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WI0400345_INJECTION AND WELL CONSTRUCTION RECORDS_20151130
ERM NC,Inc. 15720 Brixham Hill Ave. November 20,2015 Suite 120 Charlotte,NC 28277 (704)541-8345 (704)624-7928 (fax) Mr. Michael Rogers, P.G. NCDENR-Division of Waste Management Underground Injection Control "` 1636 Mail Service Center ' 4 Raleigh,North Carolina 27699-1636 ERM Via Email and FedEx Subject: Injection and Well Construction Records Energizer Battery Manufacturing,Inc. Asheboro Plant II RECEIVEDIDENRIDWR NCD000822957 Injection Permit WI0400345 NOV 3 0 2015 Dear Thomas: Water Quality Regional Operations Section On behalf of Energizer Battery Manufacturing,Inc. (Energizer),ERM NC,Inc. (ERM) is transmitting the enclosed Injection Event Record and Form GW-1 well construction records for the work conducted in accordance with the approved Injection Permit for the Energizer Battery Plant II site in Asheboro,Randolph County,NC. Please contact me if you have any questions or wish to discuss. Sincerely, o& an N�artin P. Project Manager Enclosures: Injection Record Well Construction Records (SVE-6 through SVE-16 and AS-3 through AS-13) cc: Shuying Wang,WQROS Winston-Salem Regional Office (electronic copy) Melanie Bartlett, NCDENR IHSB (electronic copy) Scott Boyle-Energizer Jeff Gipson- Energizer INJECTION EVENT RECORD North Carolina Department of Environment and Natural Resources—Division of Water Resources Permit Number WI0400345 Were any wells abandoned during this injection 1. Permit Information event? ❑ Yes 0 No _Energizer Battery Manufacturing,Inc. Permittee If yes,please provide the following information: _Energizer Battery Manufacturing Facility Number of Monitoring Wells Facility Name Number of Injection Wells _419 Art Bryan Drive,Asheboro,NC Facility Address Please include a copy of the GW-30 for each well abandoned. 2. Injection Contractor Information 4. Injectant Information _ERM NC,Inc. Nitrogen gas (Fracturing) ) Injection Contractor/Company Name Injectant Type Street Address_15720 Brizham Hill Ave, Suite 120 Concentration 100 o Nitrogen gas _Charlotte,NC 28277 City State Zip Code If the injectant is diluted please indicate the source dilution fluid. _ (_704 ) 541-8345 Area code—Phone number Total Volume Injected 5 2, 9 7 5 f t 3 3. Well Information Volume Injected per well See table attached Number of wells used for injection 2 2 5. Injection History Wellnames AS-3 through AS-13 , SVE-6 Injectiondate(s) 9/9/2015 - 10/12/2015 through SVE-16 Were any new wells installed during this injection Injection number(e.g. 3 of 5)_4 event? ® Yes ❑ No Is this the last injection at this site? ❑ Yes ® No If yes, please provide the following information: Number of Monitoring Wells 0 I DO HEREBY CERTIFY THAT ALL THE INFORMATION ON THIS FORM IS CORRECT TO Number of Injection Wells 2 2 THE BEST OF MY KNOWLEDGE AND THAT THE INJECTION WAS PERFORMED WITHIN THE Type of Well Installed (Check applicable type): STANDARDS LAID OUT IN THE PERMIT. ❑ Bored ® Drilled ❑Direct-Push ❑ Hand-Augured ❑ Other(specify) SIGNATURE OF INJECTION CONTRACTOR DATE Please include a copy of the GW-1 form for each Alan Martin well installed. 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. 8/5/2013 Energizer Battery Manufacturing 419 Art Bryan Drive Asheboro, NC 2015 Injection Record Permit Number WI0400345 Nitrogen Injection Volumes 1 Pneumatic Total Volume Of Date Fracture Interval Nitrogen Injected Pressure Range SVE Wells Completed (ft BGS) (ft3) (psi) SVE-6 9/11/2015 6-15 980 90- 125 SVE-7 10/7/2015 10-22 1,306 140- 180 SVE-8 9/15/2015 6-20 1,642 65- 130 SVE-9 9/9/2015 6-20 1,632 95- 150 SVE-10 9/10/2015 _ 6- 15 990 80- 145 SVE-11 9/23/2015 7-22 1,630 120-150 SVE-12 10/12/2015 ` 10-22 1,285 130-160 SVE-13 10/8/2015 10-22 1,280 130-170 SVE-14 9/30/2015 10-22 1,335 95- 140 SVE-15W 9/12/2015 _ 6- 15 985 115- 125 SVE-16 9/28/2015 10-22 1,330 90-140 Nitrogen Injection Volumes Pneumatic Total Volume Of ' Date Fracture Interval Nitrogen Injected Pressure Range AS Wells Completed (ft BGS) (ft3) (psi) AS-3 9/11/2015 6-42 3,910 95-220 AS-4 9/12/2015 6-39 3,590 100-230 AS-5 9/17/2015 6-54 5,220 95-260 AS-6 9/10/2015 6-42 3,980 90-230 AS-7 9/25/2015 10-46 3,920 120-260 AS-8 10/12/2015 10-32 2,280 120- 190 AS-9 10/7/2015 8-32 2,612 120-200 AS-10 10/7/2015 8-29 2,295 120-240 AS-11 9/28/2015 10-39 3,265 90-260 AS-12 10/11/2015 9-45 3,918 120-320 AS-13 9/27/2015 10-42 3,590 120-230 SVE Total 14,395 65-180(min-max) AS Total 38,580 90-320(min-max) Event Total 52,975 Client: Energizer Boring ID: AS-3 Project: Energizer Asheboro Date Started: 9/11/15 Site Location: Plant II Date Completed: 9/14/15 Project Number: 0314524 Latitude: TBD Logged By: Tom Naumann Longitude: TBD Well Lithology Lithologic Description Construction Well Construction Details 0 � 0pai - Concrete Gravel Flushmount Steel Vault ML Reddish orange clayey SILT 4 8 — Portland/Bentonite Grout 12 - 16 j; 8.25" Diameter Borehole EE. 20 2" Stainless Steel Casing ML Tan fine sandy clayey SILT 24 — 28 — 11! ''ii 32 IA!! Bentonite Seal 36 — tirb:ti ;rr 4"•'� Well Sand Filter Pack#3 — 4?4?S° L?°•°j 2" Stainless Steel 0.010" Slot r.r. •..ti.. 40 f`▪r ti,1r Screen Brown Sandy SILT �▪�` ?`so MH a:r. r::{ (PWR Auger refusal at 42.5) :l:fti :r:r End Cap 44 Drilling Contractor: ARS Technologies Outer Casing Depth: NA Drilling Method: Hollow Stem Auger Total Depth (ft): 42.5 Drilling Equipment: Geoprobe 7822DT Screened Interval: 37.5' -42.5' Responsible Professional: Chris Lacko (NC Driller#3516) Depth to Water(Final): TBD Borehole Diameter: 8.25" Elevation (msl): TBD ERM WELL CONSTRUCTION RECORD Far Internal Use ONLY: This fern can be used for single or multiple wells 1.Well Contractor Information: (�i1 r t _s L am- 14.tRROM TO-TO s DESCRIPTION Well Contractor Name ft. ft- . A/C, 3 ! G ft. ft. NC Well Connector Certification Number 13.Ot,TER CASING(tor raster-caul wells)OR LINER Of appticsbtel _ FttOM ' TO t)fAME1IR 'rid KWNEt.& —M+t1ERLAi AR_s TeckikQ io5 , e, it, ft. in. Company Name Is.INNER CASING ORTDDING(geothermal closed-loop I FROM TO DIAMETER IO. THICKNESS _MATERIAL2.Well Construction Permit It: S ft --i c ft' a id. ^31 G 53 List all applicable well permits(i.e.County,Slate,Variance,Infection.etchft. ft. 1a 3.Well Use(check well use): 17,SCREEN Water Supply Well: 7FROM TO7 DIAMETER SLOT SIZE THICICNE.I MATERIAL. ❑❑Agricultural Municipal/Public 77•5-ft' to a In. r C))0 13IL 55 - Otieothermal(Heating/CoolingSupply) CI Residential Water Supply(single) ft ft , to r • Olndustrial/Commercial ❑Residential Water Supply(shared) is,CROUT Pk(SM TO MATERIAL. EMPLACEMENT METHOD&AMOUNT ❑lrrsation ff. (-- Non-Water on Water Supply Well: f CLf t i It°7Y(�t(; Q t ❑Monitoring :Recovery . 3 7 it' 3•Vt. 8.1tre N t 6 fcL v,A7 - Ca 1.el i I Injection Well: f. tt OAquifer Recharge ❑GroundwaterRemediation 19.SAND/GRAVELPACKtifapplicable — PAquifer Storage and Recovery ❑Salinity Harrier FROM TO MATERIAL _ EMPLACEMENT METHOD IJAquifer Test ❑Stormwater Drainage ft T ft(9[l t �`"`` Lr� `lt 7 ft. {{xxtt.1 ft. • OExperimental Technology OSubsidence Control 20.DRILLING LOG;Mich additional ahem if l aringsarvl DOcothermal(Closed Loop) OTracer FROM TO DISCRIF/ION Ireton hardness,anderack typ..arate.tee,etc 1 ❑Geothermal(Heatin;'Cooling Return) t ier(explainunder#21 Remarks) 0 ft C ft. Coy,C i.e L c �y 4-it / ft 1 t \1 4.Date Well q s)Completed: 1-1 r}o15,Well LD# AS-3 _ ft ft .4. Se.Well Location: (' I fA- -t •�r Li tt q --ft S e 0 .4 f C l L.� f c; 14- 6A,:4 ; re-( 7 Co. Alft ft Faeility/Ome-r Name Facility ID#(ifapplicable) ' ft ft qi 1 �y K l„ i] Physical Address, T City,and Zit$ 1/4-11Aellek i 7 j _Ei. ! �+ 6,� 7] REMARKS{ 1l t' er^. AI r_s_itdyC 11 tCh VC(�r�r CYliet.C1 'i,6 County Parcel Identification N.I PIN) t Sb.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.C it le .,a: (if well field,one lat/long is sufficient) S7 b ` `7 S N —71 . "t S 13`� ' >t� �� fa-or-A (5 Sig L, ofCettified Well Contractor Date 6.Is(are)the well(s): 13ermanent or OTemporary 6y signing this form,1 hereby eer71 that the well(u)was(were)constructed in accordance with ISA NCAC 01C.0100 or 13A NCAC MCA200 Well Construction Standards and that a 7.Is this a repair to an existing well: ❑Yea or MC copy of this record has been provided to the well owner iftliis is a repair,Jill our known well construction irrfurmution and explain the nature ofthe repair under 421 remarks section or on the hack of this fame, 23.Site diagram or additional well details: You may use the back of this page to provide additional well site details or well &Number of wells constructed: 1 construction details. You may also attach additional pages if necessary. For multiple infection or non-water sapplywells ONLY with the same canstruelion,you can submit axe form. SUBMITTAL INSTUCTIONS 9.Total well depth below land surface: 47 ' . jff:) 24a. For 411 Wells: Submit this form within 30 days of completion of well For multiple wells list all depths!ftaferenl(example•MOO'and?(t00) construction to the following: 10.Static water level below top of casing: (it.) Division of Water Resources,Information Processing Unit, Ifwarer level is above casing,ate'•I'• 1617 Mail Service Center,Raleigh,NC 27699-1617 11.Borehole diameter: • ) (in.) 24b.For Infection Wells ONLY: In addition to sending the form to the address in n 24a above,also submit a copy of this form within 30 days of completion of well 12.Well construction method: F' Li Cq t? construction to the following: (Le.auger,rotary,cable,ttitoctpusb etc.) Division of Water Resources,Underground Injection Control Program, FOR WATER SUPPLY WELLS ONLY; 1636 Mail Service Center,Raleigh,NC 27699-1636 1.3a.Yield(gpm), Method of test: __ - Z4e,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 C1W-I North Carolina Department of Environment and Natural Resources-Division of Water Rcsomres Revised August 2013 Client: Energizer Boring ID: AS-4 Project: Energizer Asheboro Date Started: 9/12/15 Site Location: Plant II Date Completed: 9/13/15 Project Number: 0314524 Latitude: TBD Logged By: Tom Naumann Longitude: TBD Well Lithology Lithologic Description Construction Well Construction Details o. 0 _ - Concrete - "' Gravel f Flushmount Steel Vault 2 - ML Reddish orange clayey SILT 4 f 6 - 8 Portland/Bentonite Grout 10 12 14 16 8.25" Diameter Borehole 18 20 • 2" Stainless Steel Casing - ML Tan fine sandy clayey SILT 22 • 24 26 — 28 30 •- 32 34 Bentonite Seal NV: 4114 pg. rtiJtir Well Sand Filter Pack#3 36 R:743•.� ... `yJRj1 iti;tifti �f'�ti` 2" Stainless Steel 0.010" Slot `�tiiSi1 vac. 38 38 -, VAN': 4f1r•�.r Screen Brown Sandy SILT pp ti• 40 MH (PWR Auger refusal at 41) E;J:J: :J:�}r End Cap 42 Drilling Contractor: ARS Technologies Outer Casing Depth: NA Drilling Method: Hollow Stem Auger Total Depth (ft): 41 Drilling Equipment: Geoprobe 7822DT Screened Interval: 36'-41' s � Responsible Professional: Chris Lacko (NC Driller#3516) Depth to Water(Final): TBD Borehole Diameter: 8.25" Elevation (msl): TBD WELL CONSTRUCTION RECORD For Interval use ONLY. This form can be used for single or multiple wells 1.Well Contractor Information: a` /j ry s I4.WATER ZONES " I).( l~5 L.6I.,C. 1 o FROM TO DESCRIPTION welt ContractorNanoe ft, ft. AC- - 3c I ft fk NC Well Contractor Certification Number IS.OUTER CASING(for multi-cased wells)OR LINER(ifs btel rr FROM TO DIAMETER THICKNESS MATERIAL R R. G'rS Te- ttu a;,,{ 14 sy _ it fr. in Company Name i6.INNER CASING OR TUBING Itxetbermal dosed-[coat PROM 1 TO MANI:IFR rniCt.'rKFSS MATERIAL. 2.Well Construction Permit#: ka_ Ft. 3 ( it. 't in. , 2l1 C ry List all applicable well permits It e-County,:state,Variance,Injection.etc.) • 2r .J 1 —, rt. re. in. 3,Well the(check well use): 17.SCREEN Water Supply Well: FROM TO -DIAMETER SLOT SIZE THICKNESS Al AT£ROAI. _ °Agricultural °Municipal/Public 36 fr 1 tee .610 31 G C 5 R. DCieothermal(Heating/Cooling Supply) ©Residential Water Supply(Single) ft F in. Otndustrial/Commercial ❑Residential Water Supply(shared) 18 GROUT TO MATERIAL EMFI ACEMTuNC METlIon<k AMOUNT LAITI atirra; Non-Water Supply Well: ''nr CNIonitoring ❑Recovery 3,1 ft 7, P 1'GI irk b Cc.J r F"`i 'Injection Well: R. ft °AqurterRevhuete Dr.rktundwatcrR:mediation 19.SAND/GRAVEL PACKir'fspplicablel 1 FROM TO MATERIAL EMPLACEMENT METHOD °Aquifer Storage and Recovers 0Salin4 Barrier 4-2 DAquiferTest OStormwater Drainage _ 413 `� . O. ❑Fxperiltterrtal Technology 175ubsidence Control 20.DRILLING LOG(attach addltioue'berm if necessary) °Geothermal(Closed Loop) lJTntccr Faosi TO DESCHIFFION Irdar.kartinen,saiLN,Katrpr.grain size.ete.J °Geothermal(Heating/CoolinjReturn) COther(evp lain under#2t Remarks) (} A' ij R' C'sIc r-e-rrc , 4.Date Well(s)Completed: , '!�' W Well ID# A 5 - ,� it. ft. Fe f1 5a Well Location: I ft. 4 ft. C( .i.e._,5_" I ri ft it ( }t 7 c7. A— C-yl a(c 1 Z et-(' Be44-e-ry L G. A1 F it. IL Facility/Owns ame Facility ID#(if applicable) - IL fe 1a4Adnk 1/ -17 iqr bhycui 4r.-4-kif A5 ie ,o AIc ft.• ft. ' Physical Address,City,and Zip 21.REMARKS R0141ttApIN _ 77c 315-ts71,23s County Panel Identification No.(PIN) Sb,Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22, 'Rea a: 1 (dwell field,one tat/long is sufficient) 36---it leils" b N -- 7 1• ktSr. 131 SI W f f i6-C76- »:1a s Si c o Ccrti red Well unixactor Date 6.Is(are)the well(s): Grermanent or ClTemporaty Sy signing this}rarm,I hereby certtsfit that the wdrl(r)was(were)constructed In accordance with 15A MAC 02C.0100 or 1SA NCAC 02C.0200 Well Construction Standards and that a 7.Is this a repair to an existing well: DYes or Ef To copy ofthis record has been provided to Ike well owner. if this is a repair,fil nut known well constriction information and explain the nature of the repair under*21 remarks section or on the hack of this form, 23.Site diagram or additional well details: I You may use the back of this page to provide additional well site details or well &Number of wells constructed: construction details_ You may also attach additional pages if necessary. For multiple injection or non-water supply wells ONLY with the seine caastruc#an,you can submit one form, SUBMITTAL.INSTUCTIONS 1 9.Total well depth below land surface: q/ (ft.) 24a.For All Wells: Submit this form Within 30 days of completion of well Fur multple was list all depths if-dfjerent(example•3rt200'and 2@I0D'1 construction to the following: 10.Static water level below top of casing: (ft.) Division of Water Resources,Information Processing Unit, ifwater level is above casing,use " 1617 Mali Service Center,Raleigh,NC 27699-2617 11.Borehole diameter: - -a ] (tit,) 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 12.Well construction method: A JC E'( construction to the following (i.e,auger,rotary,cable,direct push,etc.) J 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 rftt test - -- 24c.For Water Supply&Injection Welts: 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 GW-t North Carolina DeparttnentoCEnvironnvnu and Nattenl Resources-Division of Water Resources Revised August 2013 Client: Energizer Boring ID: AS-5 Project: Energizer Asheboro Date Started: 9/16/15 Site Location: Plant II Date Completed: 9/17/15 Project Number: 0314524 Latitude: TBD Logged By: Tom Naumann Lon itude: TBD Well Lithology Lithologic Description Construction Well Construction Details o. 0 Concrete Flushmount Steel Vault ML \ Gravel Reddish orange clayey SILT 4 H 8 - 12 - 2" PVC Casing 16 --... 1 8.25" Diameter Borehole 20 ML Tan fine sandy clayey SILT 24 - - Portland/Bentonite Grout 28 32 - :..!:3ii. 36 €5• � 1' 2" Stainless Steel Casing 40 ill 44 - I MH Brown Sandy SILT Bentonite Seal 48 - (PWR Auger refusal at 57) {▪ rf; Well Sand Filter Pack#3 52 `1•:{▪ ? �1�ti�1 2" Stainless Steel 0.010" Slot d•d•: r•d.r• - `1••,b•�3— fdtir Screen 56 - ::r:r.�—AM End Cap 60 Drilling Contractor: ARS Technologies Outer Casing Depth: NA Drilling Method: Hollow Stem Auger Total Depth (ft): 56 Drilling Equipment: Geoprobe 7822DT Screened Interval: 51'-56' Responsible Professional: Chris Lacko (NC Driller#3516) Depth to Water(Final): TBD Borehole Diameter: 8.25" Elevation (msl): TBD M WELL CONSTRUCTION RECORD For internal Use ONLY,- This foal'can be used for single or multiple wells 1.Well Contractor Information: 7 14.WATER ZONES l�` t'rj Z-- .L .C, FROM 1' _FRO To 6I'fi.Rtl'rioN Well Contractor Name It. R. NC«. 3 i b ft. ft NC Well Contractor Certification Number 1 S.OUTER CASING ter etutti cased wells)OR LINER(if ap ieahk) FROM TO DIAMETER THICKNESS tYI:IFN'RLAt. ACS Te II.o 10] Y'O-S- it rt. in. Company Name _MANNER CASINGOR TUBING(geothermal cioted-1oa_) FROM TO DIAMETER ''THICKNESS MATERIAL 2.Well Construction Permit it: r.9 c' ft 5/ rt. L2 in- ,. /L 5 Lisa all applicable well permits(i.e.Caunry,Siam,Variance.iryeclion,etc) E� Well Use(C11CCii.well use): Q.c f 1 r ft 01- t0. 5 .kL.jo IV C.- 3. 17.SCREEN Water Supply Well: - FROM `TO ' DIAMETER _SLOT SIZE THICKNESS MATERIAL DAgricultural ❑Municiipal/Public f/ ft 5-6• G• tad is -Gj 6 'J/i S 5C]Geothermal(Heating/Cooling Supply) oResidentiai Water Supply(single) rt. rt. ., ©lndustnal/Commercial ❑Residential Water Supply(shared) 18.GROUT FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT ©Irri5ulion / ft 4 t ft d'ro„t 1 f t en WI r(' Non-Water Supply Well: j� - [y �t � t CMonitoring 17Recovery f o ft / f- B 4..�"Tdr1,t' Ci c.,u t 1 J Injection Well: ft ft I El,Aquifer DGroundwaterRemedninon 19.SAND/GRAVEL PACK(ifapplicable) 0 Aquifer Storage and Recovery ❑SalinityBarri� FROM T'fl MATERLU EMPLACEMENT METHOD 0 Aquifer Test CIStonnuuterDrainage �ct+tc - 11-3 { 0 Experimental Technology DSubsidenceControl I ft 20.DRILLING LOG(attae4 rres additional sheets if DGeothermal(Closed Loop) ❑Tracer -FROM 10 ntSCKIPS ION Qatar,bcr+lm.rt s+:a red,0Fp.RIsIc Size,etc.I ClGeothermal(Hcatin Cooling Return) DOther(explain under 421 Remarks) , 0 ft. • tj ft• tf 1r..c(t-1 /4 s f,I„(4 4.Date Well(s)Completed: 7"i 7 S ij( Well mo , `5 I it r` y II > ft Sa.Well Location: i.e. ! # i j ,.{�,�_ f� f r 9_ ft_ �, ft' j.a..,t"Q I (/ /r w 5 t-- ltet` t ter t)ts i -e f'.tP C. _ Ai A- ft. ft. Facility/t9.vnerName + Facility lDt(if applicable) q ^� t ft it 1111/ i A( + &( 9 o t'1 r,-ot. Po ke Do(d ;u C• ft ft. Physical Address,City,and Zip 21.REMARKS - ' i10t.A..ik1) (1 k 77c 375 4?1,d 35- - County Parcel identification No.(PIN) Sb.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.C7liicaA ((fwell field,oneYfatt/llong is sufficient) u -Ifr�3q 76 t'"i 7S G N _itf .Sia ( i o V1' /1+�`QU -Udil5s ee Certifiedactor gate 6.1s(are)the wilts): i t'ennaneat or OTemporary By sit nmg dos farm,I hereby cart(that the wells)was(uwre)constructed to accordance a'th ISA NCAC 02C_ 100 or ISA NCAC 02C.0200 Well Construction Standards and that a 7.Is this a repair to an existing well: ❑Yes or No copy of!hareems;has been provided to she real owner. If this is a repair.fill out known well construction itfformation and explain the nature of the repair under t21 remarks section or on the back of ibis form. 23.Site diagram or additional well details: You may use the back of this page to provide additional well site details or well 8.Number of wells constructed: construction details. You may also attach additional pages if necessary. Far multiple Injection or ton-wafer supply wells ONLY with the sane construction.YOU Can submit unclean. SUBMITTAL INSTUCTIONS 9.Total well depth below land surface: 4. 6 (ft.) 24a For All Wells: Submit this form within 30 days of completion of well For multiple wells ha'all depths sfdffferenf(example-.1@.200'and 2@l00') construction to the following: 10.Stalk water level below top of casing: (It) Division of Water Resources,Information Processing Unit, ifsvaterle=•ei is above casing,use"-""� 1617 Mail Service Center.Raleigh,NC 27699 1617 II.Borehole diameter: r3 5- (in.) 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 12.Well construction method: A t qt°( 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 130.Yield(gpm) _ Method of test: 24c.For Water Supply&Injection.Wells: —" Also submit one copy of this form Within 30 clays of completion of 13b.Disinfection type: Amount: well construction to the county health department of the county where - constructed. Form OW-I North Carolina Department of Environment and Natural Resources-Divisian of Water Resources Revised August 2013 Client: Energizer Boring ID: AS-6 Project: Energizer Asheboro Date Started: 9/10/15 Site Location: Plant II Date Completed: 9/14/15 Project Number: 0314524 Latitude: TBD Logged By: Tom Naumann Longitude: TBD Well Lithology Lithologic Description Construction Well Construction Details a) 0 oMR! - Concrete Gravel Flushmount Steel Vault ML Reddish orange clayey SILT 4 8 — Portland/Bentonite Grout 12 - 16 - 8.25" Diameter Borehole 20 -- ' 2" Stainless Steel Casing ML Tan fine sandy clayey SILT 24 — 28 32 — Bentonite Seal 36 y3+ Well Sand Filter Pack#3 - 1r� Rr:r r r tr' tiY'Y' S Y Y ir Y•Y• Lfw g}5f 2" Stainless Steel 0.010" Slot f.r 40 ; -rti:c: Screen MH Brown Sandy SILT ski — a:r End Cap _ (PWR Auger refusal at 42) 44 Drilling Contractor: ARS Technologies Outer Casing Depth: NA Drilling Method: Hollow Stem Auger Total Depth (ft): 42 Drilling Equipment: Geoprobe 7822DT Screened Interval: 37'-42' ,a Responsible Professional: Chris Lacko (NC Driller#3516) Depth to Water(Final): TBD Borehole Diameter: 8.25" Elevation (msl): TBD WELL CONSTRUCTION RECORD For Internal Lac ONLY: This faro can be used for single or multiple wells 1.Well Contractor information: r 0 rr`i'5 Las.4,-(3 14.WATER ZONES - -FROM TO DESCRIPTIONwellContntctorName ft. ft AID. - 3 5 /6 ft. ft NC Well Contractor Certification Number 15.0I'TER CASING(for nudticased wells)OR LINER(if ap ingle) QQ momTO `ulAwtift:R ' rnrrr:N1. nt.t1TRrAI. Art s --1--aLr e,(Q i c,s ft it ain. , tf' )6 55. Company Name Its.INNER CASING ORTCBING(eeothernual closed-toojl . FROM To DIAMETER TtlictoES3 MATERIAL 2.Weil Construction Permit#: 0 ft 2-7 ft o�rl tn. 3 , ,( 5 • List all applicable well permits(Le.Count Starr,Variance,Injection,etc.) ft. In 3.Well Use(check well use): I7.SCREEN Water Supply Well: FROM _ TO _ DIAMETER SLOTSIZE ' THICKNESS MATERIAL °Agricultural ❑Municipal/Public , 3/f. Li a ft a in. 86y ' .31 5 ❑Geothermal(Heating/Cooling Supply) []Residential Water Supply(single) ft it in. ClIndusuial/Commercial DResidential Water Supply(Shared) IS.GROOT FROM TO MATERIAL ' EMPLACEMENT METHOD&AMOUNT R&ris;etion 0 rt. 3 3 ft. e,f�4..pt" Tie iert4Yk!A Non-Water Supply Well: ❑Monitoring °Recovery 33 fa 5- R (.,Ver+. rie te 7�e.1."-t 1 Injection Well; ft. ft °Aquifer Recharge °Groundwater Remediation 19SAND/GRAVEL PACK(If vplkbItJ l7Aquifer Storage and Recot cry °Salinity Barrier FROM To MATERIAL EMYLACEMEh?M7710D CDAquiferTest °StorrnwaterDrainage 37t a fr. S #3 ��l c)t ,� ft. it J CI Experimental Technology ❑Subsidence Control 20.DRILLING LOG'attach additional sheets if accessary) °Geothermal(Closed Loop) °Tracer FROM , TO DESCRIPTION toast hnadnesr,sonlrock Opt graIaxtre.del °Geothermal(Heatin 'Cooling Return) ❑Otherlexplain undder#21 Remarks) 0 ft. , 5- R. (•,r7yte..p"Q - 4.Date Well(s)Completed: 74(4--(5- Well ID# 13,S 6 _ I,I s� ft. I — Sa Well Location: I. ft- 4 ft - &t`` i f Efefq.W 4e( Co A A u u� � � r�+1'" Sy ��- Facility/O&nerName Facility ioa(if applicable) ft. _ it 1 Lill A( - ( 4 r �rl t. ,4 5 h e O 1ci AR._ ft. ft. ' Physical Address,City,Aid Zip u {i I *��^P ey1 _21.REMARK� QQ t OOCk at lk 77�1 3 /)3c County 1( Parcel Iderailicatian No.(PIN) Sb.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certifi atio (if well field,one latliong is sufficient) 3s1 C14 35 6 N 7,. 1 3-13 4 ° W tio 4-4 —I3— Signs fCertified Well Contractor Date 6.Is(are)the well(s): prermanent or OTemporary By signing this,form,I hereby certify that the wells)was were,constructed in accordance with lSA NCAC 02C,0100 or 1SA NC'AC 02C.0200 Well Construct lon Standards and that a 7.Is this a repair to an existing well: °Yes or 121Cro copy ojthis record has been presided to the well Owner. If Ws is a repair,jilt out Airman well construction ralarmalion and explain the nature of the repair under 421 remarks.section or on die hack of this form. 23.Site diagram or additional well details: j You may use the back of this page to provide additional well site details or well B.Number of wells constructed: I construction details. You may also attach additional pages if necessary. Far multiple Injection or non-seater sapid wells ONLI'with the same construction,you two submit wrcfirm. Lid, SUBMITTAL INSTUCTIONS f 9.Total well depth below land surface: `7 f + (ft,) 24a. For All Wells; Submit this form within 30 days of completion of well Par multiple wells list all depth iJdii erent(crumple-3 j Z00'and 2 a©100'l construction to the following: 10.Static water level below top of casing: (ft) Division of Water Resources,Information Processing Unit, Ifi ater revel is above casing,tune"." 1617 Mail Service Center,Raleigh,NC 27699-1611 11.Borehole diameter: 6•d 4 (in.) 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 12.Well construction method; A �j-�f construction to the following: (i.e.auger;rotary,cable,direct push,etc.1 - Division of Water Resources,Underground Injection Control Program, FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636 24e-For Water Snook&Injection Wefts: 13a Yield(gpm) _ Method of rust: 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 OW-1 North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised August 2013 Client: Energizer Boring ID: AS-7 Project: Energizer Asheboro Date Started: 9/24/15 Site Location: Plant II Date Completed: 9/26/15 Project Number: 0314524 Latitude: TBD Logged By: Tom Naumann Longitude: TBD Well a �, Lithology Lithologic Description Construction Well Construction Details m 0 0 ppm _ Concrete J Gravel Flushmount Steel Vault I ML 4 Reddish orange clayey SILT 2" PVC Casing • 8 - — 12 I 16 [' : 8.25" Diameter Borehole w lEi•. 20 I ,E ; Portland/Bentonite Grout ML Tan fine sandy clayey SILT I'"` l` `ii ii FE . 24 '•.i 2" Stainless Steel Casing E.• •:f. 14 f'3E [4E:ST ], 32 II I.: iEl :':.,; E 36 —— I WI fx .-. �:11� �lEllE I.lI 40 xaal'• Bentonite Seal 44 ;: ;ti,* Brown Sandy SILT '•:ia? ••qr Well Sand Filter Pack#3 MH •r•rw— fart (PWR Auger refusal at 50) 4%14 .: ,.rtifti� o S .414—;;5*4.,[ 2" Stainless Steel 0.010" Slot 48 — r•r•, r•:.? tirtir;., f..•:r Screen nr•r• r•r.- r•r•d r.r.r i . t .a���r�r:�r1 End Cap 52 1 Drilling Contractor: ARS Technologies Outer Casing Depth: NA Drilling Method: Hollow Stem Auger Total Depth (ft): 50 ,,,,.....9, Drilling Equipment: Geoprobe 7822DT Screened Interval: 45'-50' Responsible Professional: Chris Lacko(NC Driller#3516) Depth to Water(Final): TBD �� Borehole Diameter: 8.25" Elevation(msl): TBD WELL CONSTRUCTION RECORD 'For imtxttei use ONLY: This form can be used for single or multiple wells 1.Well Contractor information: ( t .r-�tt,+ 14.WATER ZONES _ FROM TO T DESCRIPTION Well Contractor Name ft. ft. ,NC :3 57 G rt. ft. NC Well Contractor Certification Number i5.OUTER CASING(for multi-cased welts)OR LINER(if applicable) FROM TO DIAMETER TIIIC6otEs5 MATERIAL AR s Te Jut U Li e 5 ft. ft. in. Company Name Ui.INNER CASING OR TURINtG(seatkerund closed-taop! FROM TO _DIAMETER THICKNESS MATERIAL 2.Well Construction Permit# ft. C ft. If in. SG (¢o !7 U List all applicable well permits(i.e.County,State,Variance,Injection.etc.) j - 1 3.Well Use(check well use): 5 ft. i Z1 rc. t� nL 3/6 5 I%SCREEN Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS , MATERIAL R [Agricultural °Municipal/Public (s-ft 5-6 tc 0 E 0 ,3(6 5,5" °Geothermal(Heating/Cooling Supply) °Residential Water Supply(single) _ fr' _ ft in. °Industrial/Commercial ©Residential Water Supply(shared) IL GROUT FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT °Irrigation 0 ft. CI 3 ft. "'at14" I. Ise t , e Non-WaterSupplyWell: r +� t�� ❑Monitoring °Recovery '11 f _i 3 fL . f1e r11 k 9 re,th Injection Welk 2 ft °Aquifer Recharge °GroundwaterRemediution 19 SANDIGRAVEL PACK'(if appticable) °Aquifer Storage and Recovery °Salinity Barrier FROM TO MATERIAL EMPLACEMENT i!1&TTIOD °Aquifer Test OStormwatcr Drainage R ft °Experimental Technology ❑Subsidence Control 20.DRILLING LOG(inch additiaml%heels it weeaaar_r) °Geothermal(CIosed Loop) t3Tracer _fiZOM TO _DESCRIPTION isdar.lardam.sanrresk npe,4rata Axe,etc/ °Geothermal(Heating/Cooling Retum) ClOther(explain under 4121 Remarks) (j rt. , s it: :',;yr e r" ( ( /� s ft et. t j 4 4.Date Well(s)Completed: J)t'I"/5- Well mu 45 .� 1 rJa.Well Location; 1 ft. 4 f1. C to L i f. . Erler ;ce(-? � C. A- _Li k . 5-0 rr 5uyl�i7 Oa.yer 5, r7/- Facilitywner Name Facility Ulf(if applicable) rr. It 'Ill Arf-i rygLi, br1ve.i A5i1Qti0fei NC ft. ft. Physical Address.City_and Zip 21.REMARKS 1 RO.AA.r3 e I _ 7753 75b' 1 3 County Parcel Identification No(PIN) Sb.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Ceti teak lifwell field,owlet/long is sufficient) ' 35 16ag7$ -N 1i 'h-Jk (3q 0 w ` 44, /4l j5 / Signature of(*citified Well Contractor Date 6.is(are)the well(s): lE ermanent or °Temporary By signing this form.I hereby certify that She weNa)was(were)constructed in accordance with iSA Arc-"air"MC.0100 or 15A NCAC 02C.6200 Well Construction Standards and that a 7.is this a repair to an existing well: °Yes or t f o copy of this record has been presided to the well owner. If this is a repair„fill out lbio ti well construction information and explain the nature of the repair under41 remarks section or en the back ofthtsform 23.Site diagram or additional well details: f You may use the hack of this page to provide additional well site details or'well 8.Number of wells constructed: I construction details. You may also attach additional pages if necessary For multiple injection or non-water supply wells ONLY with the seine cotrsaructhma,you can submit one form• SUBMITTAL INSTUCTIONS ems 9.Total well depth below land surface: ._6 (ft) 24a. For All Wells: Submit this form within 30 days of completion of well For multiple)cells list all depths ifth,lfireni(examp;e-3Qa NIo'and*MO construction to the following: 10.Static water level below top of casing: (ft) Division of Water Resources,Information Processing Unit, If writer level is Mare casing,use"." 1617 Mail Service Center,Raleigh,NC 2 7699-1 6 1 7 11.Borehole diameter: it,J 7 (in.) 24b.For lnieetion Wells ONLY: In addition to sending the term to the address in A 240 above, also submit a copy of this form within 30 days of completion of well 12.Well construction method: L - ,f construction to the following: au auger,rotary,cable,dintetpush,etc.) -1 Division of Water Resources,underground Injection Control Program, FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636 24c.For Water Snooty&infection Wells: 13a.Yield(gpm) Method of test._. 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. Forts OW-t North Caratna Department of Environment and Natural Resources—Division of Water Resources Revised August 2013 Client: Energizer Boring ID: AS-8 Project: Energizer Asheboro Date Started: 10/12/15 Site Location: Plant II Date Completed: 10/12/15 Project Number: 0314524 Latitude: TBD Logged By: Tom Naumann Lon itude: TBD Well _c Lithology Lithologic Description Construction Well Construction Details a m 0 - Concrete `'+•'•`oe - Gravel Flushmount Steel Vault 2 —. ML Reddish orange clayey SILT 4 6 Portland/Bentonite Grout 8 10 12 - '3, I 14 a: Till 8.25" Diameter Borehole 16 [t; l 18 — 20 ML Tan fine sandy clayey SILT 2" Stainless Steel Casing 22 3E: 24 —� 26 ._- 'i f 28 F Bentonite Seal {{S { 30 r.r. !f.}r f•rr'' * Well Sand Filter Pack#3 PA {ftir.:• 32 - 1 li.I1::,1f: 2" Stainless Steel 0.010" Slot S.S. 1 Screen F::%:' 'r:rtic 34 {tir1 — e•Yti� MH— Brown Sandy SILT ''.1j. 36 - \ (PWR Auger refusal at 36) End Cap 38 7 Drilling Contractor: ARS Technologies Outer Casing Depth: NA Drilling Method: Hollow Stem Auger Total Depth (ft): 36 — - .�ti Drilling Equipment: Geoprobe 7822DT Screened Interval: 31'-36' Responsible Professional: Chris Lacko(NC Driller#3516) Depth to Water(Final): TBD Borehole Diameter: 8.25" Elevation (msl): TBD li WELL CONSTRUCTION RECORD For Internal Use ONLY: This form can be used for single or multiple well; 1.Well Contractor information: _ .0 �hI C5 L.et.c.L 14.WATER ZONES f FROM TO DESCRIPTION Well Contractor Name it ft. AIL -IC" tit. f. NC ell Contractor Certification Number 15.OUTER CASING(for multi-eased wells)OR LINER(if ap :cat tdc) FROM TO DIAMETER THICIQNF.SS MATERIAL Ags Ic?.t: Rlld1aJI ft. _ in. Company Name N.INNER CASING OR TilltiNG temthermel dosed-aorml FROM TO DIAMF..IPIe • THICKNESS MATERIAL 2.Well Construction Permit#: I,3 ft. 3 t fc r 1 in: r 2 it( 5 G last all applicable well permits 0,e.County,Slam Variance,Injection,etc) i ft ft. in. 3.Well Use(check well use): 17.SCREEN n� Water Supply Well: PROM TO _DIAMETER SLOT SIZE THICKNESS MATERIAL DAgricultural 0 Municipal/Public .3 I ft. 3 6 tr. %l in.V .0 f( r 3(6 c 5 °Geothermmal(Heating/Cooling Supply) °Residential Water Supply(single) ft R. in. 0Industrial/Commercial ❑Ressidential Water Supply(shared) I&GROCIT PROM TO MATERIAL _ EMPLACEMENT METHOD&AMOUNT ❑Irrigation 0 k' t.7 D' 6-(ov-Y j I 't9l JU)t Non-Water Supply Well: t�t} °Monitoring °Recovery J 7 ft. O { R' 6imizr7Ck ' eittl. .i47 injection Well: ft. ft. J °Aquifer Recharge °Groundwater Reined iation 19.SAND/GRAVEL PACK(if>rpalirabiel FROM TO MATERIAL I EMPLACEMENT METHOD ❑Aquifer Storage and Recovery °Salinity Hamer er ft. 3 fc 5j �,r 1 s� °AquiferTest °Stormwatcr Drainage ( ft. + 7 1Expenmental Technology °Subsidence Control -20.DRILLING LOG(attach additional ahem ifnecesl tnuy) °Geothermal(Closed Loop) °Tracer FRONT TO DESCRIPTION(color.bardnes.*AL roe 1 r.pr.eraia au,eie) °Geothermal('Heating/Cooling Return) °Other u explain under#21 Remarks) 6 ft. e 5— ft �C�.0 dt;--e 4.Date Well(s)Completed:A)-fr)-r 5 Well 1D# A 5 'ft. c I ( ' 1 t ft: c{ ft. Cla-�t 51 (�- 5a.Well Location: r Atz.[r t r 2 f <v +� L1 tit _ `3 tc+sdY C 1 e7 41'I f' - Facility/O Name Facility Ina(if applicable) Physical1A 1{City. d �,, D�- A 5 e 6 r,f•r Ai( f:. ft. 21.REMARKS Rrx1,el.ftt9 ts `775— 3 75—(9l-3S` County Parcel Identification No.(PIN) Sb.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Ce .icad i (if well Cold,one lat/long is sufficient) W•7 d'/ '17S d N ?J - 8' 1$ 13z/ ° W l'O O—/15— Sia.i e o Certified Well Corltramor Date 6.Is(are)the well(s): 12ermanent or °Temporary By signing this form,1 hereby cent f}•that the well(s)tiP:(were)rnnrtrurvad in accordance with 15.4 NCAC 02C.0100 or 15.4 NCAC 021".0200 Well Construction Standards and that a 7.Is this a repair to an existing well: °Yes or (Alva` copy of this record has been presided to the well owner. if this is a repair,fell out known well construction information and explain the nature of the repair under 421 remarks section or on the hack of rhisfartn. 23.Site diagram or additional well details: You may use the bank of this page to provide additional well site details or well 8.Number of wells constructed: construction details. You may also attach additional pages if necessary. For multiple injection or nut-water supply wells ONLY with the same construction,you can submit one farm SUBMITTAL INSTUC1"IONS 9.Total well depth below land surface: • t . _(tt.) 24a.,for All Wells: Submit this form within 30 days of completion of well l br multiple wells list all depths if djeent(e ample-3@200'and 2©100) construction to the following: 10.Static water level below top of casing: (ft) Division of Water Resources,Information Processing Unit, If tinder level is above cash}•us€"." {{ 1617 Mail Service Center,Raleigh,NC 27699-1617 11.Borehole diameter: lg '�] (in.) 241t.For Iniestion 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 12.Well construction method: A or)t"'- construction to the following: (i.e auger rotary,cable,direct push,etc.) J 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: 24e.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 OW-1 North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised August 2012 Client: Energizer Boring ID: AS-9 Project: Energizer Asheboro Date Started: 10/6/15 Site Location: Plant II Date Completed: 10/8/15 Project Number: 0314524 Latitude: TBD Logged By: Tom Naumann Longitude: TBD Well w, Lithology Lithologic Description Construction Well Construction Details a_ a 0 0 - - Concrete Gravel Flushmount Steel Vault �s's;: - tEl 2 ie 31'; ML Reddish orange clayey SILT 13 ' 4 is.* - r ' . I . — ;tj :I.1;r: 6 _ E' h_ 1° E is Portland/Bentonite Grout 8 Cd 10 E :S �IIII�:;gg�iE 12 -..t if E_ E €:. 14 -- 8.25" Diameter Borehole 16 - i-..t' 18 - If lq 20 - ML Tan fine sandy clayey SILT 2" Stainless Steel Casing 22 - 24 Ik 0 €, J qq... E: :;i 26 ,- 28 -i Bentonite Seal rii F4, 1 30 - {,�• �� Well Sand Filter Pack#3 32 y _ _ 2" Stainless Steel 0.010" Slot _ ti 7 Screen 34 . e„ r r MH Brown Sandy SILT ,:cs .49 z...ti.1 36 (PWR Auger refusal at 36) End Cap 38 Drilling Contractor: ARS Technologies Outer Casing Depth: NA Drilling Method: Hollow Stem Auger Total Depth (ft): 364) Drilling Equipment: Geoprobe 7822DT Screened Interval: 31'-36' Responsible Professional: Chris Lacko(NC Driller#3516) Depth to Water(Final): TBD Borehole Diameter: 8.25" Elevation (msl): TBD WELL CONSTRUCTION RECORD For Iotetted Use ONLY: Ibis form can be used for single or multiple vas I.Well Con tor Information: I jf ,y /�'A IS.WATER ZONES 7�Ir J Y-to( FROM TO , DESCRumON Well tr/Contractor Name ft. ft. I tJ i.-3 S C?/ ft. ft. NC Well Contractor Certification Number 15,OUTER CASING I for malts atsed wells)OR LINER(itrppl'tcabtel FROM TO DIAMETER THICKNESS ]!T MATERIAL._ PR J Tarr], r' ft. rt. in. Company Nam; I6.INNER CASING Olt TUBING(geothermal closed-loop) FROM t TO _ DIAMETER THICKN _ _MATERIAL_ 2.Well Construction Permit#: 6 fI 7 I ft. a tn. 3 r.4 55 List all applicable well perms(l.e.Coun04 State,Variance.injection,Mai' ft, It - 3.Well Use(check well use): 17.SCREEN Water Supply Well: PROM TO DIAMETER SLOT SIZE - THICKNESS MATERIAL. (Agricultural EIMunicipal/Public 1 I r` 3 6 r` a "t' ,o r v _ '31 d 55 . OOeothermal(Heating/Cooling Supply) :Residential Water Supply(single) in Oindustrial/Commercial iResidential Water Supply(shared) It GROUT FROM _TO MATERIAL EMPLACEMENT METHOD&AMOUNT Otrrigation p O ft. _s 7 ft- 9 r"� -V'fe w I' e Non-Water Supply Well: L I OMonitonng :Recovery a Fr ` ft 7 - a ft. Q1g.1-6.1, , 9(A.of t 4 In}ection Welt :Aquifer Recharge IlOmundwater Remediation O.SAND/GRAVEL PACK(if applicable) FROM TO _ MATERIAL EMPLACEMENT"METHOD ❑Aquifer Storage and Recovery :Salinity sorrier _ ):.:,Aquifer Test C3Stornt';:sec i'lrun.-gc FL ft. O}xl erarnentol'r,vitivtitigy DSuhrltlenee Control J 2e.DRILLING LOG(attach additional sheets if necessary) DCkxithemralIClosed Loop) :Ironer Mon ' i0 - DESCRf'130:N(colon hantanae.sdiVrucktype.=riln She.etc. DCieuthernialtWeanne,'CoolingReturn) DOtiver{explain tinnier 521ftenlar::st 0,, IL - 5 U ez.. c`.k• .� , f ,5-- ft, ( rt. i~r 1 ( 4.Date Well(s)Completed; l `/"SS Well ID# A 51 - r - Sa Well Location: I ft ft- c{u,r41 5 t 7 f. ` . '�,e[§.�t.c(r •cia7c:r t' if r A {�Grr ' A (`a d q rt. 6 fi- _ fr. ft Facility/Owner Name Facility ID#(if applicable) ft. ft. LI 19 AtTiNkWAju PA, l-S1-16ivQ0 Mc . ,: ' ft1 Physical Address,City,and zip 2L REMARKS Rtxr,kiek _ 775 375e7ia3 s County Parcel identification No.LPIN, Sb.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certifi y. 'on- f (if well field,one bat/longg is sufficient) 5176 i t 5- N ~ 7y ' 0 ) `3f3' T O W lfl^42 /5_ � S turcofCernSedWellContractor Date 6.is(are)the well(s): 194 rmattent or ['Temporary gt,signing this farm,1 hereby certift that the well(s)was!were)constructed in accordance with 15A IWAC OZL'0100 or 15A NCAC 02C.0200 Well Construction Standards and that a 7.Is this a repair to an existing well: :Yes or ECRU etrpp of this record has been provrded to Maud:owner, 1f this is a repair Jill out known well construction infarmat/an and explain the nature q/11re repair under I2)remarks section or on the hack of this form, 23.Site diagram or additional well details: You may use the back of this page to provide additional welt site details or well S.Number of wells constructed: construction details. You may also attach additional pages if n,,-pccary. For multiple injection or non-water supply wells ONLY with the same construction,you can submit one form. SUBMITTAL INSTUCTiONS 9.Total well depth below land surface: 3 6 (ft) 24a.yor All Wells: Submit this farm within 30 days of completion of well for multiple walls list all depths if different(example-3 a2G7'and Zr1a„100) construction to the following: 10.Static water level below top of casing (ft) Division of Water Resources,Information Processing Unit, if woler keel is above casing,use'---'" 1617 Mail Service Center,Raleigh,NC 27699-1617 I I.Borehole diameter: U ' a C (in.) 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 12.Well construction method: 71 Otyt f' construction to the following: ti,o.auger,rotary,cable,direct push etc.) I Division of Water Resources,Underground Injection Control Program, FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636 13a.Yield(gam) Method of test: 24e.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 Fomnt OW-I North Carolina Departmcni of Environment and Natural Resources-Division or Water Resources Revised August 2013 Client: Energizer Boring ID: AS-10 Project: Energizer Asheboro Date Started: Well 10/6/15 Site Location: Plant II Date Completed: 10/8/15 Project Number: 0314524 Latitude: TBD Logged By: Tom Naumann Lon itude: TBD � +., Lithology Lithologic Description Construction Well Construction Details a m 0 0 - Concrete —' �s Gravel Flushmount Steel Vault 2 ML Reddish orange clayey SILT 4 2" PVC Casing 6 • EiI 10 is 12 i y i " Portland/Bentonite Grout 14 L ii 1111: •iN• 16 I '1:0! 8.25" Diameter Borehole 18 1€ 2" Stainless Steel Casing ML Tan fine sandy clayey SILT 1 20 ;,,: — I ``:- E 22 -- -1i 24 • - Bentonite Seal 26 - L•1r. �f RR! S}}r ;tijti } Well Sand Filter Pack#3 28 =: ' �•ti ti a f:::: f'▪ d 2" Stainless Steel 0.010" Slot -SS Ffy▪rgr, Screen 30 — t;;r1 �g g 2:••.•ti 1.1• MH Brown Sandy SILT �:•j:r? ii.33§ 11 (PWR Auger refusal at 33) - - r`''�'- ~'~' End Cap 34 Drilling Contractor: ARS Technologies Outer Casing Depth: NA Drilling Method: Hollow Stem Auger Total Depth (ft): 33 Drilling Equipment: Geoprobe 7822DT Screened Interval: 28'-33' Responsible Professional: Chris Lacko (NC Driller#3516) Depth to Water(Final): TBD Borehole Diameter: 8.25" Elevation (msl): TBD ERM WELL CONSTRUCTION RECORD For Internal Use ONLY: This form can be used for single or multiple wells 1. ell Contractor Information: - - / 14.WATER ZORES 1 5 1.� PROM TO _ DESCRIPTION Well Contractor Name ft ft. /VC 3 5.16 ft ft, NC Well Contractor Certification Number 15.OUTER CASINGs lino Kimble)for multi-cased wells)OR LINER Cc c FROM TO DIAMETER THIC'KCESS MATERIAL i7 i�4.1l6 lti 5 i'e.) ft. ft. is. Company Name 16.DINER CASING OR TUBING(geothermal closed-loop) FROM TO 1 DI-AML'TER • THICKNESS MATERIAL 2.Well Construction Permit#: -- c ft 4+ ft ") in. 5 IL(IO tsvc List all applicable well permits(I.e.Carney,Slate,Variance,!njecnou.etc.) U Pr /}b 55 3.Weil Use(check well use): SCREEN Ft. ice I7,SCItFEIV Water Supply Well: FROM TO . DIAMETER SLOT SIZE - THICKNESS _MATERIAL ❑.4gricultutal ❑iYftul:cipal/ptiblic t . ft. 3 7 ft in. •a/0 3/6 ) ❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) R ] i 1°' ❑lndustriallCammerc•al LlResidential Water Supply(shared) 6.GROUT FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT °Irrigation Non-Water Supply Well: a el rt. r�J tf e lm�Q 1Monitoring CnRecovery C# It. a t/' ft. b �+1�t t k yek to,1 ty Injection Well: ft. ft DAquifer Recharge oGroundwaterRemediation L 19.SAND/GRAVEL PACK(if applicable) FROM TO MATERIAL EMPLACEMENT METHOD ❑Aquifer Storage and Recovery 0Sallnin Barrier ) 6 ft -3 ? ft- 5 A t 1J 3 4)(a_v t ❑AquiferTest CDStormwaterDrainage ft. ft �1 GExperimontal Technology (15ubsidence Control 20.DRILLING LOG(attach additional sheets if necessary) IJG^othermal(Closed Loop) ❑Tracer FROM TO DESCRt/Vr1ON(color.bantam-scrid/rackaape.arai i mi.,eie.l ClGeothermal(Heating/Cooling Return) 0Other(explain under#21 Remarks) 0 ft : ] Ili Gfe.4.-c ' 5 I ft' i U S--;)(MS-Well4.Date Well(s)Completed: /0 S--;)(MS-Well ID# A-S a (-1 f sa.Well Location: "' y -1 G..� . y ft* [',. , i e^ 3 3 f- ' - C/a-ye-75" if--- t;.i FctLet ))a. e- r ft. ft Facility/O4nerrame y Facility 113#(it applicable) —-- Cif f A f i- t c y Q t7 i I t t ix A l he s:(a- .r't1' c _ ft ft. Physical Address,City,andiZip 21.REMARKS irlCli n }-% l i 5 3 ? ti ..2 T . County Parcel Idantincaiion No.(PIN) 5b.Latitude and Longitude in degrees/minutes/secoods or decimal degrees: 22.C fife lion, (Er wall bald,one IaOleng is auffl ieiu) Si attire ofCertified well Contractor Date 6.Is(are)the evell(s): L/rnianent or ❑Temporary Ry signing rhos Jsmm.1 hereby certtlL that the well(c)nut(were)constructed in accordance with iSA NC AC 02(._0W0 or IS.l,tr('.dC'02(: 021Xi Well('oz;intcunr,Standard&and That a 7.Is this a repair to no existing well: CDY'es or 1 ?t:o cup;?.‘rhea n<r-nod nor linen provided to the,tell owner. if this is a repair,Jill odd known well au:strci-t 0n inlnttnariou and explain the'taittrc r f di; repair Mader a21 remarks.section ar an the hock of this front. 23.Site diagram or additional well details: You may use the back of this page to provide additional well site details or well S.Number of wells constructed: construction details. You may also attach additional pages if necessary, For multiple ugeettan or two-water supply wells ONL I'with the same contraction.}err can submit one ibnn. SUBMITTAL.FNSTUC'TIONS 9.Total well depth below land surface: 3 7 (ft, 2-la. For All Wells: Submit this form within 30 days of completion of well Far multiple exits List all depths tfdiffereut!'example-3«•200'and 20.7till'1 construction to the following: 10.Static water level below top of casing: (ft) Division of`Vmcler Resources,Information Processing Unit, If water la-ti is chore easing,WC'-." 1617 Mail Service Center.l2aleigb,NC 27699-1617 I I.Borehole diameter: IS 't'l S. (in.) 24b.For infection Wells ONLY: In addition to sending the fonm to the address in 24a above, also submit a copy of this loon within 30 days of completion of well 12.Well coustruetion method: (A J 5 t7 ( construction to the following. (ie-anger.'mazy.cable,direct push,CU.', Division of Water Resources,Underground Injection Control Program, FOR WATER SUPPLY WELLS S ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636 13a.Yield(gpen) Method ot test 24c.For Water Sue oh-&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 ofEnrironment and Natural Resources-Division of Water Resources Revised August 2013 Client: Energizer Boring ID: AS-11 Project: Energizer Asheboro Date Started: 9/27/15 Site Location: Plant II Date Completed: 9/29/15 Project Number: 0314524 Latitude: TBD Logged By: Tom Naumann Lon itude: TBD Well }, Lithology Lithologic Description Construction Well Construction Details Ti m 0 0 -Nig - Concrete Gravel Flushmount Steel Vault ML Reddish orange clayey SILT 2" PVC Casing 4 — 8 I Portland/Bentonite Grout 12 - 16 8.25" Diameter Borehole 20 2" Stainless Steel Casing la ML Tan fine sandy clayey SILT 24 -- I ,! :: if' Isi.1 :3: : j, 28 #' i3 32 Bentonite Seal 36 ry f• `5 j1 Well Sand Filter Pack#3 f`•rzr f":: 2" Stainless Steel 0.010" Slot 40 zf1f.: •tir1r• Screen ;Av., r:::.t7. MH Brown Sandy SILT ti::.v: rti:i:. r•r•. r•r•r1 i ''s1.1—.. 'PWR Auger refusal at 42.5) Ls1fti� K:1j�.r•A.• .1 End Cap 44 Drilling Contractor: ARS Technologies Outer Casing Depth: NA Drilling Method: Hollow Stem Auger Total Depth (ft): 42.5 L'\ ..,5- Drilling Equipment: Geoprobe 7822DT Screened Interval: 37.5'-42.5' g.i t Responsible Professional: Chris Lacko(NC Driller#3516) Depth to Water(Final): TBD Borehole Diameter: 8.25" Elevation (msl): TBD EM WELL CONSTRUCTION RECORD For internal Use ONLY: This form can be used for single or multiple wells 1.Well Contractor Information: 0]I-r I'S i4.WATER ZONES ( ��/( FROM TO DESCRIPTION Well Contractor Name ft. it. IU c 3 5-1 4 ft. ft. NC well Contractor Cmti tins Number 15.OUTER CASING(for multi-eased wells)OR LINER lif licble} FROM TO DIAMETER THICKNESS MATERIAL j.g 5 `\--e 4;6 i 6 to y f E 1 ft. ft. in. Company Name _16.1NNER.CASING OR TUBING(geothermal closed-loop] _FROM ,TO DIAMETER THICKNESS MATERIAL 2.Well Construction Permit it: 6 7,5-fr. a in. 'c�1 c(d PUG, I.crt all applicable well permits(t e.Coou1i Stare,Variance.Injection.etc.) 75--ft. in. 3.Well Use(check well use): 17 SCREEN J Water Supply Well; �FRROM TO — DIAMETER — SLOT SIZE THICKNESS MATERIAL ❑Agricultural !Municipal/Public 1 5-ft- C1�• e a in. •6( s •3/Z G j ft. °Geothermal(Heating/Coohng Supply) ❑Residential Water Supply(single) fr M. / ' °Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT 0 Non-Water Supply Well: .G�fatJ r� i t{ c-IDMonitoring °Recovery .73 ft; --It. J 11414,T:r1.1 I Q r`Lt 1/4_,, �`y Injection Well: it. ft. 1 °Aquifer Recharge DGmundwater Rented lotion 19.SANWGRAVEL PACK,(if rpolicabiel _FROM TO ' MATERIAL EMPLACEMENT METHOD ClAquifer Storage and Recovery °Salinity Earner 3 t7;r tt. gap- 1 l.d #J 2 J J /rec.If f _, °Aquifer Test °Stormwater Drainage - � fr. ft. °Experimental Technology °Subsidence Control 20.DRILLING LOG(attach additional sheets ifatttsarv} °Geothermal(Closed Loop) °Tracer FROM •ta orStaterms loi4or.buntaess,salVritag pr.=ramr.Yt.etc.) .. °Geothermal(Heatin1/Cooling Return) °Other(explain under#21 Remarks) 0 ft. t) rr. i'aYiz s 4-e 4.Date Well(s)Completed:7 4 y-'S Well m# A S i' ' it ( fr. t 4 ff. (a ft, c_ 1*-4ex I f f- S,a..Well Location: q. ft' - to c-242.4 y �' ills aye-7- S r /1` 1 Facility/Outer Name Facility ID4 Of applicable) ft it Li (Li A( k- (y }t Ili i\5'keho(;. Ai C ft. ft•. Physical Address,City.and Zip 21-RENIAAtKS County f Puget Identification No.(PIN) Sh.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22•Certific on: (if welt field,one tat/long is sufficient] tt,..,,,,,_,-- Si_ tore of Certified Well Contractor arc 6.Is(are)the well(s): t$rmanent or °Temporary By signing this farm,Ihereby certify that the wells)was(were)constructed in accordance with ISA N['AC 02C.0100 or 154 NCAC 02C.0200 Well Construction titmwdards and that a 7.Is this a repair to an existing well: ❑Yes or t]Nb copy of this record has been provided to the well owner. if this is a repair,fill out known well construction information and explain the manure'tithe repair under"21 remarks section or on the hack of thisfonn. 23.Site diagram or additional well details: You may use the back of this page to provide additional well site details or well S,Number of wells constructed: L _ construction details. You may also attach additional pages if necessary. For m:duple injection or non.water supply wells ONLY with the saute construction,von can submit one form. SUBMITTAL JNSTU IJONS 9.Total well depth below land surface 40 (ft) 24s. For All Wells: Submit this form within 30 days of completion of well For multiple wells listall depths Ifeh ferent(example-3( 200'and 2i l00") construction to the following; 10.Static water level below top of casing: (}L) Division of Water Resources,Information Processing Unit, If water level is above casing,use"i" 1617 Mail Service Center,Raleigh,NC 27699-1617 II.Borehole diameter: I•' c (in.) 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 12.Well construction method: ti a1 C1-e" construction to the following: l i.e,auger,rainy,cable,direct porn,etc.l I Division of Water Resources,Underground Injection Control Program, FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636 2dc.For Water Snooty&Ini ection Wells: I3a.Yield(gpm) Method of test _ 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. Pasta OW-1 North Carolina Department of Environment and Natural Resources—Division of Water Resources Revised August2013 Client: Energizer Boring ID: AS-12 Project: Energizer Asheboro Date Started: 10/11/15 Site Location: Plant II Date Completed: 10/11/15 Project Number: 0314524 Latitude: TBD Logged By: Tom Naumann Longitude: TBD Well Lithology Lithologic Description Construction Well Construction Details 0 Concrete Gravel Flush mount Steel Vault ML 4 Reddish orange clayey SILT 2" PVC Casing 8 - 12 16 8.25" Diameter Borehole 20 Portland/Bentonite Grout 24 - 2" Stainless Steel Casing ML Tan fine sandy clayey SILT 28 32 36 I 40 Bentonite Seal 44 1iyf▪1 .rti 1r; Well Sand Filter Pack#3 :i:▪i: •r:i:r 2" Stainless Steel 0.010" Slot tic}i} •}ti}tir Screen LS5�1 •{ti�L� 48 % { f MHtir�r Brown Sandy SILT fir` End Cap (PWR Auger refusal at 49) 52 Drilling Contractor: ARS Technologies Outer Casing Depth: NA Drilling Method: Hollow Stem Auger Total Depth (ft): 49 C'I Drilling Equipment: Geoprobe 7822DT Screened Interval: 44'-49' Responsible Professional: Chris Lacko (NC Driller#3516) Depth to Water(Final): TBD Borehole Diameter: 8.25" Elevation (msl): TBD ERM WELL CONSTRUCTION RECORD For Internal Use ONLY: This form can be used for single or multiple wells 1.Well Contractor nformation: ' h 14.WATER ZONES eik C,.f+ii+�a FROM I TO DESCRIPTION Well Contractor Name ft• ft. 11 C. "3 / G It ft. NC Well Contractor Certification Number 15,OUTER CASING(for multi-cased wells1 OR LINER(if a ikahte)- MOM TO DIAMETER r11tCKNES% MATERIAL A R5 i I��ll ft. ft. in. Company Name J 16.INNER CilSENG OR TUBING teeothcrmel closed-Noel FROM TO DIAMETER _THICKNESS MATERIAL LJ 2.Well Construction Permit#: R Li ft- d}- h C,,L F. qb P u4 q List all applicable well permits(Le.County,State;Variance,Injection,etc.) - v . Li t{ ft. g. ia. • S 5 S 3.Well Use(check well use): l _ t7.:.REEK Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS ,MATERIAL °Agricultural °Municipal/Public ow fir 7 ft a in. .610 .. .Pi _ S ❑Geothermal(Heating/Cooling Coolin Supply) °Residential WaterSu Supply _ r;' `a 1 M � S PF Y) AK Y Dlndustriat/Commercial °Residential Water Supply(shared) GROUT FROM TO _ MATERIAL EMPLACEMENT METHOD&AMOLNT ❑Irrigation �� ft t,(0 ft. - ,L. .}re (Non-Water Supply Well: fJV{lr1°Monitoring °Recovery �0 ft. o� ft. ?,,f L>al,.4orlt ff JrcLJt f, Injection Well: ft It. DAquifer Recharge °Groundwater Remediation 14.SANDIGRAYEL PACE,tif applicable) FROM To MATERIAL EMPLACEMENT °Ayuifar Storage and Recovery °Salinity Barrier yMETHOD ft. ft. °Aquifer Test °Scotmwater Drainage �`� ft � �� ft �Q i't� � �r�eC tji. °Experimental Technology [Subsidence Control 20.DRILLING LOG(Litteeh irdditiunsl sheets if reermiary) °Geothermal(Closed Loop) °Tracer FItOM °1tt n€:WRIPIIOx tr.t.r.13 Irdnims.,.Rime Id.a.er.gal.ew.<x.:I °Geothermal(Heatin 'CoolinlReturn) ❑Other(explain under#21 Remarks) n rt. ,°-5 it. C.. .4(it 4.Date Well(s)Completed:/6"�I-I S Well ID# A 5 l a �j L - 5a.Well Location: 4 ~ fr, `'(a y L,f ` l !/ T .t fa L _961r.1�[y C Ca r. fit" fE f e e.rG�;1,e/ r/ Cx .11) 4- ft ft. - l•acility/OwrjbrName Facility t04(if applicable) rr ft 1c! A f ` bf e,A of Sh baro3 A)t_ ft ft ' Physical Address,City,and Stip 21.REMARKS County Parcel identification No.(PIN) 5b.Latitude and Longitude in degrees/minutes/seconds ordechnal degrees: 22.Cer' ca. n (if well field,one lat/long is sufficient) '35-• 7 4 R(41 s 6 N -77. ifi k 13L " W eA 16-.77-6 / Signature of Certified Well Contractor Date 6.is(are)the well(s): l rmaneat or ❑Temporary Hy signing this form,1 hereby cert(fv that the well(s)Kos(were)constructed in accordance with 15A NCAC 02C.0100 or ISA NCAC 02C.0200 Well Construction Standards and that n 7.Is this a repair to an existing well: Dyes or f31tro copy Vans record has been provided to the hell owner. Ifhis is a repair,fill out known well construction information and explain the nature of the repair under'01 remarks section or an the hack of this form. 23.Site diagram or additional well details: Vim may use the back of this page to provide additional well site details or well 8.Number of wells constructed: I construction details. You may also attach additional pages if necessary F'or amillple lnjecrioh or nor!-water supply wells ONLY with the tame cnlufrtictios.you can submit one farm. SUBMITTAL INSTUCTIONS t� 9.Total well depth below land surface: r _ (IL) 24a. For All Wells: Submit this form within 30 days of completion of well For multiple wells list all depths if different(example-3@a200'and 2@1OW) construction to the following: 10.Static water level below top of casing: (ft.) Division of Water Resources,Information Processing Unit, ((water level is above casing,we"+" 1617 Mail Service Center,Raleigh,NC 27699-1617 11.Borehole diameter: 1 ?S- (in.) 24b.For injection Wells 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: 1b c}t=if construction to the following, (i.e auger,rotary.cable,direct pub,etc.) ] Division of Water Resources,Underground Injection Control Program, FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636 24c.For Water Supply&Injection Wells: 13n.Yield(gpm) Method of test: _ 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-t North Carolina Department of Environment and Naintal ltesauraes-Division of Water Resources Revised August 2013 r Client: Energizer Boring ID: AS-13 Project: Energizer Asheboro Date Started: 10/8/15 Site Location: Plant II Date Completed: 10/9/15 Project Number: 0314524 Latitude: TBD Logged By: Tom Naumann Longitude: TBD Well a Lithology Lithologic Description Construction Well Construction Details d 0 0 Concrete- .;..tir,. Flushmount Steel Vault 'tir'}::':: -- Gravel �' I 4 ; ML Reddish orange clayey SILT " 8 Portland/Bentonite Grout 3 12 - 8.25" Diameter Borehole 16 20 2" Stainless Steel Casing 24 r. d; ML Tan fine sandy clayey SILT 28 0 32 is ' '-F 36 Bentonite Seal e� pi }r�r?� 40 -- ir1fy: CfC ti.114.1 :•f.: Well Sand Filter Pack#3 r"r}a r_:.: ;f}T y.} ' ti.1.ti1 tip•".• rr'rf f ; 2" Stainless Steel 0.010" Slot 44 Brown Sandy SILT Lf=. Screen MH `r f - - ` (PWR Auger refusal at 45.5) "` End Cap 48 Drilling Contractor: ARS Technologies Outer Casing Depth: NA , ; Drilling Method: Hollow Stem Auger Total Depth (ft): 45.5 Drilling Equipment: Geoprobe 7822DT Screened Interval: 40.5'-45.5' Responsible Professional: Chris Lacko(NC Driller#3516) Depth to Water(Final): TBD Borehole Diameter: 8.25" Elevation (msl): TBD WELL CONSTRUCTION RECORD (For Intone!Use ONLY This form can be used for single or multiple wells 1.Well Contractor Information: t 14.WATER ZONES tL h J, 5 `4, FROM TO DESCRIPTION - N ell Contractor Name ft. ft, - ! flu R. ft �8 15.OIITEft CASING(for multi-eased wens)OR LENER.rf iodide) NC Well Contractor Certification Number S - { FROM r TO -DIAMETER THICKNESS MATERIAL A(] 1 0,t NKo_19�51 � ft ft. in. Company Name I Id.INNER CASING ORTIBlNG(jca thermal closed-loop) FROM ' TO DIAMETER THICKNESS MATERIAL 2.Well Construction Permit it c. ft._ 9 c-ft. a in. 3 fC 55 list all applicable well • !pp permits(Le.County,State,Nartance.lnjecliun eta ft ft. in. 3.Well Use(check well use): 17 SCREEN Water Supply Well: ' FROM- TO ' DIAMETER SLOT SIZE THICKNESS MATERIAL ❑Agricultural ❑Municipal/Public llorft' 46"4--ft , 0 1m r .0(0 . 3/4 55 ❑Geothermal(Heating/Cooiing Supply) ❑Residential Water Supply(single) rt. ft, in. J _ ❑Industrial/Commercial GResidential Water Supply(shared) t5.GR4Irr FROM TO , MATERIAL EMPLACEMENT METHOD&AMOUNT Dirrigation t ft. 36'tlt 6 t`a,., -f-f-ei�ut,�ik. Non-Water Supply Well:°Monitoring °Recovery _ 34 R - c ft` 6erikL - 4& (...51{c-a.w't y Injection Well: ft ft J °Aquifer Recharge L°Groundwater Remediation 19.SAND/GRAVEL PACK(if gtirlicable) °Aquifer Storage and Recovery °Salinity Barrier FROM TO MATERIAL EMPLACEMENT MCHUM ID Aquifer Test ❑Stonnwater Drainage `' S�t-r ` 3 6 r�i f ❑Experimental Technology ❑Subsidence Control Lid"DRILLING LOG(attach additional sheettifneceuary) ❑Geothermal(Closed Loop) ❑Tracer utom ' TO DtSCRIPTIONInrger,hardneasNarsnt+trpr.uaLcum.ri.i ❑Geothermal(Heating/Cooling Return) ❑Other(explain under021 Remarks) b D O 5— ft C u,/t Gl � ,..- 4.Date Well(s)Completed:/0 -(C Wen BM A_5 I 3 r n ) f t. �• jF ' / Sa.Well Location: i1 ( ft-.._� fL l�l4 r�t�y / �T E net t Lf( }� C a . lv _ ta ft q c, fc S C.t,ric C raye i S+ i Fajcililiity/Otvner'Na}me Facility De(if applicable) It `i l It ' ,[i ii l Li eye. 9(I 11 - /i si)e l i A#!(_ ft-.-- ft • Physical Address,City,and Zip 21.REMARKS County Parcel identification No.(PIN) ' Sh.Latitude and Longitude in degrees/minntes/seconds or decimal degrees: 22.Certificati : (if well field,one tat/long is sufficient) IS: 16 ? `° N -Ste` 13go '� �' � 7/S" Signal a afCertifred Well Contractor Date 6.Is(are)the well(s): El ermanent or ❑Temporary dy signing this form.I hereby cant&that the wells)was(were)constructed in accordance with ISA NCAC 02C.011Nt or 154 NCrlt'02C,0200 Well Construction Sretruktrds and that a 7.is this a repair to an existing well: ❑Yes or 0i o ropy a/this recan]has been provided to the well owner. If this is o repair,fill out known well construction information and explain the nature of the repair under 421 remarks section or on the hack of this form. 23.Site diagram or additional well details: You may use the back of this page to provide additional well site details or well B.Number of wells constructed: construction details. You may also attach additional pages if necessary_ For multiple Injection or non-water supply welts ONVIJwah the same Construction.you can submit ant,form. f SUBMITTAL INSTUCTIONS i. 9.Total well depth below laud surface: `f 5- - t! (ft,) 24a. For All Wells: Submit this form v:ithin 30 days of completion of well For multiple wells list all depths if-different(example-3 tt200'and 2@l0o) construction to the following. to.Static water level below top of casing: (ft,) Division of Water Resources,Information Processing Visit, 1(water level is above rasing,use•",'• 1617 Mail Service Center,Raleigh,NC 27699-1 6 1 7 II.Borehole diameter: it -? S' (in.) 24h.For Iniection Wells ONLY: In addition to sending the form to the address in 24a above,also submit a copy of this form within 30 days of completion of well 12.Well construction method: i r,)ire construction to thefollowtng• (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 13b.Disinfection type: Amount: well construction to the county health depamnent of the county where constructed, Form OW-I North Carolina Department of t nvimnment and Normal Resources-Division of Water Resources Revised August 2013 Client: Energizer Boring ID: SVE-6 Project: Energizer Asheboro Date Started: 9/11/15 Site Location: Plant II Date Completed: 9/14/15 Project Number: 0314524 Latitude: TBD Logged By: Tom Naumann Longitude: TBD Well „,., Lithology Lithologic Description Construction Well Construction Details o. a) 0 0 _ - Concrete „, Flushmount Steel Vault 1 •�l•a `..I :9•:••: -- Gravel 4" Stainless Steel Casing 2 . L. Portland/Bentonite Grout ML Reddish orange clayey SILT 3 Bentonite Seal 4 1.7...1▪` 1 r% •..•..ti VIZI tie~rtr� 5 r1r1r r r :1 dV1.:::ggti r1▪r1r 1r1r1 r.".. 1r1r1 6 4........ 1r{r;' rlrir 1{1r' r1r1r -- .441. r r.* tirtir. 7 rtirtil ti'ti+. r 1�.... tifLr i..1r 1r1r rr1r tirtir 8 r.r.} r.1. r.1�1 ~1•%1• r:1:1 Iv*. f}1'1 }f�.'. Si% 11: 10.25" Diameter Borehole r•R..lil ,11'1r• 9 1:1:r r:1. 1~1:1 {�1 5:11 L1S1• ML Tan fine sandy clayey SILT :.r1r }r▪tir. 1 o 1:1ti1 `111 r{r{r -1r1r• ryr1r '~•r1•'. 11 - .ti.Lr .ti.... r1r1r 1 1. 1�.=.•1 �r▪�: Well Sand Filter Pack#1 ry}L1 tiL�• 12 f1r1r ?. •r•r r•r• r1r1r Lr1r. r:r1r i:13• 9;1:1 ti:sip. 13 r1r1r 1:1r1 rtirLr 1r1r1 11 r;r; ;rgf; 4 Stainless Steel 0.005" Slot L•1 1••.•ti Screen r1r1r 1rr1 14 r1rr 1r•r• 1.ti r1r1r Va.. PP:- 1r1r1 :1f;r ::::St 15 55SCS ;'•;1' 1.•. rr11r 1r:::: r1rr r1r1 ALA — t.'r'r :c End Cap 16 1 Drilling Contractor: ARS Technologies Outer Casing Depth: NA Drilling Method: Hollow Stem Auger Total Depth (ft): 15.5 \,,,_,,.........., Drilling Equipment: Geoprobe 7822DT Screened Interval: 5.5'-15.5' Responsible Professional: Chris Lacko(NC Driller#3516) Depth to Water(Final): TBD Borehole Diameter: 10.25" Elevation (msl): TBD M WELL CONSTRUCTION RECORD 'For Internal Llse ONLY This form can be used for single or multiple wells 1.Welt Contractor Information: �jj fj 14.WATER ZONES t�` f l 5 tt Gtw PROM TO DESCRIPTION Well Contractor Name ft. ft. 4JC- J Sr6 ft. NC Well Contractor Certification Number IL OUTER CASING tfor multi-cased welts)OR LiNER INappttcabtel FROM TO DIAMETER .THICKNESS MATERIAL ,i6I es, i e-441.61 o fi t'0-s ft. ft io. Company Name 16.INNER CASING ORTURHNG(geothermal closed-loop) FROM TO DIAMETER ' THICKN 'Bad MATERLAI, 2.Well Construction Permit#: wj. ft J"'5-ft u in. 3 1 d S S List all applicable well permits(i.e.County,Slate,Variance,Inlectlan,etc..) ! ft. rt. Sir. 3.Well Use(check well use): 17.SCREEN Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL ❑Agricultural ❑Municipal/Public S-`)` ft f crt. G/ in. ,o �,. -3)t 5OGeothermal(Heating/Cooling Supply) ['Residential Water Supply(single) ft. ft / m ❑Industrial/Commercial [Residential Water Supply(shared) IS.GROUT FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT ❑Irrigation )r ft fteir - I ft t'idLr.t Ji' Non-Water Supply Well: f ❑_Monitoring ['Recovery ft ft P ' tWit lc 9 f.cu t i-7 Injection Well: ft. ft. ❑Aquifer Recharge CDGroundwaterRemediation 19.SAND/GRAVEL PACK Ofappiicablee FROM TO MATERIAL EMPLACEMENT diETUOD °Aquifer Storage and Recovery ❑Salinity Barrier 11 ft. jr 5-,S-ft. f L Jft. I :Ssti � 44- I "w.):4 ❑AquiferTest ❑Stomtwater Drainage ft ❑Experimental Technology i]Subsidence Control ill.DRIL,T ING LOG(attach additional sheets if neetse ry) ❑Geothermal(Closed Loop) OTracer J . To DESCRIPTION trelac,taatiaxa&ralliincti gyp',grain ru.or.l ❑Geothermal(Heating/Cooling Return) ❑Other(explain under021 Remarks) U It , Ss it e ,:C;#,l,e / 1 h, 1_ 4.Date Well(s)Completed: 11-i l iii SWell 1D# S I C C f t r If 3a Well Location: !!! ! ,�jj,� 1 t 4 ��� ft / �5' - .1[rrtt7lE} C LG��dFr r f ft. (t Facility/Owner Name Facility MC Of applicable) LiIti fi g R. JS06 g.� AG f. t Physical A css.City,and Zip 21.REMARKS D Nbo+'('il -77s-3-'s dill 35 County Parcel Identification No.(PIN) Sb.Latitude and Longitude In degrees/minutes/seconds or decimal degrees: 22.Ce .fiCati (if well field one lat/long is sufficient) J,-7 6,61.1 1 Cc"' its - 7 r t IS 131 d W 10-a) 17-ir s e of Certified Well Contractor Date 6.Is(are)the well(s): B ermanent or OTemporary By signing this form.I hereby eerttfy that the well(s)na.,(were)constructed in accordance with 154 NC'AI"02C.0100 or ISA7ICAC 02C.0200 Well Constraction Sttandarafs and that a 7.Is this a repair to an existing well: LJYes or t31(o copy of this record has been preluded to the well owner tf this is a repair,fill out known well constrrrcclion information and explain the nature of the repair under t:21 remarks section or on the back of this form. 23.Site diagram or additional well detaiis: You may use the back of this page to provide additional well site details or well &Number of wells constructed: 4 construction details. You may also attach additional pages if necessary For multiple infection or non-water supply wells ONLY with the same construction.you can submit one form, _ SUBMITTAL INST'UCTIONS 9.Total well depth below land surface: 5 - S (ft) 24a.For All Wells: Submit this form within 30 days of completion of well For multiple wells list all depths If different{azample-3 200'and 2@a 101) construction to the following: 10.Static water level below top of easing: (ft) Division of Water Resources,Information Processing Unit, if water level is above casing ore " 1617 Mail Service Center,Raleigh,NC 27699-1617 11.Borehole diameter: i 0"t)l9 (in,) 24b,For baiection Wytis 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 1Z Well construction method: A bi-ve r _ construction to the following: (i.e.auger,rotary,cable,direct Quail,etc.) Division of Water Resources,Underground Injection Control Program, FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636 13a.Yield(giro)_. . Method of tests_ Mc.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 Fore GW-I North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised August 2613 Client: Energizer Boring ID: SVE-7 Project: Energizer Asheboro Date Started: 10/7/15 Site Location: Plant II Date Completed: 10/9/15 Project Number: 0314524 Latitude: TBD Logged By: Tom Naumann Lon itude: TBD Well s ., Lithology Lithologic Description Construction Well Construction Details a a) 0 - Concrete Flushmount Steel Vault .' '•ti4 --- ' Gravel _ Y` 4" Stainless Steel Casing 2 ,;. Portland/Bentonite Grout ML Reddish orange clayey SILT 4 ���'}} ♦ Bentonite Seal _rtir,r y1?1?.. 6 - •1}LS "?S?ti ?:? r:?:?ti rrrr 3.1.1 ' :ma 8 r •� •��..nn 1•r. ^• Y r1Lf1r !j+ rrL.y rr•r•r Cr}:•� f r??�r� srA 10 ` :r1?1ftirwr 1:11L1 ti•1?•.1 �.rtir of1j. `.•... .., . '?1?1?, 1?1?1 10.25 Diameter Borehole G•r•r r.ra 12 rrlftir ti•,•rr•. ML Tan fine sandy clayey SILT ?1?1?: 11? 14 stir~:: }f f} < ti,y,ti r:rir, ..... Well Sand Filter Pack#1 16 .r:r.ry El. - I C:1?1?• 1?.5.•ti - 'r•r•r r.r•. ligs%:?:?' ?? 18 y ti rL ti :t:r :}:r}} 4" Stainless Steel 0.005" Slot r??4 ;f;:2. Screen `r 'l :f`...{s ?1?:?- : . .g 20 — `PP:: • r• 14111tirh�ti ✓ti?r 1r1r; •' L▪K••s. ti•1•'Li 22 l.t .._ �rtir "'''r•J End Cap 24 Drilling Contractor: ARS Technologies Outer Casing Depth: NA E Drilling Method: Hollow Stem Auger Total Depth (ft): 22 Drilling Equipment: Geoprobe 7822DT Screened Interval: 7'-22' ; Responsible Professional: Chris Lacko(NC Driller#3516) Depth to Water(Final): TBD Borehole Diameter: 10.25" Elevation (msl): TBD ERM WELL CONSTRUCTION RECORD Forinteraal Use ONLY: This fmm can be used for single or multiple wells 1.We Contractor Information: c�r is elk, 14 WATER ZONES lit. (`(�I Gt� FROM TO ' D1SCR1rTION Well CootractorNatas ft. NC. 3s-J-6- ft. fL NC Well CoahactarCrni6cuion Number IS.OUTER-CASING tfos awtd-eared weftstOR LINER{if applicable � FROM TO DIAMETER TRIMNESS MATERIAL (t f it s 1 ac 6.61 tJ c�r*Q-S fL R in. •- Company Name 16.INNER CASING OR TUBING(geothermal dined-loop) PROM _TO _ _ DIAMER E THICKNESS MATERIAL Z Weil Construction Permit#: D IL 7 iL. q in. 7(6 S 5 List all applicable well permits(i.e.County,Stain Yarionce,Infection,eta) ft ft in. 3.Well Use(check well use): -17 SCREEN Water Supply Well: - PROM TO DIAMETER SLOT SIVE THICIQtEss -MATERIAL ❑Agricultural OMunicipal/Public r` t� n 05 ,3 j 6 S 5 ftOGeothelmal(Heating/Cooling Supply) OResidential Water Supply(single) n 1O ❑lndustriaNCommercial DResidential Water Supply(shared) IS.GROUT FROr�M TO MATERIAL i EMPLACEMENT METHOD*AMOUNT_ 0ltngation . lJ ft'' 3 rt. 9(Jo t- }►t.►'Yt►v 1 P Non-Water Supply Well: DMonitoring DRecovery 3 ft. 5- ft. . L7�D. -,\}akle lc_ cira..0, 7 injection Well: ft. R. DAquifer Recharge DGrotmdwaterRemedia:ion 19.SANDI RAVEL,PACKIifmmlirablc) OAquiferStorage and Recovery DSalinityBarrier FROM TO MATERIAL EMPLAETaltatralElHOD DAquifer Test QStosmwater Drainage 5 ft- d f t I s''s',�` ( f co i`4-1 ft. rt. °Experimental Technology DSubsidence Control ra.DRILLING LOG Winch additional sheets if uecessaryl OGeMhetTnal(Closed Loop) OTracer PROM TO _ DESCRIPTION[nlor.benlen.r.marina wpctr-.ii axe..ctc). OGeothermalt1leatins/CoolingReturn) DOther(explain under#21 Remarks) C.) ft- S r! /45�I, 4.Date Well(s)Completed: /O-q'j LI Well ID# S VC" (� Si.Well Location: Ul l� 5! . ��� ! ft. dal fr- 5r,Ah. CAar�� ��li- re. re Facilih-'Owner Name Facility ID#(if applicable) , ft ft. (41 CI L Lit" MMN bQ. AS t 6t40 i c- ft. _ Physical A ,rss.City,and rip 21.REMARKS Ckf Naot-Pil 175-37s i10.35 County. Parcel Identification No.(PIN) Sh.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.C ea (if well field,one tat/long is sufficient) 35-,7 e 9 ( 7 c' N —7/‹ti I (3/ . W f /p'd 7/S- s- r of c rfied Well Contractor Dew 6.is(are)the well(s): E3fermaaent or DTemporary 8y signing ibis form,I hereby certify that the well(s)was(wet')cmittrucird in accordance with ISA NCAC 02C.0100 or ISA NCAC 02C.0200!Weil Comm a:lion Sumdardr and that a 7.is this a repair to an existing well: DY-es or 1314a copy of this record hasbeenpronded to the well owner. If this is a main fill our known well construction information and arplain the name¢of the repair under k2i remarks section or on she bac*of*Worm. 23.Site diagram or additional well details: You may use the back of this page to provide additional well site details or well S.Number of wells constructed: ! construction details. You may also attach additional pages if necessary. Far multiple infection or non-water sypply war ONLY with the saute caastnie ion,you can submit one form. SUBMITTAL 1NSTUCT1ONS 9.Total well depth below land surface: t (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well Far multiple wells list all depths rfdri erent(example 3@,200'and 2l100') construction to thefollowing: 10.Static water level below top of casing: (ft.) Division of Water Resources,Information Processing Unit, If water)curl it above caving use"4" 1617 Mail Service Center,Raleigh,NC 27699-1617 11.Borehole diameter: I t)•r C (in.) 24b.For Lniection 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 12.Well construction method: A 0.)er construction to the following: (i.e.sugar,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 toss: 24e.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 OW-I North Carulina i)epeiuucnt of Ravimament and Natural Resources-Division of WaterRecources Revised August 2013 Client: Energizer Boring ID: SVE-8 Project: Energizer Asheboro Date Started: 9/15/15 Site Location: Plant II Date Completed: 9/15/15 Project Number: 0314524 Latitude: TBD Logged By: Tom Naumann Longitude: TBD i Well t �, Lithology Lithologic Description Construction Well Construction Details a m 0 o - - Concrete 1:. 1 Flushmount Steel Vault 1 - ••.•„•;' _: _ 4" Stainless Steel Casing {. Gravel E 2 q Portland/Bentonite Grout ML Reddish orange clayey SILT 3 .. I • Bentonite Seal 4 ekr r1r1r �.r.r ti r:jJ ��'{f�1 5 ) f1.1f T1'.y ':'r'r i'::•r' 6 — ....▪ l▪aw fee' 7 fyfLf :ftiati :4▪ 11 CM1j4°ti r•r•r 4..r..,.. r.r.r r..•.:: 8 1▪1�•f j°:rti;! •• r•rY r'r.:. 1.1.• l'1.1.1 fLf�f E.ffy. 9 — f1r�'�: rf1rti f.f;f ftif::a. 10.25" Diameter Borehole fiJ.ir 4:.:af4� r•r.r r?r}r 'Fa ,.ti. k1•• 1t ✓:: r9 l r11pg▪ .:. r••f1, ML Tan fine sandy clayey SILT '1:1: .:'.`ti r.r.1 12 PP:, ,,41, vs::: �,•' 13 ffti :1ef� j r:r:r ?' i J :'1f1: .'i°4'kd Well Sand Filter Pack#1 --1 1 r~r:r r`~ 14r•.�: r.r•r 5 3 .tif•.f 6ti 1fti pp:.. :'f fli 15 1.1. t•..'s.1 ' .r.r •.r... 1 .:'}lr "11:f 1�1 ,.ti�:j• �•ti fti fti 16 }:rtir ;A f11 ti•il f:f�f ��f f:1 4" Stainless Steel 0.005" Slot 17 Cr1r1f Zi,lig Screen 18 tR f1▪ i▪t L f1fr.1 r•� ti•ti▪• 1•L•1 1 9 — }.r.r ;VS!. E 20 r;•r.S Mg. ,Ffti1 f s:c End Cap 21 - Drilling Contractor: ARS Technologies Outer Casing Depth: NA Drilling Method: Hollow Stem Auger Total Depth (ft): 20 Drilling Equipment: Geoprobe 7822DT Screened Interval: 5'-20' -c3 Responsible Professional: Chris Lacko(NC Driller#3516) Depth to Water(Final): TBD Borehole Diameter: 10.25" Elevation (msl): TBD ERM WELL CONSTRUCTION RECORD For Internal Use ONLY: This form can he used for single or multiple wells I.Well Contractor Information: _ -artst r t - Gt 14.WATER ZONES l/tr` ( FROM TO OSECRIPT[ON Well ContractorNamc ft. R. - NC-- 3$ J �' et. NC Well Contractor Certification Number 15.OUTER CASING Ifor matti-rased wvNW OR LINER cif au Beside) ((]] _ MS FROM TO DIAMETER THICKNESS MATERIAL MATERIAL aCkit010 1;113 ft ft in_ Company Name IS.INNER CASING OR TUBING(geotheraalclosed-loan) MOM TO DIAMETER THICKNESS ' MATERIAL 2.Well Construction Permit 4: Q R R u ill. 3 16 S s List all applicable well permits(a.e.County,State,Variance,Injection,etc,f ! B. R. is. 3.Well Use(check well use): 17.SCREEN Water Supply Well; FROM _TO DIAMETER SLOT SIZE THICKNESS MATERIAL DAgricultural ❑Municipal/Public ft. a v 1 Cl in. ,Doti -3 t G Ci S ❑Geothermal(Heating/Cooling Supply) °Residential Water Supply(single) ft. rt. iO e C7lndustlial/Commereial ❑Residential Water Supply(shared) IS.GROUT FROM TO _ MATERIAL £MPIACEMENTMETHOD dr AMOUNT °Irrigation - 0 ft rYl ft (o3}- I ftevtyvk I ? Non-Water Supply Well: $ a �1 f'un,A t�,�t; k_ C-0.) flMonitorin °Recovery _ Injection Well: tR rt °Aquifer Recharge ❑Groundwater Remediation 14.SAND/GRAVEL PACKIffapttlicrtrlei FROM TO I MATERIAL EMPLACEMENT METHOD !]Aquifer Storage and Recovery °Salinity Barrier❑Aquifer Test ❑Stormwater Drainage - q ft, O ftft1 h. I I i — <4 ru"} +i ❑ExpenmentalTechnology ❑SubsidrnceCotttroJ 2iL DRILLING LOG rattach additional sheets iime-saryl ❑Geothermal(Closed Loop) ❑Tracer FROM TO DescwrnoN asks,b,nturis.mil/rock arsenals she.errs °Geothermal(Heating/CoolingReturn) DOl}ter(explain under 42i Remarks) 0 R t 3ft. 0:.-c,..e.ir,E /4 lake_.0 4.Date Well(s)Completed: 174 5"/,S Well IDf1 S V b R" J f t. L t.. St.Well Lncadtia: `i I R y rrt. 0.ct jY S i 11- ` l , y tt do tk ..sr,,vtz12y cla •_( Si 14- R ft. Facility/Owner Name Facility 1Ok(if applicable) CI11 �r - M) bQ. As %.to AJL. n ft. Physical dress,City, 21.REMARKS OINov Z P ti ?753 75 b q Jt 3 5- County Parcel Identification No.(PIN) Sb.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 2Z Cerlilleati (if well held,one 1st/long is sufficient) 35. 7e9175 ` N --71rVlk t3/° w /0 Id/.5_ S' of Certified Wall Contractor Date 6.Is(are)the well(s): P.1't!'e'manent or ❑Temporary By signing this form,1 hereby ceritfy that the well(s)sons(were)constructed Dr accordance with 15A NCAC 02C.0100 or 15A NCAC OK.0200 Well Construction Standards and that a 7.Is this a repair to au existing well: DYes or LItllo copy of this record has been provided to the well owner. If this is a repels,fill our known well construction informorion and esplain the notion orate repair wader I21 remarks section or on the hack of its farm. 23.Site diagram or additional well details: You may use the back of this page to provide additional well site details or well S.Number of welts conatr4Cttd: construction details. You may also attach additional pages if necessary, For multiple injectlon or non-winter"apply wells ONLY with the same construction.you can submit oacporrn. SUBMITTAL INSTUCTIONS 9.Total well depth below land surface: a9 6 (ft.) 24a.jior All Wells: Submit this form within 30 days of completion of well For multiple wails list all depths if di(jerent(example-3 a@2(10'and 2@I00) construction to the following. 10.Static water level below fop of casing: (ft,) Division of Water Resources,Information Processing Unit, Ifwater level it above casing,use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617 11.Borehole diameter. '0`)9— (In.) 24b.For Injection Wells ONLY: In addition to sending the form to the address in A 24a above, also submit a copy of this form within 30 days of completion of well 12.Well construction method: t''-}me-` 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 Matz Service Center,Raleigh,NC 27699-1636 24c.For Water Sapnly&Injection Wells: 13a.Yield(gpm) Method of teat: Also submit one copy of this form within 30 days of completion of 13b.Disinfection type. Amount: well stconstruction to the county health department of the county where -Farm GW-1 Nordt Carolina Department ofEnrirobment end Naneal Resources-Division of Water Resources Revised August 2013 Client: Energizer Boring ID: SVE-9 Project: Energizer Asheboro Date Started: 9/9/15 Site Location: Plant II Date Completed: 9/15/15 Project Number: 0314524 Latitude: TBD Logged By: Tom Naumann Longitude: TBD s Well a Lithology Lithologic Description Construction Well Construction Details m 0 1 o - _ Asphalt - Flushmount Steel Vault t 1 - - .r� : it 4" Stainless Steel Casing • Gravel _ :, i Portland/Bentonite Grout ML Reddish orange clayey SILT 3 - Bentonite Seal 4 7 {{!;r z r.r.r f1f1f R1r f,# 5 - rtirtir }J.5ii .r1r'.r I▪ A ,f49. 6 rrr1r P1'1;1 i. ftir r :.••sr~ 7 rr r 1.1•r.r. L1 •1..i: 1{ti:LI •- r::•y{ gig. - {ti..1{ ti••'h{1 r;r•r r•r• y• 1•HL r•r r•r•. r r•r•. try{ { ti•{ti r::•r r r• 9 _ f1 fti j 1 fti fti •..L. ti.y.ti W r:r:r tif;,ti� 10.25" Diameter Borehole _ ti.ti. y..,.ti 10 r1r1F .0 r1•r11' Ztgl f}j j '..r,'gti11 ML Tan fine sandy clayey SILT f'e~r 1r•;rti' {'••'r 1r'r" MStir1rti+ rtrLr 1 j1.r74 7. r.,.'�P f1 fti 13 - %I'S V.i55 1.1•ti r1r1J :t.1{1 .• J•r•r r•r•. f.r.r �'�r' Well Sand Filter Pack#1 r.`~� •.•%•% r•r•. 14 ZS 1rti gig: rVII- hrsr~ r~r~r rfpp; : 15 .~' ..•'.1. r{ { g 5Lr1l 1rO 1•L•1 16 r:r~r �r}r� - aV :P 4" Stainless Steel 0.005" Slot ?:::?.:::▪ ::1 Screen 17 —• .. rrti 7igf: Mil 18 r.,,•.: r.r• "gP:, ITA :1 rs•s, tiro..�� Zaa r.r.' {ti..-1 •••r.' "1r1 J•f•. 20 ram• At'6577: End Cap 21 Drilling Contractor: ARS Technologies Outer Casing Depth: NA Drilling Method: Hollow Stem Auger Total Depth (ft): 20 , Drilling Equipment: Geoprobe 7822DT Screened Interval: 5' -20' ' Responsible Professional: Chris Lacko (NC Driller#3516) Depth to Water(Final): TBD Borehole Diameter: 10.25" Elevation(msl): TBD ERM WELL CONSTRUCTION RECORD For Internal Use ONLY: This form can be used for single or multiple wells I.We Contractor Information: J L5i4 14._FROMAlERZOIITES DESCRIPTION l Well ContraetorNansc ii fC-- 3 5—f 6 it. ft. NC Well Colmaetw Certification Number IS 0t:TER CASING(for multi-rased*alb) OR LINER(EA tF btel FROM TO DIhiMITCR THICKNESS MAXI.RIM*.ft RS : 3 e- L s710 f cr0_5 rY ft ft. Ia. Company Name 16.INNER CASING OR TiJEING i ecnehe■mal dosed-loon) _ FROM TO DIAMETER TRICIONESS . MATERIAL 2.Well Construction Permit#: '} ft. fr. td in. _3 t/ S s List all applicable we(lpermils(i.e.County,State,Variance,lryecrion,etc) �d i - - — — ft ft. in. 3.Well Use(check well use): 17,SCREEN Water Supply Well: F1tOM TO DIAMETER SLOT SIZE THICKNESS MATERIAL ` °Agricultural °Municipal/Public I ft .)0 rt" in- '00 i _.-Sit - S 5 • °Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) it In. DIndustnal/Commercial °Residential Water Supply(shared) k&GROUT( - FROMTEl MATERIAL EMFIACEMiENT bicolor,&AMOUNT 4irripation — -- - U, ft. - ft. `i/0Jt 4 1 a aim l P Non-Water Supply Well: ��I1 — �1 I Monitoring °Recovery . s ft. tj ft. I I4nk D Ai k 9( U t - 7 Injection Well: - ft. ft. / DAquifer Recharge °Groundwater Remediation i9.SAND/GRAVEL I'ACfe,tif/appl lei FROM TO MATERIAL , EMFLACEMENTMETHOD °Aquifer Storage and Recovery ❑Satin"try Barrier °Aquifer Test DStormwater Drainage 1-1 ILy�� a y °Experimental Technology °Subsidence Control i 20.DRILLING LOG(attach additional aheves if ncee>stry1 °Geothermal(Closed Loop) °Tracer FROM TO IILS(RWTIQN Wear.Lsrese .mWrork we,drain aFsa rre.1 D.GeothermaI4Heatinp/CoolingRReturn) DOther(explain under#21Remarks) 0 R ,ti- ta:.ii.pit. l4.1p�Zall.. 4,Date Weli(s)Completed: t 1 SIC-Well ID# 5 I/ �—ft' , ft F(L L i I ft: ti ft: C a 7 t i Si I+- Sa.Well Location: . 4 ft.--c4 0ft .'Sr�.✓tt�.` Cld,ri-e/ St 1E- u. >n Fecility/OwnerNarns Facility 104(if applicable) ft. ft cl c[ V- ' .WAIJ bk. Jos , O A c ft. ft - Physical Address,City,and Zip ' 21_REMARKS - .0 Ck R 1 61-T il 175-3 7s`611 3 5 County Parcel Identification No.(PIN) Sit.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Ce ft ,7 a: (if well field,one let/long is sufficient) 15—,-7 6ci1 1 Cc N --7Qrt-fg I31a w (o0) 7-/5 Signature of ComSed Well Contractor bate 4.is(are)the well(*): Ed ermaseet or L I emporary By signing this farm,1 hereby certify that the well(*)nos(were)conrrrncicd in accordance- with ISA NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standard!and that a 7.Is this a repair to an existing well: °Yes or C"10 copy(phis record has been provided to the well owner. lfthis is a repoir,Jiit our known well caicwn.caan information and explain the nature aftha repair raider$21 remarks section or on the back of thisform. 23.Site diagram or additional well details: You may use the hack of this page to provide additional wall site details or wall 2i.Number of wells constructed: I. construction details. You may also attach additional pages if necessary. For multiple injection or non-water supply tiaear ONLY with the same eonsirucifan,you can me net oneinrm. SUBMITTAL INSTUC IONS 9.Total well depth below land surface: 4 O (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well or mahlple wells list all depths if-different(croarple-3@200'and 2€000) construction to the following: 10.Static water level below top of casing: _ (R,) Division of Water Resources,information Processing Unit, tf*sate,lavel is above casing,one"4" - 1617 Mail Service Center,Raleigh,NC 27699-1617 11.Borehole diameter: 10.1("i (hi.) 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 12.Well construction method: A W-)e fr' consuuction 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 Matt Service Center,Raleigh,NC 27699-1636 Ian.Yield(gpmj Method of test: 24c.For Water Supply&Injection Wells: Also submit one copy of this form within 30 days of completion of 13tx Disinfection type: Arno-aut Well construction to the county health department of the county where constructed. Form GW-I Noah Carolina Department of Environment and Natural Resources-Division of Water Resources Revised August 2013 Client: Energizer Boring ID: SVE-10 Project: Energizer Asheboro Date Started: 9/9/15 Site Location: Plant II Date Completed: 9/15/15 Project Number: 0314524 Latitude: TBD Logged By: Tom Naumann Lon itude: TBD Well a Lithology Lithologic Description Construction Well Construction Details al 0 0 - Concrete j Flushmount Steel Vault 1 5 E .v -- Gravel ;l :Mi� 4" Stainless Steel Casing 1> sal: Portland/Bentonite Grout 2 ML Reddish orange clayey SILT 3 — Bentonite Seal 4 1 — — H,,.. f1} Lf:} 1.1 ti.1.1 V.Y ti:ti4ti - f.:41• -tif.*ti r•s. 5 — r}r1• f+;:. • j1�i.' 1 f1N m 1�:�s ti ftilti 6 r▪�.1. stir ririr }j:r. rti:tir tig.i.: r:r{f• '..f111 7 1.1•• %.ti.1 :{{L:. ti�ti:1 r1:41:Fr ti1ti:1 . •▪• ti•1.1 8 — :1?1:. 1ti:1� .ti.tis• 7.0• :' 10.25" Diameter Borehole Jtiftir' 1?tiJti} $;:{:. ;r::{S 9 rtii tir• tirtir� i11fi ti:•.:ti} ML Tan fine sandy clayey SILT j.1{ Lr1.1} tit ti1L ti} 1.1•• 1.1.ti1 rtirlj0 SST::: j 111▪�i 11 — SST::: ti?ti;'•r :Se tii i▪.iS▪1 giSi4 Well Sand Filter Pack#1 r~::::v tir':r. 1.1•• .1.11 12 .1f1f f r▪ 1 �ti1ti f •.1ti fq I f1 f1 f ti f1 f1 5tii1:. tiltirti} }}fti f• .•svi 13 Sif.;f tisstir r~rti�• tiiti�ti} 4" Stainless Steel 0.005" Slot .'4�ti�' ti�ti{� Screen 14 - rtirtir• ti'.ti:tiS ;'{:.•Y tirti▪rti. j1f▪ i3 :...'1J1. 15 -' 11!11 410:: End Cap 16 Drilling Contractor: ARS Technologies Outer Casing Depth: NA Drilling Method: Hollow Stem Auger Total Depth (ft): 15 Drilling Equipment: Geoprobe 7822DT Screened Interval: 5'- 15' t i. Responsible Professional: Chris Lacko (NC Driller#3516) Depth to Water(Final): TBD Borehole Diameter: 10.25" Elevation (msl): TBD ERM WELL CONSTRUCTION RECORD For Internal Use ONLY: This form cart be used for single or maniple wells 1-/W��ell�(Contractor Information: - -- - CAI L 62.ckc, F MWATER ZONES TO DESCRIPTION _ Well ContmetorIlame ft ft Ai.C - _t15-) $- ft ft.NC Well Ccnnactor C e min,Number IS.OUTER CASING G(Tor muId cased wdta)OR LINER f irapp6swldk) ( + FROM To DIAMETER THICKNESS MATERIAL A❑ h f e- in•`L'+f 0Ci IRa S fE ft in. Company Name 16.INNER CASING OR TUBING(geothermal elased-loop) FROM TO DIAMETER `THICKNESS MATERIAL _ 2.Well Construction Permit# - 0 ft. S ft. " 41 in. 3(t S S List all appl:achie ve!!pe hies(Le.Connty,Slate,Variance,Injection,etc.) h R. in 3.Well Use(check well use): 17.SCREEN Water Supply Well: FROM TO_ DIAMETER ' SLOT SIZE THICKNESS MATERIAL )]Agricultural OMunicipal/Public ft lS ft L' in. .t?D5.` .3,(is "j 5 EGeothennal(Heating/Cooling Supply) DResidential Water Supply(single) R ft' la I ❑Industrial/Commercial Oltesidcntial Water Supply(shared) ls.GROUT kROM TO _ MATERIAL EssrLA`t turn I METHOD&AMOUNT (]irrigation U ft. '- ft r o,...) " 7/ Pet fix! {t Non-Water Supply Well: t7Monitoting ❑Recovery s ft. 1 _na, bit r it ci Fa-L.,' i-/ Injection Well; ft ft. 1 oAquifer Recharge QGmundwater Remediation L SAND/GRAVEL PACK(if applicable) _EL TO MATERIAL EMPLACEMFNTMETROD Ll Aquifer Storage and Recovety ❑Salinity Barrier r/ P rc I (,� DAquiferTest DStonnwaterDrainage ! it. R m]Experimental Technology ❑Subsidence Control att.DRILLING LOG pawl additiouri thews Ir aemtargl OGeothermal(Closed Loop) COTtacer PROM TO _ DESMPOON Imlay.bm a tt� dne.ttalradk mar. sin.etd.t t243cz✓t;t nerd 1H�:ttn k•^Cuolin Mum) C101hcr(explain under421 Remarks) f( ft' ft. S 4,Date Well(s)Completed: 7-(5-lc-Well ID# a u t, I f Sa.Well Location: f ft' 1�`t. �y Si !}- - facility/OnwnnerNeme fJ� [ �F{acilhyID/I(ifapplicable) ' l!f( ila v r gMJ b&. J H Vkto e— ft. - . Physical A $s,City,and Zip 21.REMARKS cki)Obaag _ 75-37s6,0.35-- County Parcel idcntificationNo,(PIN) Sb.Latitude and Longitude in degreeslminutes/seconds or decimal degrees: 22, • ti , (ifwcll field,one// ltaat/long is sufficient) �J /tr/� &_ 357,713 it E 'SG N —7/rVrir 131 a W — / iJ p` ]- if— s` of Certified Well Contractor Date 6.is(are)the well(s): S ermaneut or i]Temporary By signing thisfwm,1 hereby eer ifr that the well(s)was(were)constructed in accordance with 15,4 NCAC 02C.0100 or 1SA NCAC 02C.0200 Well Construction Standards and that a 7.Is tins a repair to an existing well: DYes or Otto copy of this record has been provided to the welt owner. tjthis is a repair,fill oat known well construction tajormatfm and aeplain the nature of the repair wider 1i21 remarks section or on the back ofthisjorni. 23.Site diagram or additional well details: ii You may use the back of this page to provide additional well site details or well IL Number of wells constructed: L_ construction details. You may also attach additional pages if necessary_ For multiple infection or non-Hater supply wells ONLY with the same conrinrrdam you can submit one fame. SUBMITTAL 1NSTUCCIONS 9.Total well depth below land sedateI 5- (ft.) 24a.Por Ali Wells: Submit this form within 30 days of completion of well 1 ormulaple wells list all depths tjd(9erent(example-3@200'and 2(100) construction to the following: 10.Static water level below top of easing: (ft,) Division of Water Resources,Information Processing Unit, If water level is above easing,use"+" 1617 Mail Service Cutter,Raleigh,NC 27699-1617 I1.Borehole diameter: (0.? (in.) 24b.For Injection Wells ONLY; in addition to sending the form to the address in A 24a above.also submit a copy of this farm within 30 days of Completion of well l2.Well construction method: bier- construction to the following: (i.e.auger,meaty,sable,direct pink 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 Welts: — 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. Fort GW-I Noah Carolina Department of Eoviromment and Natural Removes-Division of WaterRwcowres Revised August 2011 Client: Energizer Boring ID: SVE-11 Project: Energizer Asheboro Date Started: 9/23/15 Site Location: Plant II Date Completed: 9/25/15 Project Number: 0314524 Latitude: TBD Logged By: Tom Naumann - Longitude: TBD t Well �, Lithology Lithologic Description Construction Well Construction Details o. m 0 0 Concrete Flushmount Steel Vault :•: :.".: ` _ Gravel ;wr 4" Stainless Steel Casing 2 f r: Portland/Bentonite Grout ML Reddish orange clayey SILT 4 Bentonite Seal Yi.�}.;: ljtiftiS r.p▪- - Lftiwr3 op.-. titi• :;,..r.Yt 'r.r.r ti•�. ititittil alp:. 4%teti ... rr▪:r Y1 iP. !RR. ftif.fS 10 rr}▪r s<<' r I Pr}r}r r=iir•�. .p:i f j'1f: .rtirtir .tir''r''. �r%rtir r}}ti}ti. :pp:. ' � ' 10.25" Diameter Borehole Wahl. ctirtir� 12 H Wahl. kit :r{r{: r{{{rti 6 .....r ryrlirs d1rtir ii.!2: ML Tan fine sandy clayey SILT r r•r•r•��� MSS: 14 :rtidti Stir rti 0..rtir rtiryrti ,f1f'.r =1f1r'L 'l.;r.•.r Satyr:: ;r;r.r r.r•r•. Well Sand Filter Pack#1 stir{r :ti:+.:ti 16 !WO FM:'Stine :`}:, WA% PPP. .r rtitir Stir{r.. r r•r•r•1r1. 'r'A: r1r . 18 :rtirtir r1r; ;.r1r c1rdrti rti, 4" Stainless Steel 0 005" Slot - I rtr r 'Zig. r'�'�' Screen rLr1r r{{{rti , .:455S 'MS 20 :AA? F:::?$ 1 r•. 1r5� rlrti H LrLr rlrlrti RR.? r•r•r•, ':▪ r11 r:11.••� r{?ti? �tirLrti r•.r•.: rsrlrti r{Sir aff." 22 End Cap 24 Drilling Contractor: ARS Technologies Outer Casing Depth: NA Drilling Method: Hollow Stem Auger Total Depth (ft): 22 Drilling Equipment: Geoprobe 7822DT Screened Interval: 7'-22' Kb...0,— Responsible Professional: Chris Lacko(NC Driller#3516) Depth to Water(Final): TBD Borehole Diameter: 10.25" Elevation(msl): TBD tRM WELL CONSTRUCTION RECORD Forinternal use ONLY: This form can be used for single or multiple wells 1.Well Contractor information:CA - / 4l$ 401-Gi`0 _U.WATER ZONES [•'ROM TO DESCRIPTION Well Contractor Name rt. it. 41 C r 3 c J_j ft. ft. NC Well Contractor CertificationNumber IS.OUTER CASING Star saaloi-rased wells)PR LINER(ifapplicable) �7 l J PROM TO DE-METER THICKNESS _ustrenLiL M l s_ e'r1,12 010 1 IL ft. in. Company Name , I6.:INNER CASING OR TUBING(geotteernadclased-loos[ FROM TO DIAMETER THICKNESS I MMSRJA1. 2.Well Construction Permit 0: C) ft. 3 ft. ei in. 3 i I s 5 List all applicable well permits(i.e.County,State.Variance,Injection,arc,) - ft. R. - 3.Well Use(check well use): I7.SCREEN water supply Wells ,FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL ❑Agricultural Municipal/Public „ -7 tL Q7d ft°... 11 O nn. 'V a .le 5 ❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0' ft' 1°.-- alndustrial/Commercial []Residential WaterSupply(shared) t$.GRo1rr PROhI TO MATERIAL _EMPLACEMENT METHOD i¢ANOINT (7iRtration (�t V/'► f- 3 €t. Non-Water Supply Well: 7 9 :l - 7 I e rvt + k OMonitoring ClRecovery 3ft 5 rt. 1 rk,-6.a.ti k _ Cl ►J 1ct t 7 Injection Well: _ ft _ ft. 7 ❑Aquifer Recharge °GroundwaterRemediatioa 19.SANDIGRAVEL PACK(ifappli5ble) °Aquifer Storage and Recovery Malady Barrier PROM TO MATERIAL rMPtaceMerrr METHOD Malady5— ft. a() fr. 5, ,41-I 1 frL,,Ji-- ❑Aquifer Test OStormwater Drainage DExperimental Technology tJSubsidence Control 20.DRILLIM JAG(attach additional slats if ecexssaryj °Geothermal(Closed Loop) Mincer moat TO DESCRIPTION{guise.hvdxrc rniYree L Inv.&rain rue.etc.} D(icothcnnalilicattrvCool trig Return) ❑Other(explain tmder#21 Remarks) , () ft. • IL (Si nt .0Ae.. I I ,pity/1.- 4.Date Well(s)Completed: 9 c)S'"/SWeil ID# -3 if&i I ' 1 ft. F(`L- I `t `i ft. C L.�e} ..I !S i I4- S,af.`Wtell Location: ft' '1 f. .y C�O'10,° Lib-�.f 1�j: f!- t i I ft �t ft. Facility/OwnerName Facility WDli(if applicable) Li 1r A(1- iSi� Art/ b . AS14 f K D A - -_ ft Physical Address,City,and Zip 21.REMARKS ck0 t+?t� Leg 77537c 111;•35 County Pared Identification No.(PIN) Sb.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.C tine ton: (if well field.one tatltong is sufficient) T (,79i7 ' N —7q-VIE I3'-I° W .• '. L) t8--d7-15— Si moire of Certified Well Contractor ate 6.is(are)the wells): fthrmanent or DTemporaty By signing this farm,I hereby cent*tine the vell(s)was(were) onairacted In accordance with l5A].'CAC 02C.AIOO or 15.4 NCAC 02C.020 Well Climetion Starr and that a 7.1s this a repair to an existing well: C]Yes or fro copy nights record has been provided to the well owner. if this is a repair,fill vet known well cannstnrcrion infornafloo and explain the nature of me repair tinder t21 mom*section or on the back o%thisfonn. 23.Site diagram or additional well details: You may use the back of this page to provide additional well site details or well IL Number of wells constructed: i construction details. You may also attach additional pages if necessary_ For taulsip/e injection or iron-water supply Ire&ONLY with the some consdacrlon,you can submit one fileal SUBMITTAL INSTUCTIONS 9.Total well depth below land surface: 9 t (ff,) 24a. For All Wells: Submit this form within 30 days of completion of well For multiple was list all depths ifdiffetent(esample-3@,200'atul2©100') construction to the following: 10.Static water level below top°leasing: (ft.) Division of Water Resources,Information Processing Unit, Ifnoler level is above casing.rue"+" 1617 Mail Service Center,Raleigh,NC 27699-1617 11.Borehole diameter: I 0"d c1 (tn.) 24b.For Infection Wells ONLY: in addition to sending the form to the address in tt 24a above. also submit a copy of this fart within 30 days of completion of well 12.Well construction method: 4"f t"'t -f- 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 Main Service Center,Raleigh,NC 27699-1636 13a Yield(gpm) Method of test 2dr.For Water SupRly&injection Welts: Also submit one copy of this form within 30 days of completion of k 13b..Disinfection type: _ Amount: - well construction to the county health department of the county where constructed. Form OW--1 North Carolina Divestment oflnvironment and Nturaal Resources—Division of Water Resources Revised August 2013 Client: Energizer Boring ID: SVE-12 Project: Energizer Asheboro Date Started: 10/12/15 Site Location: Plant II Date Completed: 10/13/15 Project Number: 0314524 Latitude: TBD Logged By: Tom Naumann Longitude: TBD Well It Lithology Lithologic Description Construction Well Construction Details o 0 a - Concrete Flush mount Steel Vault Gravel lI 4" Stainless Steel Casing 2 Portland/Bentonite Grout i ML Reddish orange clayey SILT 4 Bentonite Seal -,- r rit 'or116 -- rr ~r1r.1•� Gfti••.•1— ' ft 11 1d�!~8 -- 4f +111 f=. 0.fSf :ii:S!��r sf:fy �tti:�f .' .r.... 1 0 — r:r.r ti1.r. ftiY4r• .'rVR jr''rPf* .v:A ri ?f1' '▪:" y 10.25" Diameter Borehole 12 — ;tirtir ;r{04 f:rg r ZR Lrr�y r1r • - tirtir ML Tan fine sandy clayey SILT r:�Ltir1:;ti; if.i ...f1:14 vps 1:.:,yy ti• .ti. � 1• 1•1� rti:1: _{{1 q • co 1.r1.;i Well Sand Filter Pack#1 1▪.1▪• 1•S• *PS lail 18 r;f+f :;.3 f •.•ti• 4" Stainless Steel 0.005" Slot •- rtir1r r•r .1.7 ... i f f •Lr;'y Screen ririr -4%1:- ti.ti. •ti gi lti f1•r. ;s:A 20 — r•1i{i tir.r� :::•?: .4:4.tip ''1.:. 1..", :▪:•1. `r1:ti .1. ti.L•ti - �T :ti:.:: :.l{:{{ 22 '�'Y tirtirti End Cap 24 Drilling Contractor: ARS Technologies Outer Casing Depth: NA I Drilling Method: Hollow Stem Auger Total Depth (ft): 22 Drilling Equipment: Geoprobe 7822DT Screened Interval: 7'-22' , ',, 4. Responsible Professional: Chris Lacko(NC Driller#3516) Depth to Water(Final): TBD Borehole Diameter: 10.25" Elevation (msl): TBD ERM WELL CONSTRUCTION RECORD ForInternal Use ONLY; 1 This form can he used for single or multiple wells I.jW�ell Contractor Information: T A / t+f J s 14.WATER ZONES 1 (1iE FROM TO DESCRIPTION Well Contractor Name ft ft VC-a 15.OUTER CASINO Mar multi-eased welts!OR LINER Of so leahle} NCCWell CaruractrgCcrfifictdimtNrmb� FROM TO 1 DIAMETER THICKNESS I MATERIAL M S le.cL 0/s)7 lac ft • ft itr Company Name _1t.INNER CASING OR TUBING(geothermal dosed loan ! - FROM ' TO _ DIAMETER THICKNESS KATMRMAI. 2.Well Construction Permit#: it 3(1 5 5 List all applicable well permits(le.County,Slate,Variance,Injection,ercj tz 7 - - ft. ft. ht. 3.Well Use(check well use): _17.SCREEN Water Supply Well: - ,FROM TO , DIAMETER SLOTS= TIACtein.Ss MATERAAAI. °Agricultural °Municipal/Public -7 It. c753 IL_ 11 in. ,oo;- ;Sit S 5 OGeothermal(Heating/Cooling Supply) DRe;;identiat Water Supply(single) _ ft' ft' In DlndustrialiCommercial °Residential Water Supply(shared) t&GkOtrt PROM TO _ MATERIAL EMPLACEM@NTMEtHOD&amooe r Olrnastion r U ft: ft. Non Water Supply Well: `i` �al p t�i 'Ith`I}tnran;g. DRecoveryft. -3\nitr k. csfr_os{-' , R ft. injection Well: t]Aqu:fix Redlargc OGrounilwaterRemuliutiort 19SAND/GRAVELPACK(ifapplicable) FROM TO ' MATERIAL EMPLACEMENT METHOD i.Atte;for Stc.arrarid Rectt•,•er).- °Sall inita Battier f' scu ❑Aquifer Test OStonnwaler Drainage a- ft' aa' ft- M1ck i�1 ci reko:-I-1 is tr. OEx7uerimentsi Technology ©Subsidence Control 20.DRILLING LOG(attach additional sheets ifateeasaryl DGeothermal(Closed Loop) °Tracer FROM TO DESCRIPTION trdsr,hmiloerti sitlrack type.grain sue:est.1 °Geothermal(Hearin 'Cooling Return) °Other(explain under#21 Remarks) ft. , c ft. C17 yr,,._e_}.t ' 4,p(,tc.d- . 4.Date Weil(s)Completed: 4)-13-15—Well ID# S i/c 0 ` 4 ft. ft _ I L c_. fr ft, Llct-7 -f S i I i- lk.Wen Location: . `1{q LI o/-'_ .5 re.,,,,k,f Ct:,A .rf. .. �?, 14- it. Faccilityl/OwnerName Facility ID*(if applicable) fr. iL t fit't( �C (3,' /° bk. As Ni to 1u fr. ft. Physical ,City,and Zip al.REMARKS U\ttl)bL ' 775-37s610.35- Cooney Parcel identification No.(PIN) Sb.Latitude and Longitude in degrees/urinates/seconds or decimal degrees: 22,Certifica6 Orwell field,one tazflongis suifieiem) 35-,7e9Ylc* N *-7¢.VI, i31n W to-a 7-/c Si a of Certified Well Contractor Date 6.Is(are)the well(s): Eifermanent or °Temporary By signing this form,I hereby certify that the well(t)nor(were)constructed in accordance with 15A NCAC 02C.0100 or 154 NCAC 02C.0200 Well Construction Standards end that a 7.Is this a repair to an existing well: °Yes or 1 1iQo copy of this record has been provided to the well owner. If this is a repair,jilt out known wall construction infortnallon and explain the nature of the repair under n21 remarks section or on the bock of thisform. 23.Site diagram or additional well details: You may use the back of this page to provide additional well site details or well S.Number of was constructed: construction details. You may also attach additional pages if necnscary. Far multiple injection or non-water supply wells OPliFwith lhesaste corsttuciina,y»a con submit one form. SUBMITTAL INSi'UCTIONS 9.Total Well depth below land surfaces .t Q (ft) 24a. For Ail Wells: Submit this form within 30 days of completion of well For multiple walls list all depths ifd(fferen:(example-3(200'and 2 idO) construction to thefollowing: 10.Static water level below top of casing: (ft.) Division of WaterResonrces,Information Processing Unit, ifwater level is above easing use"-''• 1617 Mail Service Center,Raleigh,NC 27699-1617 11.Borehole diameter: f 0')•1'1 Om) 24h.Fpr Injection Wells ONLY: In addition to sending the font to the address in A 24a above,also submit a copy of this form within 30 days of completion of well 12.Well construction method: 4-4')..er construction to the following: (i.e.auger,runny,cable,diractpush,etc.! Division.of Water Resources,Underground Injection Control Program, FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Ratelgh,NC 27699-1636 24e.For Water Supply&Injection Was: 13a Yield(»n) Method of test. 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 fi W-I Norte,Carolina Departmear of Environnncm and Natural Resources-Division of Water Reseuraes Revised August 2013 Client: Energizer Boring ID: SVE-13 Project: Energizer Asheboro Date Started: 10/8/15 Site Location: Plant II Date Completed: 10/9/15 Project Number: 0314524 Latitude: TBD Logged By: Tom Naumann Lon itude: TBD t Well Z. Lithology Lithologic Description Construction Well Construction Details a a) 0 a Concrete - — Flushmount Steel Vault . L:::; -- Gravel = 4" Stainless Steel Casing 2 — I i.: Portland/Bentonite Grout - ML Reddish orange clayey SILT 4 Bentonite Seal %r; J ' IVA?: r1r1r1 6 — Si:A y f}fti Lti11.J14� 1..1.11 �1�1•t Sf•r•! i.J•J H {,S: Zr,r� :1f1f. :AS:. 39 1ti•41 1.Hti1 f�fyr f{f�.• ?1S "ti}' fL.. ffJaC Tff Ftif f 1 D :ti t1 �Yyy;rye r r•r J.� — 11:73,r1r tiftiJti: iSiS ti•ti 1 .;1rr ;,„:, 10.25" Diameter Borehole r•}•r r•r•. 12 rtirr tir:r:, C1j1i ?AV. r•f J•r.. 51S1S 14J•ti ML Tan fine sandy clayey SILT WE.' J.r.. 1•R.ti J•J f•r•. 14 1 Re 1 .1' r1:1: 1;1:ti f1:1J 1J1:1, i PP; J•r.. 1 8r:47% Lrtif.. ;;: ::w Well Sand Filter Pack#1 16 :"1:1r 1f:1' PP; 1f1rti 1 r••J J f J~ :I•7J tirlrti Sig...: ZR:i 18 i 11•.•ti f1�1� 1:4"e• 4" " Stainless Steel 0.005 Slot - }tir1r giSi Screen J:rJ 11f.•:• dti1tiJ 1f111� 1.g ti•ti•11 11r1r 1 f•'r•'= 20 lij ti�1 f1� ti:•1•tif :}}}:: -1 11tw 11A 22 r.415 f:rs14 End Cap 1 i k 24 • Drilling Contractor: ARS Technologies Outer Casing Depth: NA Drilling Method: Hollow Stem Auger Total Depth (ft): 22 Drilling Equipment: Geoprobe 7822DT Screened Interval: 7'-22' Responsible Professional: Chris Lacko(NC Driller#3516) Depth to Water(Final): TBD Borehole Diameter: 10.25" Elevation (msl): TBD ERM WELL CONSTRUCTION RECORD For Internal Use ONLY: This form can be used for single or multiple wells I.Well,Contractor Information: ak I t /L4J Gl It WATER ZONES ( l FROM TO DESCRIPTION Well Contractor NemO D EG o f ft t JC-' 3 s ! f NC Well Counselor Certification Numbs 15 OUTER CASING(fgr ankt.a sed wail*OR LINER F'd an livable} PROM TO DIAMETER THICKNESS ' MATERIAL. A R S ie.�k(Lb i0cjb .c it. ft." in. Company Name 16..INNER CASING OR TUBING Geothermal etaeddaen) lntoM To DIAMETER THICKNESS MATERIAL 2.Well Construction Permit#: 4 n. -7 ft LI in. ...zit 3 S 5 avail applicable well permits(Le County,State,Variance,Injection,ere) ft. ft, hi. 3.Well Use(check well use): 1 17.SCREEN Water Supply Well; , FROM TO ttram£7RR_SLOTS€ZE _TetimPiESI _MATERIAL , ❑Agricultural QMimicipal/Pubiic n. d art Li ta. 'VD c , r )b 6 5 _ . ❑Geothermal(Heating/Cooling Supply) °Residential Waters l sine) rr' is. � 81 g PPY1 Supply � _ Olndustrial/Commercial °Residential Water Supply(shared) fi-get IT�PRt)R TG MATERIAL Eq./PL10EMENr MErnOD&AMOUNT Dlmgation 0 ft. Non--Water Supply Weil �] ft. + (� 1` --Lit Mtn l • Q ft. 5- Lt_ cif e, NlonitoriDg L]Kecovery -2) _ S nl ti�>.I � tJ l Injection Well: ft. It. ❑Aquifer Recharge °Groundwater Remediatiort 19 SAND/GRAYEL YACiUtfaiplieablel FROM 1 TO i fitATERIAL EMPL-10EaterfrstETHOn l7Aquifer Storage and Recovery °Salinity Barrier 5- ft Ott ft , OnC:t,-IJ--I c ra,,,i-I °Aquifer Test DStormwater Drainage • l • °Experimental Technology OStabsidence Control le,DRILLING LOG(attach additional abcetsi(.ecmsa ) ❑Geothermal(Closed Loop) CtTracer FROM _ To nEs4'nirno-rows;.hanaei?-s..tot iud;sje. i.Omelet ClGeothetmel1HeatingiCooling Return) °Other(explain under#21 Remarks) Q ft . tj 2 (1.,;,�_:z k r' / .A pies 1 4.Date Well(s)Completed: /O-`1-/ Wells 110 5 6/E. ! 4 L , Sa Well Locaiirm: ft LI ., �et c g 5 i 1 W4 I 9 11. ail- ft tt& C.( it,s:J1 ft. fa `'- Faciility/Onwneer 1Name� �)f h g1 064 Ftacility ID¢A(if applicable) CI!f 1i\S Zs "ilMfi bk. AS06 ht'tt.o A/..- ft ft Physical A dress.City,and Zip 21.REMARKS . IIJDOLNI 77537c 1'Ji 35 County Posed lde tifieatienNo.(PIN) 5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 21 C - es (if welt field,one ladloug is sufficient) / //, 3�'.-76q`[ 7sc H — e?rvl ' l-3'/a IY 7-I Si ure of Certified Well Contractor Date 6.Is(are)the well(s): 1 ermanent or 13Temporary By signing this fom,I hereby verge that the well(r)sow(Irma)rarutraered in accord ntee with 15A NCAC 02C.0100 or ISA NCAC 02C.0200 Well Construction Ste danis and that a 7.Is this a repair to an existing well: CYas or Etttto copy ofthis recmrd love been provided to the welt owner. 1f this is arepeio Jill cart knossw wilt construction information and explain the nature afthe repaer wider 02i remarks section or on the back of Ndsfonn. 23.Site diagram or additional well details: You may use the back of this page to provide additional well site details or well $Number of wells constructed; _ construction details. You may also attach additional pages if necessary. For wultiple injeenon or non-water supply wells OP/LVwith the same cm Tott,;rau can submit one fame 5UBM11TAI.1NS1UCTIONS 9.Total well depth below land outface: &a (f.) 249.for Ail Wells: Submit this form within 30 days of completion of well For multiple wells list all depths Y.dijfirent(example-3[tt)200`a t12 t( l00') construction to the following: 10.Static water level below top of casing: (ft) Division of Water Resources,Information Processing Unit, If water level is above casing,use" " 1617 Mail Service Center,Raleigh,NC 21699-1617 11.Borehole diameter: 10')4 (in.) 24b.For Infection Wells ONLY: In adddition to sending the form to the address in `` 24a above,also submit a copy of this form within 30 days of completion of well 12.Well construction method: �1 i.rh'E IC construction to the following (i.e.auger,rotary,cable,duvet push,me.) Division of Water Resources,Underground Injection Control Program. FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 276994636 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 OW I North Carolina Department ofExtvitormeat and Natural R,sources-Division of WaterRemaces Revised August 20t3 Client: Energizer Boring ID: SVE-14 Project: Energizer Asheboro Date Started: 9/30/15 Site Location: Plant II Date Completed: 10/1/15 Project Number: 0314524 Latitude: TBD Logged By: Tom Naumann Lon itude: TBD Well },a Lithology Lithologic Description Construction Well Construction Details m 0 0 Concrete Flushmount Steel Vault %ye• - 1 — — — Gravel - 4" Stainless Steel Casing 2 — Portland/Bentonite Grout ML Reddish orange clayey SILT 4 Bentonite Seal 1- - _ ,. L•ti • •i• �ti1ti tif{f1 6 — r1r1r :5:r1 Slitifti.i1 i.i. 1 1t RR: rctl 1tiSb tVgeti d▪•d•d ' 1 riridr ei ti ti r.r. 1 0 — ririr r1" ti ir▪id :'V.T rd1.�•:1' ?AV. 5:45 ?AP 10.25" Diameter Borehole 12 rti{1r tir,5;ti r1r1r r%� r•r•r r.r• 1t'.:• }j„j. ML Tan fine sandy clayey SILT •i•1- P▪Pr ..... '"0., irlr• 1 4 r1r :ryr% rr1r etil ..................1. ti fti fti d..1 f ft f'L. f1r1r t•i•i° Well Sand Filter Pack#1 16 —' PP:. 1r1r14 PP; 1ri'•ti� {r{r ;AN — Y rti ti.4411 1r r1� 18 1▪rtir tir.r r;1�i ;f;rl 4" Stainless Steel 0.005" Slot ti... ti.....}! f r l �1'til Screen YIP.; 2:1.ti 20 — P▪P:- Lrtr r'r1r 1r1r1 1f ._. Set*: 1r1r11 }irti :r•.r_ RR:: .. RR:: 22 i r}ryr' iisi „r End Cap 24 Drilling Contractor: ARS Technologies Outer Casing Depth: NA Drilling Method: Hollow Stem Auger Total Depth (ft): 22 k::. \,......._ ii, Drilling Equipment: Geoprobe 7822DT Screened Interval: 7'-22' Responsible Professional: Chris Lacko(NC Driller#3516) Depth to Water(Final): TBD Borehole Diameter: 10.25" Elevation (msl): TBD ERM WELL CONSTRUCTION RECORD 'Far Internal Use ONLY: This form can housed far single ormadliple wells 1.Well Contractor Information: r15 ta. t CD 14.FROM WATER ZONES M TO DESCRIPTION Well Contractor Name R ft. ft. ft. VC-' S-1 C. Id.OUTER CASING(for atultionedwelts OR LINER(ifs:: ble) NC Well Contractor CettiSattiortNumber FROM TO DIAMETER THICKNESS MATERIAL A R_S f e€L.Vt.oL,) o-4 ft. ft in. Co/many-Name 16.INNER CASING OR TIJB1NGII.m1hormaIchned-loovl _ FROM TO DIAMETER TBICET41SS MATERIAL 2.Weil Construction Permit 0: 0 it. 7 ft di in. f c s LLci all applicable well permits(i.e.Canny.State.Variance,Injection,etc.) ft.- ft. is 3.Well Use(check well use): 17.SCREEN Water Supply Weil: .FROM TO DIAMETER SIOTSIZE ` THICKNESS MATERIAL ElAgricultural t7Municipal/Pubiic 7 iti i r-ft Zn. r Ct p t. ..sit S S °Geothermal(Heating/Cooling Supply) °Residential Water Supply(singled ft. I° —OIndustrial/Commercial 0 Residential Watcr Supply(shared) I&GRUUT FROM T'Q MATERIAL EMPLACEMENT METMIOD&AMOUNT I.Obligation it. ft. Non-Water Supply Well: ^a� f 9/`�i" r'Z M j' ()Monitoring °Recovery ) , 5— it' Plea.\not k 9 &U �/c I- Injection Well: - - ft. 1 °Aquifer Recharge °Groundwater Rem ediation 19.SAND/GRAVEL FACIE(if walkable/ °Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEl1IENTMETYIOD ^:gat it Test O tnmtwatrra:Dulet�!e C— a 01c7- ft: S'ou'sAa 44-i 9fu..)<4 R °Experimental Technology C3Subsidcnre Conlrid 20.DRJLt tG LOG(Much addirlaval sbce4 if oca yl OL..et*l n,'nurl iChased Ixrcp) Oiracer FROM TO , DES I1'r'IQN(.. st,isentnes4 r.Wrnck type.era ria.etr.L CGeethermal t Iteatiot/Cooling Return) LiOther(c tplain wader.ll_I tiemali. ) 0' IL = c it 4.Date Well(s)Completed: /v-1-I S well ID# 5 If (I i - -U.t Sa Well Location: 9 rt 1 IL L.J IL C is-.t.:I Si I f I . a cl rk `i t•..rn42 Cif f.e7 Si I f ft. II Facility/Owner Name Facility int(if applicable) ft. LI[ei AkV gAI .b . AS1-I6 ►;* .v A c-- ft ft Physical A & s,City,and Zip IL REMARKS D'V DoLPil /753'ICI 1 l 3 • Caunly Parcel IdentilcationNo.(PIN) Sb,Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Cerdticati (if well field,one tatdong is sufficient) 35-, 7&91 7SO N ...w7¢r' !& (3'1 w _ wt.-t /O127-15 s. ofCenifad Wall Contractor Date 6.is(are)the well(s): (lermauent or CiTemporary By signing this form,/hereby certify that the well(c)inn'(were)constructed in accordance with ISA NCAC 02C.0100 or 15A NCAC OZC.0.200 Welt Construction Standards and that a 7.Is this a repair to an existing well: t1Yes or ego copy chins record has been provided to the well owner. If this is a repair,fell out.brown well construction it fannation and explain'fir nature of the repair under 021 remarks section or on the back ofrhtsform. 23,Site diagram or additional well details: You may use the berlr of this pa a to provide additional well site details or well 8.Number*Twainconstructed: construction details. You may also attach additional pages if necessary For multiple injection or non-water supply wells ONLY with the woe cansdaeffon you con submitoneform. SUBMITTAL IIYSTUCTIONS 9.Total well depth below land surface: t) a- (ft) 24a. For All Wells: Submit this form within 30 days of completion of well For multiple wells list all depths IIfdiiferent(example-3(a)200'and 2@l00') construction to the following: 10.Static water level below top cleating: (ft.) Division of Water Resources.Information Processing Unit, Ifwater Iced is above casing.use"4" 1617 Mail Service Center,Raleigh,NC 27699-1617 11.Borehole diameter:� f 0`3 4 (In,) 24b.For Iniection Wells ONLY: In addition to sending the form to the address in !t 24aabove,also submit a copy of this form within 30 days of completion of well 12.Well construction method: A *-4')Ce" constntction to the following: (i.e.auger.rotary.cable,direct posh,eta.) Division of Water Resources.Underground Injection Control Program, FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636 24c.For Water Supply/&Ielection Wells: 132 Yield(gpm) method of test. 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. Perm OW-I North Carolina Department ofEnvironment and Natural Resources-Division of WeterResources Revisal August 2013 Client: Energizer Boring ID: SVE-15 Project: Energizer Asheboro Date Started: 9/12/15 Site Location: Plant II Date Completed: 9/13/15 Project Number: 0314524 Latitude: TBD Logged By: Tom Naumann Lon itude: TBD r Well a Lithology Lithologic Description Construction Well Construction Details m - 1 - Concrete ,; Flushmount Steel Vault •1 . •€i :ti:{:-r:. -- Gravel i 4" Stainless Steel Casing 2 ML Reddish orange clayey SILT .- Portland/Bentonite Grout 3 Bentonite Seal 4 ?`r ¢. .p ir,r;rti 5 ??{ {?1?'.1 5 ??t :::::::.15iSiSI 1 _ ..,..-..z L•L•Lt 6 ?1 0 ?S?'.1 ?•r•r. J.J•� ?•r1`• JLr~ 1.':::::; mid E ?{?{?• 1?1?ti 7 - ;�r�' ;. r}• L.L,• L,L•L ?1?.?• ?1?ti ▪L•L• L•L.L 8 ???� L?L?ti — < r•r•r r•r. L•L•:. ti•.tr. 10.25" Diameter Borehole ML Tan fine sandy clayey SILT ?1?▪ 1▪ r• ;?la PP:: :V.T.' J▪L••,Lf Lj tif1 L.L.• L••.•L 10 •rr :Al% i ?1?1?• 551?1 J r~}~r Lrtirb 11 —-1 Sig* ::ti i r 11*1 ll▪al f:r:r� :frf: Well Sand Filter Pack#1 I ?▪?tir illi 12 j ?L?Lr?? 1 • 'sins• rLr, L•L•• 1•L•L f1.J�•til cssA 1 3 L•L•• L•L•L rL'Lr :TPA 4" Stainless Steel 0.005" Slot .J••,tif •.fLfL .L•L•• L•L,L � .1.•..• .L•L. Screen 14 -r1?1?' STA ?1?j 1??ti ?1?{S". {?1?ti '?1?1?, 1?1?ti Er r r 1r:r 15 - . . . t rwlr6rfn: End Cap 16 Drilling Contractor: ARS Technologies Outer Casing Depth: NA Drilling Method: Hollow Stem Auger Total Depth (ft): 15 Drilling Equipment: Geoprobe 7822DT Screened Interval: 5'- 15' K''`,......1— Responsible Professional: Chris Lacko (NC Driller#3516) Depth to Water(Final): TBD Borehole Diameter: 10.25" Elevation (msl): TBD ERM WELL CONSTRUCTION RECORD For Internal Use ONLY: This form can be used for single or multiple wells 1.Well,Contractor Information: i Cikris tOLLAL 14.WATER ZONES - PROM TO DESCRIPTION Well ConOactor1 amc Well H. ft.A 1C 1S.OUTER CASINO(for multi-eased wells)OR LINER Of ap lice bit) NC Well Contractor Certification Number _FROM TO DIAMEFER THICKNESS MATERIAL i t.S 1 Lir.b19 e t'sQS -- ft . - rt. - m. Company Name / lb.iNNER.CASING OR TUBING(gildsman dosed-laopl FROM TO DIAMETER THICKNESS MATERIAL 2.Well Construction Permit#: 0 ft- `5— ft ci in. ,al( c 5 List all applicable welt permits(i.e.County,State.Variance.Injection.etc.) - I 3.Well Use(check well use): 17.SCREEN Water Supply Well; FROM TO DIAMETER. Si.OTsIZE THICENESS ' MATERIAL °Agricultural OMunicipaUPublic , c it. /5--ft. 1` in. `00tr .3(ta .S 5 ❑Geothermal(Heating/CoolingSupply) OResidential Water Supply(single) ft. ft in. ❑industrial/Commercial l7Rcsidcntial Water Supply(shared) FROM TO MATERIAL t+"•PL CEMENTMETTIOD&AMOUNT ❑Irrigation 0ft" ft �' ` Non-Water Supply Well: - 9 ir.)J 11 R►►4!r` ; 4 _l3Monitoring °Recovery ft. 1 fG 4 a m.l t i J A. Injection Well: R ft _ °Aquifer Recharge DGroundwaterRenrediation 19.SANDIGRAVEL PACK Ofapplkohle) FROM TO MATERIAL. L EMPLACEMENTME7HOD °Aquifer Storage and Recovery °Salinity Barrier - !' DAquiferTcst OStomtwaterDrainage ft. ft >cA rY lci� s ft. ft. 3 0Experimentai Technology °Subsidence Control t 20.DRILLING LOG(atmch additional alter.Ifo rearatyl CtGeothermal(Closed Loop) °Tracer FROM TO DESCRIPTION lryla,barde .*almar.yr.grain AMIN arat °Geothermal(Heating/CoolingReturn) °Other(explain under#21 Remarks)_ 0 ft' ° 5_ D' CL.� ;.p k.e // Seta.(I d.Date Well(s)Completed: 1-13 IS-Well w# 5 U'E I tr. u ft.Sit.Well Location: it' 9 (lc - s! y(R . (d "_ i_5`-"_ ,� ,e4(it, ct(.r/e/ S,'It tt. ft Facility/OwnerNam= c� Facciilitym0(if applicable) - Li�CS 1`lh '1Ail1 bi. As17 ►r!V .o E- ft. rt. PhysicalAldress,City.and Zip ^2l.1tLMAR cs r AfvboZP 75 37C/1 0 35; County Parcel IdentificationNo.(PIN) Sb.Latitude and Longitude in degrees/minutes/secondsor decimal degrees: 22.Certificeti tif well field,one let/long is sufficient) ]C �j $ 3T.76`3`( Ig .--N 7/rT5ftJ ( L6 W _ 'e27 Si a of Certified Well Contractor 6.Is(are)the well(s): 1 ermanept or °Temporary 9y signing this form,J hereby certify that the well(s)was(were)constructed in accordance with ISA NCAC 07C.0100 or ISA NCAC 02C.0200 Well Construction Standards and that a 7.Is this a repair to an existing well: °Yes or I3l(lo copy of this recant has been provided to the well owner. If this is a repair,fill out known well construction information and explain the nature ofthe repair under ii21 remarks section or on the back of this fonn. 23.Site diagram or additional well details: FF You may use the back of this page to provide additional well site details or welt8.Number elevens constructed ( construction details. You may also attach additional pages if necessary. For multiple newton or roan-water supply wells ONLY with the same consrraetion,you con submit one fbtln. C_ SUBMITTAL 1NSTUCTIONS / 9,Total well depth below land surface: ( l (ft) 24a. For All Wells: Submit this form within 30 days of completion of well For multiple wells list all depths iJdt'ereni(example-3@200'and 2()t00Y) construction to the following: 10.Static water level below top of casing: (ft.) Division of Water Resources,Information Processing Unit, If warm-keel is above casing use"4" 1617 Mail Service Center,Raleigh,NC 27699-1617 11.Borehole diameter: I 0' �1 (in.) Trio.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 12,Wellconstruction method: A '1e C construction to the following: (i.e.auger,rotary,.cable.dampish,etc.) Division of Water Resources,Underground Injection Control Program, FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636 Me.Yield(gpm) Method tpD e.For Water Sup oh-&Injection Wells: Also submit one copy of ibis form within 30 days of completion of 13b.Disinfection type: - - Amount well construction to the county health department of the county where constructed Form OW.i Worth Carolina rDepattmeet of Environment sad Natural Resources-Division of WaterResources Revised August 2013 Client: Energizer Boring ID: SVE-16 Project: EnergizerAsheboro - Date Started: 9/28/15 Site Lo ctiom Plant II Date Completed: 9/29/15 Project Numbe E 0314524 Latitude: TBD L 99e By: Tom Naumann Lon itude: TBD = Well Lt� hdo y Lit doicDe Description Construction WelConstruction Dkam 0 0 Concrete sJ mush mount Steel Vault - b ' Gravel ! iliii 4 Stainless Steel Casing �P | . 2 ® Portland/BentoniteGrout .. ` ML Reddish orange clayey SILT 4 BentoniteSeal 1 - !!!!!!!! vt.::: - e / n \ j / - / 8 § itkii :::g4 2 n. 10 / \ rt \ w�k%% 10.25" Diameter Borehole 12 -- . f - - - I . \ • ML Tan fin� esandy clayey SILT 14 .. Tr ' , Well Sand FilterPack#1 16 -- . 1 VAC ■]'I- r) ® ' 4" Stahbs Steel 0.005 Slot - \ Screen k g 2 % ip § k 2211' - End Cap - 24 - — DrmngColar Contractor: ARS Technologies Outer Casing Depth: NA DirmngMethod: Hollow Stem Auger Total Depth (ft): 2 ©2T \ Drilling Eq upmen Ge prb 7 2 DT Screened Interval: 7'-2` 2 Responsible Professional: Christ cko(NC Driller#51 @ Depth to Water(Final): TBD Borehole Diameter: 10Q5" Elevation (m s) TBD WELL CONSTRUCTION,RECORD 'For internal Use ONLY: This font*can be used for Single or multiple wells . I.Wet.Contractor Information: I - e41Lc 14.WATER ZONES _) CCI PROM TO DESCRIPTION Well Couh m actorNac R. ft. ' Nt`- 15.OUTER CASINOlfor mad-cased wells)OR LINER Drop btel NC Well Contractor Certification NumberFROM ' TO DIAMETER THICKNESS I NATERLIL fi5 .e- via 0 7;O.5 ft. ft, 4r hr. �J Company Name IS.INNER CASING OR TUBING f=otbetual dared-loop) FROM _ TO DIAMETER im/ THICKNESS MATERIAL _ 2.Well Construction Permit If:: h ft. fL i 1. 5 5 Liss all applicable we permits(i.e.CotmV.Stale,Vandere,Injection.ate) V 7 I ft. ft. is 3.Well Use(check well use): . 17.SCREEN Water Supply Well; ❑ FROM .PO _DIAMETER SLOT SIZE THICKNESS MATERIAL °Agricultural Municipal/Public • l it t, �-R' Li ta' rya,- .3 t 6 6 5 ftOGeothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. I°• ❑lodustrial/Commercial DResidential Water Supply(shared) • IL GROUT PRos1 PTO ;MATERIAL . EMPLACEMEtrr METHOD AAMOUrrr Non gation Supply Well: () ft. 3 ft, e t JJ�- 4 ftNn IN+l p OMonitoring °Recover• 3 ft- {'l f _ r.�a Z �s k C � J t Injection Wen: ft. ft. °Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK(if applicable) •�} ulfcr S[ and Recov ❑Salim Barrier , FROM TO MATERIAL EMPI ACEMENTAMErEOD ❑Aquifer Test a ❑Stormwater Drainage f r7 ft" otM[,. �� t .)i DExperimental Technology CiSubsidence Control 20,DRILLING LOG(attach additional sheets ifnemsasv) ❑Geoiherrnal(Closed Loop) ❑Tracer PROM TO DEsesur'nON*Tree.Fvd.ero.whirs*.nn•,kola s:rr.rm.) _ ❑Geothermal(Heatina.I ooling{�Returnn) ❑Other(explain under#2/1 Remarks/. 0 ft • S IICo.'le:z`k.2 /4 �.b•,s_�4- 4.Date Well(s)Completed: 1 /`( Weil ID# S Li r I�j �' t f (L L. IL _ L it. Giay2- 5 t I I" Se.Well Location: #9 ft- d f'-� :1t�Y*44. c_14.f�.r,S. I( Facility/Owaer21ame Facility UM(if applicable) h • `lit�� be qAN bk. Aso6�,• U A“., ft.Physical ,City,and Zip M.REMARKS ik i NDOL-P4 775-37ccu03t County Parcel identification No.(PIN) Sb.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification: (ifwefl field,one llaa}t/bag is sufficient) �{ yI /�( l 7 C'� 15y, -76 717JO lei --7/r Vl- i3I ° W roil ! ,7 Signs: enified Well Contractor Date 6.is(arc)the well(s): i]fermanent or ❑Temporary By signing this form,i hereby cell*,that the wells)was(were)constructed in accordance w,lh ISA NCAC OTC.0100 or ISA NCAC 02C.0200 Well Construction Standards and that a 7.Is this a repair to an esistiug well: DYes or f31 o copy of this retard has beer,provided to the well owner. If Pars is a repair,fill out brown well consrr>rcrlvn information and explain the nature ofthe repair under 1121 remarks section or an the back of thisform. 23.Site diagram or additional well details: You may use the back of this page to provide additional well site details or-well B.Number of wells constructed: ( construction details. You may also attach additional pages if necessary. For multiple injection or non-water most,well,ONLY with the some cc sfruttfon,you can submit one form. SUBMITTAL INSTUCTIONS 9.Total well depth below laud surface: f r) . (ft.) 24a. For MI Wells: Submit this form within 30 days of completion of welt For multiple wells list all depths ffd ereni(example-3Q700'and 2 a®100) construction to the following: 10.Static water Ievel below top of casing: _ _ _ (ft.) Division of Water Resources,information Processing Unit, If water level Is above caring use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617 I I.Borehole diameter: i 0`)C7 (ire.) 24h.Fgr ligation Wells ONLY: In addition to sending the form to the address in �y 24a above,also submit a copy of this foam within 30 days of completion of well 12,Well construction method: A 2.01 _ 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 fist 24c.['or Water Snooty&Injection Wells: Also submit one copy of this form within 30 days of completion of 13b.Disinfection type: Amount: well Conatniction to the county health department of the county where constructed. Fenn GW-t Nowt Carolina Department of Eaviromntat and Nannal Resources-Division of Water Resources Revised August 2011