WI0501064_Permit (Issuance)_20201120

Mid Atlantic
Engineering & Environmental Solutions
November 16, 2020
Ms. Shristi Shrestha
Hydrogeologist
North Carolina Department of Environmental Quality
Underground Injection Control Program
1636 Mail Service Center
Raleigh, NC 27699-1636
409 Rogers View Court
Raleigh, NC 27610
office 919.250.9918
facsimile 919.250.9950
MAAONLINE.COM
Subject: NOTIFICATION OF INTENT TO CONSTRUCT OR OPERATE INJECTION
WELLS
WILLOW SPRINGS ELEMENTARY SCHOOL
WILLOW SPRINGS, NORTH CAROLINA
UST INCIDENT NO. 39689
MID -ATLANTIC JOB NO. R2647.06
Dear Ms. Shrestha:
On behalf of the Wake County Public School System, Mid -Atlantic Associates, Inc. is
pleased to submit the attached Notification of Intent to Construct or Operate Injection
Wells for the Willow Springs Elementary School. Please note that a 2019 injection was
previously approved for this site under permit number W10501034. If you have any
questions or need additional information, please feel free to contact me at [phone].
Sincerely,
MID -ATLANTIC ASSOCIATES, INC.
Rava S�L�
Raymond S. Marchant, III, P.G.
Principal Geologist
Enclosures: Notice of Intent to Construct or Operate Injection Wells
Attachment A — Injection Zone Maps (Section H)
Attachment B — Safety Data Sheet (Section J)
Attachment C — Well Construction Information (Section K)
R2647.06/RSM/bro
EXPERIENCED CUSTOMER FOCUSED INNOVATIVE

NOTICE OF INTENT TO CONSTRUCT OR
OPERATE INJECTION WELLS
Mid Atlantic
Engineering & Environmental Solutions

North Carolina Department of Environmental Quality — Division of Water Resources
NOTIFICATION OF INTENT (NOI) TO CONSTRUCT OR OPERATE INJECTION WELLS
The following are `permitted by rule" and do not require an individual permit when constructed in accordance
with the rules of ISA NCAC 02C.0200. This form shall be submitted at least 2 WEEKS prior to iniection.
AQUIFER TEST WELLS (15A NCAC 02C .0220)
These wells are used to inject uncontaminated fluid into an aquifer to determine aquifer hydraulic characteristics.
IN SITU REMEDIATION (15A NCAC 02C .02251 or TRACER WELLS (15A NCAC 02C .0229):
1) Passive Injection Systems - In -well delivery systems to diffuse injectants into the subsurface. Examples include
ORC socks, iSOC systems, and other gas infusion methods.
2) Small -Scale Injection Operations —Injection wells located within a land surface area not to exceed 10,000
square feet for the purpose of soil or groundwater remediation or tracer tests. An individual permit shall be required
for test or treatment areas exceeding 10,000 square feet.
3) Pilot Tests - Preliminary studies conducted for the purpose of evaluating the technical feasibility of a
remediation strategy in order to develop a full scale remediation plan for future implementation, and where the
surface area of the injection zone wells are located within an area that does not exceed five percent of the land
surface above the known extent of groundwater contamination. An individual permit shall be required to conduct
more than one pilot test on any separate groundwater contaminant plume.
4) Air Injection Wells - Used to inject ambient air to enhance in -situ treatment of soil or groundwater.
Print Clearly or Type Information. Illegible Submittals Will Be Returned As Incomplete.
DATE: November 16, 2020 PERMIT NO. (to be filled in by DWR)
A. WELL TYPE TO BE CONSTRUCTED OR OPERATED
(1) Air Injection Well......................................Complete sections B through F, K, N
(2) Aquifer Test Well.......................................Complete sections B through F, K, N
(3) Passive Injection System...............................Complete sections B through F, H-N
(4) X Small -Scale Injection Operation ......................Complete sections B through N
(5) Pilot Test.................................................Complete sections B through N
(6) X Tracer Injection Well...................................Complete sections B through N
B. STATUS OF WELL OWNER: Business/Organization
C. WELL OWNER(S) — State name of Business/Agency, and Name and Title of person delegated authority to
sign on behalf of the business or agency:
Company Name Wake County Public School System
Delegated Signatory Authority: Mr. Todd Kneller
Mailing Address: 1551 Rock Quarry Road, Bldg B
City: Raleigh State: NC Zip Code: 27610 County: Wake
Day Tele No.: 919-588-3633 Cell No.: 919-669-9635
EMAIL Address: tkneller(a-)wcpss.net Fax No.: 919-508-0831
Deemed Permitted GW Remediation NOI Rev. 3-1-2016 Page 1

C
E.
F.
G.
PROPERTY OWNER(S) (if different than well owner)
Company Name
Same as Well Owner
Mailing Address:
City:
State: Zip Code:
County:
Day Tele No.:
Cell No.:
EMAIL Address:
Fax No.:
PROJECT CONTACT (Typically Environmental Engineering Firm)
Name and Title:
Raymond S. "Trey" Marchant, III, Principal Geologist
Company Name
Mid -Atlantic Associates, Inc.
Mailing Address:
409 Rogers View Court
City: Raleigh
State: NC Zip Code: 27610
County: Wake
Day Tele No.: (919)
250-9918 Cell No.:
[phone]
EMAIL Address:
[e-mail] Fax No.:
[phone]
PHYSICAL LOCATION OF WELL SITE
(1) Facility Name & Address: Willow Springs Elementary School
6800 Dwijzht Rowland Road
City: Willow Springs County: Wake Zip Code: 27592
(2) Geographic Coordinates: Latitude": 35 ° 35 ' 37 "or. 35.593508 "N
Longitude": -78 ° 43 ' 41 "or -78.7280240 W
Method of Collection: GooLyle Earth Pro Software
"FOR AIR INJECTION AND AQUIFER TEST WELLS ONLY: A FACILITY SITE MAP WITH PROPERTY
BOUNDARIES MAY BE SUBMITTED IN LIEU OF GEOGRAPHIC COORDINATES.
TREATMENT AREA
Note: There has been a release of heating oil from a UST at this site. The site is currently regulated by the North
Carolina Department of Environmental Quality (NCDEQ), Division of Waste Management (DWM),
Underground Storage Tank (UST) Section. Removal of free product is necessary to move the site towards closure
and prevent potential spreading of the plume (water supply wells are located nearby). Heating oil free product
remains present on the water table at wells RW-1, RW-2, and MW-3. As such, the "area of the contaminant
plume" indicated below refers to the approximate area of the heating oil free product plume. This area is roughly
equal to the area of an ellipse with dimensions 45ft by 25ft, or 900 square feet [A=n(a)(b), where (a) and (b) are
half the length of the longest and shortest axes].
Land surface area of contaminant plume: 900 square feet
Land surface area of inj. well network: 900 square feet (< 10,000 ft2 for small-scale injections)
Percent of contaminant plume area to be treated: 100% (must be < 5% of plume for pilot test injections)
Deemed Permitted GW Remediation NOI Rev. 3-1-2016 Page 2

H. INJECTION ZONE MAPS — Attach the following to the notification. Provided in Attachment A. Please
note that DEQ has only required limited assessment at this site. Groundwater isoconcentration maps are not
available (other than the one provided) and soil assessment maps are not available. Contaminated soil likely
remains in the vicinity of the UST (which was closed in place due to the presence of underground utilities over
and around the tank). However, no soil contaminant maps currently exist.
(1) Contaminant plume map(s) with isoconcentration lines that show the horizontal extent of the
contaminant plume in soil and groundwater, existing and proposed monitoring wells, and existing and
proposed injection wells; and
(2) Cross-section(s) to the known or projected depth of contamination that show the horizontal and vertical
extent of the contaminant plume in soil and groundwater, changes in lithology, existing and proposed
monitoring wells, and existing and proposed injection wells.
(3) Potentiometric surface map(s) indicating the rate and direction of groundwater movement, plus existing
and proposed wells.
I. DESCRIPTION OF PROPOSED INJECTION ACTIVITIES — Provide a brief narrative regarding the
purpose, scope, and goals of the proposed injection activity. This should include the rate, volume, and duration
of injection over time.
Residual heating oil free product (approximate thickness of 0.37 ft) remains present on the water table at the site
at well MW-3 and is also present in well RW-1 in a thickness of approximately 0.13 ft). We propose to inject
surfactant prior to performing an Aggressive Fluid Vapor Recovery (AFVR) event. Mid -Atlantic proposes to
inject EnviroClean (EC-165) at the site to enhance free product recovery during the AFVR. Injection will be
performed at wells MW-1, MW-3, RW-1, RW-2, and two additional 4-inch diameter recovery wells (yet to be
installed, designated RW-3 and RW-4). The recovery wells will be installed in locations previously negotiated_
with the UST Section. Injection will then be performed on the wells. EnviroClean (EC-165) is a common
cleanup/mitigation agent that can be applied as both an emulsifying agent for free product recovery and
biosurfactant for dissolved -phase groundwater remediation. It is estimated that up to 250 gallons of 4% solution
of EnviroClean will be gravity injected into the above -referenced wells and borings over an estimated period of
up to 8 hours on -site. An 8-hour AFVR event will then be conducted at the site approximately one to two weeks
following completion of the surfactant injection event, with post-AFVR free product gauging activities
conducted approximately two to four weeks following completion of the AFVR event.
Also, at the request of the UST Section, we propose to gravity inject a tracer dye (Fluorescent Red Dye
Rhodamine WT, Attachment B) into well MW-3 just prior to the AFVR event. The purpose is to evaluate
whether free product is being recovered from well MW-3 from nearby recovery wells RW-3 and RW-4, which
will be placed under AFVR vacuum. Water collected into the vacuum truck's tank will be visually evaluated for
the presence of the dye. Approximately 1 pint of dye will be used, which should produce a visual (red water)
result for up to 3,125 gallons of water. It is expected that less than 3,000 gallons of water will be generated.
J. APPROVED INJECTANTS — Provide a MSDS for each injectant. Attach additional sheets if necessary.
Provided in Attachment B
NOTE: Only injectants approved by the NC Division of Public Health, Department of Health and Human
Services can be injected. Approved injectants can be found online at http://deq.nc.,gov/about/divisions/water-
resources/water-resources-Dermits/wastewater-branch/ground-water-Drotection/ground-water-aDDroved-ini ectants.
All other substances must be reviewed by the DHHS prior to use. Contact the UIC Program for more info (919
807-6496).
Injectant: EnviroClean EC-165
Volume of injectant:
Concentration at point of injection
4%
Percent if in a mixture with other injectants:
Injectant: Cole-Parmer Fluorescent Red Dye Tracer
Volume of injectant:
Deemed Permitted GW Remediation NOI Rev. 3-1-2016 Page 3

Concentration at point of injection: 1 % (result in minimum lam in water) --
Percent if in a mixture with other injectants:
K. WELL CONSTRUCTION DATA GW-ls for existing wells MW-I, MW-3, RW-1, and RW-2 and a
table sun etion points are provided in Attachment C.
Number of injection wells: 2 Proposed 4 Existing (provide OW- 1s)
For Proposed wells or Existing wells not having OW-1s, provide well construction details for each
injection well in a diagram or table format. A single diagram or line in a table can be used for
multiple wells with the same construction details. Well construction details shall include the
following (indicate if construction is proposed or as -built):
(a) Well type as permanent, Geoprobe/DPT, or subsurface distribution infiltration gallery
(b) Depth below land surface of casing, each grout type and depth, screen, and sand pack
(c) Well contractor name and certification number
L. SCHEDULES - Briefly describe the schedule for well construction and injection activities.
borings are scheduled to be installed on Wednesday. December 16-2020. The surfactant
iniection event is currently scheduled for Tuesday. December 22 2020. The tracer d� a injection and the AFVR
is e be clad on Wednesday,acet th t ' 'ection
will take powzjmately 8 hours for completion. The dye injection will take a few minutes and AM is expected
to run for approximately 8 hours. Post-AFVR free product gauging will be conducted approxn�y two to four
weeks following completion of the AFVR event.
M. MONITORING PLAN - Describe below or in separate attachment a monitoring plan to be used to determine
if violations of groundwater quality standards specified inghgh!Uter Q2L result from the injection activity.
The site is oiL=& regghted
by the NCDEQ DWM UST
Seefio. &Mpft
of site monitoring wells not
eonta' t
be =fbrrned once fiegwith
results
reported to the UST Section
(assuming sampling is pre-appmoved
by the UST Section). Please note that
EnviroClean is a proprietary
blend of water based. biodegeadablg
surfactants that
was specifically en ' red as
ck=Mn a
t and vl= su ss t &ja ma
midc min of WmoshmEnviroClean.
in and of itsflf. does not gLuse
or catalyze specific chemical reactions,
nor does it
contain any bWteria cultures.
The basic pdgciple of EnviroClean is to emWgift and encagnilate
hydrocarbon Rggicim.
As such the im ection
mfiyfty is not afigipated
to result in violations of the NCM
fu addit4md mmmu&
odum than those alreaft
noted from the nrevious fuel
oil release. Similarly. the tracer
dve is commonly used
for this_vtt,mm and is not
, ' <<' d to cause violations of i I ie NCGQ
N. SIGNATURE OF APPLICANT AND PROPERTY OWNER
APPLICANT: `7 hereby certify, under penalty of law, thatl am famdliar wide the information submitted in this
document and all attachments thereto and tha4 based on my inquiry of those individuals immediately responsible
for obtaining said information, I believe that the information is true, accurate and complete. I am aware that
there are sdgnifcant penalties, including the possibility of fetes and imprisonmen4 for submitting false
information. I agree to construe; operate, maintain, repair, and if applicable, abandon the injection well and
all related appurtatances in accordance with the 15A NCAC 02C 0200 Rules. "
OW 4,PJL ass
Signature of
-- 100p+o
SO-.1WAVW
Print or Type Fu■ Name +md Title
Deemed Pam Med Gw Remedia w NOI Rev. 3-1-2016 Page 4

PROPERTY OWNER (if the property is not owned by the permit applicant):
"As owner of the property on which the injection well(s) are to be constructed and operated, I hereby consent to
allow the applicant to construct each injection well as outlined in this application and agree that it shall be the
responsibility of the applicant to ensure that the injection well(s) conform to the Well Construction Standards
(1 SA NCAC 02C .0200). "
"Owner" means any person who holds the fee or other property rights in the well being constructed. A well
is real property and its construction on land shall be deemed to vest ownership in the land owner, in the
absence of contrary agreement in writing.
Not applicable
Signature* of Property Owner (if different from applicant) Print or Type Full Name and Title
*An access agreement between the applicant and property owner may be submitted in lieu of a signature on this form.
Submit the completed notification package to:
DWR — UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone: [phone]
Deemed Permitted GW Remediation NOI Rev. 3-1-2016 Page 5

ATTACHMENT A
INJECTION ZONE MAPS
(SECTION H)
Mid Atlantic
Engineering & Environmental Solutions

REFERENCES:
1. ANGIER, NC DIGITAL RASTER GRAPHIC, USGS. SCANNED FROM
1:24,000-SCALE GREEN LEVEL, NC TOPOGRAPHIC MAP, PUBLISHED 2013, USGS.
2. INSET MAP DIGITAL DATA FROM 2002 NATIONAL TRANSPORTATION ATLAS,
BUREAU OF TRANSPORTATION STATISTICS, WASHINGTON, D.C.
3. PROPERTY BOUNDARY DATA FROM WAKE COUNTY GIS.
SCALE: 1:12,000
500 1,000
DRAWN
TOPOGRAPHIC SITE MABY:
P DRAFT
Mid Atlantic WILLOW SPRINGS ELEMENTARY SCHOOL CHECK:
Engineering & Environmental Solutions 6800 DWIGHT ROWLAND ROAD ENG.
WILLOW SPRINGS, NORTH CAROLINA CHECK:^
APPROVAL:
Feet
2,000
DATE:
APRIL 2016
JOB NO:
OOOR2647.0B
GIS NO:
04G-R2647.OB-1
DWG NO: 1

ti
rr
. 4­4
4.
-0
I
(92.8
vv_hK
3.08�
'('Vv N)'
MW-44
(92.93)
4-0
Legend
MONITORING WELL LOCATION
ESTIMATED GROUNDWATER ELEVATION CONTOUR
ESTIMATED GROUNDWATER FLOW DIRECTION
TRIBUTARY TO TERRIBLE CREEK
A&­
Y - "' w"'•.^ r'�:`%'�� 'j r' r1� SUBJECT PROPERTY BOUNDARY
NM=NOT MEASURED
ESTIMATED GROUNDWATER TABLE
t-: WILLELEVATION CONTOUR MAP (3-31-16)
OW SPRINGS ELEMENTARY SCHOOL
Mid Atlantic 6800 DWIGHT ROWLAND ROAD
759 Engineering & Environmental Solutions WILLOW SPRINGS, NORTH CAROLINA
REFERENCE: 2013 AERIAL IMAGERY FROM NC ONE MAPS. PROPERTY BOUNDARY, ROAD, WATER, SEWER, HYDROLOGY GIS FROM WAKE COUNTY GIS. MID -ATLANTIC FIELD NOTES.
Fee-
40 80 120 160
DRAWN BY: DATE: APRIL 2016
DRAFT CHECK JOB NO.: 00OR2647.OB
BY:
ENGINEER CHECK GIS NO.: 04G-R2647.OB-3
BY:
APPROVED
BY: 0�lln DRAWING NO.: 3

r
N
+
r
r . MW-2
$ -1
Proposed RW-3 $MW-1
ir
t
MW-3 '
_ TRW-2
-
Proposed RW-4
MW-4
Legend
PROPOSED RECOVERY WELL
0!� EXISTING RECOVERY WELL
MONITORING WELL LOCATION
5,000-GALLON HEATING OIL UST (CLOSED IN PLACE)
1 inch equals 20 feet
RW-1/RW-2: EXISTING RECOVERY WELLS
0
Feet
20 40
_
INJECTION POINT LOCATION MAP
DRAWN BY: KRC
DATE:
NOVEMBER 2020
DRAFT CHECK
._,
"WILLOW
M*IiId Atlantic
SPRINGS ELEMENTARY SCHOOL
DWIGHT ROWLAND ROAD
BY6800
JOB NO.:
OOOR2647.06
Engineering & Environmental Solutions
WILLOW SPRINGS, NORTH CAROLINA
ENGINEER CHECK
BY:
GIS NO.: 03G-R2647.06-4
APPROVED
BY:
DRAWING NO.: 3.2
REFERENCE: 2013 AERIAL IMAGERY FROM NC ONE MAPS. PROPERTY BOUNDARY, ROAD, WATER, SEWER, HYDROLOGY GIS FROM WAKE COUNTY GIS. MID -ATLANTIC FIELD NOTES.

N
MW 1 f
' a • V
-
,``'BMW `-" - --
=, 9a.=4
Ak
S-S6cT1oN LOCI O N 4
At
t•
Legend
MONITORING WELL LOCATION e3 Yr. r
SUBJECT PROPERTY BOUNDARY
4V#*
,d
Feet e
0 40 80 120 160"
Mid Atlantic
Engineering & Environmental Solutions
MONITORING WELL LOCATION MAP
WILLOW SPRINGS ELEMENTARY SCHOOL
6800 DWIGHT ROWLAND ROAD
WILLOW SPRINGS, NORTH CAROLINA
DRAWN BY: "'r DATE: APRIL 2016
DRAFT CHECK JOB NO.: 000132647.013
BY:
ENGINEER CHECK GIS NO.: 04G-R2647.0B-1
BY: q5
APPROVED BY: fKmDRAWING NO.: 2
11 REFERENCE: 2013 AERIAL IMAGERY FROM NC ONE MAPS. PROPERTY BOUNDARY, ROAD, WATER, SEWER, HYDROLOGY GIS FROM WAKE COUNTY GIS. MID -ATLANTIC FIELD NOTES.

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ATTACHMENT B
SAFETY DATA SHEET
(SECTION J)
Mid Atlantic
Engineering & Environmental Solutions

ENVIRO�CU
SAFETY DATA SHEET
SECTION 1 MATERIAL IDENTIFICATION
PRODUCT NAME / DESCRIPTION: EnviroClean
DISTRIBUTED / MANUFACTURED BY:
ENVIRO CLEAN PRODUCTS & SERVICES DATE: 05/18/2015
PO BOX 721090 PHONE: [phone]
OKLAHOMA CITY, OK 73172 EMERGENCY PHONE: [phone]
FUNCTION: Industrial Cleaner and Remediation Agent
SECTION 2 HAZARD IDENTIFICATION
CLASSIFICATION:
Acute Toxicity- Oral
Category 4
Skin Corrosion/Irritation
Category 3
Eye Damage/Irritation
Category 2B
Target Organ Specific Toxicity: Single
I Category 3
Target Organ Specific Toxicity: Chronic
I Category 2
SIGNAL WORD:
WARNING!
HAZARD STATEMENTS:
Harmful if swallowed
Causes mild skin irritation
Causes eye irritation
May cause respiratory irritation
May cause damage to organs through prolonged or repeated exposure
> <s !Rr"04
PRECAUTIONARY STATEMENTS:
Obtain special instructions before use
Do not handle until all safety precautions have been read and understood
Use personal protective equipment as required
Avoid breathing dust/fume/gas/mist/vapors/spray
Use only outdoors or in a well ventilated area
Wash all exposed skin thoroughly after handling
Avoid release to the environment

ENVIRO�CU
Store in a well ventilated place
TOXICITY INFO:
See Section 11.
SECTION 3 HEALTH HAZARDS
CHEMICAL NAME
(Proprietary Formula)
%WIW CAS NUMBER
Proprietary Blend of Ethoxylated Octylphenolic Surfactants
Non-ionic water based liquid blend, concentrate
This product does not contain any hazardous ingredients as defined by CERCLA and California's Prop. 65.
SECTION 4
Potential acute health effects:
FIRST AID
Eyes: May cause irritation with redness and pain.
Skin: May cause irritation with redness and pain.
Inhalation: Inhalation may cause irritation.
Ingestion: Ingestion may cause severe irritation, corrosion/ulceration, nausea, and vomiting.
Medical Conditions Aggravated by Exposure:
None known.
Eye Contact: In case of contact, immediately flush eyes with cool running water. Lift and
separate eyelids while flushing with plenty of water for at least 15 minutes. Get
medical attention.
Skin Contact: Wash with soap and water. Get medical attention if irritation occurs. Wash
clothing before reuse. Destroy contaminated shoes.
Inhalation: Remove victim to fresh air and keep at rest in a position confortable for breathing.
If not breathing, give artificial respiration. If breathing is difficult, give oxygen.
Seek medical attention if symptoms develop.
Ingestion: Do NOT induce vomiting unless directed to do so by medical personnel. Never
give anything by mouth to an unconscious person. If large quantities of this
material are swallowed, call a physician immediately. Give plenty of water.
SECTION 5 FIRE FIGHTING MEASURES
Fire Hazard Classification (OSHA/NFPA): 0
Extinguishing Media: As required for fire being fought.
Special Fire Fighting Procedures: Use self-contained breathing apparatus.
Hazardous combustion products: No known.

ENVIRO�CU
SECTION 6 ACCIDENTAL RELEASE MEASURES
Personal Precautions, PPE, and Emergency Procedures:
Wear protective clothing as described in Section 8 of this safety data sheet.
Containment Procedures: Stop the flow of material, if this is without risk. Wear appropriate protective
equipment and clothing during clean-up. Do not allow the spilled product to enter
public drainage system or open water courses.
Clean -Up Procedures: Sweep up or gather material and place in appropriate container for disposal.
Wash spill area thoroughly. Wear appropriate protective equipment during
cleanup. Dispose of collected material according to regulations.
SECTION 7 HANDLING AND STORAGE
Handling: Avoid contact with eyes, skin and clothing. Do not take internally. For industrial
use only. Wash after handling. Don't breathe dust, vapor, or gas. Keep this and
all chemicals out of reach of children.
Storage: Keep away from heat, sparks, and open flames. Prevent spills. Keep container
tightly closed and in a cool, well -ventilated place away from incompatible
materials. Empty product containers may contain product residue, do not reuse.
SECTION 8
PERSONAL PROTECTION / EXPOSURE CONTROLS
Ventilation System:
Always keep exposure below permissible exposure limits. In general, dilution
ventilation is a satisfactory health hazard control for this substance. However, if
conditions of use create discomfort to the worker, a local exhaust system should
be considered.
Airborne Exposure Limits: None Established.
Personal Protection:
As prescribed in the OSHA Standard for Personal Protective Equipment (29 CFR
1920.132), employers must perform a Hazard Assessment of all workplaces to
determine the need for, and selection of, proper protective equipment for each
task performed.
Eyes:
Wear face shield, safety glasses, or chemical goggles.
Hands & Skin:
For prolonged or repeated handling, use impervious gloves. Gloves should be
tested to determine suitability for prolonged contact. Use of impervious apron
and boots are recommended.
Respiratory:
If ventilation is not sufficient appropriate NIOSH/MSHA respiratory protection
must be provided.
Work Practices:
Eye wash fountain and emergency showers are recommended.
SECTION 9 TYPICAL PHYSICAL AND CHEMICAL PROPERTIES
Physical Form: Liquid
Color: Red

ENVIRO�CU
Odor:
Wintergreen
Odor Threshold:
NE
pH:
8.5+/-0.5
Boiling Point:
NE
Melting Point:
N/A
Flash Point:
>200 deg F
Evaporation Rate (Butylacetate = 1)
NE
Flammability:
Non -Flammable
UEL:
NE
LEL:
NE
Vapor Pressure:
NE
Vapor Density:
NE
Specific Gravity (Water =1):
1.03 +/- .05
Solubility Water:
Complete
Partition Coefficient:
NE
Auto -ignition Temperature:
NE
Decomposition Temperature:
NE
Viscosity (CPS):
NE
SECTION 10 STABILITY AND REACTIVITY
Stability: This product is stable under normal temperatures and pressures.
Incompatibility: Strong Oxidizers and strong acids.
Decomposition Products: No Known hazardous products.
Conditions to Avoid: Sparks/flames/high heat.
SECTION 11 TOXICOLOGICAL PROPERTIES
Raw Material Test Result Route Species
N/A
See Section 4 for symptoms.
CARCINOGENICITY:
No known carcinogens, mutagens, or reproductively toxic ingredients
SECTION 12 ECOLOGICAL INFORMATION
Raw Material Test Result Time Species
N/A
PERSISTENCE & DEGRADABILITY:
NE

ENVIRO�CU
BIOACCUMULATION:
NE
MOBILITY
NE
SECTION 13 DISPOSAL CONSIDERATIONS
Whatever cannot be saved for recovery or recycling should be managed in an appropriate and approved
waste disposal facility. Processing, use, or contamination of this product may change the waste
management options. State and local disposal regulations may differ from federal disposal regulations.
Dispose container and unused contents in accordance with federal, state, and local requirements.
SECTION 14 TRANSPORT INFORMATION
Not Regulated by DOT or IATA.
SECTION 15 REGULATORY INFORMATION
US FEDERAL REGULATIONS
SARA (SUPERFUND AMENDMENTS AND REAUTHORIZATION ACT):
SARA 302 EXTREMELY HAZARDOUS SUBSTANCES LIST: NA
SARA 312 HAZARD CATEGORY:
SARA 313 TOXIC CHEMICALS LIST:
M
NA
CERCLA (COMPREHENSIVE ENVIRONMENTAL RESPONSE. COMPENSATION AND
LIABILITY ACT): NA
RCRA (RESOURCE CONSERVATION AND RECOVERY ACT) LISTED HAZARDOUS WASTES:
NA
CWA (CLEAN WATER ACT) LISTED SUBSTANCES: NA
FDA (FOOD AND DRUG ADMINISTRATION): NA
TOXIC SUBSTANCES CONTROL ACT (TSCA): NA
IATA: NA

ENVIRO�CLEAN
NFPA HAZARD INFORMATION SIGN
101
4 - DEADLY
3 - EXTREME DANGER
2 - HAZARDOUS
1 - SLIGHTLY HAZARDOUS
0 - NORMAL MATERIAL
[0]
FLASH POINTS:
4
- BELOW 73 F
3
-BELOW 100 F
2
- BELOW 200 F
1
- ABOVE 200 F
0
- WILL NOT BURN
[01 REACTIVITY HAZARD (YELLOW DIAMOND)
4 - MAY DETONATE
3 - SHOCK AND HEAT MAY DETONATE
2 - VIOLENT CHEMICAL CHANGE
1 - UNSTABLE IF HEATED
0 - STABLE
[] SPECIFIC HAZARD (WHITE DIAMOND)
OXY
OXIDIZER
ACID
ACID
ALK
ALKALI
COR
CORROSIVE
W
USE NO WATER
SECTION 16 OTHER INFORMATION
THIS INFORMATION IS OFFERED IN GOOD FAITH AS TYPICAL VALUES AND NOT AS A
PRODUCT SPECIFICATION. NO WARRANTY, EXPRESSED OR IMPLIED, IS HEREBY MADE. THE
RECOMMENDED INDUSTRIAL HYGIENE AND SAFE HANDLING PROCEDURES ARE BELIEVED
TO BE GENERALLY APPLICABLE. HOWEVER, EACH USER SHOULD REVIEW THESE
RECOMMENDATIONS IN THE SPECIFIC CONTEXT OF THE INTENDED USE AND DETERMINE
WHETHER THEY ARE APPROPRIATE.

tole-Parmer
mantific experts
Home I Water Quality Products I Dye Tracers I Cole-Parmer Fluorescent Red Dye Tracers ►E EMAIL US 04 SHARE $ PRINT
4 PRODUCT OPTIONS
item
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IN
STOCK
Il • •
Gallons Of Water For
1 ppm (Gal)
.E
Cole-Parmer Fluorescent Red Dye Tracers
*614:aVe\:7u121G7
Determine water flow in ITEM(S) ON SALE
closed circuits or open $34.87 - $155.70 USD /
channels EACH
• Biodegradable and nontoxic
Dyes diffuse rapidly in water,
producing a vivid, easy -to -see
color. Excellent for identifying
diffusion and dispersion
patterns, rates of flow,
discharge locations, seepage
areas, sea marking, and more.
Fluorescent red dye
(rhodamine WT) is
noncarcinogenic. Ideal in
Reagent Platform Availability Pricing
In Stock
Tablet $51.75 USD / EACH
$57 59 USE)
�Cf'1�1'TI
25000 Liquid concentrate Usually Ships in
9 Days or $133.20 USD / GALLON OF 1
Sooner 0I SE) iGAI LE)HGF1
UX-00298-06
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item Gallons Of Water For Reagent Platform Availability Pricing
1 ppm (Gal)
3125 Liquid concentrate In Stock $34.87 USD / PINT OF 1
Iel $38.75 SE)iPINT�r�
•
UX-00298-16
In Stock
60400 Powder $155.70 USD / EACH
$177 00 USE)
Sr'l�II
UX-00298-26
Cole-Parmer 1 625 East Bunker Ct Vernon Hills, I L 60061 United States
Telephone: [phone] Fax: [phone] Email: [e-mail]
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Issue Date: 01-Jan-2006
Safety Data Sheet
Revision Date: 24-Nov-2014 Version Number: 1
1. Identification
Product Identifiers
Product Name: Red Tracing Dye Liquid
Product Number: 106523
Recommended Use & Restrictions on Use
Water tracing & leak detection dye
Manufacturer/Supplier
Cole Parmer
625 E. Bunker Ct.
Vernon Hills, IL 60061
U.S.A.
Emergency Telephone Number
Company Telephone Number: [phone]
Emergency Telephone (24 hr): INFOTRAC [phone] (North America)
[phone] (International)
2. Hazards Identification
r_InWfiratinn
This chemical does not meet the hazardous criteria set forth by the 2012 OSHA Hazard Communication
Standard (29 CFR 1910.1200). However, this Safety Data Sheet (SDS) contains valuable information critical
to the safe handling and proper use of this product. This SIDS should be retained and available for
employees and other users of this product.
3. Composition/Information on Ingredients
This product is not hazardous according to OSHA 29 CFR 1910.1200. Components not listed are not
hazardous or are below reportable limits.
4. First -Aid Measures
First -Aid Measures
Eye Contact Rinse immediately with plenty of water, also under the eyelids, for at least
15 minutes. If eye irritation persists: Get medical advice/attention.
Skin Contact Wash thoroughly with plenty of soap and water. If skin irritation occurs:
Get medical advice/attention.
Inhalation Remove to fresh air. If breathing is difficult, administer oxygen; seek
medical attention immediately.
Page 1 of 6

Red Tracing Dye Liquid Revision Date: 24-Nov-2014
Ingestion Rinse mouth. DO NOT induce vomiting. Drink plenty of water. Never give
anything by mouth to an unconscious person. Get medical attention if large
quantities were ingested or if nausea occurs.
Most Important Symptoms and Effects
Symptoms Will cause staining of the skin on contact. May cause eye irritation.
Inhalation of dust may cause respiratory irritation. Ingestion may cause
urine to be a red color until the dye has been washed through the system.
Indication of Any Immediate Medical Attention and Special Treatment Needed
Notes to Physician Treat symptomatically.
5. Fire -Fighting Measures
Suitable Extinguishing Media
Water spray (fog). Carbon dioxide (CO2). Dry chemical.
Unsuitable Extinguishing Media
Not determined
Specific Hazards Arising from the Chemical
Product is not flammable. Burning/combustion may produce oxides of carbon and nitrogen (NOx).
Protective Equipment and Precautions for Firefighters
Wear self-contained breathing apparatus pressure -demand, MSHA/NIOSH (approved or equivalent) and full
protective gear.
6. Accidental Release Measures
Personal Precautions, Protective Equipment and Emergency Procedures
Personal Precautions Use personal protective equipment as recommended in Section 8.
Environmental Precautions Prevent from entering into soil, ditches, sewers, waterways and/or
groundwater. See Section 12 and Section 13.
Methods and Material for Containment and Cleanine U
Methods for Containment Prevent further leakage or spillage if safe to do so.
Methods for Cleaning Up Sweep up and collect into suitable containers for disposal. Flush area
with water.
7. Handling and Storage
Precautions for Safe Handling
Advice on Safe Handling Handle in accordance with good industrial hygiene and safety practices.
Use personal protection recommended in Section 8. Avoid contact with
skin, eyes, or clothing. Avoid breathing dusts. Contaminated clothing
should not be allowed out of the workplace.
Page 2 of 6

Red Tracing Dye Liquid Revision Date: 24-Nov-2014
Conditions for Safe Storage, Including Incompatibilities
Storage Conditions Keep container tightly closed and store in a cool, dry, and well -
ventilated area. Keep from freezing.
Incompatible Materials Acids.
8. Exposure Controls / Personal Protection
Exposure Guidelines
This product, as supplied, does not contain any hazardous materials with occupational exposure limits
established by the region specific regulatory bodies.
Engineering Controls
Ensure adequate ventilation, especially in confined areas. Eyewash stations. Showers.
Individual Protection Measures, Such as Personal Protective Equipment:
Eye/Face Protection Goggles.
Skin & Body Protection Rubber gloves. Suitable protective clothing.
Respiratory Protection No protection is ordinarily required under normal conditions of use.
Hygiene Measures Handle in accordance with good industrial hygiene and safety practices.
9. Physical and Chemical Properties
Information on Basic Physical and Chemical Properties
Physical State Liquid Odor Mild
Appearance Dark red liquid Odor Threshold Not determined
Color Dark red
Property
pH
Melting/Freezing Point
Boiling Point/Range
Flash Point
Evaporation Rate
Flammability (solid, gas)
Upper Flammability Limits
Lower Flammability Limits
Vapor Pressure
Vapor Density
Relative Density
Specific Gravity
Solubility
Partition Coefficient
Auto -ignition Temperature
Decomposition Temperature
Viscosity
Values
8.6 — 8.8
^32° F
^212° F
Not applicable
Not applicable
Liquid — not applicable
Not applicable
Not applicable
Not applicable
Not applicable
Not applicable
1.02
Highly soluble in water
Not determined
Not determined
Not determined
Not determined
Page 3 of 6

Red Tracing Dye Liquid Revision Date: 24-Nov-2014
10. Stability and Reactivity
Reactivity
Not reactive under normal conditions.
Chemical Stability
Stable under recommended storage conditions.
Possibility of Hazardous Reactions
None under normal processing.
Conditions to Avoid
Keep separated from incompatible substances. Keep out of reach of children.
Incompatible Materials
Acids.
Hazardous Decomposition Products
Oxides of carbon and nitrogen (NOx).
11: Toxicological Information
Information on Likely Routes of Exposure
Inhalation Avoid breathing vapors or mists.
Ingestion Do not ingest.
Skin Contact May cause an allergic skin reaction.
Eye Contact Avoid contact with eyes.
Delayed, Immediate, and Chronic Effects from Short- and Long -Term Exposure
May cause an allergic skin reaction.
Numerical Measures of Toxicity
Not determined
Symptoms Associated with Exposure
See Section 4 of this SDS for symptoms.
Carcinogenicity
NTP None
IARC None
OSHA None
Page 4 of 6

Red Tracing Dye Liquid Revision Date: 24-Nov-2014
12. Ecological Information
Ecotoxicity
This product is not classified as environmentally hazardous. However, this does not exclude the possibility
that large or frequent spills can have a harmful or damaging effect on the environment.
Component Information
Not available
Persistence/Degradability
Not determined
Bioaccumulation
Not determined
Mobility
Not determined
Other Adverse Effects
Not determined
13. Disposal Considerations
Waste Disposal Methods
Dispose of in accordance with federal, state, and local regulations.
Contaminated Packaging
Do not re -use empty containers. Dispose of containers in accordance with federal, state, and local
regulations.
14. Transport Information
Note
See current shipping paper for most up-to-date shipping information, including exemptions and special
circumstances.
DOT Not regulated
IATA Not regulated
OMDG Not regulated
15: Regulatory Information
International Inventories
TSCA Listed
U.S. Federal Regulations
CERCLA This material, as supplied, does not contain any substances regulated as
hazardous substances under the Comprehensive Environmental Response
Compensation and Liability Act (CERCLA) (40 CFR 302) or the Superfund
Page 5 of 6

Red Tracing Dye Liquid Revision Date: 24-Nov-2014
Amendments and Reauthorization Act (SARA) (40 CFR 355).
SARA 313 Section 313 of Title III of the Superfund Amendments and Reauthorization
Act of 1986 (SARA). This product does not contain any chemicals which are
subject to the reporting requirements of the Act and Title 40 of the Code of
Federal Regulations, Part 372.
CWA (Clean Water Act) This product does not contain any substances regulated as pollutants
pursuant to the Clean Water Act (40 CFR 122.21 and 40 CFR 122.42).
U.S. State Regulations
California Proposition 65 This product does not contain any Proposition 65 chemicals.
U.S. State Right -to -Know This product does not contain any substances regulated under applicable
state right -to -know regulations.
16: Other Information
HMIS
Health Hazards
Flammability
Instability
1
0
0
NFPA
Health Hazards
Flammability
Physical Hazards
1
0
0
Issue Date
01-Jan-2006
Revision Date
24-Nov-2014
Revision Note
New format
Special Hazards
Not determined
Personal Protection
B
Disclaimer
The information provided in this Safety Data Sheet is correct to the best of our knowledge, information and
belief at the date of its publication. The information given is designed only as a guidance for safe handling,
use, processing, storage, transportation, disposal and release and is not to be considered a warranty or
quality specification. The information relates only to the specific material designated and may not be valid
for such material used in combination with any other materials or in any process, unless specified in the
text.
End of Safety Data Sheet
Page 6 of 6

ATTACHMENT C
WELL CONSTRUCTION INFORMATION
(SECTION K)
Mid Atlantic
Engineering & Environmental Solutions

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
James D. Barker
Well Contractor Name
3106A
NC Well Contractor Certification Number
Quantex, Inc.
Company Name
2. Well Construction Permit #: NR
List all applicable wril construction permits (i.e. County, State. Variance, ere.)
3. Well Use (check well use):
Water Supply Well-
❑Agricultural
❑Municipal/Public
❑Geothermal (Heating/Cooling Supply)
❑Residential Water Supply (single)
❑IndustriallCommercial
❑Residential Water Supply (shared)
❑Ir'i ation
Non -Water Supply Well:
E Monitoring
❑ Recovery
Injection Well:
El Aquifer Recharge
❑Groundwater Remediation
❑Aquifer Storage and Recovery
I] Salinity Barrier
❑Aquifer Test
❑Stormwater Drainage
❑Experimental Technology
❑Subsidence Control
❑Geothermal (Closed Loop)
❑Tracer
❑Geothermal (Heating/Cooling Return)
[]Other (explain under #21 Remarks)
4. Date Well(s) Completed: 411711 5 VyeB ID# MW-1
5a. Well Location:
Willow Springs ES NA
Facility/Owner Name Facility ID# (if applicable )
6800 Dwight Rowland Rd., Willow Springs 27592
Physical Address, City, and Zip
Wake
County
NA
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one ladlong is sufficient)
35.593511 N 78.728022 W
6. Is (are) the well(&): 21'ermanent or ❑Temporary
7. is this a repair to an existing well: ❑Yes or E]No
Ifthis is a repair, fill out known well construction information and explain the nature ofthe
repair under #21 remarks section or on the back of this form.
8. Number of wells constructed: one
For multiple injection or non -water supply wells ONLY with lire some construction, you can
submit oneform.
9. Total well depth below land surface: 201
For multiple wells list all depths ifdii ferent (example- 3(a)200' and 2Q100)
10. Static water level below top of casing: NA
If router level is above easing, use "+ "
Il. Borehole diameter: 6.5"
For Internal Use ONLY:
14. WATER ZONES
FROM
TO
DESCRIPTION
13 rf
14 ft.
Sandy Silt
ft.
ft.
15.OUTER CASING for multi rased we0s OR LINER if a licahle
FROM
TO
DIAMECER
THICKNESS
MA1'F:WAL
ft.
ft.
I in.
16. INNER CASING OR TUBING(geothermal closed -loop)
FROM
TO
DIAMETER
"tHICKNESS
MATERIAL
0 rr
10 rr•
2 1O
Soh 40
PVC
ft.
ft.
in.
17. SCREEN
FROM
To
DIAMETER
SLOT SILE
THICKNESS
NIA'IERIAL
10 1-
20 ft-
2 in.
0.010
Sch 40
PVC
ft.
ft.
in.
18. GROUT
FROM
To
MATERIAL
EMPLACEMENT METHOD & ANIOUN I
ft.
ft.
0 ft.
g ft.
neat cement
145 lbs. - pour
6 ft.
S ft.
bentonite
30 lbs. - pour
19. SAND/GRAVEL PACK if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
8 ft.
20 ft'
#2 sand
Pour
ft.
ft.
20. DRILLING LOG attach additional sheets if necessary
FROM
'fU
DESCRIPTION color, hardness, soil o k ty rain size, etc.
0 rr•
0.5 rr•
ground cover - Reddish Tan Silt
0.5 Ir.
13 ft.
Reddish Brown Clayey Silt
13 It-
20 rr•
Brown Sandy Silt
ft.
ft.
ft.
ft.
tt.
ft.
ft.
ft.
21. REMARKS
22. Certifict
6, 6L 4/19115
Signature of ertifted Well Contractor Date
By signing t is form, I hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy 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:
(ft.) Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
Auger above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: g construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, 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 Ni'ells: 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.
(in.)
Form GW-I North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Ian. 2013

LOG OF BORING: MW-1
,�,kVK CW�
rn919.25a'rns
'o ■
Page: I of I
Willow Springs GeoProbe DPT /
Site Name: Elementary School Drilling/Boring Method: Hollow -Stem Auger Total Boring Depth (ft): 22.0
Project Number: R2647.01 Sampling Method: Macrocore Top of Casing Elev. (ft): NA
Location: Willow Springs, NC Subcontractor/Drillers: Quantex, Inc. Latitude: NA
Date Started: 4/17/2015 Driller: James Barker Longitude: NA
Date Completed: 4/17/2015 Monitoring E ui ment: N/A Field Tech: G. Fischer
E
a
a
rn
by
i
u
rq
Odors/Staining
a
SOIL DESCRIPTION (color.lesture,moisture, ete.)
Construction Deatails
p
J
`
a
0
Grout: 0'-6'
0
No Odor
N/A
Advanced with 5-inch diameter hand auger. Light brown slightly sandy silty CLAY [CL]
4
4
Bentonite: 6'-8'
8
No Odor
N/A
Same as 0.0 - 5.0 ft [CL]
_
8
Sand: 8'-22'
Screen: 10'-20'
12
No Odor
N/A
Same as 0.0 - 5.0 ft [CL]
12
Gray
N/A
Light brown slightly clayey silty fine SAND [SM]
petroleum
No Odor
N/A
Light brown fine sandy SILT [ML]
16
16
No Odor
N/A
Light gray stiff CLAY [Cl_]; macrocore sampling terminated at 20 ft BLS
20
20
No Odor
No samples collected; hollow stem auger only
24
24
COMMENTS: in - indicates inches N/A - indicates not applicable to this boring TVA - Toxic Vapor Analyzer
ft - indicates depth in feet ppin - indicates parts per tnillion FID - Flare Ionization Detector
fl BLS - indicates feet below land surface DPT - Direct Push Technology

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
James D. Barker
Well Contractor Name
3106A
NC Well Contractor Certification dumber
Quantex, Inc.
Company Name N R
2. Well Construction Permit #:
List all applicable well construction permits (i.e. County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑Industrial/Commercial
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)
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
[]Tracer
❑Other (explain under #21
3/25/16 MW-3
4. Date Well(s) Completed: Well IDII
5a. Well Location:
Willow Springs ES NA
Facility/Owner Name Facility m# (if applicable)
6800 Dwight Rowland Rd., Willow Springs 27592
Ph ica1 Address, City, and Zip
Make NA
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one latllong is sufficient)
35,593527 N 78.728177 w
6. Is (are) the well(s): ®Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ONo
Ifthis is a repair, fill out known well construction information and explain the nature ofthe
repair under #21 remarks section or on the back of this form.
one
8. Number of wells constructed:
For multiple injection or non -water supply wells ONLY with the same construction, you can
submit oneform. 14'
9. Total well depth below land surfacer (ft.)
For multiple wells list all depths irdierent (example- 3@200' and 2Q1001
NA
10. Static water level below top of casing:
If water level is above casing, use
pin
11. Borehole diameter:y 0-)
12. Well construction method: Auger
(i.e. auger, rotary, cable, direct push, etc.)
(ft.)
For Internal Use ONLY:
14. WATER ZONES
FROM
TO
DESCRIPTION
5 &
6 It.
Light Brown Sandy SILT
ft.
ft.
15. OUTER CASING for multi cased wells OR LINER if a licable
FROM
TO
DIAbIETER
THICKINESS
MATERIAL
-t fL
16. INNER CASING OR TUBING(geothermal closed-loo
FROM
TO
D1A.NIETER
THICKNESS
MATERIAL
0 tt.
4 ft.
2 in.
Sch 40
PVC
fL
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
IA
MATERL
4 ft.
14 ft.
2 in.
0.010
Sch 40
PVC
ft.
%
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
fL
ft.
0 fL
3 ft.
neat cement
145 lbs. - pour
3 %
3.5 ft.
bentonite
30 lbs. - pour
19. SAND/GRAVEL PACK ifapplicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
3.5 %
16 %
#2 sand
Pour
fi.
fL
20. DRILLING LOG attach additional sheets if necessary)
FROM
TO
DESCRIPTION color, hardnes soiV:ock 13pe, gram situ etc.
0 fL
0.5 ft.
ground cover - Reddish Tan SILT
0.5 fL
3 ft.
Reddish Brown Clayey SILT
3 fL
14 ft.
Light Brown Sandy SILT
1L
ft
ft
ft.
fL
ft.
fL
fL
21. REMARKS
22. CertifR: 'on: 6, 1!2L
3/28/16
Signature of ertified Well Contractor Date
By signing t is 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 ofthis record has been provided to the well owner.
2.3. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Underground Injection Control Program,
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 OW-1 North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 2013

LOG OF BORING: MW-3
Atlantic ''�"`"`1 k.,i.�r. vc_reto
� E„ x E 1 s m-. Ph, 14004wasae
Page: 1 of 1
Direct Push and
Site Name: Willow Springs ES Drilling/Boring Method: Hollow Stern Auger Total Boring Depth (ft): 14.0
Project Number: R2647.OB Sampling Method: NA Top of Casing Elev. (ft): 98.04
Location: Willow Springs, NC Subcontractor/Drillers: Quantex Latitude: 35.593527
Date Started: 3/25/2016 Driller: J.D. Barker Longitude:-78.728177
Date Completed: 3/25/2016 Monitoring Equipment: Technician: G. Fischer
E
�
w
?
Odors
°
L
SOIL DESCRIPTION (cobr.texwre.muiswre.ete.)
Construction Deatails
a
m
G.
�u
3
Light Orange CLAY w/ Fine to Medium -Grained Sand
2
2
0
z
Bentonk
4
Light Grey/Red-Orange and Light Brown Very Fine to Fine -Grained Sandny CLAY
4
6
Depth to
water 5.!3n
6
`
r
c
Light Orange and Light Grey Very Fine -Grained Sandy CLAY
8
a
8
o°
o
o
z
_
Light Brown and Light Grey CLAY w/ Fine -Grained Sand
o
e
10
a
10
ca
0
12
vs
o
v
Tan and Light Grey Clayey -SAND
12
7
W
14
Light Grey CLAY (Stiff)
14
16
16
18
18
20
20
22
22
24
24
26
26
28
28
30
30
COMMENTS: in - indicates inches N/A - indicates not applicable to this boring
It - indicates depth in feet ppm - indicates pans per million
ft BLS - indicates feet below land surface

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
For Internal Use ONLY:
1. Well Contractor Information:
James D. Barker
Well Contractor Name
3106A
NC Well Contractor Certification Number
Quantex, Inc.
Company Name
2. Well Construction Permit #: N R
List all applicable well construction permits (i.e. County, State, Variance, etc)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothemtal (Heating/Cooling Supply)
❑ lndustrial/Commercial
❑ Irrigation
Non -Water Supply Well:
El Aquifer Recharge
El Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
❑Municipal/Public
El Residential Water Supply (single)
❑Residential Water Supply (shared)
El Groundwater Remediation
❑ Salinity Barrier
❑ Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 F
4. Date Well(s) Completed: 9/27/19 Well ID# RW-1 + RW-2
5a. Well Location:
Willow Spring Elmntry NA
Facility/Owner Name Facility ID# (if applicable)
6800 Dwight Rowland Rd., Willow Spring 27592
Physical Address, City, and Zip
Wake
NA
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.593559 N 78.728093 W
6. Is (are) the well(s): ❑E Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ZNo
If this is a repair, fill out known well construction information and explain the nature of the
repair under #21 remarks section or on the back of this form.
8. Number of wells constructed: two
For multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
9. Total well depth below land surface: 15'
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing: 1 1 .5'
If water level is above casing, use
11. Borehole diameter:
9"
12. Well construction method: _
(i.e. auger, rotary, cable, direct push, etc.
Auger
(ft.)
14. WATER ZONES
FROM
TO
DESCRIPTION
10 ft•
11 ft•
Light Brown Clayey Sand
rt.
rt.
15. OUTER CASING for multi -cased wells OR LINER if a licable
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING eother at closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
5 rt.
4 in
SCh 40
PVC
ft
fL
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
5 ft•
15 ft'
4 in.
0.020
Sch 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
ft.
ft.
0 rt.
3 rt.
neat cement
145 Ibs. - pour
3 ft'
4.5 ft.
bentonite
30 Ibs. - pour
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
4.5 fL
15 ft
#3 sand
Pour
rt.
rt.
20. DRILLING LOG attach additional sheets if necessary)
FROM
TO
DESCRIPTION color, hardness, soil/rock type, grain size, etc.)
0 rt.
0.5 rt•
ground cover - Reddish Tan SILT
0.5 rt.
7 rt.
Reddish Brown Clayey SILT
7 ft.
15 ft.
Light Brown Clayey Sand
rt.
rt.
rt.
rt.
ft.
ft.
rt.
rt.
21. REMARKS
22. Certifrc 'on:
_ 6, 614,,-, 9/30/19
Signature of ertified Well Contractor Date
By signing t is form, I hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Quality, 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-1 North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 2013

r
SUMMARY OF PROPOSED INJECTION POINTS
WCPSS WILLOW SPRINGS ELEMENTARY SCHOOL
WILLOW SPRINGS, NORTH CAROLINA
MID -ATLANTIC JOB NO. R2647.06
PROPOSED
ANTICIPATED
ANTICIPATED
ANTICIPATED
PROPOSED
PROPOSED
SCREEN
BENTONITE
CEMENT GROUT
SAND PACK
INJECTION POINT ID
DEPTH
DIAMETER
DEPTH
INTERVAL (FEET
INTERVAL (FEET
INTERVAL (FEET
(FEET BLS)
(FEET BLS)
BLS)
BLS)
BLS)
RW-3 AND RW-4 WELLS
j 4
15
5-15
3-4
1-3
4-15
(PERMANENT)
Notes:
BLS - Below Land Surface
Wells and borings to be installed by Parratt-Wolff, Inc. certification number 3371-A
J