GW1 - New Hanover Dec-Jun 2018

For Internal Use ONLY:
WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
ECEIVED/NCDENR/DWR
Lawrence D. Opper
Well Contractor Name
NC3322-A
DEC 3 1 2018
NC Well Contractor Certification Number Water Quality Regional
Regional Probing Service Operations Section
Niiming-ton RPginnal Office
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. County, State, Variance, etc.)
3, Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Cotnmercial
❑Irrigation
❑ Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
Mon itoring
❑ Recovery
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
OGeothermal (Heating/Cooling Return)
❑ Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 Remarks)
4. Dale Well(s) completed: 11/26/2018 MW-1
5. Well Location:
Circle K 2720915
Facility/Owner Name Facility ID# (if applicable)
5717 Castle Hayne Rd., Castle Hayne
Physical Address, City, and Zip
New Hanover
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one ladlong is sufficient)
34.354237 N 77.900332
6. is (are) the well(s): DPermanent or ❑Temporary
W
7. Is this a repair to an existing well: ❑Yes or ❑No
!phis is a repair, Jill out known well construction information and explain the nature of the
repair under `21 remarks section or on the back o/ this Jornt.
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: 13 (ft.)
For multiple welts list all depths ifd different (example- 3(5200' and 2 rt 100')
10. Static water level below top of casing: approX 8 (ft.)
If water level is above casing, use "+ "
11. Borehole diameter: 4.25
12. Well construction method: Geoprobe
(i.e. auger, rotary, cable, direct push, etc.)
13. 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 welts) OR LINER (if a livable)
FROM
TO
DIAMETER
THICKNESS MATERIAL
ft.
ft.
in.
16. INNER CASING OR 'WRING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
3 ft.
2 in.
sch 40
PVC
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIA I.
3 f.
13 ft•
2 in.
.010
sch40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 it.
2 ft•
cement grout
pour
2 ft.
2.5 ft-
bentonite
pour
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
2.5 ft•
13 ft.
#2 sand
Prepack/pour
ft,
ft.
20. DRILLING
LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, son/rock type, grain size, elc.)
0 ft.
13 ft.
tan-brn silty Sand
ft.
ft.
fL
ft.
ft.
ft.
ft,
ft.
a,
rt.
l, c, 6�,®4
ft. ft.
21. REMARKS C
v
22. Certification:
Di SPy signed by Lawrence Opper
DN. crwLawrence Ogden maegional
Lawrence Opper Probings.,,,,-
emai Ol2.egionalprobingsom,o.U5
Dnle.2O18.12.02 •':53,07 WOW
Signature of Certified Well Contractor
12/2/2018
Dale
By signing this form, 1 hereby cert) that the well(s) was (mere) constructed 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 if necessary.
24. Submittal instructions:
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, 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
above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Geothermal 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.
F01111 GW- I
Noah Carolina Department of Environment an
d Natural Resources - Division of Water Quality Revised Ian. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells RECEIVED/NCDENR/DWR
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 #:
B-CC 31 2018
Water Quality Regional
Operations Section
Wilmington Regional Office
List all applicable well construction permits (i.e. County, State, Variance, etc.)
3. Well Use (check well use):
For Internal Use ONLY:
14. WATER ZONES
3
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15.OUTER CASING (for multi -cased wells) OR INNER (if applicable)
FROM DIAMETER
TO
ft.
ft.
in,
THICKNESS
MATERIAL
16. INNER CASING OR TUBING (geothermal cloned -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0
ft.
2
ft.
2
in.
sch 40
PVC
ft.
ft.
in.
17. SCREEN
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑lrrigation
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
I21Monitoring
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑ Aquifer Test
❑ Experimental Technology
❑Geothermal (Closed Loop)
OGeothermal (Heating/Cooling Retum)
❑Recovery .
❑Groundwater Remediation
❑Salinity Barrier
OStormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: 11/27/2018 MW-1, MW-2
5. Well Location:
Circle K 2720937
Facility/Owner Name Facility ID# (if applicable)
2028 Oleander Drive, Wilmington
Physical Address, City, and Zip
New Hanover
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
34.223609 N 77'921617
6. Is (are) the well(s): DPermanent or DTemporary
7. Is this a repair to an existing well: OYes or ❑No
Ifthis is a repair, jilt out known well construction inJarmarion and explain the nature ofthe
repair under 21 remarks .section or an the back of this form.
8. Number of wells constructed: 2
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: 12
For multiple wells list all depths if different (example- 3@200' and 2@!00')
10. Static water level below top of casing: approx 6 (ft.)
If water level is above casing, use "-"
11. Borehole diameter: 4.25 (in.)
12. Well construction method: Geoprobe
(ft.)
(i.e. auger, rotary, cable, direct push, etc.)
13. FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gptn) Method of test:
13b. Disinfection type: Amount:
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
2
ft,
12 fL
2
in.
.010
sch40
PVC
ft.
ft.
in.
18, GROUT
FROM
0
ft.
TO
1
ft.
MATERIAL
cement grout
EMPLACEMENT METHOD & AMOUNT
pour
ft.
ft,
1.5 ft.
ft.
bentonite
19. SANDJGRAVEL PACK (if applicable)
FROM
TO
MATERIAL
pour
EMPLACEMENT METHOD
1.5 n•
12
ft.
#2 sand
Prepack/pour
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
0
ft.
TO
12 ft.
ft.
ft.
DESCRIPTION (color, hardness, seillrock type, grain size, etc.)
tan-brn silty Sand
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
22. Certification:
D th signed by Lawrence Opper
DN: -Lawrence Opper, waegional
Lawrence Opper,-. SeMce;au
emaa=larryasregianaaprobing.com, c=US
Data 2018.• 2.02 11.2812 0:'O0'
Signature of Certified Well Contractor
(' fl..fjG`//„Th.
LIr.t
12/2/2018
Dale
By signing this form. 1 hereby terrify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or ISA NCAC 02C .0200 Well Construction Standards and that a
copy ofthhis 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.
24. Submittal Instructions:
24a, For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: 1n 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 Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Geothermal 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-I North Carolina Department of Environment and Natural Resources - Division of Water Quality
Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
Lawrence D. Opper
RECEIVED/NCDENR/DW
Well Contractor Name
NC3322-A
NC Well Contractor Certification Number
Regional Probing Services
Company Naive
2. Well Construction Permit #:
DEC ,3 t ZU18
For Internal Use ONLY:
14, WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
Water Quality Regional
Operations Section
Wilmington Raginnal pfficr,
List all applicable well construction permits (i.e. County, State, Variance, etc.)
3. Well Ilse (check well use):
15. OUTER CASING (tor multi -cased wells) OR LINER (if applicable)
FROM DIAMETER
TO
ft.
in.
THICKNESS
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM TO
DIAMETER
THICKNESS
MATERIAL
MATERIAL
0
ft.
2
ft.
2
in.
sch 40
PVC
ft.
ft.
in.
17. SCREEN
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ In dustri al/Commercial
❑irrigation
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
OMonitoring
injection Well:
DAquifer Recharge
DAquifer Storage and Recovery
DAquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Recovery
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Geothermal (Heating/Cooling Retum) ❑Other (explain under 1121 Remarks)
4. Date Well(s) Completed: 11/26/2018 MW-1
5. Well Location:
Circle K 2720484
Facility/Owner Name Facility ID# (if applicable)
5800 Castle Hayne Rd., Castle Hayne
Physical Address, City. and Zip
New Hanover
County Parcel identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
34.354913 N 77.899565
6. is (are) the well(s): OPerntanent or ❑Temporary
7. is this a repair to an existing well: ❑Yes or ❑No
Ifsti.s is a repair, fill our known well construction information and explain the nature of the
repair under +2! remarks section or on the back of this form.
8. Number of wells constructed: 1
Mir multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
9. Total well depth below land surface: 12 (ft.)
For multiple wells list all depths ifderent (example- 3 a 200' and 2@!00')
10. Static water level below top of casing: approx 5 (ft,)
!f hater level is above casing, use "+ "
11. Borehole diameter: 4.25 (in.)
12. Well construction method: Geoprobe
(i.e. auger, rotary, cable, direct push, etc.)
13. FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: tniount:
FROM
2
Ft,
TO
12 ft.
DIAMETER
2
in.
SLOT SIZE
.010
THICKNESS
sch40
MATERIAL
PVC
ft.
ft.
in.
18. GROUT
FROM
0
ft.
TO
ft.
MATERIAL
cement grout
EMPLACEMENT METHOD & AMOUNT
pour
ft.
ft.
1.5 ft.
ft.
bentonite
pour
19. SAND/GRAVEL PACK (if applicable)
FROM
1.5 ft.
TO
12
ft.
MATERIAL
#2 sand
EMPLACEMENT METHOD
Prepack/pour
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
TO
FROM
0
ft.
12
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft. ft.
21. REMARICS
DESCRIPTION (color, hardness, sail/rock type, grain size, etc.)
tan-brn silty Sand
22. Certification:
gilally signed by Lawrence Opper
�Dtk cn=LawrenceOpper, a=Regianal
Lawrence Opper Pro.-35-,-. a,
•emal=la rry1reglonalp,obing.com, c=US
01... 2018.12.02 11e1.11 05'00'
Signature of Certified Well Contractor
12/2/2018
Date
8y .signing this form, 1 hereby certify that the well(s) was (were) constructed in accordance
with : 5A NCAC 02C .0100 or 15,4 NCAC 02(.' .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.
24. Submittal Instructions:
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For inflection Wells: in addition to sending the foul 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 Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Geothermal Wells: In addition to sending the form to
the addiess(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.
54.
Form GW- I
North Carolina Department of Environment and Natural Resources -Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:�tl�'IVLt! S111'�r1�
Donald Cummings C�l
Well Contractor Name
2412-A
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.)
3. Well Use (check well use):
UEC 1 0 2018
NC Well Contractor Certification Number
\n rr Quality,) Re Tonal
Applied Resource Manage e'ntio ' C.
Company Name llifll!�'._tUu Region) -tfICP
N/A
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
X Irrigation
Non -Water Supply Well:
]Monitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
DMunicipal/Public
DResidential Water Supply (single)
DResidential Water Supply (shared)
[Recovery
Groundwater Remediation
DSalinity Barrier
DStonnwater Drainage
Subsidence Control
DTracer
rilOther (explain under #21 Remarks)
4. Date Well(s) Completed: 1 1 /26/1-8 Well 1D# NIA
5a. Well Location:
Chris Brownfield
N/A
Facility/Owner Name Facility ID# (if applicable)
6304 Timber Creek Lane
Physical Address, City, and Zip
New Hanover
R04418001030000
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 15 27.25 N 77 48 31.22
W
6. Is(are) the well(s)4JPermanent or DTemporary
7. Is this a repair to an existing well: ElYes or xDNo
If this is a repair, fill out known well construction information and explain the nature of the
repair render '2f remarks section or on the hack of thisform.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only I GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled: 1
9. Total well depth below land surface: 165
For multiple wells list all depths ijdifferent (example- 3@,200' and 2'ru100')
(ft.)
10. Static water level below top of casing: 14 (ft.)
1f water level is above casing, use "-"
11. Borehole diameter: See remarlo(in )
12. Well construction method: Mud Rotary
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 60 Method of test: Air lift
13h. Disinfection type: HTH Amount: 3% 10 g
Print Form
For Internal Use Only:
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER
CASING (for multi -cased wells) OR LINER (if a livable)
FROM
TO - '
DIAMETER
THICKNESS
MATERIAL .
0 ft.
50 ft.
•6 In•
SCH40
PVC
16. INNER
CASING OR TUBING
(geothermal closed -loop)
FROM
' TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
140 ft•
4 in'
SCH40
PVC
125 ft•
145 ft.
2 in'
SCH40
PVC
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
145 ft.
165 ft.
2 in*
.010
SCH40
PVC
ft.
ft.
in.
18. GROUT
• '
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 it•
25 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, soillr ock type, grain size, etc.)
0 fl,
38 ft•
Sands/clay
38 ft.
85 ft.
Limestone
65 ft.
75 ft.
Clay
75 ft.
135 ft.
Limestone/clay layers
135 ft•
165 ft
Sandstone -
ft.
ft.
.� -`;_
ft.
ft.
!�
I e�C.
21. REMARKS tJ
0' to 50' = 8", 50' .to 165' = 6."
11/26/18
Sig ature of Certified Well Contractor U Date
By signing this form, l hereby terrify that the well(s) was (were) constructed in accordance
with 1SA NCAC 02C .0100 or 1SA NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram• or additionatwell: details:
You may use the back of this page to provide additional well site details or well
construction details.. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells:: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of 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 G\V-1
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2.22-2016

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Print Form
For Internal Use Only:
Donald Cummings
Well Contractor Name
2412-A
RECEIVED/MCDENR/DVIR
DEC 10 2018
NC Well Contractor Certification Number •
�' p o. l OfffcC
Company Name wn 29
I Inf7tOn K t+lUltd
2. Well Construction Permit #: " ' r 0���
List all applicable well construction pennits (Le. UIC, County, State, Variance, etc.)
3. Well Use (check well use):
Applied Resource Man'
Water Supply Well:
Agricultural .
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
Non -Water Supply Well:
Monitoring
Injection Well:
1
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heatin• CoolingRetum)
QMunicipal/Public
xDResidential Water Supply (single)
Residential Water Supply (shared)
Recovery
Groundwater Retnediation
Salinity Barrier
OStonnwater Drainage
Subsidence Control
Tracer
Other (lain under #21 Remarks)
4. Date Well(s) Completed: 1 1 /19/18 Well ID# NIA
5a. Well Location:
Ray Jolly
N/A
Facility/Owner Name Facility ID# (if applicable)
800 Cedar Ramble Lane
Physical Address, City, and Zip
New Hanover R04500-001-046-000
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one tat/long is sufficient)
34 16 30.76 N 77 47 19.58
W
6. Is(are) the well(s)X Permanent or OTemporary
7. Is this a repair to an existing well: DYes or 0No.
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 farm.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only I GW-1 is needed, Indicate TOTAL NUMBER of wells
drilled:1
9. Total well depth below land surface: 65 (ft.)
Fa' multiple wells list all depths if different (example- 3@@r 200' ant12@100' )
10. Static water level below top of casing: 8 (ft.)
If water level is above casing, use
11. Borehole diameter: See remarl tu(ln.)
12. Well construction method: Mud Rotary
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 80 Method of test: Air lift
13b. Disinfection type: HTH Amount: 3%@ 10 g
CEO
14. WATER ZONES ►-} .
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER
CASING (for
multi -cased wells) OR LINER (if a licable)
FROM
TO
DIAMETER
THICIMESS
MATERIAL
0 ft.
47 ft.
4 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
ft.
ff.
in.
ft.
ft.
in.
18. GROUT
FROM
TO _
MATERIAL
EMPLACEMENT METHOD&AMOUNT
0 ft'
25 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, soiVrock type, grain size, etc.)
0 ft,
24 ft.
Clay
24 ft'
38 ft
Candy clays/sands
38 ft.
65 ft.
Limestone
fr.
ft.
ft.
ft.
ft.
ft.
ft,
ft.
21. REMARKS
0'to25'=8", 25'to55'=6", 55'to65'= 4"
22. Certification:
ignature of Certified Well Contractor
11/26/18
Dale
By .signing this form, 1 hereby cent j5 that the well(s) was (were) constructed in accorddnc`a.,
with ISA NCAC 02C .0100 or 15A NCAC 02C .0200 We!! Construction Standards and Mato
copy of this record has been provided to the well owner.
You may use the back of this page to provide additional vitsittdaailt'or well
construction details. You may also attach additional pagefessary. ,
23. Site diagram op additionaLwelldetails:
SUBMITTAL INSTRUCTIONS
24a. For All Wells.Submit this form within 30 days of completion of well
construction tathe following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the fonn to the address in 24a
above, also submit one copy of this fonn 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 forts within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW- I
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

For Internal Use ONLY:
WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
I. Well Contractor Information:
Lewis LeFever
Well Contractor Name
2480
NC Well Contractor Certification Number
DEC 1 0 2018
Water f-raiitY Regional
WS080102 Operations Section
2. Well Construction Permit#: Jitmington Regional OffiC
List all applicable well pennies (i.e. ['aunty, State, Variance. Injection, etc.)
3. Well Erse (check well use):
Parratt-Wolff, Inc.
Company Name
14. WATER ZONES
Q0'1 9
FROM
TO
DESCRIPTION
0
fI
10.0 ft.
Wet
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if a cae li bl )
FROM
0
ft.
TO
19.0 ft,
DIAMETER
12.0
in.
THICKNESS MATERIAL
Sch. 30 Steel
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0
ft.
45.0 ft.
6.0
in.
Sch, 40
Stainless Steel
75.0 ft.
80.0 ft.
6.0
in.
Sch. 40
Stainless Steel
17. SCREEN
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
D Ind ustrial/Commercial
❑Irrigation
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
❑Monitoring
Cl Recovery
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
NIATERIAL
45.0 rt'
75.0 ft.
6.0 in.
0.015"
304
Stainless
ft.
ft.
in.
1S. GROUT
FROM
0
ft.
TO
37.0 ft.
MATERIAL
Bent/Port
EMPLACEMENT METHOD & AMOUNT
Tremied
37.0 ft.
40.0 ft.
Bentonite
Poured
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Realm)
4. Date Well(s) Completed: 11 /1 /18
5a. Well Location:
General Electric - Hitachi
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 Remarks)
Well ID# WW-20
NCD050409150
Facility/Owner Name Facility 1D# (if applicable)
3901 Castle Hayne Rd. Castle Hayne, NC 28429
Physical Address, City, and Zip
New Hanover
R01700-001-001-000
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one IaUlong is sufficient)
34.327276 N-77.927740
6. Is (are) the well(s): OPermanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or IZNo
If this is n 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: 80.0
For multiple wells list all depths if different (example- 3(4200' and 2 a,100')
10. Static water level below top of casing: 1 (:)'0
Ifwater level is above casing, use •'+"
t 1. Borehole diameter: 14.0/12.0 (in.)
12. Well construction method: Auger/Fluid Rotary
(ft.)
(ft.)
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
I3a. Yield (gpm) 10 Method of test: 24-Hour Pump
13b. Disinfection type: None Amount:
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
40.0 ft.
80.0 ft.
#1 Sand
Tremied
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
0
ft.
TO
10,0 ft.
10.0 ft.
21.0 ft.
21.0 ft.
71.0 It
46.0 ft.
71.0 ft.
71.0 ft.
81.0 ft
81.0 ft.
96.0 ft.
ft.
fr.
DESCRIPTION (color, hardness, soil/rock typ , grain size, etc.)
Brown, moist sand and silt
Tan/grey, wet clay and silt
Grey, wet sand and silt
Castle Hayne rock
Grey, wet sand and silt
Dark Grey, wet v. dense silt and sand
21. REMARKS
22. Certification:
c ' ature of Certified VWe1 .ontractor Date
By signing this form, 1 hereby certify that the well(s) was (were) constructed in accordance
with ISA 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 ifhecessar
SUBMITTAL INSTUCTIONS art
1 �® '
24a. For All Wells: Submit this form within i0 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 Nlail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells:
Also submit one copy of this fomi within 30 days of completion of
well construction to the county health department of the county where
constructed.
Form GW-I North Carolina Department of Environment and Natural Resources - Division of Water Resources
Revised .August 2013

WELL CONSTRUCTION RECOmioCDFNR/DWR
1. Well Contractor Information:
For Internal Use On}
r A
4. r 9 r� 4 J
Print Form
Donald Cummings
Well Contractor Name
2412-A
DEC 03 2018
NC Well Contractor Certification Number Water Quality Regional
Applied Resource Manageemfn oee
ice
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. U1C, County, State, Variance, etc.)
3. Well Use (check well use):
WP0291681
Water Supply Well:
i._ Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
D Municipal/Public
xDResidential Water Supply (single)
DResidential Water Supply (shared)
Non -Water Supply Well:
Monitoring
Recovery
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothennal (Closed Loop)
Geothermal (Heating/Cooling Return)
QGroundwater Remediation
Salinity Barrier
E3Stormwater Drainage
DSubsidence Control
EJTracer
'Other (explain under #21 Remarks)
4. Date Well(s) Completed: 10/22/18
5a. Well Location:
Robert Pietila
Well ID# N/A
N/A
Facility/Owner Name Facility ID# (if applicable)
130 Glendale Drive, Wilmington, NC 28411
Physical Address, City, and Zip
New Hanover R04110-005-040-000
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 16 14.03 N 77 55 55 \�
6. Is(are) the well(s)JPermanent or E3Temporary
7. Is this a repair to an existing well: DYes or fNo
If this is a repair, fill out known well construction information and exploit? the nature of the
repair ender ? 2I remarks. section or on the back of this form,
8. For GeoprobelDPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed, Indicate TOTAL NUMBER Dwells
drilled: 1
9. Total well depth below land surface: 180
For multiple wells list all depths if different (example- .i 200' and 2:^a100)
10. Static water level below top of casing:
If water level is above casing, use "+"
16
11. Borehole diameter: See Remark(in.)
12. Well construction method: Mud Rotary
(ft.)
(ft.)
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 1$
Method of test: Air lift'
13b. Disinfection type: HTH
Amount: 3%@10 g
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (for multi -cased wells OR LINER (if a licable)
FROM
TO
DIAMETER
THICIINESS
MATERIAL
0 ft.
40 ft.
6 in.
SCH40
PVC
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
90 ft.
4 in•
SCH40
PVC
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
90 ft.
110 ft.
4 in'
.010
SCH40
PVC
ft.
ft.
in.
18. GROUT
FROM'
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft.
30 ft.
Bentonite
Poured
80 ft.
85 ft.
Bentonite
Poured
ft.
ft.
I9. SAND/GRAVEL
PACK
(if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
85 ft.
110 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.
32 ft.
Sand clay/clay
32 ft.
112 ft•
Limestone/sandstone
112 ft'
180 ft.
Clay/sandstone layers
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS yaa
C.
0' to 110' = 8", 0' to 40' = 10" 0
22.
fication:
Signature of Certified Well Contractor
10/22/18
Date
By signing this form, 1 hereby certify that the well(s) was (were) constricted 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 welldetails:
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
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 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
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

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
455744
WELL CONTRACTOR CERTIFICATION # 4119-A
1. WELL CONTRACTOR:
Sage Drilling and Pump Serviceg VED/NCDENR/DyirR
Well Contractor (Individual) Name
Michael C. Sage
Well Contractor Company Name
STREET ADDRESS 204 Tom
Ave
Castle Hayne
City or Town
(910 )_ 231-6669
Area code- Phone number
NC
State
LTC 0 3 2i118
Wdltfl Manly Regional
t
Wilminzlo ebd Section
Office
2. WELL INFORMATION:
SITE WELL ID #(inapplicable)
WELL CONSTRUCTION PERMIT# \erkbcq 001
OTHER ASSOCIATED PERMIT#(if applicable)
3. WELL USE (Check Applicablep�jjox): esidential Water Supply 0
DATE DRILLED('
TIME COMPLETED s! C. C3 AM 0 PM 0
4. WELL LOCATION:
C
CITY: t /-'h n� N w (4 COUNTYC fY d
th
(Street Name, Numbers, Community, Subdiw ion, Lot No., Parcel, Zip Code)
TOPOGRAPHIC /
0 Slope 0 Valley
(check ap
LATITUDE
LONGITUDE
Latitude/longitude source: a GPS o Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
SETTING:
Ridge 0 Other
priate box)
May be in degrees,
minutes, seconds or
in a decimal format
5. WELL OWNER
OWNER'S NAME r
STREET DDRESS
ownsWr
' "S t
Area code - Phone number
Zip Code
6. WELL DETAILS:
a. TOTAL DEPTH: ��
b. DOES WELL REPLACE EXISTING WELL? YES 0
c. WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118. Q
e. YIELD (gpm): c0 METHOD OF TESTAA \ Li 4
1-� r
FT.
f. DISINFECTION: Type 4 L (i4 Amount A
g. WATER ZONES (depth):
From To From To
r
From q (r) To Flo From To
From To From To
7. CASING: Thickness/
From Depth
To (_ Ft. D meter tp S igh(t M teljal
_
From- To — Ft.
T
From To,� qU Ft. 4( g f'V
8. GROUT: Depth _Material p Me/t d r
From To-3 Ft. eel\ ote-- e � " U(C
�
From-- Tod Ft.
From To Ft.
9. SCREEN/'Depth /A / , Diameter Slot Size to I
From To Ft. L7 in. t( in.
From To Ft. in. in.
From To Ft. in. in.
10. SAND/GRAVEL PACK:
Depth �/ Size Materi 1
From—�S To —rip Ft. �' �ttLVe1 RcK
1. From To Ft.
From To Ft.
11. DRILLING LOG
From To Formation Description
d " to r (may
k cp - an s-64-1d
- . 111.-te -i-e, D t
— 3S-10 Sckndspilt
t
D. 1.
12. REMARKS: ,)� f'
�\
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 P OVID TO THE LL OWNER. -
SIGNATU OF C R IFI W L CONTRACTOR DATE
Michael C. Sage
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-la
Rev. 3/07

1. WELL CONTRACTOR:
RESIDENTIAL WELL CONSTRUCTION RECORD 455743
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
RECEIVED/NCDENR/DWR
Sage Drilling and Pump Services LLC.
Well Contractor (Individual) Name
Michael C. Sage
Well Contractor Company Name
Castle Hayne NC
City or Town State
( 910 )_ 231-6669
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
WELL CONSTRUCTION PERMIT# ` '(
OTHER ASSOCIATED PERMIT#(if applicable)
3. WELL USE (Check Applicable Box): Residential Water Supply 0
DATE DRILLED ‘-
TIME COMPLETED S 100 AM 0 cPM
DEC 03 2018
Water Quality Regional
STREET ADDRESS 204 Tom Ave Operations Section
Wilnliugton Regional Office
28429
Zip Code
4. WELL LOCATION:
CITY:40' Wi) Mt
Sri, cir0
(Street ame, Numbers, Community, Subdivision„ Cot No., Parcel, Zip Code)
6t
TOPOGRAPHIC / LAND SETTING:
0 Slope 0 Valley 0 Flat 0 Ridge 0 Other
(check appropriate box)
LATITUDE
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: 0 GPS o Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
5. WELL OWNER ! I • 1 1Q OWNER'S NAME 1 1! C r
STREET ADDRESS ( S hW 1 l #
ti1t\-1tc,cskm ttr
Ity or Town State Zip Code
Area code - Phone number
6. WELL DETAILS: �1 /r
a. TOTAL DEPTH: ff
b. DOES WELL REPLACE EXISTING WELL? (YESO) NO
c. WATER LEVEL Below Top of Casing: ..- 0 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 41 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): 5 t� METHOD OF TEST, A t \ �t- 1
4119-A
f. DISINFECTION: Type 1-17 -( Amount
g. WATER ZONES (depth):
From _1 To -"8C) From To
From To From To
From Un To From To
7. CASING: Thickness/
FromDepth ` Di meter Weight Material
Ta- tit, Ff. �'/ .`"�*g-t'"p Pi
From To Ft.
From 3 To-- SO Ft. hr/ SCaa ) TO
8. GROUT: Depth
From
From
Front`
Material Method
To -- 3 Ft. (♦�6i }�C1G1 t P-e.(t�� / O
To Ft.
To-',30 Ft.
ifs
9. SCREENir , Depth i y Diar7aeter Slot Size
From O To" 1 OM) Ft. d. in. 16
From To Ft. in.
From To Ft. in.
1Tff ti
teri
in.
in.
in.
dd tt,,�, 10. SAND/GRAVEL PACK:} ( �j
COUNTY /VOA) I-lu[�81r T From 4p aO To'I ®J Ft. ®1O twei
nl
From To Ft.
From To Ft.
11. DRILLING LOG
Fro yation Description
rIc
��c
12. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED Ts; HE WELL OWNER.
2
SIGNATUR'OF CERTI
Michael C. Sage
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
i1-iI-is,
D WELL CONTRACTOR 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-la
Rev. 3/07

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 4119-A
455740
1. WELL CONTRACTOR: C(;
Sage Drilling and Pump ServicessELi..u. EIVEDINCDENR/QWR
Well Contractor (Individual) Name
Michael C. Sage DEC 0 32018
Well Contractor Company Name
,g.
STREET ADDRESS 204 Tom Ave water (,)I+, tit k�
y Oltdl
Castle Hayne NC Wiln�pe �Section
gZIp
City or Town State
( 910 )-231-6669
Ciicel"Ildl �i�ICe
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)_
/
WELL CONSTRUCTION PERMIT# p i` s' q 1 /tyc,
OTHER ASSOCIATED PERMIT#(if applicable)
3. WELL USE (Check Applicable Box): Residential
DATE DRILLED
Water Supply 0
0 PM 0
I�f'
� �I N-
/
TIME COMPLETED AM
4. WELL LOCATION: q 4/�9
CITY: CGS t'�_ t4Q 1 e COUNTY
Ii( TOM ACaulk. 6 v28gt)(
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
O Slope 0 Valley 0 Flat 0 Ridge 0 Other
(check appropriate box)
LATITUDE
May be in degrees,
minutes, seconds or
in a decimal fonnat
LONGITUDE
Latitude/longitude source: o GPS 0 Topographic
(location of well must be shown on a USGS topo
attached to this form if not using GPS)
5.WELLOWNER '{��
OWNER'S NAME Lri�l) 1 1 '�
map
map and
C(►IY
STREET ADDRESS :LI IC,? Pn AvQ,_
Casfie f-letke LL;C ,
City or Town State
(q 0 )- ��1� (ir'
Zip Code
YES0 NOO
i FT.
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: �'
b. DOES WELL REPLACE EXISTING WELL?
c. WATER LEVEL Below Top of Casing: `A
(Use "+" if Above Top of Casing) �QQ
d. TOP OF CASING IS -I—- FT. Above
surface
2C
TEST
Land Surface*
may require
.0118.
�a y t t1
4
*Top of casing terminated at/or below land
a variance in accordance with 15A NCAC
e. YIELD (gpm): METHOD OF
f. DISINFECTION: Type i== '1 Amount , a 1115
g. WATER ZONES (depth):
From 1 To From To
From To From To
From _c 5 To 60 From To
7. CASING: Thickness/
Depth Dia ter W fight . M terial
From -% To-- p Ft. t'V-1 i'{C^ s'
From To Ft.
From To Ft.
8. GROUT: Depth Material ��M�aaethod
From 0To 3 Ft. gi--�- 014C, Cttg Pa.:
From "3 ToF 9C.,.Ft. O °,ct, Tie r.d
From To Ft.
9. SCREEN., ,,Depth �y Diame r Slot isze M , ri51„
From To—(411 Ft. in. At.:.; in. _.a.
From To Ft. in. in.
From To Ft. in. in.
10. SAND/GRAVEL PACK:
Dep Size Material
Front C) To {C) Ft;. a �� ea 0Aib&ofet
From To Ft.
From To Ft.
11. DRILLING LOG
From , ,To o e�47 Formation Description
'11-1' So .A late -fie_
12. REMARKS:
1 00 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C. LL CO STRUCT STANDARDS. AND THAT A C OF THIS
RECORD HAS EN P VIDED THE WE -LIMNER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
Michael C. Sage
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-la
Rev. 3/07

For Internal Use Only:
Print Form
WELL CONSTRUCTION RE 1 EKtgiNR/DWR
1. Well Contractor Information:
Donald Cummings
Well Contractor Name
2412-A
HFC 03 2018
Water Quality Regional
NC Well Contractor Certification Number Operations Se 10
Applied Resource Marlg�$;oi.�Lce
Company Name
2. Well Construction Permit #:
WP0291718
List all applicable well construction permits (t.e. UIC. County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Ind ustrial/Commercial
Irrigation
DMunicipal/Public
DResidential Water Supply (single)
DResidential Water Supply (shared)
Non -Water Supply Well:
Monitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
3Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed: 10/8/18
5a. Well Location:
Zach Laymon
DRecovery
DGroundwater Remediation
DSalinity Barrier
QStonnwater Drainage
DSubsidence Control
DTracer
Other (explain under #21 Remarks)
Well ID# N/A
N/A
Facility/Owner Name Facility ID# (if applicable)
520 Tibby Drive, Wilmington, NC 28411
Physical Address, City, and Zip
New Hanover R03705005006000
County Parcel Identification No. (PIN)
5b. Latitude and longitude hi degrees/minutes/seconds or decimal degrees:
(if well field, one lav'Iong is sufficient)
34 17 44.86 N 77 46 53.69
W
6. Is(are) the well(s)Jx Permanent or DTemporary
7. Is this a repair to an existing well: JYes or INo
If this is a repair, fill out known well construction information and explain the nature of the
repair under 4'21 remarks .section or on the back a this fornt.
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: 165
For multiple wells fist all depths if different (example- 3(4)200' and 2a100')
10. Static water level below top of casing:
If water level is above casing, use "+"
11. Borehole diameter: See rema rIit(ln )
8
12. Well construction method: Mud Rotary
(ft.)
(ft.)
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 80 Method of test: Air lift
13b. Disinfection type: HTH Amount: 3%@10 g
45574,
14. WATER ZONES
FROM
ft.
TO
ft.
DESCRIPTION
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LiNER (if a licable)
FROM TO DIAMETER THICKNT:SS MATERIAL
0 ft' 142 ft. t 4 in' I SCH40 PVC
16. INNER CASING OR TUBING (geothermal closed -loop)
DIAMETER
FROM
ft.
TO
ft.
in.
TFi1CKNESS
MATERIAL
ft.
17. SCREEN
FROM
ft.
in.
150 R.
ft.
TO
165 ft.
ft.
DIAMETER
2
in.
in.
18. GROUT
FROM
0
SLOT SIZEl'
.020 SCH40
THICKNESS
SS 1 MATERIAL
PVC
ft.
TO
140 ft.
111ATERL4L
Bentonite
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
ft.
ft.
MATERIAL
EMPLACEMENT METHOD & AMOUNT
Pumped
EMPLACEMENT METHOD
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
TO
FROM
0
ft.
22 ft.
DESCRIPTION (color, hardness, soiVrock lype, grain size, elc.)
Sand/clayey sands
22 ft.
122 ft.
Limestone
122 ii•
140 ft
ft.
140 ft.
165 ft.
ft.
Small clay layers/mudrock
Sandstone
ft.
ft.
lV
ft.
ft.
21. REMARKS
0' to 140' = 8', 140' to 142' = 6", 142' to 165' = 4"
22.
Si
cation:
10/8/18
edified Well Contractor Date
By signing this form, 1 hereby cenijy that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Couvtuction 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
241. For A11. Wells: Submit this form within 30 days of completion of well
constructionto the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Inieetion 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 Sunnly & Inieetion 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.
Fonn G W - I
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL CONSTRUCTION REC))ERR/DWR
I. Well Contractor Information:
Donald Cummings DEC 03 2018
Well Contractor Name
2412-A
Water Quality Regional
NC Well Contractor Certification Number Operations Section
Applied Resource Man46i'ii'hegpi.L:ffice
Company Name
2. Well Construction Permit #:
List all applicable well construction penults (i.e. UIC, County, State, Variance, etc.)
3. Well Use (check well use):
WP0008447
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
irrigation
Non -Water Supply Well:
Monitoring
Injection Well:
DAquifer Recharge
Aquifer Storage and Recovery
DAquifer Test
EiExperimental Technology.
DGeothermal (Closed Loop)
(Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed: 10/9/18
5a. Well Location:
David Forcinito
['Municipal/Public
xDResidential Water Supply (single)
DResidential Water Supply (shared)
DRecovery
Groundwater Remediation
DSalinity Barrier
DStonnwater Drainage
DSubsidence Control
Tracer
Other (explain under #21 Remarks)
Well ID# N/A
N/A
Facility/Owner Name Facility ID# (if applicable)
523 Tibby Drive, Wilmington, NC 28411
Physical Address, City, and Zip
New Hanover R03705004010000
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 17 46.11 N 77 46 50.41
W
6. Is(are) the well(s)0Permanent or DTemporary
7. Is this a repair to an existing well: QYes or EjNo
If this is a repair, fill out known well construction information and explain the nature of the
repair anekr 421 remarks section or on the hack of this fount.
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: 165
For multiple wells list all depths if different fexample- 3 .200' curd 2,a l00)
(ft.)
10. Static water Ievel below top of casing: 8 (ft.)
If water level is above casing, use ""
11. Borehole diameter: See remarl ro(in )
12. Well construction method: Mud Rotary
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 80 Method of test: Air hft
13b. Disinfection type: HTH Amount: 3%@10 g
For Internal Use Only:
Print Form
45:1 7 4 1.
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (for
multi -cased wells) OR LINER (if a
licable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL -
0 ft'
40 ft.
8 in-
SCH40
PVC
16. INNER
CASING OR TUBING
(geothermal closed -loop)
FROM
TO
DIAMETER THICKNESS
MATERIAL
0 ft.
135 ft.
4 in'
SCH40
PVC
125 ft.
145 ft•
2 ' in'
SCH40
PVC
17. SCREEN
FROM
TO
DL411IETER
SLOT SIZE
THICKNESS
MATERIAL
145 ft.
165 ft.
2 in.
.020
SCH40
PVC
ft
ft,
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METI OD & AMOUNT
0 ft'
40 ft.
Bentonite
_
Pumped
0 ft.
135 ft.
Bentonite
Pumped
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.
10 ft.
Clay
10 ft.
22 ft'
Find sand
22 ft'
125 ft.
Limestones
125 ft.
145 ft.
Clay :•
145 ft.
165 ft.
"� '
Sandstone c,
ft.
ft.
21. REMARKS
0' to 40' = 12", 40' to 135' = 6", 135' to 165' = 4"
10/9/18
Signature of Certified Well Contract' r' "' Date
By signing this form, 1 hereby cern& that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0100 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23: Site diagram' or additionaLwelldetails:
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 Iniection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Sunply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW-1
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

RECEIVED/NCDENR/DWR
DEC 03 2018
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resmg- I luivdi0jgr fg r Quality
Qperations Section
WELL CONTRACTOR CERTIFICATION # 41i 'natnn RPpional Office
1. WELL CONTRACTOR:
Sage Drilling and Pump Services LLC.
Well Contractor (Individual) Name
Michael C. Sage
Well Contractor Company Name
STREET ADDRESS 204 Tom Ave
Castle Hayne NC 28429
City or Town State
( 910 )- 231-6669
Zip Code
Area code- Phone nurnber
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
WELL CONSTRUCTION PERMIT# 3 i 03 - I6.s i--(
OTHER ASSOCIATED PERMIT#(if applicable)
3. WELL USE (Check Applicable Box : Residential
DATE DRILLED 11--0 {— 1
Water Supply 0
0 CM-11)
e
L
T
TIME COMPLETED c; no AM
N:
4. WELL LOkC\CT4OUNTY
CITY:
lot/ iv Span Polo+, 0 )$
(Street Name, Numbers, Community, SliW. vision, Lot No., P rcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
0 Slope 0 Valley 0 Flat 0 Ridge 0 Other
(check appropriate box)
LATITUDE
May be in degrees,
minutes, seconds or
in a decimal format
LONGITUDE
Latitude/longitude source: 0 GPS a Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
5. WELL OWNER n /�
OWNER'S NAME R> 1 r' i \/ a
�.. nOr
STREET ADDRES 1 (1S rsL�xA(I Qt
c)'(N'C ��o 6, �n - �j(
City or T n
(� 1 ) ciel v 1�
f111
Zip Code
�fYIES 0 ) NO a
FT.
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: • — CI 0,
b. DOES WELL REPLACE EXISTING WELL?
c. WATER LEVEL Below Top of Casing: 4-1
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 4- c . FT. Above
Land Surface'
surface may require
2C .0118. _ j1
. -\ 1 \ L t-(
'Top of casing terminated at/or below land
a variance in accordance with 15A NCAC
e. YIELD (gpm): 0 METHOD OF TEST
AA f.4
f. DISINFECTION: Type Amount 1 L6
g. WATER ZONES (de
From 5 To -' From To ` s
From C e) To OW From To
From To From To
7. CASING: Thickness/
Depth Diameter I ht Ma r'
From To— Ft. —ICI,t.0
From To Ft.
From To Ft.
8. GROUT: Depth Materi l (� Method -
From 0 To 73 FtBC01d1 1Vfr � �jS
From To — ZQ Ft. 17
From To Ft.
9. SCREEN: Diameter Slot Size Mater'
�(epth
From To CI© Ft. 2 'in. (C•s in.
From To Ft. in. in.
From To Ft. in.
in.
10. SAND/GRAVEL PACK:
Dept Size Material •
From To . (:1('iFt. 1�- s .,�
e f 1 �`r`'aKi
From To 1 Ft.
From To Ft.
11. DRILLING LOG
Frob Tea ,.FQratioUrdiption
r ck
L ,:
-65 -Ae P®
t 5 £ -6 j
12. REMARKS:
t e1(•)�
a IA,
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...
SIGNATUR(OF hTIFILLCONTRACTOR
Michael C. Sage
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-la
Rev. 3/07

North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 4119-A
1. WELL CONTRACTOR:
Sage Drilling and Pump Services LLC.
Well Contractor (Individual) Name
Michael C. Sage
Well Contractor Company Name
STREET ADDRESS 204 Tom Ave
Castle Hayne NC
28429
City or Town State
( 910 )_231-6669
Zip Code
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
WELL CONSTRUCTION PERMIT# . W 175— C 6' I1
OTHER ASSOCIATED PERMIT#(if applicable)
3. WELL USE (Check ApRlicable Box Residential Water Supply 0
DATE DRILLED T '
TIME COMPLETED
AM
4. WELL LOCATION:
CITY: H a {YIK)-J COUNTY
13c) £ by 1n C'Cc6 CFemC.26
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
0 Slope 0 Valley 0 Flat 0 Ridge 0 Other
(check appropriate box)
LATITUDE
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: 0 GPS 0 Topographic map
(location of well must be shown on a USGS topo map.and
attached to this form if not using GPS)
b. WELL OWNER L nc) W
OWNER'S NAME(3R
STREET�PS� 130 Qe(by Ln (t ior j own ✓ �$j]j]t�te6
okZip Code
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL
c. WATER LEVEL Below Top of Casing: ' % _ FT,
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS -J Ala 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 I (1
e. YIELD (gpm): J 0 METHOD OF TEST I 1 1 ,
RECEIVED/NCDENR/DWR
RESIDENTIAL WELL CONSTRUCTION RECOR15he' 4
DEC 03 2018
Water Quality Regional
j� v ccLu t0I'1S_ rtio
f. DISINFECTION: Type r I 1 !--1 Viriii2liflgtl IthiOnal 0
g. WATER Z9NES (deth):,/
From To " {DO From To
From To From To
/�
From 7 To �^� From To
V
7. CASING: /� aaall1nnn Thickness/
From4-1 DT O<'Di Ft. Dieter Ce}ght Ma ria
�!S
y
From To Ft.
From To Ft.
8. GROUT: Depth aterial �� Method
From Tpo Ft.�e it 4,
From To Ft.
From To Ft.
9. SCREEN• Depth ,,,/m�/ Diater Slot Size Met
From KC)/ To 1 1 L Ft. l in. IC) in. _y
From To Ft. in. in.
From To Ft. in. in.
10. SAND/GRAVEL PACK:
Depthtj Size�t Material (+ i
From / © To f 16, Ft. . We.(I CIQt)el
I,i�
1 3 From To Ft.
From To Ft.
11. DRILLING LOG
From To Formation Description
CN — I G C la/
10 — :0' SO flr
- --f_
I,Meciei)e gc,cK
61-v' — t7s' C lad 7/ r-16414 tooK
75 '- J lo' PQ sand 5-tope FoiI+la4-ion
12. REMARKS: au _co
,. r -, .,/"1UC • r
Ha °A Ott s o'efl - en 0 IAA XAl
I D0 HEREBY CERTTY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEE PROVI TO THE WELL OWNER.
QTE
SI ATURE O C IF WELL CONTRACTOR
Michael C. Sage
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-la
Rev. 3/07
-lice
1

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
Lawrence D. Opper
Well Contractor Name
NC3322-A
NC Well Contractor Certification Number
Regional Probing Services
Company Name
z. Well Construction Permit #: WM0801121
List all applicable well construction permits (i.e. County, State. Variance, 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
❑Geothertnal(Closed Loop)
❑Geothermal (Heating/Cooling Retum)
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
El Subsidence Control
❑Tracer
❑Other (explain under 421 Remarks)
4. Date We11(s) Completed: 10/8/2018 MW-16
5. Well Location:
Han -Dee Hugos 28
Facility/Owner Name Facility ID# (if applicable)
5002 Market Street, Wilmington
Physical Address, City. and Zip
New Hanover
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field one lat/long is sufficient)
34.243885 N 77'884415
W
For Internal Use ONLY:
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (for multi -eased we'IsZOR LINER (if a licable)
FROM
TO
DIAMETER THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
25 ft.
2 'n'
sch 40
PVC
ft.
ft.
in.
11. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
25 ft.
30 ft•
2 in'
.010
sch40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 fr.
23 ft•
cement grout
tremie
23 ft.
24 ft.
bentonite
prepack sleeve
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
24 ft'
30 ft.
#2 sand
prepack
ft.
ft.
20. DRILLING
LOG (attach additional abeets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soiVrock type, grain size, etc.)
0 ft'
30 ft.
RECEIui`( 3' DEN. /DWR
ft.
ft.
ft.
tr.
ft.
ft.
0 F C 0 3 2 018
ft.
ft.
ft.
ft.
Water Quality Regional
Section
ft.
ft.
Operations
Wilmington Regional Office
21. REMARKS
off -site well located at 5001 Market Street.
22 Certificatio
sv� •guany signed by Lawrence Opper
DN;,n=Lawrence Opper, o•Regianal
Lawrence Opper mgsermces en.
'l.brryprepanalproblrs.can. c=US
Signature of Certified Well Contractor
11/1/2018
Date
By signing this form. 1 hereby ceritj5, that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NC'AC 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
8. Number of wells constructed: 1 struction details. You may also attach additional pages if necessary.
For nnduple infection or non -water supply wells ONLY with the same construction, ou
suhmit one Arm. �s
len
24. Submittal Instructions:
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
6. is (are) the well(s): ©Permanent or ❑Temporary
7. is this a repair to an existing well: ❑Yes or ZINo
I/'this is a repair, fill out known well construction information and explain the nature oldie •
repair under 21 remarks section or on the back of this form.
9. Total well depth below land surface: 30 (ft.)
For multiple wells list all depths ifdifJerem (example- 3@200' and 2@100')
tot
10. Static water level below top (pleasing: approx 4
If waterlerel is above casing, use "
1 I. 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:
I3a. Yield (gpm) Method of test:
I3b. Disinfection type: Amount:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For lniection 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:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Geothermal 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
This form can be used for single or multiple wells
For Internal Use ONLY:
455680
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 tt:
list all applicable well constructionpernrirs (i.e. County, State, Variance, etc.)
3. Well Use (check well use):
14, WATER ZONES
FROM
TO
DESCRIPTION
ft
ft.
ft
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if applicable)
FROM TO DIAMETER THICKNESS 1 MATERIAL
ft. ft. in.
16. INNER CASING OR TUBING (geothermal dosed -loop)
FROM TO
DIAMETER
THICKNESS
MATERIAL
0
ft.
3
ft.
2
in.
sch 40
PVC
fL
ft.
in.
17. SCREEN
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑irrigation
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
['Monitoring ['Recovery
injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
['Geothermal (Heating/Cooling Return)
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
['Subsidence Control
❑Tracer
❑Other (explain under 421 Reinarks)
4. Date Well(s) Completed: 10/9/2018 MW 14, MW-15
5. Well Location:
Han -Dee Hugos 28
Facility/Owner Nance Facility 1D4 (if applicable)
5002 Market Street, Wilmington
Physical Address, City, and Zip
New Hanover
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
34.243603 N 77.883705
6. Is (are) the well(s): iilPermanent or ❑Temporary
W
7. Is this a repair to an existing well: ❑Yes or I?iNo
/flhis is a repair. fill out known well construction information and explain.11W nature of the
repair under a21 remarks section or on the back of this form.
8. Number of wells constructed: ®�
2 ; .. �gg, io
For nudiiple infection or non -water supply wells ONLY with the sam c� 'uclioa. you can
.submit one form. N�
13
9. Total well depth below land surface:
For multiple wells list all depths if d erent (example- 3@200' and 2(!a 100')
•
(ft.)
10. Static water level below top of casing: approx 4 (ft,)
If water level is above casing, use
I1. Borehole diameter: 4 (in.)
12. Well construction method: Auger/DPT
(i.e. auger, rotary, cable, direct push, etc.)
13. FOR WATER SUPPLY WELLS ONLY:
13a, Yield (gpm) Method of test:
I3b. Disinfection type: Amount:
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
3
ft.
13 ft.
tin.
.010
sch40
PVC
ft.
ft.
in.
15. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0
ft,
1.5 ft'
cement grout
pour
1.5 ft.
2
ft.
bentonite
pour
ft.
ft.
19. SAND/GRAVEL I'ACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
2
ft.
13
ft.
#2 sand
pour
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
0
ft.
ft.
TO
13
ft.
ft.
DESCRIPTION (color, hardness, sotllrock type, grain size, etc.)
Restin/DW
R
ft.
ft.
ft.
ft.
DEC vl2O18
ft.
ft.
ft.
ft.
21. REMARKS
ft.
ft.
Water Quality Regional
Operations Section
Wilminafty Regional Office
22. Certification
• y signed by Lawrence Opp.,
o " `n"""<" enppey.n.Regiona'
Lawrence Opper
p,obing Snvkes.ou,
maI Iw W ryp,egi pnalpobing<am. c=U 5
_pa,,."'a" n, an,59 0,0,
Signature of Certified Well Contractor
11/1/2018
Date
By signing this furnr, 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.
24. Submittal instructions:
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Underground injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Geothermal 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-I
North Carolina Department of Environment an
d Natural Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
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#: WMO801121
l.isr all applicable well construction permits (i.e. County, State, Variance, 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:
❑O 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: 10/8/2018 MW-17, MW-18
5. Well Location:
Han -Dee Hugos 28
Facility/Owner Name Facility ID# (if applicable)
5002 Market Street, Wilmington
Physical Address, City, and Zip
New Hanover
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field. one lat/long is sufficient)
34.243885 N-77.884415
w
6. is (are) the ivell(s): ©Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or OAro `; :: tl®t\% '
lfrhis is a repair, fill our known well construction information and explain the natuktethe
repair under e21 remarks section or on the back alibis form
2
8. Number of wells constructed:
1•irr multiple injection or non -water supply wells ONLY with the same construction, you cab
submit one farm.
9. Total well depth below land surface: 15 (ft.)
libr multiple wells list all depths ifdyfirent (example- 3 a 200' and 2©100')
10. Static water level below top ()leasing: approx 4 (ft.)
',twofer level is above casing, use "
11. Borehole diameter: 4 (in.)
12. Well construction method: Auger/DPT
(i.e. auger, rotary, cable, direct push, etc.)
13. FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
For internal Use ONLY:
455
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
n.
ft.
15. OUTER CASING (for multi -eased wells) OR LINER (if appIBcable)
THICKNESS I MATERIAL
FROM
ft.
TO
ft.
DIAMETER
in.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0
ft.
5
ft.
2
in.
sch 40
PVC
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
5
ft.
15 ft,
2 in.
.010
sch40
PVC
fr.
ft.
in.
1S. GROUT
FROM
TO
MATERIAL •
EMPLACEMENT METHOD & AMOUNT
0
ft.
3
ft.
cement grout
pour
3
ft.
4
ft.
bentonite
pour
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
4
ft.
15
ft.
#2 sand
pour
ft.
ft.
20. DRILLING LO (attach additional sheets if necessary)
FROM
0
ft.
ft.
TO
15
ft.
ft.
DESCRIPTION (color, hardness, soilrock type, grain size, etc.)
RECEIitii/I�L1-R/DWR
ft.
ft.
ft.
ft.
LJEL032018
ft.
ft.
ft.
ft.
21. REMARKS
ft.
ft.
Water Quality Regional
Operations Section
Wilmington Regional Office
MW-17, MW-18: off -site wells located at 5001 Market Street.
22. Certification:
OigiPS/ nedbyraenence Oppe,
Lawrence Opper o» " ° "°- 11/1/2018
y,a�arytaregionalp°bi ysam, c=US
Signature of Certified Well Contractor 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.
24. Submittal instructions:
24a. For MI Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c, For Water Supply & Geothermal 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-I
Notlh Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 2013

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 4119-A
1. WELL CONTRACTOR:
Sage Drilling and Pump Services LL CE VED/NCDENR/L WR
Well Contractor (Individual) Name
Michael C. Sage
Well Contractor Company Name
STREET ADDRESS 204 Tom Ave
Castle Hayne NC
City or Town State
( 910 )_ 231-6669
NOV 1 3 2fl18
Water Quality Regioni:l 7•
rations Sectiot
156 P,cgional Ctice
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
WELL CONSTRUCTION PERMIT#uc,coi 001
OTHER ASSOCIATED PERMIT#(if applicable)
3. WELL USE (Check Applicable ox): esidential Water Supply 0
DATE DRILLED 1©�
TIME COMPLETED 5.-4 CSC j AM 0 PM 0 )
4. WELL LOCATI(ONf:''
CITY: (Mlle e 1-431 oe. COUNTY % C 1A-s kta..34
(Street Name, Numbers, Community, Subdivi ion, Lot No., Parcel, Zip Code)
TOPOGRAPHIC /�TR dge
0 Slope 0 Valley Fla Ridge 0 Other
(check ap riate box)
LATITUDE
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: 0 GPS 0 Topographic map
(location of well must be shown on a USGS fopo map and
attached to this form if not using GPS)
5. WELL OWNER P
OWNER'S NAME
STRVDDRESS
uLneioon
ity or own t f - t
Area code - Phone number
Zip Code
6. WELL DETAILS: ri
A %
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES 0
c. WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS •4 FT. Above Land Surface*
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): CO METHOD OF TEST \ L �4
1 /
00
FT.
4554??.
f. DISINFECTION: Type 1 /4 Amount J. IL
g. WATER ZONES (depth):
From To From To
From (A ('; To r �� From To,
From To From To
CASING:
Thickness/
Depth D' mejerWeight
From • To ( Ft. b ' S ttf,k
From,- To - Ft.
From . - To - (.,D Ft. L U <cb k)
8. GROUT: Depth
From To "'3 Ft.
r1..m Ft.
From To Ft.
9. SCREE /+Depth
y
From �"/J To - �L-1
M IC
?VC
aterial Met
• m m rn
Diameter Slot Size toI
Ft. q _in, A() in. VC_
From To Ft. in. in.
From To Ft. in. in.
10. SAND/GRAVEL PACK:
Depth �y Size Materi 1
From-74- To - /O Ft. .. �t(i.(i�1 RICK
From To Ft.
From To Ft.
11. DRILLING LOG
From To
ey-
12. REMARKS:
Formation Description
e`cy-
1•r te.s i�;4\
wAtjA
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 - -OVID TO THE LL OWNER.
SIGNATU- OFC R IFI`i W LCONTRACTOR DATE
Michael C. Sage
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-la
Rev. 3/07

Print Form
WELL CONSTRUCTION RE (GW-N tg n
1. Well Contractor Information:
John Salmon
Well Contractor Name
3497-A
I L, ! s ? 7 p
Water Quaiity Regional
NC Well Contractor Certification Number Operatioi is Section
Applied Resource Marl' Igertle oR! 0ICe
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (le. UIC, County, State, Variance, etc)
N/A
3. Well Use (check well use):
Water Supply Well:
Agricultural
�Geothermal (Heating/Cooling Supply)
Industrial /Commercial
X )Irrigation
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 Retum)
Groundwater Remediation
Salinity Barrier
0Stormwater Drainage
Subsidence Control
Tracer
"Other (explain under #21 Remarks)
4. Date Well(s) Completed: 9/10/18
5a. Well Location:
Bass Built Inc.
Well m# N/A
N/A
Facility/Owner Name Facility ID# (if applicable)
314 North 5th Ave, Kure Beach, NC 28449
Physical Address, City, and Zip
New Hanover R09200-001-031-000
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 0 9.81 N
77 54 26.39
W
6. Is(are) the well(s)Jx Permanent or DTemporary
7. Is this a repair to an existing well: )Yes or xENo
1f this is a repair, fill out known well construction information and explain the nature of the
repair under ?r21 remarks section or on the hack n)this , form.
8. For Geoprobe/DPT 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: 140
For Internal Use Only:
14. WATER ZONES I. ;7 a l l ti,► ~•,
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
-
15.OUTER CASING (for
multi -cased wells) OR LINER (if a Iicable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
100 ft.
4 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
ft.
ft.
in.
ft.
ft.
in.
18. GROUT
FROM
TO
_ MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft•
25 ft•
Bentonite
Poured
ft.
ft.
ft.
ft.
-
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL,
EMPLACEMENT METHOD
ft.
ft.
rt.
ft.
20. DRILLLNG
LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
0 ft'
60 ft.
Sand
60 ft•
90 ft.
Clay shell layers
90 ft•
100 it
Lay/limestone layers
100 ft.
140 ft•
Limestone
ft.
ft.
-
ft.
ft.
° 2. 12
ft.
ft.
O C 1 1,
21. REMARKS
22. Certification:
ign: of Certified ontra .r
(ft.)
For multiple wells list all depths If different (example- 30200' and 1ta)100')
10. Static water level below top of casing: 37 (ft.)
If water level is above casing, use "= "
11. Borehole diameter: 5 7/8 (in.)
12. Well construction method: Mud Rotary
(Le. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 60 Method of test: Airlift
0
13b. Disinfection type: HTH Amount: 3 /o @ 10g
9/10/18
Date
By signing this form, 1 hereby certify that the well(s) was (were) constructed in accordance
with ISA 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 additionalwell 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
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 (GW-1)
1. Well Contractor Information:
k`. grl��ll's/ WR
Print Form
For Internal Use Only:
Sanford Sweeting
Well Contractor Name
2082-A
i.,C 1 22 .1)18
NC Well Contractor Certification Number
Applied Resource Managemer.it ?;G,ai
Company Name VI!!lll" :;����:ic. {fICC
2. Well Construction Permit #:
WV0800191 /W10800507
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc)
3. Well Use (check well use):
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
QMunicipal/Public
XOResidential Water Supply (single)
DResidential Water Supply (shared)
Non -Water Supply Well:
Monitoring
fl Recovery
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed: 0910/18
5a. Well Location:
Knorr Residence
DGrdundwater Remediation
Salinity Ranier
0Stonnwater Drainage
Subsidence Control
Tracer
Other (explain under #21 Remarks)
Well ID# N/A
N/A
Facility/Owner Name Facility 1D# (if applicable)
1009 Carolina Beach Ave, Carolina Beach NC
Physical Address, City, and Zip
New Hanover R09014-002-008-000
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one ladlong is sufficient)
See attached N See attached
W
6. Is(are) the well(s)JPermanent or OTemporary
• 7. Is this a repair to an existing well: OYes or xONo
If this is a repair, fill out known well construction information and explain the nature of the
repair under 421 remarkssection or on the back of this. farts.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only I GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled: 3
9. Total well depth below land surface: 800
For multiple wells list all depths if d erenr (example- 3P200' and-24400')
(ft.)
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: Mud Rotary
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm)/A Method of test: NfA
13b. Disinfection type: N/A Amount: N/A
14. WATER ZONES ��
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER
CASING (for
multi -cased wells) OR LINER (if ap licable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
300 ft.
1 in.
HDPE
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
ft.
ft.
in.
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft•
300 ft•
Thermex
Pumped
ft.
ft.
ft.
ft.
19. SAND/GRAVEL
PACK
(if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
ft.
IL
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soiVrock type, grain size, etc.)
0 ft•
25 ft.
Sand with broken shells
25 ft•
30 ft.
Fine brown sand
30 ft•
130 ft.
Silty fine sand
130 ft.
195 ft,
Limestone
195 ft.
300 ft•
Silty fine sand with shell layers
ft.
ft.
ft.
ft.
•
21. REMARKS "
22. Certification:
Signature Certified Well Contractor
9/10/18
Date
By signing this form, I hereby cerii)5, that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or ISA NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagratso or additiotiaLwell 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
eonstructio►ti to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh. NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this 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 Sunnlv & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW-I
North Carolina Deparunent of Environmental Quality - Division of Water Resources Revised 2-22-2016

ARM Project Number:
1009 Carolina Beach Ave Fulford Heating & Air
Carolina Beach
Driller: Sanford Sweeting
Date Drilled: Loop No. Loop Depth
9/4/2018 1 300
9/5/2018 2 300
9/6/2018 3 300
GPS Coordinates
34 1 27.47 77 53 44.54
34 1 27.47 77 53 44,94
34.1 27.63 77 53 45,15
lea VEO/NCIJENR/DWR
OCT 22 2018
Water Quality Regional
Orations Section
Wilmington
Reg final Office
Pagel

WELL CONSTRUCTION RECORD (GW-:I.;aA4Ri
1. Well Contractor Information:
Donald Cummings 2 2 %1118
Well Contractor Name
2412-A
Wilier Quality Regional
NC Well Contractor Certification Number Operations Section
Applied Resource Man' del ertlFC.''2n
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):
WP0018620
Water Supply Well:
Agricultural Municipal/Public
Geothermal (Heating/Cool ing Supply) xDResidential Water Supply (single)
Industrial/Commercial DResidential Water Supply (shared)
Irrigation
Non -Water Supply Well:
Monitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed: 9/21 /18
5a. Well Location:
Airlie Homes
fl Recovery
Groundwater Remediation
Salinity Barrier
DStonnwater Drainage
Subsidence Control
Tracer
Other (explain under #21 Remarks)
Well ID#N/A
N/A
Facility/Owner Name Facility ID# (if applicable)
200 Pages Creek, Wilmington, NC 28411
Physical Address, City, and Zip
New Hanover R04500-002-018-000
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 16 19.06 N 77 47 01.90
W
6. Is(are) the wells):Permanent or DTemporary
7. Is this a repair to an existing well: QYes or jNo
If this is a repair, fill out known well construction information and explain the nature of the
repair ender if. 21. remarks .section or an. the hack. of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only I GW-I is needed. Indicate TOTAL NUMBER of wells
drilled 1
9. Total well depth below land surface: 65
For multiple wells list all depths if d(erent (exa nple- 3(22•200'and-2,u,100')
(ft.)
10. Static water level below top of casing: 8 (ft.)
(water level is above casing, use " "
11. Borehole diameter: See remark (in.)
12. Well construction method: Mud Rotary
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) ao Method of test: Airlift;
13b. Disinfection type: HTH Amount: 3% �0 @ 10g
Print Form
For Internal Use Only:
454973
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if a licable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL J_
0 ft,
50 ft.
4 in.
SCH40
PVC
16. INNER CASINO 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
ft.
ft.
in.
ft.
ft.
in.
-
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft•
35 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, soiVrock type, grain size, etc)
0 ft.
18 ft•
Sands to clayey sands
18 ft•
65 ft'
Limestone
ft.
ft.
ft.
- - ft,-
ft.
ft.
(n� q r]
ft.
[
l.) lfL1
3 J •
ft.
ft.
21. REMARKS- -
22. Certifi
9/21/18
Signature i f Certed ell Contractor Date
By signing this form, 1 hereby certi y 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 additioaal.welldetails:
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 A.II Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this fonn 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 Suaaly & 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
shere constructed.
Form GW-1
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL CONSTRUCTION RECORD (GW-1.)
J. Wt'll Contractor Infortnatk a:
S
Name
Well Contract
NC Well Contactor Certification Number
A nt,,t c 1 Pam, 455
Company Name
2. %Vc11('onstruction Penult Nc
d�f
tl
I.r.rf <111 al,pin061C ,cal/ cnu..rraa!/on lkorn:iG9 pl.c. U!( Crwn.y, Store. Voirrnrae. de.J
3. Wdl lh>c (cheek rtc11 use):
Water Supply Well:
Agricultural
ft. a v fr
.Z;'1i R,.CASINOOR':
FROM
For Internal Use Only:
111914 T
a u rt.
3v-
ALZG1IP77pN
curlr5 9.e
ft.
'f, S'Q1_,TER cASRv'G00i.'iostll:eai Ok11V8'It;: e
1,1t4M 10 101AME1 $R TruacNlISS MATERIAL
O If aft`
TO ! AfAMETW TrrJCKNg$S
MATERIAL
QMunicipat/Public
Geathennal (Heating/Cooling Supply) OResidcntiai Water Supply (sin,glc)
Industrial/Commercial °Residential Water Supply (shared)
Non -Water Supply Well:
Monitorinj
llnjection Well:
cs Recovery
Aquifer Recharge QGYotmdwatcr Remcdialion
Aquifer Storage and Recovery QSalinity Barrier
Aquifer Test fStormwater Drainasc
experimental Tcc:hnology DSubsidenae Control
Geothermal (Closed Loop) 011•raa:r RECEIVED/NO
Geothermal eating/Cooling Return) nOther (explain under riA Ke
4. Date Well(s) Completed; 3 -a J r 'Wei IDd 0 C ! 0 8
Sa. Well location:.
facility/Oner N:+tne
MOM To utAMEvrea ;corm ra! p $
d 3i�
io
ft. ft. tn.
MATERUJ,
1Ae
MOM
"-
re
V MAreatm. voruf.AfR, :.:
MENT tNETKOD & jtMflCrlYt•
rt.
p•..� `1�Av� p
ft.
ff.
ARRiJiGlRtvre iP toibtej
X30tN1 .i0 MA71RtAL
ft,
hW1AC€MENT MJ7'HOD
ft
it.
��ihift�EGtatidieiQtte'1IFs9?.::....,
f[t°+rt ro IMLICR rrntm teexoWorsx.R, sae/rock lypt4 unik. the, eft-)
ri.
ift
f.
ft.
fG
fl.
Rit/rfa ft.
radii � �PCIIOfI
Za
1A/0 f3Ai4.0 r ihfice
nd zip
County Parcel 7denofiuttism No. (PIN)
fib. Latitude and lloogitade in degreea/Iolnutrs/seconds or decimal degrees;
(if well field, one Wank; is sufficient)
o ) 7 ° I') 2,,. w
6, Ia(are) the welt(s)fibertnanent or °Temporary
7.. la this It repair to au existing well; f Yes or MNo
1,f ihis is a repair. fill oui lo:Oun well construction u fiumrninn and explain the nrvurn ofthe
repair under 1,11 re'ntark,t ncciiuit or on the hack of Prig form.
8. For t,)ieoprobe/D PT or Closed -Loop Geothermal Wei» having the same
ccmattuctio . only I OW -I is needed. lredicalc TOTAL N1JM PR of wells
dritictJ'
9. Total well depth below land surface: 3 T
For multiple we/is ttisrall4pcis rfd/ff2reni (cramp*. 3@20t1' wwf 2q,1100)
10, Static water level below fop of casing:
ifwater/eve!is Dhowcateng. u.te "+"
11. finrebole diameter:._._ i1n.1
12. Well construction method: J v ?- ty j 1 -f
(i.e. SlAtt.V. rotary, tablo, direct push, ote,)
/G
(ft.)
(ft.)
FOR WATER SUPPLY WELLS ONLY:
13a, Yield (gpni) Method ethod of taps!:
13b. pisiafecoion type: Amount:
ft.
rt.
FXls
f4.
1ii?inrttisiltttxlf':rt@ :Y_'. r:) tJ,
22. Certification:
Siva t+R'oofCertimd Waft CO for
Date
By stgnfn, 'Mc JD1mr 1 ha rrifY Char the wall(...) was (aev¢l consiructErd in accordance
with ISA As/CV C 02C .0100 or 1 SA At'r1C 02C; , 020o WE'a// Cgndre l/pn ecA maLrr,dr and Au a
copy of this room, fray been provided to ON welt OMrer,
23. Site diagram or additional Weil details;
You may use the beck of this page to provide additional well site details or well
•
construction details. You may also attach additional pages if itectsary.
S11RM Tj'ALINS CTIoNs
2444 Rer_AILWelb: Submit this form within 30 days of completion of well
coctstruction to the following;
Divtaloa of Water Resources, iotbnnation Processing Unit,
I61.7 Mail Service Center, Raleigh, NC 27649-I61.7
'^'v7 VA V,la 1V1U} W„ir,t, 3v clays or complf:[ton or well
construction to the following:
Division of Water Resource,, Underground Injection Control Program,
1.636 Mail Service Center, Raleigh, NC 276 9-1431S
24c- For WJIfor ,quP.ifv de JnEmp60u Watt: An addition to sending the form to
the addrnss(cs) above, also suGmit one Dopy of this form within 3D days of
completion of well construct on to the county health department of the county
Wlw% rune nrvIrrl

3. Well Use (cheek well use):
Water Supply Well:
Agricultural
Geothermal (Heating/Cooring Supply)
industrial/Commercial
irrigation
Non -Water Supply Well:
Monitoring
Injection Wdi:
Iquirer
Recharge
qufsr $toragc and Recovery
qufer Tet
xerimai Technoloy
tlmel (Clod hp)
eothermal (Heating/Cooling
WELL CONSTRUCTION RECORD (GW-1)
1, Well Contractor Information:
GA > D-01-)•
Well Combo( to( Nome
NC Well Contractor Certification Number
Ask t,.e.A t v-t F[ pa.,
Company Name
2. Welt Construction Permit d:
/, ist ull ojiplicable wd/ allfseruction perm I.r (i, e. tl/t� �Q .n 5tr�a, Pnr}ance. ern
i 61 `9 ,)
<Q�
DMun ici frat/Fublic
DRtesidentiai Waltz Supply (single)
QResidcutial Water supply (shared)
OR,ecovery
DGroundwater Reroediailon
DSolinity Barrier
DStormwater Drainage
]ISohsidence Cixttml
arfaca
R m) thtx cx lain under ii21 Remarks)._
A. Date Well(a) Completed: a " a-? ~i4c4'tll Iry
Sa. Weil Lr,caoon:
/yli4 a.A...dc I „)
Facility/Owner Name faoilip Ii)11.tif livable)
sa_41k4A__esemiC
Physical Address. City, and Zip
County Parcel ltkntificarion No, (PIN)
Sb. Latitude and longitude in dcgreesiminutes/s€e nas or decimal degrees:
(if well field, one IA/long is sufficient)
For tnlernat Use Only:
:14713 3
ERQM 'ro DES RJpTapp___
} o 'IL. 3 t " Gv�. s 5A
ftft
13:[71,. 'CASINC.(foiieetti- ,gyp): i'1'"" iArQtiiabio
mom 1O n/AMt.1U Tuaci+SS'
-I t ft. L a tl R. 2. m. y ej
'ik6O RCil6IMOR-T lf
Riots TCl Dr4MAMETIM TRLCRIOMS
iL. ft. In.
f4 ft. ia.
1NATESOAl.
LJ Q.
MATERIAL
FROM TO
S p a Zr
ft. f�
EtF.p I gar' bier:
/ vfln. '[,l O
i,n. 1
FROM
0 n,
fk
TO
a.v fL
it.
TRU, Nlrks pow-M/t1AL
C�NO I
MATERTAL EMPLACEI,F•WTkit D&AMODUNT
fin t4 t. taj d L L j 11.4°.M-e
fL
FROM TO MATERIAL
ft.
ft.
rt.
1S M.i' LA C EME ME. METH O D
RERG' IPTION Icabr, Mordant eoa4ork ' � r
RLCE EO/NCDE �r f DWR 9es Andre
ft.
o(t.
0 8 `i�;
�n.
ft.
Waite •"Lldlit
()per_atianc,
Wilrnikton Regiak
ft,
3
on
Office
ntorao rail-Ont F;t::sc us >•a) .
22, Certification:
341 ° oa.c))/`/ N 0 f51
a S-3- ?'
6. Nam) (lie well(s) Permanent or fJ'fcmporary
7. Is this a repair to an existing well: FJYes or lallo
obit it a repair, play! known well con.ttrucilon information and explain the nature of the
re{»Ip under e2/ remarks arttian or nlh ihd hark ref dhlrJ6rm•
a. For Geoprobe/DPt or Closed -Loop Geothermal Wells having the some
construction,. only I OW -I is needed, indicate TOTAL NUMi3131i of wells
i1ri1(ed'
9. Total well depth below land surface: 3 S (ft)
For mulUp:e- wells Her all depths 11fd jrent fr.camp1e- 3@200' and 2@100)
LU, Static water Level below top of easing: e
Yrrater le vet is above ravine, use "r -
1 R. 13or&h0le diameter: (t(in.)
12. Well Coastrnction method: `-3-e-4
(i,e. auger. rotary, ruble, direct posh. etc,)
VI)
FOR WATER SUPPLY WELLS ONLY:
13a. Yteld (gam)
Method of teat:
13b. D sinfect/0o typt:
Amount:
•aS-
Sigromire of Ce ed Wr tractor Date
Ay sighing Mix farm, 1 hereby (—wiry Om the WO) was (very} too:traded !N accordance
wigs ISA NCAC 02C .0100 nr 154 MAC 02C . U20U Weft Consinedion. Se andante turd utd( a
copy of this moat has been provided to the well owner,
23. Site diagram or additional well details:
You may use the back. of this pogo to Provide additional well site details or well
construction details. You 'nay also annch additionsl pages if n.eMs•iry,
SU11M1t3 rA ) NSTRUCTLONS_
24a. For AI! Weilie Submit this form within 30. days of completion of well
Construction to the fallowing:
i Mahan of Water Resources, information Processing Unit.
1617 Man Service Center, Raleigh, NC 27699-I617
awry, caw avLMS Ul c WY! Vi UUA M.)4 wiff110 JU nays of c ttlplction Ot well
construction to the following:
Division of Water Resonrery, Undergrottud injection Control Program,
24e. For WAttr S Mat' .lAiM1004 Wcl J: [j addition to sen4 ag the form to
the aQdtes$(c) shove, also submit one copy of this term within 30 days of
completion of well construction to the county health department of the aunty
whim enncrihu•»rt
,hmlllgton

WELL CONSTRUCTION RECORD (GW-11
). Well Contractor information;
well ('u' L is !ur Name
NC Well Coattawor Certification Number
/Z Q. u.A f_w?4 41
Company Name
2, Welt Conylrt1 (ion Pernik fit
DILA1(r,4.1(:%
f'")
0
hest all opplicohla wui/ con,,tr,cai ,, permits (/IC. C'u:eur, $true. Paraaacz, etc)
3. Well 1I (check well rl$o):
Water Supply Well:
For Internal Use Only:
L
Yt10M TO
(t.
2 B ' rI. t;,u ^ rs 5;62 .
n. {" fi
. R hit:k ki.ca9cya Ort k,W121ki(l v,ry.
I'ROW TQ l—OIAMI17Eli 'kHJC CNit3sa MATERIAL
'7Ze; Rek.SfIA e,@ft' uft.IP(6 S + kid4 i(ppj;.
FROM TO arxnrerrre .,. TIIICKWER9
(L
rt.
1n.
MATF1ttA L
In.
A icultoral 11f uniciltalftblic
iieotherntal (f eating/Coofing Supply) °Residential Wafer Supply (side)
Industrial/Commercial °Residential Water Supply (shard)
tt"gation
Nop.WalerSupply Well;
Monitoring,
JoJethon Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
1.',xperimenlal Technology
Cioothermal(Closed Loop)
Geothermal (Hcntinag/Cuoling, RieturA)
4. D tt 3Welf(s) Completed:.?
Sa. Well Locatipm
; s.
Facility/Owner Name
DR.F.COvcry
DOroundwater emediarion
°Salinity Barrier
JStormweder Dn inage
°Subsidence Contiof
°Tracer
f Other(explain under ti21 Remits)
8' Well DM
Facility iDN.(ifutilisable)
.spa&et 11 • •4 t C� WLFQ
Physical Addles, City, and Zip
. J /4.4.wU —
County
Parcel Idantificntiun NU. (PM)
Sh. Latitude Ind longitude in degrees/minutes/seconds or decimal degrees;
Orwell field, one Jat/lorrg i$ s„ftWcnt)
3 y J /y- 3.3 N
n'Y)°..T73
6. Ware) the well(s): #'ermanenr or ®Temporary
7. 1s this a repair to an elsleting well: 0 Yes, or ENO
((this bra repair. felt our known well construction 1nfonco ton and explain Ike nature of elm;
rep:ne uadcr ir2l reniar*v tl n:1(cm or on the hack. f (hie jwn,.
8. ,For Gtoprobe/»PT or Closed -Loop Geothermal 'ells having the same
consttucliun, only 1 GW-1 is needed. India TOTAL NUMPER of wells
drilled:
9. Total well depth below land surface: a 8 (iL)
rear ma1rrple wells fist all depths Vcii,trent 0:romp:A, 30200' ano'201)1Mr)
W. Static water level below top of casing: / ej (ft-1
If wafer Inv! ig ohOYK oaring, eie
11. Borehole diameter: l„ fin 1
11. well eoastruction method: e—tt" S tJ Ate.,"
auger, rutty, cable, direct psR, etc.)
FOR WATER SUPPLY WELLS ON1,Y:
13a. Yield (gpm) Nletlind vilest:
13b: Dis1afectlaa type: Amount:
FROM
n
18. Ca9[
FROM
ag
ft
brAMETgA
/%In.
In.
OSIZZ j Ti3N:rtnx5$
0/0 � U ca,
MA gR1AL
TO
0
MATERIAL EMPLACEMENT Mz Etoft & AMotirrf
tr.
It.
PWiripwlabtq�'�'. •
FROM TO MATERIAlr
Fr. ft.
EMylACEMENT METHOD
fr.
leltftm k ten lio d.ci. £ W oarr WEa ova ez% asc.>
tt
ft.
rt
ft.
rt,
tt
ft.
WfttictARICCS
MAR gig
Irfsotti�i?iv`�
22. Certification:
er
tractor_�
[late
✓1y eiglavgThis rm, .( !y cerrijy (her flu; WIN w4.x (s ePel crmstreCied (n a:Crrdancs
ivlrh 154 NC 02C .0I00 or ISA NCAC 02C .0200 WNi Co twrucrrrur $ o, dents and that a
coPYaidt4 roconi/X.2 bedn pro,idtleita Ore wall owner,
23. SJtr diagram or add11Uon41 well details:
You may use the back of this page to provide additional well sire details or well
construction details.. You may also attstth additional pages if necessary,
SVJ}Mfl CAL INSTRUCTIQNc,
24L For Ay WeJJg: Submit this form within 30 days of completion of well
construction to the following;
Division of Water Resources, information Processing Unit.
1.617 Mail Ferrite Center, Raleigh, NC.27699-i617
241, ,;,:or " +leu1;wo —Citing: in addition to sending the i'nrtn to the address in 24a
above, alF0 Submit one copy of this form within 30 days of completion.of well
construction IQ the following:
Division of Water Resources, Underground Injection Contrbt Prot, ate,
. .......: ut, rivt'.curer, RUnagfti (TCZ70W-t 63b
24c. For Water $0ppJy tnieckort lii addition II) sending die form to
the addr:,ss(cs) above, also submit one copy of this form within 30 day of
completion of .well amatrucilon y`talE unto AIP4 tl.tI �t of the county
w1wrA ennOnrrrAil iUUL/LiE f/
OCT 08 2018
Water Quality Regional
Operations Section

WELL CONSTRUCTION RECORD (GW-11.
)., WcII !Contractor Information:
iFor Internal Use Only:
Well Cuntructer
gig
:rrne
NC Well Contractor Certification Nwnbet /I
t U14 . w eUj , AOQ
Con)paoy Nano 9p'40
2, Well Cooatruetion Permit tl: (J r3
_
/.rsv erll opplrcrtble rrctl rwootruction t rinlix (i.e. (,I1f;; C thtmy..State, parie„91• 'r. e9/
3. Wt11 tine (cbrck well use): Ct
Water Supply Well:
Agricultural
Geothermal (Reattng/Cooting supply)
induetrinbromrnercial
FSCRirrltlrt — 7 1 3
,ors
2fS tfi7iL�R CASINGIfny': iettl.cosnd:Aetkys• :t.ThrgR
FROM 'ro [ ntAMUM TANCut ss MATERJAL
'�.1 ft. ao tti L aIn. Ate tau
` •
PROM TE7 JAM THICKNESSMATtPIAt.
fr. ft. I in,
ft. fu
Irrigation.
Non -Water Supply Well:
Monitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
rixpetimental Technology
Deothenmal (Closed Loop)
Geothermal icTting/Cooliag Return)
FROM TO IMAMFTER ... S
a d IL der
I i viv
ia.
RAO MATrlttAi
u KU Q
ROM TO MAT IAI,.
.z
mast TO
B,
�'t►Nsliblc)';
MATERIAL.
gmm..ACEMZNT Kennon a AMOUNT
EMP1ACENU r1.1 TROD
fr_
nOthetStam main unsex 421 Remarks TQ nevxvitYrtort Won
) t to@trocicgpn p>t*aiet; t+t:1
rMunicipal/Public
°Residential Water Supply (single)
°Residential Water Supply (shared)
fRccovcry
DOtaundwatcr Rcmcdiation
Os&;nit, Barrier
ir}Stomtwtuer Drainage
°Subsidence Control
OCT 0 8 2018
rt.
fe.
Facility/Owner Name naoility tnti. la
Setion
wilmin, lotRegional Office tr.
Pbysical Address, City, and Zip
t�r�rS w• C 4C
4. Date Well(s) Completed:,.: IG -/ttWetl JAtl
S>t. Well Location:
$'" C ����<<S Water oualav Rego
County Parcel ldcnrifiuuion No. (PIN)
Six Latitude sod tougittedt in degrees/minutes/seconds or decimal degrees:
well field one 1flt/long is 2ufticiont)
33 ° 95-9 N '7g j f . 3 s'(
6. 18(are) the well(a)6Permanene or ,Q Temporary
7, Is this a repair to an existing well: Q Yes or eiIYo
If this is o rapalr, fill ow brava well construction ininr vvarin mid explain the rethrot of the
rtzpair under !21 r.rnroreaa ., lion <N• on the hock Of 4htr form.
8. For Geoprebe/Jfl f ur Closed -Loop Geothermal Wells having the same
construetjoo, only IOW -I is needed. lndioffie TOTAL NUMBER of wells
drilled:
t
9. Total well depth below land surface: yS
fior rnortoie was /1 ( all depths if dlf rent (cramplc. J(200' and 2@i0p)
10. Static water level below top of easing: (fL)
{f+calor love/ ohow (-cuing, tee ••+'•
11. Borehole diameter: (in.)
12. Well coasts -action method:
(i•c, sager. rotary, able, direct push, ore.)
I. FOR WATER 511PPLY WF1.t.0 orot.Y•
136. Disiuktdoo type Amount:
(I)
ft.
R.
h.
ft-
Et;
MAR 9,6201$
1? `t-iiit}
S•_„< r of Certified WCan or
Date
t3y rot* this form,. hereby .6.11 that the w211(.r) kat (wop1 cutraYnreted th accordmro
With /!4 % MC 02f ,0i00 or 11R AV, off; .1120u tilt COWnevttgn Zkazdarits and that a
copy efthia record as been provided to the rwetl nwrrer.
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 nccessay.
Susl>t•1T
24a.For All Walla: Submit Otis form within 30 days of cpnrptatiorr of well
ronsuuetiort to the following:
Division of Water Resources, hiformatiott Processing (In4t,
1617 Mail Service Crater, Raleigh, NC 27699-161.7
24b. F. alibi d We : In addition to sending the form to the address in 24a
above, also submit one oopy of this form within 30 days of completion of well
construction to thefolowin3:
Division of Water Reaonrcey,.tltxdergroitod tbjectloo Control krot?rotrn,
-..sw__uwvwr +r- ■ r rgasyl rrw ` in waitron to seading the corm too
the address(cs) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
whgrn MngtrruIvti

WELL CONSTRUC:1ION RLCORD.
Ti1r form :::19 Iv silo! for sink nr ,
1. Wdi Cuotrartur Information:
Rich Lemire
will f'orsralor N.imr
2593A
NC Went umlaut Canti:awnNuuber-
SAEDACCO Inc
Fat Irrcront t:►c Olst 11,'
5 38 14.WAttlt2431.41Y4
RECEIVED/NCDENR/DWR
(:'uryr;ty) NAM(
2, WrIl ('ansttsictlun Permit 4:
OCT 0 2 2018
Litra1I.rpf,hial* arNf.:n1 ,iir Cuwit,
3, Weil Use Miceli well men
Moe
Water Supply Will:
tlAgttcuhund
1:1Geothr;rrrtlrl it lealing.Cooling Snppls
1:IligiustriahContinerrial
❑irrmJtttan
Ilrri,+m a•. ffJft %r all'
Water Quality Regional
1 jorafitsnc SPrtion
Wilmington Regional Office
I:1Mnmcip;diThlbic
I:iRcsidentiat Water SOpid,. {single)
I !Residential Winer Suppl% I t ut•d
No it -Water Supply Weil:
lAionnQnng ORccovcry
tr�ect�onri'clE. -
flAtioifcr Rccharite
G Aglitter Stowe and Rcetncty
°AquiferTcst
❑EWctnnundd Technology
OCaxithen uti (Closed Loopi
OGeullremtul SFleaUtig(uullnn Return).
4. Date Well{xl Completed: 7-24-2018
Ss, Well Location:
VERTEX RAIL CAR
Fnciltty•Ourer Want
EIGronndw,ter Rcnlodi:alms
G!:ahnity H:imur
LJtitommatcr Drainage
OSubfideocc C'otum I
❑T'r cer
Mawr (explain udder 021 Rritllu )
t4'el! MOW-2 OD
c.,05A
MW-20D
R+crhh IDXiiftg:66:46tci
202 Raleigh St., WILMINGTON, NC, 28412
Pl' simt 4tithrs! Cm. find Zip
NEW HANOVER
Omni) Pahl illetnrrrc Iitrn No IPINi
Mt. Latitude titude and Itingitude in ik re caimimftesIscconds nr decimal degnsem
of wen nem, one I.i ihn 1'. sufflo tot
34.179432 N 77.942030
6. L. taxi the aelllsl: lePcrnitlilent ur Tcngrortrry
7. k this a repair to an existing well: 2.svc. nr No
ltrhilnrrr,pifI till ,tailhr:rrrnrsri!+irr',.rm1inn:,,ri,vlit r.r,rr,u,.!r1•l,iA91tin'nwm. Titr,L
,')stir urt:lu Bel ,i m,:rd... sr. Nra: or ,.v, rJh• 1•rn.0 of rflr.tform.
8. Number of w elh comminuted: 1
►�
?ur!gtrhij.dr rr+ric44rn .•r rr.hr•„rm•r ruF'/., „rlJ( 0,ll.f' „yrh the twrnreltAMIrhrwl a,•u -. r
sxM'mt:wrr jltn,
9. Tidal well depth helms land Attiact' 48'
tor utihl rle ,, ell, diet aU dog,. , .,filler, —or w !J • res•; V! ' -.1tt• i
IU. Static alter lercl below lop of ti inh!: 4'
11, Botrhnle ditimcfeel 6"
12. Well a►nrtruetlnn method: AUGER/MUD ROTARY
11 a :I1i t, rrtut,., tahkc• dltccr path al, r
FOR WATER SUPPLY WELIS ONLY:
13a1. Yield Wm,
13b. Ulslnl'ectiou type:
Mrtbud orient:
Amount:
victim tU
ft. it.
rt. n.
00':titx4PTJOV
1
1
li;.t)Q> j CASUYG Ifnr mtB I-raeetl rrens117R ! lKt K SW eBPflc iMf> t i
FROM • TO Jli METER Tr11CKSTSS MATT/RIM
t. 0 ft. 42' fr. 6" is. SCH40 PVC
114 tMMFtt CAS1Nb 4!!t TIIIINCrAer►tAtbut cis 04,0nlr)y.
1 PROM TO D14MPTf'R 1lIK'KS► MAiIRI.11 Y i
0 tt. ' 45' O. 2"SCH40 PVC —__
17. #4.3LEIEM
MROW l 10 014100-ER
1 45' ft. 48' ft. I 2,, et
s
: ft, it. I to,
v PROM iO
o ft.
41' ft.
O1fi1kits tincloot
.010 SCH40
1
►1ATLRtm, 1 mina. crstr.Y7 AME7itoo i A1HOt Syr
PORTLAND ;TREMMIE
R.
titkiliii?GRAVEL lAZ1►N 88pidi aGk
whom tt►
j 43' ft.
48' rt.
it(tERtAl
SAND
tiaPt.•N; I'MV•ka 1Nr,'11100
#2
1 ft.
j IC DRILLING LOG tstlach 1tdttnimnl sheet, if oectxsRrxl
• PROM TO DrwRIFTTON ltAr,r.lrirdwrn, mq'nKktytntirdrtin'IM.Ne:I
s 0 tt. 42' ft. SAND
1 42' ft. 42.5' fi. CLAY
42.5 it,
ft.
Sp
R.
ft,
48' tt
21. REMARftS
EENTONITE FROM 41' TO 43'.
ft.
SAND
22. itcr'tif, th,n:
7/24/2018
Sirttulur:arcnu _iYc11contrMbar [hit,;
Nr ',pule rbn r.,,,rr f ha•nhr:•crr,tr ,",a rj„• n•!•rhrl air: n.reri nr.,r:.•. sirn.r
n•rrh !!".1 Vf',t(" !VC 0100 yr ! i4 /Yi:' If el/C. _ 1'fh'1 tf,di !'+.rrn,r� n��n �rr rarAL,r,j+.�,t rjr:,l a
•-0••!tfla..rrn!hl4'41rn'.rtr•r•r,,L',tI,N:. arll'i!arp+r,
23. She dWgram or additional well details:
YcNI Ittay 11%11111!. tYdik of this page ks provld1::idshllisoutl wcl1 stir details sit udl
,'unstlut.-tion dt:tnibs You may alior:Mach utiditional pays if necesutn .
SUijM rI TAU, iN5'L'UcTi41jS
24a. Fur Ail {Fells: !inbuilt tutu ,•torn ttiihrn 10 tins al ct?nrprerinn ,a is ell
.Onsi Till tiara to the full,)lei np
Dhirloti of Water Refmrtes, Information Processing Unit.
1617 Mall Senkce Center. (;Heigh. NC 27699-1417
7.4h. ,For Inleetkig kyotti ONIAI': Fit addition to sendiIn: tite fount to ilk• address nl
24,'t above. also submit a .opt of ibis form willim to days td camplelkin elf well
cutlstfH:tiO1i to the following .
Division of Water RewiurreA. Underground injection Control Program.
1636 MxH Servicv Center. Raleigh. NC 27699.1636
24c. For Water tiup& & t jrctkm Welk:
Also submit one ;ups of This fun Aithin +rt days of completion of
well consiniction to the county health department of the county where
.tlrssttucted
Porno bly•I
sonitt'arulur,tUpsrnnrrtnifo•.'uutstntarid Nuuualk „vn5- Di, hn;r•arIl•.,Ict=imam, he, Lull August loll

WELL CONSTRUCTION RECORD (GW-1)
t, Well (:obtroclor information:
GASwc!J C olitTil )r NUnk
NC Well (aomatular Cvrtifieotion Noroler
/4 L&.A , { (i p RECEIVED/NCDEN
e'oTptny Name
2. Wort Construction permit b;
/.IAr all aplictoble ✓''F(1 r,m..truetion (one(.monett e. ibC, County. Slats. marl, afc,) 0- 2 / O
3. Web 17se (check well are):
Water Supply Weill
Agricultural
Geothermal (eating/tooting SYippty)
ndustial(Coin mare iel
Non -Water Supply Well:
Monitoring
lOject►on Plkll:
Aquifer Recharge
Aquifer Storage and 'Recovery
Aquifer'fest
peri mania I ')'cchno)pgv
geothermal (Closed Loop)
Gene thertnall (f (catin (;puling Return)
Water Quality Re
oMlmiciptll/PublicOperations Se,
ttasidrntiat' tr�dlt7irp(tlYfaiR10),I1
°Rev dential Water Supply (shared)
Recovery
DGralndwntcr Rcmediation
D.' Saliaity Barrier
DSttumwater Dluinrlgt
Ol5obsidence Control
OTracgr
Mbar (explain under i+21 Remarks)
4. Date Well(s) Completed: to - Well Dili
S. Web ',Nation:
7i4 SAO^ w14lr C tiat.
facility/Owner N:iinc /
I'acllitY t1?k (if applicable)
Physical AdirmCity, and Zip (O, 1M pc. aie
I. ar
tJ e. 4L14n..v,vtr
county (&61-Fa ecal IdunB!on Ho. ON)
t:G t ie"1 314 d c ,
5b. Latitude and !aptitude in degreea!lralnutrslScrvA(1s Or decimal degrees:
(if well field, one 1st/Iona ti suillelem)
6. as(are) the wefl(s)N: J'ermancnt or Temporary
7. fs this a repair toad existing well: jvcs or FINo
((t?uy is a rc a,r. JN(ma known w Ii rvrnsrrnMra, tnfinwration and arplu/n the narooe yry c
royal, urider N, 21 nainur&x 4u2(011 (Pr on the heck cy'U to juror.
for GeoprobeiDPT or Gabetl-Loup Geothermal Wells haying the ran
construction. only 1 OW-1 is needed. indicate TOTAL NUMBER at'Wells
9- Total well Jcpth below land surface: 7
Par muitrple wens us! 4)1 Qeprhr 114grsrent (example- 30.200' and Ig1.7,i
10. Static water level below top of rasing:_
JJ wafter broef !.+' nhn. a im'int; reCV � "
t ). Bnretwe dtsmcier: „ (in.)
12. Well construction method: A,.,r
rouvy, enlrle, dimes posh. aal
r
FOR WATER SUPPLY W{si>I S ONLY:
11:441-
(fr)
13a. Yield (gpro) aderrrwl of teat:
136. Distnfeetlon typet Amount: ,. w
PROM
la- C4Qtrr
FROM TO MCATR'RRrA{ ZMI'tACT,MENTRIETIOD 4p:
0 tt. � (45, p
idsr
For Internal Us» ()nlr
tE WA
'"`,_-----
o (t.
it.
113 �. Apse spa,
11'15CT_F..12 G4Sr_►G {loi crahkr+gt�cr
rr I O ntAnir`Isa AMOR (.
n/AMt_f¢}t '• w)rlCtrlOoki MAI rritA6
)71rAM .ln
t �_ IP.
m.
inlet£Nt~( jyA•lypy�t
19:,E01610 -AliTURA
tMrt.AC6Mt.:NT 1drtr:uD
22. Certification:
Slgo ate of r ortified ell Contractor 1)ntc
key,? ifl 1 is fopry l hereby cirtiry Nary Ore wr(I(.o) war (were) cvNsrrvard hr aoroida; Wir%11SA C 02C .0100.or ISA N[:AC 02C.02t f6 f Gonnnror,Con Stexta k and rht
copy of lhrr record Ixas been pravpdxJrn thy. wr(i or m -.
23. Site diagram or additional wen details:
Foil may use the back of this page to provide additional wolf site details or x ctmstrucxion details, You may also attach additional pages. ifnecessary.
SVIMflrfTA 1NCTRUrfQ.Ne
ye1�
24a. For Au Wait Submit this fomt within 30 days of completion of w construction to the (following:
Aivislon of Water Resources,tnfurmattou Prooesrtng Unit,
1.617 Mall Setyice Ceuter, Raleigh, NC 27699-,617
rile r Faial_ _ goA rfil: In addition to sending the form to the address in 2
above, also submit one cony of this form within 30 days of completion of w
construction t0 the follOuiag:
Division of Water R.esourco, Dudergrot,pd injection .Control Program,
1636 Mall Service Center. Ralrigki NC' 27699-e636
24e. For'Water Sunply d,Jnicct)pa wet: In addition to sending the ♦cent
rite addtuss(es) above, also submit One copy of this form within 30 days
compkiton of wctl construction to the county health department of the tour
when,, non cl rurnvi

WELL CONSTRUCJON RECORD (GW-1 "- ft
`or Intavtial lice Only:
1• Wetlt'oatractor Information:
GA 0-0 p 5'
Wc71 Contrnelot Namc
NC Well Contractor Gurtifrcation Nurnber
2. WO ('onatruelion hermit U:
/.r.rr rr//app/ieobla 1.1!1(cof..wrrcrirrn rerntitr
3. Well Use (thetk well use).
Wrte-Supply WYeW.
'�ri1icunutar
Geothcrnia! (f icatingtboiing Supply)
tndUStfiZI/ Olnillfreiat
)Von -Water Supply Well:
MMitorin
nJeedon
Aquifer Recharge
Aquifer Storage and Reotwery
Aquifer Test
;Cxperimetttal Technology
( Goorhemtal(ClosedLoop)
i Geothermal (lfer4irtVCoQting Return),
• 4542
._.:._f7OM : .
RECEIVED/NCDENR/D
cyI
'15. Oi7113 CASi.'G_If! alti esad�.o ts).Ort
Fi20,1F r !(} ntAMF,i�jt
y ! h' i Ow-� in tttrcr:NesS asrgnrAl, _
IC INNER 1 O y
Rom vo
11.e. lire.: Cranny. .%,Id T , egional
Aerations Section
Wilmington Real
— -Onal nf{irttrr--
—PROM eta '� .. ,•
1.. _ _...._.... I.1)IAMeTto FffrrFrlE
2 ft31 ft I
/ !/i kcK T niArratct_
n. us-o oa
I
rL n
nom To-MATEAIAI,
•
Mtirnen iivutlhc
°Residential Water Supply (single)
CPResidentiaf Water Supply (shared)
!Lecyvary
ntAMF:r.-m. Tint -RAMS MLTLPJAL
n• in,
IL
°Groundwater Remediation
DSaliniry Barrier
°Stormwater D ainesrx
°Sohsidcnce Conant
°1'rsax
f1other fex rein tinder#21 Remarks
4. » to Well(s) Completed: S'.l } ►L
S. Well I -oration:
Facili /Owner Name
. 4? kob•tr* E Pit-
tT v cal Addre ., City, and. Zip
Crotray
'Well Mg
facility (7)11(if applicable)
parwJ )dtiu, morn u, fare)
fib_ Latitude and longitude in degrees/minutes/seconds or dtcimat degrees;
(if well field, ono Iar/iong is Sarl lent)
39 a, j10 441/ N 2 7 s—.3. 9V 9
6. Is(are) titc well(s))erntanent or °Temporary
7. Ix this a repair to an existing weir: C3Yes.. or Callo
((this nY a M(ntir, fist nut known weft construction tilbrmorin and expluin lhl+narrhr of*
sepals under ,Y21 r rururk„ rw;Uun ur ar rhea fir!" I,
S. For Ceoprobe/IDPr or Closed -Loup Geothermal Wells having the some
construction. only i (i W-1 is needed. Indicate TOTAL NUMBER of welly
9. Total welt depth below Laird surface: 3 r
1 ire mrd(l le wells l/st all depths 1f dQftry a (example-;C:ppd' and 2(ag l00)
UK Static water, level below tap of easing:
!.fewer, Ovc'1&Choy, l nch7�; UM: '.4 "
/7
4fl-)
1 E_ Borehole diameter: Le OIL)
12. Well construction method: 4s
(Le. WW1'. rotory, able ducct push, ur.)
(ft)
FOR WATER SUPPi.;Y W,E1.1 S ONLY:
tap. Yield (g,m) Aietn04 of test:
Ufa-Disinfectiontype. Amount:
FROM
FG
Sit BRIL,
iL
rt.
rt,t.C7 Nr MEriron& Amsw_
RIfPI4CektEI rAIgpfllll
t)17 81 r feWrtmrdyosy e.* Wm, tlY•brobt,err.)
22. Certification:
S'
ay
,.r
espy ofthic sti
r�asareefC e4 Wei
rm,
rlg/rlpt rhls
!stXGIC'2C.Olr
lira
Dare
6 Oa � (n/boas.
ncono.or /SA UOWal. ,relo ono"'
rdha, beers provide t,,Ibew 1(ow'
cloy
23. Scidiagram or additional well details;
You ma use the bank of this page to Provide additional well site details or w
construction details. You may also attach additional pages if necessary.
10/1KETTAL INSTRUC_IION$
24a. Fir Wulf: Submit this ftwol within 30 dries of u)r» pletion of w
construction ter the fallowing:
Division of Water Resource?, information Procestdog [;are,
16117 Mall Service Center, Raleigh, NC.27699-i6r.7
24b. For Iuleetitla We& In addition to sending the form to the arddreat in 2
above, also ,submit.one copy of this form within 30 days of conviction of tie oonslnactirnr to the following:
Divk»on of Water Re400rccs, Underground I5 jcction Control Program,
l434 M4ilScnicc Confer. ttakigb,NC; 27 99-1636
24c. 4or Wa.,r Sonn1Y d lniecrk w.•-•• .
—O submit
o.r..,u.,. fn addition t0 within
Use days the addresses) above also submit one copy of this form within 30 days knurpterion of well construction to the uo l icy hcrdih ttcparvrttcne of the cqun rnntl ewtMt
1

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells RECEIVED/NCDENR/DWR
454130
For Internal Use ONLY:
itottlge
1. Well Contractor Information:
George Bridger
Well Contractor Name
2393A
NC Well Contractor Certification Number
0-C1022018
Water Quality Regional
Operations Section
Bridger Drilling Enterprises inc\dbailQarolln0DttiWtfg2
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/Commercia I
❑Irrigation
14, WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (for multi -cased welts) OR LINER (if applicable)
FROM DIAMETER
0
ft.
TO
6
ft.
2
In.
THICKNESS
sch40
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM DIAMETER
TO
ft.
ft.
in.
THICKNESS
MATERIAL
pvc
MATERIAL
ft.
ft.
in.
17. SCREEN
OMunicipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
LMonitoring
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Retum)
❑Recovery
FROM
6
ft.
TO
16 ft.
DIAMETER
2
in.
SLOT SIZE
.010
THICKNESS
sch40
MATERIAL
pvc
ft
in.
18. GROUT
FROM
0
ft.
TO
3
ft.
MATERIAL
neat
EMPLACEMENT METHOD & AMOUNT
in place
ft.
ft.
4. Date Well(s) Completed: 1/8/2018
5a. Weil Location:
City of Wilmington
Facility/Owner Name
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 Remarks)
well ID# PZ-4
Facility1Dl (if applicable)
1601 Wynnwood st, Wilmington 28401
Physical Address, City, and Zip
New Hanover
County
(7"
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
185237.04 N 2324025.77
6. Is (are) the well(s): OPerinanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ONo
1f this is a repair, fill out known well construction information and explain the nature of the
repair under A21 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: 16
For multiple wells Iist all depths ifdiffirent (example- 3@200' and 2@100)
10. Static water level below top of casing: 10 fit)
If water level is above casing, use "+"
It. Borehole diameter
(in.)
12. Well construction method: Direct Push
(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
ft.
rt.
19. SAND/GRAVEL PACK (if applicable)
FROM
4
ft.
TO
16
ft.
MATERIAL
sand
EMPLACEMENT METHOD
in place
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
DESCRIPTION (color, hardness, soil/rock type, crate gin etc.)
FROM
0
ft.
ft.
TO
16
rt.
ft.
Tan and dark gray sand trace to some clay
ft.
ft.
ft.
ft.
ft,
ft.
ft.
H.
a:F•5',
PFC INif
rt.
ft.
21. REMARKS
JAN 8 2018
tii1 orii'I:d(ioit I-'ref.:.'-:rs ej `.)is:;
[`I`11`1Q1i (_tv:
22. Certification:
S , ; e of Certified Well Co actor D e
signing this form, 1 her certify that the well(s) was (were) c tructed in accordance
•ith 1 SA NCAC 02C .0100 or 1 5A NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
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 this form within 30 days of completion of
well construction to the county health department of the county where
constructed.
North Carolina Department of Environment and Natural Resources — Division of Water Resources Revised August 2013

f
WELL CONSTRUCTION REG VEb/NCDENR/QWR
This form can be used for single or multiple wells
1. Well Contractor Information:
George Bridger
OCT 02 2018
Well Contractor Name
2393A
NC Well Contractor Certification Number
Bridger Drilling Enterprises
Company Name
2. Well Construction Permit #:
List all applicable well permits 0.e. County, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Quality Regional
Operations Section
Wilmington Regional Office
Inc dba Carolina Drilling
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industria1JCommercial
❑irrigation
❑Municipal/Public
❑ Res idential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
DJ Monitoring
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Retum)
4. Date We11(s) Completed:
5a. Well Location:
City of Wilmington
❑Recovery
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #2I Remarks)
11/7/2017we11ID#CB 3 C7P-3
Facility/Owner Name
Facility ID# (if applicable)
1601 Wynnwood st, Wilmington 28401
Physical Address, City, and Zip
New Hanover
County
75777)
Parcel dcntification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field one lat/long is sufficient)
185336.947 N-2323700.415
6. Is (are) the well(s): ❑Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or EiNo
If this is a repair, fill out known well construction information and explain the nature of the
repair under #21 remarks section or on the back of this form.
8. Number of wells constructed: 1
For multiple ity'ection 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 if different (example- 3 200' and 2@100)
10. Static water level below top of casing:
If water level is above casing, use "+ "
11. Borehole diameter: 4 (in.)
12. Well construction method: Direct Push
F4412
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (for
multi -cased wells) OR LINER (if ap Health)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 °-
5 ft.
2 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
5 n-
10 ft.
2 in.
.010
sch40
pvc
fL
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft.
2 ft.
neat
in place
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK
(if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
3 rt.
10 ft.
sand
in place
ft.
ft.
20. DRILLING LOG (atacb additional sheets if necessary)
PROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain sire, etc.)
0 ft•
10 ft
Tan and dark gray sand trace to some day
ft.
ft.
R.
ft.
ft.
ft.
rt.
ft.
ft.
ft.
21. REMARKS
22. Certification:
f Certified We
actor
i C2/is Cr3
Date
piing this farm, 1 her ,y certij that the well(s) was (were) constructed in accordance
vith 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, INSTUCfIONS
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
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:
(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
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells:
Also submit one copy of this form within 30 days of completion of
well construction to the county health department of the county where
constructed.
North Carolina Department of Environment and Natural Resources — Division of Water Resources Revised August 2013

WELL CONSTRUCTION REr� lED/NCDENIa/DWR
This form can be used for single or multiple wells GL�Y
1. Well Contractor Information:
George Bridger
OCT022018
Well Contractor Name
2393A
Water Quality Regional
NC Well Contractor Certification Number Operations Section
� l �t �� n�
Bridger Drilling Enterprises inild' aRrc�f i rya ura fce
ling
Company Name
2. Well Construction Permit #:
List all applicable well permits (re. County, State, Variance, Injection, etc.)
3. Well Use (check well use):
For Internal Us Qj.iLY:
54
� 2s
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
rt.
ft.
15. OUTER CASING (for multi -caned wells) OR LINER (if applicable)
FROM TO
DIAM ETER
THICKNESS
MATERIAL
0
ft.
10
ft.
2
in.
sch40
pvc
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
is
ft.
ft.
in.
17. SCREEN
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
injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Retum)
4. Date Well(s) Completed: 1/8/201
5a. Well Location:
City of Wilmington
❑Recovery
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 Remarks)
8 Well ID# PZ-1
Facility/thvner Name Facility ID# (if applicable)
1601 Wynnwood st, Wilmington 28401
Physical Address, City, and Zip
New Hanover
County
2j �!%Q( r 1
Paree�entificat�No. (PIi�
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one tat/long is sufficient)
183987.15 N 2323774.98
6. Is (are) the well(s): ❑Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ONo
If this is a repair, fill out known well construction information and explain the nature of the
repair under 121 remarks section or on the back of this form.
8. 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: 20
(ft.)
For multiple wells list all depths ifdifferent (example- 3®200' and 2@100)
10. Static water level below top of casing: 11 (ft.)
flower level is above casing, use "+"
11. Borehole diameter. 4
(in.)
12. Well construction method: Direct Push
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
136. Disinfection type: Amount:
Form GW-1
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
10 °
20 ft.
2
in.
.010
sch40
pvc
rL
rr.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0
ft.
7
ft.
neat
in place
ft.
H.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
8
ft.
20
ft.
sand
ft.
ft.
in place
20. DRILLING LOG (attach additional sheets if necessary)
FROM
0
ft.
ft.
TO DESCRIPTION (color,budness, soWOreck type, 6nm size, ete_)
20 ft.
ft.
Tan and dark gray sand trace to some clay
ft.
ft.
ft.
ft.
ft.
ft.
fL
ft.
rt.
'I C ZOill
21. REMARKS
22. Certification:
t
Sigti5tuej f Certified Well Contr. _ r
• ilit;t7rt g tn. -1 1-ki0:`s'J:1Vi
11A1C,VL,C- -.
ping this form. I hereby `ertify 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:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniect)on 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.
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:
George Bridger
RECE1VEED/NCDENR/DWR
Well Contractor Name
2393A
NC Well Contractor Certification Number
OC I 0 2 2018
Bridger Drilling Enterprises inc ti8r in
peratlons
Company Name _ + g
Wilmington Regional Office
2. Well Construction Permit #:
List all applicable well permits (i.e. County, State, Variance, Infection, etc.)
3. Well Use (check well use):
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if ap w 6 bi e)
FROM TO
0
it.
7
ft.
DIAMETER
2
in.
THICKNESS MATERIAL
sch40 pvc
16. INNER CASING OR TUBING (seotbermal dosed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
ft.
ft.
in.
17. SCREEN
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:
0Monitoring
❑Recovery
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
7
1L
17
2
in.
.010
sch40
pvc
ft.
ft.
in.
18. GROUT
FROM
0
ft.
TO
3
ft.
MATERIAL
neat
EMPLACEMENT METHOD & AMOUNT
in place
ft.
ft.
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
°Experimental Technology
❑Geothermal (Closed Loop)
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Geothermal (Heating/Cooling Retum) °Other (explain under #21 Remarks)
4. Date Well(s) Completed: 1/8/2018 Well into PZ-2
Sa. Well Location:
City of Wilmington
Facility/Owner Name Facility ID# (if applicable)
1601 Wynnwood st, Wilmington 28401
Physical Address, City, and Zip
New Hanover
County
-3 5 75 7)
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
184756.89 N -2324002.99
6. Is (are) the well(s): la Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or EINo
!f 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 'Menton or non -water supply wells ONLY with the same construction, you can
submit one form.
9. Total well depth below land surface: 17
For multiple wells list all depths if different (example- 3@200' and 2@100')
(ft.)
10. Static water level below top of casing: 1 1 (B,)
If water level is above casing, use "+"
11. Borehole diameter: 4 (in.)
12. Well construction method: Direct Push
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
Form GW-1
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
5
ft.
17
ft.
sand
in place
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
TO
FROM
0
ft.
ft.
17 ft.
ft.
DESCRIPTION (rotor, hardness, sail/rock type, grain sae, etc.)
Tan and dark gray sand trace to some clay
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
rt.
ECE!\I
21. REMARKS
JAN
262018
22. Certification:
trifOrTOStIOD
OW O/i4
�2! i8
ofCertified ell Co' • actor D e
rgning this form, I her, y certt& that the we(s) was (were) constructed in accordance
h 15A NCAC 02C .01 t,t 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 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.
North Carolina Department of Environment and Natural Resources - Division of Water Resources
Revised August 2013
TN

Company Name
2. Well Construction Permit #: N/A
WELL CONSTRUCTION RECORD
This fonn can be used for single or multiple wells
1. Well Contractor Information:
D.T. CHALMERS, JR.
For internal Use ONLY
RECEIVED/NCDENR/DWR $1 ? 6
14 A R TONES
Well Contractor Name
4146A
NC Well Contractor Certification Number
OCT 02 2018
Water Quality Regional
CATLIN Engineers and Scientists Operations Section
b rngton Regional Office
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
OResidential Water Supply (single)
0 Residential Water Supply (shared)
Non -Water Supply Well:
® Monitoring
Injection Well:
❑Aquifer Recharge
❑ Aquifer Storage and Recovery
OAquifer Test
OExperimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
❑ Recovery
❑Groundwater Remediation
❑Salinity Barrier
❑ Stormwater Drainage
❑ Subsidence Control
O Tracer
DOther (explain under #21 Retnarks)
4. Date Well(s) Completed: 01/29/18 Well ID#: MW-57
5a. Well Location:
N.C. State Ports Authority NCSPA SWP
Facility/Owner Name
Facility [D# (if applicable)
GREENFIELD STREET, WILMINGTON, NC
Physical Address, City, and Zip
NEW HANOVER � ? 14
County Parcel Identification No. (N)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
34.21593508 N 77.95105276
6. is (are) the well(s): ®Permanent or OTemporary
w
7. Is this a repair to an existing well: OYes or III No
!f this is a repair, fill out known well construction information and explain the nature of
the repair render #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: 1 1 (ft.)
For multiple wells list all depths in different (example- 3@200' and 2 a 100 J
10, Static water level below top of casing: O.7 (ft.)
If water level is above casing, use "+"
11. Borehole diameter: 8 (in.)
12. Well construction method: Mud Rotary/HSA
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
VINO'
FROM
TO
DESCRIPTION
rt.
ft.
ft.
rt.
15.INNER CASiNG_QR' USING(Reotbeimaldosed-bop)
FROM
0 ft.
TO
DIAMETER
2 in.
THICKNESS
Sch. 40
•
MATERIAL
PVC
16. OUTER ASING (for Multi -cased wells) OR L NER fd applicable
FROM
rt
TO
n. .
DIAMETER
in.
THICKNESS MATERIAL
ft. rt.
in.
17.SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
1 rt.
10.5 rt.
2 in.
Slot .010
Sch. 40
PVC
u.
u.
in.
i& GROOT
FROM
TO
0 n.
0.40.
ft.
0.4 rt.
0.6 n.
u.
MATERIAL
Portland Cement
Bent. Pellets
EMPLACEMENT METHOD & AMOUNT
Surface Pour
Surface Pour
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
0.6 rt.
11 rt.
#2 Medium Sand
Surface Pour
ft.
ft.
20. DRILLING LOG (attaFh additional sheets It necessary)...:
FROM
0.
TO
0.
ft.
ft.
ft.
0.
DESCRIPTION (color, hardness, snVrock type. grain size, etc.)
See- P� P NCO
ft.
ft.
21. REMARKS
MAR g ZIJIR
22. Certification:
Signature of Certified Well Contractor
k orrn3 iOl Pf
t)V11 t.)! f r:--r---/
3/5/2018
Date
By signing this 'Orin, 1 hereby certify that the well(s) was (were) constructed in accordance with
15A NC AC 02C .0/00 or 15A NC A(' 02C .0200 Well Construction Standards and that a copy of
this record has heen 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 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 Svpply & 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 2-22.2016

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
For Interval Use ONLY:
I. Well Contractor Information:
D.T. CHALMERS, JR.
Well Contractor Name
4146A
NC Well Contractor Certification Number
CATLIN Engineers and Scientists
15
- v 4 14.WATER ZONES,
RECEIVED/NCDENR/D
FROM
AIR n.
TO
DESCRIPTION
n.
n.
ft.
OCT 02 2018 is. iNNEI;t CASING 4RU1BING (geothermal dosed -WO
FROM TO DIAMETER TIDCKNESS
Company Name
OSect
2. Well Construction Permit #: N/A Wilmfnrtper00 atioRncRsionaiol Onnice
List all applicable well permits (i.e. County, State, Variance, lnjectio , etc)
3. Well Use (check well use):
Water Supply Well:
❑ Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
OIrrigation
❑Municipal/Public
❑ Residential Water Supply (single)
O Residential Water Supply (shared)
Non -Water Supply Well:
tZl Monitoring
injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
OExperimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
0 Recovery
❑Groundwater Remediation
❑ Salinity Barrier
❑ Stormwater Drainage
❑ Subsidence Control
❑ Tracer
❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: 02/05/18
5a. Well Location:
N.C. State Ports Authority
Facility/Omer Name
GREENFIELD STREET,
Physical Address, City, and Zip
NEW HANOVER
County
Well ID#: MW-59
NCSPA SWP
Facility ID# (if applicable)
WILMINGTON, NC
C3S71‘
Parcel Identification No. ( )
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(dwell field, one lat/long is sufficient)
34.21597783 N 77.94864566 4V
6. Is (are) the well(s): ®Permanent or °Temporary
7. Is this a repair to an existing well: °Yes or No
If this is a repair, fill out known well construction information and explain the nature of
the repair wider #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: 12 (ft.)
For multiple wells list all depths in different (example- 3@200' and 2 « 100')
10. Static water level below top of casing: 1.7 (ft.)
If water level is above casing, use "+"
11. Borehole diameter: 8 (in.)
12. Well construction method: Mud Rotary/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
0 ft.
2
2 in.
Sch. 40
Water Quality Region , f 16. OUTER CASING (for muki'cased we{Ls) OR LSNER (if applicable)
THICKNESS
TO
DIAMETER
MATERIAL
PVC
MATERIAL
ft.
ft.
rt.
ft.
in.
in.
17.SCREEN .
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
2ft.
11.5 ft.
2 in.
Slot .010
Sch. 40
PVC
ft.
ft.
in.
IS. GROUT
FROM
TO
0 ft.
0.5n.
ft.
0.5 ft.
1ft.
n.
MATERIAL
Portland Cement
Bent. Pellets
EMPLACEMENT METHOD & AMOUNT
Surface Pour
Surface Pour
19. SAND/CRAVELPACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
1 ft.
12n.
#2 Medium Sand
Surface Pour
n.
ft.
20. DRILLING. LOG (attach additional 8heeta If necessary)
FROM
TO
n.
ft.
ft.
ft.
ft.
n.
ft.
ft.
DESCRIPTION (color, hardness, soil rock type, grain size, etc.)
21. REMARKS
4 AR zIJ1R
22. Certification:
Signature of Certified Well Contractor
Date
3/5/2018
By signing this _form, 1 hereby certify that the well(%) was (were) constructed in accordance with
15A N(AC 02C .0100 or 15A NCAC 02C .0200 Well ('onst, ucuon Standards and that a copy o/•
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 Infection Wells ONLY: In addition to sending the font 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 & 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 Department of Environment and Natural Resources - 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:
D.T. CHALMERS, JR.
Well Contractor Name
4146A
RECEIVED/NCDENR/DWR
OCT 0 2 2018
NC Well Contractor Certification Number
CATLIN Engineers and Scientists Water Quality Regional
Company Name Operations Section
Wilmington Regional Office
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)
0 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)
0 Recovery
❑Groundwater Remediation
❑Salinity Barrier
❑ Stonnwater Drainage
❑ Subsidence Control
❑ Tracer
DOther (explain under #2I Remarks)
4. Date Well(s) Completed: 02/05/18 Well ID#: MW-58
5a. Well Location:
N.C. State Ports Authority
Facility/Owner Name
GREENFIELD STREET,
NCSPA SWP
Facility iD# (if applicable)
WILMINGTON, NC
Physical Address, City, and Zip
NEW HANOVER
County
Parcel Identification No. (PiN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
34.21620384 N 77.94938865
6. Is (are) the well(s): ®Permanent or OTemporary
w
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 #2l 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: 12 (ft.)
For multiple wells list all depths in different (example- 3@200' and 2@ i002
10. Static water level below top of casing: 0 (ft.)
If water level is above casing, use "+"
11. Borehole diameter: 8 (in.)
12. Well construction method: Mud Rotary/HSA
(i. e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
I3a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
14. WATER ZONES 4 1 C" ,
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. INNER CASING oR'DURING (eeotherntal dosed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
2 ft.
2 in.
Sch. 40
PVC
iG OUTER CASING (tor multi -cased wills) OR LINER Cif applicable
FROM
TO
DIAMETER
THICKNESS
MATERIAL
rt.
ft.
in.
ft.
ft.
in.
• 17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
2 ft.
11.5 ft.
2 in.
Slot .010
Sch. 40
PVC
ft.
n.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft.
0.5 rt.
Portland Cement
Surface Pour
0.5 rt.
1 ft.
Bent. Pellets
Surface Pour
ft.
ft.
'19.SAND/GRAVLL
PACK (if
aupl'kable) "' -..
FROM
TO
MATERIAL
EMPLACEMENT METHOD
1 R.
12 rt.
#2 Medium Sand
Surface Pour
0.
ft.
: • AO. DR WN
LOG (attach sdditkoel
tlteets If necessary)
FROM
TO
DESCRIPTION (color, hardness. soil/reek type, grain size, etc.)
ft.
ft.
ee
ft.
ft.
_
sVC)
ft.
ft.
ft.
1040.‘
ft.
11.411 ) a
e r,, is
rt. � ft.
.
21.12EDiAItICS , • MAR' 2 8YG 11. .
AR�
anttir .sio t pf C. .. .....
22. Certification:
t441/
Signature of Certified Well Contras or
3/5/2018
Date
By signing this form, 1 hereby certify that the well(s) was (were) constructed in accordance with
15A NCAC 02C .0100 or 15A NC'AC 02C .0200 Well Const nrction 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 font 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 Svnnly & 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

WELL CONSTRUCTION RECORD
This fiat m 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
RE4€I10/NCt/III
OCT 0 2 2018
water Qudlity Regional
2. Well Construction Permit #: N/AOperationsiSecton
Wilmington Regional Offi
List all applicable well permits (i.e. County, State, Variance, Injection, etc)
3. Well Use (check well use):
Water Supply Well:
DAgricultural
❑ Geothermal (Heating/Cooling Supply)
D Industrial/Commercial
❑ Irrigation
❑Municipal/Public
O 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
OGeotherrnal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
0 Recovery
❑Groundwater Retnediation
❑ Sal inity Barrier
DStormwater Drainage
❑ Subsidence Control
❑ Tracer
❑ Other (explain under #21 Remarks)
4. Date Well(s) Completed: 02/08/18 Well ID#: MW-60
5a. Well Location:
N.C. State Ports Authority
Facility/Owner Name
NCSPA SWP
Facility ID# (if applicable)
GREENFIELD STREET, WILMINGTON, NC
Physical Address, City, and Zip
NEW HANOVER
County
(37u)
Parcel Identification No. (PI
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one eat/long is sufficient)
34.21633462 N 77.9469623 w
6. Is (are) the well(s): ®Permanent or ❑Temporary
7. Is this a repair to an existing well: OYes or No
If this is a repair, fill out known well construction information and explain the nature of
the repair under #2I 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: 12 (ft.)
For multiple wells list all depths in different (example- 3@200' and 2@100)
10. Static water level below top of casing: 1.3 (ft.)
If water level is above casing, use "+"
11. Borehole diameter: 8 (in.)
12. Well construction method: Mud Rotary/HSA
(i. e. auger, rotary, cable, direct push, etc.)
1
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
14. WATER ZONES
R FROM
TO
ft.
n.
ft.
ft!.
I5. INNER CASING OR IUD NG (geothermal dosed -loop)
FROM TO
0 rt.
DESCRIPTION
454123
DIAMETER THICKNESS MATERIAL
2 0. 2 in. Sch. 40 PVC
16, OUTER CASING (for muhl-cased'welta) OR LINER (d sPplkable)
ye MATERIAL
THICKNESS
D.
FROM
TO
n.
DIAMETER
in.
ft.
17. SCREEN
FROM
TO
ft.
DIAMETER
in.
SLOT SIZE
THICKNESS
2 ft.
11.5ft.
2 in.
Slot .010
Sch. 40
MATERIAL
PVC
n.
1& GROUT
FROM
rt.
in.
0 rt.
TO
0.5 rt.
MATERIAL
Portland Cement
EMPLACEMENT METHOD & AMOUNT
Surface Pour
0.5n.
rt.
1 ft.
rt.
Bent. Pellets
19. SAND/GRAVEL PACK Of applicable)
FROM
TO
1 ft.
ft.
Surface Pour
MATERIAL EMPLACEMENT METHOD
12 rt. #2 Medium Sand Surface Pour
n.
20. DRrl.L1NG LOG (attach additionstahc is if necesaari)
TO
FROM
ft.
ft.
o.
ft.
n.
ft.
ft.
21: REMARKS
n.
ft.
n.
ft.
ft.
DESCRIPTION (color, hardness, sal/rock type, grain size, etc )
BAR' �t iflt
OriV-1,3sOfi
22. Certification:
> • �� Signature o f certified Well Contractor Date
3/5/2018
By signing this form, I hereby certtfy that the well(s) was (were) constructed in accordance with
LJA NC AC 02C .0100 or I SA NCAC 02C .0200 Well Canstnrc1,on 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.
SUBMI1TAL 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 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 font 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

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
RECEIVED/NCDENR/DWR
4146A OCT 02 2018
Water Quality Regional
Operations sedion
Wilmington Regional Office
2. Well Construction Permit #: N/A
List all applicable well permits (i.e. County, State, Variance, Injection, etc.)
NC Well Contractor Certification Number
CATLIN Engineers and Scientists
Company Name
3. Well Use (check well use):
Water Supply Well:
❑Agri cultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
❑Municipal/Public
❑Residential Water Supply (single)
❑ Res idential 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)
CI Geothermal (Heatin Cooling Return)
❑Groundwater Retnediation
❑ Salinity Barrier
❑ Stormwater Drainage
❑ Subsidence Control
❑ Tracer
❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: 02/02/18
5a. Well Location:
N.C. State Ports Authority
Facility/Owner Name
Well ID#: MW-61
NCSPA SWP
Facility ID# (if applicable)
GREENFIELD STREET, WILMINGTON, NC
Physical Address, City, and Zip
NEW HANOVER
3s750
County Pa?eel Identification No. (PiN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one Iat/long is sufficient)
34.21534571 N 77.94973802
6. Is (are) the well(s): ®Permanent or ❑Temporary
w
7. Is this a repair to an existing well: OYes 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: 1
For multiple injection or non -water supply wells ONL Y with the same construction, you
can submit one form.
9. Total well depth below land surface: 1 1 (ft.)
For multiple wells list all depths in different (example- 3@200'and 2@100)
10. Static water level below top of casing: 0.9 (ft.)
If water level is above casing, use "+"
11. Borehole diameter: 8 (in.)
12. Well construction method: Mud Rotary/HSA
(i.e. anger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. yield (gpm) Method of test:
13b. Disinfection type: Amount:
454122
14, WATER ZONES •
FROM
TO
DESCRIPTION
ft.
- ft.
ft.
ft.
• 15. INNER CASING OR TUBING (Peothentiatdosed-loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
1 rt.
2 in.
Sch. 40
PVC
t6.'OUTER CASING (for mukiaated welts) OR LINER Of applicab14
FROM
TO
DIAMETER
THICKNESS
MATERIAL
rt.
ft.
in.
ft.
fl.
in.
-17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
1 n.
10.5 n.
2 in.
Slot .010
Sch. 40
PVC
ft.
ft.
in.
IS; GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft.
0.4 ft.
Portland Cement
Surface Pour
0.4 rt.
0.6 ft.
Bent. Pellets
Surface Pour
a.
ft.
19. SAND/GRAVEL
PACK Of
aptkable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
0.6 ft.
11 rt.
#2 Medium Sand
Surface Pour
rt.
n.
20:DRILLING1LOG
(attach additiorat
sheets If necessary) .
FROM
TO
DESCRIPTION (color, hardness, soilirock type, grain size, etc)
ft.
ft.
n.
ft.
tole.
ft.
ft.
- G
s 40
n.
n.
G,
1 1
--''') r 3 ra. y k if i. 'ft
1ft. f!.4. -K
ft.
ft.
21. REMARKS . PEAR 2 0 .2018
}3'ont1uyion 'f,.:L..... ,,i i.,, I.
[l11'.'f-16....
22. Certification:
Signature of Certified Well Contractor
3/5/2018
Date
By signing tlluJorm, 1 hereby certify that the well(%) was (were) constructed in accordance with
15A NCAC 02C.0100 or 15A MAC 02C .0200 Well Consnvcvion 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 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- I
North Carolina Department of Environment and Natural Resources - Division of Water Resources Revised 2-22-2016

WELL CONSTRUCTION RECaE(VED/NCDENR/DWR
This form can be used for single or multiple wells
45'"°8Y pwwiet
1. Well Contractor Information:
George Bridger
Well Contractor Name
2393A
OCT 022018
NC Well Contractor Certification Number
Water Quality Regional
Operations Section
Wilmington Regional Office
Bridger Drilling Enterprises inc dba Carolina Drilling
Company Name
2. Well Construction Permit it:
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 indu strial/Commercial
°Irrigation
Non -Water Supply Well:
Monitoring
OMunicipal/Public
°Residential Water Supply (single)
°Residential Water Supply (shared)
°Recovery
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
°Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
❑Groundwater Remediation
°Salinity Barrier
DStormwater Drainage
°Subsidence Control
°Tracer
DOther (explain under #21 Remarks)
14. WATER ZONES
FROM
TO
DESCRIPTION
f6
ft.
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if a e licabl )
FROM
0
ft.
TO
7 ft.
DIAMETER
2
is
TFI
THICKNESS MATERIAL
sch40 pvc
16. INNER CASING OR TUBING (Reotberms1 closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
TmCICNEsS
MATERIAL
7
a
17
2
;R
.010
sch40
pvc
ft.
Ot
in.
1& GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0
ft.
3
ft.
neat
in place
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
5 n.
17
ft.
sand
in place
ft.
ft.
20. DRILLING LOG (atta b additional sheets if necessary)
FROM
0
ft.
TO
17 f.
DESCRIPTION (tolor, bardaera, roil/rock type, grain On, etc.)
Tan and dark gray sand trace to some clay
4. Date Well(s) Completed: 1/8/2018
5a. Well Location:
Municipal Investments
Facility/Owner Name
Well ins PZ-3
c-)Facility ID1t(if applicable)
1601 Wynnwood st, Wilmington 28401
Physical Address, City, and Zip
New Hanover
County Parcel identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one Iat/iong is sufficient)
e. 184879.93 N-2323779.32
6. Is (are) the well(s): ❑Permanent or ❑Temporary
7. Is this a repair to an existing well: DYes or LINo
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: 17 (ft.)
For multiple wells list all depths if different (example- 3@200' and 2@l00')
10. Static water level below top of casing: 11 (ft)
Ifwater level is above casing, use "+"
11. Borehole diameter: 4 (in.)
12. Well construction method: Direct Push
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
ft.
ft.
fL
fL
ft.
ft.
fL
ft.
fL
ft.
RECEIVED
ft.
21. REMARKS
ft.
JAN 2 F 2018
ini`ot7y Oon
D\NC}llCr';
22. Certification:
Sir 'ff of Certified Well Con actor
1$
gning this form, 1 here/certify that the well(s) was (were) constructed in accordance
with ISA 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 Inlec ion 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 an
d Natural Resources - Division of Water Resources Revised August 2013

Physical Address, City, and 2io
4-1wa I A Am •14`f'
County
WELL CO,NSTRUCTION RECORD (GW-1) For internal Ilk Only:
456042
1. Well Contractor Information:
GAu ri
w contruttur Name
NC Well Contractor Ccrtification Number
RECEIVED/NCDENR/Dvrn
CO22018
CornPanY NAinc
se):
2, Welt Colurrocrion Permit WN A,
u
i.ms all applicable cothvniclioA DC. Comniy. Spypep. non
3. Well (check well
Wilmington Regional Office
Water Suppty Well:
Agricultural fjMunicirral/Public
Geothermal (14eafing/COoring Supp(y) Residential War= Soppily (single)
industrial/Comm erctal E3Residential Water Supply (shared)
Irrigation
Non -Water Supply Wells
Monitoring
Ag/C
Injection eit:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer TM
Experimontat Tcchnolosay
Ccothemtal (Cod 1.4x,p)
Geothermal (If es1 -ooling Return)
EartRzovary
OGroundwater Rernedialion
DSallnlry Denier
EDS tomtwater Drainage
OSubsittence Comm;
afracer
DOther (explain under Fi21 ernaiks g
A. Date WOO) Cornpleted: 100
5a. Well Location:
el R‘eAL.tCt ( Piei35141 I)
Fiwe acitity/owNote Pauilit, (if applicable)
moat ro DEiclit.IPT3ON
0 ft. T 14' c.o.A r d9
fe.
' f %In CASING (for en set6-zikpott oat* ft L/Itiliktit
FROM OlAMPl 1 runacttest
÷ t it a- 0 ft.2. c.cf
• . •
.bk).
1M ATT.R)
1
a_
PROM
TO
DIAMETER
7TCIORMS
M *TEMA L
re
ft.
in
Ft.
ft.
in.
mamma
syn. SOY.
Iffickr..,NM•
MKTIMA I.
2 7 ft.
/ Vg,/ in
0 i 0g-
o.
re
in.
•
PROM
ft.
ft.
MxttrefA 1354PLAcrIsIgNJ &MOUNT
454±22..) L m440_
:19i; , ' rikkligkit•ACIC
PROM TO MATERIAL.
fr.
re
itNIPLACISKENTMETHOD
toc.
, iidelattittuiLekeillettietiiliii). •
littoat nearitifTION feakr,Iterdsen. taiiiree± trocto slog et,c),
it
ft
.
ft
ft.
ft.
ft.
17,
• C7.7 P7:,1
4'0 / Po du 2 CA a-ma:AA ../Je jill;:L____
ft. ft.
Parcel hicotificesion No, (PIN)
:5 b_Latilude and longitude in dcgrees/mlnutes/seemods or decimal degrees:
(if well field, one )atilont is sufficient)
b op,..zwy N 0')/ 5. ?/D
6. 1(arc) the well(s)&ermanent or DTcmporary
7- Is this a repair to an extating weft: OYcs or ,No
oho k a repair, file au( knQviit COngfillaft,17 infonn.dtimr and explain thl nowt of thv
WW1 UtIder r`f 2) renIGAT tian or op the lx.ockoyrdils,brir,
For GeoprobeiDPT or Cost -Loop Geothermal Wells having the some
construction. only 3 GW.t it. needed, %dime TOTAL NUMBER of wolls
drilled;
rota, welt depth below lead surface: r
rot invitipfe way IA( afi depths yehipror (example- )@2041' and 2@f00.)
10, Static water level below lop of easing:
Irrozoter /ere! ehrire racing, we "4-"
II. Borehole diameter:
12. Well conitretcriwi method: 14.,Jhobt.ter
(i.e. auscr, rotaly, cible, direct push ete,)
(ft.)
((t)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gum)
13b. Disinfee6on type: Amount:
Method of test:
C.WV0.4.1)(Xv
=Certification:
S-
ffy•figning thig form. I AffdY cier4f,v Mai the w11(0 was (*ere) crosItaded rn extort:tree
with JM NCAC 02C .0100 or 154 NCAC 02(1 %OW Wall COnSintdi4a doter,arls *
C. ef this record hos bean pervaded the Well oarrior,
23. Site diagram, or 4104101AI well details;
You OR' us back of thIS Page to Provide additional well site details or well
conStruction details. You May also attach additional rages if necessary.
SVORECTAL rtinjkl./CIKINS
24a. For AU Wells: Submit this form within 30 days or completion of well
eonstruction to titc following:
Oil/talon of Water Resources, Information Processireg Unit.
107 Mall Service Center, Weigh, NC 276994617
MA".• nay 1...M1011. ,JJAC WPfUJ trUtiWJ1J wit4110 MI gays ca c.ornpiction Or well
construction to the fhllowing
Division of Water Resourcea, Underground Injection Control Program,
141h
24c. r or Wpter Supply if& IftiettiortW fri addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days o(
completion of well construction to the county health depanni•ent of the county
whirr rnnarnwtovi

WELL CONSTRUCTION RECORD (G►W
1.. Well Conrmtor Information;
-Well Conku or Name
For Internal lUse Only;
454041.
RECEIVED/NCDENR/DW 14.WA, it
MOM ro
a` 199 OCT 0 2 2018
NCWellConttaolor C,:nifrwtiorr Number
/ Q u•.A l �t ALL..i/ rA./Nater (Duality Regional
CompanyNamc Operations Section
2. Welt Conytruction Permit ft: Wilmington Regional Ofificly
l,rs'a all npplicoMa well r,prerruufMn purntits (i c. t))C. Cwuuy, $fate. Parieurce. ate,)
3. Well Uric (check well use):
Water Supply Well:
L1'ri.
tZ
P.P ourrloN
C..VArs 5:4
EtJ' R tor'raalti-ems•. ozmo t
FROM TO O1AMri �1'i AT
� TRIMNESS MATERIAL
•11-j o' au f c w, o cr0
14,1KNERCAROM,ORTURING (t►a+Ytbr.i>Qrkiiobpd{pali)>.
PROM Tel Cr1AMcT¢R 'rH crecess
A.
tn.
in.
_.e)`•
MATi�UA L
rjAgricultoral f NMunicipal/public
Oiicothermat (Heating/Cuolint Supply) OResidential Water Supply (singly:)
JndestriaVCummercial [ Residential Water Supply (shared)
Non -Water Supply Well;
(�Monitotihe_
injection Weil:
D;pquifer Recharge
DAquifcr Storage and Recovery
Aquifer Test
Experimental Technology
�Gwthcrmal (Closed Loop)
(Geothermal tin'Cooling, Return)
4. bate W%I1(s) Completed: ,,—
QGroundwater Rerncdiation
[Salinity 8atxier
OStotmwater Drninagc
QQSubsidcnce Control
�1'rac,Y
after(explainunder tell Rena rks)
`/` J7 WeIIA)d
• 3a. Well Landon:
Facility/Owner Naarnc tracitity 1j)il (if iinplilable)
�oZ GtZAc-c .1/AL RUC, c getc 1
Physical Address., City, and 2ip
( nh h)
County Parcel tdenoficntiun No. (MN)
Sb. Latitude and longitude in degrees/minutes/seconds or deceimal degrees:
(irwai lid, one )at/tong issrr cunt)
3 e `' iy. 33 3 N coil') ° 3�r. , T-) 3 W
6. Is(are) the wells) i ermanent or ®Temporary
7. to this a repair to an ekledng well: ®Yes. or ElNo
01,4 L, a repair. fill out known welt oora ruerkn Information and axplaln tko nature 4f the
repair under 42I r>Inlarhs stuaturi yr on rho hock rprr6irJwh,.
8. For Gaollrobe/APT•or Closed -Imp Geothermal Wells having the same
construction, only 1 GW-1 it nod. Indicate TOTAL NUMBER of wells
dr()Icd'
9. Total well depth below land surface: a 8 r
For okdaple tells fiscal depths (ldi[frrrnr (trample- 420 ' or f 2 I00)
W. Static water level below top of c>aling: / 17
If,rafrr lave! i•r above caring, rub' " F"
I. Ottehole diameter: (ir (in 1
12. Well arortruction method:_Q" 4tJ
fi•o, pager, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ON1,Y:
13a. Yield (gpm) Method of teat•.
13b. Disinfectlao type: Amount:
47, SCRL)bj11'c.;
FROM
n AIAMF. r sk
. � R: PS Ft• P /Y in. 0/0 V
ft. ft
TO
SfTE... irroc.KNL$ M.T,eRU11.
FROM TO
9
MATRitrAt..
E PLACE MIENT MEMO' & Ahto ,
tr.
r4
PROM TO I MATER/Al,
R. ft.
rr,
LatMAC4Mi:NT Mt7714011
VSIOM TO tuP't'tVrr leery. tara.ay bra/rock ►ue. t..rs.ebt% cre)
R
lit,
fr.
n
ft-
fr.
tt.
R.
(t
R.
rt.
;.: 1;•pi; : .
ln�rsl�'t'
[)WC.:11 rC
22. Certification:.
Sig'aaL* of Certi[i Well tractor1/ ^/
Date
8Y41811611 this rm, 1 y ea'rtijb Una fora well(r) was (were) construo'ed In accordance
trim 154 NC, 02C .0I00 or l$A NC -AC 02C .0200 Wall CO i rrrcNGri Standards lords and Mar p
copy ofdtfs record has bean provided to the well owner,
23. Sik diagratfu or additional well detail;; •
You nay use the back of this page to provide additional Well site details or well
construction details... You may also attach additional pages iftleeessery.
st(JRmi7T M. )N yeas JQN,b
24a. for Ay %yang: 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, 1NNC.27699-I617
R4 ,. 1Cirr ' vp a 1; in ultimo/1 to sending the taan to the address in 24a
above, also submit One copy of this form within 30 dot's of conviction .of wo11
construction to the following:
Division of Water Resonreesr Underground Injection Control Program,
•••:: �.., .ice c,cuicn Kamm lsrc.; L'roY9'-16;t0
24c. P_4C _Sher pact de jaktg n Wits; lii addition to sending the form to
the address(cs) above, also submit one copy of this form within 30 days of
completion of .well constuctron to the county health dcparonent of the county
W1,P.rn ennOnrrrorl

WELL CONSTRUCTION RECORD (pW-l.)
J. Writ Contractor informatioo:
For Internal Use Only:
2. Well Conerruelion Permit f1: npcvntipn4 SActi
4r.cc ull applkkrbie writ <,nrr.r/ruc'riori p rrn:ily (f.c. U1C.. (:rxurry, S<u91/2/N yW
Bfi`4Regl0na l
3. Well 11Ae (check well .0 e):
Water Supply Welk
RECEIVED/N4CDENR
NC Well Cnna;ictor Certification Number
�4 0O.,14 ► (4 Pad)* 0-155
Company Name
Water Quality Regic'.
70
{ tro tttruoK
ft.
OCI 0 2 201RCA] naC
ft.
Gu,^r5 3,49��
•1--1/ ft. a v fs
sININIER.f A8QYt< OR
71{1rP
(4
ti-cj-. a me
DIANture i
Ic,
ttucXNq
To PIAM T6 taltelOttgia
K
m
i9•
MATERIAL
MATERIAL
Agricultural °Municipal/Public
Geothermal (Heating/Cooling Suppty) OResidentia/ Water Supply (single)
Industrial/Commer ,a( DResidential Water Supply (shared)
Non -Water Supply Well:
Mortitoriti3
Injection We9L•
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
1xrerimrntal Technology
Goothemtal (Closed Loop)
Geothermal eatinreCoolin- Return)
°Recovery
°Groundwater Retnedimion
°Salinity Barrier
C3Stotmwater Drainage
°Subsidence Control
()Tracer
Other ex lain under #21 Remarks
4. Date Welt(s) Completed; 3 -a- `/ r 'Well mf1
Sa. We11 Locution;,
1• r,cility/(honer Name
r:1) r790)
Facility K (if apolioablc)
MI/041.A. Ott w.1.e. .1/4,c-
Pbyskal Adams, City, and zip
N 6IAlro04r-
County
Parcel 7Aealfiauinn No. (PIN)
Sri. Latitude and longitude in degree/minute/seconds or decline] degrees:
(if well !loid, voc taf/lp14; is suH7c1csn)
6, la(are) the well(s)> ermanent or °Temporary
7. Is this a repair to au existtnzwell: E3YcS or U4No
If this isa repair, fill our known well construction Infonnrninn and explom the nature of the
repair smiler t'21 remarks nccfwn err per the hack pf thi4form.
8. For Geopirobe/DPPT or Closed -Loop Geothermal Well having the same
construction, only 1 GW t is needed. Indicate TOTAL NttM 1iR of wells
•driile(1•
9. Total well depth below land surface: 3 7
For inutiip(e welts (Walt depths rfd reni (example- i 2Oti •an/f 2,V100)
10. Static water level below top of casing: /G
Ijworer (eve( is ohovy casing. rise
11.'Borehole diameter.(in.1
12. Well construction method: J s.r t 4r f
(i.e. auger, ivory, cable, direct push, W.)
(ft)
(ft.)
FOR WATF.k SUPPLY WELLS ONLY:
13a, Yield Win)
13b. Pfslofectioo type; Aarount:
Method of test:
MOM
TO
34'r'
rr,
DIAMR'rgA RUH' Tat
/ye_ 0/o o�0
Ie, •
MATEFUA
FROM
O h.
aO f
MAURIAl, ,. f..4CRMENTrETHOD &UF(itiNT
R
ff.
ft.
AOtamo
.F)XIM
ft.
ft,
Vidi:P
12iFDlii'iabti�MATIERIAL
h.l n.
ILIMPI.AC:EMENTMi o
to;ijl�l:'t,ij!!rc�EbG`t,rr�rle.:ied(4�m�(1;;ieNi"9e''aia, ; .
RROM TD comet rnarr(etaivarrsmv.J recktrpkoabribe,ee)
fie
fc
ft,
h.
h.
ft.
t.
fa
22. Certification:
3-c -
Welt CO or
Dawn
By slgnfn{q rhfs/bnif thOr rhr wef/4 was (reef¢) con:frame, us accordance
v ffr 1JR teCRC O2C -01QO or I SA NC'itc L UC.020o Wall Canafrrrciton ay -dads Wed lie o
copy ofrhis record etas bare provided to the well owner,
23. Site diagram or additional well dei2ils;
You may use the back of this page to provide additional well site details or well
construction details. Yon may also attach additional pays if memory.
Si1BA4IT'rAii.INC1'RYl TIOIVC
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following;
Division of Water Reources, rofortnaltion Pt'occsaing Unit,
16117 Mail Service Center, Raleigh, NC.27699.161.7
•i•'•••••• •• .vu. wVy vi uM won wrr)Ipr
construction to the following:
v says cn COMpleTIOJI Or WGII
Division ofWster Resource, UDdet'grootid Injection Coe Ito Vrografn,
1.636 Mail Service Center%Raleigh, NC 27599-1436
24c. For Water fiometitr di Jnljpo weft In addition 10 sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well tStrvction to the county health department of the county
Whp,N rhnftrowtrrl

WELL CONSTRUCTION RECOR y 1cDENR/DWR
Print Form
For Internal Use Only:
1. Well Contractor information:
Sanford Sweeting
Well Contractor Name
2082-A
G1C1 02 2018
Water Quality Regional
NC Well Contractor Certification Number Operations Section
Applied Resource Manag i t nP pal Offi
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:
a Agricultural DMunicipal/Public
Geothermal (Heating/Cooling Supply) DResidential Water Supply (single)
R Industrial/Commercial DResidential Water Supply (shared)
x Irri • ation
Non -Water Supply Well:
Monitoring
Recovery
Injection Well:
!Aquifer Recharge
al:Aquifer Storage and Recovery
'Aquifer Test
al Experimental Technology
Geothermal (Closed Loop)
Geothennal (Heating/Cooling Retum)
4. Date Well(s) Completed: 8/16/18
5a. Well Location:
DGroundwater Remediation
DSalinity Barrier
DStormwater Drainage
Subsidence Control
DTracer
Other (explain under #21 Remarks)
Well iD# N/A
Peter Lamporte N/A
Facility/Owner Name Facility ID# (if applicable)
6412 Shinncreek Lane, Wilmington, NC 28409
Physical Address, City, and Zip
New Hanover
R02169-011-039-0000
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 11 49.5 N 77 49 54.96
6. Is(are) the well(s)Jx• Permanent or DTemporary
7. Is this a repair to an existing well: DYes or INo
1f this is a repair, full our known well construction information and explain the nature of the
repair under f21 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: 'l
9. Total well depth below land surface: 1 70 (ft,)
For nrrdtiple wells list all depths ifdifferent (example- 3 )200' and 2a100')
10. Static water level below top of casing: 1 1 (ft.)
If water level is above casing, use "+"
11. Borehole diameter: 5 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) 60 Method of test: Airflft
0
13b. Disinfection type: HTH Amount: 3 /o @ 10g
454174
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER(if a licable)
FROM
TO
DIAMETER
THICIOYESS
MATERIAL
0 ft.
150 ft.
4 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
150 ft,
170 ft
2 in
.010
SCH40
PVC
ft.
ft.
in.
-
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft.
25 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, soil/rock type, grain size, etc.)
0 ft.
20 ft
Fine sand
20 ft.
35 ft•
Silty fine sand
35 ft.
45 ft.
Grey sticky clay
45 ft-
130 ft.
Limestone
130 ft.
135 ft.
Clay
135 ft•
170 ft•
Sandstone F.9 („ "` I VL• 1)
ft.
ft.
21. REMARKS J-F i 11 2018
Tri packer set on top of 2" casing
ifitiOrmStton Nra rn ;s . ' )mil
E Itl to!(• r> ,
22. Certi cation:
8/16/18
igna e of " -rtified Well Contractor Date
By s gning this form, 1 hereby certh' that the well(s) was (were) constructed in accordance
with I5A NC.9C 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to thew!! owner.
23: Site diagratrt or additionatwell 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 web
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 fonn 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 (GW-1)
Print Form
1. Well Contractor Information:
Donald Cummings
Well Contractor Name
2412-A
RECEIVED/NCDENR/DWR
OCT 02 2018
NC Well Contractor Certification Number
Water Duality Regional
Applied Resource Management' 6ctlon
Company Name Wi miiigton R giorlal Ofc
2. Well Construction Permit #:
List all applicable well construction permits (i. e. U1C County, State, Variance, etc.)
3. Well Use (check well use):
WP0291671
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
Non -Water Supply Well:
Monitoring
Injection Well:
DMunicipal/Public
Residential Water Supply (single)
DResidential Water Supply (shared)
Q Recovery
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal(Closed Loop)
Geothermal (Heating/Cooling Retum)
4. Date Well(s) Completed: 8/27/18
5a. Well Location:
Langbeen Builders
QGroundwater Remediation
Salinity Barrier
DStonnwater Drainage
DSubsidence Control
Tracer
r)Other (explain under #21 Remarks)
Well ID# N/A
N/A
Facility/Owner Name Facility 1Df/(if applicable)
346 Shorepoint Dr, Wilmington, NC 28411
Physical Address, City, and Zip
New Hanover R04407-004-013-000
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 16 28.7 N
77 48 4.09
W
6. Is(are) the well(s)Jx Permanent or OTempormy
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 nmkr t421 remarks .section or an the back of this, fortn.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction. only GW- I is needed. Indicate TOTAL NUMBER of wells
drilled: 1
9. Total well depth below land surface: 180
For multiple wells list all depths ifdifferent (example- 3`200' and 2(10100')
10. Static water level below top of casing: 10
!limier level is above casing, use "- "
11. Borehole diameter: See Rema(in )
12. Well construction method: Mud Rotary
(i.e. auger, rotary, cable, direct push, etc.)
(ft.)
(ft.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) $d Method of test: Airlift
13b. Disinfection type: HTH Amount: 3% @ 10g
For Internal Use Only:
14. WATER ZONES
FROM
ft.
ft.
TO
15. OUTER CASING
FROM
TO
DESCRIPTION
ft.
ft.
for multi -cased wells OR LINER if a
DIAMETER
0 ft. 155 ft.
THICKNESS
4 SCH40
16. INNER CASING OR TUBING eothermal closed -too
FROM TO DiAM1iETER THICKNESS M1fATERIAL
licable
MATERIAL
ft.
ft.
17. SCREE
FROM
ft.
ft.
N
TO
18. GROUT
FROM
0
ft.
ft.
ft.
ft.
ft.
TO
ft.
ft.
24 ft
ft.
ft.
DIAMETER
in.
in.
MATERIAL
in.
in.
SLOT SIZE
Bentonite
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
ft. I ft.
ft. ft.
MATERIAL
PVC
THICKNESS
11fATERiAL
EMPLACEMENT METHOD & AMOUNT
Poured
EMPLACEMENT METHOD
20. DRILLING LOG (attach additional sheets if necessary)
FROM TO DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
Clay/sands
0
ft.
18 ft.
135 ft.
150 ft.
ft.
ft.
18 ft.
135 ft.
Limestone
150 ft.
180 fc
ft.
ft.
Limestone/sandstone mix
Sandstone
rrr-kr.„:1 ; j6=v
ft.
21. REMARKS
ft.
0' to 40' = 8" 40' to 180' = 6"
SEP 1 1 2018
infnrtn''iciiorl Prt G t jitii
22. C gijfication:
Si attire oTCertified Well Contractor
8/27/18
Date
By signing this form, 1 hereby cert fy that the well(s) was (were) constructed in accordance
with 1SA NCAC 02C .0100 or 1SA NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
21 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 font within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the font to the address in 24a
above, also submit one copy of this fonn 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 Surmly & Injection Wells: In addition to sending the fonn to
the address(es) above, also submit one copy of this fonn within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW-1
North Carolina Department of Environmental Quality - Division of Water Resources
Revised 2-22-2016

WELL CONSTRUCTION RECORD GW-1)
1. Well Contractor Information: -- , VED/NCDENN/DWR
John Salmon
Well Contractor Name
3497-A
SEP 04 "918
NC Well Contractor Certification Number Water Quality Reoona I
Applied Resource Manage ' l,s o,;laYOftfce
Company Name
2. Well Construction Permit #:
List all applicable well construction pennits (t e. UIC, County, State, Variance, etc.)
3. Well Use (check well use):
WP0291098
Water Supply Well:
Agricultural DMunicipal/Public
Geothermal (Heating/Cooling Supply) xJResidential Water Supply (single)
Industrial/Commercial DResidential Water Supply (shared)
Irrigation
Non -Water Supply Well:
Monitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed: 8/7/18
5a. Well Location:
Brian Welch
Facility/Owner Name
4024 Lockwood Drive,
DRecovery
Groundwater Remediation
Salinity Barrier
QStormwater Drainage
Subsidence Control
DTracer
Other (explain under #21 Remarks)
Well ID# N/A
N/A
Facility ID# (if applicable)
Wilmington, NC 28405
Physical Address, City, and Zip
New Hanover
R04219-001-004-000
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, ono latnong is sufficient)
34 15' 28.33" N 34 15' 28.33"
W
6. Is(are) the well(s)x Permanent or OTemporary
7. Is this a repair to an existing well: []Yes or 3No
If this is a repair, fill out known well construction information and explain the nature of the
repair under #21 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:1
9. Total well depth below land surface: 90
For multiple wells list all depths if different (example- 3@200' and 2@100)
10. Static water level below top of casing: 0 (ft.)
If water level is above casing. use "+"
11. Borehole diameter: See Remark(in.)
12. Well construction method: Mud Rotary
(f.)
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Artesian Method of test: Airlift
0
13b. Disinfection type: HTH Amount: 3 �o @ 10g
Print Form
For Internal Use Only:
45IRS
14. WATER ZONES
PROM
TO
DESCRIPTION
ft.
ft
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (Da able)
FROM
TO
DIAMETER
THICKT'ESS
MATERIAL
0 rc
78 rt
4 in-
SCH40
PVC
16. INNER
CASING OR TUBING
(geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft
ft
in
ft.
It
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
ft
ft
to
ft.
ft
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 It.
20 rt.
Bentonite
_
Poured
11.
ft
ft
ft
19. SAND/GRAVEL PACE{ (inapplicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
ft
it.
ft
ft.
20. DRILLING LOG (attach additional sheets If necessary)
FROM
TO
DESCRIPTION (color, hardness, soNrock type, grain size, etc)
0 ft*
10 n•
Orange sand
10 't•
20 ft
Coasrse sand some clay
20 rt.
75 ft
Clay
75 tk
90 tf.
Limestone
ft
ft.
ft.
it.
21. REMARKS 6 (� L
AUU `�
0 20'/8" 20-OO'/6"
22. Certification:
Si tureofCertified Well Contractor
8/7/18
Date
By signing this farm, 1 hereby certyy that the well(s) was (were) constructed in accordance
with 15A NC.4C 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 fonn 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
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 & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW-1
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL CONSTRUCTION RECORD
Thf • Awl can tic uucll for sink nr rrorltipk n r Iv
I. Well Contractor Information: REGEIVFa/NCDENR/DWR
Rich Lelaire
Berle t_ or4nrr(orltnrr>4
2593A
N( W.11 C umac(ur (rtif pt,is NwICitY
SAEDACCO Inc
t ari1111111y Nan,
2. Weil ('uasttnstkm Permit If:
AUG 14 2018
Water Quality Regional
Operations Section -
Wilmin2nn Rpp)onal Office
Lin .,l 4.1,pfft Are fiatpr.rri i t (i r. (.iuuy. SJotr• Vuriqiire, kjetig a (h•. J
3. Well lase. (cheek iadl use):
Rater Supply Well:
t Agrl~nlnind
rtGeot ermat bleating Coolish Supply
i:1 industrial; C(4)unerc is l
❑ftl7illfion
Non -water Supph Well:
I&Mntutonog
"ln a thoa ►T'el(
l:lA.lunicipahPnblir
rilltsidential Want Supply (single)
f IRt id marl Vi ie** Supply ishar t
Cl Agaifc1 Rechnrg¢
❑Aquifer Storage aid Recovers
IDAglnter'rest
❑tspxnnlentltl Toehnofogy°
❑Geodlenui (Closed Loop)
❑Geothetnud tlie.7utl 'Coulit>g Rennin
4. daft. Nellix) Cuniplcled: 7-24-2018
5a, Well Lo►atina:
VERTEX RAIL CAR
Facibir(t,eoor Noma
❑Recovers•
tltireundts:tter Rpounilatian
CJsalinity homer
riSf miiatert)nllnagr
❑Sublciden:e Control
❑Qtia:f tc+cp(airt under it21 Reamtl s)
W4t1DR -20D
MW-20D
F oi1 IDK (if a t,ls:7411,10
202 Raleigh St., WILMINGTON, NC, 28412 '
NEW HANOVER
(hyrily
c r.R(I)( ID ni•J(t-elt'rlOS
rt.
h.
I5.fl CAbING I/or IauUlMaxd ttetai Qtf lJ5C11(N a�afftrhkt
•rEOM TO J* METRR Tllfchvi;,s K,1TP.R/A1.
0 ft. 42' ft. 6" to. SCH40 PVC
MIN gat rilkeffilltokSOfittitte415-0 -
DIAMETER THICKNESS SI.�IYIIL4L
45' f. 12" ir1 SCH40 PVC
PK(Osr l ro
45' ft.
ft,
n.
48' ft,
:ifi.cftorr
MOM ' TO
0 ft.
tL
DIAMETTPC
2" lll.
n1.
sheer t7J'
.010
nuttiness • 1 ,l,stato it,
SCH40 _{ PVC
41'
t;.
T MATERLst
PORTLAND
�I LMWWC424FST 5t! Triaj A Trill
1TREMMIE
ri.
ft,
i9i si1NIi;K".FtA4'lC1 !►1C4.M. ..._... :.. _.� _
mom rfl Mt►tr VSIKAtillrv't Mr.`11 11
43' ft. 48' U. SAND #2
ft.
rt.
211,dRILIJNg LOG(VW iaddltrmixttied, .itaeressuyt ' ` -;
FROM TO DEYCRIFflOVkelor.Atninasi,enR'msrsr, -- .
int
0 tt. 42' h. SAND i
42' fi.
42.5' ft.
CLAY
42.5tt,
rt.
1r.
f4. .
48' ry,
ft.
ft.
SAND
PU,vim) 4tAtiex; Crtr. IRO Zip y rr{{��.R. tw - --.y-s.� � Nei• c L - a _�,�
i� RithI � �'ii t. �• •- .r..r...,.,r,y
BENTONITE PROM 41' TO 43'.t�;
---
t ii. d I4crr1iftminim N,, (PIN)
511. IAlitUtlt'Mid Longitude in ilegromea rltA1e iseetlnllsor dccimirl **Rest
of scot lied. Atli! kiilEthe IL MelliCIOLI)
34.179432
1' 77.942030
n. Ix tare) the well(it: ZPerniiuent . or UTerllp(rrrtry
7. is this a repaflr to au existing well ii'es or KNip
(jlhJa J,, rJ tt' rfu fill .:vi1 (tr,n,n 11 rt l i.uttfb, /R1l, ohfr. i LI?t•r,l , rod 1' 4(rGJJn ,.I.I n1rrJIf rfrr,.
la (r, it urtrlr.•r i'J rr enorks u, lbw err i yr du• t're 1f ,i( tilts form.`
8. Number of wetly constructed: 1. • •
For muftis* Al.,.rq,q•rf i7,:0-nreer I ItiV1 a rlrr (r,C'IE•,klr the 6rfllr C� r rrMltte7hM tow,1,1
.rvhtmr .'Jr f'r1F..
'.'Patrol well depth below land surface:
FhJr .11.0 lrh• r rots Ii,r tit I ,ti•t111+ i i f .ktli'.T.ru Pcv?Ikki , rnf '4r ftAY
1U. Stolle rarer level below top of casings 4'
IJ blur! Jet r1 J, ,Jha.'r r 0144 rt.,' "a
1 Ir Burtrlutle distorter: 6„
12. Well construction method: AUGER/MUD ROTARY
If a raiser. Rtes. cahlc, dlrccl push cI:.I
FOR %ATERSUPPLY ►VFLLS ONLY:
130. Vinod (*tuft
Iib. Diii4nfcrtfnn type;
.(ft. i
Method of trait: -
Amount:
22. Certification:
Signaus'tofC'eitilf We'll Comma( 7/24/2018
time
hi _srgnr•m &AI Mein t irrn•hr rrrr,r'a thief rt.r wally r ,. r;x rs,rrr.l rvIn%(Raved ,n ,,r4.0Ninre• b'rril 1 s;1 4('tt t'.'t WOO 1 iu i fd Nt1f il`f' ..9700 tlr(J ('rriitrrei flout Srr,rudo,ft alb( rho .1
./r,4rh, ie.,,n)M„•r.[ervrf",roityfn..., . f010101.
23. Site diagram or additional well dutaili:
YOU III* Ilse the bnt:k of this [NW Io ptovtde ;Willow!!! wi.1l sue de .411 io w°eli
.rorattuctinfi details. You may also ;iva4b;addslrc.nnl pages If tittessro ;.
tlif UM 1 PTAI, Irys'rsJcT•Oly3
24a. For An ►\'dose Siibnlit this felon Milan #U tf=n•:s of usnrpleriiii . f Belt
cominirtinn to the ifikl ing
Disiviva of Water Revlon reel, iatormatina Proccfsing I;nit.
1617 Mail tiervice Center. Rilei*fl. NC 27699-J617
24b. For Inktlin Wells ONLY: hi addition to sendilu: the forth to the t'dtirecs III
24Iabuse. also sirbtnff 4 copy tit this form within 30 day5 of completion of well
eonstnistiou In the following.
Division of Witter Resources. Underf found injection Control Program.
i636 Atoll Service Center. Raleigh.: NC 27699-162
24c. For Water Sunnis & Infection Wells;
Also subttul one copy of this fund within .'l dn/, of ColtiplalIon of
t - U 4ot1it111.Ct►on to the lwitnz-- /moth department or the county u hece
cs>nsttuCtcd
I'urni t.1t-1
`.ono C.;ntlu a Eap,rnnt Id of Lit uillura.lu and t'aIAEA! 7r..wuroie - bit au,n or W:,1cl Remus
s
IJ. I cd ,vugtrA 1

WELL CONSTRUCTION RECORD CUENR�DWR
This form can be used for single or multiple E
1. Well Contractor Information:
Gerald R. Eister
Well Contractor Name
2394A
,lU-l_ 3 0 2018
NC Well Contractor Certification Number Water Quality Regional
0 er tions Section
Bridger Drilling Enterprisemiitip,0@ §triQlinaffanlling
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)
OlndustriallCommercial
O Irrigation
Non -Water Supply Well:
OMonitoring
DMunicipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Recovery
Injection Well:
DAquifer Recharge
❑ Aquifer Storage and Recovery
❑ Aquifer Test
DExperimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
❑Groundwater Remediation
❑ Sal inity Barrier
OStormwater Drainage
❑Subsidence Control
❑Tracer
DOther (explain under #21 Remarks)
4. Date Well(s) Completed: 6/8/201
5a. Well Location:
Han Dee Hugo's #28
8 Well ID# RW-1
Facility/Owner Name Facility 1D# (if applicable)
5002 Market St. Wilmington, NC, 28401
Physical Address, City, and Zip
New Hanover
County Parcel ldeca*iflcatiori No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
34.,14',36.87" N-77,53',00.41"
6. Is (are) the well(s): ®Permanent or OTemporary
w
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 1121 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: 13
(ft.)
For multiple wells list all depths if different (example- 3 t@200' and 2Q100)
10. Static water level below top of casing: 5 (ft.)
If water level is above casing, use "+"
11. Borehole diameter: 1 0 (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:
Form GW-I
For Internal Use ONLY:
452978
FROM
TO
DESCRIPTION ,
fr.
ft.
ft.
ft.
IS: OUT CASTNG (forntulti-cas11d seet,$)'Oli LINER (if sip licable)
FROM
TO
DIAMETER
THICKNESS MATERIAL
0 ft.
3 ft.
4 1"• sch40
pvc
16. INNER
CAS)NGOlt TI)B11k
(geothermal closed -loop')
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
ft.
ft.
in.
119 sdiON .. a
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
3 fL
13 ft-
4 in'
.020
sch40
pvc
ft. fr.
in.
18; GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft.
1 ft•
neat
in place
ft.
ft.
ft.
ft.
:14..0r /IA411604t
Ci mtspll >it4 ` . _ .,
FROM
TO
MATERIAL
EMPLACEMENT METHOD
2 ft•
13 ft•
sand
in place
ft.
ft.
:20. DR.ILUNG
LOG (aitarh
additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soiVrnck type, grain sire, etc.)
0 ft.
13 ft•
Tan and dark gray sand trace to some clay
ft.
ft.
ft.
ft.
ft.
ft.
.. 1,4,E �6
ft.
ft.
a-'
r;I-..''i
% w
ft.
ft.
%.( ©`a
et.
ft.
�s l - ;•'"
il,1 J fAR1 'f °"
22. Certification:
Signature of Certified Well Contractor
, f—s 2, Ze)
Date 41
By signing this form, 1 hereby certifr that the weli(s) was (were) constructed to accordance
with 15A NCAC 02C .0100 or I SA NCAC 02C .0200 Well Construction Standards and that a
ropy 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 subtnit 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.
North Carolina Department of Environment and Natural Resources — Division of Water Resources Revised August 2013

WELL CONSTRUCTION R>> 8 D/NCQENR/DWR
This form can be used for single or multiple wells
1. Well Contractor information:
Gerald R. Eister JUL 30 2018
Well Contractor Name
2394A Water Quality Regional
NC Well Contractor Certification Number Operations Section
WiimingtorRe t•onal fti e
Bridger Drilling Enterprises inc dba Carolina Drilling
Company Name
2. Well Construction Permit #:
List all applicable welpermits (i.e. County, State, Variance, Injection. etc)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
D Industr ial/Comme rc is t
❑ Irrigation
❑Municipal/Public
❑Residential Water Supply (single)
:Residential Water Supply (shared)
Non -Water Supply Well:
OMonitoring
Injection Well:
❑ Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Recovery
❑Groundwater Remediation
❑Salinity Barrier
OStormwater Drainage
❑Subsidence Control
❑Tracer
❑Geothermal (Heating/Cooling Return) ❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: 6/8/2018 Well ID# RW 2
5a. Well Location:
Han Dee Hugo's328
Facility/Owner Name Facility iD# (if applicable)
5002 Market St. Wilmington, NC, 28401
Physical Address, City, and Zip
New Hanover
County Parcel Identification No. (PiN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one Iat/long is sufficient)
34.,14',37.05" N-77,53',00.71"
W
6. Is (are) the well(s): 10Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ONo
If this is a repair, f,Il out known well construction information and explain the nature of the
repair under #21 remarks section or on the back of this form.
8. 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: 13 (ft.)
For multiple wells list all depths ifdifferent (example- 3@200' and 2@I00')
10. Static water level below top of casing: 5 (ft.)
If water level is above casing, use " "
11. Borehole diameter: 10 (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:
Form GW-I
FROM
ls. t>JfTEi1 CASINO (f exonld.c'aged welIstOR2JI+iI li ta-sTl caji%Y
THICKNESS
0
fL3
tr.
4
in,
sch40 1 pvc
jd. INNER. CASING OR TIMING, do)4440411)
TO
FROM
ft.
ft.
DIAMETER THICKNESS
in.
MATERIAL
fL
17. SEEN
FROM
3
TO
ft.
in.
ft. 13 ft.
DIAMETER
4
in.
SLOT SIZE
.020
THICKNESS
sch40
MATERIAL
pvc
ft.
ft.
18. GROUT
FROM
0
ft.
TO
MATERIAL •
1 ft• neat
EMPLACEMENT METHOD & AMOUNT'
in place
ft.
ft.
ft. l ft.
19, SAND/GRAVEL PAC Is Of applicable)
FROM TO MATERIAL
2 ft.
ft.
For Internal Use ONLY:
452.
• #4AVA1'tit
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
TO
13
n,
sand
EMPLACEMENT METHOD
in place
ft.
DIAMETER
MATERIAL
20, DRILLING IXIGt'atta(r adi Nuiitil shots ifnecessarp)'.'
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
0 ft. 13 ft• Tan and dark gray sand trace to sonde day
fL
FROM
ft.
ft.
TO
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
Jai-
;
Imo; ci
22. Certification:14W1.41-
U zt 20 ie
Signature of Certified Well Contractor Date
By signing this fonn, 1 hereby centt& that the well(s) was (were) constructed in accordance
with iSA NCAC 02C .0100 or iSA NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided iu the well under.
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 stlbrnit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Prograrn,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells:
Also submit one copy of this form witfiin 30 days of completion of
well construction to the county health department of the county where
constructed. '
North Carolina Department of Environment and Natural Resources - Division of Water Resources Revised August 2013

WELL CONSTRUCTION RECORD (GW-41
Per Internal Use Only;
1. Well Contras -or tatormation:
S RECEIVEDL [DENR!DWT
u'c!i C`onuro� iur Nanic
; 9F
-NC Well Cann -noun Con itioation N,w,bar
JUL 2 3 2018
/44v,^ tr��(I' poal ,4445rQ
Company Nam: peratlons
Wilmington Section
z, Well (:aoytrue in Cermit/h Regional 0f
L.bcf rr1l n/iplicdble wig C��n..tropi)# /Xsrn�it.�•(i. t. (1%t;, !',unit.•. S ji vorianv. Plr.��"
3. Wen Use (check feral) use):
O trali.Y Negional
'1'i/uter Supply Well:
Agriouitnrsi � ;tnici 111 chile
e thonnai (Heating/Cooling Supp(y) OR,3idential Water SuPpfy (single)
lndacttiat/Commercial OResidential Water Supply (shsted)
on
Non -Wider Supply Well.;
Monitoring .
Infection Well;
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
l-,xperimentat 'Technology
Geothermal (Closed Loop)
Geothermal (lfcatinC oolin atum)
° Recovery
EI(;toundwater Rernediatioli
[Salinity Barrier
Storrmvaler Drainge
DISubsidcnw Control
ttrol
titer ex'tain under #2l Remarks
4. Date Weli(s) Completed:'-/ %>/ 2'
Sa. Welt L.ocotion:
/Bu ' i .we AAA,' —
Faeil oyibvmcf Name
r-i 6-o 1-
Physical /lddress, Cty, and Zip
til'elr IDI
Facility ITS (if naplicabk)
C':mmiy Panel lxknt:Ficarlon No. (,PIN)
Sis. Latitude and longitude in degrees/minutes/seconds or decimal. degrees:
(lfwell?laltl oat lat/longinyutRcbnt)
rya 03•rs� N �e _f ,a0° w
6. te(are) the wetl(sAkermaneat or Elfemp.rary
7. 6..$. aria a repair to an existing well: 0Xe4 or l,Plo
(frirry is a Mpuir; 411 vru known writ crnh.s(rurrion in:Htnsnatrnn cmd cxp(aln lira nomyr of the
repor+n:dar aai +wo44. ke: nowt kg) or of tiny Aue'k r�''tb%a'Jornr,
8. Per Gcoprobt /Drll' ur Closed. -Loup Geothermal Willa baying to same
emsttuction. only I (3W-1 is needed, Iodide TOTALNUNaf3ER of wells
drifted:,___. _______
-- ..._�.__._.._.
9. Total welt ifept8 below land serrate: -Yr (ft-)
YonriWtlple all depths tfdlfferen! (anon(k• 3(00'anrl 20:1?..r00')
J.U. Static water icvel below top of easing: /,/ (ft,)
(lxWrerlevel Is thaw atgag, tar "r"
i.. Borehole diameter: rf' (in.)
i2. WdJ construction method: 4t).4{4e'
(i.v. nueo, rotary,oiblb, dung Duvh, cm
POR WATER SUPPLY WELLS ONLY:
13a, Yield ( pm) A'tetbud rtf test:
13b. D sin(Kttoi type; Amount:
kaOnf
'lip
____•
rr.
ye st.
coops. 5 9. .
It.
ft.
•!'Lr- U- . R GAS1"it;� anal( eat .ter7#y.`bi7:> (2'•• —'bk). ..
. I 'l(DIAMETER _ DIAMETER[HttNNEW MA'rk1UAI. .
h. fj 3 p A.. in. a t D v
t 7o�tl i. nt� �ig� ���., s. voice :P..:::::•...;
P(WD}
in
p14MrrErt
MAi'eklm.
It.
ft
in,
.-i'OTCIt1`
h
(t
in.
i OM
7
t tAMX,'i'tli MATT SIZE TAIL N!<& MA
% in, d /0 v S'O . VC
iq. .
F'iATER�4 . F, PtAf�t�f r tY MIETECOD & ANTO)U
tj 4 �i ifo4nq iv r' 7%,.4t.Al f
ir. 4.
t9'8i'tJ!b)2tr1tiarEk ACfC4P'0imitiAL,:,.
FROM TO MAl!k1AL
tt.
Ical,PLSCEMterThlt17HOtt
It.
ft,
!;'ROM. TO n£rfdttrroks (.toter, hscdsarr. rod (Mr, rein. rx c, aRl
ft. tt
(t. i , It.
f
fc.
ft.
ft.
tti
t'tt '
ft.
n.i
j'j' 92018
22, Certification:
Sign net of Ccrtifiod
HY,rlgrrnrg rh(e fo
wnh iSA NC.4C 0.
ahoy emit neon
DAN
1 hnrcby Or (hat the kk!((s) (irand) COTS tteued In aeevr i
0f00 or4 NCAC 02c .R200 Wol! Ceur rArlOn , e.ocforrls and rl
iras boar provided to the well owner,
23. Site diagram tin s(Idtblonel vrth detal6;
You .rnay use the back of this page to provide additional well site details or
'construction details, You may also attaob odditional pages iftioocs_ uy,
$C1101►'ft LJl` �TiniC.A9h1$
24a. Fur AI) Wey3: Submit thin foot within 30 days 4f completion of
construction to the following;
Division of Water Raeturces. information Procesofng Unit
1617 Mall Scrvicc Ceut2r, Raleigh, NC 27699-141.7
24b. Fir /0fec[itdt Welt In addition to sending tho .tbmr to the address in
nbove, also submit one copy of this form within 30 days ofcomprotion -of
co»5truon to the'ib#lowi»g:
1)iviaion
Water R+sourees,-Und't!rground ltrjectioD Control PrRgfao
t636 Mnit Service Cenecrr Raleigh, NC 27699-1636
24c I t)r Welter Sup ' luirzsOti Wrdls: in addition to sending dm font
dte addiee.s(es) above,, also submit one copy of this noun( within 30 day:
completion or war ceitsmcction to the County health deportment or rice cot
,bore rein chrrfPei

Aqua Well Drilling
1706 Kennedy Road Wilmington, NC 28409
910-395-19B7—fax [phone] [e-mail] ECEIVED/NCDENR/DWR
fax
TO:
JUL 2 3 2018
Water Quality Regional
Operations Section
Wilmington Regional Office
N.C. Ground Water FROM: Gary Jones — Aqua Well
Drilling
FAX: [phone] PAGES:
e8 15
PHONE:
919-807-6301 DATE: 07-18-18
RE:
Well Records CC:
Urgent
C
For Review n Please Comment n Please Reply n Please Recycle
Comments: 15 pages includes cover sheet

WELL CONSTRUCTION, RECORD rGW-1.)
1. Well CAN' tractor Information:
Gig Z-1)
Well Cc'ntraet/,r• Name
RECEIVED/NCDENR/DWR
JUL 232018
NC WWI Coblaac or Number
.123 w.e !1 .. pIr Water Quality Regional
Opernons SELrflon
Wilmington Regional Office
C,;ompany Namo
2, Wetl Corustruciton Permit fi:
l.rsz,dt mp,tinobfr. well th wtiarr pr:rnuLr li.r. (ITC. Cr,wt(v...Sfate. vnrformc. ere',)
3, Well Use (cheek Well Use):
Water Supply Well:
Agricultural 0Municinal!Public
Gcothennaf (Heutin}/C:oofing Supply) jResidcntial Wal>:r Supply (single)
Industrial/Commercial f Residential Water Supply (shared)
Non -Water Supply Well:
Monitoring
JuJtenon tit:
Aquifer lQechaige
Aquifer StoT ge and Rerarvcry
Aquifer Test
1;xperimentel 'Technology
Coo/humid (Closed Loop)
Creothecenal (Rentin . Coolineetur1
ltec:ov¢ty
DOroundwatcr ItCmcdiation
�5tiliniiy Barrier
DStorrnweter Dr.inage
DSubsittcnce Control
arrsczt
f Othcr1explain untie• ti21 Remarks
4. Date Well(s) Completed:
Sa. VVui! L,ocmcon:
KA.L )VrJ(�r
Faer llty/Owo'r Name
69/0 LCtilo; ,e Pk?
1>Insxal AddrtEs..City, and Zip
f'Mmy
Well 11)1i
Pacitity lf)if (iftwrolicab4c)
Pambl ydentifintititn No. (PIN)
Sb:. Latitmie and longitude in de gre&tninttte€/rcconds or decimal degrees:
Orwell field, cm latllong is sufficient)
3y° or• 3‘ s' N. D7?° S'9. 3o3,v
6. Waite) thewdl(s)Gkertpaner,t or D'remporary
7. Is t(tis a repair to an existing well: QYes or @kilo
If Miele a repair. fill our known well cvnsrrmi ton infgnngt/orr and explain the nantrr. 4f the
repair utter rr21 ranuirky >(:: r ue pn!!ry 60c'4 oftickfjrm.
g. For Geopro1*/DF'rl or Closed -Loop Gtolbett:Lal %Vella having the same
contruction. only l ()W-1 is needed, Indicate TOTAL NUMBER ofwells
9. Total well depth below land surface: 4.1
1'Or mpdElple wells kV all d oih.s Tel re rn (etmnple- . @ 2OO'an(1'2(I W )
1,0. Static water levei below top of eseaDg:
tre•atrrlevel trabove <'O.'V , arc ""'r"
I. linreboke diameter:
12. Weft eonstruction,a)ethod• ''Zt444i+1 L3Z --
(i.e. uugor, rotary, ebie, cheer push, elc.l
(ft)
ToR WATER Si)PP1,Y Wr;1,1 S fl' ,y:
13r.'Yield (gpm)
Method or test: ,�_
13b. Disinfection type; Amount:
C}ar internal Use Only: 'T .w
YRQM
v
'ro
DESCRIPTION .
&3 ft.
-o Ar-s- S-_,rl
ft. ft.
Ts; oIhTER'rrCASINCi
m+ilti-eost'd'ti ySiR lead
. bk), :.
FROM 1 'O
""
t2rAM6,i'P.R
TRIMNESS
MATERIAL
it. • ya ft.
2 ;n.
v Yo
rc„:1Vn i £4i SOdG:OR1
; < OK; of trEk6i' Sb
•L
' rM
'
DIAMp' E•
TilICKM rERi
MA•
n.
in,
(i.
yn.
•
'TRICK!?
PROM
To
arnFtrrKti
NWT Sit
'c
A l
4, ft
6 3 . '
/ /uie,
Jan.
o/0
Q^.t,.
(t._
rt
�?0C
. ,.
::t8s( tAi' .
,.. :
MIMI
ft.
•t0
MATkRAI_
EMUr,ACE IFNTMHET00n&pd. ot!
p6 V i ale •
R.
ft.
it.
....-_...
._
19:.:;- rr...
:4 y;:P: .'t4 ......;41,.:
FROM
IIIMIIIIIIII MATTRIAL Si11PLAct4tiTTMETHOD
ft.
ft.
it.
le.
?A;:i •
,:e+ • ..
t 9ttai ,1?e! ':x_, .
Pita.4
IV.
rrliCitSPl•tt3N Bast, Irnitloam. =Miro& fyrq m ahFal m e
tt,
ft
ft.
-
IL
ft
D.
r—?
,��
R,
fi
i 11 i._ li• •. 9 a
22. Certification:
De
Ay zo.tvziPiti rhts form, 1 hereby c V thvt the toch:ttr% Teas (were) ecinettrreled in accorr!
wl6t /SR ! trrIC OlC r/00 or /5 - LAC (/2 ,(1200 Well Canstrricitan Standards and r!
espy ref lhtr reeord lras . eerr provided to drew!! Owner.
23. Site diagram or additional well details:
You may use the back of this page to provide addltiOrini :well site details or '
construction details. You may also attach additional pages i};ttcoasirry,
',941t1titAt tN 1'RUCLW1d$
24a. For All Wells: Submit this Comi within 30 days of completion of •
construction to the following:
Division of water Resources, Information Processing Unit,
1619 Mall Service Center, Rafelgh, NC 29699-i617
24b, Mien- ]meths: In addition to sending the form ro the address to
above, also'submit one Dopy of this form within 30 der of conviction of
construction to'the following:
l)iviion of Water Resonrces, Underground.lojectiou Contra Program
1636 Moil Service lento. Moth, h, NV27.1994436
24c, lzgr Water Satroty'e: Irdectioe Weill: fn addition to tending the fort
the address(es) above,, elsxi submit one cony of this form within 30 day:
ennilrtcrron of via c ann:lion to the Wunty health dopsai:meat of the clot
whpra rnpctmrr>rl

WELL CONSTRUCTIONRECORD (GW-i)
IIECEIVED/NCDENR/DWR
J. Welt Contractor Information:
For Internal U4l
Ft() 3
IYhys:eai Address, C+Iy, And Zip
NC wth Cnntrgetof Centfcation Nuwlror
-4I OgA
(;vmpany TT wnc
JUL 2 3 2018
Water Quality Regional
Operations Section
Fi ngtntlBaSiOna) Office
2,Wclf Conatructitrn Permit N:
Lim aO app(Cnhie woe( rrJNs(ru m)', µerpliL)' (i.e. tie:. County. SkY/e. VOrlarw*.. Pk.)
3. Wc)l Use (Cheek well' use):
Water Supply Well:
Awicofturlal OPlttnioirtallPublic
Ocothe,lnaL (ffeating(Ci cling S ipp(y) ckessdentiaf Water Supply (single)
Industrial/Commercial DRcsidcitiaf Water Supply (sht4ieri)
on
iYon.Water Sappy Well:
Monitoring
Recovery
Injection ` ell:
Aquifer Recharge
Aquifer StOtage and Recovery
Aquifer Test
tixperitwoniai'Technology
Geothermal (Clo9ed Loop)
Geothermal (I$eaTin , Coolies Retumi
()Groundwater Rernedintion
Salinity Barrier
JStormwaler Drtinage
DISubside tee Control
()Tracer'
Mier (explain under 12t Remand
4.Oak Wrl)(s) Completed: Well 11D#
Sa. Wt4l &Asl)tiOn:
A .Air 0A..t : 4
Facility/Owen plains
Facility IAl{.iifapnlicatc)
s aerlxi,6,A- ni> A• c. c4(241(.N0
bet.; CI —
Comity Parcel ldendfidartron No. (I'Inr)
5b, .La6tude and Itongiteide la olegrees/tnann.tcseseconde or ()ceiling) degrees;
(if well field, onelatftong is sofficfcrt)
37 • 0i w
6. Is(are) the welt(9) L'ertaanent or DTemporary
7. la this a repair to an cutting well: QYes or Cl(Vo
!Pelts i< a rcrxdic fill i ui known rid( c fnuttirc1ian infnrvxoefo» raid arpfam (hit nature offhe
rehab wider A21 erlwurlt:.yeoitwt or on rho husk hiv/nr. .
8. For GeoprobelDYlf or Closed -Loop Geothermal Wells havtng the Same
construction_ only 1 OW-1 is needled. Indicate TOTAL NUM13EF ot•welts
9. Total w•elt.depth below land surface: 3 t.
For multiple wer/S !Wall dcp(A of d, d real (eW7nµrc- 3 s1 fi0 • a ul 2(cb nPfl
10. Static water level below top of casing:
If w 11l r (Cd'L( Ls ?iMrr C2ring. IGta •¢ "
1 t. $orehule diameter: W (in.)
12. Well construction method; u
atICr, rotary, cnble, direct Push, the.)
Fj iFil •r� .ro russemrnpts .
ft.
ft.
irtiVIIR CA SVC 11;00t lir ',rir'q; ibk1„ : .
tkG.t rrY) ptAME R 1nOcNtsSfi MA'tWM.
4-1 ft. au
art8EiG.ORTVAIN43 tR'ettaer a t#a7+@a
TO ntAatt:teR 9_i7ttCKNMS MArRR.1....
pLIOM
in.
ft- ft
11..$i t6$
FRONT TO s)tA7� Ellif RAM' ' AJ{;ytN 'e
old gr fyi/Uin. 4r/0 off()
ft. R ! bti
l& GRotre.
M TERIAA
MOM
0 11`.
rt.
fr.
Mtn temAi_� CIPIAr lr METHOD re AMQ )
ft. ft.
FRAM TO MATERIAL 1 RMPLIC ME TMETHOD
ft.
ft.
ft.
lt.
J
•
20:'lDRiLLINE :L G txttec l.kidirSgpt i i } •' ::'::
FROM 'rU Ck:RCNf fit) P: (obr, Ra+drkis urikotah Hera mkt dim -;
F. tt
ft-
fz
ft.
ff.
ft.
t ,+
ft-
ft. rt.
z: r nos:....
y!1"i4;fii�}.�
22. Certification:
Date
ray aijlin rhlij' ni, 1 ht'.h'- y card(), d(ar the 1+2ff(.rj Mat (we're) tyostirtUsd rR accord
will+ ISA NCAC (I2C11ic o nr iSA WOW VA: .0200 Weil CamorricUrn SYandcmir and 41
copy of Ihi9 snort her bc¢n provided ep the wdl p wper.
23. Site diegram or additiot aj wdl debts:
:You msty use to back of this page to provide additional Weil site detail or •
construction details. You may also attach additional pitg. • If nocessaiy,
iforkirrrAvvorRuclitivi
(ft-) 2a• ,EauSkY: Submit this firth within 30 days of completion of .
coasttltction to the following:
(ft) Dtviaon of Water Resources, fo{r)rmation P4-ncew;Ing Unit,
1617 Mill Service Center, Raleigh, NC 27690-161.7
24b. 1or folecOIon Wells: In addition to sending the form to the address in
•abnve, tdso submit one copy of this furl within 30 days •af completion ol( •
construction to the following;
FOR WATER SUPPLY WEL9:.V °T 1.Y:
13a. Yield (ghat) Ntr. had of test:
)3b. Plsinfectiou type: Amount:
Division of Water Rttourcee, Underground Injection Control l'rogran
1636'Mall Service Corner, Raielg)t, W- 27649-i636
24c. For Wt:rer Supply %mastic% Wick: in ad4itiou ea *curling the fVf7
tiro ifdddcss(es) above, also submit one copy of this form within 30 day:
completion of well construction to the county (health deportment of the ca
wh. rp teen gft-,,,,te-el

WELL CONSTRUCTION SGW-I)
RECEIVED/NCDENR/DWR
I. Well Contractor information:
Hof lumina! Ust Only:
R?2
i
10
1
ills
14C Wclt Contractor tificotivr Number
/4- - i A t 4-11
.(' nr,' y Namw
Z. Mica Construction i'ertriit 4/1
/_,.cp, ull oppficnhh Wert t .w.ylrvctiun permitfl.c. (/IC Coonry. Stale. Parlance. eta).
3. Well UseIcheckxell
Water Supply Welt:
Agri cultural rJ Mtmici{•ral/Public
!� Geothermal (Keah ny/Cbofing Supply) DResidentiai Water Supply (single)
In da.StriaUColnrnercial 0Residcntial Water Supply (shared)
JUL. 23 2018
Water Quality Regional
0pp� ftQtp itls Section
771iffiirptol ilts,aitat Office .
In
Non -Water Supply Well:
141oiuteuring #. Recovery
O(iroundwater Remedietiort
OStditJity Barrier
Aquifer 1•cst DStorrmvatcr DrainaE;c
l xper me -mar Technology DSubsinence Control
Geothermal (Clotted Loop) Traeor
f Geothertnat (ticntineuolin ftctumt Quiet (explain under021 Remarks)
4. » to Wd10) Completed:. e9 a -yr Well MO
ajeeyro° ell;
Aquifer Recharge
Aquifer Storage and Re(x>very
53. Weil l,ncMinn:
Facility/Crwoer art:
Facility USN (if appltcatilc)
:ea' A /-e 1k S?' CLdi sir w? et t C/N
Physical Address, City, and Zip
iO ,l1l'X-b 04—
Cainly Parw1 Jderrtifwaion No. {PiN)
;Sb. imitate and longitude it dtgree€lnuiztutes/secoads or decimal degrees:
(if well veld, one ia'/lorig is sufficient)
3y ag-,a6a. N °) D sir 3i�
6. Is(ore) the well(s)eXermancnt or ED Cemporary
7. Is this a rcpHir to ad existing well: 0 Yes or ONa
11 this a er r??prtir,,/i1l out known wen crucstrucflon fnforinarion and eepkifn the noluek ofthc
Pamir wrdar 21 vdiaurf:S section irr Mt die h i k r f th4 loan.
8. For Geoprobe/ANT or Closed -Loop Geothermal Wells having rile sumo
constriction. only 1 GW-1 is needed. indicate TOTAL NUMBER of wells
9. Total well depth below land Attract: 3 �/ (ft)
Par Inuirlple wells 11s &t depthetepthz ifdlfferent, (camp;.- 362200' awl 2(mr001
l,e. Ststit water level below top of casing:
/rwarrr fcvd ix afWrvc casing. LA. "•'
II. flort:hole diamctcr: , i (in.)
12. Well cooblr•ucdoa tncibod: c.%),9 '.l •.r?y--
(i,t. woe:, , rotary, able, banks push. pc.)
(FL)
to VA 72Rr
og'tne'cton
318". ". 0.3 rs sAA.1
ft, R•
XER CAS(NG 1 attritittuscd:'ttelfy
mist 4 fa 4tAME1Ek
fr.0 s
at) a in.
THKKNtfSS !dA'rg.52lAl.
0 0 Poe
AMet'er;
in,
Tttrev.A MA AL
itiAMt•;1',• kfdlrS
m,
+en
b
TAU
N ' ' AT .;.R
U 0
MAT R .U..
IOUit.
1111111111111111
�• :e.r� C>GtsW:L.
man.ra MATE, L
1111111111.11111111
tPiPLAVAtEriT iAL111X18 & AMTV
r +Af,
ttl''F'
rryvn.
ft-
AIM' r twrt /CONK, SUM DOI% ern TIM(lop. GLa3'reL4 a`"-
ft. .
Ts.
LA.::
'J '
fj
d
4°
• �. ,
'Zi:'KtiAi�St;iy�: :1:.: .;... ...: _. .. :.:i;.. �•,-•�';';�,'.; �'1>r {''!L-y'�y1k i, ,.
ftri:i?4if)ci
FOR WATER SUPPLY WRI,f S ONLY:
{3a. Yield (gpui) ltlotttcrd of test:
136, Disipfeetina type: Amount:
SignanCedifsed Well Cent
t3y .velra8 rhlr form, t harpy
w116 fSa NCRC 02C .Q(00 or 1
copy (Phis meord has I gerr pro'
pair
c we*, IRO (JVvvtV evnrdrocr& 1 in accord
1' .02(10 Kra!! (.nnnnrcifan S{orrdurtlr anti
trr Or: well owner.
2.3. Site diagram or additlonol wdl details,
You trA9xy use the bad( of this page to provide additional <well site details or
construction details. Your May also attjlch additional pages' itnecesstvy.
INS'I'1A'CVl'1QNS
24a. Fos All Weiir Subnlit 'WS Corm within 30 star of completioo of
construction to the following;
Divided of Wafer I04ot3rce.K, In orrnot3ou Processing Unit.
1617 Mail Service Center, Raleigh, NC 27699-1611
24b. For roJe.e0nn We111: lu addition to sending the form to the address in
above, Also submit one copy of this form within 30 days of conviction of •
construction to the follou9ng:
ItFvisinn of Water Rtsonrces, [lndergro uiddajection COP (roil rogt'esn
)6.34 Mr:U S rv1. C'c ettr• RaictgtLtr 1VGTAG?1-1434
24s• FQr WzE(4r Sitoely c Iniootiva_WeIJ: In addition to eanding the Fan
dto addlxr_es(es) above,, also submit one Dopy Of this form Within 30 day
completion of well constrction to the. county health dopActment. of the etr
tvhe.pnncictirte4

WELL. CONSTRUCTION RECORD (GW-1)
For Internal rise btsly:
I. Welt f ontracor lnformatinn:
GA
t%r'cn (:getr;r .x Nafno
NC Well Contractor CcniGw[iat Nutt+bcr
(ompan): Nanhe
RECEIVED/NCDENR/DWR
JUL 2 3 2018
ter Quality Regional
1poations SeLtirnl
Wilfiington Regional Office
'`Fell Construction Permit
Lc( uhQM/Tubb( sell r.,,n..rn,ctlon permits G.e. WC, Comfy. •Snue, Porlrmac. etz)
3. Well Use '(cfteckwell use);
Water Supply 'Well;
Alpricultnr,tl nivlunicii, 1JP hlic
Geothermal (Heating/Cooling Supply) cJRcsidcotial Water $upply (single)
iltdttstrinllGc)mrnetcial oResidt:nttiaJ Water Supply (Shared)
on
Non -Wafer Sootily Well;
Monitoring
Injection ell:
Aquifer Recharge
Aquifer Sttxage and Recovery
Aquifer Test
Experimumal •fechnoiugy
Geothermal (Closed Loop)
ltccuuery
EJt3roundwater Remediation
°Salinity Barrier
DSttxmwater Drunsge
DSubSidenee Control
ElTraoct
Geothermal ((featinP (,',nouns Reim) flouter (explain under #21. Remarks)
4. Date Well(s) Completed: &y'1:99-1Lio Well 7ilN
Sst. Wt.1 ($senor;
,i»o,J
Facility/Owacr Nutt Facility IfNF'(if applicnbie)
d-06S (t...460-1e.
l'1lysic.41 Address, City. and Zip
fi¢.-a,mf
Couviy
#54-
Paa*1 tdetWffUPtiW. No. (.DIN)
5h_ Latitude and (odgitode ip degreeslminutetc/set`onds or deelthzl degree$:
(if%nil field, one 1at/loog soft:Weal)
3y.° "a.39 6 N 4_ 5—
w
6. Is(are) thewetl(s)xtnalaent or ©"Cemporery
7. is this 9 rcttair to an cXtgttng well: JYcs or /solo
(%th(s is u rcpuir,jOI out known w O ca+srnrcrrcin information ond'exptum # minor; Oftire
reprtbf under i12 i ra,nurkr a'wtirv, or co the hu'k cD' th,:, form.
S. For Geoprobc/APT or Clos44-Loup Geothermal Wells having -rho same
construction, only 1 C)W--1 is needed. brlicaleTOTAL NUh1l;ER of'.yells
9- Total Welt dcptft below tape surface: 3e? ' (IL)
For multiple wells list &!depths ((cdeffetet+t (ex -ample. ScE,2CIO' and 2(0CY)
10. Static water level bekva top of easing: {;'t.)
!f wartr level i , oht, m aadng, uca " v "
11. Borehole diameter: b* {in.)
12. Well construction method:
(i,e, n roe*, rOtaty, cvbiq direct ou:b. cit. )
Rat WATER SUPPLE' VYf 1.1 ti'Y7.Y:
13a. Yield (gym) Mctt o.4 of test;
1.31). cc on type: Amounts:
rtcaa
'rn
DESCRIPTION
aO tt.
g 5V- fl'
Cv,Ar3 59• 4
ft.
ft.
li.. MT ,R'CASING
Lfr.5
nyt1-catty: yl; . Op/kit/14.:...:.
Fgcrm i
ro
TOMAMETBR ittioctlesq
MA'1ERIAi,
11 11.
1 a0 `t 1
1 In, p y a
"'Lie.—
trtat a
XiSEIG'ORIVOI
cion fiie ri at
FROM
TO
. DIAMETER
VD
MATERIAL
D.
f4
in.
FROM .
't'O
II IAnat:•iti;R
SU►j•8171
TRrl3CNf;.CS
MA.
dd k
3r ft
/YyiT'
oho
oyo
ft
fl,
ia.
FROM
To
AtATT,RrAI, i EMPLAC.t5R4Vb1E'r{louLtAmOU
2
O.
Ij
ft.
ft,
I
' 15.;:t hilt d'ritAV
LTAt
Atf.a. i1iililite}..'.~ ' .'.. :. ,
FROM
TO —
MATERtAt4
CNIPrACEW.NIME71101.1
ft
ft-
ft,
T.
r
l
7A;DR113;11:41131::'.
atte ti3ili
EKQM
TO
nP.:fySLOP IIMI (4016e, larerIsT,s0dINOL VIM ftetag,•tx, 1
ft.
R.
n..
. rt.
ft.
ft
rt.-
it.
r: :z
_,3h
1I C. , i „ 3 syyr.
ff.
f2.
trti�.:.r§
9 018. .
ft.
l4
30�
:zlritQlbfiL
wr;i 3t=,.r
22. Cerlifitation:
Signature,ofCct1''cdwoo ComN
Ny signing this form, 1 heresy • .' Meg 11,e WAN vas (were) corin`ructed irr acconG
,w£llr ISR NC•7tC 02C 4700 u CAC VC .(120 WaI1 Crum inteitun .SYondn,rlr cnc' f/
miry of thlr ►acord knr dear, provid,4tp the volt owner,
23. Sitt diagram or additional Welt details:
You may use the back of this page to provide addlnonol well site tl'ctdils or
wnstzutxion details, You may also attach additional pligts if naSsuty,
DMrrrA ,.1N us uu,N$
24a. Far All Weltit Submitthis fort within ' M days of a mpktioo of
coostzuc ioll to the (following;
Date
Division of Water Rt oureev, fafotntatfon Rrocessir g UoO.
1617 Matt Sesvica Center, ltatelgb, NC 27699-1G17
24b. iror 1:niestion Went: In scklition to sanding the form to the address in
above, also submit one copy of this form within'30 days of completion of '1
cotistrtrMion to'tite following:
Division of Water Retontcea, Underground 1ltject oo Control Program
1.436 Mall gervice C;¢ntcr, t3 tteig lr NCZ7499-t636
24c, For `Water Sunniv X Weskit wail: In addition rt.) sanding taw f0cn
rho addtoss(es) abuv,e, also submit one copy of this form within 30 day
compaction of vnll cpngtnutiort In tits county health department of the oat
whnrn nnctnit'd

WELL CONSTRUCTION RECORD (GW-1,) For Internal U$ Only:
I. Well (Antrsclor information: RECEIVED/NCDENR/CJV -
IROnt •rn OIScttrirus t
3 p st. C.4, eS �J
W& n t labor Name
14C Well Contractor Csrtifiwtinn Nurobcr
A 13 ‘a,d47 (41-e-1 i • L?fG /l- �•‘) SCclrttfun Y l ?-� ' ft a (LT a.
Olurattons �r, j
Wilrnington Regional Office Vs IKatcermac'.old'x 34(3:{
DIAMETER THrtritt
in.
ln.
t:M
n,.lny Ni
1$.' E fST$R CAS-1NtC , Rt3064I dli tretKO tNeR'(i 3 .
Water Qualit R Fk9+i rco rDIAME:bER Trtrtxtetm MiveranAL.
2. Wall t:ontArurtinn Permit Os
/.r of td! o)pllezGle well rr,h.vlrwction pmrnritx .4r. (1)C. County. Stale. Parlance. tde,)
3. Well 11%e (cheek well Aim):
Water Supply Well:
Agricultural ONit,nicipallfyhlic
kieoihennal (ffeating/tba(ing S'uppiy) Qltesidentiad Water Supply (single)
Industrial/Catnnnercial °Residential Water Supply (slued)
Non -Water Su ppty Welt:
Mon itorin
FROM
FROM
rt.
rl.
TO
ft.
f1.
` DtAMt'rt w`' SUIT TAR
a't F.
t- /y9, In, .ol
ft.
'ft)
FRAM
0 ft,
ft,
To
o ft
ft.
JUL 2 3 2018
452820
ft. ft.
tee?
pa �
MATERIAL
040 41.0-
UrATknrA . ATrflAcrMr 1T at oms,& AFtotr.
Injection 'ell:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
rt,w, mini nal Technology
Qfiroun.dwater rem ediation
°Salinity Barrier
DStorrowaIer Dui
Dtubsidatee Control
Geothermal (Cloed 1 odp) QTracer
Geothermal (lioMin.Veonlin Return) 5)Other (explain under n2D Remarks)
d. Date Well(s) Completed: 4-- Well MR
sr. Well t.ecaalon:
1Facility/61.cm% Name
Faculty PH elf applicaiik)
31 . sieve ° A CA ,
Physical Addle. City, and 7,ip
Crt(1ny
Pomol 1rlrntineation No. (PIN)
sb. Ltttitnde and Iota itnete in degreesinainutet/seconds or decisost) degrees:
(ifwe! field, one let/long is sufficiaal)
33 D D a. cr/ N
6. is(ar'e) the wells?
??°S.3• /ao
Permanent or D'remporar'
7. is this a repair to an existing well: E3Yes or ONo
!phis is rr rcpuir,.went kh()141114,C11LIMSirtietfOh io/nnnpt/on and explain the astern of the
repcir wvlor P21 ranuArt+a' Y44.trUf4 w' Me ilk: hat'k fArtft.
.Por Geoprobc/DPT or Closed -Loop Ceothc:Toat Wens having the same
constrtiction. tmly 1 OW-1 is needed, lndicate.TOTAL NUMI3cR of wells
chi llccl: ._._______—._._._......
9. Total well depth below lattt# 3airface: I r
Forrrtdlllpte wetly loaf alldeprlcr ifc1 krav (crampte• 3(9i00'and 2(dV00.)
I(. Static water level below top oft sirtg:
/( 'raw lcve'l is ahnvt. casing. use
D D. }forenoon diameter: t//d (in.)
12. Well construction method: lct)/4 r
(i.e. oat s-, r9ewy, cable, ti'aoct push,
(ft.)
PO.11 WATER SUPPLY WELLS ONLY:
t34. Yield (gpr>'r) MCtuod. o: teat:
Disinfection type: Amwtnt:
ft. Il•
15.r86103YrAtRAVIViefZ. itatuie) . ,.:..
FROM
ft.
TO
ft.
MATERIAL EMDLACEMENT1dliTHOD
it.
ft.
as nr ttT +rpI&'S 4et *Ittl 4: ,
nttsCstnmtrllJcG s aaoest, aeslr«k Sy/am errata theZRel
FROM
ft.
TO
it.
tt.•
ft.
n.
ft.
t1.
rt. f .
ft. ft.
9/0
22, Certification',
s-19=/A
Si' ttuo of CoFt A 'Antracorl pates
My signing rhit$ form, 1 + ,y arty' that the wefts) 041 (wepa) epnsFrevcrrd in atcon4
wltlt /SR )1CitC 02C r.or /54 NC'AC 02C'.0200 writ Constraction Standards, and a
Copy ethic rfcorci has Mn6ep?O''ktudY>t j wrN ntvner.
23. Silo diiigr'xm or additional well details:
You may stye the back of this page to provide additional well ,Site details or
construction details. You may also attach additional pages if:neceswwzy,
24a, Pt A}) Well : Submit this inrni within 30 days of completion of
construction to the, following:
Division of Water Refotrrces, lnforatatinn Preeessfnq Unit,
1617 MaliSetwice Center, Raleigh, NC.276Zt-1617
24b. fps Jniceljpj W fly: In addition to sending the form to the address in
above, Ow submit one copy of this form within 30 days of -completion .of
construction to the following:
Division of Water Rt onrces, Underground tnJectioo Control Prowsur
1636'Men Se vice Ttatc gb, isk: 21459,-:636
24c. Eqf Wttet• Crtprity & Infection Wxl€:s: fn addition to sending trite Farr
tam address(es) above, nl,o)o submit one copy of this lam within 30 day;
completion (ye well cptattnsetiot+ Co the county health department of the an;
uRPro nnnman- •at

WELL CONSTRUCTION RE D/NCDENR/DWR
This form can be used for single or multiple wells
1. Well Contractor Information:
Gerald R. Eister
JUL 1 6 2018
Well Contractor Name
2394A
Water Quality Regional
Operations Section
NC Well Contractor Certification Number Wilmington Regional Office
Bridger Drilling Enterprises inc dba Carolina Drilling
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
DESCRIPTION
4
2
ft.
ft.
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if
tl bl )
FROM
0
H.
TO
3
H.
DIAMETER
4
in.
ap
ca e
MATERIAL
sch40 pvc
THICKNESS
TH
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
fL
H.
in.
ft.
ft.
in.
17. SCREEN
Water Supply Well:
❑Agricultural ❑MunicipallPublic
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑hrdustrial/Commercial ❑Residential Water Supply (shared)
❑Irrigation
Non -Water Supply Well:
OMonitoring ❑Recovery
Injection Well:
❑Aquifer Recharge ❑Groundwater Remediation
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control
❑Geothennal (Closed Loop) ❑Tracer
❑Geothermal (Heating/Cooling Return) ❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: 6/8/2018 Well ID# RW-2
5a. Well Location:
Han Dee Hugo's #28
Facility/Owner Name Facility ID# (if applicable)
5002 Market St. Wilmington, NC, 28401
Physical Address, City, and Zip
New Hanover
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lallong is sufficient)
34.,14',37,05" N 77,53',00.71" .i
Signature of Certified Well Contractor
D-
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAI.
3
ft.
13 n•
4
in,
.010
sch40
pvc
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0
R.
1
ft.
neat
in place
ft.
ft.
R.
ft.
19. SAND/GRAVEL PACE{ (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
2
ft.
13
ft.
sand
in place
ft.
ft.
20. DRILLiNG LOG (attach additional sheets if necessary)
FROM
0
TO
13
n.
ft.
DESCRIPTION (color, hardness, soitlroek type, grain size, etc.)
Tan and dark gray sand trace to some clay
ft.
n,
ft.
ft.
ft.
ft.
R
ft.
n
ft.
ft.
ECEIVED
Jul 0 g 2018
21. REMARKS
toogantitbon
6. Is (are) the well(s): ©Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ❑No
If this is a repair, fill out known well constntction information and explain the nature of the
repair under 421 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: 13
For multiple melts list all depths if different (example- 3@200' and 2@100)
(ft.)
10. Static water level below top of casing: 5 (ft.)
if miter level is above casing, use "+"
11. Borehole diameter: 10 (in-)
12. Well construction method: Auger
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpnl) Method of test:
13b. Disinfection type: Amount:
22. Certification:
By signing this form, 1 hereby certify that the well(s) was (were) constructed in accordance
with iSA NCAC 02C.0100 or 154 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 this form within 30 days of completion of
well construction to the county health department of the county where
constructed.
Form GWI
North Carolina Department of Environment and Natural Resources - Division of Water Resources Revised August 2013

WELL CONSTRUCTION REC( DIVED/NCDENR/DWR
This form can be used for single or multiple wells
1. Well Contractor Information:
Gerald R. Eister
JUL 1 6 2018
Well Contractor Name
2394A
NC Well Contractor Certification Number
Bridger Drilling Enterprises
Company Name
2. Well Construction Permit #:
List all applicable well permits (i.e. County, State, Variance, Injection. etc.)
3. WeII Use (check well use):
Water Quality Regional
Operations Section
Wilmington Regional Office
Inc dba Carolina Drilling
For Internal Use ONLY:
14. WATER ZONES
,52460
FROM
TO
DESCRIPTION
rt.
ft.
ft.
ft.
15. OUTER CASING (for multi -eased wells) OR LINER (if
li bl )
FROM
0
ft.
TO
3 n•
DIAMETER
4 to.
ap
p ea e
MATERIAL
sch40 ] pvc
THICKNESS
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
ft.
ft.
in.
17. SCREEN
Water Supply Well:
❑Agricultural
['Geothermal (Heating/Cooling Supply)
❑ hadustrial/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
❑Geothennal(Closed Loop)
❑Geothenal (Heating/Cooling Return)
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
DOther (explain under #21 Remarks)
6/8/2018 Well iD# RW-1
4. Date Well(s) Completed:
5a. Well Location:
Han Dee Hugo's #28
Facility/Owner Name Facility ID# (if applicable)
5002 Market St. Wilmington, NC, 28401
Physical Address, City, and Zip
New Hanover
County Parcel identification No. (PiN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
34.,14',36.87" N-77,531,00.41"
6. is (are) the well(s): ©Permanent or ❑Temporary
7. Is this a repair to an existing well: [Wes or EINo
If this is a repair, fill out known well construction information and explain the nature of dre
repair under 1171 remarks section or on the back of this form.
8. Number of wells constructed:
For multiple injection or non -tenter supply wells ONLY with Me same construction. you can
submit one form.
9. Total well depth below land surface: 13
For multiple wells list all depths if different (example- 3@200' and 2@100)
10. Static water level below top of casing: 5 (fi.)
limner level is above casing, use "4 "
11. Borehole diameter: 1 0 (in.)
(ft.)
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:
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
3
ft.
13 n,
4
in.
.010
sch40
pvc
ft.
1S. GROUT
FROM
ft.
In.
TO
MATERIAL
EMPLACEMENT METHOD & ASIOUNT
0
H.
ft.
neat
in place
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
2
ft.
13
ft.
sand
in place
ft.
ft.
20. DRILLING LOG (attach additional sheets If necessary)
FROM
0
ft.
ft.
TO
13 ft
ft.
DESCRIPTION (color, hardness, soil/rock type, grain size, etc)
Tan and dark gray sand trace to some clay
ft.
ft.
ft.
ft.
ft.
ft.
046
21. REMARKS p ( ors
`
ft.
ft.
ft.
ft.
22. Certification:
W jge24O- 4 , 0u4 /3/ Zcp t e
Signature of Certified Well Contractor 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 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 iniectiion Wells ONLY: In addition to sending the fonn 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:
Mao 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�tuw-11iCDENR/QWR
1. Well Contractor Information:
Donald Cummings
Well Contractor Name
JUL 16 2018
Water Quality Regional
Operations Section
NC Well Contractor Certification Number Wilmington Regional Offic
Applied Resource Management, P.0
Company Name
2412-A
2. Well Construction Permit 8:
List all applicable well construction permits (i.e. 1I1C• C'ounry•, State, Variance, etc.)
3. Well Use (check well use):
WP0291633
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
DMunicipal/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 Retum)
4. Date Well(s) Completed: 7/5/18
DReeovery
QGroundwater Remediation
DSatinity Barrier
0Stormwater Drainage
QSubsidence Control
Tracer
Other (explain under 1121 Remarks)
Well ID# NIA
5a. Well Location:
Kersting Architecture N/A
Facility/Owner Name Facility m# (if applicable)
7508 Dunbar Road, Wilmington, NC 28411
Physical Address, City, and Zip
New Hanover R04505-010-005-000
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one Iat/long is sufficient)
34 16 35.64 N 77 46 54.59
6, Is(are) the well(s)I Permanent or DTemporary
7. Is this a repair to an existing well: ®Yes or xON°
If this is a repair, fill out known well constriction information and explain the nature of the
repair under i'2I 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-i is needed. Indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface: 70
For multiple wells list all depths if different (example- 3.a•200' and 2'iu100')
10. Static water level below top of casing:
If water level is above casing, use "- "
11. Borehole diameter: See Remark(in•)
13
12. Well construction method: Mud Rotary
(ft.)
(ft.)
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 80 Method of test: Airlift
13b. Disinfection type: HTH Amount: 3% @ 10g
Print Form
For Internal Use Only:
9
14. WATER ZONES -.-
FROM
TO
DESCRIPTION
ft.
ft.
e ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if a licabk)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 f'•
43 D•
6 is
SCH40
PVC
16. INNER
CASING OR TUBING
(geothermal dosed -loop
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
fL
ft.
in.
17.SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
ft.
ft.
in.
ft.
rt.
in.
1R GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 fL
35 fi•
Bentonite
Pumped
rt.
ft.
ft
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
IL
fL
fL
ft.
20. DRILLING LOG (attach
additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock qpe, grain size, etc.)
0 ft•
23 ft
Sandy clay
23 it
70 ft.
Limestone
f4
ft
ft
ft.
�t�
ft.
fL
ft.
ft.
r,0
^ / !./
fL
ft.
® (e0
21. REMARKS \\�
vt
22. Ce
tion:
7/5/18
Si: lure o Certified Well Contrac or Date
By signing this form, 1 hereby certi that the well(s) was (w ) 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 INSTRUCTIONS
24a. For All Wells: Submit this fonn 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
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 SupD1v & Infection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.

WELL CONSTRUCTION RECORD (IE14D/NCDENR/D r Internal Use Only:
1. Well Contractor Information:
Donald Cummings
Well Contractor Name
2412-A
JUL 1 6 ?01
Water Quality Regi
NC Well Contractor Certification Number Operations Secti
Applied Resource Managem*Iti,n'w.-0egional
Company Name
2. Weil Construction Permit #:
hill all applicable well construction permits (i.e. (AC, Counryt State. Variance, etc.)
3. Well Use (check well use):
N/A
Water Supply Well:
DAgricultural
Geothermal (Heating/Cooling Supply)
Q industrial/Commercial
I x"IIrrigation
Non -Water Supply Well:
DMonitoring
Injection Well:
BAquifer Recharge
Aquifer Storage and Recovery
DAquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Retum)
4. Date Well(s) Completed: 6/19/18
5a. Well Location:
Justin Fulford
�Municipal/Public
Residential Water Supply (single)
[Residential Water Supply (shared)
D Recovery
[Groundwater Remediation
Salinity Barrier
�Stormwater Drainage
DSubsidence Control
OTracer
(Other (explain under #21 Remarks)
Well ID# N/A
N/A
Facility/Owner Name Facility iD# (if applicable)
6606 Lyonia Ct, Wilmington, NC 28411
Physical Address, City, and Zip
New Hanover R04414-005-005-000
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one Tat/long is sufficient)
34 15 5015 N 77 48 5261
w
6. Is(are) the well(s)jPermanent or DTemporary
7. is this a repair to an existing well: (Yes or XE 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 hack of this form.
8. For Geoprobe/DPT 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: 165
For multiple wells list all depths if different (example- 3' 200' and 1 @ 100)
(ft.)
10. Static water level below top of casing: 7 (ft.)
If water level is above casing, use "+"
11. Borehole diameter: See remark (in.) r1�
12. Well construction method: Mud Rota' 1
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 80 Method of test: Airlift
13b. Disinfection type: HTH Amount: 3% @ 10g
Print Form
5245S
3 14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
Dr al re.
ft.
c {4 .aOUTER CASING (for multi -cased ae0s) OR LINER Ora licabie)
'# bM
TO
DIAMETER
THICKNESS'
MATERIAL
0 11'
20 ft
8 in-
SCH40
PVC
16. INNER
CASING OR TUBING
(geothermal closedaoopl
FROM
TO
DIAMETER
THICKNESS
MATERIL
0 ft'
60 fl.
6 i"•
SCH40
PVC
0 ft.
140 ft.
4 '"•
SCH40
PVC
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
ft.
ft.
m.
ft.
ft.
in.
1& GROUT
FROM
TO
MATERIAL
E.MPLACEM£A? METHOD & AMOUNT
0 ft.
20 ft
Bentonite
Poured
130 ft
140 ft.
Bentonite
Poured
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, soiVrork One, grain size, eta)
0 ft
18 ft
Sand
18 ft
20 fL
Clayey sand
20 ft.
58 ft.
Sands
58 ft.
83 rt.
Limestone - Void at 55' & 58'
83 ft.
135 ft-
Clay/mudrock
135 ft-
165 fi.
Sandstone
ft.
ft.
21. REMARKS
0' to 20' = 12", 20' to 60' = 8", 60' to 165' = 6"
6/26/18
Si a lure ofCertified Well Contractor Date
By signing this fona, 1 herby cenifyr Thai the wcll(s) Has (were) cons ru t �ecordance
with ISA hC:AC 02C.0100 or ISA NCAC 02C .0200 Well CoasrruG►+'rllt rdds and that a
copy of this record has been provided to the well owner. off/ _` O�a
23. Site diagram or additional. well details: V QQt� V ‘y4'
You may use the back of this page to provided tonal wAsift detail well
construction details. You may also attach additional pag iinecessa
SUBAIITTAL INSTRUCTIONS J" ``(�j P'
24a. For All Wells: Submit this form within Aof completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this 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 Sunnily & Iniection Wells: In addition to sending the fonn 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.

WELL CONSTRUCTION RECO-EMEDEl�R/DWRfFYi
1. Well Contractor Information:
Donald Cummings
JUL 1 6 2018
Well Contractor Name
Water Quality Regional
Operations Section
NC Well Contractor Certification Number Wilmington Regional Office
Applied Resource Management, P.0
Company Name
2412-A
2. Well Construction Permit #: WP0291640
List all applicable well construction permits (i.e. U/C. County, Stale, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
Non -Water Supply Well:
Monitoring
DMunicipal/Public
XDResidential Water Supply (single)
Residential Water Supply (shared)
Recovery
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal(Closed Loop)
Geothermal(Heating/Cooling Return)
4. Date Well(s) Completed: 6/19/18
5a. Well Location:
Ronald Nance
QGroundwater Remediation
Salinity Harrier
1JStormNater Drainage
Subsidence Control
DTracer
Other (explain under #21 Remarks)
Well ID# N/A
N/A
Facility/Owner Name Facility Off (if applicable)
7403 Janice Lane, Wilmington, NC 28411
Physical Address, City, and Zip
New Hanover R04509-003-017-000
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 16.1598 N 77 46 45.63
6. Is(are) the well(s)IJPermanent or OTemporary
7. Is this a repair to an existing well: ®Yes or EiNo
If this is a repair, fill out known well construction information and explain the nature of the
repair under +21 remarks section or on the hack of this forms.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only I G W-1 is weeded. Indicate TOTAL. NUMBER of wells
dti$ed:1
9. Total well depth below land surface: 65
For :nuliple wells list all depths if different (exanple- 3[m200' and 2.2100)
(ft.)
10. Static water level below top of casing: 23 (ft.)
filmier level is above casing, use "r "
11. Borehole diameter: 5 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) 5fl Method of test: Airlift
13b. Disinfection type: HTH
Amount: 30 0 © 10g
Print Form
For Internal Use Only:
452456
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ff.
ft.
15. OUTER
CASING (for
multi -cased wells) OR LINER (if a • able)_
FROM
TO
DIAMETER
TRIMNESS MATERIAL
0 ft'
40 ft.
4 is
SCH40 PVC
16. INNER
CASING OR TUBING
(geothermal closed -loop)
FROM
TO
DIAMETER
TInCKNESS
MATERLAL
ft.
ft.
hi.
ft.
ft.
is
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
ft.
ft.
in.
ft.
ff.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft• '
20 ft.
Bentonite
Poured
ft.
ft.
ft.
ff.
19. SAND/C
RAVEL PACK
(if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
it.
ft.
ft.
ff.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain site, etc.)
0 ft.
5 ft.
Sand
5 it
15 ft•
Gray sticky clay
15 ft
25 ft.
Fine sand
25 it
35 ff•
Weathered limestone
35 ft.
65 ft.
Sandstone
ft.
ft.
��
21. REMARKS RGIel\IJut-
° y 2p1
rY•
22. Certifyvon:
ow`� 6/26/18
Signature of Certified Well Con riactor 1 Date
By signing this form, I hereby certrfy dial the well(s) was (were) constructed in accordance
with 15A NC:AC 02C .0100 or 15A NCAC. 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well retails:
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
above, also submit one copy of this fonn 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 & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.

RESIDENTIAL WELL CONSTRUCTION RECORD
IVO 11
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 4119-A
1, WELL CONTRACTOR: RECEIVED/NCDENR/DW3
Sage Drilling and Pump Services LLC.
Well Contractor (Individual) Name
Michael C. Sage
Well Contractor Company Name
STREET ADDRESS 204 Tom Ave
Castle Hayne NC
City or Town State
910 )- 231-6669
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
JUN 25 ?018
Water Quality Regional
Operations Section
Wilmington Regiona�Office
26429
Zip Code
WELL CONSTRUCTION PERMIT# \•`,TC\. \ 1 6 (} 6
OTHER ASSOCIATED PERMIT#(if applicable)
3. WELL USE (Check A lica jto B x): R sidential Water Supply II
DATE DRILLED — )D—'
TIME COMPLETED (.-f ; 00 AM 0 t`M 0
4. WELL LOCATION: Ni [
CITY: �.; ; 1(`) i1 1-11 1O couNT*Cle.' iC�;lt`Vt
\3 i CL.<f'S fl(\t { \
(Street Name, Numbers. Community, Subdivision, Lot No.. Parcel, Zip Code)
TOPOGRAPHIC - AND -SETTING:
Slope 0 Valley (.1.F_Igj-4 Ridge 0 Other
(check appropriate box)
LATITUDE
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: 0 GPS o Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
5:1Q(ELL OWNER
OWNER'S NAiv1E •( t �.` .-m l . l.`i, ,
STREET ADDRESS
r.)C_te,S6 )f)C0 ti' C . (6City or Town State Zip Code
i
( COO )-
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:,..__gC) f- I
b. DOES WELL REPLACE EXISTING WELL? YESi, NO
c. WATER LEVEL Below Top of Casing:] FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1
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). 1 ) METHOD OF TESTA 1 I
f, DISINFECTION: Type Amount
g. WAr� ZONES (d th):
From O To From To
From To From To
From To From To
7. CASING:
Material
CY.r{
Thickness/
`` 4 Depth [ r Diameter Weight M erial From —I-J-- To G�J Ft. Sch 110 ' �L _
From To Ft.
From To Ft.
8. GROUT: Depth Method: From (' To Ft._
From 3 To C! .. Ft.
From To Ft.
9. SCREEN•- Depth Dia er Slot Size IT rj'�I
From ) To �b Ft. in. in. L -
From To Ft, in. in,
From To Ft. in. in.
10. SAND/GRAVEL PACK:
Dep h Size Materi j From To go Ft._ta Lit" 11 c\ f (t(.l
J
From To Ft. �J
From To Ft.
11. DRILLING LOG
From To
0 50
3r)
12. REMARKS:
Formation Description
Dr
I DO HEREBY CERTIFY T
15A NCAC 2C, ELL C
RECORD HAS EN P
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
TRUCTION STAND DS, AND THAT A.COPY OF THIS
DE THE 1 OWNER,
SIGNATURE OF REFL CONTRACTOR
Michael C. Sage
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Sti4tiAt tin; original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
161,''RZaiI Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
.:a
Form GVV-la
Rev. 3/07

WELL CONSTRUCTION RECORD w i-
ntuti I DENR/DWR
1. Well Contractor information:
Donald Cummings
Well Contractor Name
2412-A
JUN 25 Z018
NC Weil Contractor Certification Number Water Quality Regional
Operations Section
Applied Resource Mandtjitiltritvph.aaffice
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. VIC, County, State, Parlance, etc.)
3. Well Use (check well use):
Water Supply Well:
N/A
IFor Internal Use Only:
14. WATER ZONES
FROM
ft,
TO
ft.
451.653
DESCRIPTION
Agricultural
DGeothennal (Heating/Cooling Supply)
DI Industrial/Commercial
hl irrigation
Non -Water Supply Well:
XDI Monitoring
Injection Well:
QAquifer Recharge
Aquifer Storage and Recovery
DlAquifer Test
ID Experimental Technology
DGeothennal (Closed Loop)
DMunicipal/Public
DResidential Water Supply (single)
DResidential Water Supply (shared)
DRecovery
®Groundwater Remediation
ID Salinity Barrier
DStonnwater Drainage
D Subsidence Control
DTracer
DGeothennal (Heating/Cooling Return) DOther (explain under #21 Remarks)
4. Date Well(s) Completed: 5/17/18 Well ID# BG-1
5a. Well Location:
NHRMC N/A
Facility/Owner Name Facility ID# (if applicable)
2131 S. 17TH STREET WILMINGTON, NC 28402
Physical Address, City, and Zip
New Hanover R06011-004-001-000
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one latflong is sufficient)
34 12 16.95 N 77 55 04.57
W
6. is(are) the well(s)0Permanent or DTemporary
7. Is this a repair to an existing well: DYes or EINo
Obis is a repair, •1i1l out known well construction in anmation and explain the nature ofthe
repair under tt21 remarks section or on the back 0-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: NA
9. Total well depth below land surface: 25
For multiple wells list all depths ifd(jfeient (example- 31i2200' and 2 @100)
10. Static water level below top of casing:
1f'water level is above casing, use "+"
11. Borehole diameter:
8"
14.05
12. Well construction method: Auger
(i.e. auger, rotary, cable, direct push. etc.)
(ft.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) N/A Method of test: N/A
13b. Disinfection type: N/A
Amount: N/A
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if ap licable)
FROM TO __. 'DIAMETER. THICKNESS 5L4TERLkL
0 in. I SCH40 PVC
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM TO 1 DIAMETER
ft. 1
ft.
ft.
17. SCREEN
ft. 2
THICKNESS
ft.
ft. 1 In.
MATERIAL
FROM TO
15 ft. 25 ft
ft. ft.
18. GROUT
FROM
0.2 ft.
1
ft.
TO
DIAMETER" SLOT SIZE THICKNESS MATERIAL
2 In. .010 SCH40 PVC
in.
MATERIAL
1 ft. Concrete
13
ft.
Bentonite
EMPLACEMENT METHOD & AMOUNT
Poured
Poured
ft.
ft.
19. SAND/GRAVEL PACK (If applicable)
FROM 1 TO
13 ft• 125
ft.
MATERIAL EMPLACEMENT METHOD
ft, Coarse ,Poured
ft.
20. DRILLING LOG (attach additional sheets If necessary)
FROM DESCRIPTION (color, hardness, soil/rock 1}'pe, grain size, etc.)
See Attached
TO
ft,
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS.
22. Certification:
ft.
ft.
ft.
ft.
ft.
ft.
ft.
Si nyatdTe of Certified Well Contractor
014 9 2.Ol2)
5/24/18
Date
By signing this form, t hereby certif' that the well(s) was (were) constructed in accordance
with 1 SA 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
(ft.) 24a. For All Wells: Submit this fonn within 30 days of completion of we]]
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 font to the address in 24a
above, also submit one copy of this fonn 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 & infection Wells: In addition to sending the fonn to
the address(es) above, also submit one copy of this fonn within 30 days of
completion of well construction to the county health department of the county
%%here constructed.
Fonn GW-1
North Carolina Department of Environmental Quality - Division of Water Resources
• Revised 2-22-20] 6

BORING LOG
New Hanover Regional Medical Center
2131 S. 17th Street
Wilmington, North Carolina
BG-1
Drilled by: Applied Resource Management, P.C.
Logged by: J. Zuncich
Date: 5/17/18
De h.
p �
De
, . A ascription -
, >.
Water
Content'
.-
Blow
Count
2'- 4'
Light brown fine sands with minor gravel and trash.
Low
Grab
5' - 7'
Medium brown very fine to fine sand. No hydrocarbon odor,
Low
HP
10' - 12'
Tan to light brown very fine to fine grained sands. No
hydrocarbon odor.
Low
HP
15' - 17'
Dark gray fine grained sands. No hydrocarbon odor.
Moderate
HP
20' - 22'
Dark gray fine grained sands. No hydrocarbon odor.
Moderate
HP
23' - 25'
Medium brown fine sand changing to tan gray, silty sandy clay,
clayey sand mixture, loose. No hydrocarbon odor.
High
HP
HP - Hydraulic Push
RECElVEDINC0ENR/DWR
JUN252018
Water Quality Regional
Operations Section
Wilmington Regional Office

BG-1
Steel Manhole 0.5' Concrete/Grout Crown
Locking Cap
Ground Surface
13' Bentonite
vly
Groundwater
Table
12' Sand
•
• • •
•••••
►•�•�•
•••••
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s•o.**
*
•
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•••
••••�•
••
1••••• •
t,••••
15' Riser
♦
10' Screen
25' Total Depth
RECEIVED/NCDENR/DWR
JUN 2 5 2018
Water Quality Regional
Operations Section
Wilmington Regional Office

WELL CONSTRUCTION RE1R jVJNC# 1R/DWR
1. Well Contractor Information:
Donald Cummings JUN 2 5 2018
Well Contractor Name
2412-A
Water Quality Regional
NC Well Contractor Cdenification Number Operations Section
Wilmington Regional Office
Applied Resource Management, P.C.
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. L7C, County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
N/A
For Internal Use Only:
51.' 2
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
•
ft.
15. OUTER CASLNG (for multi -cased wells) OR LINER (if ap licable)_
THICKNESS MATERIAL
0 ft. 15 fL 2 SCH40 PVC
16. INNER CASING OR TUBING (geothermal closed -loop)
ft, in.
ln,
®Agricultural
QGeothennal (Heating/Cooling Supply)
0 Industrial/Commercial
',Irrigation
Non -Water Supply Well:
XpMonitoring
Injection Well:
0Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
® Municipal/Public
Residential Water Supply (single)
Residential Water Supply (shared)
0 Recovery
®Groundwater Remediation
Salinity Barrier
�Stormwater Drainage
Subsidence Control
0 Tracer
Q Other (explain under #21 Remarks)
4. Date Well(s) Completed: 5/17/18 1ire11 ID# PW-1
5a. Well Location:
NHRMC N/A
Facility/Owner Name Facility 1D11 (if applicable)
2131 S. 17TH STREET WILMINGTON, NC 28402
Physical Address, City, and Zip
New Hanover R06011-004-001-000
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field one latilong is sufficient)
34 12 13.84 N
77 55 09.43
6. Is(are) the well(s)0Permanent or pTemporary
W
7. Is this a repair to an existing well: © Yes or No
If this is a repair,, fill out brow; well construction information and explain the nature of the
repair under #21 remarks section or on the back of this form
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. indicate TOTAL NUMBER of wells
drilled: NA
1:3
9. Total well depth below land surface: 25
For multiple wells list all depths ifdifferent (example- 3" 200' and 2c i00')
15
(ft.)
10. Static water level below top of casing: (ft.)
If water level is above casing, use "+"
$r'
11. Borehole diameter:
12. Well construction method: Auger
(i.e. auger, rotary, cable, direct push. etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) N/A Method of test: NSA
13b. Disinfection type: N/A Amount: NIA
FROMTO DIAMETER
FROM
ft.
ft.
17. SCREEN
FROM
TO
ft.
DIAMETER
THICKNESS
MATERIAL
15 ft.
ft.
TO
25 ft.
fL
DIAMETER
2
In.
in.
SLOT SIZE
.010
THICKNESS \LITERI.4L
SCH40 PVC
18.GROUT
FROM
0,2 It.
TO
1
ft.
MATERIAL
Concrete
1
ft.
13
ft.
Bentonite
EMPLACEMENT METHOD & AMOUNT
Poured
Poured
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROTO
13 ft.
25 ft.
MATERIAL
Coarse
EMPLACEMENT METHOD
Poured
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
DESCRIPTION (color. hardness, soiltrock type, grain size, etc.)
FROM
ft.
TO
ft.
ft.
ft.
ft.
ft.
ft,
ft.
See Attached
ft.
ft.
�[,„�•� 1. •-
ft.
ft.
21. REMARKS
ft.
ft.
JU
19 2O1$
•
krftft
22. Ce • cation:
Si nature ofCertified Well Contractor
5/24/18
Date
By signing this form, 1 hereby cergfr that the well(s) was (were) constructed in accordance
with ISA NCAC 02C.0100 or ISA NCAC 02C.0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-I617
24h. For Infection Wells: In addition to sending the fonn 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 & iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this fonn within 30 days of
completion of well construction to the county health department of the county
sshere constructed.
Fonn GW-1
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

BORING LOG
New Hanover Regional Medical Center
2131 S. 17th Street
Wilmington, North Carolina
PW-1
Drilled by: Applied Resource Management, P.C.
Logged by: J. Zuncich
Date: 5/17/18
Depth
•
Description
Water
Content
Blow
Coun
2' - 4'
Light brown very fine to fine grained sand.
Low
Grab
5' - 7'
Tan to beige, very fine to fine grained sand. No hydrocarbon
odor.
Low
HP
10' - 12'
Tan -light brown with light gray mottles, very fine to fine grained
sand. No hydrocarbon odor.
Low
HP
15' - 17'
Light to medium gray silty to fine grained sands changing to
dark gray brown fine sand at 16'. No hydrocarbon odor.
Moderate
HP
20' - 22'
Medium brown very fine to fine grained sands. No hydrocarbon
odor.
High
HP
23' - 25'
Greenish gray silty sandy clay/clayey sand mixture. No
hydrocarbon odor.
High
HP
HP - Hydraulic Push
RECEIVED/NCDENR/DWR
JUN 25 2018
Water Quality Regional
Operations Section
Wilmington Regional Office

RECEIVER/NCDENR/DWR
Steel Manhole
Ground Surface
♦
13' Bentonite
♦
Groundwater
Table
12' Sand
PW-1
Locking Cap
•••
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• i••••••
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1•••• •w *0%
•••••••
JUN252018
Water Quality Regional
Operations Section
Wilmington Regional Office
0.5' Concrete/Grout Crown
15' Riser
10' Screen
y
25' Total Depth

WELL CONSTRUCTION RA YM DWR
For Internal Use Only:
1. Well Contractor Information:
Donald Cummings
JUN 25 2018
Well Contractor Name
Water Quality Regional
Operations Section
NC Well Contractor Cenification Number Wilmington Regional Office
Applied Resource Management, P.C.
Company Name
2412—A
2. Well Construction Permit #:
N/A
List all applicable well construction permits (Le. WC, County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
El Agricultural
0Geothennal (Heating%Cooling Supply)
0 Industrial/Counrnercial
l� Irrigation
Non -Water Supply Well:
()Monitoring
Injection Well:
©I Aquifer Recharge
Aquifer Storage and Recovery
❑IAquifer Test
El Experimental Technology
DGeothennal (Closed Loop)
� Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed: 5/22/18
5a. Well Location:
NHRMC
Municipal/Public
j Residential Water Supply (single)
El Residential Water Supply (shared)
© Recovery
©Groundwater Remediation
Salinity Barrier
IDStonnwater Drainage
IDSubsidence Control
Tracer
Other (explain under #21 Remarks)
Well ID#A l B
N/A
Facility/Owner Name Facility I DN (if applicable)
2131 S. 17TH STREET WILMINGTON, NC 28402
Physical Address, City. and Zip
New Hanover
R06011-004-001-000
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field. one tat/long is sufficient)
34 12 21.43 N
77 55 13.01
6. Is(are) the IN X Permanent or ElTemporary
7. Is this a repair to an existing well: DYes or 12 No
If this is a repair,/ill out Anown well construction information and explain the nature of the
repair Ruder #21 remarks section or on the back of this form.
8. For Ceoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only I GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled: NA
9. Total well depth below land surface: 15
For multiple wells list all depths ifdr,'/ferent (example- Raa2200' and 2(ad00')
(ft.)
10. Static water level below top of casing: 5' 00 (ft.)
If water lerel is above casing, use "+"
I. Borehole diameter:8" (in.)
12. \\'ell construction method: Mud Rotary
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) N/A Method of test: N/A
13b. Disinfection type: N/A Amount: N/A
t�5
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
rt.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (If a IicableJ
FROM
TO
- DIAMETER
THICKNESS
MATERLAL
0 ft.
5 ft.
2 - 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
MATERLAL
5 ft,
15 ft
2 in'
.010
SCH40
PVC
ft.
ft
in.
18. GROUT ....:.
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0.2 ft.
1 fr.
Concrete
Poured
1 fr.
3 ft.
Bentonite
Poured
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)•
FROM
TO
MATERIAL
EMPLACEMENT METHOD
3 ft.
15 fr•
Coarse
Poured
ft.
ft.
20. DRILLING
LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness. soil/rock type, grain size, etc.)
ft.
ft.
See Attached
ft.
ft.
ft.
ft.
, .
f
ft.
ft.f
9
ft.
ft.
19 Nita
ft.
ft.
�0�
", i t ,•'.
J's,..,
21. REMARKS ' ..
22. Ccrtif . ion:
C O
Signal re o Certified Well Contractor
) 5/22/18
Date
By signing this form, 1 hereby certiti• that the well(s) was (were) constructed in accordance
with 15A NCAC 02C.01(10 or 15A A'CAC 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 fonn 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 fonn to the address in 24a
above, also submit one copy of this fonn 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 Sunplv & Injection Wells: In addition to sending the fonn to
the address(es) above, also subunit one copy of this fonn within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW-1
North Carolina Denarnnent of Environmental Oualitv - Diviainn of Watpr Rpcnnrrae
Go,r:rn.i '1 11 ln1 L

BORING LOG
New Hanover Regional Medical Center
2131 S. 17th Street
Wilmington, North Carolina
AIB
Drilled by: Applied Resource Management, P.C.
Logged by: J. Zuncich
Date: 5/21/18
Depth
Description
Water
Content
Blow
Count
2'- 4'
'Tan brown to 'beige very fine to fine grained sand. No
hydrocarbon odor.
Low '
Grab
5' - 7'
White beige fine to medium grained sand. No hydrocarbon
odor.
Moderate
HP
10' - 12'
Light gray brown fine to medium grained sand. No
hydrocarbon odor.
High
HP
13' - 15'
Light gray brown fine to medium grained sand. No
hydrocarbon odor.
High
HP
HP = Hydraulic Push
RECEIVEDINCDENRIDWR
JUN252018
Water Quality Regional
Operations Section
Wilmington Regional Office

12' Sand
Steel Manhole
Ground Surface
3' Bentonite
AIB
Locking Cap
,..
••_• 1�• •••
• •
• 1•• •••
•
• •
•;•_. �•�•�•�
••�• 1••❖•4
Groundwater •.�•• 0•�•�•�
Table •• ••••1
•_•_• 10•00
•••••I
•••• •
• 1••
•••
••• •❖.•: •
•• C•••
•�••• 1se
�•�•�••
•••
••• 1 • • •
••••1• •••••
•00 100••••
••S • 1 i•0•i
••••. 1•.•.•j
•..�. 1:• S••
• • • 06041
. • 0.. 1••••••
•••� 1••••••4
•••• 10• ••:
•••
•
p••••1 &•••
•••• 1•.•.•.
•;•;• Dee40:
[• • ;• 1000
•;•• 1�•:•�•
I•••'••• ••:.•.
E•••••••l
0.5' Concrete/Grout Crown
5' Riser
10' Screen
RECEIVED/NCDENR/DWR
JUN 25 '018
Water Quality Regional
Operations Section
WIIn1lnntnn Uoainnal nKCe
•
15' Total Depth

WELL CONSTRUCTION RECMIMMNMO R/DWR
1. Well Contractor Information:
Donald Cummings
JUN 25 2018
Well Contractor Name
2412-A
Water Quality Regional
NC Well Contractor Certification Number Operations Section
Applied Resource Mana tel9 o 't e
'h
•
Company Name
2. Well Construction Permit #:
N/A
List all applicable well construction permits (i.e. UUC, County, State, Variance. etc.)
3. Well Use (check well use):
Water Supply Well:
® Agricultural
°Geothermal (Heating/Cooling Supply)
° Industrial/Commercial
',Irrigation
Non -Water Supply Well:
x° Monitoring
Injection Well:
Aquifer Recharge
°Aquifer Storage and Recovery
Aquifer Test
°Experimental Technology
°Geothermal (Closed Loop)
°Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed: 5/22/18
5a. Well Location:
©Municipal/Public
°Residential Water Supply (single)
°Residential Water Supply (shared)
®Recovery
®Groundwater Remediation
°Salinity Barrier
Stonnwater Drainage
°Subsidence Control
Tracer
°Other (explain under #21 Remarks)
Well ID#AiA
NHRMC N/A
Facility/Owner Name Facility IDt1 (if applicable)
2131 S. 17TH STREET WILMINGTON, NC 28402
Physical Address, City, and Zip
New Hanover
R06011-004-001-000
C'omnty Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field. one IaNlong is sufficient)
34 12 20.47 N 77 55 13.16
6. is(are) the well(s) X0Permanent or ®Temporary
7. Is this a repair to an existing well: ° Yes or d No
If this is a repair, fill out known well construction infa•nnatior and explain the nature of the
repair under 421 reamrke 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: NA
9. Total well depth below land surface: 15
For multiple wells list all depths ii'fdijferent (example- 30n_ D0' and 2%100)
10. Static water level below top of casing: 3.77 (ft.)
Ifwater level is above casing, use "+"
11. Borehole diameter: 8" (in.)
12. Well construction method: Mud Rotary
(ft.)
(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:
453617
14. WATER ZONES
FROM
TO
ft,
ft.
ft.
ft.
DESCRIPTION
15. OUTER CASING (for multi -cased wells) OR LINER (if a licahle)
FROMTHICKNESS MATERIAL
0 SCH40 PVC
ft.
TO
5
ft.
DIAMETER
2
in.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROTO
DIA.!IETER
THICKNESS
MATERLAL
ft.
ft.
n.
ft.
17. SCREEN
ft.
in.
FROM
5
ft.
TO
15 ft
DIAMETER
2
in.
SLOT SIZE
.010
THICKNESS
SCH40
MATERIAL
PVC
ft.
ft.
in.
18. GROUT
FROM
0.2 ft.
TO
1
ft.
MATERIAL
Concrete
EMPLACEMENT METHOD & AMOUNT r
Poured
1
ft.
3
ft.
Bentonite
Poured
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
3
ft.
15 ft.
Coarse
Poured
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
ft.
ft.
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
See Attached
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
-
ft.
ft.
ft.
ft.
it_N 19 Zr
21. REMARKS
22. Ce cation:
r�
Signature of Certified We Contractor t( Dale
By signing this firm, I hereby certr'fi' that the well(s) was (were) constructed in accordance
with 1 SA NCAC 02C .0100 or ISA NC4C 02C .0200 Well Consa•nction 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 fonn within 30 days of completion of well
construction to the following:
5/21/18
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells: In addition to sending the fonn 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 & lnjection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this fonn within 30 days of
completion of well construction to the county health department of the county
where constructed.
Fonn GW-I
North Carolina Department of Environmental finality- nivicinn nfWater RPc,uirroo

BORING LOG
New Hanover Regional Medical Center
2131 S. 17th Street
Wilmington, North Carolina
AIA
Drilled by: Applied Resource Management, P.C.
Logged by: J. Zuncich
Date: 5/22/18
Depth
Description .: ;:
Water
Content
- Blow_
Count
2 '- 4'
Gray `brown sand fine to medium grained with gravel rock. No
hydrocarbon odor.
Low
Grab
5' - 7'
Dark gray fine to medium grained sands. Wet at 7'. No
hydrocarbon odor.
Low to
Moderate
HP
10' - 12'
Medium to dark brown fine to medium grained sand. No
hydrocarbon odor.
High
HP
13' - 17'
Medium gray fine to medium grained sand. No hydrocarbon
odor.
High
HP
HP - Hydraulic Push
RECEIVED/NCDENR/DWR
�IJN 1 5 118
Water Quality Regional
Operations Section
Wilmington Regional Office

Steel Manhole
Ground Surface
3' Bentonite
Groundwater
Table
12' Sand
AIA
Locking Cap
0.5' Concrete/Grout Crown
5' Riser
10' Screen
RECEIVED/NCDENR/DWR
JUN 25 2018
Water Quality Regional
Operations Section
Wilmington Regional Office
15' Total Depth

WELL CONSTRUCTION REC(PafvENR/DWR
i. Well Contractor Information:
Donald Cummings
Well Contractor Name
2412-A
lMIN252018
Water Quality Regional
NC Well Contractor Certification Number Operations Section
Applied Resource ManaPregftePt.Office
Company Name
2. Well Construction Permit #:
List all applicable well conctniction permits (Le. C11C, County, State, Variance, etc)
3. Well Use (check well use):
Water Supply Well:
N/A
For Internal Use Only:
451646
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
Non -Water Supply Well:
•Monitoring
Injection Well:
�Municipal/Publ is
Residential Water Supply (single)
QResidential Water Supply (shared)
['Recovery
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
'Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed: 5/21/18
5a. Well Location:
NHRMC N/A
Groundwater Remediation
['Salinity Barrier
JStonttwater Drainage
Subsidence Control
Tracer
['Other (explain under #21 Remarks)
Well ID# A-3
Facility/Owner Name Facility IDt' (if applicable)
2131 S. 17TH STREET WILMINGTON, NC 28402
Physical Address, City, and Zip
New Hanover R06011-004-001-000
County Parcel identification No. (PiN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
34 12 18.84 • N 77 55 09.90
6. Is(are) the well(s)1x Permanent or DITemporary
7. [s this a repair to an existing well: Dyes or ONo
this is a repair, fill ota known well construction information and explain the nature of the
repair under u21 remarks .section or an the back of this, form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Welts having the same
construction, only I GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled: NA
9. Total well depth below land surface: 20
For multiple wells list all depths if d(erent (example- 3@t200' and 2@I00)
10. Static water level below top of casing:
If water level is above casing, use "-' "
8n
11. Borehole diameter:
11.50
(in.)
12. Well construction method: Mud Rotary
(i.e. auger, rotary, cable, direct push, etc.)
(ft.)
(ft.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) N/A Method of test: N/A
13b. Disinfection type: N/A Amount: N/A
14. WATER ZONES
FROM TO • DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if ap licable)
FROM TO .. . . DL4METER THICKNESS MATERIAL
0 10. ft' 2 in. I SCH40 PVC
16. INNER CASING OR TUBING (geothermal closed -loop)
FROMDL METER
ft.
ft.
ft.
17. SCREEN
TO
ft.
ft.
in.
in.
THICKNESS 1 MATERIAL
FROM
TO
DIAMETER-
SLOT SIZE
THICKNESS
MATERIAL
10 ft'
20 ft.
2 in'
.010
SCH40
PVC
ft.
IR f_Drlr im
ft.
in.
FROM
0.2 ft.
1
ft.
ft.
TO
1
8
ft.
ft.
ft.
MATERIAL
Concrete
Bentonite
19. SAND/GRAVEL PACK (if applicable)
FROTO
8
ft.
20 ft
MATERIAL
Coarse
EMPLACEMENT METHOD & AMOUNT
Poured
Poured
EMPLACEMENT METHOD
Poured
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
See Attached
TO
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
22. Certi won:
ft.
ft.
ft.
ft.
ft.
ft.
ft.
SignatUreofCertified Well Contractor
5/21/18
Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction .Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this 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 Sunni), & Iniection Wells: 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
where constructed,
Form GW-)
North Carolina Department of Environmental Quality - Division of Water Resources
Revised 2-22-2016

BORING LOG
New Hanover Regional Medical Center
2131 S. 17th Street
Wilmington, North Carolina
A-3
Drilled by: Applied Resource Management, P.C.
Logged by: J. Zuncich
Date: 5/22/18
Depth
Description
Water
Content
Blow
Count
2 '- 4'
White to beige very fine to fine grained sand. No hydrocarbon
odor.
Low
Grab
5' - 7'
Medium to dark brown silty to fine grained sand. No
hydrocarbon odor.
Low
HP
10' - 12'
Light brown fine grained sand with some medium grains. No
hydrocarbon odor.
Moderate
HP
15' - 17'
Light brown fine grained sand with some medium grains
changing to light gray fine to medium grained sand. No
hydrocarbon odor.
High
HP
18' - 20'
Light gray very fine to fine sand. No hydrocarbon odor.
High
HP
HP = Hydraulic Push
RECE VEC/NCDENk/N'
JUN252018
Water Quality Regional
Operations Section
Wilmington Regional Office

12' Sand
A-3
Steel Manhole 0.5' Concrete/Grout Crown
Ground Surface
T
8' Bentonite
♦
1•••••
•••
Groundwater : �•:•:•
Y•
•
'' •••••
•
••• •
••• •
•••••
•i ••
•••
•••••
••• •
••• •
•••••
•••••
to •••
•• ••
NV
•••••
•�•.••
••
•• • •
.�•••
Table
Locking Cap
10' Riser
10' Screen
•
20' Total Depth
RECEIVED/NCDENR/DWR
JUN 2 5 2018
Water Quality Regional
Operations Section
Wilmington Regional Office

WELL CONSTRUCTION RE - NR/DWR
1. Well Contractor Irrforntatioit:
For internal Use Only:
451.645
Donald Cummings
JUN 25 2018
Well Contractor Name
2412-A
Water Quality Regional
NC Well Contractor Certification Number Operations Section
Applied Resource Mana� �r✓13fitoen�lggipgaefit:e
Company Name r
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
DGeothennal (Heating/Cooling Supply)
D industrial/Commercial
Irrigation
Non -Water Supply Well:
Of Monitoring
Injection Well:
©'Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
D Experimental Technology
El Geothermal (Closed Loop)
DGeothennal (Heating/Cooling Return)
4. Date Well(s) Completed: 5/24/18
5a. Well Location:
NHRMC
DMunicipal/Public
DResidential Water Supply (single)
DResidential Water Supply (shared)
()Recovery
©Groundwater Remediation
®'Salinity Barrier
DStormwater Drainage
D Subsidence Control
DTracer
©'Other (explain under #21 Remarks)
Well iD# PW-2
N/A
Facility/Owner Name Facility 1 D# (if applicable)
2131 S. 17TH STREET WILMINGTON, NC 28402
Physical Address, City, and Zip
New Hanover
R06011-004-001-000
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field. one Iavlong is sufficient)
34 12 14.05 N 77 55 10.87
6. Is(are) the IIell(s)I _'Permanent or DTemporary
W
7. is this a repair to an existing well: ®Yes or d No
If this is a repair, )ill out known well construction information and explain the nature ofthe
repair wader I21 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only I GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled: NA
9. Total well depth below land surface: 180
For multiple wells list all depths ifdifferent(example-3' 00'and2(41400')
10. Static water level below top of casing: 40.3 (ft.)
Ifwater- level is abore casing, use "+"
11. Borehole diameter: 8" (in.)
12. Well construction method: Mud Rotary
(ft.)
(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
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft,
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if a licable)
FROM
TO DIAMETER
THICKNESS
MATERIAI.
0 rt,
62 0.1
8 ln•
SCH40
PVC
16. INNER
CASING OR TUBING
(geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERLAL
0 ft.
140 ft.
4 in'
SCH40
PVC
rt.
ft.
in.
17. SCREEN .
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
140 ft.
180 It
4 in'
.020
SCH40
Pvc
ft.
ft.
In.
18. GROUT . - .. .
FROM
TO
MATERIAL
EMPLACEMENT pfETHOD & AMOUNT
0 ft'
130 ft•
Bentonite
Poured
130 ft.
135 ft.
Bentonite
Poured
ft.
ft.
19. SAND/GRAVEL PACK
(if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
135 ft.
140 ft•
Coarse
Poured
ft.
ft.
20. DRILLING
LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness. soil/rock type, grain size, etc.)
ft.
ft.
See Attached
ft.
ft.
ft.
ft.
ft,
ft.
i _
ft,
ft.
__ ... ..}
rt.
ft.
3.'�..jy. y
SSryry
F11®
ft.
ft,
SOq,
21: REMARKS _•'
rt:"�rii„
22. Certit' 'on:
Sigmatu f red Well Contractor
5/24/18
Date
By signing this form. 1 hereby certifp that the well(s) was (were) constructer/ in accordance
with 15A NCAC 02C .0100 or 15A A'CAC 02C .0200 Well Construction Standards and that a
copy ofthis 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 fonn within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the fonn to the address in 24a
above, also submit one copy of this fonn 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 & iniection Wells: In addition to sending the fonn to
the address(es) above, also submit one copy of this fonn within 30 days of
completion of well construction to the county health department of the county
where constructed.
Fonn GW-I
North Carolina Deparnnent of Environmental Oualitv - Division of Water Resources
Pebado-A 291 11114

RECEIVED/NCnENIR/I)WR
JUN 5
Water 0
P i • .)tt, RA
BORING LOG Wilmington Regionai Office
New Hanover Regional Medical Center
2131 S. 17th Street
Wilmington, North Carolina
PW-2
Drilled by: Applied Resource Management, P.C.
Logged by: J. Zuncich
Date: 5/23/18
Depth
Description
Water
Content-
. Blow
Count
0 '- 20
Tan brown to gray fine to medium grained sands with orange
brown cemented sands near 19 - 20'.
Low
MR
20' - 40'
Orange brown cemented sands 20' to 22' changing to gray
brown medium to coarse sands with alternation clay layers.
Low to
Moderate
MR
40' - 60'
Gray brown coarse sands changing to sandy clay at 50' with
alternating sands and clays to 60' then changing to silty stiff
clay at 57' to 60'.
High
MR
60' - 80'
Light gray sand clay to 72'. Void from approximately 72' to
80'. 65' to 70' shell hash.
Moderate
to High
MR
80' - 85'
Limestone rock
High
MR
85' - 120'
Alternating PeeDee clay mud rock, limestone mixtures.
High
MR
120' - 140'
Alternating PeeDee clay mud rock, limestone mixtures
changing to a coarse sand stone at 138'.
High
MR
138' - 185'
Light gray, coarse sand stone.
High
MR
MR = Mud Rotary

Lock
Concrete Surface
135' Bentonite
Groundwater. Table
5' Sand
P W-2
1' Stick up
In 6" x 6" Locking
Cover
62'x8"
Casing
RECEJt`E J/NCoENR/Dwk
JUN 5 2018
Water Quality Regional
Wilmington Operations Sectio,;
Regional ,five
0-140'x4"
Riser

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
For Internal Use Only:
451644
Donald Cummings
Well Contractor Name
2412-A
NC Well Contractor Cenificat ion Number
Applied Resource Mana
RECEIVED/NCDENR/DWR
JUN 25 2018
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (,.e. UIC County, State. Variance, etc./
3. Well Use (check well use):
tit$ k*jaI
s ectect rt
Wilmington Regional Office
N/A
Water Supply Well:
Agricultural
DGeothennal (Heating/Cooling Supply)
Industrial/Commercial
',Irrigation
Non -Water Supply Well:
x3 Monitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
®Experimental Technology
DGeothenllal (Closed Loop)
Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed: 5/21/18
Sa. Well Location:
NHRMC
14. WATER ZONES
FRO\]
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if a livable)
THICKNESS AtATER1AL
SCH40 PVC
16. INNER CASING OR TUBING (geothermal closed -loop)
TO
0
FROM
FROM
ft.
9 ft.
• DIAMETER-
2
...in.
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
El Municipal/Public
0 Residential Water Supply (single)
Residential Water Supply (shared)
® Recovery
©Groundwater Remediation
Salinity Barrier
}}Stonnwater Drainage
▪ Subsidence Control
Tracer
✓ Other (explain under #2I Remarks)
Well ID#A-2
N/A
Facility/Owner Name Facility ID# (if applicable)
2131 S. 17TH STREET WILMINGTON, NC 28402
Physical Address, City, and Zip
New Hanover R06011-004-001-000
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one rat Long is sufficient)
34 12 18.87 N 77 55 11.79
6. ls(are) the well(s) 3Permanent or EiTemporary
7. Is this a repair to an existing well: ® Yes or QNo
If7his is a repair, Jill out known well construction htforn,atiot and explain the nature of the
repair under #21 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the sane
construction, only I GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled: NA
9. Total well depth below land surface: 19
For multiple hve!!s listal!depths ifdii erent (emnnple- 3�a1200' and 2ti 100')
W
(ft.)
10. Static water level below top of casing: 8.10 (ft.)
If water level is above casing, use "+"
11. Borehole diameter: 8" (ill.)
12. Well construction method: Mud Rotary
(i.e. auger, rotary, cable. direct push. etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) N/A Method of test: N/A
13b. Disinfection type: N/A Amount: N/A
ft.
17. SCREEN
ft.
In.
FROM
9
ft.
TO
19 ft.
DIAMETER •
2
in.
SLOT SIZE
.010
THICKNESS
SCH40
MATERIAL
PVC
ft.
ft.
in.
18. GROUT..
FROM
0.2 ft.
TO
1
ft.
_ MATERIAL
Concrete
EMPLACEMENT METHOD & AMOUNT
Poured
1
ft.
7 ft.
Bentonite
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
7 ft.
TO
19 ft.
ALATERL4L
Coarse
Poured
EAIPLACE'tIENT METHOD
Poured
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM TO
ft.
ft.
ft.
ft.
ft.
ft.
DESCRIPTION (color, hardness, soil/rock ttpe, grain size, etc.)
See Attached
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
.101 2-
21. REMARKS
4001 4r•
22. Certification:
Sit, 1, a ure o rti e ell
5/21/18
Date
Br signing this fw•tn. I hereby certif' that the wells.) was (were) constructed in accordance
with 15,4 NCAC 02C .0100 or ISA NC4C 02C.0200 Well Corsa•uction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You ]nay use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this fonn 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 fonn to
the address(es) above, also submit one copy of this fonn within 30 days of
completion of well construction to the county health department of the county
where constructed.
Fonn GW-1
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

BORING LOG
New Hanover Regional Medical Center
2131 S. 17th Street
Wilmington, North Carolina
A-2
Drilled by: Applied Resource Management, P.C.
Logged by: J. Zuncich
Date: 5/21/18
Depth
Description
Water
Content
Blow ,'
Count
2 '- 4'
White to beige very fine to fine grained sand. No hydrocarbon
odor.
tow
Grab
5' - 7'
Medium to dark brown fine to medium grained sand. No
hydrocarbon odor.
Low
HP
10' - 12'
Gray brown fine to medium grained sand mixture. No
hydrocarbon odor.
Moderate
HP
15' - 17'
Dark brown very fine to fine grained sand. No hydrocarbon
odor.
High
HP
18' - 20'
Dark brown very fine to fine grained sand. No hydrocarbon
odor.
High
HP
HP - Hydraulic Push
RE CEIVEDINCQENRIRWR
JUN 2 5 2018
Water Quality Regional
OperationSection
Wilmington Regional

Steel Manhole
Ground Surface
3' Bentonite
Groundwater
Table
12' Sand
A-2
Locking Cap
0.5' Concrete/Grout Crown
A
9' Riser
A
10' Screen
RECEIVED/NCDENR/DWR
JUN252018
Water Quality Regional
Operations Section
Wilmington Regional Office
19' Total Depth

For Internal Use Only:
WELL CONSTRUCTION RE�OR.D.L(;iW,11NR/DWR
1. Well Contractor information:
Larry W Skipper
Well Contractor Name
2483-A
NC Well Contractor Certification Number
JUN 1 8 2018
Water Quality Regional
Operations Section
Skipper's Well Drilling & Pump Se#0n Regional Office
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):
WS0801028
Water Supply Well:
Agricultural
Geothennal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
Non -Water Supply Well:
Monitoring
Injection Well:
DMunicipaVPublic
:Residential Water Supply (single)
DRcsidenlial Water Supply (shared)
Recovery
(Aquifer Recharge
(Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothennal (Closed Loop)
Geothennal (Heating/Cooling Return)
Groundwater Remediation
DSalinity Barrier
fStormwater Drainage
Subsidence Control
Tracer
rIlOther (explain under tt21 Remarks)
4. Date Well(s) Completed: 5/16/2018
5a. Well Location:
Crete Holdings, LLC/Tyler Shaw
Facility/Owner Name
239 Raleigh St, Wilmington, NC 28412
Well ID#
Facility ID# inapplicable)
Physical Address, City, and Zip
New Hanover
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field. one laUlong is sufficient)
34°10'2" ,N W
6. Is(are) the wells) Permanent or OTemporary
7. Is this a repair to an existing well: DYes or XNo
If this is a repair,_lill out known well construction information and caplaln the nature of the
repair under 1121 remarks section or an the back ofthil farm.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the sane
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:
77°56'32"
9. Total well depth below land surface: 140 (ft.)
For multiple wells list all depths ifdiJerenl (example- 3(w 200' and 24100')
10. Static water level below top of casing: 30 (ft.)
If Hater level is above easing. use "+ •'
11. Borehole diameter: 12 (in.)
Rotary
12. Well construction method:
(i.e. auger, rotary, cable, direct push. etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 120 Method of test: Pump
13b. Disinfection type: HTH
Amount:
101b.
45
14. WATER ZONES
FRO?1 TO
125 ft„ 140.
DESCRIPTION
PD..-,
rt.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if apRlicable)
FROM _ TO DIAMETER THICKNESS I MATERIAL.
ft.
ft.
in.
16. INNER CASING OR T(IBING
FRONT
TO
+1 ft. 84 ft.
(geothermal closed -loop)
i DIAMETER
THICKNESS
6;-in' Sch 40
MATERIAL
Steel
n ft. •
17. SCREEN
FROM
ft.
none
'TO
ft.
ft.
ft.
IIANIE'rER SLOT SIZE
in.
in.
THICKNESS
MATERIAI
IS. GROUT
FROM
TO
0 ft. 84 ft.
MATERIAL
Ben. Grout
EMPLACEMENT METHOD & AMOUNT
T Line
ft.
fL
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
'IQ
ft.
ft,
MATERIAI.
EMPLACEMENT METHOD
rt.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
DESCRIPTION (eolnr, hardness, soil/rock lype,Jrain site. etc.)
Coarse Sand
FROM
0 ft.
20 rt.
TO
20 h,
40 ft.
Clay and Sand
40 ft.
75 ft.
Limestone
75 ft*
125 rt.
125 ft'
140 ft.
ft.
ft.
21. REMARKS
ft.
ft.
Clay and Rock
PD
JUN 1 ; ZU1')
22. Certification:
)t}{pt tSla4 .
d W �� 1�'� June 5, 2016
Signature of ' tilled Well Contras o'. Date
Bv.vigning this fore;, I hereby genii that the well(s) was (were) constructed in accordance
with 1.5.4 NCAC 02C .0100 or 15A NCAC 02C..0200 Well Construction Standards and that a
cops 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 Iniection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following: .
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

I. Wtu Contractor Information;
For Internal Use <?niy;
450'6
f
t'ao;l;ty In4 ClrapplioaDte)
35-0 A`5%1 be,7 ct t o 1� c�-1 l.k tee,
Physical Addrox, City, and Zip
i41.4wtt4r
(County
WELL CONSTRUCTION RECORD (G'W-1)
RECEIVED/NCDENR/DWR
Well Contract 1 Nutt
NCWen C'ontractor C7riifleation Nunnccl
Company Narita
N112018
Water Quality Regional
Operations Section
• ice
2. Well Construction Permit N-
/,Ise are/ opplicabie Wrll crr>farnrcyion permit:, II,r. (//C. County. $rare. Parlance, reel
3. Well t)se (check well use):
Water Supply V4c{t:
Agricultural OMltnicipaiieublic
Gcdtherma! (Heatin oo(ing SUppty) QResidcntfal Webs Supply (single)
ladtistrial/Commgrcial D12idential Water Supply (shifted)
NOR -Water Supply Wdl:
Monitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
ixperimcntal Technology
Geothermal (Closed Loop)
Geothermal (1-featin Cooling kctum),
OitzeovztY
DGroundweter Retrlediation
DSaliniry Barrier
C)StOrrfwater Drainage
08obSldCnetCO61701
El['[aocr
Other (e;cploin under Al l I2t:marks)
4. Date Well(s) Completed: 6.--/d! f well Mb
Sa. Weil location;
Kic
FaciiilyfO icrNamc
Kneel' rtitlntillcnfion No. (PIN)
Sb. Latitude end longitude in degreeernimates4econds or decimal do reca:
(if well flew, out let/long is sufficient)
3((s // N oY7oS'3. ��7r w
6. ib(are) the well(s)aPerniancnt or O'ternporary
7. is this a repair to art cx(uting well: FJYes or io
If this is u eepuv ,/tli lifer k, ,win well crM.1rbulan Pitfirr,nhf!on fold explain the aeoete of fete
uud.rY2irrruwrk.xeu;florlarofdta(wckofMa, fin,..
S. For Geoprobe/D.PT or posed -Loop Gtotbermat Was having the same
constru lkn. only I UW-t is needed, Indicate 'TOTAL NUMBER of wells
9. Total well deptti below /And surface: al
Per mrelt/piewelly llsrall depths ,/differ u(ermnpe,.W.200•end1t ttv'
I.O. Stacie water tcvcl below top of casing: to (f.)
0-wafer lave'! IN OpIrre ming, te*t' ,,r. •.
I. borehole diameter: lip (in.)
12. Well construction method: 4.14 f t'
(;.o. ztuser, rotary, ciblc, direct pu.lb, ar,1
(�)
FOR WATER SUPPLY Wfif.1. S ONL
03a. Yield'(gp[b)
13b. Dtmofecdou woe:
Y:
Nletbod of test:
Am
PROM TO f*' fi r S ` .. .
rt.
�h
d a,
ft.
ft.' ilTE1Q C/iS1'tG_ Iformalf i•Rsr�. + .. `i �' �:.: hie
'
_ to
"'I �-
�t*'t,enlilaltttatri� (,tl'. neon'
FROM - 7`O pMMe'1-µrJ, rtit(yrPtms
in•
rt. a.
rt. ft.
Xt
rt.
FROM TO
N
.
FROM TO•
In.
tn.
V fr,
in.
0 0
MATERIAL
TRU('/ENY MATCRJA
ft.
Mj R1A1, ii_RMFLAMSEZT WOOD R Mtt3t7
neatTO
n.
(0.
ff.
rl,
tl.
ft.
fi1(+rd�rrri�e),
MATERIAL 1tMPtACCMfiii%'hth'77fOD
FROM 7U n1s1ntvrtpal (caw. r.
intarot t tyro p>'ineDt etc)
ff,
ft.
It.
k
ft.
rt.
fr.
rt.
JONI)52-84a-J
22, Certification
nuts
file a+gnbrg fhisrorm, 1 Here �'a,, ( (her theweI!•(.t) was (were) etmlrirrGed In occorde
w(H, ISR NC:4C 02C 4100 iJA ` 41(; 02c .0200 Wtli (:anarAtIlon &ma w& furs, Oro
&py pf this ►ecofd leas been provided r4 rho xdI *wavy,
23, Sitc dingrarn or additional reel/ details;
You may use the, back of this page to provide Militia/la! well she details or w
cot1E/ruction details. You may also attach additional piiges if ntxessiiry.
5 J MI.1"c,1NS'1ffi:UCTIONS
24a, ForAll Was: Submit this Conn within 30 days of completion of w
construction to the following:
Divisional Water Resource*, tatormatiou ktvc,ess1op, ()nit.
1617 Mali Service Center, Raleigh, NC 27699-1617
24b. For infection Wegaa: In addition to sending the ibm, to the address in 2
above, also submit one copy of this form within 30 days of completion of tie
oonstruclien:to the Mowing:
Division of Water Re: ttrcei,.Underground Injection Control program,
1636 (nfa11.Service Cr, Relegbt W.27699-i636
• For Wafer Sootily & loleeiJua *dip in ackiition to sending the form
A address(es) above, also submit one copy of this tonrn within •30 days
Si e of Cortified r7-0l

For Inttrnai Use Only:
I. Well Contractor Information:
_A lei
Well (:vntrocoiNpnte
WELL CONSTRUCTIO?J RECORD (GW-1)
RECEIVED/NCDENR/DWR
a-I�9
NC Walt Contactor CCrtitiwtion Nnrnber
/4-/2%;ut_ pl4
Company Numc
2, Weil Construction Permit N:
l,tru/7appIkahlr. well CQh. Iraclinn ryrnnIls (Lr.
3. W,cf Use (check well use):
iVe� t pply Wetl;
tp_Tkadon
iUN 1 1 ?018
Water Quality Regional
� Operations Section
I—n+ ,iilgtoP- Rogierral Office
(UC. Cowd(v. State. Porfancg @k:J
DAgiicuhutal f Mnnicipal/Pohlic
DGcot)termal ((1eating/Cootivg SLPPtY) Oltesidennaf Water Supply (single)
indttsfrial/Commercittl °Residential Water Supply (shared)
Non -Water Supply Well:
QMonito,ing _ _
Injection Well;
©Aquifer Recharge
°Aquifer Storage and Recovery
Aquifer'fest
IAxncritn('ntal Technology
Geothermal (Closed Loop)
Geothermal ([4ealing/Cooling RctunrJ
nleceovery
DGroundwnecr Remediation
°Salinity Barrier
rStotmwater Dnuinage
EDSubSidc, oc Corttmt
°Tracer
_pottier (explain andel. #21 Remarks)
4. Date Well(s) Completed: ,S-s S -Ig'Weft Ilia
Sa. Wed Location:
loft,) .. S . c or
FacititytOwncr Ntunc
S", ?� � DAL
Pltysical Address.. (:itv, and Zit)
Facility tY)fi hi -applicable)
(:Meaty Pare& 1tiontAw.ttion No. (MN)
Sb. Latitude and longitude io degrees/minuteNseconds or decimal &grew:
(If Well Held, one iet/1org u 3ufileieet)
3 `i u Jo N . 0 7 ri, o').r w
6.1s(arc)the wetl(s)t 'erraaneat or °Temporary
7, is this to repair to an existing wet: Dires or E}No
I/'thfs IS u p s/r,,/1tl on known wctl crwr,l mina infltrmntinn one explain dm 'want Oftke
repair undo 11'2 i rvtnarls .audios or on flies hrrejc of ikipPubr,,
8..For Geoprolte/p?r or Closed -Loup Geothrzmal Wells haying the same
construction. only 1 GW-i is needed. lnniesirPTOTALNUMBER of wells
' multi* list all aepikc ((fdifjsrfnt (erotnp(plc. 0p•und 2(gll JO'j � )
for
9. Total well &pdi t Mw land surface: r% t
1.0. Static water level below to pleasing: / '7 (ft% )
//Mohr /awe is f// ova eYrring oaf, -" „
t 1. •tinreltote diameter: et, (in.)
12.'Wed1 construction method: (J,A9eej
(i.e, awl% notary, ,iyle, duos/ posit, ale.)
FOR WATER SUPPLY WRI,M S ONI..Y:
f3a. Yield (gpm) Method of teats
13b-Ditsinfection typo; Amount:
MATL l�r EMPMACEMF TMg'kit'QD&?MOS/
leMPiAC,eM F.N T MEM(113
n171CkiVTWfricetor.brrharkteN4ec,I pc a»la2h • •
45°172
PiWM 'Fri Jursournon
tt. 2 N' coArI ga .,l
It.
'I3.MYfERCASINCAfro trli .
caw r0 -"" M' l 1 R ?•?tt"Ts llt4Dm'i4ibdo):'•
ptAt1161%L2 TFrICKNCSS I MA•PRybtt—t[,
s%t % ii Mlj_ ..., •
iA, e Dct tS )t pvC
FROM
ft.
04,11.1
Dr art '. itootsys._,- tL in, I
DtAtlf.;:a i
in.
11,0T.SrLt : TAH'K,N9't
via o a
•
1HArr tat.
20/DR Li' •` Aeke .iidda
MOM
t( n
f•ft
ft, R.
inemsz
i
22(;ertMradon: Din;Q/r,r -
ntractor DMA
lsy ,rrgtthrg this no, 1 l+�e}by certify Oar lire WIN wort (were) cud Dr aCOOrden
t tt* al NCAC 02C.0I or /,F,f NCA(' tt2c .0200 K'ol/ Cantu ec1Aut .Seonecirtr end rho
chpy of rhls record tips t car provided to the well nwaor,
23. Site diagram or additional well details:
You may use the beck of this page to provide additional well site details or w
construction details. Yob may also attectl additional PaRts if noccssary.
$1./BNIIIITAL INSTRUCTIONS
24e, (nor All Wdt.; Submit this Cori within 30 days of compietioo of w
construction to the following:
Division of Wader Resources. Information rrocesstog tints,
1.07 Nall Service Center, Raleigh, NC 27649-I4f7
24b. rm. iniection Wes; in adititios) co sending the font to the „dares in 2
above, also submit one Dopy of this form within 30 days of completion of w
construction to'tbc following:
Division of Water Resources, Underground Injection Control Program,
1436 Merit Servlec• Castor, eatkiiptc 14(: 27699-1636
24c, For Water Song S: Iniustiou Wells; In addition to sending the form
the addres os) above, also submit one copy of this form within 30 days
annplerion or well construction to the c1Mtnity health depatlment of the coun
whore rrencirur'o,i
Signature of m Mi vcrdtr ^�s' l`

2. V1'eli C.onatr'uction Perodt # W
t.,.<r iIf applicable well (obstruction perttila A .. U/r:. CaiuJN. Stares j017mnc, Rini
3. Wc1 Use (check well use):
Witter Supply Well:
Agricultural °Mfunicipal/Public
Geothermal (fteatingtoofing Supply) °Residential Water Supply (single)
tniltlstrial/COmmrrcial f Recidentinl Water Supply (shared)
to
Non -Water Supply Well:
Monitoring jlte:Ovtry
DGroundwater Remcdiation
DSalinity Barrier
DStormwater Drainage
OStibsidenoe (:odtinl
Geothermal ((;hosed Loop) Clrfa:car
Gentherniat (1{cating/Cooling Return) tjOIher (explain under#2t Remarks)
4. Date Well(s) Completed:.S:'7dr Well Jt)tl
3a. Wet location:
Injection Well:
Aqui(er Rechaige
Aquifer Storage and Recovery
Aquifer Test
17,xperimontal 'Technology
WELL CONSTRUCTION RECORD fGW.41
). weft Coatractnr information:
Gn .)..e,S'
K cII I�Un I7b or Name
el99
fiECEIVED/NCDENR/DWR
JUN 11 2018
NC Well Contractor C rtifrcation Number
6
.4
,/1 u p gir ` titer Quality Regional
(;Cr•upgny NameftCi iSSectit if
Wilmington RPaional Office
Vo gobJ4'a
ZAcg tBRtal
Faciiily/Owrwr Niunc Facility il)1! (if applicable)
Lt �y3 b QtL^ 1 Sla.lf 4 e,dltalyi4 IQ
Physical Address, City, and Zip AjC .
!u �lAA•t
Ccunly ParcelIdentificarion No. (PIN)
fib - Latitude and longit & is degrees/minutes/seconds or declm) degrees:
Orwell field, one tat/long is sufrlolen()
6. la(are) thewetl(s)
jtv
Permanent or OTcmporery
7. Is thfs a repair to an existing weft: OVesryiN.
(l Jni.t' is a rlyrair. fiu 010 kn0wra wrli @anslruc,fm l'nfignfation and Cxe;(a/n ifra nature of the
repair under 22 i remark., sediwr or on the huc'k ofrhie forte.
S.For Geoprobc/U.P"f or Cluscd.L,00p Geotbenant.Wets having rho same
construction, only 1 GW-1 is needed. Indicate TOTAL MJMBER of wells
th'il Icd:. .
r
9. Total well depth below had surface: J is
I'ar m illlple wells ilsl an &pths ifdJIffirent (ample- 30200' and 201007
1.0, Static water level below top of egisiog:
{rw ,tar hold iv ahnre e'oa'tng• au- "•r"
11, $nrebole'darameter_ 4 (in.)
12. Well etlnntrucdori method:
fi.o. auger, rotary. cnblo, direct push. etc.)
c'3'-tom
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gym) Slothful or teat:
13b. U3ainfectiAn type: Amount:
For internal Us Only: .
450771
Qo
ft.
3$�.
ft.
�s d
15.,(DIT1:R'CASNCJIoi'miffti.eaacb..> ZEIKERM
FROM {{��--ro Nieman
bh)
'. 1 `_ R DIAlw_ T'lrtt 70. T$rr• Mt em n At.
^ a.oy a 1fff �i�
tl iKAERaG:91tilltt;.ftr••�ott,4�a1 .0403
r���-
.�M TO MAMP,:rlk i'tll�r7(N 0)''' MA'r Jt1AL
ft.tl: (n.
17.I •SCP-EE •
FROM , TI
ft.
ft.
TO
rt.
ff.
baAMl:7'Kk . St,n'r02,F TRKIEa.�U MA'aERlAll
n, L410 / )t__1
MAT OAI, rMh)r�t pp on&,emu
IF ft,
19. 1!707MliVE I1PAcAtfappilipbte1;;•
FROM m MATERIAL
/LQ stir. ^ 'lee*
ti
ft.
Mt't4C4 rrrftgc11f i
R
ft.
tc
rt.
ft.
InSatwF;OF Rwort i.rd.tar, reWresit Inks Realm+Ns etc)
fL
f.
R.
14
rr�D\r Pin f;
22. Certification:
Sigtm • orCerti wet CoOr J~ Dine
Kai 119pin$ Ott fo t hereby iffy that the tvcil(s) war twee cvnelncted in accarde"
mirk 1.54 NCe (: 02C.0(00 or iSA N(.'rl(; 02C.0.200 Well Conrrrtrcvurn ROAdartIC n»d rhr,
copy aphis mare has been provided ea the wc:J owner,
D. Site tliagrarn or additional well details:
You rely use the back of this page to provide additional well site dctaits Or w
'construction details. Yee May also attach additional pages ifiSerps'ary.
glii %1 -AN TRUC17QN$
24a. For MI We Submit this font within 30 days of ctuupletion of w
construction, to the following:
Division of Wrener Resources, Infortatatian Prorcasing Unit,
1617 Mail Service Center. Raleigh, NC 27699.161.7
24b. err JWiectton Wetla• In addition to sanding the form to the alWI.0z in 2
above:, also submit one copy of this form within 30 days of oomDlctlon of w•
construction to thc'foltowing:
Division of Water t nrces; Underground 1113jeetioo Control Program,
1 1636 Mail Serviec Center, ho NC27699•f636
~�— — 24e, 1'0 �FSs.r.tqi'71y r ..1nfee({gn_ Wight: In addition to sending h.c fore
the address(*) above. also submit one copy of this forte within 30 days
conviction of well constructionconstruetion to the Fumy health department of the coon
wIternr r•rwrciru -rr,i
,(M)
(ft_)

WELL CONSTRUCTION RECORD fGW-1)
1. Well Contractor information:
"3.,,..5'
`ken C'ucurndor Name
'NC wen Contfaelor Ctsrlitia4oe1 Number
ekt-s-A uit tL ► .
C:V:npany Name
2. Wen Coastruction PcrmltN:
a.*t air o.y lie»kle well ran.,rrucrlon pima( y U.e. or:, rouge. Stole. ("origin:4.. al.
3. Wcli Use (check well wsej:
Water Supply Vt'elt:
Agricultural
Geothermal (Heating/Cooling Supp(y)
indttstriai/Commerciai
ization
For Internal Use Only:
---
ft
1s: 0111 :1_ CASH ifoo rti/oLea edep ejlQ$t: , fai 144. •,
moor rrc �ntantf7ra , .macros M V Rta• i.
+, I ft' i ,fA a a. 1 - in. ` u� a I f� �
.fli':ti1ahltFtFAt ;pi#IVISli�ttD. ,. id.... '..'Y'.. ,,.:
�044M TO nr,ainEren Ma vutint, •
ft. R in,
N ft.
to,
TnrrANOSS
DMtmicinal!Fuhlic
OResidentiai Water Supply (single)
°Residential Water Supply (shared)
Nou-Wader Supply Well:
Monitoring °Recovery
n(eet in'Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer 'Test
kixperit+temal Technology
Geothermal (Closed Loop)
ls'fs�J1
RECEIVED/NCDENR/DWR
JUN11?.018
Water Quality Regional
V'/ilminpto.i Regional Office
00roundwater .Retnediat ion
°Salinity Barrier
OStotmwater Drainage
°Subsidence Control
°Tracer r
(Gopthennat (k•fentin !(;(ruling ttefum) Manx (explain under $02t Remarks)
4. Dote Well(s) Completed: S / It —Jr wen lflrY
S21. Wet) i,ncatfon:
P1AN-R.. PI9Nc2/ie„
Facility/Owner Name 1 Facility IDN (If apolloab1c)
Physical AdcGCss, C:ky, and 7,ip C AW.4.31,»/I 8tAC4 N
c:riunly
Parcel JdrntiliwAon No, (PIN)
Nb. Latitude and longitude in flegreea/minutes/seroods or decimal degrees:
(If well field, one IslAorts is sufficient)
.74 ° 03 , JM O 72 , SR
6. 18(ate) the well(a)01Rerreaneat or Cj'1'emporury
7. is this a repair to an existing well: .°Yes rye NPlo
Oars is a rep(ir• f ll o',i known well t wts(ruCtfan Inf rmo(i.n and exploln Ike nowt ra of.*
repoir (ardor ii21 remarks 41.4Y1011 or on Nth hcn/c t1J'fhbsjorm.
8. for Geoprobe/DPT or Closed.Loop Geothermal Welb having fife same
cnnstructiom only 1 GW 1.is needed. badicate TOTAL Nt,JM13R of wells
drilled
9. Total well depth bctow tend surface: 3 S (11.4
Forntp(tlplewells fist all d th,(jd erent(otample_3g200•and2( t0V)
10. Static natter, level below top of easing:
((woos" nowt is cont., croin�, exc. "I. "
a t. Borehole diameter: _ (in.)
12. Weft construction method: 61.) flied
(i:o• aver, rotary, cnblq dir4rt p%L h. Qv)
(ft)
FOR WATER SUPPLY WELDS ONLY:
13a. 'Odd (gpto)
Method of teat: ,
f3b. Disinfection type:
Amount:
FROM TO
,cL 0 �� R
ft,
?r;•
1:9Ant11:1171 LSr s zr 1B `N
J7Ykn. .0/
inf
FROM
h
•
Q. .
MAtICATA , EMPAM hfENt ME71a'OD & Algf4I
Ar ��5e
ft.
ft.
MATitttAt, tSllrt'r.Ac€ntE.frtMflfl)b
fr.
it
,20AVEUXO.f OU'faLOQef:irtiklrt.;
•
FROM TO } 026c1OFTIONfeoten 1
ft, ft. nio"°�.r°"f'°`k ""for" `"
ft.
ft.
fl.
ft.
fr.
22, Certification:
Sigratura of Ce ed We Ontmcror
8y AO* tM ,form, I v ce'I y oaar the WIN too (µ'Q// ethnsr wiet der atom
Welk .ISA (I2C.0104err iSA NCAe 02C.0200 WWI Cementatiron.51tarda,rls mrd ur
copy of 614 Merl hos been'provldrd f9 the well owner.
23. Site diagram or gdditioopl well details:
'You may use the back of this page to provide addUtional welt site details or v
construction details. You may also attach additional pages if nccess:;ry.
St'BMftLAL ThiSTFUCTIKINS
24. )44r AY Weill* Submit this foram within 30 days of completion of W
construction to the following:
Dtv(sion of Water lftaoarcee, foformation kroceseing Uniq
1.614 Mait Service Center, Raleigh, IVC 27699-1611
24b. FurJWJ&cttoo. Well1: in addition to sending the foaan to the address in :
nbove, also submit one mry of taus form within 30 dayys of conviction ufvi
construction.* the following:
Division of l6tater Reaoorces,'Under?tr*end )loJ Control .Program,
1436 Mail Service Center, Redd" 7VC2.7699-i.36
2.4e. Tor Water Supttl ,at infest/ion 5(eIJ ld addition W sending the Corm
tho addross(es) abavo, nlyO submit one copy of this form within 30 days
completion of Wert con,swetivtt to the county health department of the coot
whom Prtncfrl,rfeti

2. Welt Construction Permit it:
J.c,•' ufl atipiicablr wtdl construction genrtict (i. e. {l/C, Co uts) .pass, ltOh'onK. etc)
3. Well the (check well use):
Water Supply Wept
Agricultural OMunicipal/Public
Geotitcamai (iteatingt;ooting Supply) QResidentiai Water Supply (single)
lndtuuial/Cvtntncrssl DRecidcutiol Water Supply (shared)
kr,._ ,
WELL COJNSTRUCTION RECORD (GW .1)
1. Well Contrarm) information:
Ge Jl • v s
c!1 ColitSilthr Narnlo
.2.)44
RECEIVED/NCDENR/DWR
JUN 1 1 2018
NC Well Coorratctor Curia -motion Number
li Au11 L4.1.4 1.1 pri.iii,;36,ter Quality Regional
(:Qmnany Mane
Afat1of13 .kctton
Wilmine-ton Regional office
Non -Water Supply Well:
Monitoring
lojecbon "ell:
Aquifer Recharge DGroundwntcr Remediation
Aquifer Storage and Recovery DSalinity Barrier
Aquifer 'I'est OStorrmvater Dnlinn4t
i$xperintental'rcehnolpfiv ClQSuhsidenceContml
Geothermal (Cloted Ulm) DTracc
Geothermal ft (eatfm (uultng Rctum)_ 00ther (explain ands•f12(Romarks)
4. Date Weil(s) Completed: 6- 6J- )1 Wrf I1)1)
Sat. Wd illation:
ation:
c,ku,,cJ.
Facility/Owner Name
ReteVcry
facility 1.1*(if applicable)
l:G t'? CARoj,4,4 6e.4-c4 ii
Physical Add'e ,, City, anti Zip l..l , I M /uc . a f 4 e9
Gmrnry Picot Idnnofiurtion No. CNN)
fib. Latitude and Ip*h de in degrees/minutes/set-rinds or decimal degree,:
(if well field, one Iet/lons is sufficient)
�Y
6.le(att)tirowell(s) Permanent or °Temporary
7. fs this a repair to an existing well: E3Vet orONO
(l(hu' is a r%c(ir. fill iron known writ con:amcrta+ lnf(>nnoricn ad rxp(a/n the natmr.2flbc
repair ocular t!21 rapawkx ct toot In' on the hock oftha farm.
S. For GeoprobtACIP'r or Clt,sctl-hoop Geothermal Wells baying the some
cttnstructkm. only 1 GW-I i$ needed. Indicate TOTAL NUMBER of wells
9- Tolrr►well Jcpth blow land surface: 7 9 y
l-or multiple wells lost all &ohs Vet fsren! (ermnple- $0.700' and 2¢y;;I005
0. &alit water level below cop of easing:
Tfream'. Ave Isalto byia.sin , cm.
i I. liorenple diameter: fo (tn.)
12. Welt construction ctcthod: /A.)
(i,c. arty; cony, vnble, loyal pads rut)
FOR WATER SUI'Pl,3r WEJ.i S ONJ.v:
13a. Yield (glrro) Method of teat:
„ V
131% bisinfecbton types Amount:
(ft)
Eft)
For internal list, Unly: 50769
It W,ATKR'BO(til.8,;':1
t9 QM To
o Q.
.fig � COS (SY • S.C./.
ft. ft.
• .
siVTERC SINCOorareo.t►Ant,sotds� Tt �.
'
MOM
� rat I ell'�M/v(0(1At.
,t, / �. i � �[�
�f a
.
FROM TO n►AMrrarx • 911►CH.MB&R'... ..
t6 R. in,
R rt. in.
SCAN..:
FROM irT
lkt;;ihrallSig
22. Certification:
StR r:
0/ 0
141
MATRIULAI.
eltlft£NR.tS MATERIAft.
I
•
EMPLA MENTreret2L&lani.
J .-Ae901-A
t^ttiFI.ACCMI:t'rRME7 WD
SI6ma iw of citified Veil Contractor tau %r
1)nu
fbAnn, f &raby certify moot me i 'ii(.o) war free) ew,snrpted rn 0000(z ,,
wfk !SA C 02C,0140.v►1Set ivGAC 02C.0200 WI emrrnnretton S4Mcbrelc (uuf Ih(
copy *Phis rocord fran baen Provided to (he wall mwner.
23. ,Site diagram or addltioDaJ well details:
You may use the back of this page co provide additional well site details or r
construction details, You may also attach additional Ages' if n2i:essaiy.
24a. J(or All Walt Submit this form within 30 days of completion of w
construction to tho following:
Division of Water Reaouree, information Protesting Ginn,
1.617 Mail Service Center, iialtigb, NC 27699-1617
24tti Fry lnicctfon ybrefli: In addition to sending the form to the address in 2
nbovo aisv submit one copy of this form within 30 days of completion of w
const action to the following:
Division of Water Rc wsirceS, UBderground lnJestivn Control Program,
1636 (►1ri113erviee t enter•. Raleigh, NC:27699. toss
24e. C()
In addition W sending tide lama
die address(0) above, also stabmit one copy of this font within 3O days
completion of well coon -notion to the county health department of the eour
whin+, r nnui'm-rnd

WELL CONSTRUCTION RECORD fGW-1)
For Internal life Only;
1. Well Coatratinr Informatioo:
GlArati�e Nc5-
wd9 L;notrattur Namo
NC WWI Contractor Curtifica,tion Numbor
RECEIVED/NCDENR/DWR
JUN 11 2018
Water Quality Regional
/4 g w I 0 La ��iy,�perations Section
Company Name %"" On•" l frfigr7l rat Offlce
2. % •ell Construction permit do
/.r.rr 1/11 appli.,abla welt roR.vrnnrrion pCrntike 11.a. !DC.. County. SIdC. Porkmco. 040
3, Well Use (thetk }tell use):
Water Supply Weil:
/%gncunurai LiMumCipalwat ie
Geothermal (Heating/Cooling Supply) )!(tsidentiat Water Supply (single)
Industrial/Commercial DResidentinl Water Supply (shared)
Noa-Water Supply Well:
Monito.rin; R-covery
njeetlon eU:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
r"xpeilmental Technology
°Groundwater Reinediation
QSaliniry Barrier
DStormwatet Drainar
QSubsidcnce Control
Geothermal (Closed Loop) Ot1•ceaar
Geothermal (f leetinsg/Cooling Return) Other fez itin uncler #2 E Remark
4. date Well(s) Completed:
Sa_ W,1t1 !Amnion:
Facili /Owner Namc Facility r7)11(ifapplicable)
4b ,gobtr-t• EAn-
Physical Address. City, and Zip
Nt.QA,ttcv
County
t..f•a.tl •'t .N C-
'Well il)t)
lip i?
NArval hiss fiontion No. (.1114)
fib. Latitude and longitude it degreea/minutrs/seconds or decimal degrees;
tifwell field, one IaUlong is siifflcien )
d 5'3 - ;' 9
6.18(are) the wells) 'ermasent or Q'rvmporary
7. Is this a repair to an existing well: eves, or eV'n
lfthis k a repair, fill nut known wtil jor:srroMon fnbmorf.n and extrruto rho nature of the
repair under n2l tvutarka y.u;i(on or al the (we;knf chi.. Jorei.
& For Geoprobe/UP'r or Closed -loop Geothermal Wells having the some
consituction. only 1 (]W-t is needed. Indicate TOTALNUMBER of wells
9.'Total well depth below lairdauriace: 3
1 i r mid yr/e wells '/sY aft a14ndt.t 1j(Q)rvu (ample, 30209 and 1(100'j
tt. Stant water level below tap of easing:
!ttvaterkw( (Sabort'cmq,i , un: "4-"
11. Borehole' diameter:
r
(in.)
12. Welt eons+tn•uction method: &. Ai-" .A.-f—
{i.c. IMPF, rtNery, u,blo, direct push, cw.)
(ft-)
(ft.)
FOR WATER SUPPLY WELLS ONLY:
13*. Yield (Spun) Method of teat:
13b. Diriafectioa type Amount:
:14.. WATZR Oielf:
50"
FROM t, oral wrr.nv —
�o rl. � � +�. ca�►rs . ,ras .�
tt. ft.
3. OUi'Ft2 CA33NG_itlti-ctreitll?.
FRAM fb ntArtP;oR Kfl,CKNess M 'rr,R1At.
• a tffritiat. T41t3iNG ikenttittii$ ltyq p)
q. .: ..',
FROM TO MAMFT It l'Or(:K11RS5 MATERIAL
h. ft. in,
h rt. in.
0Q._
matt 1..:rO ..._..._..... I minairtfca 1 XA/T.lJTT 1 TNrrXNv rIV ATArtlAt.
42g ft : / fry in• J 0/0 .0c1e ,ova—.
2 ft in.
FROM TO
G fr. a.
fF.
n.
ll/AiratIAI.
l• e
ff,
101,r NTMfTWOAdtAntOtl'
ou.l —..7
:t9NautteXtvirlils;
PAM
ft.
ft.
1t.
MAT Ri1L aantr ciao refit i on
:StF'flRil:
FROM
ft.
tesids
DrfiT.421
ft
War,.bordrnr, w.Wreck bar entrr;l , etc)
n.
ft.
ft.
01,5
DcN
22. Certification:
Signature ofC • edWel:on 'cior
Date
By .r(gnntg Ihrs rm. ( csnjg. Olor ihr wr(i(s) teas (Arc) constnrard rn accordm
wham (SANG1C r2C.OI t. or ISA MGAC O2C.p?oo Wall Carranation 5tondardc and lira
copy of thh ra - norla y boon provrdrf to the x•M( owner.
23. Site diagram or additional well details;
You may use the back of this page to provide additional well site details c+r w
construction details, You may also attach additional pages iffiecesstuy.
91.191► I TAL INSTR'UC'li(ON t
248. Fur All WO: Submit this fort within 30 days of canonic -don of w
construction to the following:
Division of Water Resoorceg, lnfotivattoa Processtog Gott,
1.617 Mall Service Center, Raleigh, NC 27G99-161.7
24b. for falsetto() Welk! 1n addition to sending the form to the addres4 in 2
above, also .submit •one copy of this form witnio 30 days of completion of W.
00tSiructiotrto the'f4liowing:
Division of Water Reecterces, UiodergroundInJection Control Program,
A636 M*R Scnice Center. Raleigh, NC 27 99-1636
24c. Eg Watcrysynnlr dt inizitua W_tUs: In addition to $coding the forth
The address(es) above, also submit one copy of this form within 30 days
Vlit cation of well aons6vction to the county hctilih department of tttc awn
. atln CI7t11•tati

NONRESIDENTIAL WELL CONSTRUCTION REC0171064111
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
1. WELL CONTRACTOR:
William M Wiaains
Well Contractor (Individual) Name
Mid -Atlantic Drilling, Inc.
Well Contractor Company Name
PO Box 315
Street Address
Carolina Beach
City or Town
(910 ) 458-5020
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(ir applicable)
SITE WELL ID #(if applicable) MW 1 ,MW2,MW3,MW4
3. WELL USE (Check One Box) Monitoring ttf Municipal/Public ❑
Industrial/Commercial 0 Agricultural 0 Recovery ❑ Injection ❑
Irrigation❑ Other 0 (list use)
DATE DRILLED 1 1 /28/2017
4. WELL LOCATION:
2461 Carolina Beach Road
NC 28428
State Zip Code
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Wilminaton COUNTY New Hanovo
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley "Flat ❑Ridge ❑Other
LATITUDE 34
LONGITUDE 77 °
" DMS OR
" DMS OR
DD
DD
4506'17
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):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
7. CASING: Depth Diameter
Top 0 Bottom 5 Ft. 2"
Top Bottom Ft.
Top Bottom
8. GROUT: Depth
Top 0 Bottom 1
Top 1 Bottom 3
Top Bottom
9. SCREEN: Depth
Top 5 Bottom 15
Ft.
Material
Ft. Concrete
Thickness/
Weight Material
sch 40 PVC
Method
Pour
Ft. Bentonite Chi Pour
Ft.
Diameter Slot Size Material
Ft. 2 in. .010 in. PVC
Top Bottom Ft.
Top Bottom Ft.
10. SAND/GRAVEL PACK:
Depth
Top 3 Bottom 15 Ft.
Top Bottom Ft.
Latitude/longitude source: ❑GPS oTopographic map Top
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS) /I1,l-Q- 11. DRILLING LOG
5. FACILITY (Name of the business where the well is located.) ('V Top Bottom
/
Coastal Fuels
Facility Name Facility ID# (if applicable)
2461 Carolina Beach Road
Street Address
Wilminaton NC 28401
City or Town State Zip Code
RECEIVED/NCDENR/DWR Zip Code
Contact Name
Mailing Address
City or Town Water Quality Regional State Zip Code
vd I Operations Section
Area code PhbhlAffitIM 8P Regional Office
6. WELL DETAILS:
a. TOTAL DEPTH: 15
b. DOES WELL REPLACE EXISTING WELL'? YES 0 NO q/
c. WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
12. REMARKS:
in. in.
in. in.
Size Material
#2 torpedo sand
Bottom Ft.
Formation Description
J AN ' 6 2O1a
us n mount man nole covers
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
12/20/17
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
Jr-
PRIIGtE`OFRSON OtJSRUAla2 THE 1/OELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GW-1 b
Rev. 2/09

WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
uu1. i vi n,
1. Well Contractor Information: 45
n G
Donald Cummings
�f'!
Well Contractor Name
2412-A
NC Well Contractor Certification Number
Applied Resource Management, P.C.
Company Name
2. Well Construction Permit #:
N/A
List all applicable well construction permits (i.e. UJC, 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
fMunicipal/Public
°Residential Water Supply (single)
°Residential Water Supply (shared)
Recovery
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
°Groundwater Remediation
°Salinity Barrier
fStormwater Drainage
°Subsidence Control
Tracer
°Other (explain under #21 Remarks)
4. Date Well(s) Completed: I //20/17 Well ID#N/A
5a. Well Location:
City of Wilmington
"mac
N/A
Facility/Owner Name Facility ID# (if applicable)
Green Field Lake Park, Wilmington, NC 28402
Physical Address, City, and Zip
New Hanover R05417-017-001-000
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
34 12 54.4 N 77 56 32.3
W
6. Is(are) the well(s)0Permanent or °Temporary
7. Is this a repair to an existing well: °Yes or x°No
If this is a repair, fill out known well construction information and explain the nature of the
repair wider #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: 100
For multiple wells list all depths if different (example- 3@200' and 2@100')
(ft.)
10. Static water level below top of casing: 1 1 (ft.)
If water level is above casing, use "+"
11. Borehole diameter: 0-100/8" (in.)
12. Well construction method: Mud Rotary
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 80 Method of test: Airlift
13b. Disinfection type: HTH 3°/ @10g
Amount:
Form GW-1
14. WATER ZONES
FROM
r TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (for multi -cased wens) OR LINER 0f a licable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
80 ft.
4 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
80 ft.
100 ft.
4 in-
.020
SCH40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft'
24 ft
Grout
Poured
70 ft,
75 ft.
Bentonite
Poured
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
75 it
100 ft.
Course
Poured
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc)
0 ft,
60 ft,
Sandy clay to clay
60 ft.
110 ft•
Limestone to cemented sands
110 ft
225 ft.
Clay (some mud rock to 135')
ft.
ft.
ft.
ft.
ft,
ft,
r- ems, f -..
rt.
ft,
1 1,
` 7. C,.., $. Q 1.
21. REMARKS
DEC5 201?
0
unit
;n¢0r>�.,:,sion PrcC05-3'-tg „alit
22. Certification:
Signature of Certified Well Contractor
CJ:1'iQ/F L(v
11/29/17
Date
By signing this form, 1 hereby certifj+ that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NC.AC 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 inay 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 Iniection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this fornllyy i�McptifR BIn of well
construction to the following: KKCt�Gtt llttUULL fft����������
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleieh,uI 17T921148
24c. For Water Supply & Iniection Wells: Inn l�aaddition to sending the form to
the address(es) above, also submit one copy of this f vi pP days of
° completion of well construction to the courWatt86l�� ��0 the county
where constructed. (�i]erat1D S
Wilmington Regional Office
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

Print Form
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Terry White, Jr
Well Contractor Name
3287-B
RECEIVED/NCDENR/DWR
NC Well Contractor Certification Number
IET
JUN 11 2018
Water Quality Reg uiwl
Company Name Operations Section
2. Well Construction Permit #: Wilmington Regional Office
List all applicable well caltsonction permits (i.e. UIC, County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
©Agricultural
ElGeothermal (Heating/Cooling Supply)
Industrial/Commercial
"Irrigation
Non -Water Supply Well:
OMonitorin g
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
ElMunicipal/Public
Residential Water Supply (single)
Residential Water Supply (shared)
▪ Recovery
QGroundwater Rem ediation
®Salinity Barrier
® Storrnwater Drainage
Subsidence Control
Tracer
Other (explain under #21 Remarks)
4. Date Well(s) Completed: 1 1 /06/1 7 Well ID# M W 8
5a. Well Location:
Modern Laundry
(0'1
FacilityiOwner Name Facility ID# (if applicable)
3607 Oleander Dr, Wilmington 28403
Physical Address, City, and Zip
New Hanover
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
For I ternal Use Only:
14. WATER ZONES
FROM
TO
DESCRIPTION
7 ft.
15 ft.
sand
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if a licable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
5 •
2 I"'
Sch40
PVC
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
5 ft.
15 ff.
2 in'
0.010
Sch40
PVC
ft.
ft.
in.
1R GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft.
1 ft.
concrete
pour
1 ft.
3 fir
bentonite
pour
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
3 ff.
15 ft.
#2 silica sand
pour through augers
ft.
ft.
20. DRILLING
LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soiVrock type, grain size, etc.)
ft.
ft.
See Consultant's Log
ft.
ft.
ft.
ft.
ft.
rt.
ft.
ft.;a
: ". ,' i,
ft.
ft.
7
ft.
ft.
NOV .A 2017
21. REMARKS
22. Certification:
34 12 58.43 N 77 54 11.05
/qitadf.. 2725-A for Terry VVhite
6. Is(are) the well(s)0Pernianent or OTemporary
7. Is this a repair to an existing well: IJYes or No
If this is a repairr, fill out known well construction infotnlation and explain the nature of the
repair under #21 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface: 15
For multiple wells list all depths if different (example- 3@200' and 2@100)
(ft.)
10. Static water level below top of casing: 7 (ft.)
If water level is above casing, use "+"
11. Borehole diameter: 8.5 (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:
St,natute ofrcitified Well Contractor
11/19/17
Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 15ANCAC 02C.0100 or 15A NC.4C 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
constriction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniectiotl Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this fonn 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 fonn within 30 days of
completion of well construction to the county health department of the county
whore constructed.
Form GW-I
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Terry White, Jr
Well Contractor Name
3287-B
NC Well Contractor Certification Number
IET
Company Name
2. Well Construction Permit k:
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
©Agricultural
®Geothermal (Heating/Cooling Supply)
ElIndustrial/Commercial
',Irrigation
Non -Water Supply Well:
jaMonitoring
Injection Well:
0Aquifer Recharge
0Aquifer Storage and Recovery
0Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothennal (Heating/Cooling Return)
©Municipal/Public
Residential Water Supply (single)
Residential Water Supply (shared)
®Recovery
Groundwater Remediation
Salinity Barrier
Stormwater Drainage
Subsidence Control
Tracer
Other (explain under #21 Remarks)
4. Date Well(s) Completed: 1 1 /06/17 Well ina M W-7
5a. Well Location:
Modern Laundry
Facility/Owner Name Facility IDII (if applicable)
3607 Oleander Dr, Wilmington 28403
Physical Address, City, and Zip
New Hanover
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
34 12 58.64 N 77 54 10.27
6. Is(are) the well(s)OPermanent or ©Temporary
7. Is this a repair to an existing well: ©Yes or No
If this is a repair: fill out known well construction information and explain the nature of the
repair under #21 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface: 15
For multiple wells list all depths if different (example- 3@200' and 2@100)
10. Static water level below top of casing: 7
If water level is above casing, use "+"
11. Borehole diameter: 8.5 (in.)
12. Well construction method: auger
(i.e. auger, rotary, cable, direct push. etc.)
(ft.)
(ft.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm)
Met
13b. Disinfection type:
Form GW-1
Print Form
14. WATER ZONES
FROM
TO
DESCRIPTION
7 ft
15 ft.
sand
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if ap licable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
5 ft.
2 i"'
Sch40
PVC
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
5 ft.
15 ft
2 tn'
0.010
Sch40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft
1 ft.
concrete
pour
1 ft.
3 ft.
bentonite
pour
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
3 ft.
15 ft
#2 silica sand
pour through augers
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
ft.
ft.
See Consultant's Log
ft
ft.
ft.
ft.
ft.
ft.
ft.
ft.
_
ft.
ft.
'� . ry_, i , . ,
ft.
ft.
`� �f
s,' I 017
21.REMARKS 0\I
22. Certification:
w
i� /cI11.4241., 2725-A for Terry White
Stgnatute a et u6ed Well Contractor
11/19/17
Date
By signing this form, 1 hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C.0100 or I5ANCAC 02C.0200 Well Construction Standards and that a
copy of this record has been provided to are 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 Webs: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:C�►UCQ
li f Il iJ/NioD� M'�
Division of Water Resources, Underground Injection on gram,
1636 Mail Service Center, Raleigh, NC 27699-1636
hod of test: 24c. For Water Supply & Infection WeI1s�frVaditin ding the form to
the address(es) above, also submit one copy of this form ''. ithin 30 days of
completion of well construction to the, �oIunty health department of the county
where constructed. vvaier Quality Regional
operations Section
North Carolina Department of Environmental Quality - Division of Water Resourcesrlf Wilmington Regional p( ,Revised 2-22-2016
Amount:

Print Form
6. Is(are) the well(s)0Permanent or ©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 thisfonn.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface: 15 (ft,)
For multiple wells list all depths if different (example- 3@200' and 2(d 100'
10. Static water level below top of casing: 7 (ft.)
If water level is above casing, use "+"
11. Borehole diameter: 8.5 (in.)
12. Well construction method: auger
(ie. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Terry White, Jr
Well Contractor Name
3287-B
NC Well Contractor Certification Number
IET
4506
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. we. County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
Agricultural
®Geothermal (Heating/Cooling Supply)
[' lndustriailCommeroial
11Irrigation
Non-Water Supply Well:
Monitoring
Injection Well:
© Aquifer Recharge
Aquifer Storage and Recovery
© Aquifer Test
RExperimental Technology
Geothermal (Closed Loop)
['Geothermal (Heating/Cooling Retum)
['Municipal/Public
['Residential Water Supply (single)
®Residential Water Supply (shared)
['Recovery
Groundwater Remediation
©Salinity Barrier
['Stormwater Drainage
['Subsidence Control
['Tracer
['Other (explain under #21 Remarks)
4. Date Well(s) Completed: 11 /06/17
5a. Well Location:
Modern Laundry
Well ID# M W 6
Facility/Owner Name Facility m# (if applicable)
3607 Oleander Dr, Wilmington 28403
Physical Address, City, and Zip
New Hanover
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
For Internal Use Only:
14. WATER ZONES
FROM
TO
DESCRIPTION
7 ft'
15 ft'
sand
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if ap flexible)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
itt.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
5 ft.
2 in.
8ch40
PVC ,
ft.
rt.
in.
17.SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
5 it.
15 ft.
2 itr'
0.010
Sch40
PVC
ft.
ft.
in.
IS. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft'
1 ft.
concrete
pour
1 ft.
3 ft
bentonite
pour
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
3 ft.
15 ft•
#2 silica sand
pour through augers
ft.
ft.
20. DRILLING
LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
ft.
it.
See Consultant's Log
ft.
ft.
ft.
ft.
rt.
ft.
ft.
ft.
ft.
ft.
f . If ` ,. 3 , t„
7 ° r
ft.
ft.
21.REMARKS Y. 1 7017
}V®`i
,t•..p( rr,-,.
22. Certification:
34 12 57.71 N 77 54 10.67 w
/c�1Z[ZiL 2725-A for Terry White
Signature a ettified Well Contractor
11/19/17
Date
By signing this foray I hereby certify that the well(s) was (were) constructed in accordance
with 1 SA NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL 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
above, also submit one copy of this fort within 30 days of completion of well
construction to the following:
Division of Water Resources, entergrmAkare ip �t)grip}f'Bq®p rt,
1636 Mail Service Center, Rmk , l���gl��j�/���R
24c. For Water Supply & Injection Wells: In addition to sending the foram to
the address(es) above, also submit one copy off itliksi fTmi wijitlifQ30 days of
completion of well construction to the county haiiiiidefs.adm&V bY the county
where constructed. •
Form GW-1
North Carolina Department of Environmen
tal Quality - Division of Water Resources
Water Quality gg,liora,l zz-zn16
Operations Sii�n
Wilmington Regional Office

WELL CONSTRUCTION RECORD (GW-1)
Print Form
For Internal Use Only:
1. Well Contractor Information:
Terry White, Jr
Well Contractor Name
3287-B
NC Well Contractor Certification Number
IET
45O6 3
RECEIVED/NCDENR/DWR
JUN 1 1 2018
Company Name
2. Well Construction Permit ti: Water Quality Regional
List all applicable well construction permits (i.e. u par ortsteGE 0e, etc.)
Wilmington Regional Office
3. Well Use (check well use):
Water Supply Well:
®Agricultural
©Geothermal (Heating/Cooling Supply)
QIndustrial/Commercial
lj hrigation
Non -Water Supply Well:
Monitoring
Injection Well:
© Aquifer Recharge
0 Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
©Municipal/Public
®Residential Water Supply (single)
©Residential Water Supply (shared)
Recovery
▪ Groundwater Remediation
© Salinity Barrier
0 Stormwater Drainage
Subsidence Control
Tracer
®Other (explain under ti21 Remarks)
4. Date Well(s) Completed: 1 1 /06/ 1 7
5a. Well Location:
Modern Laundry
Well IDaMW 5
Facility/Owner Name Facility ID# (if applicable)
3607 Oleander Dr, Wilmington 28403
Physical Address, City, and Zip
New Hanover
County Parcel ldentification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one Iat/long is sufficient)
34 12 56.06 N 77 54 10.65
6. Is(are) the well(s)OPermanent or OTemporary
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 wider t121 remarks section or on the back of this fonn.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface: 15
For multiple wells list all depths if different (example- 3@200' and 2@I00')
(ft.)
10. Static water level below top of casing: 7 (ft.)
1f water level is above casing, use "+"
11. Borehole diameter: 8-5 (in.)
12. Well construction method: auger
(i.e. auger, rotary, cable, direct push, etc.)
14. WATER ZONES
FROM
TO
DESCRIPTION
7 ft.
15 ft.
sand
ft.
ft.
15. OUTER CASING (for multi -eased wells) OR LINER (if a licable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
p ft.
•5 ft.
2 in.
Sch40
PVC
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
5 f•
15 ft.
2 In
0.010
Sch40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft.
1 ft.
concrete
pour
1 ft.
3 ft•
bentonite
pour
ft.
ft.
19. SAND/GRAVEL PACK
(if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METIIOD
3 ft.
15 it.
#2 silica sand
pour through augers
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (colot; hardness, soil/rock type, grain size, etc)
IL
it'
See Consultant's Log
ft.
ft.
ft.
ft.
ft.
ft.
et.
fL.
r.. 4 t
ft.
ft.
i 7� ..
' '
rt.
ft.
NOV ?, q 2n17
21. REMARKS
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpnr) Method of test:
13b. Disinfection type: Amount:
22. Certification:
/y.LCL>{'L 2725-A for Terry White
11/19/17
Signature o et lied Well Contractor Date
By signingthisform, 1 hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For MI Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this fonn 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 & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW-1
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Donald Cummings
Well Contractor Name
2412-A
4506
NC Well Contractor Certification Number
Applied Resource Management, P.C.
Company Name
N/A
2. Well Construction Permit #:
List all applicable well constnulion permits (i.e. (IIC, County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
Agricultural DMunicipal/Public
Geothermal (Heating/Cooling Supply) DResidential Water Supply (single)
Industrial/Commercial DResidential Water Supply (shared)
Irrigation
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
DSalinity Barrier
fStormwater Drainage
Subsidence Control
QTracer
Other (explain under #21 Remarks)
4. Date Well(s) Completed: 1 1/3/17 Well ID# N/A
5a. Well Location:
Toledo Carolina
N/A
Facility/Owner Name Facility [D# (if applicable)
2915 Blue Clay Road, Castle Hayne NC 28429
Physical Address, City, and Zip
New Hanover R03312-003-031-000
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/fong is sufficient)
34 17 30.55 N 77 54 35.01
w
6. Is(are) the wells) fjPermanent or DTemporary
7. Is this a repair to an existing well: EjYes or allo
If this is a repair, frll out known well construction information and explain the nature of the
repair under #21 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled: 1
9. Total well depth below land surface: 13
For multiple wells list all depths if different (example- 3@200' and 2@100')
(ft.)
10. Static water level below top of casing: 4.51 (ft.)
If water level is above casing, use "- "
11. Borehole diameter: 8„ (in.)
12. Well construction method: Mud Rotary
(i.e. auger, rotary, cable, direct push, etc.)
For Internal Use Only:
J 6?3
I WATER ZONES
/i, M
TO
DESCRIPTION
ft.
fL
a t
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if a icable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
3 ft-
2 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
3 ft.
13 ft.
2 in'
.010
SCH40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0.1 ft.
0.3 ft-
Grout
Poured
.3 ft-
1.5 ft-
Bentonite
Poured
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
1.5 ft-
1.5 ft-
Coarse
Poured
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soiUrock type, grain size, etc.)
ft,
ft.
See Attached
ft.
ft.
ft.
ft.
ft,
ft.
RECEIVEC
ft.
ft.
ft,
ft.
NOV 14 2017
ft.
rt.
21. REMARKS -oration PrtscesM 4.110 i)ttn
itifo
owQmoo
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) N/A Method of test: N/A
13b. Disinfection type: N/A Amount: N/A
ertification:
JQ(Q<.take_z,
11 /3/17
Sig a' . ertified Well Contractor 1 \ Date
By signing this form, 1 hereby certify that the well(s) was (were) constructed in accordance
with I5A NCAC 02C.0100 or I5A NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the we!! 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
constnuction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the font to the address in 24a
above, also submit one copy of this foliE8E IET PI ENI Wn of well
construction to the following:
Division of Water Resources, Underground 1nje tign cRrit fol Program,
1636 Mail Service Center, Ra i Nt 21769Siite6
24c. For Water Supplv & Injection Wells: In addition to sending the form to
the address(es) above, also submit one w epk Mity'l g1'ii11t11 30 days of
completion of well construction to the courMArAthrdsiStsmient of the county
where constructed. Wilmington Regional Office
Font GW-1
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

TOLEDO CAROLINA
2915 BLUE CLAY ROAD
WILMINGTON, NC
MW - 18R
Drilled by: Applied Resource Management, P.C.
Logged by: J. Zuncich
Date: 11/03/17
Depth
(ft)
- Description
Water
Content
Blow
Count-
0 - 10
Medium gray to brown orange, clean backfill sand material.
Moderate
Grab
10 - 13
Medium gray, silty clay changing to slightly clayey fine sands.
Minor hydrocarbon odor present.
High
HP
HP - Hydraulic Push
RECEIVED/NCDENR/DWR
JUN 1 1 2018
Water Quality Regional
Operations Section
Wilrnington Regional Office

MWR-18 R
Locking Well Cap
Steel Manhole __ 0.3' Concrete/Grout Crown
Ground Surface
1.2' Bentonite
11.5' Sand
3' Riser
10' Screen
RECEIVED/NCDENR/DWR
JUN 1 1 2018
Water Quality Regional
Operations Section
Wilmin.aton Regional Office
1 3' Total Depth

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
,,un/ %/lm
For Internal Use Only:
4626 r
Donald Cummings
611
Well Contractor Name
2412-A
NC Well Contractor Certification Number
Applied Resource Management, P.C.
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC County, State, Variance, etc.)
3. Well Use (check well use):
WS0801 007
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Ind ustrial/Commercial
Irrigation
Non -Water Supply Well:
Monitoring
fMunicipal/Public
Residential Water Supply (single)
Residential Water Supply (shared)
Recovery
Injection Well:
Aquifer Recharge
�IAquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Retum)
4. Date Well(s) Completed: 10/5/17
5a. Well Location:
Invista
Facility/Owner Name
4600 US Highway 421 N,
DGroundwater Remediation
Salinity Barrier
EJStormwater Drainage
DSubsidence Control
Tracer
Other (explain under #21 Remarks)
Well ID#OH-3
/5v(aCt
N/A
Facility mtt (if applicable)
Wilmington, NC 28401
Physical Address, City, and Zip
New Hanover
County
R02400-001-001-000
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
34 18 37.42 N 77 58 59.97
6. Is(are) the well(s)Jx Permanent or DTemporary
7. Is this a repair to an existing well: EJYes or XONo
If this is a repair, fill out known well construction information and explain the nature ofthe
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 I GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled: t
9. Total well depth below land surface: 60
For multiple wells list all depths if different (example- 3@200' and 2@100')
(ft.)
10. Static water level below top of casing: 8. 05 (ft.)
If water level is above casing, use "- "
11. Borehole diameter:
12"
12. Well construction method: Mud Rotary
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) +300@20' Method of test: Airlift
13b. Disinfection type: HTH Amount: 3% @ 10 gallons
Fonn GW-1
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if ap licable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
30 ft.
8" in-
SDR17
PVC
16. INNER CASING OR TUBING (geothermal closed -loop}
FROM
TO
DIAMETER
TIUCKNESS
MATERIAL
ft.
ft.
in.
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
30 ft.
60 ft-
8 in.
0.03
Stainless Steel
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft•
24 rt•
Neat Cement
Tremmie
24 ft•
28 ft•
Bentonite
Poured
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
NIATERL\L
EMPLACEMENT METHOD
28 ft•
60 ft.
Coarse
_
Poured
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soillrock type, grain sae, etc)
ft.
ft•
See Attached
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
• c: r- ��v -- d (i
ft.
It.
OCT
ft.
ft.
232017
21.REMARKS into 'n1t1o2 Procyss ng t_trlit
DlNQ/l O'Z
22. Certification:
Aicao
Sign�ue oferrtified Well Contractor
10/5/17
Date
By signing this faun, 1 hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
RECEIVED/NCDENR/DWR
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Ralei h, NC27699-1636
24c. For Water Supply & Injection WedWedsY addiiti o go sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to thevaffityM16 Atermlt of the county
where constructed. Operations Section
Wilmington Regional Office
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

DRILLING LOG
INVISTA
4600 HIGHWAY 421 NORTH
WILMINGTON, NORTH CAROLINA
OG-3
Drilled by: Applied Resource Management
Logged by: J. Zuncich
Date: 10/3/17
DEPTH
(FT)
DESCRIPTION
WATER
CONTENT
BLOW
COUNT
0 - 10
Light gray to brown, fine to medium gray medium sand mixtures
with some organic material.
Low
MR
10 - 25
Tan to brown, medium to coarse sands with minor wood
fragments.
Moderate
to High
MR
25 - 30
Grayish brown, fine to coarse grained sand mixtures with minor
gravely sands near 30'.
Moderate
to High
MR
30 - 55
Tan brown, very coarse to gravely sands with thin gray clay tense
at 35'. Loss of circulation at approximately 30 - 40'.
High
MR
55 - 59.5
Greenish gray, fine to gravely sand mixtures with organics and
peat.
High
MR
59.5 - 62
Dark gray, silty clay with gravely sand mixtures.
High
MR
MR - Mud Rotary
RECEIVED/NCDENR/DWR
JUN 1 1. 2018
Water Quality Regional
Operations Section
Wilmington Regional Office

I 11111. 1 VI11
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Donald Cummings
Well Contractor Name
2412-A
NC Well Contractor Certification Number
4506'3
Applied Resource Management, P.C.
Company Name
2. Well Construction Permit #:
WS0801007
List all applicable well constniction permits (i.e. UIC, County, State, Y'ariance, etc)
3. Well Use (check well use):
Water Supply Well:
Agricultural
�Geothertnal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
Non -Water Supply Well:
Monitoring
OMunicipaUPublic
Residential Water Supply (single)
Residential 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 Well(s) Completed: 10/3/17
5a. Well Location:
Invista
Facility/Owner Name
Groundwater Remediation
Salinity Barrier
0Stormwater Drainage
Subsidence Control
Tracer
LOlher (explain under 421 Remarks)
Well ID#OG-3
3 cif c9Ct
N/A
Facility ID# (if applicable)
4600 US Highway 421 N, Wilmington, NC 28401
Physical Address, City, and Zip
New Hanover
R02400-001-001-000
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 18 40.68 N 77 59 02.73
6. Is(are) the well(s)x Permanent or DTemporary
7. Is this a repair to an existing well: OYes or x®No
If this is a repair, fill out known well construction information and explain the nature of the
repair under #21 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled: 1
9, Total well depth below land surface: 60
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing: 7.53
If water level is above casing, use "+"
11. Borehole diameter:
12"
(in.)
12. Well construction method: Mud Rotary
(ft.)
(ft.)
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) +300@20' Method of test: Airlift
13b. Disinfection type: HTH Amount: 3% @ 10 gallons
For Internal Use Only:
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if a ae lie bl )
FROM
TO
DIAMETER
THICKNESS MATERIAL
0
ft.
30 rt.
8"
in.
SDR17 PVC
16. INNER CASING OR TUIIING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
et.
ft.
in.
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
30 ft.
60 ft•
8
in.
0.03
Stainless Steel
ft.
ft.
in.
18. GROUT
FROM
0
ft.
TO
24 ft.
MATERIAL
Neat Cement
EMPLACEMENT METHOD & AMOUNT
Tremmie
24 ft.
28 ft.
Bentonite
Poured
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
28 ft-
60 ft-
Coarse
Poured
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary
DEMR/DWG
FROM
ft.
ft.
TO
ft.
ft.
DESCRIPTION (color, hardness, soil/rock type, grain sine, etc.)
See Attached
JUN 1 1-
20t8
ft.
ft,
ft.
ft.
ft.
ft.
ft.
ft.
Water 4uaii#y. Regional
O•
perations SPrtit,n
WI Regional Office
ft.
21. REMARKS
ft.
OCT 2
2 2o17
;I':t,
•
C31hf7JU'• _, y
22. Certification:
p,IM A
10/3/17
Sig -nature of Certified Well Contractor Date
13y signing this form, I hereby certify that the well(.$) was (were) constructed in accordance
with 1 SA NCAC 02C .0100 or 15A NC:AC 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 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.
Form GW-1
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

DRILLING LOG
INVISTA
4600 HIGHWAY 421 NORTH
WILMINGTON, NORTH CAROLINA
OH-3
Drilled by: Applied Resource Management
Logged by: J. Zuncich
Date: 10/05/17
DEPTH
(FT)
DESCRIPTION
WATER
CONTENT-
BLOW
COUNT
0 - 10
Tan gray to brown medium to coarse sand mixtures with root
matter and organics.
Low
MR
10 - 28
Tan brown medium to coarse sands with some wood fragments.
Moderate
to High
MR
28 - 55
Tan beige to medium brown very coarse to gravely sand mixtures
with minor wood fragments.
High
MR
55 - 62
Greenish gray fine to coarse sand mixtures, some gravel present
with minor peat changing to a dark gray silty clay with gravel
sands at 59'.
High
MR
MR - Mud Rotary
RECEIVED/NCDENR/DWR
JUN 1 1 2018
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:
Donald Cummings
Well Contractor Name
2412-A
NC Well Contractor Certification Number
Applied Resource Management, P.C.
Company Name
2. Well Construction Permit#: WMO801100
List all applicable well construction permits (i.e. County, Stale, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑Industrial/Commercial
❑Irrigation
Non -Water Supply Well:
EMonitoring
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Retum)
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Recovery
❑Groundwater Rem ediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: 9/10/17
5a. Well Location:
CFPUA
Facility/Owner Name
Well ID# MW-11
3. 59
N/A
Facility ID# (if applicable)
1508 Military Cutoff Road, Wilmington, NC
Physical Address, City, and Zip
New Hanover
R05612-004-018-000
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 13 25.25 N 77 49 53.38
6. Is (are) the well(s): OPermanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ENo
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: 183
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing: 21 .31
'firmer level is above casing, use "r"
11. Borehole diameter: 5 7'8 (in.)
12. Well construction method: Mud Rotary
(ft.)
(ft.)
(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
7 I4. WATER ZONES
FROM
TO
DESCRIPTTON
ft.
ft.
-
ft.
ft.
15. OUTER
CASING (for
multi -cased welts) OR LINER (if app icable) -
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
66 ft
6 in•
SCH40
PVC
16. INNER
CASING OR TUBING
(geothermal cloned -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
153 ft-
2 in.
SCH40
PVC
ft.
ft
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
153 ft
183 le•
2 in.
.010
SCH40
PVC
R
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0.3 ft
1 ft
Concrete
_
Poured
1 ft
142 ft
Grout
Tremmie
142 ft
150 fL
Bentonite Pell
Poured
19. SAND/GRAVEL PACK
(if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
150 ft
183 ft
Coarse
Poured
ft.
ft.
20. DRILLING
LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soiVrock (ape, grain size, etc.)
ft.
ft
ft.
ft.
See attached
ft.
ft.
ft.
ft
')
ft.
ft.
ft.
ft.
S E f 2 t= 2017
21. REMARKS l j .
k s tS%1'aa o#zo
22. Certific 'on:
Signa e of Certified Well Contractor
9/10117
Date
By .signing this form, 1 hereby certify that the well(s) was were) canstnrcted 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 Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells: In addition to sen to,,� ,thh�Q f rin to the address in 24a
above, also submit a copy of this form wit dghLIMN NIRyi Rel1
construction to the following:
Division of Water Quality, Underground Injecljgt 1Coptsol grptam,
1636 Mail Service Center, Raleigh, N 9 -1 3
24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy ocA,tbiyeriatyipirte.EcOgp of
completion of well construction to the county he�jl b ers e6 county
where constructed. Wilmington Regional Office
Form GW-1
North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
For internal Use ONLY:
1. Well Contractor Information:
Donald Cummings
450698
Well Contractor Name
2412-A
NC Well Contractor Certification Number
Applied Resource Management, P.C.
Company Name
2. Well Construction Permit& WM0801101
List al! applicable well construction permlls (i e. County, Stale, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑ Agricultural
❑Geothermal (Heating/Cooling Supply)
❑Industrial/Commercial
❑irrigation
❑Municipal/Public
❑Residential Water Supply (single)
17Residential Water Supply (shared)
Non -Water Supply Well:
Monitoring ❑Recovery
Injection Weil:
❑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: 9/10/17 Well ID# MW-12
6
(1)a
5a. Well Location:
CFPUA
Facility/Owner Name
N/A
Facility iDII (if applicable)
Aliens Lane and Jones Road, Wilmington, NC
Physical Address, City, and Zip
New Hanover
R05713-001-021-001
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one Iat/long is sufficient)
34 13 21.54 N 77 49 36.59
6. Is (are) the well(s): 1 JPermanent or ❑Temporary
W
7. Is this a repair to an existing well: ❑Yes or E No
1f this is a repair, fill our 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 seine construction, you can
submit one form.
9. Total well depth below land surface: 183
For multiple wells list all depths if different (example- 3@200' and 2@100')
(ft.
10. Static water level below top of casing: 22.52 (ft.)
lfwater level is above casing, use "+"
11. Borehole diameter: 5 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) N/A Method of test: N/A
13b. Disinfection type: N/A Amount: N/A
Form GW-1
14. WATER ZONES .
FROM
- TO -
- DESCRIPTION - -
ft
ft
ft
ft..
15.OUTER CASING (for multi -cased wells) OR LINER (if.app icabte)
FROM
TO ..
DIAMETER
THICKNESS
MATERIAL
0 ft.
72 rt.
6 - in.
SCH40
-PVC ..
16. INNER CASING OR TUDiNG (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS- -
-MATERIAL
0 ft
153 ft
2-, in-
SCH40
PVC
ft.
rt.
in
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
153 ft.
183 ft
2 in.
.010
SCH40
_
PVC
ft
ft
in.
18. GROUT
FROM
TO
btATER(AL
EMPLACEMENT METHOD & AMOUNT
0.3 ft
1 ft
Concrete
Poured
1 ft
142 ft-
Grout
Tremmie
142 ft.
150 ft-
Bentonite Pell
Poured
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
150 ft
183 ft
Coarse
Poured
ft.
ft
20. DRILLING
LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
ft
ft
ft.
ft.
See attached
ft.
ft.
ft.
ft.
��P L
ft.
ft.
�-
ft.
ft.
S f 2 3 2017
1
ft.
ft.
t')ic.t
21. REMARKS intorioroi!ftt: ?'i•N 34sTt)
22. CertiGeation:
Zt:
9/10/17
Signature of Certified Well Convector V Date
By signing this form, 1 hereby certj that the well(s) was (sere) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Wel! 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 Quality, information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Quality, UndergRi5piaiaii ttt6triibt'Progrram,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Sunnlv & Iniection Wells: In fflasoiltoterrjlimhe form to
the address(es) above, also submit one copy *AIM 30 days of
completion of well construction to the county health department of the county
where constructed. i0llal
North Carolina Depa trnent of Em nWater Quality Reg
orunent and Natural Resources- Division of Water Quality Operations Section biped Jan. 2013
Wilmington Regional

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
RECEIVED/NCDENR/DWR
JUN 0 2 2018
Water Quality Regional
Operations Section
Wlinhington Regional Office
For Internal Use ONLY:
14. WATER ZONES
FROM
TO
DESCRIPTION
A50
ft.
n.
a.
f.
15. INNER CASING OR TUB NG (geothermal closed -coop)
FROM TO
0 rt.
2.9n.
DIAMETER
2 in.
THICKNESS
Sch. 40
MATERIAL
PVC
16. OUTER CASING (for multi -cased wells) OR LINER (if applicable)
FROM DIAMETER
TO
ft.
n.
in.
THICKNESS
MATERIAL
[t.
rt.
in.
17. SCREEN
❑Municipal/Public
❑ Residential Water Supply (single)
O 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)
0 Recovery
❑ Groundwater Remediation
❑ Salinity Barrier
❑Stormwater Drainage
❑ Subsidence Control
❑Tracer
❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: 03/01/18 Well ID#: MW-15
5a. Well Location:
Facility/Owner Name
Physical Address, City, and Zip
NEW HANOVER
Facility ID# (if applicable)
, WILMINGTON, NC
County
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
34.221612 N-77.824012
6. Is (are) the well(s): ® Permanent or OTemporary
7. Is this a repair to an existing well: OYes or No
If this is a repair, fill out known well construction information and exploit
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 smite co
can submit one form.
/7ctiott, y,q
•jO
9. Total well depth below land surface: 7.9 A ,)
For multiple wells list all depths in different (example- 3@200' and 2 a l t
10. Static water level below top of casing:
If water level is above casing, use "+"
11. Borehole diameter:
(ft.)
12. Well construction method: Hand Auger
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
w
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
2.9 a.
7.5 f,
2 in.
Slot .010
Sch. 40
PVC
R.
ft.
in.
18. GROUT
FROM
0 it.
TO
0.8rt.
MATERIAL
Portland Cement
EMPLACEMENT METHOD & AMOUNT
Surface Pour
0.8 a.
ft.
1.8 rt.
rt.
Bent. Pellets
Surface Pour
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAI.
1.8 ft.
8 ft.
#2 Medium Sand
EMPLACEMENT \tl:T1101.>
ft.
rt.
20. DRILLING LOG (attach additional sheets if necessary)
TO
FROM
ft.
ft.
11.
ft.
ft.
ft.
DESCRIPTION (color. hardness, soil/rock type. grain size, etc.)
ft Seu
Pfi PkG
:CS
ft.
fl.
21. REMARKS
22. Certification:
Signature of Certified Well Cont or
4/9/2018
Date
signing this form, I hereby certify that the 'vents) was (were) constructed in accordance with
15A NCAC 02C.0100 or 15A NCAC 02C .0200 Well Construction Standards and that a copy of
a aids record has been provided to the well owner.
treo
®�23. S, E'diagram or additional well details:
(43 Yay use the back of this page to provide additional well site details or well
struction details. You may also attach additional pages if necessary.
IIJBMITTAL INSTRUCTIONS
24a. For All Welts: 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 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 2-22-2016

LOG
CATLIN
Engineers and Scientists
21ELL 7081
Wilmington. NC SHEET 1 OF 1
PROJECTNO.: 217081
STATE: NC
COUNTY: NEW HANOVER
LOCATION: WILMINGTON
PROJECT NAME: CFPUA AQUIFER WITHDRAWL OF
GenX
LOGGED BY: M. Robinson
WELL ID:
MW-15
DRILLER: William J. Miller
NORTHING: N/A
EASTING: N/A
CREW:
SYSTEM: N/A
BORING LOCATION:
T.O.C. ELEV.: 20.61
DRILL MACHINE: Hand Auger
METHOD: Hand Auger
0 HOUR DTW: N/A
TOTAL DEPTH: 8.0
START DATE: 03/01/18
END DATE: 03/01/18
24 HOUR DTW: N/A
WELL DEPTH: 7.9
DEPTH
BLOW
0.5ft
0.5ft
COUNT
0.5ft
0.5ft
OVA
(PPm)
LAB.
o
s
L
G
SOIL AND ROCK
DEPTH DESCRIPTION ELEVATION
WELL
DETAIL
0.0 LAND SURFACE 20.6
0.0
0.0
—
-
8.0
G
R
A
B
•
(SP) - SAND
RECEIVED/NCDENR/DWR
JUN 0 2 2018
Water Quality Regional
Operations Section
Wilmington Regional Office
8.0 12.6
.l.11tIl11LJ1iftlil1IJ[11 I1I111IJL, -.....
Coo
BORING TERMINATED AT ELEVATION 12.6 ft
HPortland Cement
Bentonite Pellets [ #2 Medium Sand

RECEIVED/NCDENR/DWR
1. WELL CONTRA
4503R5
JUN 0 2 2018 RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
ater Qua�li�ty I3eggional
Operationgki1 iONTRACTOR CERTIFICATION # 4119-A
= ona 1 Ice
Sage Drilling and Pump Services LLC.
Well Contractor (Individual) Name
Michael C. Sage
Well Contractor Company Name
STREET ADDRESS 204 Tom Ave
Castle Hayne NC
City or Town State
( 910 )_ 231-6669
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable).
WELL CONSTRUCTION PERMIT# 0`Qv
OTHER ASSOCIATED PERMIT#(if applicable) cT 1 1
3. WELL USE (Check (�plicable Box): Residential Water Supply 0
DATE DRILLED
TIME COMPLETED
4. WELL LOCATION:
CITY: i_ I I tN1 l nf COUNTY I.� "&� Li et A ex/t
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
0 Slope 0 Valley II Flat 0 Ridge P Other
(check appropriate box)
LATITUDE
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: 0 GPS 0 Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
5. WELL OWNER
OWNER'S NAME en 0
28429
Zip Code
M AMO PMO
ecvIer
STREET ADDRESS ' l Of •t I ('.3 (-1k
t t
0/1 OTC.)(\ (vC
vn1
(►0)-,Q31-666q
City or To State Zip Code '
Area code - Phone number
6. WELL DETAILS: (7°
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL?
NO0
c. WATER LEVEL Below Top of Casing: `iNtietti:V©FT
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS-4 1 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accor ance with 15A NCAC 2C .0118.
e. YIELD (gpm): oL METHOD OF TESTA `i J t
f. DISINFECTION: Type 1—' 11i
g. WATER ZONES (de th):
From 1 (� Toa From
From To From
From To From_
7. CASING:
From -4- ( Depth Dia eter
To�Ft.
From To Ft.
From To Ft.
8. GROUT: Depth
From 0 To 2j Ft.
From J To - Dd- Ft.
From To Ft.
Amount _11:J_
To
To
To
Thickness/
Weight� �tv M rial
Material Method
Cco f -rre44
ouf
9. SCREEN: Depth Diameter Slot Size Material
From To Ft. in.
in.
From To Ft in.
in.
From To Ft. in.
in.
10. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
11. DRILLING LOG
From To
Formation Description
c j an
WG
12. REMARKS:
REivt-
., . '
Inforts15tiOn FFrocr'. rtg Unit
DWQ/I3C.J3
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDA
15A NCAC 2C, WE ONSTRUCTION STANDARDS, AND THAT A COP
RECORD HAS B PROVED TOT WELL OW
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
Michael C. Sage
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to theivision of Water Q alityLithin 30 days. Attn: Information Mgt.,
11617 Mail Service Center\Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 3/07

WELL CONSTRUCTION RECORD (GW-1)
Print Form
For Internal Use Only:
1. Well Contractor Information: RECE EoicD �O
Donald Cummings 141040
Well Contractor Name
2412-A
JUN 02 2018
Applied Resourcewinm 11/C musPgioudi
nt, P.C.
Company Name
NC Well Contractor Certification Number
WPO6i4nii on
2. Well Construction Permit #: !CP
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
'Irrigation
Non -Water Supply Well:
Monitoring
DMunicipal/Public
XDResidential Water Supply (single)
DResidential Water Supply (shared)
Recovery
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal(Closed Loop)
Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed: 9/29/17
5a. Well Location:
Airlie Homes
Facility/Owner Name
342 Shore Point Drive
DGroundwater Remediation
DSalinity Barrier
fStormwater Drainage
Subsidence Control
Tracer
Other (explain under #21 Remarks)
Well ID# N/A
N/A
Facility IDN (if applicable)
Physical Address, City, and Zip
New Hanover R04400-004-014-000
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one tat/tong is sufficient)
34 16 27.6 N 77 48 4.3
W
6. Is(are) the well(s)IjPermanent or OTemporary
7. Is this a repair to an existing well: QYes or QNo
If this is a repair, fill out known well construction information and explain the nature of the
repair under u21 remarks section or on the hock of this form.
8. For Geoprobe/APT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled: 1
9. Total well depth below land surface: 60
For multiple wells list al! depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing: 3
If water level is above casing, use "+"
11. Borehole diameter: 0-26/10",2�'(in )
12. Well construction method: Mud Rotary
(ft.)
(ft.)
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 80 Method of test: Airlift
13b. Disinfection type: HTH Amount: 3%@10g
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (for multi -cased wells OR LINER (ifa Iicable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 fl.
26 ft
6 (n.
SCH40
PVC
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
TA1CttNESS
MATERL►L
0 ft
40 ft.
4 i"'
SCH40
PVC
37 f°
47 ft-
2 in.
SCH40
PVC
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
FL
EL
in.
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
f`'
40 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, so.Vrock type, grain size, etc.)
0 ft"
17 ft
Sands/clayey sands (orange)
17 ft
45 fL
Weathered orange limestone
45 fL
60 ft'
Gray linestone
ft.L
f�lY
fL
,eb..
OW)
r� ft.
l
1'
EC IVE
ft,
ttj ft
21. REMARKS O C T 06 2017
IntoMatiwlt Piace®91310 :. .
nvvoiBOG
22. Certirjcation:
4444.0
Signature of Certified Well Contractor
Date
%I-7W/ -2
By signing this form, 1 hereby cent' that the well(s) wasere) constructed in accordance
with 15.4 NCAC 02C .0100 or l5A NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit;
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For 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 & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW-I
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor information:
Donald Cummings
• Well Contractor Name
2412A
NC Well Contractor Certification Number
RECEIVED/NCDfJM?
J(1N 0 2 2018
Applied Resource Man erg
Company Name Wilmint=fattons Secti nnpl
°n Regional
2. Well Construction Permit #: N/A Office
List all applicable well consa ucnon permits ('.e. VIC, Counq', State, Variance, etc)
3. Well Use (check well use):
Print Form
For Internal Use Only:
Water Supply Well:
Agricultural DMunicipal/Public
]Geothermal (Heating/Cooling Supply) DResidential Water Supply (single)
�Industrial/Commercial ()Residential Water Supply (shared)
Irrigation
Non -Water Supply Well:
Monitoring
Injection Well:
JAquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
�Experimental Technology
]Geothennal (Closed Loop)
�Geothennal (Heating/Cooling Return)
4. Date Well(s) Completed: 5/25/1 7
5a. Well Location:
Invista
Recovery
©Groundwater Reinediation
0 Salinity Barrier
�Stonnwater Drainage
Subsidence Control
Tracer
Other (explain under #21 Remarks)
welllD#PTW-4
Facility/Owner Name Facility ID# (if applicable)
4600 US Highway 421 N, Wilmington, NC 28401
Physical Address, City, and Zip
New Hanover
R02400-001-001-000
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one lat/long is sufficient)
34 deg. 18' 27.62 N -77 deg. 58' 59.50"
W
6. Is(are) the well(s)l% 'Permanent or OTemporary
7. Is this a repair to an existing well: QYes 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. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:
(ft.)
For multiple wells list all depths ifd different (example- 3@200' and 2@100)
t
9. Total well depth below land surface: 5
10. Static water level below top of casing: 10.89 (ft.)
/farater level is above casing, use "+"
11. Borehole diameter: 8
12. Well construction method: rotary
(in.)
(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 mull -cased wells) OR LINER (Ifa Ileable)_
FROM
TO
DIAMETER
THICKNESS
MATERIAL
+1.5 ft
24 ft.
4 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
24 ft•
54 ft.
4" in'
0.020
SCH40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft
21 ft•
Bentonite
Poured
ft
ft.
ft
ft.
19. SAND/GRAVEL
PACK
(if applicable)
FROM
TO
MATERIAL
EMPLACEMENT Al ETHOD
21 ft
54 ft•
Coarse
Poured
ft
ft.
20. DRILLING
LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soll/rock type, grain size, etc.)
ft
W
a Attached
ft
t.
ft
f./I/yt, ft"'
..
ft
ft.
G l
ft
It.
t )° Y �, 6
`� .r E 1 �l* n -zc
ft
ft.
5.
ft
ft.
JUN 2 6 2017
21. REMARKSIleU
�nn
infOftilia 00 P'°eif'%341'g ..
of Certified Well Contractor
6/12/17
Date
By signing this form, I hereby cert)fy that the well(s) t)rere) 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 fonn 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 fonn to the address in 24a
above, also submit one copy of this fonn 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 & Iniection Wells: In addition to sending the fonn to
the address(es) above, also submit one copy of this fonn within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW-i
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

dill For
WELL CONSTRUCTION RECORD (GW-1) FR Internal Use Only:
450 3R
RECEIVED/NCDENR/DWR
JUN 0 2 2018
Well Contractor Name
2412A
1. Well Contractor Information:
Donald Cummings
NC Well Contractor Certification Number
Applied Resource MaVYagQyrEt, P.C.
Company Name N/AWilr>°o�'ons sect�ion'al
2. Well Construction Permit #: RegjOflaj C CP.
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
0 Industrial/Commercial
l� lmgation
Non -Water Supply Well:
Monitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
13 Experimental Technology
Geothermal (Closed Loop)
()Geothermal (Heating/Cooling Retum)
4. Date Well(s) Completed: 5/22/17
5a. Well Location:
Invista
DMunicipallPublic
IDResidential Water Supply (single)
()Residential Water Supply (shared)
Recovery
Groundwater Retnediation
Salinity Barrier
IDStormwater Drainage
Subsidence Control
Tracer
Other (explain under #21 Remarks)
Well ID# PTW-2 . (�
3`.tv
Facility/Owner Name Facility ID# (if applicable)
4600 US Highway 421 N, Wilmington, NC 28401
Physical Address, City, and Zip
New Hanover
R02400-001-001-000
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 deg. 18" 37,33"N -77 deg. 58' 59.29"
W
6. Is(are) the well(s)o% Permanent or OTemporary
7. is this a repair to an existing well: ®Yes or x�No
If this is a repair, fill out bloat well construction information and explain the nature of the
repair under 1121 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-i is needed. Indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface: 63'
For multiple wells list all depths if different (example- 3@200' and 2@100)
(ft.)
10. Static water level below top of casing: 7.91 (ft.)
If water level is above casing, use "+"
11. Borehole diameter: 8 (in.)
12. Well construction method: rotary
(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 mull -cased wells) OR LINER (ifap llcable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
+1.5 ft
33 ft.
4 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
33 ft.
63 ft.
4" in'
0.020
SCH40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO -
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft
30 ft.
Bentonite
Poured
ft
ft.
ft.
ft.
19. SAND/GRAVEL
PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
30 ft
63 ft.
Coarse
Poured
ft.
ft.
20. DRILLING
LOG (attach additional sheets if necessary) ..
FROM
TO
DESCRIPTION (color, hardness, soilfrock type, grain size, etc.)
ft
ft'
See Attached
ft.
ft.
ft.
ft.
ft
ft.
5 P :
e
,y9
{4..'.v`7 ft.
.fly'" r . ., 4 ,
a . r::: k-i, . s F,� a. -,
it�t
ft.
,,''
c°
j�
JUN 262017
21MARKs .
' t
lsil - wistti3, i (,,,.4(2f11'?- `tn1
22. Cortification:
Signature of CertifiedWe*Contractor
6/12/17
Date
By signing this form, 1 hereby certfy that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or I5A NCAC 02C .0200 We!! Construction Standards and that a
copy of this record hos 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 fonn 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 fonn to the address in 24a
above, also subunit one copy of this fonn within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1638 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells: In addition to sending the fonn to
the address(es) above, also submit one copy of this fonn within 30 days of
completion of well construction to the county health department of the county
where constructed.
FormGW-1
North Carolina Department of Environmental Quality - Division of Water Resources
Revised 2-22-2016

rintForm
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Donald Cummings
Well Contractor Name
2412A
NC Well Contractor Certification Number
etAa�
RECEIVE DENR/DWR
JUN 02 2018
Applied Resource ManagsappitlitP46e1
Company Name Operations Section
2. Well Construction Permit #: N/A Wilmington Regional Office
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc)
3. Well Use (check well use):
Water Supply Well:
Agricultural
�Geothennal (Heating/Cooling Supply)
Industria1/Coinrnercial
l ,Irrigation
Non -Water Supply Well:
Monitoring
injection Well:
Aquifer Recharge
DAquifer Storage and Recovery
DAquifer Test
DExperimental Technology
OGeothennal (Closed Loop)
DGeothennal (Heating/Cooling Return)
4. Date Well(s) Completed: 5/23/1 7
5a, Well Location:
Invista
Facility/Owner Name
DMunicipal/Public
Residential Water Supply (single)
QResidential Water Supply (shared)
DRecovery
4600 US Highway 421 N,
Physical Address, City, and Zip
New Hanover
DGroundwater Retnediation
Salinity Barrier
Stonnwater Drainage
Subsidence Control
DTracer
❑Other (explain under #21 Reinatks)
Well ID# PTW-1
Facility ID# (if applicable)
Wilmington, NC 28401
R02400-001-001-000
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 deg. 18' 42.34" N -77 deg. 59' 03.62"
W
6. Is(are) the well(s)D%'Permanent or DTemporary
7. Is this a repair to an existing well: DYes or XDNo
If this is a repair, fill out knoun well construction information and explain the nature of the
repair under #21 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. indicate TOTAL NUMBER of wells
drilled:
t
9. Total well depth below land surface: 63
For multiple wells list all depths if different (example- 3@200' and 2@100)
(ft.)
Ill. Static water level below top of casing: $' (ft.)
If water level is above casing, rise "+"
11. Borehole diameter: 8 (in.)
12. Well construction method: rotary
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
For Internal Use Only:
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if ap !Stable)
FROM
TO
DIAM ElER
THICKNESS
MATERIAL
+1.5 ft.
33 ft.
4 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
33 ft•
63 ft•
4" ia'
0.020
SCH40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft
30 ft.
Bentonite
Poured
ft
ft.
ft,
ft.
19. SAND/GRAVEL
PACK Of applicable)
FROM
TO
MATERIAL
EMPLACEMENT M ETHOD
30 ft
63 rt.
Coarse
Poured
ft
ft.
20. DRILLING
LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soli/rock type, grain size, etc.)
ft.
ft'
See Attached
ft,
ft.
ft
f
G
ft
Yt.o
_
_
ft.
MAY f4)
9 l,',) R
C a��ED
ft
ft'
2 6 2017
ft
ft.
21:REMARKS inforB13ii:]rt'PrOc.o& li9 U(S(c
22. Ce •,{cation:
1
Signature olCertified Well Contractor
/12/17
Date
By signing this form, I hereby certOr 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 INSTRUCTIONS
24a. For All Wells: Submit this fonn within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the fonn to the address in 24a
above, also submit one copy of this fonn 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 & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this fonn 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 Envirorunental Quality - Division of Water Resources Revised 2-22-2016

V11ELL CONSTRUCTION RECORD
7lti Wit l ,ror•cFrrr;iucyk ieruullipi;'A ME
1. Well Contractor ittfnruAdntl:
Brian Ewing
Well 1 ,'I t1L1cr h.lnw
4240E
NI; Wen r.ulnndtut f rtitic:4k.nNnu,b r
SAEDACCO Inc
RECEIVW/NCDENR/DWR
JUN 02 2018
C:1114n1;0 N.i ii.
Water Quality Re
2. Wclt ('Iun1,11L't uiI Pens* B. Operatic)6gf 010 R
Li .1 ..i1.:1.p,ArrrmieI iir r Oivirs .S,SCr 1',r , •,1
m14egional Office
3, tl'r1t Ise (check will rlsa'i;
Frtrtl1 Tlpri(<<c1
.14535i
w. t1•.it�k �iilYfL4,-.. •...a.. o�n.�,.�...-.o,a�..�..,,.��.�,v...__.�..,..,-�._.-�.,..�.,j
room —mkt oprmos
rt, fj ft,
t5..OMR CANING [for tomilt-cased welts) Oft LINER iW Rcaltlrt
FROM TO l rff\t1rrrn ftticiiNrss surrottAL
ft. h,
1e INNER CANIN4: )1CrI1BtNC ftpethertnat
FROMTf► OLVAIFTER fIH(t NESS MATERIAL
i9. SCREEN
Water Supply Well:
CiAgn illtulnd
r_icicol4;.ilnlfl illectting?Cooliti Supply)
(' I ltulusttitib't7o1nmlaic ial
❑ lttruLunun
OlMJnliu;l ti.'Thtilc
I•IRrsi&h;nrt;t1 Wale r SLITiI rsin{;lei
11R ith nn;tl Watt,`* Suupph•i;lsr.l(d)
Non -Water Supply Well:
hlomlonne
injection Well:
El Armorer Recharge:
CM' pilfer Storage 4n'ai Roszosen
L7 M1lnfcr "f.
CIi'7xmnenCll Technology
❑exotiatosat { Closed 1_Unp1
❑Gixothenmll I I leatstieZeoullng Return].
4. Oak W tltrt Completed: 6-29-17
54, N'L•II Lecathln:
Vertex Railcar Corporation
F,rcol,l5,th11rr 51,tn'c
CIRecoven'
1.IKirroluninater Remedi;nintt
G15:Ilinitt Ramer
°Storm -Met Drainage
❑4ubsidencc ('oi niI
❑ l.nictr
❑Other te1]r1Wll ni►det u:' I Remuukai
W'(. I lf,MW-3
F.•.olol, Ind (it :alrptis It,I,,
202 Raleigh Street, Wilmington, NC, 28412
tflly 5sl:Ji )11111triu C'it+. Will Zip
New Hanover
Itutc1IIr:NI1fr4:Ilir,lINU Ir'INi
Sit. Latitude anal Longitude in ik gicesirninuirs'seconill(,'r dreimid 1Iegr4i *;
tfuclrlaarl.OW lui•Intulfsulticr:ul
fr. b tarsi the stell(.sir lePernhtnent ue
'_Yi'emputaq
7, La this a repair to an eustisl; we1L• LV'es nr $11u
fr•,.,:n,.',•1t1i5 fih',ry: Purun I. ,-f.,:osnn,!t. .ni,rt'„fa n,lr,lr, .:n 01.1!1,R;trr„f:',
1 remark. ," !INV'le IA die7�.:rs•.,f :!Ir•, forma.
N. lumiter of netts Loitlatntr:tcd: 1
1-:•, ,n.,llrjrlr ,r tr r'Q,�'I ., 91`; 1-'r+ire•r iuj',Tlr ,. r•ll, lkl'b Y' n•,tll rin•.rrrhr,vud r, ii. iMr
s.vi: •nn ; wp h,rv»
O. Total to ill depth helon land carfare: 12 _
ril h,r al; v,'pil , 'r ,h Qp:rn! -,•, ,:,q,l, ;r„r a ,t l a; `.w
III. Static dater level below top of casing:
!11„I:,•r ir'1'1 '. 'I.' ei'l t:f,4/; 't'• -
11. Borehole dirmcler. a tin i
,t., matt rialto,. �ibic, dinxt ryish ar_ t
D '-.:r"`'-`.'''- i'h'isitft of Water Resources, Undergr
ound Injection Cuntrrt! Program.
1 163?flail
r, Service Center. Ratelth. NC 27611.163(r
24c. For Water Sup Jtls & Injection Weth:
alo' sIhnnl OW .,}n of lliis flltnt nilhul Bi dun-st,!fconiplelion cof
ttell ccnstmcnnu to the cotton health department or rite county sills=
;( lL 11lefcd
OM
}'
MOM TO I ulA.NkT4.R
2 ft. 112 ft.
2
lit
al,frt Mfl Illichsp..iu
.001 1sch 40
pvc
ft. ft
18..GROIrr
'ROM
P.
r
1
0 tt. 1 5 ri,
MATERIAL ' i 1tpLACi.MF T 1IETRO0 A AMOUNT
portland poured
rt. It,
n. '� tf,
19.-iAND,taLAVEL PACK at appliesbLty_,_
VIII%I rtl Unremit.
1 ft. j 14 fr,
filter sand
t?MPt.it, I lrr.N1' !H1"flIOP
# 2
ft. R„
Ill. DRILLING LOG (adlach AddiNagut sheet) if nrressan'1
PROM
0
ft.
It.
IL
Tft oes(Rlrflo ,,iiikrIrk I:Omgrtlinr+M.YCt.1
14 ft. sand moist to wet
9,
It,
ff.
iI.
ft,
r 1L RLRIAWRS
bentonite seal from .5 to 1
•
22. Certification:
Brian Ewing
�1alL1I I' „ri'eni fiat Well (':tnrrt,'.iar
7/9/2017
1L ,r_nr t, are, ionr± r 'wry)" ;Fair ,! r
;•r :r: •lr, . r ,;'r r. r; r, r,r•'„lnrrrr! nr nnwnhorn
u',f'' l \!•.I •- 10- ,lliv:er 151 V1 1, (I' •"l,1 liI- th,,, ;,fnl tir,.,7hkd•11 n+h111i,J,1
,.i''•.,1l4,:1rr:•,.,,!i-',, I'1„71,r,
1.3. She dtln!ran, tor additional well details:
1`t:n 11110 lieu tlti^ b,r.,k al'alils pia 111 ptl'vide 1 ft1111't ll ,►r:11 sitr: dctifls Fit cell
1. rI. tttciiosl deIttls, You may :Ilacrattach aclditlr-luel pat,w> 1f necessary.
-Sill/MIVEAL I : sifv("i'IoLNS_
24a. Fur Ail Wells: Sallow alms faint \tilltm 111 th*:, ,If :anlllkkti9II of. 'l eft
:o niilnlcttnrl tut the rationing
") r.em I''''''kP"'- \ Division of Water Resources, information Processing Unit.
1617 NUR Service tenter. Raleigh. N(' 27699-1617
JUL 2 7 2017h. For ln}trtto Wdb ON!,Y: itt adelitinit to sending 1114 form u1 iIP addrl�s. in
!•►irablite. ails, submit d ropy or this rattli %litho) Itt Jry!, iif Cultlplett1f ,'r tc,:ll
12. Well cIn.3tnt tk iiitstihad: BORED h • . • ;, Igtr(tkitimr to rite I:011utt'i)
FOR WATER S!'PPL 1 WELLS ONLY:
IS*. Ykid ittillut
lib. Disinfection type:
Method of teat:
Amount;
Ktla, Ls1t'-1
.Allll ('.d!'II.t C1.1 Jrtill..111'.I Ells a..luPtll! .xfel Sallttal l'::?7LUi c - Liu eSfUli Jr ll',,IdI eSOtrtm ILCY L d •\I{{u9''117

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Donald Cummings
RECEIVED/NCDENR/DWR
Well Contractor Name
2412-A
JUN 02 ?018
NC Well Contractor Certification Number
Applied Resource Mana Al tsysP :
Company Name WP0291566 Regional Office
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc)
3. Well Use (check well use):
Water Supply Well:
Agricultural
©Geothermal (Heating/Cooling Supply)
3IndustriaUCommercial
f" plrrigation
Non -Water Supply Well:
Monitoring
QMunicipal/Public
Residential Water Supply (single)
Residential Water Supply (shared)
Recovery
Injection Weil:
Aquifer Recharge
DAquifer Storage and Recovery
Aquifer Test
fExperilnental Technology
DGeothermal (Closed Loop)
Geothermal (Heating/Cooling Retum)
4. Date Well(s) Completed: 1 1 /3/17
5a. Well Location:
Andy Simmons
Facility/Owner Name
QGroundwater Remediation
Salinity Barrier
JStormwater Drainage
Subsidence Control
Tracer
Other (explain under #21 Remarks)
Well ID# N/A
2613 Middle Sound Loop Rd,
N/A
Facility IDO (if applicable)
Wilmington, NC 28405
Physical Address, City, and Zip
New Hanover
County
R05100-006-013-000
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(dwell field, one lat/long is sufficient)
34 15 07.6 N 77 47 23.8
W
6. Is(are) the well(s)01Permanent or DTemporary
7. Is this a repair to an existing well: r}Yes or ONo
If this is a repair, fill our known well construction information and explain the nature of the
repair under .21 remarks section or on the back ofthisform.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only I GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled: 1
9. Total well depth below land surface: 180
For multiple wells list all depths ifdifferent (example- 3@200' and 2@100')
(ft.)
10. Static water level below top of casing: 17 (ft.)
If water level is above casing, use ", "
11. Borehole diameter: See Remab(in.)
12. Well construction method: Mud Rotary
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 60CC�100' Method of test: Airlift
HTH
0
13b. Disinfection type: Amount: 3 'o@10g
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if a livable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
160 ft-
4 in'
SCH40
_
PVC
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
_ MATERIAL
150 ft•
160 it-
2 'n•
SCH40
PVC
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
160 ft-
180 ft-
2 in-
.020
SCH40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft'
30 ft-
Bentonite
Poured
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
ft.
ft.
ft.
rt.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
0 ft.
60 ft•
Sandy clay to clay
60 ft.
120 ft.
Limestone
120 ft'
155 ft'
Clay with mudrock
155 ft•
180 it
Sandstone
ft.
ft.
N 1 J,J ea '� 21I f7
21. REMARKS
0 - 105/8" 65-180/6" ;it:7 !�;c,�c*=e g'`','4`
22. Certification:
Signat6re of Certified Well Contractor
11/14/17
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 INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
constntction 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 (GW-1)
1. Well Contractor Information:
Donald Cummings
Well Contractor Name
2412-A
NC Well Contractor Certification Number
RECEIVED/NCDENR/DW
JUN 0 2 2018
Applied Resource Management, P.C.
Company Name 1 p,n Water Quality Regional
er2. Well Construction Permit #: V V r O2 �ttl pt�l R� Section
tnclal Office
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
Non -Water Supply Well:
Monitoring
infection Well;
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed: 1 1 /7/1 7
5a. Well Location:
S & W Builders
DMunicipal/Public
Residential Water Supply (single)
Residential Water Supply (shared)
fl Recovery
Groundwater Remediation
Salinity Barrier
JStormwater Drainage
DSubsidence Control
DTracer
nOther (explain under #21 Remarks)
well iD# N/A
N/A
Facility/Owner Name Facility 1D# (if applicable)
1211 Hellene Drive, Wilmington, NC 28409
Physical Address, City, and Zip
New Hanover
County
R04400-003-165-000
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
34 16 26.18 N 77 47 30.01
W
6.Is(are)the well(s)lPermanent or lJTemporary
7. is this a repair to an existing well: jYes or E1No
1/this is a repair, fill out known well construction information and explain the moire of the
repair tinder 421 remarks section or on the back of this forin.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the st ,e' ;., =.
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:1 NOV
9. Total well depth below land surface: 60
For Internal Use Only:
�5"L • witty
14. WATER ZONES
R PROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if ap livable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft*
44 ft.
6 i°•
SCH40
PVC
16. INNER
CASING OR TUBING
(geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft-
50 fL
4--_ in,
SCH40
PVC
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.
44 ft.
Bentonite
_
Poured
ft.
ft.
ft.
ft.
19. SAND/GRAVEL
PACK
(inapplicable)
FROM
TO
!OATMEAL
( I '1PLACEMENTMETIHOD
ft.
ft
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, sail/rock tv. _ rain size, etc.
0 ft.
30 ft.-
Sands/same clays
30 ft.
35 ft.
Clay •
35 ft.
38 ft.
Sanc?;orange weathered iimestone
38 ft.
. 60 f'•
L•imeso;l.' (w 1ds at 40' and 46`)
ft.
ft.
ft.
ft.
. .
ft.
ft.
-
21. REMARKS
0-44/10" 44-60/6"
22. Ce cation:
• Signature of Certified Well Contactor
l , ,
By signing this juror, 1 ill reby (3ii J4' thin drt N'GII p1] Lry (.1 .V17.4rach.ed It aeGa. dunce
with 15A NCAC 02C .0100 or 15A NCAC tC 92C .0200 1Vc11 Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site . (m-Ya`lW'or additional well details:
Y13u ma' Use the back of this page to provide additional well site details or well
construction??((;details. You may also attach additional pages if necessary.
6AUl3lIa 7AL INSTRUCTIONS
11/14/17
Date
3 ` 1411s: Submit this form within 30 days of completion of well
For multiple wells list all depths ifdii different (example- ( a720o' and 2@l00)
10. Static water level below top of casing:
If water level is above casing, use "- "
11. Borehole diameter: See Remafi(in )
12. Well construction method: Mud Rotary
20
(ft.)
(i.e. auger, rotary, cable, direct push, etc.)
,.l,, of}strrt.rxion to the following:
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 80 Method of test: Airlift
13b. Disinfection type: HTH Amount: 3% 10g
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this 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 & Iniection Wells: in addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Fonn GW-1
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016