WI0100230_Complete File - Historical_20191017

North Carolina Department of Environmental Quality — Division of Water Resources
INJECTION EVENT RECORD (IER)
OCT 17 2M,
Permit Number WI0100230
1. Permit Information
Chemtronics, Inc.
Permittee
Chemtronics Superfund Site. APA — P-5 (Back Valley) PTA
Facility Name
_180 Old Bee Tree Road, Swannanoa, NC 28778
Facility Address (include County)
?. Injection Contractor Information
Geosvntec Consultants of NC. P.C.
Injection Contractor / Company Name
Street Address 1255 Roberts Boulevard, Suite 200
Kennesaw GA 30144
City State Zip Code
[phone]
Area code — Phone number
3. Well Information
Number of wells used for injection 5
Well IDs: IP-BV-1, -2, -3, -4. -5
Were any new wells installed during this injection
event?
❑ Yes ® No
If yes, please provide the following information:
Number of Monitoring Wells
Number of Injection Wells
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 abandone c�Secton
event?
❑ Yes ® No
If yes, please provide the following information:
Number of Monitoring Wells
Number of Injection Wells
Please include a copy of the GW-30 for each well
abandoned
4. Injectant Information
Nutrisulfate. sodium bicarbonate. diammonium
phosphate (DAP), fluorescein dye
Injectant(s) Type (can use separate additional sheets
if necessary
Concentration 24 cJL Nutrisulfate (3,069 mg/L sulfate),
13 g/L sodium bicarbonate. 67 mg/L DAP, 46 mg/L
fluorescein
If the injectant is diluted please indicate the source
dilution fluid. City water (45,193 gallons) and extracted
groundwater (475 gallons)
Total Volume Injected (gal) 45,668
Volume Injected per well (gal) 3,185 to 13,629
5. Injection History
Injection date(s) August 22 to September 16, 2019
Injection number (e.g. 3 of 5) 2 of 2
Is this the last injection at this site?
❑ Yes ® 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.
��� �Qd..•- col tl/ Zo19
SIGNATURE OF INJECTION CONTRACTOR DATE
&OKCA-Or11- XK-j- A& PE.- V q1 ZJ?
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-TER
Attn: UIC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-807-6464 Rev. 3-1-2016

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
Randy Phillips
Weil Contractor Name
1096-A
NC Well Contractor Certification Number
A.E. Drilling Services
Company Name
2. Well Construction Permit #:
List all applicable uv ff per mus fr.e_ Comity. State, Variance, h jectiort, etc)
3. Well Use (check well Ilse):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
Non -Water
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed .Loop)
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 92
4. Date Well(s) Completed: 11 /20114 Wev >D# IP-BV-1
Sa. Well Location:
Chemtronics
Facility/Owner Name Facility ID# (if applicable)
180 Old Bee Tree Rd. Swannanoah
Physical Address, City, and Zip
Buncombe
County
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one latflong is sufficient)
N
6. Is (are) the well(s): 211'ermanent or ❑Temporary
W
7. Is this a repair to an existing well: ❑Yes or ®No
If this is a repair• fill out /maim well construction information and rplain the nature of due
repair under #21 remarks section or on the back ofthis form.
8. Number of wells constructed: 1
For multiple h jection or non -water supply wells ONLY with the same construction. you can
submit omefam.
9. Total well depth below land surface: 92 (ft.)
For multiple wells lust all depths ifdifferent (example- 3@ 00' and 2@101f)
10. Static water level below top of casing: 22.1 (ft.)
if water level is above casing, rise '•+"
11. Borehole diameter: 6
12. Weil construction method: Auger / Core
(i.e. auger, rotary, cable, direct push, etc.)
For internal Use ONLY:
14. WATER
ZONES
FROM
TO
DESCRIPTION
ft.
R.
ft.
fc
15.OUTER CASING [or
mnitiaased wtdh) ORLRyEA Ha
Hcable
FROM
To
DIAMETER
THICKNESS
MATERIAL.
0 ft-
72 e.
2 1O
Sch 40
1 PVC
16. INNER CASING OR
TUBING Neothermat
closed -lap
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft
in.
ft.
ft.
in
17. SCREEN
FROM
TO
DIAMETER
I SLOT SIZE
I THICKNESS
1MATERIAL
72 "'
92 rt.
2 In
.010
Sch 40
PVC
ft.
It.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
65.9 ft,
69.4 ft
chips
tremmie
0 9-
65.9 fL
neat cement
tremmie
ft.
ft.
19. SAND/GRAVEL PACK
if applicable)
FROM
TO
MATERIAL
EMPLACEMETTMEIHOD
69.4 ft•
92 fc
#1 sand
tremmie
ft.
ft.
20. DRILLING
LOG (attach additional sheets if necessa
FROM
I TO
DESCRIPTION (color, hardness, soWrnch type, grain size, etc.)
It.
ft.
ft.
it.
ft.
ft.
ft.
R.
ft.
ft.
ft.
rt.
Iit.
21. REMARKS
22. Certification:
/l7 12J18114
Signature ofC 'find Well Contractor Date
By signing t is farm, 1 hereby certify that the nril(s) was (were) constructed in accordance
Will 15A NCAC 02C.0100 or 15A NCAC 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 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 Matt Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells ONLY: in addition to sending the form to the address in
24aabove., 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,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center. Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Injection Wells:
Also submit one copy of this form within 30 days ofcompletion of
13b. Disinfection type: Amount: well construction to the cotmry 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 RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
Randy Phillips
Well ContracterName
1096-A
NC Well Contractor Certification Number
A.E.Ddlling Services
Company Name
2. Well Construction Permit #:
List all applrcable iw11permits (Le County, State, Variance. It#ection, etc.)
3. Well Use (check well use):
❑Agricultural
❑Geothermal (Fleating/Cooling Supply)
❑Industria /Commercial
Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Fleatine/Cooline
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Groundwater Remediation
❑Salinity Barrier
❑Stornwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21
4. Date Well(s) Completed: 1 1 /1 31 1 4 Well ID# I P-BV-2
So. Well Location:
Chemtronics
Facility/Owner Name Facility ID# (if applicable)
180 Old Bee Tree Rd. Swannanoah
Physical Address, City, and Zip
Buncombe
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one iat/long is sufficient)
N
6. Is (are) the well(s): OPermanent or ❑Temporary
W
7. Is this a repair to an existing well: ❑Yes or FIND
Ifthis is a repair, fill and laimwe ivell consirriction information mid explain the nature ofthe
repair under #11 remm4rs section or on the back of this form.
8. Number of wells constructed: 1
For multiple isyection or non -water supply wells ONLY with the same construction, you cats
submit one form.
9. Total well depth below land surface: 92 (ft.)
For inuldple wells list all depths ifdiffereut (ermuple- 3@200' and 2Cy100l
10. Static water level below top of easing: 18.02 00
If water level is ahove casing: use
11. Borehole diameter: 6
12. Well construction method: Auger / Core
(i.e. auger, rotary, cable, direct Ruch, etc.)
For Internal Use ONLY:
14. WATER ZONES
FROM
TO
I DESCRIPTION
ft.
fr_
ft.
fr.
15.OUTER CASING for multi -cased wells OR LINER H a
0cable
FROM
TO DIAMETER
THICKNESS
MATERIAL
0 ft-
72 ft- 2 in
SCh 40
PVC
16. INNER
CASING OR TUBING(geothermal
closed-loo
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
It.
In.
ft.
ft.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
72 fr.
92 ft.
2 In.
.010
sch 40
PVC
ft.
ft.
in.
18. GROUT
FROM
I TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
67 ft.
70 IL
chips
tremmie
0 ft.
67 It.
neat cement
tremmie
ft.
ft.
19. SAND/GRAVEL PACK
if a tleable
FROM
TO
MATERIAL I
EMPLACEMENT METHOD
70 et•
92 fr
#1 sand
tremmie
f6
ft.
20. DRILLING
LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soltfmck type, grain sine. etc.)
fr.
ft.
fr.
fL
fr.
ft.
ft.
ft,
fr.
rr.
IL
ft.
1L
ft.
21. REMARKS
22. Certification:
12/18/14
Signature ofeErtificd Well Contractor Date
8y signing lids form. I hereby certify that the wells) was (were) constructed in accordance
with 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Cousnricdon Standards and that a
copy of this record has beers provided to the aril 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.
SUBNf YTAL 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,
107 Mail Service Center, Raleigk, 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,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Injection Wells:
Also submit one copy of this form within 30 days of completion of
13b. Disinfection type: Amount: well construction to the county health department of the county where
constructed.
Form GW-1 North Carolina Department of Environment and Natural Resources —Division of Water Resources Revised August 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
Randy Phiiiips
Well Contractor Name
1096-A
NC Well Contractor Certification Number
A.E. Drilling Services
Company Name
2. Well Construction Permit #:
List all applicable »ell permits (i.e. County, State, Variance, Injection, etc_)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural ❑Municipal/Public
❑Geothemtal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial El Residential Water Supply (shared)
Well:
❑Recovery
❑Aquifer Recharge
❑Groundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
❑Stormwater Drainage
❑Expeiimentai Technology
❑Subsidence Control
❑Geothermaf (Closed Loop)
❑Tracer
❑Other (explain udder #21
4. Date Well(s) Completed: 1 1 /%/14 Weil ID# IP-BV-3
5a. Well Location:
Chemtronics
Facility/Owner Name Facility lD# (ifapplicabie)
180 Old Bee Tree Rd. Swannanoah
Physical Address, City, and Zip
Buncombe
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one Iat/long is sufficient)
N
6. Is (are) the well(s): 2Permanent or ❑Temporary
1J
7. is this a repair to an existing well: ❑Yes or EINo
If this is a repair. ft(l out knonw welt construction information and explain the nurture of the
repair under t121 remarks section or on the back aj'thir form_
S. Number of wells constructed: 1
For multiple injection or non -water supply svells ONLY with the same construction, you can
submit oneform. 9. Total well depth below land surface: 91 •5 (ft )
For multiple wells list all deptim ffdierent (example- 3@4200' and 2@10ti)
10. Static water level below top of casing: 21 ' 96 (ft.)
If water level is above casing. tire --"
it. Borehole diameter: 6 (in.)
12. Well construction method: Auger / Core
(i.e. auger, rotary, cable, direct push, etc.)
For internal Use ONLY:
14. WATER ZONES
FROM
TO
I DESCRIPTION
ft
R,
fL
R-
15.OUTER CASING (for
multi -cased we OR LINER if a
licableCKNESS
FROM
TO
DWa1ETER
THIMATERIAL
0 R
71.5 _ft'
2 i"
sch 40 PVC
16. INNER
CASING OR TUBING(geothermal
closed -lop
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
ft.
ft,
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATFAIAT.
71.5 ft,
91.5 ft• 2
In.
.010
sch 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
66.5 ft'
69.5 ft-
chips
tremmie
0 R•
66.5 ft
neat cement
tremmie
Ct.
ft.
19. SAND/GRAVEL PACK if applicable)
FROM
TO
MATERIAL I
EMPLACEMENTMETHOD
69.5 CL
91.5 ft-
#1 sand
tremmie
ft.
ft.
20. DRILLING LOG attach additional sheets if necessary)
FROM
I TO
DESCRIPTION color, hardness soiVrak type. grain sit, etc.)
f.
fL
ft.
ft.
ft.
fc
ft.
Ct.
ft.
ft.
ft.
ft.
ft.
R.
21. REMARKS
2L Certification:
r'x 12/18/14
Signature of C rfied Well Contractor Date
By signing this farm. 1 hereby certi• that the wells) was (were) constructed in accordance
with ISA NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a
ropy of this record has been provided to the aell 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 JNSTUCTIONS
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 fort within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY- 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Injection Wells:
Also submit one copy of this form within 30 days of completion of
13b. Disinfection type: Amount: well construction to the county health department of the county cohere
constructed.
Form GW-1 North Carolina Department of Envirenment and Natural Resources - Division oCWater Resources Revised August 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple welts
1. Well Contractor Information:
Randy Phillips
Well Contractor Name
1096-A
NC Well Contractor Certification Number
A.E.Drilling Services
Company Name
2. Well Construction Permit#:
List all applicable uvll permits (i.e. County; State, Variance, b#ecvion, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural ❑Municipai/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial ❑Residential Water Supply (shared)
Non -Water Supply Well:
❑Aquifer Recharge
❑Groundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
❑Stormwater Drainage
❑Experimental Technology
❑Subsidence Control
❑Geothermal (Closed Loop)
❑Tracer
❑Geothermal (Heatine/Cooline Return)
❑Other (explain under #21 1
4. Date Well(S) Completed: 11113/ 14 Wen ID# f P-BV-4
So. Well Location:
Chemtronics
FacilityfOwner Name Facility 1D9 (if applicable)
180 Old Bee Tree Rd. Swannanoah
Physical Address, City, and Zip
Buncombe
County Parcel Identification No. (PEN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one latflong is sufficient)
I:j
6. Is (are) the well(s): ®Permanent or ❑Temporary
W
7. Is this a repair to an existing well: ❑Yes or ®No
ff this is a repair, fill out !mown well construction information mid explain the nature of the
repair tender #21 remarks section or on the back oJ'thls Jbrm.
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 wen depth below land surface: 92
For• multiple wells list all depths if different (example- 3@200' and 2(a,I MY)
I0. Static water level below top of casing: 22, 01
lfwater level is above casing, use
11. Borehole diameter: 6 (in.)
12. Well construction method: Auger / Core
(i.e. auger, rotary, cable, direct push, etc.)
Fur Internal Use ONLY:
14. WAT'ERZONES
FROM
TO
I DESCRIPTION
t4
R.
15. OUTER CING formutudwells
OR
tnbte
FROM
T&
MATERIAL.
0 fi
72 R
2 i"
sch 40
PVC
I& INNER
CASING OR
TUBING (geothermal closed400
FROM
TO
UMMLTER
TH7CICNtSS
MATERIAL
ft.
ft
In.
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
72 1"
92 it-
2 in•
.010
sch 40
PVC
fL
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AhIOUNT
67 fr.
70 ft
chips
tremmie
0 it.
67 ft.
neat cement
tremmie
R.
ft
19. SAND/GRAVEL PACK
if a usable
FROM
TO
I MATERIAL
EMPLACEMENTMETHOD
70 ft
92 ft-
#1 sand
tremmie
ft
ft.
20. DRILLING LOG attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soalrock type, grain size, eta
fL
ft.
ft.
R.
ft.
ft.
R.
R.
ft.
ft
ft.
ft.
21. REMARKS
22. Certification:
12/18/14
Signature ofCe 'ed Well Contractor
Date
By signing this Jorm, l hereby cerlh, 11-1 the wells) was (ivere) constructed in accordance
ivith 15A NCAC 02C.0100 or 15A NCAC 01C.0200 iYell Construction Srandards and that a
ropy of Nils 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.
SUBMITTALINSTUCTIONS
(fL) 249. For An Wells: Submit this form within 30 days of completion of well
construction to the folloaring:
(R-) Division of Water Resources, information Processing Unit,
1617 Man 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,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Injection Wells:
Also submit one copy of this form within 30 days of completion of
I3b. Disinfection type: Amount: well construction to the county health department of the county where
constructed.
Form OW-1 North Carolina Department of Environment and Natural Resources — Division of Water Resources Revised August 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor information:
Randy Phillips
Well Contractor Name
1096-A
NC Well Contractor Certification Number
A.E.Drilling Services
Company Name
2. Well Construction Permit #:
List all applicable cell permits (i.e. Comity. State. Yariance, Injection, etc.)
3. Well Use (check well use):
Water Supply We&
❑Agricultural
❑Geothemmd (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
[]Geothermal (Closed Loop)
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Groundwater Remediation
❑Salinity Barrier
❑Stonnwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 1
4. Date Well(s) Completed: 11/10/14 WeBID# IP-BV-5
5a. Well Location:
Chemtronics
Facility/Owner Name Facility ID# (if applicable)
180 Old Bee Tree Rd. Swannanoah
Physical Address. City, and Zip
Buncombe
County
Parcel Identification No. (PIN)
For interval Use ONLY:
14. WATER ZONES
FROM
To
I DESCRIPTION
ft.
fL
ft.
ft.
15. OUTER CASING for
mut4eased wells OR
L1NER Ef a
licable
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft'
j 71 ft
2 iii I
sch 40
1 PVC
16. INNER
CASING OR TUBING(geothermal
closed-loo )
FROM
To
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
En.
ft,
ft.
in
17. SCREEN
FROM
TO
DL%N=R
SLOT SiZE
THICKNESS
MATERIAL
71 fr'
91 ft.
2 in.
.010
sch 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & .AMOUNT
66 ft'
69 ft.
chips
tremmie
0 ft.
66 ft.
neat cement
tremmie
ft.
ft.
19, SANDIGRAVEL PACK
if applicable)
FROM
TO
MATERLAL
EMPLACEMENT METHOD
69 fr.
91 M
#1 sand
tremmie
ft.
ft.
20. DRILLING LOG (attack additional sheets if necessary)
FROM
TO
DESCRIPTION color, hardness solllrack type, grain slre, etc.)
ft.
fL
ft.
ft.
ft,
ft.
ft.
ft.
ft
to
ft.
[t
ft.
fr.
21. REMARKS
5b. Latitude and Longitude in degrees(minntes/seeonds or decimal degrees:
(ifwell field, one lat/long is sufficient)
22. Certification:
ffi
N
6. Is (are) the wel (s): ®Permanent or ❑Temporary
W 2zr� 12/18/14
Signature of�ed Well Contractor Date
7. Is this a repair to an existing well: ❑Yes or LINo
If this is a repair. flit our knmvn well construction information and explain the nature of the
repair under #21 remarks seclion or on the back of thiv form.
8. Number of wells constructed: 1
For multiple injection or non -water supply wells ONLYwilh lire same construction, you can
submit one form.
9. Total well depth below land surface: 91 (fL)
For multiple ivells list all depths if different (example- 3 r�r 00' and 1@1Wf)
10. Static water level below top of casing: 22.1 -(ft.)
iJ'ivaterlevel is above casing use "+"
11. Borehole.diameter. 6 (in.)
12. Well construction method: Auger / Core
(i.e. auger, rotary, cable, direct push, etc.)
By signing this fluor. 1 hereby cert!o, that the wells) was (were) constructed in accordance
with 15A NCAC 01C .0160 or 1SA NCAC 02C..0100 Nell Construction Standards and that a
copy of this record has been provided to the well oun2r.
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 INSTUMONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mall Service Center, Raleigh, NC 27699-1617
24b. For Injecdon 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,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Injection Wells:
Also submit one copy of this form within 30 days of completion of
13b. Disinfection type: Amount- well construction to the county health department of the county where
constructed.
Form G W-I North Carolina Department of Environment and Natural Resources— Division of Water Resources Revised August 2013

Central Files: APS _ SWP
5/9/2019
Permit Number W10100230 Permit Tracking Slip
Program Category
Status Project Type
Ground Water
Active New Project
Permit Type
Version Permit Classification
Injection In situ Groundwater Remediation Well
1.00 Individual
Primary Reviewer
Permit Contact Affiliation
thomas.slusser
Todd Hagemeyer
Coastal SWRule
1255 Roberts Blvd
Kennesaw GA 30144
Permitted Flow
Facility
Facility Name Major/Minor Region
Chemtronics Inc Minor Asheville
Location Address County
180 Old Bee Tree Rd Buncombe
Facility Contact Affiliation
Swannanoa NC 28778
Owner
Owner Name Owner Type
Chemtronics Inc Non -Government
Owner Affiliation
Charles Lynn Miller
2107 City W Blvd
Dates/Events Houston TX 77042
Scheduled
Orig Issue App Received Draft Initiated . Issuance Public Notice Issue Effective Expiration
11 /1 /2012 10/17/2012 11 /1 /2012 11 /1 /2012
Regulated Activities Requested /Received Events
Groundwater remediation
Outfall
Waterbody Name Streamindex Number Current Class Subbasin

.--I -s X,,(. w.z G I 0 0 2 3 0
v, RE.CEI`1EDINMEQIDWR
Geosyntec NOV 16 Z017
consultants water Quality Regional
p�erations Section TO: UIC Program DATE: November 13, 2017
COMPANY Division of Water Resources PROJECT NAME: Chemtronics
- 1636 Mail Service Center PROJECT NO.: GR4943A/03/3.8A
Raleigh, NC
27699-1636
TRANSMITTAL
® ENCLOSED
❑ UNDER SEPARATE COVER
VIA:
❑
MESSENGER
❑
FIRST CLASS MAIL
❑
SPECIAL DELIVERY
❑
AIR MAIL
®
FEDEX
❑
FOR APPROVAL
®
FOR YOUR USE
❑
AS REQUESTED
❑
APPROVED
❑
APPROVED AS
NOTED
ACTION:
❑ RESUBMIT
❑ RETURN CORRECTED
PRINTS
❑ FOR COMMENT
NO. OF
COPIES
DWG
NO.
DESCRIPTION
DATE
l
Injection Summary Forms for Permit # WI0100230
Nov 13,
2017
REMARKS:
COPY TO:
1255 Roberts Boulevard, Suite 200
Kennesaw, Georgia 30144
FROM: Benjamin Amos (678.202.9597)

North Carolina Department of Environmental Quality — Division of Water Resources
INJECTION EVENT RECORD (IER)
100230
NOV 16 2017
Were any wells abandoned during this injection
1. Permit Information
event?
Water Quality Region
il
® Yes ❑ No
Chemtronics, Inc. Operations Section
Permittee
If es, please provide the following information:
Number of Monitoring Wells 2
Chemtronics Superfund Site, BW-14 Area
Number of injection Wells none
Facility Name
Please include a copy of the GW-30 for each well
Old Bee Tree Road, Swannanoa, NC 28778
abandoned
_180
Facility Address (include County)
4. Injectant Information
2. Injection Contractor Information
Hydrogen Peroxide
Injectant(s) Type (can use separate additional sheets
Consultants of NC, P.C.
_Geosyntec
Injection Contractor / Company Name
if necessary
Street Address 1255 Roberts Boulevard, Suite 200
Concentration 388 m /L
Kennesaw GA 30144
If the injectant is diluted please indicate the source
City State Zip Code
dilution fluid. Extracted eroundwater (MW302-
R30CD, MW304-R30CD, and/or MW305-R30CD)
and Fire Hydrant
[phone]
Area code — Phone number
Total Volume Injected (gal) 25 100
3. Well Information
Volume Injected per well (gal)�12,400 (MW301-
Number of wells used for injection 2
R30CD), 12,700 (MW305-R30CD)
Well IDs MW301-R30CD, MW305-R30CD
5. Injection History
Were any new wells installed during this injection
Injection date(s) October 3 to 26, 2017
event?
® Yes ❑ No
Injection number (e.g. 3 of 5) 1 of I
If yes, please provide the following information:
Is this the last injection at this site?
❑ Yes ® No
Number of Monitoring Wells 5
I DO HEREBY CERTIFY THAT ALL THE
Number of Injection Wells 2
INFORMATION ON THIS FORM IS CORRECT TO
—
THE BEST OF MY KNOWLEDGE AND THAT THE
Type of Well Installed (Check applicable type):
INJECTION WAS PERFORMED WITHIN THE
❑ Bored ® Drilled El Direct -Push
STANDARDS LAID OUT IN THE PERMIT.
❑ Hand -Augured ElOther (specify)
��'�..� 24/ aM if /(3/mil
SIGNArURE OF INJECTION CONTRACTOR DATE
Please include a copy of the GW-1 form for each
//��
well installed
[.Lry .,n /K /gyro) yye- PF, A a y 113 9
within
_
PRINT NAME OF PERSON PERFORMING THE INJECTION
Submit the original of this form to the Division of Water Resources
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 (GW-1)
For Internal Use Only:
1. Well Contractor Information:
i
Well Contractor Name
NC Well Contractor Certification Number O
Cascade r.\\\-\ct
Company Name a�a"Me�\\pc
2. Well Construction Permit
List all applicable well construction permits ft e UIG CouiiO. S( re. etc)
3. Well Use (check well use):
(Heating/Cooling Supply)
Non -Water SUDDIv Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
13MunicipaUPubhc
E]Residential Water Supply (single)
13Residennal Water Supply (shared)
Groundwater Remediatron
E]Salmity Barrier
0 Stormwater Drainage
Subsidence Control
Tracer
under #21
4. Date Weil(s) Completed: (y.D \3- \-\ Well iD# \ -
R C
5a. Well Location:
���tl\�•ro�n\ LS
Facility/Owner Name
Facility iDs (if applicable)
1e0 O\8 \3c�Trc�Qcl S.)an^Q^00. K)C,
Physical Address. City, and Zip
County Parcel identification No. (PiN)
5b. Latitude and longitude in degreWminuteVseconds or decimal degrees:
(if well field, one lavlong is sufficient)
W
6. Is(are) the well(s)oPermanent or 13Temporary
7. Is this a repair to an existing well. Yes or RINo
If rhu is a repair. fill out brown well construction information and explain the nature of the
repair under 921 remarks section or on Um back of this form
8. For GeoprobefDPT or Closed -Loop Geothermal Wells having the same
construction, only I GW-i is needed Indicate TOTAL NUMBER of wells
drilled
9. Total well depth below land surface: (ft.)
For multiple welts list all depilis if different (example. 3@200' and 2@100)
10. Static water level below top of casing:
If water level is above casinz use - - .
11. Borehole diameter: S (in.)
12. Well construction method: Son \ L
(i a auger, rotary, cable, direct push, etc )
14, WATER 7.0NES -
FROM
TO
DESCRIPTION
ft.
%
f4
fL
15.OUTER CASING for mold -cased wells OR LINER if a Ikable
FROM
TO
DIAMETER
THICKNESS
MATERIAL
I'
I ft.
I in.
I& INNER CASING OR TUBING eotheraral dosed -loop)
FROM
TO
DIAMETER
HI
TCKNESS
MATERIAL
5\ f4
v��
O fL
In
fL
I f4
in.
17. SCREEN
FROM
TO
DIAMETER
I SLOT SIZE
I THICKNESS
MATERIAL
fL
h.
L/ is
140
fL
ft.
in.
It GROUT
FROM
I TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
2, rJ R.
O fL
R.
fL
fL
fL
19. SAND/GRAVEL PACK f a liable
FROM
TO
MATERIAL I
EMPLACEMENT METHOD
(65 rL
y-7.5fL
4 2,0t,6
--i-bo'r Go v\ so,fo,,s
fL
fL
20. DRILLING LOG attach additional sheets if accessary)
FROM
TO
DESCRIPTION color, hardness, mil rock type, gridn size, etc.
f.
fL
fL
rL
1 e-
ft.
ft.
of o t ! e S
ft.
rL
}
tt.
rt.
ft.
ft.
ri.
h.
21. REMARKS
22. Mflation:
0-1- t0 Al
Sig9ture of Certified Well Contractof Date
AP signing this form. I hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C 0100 or 1 SA NCAC 02C 0200 Well Construction Standards and that a
copy of this record has been provided to the well owner
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details You may also attach additional pages if necessary
SUBMITTAL INSTRUCTIONS
24a. ,For All Wells: Submit this form within 30 days of completion of well
construction to the following
(ft.) 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,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Sunoly & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed
Form GW- i North Carolina Department of Environmental Quality - Division of Water Resources Revised 2 22-2016

WELL CONSTRUCTION RECORD (GW-1)
For Intemal Use Only:
1. Well Contractor Information:
Well Contractor Name
1.
NC Well Contractor Certification Number � V G�
On ale1\�nG
str�
Company Name
2. Well Construction Permit #: r ti
List all applicable well construction pernuts 6 e. UIC, County, State, Variance, etc)
3. Well Use (check well use):
Well:
(Heating/Cooling Supply)
Non -Water Supply Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
(Closed Loop)
C._f MumctpaITubhc
[]Residential Water Supply (single)
E)Residential Water Supply (shared)
�rroundwater Remediation
[3Sahmty Barrier
[3Stormwater Drainage
[DSubsidence Control
OTracer
under #21
4. Date Well(s) Completed: (XD'?5• 11 Well ID# f•AU)!) OL
—Val 3OCD
5a. Well Location:
CitiR,M�ro ny C_ 5
Facility/Owner Name
Famlity ID# (if applicable)
12o co Bee TrCe--Qd s'o0& O'r%C<1 UC Z4311�
Physical Address, City, and Zip
'B(I 0/X9-
County Parcel Identification No (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat(long is sufficient)
N W
6. Is(are) the well(s)MPerminent or Temporary
7. Is this a repair to an existing well: 1:)Ycs or oNo
If this is a repair, fill out !Drown 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 I GW - I is needed. Indicate TOTAL NUMBER of wells
9. Total well depth below land surface: , o (ft.)
For multiple wells list all depths tf different (example- 3 al 00' and 2@1001
10. Static water level below top of casing: (fL)
lfwater level is above casing, use '
It. Borehole diameter:
12. Well construction method: &Y) 1 C
(i.e auger, rotary, cable, direct push, etc )
14. WATER ZONES
FROM
TO
DF-',Mr ION
0 ft.
ft.
«,
fL
15.OLTER CASING for uald-cased wel4 OR LINER f a liable
FROM
TO
DIAMETER
THICKNESS
MATERIAL
rt
ft.
in.
16. INNER CASING OR TUBING eothermal domed -loop)
FROM
TO
DIAMETER
iHICKNFSS
MATERIAL
q
ft
y in
xh yo
c-
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SITE
THICKNESS
MATERIAL
o ft.
39 ft.
y la
SO t_1p
Svc
ft
ft
IL
IA.GROUT
FROM
TO
MATERIAL
EMPLACEMEN7 MrMOD & AMOUNT
3\ ft.
O fL
TqID 11 33
ft.
ft.
ft.
ft
19. SAND/GRAVEL PACK f applicable)
FROM
TO
MATERIAL I
EMPLACEMENT METHOD
ao fL
3-1 ft
2 -
� r
tt
ft.
20. DRILLING LOG attach additional sheets If necessary)
FROM
TO
DESCRDTION color, kardnem wfll e k type, grain We, etc.)
ft
ft
M
ft
ft.
«.
ft.
d }C'a
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
-" �d
bf=low Sand
22. ZIM
(» ► O t'�
Si re of Certified W111 Contractor Date
By signing this form. I hereby certify that the welf(s) was (were) constricted in accordance
with 13A .NCAC 02C 0100 or 15A NCAC 02C 0200 Well Construction Standards and that a
copy of this record has been provided to the well owner
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
constnicnon details You may also attach additional pages if necessary
SUBMITTAL INSTRUCTIONS
24s. 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 wittun 30 days of completion of well
construction to the following
Division of Water Resources, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & [niection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type- Amount: completion of well construction to the county health department of the county
where consttvcted
Form GW-I North Carolina Department of Environmental Quality - Division of Water Resources Revised 2 22-2016

WELI. CONSTRUCTION RECORD (GW-1)
For Internal 'se Only-
1. Well Contractor Information:
Ar1T1'1�flU Co�Mler..ti
Well Contractor Name -�
y3y"z-,,A
NC Well Contractor Certification Number
V
\�"c .�\ .,\A
Company Name
2. Well Construction Permit
List all applicable well construction permits 0 e U16 bunty, St- rVariance. etc.)
3. Well Use (check well use):
Well.
(Heating/Cooling Supply)
Non -Water Supply Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
E]MunicipaMbitc
13Residential Water Supply (single)
[]Residential Water Supply (shared)
Groundwater Remediation
[3SaILmty Banner
13Stormwater Dminage
[3Subsidence Control
QTtacer
under #21
4. Date Wells) Completed: O(D ' N - I 1 Well ID#
5a. Well Location:
C%�MTTy n \ LS
Facility/Owner Name
Facility IDu (if applicable)
I In Olc1 ` z t t't-- '1�2 (A Sk. n/\Gr Ot, NC. MT) b
Physical Address, City, and Zip
County Parcel Identification No (PiN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(dwell field, one lavlong is sufficient)
N W
6. Is(sre) the well(s)wermanent or 13Temporary
7. Is this a repair to an existing well: 0Yes or *o
if this is a repair. fill out known well construction information and explain the native of the
repair under #21 remarks section or on the back of this form
8. For Geoprobc/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed indicate TOTAL NUMBER of wells
dniled
9. Total well depth below land surface: (05 (ft.)
For multiple wells list all depths if different (example- 3Q100' and 1®1001
10. Static water level below top of casing:
1f water level is above caring, use "+
11. Borehole diameter: (in.)
12. Well construction method: Z_J( l 1 L
(i a auger, rotary, cable. direct push, etc )
14, WATER ZONES
FROM
TO
I DESCRIMON
ft.
ft.
ft.
n.
15.OUTER CASING for asnld-cased wells OR LINER to Ikable
FROM
TO
DIAMETER
THICKNESS
MATERIAL.
n.
fL
is
16. INNER CASING OR TUBING eotbersal
closed-1
FROM
TO
DIAMETER
THICKNESS
MATERIAL
rL
O ft.
L4 In-
SCh LIO
—+ VC.
ft.
ft.
In.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATRRIAL
n.
ft.in.
SCht-�O
-PVL
fL
ft.
in
IL GROUT
FROM
I To
MArERIAL
EMPLACEMENT METHOD At AMOUNT
3 ft
0 ft.
► _
rt.
f4
ft.
ft.
19. SAND/GRAVEL PACK f applicable)
FROM
TO
L MATERIAL I
EMPLACEMMEPIT METHOD
6o,5rL
(,lb
20. DRILLING LOG attach additional sheets If necessary)
FROM
TO
DESCRIPTION color, hardnew, asi frock tfpe. linuff sta- etc.)
ft.
ft.
f1t.
ft.
l C /
n.
ft.
.r— t�
n.
ft.
fL
ft.
fL
fL
tL
fL
21. REMARKS
22. Certification,
Z�4&
Signature of Certified Well Contractor I Date
Bf , signing this form. 1 hereby certify that the wellls) was (were) constructed in accordance
with 15A ,NCAC 02C 0100 or 15A NCAC 02C 0200 Well Construction Standards and that a
copy of dbir 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 CVSfRUCTIONS
24a. For All Wells: Submit this form witlun 30 days of completion of well
construction to the following,
(ft.) 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,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & infection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
t3b. Disinfection type: Amount' 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)
For Internal Use Only:
1. Well Contractor Information:
AnA-V\Qn& 1 (lave -CA
Well Contractor Name
114
NC Well Contractor Certification Number
Company Name
2. Well Construction Permit A
List all applicable well construction permits (i a VIC. County. State, Torrance, etc)
3. Well Use (check well use):
Water Supply Well:
:)Agricultural [3Mtmrcipal/Pabhc
Geothermal (Heatmg/Cooling Supply) E311esidential Water Supply (single)
Industrial/Commercial [31kesidential Water Supply (shared)
Imeation
Non -Water Supply Well:
Recharge
Storage and Recovery
Test
rental Technology
mal (Closed loop)
Groundwater Remediation
Salinity Banter
[DStormwater Drainage
Subsidence Control
Tracer
under #21
4. Date Well(s) Completed:[io •ZQ - %-I Well ID# Wl J1'4)5
Sit. Well Location: Plboclz.)
` Facility/Owner Name Facility ID# (if applicable)
i91n okc-I Lie -Tr c e --'D-4 St.,�XACAA QO0. 1�1C- 2�i114�
Pliystcal Address, City, and Zip
.�� Lug Covx--(o e _
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one fatflong is sufficient)
N W
6. Is(are) the well(s)OrPermanent or [3'I'emporary
7. Is this a repair to an existing well: Yes orgEA
ff this is a repair, fill out known well construction tnformatio and explain the nature ofthe
repair under #11 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-I is needed Indicate TOTAL NUMBER of wells
drilled
14. WATER ZONES
FROM
TO
I DESCRIPTION
ft.
fL
fL
tL
15.OUTER CASING for
O R a
liaable
FROM
TO
TEL
E
MATERIAL
fL
ft.
in.
16. INNER CASING OR
TUBING eothe
closed-loop)
FROM
TO
DIAMETER
THICKNESS
IMA'[F3UAL
fL
tt.
in-
y
��
fL
tL
In.
17. SCREEN
FROM
TO
DIAMETER
SIZE SLOT SI
THICKNESS
MATERIAL
>w
y fL
y In
sc�. do
ft.EL
to
I& GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
q0 tL
ft.
fL
ft.
fL
19. SAND/GRAVEL
PACK
f a liable
FROM
TO
MATERIAL I
EMPLACEMENT METHOD
105 it.
4A0fL
-* 2-
--1 �•r
ft.
ft.
20. DRILLING
LOG attach
additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, sailtroek ins etc.
fL
ft.
fL
EL
-'Jp1 e
ft.
ft.
l 1
fL
ft.
fL
ft.
fL
fL
fL
ft.
2I. "MARKS
22. Certific4n•
Signa of Certified Will Contractor I V Date
By signing this form. I hereby certify that the well(s) was (were) constructed in accordance
with 1 SA NCAC 02C 0100 or 1 SA NCAC 02C 0200 Well Construction Standards and that a
copy of this record has been provided to One 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
CTIRMIT'i'AL INSTRUCTIONS
9. Total well depth below land surface: �n.es.e rrr. rr t nr�r(fNlIU�7'rV�" �or All Wells: Submit this fort within 30 days of completion of well
For multiple wells list all depths tf different (example- 3(a)24(( " constructio" n to the following:
10. Static water level below top of casing: i n u r 7 ro ntq) Division of Water Resources, Information Processing Unit,
If water level is above casing, rise "- " 1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: fin') Water Quality Regiola¢d• For Infection Wells: In addition to sending the form to the address in 24a
12. Well construction method .SO(l1 Operation Seeti0rgbove, also submit one copy of this form within 30 days of completion of well
construction to the following:
(te auger, rotary, cable, direct push, etc.)
Division of Water Resources, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method oftest: 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
13b. Disinfection type: Amount: 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:
Well Contractor Name
Ll3y?",iA
NC Well Contractor Certification Number
Company Name
2. Well Construction Permit #:
List all applicable well constriwaon pemius ae OF Cormty, State. Variance. etc.)
3. Well Use (check well use):
Water Supply Well:
Agncultuml [Municipal/Public
Geothermal (Heating/Coolmg Supply) [Residential Water Supply (single)
Industnal/Commercial [Residential Water Supply (shared)
hneaUOn
Non -Water Supply Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Oiroundwater Remediation
[Sahmty Barer
[Stormwater Drainage
[Subsidence Control
[Tracer
under #21
4. Date Well(s) Completed: Cto-ZCD Well ID# MU2aJlD
SS(a.. Well Location:
�j 1:�14dV1��� CS
Facility/Owner Name Facility iDO (if applicable)
TO ad lRee-Tr t-.- 12-8 a X At'afl a NC 2901
Physical Address. City. and Zip
1 VI C.O Y r<--6 C
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(tfwell field, one lat(long is sufficient)
W
6. Is(are) the weli(s)wermanent or [Temporary
7. Is this a repair to an existing well: s or No
If this is a repair. fill otit brown well constnicti rn irgormation and explain the nave ofthe
repair raider 921 remarks section or on (lie 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 NLMBER of wells
dnlled.
For Internal Use Only:
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft
f6
15. OUTER CASING for
reuld cased waits OR LINER rt a Iieable
FROM
TO
DIAMETER
1'ffiCKNFSS
MATERIAL
ft.
I ft
in
16. INNER CASING OR TUBING eothennal
dosed-t
FROM
TO
DIAMETER I
THUCKNESS
I MATERIAL
22 it.
O ft.
(4 Ira
Solt, y0
-->Vc--.
ft.
ft.
In.
17. SCREEN
FROM
TO I
DIAMETER
I SLOT SIZE
I THICKNESS
I MATERIAL
rt.
Z2- fL
L/ :o.
sc>r, t-10
dC.
ft.
ft.
in
!& GROUT
FROM
TO
MATERIAL
ENT METHOD A AMOLWT
10 O ft.
(0 It.
T- _ =
EMPLACEM
ft.
ft.
19. SAND/GRAVEL
PACK
f ■ liable
FROM
TO
MATERIAL
EMPLACEMENT METHOD
IS-R fL
20 It.
1 2
—L>O,) r
fL
ft.
10. DRILLING
LOG attaeY
additional sheets If necessary)
FROM
I TO
DESCRH?(ON (color, hardness, 3or7/rock type, Vain sloe, eta
ft.
ft.
ft.
ft.
IL
it
ft.
ft.
ft.
ft,
ft.
fe
I ft.
21. REMARKS
22. Certification:
dz�vl/L
1 %r/k e// �n-1- tO- t"1
Signa reof Certified Well Contrac�to — Date
By signing this form. I hereby certify that the well(s) was (were) constricted In accordance
with 15A NCAC 02C 0100 or 15A NCAC 01C 0200 Well Construciton 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 iNSTRI:CTiONS
9. Total well depth below land surface: �� (D ` s: Submit this form within 30 days of completion of well
For inidtiple welts list all depths (f dti ferenI (exam20 ple- 3@0' and 0 o the following.
10. Static water level below top of casing: (f ) Division of Water Resources, Information Processing Unit,
lfwater level is above caring. use INSZ 017
17 1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: (in.) 24b Epic n'ection Wells: In addition to sending the form to the address in 24a
cy� Water Quality R� submit one copy of this form within 30 days of completion of well
12. Well construction method: C _ (Inaratinnc E�gARt6tion to the following:
(Le. auger, rotary. cable. direct push. etc.)
Division of Water Resources, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & infection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount. completion of well construction to the county health department of the county
where constructed.
Forth GW-1 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

r
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
--honest (20nue
Well Contractor Name r
1_-13(4 3 A
NC Well Contractor Certification Number
Onnonde _-r%),riWAQ
Company Name t
2. Well Construction Permit #:
List all applicable well construction permhs 0 a UIC County. State. Vanance. elr)
3. Well Use (check well use):
Water Supply Well:
Agncultural 13Municipal/Public
Geothermal (Heating/Cooling Supply) [31kesidential Water Supply (single)
hidustnal/Commercial [3Residential Water Supply (shared)
Irripation
Non -Water Supply Well:
Recharge
Storage and Recovery
Test
ental Technology
nal(Closed Loop)
Groundwater Remediation
E3Salmity Barrier
E3Stormwater Drainage
[3Subsidence Control
Tracer
under #21
4. Date Well(s) Completed: 6-1-1&�-1-1 Well iD# M 1'411�
a
531. Well Location: MW:�3R.AEt.1�
��M�F•COtI l t_S
Facility/Owner Name
Facility IDN (if applicable)
1i[n (Old t�Tcee IM ,S_.-nnnanaa Lr 2451'7A
Physical Address. City, and Zip
UjA condo
County Pascal identification No. (PiN)
5b. Latitude and longitude in degrces/minutes/seconds or decimal degrees:
(if well field, one lattlong is sufficient)
W
6. Islam) the well(s)orPermanent or Temporary
" Pr nf�orm'
For Internal Use Only:
1C WATER
ZONES
FROM
TO
I DFSC'Rlr rION
fL
%
ft.
R.
- -
15. OUTER CASING for
multi cased sells OR
LINER f a
Bnblc
FROM
TO
DIR
AMETEESS
THICKN
MATERIAL
y iL
®Il.
�6 ia.
SV4W_Q
I & INNER
CASING OR
TUBiNG (geothermal
closed -loop) t . '
FROM
TO
DIAMETER
THICKNESS
MATERIAL
rL
rc
� in
SCIn�10
-�L
17. SCREEN
FROM
TO I+
DIAMETER I
SLOT SIZE
I THICKNESS
I MATERIAL
a_0 fL
2 ""
yy\ NO
—ANC
rc
ft.
j in.
I& GROl1T
FROM
I TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
y2 f4
© fL
T oI 7E
'T, VIA
�2 ft.
O "-:ryp:i
m
Mn
ft.
l9. SAND/GRAVEL
fL
PACK
if a linable
FROM
TO
MATERIAL I
EMI7ACEMENTMETHOD
Qq fL
C/7 ft-
is 2 IJr
20. DRILLING
LOG attach
additional abeeb if necessary)
FROM
TO
ft.
DESCRIPTION ealer. hmdiicn, soiltmek tym grain size eta
R.
fL
ft-,
L
ipkraw� Sella
ft.
tt
e_�-r
ft.
fL
&
ft.
EL
ft.
fL
ft.
21. REMARKS '
22. Cema�Ll
Signat"ofCcrtifi4w.,fcon--tmcj6r Date
�..j By sighing this form I hereby certify that the welf(s) was (were) constructed in accordance
7. Is this a repair to an existing well: 13Yes or 11A'VO with 15A NCAC 02C 0100 or 15A NCAC 02C 0200 Well Cvnsrruutan Standard., and that a
jthts Is a repair fill our knos.•h well construction information and esp/ant the naarreof the copy of this record has been provided to the well owner
repair under 021 remarks .vecumt or an flee hack of this farm
23. Site diagram or additional well details:
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same You may use the back of this page to provide additional well site details or well
construction, only 1 GW-I is needed. Indicate TOTAL NUMBER of wells construction details You may also attach additional pages if necessary
dulled _ SUBMITTAL INSTRUMONS
Q� r nn
9. Total well depth below land surface: CDJ E @ "t (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
For hnthiple wells list all depths lfdifferent (example- 3@200' and 2@11M F R On to the following.
10. Static water level below top of casing: RECEIVEDI `C (Qtt,� Division of Water Resources, Information Processing Unit,
lwater level is above raunR iae 1617 Mail Service Center, Raleigh. NC 27699-1617
Is
11. Borehole diameter: G(in.)
12. Well construction method: _
(i a auger, rotary, cable. direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm)
Method of test:
13b. Disinfection type: Amount:
NOV 16 20 I724b. 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
; Qj0P,9.&cuon to the following.
O%,vision 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 form to
the address(es) above, also submit one copy of this forth 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

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1. Well Coulractor lalortluotiow
�r)777��11
1,�7tit;�LC
Well ('bnttuWr Nmlc tJr well vwan ptaxunally a6andmuna well tin Ou'Mt Invpenyl
y 314 A
KC Weil Calf •lot Celtifisallun Nuotl-VI
CbzCCtd x\\t
Company Norm
2. Well Construction Permit 0:
tau ait gP1Nr (tier nett ta/urssrcraln1rr»Iw II a Lit
3. Well use (cheek well use):
Wsler Supple WcW
CAgn�ultuml ❑MtinielpsVPubitc
ClCm)thermal (NeannWCooling Supply) ORosidantial Water Supply isinilel
❑lndu+t[ial'Ctmuntrctal O1Ctsiden0ol Water Supply (sllaredl
Vo'n-N atcr Supply Well'r Ionit.rrtlig
17314cuot,ety
Injection Well:
OAquifcr Rcihargc
t7Groulnlwa!er ROntt411110ua
ClAquiler Storage and R, t at rr.
O3allnny Harriet
0AquiferT,,st
(7Stormwatcr I)rainsfle
OExperrirscnial TwhnoloKy
GSuba)dcmc (oniml
nOaothcnnal tClosed Loop)
0 ini:rr
-, i,:othermal i licAling Conling Rctunv
OUdIIY (Cs tarn under 7 i
d, Date wilht) abandoned
,;A 1%ell Incatron
�%CJ1'� �lltiL�
�: (.:t G.i,hcahftr
th. I.slitudc and iioirtiudr In dtgrrc% minuics sceonds lit rtrrinial drgretl.
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6d ttatcrlr.rlhrinwground %urfala: _lflI
6c rlutrr clung lcnglh tlf known): Ifr 1
ill. Inorr casing tithing length (Ir knawnl
Eg. \crreu Irngth id known):
µt;u;fjf B ANDt)NMFN1 pET&
7a. For GeoproheJOP1 or Closed-1 uop Geothermal Wells hat,mg the same
well conttru looACpdi rnl, i i ;%t -tit es nseded Indreaic TOTAL NIUMBUR of
Wells abMndwicd-_. - -
7b, Apl//nalltlale.(/IUmI' of wall'( It/Itallllflk ill wells
�: �_fgal.l
r
wA rrrR sl"PPLI vile or dWnfectanf wird _
7d. Anwuul of dlsildctl/int used
If, Seslnig nlattrlais used klleck all Iha1 applt I'
tiff Ilctttonnc (. hips or Fetish
C1 Neal Cement (•itoul
n Sand Cerncni Grcul
O C)r� t lav
0 Comfete Ca-11
0 Doll Cunings
U Specluit; ' :i.1
O Gravel
0 Denlonire Sl,:rc.
t (;tier icsl:law undcr'gl
11 bnr t:u h ulaterrel sclrctell ahoto
Pro%Idt amount of nlattrtals used.
?K I'n/tittle a briertlrscription of (lit.
abandonment procedure:
uc,r�r1C
n nC� c1 ';v c�--
•t.i rh X r cc, L c
N < trNfirallnn
Darr
h. -. ,•rrtrs., rni: 6.,' l,crc3+: rrru/S� Ina( for tcrfl(s/ tuu (acre) ahandrrted in
rii (_-onc!rvrrlan Sran:far-&
�nJ li-ra �nr of vied nr Pw nti! vvner
9. she dlaKram or additional well dctslls:
'4:nr fna}• use tit hatk nrflits page to provide additional x%cll site details or well
aba'dwirnrnt detail, You may abo aitaa/ additional pages ffneccsvry
of full? T-tl INSTRUCTIONS
lua, I -or ,ifll Wtlls: Submit this loan within 30 days of curnpleuun of well
at)nndttrmcnt li, the lolioomg
frivislon of N aler Resources, Information Processlog Unit,
1611 ,'Hail Service Center, Raleigh, NC 27699-1617
lob. line InieNinn Neils: in addition to sending the form to the address in I0a
aj' :tc. also suhmli one copy nr flits form within 30 days of completion of ueli
ab.indanrncni to the lolloumg
Dlvlsion of µ"aser Resources, Underground Injection Control Program,
1636 hIsll Serf kc Center, Rsteigh, NC 27699-1636
lot For Water Sunyll & injection Wells: In addition to sending the fomt to file
mjdr-rsa(rtl ahuv., alto stlbrnit one copy of this form ss'tthin 30 dayi of :cxnplction
A wcli abandonment to the cuunty health department ell the county where
Abandoned
I 5 v � r ,,,I, .., Rrrescd 2-12-201 h

.J-v►- S t-VJ-6 ( 0 0 2 3 o
North Carolina Department of Environmental Quality — Division of Water Resources
INJECTION EVENT RECORD (IER)
Permit Number W10100230
1. Permit Information
Chemtronics, Inc.
Permittee
Chemtronics S perfund Site, BW-14 Area
Facility Name
_180 Old Bee Tree Road, Swannanoa, NC 28778
Facility Address (include County)
2. Injection Contractor Information
Geosyntec Consultants of NC, P.C.
Injection Contractor / Company Name
Street Address 1255 Roberts Boulevard, Suite 200
Kennesaw GA 30144
City State Zip Code
[phone]
Area code — Phone number
3. Well Information
Number of wells used for injection 5
Well IDs: MW301-R30CD, MW303-R30E,
MW304-R30CD, MW305-R30CD, MW307-S30CD
Were any new wells installed during this injection
event?
® Yes ❑ No
If yes, please provide the following information:
Number of Monitoring Wells
Number of Injection Wells.
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
Number of Injection Wells
-WIN
�de a copy of the GW-30 for each well
abandoned
V
4. lIsjWNW Information
MJe ) Type (can use separate additional sheets
if necessary
Concentration 380 mg(L H2O2 and 48 mg/L DAP
If the injectant is diluted please indicate the source
dilution fluid. Extracted groundwater (MW302-R30CD. MW308-
S30C, MW309-S30CD and MW310-R30C)
Total Volume Injected (gal) 68,956
Volume Injected per well (gal) 13,163 (MW301-
R30CD).14.392 (MW303-R30E). 13.370 (MW304-R30CD),
14,723 (MW305-R30CD). 13,308 (MW307-S30CD)
5. Injection History
Injection date(s) Sept. 25 to Oct. 16, 2018
Injection number (e.g. 3 of 5)__3 of 3
Is this the last injection at this site?
❑ Yes ® 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.
04 it
SIGN URE OF INJECTION CONTRACTOR DATE
—g,...i,' K- A"•s Nk- PFA vqli;9
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

Pint Form
r fait -I
i Ei
FT Internal Usd`On1y'
WELL C0 f'8?iJC-1'i�i\
1. Well Contract0W1_..•uati0n:
1JH•ATERZON£S.
s •f .JF"+0Y2'�
r'"Jd
mat io Dt'scmrnov
well Coots:cter Natbs
R. R.
::.
`xtion
mult
I&OUTER CASt\G fd l�ared wells) OR
t tE [t5f ra t131. RL%L
NC well Contract0ro6• lamps
•
FREAl TO DL%}tLT1A I
l''
r•i ��n
C
R. R�
xc
4. •' ... :;i?
16.INNER ASIHGO TUAIYG tatlecmalTulcul'sW. }L\T ERIAL
CaaPaay\:tee. ..
Wo ,sermit N:
sTMM - To._ :: DL\}tETKA .
vc'
b `a' 1/02.1ell
Coos!p r.fjutn:e. t*)
a!1 opplicae w� eonst.-achaf Femils 1L
In,Use '
R: R.
3. Nell Use ( It Nwcll use):
�-
11SCREER°
DU}IErFR starsIZE TIIICICYESS }t.\TFOAI.
11'ater Snp�I <IB 1:
` ®MuaiipaliPublic • ..
FRI}I
0 fL' rt,, to
Agricult
a Supply) 0 ResidntinllVaterSlipply(single)
ft. n, G in. rO20 lr� S%0 V&
�y(, h
Gtothent l.l(Hating/Cooling
Dt--�Residmial Waler Supply (shared)
!J
is GROUT UT L\lPL\CEMG�T•}ItTtmD & XIM, r
%IATERL%L
lndustriaVCoM0rcial
Imcation' -
a To
FIIn R. S"� fr• �✓n�rniiL 'rflnr i C.
Noa-IVaterSup y1�'ell:U
Reeonry : ' l
h. P f �r�u++tG
R s,' err
Monitoring
injection WeIL
Aquifertecha8e E]GroadwtcrRemediation
PACC IaA.SA•DIGRAVEprnrn
MATERM E/urerr+3rILrWr�
t and RecoverL{ISolmty B3f[7tr
ytra4IM"E
Fa0}I fAquifec5tome
:. 70
IL
[Stomt\atcr Drturogc
Aquifer Test
DSubgdcncoConifot
rss
EYperimental'fechnology
�Tlam{
<]).DRILLPIGLOG attaehdd
`TO dltlornlsheetslfnece
DFSCRiPTtort cedar. hardnnu Walmk esh%e>ia etet
Geothermal (dosed LOOP)
(){eatin Caolsn1 Retum) Olhq (explain�+1 er 021 Remarks)
TRO}I
• tr el % 1
'p 3
Geothermal
Completed: -� %all )bit S30L� tr. D tr. 1�
R.
4. Date Welt(s)
tL
5a. Well Location:
rr. R.
JJ
t�Ltytlj3(ifapplirahle)
R. R•
Facilitylowner:tane i;'
�G
ft. h.
) 6e
fr.
,.: t•: i;-;
PhysicalAddress-city. and ZP
2 LREMARKS:
1�t-�rsm�e'• ¢+arcelldrnti6catitmRo.iP1Y)
- -
County .::- '
5b. Latitude and longitude in degrepslminuteslst ands or decimal degrees:
32. Certifiras
(if u ell Geld. atu lallong issuf.aciem) 1
Dale
S turn CenifiedweUCon"t -
tt--'(I
6. ls(are) the well(s)ermanent or F_2Trmporary
8y stg»1ng this jomL 1 hdre4• eentfy that the xvl/(r) was {wire) eansrructed In atearJartrn
NCAC 02C.0100 ar IS,1 NCAC OX .02001►e11 Canstneelion Siandorth and tlmr a
g Yes or Yo
7.Itthisarepairtoaneaistio wet): tto ndrxF+lalnthenuarreoftht
In arm
%•fill 1Srl
ropy ojdiixseconllrosbeeaprovWrdlot5ewrl!antra
lj this is a repair• fill our knasn well rnNrrocllan
fur
repair urnfdr e11 remarks sertton nron he back of P
You mayru a fhe back of this page agram or additional lto provide additional well site details or vvell
8: For Geoprobe/DPT or Closed -Loop Geothermal Wells having the some
TOTAL NUMBER of %VIls
construction details. You may also attach additional pages if necessary.
construction, only I GW-1 is needed. indicate
SUBhI1Tr,.I INS I RUCTIONS
drilled: letion of well
0 (M) 24a. U n:dh:. Submit this form within 30 days of -comp
7For A
9. Total well depth below land surface:
(eramp)r-J�700' md2rallw7
construction to the following
F•aramhtple wells list all dell /y wUrrent
((L) Division of Water Resources, Information Processing Unit,
10. Static water level below top of casing: 1
617 Mall Service Center, Raleigh, NC 27699-1617
l/woter 1nv1 is 6hove casfn& arc
24b. Fnr I eetl W lls: In addition to sending the form to the address in 34a
11. Borehole diameter. --rn) above, also submit one copy of this form within 30 days of completion of well
12. Well construction melhad: �� IG• construction to the fallowing:
(i.e, auger, rotary, cable- d'utet ptah, NCJ .
Division of Water Resources, Underground Injection Control Program,
I636 hlafl Service Center, Raleigh, NC 27699-1636
FOR WATF,R SUPPLY WFLIS ONLY:
11Nhad of test 24c. Far Witter So Br Iniection Welh: In addition to sending the farm to
t3a. Yield (t pm) �- the address(es) above, also submit one copy of this fora) within )0 days of
Amount: completion of well construction to the county health department of the county
13b. AisinfestloD type: �— where constructed.
Re•,ised 2•12.2016
Scanned with CamScannerr

WELL CONSTRUCTION RECORD (GW-1)
For Internal Use Only:
1. Well Contractor Information:
INA-V)0811 �OnVPr�(
Well Contractor Name
H y3 A
'-NC Well Contractor Certilimuon Number " -- -"
Cascade
Company Name
2. Well Construction Permit #:
List all applicable well construction permits it e UIC. Cormty, State. Variance, eta)
3. Well Use (check well use):
Water Supply Well:
Agricultural
0Municipal/Pubhc
Geothermal (Heating/Cooling Supply)
E]Residential Water Supply (single)
Industrial/Commercial
[3Residential Water Supply (shared)
Irrigation
Non -Water Supply Well:
Monitoring
QRccovery
ection Well:
Aquifer Recharge
jffGroundwatcr Remedtation
Aquifer Storage and Recovery
JjEExpenmental
[3Salmity Barrierquifer
Test
[]Stormwater Drainage
Technology
[3Substdence Control
eothermal (Closed Loop)
13Tracer
under #21
4. Date Well(s) Completed: C LD 13- \i Well ID# \
5a. Well Location: C
� �1n9w\�roinx�S
FacilitylOwner Name
Facility IDn (dapplicable)
1bQ old %ccTfGC rCO �rnr,oa 1.3G Z81Z�
Physical Address, City, and Zip
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lavlong is sufficient)
N
6. Is(are) the well(s)OPermanent or Temporary
W
7. Is this a repair to an existing well: 13Yes or mNo
If this is a repair. fill out known well construction information and explain the nature of the
repair carder 421 remarla section or on the back of this form.
8. For Geoprobc/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed Indicate TOTAL NUMBER of wells
drilled
"_fi�t
9. Total well depth below land surface: (015 (ft.)
For multiple wells list all depths hf different (example- 3@200' mid 2@100)
10. Static water level below top of casing: (ft.)
If water level is above casing, use " • "
11. Borehole diameter: S (in.)
12. Well construction method: on \ L
lie an er rotary cable da t h t )
14. WATER ZONES
FROM
TO
DESCRIPTION
fL
%
ft.
ft.
15.OUTER CASING for teuld-cased wells OR LWER [ a
lkable
FROM
TO
DIAMETER
THICKNESS
MATERIAL
IL
rt.
in.
16. INNER CASING OR
TUBING eotherinal closed -too
FROM
TO
DIAMETER
THICKNESS
MATERIAL
� ft.
O fL
el in.
SCI-1 mid
rL
fL
In.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
%
f1.
L/ Ia
SC -I -\-to
fL
%
in.
It GROUT
FROM
TO
MATERIAL
EWLACEMENT METHOD & AMOUNT
2, 51t.
O fL
TC
fL
fL
ft.
fL
19. SAND/GRAVEL PACK f a livable
FROM
TO
MATERIAL.
EMPLACEMENT METHOD
(05 fL
y7.5rL
w,-,6
c.�t„� sjJase
fL
fL
20. DRILLING
LOG attach additional sheets if necessary)
FROM
TO
DESCRIPTION color, hWness. soNrock to sire, etc.
fL
tL
ft.
ft.
ft.
OHO l- E' ies
fL
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
22. Certify ation:
01- 10 1-1
Sr ture of Certified Well Contracto Date
By signing flits form, 1 hereby certify that the wells) was (were) constructed in accordance
with 15A NCAC 02C 0100 or 15A NCAC 02C 0200 Well Construction Standards and that a
copy of this record has been provided to the well owner
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
constriction 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
g ec pus a c.
Division of Water Resources, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY:
1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Suyniv & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
I3b. Disinfection type: Amount: 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)
For Internal Use Only,
1. Well Contractor Information:
An'i�0 (2002SC.1
Well Contractor Name
0 y3y__z1'A
NC Well -Contractor Certification Number -- -
Cga_ead9-_t>i_1 k\ �G
Company Name -- -_ -- _
2. Well Construction Permit #-
List all applicable well construction permiu (l.e. UIC. Conmry, State. Vartance. etc,)
3. Well Use (check well use):
Water Supply
(Heating/Cooling Supply)
Well:
Recharge
Storage and Recovery
Test
iental Technology
mal (Closed Loop)
[3Municipal/Publtc
Residential Water Supply (single)
13 Residential Water Supply (shared)
Groundwater Remediat►on
[3Saluuty Bamer
13Storinwater Drainage
13Subsidence Control
[#TMcer
under 421
4. Date Well(s) Completed: aD ' N ' { 1 Well ID#
5s. Well Location: zocC >
isCka0-�ko.., c5
Facility/Owner Name
Facility IDtt (if applicable)
19n O1d1 (ice_ Tre,C Q(A S" anl\gr'00, NC. Z�li
Physical Address. City, and Zip
zcnlwbe.,
CParcel identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one laViong is sufficient)
6. Is(are) the well(s)ofermanent or Temporary
14. WATER ZONES
FROM
To
IDESCRUMON
ft.
ft.
-
ft.
a.
15. OUTER CMING for multi cased wells OR LINER if a Ikable
FROM
TO
DIAMETERT
THICKNESS =
MATERIAL -
ft.
ft
in.
16. INNER
CASING OR TUBING(toot beroal
closed-1
FROM
I TO
DIAMETER I
THICKNESS
I MATERIAL
ft.
ft.
L4 In-
SCh LIO
---y;>-4C_
ft.
ft.
in.
17.SCREEN
FROM -
-TO- I
DIAMETER
SLOTSIZE
I TIIICKNESs
_.MATERIAL
ft.
fL
i�
��y0
�VL
ft.
tt.
i6
1L GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
J
fL
-r _ M_
Aytvys
ft.
fL
ft.
ft.
19. SAND/GRAVEL
PACK da icable
FROM
I To
MATERIAL
EMPLACEMENT METHOD
ft.
1-16 ft.
ft.
fL
20. DRILLING LOG attach additional sheets If necessary)
FROM
TO
I DESCRIPTION (color, hardness, soiltieek type. amin sim etc.)
ft.
ft.
ft.
ft.
l C
tt.
ft.
tt.
ft.
ft.
ft.
t6
1 fL
f4
I ft.
21. RENIARKS
22. Certification-
W
z�L Awe�L,'/
01 -1O t1
Signature of Certified Well Contractor I Date
7. Is this a repair to an existing well: 13Yes or *o
If this is a repair, fill our known well construction information and explain the native of the
repair tinder x21 remarks section or on the back of thisform,
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
constriction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled 9. Total well depth below land surface: (05 (ft.)
For multiple wells list all depths if different (example- 3@200' and 2@I00)
10. Static water level below top of casing: (ft.)
If water level is above casing, use "- "
11. Borehole diameter: (in.)
12. Well construction method: Lill l C_
(i.e. auger, rotary, cable, direct push. eta )
"FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
By signing this farm. 1 hereby cerllfy 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 Infection Wells: In addition to sending the form to the address to 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 constriction 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)
For Internal Use Only:
1. Well Contractor Information:
A n�non.�a C�onv�ctt
Well Contractor Name
NC Well Contractor Certification Number
Oa-,0Gtcf e -1�)A `1; rya _
Company Name
2. Well Construction Permit #;
List all applicable well construction permits (1e UiC. County. State. Yartance, eta)
3. Well Use (check well use):
Water Supply
Agricultural ©Mumcipal/Pubhc
Geothermal (Heatmg/Cooling Supply) [3Residential Water Supply (single)
Industrial/Coinmercial [3Residential Water Supply (shared)
Non -Water Supply Well:
Well:
Recharge
Groundwater Remediation
Storage and Recovery
Salinity Barrier
Test
[DStormwater Drainage
rental Technology
Subsidence Control
mal(Closed Loop)
OTracer
mal (Heating/Cooling Return)
[Other (explain under #21 Remarks)
4. Date Well(s) Completed:n(6 4 - n Well IDWo-'1 5
5a. Well Location:
C Q,m-�-ron�c-s
- ' FacilityiOwner Name Facility ID# (if applicable)
1F--o OW ZaTr ce QA su-wo'c'A 00. NC 2?)-1q�
Physical Address. City, and Zip
.�� Lug C P
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
W
6. Is(are) the well(s)opermanent or Temporary
7. Is this a repair to an existing well: [3Yes or
If this is a repair, full oat bzowa well constriction irtformalto mud explain die native ofthe
repair tmder #21 remark 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
dulled
9. Total well depth below land surface:
For multiple wells list all depths if different (example- 3@200' and 2Q1001
10. Static water level below top of easing: (ft.)
lfwater level is above casing, rise "+ "
11. Borehole diameter:
12. Well construction method: ZS % C
(t a 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.
tt.
15.OUTER CASING for
multi -eased wells OR LINER f a 1'icable
FROM
TO
DIAMETER
THICKNESS
MATERIAL
tL
fL
In.
.
16. INNER CASING OR TUBING
eothermal
closed -too
FROM
TO
I DIAMETER I
THICKNESS
I -MATERIAL
tt
t
O it.
in
x1_ Li
1
fL
fL
In.
17. SCREEN -
TO
DIAMETER
Sy
Ff
fL
y la.
ft.
in
I& GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
yp ft.
O ft
T 9 r Mr
r i e
ft.
fL
ft.
ft.
19. SAND/GRAVEL
PACK ita licable
FROM
TO
MATERIAL
EMPLACEMF.Nf METHOD
ft.
(o ft.
2
r
ft.
ft.
20. DRILLING LOG Cattach
additional sheets If necema
FROM
TO
DESCRIPTION (color, hardness, seil/reck type, 9min size, eta
ft.
ft.
tL
fL
ft.
` 1
ft.
ft.
ft.
ft.
fL
ft.
It.
ft.
21. REMARKS
22. Certific ' n-
ll'alxrvdl-a�l' /' a O1-%0- t1
SignaturKfCertified Will Contractor I V Date
By signing this form. i hereby certify that the wells) was (were) constructed in accordance
with 15A NCAC 02C 0100 or 15A NCAC 02C 0200 Well Constriction Standards and that a
copy of this record has been provided to die well owner
73. 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 SUDDIV & 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 (GW4)
1. Well Contractor information:
nnPhooW Comer- _
Well Contractor Name
`-I 112)y
NC Well Contractor Certification Number
(" nand e �r11 t ► nc�
Company Name
2. Well Construction Permit #:
Dsl all applicable well construction pernras (I e U1C County, Stale. Variance. etc.)
3. Well Use (check well use):
Water Supply Well:
Agncultural E3Mumcipal/Public
Geothermal (Heating(Cooling Supply) 13Residential Water Supply (single)
industnal/Commercial [31tesidential Water Supply (shared)
Imeation
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
oGroundwater Remediation
13Salrmty Barrier
13Stormwater Drainage
Subsidence Control
Tracer
under #21
4. Date Well(s) Completed: 6-1-17-�- 1-1 Well 1D# Ml 1'l9S QME
/5a. Well 'Location: ►-1W�D3��(u
l-hQM'iTOdl l t_S
-- Facility/Owner Name Facility I138 (if applirable)
1W Olcl _%?-10 T� Rd 5_,-nnnanoat ).r ZVO-A
Physical Address, City, and Zip
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
N
W
6. Islam) the well(s)opermanent or 13Tempornry
7. is this a repair to an existing well: 13Yes or i40
if this is a repair fill out known well constriction information and esp/ahr the nature of the
repair under u11 remarks section or a))the hack of this form
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled
r Pr ntT6hii'
For Internal Use Only:
14: WATER ZONES
FROM
TO
DESCRIPTION --- - -
ft
fL
ft.
fl.
- -
I& OUTER CASING fec
iaiilti-eued weLLs OR LINER st
lieablc
FROM -
TO
DIAMETER THICKNESS-
MArER1AL
//tL
® n.
in.
S1 4
16. INNER
CASING OR
TUBING (geothermal
closed -too -y
FROM
TO
DIAMETER
THICKNESS
MATERIAL
` 6 rL
© fL
� to
W-VN-10
C
17. SCREEN
FROM
TO --- --DIAMETER
SLOT SIZE
THICKNESS
MATERIAL -
m
-eft.
2 in.
_ =
xV�140
NC_--
ft
I& GROUT
FROM
TO
MATERIAL
EMPLACEMENT -METHOD & AMOUNT
yz
©
-� _ 2E
_rIv"
14-Z r`
O - fti
_ IC
Mr,
ft.
19.SAND/GRAVEL
ft.
PACK
ifa liable
—_
FROM
TO
MATERIAL
EMPLACEMENTMETHOD
Q� R.
v6
ft.
2r
y7 ft-
2
��
20. DRILLING
LAG attach additional sheets if necessary)
FROM
TO
ft.
DESCRIPTION color, hwdoess, soilimpkityM grals size, etc.
ft.
ft
ft.
T
ft.
fL
ft
ft.
tL
ft.
M
M
21. REMARKS '
22. Certifrc n-
01 - f-7
Signa ofCenifiWe Contiac r Date
By signing this form, 1 hereby ceritA Aral the we//(s) was (were) constructed in accordance
with 15A NCACO2C 0100 or-1 SA NCAC 01C 0100 Well Consrructlon Standards and Thar o
copy of t/ris 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
n ' -
9. Total well depth below land surface: (" (ft.) 24n. For All Wells: Submit this forth Within 30 days of completion of well
For nnrlliple wells list all depths Ifdifjerent (exanple- 3@200' and 2@1001) construction to the followin
10. Static water level below top of casing: (ft.)
/f eater level is above casing, ace "+ -
it
11. Borehole diameter: G
� ^^
12. Well construction method: � 1 c
(ta auger, rotary, cable. direct push. etc.)
g
Division of Water Resources, information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-16I7
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
FOR WATER SUPPLY WELLS ONLY: Division of Water Resources, Underground Injection Control Program,
11636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & lniection Wells: in addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount completion of well construction to the county health department of the county
where constricted
Form G W • I , North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

.fi>1,- Si4, bv� t 0 0 2 3 p
North Carolina Department of Environmental Qualify — D WOW of Water Resourees
IN EMON EVENT RECORD R
r
J Permit N>tmber nits 8
1. result Informtion i` N0� j
Facility
Jd'0 or a ,reepdy Swtxman q/IJL
Byo co fiA j �a , OR-72s?
Facility Address (include County)
2. injjeetion Contractor Information
&nn;et FO-,rr�r�
Injection Contractor! Company Name
Shwt Address
l�17 .'ri'�%�
#.�?ta of +aa•
City State
Area. code —Phone "ber NQV
3. Well Information Vyager ,. A,.,,,i0l,
Fteg►onal OPgredoss ,
Member of wells used for injection I �i —
Wel IDs fp +/'> .
Were any new wells installed during this injection
event?
® Yes ❑ No
- fyes, please p wide the following infomaatiW
Number Of Monitoring Wells
Number of Injection"@Bells / d
Type of Wen Installed (Check applicable type):
❑ Bored ❑ Drilled 0 Dired4push
❑ Hand Augured ❑ Other (sped&Y)
please indude a copy of the Gl- l LiEgfor each.
well installed
Were any wells abandoned during this injection
event?
Yes ❑ No
If yes, please provide the following lion:
Number of Monitoring Wells .
Number of ejection Wells / 0
Please brelude a copy of Me GK 30 or each well
abandoned
4. Injectant Information
r—��Al u-%'c� zsnOIn�Type (cau use separate additio W ssl►ects
ifxvecessary
Concentration Iq f°
If the injectiot is dil please ifldi ate the source
dilution fluid. W Ar erg o
Total Volume Injected (gal)�i a
Volume Injected per well (gal) p
5. Injection History i xd1
3
Injection dates)
Injection number (e.g. 3 of 5)
Is this the last injection at this site?
❑ Yes ® 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.
SIGNATM OF MA E.0 iON CONTRACTOR DAZE.
of this form too the Division of Water Resources within 34 days of injection. Form UIGIER
Submit the original Rev. 3_a 2016
Attu UYC prog mm,1636 Mail Service Center, Raleigh, NC 27699-4636, Phone No. 919-8o7-6464

- -r—S W30 / 002,30
North Carolina Department of EnVironmenta1 Quality — Division of Water ResoEnrees
INJECTION EVENT RECORD
'Permit ember
1. permitinferination i' Npy
L '�i� 9i <<w1 .SsnA�'isr►� �e �i9 1 � r'ie ;. ��'J l,:i
Facility tie
tnn ca uC e►: �1 fo
M72?
Facility Address (include County)
2. injection Contractor Information
Injection Contractor! Company Name
SireetAddc+ess % of l �&A ..
XA;J .7 4
city state zip Code
RECEIVEDIMC-O/Dwr-
Area code —Phone. nuxuber NOV 0.8 7 018
3. Wsii Ubrmatiun ► a.
IRegio 4C°
Number of wells used for injection
Were any new wells installed during this injection
event.?
® Yes ❑ No
If yes, please provide the following information:
NumberofMouitoring Wells
Number of Injection Wells `a
Type of Well Installed (Check applicable type):
❑ Bored. ❑ Drilled. ® Dired4lush
❑ Band Augured ❑ Other (specifY)
Please bscWe a copy of the GW�-lam far each.
well installed
Were any wells abandoned during this Wiw ion
' event?
Yes ❑ No
If yes, please provide the following bdonnation:
Number ofMonitoring Wells
Number of Injection Wells /
Please urelade a copy of the G� 30 for each well
ahanAkned
4. Ujectant MOrM60" r
G f r c-tn z-crnP
Qectant(s Type (can use separate additional sheets
if necessary
Concentration f°
If tiie injeetant is dil►�}}led please in the source
dilution fluid. is X-r c10
Total Volume Injected (gal)�u �}
Volume Injected per well (gal) Q r
5. injection History � T S. i 201�
Injectiondate(s}
'.�-
Injection number (e.g. 3 of 5)'/ Lira;}
is this the last injection at this site?
❑ yes [} Na
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 WiTIIIN THE
STANDARDS.AID OUT IN THE PEItIVI T-
SIGNA OF RUECTWN CONTRACTOR DATE.
_ Form vrc >E>z
Submit the original of this form to the Division of Water Resources within 30 days of injection. p4v. 3_1 2016
Attu. UIC pmgmin,1696 Mail service Center. Raleigh, NC 27699-1636, Phone No. 919-907-6464

s � w� 1 ° 0 2 30 'r_CE1VFD/NCDEQID�i',
_•
INJECTION EVENT RECORD AUG „1 1n "'
"ater Quality
North Carolina Department of Environment and Natural Resources — Division of Water kes8&6§
Permit Number WI0100230
1. Permit Information
Chemtronics, Inc.
Permittee
Chemtronics Superfund Site DA 23/B116 Area
Facility Name
180 Old Bee Tree Road, Swannanoa, NC 28778
Facility Address
2. Injection Contractor Information
Geosyntec Consultants of NC, P.C.
Injection Contractor / Company Name
Street Address 1255 Roberts Boulevard, Suite 200
Kennesaw GA 30144
City State Zip Code
6( 78 ) 202-9597
Area code — Phone number
3. Well Information
Number of wells used for injection 5
Well names MW278-136D, MW249-J36CD
MW250-J36CD, MW248-J36CD, BW-4
Were any new wells installed during this injection
event?
❑ Yes x❑ No
If yes, please provide the following information:
Number of Monitoring Wells none
Number of Injection Wells none
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 0 No
If yes, please provide the following information:
Number of Monitoring Wells
Number of Injection Wells
Please include a copy of the GW-30 for each well
abandoned.
4. Injectant Information
Hydrogen Peroxide
Injectant Type
Concentration 439 mg/L
If the injectant is diluted please indicate the source
dilution fluid. Fire Hydrant
Total Volume Injected 156, 047 L
,81 L M -J ,
Volume Injected per well 33,838 L (MW278-136D)
33,804 L (MW249-J36CD)
5. Injection History 27,331 L (MW248-J36CD)
27,255 L (BW-4)
Injection date(s) Jun 26-Jul 5, 2018, Jul 9-Jul 13, 2018,
Jul 16 -Jul 20, 2018 and Jul 23, 2018
Injection number (e.g. 3 of 5) 3of 3
Is this the last injection at this site?
❑ Yes 0 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.
SIGNAT76RE OF INJECTION CONTRACTOR DATE
I_,a.nk 11. /y^-s M6 PEAQW-37
PRINT NAME OF PERSON PERFORMING THE INJECTION
Submit the original of this form to the Division of Water Resources within 30 days of injection.
Attn: UIC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-807-6464
Form UIC-IER
Rev. 8/5/2013

WELL CONSTRUCTION RECORD
This fort; can be used for single or multiple wells
1. Well Contractor Information:
Randy Phillips
Well Contractor Name
2209-A
V
—.;EIV
NC Well Contractor Certification Number
y
AUGA ,
A.E.Drilling Services
Company Name
piae
�pfAtli
2. Well Construction Permit #:
List all applicable well pemits (i.e. County. State, Variance, Injection, etc.)
3. Well Use (check well use):
well:
❑Agricultural
❑Geothermal (Neatiog(Cooling Supply)
❑ 1ndustria l/Commercial
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Recovery
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21
4. Date Well(s) Completed: 8-27-13 Well ID# MW248-J36CD
5a. Well Location:
Chemtronics
Facility/Owner Name Facility TDil (if applicable)
180 Old Bee Tree Rd. Swannanoa, NC
Physical Address, City, and Zip
Buncombe
County
Parcel Identification No. (PUN)
5b. Latitude and Longitude in degrees/minuteslseconds or decimal degrees:
(if well field, one lat/long is sufficient)
700716.497 N 978821.321 W
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 ivell construction information and explain the nature of the
repair under 0021 remarks section or on the back of this form.
8. Number of wells constructed: 1
For multiple injection a• non -water supply wells ONLY with the some consirmcdon, you can
submit onefarm.
9. Total well depth below land surface: 70 (ft.)
For multiple wells list all depths if different (example- 3Q200' and 1Q1001
10. Static water level below top of casing: (ft.)
If water level is above casing. use -+ "
11. Borehole diameter: 8 (in.)
12. Well construction method: auger/core
(Le. auger, rotary, cable, direct push, etc.)
For Internal Use ONLY:
14. WATER ZONES
t�aOW TO DESCRIpT10N
7rfL ft.
R. R,
15.OUTER CASING for uui[i-cased wells OR LINER its Rrable
FROM TO DIAMETER THfCKNESS MATERIAL
R- ft. in.
16. INNER CASING OR TUBING eethermat dead-loo
FROM TO DIAMETER TRICKNE55 MATERIAL
+3 fL 55 h 2 in SCh 40 PVC
R- R. in.
17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
55 IL 70 n- 2 .010 sch 40 PVC
ft. fL in
I& GROUT
FROM TO MATERIAL EMPLACEMENT METHOD & AMOt1NT
0 fL 49.5 R- neat cenent tremmie
49.5 IL 52 It. chips tremmie
It. fl.
19. SAND)GRAVEL PACK if applicable)
FROM TO I MATERIAL F EMPLACEMENT METHOD
52 ft- 71 IL #1 sand tremmie
rt. rt.
X DRILLING LOG attach additional sheets ifnecessary)
FROM TO DESCRIPTION (color, hardneu, soiltroca typl., grain sill, etc)
ft. ft.
R. R.
ft. ft.
h, ft.
n- h.
21.. REMARKS
22. Certification:
9/14/2015
Signature Of CpKified Well Contractor Date
By signing this form, I hereby certify that the tvell(s) )vas (were) constructed in accordance
with )5A NCAC 02C .0100 or )SA NCAC 02C.0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
242. 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,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Injection Wells:
Also submit one copy of this form within 30 days of completion of
13b. Disinfection type: Amount: well construction to the county health department of the county where
constructed.
Form G W-1 North Carolina Department of Environinent 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:
Randy Phillips
Well Contractor Name
1096-A
NC Well Coraractor Certification Number
A.E.Drilling Services
N, t,
Company Name
NV -
2. Well Construction Permit
List all applicable -I/ permits (t. e. Conn[. State, iQ rl nj.rls i}. i, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
OGeothermal (Heating/Cooling Supply)
0Industrial/Commercial
❑irrigation
Non -Water Supply Well:
OAquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
OGeothermal (Closed Loop)
OGeothermal (Heatiny/Cooline i
OMunicipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
OGroundwater Remediation
❑Salinity Barrier
OStormwater Drainage
OSubsidence Control
❑Tracer
under #21
4. Date Well(s) Completed: 8-20-13 µnew WX MW249-J36CD
5a. Well Location:
Chemtronics
Facility/Owner Name
180 Old Bee Tree Rd.
Physical Address, City, and Zip —
Buncombe
Facility ID# (ifapplicable)
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minotes/secoods or decimal degrees:
(if well field, one latflong is sufficient)
N W
6. Is (are) the well(s): ®Permanent or OTemporary
7. )s this a repair to an existing well: []Yes or EINo
If this is a repay, fill out known well construction information and explain the nature of the
repair muter #21 remarks section or on the back of this form.
8. Number of wells constructed: 1
For multiple injection or uort-water supply wells ONLY with the some construction, yvu cart
submit oneform.
9. Total well depth below land surface: 84.3 (ft-)
For multiple wells lirt all drprbs ifdirrent (example- 3(rtj200' and 2@101f)
10. Static water level below top of casing: (ft.)
ffwnter level a above casing, use "+"
t 1. Borehole diameter: 8
12. Well construction method: Auger % core
(i.e. auger, rotary, cable, direst push, etc.)
Fur Interim Use O TY:
22. Certification:
,/z/ 12/18/2014
Signature of Ce feed Well Contractor Date
By signing this form, I hereby cert01 that the well(s) was (were) constructed in accordance
with 15,4 NCAC 01C .0100 or 13A NCAC 02C.0200 rVell Construction Standards and drat a
copy of this record has been provided to the wvll owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site derails or well
construction details. You may also attach additional pages if necessary.
SUBMTITAL INSTTICITONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mad Service Center, Raleigb, 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,
FOR WATER SUPPLY WELLS ONLY: 16M Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) _ Method of test: 24a For Water Supply & infection Wells:
Also submit one copy of this foot within 30 days of completion of
13b. Disinfection type:___ Amount: well construction to the county health department of the county where
-- constructed.
Form C.W-I North Carolina Department of Environment and Natural Resources- Division of Water Resources Revised August 2013

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Tommy Burnette
Well Contractor Name
2277-A1
J
NC Well Contractor Certification Number
A.E. Drilling Services, LLC C�
Company Name ` ) v
2X\
2. Well Construction Permit #: (`;�. r
List all applicable well co
nstruction permits (i.e. UIC. County; Stale, fWQ e. etc.)
3. Well Use (check well use):
Water Supply Well:
\!bicultural
� 6eothennal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
Non -Water Supply Well:
Monitoring
Injection Well:
)Aquifer Recharge
)Aquifer Storage and Recovery
)Aquifer Test
]Experimental Technology
]Geothermal (Closed Loop)
M unicipal/Public
Residential Water Supply (single)
0 Residential Water Supply (shared)
Groundwater Renlediation
QSalinity Barrier
[]Stormwater Drainage
Subsidence Control
Tracer
)lain under #21 Remarks
4. Date Well(s) Completed: 8/29/13 Well ID# MW250-J36CD
Sa. Well Location:
Chemtronics Inc.
Facility/Owner Name Facility ID# (if applicable)
180 Old Bee Tree Rd., Swannanoa, NC
Physical Address, City, and Zip
Buncombe
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one Iat/long is sufficient)
700608.673 N 978805.659
6. ls(are) the well(s)Ex Permanent or Temporary
W
7. Is this a repair to an existing well: OYes or x)No
1f rhis is a repair, ill out knot- well construction information and eiplain the nature of the
repair under #21 remarks section or on the hack o%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
9. Total well depth below land surface: 95.5 (ft.)
For multiple wells list all depths ifdijjerent (crumple- 3@)200' and 2tai/00')
10. Static water level below top of casing:
If water level is above casing, use
11. Borehole diameter: 8
(in.)
12. Well construction method: 4.25" HSA Auger
(i.e. auger, rotary, cable, direct push, etc.)
Print Form
For Internal Use Only:
14. WATER ZONES
FROM
TO
DES 'RIP "I ION
fl.
ft.
ft.
ft-
15.'OUTER CASING for multi -cased wells 0 t LINER if a licable
M FRO
TO
DIAMETER
THICKNESS
MATERIAL
fL
ft.
in.
16. INNER
CASING OR TUBING geothermal closed-loo
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
ft.
ft.
in.
17. SCREEN
FRTGROUT
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
8095.5
rf•
2 in.
0.010
Sch.40
PVC
ft.
in.
18.FRTO
0 ft'
73 ft'
MATERIAL
Neat cement
EMPLACEMENT METHOD $ AMOUNT
Tremie
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if a licable
FROM
TO
MATERIAL
EMPLACEMENT METHOD
76.5 ff•
99.8 ft.
#1 sand
Tremie
ft.
ft.
20. DRILLING
LOG anachadditionaI sheets if necessary
FROM
TO
DESCRIPTION (colur, hardness, wittmck iype, gmin.sim, etc
It.
ft.
n.
n.
It.
n.
ft.
ft.
e.
a.
u.
It.
21. REMARKS
22. Certification:
L 8/29/13
Signature of Certified Well Contractor Date
All signing this form, I hereby certify that the itr/l(s) nits (were) conutructed in accordance
with 1 SA NCAC 01C .0100 or 1 SA NCAC 01C .0200 Well Construction Standards and that a
cc/ry 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:
(ft.) 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,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 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
13b. Disinfection type: Amount: 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
This f,rm can be used for i*c or multiple wells
1. Well Contractor Information:
Abz l AIIt (I
Well Contractor Name \`� • \ \�
NC Well Contractor Certification Number
f7IC- 0t"
Company Name r�\\�) C. r
U
2. Well Construction Permit _r Ii\
List all applicable well permits (i.e. County, Stare, Variance, IaiiecNogl, etc.)
3. Well Use (check well use):
[]Agricultural
❑Geothermal (Heating/Cooling Supply)
❑Industrial/Commercial
❑ln'iealion
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Groundwater Remediation
❑Salinity Harrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 R
4. Date Well(s) Completed: 3- - 11 Well iD# AV - 2-79 -
5a. Well Location:
Facility/Owner Name
Physical Address, City, and Zip
County
Facility ID# (if applicable)
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degree0minutes/seconds or decimal degrees:
(if well field, one laVlong is sufficient)
N
6. Is (are) the weli(s): permanent or ❑Temporary-
W
7. Is this a repair to an existing well: ❑Yes or FT qo
(this is a repair, fill out known well cons"ction information and eiplain the nanrre 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 we ONLY with the same construction, you can
submit oneform.
For Internal Use ONLY:
14. WATERZONES
FROM TO DESCRIPTION
n. n.
ft. n.
15, OUTER CASING for multi cased wells OR LINER f a tcablc
FROM 70 DIAMETER THICKNESS MATERIAL
ft rt in
16. INNER CASING OR TUBING eothermal closed-lam
FROM TO I DIAMETER THICI --a-m MATERuL
ft. ft. In
n. ft. bL
17.SCREEN
FROM TO DIAMETER SLOTSIZE THICKNESS I MATERIAL
S ft n. 21 in.
in.
18.GROUT
FROM - -TO MATERIAL EMPLACEMENT METHOD & AMOUNT
t n. n: t ft.
Zm
ft :: ft.
i
79. SAND/G VEL PACK If a licable
FROM TO MATERIAL EMPLACEMENT METHOD
t1z, rt. 1173 n. -if~1 S J j rr„ etQ
n. n.
20. DRILLING LOG attach additional sheets if aeeessar
FROM TO DESCRIPTION rotor, aardons, ,eiNrock r, alas ett.
ft. ft
ft. ft.
ft. ft
n. n.
n. n.
w n.
n ft
21. REMARKS
22. Certification:
SngnatureofCeRifned ell atract r Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 1 SA NCAC 02C .0100 or 1 SA NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owster.
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
9. Total well depth below land surface: 117. S (ft.) 242. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths ifdifferent (example- 3@200' and 1@1M construction to the following:
10. Static water level below top of casing. lvlig (ft.) Division of Water Resources, Information Processing Unit,
lfwater level is above casing, use +" 1617 Mail Service Center, Raleigh, NC 27699-1617
ll. Borehole diameter: {in.) 24b. For Iniection Welk ONLY: In addition to sending the form to the address in
nn ++ 24a above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: 14 H ti ar P d 4- f 0 r t J construction to the following:
(ie. auger, rotary, cable, direct puab, etc.)
Division of Water Resources, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) _ Method of test: 24c. For Water Supply & Injection Wells:
Also submit one copy of this form within 30 days of completion of
13b. Disinfection type: Amount: _ 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

Project Abbrev. nl^.,r14Y.0rrrf
Project No. -_ / 12 r
LOG OF ROCK CORE
Boring No. /-3r/) -
Depth of Boring, 5 Lf
Size of Core - hrn- 17/ In .
Type of Core Barrel do+rbL-
Depth f Run I Recovery I ROD I Graphic
na
I No. % % Log
r•r •-
'r -�
�r - i-
r
1DO,ID
q���
N•r.
- ~r
• - r
r-
.r
r'
R-3 I /oot MI.
20
t2r.5
Date
Looced by
Location ✓)Qt Y-ir�7�l
Boring Elev- ":y d i
Elev. Top of Bedrock ^'95 *= "bv/o,,)
Elev. Groundwater /n• 9 �� l,r/�, varaunci
V
Fractures ! ,Lithology
:0=O'OrenaG
Sruilf
U Je-t &rojgUArf2 - �lo%¢B
Glvcr55, carrkt.�ncr� 6ar:dQ oor=.3�'
t:k. and coarse �rcuns o� wlt.��e.l
rnaXz�c��x�ff, h�car-rt,L*�
m1re lI7 G t0[t� lilt anA
Sarnchkrous trn a Ll'-W Pizu-s,
ra u.'Lh 3o - boo gZP h
ft5si ve In -516 . a•lla.5. Core �s
�L��
�a�3o's Se
fDY sJ tttrtinsq a,c.ra-n
rai
I(v°IvQ 6%tn� ?)rYC-G1ureS �C -
10",rDrs t Slum
(57. 0rnri9e 5kL.-
rhaL rl� 0 t a-,— V
2G ,brown 5fa.n
-2o, ovn"e s{cin
15'1
.2 trrcl► �+ortL
1 �
31orart)e ,;lain
:frtrt0
of /n of Able at /Z I. S'
Ail : Lela 1hs on ecre e7 a tz
/e75 ff'Ltn Yt',cz;I -P c �e
co,"s WLc!• u,J;-e r,u�a- cI
Form No. 350--r--LF -EDDY

Project Abbrev.
Project No. 15411
LOG OF ROCK CORE
Borino No. ��%~Q Location - /Jnr�1r�!/Ji/i°ir f —/tea 1'
Depth of Boring_ 2�/• 5 / ¢ ore - Boring Elev.- -: %'J $/ r�un� <ur
Size of CNO 1 %rn e
Elev. Top of Bedrocz --^ 9_-5 r' c> /—
T
YGe of Core Barrel ��!n/D_ YLrbE Elev. Groundwater
arennr�
Depth Run Recovery RQD Grapnie
No. I % % I Log
Date 614180
Logged by- C . 5t,1r,T
via
/00 ,
.r
r ,r
r „
r. -
• r
/05
'
r
r,
10
/0
16,,,l
orm No. 350
Fractures
50' 51 brown
Lithology
tproy-,'maJe Too of
crock ® `/5 f-I
Qom a� SS t�s�r/ ® /DO/t,
Ip
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North Carolina Department of Environmental Quality — Division of Water Resources
INJECTION EVENT RECORD (IER)
Permit Number W10100230
1. Permit Information Y ' WEB EDINCaF_(A
Chemtronics, Inc.R
Permittee
Chemtronics Superfund Site, BW-14 Area
Facility Name
_180 Old Bee Tree Road, Swannanoa, NC 28778
Facility Address (include County)
2. Injection Contractor Information
Geosvntec Consultants of NC. P.C.
Injection Contractor / Company Name
Street Address 1255 Roberts Boulevard, Suite 200
Kennesaw GA 30144
City State Zip Code
678 202-9507
Area code — Phone number
3. Well Information
Number of wells used for injection _4
Well IDs MW301-R30CD, MW303-R30E,
MW304-R30CD, MW305-R30CD
Were any new wells installed during this injection
event?
❑ Yes ® No
If yes, please provide the following information:
Number of Monitoring Wells
Number of Injection Wells
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
Number of Injection Wells
Please include a copy of the GW-30_ for each well
abandoned
4. Injectant Information
Hydrogen Peroxide
Injectant(s) Type (can use separate additional sheets
if necessary
Concentration 386 mWL
If the injectant is diluted please indicate the source
dilution fluid. Extracted groundwater (MW302-
R30CD, MW301-R30CD, and/or MW303-R30E)
Total Volume Injected (gal) 29 130
Volume Injected per well (gal) 5,g40 (MW301-
R30CD), 7,920 (MW303-R30E), 7,700 (MW304-
R30CD), 7,670 (MW305-R30CD)
5. Injection History
Injection date(s) January 9 to 25, 2018
Injection number (e.g. 3 of 5) 2 of 2
Is this the last injection at this site?
❑ Yes ® 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.
z dry.. 2 h z1 va
SIGNATURE OF INJECTION CONTRACTOR DATE
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

Rogers, Michael
From: Anchor QEA (Chemtronics Project) <[e-mail]>
Sent: Wednesday, May 10, 2017 5:36 PM
To: Bornholm, Jon
Cc: Hartzell, Beth; Rogers, Michael; Watts, Debra; Stu Ryman
Subject: Chemtronics - Proposed Bioremediation Pilot Test in the BW-14 Area
Attachments: 2017-0509-Chemtronics-BW-14 Area Pilot Test work plan.pdf
Jon,
As we discussed recently on a May 10, 2017 call, the Companies are planning a pilot test at the Chemtronics Site in the
area of the Back Valley near Zone E well`8W-14, and further downgradient to the property boundary. This pilot test is in
response to the September 2016 detections in well MW172-T32D. This pilot test will evaluate potential groundwater
treatment options from well BW-14 downgradient to the property boundary utilizing enhanced in situ bioremediation
(EISB).
Depending on the review time required by the EPA, the Companies would like to commence drilling activities in early
June with the goal of commencing the pilot test injections in early July. We would appreciate a review by the Agencies
as soon as possible, but preferably not later than May 31st.
Please let us know if you have any questions or would like to arrange a phone call to discuss in more detail.
Rob
Robert Cork, P.E., PMP
ANCHOR QEA OF NORTH CAROLINA, PLLC
Cell: 828.450.6435 1 Direct: 828.771.0370

Geosyntec("
consultants
Mr. Jon Bornholm
Project Manager
USEPA, Region 4
Sam Nunn Atlanta Federal Center
61 Forsyth Street, S.W.
Atlanta, Georgia 30303-8960
1255 Roberts Boulevard, Suite 200
Kennesaw, Georgia 30144
PH 678.202.9500
FAX [phone]
www.geosyntec.com
May 9, 2017
Subject: Proposed Bioremediation Pilot Test in the BW-14 Area
Chemtronics Superfund Site
Swannanoa, Buncombe County, North Carolina
Dear Mr. Bornholm:
Geosyntec Consultants of NC, P.C. (Geosyntec) has prepared this letter on behalf of
Chemtronics, Inc., Northrop Grumman Systems Corporation, and CNA Holdings LLC
(collectively "the Companies") regarding the area in the Back Valley near Zone El well BW-14
and further downgradient to the property boundary at the above referenced site (Figures 1 and
2). In September 2016, tert-butyl alcohol (TBA) (120 micrograms per liter [[Lg/L]), benzene (3.7
µg/L), and other volatile organic compounds (VOCs; e.g., methyl tert-butyl ether [MTBE]) were
detected at Back Valley property boundary well MW172-T32D, which is screened in Zone D
and shown on Figure 2. The TBA and benzene concentrations are greater than their Title 15A,
North Carolina Administrative Code, Subchapter 2L groundwater standards. These
concentrations were confirmed when well MW 172-T32D was resampled in October 2016.
In response to the detections in well MW 172-T32D, additional groundwater monitoring and
hydraulic characterization activities were performed in the Back Valley. This letter summarizes
the results from these recent evaluations performed to assess potential transport pathways of
constituents of concern (COCs) in the lower portion of the Back Valley, consistent with the Off -
Site Groundwater Use Survey and Sampling —Summary of Activities, which was submitted to the
United States Environmental Protection Agency (USEPA) and North Carolina Department of
Environmental Quality (NCDEQ) on January 31, 2017, by Anchor QEA of North Carolina,
'Zone EF is the competent portion of the bedrock aquifer. Above this, Zone D is the highly fractured upper portion
of the bedrock aquifer (see Figure 3), which is overlain by partially weathered rock (PWR) (referred to as Zone C).
Zones A and B overlay Zone C and are the unconsolidated material designated as the surficial aquifer.
GR4943/2017-0509-Chemtronics-BW14 Pilot Test WP
engineers I scientists I innovators

Mr. Jon Bomholm
9 May 2017
Page 2
PLLC (Anchor QEA). Based on information obtained from these additional activities, an
enhanced in situ bioremediation (EISB) pilot test is proposed to evaluate potential groundwater
treatment options for the area from well BW-14 downgradient to the property boundary (i.e. the
leading edge of the COC plume in the Back Valley) (Figure 2).'
The purpose of this letter is to:
• Summarize the 2003 groundwater investigation, where VOCs were detected at the
shallow property boundary well MW 163-T32C, which is adjacent to MW 172-T32D;
• Summarize the groundwater monitoring results from 13 wells sampled in January 2017,
10 of which are not routinely sampled, to further evaluate COC distribution in the Back
Valley;
• Summarize the results from a flow -rate test performed at well BW-14 in February 2017,
which was used to quantify the natural artesian flow rate and present results regarding
potential hydraulic connections to other wells, as well as COC concentrations and
geochemical trends;
• Present the groundwater level measurements and calculated vertical hydraulic gradients
along the axis of the Back Valley; and
• Provide details and request Agency approval for a pilot test to evaluate an aerobic or
anaerobic EISB approach to treat TBA, MTBE and benzene in the downgradient portion
of the Back Valley plume in the vicinity of BW-14.
The Companies plan to proceed with the proposed pilot test in the vicinity of BW-14, as
described herein, in June 2017 upon receiving Agency approval. Additional details are provided
in the subsections that follow.
SUMMARY OF RECENT EVALUATIONS
The results of the previous property boundary groundwater investigation, recent groundwater
monitoring event, flow -rate test, and vertical hydraulic gradient evaluation are presented in this
section to:
• Assess potential transport pathways of COCs in the area between BW-14 and the Back
Valley property boundary; and
• Demonstrate the basis for and objectives of the proposed EISB pilot test approach.
The cross section presented in Figure 4 provides ,a summary of recently collected data discussed
in this section and illustrates hydrogeologic data. Historical analytical data for TBA is also
GR4943/2017-0509-Chemtronics-BW 14 Pilot Test WP
engineers I scientists I innovators

Mr. Jon Bornholm
9 May 2017
Page 3
presented on Figure 4 since it is the COC present at the highest concentration in well BW-14
and at the property boundary.
Summary of 2003 Property Boundary Groundwater Investigation
A summary of the investigations performed in 2003 near the Back Valley property boundary is
presented in this section to provide background on previous detections of VOCs in shallow
groundwater and actions taken to address the source (a leaking discharge line). Although
MW 172-T32D is located in the vicinity of this area, the discharge line is not expected to be a
contributor to the recent detections.
As presented in the 2006 Data Summary Report (Altamont, 2006), 1,2-dichloroethane (1,2-
DCA) and MTBE were detected at shallow Zone CD well MW 163-T32C (which is 16.5 feet
deep) and at two shallow Geoprobe groundwater sample locations near the Back Valley property
boundary in 2003. TBA was not included in the 2003 data set (analysis for TBA at the Site
began in 2007). It was subsequently confirmed in the 2007 sampling event that 1,2-DCA and
MTBE were not detected at Zone D and E wells in the immediate vicinity (MW 172-T32D and
MW172-T32E) or further upgradient (BW-14).
At the time of these detections at MW 163-T32C, the Companies performed an evaluation of the
integrity of the underground Back Valley discharge line, which was suspected to be the source
given the close proximity of the discharge line to the affected well. Inspection of the discharge
line confirmed some of the pipe fittings were leaking. As a result, the line was replaced in 2004
and the new line was pressure tested to confirm integrity before being brought back on line. This
line has remained idle since September 2014 when the Back Valley Pump and Treat System
operation was suspended.
Groundwater data from fall and winter 2016 did not show any detections of 1,2-DCA, MTBE,
TBA or benzene in shallow groundwater at the property boundary.:' Rather, the detections were
at monitoring well MW172-T32D, which is screened at the top of rock. Thus, the historical
COC fingerprint and depth of impacts from the Back Valley line release, coupled with the
recently obtained groundwater data discussed above, do not suggest that the Back Valley
discharge line is the source of the current VOC detections in MW 172-T32D.
January 2017 Groundwater Monitoring Results
To further evaluate the confirmed detection in MW 172-T32D, 13 wells were sampled on
January 3 and 4, 2017, in the Back Valley by Anchor QEA. The sampled wells were selected to
- provide 'additional spatial (horizontal and vertical) coverage beyond the monitoring network
utilized for the annual assessment monitoring in fall 2016 and/or to evaluate temporal variability
at select wells sampled in fall 2016. The groundwater field parameter, VOC, and nitroaromatic
GR4943/2017-0509-Chemtronics-BW 14 Pilot Test WP
engineers I scientists I innovators

wT0ro0230
INJECTION EVENT RECORD
North Carolina DepaAtvM*@6)Lr�TpUWgt and Natural Resources — Division of Water Resources
Permit Number WI0100230
DEC 212016
I. Permit Information
Water Quality
Chemtronics, Inc. Regional Operations Section
Permittee
Chemtronics Superfund Site, DA 23/B116 Area
Facility Name
180 Old Bee Tree Road, Swannanoa, NC 28778
Facility Address
2. Injection Contractor Information
Geosyntec Consultants of NC, P.C.
Injection Contractor / Company Name
Street Address 1255 Roberts Boulevard, Suite 200
Kennesaw GA 30144
City State Zip Code
6( 78 ) 202-9507
Area code — Phone number
3. Well Information
Number of wells used for injection 5
Well names MW246-J36CD, MW248-J36CD
MW249-J36CD, MW277-136CD, BW-4
Were any new wells installed during this injection
event?
❑ Yes 0 No
If yes, please provide the following information:
Number of Monitoring Wells none
Number of Injection Wells none
Type of Well Installed (Check applicable type):
❑ Bored ❑ Drilled ❑ Direct -Push
❑ Hand -Augured ❑ Other (specify)
Please include a copy of the GW-I 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
Number of Injection Wells
Please include a copy of the GW-30 for each well
abandoned.
4. Injectant Information
Hydrogen Peroxide
Injectant Type
Concentration 337 mg/L
If the injectant is diluted please indicate the source
dilution fluid. Fire Hydrant
Total Volume Injected 238, 560 L
14,865 L (MW246-J36CD),
Volume Injected per well64,647 L (MW248-136CD)
60,089 L (MW249-J36CD)
Injection History 67,755 L (MW277-136CD)
31,203 L_(BW-4)
Injection date(s) Oct 25-28, Oct 31-Nov 4, 2016, Nov 7, 2016,
Nov 15-18, 2016, Nov 21-23, 2016 and Nov 28-30, 2016.
Injection number (e.g. 3 of 5) 2 of 2
Is this the last injection at this site?
❑ Yes ❑x 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.
l/9f 2rar6
S`iGN URE OF INJECTION CONTRACTOR DATE
PRINAME 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. 8/5/2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
Randy Phillips
RECEIVEDINCDEQIDWR
Well Contractor Name
1096-A
DEC 212016
NC Well Contractor Certification Number
A.E.Drilling Services
Water Quality
Company Name
eglo
2. Well Construction Permit #:
List all applicable w4l permits (i.e. County, State, 10arianee, Ir feetion, etc.)
3. Well Use (cheep well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑htdustriakommercial
Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Municipal/.Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Groundwater Remediation
❑Salinity Barrier
❑Stornwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 F
4. Date Well(s) Completed: 8123/13 Weft ID# MW246-J36CD
5o. Well Location:
Chemtronics
Facility/Owner Name Facility W# (if applicable)
180 Old Bee Tree Rd. Swannanoah
Physical Address, City, and Zip
Buncombe
County
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/ndautes/seconds or decimal degrees:
(if well field, one lablong is sufficient)
lj
6. Is (are) the well(s): ©Permanent or ❑Temporary
►:9
7. Is this a repair to an existing well: ❑Yes or ®No
If this is a repair, fit out known well construction informatim? and explain the nature of the
repair under ti21 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 coavtraction. you can
submit one form. 9. Total well depth below land surface: 96.5 (ft.)
For multiple wells list all depths ifdifferent (example- 3(rg200' and 2@1 MY)
10, Static water level below top of casing:
If water level is above casing, use
11. Borehole diameter: 8
12. Well construction method: Auger Core
(i.e. auger, rotary, cable, direct push, etc.)
For Internal Use ONLY:
14. WATER ZONES
FROM
TO
I DEESCRU' N
ft.
ft.
ft.
ft.
15. OUTER CASING for
multi -cased wells OR LINER rf a licable
FROM
TO
DIAMETER
THIC7LNESSI MATERIAL
0 ft-
81.5 1-
2 In
sch 40 PVC
16. INNER
CASING OR
TUBING fizeathermal
closed -lop
FROM
I TO
I DIAMETER F
THICKNESS
I MATERIAL
ft,
ft.
I in.
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
I SLOT SIZE
I THICKNESS
I MATERIAL
81.5 fL
96.5 ft-
2 in.
.010
sch 40
PVC
fL
ft.
in.
19. GROUT
FROM
I TO
MATERIAL
EMPLACEMENT METHOD & AMOU.Yr
75.5 ft.
78.3 ft.
chips
tremmie
0 ft-
75.5 ft.
neat cement
tremmie
ft.
ft.
19. SAND/GRAVEL PACK ff a licable
FROM
TO
MATERIAL
EMPLACEMENT METHOD
78.3 ft.
99.8 ft'
#1 sand
tremmie
ft.
ft.
20. DRILLING
LOG attach
additional sheets if necessary)
FROM
I TO
DESCRIPTION (color. hardness, soNrock e. grzdn stu etc.
ft.
fL
ft.
ft.
ft.
fL
ft.
ft.
rt.
ilr.
ft.
ft.
ft.
ft.
21. REMARKS
22. Ceerdfleaden:
12/18/14
Signature ofC "fted Well Contractor Date
By signing this form. I hereby certify that the uell(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or I5A MCA 02C.02PO Well Construction Standards and that a
copy of this record has been provided to the rsrll owner.
23. Site diagram or additional weft 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: Subunit this form within 30 days of completion of well
construction to the following:
(ft.) 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,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
m Method of test: 24c. For Water Supply & Injection Wells:
13a. Yield (gp ) Also submit one copy of this famt within 30 days of completion of
13b. Disinfection type: Amount: well construction to the county health department of the county where
constructed.
Form GIV-1 North Carolina Department of Environment and Natural Resources - Division of Water Resources Revised August 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
For Internal Use ONLY:
1. Well Contractor Information:
Randy Phillips
RECEIVED/NCDE
Well Contractor Name
2209-A
DEC 212
NC Well Contractor Certification Number
A.E.Drilling Services
WalerQuall
Company Name
tiegional Operelaw
2. Well Construction Permit#:
List all applicable well permits (Le, County, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Municipal/Public
❑Geothermal (Heating/Cooling Supply)
❑Residential Water Supply (single)
❑Industrial/Commercial
❑Residential Water Supply (shared)
C
El Aquifer Recharge ❑Groundwater Rernediation
OAquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology OSubsidence Control
❑Geotbennal(Closed Loop) ❑Tracer
❑Geothermal (Heating/Cooling Return) ❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: 8-27-13 weu ID# MW248-J36CO
5a. Well Location:
Chemtronics
Faciliry/Owner Name Facility ID# (if applicable)
180 Old Bee Tree Rd. Swannanoa, NC
Physical Address, City, and Zip
Buncombe
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees)minutes/seconds or decimal degrees:
(ifwell field, one lat/long is sufficient)
700716.497 N 978821.321 W
6. Is (are) the well(s): (aPermanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ©No
lfthis is a repair•, fill out known well construction information and explain the nature ol'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 ONLYwith the same construction, you can
submit one form.
li'. I ft.
ft. I n. I in.
vWMNER CASING OR TUBING eethermal closed -loon)
FROM To I DIAMETER f nUCI -NM MATERIAL
+3 it 55 R 2 in. sch 40 PVC
ft. R. in.
17. SCREEN
FROM TO DLILM:TER SLOTSI7E THICKVESS -HATERIA
55 11 N 11• 2 i"' .010 sch 40 PVC
it I ft. in.
0 11
49.5 FL
Ineatcenent
Itremmle
49.5 n
52 n
chips
tremmie
ft.
I ft.
19. SAND/GRAVEL
PACKOf2pplicable
FROM
I TO
MATERIAL
EMMACEMEW METHOD
52 ft
71 it-
#1 sand
tremmie
ft. I
it..
20. DRILLING
LOG (attach
additional sheets if necessarvl
rt. rt.
ft, ft.
ft. ft.
ft. Ft.
ft. ft.
ft. fG
22. Certification:
�9" 9/14/2015
Signature ofCp6ified Well Contractor Date
By signing this form, I hereby certify that the wells) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
9. Total well depth below land surface: 70 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths if different (example- 3 t@200' and 2Q100') construction to the following:
10. Static water level below top of casing: (ft.) Division of Water Resources, Information Processing Unit,
Ifivaler level is above casing, use "+^ 1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 8 (in.) 24b. For Infection Wells ONLY: In addition to sending the form to the address in
ll erlCOre 24aabove, also submit a copy of this form within 30 days of completion of well
a
12. Well construction method: 9 construction to the following:
(i.e. auger, rotary, cable, direct pushy etc.)
Division of Water Resources, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 276994636
24c. For Water Supply & Injection Wells:
13a. Yield (gpm) Method of test: Also submit one copy of this foam within 30 days of completion of
13b. Disinfection type: Amount: 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 For Internal Use ONLY:
This form can be used for single or multiple wells
1. Well Contractor Information: RECSIVEDMCDEQIDWR
14. WATER ZONES
Randy Phillips
!
Well Contractor Name
D E C 212016
1096-A
NC Well Contractor Certification Number
Water Quality 1
A.E.Ddlling Services
Regional Operations Suction 0
Company Name
1
2. Well Construction Permit #:
Uts all applicable neW permits (i.e. Counlx State, Variance, L jecdon, etc.)
3. Well Use (check well use):
Water Supply Well:
!
❑Agricultural
❑MunicipaUPublic
6
❑Geothermal (Heating/Cooling Supply)
El Residential Water Supply (single)
❑Industrial/Commercial
❑Residential Witter Supply (shared)
!
❑Aquifer Recharge
❑Groundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
❑Storrawater Drainage
❑Experimentai Technology
❑Subsidence Control
❑Geothermal (Closed Loop)
❑Tracer
❑Geothermal (Aea4g&fCooling Return)
❑Other (explain under #21 Remarks)
4.Date Well(s) Completed: 8-20-13 Well ID# MW249-J36CD
5a. Well Location:
Chemtronics
Facility/Owner Name Facility ID# (ifapplicable)
180 Old Bee Tree Rd.
Physical Address, City, and Zip
Buncombe
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degreedminutes/seconds or decimal degrees:
(ifwell field, one latilong is sufficient)
N W
6. Is (are) the weil(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 arplain the nature ofthe
repair tender #21 remarks section or on the back of this form.
S. Number of wells constructed: 1
For multiple infection or non-watersupply wells ONLY with the same construction, you call
submit oneform. 9. Total well depth below land surface: 84.3 (ft.)
For multiple wells list all depths a%different (exmnple- 3@200' and 2@100)
10. Static water level below top of casing: (ft.)
If water level is above casing: use "+"
11. Borehole diameter: 8 (jn.)
12. Well construction method: Auger / Core
(i.e. auger, rotary• cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
n. I e.
ft. I R.
ft. 169.5 ft, 12 In. I SCh 40
ft. I ft. I In.
ft. I fit in.
ft. 184.5 ft 2 In' 1 .010 1 sch 40
ft ft. io.
to
TO afAMIAL EMPLACEMENTM
rt 67 chips tremmie
ft. 64 lt. neat cement tremmie
ft. ft.
PVC
67 184.5 ft• 1 ##1 sand I tremmie
ft. ft.
20. DRILLING LOG fanach additional sheets If necessarvl
ft.
ft.
ft.
rt.
re.
ft.
ft.
PVC
22. Certification:
�. 12/18/2014
Signature ofCcaffied Well Contractor Date
By signing this form, Iltereby certi, that the ivell(s) was (were) constructed in accordance
with 15A NCAC 01C.0100 or 15A NCAC 01C.0100 fiell Construction Standards and that a
copy of this record has been provided to the %wit owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells ONLY: In addition to sending the form to the address in
24aabove, 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 OW-1 North Carolina Department of Environment and Natural Resources— Division ofWater Resources Revised August 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
For Internal Use ONLY:
1. Well Contractor Information:
Randy Phillips
Well Contractor Name
2209-A
NC Well Contractor Certification Number
RECEIVED/NCDE(
A.E.Drilling Services
Company Name
D K 212(
2. Well Construction Permit #:
List all applicable well permits (i.e. County, State, Variance, Injection, etc.) Water auallt)
3. Well Use (check well use):
Regional Operations
Water Supply Well:
❑Agricultural
❑Municipal/Public
❑Geothermal (Heating/Cooling Supply)
❑Residential Water Supply (single)
❑Industrial/Commercial
❑Residential Water Supply (shared)
Non -Water
❑Aquifer Recharge ❑Groundwater Remediation
Cl Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control
❑Geothermal (Closed Loop) ❑Tracer '
❑Other (explain under #21
4. Date Well(s) Completed: 3-11-14 Well ID# MW277-136CD
Sa. Well Location:
Chemtronics
Facility/Owner Naine Facility ID# (if applicable)
180 Old Bee Tree Rd. Swannanoa, NC
Physical Address, City, and Zip
Buncombe
County Parcel Identification No. (PIN)
5b. Latitude and Longitude In degrees/minutes/seconds or decimal degrees:
(if well field, one fat/long is sufficient)
700645.024 N 978735.505 W
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 oj'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 oneform.
9. Total well depth below land surface: 100 (ft.)
For multiple wells list all depths !f dVerent (example- 3@200' and 2@I00')
10. Static water level below top of casing:
11'water level is above casing, use "+"
11. Borehole diameter: 9 (in.)
12. Well construction method: auger/Core
(i.e. auger, rotary, cable, direct push, etc.)
14. WATER ZONES
FROM
TO
DESCRIPTION
ft
ft.
ft
I ft.
ER CASING for multi -cased wens OR LINER rf a
I! ]Te
TO DIAMETER
TRICKNESS
itATERJAL
f4
R. in.
f . INNER CASING OR
TUBING eothermal dosed400
I OM
TO
DIAMEIER
TMCKNM
I MATERIAL
+3 IL
80 ft.
2
sch 40
PVC
R,
SWMEN
R.
in.
FROM
TO
DWAIETER
SLOT SIZE
TRICKWSS
MATERIAL
80 ft.
100 f0
2 in.
.010
sch 40
PVC
R.
R,
in.
10. GROUT
FROM
TO
MATERIAL
EMPLACEMEgT METHOD & AMOUNT
0 R•
74 ft.
neat cenent
tremmie
74
77 rt.
chips
tremmie
R.
R.
19. SAND/GRAVEL
PACK
applicable)
FROM
TO
MA7RRrat_
EMPLACEMENTMEMOD
77 It.
102.4 rL
#1 sand
tremmie
ft.
it.
20. DRILLING LOG attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, gMn size, etc.)
ft.
It.
It,
ft.
R,
ft.
ft.
ft.
ft.
rL
fit.
R.
n.
R.
21.. REMARKS
22. Certification:
M9/14/2015
Signature off e�itified Well Contractor Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or ) 5A NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details -
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.
SU13MITTALINSTUCTIONS
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 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,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Infection Wells:
Also submit one copy of this form within 30 days of completion of
13b. Disinfection type: Amount: 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 W ater Resources Revised August 2013

r;
z
i
0
0
W
U.
1
U
W
a
Project. Abbrev. +nl'=>rirfror.irs
Project No. / -3,:2 /
Boring No. 13W - 4-
Depth of Boring- 121, 5 -P-
Size of Core ALn- 17!Q bi.
Type of Core Barrel L„bf-
Oeoth
115
116.5
/20
1121.6
Date
Loaced by R �Woa_T
LOG OF ROCK CORE
Location ,
Boring Elev. 5/ r.v,.n <ur. re
Elev. Top of Bedrock N95.- uAo/ „) orour+
Elev. Groundwater 4,- q ,2 h /e , "around
Run I Recovery I RQO I Graphic No. No. % % Log Fractures
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31 oranie SFaln RECEIVEDINCOMIDWR
DEC 212016
Water Quality
Regional Operations Section
P
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Alo4e : �PYhs Dn ecre Gal ate O. 9
Caxc s w4, C.l. tvf r t rn teA .1cL l ,1;,
C...•w AID 7GA
41 F R Cnnv

Project Abbrev, 0 r) rS
Project No. / 5,01
LOG OF ROCK CORE
Boring No.
Depth of Boring - / /• $ -Fi-
a
Size of Core
Type of Core Barrel
Deoth Run I Recovery RQD Grsonic
No. '% % Log
15
105
106.5
r. • 'r
17�.�r
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t%0'6
•
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to
Q ,
i-
40
1
rm'No. 350
Date _ 6141$0
Logged by_C. Sidi-i '
Location—AldrlrI7,11 r t - A-ioa ?3
Boring Elev.__ 42 795/ around cur {tom
Elev. Top of Bedrock — 9-� L= / ,/o .ram,,
Elev. Groundwater / , 9 !"1 41 /o,
v,
Fractures I Lithology
e' SI bro,.an 54a;n
tpraxl•naje fop of
c-yrocic D 95 A:
RECEIVED/NCDEQ/DW.,
DEC 212016
Water Quality
Regional operations section
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North Carolina Department of Environmental Quality —Division of Water Resources
INJECTION EVENT RECORD (IER)
Permit Number W10100230
1. Permit Information RECEIVEDUDEOIDWR
Chemtronics, Inc. NOV 17 2016
Pertnittee
Water Quality 1® AI
Chemtronics Superfund-`f`I�il)Q�1 8i®19
Facility Name
180 Old Bee Tree Road, Swannanoa, Buncombe
County, NC 28778
Facility Address (include County)
2. Injection Contractor Information
Geosyntec Consultants of NC, P.C.
Injection Contractor / Company Name
Street Address 255 Roberts Boulevard, Suite 200
Kennesaw GA 30144
City State Zip Code
6( 78 ) 202-9597
Area code — Phone number
3. Well Information
Number of wells used for injection 13
IP-147-02,-03,-04,-05,-06,-07
Well IDs -08, -09, -10, -11, -12, -13, -14
Were any new wells installed during this injection
event?
❑ Yes X❑ No
If yes, please provide the following information:
Number of Monitoring Wells
Number of Injection Wells
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 ❑X No
If yes, please provide the following information:
Number of Monitoring Wells
Number of Injection Wells
Please include a copy of the GW-30 for each well
abandoned.
4. Injectant Information
A) Newman Zone; B) Sodium Lactate; C) Neutral Zone';
D) Sodium Bicarbonate; E) Sodium Sulfite; F) KB-I"Plus
Injectant(s) Type (can use separate additional sheets
if necessary
A) 17 g/L, B) 5.3 g/L; C) 17 g/L;
Concentration D) 21 g/L; E) 106 mg/L; F) 0.007 %v/v
If the injectant is diluted please indicate the source
dilution fluid. Potable water (hydrant) and groundwater
extracted from within the test area.
Total Volume Injected (gal) 42,524
Volume Injected per well (gal) 99 to 5,798
(average 3,271)
Injection History
Injection date(s) 23-Sept to 18-Oct, 2016
Injection number (e.g. 3 of 5) 4 of 4
Is this the last injection at this site?
❑ Yes ❑X 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.
SIGNATURE OF INJECTION CONTRACTOR DATE
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

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
-M WELL CONTRACTOR CERTIFICATION # J5'7)
1. WELL CQNTRACTOR:
Well Contractor (Individual) Name
A E DRILLING SERVICES, LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
City or Town State Zip Code
8( 64 ) 288-1986
Area code Phone number
2. WELL INFORMATION: T.Q- N-1-Z
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑--'
Irrigation[? Other ❑ (list use)
DATE DRILLED 1!-zI^•?Z
4. WELL LOCATION:
aem4nr>I' CS
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY:
COUNTY
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley ❑ Flat ❑ Ridge ❑ Other
LATITUDE 36 " DMS OR 3X.XXXXXXXXX DD
LONGITUDE 75 " DMS OR 7X.XXXXXXXXX DID
LatitudeRongitude source: ❑GPS Dropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
S. FACILITY (Name of the business where the well is located.)
d. TOP OF CASING IS .71 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): "A - METHOD OF TEST Alw
f. DISINFECTION: Type A I:7 Amount
g. WATER ZONES (depth):
Top-- Bottom Top . rt%At— Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top_ D` Bottom /l• Ft. 2" .�c.�t Yt1 - looL-
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top t Bottom 12— Ft'f"i e
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot°Size Material
Top i W Bottom Ot r Ft. Zi � in. -1J> in. 0, : «` P
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
Top JAY' Bottom �% � Ft.P_ .sAA:�
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom Formation Description
Cher, Icon;
l tea; cl� Fe
Facility Name Facility ID# (If applicable)
/
18 o O I� BPS 7iY r p�
l
Street Address
/
City or Town F State Zip Code
/
1nI ` II f
Yi17�141c11�- �IIUifMnun�t I
/
Contact Name
Mailin Address p
i�5%�;I� (ic- o2S�6LI
/
l
City or Town RECiED����ypREMARKS:
( 2 ) ' NI -3350
Area code Phone number NOV
1 fi 2016
6. WELL DETAILS:
: 100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S
a. TOTAL DEPTH: tXo' Water Quality Re9iOnaIRECORD HAS SUN P V'DE p THE WELL OWNER.
Zy %�
b. DOES WELL REPLACE EXISTING WELL�POR3Ct10rl SIGNA RE OF CERTIFIED ELL CONTRACT DATE
c. WATER LEVEL Below Top of Casing _ 13, 0'7 FT.
(Use "+" if Above Top of Casing)
: PRINTED NAME OF PERSON STRUCTING THE WELL
Form GW-1 b
Rev. 2109

NON RESIDENTUL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # K7I
1. WELL CONTRACTOR:
Well Contractor (Individual) Name
A E DRILLING SERVICES, LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
City or Town State Zip Code
8( 64 288-1986
Area code Phone number
2. WELL INFORMATION: XP- N7-3
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(iiapplicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection R-0
Irrigation❑ Other ❑ (list use)
DATE DRILLED a- 209-12-
4. WELL LOCATION:
CII�lrr�rorv`c5
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: '5L1161n/k4noa .1Y COUNTY
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley ❑Flat []Ridge ❑Other
LATITUDE 36 _' " DMS OR 3X.XXXXXXXXX DD
LONGITUDE 75 " DMS OR 7X.XXXXXXXXX DD
Latitude/longitude source: ❑3PS aopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located,)
C�•emk,r�„��.s
Fa Name Facility ID# (if applicable)
7o Old 'e TIC PJ
Str//E��et Address aW015'
City orTown
c State Zip Code
A(�amen�l u)Vi��onme!?�I
Contact Name
a31 oawl� s1-
Mailing Address)
% i .,I — . -1 00A r
City or Town RCl�l1ECURtDLC►btfal�
(&U) 19Il� NOV172016
Area code Phone number
d. TOP OF CASING IS 21 - 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): AVA- METHOD OF TEST AMW
f. DISINFECTION: Type Amount
g. WATER ZONES (depth): N J�
Tope Bottom r !W - TOP �(� Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness!
7. CASING: Depth Diameter Weight PAC -
Top Top_4' _ Bottom # Si► Ft. .� r y� PAC.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top a Bottom 1i FL���-
Top Bottom Ft.
Top Bottom Ft.
SCREEN:S.
Top am— Bottopm FD in, _6LO In. U+e(.1J.Iis' A
Top. 134,80ttom 33.5•Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
4110 Depth Size Material ,
Top�Botto RAW
Top _a ttom vt.
Top Bottom k Ft.� near
11. DRILLING LOG
Top Bottom Formation Description
! 5aarai� �e
/
6. WELL DETAILS: ' I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WrM
p� ► Water Quality Regiorr,�A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
a. TOTAL DEPTH: tiaJ CD D HAS EN PROVIDED TO THE WELL OWNER,
Operations Section,
—dry _t—
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 3� SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: �� I FT. Ad Nq!��q
(Use "+" if Above Top of Casing) PRINTrED NAME OF PERSON CONSTRUCTING THE WELL f
Form GW-1b
Rev. 2/09

NON ONRESIDENTIAL WELL CONSTRtiCTION RECORD
' 1 North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 1971
1. WELL CONTRACTOR:
Abel MiGu;ciia-
Well Contractor (Individual) Name
A E DRILLING SERVICES, LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
City or Town State Zip Code
8� 64 ) 288-1986
Area code Phone number
2. WELL INFORMATION: f - I y7 - q
WELL CONSTRUCTION PERMIT#
d. TOP OF CASING IS 3 Fr. Above Land Surface"
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0116.
e. YIELD (gpm): METHOD OF TESTtt'' !t
f. DISINFECTION: Type 044 Amount /v14
g. WATER ZONES (depth):
Top pl /& Bottom by& Top 11r/R Bottom NIR
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top Bottom y + -Ft. a" ov
OTHER ASSOCIATED PERMIT#(if applicable) Top Bottom Ft.
SITE WELL ID #tit applicable) : Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public+❑
Industrial/Commercial ❑ Agricultural ❑ Recovery pInjecbon ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED lQ- Z3 flZ
4. WELL LOCATION:
r- tem�wi'cs
(Street Name, +Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: tLJ I' _ IU •G COUNTY
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley []Flat []Ridge ❑Other
LATITUDE 36 o I" DMS OR 3X.XXXXXXXXX DD
LONGITUDE 7$ " DMS OR 7X.XXXXXXXXX DD
Latitudellongitude source: (]GPS OTopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
S. FACILITY ((Name of the business where the well is located.)
Cheer+ro rn i ci
Facility Name Facility ID# (if applicable)
Ill') Old e'." 1 f-ee PC)
Street Address
City or Town State Zip Code
Contact Name
dl3 ti ��'u���� S�-
MailiAddress
i , kev, I ie 'a8501
City or Town T State Zip Code
8. GROUT: Depth Material Method
Top_D• Bottom 13' Ft. —jfA!
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
; Top IT Bottom 3 r Ft. 2in. .10 in. _LkAM Lim'
Top Bottom Ft. in.
Top Bottom Ft. in.
10. SAND/GRAVEL PACK:
Depth Size
Top 1S• Bottom__3r Ft.�_
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
in.
in.
Material
3"^1
Formation Description
12. REMARKS:
"ECENEDINCDEM,3I�'
Area Cade Phone number
6. WELL DETAILS: NOV 17 2016 100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C. WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
a. TOTAL DEPTH: 32, r} - RECORRjDQHAS_(BEEEN PROVIDED
TTOOTTHE
-,WELL OWNER.
b. DOES WELL REPLACE EXISTING WEagIatUQUall e9iOnal '�`'".�'� = —
�l tons section SIGNATURE OF CERTIFIED WELL ONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: Q FT. Abe. i „ M G
(Use "+" if Above Top of Casing) PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-lb
Rev. 2109

NONREUDENTML WELL CONSTRUCTION RECORD
Nary Carolina Depwtaoent of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTMCATION #%�
1. WELL CO9
Well Contractor (Individual) Name
A E DRILLING SERVICES. LLC
Well Contractor Company Name
TWO UNITE© WAY
Street Address
GREE VILLE _ SC 29607
City or Town State Zip Code
8r 64 ) 288-1986
Area code Phone number
2. WELL INFORMATION: Z'# ly?-S
WELL CONSTRUCTION PERMIT#
d. TOP OF CASING IS 3`-,.,— FT. Above Land Surface
*Top of casing terminated atlor below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): _ �% METNOD OF TEST_
L DISINFECTION: Type,_ /V/A Amount AAA M
: g. p AR ZONES (depth_ ): _� AN
y
To Bottom Tap ottom
Top r Bottom _ Top _ Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top__QL Bottom Ft. Sol
� 1�
OTHER ASSOCIATED PERMIT#(if applicable)
Top Bottom FL
Top Bottom FL
SITE WELL ID #Qf applicable)
S. WELL USE (Cheat One Box) Monitoring ❑ Municipal/Public; ❑
M_atengl Method
8. GROUT: Depth /�,-
&A
Bottom 14r FL W
industrialfCommerdal ❑ Agricultural [I Recovery ❑ injection Q�`
: Top.•
Inigafionl3 Other ❑ (list use)
: Top Bottom Ft -
DATE DRILLED_L Z _ Z
; Top Bottom FL
4.WELL
'fLOCATION:
4relfl
:9. SCREEN: Depth Diameter Slot Size Material
: Top17. s Botto-AL Ft.n. • /D in. rx—
( fl�m r'-<
(Street Name, Numbers, Community, SubdMston, Lot No., Parcel, Zip Code)
: Top Bottom Ft. in. lim.
CITY: ! �5y Z d 44 r)c COUNTY
: Top Bottom Ft. in. in.
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley ❑Flat ❑Ridge ❑Other
10.5ANDIGRAVEL PACK:
Depth See AAe 1
LATITUDE " DMS OR 3XJOO000000t DD
r
� Top /S'y__—Batfom.��Ft�_ �
LONGITUDE 75 r " DM5 OR %X.)oOooODOUt DD
: Top Bottom Ft.
Latitude/longitude source: [335PS Cropographic map
Top Bottom FL
(location otwell must be shown on a USGS topo map andattached to
this fort if not using GPS)
' 11. DRILLING LOG
8. FACILITY (Name of the business where the well Is located.)
Top Bottom Formation Description
FacNamlrba ics
ility Name _ Facility ID# (If Opicable)
[uC:) old Le T�"
/
Street Address
/
CityorTown State Zip Code
/
II
F-t i �cllvl6n`f �(l � � f df11V•.t1\`Ya_1
/
/
Contact Name
l f
!
{1
Mailing Address
/
�R(?o i
/
City or Town State Zip Code
RECEIVEMCDEQI
2 REMARKS:
We
a9i _ (�
Area code Phone number
$. WELL DETAILS: N O V 12016
: 100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
; 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
�J
;RECORD EE R�TOTH WEL«OWNER.
a. TOTAL DEPTH: •� IY
--Water Quality Regional: _ � t
b. DOES WELL REPLACE EXISTING WEI��j�16n S@ction :SIGNATURE OF CERTIFIED WELL COIV I RACTOR DATE
c. WATER LEVEL Below Top of Casing: FT
i� j (cQi
(Use °+" ff Above Top of Casing)
: PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Rev. 2109

SA�v
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3S71
1. WELL CONTRACTOR:
m� CTt I�C�
Well Contractor (Individual) Name
A E DRILLING SERVICES, LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
City or Town State Zip Code
8r 64 ) 288-1986
Area code Phone number
2. WELL INFORMATION: XV1447—le
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(f applicable)
SITE WELL ID #(it applicable)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public❑
Industrial/Commercial ❑ Agricultural II Recovery ❑ Injection B---
Irrigation❑ Other ❑ (list use)
DATE DRILLED jhZB%Z
4. WELL LOCATION:
C{L¢N17-MkS
(Street Name, Numbers, Community, Subdlvislon, Lot No., Parcel, Zip Code) n
CITY: I� - (lc 1 k� COUNTY
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope []Valley ❑Flat ❑Ridge ❑Other
LATITUDE 36 �' " DMS OR 3X.XXXXXXXXX DD
LONGITUDE 75 " DMS OR 7X.XXXXXXXXX DID
d. TOP OF CASING IS 3' _ 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): JU0METHOD OF TEST 101.4
f. DISINFECTION: Type N/2 Amount
g. WATER ZONES (depth): y �}
Top A)IA Bottom WATop 1)j1A Bottom ZL1)
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
:Top Bottom /SS FL
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top d' Bottom Ft. !Ih
Top Bottom Ft.
Top Bottom Ft.
: 9. SCREEN: Depth Diameter Slot Size Material Top /1 Bottom Ft Z in. . 1O in. V a -Al' 7 Q
ee—
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SANDIGRAVEL PACK:
Depth Size %ateri
Top �S•,s• Bottom .jaS Ft._L
Top Bottom Ft.
Latitude/longitude source: D3PS Qfopographic map : Top Bottom Ft.
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS) : 11. DRILLING LOG
5. FACILITY (Name of the business where the well is located.) : Top Bottom Formation Description
Facility Name Facility ID# (if applicable) /
)5�/D NJ &e Ti,, �r1
Str et Address /
.0 I SFSCS l
City or Town T State Zip Code /
A4 4mol' (gnu ronn�a� l /
Contact Name
Mailing Address
,,,t,.� IlC_ 2�s8or
City or Town State Zip Code
ng 21 I-113 56 t�ECEIVEDINCDEQIQ REMARKS:
Area code Phone number
6. WELL DETAILS: NOV V 7 2016 . 1110 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
I'1 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
n) � RECOR S B P�� N �yyy��}000F, TO THE WELL OWNER.
a. TOTAL DEPTH: � r 1J8�
b. DOES WELL REPLACE EXISTING WELL
ra I ❑QjAj�ll Regions
SeCIIO IGNATURE OF CERTIFIED WELL CONTRACTOR DATE
C. WATER LEVEL Below Top of Casing: _ 13:2r FT. r+
(Use "+' if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Rev. 2/09

a W
NON ONRESIDENTML WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 357.1
1. WELL CO T!,RA_O�TOgg��
.4 ;W f6�gi t�
Well Contractor (Individual) Name
A E DRILLING SERVICES, LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
City or Town State Zip Code
(864 ) 288-1986
Area code Phone number
2.WELL INFORMATION: XA-e1y7
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(itapplicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
IndustriaVCommercial ❑ Agricultural ❑ Recovery ❑ Injection Q-**,
Irrigation❑ Other ❑ (list use)
DATE DRILLED
4. WELL LOCATION:
CLMI On 6
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Ne ! 1C COUNTY
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley ❑Flat []Ridge ❑Other
LATITUDE 36 " DMS OR 3X.XXXXXXXXX DD
LONGITUDE 75 " DMS OR 7X.XXXXXXXXX DD
d. TOP OF CASING IS ys FT. Above Land Surface'
"Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): NIA METHOD OF TEST AJAk
f. DISINFECTION: Type /��/i' Amount_
g. WATER ZONES (depth):
Top rJ/i#- Bottom J[ TopeBottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top Bottom /2 Ft. e2r' ���y0 �P)L
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Topes Bottom i0 • Ft. e Tii71►�
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Tap 144s , Bottom Ft. Z, • in. . /V in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SANDIGRAVEL PACK:
Depth a� t+ Size Material /
Top 12S Bottom .�•�+ Ft. Vf --- JG L
Top Bottom Ft.
Latitudellongitude source: E]GPS aopographic map : Top Bottom Ft.
(location of well must be shown on a USGS topo map an ad to
this form if not using GPS) : 11. DRILLING LOG
5. FACILITY (Name of the business where the well is located.) Top
Bottom
u�c�7�GA IGS
l
_
Facility Name Facility ID# (if applicable)
014 �_ 7ne
/
l kb G
l
F' it Address
/
t;Ity or I own , State Zip Code
/
�I�Menf r/1U�fc�nnun �-�i
/
Contact Name
/
2,31 Sf
l
Mailing AddressDINCDEQI�—�
City or Town State Zip Code C
12. REMARKS:
() 2g1- ,�3 56 NOV 17
Area code Phone number
6. WELL DETAILS: \Nater Quality
a. TOTAL DEPTH: �y S t Operations
b. DOES WELL REPLACE EXISTING WELL? /YES ❑ NO a-
c. WATER LEVEL Below Top of Casing:
(Use '+" if Above Top of Casing)
Formation Description
'HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
NCAC 2Ce, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
ORD A BEEN PROVIDED 10 THE_IWLL OWNER.
.NATURE OF CEPT DfL' V�IEL`L CONTRACTOR DATE
PERSON CONSTRUCTING THE WELL
Form GW-1b
Rev. 2109

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
�._ WELL CONTRACTOR CERTIFICATION # 3X7/
1. WELL yO-fVPRACCTmTOR:
i&w AL -
Well Contractor (Individual) Name
A E DRILLING SERVICES, LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
City or Town State Zip Code
$( 64 ) 288-9 986
Area code Phone number-
2. WELL INFORMATION:V-1 47-9
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(it applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection p***
Irrigation[] Other ❑ (list use)
DATE DRILLED
4. WELL LOCATION:
r&m-km;6
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: A,Slyti, isle nC COUNTY
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley ❑Flat ❑Ridge ❑Other
LATITUDE 36 " DMS OR 3X.XXXXXXXXX DID
LONGITUDE 75 " DMS OR 7X.XXXXXXXXX DID
LatitudsAongitude source: BPS pfopographic map
{location of well must be shown on a USGS topo map andattached to
this fnmr if not using GPSI
S. FACILITY (Name of the business where the well is located.)
Facility Name r TMC �A Facility ID# (if applicable)
StreerlAddress Cho[
�kkJ;IlC_ _��L M05
City or-forrwn Zip Code
h'�f'tG1 LNiT" t-7lv;ytrj</ticn'1� i
Contact Name
:�31 S-1-
Mailing Address `l
u.�« 1�C. 78S(5I
City or Town State Zip Code
)-gi- 3355 RE�E,VEDN
Ph b
d. TOP OF CASING IS 3 FT. Above Land Surface*
"Top of casing terminated atlor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): A)/A- METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZPNES (depth): pry
Top--AIMBottom/!I Top NIA Bottom_
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight /Material
Tope BottomlyS► Ft. Zrt •y0 V L
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Topes Bottom i 2•S' Ft. _yvyc t ,
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter
�
Top /'rwl "r
Bottom Ft. 2" in.
Top Bottom Ft. in.
Top Bottom Ft. in.
10. SAND/GRAVEL PACK:
Depth Size
TopJ,SBottom �'� ' Ft..
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
/
/
/
/
Slot Size Material
to in. in. &J,-rtQL2:,
in.
in. - - -
Formation Description
Area code one num er
`' REBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
6. WELL DETAILS: A�1 NO V 1 �' NCAC 2C, WELL CONSTRJCTION STANDARDS, AND THAT A COPY OF THIS om
RECORDk PROVICED T THE WELL OWNER.
a. TOTAL DEPTH: t
b. DOES WELL REPLACE EXISTING WELL? YES ❑ ualit�l Z
� e-att�11 CE TIFIE EL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: —ig.s FT' G
(Use "+" if Above Top of Casing) :PRINTED NAME .7
OF PERSON CONSTR C G THE WELL
Form GW-1b
Rev- 2/09

NONl►ESIDENTL4L WELL CONSTRUCTION RECORD
4 ' North Carolina Department of Environment and Natural Resources- Division of Water Quality
X WELL CONTRACTOR CERTIFICATION #
a........ S,
1, W41. C;ONTt36CC1Og:
h,01 Z7.ztalte
Well Contractor (Individual) Name
A E DRILLING SERVICES, LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
City or Town State Zip Code
8( 64 ) 288-1986
Area code Phone number '/ Q
2. WELL INFORMATION: 3iI'-17 7r /
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(If applicable)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection W.-
Irrigation❑ Other ❑ (list use)
DATE DRILLED R- ZD I2
4. WELL LOCATION:
Cif em-}-rollicc
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: 3 �Onal10C, COUNTY
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope []Valley ❑ Flat ❑ Ridge ❑ Other
LATITUDE 36 " DMS OR 3X.XXXXXXXXX DD
LONGITUDE 75 " DMS OR 7X.XXXXXXXXX DD
d. TOP OF CASING IS --.7' 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 VIA
f. DISINFECTION: Type 1J/A Amount
g. WATER ZONES (depth):
: Top, N!A Bottom r/L4 - Top A%%%F Bottom�li�
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
: Top A�Bottom` _Ft. Z� QO pJc-
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material
Method
Top O, Bottom.•
Top Bottom Ft.
Top Bottom Ft.
• 9. SCREEN: Depth Diameter Slot Size Material (�y
Top Z�LBottom O` Ft._+, in. .10 in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top 19' Bottom­WL Ft. �
Top Bottom Ft.
Latitude/longitude source: []GPS Qfopographic map : Top Bottom Ft.
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
11. DRILLING LOG
& FACILITY (Name of the business where the well is located.)
Top Bottom
Facility Name _
Facility ID# (if applicable)
/
Street Address
a9W,5
/
City or Town
State Zip Code
/
A 4ro1 m4
Contact Name
/
Mail' g Address
/
svilC (
/
State Zip Code KS:
EMAF
City or Town
Area code Phone number
V
Materj
IMA
Formation Description
S. WELL DETAILS: + f: 100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
A, 1 15A N AC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
a. TOTAL DEPTH: W.HAS BEQEN PROVIDED TO T 1E WELL OWNER.
b. DOES WELL REPLACE EXISTING WELL? YES f005
SSOGNATURE OF RTIFIED CONTRACTOR ' DATE
1Z
c. WATER LEVEL Below Top of Casing
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Rev. 2109

rl `
NONRESMENTUL WELL CONS! �UCTIIQ�N RECORD
ri It DiDlm 1 eaumert of Ewmnrnent and Natural Resources- avisum of W.ua Quably
R�
'VVEIL CO ORCERTMCATION#
1. WELL CONTRACTOR
Well Contractor (Irr midu4 Name
A E DRILLING SERVICES, LLC
Well Contrador Company Name
TWO UNITED WAY
Sb'eei Address
GREENVILLE SC 2960T
City or Town State Zip Code
8r 64 288-1986
Area code Phone number
2. WELL INFORMATION: %P' 141— 10
WELL CONSTRUCTION PERMIT)
OTHER ASSOCIATED PERMfT;W applicable)
SITE WELL ID 1(d applicable)
3 WELL USE (Check One Box) Monitoring 0 Municipal/Public Q
brdustriallCommercial ❑ Agricultural ❑ Recovery 0 Injection 20 '
: d. TOP OF CASING IS �� FT. Above Land Surface
'Top of casing terminated atfor below land surface may require
a variance in accordance with 15A NCAC 2C .o118.
e. YIELD (gpm). ,WA INETHOD OF TEST- +'
f. DISINFECTION: Type, L � Mwart�
g. WATER ZONES (depth):
top��_Botiom_ /V�/i' Top IL l�, Boftom��/�
Top Bottom Top Baum
Top Botlo Top Bottom
Thlctmess►
7. CASING: Depth Diameter Weight Material
Top Or Bottom ;4 L Ft
Top Bottom Ft
Top Bottom Ft
8. GROUT: Depth Material Method
:Top D` Bottom_ f 6 ' Ft
Inigationp Other p (list use) : Top Bottom Ft
DATE DRILLED i L =.J - )'2, : Top Bof rr Ft
4. WELL LOCATION: : 8. SCREEN: Depth Diameter Slot Size Material
�em-7MICS :Top 20' Bottom FtV' in. •!0 in.
(Strec Name. Numbers, Community, Subdivision, Lot No., Pareet, Zip code) :Tap Bottom Ft In. in
crm- kev; le- * ()IC COUNTY : Top Bottom Ft iq. In.
TOPOGRAPHIC I LAtdD SETTING: (check appropriate bo.)
oSlope ❑Valley OFlat pRidge []Other10. SANDIGRAVEL PACK
Depth rkd
LATITUDE 36 " DMS OR 3x.X)000O000t: DD ; Top
r - Q ` Bottom _yLr R Sim s
_--
LONGITUDE 75 " OMS OR 7x.XXXKXK XX DO ;Top Batlom Ft
I atib deAongitude source: [33PS Oropographic map : Top Bottom Ft
(locatfon of well mast be shown on & USGS [typo map andatlached to
this form if not rising GPS) : 11. DRILLING LOG
5 FACILITY! (Name of the business where the web is located.) : Top Bottom Formation Description
Facility Name Facility ID# (if applicable) /
_ I z( i"�d i_ct_TrPr �cl __ 1
Street Address /
City or Tuw+i State Zip Code /
(+c,mnnk E)Vicon[
Contact Name
�� a f 1C2L 11 Joni
Marling Address /
City or Town State Zip Code �4. REMARKS:
�� -)-9 ) Ai - 33 5 0
Area code Phone number Q`
a. WELL DETAILS: : 100 HEREBY CERTIFY THAT INS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ICA NCAC 2C. WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
a. TOTAL DEPTH: yap �v ` `l 1� 0 QTHE V&LLOWNEFL -Tr`''
b. DOES WELL REPLACE EXISTING WELL? YES []OVNO ` /`
Jr I See : NA RE OF T�I/E¢ NE�CTOR DATE
c. WATER LEVEL Below Top of Casing:
(Use "+' if Above Top of Casing) �jV�OpO` : PRi D NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Rev. 2109

NON n N.SMENTML WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # IS%/
1. WELLI�TO
Weti Contractor (Individual) Name(Individual) Name
A EA E DRILLING SERVICES. LLCSERVICES, LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
City or Town State Zip Code
8( 64 ) 288-1986
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(If appiicable)
SITE WELL ID *(if applicable)
3. WELL USE (Check One Box) Monitoring ❑ MunicipaliPublic ❑
. IndustriaVCommercial ❑ Agricultural ❑ Recovery ❑ injection 01"
Irigation❑ Other ❑ (list use)
DATE DRILLED k-a7--17-
4. WELL LOCATION:
c kz4coN�6
(Street Names, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
Coy-� �� ,1 �Z n� COUNTY
TOPOGRAPHIC I LAND SETTING: (check appropriate box)
❑Slope ❑Valley ❑Flat ❑Ridge ❑Other
LATITUDE 36 " DMS OR 3X.)000OOOOOC DID
LONGITUDE 75 " DMS OR 7)cxnxxxKxx DD
LatitudeAongitude source: OGPS aopographic map
(location of weU must be shown on a USGS topo map endettached to
this fora If not using GPS)
S. FACILITY (Name of the business where the well Is located.)
LI
L./ eA �rOrI_ ;ram
Facility�Na me o I L r Facility 1D# (If applicable)
GLA
Street Address !,AA f,
aety rtyor ovt
State Zip Code
Contact Name
Mailing LAddrass$�
City or Town State Zip Code
( 9A ) a9i - 3,3S-0
Area code Phone number RE�ENEp{NCD��
6. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES
�'''
c. WATER LEVEL Below Top of Casing: \N 9'ry
(Use "+• if Above Top of Casing)
d. TOP OF CASING IS Y' Ff. Above Land Surface -
'Top of casing terminated aVor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (Span): Jl%%/r METHOD OF TEST
f. DISINFECTION: Type IV�/q Amount—l—
g. WATER ZONES (depth):
Tope Bottom /yIA— Top_A2/4sottom_Amd--
Top . Bottom Top Bottom
Top Bottom Top Bottom -
Thickness/
7. CASING: Depth Diameter Weight Material
Top 12 Bottom_ %± . Ft off "_
Top Bottom Ft
Tap Bottom Ft
& GROUT: Depth Material Method
Top" O• Bottom rr, Ft_ Tilr't'C--
Top Bottom Ft.
Top Bottom Ft.
S. SCREEN: Depth Diameter Slot Size Material
Top Bottom _JW Ft. —in. •./b in. 0'14—ktR- VC
Top Bottom Ft. in. in.
Top Bottom Ft, in. in.
10. SANDIGRAVEL PACK:
Depth Size Mate , I
TopBottam�_ Ft. , 'I
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom Formation Description
we �e
/
I
i12. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
m SA WAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD P B I PROVIDED TD jH =WELL OWNER
SIr,NIATWRF OF CERTIFIED WELL CONTRACTOR DATE
PRINTED NAME O PERSON CONSTRUCTING THE WELL
Form GW-1b
Rev. 2109

T NON ONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
1. WELL CONTRACTOR:
WellContractor (Individuaq Name
A E DRILLING SERVICES. LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
City or Town Slate Zip Code
8( 64 ) 288-1986
Area code Phone number
2. WELL iNFORMATTON: rA •i,47- 1"Z
WELL CONSTRUCTION PERMfF#
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(If applicable)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection L'1100
Irrigation❑ Other q (list use)
DATE DRILLED —/
4. WELL LOCATION:
Dam
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: /�h5�1.QVllt �L COUNTY
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley ❑Rat ❑Ridge ❑Other
LATITUDE 36 ' DMS OR 3x.X*0000= DO
LONGITUDE 75 " DMS OR 7X.X)O(&Qg= DD
Latitude/iongitude source: [GPS propographic map
(location of well must be shown on a USGS topo map andaftached to
this form if not using GPM
B. FACILITY (Name of the business where the well is located.)
Facility �,t� � ! ,e P I Facility ID# (if applicable)
Street Address C7
_— (f , , N. G �8o s�' �gGS
City or Town State Zip Code
Contact Name
5-�-
Magi Address mwR
1L
City or Town �EV Zip Code
3s b G N�V 17 2016
Area code Phone number
6. WELL DETAILS: atef QVa,I'ry Sg �Of►a`
a. TOTAL DEPTH: W 9era�wns
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 3'
c. WATER LEVEL Below Top of Casing: _, 13. i �, FT
(Use'+° if Above Top of Casing)
d. TOP OF CASING IS _ I ` FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
:a. YIELD (gpm): METHOD OF TEST AVA
: C DISINFECTION: Type VIA Amount AM
g. WATER ZONES (depth):
: Top_ Bottom Fop Bottom
Top
Bottom
Top
Bottom
Top
Bottom
Top
Bottom
Thickness/
: 7. CASING:
Depth
Diameter
Weight I
Material
Top 61,
Bottom /S�
Ft. 2"
.Sc�i•YD
1' '
Top
Bottom
Ft.
Top
Bottom
Ft.
8. GROUT.
Depth
Material
Method
Top__AL
Bottom _A ^
Ft.
�
� iM i 0—
Top
Bottom
Ft.
Top
Bottom
Ft.
: 9. SCREEN: Depth Diameter Slot Size Material ,p
Top I.i, Bottom_ Ft. J" in. 01V in.
Top Bottom Ft. in. In.
Top Bottom Ft in. in.
10. SAND/GRAVEL PACK:
Depth .y Size MaterialTop� • �Boftom �0 Ft. 40
Top Bottom R.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom Formation Description
/ _!
/
/
12. REMARKS:
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 EE R D HE WF1L OWNER.
SIG A E OF CERTIFIED WELL CONTRACTOR DATE
,�e,/"ire_
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1 b
Rev. 2/09

bl,

NON ONRESIDENTL4L WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3S71
1. WELL CONTRACTOR:
Alm l ms. &'Al E
Well Contractor (Individual) Name
A E DRILLING SERVICES, LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
City or Town State Zip Code
8( 64 l 288-1986
Area code Phone number
2. WELL INFORMATION: I p_ 1 y7.1,3
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(ii applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection T�'
Irrigation❑ Other ❑ (list use)
DATE DRILLED 10• Z3-1 Z
4. WELL LOCATION:
�em (roo, CC
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: JCsalQAii@Aan uG COUNTY
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑Valley ❑ Flat ❑ Ridge []Other
LATITUDE 36 " DMS OR 3X.XXXXXXXXX DD
LONGITUDE 75 " DMS OR 7X.XXXXXXXXX DD
Latitude/longitude source: pGPS Oropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Facility Name n , Facility ID# (if applicable)
1'5�0 nief � ee 77�e
Street Address
1` -sk,' -
City or Town State Zip Code
�I-larnon�t [;��ii'onm.rl,-I-Lt)
Contact Name
3 I a • o� S-{-
Mai ng Address
J?
City or Town State �jp de
(2'a�- ;3� Nov 1 U
Area code Phone number Regkona\
6. WELL DETAILS: ater Qua t� Section
Vd OP s
TOTAL DEPTH: 4Z,
e�at►on
a.
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0,
c. WATER LEVEL Below Top of Casing: 7,3,94 FT.
(Use "+" if Above Top of Casing)
: d. TOP OF CASING IS 3% FT. Above Land Surface`
`Top of casing terminated atior below land surface may require
a variance in accordance with 15A NCAC 2C .011 B.
: e. YIELD (gpm): N« METHOD OF TEST___hyA-
f. DISINFECTION: Type IJ/A Amount —A210 _
: g. WATER ZONES (depth):
dd
: Top Il�%rJ Bottom Top A)%�}%& Bottom -A.
Top Bottom Top Bottom
Top Bottom Tap Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top U Bottom_ Z`. _ Ft.�
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
TopwBottom L2 Ft. Ct _ — _
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Tope Bottom _q Ft. 26 in. .10 in. Qife. Wt'aP pdc-
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SANDIGRAVEL PACK:
Depth Size �M+ateri I
Top ]014r14Bottom__42 Ft.$0 �7QAG�
Top Bottom Ft,
Top Bottom Ft.
11. DRILLING LOG
Top Bottom Formation Description
l &41-1 �f
/
12. REMARKS:
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.
(.6 a inn 14" ��
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
A15A M4411,41174_
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Rev. 2109

NONRESMENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELD CONTRACTOR CERTIFICATION #7/
1. WELL CONTRACTOR:
44ZAft, Al,
Well Contractor (Individual) Name
A E DRILLING SERVICES, LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
City or Town State Zip Cade
8t 64 ) 288-9 986
Area code Phone number
2. WELL INFORMATION: Z/ `fJ" /i
WELL CONSTRUCTION PERMIT#
d. TOP OF CASING IS .I� FT. Above Land Surface`
"Top of casing terminated atlor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
: e. YIELD (gpm): _ /&A IIIET�tOD OF TEST
,r__
f. DISINFECTION: Type �I�- Amount
g. WATER ZONES (depth): �1
Top_ _ Bottom /li//1r Tap ,6662 BoBom. ,W10--
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness(
T. CASING: Depth Diameter Weight Material
: Topes Bottom Ft Zrr
OTHER ASSOCIATED PERMIT#(If applicable) TOP Bottom Ft.
SITE WELL ID #(If applicable) : Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural © Recovery ❑ Injection 3-'
Irrigation❑ Other ❑ (list use)
DATE DRILLED //—ZJ-/ 7 --
4. WELL LOCATION:
Cf1CM4'wi cs
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, 2p Code)
CITY: SL Ci!\/IAr�C lii COUNTY
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley ❑Flat ❑Ridge ❑Other
LATITUDE 36 " DMS OR SX.XXXXXXXXX DD
LONGITUDE 75 " DMS OR 7X.X VJOOO= DD
Latitudetlongitude source: 03PS [ITopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
S. FACILITY (Name of the business where the well is located.)
Cher" �no/1/LS
Facility Name Facility ID# (If applicable)
Street Address �L5
City or Town � State Zip Code
ff
Contact Name) f
Mail! g Address
/ „+IP f)L �8isoI
City ar Town State Zip Code
a�) ')�+ 355o EIVEDINC���wR
Area code Phone number
6. WELL DETAILS: .r " A10`I 7 'Z016
a. TOTAL DEPTH:
eglul J l
b. DOES WELL REPLACE EXISTING r 'GM@Jt�tOn
c. WATER LEVEL Below Top of Casing: OPPOt- FT.
(Use'+° if Above Top of Casing)
8. GROUT: Depth Material lqe d
Top A' Bottom f'*' Ft. f A�
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Z1• Bottom Ft.jin. v 10 In. J W fie,
Top BottorrL Ft. in. in.
Top Bottom Ft. in. in.
10. SANDIGRAVEL PACK:
Depth Sae material
TopBottom—qZ Ft._k_
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom Formation Description
!
!
!
12. REMARKS:
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 16A NCAC 2C. WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS SEEN PROVIDED TO THE WELL OWNER.
{1(1
SIG QT�R�E /�F �C,E�RTIFIED CONTRACTOR DATE
/t+jOLt A:(TArI-C
: PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Rev. 2109

North Carolina Department of Environmental Quality — Division of Water Resources
INJECTION EVENT RECORD (IER)
Permit Number W10100230
Were any wells abandoned during this injection
1. Permit Information event?
❑ Yes ❑X No
Chemtronics, Inc.
Permittee
Chemtronics Superfund Site, B105-139 PTA
Facility Name
180 Old Bee Tree Road, Swannanoa, Buncombe /��
County, NC 28778 RECEIVED/N(
Facility Address (include County)
NOV 17
2. Injection Contractor Information
Water Quality
Geosyntec Consultants of NC, P.C. Operations
Injection Contractor / Company Name
Street Address 255 Roberts Boulevard, Suite 200
Kennesaw GA 30144
City State Zip Code
6( 78) 202-9597
Area code — Phone number
3. Well Information
Number of wells used for injection 12
IP-105-01, -02, -03, -04, -05, 06,
Well IDS -07, -09, -10, -11, -13, -14
Were any new wells installed during this injection
event?
❑ Yes ® No
If yes, please provide the following information:
Number of Monitoring Wells
Number of Injection Wells
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.
If yes, please provide the following information:
Number of Monitoring Wells
Number of Injection Wells
Cl^'�11 .
pease include a copy of the GW-30 for each well
e abandoned.
,nenjectant Information
n A) Newman Zone"; B) Sodium Lactate; Q Neutral Zone*;
D) Sodium Bicarbonate; E) Sodium Sulfite; F) KB-1 ° Plus
Injectant(s) Type (can use separate additional sheets
if necessary
A) 17 g/L; B) 5.3 g/L; Q 13 g/L;
Concentration D) 19 g/L; E) 92 mg/L; F) 0.012 %v/v
If the injectant is diluted please indicate the source
dilution fluid. Potable water (hydrant) and groundwater
extracted from within the test area.
Total Volume Injected (gal) 26,481
Volume Injected per well (gal) 8 to 4,252
(average 2,207)
5. Injection History
Injection date(s) 26-Sept to 19-Oct, 2016
Injection number (e.g. 3 of 5)
4of4
Is this the last injection at this site?
❑ Yes ❑X 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.
t I//,/( Zo t b
SIGNATURE OF INJECTION CONTRACTOR DATE
ff,-* oyl2
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

d,iF ��oQ
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
�= WELL CONTRACTOR CERTIFICATION # 7/
1. WELL CON CTOR:
Well Contractor (Individual) Name
A E DRILLING SERVICES. LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
City or Town State Zip Code
8t 64 ) 288-1986
Area code Phone number
2. WELL INFORMATION: P' WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(If applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection p--
Irrigation❑ Other ❑ (list use)
DATE DRILLED 17
4. WELL LOCATION:
C�IC M 4ron cS
(Street Name. Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY:
COUNTY
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley []Flat ❑Ridge ❑Other
LATITUDE 36 " DMS OR 3X.xxxxxxxxx DO
LONGITUDE 75 " DMS OR 7X.XXXXXXXXX DD
Latitude/longitude source: (BPS OTopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Facil Name Facility ID# (if applicable)
lab Old a ee Trcc
Street Address G1 5
City or Town State Zip Code
Al4-alyionl gnu ronrvtz,��ul
Contact Name I
Mailing Address
d. TOP OF CASING IS -? FT. Above Land Surface'
"Top of casing terminated atlor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): A6/ a METHOD OF TEST/
f. DISINFECTION: Type AMA Amount
g. WATER ZONES (depth): r,1t
Top Bottom �� Top 4/1_ Battom /1%�/1--
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
T. CASING: Depth Diameter Weight Material
:TopTBottom /2 Ft. Z�r 'LA�qv rppV �—
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Topes Bottom S' - Ft. �E�✓lC✓L //iAt+e
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top- /2 Bottom e?7' Ft. Z` in. • ID in. V' 0
Top Bottom Ft. in.
Top Bottom Ft. in.
10. SAND/GRAVEL PACK:
Depth Size
Top /U , Bottom ?4` Ft. t-/
Top Bottom Ft.
Top Bottom Ft,
11. DRILLING LOG
Top Bottom
!
!
!
!
in.
in.
Mraterial�
, n
Formation Description
��roi� -fie
City or Town ���-"5i>1te— Zip Code
12. REMARKS:
NOV 17 2016
Area code Phone number
6. WELL DETAILS: Water QUafty RegiOO HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTEMN ACCORDANCE WITH
a. TOTAL DEPTH: pw t / r OpQ(d�IOnS Sep RECORAC 2C, WELL P CONSTRUCTION Tn00 H� WELL OWNER. D THAT A COPY OF THIS
y J
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Q---CERTIFIED
t1lN— — _
SIGNATU OF CE TI ED WELL CONTRACTOR DATE-
C. WATER LEVEL Below Top of Casing: _ �}• y3 FT. % ' bG �H ! Ire
(Use "+" if Above Top of Casing) PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1 b
Rev. 2/09

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
Randy Phillips
Well Contractor Name
2209-A
NC Well Contractor Certification Number
A.E.Drilling Services
Company Name
2. Well Construction Permit #:
List all applicable well permits (i.e. Coun(y, State, Variance, byection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothemral (Heating/Cooling Supply)
❑Industrial/Commernial
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling.
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Recovery
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other• (exnloin under #21
4. Date Well(s) Completed: 11/27/12 Well ID# IP 105-2
Sa. Well Location.,
Chemtronics
Facility/Owner Name Facility ID# (ifapplicable)
180 Old Bee Tree Rd.Swannanoah 28778
Physical Address, City, and Zip
Buncombe
County
Parcel Identification No- (PEN)
5b. Latitude and Longitude in degreesiminates/seconds or decimal degrees:
(ifwell field, one IaNlong is sufficient)
Q
6. Is (are) the well(s): 2Permanent or ❑Temporary
w
7. Is this a repair to an evsting well: ❑Yes or ElNo
If this is a repair, fill out tatowvi well consinrction information and explain the manure of the
repair under #21 remarkv section or on the back of this fonn.
S. Number of wells constructed: 1
For udtiple ir?jection or non -water supply ivells ONLY with the same construction, you cmr
submit one fmwr.
For Internal Use ONLY:
14. WATER ZONES
FROM
ro
DESCRIPTION
ft.
fr.
tt.
ft.
15. OUTER CASING for
mnitt-cased wells OR
LINER if llcable
FROM
TO
DIAMETER
THICKNESS MATERIAL
13 ft
+3.5 ft-
2 in I
Sch 40 1 PVC.
16, INNER CASING OR TUBING (aeotherinal
closed -log
FROM
TO
DIA IETER
THICKNESS
I MATERIAL
ft.
It.
ia.
ft.
ft.
in.
17.SCREEN
FROM
TO
DIAMETER
I SLOT SIZE
THICKNESS
I NIATERW.
13 tt.
28 ft.
2 is
.010
SCh 40
PVC
ft.
in -.]prepack
19. GROUT
FROM
I TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
11 ft.
9 fL
318 holeplug
pour
9 rt.
0 ft.
neat cement
pump
ft.
ft.
19. SAND/GRAVEL PACK if applicable)
FROM
TO
MATERIAL
EMPLACEMEM1IMEI'HOD
29 f'
11 ft•
#1
pour
ft.
ft
20. DRILLING LOG (attach additional sheets If necessa
FROM
TO
DESCRIPTION color. hardness, soll/rock 13rpe, grain size etc.)
ft.
ft,
ft.
ft.
ft.
ft.
ft.
fr.
fr.
ft.
ft.
ft.
ft.
ft.
2I. REMARKS
22. Certification:
Signature of Certified Well Contractor Date
By signing this form, i hereby certify that the well(s) aws (were) constructed in accordance
with ISANCAC 02C.0100 or 15A NCIC 02C'.0300 Well C•onstrrction .Standards and that a
copy ofthis record has been provided to the oell 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
9. Total well depth below land surface: 28.0 R24a. For All Wells: Submit this form within 30 days of completion of well.
For multiple bells list all depths ifdi,(jerent (exam t construction to the following:
10. Static water level below top of casing: t r 1 7 0 (116 (ft.) Division of Water Resources, Information Processing Unit,
Ifwater 16"1 is above easing, axe + 1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 8 (in ) Quality Reg10nal 24b. For Infection Wells ONLY: In addition to sending the form to the address in
auger Water SCaor, 24a above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction construction to the following:
(i.e. auger, rotary, cable. direct push, etc.)
Division of Water Resources, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Injection Wells:
Also submit one copy of this form within 30 days of completion of
13h. Disinfection type: Amount: 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

d. TOP OF CASING IS 11 FT. Above Land Surface`
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): N/* METHOD OF TEST N114
f. DISINFECTION: Type %� Amount
g. WATER ZONES (depth):
Top A_ Bottom Top_/ Bottom
Top_ _ Bottom_ Top.... . � Bottom__ _
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top .10" Bottom___T_ Ft.J!:-l 1 r; rw:eld
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top �3• Bottom_28' Ft._ in. .10 in. U111e (Jr-alo RUC.
Top Bottom Ft. in. in.
: Top Bottom Ft. in. in.
10. SANDIGRAVEL PACK:
Depth Size Material
Top_1jr Bottom �i I Ft.40
Top W Bottom Zi` Ft..91 .Sane
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
1 MARKS:
RECENEDINCDEQt
` NON ONl1ESIDENTIAL WELL CONSTRUCTION RECORD
° North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # $'S7/
1. WELL CONTRACTOR:
Abel M te
Well Contractor (Individual) Name
A E DRILLING SERVICES. LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
City or Town State Zip Code
8( 64 ) 288-1986
Area code Phone number 2. WELL INFORMATION: & for -
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Monitoring CirMunicipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection B
Irrigation❑ Other ❑ (list use)
DATE DRILLED I1- 2 - 1 Z-
4. WELL LOCATION:
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Swer►t-441%#Q COUNTY
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley ❑ Flat ❑ Ridge ❑ Other
LATITUDE 36 " DMS OR 3X.XXXXXXXXX DD
LONGITUDE 75 " DMS OR 7X.XXXXXXXXX DO
Latitude/longitude source: BPS ❑Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
6. FACILITY (Name of the business where the well is located.)
c,j%&h 'r'n r»Gt
Facility Name Facility ID# (if applicable)
(so Ofcl &,- `T`r td
Straaf AddressI
City or Town State Zip Code
Aim"6f) bD rC1)mah+al
Contact Name,, jr
�-1 I N0., WGf rt _cc +'
Malfng Address
lhe�
City or Town State Zip Code
a�g ) a�i-3350,
Area code Phone number
6. WELL DETAILS: NOV 1 7 cc I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED INACCORDANCE WITH
�•O1 U ; 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
a. TOTAL DEPTH: pZ4 : RECORD HAS BEEN PROVIDED TO TH WELL OWNER.
b. DOES WELL REPLACE EXISTING WELL? WB �ielSB'� Re9�n��t�
�pelrat OnS SeC#0WNATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: _ re` _FT. v/ /rxG6--'";
(Use "+" if Above Top of Casing) PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Formation Description
Sa
Form GW-lb
Rev. 2/09

_ NONRESIDENI'IAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
} *^_ WELL CONTRACTOR CERTIFICATION #
1. WELL CONTRACTOR:
Well Contractor (Individual) Name
A E DRILLING SERVICES, LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
City or Town State Zip Code
8( 64 ) 288-1986
Area code Phone number
2. WELL INFORMATION: :rP- ias-R 'i
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(If applicable)
SITE WELL ID *(if applicable)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection B"
Irrigation❑ Other ❑ (list use)
DATE DRILLED 11— M- t?:!—
4. WELL LOCATION:
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: <n kbMnoCi fy— COUNTY
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley ❑Fiat []Ridge []Other
LATITUDE 36 " DMS OR 3X.XXXXXXXXX DO
LONGITUDE 75 " DMS OR 7X.XXXXXXXXX DD
Latitude/longitude source: (BPS Oropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
0mod.,64KRC
Facility Name Facility ID# (if applicable)
,d
C ♦ ArilirMRR
ltu;IT . &x. agByS
City or - own State Zip Code
/—r4aAwh+ Eov,copfYrA, I
Contact NameJ� 1
1;31 /VG�L4itoLX] S f,
Mail' g Address
i"eu+l 1P
City or Town State Zip Code
d. TOP OF CASING IS .3 % FT. Above Land Surface'
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118,
e. YIELD (gpm): %y10- METHOD OF TEST WA
f. DISINFECTION: Type ,d1N Amount A VA
g. WATER ZONES (depth):
Tope Bottom �V/ Top A-V06 Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter c Weight Material
Tope Bottom 1 " Ft. V • iy Fia
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material LL Method
Top O' Bottom
_J:_ Ft.950le"P.-L ri
Top Bottom Ft.
Top Bottom Ft.
: 9. SCREEN: Depth Diameter Slat Size Material
Topes_ Bottom ZS' Ft. in. . f0 in. W i Lr,.
Top Bottom Ftin. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom_ Zf_ Ft._L
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
/
/
/
/
/
12. REMARKS:
Material
J1 r3A
Formation Description
17�
Area code Phone number �E.�►E�VEDINCDEQIp
6. WELL DETAILS: : 100 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.
a. TOTAL DEPTH: ZS NOV 17 2016 ` _
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO �
QUcllthi�eg�on: IGNATUTURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing. W/ t �� sectlon
e: AC. / /' lt(lkI l`f
(Use "+" if Above Top of Casing) CV1 : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1 b
Rev. 2/09

NONRESIDENTIAL WELL CONSTRUCTION RECORD
` North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 36-V
1. WELL CONTRACT0 . G
Well Contractor (Individual) Name
A E DRILLING SERVICES, LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
City or Town State Zip Code
8( 64 ) 288-1986
Area code Phone number [} ,r
2. WELL INFORMATION: �/- to
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection 9/
Irrigation❑ Other ❑ (list use)
DATE DRILLED ��`,le �L
4. WELL LOCATION:
15e in�t`on� ffi
(Street Name, Numbers, Community, Subdivision, Lot No., Pareet, Zip Code)
CITY: r)C COUNTY
TOPOGRAPHIC 1 LAND SETTING: (check appropriate box)
❑Slope ❑Valley ❑Flat ❑Ridge ❑Other
LATITUDE 36 " DMS OR 3X.XXXXXXXXX DD
LONGITUDE 75 " DMS OR 7X.XXXXXXXXX DD
Latitude/longitude source: BPS Dropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
6. FACILITY (Name of the business where the well is located.)
Facility Name Facility ID# (if applicable)
Iry DidCc Ir�r
Street Addroaa �, C AtjyI i J Le , oZb gCJ�
City//t�or Town State Zip Code
/-t +&QA,,. - Gt1V i1`UYYielti� i
Contact Name
231 CIA S
Mail i g Address
City or Town State Zip Code
Area code Phone number �E�EIVEDINCDEQIC
6. WELL DETAILS: q
a. TOTAL DEPTH: / ' NOV 17 2A
b. DOES WELL REPLACE EXISTING WELL? YES ❑ ,NO d ov
c. WATER LEVEL Below Top of Casing: � ``
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS I FT. Above Land Surface"
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): *14 METHOD OF TEST tV rI
f. DISINFECTION: Type WI AmountA11A.—
g. WATER ZONES (depth):
Top A11A Bottom_AV Top Bottom Aw
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight 1JMaterial
Top 0' Bottom, lT Ft. 2_ 5.1t-%) 00C--
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top— D! Bottom 9 `--.- Ft. CG�1 �;iWie
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material �/Yy
Top /3 Bottom Ft.42 " in. ;!�L- in. L AL
Top Bottom Ft in
Top Bottom FL in
10. SAND/GRAVEL PACK:
Depth wSize
Top /1 ' Bottom ZS Ft._ y7 %
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
12. REMARKS:
in.
in.
Material
Foorrmationl Descdp5on
c �Gtl�/Y)fr�
I DO H2REBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF TH,S
PD non uec nPZN DD VlnFn Tn THE NIFLL OWNER.
CERTIFIED WI
z
DATE
NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Rev. 2/09

NONRESIDENTL4L WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # A-71
1. WELL C NT CTOR:
Well Contractor (Individual) Name
A E DRILLING SERVICES, LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
Clty or Town State Zip Code
8( 64 ) 288-1986
Area code Phone number 2. WELL INFORMATION: 2:�n 1,0'r— 6
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(d applicable)
SITE WELL ID #(it applicable)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection 9-�
Irrigation❑ Other C (list use)
DATE DRILLED 4%&-Z7-
4. WELL
� LOCATION:
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: S, f'jY)GU�_ nC COUNTY
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
[]Slope ❑Valley []Flat ❑Ridge ❑Other
LATITUDE 36 " DMS OR 3X.XXXXXXXXX DID
LONGITUDE 75 " DMS OR 7X.XXXXXXXXX DD
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. A
e. YIELD (gpm): �� METHOD OF TEST 411i-'
L DISINFECTION: Type._ Amount All
g. WATER ZONES (depth): L
: Top41A_ BottomTop&Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top___L_ Bottom /l Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top O' Bottom y� Ft._ — �� n P
al
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth r Diameter
Top / � Bottom4� FL_jg!Ljn.
Top Bottom Ft. in.
Top Bottom Ft. in.
10. SAND/GRAVEL PACK:
Depth Size
Top %�, Bottom d� ' Ft. #L_
Top Bottom Ft.
Latitude/longitude source: ❑GPS []Topographic map : Top Bottom Ft.
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
: 11. DRILLING LOG
6. FACILITY (Name of the business where the well is located.)
Top Bottom
Oem 1�-onicS
Facility Name Facility ID# (if applicable)
& 0
/
/
1�o C'Id Tree J
street ?+dress
/
Cmy— ,, I State Zip Code
/
`, {
t tI TrtfY10/14 C I rG f�ltiit fl %Ll!
/
Contact Na e
/
IQ3 { M is .c_C cd —%.
/
Mailing Add t� C aS��O i
f-1S eg, II( ` I
/
City or Town State Zip
12. REMARKS:
��� 335EN EDINCDE�WR:
Area code Phone number
6. WELL DETAILS: NOV 17 20 1U
l
a. TOTAL DEPTH: (n�`t �onak
b. DOES WELL REPLACE EXISTING 11"0 asf lOf1
c. WATER LEVEL Below Top of Casing: 0 Str FT.
(Use "+" if Above Top of Casing)
slot sizeM�aterial
*1/0 in.AMC
in.
in.
Material ,
Formation Description
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 B lyPRO E TO E_WELL OWNER.
/00117
SIGNATURE OFC E�IE FD W L CONTRACT DATE
PR 'tD RMAE OF PER3°ON CONSTRUCTING THE WELL
Form GW-1 b
Rev. 2/09

a �sraTi,o-
NONRESIDENTIAL WELL CONSTRICTION RECORD
_ North Carolina Department of) nvironment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3S7I
1. WELL CONTRACTOR:
Well Contractor (Individual) Name
A E DRILLING SERVICES, LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
City or Town State Zip Code
8( 64 ) 288-1986
Area code Phone number
2. WELL INFORMATION:Zp fats'-7
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Ind ustrial/Commercial ❑ Agricultural ❑ Recovery El Injection Er-'
Irrigation❑ Other ❑ (list use)
DATE DRILLED 11-fV-/7-
4. WELL LOCATION.,
( llem4ron, L3 _
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Si^ ��C nr5<� �L COUNTY
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley ❑Fiat ❑Ridge ❑Other
LATITUDE 36 " DMS OR 3X.XXXXXXXXX DID
LONGITUDE 75 " DMS OR 7X.XXXXXXXXX DD
Latitude/longitude source: 03PS ❑Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
S. FACILITY (Name of the business where the well is located.)
d. TOP OF CASING IS 3" FT. Above Land Surface'
"Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .011 B.
e. YIELD (gpm): — A%IA - METHOD OF TEST AX
f. DISINFECTION: Type_ Amount AMI
g. WATER ZONES (depth):
Top�1 Bottom Topes_ Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
:Top Bottom_JX� Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Metho
Top D� Bottom 9� Ft.AftnE T MJ
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top i.I` Bottom UPS Ft.Zoin. • 110 in. Ili
Top Bottom Ft. in.
Top Bottom Ft. in.
10. SAND/GRAVEL PACK:
Depth Size
Top_ /1' Bottom Zgr Ft. _
Top Bottom Ft.
: Top Bottom Ft.
11. DRILLING LOG
Top Bottom
4irJC/n 7r:%Yl / �Jrf
/
Facility Name
J 8 0
Facility 1D# (if applicable)
/
Street Address
�4�e
r�%
'tar-
�g�OJ
/
City or Tow+
City
State Zip Code
/
A 1 6iy)cf4
D)y �rcPPPeN4e-,
I
/
Contact Name
�3+ Nrnt_I�L�,-«6 s+.
/
/
MailiAddress
/
ASht ti" I ie
nc
City or Town
12. REMARKS:
UNictVIMR'
NEB
Area code Phone number NOV
6. WELL DETAILS: I'I ",,,
a. TOTAL DEPTH: 011, ter Quality r';;rVIuT)';
b. DOES WELL REPLACE EXISTING WEb}J% 514 t
C. WATER LEVEL Below Top of Casing: _ /D,Q5 _FT.
(Use °+" if Above Top of Casing)
in.
in.
Mate
,5 Ae�
Formation Description
-SA Ord; -k-
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 BE PROM D Tq�HE WELL OWNER.
a�v Wiz..
SIG AT RE OF CE/ T7 FIED WELL CONTRA TOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit within30 days ocamp[etlon to Division of 1�Jateir o Rev. 2ros
1617 Mail Service CellterR lei NC 27ti99 161, Phone : (919) 807�SgP o

NONRESIDENTIAL WELL CONSTRUCTION RECORD
= North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 1C71
1. WELL CONTRACTOR:
Aloe! tn1�G4t rt
Well Contractor (Individual) Name
A E DRILLING SERVICES, LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
City or Town State Zip Code
8�288-1986
Area code Phone number
2. WELL INFORMATION: -"&P- IM- 9
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection [Ft-
Irrigation❑ Other ❑ (list use)
DATE DRILLED
4. WELL LOCATION:
�her>•�-�an � cs
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: S�tyw'f\e'a COUNTY
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley ❑Flat ❑Ridge ❑Other
LATITUDE 36 " DIMS OR 3X.XXXXXXXXX DO
LONGITUDE 75 " DMS OR 7X.XXXXXXXXX DD
Latitudefiongitude source: ❑SPS ❑ropographic map
(location of well must be shown on a USGS topo map endettached to
this form if not using GPS)
S. FACILITY (Name of the business where the well is located.)
d. TOP OF CASING IS S' FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): A11A METHOD OF TEST
t DISINFECTION: TypeJVIA Amount
g. ATER ZONES (depth):
Top W_A04_ Bottom *IA Top " Bottom /VIi4
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top esBottom'_Ft. _2" Sih•YO —Poo—
: Top Bottom Ft.
Top Bottom Ft.
LlfAM LI, i G1;
Fad Uty0amQe I�C �l r��
I
le)
Facility ID# (if applicable}
Street Address
",di t It' AA C.
O
Ci or Town
State rip Code
_ �
Contact Name
,3 i �ct�wnr,ri S�
Mailing Address
Cg�l
W�
City or Town
1� E
[`
335O
NOV 17 Za16
Area code Phone number
6. WELL DETAILS:
Water Quality Regional;
a. TOTAL DEPTH:�f
Operation s Section
WELL
b. DOES WELL REPLACE EXISTING YES ❑ NO [3-
c. WATER LEVEL Below Top of Casing: 7 3 FT.
(Use "+' if Above Top of
Casing)
8. GROUT: Depth �Ma"t'eriria"l Metho
Topes Bottom V FL Cr,nutf` .-; i
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter
Top t r Bottom 28' Ft.. V in.
Top Bottom Ft. in.
Top Bottom Ft. in.
Slot Size Material
. j
o in. U LAfe- Sc -een e l
in.
in.
10. SAND/GRAVEL PACK:
Depth Size Meter' I
Top114 _Bottom i'} � . Ft..'01 .sG A
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom Formation Description
I
/
/
12. REMARKS:
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECOBEEN PROVIDED T THE WELL OWNER.
,I D fYl A-Al-/Z-
SIGNATURE OF CERTIFIED WELL I NTRACTOR DATE
4.
met I . LM, G-4 1 _.
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1 b
Rev. 2109

a�`sr"tEo.
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
*.. WELL CONTRACTOR CERTIFICATION # Jf7l
1. WELL Cljf,�TRFjCTO;,G
Well Contractor (Individual) Name
A E DRILLING SERVICES LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
City or Town State Zip Code
8( 64 288-1986
Area code Phone number n
2. WELL INFORMATION: 1�'' 7—)— 10d li�;?
WELL CONSTRUCTION PERMIT#
d. TOP OF CASING IS 2- FT. Above Land Surface"
'Top of casing terminated aUor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): A METHOD OF TEST
: f. DISINFECTION: Type`_ Amount /Y
g. pWAT�,F$ ON0 (depth); �„ ,�y y `
TO �� Bottom �✓/%f Top Bottom_ /✓�/%
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter cWeight Material
Top 6" Bottom /LFt.
OTHER ASSOCIATED PERMIT#(it applicable) :Top Bottom Ft.
SITE WELL ID #(N applicable) Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
IndustriallCommercial ❑ Agricultural ❑ Recovery ❑ Injection
IrrigationC Other D (list use)
DATE DRILLED
4. WELL LOCATION:
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: S(�2/1(,��� rC COUNTY
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope []Valley ❑Flat ❑Ridge ❑Other
LATITUDE 36 " DMS OR 3X.XXXXXXXXX DID
LONGITUDE 75 " DMS OR 7X.XXXXXXXXX DID
Latitudellongitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
8. GROUT: Depth Material Meth
Top D' Bottom 9` Ft. 6?,-Ae4
Top Bottom Ft.
Top Bottom FL
9. SCREEN: Depth Diameter Slot Size Material Top /f Bottom A&S' Ft. Z° in. •10 in. (%" 'ram Px—
Top Bottom Ft. in.
Top Bottom Ft. in.
10. SANDIGRAVEL PACK:
Depth Size
Top f( Bottom 21 Ft. _
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
Facility Name
�G F(d'e
Tie
Facility ID# (if applicable)
12d
/
l
Street Address
J66hev.11�
/
City or Town
State Zip Code
/
AITLLMm+
Env; runNyi,+I
/
Contact Name
/
Me ing Addres
psheu I I e
nC
1-;8kd (
/
/
City or Town
REMARKS:
6ECC1StEteuIA'�m1
C lit LV j I J V V:f t2
Area code Phone number
, n An
in.
in.
MaterialQ
S nab
Formation Description
I
6. WELL DETAILS: N U V 1 1 L U IQ ; 100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
i 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
�} RECORD HAS BEEN PROVIDE TO TF WSLL OWNER.
a. TOTAL DEPTH: Or thlater Quality CCK��ey+onai
b. DOES WELL REPLACE EXISTING WEL0P6E3*�i�A0*( `1U^ :SIGN R ERTIFIED WELt CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: s`� FT.
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Rev. 2/09

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3S71
1. WELL CONTRACTOR:
Ad mli&�;
Well Contractor (Individual) Nime
A E DRILLING SERVICES, LLC
Well Contractor Company Name
TWO UNITED WA
Street Address
GREENVILLE SC 29607
City or Town State Zip Code
8( 64 ) 288-1986
Area code Phone number
2. WELL INFORMATION: Zp—i05 —11
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(•if applicable)
SITE WELL ID #(If applicable)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection 2--
Irrigation❑ Other ❑ (list use)
DATE DRILLED
4. WELL LOCATION:
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Stk-n4y\ZILo t AC COUNTY
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley ❑Flat ❑Ridge ❑Other
LATITUDE 36 " DMS OR 3X.XXXXXXXXX DO
LONGITUDE 75 " DMS OR 7X_XXXXXXXXX DID
Latitude/longitude source: 03PS ❑Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
�-i�BM?f on jcS
Facility Name p _ Facility ID# (if applicable)
iCfC
Street Address
- (�shet)►l le r G � Y� G5
L.iry or Town State Zip Code
A 4amcn�- En tr;mnmen+af
Contact Na� e
�3 h lay L'bcd �+
MaM Addre
Ulf
re QC -12�11U)J
City or Town
u as 1 335� NOV 17 2016
Area code Phone number
6_ WELL DETAILS:
a. TOTAL DEPTH: �� t Water Quality Regional
verations Section
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: i 1 �r SS _FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS I� FT. Above Land Surface"
'Top of casing terminated atior below land surface may require
a variance in accordance with 15A NCAC 2C .0118,
e. YIELD (gpm): 60t METHOD OF TEST A
f. DISINFECTION: Type 41'/,O�- Amount AIIA
g. WATER ZONES (depth):
Tap i1J %" Bottom Top Bottom A1
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
:Top /I ' Bottom , Ft. 2 r� �GC < <�!) uc
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Topes Bottom_ Ft. rihl
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Topes_ Bottom Ti0' Ft. Z r' in. ./O in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top !1 Bottom 29 f Ft._
Top Bottom Ft,
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
12. REMARKS:
Material
S n
Formation Description
i
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED INACCORDANCE WITH
15A NCAC 2C, WELL OCNSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BE PR VJDETOJJ-I.,�. WELL OWNER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
17De0�I �Gu;
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GVU-Ib
Rev. 2/09

NONRESIDENTIAL WELL CONSTRUCTION RECORD
{ • North Carolina Department of Environment and Natural Resources- Division of Water Quality
` WELL CONTRACTOR CERTIFICATION # $S'7
1. WELL CONTRACTOR:
Well Contractor (Individual) Name
A E DRILLING SERVICES, LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
City or Town State Zip Code
8f 64---,) 288-1986
Area code Phone number
2. WELL INFORMATION: SP — jQs--{I
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(Ir applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection Q--"
Irrigation❑ Other ❑ (list use)
DATE DRILLED i I-13 — I Z
4. WELL LOCATION:
CFICI 4obr�i 6
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: SVCq)M4YyA AC COUNTY
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
[]Slope (:]Valley pFlat ❑Ridge ❑Other
LATITUDE 36 " DMS OR 3X.XXXXXXXXX DD
LONGITUDE 75 " DMS OR 7X.XXXXXXXXX DD
Latitude/longitude source: EISPS (]Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
6. FACILITY (Name of the business where the wellislocated.)
C4�e.M �r on i Cs
Facili Name Facility iD# if applicable)
,Z+— # AAA. ---
If- , n .C. a �Sa,S
%.uy Ui kUw1I State Zip Code
/11 �CuYtoI1.'� Cnu'Irtsnrl�n+ci
Contact Name
-23I �A(-nod S4
Mailing Address
xb roc a� I
f
City or Town
Area code Phone number Nov1 1 'ZO�
6. WELL DETAILS. /�Y
a. TOTAL DEPTH: ter Quality Regional
nos Sectton
b. DOES WELL REPLACE EXISTING WEopef@RII NO 2/
c. WATER LEVEL Below Top of Casing: _ i _g� FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS y' FT. Above Land Surface-
; `Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): N/A METHOD OF TEST AJ A
f. DISINFECTION: Type —WA —Amount Ma
. g. WATER ZONES (depth):
TOP—"— Bottom Ayk Top AJIA Bottom�%�
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top O� Bottom IV Ft. V Ann.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material,] Method
Top Bottom V Ft. !
tcj—
Top_ Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top 1 g � Bottom Zg Ft. ?'% in. , i7 b in. 1,1' LJ r t2. ,5C,f E4/1
t1
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Mated I
TopBottom Zgr FL �L_ , 9tswrl ,
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom Formation Description
/
/
/
/
12. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
t5A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF CERTIFIED YELL CONTRACTOR DATE
All mt&L, m' -
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Rev. 2/09

NONRESIDENTIAL WELL CONSTRUCTION RECORD
t North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
1. WELL CONTRACTOR:
Well Contractor (Individual) Name
A E DRILLING SERVICES, LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
City or Town State Zip Code
8( 64 ) 288-1986
Area code Phone number
2. WELL INFORMATION: X - I or -
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#('d applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection E3'
Irrigation❑ Other (list use)
DATE DRILLED -1 3 - 12
4. WE LOCATION:
Jrn-66 fs
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Cade)
CITY: SG i (r�nctnOQ 66 COUNTY
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑Valley ❑ Flat []Ridge ❑ Other
LATITUDE 36 " DMS OR 3X.XXXXXXXXX DD
LONGITUDE 75 " DMS OR 7X.XXXXXXXXX DD
Latitude/longitude source: OGPS Oropographic map
(location of well must be shown on a USGS topo map andattached to
this form ifnot using GPS)
S. FACILITY (Name of the business where the well is located.)
Facll�y Name Facility ID# (if applica e)
1 �S , D (d ,&'c f fee -
St
r et Aridraec
�hPU
City or Town State Zip Code
/-ritQ(`(>Gor)i Eny'iforiyier)4zt
Contact Name
Mailing Addres
Ashev l�e nC ';$ec'
City or Town State
( 8,► 3 3 5 o kECEIVEDINCDt1R
Area code Phone number S. WELL DETAILS: ` NOV 17 2016
a. TOTAL DEPTH: Z !t r Quality Regional
b. DOES WELL REPLACE EXISTING' &aftWa SeafifM
c. WATER LEVEL Below Top of Casing: _ q F �FT.
(Use "+" if Above Top of Casing)
i
d. TOP OF CASING IS 3 FT. Above Land Surface'
"Top of casing terminated at below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
' e. YIELD (gpm): N/A _ METHOD OF TEST AJIA
f. DISINFECTION: Type NY#- Amount AWBI
g. WATER ZONES (depth):
Top N/JI- Bottom_Nl� Top AU%t Bottom Ids
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Topes Bottom_r13 Ft. 2„i . j� _ P UX,
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method(
Top_Q` Bottom_Ft.� T:try;44
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter
Top t 21 Bottom Ft.2_in
Top Bottom Ft. in
Top Bottom Ft. in
10. SAND/GRAVEL PACK:
Depth Size
Top 1 ij Bottom 2V
Ft. 9"
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
/
/
/
' 12. REMARKS:
Slot Size Material
f--10 in. —J K. 0 rn p
in.
in.
Material
Formation Description
bra i, -�-
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED INACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
//-/k-/Z-
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1 b
Rev. 2/09