to an existing well: EYes or DNo
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: 001
9. Total well depth below land surface: 6'89
(ft.)
12. Well construction method: Direct Push Tecnology
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
For Internal Use Only:
4443Q9
Print Form
14. WATER ZONES
FROM TO
1.00 ft•
ft.
6.89 ft.
ft.
DESCRIPTION
Depth of water in well 24hrs after well installed.
15. OUTER CASING (for multiased wells) OR LINER' (if applica 'le)
FROM ` TO THICKNESS]
ft.
ft.
DIA TER
in.
16.'INNER CASING OR TUBIN
(geothermal cl
M TERIAL
.......-.....jr)
FROM
1.89 ft.
ft.
TO
6.89 ft.
ft.
DIAMETER
1
in.
in.
18. GROUT
FROM
ft.
ft.
TO
ft.
ft.
MATERIAL
SLOT SIZE
.010
THICKNESS [ MATERIAL
Sch 40 PVC
EMPLACEMENT METHOD & AMOUNI'�
ft.
ft.
19. SAND/GRAVEL : PACK (if a licable)
FROM TO MATERIAL
,0 ft.
ft.
6.21 ft•
ft
# 2 LFilter Sand
EMPLACEMENT METHOD
Hand Pour
20. DRILLING LOG (attach add tional sheetsif necessary)..
FROM TO DESCRIPTION (color, hardness,soil/rock type, dra.m size, etc.)
4.0 ft. Silty Sand(SM)black to Sandy Cla CL ra
. � y( )9 Y
4.0 f•
8.0 ft.
ft.
4.0 fr.
8.0 ft.
12.0 ft.
ft.
Sandy Clay(CL) to Clayey Sand(CL)black/gray
_ Sandy Clay(CL) gray, moist to Sand, gray, saturated
ft.
ft.
ft.
ft.
ft.
21. REMARKS.
ft.
J1iN.O 8 2017
22. Certif : on.
fh4
•
Sign ! ifie ell. C�ontrac or 1 D
13y signing this form, I hereby certifr that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards crnd that a
copy of this record has been provided tothe 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 INSTRUCTIOI IS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following: .
Division of Water Resources, Information Processin Unit,
1617 '
Mad Service �:��; 'ka,pirgoomem
24b. For Injection 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:
JUN i9i
7
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center 'i'gh,NN -s�27 9q4y- 36
24c. For Water Supply & Iniec g Oka ing the form to
the address(es) above, also submki
completion of�°�9�� din 30 days 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

Print Form
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Jeffrey A Stewart
Well Contractor Name
(NCWC) 254OA
NC Well Contractor Certification Number
Mid -Atlantic Drilling, Inc.
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UK County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
11
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial.
Irrigation
OMunicipal/Public
DResidntia1 Water Supply (single)
DResidential Water Supply (shared)
Non -Water Supply Well:
Monitoring ORecovery
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
OGroundwater Remediation
DSalinity Barrier
DStormwater Drainage
DISubsidence Control
DTracet
Other (explain under #21 Remarks)
4. Date Well(s) Completed: 4/12/2017 Well 1# UST-FC39-TW03
5a. Well Location:
Commanding General USMC
Facility/Owner Name Fadility ID# (if applicable)
Sneads Ferry Rd, Camp Lejeune, NC, 28547
Physical Address, City, and Zip
Onslow
NA
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
No Coordinates No Coordinates
N W
6. Is(are) the well(s)rJPermanent or DITemporary
7. Is this a repair to an existing well: OYes or Di 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: 001
9. Total well depth below land surface: 6.21
For multiple wells list all depths i f different (example- 3 chi 20(J' and 2 u,100')
10. Static water level below top of casing: 0' 93
If water level is above casing, use "+"
(ft.)
(ft.)
11. Borehole diameter: 2" (in.)
12. Well construction method: Direct Push Tecnology
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
For Internal Use Only: 4443
14. WATER ZONES ,
FROM
TO
DF,Slr uPTION .
0.93 ft.
6.21 ft•
Depth of water in well 24hrs after well installed.
ft.
ft.
15 OUTER CASING (for multi -eased wells) OR LINER (if ap licahle)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING (geothermal closed -loop)
• FROM
TO
DIAMETER
THICKNESS
MATERIAL .
0.0 ft*
6.21 ft.
1 in'
,
Sch 40
PVC
ft.
, ft.
in.
17. SCREEN : _ j
FROM
TO
DIAMETER _
SLOT SIZE
THICKNESS
MATERIAL
1.21 ft.
6.21 ft.
1 in.
.010
Sch 40
PVC
ft.
ft.
in.
18. GROUT.
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
ft.
ft.
ft.
ft,.
ft.
ft.
19. SAND/GRAVEL
PACK (if applicable)
FROM .
TO
MATERIAL
EMPLACEMENT METHOD
Hand Pour
1.0 ft•
6.21 ft•
# 2 Filter. Sand
ft.
ft.
20. DRILLING
LOG (attach add tional sheets if necessary)
FROM
TO
DES(RYPTION (color, hardness, soil/rock type, grain size, etc.) ,
0.0 ft'
4.0 ft-
Fill sand, tan, dry
4.0 ft.
8.0 ft-
Clayey Sand(SC), tan/gray, saturated
8,0 ft•
12.0
Sandy Clay(CL) gray to Silty Sand(SM
ft.
ft.
ft.
ft.
c='-'ti'`\ :y -`=:a - Y+. .. -..
ft*
ft.
ft.
ft.
JUG o 9 9017.
21. REMARKS
22. Cer ' 'cation:
Si
By -gning this form, 1 hereby cert bi 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: Su
construction to the follows
ditifflittioite
R of completion of well
Division of Water Resources, Information Processing Unit,
1617 Mail ServiceMere lei i INC 27699-1617
24b. For Injection. 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: ter Quartegiona
Water Y
O rti0fS
Rl
Division of Water Res`� .'�pControl Program,
1636 Mail Se W ter, Ra ei hSection 27699-1636 NC
g�
24c. For Water Sunnlv & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well 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

Print Form
WELL CONSTRUCTION RECOR4 (GW-1)
1. Well Contractor Information:
Jeffrey A Stewart
Well Contractor Name
(NCWC) 2540A
NC Well Contractor Certification Number
Mid -Atlantic Drilling, Inc.
Company Name
2. Well Construction. Permit #:
List all applicable well construction permits (i e. UIC, County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
Non -Water Supply Well:
Monitoring
DMuniaipalIPublic
EResidntia1 Water Supply (single)
DResidontial Water Supply (shared)
Recovery
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling .Return)
OGroundwater Remediation
0 Salinity Barrier
DStormwater Drainage
DSubsidence Control
OTracer
(Other (explain under #21 Remarks)
4. Date Well(s) Completed: 4/12/20 1 ?
5a. Well Location:
Commanding General USMC
Facility/Owner Name
Sneads Ferry Rd, Camp
Well ID# UST-FC39-TWO7
Facility ID# (if applicable)
Lejeune, NC, 28547
Physical Address, City, and Zip
Onslcw
NA
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
No Coordinates N No Coordinates
,
W
6. Is(are) the well(s)Permanent or OTemporary
7. Is this a repair to an existing well: £Yes or ON°
If this is a repair, jilt out known well construction information and explain the nature of the
repair under 1#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: 001
9. Total well depth below land surface: 6.5
For multiple wells list all depths if deerent (example- 3@200' and 2@,100')
(ft)
10. Static water level below top of casing: " $ ( ft,
l
)
If water level is above casing, use "+"
�n
11. Borehole diameter: (in.)
12. Well construction method: Direct Push Tecnology
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm)
Method of test:
13b. Disinfection type: Amount:
FROM
For Internal Use Only:
4443O7
14. WATER: ZONES
FROM
TO
DESCRIPTION
1.15 ft.
ft.
6.5 ft.
ft.
Depth of water in well 24hrs after well installed.
15. OUTER CASING (for multi -cased wells) OR LINER (if ap iicable)
THICKNESS MATERIAL
ft.
TO
ft.
DIAMETER
in.
16.1NNER CASING OR TUBIN (geothermal closed -loop)
,FRROM LE
0.0 ft.
TO
6.5 ft•
D TER
1
in.
THICKNESS
Sch 40
MATERIAL
PVC
It.
ft.
in.
17. SCREEN
, FROM
1.5 ft.
TO
6.5 ft.
DIAMETER
1
in,
SLOT SIZE
.010
THICKNESS
Sch 40
MATERIAL
PVC
ft.
ft.
in.
18. GROUT
FROM
ft.
TO
ft.
MATERIAL
EMPLACEMENT METHOD & AMOUNT
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK(ifaolivable)
MATERIAL
FROM
1.0 ft-
TO
6.5 ft.
# 2 Filter Sand
EMPLACEMENT METHOD
Hand Pour
ft.
ft.
20. DRILLING LOG >(attach ;addltional sheets if necessary)
FROM
0.0
4.0 ft.
ft.
TO
4.0 ft.
8.0 ft.
ft.
DESCRIPTION (color, hardness, soiUrock type, grain size, etc.)
Fill sand, tan, dry
Clayey Sand(SC), tan/gray, saturated
ft.
ft.
ft
ft.
ft.
21. REMARKS
ft.
ft.
ft.
JUN
0 201
Si y o� �.�ji ed 11 o. :c or .. Date
By signing this for _ / hereby cert f that the well(s) was (were) constructed in accordance
with ISA NCAC 02 .0100 or 1SA 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 m . ,• .;,» , v , °' ecessary.
S1BMITTAL INSTRUCTIONS
24a. For All Wells: Submit this AIN. v 11itl - itlips of completion of well
construction to the following:
Division of Water Resources, Information,Pro essing Unit,
1617 Mail Servic�IQlal;��99_1617
Operations Section
24b. For Injection Wells: y � ® ; ge l Raab the address in 24a
above, also submit one copylii o� s form within 30 days d ys 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 Supnlv & Inipciioa Wells: In addition to sending the form to
the address(es) above, also submit one copy of this foram 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

Print Form
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Jeffrey A Stewart
Well Contractor Name
(NCWC) 2540-A
NC Well Contractor Certification Number
Mid -Atlantic Drilling, inc.
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc)
3. Well Use (check well use):
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
DMunicipal/Public
OResidential Water Supply (single)
DResidential Water Supply (shared)
Non -Water Supply Well:
Monitoring
(,Recovery
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
jGeothemia1(HeatingICoo1inn Return)
DGroundwater Remediation
Salinity Barrier
DStormWater Drainage
Subsidence Control
DTracet -
DOther (explain under #21 Remarks)
4. Date Well(s) Completed: 4/12/2017 Well ID# UST-FC39-TW06
5a. Well Location:
Commanding General USMC
Facility/Owner Name Facility ID# (if applicable)
Sneads Ferry Rd, Camp Lejeune, NC, 28547
Physical Address, City, and Zip
Onslow NA
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
No Coordinates N No Coordinates
W
6. Is(are) the well(s)Permanent or ;Temporary
7. Is this a repair to an existing well: JYes 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.
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: 001
9. Total well depth below land surface: 7.03
For multiple wells list all depths i f different (example- 3 ,,200' and 2Q,100)
(ft)
10. Static water level below topof casing: 1.15
ft
g ( ) •
If water level is above casing, use "+ "
2"
11. Borehole diameter: (in.)
12. Well construction method: Direct Push Tecnology
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm)
Method of test:
13b. Disinfection type: Amount:
For Internal Use Only:
444308
14. WATER ZONES
:FROM
r
1.15 ft'
ft.
TO
7.03 ft.
ft.
DESCRIPTION
Depth of water in well 24hrs after well installed.
FROM
15. OUTER CASING (for multi-4ased wells) OR LINER(if ap licable)
THICKNESS MATERIAL
ft.
TO
ft.
DIAMETER
in.
16. INNER CASING OR TUB1N4 (geothermal closed -loop)
FROM
0.0 ft.
TO
7.03 ft.
DIAMETER
1
in.
THICKNESS
Sch 40
MATERIAL
PVC
ft.
17. SCREEN
.FROM
2.03 ft.
ft.
ft.
in.
TO
7.03 ft.
ft.
DIAMETER
.1
in.
in.
SLOT SIZE
.010
THICKNESS
Sch 40
MATERIAL
PVC
18. GROUT
,FROM
ft.
TO
ft.
MATERIAL
EMPLACEMENT METHOD & AMOUNT
ft.
ft.
ft.
ft.
9. SAND/GRAVEL PACK (if applicable)
FROM
1.0 ft•
ft.
TO
7.09 ft.
ft.
MATERIAL
# 2 Filter Sand
EMPLACEMENT METHOD
Hand Pour
20. DRILLING LOG (attach additional sheets if necessary)`
FROM
0.0 ft.
TO
4.0
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
Clayey Sand(SC) gray, trace silt
4.0 ft-
8.0 ft.
Sandy Clay(CL) to Clayey Sand(SC) gray/black, few organics
8.0
12.0 ft•
Same as above
ft.
ft.
ft.
ft.
ft.
ft.
•
ft.
21. REMARKS
ft.
JUN o 8 2017
eo
f ell Contractor
By signing this for `` I hereby certifr that the well(s) was (were) constructed in accordance
with 13A 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 INSTRUCTIO11S
24a. For All Wells: Submit
construction to the following:'
NODE . /npletion of well
Division of Water Resources, Informa ' n ssing Unit,
1617 Mail Service Centeiei �h 99-1617
24b. For Injecion. Wells: In addition to sending the forrn 'to the address in 24a
above, also submit one copy of this form in `'`': gib te'4mpletion of well
construction to the following: Wat �' tip ,
operations sec
IQnal ��1t;�'
Division of Water Resources ,II1f2Qiit�on Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this foram 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

Print Form
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Jeffrey A Stewart
Well Contractor Name
(NCWC) 2540-A
NC Well Contractor Certification Number
Mid -Atlantic Drilling, Inc.
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UK, County, State, Variance, etc)
3. Well Use (check well use):
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
DMunicipa1/Pubtic
£Residential Water Supply (single)
ORegidential 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)
OGroundwater Remediation
OSalinity Barrier
DStormwater Drainage
DSubsidenee Control
DTracer
'`Other (exlain under #21 Remarks)
4. Date Well(s) Completed: 4/12/2017 Well ID# UST-FC39-TWO5
5a. Well Location:
Commanding General USMC
Facility/Owner Name Facility ID# (if applicable)
Sneads Ferry Rd, Camp Lejeune, NC, 28547
Physical Address, City, and Zip
Onslow NA
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
No Coordinates N No Coordinates
6. Is(are) the well(s)Permanent or DTemporary
7. Is this a repair to an existing well: EYes or QNo
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: 001
9. Total well depth below land surface: 6.03 (ft)
For multiple wells list all depths if different (example- 3@200' and 2@,100')
10. Static water level below topof casing: 1 .2
(ft)
If water level is above casing, use "+"
"
11. Borehole diameter:
2
12. Well construction method: Direct Push Tecnology
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
For Internal Use Only:
444305
FROM
14. WATER ZONES
TO
1.2 ft.
6.03 ft.
DESCRIPTION
Depth of water in well 24hrs after well installed.
ft.
ft.
FROM
15. OUTER CASING (for multi -cased wells) OR LINER (if ap livable)
THICKNESS MATERIAL
ft.
TO
ft.
DIAMETER
in.
16. INNER CAS.ING OR TUBING (geothermal. closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
4.0 ft.
6.03 ft.
1
in.
Sch 40
PVC
ft.
ft.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
1.03 ft.
6.03 ft.
1
in.
.010
Sch 40
PVC
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
ft.
ft.
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
1.02 ft.
TO
7.09 ft.
MATERIAL
# 2 Filter Sand
EMPLACEMENT METHOD
Hand Pour
ft.
ft.
20. DRILLING LOG' (attic) additional sheets if necessary
FROM
0.0 ft.
TO
4.0 ft.
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
Fill sand to Clayey Sand(SC) tan/gray,dry
4.0 ft•
8.0 ft.
Clayey Sand(SC),grayitan to Silty Clay(SM), to Clayey Sand(SC)
8.0 ft.
ft.
12.0
.
ft.
Silty sand(SM) gray
ft.
ft.
ft.
ft.
ft.
•
21. REMARKS
Jii 8 2017
ture of ' 'fi: ► ell Contractor Date
y signing this form, 1 hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 1SA 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 Resou i` , , GENEW 1 & it,
•
1'
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to imform the address in 24a
above, also submit one copyof this form' W n a co
mpletion ono letton of well
y P
construction to the following:
Division of Water Resources, UndWeteonglgaigt9tiyiappitilal Program,
1636 Mail Service Center,OStidjotiCSMN636
24c. For Water Supply & Iniectionnwens.., innaaarnRezio nto seenciial ng 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

WELL CONSTRUCTION RECORD (GW4)
1. Well Contractor Information:
Jeffrey A Stewart
Well Contractor Name
(NCWC) 2540-A
NC Well Contractor Certification Number
Mid -Atlantic Drilling, Inc.
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. U.IC, County, State, Variance, etc,)
3. Well Use (check well use):
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
Non -Water Supply Well:
X Monitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
DMunicipal/Publjc
Residential Water Supply (single)
OResidential Water Supply (shared)
Recovery
OGroundwater Remediation
OSalinity Barrier
Dstorniwater Drainage
D5ubsidence Control
[Tracer
IOther (explain under #21 Remarks)
4. Date Well(s) Completed: 4/12/2017 Well ID#UST-FC39-TWO4
5a. Well Location:
Commanding General USMC
Facility/Owner Name Facility !D# (if applicable)
Sneads Ferry Rd, Camp Lejeune, NC 28547
Physical Address, City, and Zip
Onslow NA
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(dwell field, one lat/long is sufficient)
No Coordinates No Coordinates
N
6. IS(are) the well(s)Permanent orX: Temporary
7. Is this a repair to an existing well: EYes or 0No
1f this is a repair, fill Il 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: 001
9. Total well depth below land surface: 7' 09
For multiple wells list all depths different (example- 3 ct,')200' and 2@100(f �)
i f
81
10. Static water level below top of casing: i '
(ft)
If water level is above casing, use "+"
2"
11. Borehole diameter: (in.)
12. Well construction method: Direct Push Tecnology
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
TO
TO
ft.
24c. For Water Supply & Injection
the address(es) above, also subrn
completion of well construction to �e co
where constructed.
For Internal Use Only:
Print Form
14. WATER ZONES
FROM
1.81 ft.
ft.
TO
vairivtain
.DESCRIPTION
7.09 ft•
ft.
Depth of water in well 24hrs after well installed.
15. OUTER CASING (for :multi -cased wells) OR LINER (if applicable)'
FROM _ DIAMETER I THICKNESS MATERIAL
in.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM _ DIAMETER i THICKNESS
ft.
0.0 ft.
ft.
17. SCREEN
7.09 ft.
ft.
1
in.
in.
Sch 40
MATERIAL
PVC
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
2.09 ft.
7.09 ft•
1 in.
.010
Sch 40
ft.
1 Q . rni1Y7T:.
ft.
in.
FROM
ft.
TO
MATERIAL
PVC
ft.
MATERIAL
EMPLACEMENT METHOD & AMOUNT
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PAC
FROM
0.8 ft.
TO
7.09 ft
K (if applicable)
MATERIAL
# 2 Filter Sand
EMPLACEMENT METHOD
Hand Pour
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
DESCRIPTION (color, hardness, soil/rock type, grain size,
Fill sand to Clayey Sand(SC)gray,
� Y,
FROM
0.0 •
4.0 ft:
8.0 ft.
ft.
TO
4.0 ft.
8.0 ft.
12.0 ft.
ft.
Clayey Sand(SC) tan/gray, trace silt, few organics.
Clayey Sand(SC)black/gray to Sand Clay(CL)
ft.
ft.
ft.
ft.
ft.
21. REMARKS
ft.
JUN y)
2017
22. Ce . fication:
e . ntractor • Date
igning this .form, 1 hereby certfy that the well(s) was (were) constructed in accordance
with 1 SA NCAC 02C .0100 or 1 SA 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 CattElitiMe
24b. For Injection. 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:
JUN 1 9 ?017
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
t- r Q all . Regional
-ia a • ti8 mending the form to
-. .n 30 days of
Oita/merit of the P county
Form GW-1
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:
Jeffrey A Stewart
Well Contractor Name
(NCWC) 2540-A
NC Well Contractor Certification Number
Mid -Atlantic Drilling, Inc.
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC, 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
OMunicipal/Public
£Residential Water Supply (single)
DResidential Water Supply (shared)
Recovery
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
DGroundwater Remediation
OSalinity Barrier
Estormwater Drainage
DSubsidence Control
DTracer
EOther(explainunder #21 Remarks)
4. Date Well(s) Completed: 4'1-1 12n 17 Well ID# UST-FC39-TWO3
5a. Well Location:
Commanding General USMC
Facility/Owner Name Facility ID# (if applicable)
Sneads Ferry Rd, Camp Lejeune, NC, 28547
Physical Address, City, and Zip
Onslow NA
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
No Coordinates N No Coordinates
6. Is(are) the well(s)4JPermanent or STemporary
7. Is this a repair to an existing well: ElYes ort 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:001
9. Total well depth below land surface: 6' 94 (ft)
For multiple wells list all depths if d fferent (example- 3@200' and 2 u,100')
10. Static water level below topof casing: 2.05
(ft)
1f water level is above casing, use "+ "
11. Borehole diameter: 2"(in.)
12. Well construction method: Direct Push Te cn o l og y
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm)
Method of test:
13b. Disinfection type: Amount:
For Internal Use Only:
444,03
14. WATER ZONES
FROM
TO
_ DESCRIPTION
2.05 ft.
6.94 ft•
Depth of water in well 24hrs after well installed.
ft.
ft.
15. OUTER CASING. (for multi -cased wells) OR LINER (if ap licable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING
(geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0.0 ft'
6.94 ft•
1 in'
Sch 40
PVC
ft.
ft.
in.
17.;SC.REEN -
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
1.94 ft.
6.94 ft.
1 in.
.010
Sch 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO ,
MATERIAL
EMPLACEMENT METHOD & AMOUNT
ft.
ft.
ft.
ft.
3
ft.
ft.
19. SAND/GRAVEL
PACK
(ifli 1icable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
0.8 ft.
6.94 ft.
# 2 Filter Sand
Hand Pour
ft.
ft.
20. DRILLING
LOG (attac_h
additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
0.0 ft'
4.0 ft'•
Clayey Sand(SC) moist, tan to Sandy Clay(CL) tan
4.0 ft.
8.0 ft'
Clayey Sand(SC) gray, dry, to Sandy Clay(CL) gray, to Silty Sand(SM)
8.0 ft.
12.0 ft'
Silty Sand(SM), black, saturated to Silty Clay(CL), black
ft.
ft.
ft.
ft.
ft.
f
`'Ss ( lV �-�
ft.
ft._
21. REMARKS
1-0 8
`i ),
2017
22. C
W
Si
'fic : tion:
ertifie ' Fell. Contrast r
ignin, this form, 1 hereby certifr 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: RECEIVED/NCDENR/OWR
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addiV t8 s ci 2tai form to the address
g in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Water Quality Regional
Division of Water Resources ekEdiraieeneljebtOpn Control Program,
1636 Mail ServIiiiiethilgtOtttiNgIOT yottb4636
24c. For Water SunDIv & Injection Wells: In addition to .sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well 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

WELL CONSTRUCTION RECORD (GW_1)
1. Well Contractor .Information:
Jeffrey A Steward
Well Contractor Name
(NCWC) 2540-A
NC Well Contractor Certification Nutnber
Mid -Atlantic Drilling, Inc.
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc)
3. Well Use (check well use):
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
Non -Water Supply Well:
x. Monitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
DMunicipal/Public
DResidential Water Supply (single)
OResidential Water Supply (shared)
Recovery
Groundwater Remediation.
OSalinity Barrier
DStormwater Drainage
Subsidence Control
Tracer
flOther(explain under #21 Remarks)
4. Date Well(s) Completed: 4/11 /201 ? Well ID# UST-FC9-TWO2
5a. Well Location:
Commanding General USMC
Facility/Owner Name Facility ID# (if applicable)
Sneads Ferry Rd, Camp Lejeune,
Physical Address, City, and Zip
Onslow NA
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well .field, one lat/long is sufficient)
No Coordinates N No Coordinates
6. Is(are) the well(s)Permanent or fTemporary
•
7. Is this a repair to an existing well: EJYes or oNo
If this is a repair, fill out known well construction information and explain the nature of the
repair under 1#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: 001
9. Total well depth below land surface: 6.92
•
For multiple wells list all depths if different (example- 3 tr200' and 2@')iO0(f t)
10. Static water level below top of casing:
If water level is above casing, use "+"
1.85
11. Borehole diameter: '2 (i
n.)
12. Well construction method: Direct Push Tecnology
(i.e. auger, rotary, cable, direct push, etc.)
(ft)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
For Internal Use Only:
4302
14. WATERZONES
FROM
TO 1 DESCRIPTION
1.82 ft. 6.92 ft. Depth of water in well 24hrs after well installed.
ft. ft.
15,: OUTER CASING (for multi -cased' wells) OR LINER (if ap
FROM I TO I DIAMETER I THICKNESS
ft.
ft. in.
16. INN,ER CASING OR TUBING (geothermal closed -loop)
FROM TO DIAMETER THICKNESS
0,0 ft; 6.92 ft. 1 in.
Sch 40
ft.
licable)
MATERIAL
MATERIAL
PVC
17 SCREEN
FROM
1.92 ft.
ft.
ft.
m,
TO
6.92 ft.
DIAMETER
in.
SLOT SIZE
.010
THICKNESS
MATERIAL
Sch 40 PVC
18. GROUT
FROM
ft.
tn.
ft. •
ft.
ft.
TO
ft.
MATERIAL
EMPLACEMENT METHOD & AMOK
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM 1 TO
0.8
ft.
ft.
MATERIAL
6.16 ft• # 2 Filter Sand
EMPLACEMENT METHOD
Hand Pour
ft.
20.:DRILLING LOG (attach additional sheets if necessary)
FROM TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.
0.0 ft. 4.0 ft. Clayey Sand(SC), backfill,tan, wet,trace si
lt >t at 27"
4.0
ft.
8.0 fte
ft.
ft.
ft.
ft.
8.0
12.0
ft.
ft.
ft.
Clayey sand(SC)trace silt, trace organics, dry
Sandy, gray, saturated, to Sandy Clay(CL), gray, to and
ft.
21. REMARKS
ft,
ft.
JUN 8 2017
22. , reification:
Y d Well Contractor
signing this form, 1 hereby certin, 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 iaN4 om l.etion
construction to the following: P of well
Division of Water '•��i:�.� � � ' � Processing orm anon Processing Unit,
1617 Mail Service Center, Raleigh,NC 99-1617
24b. For Inflection Wells: In addition on `
e form to the address
i �� nin 24a
above, also submit t one copy of this f. within
30 days of cnmtpletion of well
construction to the following: .C�d
Division of Water Resources, Un ; cUctVr ,
1636 Mail Service Center i'1 : �'� � � ,* 9-1 rogram,
1C' 636
n
24c. For Water Suunly & Infection ells: In addition to
the address(es) above, also submit one copysending the form to
completion of well construction to the cou°f this form within 30 days of
where constructed. county health department of the county
Form GW-1
North Carolina Department of Environmental Quality - Division of Water Resources
Revised 2-22-2016

rint Form
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Jeffrey A Stewart
Well Contractor Name
(NCWC) 2540-A
NC Well Contractor Certification Number
Mid -Atlantic Drilling, Inc.
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc)
3. Well Use (check well use):
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
Non -Water Supply Well:
Monitoring DRecovery
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
0Municipal/Public
OResidential Water Supply (single)
OResidential Water Supply (shared)
DGroundwater Rem.ediation
Salinity Barrier
DStormwater Drainage
0Subsidence Control
ETracer
DOther (explain under #21 Remarks)
4. Date Well(s) Completed: 4/1 1 /2017 Well ID#UST-FC39-T1N01
5a. Well Location:
Commanding General USMC
Facility/Owner Name Facility ID# (if applicable)
Sneads Ferry Rd, Camp Lejeune, NC, 28547
Physical Address, City, and Zip
Onslow NA
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
No Coordinates N No Coordinates
6. Is(are) the well(s)Permanent .or oTemporary
7. Is this a repair to an existing well: EYes orNo
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: 001
9. Total well depth below land surface: 6.16
For multiple wells list all depths if different (example- 3@200' and 2@..100)
(ft)
10. Static water level below top of casing: Q' 2 (ft)
If water level is above casing, use "+"
2"
11. Borehole diameter: (in.)
12. Well construction method: D i rent Push Tecnology
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm)
Method of test:
13b. Disinfection type: Amount:
For Internal. Use Only:
444n s
1.4. WATER ZONES
FROM
TO
DESCRIPTION
0.2 ft.
6.16 ft•
Depth of water in well 24hrs after well installed.
r
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if applicable)
FROM
TO , DIAMETER
THICKNESS
MATERIAL
ft.
ft. in.
,
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
„ DIAMETER
THICKNESS
MATERIAL
0.0 ft•
616 ft.
1 in*
Sch 40
,
PVC
ft. ft.
in.
17. SCREEN
FROM ,
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
1.15 ft.
6.16 ft.
1 in.
.010
Sch 40
PVC
ft.
ft.
in.
18 GROUT
TO
_FROM MATERIAL_
EMPLACE METHOD & AMOUNT
ft.
ft.
ft.
ft.
ft.
ft.
fr
19. SAND/GRAVEL PACK (if applicahle)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
0.8 ft•
6.94 ft.
# 2 Filter Sand
Hand Pour
ft.
ft.
20. DRILLING
LOG (attach additional sheets if necessary,)
FROM
TO
DESCRIPTION (color, hardness, soiVrock type, grain sine, etc.)
0.0 ft'
4.0 ft' Tan, fill sand, to Clayey Sand(SC) to gray,saturated
4.0 ft'
8.0
Clayey Sand(SC) Gray, dry, to graylblack Silty Sand(CL) to Silty Clay(CL) black organics
8.0
12.0 ft•
. Gray, sand, to Clay, saturated
ft.
ft.
ft.
ft.
21. REMARKS
iLJN 4 .8
20'7
tro,c.,,...4,..;,,,,A-.),., ,. ,,,,,,,,,, ,.....; ,:,-, ''-'
22.Certification:
at
e ' Well Contractor
By signing this form, 1 hereby certifr that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 1SA 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
construction to the folio ' y CO
Division of Water Resources, Ink
1617 Mai! Service r, i
j®Y%VAO a s of completion of well
P
Processing Unit,
NC 27699-1617
24b. For Injection Wells: In addition to sending the for to the address in 24a
above, also submit one copy of this form uy,n 'Qs of completion of well
construction to the following: ate( Q' eat SeCttOjj0�� 'ice
eat rona\.
liuitaf nlection Control Program,
Division of Water Resourc``e��s,,''
1636 Mail Servial n er, Raleigh, NC 27699-1636
24c. For Water Supply & fntection 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

rnt 'or
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Jimmy D. Hines
Well Contractor Name
4149-B
NC Well Contractor Certification Number
Geological Resources, Inc.
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
0Agricultural .
Geothermal (Heating/Cooling Supply)
EDIndustrial/Commercial
DIrrigation
DMunicipal/Public
DResidentialWater Supply (single)
DResidential Water Supply (shared)
Non -Water Supply Well:
OMonitoring DRecovery
Injection Well:
DAquifer Recharge [.Groundwater Remediation
Aquifer Storage and Recovery Eialinity Barrier
DAquifer Test Stormwater Drainage
DExperimental Technology 0 Subsidence Control
OGeothermal (Closed Loop) 0 Tracer
0 Geothermal (Heating/Cooling Return) nOther (explain under #21 Remarks)
4. Date Well(s) Completed: 05/16/2017 Well m# MI"
5a. Well Location:
Speedway #8289
0-035920
Facility/Owner Name Facility ID# (if applicable)
1495 Burgaw Highway Jacksonville 28540
Physical Address, City, and Zip
Onslow
435611555926
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
34.7460480 N 77.4835650. w
6. Is(are) the well(s)Permanent or OTemporary
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: 12 (ft.)
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing: 8 (ft.)
If water level is above casing, use "+"
11. Borehole diameter: 3.25 (in.)
12. Well construction method: Hand Auger/ Direct Push
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
Form GW-1
For Internal Use Only:
444104
14. WATER ZONES
FROM
TO
DESCRIPTION
8
ft.
12
ft.
Saturated
ft.
ft.
15. OUTER CASING (for multi -eased wells) OR LINER (if ap Iicat le) .. :
FROM TO DIAMETER THICKNESS MATERIAL
N/A ft. ft. in.
6. INNER CASING OR TUBING (geothermal closed -loop
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0
ft.
2
ft.
2"
in.
Sched 40
PVC
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
2
ft.
12
ft.
2"
in.
0.010
Sched 40
PVC
ft.
ft.
in.
ROUT....
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0
ft. •
0.5
ft.
Grout
Pour
0.5
ft.
1 ft.
Bentonite Chips
Pour
ft.
ft.
AND/GRVE:;PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
ft.
12
ft.
#2 Gravel Pack
Pour
ft.
ft.
-20. DRIL,ING':LOG (attach additional sheets if:necessar
FROM
0
ft.
TO
6.
ft.
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
Tan fine sandy clay
6
ft.
12
ft.
Direct Push Technology - No Lithologies
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
ft.
Finished with flush pad
22. Certification:
1
'� �� %�'r:; G+:: tt•'+s. n � .. :�a ..';'4:5 � l j B pi
t ,
Signal of Cl6rtified Well Contractor
05/16/2017
Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 1 SA 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
24b. For Injection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of thi ;. : -roa.within30 days of completion of well
construction to the following: f
g CD�N
R/DWR
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, leig 27699-1636
7
24c. For Water Su l & Wells: ' ' O 1 po v IniectionIn ad rtion 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 t tAt. lalth m nt of the county
where constructed. TtY e
Operations Section
Wilmington Regional Office
North Carolina Department of Environmental Quality - Division of Water Resources evised 2-22-2016

ti CATLIN
Post Office Box 10279
Wilmington, North Carolina 28404-0279
Engineers and Scientists Telephone: [phone]
Fax: [phone]
www.catlinusa.com
May 22, 2017
North Carolina Department of Environmental Quality
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Re: NC Well Construction and/or Abandonment Record(s)
NAVFAC Well Abandonment
Camp Lejeune, NC, North Carolina
CATLIN Project No.: 213105.28
To Whom It May Concern:
CATLIN Engineers and. Scientists (CATLIN) recently constructed and/or abandoned well(s) at the
above referenced site. Attached to this letter are completed North Carolina Well Construction Records
and/or North Carolina Well Abandonment Records with associated Attachment(s) for the above
referenced site located at MCB Camp Lejeune in Camp Lejeune, NC, North Carolina.
If you have any questions or require any additional information, please feel free to contact us at (910)
452-5861.
Sincerely,
d!,
tivim
Michael E. Mason, P.E.
Project Manager
Enclosures
S:\GINT\PROJECTS\DAVENPORT\213105.29 WELL ABANDONMENT.GPJ,«DrawingFileSpec»
RECEtVED/NENROR
JUN 12 2017
Water Quality Regional
Operations Section
Wilmington Regional OffiCe

WELL CONSTRUCTION RECORD
For Internal Use ONLY:
This form can be used for single or multiple wells
1. Well Contractor Information:
D.T. Chalmers, Jr.
Well Contractor Name
4146A
NC Well Contractor Certification Number
CATLIN Engineers and Scientists
Company Name
2. Well Construction Permit #:
List all applicable well permits (i.e. County, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑ Agricultural
❑ 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: 03/01/17
5a. Well Location:
MCB, Camp Leieune
Facility/Owner Name
Well ID#: MW-41
Facility ID# (if applicable)
MCB Camp Lejeune, Camp Lejeune, NC
Physical Address, City, and Zip
ONSLOW
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): ® Permanent or D Temporary
7. Is this a repair to an existing well: D 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. Number of wells constructed:
For multiple injection or non -water supply wells ONLY with the same construction, you
can submit one form.
9. Total well depth below land surface: 80 (ft.)
For multiple wells list all depths in different (example- 3 @ 200' and 2 @ 100')
10. Static water level below top of casing: 17.23 (ft.)
If water level is above casing, use "+"
11. Borehole diameter: (in.)
1
12. Well construction method: HSA
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
titt-Ft4
�4036
14. WATER ZONES',
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. INNER CASING OR TUBING Geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
75 ft.
2 in.
Sch. 40
PVC
FROM
16 OUTER CASING (for multi -cased wells) OR LINER (if applicable)
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
70 ft.
4
in.
PVC
PVC
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
75 ft.
80 ft.
2 in.
Slot .010
Sch. 40
PVC
ft.
ft.
in.
GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
ft.
ft.
68 ft.
70 ft.
Bent. Pellets
Surface Pour
ft.
ft.
19 SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
70 ft.
80 ft.
ff2 Medium #2 Medium
Surface. Pour
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary
FROM
ft.
TO
ft.
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
P4G41)
r14.tr"1 Ji
L a
Y .1-19
JU 0 2017
22. Certification:
o nation roc
DAB Y'
Signature of Certified Well Contractor
5/23/2017
Date
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.
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 Servic,, 1617
24b. For Injection 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 thealwlg� Z 7
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Centte{rdrl ei l!iGian-1636
uua
24c. For Water Supply & InjectionGn ti0nS Sectlff0Off
tl
Also submit one copy of this forW utnion of well
construction to the county health department of the county where constructed.
Adapted from Form GW-1
North Carolina Department of Environment and Natural Resources - Division of Water Resources Revised 2-22-2016

CATLIN
Engineers and Scientists
May 23, 2017
North Carolina Department of Environmental Quality
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Re: NC Well Construction and/or Abandonment Record(s)
Site 645 Type 111 Well Installation
Camp Lejeune, NC, North Carolina
CATLIN Project No.: 217030
To Whom It May Concern:
Post Office Box 10279
Wilmington, North Carolina 28404-0279
Telephone: [phone]
Fax: [phone]
www.catlinusa.com
CATLIN Engineers and Scientists (CATLIN) recently constructed and/or abandoned well(s) at the
above referenced site. Attached to this letter are completed North Carolina Well Construction Records
and/or North Carolina Well Abandonment Records with associated Attachment(s) for the above
referenced site located at MCB Camp Lejeune in Camp Lejeune, NC, North Carolina.
If you have, any questions or require any additional information, please feel free to contact us at (910)
452-5861.
Sincerely,
Michael E. Mason, P.E.
Project Manager
Enclosures
S:\GINT\PROJECTS\217030 CONSULTECH SITE 645.GPJ,«DrawingFileSpec»
RECEIVED/NCDENR/DWR
JUN 12 2017
Water Quality Regional
Operations Section
Wilmington Regional Office

CATLIN
217070Engineers and Scientists
217030 SHEET 1 OF 1
ELL
LOG
PROJECT NO.: 217030
STATE: NC
COUNTY: ONSLOW
LOCATION: Camp Lejeune, NC
PROJECT NAME:
Site 645 Type III Well Installation
LOGGED BY: J. Liebig
WELL ID:
MW-41
DRILLER: D.T. Chalmers, Jr.
NORTHING:
EASTING:
CREW: CATL I N
SYSTEM:
BORING LOCATION:
T.O.C. ELEV.:
DRILL MACHINE: C M E 45B
METHOD: HSA
0 HOUR DTW: 17.2
TOTAL DEPTH: 80.0
START DATE: 2/28/17
FINISH
DATE: 3/1/17
24 HOUR DTW: N/A
WELL DEPTH: 80.0_
DEPTH
BLOW
o.5ft
COUNT
0.5ft
0.5ft
OVA
Eppm)
LAB.
o
l
s
L
G
SOIL AND ROCK
DEPTH DESCRIPTION
WELL
DETAIL
LAND SURFACE
o.o
--
4.0
=
7.0 E
-
13.0 -.;.',
i
r
1
=
_
----.
„-
_
_
80.0 =
•.•,•
•••••
,0.0
(CL) - Dark brown, Sandy CLAY
'
4" PVC PVC
cm
0
M
(ML) - Lt. gray, Sandy SILT w/some clay.
7.0
M
(CL) - Lt. brown, Sandy CLAY.
*. ECEVEDNC0E/ ®
JUN 122Q7
70.0
Sat.
•
/,
....
••••
;•::
Water Quality Regior
Operations Section
- Wilmington Regional q
(SP)Gray, Poorly Graded SAND. Wil
80.0
7.=
--
BORING TERMINATED AT DEPTH 80.0 ft in Poorly
Graded SAND.
*Lithology provided by John Liebig of Consultech
Environmental, LLC.
Bentonite Grout
Bentonite Pellets [1#2 Medium Sand

STATE- c,;74.,
•
1. WELL CONTRAcT
NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
, Lief
Id,
Wel Contracto (Indiyidual) Na
\.;;oi actor Co
Name
_
c:/err47
sc.
City or Town
(5( 44
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
State - Zip Code
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Monitoring 0 Municipal/Public El
Industrial/Commercial /Agricuttural 0 Recovery 0 Injection 0
IrrigationD Other". (list use) (
orfer_
DATE DRILLED4-1, —/
4. W L LOCATION:
(Stet Name, NuMbers,
CITY: 46
TOPOGRAPHIC / LA
D Slope D Valley
/ I
ommunity, Subdivision, Lot No., Parcel, Zip
it4.7; COUNTY ()/L'
SETTING: (check appropriate box)
lat 0Ridge 00ther
LATITUDE 36 ) ad:7 " DMS OR 3X.XXXXXXXXX DD
LONGITUDE 75677'11' " DMS OR 7X.XXXXXXXXX DD
Latitude/longitude source: [3Corg lopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business wherejbe well is located.)
F ility ,ame ,
F cility ID#(if
pplicable)
Street,
ity or To
SS
Contact Name
"--)
627
tate Zip Code
Mar
City or Town
(g(3)
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:
„-----State Zip Code
. .
v
b. DOES WELL REPLACE EXISTING WELL? YES D
NO V/
c. WATER LEVEL Below Top of Casing: FT.
• (Use "+" if Above Top of Casing)
i ,-,
i d. TOP OF CASING IS /d.)
-'-i-i FT. Above Land Surface*
' . *Top of casing terminated at/or below land surface may require
. a variance in accordance with 15A NCAC 2C .0118.
: e. YIELD (gpm):
THOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
: Top Bottom ••Bottom
: Top • m Top Bottom
•• Bottom Top Bottom
•
7. CASING: Depth
Top Bottom Ft.
Top Bottom Ft.
: Top Bottom
8. OUT: Depth .„
: Top Bottom'
Top
Bottom
Ft.
Ft.
Diameter
Thickness/
Weight
Material
Material Method
541e-b, fhe.,u-ttg7-&--
Top Bottom Ft.
9. SCREEN: Depth
Top
: Top Bottom
Ft.
Ft.
Bottom
Top •
Top Bott
T Bottom
11. DRILLING LOG
: Top Bottom
:
• 12. REMARKS:
10. SAND/GRAVEL PACK:
Depth
Bottom
2-1-0 /
( /9\ o
t I / 6 5
tc2'/t :9 (-)
(-) 5 0
Diameter Slot Size
Ft.
Size
Ft.
Ft.
in.
in. in.
in.
Material
Material
"
•
Formation Nakiptitetion Processing Unit
(3I-
DWQ/BOG
1.1 )44 S tA-
cl
)44
07,4 t p?-5.
‘7.
IFREeEIVED/NCDENR/DWR
/ MAY 30 2017
Water Quality Regonal
i DO HEREBY CEIMFY,
. 15A NCAC 2C, WEVL.Int
RECORD HAS
oroTAO uoT E D.4NCPYOACCORDANCE THIS WITH
ER.
SIGNkIL4R OF CERTIFI D ELL CpRA
191; V-- /
/62106-7/i
—FOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GW-lb
Rev. 2/09

�en�telr �f alekgf
Tei...?•'°ti.Rrd.tL' �.. ..a.�.-r�,,, is ..�+�tl �.:.'�
COP g
NONRESIDENTIAL WELL CONSTRUCTION
RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
tY
WELL CONTRACTOR CERTIFICATION #
1. WELL CONTRACTOR:
DANNY SUMMERS
Well Contractor (Individual) Name
GEOLOGIC EXPLORATION, INC
Well Contractor Company Name
176 COMMERCE BLVD
Street Address
g. WATER ZONES (depth):
STATESVILLE NC 28625 Top
City or Town Bottom
State Zip Code
( 704 ) 872-7686
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# N/A
OTHER ASSOCIATED PERMIT#(ir applicable)_
SITE WELL ID #(if applicable) MW-25
3. WELL USE (Check One Box) Monitoring Cl' Municipal/Public 0
Industrial/Commercial ❑ Agricultural 0 Recovery 0 Injection 0
Irrigation Other 0 (list use)
DATE DRILLED 02/08/12
4. WELL LOCATION:
5506 RICHLANDS HIGHWAY 28540
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: JACKSONVILLE COUNTY ONSLOW
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
['Slope ❑Valley ❑ Flat ❑ Ridge ❑ Other
LATITUDE " DMS OR
- - DD
LONGITUDE ° " DMS OR
DD
Latitude/longitude source: 03PS ❑Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
RHODESTOWN GROCERY
Facility Name
5506 RICHLANDS HIGHWAY
Street Address
JACKSONVILLE
City or Town
WORSLEY FAMILY HOLDINGS
Contact Name
123 SHIPYARD BLVD
N/A 3 I t.
Facility ID# (if applicable
NC
State
2579
4G's6030
d. TOP OF CASING IS 0.0 FT. Above Land Surface*
: *Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
•
e. YIELD (gpm): N/A METHOD OF TEST N/A
f. DISINFECTION: Type N/A Amount N/A
Top
Top Bottom Top
: Top Bottom Top
Thickness/
7. CASING: Depth Diameter Weight
Top 0.0 Bottom 2.0 Ft. 2 INCH SCH 40
Top Bottom Ft.
. Top Bottom Ft.
: 8. GROUT: Depth
Top 0.0 Bottom 1.0 Ft.
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth
Material
PORTLAND BENTONITE
Diameter Slot Size
Bottom
Bottom
Bottom
Material
PVC
Method
SLURRY
Material
Top 2.0 Bottom 12.0 Ft. 2.0 in. 1
• Top Bottom Ft.REOVED Pi
Top Bottom Ft. • in. in.
10. SAND/GRAVEL PACK:
Depth
• Top 1.5 Bottom 12.0
• Top Bottom Ft
Top Bottom
11. DRILLING LOG
: Top Bottom
•
28540 •
Zip Code
•
Mailing Address
WILMINGTON NC 28412
City or Town State Zip Code
( }
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 12.0 FEET
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO
c. WATER LEVEL Below Top of Casing: 4.0
(Use "+" if Above Top of Casing)
FT.
w h•• a �tr�zr; f �� � i, r 9 �'v� 4 ..1 t y .r .t�7 , � � �.
:?aiii�� �2'..., • tit t�,. � r , �•:-ic 1,� y r.'�•�` r r „j`i �r} a. y , c
.•1. y,...,4 . e f :::4'C 1�I a r � A�.-�. ht) ��v:f1�'i{.
cornpleflon to DIv�S�on �o�
.:a•' . � .. x�T jv �' _ • w} iris }..h,.'�'t r 1,.„
.h i{y st••..r. ?.<.s5u, .5.�f;• .L^:;L:...x'4." te,.•, rF'
� -.i, > ! r-•,fit i y
•
•
•
•
•
0.0 / 8.0
8.0 / 12.0
12. REMARKS:
MAY ao zo7
Size Material
Ft. 20-40 Fimr D
Water Qu �
• Oerations Section Ft. Wilmington Regional Office
Formation Description
BROWN CLAYEY SILT
TAN SANDY CLAY
'r'a'Yiit1i2G1'C �I.tr..
�����ion P r;y�
��
: BENTONITE SEAL FROM 1.Q TO 1 t5 FEET
•
I DO HEREBY CERTIFY THAT THIS WELL W
15A NCAC 2C, WELL CO STRUCTION STA
• RE HAS BEEN P. • DED TO THE
ERTIF D
CONSTRUCTED IN ACCORDANCE WITH
RDS, AND THAT A COPY OF THIS
OWNER.
02/14/12
LL CONTRACTOR DATE
: DANNY SUMMERS
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Info1irmation `Process°if nc
Form GW-1 b
Rev. 2/09

Cop
NONRESIDENTIAL WELL STRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2579
1. WELL CONTRACTOR:
DANNY SUMMERS
Well Contractor (Individual) Name
GEOLOGIC EXPLORATION, INC
Well Contractor Company Name
176 COMMERCE BLVD
Street Address
STATESVILLE
City or Town
( 704 ) 872-7686
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# N/A
NC
State
28625
Zip Code
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) MW-24
3, WELL USE (Check One Box) Monitoring El Municipal/Public 0
Industrial/Commercial 0 Agricultural 0 Recovery 0 Injection 0
lrrigaiion❑ Other 0 (fist use)
DATE DRILLED 02/08/12
4. WELL LOCATION:
5506 RICHLANDS HIGHWAY 28540
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: JACKSONVILLE COUNTY ONSLOW
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑Valley ❑Flat ❑Ridge ❑Other
LATITUDE " DMS OR DD
LONGITUDE ° " DMS OR DD
Latitude/longitude source: ❑3PS ❑Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
RHODESTOWN GROCERY
Facility Name
5506 RICHLANDS HIGHWAY
N/A(.31717r)
Facility ID# (if applicab e)
Street Address
JACKSONVILLE NC 28540
City or Town State Zip Code
WORSLEY FAMILY HOLDINGS
Contact Name
123 SHIPYARD BLVD
Mailing Address
WILMINGTON NC 28412
City or Town
State Zip Code
( )
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 12.0 FEET
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO (1
c. WATER LEVEL Below Top of Casing: 4.0 FT.
(Use "+" if Above Top of Casing)
♦ 1t 4
' r J f` w7-{r./.�i�f�ttf`i.r'S,C�[�� N a1, er<!t✓.
I 'INIt f h
CQ
�'L'ft.:.•:i. Si't'�:.,:� c �_t!!...ti e.:f. .....a _ r.}��(1,E 3:!ti.,.s-did
•
:Top 1.5
Top
• Top
11. DRILLING LOG
: Top Bottom
•
•
0.0 / 8.0
8.0 / 12.0
/
/
/
4036020
d. TOP OF CASING IS 0.0 FT. Above Land Surface*
*Top of casing terminated at/or below land surface: may require
a variance in accordance with 15A` NCAC 2C..0118. . -
e. YIELD (gpm): N/A METHOD OF TEST
f. DISINFECTION: Type N/A
g. WATER ZONES (depth):
Top Bottom Top, Bottom
Top Bottom Top . Bottom
: Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight
Top 0.0 Bottom 2.0 Ft. 2 INCH SCH 40
Top Bottom Ft.
: Top Bottom Ft.
8. GROUT: Depth Material
Top 0.0 Bottom 1.0 Ft. PORTlAND BENTONITE
N/A
N/A
Amount
Top Bottom Ft.
: Top Bottom Ft.
9. SCREEN: Depth
Top 2.0 Bottom 12.0 Ft. 2.0 in.
Top . Bottom Ft. in.
Top Bottom Ft. in.
10. SAND/GRAVEL PACK:
Depth Size
Bottom 12.0 Ft. 20-40
Bottom Ft.
Bottom Ft.
Material
PVC
Method
SLURRY
Diameter Slot Size Material
.010 in. PVC
in.
in.
Material
FINE SILICA SAND
RECEtIN.0DRIDµnNR
BROWN CLAYEY SILT
TAM NarlaLZV17
Water Quatily Re
Op -a
VWiln'til
12. REMARKS:
BENTONITE SEAL FJ QM 1.0 TO 1.5 FEET
• 'i'' Ice
\AO. - 70.
OP CO;
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION ST DARDS, AND THAT A COPY OF THIS
RD HAS BEEN ' OVIDED TO THE LL OWNER.
02/14/12
CE 1 =6 Or M- DATE
•
DANNY SUMMERS
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
CR 5t
t i.-`r,^ it- I M:.F ^ `,-i,•,'�'ilY. Fr � � l ., ��:IJ!itp'Y`:�Y.,�'r' i
I.L.i, ,r , �a t iry.'s.Xd• �.r .�: 3 r ITT; .r I.
.r• }
is a
/�IiJ'�:'„M ■ .r��l , �;"7 "Y�4... i.•.'F:': � •�r�.Yt �_ r) T•.r�..'r" i ' t.: i.
;�;nformat�an P�rrQcessin
Form GW-1 b
Rev. 2/09
Y , .r!✓: �'ni+y�:i'�..:r11 c "�1,? fN p �A„t;� w

cop
NON .SI.D.ENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
t3'
WELL CONTRACTOR CERTIFICATION # 2579
1. WELL CONTRACTOR:
DANNY SUMMERS
Well Contractor (individual) Name
GEOLOGIC EXPLORATION, INC
Well Contractor Company Name
176 COMMERCE BLVD
Street Address
STATESVILLE
City or Town
( 704 ) 872-7686
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# N/A
NC
State
28625
Zip Code
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) MW-23
3. WELL USE (Check One Box) Monitoring d Municipal/Public 0
Industrial/Commercial 0 Agricultural 0 Recovery 0 Injection 0
Irrigationo Other 0 (list use)
DATE DRILLED 02/08/12
4. WELL LOCATION:
5506 RICHLANDS HIGHWAY 28540
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: JACKSONVILLE COUNTY ONSLOW
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
D Slope D Valley 0 Flat 0 Ridge ❑ Other
LATITUDE "DMS OR DD
LONGITUDE ° " DMS OR DD
Latitude/longitude source: DGPS []Topographic map
(location of well must be shown an a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
RHODESTOWN GROCERY
Facility Name
5506 RICHLANDS HIGHWAY
Street Address
JACKSONVILLE
City or Town
WORSLEY FAMILY HOLDINGS
Contact Name
123 SHIPYARD BLVD
N/A 311 t
Facility ID# (if applicable
NC 28540
State Zip Code
Mailing Address
WILMINGTON NC 28412
City or Town State Zip Code
( )
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 12.0 FEET
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO L f
' c. WATER LEVEL Below Top of Casing: 4.0 FT.
(Use "+" if Above Top of Casing)
`ll a�1 Service { Cents
omptefi�on•o� .c
ale
•ti' 1 �: i 11 r f..�
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
4036010
d. TOP OF CASING IS 0.0 FT. Above Land Surface*
• *Top of casing terminated at/or below land surface may require
• a variance in accordance with 15A NCAC.2C .0118.
e. YIELD (gpm): N/A METHOD OF TEST N/A
f. DISINFECTION: Type N/A Amount N/A
g. WATER ZONES (depth):
Top Bottom Top ' Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
: 7. CASING: Depth Diameter Weight Material
Top 0.0 Bottom 2.0 Ft. 2 INCH SCH 40 PVC
Top Bottom Ft.
: Top Bottom Ft.
•
8. GROUT: Depth Material Method
Top 0.0 Bottom 1.0 Ft. PORTLANDBENTONITE SLURRY
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top 2.0 Bottom 12.0 Ft. 2.0 in. .010 in. PVC
: Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
Top 1.5 Bottom 12.0 Ft. 20-40 FINE SILICA SAND
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
: Top Bottom Formation Description
D1N��
AYEY SILT
0.0 /
8.0 /
TAN SANDY CLAY
1411W 3 20\7
Quality
Water Q Regional1►:,. .
Operations Cn
Wilmington Red
12. REMARKS:
PNCI),
Intormallon Pro? C
: BENTONITE SEAL FROM 1,0 TO 1.UEET
I
— c:4 (1-c)\7'
I DO HEREBY CERTIFY THAT THIS WELL
• 1 CAC 2C, WELL NSTRUCTION ST
• C D HAS BEEN' VIZ TO THE
S CONSTRUCTED IN ACCORDANCE WITH
DARDS, AND THAT A COPY OF THIS
ELL OWNER.
ST NATURE OF CERTIFIED WELL CONTRACTOR DATE
: DANNY SUMMERS
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
utility - Information-Processi g
02/14/12
Form GW-lb
Rev. 2/09

REVISED
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2986
1. WELL CONTRACTOR:
L. Martin Shaver
Well Contractor (Individual) Name
American Environmental Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 324 Fields Drive, Suite C
Aberdeen NC 28315
City or Town State Zip Code
( 910 )- 944-3140
Area code- Phone number
2. WELL INFORMATION:
SITE WELL # (if applicable) IW 2
STATE WELL PERMIT# (if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring 0 Municipal/Public 0
Industrial/Commercial 0 Agricultural 0 Recovery ❑ Injection
Irrigation 0 Other 0 (list use)
DATE DRILLED 11-8-2011
TIME COMPLETED 11:50 AM ® PM ❑
3. WELL LOCATION:
CITY: Jacksonville COUNTY Onslow
Route 24
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
EISlope ['Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 34° 44.453
LONGITUDE 077° 22.308
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: GPS ❑ Topographic map (location of
well must be shown on a USGS topo map and attached to this form
if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID # (if applicable)
NAME OF FACILITY MCB Camp Lejuene
STREET ADDRESS Route 24
Jacksonville
NC 28547
City or Town State
CONTACT PERSON Jeffrey Enos
Zip Code
MAILING ADDRESS 1005 Michael Road
Camp Lejuene
City or Town
NC 28547
( 910 )- 451-4318
State Zip Code
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 35'
b. DOES WELL REPLACE EXISTING WELL? YES 0
NO Eg
c. WATER LEVEL Below Top of Casing: 7.23 FT.
(Use "+" if Above Top of Casing)
.
tti,
git-
d. TOP OF CASING IS 0 FT. Above Land Surface
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm) METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From 7' To 35' From To
From To From To
From To From To
S. CASING:
From 0'
From
From
Depth
Thickness/ Material
Weight
To20' Ft. 2" SCH80 PVC
To Ft.
To Ft.
Diameter
7. GROUT: Depth Material
From 12.7 To0 Ft. Grout
From 17.9 To 12.7
From To
Method
Tremie
Ft. Pellets Pour
Ft.
8. SCREEN: Depth Diameter Slot Size
From 20' To 35' Ft. 2 in. .0020 in.
From To Ft. in. in.
From ToFt. in. in.
9. SAND/GRAVEL PACK:
Depth
From 35'
From
From
To 17.9 Ft. #3
To
To
Ft.
Ft.
Size Material
Sand
Material
PVC
10. DRILLING LOG:
From To Formation Description
0' 1' Top Soil
1'
10' Tannish White Silty Sand
10' 18' Tannish White with Grey Silty
18' 27' White Fine Sands
27' 35' fsh GreySilty Fine Sands
RCE AVEDMrpENR/DwR
11. REMARKS
MAY 30 2017
Water Quality..Reginnai
uperatlons
Wilmington Sec��p�' - -
n RegionaltIffice
l DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE CER
L. Martin Shaver
D WELL CONTRACTOR
11-12-2011
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW 1 b
Rev. 7/05

REVISED bo y
NON RESIDENTIAL WELL CONSTRUeTIRE
CORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2986
1. WELL CONTRACTOR:
L. Martin Shaver
Well Contractor (Individual) Name
American Environmental Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 324 Fields Drive, Suite C
Aberdeen NC 28315
City or Town State Zip Code
(910 )- 944-3140
Area code- Phone number
2. WELL INFORMATION:
SITE WELL # (if applicable) IW-3
STATE WELL PERMIT# (if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring 0 Municipal/Public ❑
Industrial/Commercial 0 Agricultural ❑ Recovery ❑ Injection El
Irrigation ❑ Other ❑ (list use)
DATE DRILLED 11-8-2011
TIME COMPLETED 2:38 AM ❑ PM
3. WELL LOCATION:
CITY: Jacksonville COUNTY Onslow
Route 24
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
®Slope ❑Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 34° 44.444
LONGITUDE 077° 22.308
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ®GPS ❑ Topographic map (location of
well must be shown on a USGS topo map and attached to this form
if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID # (if applicable)
NAME OF FACILITY MCB Camp Lejuene
ci)1(sic4)
STREET ADDRESS Route 24
Jacksonville
NC 28547
City or Town State
CONTACT PERSON Jeffrey Enos
Zip Code
MAILING ADDRESS 1005 Michael Road
Camp Lejuene
NC 28547
City or Town
( 910 )- 451-4318
Area code - Phone number
5. WELL DETAILS:
a_ TOTAL DEPTH: 35'
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NOIEI
c. WATER LEVEL Below Top of Casing: 7.1 FT:
(Use "+" if Above Top of Casing)
4
d. TOP OF CASING IS 0 FT. Above Land Surface
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm) METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From 7' To 35' From To
From To From To
From To From To
6. CASING:
From 0'
From
From
Depth Diameter Thickness/ Weight Material
To20' Ft. 2" SCH80 PVC
To Ft.
To Ft.
7. GROUT: Depth
From 12.7 To 0
From 17.9 To 12.7
From To
Material
Ft. Grout Tremie
Ft. Pellets Pour
Ft.
Method
8. SCREEN: Depth Diameter Slot Size
From 20' To 35' Ft. 2 in. .020 in.
From To Ft. in. in.
From To Ft. in. in.
Material
PVC
9. SAND/GRAVEL PACK:
Depth
To17.9
To Ft.
To Ft.
From 35'
From
From
Size
Ft. #3
Material
Sand
10. DRILLING LOG:
From To Formation Description
0' 1' Top Soil
1'
10' Tannish White Silty Sand
10' 18' Tannish White with Grey Silty
18' 27' White Fine Sands
27' 35' Whitish Grey Silty Fine Sands
RECE1f1WCDE
11. REMARKS
MAY 3O2.Q1
t�'1::'
Water Quality Rg t91�
Action
Operations S Office
Wilmington Regional.._
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE{- ' CER
L. Martin Shaver
D WELL CONTRACTOR
11-12-2011
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW l b
Rev. 7/05

REVISED (09V
NON RESIDENTIAL WELL CONSTRUMIONTECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2986
4d
1. WELL CONTRACTOR:
L. Martin Shaver
Well Contractor (Individual) Name
American Environmental Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 324 Fields Drive, Suite C
Aberdeen NC 28315
City or Town State Zip Code
( 910 )- 944-3140
Area code- Phone number
2. WELL INFORMATION:
SITE WELL # (if applicable) 1W-1
STATE WELL PERMIT# (if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring 0 Municipal/Public ❑
Industrial/Commercial ❑ Agricultural 0 Recovery ❑ Injection IE
Irrigation 0 Other 0 (list use)
DATE DRILLED 11-8-2011
TIME COMPLETED 9:49
3. WELL LOCATION:
CITY: Jacksonville
AM El PM ID
COUNTY 0nslow
Route 24
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
lEISlope ['Valley ['Flat DRidge ❑Other
(check appropriate box)
LATITUDE 34° 44.451
LONGITUDE 077° 22.308
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ®GPS 0 Topographic map (location of
well must be shown on a USGS topo map and attached to this form
if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID # (if applicable)
NAME OF FACILITY MCB Camp Lejuene
c 330154)
STREET ADDRESS Route 24
Jacksonville
NC 28547
City or Town State
CONTACT PERSON Jeffrey Enos
Zip Code
MAILING ADDRESS 1005 Michael Road
Camp Lejuene
City or Town
NC 28547
( 910 )- 451--4318
State Zip Code
Area code - Phone number
5. WELL DETAILS:
a_ TOTAL DEPTH: 35'
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
c. WATER LEVEL Below Top of Casing: 7.85 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 0 FT. Above Land Surface
*Top of casing terminated at/or below. land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm)
f. DISINFECTION: Type
METHOD OF TEST
Amount
g. WATER ZONES (depth):
From 7' To 35' From To
From To From To
From To From To
6. CASING:
Depth Diameter Thickness/ Material
Weight
From 0' To20' Ft. 2" SCH80 PVC
From To
From To
7. GROUT: Depth
From 13.2 Too
Ft.
Ft.
Material
Ft. Grout
Method
Tremie
From 17.7 To 13.2 Ft. Pellets Pour
From To
8. SCREEN: Depth
From 20' To 35'
From To
From T
Ft.
Diameter Slot Size Material
Ft. 2 in. .020 in. PVC
Ft. in. in.
o Ft. in. in.
9. SAND/GRAVEL PACK:
Depth
From 35' To 17.7
From To Ft.
From To Ft.
10. DRILLING LOG:
From To
0' 1'
1' 10'
10' 18'
18' 27'
27' 35'
11. REMARKS
Size
Ft. #3
Material
Sand
Formation Description
Top Soil
Tannish White Silty Sand
Tannish White with Grey Silty
White Fine Sands
Whitish Grey Silty Fine Sands
RECEIVED1NCDENR/DWR
MAY 302017
Wetter Quality 'Regional t f
Operations Section.
Wilmington Regional' Office
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGN TURE . CER
L. Martin Shaver
D WELL CONTRACTOR
11-12-2011
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW l b
Rev. 7/05

REVISED
C 69'1
NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2986
403
1. WELL CONTRACTOR:
L. Martin Shaver
Well Contractor (Individual) Name
American Environmental Drilling, inc.
Well Contractor Company Name
STREET ADDRESS 324 Fields Drive, Suite C
Aberdeen NC 28315
City or Town State Zip Code
910 )- 944-3140
Area code- Phone number
2, WELL INFORMATION:
SITE WELL # (if applicable) IW-4
STATE WELL PERMIT# (if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring ❑ Municipal/Public 0
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection Egl
Irrigation 0 Other ❑ (list use)
DATE DRILLED 11-9-2011
TIME COMPLETED 2:35 AM 0 PM Ea
3. WELL LOCATION:
CITY: Jacksonville COUNTY Onslow
Route 24
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
®Slope ❑Valley ❑Flat ❑Ridge ['Other
(check appropriate box)
LATITUDE 34° 44.444
LONGITUDE 077° 22.305
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ®GPS ❑ Topographic map (location of
well must be shown on a USGS topo map and attached to this form
if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID # (if applicable)
NAME OF FACILITY MCB Camp Lejuene
(33c4)
STREET ADDRESS Route 24
Jacksonville
NC 28547
City. or Town State
CONTACT PERSON Jeffrey Enos
Zip Code
MAILING ADDRESS 1005 Michael Road
Camp Lejuene NC
City, or Town
28547
( 910 )- 451-431.8
State Zip Code
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 35'
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
c. WATER LEVEL Below Top of Casing: 7.7 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 0
*Top of casing terminated
a variance in accordance
FT. Above Land Surface
at/or below land surface may require
with 15A NCAC 2C .0118.
e. YIELD (gpm)
f. DISINFECTION: Type
METHOD OF TEST
Amount
g. WATER ZONES (depth):
From 7' To 35' From To
From To From To
From To From To
6. CASING:
Depth
From 0' To 20' Ft. 2"
From To Ft.
From To Ft.
7. GROUT: Depth Material
From 11.7 To 0 Ft. Grout
From 17.5 To 11.7 Ft. Pellets
From To Ft.
8. SCREEN: Depth
From 20' To 35'
From To
From T
Diameter Thickness/ Material
Weight
SCH80 PVC
Method
Tremie
Pour
Diameter Slot Size Material
Ft. 2 in. .020 in. PVC
Ft. in. in.
o Ft. in. in.
9. SAND/GRAVEL PACK:
Depth
To 17.5
From 35'
From
From
To
To
Size
Ft. #3
Ft.
Ft.
Material
Sand
10. DRILLING LOG:
From To Formation Description
0'
1'
10'
18'
27'
1'
10'
18'
27'
35'
11. REMARKS
Top Soil
Tannish White Silty Sand
Tannish White with Grey Silty
White Fine Sands
villefOHNINDE
1 fir•
WR
MAY S 0 ?flVi
Water Quality Reg,ional, �
Operations '5.eCtlorf
Wilmington Regional Office ._
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE F CER
L. Martin Shaver
D WELL CONTRACTOR
11-12-2011
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW l b
Rev. 7/05

REVISED
NUN RESIDENTIAL WELL CONST IRMION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2986
1. WELL CONTRACTOR:
L. Martin Shaver
Well Contractor (Individual) Name
American Environmental Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 324 Fields Drive, Suite C
Aberdeen NC 28315
City or Town State Zip Code
( 910 )- 944-3140
Area code- Phone number
2. WELL INFORMATION:
SITE WELL # (if applicable) IW-5
STATE WELL PERMIT# (if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection El
Irrigation ❑ Other ❑ (list use)
DATE DRILLED 11-9-2011
TIME COMPLETED 10:47 AM ® PM ❑
3. WELL LOCATION:
CITY: Jacksonville COUNTY Onslow
Route 24
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
®Slope ❑Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 34° 44.445
LONGITUDE 077° 22.299
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ®GPS ❑ Topographic map (location of
well must be shown on a USGS topo map and attached to this form
if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID # (if applicable)
NAME OF FACILITY MCB Camp Lejuene
C30534)
STREET ADDRESS Route 24
Jacksonville
NC 28547
City or Town State
CONTACT PERSON Jeffrey Enos
Zip Code
MAILING ADDRESS 1005 Michael Road
Camp Lejuene
NC 28547
City or Town
( 910 )- 451-4318
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 35'
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 10
c. WATER LEVEL Below Top of Casing: 6.4 FT.
(Use "+" if Above Top of Casing)
4O•
d. TOP OF CASING IS 0 FT. Above Land Surface
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm) METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From 7' To 35' From To
From To From To
From To From To
6. CASING:
Depth Diameter Thickness/ Material
Weight
From 0' To20' Ft. 2" SCH80 PVC
From To Ft.
From To Ft
7. GROUT: Depth Material Method
From 11.6 To 0 Ft. Grout Tremie
From 17.6 To 11.6 Ft. Pellets Pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 20' To 35' Ft. 2 in. .020 in. PVC
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 35' To 17.6 Ft. #3 Sand
From To Ft.
From To Ft.
10. DRILLING LOG:
From To Formation Description
0' 1' Top Soil
1' 10' Tannish White Silty Sand
10' 18' Tannish White with Grey Silty
18' 27' White Fine Sands
27' 35'
MAYaO2O17
Water
Quality Regional .41
Operations ScctionY ` '�F
..,,
Wilmington Regional �Ef i e
11. REMARKS
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
11-12-2011
SIGNATURE CER D WELL CONTRACTOR DATE
L. Martin Shaver
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW--1 b
Rev. 7/05
.750 Y

REVISED
NON RESIDENTIAL WELL CONSTRUCTION -RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2986
1. WELL CONTRACTOR:
L. Martin Shaver
Well Contractor (Individual) Name
American Environmental Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 324 Fields Drive, Suite C
Aberdeen NC 28315
City or Town State Zip Code
( 910, )- 944-3140
Area code- Phone number
2. WELL INFORMATION:
SITE WELL # (if applicable) IW-7
STATE WELL PERMIT# (if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring ❑ Municipal/Public ❑
industrial/Commercial ❑ Agricultural ❑ Recovery 0 Injection ¢g
Irrigation 0 Other 0 (list use)
DATE DRILLED 11-10-2011
TIME COMPLETED 1:45 AM 0 PM la
3. WELL LOCATION:
CITY: Jacksonville COUNTY Onsiow
Route 24
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
®Slope ['Valley ❑Flat [Midge ❑Other
(check appropriate box)
LATITUDE 34° 44.447
LONGITUDE 077° 22.297
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: EIGPS 0 Topographic map (location of
well must be shown on a USGS topo map and attached to this form
if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID # (if applicable))
NAME OF FACILITY MCB Camp Lejuene
STREET ADDRESS Route 24
Jacksonville
NC 28547
City or Town State
CONTACT PERSON Jeffrey Enos
Zip Code
MAILING ADDRESS 1005 Michael Road
Camp Lejuene
NC 28547
City or Town
( 910 )- 451-4318
Area code - Phone number
5. WELL DETAILS:
a_ TOTAL DEPTH: 35'
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ja
c. WATER LEVEL Below Top of Casing: 5.92 FT.
(Use "+" if Above Top of Casing)
4 0 3 '7 4 0
d. TOP OF CASING IS 0 FT. Above Land Surface
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm) METHOD OF TEST
f, DISINFECTION: Type Amount
g. WATER ZONES (depth):
From 7' To 35' From To
From To From To
From To From To
6. CASING:
Depth Diameter Thickness/ Material
Weight
From 0' To20' Ft. 2" SCH80 PVC
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 12.8 Too Ft. Grout Tremie
From 17.6 To 12.8 Ft. Pellets Pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 20' To 35' Ft 2 in. .020 in. PVC
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 35' To 17.6 Ft. #3 Sand
From To Ft.
From To Ft.
10, DRILLING LOG:
From To Formation Description
0' 1' Top Soil
1' 10' Tannish White Silty Sand
10' 18' Tannish White with Grey Silty
18' 27' .i;;` i. w:5: i. 44 - . ? ,i., ; 1.
27' 35' . IT'i Is re 'Ii ine 'an•s
MAY3O2O17
Water Quality
Regional .
Operations Section
Wilmington Regional Of r'e .,;;td,
., ^ 11. REMARKS : , �y
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
4111. /iiiiii 11-12-2011
SIGNATURE % CERlr D WELL CONTRACTOR DATE
L. Martin Shaver
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days, Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-1 b
Rev. 7/05

REVISED(69-y
NONRESIDENTIAL WELL Co
Ns'rR..uC � SEC aRD
North Carolina Department of Environment and Natural Resources- Division
son of Water Quality
WELL CONTRACTOR CERTIFICATION # 2986
1. WELL CONTRACTOR:
L. Martin Shaver
Well Contractor (Individual) Name
American Environmental Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 324 Fields Drive, Suite C
Aberdeen NC
City or Town State
( 910 )- 944-3140
Area code- Phone number
2. WELL INFORMATION:
SITE WELL # (if applicable) IW-8
28315
Zip Code
STATE WELL PERMIT# (if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection
El
Irrigation ❑ Other ❑ (list use)
DATE DRILLED 11-12-2011
TIME COMPLETED 12:39
3. WELL LOCATION:
CITY: Jacksonville COUNTY Onslow
Route 24
tree 1 ame, z umbers, ommunity, ub
TOPOGRAPHIC / LAND SETTING:
EiSlope [Walley ❑FIat ['Ridge ❑Other
(check appropriate box)
LATITUDE 34° 44.433
LONGITUDE 077° 22.305
AM El PM®
ivision, of o., Parce , ip ode)
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: igIGPS ❑ Topographic map (location of
well must be shown on a USGS topo map and attached to this form
if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID # (if applicable)
NAME OF FACILITY MCB
Camp Lejuene
STREET ADDRESS Route 24
Jacksonville
NC
City or Town State
CONTACT PERSON Jeffrey Enos
MAILING ADDRESS 1005 Michael Road
Camp Lejuene
City or Town
1 910 )- 451-4318
Area code - Phone number
5. WELL DETAILS:
a_ TOTAL DEPTH: 35'
C c'
28547
Zip Code
NC 28547
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
el
c. WATER LEVEL Below Top of Casing: 8.4 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 0 FT. Above Land Surface
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm) METHOD OF TEST
f. DISINFECTION: Type Amount
8•
WATER ZONES (depth):
From 7'
From
From
6. CASING:
From 0'
From
From
To 35'
To
To
Depth
To20'
To
To
7. GROUT: Depth
From 12.7 To 0
From 18' To 12.7
From To
8. SCREEN: Depth
From 20' To 35'
From To
From To
9. SAND/GRAVEL PACK:
Depth
From 35' To 18'
From
To
From
To
From
From
From
To
To
To
Diameter
Thickness/ Material
Weight
Ft. 2" SCH80 PVC
Ft.
Ft.
Material
Ft. Grout
Ft Pellets
Ft
Method
Tremie
Pour
Diameter Slot Size
Ft.2in. .020 in.
Ft. in.in.
Ft. in. in.
Size
Ft #3
Ft.
Ft.
Material
Sand
Material
PVC
10. DRILLING LOG:
From To Formation Description
0' 1'
Top Soil
1'
10'
18'
27'
10'
18'
27'
35'
11. REMARKS
Tannish White Silty Sand
Tannish White with Grey Silty
White Fine Sands
201 7
Water Wiled Ity Regivflai k'
,.:C t
Opera#ions Sectt�on; .
Wilmington Region'a% Office
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THATA COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGN
TURE CER D WELL CONTRACTOR
L. Martin Shaver
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality
1C1'1 Mail Service Center- Italei h NC 27 withi n 30 days. Attn: Information Mgt.,
Raleigh, 699-1617 Phone No. [phone] ext 568.
11-12-2011
DATE
Form GW l b
Rev. 7/05
40337 0
4Us,
YE

REVISED
(cpyRESIDENTIAL wE,L coxsnzuc� �
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2986
4 3 t'
1. WELL CONTRACTOR:
L. Martin Shaver
Well Contractor (Individual) Name
American Environmental Drilling, inc.
Well Contractor Company Name
S
REET ADDRESS 324 Fields Drive, Suite C
Aberdeen
NC 28315
City or Town State Zip Code
( 910 )- 944-3140
Ara code- Phone number
2. WELL INFORMATION:
SI}rE WELL # (if applicable) IW-11
I
STATE WELL PERMIT# (if applicable)
D Q or OTHER PERMIT #(if applicable)
WkL USE (Check Applicable Box) Monitoring 0 Municipal/Public ❑
Industrial/Commercial 0 Agricultural 0 Recovery 0 Injection El
Irrigation 0 Other 0 (list use)
D4TE DRILLED 11-11-2011
TII!1E COMPLETED 12.39 AM 0 PM El
3. WELL LOCATION:
CITY: Jacksonville COUNTY Onslow
Route 24
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOFOGRAPHIC / LAND SETTING:
IESlope ['Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 34° 44.440
LOtlGiTUDE 077° 22.277
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ®GPS ❑ Topographic map (location of
well must be shown on a USGS topo map and attached to this form
if lot using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID # (if applicable)
NAME OF FACILITY MCB Camp Lejuene
STREET ADDRESS Route 24
Jacksonville NC 28547
City or Town State
C dNTACT PERSON Jeffrey Enos
MAILING ADDRESS 1005 Michael Road
Cafnp Lejuene NC 28547
Zip Code
City or Town State Zip Code
( 9110 )-451-4318
Area code - Phone number
5. WELL DETAILS:
aJ TOTAL DEPTH: 35'
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
c.
WATER LEVEL Below Top of Casing: 7.55 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 0 FT. Above Land Surface
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm)
f. DISINFECTION: Type
METHOD OF TEST
Amount
g. WATER ZONES (depth):
From 7' To 35' From To
From To From To
From To From To
6. CASING:
Depth Diameter Thickness/ Material
Weight
From 0' To 20' Ft. 2" SCH80 PVC
From To Ft.
From To Ft.
7. GROUT: Depth Material
From 12.3 Too Ft. Grout Tremie
From 18.1 To 12.3 Ft. Pellets Pour
From To Ft.
Method
8. SCREEN: Depth Diameter Slot Size Material
From 20' To35' Ft. 2 in. .020 in. PVC
From To Ft. in.in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 35' To 18.1 Ft. #3 Sand
From To Ft.
From To Ft.
10. DRILLING LOG:
From To Formation Description
0' 1'
1' 10'
10' 18'
18' 27'
27' 35'
11. REMARKS
Top Soil
Tannish White Silty Sand
Tannish White with Grey Silty
White Fine Sands
MAY 3 0 2017
WatAr Q' iality Regional. }:'r s1 ‘'
Operations S tiri "
Wilmington Regional Office
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THATA COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
11-12-2011
SIGNATURE • CER D WELL CONTRACTOR DATE
L. Martin Shaver
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Subiiit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-lb
Rev. 7/05

REVISED Cop y
NONRESIDENTIAL WELL corrsTxv�roN RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2986
1. WELL CONTRACTOR:
• I
L; Martin Shaver
WUeil Contractor (Individual) Name
# OTHER PERMIT #(if applicable)
WELL USE Check Applicable Industrial/Commercial ❑ Agricultural 0 Recovery 0 Injection
IrrigationOther1 ton ►�
0 0 (list use)
DATE DRILLED 11-11-2011
1
TIME COMPLETED 11:2
3• LL LOCATION: AM ® PM 0
C TY: Jacksonville
Route 24
t ee Name, 1 um • ers, ommunity,
TO OGRAPHIC / LAND SETTING:
IRISlope ❑Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 34° 44.433
LONGITUDE 077° 22,295
La Eitude/longitude source: GPS 0 Topographic
w ll must be shown on a USGS topo map map (location of
if rot using GPS) A and attached to this form
I
4. FACILITY- is the name of the business where the well is loc
ated.
American Environmental Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 324 Fields Drive, Suite C
Aberdeen
City or Town
910 - 944-314O
Alyea code- Phone number
2. WELL INFORMATION:
SITE WELL # (if applicable) IW-12
S ATE WELL PERMIT# (if applicable)
D Qor
i ( pplicable Box) Monitoring 0 Municipal/Public
FACILITY ID # (if applicable)
N AME OF FACIL
ITY MCB Camp Lejuene
S EET ADDRESS Route 24
�1 O - 451-4318
Ara code - Phone number
5. LL DETAILS:
a, TOTAL DEPTH: 35'
NC 28547
City or Town State
CONTACT PERSON Jeffrey Enos Zip Code
M 1LIN G ADDRESS 1005 Michael Road
C p Lejuene NC
City or Town State
b. DOES WELL REPLACE EXISTING WELL? LLYES 0
c. i WATER LEVEL Below Top of Casing: 7.55
I (Use "+" if Above Top of Casing)
i
I
28315
Zip Code
COUNTY Onslow
u • • Ivision, of To., `arcs , Zip o. e
May be in degrees,
minutes, seconds or
in a decimal format
28547
Zip Code
d. TOP OF CASING IS 0
*Top of casing terminated at/or below land surfAbove Land Surface
a variance in accordance with 15A NCAC 2C .0118 ay quire
e. YIELD (gpm) METHOD OF TEST
f DISINFECTION: Type
Amount
g. WATER ZONES (depth):
From 7' ` o 35'
From —_ To
To To
From To
6. CASING:
From
From
From
Depth Diameter
From 0' To20' Ft. 2"
From To
From --
To Ft.
7. GROUT: Depth
From 12.2 To0
From 17.9 To 12.2 _
From
To Ft.
8. SCREEN: Depth
From 20' To 35'
From To
From To
9. SAND/GRAVEL PACK:
Depth
From 35' To17.9
From To
From
11. REMARKS
Thickness/ Material
Weight
SCH80 PVC
Method
Tremie
Pour
Diameter Slot Size Material
Ft. 2 in. .020 in. PVC
Ft.
in. in.
Ft.
_.,........_ in. in.
Material
Sand
Formation Description
Top Soil
Tannish White Silty Sand
Tannish White with Grey Silty
White Fine Sands
Whitish Grey Silty Fine Sands
Water Qualrfy` i Re gonat.
Operations
Section
Wilmington, Regional .Office
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS WITH
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
AP /, ,
C. ER T
SIGNATURE D WELL CONTRACTOR
L. Martin Shaver
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Sub4iitthe original to the Division of Water Quali within
1617 Mail Service Center- RaIeigh,llTC �769 _ �' 34 days..Attn: Information M .
9 1617 Phone No. [phone] ext 568. � �
11-12-2011
DATE
Form GW 1 b
Rev. 7/05
4 0 3 '2 ;9c

REVISED C
NON RESIDENTIAL WELL CONS CTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality4 0 3
�.
WELL CONTRACTOR CERTIFICATION # 2986
WELL CONTRACTOR:
L. Martin Shaver
Well Contractor (Individual) Name
A
merican Environmental Drilling, Inc.
Well Contractor Company Name
A
REET ADDRESS 324 Fields Drive, Suite C
erdeen NC 28315
City or Town State Zip Code
910 - 944-3140
A
2. W
S
S
D
a code- Phone number
LL INFORMATION:
E WELL # (if applicable)
IW-13
ATE WELL PERMIT# (if applicable)
Q or OTHER PERMIT #(if applicable)
LL USE (Check Applicable Box) Monitoring 0 Municipal/Public ❑
In ustrial/Commerclal ❑ Agricultural ❑ Recovery 0 Injection la
Ir gation ❑ Other ❑ (list use)
D TE DRILLED 11-11-2011
TI E COMPLETED 9:28
3. W LL LOCATION:
C TY: Jacksonville
AM® PM
COUNTY Onslow
R ' ute 24
(S eet Name, Numbers, Community, Subdivision,LotNo., Parcel, Zip Code)
TO OGRAPHIC / LAND SETTING:
Slope ❑Valley ❑Flat :Midge ❑Other
(check appropriate box)
LA ITUDE 34° 44.434
Ltd GITUDE 077° 22.301
May be in degrees,
minutes, seconds or
in a decimal format
La 'tude/longitude source: EIGPS ❑ Topographic map (location of
w l must be shown on a USGS topo map and attached to this form
if of using GPS)
4. FACILITY- is the name of the business where the well is located.
F CILITY ID # of applicable)
N ME OF FACILITY MCB Camp Lejuene
(336(A)
S - EET ADDRESS Route 24
Ja ksonville
NC 28547
or Town State
NTACT PERSON Jeffrey Enos
Zip Code
!LING ADDRESS 1005 Michael Road
Ca p Lejuene
NC 28547
Ci , or Town
10 )- 451-4318
A - a code - Phone number
5. LL DETAILS:
a TOTAL DEPTH: 35'
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
c. WATER LEVEL Below Top of Casing: 8.2 FT.
(Use "+" if Above Top of Casing)
U
d. TOP OF CASING IS 0 FT. Above Land Surface
*Top of casing terminated at/or below: land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm) METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From 7' To 35' From To
From To From To
From To From To
8. CASING:
Depth Diameter Thickness/ Material
Weight
From 0' To20' Ft. 2" SCH80 PVC
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 12.7 To 0 Ft. Grout Tremie
From 18.1 To 12.7 Ft. Pellets Pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 20' To 35' Ft. 2 in. .020 in. PVC
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 35' To 18.1 Ft. #3 Sand
From To Ft.
From To Ft.
10. DRILLING LOG:
From To Formation Description
0' 1' Top Soil
1' 10' Tannish White Silty Sand
10' 18' Tannish White with Grey Silty
18' 27' White Fine Sands
27' 35' Whitish Gre Sil Fine Sands
s
MAY 3 0 ?O17
Water Quality Regional. I .
O eration5- '0IC n
11. REMARKS Wilmington Regioynial Office
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
11-124011
SIGN TURF CER D WELL CONTRACTOR DATE
L. Martin Shaver
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Sub + it the original to the Division of Water Quality within 30 days. Attn: Information MFt.,
1617 ail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-lb
Rev. 7/05

LL CONTRACTOR:
Martin Shaver
REVISED
Cc91
NUN RESIDENTIAL WELL CONSTRU RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2986
11 Contractor (Individual) Name
erican Environmental Drilling, Inc.
ell Contractor Company Name
REET ADDRESS 324 Fields Drive, Suite C
erdeen
City or Town
910 )- 944-3140
a code- Phone number
LL INFORMATION:
E WELL # (if applicable) IW-14
ATE WELL PERMIT# (if applicable)
Q or OTHER PERMIT #(if applicable)
LL USE (Check Applicable Box) Monitoring 0 Municipal/Public 0
In ustrial/Commercial ❑ Agricultural 0 Recovery 0 Injection
Ir gallon 0 Other ❑ (list use)
D TE DRILLED 11-10-2011
TI E COMPLETED 3:45 AM ❑ PM Ea
3, W LL LOCATION:
C TY: Jacksonville COUNTY Onslow
R ' ute 24
eet ame, Num • ers, ommunity, u • + [vision, of 1 o., arcel, ip ode)
TO OGRAPHIC / LAND SETTING:
►� Slope ['Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LA ITUDE 34° 44.447
LONGITUDE 077° 22.297
May be in degrees,
minutes, seconds or
in a decimal format
La 'tude/longitude source: ®GPS 0 Topographic map (location of
w !I must be shown on a USGS topo map and attached to this form
if of using GPS)
4. FACILITY- is the name of the business where the well is located.
F CILITY ID # (if applicable)
N ME OF FACILITY MCB Camp Lejuene
CW1631-k)
S REET ADDRESS Route 24
Ja ksonville NC 28547
Ci or Town State Zip Code
C f NTACT PERSON Jeffrey Enos
M i (LING ADDRESS 1005 Michael Road
C p Lejuene NC 28547
City or Town
10 )- 451-4318
Ar a code - Phone number
5. ELL DETAILS:
a . TOTAL DEPTH: 35'
b.
c.
State Zip Code
DOES WELL REPLACE EXISTING WELL? YES 0 NO
WATER LEVEL Below Top of Casing: 7.78 FT.
(Use "+" if Above Top of Casing)
.z/
4032670
d. TOP OF CASING IS 0 FT. Above Land Surface
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm) METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From 7' To 35' From To
From To From To
From To From To
6, CASING:
Depth Diameter Thickness/ Material
Weight
From 0' To20' Ft. 2" SCH80 PVC
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 12.6 Too Ft. Grout Tremie
From 17.9 To 12.6 Ft. Pellets Pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 20' To35' Ft. 2 in. .020 in. PVC
From To Ft. in. in.
From To Ft in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 35' To 17.9 Ft. #3 Sand
From To Ft.
From To Ft.
10. DRILLING LOG:
From To Formation Description
0' 1' Top Soil
1' 10' Tannish White Silty Sand
10' 18' Tannish White with Grey Silty
18' 27' White Fine Sands
27' 35' Whitish Grey Silty Fine Sands
:� 1
.
MAY 0
11. REMARKS Water Quati .j4egional
Operations Section .
Wilmington Regional Office
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
/ 11-12-2011
SIGNATURE % CER D WELL CONTRACTOR DATE
L. Martin Shaver
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-1 b
Rev. 7/05

REVISED CfdL..,_.
NON RESIDENTIAL WELL CONST CTION RECO
RD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2986
1. WELL CONTRACTOR:
L. Martin Shaver
Well Contractor (Individual) Name
American Environmental Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 324 Fields Drive, Suite C
Aberdeen NC
28315
City or Town State Zip Code
1 10 )- 944-3140
Ar-a code- Phone number
2. LL INFORMATION:
SI E WELL # (if applicable)
IW-15
S ATE WELL PERMIT# (if applicable)
D Q or OTHER PERMIT #(if applicable)
W LL USE (Check Applicable Box) Monitoring ❑ Municipal/Public 0
In• ustrial/Commercial 0 Agricultural ❑ Recovery 0 Injection Eg
Irri ! ation ❑ Other ❑ (list use)
D E DRILLED 10-19-2011
TI E COMPLETED 4:36
3. W = LL LOCATION:
CI : Jacksonville
Ro to 24
(Str
TO
►_�
LA
LO
Lati
well
if n•
4. FA
AM 0 PM
COUNTY Onslow
et Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
OGRAPHIC / LAND SETTING:
Slope ❑Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
TUDE 34° 44.479
GITUDE 077° 22.311
May be in degrees,
minutes, seconds or
in a decimal format
de/longitude source: ®GPS 0 Topographic map (location of
must be shown on a USGS topo map and attached to this form
using GPS)
ILITY- is the name of the business where the well is located.
FACILITY ID # (if applicable)
NA E OF FACILITY MCB Camp Lejuene
C1.1684)
ST EET ADDRESS Route 24
Jac
onville NC
City • r Town State
CO TACT PERSON Jeffrey Enos
28547
Zip Code
MAI ING ADDRESS 1005 Michael Road
Cam • Lejuene
NC 28547
City • r Town State Zip Code
( 910 )- 451-4318
Area code - Phone number
5. WE L DETAILS:
a. OTAL DEPTH: 35'
b. OES WELL REPLACE EXISTING WELL? YES 0
NO 121
c. ATER LEVEL Below Top of Casing: 6.68 FT.
(Use "+" if Above Top of Casing)
4�326O
d. TOP OF CASING IS 0
*Top of casing terminated
a variance in accordance
e. YIELD (gpm)
f. DISINFECTION: Type
FT. Above Land Surface
at/or below; land surface may require
with 15A NCAC 2C .0118.
METHOD OF TEST
Amount
g. WATER ZONES (depth):
From 7' To 35' From To
From To From To
From To From To
6. CASING:
Depth Diameter Thickness/ Material
Weight
From 0' To 20' Ft. 2" SCH80 PVC
From To Ft.
From To Ft.
7. GROUT: Depth
From 12.6 To 0
From 17.9 To 12.6
From To
Material
Ft. Grout
Ft. Pellets
Ft.
Method
Tremie
Pour
8. SCREEN: Depth Diameter Slot Size Material
From 20' To 35' Ft. 2 in. .020 in. PVC
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth
To 17.9
From 35'
From
From
To
To
Size
Ft. #3
Ft.
Ft.
Material
Sand
10. DRILLING LOG:
From To Formation Description
0' 1'
1' 10'
10' 18'
18' 27'
27' 35'
11. REMARKS
Top Soil
Tannish White Silty Sand
Tannish White with Grey Silty
White Fine San
t
MAY 3 t� to ►
101131
WaterQUailty Reg,
O eratlousrSecttbin I
}offal Office
VUilm►n�or� �. g
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
10-30 2011
SIGN ' TURE CERD WELL CONTRACTOR
L. Martin Shaver
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
DATE
Submi the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 ail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW l b
Rev. 7/05

REVISED Co
NQL,LRBjDENTJAL WELL CONST
RUCTION RECORD
North Carolina Department of Environment and Natural Resources- Div
ision of Water Quality
WELL CONTRACTOR CERTIFICATION # 2986
1. W
LL CONTRACTOR:
L. Martin Shaver
W - II Contractor (Individual) Name
A erican Environmental Drilling, Inc.
W-II Contractor Company Name
S REET ADDRESS 324 Fields Drive, Suite C
A • erdeen NC 28315
City or Town State Zip Code
10 - 944-3140
Ar-a code- Phone number
2. W LL INFORMATION:
SI E WELL # (if applicable) IW-16
S ATE WELL PERMIT# (if applicable)
D Q or OTHER PERMIT #(if applicable)
W LL USE (Check Applicable Box) Monitoring 0 Municipal/Public ❑
In ustrial/Commercial 0 Agricultural ❑ Recovery 0 Injection
1531
Ir • ation ❑ Other ❑ (list use)
D TE DRILLED 10-20-2011
TI
3. W
CI
E COMPLETED 5:43
LL LOCATION:
. Jacksonville
R r ute 24
et ame, Numbers, Community, u•division, of �o., �arce, ip ode)
TO OGRAPHIC / LAND SETTING:
Slope ❑Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LA ITUDE 34° 44.466
LO GITUDE 077° 22.304
AM 0 PM®
COUNTY Onslow
Lat
we
ifn
May be in degrees,
minutes, seconds or
in a decimal format
tude/longitude source: ®GPS ❑ Topographic map (location of
1 must be shown on a USGS topo map and attached to this form
• t using GPS)
4. F ' CILITY- is the name of the business where the well is located.
FA ILITY ID # (if applicable)
NA E OF FACILITY MCB Camp Lejuene
ST EET ADDRESS Route 24
Ja sonville
Ci or Town State
CO TACT PERSON Jeffrey Enos
MA LING ADDRESS 1005 Michael Road
Ca p Lejuene NC
Ci or Town State
9 0 - 451-4318
Arm. code - Phone number
5. W : LL DETAILS:
a. TOTAL DEPTH: 35'
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO
IE
c. WATER LEVEL Below Top of Casing: 8.4 FT.
(Use "+" if Above Top of Casing)
From 35'
From
To
From To
10. DRILLING LOG:
From To
0'
1'
10'
18'
27'
1'
10'
18'
27'
35'
11. REMARKS
Method
Tremie
Pour
Diameter Slot Size Material
Ft. 2 in. .020 in. PVC
Ft. -_- in.in.
Ft. in. in.
Size
Ft. #3
Ft.
Ft.
Material
Sand
Formation Description
Top Soil
Tannish White Silty Sand
Tannish White ...t. -
71 i ish Grey Silty Fine Sands
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THATA COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE CER ~ D WELL CONTRACTOR
L. Martin Shaver
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Sub it the original to the Division of Water Qualih � � within 30 days. Attn: Information Mgt.,
1617 ail Service Center- Raleigh, , NC 27699-1617 Phone No. [phone] ext 568.
10-30-201 1
DATE
II
NC
28547
Zip Code
28547
Zip Code
O' cSo
4 0 3
d. TOP OF CASING IS0
*Top of casing terminate
a variance in accordanc
e. YIELD (gpm)
f. DISINFECTION: Type
FT. Above Land Surface
d at/or below land surface may require
ewith 15A NCAC 2C.0118.
METHOD OF TEST
Amount
g. WATER ZONES (depth):
From 7' To 35'
From
To
From To
6. CASING:
From 0'
From
From
Depth
To 20'
To
To
7. GROUT: Depth
From 12.6 To 0
From 17.7
From
To
To
To
Thickness/ Material
Weight
Ft. 2" SCH80 PVC
Ft.
Ft.
Material
Ft. Grout
To 12.6 Ft. Pellets
To Ft.
8. SCREEN: Depth
From 20' To 35'
From To
From To
9. SAND/GRAVEL PACK:
Depth
To17.7
From
From
From
Diameter
Form GW-1 b
Rev. 7/05

REVISED
NON RESIDENTIAL WELL coxsTR RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2986
LL CONTRACTOR:
Martin Shaver
II Contractor (Individual) Name
erican Environmental Drilling, Inc.
II Contractor Company Name
REET ADDRESS 324 Fields Drive, Suite C
rdeen
City or Town
( • 10 )- 944-3140
Ar-a code- Phone number
2. W LL INFORMATION:
SI E WELL # (if applicable) IW-17
S ATE WELL PERMIT# (if applicable)
D Q or OTHER PERMIT #(if applicable)
W LL USE (Check Applicable Box) Monitoring 0 Municipal/Public 0
In ' ustrial/Commercial 0 Agricultural 0 Recovery 0 Injection EI
Irr gation ❑ Other ❑ (list use)
D • TE DRILLED 10-28-2011
TI E COMPLETED 10:55 AM ® PM ❑
3. W LL LOCATION:
CI : Jacksonville COUNTY Onslow
R ' ute 24
(S - et Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TO n OGRAPHIC / LAND SETTING:
Slope ❑Valley ['Flat ❑Ridge ❑Other
(check appropriate box)
LA ITUDE 34° 44.493
LO GITUDE 077° 22.282
May be in degrees,
minutes, seconds or
in a decimal format
La We/longitude source: ®GPS 0 Topographic map (location of
we 1 must be shown on a USGS topo map and attached to this form
if n • t using GPS)
4. F • CILITY- is the name of the business where the well is located.
FA ILITY ID # (if applicable)
NA E OF FACILITY MCB Camp Lejuene
ST ` EET ADDRESS Route 24
Ja• sonville
c:b.out)
NC 28547
City or Town State
CONTACT PERSON Jeffrey Enos
Zip Code
ILING ADDRESS 1005 Michael Road
Camp Lejuene NC 28547
Cityl or Town State Zip Code
Lei O )- 451-4318
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 35'
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
c. WATER LEVEL Below Top of Casing: 7.7 FT.
(Use "+" if Above Top of Casing)
4 0 3;Gs
40
d. TOP OF CASING IS 0 FT. Above Land Surface
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm) METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From 7' To 35' From To
Fromr To From To
From To From To
6. CASING:
Depth Diameter Thickness/ Material
Weight
From 0' To20' Ft. 2" SCH80 PVC
From To Ft.
From To Ft.
7. GROUT: Depth Material ' Method
From 14.2 To0 Ft. Grout Tremie
From 17.9 To 14.2 Ft.. Pellets Pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 20' To35' Ft. 2 in. .020 in. PVC
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 35' To 17.9 Ft. #3 Sand
From To Ft.
From To Ft.
10. DRILLING LOG:
From To Formation Description
0' 1' Top Soil
1' 10' Tannish White Silty Sand
10' 18' Tannish White with GreyakIvict
18' 27' White Figefi , OKI u
,.,
27' 35' ', ' - ` iltyFine Sands
731
01V
Reg 0 , f
aye;. Quaky
5��,1�
*WI • F. �' 'r.e
11. REMARKS
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
10-30-2011
)
SIGNATURE ci CER D WELL CONTRACTOR DATE
L. Martin Shaver
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW l b
Rev. 7/05

REVISED
NON RESIDENTIAL WELL CONS
RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2986
. LL CONTRACTOR:
L. Martin Shaver
ell Contractor (Individual) Name
A erican Environmental Drilling, Inc.
ell Contractor Company Name
S REET ADDRESS 324 Fields Drive, Suite C
A n erdeen NC 28315
City or Town State Zip Code
1 10 )- 944-3140
A ea code- Phone number
2. W LL INFORMATION:
S E WELL # (if applicable) IW-18
S ATE WELL PERMIT# (if applicable)
D q or OTHER PERMIT #(if applicable)
LL USE (Check Applicable Box) Monitoring 0 Municipal/Public 0
In. ustrial/Commercial ❑ Agricultural 0 Recovery 0 Injection El
I gation Ll Other 0 (list use)
D TE DRILLED 10-20-2011
TI E COMPLETED 9:15
3. W LL LOCATION:
C TY: Jacksonville
AM® PM ❑
COUNTY Onslow
R ute 24
(St eet Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TO OGRAPHIC / LAND SETTING:
Slope ❑Valley ❑Flat ❑Ridge DOther
(check appropriate box)
LA ITUDE 34° 44.481
LO GITUDE 077° 22.308
La
w.
if
May be in degrees,
minutes, seconds or
in a decimal format
itude/longitude source: ®GPS ❑ Topographic map (location of
I must be shown on a USGS topo map and attached to this form
of using GPS)
4. F • CILITY- is the name of the business where the well is located.
F • ILITY ID # (if applicable)
N F ME OF FACILITY MCB Camp Lejuene
ST - EET ADDRESS Route 24
Ja ksonvilte NC
CI , or Town State
C • NTACT PERSON Jeffrey Enos
28547
Zip Code
(LING ADDRESS 1005 Michael Road
Ca p Lejuene
NC 28547
Ci or Town
10 ),- 451-4318
A -a code - Phone number
5. W LL DETAILS:
a TOTAL DEPTH: 35'
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
c. WATER LEVEL Below Top of Casing: 6.08 FT.
(Use "+" if Above Top of Casing)
4 J 3
�K
d. TOP OF CASING IS 0 FT. Above Land Surface
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm) METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From 7' To 35' From To
From To From To
From . To From To
6. CASING:
Depth Diameter Thickness/ Material
Weight
From 0' To20' Ft. 2" SCH80 PVC
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 12.9 Too Ft. Grout Tremie
From 17.6 To 12.9 Ft. Pellets Pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 20' To 35' Ft. 2 in. .020 in. PVC
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 35' To 17.6 Ft. #3 Sand
From To Ft.
From To Ft.
10. DRILLING LOG:
From To Formation Description
0' 1' Top Soil
1' 10' Tannish White Silty Sand
10' 18' Tannish White with Grey
act
18' 27' White Fit - - •30,1i.1%)"
27' . 35' , . ''1..: '' 'il Fine Sands
k\10 3Vji
•Ity Re
(la 106
ate��tors seca� Ice
,
Op on Region \'
WI\0I
11. REMARKS
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
`, 10-30 2011
SIGN • TURE • CER D WELL CONTRACTOR DATE
L. Martin Shaver
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Sub it the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 ail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-1 b
Rev. 7/05
tOki

CM7Y
NONRESIDENTIAL WELL coNsTx xEcoxv
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2986
1. W LL CONTRACTOR:
L. Martin Shaver
II Contractor (Individual) Name
A erican Environmental Drilling, Inc.
ii Contractor Company Name
S REET ADDRESS 324 Fields Drive, Suite C
A erdeen NC 28315
City or Town State Zip Code
10 % 944-3140
A -a code- Phone number
2. W LL INFORMATION:
SI E WELL # (if applicable) IW-19
S ATE WELL PERMIT# (if applicable)
D Q or OTHER PERMIT #(if applicable)
W LL USE (Check Applicable Box) Monitoring ❑ Municipal/Public ❑
In ustriai/Commercial ❑ Agricultural ❑ Recovery ❑ Injection
1 gation ❑ Other ❑ (list use)
D TE DRILLED 10-24-2011
Ti E COMPLETED 9:33
3. W LL LOCATION:
C : Jacksonville
R
TO
AM® PM
COUNTY Onslow
ute 24
eet ' ame, 1 um • ers, ommunity, u • • tvis on,
OGRAPHIC I LAND SETTING:
Slope ❑Valley ❑Flat Midge ❑Other
(check appropriate box)
LA ITUDE 34° 44.479
LO GITUDE 077° 22.295
of o., arcel, ip o • e)
May be in degrees,
minutes, seconds or
in a decimal format
La tudeflongitude source: ®GPS 0 Topographic map (location of
we I must be shown on a USGS topo map and attached to this form
if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID # (if applicable) '3°4
NAME OF FACILITY MCS Camp Lejuene
STREET ADDRESS Route 24
Jacksonville NG 28547
City or town State Zip Code
CONTACT PERSON Jeffrey Enos
MAILING ADDRESS 1005 Michael Road
Camp Lejuene
NC 28547
City or Town
f9,10 )- 451-4318
Area code - Phone number
5. WELL DETAILS:
a_ TOTAL DEPTH: 35'
b.
c.
State
Zip Code
DOES WELL REPLACE EXISTING WELL? YES ❑ NO el
WATER LEVEL Below Top of Casing: 7.4 FT.
(Use "+" if Above Top of Casing)
4 0 3 6„ c
d. TOP OF CASING IS 0 FT. Above Land Surface
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm) METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From 7' To 35' From To
From To From To
From To From To
6. CASING:
Depth Diameter Thickness/ Material
Weight
From 0' To 20' Ft. 2" SCH80 PVC
From To . Ft.
From To Ft.
7. GROUT: Depth Material Method
From 12.3 To 0 Ft. Grout Tremie
From 17.5 To 12.3 Ft. Pellets Pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 20' To 35' Ft. 2 in. .020 in. PVC
From To Ft. in. in.
From To Ft in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 35' To 17.5 Ft. #3 Sand
From To Ft.
From To Ft.
10. DRILLING LOG:
From To Formation Description
0' 1' Top Soil
1' 10' Tannish White Silty Sand
iain
10' 18' Tannish W i :- : 'IDASSIR
18' 27' s
27' 35' it ttish Grey Silty Fine Sands
® 7\1
ON\i
R0
vity Ped
o
jNa \ a�nr SCtiC)\,©i#t.
°peat .n3
,:.:�,.
SY�n
11. REMARKS
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED.IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THiS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
10-30-2011
SIGN ' TURE • CER r D WELL CONTRACTOR DATE
L. Martin Shaver
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617MailCenter- Raleigh, 27699-1617-
6Service Ra a gh, NC Phone No. [phone] ext 568.
Forrn GW-1 b
Rev. 7/05

REVISED (op y
NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2986
1. W LL CONTRACTOR:
L. Martin Shaver
W-Il Contractor (Individual) Name
A erican Environmental Drilling, Inc.
II Contractor Company Name
S REET ADDRESS 324 Fields Drive, Suite C
A ' erdeen NC 28315
City or Town State Zip Code
10 )- 944-3140
Ar-a code- Phone number
2. W LL INFORMATION:
SI E WELL # (if applicable) IW-20
S ATE WELL PERMIT# (if applicable)
D Q or OTHER PERMIT #(if applicable)
W LL USE (Check Applicable Box) Monitoring 0 Municipal/Public 0
In ustrial/Commercial 0 Agricultural ❑ Recovery ❑ Injection Eg
1 gation ❑ Other ❑ (list use)
D TE DRILLED 10-28-2011
TI E COMPLETED 11:50 AM ® PM ❑
3. W LL LOCATION:
CI : Jacksonville COUNTY Onsiow
t - et Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TO a OGRAPHIC / LAND SETTING:
►� Slope ❑Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LA—ITUDE 34° 44.487
LONGITUDE 077° 22.304
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ®GPS ❑ Topographic map (location of
we must be shown on a USGS topo map and attached to this form
if n Mt using GPS)
4. F CILITY- is the name of the business where the well is located.
FA ILITY ID # (if applicable)
NA E OF FACILITY MCB Camp Lejuene
(3308�k�
ST - EET ADDRESS Route 24
Ja sonville
NC 28547
Ci or Town State
CO TACT PERSON Jeffrey Enos
Zip Code
MA LING ADDRESS 1005 Michael Road
Ca p Lejuene NC 28547
Ci
or Town
9 0 -451-4318
State Zip Code
Ar- - code - Phone number
5. W LL DETAILS:
a. TOTAL DEPTH: 35'
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO
c. WATER LEVEL Below Top of Casing: 6.9 FT.
(Use "+" if Above Top of Casing)
4 0 3 E'
,ctir"4.,
d. TOP OF CASING IS 0 FT. Above Land Surface
*Top of casing terminated atior below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm) METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From 7' To 35' From To
From To From To
From To From To
6. CASING:
Depth Diameter Thickness/ Material
Weight
From 0' To20' Ft. 2" SCH80 PVC
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 13.3 Too Ft. Grout Tremie
From 18' To 13.3 Ft. Pellets Pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 20' To 35' Ft. 2 in. .020 in. PVC
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 35' To 18' Ft. #3 Sand
From To Ft.
From To ' Ft.
10. DRILLING LOG:
From To Formation Description
0' 1' Top Soil
1' 10' Tannish W
ttio,
.
10' 18' t :to r i h Grey Silty
18' 27' a ite Fine Sands
27' 35' Whitish Grey SiIt ,Fir Sands
giV 3 0 u
�ev)Qnal
a Pr cl a m Spct�ol
0P
n �agio o
11. REMARKS
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
10-30-2011
SIGNATURE ' CER D WELL CONTRACTOR DATE
L. Martin Shaver
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617
M
ail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW 1 b
Rev. 7/05

REVISED (7Y
NONRESIDENTIAL WELL CONSTRUCTION RECORD O
North Carolina Department of Environment and Natural Resources- Division of Water Quality 4 � 3 2 .i u
WELL CONTRACTOR CERTIFICATION # 2986
ELL CONTRACTOR:
L. Martin Shaver
ell Contractor (Individual) Name
A erican Environmental Drilling, Inc.
ell Contractor Company Name
S REET ADDRESS 324 Fields Drive, Suite C
A ' erdeen NC 28315
City or Town State Zip Code
10 ) 944-3140
A ea code- Phone number
2. LL INFORMATION:
S TE WELL # (if applicable) .IW-21
S ATE WELL PERMIT# (if applicable)
Q or OTHER PERMIT #(if applicable)
ELL USE (Check Applicable Box) Monitoring ❑ Municipal/Public 0
In• ustrial/Commercial El Agricultural 0 Recovery 0 Injection El
igation ❑ Other 0 (list use)
D + TE DRILLED 10-20-2011
TI E COMPLETED 10:35
3. LL LOCATION:
C TY: Jacksonville
R• ute 24
eet Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
T OGRAPHIC / LAND SETTING:
Slope ❑Valley ❑Flat Midge ❑Other
(check appropriate box)
ITUDE 34° 44.476
L+NGITUDE 077° 22.307
AM® PM El
COUNTY Onslow
May be in degrees,
minutes, seconds or
in a decimal format
La itude/longitude source: INGPS 0 Topographic map (location of
w=ll must be shown on a USGS topo map and attached to this form
if of using GPS)
4. F CILITY- is the name of the business where the well is located.
F CILITY ID # (if applicable) C' 6t5C
N i ME OF FACILITY MCB Camp Lejuene
S REET ADDRESS Route 24
Ja ksonville NC 28547
Ci n or Town State Zip Code
C a NTACT PERSON Jeffrey Enos
!LING ADDRESS 1005 Michael Road
C. mp Lejuene
Ara code - Phone number
5. LL DETAILS:
a TOTAL DEPTH: 35'
NC 28547
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO181
c. WATER LEVEL Below Top of Casing: 6.62 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 0 FT. Above Land Surface
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm) METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From 7' To 35' From To
From To From To
From To From To
6. CASING:
Depth Diameter Thickness/ Material
Weight
From 0' To20' Ft. 2" SCH80 PVC
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 12.6 To 0 Ft. Grout Tremie
From 18.1 To 12.6 Ft. Pellets Pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 20' To 35' Ft. 2 in. .020 in. PVC
From To Ft, in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK: .
Depth Size Material
From 35' To 18.1 Ft. #3 Sand
From To Ft.
From To Ft.
10. DRILLING LOG:
From To Formation Description
0' 1' Top Soil
1' 10' Tannish White Silty Sand
10' 18' Tannish White with Grey Silty
18' 27' White Fine San s (�
27' 35' ItiriGGLands
Kai
3 0 nil
mAC
• Regiona.
aua��
water section 15,
• in�nRego � ' � ��
n
11. REMARKS Wt`m
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
//
- 10-30-2011
SIGNATURE CER r D WELL CONTRACTOR DATE
L. Martin Shaver
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Sub it the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 1 ail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW l b
Rev. 7/05

REVISED cog y
NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2986
. LL CONTRACTOR:
L. Martin Shaver
ell Contractor (Individual) Name
American Environmental Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 324 Fields Drive, Suite C
Aberdeen NC 28315
City or Town State Zip Code
S 910 )- 944-3140
Area code- Phone number
2. WELL INFORMATION:
SITE WELL # (if applicable) IW-25
STATE WELL PERMIT# (if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring ❑ Municipal/Public 0
Industrial/Commercial 0 Agricultural 0 Recovery ❑ Injection 10
Irrigation 0 Other ❑ (list use)
DATE DRILLED 10-20-2011
TIME COMPLETED 1:15
AM❑ PM®
3. WELL LOCATION:
CITY: Jacksonville COUNTY Onslow
Route 24
(ttreet Name, Numbers, Community, Subdivision, Lot No., Parcel, dip Code)
TO OGRAPHIC / LAND SETTING:
Slope ['Valley ['Flat ❑Ridge ['Other
(check appropriate box)
LA ITUDE 34° 44.477
LO GITUDE 077° 22.311
May be in degrees,
minutes, seconds or
in a decimal format
La 'tude/longitude source: ®GPS ❑ Topographic map (location of
w I must be shown on a USGS topo map and attached to this form
if of using GPS)
4. F CILITY- is the name of the business where the well is located.
F ILITY ID # of applicable) ? `�
N + ME OF FACILITY MCB Camp Lejuene
ST • EET ADDRESS Route 24
Ja . ksonville NC 28547
Ci or Town State
C • NTACT PERSON Jeffrey Enos
Ca
Zip Code
ILING ADDRESS 1005 Michael Road
p Lejuene
NC 28547
A
5. W
a
b.
c.
or Town
10 )- 451-4318
a code - Phone number
LL DETAILS:
TOTAL DEPTH: 35'
State Zip Code
DOES WELL REPLACE EXISTING WELL? YES 0 NO
WATER LEVEL Below Top of Casing: 6.4 FT.
(Use "+" if Above Top of Casing)
40
d. TOP OF CASING IS 0 FT. Above Land Surface
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm) METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From 7' To 35' From To
From To From To
From To From To
6. CASING:
Depth Diameter Thickness/ Material
Weight
From 0' To20' Ft 2" SCH80 PVC
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 11.8 Tot) Ft. Grout Tremie
From 17.1 To 11.8 Ft. Pellets Pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 20' To 35' Ft 2 in. .020 in. PVC
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 35' To 17.1 Ft. #3 Sand
From To Ft.
From To Ft.
10. DRILLING LOG:
From To Formation Description
0' 1' Top Soil
1' 10' Tannish White ► ., ,011,
10' 18' a Silty
18' 27' 1 e ine Sands
27' 35' Whitish Grey Silty Fin nds
g 31) 2 ‘i
tit
tong
section
viatp.C.
pperatIons `' ice .
11. REMARKS
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WfTH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
10-30»2011
SIGN i TURE % CER D WELL CONTRACTOR DATE
L. Martin Shaver
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW 1 b
Rev. 7/05

Ted Grrider
Contact Name
212 Portside Dr.
Mailing Address
Sneads Ferry
City or Town
( 910 ) 741-0399
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 11 0'
ON
(910 ) 270-2919
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigationd Other ❑ (list use)
DATE DRILLED 02/06/12
4. WELL LOCATION:
212 Portside Dr.
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Sneeds Ferry COUNTY Onslow
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley elat ❑ Ridge DOther
LATITUDE 34 ° 30 ' 8.3700 it DMS OR
--- DD
LONGITUDE 77 ° 25 , 7.6200 ° DMS OR DD
Latitude/longitude source: 13PS ❑Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
3
Facility Name (31a
Facility ID if applicabl
Street Address
City or Town State Zip Code
NC 28460
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO c/
c. WATER LEVEL Below Top of Casing: 14'
(Use "+" if Above Top of Casing)
FT.
CoP I
ESIDEN7'.�..f.�.L WELD. CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality,
ty.
WELL CONTRACTOR CERTIFICATION # 2412-A
1. WELL CONTRACTOR:
Donald H. Cummings
Well Contractor (Individual) Name
Applied Resource Management, P.C.
Well Contractor Company Name
257 Transfer Station Rd.
Street Address
Hampstead NC 28443
City or Town State Zip Code
7. CASING: Depth
# Top0'
Top
• Top
: d. TOP OF CASING IS 1.5 FT. Above Land Surface*
*Top of casing terminated at/or below land surface may require
•
• a variance in accordance with 15A NCAC 2C .0118.
.
. e. YIELD (gpm): 80+ METHOD OF TEST Airlift
: f. DISINFECTION: Type HTH Amount3q1Q%
g. WATER ZONES (depth):
: Top Bottom Top Bottom
Top Bottom Top Bottom
: Top Bottom Top Bottom
Thickness/
Weight Material
— Bottom 90' s ch4Q PVC
Bottom Ft.
Bottom Ft.
8. GROUT: Depth
: Top 0' Bottom 20'
Diameter
Ft. 4"
Material
Ft. Grout
Method
Tremmie
: Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
r
Top Bottom Ft. in. in.
Top Bottom Ft. in.
• in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
: Top Bottom Ft.
Top Bottom Ft.
: Top Bottom Ft.
11. DRILLING LOG
Top Bo ��I®
Pi
Formation Description
Sands
.
2 75' �11 Gays
. 2
7' !. ® Sandstone
/ ,.
• •
non 1
. 0t�Rega
. / Qu0‘
�atg\ans Se` O1\C
•
I ea 400
nrfelq-z- oitiar‘
. i V ., Lx
/
12. REMARKS:
1`- J1€
WATER QUALITY SEC I"ION
.INFORMATION P OMSING, UNIT
: I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
• RECOR HAS BEEN PROVIDED Tth THE ELL OWNER,
• ( f
./A , LJ,e. ��A x4. _�,() 2/6/12
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
•
Donald H. Cummings
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Rev. 2/09

1. WELL CONTRACTOR:
DANNY SUMMERS
Well Contractor (individual) Name
GEOLOGIC EXPLORATION, INC
Well Contractor Company Name
176 COMMERCE BLVD
COP Y
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2579
d. TOP OF CASING IS 0.0 FT. Above Land Surface*
*Top of casing terminated atlor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
Street Address
STATESVILLE
City or Town
( 704 ) 872-7686
2-7686
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# N/A
NC 28625
State Zip Code
OTHER ASSOCIATED PERMIT#(ir applicable)
SITE WELL ID #(if applicable) MW-22
3. WELL USE (Check One Box) Monitoring Lf Municipal/Public 0
Industrial/Commercial 0 Agricultural 0 Recovery 0 Injection 0
Irrigation° Other 0 (list use)
DATE DRILLED 02/08/12
4. WELL LOCATION:
5506 RICHLANDS HIGHWAY 28540
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: JACKSONVILLE COUNTY ONSLOW
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
D Slope ❑Valley 0Flat D Ridge ❑Other
LATITUDE "DMS OR DD
LONGITUDE , _° " DMS OR DD
Latitude/longitude source: IJ3PS :Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
RHODESTOWN GROCERY
Facility Name
5506 RICHLANDS HIGHWAY
Street Address
JACKSONVILLE
City or Town
WORSLEY FAMILY HOLDINGS
Contact Name
123 SHIPYARD BLVD
N/A (31718)
Facility ID# (if applicable)
NC 28540
State Zip Code
Mailing Address
WILMINGTON NC 28412
City or Town State Zip Code
( )
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 15.0 FEET
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO Q/
c. WATER LEVEL Below Top of Casing: 4.0
(Use "4." if Above Top of Casing)
.i r�..'4t�A 'y ;,S:M 3 +. d= �'+'i ��4t^ � i'�+ .Y'j )/ •`Y° � .Y:S'fi r.d1.
{{ trade ,Center,Raleigh,,;
��''�{�,*�}JrlS,F�V i(�r n1'�.�t �1! JJ ��++-11 �{•,G � �4Ju1 i :�i`Y,� +,'j �..
FT.
u.,Divisi nc/'
ti/t .s i�� �J:rw• S �
e. YIELD (gpm): N/A METHOD OF TEST
f. DISINFECTION: Type NIA Amount
g. WATER ZONES (depth):
Top Bottom Top
Top Bottom Top
•
: Top Bottom Top
7. CASING: Depth
Top 0.0 Bottom 2.0
4O33QO0
N/A
N/A
Bottom
Bottom
Bottom
Diameter Material
Ft. 2 INCH PVC
Thickness/
Weight
SCH 40
: Top Bottom Ft.
: Top Bottom Ft.
: 8. GROUT: Depth Material Method
Top 0.0 Bottom 1.0 Ft. PORTLAND BENTONITE SLURRY
: Top Bottom Ft.
Top_ Bottom Ft.
9. SCREEN: Depth
Top 2.0 Bottom 15.0
: Top Bottom
Top Bottom
Diameter Slot Size
Ft. 2.0 in. .010 i ed fC
Ft_w
ietigt rgas
EV" in.
Material
10. SAND/GRAVELPACK: 3F01
nTap 1.5BoDettoth m15.0Ft. 20-40 NE' L AND
• Top Bottom
Top
Ft Bottom
R Ft.\NatpC �u�l Section
OpeCa�i�iong Oli‘ce
• rn���°n Red
11. DRILLING LOG
: Top Bottom
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
0.0 / 8.0
8 15.0
/
Formation Description
BROWN CLAYEY SILT
TAN SANDY CLAY
r
kni4art.tC
12. REMARKS:
: BENTONITE SEAL FROM 1.0 Tl 1.5 FEET
I DO HEREBY CERTIFY THAT THIS WELL
• 15 NCAC 2C, WELL. ONSTRUCTION S
RD HAS BEEN OVJDED TO THE.
CERTII
DANNY SUMMERS
AS CONSTRUCTED IN ACCORDANCE WITH
DARDS, AND THAT A COPY OF THIS
ELL OWNER.
02/14/12
ELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
`'r..l i`i. Fro •':{�..r•. ,A�-.t ,.(,1 li�
f1 +w
4V
teat
y r
+. ♦J I..:�It�..rt i�
Tr r
f
orrr�
�rRO�n
Form GW-1 b
Rev. 2/09

)g V
NON RESIDENTIAL , ' 1 CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION #: 2927A
1. WELL CONTRACTOR:
William J. Miller
Well Contractor (Individual) Name
CATLIN Engineers and Scientists
Well Contractor Company Name
220 Old Dairy Road
' Street Address
Wilmington North Carolina 28405
City or Town State Zip Code
( 910) - 452-5861
Area code - Phone number
2. WELL INFORMATION
WELL CONSTRUCTION PERMIT #: N/A
OTHER ASSOCIATED PERMIT # (if applicable): N/A
SITE WELL ID # (if applicable) PT5- TWO8
3. WELL USE (Check One Box): Monitoring ►1 Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation ❑ Other ❑ (list use)
DATE DRILLED: February 9, 2012
4. WELL LOCATION:
MCB Camp Lejeune,
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Camp Lejeune COUNTY: Onslow
TOPOGRAPHIC / LAND SETTING (check appropriate box)
❑Slope ❑Valley 1:4 Flat El Ridge El Other:
LATITUDE: 34.678920945 DD
LONGITUDE: 77.338155265 DD
Latitude/longitude source: • ►:4 GPS ❑ Topo. map
(Location of well must be shown on a USGS topo map anc
attached to this form if not using a GPS.)
5. FACILITY (Name of the business where the well is located.)
N/A (331)41/A
Facility Name Facility ID # (if applicable)
MCB Camp Lejeune
Street Address
Camp Lejeune NC
City or Town State
Ms. Jenni Provost
Contact Name
Attn: I&E/ EMD/ EQB/ PSC Box 20004
Zip Code
Mailing Address
Camp Lejeune NC 28542-0004
City or Town State Zip Code
f910)- 451-5068
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 20
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
FT.
►:1
4 0 3 1-1
d. TOP OF CASING IS 0.00 FT. Above Land Surface*
* Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C.0118.
e. YIELD (gpm): N/A METHOD OF TEST: N/A
f. DISINFECTION: Type N/A Amount: NIA
g. WATER ZONES (depth):
• Top Bottom Top Bottom
-Top Bottom Top Bottom
Top Bottom Top Bottom
7. CASING:
Thickness/
Depth Diameter Weight
Top 0 Bottom 10 Ft. 1 in. Sch. 40
Top Bottom Ft. in.
Top Bottom Ft. in.
8. GROUT:
Depth
Top Bottom
Top Bottom
Top Bottom
9. SCREEN:
Top 10
Top
Top
Depth
Bottom
Bottom
Bottom
Ft.
Ft.
Ft.
Material
Material
PVC
Method
Diameter Slot Size Material
20 Ft. 1 in. Slot .010 in. PVC
Ft. in. in.
• 10. SAND/GRAVEL PACK:
Depth
Top Bottom
Ft. in. in.
Ft.
Top 0 Bottom 20 Ft.
• Top Botc. e�VE�NGIORB 2 3 2012
•
• 11. DRILLING LOG
Top Bottom
/
•/
/
/
/
/
12. REMARKS:
WATER QUALITY SECTION
we 6 wilV `'SSING UNIT
Wate r Quality regional
op
era ,foils SDualecti°�ifitc�
ATTACHED
• I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
• RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
d •'
•
• SIGNATURE/OF CERTIFIED WELL CONTRACTOR
William J. Miller
"://'
: PRINTED NAME OF PERSON CONSTRUCTING THE WELL
DATE
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-1617, Phone No. [phone]
Modified from
Form GW-lb
Rev. 2/09

( Y
NON RESIDENTE4iTWLL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION #: 2927A
1. WELL CONTRACTOR:
William J. Miller
Well Contractor (individual) Name
CATLIN Engineers and Scientists
Well Contractor Company Name
220 Old Dairy Road
Street Address
Wilmington
City or Town
( 910) - 452-5861
Area code - Phone number
North Carolina 28405
State Zip Code
2. WELL INFORMATION
WELL CONSTRUCTION PERMIT #: N/A
OTHER ASSOCIATED PERMIT # (if applicable): N/A
SITE WELL ID # (if applicable) PT5- TWO7
3. WELL USE (Check One Box): Monitoring 1;1 Municipal/Public ❑
Industrial/Commercial 0 Agricultural ❑ Recovery ❑ Injection ❑
Irrigation ❑ Other ❑ (list use).
DATE DRILLED: February 9, 2012
4. WELL LOCATION:
MCB Camp Lejeune,
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Camp Lejeune COUNTY: Onslow
TOPOGRAPHIC / LAND SETTING (check appropriate box)
❑Slope ❑Valley 1:4 Flat ❑ Ridge ❑ Other:
LATITUDE:
LONGITUDE'
34.678537802 DD
77.338323648 DD
Latitude/longitude source: 1:1 GPS ❑ Topo. map
(Location of well must be shown on a USGS topo map and#
attached to this form if not using a GPS.)
5. FACILITY (Name of the business where the well is located.)
N/A
Facility Name
MCB Camp Lejeune
Street Address
Camp Lejeune NC
City or Town State
Ms. Jenni Provost
Contact Name
Attn: I&E/ EMD/ EQB/ PSC Box 20004
(33j'JIA
Facility ID # (if applicable)
Zip Code
Mailing Address
Camp Lejeune NC 28542-0004
City or Town State Zip Code
(910)- 451-5068
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 20
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: , FT.
(Use "+" if Above Top of Casing)
40314.1.
d. TOP OF CASING IS 0.00 FT. Above Land Surface*
* Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C.0118.
e. YIELD (gpm): N/A METHOD OF TEST: N/A
f. DISINFECTION: Type N/A Amount: N/A
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
7. CASING:
. • 1ffllm
inOon ReD
/
12. REMARKS:
Depth
Top 0 Bottom
Top Bottom Ft.
Top Bottom Ft.
8. GROUT:
Thickness/
Diameter Weight
10 Ft. 1 in. Sch.40
in.
in.
Depth Material
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN:
Top 10
Top
Top
Depth Diameter
Bottom 20 Ft. 1 in.
Bottom Ft. in.
Bottom Ft. in.
• 10. SAND/GRAVEL PACK:
Depth
Top Bottom Ft.
Top 0 Bottom 20 Ft.
Top Bottom Ft.
11. DR
Vattl"u
r; <<
ottom
Size
Material
Pvc
Method
Slot Size Material
Slot .010 in. PVC
in.
CE
in.
Material
VE
FEB 232012
Formation Description
WATER QUALITY SECTION
INFORMATION PROCESSING UNfl
.1ona1
�'��t�or S E E
flAT'TAC H E D
• I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
• RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
• SIGNATUi&OF CERTIFIED WELL CONTRACTOR
. William J. Miller
: PRINTED NAME OF PERSON CONSTRUCTING THE WELL
DATE
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-1617, Phone No. [phone]
Modified from
Form GW-1 b
Rev. 2/09

--.°."4"aual CATLIN
Post Office Box 10279
Wilmington, North Carolina 28404-0279
Engineers and Scientists
May 16, 2017
North Carolina Department of Environmental Quality
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Re: NC Well Construction and/or Abandonment Record(s)
Hadnot Point Fuel Farm
MCB Camp Lejeune, North Carolina
CATLIN Project No.: 217041
To Whom It May Concern:
Telephone: [phone]
Fax: [phone]
www.catlinusa.com
CATLIN Engineers and Scientists (CATLIN) recently- constructed and/or abandoned well(s) at the
above referenced site. Attached to this letter are completed North Carolina Well Construction Records
and/or North Carolina Well Abandonment Records with associated Attachment(s) for the above
referenced site located at Hadnot Point Fuel Farm in MCB Camp Lejeune, North Carolina..
If you have any questions or require any additional information, please feel free to contactus at (910)
452-5861. EttIlEDII‘C°141‘)
MPS $11 ""
Sincerely,
Michael E. Mason, P.E.
Project Manager
Enclosures
Reg1Ona,
Wa�CQ�o��n gect�on�.4Ce
w� mpnb'�°n Reg�O�'a
S:\GINT\PROJECTS\217041 CONSULTECH ENVIRONMENTAL HPFF.GPJ,C:\USERS\PUBLIC\DOCUMENTS\BENTLEY\GINT\TEMP\DWG51692.GDW

4 0 3 50
ON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION #: 2927A
1. WELL CONTRACTOR:
William J. Miller
Well Contractor (Individual) Name
CATLIN Engineers and Scientists
Well Contractor Company Name
220 Old Dairy Road
Street Address
Wilmington
City or Town
(910 ) - 452-5861
Area code - Phone number
North Carolina
State
28405
Zip Code
2. WELL INFORMATION
WELL CONSTRUCTION PERMIT #: N/A
OTHER ASSOCIATED PERMIT # (if applicable): N/A
SITE WELL ID # (if applicable) USTHPFFMW22R
3. WELL USE (Check One Box): Monitoring 1:4 Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation ❑ Other ❑ (list use):
DATE DRILLED: February 1, 2012
4. WELL LOCATION:
Holcolmb Blvd.,
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: MCB, Camp Lejeune COUNTY: Onslow
TOPOGRAPHIC / LAND SETTING (check appropriate box)
❑Slope ❑ Valley 1:1 Flat ❑ Ridge DOther:
LATITUDE: DD
LONGITUDE: DD
Latitude/longitude source: 1:4 GPS ❑ Topo. map
(Location of well must be shown on a USGS topo map and
attached to this form if not using a GPS.)
5. FACILITY (Name of the business where the wet is located.)
Former Hadnot Point Fuel Farm (331 2 N/A
Facility Name Facility ID # (if applicable)
Holcolmb Blvd.
Street Address
MCB, Camp Lejeune NC
City or Town State Zip Code
Ms. Jenni Provost
Contact Name
Attn: I&E/ EMD/ EQB/ PSC Box 20004
Mailing Address
Camp Lejeune
City or Town
(910)- 451-5068
Area code - Phone number
NC
State
6. WELL DETAILS:
a. TOTAL DEPTH: 15
28542-0004
Zip Code
d. TOP OF CASING IS 3.00 FT. Above Land Surface*
* Top of casing terminated atlor below land surface may require
a variance in accordance with 15A NCAC 2C.0118.
e. YIELD (gpm): N/A METHOD OF TEST: N/A
f. DISINFECTION: Type N/A Amount: N/A
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
7. CASING: Thickness/
Depth Diameter Weight Material
Top 0 Bottom 5 Ft. 2 in. Sch. 40 PVC
Top Bottom Ft. in.
Top Bottom Ft. in.
8. GROUT:
Top 0
Top 1
Top
9. SCREEN:
Depth Material
Bottom 1 Ft.Portland Cement
Bottom 3 Ft. Bent. Pellets
Bottom Ft.
Depth Diameter
Top 5 Bottom 14.5 Ft. 2 in.
Top Bottom Ft. in.
Top Bottom Ft. in. in.
Method
Surface Pour
Surface Pour
Slot Size Material
Slot .010 in. PVC
in.
• 10. SAND/GRAVEL PACK:
Depth Size
: Top 3 Bottom 15 Ft. #2 Medium
• Top Bottom Ft.
Top Bottom Ft.
• 11. DRILLING LOG
Top Bottom
tlECEIVED/14COENR
Material
Torpedo Sand
Formation Description
MP'( 3131-titEE
-ATTACHED
Water Quality Regions
/ Operations Section/
Wilmington Regional OffiFt� 1 0 201'.
12. REMARKS:
PERMENENT TYPE -II STICK-UP
- I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
• RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
b. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑ ;
c. WATER LEVEL Below Top of Casing:6 FT.
,
(Use +, if Above Top of Casing)
g85 zo/ Z
• SIGNATU
OF CERTIFIED WELL CONTRACTOR
: William J. Miller
: PRINTED NAME OF PERSON CONSTRUCTING THE WELL
DATE
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-1617, Phone No. [phone]
Modified from
Form GW-1b
Rev. 2/09

c. WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
IVON WELL CONSTRUCTION RECORD'
North Carolina Department of Environment and Natural Resources - Division of Water Quality
1. WELL CONTRACTOR:
William J. Miller
ofn
WELL CONTRACTOR CERTIFICATION #: 2927A
Well Contractor (Individual) Name
CATLIN Engineers and Scientists
Well Contractor Company Name
220 Old Dairy Road
Street Address
Wilmington
City or Town
( 910) - 452-5861
Area code - Phone number
North Carolina 28405
State Zip Code
2. WELL INFORMATION
WELL CONSTRUCTION PERMIT #: N/A
OTHER ASSOCIATED PERMIT # (if applicable): N/A
SITE WELL ID # (if applicable) PT5- TWO6
3. WELL USE (Check One Box): Monitoring 1:1 Municipal/Public ❑
Industrial/Commercial ❑ Agricultural El Recovery ❑ Injection ❑
Irrigation ❑ Other ❑ (list use)
DATE DRILLED: February 9, 2012
4. WELL LOCATION:
MCB Camp Lejeune,
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Camp Lejeune COUNTY: Onslow
TOPOGRAPHIC / LAND SETTING (check appropriate box)
❑Slope ❑Valley 0:1 Flat ❑ Ridge ❑ Other:
34.678650283 DD
77.338694306 DD
LATITUDE:
LONGITUDE:
Latitude/longitude source: ►:1 GPS ❑ Topo. map
(Location of well must be shown on a USGS topo map and
attached to this form if not using a GPS.)
5. FACILITY (Name of the business where the well is located.)
N/A -61 /A
Facility Name Facility ID # (if applicable)
MCB Camp Lejeune
Street Address
Camp Lejeune NC
City or Town State
Ms. Jenni Provost
Zip Code
Contact Name
Attn: I&E/ EMD/ EQB/ PSC Box 20004
Mailing Address
Camp Lejeune NC 28542-0004
City or Town State Zip Code
1910)- 451-5068
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 20
4031
d. TOP OF CASING IS 0.00 FT. Above Land Surface*
Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C.0118.
e. YIELD (gpm): N/A METHOD OF TEST: N/A
f. DISINFECTION: Type N/A Amount: N/A
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
7. CASING:
Depth
Thickness/
Diameter Weight
Top 0 Bottom 10 Ft. 1 in. Sch. 40
Top Bottom Ft. in.
Top Bottom Ft. in.
8. GROUT:
Top
Top
Top
9. SCREEN:
Depth
Bottom
Bottom
Bottom
Ft.
Ft.
Ft.
Material
PVC
Material Method
Depth Diameter Slot Size Material
Top 10 Bottom 20 Ft. 1 in. Slot .010 in. PVC .
• Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
• 10. SAND/GRAVEL PACK:
Depth
Bottom Ft.
0 Bottom 20 Ft.
Bottom Ft.
Top
Top
Top
• 11. DRILLING LOG
Top
/
Size
Material
r�il�►�E 1E
PED 2 3 2012
Bottom s Description
RECEINIEVIACUL. WATER QUALITY SECTION
INFORMATION PRCCFSSING UNIT
MAY. 3 7-°1
� S
NidOctr
/
/
12. REMARKS:
Operaon Reg�ana
�i1m�n�
io
Ge
• I Do HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
• RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ®
• SIGNATUIEOF CERTIFIED WELL CONTRACTOR
FT.
: William J. Miller
: PRINTED NAME OF PERSON CONSTRUCTING THE WELL
DATE
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-1617, Phone No. [phone]
Modified from
Form GW-lb
Rev. 2/09

NON ESIDENTIAL WELL CONSTRUCTION REco � � �"r'861
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION #:
1. WELL CONTRACTOR:
D.T. Chalmers, Jr.
Well Contractor (Individual) Name
CATLIN Engineers and Scientists
Well Contractor Company Name
220 Old Dairy Road
Street Address
Wilmington North Carolina 28405
City or Town State Zip Code
( 910) - 452-5861
Area code - Phone number
2. WELL INFORMATION
WELL CONSTRUCTION PERMIT #: N/A
OTHER ASSOCIATED PERMIT # (if applicable): N/A
SITE WELL ID # (if applicable) MW-2
3. WELL USE (Check One Box): Monitoring ® MunicipaVPublic ❑
IndustriaVCommercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation ❑ Other ❑ (list use):
DATE DRILLED: March 23, 2017
4. WELL LOCATION:
Hadnot Point Fuel Farm,
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: MCB Camp Lejeune COUNTY: ONSLOW
TOPOGRAPHIC / LAND SETTING (check appropriate box)
❑Slope ❑ Valley ® Flat ❑ Ridge 0 Other:
LATITUDE: DD
LONGITUDE: DD
Latitude/longitude source: Da GPS ❑ Topo. map
(Location of well must be shown on a USGS topo map and
attached to this form if not using a GPS.)
5. FACILITY (Name of the business where the well is located.)
N/A
Facility Name
Hadnot Point Fuel Farm
N/A
Facility ID # (if applic��tEVEVIACDEO/-rVIR
•
•
•
4146A
d. TOP OF CASING IS '0.50 FT. Above Land Surface*
* Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C.0118.
e. YIELD (gpm): N/A METHOD OF TEST: N/A
f. DISINFECTION: Type N/A Amount: N/A
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
7. CASING:
Depth
Thickness/
Diameter Weight Material
Top 0.5 Bottom 5 Ft. 2 in. Sch. 40 PVC
Top Bottom Ft. in.
Top Bottom Ft. in.
8. GROUT:
Depth
Top Bottom Ft.
Top 1 Bottom 3 Ft. Bent. Pellets
Top Bottom Ft.
9. SCREEN:
Depth
Top 5 Bottom 15
Top Bottom
Top Bottom
Diameter
Ft.. 2 i n .
Ft. in.
Ft. in.
Material Method
Surface Pour
Slot Size Material
Slot .010 in. PVC
in.
in.
10. SAND/GRAVEL PACK:
Depth Size Material
Top 3 Bottom 15 Ft. #2 Medium Torpedo Sand
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
Formation Description
Street Address S E E
MCB Camp Lejeune NC
City or Town State Zip Code k\10 / _ATTAC
'�g1e�a�
Contact Name �y3eY Qu�\S�c�a�' Y?
O�etatiOn e ;�Sna� ���ce
*WI or' R �
V�I . REMARKS:
Mailing Address
City or Town State
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 15
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑
c. WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
information
x. BC *ram
• I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
• RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
NO ® •
• SIGNATURE OF CERTIFIED WELL CONTRACTOR
: D.T. Chalmers, Jr.
: PRINTED NAME OF PERSON CONSTRUCTING THE WELL
DATE
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-1617, Phone No. [phone]
Modified from
Form GW-1b
Rev. 2/09

IN_GDT 5/16/17
a
LL
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W
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cc
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W
u_
z
c
G
r.
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m
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J
VVELL LOG
PROJECT NO.: 217041 I STATE: NC COUNTY: ON
SLOW
PROJECT NAME:
Hadnot Point Fuel Farm
NORTHING: 3839190 I EASTING: 286608
SYSTEM: UTM NAD83 (m)
DRILL MACHINE:CME 45B TRACK
START DATE: 3/23/17
DEPTH
BLOW COUNT
0.5ft 0.5ft 0.5ft 0.5ft
OVA
(pPm)
LAB.
BORING LOCATION:
217041
CATLIN
Engineers and Scientists
SHEET 1 OF 1
LOCATION: MCB Camp Lejeune
ohn Liebi WELL ID:
LOGGED BY: J g
DRILLER: D.T. Chalmers, Jr.
CREW: Thomas Spencer
METHOD: H.S. Augers
FINISH DATE: 3/23/17
M
s
L
0
G
DEPTH
MW-2
T.O.C. ELEV.:
0 HOUR DTW N/A
24 HOUR DTW: N/A
SOIL AND ROCK
DESCRIPTION
TOTAL DEPTH: 15.0
WELL DEPTH: 15.0
15.0
0
0.0 LAND SURFACE
0.4 Asphalt
WELL
DETAIL
5.5
(CL/ML) - Dark brown, Silty CLAY, moist
0.0
_ - 0.5
_ 5.0
i
15.0
(CUML) - Light brown, Silty CLAY, moist, saticirated
at 9.0'
RECEIIEDitiCOMRIOVIH
tsAP'( 3 zo017
Water Quality Regional
Operations Section.ice
Wilmington Regional
2" Sch. 40 PVC
- o>
a —
- cm
BORING TERMINATED AT DEPTH 15.0 ft
A
1.0
.❖
.❖
.•.
3.0
•
15.0 -* 15.0
Concrete
Bentonite Pellets EJ#2 Medium Sand

NON RESIDENTIAL WELL CONSTRUCTION RECORD1 4
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION #: 4146A
1. WELL CONTRACTOR:
D.T. Chalmers, Jr.
Well Contractor (Individual) Name
CATLIN Engineers and Scientists
Well Contractor Company Name
220 Old Dairy Road
Street Address
Wilmington North Carolina 28405
City or Town State Zip Code
( 910) - 452-5861
Area code - Phone number
2. WELL INFORMATION
WELL CONSTRUCTION PERMIT #: N/A
OTHER ASSOCIATED PERMIT # (if applicable): N/A
SITE WELL ID # (if applicable) MW-1
3. WELL USE (Check One Box): Monitoring ® MunicipaVPublic 0
IndustriaVCommercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation ❑ Other ❑ (list use):
DATE DRILLED: March 23, 2017
4. WELL LOCATION:
Hadnot Point Fuel Farm,
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: MCB Camp Lejeune COUNTY: ONSLOW
TOPOGRAPHIC / LAND SETTING (check appropriate box)
❑Slope ❑ Valley ® Flat 0 Ridge ❑ Other:
LATITUDE: DD
LONGITUDE: DD
Latitude/longitude source: ® GPS 0 Topo. map
(Location of well must be shown on a USGS topo map and
attached to this form if not using a GPS.)
5. FACILITY (Name of the business where the well is located.)
N/A N/A
Facility Name Facility ID # (if applicable)
Hadnot Point Fuel Farm
Street Address
MCB Camp Lejeune NC
City or Town
State Zip Code
Contact Name
Mailing Address
City or Town State Zip Code
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 15
b. DOES WELL REPLACE EXISTING WELL? YES ❑
c. WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
Aso
d. TOP OF CASING IS -0.50 FT. Above Land Surface*
* Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C.0118.
e. YIELD (gpm): WA METHOD OF TEST: N/A
• f. DISINFECTION: Type N/A Amount: N/A
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
: 7. CASING:
Depth
Thickness/
Diameter Weight Material
Top 0.5 Bottom 5 Ft. 2 in. Sch. 40 PVC
: Top Bottom Ft. in.
• 8. GROUT: Depth Material Method
: Top Bottom Ft.
• Top 1 Bottom 3 Ft. Bent. Pellets Surface Pour
• Top Bottom Ft.
• 9. SCREEN: Depth Diameter Slot Size Material
•
• Top 5 Bottom 15 Ft. 2 in. Slot .010 in. PVC
Top Bottom Ft. in.
•
•
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
• 10. SAND/GRAVEL PACK:
Depth Size Material
: Top 3 Bottom 15 Ft. #2 Medium Torpedo Sand
Top Bottom Ft.
Top Bottom Ft.
• 11. DRILLING LOG
Top Bottom
NO ® •
•
/
Formation Description
g
SEE MAY 1 9 2017
12. REMARKS:
ECEIVED/NCDENR/DWR
to
15A NCAC 2C, WELL CON '�'I'RUCITI !1 AIN-DSSAND THAT A COPYOOFF TH SE WITH
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
Water Quality Regional
Operations Section
Wilmington Regional Office
SIGNATURE OF CERTIFIED WELL CONTRACTOR
: D.T. Chalmers, Jr.
: PRINTED NAME OF PERSON CONSTRUCTING THE WELL
DATE
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-1617, Phone No. [phone]
Modified from
Form GW-lb
Rev. 2/09

WELL
LOG
,...,,,,,
LATLIN
Engineers and Scientists
217041
SHEET 1 OF 1
PROJECT NO.: 217041
STATE: NC
COUNTY:
ONSLOW
LOCATION: MCB Camp Lejeune
PROJECT NAME: Hadnot Point Fuel Farm
LOGGED BY: John Liebig
WELL ID:
MVV-1
DRILLER: D.T. Chalmers, Jr.
NORTHING: 3839146
EASTING: 286614
CREW: Thomas Spencer
SYSTEM: UTM NAD83 (m)
BORING LOCATION:
T.O.C. ELEV.:
DRILL MACHINE:CME 45B TRACK
METHOD: H.S. Augers
0 HOUR DTW: N/A
TOTAL DEPTH: 15.0
START DATE: 3/23/17
FINISH DATE: 3/23/17
24 HOUR DTW: N/A
WELL DEPTH: 15.0
DEPTH
BLOW
0.5ft
0.5ft
COUNT
0.5ft
0.5ft
OVA
,
(PPM)
LAB.
m
,
-
1
S
L
,
' 0
DEPTH
SOIL AND ROCK
DESCRIPTION
WELL
DETAIL
0.0
LAND SURFACE
0.0
-
_
_
-
...
.).
E
: _
-
- :-
c
! -
-, —
-
-
-
o_
:
pi
0.4 Asphalt
• .
'' ... ... ... .... '...*:.........: V.:: .. ..,. ... ............ *.'......*. .. .. ... ... 2'....*•.'.......:'......: .. ... .. ... .lJ ... '..r.....:1.....: .. ... .. ... ......----J
.......... ::•.% .. ..... ... ...... '..'.......:'......: .. ... ... ... ...... '..1.......:::.:: .. ..... ... ...... '..'.....1:'......: .. ... .*:':•:•:: ... ... ... ... '....::'•,::%:*:•:•:'.. ... ... ...... :::::::::::::::::::::::::::::•:::AP;if.ii::
....
cr. P
0 ' • 0 - . 0
(CUML) - Dark brown, Silty CLAY, moist
5.5
/
.
(CUML) - Light brown, Silty CIAYN ,.(i= larated
at 9.0' RECEINEDINtiU
wim 30 zo\7
Reoonal
Quam • n
\Nate ,.,lis SeCtIO _
09efatNeCAOnal OfiC
WilillIntOn .-3
15.0
1 5.0
BORING TERMINATED AT DEPTH 15.0 ft
r.
riConcrete
Bentonite Pellets 0#2 Medium Sand

" DMS OR 3x.xxxxxxxxx DD
I_(',)NIf ITI.1C)I=. 75
-- -- " U MS OR 7x. xxxxxxxxx (3 D Latitude/longitude source. ._.,`��, ..__.... _.
I �. f _7Uopoyr r f iir: rnal3 (/ocaliotr of well n?ricf be howl, ran 0 U:%GS fry/)n Mr, 3
!/rig; Irvinif nol rtsii�g GP S) ( rrrl�',flrtr.a�r?rl fry
5. WELL. OWNER
04.4.
Ow
Street Adds FT
City or I -own
o _IL7gG'
Area code Phone number
6. WELL DETAILS:
a: TOTAL DEPTH:
:011:_tat'l
Stair,
4
Zip Code
•
•
•
b, DOES WELL REPLACE EXISTING WELL?
c, WATER LEVEL Below Tole of Casing
(Use „+" if Above Top of Casing)
rt. TOP OF CASING IS .
'Top of casing terminated at/or below land hove Land Surface`
ce
a variance: iri accordance with 15A NCAC 2rCrg may require
1 f3_
e. YIELD (gprn):
f. DISINFECTION: Type_
_RESIDENTIAL wELL CONSTRUCTION RECORD
North Carolina Department of FAIN/from-milt and
NaNtra1 Resources- Division of Water QualityWELL CONTRACTOR
CERTIFICATION F/
Y `.J� �r
1. WELL C • NTRACT R:
Weil Contractor (individiial) Name
SQL
Wel Contr. c f.or Corn . any Na e
Street Add ._.ss
City r,r T; awn
-_.. .10-.t •- -�
Area rode Phone_rn-_-
nr�her
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT/-t
OTHER ASSOCIATED PE RMIT fi(if applicable
SITE WELL ID /l(►f af►I)Ii(;Ct.,Io)
3. WELL, USE (Check Applicable Box). • Residential Water Supply
DATE DRILLED
__' 3_7)3da.
TIME C(JMPI..ETFD
______A:100_____ _ AM PM
4. WELL LOC TION:
State
Zip Code
CIT
fi
__. COUN TY
(Street 7arnn.Numbers, Community, . ubdivisian, Lot No., Parcel, Zip Code.
TOPOGRAPHIC / LAND S - TING: (check appropriate
r_.i Slr,f hox)
see f1 galley r-_ ,�t FIR/Age (-I Other
LATITLJpF 3(3 — - -
YES It NO
r-T
METHOD OF TEST
411 Amount
Submit
F' F? ! ref TF� D NAME -_ �
CIF f�ER3 t t CON • t-/C, INC, THE: WELL
S��rt within 30 days of completion
� ub j SCenter-, R co t can to: .Division of Water Quality -a Infer
NC 2769 �16i, Phone ; Information Processing,
[phone]cog so 7 69,4 (6
g. W ER ZONES (de
Top Bottom
Top Bottom
Toe_..-_ Bottom
•
•
443840
fop-- _ Bottom
Top_____----••--- Bottom_.
Top Bottom
7. CASING: Depth DiThickness/
am ter W fgh terlal
Top. Bottom r;1
Top [3otfc,n, •S
rt.
Fop l3otlorn
8. GROUT:' Depth
_ Material Method Bottom,- Ef
T`�1� Bottom Ft.
Tom Bottorn-....a0 Ft. oF-
9. SCREEN: Depth
Diameter Slot Size-
.
Top _qGBottom -
Ft. rr1. _IQ
: Top_ Bottom
Tor---- — Bottom Ft. r r 1 -
10. SAND/GRAVEL PACK:
Depth
Top - - - ....-.._._Bottom ---- Ft.
in
Size PJiater-fa t
Top-_._--. Bottom__ Ft.
Top- Bottom
11. DRILLING LOG
Top E tf_orr,
/•-
19
F=ormatior L esc n
"eta_
� ,emu--��y e�tto�._
/ �� eCa� I'lS D� 1
L• REMARKS:
Materfaf
£vc.
rt0 Processin Unif
DWOISOG
I DO HEREBY CER FIFY THAT THIS WELL WAS CONSTRUCTED
ACCORDAFJCE WITH 15A NCAC r�� �IN
STANDARDS, AND THAi_A COPY C�FTWELL �,C�('I�R►JCTit��r•1
PROVI E T O E �RD RHAS BEENLt_ OWNER.
JIr
-IED !NELL CONTRACTOR
Y
Rev 2/0,)

..•r•
cl-Arr
_R ESID EN TIA w ELL coNsTRucT i()N REcolt.)
T
LiSlope EjValley
LATITUDE 313
LONGITUDE 75
I •
.s.4. North Carolina Department of 1_7..nvironment. and Natural Resources- Division of Water Quality
WELL coNTRAcToR CERTIFICATION #
1. WELL CON ACTOR:
rn Se
VVell Contractor (Individual) Name
Sei1/4%t
VVell Contractor Company Name
gVAk)6> Hwy 1t7
Street Address
City or Town
)
t 6
zi-km,{) .geivIzcc
Area ;ode Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMITII.
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID ii(if
State Zip Code
3. WELL USE (Check Applic.;ahle Bo). Residential Water Supply F-1
DATEDRR.LED
TIME COMPLETED
4. WELL LOCATI N:
CITY,
AM PM
COUNTY
(Street 1a8Th., Numbers, Community, Sul)tivision, Lot rlo., Parcel, Zi •
TOPOGRAPHIC / LAND S TING: (check appropriate box)
F:1 Ridge 11 Other
f e
" DMS OR 3x.xxxxxxxxx or)
" DMS OR 7x.xxxxxxxxx 1)1.)
Latitude/longitude source: 17...)DPE; EiTopographic rnap
(location of well 1771/St be shown on a USG'S typo map an(/attache(/ to
f/r/s form if not ti.c.ing DPI)
5, WELL OWNER
tr\ P- A -
(-wrier Na e
Sfreot Addies
aft\
c: y or lown
Area code Phone number
6, WELL DETAILS:
a: TOTAL DEPTH:
NSta
1114
e Zip -ode
b, DOES WELL REPLACE EXISTING WELL? YES n NO
G. WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
cf. TOP OF CASING IS A- FT. Above Land Surface*
•Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118
e. YIELD (gpm): METHOD OF TESTAlcs" iLf
f, DISINFECTION: Type_ ".1\C Amount
FT
g. ATER ZONES (d
Top L1cD Bottom —
Bottom.::
7-op Bottom
443839
*Top Bottom
Top Bottom
Top Bottom
7. CASING: Depth Diameter
Top Bottom Ft.
Top Bottom Ft.
--Fop Bottom
8. GROUT: Depth Material
Tope-0 Bottom --- Ft.
Top-- 3 Bottom.. Ft.1).
Top Bottom Ft.
Thickness/
Weight Material
&11. Lb ?tic_
lethod
4-e N5 -fo
9. SCREEN: Depth Diameter Slot Size
Top- - Bottom7 SO Ft. in. ‘0 in.
Top Bottom Fi. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Top Bottom Ft
Top Bottom Ft.
Top Bottom Ft.
- 11. DRILLING LOG
Top Bottom
Size
2.0-1
Material
Material
\Nate Citia\At`TP4°"a /
e n
OpetatIoAls-Sectionn4ii
woogton Reg: °I.1- '.-1,,,,,tf
12. REMARKS:
tnformation Processing Unit
EXIVa/BOG
I DO HEREBY CERTIFY THAT THIS WELL VAS CONSTRUCTED IN
ACCORDANCE WITH 15A NCAC 2C. VV _ CONSTRUCTION
STANDARDS AND THAT A COPY THIS RECORD HAS BEEN
MOVIE) D TH ELL Mr
SIGNATURE OF
TIN -D WELL CONTRACTOP
PRINTED NAME OF PFRSOtA CONS7 R ING THE `A/ELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
coci-s07-69-w
Fot-r-n (3'11-1%3
Rev. 2../0`.-,1

_RESIDENTIAL .ESIDENTIAL WELIJ CONSTRUCTION RECORD
North Carolina Department or Environment and Natural Resources- Division of -Water Quality
'WELL LI1 CONTRACTOR CER i'I F IC.1 ION #
1, WEl_L�QJ�(,T;
` 1f
Wp I C niractor (individual) Name ,1
Ne.1, \ °4-1i)04„Me
"fei; Contractor Company Name
—\,(A))/
Street Address 1 .�
_.ily or Town
Area code Phone. num .per
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#_.
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL iD i((ii Fipplical.dr,)
Ewno\a--
.
a
3. WELL USE (Check Appiicahle o .). Residential Water Supply [
DATE DRiL..LED
TIME COMPLETED
4. WELL LOCATI $ N:
CiTY I COUNTY
:oo
AMn PM��
74ci
reet 1-lame, t-Jr mbers, Community, Subdivision, Lot f lo., Parcel, Zip Corte)
TOPOGRAPHIC / LAND S - ING: (r.heck appropriate box)
r:1 Slope ri Valley i at i-1 Ridge ilOther
LATITUDE 36 " DMS OR 3x.xxxxxxxxx Dr)
LC.MGiTUDF %' " DMS OR 7x.xxxxxxxxx fin
Latitude/longitude source: iP 131-opographic: nap
("/c cation of well nnist he shown on a USGS trypo neap onclattrac:horl try
this foam rf not tr.cing GP 3) /
5. WELL OWNER - - -- - �R, , � . 9VED'C
N) r)n TJAV6-±pit:41461,6(
. „i;
MAY 3 O-7iy17
g. WATER ZONES (c thy
Top & Bottom 'Fop Bottom_
Top7 .__.. _. Bottom Top Bottom
Top _- - ---- Bottom--- — Top Bottom
7. CA►SI IG: Depth
Top 4"' Bottoms'
Top ....._._._ Bottom
Totp __- Bottom _
8. GROUT: Depth
Top 0 F3otfom Ft.
Tom _ .. - Bottom7: Ft.
Top_ _ Bottom F=1.
rt.
r t .
r1.
9. SCREEN: Depth
To1r
Top_
Top
Top
Top
Top
443838'
Thickness/
D i a rte to r dEc
i g ht
terial
VC,
Material Me hod
LFG.
fl 1-1C--CR
Diameter Slot Size Material
Bottom -� Ft._ --in. 1 - in. -_ pit.,
Bottom Fi. in.
Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Bottom .._ Ft
Bottom_---_
Bottom Ft
11. DRILl.-ii-IG LOG
Top Bottom
City or to
Area code Phone number
6, WELL DETAILS:
a, TOTAL DEPTHS ec)_
b. DOES WELL REPLACE EXISTING WELL? YES E-1
c, WATER LEVEL Below Tnp c,f Casing: •' -® f-T
(Use "+' if Above lop of Casing)
cf. TOP OF CASING IS 4 FT. Above Land Surface'
'Top of casing terminated at!or below land surface may require
a variance in accordance with 1 5A NCAC 2C .0118.
e. YIELD (gprn) METHOD OF TEST
f. DISINFECTION: Type Amount
siC
Size Material
/ Operations -Section
/ 'min on Regional Office Ott A \
/ Water -Quality Regio
12. REMARKS.
rye
I DO HEREBY CER HEY THAT THIS \NELL WAS CONSTRUCTED IN
ACCORDANCE WIT H 15A NGAO 2C. WF_-f.-I00t-?STI?I ►C:TI01',i
STAN AR S, AND THAT A COPY 0 - 1-IS RECORD 1-IAS BEEN
PR( 1r . _ Eo E WELL 0Wr.
;ICtHH TURE
FEiINTED t-IAMF_ 0 PE SOi1 COf ,7r1I-l'T NC0 Ti-1L
C:ERTir I ---D WELL C01 ITRAc_ -
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone] raj
qiq o7t98
l
Fr,rrn
2109

Nov
443811
ESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION #: (1
1. WELL CONTRACTOR:
D. T. Chalmers, Jr.
Well Contractor (Individual) Name
CATLIN Engineers and Scientists
Well Contractor Company Name
220 Old Dairy Road
Street Address
Wilmington North Carolina 28405
City or Town State Zip Code
(910 ) - 452-5861
Area code - Phone number
2. WELL INFORMATION
WELL CONSTRUCTION PERMIT #: N/A
OTHER ASSOCIATED PERMIT # (if applicable): N/A
SITE WELL ID # (if applicable) USTPP3343 -MWO1
3. WELL USE (Check One Box): Monitoring Municipal/Public D
Industrial/Commercial 0 Agricultural CI Recovery 0 njection El
1.4
Irrigation CI Other El (list use).
DATE DRILLED: December 12, 2011
4. WELL LOCATION:
Building PP-3343, MCB Camp Lejeune,
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Jacksonville COUNTY: Onslow
TOPOGRAPHIC / LAND SETTING (check appropriate box)
EISlope DValley 1:1 Flat El Ridge Ci Other:
LATITUDE:
LONGITUDE:
34.685115 DD
77.368963 DD
Latitude/longitude source: I:4 GPS 0 Topo. map
(Location of well must be shown on a USGS topo map and
attached to this form if not using a GPS.) 3 3 o
5. FACILITY (Name of the business where the well is located.)
N/A
Facility Name
Building PP-3343, MCB Camp Lejeune
Street Address
Jacksonville NC
N/A
Facility ID # (if applicable)
City or Town State
Ms. Jenni Provost
Contact Name
Attn: I&E/ EMD/ EQB/ PSC Box 20004
Zip Code
Mailing Address
Camp Lejeune NC 28542-0004
City or Town State Zip Code
(910)- 451-5068
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:
17
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO
c. WATER LEVEL Below Top of Casing: 10.76 FT.
(Use "+" if Above Top of Casing)
-44-77:77
d. TOP OF CASING IS 0.00 FT. Above Land Surface*
* Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C.0118.
: e. YIELD (gpm): N/A METHOD OF TEST: N/A
f. DISINFECTION: Type N/A Amount: N/A
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
7. CASING:
Depth
Top 0 Bottom 7
Top Bottom
Top Bottom
8. GROUT:
Thickness/
Diameter Weight Material
Ft. 2 in. Sch. 40 PVC
Ft. in.
Ft. in.
Depth Material Method
Top 0 Bottom 1 Ft.Portland Cement Surface Pour
Top 1 Bottom 5 Ft. Bent. Pellets Surface Pour
Top Bottom Ft.
9. SCREEN:
Depth Diameter Slot Size Material
Top 7 Bottom 17 Ft. 2 in. Slot .010 in. PVC
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
• 10. SAND/GRAVEL PACK:
Depth
: Top 5 Bottom 17
Top Bottom
Top Bottom
11. DRILLING LOG
Top Bottom
•
•
Ft.
Ft.
Ft.
Size Material
#2 Medium Torpedo Sand
Formation Description
DENR/DWR
SEE
MAY 2 2 ?MAITACHED
mAY 182017
V‘ipter Quality Regiona
pperations S
Wilmitvton Regi
12. REMARKS-:
FFR 0 3_2012
WATER QUALITY SECTION
MeESSINWIFTI
THAT A COPY OF THIS
• I DO HEREBY CERTIFY THAT THIS WELL W
• 15A NCAC 2C, WELL CONSTRUCTION STAN
• RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
17
ri fro
I A A B
TUFE OF CERTIFIED W LL CONTRACTOR
: D. T. Chalmers, Jr.
: PRINTED NAME OF PERSON CONSTRUCTING THE WELL
DATE
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-1617, Phone No. [phone]
Modified from
Form GW--1 b
Rev. 2/09

NON
RESIDENT1ALLLCONSTRTILQNCORD
North Carolina Department of Environment and Natural Resources- Division of Water
WELL CONTRACTOR CERTIFICATION # 23 4 4
1. WELL CONTRACTOR:
Gerald R. Eister
Well Contractor (Individual) Name
Bridger Drilling Entry., Inc. dba Carolina Drilling
Well Contractor Company Name
114 Chimney Lane
Street Address
Wilmington NC 28409 : Top
City or Town State Zip Code Top
(910 ) 799-0493 : Top
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) M W-1
3. WELL USE (Check One Box) Monitoring di Municipal/Public 0
Industrial/Commercial 0 Agricultural 0 Recovery 0 Injection 0
Irrigation❑ Other 0 (list use)
DATE DRILLED 2/22/12
wally -Jr; �.
d. TOP OF CASING IS 3" s. FT. Above Land Surface*
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
4. WELL LOCATION:
2003 Highway 24
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Jacksonville COUNTY Onslow
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope [Valley DFlat ❑Ridge ❑Other
LATITUDE 34 0 44 523.0000 „ DMS OR 3X.XXxXXXXxX DD
LONGITUDE 77
0 22 323.0000 " DMS OR 7x.xXXxxxXXx DD
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)
S. FACILITY (Name of the business where the well is located
3
former John's Mobil ServicE
Facility Name
2003 Hiahwav 24
Facility ID# (if applicable)
Street Address
Jacksonville
City or Town
Scott-Yoan-a S$cM
Contact Name
.3006 Hail
Mailing Address
NC
State Zip Code
tamer Dr STE 10O
or Town. State Zip Code
one number
S
TH: 16
L REPLACE EXISTING WELL? YES ❑ NO rij
L Below Topof Casing:IV •
R..�_� raid R. Eister
: e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type n/a Amount
g. WATER ZONES (depth):
7. CASING: Depth
: Top 0 Bottom 6
Bottom Top A Bottom
Bottom Top Bottom
Bottom Top Bottom
Thickness/
Diameter Weight Material
Ft. 2 sch40 pvc
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth
Top 0 Bottom 1
Top Bottom
Top Bottom
e. SCREEN: Depth
: Top 6 Bottom
Top Bottom
Top Bottom
Material Method
Ft. concrete in place
Ft.
Ft.
Diameter Slot Size
Material
16 Ft. 2 in. 010 in. pvc
: 10. SAND/GRAVEL PACK:
Depth
Top 3
Top Bottom Ft.
: Top Bottom Ft.
Ft. in. in.
Ft. in. in.
Size Material
Bottom 16 Ft. #2 torpedo
11. DRILLING LOG
Top, Bottom
0 /4
4 /7
7 /16
/
Formation Description
brown sand
gray sandy clay
tan sand
RECEIVEDJNCDENR/DwR
/
12. REMARKS:
MAY 22 20
Water Quality` i �' Baal,
Operdtions Section
Wilmington Regional Office
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION D ' DS, AND THAT A COPY OF THIS
• RECORD HAS :E ROVIDED TO =-' * R.
"-" if Above Top of Casing)
SIGNATURE OF CERTIFIED WELL CONTRACTOR
2/22/12
DATE
MAR 3 2�RINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-lb
Rev. 2/09

City or Town
( 910) - 452-5861
Area code - Phone number
Noiv RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality;
WELL CONTRACTOR CERTIFICATION ##: 4146A
1. WELL CONTRACTOR:
D.T. Chalmers, Jr.
Well Contractor (Individual) Name
CATLIN Engineers and Scientists
Well Contractor Company Name
220 Old Dairy Road
Street Address
Wilmington North Carolina
State
28405
Zip Code
2. WELL INFORMATION
WELL CONSTRUCTION PERMIT #: N/A
OTHER ASSOCIATED PERMIT # (if applicable): N/A
SITE WELL ID # (if applicable) U STLC H4007-MWO3
3. WELL USE (Check One Box): Monitoring 1:4 Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation ❑ Other 0 (list use).
DATE DRILLED: April 3, 2012
4. WELL LOCATION:
Butler Drive North, 28544
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Jacksonville COUNTY: Onslow
TOPOGRAPHIC / LAND SETTING (check appropriate box)
❑Slope ❑Valley 1:1 Flat ❑ Ridge ❑ Other:
LATITUDE: 34.727794108 DD
LONGITUDE 77.339318089 DD
Latitude/longitude source: ►:/ GPS ❑ Topo. map
(Location of well must be shown on a USGS topo map and
attached to this form if not using a GPS.) _,. •"
5. FACILITY (Name of the business where the well is located.)
)
Midway Park CDC
Facility Name
Butler Drive North
Street Address
Jacksonville
City or Town
Ms. Jenni Provost
N/A
Facility ID # (if applicable)
NC
State
Contact Name
Attn: I&E/ EMD/ EQB/ PSC Box 20004
Mailing Address
am Le•eune
City or Town
910- 451-5068
Area code - Phone number
WELL DETAILS:
a. TOTAL DEPTH:
NC
State
13.5
28544
Zip Code
28542-0004
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
• WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
►:1
•
d. TOP OF CASING IS -0.59 FT. Above Land Surface*
* Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C.0118.
e. YIELD (gpm): N/A METHOD OF TEST: N/A
f. DISINFECTION: Type N/A Amount: N/A
g. WATER ZONES (depth):
hi ?"/
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
7. CASING: Thickness/
Depth Diameter Weight Material
Top 0.593 Bottom 3 Ft. 2 in. Sch. 40 PVC
Top Bottom Ft. in.
Top Bottom Ft. in.
8. GROUT: Depth Material Method
Top 0.7 Bottom 1 Ft.Portland Cement Surface Pour
Top 1 Bottom 1.5 Ft. Bent. Pellets Surface Pour
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top 3 Bottom 13 Ft. 2 in. Slot .010 in. PVC
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
• 10. SAND/GRAVEL PACK:
Depth Size Material
Top 1.5 Bottom 14.5 Ft. #2 Medium Torpedo Sand
• Top Bottom Ft.
Top Bottom Ft.
• 11. DRILLING LOG
• Top Bottom Formation Description
/
/
/
/
SEE
RECEI4/i)
, 49E---i-z-41.47,---
/ g V.' # ,
„ pi 201?
,�: Tonalpera�lon� i IC%u:'.6y:,.•ilmin onire fnTATIELLDNSTRUCTEDACCORDANCE WITH
12. REMARKS:
MAY 2?�
ater.
• 15A NCA , C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
• RECOR P ► S BEEN PROVIDED TO THE WELL OWNER.
• SIG ATURE 0 CERTIFIED WELL CONTRACTO
: D.T. Chalmers, Jr.
: PRINTED NAME OF PERSON CONSTRUCTING THE WELL
mit within 30 days of completion to: Division of Water Quality - Information Processing,
Mail Service Center, Raleigh, NC 27699-1617, Phone No. [phone]
DATE
Modified from
Form GW-1 b
Rev. 2/09

Engineers and Scientists
March 8, 2012
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Information Processing
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Re: NC Well Construction and/or Abandonment Record(s)
Midway Park CDC
Jacksonville, North Carolina
CATLIN Project No,: 211020
To Whom It May Concern:
Post Office Box 10279
Wilmington, North Carolina 28404-0279
Telephone: [phone]
Fax: [phone]
www.catlinusa.corn
CATLIN Engineers and Scientists (CATLIN) recently constructed and/or abandoned well(s) at the
above referenced site. Attached to this letter are completed North Carolina- Well Construction Records
and/or North Carolina Well Abandonment Records with associated Attachment(s) for the above
referenced site located at Butler Drive North in Jacksonville, North Carolina.
If you have any questions or require any additional information, please feel free to contact us at (910)
452-5861.
Sincerely,
ob C. Wessell, P.E.
roject Manager
Enclosures
ECEIVE
RECEIVED/NCDENR/DWRR
MAR 1 2012
WaMteArYQu2ali2ty R2e0g1i7°nipformation Processi
ng
Operations Section
Wilmington Regional Office owcvsoc Unit
41"
SAGINT\PROJECTS1211020 MIDWAY PARK CDC.GPJ,SAWPMKTG\PROJEC-R20111211020.SS SHIEL SEXTON MIDWAY PARKIOGS&WELLCONS\HA01-HA02_WELL-TRANS.GDW

IVON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION + ICATION #: 2927A
1. WELL CONTRACTOR:
William J. Miller
Well Contractor (Individual) Name
CATLIN Engineers and Scientists
Well Contractor Company Name
220 Old Dairy Road
Street Address
Wilmington
City or Town
( 910) - 452-5861
Area code - Phone number
North Carolina
State
2. WELL INFORMATION
WELL CONSTRUCTION PERMIT #: N/A
OTHER ASSOCIATED PERMIT # (if applicable): N/A
SITE WELL ID # (if applicable) HA-01
28405
Zip Code
3. WELL USE (Check One Box): Monitoring 14 Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery El Injection ❑
Irrigation ❑ Other ❑ (list use)•
DATE DRILLED: January 31, 2012
4. WELL LOCATION:
Butler Drive North, 28544
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Jacksonville COUNTY: OnsloW
TOPOGRAPHIC / LAND SETTING (check appropriate box)
❑Slope ❑Valley /:1 Flat ❑ Ridge ❑ Other:
LATITUDE:
34.727986899 DD
LONGITUDE: -77.339122030 DD
Latitude/longitude source: ® GPS ❑ Topo. mp
(Location of well must be shown on a USGS topo map and
attached to this form if not using a GPS.) �.
5. FACILITY (Name of the business where the well is located.) 3,
Midway Park CDC N/A
Facility Name
Butler Drive North
Street Address
d. TOP OF CASING IS 3.60 FT. Above Land Surface*
* Top of casing terminated atior below land surface may require
a variance in accordance with 15A NCAC 2C.0118.
e. YIELD (gpm): N/A METHOD OF TEST: N/A
f. DISINFECTION: Type N/A Ainount: N/A
g. WATER ZONES (depth):
Top Bottom Top Bottom
• Top Bottom Top Bottom
• Top Bottom Top Bottom
•
•
7. CASING:
Depth
Thickness/
Diameter Weight
Top 0 Bottom 6.4 Ft. 1 in. Sch. 40
Top Bottom Ft. in.
Top Bottom Ft. in.
8. GROUT:
Top
Top
Top
9. SCREEN:
Top 6.4
Top
Top
Depth
Bottom Ft.
Bottom Ft.
Bottom Ft.
Depth
Bottom
Bottom
Bottom
Material
PVC
Material Method
Diameter Slot Size Material
11.4 Ft. 1 in. Slot .010 in. PVC
Ft. in. in.
Ft. in. in.
• 10. SAND/GRAVEL PACK:
Depth Size Material
Top Bottom Ft.
• Top 0 Bottom 11.6 Ft.
Top Bottom Ft.
• • 11. DRILLING LOG
Top Bottom Formation Dessri. t s
Facility ID # (if applicable)
Jacksonville NC 28544
City or Town State Zip Code
Ms. Jenni Provost
Contact Name
Attn: I&E/ EMD/ EQB/ PSC Box 20004
Mailing Address
Camp Lejeune
NC 28542-0004
City or Town State Zip Code
(910)- 451-5068
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 11.6
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: 11 FT.
�
(Use + if Above Top of Casing)
1:1
/
/
RiCE1VED/NCDENR/DWR V Li17
SEE
MAY 1
MAY224d?TACHED
/Water Quality Regional RECEIVED
• 12. RE peratlons Section
M�}il ington Regional Office BAR 1 3 2012
Unkt
• I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRU • .ANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
• RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
• SIGNATt E OF CERTIFIED WELL CONTRACTOR
: William J. Miller
: PRINTED NAME OF PERSON CONSTRUCTING THE WELL
DATE
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-1617, Phone No. [phone]
Modified from
Form GW-lb
Rev. 2/09

'; : ,-•
,
•
' - — . , ---, ,--', , : ' :- . , • ' '• '
ATLIN
Engineers and Scientists
211020
Wilmington, NC SHEET 1 OF 1 1
PROJECT NO.: 211020
STATE: NC
COUNTY: Onslow
LOCATION: Jacksonville
PROJECT NAME: Midway Park CDC
LOGGED BY: Ben Ashba
WELL ID:
HA®
DRILLER: William J. Miller
NORTHING: 3845362.2
EASTING: 285825.7
CREW:
SYSTEM: UTM NAD83 (m)
BORING LOCATION: Inside Building @ location of former S003 location
T.O.C. ELEV.:
DRILL MACHINE: Hand Auger
METHOD: Hand Auger
0 HOUR DTW: N/A
TOTAL DEPTH: 11.6
START DATE: 1/31/12
FINISH DATE: 1/31/12
24 HOUR DTW: F IAD
WELL DEPTH: 11.6
DEPTH
BLOW
6in
6in
COUNT
6in
6in
OVA
,
(PPM)
LAB.
m
o
1
S
L
0
G
SOIL AND ROCK
DEPTH DESCRIPTION
WELL
DETAIL
0.0 LAND SURFACE
3.6
0.0
_
—
—
,
- -
Concrete Floor
0.5
1" Slot .010 1" Sch. 40 PVC
Sch. 40 PVC
-_--
_
- 1
—
_-_
:....
_
:--,,
,.....
_---
......,
.____
,-..,.
:„..
.---
_
— :.._
..--..
„,.
:-..
..,._
:....
.---..
:...,
:,...
..-..
„....
---_
—__
----- —
----
_,....
—_-.
—
____-....
— --:
— ---
—
—.....-
• .(
•: 0 (
•)
•: (
• '
•
•
: • (
•: 0 (
0
...)
•*
•0(
•••
•
. of
•
(GW) - Fill. Similar to ABC.
5.0
5.0
-GR
AB
122
HA-01
(57)
/
: (CL/ML) - Dark brown to brown, Sandy to Silty
CLAY. Sand content increase w/depth. Foam
on sample w/sewage odor. Sewage odor
changes to HCO (gasoline) @ 7ft.
9.0
M
60
.
-
7.0
-
G
R
A
B
87.6
G
R
A
B
428
HA-01
(79)
M
W
8.0
-
9.0
-GR
.F:---_-.
.,..
G
R
A
B
504
A
B1785
HA-01
(9-11)
Sat.
,
. —
. .
. :
'
.,
••
RECEIVED/NCDENR/N
(SM) - Gray, Silty, f. SAND. No flgy 2 2 2017
Decrease in HCO.
Water Quality Regional
11.6 Operations Section
_ ..
—
_._
—,--:
--...-
----:
_.....
—_-.
—_-.
..--—•-• 11.6
Sat.
i 1 0.0
-
L.'
.;,
c
e
t
L.
___
:-:
, -
2,
i _
E-
.:i
-i.
G
R
A
6
68.7
C*f
Boring Terminated at De[grW1611 'gif)i) .•
Set TEMPORARY 1" PVC well and then
abandoned well subsequent to water sample,_
collection. RECEIVED
MAP,
Information
_
I p 2'C 7
Processing unit
DWQ/BOG
Native Backfill

NON RESIDENTIAL WELL CONSTRUCTION RECO
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION #: 2927A
1. WELL CONTRACTOR:
William J. Miller
Well Contractor (Individual) Name
CATLIN Engineers and Scientists
Well Contractor Company Name
220 Old Dairy Road
Street Address
Wilmington North Carolina 28405
City or Town State Zip Code
( 910) - 452-5861
Area code - Phone number
2. WELL INFORMATION
WELL CONSTRUCTION PERMIT #: N/A
OTHER ASSOCIATED PERMIT # (if applicable): N/A
SITE WELL ID # (if applicable) HA-02
3. WELL USE (Check One Box): Monitoring 1:1 Municipal/Public ❑
Industrial/Commercial 0 Agricultural ❑ Recovery ❑ Injection ❑
Irrigation ❑ Other ❑ (list use):
DATE DRILLED: February 2, 2012
4. WELL LOCATION:
Butler Drive North, 28544
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Jacksonville COUNTY: Onslow
TOPOGRAPHIC / LAND SETTING (check appropriate box)
❑Slope ❑Valley 1:1 Flat ❑ Ridge ❑ Other:
LATITUDE:
LONGITUDE:
34.727976295 DD
-77.339097165 DD
Latitude/longitude source: ►:/ GPS 0 Topo. map
(Location of well must be shown on a USGS topo map and
attached to this form if not using a GPS.)
5. FACILITY (Name of the business where the well is located.)
Midway Park CDC
Facility Name
Butler Drive North
Street Address
Jacksonville NC
City or Town State
Ms. Jenni Provost
Contact Name
Attn: I&E/ EMD/ EQB/ PSC Box 20004
3.3_ .:(-)
N/A
Facility ID # (if applicable)
28544
Zip Code
Mailing Address
Camp Lejeune NC 28542-0004
City or Town State Zip Code
(910)- 451-5068
Area code - Phone number.
6. WELL DETAILS:
a. TOTAL DEPTH: 11.5
b. DOES WELL REPLACE EXISTING WELL? YES 0
c. WATER LEVEL Below Top of Casing: 11.2 FT.
(Use "+" if Above Top of Casing)
•
•
•
•
r-?
d. TOP OF CASING IS 3.70 FT. Above Land Surface*
Top of casing terminated atlor below land surface may require
a variance in accordance with 15A NCAC 2C.0118.
e. YIELD (gpm): N/A METHOD OF TEST: N/A
f. DISINFECTION: Type N/A A'nount: N/A
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
7. CASING: Thickness/
Depth Diameter Weight Material
Top 0 Bottom 6.3 Ft. 1 in. Sch. 40 PVC
Top Bottom Ft. in.
Top Bottom Ft. in.
8. GROUT:
Depth Material Method
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN:
Top 6.3
Top
Top
Depth
Bottom
Bottom
Diameter Slot Size Material
11.3 Ft. 1 in. Slot .010 in. PVC
Ft. in. in.
Bottom Ft. in. in.
• 10. SAND/GRAVEL PACK:
Depth Size Material
Top Bottom Ft.
• Top 0 Bottom 11.5 Ft.
Top Bottom Ft.
• 11. DRILLING LOG
Top Bottom
▪ MAY 1 % 7017
ATTACHErnnation Prc�cessing S�r�it
DWC�/BC�G
Formation Description
� UTAR 7 : 2012
SEE
/
/
' 12. REMARKS:
RECEIVED/NCDENR/DWR
MAY 2 2 2017
• I DO HEREBY CERTIFY THAT THIS WELL WAS • �•' •• A . o " r E WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDAR I• S
WI
• RECORD HAS BEEN PROVIDED TO THE WELL 0 t;t'" ra Ions ection
Wilmington Regional Office
NO ® •
.
• SIGNATURE OF CERTIFIED WELL CONTRACTOR
: William J. Miller
: PRINTED NAME OF PERSON CONSTRUCTING THE WELL
DATE
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-1617, Phone No. [phone]
Modified from
Form GW-1 b
Rev. 2/09

PROJECT No.: 211020
PROJECT NAME:
STATE: NC
Midway Park CDC
NORTHING: 3845361.0
SYSTEM: UTM NAD83 m
DRILL MACHINE: Hand Au. er
START DATE: 2/2/12
DEPTH
BLOW COUNT
6in 6in 6in 6in
OVA
(ppm)
EASTING:
HA-02
(5-7)
HA-02
(7-9)
HA-02
(9-11)
2
METHOD: Hand Au r er
DEPTH
2/2/12
COUNTY: O n s l ow
LOGGED BY:
DRILLER:
85827. CREW:
BORING LOCATION: Inside Building
@ location of former S002 location
211020
Wilmington, NC
ATLIN
Engineers and Scientists
SHEET 1 OF
LOCATION: Jacksonville
Ben Ashba
William J. Miller
O HOUR DTW: 11.2
24 HOUR DTW: FAD
SOIL AND ROCK
DESCRIPTION
LAND SURFACE
0.5 Concrete Floor
pperQuail
Wilmington Regional
minion Ro �octian
gonai office
(CUML) - Dark brown to black, Sand
SILT/CLAY. Foam on sample w/sewage odor changes to HCO (gasoline) odor.
8ft. (9 oline) @
(SM) - Gray changing to light tan gray, Silt f.
SAND. No foam. y y,
Boring Terminated at Depth 11.5 ft
Set TEMPORARY 1" PVC well and then
abandoned well subsequent to water sample
collection. p
Native Backfill
WELL ID:
HA-02
T.O.C. ELEV.:
TOTAL DEPTH: 11.5
WELL DEPTH: 11.5
WELL
DETAIL
RECEIVE
MAR 1 g 20*
intact) c3tic •, Processing
OW • BOG

REVJSED COPY S
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality `. 8 :
20
WELL CONTRACTOR CERTIFICATION # 2986
1. ELL CONTRACTOR:
L Martin Shaver
ell Contractor (Individual) Name
A erican Environmental Drilling, Inc.
ell Contractor Company Name
S REET ADDRESS 324 Fields Drive, Suite C
A erdeen NC 28315
City or Town State Zip Code
(10 )- 944-3140
A - a code- Phone number
2. W LL INFORMATION:
SI E WELL # (if applicable) MW-53
S ATE WELL PERMIT# (if applicable)
D Q or OTHER PERMIT #(if applicable)
W LL USE (Check Applicable Box) Monitoring ® Municipal/Public ❑
In ustrial/Commercial El Agricultural ❑ Recovery 0 Injection ❑
Irri_• ation ❑ Other 0 (list use)
D • TE DRILLED 11-13-2011
TI E COMPLETED 12:10
3. W : LL LOCATION:
CI : Jacksonville
R• ute 24
LA
LO
Lati
wet
if n
AM PMEj
COUNTY Onslow
et Name, Numbers, Community, Subdivision, Lot No., -Parcel, Zip Code)
OGRAPHIC / LAND SETTING:
Slope ❑Valley ❑Fiat :Midge ❑Other
(check appropriate box)
ITUDE 34° 44.442
GITUDE 077° 22.304
May be in degrees,
minutes, seconds or
in a decimal format
de/longitude source: ®GPS ❑ Topographic map (location of
must be shown on a USGS topo map and attached to this form
t using GPS)
ILITY- is the name of the business where the well is located.
FA • ILITY ID # (if applicable)
NA E OF FACILITY MCB Camp Lejuene
ST EET ADDRESS Route 24
Jac sonville NC
City or Town State
CO TACT PERSON Jeffrey Enos
28547
Zip Code
MAI ING ADDRESS 1005 Michael Road
Ca p Lejuene
NC 28547
City • r Town State Zip Code
,( 910 )- 451-4318
Are- code - Phone number
5. WE L DETAILS:
a. OTAL DEPTH: 30'
b. OES WELL REPLACE EXISTING WELL? YES 0 NO to
c. ATER LEVEL Below Top of Casing: 7.05 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING 1S 0 FT. Above Land Surface
*Top of casing terminated atlor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm) METHOD OF TEST
f. DISINFECTION: Type Amount
g.
WATER ZONES (depth):
From 7' To 30' From To
From To From To
From To From To
6. CASING:
Depth Diameter Thickness/ Weight Material
From 0' To20' Ft. 2" SCH40 PVC
From To Ft.
From To Ft.
7. GROUT: Depth Material
From 13.2 To 0 Ft. Grout
From 17.10 To 13.2 Ft. Pellets
From
To Ft.
Method
Tremie
Pour
8. SCREEN: Depth Diameter Slot Size
From 20' To 30 0'Ft. 2 in. .010 in.
From To Ft. in. in.
From To Ft. in. in.
8. SAND/GRAVEL PACK:
Depth
To17.10
From 30'
From
From
10. DRILLING LOG:
From To
0' 1'
To
To
1' 10'
10' 18'
18' 27'
27' 30'
11. REMARKS
Size
Ft. #1
Ft.
Ft.
Material
Sand
Material
PVC
Formation Description
Top Soil
Tannish White Silty Sand
Tannish White with Grey Silty
White Fine Sands
Whitish Grey Silty Fine Sands
t.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE % CER
D WELL CONTRACTOR D/NC
L. Martin Shaver
PRINTED NAME OF PERSON CONSTRUCTIN
yal 2017
•
Submi the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Water Quality,* • 0
1617 ail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Operations ��
Wilmington Regional Office

.REVISED oipy g
NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2986
1. WELL CONTRACTOR:
L. Martin Shaver
Well Contractor (individual) Name
American Environmental Drilling, Inc.
'ell Contractor Company Name
S REET ADDRESS 324 Fields Drive, Suite C
A erdeen NC 28315
A
2. W
SI
S
D
W
Ini
Irr
City or Town State Zip Code
10 )- 944-3140
a code- Phone number
LL INFORMATION:
E WELL # (if applicable) MW-54
ATE WELL PERMIT# (if applicable)
Q or OTHER PERMIT #(if applicable)
LL USE (Check Applicable Box) Monitoring ® Municipal/Public 0
ustrial/Commercial 0 Agricultural 0 Recovery 0 Injection ❑
ation 0 Other 0 (list use)
D TE DRILLED 11-12-2011
TI E COMPLETED 4:00
3. WELL LOCATION:
CITY: Jacksonville
Route 24
(Str
TOF
AM 0 PM®
COUNTY Onslow
et Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
(GRAPHIC / LAND SETTING:
(Slope ['Valley ❑Flat ['Ridge ❑Other
(check appropriate box)
LA1TITUDE 34° 44.423
II --
LONGITUDE 077° 22.300
May be in degrees,
minutes, seconds or
in a decimal format
Lati'.ude/longitude source: ®GPS ❑ Topographic map (location of
well must be shown on a USGS topo map and attached to this form
if not using GPS)
4. FAILITY- is the name of the business where the well is located.
FA ILITY ID # (if applicable)
NA E OF FACILITY MCB Camp Lejuene
STREET ADDRESS Route 24
Jac sonville
(33ogy)
NC 28547
City or Town State
CO TACT PERSON Jeffrey Enos
Zip Code
MAILING ADDRESS 1005 Michael Road
Can- p Lejuene NC
28547
City or Town State Zip Code
( 910 )- 451-4318
Area code - Phone number
5, WELL DETAILS:
a. TOTAL DEPTH: 35'
b. DOES WELL REPLACE EXISTING WELL? YES ❑
NO
c. WATER LEVEL Below Top of Casing: 9.2 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 0
*Top of casing terminated
a variance in accordance
e. YIELD (gpm)
f. DISINFECTION: Type
FT. Above Land Surface
at/or below land surface may require
with 15A NCAC 2C .0118.
METHOD OF TEST
g. WATER ZONES (depth):
From 7' To 35'
From To
From To
S. CASING:
From 0'
From
From
Depth
To25'
To
To
7. GROUT: Depth
From11.1 Too
From 21.5 To11.1
From To
From
From
From
Amount
To
To
To
Diameter Thickness/ Material
Weight
Ft. 2" SCH40 PVC
Ft.
Ft.
Material Method
Ft. Grout Tremie
Ft. Pellets Pour
Ft.
1
1
8. SCREEN: Depth Diameter Slot Size Material
From 25' To 35' Ft. 2 in. .010 in. PVC
From To Ft. From To Ft. in. I in.
i
i
1
i
9. SAND/GRAVEL PACK:
Depth
From 35' To21.5
From
From
10. DRILLING LOG:
From To
0'
1'
10'
18'
27'
1'
10'
18'
27'
35'
To
To
11. REMARKS
Size
Ft. #1
Ft.
Ft.
Material
Sand
Formation Description
Top Soil
Tannish White Silty and
Tannish White with prey Silty
White Fine Sands
Whitish Grey Silty Fine Sands
(4. './,‘3)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
RECJVED/Npg�,,
SIGN TURE . CER D WELL CONTRACTOR DATE
L. Martin Shaver
MAY 2 2 2017
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
WR
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
titer Uua l ity Regional
Operaf,�r gOipn
Wilrn!ngto AmorOffice

REVISED CO/7`./
NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2986
1. WELL CONTRACTOR:
L. Martin Shaver
Well Contractor (Individual) Name
American Environmental Drilling, Inc.
Well. Contractor Company Name
STREET ADDRESS 324 Fields Drive, Suite C
A 3erdeen NC 28315
City or Town State Zip Code
1 910 )-. 944-3140
Area code- Phone number
2. WELL INFORMATION:
SITE WELL # (if applicable) MW-55
STATE WELL PERMIT# (if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring IN Municipal/Public 0
In ❑ Agricultural 0 Recovery ❑ Injection 0
Irr gation ❑ Other ❑ (list use)
DATE DRILLED 11-7-2011
TIME COMPLETED 11:40
3, WELL LOCATION:
CITY: Jacksonville
Route 24
AM® PM 0
COUNTY Onslow
(Strset Name, Numbers, Immunity, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
®Slope ❑Valley ❑Flat :Midge ❑Other
(check appropriate box)
LATITUDE 34°. 44.406
LONGITUDE 077° 22.304
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/Iongitude source: EIGPS ❑ Topographic map (location of
wel ' must be shown on a USGS topo map and attached to this form
if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID # (if applicable)
NAME OF FACILITY MCB Camp Lejuene
STREET ADDRESS Route 24
Jacksonville
33O96
NC 28547
City or Town State
CONTACT PERSON Jeffrey Enos
Zip Code
MAILING ADDRESS 1005 Michael Road
Camp Lejuene
City or Town
NC 28547
( 910 )- 451-4318
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 35'
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
c. WATER LEVEL Below Top of Casing: 10.8 FT.
(Use "+" if Above Top of Casing)
Depth Diameter
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
4 f
y ri 00
d. TOP OF CASING IS 0 FT. Above Land Surface
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm)
f. DISINFECTION: Type
METHOD OF TEST
Amount
g. WATER ZONES (depth):
From 7' To 35' From To
From To From To
From To From To
6. CASING:
Thickness/ Material
Weight
From 0' To25' Ft. 2" SCH40 PVC
From To Ft.
From To Ft.
7. GROUT: Depth
Material
From 21' To 0 Ft. Grout
From 23' To21 Ft. Pellets Pour
From To Ft.
Method
Tremie
8. SCREEN: Depth Diameter Slot Size Material
From 25' To 35' Ft. 2 in. .00110 in. PVC
From To Ft. in.in.
From To Ft. in.in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 35' To23' Ft. #1 Sand
From To Ft.
From To Ft.
10. DRILLING LOG:
From To Formation Description
0' 1'
1' 10'
10' 18'
18' 27'
27' 35'
11. REMARKS
Top Soil
Tannish White Silty Sand
Tannish White with Grey Silty
White Fine Sands
Whitish Grey Silty Fine Sands
jr
l DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
RECEIVED/NCDER/DWP
11-12- 1 SIGN • TURE . CER DWELL CONTRACTOR DATE
MIAY 222017
L. Martin Shaver
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Water QuaIi
.egiorlal
Operations Secti n
Wilmington ';.. i iAlai
Re 'Office

REVISED
C(4)1
NON JESJDE]VTJAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2986
1. WELL CONTRACTOR:
L. Martin Shaver
Wet Contractor (Individual) Name
American Environmental Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 324 Fields Drive, Suite C
Aberdeen NC 28315
City or Town State Zip Code
( 910 )- 944-3140
Area code- Phone number
2. WELL INFORMATION:
SITE WELL # (if applicable)
IW-28
STATE WELL PERMIT# (if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection C".t
Irrigation ❑ Other ❑ (list use)
DATE DRILLED 10-27-2011
TIME COMPLETED 11:42 AM ►I PM ❑
3. WELL LOCATION:
CITY: Jacksonville COUNTY Onslow
Route 24
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
®Slope ❑Valley ❑Flat [Midge DOther
(check appropriate box)
LATITUDE 34° 44.474
LONGITUDE 077° 22.296
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: EIGPS ❑ Topographic map (location of
well must be shown on a USGS topo map and attached to this form
if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID # (if applicable)
NAME OF FACILITY MCB Camp Lejuene
("'D-So6ct)
STREET ADDRESS Route 24
Jacksonville
NC 28547
City or Town State
CONTACT PERSON Jeffrey Enos
Zip Code
MAILING ADDRESS 1005 Michael Road
Camp Lejuene
NC 28547
City or Town State Zip Code
( 910 )- 451-4318
Area code - Phone number
5. WELL DETAILS:
a_ TOTAL DEPTH: 35'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
c. WATER LEVEL Below Top of Casing: 6.6 FT.
(Use "+" if Above Top of Casing)
Y; ? is
d. TOP OF CASING IS 0 FT. Above Land Surface
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm) METHOD OF TEST
I. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From 7' To 35' From To
From To From To
From To From To
6. CASING:
Depth Diameter Thickness/ Material
Weight
From 0' To20' Ft. 2" SCH80 PVC
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 12.10 To0 Ft. Grout Tremie
From 17.9 To 12.10 Ft. Pellets Pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 20' To 35' Ft. 2 in. .020 in. PVC
From To Ft. in. in.
From To Ft. in. in.
1
9. SAND/GRAVEL PACK:
Depth Size Material
From 35' To 17.9 Ft. #3 Sand
From To Ft.
From To Ft.
10. DRILLING LOG:
From To Formation Description
0' 1' Top Soil
1' 10' Tannish White Silty Sand
10' 18' Tannish White with Grey Silty
18' 27' White Fine Sands
27' 35' Whitish Grey Silty Fine Sands
'
11. REMARKS
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
EIVNC® ■� :►,011
:%f
SIGNATURE CER D WELL CONTRACTOR 1 ' E
L. Martin Shaver ti4L'( 2
PRINTED NAME OF PERSON CONSTRUCTING TH L O 1
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Water Quality Re
,Operations Sec &-1 b
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568. @�'17/05
WIlmIngton Regional Office

REVISED
),IV RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION,# 2986
1. WELL CONTRACTOR:
L. Martin Shaver
Well Contractor (Individual) Name
American Environmental Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 324 Fields Drive, Suite C
Aberdeen NC
28315
City or Town State Zip Code
( 910 )- 944-3140
Area code- Phone number
2. WELL INFORMATION:
SITE WELL # (if applicable) 1W-29
STATE WELL PERMIT# (if applicable)
Da.NCI or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection
Irrigation ❑ Other ❑ (list use)
DATE DRILLED 10-18-2011
TIME COMPLETED 4:57 AM ❑ PM
3. WELL LOCATION:
CITY: Jacksonville COUNTY Onslow
Route 24
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
®Slope ['Valley ❑Flat ❑Ridge DOther
(check appropriate box)
LATITUDE 34° 44.450
LONGITUDE 077° 22.325
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ®GPS ❑ Topographic map (location of
well must be shown on a USGS topo map and attached to this form
if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID # (if applicable)
NAME OF FACILITY MCB Camp Lejuene
STREET ADDRESS Route 24
Jacksonville
City or Town
NC 28547
State Zip Code
CONTACT PERSON Jeffrey Enos
MAILING ADDRESS 1005 Michael Road
Camp Lejuene
NC 28547
City or Town State Zip Code
( 910 )-451-4318
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 37'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
c. WATER LEVEL Below Top of Casing: 6.2 FT.
(Use "+" if Above Top of Casing)
SIGNATURE CERTTF- D WELL CONTRACTOR
L. Martin Shaver
d. TOP OF CASING IS 0 FT. Above Land Surface
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
, e. YIELD (gpm)
f. DISINFECTION: Type
g. WATER ZONES (depth):
From 7'
From
From
To 35'
To
To
6. CASING:
From 0'
From
From
METHOD OF TEST
Amount
Depth
To20'
To
To
From
From
From
To
To
To
Diameter Thickness/ Material
Ft. 2"
Ft.
Ft.
7. GROUT: Depth Material
From 12.9 To 0 Ft. Grout
From 17.9 To 12.9 Ft. Pellets
From To
8. SCREEN:
From 22'
From
Depth
To 37'
To
From To
9. SAND/GRAVEL PACK:
Depth
To 17.9
From 37'
From
To
From To
10. DRILLING LOG:
From To
0' 1'
Ft.
Weight
SCH80 PVC
Method
Tremie
Pour
Diameter Slot Size Material
Ft. 2 in. .020 in. PVC
Ft. in. in.
Ft. in. in.
Size
Ft. #3
Ft.
Ft.
Material
Sand
Formation Description
Top Soil
1' 10' Tannish White Silty Sand
10' 18' Tannish White with Grey Silty
18' 27' White Fine Sands
27' 37' Whitish Grey Silty Fine Sands
0
11. REMARKS
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
ECEVED/NO DATE
MAY 2 2 2017
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
•Divisionli within 30 days. Attn: Information Mgt.,Water Quality Regional
Submit the original to the of Water Quality y Operations„$ , oVp
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Wilmington RtgloTM Office

REVISED
gy
NON RESIDEIVT2AL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELLCONTRACTOR CERTIFICATION # 2986
1. WELL CONTRACTOR:
L. Martin Shaver
Well Contractor (Individual) Name
American Environmental Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 324 Fields Drive, Suite C
Aberdeen NC 28315
City or Town State Zip Code
( 910 )- 944-3140
Area code- Phone number
2. WELL INFORMATION:
SITE WELL # (if applicable)
IW-30
STATE WELL PERMIT# (if applicable)
DWO or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring ❑ Municipal/Public 0
Industrial/Commercial 0 Agricultural ❑ Recovery 0 Injection lZ
Irrigation ❑ Other 0 (list use)
DATE DRILLED 10-20-2011
TIME COMPLETED 3:19 AM 0 PM El
3. WELL LOCATION:
CITY: Jacksonville COUNTY Onslow
Route 24
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
Slope ❑Valley ❑Flat ❑Ridge ['Other
(check appropriate box)
LATITUDE 34° 44.477
LONGITUDE 077° 22.307
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ®GPS ❑ Topographic map (location of
well must be shown on a USGS topo map and attached to this form
if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID # (if applicable)
NAME OF FACILITY MCB Camp Lejuene
c_1368sua
STREET ADDRESS Route 24
Jacksonville
NC 28547
City or Town State
CONTACT PERSON Jeffrey Enos
Zip Code
MAILING ADDRESS 1005 Michael Road
Camp Lejuene
NC 28547
City or Town State Zip Code
( 910 )- 451-4318
Area code - Phone number
5. WELL DETAILS:
a_ TOTAL DEPTH: 35'
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
c. WATER LEVEL Below Top of Casing: 6.39 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 0 FT. Above Land Surface
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm) METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From 7' To 35' From To
From To From To
From To From To
6. CASING:
Depth Diameter Thickness/ Material
Weight
From 0' To20' Ft. 2" SCH80 PVC
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 12.2 Too Ft. Grout Tremie
From 17.6 To 12.2 Ft. Pellets Pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 20' To 35' Ft. 2 in. .020 in. PVC
From To Ft. in. in. .
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 35' To 17.6 Ft. #3 Sand
From To Ft.
From To Ft.
10. DRILLING LOG:
From To Formation Description
0' 1' Top Soil
1' 10' Tannish White Silty Sand
10' 18' Tannish White with Grey Silty
18' 27' White Fine Sands
27' 35' Whitish Grey Silty Fine Sands
11. REMARKS
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
10-30-2011
SIGNATURE CER D WELL CON !` ;" , DMCDENOVVR
L. Martin Shaver
PRINTED NAME OF PERSON CONSTRUCTINf►WL 201?
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Water Quality R y'-1b
Operations Section
Wilmington Regional Office

REVISED
609v
NOI\T RESiDENIL4L WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of \Alater Quality
WELL CONTRACTOR CERTIFICATION # 2986
1. WELL CONTRACTOR:
L. Martin Shaver
Well Contractor (Individual) Name
American Environmental Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 324 Fields Drive, Suite C
Aberdeen NC 28315
City or Town State Zip Code
( 910 )- 944-3140
Area code- Phone number
2. WELL INFORMATION:
SITE WELL # (if applicable)
IW-31
STATE WELL PERMIT# (if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection
Irrigation ❑ Other ❑ (list use)
DATE DRILLED 10-24-2011
TIME COMPLETED 3:55 AM ❑ PM
3. WELL LOCATION:
CITY: Jacksonville COUNTY Onslow
Route 24
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope ❑Valley ❑Flat ❑Ridge DOther
(check appropriate box)
LATITUDE 34° 44.471
LONGITUDE 077° 22.304
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ®GPS ❑ Topographic map (location of
well must be shown on a USGS topo map and attached to this form
if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID # (if applicable)
NAME OF FACILITY MCB Camp Lejuene
STREET ADDRESS Route 24
Jacksonville
NC 28547
City or Town State
CONTACT PERSON Jeffrey Enos
Zip Code
MAILING ADDRESS 1005 Michael Road
Camp Lejuene
NC 28547
City or Town State Zip Code
( 910 )-451-4318
Area code - Phone number
5. WELL DETAILS:
a_ TOTAL DEPTH: 35'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
c. WATER LEVEL Below Top of Casing: 7.8 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 0 FT. Above Land Surface
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm) METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From 7' To 35' From To
From To From To
From To From To
8. CASING:
Depth Diameter Thickness/ Material
Weight
From 0' To20' Ft. 2" . SCH80 PVC
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 12.1 To() Ft. Grout Tremie
From 17.4 To 12.1 Ft. Pellets Pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 20' To 35' Ft. 2 in. .020 in. PVC
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 35' To 17.4 Ft. #3 Sand
From To Ft.
From To Ft.
10. DRILLING LOG:
From To Formation Description
0' 1' Top Soil
1' 10' Tannish White Silty Sand
10' 18' Tannish White with Grey Silty
18' 27' White Fine Sands
27' 35' Whitish Grey Silty Fine Sands
11. REMARKS
RECEIVED/NCDENR/DWR
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER& p n 'J 222017
AO - -
10-30-2011
SIGNATURE % CER D WELL CONTRA 2er Quality Regional
Operations Section
L. Martin Shaver Wilmington Regional Office
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-1 b
Rev. 7/05

REVISED copt
ON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2986
1. WELL CONTRACTOR:
L. Martin Shaver
Well Contractor (Individual) Name
American Environmental Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 324 Fields Drive, Suite C
Aberdeen NC 28315
City or Town
( 910 )- 944-3140
State Zip Code
Area code- Phone number
2. WELL INFORMATION:
SITE WELL # (if applicable) IW-32
STATE WELL PERMIT# (if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection
Irrigation ❑ Other ❑ (list use)
►f
DATE DRILLED 10-28-2011
TIME COMPLETED 4:31
3. WELL LOCATION:
CITY: Jacksonville
AM ❑ PM
COUNTY Onslow
Route 24
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑C Slope ❑Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 34° 44.471
LONGITUDE 077° 22.304
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: DAGPS ❑ Topographic map (location of
well must be shown on a USGS topo map and attached to this form
if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID # (if applicable)
NAME OF FACILITY MCB Camp Lejuene
STREET ADDRESS Route 24
Jacksonville
NC 28547
City or Town State
CONTACT PERSON Jeffrey Enos
Zip Code
MAILING ADDRESS 1005 Michael Road
Camp Lejuene
City or Town
NC 28547
( 910 )- 451-4318
Area code - Phone number
5. WELL DETAILS:
a_ TOTAL DEPTH: 35'
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IZ
c. WATER LEVEL Below Top of Casing: 6.9 FT.
(Use "+" if Above Top of Casing)
1 DO HEREBY CERTIFY THAT THIS WELL WAS CON
15A NCAC 2C, WELL CONSTRUCTION STAN
RECORD HAS BEEN PROVIDED TO THE WELL • 1
d. TOP OF CASING IS 0 • FT. Above Land Surface
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm) METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From 7' To 35' From
From To From
From To From
6. CASING:
From 0' To20' Ft. 2"
From To Ft.
From To Ft.
To
To
To
Depth Diameter Thickness/ Material
Weight
SCH8o PVC
7. GROUT: Depth Material
From 13.3 To0 Ft. Grout Tremie
From 17.6 To 13.3 Ft. Pellets Pour
From To Ft.
Method
8. SCREEN: Depth Diameter Slot Size Material
From 20' To 35' Ft. 2 in. .020 in. PVC
From To Ft in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 35' To 17.6 Ft. #3 Sand
From To Ft.
From To Ft.
10. DRILLING LOG:
From To Formation Description
0' 1', Top Soil
1 10' Tannish White Silty Sand
10' 18' Tannish White with Grey Silty
18' 27' White Fine Sands
27' 35' Whitish Grey Silty Fine Sands
11. REMARKS
•
MAY 2
Water Quality Regional
eratng tit,.' t FE WITH
WATP6klaifiIffice
10-30-2011
SIGNATURE CER D WELL CONTRACTOR DATE
L. Martin Shaver
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-lb
Rev. 7/05

sTATE
. WELL CONTRACTOR:
L. Martin Shaver
REVISED cop')
VON RESIDEI'/.TiAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2986
Well Contractor (Individual) Name
American Environmental Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 324 Fields Drive, Suite C
Aberdeen
NC
28315
City or Town State Zip Code
( 910 )- 944-3140
Area code- Phone number
2. WELL INFORMATION:
SITE WELL # (if applicable)
IW-33
STATE WELL PERMIT# (if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ►.�
Irrigation ❑ Other ❑ (list use)
DATE DRILLED 10-27-2011
TIME COMPLETED 9:38 AM PM ❑
3. WELL LOCATION:
CITY: Jacksonville
COUNTY Onslow
Route 24
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
Slope ❑Valley ❑Flat :Midge DOther
(check appropriate box)
LATITUDE 34° 44.473
LONGITUDE 077° 22.290
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ®GPS ❑ Topographic map (location of
well must be shown on a USGS topo map and attached to this form
if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID # (if applicable)
NAME OF FACILITY MCB Camp Lejuene
(c)
STREET ADDRESS Route 24
Jacksonville
NC 28547
City or Town State
CONTACT PERSON Jeffrey Enos
Zip Code
MAILING ADDRESS 1005 Michael Road
Camp Lejuene
NC 28547
City or Town
( 910 )- 451-4318
Area code - Phone number
3. WELL DETAILS:
a_ TOTAL DEPTH: 35'
State
Zip Code
. b. DOES WELL REPLACE EXISTING WELL? YES 0 NO
c. WATER LEVEL Below Top of Casing: 7.8 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 0 FT. Above Land Surface
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm) METHOD OF TEST
[. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From 7' To 35' From To
From To From To
From To From To
6. CASING:
Depth Diameter Thickness/ Material
Weight
From 0' To20' Ft. 2" . SCH80 PVC
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 12.4 To0 Ft. Grout Tremie
From 17.1 To 12.4 Ft. Pellets Pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 20' To 35' Ft. 2 in. .020 in. PVC
From To Ft in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 35' To 17.1 Ft. #3 Sand
From To Ft.
From To Ft.
10. DRILLING LOG:
From To Formation Description
0' 1' Top Soil
1' 10' Tannish. White Silty Sand
10' 18' Tannish White with Grey Silty
18' 27' White Fine Sands
27' 35' Whitish Grey Silty Fine Sands
Y. . ;r... :!.
MAY22201? .j. .
11. REMARKS
Water Quality-Regionat
Operations Section
Wilmington Regional Office
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
10-30-2011
SIGNATURE CER 1D WELL CONTRACTOR DATE
L. Martin Shaver
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-1 b
Rev. 7/05

REVISED C
NON _RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2986
1. WELL CONTRACTOR:
L. Martin Shaver
VVeli Contractor (individual) Name
American Environmental Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 324 Fields Drive, Suite C
Aberdeen
NC 28315
City or Town State Zip Code
( 910 )- 944-3140
Area code- Phone number
2. WELL INFORMATION:
SITE WELL # (if applicable)
IW-34
STATE WELL PERMIT# (if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring ❑ Municipal/Public 0
Industrial/Commercial 0 Agricultural 0 Recovery ❑ Injection
Irrigation ❑ Other 0 (list use)
DATE DRILLED 10-18-2011
TIME COMPLETED 2:37 AM ❑ PM
3. WELL LOCATION:
CITY: Jacksonville COUNTY Onslow
Route 24
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
Slope ❑Valley ['Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 34° 44.463
LONGITUDE 077° 22.312
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: GPS 0 Topographic map (location of
well must be shown on a USGS topo map and attached to this form
if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID # (if applicable)
NAME OF FACILITY MCB Camp Lejuene
C-6,3ym)
STREET ADDRESS Route 24
Jacksonville NC
City or Town State
CONTACT PERSON Jeffrey Enos
28547
Zip Code
MAILING ADDRESS 1005 Michael Road
Camp Lejuene NC
City or Town State
( 910 )- 451-4318
28547
Area code - Phone number
5. WELL DETAILS:
a_ TOTAL DEPTH: 35'
b. DOES WELL REPLACE EXISTING WELL? YES 0
Zip Code
NO EI
c. WATER LEVEL Below Top of Casing: 6.43 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 0 FT. Above Land Surface
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm)
£. DISINFECTION: Type
METHOD OF TEST
WATER ZONES (depth):
From 7' To 35'
From To
From To
6. CASING:
From
From
From
Amount
To
To
To
Depth Diameter Thickness/ Material
Weight
From 0' To20' Ft. 2" SCH80 PVC
From To Ft.
From To Ft.
7. GROUT: Depth
From 12.6 To 0
From 17.8 To12.6
From To
Material
Ft. Grout
Ft. Pellets
Ft.
Method
Tremie
Pour
8. SCREEN: Depth Diameter Slot Size
From 20' To 35' Ft. 2 in. .020 in.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth
To 17.8
From 35'
From
From
10. DRILLING LOG:
From To
0' 1'
To
To
1' 10'
10' 18'
18' 27'
27' 35'
11. REMARKS
Size
Ft. #3
Ft.
Ft.
Material
Sand
Material
PVC
Formation Description
Top Soil
Tannish White Silty Sand
Tannish White with Grey Silty
White Fine Sands
Whitish Grey Silty Fine Sands
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE P CER D WELL C
10-30-2011
WCDENR/ijjrE
L. Martin Shaver
PRINTED NAME OF PERSON CONSTRUCtOrHff 1gELt0ll
L 4
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Wader Qtr�llty Reec ° vb
0 r� n�
pe Lions Sec ron
Wilmington Regional
Office

REVISEDCogY
]Q]\/ RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2986
. WELL CONTRACTOR:
L. Martin Shaver
Well Contractor (Individual) Name
American Environmental Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 324 Fields Drive, Suite C
Aberdeen
NC
28315
City or Town State Zip Code
( 910 )- 944-3140
Area code- Phone number
2. WELL INFORMATION:
SITE WELL # (if applicable) 1W-35
STATE WELL PERMIT# (if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring 0 Municipal/Public ❑
Industrial/Commercial 0 Agricultural 0 Recovery 0 Injection ►�
Irrigation 0 Other 0 (list use)
DATE DRILLED 10-20-2011
TIME COMPLETED 4:13 AM ❑ PM
3. WELL LOCATION:
CITY: Jacksonville
COUNTY Onslow
Route 24
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
Slope ❑Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 34° 44.466
LONGITUDE 077° 22.289
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: GPS ❑ Topographic map (location of
well must be shown on a USGS topo map and attached to this form
if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID # (if applicable)
NAME OF FACILITY MCB Camp Lejuene
C.:63aq)
STREET ADDRESS Route 24
Jacksonville
NC 28547
City or Town State
CONTACT PERSON Jeffrey Enos
Zip Code
MAILING ADDRESS 1005 Michael Road
Camp Lejuene
NC 28547
City or Town
( 910 )- 451-4318
Area code - Phone number
5. WELL DETAILS:
a_ TOTAL DEPTH: 35'
State
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: 6.57 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 0 FT. Above Land Surface
*Top of casing terminated atior below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm) METHOD OF TEST
£ DISINFECTION: Type Amount
g. WATER ZONES (depth):
From 7' To 35' From To
From To From To
From To From To '
' 6. CASING:
Depth Diameter Thickness/ Material
Weight
From 0' To 20' Ft. 2" . SCH80 PVC
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 12.5 To 0 Ft. Grout Tremie
From 17.8 To 12.5 Ft. Pellets Pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 20' To 35' Ft. 2 in. .020 in. PVC
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 35' To 17.6 Ft. #3 Sand
From To Ft.
From To Ft.
10. DRILLING LOG:
From To Formation Description
0' 1' Top Soil
1' 10' Tannish White Silty Sand
10' 18' Tannish White with Grey Silty
18' 27' White Fine Sands
27' 35' Whitish Grey Silty Fine Sands
Jai:.
a
11. REMARKS ECEIVED
,,, ..„, ,
MAY 22201?
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO TH . / J O E .,
• -r'ua Ity Regional
Operations Section 10-30-2011
- . l �. " • ' • n Regional
.^: Office
SIGNATURE ! CER D WELL CONTRACTOR DATE
L. Martin Shaver
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-lb
Rev. 7/05

REVISED COO
NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2986
1. WELL CONTRACTOR:
L. Martin Shaver
Well Contractor (individual) Name
American Environmental Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 324 Fields Drive, Suite C
Aberdeen NC 28315
City or Town State Zip Code
( 910 )- 944-3140
Area code- Phone number
2. WELL INFORMATION:
SITE WELL # (if applicable) IW-36
STATE WELL PERMIT# (if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring ❑ Municipal/Public 0
Industrial/Commercial ❑ Agricultural 0 Recovery ❑ Injection
Irrigation ❑ Other ❑ (list use)
DATE DRILLED 10-24-2011
TIME COMPLETED 5:35 AM 0 PM
3. WELL LOCATION:
CITY: Jacksonville
COUNTY Onslow
Route 24
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
Slope ❑Valley ❑Flat :Midge ❑Other
(check appropriate box)
LATITUDE 34° 44.466
LONGITUDE 077° 22.310
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: IZIGPS ❑ Topographic snap (location of
well must be shown on a USGS topo map and attached to this form
if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID # (if applicable)
NAME OF FACILITY MCB Camp Lejuene
(_53oat-t)
STREET ADDRESS Route 24
Jacksonville
NC 28547
City or Town
State Zip Code
CONTACT PERSON Jeffrey Enos
MAILING ADDRESS 1005 Michael Road
Camp Lejuene
NC 28547
City or Town
( 910 )- 451-4318
Area code - Phone number
5. WELL DETAILS:
a_ TOTAL DEPTH: 35'
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
c. WATER LEVEL Below Top of Casing: 8.15 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 0 FT. Above Land Surface
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm) METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From 7' To' 35' From To
From To From To
From To From To
6. CASING:
Depth Diameter Thickness/ Material
Weight
From 0' To20' Ft. 2" SCH80 PVC
From - To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 12.7 To() Ft. Grout Tremie
From 17.9 To 12.7 Ft. Pellets Pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 20' To 35' Ft. 2 in. .020 in. PVC
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 35' To 17.9 Ft. #3 Sand
From To Ft.
From To Ft.
10. DRILLING LOG:
From To Formation Description
0' 1' Top Soil
1' 10' Tannish White Silty Sand
10' 18' Tannish White with Grey Silty
18' 27' White Fine Sands
27' 35' Whitish Grey Silty Fine Sands
.
_,,,y,,,
, , ,..) -
l'ECEIVED/NCDA
7WR
11. REMARKS
M/-\Y 222b
Water Quality Regional
g nal
((''����L`)iVr
1 DO HEREBY CERTIFY THAT THIS W A�;at4t ti, iNRDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION sim S (ji ilJ nV 1I11 1 r .., ,; /T . p' ice THIS
RECORD HAS BEEN PROVIDED TO THE WELL 0 ER. -
10-30-2011
SIGNATURE CERTEF- D WELL CONTRACTOR DATE
L. Martin Shaver
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-1 b
Rev. 7/05

RIVISED C6QI
NON RJESJDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2986
. WELL CONTRACTOR:
L. Martin Shaver
Well Contractor (Individual) Name
American Environmental Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 324 Fields Drive, Suite C
Aberdeen NC 28315
City or Town State Zip Code
( 910 )- 944-3140
Area code- Phone number
2. WELL INFORMATION:
SITE WELL # (if applicable) IW-37
STATE WELL PERMIT# (if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial 0 Agricultural 0 Recovery ❑ Injection
Irrigation 0 Other 0 (list use)
DATE DRILLED 11-1-2011
TIME COMPLETED 9:27 AM PM 0
3. WELL LOCATION:
CITY: Jacksonville
Route 24
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
®Slope ['Valley ['Flat ['Ridge ['Other
(check appropriate box)
LATITUDE 34° 44.478
LONGITUDE 077° 22.307
COUNTY Onslow
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: GPS ❑ Topographic map (location of
well must be shown on a USGS topo map and attached to this form
if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID # (if applicable)
NAME OF FACILITY MCB Camp Lejuene
(a"WV-e)
STREET ADDRESS Route 24
Jacksonville
City or Town
NC 28547
State Zip Code
CONTACT PERSON Jeffrey Enos
MAILING ADDRESS 1005 Michael Road
Camp Lejuene
City or Town
( 910 )- 451-4318
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 35'
NC 28547
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO
c. WATER LEVEL Below Top of Casing: 7.8 FT.
(Use "+" if Above Top of Casing)
s'.V \ J
d. TOP OF CASING IS 0 FT. Above Land Surface
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm) METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
I.
From 7' To 35' From To
From To From To
From To From To
6. CASING:
Diameter Thickness/ Material
Weight
From 0' To20' Ft. 2" . SCH80 PVC
Depth
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 12.9 To 0 Ft. Grout Tremie
From 17.8 To 12.9 Ft. Pellets Pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 20' To35' Ft. 2 in. .020 in. PVC
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 35' To 17.8 Ft. #3 Sand
From To Ft.
From To Ft.
10. DRILLING LOG:
From To Formation Description
0' 1' . Top Soil
1' 10' Tannish White Silty Sand
10' 18' Tannish White with Grey Silty
18' 27' White Fine Sands
27' 35' Whitish Grey Silty Fine Sands
11. REMARKS
EIVED/NCDENR/DWR
2 2 2017
I DO HEREBY CERTIFY THAT THIS WELL WAS C+ RUC ED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDAR I . • `��' i�
RECORD HAS BEEN PROVIDED TO THE WELL OW ;�; perat(ons Section
Wilmington Regional ace
10-36-2�'r
SIGNATURE . CER D WELL CONTRACTOR DATE
L. Martin Shaver
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-lb
Rev. 7/05

REVISED
NON RI'SJDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality ,
WELL CONTRACTOR CERTIFICATION # 2986
. WELL CONTRACTOR:
L. Martin Shaver
Well Contractor (Individual) Name
American Environmental Drilling, inc.
Well Contractor Company Name
STREET ADDRESS 324 Fields Drive, Suite C
Aberdeen
NC
28315
City or Town State Zip Code
( 910 )- 944-3140
Area code- Phone number
2. WELL INFORMATION:
SITE WELL # (if applicable)
IW-38
STATE WELL PERMIT# (if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring 0 Municipal/Public ❑
Industrial/Commercial ❑ Agricultural 0 Recovery ❑ Injection ►4
Irrigation 0 Other 0 (list use)
DATE DRILLED 10-28-2011
TIME COMPLETED 9:34 AM 'Z1 PM ❑
3. WELL LOCATION:
CITY: Jacksonville
COUNTY Onslow
Route 24
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
►Z1 Slope ❑Valley ['Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 34° 44.472
LONGITUDE 077° 22.302
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ►S GPS 0 Topographic map (location of
well must be shown on a USGS topo map and attached to this form
if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID # (if applicable)
NAME OF FACILITY MCB Camp Lejuene
STREET ADDRESS Route 24
Jacksonville
NC 28547
City or Town State
CONTACT PERSON Jeffrey Enos
Zip Code
MAILING ADDRESS 1005 Michael Road
Camp Lejuene
NC 28547
City or Town
( 910 )- 451-4318
Area code - Phone number
5. WELL DETAILS:
a_ TOTAL DEPTH: 35'
State
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: 7.6 FT.
(Use "+" if Above Top of Casing)
.:y
; fir 'CO
d. TOP OF CASING IS 0 FT. Above Land Surface
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm) METHOD OF TEST
t: DISINFECTION: Type Amount
g. WATER ZONES (depth):
From 7' To 35' From To
From To From To
From To From To
6. CASING:
Depth Diameter Thickness/ Material
Weight
From 0' To20' Ft. 2" • SCH80 PVC
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 13.2 To0 Ft. Grout Tremie
From 18.1 To 13.2 Ft. Pellets Pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 20' To 35' Ft. 2 in. .020 in. PVC
From To Ft. in. in. ,
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 35' To 18.1 Ft. #3 Sand
From To Ft.
From To Ft.
10. DRILLING LOG:
From To Formation Description
0' 1' Top Soil
1' 10' Tannish White Silty Sand
10' 18' Tannish White with Grey Silty
18' 27' White Fine Sands
27' 35' Whitish Grey Silty Fine Sands
RECEIVEDINCDENR/DWR ,,j,-i
..
--c-.,), -
,,,,,
. _
11. REMARKS MAY 2 2 2017
.\;,.
Water Quality kegionat
Operations Section
I DO HEREBY CERTIFY THAT THIS WELL 1N'A raig UIt D9 i ACRDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
10-30-2011
SIGNATURE : CER D WELL CONTRACTOR DATE
L. Martin Shaver
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-1 b
Rev. 7/05

REVISED
N'OiV RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
41.
WELL CONTRACTOR CERTIFICATION # 2986
1. WELL CONTRACTOR:
L. Martin Shaver
Well Contractor (Individual) Name
American Environmental Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 324 Fields Drive, Suite C
Aberdeen NC 28315
City or Town State Zip Code
( 910 )- 944-3140
Area code- Phone number
2. WELL INFORMATION:
SITE WELL # (if applicable)
IW-39
STATE WELL PERMIT# (if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery 0 Injection
Irrigation ❑ Other ❑ (list use)
DATE DRILLED 10-18-2011
TIME COMPLETED 11:46 AM PM ❑
3. WELL LOCATION:
CITY: Jacksonville
COUNTY Onslow
Route 24
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
Slope ❑Valley ['Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 34° 44.465
LONGITUDE 077° 22.315
/
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: GPS ❑ Topographic map (location of
well must be shown on a USGS topo map and attached to this form
if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID # (if applicable)
NAME OF FACILITY MCB Camp Lejuene
.YYLk)
STREET ADDRESS Route 24
Jacksonville
NC 28547
City or Town State
CONTACT PERSON Jeffrey Enos
Zip Code
MAILING ADDRESS 1005 Michael Road
Camp Lejuene
NC 28547
City or Town State Zip Code
( 910 )-451-4318
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 35'
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO
c. WATER LEVEL Below Top of Casing: 5.9 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 0 FT. Above Land Surface
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm) METHOD OF TEST
f DISINFECTION: Type Amount
g. WATER ZONES (depth):
From 7' To 35' From To
From To From To
From To From To
6. CASING:
Depth Diameter Thickness/ Material
Weight
From 0' To20' Ft. 2" . SCH80 PVC
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 12.8 To 0 Ft. Grout Tremie
From 17.7 To 12.8 Ft. Pellets Pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 20' To 35' Ft. 2 in. .020 in. PVC
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 35' To 17.7 Ft. #3 Sand
From To Ft.
From To Ft.
10. DRILLING LOG:
From To Formation Description
0' 1' Top Soil
1' 10' Tannish White Silty Sand
10' 18' Tannish White with Grey Silty
18' 27' White Fine Sands
27' 35' Whitish Grey Silty Fine Sands
•
-r r. "1, . f ' � i 11 * . .
11. REMARKS
MIAY 22201?
Water Qua'. Reel()
ol.
I DO HEREBY CERTIFY THAT THIS WELL WAS or„,, i` • - CE WITH
15A NCAC 2C, WELL CONSTRUCTION ST/ y��,�,I_ . N CJ . - ui THIS
RECORD HAS BEEN PROVIDED TO THE $-!LlO n eglonal Office
/ 10-30-2011
SIGNATURE : CER D WELL CONTRACTOR DATE
L. Martin Shaver
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-1 b
Rev. 7/05

REVISED
NC) RESIDE]\/TJAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of V\Jater Quality
WELL CONTRACTOR CERTIFICATION # 2986
. WELL CONTRACTOR:
L. Martin Shaver
Wet Contractor (Individual) Name
American Environmental Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 324 Fields Drive, Suite C
Aberdeen
NC
28315
City or Town State Zip Code
( 910 )- 944-3140
Area code- Phone number
2. WELL INFORMATION:
SITE WELL # (if applicable) IW-40
STATE WELL PERMIT# (if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation ❑ Other ❑ (list use)
DATE DRILLED 10-25-2011
TIME COMPLETED 8:45 AM ❑ PM ❑
3. WELL LOCATION:
CITY: Jacksonville COUNTY Onslow
Route 24
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
® Slope ❑Valley ❑Flat ❑Ridge ['Other
(check appropriate box)
LATITUDE 34° 44.466
LONGITUDE 077° 22.302
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ®GPS ❑ Topographic map (location of
well must be shown on a USGS topo map and attached to this form
if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID # (if applicable)
NAME OF FACILITY MCB Camp Lejuene
(3c4)
STREET ADDRESS Route 24
Jacksonville
NC 28547
City or Town State
CONTACT PERSON Jeffrey Enos
Zip Code
MAILING ADDRESS 1005 Michael Road
Camp Lejuene
NC 28547
City or Town
( 910 )- 451-4318
Area code - Phone number
5. WELL DETAILS:
a_ TOTAL DEPTH: 35'
State
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 12
c. WATER LEVEL Below Top of Casing: 5.95 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 0 FT. Above Land Surface
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm) METHOD OF TEST
f DISINFECTION: Type Amount
g. WATER ZONES (depth):
From 7' To 35' From To
From To From To
From To From To
6. CASING:
Depth Diameter Thickness/ Material
Weight
From 0' To20' Ft. 2" SCH80 PVC
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 13.5 To 0 Ft. Grout Tremie
From 18.2 To 13.5 Ft. Pellets Pour
, From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 20' To 35' Ft. 2 in. .020 in. PVC
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 35' To 18.2 Ft. #3 Sand
From To Ft.
From To Ft.
10. DRILLING LOG:
From To .Formation Description
0' 1' Top Soil
1' 10' Tannish White Silty Sand
10' 18' Tannish White with Grey Silty
18' 27' White Fine Sands
27' 35' Whitish Grey Silty Fine Sands
t1 i
MAY 2iJi7
2
11. REMARKS
Water Quality Regional
Operations Section
Wilmington Regional Office
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
10-30-2011
SIGNATURE CER D WELL CONTRACTOR DATE
L. Martin Shaver
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-lb
Rev. 7/05

REVISED
NOI\T RESJDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality ,
WELL CONTRACTOR CERTIFICATION # 2986
WELL CONTRACTOR:
L. Martin Shaver
Well Contractor (Individual) Name
American Environmental Drilling, inc.
Well Contractor Company Name
STREET ADDRESS 324 Fields Drive, Suite C
Aberdeen
NC
28315
City or Town State Zip Code
( 910 )- 944-3140
Area code- Phone number
2. WELL INFORMATION:
SITE WELL # (if applicable)
IW-41
STATE WELL PERMIT# (if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection
Irrigation ❑ Other ❑ (list use)
►mot
DATE DRILLED 10-27-2011
TIME COMPLETED 4:47 AM ❑ PM
3. WELL LOCATION:
CITY: Jacksonville
COUNTY Onsiow
Route 24
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
►;< Slope ❑Valley ['Flat ❑Ridge DOther
(check appropriate box)
LATITUDE 34° 44.470
LONGITUDE 077° 22.309
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ®GPS ❑ Topographic map (location of
well must be shown on a USGS topo map and attached to this form
if not using GPS)
4. FACILITY- is the name of the business where the well is located.
C,1"6a4)
FACILITY ID # (if applicable)
NAME OF FACILITY MCB Camp Lejuene
STREET ADDRESS Route 24
Jacksonville
NC 28547
City or Town State
CONTACT PERSON Jeffrey Enos
Zip Code
MAILING ADDRESS 1005 Michael Road
Camp Lejuene
NC 28547
City or Town
( 910 )- 451-4318
Area code - Phone number
5. WELL DETAILS:
a_ TOTAL DEPTH: 35'
State
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
c. WATER LEVEL Below Top of Casing: 7.5 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 0 FT. Above Land Surface
'Top of casing terminated atlor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm) METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From 7' To 35' From To
From To From To
From To From To
6. CASING:
Depth Diameter Thickness/ Material
Weight
From 0' To20' Ft. 2" SCH80 PVC
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 12.9 To 0 Ft. Grout Tremie
From 17.7 To 12.9 Ft. Pellets Pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 20' To35' Ft. 2 in. .020 in. PVC
From To Ft. in. in.
From To Ft in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 35' To 17.7 Ft. #3 Sand
From To Ft.
From- To Ft.
10. DRILLING LOG:
From To Formation Description
0' 1' Top Soil
1' 10' Tannish White Silty Sand
10' 18' Tannish White with Grey Silty
18' 27' White Fine Sands
27' 35' Whitish Grey Silty Fine Sands
REIcr?,DWR
;.4
. '-'-:` 2 2-
11. REMARKS:- ��,s _:, '....�
Water Quasi. '
:.�!�����glonaf
O eratin,Section
$5e
W1�r
. �` ' ion Regional Office
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
10-30-2011
SIGNATURE CERTiF D WELL CONTRACTOR DATE
L. Martin Shaver
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-lb
Rev. 7/05

REVISED
COP/
NON IRESLDENTIALWELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2986
1. WELL CONTRACTOR:
L. Martin Shaver
Well Contractor (Individual) Name
American Environmental Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 324 Fields Drive, Suite C
Aberdeen NC 28315
City or Town State Zip Code
( 910 )- 944-3140
Area code- Phone number
2. WELL INFORMATION:
SITE WELL # (if applicable) IW-42
STATE WELL PERMIT# (if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery D Injection ❑
Irrigation ❑ Other ❑ (list use)
DATE DRILLED 11-1-2011
TIME COMPLETED 10:45 AM r PM ❑
3. WELL LOCATION:
CITY: Jacksonville
COUNTY Onslow
Route 24
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
Slope ❑Valley ❑Flat ❑Ridge :Other
(check appropriate box)
LATITUDE 34° 44.476
LONGITUDE 077° 22.300
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ®CGS ❑ Topographic map (location of
well must be shown on a USGS topo map and attached to this form
if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID # (if applicable)
NAME OF FACILITY MCB Camp Lejuene
C �3os�t)
STREET ADDRESS Route 24
Jacksonville
NC 28547
City or Town State
CONTACT PERSON Jeffrey Enos
Zip Code
MAILING ADDRESS 1005 Michael Road
Camp Lejuene
NC 28547
City or Town State Zip Code
( 910 )- 451-4318
Area code - Phone number
5. WELL DETAILS:
a_ TOTAL DEPTH: 35'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: 6.7 FT.
(Use "+" if Above Top of Casing)
_4
d. TOP OF CASING IS 0 FT. Above Land Surface
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm) METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From 7' To 35' From To
From To From To
From To From To
6. CASING:
Diameter Thickness/ Material
Weight
From 0' To20' Ft. 2" SCH80 PVC
Depth
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 12.5 To0 Ft. Grout Tremie
From 17.8 To 12.5 Ft. Pellets Pour
From To
Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 20' To 35' Ft. 2 in. .020 in. PVC
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 35' To 17.8 Ft. #3 Sand
From To Ft.
From To Ft.
10. DRILLING LOG:
From To Formation Description
0' 1' Top Soil
1'
10' Tannish White Silty Sand
10' 18' Tannish White with Grey Silty
18' 27' White Fine Sands
27' 35' Whitish Grey Silty Fine Sands
11. REMARKS
RECEIVFD/NCDENRJD'
MAY 2 2 2017
_•
veil
r
Water Quality Regional
Operations Section
ilmington Regional Office
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE
11-3-2011
CER D WELL CONTRACTOR DATE
L. Martin Shaver
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-1 b
Rev. 7/05

REVISED
]\TQJ\T RWELL.CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2986
1. WELL CONTRACTOR:
L. Martin Shaver
Well Contractor (Individual) Name
American Environmental Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 324 Fields Drive, Suite C
Aberdeen NC 28315
City or Town State Zip Code
( 910 )- 944-3140
Area code- Phone number
2. WELL INFORMATION:
SITE WELL # (if applicable) IW-43
STATE WELL PERMIT# (if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection
Irrigation ❑ Other ❑ (list use)
if
DATE DRILLED 10-18-2011
TIME COMPLETED 9:38 AM PM 0
3. WELL LOCATION:
CITY: Jacksonville
COUNTY Onslow
Route 24
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
Slope ❑Valley ❑Flat :Midge DOther
(check appropriate box)
LATITUDE 34° 44.464
LONGITUDE 077° 22.312
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: GPS ❑ Topographic map (location of
well must be shown on a USGS topo map and attached to this form
if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID # (if applicable)
NAME OF FACILITY MCB Camp Lejuene
STREET ADDRESS Route 24
Jacksonville
NC 28547
City or Town
State Zip Code
CONTACT PERSON Jeffrey Enos
MAILING ADDRESS 1005 Michael Road
Camp Lejuene
NC 28547
City or Town State Zip Code
( 910 )- 451-4318
Area code - Phone number
5. WELL DETAILS:
a_ TOTAL DEPTH: 35'
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO
c. WATER LEVEL Below Top of Casing: 5.50 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 0 FT. Above Land Surface
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm) METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From 7' To 35' From To
From To From To
From To From To
6. CASING:
Depth Diameter Thickness/ Material
Weight
From 0' To20' Ft. 2" . SCH80 PVC
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 13.2 To 0 Ft. Grout Tremie
From 17.10 To 13.2 Ft. Pellets Pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 20' To35' Ft. 2 in. .020 in. PVC
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 35' To 17.10 Ft. #3 Sand
From To Ft.
From To Ft.
10. DRILLING LOG:
From To Formation Description
0' 1' Top Soil
1' 10' Tannish White Silty Sand
10' 18' Tannish White with Grey Silty
18' 27' White Fine Sands
27' 35' Whitish Grey Silty Fine Sands
---R-EGEWED/NODENinwr7tt,
._..,.. :.
. ,.... . -
'1_
MAY222017 c,, .J -, ►•\
\-,:yr3 - '-' -
11. REMARKS Water Quality Regional = ...
Operatjons Section :.
Wilmington <1egionai Office
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
10-30-2011
SIGNATURE CER D WELL CONTRACTOR DATE
L. Martin Shaver
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-1 b
Rev. 7/05

REVISED Lci'/
.� '1 RESJDENTJAL WELL CONSTRUCTION ECOR
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2986
1. WELL CONTRACTOR:
L. Martin Shaver
Well Contractor (Individual) Name
American Environmental Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 324 Fields Drive, Suite C
Aberdeen NC 28315
City or Town State Zip Code
( 910 )- 944-3140
Area code- Phone number
2. WELL INFORMATION:
SITE WELL # (if applicable)
IW-44
STATE WELL PERMIT# (if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection
Irrigation ❑ Other ❑ (list use)
DATE DRILLED 10-25-2011
TIME COMPLETED 11:45 AM PM ❑
3. WELL LOCATION:
CITY: Jacksonville COUNTY Onslow
Route 24
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
®Slope ❑Valley ['Flat ❑Ridge DOther
(check appropriate box)
LATITUDE 34° 44.472
LONGITUDE 077° 22.303
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: GPS ❑ Topographic map (location of
well must be shown on a USGS topo map and attached to this form
if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID # (if applicable)
NAME OF FACILITY MCB Camp Lejuene
rsIng,)
it
STREET ADDRESS Route 24
Jacksonville
NC 28547
City or Town State
CONTACT PERSON Jeffrey Enos
Zip Code
MAILING ADDRESS 1005 Michael Road
Camp Lejuene
NC 28547
City or Town State Zip Code
( 910 )--451-4318
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 35'
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO ED
c. WATER LEVEL Below Top of Casing: 6.08 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 0 FT. Above Land Surface
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm) METHOD OF TEST
t. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From 7' To 35' From To
From To From To
From To From To
6. CASING:
Depth Diameter Thickness/ Material
Weight
From 0' To20' Ft. 2" SCH80 PVC
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 12.7 To 0 Ft. Grout Tremie
From 17.10 To 12.7 Ft. Pellets Pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 20' To35' Ft. 2 in. .020 in. PVC
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 35' To 17.10 Ft. #3 Sand
From To Ft.
From To Ft.
10. DRILLING LOG:
From To Formation Description
0' 1' Top Soil
1' 10' Tannish White Silty Sand
10' 18' Tannish White with Grey Silty
18' 27' White Fine Sands
27' 35' Whitish Grey Silty Fine Sands
•
RECEIVED/NENR/DW
,:-5
..: .:
MAY11. REMARKS ,, , r' 2.017-.
Water Quality Regional
Operations Section
Wilm i�u
I DO HEREBY CERTIFY THAT THIS WELL WAS CON ItUlAi�Illce WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
10-30-2011
SIGNATURE CER D WELL CONTRACTOR DATE
L. Martin Shaver .
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-1 b
Rev. 7/05

REVISED
NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2986
1. WELL CONTRACTOR:
L. Martin Shaver
Well Contractor (individual) Name
American Environmental Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 324 Fields Drive, Suite C
Aberdeen NC 28315
City or Town State Zip Code
( 910 )- 944-3140
Area code- Phone number
2 WELL INFORMATION:
SITE WELL # (if applicable) IW-45
STATE WELL PERMIT# (if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring 0 Municipal/Public 0
Industrial/Commercial 0 Agricultural ❑ Recovery 0 Injection
Irrigation 0 Other 0 (list use)
DATE DRILLED 11-1-2011
TIME COMPLETED 2:38 AM 0 PM Eg
3. WELL LOCATION:
CITY: Jacksonville COUNTY Onslow
Route 24
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
►� Slope ❑Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 34° 44.463
LONGITUDE 077° 22.301
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ®GPS 0 Topographic map (location of
well must be shown on a USGS topo map and attached to this form
if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID # (if applicable)
NAME OF FACILITY MCB Camp Lejuene
STREET ADDRESS Route 24
Jacksonville
NC 28547
City or Town
State Zip Code
CONTACT PERSON Jeffrey Enos
MAILING ADDRESS 1005 Michael Road
Camp Lejuene
NC . 28547
City or Town State Zip Code
( 910 )- 451-4318
Area code - Phone number
5. WELL DETAILS:
a_ TOTAL DEPTH: 35'
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO Eg
c. WATER LEVEL Below Top of Casing: 7.3 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 0 FT. Above Land Surface
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm) METHOD OF TEST
I. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From 7' To 35' From To
From To From To
From To From To
6. CASING:
Depth Diameter Thickness/ Material
Weight
From 0' To20' Ft. 2" SCH80 PVC
From To Ft. .
From To Ft.
7. GROUT: Depth Material Method
From 12.7 To 0 Ft. Grout Tremie
From 17.9 To 12.7 Ft. Pellets Pour
From To Ft.
8, SCREEN: Depth Diameter Slot Size Material
From 20' To 35' Ft. 2 in. .020 in. PVC
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 35' To 17.9 Ft. #3 Sand
From To Ft.
From To Ft.
10. DRILLING LOG:
From To Formation Description
0' 1' Top Soil
1' 10' Tannish White Silty Sand
10' 18' Tannish White with Grey Silty
18' 27' White Fine Sands
27' 35' Whitish Grey Silty Fine Sands
RECEIVFD/NCEWNR/DWR
,,_ , , ,. . . ,.,
. , ,
,.: ,,
MAY 2ZO?'
11. REMARKS Water Quality Regiora"l`
Operations Section
Wilmington Regiurlal 0(i!Le
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
11-3-2011
SIGNATURE CER D WELL CONTRACTOR DATE
L. Martin Shaver
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-1 b
Rev. 7/05

‘c)
NO RRSiDEiVTJAL WELL CON T U,ION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
REVISED
WELL CONTRACTOR CERTIFICATION # 2986
1. WELL CONTRACTOR:
L. Martin Shaver
Well Contractor (Individual) Name
American Environmental Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 324 Fields Drive, Suite C
Aberdeen NC 28315
City or Town State Zip Code
( 910 )- 944-3140
Area code- Phone number
2. WELL INFORMATION:
SITE WELL # (if applicable)
IW-46
STATE WELL PERMIT# (if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring ❑ Municipal/Public ❑
industrial/Commercial 0 Agricultural ❑ Recovery ] Injection Eg
Irrigation ❑ Other C1 (list use)
DATE DRILLED 11-1-2011
TIME COMPLETED 12:01 AM ❑ PM
3. WELL LOCATION:
CITY: Jacksonville COUNTY Onslow
Route 24
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope ❑Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 34° 44.467
LONGITUDE 077° 22.305
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ®GPS 0 Topographic map (location of
well must be shown on a USGS topo map and attached to this form
if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID # (if applicable)
NAME OF FACILITY MCB Camp Lejuene
STREET ADDRESS Route 24
C330s(4)
Jacksonville NC
28547
City or Town State
CONTACT PERSON Jeffrey Enos
Zip Code
MAILING ADDRESS 1005 Michael Road
Camp Lejuene
NC 28547
City or Town State Zip Code
( 910 )- 451-4318
Area code - Phone number
5. WELL DETAILS:
a_ TOTAL DEPTH: 35'
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
c. WATER LEVEL Below Top of Casing: 6.8 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 0 FT. Above Land Surface
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm) METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From 7' To 35' From To
From To From To
From To From To
6. CASING:
Depth Diameter Thickness/ Material
Weight
From 0' To20' Ft. 2" . SCH80 PVC
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 12.7 To0 Ft. Grout Tremie
From 18.3 To 12.7 Ft. Pellets Pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 20' To 35' Ft. 2 in. .020 in. PVC
From To Ft. in. in.
From To Ft in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 35' To 18.3 Ft. #3 Sand
From To Ft.
From To Ft
10. DRILLING LOG:
From To Formation Description
0' 1' Top Soil
1' 10' Tannish White Silty Sand
10' 18' Tannish White with Grey Silty
18' 27' White Fine Sands
27' 35' Whitish Grey Silty Fine Sands
RECEIVED/NCDENR/DWR
�� I
,_.,-
Mi 222017.t_ ��.r,
11. REMARKS
Water Quality •�
Regla����i
Operations
Wilmington � Section
on Regional
Office
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
11-3-2011
SIGNATURE CERTTF D WELL CONTRACTOR DATE
L. Martin Shaver
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-1 b
Rev. 7/05

REVISED C60'1
_NON RESIDENTIAL WELL CONSTkUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of W1later duality
WELL CONTRACTOR CERTIFICATION # 2986
1. WELL CONTRACTOR:
L. Martin Shaver
Well Contractor (individual) Name
American Environmental Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 324 Fields Drive, Suite C
Aberdeen NC 28315
City or Town State Zip Code
( 910 )- 944-3140
Area code- Phone number
2. WELL INFORMATION:
SITE WELL # (if applicable)
IW-47
STATE WELL PERMIT# (if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring ❑ Municipal/Public 0
Industrial/Commercial 0 Agricultural ❑ Recovery 0 Injection El
Irrigation 0 Other ❑ (list use)
DATE DRILLED 10-25-2011
TIME COMPLETED 3:55 AM ❑ PM 10
3. WELL LOCATION:
CITY: Jacksonville COUNTY Onslow
Route 24
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
Slope ❑Valley ❑Flat ❑Ridge ['Other
(check appropriate box)
LATITUDE 34° 44.468
LONGITUDE 077° 22.311
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ®GPS ❑ Topographic map (location of
well must be shown on a USGS topo map and attached to this form
if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID # (if applicable)
NAME OF FACILITY MCB Camp Lejuene
'b3(3g4
STREET ADDRESS Route 24
Jacksonville
NC 28547
City or Town
State Zip Code
CONTACT PERSON Jeffrey Enos
MAILING ADDRESS 1005 Michael Road
Camp Lejuene
NC 28547
City or Town State Zip Code
( 910 )- 451-4318
Area code - Phone number
5. WELL DETAILS:
a_ TOTAL DEPTH: 35'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IZ
c. WATER LEVEL Below Top of Casing: 6.8 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 0 FT. Above Land Surface
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm) METHOD OF TEST
f DISINFECTION: Type Amount
g. WATER ZONES (depth):
From 7' To 35' From To
From To From To
From To From To
6. CASING:
Depth Diameter Thickness/ Material
Weight
From 0' To 20' Ft. 2" SCH80 PVC
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 12.6 To 0 Ft. Grout Tremie
From 17.4 To12.6 Ft. Pellets Pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 20' To 35' Ft. 2 in. .020 in. PVC
From To Ft. in. in. ,
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 35' To 17.4 Ft. #3 Sand
From To Ft.
From To Ft.
10. DRILLING LOG:
From To Formation Description
0' 1' Top Soil
1' 10' Tannish White Silty Sand
10' 18' Tannish White with Grey Silty
18' 27' White Fine Sands
27' 35' Whitish Grey Silty Fine Sands
RECEIVED/NCDENR/DWR .
:
._,, . , ,,
,4\ i
., , •
M2217
11. REMARKS
Water cau14., Regional
Operations Section
Wilmington Regional Office
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
10-30-2011
SIGNATURE CERT(I= 'D WELL CONTRACTOR DATE
L. Martin Shaver
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-1 b
Rev. 7/05

REVISED(,001
IVO\r RESJDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2986
. WELL CONTRACTOR:
L. Martin Shaver
Wet Contractor (Individual) Name
American Environmental Drilling, Inc.
Well Contractor Company Name
STREET .ADDRESS 324 Fields Drive, Suite C
Aberdeen NC 28315
City or Town State Zip Code
( 910 )- 944-3140
Area code- Phone number
2. WELL INFORMATION:
SITE WELL # (if applicable) IW-48
STATE WELL PERMIT# (if applicable)
DWG) or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring 0 Municipal/Public 0
Industrial/Commercial 0 Agricultural 0 Recovery ❑ Injection 1l
Irrigation ❑ Other ❑ (list use)
DATE DRILLED 10-26-2011
TIME COMPLETED 9:25 AM PM 0
3. WELL LOCATION:
CITY: Jacksonville
COUNTY Onsiow
Route 24
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
Slope ❑Valley ❑Flat [Midge ❑Other
(check appropriate box)
LATITUDE 34° 44.465
LONGITUDE 077° 22.307
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: GPS ❑ Topographic map (location of
well must be shown on a USGS topo map and attached to this form
if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID # (if applicable)
NAME OF FACILITY MCB Camp Lejuene
STREET ADDRESS Route 24
Jacksonville
NC 28547
City or Town
State Zip Code
CONTACT PERSON Jeffrey Enos
MAILING ADDRESS 1005 Michael Road
Camp Lejuene
NC 28547
City or Town
( 910 )- 451-4318
Area code - Phone number
5. WELL DETAILS:
a_ TOTAL DEPTH: 35'
State
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO
c. WATER LEVEL Below Top of Casing: 6.8 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 0 FT. Above Land Surface
*Top of casing terminated atior below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm) METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth): 1
From 7' To 35' From To
From To From To
From To From To
6. CASING:
Depth Diameter Thickness/ Material
Weight
From 0' To 20' Ft. 2" • SCH80 PVC
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 12.8 To 0 Ft. Grout Tremie
From 17.9 To 12.8 Ft. Pellets Pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 20' To35' Ft. 2 in. .020 in. PVC
From To Ft. in. in. ,
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 35' To 17.9 Ft. #3 Sand
From To Ft.
From To Ft.
10. DRILLING LOG:
From To Formation Description
0' 1' Top Soil
1' 10' Tannish White Silty Sand
10' 18' Tannish White with Grey Silty
18' 27' White Fine Sands
27' 35' Whitish Grey Silty Fine Sands
RECEIVED/NCDE1R/owR
, .
MAY'r-- 2017,.
11. REMARKS Wate Quality Regional
Operations Section
Wilmington Regional Office
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
/La 10-30-2011
SIGNATURE : CER D WELL CONTRACTOR DATE
L. Martin Shaver
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-lb
Rev_ 7/05

REVI SED
G°
NON RESIDENTIAL WELL CON S TUC ION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
t�
WELL CONTRACTOR CERTIFICATION # 2986
1. WELL CONTRACTOR:
L. Martin Shaver
Well Contractor (Individual) Name
American Environmental Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 324 Fields Drive, Suite C
Aberdeen NC 28315
City or Town State Zip Code
( 910 )- 944-3140
Area code- Phone number
2. WELL INFORMATION:
SITE WELL # (if applicable) 1W-49
STATE WELL PERMIT# (if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection
Irrigation ❑ Other ❑ (list use)
DATE DRILLED 11-2-2011
TIME COMPLETED 11:20 AM ❑C PM ❑
3. WELL LOCATION:
CITY: Jacksonville COUNTY Onslow
Route 24
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
Slope ❑Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 34° 44.464
LONGITUDE 077° 22.307
)t
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ®GPS ❑ Topographic snap (location of
well must be shown on a USGS topo map and attached to this form
if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID # (if applicable)
NAME OF FACILITY MCB Camp Lejuene
C31O 1)
STREET ADDRESS Route 24
Jacksonville
NC 28547
City or Town State
CONTACT PERSON Jeffrey Enos
Zip Code
MAILING ADDRESS 1005 Michael Road
Camp Lejuene
NC 28547
City or Town State Zip Code
( 910 )- 451-4318
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 35'
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO
c. WATER LEVEL Below Top of Casing: 7.35 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 0 FT. Above Land Surface
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm) METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From 7' To 35' From To
From To From To
From To From To
6. CASING:
Depth Diameter Thickness/ Ailaterial
Weight
From 0' To20' Ft. 2" SCH80 PVC
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 12.6 To0 Ft. Grout Tremie
From 17.9 To 12.6 Ft. Pellets Pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 20' To 35' Ft. 2 in. .020 in. PVC
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 35' To 17.9 Ft. #3 Sand
From To Ft.
From To Ft.
10. DRILLING LOG:
From To Formation Description
0' 1' Top Soil
1' 10' Tannish White Silty Sand
10' 18' Tannish White with Grey Silty
18' 27' White Fine Sands ,,._:_::Y.:.
27' 35' Whitish Grey Silty Fine Sands.,.
•
MAY 2 2 217 :
7",
11. REMARKS Water Quality Regional
Operations Section
Wiimington Regional Office
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
IMP / + 11-3-2011
SIGNATURE : GER D WELL CONTRACTOR DATE
L. Martin Shaver
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW 1 b
Rev. 7/05
800

CO
NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2986
1. WELL CONTRACTOR:
L. Martin Shaver
Well Contractor (Individual) Name
American Environmental Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 324 Fields Drive, Suite C
Aberdeen NC 28315
City or Town State Zip Code
( 910 )- 944-3140
Area code- Phone number
2. WELL INFORMATION:
SITE WELL # (if applicable)
1W-50
STATE WELL PERMIT# (if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection El
Irrigation 0 Other ❑ (list use)
DATE DRILLED 10-26-2011
TIME COMPLETED 11:25 AM ►5 PM ❑
3. WELL LOCATION:
CITY: Jacksonville
COUNTY Onslow
Route 24
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
Slope ❑Valley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 34° 44.458
LONGITUDE 077° 22.309
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ►Zs GPS ❑ Topographic map (location of
well must be shown on a USGS topo map and attached to this form
if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID # (if applicable)
NAME OF FACILITY MCB Camp Lejuene
STREET ADDRESS Route 24
Jacksonville
NC 28547
City or Town State
CONTACT PERSON Jeffrey Enos
Zip Code
MAILING ADDRESS 1005 Michael Road
Camp Lejuene
NC 28547
City or Town
910 )- 451-4318
Area code - Phone number
5. WELL DETAILS:
a_ TOTAL DEPTH: 35'
State
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
c. WATER LEVEL Below Top of Casing: 6.55 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 0 FT. Above Land Surface
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm) METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From 7' To 35' From To
From To From To
From To From To
6. CASING:
Depth Diameter Thickness/ Material
Weight
From 0' To 20' Ft. 2" . SCH80 PVC
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 12.3 To() Ft. Grout Tremie
From 17.9 To 12.3 Ft. Pellets Pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 20' To 35' Ft. 2 in. .020 in. PVC
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 35' To 17.9 Ft. #3 Sand
From To Ft.
From To Ft.
10. DRILLING LOG:
From To Formation Description
0' 1' Top Soil
1' 10' Tannish White Silty Sand
10' 18' Tannish White with Grey Silty
18' 27' White Fine Sands
27' 35' Whitish Grey Silty Fine Sands
,o,
MAY 22Dtr; '--
-,.- ...,.,
.,.,_ ,,s..t., - .
11. REMARKS Water QUa-1,ity Regional •
Operations Section
Wilmington RPgionai Office
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH.
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
10-30-2011
SIGNATURE CER D WELL CONTRACTOR DATE
L. Martin Shaver
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-1 b
Rev. 7/05

REVISED
cse)
NON RESIDENTIAL WELL CONSTRUCT ON RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2986
. WELL CONTRACTOR:
L. Martin Shaver
Well Contractor (Individual) Name
American Environmental Drilling, Inc.
Well Contractor Company Name
STREET ADDRESS 324 Fields Drive, Suite C
Aberdeen NC 28315
City or Town State Zip Code
( 910 )- 944-3140
Area code- Phone number
2. WELL INFORMATION:
SITE WELL # (if applicable)
IW-51
STATE WELL PERMIT# (if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection El
Irrigation ❑ Other ❑ (list use)
DATE DRILLED 11-1-2011
TIME COMPLETED 3:57 AM ❑ PM ►<
3. WELL LOCATION:
CITY: Jacksonville COUNTY Onslow
Route 24
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
EISlope ❑Valley ['Flat ❑Ridge DOther
(check appropriate box)
LATITUDE 34° 44.462
LONGITUDE 077° 22.306
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ®GPS 0 Topographic map (location of
well must be shown on a USGS topo map and attached to this form
if not using GPS)
4. FACILITY- is the name of the business where the well is located.
FACILITY ID # (if applicable)
NAME OF FACILITY MCB Camp Lejuene
STREET ADDRESS Route 24
Jacksonville
NC 28547
City or Town State
CONTACT PERSON Jeffrey Enos
Zip Code
MAILING ADDRESS 1005 Michael Road
Camp Lejuene
NC 28547
City or Town
( 910 )- 451-4318
Area code - Phone number
5. WELL DETAILS:
a_ TOTAL DEPTH: 35'
State
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: 6.65 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 0 FT. Above Land Surface
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm) METHOD OF TEST
f DISINFECTION: Type Amount
g. WATER ZONES (depth):
From 7' To 35' From To
From To From To
From To From To
6. CASING:
Depth Diameter Thickness/ Material
Weight
From 0' To20' Ft. 2" . SCH80 PVC
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 12.9 To() Ft. Grout Tremie
From 17.8 To 12.9 Ft. Pellets Pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 20' To 35' Ft. 2 in. .020 in. PVC
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From 35' To 17.8 Ft. #3 Sand
From To Ft.
From To Ft.
10. DRILLING LOG:
From To Formation Description
0' 1' Top Soil
1' 10' Tannish White Silty Sand
10' 18' Tannish White with Grey Silty
18' 27' White Fine Sands
27' 35' Whitish Grey Silty Fine Sands
i,. 1
,�- i T r rr : -
22U.17 ��. k; .-
Water Quality
11. REMARKS �4gI,OJ��I .
�.
Operatiols� �Sebtion : ••
Wilmington Regional Mice
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
��14�_ 11-3-2011
SIGNATURE CER D WELL CONTRACTOR DATE
L. Martin Shaver
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-1 b
Rev. 7/05