WI0400563_Site Plans/Maps_20210129

Appendix I -Figures

d by mverbanic 09-26-2020
Drawing Path: C:\Users\mverbanic\Desktop\Remote GIS\4305-18-033D Oak Ridge\Fig4_Constituent.mxd plot
MW-27 pg/L
BENZENE 9.7
C9-C10 AROMATICS 210
UNDERGROUND
STORAGE TANKS
APPROXIMATE
LOCATION OF
PUMP ISLAND
MW-9 pg/L
BENZENE 32
N-BUTYLBENZENE 120
ETHYLBENZENE 1,200
ISOPROPYLBENZENE 130
NAPHTHALENE 320
N-PROPYLBENZENE 340
1,2,4-TRIMETHYLBENZENE 2,700
1,3,5-TRIMETHYLBENZENE 800
TOTAL XYLENES 7,900
MW-24
BENZENE
N-BUTYLBENZENE
ETHYLBENZENE
ISOPROPYLBENZENE
sue. �i +� 7• 41!
pg/L
1,300
78
3,500
200
METHYL TERT-BUTYL ETHER 75 J
NAPHTHALENE 540
N-PROPYLBENZENE 540
TOLUENE 22,000
1,2,4-TRIMETHYLBENZENE 3,500
1,3,5-TRIMETHYLBENZENE 960
TOTAL XYLENES 16,900
APPROXIMATE LOCATION
OF UNDERGROUND
STORAGE TANKS
NOTES:
GROUNDWATER SAMPLES COLLECTED ON SEPTEMBER 10, 11, AND 14, 2020.
CONCENTRATIONS REPORTED IN MICROGRAMS PER LITER (pg/L).
ONLY CONCENTRATIONS WHICH EXCEED THE NC 2L STANDARD ARE SHOWN.
CONCENTRATIONS SHOWN IN BOLD TEXT EXCEED THE GROSS CONTAMINATION LEVEL.
J = CONCENTRATION IS AN ESTIMATED VALUE
BDL = BELOW DETECTION LIMIT
(NS) = NOT SAMPLED
BELOW 2L STANDARDS
VE-1 pg/L
BENZENE 110
METHYL TERT-BUTYL ETHER 41
ETHYLBENZENE
ISOPROPYLBENZENE
NAPHTHALENE
N-PRO PYLBENZENE
TOLUENE
1,2,4-TRIM ETHYLBENZENE
1,3,5-TRIM ETHYLBENZENE
TOTAL XYLENES 18,100
ug/L
2,800
160 J
800
420
1,900
4,500
1,700
BELOW 2L STANDARDS
MW-5
BENZENE
DIISOPROPYL ETHER
ETHYLBENZEN E
METHYL TERT-BUTYL ETHER
NAPHTHALENE
N-PROPYLBENZENE
TOLUENE
TOTAL XYLENES
MW-25
BENZENE
1,2-DIBROMOETHANE
DIISOPROPYL ETHER
ETHYLBENZENE
ISOPROPYLBENZENE
pg/L
4,700
290
610
3,800
160
420
2,100
3,000
pg/L
7,700
0.19
100 J
3,800
180 J
METHYL TERT-BUTYL ETHER 830
NAPHTHALENE 580
N-PROPYLBENZENE 460
TOLUENE 35,000
1,2,4-TRIMETHYLBENZENE 3,400
1,3,5-TRIMETHYLBENZENE 910
TOTAL XYLENES 21,100
MW-23
REFERENCE:
GIS BASE LAYERS WERE OBTAINED FROM THE 2018 NCONEMAP.COM ORTHOIMAGERY
BASEMAP LAYER. THIS MAP IS FOR INFORMATIONAL PURPOSES ONLY. ALL FEATURE
LOCATIONS DISPLAYED ARE APPROXIMATED. THEY ARE NOT BASED ON CIVIL SURVEY
INFORMATION, UNLESS STATED OTHERWISE.
MW-26 pg/L
BENZENE 21,000
1,2-DIBROMOETHANE 1.9
DIISOPROPYL ETHER 700
ETHYLBENZENE 3,100
ISOPROPYLBENZENE 120 J
METHYL TERT-BUTYL ETHER 3,400
NAPHTHALENE
N-PROPYLBENZENE
TOLUENE
1,2,4-TRI M ETHYLBENZEN E
1,3,5-TRIMETHYLBENZENE
TOTAL XYLENES
C5-C8 ALIPHATICS
C9-C10 AROMATICS
470
300
42,000
2,200
570
16,600
140,000
14,000
MW-20
BELOW 2L STANDARDS
BELOW 2L STANDARDS
Monitor Well (Confirmed)
0 Monitor Well (Not Located)
Subject Property
Guilford County Parcels
i
GROUNDWATER CONSTITUENT MAP
OAK RIDGE GAS MART (TF-1445
2105 OAK RIDGE ROAD
SCALE:
1 "=75'
OAK RIDGE, GUILFORD COUNTY, NORTH CAROLINA
DATE:
9-26-20
PROJECT NUMBER
4305-18-033E
FIGURE NO.
4

Drawing Path: C:\Users\mverbanic\Desktop\Remote GIS\4305-18-033D Oak Ridge\Fig6_Benzene ISO.mxd plotted by mverbanic 09-28-2020
9.7
MW-22
UNDERGROUND
STORAGE TANKS
APPROXIMATE
LOCATION OF
PUMP ISLAND
APPROXIMATE LOCATION
OF UNDERGROUND
STORAGE TANKS
At_-1
110
•MW-1
(LNAPL)
MW4NM
MW-3
<0.50
NOTES:
GROUNDWATER SAMPLES COLLECTED ON SEPTEMBER 11 AND 14, 2020.
BENZENE CONCENTRATIONS REPORTED IN MICROGRAMS PER LITER (7,700 Ng/L)
VE-1 NOT USED IN THE CALCULATION OF BENZENE ISOCONCENTRATION CONTOURS
REFERENCE:
GIS BASE LAYERS WERE OBTAINED FROM THE 2018 NCONEMAP.COM ORTHOIMAGERY
BASEMAP LAYER. THIS MAP IS FOR INFORMATIONAL PURPOSES ONLY. ALL FEATURE
LOCATIONS DISPLAYED ARE APPROXIMATED. THEY ARE NOT BASED ON CIVIL SURVEY
INFORMATION, UNLESS STATED OTHERWISE.
4
0
Monitor Well (Confirmed)
Monitor Well (Not Located)
Benzene Isoconcentration Contour
Subject Property
Guilford County Parcels
BENZENE ISOCONCENTRATION CONTOUR MAP
2105 OAK RIDGE ROAD
SCALE:
1 "=75'
DATE:
9-28-20
OAK RIDGE, GUILFORD COUNTY, NORTH CAROLINA
PROJECT NUMBER
4305-18-033E
FIGURE NO.
6

•
UNDERGROUND
STORAGE TANKS
MW-27
0.50
APPROXIMATE
LOCATION OF
PUMP ISLAND
APPROXIMATE LOCATION
OF UNDERGROUND
STORAGE TANKS
MWu.
�.� <0.50
NOTES:
GROUNDWATER SAMPLES COLLECTED ON SEPTEMBER 11 AND 14, 2020
METHYL TERT-BUTYL ETHER (MTBE) CONCENTRATIONS REPORTED IN MICRO GRAMS PER
LITER (pg/L)
VE-1 NOT USED IN THE CALCULATION OF MTBE ISOCONCENTRATION CONTOURS
REFERENCE:
GIS BASE LAYERS WERE OBTAINED FROM THE 2018 NCONEMAP.COM ORTHOIMAGERY
BASEMAP LAYER. THIS MAP IS FOR INFORMATIONAL PURPOSES ONLY. ALL FEATURE
LOCATIONS DISPLAYED ARE APPROXIMATED. THEY ARE NOT BASED ON CIVIL SURVEY
INFORMATION, UNLESS STATED OTHERWISE.
(FEET)
1'
N1W-20
3:4
4
0
Monitor Well (Confirmed)
Monitor Well (Not Located)
Methyl tert-Butyl Ether Isoconcentration Contour
Subject Property
Guilford County Parcels
METHYL TERT-BUTYL ETHER ISOCONCENTRATION CONTOUR MAP
2105 OAK RIDGE ROAD
OAK RIDGE, GUILFORD COUNTY, NORTH CAROLINA
SCALE:
1 "=75'
DATE:
9-28-20
PROJECT NUMBER
4305-18-033E
FIGURE NO.
7

Appendix II -Tables

•
usr Facility ID #:00-0-0000009173
TABLE 4
MONITOR WELL CONSTRUCTION AND LIQUID LEVEL DATA
Oak Ridge Gas Mart (Incident No.: 14451, UST No.: 4461)
2105 Oak Ridge Road, Oak Ridge, Guilford County, NC
S&ME Project No. 4305-18-033E
Revison Date 9/26/2020
Well ID
Date Installed
Date
Measured
Total Well
Depth
(ft-BTOC)
Screened
Interval
(ft-bgs)
Top of Casing
Elevation*
(ft-rel)
Depth to Water
(ft-BTOC)
Depth to Free
Product (ft)
Free Product
Thickness
(ft)
Groundwater
Elevation
(ft-rel)
MW-1
7/10/1995
7/12/1995'
30.00
30-15
100.04
20.09
NM
0.00
79.95
8/2/1995+
100.04
20.16
NM
0.00
79.88
3/7/2003+
100.00
21.65
20.27
1.38
79.39
9/29/2003'
100.00
17.48
16.99
0.49
82.89
10/28/2003'
100.00
17.71
17.66
0.05
82.33
05/5/2004'
100.00
17.94
17.92
0.02
82.08
1/5/2005l
100.00
20.29
20.13
0.16
79.83
7/27/2005A
100.00
20.12
19.98
0.14
79.99
12/28/2005"
100.00
22.94
22.22
0.72
77.60
11/2/2007^
100.00
25.10
23.85
1.25
75.84
1/14/2010'
100.00
21.92
21.42
0.5
78.46
2/21/2020+
100.00
20.74
20.31
0.43
79.59
6/15/2020
100.00
18.29
18.08
0.21
81.87
9/11/2020
100.00
19.72
19.24
0.48
80.64
MW-2
7/10/1995
7/12/1995+
30.00
30-15
100.32
20.31
NM
0.00
79.98
8/2/1995+
100.32
20.52
NM
0.13
79.90
3/7/2003+
100.29
21.00
20.78
0.22
79.46
9/29/2003'
100.29
17.35
17.26
0.09
83.01
10/28/2003+
100.29
17.88
sheen
sheen
82.41
05/5/2004A
100.29
18.09
18.08
0.01
82.21
1/5/2005'
100.29
20.33
20.31
0.08
79.96
7/27/2005'
100.29
20.23
20.18
0.05
80.10
12/28/2005^
100.29
23.00
22.43
0.57
77.72
11/2/2007^
100.29
24.41
23.30
0.91
76.76
1/14/2010'
100.29
21.79
21.74
0.05
78.54
2/21/2020
100.30
20.21
NM
0.00
80.09
6/15/2020
100.30
18.30
18.29
0.01
82.01
9/11/2020
100.30
19.56
NM
0.00
80.74
MW-3
7/10/1995
7/12/1995'
30.00
30-15
99.52
19.69
NM
0.00
79.83
8/2/1995+
99.52
19.84
NM
0.00
79.68
9/29/2003'
99.49
20.25
NM
0.00
79.24
1/14/2010+
99.49
21.11
NM
0.00
78.38
2/21/2020
99.53
19.46
NM
0.00
80.07
9/11/2020
99.53
19.03
NM
0.00
80.50
MW-4
7/11/1995
7/12/1995+
30.00
30-15
99.27
19.54
NM
0.00
79.73
8/2/1995+
99.27
19.59
NM
0.00
79.68
3/7/2003+
99.25
20.31
19.90
0.41
79.25
9/29/2003'
99.25
16.51
16.51
0.00
82.74
10/28/2003'
99.25
17.08
17.07
0.01
82.18
05/5/2004A
99.25
17.40
17.39
0.01
81.86
7/27/2005^
99.25
19.44
19.43
0.01
79.82
12/28/2005'
99.25
22.20
21.70
0.50
77.43
11/2/2007^
99.25
25.17
24.11
1.06
74.88
1/14/2010'
99.25
21.05
20.91
0.14
78.31
MW-5
6/17/1995
9/11/2020
30.00
Unknown
96.05
18.09
NM
0.00
77.96
MW-7
Unknown
3/7/2003
29.30
Unknown
99.17
18.46
NM
0.00
80.71
9/11/2020
99.17
17.23
NM
0.00
81.94
MW-9
Unknown
3/7/2003+
30.00
30-15
99.71
20.81
20.03
0.78
79.49
9/29/2003+
99.71
17.25
16.51
0.74
83.02
10/28/2003+
99.71
17.26
sheen
sheen
82.45
05/5/2004'
99.71
17.56
17.55
0.01
82.16
1/5/2005a
99.71
19.82
19.78
0.04
79.92
7/27/2005^
99.71
19.60
sheen
sheen
80.11
12/28/2005A
99.71
22.55
21.88
0.67
77.66
11/2/2007^
99.71
24.22
23.62
0.60
75.94
1/14/2010'
99.71
21.20
21.19
0.01
78.59
2/21/2020
99.70
19.79
19.71
0.08
79.97
6/15/2020
99.70
17.95
NM
0.00
81.75
9/11/2020
99.70
17.10
NM
0.00
82.60
MW-11
Unknown
3/7/2003
28.90
Unknown
94.03
17.87
NM
0.00
76.16
9/11/2020
94.03
17.10
NM
0.00
76.93
MW-14
Unknown
3/7/2003
25.10
Unknown
94.47
15.53
NM
0.00
78.94
9/11/2020
94.47
16.14
NM
0.00
78.33
MW-15
Unknown
3/7/2003
30.00
Unknown
91.07
16.39
NM
0.00
74.68
9/11/2020
91.07
15.88
NM
0.00
75.19
MW-19
Unknown
9/11/2020
23.10
Unknown
NM
9.41
NM
0.00
NM
MW-20
Unknown
3/7/2003
30.00
Unknown
91.21
21.57
NM
0.00
69.64
9/11/2020
91.21
21.26
NM
0.00
69.95
MW-24
6/12/2020
6/15/2020
28.50
8.5 to 28.5
100.37
18.39
NM
0.00
81.98
9/11/2020
100.37
19.68
NM
0.00
80.69
MW-25
6/12/2020
6/15/2020
29.00
9 to 29
99.68
17.83
NM
0.00
81.85
9/11/2020
99.68
19.08
NM
0.00
80.60
MW-26
9/10/2020
9/11/2020
28.00
13.0 to 28.0
99.31
18.86
NM
0.00
80.45
MW-27
9/10/2020
9/11/2020
27.60
13.0 to 28.0
99.03
18.37
NM
0.00
80.66
VE-1
Unknown
3/7/2003
95.20
Not Measured
99.32
19.81
NM
0.00
79.51
9/11/2020
99.32
18.68
NM
0.00
80.64
NOTES, ft-BGS - Feet Below Ground Surface
NM - None Measured
BTOC - Below Top of Casing
'Reference point for Elevation Measurements: Benchmark Datum: MW-1 top of casing
Assumed or Measured: Measured
TM = B Free Product is present in a well, groundwater elevation should be calculated by [Top of Casing Elevation - Depth to Water] + [thickness x 0.7489]
- August 3, 1995 Terra Technologies Initial Site Assessment Report
NA = Not Applicable
11.00
Bechmark Elevation: 100.00

TABLE 5
SUMMARY OF WATER SUPPLY WELL SAMPLING RESULTS
Oak Ridge Gas Mart (Incident No.: 14451, UST #: 4461)
2105 Oak Ridge Road, Oak Ridge, Guilford County, NC
S&ME Project # 4305-18-033E
UST Facility ID #: 00-0-0000009773
Revison Date: 9/26/2020
Analytical Method ->
Volatile Organic Compounds (VOCs)
504.1
Contaminant of Concern -
cetone
Benzene
2-Butanone (MEK)
Ethylbenzene
Methyl tert-butyl ether
Toluene
d
0
d
N
0
W
A
u
.0
H
N
N
Total Xylenes
1,2-Dibromethane (EDB) 1
WellID
Date
Collected
WSW-1
7/27/2005*
BDL
<0.50
BDL
n/a
<0.50
BDL
BDL
BDL
NA
2/21/2020
<50
<0.50
<5.0
<1.0
<0.501
<0.50
<0.50
<1.50
NA
9/10/2020
4.1 J
<0.50
<5.0
<0.50
<0.50
<0.50
<0.50
<1.50
<0.019
WSW-3
2/21/2003'
BDL
<0.50
BDL
<0.50
<1.0
BDL
BDL
BDL
NA
2/21/2020
<50
<0.50
<5.0
<1.0
<0.50'
<0.50
<0.50
<1.50
NA
WSW-5
2/21/2003'
BDL
<0.50
BDL
<0.50
1.6
BDL
BDL
BDL
NA
5/5/2004*
BDL
<0.50
BDL
<0.50
3.1
BDL
BDL
BDL
NA
12/6/2004"
BDL
<0.50
BDL
<0.50
3.8
BDL
BDL
BDL
NA
7/27/2005*
BDL
<0.50
BDL
<0.50
4.05
BDL
BDL
BDL
NA
12/28/2005*
BDL
<0.50
BDL
0.68
3.8
BDL
BDL
BDL
NA
5/18/2020
<50
<0.50
<5.0
<0.50
1.2
<0.50
<0.50
<1.50
NA
9/10/2020
<50
<0.50
<5.0
<0.50
1.1
<0.50
<0.50
<1.50
<0.20
WSW 6
5/18/2020
4.3 J
<0.50
<5.0
<0.50
<0.50
<0.50
<0.50
<1.50
NA
9/10/2020
<50
<0.50
<5.0
<0.50
<0.50
<0.50
<0.50
<0.50
<0.20
WSW 9
2/21/2003'
BDL
<0.50
BDL
<0.50
<1.0
BDL
BDL
BDL
NA
2/21/2020
<50
<0.50
<5.0
<1.0
<0.501
<0.50
<0.50
<1.50
NA
WSW-11
WSW-12
2/21/2020
<50
<0.50
<5.0
<1.0
<0.501
<0.50
<0.50
<1.50
NA
2/21/2020
<50
<0.50
<5.0
<1.0
<0.501
<0.50
<0.50
<1.50
NA
WSW-13
2/21/2020
<50
<0.50
<5.0
<1.0
<0.50 1
<0.50
<0.50
<1.50
NA
Field Blank
5/18/2020
47 J
<0.50
5.1
0.15 J
<0.50
0.6
0.35 J
0.73 J
NA
9/11/2020
<50
<0.50
<5.0
<0.50
<0.50
<0.50
<0.50
<1.50
NA
ME 2L Standard
6,000
1
4,000
3
20
600
400
500
0.02
GCL
6,000,000
5,000
4,000,000
3,000
20,000
260,000
28,500
85,500
50
Notes:
Analytes that are not shown for the method were not detected.
Concentrations are reported in micrograms per liter (µg/L).
J. Indicates detection above the method detection limit, but below the reporting limit; therefore, result is an estimated concentration
GCL - Gross Contamination Level
2L Standard: North Carolina Groundwater Quality Standards: 15A NCAC 2L.0202
Concentrations exceeding the 2L Standards are shown in Shaded and BOLD fields.
Concentrations exceeding the laboratory's reporting limits are shown in BOLD fields.
1 - Laboratory fortified blank/laboratory control sample recovery and duplicate recovery are outside of control limits. Reported value for this compound is likely to be biased on the low side
2 - Elevated reporting limit due to high concentration of target compounds
*Sampling completed by Pyramid Environmental on behalf of NCDENR (documentation in Appendix I)
# - NCDEQ edoc WS-4461_14451_M_DENR_20140828_19960103
*Sampling completed by Pyramid Environmental on behalf of NCDENR (documentation in Appendix I)
# - NCDEQ edoc WS-4461_14451_M_DENR_20140828_19960103
BDL - Not detected in concentrations exceeding laboratory detection limits

Appendix IV - Boring Logs, Well Construction Details,
Well Construction Records, Groundwater Sampling Forms,
Permission to Sample Water Supply Wells, and Field Notes

PROJECT: 14451-Oak Ridge Gas Mart
2105 Oak Ridge Road
S&ME Project No. 4305-18-033D
BORING LOG: MW-26
DATE DRILLED:
Thursday, September 10, 2020
BORING DEPTH (FT):
28
DRILL RIG:
Diedrich D-50
WATER LEVEL:
DRILLER:
Geologic Exploration, Inc.
CAVE-IN DEPTH:
HAMMER TYPE:
Not Applicable
LOGGED BY:
G. Simcox
SAMPLING METHOD:
Grab
NORTHING:
DRILLING METHOD:
Hollow Stem Augers (4 1/4-in. ID)
EASTING:
DEPTH
(feet)
GRAPHIC
LOG
MATERIAL DESCRIPTION
WATER LEVEL
SAMPLE
OVA READINGS
(PPM)
LABORATORY
ANALYSES
Sample Time /
1st 6in
v
N
3rd 6in
N VALUE
Residuum, Sandy Silt, Red, Orange, Dry,
1
1
'
2.1
10
Residuum, Sandy Silt, Red, Orange, Dry, Petroleum Odors
1
1
'
33.9
15
Residuum, Sandy Silt, Tan, Orange, Dry, Petroleum Odors
1
1
1
'
52.3
20
Residuum, Sandy Silt, Tan, Brown, Moist, Strong Petroleum Odors
I
I
I
'
25
Residuum, Sandy Silt, Tan, Wet,
30
Boring Terminated at 28 Ft-BGS

PROJECT: 14451-Oak Ridge Gas Mart
2105 Oak Ridge Road
S&ME Project No. 4305-18-033D
BORING LOG: MW-27
DATE DRILLED:
Thursday, September 10, 2020
BORING DEPTH (FT):
28
DRILL RIG:
Diedrich D-50
WATER LEVEL:
DRILLER:
Geologic Exploration, Inc.
CAVE-IN DEPTH:
HAMMER TYPE:
Not Applicable
LOGGED BY:
G. Simcox
SAMPLING METHOD:
Grab
NORTHING:
DRILLING METHOD:
Hollow Stem Augers (4 1/4-in. ID)
EASTING:
DEPTH
(feet)
GRAPHIC
LOG
MATERIAL DESCRIPTION
WATER LEVEL
SAMPLE
OVA READINGS
(PPM)
LABORATORY
ANALYSES
Sample Time /
1st 6in
v
N
3rd 6in
N VALUE
Residuum, Sandy Silt, Red, Orange, Dry,
1
1
'
1.1
10
Residuum, Sandy Silt, Red, Orange, Dry,
I
I
'
1.0
15
Residuum, Sandy Silt, Tan, Orange, Dry,
I
I
'
1.6
20
Residuum, Sandy Silt, Tan, Brown, Moist,
1
1
1
'
25
Residuum, Sandy Silt, Tan, Wet,
30
Boring Terminated at 28 Ft-BGS

Well
ID
iik&
WELL CONSTRUCTION DETAI
Project Name
Project Number
14451-Oak Ridge Gas Mart
4305-18-033D
MW-26
S&ME Staff
Installation Date
County
City
Well Permit Number
G. Simcox
9/10/2020
Guilford
Oak Ridge
NA
Drilling Contractor
License Number
Drill Rig
Well Type / Use
Gelogic Exploration, Inc.- Jacob Messick
Flush Monitor Well
Water Level at TOB (0.01 ft- BTOC)
Date/Time
Northing (0.1 ft)
Land Surface Elev. (0.01 ft)
Drilling Method
9/10/20 10:50
Hollow Stem Auger
Depth to Water (0.01 ft- BTOC)
Date/Time
Easting (0.1 ft)
Total Well Depth (0.1 ft-bgs)
Borehole Diameter (1 in)
8-inch
i
Pad Type
2' x 2' Concrete
Protective Casing
Flush Vault (8" diam)
TOC Relative to Ground 0.30 ft
j
iz
Casing Material
Depth Below Ground Surface (ft-bgs)
%
2-in Sch 40 PVC
/
Casing Interval (0.1 ft-bgs)
/
0.3
to
13.0
/
I Screen
Type
2-in Sch
40 PVC
(0.010)
Screen Interval
(0.1 ft-bgs)
13.0
to
28.0
Top of Seal - 9.0 0.1 ft-bgs
Grout
Type
i
Portland
Cement
T2
Top of Filter Pack 11.5 0.1 ft-bgsi
Grout Interval
(0.1
ft-bgs)
0.3
to
9.0
Top of Screen - 13.0 0.1 ft-bgs
Seal
Type
♦
3/8 in.
Holeplug®
•
Seal Interval
(0.1
ft-bgs)
9.0
to
11.5
• :
Screened Interval - 15.0 0.1 ft-bgs
-
Filter Pack
#2 Silica Sand
•
'
Filter Pack Interval (0.1 ft-bgs)
♦
•
11.5
to
28.0
•
Bottom of Screen - 28.0 0.1 ft-bgs
Development
Bottom of Filter Pack - 28.0 0.1 ft-bgs
Yes
Cave In - 0.1 ft-bgs
Development Volume (gal)
Total Boring Depth - 28.0 0.1 ft-bgs
Notes:
BTOC - Below Top of Casing
TBD - To Be Determined
For lithologic information
see attached boring log
Form Revision Date:
9/1/17 2:10 PM

Well
ID
iik&
WELL CONSTRUCTION DETAI
Project Name
Project Number
14451-Oak Ridge Gas Mart
4305-18-033D
MW-27
S&ME Staff
Installation Date
County
City
Well Permit Number
G. Simcox
9/10/2020
Guilford
Oak Ridge
NA
Drilling Contractor
License Number
Drill Rig
Well Type / Use
Gelogic Exploration, Inc.- Jacob Messick
Flush Monitor Well
Water Level at TOB (0.01 ft- BTOC)
Date/Time
Northing (0.1 ft)
Land Surface Elev. (0.01 ft)
Drilling Method
9/10/20 13:30
Hollow Stem Auger
Depth to Water (0.01 ft- BTOC)
Date/Time
Easting (0.1 ft)
Total Well Depth (0.1 ft-bgs)
Borehole Diameter (1 in)
8-inch
i
aim -
Pad Type
2' x 2' Concrete
Protective Casing
Flush Vault (8" diam)
TOC Relative to Ground 0.30 ft
j
iz
Casing Material
Depth Below Ground Surface (ft-bgs)
%
2-in Sch 40 PVC
/
Casing Interval (0.1 ft-bgs)
/
0.3
to
13.0
/
I Screen
Type
2-in Sch
40 PVC
(0.010)
Screen Interval
(0.1 ft-bgs)
13.0
to
28.0
Top of Seal - 9.5 0.1 ft-bgs
Grout
Type
i
Portland
Cement
T2
Top of Filter Pack 11.5 0.1 ft-bgsi
Grout Interval
(0.1
ft-bgs)
0.3
to
9.5
Top of Screen - 13.0 0.1 ft-bgs
Seal
Type
♦
3/8 in.
Holeplug®
•
Seal Interval
(0.1
ft-bgs)
9.5
to
11.5
• :
Screened Interval - 15.0 0.1 ft-bgs
-
Filter Pack
#2 Silica Sand
•
'
Filter Pack Interval (0.1 ft-bgs)
♦
•
11.5
to
28.0
•
Bottom of Screen - 28.0 0.1 ft-bgs
Development
Bottom of Filter Pack - 28.0 0.1 ft-bgs
Yes
Cave In - 0.1 ft-bgs
Development Volume (gal)
Total Boring Depth - 28.0 0.1 ft-bgs
Notes:
\ II
BTOC - Below Top of Casing
TBD - To Be Determined
For lithologic information
see attached boring log
Form Revision Date:
9/1/17 2:10 PM

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
JACOB MESSICK
Well Contractor Name
A - 4252
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑ Agricultural ❑Municipal/Public
❑ Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial ❑Residential Water Supply (shared)
❑ Irrigation
Non -Water Supply Well:
❑� Monitoring ❑Recovery
Injection Well:
❑ Aquifer Recharge ❑Groundwater Remediation
❑ Aquifer Storage and Recovery ❑ Salinity Barrier
❑ Aquifer Test ❑ Stormwater Drainage
❑ Experimental Technology ❑Subsidence Control
❑ Geothermal (Closed Loop) ❑Tracer
❑ Geothermal (Heating/Cooling Return) ❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: 09/10/20 Well tD#
5a. Well Location:
OAK RIDGE GAS MART
MW-26
Facility/Owner Name Facility ID# (if applicable)
2105 OAK RIDGE ROAD OAK RIDGE 27310
Physical Address, City, and Zip
GUILFORD
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
36° 10' 13.92" N 79° 53' 37.28"
6. Is (are) the well(s): OPermanent or ❑Temporary
w
7. Is this a repair to an existing well: ❑Yes or ONo
If this is a repair, fill out known well construction information and explain the nature of the
repair under #21 remarks section or on the back of this form.
8. Number of wells constructed: 1
For multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
For Internal Use ONLY:
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if ap licable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0.0 ft.
13.0 ft•
2.0 in.
SCH 40
PVC
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
13.0 ft.
28.0 ft.
2.0 in.
.010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0.0 ft•
90 ft•
PORTLANDBENTONITE
SLURRY
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
11.0 ft.
28.0 ft.
20-40
FINE SILICA SAND
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
0.0 ft.
1.0 ft.
ASPHALT/STONE
1.0 ft•
18.0 ft•
BROWN/RED SILTY CLAY
18.0 ft.
28.0 ft.
BROWN/TAN SILTY SAND
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
BENTONITE SEAL FROM 9.0 TO 11.0 FEET
22. Certification:
09/21/20
Signature of Certified Well Contractor
Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
9. Total well depth below land surface: 28'0 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths if different (example- 3@200' and 2@100') construction to the following:
10. Static water level below top of casing: 16.0 (ft) Division of Water Quality, Information Processing Unit,
If water level is above casing, use "+ " 1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 8•0 (in.) 24b. For Injection Wells: In addition to sending the form to the address in 24a
AUGER above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW-1
North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
JACOB MESSICK
Well Contractor Name
A - 4252
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑ Agricultural ❑Municipal/Public
❑ Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial ❑Residential Water Supply (shared)
❑ Irrigation
Non -Water Supply Well:
❑� Monitoring ❑Recovery
Injection Well:
❑ Aquifer Recharge ❑Groundwater Remediation
❑ Aquifer Storage and Recovery ❑ Salinity Barrier
❑ Aquifer Test ❑ Stormwater Drainage
❑ Experimental Technology ❑Subsidence Control
❑ Geothermal (Closed Loop) ❑Tracer
❑ Geothermal (Heating/Cooling Return) ❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: 09/10/20 Well tD#
5a. Well Location:
OAK RIDGE GAS MART
MW-26
Facility/Owner Name Facility ID# (if applicable)
2105 OAK RIDGE ROAD OAK RIDGE 27310
Physical Address, City, and Zip
GUILFORD
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
36° 10' 13.92" N 79° 53' 37.28"
6. Is (are) the well(s): OPermanent or ❑Temporary
w
7. Is this a repair to an existing well: ❑Yes or ONo
If this is a repair, fill out known well construction information and explain the nature of the
repair under #21 remarks section or on the back of this form.
8. Number of wells constructed: 1
For multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
For Internal Use ONLY:
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if ap licable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0.0 ft•
13.0 ft•
2.0 in.
SCH 40
PVC
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
13.0 ft•
28.0 ft•
2.0 in.
.010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0.0 ft•
90 ft•
PORTLANDBENTONITE
SLURRY
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
11.0 ft.
28.0 ft.
20-40
FINE SILICA SAND
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
0.0 ft•
1.0 ft.
ASPHALT/STONE
1.0 ft•
18.0 ft•
BROWN/RED SILTY CLAY
18.0 ft.
28.0 ft•
BROWN/TAN SILTY SAND
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
BENTONITE SEAL FROM 9.0 TO 11.0 FEET
22. Certification:
09/21/20
Signature of Certified Well Contractor
Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
9. Total well depth below land surface: 28'0 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths if different (example- 3@200' and 2@100') construction to the following:
10. Static water level below top of casing: 16.0 (ft) Division of Water Quality, Information Processing Unit,
If water level is above casing, use "+ " 1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 8•0 (in.) 24b. For Injection Wells: In addition to sending the form to the address in 24a
AUGER above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW-1
North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 2013