WI0700470_Compliance_20200616

June 16, 2020
North Carolina Department of Environmental Quality
Division of Water Resources
Aquifer Protection Section
1636 Mail Service Center
Raleigh, NC 27699-1636
Attn: Ms. Shristi Shrestha
Re: Injection Event Record
Injection Permit W 10700470
Goldsboro Milling Company Mil[ #1
938 Millers Chapel Road, Goldsboro, North Carolina
Terracon Project No. 70207087 (Historical No. 70167098)
Dear Ms. Shrestha:
Irerracon
On behalf of Goldsboro Milling Company, Terracon Consultants, Inc. (Terracon) is submitting
the attached injection event record pursuant to the requirements of Injection Well Permit
WI0700470. Terracon completed injection activities for the Surficial Aquifer between April and
June of 2020. Data from the prior May 2018 and October 2019 small-scale events was utilized
to design this injection event. Terracon oversaw the installation of 10 additional permanent
injection wells in April 2020 (IW-02A through IW-11A).
During the injection event, Terracon field personnel injected Electron Donor Solution -Extended
ReleaseT" (emulsified vegetable oil), Nutrimens° aqueous bioremediation nutrient, sodium
bicarbonate, and a dechlorinating microbial culture through 11 permanent injection wells
(IW-01A through IW-11A). Terracon injected a total of 20,647 gallons of aqueous injectate
solution and water into the 11 injection wells. The injection was conducted in accordance with
the referenced permit.
If you have any additional questions, please feel free to contact us at 919-873-2211.
Sincerely,
Terracon Consultants, Inc.
David W. Hawkins, PG
Staff Geologist
Attachments
Donald R. Malone, PE, RSM
Senior Engineer
Terracon Consultants, Inc. 2401 Brentwood Road, Suite 107 Raleigh, North Carolina 27604
P [919] 873 2211 F [919] 873 9555 Terracon.com North Carolina Registered F-0869

North Carolina Department of Environmental Quality — Division of Water Resources
INJECTION EVENT RECORD (IER)
Permit Number WI0700470
1. Permit Information
Goldsboro Milling Company
Permittee
Goldsboro Milling Company Mill #1 Property
Facility Name
938 Millers Chapel Rd., Goldsboro, Wayne County,
North Carolina
Facility Address (include County)
2. Injection Contractor Information
Terracon Consultants, Inc.
Injection Contractor / Company Name
Street Address: 2401 Brentwood Road, Suite 107
_Raleigh North Carolina 27604
City State Zip Code
(919) _873-2211_
Area code — Phone number
3. Well Information
Number of wells used for injection _I I
Well IDS: IW-01A, IW-02A, IW-03A, IW-04A,
IW-05A, IW-06A, IW-07A, IW-08A, IW-09A,
IW-10A, IW-11A
Were any new wells installed during this injection
event?
® Yes ❑ No
If yes, please provide the following information:
Number of Monitoring Wells 0
Number of Injection Wells _10
Type of Well Installed (Check applicable type):
❑ Bored ® Drilled ❑ Direct -Push
❑ Hand -Augured ❑ Other (specify)
Please include a copy of the GW-1 form for each
well installed.
Were any wells abandoned during this injection
event?
❑ Yes ® No
If yes, please provide the following information:
Number of Monitoring Wells N/A
Number of Injection Wells N/A
Please include a copy of the GW-30 for each well
abandoned.
4. Injectant Information
Emulsified Vegetable Oil (EVO). Nutrimens®.
Sodium Bicarbonate, Microbial Culture,
Anaerobic Water
Injectant(s) Type (can use separate additional sheets
if necessary
Concentration EVO (9%, 1,881 gallons); Nutriment
(0.8%, 165 gallons)-, Sodium Bicarbonate (<0.2%, 2,000
lbs), Microbial Culture (0.03%, 5.6 gallons); Anaerobic
Water (90 /o
If the injectant is diluted please indicate the source
dilution fluid. Upgradient supply well (WSW-2);
sampled in April 2020, non -detect for VOCs)
Total Volume Injected (gal) 20,647 gal
Volume Injected per well (gal) 350 — 2,480
5. Injection History
Injection date(s)_April 21-May 1, 2020;
June 1-2, 2020
Injection number (e.g. 3 of 5)_3 of 3
Is this the last injection at this site?
® Yes (for Surficial Aquifer)'' ❑ No
I DO HEREBY CERTIFY THAT ALL THE
INFORMATION ON THIS FORM IS CORRECT TO
THE BEST OF MY KNOWLEDGE AND THAT THE
INJECTION WAS PERFORMED WITHIN THE
STANDARDS LAID OUT IN THE PERMIT.
16 6/16/2020
SIGNATURE OF INJECTION CONTRACTOR DATE
Donald R. Malone, P.E.
PRINT NAME OF PERSON PERFORMING THE INJECTION
Submit the original of this form to the Division of Water Resources within 30 days of injection. Form UIC-IER
Attn: UIC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-807-6464 Rev. 3-1-2016

WELL CONSTRUCTION RECORD
This roan can be used for single or mull iPk uclls
1. Well Cantrartor Information:
Brian Ewing
Wcll Cortrao m Name
4240-B
NC Well Coniractor Ceti ifrCation Number
SAEDACCO Inc
.m4mv) Name
2, Well CanstMCtinH Permit #-,
List all appJirablr ,sell prtadts rLr.. Caunh+. Matr, Yariamre, JRlOB UaR ell-.)
3. Wd1 Use (check well ulir):
CIALtti uIturat
OGeo(hemtal iNealing)Cooling Supply)
D Industrial/Commercial
❑ hTipatwn
Not -Water Supply Welt:
Q Agilrfier Recharge
❑ Aquifer Storage and Recnti'cry
❑Aquifer TN
❑Expctimental Tixhrtol;og•
❑Genthemial IClosed Leap)
❑GN(lienual IHe9fi1k0'Co0line Relum
4. Date Well(s) Completed: 4-6-20
5a. Well Location:
Goldsboro Milling
Facilib 'Cr,.. , r `• ! r.
DMtinicipatTublic
UResidential Water Supph' (single)
❑Residential Water Supply (shared)
043roundwicr Rcuicdiallion
❑Salinity Hamer
❑Stormivatcr DTa'L1WgC
❑ SrlkrsaderrcC Cniltrpl
❑Tracer
❑talker ttwlain under 1*21 1
We11 ID# IW-2A
Facilih' TD4 f.irapplicablei
938 Millers Chapel Road, Goldsboro, NC, 27534
Pinsical Address. City. and Zip
Wayne
OM1141
ftrvel Ida:ni36=0vn No. (WN)
ib, l.Rtitudc anil lAiiigitude i,r ik gixeuminutes{aecondfi or dccimmi degrms;
(Ifaellficid. u,t Tar Ir+n11%%wlllek„1r
N
For Inreniol Usc ONLY:
IA. WATKI ZONJIS
FROM
TO
orsicKi nosi
tt.
fi,
ft,
fi,
15. OUTER CAS fNG for
muNF-easnl nc9s1 OR
LINER (if
Rcable
FROM TO
ProV1FTFR
THICK.NESti
M,+ITTRIAI.
0 ft. 6' (i.
1 2" in.
SCH-40
PVC
2d. INNER CASING.OR n1fiIVillerw&I ctuwd-lixi
FROM To DL.%MFTER W1ffKNi53 MATERIAL
ft. A,
is
ft. fi,
i4
f?. Se"E.N
FROM
TO
Or VETFR
!:I.OTSITi
THriKSM I
MAYRRIAL
6' ft.
16' (1,
2" ill,
.020
SCH-40
PVC
I'L
rt.
ra•
18. GROUT
FROM
TO
MATERLALL
EMPLO&TMENT ME'f11011d AMOUNT
0 ft.
3' R,
PORTLAND
POURED
it.
rL
tt.
ft,
RAVEL PACK fif rlicable)
19, SAND1
FROM
Tr) ' )l%ri"RILi. I
E:51Pi.ttr'Mi:NI"Sirrunn
4' R.
16' A, FILTER SAND
# 2
ff.
I A.
28. DRQ.1.JING
LOG (attack addilional ibmi it rime%mr7yi
FROM
TO
DESCRIPTION i m6ir, h;aninv,,,.'i,'nwk rr ow., wain 4k, rots
0 fL
15' fr.
FILL SAND/SILT MOIST TO WET
151 (L
16, (c
SAME
ft.
ft,
ft.
rL
fi
IL
ft.
H.
It. RENLAR"
BENTONITE SEAL 3' TO 4'
22. C:ertil"ieatinn:
Brian Ewing_4/14/2020
Sigmmtrrr ofctrtifwd well Contractor E6C
6. is (are) the well(s)r EPennanent ur ::]Temporary Ov aignit,g thin fierm, l hereby rerrrfa• that nor well(a'J wmy (wrm) mprinwied im Mrar'Awre,
Wrh 15A 11CAC 02C ,0100 or 15A NCAC 0.0 .021VO Well Comirnraon Srdmdards and firer a
7. Is this a repair to in exhung w'eIL• ::l Yes or IMP repy a thir r"ord Am been pnn-A l ra dw nrli inri wr.
ljrhis is n rrlxur, fill var Cnnkv, wVil t cWfsuuL tint, atrfotw4e wt avid ea'plaJji 0w ,aerr,re° tr/ rhr
repair under 021 rmarks.rrx•Jian or on the bark n1 Mis fora,. 23, Site diAgram or aad.diliumll well details:
You may use die back of this page to provide additional u'01 site details or well
S. [number of wells nrmdructed: 1 Cousiruction details. You may aLto attach additional pages if necessan .
formuldlIr a,r}eerJwl or sm-waarer utpph wells ONJ V w-Jrh the samtconstruedon. k4m c<in
salr,ur`t �r,e f,rm. SC RNUTTAL INSTUCTlONS
11, Total V, dI depth loolli 4 land wrface, 16 (tj,) 24a. Far All ► ells Submit this farm within -IU dais of compinion of well
For multiplewells liaral1,lvfuhrijdifiWou+rrcmiplr- @ Of+'aid.@';00) Con5tnictipntoIlk follonirtg-
10. Static water level below top of casin%:
If wYlter le'kel is didVe [YISIN't, Ns,• +
�) Division of Water Resources, InforRmatiun Prucezxing Unit,
1617 Mail Ser vire [center, Ralrigh, NC 27699-1617
11. Borrhok iliametcr. 4.25 Ow) 24b. Egr Iniertion ti4'ells ONLY: In addition to sending the form to Ilfe address in
24a above. also submit a cop}• of this farm within 3O dams of completion of well
12, Well coffiTeuczirni rncthod: BORED Lominiction, to [lie following-
ti.c. auger. rotary, cable. dirccl push cec.l
Dhisian of Walter Resources, Lfndcrpraund Injection Central Program,
FOR WATER SUPPLY WELLS ONLY: 1636 ]Hall Seri ice Cenler, Raleigh, NC 276"-1636
13a, Yield 24c. For Water 5uC !j & lnjcctaxn Welb
t5tpml iNtltrad Dftest: Also submit one cop}- of this foam +within 30 days ofconmplelion of
13h. bisinftYtian hpe: Amount well comli mction to the county health dcporimesmt of hy the counwhat
C#fn5trUctCd.
Far rin Crw-1 Nord Carokiia D elkinnienr of Em irollmirta and Nan" Resources - Di%ision of Aliaier Resources Rei ised Airgiat-4011

WELL CONSTRUCTION RECORD
This roan can be used for single or mull iPk uclls
1. Well Cantrartor Information:
Brian Ewing
Wcll Cortrao m Name
4240-B
NC Well Coniractor Ceti ifrCation Number
SAEDACCO Inc
.m4mv) Name
2, Well CanstMCtinH Permit #-,
List all appJirablr ,sell prtadts rLr.. Caunh+. Matr, Yariamre, JRlOB UaR ell-.)
3. Wd1 Use (check well ulir):
CIALtti uIturat
OGeo(hemtal iNealing)Cooling Supply)
D Industrial/Commercial
❑ hTipatwn
Not -Water Supply Welt:
Q Agilrfier Recharge
❑ Aquifer Storage and Recnti'cry
❑Aquifer TN
❑Expctimental Tixhrtol;og•
❑Genthemial IClosed Leap)
❑GN(lienual IHe9fi1k0'Co0line Relum
4. Date Well(s) Completed: 4-6-20
5a. Well Location:
Goldsboro Milling
Facilib 'Cr,.. , r `• ! r.
DMtinicipatTublic
UResidential Water Supph' (single)
❑Residential Water Supply (shared)
043roundwicr Rcuicdiallion
❑Salinity Hamer
❑Stormivatcr DTa'L1WgC
❑ SrlkrsaderrcC Cniltrpl
❑Tracer
❑talker ttwlain under 1*21 1
We11 ID# IW-3A
Faciliq TD4 f.irapplicablei
938 Millers Chapel Road, Goldsboro, NC, 27534
Pinsical Address. City. and Zip
Wayne
OM1141
ftrvel Ida:ni36=0vn No. (WN)
ib, l.Rtitudc anil lAiiigitude i,r ik gixeuminutes{aecondfi or dccimmi degrms;
(Ifaellficid. u,t Tar Ir+n11%%wlllek„1r
N
For Inreniol Usc ONLY:
IA. WATKI ZONJIS
FROM
TO
orsicKi nosi
tt.
fi,
ft,
fi,
15. OUTER CAS fNG for
muNF-easnl nc9s1 OR
LINER (if
Rcable
FROM TO
ProV1FTFR
THICK.NESti
M,+ITTRIAI.
0 ft. 6' (i.
1 2" in.
SCH-40
PVC
2d. INNER CASING.OR n1fiIVillerw&I ctuwd-lixi
FROM To DL.%MFTER W1ffKNi53 MATERIAL
ft. A,
is
ft. fi,
i4
f?. Se"E.N
FROM
TO
Or VETFR
!:I.OTSITi
THriKSM I
MAYRRIAL
6' ft.
16' (1,
2" ill,
.020
SCH-40
PVC
I'L
rt.
ra•
18. GROUT
FROM
TO
MATERLALL
EMPLO&TMENT ME'f11011d AMOUNT
0 ft.
3' R,
PORTLAND
POURED
it.
rL
tt.
ft,
RAVEL PACK fif rlicable)
19, SAND1
FROM
Tr) ' )l%ri"RILi. I
E:51Pi.ttr'Mi:NI"Sirrunn
4' R.
16' A, FILTER SAND
# 2
ff.
I A.
28. DRQ.1.JING
LOG (attack addilional ibmi it rime%mr7yi
FROM
TO
DESCRIPTION i m6ir, h;aninv,,,.'i,'nwk rr ow., wain 4k, rots
0 fL
15' fr.
FILL SAND/SILT MOIST TO WET
151 (L
16, (c
SAME
ft.
ft,
ft.
rL
fi
IL
ft.
H.
It. RENLAR"
BENTONITE SEAL 3' TO 4'
22. C:ertil"ieatinn:
Brian Ewing_4/14/2020
Sigmmtrrr ofctrtifwd well Contractor E6C
6. is (are) the well(s)r EPennanent ur ::]Temporary Ov aignit,g thin fierm, l hereby rerrrfa• that nor well(a'J wmy (wrm) mprinwied im Mrar'Awre,
Wrh 15A 11CAC 02C ,0100 or 15A NCAC 0.0 .021VO Well Comirnraon Srdmdards and firer a
7. Is this a repair to in exhung w'eIL• ::l Yes or IMP repy a thir r"ord Am been pnn-A l ra dw nrli inri wr.
ljrhis is n rrlxur, fill var Cnnkv, wVil t cWfsuuL tint, atrfotw4e wt avid ea'plaJji 0w ,aerr,re° tr/ rhr
repair under 021 rmarks.rrx•Jian or on the bark n1 Mis fora,. 23, Site diAgram or aad.diliumll well details:
You may use die back of this page to provide additional u'01 site details or well
S. [number of wells nrmdructed: 1 Cousiruction details. You may aLto attach additional pages if necessan .
formuldlIr a,r}eerJwl or sm-waarer utpph wells ONJ V w-Jrh the samtconstruedon. k4m c<in
salr,ur`t �r,e f,rm. SC RNUTTAL INSTUCTlONS
11, Total V, dI depth loolli 4 land wrface, 16 (tj,) 24a. Far All ► ells Submit this farm within -IU dais of compinion of well
For multiplewells liaral1,lvfuhrijdifiWou+rrcmiplr- @ Of+'aid.@';00) Con5tnictipntoIlk follonirtg-
10. Static water level below top of casin%:
If wYlter le'kel is didVe [YISIN't, Ns,• +
�) Division of Water Resources, InforRmatiun Prucezxing Unit,
1617 Mail Ser vire [center, Ralrigh, NC 27699-1617
11. Borrhok iliametcr. 4.25 Ow) 24b. Egr Iniertion ti4'ells ONLY: In addition to sending the form to Ilfe address in
24a above. also submit a cop}• of this farm within 3O dams of completion of well
12, Well coffiTeuczirni rncthod: BORED Lominiction, to [lie following-
ti.c. auger. rotary, cable. dirccl push cec.l
Dhisian of Walter Resources, Lfndcrpraund Injection Central Program,
FOR WATER SUPPLY WELLS ONLY: 1636 ]Hall Seri ice Cenler, Raleigh, NC 276"-1636
13a, Yield 24c. For Water 5uC !j & lnjcctaxn Welb
t5tpml iNtltrad Dftest: Also submit one cop}- of this foam +within 30 days ofconmplelion of
13h. bisinftYtian hpe: Amount well comli mction to the county health dcporimesmt of hy the counwhat
C#fn5trUctCd.
Far rin Crw-1 Nord Carokiia D elkinnienr of Em irollmirta and Nan" Resources - Di%ision of Aliaier Resources Rei ised Airgiat-4011

WELL CONSTRUCTION RECORD
This roan can be used for single or mull iPk uclls
1. Well Cantrartor Information:
Brian Ewing
Wcll Cortrao m Name
4240-B
NC Well Coniractor Ceti ifrCation Number
SAEDACCO Inc
.m4mv) Name
2, Well CanstMCtinH Permit #-,
List all appJirablr ,sell prtadts rLr.. Caunh+. Matr, Yariamre, JRlOB UaR ell-.)
3. Wd1 Use (check well ulir):
CIALtti uIturat
OGeo(hemtal iNealing)Cooling Supply)
D Industrial/Commercial
❑ hTipatwn
Not -Water Supply Welt:
Q Agilrfier Recharge
❑ Aquifer Storage and Recnti'cry
❑Aquifer TN
❑Expctimental Tixhrtol;og•
❑Genthemial IClosed Leap)
❑GN(lienual IHe9fi1k0'Co0line Relum
4. Date Well(s) Completed: 4-7-20
5a. Well Location:
Goldsboro Milling
Facilib 'Cr,.. , r `• ! r.
DMtinicipatTublic
UResidential Water Supph' (single)
❑Residential Water Supply (shared)
043roundwicr Rcuicdiallion
❑Salinity Hamer
❑Stormivatcr DTa'L1WgC
❑ SrlkrsaderrcC Cniltrpl
❑Tracer
❑talker ttwlain under 1*21 1
We11 ID# IW-4A
Facilih' TD4 f.irapplicablei
938 Millers Chapel Road, Goldsboro, NC, 27534
Pinsical Address. City. and Zip
Wayne
OM1141
ftrvel Ida:ni36=0vn No. (WN)
ib, l.Rtitudc anil lAiiigitude i,r ik gixeuminutes{aecondfi or dccimmi degrms;
(Ifaellficid. u,t Tar Ir+n11%%wlllek„1r
N
For Inreniol Usc ONLY:
IA. WATKI ZONJIS
FROM
TO
orsicKi nosi
tt.
fi,
ft,
fi,
15. OUTER CAS fNG for
muNF-easnl nc9s1 OR
LINER (if
Rcable
FROM TO
ProV1FTFR
THICK.NESti
M,+ITTRIAI.
0 ft. 6' (i.
1 2" in.
SCH-40
PVC
2d. INNER CASING.OR n1fiIVillerw&I ctuwd-lixi
FROM To DL.%MFTER W1ffKNi53 MATERIAL
ft. A,
is
ft. fi,
i4
f?. Se"E.N
FROM
TO
Or VETFR
!:I.OTSITi
THriKSM I
MAYRRIAL
6' ft.
16' (1,
2" ill,
.020
SCH-40
PVC
I'L
rt.
ra•
18. GROUT
FROM
TO
MATERLALL
EMPLO&TMENT ME'f11011d AMOUNT
0 ft.
3' R,
PORTLAND
POURED
it.
rL
tt.
ft,
RAVEL PACK fif rlicable)
19, SAND1
FROM
Tr) ' )l%ri"RILi. I
E:51Pi.ttr'Mi:NI"Sirrunn
4' R.
16' A, FILTER SAND
# 2
ff.
I A.
28. DRQ.1.JING
LOG (attack addilional ibmi it rime%mr7yi
FROM
TO
DESCRIPTION i m6ir, h;aninv,,,.'i,'nwk rr ow., wain 4k, rots
0 fL
15' fr.
FILL SAND/SILT MOIST TO WET
151 (L
16, (c
SAME
ft.
ft,
ft.
rL
fi
IL
ft.
H.
It. RENLAR"
BENTONITE SEAL 3' TO 4'
22. C:ertil"ieatinn:
Brian Ewing_4/14/2020
Sigmmtrrr ofctrtifwd well Contractor E6C
6. is (are) the well(s)r EPennanent ur ::]Temporary Ov aignit,g thin fierm, l hereby rerrrfa• that nor well(a'J wmy (wrm) mprinwied im Mrar'Awre,
Wrh 15A 11CAC 02C ,0100 or 15A NCAC 0.0 .021VO Well Comirnraon Srdmdards and firer a
7. Is this a repair to in exhung w'eIL• ::l Yes or IMP repy a thir r"ord Am been pnn-A l ra dw nrli inri wr.
ljrhis is n rrlxur, fill var Cnnkv, wVil t cWfsuuL tint, atrfotw4e wt avid ea'plaJji 0w ,aerr,re° tr/ rhr
repair under 021 rmarks.rrx•Jian or on the bark n1 Mis fora,. 23, Site diAgram or aad.diliumll well details:
You may use die back of this page to provide additional u'01 site details or well
S. [number of wells nrmdructed: 1 Cousiruction details. You may aLto attach additional pages if necessan .
formuldlIr a,r}eerJwl or sm-waarer utpph wells ONJ V w-Jrh the samtconstruedon. k4m c<in
salr,ur`t �r,e f,rm. SC RNUTTAL INSTUCTIONS
11, Total V, dI depth loolli 4 land wrface, 16 (tj,) 24a. Far All ► ells Submit this farm within -IU dais of compinion of well
For multiplewells liaral1,lvfuhrijdifiWou+rrcmiplr- @ Of+'aid.@';00) Con5tnictipntoIlk follonirtg-
10. Static water level below top of casin%:
If wYlter le'kel is didVe [YISIN't, Ns,• +
�) Division of Water Resources, InforRmatiun Prucezxing Unit,
1617 Mail Ser vire [center, Ralrigh, NC 27699-1617
11. Borrhok iliametcr. 4.25 Ow) 24b. Egr Iniertion ti4'ells ONLY: In addition to sending the form to Ilfe address in
24a above. also submit a cop}• of this farm within 3O dams of completion of well
12, Well coffiTeuczirni rncthod: BORED Lominiction, to [lie following-
ti.c. auger. rotary, cable. dirccl push cec.l
Dhisian of Walter Resources, Lfndcrpraund Injection Central Program,
FOR WATER SUPPLY WELLS ONLY: 1636 ]Hall Seri ice Cenler, Raleigh, NC 276"-1636
13a, Yield 24c. For Water 5uC !j & lnjcctaxn Welb
t5tpml iNtltrad Dftest: Also submit one cop}- of this foam +within 30 days ofconmplelion of
13h. bisinftYtian hpe: Amount well comli mction to the county health dcporimesmt of hy the counwhat
C#fn5trUctCd.
Far rin Crw-1 Nord Carokiia D elkinnienr of Em irollmirta and Nan" Resources - Di%ision of Aliaier Resources Rei ised Airgiat-4011

WELL CONSTRUCTION RECORD
This roan can be used for single or mull iPk uclls
1. Well Cantrartor Information:
Brian Ewing
Wcll Cortrao m Name
4240-B
NC Well Coniractor Ceti ifrCation Number
SAEDACCO Inc
.m4mv) Name
2, Well CanstMCtinH Permit #-,
List all appJirablr ,sell prtadts rLr.. Caunh+. Matr, Yariamre, JRlOB UaR ell-.)
3. Wd1 Use (check well ulir):
CIALtti uIturat
OGeo(hemtal iNealing)Cooling Supply)
D Industrial/Commercial
❑ hTipatwn
Not -Water Supply Welt:
Q Agilrfier Recharge
❑ Aquifer Storage and Recnti'cry
❑Aquifer TN
❑Expctimental Tixhrtol;og•
❑Genthemial IClosed Leap)
❑GN(lienual IHe9fi1k0'Co0line Relum
4. Date Well(s) Completed: 4-7-20
5a. Well Location:
Goldsboro Milling
Facilib 'Cr,.. , r `• ! r.
DMtinicipatTublic
UResidential Water Supph' (single)
❑Residential Water Supply (shared)
043roundwicr Rcuicdiallion
❑Salinity Hamer
❑Stormivatcr DTa'L1WgC
❑ SrlkrsaderrcC Cniltrpl
❑Tracer
❑talker ttwlain under 1*21 1
We11 ID# IW-5A
Facilih' TD4 f.irapplicablei
938 Millers Chapel Road, Goldsboro, NC, 27534
Pinsical Address. City. and Zip
Wayne
OM1141
ftrvel Ida:ni36=0vn No. (WN)
ib, l.Rtitudc anil lAiiigitude i,r ik gixeuminutes{aecondfi or dccimmi degrms;
(Ifaellficid. u,t Tar Ir+n11%%wlllek„1r
N
For Inreniol Usc ONLY:
IA. WATKI ZONJIS
FROM
TO
orsicKi nosi
tt.
fi,
ft,
fi,
15. OUTER CAS fNG for
muNF-easnl nc9s1 OR
LINER (if
Rcable
FROM TO
ProV1FTFR
THICK.NESti
M,+ITTRIAI.
0 ft. 6' (i.
1 2" in.
SCH-40
PVC
2d. INNER CASING.OR n1fiIVillerw&I ctuwd-lixi
FROM To DL.%MFTER W1ffKNi53 MATERIAL
ft. A,
is
ft. fi,
i4
f?. Se"E.N
FROM
TO
Or VETFR
!:I.OTSITi
THriKSM I
MAYRRIAL
6' ft.
16' (1,
2" ill,
.020
SCH-40
PVC
I'L
rt.
ra•
18. GROUT
FROM
TO
MATERLALL
EMPLO&TMENT ME'f11011d AMOUNT
0 ft.
3' R,
PORTLAND
POURED
it.
rL
tt.
ft,
RAVEL PACK fif rlicable)
19, SAND1
FROM
Tr) ' )l%ri"RILi. I
E:51Pi.ttr'Mi:NI"Sirrunn
4' R.
16' A, FILTER SAND
# 2
ff.
I A.
28. DRQ.1.JING
LOG (attack addilional ibmi it rime%mr7yi
FROM
TO
DESCRIPTION i m6ir, h;aninv,,,.'i,'nwk rr ow., wain 4k, rots
0 fL
15' fr.
FILL SAND/SILT MOIST TO WET
151 (L
16, (c
SAME
ft.
ft,
ft.
rL
fi
IL
ft.
H.
It. RENLAR"
BENTONITE SEAL 3' TO 4'
22. C:ertil"ieatinn:
Brian Ewing_4/14/2020
Sigmmtrrr ofctrtifwd well Contractor E6C
6. is (are) the well(s)r EPennanent ur ::]Temporary Ov aignit,g thin fierm, l hereby rerrrfa• that nor well(a'J wmy (wrm) mprinwied im Mrar'Awre,
Wrh 15A 11CAC 02C ,0100 or 15A NCAC 0.0 .021VO Well Comirnraon Srdmdards and firer a
7. Is this a repair to in exhung w'eIL• ::l Yes or IMP repy a thir r"ord Am been pnn-A l ra dw nrli inri wr.
ljrhis is n rrlxur, fill var Cnnkv, wVil t cWfsuuL tint, atrfotw4e wt avid ea'plaJji 0w ,aerr,re° tr/ rhr
repair under 021 rmarks.rrx•Jian or on the bark n1 Mis fora,. 23, Site diAgram or aad.diliumll well details:
You may use die back of this page to provide additional u'01 site details or well
S. [number of wells nrmdructed: 1 Cousiruction details. You may aLto attach additional pages if necessan .
formuldlIr a,r}eerJwl or sm-waarer utpph wells ONJ V w-Jrh the samtconstruedon. k4m c<in
salr,ur`t �r,e f,rm. SC RNUTTAL INSTUCTlONS
11, Total V, dI depth loolli 4 land wrface, 16 (tj,) 24a. Far All ► ells Submit this farm within -IU dais of compinion of well
For multiplewells liaral1,lvfuhrijdifiWou+rrcmiplr- @ Of+'aid.@';00) Con5tnictipntoIlk follonirtg-
10. Static water level below top of casin%:
If wYlter le'kel is didVe [YISIN't, Ns,• +
�) Division of Water Resources, InforRmatiun Prucezxing Unit,
1617 Mail Ser vire [center, Ralrigh, NC 27699-1617
11. Borrhok iliametcr. 4.25 Ow) 24b. Egr Iniertion ti4'ells ONLY: In addition to sending the form to Ilfe address in
24a above. also submit a cop}• of this farm within 3O dams of completion of well
12, Well coffiTeuczirni rncthod: BORED Lominiction, to [lie following-
ti.c. auger. rotary, cable. dirccl push cec.l
Dhisian of Walter Resources, Lfndcrpraund Injection Central Program,
FOR WATER SUPPLY WELLS ONLY: 1636 ]Hall Seri ice Cenler, Raleigh, NC 276"-1636
13a, Yield 24c. For Water 5uC !j & lnjcctaxn Welb
t5tpml iNtltrad Dftest: Also submit one cop}- of this foam +within 30 days ofconmplelion of
13h. bisinftYtian hpe: Amount well comli mction to the county health dcporimesmt of hy the counwhat
C#fn5trUctCd.
Far rin Crw-1 Nord Carokiia D elkinnienr of Em irollmirta and Nan" Resources - Di%ision of Aliaier Resources Rei ised Airgiat-4011

WELL CONSTRUCTION RECORD
This roan can be used for single or mull iPk uclls
1. Well Cantrartor Information:
Brian Ewing
Wcll Cortrao m Name
4240-B
NC Well Coniractor Ceti ifrCation Number
SAEDACCO Inc
.m4mv) Name
2, Well CanstMCtinH Permit #-,
List all appJirablr ,sell prtadts rLr.. Caunh+. Matr, Yariamre, JRlOB UaR ell-.)
3. Wd1 Use (check well ulir):
CIALtti uIturat
OGeo(hemtal iNealing)Cooling Supply)
D Industrial/Commercial
❑ hTipatwn
Not -Water Supply Welt:
Q Agilrfier Recharge
❑ Aquifer Storage and Recnti'cry
❑Aquifer TN
❑Expctimental Tixhrtol;og•
❑Genthemial IClosed Leap)
❑GN(lienual IHe9fi1k0'Co0line Relum
4. Date Well(s) Completed: 4-7-20
5a. Well Location:
Goldsboro Milling
Facilib 'Cr,.. , r `• ! r.
DMtinicipatTublic
UResidential Water Supph' (single)
❑Residential Water Supply (shared)
043roundwicr Rcuicdiallion
❑Salinity Hamer
❑Stormivatcr DTa'L1WgC
❑ SrlkrsaderrcC Cniltrpl
❑Tracer
❑talker ttwlain under 1*21 1
We11 ID# IW-6A
Facilih' TD4 f.irapplicablei
938 Millers Chapel Road, Goldsboro, NC, 27534
Pinsical Address. City. and Zip
Wayne
OM1141
ftrvel Ida:ni36=0vn No. (WN)
ib, l.Rtitudc anil lAiiigitude i,r ik gixeuminutes{aecondfi or dccimmi degrms;
(Ifaellficid. u,t Tar Ir+n11%%wlllek„1r
N
For Inreniol Usc ONLY:
IA. WATKI ZONJIS
FROM
TO
orsicKi nosi
tt.
fi,
ft,
fi,
15. OUTER CAS fNG for
muNF-easnl nc9s1 OR
LINER (if
Rcable
FROM TO
ProV1FTFR
THICK.NESti
M,+ITTRIAI.
0 ft. 6' (i.
1 2" in.
SCH-40
PVC
2d. INNER CASING.OR n1fiIVillerw&I ctuwd-lixi
FROM To DL.%MFTER W1ffKNi53 MATERIAL
ft. A,
is
ft. fi,
i4
f?. Se"E.N
FROM
TO
Or VETFR
!:I.OTSITi
THriKSM I
MAYRRIAL
6' ft.
16' (1,
2" ill,
.020
SCH-40
PVC
I'L
rt.
ra•
18. GROUT
FROM
TO
MATERLALL
EMPLO&TMENT ME'f11011d AMOUNT
0 ft.
3' R,
PORTLAND
POURED
it.
rL
tt.
ft,
RAVEL PACK fif rlicable)
19, SAND1
FROM
Tr) ' )l%ri"RILi. I
E:51Pi.ttr'Mi:NI"Sirrunn
4' R.
16' A, FILTER SAND
# 2
ff.
I A.
28. DRQ.1.JING
LOG (attack addilional ibmi it rime%mr7yi
FROM
TO
DESCRIPTION i m6ir, h;aninv,,,.'i,'nwk rr ow., wain 4k, rots
0 fL
15' fr.
FILL SAND/SILT MOIST TO WET
151 (L
16, (c
SAME
ft.
ft,
ft.
rL
fi
IL
ft.
H.
It. RENLAR"
BENTONITE SEAL 3' TO 4'
22. C:ertil"ieatinn:
Brian Ewing_4/14/2020
Sigmmtrrr ofctrtifwd well Contractor E6C
6. is (are) the well(s)r EPennanent ur ::]Temporary Ov aignit,g thin fierm, l hereby rerrrfa• that nor well(a'J wmy (wrm) mprinwied im Mrar'Awre,
Wrh 15A 11CAC 02C ,0100 or 15A NCAC 0.0 .021VO Well Comirnraon Srdmdards and firer a
7. Is this a repair to in exhung w'eIL• ::l Yes or IMP repy a thir r"ord Am been pnn-A l ra dw nrli inri wr.
ljrhis is n rrlxur, fill var Cnnkv, wVil t cWfsuuL tint, atrfotw4e wt avid ea'plaJji 0w ,aerr,re° tr/ rhr
repair under 021 rmarks.rrx•Jian or on the bark n1 Mis fora,. 23, Site diAgram or aad.diliumll well details:
You may use die back of this page to provide additional u'01 site details or well
S. [number of wells nrmdructed: 1 Cousiruction details. You may aLto attach additional pages if necessan .
formuldlIr a,r}eerJwl or sm-waarer utpph wells ONJ V w-Jrh the samtconstruedon. k4m c<in
salr,ur`t �r,e f,rm. SC RNUTTAL INSTUCTlONS
11, Total V, dI depth loolli 4 land wrface, 16 (tj,) 24a. Far All ► ells Submit this farm within -IU dais of compinion of well
For multiplewells liaral1,lvfuhrijdifiWou+rrcmiplr- @ Of+'aid.@';00) Con5tnictipntoIlk follonirtg-
10. Static water level below top of casin%:
If wYlter le'kel is didVe [YISIN't, Ns,• +
�) Division of Water Resources, InforRmatiun Prucezxing Unit,
1617 Mail Ser vire [center, Ralrigh, NC 27699-1617
11. Borrhok iliametcr. 4.25 Ow) 24b. Egr Iniertion ti4'ells ONLY: In addition to sending the form to Ilfe address in
24a above. also submit a cop}• of this farm within 3O dams of completion of well
12, Well coffiTeuczirni rncthod: BORED Lominiction, to [lie following-
ti.c. auger. rotary, cable. dirccl push cec.l
Dhisian of Walter Resources, Lfndcrpraund Injection Central Program,
FOR WATER SUPPLY WELLS ONLY: 1636 ]Hall Seri ice Cenler, Raleigh, NC 276"-1636
13a, Yield 24c. For Water 5uC !j & lnjcctaxn Welb
t5tpml iNtltrad Dftest: Also submit one cop}- of this foam +within 30 days ofconmplelion of
13h. bisinftYtian hpe: Amount well comli mction to the county health dcporimesmt of hy the counwhat
C#fn5trUctCd.
Far rin Crw-1 Nord Carokiia D elkinnienr of Em irollmirta and Nan" Resources - Di%ision of Aliaier Resources Rei ised Airgiat-4011

WELL CONSTRUCTION RECORD
This roan can be used for single or mull iPk uclls
1. Well Cantrartor Information:
Brian Ewing
Wcll Cortrao m Name
4240-B
NC Well Coniractor Ceti ifrCation Number
SAEDACCO Inc
.m4mv) Name
2, Well CanstMCtinH Permit #-,
List all appJirablr ,sell prtadts rLr.. Caunh+. Matr, Yariamre, JRlOB UaR ell-.)
3. Wd1 Use (check well ulir):
CIALtti uIturat
OGeo(hemtal iNealing)Cooling Supply)
D Industrial/Commercial
❑ hTipatwn
Not -Water Supply Welt:
Q Agilrfier Recharge
❑ Aquifer Storage and Recnti'cry
❑Aquifer TN
❑Expctimental Tixhrtol;og•
❑Genthemial IClosed Leap)
❑GN(lienual IHe9fi1k0'Co0line Relum
4. Date Well(s) Completed: 4-8-20
5a. Well Location:
Goldsboro Milling
Facilib 'Cr,.. , r `• ! r.
DMtinicipatTublic
UResidential Water Supph' (single)
❑Residential Water Supply (shared)
043roundwicr Rcuicdiallion
❑Salinity Hamer
❑Stormivatcr DTa'L1WgC
❑ SrlkrsaderrcC Cniltrpl
❑Tracer
❑talker ttwlain under 1*21 1
We11 ID# IW-7A
Facilih' TD4 f.irapplicablei
938 Millers Chapel Road, Goldsboro, NC, 27534
Pinsical Address. City. and Zip
Wayne
OM1141
ftrvel Ida:ni36=0vn No. (WN)
ib, l.Rtitudc anil lAiiigitude i,r ik gixeuminutes{aecondfi or dccimmi degrms;
(Ifaellficid. u,t Tar Ir+n11%%wlllek„1r
N
For Inreniol Usc ONLY:
IA. WATKI ZONJIS
FROM
TO
orsicKi nosi
tt.
fi,
ft,
fi,
15. OUTER CAS fNG for
muNF-easnl nc9s1 OR
LINER (if
Rcable
FROM TO
ProV1FTFR
THICK.NESti
M,+ITTRIAI.
0 ft. 6' (i.
1 2" in.
SCH-40
PVC
2d. INNER CASING.OR n1fiIVillerw&I ctuwd-lixi
FROM To DL.%MFTER W1ffKNi53 MATERIAL
ft. A,
is
ft. fi,
i4
f?. Se"E.N
FROM
TO
Or VETFR
!:I.OTSITi
THriKSM I
MAYRRIAL
6' ft.
16' (1,
2" ill,
.020
SCH-40
PVC
I'L
rt.
ra•
18. GROUT
FROM
TO
MATERLALL
EMPLO&TMENT ME'f11011d AMOUNT
0 ft.
3' R,
PORTLAND
POURED
it.
rL
tt.
ft,
RAVEL PACK fif rlicable)
19, SAND1
FROM
Tr) ' )l%ri"RILi. I
E:51Pi.ttr'Mi:NI"Sirrunn
4' R.
16' A, FILTER SAND
# 2
ff.
I A.
28. DRQ.1.JING
LOG (attack addilional ibmi it rime%mr7yi
FROM
TO
DESCRIPTION i m6ir, h;aninv,,,.'i,'nwk rr ow., wain 4k, rots
0 fL
15' fr.
FILL SAND/SILT MOIST TO WET
151 (L
16, (c
SAME
ft.
ft,
ft.
rL
fi
IL
ft.
H.
It. RENLAR"
BENTONITE SEAL 3' TO 4'
22. C:ertil"ieatinn:
Brian Ewing_4/14/2020
Sigmmtrrr ofctrtifwd well Contractor E6C
6. is (are) the well(s)r EPennanent ur ::]Temporary Ov aignit,g thin fierm, l hereby rerrrfa• that nor well(a'J wmy (wrm) mprinwied im Mrar'Awre,
Wrh 15A 11CAC 02C ,0100 or 15A NCAC 0.0 .021VO Well Comirnraon Srdmdards and firer a
7. Is this a repair to in exhung w'eIL• ::l Yes or IMP repy a thir r"ord Am been pnn-A l ra dw nrli inri wr.
ljrhis is n rrlxur, fill var Cnnkv, wVil t cWfsuuL tint, atrfotw4e wt avid ea'plaJji 0w ,aerr,re° tr/ rhr
repair under 021 rmarks.rrx•Jian or on the bark n1 Mis fora,. 23, Site diAgram or aad.diliumll well details:
You may use die back of this page to provide additional u'01 site details or well
S. [number of wells nrmdructed: 1 Cousiruction details. You may aLto attach additional pages if necessan .
formuldlIr a,r}eerJwl or sm-waarer utpph wells ONJ V w-Jrh the samtconstruedon. k4m c<in
salr,ur`t �r,e f,rm. SC RNUTTAL INSTUCTlONS
11, Total V, dI depth loolli 4 land wrface, 16 (tj,) 24a. Far All ► ells Submit this farm within -IU dais of compinion of well
For multiplewells liaral1,lvfuhrijdifiWou+rrcmiplr- @ Of+'aid.@';00) Con5tnictipntoIlk follonirtg-
10. Static water level below top of casin%:
If wYlter le'kel is didVe [YISIN't, Ns,• +
�) Division of Water Resources, InforRmatiun Prucezxing Unit,
1617 Mail Ser vire [center, Ralrigh, NC 27699-1617
11. Borrhok iliametcr. 4.25 Ow) 24b. Egr Iniertion ti4'ells ONLY: In addition to sending the form to Ilfe address in
24a above. also submit a cop}• of this farm within 3O dams of completion of well
12, Well coffiTeuczirni rncthod: BORED Lominiction, to [lie following-
ti.c. auger. rotary, cable. dirccl push cec.l
Dhisian of Walter Resources, Lfndcrpraund Injection Central Program,
FOR WATER SUPPLY WELLS ONLY: 1636 ]Hall Seri ice Cenler, Raleigh, NC 276"-1636
13a, Yield 24c. For Water 5uC !j & lnjcctaxn Welb
t5tpml iNtltrad Dftest: Also submit one cop}- of this foam +within 30 days ofconmplelion of
13h. bisinftYtian hpe: Amount well comli mction to the county health dcporimesmt of hy the counwhat
C#fn5trUctCd.
Far rin Crw-1 Nord Carokiia D elkinnienr of Em irollmirta and Nan" Resources - Di%ision of Aliaier Resources Rei ised Airgiat-4011

WELL CONSTRUCTION RECORD
This roan can be used for single or mull iPk uclls
1. Well Cantrartor Information:
Brian Ewing
Wcll Cortrao m Name
4240-B
NC Well Coniractor Ceti ifrCation Number
SAEDACCO Inc
.m4mv) Name
2, Well CanstMCtinH Permit #-,
List all appJirablr ,sell prtadts rLr.. Caunh+. Matr, Yariamre, JRlOB UaR ell-.)
3. Wd1 Use (check well ulir):
CIALtti uIturat
OGeo(hemtal iNealing)Cooling Supply)
D Industrial/Commercial
❑ hTipatwn
Not -Water Supply Welt:
Q Agilrfier Recharge
❑ Aquifer Storage and Recnti'cry
❑Aquifer TN
❑Expctimental Tixhrtol;og•
❑Genthemial IClosed Leap)
❑GN(lienual IHe9fi1k0'Co0line Relum
4. Date Well(s) Completed: 4-8-20
5a. Well Location:
Goldsboro Milling
Facilib 'Cr,.. , r `• ! r.
DMtinicipatTublic
UResidential Water Supph' (single)
❑Residential Water Supply (shared)
043roundwicr Rcuicdiallion
❑Salinity Hamer
❑Stormivatcr DTa'L1WgC
❑ SrlkrsaderrcC Cniltrpl
❑Tracer
❑talker ttwlain under 1*21 1
We11 ID# IW-8A
Facilih' TD4 f.irapplicablei
938 Millers Chapel Road, Goldsboro, NC, 27534
Pinsical Address. City. and Zip
Wayne
OM1141
ftrvel Ida:ni36=0vn No. (WN)
ib, l.Rtitudc anil lAiiigitude i,r ik gixeuminutes{aecondfi or dccimmi degrms;
(Ifaellficid. u,t Tar Ir+n11%%wlllek„1r
N
For Inreniol Usc ONLY:
IA. WATKI ZONJIS
FROM
TO
orsicKi nosi
tt.
fi,
ft,
fi,
15. OUTER CAS fNG for
muNF-easnl nc9s1 OR
LINER (if
Rcable
FROM TO
ProV1FTFR
THICK.NESti
M,+ITTRIAI.
0 ft. 6' (i.
1 2" in.
SCH-40
PVC
2d. INNER CASING.OR n1fiIVillerw&I ctuwd-lixi
FROM To DL.%MFTER W1ffKNi53 MATERIAL
ft. A,
is
ft. fi,
i4
f?. Se"E.N
FROM
TO
Or VETFR
!:I.OTSITi
THriKSM I
MAYRRIAL
6' ft.
16' (1,
2" ill,
.020
SCH-40
PVC
I'L
rt.
ra•
18. GROUT
FROM
TO
MATERLALL
EMPLO&TMENT ME'f11011d AMOUNT
0 ft.
3' R,
PORTLAND
POURED
it.
rL
tt.
ft,
RAVEL PACK fif rlicable)
19, SAND1
FROM
Tr) ' )l%ri"RILi. I
E:51Pi.ttr'Mi:NI"Sirrunn
4' R.
16' A, FILTER SAND
# 2
ff.
I A.
28. DRQ.1.JING
LOG (attack addilional ibmi it rime%mr7yi
FROM
TO
DESCRIPTION i m6ir, h;aninv,,,.'i,'nwk rr ow., wain 4k, rots
0 fL
15' fr.
FILL SAND/SILT MOIST TO WET
151 (L
16, (c
SAME
ft.
ft,
ft.
rL
fi
IL
ft.
H.
It. RENLAR"
BENTONITE SEAL 3' TO 4'
22. C:ertil"ieatinn:
Brian Ewing_4/14/2020
Sigmmtrrr ofctrtifwd well Contractor E6C
6. is (are) the well(s)r EPennanent ur ::]Temporary Ov aignit,g thin fierm, l hereby rerrrfa• that nor well(a'J wmy (wrm) mprinwied im Mrar'Awre,
Wrh 15A 11CAC 02C ,0100 or 15A NCAC 0.0 .021VO Well Comirnraon Srdmdards and firer a
7. Is this a repair to in exhung w'eIL• ::l Yes or IMP repy a thir r"ord Am been pnn-A l ra dw nrli inri wr.
ljrhis is n rrlxur, fill var Cnnkv, wVil t cWfsuuL tint, atrfotw4e wt avid ea'plaJji 0w ,aerr,re° tr/ rhr
repair under 021 rmarks.rrx•Jian or on the bark n1 Mis fora,. 23, Site diAgram or aad.diliumll well details:
You may use die back of this page to provide additional u'01 site details or well
S. [number of wells nrmdructed: 1 Cousiruction details. You may aLto attach additional pages if necessan .
formuldlIr a,r}eerJwl or sm-waarer utpph wells ONJ V w-Jrh the samtconstruedon. k4m c<in
salr,ur`t �r,e f,rm. SC RNUTTAL INSTUCTlONS
11, Total V, dI depth loolli 4 land wrface, 16 (tj,) 24a. Far All ► ells Submit this farm within -IU dais of compinion of well
For multiplewells liaral1,lvfuhrijdifiWou+rrcmiplr- @ Of+'aid.@';00) Con5tnictipntoIlk follonirtg-
10. Static water level below top of casin%:
If wYlter le'kel is didVe [YISIN't, Ns,• +
�) Division of Water Resources, InforRmatiun Prucezxing Unit,
1617 Mail Ser vire [center, Ralrigh, NC 27699-1617
11. Borrhok iliametcr. 4.25 Ow) 24b. Egr Iniertion ti4'ells ONLY: In addition to sending the form to Ilfe address in
24a above. also submit a cop}• of this farm within 3O dams of completion of well
12, Well coffiTeuczirni rncthod: BORED Lominiction, to [lie following-
ti.c. auger. rotary, cable. dirccl push cec.l
Dhisian of Walter Resources, Lfndcrpraund Injection Central Program,
FOR WATER SUPPLY WELLS ONLY: 1636 ]Hall Seri ice Cenler, Raleigh, NC 276"-1636
13a, Yield 24c. For Water 5uC !j & lnjcctaxn Welb
t5tpml iNtltrad Dftest: Also submit one cop}- of this foam +within 30 days ofconmplelion of
13h. bisinftYtian hpe: Amount well comli mction to the county health dcporimesmt of hy the counwhat
C#fn5trUctCd.
Far rin Crw-1 Nord Carokiia D elkinnienr of Em irollmirta and Nan" Resources - Di%ision of Aliaier Resources Rei ised Airgiat-4011

WELL CONSTRUCTION RECORD
This roan can be used for single or mull iPk uclls
1. Well Cantrartor Information:
Brian Ewing
Wcll Cortrao m Name
4240-B
NC Well Coniractor Ceti ifrCation Number
SAEDACCO Inc
.m4mv) Name
2, Well CanstMCtinH Permit #-,
List all appJirablr ,sell prtadts rLr.. Caunh+. Matr, Yariamre, JRlOB UaR ell-.)
3. Wd1 Use (check well ulir):
CIALtti uIturat
OGeo(hemtal iNealing)Cooling Supply)
D Industrial/Commercial
❑ hTipatwn
Not -Water Supply Welt:
Q Agilrfier Recharge
❑ Aquifer Storage and Recnti'cry
❑Aquifer TN
❑Expctimental Tixhrtol;og•
❑Genthemial IClosed Leap)
❑GN(lienual IHe9fi1k0'Co0line Relum
4. Date Well(s) Completed: 4-8-20
5a. Well Location:
Goldsboro Milling
Facilib 'Cr,.. , r `• ! r.
DMtinicipatTublic
UResidential Water Supph' (single)
❑Residential Water Supply (shared)
043roundwicr Rcuicdiallion
❑Salinity Hamer
❑Stormivatcr DTa'L1WgC
❑ SrlkrsaderrcC Cniltrpl
❑Tracer
❑talker ttwlain under 1*21 1
We11 ID# IW-9A
Facilih' TD4 f.irapplicablei
938 Millers Chapel Road, Goldsboro, NC, 27534
Pinsical Address. City. and Zip
Wayne
OM1141
ftrvel Ida:ni36=0vn No. (WN)
ib, l.Rtitudc anil lAiiigitude i,r ik gixeuminutes{aecondfi or dccimmi degrms;
(Ifaellficid. u,t Tar Ir+n11%%wlllek„1r
N
For Inreniol Usc ONLY:
IA. WATKI ZONJIS
FROM
TO
orsicKi nosi
tt.
fi,
ft,
fi,
15. OUTER CAS fNG for
muNF-easnl nc9s1 OR
LINER (if
Rcable
FROM TO
ProV1FTFR
THICK.NESti
M,+ITTRIAI.
0 ft. 6' (i.
1 2" in.
SCH-40
PVC
2d. INNER CASING.OR n1fiIVillerw&I ctuwd-lixi
FROM To DL.%MFTER W1ffKNi53 MATERIAL
ft. A,
is
ft. fi,
i4
f?. Se"E.N
FROM
TO
Or VETFR
!:I.OTSITi
THriKSM I
MAYRRIAL
6' ft.
16' (1,
2" ill,
.020
SCH-40
PVC
I'L
rt.
ra•
18. GROUT
FROM
TO
MATERLALL
EMPLO&TMENT ME'f11011d AMOUNT
0 ft.
3' R,
PORTLAND
POURED
it.
rL
tt.
ft,
RAVEL PACK fif rlicable)
19, SAND1
FROM
Tr) ' )l%ri"RILi. I
E:51Pi.ttr'Mi:NI"Sirrunn
4' R.
16' A, FILTER SAND
# 2
ff.
I A.
28. DRQ.1.JING
LOG (attack addilional ibmi it rime%mr7yi
FROM
TO
DESCRIPTION i m6ir, h;aninv,,,.'i,'nwk rr ow., wain 4k, rots
0 fL
15' fr.
FILL SAND/SILT MOIST TO WET
151 (L
16, (c
SAME
ft.
ft,
ft.
rL
fi
IL
ft.
H.
It. RENLAR"
BENTONITE SEAL 3' TO 4'
22. C:ertil"ieatinn:
Brian Ewing_4/14/2020
Sigmmtrrr ofctrtifwd well Contractor E6C
6. is (are) the well(s)r EPennanent ur ::]Temporary Ov aignit,g thin fierm, l hereby rerrrfa• that nor well(a'J wmy (wrm) mprinwied im Mrar'Awre,
Wrh 15A 11CAC 02C ,0100 or 15A NCAC 0.0 .021VO Well Comirnraon Srdmdards and firer a
7. Is this a repair to in exhung w'eIL• ::l Yes or IMP repy a thir r"ord Am been pnn-A l ra dw nrli inri wr.
ljrhis is n rrlxur, fill var Cnnkv, wVil t cWfsuuL tint, atrfotw4e wt avid ea'plaJji 0w ,aerr,re° tr/ rhr
repair under 021 rmarks.rrx•Jian or on the bark n1 Mis fora,. 23, Site diAgram or aad.diliumll well details:
You may use die back of this page to provide additional u'01 site details or well
S. [number of wells nrmdructed: 1 Cousiruction details. You may aLto attach additional pages if necessan .
formuldlIr a,r}eerJwl or sm-waarer utpph wells ONJ V w-Jrh the samtconstruedon. k4m c<in
salr,ur`t �r,e f,rm. SC RNUTTAL INSTUCTlONS
11, Total V, dI depth loolli 4 land wrface, 16 (tj,) 24a. Far All ► ells Submit this farm within -IU dais of compinion of well
For multiplewells liaral1,lvfuhrijdifiWou+rrcmiplr- @ Of+'aid.@';00) Con5tnictipntoIlk follonirtg-
10. Static water level below top of casin%:
If wYlter le'kel is didVe [YISIN't, Ns,• +
�) Division of Water Resources, InforRmatiun Prucezxing Unit,
1617 Mail Ser vire [center, Ralrigh, NC 27699-1617
11. Borrhok iliametcr. 4.25 Ow) 24b. Egr Iniertion ti4'ells ONLY: In addition to sending the form to Ilfe address in
24a above. also submit a cop}• of this farm within 3O dams of completion of well
12, Well coffiTeuczirni rncthod: BORED Lominiction, to [lie following-
ti.c. auger. rotary, cable. dirccl push cec.l
Dhisian of Walter Resources, Lfndcrpraund Injection Central Program,
FOR WATER SUPPLY WELLS ONLY: 1636 ]Hall Seri ice Cenler, Raleigh, NC 276"-1636
13a, Yield 24c. For Water 5uC !j & lnjcctaxn Welb
t5tpml iNtltrad Dftest: Also submit one cop}- of this foam +within 30 days ofconmplelion of
13h. bisinftYtian hpe: Amount well comli mction to the county health dcporimesmt of hy the counwhat
C#fn5trUctCd.
Far rin Crw-1 Nord Carokiia D elkinnienr of Em irollmirta and Nan" Resources - Di%ision of Aliaier Resources Rei ised Airgiat-4011

WELL CONSTRUCTION RECORD
This roan can be used for single or mull iPk uclls
1. Well Cantrartor Information:
Brian Ewing
Wcll Cortrao m Name
4240-B
NC Well Coniractor Ceti ifrCation Number
SAEDACCO Inc
.m4mv) Name
2, Well CanstMCtinH Permit #-,
List all appJirablr ,sell prtadts rLr.. Caunh+. Matr, Yariamre, JRlOB UaR ell-.)
3. Wd1 Use (check well ulir):
CIALtti uIturat
OGeo(hemtal iNealing)Cooling Supply)
D Industrial/Commercial
❑ hTipatwn
Not -Water Supply Welt:
Q Agilrfier Recharge
❑ Aquifer Storage and Recnti'cry
❑Aquifer TN
❑Expctimental Tixhrtol;og•
❑Genthemial IClosed Leap)
❑GN(lienual IHe9fi1k0'Co0line Relum
4. Date Well(s) Completed: 4-8-20
5a. Well Location:
Goldsboro Milling
Facilib 'Cr,.. , r `• ! r.
DMtinicipatTublic
UResidential Water Supph' (single)
❑Residential Water Supply (shared)
043roundwicr Rcuicdiallion
❑Salinity Hamer
❑Stormivatcr DTa'L1WgC
❑ SrlkrsaderrcC Cniltrpl
❑Tracer
❑talker ttwlain under 1*21 1
WeD ID# IW-IOA
Facilih' TD4 f.irapplicablei
938 Millers Chapel Road, Goldsboro, NC, 27534
Pinsical Address. City. and Zip
Wayne
OM1141
ftrvel Ida:ni36=0vn No. (WN)
ib, l.Rtitudc anil lAiiigitude i,r ik gixeuminutes{aecondfi or dccimmi degrms;
(Ifaellficid. u,t Tar Ir+n11%%wlllek„1r
N
For Inreniol Usc ONLY:
IA. WATKI ZONJIS
FROM
TO
orsicKi nosi
tt.
fi,
ft,
fi,
15. OUTER CAS fNG for
muNF-easnl nc9s1 OR
LINER (if
Rcable
FROM TO
ProV1FTFR
THICK.NESti
M,+ITTRIAI.
0 ft. 6' (i.
1 2" in.
SCH-40
PVC
2d. INNER CASING.OR n1fiIVillerw&I ctuwd-lixi
FROM To DL.%MFTER W1ffKNi53 MATERIAL
ft. A,
is
ft. fi,
i4
f?. Se"E.N
FROM
TO
Or VETFR
!:I.OTSITi
THriKSM I
MAYRRIAL
6' ft.
16' (1,
2" ill,
.020
SCH-40
PVC
I'L
rt.
ra•
18. GROUT
FROM
TO
MATERLALL
EMPLO&TMENT ME'f11011d AMOUNT
0 ft.
3' R,
PORTLAND
POURED
it.
rL
tt.
ft,
RAVEL PACK fif rlicable)
19, SAND1
FROM
Tr) ' )l%ri"RILi. I
E:51Pi.ttr'Mi:NI"Sirrunn
4' R.
16' A, FILTER SAND
# 2
ff.
I A.
28. DRQ.1.JING
LOG (attack addilional ibmi it rime%mr7yi
FROM
TO
DESCRIPTION i m6ir, h;aninv,,,.'i,'nwk rr ow., wain 4k, rots
0 fL
15' fr.
FILL SAND/SILT MOIST TO WET
151 (L
16, (c
SAME
ft.
ft,
ft.
rL
fi
IL
ft.
H.
It. RENLAR"
BENTONITE SEAL 3' TO 4'
22. C:ertil"ieatinn:
Brian Ewing_4/14/2020
Sigmmtrrr ofctrtifwd well Contractor E6C
6. is (are) the well(s)r EPennanent ur ::]Temporary Ov aignit,g thin fierm, l hereby rerrrfa• that nor well(a'J wmy (wrm) mprinwied im Mrar'Awre,
Wrh 15A 11CAC 02C ,0100 or 15A NCAC 0.0 .021VO Well Comirnraon Srdmdards and firer a
7. Is this a repair to in exhung w'eIL• ::l Yes or IMP repy a thir r"ord Am been pnn-A l ra dw nrli inri wr.
ljrhis is n rrlxur, fill var Cnnkv, wVil t cWfsuuL tint, atrfotw4e wt avid ea'plaJji 0w ,aerr,re° tr/ rhr
repair under 021 rmarks.rrx•Jian or on the bark n1 Mis fora,. 23, Site diAgram or aad.diliumll well details:
You may use die back of this page to provide additional u'01 site details or well
S. [number of wells nrmdructed: 1 Cousiruction details. You may aLto attach additional pages if necessan .
formuldlIr a,r}eerJwl or sm-waarer utpph wells ONJ V w-Jrh the samtconstruedon. k4m c<in
salr,ur`t �r,e f,rm. SC RNUTTAL INSTUCTlONS
11, Total V, dI depth loolli 4 land wrface, 16 (tj,) 24a. Far All ► ells Submit this farm within -IU dais of compinion of well
For multiplewells liaral1,lvfuhrijdifiWou+rrcmiplr- @ Of+'aid.@';00) Con5tnictipntoIlk follonirtg-
10. Static water level below top of casin%:
If wYlter le'kel is didVe [YISIN't, Ns,• +
�) Division of Water Resources, InforRmatiun Prucezxing Unit,
1617 Mail Ser vire [center, Ralrigh, NC 27699-1617
11. Borrhok iliametcr. 4.25 Ow) 24b. Egr Iniertion ti4'ells ONLY: In addition to sending the form to Ilfe address in
24a above. also submit a cop}• of this farm within 3O dams of completion of well
12, Well coffiTeuczirni rncthod: BORED Lominiction, to [lie following-
ti.c. auger. rotary, cable. dirccl push cec.l
Dhisian of Walter Resources, Lfndcrpraund Injection Central Program,
FOR WATER SUPPLY WELLS ONLY: 1636 ]Hall Seri ice Cenler, Raleigh, NC 276"-1636
13a, Yield 24c. For Water 5uC !j & lnjcctaxn Welb
t5tpml iNtltrad Dftest: Also submit one cop}- of this foam +within 30 days ofconmplelion of
13h. bisinftYtian hpe: Amount well comli mction to the county health dcporimesmt of hy the counwhat
C#fn5trUctCd.
Far rin Crw-1 Nord Carokiia D elkinnienr of Em irollmirta and Nan" Resources - Di%ision of Aliaier Resources Rei ised Airgiat-4011

WELL CONSTRUCTION RECORD
This roan can be used for single or mull iPk uclls
1. Well Cantrartor Information:
Brian Ewing
Wcll Cortrao m Name
4240-B
NC Well Coniractor Ceti ifrCation Number
SAEDACCO Inc
.m4mv) Name
2, Well CanstMCtinH Permit #-,
List all appJirablr ,sell prtadts rLr.. Caunh+. Matr, Yariamre, JRlOB UaR ell-.)
3. Wd1 Use (check well ulir):
CIALtti uIturat
OGeo(hemtal iNealing)Cooling Supply)
D Industrial/Commercial
❑ hTipatwn
Not -Water Supply Welt:
Q Agilrfier Recharge
❑ Aquifer Storage and Recnti'cry
❑Aquifer TN
❑Expctimental Tixhrtol;og•
❑Genthemial IClosed Leap)
❑GN(lienual IHe9fi1k0'Co0line Relum
4. Date Well(s) Completed: 4-8-20
5a. Well Location:
Goldsboro Milling
Facilib 'Cr,.. , r `• ! r.
DMtinicipatTublic
UResidential Water Supph' (single)
❑Residential Water Supply (shared)
043roundwicr Rcuicdiallion
❑Salinity Hamer
❑Stormivatcr DTa'L1WgC
❑ SrlkrsaderrcC Cniltrpl
❑Tracer
❑talker ttwlain under 1*21 1
WeD ID# IW-IIA
Facilih' TD4 f.irapplicablei
938 Millers Chapel Road, Goldsboro, NC, 27534
Pinsical Address. City. and Zip
Wayne
OM1141
ftrvel Ida:ni36=0vn No. (WN)
ib, l.Rtitudc anil lAiiigitude i,r ik gixeuminutes{aecondfi or dccimmi degrms;
(Ifaellficid. u,t Tar Ir+n11%%wlllek„1r
N
For Inreniol Usc ONLY:
IA. WATKI ZONJIS
FROM
TO
orsicKi nosi
tt.
fi,
ft,
fi,
15. OUTER CAS fNG for
muNF-easnl nc9s1 OR
LINER (if
Rcable
FROM TO
ProV1FTFR
THICK.NESti
M,+ITTRIAI.
0 ft. 6' (i.
1 2" in.
SCH-40
PVC
2d. INNER CASING.OR n1fiIVillerw&I ctuwd-lixi
FROM To DL.%MFTER W1ffKNi53 MATERIAL
ft. A,
is
ft. fi,
i4
f?. Se"E.N
FROM
TO
Or VETFR
!:I.OTSITi
THriKSM I
MAYRRIAL
6' ft.
16' (1,
2" ill,
.020
SCH-40
PVC
I'L
rt.
ra•
18. GROUT
FROM
TO
MATERLALL
EMPLO&TMENT ME'f11011d AMOUNT
0 ft.
3' R,
PORTLAND
POURED
it.
rL
tt.
ft,
RAVEL PACK fif rlicable)
19, SAND1
FROM
Tr) ' )l%ri"RILi. I
E:51Pi.ttr'Mi:NI"Sirrunn
4' R.
16' A, FILTER SAND
# 2
ff.
I A.
28. DRQ.1.JING
LOG (attack addilional ibmi it rime%mr7yi
FROM
TO
DESCRIPTION i m6ir, h;aninv,,,.'i,'nwk rr ow., wain 4k, rots
0 fL
15' fr.
FILL SAND/SILT MOIST TO WET
151 (L
16, (c
SAME
ft.
ft,
ft.
rL
fi
IL
ft.
H.
It. RENLAR"
BENTONITE SEAL 3' TO 4'
22. C:ertil"ieatinn:
Brian Ewing_4/14/2020
Sigmmtrrr ofctrtifwd well Contractor E6C
6. is (are) the well(s)r EPennanent ur ::]Temporary Ov aignit,g thin fierm, l hereby rerrrfa• that nor well(a'J wmy (wrm) mprinwied im Mrar'Awre,
Wrh 15A 11CAC 02C ,0100 or 15A NCAC 0.0 .021VO Well Comirnraon Srdmdards and firer a
7. Is this a repair to in exhung w'eIL• ::l Yes or IMP repy a thir r"ord Am been pnn-A l ra dw nrli inri wr.
ljrhis is n rrlxur, fill var Cnnkv, wVil t cWfsuuL tint, atrfotw4e wt avid ea'plaJji 0w ,aerr,re° tr/ rhr
repair under 021 rmarks.rrx•Jian or on the bark n1 Mis fora,. 23, Site diAgram or aad.diliumll well details:
You may use die back of this page to provide additional u'01 site details or well
S. [number of wells nrmdructed: 1 Cousiruction details. You may aLto attach additional pages if necessan .
formuldlIr a,r}eerJwl or sm-waarer utpph wells ONJ V w-Jrh the samtconstruedon. k4m c<in
salr,ur`t �r,e f,rm. SC RNUTTAL INSTUCTlONS
11, Total V, dI depth loolli 4 land wrface, 16 (tj,) 24a. Far All ► ells Submit this farm within -IU dais of compinion of well
For multiplewells liaral1,lvfuhrijdifiWou+rrcmiplr- @ Of+'aid.@';00) Con5tnictipntoIlk follonirtg-
10. Static water level below top of casin%:
If wYlter le'kel is didVe [YISIN't, Ns,• +
�) Division of Water Resources, InforRmatiun Prucezxing Unit,
1617 Mail Ser vire [center, Ralrigh, NC 27699-1617
11. Borrhok iliametcr. 4.25 Ow) 24b. Egr Iniertion ti4'ells ONLY: In addition to sending the form to Ilfe address in
24a above. also submit a cop}• of this farm within 3O dams of completion of well
12, Well coffiTeuczirni rncthod: BORED Lominiction, to [lie following-
ti.c. auger. rotary, cable. dirccl push cec.l
Dhisian of Walter Resources, Lfndcrpraund Injection Central Program,
FOR WATER SUPPLY WELLS ONLY: 1636 ]Hall Seri ice Cenler, Raleigh, NC 276"-1636
13a, Yield 24c. For Water 5uC !j & lnjcctaxn Welb
t5tpml iNtltrad Dftest: Also submit one cop}- of this foam +within 30 days ofconmplelion of
13h. bisinftYtian hpe: Amount well comli mction to the county health dcporimesmt of hy the counwhat
C#fn5trUctCd.
Far rin Crw-1 Nord Carokiia D elkinnienr of Em irollmirta and Nan" Resources - Di%ision of Aliaier Resources Rei ised Airgiat-4011

s
�
F-1
MW-2 '•�,, O
� � 1
��♦ BMW-1
DW-1 A� MW-3 ��♦ , /
MW-15
�M^W-14
l0�
BMW-16
� MW-17
O
� MW-13
Legend
Existing Permanent Injection Well
Monitoring Well (Surficial Aquifer)
Monitoring Well (Black Creek Aquifer)
CParcel Boundary
0 15 30
Feet
1in=15ft
NC OneMap, NC Center for Geographic Information and Analysis, NC 911 Board
w
LL
U
z
Q o
> o
c
ca cn
C Q-0
O U U°
0CU
�
J
4) o 0
o C6
� � U
O
d
00
co
r-
00
0
r- 0
m
� o
• N � >,
a 6, m
z ; m _0
U LO C Y
ai 3
o � Co �
o_��U