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REVISED
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N N 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-52
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 0 (list use)
DATE DRILLED 11-2-2011
TIME COMPLETED 3:30 AM ❑ PM
3. WELL LOCATION:
CITY: Jacksonville
COUNTY Onslow
Route 24
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
►ZtSlope ❑Valley ❑Flat ❑Ridge DOther
(check appropriate box)
LATITUDE 34° 44.464
LONGITUDE 077° 22.297
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
330st6
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 El
c. WATER LEVEL Below Top of Casing: 8.5 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 12.6 Too Ft. Grout Tremie
From 17.8 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 17.8 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
l i
MAY
20
K ,
11. REMARKS Water Quality i eg anal
Operations Section
' Wiitirgton '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 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 GN 1 b
Rev. 7/05

REVISED COP \,/
NON RES[DENTJAL -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-53
STATE WELL PERMIT# (if applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ►4
Irrigation ❑ Other ❑ (list use)
DATE DRILLED 10-26-2011
TIME COMPLETED 4:25 AM ❑ PM
3. WELL LOCATION:
CITY: Jacksonville
COUNTY Onslow
Route 24
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
►Zt Slope ❑Valley ❑Flat ❑Ridge DOther
(check appropriate box)
LATITUDE 34° 44.458
LONGITUDE 077° 22.310
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ►t 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 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 IZ
c. WATER LEVEL Below Top of Casing: 6.4 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)
. DISINFECTION: Type
g. WATER ZONES (depth):
From 7'
From
From
To 35'
To
To
6. CASING:
From 0'
From
From
METHOD OF TEST
Depth
From
From
From
Amount
To
To
To
Diameter Thickness/ Material
Weight
To 20' Ft. 2" . SCH80 PVC
To Ft.
To Ft.
7. GROUT: Depth
From 12.4 To()
Material
Ft. Grout
From 17.9 To 12.4 Ft. Pellets
From To 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
10. DRILLING LOG:
From To
0'
1'
To
To
1'
Size
Ft. #3
Ft.
Ft.
Material
Sand
Formation Description
Top Soil
10' Tannish White Silty Sand
10'
18' Tannish White with Grey Silty
18' 27' White Fine Sands
27'
35'
11. REMARKS
Whitish Grey Silty Fine Sands
RtCH1ED/NCDENR/DWR
Water Quality Regional
Operations Section
iimington 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
SIGNATUREfCEWELL 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
AIO]\T _f?ESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2986
�.NELL 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-54
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 5:25 AM ❑ 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 :Walley ['Fiat [Midge DOther
(check appropriate box)
LATITUDE 34° 44.454
LONGITUDE 077° 22.304
>r�4
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 33os(-0
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
( 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 ❑ NO
c. WATER LEVEL Below Top of Casing: 6.7 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
From
To
To
6. CASING:
From
From
From
To
To
To
Depth Diameter
From 0' To 20' Ft. 2"
From To Ft.
From To Ft.
7. GROUT: Depth Material
From 12.3 To() Ft. Grout
Thickness/ material
Weight
SCH80 PVC
From 17.8 To 12.3 Ft. Pellets
From To Ft.
Method
Tremie
Pour
8. SCREEN: Depth Diameter Slot Size Material
From 20' To35' Ft. 2 in. .020 in PVC
From To Ft.
From To Ft.
9. SAND/GRAVEL PACK:
Depth Size
From 35' To 17.8 Ft. #3
From To Ft.
in. in
in. in.
From To Ft.
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
11.,REMARKS
M14Y42NlI�7
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.
11-3-2011
SIGNATURES CERTIF4D WELL CONTRACTOR
L. Martin Shaver
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-lb
Rev. 7/05

RFIVISED COP
NCI\/ 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)
MW-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
Irrigation ❑ Other ❑ (list use)
DATE DRILLED 11-2-2011
TIME COMPLETED 9:35 AM jt 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 :Midge ❑Other
(check appropriate box)
LATITUDE 34° 44.465
LONGITUDE 077° 22.305
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ►2 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 nos4)
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 EI
c. WATER LEVEL Below Top of Casing: 9.6 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 15' From To
From To From To
From To From To
8. CASING:
Depth Diameter Thickness/ Material
Weight
From 0' To 5' Ft. 2" . SCH40 PVC
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 1' To 0 Ft. Grout Pour
From 3' To 1' Ft. Pellets Pour
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From 15' To 5' Ft. 2 in. .010 in. PVC
From To Ft. in. in.
From To Ft. in. in. '
9. SAND/GRAVEL PACK:
Depth Size Material
From 15' To 3' Ft. #1 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' 15' Tannish White with Grey Silty
•
V
MAY22. ?U1/
.
rf�l
oa rl 1�
c;S: \t) -
Wdter uaiity i-regional. '••;
Operations _... ...��...
11. REMARKSSe.CtiOf1`,' : ..
Wiimingt irRegibiie Of to.�
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-lb
Rev. 7/05
g

REVISED coeY
NON 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)
MW-52
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 3:35 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° 22.312
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: E1GPS ❑ 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) 3 3 .)
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: 30'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: 7.65 FT.
(Use "+" if Above Top of Casing) .
d. TOP OF CASING IS 0
*Top of casing terminated
a variance in accordance
e. YIELD (gpm)
[. 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'
From
To 30'
To
From To
6. CASING:
From 0'
From
From
Depth
To 20'
To
To
7. GROUT: Depth
From 14.6 To()
From 18' To14.6
From
From
From
To
To
To
Diameter Thickness/ Material
Weight
Ft. 2" SCH40 PVC
Ft.
Ft.
Material
Ft. Grout
Method
Tremie
Ft. Pellets Pour
From To Ft.
8. SCREEN:
From 20'
From
Depth
To 30'
To
From To
9. SAND/GRAVEL PACK:
Depth
From 30' To 18'
From To
From To
10. DRILLING LOG:
From To
0' 1'
1' 10'
10' 18'
18' 27'
27' 30'
11. REMARKS
Diameter Slot Size Material
Ft. 2 in. .010 in. PVC
Ft. in. in.
Ft. in. in.
Size
Ft. #1
Ft.
Ft.
Material
Sand
Formation Description
Top Soil
Tannish White Silty Sand
Tannish White with Grey Silty
White Fine Sands
Whitish Grey Silty Fine Sands
•
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.
D WELL CONTRACTOR
L. Martin Shaver
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
11-12-2011
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

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
For Internal Use ONLY:
1. Well Contract Information:
got &5 /C1
Well Contractor Name
/6/023
NC Well Contractor Certification Number
Company Name
2. Well Construction Permit #:
List all applicable well permits (i.e. County, Stale, Variance, Injection, etc)
3. Well Use (check well use):
Water Supply Well:
DAgricultural
❑Geothermal (Heating/Cooling Supply)
Dlndustrial/Commercial
❑Irrigation
OMunicipal/Public
DResidential Water Supply (single)
DResidential Water Supply (shared)
Non Water Supply Well:
DMonitoring
Injection Well:
OAquifer Recharge
DAquifer Storage and Recovery
['Aquifer Test
['Experimental Technology
❑Geothermal (Closed Loop)
DGeothermal (Heating/Cooling Return)
Aikl*:overy
DGroundwater Remediation
DSalinity Barrier
❑Stormwater Drainage
['Subsidence Control
❑Tracer
['Other (explain under #21 Remarks).
4. Date Well(s) Completed: be, �� veil ID#, �� K
5a. Well Location:
Facility/Owner Name
Facility ID# (if applicable)
PhAddres, City, and Zip
ks1o1AJ")
County
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one !at/long is sufficient)
N w
6. Is (are) the well(s): ermanent or DTemporary
7. Is this a repair to an existing well: ❑Yes or W o
If this is a repair, fill out known well construction information an lain the nature o the
P .f P .f
repair under 121 remarks section or on the back of this form.
8. Number of wells constructed:
For multiple injection or non -water supply wells ONL with the same construction, you can
submit one form.
9. Total well depth below land surface:
For multiple wells list all depths if different (example-
5
700' and 2 a 100')
(ft)
10. Static water level below top of casing: (ft.)
If water level is above casing, use " }-"
11. Borehole diameter:
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc_)
e4,4r,
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
443302
14 WATER ZONES
FROM
TO
DESCRIPTION
ft
ft.
ft.
ft.
FROM
15. OUTER CASING (for multi -cased wells) OR LIPNER. (if applicable)
DIAMETER
TO
THICKNESS
MATERIAL
ft.
ft.
in.
16 INNER CASING OR TUBING. (geothermatclosetWoop);
FROM
0 ft.
ft.
TO
?ert•
ft
DIAMETER
in.
in.
THICKNESS
tz2
MA
17.-SCREEN
FROM
cg16-TE
ft.
TO
/A'
ft.
DIAMETER
in.
in.
SLOT SIZE
. OlD
THIC SS
MATERIAL
c.
IS, GROUT'
FROM
ft.
TO
fw
ft.
TERI L
,"
EMPLACEMENT METHOD & AMOUNT
ft
ft.
19.. SAND/GRAVEL PACK (if applicable)
FROM
TO
Q\13 fr.
ft
ft.
MATERIAL
At- C12- 5' CI
EM ' LACEMENT METHOD
208.;: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
Sce 60°4f9 04-5
ft.
ft.
*a r/ L� p 1��K1
M k
ft.
ft.
ft.
ft
APB 2 9 2'017
21` RE]
_ 1 No priatIon
1-
22. Certification:
Si use. i Certified Well Contract
V----42 5
Date
Ily signing this form, I hereby cert( 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 INSTUC
r.
VED/NCDENR/DWR
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
1AYO2O17. Division ofWater eour as normation Processin Unit, f
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells r: Qatigticling the form to the address in
24a above, also submit col ii 0 days of completion of well
construction to the follov nlington 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
1. Well Contractor Information:
Well Contractor Name
el12.2
NC Well Contractor Certification Number
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)
O Industrial/Commercial
❑Irrigation
Non Water Supply Well:
E1Monitoring
Injection Well:
❑ Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
D Geothermal (Closed Loop)
❑ Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed:
5a. Well Location:
❑Municipal/Public
OResidential Water Supply (single)
[Residential Water Supply (shared)
,AkITecovery
Facility/Owner Name
OGroundwater Remediation
❑ Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑ Tracer
DOther (explain under #21 Remarks)
ell ID# rims- ' 1:)(0.2,
Facility ID# (if applicable)
Physi Address, City, and Zip
katr.
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): (ermanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or NIrtNo
If this is a repair, fill out known well construction information an 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: (ft.)
For multiple wells list all depths if different (example- 3@20D' and 2@100')
10. Static water level below top of casing: (ft.)
If water level is above casing, use "+ "
11. Borehole diameter:
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
in.
tieL
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
FROM
For Internal Use ONLY:
,14330.i
14 WATER ZONES
FROM TO
ft.
ft
DESCRIPTION
ft
ft
kS 'OUTER CASING (form'
FROM TO
DIAMETER
cased wells) OR' LINER (if applicable)
DIAMETER THICKNESS
in.
NNER CASING .OR TUBING (geother mal closed -loop)
, , ft
TO 1 DIAMETER
in.
MATERIAL
THICKNESS
MATERIAL
t
ft.
I
SCREEN.
FROM
FROM
ft. ft.
GRO
FROM
TO
ej ft
ft
ft.
TO
ft.
ft ft.
DIAMETER
in.
in.
in.
SLOT SIZE
THICKNESS
ScA
�G
MATERIAL,
pee.,
-7
ft
ft.
ft.
MATERIAL EMP CEMENT METHOD & AMOUNT
l`
'SAND/GRAVEL`>PACK (if applicable)
FROM TO
ft.
ft.
5---ft.
ft.
MATERIAL
20.;DRILLING: LOG'(attach additional:sb
FROM
ft.
TO
ft.
EMPLACEMENT METHOD
Jektro
ts if necessary)
DESCRIPTION (color, hardness, soilirock type, grain size, etc.)
ft.
ft.
ft.
ft
ft
ft.
21.. REMARKS
ft
ft
ft.
ft.
ft.
ft.
D
R 8 2017
Pp1•04 ri . !
py�j�,; P t,.ji,g`.r ;lri3. r'
22. Certification:
Signature of Certified Well
ontractor
fY7
Date
By signing this form, I hereby certi y that the well(s) was (were) constructed in accordance
with I5A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this.page to provide additional well site details or well
construction details. You may also attach additional ages if necessary.
BREIVED/NCDENR/DWRSUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following: MAY 0 8 2017
Division of Water Resources, Information Processing Unit,
1617 Mail ServiceService.Center, Raleielh NC 27699-1617
water uuairty Regional
24b. For Injection Wells ONLY:OPelagiamstSeetidiag the form to the address in
24a above, also submit a coWiLmi
ngteniRegibileaMos of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636 g
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:
Well Contractor Name
ef.2023-
NC Well Contractor Certification Number
•
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
Olrrigation
Non -Water Supply Well:
❑✓Monitoring
Injection Well:
❑Aquifer Recharge
❑ Aquifer Storage and Recovery
DAquifer Test
❑Experimental Technology
❑ Geothermal (Closed Loop)
OGeothermal (Heating/Cooling Return)
For Internal Use ONLY:
443300
14. WATER ZONES
FROM
TO
DESCRIPTION
ft
ft.
FROM
ft.
ft.
15:.OUTER CASING (for multi -cased wells) OR LINER (if a p' licablej
FROM TO DIAMETER I THICKNESS
in.
6. INNER CASING OR TUBING
TO
nrAM (leathering p�,�, osed ;)
ft. I ft.
0 ft.
ft.
qc-ft
. SCREEN
ft.
in.
in.
MATERIAL
THICKNESS MATERIAL
Y. Pbk
DMunicipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Tecovery
❑Groundwater Remediation
❑Salinity Barrier
0 Stormwater Drainage
❑ Subsidence Control
OTracer
❑ Other (explain under #21 Remarks)
4. Date Well(s) Completed: //9-47-17Well.pe.69--(0.--FAvir
5a. Well Location:
Facility/Owner Name
Facility JD# (if applicable)
Phys . ddress City, and Zip
ti"%5 6UX
County
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
S. Number of wells constructed:
For multiple injection or non -water supply wells ONL ith the same construction, you can
submit one form.
N W
6. Is (are) the well(s): ermanent or ❑Temporary
7. Is this a repair to an existing well:. Oyes or o
If this is a repair, fill out known well construction information an explain the nature of the
repair under #21 remarks section or on the back of this form.
w
9. Total well depth below land surface:
For multiple wells list all depths if different (example- 3 200' and 2@100')
(ft.)
10. Static water level below top of casing: (ft.)
If water level is above casing, use "+"
11. Borehole diameter:
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
(in.
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
FROM TO DIAM TER
7c-ft. /75-Tt. in.
ft. ft. in.
/8, GROUT'
FROM
ft
ft.
SLOT SIZE
vex°
THI KNESS
c
MATERIAL
TO
., _
;7fft
:
ft.
M.4TERIA
EMPLACEMENT METHOD & AMOUNT
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
g3ft
ft.
TO MATERIAL
14 02 541
/15-ft-
ft.
EMP CEMENT METHOD
20. DRILLING 'LOG;(attach additional sheets if:necessary)
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
FROM
ft.
TO
ft.
ft
ft.
ft.
ft.
ft.
ft.
Gek, Ater(e,
ft.
ft.
(7.1L hick .7 N
ft.
ft.
ft.
ft.
APR g 2017
2L REMARKS
22. Certification:
Signature of Certified Well Contractor
ti-61,5----( 7
ate
By signing this form, I hereby certify that the wells) 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 INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of arklYskaliPnctilalotitrocessing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells 0 d 'ti i sending the form to the address in
24a above, also submit a copyof thi r�
within lim 30 days of com
pletion mpletion of well
construction to the following:
Division of Water ReWateisgWal i' 4ii4ction Control Program,
1636 Mail SerAZEtratifiii`'r k Ji' 1C 27699-1636
Wilmington Regional Office
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

Print Form
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Sanford Sweeting
Well Contractor Name
2082-A
NC Well Contractor Certification Number
Applied Resource Management, P.C.
Company Name
2. Well Construction Permit ##:
EHWP-2017-00007
List all applicable well construction permits (i.e. WC_ County. State, Variance. etc.)
3. Well Use (check well use):
Water Supply Well:
Agricultural Municipal/Public
Geothermal (Heating/Cooling Supply)-DResidential Water Supply (single)
Industrial/Commercial DResidential Water Supply (shared)
Irrigation
• Non -Water- Supply Well:
Monitoring Dgecovery
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed: 04/1 911
5a. Well Location:
DGroundwater Remediation
E3 Salinity Barrier
DStorrnwater Drainage
Subsidence Control
Tracer
Other (explain under#21 Remarks)
7 Well ID# NIA
Larry & Tammy Black N/A
Facility/Owner Name Facility ID# (if applicable)
360 Brothers Lane, Jacksonville, NC 28546
Physical Address, City, and Zip
Onslow 324-2.13
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one la/long is sufficient)
34 50 46.5613 � 77 27 1.0617
6. Is(are) the well(s)Permanent or OTemporary
7. Is this a repair to an existing well: LYes orNo
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..
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: 145 (ft.)
For multiple wells list all depths if different (example- 3@200' and 2 r)I00).
10. Static water level below top of casing: 14 (ft.)
I f water level is above casing, use "÷"
11. Borehole diameter: 8 (in.)
12. Well construction method: Mud Rotary
c
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 50 Method of test: Airlift
13b. Disinfection type: HTH Amount: 3% @ 10 Gallons
For Internal Use Only:
443275
14. WATER ZONES
FROM
TO
DESCRIPTION
100 ft'
145 ft-
Limestone
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER. (if applicable)
FROM
TO
DIAMETER ,
THICKNESS
MATERIAL
0 ft'
135 ft.
4 in.
SCH40
PVC
16. INNER
CASING OR. TUBING
(geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
M ATERLAL
ft.
ft.
in.
ft.
ft.
in.
17. SCREEN:
FROM
TO
DIAMETER
SLOT SIZE
' THICKNESS
MATERIAL
ft.
ft.
in.
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft;.
29 ft.
Bentonite
Poured
ft.
ft.
ft.
ft.
19. SAND/GRAVEL
PACK
(if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
ft.
ft.
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary) ,
FROM '
TO
DESCRIPTION (color, hardness, soiltrock type, grain size. etc.)
0 ft-
20 ft•
Sand some clay
20 ft.
105 ft°
Sandy silt
105 ft-
145 ft-
Limestone
ft.
ft.
rEcEv " ."'''
ft,
ft.
ft.
ft:.
PPR72O17
ft.
ft.
21. REMARKS `..,, ° OM:
t ' ill,, r t_,s . yi
3:5Krddrl-:-w
22. C ti
ignat ed Well Contractor
Date
By sr ning this form, I hereby certifr that the well(s) was /were,) constructed in accordance
with 15,4 N1C'AC 02C .0100 or 15A A'CAC.' 02C .0200 Well Construction Standards and that a
copy of this record has been provide -ell owner.
gOt23. Site diagram or additional wellto provide
You may use the back of thispage ad � ite details or well
construction details. You may also ch additional pages i `-` essary.
Y 1
SUBMITTAL INSTRUCTIONS ®.
24a. For All Wells: SubmW6r ' rm within 30 days of completion of well
construction to the follow10
� �per'at� � Re
mJ'n Qns S,on
Division of Water Res 4rkp fd n`'Processing Unit,
1617 Mail Service Center, Ali 27699-1617
'Ce
24b. For Infection 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:
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 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.
Foam GW-1
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

L01714,
Print Form
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Sanford Sweeting
Well Contractor Name
2082-A
NC Well Contractor Certification Number
Applied Resource Management, P.C.
Company Name
Per
mit
2. Weil Construction. Permit #:
EHWP-2O17-OOOO6
List all applicahie well construction permits (Le. WC, County. State. Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
Agricultural
4'
'Geothermal (Heating/Cooling Supply)
(Industrial./Commercial
lIrrigation
Non -Water Supply Well:
Monitoring
{Municipal/Public
lResidential Water Supply (single)
DResidential Water Supply (shared.)
D.Recovery
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
'Aquifer Test
Experimental Technology
IGeother11al (Closed Loop)
IGeothernal (Heating/Cooling Return)
+Groundwater Remediation
Salinity Barrier
DStorrnwater Drainage
'Subsidence Control
[2)Tracer
;Other (explain under#21 Remarks)
Well ID# N/A
4. Date Well(s) Completed: 011 /1
7
5a. Well Location:
Valerie Dukes
NIA
Facility/Owner Name 1DI (if applicable)
171 Holden Road, Holly Ridge, NC
Physical Address. City, and Zip
Onslow
735-40.33
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 28 32.9797 77 34 13.6765
6. Is(are) the well(s)Permanent or EtTemporary
7. Is this a repair to an existing well: OYes or EINo
If this is a repair. fill out k/101177 well construction infh1':nation and eArlcnn 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: 1 25
For multiple wells list all depths if different (example- i1V 200' and 22(.100')
(ft )
10. Static water level below top of casing: 1 (ft.)
If wafer 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 WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 100 Method of test: Airlift
13b. Disinfection type: HTH Amount: 3% @ 1 Gallons
For Internal Use Only:
443274
14. WATER ZONES
FROM
TO
DESCRIPTION
60 ft.
90 ft-
Sand
90 ft-
125 ft-
Limestone
15. OUTER. CASING (for multi -cased wells) OR LINER (ifap livable)
FROM
TO
DM -METER
THICKNESS
MATERIAL
0 ft.
60 ft.
6 in
SCH40
PVC
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DL4.METER
THICKNESS
MATERL1L
0 ft.
100 ft.
4 in•
SCH40
PVC
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS 1 MATERIAL
100 ft.
125 ft.
2 in
.020
SCH40
I PVC
ft.
ft.
in.
l
i
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD 43,. AMOUNT
ft.
60 ft.
Bentonite
Poured
ft.
ft.
ft.
ft.
19. SAND/GRAVE L PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT T METHOD
ft.
ft.
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRII'TION (color, hardness. soil/rock type. grain size, etc.)
0 i=t.
20 ft.
Sand some silt
20 ft.
60 ft'
Clay some fine sand
60 ft-
90 ft.
Sand
90 ft-
125 ft.
Limestone
ft.
ft.i
) L.7, . \ fiz,r-H,
ft.
ft.
APR 1,7 2017
21. REMARKS
4
Information P �r, 4.6.. 9 Unit
DVitalBf_k;
22. ert ation.
ft m!!"V
atuie ofCe.Well Contractor
v
Date
By siAning this form. 1 her eh. v c ertifi; that the well(s) was (were) constructed in aecordaince
with 1?.4 NC AC 02C .0100 or 15A N .4('.'- 02( .0200 Well (::'obstruction Standards and Thai a
copy of this record has been pr•or' o the well owner.
�� j I
23. Site diagram or additional we I WCD
you lnay use the back of this page to provide additional tive'll site details or well
construction details. You may a1s attach additional pages if necessary.
MA
SUBMITTAL INSTRUCTI � ® 1 INSTRUCTIONS • Z017
24a. For All Wells: SubnW its f rm within 30 days of completion of well
construction to the following: r Quality
• �Peratio Re •. al
ns Se .
Division of Wa i��f�ns �a '°r Processing Unit,
1617 Mail Service Center, ` aTel t 2 699-1617
24b. For Infection «'ells: 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:
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 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
This form can be used for single or multiple wells
1. Well Contractor Information:
Joshua Lemere
Well Contractor Name
4310-A
NC Well Contractor Certification Number
Coastal Geothermal
Company Name
2. Well Construction Permit #: W 10800479
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
❑Irrigation
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
❑Monitoring
❑Recovery
Injection Well:
0 Aquifer Recharge
OAquifer Storage and Recovery
❑Aquifer Test
0Experimental Technology
0 Geothermal (Closed Loop)
0 Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed: 4-17-17
5a. Well Location:
Mark Jackson
❑Groundwater Remediation
❑Salinity Barrier
❑ Stormwater Drainage
0 Subsidence Control
❑Tracer
❑Other (explain under #21 Remarks)
Well ID#
Facility/Owner Name Facility ID# (if applicable)
240 Deer Island Rd., Swansboro 28584
Physical Address, City, and Zip
Onslow
536410258187
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
6. Is (are) the well(s): ©Permanent or ❑Temporary
7. Is this a repair to an existing well: [Wes or
If this is a repair, fill out known well construction information and
repair under #21 remarks section or on the back of this form.
8. Number of wells constructed:
For Internal Use ONLY:
443199
14. WATER -ZONES
FROM
TO
DESCRIPTION
n/a ft.
ft.
ft.
ft.
UTER CASING (far mnl
FROM.
TO
yells) °OR LINER (if applicable)
DIAMETER
THICKNESS
MATERIAL
n/a
ft.
ft.
in.
., INNER. CASING: OR TUBING,
FROM
TO
;eothermal closed -loop)
DIAMETER
THICKNESS •
MATERIAL
000 ft.
225 ft-
3/4
in.
SDR-11
HDPE
ft.
ft.
in.
17; SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
n/a ft.
ft.
in.
ft.
ft.
in.
GRO
FROM
TO
MATERIAL
000 ft.
230 ft.
Bentonite
EMPLACEMENT METHOD & AMOUNT
Pump/tremmie
ft.
ft.
ft.
ft.
/GR
CK (if applica
FROM
TO
MATERIAL
EMPLACEMENT METHOD
n/a
ft.
ft.
ft.
ft.
.. DRILLING LOG (attar
FROM
000 ft.
TO
040 ft-
additional sbeei
DES
ec
rain size, etc.)
andy Silt/Clay Layers
040 ft.
110 ft.
110 ft-
190 ft-
Sil A nim e�tc{n�gr�e Clay
rn� ��st ne/ ilt Layers
190 ft.
ft.
ft.
225
ft.
ft.
ft.
ft.
Silty Sand Qwith uat ty Reg o��lLayers
operations Section
Off►�e
1{Uilmington Reg'n
MARKS
Drilled 4-230' boreholes and set 3/4" geothermal.
Loop in each @ 225' (fully grouted)
22. Certif
Si
e of Certified Well Contractor
11/16//17
Date
By signing this form, I hereby certt& 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.
ite diagram or additional well details:
4 You may use the back of this page to provide additional well site details or well
217 construction details. You may also attach additional pages if necessary.
For multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form. SUBMITTAL INSTUCTIONS
9. Total well depth below land surface: 230 U'S(ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths if different (example- 3@200' and 2@100') construction to the following:
iribtp Praising U
10. Static water level below top of casing: n/a (ft.)
If water level is above casing, use "+"
11. Borehole diameter: 4 (in.)
12. Well construction method: Mud Rotary
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection 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

rint Form
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
John Salmon
Well Contractor Name
3497-A
NC Well Contractor Certification Number
Applied Resource Management, P.C.
Company Name
2. Well Construction Permit #:
WI 0800477
List all applicable well construction permits (i.e. GIB , 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
D Municipal/Public
!Residential Water Supply (single)
DResidential Water Supply (shared)
DRecovery
Inj ection Well:
(Aquifer Recharge
Aquifer Storage and Recovery
(Aquifer Test
!Experimental Technology
(Geothermal (Closed Loop)
!Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed: 03/16/1
5a. Well Location:
David Adams
OGroundwater Remediation
DSalinity Barrier
DStormwater Drainage
DSubsidence Control
DTracer
Other (explain under #21 Remarks)
7 Well ID# N/A
N/A
Facility/Owner Name Facility I.D# (if applicable)
107 Fox Lane, Hubert, NC 28539
Physical Address, City', and. Zip
Onslow 534304511180
County Parcel identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat long is sufficient)
See Attached
See Attached
6. Is(are) the well(s)Permanent or DTemporary
7. Is this a repair to an existing well: DYes 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 hack 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:4
9. Total well depth below land surface: 255 (ft)
For multiple wells list all depths if different (example- 3@2200' and 2(ii?100')
10. Static water level below top of casing: N/A ft,
( )
If water level is above casing, use
11. Borehole diameter: 6 (in.)
12. Well construction method: 1.1 d Rotary
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) N/A Method of test: N/A
13b. Disinfection type: N/A Amount: N/A
For Internal Use Only:
443076
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (for multi -Cased wells) OR LINTER (if applicable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
O ft.
255 ft.
1 in.
HOPE
16. INNER
CASLNG OR TUBING
(geothermal dosed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERLAL
ft.
ft.
in.
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
ft.
ft.
in.
ft
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METPiOD & AMOUNT
0 ft.
255 ft
Thermex
Pumped
ft.
ft.
ft.
• ft.
• 19. SAND/GRAVEL PACK
(if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
ft.
ft.
ft.
ft.
•
.
20..DRILLING
LOG (attach. additional sheets if necessary) .
FROM
TO
• DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
0 ft.
15 ft.
Orange sand
15 ft.
60 ft.
Sandy clay
60 ft.
100 ft.
Sandy clay with shell layers
100 ft-
255 ft.
Gray limestone
ft.
ft.
ft.
ft.
''''''-'‘
ft.
ft.
k '''-'4
. 7..%_,,c-.4 i _E.)
• 21 REMARKS `.
APR I. 7 2017
, i..6 rr,st" ,.., `,11' ; , -6, r ' • 1 ,I • •
22. Certification:
4
�► ry s•�s,�n.��
DONQIBGG
'3 -2
Sniatur- Cei .: • 'Fell Contractor
Date
By signing this form, 1 hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15,4 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 CREctivbhett74k9A
24b. For Infection 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:
o«ling: APR 2 4 2017
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
Water Quality, Regional
24c. For Water Supply & Infection YiNitsratliongdgaitirdnsending the fonn to
the address(es) above; also subinWI ':''ta'ncR ;brfi tin 30 days of
completion of well construction to the countyheatTh department
p p ment 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
Ibis Irwin can be used for sin,* cir multiple wens
1. Vefl Contractor Information:
D.T. Chalmers. Jr.
Weil Contractor Name
4146A
NC Well Contractor Certification Number
CATLIN Engineers and Scientists
Company Name
2. Well Construction Permit #: N/A
List all applicable well permits (Le Ce 'HIM State Vat -twice Nemo'', err )
3. Well Use (check well use):
Water Supply Well:
0 Agricultural
CO Geothermal (Heating/Cooling Supply)
0 Industrial/Commercial
O Irrieation
Non -Water Supply 'Well:
IEMonitoring
injection Well:
°Aquifer Recharge
0 Aquifer Storage and Recovery
°Aquifer Test
0 E.xperimental Technology
°Geothermal (Clo5ed Loop)
O. Geo( henna I (Heating/Cooling_Return)
4. Date Well(s) Completed:
5a. Well Location:
0 MunicipaliPuhltc
O Residential Waier Supply (single)
°Residential Water Supply (shared)
0 Recovery
0 Groundwater Remediation
°Salinity Barrier
C3 Stormwater Drainage
°Subsidence Control
°Tracer
°Other (explatn under #12.1 Remarks)
11ii8/16 Well ii#:.JJSTPW647'MWC
Facilit):Ovvnis Name Facility 113# 1,f npplicable)
iSamp Lejeune
Physii.al Atidn.iss. City. h:.,nd hip
ONSLOW
County
11111awer...tame
Parcel Identification No. PIN I
3b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
if well Felkt. due latflong i 5tifticient)
34.7175011 N 77.337858
6, Is (are) the well(s):111Permanent or DTemporary
7. Is this a repair to an existing well: 1:3Ycs or CO No
Olds is it repair. fill act known well eonstructkn infinntotion and esplain the wtture o.f
the repair under #21 remarks section or on the back 4:his finnt.
8. Number of wells constructed: 1
For ntithiple injection or non -water stipple wells ONLY with the same cm:sir-action. viw
an .submit one form.
9. Total well depth below land surface: 11 (ft.)
For multiple wells list all depths in differm (example- .1@.200' and 27100')
10. Static water level below top of casing:
limiter level is above casing, use "+
11. Borehole diameter: 8.25 (in.)
3.17
12. Well construction method: HSA
i.e. art,T, rchiry, t push, ek.)
(ft.)
For internal 1 sc ONLY
441925
14. 'WATER ZONES
i Kohl
TO
DENCH. fill iN
fl.
it
ft
it.
IS. INNER CASING OR TUlat NG tteothennad elcortWoopl
ilium
11).
DiAhliTUR
Ti IICKNESN
hi ATElt IAL
0 it
1 n.
2 in. I
Sch. 40
PVC
Its, OUTER CASING I n. tntikkesed wells) OR 1. NER tit applicable)
i ISIIM
Tt )
t )11ANI1TER
'ruiCKNESS
NiAllERM.
.
rt.
in.
17. SCREEN
Mt Mt
To
1)tAs111ut
NU IT SIZE
'II I R. K.N LSS
hi A I DIIIAL
1 0.
11 n.
2 i
Slot .010
Sch. 40
PVC
rt.
i
18. GROUT
FROM
ii)
htATER W..
1:2011.AciNIENT hilTiii )1.) & NM( R •NT
0 ti.
0.25 ft.
Portland Cement
Surface Pour
0.25 ft.
0.5 rt.
Bent Pellets
Surface Pour
rt.
19. SAND/GRAVEL PACK I itapolleable
!Rohl
11 i
hi AllICAL _
1-..hill_ALLhlitrqr hli, i110D
0.5 rt.
11 n.42
Medium #2 MediurrOt
......_
Surface Pour
rt.
tt
39. DRILLING LOG ;Wadi attic shgets If
titoNt . _
To
Di.scittifni. t-IN tvnior, hanInesi, soil/mkt mte. taaut SM. CIC )
rt.
rt.
.
rt.
rt.
n.
rt.
ft .
rt.
21. REMARKS 1.......
- • .' - • - ,
-FES
2-1 201
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gprn) Method of test:
13h. Difinfection type:
Amount:
22. C ifi ion:
Sign
Certified Yv 1 Contra'.
Proctx4.,in3
Dwgisikoi6
Date
IN signing this form I hereby certify that the nvIl(s) mts (uvre) constructed in acconLince with
154 /VC IC 02e. Itio0 NCAC 0,,?00 Well Construcaln Standards tall that cz
OM set 1.111 hats been prvvided to the 0t.11 (Amer
23. Site diagram or additional well detniLs:
You may use the back of this page to prnvide additional well site details or well
construction details. You may also attach additional pages if necessary,
suilmiTyAL INS )NS
241i. For All 'Wells: Submit thisfrADAINI/Ms of completion of well
wnstruction to the followinLv
Division of Waif Processing Unit.,
1617 Mail Service Center; Rideigh, NC 27699-1617
24b. For Iniection % s ONLY: ,In addition to Sending the form to the
:11dress in 24a above. a 1.
ci...Impletion pi well gons Egigitrie.
VVIirr!!1:41or 6Reit:i0nalitiOnf9filrerrn within 30 days ot
Division or Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Svonlv & Injection Wells:
Also summit one copy of this form within 30 days ofcompletion of well .
ristruction to the county health department of the county where constructed.
Adapted From Form GW. North Carolina Departmot ironment and Natural R, sourcr Da.ision of War Rurc-e5 Revised August 2011

WELL CONSTRUCTION RECORD
D is font) Lan he ttsc'd for sirqle !x nxriiple wells
I. well Contractor Information:
war• Chalmers, Jr.
Well Ccrtractor Name
4146A
NC We:I Coucractvr Certttication Number
CATLIN Engineers and Scientists
Company Name
?. Well Construction Permit #: N/A
List rtll . ipplic ctbl:{ well permits (Le. County, ::r:re. Variance irrt&ctrcan, etc.)
3, Well Use (check wdll use):
Water Supply well:
0 Agricultural
Dt otherrnal (Heating/CotlEtng Supply)
IC inclustnat/Crtnmetcial
0 Irrigation
Non -Water Supply well:
(�! Moititorinz
n ection
D Aquifer Recharge
D Aquifer Storage and Recovery
D Aquifer Test
D Experimental T c:hnntosy
° Geothermal (Clof,ed Loop)
°Geothermal i ffeatineiCoaltne Return)
C3 Municipal/Public
D Reidertlial Water Supply (sin ;k
D Residential Water Supply (shared)
° Recovc ry
1
Groundwater Kemediation
°Salinity f3arri} r
0 Stonnwater Drainage
Ci Subsidence Control
°Tracer
i3Other (explain molder #21 Remarks
4. Date Well(s) Completed: 11/17116 Well ID#: tJSTPW647-MWO
5u. Well Locution:
Fv:,cility Ownor Name Facility ID# (if applicable)
Camp L.ejeune
Physical Addrx:s. City. and tap
ONSLOW/ -..
Cc.tmty
Parcel Identification No. (PIN)
5h. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
well field, one i trl Ong is sufficient
3,4.7175728 N-77.3377208
6. Is tare) the w'ell(s): 23Permanent or DTempur•.try
7. Is this a repair to an existing well: DYrs or M No
If this L% it repair, ft1t term k,w nn well :construction Win -minion and exxp(rrin the nature of
the repair render #2 1 r mark; section or on the hack cif this f )rut.
8. Number of wells constructed: , 1
I". r itu:ltiple injectiu ar noti •water supply wells ONLY with the same construction, you
c zttr std)r)Iit one _form.
9 Total well depth below land surface: 11 (fL,)
trttiltiptt.' wells list all depths in k,ifi!irerPitt a .j:tiitltle- 3 (0200' and 2 t.. WO')
10. Static water level below top of casing: 2.51
!f waxer level is aboee c.rtsim,', list.' ..}
l 1. Borehole diameter: 8.25 (.on.)
11 well construction method: HSA
(Le. auger, wan, cable, direct pits&&, kac..
(rt.)
410111111.14.111a se wan wa
For intend Use ONLY
471-97r-1
El. WATER ZONES
"
Ettt tM
TO l
1)LSCI Q't t(15
f,
o,
f1..
IS. INNER CASING OR TUB NG (ce,utherntd d srd•fkup)
Elt4 ltil
'tit O
1_ ULN'•iETE?do
11llt.'KNENS
Mryr1 t u
0 h.
1 ft.
2 in.
Sch. 40
PVC
166. OUTER CASING !for mu ti.atiaI vt t OR LINER tiirapprrbk)
l'Itt)h1 „
1.i
l}IAME'IER
"t111C'KNi:SS
11ATi;RIAL
R.
tt•
(r.
M.
in.
17. SCREEN
Ftt1)ht
'r't) '
DIAMETER
%LiJTN1'.E
'11 lit:KW:NS
NIA\ .i;1.\L
1 rt,
11 rt.
2 in.
Slot .010
Sch. 40
PVC
ft.
rt.
i,r•
1& GROUT
FRI Si
11)
MA'11:KIAL
N
EMPLACEMENT A1t:111O0 & ‘Mt1LINT
0 rt.
0.25 ft.:
Portland Cement
Surface Pour
0.25 rr.
0.5 h.L
Bent. Pellets
Surface Pour
n.
ft.
19.SANEl1CRAVEL
PACKtit`
i, -., It)
most
01
h1ATt:tt1AL 1.NI'1..ACLMEN N111110-1)
0..5 it.
11 rt.
C. 2 Medium #2 Me iiu Surface Pour
0. rt,
20. DRILLING LOG (Mach additional :tits if necessary)
I KOM
Tt l -
VEY:Rumt is tcot,,e. ItanUtrss, sc i1h .k lvpc, grain size..-;,
rt•
it,
it.n.
•
n.
n.
ii El
`...
rt.
21. REMAii1
FEB ?A
livformation Prot .1:4.
FOR WATER SUPPLY WELLS ONLY:
13u. Field (gpm) Nlethod of test: ,
13h. Difinreetion type:
Amount:
.: •
22. Cnrtir
l
Signature t Welt Contractor
12/6/2016
Date
llv signing this farm, 1 herein. •errify dun the ++xiits l 4trrs 'air) constructed tit accordance with
15A N'C 1 C 02C ,0100 or 1.5.4 NOW'02C .0200 Well Construction Standards anel ;)sari u .:;fin' : f
this record IRIS been provided ,tu the well ottn .'r
23. Site diagram or additional well details:
You may use the back of this Rige to provide additional well site details or well
construction details. You ma also attach additional pages if necessary.
SIJIIMITI AL INS
CDENR/DWR
24a. For Ail Wells: Submit this form within 30 days of completion of well
construction to the followinsr
017
Division of WatFEB 2 7 er esources, nformation Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24h. For Iuleetion WMh1.a t ailks l&sending the torn to the
address in 24a above, tprrn within 30 days of
completion of well ciimlMtiea lfteI6airfCe
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
'2' • For water Sypply & Injection wells:
Also stabrnit one copy of this form within 30 days of completion of well
construction to the county health department of the county where constructed.
!1/4d,:pted front Form ON-1 North C sr ,Einar Department of Environment and Natural Resources - Division of Water Resources Revised August 2011

WELL CONSTRUCTION RECORD
fits form i.an t>e nsa! for 'mete of tsar lime 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 #: N/A
List all upphcable welt p rants (r.eStare Varsintee. Injection, en-)
3. Well Use (check well u.se):
Water Supply Well:
D Agricultural
©G'eothcrmat (FleaI3n /Cooling Supply)
O lndustnaiiCnmrnercial
°irrigation
Nun -Water Supply'Well:
X$ Monitoring
Injection Well:
© Aquifer Recharge
0 Aquifer Storage and Recovery
co Aquifer Test
CI Experimental Technology
O Ge thermal (Closed Loop)
°Geothermal f Hcating/Cooline Return)
O Miunic:ipal/Punitc
C] Residential Water Supply (single)
°Residential Water Supply (flared)
0 Recovery
° Groundwater Remediation
° Salinity Barrier
Ca Siort»wuier Drainage
° Subsidence Control
°Tras:er
0 Other (explain under #? 1 Remarks)
4. Date Well(s) Completed: 11/17/16 Well
5a. Well Locution:
USTPW647-MWO
Facility Owntr Name Facility Mir ► if applicable)
, Camp Leieune
Physical Addre s. Ci.ty: and Zip
ONSLOW
f"ounty Parcel Identification No, (PIN)
5h. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
if well field, one latllong is u(ficicnti
34.7175609
N 47.3377945- w
6. Is (are) the well(s): Permanent or D7'Ternporrary
7. Is this a repair to an existing well: D Ye7.. or CM Nc,
If this is a repair: i111 tart ,town u t I! c)►nstruc'tion inf rtnattan e-xplain the :iu::ir-e if
!Ise rt pair ttucicr #21 remarks aection or on the lack of this form.
8. Number of wells constructed:
Per multiple injection e)r non wirer supply wells ONLY with the same constructionrim
i -WI submit mitt form.
9. Total well depth below land surface: 1 i (t,)
i• or multiple er'ct 1Ps lift all cteptlas iii clt, ere nt (example. 3 Yn' 21Xr and . @ 1(X) )
10. Static water level below top of casing: ,o._.,.. 2.96 4 ft.)
If water tet e!ts alter et I'tlstrt4, ::Ise, "+"
11. Borehole diameter: 8.25 .,� (0.)
12. Well construction method: HSA
(Le. linger neviiirr. cable dirtier push, etc.)
1
Internal ONE Y
441923
14. WATER 7ONFS
Litt AI
TO
j�
DI �icn1i01c:;.N
r.
rt.
rt.
ER CASING OR TIJUING (geothermal c osed4oup)
, _la.1Nt
110)M
TO
I)1A:ttt•`f`ER
.nllCKNLSs
MATERIAL
0 nt.
1 rt.
2 in.
Sch. 40
PVC
16. Olfltfl CASING (tor nr 1i3 d Ivellisl OR LINER 1itaptri ble
1•Kt 1M
'T't}
DIA IFTI 4
T3Ii(:KNt_sS
NIAT11IUAl.
fG;
rt.
. in.
ft.
ft.
tn.
17. SCREEN
mom
t1)
I)1ANtrili4(
Lt FT SUM
TIIK'l.NI.SN
MX I1:It1AL
1 ft.
11 n.
2 t
Siot .01 o
Sch. 40
PVC
youto --
Ti)
.tAT RIAL
tiM1'l.AI I:ht1 N T M1fl1U 1I) & )J1tOUNT
0 It
0.25 r►.
Portland Cement
Surface Pour
0.25 ft.
0.5 rt.
Bent PeI ets
Surface Pour
Pt.
ft.
19.SAND1CRAVEL
PACK (If
ble
FROM
7'c)
MATERIAL
LMI LAI, • N 11 lop
0.5 o.
11 rt.
#2 Medium #2 Medium
Surface Pour
ri.
ft.
_
20. DRILLING LOG{nttachadditionalsheets iictt
I -Kt M1
1 O) -
`.�tr`�)
�), t
I Jt .SLR1I' ( :cc.k 1 hard ps. wilinv.:k �-1 T . erau .i . ti: /
rt.
ft.
ft.
11.
fi.
Clitikt9
. ft..
ft.
IV
n.1
►~l
n.
�-
2�
21. REMARKS2011
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13h.13ilinfection type: _�.___.____ Amount:
22. Ca
on:
S1gnaof Certified Well Contract'
12/6/2016
Date
Br signing this form, I hereby certify thin the 1t u ;1i s)1 rs (tie,' r t`rar tnrc'h:el e 31711h
1 ¶A NCItC 02C 0100 d)r ISA NC I C 02C .0200 Wet1 thin Standards and that r of
this ream! has been provided to the t<nt'!? ;.;seer
�• a EAISKtcuR DW'R2.ieitaaiD:
..3.:�ate diat�,t°aaalru tar
You may use the back of this page to pro idc additional well site details or well
_ nstruction details You may also attach additions ages if necet ary.
•
SUIIMITI AL INSTRUCF s2 7 201T
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the folio r Quality Reg1ena
., erationsleiviiraCtiOnitiokocessing.Division oi'4 �� �I Unit,
1617a� see (.enter alei = NC 27699-1617
24h. 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 the following: •
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For 'hater Synn1 ection Wells:
Also submit one copy of this torm within 30 days of completion of well
construction to the county health departinent of the county where constructed,
Adapted f'roni Form GW-I Nerd) Carolina Department of En ironmcnt and Natural Rc ourcc;s Di‘is:on of Water Resources
Revised August 2013

ELL
LOG
. , !,.�# ZCATLIN
Engineers and Scientists
15-803 9.7
SHEET 1 OF 1
PROJECT NO.: 15-803 9.7
STATE: NC
COUNTY: ONSLOW
LOCATION: Camp Lejeune
PROJECT NAME:
LOGGED BY: Katie Pressley
WELL ID:
PW 647
Initial Response
DRILLER: . D.T. Chalmers, Jr.
USTPW647—
NORTHING: 3844211
EASTING: 285921
CREW: CATLIN
MWO2
SYSTEM: UTM NAD 83 (m)
BORING LOCATION:
T.O.C. ELEV.: 28.89
DRILL MACHINE:C M E 456 TRACK
METHOD: HSA
0 HOUR DTW: 3.0
TOTAL DEPTH: 11.0
START DATE: 11/17/16
FINISH
DATE: 11 /17/16
24 HOUR DTW: N/A
WELL DEPTH: 11.0
DEPTH
BLOW
0.5ft
COUNT
0.5ft
0.5ft
0.5ft
OVA
(ppm)
LAB.1
o
s
L
SOIL AND ROCK
DESCRIPTION
DEPTH ELEVATION
WELL
DETAIL
0.0 LAND SURFACE 28.9
0.0
0.0
-
4
3
1
2
0.9
UST
MWo2
(1.0-2.0')
:`:-'':•:
n `(SP) - TOPSOIL
00
0
in
..
(SP) - Dark brown, v.f. SAND.
2.0 26.9
W
(CL) - Brown w/orange mottling, Sandy CLAY.
Slight HCO.
4.0 24.9
2.0
-
2
2
1
3
1.9
Sat.
Sat.
Sat.
•....
(SP) - Lt. gray to gray, f. grading to med.
SAND. Stong HCO.
10.0 18.9
4.0
-
1
3
3
2
16.6
6.0
-
o
1
1
1
1
D 8.0
.a
2 -woh
Li
-
z
J
i
n
woh
1
1
Y
J
—
z
11.0
.6
n
;o
R.
-
J
0
z_ _
G
m
z —
~Q
BORING TERMINATED AT ELEVATION 17.9 ft
in med. SAND.
ElPortland Cement
Wet
Bentonite Pellets #2 Medium Sand

WELL CONSTRUCTION RECORD
For Infernal Use ONLY
441922
This form rn h rased for ,-,.oe or !Isotopic weiti.
1. Well Contractor Infomtation:
D.T. Chalmers, Jr.
Well Cuntraetor Name
4146A
NC Well Ccntractor Certificatton Number
CATLIN Engineers and Scientists
Company Nanie
2. Well Construction Permit #: N/A
Last all appla able ti all permits (i.e. County State. Variancc. Ith'erthi. et,
3. Well Use (check well use):
Water Supply Well:
O Agncultural
OGeothermal L:HeatitieiCcoling Supply)
CI Industraat/Cc:Inmereial
0 Irrigation
0 MunicipatiPublic
CI Residential Water Supry isingle)
0 Residental Water Supply shared)
Non.Water Supply Well:
Monitering
niettion
13 Aquifer Recharge
0 Aquifer Storage and Recovery
0 Aquifer Test
0 P.perirnental TechnoV:gy
0 Geothennal fClosed Loop)
OGeothermal ,;!EleatingicVoling Return)
0 Recovery
4. Date Well(s) Completed: 11/17/16
Sa. Well Location:
OCroundwater Remediation
0 Salinity Ban -ter
0Stormwater Drainage
0 Subsidence Control
0 TraCer
°Other ain under #21 Remarks)
%velum: USTPW647-MWO1
facilityfOwrwr m& Facility 1D# if appliz:-.110
, Camp Leleune
Physical Address, City. and Zip
ONSLOW
County Pant' Identification No, (PIN:,
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one fat/long is sufficient'
34.7176403 N -77.3378144
6. Is (are) the weli(s): Ea Permanent or arearsportary
7, Ls this a repair to an existing well: CIYes or WNo
if this is a repair. fill out known well construction information and etplam th47 nature of
lit repair under #21 rcoutrIcs section or on the back of this fiirm.
8. Number of wells constructed:
For multiple tufa (ion or noot-water supply wells ONLY 11 tell the same construction, You
submit one brin
1
9. Total well depth below land surface: •11 (ft.)
For multiple wells list all thrills in different (example- ..1200' and2.!OO)
M. Static water level below top arising: 2.80
If water kvel is above (am:. use "+"
Borehole diameter: 8.25 (in.)
12. Well construction method: HSA
ae (lager. rotary. cable direct push, en.)
"Ira,
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13h. Dilinfection type: Amount:
Sig. aiure 01 Certified Well Contrae
14. WATER ZONES
1.1iDN1
'11)
1)L-SCRI1MON
•
ft.
ft. i
ft.
is. INNER CASING OR TUB
NG (geothermal clasetl•kxp)
titof‘i
To
1 A ANtliTER
.ntlICKNESS
N1 ATERIAL
0 rt.I
in.
2 in.
Sch. 40
PVC
16,PUTER CASING dor natItiocasal wells) OR LINER (11 applicable
iiioNI
To
Do ktrilli-
nut. KNEM
hl 8TLRIAL
ft.
rt.
in.
II.
0.
In.
17. SCREEN
Hit 1N1
11)
1 )110,11111ilt.
SLOT N1ZE
J 1111C1N LS S
N1Altfi 1,U.
1 n.
11 n.
2 in.
Slot .010
Sch. 40
PVC
ft.
ft.
t
ig. GROUT
I
MOM
111
',wall lAl.
1,7+11'LALIA1ENT mcnIon elk AMR r,rt
0 a.
0.25 ft.
Portland Cement
,
Surface Pour
0.25 it
0.5 n.
Bent. Pellets
Surface Pour
rt.1
n.
19. SANDIGRAVEL
PACK iiroPPAchtbiel
1,14t 1%1
11)
NIA-1110AL
etkit,LALLMINV h in kw
0.5 ft.
11 ft.
N2 Medium #2 Medium
Surface Pour
(1.
rt.
zft. DRILLIN9 LOG attach additional
mbeeta it torixssarv)
Tel
DeictorTioN . ::or, hartifr,- suit/rck ire. se:Jo size. rte
•
ft.
ft,
.
ft,
ft.
• ribltellg9
‘1010
rt.
11.‘
rt.
DIAll
• - - RECEIVE-17,:E
rt.
I k .1
21. REMARKS 2017
FEB'2 1
inforpnatiori Proctae.sing Unii
22. C ri !cation:
,401.1r
fir
DWQI
1216/2016
Date
Dv sOit'ng this form 1 hereby certify that the 14r(I(s)nas (mre) constructed in it: :1,r1antewuh
NC1C 02C WOO or 15,4 NCAC 02C .0200 Well Construttion Standarris anti that e f
this rec. tuti has been Novi/EMMA CDENR/DWR
23. Site diagram or additional well details:
You may use the back of this.page to provide additional well site details or well
ristrtiction details. You may apEagactad1iti2roilirges if necessary.
SURMI11'AL INSTRUCTIONS •
24a. For All Wells: SuhvAthirsOffirpli4egleistays of completion or well
construction to the followinok
vperaions Section
Division. of W\TIPligirRPce?Cflialiisturtiroiit'romsing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24h. 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 the following:
Division of Water Resource, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c, For Water Svpplv & Injection Wells:
Also submit one copy of this form within 30 days cat completion of well
construction to the county health department of the county where constructed.
1dapted from Form OW 1 North Carolina Department al Environment and Natural Resources Division of Water Resources
Revi,11 Attest 2013

WELL LOG
PROJECT NO.: 15-803 9.7
PROJECT NAME:
STATE: NC
COUNTY:
PW 647 Initial Response
NORTHING: 3844219
EASTING:
SYSTEM: UTM NAD 83 m
DRILL MACHINE:C M E 45B TRACK
11/17/16
START DATE:
DEPTH
0.0
1.0
2.0
4.0
6.0
BLOW COUNT
0.5ft 0.5ft 0.5ft 0.5ft
8.0
11.0
OVA
(PPm)
29.1
5.6
1.9
3.9
LAB.
285919
BORING LOCATION:
METHOD:
FINISH DATE:
UST
PW647-
MW01
(1.0-2.0')
M
s
L
0
G
W
W
Sat.
DEPTH
0.0
3.0
4.0
ONSLOW
LOGGED BY:
DRILLER:
CREW:
HSA
11/17/16
15-803 9.7
CATLIN
Engineers and Scientists
SHEET 1 OF 1
LOCATION: Cam • Legeune
Katie Pressle
D.T. Chalmers J
CATLIN
0 HOUR DTW: 2.8
24 HOUR DTW: N/A
SOIL AND ROCK
DESCRIPTION
LAND SURFACE
(SP) - Dark brown, v.f. SAND.
Strong HCO from 2.0-4.0' BLS.
WELL ID:
USTPW647-
MWOI
T.O.C. ELEV.: 28.94
TOTAL DEPTH: 11.0
WELL DEPTH: 11.0
ELEVATION
(SC) - Gray, Clayey SAND. Strong HCO
10.0
(SP) - Tan grading to gray, f. to med. SAND.
Strong HCO.
28.9
WELL
DETAIL
0.0>
a.
1.0n
25.9
24.9
BORING TERMINATED AT ELEVATION 17.9 ft
in v.f. SAND.
ElPortland Cement
18.9
Bentonite Pellets 0#2 Medium Sand
0 U
0
11.0
•
NEI
NEI
INN
INNI
INN
INN
NIN
INN
►:4
•
IINN
NEI
N'
1.111
NEI
INN
INN
..INN
111111
V•
M�;:
= :•;
INII
INN
INN
NEI
NMI
NEI
1111
NIN
INNI
111111
NIN
11111
111111
-.
0.0
0.3
0.5
11.0

WELL LOG
15-803 9.7.
CATLIN
Engineers and Scientists
SHEET 1 OF 1
PROJECT NO.: 15-803 9.7
PROJECT NAME:
STATE: NC
COUNTY: O N S LOW
PW 647 Initial Response
NORTHING: 3844212
SYSTEM: UTM NAD 83 (m)
EASTING: 285928
LOCATION: Camp Lejeune
LOGGED BY: Katie Pressley
DRILLER: D.T. Chalmers, Jr.
CREW: CAT L I N
WELL ID:
USTPW647-
MWO3
BORING LOCATION:
T.O.C. ELEV.: 28.44
DRILL MACHINE:CME 45B TRACK
START DATE: 11/17/16
METHOD: HSA
0 HOUR DTW:
2.5
TOTAL DEPTH: 11.0
FINISH DATE: 11/17/16
BLOW COUNT OVA o
DEPTH m LAB.
0.5ft 0.5ft 0.5ft 0.5ft DPP )
0.0
2.0
4.0
6.0
8.0
11.0
1
1
2
2
1.2
UST
PW647-
MWO3
(0.0-2.0')
woh
1
1
2
1.1
1
2
2
2
1
1
2
1
woh
woh
1
1
s
W
L
0
G DEPTH
24 HOUR DTW: N/A
SOIL AND ROCK
DESCRIPTION
0.0 LAND SURFACE
0.3
,,, 2.0
•
•
(SP) - TOPSOIL
(SP) - Dark brown, med. SAND.
(CL) - Dark brown, Sandy CLAY.
WELL DEPTH: 11.0
ELEVATION
28.4
28.1
26.4
4.0 24.4
(SP) - Lt. gray, med .SAND.
Dark gray from 4.0-6.0' BLS.
Med. to cse. SAND from 6.0-10.0' BLS.
Strong HCO from 8.0-10.0' BLS.
10.0 18.4
BORING TERMINATED AT ELEVATION 17.4 ft -
in med. to cse. SAND.
WELL
DETAIL
0.0
0.3
0.5
11.0
ElPortland Cement
••❖•'
Bentonite Pellets [']#2 Medium Sand

ELL
LOG
,,
CATLIN
EI°sgfi` eers and Scientists
15-803 9.7 SHEET 1 OF 1
PROJECT NO.: 15-803 9.7
STATE: NC
COUNTY: ONSLOW
LOCATION: Camp Lejeune
PROJECT NAME:
LOGGED BY: Katie Pressley
WELL ID:
PW 647 Initial Response
DRILLER: D.T. Chalmers, Jr.
USTPW647-
NORTHING: 3844204
EASTING: 285915
CREW: CATLIN
MWO4
SYSTEM: UTM NAD 83 (m)
BORING LOCATION:
T.O.C. ELEV.: 29.23
DRILL MACHINE:C M E 45B TRACK
METHOD: HSA
0 HOUR DTW: 3.2
TOTAL DEPTH: 11.0
START DATE: 11/18/16
FINISH DATE:
11/18/16
24 HOUR DTW: N/A
WELL DEPTH: 11.0
DEPTH
BLOW
0.5ft
COUNT
0.5ft
0.5ft
0.5ft
OVA
(Ppm)
LAB.
o
1
S.
L
G
SOIL AND ROCK
DESCRIPTION
DEPTH ELEVATION
WELL
DETAIL
0.0 LAND SURFACE 29.2
0.0
0.0
2
4
4
5
0.2
UST
PW647-
MW04
(0.0-2.0')
:� c :•
0.i (SP) - TOPSOIL "xi-
o.00
LC;
-= 0.3
.
..
-
(SP) - Dark brown, f. to med. SAND. -
_
2.0 27.2:
o
.d
1.0cA --'�:.
:
-�
0.5
�..
•
W
(CL) - Brown w/orange mottling, Sandy CLAY.
Strong sulfur smell.���
4.0 25.2
_
2.0
1
2
2
2
3.6
Sat.
•
(SP) -Brown to tan, med. to cse. SAND.
10.0 19.2
-
- ,
- N
-
~
_
=`'
•
--/
-:
.
-
-:::
- •
�'
4.0
woh
1
2
2
6.0
1
2
1
8.0
a ,
w
z
a
woh
1
0
1•
11.0
11.0
11.1
h* 11.0
M
a
c
tL7
il
CrO
N
a
J
Z
0
m
Z
J
a
BORING TERMINATED AT ELEVATION 18.2 ft
in med. to cse. SAND.
-
-
_
-
-
LH_ Portland Cement
•.••1�•, •11••,
Bentonite Pellets [#2 Medium Sand

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
William J. Miller
Well Contractor Name
2927A
NC Well Contractor Certification Number
CATLIN Engineers and Scientists
Company Name
2. Well Construction Permit #: N/A
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
0 Tracer
❑ Other (explain under #21 Remarks)
4. Date Well(s) Completed: 09/28/16 Well ID#: PW647-TW02
5a. Well Location:
Facility/Owner Name
, Jacksonville
Facility D# (if applicable)
Physical Address, City, and Zip
ONSLOW
County Parcel Identification No. (PIN)
For Internal Use ONLY:
441921
't.: t+]. .A5:JNE§?.. s 'it s S-... .. ... \as ,t.!
_.; . , s iti i fi 1- s % i ;� t
FROM
TO
DESCRIPTION
ft.
ft
ft.
ft.
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft
ft„..,
n.�
C.
V�yC-.�i
1 e o�:.
,h3i �titizil°.
, �,,d�1 . gLK.�_i
. l6_�i€tt0u�f�AS�,
::.,:.4 'iS
'0
Y0..2 � 7 :S , �Pt
FROM J TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft
in.
ft.
ft.
in.
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL '
0 ft.
10 ft.
1 in.
Slot .010
Sch. 40
PVC
ft.
ft.
in.
W 4it.i . .. .. ! ' S !~ t. K: 1 4 1 l s t r i
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
ft.
ft
ft.
ft.
ft.
ft.
FROM
TO
MATERIAL
EMPLACEMENT METHOD
ft.
ft.
0 ft.
10 ft.
Natural Backfill
� `-:..
.RdFR
-w s l.� 1y�..t�"rt c.t K„r .. + l,. ,K � t
#7F'_ t y_(� 'ram- iii th :fnM.l�a ; :,.,:-.:' r ti.. ,.. �-.`. t r � �3A`' - ..t >ic. v ..X
FROM
TO
DESCRIPTION (color, hardness, soiVrock type, grain size, etc.)
ft.
ft
ft.
ft.
ft.
ft.
A - 0
Si
ft.
ft.
r
1$1‘GF S w_
ft.
ft.
P411 RECE!VED
ft.
ft.
.� �R�a•: . C ,, sings-?- ri.. ;�'t� ,, ,4._.' ^ ,t . a t i r �- r x .. . .. _ , y. ' y
Inforivitation P rocr. ,f , t.,
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22. Cartification:
(if well field, one lat/long is sufficient)
34.717562
N-77.337778 w
6. Is (are) the well(s): OPermanent or ®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: 1 0 (ft.)
For multiple wells list all depths in dierent (example- 3@200' and 2@100)
10. Static water level below top of casing: 3.60 (ft.)
If water level is above casing, use "+"
11. Borehole diameter: 8.25 (in.)
12. Well construction method: DPT
1
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Difinfection type: Amount:
Signature of Certified Well Contractor
By signing this form, 1 hereby certify that the well(s) was (were) constructed in accordance with
15A NCAC 02C .0100 or 15A
11/9/2016
this record has been provided
23. Site diagram or additional well details:
You may use the back of this pagErwaivisiet d
construction details. You may als . h Rkiiiiotra
Date
ndards and that a copy of
well site details or well
ges if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit ter QUaliti ,,Re Tonal
�ys of completion of well
construction to the follo *i.nington Regional Office
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
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 the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Sypply & 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.
Adapted from Form GW-1
North Carolina Department of Environment and Natural Resources - Division of Water Resources Revised August 2013

..---- CATLIN
Engineers; and Scientists
15-803 9.8 SHEET 1 OF 1
ELL
LOG
PROJECT NO.: 15-803 9.8
STATE: NC
COUNTY: O N S LOW
LOCATION: Jacksonville
PROJECT NAME: Temporary Well Installation at PW
LOGGED BY: Katie Pressley
WELL ID:
PW647-TW02
647
DRILLER: William J. Miller
NORTHING: 3844211
EASTING: 285922
CREW: • Zach Bush
SYSTEM: UTM NAD 83 (m)
BORING LOCATION:
T.O.C. ELEV.: 32.94
DRILL MACHINE: GeoProbe
METHOD: DPT
0 HOUR DTW: 3.6
TOTAL DEPTH: 12.0
START DATE: 9/28/16
FINISH DATE: 9/28/16
24 HOUR DTW: FIAD
WELL DEPTH: 10.0
DEPTH
BLOW
0.5ft
COUNT
0.5ft
0.5ft
0.5ft
OVA
(PPm)
LAB.
o
1
s
L
SOIL AND ROCK
DESCRIPTION
DEPTH ELEVATION
WELL
DETAIL
0.0 LAND SURFACE 32.9
0.0
0.0
_
-
D
P
T
0.0
!i•aaT��
W
•,1 1y•
•---..-?
•' • .-
;• • •,�•►,
i,' •;‘. r,
(SP) - Dark brown to med. brown, f. SAND.
ORGANICS.
2.0 30.9
a.o>
- v
- "
--�
--,�
(CL) -Dark brown w/orange mottling, Sandy
CLAY. Strong organic odor.
4.0 28.9
_
-
_
EC
2.0
-
_
D
P
T
0.0
2
AV
/�
(SC/CL) - Orange mottling, Sandy CLAY to
Clayey SAND. Stong organic odor.
26.9_
_ U
- o
__ •r
� -
A
_--/
_
4.0
-
D
P
T
0.5.60
,6.0
�'• �
�80•
(SC) -Tan to gray, Clayey SAND. Stong
organic odor.
24.9
-
-r..
-
D
P
T
1.3
(CL) - Dark brown, Sandy CLAY.
10.0 22.9
-
10.0
ti
ti
10.0
. 8.0
1
r
r
c -
z
a
D
P
T
•
(SP) - White to gray, med. SAND.
12.0 20.9
-
-
10.0
a
-
v
-
•
D
P
T
Lit. 0
W 12
0
0
0
0
J
C.
m
Z"
P
Q
_
BORING TERMINATED AT ELEVATION 20.9 ft
in f. to med. SAND.
-
_
Native Backfill

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
William J. Miller
Well Contractor Name
2927A
NC Well Contractor Certification Number
CATLIN Engineers and Scientists
Company Name
2. Well Construction Permit #: N/A
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)
0 Geothermal (Heating/Cooling Return)
❑ Groundwater Remediation
❑ Salinity Barrier
❑ Stormwater Drainage
❑ Subsidence Control
❑ Tracer
❑ Other (explain under #21 Remarks)
4. Date Well(s) Completed: 09/28/16 Well ID#: PW647-TW01
5a. Well Location:
Facility/Owner Name
, Jacksonville
Facility ID# (if applicable)
Physical Address, City, and Zip
ONSLOW
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22. Cartification:
(if well field, one lat/long is sufficient)
For Internal Use ONLY:
441920
FROM
TO
DESCRIPTION
ft.
ft
ft.
ft.
..:INNFOCASIN 'TUB
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
0ft.
1
in.
PVC
Sch. 40
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft
in.
ft.
ft.
in.
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
0 ft.
10 ft.
1 in.
Slot .010
Sch. 40
PVC
ft.
ft.
in.
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
ft.
ft.
ft.
ft.
FROM
ft.
J
TO
ft.
MATERIAL
EMPLACEMENT METHOD
ft.
ft.
0 ft.
10 ft.
Natural Backfill
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
FEB 2 1 2017
34.717655
N-77.337836 W
6. Is (are) the well(s): DPermanent or ®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 o
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: 10
For multiple wells list all depths in different (example- 3@200' and 2@100)
10. Static water level below top of casing: 1.57 (ft.)
If water level is above casing, use "+
11. Borehole diameter: 8.25 (in.)
12. Well construction method: DPT
(i.e. auger, rotary, cable, direct push, etc.)
1
(ft.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Difinfection type: Amount:
intomation Pr®c ,I ,t.g LP'
/tYkriftliBOG
Signature of Certified Well Contractor
11/9/2016
Date
By signing this form, I her Et ' • ". Rnstructed in accordance with
15A NCAC 02C .0100 or 15A NCAC 02C200 We Construction Standards and that a copy of
this record has been provided to the well owner.
23. Site diagram or addit iJ 1 qt ]
You mayuse the back of this page ti vide ifibnal well site details or well
Pg P
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRMIORNality Regional
operations Section
24a. For All Wells: Willynittoffpftelliiiii biffitts 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 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 Sypply & 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.
Adapted from Form GW-1
North Carolina Department of Environment and Natural Resources - Division of Water Resources Revised August 2013

WELL LOG
PROJECT NO.: 15-803 9.8
STATE: NC
COUNTY: ONSLOW
CATLIN
Engineers and Scientists
15-803 9.8 SHEET 1 OF 1
PROJECT NAME: Temporary Well Installation at PW
647
LOCATION: Jacksonville
LOGGED BY: Katie Pressley
DRILLER:
NORTHING: 3844221
SYSTEM: UTM NAD 83 (m)
DRILL MACHINE: GeoProbe
START DATE: 9/28/16
EASTING: 285917
BORING LOCATION:
METHOD:
CREW:
DPT
FINISH DATE: 9/28/16
William J. Miller
Zach Bush
0 HOUR DTW: 1.6
24 HOUR DTW: FIAD
DEPTH
BLOW COUNT
0.5ft 0.5ft 0.5ft 0.5ft
OVA
(PM)
LAB.
M
s
L
0
G
DEPTH
SOIL AND ROCK
DESCRIPTION
WELL ID:
PW647-1WO1
T.O.C. ELEV.: 33.09
TOTAL DEPTH: 12.0
WELL DEPTH: 10.0
ELEVATION
WELL
DETAIL
0.0
2.0
4.0
6.0
0.0 LAND SURFACE
0.0
0.0
0.0
H
0.0
w
Sat.
33.1
n (SP) - Dark brown, f. SAND. ORGANICS. J2 a
(CL) - Brown w/orange mottling, Sandy CLAY.
4.0
(SC) - Dark brown, Clayey SAND.
6.0
(SP) - Lt. tan and gray, med. SAND.
10.0
12.0
SC) - Lt. gray, Clayey SAND.
BORING TERMINATED AT ELEVATION 21.1 ft
in Clayey SAND.
29.1
27.1
23.1
21.1
ouoa
0
co
10.0
oa
O 0
10.0
0.0
ti
Native Backfill

WELL CONSTRUCTION RECORD
This form can he use:if for sank or multi* wclls
I. Well Contractor Information:
DJ.ChaImers1 Jr.
Well Contractor Name
4146A
NC Well Contractor Certification Number
CATLIN En 'nears and Scientists
Company Name
2. Well Construction Permit #: N/A
List all applicable wel pennizs (i.e Comm., State, Variance, Injettion, etc )
3. Well Use (check well use):
Water Supply Well:
°Agricultural
°Geothermal (Heating/Cooling Supply)
0 Industrial/Commercial
0 irrieation
GIIKONNIMINC0116110.,
0 Municipal/Public
o Residential Water Supply (single)
°Residential Water Supply (shared)
Non -Water Supply Well:
tle Monitoring ORccosciy
Tnjection Well:
°Aquifer Recharge
°Aquifer Storage and Recovery
0 Aquifer Test
0ExperimentaI Technology
°Geothermal (Closed Loop)
°Geothermal (Heath. Coolin)
°Groundwater Remediation
°Salinity Barrier
0 Stormwater Drainage
°Subsidence Control
°Tracer
°Other (explain under #2I Remarks)
-AMOUNIU11111101,
4. Date Well(s) Completed: 01/17/17 Well ILO: UST1841-MWO2
5a. Well Location:
Facility/Owner Name
Camp Leteune
Physical Address, City. and Zip
Onslow
Allimmumes
Facility ID# Of applicable)
County Parcel Identification No, 4 PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
Owen field, one latflong is sufficient:,
34.65592 N -77.33535
AMP aleheammumma...
6. Ls (are) the well(s): DPermaneut or Erremporary
7. Ls thlsu repair to an existing well: Mrs or IXINo
If this is a repair.fill out known yell onstnction infinmation and explain the nature of
t re repair under #21 remarks set non or on the hack o f this Pm:.
8. Number of wells constructed: 1
For multiple injection or non water supply wells ONLY with the same construction, you
can submit one fin-nr.
9. Total well depth below land surface: 13
For multiple wells list ail depths in different (example- .10.1200' and 20 I00)
10. Static water level below top nr casing: (ft)
if water level is above casing, use "4-
11. Borehole diameter: 8.25 (in.)
12. Well construction method: HSA
ieauger, rotary, cable, direct push. etc
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Difinfection type: Amount:
(ft.)
For Intrntal Usc ONLY
1.1. WATER ZONES
IROM
-ro
441887
ft.
n.
111:SCRIPTION
rt.
ft.
15. INNER CASLNiG ORrurnNc ketnhernia1 closed4uop
TtioN9 rTo 4-InAmiar.R THICKNESS
0L
3 n.
2
Sch. 40
h tATERIAI ,
PVC
it. UV : LK L.itNinti (tor mutti-casrd vats) OR LINER
Gloppro.:abl)
IlioNt
To
1n:11'411TR
-niICKNESS
MATI.RIAI
(1.
(1.
In.
rt.
. ,..... ......•
rts_.............
FRI)Ibt 11)
GRO
I )1AN11111( SIOT SUE 1-"--Tira----(NESS
13 it 2 in.
(1. tt.
VROM TO
Slot .010
MATERIAL
0 o. 0.5 fLlPoftjafld Cement
0.5 rt. 2 rt.
it. rt.
19. SANiD/GRA V
PACK
of a
Bent. Pellets
MAT11171.---".
Sch. 40
PVC
ble
IE.MPLACI:NIENT ht111101) At: AA II )1.ttil
Surface Pour
Surface Pour
11 .AC tt.N1MIiHoj)
2 rt. 13 it. #2 Medium Sand Surface Pour
rt. ft.
211. DR ILUNG LOC attach additional she1nceasari
TO
(1.
ft.
21. REMARKS
21 Cartificaf n:
Signature of Certified Well Contractor
imfor, f.niiirm-----1; . emu, ut
212/2017
Date
signing tht, f rn 1 hereby certify that the ttiell(s) nus (some) cdnstruk.-ted iP1 th....,rdance sitl
JA NCAC 02C .0100 or 1.5.4 NCAC 02C .0200 MI Constnti. list Standards and that a cap 1.
thr has provided ra the well ouner.
23. Site diagram or additional well details:
You tnay use the back of this page to provide additional well site details or well
construction details You may also attach additional pages if necessary,
SUBMWTAL INSTRUCTIONS
24a. For All Wells: SubBiEgEWIEN, mpletion of well
construction to the following:
Division of Water R
1617 Mail Servic
0
anc9rwation Processing Unit,
eandleitY,16C 27699-1617
lati ; gionaI
24b. For Injection Welts ONLY: In addition to sending the form to the
caodmdrepstestiionn2o4fawabeollvceo,nasltsnio cs.,
''Penr9:Ptiftf IShfctoirmon within 30 days of
.
ll.
Division of Water ReakatiPliftraifilidehijefileeControl Progran
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For WatetSvnplv & 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
Adapted from Form GW- I
North Carolina Depanment of Environment and Natural
Resources Division of Water Resources
Revised August 20

CATLIN
213:75Engineers and Scientists
213105 SHEET 1 OF 1
ELL
LOG
PROJECT NO.: 213105
STATE: NC COUNTY: Onslow
_
LOCATION: Camp Lejeune
PROJECT NAME: Site. Investigation Of SeleC ed Sites
Profiled in the Final 1977 Report Oil
Pollutio Survey -Site 1841
LOGGED BY: Katie PressleyWELL
_
ID:
USTI84I-
MWO2
DRILLER: D.T. Chalmers, Jr.
NORTHING: 3339051 EASTING: 2500583
CREW: CATLIN/Davenport
SYSTEM: UTM NAD83 (m)
BORING LOCATION:
T.O.C. ELEV.: 9.32
DRILL MACHINE:C M E 45B TRACK
METHOD: HSA
0 HOUR DTW: N/A
TOTAL DEPTH: 13.0
START DATE: 1/17/17
FINISH
DATE: 1/17/17
24 HOUR DTW: N/A
WELL DEPTH: 13.0
DEPTH
BLOW
0.5ft
0.5ft
COUNT
0.5ft
0.5ft
OVA
(PPm)
LAB,
o
I
S
L
0
0
SOIL AND ROCK
DEPTH DESCRIPTION ELEVATION
WELL
DETAIL
0.0 LAND SURFACE 9.3
0.0
0.0
-
1
2
3
4
4.3
•:••
•' -'
i� 3, i
♦•y
,y •
• • •
• -� • •
' '' •
♦5
;.
•3
•5
♦S • • .t?
.y
,-....
•-•
'
(SW) - Dark brown grading to It. tan to dark
tan, med. to cse SAND
Wet at 9.0' BLS
13.0 -3.7
1.1J_l 1.1 I I J I1J� I J.1 I I J 1.1J.11 J.1 I I J 1.1JJ I J I I 1 J 1,.1J11 JI I !MI] I J,I I I J1,1J11 JL I 1.1J...
01•
6.0
-
-
1
2
2
1
0.6
_
10.0
-1
1
1
1
0.4
13.0
_
1
BORING TERMINATED AT ELEVATION -3.7 ft
in med. to cse. SAND
EiPortland Cement
:❖.•.'
Bentonite Pellets
#2 Medium Sand

WELL CONSTRUCTION RECORD
This farm can bc used for single or multiple wcU
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 #: N/A
UST an applicable welt permits County. State l'ttrian,e, Infection, etc )
3. Well Use (check well use):
Water Supply Well,
0 Agricultural
°Geothermal (HeatingiCooling Supply)
0 Industnal/Commerctal
CI Irrigation
Non -Water Supply Well:
0/ Monitoring
intjectiat
Municipal/Pubhe
°Residential Water Supply (single)
°Residential Water Supply (shared)
0 Recovery
CI Aquifer Recharge
0 Aquifer Storage and Recoscry
O Aquifer Test
°Experimental Technology
°Geothermal (Closed Loop',
°Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed:_01/17117
5a. Well Location:
°Groundwater Remediation
0 Salinity Barrier
OStormwater Drainage
°Subsidence Control
0Tracer
OOthxIajn .....under #21 11r:fa:arks)
Well ID#; UST1841-111W01
FacilitylOwner Nanie Facility ID# (if applicable.)
Physical Address, City, and Zip
Onslow
County
Parcel Identification No. (PIN)
Sb. Latitude and Longitude in degret.isiminutesiseconds or decimal degree:
(if well field, one Iatilong is sufficient)
34.65718 N :77.33438
6. Is (are) the well(s): OPenntment or OTeinporary
7. Is this a repair to an existing well: ClYes or No
If this is a repair, fig out known well construction informaihm and esplain the nature (1"
the repair under 112I remarks seaion or on the hack qf this fisrut
8. Number or wells constructed:
Far multiple injection or nan Rater supplt wells ONLY with the same construction. you
can submit me farm.
9. Total well depth below land surface: 17 (rt.)
For multiple neaps list all depths in different -f example-. .34P200 and 2 0100
10. Static water level below top of casing:
limiter level is aln,ve casing, use -4-
11. Borehole diameter: 8.25 (in,)
12. Well construction method: HSA
(i.e auger, rotary. cable, direct push. etc.)
(1)
,11.11baimmeara,
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gptn)
13b. Difinfection type:
Method of test:
Amount:
For totem! Usc ONLY
441886
14. WATER ZONES
IROM
TI )
)1ESCRIII1( )N
ft.
0.
15. INNER CASI▪ N▪ G OR TUBING imulbemisd dosed-laoal
110)N1 TO !MAAR lilt
0.
OfL 70. 2 a.
16.. MUER. CASING (tor multkaled vstas) OR LINER or oppumbk2,
FROM TO 1I )1AN11:11'.1t THICKNI:SS
ft.
rt.In.
11IKKNLSS
Sch. 40
PVC
NATI:141AI -
.1.1.10 MOO
in.
17. SCREEN
litt)ht It)
t )1A1111,71,R
sixrr sr/F.
7 ft.
0.
18. GROUT
FROM
17k
2i
Slot .010
THICKNLSS
NtivniRIAL
Sch. 40 PVC
0.5 ft,
3 rt,
Tt)
30.
50.
AtATERJAJ. FAIPLACEMENT NUMMI) & AM( )k
Portland Cement Surface Pour
Bent. Pellets
Surface Pour
ft.
ft.
19, SAND/GRAVEL PACK (if ae
litom To
5ft.
MATIERIA1, 1,MICALT.1111...NT
17 rt, #2 Medium Sand
rt.
Surface Pour
20. DRILLING LOG (attach additional sheets It Ammar')
FRI )M Th
ft.
ft.
ft.
ft.
1)1'.'iCRIPTION lerslur. hardness. suit/nick tv erain
ft.
rt.
ft.
fL
0.1
P4,
FEB
2017
.ILREMARKS
Signature of Certified Weil Contractor
2/2/2017
Date
11% signing thi.j,rfit, i hereby certify that the vivli(s) oats (orre) on.vmuied in accordance wit
1VCAC 02C .0100 or 15.4 NCAC 02C .0200 Well ConstructIon Standards and that a copy
this reiircif has hem provided to the wellinmer
23. Site diagram or addiNmerighncluDiniiin
You may use the back of this page to provfdablidtforitYRIM tails or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL iNSTRt1cTfQp2 7 2017
24a. For All Wells: Submit this foe within 30 days of completion of well
construction to the following:
Division of Water Water Qu legxiie _70 ,i,i)loteittioffirtac7e6C9eSS92116i7Unit,
1617 Mail Sffr
I -44
24b. For In'eLskin Welts 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 Provo
1636 Mail ServiceCenter, Raleigh, NC 27699-1636
24c. For Water Synnlv & 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 when constructed
Adapted from Form GW1 North Carolina Department of Environment and Natural Resources • Division of Water Resources Revised August 21

CATLIN.GDT 2/2/17
C9
03
M 17.0
m
Q
WELL LOG
PROJECT NO.: 213105 I STATE: NC COUNTY:
PROJECT NAME: Site Investigation of Selec ed Sites
Profiled in the Final 1977 Report Oil
P p
fey -Sate 1841
NORTHING: 334370
SYSTEM: UTM NAD83 (m)
EASTING:
DRILL MACHINE:C M E 45B TRACK
START DATE:
DEPTH
0.0
6.0
10.0
14.0
1/17/17
BLOW COUNT
0.5ft 0.5ft 0.5ft 0.5ft
2
2
woh
8
5
4
1
9
8
4
1
8
6
6
1
9
OVA
(PPm)
92.4
89.9
4.6
19.4
LAB.
2500867
BORING LOCATION:
METHOD:
FINISH DATE:
W
M
0
L
0
G
DEPTH
0.0
6.0
10.0
Onslow
LOGGED BY:
DRILLER:
213105
CATLIN
Engineers and Scientists
SHEET 1 OF 1
LOCATION: Camp Lejeune
Katie Pressley
D.T. Chalmers, Jr.
CREW: CATLIN/Davenport
HSA 0 HOUR DTW: N/A
1/17/17 24 HOUR DTW: N/A
SOIL AND ROCK
DESCRIPTION
WELL ID:
USTI84I..
MWOI
T.O.C. ELEV.: 16.23
TOTAL DEPTH: 17.0
WELL DEPTH: 17.0
ELEVATION
LAND SURFACE 16.2
(CL) - Dark brown, f. to cse. Sandy CLAY.
Very strong HCO
(SP) - Dark brown to tan, med. SAND. Strong
HCO
0.0
10.2
7.0
14.0
17.0
(SC
- Dark brown, Clayey med. SAND
(CL) - Dark brown w/oragne mottling, Sandy
CLAY
BORING TERMINATED AT ELEVATION -0.8 ft
in Sandy CLAY
6.2
2.2
-0.8 17.0
2" Sch. 40 PVC
WELL
DETAIL
3.0
5.0
•
•
•
•
•
•
17.0
0.0
Portland Cement
Bentonite Pellets
#2 Medium Sand

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
For Internal Use ONLY:
441509
1. Well Contractor information:
William M Wiggins
Well Contractor Name
(NCWC) 347O-A
NC Well Contractor Certification Number
Mid -Atlantic Drilling, Inc.
Company Name
2. Well Construction Permit #: N/A
List all applicable well construction permits (i.e. County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑ Agricultural
DGeothermal (Heating/Cooling Supply)
D Industrial/Commercial
❑Irrigation
Non -Water Supply Well:
EMonitoring
Injection Well:
DAquifer Recharge
DAquifer Storage and Recovery
❑Aquifer Test
DExperimental Technology
DGeothermal (Closed Loop)
DGeothermal Heating/Coolin Return
OMunicipal/Publ.ic
DResidential Water Supply (single)
DResidential Water Supply (shared)
❑Recovery
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
OTracer
g ) DOther (explain under #21 Remarks)
4. Date Well(s) Completed: 11 /3/2016 Well m# USTTC341-Mlib
5a. Well Location:
Facility/Owner Name
Facility 110 (if applicable)
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)
34.739097 N 77.451525 W
6. Is (are) the well(s): ©Permanent or OTemporary
7. Is this a repair to an existing well: ❑Yes or I?JNo
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: 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: 16 (ft.)
For multiple wells list all depths if different (example- 3@200' and 2 rt 100')
10. Static water level below top of casing: (ft.)
If water level is above casing, use " ; "
11. Borehole diameter: 8 (in.)
12. Well construction method: auger
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
14 WATER ZONES
_ FROM
( TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (for multi -eased 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 ft.
ft.
2 in'
Sch40
PVC
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
_
THICKNESS
MATERIAL
0 ft.
15 ft.
2 in.
0.001
Sch40
P
ft.
ft.
in.
18. GROUT
. .
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft.
ft.
bentonite
pour
ft.
ft.
concrete
pour
ft.
ft.
19. SAND/GRAVEL PACK
(if applicable)
_ FROM
TO
MATERIAL
EMPLACEMENT METHOD
ft.
ft+
#2 torpedo sand
pour
ft.
ft.
natural pack
20. DRILLING
LOG (attach additional sheets if neeessory)
FROM
TO
DESCRIPTION (color, hardness, soil/rock types grain size, etc.)
ft.
ft.
ft.
ft.
ft.
ft.
;; s f _ .. y, , '
j c
-
ft.
ft.
r:B-032017
ft,
ft.
ft.
ft,
ft.
ft.
shy, .— c, ,
21. REMARKS'
2x2 flush protective cover
22. Certification:
tividk
Signature of Certified Well Contract°
12/01/2016
Date
By signing 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 INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following: RECEIVED/NCDENR/DWR
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For injection Wells: In addition tIgnd 2 j � �� to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Water Quality Regional
Division of Water Quality, • ,� Nlt leja'n ontrol Program,
1636 Mail ServiceTIM
fOgg,[7,4 06136
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 Environment and Natural Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
For Internal Use ONLY:
This form can be used for single or multiple wells
1. Well Contractor Information:
John Salmon
Well Contractor Name
3497-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. County. State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
OAgricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
© Irrigation
Non -Water Supply Well:
D Monitoring
OMunicipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Recovery
Injection Well:
❑ Aquifer Recharge
❑Aquifer Storage and Recovery
0 Aquifer Test
DExperimental Technology
OGeothemial (Closed Loop)
❑Geothermal (Heating/Cooling Return)
❑Groundwater Rem ediation
El Salinity Barrier
❑Stormwater Drainage
OSubsidence Control
❑ Tracer
DOther (explain under #21 Remarks)
4. Date Well(s) Completed: 01 / 18/ 1
5a. Well Location:
David C. Humphrey
Facility/Owner Name
7 Well ID# N/A
N/A
Facility ID# (if applicable)
719 Bell Fork Road, Jacksonville, NC 28540
Physical Address, City, and Zip
Onslow
012387
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 44 57.75 N 77 23 00.94
W
6. Is (are) the well(s): ©Permanent or ❑Temporary
7. Is this a repair to an existing well: DY.'es or ENo
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.
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: �60 (ft.)
For multiple wells list all depths if different (example- 3@200' and 20r,100')
10. Static water level below top of casing: 27 (ft.)
If water level is above casing, use "= "
10"
11. Borehole diameter: (in.)
12. Well construction method: Mud Rotary
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 100 Method of test: Airlift
13b. Disinfection type: HTH Amount: 3%(1 Og
441508
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (formulti-cased wells) OR LINER (if applicable)
FROM
TO
DLAMETER
THICKNESS
MATERIAL
0 ft.
220 ft.
6 in'
SCH40
PVC
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
.
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
220 ft-
260 ft.
.012 in'
6
SCH40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft-
30. ft.
Grout
Poured
210 ft.
125 ft.
Bentonite
Poured
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
215 ft.
260 ft•
Coarse
Poured
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type. grain size, etc.)
0 ft.
40 ft.
Silty sands
40 ft-
82 ft.
Sandy limestone
82 ft-
120 ft.
Clay with limestone
120 ft-
218 ft'
Green marine clay
218 ft.
260 ft.
Sandy limestone
ft.
ft.
ft.
ft.
21. REMARKS
22. Certification:
nature of Certified Well Contractor
of /pi?
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 Standat:ds-and that a
copy of this record has been provided to the well owner. ` :.,T�
23. Site diagram or additional well detain:1, - "
You may use the back of this page to praxiae,--aIrditional well4Wiletails or well
construction details. You may also attach addi +..� . . a s na
� ry.
SUBMITTAL INSTUCTIONS
24a. For All Wells: SubnA trithiff;Sib 'da.. `of 'corn.pletion of well
construction to the followingDENR
Division of Water Quality, Information Processing Unit,
1617 Mail Service Crtn, ItlgglSNT027699-1617
24b. For Infection Wells: 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: Water Quality Regional
Division of WerationS ecti nater Quaff off, lifi`antrol Program,
1636 Mail Service en err, al` N� -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.
Form GW-1
North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
Thisf m rtn be used for single or multiple wells
1. Well Contractor Information:
For Internal Use ONLY:
441400
D.T. Chalmers, Jr.
Well Contractor Name
4146A
NC Well Contractor Certification Number
CATLIN Engineers and Scientists
Company Name
2. Well Construction Permit #: N/A
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 0 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: r12-31' -cl ` Well ID#: UST1943-MWO9
5a. Well Location:
Facility/Owner Name
, Camp Lejeune
Facility ID# (if applicable).
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)
799-.3tcOS32(69)0 N 3i-.bbci24495S w
6. Is (are) the well(s): 'ermanent or D Temporary
7. Is this a repair to an existing well: DYes 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: 18 (ft.)
For multiple wells list all depths in different (example- 3@200' and 2 @ 100')
10. Static water level below top of casing: 13 (ft.)
If water level is above casing, use "+"
11. Borehole diameter: 8.25 (in.)
12. Well construction method:. H.S. Augers
1
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Difinfection type: Amount:
14..
ES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
151E . CAStN
FROM
TO
(geothermal dosed-lo©
DIAMETER
THICKNESS
MATERIAL
0 ft.
8 ft.
2 in.
Sch. 40
PVC
&OUTER /4 ING Efc t-ea
we
FROM
TO
DIAMETER
ppaille)
THICKNESS
MATERIAL
ft.
ft.
in.
ft.
ft.
in.
sew
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
8 ft.
18 ft.
2 in.
Slot .010
Sch. 40
PVC
ft.
ft.
in.
=:t
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
ft.
ft.
2 ft.
6 ft.
ft.
ft.
VEL.
ppata
FROM
TO
MATERIAL
EMPLACEMENT METHOD
6 ft.
18 ft.
#2 Medium #2 Medium
ft.
ft.
DRILLING
I tion shy if ) .
FROM
ft.
ft.
ft.
ft.
ft
ft.
ft.
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
ft.
ft.
ft.
ft.
}. f 8 crf rust a '
4 ;•�T
Sign .► e of Certified Well Contractor
1/30/2017
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 tho,gP
construction to the following:
letion of well
Division of Water Resource ;,4 �; processing Unit,
1617 Mail Service Center, • >< 27699-1617
24b. For Infection Wells ONL'A• I ad ition to sending the form to the
address in 24a above, also submitvA ; r� �:f � ►etl* 30 days of
completion of well constructio elolifgection
vlmington Re tonai
�' 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.
Adapted from Form GW-1
North Carolina Department of Environment and Natural Resources - Division of Water Resources Revised August 2013

1 ,
ELL
LOG
-�' ATLIN
Engineers and Scientists
213105 SHEET 1 OF 1
PROJECT NO.: 213105
STATE: NC
COUNTY: Onslow
LOCATION: Camp Lejeune
PROJECT NAME: Site Investigation of Selec
Profiled in the Final 1977 Report
ed Sites
Oil
Adrienne
LOGGED BY:Rodgers
WELL ID:
Pollution,Survey-Site 1943
DRILLER: D.T. Chalmers, Jr.
UST1943-
NORTHING: 345905 I
EASTING: 2492810
CREW: CATLIN/Davenport
MWO9
SYSTEM: UTM NAD83 (m)
BORING LOCATION:
T.O.C. ELEV.:
DRILL MACHINE:CME 45B TRACK
METHOD: H.S. Augers
0 HOUR DTW: 13.0
TOTAL DEPTH: 18.0
START DATE: 1/23/17
FINISH
DATE: 1/23/17
24 HOUR DTW: N/A
WELL DEPTH: 18.0
DEPTH
BLOW
0.5ft
0.5ft
COUNT
0.5ft
0.5ft
OVA
m
(pP)
LAB.
o
l
s
L
G
SOIL AND ROCK
DEPTH DESCRIPTION
WELL
DETAIL
0.0 LAND SURFACE
o.o
_IIII
1.0
—13
3.0
_
—13
-
-
-
8.0
r•"•
��
y•
....„
• v
.'.1
;-.i •'.•
: y.
'"'
•:' .:.
:• --.-
•f
y
5
S
.:••' •••
0.5 Asphalt
I �l11IIjl11Ij
.11I1RI (I11.11.l'
1
0 P N
D 0 0
(SW) - Brown to orange, med., WELL
GRADED SAND, dry
Grey to brown at 7.0' BLS.
Moist at 10.0' BLS.
Lt. grey w/ organic sand grains mixed through,
med. to coarse, wet at 13.0' BLS.
15.0
7
4
4
7
4
4
0.3
-
-
_
3
4
4
7
0.6
—
-
18.0
/
(CL) - Lt. grey, LEAN CLAY, saturated
18.0
_
s _
! —
BORING TERMINATED AT DEPTH 18.0 ft
.
5 Concrete
Bentonite Pellets ''•.''• • #2 Medium Sand

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 #: N/A
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:
o 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: ‘ t2fr0 i Well ID#: UST1943-MW08
5a. Well Location:
Facility/Owner Name
, Camp Leleune
Facility ID# (if applicable)
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)
t1/4c01-Gc N bbS9 69- 2-S
w
6. Is (are) the well(s): gPermanent or D Temporary
7. Is this a repair to an existing well: D Yes or No
If this is a repair, ,till out known well construction information and explain the nature o
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: i8 (ft.)
For multiple wells list all depths in different (example- 3@200' and 2 @ 100')
10. Static water level below top of casing: 13 (ft.)
If water level is above casing, use "+"
11. Borehole diameter: 8.25 (in.)
12. Well construction method: H.S. Augers
1
(i. e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Difinfection type: Amount:
441399
14WA'TER ZO
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
IS INNER CASING 0 TUBING (geothermal d
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
8ft.
2 in.
Sch. 40
PVC
IYFE CASING (for n ti.cased wi lls)
pollen
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
ft.
ft.
in.
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
8 ft.
18 ft.
2
Slot .010
Sch. 40
PVC
ft.
ft.
in.
FROM
ft.
TO
ft.
MATERIAL
EMPLACEMENT METHOD & AMOUNT
2 ft.
6 ft.
ft.
ft.
1
SAND/
appikab
FROM
TO
MATERIAL
EMPLACEMENT METHOD
6 ft.
ft.
18ft.
ft.
#2 Medium #2 Medium
G L (tt�r h.> dltio i sheels' f neeessaryY'
FROM
TO
DESCRIPTION (color, hardness, soillrock type, grain size, etc.)
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
REMARK&
FEB
22. Ctitification:
Sign e of Certified Well Contractor
�� ,.' =1, �";'r"2� SI,'�•' 4 1 � ? is
1/30/2017
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 diagram or additional well details:
You may use the back of this page R+. �� �� +' _ • -ksikalptails or well
construction details. You mayalso attac a• .
rY
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this fo thtn 30 2'17of completion of well
construction to the following:
Division of Water Res s E'eg, a t 's c e' ,+ cessing Unit,
1617 Mail Servi g e, C'. s ' l g 2 699-1617
�Im►ngton Regional�{�
24b. For Injection Wells ONLY: In addition to sending -me 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 Sypply & 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.
Adapted from Form GW-1 North Carolina Department of Environment and Natural Resources - Division of Water Resources Revised August 2013

I 0
ELL
LOG
CATLIN
Engineers and Scientists
213105 SHEET 1 OF 1
PROJECT NO.: 213105
STATE: NC
COUNTY: Onslow
LOCATION: Camp Lejeune
PROJECT NAME: Site Investigation of Selec
Profiled in the Final 1977 Report
ed Sites
Oil
LOGGED BY: Adrienne Rodgers:
WELL ID.
' p
Survey -Site 1943
D.T. Chalmers, Jr.
DRILLER:943-
UST1
NORTHING:Pollutio
345799 I EASTING: 2492744
CREW: CATLIN/Davenport
MWO8
SYSTEM: UTM NAD83 (m)
BORING LOCATION:
T.O.C. ELEV.:
DRILL MACHINE:C M E 45B TRACK
METHOD: H.S. Augers
0 HOUR DTW: 13.0
TOTAL DEPTH: - 18.0
START DATE: 1/23/17
FINISH
DATE: 1/23/17
24 HOUR DTW: N/A
WELL DEPTH: 18.0
DEPTH
BLOW
0.5ft
0.5ft
COUNT
0.5ft
0.5ft
OVA
(ppm)
LAB,
M
o
s
L
o
G
SOIL AND ROCK
DEPTH DESCRIPTION
WELL
DETAIL
0.0 LAND SURFACE
o.o
3.0
—
_
8.0
•
•;.
.:.
•::,-%:-
•• -
`
;•• .•••:
•••�-- :-:.
:," ' •
,•• ;:•.,
•:•"••.:•
0.1
(SW) - Brown, f., WELL GRADED SAND, dry,
loose.
Lt. brown to tan at 2.0' BLS.
Brown to orange at 2.7' BLS.
Lt. brown at 7.0' BLS.
Lt. grey, prominent mottling at 8.0' BLS.
I) ll JI J �..I I LI (ItII J I I I)11_1117 HI
...�I ..........
J
p O) N
D • o 0
2
4
3
2
0.4
-
2
3
2
2
0.2
—
-
13.0
(CL) - Lt. grey w/ prominent mottling, LEAN
CLAY, wet
15.0
—
2
2
3
5
16.0
`•. ••'''
. •. - . •
::: '
,-_-•:i
(SW) - Tan to It. brown, coarse, WELL
GRADED SAND, saturated
18.0
1 -
-
! 18.0
5
2
3
2
i -
-
BORING TERMINATED AT DEPTH 18.0 ft
•
•
Concrete
Bentonite Pellets El#2 Medium Sand

WELL CONSTRUCTION RECORD
This form can Ix: used for single or multiple wells
1. Well Contractor Information:
For Internal Use ONLY:
441398
William J. Miller
Well Contractor Name
2927A
NC Well Contractor Certification Number
CATLIN Engineers and Scientists
Company Name
2. Well Construction Permit #: N/A
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 0 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
0 Subsidence Control
0 Tracer
❑ Other (explain under #21 Remarks)
4. Date Well(s) Completed: 11/23/16 Well ID#: UST1 943-MWO7
5a. Well Location:
Facility/Owner Name
, Camp Lejeune
Facility ID# (if applicable)
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)
a.kt.41/4")89100b t N3409OSW+2— 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: 18 (ft.)
For multiple wells list all depths in different (example- 3 @ 200' and 2 @ 100')
10. Static water level below top of casing: 13 (ft.)
If water level is above casing, use "+"
11. Borehole diameter: 8.25 (in.)
12. Well construction method: H.S. Augers
• 1
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Difinfection type: Amount:
14 WATER ZC N
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
IS INNER CASINGOR TUBING (genthermal cl
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
8 ft.
2 in.
Sch. 40
PVC
UTE
FROM
TO
f wells) OR UN
DIAMETER
PPl
THICKNESS
MATERIAL
ft.
ft.
in.
ft.
ft.
in.
•
FROM
8 ft.
TO
18 ft.
DIAMETER
2 in.
SLOT SIZE
Slot .010
THICKNESS
Sch. 40
MATERIAL
PVC
ft.
ft.
in.
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
ft.
ft.
2 ft.
6 ft.
ft.
ft.
FROM
'tom. P IIx:(lfap
TO
MATERIAL
EMPLACEMENT METHOD
6 ft.
18 ft.
#2 Medium #2 Medium
ft.
ft.
FROM
LN
ft.
ft.
ft
ft.
TO
ft.
ft.
ft.
ft.
ft.
ft.
ft.
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
22. Cartification:
Signature of Certified We actor
1n=,�
/ y
n I/LIC 3
•
1/30/2017
Date
By signing this fo ereby 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 ad ' �CEfD/NCDENR/DWR
' nala es if necessary.
V
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
FEB32017
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, ; ; h a C i2y 9 -ipn 7
g al
24b. For Injection Wells ONLY: In tigiVOASOftettOrm to the
address in 24a above, also submit a cop [► 30005,60
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 Sypply & 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.
construction to the following:
Adapted from Form GW-1
North Carolina Department of Environment and Natural Resources - Division of Water Resources Revised August 2013

r-;
WELLLOG
213105
CATLIN
Engineers and Scientists
SHEET 1 OF 1
PROJECT NO.: 213105
STATE: NC COUNTY: Onslow
PROJECT NAME: Sitep Investigation of Selec ed Sites .
Profiled in the Final 1977 Report Oil LOGGED BY:
Pollution,Survey-Site 1943
345833 EASTING: 2492702
NORTHING:
SYSTEM: UTM NAD83 (m)
DRILL MACHINE:C M E 45B TRACK
START DATE: 11 /23/16
DEPTH
BLOW COUNT
0.5ft 0.5ft 0.5ft 0.5ft
OVA
(PM)
LAB.
DRILLER:
CREW:
BORING LOCATION:
METHOD: H.S. Augers
FINISH DATE: 11/23/16
M
s
L
0
G
DEPTH
LOCATION: Camp Lejeune
Katie Pressley
William J. Miller
CATLIN/Davenport
O HOUR DTW: 13.0
24 HOUR DTW: N/A
SOIL AND ROCK
DESCRIPTION
WELL ID:
UST1 943-
MWO7
T.O.C. ELEV.:
TOTAL DEPTH: 18.0
WELL DEPTH: 18.0
WELL
DETAIL
3.0
8.0
3
2
3
3
0.5
3
5
3
4
0.5
•
•
•
0.0 LAND SURFACE
8.0
(SC) - Tan to brown, f., clayey SAND
18.0
(CL) - Brown w/ orange mottling, LEAN CLAY
White, sandy at 9.0' BLS.
Brown w/ orange mottling at 13.0' BLS.
Saturated at 13.0' BLS.
BORING TERMINATED AT DEPTH 18.0 ft
0.0
8.0
18.0
2" Sch. 40 PVC
0.0
2.0
6.0
18.0
FIConcrete
Bentonite Pellets [1#2 Medium Sand

WELL CONSTRUCTION RECORD
For Internal Use ONLY:
This form can be used for single or multiple wells
1. Well Contractor Information:
William J. Miller
Well Contractor Name
2927A
NC Well Contractor Certification Number
CATLIN Engineers and Scientists
Company Name
2. Well Construction Permit #: N/A
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
D Municipal/Public
D Residential Water Supply (single)
D Residential Water Supply (shared)
Non -Water Supply Well:
® Monitoring D Recovery
Injection Well:
D Aquifer Recharge
D Aquifer Storage and Recovery
D Aquifer Test
❑ Experimental Technology
D Geothermal (Closed Loop)
D Geothermal (Heating/Cooling Return)
D Groundwater Remediation
D Salinity Barrier
D Stormwater Drainage
D Subsidence Control
D Tracer
❑ Other (explain under #21 Remarks)
4. Date Well(s) Completed: 11/23/16 Well ID#: UST1943-MW06
5a. Well Location:
Facility/Owner Name
, Camp Lejeune
Facility ID# (if applicable)
Physical Address, City, and Zip
4nslow
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
6k, I 9- N a 669 beC3 2_,
6. Is (are) the well(s): thermanent or O 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: 18 (ft.)
For multiple wells list all depths in different (example- 3 @200' and 2 @ 100)
10. Static water level below top of casing: 13 (ft.)
If water level is above casing, use "+"
11. Borehole diameter: 8.25 (in.)
12. Well construction method: H.S. Augers
1
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Difinfection type: Amount:
44139'
14., VVATER N
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
11.INNER CAS1N
FROM
TO
R MIN (geothertnal dosed400
DIAMETER
THICKNESS
MATERIAL
0 ft.
8 ft.
2 in.
Sch. 40
PVC
R OUTER .. .............
for rru i
FROM
TO
DIAMETER
pp)...:;
THICKNESS
MATERIAL
ft.
ft.
in.
ft.
ft.
in.
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
8 ft.
18 ft.
2 in.
Slot .010
Sch. 40
PVC
ft.
ft.
in.
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
ft.
ft.
2 ft.
6 ft.
ft.
ft.
tea
FROM
TO
MATERIAL
EMPLACEMENT METHOD
6 ft.
18 ft.
#2 Medium #2 Medium
ft.
ft.
NUM
FROM
ft.
TO
tt t d t oral et
ft.
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
P:11 P*C‘C4
ft.
22. Cartification:
Signature of Certified W- - ' + . ctor
1/30/2017
Date
By signing this form,"' .y 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 wa',4 EilLED/NCDENR/DWR
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
FEB 13 2017
•
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following: Water Quality Regional
Operations Section
Division of Water Resou a • 'go .6 ,, Unit,
1617 Mail Service Center, . eigh, 2769 -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 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.
Adapted from Form GW-1
North Carolina Department of Environment and Natural Resources - Division of Water Resources Revised August 2013

c
ELL
LOG
CATLIN
Engineers and Scientists
2,s,os SHEET 1 OF 1
PROJECT NO.: 213105
STATE: NC COUNTY: Onslow
LOCATION: Camp Lejeune
PROJECT NAME: Site Investigation of Selec ed Sites
Profiled in the Final 1977 Report Oil
LOGGED BY: Katie Pressley
WELL ID:
Pollution,DRILLER:
Survey-Site 1943
William J. Miller
UST1 943-
NORTHING: 345849
FASTING: 2492573
CREW: CATLIN/Davenport
MWO6
SYSTEM: UTM NAD83 (m)
BORING LOCATION:
T.O.C. ELEV.:
DRILL MACHINE:CME 45B TRACK
METHOD: H.S. Augers
0 HOUR DTW: 13.0
TOTAL DEPTH: 18.0
START DATE: 11/23/16
FINISH DATE: 11 /23/16
24 HOUR DTW: N/A
WELL DEPTH: 18.0
DEPTH
BLOW
0.5ft
O.Sft
COUNT
0.5ft
0.5ft
OVA
(PPm)
�B
o
s
L
G
SOIL AND ROCK
DEPTH DESCRIPTION
WELL
DETAIL
0.0 LAND SURFACE
o.o
3.0 —
-
-
10.0
�
(CL) - Brown w/ orange mottling, sandy, LEAN
CLAY
Tan to white at 10.0' BLS.
Wet at 12.0' BLS.
Saturated at 16.0' BLS.
'is.o
.1.(I 111 .I .I I t 11I J(1 .lI i..I I I j .11.1] Al
i
10 P N
D 0 0
2
3
3
7
0.3
_
-
3
4
3
9
0.9
16.0
-
18.0
2
2
9
12
-
j -
BORING TERMINATED AT DEPTH 18.0 ft
El
Concrete
Bentonite Pellets [1#2 Medium Sand

WELL CONSTRUCTION RECORD
e This form Gan be used for single or multiple wells
1. Well Contractor Information:
William J. Miller
Well Contractor Name
2927A
NC Well Contractor Certification Number
CATLIN Engineers and Scientists
Company Name
2. Well Construction Permit #: N/A
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 0 Recovery
Injection Well:
❑ Aquifer Recharge
❑ Aquifer Storage and Recovery
D 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: 11/23/16 Well ID##: UST1943-MWO5
5a. Well Location:
Facility/Owner Name
, Camp Lejeune
Facility ID# (if applicable)
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 3+0 689510sG-4.
6. Is (are) the well(s): Et/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: 18
For multiple wells list all depths in different (example- 3 @ 200' and 2 @ 100')
10. Static water level below top of casing: 13 (ft.)
If water level is above casing, use "+
11. Borehole diameter: 8.25 (in.)
12. Well construction method: H.S. Augers
(i.e. auger, rotary, cable, direct push, etc.)
1
(ft.)
For Internal Use ONLY:
441396
14�.'4?1rA
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft
tSINNE
s.
TUBING :( he: 'r1osed-
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
8 ft.
2
in.
Sch. 40
PVC
lJTE
for nib -cased we
puGcn6le?
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
ft.
ft.
in.
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
8 ft.
18 ft.
2 in.
Slot .010
Sch. 40
PVC
ft.
ft.
in.
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
ft.
ft.
2 ft.
6 ft.
ft.
ft.
1!
FROM
VELAC (if applble)
TO
MATERIAL
EMPLACEMENT METHOD
6 ft.
18 ft.
#2 Medium #2 Medium
ft.
ft.
FROM
. {aflaeh adcin<sh if nsa
ft.
TO
ft.
ft.
ft.
ft.
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Difinfection type: Amount:
ft.
ft.
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
ft.
90.
0-1 Ncto
1..1
fL�L',!
...L.
FEB
0 2 2017
22. Cartification:
i1foN C_)'••''9 `wiCI'8E 5g
Signature of Certified . tractor
1/30/2017
Date
By signing this form, 1 hereby certify that the well(s) was (were) constructed in accordance with
1 SA NCAC 02C .0100 or 1 SA NCAC 02C .
this record has been provided to the well o
kutiiiceof' that a copy of
23. Site diagram or additional well details:
You may use the back of this page to provide . s Rio al el s't etails or well
-� �: 1 s iLib�dss
construction details. You mayalso attach adHi .ary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form at r. Q ! Re ionpletion of well
construction to the following: Wilmington Regional Office
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
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 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.
Adapted from Form GW-1
North Carolina Department of Environment and Natural Resources - Division of Water Resources Revised August 2013

m ELL
LOG
ATLIN
Engineers and Scientists
213105
SHEET 1 OF 1
PROJECT NO.: 213105
STATE: NC COUNTY: Onslow
LOCATION: Camp Lejeune
PROJECT NAME: Site Investigation of Selec ed Sites
Profiled in the Final 1977 Report Oil
LOGGED BY: Katie PressleyWELL
ID:
Pollution,Survey-Site 1943
DRILLER: William J. Miller
UST1943-
NORTHING: 346020 J
EASTING: 2492712
CREW: CATLIN/Davenport
MWO5
SYSTEM: UTM NAD83 (m)
BORING LOCATION:
T.O.C. ELEV.:
DRILL MACHINE:C M E 45B TRACK
METHOD: H.S. Augers
0 HOUR DTW: 13.0
TOTAL DEPTH: 18.0
START DATE: 11 /23/16
FINISH
DATE: 11 /23/16
24'HOUR DTW: N/A
WELL DEPTH: 18.0
DEPTH
BLOW
0.5ft
0.5ft
COUNT
0.5ft
0.5ft
OVA
(ppm)
LAB.
M
°
s
L
0
G
SOIL AND ROCK
DEPTH DESCRIPTION
WELL
DETAIL
0.0 LAND SURFACE
•
o.o
_
_
3.0
-
5.0
%3
. S
; :• ..•:
: :'.
•y
r::;:••i
' -".
; =:'w ;
•
, •• •.•.
..,•
••/w .
(SW) - Dark brown and tan, med. to coarse,
WELL GRADED SAND, w/ few shale frags.
MO
I(I.(Il1I1 ► IUl1..I1.II(I1111I ..lilI11.Ij_11Ij1I11I11I1j1111I
....I ............
n 0 N
D 0 0
3
5
4
4
0.6
—
4
3
8
6
0.3
8.0
-
4
3
3
5
0.4
—
-
-
16.0
jjw
.
(CL) - Tan w/ orange mottling, sandy, LEAN
CLAY
Wet at 13.0' BLS.
16.0
-
-
18.0
4
4
8
7
•. .•♦�
'-.'
'�' • .
(SW) - Brown to tan, coarse, WELL GRADED
SAND, w/ few shale frags.
18.0
-
BORING TERMINATED AT DEPTH 18.0 ft
PiConcrete
Bentonite Pellets ri #2 Medium Sand

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 #: N/A
List all applicable well permits (i.e. County, State, Variance, Injection, etc.)
3. Well Use (check well use):
441394
14. WATER'
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
ZNl! R CAS s R TU: tN( ► erniai cl
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
6.5 ft.
2
in.
Sch. 40
PVC
UTEIt UASING. (Inca* multi -used we
pai
FROM
ft.
TO
ft.
DIAMETER
in.
THICKNESS
MATERIAL
ft.
ft.
in.
Water Supply Well:
❑ Agricultural
❑ Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
❑ MunicipallPublic
❑ Residential Water Supply (single)
❑ Residential Water Supply (shared)
Non -Water Supply Well:
® Monitoring 0 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: 09/28/16 Well ID#: UST1943-MWO3
5a. Well Location:
Facility/Owner Name
, Camp Lejeune
Facility ID# (if applicable)
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)
-ffq.3LI.9)ZSIN 1,h6151zic4�� w
6. Is (are) the well(s): Wermanent or D Temporary
7. Is this a repair to an existing well: D Yes or El 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: 16.5 (ft.)
For multiple wells list all depths in different (example- 3 @200' and 2 @ 100')
10. Static water level below top of casing: 13
If water level is above casing, use "+"
11. Borehole diameter: 8.25 (in.)
12. Well construction method: H.S. Augers
(i.e. auger, rotary, cable, direct push, etc.)
1
(ft.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Difinfection type: Amount:
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
6.5ft.
16.5ft.
2 in.
Slot .010
Sch. 40
PVC
ft.
ft.
in.
FROM
TO .
MATERIAL
EMPLACEMENT METHOD & AMOUNT
ft.
ft.
1.5ft.
4.5 ft
ft.
ft.
vEL:PA.0 (fapp b
FROM
TO
MATERIAL
EMPLACEMENT METHOD
4.5ft.
16.5ft.
#2 Medium #2 Medium
ft.
ft.
20. DRILLING1,06(a > . d tion l'sbee <il~ rt sa n)
•
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft
ft.
ft.
FEB
2 2017
i rfC11Ofl Prop.;
22. Cartific
Signature of erti ied Well contractor
1/30/2017
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 a � - e% details or well
construction details. You maya soya t'a ' � �` _ =� "'f essa .
rY
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit thiE1f litlan 30 lays of completion of well
construction to the following:
Division of WateriaiteilfratOgo r ; rocessing Unit,
1617 Mail ServicOP>grR .; : T 27699-1617
Wilmington RPP�ion l Oft'
.
24b. For Infection Wells ONLY: In addition to senamg 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 Sypply & 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.
Adapted from Form GW-1
North Carolina Department of Environment and Natural Resources - Division of Water Resources Revised August 2013

,,
3105CATLIN
Engineers and Scientists
21ELL SHEET 1 OF 1
LOG
PROJECT NO.: 213105
STATE: NC COUNTY: Onslow .
LOCATION: Camp Lejeune
PROJECT NAME: Site Investigation of Selec ed Sites
Profiled in the Final 1977 Report Oil
• p
Pollutio Survey -Site 1943g
LOGGED BY: Adrienne Rodgers
WELL ID:
UST1 943-
MWO3
DRILLER: D.T. Chalmers, Jr.
NORTHING: 346021
EASTING: 2492569
CREW: CATLIN/Davenport
SYSTEM: UTM NAD83 (m)
BORING LOCATION:
T.O.C. ELEV.:
DRILL MACHINE:C M E 45B TRACK
METHOD: H.S. Augers
0 HOUR DTW: 13.0
TOTAL DEPTH: 17.0
START DATE: 9/28/16
FINISH DATE: 9/28/16
24 HOUR DTW: N/A
WELL DEPTH: 16.5
DEPTH
BLOW
0.5ft
0.5ft
COUNT
0.5ft
0.5ft
OVA
(pPm)
�B•
o
l
S
G
SOIL AND ROCK
DEPTH DESCRIPTION
WELL
DETAIL
0.0 LAND SURFACE
o.o
,•
•
..; .
1 � :7
r•" "•'♦1
.:'-...
. •:'::
`-• . ♦-
w
•:,-.,
-.
h
• ♦
•
1 , 3 .
i• • • :
..
(SW) - Brown to orange, f. WELL GRADED
SAND, loose, dry.
Medium at 8.0' BLS.
Lt. grey, med. to coarse, wet at 13.0' BLS.
15.0
111) .(1.11.I J1 .11 j �1.11,I J 11IKM 1,1 J 111)1,1.11.1 Jl 1 I).�1.11,1 j.1 N)1,1l1,I J.l 1
........... ..
N N a,
3.0
—
0.7
_
8•0
-
1.5
11.0
-
20.2
_
—
_
: -
-
17.0
-
_
:
i
7 -
S
(CL) - Lt. gray, LEAN CLAY, saturated
17.0
BORING TERMINATED AT DEPTH 17.0 ft
LiConcrete
Bentonite Pellets [1#2 Medium Sand

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 #: N/A
List all applicable well permits (i.e. County, State, Variance, Injection, etc.)
3. Well Use (check well use):
441395
14.WATER
FROM
TO
DESCRIPTION
ft
ft.
ft.
ft.
15. INNERCASING O
(lei Dosed-1
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
6.5 ft.
2 in.
Sch. 40
PVC
16.: 3UTE CASING (fir mukkased well
ppli
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
ft.
ft.
in.
17.
Water Supply Well:
0 Agricultural
❑ Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
0 Irrigation
0 Municipal/Public
❑ Residential Water Supply (single)
❑ Residential Water Supply (shared)
Non -Water Supply Well:
Monitoring 0 Recovery
Injection Well:
0 Aquifer Recharge
0 Aquifer Storage and Recovery
0 Aquifer Test
❑ Experimental Technology
0 Geothermal (Closed Loop)
0 Geothermal (Heating/Cooling Return)
❑ Groundwater Remediation
O Salinity Barrier
❑ Stormwater Drainage
O Subsidence Control
0 Tracer
0 Other (explain under #21 Remarks)
4. Date Well(s) Completed: 09/28/16 Well ID#: UST1943-MWO4
5a. Well Location:
Facility/Owner Name
, Camp Lejeune
Facility ID# (if applicable)
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)
bO N 6c())61 1 ci5�-d" W
6. Is (are) the well(s): ffi[Permanent or DTemporary
7. Is this a repair to an existing well: DYes 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. 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: 16.5 (ft.)
For multiple wells list all depths in different (example- 3@200' and 2 @ 100')
10. Static water level below top of casing: 13 (ft.)
If water level is above casing, use "+ "
11. Borehole diameter: 8.25 (in.)
1
12. Well construction method: H.S. Augers
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Difinfection type: Amount:
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
6.5 ft.
16.5 ft.
2 in.
Slot .010
Sch. 40
PVC
ft.
ft.
in.
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
ft.
ft.
1.5 ft.
4.5 ft.
ft.
ft.
iSAND
applieab
FROM
TO
MATERIAL
EMPLACEMENT METHOD
4.5 ft.
16.5 ft.
#2 Medium #2 Medium
ft.
ft.
°MEIN ditiontd sheets
sa)
FROM
ft.
TO
ft.
DESCRIPTION (color, hardness, soil/rock type, Drain size, etc.)
ft.
ft.
ft.
ft.
ft.
ft.
ft.
Nft
P‘C‘A°
fRECFF1E
ft.
1..i
21.:REMARKS
FEB
22. Cartif, •o
•
Signat - of ' : .ified Well Contractor
srolomailtm
�
DWQ/BOG
1 /30/2017
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 diagram or additi �� : . ' •
You may use the back of this pall'
construction details. You may also attach additional pages if necessary.
etails or well
SUBMITTAL INSTRUCTIONNEB 1 3 2017
24a. For All Wells: Submit thWisater form withinQuality 30Rewion days of completion of well
construction to the following:
i ,
Division of Water ResC#�9 Processing Unit,
1617 Mail Sel filers tegilRcaktigibi 4 '4,699-1617
24b. For Infection Wells ONLY: In addition to sending the form to the
address in 24a above, also submit a copy of this form within 30 days of
completion of well construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells:
Also submit one copy of this form within 30 days of completion of well
construction to the county health department of the county where constructed.
Adapted from Form GW-1
North Carolina Department of Environment and Natural Resources - Division of Water Resources Revised August 2013

-�CATLIN
Engineers and Scientists
213105 SHEET 1 OF 1
,, .. ELL
LOG
PROJECT NO.: 213105
STATE: NC
COUNTY: Onslow
LOCATION: Camp Lejeune
PROJECT NAME: SiteInvestigation of Selec
Profiled in the Final 1977 Report
Pollution,Survey-Site 1943
ed Sites
Oil
LOGGED BY: Adrienne Rodgers
WELL ID:
UST1 943-
MWO4
DRILLER: D.T. Chalmers, Jr.
NORTHING: 345884 IEASTING:
2492623
CREW: CATLIN/Davenport
SYSTEM: UTM NAD83 (m)
BORING LOCATION:
T.O.C. ELEV.:
DRILL MACHINE:CME 45B TRACK
METHOD: H.S. Augers
0 HOUR DTW: 13.0
TOTAL DEPTH: 17.0
START DATE: 9/28/16
FINISH DATE: 9/28/16
24 HOUR DTW: N/A
WELL DEPTH: 16.5
DEPTH
BLOW
0.5ft
0.5ft
COUNT
0.5ft
0.5ft
OVA
DPPm)
LAB.
o
l
s
L
G
SOIL AND ROCK
DEPTH DESCRIPTION
WELL
DETAIL
0.0 LAND SURFACE
o.o
r
• ♦i
•.
• :
• :'^ :-
i ♦i
...; .-.
♦
�: �� .
i;" .•'♦'
;•-
: :
• ...♦i
: .
♦
.
••.•:
;i
♦
:a ,
i •. i
�•• .
(SW) - Brown to orange, f., WELL GRADED
SAND, w/ few rock frags., dry
Med. to coarse, few organics at 8.0' BLS.
Lt. grey, w/ few org. sand grains, wet at 13.0'
BLS.
15.0
R1(1_1i.11►
.11(.11_[i11..II�!.Il(i11IIJllllIl.II1JUIJII�i�1IIIJ..I�
..............
1 cr)j
in cn in
a
3.0
—
-
-
-
8.0
_
-
1.2
11.0
20.1
_
—
_
z
7/2
(CL) - Grey, LEAN CLAY, some mottling,
saturated.
17.0
17'0
BORING TERMINATED AT DEPTH 17.0 ft
[—IConcrete
Bentonite Pellets [1#2 Medium Sand

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
For Internal Use ONLY:
441393
D.T. Chalmers, Jr.
Well Contractor Name
4146A
NC Well Contractor Certification Number
CATLIN Engineers and Scientists
Company Name
2. Well Construction Permit #: N/A
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 0 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: 09/28/16 Well ID#: UST1943-MW02
5a. Well Location:
Facility/Owner Name
, Camp Leleune
Facility ID# (if applicable)
Physical Address, City, and Zip
Ornslow
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
•1-9-.3b090b2-1 N M'.10ffiaq-6-1-63
6. Is (are) the well(s): Permanent or D Temporary
w
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 o
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: 16.5 (ft.)
For multiple wells list all depths in different (example- 3@200' and 2 @ 100')
10. Static water level below top of casing: 12.5 (ft.)
If water level is above casing, use "+"
11. Borehole diameter: 8.25 (in.)
12. Well construction method: H.S. Augers
1
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Difinfection type: Amount:
4« 'WATER ZON
............ ......
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. INN
((eothernni eloloop).
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
6.5 ft.
2 in.
Sch. 40
PVC
ocrrE
or mild -cased' we
(if applicable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
ft.
ft.
in.
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
6.5 ft.
16.5 ft.
2 in.
Slot .010
Sch. 40
PVC
ft.
ft.
in.
FROM
ft.
TO
ft.
MATERIAL
EMPLACEMENT METHOD & AMOUNT
1.5 ft.
4.5 ft.
ft.
ft.
AND I+ RA'V EL
FROM
TO
MATERIAL
EMPLACEMENT METHOD
4.5 ft.
16.5 ft.
#2 Medium #2 Medium
ft.
ft.
21. i N (ate>add 6.o :s
sa)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
I J'1 `� ) �. f" F. ya L4 J3 o P E 't9 ' •; S•�
22. Ca . tion:
Sign
of Certified ell Contractor
1/30/2017
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. Yo tivtbalitalskif
necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Sub thiA forawithin 30 days of completion of well
construction to the followi :
1 3 2017
Division of Water Resources, Information Processing Unit,
1617 MailtitagfeiStOrf,. ►_ ` At NC 27699-1617
24b. For In'ection 'TAM a M . sending the form to the
address in 24a above, a 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.
Adapted from Form GW-1
North Carolina Department of Environment and Natural Resources - Division of Water Resources Revised August 2013

PROJECT NAME: 1 e nves e ig a ion o . r:
ec e• i es
Profiled
in the Final 1977 Report•
Oil
DIConcrete
to orange, f., WELL GRADED
ose.
f. to med., some mottling at 8.0'
coarse, wet at 13.0' BLS.
Bentonite Pellets Ej#2 Medium Sand

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
William J. Miller
Well Contractor Name
2927A
NC Well Contractor Certification Number
CATLIN Engineers and Scientists
Company Name
2. Well Construction Permit #: N/A
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
❑•igation
For Internal Use ONLY:
441239
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft,
ft.
55 INNER CASING OR TUBIING (geothermal'dosed-loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
8 ft.
2 in.
Sch: 40
PVC
16. OUTER. CASING (fur multi -cased wells) ) OR`.LINER (if applicable) `
FROM
TO
DIAMb I'ER
THICKNESS
ft.
ft.
in.
MATERIAL
ft
ft
in.
17. SCREEN
❑ Municipal/Public
❑ Residential Water Supply (single)
❑ Residential Water Supply (shared)
Non -Water Supply Well:
. ® Monitoring
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑ Aquifer Test
❑ Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
❑ Recovery
❑ Groundwater Remediation
❑ Salinity Barrier
❑ Stormwater Drainage
❑ Subsidence Control
0 Tracer
❑ Other (explain under #21 Remarks)
4. Date Well(s) Completed: 08/10/16 Well ID#: USTCCC2-TWO2
5a. Well Location:
Facility/Owner Name
Facility ID# (if applicable)
MCB CAMP LEJEUNE, JACKSONVILLE
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)
34.73517 N -77.39029 vtr
6. Is (are) the well(s): ❑Permanent or ®Temporary
7. Is this a repair to an existing well: DYes or ®No
If tliis 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 • forum.
8. Number of wells constructed:
For multiple injection or non -water supply wells ONLY with the same construction, you
can subunit one form.
1
9. Total well depth below land surface: 18
For multiple wells list all depths in different (example- 3@200' and 20009
10. Static water level below top of casing: 13.42
If water level is above casing, use "+"
11. Borehole diameter: 8.25 (in.)
12. Well construction method: HSA
(ft.)
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Ditintection. type: Amount:
20. `DRILLING LOG (at ch: a td iai:si` s i f n aryl
FROM
ft,
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
ft.
ft.
ft
ft.
ft.
WA°
F.5-c
ft.
ft '
21. REMARKS`
E‘,„ _7,11
JAN23 2017
22. Cartification:
'gnature of C ell Contractor
Von Procaswig Un4
OW
11 /15/2016
Date
By signing this f Jr,n, 1 hereby' c'erti/V that the uut'11l) was (were) constructed in accordance with
15A LV'C4 C 0 2C .0100 or 15A i CAC 02C .02(XI Well Construction Standards and that a copy of
this record has been provided to the well (Amer.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site detR/�1NailsR or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL 1NSTRUCTIO GE�VED/NCDEH
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the fallowing:
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL,
8 ft.
18 ft
2 in.
Slot .010
Sch . 40
PVC
ft:
IS. GROUT
FROM
ft.
in.
ft.
TO
ft.
MATERIAL
EMPLACEMENT METHOD & AMOUNT
4 it
ft.
6 ft.
ft
19.. SAND/GRAVEL PACK (if applicable/
FROM
TO
MATERIAL
6 ft.
18 ft.
#2 Medium Sand
EMPLACEMENT METHOD
ft.
ft.
TO
JAN 30201
Division of Water Resources,Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells ONLY:Wte
address in 24a above, also subns
completion of well construction to
•
!4 -� t` +�Officeform to the
loin 30 days of
.ii .glona!
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Sypplv & 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.
Adapted from Form GW- I
North Carolina Department of Environment and Natural Resources - Division of Water Resources Revised August 2013

WELL LOG
��"' CATLIN
216080.02
PROJECT NO.: 216080.02
STATE: NC
COUNTY: ONSLOW
PROJECT NAME: Install Wells at CCC-2, Knox
Landing
NORTHING:
362471
EASTING: 2483596
Engineers and Scientists
SHEET 1 OF 1
LOCATION: JACKSONVILLE
LOGGED BY: Zach Bush
DRILLER: William J. Miller
CREW:
SYSTEM: NCSP NAD 83 (USft)
DRILL MACHINE: CME-45B
BORING LOCATION:
METHOD:
HSA
CATLIN
OHOURDTW: 13.4
START DATE: 8/10/16
FINISH DATE: 8/10/16
DEPTH BLOW COUNT
0.5ft 0.5ft 0.5ft 0.5ft
OVA
(PM)
LAB.
M
0
L
0
G
DEPTH
24 HOUR DTW: N/A
SOIL AND ROCK
DESCRIPTION
WELL ID:
USTCCC2
-TWO2
T.O.C. ELEV.: 18.80
TOTAL DEPTH: 18.0
WELL DEPTH: 18.0
ELEVATION
WELL
DETAIL
3.0 -
5.0
7.0
9.0
c
c..
v.
9 18.0
c
z
c
-'woh
woh
2
2
7.7
1
2
3
4
7.3
2
3
11
15
8.9
5
-
7
7
4
9.0
9.1
W
W
oU
3c
)O a
0.0 LAND SURFACE
1.0
(GW) - ABC STONE
•
3.0
8.0
9.0
11.0
13.0
(SC) - Tan w/orange mottling, Clayey, f. SAND.
Moderatley plastic.
(CL) - Gray, CLAY w/orange mottling.
Moderatley plastic.
(SP) - Tan, med. SAND.
(SW) - Tan, med. to cse. SAND.
(SC) - Tan, Clayey, f. SAND.
17.8
15.8
-
0.0
10.8 _ 8.0
9.8
7.8
2" Sch. 40 PVC
0>
5.8 o ;
- o0
CV(j
RECEIVED/NCDENEf/DWR
JAN 3 0 2017
Water Quality Region40
BORING TERMINATED AT ELE#
in Clayey, f. SAND.
era
i Qn Sec
•RtigionaLOffice
•
6.0
18.0
Bentonite Pellets E#2 Medium Sand

For Internal Use ONLY:
WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
William J. Miller
Well Contractor Name
2927A
NC Well Contractor Certification Number
CATLIN Engineers and Scientists
Company Name
2. Well Construction Permit #: N/A
List all applicable well permits (Le. County, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
D Geothermal (Heating/Cooling Supply)
D Industrial/Commercial
❑ Irrigation
Non -Water Supply Well:
Oil Monitoring
D Municipal/Public
❑ Residential Water Supply (single)
❑ Residential Water Supply (shared)
Injection Well:
D Aquifer Recharge
D Aquifer Storage and Recovery
DAquifer Test
❑ Experimental Technology
❑Geothermal (Closed Loop)
❑ Geothermal (Heating/Cooling Return)
0 Recovery
❑ Groundwater Remediation
❑ Salinity Barrier
❑ Stornwater Drainage
❑ Subsidence Control
0 Tracer
❑ Other (explain under #21 Remarks)
4. Date Wells) Completed: 08/10/16 Well ID#: USTCCC2-TWOi
5a. Well Location:
Facility/Owner Name
Facility ID# (if applicable)
MCB CAMP LEJEUNE, JACKSONVILLE
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 Lai/long is sufficient)
34.73519 N-77.39035 «I
6. Is (are) the well(s): DPermanent or ®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 ks section or on the back of 'this form.
8. Number of wells constructed: 1
For multiple injection or non -water supply wells ONLY with the same construction,
can submit one, farm.
9. Total well depth below land surface: 18
For multiple wells list all depths in different (example- 3()200' and 2@1009
10. Static water level below top of casing: 13.43 (ft.)
limiter level is above casing, use "+"
11. Borehole diameter: 8.25 (in.)
12. Well construction method: HSA
YOU
(ft.)
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Difinfection. type: Amount:
441238
14. WAITER ZONES ; -
FROM
TO
DESCRIPTION
ft.
ft.
.
ft.
ft.
. 15. INNER CA S NNC OR TUSING. eothermal c%sec ititq'
TO
FROM
THICKNESS
Oft.
8 ft.
2 in.
Sch. 40
16. OUTER;CAS;INO (for muds cased wets) OR E NER (if. applicable)
TO
FROM
DL4METER
DIAMETER
THICKNESS
01tILLI G-LOG (at eh ad al sheefs if necessary)
TO
ft.
ft.
ft.
ft.
ft.
ft.
ft.
See-
ft
p‘111$w
ft.
21. REMARKS.
ft.j
FROM
ft.
ft.
in.
MATERIAL
Pvc
MATERIAL
ft.
17. SCREEN•
FROM
ft.
in.
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
8 ft.
18 rr.
2 in.
Slot .010
Sch. 40
PVC
ft.
ft.
in.
18.GROUT
FROM
ft.
TO
ft.
MATERIAL
EMPLACEMENT METHOD & AMOLTNT
5 ft.
7 ft.
ft.
ft.
9 SA►NDIGRAVEL`PA (f aPpneabie):
FROM
TO
MATERIAL
7 ft.
18 ft.
#2 Medium Sand
EMPLACEMENT METHOD
ft.
ft.
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
RECEVEQ
JAN 2
4
z-)
2017
22. Cart cation:
•
Signature of C
Ion r OCC. Vil U n'
OV OG
I Contractor
11/15/2016
Date
By signing 1 is for'rn, I )hereby cert j/V that the 14el1(s) was (were) constructed to accordance with
15A NCAC 02 C .0100 or 15A NC4C 02C .0200 Well Construction Standards and that a copy of
this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTR �'+ .:E$VD/NCDENR/R
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
JAN Rf9rhonDivision of Water Ruce Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells .k f131Eiing the form to the
address in 24a above, also su 0 •° ra&ijm within 30 days of
completion of well consWi#liginigttin ''':_ ,911, ,!.1 Office
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supplv & 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.
Adapted from Form GW-1
North Carolina Department of Environment and Natural Resources - Division. of Water Resources Revised August 2013

WELLLOG
"��" CATLIN
216080.02
PROJECT NO.: 216080.02
STATE: NC
COUNTY: ONSLOW
PROJECT NAME: Install Wells at CCC-2, Knox
Landing
NORTHING: 362478
EASTING: 2483576
SYSTEM: NCSP NAD 83 (USft)
DRILL MACHINE: CME-45B
BORING LOCATION:
METHOD:
LOGGED BY:
Engineers and Scientists
SHEET 1 OF 1
LOCATION: JACKSONVILLE
Zach Bush
DRILLER:
CREW:
HSA
William J. Miller
CATLIN
0 HOUR DTW: 13.4
START DATE: 8/10/16
FINISH DATE: 8/10/16
DEPTH
BLOW COUNT
0.5ft 0.5ft 0.5ft 0.5ft
OVA
(PPm)
LAB.
M
s
L
0
G
DEPTH
24 HOUR DTW: N/A
SOIL AND ROCK
DESCRIPTION
3.0
8.0
z
z
13.0
G
8 18.0
m
2
2
2
2
8.5
3
10
17
22
9.2.
4
6
4
5
8.7
Sat.
BORING TERMINATED AT 4,0
in f. SAND.' mm
out
'O Q
•
;If
•
•
•
0.0 LAND SURFACE
WELL ID:
USTCCC2
-TW01
T.O.C. ELEV.: 18.43
TOTAL DEPTH: 18.0
WELL DEPTH: 18.0
ELEVATION
(GW) - ABC STONE
1.0
3.0
8.0
9.0
15.0
(SC) - Tan, Clayey, f. SAND. Moderatley
plastic.
(CO - Gray w/orange mottling, CLAY.
Moderatley plastic.
(SC) - Tan to light brown, Clayey, f. SAND.
(SP) - White w/orange redox, f. SAND.
Tan from 13.0-15.0' BLS.
18.4
17.4
15.4
WELL
DETAIL
0.0
10.4 8.0
9.4
3.4
RECEIVED/NCDENR/R
JAN 3 0 2017
Water Quality Regional 18.0
�'.4ction
on eglonalOfce
•
2" Sch. 40 PVC
••••
f•
•
•
r:
•
7.0
18.0
0.0
Bentonite Pellets D#2 Medium Sand

lit)TR4)
WELL CONSTRUCTION RECORD GW-1
1. wen co"t$ctar Info don:
'Well Contractor
Name
NC Well
Contractor Certifies Name
Gs
{Water Supply Wen
Agricultural
Geothermal QMunicipal/Public
(Heating/Cooling Supply) °Residential Water Supply (single)
Industriawommercial DReSIdIJZII Water Supply (mod)
CoY Name
Z Well
List Construction Permit#:
al applicable welt coiutissction permits (i.e. WC CosiSir Variance'
3. Wei U e c ''tic)( heck well pall:
Non -Water Supply Wen:
Monitoring
4. Date Well(s) Completed:1Z -e' /6 Well ID# rR77 natimb
Sa. Well Location:
Facility/Omar Name Facility WO (if applicable)
„ zijfyi / a/ d eix Z 7.r 7
Physical Address. City. andZip
4",
Canty Parcel Identification No.
5b. Latitude and longitude in degrees/minutes/seconds or decimal d
Of'we3l field. one Wiens is sufficient) agrees.
4e-
3 77 ° e?a 1 / 3, rr-r �•
6. h(are) the wef(s) Jpennaieot or °Temporary
7. Is this a repair to an existing well: OYes or ESNo
fair ire repair. fill out known well construction repair alder 821 remarks section or on the back O t� information the ?10t1t11C D the
1
S. For Ceoprobe/DPT or Closed -hoop Geothermal Weis having the
con, only I GW l is needed. Indicate TOTAL S saran
dulled: 1 NUMBER of wells
9. Total well depth below land surface:
For matilsk was list all depths y, fr (e pis- 3@2O(r and 2@Jco
10. Static water level below top of g:
, owler level is above casi use"+" ( )
11. Borehole diameter: t7 ( )
12 Well constroctioe_method:
(e. auger, rotary. cable. direct push. ate-)
Sein
60
(fL)
FOR WATER SUPPLY WELLS ONLY:
13a. 'Yield (gpm)
Method of test:
13b Disinfection type: Amount:
Form GW.1
441127
�•�■a .'y0
11111111
17. SCREEN
I8.GROUT
Sign 5e of Certified Well Contractor
1636 Math Service Center, Raleigh,
NC 2 � '� -�i
24e. For Water Suzy & lnjeetion Welts: In additionlei
the address(es) above, also submit onesending the form to
completion of will to the � Y of this form within 30 days of
where constructed. county health department of the countl,
North Carolina Department of End
Quality - Division of Water Resources
Date
By signing this film f hereby stirs, fj, that the wells) was (were) constnicted in accordance
with 154 YCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standar and that as
ropy of thte record has been pmvlded to the wall over.
23. Site diagram or addition well details:
You may use the back of this page to provide additional well site details or
construction details. You may also attach additional P ii'necessary.welt SUBAL YNSTitUCI'It3NS ''ECti0,
24a. F
For All Wells. Submit this form within 30 .. '� days of � «::
constnrctton to the following: APAO
Division of Water Re
source; Inform�; � , ., : ,: Unit,
1617 Mai Service Center, Raleigh, NC 7 ? ! 6
Po,,
24b. For Injection Wilts: addition addition to the form to the address in 24a
above, also submit one copy of this form
construction to the following: kitheraj1°fcornptetion of well
i% lOtis �g%n
Division of Water Resources, Undergroun 'o ^ `Sry•� ��114
Revised 2.22_20i6
Print Form
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WELL CONSTRUCTION RECORD (GW-1
I. Wen Contractor Information:
Nicholas Sean Moreno
Wc1I Contractor Nance
4209-A
NC Well Contractor Certification, Number
GSE
Cony Name
2., Well Construction Permit #:
List all applicable well constnretion permits (La flit, County, State, Krionce. eta)
3. Wen Use (check well use):
Water Supply Well:
Agricutitutal QMunicipal/publjc
Geothermal (Heating/Cooling Supply) ()Residential Water Supply (ogle)
Industrial/Commercial
DResideatial Water Supply (shared)
Irrigation
Non -Water Supply Well:
Monitoring
Injection Well:
13
13
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
Recovery
QGroundwatcrRcrncdjatjon
C Salinity Barrier
OStormwater Drainage
DC Subsidence Control
aTsacer
(Other (explain under #21 Remarks)
4. Date Well(s) Completed: / Z 41744 Well ID# =K77 ittsi / 3??
Sa. Well Location:
MCB Camp Lejeune
Facility/Owner Name
rotes. � r, (AA
Physical
Address. City, and Zito
Onslow
Facility Ifs# (if applicable)
Z Yr'/7
County Parcel identification No. (PIN)
Sb. Latitude and longitude in degrees/Mbmtesfseconds or dedrttal degrees:
of well field, one latilong is sufficient)
41) V. ie6 N 77° J 'C 7e
6. ls(arej the well(s)Permanent or C)Temp►orary
7. Is this a repair to as existing well: QC Yes or No
if this it a repair, fill out known well cuv4rrwiiurr Information ml erplai» Ike Mure of the
fair arrder at r+eara, t xectinrr or em the bark of :Worn,.
8. For GeoprobelDPT or Closed -Loop Geothermal Wells having the same
construction. only 1 GW-I is needed. Indicate TOTAL NUMBER of wells
drilled:
9, Total well depth below land surface: 1 ' (R,)
For nothiple wells list all depths' ifdiffi ent (ample- 3 a(?0O' and 2@100')
For Internal Use only:
Print Form
14. WATER ,ONES
FROM
f.
TO
DESCRIPTION
IS. OUTER CASING (for multi -cased welh) OR LINER (if a linable)
FROMTO DIAMETER TNICKNEsS MATERIAL
ft.la.
16. INNER CASING OR TUIRING (geothermal closed -loop)
FROM TO DIAMETER ! THICKNESS ) MATERIAL
D ft•
Z
Z
IL
,�/u
17. SCREEN
FROM
, Z1
TO
DIAMETER
/nCf! Z
SLOT SIZE
/0
THICKNESS
MATERIAL
tr<
1/1. GROUT
i..
FROM TO
MATERIAL EMPLACE?
T METHOD & AMOUNT
U I /7 ft' 12-- 4..,
tti
19r SANDGRAVEI, PACK (if applicable)
FROM 1 TO
1
17
f.
MATERIAL
1zGf, 2 Sn�
ft.
EMPLACEMENT METHOD
r'r►'r 7
20. DRILLING LOG (attach additional sheet if necessary).
FROM TO DESCRIPTION {cep. hardens. sail►raelt t}pa grain daa at.
/0 FL 6.1, 14. r,
.17
f.
S-7.a
31)
"6
7-
,.� 1.A
ft.
ft.
f.
21. REMARKS
RE
22. Certification:
1.7 2017 i
inftmmation Rrocessin U 4
DWQ/
Dais
8y signing this forma hereby oertO, that eke well(s) ) coea'tm:hid in acuodance
with 1SA NCAC 02C .0100 or 1 SA NCAC 02C .0200 Well Corntrrictfan Standar& and that a
mry of this record has been provided to the wrjl 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:
10. Static water level below top of casing: (ft.) Division of Water Resources, If ucctter lee�lel it above casing, use" 1 " �'�, Information Processing Unit,
11. Borehole diameter: 6 (in.)
ILWell construction method: Sonic
(L . auger, rotary. cable, direct push, etc.)
Sign of C:ri;fled Wcll Contractor
1617 Mail Service Center, Raleigh, NC 17699-1617
24b. For lnlection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days ofcompletion of well REcEgvw/NcoENRtDWr°
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c, For Water Supply & Infection Welts: In addition to sending the form to
the addresses) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm)
Meth°d °f test: JAN 2s3 2017
136. Disinfection type:
Amount:
Form GW-1
where constructed.
Water Quality Regional
North Caroli fi j'ja lieyatarAtal Quality - Division of Water Resources
Wilmington Regional Office
Revised 2 22-2016
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WELL CONSTRUCTION
RECORD OW -I
1. Well Contractor Information:
Nicholas Sean More
well Contractor Name do
4209-A
NC Well Contractor CertificationNumber
GSE
Company Name
2. Well Construction Permit fit:
list all gsplkoble keg construction pits ast, MC, County,
3. Well Use (Check well use): Ya,nku„aa a
Water Supply Wen:
Agricultural
Geothermal(Heating/Cooling
DMunicipa!,1tzbljc.
Supply) EC Residential Water industrial/Commercial DResidential Supply (single)
bri Water Supply ice }
Non -Water Suppb, Well:
Ci Monitoring
[a.. :rWell:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal Hearin: o©lin: Return
E JGr undwater Rcmediation
OSalinity Banicr
OStormwater Drainage
()Subsidence Control
°E Tracer
er , lain under #21 Remarks
4. Date Well(s) Completed: /2- / P- f C Wen ID# 7w
irr
5a- Welt Location:
MC6 Camp Lejeune
Facility/Owner Nuns
Vi,cI Facility ION (if applicable)
t9/ A
i�
Physical Adrhess, may, sad Zip
Onslow
Cowry
Parcel Identification No, (PIN)
56. Latitude and longitude in degreeslm1 utes/secon . or
(if well field, one Iatlko�g is sufficient) � ` =
3Va 'd erg. 7PZ- N 77'
ti. Is(are) the well(s) ;''4 Permanent or QTempor,r
7. Is this a repair to as existing well: °C Yes or ' No
#*thisr is a repair:fill out kroune well c ,,
repair under #21 re v seecnom or on the bad ojth�rmexpfain the nature o}7hr
8. For Ceopr+obelDPT or Closed - Loop
construction, on 1 �_LOOp Geothermal Wells having the same
drilled: " l is needed. Indicate TOTAL NUMBER of wells
For scale e Ntlls / z
lixrall depths rd nt t' j@200* and 2(g1001
10. Static water level below top of casings
If way" !evens °hovecavin rare " I "
9. Total well depth below land surface:
11. Borehole diameter: 6
12. Well construction ,mod: Sonic
(Le. anger, rotary, cable. direct push, etc,)
fA.)
(fL)
(ft)
For Internal Use Only:
15. OUTER C'ASII�i(f f multi -cased wells OR I
TO DIAMETER INF.R ita *able
20. DRILLING LOG attach additional staff ; f ecessa
S ofCcrtiftcd WeI1 Contractor
Date
Ry :Igsigning lhis)6rm, 1 hereby c e tify that the aell s with 1SA NCAC 02C,0I00 or 1SA NC.AC. 02C.02O Well C � ter! at ° J1ra
copy o, f this recanthas been provided to the well owner. and that a
23. Site diagram or additional well details:
You may use the back of this page to
construction details. You may provide additional well site details or well
y also attach additional Pages if necessary,
a
24n, For All elts; Submit this form within 30 days of
construction to the following: completion of well
Division of Water Resources, Information Pro
cessing 16/7 Mail Service Center, Raleigh,Unit,
�C 27699L161?'
24b. For lnfcction 1Y H : In addition to sending thc form to above, also submit one copy of this fora within 30 the completion
of well
following: of completior of welt
Division of Water Resources, Underground Injection Con
trol Progra
1636 Mail Service Center, Raleigh, NC 27699-1636R`'
the address(es) above, also submit one : In addition to standing the form to
completion of well construction tothe �y of this foam within 30 days of
county health
�) .. + ructed.department of thc county
NorthCarolina Operations S tin ..
tly� msion of Wetter Rcsounres
-luxe
tr uIn
e
W
Revised 2 22-20I a
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WELL CONSTRUCTION RECORD (GW-1)
I. Well Contractor Information:
Nicholas Sean Moreno
Well Contras Nana
4209-A
NC Well Contractor Certification Number
GSE
Company Name
2. Well Construction Permit #:
List all applicable xtrlI construction permits (i.e. UJ : ('our ty, Steft Variance, efcj
3. Well Use (check well use):
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
lrrigation
Non -Water Supply Well:
Monitoring
Injection WeU:
113
IjMunicipal/Public
lE Residential Water Supply (single)
Residential Water Supply (shared)
C Recoverry
['Groundwater Rcmediation
DSalinity Barrier
DStormwater Drainage
Li Subsidence Control
For Internal Use Only:
441138
Print Form 1
14. WATER ZONES
FROM ' p
ft.
ft.
DESCRIPTION
ft.
15. OUTER CASING (far multi -eases! welk) OR INNER (if ap
FROM TO DIAMETER THICKNESS
it. h.
Ia.
16. INNER CASING OR TUBING (geothermal dosed -loop)
FROM TO TRICKNESS
O
.s"7t' . ft.
DIAMETER
z in.
, tic/
licabk)
MATERIAL
MATERIAL
PVC
ft.
fL
in.
17. SCREEN
FROM J TO
I n-ft
ft
ft.
DIAMETER
z
in.
in.
SLOT SITE
/1/
THICKNESS
,4'o
MATERIAL
Pig
18. GROUT
FROM
n
TO
ft.
// 7 ft.
MATERIAL .
4,44-
EMPLACEMENT METHOD & AMOUNT
ft.
ft.
19. SAND/GRAVEI. PACK (if applicable)
FROM
e ft.
ft.
TO
to ft-
-
MATERIAL
- z. „A
EMPLACEMENT METHOD
fTracer 20. DRILLING LOG (attach additional sheets if necessary)
Other (explain under #21 Remarks) , FROM 10 DESCRIPTION (tow. banter's, salifrock type. Isshe. eta)
4. Date Wells) Completed: 1 Z - r7- ! G Well zoo 77 Mkt 1 rz /U R- .i G ft. Z"'n. / /7.,
Aquifer Recharge'
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heathy/Cooling Return)
Sa. Well Location:
MCB Camp Lejeune
Facility/Owner Name
Facility 1D# (if -applicable)
Physical Address, City, and Zip
Onslow
County Parcel Identification No. (PIN)
Sb. Latitude and longitude in degreeslminutesiseeonds or decimal degrees:
(if well field, one tat/tong is suffrcicnt)
7' °'/0 (2 r. 5�01 N 77' ZO' / 9. 3'7 a? W
6. Is(are) the wells) Permanent or Temporary
7. Is this a repair to an existing well: Dies or N©
If this Is a repair, fill our known well construction lnfvrntation explain the nature oft e
repair tender 1121 remarks section or on the hack of thkform.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GIN-1 is needed. indicate TOTAL NUMBER of wells
drilled: 1
9. Total well depth below land surface: 60
Far multiple welly nit all rleeptinr if different (example-S a�32(10'and 43100')
10. Static water level below top of easing:
if Kbler tenet it above caring, ore
11. Borehole diameter: 6
(l)
(ft)
12. Well construction method: Sonic
(i.e. auger, rotary, cable, disoct push, etc.)
o ft.
f1.
ft.
0.
ft.
ft.
f
it
21. REMARK'S
JAN
information Proc
22. Certilicatia
fft•
Date
By signing this dorm, I hereby certl that Me aell(s) mu Om) constructed In accordance
with ISA NCAC 02C .0100 or ISA NCAC 02C .0200 Well Comvtr teflon Stir& and that a
copy of this record hat been provided to lime well mower.
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 Infection Wells: In addition to sending the form to the address in 24a
RECEIVED/NCDEN'submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
FOR WATER SUPPLY WEI.I.S ONLY:
13a. Yield (gpin)
13b. Disinfection type:
Fenn GW-I
Method of test:
JAN 2 3 2
Si: -. crtifi.• ` ell Contractor
017 1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Sunnily & Infection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
Million of well construction to the county health department of the county
Operations Se constructed.
North Carolina 111111 n o EnvRrorf gto t l l cgivision of Water Rcsourcc�
'� Revisal 2-21-2016
Amount:
Water Quality .P
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WELL CONSTR U 'I'ION RECOR
D GW-1
1. Well Contractor Information:
Nicholas Sean Moreno
Well Conte Name
4209-A
NC Well Contractor Ceetificat;ote Number
GSE
Company Nam
2. Wet! Coon Permit *:
Zist ataip/kttbk waggons Pe r e►be (ter UR; cowry siaiA variance.
eft)
3. Weti Use (check well use):
Water Supply Welt:
Agricultural
Geothamal OM.unicipal/Public
(Heating/Cooling Supply) tE Residential Water S
�'•
i . � � C�Rcs�d Supply (single)
Ini:. , ' �tial water Supply (shared)
Non -Water Supply Well:
.4 Monitoring
14 - , ,a ell:
Aquifer r Recharge
Aquifer Storage and Recovery
Aquifer Test
EltPcfmeatal Technology
Geothermal (Closed Loop)
Geothermal Heatin lin Return
4. Date Well(*) CompkJ: / _ -1
Sa. Well Location:
tvICB Camp Lejeune
Facility/Owner Nam
f f'c e,o, h ' /ur (
Physical Address. City. and Zip
OnsIQW
County
Parcel Identification No. (PIN)
Sb. Latitude and Longitude in
(ifw ll field, one lattlong is sufficient)�Uileuteslse�eon� or decl�nal deg :
Weu IDd ZI 77 t^, if/
Facility ID# (ifapplicable)
fLAC ZIT?
70 Z.0_ w
6. Is(are) the wett(s) f Peratanent or IjTemporary
7. is this a repair to an existing well: °[ Yes or { No
/f thin k o repair, fellow known well wean coax hit
repairander 421 t section or. on J�rutwius and a lair► oldie
the had nftirtr foam
8. For Ceoprobe/DPT or Closed -Loop Geothermal Wells
construction, only I GW-I is needed. indicate TOTAL ER the same
drilled: ! NUMBER of wells
9. Total well depth below land surface: CO
For nadripte aeltr list al detul, If drff (maple- IGa 200' anr! 2 /
001)
10. Static water level below top of casing:
/f tamer 1 1 ivbo above caving, nve " .
11. Borehole diameter: "I
On.)
12. Wed construction method. Sonic
(ere . suvr, rotary, cable, direct Pam, a e.l
FOR WATER SUPPLY WELLS ONLY:
13a. Yleid (gpm) Method of test:
13b. Disinfection type:
Form Gw.I
For Internal Use Only:
44113'7
I& OUTER CASING morn
. t iti-cased wells OR LINER if s ieabte
16, INNER CASING OR TUBING thermal closed
17. SCREEN
20
DRILLING LOG attach additional sheen if .ecles3al
DEsaurnav cube hardness. saittr.rk
22. Certificatio
DWQI
end. Well Contractor
Date8Y signing this � form.
with ISA hrC�C O2G,DI� lcertN that the�e!!(s) mu(were) contracted tt ,acti�vpka,c+e
copy afro #w rdha, been QZftQ Well Curative** Io u� well owner.� and that a
23. Site diagram or additional well details:
Youmay use the back of this page to
construction details. You may provide additional weft site details or well
y also attach additional pages if necessary.
,(N 24a. For All Walla: Submit this femrrt
within 30
construction to the following: Sys of completion well
M.)
s•
itc„iaLtaimak.t. , Raleigh,lliC2?6991636
in ion W t1s: in addition tut
Amount: the address(es) above, also submit onesending the form to
completion earl construction to the county of this form within 30 th
Qua ty health department of � �� °f
Water g
North C,arolirta Dcpert ntof t ! s Section
Wilmington .. itC1Ply +i atcr Resources
t- t
Division of Water Resources, information ProcessingU 1617 Mail Service Center, Raleigh, NC 27699-1617
246. F � r in � tfi � n W B : in addition to sending the f
to
t one copy of this °� address to 24a
to e following;
orm within 30 days of completion of well
Division at Water Resources,
1636 Mai[ Se Underground Injection Control Program,
Service Center
Revised 2-22-2616
Pant Form
Ulm
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WELL. CONSTRUCTION RECORD (GW-1
1. Well Contras Information:
Nicholas Sean Moreno
Weil Contractor Name
4209-A
NC Well Contractor Certification Number
GSE
Company Name
2. Well Construction Permit *:
List all gpplicabk wet/ construction pennies (La Ulf; ('slimy, Stave, Val eta)
3. Well Ilse (check well use):
Water Supply Wen:
Agricultural f Munic.
ipal/Prrb[ic
Geothemal (Heating/Cooling Supply) QResideatial Water Supply (single)
Industrial/Commercial , r Residential Water Supply (sherd)
lrri; on
Nos -Water Supply Well:
Monitoring
Injection en:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Technology
Geothermal (Closed Loop)
Geothermal Heating/Cooling Return)
DReonvery
,[ .Gnwndwatcr Rcmcdiation
['Salinity Barrio
D Stormwater Drainage
EC Subsidence Cow
DTracer
[lC Othercexplain under #21 Remarks)
4. Date Well(s) Completed: ,Z - / G - / G Well ID# J?Y ma r°
Sa. Well Location:
MCB Camp Lejeune
Facility/Owner Name
Alc.4 rrivd
Physical. Address, City, and Zip
Onslow
Facility IDS (if applicable)
K 1: ,e.• zyre
County Parcel Identification No. (PiN)
5b. Latitude and longitude In degrees/minuteslsecoads or decimal degrees:
Orwell field, one Iatflong is sufficient)
e) Ze4 r N 77 # zv ` 27. t9? '
w
6. Is(are) the wells)0Permanent or [}Temporary
7. Is this a repair to se existing well:. QYes or ON.
if this is a repair,; fill tat known WI consinest m 1nfirawtiva and explain the nature of the
repair solder N21 restarts section or on the hack of t L form:
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells ,having t e same
construction, only 1 GW-i is needed.. indicate TOTAL NUMBER of wells
drilled: 1
9. Total well depth below land surface: 60 (ft.)
For arriltiple svelb list all depths if different (exmrpk- 3@2O0' and 2 100')
10. Stade water level below top ()leasing: tom)
If %vier le►eJ iv above paying, use " t "
11. Borehole diameter: 6 (In.)
12. Wen construction method: Sonic
(Le. auger, rotary, cable, direct push, etc.)
RECEWED/NCDENRIDWR
FOR WATER SUPPLY WELLS ONLY:.
tie. Yield (gpm)
13b. Disinfection type:
Method of test:
Water Quality Rcg
Amount:rani ns Sect
on Wort'
JAN 23 2fil
Form GW-1
W'rlrntn
19 SAND/GRAVEL PACK (if applicable)
TO
FROM 1 TO
FROM TO
fForLntcrnaIUi y: 4411
14. WATER ZONF.S
FROM TO
IL
Print Form
DESCRIPTION
ft.
fl�
IS. OUTER CASING (for multi -cased wells) OR LINER (if a-
DIAMETER I THICKNESS MATERIAL
la.
16. INNER CASING OR TUBING ((eothernial closed -loop)
DIAMETER THICKNESS
Z i
17. SCREEN
FROM
1a.
,'lt)
bkt
MATERIAL
vL
TO
DIAMETER
rr ft.
eo * z.
far.
SLAT SIz.E
!b
THICKNESS
MATERIAL
ft.
18. GROUT
FROM
4/99 ft.
To
ce f
MATERIAL
EMPLACEMENT METHOD & AMOUNT
'TF.,e,s t�
ft.
FROM
f''z't. '°Ez .>!,.r� �(
MATERIAL
EMPLACEMENT METHOD
2& DRILLING LOG (attar.* additional sheets if necessary
e-Ptrt
raav:.i
i IAUEr�
ZON (flair baidslels. ! E
fie.)
Ik 0
/0
f`
r. ,4
11) n•
3o
It
104.4
/ TA" -5,-.4
- 3uft'
ea
It.
...
jJ
ft.
ft.
I
ft.
ft.
E$\IFE
R.
ft.
21. REMARKS
1 7 2017
,_____L:____
F„____.....,......, ..,
DWQ/BOG
Date
By signing this form I hereby certify drat the well(s) was (were) constructed in ice
with 1SA NCAC 02C.0100 or 13A NCAC d2C.020(f Wen Construction &enchain and that a
copy r fthir 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 welt site details or well
construction details. You may also attach additional pages ifnecessary.
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 Mad Service Center, Raleigh, NC 27699-1617
24b. For Infection 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:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699.1636
For Water Sunnily & Infection Welts: In addition to sending the form to
address(es) above, also submit one copy of this form within 30 days of
ion of well construction to the county health department of the county
constructed.
North Caroiina Department of Environmental Quality - Division of Water Rcsourvcs Revised 2 22.2016
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3. Well Use (check well use):
Water Srtpply Wen:
Agricultural QMupa!Jpubijc
Geothermal (Heating/Cooling Supply) QRW*SU,II*)
onnmcrciai OResidcntial Water Supply (shy)
Irri : lio
n
Non -Water Supply Well:
Monitoring
Injection Wen:
Aquifer Recharge
Aquifer Storngc and Recovery
Aquifer Test
&Pcrime ntal Technology
Geothermal (Closed Loop)
Geothermai (He atin : + l€n = Return)
Recovery
t ;tGroundwater Rcmcdiation
DE Salinity 'larder
cStormwater Drainage
()Subsidence Control
()Tracer
Other a • fain under #2l Remarks
4. Date Well(s) Completed: / z - / r- / L Well ID# 'C 7 7 "Ai /97
5a. Well Location:
MCB Camp Lejeune
facilityiOwnerNan
WELL CONSTRUCTION RECORD GW-I
1. Well Contractor lafornuttion:
Nicholas Sean Morena
wcrl Contractor Name
4209-A
NC Wen Con Certification Number
GSE
Cony Name
2. Well Coon Permit if:
Litt all applicable Ise +c tnrcvi rn permits (Le. W(; f'ounty.. Variance. etc}
Facility IDo (if applicable)
i1 //c. ale, el( e4 , /e zyrv7
Physical. Address, City, and rip
Onstow
County Parcel Identification No. (PIN)
Sb. Latitude and longitude in degreeslmuiauteslseconds or decimal degrees:
(if well field, one rat/long is sufficient)
7 /4 .r`}' 61.411. N 77° 20 VV '//7 w
6. Is(are) the weil(s)akerfnaaent or OTemporary
7. Is this a repair to an existing well: fC Yes orAll-No
lf1hi it a ► epair, fill asu known well caostructko information and explain the nature ((the
repair under t12 t r+t drkr seam" or at the hard of this fitrm
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: 30 t )
For multy le welts ltrt all depths ffd lffcxw (ale. 3 00. and 2@100).
10. Static water level below top of easing: l�
1 water level � above )
f Vie casing, exC r
11. Borehole diameter: 6
12. Well construction method: Sonic
(e.e. auger, rulaiy. able. durct push„ etc.)
rn+) 24b. For Infection Wells: In addition to scndin th
g c form 1Q the address in 24a
.rt .►,'` submit one copy of this form within 30 days of completion of well
REeEVED/NCDENR �s I 'on to the following:
/-/-/G
Date
By signing this frer.1 herrby cert6 that the tie l(s) was (*ere) amstnrcted In =alliance
with 15A NCAC 02C.0100 ar 111 NCAC 02C.0200 Well Canatrnction Simulants and that a
copy of Phis record Iris been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additions/ well site details or well
construction details. You may also attach addtional 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 Unity
20. DRILLING LOG (attack additional sheets if necessary)
FROM t. DESCRIPTION (color. ssfesei
type., Ends tbs. etc.
/
ft.
ft.
For Internal Use Only:
ft.
DESCRIPTION
441135
tS, OUTER CASING (for alahi-cased wells) OR LINER (Way licshIe)
FROM TO DIAMETER T1rlCKNIrsg MATERIAL
t!. In.
ft.
17. SCREEN
FROM
20 R'
ft.
beratal closed
i rs_'' MATERIAL
tiG
Print Form 1
TO
3d
DIAMETER
Z
Sc.O't` SIZE
10
THICKNESS
(• .10
MATERIAL
1*. GROUT
FROM
f.
is.
eve
9 ft`
R.
ft.
TO
(MATERIAL EMPLACEMENT METHOD & AMOUNT
f 7 ft'�X.a fir r t (tern 6
ft- ILLA
Tie"/wk...
fr.
19. SAND!(;RAVF!. PACK cif applicable)
FROM l TO
MATERIAL
/ i 3'0 R ez
ft.
EMPLACEMENT METRO!)
TO
.70
f.
ft.
J3 /7; j...(
21. REMARKS
22. Certification:
Signatdc of Certified Well Contractor
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test AN V 2
13b. Disinfection type: Amount:
Form GW-i
North carols
1617 Mail Service Center, Raleigh, NC 27699-1617
ivision of Water Resources, Underground Injection Control Program,
1636 Man Service Center, Raleigh, NC 27699-1636 •
2014c, For Water Sung
h► & Infection Wells: In addition to sending the forth, to
the address(es) above, also submit one copy of this form within 30 days of
completion of well constrvction to the county health department of the county
Water Quala y, tonstracted..
.� aerations Section
1
' cob 4 eDivision of Water Rcsoweca
Revised 2.22.2016
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WELL CONSTRUCTION RECORD GW-1
1. well Ceara ttor',format on
Nicholas Sean Moreno
weir Contractor Name
4209-A
niC Wen Contractor Certification Number
3.Wen Use (check wen use)
GJE
Company Nam
2. WeR Comet Permit Ill:
Liu all applk rconstruction perwalts (e tUR[I Comity, State; Varlorce.eft t
Water Supply Well:
Agricultural
['Municipal/Public
Geothermal (Heating/Cooling Supply) E Residential Water Supply (single)
Industrial/CommercialJResidentiai Water S
Irtti . uPPIY (shared)
lion
4. Date VWe 1(s) meted: Z - I'/ -/t
Sit. Wen Location:
MCB Camp Lejeune
Facility/Owner Nurse
Weft ill# 7?--N
Facility ID# (if applicable)
frie 11144 641 Z 71.5f
Physical As;. City. and vp
endow
County
Parcel identification Na. (PIN)
Sh. Latitude and longitude fit degrees/minutes/Seconds or decunal degrees:
(if well field, one latflong is sufficient)
W
h. Is(are) the weds}WPermaaent or DC Temporary
7. is this a repair to an existing wen: DC Yes orNa
filar is at raepair, fill neat *saw well c9rrnrte'nc:tian Inflarmaikm and
ter wickr 021 remarks acetic)" or an the hock of thin form.
° ke the eaten: alike
8. For GeoprobefDPT or Closed -Loop Geothermal Welts having the same
construction, only 1 CW-1 is ncndcd. Indicates TOTAL NUMBER of wells
drilled: I
9. Total well depth below land surface: (0.)
Far ar sbpk wells It%f all depth ff different (example- 3(02 1 •and 2 10frj
10. Stalk water level below top (Waning:
If outer level is abort eating uw °'r "
it. Borehole. diameter; 6 (in.)
12. Well construction method: -- Sonic
(ere. auger, Mary, cable, died push, etc.)
FOR WATER SUPPLY WFIJ.S ONLY:
izr
(0.)
For Internal IJsc Only:
14. WATER FOES
FROM i TO
DESCRIPTION
441134
15.OUTER CASING (far mufti -cased welMt0R LINER (f ap Heat*)
FROM TO DIAMETER THICKNESS I►tATERlAI.
ti be.
16. INNER CASING OR TURING (Eeotber/nal closed -loop)
FROM TO — DIAMETER THICKNESS
• 17. SCREEN
1& C:RdiiT
FROM
/o s
R:
To
?
ro5 t.
Ile
DIAMETER
MATERVAL
PVC
TRICKPEss
, i/b
Print Form
MATERIAL
MATERIAL EMPLACEMENT METHOD it AMOUNT
�r•►7• wit ie I Cr
Pe —#.41 "Tre.brs.
19. SAND/GRAVEL PACK (if applicable)
FROM
`
/�
0.
1 MATERJAI.
Ifts46.Z. 1..,,j
0.
EMPLACEMENT METHOD
r pu
20. DRILLING LOG (attach additional sheets if necessary)
FROM 1 TO DESCR[Ir'f0y ((Nee. hardness. sot eck
�► ts+� rDe. eta)
0 it ft. kik X.
/0
410
21. REMARKS
22. Certification` DWQ /B
OG
ft.
M1r �It
�.� r,G,(
,�* 1- / -
Si 1
'lied Wc11 Contneetoc Date:
Ry slgrrhrg Ms Prim I hereby � f, that the 1+ecll(s) was (were) cans frvaej In arearclancer
with 1SA it+CAC (12C .0100 er t SA NCAC 02C .0200 Well Cnn inaction Stancher and that ar
copyofthts recant has beat provkkd to the well wrier.
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.
5virgi iAL LNSTRUCTtON�
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 276994617
24b. For jnj �'Yet1 e.�ctlon t• In addition to sending the form to the address in 24at
above, also submit one copy of this form within 30 days of completion of well
JAN 1 7 2017
icon Procftssing Una
_$ECEIVEDINCDE
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
Fonn OW-1
of
the following:
Division of Water Resources, Undergrvtrnd Injection Control Program,
1636 Mall Service Crater, Raleigh, NC 27699-1636
filr Water Suoolx & Infection Wad: In addition to sending rho form to
treaudt£ress(es ) above, also submit one copy of this farm within 30 days of
completion of well construction to the county health department of the county
1M
where c nsc .
Mw r Quality Reg
North Camilla Dcpartmc p 1 CC of Water Resources .
. a Rev 2 22-2O t
Wilmington Region. .
Scanned by CamScanner

WELL CONSTRUCTION RECORD GW-1
1. Wdl Centractor Information:
Nicholas Sean Moreno
wo Contractor Name
4209-A
NC Well Contractor Certification Number
GSE
company Nance
2, Well Construction Permit #:
List all ("Amble rya construction permits (Ls. fJI(; (bony. Stagy Variance, etc. j
3. Wd1 Use (check well use):
Water Supply Well:
Agricultural QMunicipal/Public
Geothermal (Heating/Cooling Supply) DResidential Water Supply (Single)
Industzial/Commercial DResidential Water Supply (shared)
Non -Water Supply Well:
'( Monitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
()Recovery
QGroundwatc r Rcxlx:diatiorn
()Salinity Barrier
EC Stormwatcr Drainage
()Subsidence ConM©l
()Tracer
tOther(explain louder #21 Remarks)
4. Date Well(s) Completed: I? ` (- J G Wen ID# 2 7? NW Ng
Sa. Well Location:
MCB Camp Lejeune
Facility/Owner Name Facility MN (if applicable)
G h. LIb,G', Ciao /rrctt Z 'f4r?
Physical Address, City, and Zip
OfIStow
County Parcel Identification No. (MN)
56. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lattlong is sufficient)
TV ° 3 S 1 'yy- 073 t► N 77' 201 g 7. 777 'r
vEr
6. IS(are) the weil(s) f Permanent or ()Temporary
7. Is this a repair to an existing well: QYes or fiNo
If this is a repair, fill out known well c+aoatrmct&ut information and explain the nature of the
repair sender 1121 marks section or on the hack of thivform.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW- I is ne:cdod.. Indicate TOTAL NUMBER of wells
tiled: 1
9. Total well depth below land surface: 60 ( )
For surltipk resells list all depths tf66ferr u (txample- 3Q200`and 24100)
10. Static water level below top of easing: (f)
glower level is above awing, ing one b I "
11. Borehole diameter. 6 (in,)
ILWen construction method: Sonic
(Le. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
Form GW-I
For Internal Usc Only:
441133
I Print Form
14. WATER ZONI.S
FROM
TO
DESCRIPTION
rt.
15. OUTER CASING (for malt -cap' ed wells) OR 1.INF.R (if ap inditeL_
FROM I TO DIAMETER THICKNESS MATERIAL,
h'ft. la.
16. INNER CASING OR TUBING (aeot ermat closed -loop)
THICKNESS
FROM I TO DIAMETER
C. IL s—x"" ft• iu.
ft.
17.SCRFEN
FROM
f rR
n
TO
MATERIAL
yu
pvc-
eo ft.
DIAMETER
in..
SLOT S1%E. LTHICKNESS
♦C>
18. GROUT
ft.
ie.
.g o
MATERIAL
rivc
FROM TO
MATERIAL
��r.srTG
n ti y!-� �
0 fc '/? '
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM ( TO 1 MATERIAL
fre
ea ft.lsz s;
EMPLACEMENT METHOD & AMOUNT
ft.
rt.
1 EMPLACEMENT METHOD
20. DRILLING LOG (ittecie additional sheets if necessary)
FROM TO DESCRIPTION (color. hardens. eelticeek type. Ernie sleet etc-)
Lui 1;J
♦c
tco
!t.
ft.
ft.
Tei
�D
ft;.
war 7't
ft.
ft.
f1,
21. REMARKS
JAN 1 7
22. Certification:
ion Processing Una
DWQIBOG
Signature of Certified Well Contractor Date
Ry signing this form I hereby certify that the welt(s) ii (were) constructed in accordance
with 13A NCAC 02C .0100 or 13d NCAC 02C .0200 Weil Cotatructtatt Staab and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional wet! 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 !flail. Service 1'EIY!Yffijt1
24b. For infection Weill: in addition to sending the form to die address in 24a
above, also submit one copy of this form within. 30 days of completion of well
construction to the following:
JAN 2. 2 ?
Division of Water Resources, Underground a
� �tl ontroi
1636 Mail Service Center, Raleigb, NC 27699-1636 M�
24c. For Water Sunolv & InIeetio��Q i rj l' 8 the font' to
the address(es) above, also submit oetpepartd1131€6mdflithin 30 dais of.
completion of well construction WilimiffirkihRtitirdprinigthe county
where constructed.
North Carolina Department of Environmental Quality - Division of Water Resources Revised 22 2bl 6
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WELL CONSTRUCTION RECORD
1. Well Coo
etor Information:
NTh2flMoreCiO
Namc
42pg_q
NC Well Co
C�fia�tion Number
Company Name
2. 2.�e1DConstructionP a:
applicable we11construction pewits (Le UR;
3. f' oa�+y..�IaJe: vav etch
Welt Use (check well use):
Water Supply Wen:
Agricultural °
M ipal/PublicGeothe al (Heating/CoolingSupply) CResidential Water Supply (single)
hri , I Residential Water Supply (shared)
Non -Water Soppy, Well:
Monitoring _
4. Date Welk') Completed: % r. /
Sa. Wen
MCB Camp Lejeune
FacilitytOwner Name
tit ix, '' 4,4
PhysicalAddress, City, and Zp
Onstow
County
Parcel Identification N4 (PIN)
Sb. p titade and longitude in degrees/minutes/seconds inutes/seconds or decimal
field,
one g is sufficient)
Se/ '57. 007" N 77° 20 1.7C) , "�
70 Z w
6.1s(are) the wetl'(s), Pertmanent or , f Tempora
ry
L well um i7 ? 4'C
Facility ED# (ifapplicable)
For wrultyle *es ha all /
depths V'd (inane le- 3@200' and 2®1063
10 Static water level below top oteasing:
If stater level Er above cant sae a t �•
11. BoreLotc din' meter: 6
CW-i
7. Is this a repair to as ezisting wen: DE Yes or alNo
tf t is is a repair. fll out known well construction i
repai+ der elr *action orraw the hock ofthtr f ttn ffunnalion and
explain the nature oftlGe
8. For Ceoprobel»PT or Closed -Loop Geothermal Wells having the same
drillconstd�on. only 1 GWT 1 is needed. Indicate TOTAL NUMBER of wells
9.Total well depth below lard surface:
12. Wen construction method: Sonic
(i.e. aum rotary, cable, direst push, etc.--)-_
FOR WATER SUPPLY WELLS ONLY;
13a. Ykld (gpm) Method of test:
13b. Disinfection type: Amount:
Form GW--t
(f)
IS. OUTER CASING fomulti-eased wells OR LINER if. 7Iicable
Ie. INNER CASING OR TUBING eotbermal c�
MATERIAL
17. SCREEN
18. GROUT
ItSAND/GRAVEL PA(:K ifa, ,.•
22. Certification:
Si. urn of Certified Well Contra
ctor Datc
By signing this Prot I hereby acrid, that the Me!! s was
with 1 SA N AC 02C .0100 or 114 NOW' 02C.0200 Well � ta`I in
r accordance
copy of this record has been provided to the well owner. that o
23. Site diagram or additional well details:
You may use the back of this page to
Provide additional
construction details. You additional well site details or well
y else attach additional pages ifnecessacy.
�TTAI mINS'I'Ri1CTrttNa
24a. For An Wens: Submit this form within 30 days of completion f
construction to the following: p o well
con
Division of Water Resources, Information Processing
1617 Mail Service Center. Raleigh, NC 276991 Unit,
1617
24b. Fo!Jnicchon was: In addition to sending the form to the
address Within. 30 of 30 days f in 24a
o well
Division or Water Resources, Underground Injection Control
QQ Program,
3in
econ Wens: in addition to sending the form to
the address(es) above;, also submit one copy of this form within 30
completion of well construction to,thc county health d days of
where com�%t r Quality Regiana: department of country
1i1oirtli;mta,c+rtofE„vii+anmcnw Operations Sectiorf
Quality1 I Off icy
1636 Mail Servi ter, Raleigh, NC 27699-1636
N .r�
Revised 22.2016
Print Form
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WELL CONSTRUCTION RECOR
D GW-1
1. Wdl Cout actor Information:
Nicholas Sean Moreno
Well Contract. Name
4209-A
NC Well ContractorCertification Number
3. Well Use (check well use):
GSE
Company Name
2. Wen Construction Permit #:
Leal all applicable well construction permits (1.a Ul(; roomy, »ate. Variance. arc
Water Supply WeQ:
Agricultural [Municipal/Public
Geothermal eating/Cooling Supply) ()Residential Water Supply (single)
Industrial/Commercial lResidential Wa
Ir i tier to supply (shared)
Injection ell:
Aquifer Recharge
Aquifer Storage and Recovery
Alfa Test
Experimental Technology
Geothermal (Closed LAP)
OGroundwater Rcr»cdiation
„C Salinity Barrier
f Stotmwater Drainage
()Subsidence Control
DTracer
Geothermal (Heatins/Cooling Return) [T[ other' (e.>plain ernder #2I Remarks)
4. Date Wells) Completed: 1 z - 4 - !G
Sa. Wen Location:
MCB Camp Lejeune
Facility/Owner Name
Well ID# .7e77 PfsWeic
Facility ION (ifapplicibke)
flii• ei*�' ej 'r"7
Physical Address. C ty, and Z'up
•onsfow
CountyParcel Identification No. (PIN)
Sh. Latitude and longitude le degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
79o,17 `Sa. 5re N 77° zo l 70- Zf Z.. ,w
b.is(art) the well(s))Pernlanent or ['Temporary
7. Is this* repair to an existing well: ['Yes or , No
files *i a repair, fill out known welt c omdrurtlow information and explain the ante (Ole
repair mode, 021 remarks semi,+, or on the -hack rftkir form.
8. For Geoprerbe/DPT or Closed -Loop Geothermal Wells having the same
constriction. only 1 GW 1 is needed. Indicate: TOTAL NUMBER of wells
drilled: 1
9. Total well depth below land surface:
For multiple sells Jest all (Apthe ff dlff�At (example- 3@200' and 2@100 )
10. Static water level below top of easing: (ft.) If seater !evens ahoy casing we " "
11. Borehole diameter: 6 (in.)
12. Well construction method: SOnIC
(i.e. auger, rotary, cable, direct push, etc.)
(IL)
FOR WATER SUPPLY WELLS ONLY:
I3a. Yield (gpm) Method of test:
13b. Disinfection type:
Form GW-1
For Internal Use Only:
14. WATER ZONES
FROM
a.
ft.
TO
441131
IPrint Form
DESCRIPTION
ft.
IS. 0111'ER CASING (tor multi -cased wells OR LINER (if sp icable)
FROM TO DIAMETER t THICKNESS MATERIAL
ft. In.
16.1NNER CASING OR TUBING (geothermal closed__
FROM TO DIAMETER J THICKNESS
o ° sr ft-
ft.
17. SCREEN
FROM.
rrft
ft.
lit. GROUT
FROM
1
MATERIAL
prc
TO
GO
ft.
ft.
DIAMETER
Z Ia.
,e.
SLOT SIZE THICKNKSS
/0 , /o
MATE RIAI,
L/5f
v ft:
tw
TO 1 MATERIAL
rz.0.
cyan.
g,./1„di
EMPLACEMENT METHOD & AMOUNT
1' Pis
ft.
14. SANID/GRAVE1. PACK (if applicable)
FROM TO MATERIAL f EMPLACEMENT METHOD
fts e o 3t-z s^ram
f.
ft
20. DRILLING LOG (attach additional sheets if aeceuary)
FROM TO DESCRIPTION (attar, br isesj, soil/reek type, Eras da` et.
I41/ I;,
/u
30
ft.
ft.
/0
tr.
?o ft.
t0
ft.
r_...eA
r^�eit
ft.
21. REMARKS
EC
22. Certification-
Si _. of Certified Well Contractor Date
By signing Ills fcrrm.1 hereby atriO, that the WIN war (were) co utractad 1, accordance with ISA NCAC 02C .0100 or I SA NCAC 02C .0200 Well Cooytructgart Standards and that et
copy of this record liar been provkled to the x+rl1 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-I617
241,. For In cction Wells: '
� to addition to sending the form to the address in 24a
above, also submit one copy ' , .' t , : : etion of well
construction to the following: i� , -• j ' ,
• ion ProceisOng Unit
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center Raleigh, NC 27699-1636
24e, For Water Supply & Iniectinn 1 : I ladial sending
the address(es) above, also submit one copy of this form within the form to
Amount: completion of well construction to the coup health days of
-. county department of the county
where constructed. Water Quality Regional
Operations Section
Mirth carulina DcpartmcM of Envimiuncntat Quality - Division of Water RcsouWil m i n gto n Regional Off i$+& d 2 22 2016
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WELL CONSTRUCTION RECORD GW-1
1. Well Contractor tarorn atiio■:
Nicholas Sean Moreno
welt Contractor Name
42O9 A •
tic Wen Contractor Catigation Number
nnr-
Company Name
2. Welt Coastracdoe Permit W:
l let all applicable Kell cansfrr,rlton permits (i.e. tilt ; County, .4sare Variance. we-)
3. Well Use (check well use):
Water Supply Weft:
FROM 1 TO
a
R.
ft.
lb. INNER ('ASINC OR TIMING (geothermal closed -loop)
DIAMETER THICKNESS
I
For Internal Use Only:
Print Form
14. WATER ?.ONES
FROM
f.
TO j DESCRIPTION
1t.
15. OUTER CASING (for multi -eased wells) (R LINER if a icabkr
FSWM T om, DIAMETER I THICKNESS MATERIAL
R- ill.
Z i` Liu
Agricultural C Munici
IpaUPublic
Geothermal (Heating/Cooling Supply) Qi Residential Water Supply (single)
Industrial/Commercial
QC Residential Water Supply (shared)
hri _ tion
Non -Water Supply Well:
Monitoring
Injection Well;
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Fleeting/Cooling Return)
fljRecovcry
QGroundwater Remediation
QSalinity Barrier
[ Stonawater Drainage
Q[ Subsidence Control
Chaco.
°E Other (explain under #21 Remarks)
4, Date Well(s) Completed: f z — 3 ' / G Welt ID# r 77 4-1W Pig
Sa. Well Location:
MCB Camp Lejeune
Facility/Owner Name Facility ID# (if applicable)
tie 1-4 4 ,r/54 A,1k,'c •e ?rei7
Physical Address, City. and Zip
Onslow
Coinly Parcel Identification No. (PIN)
3b. Ladtude and longitude In degreeshoiautestsecoids or decimal degrees:
(if well field, one tat/long is sufficient)
?r'-t5 `ro. 76r" N 77' zo' 3o. 1170 #
6. Is(are) the wells) jaPermanent or Qt Temporary
7. Is this a repair to an existing well: pies or No
!f thin is a repair, fill OW know, well construction information explain the nature oldie
repair under 021 reararha section or on the hack of thtr 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 surrace: Z. (ft.)
For rwuhlpla xe11x llrt all depths if different (example- 3@u 201i' and 2@ 100)
10. Static water level below top of casing: (f)
ff water kvee1 iv abuse caving uve " " •
11. Borehole diameter: 6 (in.)
IL Well construction method: OnIC
(i.e. auger. rotary. cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b.Disiafectlon type: Amount;
arm GW•l
17. SC'REtN
FROM 1 TO
f f Z-7,
I8. GItOi1T
FROM
7
v
MATERIAL
PvL
R
DIAMETER
-� in.
der.
SLOT SIZE
io
THICK NESS
4/0
MATERIAL
15.
TO
/6 fe'
F) R'
n.
MATERIAL
t ]rh'Tis r�
/cr rlsI 4
19. SAND/GRAVEI. PACK (if applicable)
FROM 1
TO MATERIAL
/6 l
ft.
ev R. tLz r
EMPLACEMENT METHOD & AMOUNT
rPei
er rm
EMPLACEMENT METHOD
rr"le r II
20 DRILLING LOG (attach additional sheets if necessarn
FROM TO DESCRIPTION {color, hardaess.solgrock type, arena atu, ate
U /(lft.he tr�r rA,c4
7d
15.
rt.
ft.
ft.
21. REMARKS
ECEI\'EDED
JANi.7 2017
22. Certifkatio
ipn Proceesing Qnit
DINC)/BOG
Si . turn of Certified Well Contractor Dam
G
By signing this fur" 1 hereby c ertifp drat the *riffs) war (were) contracted in accordance
with 15A NCAC 02C.0100 or 154 NCAC 02C.020v3 Wetf Co clan St it and that a
copy of this record has been provided to the Kell oasrer.
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 ifne cessary.
SUBMITTAL INSTRUCTIONS tram 24a. For MI Wells: Submit this m within 30 days of completion of well
construction to the following: ia
Division of Water Resources, Inforation Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-16I7
24b. For Infection Wells(: 1
above, also submit one copy
construction to the following:
14. ri
rims in 24a
lotion of well
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Cen t 1SN yf q-I636
24c. Fr Witter Sunni* & Infection Welts: In eaddition to sending the forth to
the addresses) above, also submit one copy of this form within 30 days of
compaction of well construction t of the county
where constructed. ����������
Operations Section
�,�;�, Wilmington Regional Office
Department of Environmental Quality. Division of Water Resources Revised 2-22-2016
Scanned by CamScanner

WELL CONSTRUCTION RECORD GA-1)
1. Well Contractor Information:
N) PI
Nn
Well Contractor Name
r-+L reIvo
4,1 i' o
NC Well Contactor Catification Number
Cot:y- Nam
2. Well Construction Permit #:
List all applicable well construction permits fee UIC, County. State. Variance. etc.)
3, Well Use (check well use):
Water Supply Well:
Agricultural. ElMunicipal/Public
Geothermal (IleatingfCooling Supply) DResidcntial Water Supply (single)
gle)
Industrial/Commercial DResidcntial Water Supply (shared)
Inigatian
Non -Water Supply Well:
Monitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Recovery
DGroutzdwate:r Remediation
DSalinity Barrier
DStormwater Drainage
Experimental Technology DSubsidcnce Control
Geothermal (Closed Loop) f Tracer
Geothermal (Heating/Cooling Return) DOther (explain under #21 Remarks)
4. Date Well(s) Completed: JZ - 7- / G Well ID# Jr 7 --inW /9 3
Sa. Well Location:
17 C ($ CApl.-,
FacRity/Owster Name
1' l C) el ` /7/r e C^n .p
Physical Address. City. and Zip
r h
Facility ID/1 (if applicable)
I� tt�rC 'Z7S-V7
County Parcel IdentificationNo. (PIN)
Sb.. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one. fat/long is sufficient)
re/ ° 7L N 77 zu 76t/ f W
6. Is(:re) the well(s)OPern anent or IJTetnporary
7. Is this a repair to an existing well: DYes or ,iNo
If this is a repair. fill out known well construction information and explain the nature of the
repair under 1121 remarks section or on the back of thisform.
8. For GeoprobelDPT or Closed -Loop Geothermal Wells having the same
construction, only I GW-I is needed. Indicate TOTAL NUMBER of wrens
drilled: 1
9. Total well depth below land surface: 6. 0
For multiple wells list all depths 1f dr,�ferent (example. 3@d,10O' and 2 IOO1)
10. Static water level below top of casing: (0.)
It water level is above caxiag use
I I. BBorehoIe diameter. (In,)
12. Well construction method:
5-on1C
(0.)
(i.e. anger. rotary, cable., direct push, err.)
FOR WATER SUPPLY WELLS ONLY:
13s. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
Form GW-1
For Intcrnat Use Only:
PrintForm
441129
14. WATER ZONES
noM
TO
DFSCRWPIION
ft.
ft.
fL
15. OUTER CASING; fnr multi -eased welts) OR LINER Map icabte�
FROM TO -DMMfTF.R THICKNESS MATERIAL
ft. in.
FROM
16. INNER CASING OR TURING (geothermal closed -loop)
TO
s--r it.
OIAMI TRR
in.
• TRIMNESS
tja
MATERIAL
I vc._
!t.
la.
17. SCREEN
FROM
TO I DIAMRTER
�► far.
Ko ft-
SLOT SIZE
/0
THICKNFSS
4/0
MATERIAL
pVC
ha.
19. GROUT
FROM
0.
0 ft..
TO
Ss ft*
fr.
ft
MATERIAL EMPLACEMENT METHOD & AMOUNT
ge,1 TL llFVr
-fro,,, , e_
19. SAND/GRAVEL PACK (if applicable)
FROM
I ft-
, TO i MATERIAL.
0 ft-
it_
z rp r
EMPLAcRMENT ME11100
rtbiI
f
20. DRILLING LOG (attach additional sheets if necessary)
'ROM TO
10 R.
10 ft`
ft.
ft.
DESCRIPTION (collars ianfim, soirfreck,,pe, gr* et)
1 t 3 nei n 4,4
AT
j
--JAN 172017
22. Certification: friformation Processing Unit
DWQ/B Os wd
iz-77-/
Siof Certified Well Contactor hate
By signing this form 1 hereby cert fy that the %Tiffs) was (were) constructed in aiccordmce
with 15A NCAC 02C .0100 or ISA .C,dC 02C .0200 Weil 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 mayalso attach additional pages if ncccssaty.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
constiuction to the fbllowing:
Division of Water Resources, Information Processing Unit,
1617 Mail Service i e
JAN :3 2017
Division of Water Resources, Underground ojectionQontrot Program. rug tn,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & tnlectio a e:G a tie ggi g the form to
the address(es) above, also submit orStClhtCijonn �30 days of
completion of well construction WiitylictigitynhfittideouridrwartmeRticoerthe county
where constructed.
24b. For Infection Wells: In addition to sending the form tofeWR
the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016
Scanned by CamScanner

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
wen Contractor Name
zo9-4
NCWell Contractor Certification Number
Cody Nair
2. Well Construction Permit #:
List all applicable well construction permits (1 e. UIC. Cosmos, State. Variance, etc)
3. Well Use (check well use):
Water Sol play Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
I ri : ation
Non -Water Supply Well:
Monitoring
Injection Well:
)Aquifer Recharge
iAquifer Storage arid Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
4. Date Wel1(s) Completed: / Z - Z - f L
5a- Well Location:
Cl (Pry, /c f =e:..-ye_
Facility/Owner Name
fdy„, git,ot c,,,
Physical .Address, City, and Zip
err/-1/
County
JMtmicipaIIPublie
DResidential Water Supply (single)
DResidential Water Supply (shared)
IJRecoveiy
DGroundwatcr Remedlatlon
DSalinity Ranier
DStormwater Drainage
(Subsidence Control
DTI
Other (explain under #21 Remarks)
Well ID# 7? / 1J /LZ
Facility ID# (if applicable)
z's'7
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one 1st/tong is sufficient)
Tg 4 N '77 ° a `
6. Is(are) the wells) JPermanent or [jTemporacy
7. Is this a repair to an existing well: DYes or E6No
If this is a repair fill out known well construction lnfonnvtfon and explain the nature of the
rrpair under 021 remarks section or on the back ofthis form.
8. For GeoprobelDPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-I is needed. Indicate TOTAL NUMBER of wells
drilled: 1
9. Total well depth below land surface: -3 o
For multiple wells list all depths if d�ereent (example- .3®200' and 2@7u 1001)
10. Static water level below top of rasing: (ft.)
If water level is above casing use "f "
11. Borehole diameter: {in.)
12. Well construction method:
(i.e_ auger, notary. cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
Fan GW- I
Print Form
For Intcrnal Usc Only:
44
14. WATER 7.ONF.S
PROM
TO
DFSCRIPTION
0.
15. OUTER -CASING (foe -multi -cased wells) OR LINER if applicable)
FROM / TO DIAMETER 71110ZPOT S MATERIAL
0.
f..
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM TO ! DIAMETER 7RICIOVIC3S
o ft-
ft.
zo ft-
tt.
Z
in.
ter.
,yu
MATERIAL
pvC
17. SCREEN
• FROM TO
zo ft.
.7v tL
DIAMETER
2
SLAT SIZE
/0
TITICIENESs
,eft
MATERIAL
pv c.
!t.
IL GROUT
FROM
9 ft`
o
TO
f? >
5
ft.
MATERIAL
[3r'nTCMi T�
EMPLiCEMENT METHOD * AMOUNT
err if
19. SAND/GRAVEL PACK (if applicable)
FROM
/•f',
n
TO
ro 1t
ft.
MATERIAL
EMPLACEMENT METHOD
er e in
20. DRILLING LOG (attach additional sheets if necessary)
FROM -TO
iJ ft.
Iv EL
L1SCRIp TION (color. bardaess, sanfreck type, moire sine. eta)
t s17C 5-pp
fo it.
1Y
"Tv,
s rat.
ft.
11.
ft.
R
0.
f.
ft.
t
2t. REMARKS
ENE
JAN 1 nrt
22. Certificati
tnformstion Processing U
DWG.
Stgnome of Certified Welt Contractor
/Z-z`7 /6
Datc
By signing this form, I hereby cerir; fy that the well(s) was (were) constructed in accordance
with 1 SA 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 detal'Is:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
(ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Cent i Ee �, 7699-1617
24b. For Injection Wells: In addition to sending that CNN 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
JiNDivision of Water Resources,Unde rouintone , ,
� �� Program,
1636 Mai Service Center, Raleigh, NC 27699-1
24e. For Water Supply & Infection 'Atte
the address(es) above, also submit one eyg
completion of well construction tolj►.
where constructed.
North Carolina Department of Enviromslenta/ Quality - Division of Water Resources
o sending the form to
ii��tt�gittpiel30 days of
41 eg m, o the county
!e a I Office
Revised 2-22-2016
Scanned by CamScanner

For Internal Use ONLY:
445288
WALL CONSTRUCTION RECORD
This form can be used for single or multiple wells N C Department of
Environmental Quality
Received
Well Contractor Information:
Rodney Wilson
Well Contractor Name
2798-A
Winston-Salem
NC Well Contractor Certification NumberRegional Office
Wilson Well & Pump Compay, LLC
Company Name
2. Well Construction Permit #:
List all applicable wellpermits (i.e. County, State, Variance, etc.)
3. Well Use (check wren use):
Water Supply Well:
0 Ag;ticultural
0Geothermal (Heating/Cooling Supply)
0 Industrial/Commercial
0 Irrigation
Non -Water Supply Well:
0Monitaing
Injection Well:
DAquifer Recharge
0Aquifer Storage and Recovery
DAquifer Test
0 Experimental Technology
0Geothermal (Closed Loop)
0Geothermal (Heating/Cooling Return)
RECEAVEDitiCDSR/DVIR
0Municipal/Public
OResiflieTil Aaterrply (single)
OReAV ti Water Supply (shared)
Water Quality Retonst
oRdapiOtions Section
ilmingon egrlaoffice
0Groundi,vater Remediation
WRiol
°Salinity Barrier
0 Stormwater Drainage
0 Subsidence Control
0 Tracer
0Orther (explain under #21 Remarks)
4. Date well(s) Completed: 7/1 4/1 7 Well ID#
5a. Well Location:
Turning Leaf Farms
Facility/Owner Name
. Facility ID# (if applicable)
A I Taylor Rd Richlands, NC
Physical Address, City, and Zip
Onslow
County Parcel Identification No. (PLNT)
5b. Latitude and Longitude in degyeeshrinutesiseconds Or dechnal degrees:
(if well field, one lat./long is sufficient)
s-s
N 77-
6. Is (are) the well(s): [2]Permanent or DTeanporary
7. Is this a repair to an existing -well: Dyes or 1No
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 forrn.
8. Number ofwells constructed: 1 .
For multiple injection or non -water supply wells ONLY with the same construe you can
submit one form
9. Total well depth below land surface: 260
For multiple wells list all depths if different (example- .5V200' and 2aiou)
(ft.)
10. Static water level below top of casing: 32 (ft.)
If water level is above casing, use "-i- "
11. Borehole diameter: 12 3/4 On)
12. Well construction method: Rotary
(i.e. auger, rotary, cable, direct push, etc.)
FROM
200 ft'
ft
TO
260
TO
200
TO
260 ft•
ft.
DESCRIPTION ,
ft.
ft.
ft.
ft.
Small / Medium Gray Sand
DIAMETER
8
DIAMEI
DIAMETER
8
in.
in.
in.
in.
in.
op Leo
THICKNESS
SDR 17
THICKNESS
SLOT SIZE
.025
MATERIAL
PVC
MAI1KL41
THICKNESS MATERIAL
PVC
SDR 17
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0
ft.
ft.
25 ft.
ft.
Concrete
Pour- 4 yds.
ft.
ft.
FROM
TO
MATERIAL
EMPLACEMENT METHOD
195 It 260
ft.
Pour
ft.
ft.
15
P5
50
ft.
ft.
120 ft-
145
25
50
120
145
190
•
1 r-
DESCRIPTION (color, hardness, sot grain vim, etc.)
Red Clay
Limestone / Sand
Gray Sand
Black Clay / Sand
Small Gray Sand
Black Clay / Sand
190 ft.
I FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 230 Method of test: Pump
13b. infection type: HTH
Amount: 3 lb
JUL S 4 2011
22. Certifi. a on:
Si
ature of Ce
ied Well Contractor
kiciorAiaon Ptly7,
D'110.1Z0,3
Date
By signing this j'brrn, I hereby eel -lift that the well(s) was (were) constnacted in accordance
with 15:4 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 ifnecessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the follovving:
Division of Water Resources, hiformation Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
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 tote following:
Division of Water Resources, Underground Injection Control Program.,
1636 Mail Service Center, Raleigh, NC 276994636
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 Revised A 2013

WILSON WELL & PUMP COMPANY, LLC
P. O. Box 355
Faison, NC 28341
910-990-2256
Date: July 17, 2017
Customer: Turning Leaf Farms, LLC
Address: A I Taylor Rd
Richlands, NC
P.O. # Irrigation Well - Test Pump
NC Department of
Environmental Quality
Received
JUL 3 I 2017
Winston-Salem
Regional Office
Time:
June 26, 2017
Pump Set: 195'
Depth:
GPM:
11:00
11:15
11:30
11:45
12:00
12:30
1:00
1:30
2:00
3:00
6:00
8:00 a.m.
11:00
32' Static Water Level
152'
160'
169'
175'
180'
180'
180'
181'
181'
182'
185'
185'
Wilson Well & Pump Company.
THANK YOU!
0 Start Pump
270
265
250
240
235
235
235
235
235
233
230
230 Stop

Date: July 17, 2017
WILSON WELL & PUMP COMPANY, LLC
Ai C Department of
Faison, NC 28341
P. a lox 355
.... Received
".. Environment-al:Quality
910-990-22.56 -_,
AR_ 3 I 2017
. Winston-Salem
Regional Office
Customer: Turning Leaf Farms, LLC
Address: A I Taylor Rd
Richlands, NC
P.O. # Irrigation Well - Drawing
of.,‘ Vocl <
41,"
t
rmars,.......-neatasearrasmewsma.t
ti
•
7-1
Wilson well & Pump Company.
THANK YOU!
R. 4 (17 7 ei k)71 21 7g A
elt
,5-DR
Ajibil

WELL CONSTRUCTION RECORD
This fonn can be used for single or multiple wells
1. Well Contractor Information:
7
For Internal Use ONLY:
D.T. Chalmers, Jr.
Well Contractor Name
4146A
NC Well Contractor Certification Number
CATLINI Engineers and Scientists
Company Name
2. Well Construction Permit #: N/A
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
D Irrigation
D Municipal/Public
D Residential Water Supply (single)
0 Residential Water Supply (shared)
Non -Water Supply Well:
® Monitoring
0 Recovery
Injection Well:
D Aquifer Recharge
D Aquifer Storage and Recovery
D Aquifer Test
0 Experimental Technology
D Geothennal (Closed Loop)
D Geothennal (Heating/Cooling Return)
D Groundwater Remediation
D Salinity Barrier
❑ Stonnwater Drainage
D Subsidence Control
D Tracer
D Other (explain under #21 Remarks)
4. Date Well(s) Completed: 06/20/17 Well ID#: USTCGI -MW35
5a. Well Location:
Facility/Owner Name
MCAS New River
Facility ID# (if applicable)
MCAS New River-PPV Site, JACKSONVILLE
Physical Address, City, and Zip
ONSLOW
County Parcel Identification No. (PIN)
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
• *oltg cxstaw
FROM
0 ft.
TO
InorwiN-
FROM
ft.
ft.
TO
5 ft.
ft.
ft.
DIAMETER
2
DIAMETER
in.
THICKNESS
Sch. 40
imEg
in.
in.
THICKNESS
MATERIAL
PVC
FROM
5 ft.
TO
15 ft.
DIAMETER
2 in.
SLOT SIZE
Slot .010
THICKNESS
Sch. 40
MATERIAL
PVC
ft.
ft.
in.
datt
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
ft.
ft.
0.5ft.
3 ft.
Bent. Pellets
Surface Pour
ft.
ft.
k
%a
FROM
TO
MATERIAL
EMPLACEMENT METHOD
3 ft.
15 ft.
#2 Medium Sand
Surface Pour
ft.
U i
4
'1
7
ft.
FROM
TO
DESCRIPTION (color, hardness, soilirock type, grain size, etc.)
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
t
see -
PGN
SEP 1 8 2017
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.
(if well field, one lat/long is sufficient)
34.72488
N-77.46226 w
6. Is (are) the well(s): ®Permanent or OTemporary
7. Is this a repair to an existing well: D Yes or No
'Phis 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: 15
For multiple wells list all depths in different (example- 3@200' and 2@1002
10. Static water level below top of casing: 3.0 (ft.)
If water level is above casing, use "+"
1
11. Borehole diameter: 8
12. Well construction method: HSA
(ft.)
(i. e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type:
Amount:
tification:
L L Y v'i.✓'� s''f4Y'v364.7 i : P
Si e of Certified Well'Contractor
9/8/2017
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 Wa ,frrocessing Unit,
1617 Mail Service Center, Ralei �I27699-161 g, 7
24b. For Injection Wells Oki
s ition to sending the form to the
address in 24a above, also su tra .. oet{l 4slform within 30 days of
completion of well construction to the following:
Division of Water Resi, �i>g .6ection Control Program,
1636 Mail Seri i a, i , NC 27699-1636
Wilmington Rc i naiOffics
24c. For Water Svppl_y & Injection Wens:
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.
Adapted from Form GW-1
North Carolina Department of Environment and Natural Resources - Division of Water Resources Revised 2-22-201

,
, , ,
LOG
.,
...„,„,,,,,,,,, ATLIN
Engineers and Scientists
211111.31 SHEET 1 OF 1
WELL
PROJECT NO.: 211111.31
STATE: NC
COUNTY: ONSLOW
LOCATION: JACKSONVILLE
PROJECT NAME:
MCAS New River
LOGGED BY:
WELL ID:
DRILLER: D.T. Chalmers, Jr.
NORTHING: 35839
EASTING:
S NG: 2462033
CREW: RHEA/CATLIN
USTCG1-MW35
SYSTEM: NCSP NAD 83 (USft)
, BORING LOCATION: MCAS New River
T.O.C. ELEV.: 27.43
DRILL MACHINE: C M E-45 B
METHOD: HSA
0 HOUR DTW: 3.0
TOTAL DEPTH: 15.0
START DATE: 6/20/17
FINISH DATE: 6/20/17
24 HOUR DTW: N/A
WELL DEPTH: 15.0
DEPTH
BLOW
COUNT
OVA
LAB,
o
L
O
_
. SOIL AND ROCK
WELL
0.5ft
0.5ft
0.5ft
0.5ft
(pPm)
sG
DEPTH DESCRIPTION ELEV
ELEVATION
DETAIL
0.0
LAND SURFACE 27.4
0.0
.,.
• •�
•
8
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,
•
•
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(SM) - Light to dark brown, f. SAND to SILT with
-
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BORING TERMINATED AT ELEVATION 12.4 ft in f.
-
SAND to SILT w/ some trace gravel and little clay
. _
'; ECEIVED/NCDENR/DWR
, _
_
_
SEP 252017
-
Water Quality Regional
-
Operations Section .
Wilmington Regional Offict
4
Concrete
Bentonite Pellets #2 Medium Sand

WELL CONSTRUCTION RECORD
This fonn can be used for single or multiple wells
1. Well Contractor Information:
For Internal Use ONLY:
tAi
D.T. Chalmers, Jr.
Well Contractor Name
4146A
NC Well Contractor Certification Number
CATLIN Engineers and Scientists
Company Name
2. Well Construction Permit #: N/A
List all applicable well permits (i. e. County, State, Variance, Injection, etc.)
3. Well Use (check well use):
FROM
czti*
TO
DESCRIPTION
R4 .
ft.
ft.
ft.
ft.
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
5 ft.
2 in.
Sch. 40
PVC
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
ft.
ft.
in.
Water Supply Well:
O Agricultural
D Geothennal (Heating/Cooling Supply)
❑ IndustriaUCorrunercial
❑ Irrigation
❑ MunicipaUPublic
❑ 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
D Geothennal (Closed Loop)
❑ Geothennal (Heating/Cooling Return)
❑ Groundwater Remediation
❑ Salinity Barrier
❑ Stonnwater Drainage
❑ Subsidence Control
❑ Tracer
❑ Other (explain under #21 Remarks)
4. Date Well(s) Completed: 06/20/17 Well ID#: USTCGI -MW34
5a. Well Location:
Facility/Owner Name
MCAS New River
Facility ID# (if applicable)
MCAS New River-PPV Site, JACKSONVILLE
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)
34.72499
N-77.47202 w
6. Is (are) the well(s): ®Permanent or ['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: 15 (ft.)
For multiple wells list all depths in different (example- 3@200' and 2@1009
10. Static water level below top of casing: 2.5 (ft.)
If water level is above casing, use "+"
11. Borehole diameter: 8 (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:
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
5 ft.
15 ft.
2 in.
Slot .010
Sch. 40
PVC
ft.
ft.
in.
FROM .
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
ft.
ft.
0.5ft.
3 ft.
Bent. Pellets
Surface Pour
ft.
ft.
FROM
TO
MATERIAL
EMPLACEMENT METHOD
3 ft.
15 ft.
#2 Medium Sand
Surface Pour
FRO
ft.
ft. .}fjnnkk ��'; ��yy ..�.-y�`•
•l±A.+?�,Y����Ci�� �PR .7�r, i .�a d �:. •} � . .. x . ... � .. Z . .. �} , t� t... !
M DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
TO
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
P.C#1 P‘G41)
ft.
fi!� �c.�2+�t•.r:tR� Y .+4'
:�jC
c1L'A�
SEP a b 2017
22.
er
'cation:
riMnil
Sign i e of CertifieWell Contractor
9/8/2017
Date
By signing this, fornz, 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 foil •, , •..•
IVED/NCDENR/DwR
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells (AEI?: . cct 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:
Water Quality Regional
Division of Water Resotei p llds @ ginjection Control Program,
1636 MaiMpfjcgtfirftgtiMpleky 27699-1636
24c. For Water Syppl_y & 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.
Adapted from Form GW-1
North Carolina Department of Environment and Natural Resources - Division of Water Resources Revised 2-22-201 c

v.,..
LOG
......,--„,„ ATLIN
Engineer. and Scientists
211111.31 SHEET 1 OF 1
WELL
PROJECT NO.: 211111.31
STATE: NC
COUNTY: ONSLOW
LOCATION: JACKSONVILLE
PROJECT NAME:
MCAS New River
LOGGED BY:
WELL ID:
USTCG1 -MW34
DRILLER: D.T. Chalmers, Jr.
NORTHING: 358378
EASTING: 2459100
CREW: R H EA/CATL I N
SYSTEM: NCSP NAD 83 (USft)
BORING LOCATION: MCAS NEW RIVER
T.O.C. ELEV.: 27.78
DRILL MACHINE: CM E-45 B
METHOD:
HSA
0 HOUR DTW: 2.5
TOTAL DEPTH: 15.0
START DATE: 6/20/17
FINISH DATE:
6/20/17
24 HOUR DTW: N/A
WELL DEPTH: 15.0
DEPTH
BLOW
0.5ft
0.5ft
COUNT
0.5ft
0.5ft
OVA
m
(pp )
LAB.
o
l
S
L
G
SOIL AND ROCK
DEPTH DESCRIPTION ELEVATION
WELL
DETAIL
0.0
LAND SURFACE 27.8
0.0
_•:.
_
_
-
_
_
'
-
15.0
• '•4,
.a
.
` • .,:
•
; :am•
•
r
•tee
r.
.h•
6
.•
=•.
b p
ra
.P
y o
15.0
(SM) - Light to dark brown, f. SAND to SILT with
some trace gravels and little clay -based on drill
cuttings
12.8
J.11. � I_ J. l .� .� I I T I l ;���.1 J.1�, j ,-.. i t --
..............
CJ1 w . P
C 0
i -
i.
-
_
_
_
-
-
BORING TERMINATED AT ELEVATION 12.8 ft in f.
SAND to SILT w/ some trace gravel and little clay
RECEfl1ED/NCDENR/DWR
SEP 25 2017
Water Quality Regional
Operations Section
Wilmington Regional Office -
.
-
['Concrete
Bentonite Pellets [1#2 Medium Sand

4-czeir CATLIN
Engineers and scientists Telephone: [phone]
Fax: [phone]
September 4, 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)
Install Two Monitoring Wells at Knox Landing
Jacksonville, North Carolina
CATLIN Project No.: 217083
To Whom It May Concern:
Post Office Box 10279
Wilmington, North Carolina 28404-0279
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 Knox Landing 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,
Michael E. Mason, P.E.
Project Manager
Enclosures
S:\GINT\PROJECTS\217083 KNOXLANDING.GPJ,«DrawingFileSpec»
RECEIVED/NCDENR/DWR
SEP 11 2017
Water Quality Regional
Operations Section
Wilmington Regional Office

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
William J. Miller
Well Contractor Name
2927A
NC Well Contractor Certification Number
CATLIN Engineers and Scientists
Company Name
2. Well Construction Permit #: N/A
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
0 Irri&ation
❑ Municipal/Public
❑ Residential Water Supply (single)
❑ Residential Water Supply (shared)
Non -Water Supply Well:
® Monitoring 0 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: 07/24/17
5a. Well Location:
MCB, Camp Lejeune
Facility/Owner Name
Well ID#: UST-CCC2-MWO2
Knox Landing
Facility ID# (if applicable)
Knox Landing, Jacksonville
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 DTemporary
7. Is this a repair to an existing well: D Yes or ® No
'Phis is a repair, fill out known well construction information and explain the nature of
the repair under '=21 remarks section or on the hack of this form.
8. Number of wells constructed:
For multiple injection or non -water supply wells ONLY with the same construction, you
can submit one, form.
9. Total well depth below land surface: 18 (ft.)
For multiple wells list all depths in different (example- 3@200' and 2620002
1
10. Static water level below top of casing: (ft.)
if water level is above casing, use " - "
11. Borehole diameter: 8 (in.)
12. Well construction method: HSA;Split Spoon
(i. e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
Adapted from Form GW- l
For Internal Use ONLY:
44
cs
FROM
TO
DESCRIPTION
ft.
ft.
FROM
FROM
ft.
ft.
TO
TO
ft.
M '�S`. t ,`i �Y Y •+ a- • x. .l.t t.,_ t.-. ` S.
8 ft.
ft.
DIAMETER
2
in.
THICKNESS
Sch. 40
DIAMETER THICKNESS
in.
MATERIAL
Sch. 40
MATERIAL
ft.
ft.
in.
_ �`! � �:. � S...xY+ -} � "* 31:�:s; � •1,L sZ � �. '�T` � "y.•. {..-ssJ e� r �r .c t, i. 2 � i�'� T - e
� :, . �•�f, r�� : �':..rF...t.1-'. , v'*t.:' r'.'� t ': 'iti ! e _ rvii , x' s• i, �'.. .. ; . .._ ...- .'T _�,..t', � 1-...�. s....... -.Y^ .�r�.:'� � . ,_ kr: 1' fir. ...!t ..:.♦.x,
FROM
8 ft.
TO
18 ft.
DIAMETER
2 in.
SLOT SIZE
Slot .010
THICKNESS
Sch. 40
MATERIAL
PVC
ft.
ft.
in.
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0.5 ft.
2 ft.
Portland Cement
Surface Pour
2 ft.
6 ft.
Bent. Pellets
Surface Pour
ft.
ft.
FR
OM EMPLACEMENT METHOD
TO
MATERIAL
6 ft.
18W
2 Medium Torpedo Sar
dSurface Pour
ft.
ft.
FROM
ft.
TO
ft.
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
ft.
ft.
ft.
ft.
ft.
ft.
ft. s$.
ft.
P411 P4G
ft.
ft.
1
WOorwratIon
22. Certification:
Signature of Certified Well Cont or
8/21/2017
Date
By signing this form, 1 hereby certify that the w0(4 was (were) constructed in accordance with
15A NCAC 02C'.0100 or 15A MAC 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 ONLY: In addition to sending the form to the
address in 24a above, also s ���� ; ► Aftirtif ,� t r: ,� ' 30 days of
completion of well construct' `' `
p
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service CNIP, lial iglu 1 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 healWatpri t haiityf I Atgr (y where constructed.
Operations Section
Wilmington Regional Office
North Carolina Department of Environment and Natural Resources - Division of Water Resources Revised 2-22-2016

F V 1 G
PROJECT
Knox Landing CC
BORING NUMBER B2 (MW01)
CCC2-B2 SHEET 1 OF 1
SOIL BORING LOG
PROJECT : Knox Landing CC / 7720-010
ELEVATION : 19.74
DRILLING METHOD AND EQUIPMENT USED : HSA; Split -spoon
DRILLER : Bill Miller
DEPTH BELOW SU
RFACE (FT)
DRILLING CONTRACTOR : Catlin Engineers LOCATION: Camp Lejeune, NC
Northing: 3846276.179 Easting: 281154.333
DATE : 7/24/2017 LOGGER : Jonathon Robinette
CORE DESCRIPTION
COMMENTS
INTERVAL
FT)
RECOVERY
(FT)
#/TYPE
SOIL NAME, USCS GROUP SYMBOL, COLOR,
MOISTURE CONTENT, RELATIVE DENSITY,
OR CONSISTENCY, SOIL STRUCTURE,
MINERALOGY.
DEPTH OF CASING, DRILLING RATE,
DRILLING FLUID LOSS,
TESTS, AND INSTRUMENTATION.
3.50-5.50
5
2.00
CL
8 50 -10.50
10
(Change of Scale)
2.00
CL
SP
13.5-15.5'
1 50
SP
20
(0 - 0.25) Asphalt
(0.25 - 1.00') ABC stone/sand mix
(3.50 - 5.50') Sandy clay (CL), orange/tan, moderate plasticity, dry, medium soft
(8.50 - 9.00') Sandy clay (CL), orange/tan, moderate plasticity, dry
(9.00 - 10.50') Poorly -graded sand (SP), some gravel, tan/white, dry, dense
(13.50 - 15.00') Poorly -graded sand (SP), some gravels, tan/white, saturated, medium dense
Boring terminated at 18.00'
RECEE
NOTES : Blow Count
DiNCDENR/DWR
SEP 11 2017
Water Quality Regional
Operations Section
Wilmington Regional Office
2-172-3
7-13-13-14
4-5-5-6

WELL CONSTRUCTION RECORD
For Internal Use ONLY:
This form can be used for single or multiple wells
1. Well Contractor Information:
William J. Miller
Well Contractor Name
2927A
NC Well Contractor Certification Number
CATLIN Engineers and Scientists
Company Name
2. Well Construction Permit #: N/A
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
0 Recovery
Injection Well:
❑ Aquifer Recharge
❑ Aquifer Storage and Recovery
❑ Aquifer Test
❑ Experimental Technology
❑ Geothermal (Closed Loop)
0 Geothermal (Heating/Cooling Return)
❑ Groundwater Remediation
0 Salinity Barrier
0 Stormwater Drainage
❑ Subsidence Control
❑ Tracer
❑ Other (explain under #21 Remarks)
4. Date Well(s) Completed: 07/24/17
5a. Well Location:
MCB, Camp Lejeune
Facility/Owner Name
Well ID#: UST-CCC2-MW01
Knox Landing
Facility ID# (if applicable)
Knox Landing, Jacksonville
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 DTemporary
• 7. Is this a repair to an existing well: O Yes or ® No
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 hack 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: 18 (ft.)
For multiple wells list all depths in different (example- 3@200' and 2@100')
1
10. Static water level below top of casing: (ft.)
1 f water level is above casing, use " - "
11. Borehole diameter: 8
12. Well construction method: HSA;Split Spoon
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
446254
FROM
TO
DESCRIPTION
ft.
ft.
ft.
y,
iNAR
ft.
l:,y rtti .i�
FROM TO.
DIAMETER
THICKNESS
MATERIAL
0.24 ft.
8 ft.
2 in.
Sch. 40
Sch. 40
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
ft.
ft.
in.
. - .+.++�1 r � r ..s� t +1+' R - . y r. z,�•U.. r rt .i ,, t- 5+ 5 u
,i � ,.. ,.� � ' �-. �(� ._ _-.'a:a. K r_..fz' _ } K. 57§ .�, ". " �. a ,a. ... •� ?_ � L.:. }� j . . � �x � .. t. f, ..5 ......
v
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
8 ft.
18 ft.
2 in.
Slot .010
Sch. 40
PVC
ft.
ft.
in.
F
ROM TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0.5 ft.
2 ft.
Portland Cement
Surface Pour
2 ft.
6 ft.
Bent. Pellets
Surface Pour
ft.
ft.
FROM
TO
MATERIAL
4 r a
EMPLACEMENT METHOD
6 ft.
181#
2 Medium Torpedo Sar
dSurface Pour
ft.
ft.
FROM
ft.
ft.
ft.
ft.
r4
;. � �..� r t,:.:• x ... :_ lit._. :, r _.,., .k�
TO DESCRIPTION (color, hardness, soil/rock type, grain size, etc.) •
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
Lys. �°.'.:x ry dr. 2
Ramo
srP
22. Certification:
31•
ePi
8/21/2017
Signature of Certified Well Co EG... w NCDENR/DWR Date
By signing this, form, I hei by certify t at the wells) was (were) constructed in accordance with
ISA NC AC' 02(' ,0100 or I SA NCAC' 02C' .0200 Well ('onslr action Standards and that a copy of
this record has been provided to g the well owner.
23. Site diagram or addit ba'1 will 1e29si7
You may use the back of this page to provide additional well site details or well
construction details. You may also attach, d ' ionalnames if necessary.
Water Quall r` eglonai
SUBMITTAL INSTRU(kons Section
lira e Re lon.al Office
24a. For All Wells: u sform ithln 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 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.
Adapted from Form GW-1
North Carolina Department of Environment and Natural Resources - Division of Water Resources Revised 2-22-2016

ilich,
..,,',t� x Y ..... .♦\% )J1i`'. 4!a xYY;3'Y ... .. .
'R
PROJECT
Knox Landing CC
BORING NUMBER B 1 (MW02)
CCC2-B1 SHEET 1 OF 1
SOIL BORING LOG
PROJECT : Knox Landing CC / 7720-0.10
ELEVATION : 19.78
DRILLING METHOD AND EQUIPMENT USED : HSA; Split -spoon
DRILLER : Bill Miller
DEPTH BELOW S
URFACE (FT)
DRILLING CONTRACTOR : Catlin Engineers LOCATION: Camp Lejeune, NC
Northing: 3846274.668 Easting: 281158.578
DATE : 7/24/2017 LOGGER : Jonathon Robinette
CORE DESCRIPTION
INTERVAL (FT
RECOVERY
(FT)
#/TYPE
SOIL NAME, USCS GROUP SYMBOL, COLOR,
MOISTURE CONTENT, RELATIVE DENSITY,
OR CONSISTENCY, SOIL STRUCTURE,
MINERALOGY.
COMMENTS
DEPTH OF CASING, DRILLING RATE,
DRILLING FLUID LOSS,
TESTS, AND INSTRUMENTATION.
3.00 -5.00
5
200
CL
8.00 -10.00
10
(Change of Scale)
2.00
CL
SP
SW
13.00 -15.00
1.50
SC
SC
20
(0 - 0.25') Asphalt
(0.25' - 1.00') ABC stone/sand mix
(3 00 - 5.00') Sandy clays(CL), orange/tan, low plasticity, dry, stiff
(8.00 - 9.00') Sandy clay(CL), orange/tan, low plasticity, dry
(9.00 - 9.67') Poorly -graded sand (SP), some gravel, tan, dry
(9.67 - 10.00') Fine to coarse sand (SW), white/orange, moist, dense
(13.00 - 14.00') Clayey sand (SC), tan, moist
(14.00 - 14.50') Clayey sand (SC), tan, saturated, medium dense
Boring terminated at 18.00'
NECEIVED/N
NOTES : Blow Count
ENR/DWR
2-2-3-7
4-17-25-20
3-6-7-7
SEP
t
Water Quality Regional
Operations Section Wilmington Regional Office

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:
446077
14. WATER ZONES
FROM
2.42 ft.
ft.
TO
11.32 ft.
ft.
DESCRIPTION
Water levels collected at 0 hrs
15.:OUTER CASING (for multi -cased wells) OR LINER (if applicablei
FROM
TO
DIAMETER
THICKNESS
MATERIAL
NA
ft.
NA ft-
NA
in.
NA
NA
16. INNER CASING OR TUBING (geothertnaI closed -loop)
THICKNESS MATERIAL
FROM
0.0 ft.
TO
11.32 ft'
DIAMETER
1
in.
Sch 40
PVC
ft.
ft.
in.
• 17. SCREEN
Water Supply Well:
❑Agricultural
OGeothermal (Heating/Cooling Supply)
CJ lndustrial/Commercial
❑Irrigation
Non -Water Supply Well:
°!Monitoring
❑Municipal/Public
DResidential Water Supply (single)
❑Residential Water Supply (shared)
ClRecovery
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
DAquifer Test
OExperimental Technology
DGeothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
❑Groundwater Remediation
OSalinity Barrier
❑Stormwater Drainage
DSubsidence Control
OTracer
❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: Well ID# UST-FC39-MW16
8/8/2d 17
5a. Well Location:
Commanding General USMC NA
Facility/Owner Name Facility !DI (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)
34.65811 N-77.31541
6. Is (are) the well(s): ©Permanent or °Temporary
7. Is this a repair to an existing well: ❑Yes or L1No
If this is a repair, fill out known well construction information and explain the nature of the
repair under #21 remarks section or an 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: 11.32 (ft.)
For multiple wells list all depths if different (example- 3@a 200'. and 2 a 100')
10. Static water level below top of casing: 2'42 (ft.)
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.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
Form GW-1
FROM
1.32 ft*
ft.
TO
11.32 ft.
ft.
DIAMETER
1
in.
in.
SLOT SIZE
.010
THICKNESS
Sch 40
MATERIAL
PVC
18. GROUT
FROM
0.00 ft.
TO
0.33 ft'
MATERIAL
QuikRete
EMPLACEMENT METHOD & AMOUNT
Hand Pour
ft.
ft.
ft.
ft.
19 SAND/GRAVEL 'PACK ,(if applicable)•
FROM
0.33 ft.
TO
0.66 ft.
MATERIAL
Hole Plug 3/8" Chips
EMPLACEMENT METHOD
Hand Pour
0.66 ft.
11.32 ft.
# 2 Filter Sand
Hand Pour
20.DRILLING; LOG:(attacb additionar;:sheets if necessary
DESCRIPTION (color, hardness, soil/rock type, gain size, etc.)
FROM
0.0 ft:
TO
1.0
ft.
Clayey Sand, SC, gray/brown, dry
1.0 ft.
6.0 ft.
Course sand, gravel, backfill, gray/brown, dry to moist
6.0 ft.
ft.
12.0 ft.
ft.
Clayey sand, SC, brown/gray, moist to saturated.
ft.
ft.
ft.
ft.
ft
ft.
21. REMARKS
22. Certification:
AtIG 0
2011
lnration Hroc6seing Unit
OWC/B G-
Signa
ified ,; ell Contractor
e t /11
Date
By signing this form, I hereby certj 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:
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:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
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 the following:
Division of Water .Resources, Und. �� 1 4o am,
1636 Mail Service Center , .,,.
North Carolina Department of Environment and
24c. For Water Supply & Injection Wells:
Also submit one copy of this form within 3 y5 o coppLetion of
well construction to the countyhealth de arts of t eo here
p �1�
constructed.
Natural Resources - Division of Water Resources Water Quality Re dr 'August 2013
Operations Section
Wilmington Regional Office

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:
446076
14. WATER ZONES
FROM
TO
DESCRIPTION
2.29 ft.
11.20 ft.
Water level collected at 24 hrs.
ft.
ft.
FROM
15. OUTER CASING (for multi-casedwelis) OR LINER if applicable
TO
NA
ft.
NA
ft.
DIAMETER
NA
in.
NA
THICKNESS MATERIAL
NA
, ; 16. INNER CASING OR TUBING (geotherrnal'closed»loop)
FROM
0.0 ft.
TO
11.20 ft.
DIAMETER
1
in.
THICKNESS
Sch 40
MATERIAL
PVC
ft.
ft.
in.
17. SCREEN
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑Industrial/Commercial
❑Irrigation
❑Municipal/Public
❑Residential Water Supply (single)
OResidential Water Supply (shared)
Non -Water Supply Well:
OMonitoring ❑Recovery
Injection Well:
° Aquifer Recharge
DAquifer Storage and Recovery
❑Aquifer Test
DExperimental Technology
❑Geothermal (Closed Loop)
DGeothermal (Heating/Cooling Return)
OGroundwater Remediation
OSalinity Barrier
OStormwater Drainage
❑Subsidence Control
[Tracer
❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: 8/8/2017 Well m# UST-FC39-MW15
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)
34.658143 N-77.315396
6. Is (are) the well(s): 121Permanent or [Temporary
7. Is this a repair to an existing well: ❑Yes or . L 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: 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: 11.2
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing: 2`29
If water level is above casing, use -"
11. Borehole diameter: 2
(in.)
12. Well construction method: Direct Push Technology
(ft.)
(ft.)
(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
FROM
1.20f
ft.
TO
11.20 ft.
ft.
DIAMETER
1
in.
in.
SLOT SIZE
.010
THICKNESS
Sch 40
MATERIAL
PVC
18. GROUT
FROM
0.00 ft.
ft.
TO
0.30 ft.
ft.
MATERIAL
QuikRete
EMPLACEMENT METHOD & AMOUNT
Hand Pour
ft.
ft
19. SAND/GRAVEL ' PACK (if applicable)
FROM
TO
MATERIAL
0.30 ft.
0.60 ft.
Hole Plug 3/8" Chips
EMPLACEMENT METHOD
Hand pour
0.60 ft.
11.20 ft.
# Filter Sand
Hand pour
.20.' DRILLIN.G'LOG, (attach additional sheets if necessary)
FROM
0.00 ft.
6.00 ft.
6.00 ft;
7.00 ft.
DESCRIPTION (color, hardness, sod/rock type,grain size,
Clayey sand, SC, tan/gray, dry to moist
Course Sand to rock, (fill)gray, saturated
7.00 ft.
12.00 ft.
Silty sand, trace clay, gray, saturated
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
C
.42,53
21. REMARKS
G 2Oi7
information Proces,9ing Unit
22. Certification:
b zt[l)
Sign . ST. e o ified ell Contractor Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with BA NCAC 02C .0100 or ISA NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL 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
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 the following:
RECEIVED/NED >: t ..Division of Water .Resources, Under round In econ m
g � ram,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection. Wells: SEP
7
Also submit one copyof this form within n 30 days ofco e�f y r on of
well construction to the county health department of the county where
constructed. INatel° Quality Regional
North Carolina Department of Environment and Natural Resources - Division of Water Re Operations SeCtiQtivised August 2013
Ington Regional Office
TO

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
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
°Irrigation
Non -Water Supply Well:
0Monitoring
Injection Well:
❑Aquifer Recharge
°Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
°Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling .Return)
, Variance, Injection, etc.)
OMunicipal/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)
4. Date Well(s) Completed: 8/9/2017 Well ID# UST-FC39-MW14
5a. Well Location:
Commanding General USMC
Facility/Owner Name
Sneads Ferry Rd. Camp Lej
Physical Address, City, and Zip
Onslow County
County
NA
Facility ID4 (if applicable)
eune, NC, 28547
NA
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
34.658159 -77.315449
6. Is (are) the well(s): ©Permanent or ❑Temporary
7. Is this a repair to an existing well: DYes or IJNo
1f 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,
For multiple wells list all depths if different (example- 3@u 200' and 2@100')
9. Total well depth below land surface: 5'40 (ft.)
10. Static water level below top of casing: 1.42 (ft)
If water level is above casing, use "+ "
1.1. Borehole diameter: 2
(in.)
12. Well construction method: Direct Push Technology
(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:
446075 -
14. WATER ZONES
FROM
1.42 ft,
ft.
TO J DESCRIPTION
6.40 ft j Water level collected at 24 hrs.
ft.
15. OUTER CASING (for multi -cased wells): OR LINER (if ap licable)
FROM TO DIAMETER THICKNESS MATERIAL
NA ft.
NA
ft.
NA
in.
NA
NA
:16. INNER CASING: OR TUBING (geothermal closed -loop)
FROM TO DIAMETER [ THICKNESS l MATERIAL
0.0
ft.
6.40 ft•
1
in.
Sch 40
PVC
ft.
17.'SCREEN-
FROM
1.40 ft
ft.
ft.
in.
TO
6.40 ft
DIAMETER SLOT SIZE THICKNESS I MATERIAL
1
.010
Sch 40
PVC
18. GROUT
FROM
ft.
in.
TO
0.00 ft- 0.35 ft;
ft
ft.
MATERIAL
QuikRete
EMPLACEMENT METHOD & AMOUNT
Hand Pour
ft
ft.
19.SAND/GRAVEL. PACK (if applicable)
FROM
0.35 ft
TO
0.70 ft.
0.70 ft- 1 6.40 ft.
MATERIAL
Hole Plug 3/8" Chips
# Filter Sand
l EMPLACEMENT METHOD
Hand Pour
Hand Pour
20. DRILLING LOG (attach additional sheets if necessary)
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
FROM
0.0
ft.
TO
8.0 ft.
Clayey sand,SC, tan, dry to saturated
ft.
ft.
ft.
ft.
ft.
ft
ft.
ft.
ft.
ft.
ft.
21. REMARKS
ft
AUG 01 2O17
A.ATINIatu? (Yu
22. Certification:
Ca it Z.1 n
Sign . 11 e o ' r' e ifeed ' I Contractor Date
By signing this form, 1 hereby certifi, 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:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells ONLY: In addition to sending the form to the address in
24a above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells:
Also submit one copy of
well construction to the co
constructed.
North Carolina Department of Environment and Natural Resources Division of Water
SeErcel12011
etion of
ty where
Revised August 2013
Water Quality Regional
Operations Sectiot
Wilmington Regiona' Office

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
For Internal Use ONLY:
446074
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)
❑ Industrial/Commercial
OIrrisation
DMunicipal/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: 8/9/2017 Well UST-FC39-MW12
5a. Well Location:
Commanding General USMC NA
Facility/Owner Nance 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)
34.65812 N-77.315488
6. Is (are) the well(s): ©Permanent or ❑Temporary
7. Is this a repair to an existing well: DYes or MNo
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: 11'23 (ft.)
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing: 1 ' 51 (ft.)
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.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
Form GW-1
North Carolina Department of Environment an
14 WATER ZONES.
FROM
TO
DESCRIPTION
1.51 ft.
11.23 ft.
Water level collected at 24 hrs.
ft.
ft.
15. OUTER CASING(for multi -cased wells) OR LINER: (if applicable)
FROM
NA ft.
TO
NA ft.
DIAMETER
NA
in.
THICKNESS
NA
MATERIAL
NA
FROM
16. INN.ER CASING>OR TUBING (aeothernial closed -loop)
TO
0.0 ft.
11.23 ft.
DIAMETER
1
in.
THICKNESS
Sch 40
MATERIAL
PVC
ft.
ft.
in.
17. SCREEN
.FROM
1.23 ft.
ft.
TO
11.23 ft.
ft.
DIAMETER
1
•
in.
SLOT SIZE
.010
THICKNESS
Sch 40
MATERIAL
PVC
18. GROUT
FROM
TO
MATERIAL
0.00 ft.
ft.
0.30 ft.
ft.
QuikRete
EMPLACEMENT METHOD & AMOUNT
Hand Pour
ft.
ft.
19.'SAND/GRAVEL; PACT (if applicable)
FROM.
TO
MATERIAL
EMPLACEMENT METHOD
0.30 ft-
0.62 ft.
Hole Plug 3/8" Chips
Hand. pour
0.62 ft• 11.23 ft.
# Filter Sand
Hand pour
20.: DRILLING LOG (attach additional sheets if necessar
FROM
0.00 ft.
TO
9.00 ft.
DESCRIPTION (color, hardness, soil/rock type, rain she, etc.)
Clayey sand, SC, tan/gray, dry to moist
9.00 ft-
12.00 ft.
Sandy, gray, saturated
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
RED
ft.
21. REMARKS
ft.
AUG 0 1 2017
DWG/BOG
22. Certification:
Sign . e f :ertifie
r6c
ell Contractor
gill /II
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 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 Wens: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells 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, Unde
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells:
Also submit one copy of this form within 30 &fcm31ec34
well construction to the county health department of the county where
constructed.
Water Quality Regional
d Natural Resources - Division of Water Resources Operations SgelibiliAugust 2013
Wilmington Regional Office

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
DGeothermal (Heating/Cooling Supply)
Dlndustrial/Cornmercial
Dlrrigation
❑Municipal/Public
DResidential Water Supply (single)
DResidential Water Supply (shared)
Non :Water Supply Well:
OMonitoring
❑Recovery
Injection Well:
DAquifer Recharge
DAquifer Storage and Recovery
❑Aquifer Test
DExperimental Technology
❑Geothermal (Closed Loop)
DGroundwater Remediation
DSalinity Barrier
DStormwater Drainage
DSubsidence Control
❑Tracer
•
❑Geothermal (Heating/Cooling Return) El Other (explain under #21 Remarks)
4. Date Wells) Completed: Well ID# UST-FC39-MW13
8/8/2017
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:
(dwell field, one lat/long is sufficient)
34.6581 08 N -77.315456
6. Is (are) the well(s): ©Permanent or ❑Temporary
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.
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: 1 1.41
For multiple wells list all depths if different (example- 3@200' and 2 a 100')
10. Static water level below top of casing: 1.68 (ft,)
If water level is above casing, use " ; "
11. Borehole diameter: 2 (in.)
12. Well construction method: Direct Push Technology
(ft.)
(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:
446073
14. WATER ZONES
FROM
1.68 ft-
TO
11.41 ft.
DESCRIPTION
Water level collected at 24 hrs.
ft.
ft.
:15.'OUTER 'CASING (for multi -cased wells)OR;LINER .(if applicable)
TO
FROM
DIAMETER
THICKNESS
MATERIAL
NA ft.
NA
ft.
NA
in.
NA
16. INNER CASINGOR TUBING (geothermal closed -loopy
DIAMETER
FROM
0.0 ft.
TO
11.41
1
in.
THICKNESS
Sch 40
NA
MATERIAL
PVC
ft.
ft.
in.
17. SCREEN
FROM
1.68 ft-
ft.
TO
11.41 ft.
18. GROUT
ft.
DIAMETER
1
in.
in.
SLOT SIZE
.010
THICKNESS
Sch 40
MATERIAL
PVC
FROM
0.00 ft.
ft.
TO
0.35 ft:
0.
MATERIAL
QuikRete
EMPLACEMENT METHOD & AMOUNT
Hand Pur
ft.
ft.
19. SAND/GRAVEL` PACK (if applicable)
FROM
TO
MATERIAL
0.35 ft-
0.71 ft.
Hole Plug 3l8" Chips
EMPLACEMENT METHOD
Hand Pour
0.71 ft.
11.41 ft.
# 2 Filter Sand
Hand Pour
20. DRILLING LOG (attach additional sheets if. necessary)
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
FROM
0.00 ft.
TO
8.00 ft.
Clayey sand, SC, trace organics, gray, dry to saturated.
8.00 ft.
12.00 ft.
Silty sand,trace silt,trace clay,dark,saturated
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
ft.
ft.
ft.
r
AUG o 1267
h 6 rm on %io'3i.n Uri
DWC IC
22. Certification:
BIZ( t1
Sign a rtified ell Contractor Date
SEP
North Carolina Department of Environment and Natural Resources - Division of Water Resources Revised Anugust 2013
Water Quality RIoa
t
Operations Section1
Wilmington Regional Office
112017
By signing this form, I hereby certify that the wells) was (were) constructed in accordance
with 15A NC.AC. 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 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
24b. For Iniection 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:ECEIVED/NCDElyR/DWR
completion
Also submit one copy of this form within 30 da s of o
well construction to the county health department of the county where
constructed.

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):
446072
14, WATER ZONES
FROM
TO
DESCRIPTION
1.18
ft.
11.10 ft.
Depth of water level collected at 24 hrs.
ft.
ft.
15..OUTER :CASING `(for multi -cased wells) OR LINER (if applicable).
FROM
TO
DIAMETER
THICKNESS
MATERIAL
NA ft.
NA
ft.
in.
16 INNER CASING OR: TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0.0 fit.
11.10 fit'
1
in.
Sch 40
PVC
ft.
ft.
in.
17.: SCREEN
Water Supply Well:
DAgricultural
❑Geothermal (Heating/Cooling Supply)
D Industrial/Commercial
Dlrrigation
DMunicipal/Public
OResidential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
RiMonitoring
ORecovery
Injection Well:
OAquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
OGeothermal (Closed Loop)
OGroundwater Remediation
❑Salinity Barrier
OStormwater Drainage
❑Subsidence Control
❑Tracer
OGeothermal (Heating/Cooling Return) OOther (explain under #21 Remarks)
4. Date Well(s) Completed: 8r9/2017 Well ID# UST-FC39-MW11
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
Qnslow County
NA
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(dwell field, one lat/long is sufficient)
34.658178 N-77.315493
W
6. Is (are) the well(s): ©Permanent or ❑Temporary
7. Is this a repair to an existing well: [Wes or i?iNo
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: 11 0 (ft.)
For multiple wells list all depths if different (example- 3©200' 200' and 2@100')
10. Static water level below top of casing: 1 ' 18
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:
Form GW-1
FROM
1.10ft.
ft.
TO
11.10 ft.
ft.
DIAMETER
1
in.
in.
SLOT SIZE
.010
THICKNESS
Sch 40
MATERIAL
PVC
18.GROUT
FROM
0.00 ft.
ft.
TO
0.28 ft.
ft.
MATERIAL
QuikRete
EMPLACEMENT METHOD & AMOUNT
Hand Pour
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO.
MATERIAL
EMPLACEMENT METHOD
0.28 ft-
0.55 ft.
Hole Plug 3/8" Chips
Hand Pour
0.55 ft-
11.10 ft.
# 2 Filter Sand
Hand Pour.
-20.: DRILLING LOG; (attach additionsd sheets' if necessary)
FROM
0.00 ft.
TO
8.00 fit
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
Clayey Sand,SC dark, trace fines, moist
8.00 ft.
12.00 ft.
Fine silty sand, dark, saturated
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ECEVED
ft.
21. REMARKS
ft.
AUG 4 L•2017
infofFmilion Pzr „ ,g
22. Certification:
lel' ADvAit--
Sign f ertifie ell Contractor
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:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
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 the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center,
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 departmei8 EfpheRaicol11.. nt2171t7e
constructed.
JJ?NR/DWR
Water Quality Regional
Operations Section
North Carolina Department of Environment and Natural Resources -Division of Water Resources Revised August 2013
Wilmington Regional Office

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
°Geothermal (Heating/Cooling Supply)
D Industrial/Commercial
°Irrigation
Non Water Supply Well:
[Monitoring
Injection Well:
°Aquifer Recharge
ElAquifer Storage and Recovery
❑Aquifer Test
°Experimental Technology
°Geothermal (Closed Loop)
°Geothermal (Heating/Cooling .Return)
OMunicipal/Public
°Residential Water Supply (single)
°Residential Water Supply (shared)
❑Recovery
❑Groundwater Remediation
❑Salinity Barrier
OStormwater Drainage
°Subsidence Control
°Tracer
❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: 8/9/2017 Well ID# SST-FC39-MW10
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 de rees:
(if well field, one lat/long is sufficient) g
34.658159 -77.315514
N
6. Is (are) the well(s): ©Permanent or °Temporary
7. Is this a repair to an existing well: ❑Yes 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 firm.
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: 1 1 ' 2d
For multiple wells list all depths if different (example- 3@a 200' and 2 rr 100')
10. Static water level below top of casing: 1.83
If water level is above casing, use "-I- "
11. Borehole diameter: 2
(in.)
12. Well construction method: Direct Push Technology
(i.e. auger, rotary, cable, direct push, etc.)
(ft.)
(ft.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
Form GW-1
For Internal Use ONLY:
14. WATER ZONES
FROM
1.83 ft
ft.
TO
11.20 ft
1S OUTER CASING
FROM
NA ft.
ft.
DESCRIPTION
Water level collected at 24 hrs.
for multi -cased wells OR LINER if a livable
DIAMETER
NA
16:INNER CASING OR TUBING :(geothermal :closed -loop)
FROM TO DIAMETER
0.0
ft.
ft.
11.20 • ft.
ft.
17.'SCREEN:
FROM
1.20 f t•
ft.
TO
11.20 ft
ft
18. GROUT
FROM
0.0
ft.
ft.
ft.
TO
0.30
ft.
ft.
ft.
1
DIAMETER
1
in.
in.
MATERIAL
QuikRete
in.
in.
THICKNESS
Sch 40
SLOT SIZE
19. SAND/GRAVEL.PACK (if applicable)
FROM TO MATERIAL
0.30 ft.
0.60 ft.
20.. DRILL!
.FROM
0.00 ft'
7.00 ft.
8.00 ft.
ft.
ft.
ft.
ft.
.010
MATERIAL
PVC
THICKNESS MATERIAL
Sch 40 PVC
EMPLACEMENT METHOD & AMOUNT
Hand Pour
EMPLACEMENT METHOD
0.60 ft
11.20 ft
NG'LOG:(attach additional sheen rf necessary)
DESCRIPTION color hardness sail/k
TO
7.00
ft.
8.00 ft
12.00 ft.
21. REMA_RI1S
22. Certification:
Signa
ft.
ft.
ft.
Hole Plug 3/8" Chips
# 2 Filter Sand
Hand Pour
Hand Pour
roc in six
Clayey Sand ,SC, Tan to Brown, Dry to Moist, few
Course Sand,SW, Trace Fines, light tan, saturated
Sand,SW, Tan, Saturated . 1
Information i''r
etc.
LE1Jtz
Z1 11
Date
By signing this form; I hereby certify that the well(s) was (were) constructed in accordance
with 1 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 INSTUCTIONS
24a. For All Wells: Submit this fonn within 30 days of completion
construction to the following: p on of. well
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Infection W Hs ONLY: In addition to sending the fonn to the address 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 °g am,
24c. For. Water Supply & Injection Wells;RECEIVED/NCDENRIDWRAlso submit one copyof
this form within 30 days of completion of
well construction to the county health department of the county where
constructed.
AZ4NrAitt
rtified i ell Contractor
North Carolina Department of Environment and Natural Resources - Division of Water Resources
SEP 1 1 2017
Revised August 2013
Water Quality Regional
Operations Section
Wilmington Regional Office

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
DGeothermal (Heating/Cooling Supply)
D Industrial/Commercial
❑Irnjation
Non Water Supply Well:
E Monitoring
Injection Well:
❑Aquifer Recharge
DAquifer Storage and Recovery
DAquifer Test
DExperimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
8/g/2017
DMunicipal/Public
DResidential Water Supply (single)
[Residential Water Supply (shared)
DRecovery
DGroundwater Remediation.
❑Salinity Barrier
D Stormwater Drainage
❑Subsidence Control
DTracer
DOther (explain under#21 Remarks)
4. Date Weil(s) Completed: Well ID# UST-FC39-MWO8
5a. Well Location:
Commanding General USMC
Facility/Owner Name
Sneads Ferry Rd. Camp
NA
Facility ID# (if applicable)
Lejeune, NC, 28547
Physical Address, City, and Zip
Onslow County
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)
34.658134 N -77.315423
_ W
6. Is (are) the well(s): ©Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ElNo
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: 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: 11.51 ft.
For multiple wells list all depths if. different (example- 3@200' 200' and 2 rr 100') ( )
10. Static water level below top of casing: 1.94 (ft.)
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.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
Form GW-1
For Internal Use ONLY:
446069
14. WATER ZONES
FROM
1.94 ft.
TO
11.51 ft.
DESCRIPTION
Water level collected at 24 hrs.
ft.
ft;
15. OUTER CASING (for multi -cased wells) OR LINER (if applicable)
DIAMETER THICKNESS MATERIAL
NA in. NA NA
16. INNER CASING OR TUBING (geothermal closed -loop)'
TO ( DIAMETER 1 THICKNESS l
FROM TO
NA ft.
FROM
0.0 ft
NA
ft.
11.51 ft.
1
in.
Sch 40
MATERIAL
PVC
ft.
17. SCREEN
ft.
in.
FROM TO
1.51 ft. 11.51 ft.
ft. ft.
18. GROUT
FROM
_0.0 ft.
DIAMETER SLOT SIZE ,
in.
1
in.
.010
THICKNESS
Sch 40
MATERIAL
PVC
TO
0.37 ft*
MATERIAL
QuikRete
EMPLACEMENT METHOD & .AMOUNT
Hand Pour
ft.
ft.
ft.
ft.
19.`SAND/GRAVEL .PACK (if applicable)
FROM
0.37 ft.
TO
0.75 ft.
MATERIAL
Hole Plug 3/8" Chips
EMPLACEMENT METHOD
Hand Pour
0.75
ft.
11.51 ft
# 2 Filter Sand
Hand Pour
20. DRILLING LOG (attach 'additional sheetsif necessary)
DESCRIPTION (color, hardness, soil/rock type, grain sae, etc.)
FROM
0.00 ft.
8.00 ft.
TO
8.00 ft.
12.00 ft.
Clayey sand, SC, gray, dry to saturated, backfll
ft.
ft.
Clayey sand, SC, gray, trace silt, saturated
ft.
ft,
ft.
ft.
ft. .
ft.
ti is
ft.
21. REMARKS
ft.
22. Certification:
Si
i'
AUG%` ' 17
tinftwation Pro€ ly Unfit.
n of c,G
dr
ertifi4.Well Contractor
Date
By signing this form, I hereby cert6 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 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
24b. For Iniection 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 with
well construction . - ���� o to the county health department of the county where
constructed.
North Carolina Department of Environment and Natural Resources * Division of Water Resources
WR
SEP 11 2.012
August 2013
Water Quality Regional
Operations Section
Wilmington Regional Office

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
Jeffery A. Stewart
Well Contractor Nance
(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:
DAgricultural
DGeothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
Dlrrigation
For Internal Use ONLY:
446068
14, WATER ZONES;
FROM
To
DESCRIPTION
1.63 ft.
ft.
11.4 ft.
ft.
Depth of water collected at 24hrs
15. OUTER CASING (for multi -eased OR LINER (if 'applicable)
::
TO
FROM
DIAMETER
THICKNESS
MATERIAL
NA
ft.
NA ft.
NA
in.
NA
16. INNER CASING OR TUBING (geothermal closed -loop)
TO
FROM
DIAMETER
THICKNESS
NA
MATERIAL
0.0 ft.
11.4 ft.
1
in.
Sch 40
PVC
ft.
ft.
in.
17. SCREEN
DMunicipal/Public
DResidential Water Supply (single)
DResidential Water Supply (shared)
Non -Water Supply Well:
IZ1Monitoring
Injection Well:
❑Aquifer Recharge
DAquifer Storage and Recovery
DAquifer Test
DExperimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return
DRecovery
❑Groundwater Remediation.
D Salinity Barrier
❑ Stormwater Drainage
DSubsidence Control
DTracer
DOther (explain under #21 Remarks).
4. Date Well(s) Completed: Well ID# UST-FC39-MW04
8/9/2017
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)
34.658156 N-77.315485
6. Is (are) the well(s): ©Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or LINO
!Phis 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: 11.4
For multiple wells list all depths if different (example- 3@200' and 2(31001
10. Static water level below top of casing: 1.63 (ft.)
If water level is above casing, use "+ "
11. Borehole diameter: 8.25 (in.)
12. Well construction method: Hollow Stem Auger
(i.e. auger, rotary, cable, direct push, etc.)
(ft.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
Form GW-1
FROM
1.4 ft.
ft.
TO
11.4 ft.
8. GROUT
FROM
0.00 ft-
TO
ft.
DIAMETER
2
in.
in.
SLOT SIZE
.010
THICKNESS ,
Sch 40
MATERIAL
PVC
0.35 ft;
•
MATERIAL
Quikrete
EMPLACEMENT METHOD & AMOUNT
Handpour
ft.
ft.
ft.
ft.
`19'.SAND/GRAVEL :`PACK (if applicable)'`
FROM.
TO
MATERIAL
0.35 ft-
0.70 ft.
Hole Plug 3/8" Chips
EMPLACEMENT METHOD
Hand Pour
0.70 ft.
11.40 ft.
# 2 Filter Sand
Hand Pour
20. DRILLING LOG (attach additional sheets if necessary)
FROM DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
0.00 ft.
8.00 ft.
TO
8.00 ft
12.00 ft.
Clayey Sand, SC, tan/gray, trace silt, moist at 5'.
Sand, SW, gray, trace silt, saturated
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
/UG 0 "a 2017
ft.
21. REMARKS
ft.
klan,nirdion Procraixv Unit
DINCOOG
22. Certification:
Sig
ertifieell Contractor
r
`,Z\j►l
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:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells ONLY: In addition to sending the form to the address in
24a above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Cente i .►�. ; �, f; -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 depa o county where
constructed.
-� 2011
North Carolina Department of Environment and Natural Resources - Division of Water Resour Revised. August 2013
water C�ual�t
Operations
F�eg�onal
VVilming�on S Sect
Office

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:
14. WATER ZONES
FROM
TO
446067
DESCRIPTION
1.76 ft.
11.56 ft.
Water level collect
d at 24 hrs.
ft.
ft.
IS. OUTER CASING (for multi cased weils).OR LINER (if jcable)
FROM
NA ft:
TO
NA
ft.
DIAMETER
NA
in,
THICKNESS MATERIAL
NA
NA
16. INNER CASING OR TUBING (geothermal closedaoep)
THICKNESS MATERIAL
FROM
0.0 ft.
ft.
TO
11.56 ft.
ft.
DIAMETER
1
in.
in.
Sch 40
PVC
17.`SCREEN
Water Supply Well:
CI Agricultural DMunicipal/Public
DGeothermal (Heating/Cooling Supply) DResidential Water Supply (single)
0Industrial/Commercial DResidential Water Supply (shared)
0Irrig;ation
Non -Water Supply Well:
121Monitoring
❑Recovery
Injection Well:
❑Aquifer Recharge
OAquifer Storage and Recovery
OAquifer Test
DExperimental Technology
❑Geothermal (Closed Loop)
Groundwater Remediation
OSalinity Barrier
O Stormwater Drainage
❑Subsidence Control
❑Tracer
OGeothermal (Heating/Cooling Return) ❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: 8/9/2°17 Well ID# UST-FC39-MWO3
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)
34.658134
N-77.315468
6. Is (are) the well(s): 121Permanent or OTemporary
7. Is this a repair to an existing well: °Yes . or I 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 form.
8. Number of wells constructed:
For multiple injection or non -water supply wells ONLY with the saute construction, you can
submit one form.
9. Total well depth below land surface: 11.56 (ft.)
For multiple wells list all depths if different (example- 3@200' and 2@I00')
10. Static water level below top of casing: 1.76 (ft,)
If water. level is above casing, use "-f- "
11. Borehole diameter: 2
12. Well construction method: Direct push technology
(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
FROM
1.56 ft.
ft.
TO
11.56 ft-
ft.
DIAMETER
1
in.
in.
SLOT SIZE
.010
THICKNESS
Sch 40
MATERIAL
PVC
18. GROUT . .
FROM
0.00 ft-
ft.
TO
0.39 ft.
ft.
MATERIAL
QuikRete
EMPLACEMENT METHOD & AMOUNT
Handpour/ Approximately 611
ft.
ft.
19. SAND/GRAVEL :PACK `(if applicable)
FROM
0.39 ft.
TO
0.78
ft.
MATERIAL
Hole Plug 3/8" Chips
EMPLACEMENT METHOD
Hand Pour
0.78 ft.
11.56 ft.
# Filter Sand
Hand Pour
20. DRILLING LOG (attach additional' sheets if necessary)
FROM
0.0 ft.
TO
5.0 ft•
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
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.
REEIVE
21. REMARICS
22. Certification:
1)
Signa
tr
ified W; l Contractor
AUG
0 4 2017
ti-t .wmailor1 Piuc
eesmg
okNoMOG
,.-12v-cte
tizat
r� '1tl
Date
By signing this form, 1 hereby certify that the wells) 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 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
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 the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 276994fabENR/DwR
24c. For Water SupplyInjection Wells: RECEIVED/
Nuu
&
Also submit one copy of this form within 30 days of completion of
well construction to the county health department of the coun w
constructed.S1 I L`
EP .� 7
North Carolina Department of Environment and Natural Resources - Division of Water Resources •
Revised August 2013
Water Quality Regional
Operations Section Wilmington Regional Office

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
For internal Use ONLY:
446292
1. Well Contractor Information:
Lawrence D. Opper
Well Contractor Name
NC3322-A
NC Well Contractor Certification Number
Regional Probing Services
Company Name
2. Well Construction Permit #:
list all applicable well construction permits (i.e. ('ou1171y, State, Variance, etc.)
3. Weil Use (check well use):
WATER : ZONES.
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
I5 OUTER Z S:1NG (foie multi -cased wells) OR:LINER (if applicable);
FROM TO DIAMETER THICKNESS MATERIAL
ft.
ft.
in.
16-..11VNER C ASING OR TtTHiI 'G:(geothermal closed -loop
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0
ft.
3
t't.
2
in.
sch 40
PVC
ft.
ft.
in.
CR.EE1l
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑Irrigation
❑Municipal/Public
DResidential Water Supply (single)
DResidential Water Supply (shared)
Non -Water Supply Well:
OMonitoring DRecovery
injection Well:
❑Aquifer Recharge
DAquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
❑Groundwater Remediation
❑Salinity Barrier
❑Storrnwater Drainage
DSubsidence Control
❑Tracer
DOther (explain under #21 Remarks)
4. Date Well(s) Completed: 10/4/2017 Well ID= MW-1
5. Well Location:
Union Chapel Church Rd103 Incident #32980
Facility/Owner Name Facility ID# (if applicable)
103 Union Chapel Church Road, Richlands
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)
34.845878 N 77.535941
6. Is (are) the well(s): ©Permanent or ❑Temporary
7. is this a repair to an existing well: ❑Yes or ✓UNo
If *this is a repair, .fill out known well construction informaliwn and explain the nature (#. the
repair under 1,21 remarks' section or on the hack o f this form.
8. Number of wells constructed:
For multiple injection or non -water supply wells ONL Y ►pith the same construction, .v m can
submit one firm.
9. Total well depth below land surface: 15
For multiple wells list all depths ifdifferent (exaniple- 3 a,200' and ?(iD..100')
10. Static water level below top of casing: approx.10
If'►waler level is above casing, use " "
11. Borehole diameter: 4 (in.)
12. Well construction method: auger-dpt
(i.e. auger, rotary, cable, direct push, etc.)
(ft.)
13. FOR WATER SUPPLY WELLS ONLY:
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
3
ft.
15 ft.
2
in.
.010
sch40
PVC
ft.
ft.
in.
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0
ft.
1.5
ft.
cement grout
pour
1.5 ft-
2.5 ft.
bentonite
pour
ft.
ft.
: SAND/GR..V'EL'PACK (if applicable)_:
FROM
TO
MATERIAL
EMPLACEMENT METHOD
2.5
ft.
15
ft.
#2 sand
pour
ft.
ft.
. DRIL 1NG L�E7G (attuchaddit.onal sheets, it necessary
FROM
0 ft.
TO DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
1
ft.
Topsoil/gravel
1
ft.
15 ft.
Claey, Sandy Silt
ft.
ft.
ft.
ft.
ft.
ft.
i 4LT,
ft.
ft.
OCT 2
2017
ft.
ft.
22. Certification: Lawrence
O•per
1)npl,dly �i�yrrvl by 1 awrrnrr ()ppm
DN cn Lawrence Opper, o Regional
Probing Services, au,
email=larryceregionalprabing.com.
c_Us
Date: 2017.10 201101:08
10/16/2017
Signatut` of `tedified Well Contractor Date
Nv signing this farm, 1 hereby cerli/j that the well(s) was (iwere) constructed in accordance
with 13.4 N('.4(' 02(" .0100 or I jA N('A(' 02C .0200 Well Construction Standards and That a
copy (phis •This record has been prorided to the ►1'cll miner.
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.
24. Submittal Instructions:
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
'
EQ D1 I ► 1 ter Quality, Information Processing Unit,
1 `'1 nice Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
mm, is st4j/ ia copy of this form within 30 days of completion of well
tru ! t �ifollowing:
Division of Water Quality, Underground Injection Control Program,
Water Quality R1Sertl!l tl Service Center, Raleigh, NC 27699-1636
�RloIr�► ly & Geothermal Wells: In addition to sending the form to
l 3a. Yield (gpm) Method of test: �/i � Cl� 1 ,l � , l ,
�i�i g4RP§ii , 'so submit one copy of this form within 30 days of
13b. Disinfection type: _ Amount:
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 Quality
Revised Jan. 2013

Print Form
WELL CONSTRUCTION RECORD (GW-1)
1. WeIl Contractor Information:
John Salmon
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
X. Irrigation
Non -Water Supply Well:
"�. Monitoring
DMunicipal/Public
DResidential Water Supply (single)
DResidential Water Supply (shared)
DRecovery
Injection Well:
;Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
4. Date Wells) Completed: 09/13/1
5a. Well Location:
Don Walton
OGroundwater Remediation
Salinity Barrier
DStormwater Drainage
DSubsidence Control
DTracer
Other (explain under #21 Remarks)
7 Wel1 ID# N/A
N/A
Facility/Owner Name Facility IDff (if applicable)
Near 139 Lamm Lane, Jacksonville, NC
Physical Address, City, and Zip
Onslow
005267
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 44 55.21 N 77 34 23.47
W
6. Is(are) the well(s)JPermanent or OTemporary
7. Is this a repair to an existing well: DYes or ONo
If this is a repair, fill out known well construction information and explain the nature of the
repair under 1t21 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: 80
For multiple wells list all depths if different (example- 3@,200' and 2@100')
(ft.)
10. Static water level below top of casing: 15 ft.
( )
If water level is above casing, use "+ "
11. Borehole diameter: 7 7/8 (in.)
12. Well construction method: Mud Rotary
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 100 Method of test: Airlift
13b. Disinfection type: HTH Amount: 3%@ 10g
For Internal Use Only:
446880
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
15. OUTER CASING (for'mult-cased wells) OR :LINER Off a .
FROM TO
0
ft.
50 ft-
DIAMETER
4
in.
p cable}
THICKNESS MATERIAL
SCH40
16.:INNER CASING OR TUBING (geothermal closedloop
FROM
TO
DIAMETER
THICKNESS
PVC
MATERIAL
ft.
ft.
in
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
50 ft;
80 ft.
2
to.
.020
SCH40
PVC
ft.
ft.
in.
IS. GROUT`
FROM
0 ft.
TO
45 ft
MATERIAL
Bentonite
EMPLACEMENT METHOD & AMOUNT
Poured
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)`:
FROM
TO
MATERIAL
EMPLACEMENT hILTHOD
45 ft.
80 ft-
Coarse
Poured
ft.
ft.
20..DRILLINC:LOG (attach additional sheets if necessary
FROM
0
ft.
TO
10 ft-
DESCRIPTION (color, hardness, soilfrock type, grain size, etc.)
Sand
10
15
35
ft.
ft.
15 ft.
35 ft.
80
Sandy clay
Grey stickey clay
Limestone
ft.
ft.
ft.
ft.
ft.
RFC' V, PrO
21. REMARKS
C•T O2Oi7
Normiallion Procw.mng Unit
22. Certification:
ture of
11 Contractor
9/13/17
Date
signing 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:
Division of Water Resources
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells: In addition to seigAgrthc form to the address in 24a
above, also submit one copy of this form within SO1Ia linpletion of well
construction to the following:
Division of Water Resources, Underg. Voi t 'rogram,
!
1636 Mail Service Center, R y ; + 9 -.. ,'
,,
24c. For Water Supply & Infection 4111slingtgdgggiMenciifftle 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