NCG510429_Regional Office Historical File Pre 2018

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Tommy Bolyard
Well Couuactor Name (or well owner personally abandoning well on his/her property)
3307
NC Well Contractor Certification Number
Environmental Drilling & Probing Services
Company Name
2. Well Construction Permit #:
List all applicable xrll construction permits ri.e. UIC, County, State. Variance, etc.) iifknowm
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑MunicipaUPublic
❑Geothermal (Heating/Cooling Supply)
❑Residential Water Supply (single)
❑lndush ial/Commercial
❑Residential Water Supply (shared)
❑Irri ation
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 7g)
4. Date well(s) abandoned:
Sa. Well location:
Brawley Construction Co.
5/10/17
Facility/Owner Name Facility ID# (ifapplicable)
954 Oak Ridge Farm Hwy, Mooresville, NC
Physical Address, City, and Zip
Iredell
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one lattlong is sufficient)
N
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the sums
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approidmate volume of water remaining in well(s): (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
e Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Concrete Grout
❑ Specialty Grout
❑ Bentonite Slurry
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (exphun under 7g)
7E For each material selected above, provide amount of materials used:
7g. Provide a brief description of the abandonment procedure:
2" well was tremie grouted from bottom to top;
allowed to settle; and Capped with ce nt to
match the surroun I!ng asphalt surface.
JUL °Ca at �U-If .
S. Certification: MROS
L RE L OFFICE
5/22/17
Sigma erti5ed Con ctn Well Owner Date
By signing this form, l hereby certify that the well(s) was (were) abandoned in
accordance with 15.4 NCAC 02C .0100 or 2C .0200 Well, Construction Standards
and that a cony of this record has been provided to the well owner.
9. Site diagram or additional well details:
W You may use the back of this page to provide additional well site details or well
abandonment details. You may aLso attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELLS) BEING ABANDONED
Attach well construction record(s) ifavailabte. For multiple injection or non-watersupply writs
ONLY wish the sane con�ti
siAru`ctio/n/abbandonment, you can submit one form.
6a. Well ID#: I V' y V —o
6b. Total well depth: _2100 (ft-)
JUL 14 20V
6c. Borehole diameterOVA.
'; r-• . .
6d. Water level below ground surface:
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Injection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
6e. Outer casing length (if known): (ft) 10e. For Water Supply & Injection Wells: In addition to sending the fort[ to the
addttss(es) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f. Inner casing/tubing length (if known): (ft-) abandoned.
6g. Screen length C¢ known): (ft.)
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Tommy Bolyard
Well Contractor Name (or well owner personally abandoning well on his/ber property)
3307
NC Well Contractor Certification Number
Environmental Drilling & Probing Services
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC, County, Stale, Variance, etc) ifbtown
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑MunicipaUPublic
❑Geothermal (Heating/Cooling Supply)
❑Residential Water Supply (single)
❑Industrial/Commercial
❑Residential Water Supply (shared)
❑ Inrigation
Non -Water Supply Well:
eMonitoring
❑Recovery
Injection Well:
❑Aquifer Recharge
❑Groundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
❑StormwaterDrainage
❑Experimental Technology
❑Subsidence Control
❑Geothermal (Closed Loop)
❑Tracer
❑Geothermal (Heatntg/Cooting Return)
❑Other (explain under 7g)
4. Date well(s) abandoned:
5/1.0/17
58. Well location:
Brawley Construction Co.
Facility/Owner Name Facility ID# (if applicable)
954 Oak Ridge Farm Hwy, Mooresville, NC
Physical Address, City, and Zip
Iredell
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one Iat/long is sufficient)
N
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construetion/depth, only 1 GW-30 is needed- Indicate TOTAL NUMBER of
wells abandoned:
7b. Approrimate volume of water remaining in well(s): (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
S Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Concrete Grout
❑ Specialty Grout
❑ Bentonite Slurry
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
7g. Provide a brief description of the abandonment procedure:
2" well was tremie grouted from bottom to top;
allowed to settle; pad/cover removed; patched with
cement; and filled with top ,§Wdftt&VwFWyyR
match the surrounding grassy syyface
8. Certi nation: wQROS
00 V LE REG109222PI7;E
si Ce ' ed Well onttactor or ell r Date
8y signing th rm, J hereby cer ' [ the well(s) was (were) abandoned in
accordance with 1 SA NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
W abandonment details. You may also attach additional pages if necessary.
Attach well construction record(s) ifavailable. For multiple injection or non-watersuppli, wells
ONLY with the same construction/abandonment, you can submit one form.
6a. Well ID#: M W-9
6b. Total well depth: 19.95
JUL - 4 2017
6c. Borehole diameter:
1?FSOr1ro��'a7OR `�rJiJtac".r+:.^ ;
6d. Water level below ground surface: (ft.) -
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Injection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
6e. Outer casing length (if known): (ft-) 10c. For Water Supply & lniection Wells: In addition to sending the form to the
address(es) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6L Inner casing/tubing length (if known): (ft.) abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Tommy Bolyard
Well Contractor Name (or well owner personally abandoning well on his/her property)
3307
NC Well Contractor Certification Number
Environmental Drilling & Probing Services
Company Name
2. Well Construction Permit #:
List all applicable Yell construction permits r.e. UIC. County, State, Variance. etc.) ifknown
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)
❑Irri lion
Non -Water Supply Well:
eMonitoring
❑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 7g)
4. Date well(s) abandoned:
5/10/17
5a. Well location:
Brawley Construction Co.
Facility/Owner Name Facility ID# (if applicable)
954 Oak Ridge Farm Hwy, Mooresville, NC
Physical Address, City, and Zip
Iredell
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lattlong is sufficient)
ILI
W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach Yell construction record(s) ifavailable. For multiple injection or non-watersupply we1Ls
ONLY with the same consimction/abandonment, you can submit one form.
6a.Well ID#: 'V'Vv-10
o
6b. Total well depth: 22.6`�GC (ft.) ir.'' �r <• 3F 4`ry; '
6c. Borehole diameter: (in.) JUL 14 2017
6d. Water level below ground surface:
For Intemal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only I GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): (gat.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used-
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
IN Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Concrete Grout
❑ Specialty Grout
❑ Bentonite Slurry
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (explain under 7g)
7L For each material selected above, provide amount of materials used:
7g. Provide a brief description of the abandonment procedure:
2" well was tremie grouted from bottom to top;
allowed to settle; pad/cover removed; patched with
cement; and filled with topsoil/seed/straw to.
match the surrounding grassy surface.
S. Certifi tion: I' ASC51V CDENR/DWR
2017 5/22/17
Si o ertifi ell Contrac or Owner Date
By signing this form, 1 h (� �j'�!w R s �+ps, were abandoned in
accordance with ISA NC PPil h t ��1/-( �on Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Injection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this forth within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
6e. Outer casing length (if known): ({t,) 10c. 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 abandonment to the county health department of the county where
6f. Inner casing/tubing length (if (mown): (ft.) abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Tommy Bolyard
Well Contractor Name (or well owner personally abandoning well on his/her property)
3307
NC Well Contractor Certification Number
Environmental Drilling & Probing Services
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC. County, State, Variance, etc.) ifknown
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Inclustrial/Commercial
Non -Water Supply Well: .
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
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 7g)
4. Date well(s) abandoned: 5/ 1 0/.1 7
5a. Well location:
Brawley Construction Co.
Facility/Owner Name Facility ID# (if applicable)
954 Oak Ridge Farm Hwy, Mooresville, NC
Physical Address, City, and Zip
I redell
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one Iat/long is sufficient)
N W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non -water supply wells
ONLY with the same constructionlabandonment, you can submit one form.
6a. Well ID#: MW-1 1
15.40 C �� L '.1 / . t.._°
6b. Total well depth: (ft) '
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approvmate volume of water remaining in well(s): (gaL)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
e New Cement Grout
❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7E For each material selected above, provide amount of materials ased:
7g. Provide a brief description of the abandonment procedure:
2" well was tremie grouted from bottom to top;
allowed to settle; pad/cover removed; patched with
cement; and filled with topsoil/seed/straw to.
match the surrodffdFi,'YF— 'W§fAt UI.fgce.
S. Ct lion: ',�Z-7 ) ( , � . Z Q 1
O� I .5/22117
Signature erti5 � Rcr t1 t01VAl QFFIM
By sighing1his form, I he certify that the well(s) was (were) abandoned in
accordance with 1 SA NCAC 02C . 0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages ifnecessary.
SUBMITTAL INSTRUCTIONS
10a. For All Weds: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
JUL�f l �L2t� 9 r��`p lOb. For Injection Wells: In addition to sending the form to the address in 10a
u
6c. Borehole diameter: (in.) above, also submit one copy of this form within 30 days of completion of well
11. p• ?fr „4 �{ r i. abandonment to the following:
...
Division of Water Resources, Underground Injection Control Program,
6d. Water level below ground surface: (ft.)
1636 Mail Service Center, Raleigh, NC 27699-1636
6e. Outer casing length (if known): (ft.) 10c. For Water Supply & Infection Wells: In addition to sending the form to the
address(es) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f. Inner easing/tubing length (f known): (ft.) abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Tommy Bolyard
Well Contractor Name (or well owner personally abandoning well on his/her property)
3307
NC Well Contractor Certification Number
Environmental Drilling & Probing Services
Company Name
2. Well Construction Permit #:
List all applicable wellconstruction permits (i.e. UIC County, State, Variance, etc.) ifknown
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)
❑lrri tion
Non -Water Supply Well:
eMonitoring
❑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 7g)
4. Date well(s) abandoned: 5/ 1 0/ 1 7
58. Well location:
Brawiey Construction Co.
Facility/Owner Name Facility ID# (if applicable)
954 Oak Ridge Farm Hwy, Mooresville, NC
Physical Address, City, and Zip
Iredell
County
Parcel Identification No. (PM)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
N
For hnernal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only I GW-30 is needed, Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): (gaL)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
S Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Concrete Grout
❑ Specialty Grout
❑ Bentonite Slurry
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
7g. Provide a brief description of the abandonment procedure:
2" well was tremie grouted from bottom to top;
allowed to settle; pad/cover removed; patched with
cement; and filled with toRsoil/seed/straw to.
match the the surrounding grassy surface.-
JUL Z ,k DW
S. Certific Lion:
QRos 5/22/ 7
Signa Certi Well Contractor r GI to
By si in n, 1 hereb cer ' that the well(s) was (were) abandoned in
actor nc l SA NCAC O_ .0100 or 2C .0200 Well Construction Standards
and that a copy of t&v record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach hell construction record(s) ijavailable. For multiple ejection or non -water supp(v hells
ONLY wilh the same consimcdonlabandonment, you can submit one form.
6a. Well ID#: M W-1 2
10
6b. Total well depth: 17.(ft) '11-U -
JULg 2019 q-�7
1 4
6c. Borehole diameter: (in-)
6d. Water level below ground surface: (ftl
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Injection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
6e. Outer casing length (if known): (ft.) 10c. 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 abandonment to the county health department of the county where
6L Inner casing/tubing length (if known): (ft.) abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Conn -actor Information:
Tommy Bolyard
Well Contractor Name (or well owner personally abandoning well on his/her property)
3307
INC Well Contractor Certification Number
Environmental Drilling & Probing Services
Company Name
2. Well Construction Permit M
List all applicable well construction permits (.e. U/C, County, State, Variance, etc.) ifknown
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ industrial/Commercial
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
❑ MunicipaUPublic
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 7
4. Date well(s) abandoned: 5/ 10/ 1 7
Sa. Well ►ocation:
Brawley Construction Co.
Facility/Owner Name Facility ID# (if applicable)
954 Oak Ridge Farm Hwy, Mooresville, NC
Physical Address, City, and Zip
Iredell
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
lv
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): (gaL)
FOR WATER SUPPLY WELLS ONLY:
7c Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
e Neat Cement Grout
❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay .
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7L For each material selected above, provide amount of materials used:
7g. Provide a brief description of the abandonment procedure:
2" well was tremie grouted from bottom to top;
allowed to settle; pad/cover removed; patched with
cement; and filled with topsoil/seed/straw to.
match the surrounding grassy surface. -
8.
or Well Offer WQR.Date
'5122/17
By si ing Oi orm, l reby cer Il/lh�hile Nttsk# Qil�3@ �6✓ n
accor a with 1 SA N C .0100 or 2C .0200 Well Construction Standards
and that a cony of this record hac been provided to the well owner.
9. Site diagram or additional well details:
W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non -water supply wells
ONLY with the same consttruucttioonl abandonment you can submit one form.
6a.Well M#: tV'VV-13
6
6b. Total well depth: 17.(ft-)
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
JUL2017 10b. For Injection Wells: In addition to sending the form to the address in 10a
6c. Borehole diameter: (in-) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
r =. -
6d. Water level below ground surface: (ft-) Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
6e. Outer casing length (if known): (ft.)
6f. Inner casing/tubing length Cif known): (fL)
6g. Screen length (if known): (ft.)
10c. 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 abandonment to the county health department of the county where
abandoned.
Form GW-30 North Carolina Department of Environmental Duality - Division of Water Resources Revised 2-22-2016

1�.�'% v� II II:\ .N► Dili 121►�1 ► : 1
1. Well Contractor Information:
Tommy Bolyard
Well Contractor Name (or well owner personally abandoning well on his/her property)
3307
NC Well Contractor Certification Number
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only I GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): (gal.)
Environmental Drilling & Probing Services I FOR WATER SUPPLY WELLS ONLY:
Company Name lc- Type of disinfectant used:
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC. County, State, Variance, etc.) i%/worm
7d. Amount of disinfectant used:
3. Well use (check well use):
Water Supply Well:
❑ Agricultural
❑ M unicipaUPubl is
❑Geothermal (Heating/Cooling Supply)
❑Residential Water Supply (single)
❑ IndustriaUCommercial
❑Residential Water Supply (shared)
01nigation
Non -Water Supply Well:
mmonitoring
❑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 7g)
4. Date well(s) abandoned:
5a. Well location:
Brawley Construction Co.
5/10/17
Facility/Owner Name Facility ID# (if applicable)
954 Oak Ridge Farm Hwy, Mooresville, NC
Physical Address, City, and Zip
Iredell
County
Parcel Identification No. (PIN)
Sb. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
N
W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) iifavailable. For multiple injection or non -water supply welts
ONLY with the same constructionlabandonment, you can submit one form.
6a. Well ID#: M W-14
21.10 (ri.).
6b. Total well depth:
JUL 14 2017
6c. Borehole diameter: (in.)
6d. Water level below ground surface: (ft.)
7e. Seating materials used (check all that apply):
e Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Concrete Grout
❑ Specialty Grout
❑ Bentonite Slurry
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (explain under 7g)
7C For each material selected above, provide amount of materials used:
7g. Provide a brief description of the abandonment procedure:
2" well was tremie grouted from bottom to top;
allowed to settle; pad/cover removed; patched with
cement; and filled with topsoil/seed/straw to.
RE match the surrounding grassy su 'alce. eDENRi�w�
8. Certification: JUL L 2 4 2017
wQ 22/17
Si turf f Certi Contra r Well E W IONAL OFFICE
BY signIng IN m, I her by c that the well(s) was (were) abandoned in
accordance with 15.4 NCAC 2C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
6e. Outer casing length (if known): (ft.) 10c. 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 abandonment to the county health department of the county where
6f. Inner eming/tubing length (if known): (ft.) abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Tommy Bolyard
Well Contractor Name (or well owner personalty abandoning well on his/her property)
3307
NC Well Contractor Certification Nomber
Environmental Drilling & Probing Services
Company Name
2. Well Construction Pernrit #:
List all applicable well construction permits li.e. U/C County, State. Variance, etc.) ff nown
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ industrial/Commercial
Non -Water Supply Well:
❑MunicipallPublic
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
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 7g)
4. Date well(s) abandoned:
5a. Well location:
Brawley Construction Co.
5/10/17
Facility/Owner Name Facility 1D# (if applicable)
954 Oak Ridge Farm Hwy, Mooresville, NC
Physical Address, City, and Zip
I redell
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
h:l
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construedon/depth, only 1 GW-30 is needed_ Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): (gaL)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
G Neat Cement Grout
❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Graver
❑ Bentonite Slurry
❑ Other (explain under 7g)
7E For each material selected above, provide amount of materials used:
7g. Provide a brief description of the abandonment procedure:
2" well was tremie grouted from bottom to top;
allowed to settle; pad/cover removed; patched with
cement; and filled with topsoil/seed/straw to.
match the surrounding grasEIVsy(' ISu ace". 'LIEu
VW
8.Certification: JUL 2 4 2097
Ros 5/22/17
By signin this form, 1 her by eert� tafthe well(s) was (were) abandoned in
accordan with I SA Ni 00 or 2C .020t7 Well Construction Standards
and that a c t s record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non -water supply wells
ONLY with the same constructionlabandonmera, you can submit one form.
6a. Well ID#: M W-1 5
6b. Total well depth: 1 •75 (fL)
6c. Borehole diameter: (in.)
)fI�C"iYhS•'�+.:rlri r'tr_s(?::.:�: .
6d. Water level below ground surface:
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For lniection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
6e. Outer casing length (if (mown): (ft.) 10c. 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 abandonment to the county health department of the county where
6f. Inner casingltubing length Cif known): (fL) abandoned.
6g. Screen length (if known):
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Tommy Bolyard
Well Contractor Name (or well owner personally abandoning well on his/her property)
3307
NC Well Contractor CenificationNumber
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approrimate volume of water remaining in well(s): (gal.)
Environmental Drilling & Probing Services FOR WATER SUPPLY WELLS ONLY:
Company Name
17c- Type of disinfectant used:
2. Well Construction Permit #:
List all applicable well construction permits (.e. UIC, County, State, Variance, etc.) ifknown
• 7d. Amount of disinfectant used:
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 (sham)
❑lrri ation
Non -Water Supply Well:
RMonitormg
❑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)
OOther (explain under 7g)
4- Date well(s) abandoned.
5/10/17
Sa. Well location:
Brawley Construction Co.
Facility/Owner Name Facility 1139 (if applicable)
954 Oak Ridge Farm Hwy, Mooresville, NC
Physical Address, City, and Zip
Iredell
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one lattlong is sufficient)
N
7e. Sealing materials used (check all that apply):
e Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Concrete Grout
❑ Specialty Grout
❑ Bentonite Slurry
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
7g. Provide a brief description of the abandonment procedure:
2" well was tremie grouted from bottom to top;
allowed to settle; pad/cover removed; patched with
cement; and filled wk ' 9R1 l - Get aw to.,
match the surrounding gl-assy,sulacwe.
Out_ � ,s
8. Certification:
t04Wk111LoFFFd22/17
11
ZALL
Signa fi ell C n ctor or W Date
By signing is form hereby cer that a wells) was (were) abandoned in
accordance wt A NCAC 03C , r 2C .0200 Well Construction Standards
and that a copy of thiv record hav been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s)1favailable. For multiple injection or non -watersupply welLs
ONLY with the some corutructionlabandonment, you can submit one.%rm.
6a. Well ID#: MW 16
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
_ Division of Water Resources, Information Processing Unit,
16.00 g ? 1617 Mail Service Center, Raleigh, NC 27699-1617
6b. Total well depth: M.) p, E. +�, r ,,mot. c
10b. For lniection Wells: In addition to sending the form to the address in 10a
6c. Borehole diameter: (in-) JUL 14 2017 above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d. Water level below ground surface: (1f �'f ?LG:: Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
6e. Outer casing length (if known): (ft.) 10c. 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 abandonment to the county health department of the county where
6f. Inner easing/tubing length (if known): (ft.) abandoned.
6g. Screen length (if known):
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Tommy Bolyard
Well Contractor Name (or well owner personally abandoning well on his/her property) -
3307
NC Well Contractor Certification Number
Environmental Drilling & Probing Services
Company Natnc
2. Well construction Permit #:
List all applicablewell construction permits (i.e. UIC. County, Stare. Variance, etc.) ifknown
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling SuPply)
❑ industrial/Commercial
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
Non -Water Supply Well:
I'Monitoring
❑Recovery
Injection Well:
❑Aquifer Recharge
❑Groundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
❑Stomnwater Drainage
❑Experimental Technology
❑Subsidence Control
[]Geothermal (Closed Loop)
❑Tracer
❑Geothermal (Heating/Cooling Return)
❑Other (explain under 7g)
4. Date well(s) abandoned:
5/10/17
Sa. Well location:
Brawley Construction Co.
Facility/Owner Name Facility ID# (if applicable)
954 Oak Ridge Farm Hwy, Mooresville, NC
Physical Address, City. and Zip
Iredell
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only I GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): (gaL)
FOR. WATER SUPPLY WELLS ONLY:
lc- Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Seating materials used (check all that apply):
19 Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Concrete Grout
❑ Specialty Grout
❑ Bentonite Slurry
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (explain under 79)
7f. For each material selected above, provide amount of materials used:
7g. Provide a brief description of the abandonment procedure:
2" well was tremie grouted from bottom to top;
allowed to settle; and capped with cement to
match the surrounding���1��t
it II sn /I Qn,1
J L d 1c "Vtt
S. CerMea 'on:
QROS
M VIL E REGION, M�7CE
Si o ertif Il Contractor Well r Date
By sign is form, I hereby c t that the we
was (were) abandoned in
accordance with 15A NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
(if well field, one latllong is sufficient)
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
N W
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
SUBMITTAL INSTRUCTIONS
Attach well construction record(s) ifavailable. For multiple injection or non-watersupply vveILs
ONLY with the same constructionlabandonmeni, you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of wcll
M W 1 7
abandonment to the following:
6a. Well ID#:
v�
Division of Water Resources, Information Processing Unit,
. t,. .: 1617 Mail Service Center, Raleigh, NC 27699-1617
21.30 .
6b. Total well depth: (ft.)
14
JU f_ 2017
lob. For Injection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
6c. Borehole diameter (in.) >D{r:>,:y,; , •
,abandonment to the following:
(ft.)Division
of Water Resources, Underground Injection Control Program,
6d. Water level below ground surface:
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Supply & Iniection Wells: In addition to sending the form to the
6e. Outer casing length (if known): (ft.)
address(es) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f. Inner casing/tubing length (if known): (ft.) abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Tommy Bolyard
Well Contractor Name (or well owner personally abandoning well on his/her property)
3307
NC Welt Contractor Certification Number
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): (gaL)
Environmental Drilling & Probing Services I FOR WATER SUPPLY WELLS ONLY:
Company Namc
7c 'type of disinfectant used:
2. Well Construction Permit #:
List all applicable %ell construction permits ri.e. U1C, County, Stare. Variance, etc.) ifArown
7d_ Amount of disinfectant used:
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Municipal/Public
❑Geothermal (Heating/Cooling Supply)
❑Residential Water Supply (single)
❑lndustrial/Commercial
❑Residential Water Supply (shared)
❑Irrigation
Non -Water Supply Well:
SMonitoring
❑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 Retum)
❑Other (explain under 7g)
4. Date well(s) abandoned: 5/ 1 0/ 1 7
Sa. Well location:
Brawley Construction Co.
Facility/Owner Name Facility ID# (if applicable)
954 Oak Ridge Farm Hwy, Mooresville, NC
Physical Address, City, and Zip
I redell
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one [at/long is sufficient)
N W
CONSTRUCTION DETAILS OF WELL(S).BEING ABANDONED
Allach well consimctfon records) ifavailable. For multiple b jeclion or non-wafersupply umllr
ONLY wish the same consttruuctionlabandonmeni, you can submit one form.
6a. Well m#: MW-1
6b. Total well depth:
18.25
,
.E_��.,,`
JUL 1, 4 2017
6c. Borehole diameter: (ip I.
hl)tYOft;'1aEii�f1 ?-'rtu'es�ai y,i %J)!
6d. Water level below ground surface: (ft.)
7e. Sealing materials used (check all that apply):
S Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Concrete Grout
❑ Specialty Grout
❑ Bentonite Slurry
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
7g. Provide a brief description of the abandonment procedure:
2" well was tremie grouted from bottom to top;
allowed to settle; and cappedRLddEq WW_M iWR
the surrounding asphalt stu,�face-gn17
WQROS
8. C ication: q�0 RESV GIONAL OFFICE
5/22/17
of ert'tied ntractor or We Owner Date
By sign' ,this fo 1 Hereby certi t e well(s) was (were) abandoned in
accords I5A NC.(C 02C .0100 or 2C .0200 Well Construction Standards
and that a cop), of thiv record hac been provided to the well owner.-
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, information Processing Unit, ' .
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Injection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 276994636
6e. Outer casing length (if known): (ft.) 10c. 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 abandonment to the county health department of the county where
6f. Inner casing/tubing length (if known): (ft.) abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Tommy Bolyard
Well Contractor Name (or well owner personally abandoning well on his/her property)
3307
NC Well Contractor Certification Number
Environmental Drilling & Probing Services
Company Name
2. Well Construction Permit#:
List all applicable well construction permits (i.e. U1C. County, State, Variance. etc.) ifAnown
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:
mMonitoring
❑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 7g)
4. Date wells) abandoned. 5/ 1 0/ 17
5s. Well location:
Brawley Construction Co.
Facility/Owner Name Facility W# (if applicable)
954 Oak Ridge Farm Hwy, Mooresville, NC
Physical Address, City, and Zip
I redel I
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field one lattlong is sufficient)
N W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection ornon-watersupply Vve/ls
ONLY with the same construction/abandonmeni, you can submit one form.
6a. We11ID#: MW-2
6b. Total well depth: 18.16 (ft.) q
JUL 14 2�9�
6c. Borehole diameter: 1inilirOtti9i i�ft PrCKYliz `)i1
Ell
6d. Water level below ground surface: (ft.)
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approumate volume of water remaining in weII(s): (gat.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
m Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Concrete Grout
❑ Specialty Grout
❑ Bentonite Slurry
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
7g. Provide a brief description of the abandonment procedure:
2" well was tremie grouted from bottom to top;
allowed to settle; and capped with cement to match
the surrounding asphaltss��f�t� introFNRIDWR
J�; ! _ ra :t t-.v e u
8. Certifi ation:
WQRO
Gl l �Q17ElC.
Si o ertified Conuac a Well Date
By signi is form, I hereby t the well(s) was (were) abandoned in
accordance with 1 SA NCAC 02C .0100 or 1C .0200 Well Construction Standards
and that a copy of this record hav been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
SUBNMTAL (INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For lnieclion Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground Injection. Control Program,
1636 Mail Service Center, Raleigh, NC 276994636
6e. Outer casing length (if known): (ft-) 10c. 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 abandonment to the county health department of the county where
6f. Inner casing/tubing length (if known): (fL) abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Tommy Bolyard
Well Contractor Name (or well owner personally abandoning well on his/her property)
3307
NC Well Contractor Certification Number
Environmental Drilling & Probing Services
Company Name
2. Well Construction Permit #:
List all applicable w 11 construction permits (i.e. UIC County, State, Variance, etc.) iftmown
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑MunicipaUPublic
❑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)
❑Ctther (explain under 7g)
4. Date well(s) abandoned: 5/ 1 0/ 1 7
5a. Well location:
Brawley Construction Co.
Facility/Owner Name Facility ID# (if applicable)
954 Oak Ridge Farm Hwy, Mooresville, NC
Physical Address, City, and Zip
I redell
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one [attlong is sufficient)
N
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only I GW-30 is needed- Indicate TOTAL NUMBER of
wells abandoned:
7b. Approrimate volume of water remaining in well(s): (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Seating materials used (check all that apply):
e Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Concrete Grout
❑ Specialty Grout
❑ Bentonite Slurry
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used.-
7g. Provide a brief description of the abandonment procedure:
2" well was tremie grouted from bottom to top;
allowed to settle; and capped qepug
the surrounding asphalt surface,.,
JUL fa 5e Lu5u
WQROS
8. Certi atior Op - ' LL, REGIONAL, OFF(C19
L �'
5/22/17
Signature ofVe-ruffiedl Contractor or r Date
By signingI hereby certify that the well(s) was (were) abandoned in
accordance with 15.4 NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of thii record has been provided to the well owner.
9. Site diagram or additional well details:
W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non -water supply wells
ONLY with the same constructtinonl abandonment, you can submit one form.
6a. Well ID#: M Y V —3
R``� � E I '
6b. Totalwelldepth: 18.87 (ft.) JUL
lJ' L 14
2017
6c. Borehole diameter: so n
Ian' 1L21ut;G
6d. Water level below ground surface:
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, information Processing Unit,
1617 Mail Service Center, Raleigh, NC 276994617
10b. For lniection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources; Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
6e. Outer casing length (if known): (ft.) 10c. For Water Supply & Iniection Wells: In addition to sending the form to the
address(es) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f. Inner casing(tubing length (if known): (ft.) abandoned.
6g. Screen length (if known):
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Tommy Bolyard
Well Contractor Name (or well owner personally abandoning well on his/her property)
3307
NC Well Contractor Certification Number
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): (gaL) .
Environmental Drilling & Probing Services I FOR WATER SUPPLY WELLS ONLY:
Company Name
7c. Type of disinfectant used:
2. Well Construction Permit #:
List all applicable well construction permits (.e. UIC. County, State, Yariance, etc.) ij noym
7d. Amount of disinfectant used:
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Municipal/Public
❑Geothermal (Heating/Cooling Supply)
❑Residential Water Supply (single)
❑industrial/Commemial
❑Residential Water Supply (shared)
❑ Irrigation
Non -Water Supply Well:
RMonitoring
❑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 7g)
4. Date well(s) abandoned:
5/10/17
5a. Well location:
Brawley Construction Co.
Facility/Owner Name Facility ID# (if applicable)
954 Oak Ridge Farm Hwy, Mooresville, NC
Physical Address, City. and Zip
I redell
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/)ong is sufficient)
(v
7e. Sealing materials used (check all that apply):
e Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Concrete Grout
❑ Specialty Grout
❑ Bentonite Slurry
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (explain under 7g)
If. For each material selected above, provide amount of materials used:
7g. Provide a brief description of the abandonment procedure:
2" well was tremie grouted from bottom to Agp;
(; VEUIIVt..uctr�""""
allowed to settle; and capped VK ment to match
the surrounding asphalt
WQROS FiCE
rti tion:
OORES77VI E REGIONAL
S. Ce
5/22/17
Signs of C - ed W C tractor or Well O r Date
By sigriin this 1 hereby certify that wells) was (were) abandoned in
accordance with 1 SA NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of thiv record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
W abandonment details. You may also attach additional pages if necessary. .
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s) ifavailable. For multiple injection or non-watersupp(v "ILv
ONLPwiih the same construction/abandonment, you can submit one form.
lOs. For All Wells: Submit this form within 30 days of completion of well
62. Well ID#:
MW-4 _ _ abandonment to the following:
�-, . "i;�
'Ll Division of Water Resources, information Processing Unit,
6b. Total well depth: 19.00 (ft.) JUL
I 9 �g� 1617 Mail Service Center, Raleigh, NC 27699-1617
14 J U L G i 10b. For lniection Wells: In addition to sending the form to the address in 10a
6c. Borehole diameter. (in.) '1F';^'ttv:-E?I! ?t;;',i','si; above, also submit one copy of this form within 30 days of completion of well
r-+i,j{^.,/;= abandonment to the following:
6d. Water level below ground surface:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
6e Outer casing length (if known): (ft.) 10c. 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 abandonment to the county health department of the county where
6f. Inner casing/tubing length (if known): (ft.) abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Tommy Bolyard
Well Contractor Name (or well owner personally abandoning well on his/her property)
3307
NC Well Contractor Certification Number
Environmental Drilling & Probing Services
Company Namc
2. Well Construction Permit #:
List all applicable well construction permits (.e. U/C. County, State, Yariance, etc.) iflnown
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)
Olnigation
Non -Water Supply Well:
eMonitoring
❑Recovery
Injeetion Wen:
❑Aquifer Recharge
❑Groundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
El Aquifer Test
❑Stormwater Drainage
❑Experimental Technology
❑Subsidence Control
❑Geothermal (Closed Loop)
❑Tracer
❑Geothermal (Heating/Cooling Return)
❑Other (explain under 7g)
4. Date well(s) abandoned:
5/10/17
5a. Well location:
.Brawley Construction Co.
Facility/Owner Name Facility ID# (ifapplicable)
954 Oak Ridge Farm Hwy, Mooresville, NC
Physical Address, City, and Zip
Iredell
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat(long is sufficient)
N
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only I GW-30 is needed_ Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in weD(s): (gaL)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d- Amount of disinfectant used:
7e. Seating materials used (check all that apply):
e Neat Cement Grout ' ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Concrete Grout
❑ Specialty Grout
❑ Bentonite Slurry
❑ Dry Clay.
❑ Drill Cuttings
❑ Gravel
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used-
7g. Provide a brief description of the abandonment procedure:
2" well was tremie grouted from bottom to top;
allowed to settle; and capped with cement to match
the surrounding asphalt sGffW6PINcDF-N
II lL , 4s 2017
8. Certification: WQROS
RESV LE J�,pALOFFICE
Signa of C ed Well tractor or Well Owner Date L/ l /
By signing this orm, 1 hereby certify that the well(s) was (were) abandoned in
accordance with 15.4 NCAC 02C . 0100 or 2C . 0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCITON DETAIIS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavai/able. For multiple injection or non-watersupply wells
ONLY with the same consiruuctionlabandonment, you can submit one form.
6a. Well ID#: 1V1W-5
6b. Total well depth: 18.65(ft-) JUL 14
6c. Borehole diameter:
6d. Water level below ground surface: (ft.)
SUBMITTAL INSTRUCTIONS
10a. For All Wens: Submit this form within 30 days of complction of wcll'
abandonment to the following:
Division of Water Resources, information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Injection Wells: In addition to sending the form to the address in ]Oa
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mall Service Center, Raleigh, NC 27699-1636
6e. Outer casing length (if known): (ft.) 10c. For Water Supply & Infection Wells: In addition to sending the form to the
address(es) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f. Inner casing/tubing length (if known): (ft,) abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environmentat Quality - Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Tommy Bolyard
Well Contractor Name (or well owner personally abandoning well on his/her property)
3307
NC Well Contractor Certification Number
Environmental Drilling & Probing Services
Company Name
2. Well Construction Permit #-
List all applicable v ell construction permits (.e. UIC, Coanty, State, Variance, etc.) if laown
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)
Olnigation
Non -Water Supply Well:
eMonitonng
❑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 Retum)
❑Other (explain under 7g)
4. Date well(s) abandoned. 5/ 1 0/ 1 7
5a. Well location:
Brawley Construction Co.
Facility/Owner Name Facility ID# (if applicable)
954 Oak Ridge Farm Hwy, Mooresville, NC
Physical Address, City, and Zip
Iredell
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
N
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): (gaL)
FOR WATER SUPPLY WELLS ONLY:
lc. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
s Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Concrete Grout
❑ Specialty Grout
❑ Bentonite Slurry
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (explain trader 7g)
7f. For each material selected above, provide amount of materials used:
7g. Provide a brief description of the abandonment procedure:
2" well was tremie grouted from bottom to top;
allowed to settle; pad/cover remove�900*� ARI6WR
cement; and filled with topsoil/seed/straw, to.) r
Km match the surrounding grassy surface:
8. Certifi on: WQROS
00 E E REGIONAL OFFICE
5/22/17
Signs el] Con for or ell Date
By signing his fonn, I ereby c rd at the well(s) was (were) -abandoned in
accordant NCAC 0. . 00 or 2C .O100 Well Construction Standards
and that a cony of this record has been provided to the well owner.
9. Site diagram or additional well details:
W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s) ifavailable. For multiple injection or non-watersupply Hells
ONLY with the same co nstruction/abandonmenl, you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a. Well ID#• MVP-6 �^ ��: abandonment to the following:
? ate " . E
Division of Water Resources, Information Processing Unit,
6b. Total well depth 21.00 (ft-) JUL 14 2017 1617 Mail Service Center, Raleigh, NC 276994617
LOb. For iniection Wells: In addition to sending the form to the address in 10a
6c. Borehole diameter: (in.) )�}zOrcCt'=ai L?ft Ui7&ve, also submit one copy of this form within 30 days of completion of well
CAh'; Q/ 13, abandonment to the following:
6d. Water level below ground surface:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
6e. Outer casing length (if known): (ft.) 10c. 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 abandonment to the county health department of the county where
6f. Inner casing/tubing length (if known): (ft.) abandoned.
6g. Screen length (if known):
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Tommy Bolyard
Weil Contractor Name (or well owner personally abandoning well on his/ber property)
3307
NC Well Contractor Certification Number
Environmental Drilling & Probing Services
Company Nam
2. Well Construction Permit#:
List all applicable wrll construction permits (I.e. U1C, County, State, Yariance. etc.) ifbtown
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Municipal/Public
❑Geothermal (Heating/Cooling Supply)
❑Residential Water Supply (single)
❑Industrial/Commemial
❑Residential Water Supply (shared)
❑Irri lion
Non -Water Supply Well:
eMomtormg
❑Recovery
Injection Well:
❑Aquifer Recharge
❑Groundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity Bawer
❑Aquifer Test
❑Stormwater Drainage
❑Experimental Technology
❑Subsidence Control
❑Geothermal (Closed loop)
❑Tracer
❑Geothermal (Heating/Cooling Return)
❑Other (explain under 7g)
4. Date weil(s) abandoned:
5/10/17
Sa- Well location:
Brawtey Construction Co.
Facility/Owner Name Facility ID# (if applicable)
954 Oak Ridge Farm Hwy, Mooresville, NC
Physical Address, City, and Zip
I redell
County
Parcel identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field one Wlong is sufficient)
N
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well consttaetion/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER_ of
Wells abandoned:
7b. Approximate volume of water remaining in weH(s): (gal)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used-
7d. Amount of disinfectant used:
7e. Seating materials used (check all that apply):
S Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Concrete Grout
❑ Specialty Grout
❑ Bentonite Slurry
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (explain under 7g)
7C For each material selected above, provide amount of materials used:
7g. Provide a brief description of the abandonment procedure:
2" well was tremie groutPdcfLrQM of o ;,tc��top;
allowed to settle; and capped ,with, cement to
match the surrounding asphalt surface.
WQROS
Pir;Q1Q 4AkQFFIGE
S. Certification:
5/22/17
Si ctor or a Date
By signin this I hereby c rti t the well(s) was (were) abandoned in
accordance with 1 SA NCAC 02C. 0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach Kwit construction records) ifavailaNe. For multiple injection or non-watersupply wells
ONLY with the same constructionlabandonment, you can submit
t�one form.
6a. Well )D#: MW-7
6b. Total well depth: 20.48 00 J U L 14 2017
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For tnjection Wells: in addition to sending the form to the address in 10a
6c. Borehole diameter: (in-) r-;Vt ; ;;%i-, above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d. Water level below ground surface:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
6e. Outer easing length (if (mown): (ft.) 10c. For Water Supply & Injection Wells: In addition to sending the form to the
address(cs) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f. Inner casing/tubing length (d known): (fL) abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
For Internal Use ONLY:
/Vec-7 5
WELL ABANDONMENT DETAILS
Tommy Bolyard 7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
Well Contractor Name (or well owner personally abandoning well on his/her property) well constivetion/deptlionly 1 GW-30 is needed. Indicate TOTAL NUMBER of
3307 wells abandoned:
NC Well Contractor Certification Number
Environmental Drilling & Probing Services
Company Name
2. Well Construction Permit #:
List all applicable well construction permits ri.e. UIC County, State, Yarionce, ere.) iflnown
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Mtmicipal/Public
❑Geothermal (Heating/Cooling Supply)
❑Residential Water Supply (single)
❑industrial/Commercial
❑Residential Water Supply (shared)
❑Irri ation
Non -Water Supply Well:
SMonitoring
❑Recovery
Injection Well:
❑Aquifer Recharge
❑Groundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
❑Stormw•ater Drainage
❑Experimental Technology
❑Subsidence Control
❑Geothermal (Closed Loop)
❑Tracer
❑Geothermal (Heating/Cooling Return)
❑Other (explain under 7g)
4. Date well(s) abandoned:
5/10/17
59. Well location:
Brawley Construction Co.
Facility/Owner Name Facility ID# (ifapplicable)
954 Oak Ridge Farm Hwy, Mooresville, NC
Physical Address, City, and Zip
Iredell
County
Parcel Identification No. (PIN)
51b._ Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
N
7b. Approximate volume of water remaining in well(s): (gaL)
FOR WATER SUPPLY WELLS ONLY:
lc. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
e Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Concrete Grout
❑ Specialty Grout
❑ Bentonite Slurry
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (explain under 7g)
7L For each material selected above, provide amount of materials used:
7g. Provide a brief description of the abs o 1 W00F.,
4" well was tremie grouted from bottom to top after re5ttoving(stinger pipe;
(•� /J i Illl
allowed to settle; pad/cover removed; pafched with
cement; and filled with topsoil/seema or-Fics
match the surrounding g n ace.
S. Certifi tion:
/22/17
Si of Co ctor or Well Date
By signing his fo , I hereby cera the well(s) was (were) abandoned in
accordance wit 15A NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WE; LDS) BEING ABANDONED
Atiaeh"llconrtructionrecord(s)ifavailable. For multiple injection or non-watersupplvwel/s
ONLY with the same constructionlabandonmeru, you can submit one,form.
6a- Well ID#: EW-1 2
2260
6b. Total well depth: .(ft)
JUL 2 4 2097
6c. Borehole diameter:
6d. Water level below ground surface: ($-)
6e. Outer casing length (if known): (ft.)
6f. Inner casing/tubing length (if known):
6g. Screen length (if known): (ft.)
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. 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 abandonment to the county health department of the county where
abandoned.
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Tommy Bolyard
Well Contractor Name (or well owner personally abandoning well on his/her property)
3307
NC Well Contractor Certification Numbcr
Environmental Drilling & Probing Services
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC. County. State. Yarianre, etc.) ifbtown
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.
mmonitoring
❑Recovery
Injection Well:
❑Aquifer Recharge
❑Groundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
El Aquifer Test
❑Stormwater Drainage
❑Experimental Technology
❑Subsidence Control
❑Geothermal (Closed Loop)
❑Tracer
❑Geothermal (Heating/Cooling Return)
❑Other (explain under 7g)
4. Date wells) abandoned:
5/10/17
5a. Well location:
Brawley Construction Co.
Facility/Owner Name Facility ID# (if applicable)
954 Oak Ridge Farm Hwy, Mooresville, NC
Physical Address, City, and Zip
Iredell
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lattlong is sufficient)
N W
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Weds having the same
well construction/depth, only I GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approrimate volume of water remaining in weil(s): (gaL)
FOR WATER SUPPLY WELLS ONLY:
lc- Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
e Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout ❑ Dry Clay
❑ Concrete Grout ❑ Drill Cuttings
❑ Specialty Grout ❑ Gravel
❑ Bentonite Slurry ❑ Other (explain under 7g)
7f. For each material selected above, provide amount oft{IR
RIMIVEit3
ill' q U t
7g. Provide a brief description of the abandonment pral! ire9s 1C�
11 1 F RFG10NNL OFF
4" well was tremie groLded from bottor��(jr t ovmg stinger pipe;
allowed to settle; pad/cover removed; patched with
cement; and filled with topsoil/seed/straw to.
match the surrounding grassy surface.
S. Certification:
5/22/17
Si enifiWe Co ctor r Date
By signing is form, / hereby certify that the well(s) was (were) abandoned in
accordance with 1 SA NCAC 02C.0100 or 2C .0200 Well Construction Standards
and that a copy of this record hav been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s) ifavailable. For multiple injection or non-watersupp(v we/iv .
ONLY with the same consiruction/abandonment, you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a. Well ID#: E W-11 abandonment to the following:
Division of Water Resources, Information Processing Unit,
6b. Total well depth:
23.90 l? � : '� 1617 Mail Service Center, Raleigh, NC 27699-1617
(ft-) z• ,wry q �� L,i4
JUL
�{ 9 q57 10b. For Infection Wells: In addition to sending the form to the address in 10a
6c. Borehole diameter: (in.) JUL � g S� 8 d' above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d. Water level below ground surface: (R,) Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
6e. Outer casing length (if known): (ft.) 10c. For Water Supply & Iniection Wells: In addition to sending the form to the
address(es) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f. Inner casing/tubing length (if known): (ft.) abandoned.
bg. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Tommy Bolyard
Well Contractor Name (or well owner personally abandoning well on his/her property)
3307
NC Well Contractor Certification Number
Environmental Drilling & Probing Services
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UiC County, State, Variance, etc.) iflmown
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
Non -Water Supply Well:
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
❑Mtmicipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
IN,
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 7g)
4. Date well(s) abandoned: 5/ 1 0/ 1 7
5% Well location:
Brawley Construction Co.
Facility/Owner Name Facility ID# (if applicable)
954 Oak Ridge Farm Hwy, Mooresville, NC
Physical Address, City, and Zip
Iredell
County
Parcel identification No. (PiN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one latAong is sufficient)
N
W
CONSTRUCTION DETAILS OF WELLSS) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non-watersuppiv welL5
ONLY with the same construction/abandonment, you can submit one form.
6a. Well ID#: EW-10
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For GeoprobelDPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): (gall.)
FOR WATER SUPPLY WELLS ONLY:
lc- Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
s Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Concrete Grout
❑ Specialty Grout
❑ Bentonite Slurry
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (explain under 7g)
7G For each material selected above, provide amount of materials used:
7g. Provide a brief description of the abandonment procedure:
4" well was tremie grottted from bottom to top after removing stinger pipe;
allowed to settle; pad/cover removed; patched with
cement; and filled with ts�,00-il/seed/mo.
�.Qr,
match the surrounding grassy surface.
JUL Z�01f
8. Certifi tion:
WLR 0W ROS / l 7
IONAI
Si tore rthis.
ell C ttac or el wne Date
By sigrti 1 hereby cer ' l the well(s) was (were) abandoned in
accordancewit15A NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of thiv record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
ltla. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, information Processing Unit,
23.30 c� - -� 3 aR'� ` 1617 Mail Service Center, Raleigh, NC 27699-1617
6b. Total well depth: (ft-) '
�Ui ��pA 10b. For lniection Wells: In addition to sending the form to the address in l0a
6c. Borehole diameter: in.) ff 9 above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d. Water level below ground surface (Ct-) Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
6e. Outer casing length (if known): (ft.) 10c. 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 abandonment to the county health department of the county where
6f. Inner casing/tubing length (if known): (CG) abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Tommy Bolyard
Well Contractor Name (or well owner personally abandoning well on his/her property)
3307
NC Well Contractor Certification Number
Environmental Drilling & Probing Services
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC County, State. Variance, etc.) ifktown
3. Well use (check well use):
Water Supply Well:
❑ Agricultural
❑ MunicipaUPublic
❑Geothermal (Heating/Cooling Supply)
❑Residential Water Supply (single)
❑industrial/Commercial
❑Residential Water Supply (shared)
❑hri ation
Non -Water Supply Well:
RMonitonng
❑Recovery
Injection Well:
❑Aquifer Recharge
❑Groundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity Ramer
❑Aquifer Test
❑Stormwater Drainage
❑Experimental Technology
❑Subsidence Control
❑Geothermal (Closed Loop)
❑Tracer
❑Geothermal (Heating/Cooling Return)
❑Other (explain under 7g)
4. Date well(s) abandoned: 5/ 10/ 1 7
5a. Well location:
Brawiey Construction Co.
Facility/Owner Name Facility ID# (if applicable)
954 Oak Ridge Farm Hwy, Mooresville, NC
Physical Address, City, and Zip
Iredell
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one lat/long is sufficient)
N W
CONSTRUCTION DETAILS OF WELLIS) BEING ABANDONED
Attach vivilconatruction record(s) ifavailable. For multiple injection or non-ivatersupply welLs
ONLY with the same consiructionlabandonmeni, you can submit one form.
6a- Well ID#: EW-9 _
6b. Total well depth: 23.20
6c.Borehole diameter: <c4�F�)P's)(lOrl �;rt^if.a?y?.jitti
Vrt
6d. Water level below ground surface: (ft.)
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in weD(s): (gaL)
FOR WATER SUPPLY WELLS ONLY:
7c Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Seating materials used (check all that apply):
e Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Concrete Grout
❑ Specialty Grout
❑ Bentonite Slurry
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
7g. Provide a brief description of the abandonment procedure:
4" well was tremie grouted from bottom to top after removing stinger pipe;
allowed to settle; pad/cover removed; patched with
cement; and filled with topsoil/Aft, raw o.
match the surrounding grassy surface.L Q 201
8. Certification: WQROS
M0 SVILLE F q)�� f� OFFICE
Signature of Certili ell C ctor or ell Date �� ��
By signing th I hereby certify that the well(s) was (were) abandoned in
accordance with I5A NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a cony of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Tnformation Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Injection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
6e. Outer casing length (if known): (ft.) 10c. For Water Supply & Iniection Wells: In addition to sending the form to the
addresses) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6L Inner casing/tubing length (if known): (ft,) abandoned.
6g- Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
Tommy Bolyard
Well Contrwtor Name (or well owner personally abandoning well on his/her property)
3307
NC Well Connactor Certification Number
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed- Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): (gal)
Environmental Drilling & Probing Services I FOR WATER SUPPLY WELLS ONLY:
Company Name 7c- Type of disinfectant used:
2. Well Construction Permit #:
List all applicable well construction permits (i.e. U/C. County, State, Variance. etc.) ifknown
7d. Amount of disinfectant used:
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑MunicipaUPublic
❑Geothermal (Heating/Cooling Supply)
❑Residential Water Supply (single)
❑Industrial/Commercial
❑Residential Water Supply (shared)
❑Irrigation
Non -Water Supply Well:
IMMonitoring
❑Recovery
Injection Well:
❑Aquifer Recharge
❑Groundwater Remediation
❑Aquifer Storage, and Recovery
❑Salinity Barrier
❑Aquifer Test
❑Stomtw•ater Drainage
❑Experimental Technology
❑Subsidence Control
❑Geothermal (Closed Loop)
❑Tracer
❑Geothermal (Heating/Cooling Return)
❑Other (explain under 7g)
4. Date well(s) abandoned:
5a. Well location:
Brawley Construction Co.
5/10/17
Facility/Owner Name Facility 1D# (if applicable)
954 Oak Ridge Farm Hwy, Mooresville, NC
Physical Address, City, and Zip
Iredell
County
Parcel identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
N W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non-watersuppty wells
ONLY with the same consiructionlaabandonmem, you can submit one form.
6a. Well ID#: EW—o
7e. Sealing materials used (check all that apply):
IN Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Concrete Grout
❑ Specialty Grout
❑ Bentonite Slurry
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
7g. Provide a brief description of the abandonment procedure:
4" well was tremie grouted from bottom to top,
after removing stinger piping; allowed to settle;
and capped with cem2WAEpWh", R
9 -
surrounding asphalt surface. ,,,t ,1 9Q17
JIJt— o —_
S. Certification:
\NQROS
_ LLEGIOCE
Signa of e Ittou =ha;l
well
bate
By signing thi 1 hereby the well(s) was (were) abandoned in
accordance with I SA NCAC 02C.0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
t
d
23.30 1 4° 3 5 " � Division of Water Resources, information Processing Unit, 1617 Mail Service Center, Raleigh, NC 27649-1617 g
6b. Total well depth: (it.) � � �,d'�re : �>� ;. g
��S 9
6c. Borehole diameter: (in,) L
��a� 10b. For Injection Wells: In addition to sending the form to the address in 10a
1 above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d. Water level below ground surface: (ft.)'' ` `
Division of Water Resources, Underground
�, ergroung Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
6e. Outer casing length (if {mown): (ft.) 10c. For Water Supply & Iniection Wells: in addition to sending the form to the
address(es) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6L Inner casing/tubing length Cif known): (ft.) abandoned-
6g. Screen length (if known): (ft-)
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

NVELL ABANDONMENT RECORD
1. Well Contractor Information:
Tommy Bolyard
Well Contractor Name (or well owner personally abandoning well on his/her property)
3307
NC Well Contractor Certification Number
Environmental Drilling & Probing Services
Company Name
2. Well Construction Permit #:
List all applicable xrll construction permits (i.e. U1C. County, State, Variance. etc.) ifbrown
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
Non -Water Supply Well:
❑MunicipaUPublic
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Recovery
Injection Well:
❑Aquifer Recharge
❑Groundwater Remediation
❑Aquifer Storage and Recovery
❑Satin ity Barrier
❑Aquifer Test
❑Stormwater Drainage
❑Experimental Technology
❑Subsidence Control
❑Geothermal (Closed Loop)
❑Tracer
❑Geothermal (Heating/Cooling Return)
❑Other (explain under 7g)
4. Date wells) abandoned. 5/ 10/ 17
5a. Well location:
Brawtey Construction Co.
ror Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
Well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): (gaL)
FOR WATER SUPPLY WELLS ONLY:
lc. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
IN Neat Cement Grout
❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
7g. Provide a brief description of the abandonment procedure:
4" well was tremie grouted from bottom to top,
after removing stinger,piping; allowed to settle;
and capped with cemeff, %N 4 �- e
surrounding asphalt surface. JUL S A 2017
Facility/Owner Name Facility ID# (if applicable) 8.
954 Oak Ridge Farm Hwy, Mooresville, NC
Physical Address, City, and Zip
Iredell
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
0
5ICS
Certified WeVontract& or Well Owner / I Date
By si ing th' ortn, I her y eerot.4 tat the well(s) was (were) abandoned in
accor ce with 1 SA NCAC 0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non-watersuppty wells
ONLY with the same consttr�u/cii/onlabandonmem, you can submit one form.
6a. Well ID#: E V y —7
6b. Total well depth: 23.90(ft-)
i 4 nqT
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
JULA 10b. For Injection Wells: In addition to sending the form to the address in 10a
6c. Borehole diameter: (in,) above, also submit one copy of this form within 30 days of completion of well
;, ; r,:"..:. }%s•' abandonment to the following:
6d. Water level below ground surface:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
6e. Outer casing length (if known): (ft.) 10c. 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 abandonment to the county health department of the county where
6f. ]inner casing/tubing length (if known): (ft.) abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Tommy Bolyard
Well Contractor Name (or well owner personally abandoning well on his/her property)
3307
NC Well Contractor Certification Number
Environmental Drilling & Probing Services
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC. County, State, Variance, etc.) ifAnown
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ industrial/Commercial
❑Irrigation
Non -Water Supply Well:
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑ Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
4. Date well(s) abandoned:
5a. Well location:
Brawley Construction Co.
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑other (explain under
5/ 10/ 17
Facility/Owner Name Facility III# (ifapp6cable)
954 Oak Ridge Farm Hwy, Mooresville, NC
physical Address, City, and Zip
Iredell
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lattlong is sufficient)
N
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): (gal.)
FOR WATER SUPPLY WELLS ONLY:
lc- Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
IN Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Concrete Grout
❑ Specialty Grout
❑ Bentonite Slurry
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Colter (explain under 7g)
7f. For each material selected above, provide amount of materials used:
7g. Provide a brief description of the abandonment procedure:
4" well was tremie grouted from bottom to top,
after removing stinger piping; allowed to settle;
and capped with cementdmMtffl- t °
surrounding asphalt surface. 1�t p17
8. Certification: \NQROS
J/ ��7rlc�
aRESV LE REG
Signs of ed Kontra r ell Owtter Date
By signing this fo ereby c rtify that well(s) was (were) abandoned in
accordance wr 15.4 NCAC 02 .0100 1C .0200 Well Construction Standards
and that a copy of this record has een provided to the well owner.
9. Site diagram or additional well details:
W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages ifnecessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non-xatersupplvWIU
ONLY with the some construction/abandonmeni, you can submit one form.
6a. Well ID#: EW-6
6b. Total well depth: 21.00(ft)
6c. Borehole diameter: (in.)
6d. Water level below ground surface:
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For iniection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
6e. Outer casing length (if known): (fL) 10c. For Water Supply & Iniection Wells: In addition to sending the form to the
address(es) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f. Inner casing/tubing length (if known): (ft) abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Tommy Bolyard
Well Contractor Name (or well owner personally abandoning well on his/her property)
3307
NC Well Contractor Certification Number
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): (gal.)
Environmental Drilling & Probing Services I FOR WATER SUPPLY WELLS ONLY:
Company Namc 7c. Type of disinfectant used:
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC. County, State, Yariance. etc;) iifknown
7d. Amount of disinfectant used:
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ industrial/Commercial
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑ Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
❑Municipal/Public
❑Residential Water Supply (single)
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 7,
4. Date well(s) abandoned: 5/ 1-0/ 1 /
5a. Well location:
Brawley Construction Co.
Facility/Owner Name Facility ID# (if applicable)
954 Oak Ridge Farm Hwy, Mooresville, NC
Physical Address, City, and Zip
Iredell
Parcel identification No. (PTN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
N
W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non-watersupply wells
ONLY with the same consiruction/abandonment, you can submit one form.
6a. Well ID#: EW-5
el_ '.'y
f �.:s,.
22.40
6b- Total well depth: (ft.)
7e. Sealing materials used (check all that apply):
S Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Concrete Grout
❑ Specialty Grout
❑ Bentomte Slurry
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (explain under 7g)
7L For each material selected above, provide amount of materials used:
7g. Provide a brief description of the abandonment procedure:
4" well was tremie grouted from bottom to top,
after removing stinger piping; allowed to settle;
and capped with cementfl1►�v�r
surrounding asphalt surface. 11 II4 ZU i r
8. Certification: WQRO$
Signature Ce Well ntra r or Well Owner Date
By si 'n orm, I hereb certify t the well(s) was (were) abandoned in
accordance with 15A NCAC 02 . or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well detains: -
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages ifnecessary.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
JUL1 4 2017 10b. For lniection Wells: In addition to sending the form to the address in 10a
6c. Borehole diameter: (in,) above, also submit one copy of this form within 30 days of completion of well
1 04 5 i, ty�fl p r oc ?N,,A) ! Jill, abandonment to the following:
6d- Water level below ground surface: (D,) Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
6e. Outer casing length (if known): ({t,) 10c. 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 abandonment to the county health department of the county where
6f. Inner casing/tubing length (if known): (n,) abandoned.
69. Screen length (if known):
Form G W-30 North Carolina Department of Environmental Quality - Division of W ater Resources
Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Tommy Bolyard
Well Contractor Name (or well owner personally abandoning well on his/her property)
3307
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the samc
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
NC well Contractor Certification Number 7h. Approximate volume of water remaining in well(s): (gal.)
Environmental Drilling & Probing Services I FOR WATER SUPPLY WELLS ONLY:
Company Nara
7c. Type of disinfectant used:
2. Well Construction Permit #:
List all applicable well construction permits (.e. U/C. County, State. Variance, etc.) ifbtown
7d. Amount of disinfectant used:
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)
❑Irri ion
Non -Water Supply Well:
®Monitoring
❑Recovery
Injection Weu:
❑Aquifer Recharge
❑Groundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
❑Stormwater Drainage
❑Experimental Technology
❑Subsidence Control
❑Geothermal (Closed Loop)
❑Tracer
❑Geothermal (Heatmg/Coolin Return)
❑Other (explain under 7g)
4. Date well(s) abandoned- 5/ 10/ 17
5a. Well location:
Brawley Construction Co.
Facility/Owner Name Facility 1D# (if applicable)
954 Oak Ridge Farm Hwy, Mooresville, NC
Physical Address, City, and Zip
Iredell
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one ]at/long is sufficient)
N W
CONSTRUCTION DETAILS OF WELDS) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non -water suppty wells
ONLY with the sane construction/abandonment, you can submit one form.
6a. Well ID#• E W-4
I PT,t o' 5 f L
6b.Total well depth: 23.20 fit.) JULI
6c. Borehole diameter: (in jr%fon atkuri
6d. Water level below ground surface: If .)
6e. Outer casing length (if known): (ft.)
6f. Inner casing/tubing length (if known): (ft.)
6g. Screen length (if known)- (ft.)
7e. Sealing materials used (check all that apply):
IN Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Concrete Grout
❑ Specialty Grout
❑ Bentonite Slurry
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (explain under 7g)
7L For each material selected above, provide amount of materials used:
7g. Provide a brief description of the abandonment procedure:
4" well was tremie grouted from bottom to top,
after removing stinger piping; allowed to settle;
and capped with cement to match the
surrounding asphalt sqdM(EDINMENRID
S. Certification: )Ul d -4• Z017
w Ros 5/22/17
signs ofCe V66 LLER C
By s S.form, I her r that the well(s) was (were) abandoned in
accordance with 1 SA NCAC 02C . 0100 or 2C .0200 Well Construction Standards
and that a copy of thic record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of wcll
abandonment to the following:
Division of Water Resources, information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For lniection Wells: In addition to sending the form to the address in I Oa
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. 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 abandonment to the county health department of the county where
abandoned.
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Tommy Bolyard
Well Contractor Name (or well owner personally abandoning well on his/her property)
3307
NC Well Connector Certification Number
Environmental Drilling & Probing Services
Company Nam
2. Well Construction Permit #:
List, all applicable well construction permits (i.e. UIC County, State. Variance, arc.) ifknown
3. Well use (check well use):
Water Supply Well:
❑Agricultural .
❑MunicipaUPublic
❑Geothermal (Heating/Cooling Supply)
❑Residential Water Supply (single)
❑Industrial/Commercial
❑Residential Water Supply (shared)
OhTigation
Non -Water Supply Well:
IMMonitoring
❑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 7g)
4. Date well(s) abandoned: 5/ 10/ 1 7
5a. Well location:
Brawley Construction Co.
Facility/Owner Name Facility ID# (if applicable)
954 Oak Ridge Farm Hwy, Mooresville, NC
Physical Address, City, and Zip
Iredell
County
Parcel identification No. (PiN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one [attlong is sufficient)
N W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non -water supply wells
ONLY with the same constr`u/c�ti'onlabondonment, you can submit one form.
6a. Well ID#: Eyy —3
r�L'" "�"'� :i yy �
23.70 E7 U,
6b. Total well depth: (ft.)
6c. Borehole diameter:
6d. Water level below ground surface: (ft.)
6e. Outer casing length (if known):
6f. Inner casing/tubing length (if known): (ft.)
6g. Screen length (if known): (ft-)
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUNBER of
wells abandoned:
7b. Approrimate volume of water remaining in well(s): (gal )
FOR WATER SUPPLY WELLS ONLY:.
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
e Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout ❑ Dry Clay
❑ Concrete Grout ❑ Drill Cuttings
❑ Specialty Grout ❑ Gravel
❑ Bentonite Slung ❑ Other ex R
7f. For each material selected above, provide amount of materials•ased:
JUL 2 4: ZUI?
wQRos FFIGE
�af�fn1��ESVILLE REGI
7g. Provide a brief description of d ec8U4t[donment procedure:
4" well was tremie grouted from bottom to top,
after removing stinger piping; allowed to settle;
and capped with cement to match the
surrounding asphalt surface.
8. Certification:
5/22117
Si ertified Well C tractor or Well Owner Date
By si ng this 1 hereby certify that the well(s) was (were) abandoned in
accords tth I SA NCAC 02C .0100 or 1C .0200 Well Construction standards
and that a copy of thic record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages ifnecessary.
SUBMITTAL INSTRUCTIONS'
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For lniection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this forth within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. _For Water Suualy & 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 abandonment to the county health department of the county where
abandoned.
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD
I. Well Contractor Information:
Tommy Bolyard
Well Contractor Name (or well owner personally abandoning well on his/her property)
3307
NC Well Contractor Certification Number
Environmental Drilling & Probing Services
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (.e. UIC County, State. Variance, etc.) iflnrown
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ industrial/Commercial
Non -Water Supply Well:
❑MunicipaYNblic
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
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 Retum)
❑Other (explain under 7g)
4. Date well(s) abandoned: 5/ 10/ 1 7
5a. Well location:
Brawley Construction Co.
Facility/Owner Name Facility 1D# (if applicable)
954 Oak Ridge Farm Hwy, Mooresville, NC
Physical Address, City, and Zip
Iredell
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
N
W
CONSTRUCTION DETAILS OF WELDS) BEING ABANDONED
Attach wrll construction record(s) ifavailable. For multiple injection or non -water supply rrelLr
ONLY with the same construction/abandonment, you can submit one form.
6a. Well ID#: EW-2
40
6b. Total well depth: 23.(ft,)
5 A-')n17
For Internal Use ONLY: .
WELL ABANDONMENT DETAILS
7a. For GeoprobeIDPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): (gal-)
FOR WATER SUPPLY WELLS ONLY:
lc. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Seating materials used (check all that apply):
IN Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Concrete Grout
❑ Specialty Grout
❑ Bentonite Slurry
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (explain under 7g)
7L For each material selected above, provide amount of materials used:
RECgivr=arNC©ENRIDWR
JUL 2 4 Z017
7g. Provide a brief description of the abandbocedure:
4" well was tremigVkLgWpALd drAqbg6p,
after removing stinger piping; allowed to settle;
and capped with cement to match the
surrounding asphalt surface.
8. Certification:
5/22/17
Signature Certified Well o c r or Well Owner to
By signi this fo , I here that the well(s) was (were) abandoned in
accordance ! SA NCAC 02C . 0100 or 1 C .0200 Well Construction Standards
and that a copy of this record hav been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
102- For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
JUL e 10b. For lniection Wells: In addition to sending the form to the address in 10a
6c. Borehole diameter: (in,) rs above, also submit one copy of this form within 30 days of completion of well
a cPer;• +
"' abandonment to the following:
6d. Water level below ground surface: (ft-)
6e. Outer casing length (if known): (ft.)
6L Inner casing/tubing length Cif known): (fL)
6g. Screen length (if known): (ft.)
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Supply & Injection Wells: In addition to sending the form to the
addresses) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
abandoned.
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD
I. Well Contractor Information:
Tommy Bolyard
Well Contractor Name (or well owner personally abandoning well on his/her property)
3307
NC Well Contractor Certification Number
Environmental Drilling & Probing Services
Company Namc
2. Well Construction Permit #:
List all applicable xrll construction permits 0.e. U/C. County, State. Variance, etc.) ifknown
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)
❑lrri lion
Non -Water Supply Well:
mmonitoring
❑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 7g)
4. Date well(s) abandoned: 5/ 1 0/ 1 7
5a. Well location:
BraWley Construction Co.
Facility/Owner Name Facility ID# (if applicable)
954 Oak Ridge Farm Hwy, Mooresville, NC
Physical Address, City, and Zip
Iredell
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field one lat/)ong is sufficient)
rl
W
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well coastruction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): (gap
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
C Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Concrete Grout
❑ Specialty Grout
❑ Bentonite Slurry
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (explain under 7g)
711 For each material selected abov f utaterials used;
R�CENEbII y�d
.JUL 2 47011
7g. Provide a brief description of tbN t:
4" well was fi V6&9T1rom bottom to top,
after removing stinger piping; allowed to settle;
and capped with cement to match the
surrounding asphalt surface.
8. Certification-
5/2,
Signs of Certified W Contractor or rte
By si g this form, I hereby certify that the weU(s) was were) abandoned in
accordance with 1 SA NCAC 0 1C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach wVllconstruction record(s) ifavailable. For multiple injection ornon-watersupphv %vlLs
ONM**h the same consiruciionlabandonment, you can submit one form.
E W-1 loa. For All Wells: Submit this form within 30 days of completion of well
6a. Well ID#: abandonment to the following:
x� r - Division of Water Resources,information Processing Unit,
bb. Total well depth: (ft-) 1617 Mail Service Center, Raleigh, NC 27699-1617
JUL 2017 10b. For Injection Wells: In addition to sending the form to the address in 10a
6c. Borehole diameter: (in,) above, also submit one copy of this form within 30 days of completion of well
Irl¢pfp��ify 17t, qt , i :abandonment to the following:
6d. Water level below ground surface: (g,) Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
6e. Outer easing length (if known): (ft.) 10c. For Water Supply & Injection Wells: In addition to sending the form to the
addresses) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
611 Inner casing/tubing length (if known): (ft.) abandoned.
6g. Screen length (if (mown):
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Tommy Bolyard
Well Contractor Name (or well owner personally abandoning well on his/her property)
3307
NC Well Contractor Certification Number
Environmental Drilling & Probing Services
Company Name
2. Well Construction Permit #:
List all applicable well construction permits 0.e. UIC. County, State, Variance, etc.) ifknown
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
4. Date well(s) abandoned:
Sa. Well location:
Brawley Construction Co.
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Groundwater Remediation
❑ Salinity Barrier
❑ Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 7g)
5/10/17
Facility/Owner Name Facility 1D# (if applicable)
954 Oak Ridge Farm Hwy, Mooresville, NC
Physical Address, City, and Zip
Iredell
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one [at/long is sufficient)
N
W
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the samc
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Appromdntate volume of water remaining in well(s)• (gaL)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Seating materials used (check all that apply):
19 Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Concrete Grout
❑ Specialty Grout
❑ Bentonite Slurry
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (explain under 7g).
7E For each material selected above, provide amount of materials used:
7g. Provide a brief description of the abandonment procedure:
4" well was tremie grouted from bottom to top;
allowed to settle; and capped with cement to
1
match.the surrounding asghal urface.
g3ECE1 u—I qt
8. Certifi Hon:
on. °)a 4 Ulf
Signature of ertifi C W C' S ALOCF Dam
By signi g this f /hereby ce ell( as (were) abandoned in
accorda ' 15A NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of thiv record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELLS) BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s) ifavailable. For multiple injection or non-warersupp(v welLv
OIQY with the same construction abandonment, you can submit one form.
o`/►' .t 10a. For All Wells: Submit this form within 30 days of completion of well
6a. Well ID#: R V V I abandonment to the following:
a• Division of Water Resources, information Processing Unit,
6b. Total well depth 43.60 (ft) 1617 Mail Service Center, Raleigh, NC 27699-1617
JUL 1 2017 10b. For lniection Wells: In addition to sending the form to the address in l0a
6c. Borehole diameter: above, also submit one copy of this forth within 30 days of completion of well
abandonment to the following:
6d. Water level below ground surface: (ft.) Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
6e. Outer casing length (if known): (ft.) 10C. 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 abandonment to the county health department of the county where
61. Inner casing/tubing length (if known): (ft.) abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

Facility ID# (ifapplicable)
954 Oak Ridge Farm Hwy, Mooresville, NC
Physical Address, City, and Zip
Iredell
County
Parcel identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
N
WELL ABANDONMENT RECORD
1. Well Contractor Information:
Tommy Bolyard
Well Contractor Name (or well owner personally abandoning well on his/her property)
3307
NC Well Contractor Certification Number
Environmental Drilling & Probing Services
Company Name
2. Well Construction Permit #:
List all applicable wit construction permits ri.e. U/C. County, Slate. Variance, etc.) ifknown
3. Well use (check well use):
Water Supply Well:
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Watei
❑Industrial/Commencial ❑Residential Water Supply (shared)
❑hrigation
Non -Water Supply Well:
Mmonitoring ❑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 7g)
4. Date well(s) abandoned: 5/ 1 0/ 1 7
5a. Well location:
Brawiey Construction Co.
Facility/Owner Name
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): (gaL)
FOR WATER SUPPLY WELLS ONLY:
lc. Type of disinfectant used•-
7d. Amount of disinfectant used:
7e. Seating materials used (check all that apply):
e Neat Cement Grout
❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
7g. Provide a brief description of the abandonment procedure:
4° well was tremie grouted from bottom to top;.
allowed to settle; and capped with cement to
match the surrounding asphalt surface.
S. Certification: JUL 2" 4, 20 I7
s 5/22/17
Signature of ertified ell ntractor or REGI A to
MOOR
By signi g this fon , hereby certi that th el1(s) (were) abandoned in
accords SA NCAC 02C . 0 0 .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach n+ell conshvction records) ifavailable. For multiple injection or non-watersupply wells
ONLY wilh the same consiruction/abandonmenl, you can submil one form.
6a. Well ID#: SVE-1
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
12.42 Division of Water Resources, Information Processing Unit,
6b. Total well depth: (it) ate• a" ' µs.� 1617 Mail Service Center, Raleigh, NC 27699-1617
�..':-.A' lea--, � �t` a,�m :,_ •
10b. For iniection Wells: In addition to sending the form to the address in 10a
6c. Borehole diameter: (in.) JUL
`� 4 `201 7 above, also submit one copy of this form within 30 days of completion of well
eDld abandonment to the following:
6d- Water level below ground surface ?.?fOgEjI fr t�f1 •`;_r,' :" 'I-`-`' ; '"'
(,2 Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 276994636
6e. Outer casing length (if known): (ft.)
6E Inner casing/tubing length (if known): (ft.)
6g. Screen length (if known): (ft.)
10c. 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 abandonment to the county health department of the county where
abandoned.
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

• WELL ABANDONMENT RECORD
1- Well Contractor Information:
Tommy Bolyard
Well Contractor Name (or well owner personally abandoning well on his/her property)
3307
NC Well Contractor Certification Number
Environmental Drilling & Probing Services
Company Name
2. Well Construction Permit #•
List all applicable wvll construction permits (i.e. UIC, County, State. Variance, erc.) ii(known
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commemial
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal(Closed Loop)
❑Geothermal (Heating/Cooling
❑Mrmicipal/Public
❑Residential Water Supply (single)
❑ Residential Water Supply (shawl)
❑Recovery
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under
4. Date well(s) abandoned. 5/ 10/ 17
5a. Well location:
Brawley Construction Co.
Facility/Owner Name Facility ID# (if applicable)
954 Oak Ridge Farm Hwy, Mooresville, NC
Physical Address, City, and Zip
I redell
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
N
W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach xA,ll construction record(s) ifavailable. For multiple injection or non-watersupp(v wells
OATY with the same consstucction/abaudonment, you can submit one form.
6a. Well ID#: ' V V 1
6b. Total well depth: 38.51 (ft-) Rrtkllp
ggHgg
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For GeoprobelDPT or Closed -Loop Geothermal Weds having the same
well construc6on/depth, only 1 OW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
S Neat Cement Grout
❑ Bentomte Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
711 For each material selected above, provide amount of materials used:
7g. Provide a brief description of the abandonment procedure:
2" well was tremie grouted from bottom to top;
allowed to settle; and capped with cement to
match the surrounding asphalt surface.
FRECEIVED/NCDPzNR/b0WR%
8. Certifi94on: li j i' � 4
5/22/17
By signing i is form, ereby cerhfy hat t well(s) was (were) abandoned in
accordance Mdkin NCAC 02C.01 or 0200 Well Construction Standards
and that a copy of this record has hee nvided to the coal! owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in l0a
6c Borehole diameter (in above, also submit one copy of this form within 30 days of completion of well
nn 1'r`) z ` S r abandonment to the following:
6d. Water level below ground surface:
6e. Outer rasing length (if known): (ft.)
611 Inner casing/tubing length (if known): (ft.)
6g- Screen length (if known): (ft.)
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Supply & Injection Wells: In addition to sending the form to the
addresses) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
abandoned.
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Tommy Bolyard
Well Contractor Name (or well owner personally abandoning well on his/her property)
3307
NC Well ConaactorCertification Number
Environmental Drilling & Probing Services
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. U1C. County, State. Variance, etc.) ifbrown
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)
❑Irri tion
Non -Water Supply Well:
eMonitonng
❑Recovery
Injection Wen:
❑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 7g)
4. Date well(s) abandoned:
5/10/17
5a. Well location:
Brawley Construction Co.
Facility/Owner Name Facility 1D# (if applicable)
954 Oak Ridge Farm Hwy, Mooresville, NC
Physical Address, City, and Zip
I redell
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
z
For Internal Use ONLY:
WELL ABANDONMENT DETAII,S
7a. For GeoprobelllPT or Closed -Loop Geothermal Wens having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b- Approximate volume of water remaining in well(s): (gaL)
FOR WATER SUPPLY WELLS ONLY:
lc. Type of disinfectant used-
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
e Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Concrete Grout
❑ Specialty Grout
❑ Bentonite Slurry
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (explain under 7g)
7E For each material selected above, provide amount of materials used:
7g. Provide a brief description of the abandonment procedure:
2" well was tremie grouted from bottom to top;
allowed to settle; and capped with cement to
match the surrounding asphalt surface.
Rr:Cr1VEDTJqGDENR1bWR
I
8. Certifi tion: JUL L 2 4 20 "'
w 5/22/17
Signature ofCertifi Well C aactr NOFFICE
to
By signing this form, l hereby certify that the well(s) was (were) abandoned in
accordance with 1 SA NCAC 02C .0100 or 2C . 0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
W You may use the back of this page to provide additional well site details or well
abandonment details_ You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non-watersupp(v welts
ONLY with the same consirucliio�nlabandonmeni, you can submit one form.
6a. Well ID#: M � y —C
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
1220RE ,�f K. T , . Division of Water Resources, information Processing Unit,
.
6b. Total well depth: (ft-) 1617 Marl Service Center, Raleigh, NC 27699-1617
JUL! 4 2017 10b. For injection Wells: In addition to sending the form to the address in l0a
6c. Borehole diameter: (in,) above, also submit one copy of this form within 30.days of completion of well
;abandonment to the following:
( �'V` A..t,"t '-C.- Division of Water Resources, Underground Injection Control Program,
6d- Water level below ground surface: ft, roes, rg I
1636 Mail Service Center, Raleigh, NC 27699-1636
6e. Outer casing length (if known): (ft.) 10c. For Water Supply & Injection Wells: In addition to sending the form to the
addresses) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
611 Inner easing/tubing length (if mown): (ft.) abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD
I. Well Contractor Information:
Tommy Bolyard
Well Contractor Name (or well owner personally abandoning well on his/her property)
3307
NC Well Contractor Certification Number
Environmental Drilling & Probing Services
Company Name
2. Well Construction Permit #:
List all applicable xe11 construction permits li.e. UIC. County, State, Variance, etc.) ifknown
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/CommeTeial
Non -Water Supply Well:
Injection Well:
❑Aquifer Recharge
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Groundwater Remediation
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control
❑Geothermal (Closed Loop) ❑Tracer
❑Geothermal
❑Other (explain under
4. Date well(s) abandoned: 5/ 1 0/ 1 7
5a. Well location:
BraWey Construction Co.
Facility/Owner Name Facility ID# (ifapplicable)
954 Oak Ridge Farm Hwy, Mooresville, NC
Physical Address, City, and Zip
Iredell
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/bng is sufficient)
QI
W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non -water supply wells
ONLYi4th the same constmclliion/abandonment, you can submit one form.
6a. Well ID#: M V Y —B
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s); (gal.)
FOR WATER SUPPLY WELLS ONLY:
lc- Type of disinfectant used-
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
e Neat Cement Grout
❑ Bentomte Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
711 For each material selected above, provide amount of materials used:
7g. Provide a brief description of the abandonment procedure:
2" well was tremie grouted from bottom to top;
allowed to settle; and capped with cement to
match the surrounding asphalt surface.
RECEIVEDINCDENRIDWR
S. Certifica ' n: J U i . 2
5122/17
signs of e e Co.
E REGIONALDOFFICE
By signing this form, l hereby c rtify that the wells) was (were) abandoned in
accordance with 15A NC.AC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
1205 0. v `r J ° �:,_m'�"` Division of Water Resources, Information Processing Unit,
.
6b. Total well depth: (ft.) 1617 Mail Service Center, Raleigh, NC 27699-1617
Ju L 14 201710b. For lniection Wells: In addition to sending the form to the address in l0a
6c. Borehole diameter: (in,) above also submit one copy of this form within 30 days of completion of well
Ott tv9^a r '' OC-*'n' '`abaiiiTonment to the following: p
6d. Water level below ground surface: (ft.) Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
6e. Outer casing length (if known):
6f. Inner casing/tubing length (if known); (fl.)
6g. Screen length (if known):
10c. 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 abandonment to the county health department of the county where
abandoned.
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD lFor Internal Use ONLY
1. Well Contractor Information: WELL ABANDONMENT DETAIIS
Tommy Bolyard 7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
Well Contactor Name (or well owner personally abandoning well on his/her property) well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
3307
NC Well Contractor Certification Number
Environmental Drilling & Probing Services
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. U1C, County, State, Variance, etc.) ifbrown
3. Well use (check well use):
Water Supply
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑Irrigation
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
[]Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
4. Date well(s) abandoned:
5a. Well location:
❑ MunicipaUPublic
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Groundwater Remediation
❑ Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under
5/10/17
Brawley Construction Co.
Facility/Owner Name Facility ID# (if applicable)
954 Oak Ridge Farm Hwy, Mooresville, NC
Physical Address, City, and Zip
Iredell
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
N
7b. Approrimate volume of water remaining in well(s): (gaL)
FOR WATER SUPPLY WELLS ONLY:
lc. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
N Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Concrete Grout
❑ Specialty Grout
❑ Bentonite Slurry
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (explain under 7g)
7L For each material selected above, provide amount of materials used:
7g. Provide a brief description of the abandonment procedure:
2" well was tremie grouted from bottom to top;
allowed to settle; and capped with cement to
match the surrounding asphalt surface.
8. Certification: RECE1VED/NCDENR/DWR
2017 /22/17
Signature of Ri e0 Contrac or Well Ow Date
WQROS
By signi g th' ornt, 1 hereby cer r( a l(� ya u �ed In
accorda a with /SA NCAC 02C . e }' nrtructton tandards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
R abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction records) ifavailable. For multiple injection or non-watersupply welLt
ONLY with the some construction/abandonment, you can submit one form.
6a Wets ID#• MW—A
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
;CYO'
rt C a, g y Division of Water Resources, information Processing Unit,
12.20 �...
6b. Total well depth• ({t,) pp�� gggg ry g 1617 Mail Service Center, Raleigh, NC 27699-1617
JUL1 4 S,01710b. For Injection Wells: in addition to sending the form to the address in 10a
6c. Borehole diameter: (in.) above, also submit one copy of this form within 30 days of completion of well
worm— i�Jr! P;t;;:(; :_ !.`; 'abandonment to the following:
6d. Water level below ground surface:. ({t•) Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Supply & Injection Wells: In addition to sending the form to the
6e. Outer casing length (if know"): (ft.) address(es) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f. Inner casing/tubing length Cif known): Up abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Tommy Bolyard
Well Contractor Name (or well owner personally abandoning well on his/her property)
3307
NC Well Contractor Certilication Number
Environmental Drilling & Probing Services
Company Name
2. Well Construction Permit #:
List all applicable µell construction permits (i.e. UIC. County, State, Variance, etc) ifknown
3. Well use (check well use):
Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ industrial/Commercial
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
❑ M un icipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 7g)
4. Date well(s) abandoned: 5/ 10/ 1 7
5a. Well location:
Brawley Construction Co.
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7L For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7h. Approximate volume of water remaining in well(s): (gal )
FOR WATER SUPPLY WELLS ONLY:
7c- Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
e Neat Cement Grout
❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
7g. Provide a brief description of the abandonment procedure:
2" well was tremie grouted from bottom to top;
allowed to settle; pad/cover removed; patched with
cement; and filled with topsoiVseed/straw to.
match the surrounding grassy surface.
Facility/Owner Name Facility ID#(ifapplicable) 8•
954 Oak Ridge Farm Hwy, Mooresville, NC
Physical Address, City, and Zip
Iredell
County Parcel identification No. (PIN)
5b. Latitude and longitude in degrees/mintites/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
N W
CONSTRUCTION DETAILS OF WELUSI BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non-walersupply wells
ONLY with the same construction/abandonment, you can submit one (arm.
6a. Well ID#: MW-1 9
A 2f5/22/17
wellOwney' / Date
By signi g this form,,,1--herebi certi al the well(.I<r1�Nere) abandoned in
accords *!.wit A NCAC iOAItlDLI�EiL4ldl�tlo��ds
and that a copy of this record hac been provided to the well owner.
9. Site diagram or additional well details. -
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
(ft.) Division of Water Resources, information Processing Unit,
6b. Total well depth:
21.80 1617 Mail Service Center, Raleigh, NC 27699-1617
it E,
�„�I �/• � .J10b. For lniection Wells: in addition to sending the form to the address in 10a
6c. Borehole diameter tn. above, also submit one copy of this form within 30 days of completion of well
( ) JUL
`� 4 2017 abandonment to the following:
J Ll 8 t i ` Division of Water Resources, Underground Injection Control Program,
6d. Water level below ground surface: ,r(ft,;),•�., .:, . .;,r; tF 1636 Mail Service Center, Raleigh, NC 27699-1636
6e. Outer casing length (if known): (ft.) 10c. 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 abandonment to the county health department of the county where
6f. Inner casing/tubing length (if known): (ft•) abandoned.
6g. Screen length (if known):
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

• WELL ABANDONMENT RECORD
1. Well Contractor Information:
Tommy Bolyard
Well Contractor Name (or well owner personally abandoning well on his/her property)
3307
NC Well Contractor Certification Number
Environmental Drilling & Probing Services
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (.e. U1C. County, State. Variance, etc.) ifknown
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)
❑b:ri tion
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)
❑tither (explain under 7g)
4. Date well(s) abandoned:
5a. Well location:
Brawley Construction Co.
5/10/17
Facility/Owner Name Facility IDII (if applicable)
954 Oak Ridge Farm Hwy, Mooresville, NC
Physical Address, City, and Zip
I redell
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one lat/long is sufficient)
IQ
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): (gaL)
FOR WATER SUPPLY WELLS ONLY:
lc- Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
@ Neat Cement Grout ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Concrete Grout
❑ Specialty Grout
❑ Bentonite Slurry
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
7g. Provide a brief description of the abandonment procedure:
2" well was tremie grouted from bottom to top;
allowed to settle; pad/cover removed; patched with
cement; and filled with topsoil/seed/straw to.
match the surrounding 6fWW race.
8. Cc ' cation: i v
aRo 5/22/17
Signature of C fied Well ontractor lAlu E REG 0�e_
By signing onn, I hereby certify that the well(s) was (were) abandoned in
accordance with 1 SA NCAC 02C.0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
W You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s) ifavailable. For multiple injection or non- water suppb wells
ONLY with the same construction/abandonment, you can submit one form.
M W-18 Ills. For All Wells: Submit this form within 30 days of completion of well
6a. Well ED#: abandonment to the following:
s , t Division of Water Resources, information Processing Unit,
k 6b. Total well depth: 20.08 , ' ,}
(ft,) '{� y � c- ���-� 1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Injection Wells: In addition to sending the form to the address in 10a
6c. Borehole diameter: (in,) �U L L above, also submit one copy of this form within 30 days of completion of well
_abandonment to the following:
bd. Water level below ground surface: M)nf„� � Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
6e. Outer casing length (if known): (ft.) 10c. 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 abandonment to the county health department of the county where
6L Inner casing/tubing length (if known): (ft,) abandoned.
6g. Screen length (if known): (ft.)
Form OW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

United States Environmental Protection Agency
Form Approved.
EPA Washington, D.C.20460
OMB No. 2040-0057
Water Compliance Inspection Report
Approval expires 8-31-98 ,
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector FacType
2 15 I 3 I NCG510429 I11 12 17/08/02 17
18 i o i 19 i G i 201
211III I I I I I III I I I I I I I I I I I I I I I I I
I I I I I III I I1 1 1 166
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA
---Reserved
67 1.0 70 I I 71 [ � j' 72 N
L-1 LJ
73 1 I I 174 751 I I I I I I I8O
I
Section B: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
Entry Time/Date
Permit Effective Date
POTW name and NPDES permit Number)
09:OOAM 17/08/02
16/11/21
Brawley Construction Company
954 Oak Ridge Farm Hwy
Exit Time/Date
Permit Expiration Date
Mooresville NC 28115
10:OOAM 17/08/02
20/09/30
Name(s) of Onsite Representative(s)lritles(s)/Phone and Fax Number(s)
Other Facility Data
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Allen Brawley,PO Box 1067 Mooresville NC 281151067//704-663-5270l7046634933
No
Section C: Areas Evaluated During Inspection (Check only those.areas evaluated)
Permit
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers
Date
Edward Watson MRO GW///
S 2z LZO1 i
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers
Date
� a
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page#

NPDES yr/mo/day Inspection Type
31 NCG510429 I11 121 17/08/02 11 7 18 i o i
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Permit rescission.
Page#

Permit: NCG510429 Owner - Facility: Brawley Construction
Company
Inspection Date: 08/02/2017 Inspection Type: Reconnaissance
Permit
Yes No' NA NE
(If the present permit expires in 6 months or -less). Has the permittee submitted a new
❑
❑
0
❑
application?
Is the facility as described in the permit?
0
❑
❑
❑
# Are there any special conditions for the permit?
❑
0
❑
❑
Is access to the plant site restricted to the general public?
❑
M
❑
❑
Is the inspector granted access to all areas for inspection?
0
❑
❑
❑
Comment: The system is no longer affective in treating the remaining GW impacted area. The last site
inspection was in 2016. This permit has been rescinded. A different remediation system my
be required in the future to continue to treat GW impacts.
Page# 3

Water- Resources
ENVIRONMENTAL QUALITY
August 16, 2017
Mr. Allen Brawley
Brawley Construction Company
P.O. Box 1067
Mooresville, NC 28115-1067
ROY COOPER
Govelvor
MICHAEL S. REGAN
Secretary
S. JAY ZIMMERMAN
Director
RECEIVED/NCDENR/DWR
AUG 21 Z017
WQROS
MOORESVILLE REGIONAL OFFICE
Su bject:Rescission of Certificate of Coverage
NCG510429
Brawley Construction site
Iredell County
Dear Mr. Brawley:
Division staff has confirmed that the subject Certificate of Coverage (CoC)
is no longer required.. Therefore, in accordance with your request, NPDES
CoC NCG510429 is rescinded, effective immediately.
If in the future your company wishes to discharge wastewater to the
Staters surface waters from the subject site, you must first apply for
and receive a new NPDES permit.
If you have any questions concerning this matter, please contact Charles H.
Weaver at [phone] or -via e-mail [[e-mail]].
incere y,
for S. Jay Zimmerman, Director
Division of Water Resources
cc: e
NPDES files
Teresa Revis / Budget
Danelle Blackwell / ATC Associates
[7606 Whitehall Executive Center Dr, Suite 800, Charlotte, NC 28273
State of North Carolina I Environmental Quality I Water Resources
1617 Mail Service Center I Raleigh, NC 27699-1617
919 807 6300 919-807-6389 FAX
https://deq.nc.gov/about/divisions/water-resourcestwater-resources-permitslwastewater-brancli/npdes-wastewater-permits

NC Department of
Environmental Quality .0
Received'=�
O G 20�6 DONALD
DEC
; Winston-Salem
'#
Water Resources �? ':` l
ENVIRONMENTAL QUALITY
Regional Office
November 21, 2016
Mr. Allen Brawley
Brawley Construction Company
P.O. Box 1067
Mooresville; NC 28115-1067
PAT MCCRORY
Governor
R. VAN DER VAART
Secretniy
JAY ZIMMERMAN
Director
RECEIVEDINCDENR/DWR
DCEC -- 8 2016
WO ROS
=ORESVILLE' EOION1:aLOFFICE
Subject: General Permit NCG510000
Certificate of Coverage NCG510429
Brawley Construction Company
Iredell County -
Dear Permittee:
The Division received a request to renew Certificate of Coverage (CoC) NCG510429 on October 5,
2016. This CoC renewal is issued pursuant to the requirements of North Carolina General Statute 143-
215.1 and the Memorandum of Agreement between North Carolina and the US Environmental Protection
agency dated October 15, 2007.
A copy of General Permit NCG510000 is enclosed. If any parts, measurement frequencies or
sampling requirements contained in this permit are unacceptable to you, you have the right to request an
individual permit by submitting an individual permit application. Unless such demand is made, this CoC
shall be final and binding.
The CoC is not transferable except after notice to the Division. You must notify the Division if you
sell or otherwise transfer ownership of the permitted facility. The Division may require modification or
reissuance of the CoC.
If your facility ceases discharge of wastewater before the expiration date of this permit, contact the
Regional Office listed below. Once discharge from your facility has ceased, this permit may be rescinded.
This permit does not affect the legal requirements to obtain any other permit required by Federal, State, or
Local government. If you have any questions concerning this permit, please contact Charles Weaver at the
telephone number listed below, or via email [[e-mail]].
Sincerely,
p S. Jay Zimmerman,
Director, Division of Water Resources
cc: fMgoresv_i11e Regional Office.
NPDES file
State of North Carolina I Environmental Quality I Water Resources
1617 Mail Service Center I Raleigh, NC 27699-1617
919 807 6391 919-807-6389 FAX
https://deq.nc.gov/about/divisions/water-resources/water-resources-permits/wastewater-branch/npdes-wastewater-permits

STATE OF NORTH CARO.LINA
DEPARTMENT OFENVIRONMENTAL QUALITY
DIVISION �OF WATER RESOURCES
GENERAL PERMIT NCG510000
CERTIFICATE OF COVERAGE NCG510429
TO DISCHARGE PETROLEUM CONTAMINATED GROUNDWATER AND SIMILAR WASTEWATERS
UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful
standards and regulations promulgated and adopted by the North Carolina Environmental
Management Commission, and the Federal Water Pollution Control Act, as amended,
Brawley Construction Company
is hereby authorized to operate a groundwater remediation system for petroleum -contaminated groundwater
or similar waste streams that will discharge treated wastewater from the
Brawley Construction Company.,
954 Oak Ridge Farm Hwy
Mooresville
Iredell County
to receiving waters designated as Back Creek, a class C stream in subbasin 03-07-06 of the
Yadkin -Pee Dee River Basin.
All discharges shall be in accordance with the effluent limitations, monitoring requirements, and
other conditions set forth in Parts I, II, III and IV of General Permit NCG510000 as attached.
This certificate of coverage shall become effective November 21, 2016.
This Certificate of Coverage shall remain effective for the duration of the General Permit.
Signed this day, November 21, 2016
for S. Tay Zimmerman, P.G.
Director, Division of Water Resources
By Authority of the Environmental Management Commission

r.
.fill
WaierResources
ENVIRONMENTAL QUALITY
March 21, 2016
Mr. Allen Brawley, Owner
Brawley Construction Company
P.O Box 1067
Mooresville, NC 28115
PAT MCCRORY
Governor
DONALD R. VAN DER VAART
Secretary
S. JAY ZIMMERMAN
Subject: Compliance Evaluation Inspection
Brawley Construction Company
NPDES .Permit No. NCG510429
Iredell County
Dear Mr. Brawley:
Enclosed is a copy of the Compliance Evaluation Inspection- for the inspection conducted at
the subject facility on March 10, 2016 by Ori Tuvia. Please advise the staff involved with this
NPDES Permit by forwarding a copy of the enclosed report.
The inspection confirmed the site is inactive.
The report should be self-explanatory- however, should you have any questions concerning
this report, please do not hesitate to -contact Ori Tuvia at [phone], or at [e-mail].
Sincerely,
cc: NPDES Unit
MRO Files
Ori Tuvia, Environmental Engineer
Mooresville Regional Office
Division of Water Resources, DEQ
Mooresville Regional Office
Location: 610 East CenterAve., Suite 301 Mooresville, NC 28115
Phone: [phone] \ fax: [phone] \ Customer Service:1-877-623-6748
Internet: www.newaterquality.org
Director .

United States Environmental Protection Agency
Form Approved.
EPA. Washington, D.C. 20460
OMB No. 2040 0057
Water Compliance Inspection Report
Approval expires 8-31-98
Section A: National Data. System. Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type
Inspector Fee Type
1 IN I 2 is I 3 I NCG510429 I11 12 16/03/10 17 18 l,, I
19 I G I 20I
211 I I I I 1 I I I I II I I l I I I I I I I I I I I I I I I I I I
I III I I I 1166
Inspection
Work Days Facility Self -Monitoring Evaluation Rating B1 QA
Reserved--
67
1.0 70 u 71 II 72 I L�, JI 73 L 74 711
I I I I I I I80
Section B: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include .
Entry Timebate
Permit Effective Date
POTW name and NPDES oermit Number)
12:30PM 16/03/10
11/10/18
Brawley Construction Company
954 Oak Ridge Farm Hwy
Exit Time/Date
Permit Expiration Date
Mooresville NC 28115
12:45PM 16/03/10.
16/09/30
Name(s) of Onsite Representative(s)/ritles(s)/Phone and Fax Number(s)
Other Facility Data
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Allen Brawley,PO Box 1067 Mooresville NC 281151067//704-663-5270/7046634933
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit Operations & Maintenance Facility Site Review
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers
Date
Edward _ Watson MRO GW///
Ori A Tuvia �� MRO WQ//704-663-1699/
3 j2-
Signature of Management Q A Reviewer Agency/Office/Pho and x N tubers
Date
W. Corey Basinger MRO WQ//704-235-2194/
E;J2 vsc�
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page#

NPDES yrlmolday. Inspection Type 1
31 NCG510429 I11 12 16/03/10 117 18 1,1
Section D: Summary of Finding/Comments (Attach additionalsheetsof narrative and checklists. as necessary)
Notes by Ed Watson:
The system has been inactive since December of 2015. The reason for the system being turned off, is
the site was able to achieve groundwater standards at or below treatment limits. The permit is
currently active and is due to expire at the end of September 2016. The system is inside of a fenced
area surrounded by a chain -link fenced yard. There are three drums of drill cuttings onsite and three
empty 55 gallon drums on site that should be removed.
Page#

Permit: NCG510429,
Inspection Date: 03/10/2016
Owner -Facility: Brawley Construction Company
Inspection Type: Compliance Evaluation
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? N ❑ ❑ ❑
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable ❑ ❑ 0 ❑
Solids, pH, DO, Sludge Judge, and other that are applicable?
Comment: This system has been inactive since December of 2015. The reason for the system being_
.turned off, is the site was able to achieve groundwater standards at or below treatment
limits. There are three drums of drill cuttings onsite and three empty 55 gallon drums on site
that should be removed.
Permit
(If the present permit expires in 6 months or less). Has the permittee submitted a new
application?
Is the facility as described in the permit?
# Are there any special conditions for the permit?
Is access to the plant site restricted to the general public?
Is the inspector granted access to all areas for inspection?
Comment:
Yes No NA NE
❑ ❑ ■ ❑
■
❑
❑
❑
■
❑
❑
❑
❑
❑
❑
Page# 3

F�LE
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Mr. Allen Brawley
Brawley Construction Company
P.O. Box 1067
Mooresville, North Carolina 28115
Dear Mr. Brawley:
Donald R. van der Vaart
Secretary
June 18, 2015
Subject: Compliance Evaluation Inspection
Brawley Construction Company
NPDES General Permit NCG510000
Certificate of Coverage NCG510429
Iredell County
Enclosed is a copy of the Compliance Evaluation Inspection report (CEl) for the inspection
conducted at the subject facility on June 17, 2015 by Mr. Barry Love with this Office. Thank you for your
assistance and cooperation during the inspection.
The report should be self-explanatory. Please take special note of the comments sections for things
which may need to be addressed. In particular, it was noted that pH and 1,2 Dichloroethane of the effluent are
not being monitored quarterly as required by the permit. 1,2 Dichloroethane may be discontinued if not
detected above practical quantitation level for the first eight sampling events, but pH is an ongoing
requirement.
If you have any questions, comments, or need assistance with understanding any aspect of your
permit or this report, please do not hesitate to contact me at (704)-663-1699.
Sincerely,
Barry Love, Environmental Specialist
Mooresville Regional Office
Water Quality Regional Operations Section
Division of Water Resources, NCDENR
Cc: MRO SFR - Brawley
Central Files
Mooresville Regional Office, 610 East Center Avenue, Suite 301, Mooresville, NC 28115
Phone: [phone]W Internet: www.ncwaterquality.org
An Equal Opportunity 1 Affirmative Action Employer — Made in part by recycled paper

United States Environmental Protection Agency ,
Form Approved.
EPA Washington,.D.C.20460
OMB No. 2040-0057
Water Compliance Inspection Report
Approval expiresB-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector FacType
1 IN 1 2 I5 j 3 I NCG510429 I11 12 15/06/17 17 181 , 1 19 I G I 201
Ld
21I11I I I I I I I II 1 I I 1 I I I I I I I I I I I I I I I I I I I II I I I I I f6
Inspection
Work Days Facility Self -Monitoring Evaluation Rating B1 QA-Reserved--I
67
70 IJ 71 I I l72 1 N 1 7.31 . I 174 75� I I I I I I 180
L' J
Section B: Facility Data
Name and Location of Facility Inspected" (For Industrial Users discharging to POTW, also include
Entry Time/Date
Permit Effective Date
POTW name and NPDES permit Number)
10:OOAM 15/06/17
11/10/18
Brawley Construction Company
954 Oak Ridge Farm Hwy
Exit Time/Date
Permit Expiration Date
Mooresville NC 28115
11:30AM 15/06/17
16/09/30
Name(s) of Onsite Representative(s)fritles(s)/Phone and Fax Number(s)
Other Facility Data
///
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Allen Brawley,PO Box 1067 Mooresville NC 281151067//704-663-5270/7046634933
No .
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit Flow Measurement Operations & Maintenance Records/Reports
Self -Monitoring Program Facility Site Review Effluent/Receiving Waters Laboratory
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date
Barry F Love MRO WQ/1704-663-1699 Ext.263/
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date .
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page#

NPDES yr/mo/day Inspection Type
31 NCG6104! I11 12 15/06/17 17 18 C ,
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Page#

M
W
Permit: NCG510429 Owner - Facility: Brawley Construction Company
Inspection Date: 06/17/2015 Inspection Type: Compliance Evaluation
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? ❑ 0 ❑ ❑
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable ❑ ❑ M ❑
Solids, pH, DO, Sludge Judge, and other.that are applicable?
Comment: Vegetation was grown up, and access was not available to effluent pipe.
Permit
Yes No NA NE
(If the present permit expires in 6 months or less). Has the permittee submitted a new
❑
❑
M
❑
application?
Is the facility as described in the permit?
M.
❑
❑
❑
# Are there any special conditions for the permit?
❑
M
❑
❑
Is access to the plant site restricted to the general public?
M
❑
❑
❑
Is the inspector granted access to all areas for inspection?
. ❑
❑
❑
Comment: The permittee was advised that the permit expires on September 30, 2016, and that a
renewal request must be submitted at least 180 days prior to expiration of the permit.
Record Keeping
Yes No NA NE
Are records kept and maintained as required by the permit?
M
❑
❑
❑
Is all required information readily available, complete and current?
M
❑
❑
❑
Are all records maintained for 3 years (lab. reg. required 5 years)?
M
❑
❑
❑
Are analytical results consistent with data reported on DMRs?
❑
❑
❑
Is the chain -of -custody complete?
M
❑
❑
❑
Dates, times and location of sampling
Name of individual performing the sampling
Results of analysis and calibration
Dates of analysis
Name of person performing analyses
Transported COCs
Are DMRs complete: do they include all permit parameters?
❑
❑
❑
M
Has the facility submitted its annual compliance report to users and DWQ?
❑
❑
M
❑
(If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified operator
❑
❑
0
❑
on each shift?
Is the ORC visitation log available and current?
❑
❑
M
❑
Is the ORC certified at grade equal to or higher than the facility classification?
❑
❑
M
❑
Is the backup operator certified at one grade less or greater than the facility classification?
❑
❑
0
❑
Is a copy of the current NPDES permit available on site?
❑
M
❑
❑
Page#
3

Permit: NCG510429
Inspection Date: 06/17/20.1.5
Record Keeping
Facility has copy of previous year's Annual Report on file for review?
Comment: Records are being kept as required.
Owner - Facility: Brawley Construction Company
Inspection Type: Compliance Evaluation
Effluent Pipe
Is right of way to the outfall properly maintained?
Are the receiving water free of foam other than trace amounts and other debris?
If effluent (diffuser pipes are required) are they operating properly?
Comment: Access to the outfall was not available due to debris and heavy vegetation.
Laboratory
Are field parameters performed by certified personnel or laboratory?
Are all other parameters(excluding field parameters) performed by a certified lab?
# Is the facility using a contract lab?
# Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees
Celsius)?
Incubator (Fecal Coliform) set to 44.5 degrees Celsius+/- 0.2 degrees?
Incubator (BOD) set to 20.0 degrees Celsius +/-1.0 degrees?
Yes No NA NE
❑ ❑ ■ ❑
Yes No NA NE
❑
■
❑
❑
❑
❑
❑
M.
❑
❑
■
❑
Yes No NA NE
❑ ■ ❑ ❑
■ ❑ ❑ ❑
❑ ❑ ❑
■ ❑ ❑ ❑
❑ ❑ M ❑
❑ ❑ M ❑
Comment: DH is not being monitored. The permit requires that DH be monitored quarteriv. 1,2
dichloroethane is not being monitored. The permit requires that it be monitored quarterly
(but may be discontinued if there are no detections above the practical quantitation level for
the first eight sampling events).
Flow Measurement ­Wtment— Yes No NA NE
# Is flow meter used for reporting? M ❑ ❑ ❑
Is flow meter calibrated annually? ❑ ❑ ❑
Is the flow meter operational?
❑
❑
0
(If units are separated) Does the chart recorder match the flow meter?
❑
❑
❑
Comment: A record of flow meter calibration was not available at the time of the inspection.
Page# 4

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r:� CEiVED
DIVISION OF WATER QUALITY
OCT� � Z 011
NCDENR
JUJU a=C I.'JI'M
!Ui`Jflr:ESVtL_>= t?- i%'Ai fl!=riCE
North Carolina Department of Environment and Natural
Resources
Division of Water Quality
Beverly Eaves Perdue, Governor Coleen H. Sullins, Director
Dee Freeman, Secretary
October 18, 2011
Mr. Allen Brawley
Brawley Construction Company
P.O. Box 1067
Mooresville, NC 28115-1067
Subject: NPDES General Permit NCG510000
Certificate of Coverage (CoC) NCG510429
Brawley Construction Company
Iredell County
Dear Permittee:
The Division received your request for renewal of NCG510429 on April 5, 2011. The revised General
Permit was signed on September 20th, 2011 and took effect October 1, 2011. This renewed CoC is issued
pursuant to the requirements of North Carolina General Statute 143-215.1 and the Memorandum of
Agreement between North Carolina and the US Environmental Protection agency dated October 15, 2007 [or
as subsequently amended].
A copy of the NCG510000 is enclosed, as well as an updated Technical Bulletin. The Technical
Bulletin summarizes the changes from the previous version of NCG510000. If any parts, measurement
frequencies or sampling requirements contained in this permit are unacceptable to you, you have the right to
request an individual permit by submitting an individual permit application. Unless such demand is made,
this CoC shall be final and binding.
The CoC is not transferable except after notice to the Division. You must notify the Division if you sell
or otherwise transfer ownership of the permitted facility. The Division may require modification or reissuance
of the CoC.
If your facility ceases discharge of wastewater before the expiration date of this permit, contact the
Regional Office listed below. Once discharge from your facility has ceased, this CoC may be rescinded. This
permit does not affect the legal requirements to obtain other permits which may be required by the Division of
Water Quality, the Division of Land Resources, Coastal Area Management Act or any other Federal or Local
government. If you have any questions concerning this permit, please contact Charles H. Weaver at the
telephone number or e-mail address listed below.
S' cerely,
oleen H. Sullins . .
cc: '1GIooresville Regional -Office =urfac Seter WaProtection
DES-fiI_ _ e— _ __._- ----- - __-
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 One
512 North Salisbury Street, Raleigh, North Carolina 27604 NofthCarohna
Internet: wali
Phone: [phone] ]FAX [phone] VVRturally
[e-mail]
An Equal Opportunity/Affirmative Action Employer- 50% Recycled/10% Post Consumer Paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NCG510000
CERTIFICATE OF COVERAGE NCG510429
TO DISCHARGE PETROLEUM CONTAMINATED GROUNDWATER AND SIMILAR, WASTEWATERS
UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance' with the provision of North Carolina General Statute 143-215.1, other lawful standards and
regulations promulgated and adopted by the North Carolina Environmental Management Commission, and
the Federal Water Pollution Control Act, as amended,
Brawley Construction Company
is hereby authorized to operate a groundwater remediation system for petroleum -contaminated groundwater
or similar waste streams that will discharge treated wastewater from the
Brawley Construction Company
954 Oak Ridge Farm Hwy
Mooresville
Iredell County
to receiving waters designated as Back Creek, a class C stream in subbasin 03-07-06 of the Yadkin -
Pee Dee River Basin.
All discharges shall be in accordance with the effluent limitations, monitoring requirements, and
other conditions set forth in Parts I, II, III and IV of General Permit NCG510000 as attached.
This Certificate of Coverage shall take"effect on October 18, 2011.
This Certificate of Coverage shall expire on=,September 30, 2016.
Signed this day, October 18, 2011
for ColeeplYSullins, Director
Division of Water Quality —
By Authority of the Environmental Management Commission

Mecklenburg County
f Public Information
Department
March XXX, 2016
Chemical Contamination Found in Little Sugar Creek
Charlotte, NC — The Mecklenburg County Health Depar
fishing and/or bathing in Little Sugar Creek between E. 3
tributary to Little Sugar Creek at E. 27th and N. Davidson'
levels of chemical contaminants. al
Results from testing performed by Charlotte-
2016 have revealed elevated levels of Val
the waters of Little Sugar Creek between E. 36
and elevated levels of PCE in a tributary to Little
27th and N. Davidson Streets. TCE " E are c
a variety of commercial and industria ,a e -es.
Creek is currently under investigation, is
the area...
TCE and PCE may c41111,
ingestion. Therefore; t
fishing and/or bathing I
Avenue anw utary o:
Water 101-hr
ices. Th(31
adviso TCE and
Elevatedle �g TCE and D
fr
areas of Little Swreek; he
sources and are nUfft beused
such as boating and w ai
More information is
advising against drinking,
I and Parkwood Avenue and a
in Charlotte due to elevated
burg Storm WY za' ervices in January
lene (TCE) and perc ethylene (PCE) in
et and P wood Ave Cordelia Park
Cr cated at the ection of E.
olor�le : ' " ammable liquid` f at are used in
The so '' f the contamination in Little Sugar
�ht to be s_ - iated with industrial activities in
;h mind lef��'Bi; sure, including inhalation and
County >::;: Department is advising against drinking,
Little Su Creek between E. 36th Street and Parkwood
k loca . t the intersection of E. 27th and N.
erf ` d by Charlotte -Mecklenburg Storm
Off, m
be po " "`Y`` F h signs. Notification will be issued when the
rear Creek' lifted.
no en detected in water sampling performed in other
these waters are subject to contamination from a variety of
king and/or bathing. Fishing and infrequent human contact
'able uses of these waters.
calling 311.
Media Contact: Rick Christenbury @ 704-577-2587 or
[e-mail]

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al
TM
ERTIFIED
C
MAILTM
RECEIPT
omestic
Mail
Only;
No Insurance
Coverage
Provided)
For delivery
information
visit our
website
at
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Postage F
Cert(fied Fee
Return Receipt Fee f Postmark T�
(Endorsement Required) — 2a1u09
Restricted Delivery Fee
Endorsement Required)
Total I ��;;� ��
i MR ALLEN BRAWLEI'�-------�
sent ro BRAWLEY CONSTRUCTION CO.
i-------- PO BOX 1157----------
I srreer, ,
or POE MOORESVILLE NC 28115
city,se� swp,Jh 10/2/09

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NIPORTANT. Save this receipt and present it when making an inquiry.
IS Form 3600, August 2006 (Reverse) PSN 7530-02-000-9047

'NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
70071490 0004 4509 6178
October 2, 2009
Mr. Allen Brawley
Brawley Construction Company
P.O. Box 1157
Mooresville, NC 28115
Subject: NOV-2009-PC-0840
Compliance Evaluation Inspection
Brawley Construction Company
NPDES General WW Permit NCG510429
Iredell County, North Carolina
Dear Mr. Brawley:
Enclosed please find a copy of the Compliance Evaluation Inspection Report for the inspection conducted at the
subject facility on August 26, 2009 by Ms. Donna Hood. of this Office.
This report is being issued as a Notice_ of Violation (NOV) because of the violations of the subject NPDES
permit and North Carolina General Statute (G.S.) 143-215.1 as detailed in the Record Keepin% Effluent Flow
Measurement, and Effluent Pipe Sections of the attached report. Pursuant to G.S. 143-215.6A, a civil penalty of
not more than twenty five -thousand dollars (25,000.00) per violation per day may be assessed against any person
who violates or fails to act in accordance with the terms, conditions, or requirements of any permit issued pursuant
to G.S. 143-215.1.
It is requested that a written response be submitted to this Office by November 2, 2009, addressing the
deficiencies noted in the Record Keeping, Effluent Flow Measurement, and Effluent Pipe Sections of the
report. In responding, please address your comments to the attention of Ms. Marcia Allocco.
Mooresville Regional Office
Location: 610 East Center Ave., Suite 301 Mooresville, NC 28115 One
Phone: [phone] Fax: [phone] l Customer Service: 1-877-623-6748 North Carolina
Internet: www.ncwaterquality.org
�17irtsir►irl/��

Mr. Allen Brawley
NOV-2009-PC-0840, page 2
October 2, 2009
This report should be self-explanatory; however, should you have any questions concerning the report, please
do not hesitate to contact Ms. Hood or me at [phone].
Sincerely,
.Robert B. Krebs
Surface Water Protection Regional Supervisor
Enclosure
DH

United States Environmental Protection Agency
Form Approved.
EPA Washington, D.C. 20460
OMB No. 2040-0057
Water Compliance Inspection Report
Approval expires 8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 I NI 2 I SI 31 NCG510429 Ill 121 09/08/26 117 18I CI 191 si 20III
Remarks
21I111IIIIIIIIIIII IIIIIIII IIIIIIIIIIII II111III1116
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA --- -- --Reserved-- -------
671 1. o 169 701 41 711 I 721 NJ 73 I I 174 751 I I I I I I 180
w
Section B: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
Entry Time/Date
Permit Effective Date
POTW name and NPDES permit Number)
09:00 AM 09/08/26
08/10/15
Brawley Construction Company
Exit Time/Date
Permit Expiration Date
954 Oak Ridge Farm Hwy
Mooresville NC 28115
11:00 AM 09/08/26
11/09/30
Name(s) of Onsite Rep resentative(s)lTitles(s)/Phone and Fax Number(s)
Other Facility Data
Name, Address of Responsible Official/Title/Phone and Fax Number
Allen Brawley,PO Box 1067 Mooresville NC Contacted
Yes
281151067//704-663-5270/7046634933 _
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit Flow Measurement Operations & Maintenance Records/Reports
Self -Monitoring Program Facility Site Review Effluent/Receiving Waters Laboratory
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date
Donna Hood
, �� l •' MRO WQ//704-663-1699 Ext.2193/
"y fJ J 1?f /ram f'!�
Sig,nature of Management Q A Revi wer Agency/Office/Phone and Fax Numbers Date
TM
Marcia"
Allocco MRO WQ//704-663-1699 Ext.2204/
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page # 1

NPDES yr/mo/day Inspection Type
3I NCG510429 111 121 09/08/26 11.7 18ICI
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Page # 2

Permit: NCG510429
Inspection Date: 08/26/2009
Owner - Facility: Brawley Construction Company
Inspection Type: Compliance Evaluation
(If the present permit expires in 6 months or less). Has the permittee submitted a new application? n n ■ n
Is the facility as described in the permit? n n ■
# Are there any special conditions for the permit? fl ■ 0 n
Is access to the plant site restricted to the general public? ■ n n n
Is the inspector granted access to all areas for inspection? ■ n n n
Comment: Discharge ceased at this facility in March 2004, when the system was shut
down. The renewed certificate of coverage was issued on October 15, 2008, prior to
recommencement of the discharge. The discharge resumed in July 2009.
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? ❑ ■ ❑ ❑
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable Solids, pH, DO, Sludge n n ■
Judge, and other that are applicable?
Comment: The facility has not been maintained for easy access.
Record Keeping
Yes
No
NA
NE
Are records kept and maintained as required by the permit?
❑
■
n
Is all required information readily available, complete and current?
0.
■
n
n
Are all records maintained for 3 years (lab. reg. required 5 years)?
n
■
n
n
Are analytical results consistent with data reported on DMRs?
n
n
❑
■
Is the chain -of -custody complete?
■
n
n
❑
Dates, times and location of sampling
■
Name of individual performing the sampling
■
Results of analysis and calibration
■
Dates of analysis
■
Name of person performing analyses
■
Transported COCs
■
Are DMRs complete: do they include all permit parameters?
■
n
n
n
Has the facility submitted its annual compliance report to users and DWQ?
n
n
■
(If the facility is = or > 5 MGD permitted flow) Do they operate 2417 with a certified operator on each shift?
n
n
■
n
Is the ORC visitation log available and current?
n
n
■
n
Is the ORC certified at grade equal to or higher than the facility classification?
n
n
■
n
Is the backup operator certified at one grade less or greater than the facility classification?
n
n
■
n
Page # 3

Permit: NCG510429
Inspection Date: 08/26/2009
Record Keeping
Is a copy of the current NPDES permit available on site?
Owner - Facility: Brawley Construction Company
Inspection Type: Compliance Evaluation
Facility has copy of previous year's Annual Report on file for review?
Comment: The facility has not maintained records. Only the last lab reports from
March 2004 were available for review. Only one chain of custody was available for
review. Sample results from 2000-2004 were observed, but so supporting lab
documents were available for review. Flow totals were not available for the previous
discharge period. The facility did not sample during the first quarter of operation.
La bo rato ry
Are field parameters performed by certified personnel or laboratory?
Are all other parameters(excluding field parameters) performed by a certified lab?
# Is the facility using a contract lab?
# Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees Celsius)?
Incubator (Fecal Coliform) set to 44.5 degrees Celsius+/- 0.2 degrees?
Incubator (BOD) set to 20.0 degrees Celsius +/- 1.0 degrees?
Comment: The facility used Prism Labs for effluent sample analyses.
Flow Measurement - Effluent
# Is flow meter used for reporting?
Is flow meter calibrated annually?
Is the flow meter operational?
(If units are separated) Does the chart recorder match the flow meter?
Comment: The flow meter has not been calibrated.
Effluent Pipe
F`
Is right of way to the outfall properly maintained? _ 6/1
Are the receiving water free of foam other than trace amounts and other debris?
If effluent (diffuser pipes are required) are they operating properly?
Comment: The access to the effluent pipe has not been maintained.
■ ❑ ❑ ❑
nn■o
Yes No NA NE
Yes No NA NE
n■nn
nnn■
❑ ❑ ❑ ❑
Page # 4

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item 4 if Restricted Delivery is desired.
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or on the front if space permits.
. Article Addressed to:
MR ALLEN BRAWLEY
BRAWLEY CONSTRUCTION CO.
PO BOX 1157
MOORESVILLE NC 28115
swp/dh 10/2/09
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X ❑ Agent
V (i ❑ Addressee
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007 1490 0004.:4509 6178
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102595-02-M-1541

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-•i
:� Fist= ss Mail
f ^, P0'S%ges Paid
USPS
Permito. G-10
Sender: Please petit your name, address, and ZIP+4 in thi ex;•
NCDENR
M ttdFACE WATER PROTECTION
o '610jEAST CENTER AVE
=''SUITE 301
-:M.O. RESVILI-E_NC 28115

NCDENR:
North Carolina Department of Environment a `Naf rk"Resources
Division of Water Quality
Michael F. Easley, Governor
Mr. Allen Brawley
Brawley Construction Company
P.O. Box 1157.
Mooresville, NC 28115-1067
Dear Permittee:
CMilliarn & Ross; Jr., Secretary
Coleen H. Sullins, Director
October 15, 2008
M-Surface Wafer Proi.AAI'Oil
Subject: General Permit NCG510000
Certificate of Coverage NCG510429
Brawley Construction Company
Iredell County
The Division received your request for renewal of the subject Certificate of Coverage (CoC) on
October 2, 2008. Accordingly, we are forwarding the attached CoC to discharge under NCG510000. This
CoC is issued pursuant to the requirements of North Carolina General Statute 143-215.1 and the
Memorandum of Agreement between North Carolina and the US Environmental Protection agency dated
May 9, 1994.
A copy of the renewed General Permit is enclosed, as well as an updated Technical Bulletin. The
Technical Bulletin summarizes the changes from the previous version of NCG510000. If any parts,
measurement frequencies or sampling requirements contained in this permit are unacceptable to you, you
have the right to request an individual permit by submitting an individual permit application. Unless such
demand is made, this Certificate of Coverage shall be final and binding.
The CoC is not transferable except after notice to the Division. You must notify the Division if you
sell or otherwise transfer ownership of the permitted facility. The Division may require modification or
reissuance of the CoC.
If your facility ceases discharge of wastewater before the expiration date of this permit, contact the
Regional Office listed below. Once discharge from your facility has ceased, this permit may be rescinded.
This permit does not affect the legal requirements to obtain other permits which may be required by the
Division of Water Quality, the Division of Land Resources, Coastal Area Management Act or any other
Federal or Local government. If you have any questions concerning this permit, please contact Charles
Weaver at the telephone number or e-mail address listed below.
cc:
Moor s�r1lle"Regional Office — Surface Water Protection
Sin rely, N"mD
for Coleen H. Sullins
OCT 2 0 2008
NPDES file
James D. Rudder, Jr. / ECS, Inc. [13504 South Point Blvd, Unit F, Charlotte, ��N�yC 2827311.
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 One
512 North Salisbury Street, Raleigh, North Carolina 27604 NofthCarohna
Phone: [phone] /FAX [phone] / Internet: h2c.enr.state.nc.us An Equal Opportunity/Affirmative Action Employer— 50% Recycled/10% Post Consumer Paper Nationally

r
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NCG510000
CERTIFICATE OF COVERAGE NCG510429
TO DISCHARGE PETROLEUM CONTAMINATED GROUNDWATER AND SIMILAR WASTEWATERS
UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful
standards and regulations promulgated and adopted by the North Carolina, Environmental
Management Commission, and the Federal Water,Pollution Control Act, as amended,
is hereby authorized to operate a groundwater remediation system for petroleum -contaminated groundwater
or similar waste streams that will discharge treated wastewater from the .
Brawley Construction Company
954 Oak Ridge Farm Hwy
Mooresville
IredeR County
to receiving waters designated as Back Creek, a class C stream in subbasin 03-07-06 of the
Yadkin -Pee Dee River Basin.
All discharges shall be in accordance with the effluent limitations,. monitoring requirements, and
other conditions set, forth in Parts I, II, III and IV of General Permit NCG510000 as attached.
This certificate of coverage shall become effective October 15, 2008.
This Certificate of Coverage -shall -remain expire on September 30, 2011.
Signed this.day, October 15, 2008.
for doenH. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission

e��
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Allen Brawley
-Brawley Construction Company
P.O. Box 1067
Mooresville,NC 28115-
Dear Permittee:
William G o , Jr., Secretary
Vnt +�irector
�3Aa RL CEO .
June 5, 2006 MOORES ' LE CKOINA, OFFICE
UUN 1 9 2006
WATER QUALIFY SCTI0Rug
Subject: Notice of Violation
Failure to Submit Permit Renewal Application
Certificate of Coverage NCG510429
Brawley Construction Company
Iredell County , ,
NPDES General Permit NCG510000, under which the subject facility is covered, expires on
September 30, 2006. North Carolina Administrative Code (15A NCAC 2H.0105(e)) requires that an
application for permit renewal be filed at least 180 days prior to expiration of the current permit. To satisfy
this requirement, your renewal package should have been sent to the Division postmarked no later than
April 3, 2006.
The Division has not received a renewal request for the subject .CoC. This is a violation of your
permit at Part II. B. 10, which states "Any permittee that has not requested renewal at least 180 days prior
to expiration... will subject the permittee to enforcement. procedures' as provided in NCGS 143-215.6 and 33
USC 1251 et. seq.".
To prevent an assessment of civil penalties you must submit a completed permit application .(see
enclosed forms) no later than June 16, 2006. If the system is inactive due to lack of trust fund payments,
but the remediation equipment is still on site, the CoC should be renewed.
If all remediation discharge from this facility has ceased and you wish to rescind this CoC [or if you
have any other questions], contact Charles Weaver of my staff. Mr. Weaver's telephone number, fax number
and e-mail address are listed -at the bottom of this page.
Sincerely;
OR@GINk- SIGNED BY
AN A. WILSON
Alan W. Klimek, P.E.
cc: Central Files
_ gpxes: � � e �.,e;glo� • ee " ur aco - . �a�ei =ro ec ian
NPDES File
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 919 733-5083, extension 511 (fax) 919 733-0719
VISIT US ON THE INTERNET @ http:I/h2o.enr.state.nc.uSINPDES e-mail: [e-mail]

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
February 10, 2006
Allen Brawley
Brawley Construction Company
P.O. Box 1067
Mooresville, NC 28115
William G. Ross, Jr., Secretary
Alan W. Klimek, P.E., Director
Subject: NPDES Permit NCG510000 renewal
Certificate of Coverage (CoC) NCG510429
Brawley Construction Company
Iredell County
Dear Permittee:
The facility listed above is covered under NPDES permit NCG510000 for discharge of remediated
groundwater. NCG510000 expires on September 30, 2006. Federal (40 CFR 122.41) and North Carolina (15A
NCAC 2H.0105(e)) regulations require.that permit renewal applications must be filed at least 180 days prior
to expiration of the current permit. If you have already mailed your renewal request, you may
disregard this notice'.
To satisfy this requirement; the Division must receive your renewal request postmarked no later than
April 3, 2006. Failure to request renewal by this date may result in a civil assessment of at least $500.00.
Larger penalties may be assessed depending upon the delinquency of the request.
If any discharge from the remediation system will occur after September 30, 2006, your CoC must be
renewed. Discharge of wastewater without a valid permit would violate North Carolina General Statute 143-
215.1; unpermitted discharges of wastewater may be assessed civil penalties of up to $25,000 per day.
If you have halted remediation activity due to lack of trust fund money, but your site ranking from the
Aquifer Protection Section requires future remediation & discharge, your CoC must be renewed.
If all discharge has ceased at your facility and you wish to rescind this CoC [or if you have other
questions], contact me at the telephone number or e-mail address listed.below.
Sincerely, //�/ /// ■
CIE -
Charles H. Weaver, Jr.
NPDES Unit
M. Central Files F E
4bIooreswi1 i e _"F" io' n'�ati OO fie = u-face Water P',rotection
NPDES File
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 One 1
512 North Salisbury Street, Raleigh, North Carolina 27604 NorthCarollna
Phone: [phone], extension 511 / FAX 919 733=0719 / [e-mail] ;Vaharallff
An Equal Opportunity/Affirmative Action Employer — 50% Recycled/10% Post Consumer Paper

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross Jr., Secretary
Gregory J. Thorpe, Ph.D., Acting Director
September 26, 2001
ALLEN BRAWLEY
BRAWLEY CONSTRUCTION COMPANY
POST OFFICE BOX 1067
MOORESVILLE, NC 28115
1�•
NCDENR
NORTH CAROLINA DEPARTMENT OF
.ENVIRONMENT AND NATURAL RESOURCES
Subject: Reissue - NPDES Wastewater Discharge Permit
Brawley Construction Company
COC Number NCG510429
Iredell County
Dear Permittee:
In response to your renewal application for continued coverage under general permit NCG510000, the Division of
Water Quality (DWQ) is forwarding herewith the reissued wastewater general permit Certificate of Coverage
(COC). This COC is reissued pursuant to the requirements of North Carolina General Statute 143-215.1 and the
Memorandum of Agreement between the state of North Carolina and the U.S. Environmental Protection Agency,
dated May 9, 1994 (or as subsquently amended).
The following information is included with your permit package:
* A copy of the Certificate of Coverage for your treatment facility
* A copy of General Wastewater Discharge Permit NCG510000
* A copy of a Technical Bulletin for General Wastewater Discharge Permit NCG510000
Your coverage under this general permit is not transferable except after notice to DWQ. The Division may require
modification or revocation and reissuance of the Certificate of Coverage. This permit does not affect the legal,
requirements to obtain other permits which may be required by DENR or relieve the permittee from responsibility
for compliance with any other applicable federal, state, or local law rule; standard, ordinance, order, judgment, or
decree.
If you have any questions regarding this permit package please contact Aisha Lau of the Central Office Stormwater
and General Permits Unit at [phone], ext. 578
Sincerely,
for .Gregory J. Thorpe, Ph.D.
cc: Central Files
Stormwater & General Permits Unit Files
Mooresville Regional Office
roc DErT. cr,= 04 K—:
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I•.,
OCT 0 4 2001
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1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG510000
CERTIFICATE OF COVERAGE No. NCG510429
TO DISCHARGE PETROLEUM CONTAMINATED GROUNDWATER AND SIMILAR
WASTEWATERS UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful standards and
regulations promulgated and adopted by the North Carolina Environmental Management Commission, and the
Federal Water Pollution Control Act, as amended,
BRAWLEY CONSTRUCTION COMPANY
is hereby authorized to construct and operate or continue operation of a groundwater treatment system for
petroleum contaminated groundwater or similar waste streams with the discharge of treated wastewater from a
facility located at
BRAWLEY CONSTRUCTION COMPANY
954 OAK RIDGE FARM HWY
MOORESVILLE
IREDELL COUNTY
to receiving waters designated as Back Creek, 'a class WS-II stream, in the Yadkin - Pee Dee River Basin in
accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts I, H, III,
IV, V, and VI of General Permit No. NCG510000 as attached.
This certificate of coverage shall become effective October 1, 2001.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day September 28, 2001.
for Gregory J. Thorpe, Acting Director
Division of Water Quality
By Authority of the Environmental Management Commission

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
September 17, 1999
Mr. Allen Brawley
Brawley Construction Company
P.O. Box 1067
Mooresville, North Carolina 28115
1 •
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
Subject: NPDES General Permit Application
Application Number NCG510429
Brawley Construction Company
Iredell County
Dear Mr. Brawley:
In accordance with your application for discharge permit received on April 8, 1999 by the Division, we are
forwarding herewith the subject Certificate of Coverage to discharge under the subject state - NPDES general permit
for petroleum contaminated groundwater remediation systems and one set of final approved plans and specifications.
Authorization is hereby granted for the construction and operation of a ground water remediation system consisting
of a oil/water separator with a rated flow capacity of 18-45 GPM, a 300-CFM air stripper with Air to Water ratio of
94:1, and a 25 GPM carbon adsorption system with 2 - 350 lb units in two parallel series, preceded by a particulate
filter with discharge of treated wastewater into Back Creek, a class WS-II water in the Yadkin - Pee Dee River
Basin. This Certificate of Coverage is issued pursuant to the requirements of North Carolina General Statute 143-
215 .1 and the Memorandum of Agreement between North Carolina and the US Environmental Protection Agency
dated December 6, 1983 and as subsequently amended.
Based on the source of your contamination, specifically gasoline and diesel, effluent page A. (3) applies to
your facility and lists required effluent limitations and monitoring frequencies.
If any parts, measurement frequencies or sampling requirements contained in this permit are unacceptable to
you, you have the right to request an individual permit by submitting an individual permit application and letter
requesting coverage under an individual permit. Unless such demand is made, this certificate of coverage shall be
final and binding.
Please take notice that this certificate of coverage is not transferable except after notice to the Division of
Water Quality. The Division of Water Quality may require modification or revocation and reissuance of the
certificate of coverage in case of change of ownership or control of this discharge.
The Authorization to Construct is issued in accordance with Part III, Paragraph 2 of NPDES Permit No.
NCG510000, and shall be subject to revocation unless the wastewater treatment facilities are constructed in
accordance with the approved plans and specifications and the conditions and limitations specified in Permit No.
NCG510000.
In the event that the facilities fail to perform satisfactorily, including the creation of nuisance conditions, the
Permittee shall take immediate corrective action, including those as may be required by this Division, such as the
construction of additional or replacement wastewater treatment or disposal facilities.
The Mooresville Regional Office, telephone number [phone], shall be notified at least forty-eight
(48) hours in advance of operation of the installed facilities so that an in -place inspection can be made. Such
notification to the regional supervisor shall be made during the normal office hours from 8:00 a.m. until 5:00 p.m. on
Monday through Friday, excluding State Holidays.
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

Mr. Brawley
NCG510429
September 17, 1999
Page 2
F iayA 0) J 1,91991
Upon completion of construction and prior to operation of this permitted facility a certit.taffpn mmust be!,,.
received from a professional engineer certifying that the permitted facility has been installed in accordance wifh the
NPDES Permit, the Certificate of Coverage, this Authorization to Construct and the approve&plans and
specifications. Mail the Certification to the Stormwater and General Permits Unit, 1617 Mail Service Center,
Raleigh, NC 27699-1617.
A copy of the approved plans and specifications shall be maintained on file by the Permittee for the life of
the facility.
Failure to abide by the requirements contained in this Authorization to Construct may subject the Permittee
to an enforcement action by the Division of Water Quality in accordance with North Carolina General Statute 143-
215.6A to 143-215.6C.
This permit does not affect the legal requirements to obtain other permits which may be required by the
Division of Water Quality or permits required by the Division of Land Resources, the Coastal Area Management Act
or any other Federal or Local governmental permit that may be required.
If you have any questions concerning this permit, please contact Darren England at telephone number (919)
733-5083, extension 545.
Sincerely,
for err T. Stevens
Attachment
cc: Rohit Sh_etty, CBM Environmental Services, Inc,
"Mooresville Regional. Office, Water. Quality -Section
Stormwater and General Permits Unit
Point Source Compliance and Enforcement Unit
Central Files
S WU-207-061899

Mr. Brawley
NCG510429
September 17, 1999
Page 3
Engineer's Certification*
I, , as a duly registered Professional Engineer in the State of North Carolina,
having been authorized to observe (periodically, weekly, full time) the construction of the
project,
Project Name Location
for the
Permittee, hereby state that, to the best of my abilities, due care and diligence was used in the observation of the
construction such that the construction was observed to be built within substantial compliance and intent of the
approved plans and specifications.
Signature
Registration No.
Date
Seal
Upon completion of construction and prior to operation of this permitted facility a certification must be received
from a professional engineer certifying that the permitted facility has been installed in accordance with the NPDES
Permit, the Certificate of Coverage, this Authorization to Construct and the approved plans and specifications. Mail
the certification to Stormwater and General Permits Unit, P.O. Box 29535, Raleigh, North Carolina 27626-0535
S WU-207-061899

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG510000
CERTIFICATE OF COVERAGE NO. NCG510429
TO DISCHARGE PETROLEUM CONTAMINATED GROUNDWATER AND SIMILAR
WASTEWATERS UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful standards and
regulations promulgated and adopted by the North Carolina Environmental Management Commission, and
the Federal Water Pollution Control Act, as amended,
Brawley Construction Company
is hereby authorized to construct and operate or continue operation of a groundwater treatment system
consisting of an oil/water separator, an air stripping system and carbon filtration for petroleum contaminated
groundwater or similar waste streams with the discharge of treated wastewater from a facility located at
Brawley Construction Company
954 Oak Ridge Farm Highway
Mooresville
Iredell County
to receiving waters designated as Back Creek in the Yadkin - Pee Dee River Basin
in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts
I, H, III and IV hereof.
This certificate of coverage shall become effective September 24, 1999.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day September 17, 1999.
for rr T. Stevens, Director
Division of Water Quality
By Authority of the Environmental Management Commission

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CBM PROJECT NO. 1045E

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
Kerr T. Stevens, Director
Mr. Rohit Shetty
CBM Environmental Services, Inc.
P.O. Box 411387 -
Charlotte, North Carolina 28241
Dear Mr. Shetty:
1 M?0WAA • 2
NCDENR,,,,,, NORTH CAROLINA DEPARTM_NT OF,, • E
ENVIRONMENT AND N�ATuItALjRESOUR`CES cj ` ?3
July 8, 1999 r (b;l 3,
1999
T 77
Subject: NPDES General Permit Application
Application Number NCG510429
Brawley Construction Company
Iredell County
This correspondence is concerning the engineering proposal submitted for the subject project. The Stormwater and
General Permits Unit is responsible for evaluating the plans proposed in conjunction with permitting under General
Permit NCG510000. The staff has reviewed the submitted plans and determined that additional information /
revisions are necessary to complete the technical review process. The required additional information / revisions are
as follows:
1) Discharge Flow - Appendix C of your submittal package list various system components with maximum design
flows ranging from 10 gpm to 100 gpm. The activated carbon filters would be the limiting factor at 10 gpm. A
system discharge flow of 34560 gpd is indicated on the your NOI. This equates to 24 gpm, which is above the
design capacity of at least two components of the proposed treatment system. Please submit information to
resolve this discrepancy.
2) Air Stripper specifications - Please submit the following information: The air stripper removal efficiencies for
the parameters of concern (Benzene, Toluene, Ethyl Benzene, Xylene, Lead, MTBE, IPE) and the size of blower
for air stripping (cfm).
3) Activated Carbon Units - Please specify the number of units to be used and the configuration.
The requested information or a deadline extension request must be submitted within 30 days. Division
stormwater staff will strive to complete a final technical review within 10 working days of receipt of the requested
information. You will be advised of any comments, recommendations, questions or other information necessary for
the review of the application. If you have any questions or would like to discuss this project, please contact me at
[phone], extension 545.
Sincerely,
Darren M. England
Environmental Engineer
cc: Mr. Allen Brawley, Brawley Construction Co.
tMooresville_RegionalOffide
Stormwater am cneral Permits Unit
Central Files
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

SOC PRIORITY PROJECT: No
to
To: Permits and Engineering Unit
Water Quality Section
Attention: Darren England
Date: June 4, 1999
NPDES STAFF REPORT AND RECOMMENDATIONS
County: Iredell
NPDES Permit No.: NCG510429
MRO No.: 99-83
PART I - GENERAL INFORMATION
1. Facility and Address: Brawley Construction Company
Post Office Box 1067
954 Oak Ridge Farm Highway
Mooresville, N.C. 28115
2. Date of Investigation: May 27, 1999
3. Report Prepared By: Michael L. Parker, Environ. Engr. II
4. Person Contacted and Telephone Number: Allen Brawley, (704)
5. Directions to Site: From the jct. of Hwy. 801 and Hwy. 150 northeast of the Town of
Mooresville, travel east on Hwy. 150 = 0.3 mile. The Brawley Construction Company is
on the right (south) side of Hwy. 150 just before crossing Back Creek.
6. Discharge Point(s), List for all discharge Points: -
Latitude: 350 36' 26"
Longitude: 800 47' 14"
Attach a USGS Map Extract and indicate treatment plant site and discharge point on map..
USGS Quad No.: E 15 SE
7. Site size and expansion area consistent with application: Yes. Sufficient area exists for the
construction of the proposed WWT facilities.
8. Topography (relationship to flood plain included): The entire site is sloping towards the
receiving stream at a rate of 3-8%. The site is not located in a flood plain.
9. Location of Nearest Dwelling: Approx. 500+ feet from the proposed WWTP site.

Z Pa!e Two
10. Receiving Stream or Affected Surface Waters: Back Creek
a. Classification: WS-II
b. River Basin and Subbasin No.: Yadkin 030706
C. Describe receiving stream features and pertinent downstream uses: Good flow in
the receiving stream.. Channel width 4-5 feet wide X 2-6 inches deep. No
downstream dischargers known for a distance of at least 1 mile.
PART H - DESCRIPTION OF DISCHARGE AND TREATMENT WORKS
1. a. Volume of Wastewater: 0.03456 MGD (Design Capacity)
b. What is the current permitted capacity: N/A
C. Actual treatment capacity of current facility (current design capacity): N/A
d. Date(s) and construction activities allowed by previous ATCs issued in the
previous two years: N/A
e. Description of existing or substantially constructed WWT facilities: There are no
existing WWT facilities.
f. Description of proposed WWT facilities: The applicant proposes to construct a
GW remediation system consisting of an oil water separator followed by an air
stripper, and an activated carbon filter.
g. Possible.toxic impacts to surface waters: There are no toxic impacts expected.
h. Pretreatment Program (POTWs only): Not Needed.
2. Residual handling and utilization/disposal scheme: residuals generation is not expected.
3. Treatment Plant Classification: The operator of this facility should have at least the
minimum level of operator training (currently Class I is the only certification available for
systems of this type).
4. SIC Code(s): unknown Wastewater Code(s): 66
5. MTU Code(s): 56010
PART III - OTHER PERTINENT INFORMATION
1. Is this facility being constructed with Construction Grant Funds or are any public monies
involved (municipals only)? No
2. Special monitoring or limitations (including toxicity) requests: None at this time.
3. Important SOC/JOC or Compliance Schedule dates: N/A
to

t
Page Three
4. Alternative Analysis Evaluation
a. Spray Irrigation: Insufficient area.
b. Connect to regional sewer system: There is presently no sewer service available to
serve this location nor is any proposed in the near future.
C. Subsurface: Insufficient area.
PART IV - EVALUATION AND RECOMMENDATIONS
The applicant, Brawley Construction Company, has requested approval to install a GW
remediation WWT system to pump and treat contaminated GW resulting from the leakage of an
underground gasoline storage tank.
Pending a technical review and approval by P&E, it is recommended that the permit be
issued as requested.
,Signature of Report Preparer Date
Water Quality Regional
hAdsr\dsr99\braw1ey.dsr
isor Date
to

i State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
Kerr T. Stevens, Director
Mr. Allen Brawley
Brawley Construction Company
P.O. Box 1067
Mooresville, North Carolina 28115
Dear Mr. Brawley:
pn� �n AAA
11
CS
April 19, 1999
•
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMEND' p*KU RESOURCES
ar
APR 21 1999
Subject: NPDES General Permit Application
Application Number NCG510429
Groundwater Remediation
Iredell County
The Division of Water Quality's Stormwater and General Permits Unit hereby acknowledges receipt of
your Notice of Intent (Application Form) for coverage under NPDES Permit Number NCG510000 on
April 8, 1999. This NOI has been assigned the application number shown above.
The submitted package contained a completed NOI, processing fee, and engineering plans.
Please be aware that the Division's ashington egional office, copied below;, must provide
recommendations from the Region tsor prior to final action by the Division. I am, by copy of
this letter, requesting that our Regional Office Supervisor prepare a staff report and recommendations
regarding this discharge. y
You should be aware that the review process generally takes 90 days from the date your complete
submittal is received. This 90-day process may be extended if additional information is required.
If you have any questions, please contact me at [phone], extension 545.
Sincerely,
Darren M. England
Environmental Engineer
cc: Rohit Shetty, CBM Environmental Services, Inc
,Mooresville -RCgional Office:
Stormwater and General Permits Unit
Central Files '
SWU-210-081298
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper
� I

James G.1,jartin, Governor
William W. Cobey, Jr., Secretary NOTICE OF INTENT
State of North Carolina
' Health and
Department of EnvirofEnvironmental Management al Resources
Division o
512 North Salisbury Street • Raleigh, North Carolina 27611.
A. Preston Howard, Jr., P.E.
Acting Director
T�Tationa] Pollutant D1Schar a Elimination System Groundwater remediation projects
Application for Coverage under General Permit NCG�1p000;
designed to treat petroleum contaminated groundwater.
1. Name, Address , location, and telephone number of facility requesting Per nut.
A. Official Name:
Brawle Con structioBrawleynConstruction Company
Allen Brawley,
B. 1v4ailing Address:
c/o Mr.
p. 0. Box 1067
(1)Street Address;
Mooresville
(2)City;
North Carolina
(3)State;
28115
(4)Zip;
Iredell
(5)County;
C. Location. (Attach map delineating
general54 Oak facility
}dgec Farm Highway
(1)Street Address;
Mooresvi e
(2)City;
Nort aro ina
(3)State;
Iredell '
(4)County;
D. Telephone Number;
663 _ 5270
�704)
2. Facility Contact:
Mr. Allen Brawley
A. Name;
B. Title;
resident
rawle Construction Company
T
C. Company Tame;
Phone Number,
(_L04 )' 663 _ 5270
D.
3. Application type (check appropriate
selection):
A. New or Proposed;
previously permitted, provide perms t number
B , Existing;
_If
and issJe date
C, Modification' —
(Describe the nature of the modification):
4. Description of discharge
A. Please state the number of separate discharge points:
1,[ J ; 2,[ l ; 3,[ J ; 4,[ 1; �[
Page 1

Y't
are describe the amount of wastewater being discharged per each separate discharge point:
B. Plg 2: _ ) 3: — (gpd) 4: — (gp c
' S6.
t 134 �allons per day frequency uen of the discharge, per each separate discharge point:
C. Check the duration and freq cy
1. Continuous', X
2. Intermittent (Plea desrnbe): anua R February f�l; March (]; April ( ,
3. Seasonal (check month(s) the discharge �r ani NovembenE ;December [A -
May [�;June t-J; July 14; Augur Sep
4. How many days per week is there a discharge?(check
[x], Saturd ay (4the days the ,Sunday [xl occurs)
Mondayll, Tuesday H, Wednesday H5 Thursd y Y
5. How much of the volume discharged is treated? (state in percent)-10-0 �+o
D
. Describe the type of wastewater being discharged per separate
odischarge ls founSpecify
n what is
being removed and products recovered. This includes a g
detectable amounts with the maximum observed concentration
ue should also rep rted. The summary
u he l of
not
analytical results containing this maximuman
the graphical scan). The most recent sample olderus shouldebe incpuded along we
th to
oranic compounds of this application. The fo]]oHing volatile g Pod
any suspected fuel additive; Note: Remediated Groundwater will be
The
Benzene'; discharged at one discharge point. e
1• point is
2. Toluene'; location of the discharg p Appendix A.
3• Ethylbenzene'; ` shown on Figures 2 and 12 in APp g• Xylene'; A summary •of the,'GroundwaterAAnalytic Al
5.
Lead; Results is presented in Appendix B,
6. Methyl tert-butylether (MTBE); Table 3.
7. Dibromoethane (EDB);
S. 1,2-dichloroethane;
9. Isopropyl ether;
10. Naphthalene;
11. Phenol;
apable of detection levels to 1 ppb should be used to detect these
'(An EPA approved method.c
compounds).
E. Please check the appropriate type of treatment being used to treat the groundwater;
1. Oil/Water Separ
2. Air Shipper; x -
3. Diffused Aeration
4. Activated Carbon Absorption;--L—
5. Other(speafy);
6. Separately, please describe in detail size, volume capacity,
lvou ih 5. Include, if any, the esign flowthrough treatment,
etc.) each type of treatment that was checked $
manufacturers information on each type of treatment. Also provide the removal efficiency of
each compound detected for the project, if known.Giv dfreg{ specifics facilities should beume o
each unit, materials used in air stripper, etc.). g
described in detail and design criteria or perk l wah requiTemen s of the General
calculations) to ensure that the facility P Y
Please include model and calculations used in determining the design requirements foee ea Pt
stripper. See Appendix C. 12 _ 4" Diameter wells @ 22. f
7. What are the well sizes and how many exist. in
8. Please state the pump sizes and their location in relation
,and viesual treatment
l erntis or rut maatic E•
9. Please explain what fail-safe measures, such as a gi/Lo Level 'Sensors .
shutoff systems, are provided to ensure no system failures.
10. Is there an access to the effluent o to influent and effluent sampling ports.
toan open pipe or a valve to obtain'a
sample) Access is available
Page 2

NOTE: Construction of any wastewater treatment facilities require submission of three t.51 sets of plans
T and specifications along with their application. Design of treatment facilities must. comply
with requirement 15A NCAC 2H .0138. If construction applies to the discharge, include the
C three sets of plans and specifications with the application.
5. What is the nature of the business applying for this permit. Site is a construction company
6. Name of receiving water or waters; Back Creek Classification:
(Attach a USGS topographical map with all discharge point(s) clearly marked)
7. Is the discharge directly to the receiving water?(Y,N) Y
If no, state specifically the discharge point. Mark clearly the pathway to the potential receiving
waters on the site map. (This includes tracing the pathway of the storm sewer to its discharge
point, if a storm sewer is the only Viable means of discharge.)
8. Please address possible non -discharge alternatives for the following options:
A. Corinection to a Regional Sewer Coll ectioe n System; According to local city officials,
a•regional sewer collection facity is not available near the site.
B. Subsurface Disposal; This is not feasible due to spatial constraints.
C. Spray Irrigation; Does not appear to be an appropriate option.
9. I certify that I am familiar with the information contained in the application and that to the best of
my knowledge and be1jef such information is true, complete, and accurate.
I',L,t`dNa-reof Pa -son S ��lir� Mr . Allen Brawlev
T3&_ President
Date ApplesSa, dyed
Signature of App'. ant.1
NORTH CARO iI ''A CFNFR4 . �Tj= 1'..S 6�i}_M PROV1DE5 THAT;
Any person who knowingly makes any false statement, representation, or certification in any
application, record, report, plan or other document filed or required to be maintained under Article 21 or
regulations of the Ewiironmental Management Commission implementing that Article, or who falsifies,
tampers with or knowingly renders inaccurate any recording or monitoring device or method required to
be operated or maintained under Article 21 or regulations of the Environmental Management
Commission implementing that Article, shall be guilty of a misdemeanor punishable by a fine not to
exceed $10,000, or by imprisonment not to exceed six months, or by both. (18 U.S.C. Section 100i pro%ides
a punishment by a fine of not more than $10,000 or imprisonment not more than 5 years, or both, for a
similar offense.)
Niotice of Intent must be accompanied by a check or money order for $400.00 made payable.to the North
Carolina Department of Environment, Health, and Natural Resources. Mail three (3) copies of enure
package to:
Division of EnvironmenW Management
NTPDES Permits Group
Post Office Box 29535
Raleigh, North' Carolina 27626-0535
Page 3

APPENDICES
APPENDIX A: (FIGURES)
• USGS Topographic Map
• Site Map
• Site Vicinity Map
• Proposed Extraction Well Location Map
• Multi -Phase Extraction Process and Instrumentation Diagram
• Multi -Phase Extraction Well Diagram
• Multi -Phase Extraction Well Vault Detail
• Trench Layout
• Trench Detail
APPENDIX B: (TABLES)
• Summary of Laboratory Analyses — Soil Samples
• Summary of Groundwater Elevation Data
• Summary of Laboratory Analyses — Groundwater Samples
• Target Cleanup Concentrations for Soil and Groundwater
APPENDIX C: (EQUIPMENT SPECIFICATIONS)

APPENDIX A
FIGURES

Vd) 1� �o
--\'N "X\ 00%
%
so 1
tra l 7,
nici al "o ok
SCALE 1:24,000 zf■ N.G
1 MILE
1000 0 1000 2000 3000 4000 5000 8000 7000 FEET QUADRANGLE LOCATION
CONTOUR INTERVAL 10 FEET MOORESVILLE, NC QUADRANGLE
LATITUDE: 35* W 25' N - BRAWLEY CONSTRUCTION CO. FIGURE I
LONGITUDE- 80" 4r 154 W 954 OAK RIDGE FARM HWY
DATE: 11/05/98 USGS TOPOGRAPHIC
- MOORESVILLE, NORTH CAROLINA
INS. DRAWN BY: AM MAP
L FCHECKED BY: RS- Li GW INCIDENT NO. 16495 CBM PROJECT NO. 10459

/
/
yam_'. ♦♦ ' - GRASS AREAI
\`gip I %dZFJ� PUNTER
SIGN U
`\ ^
��
PPLI�
lEGEZiD
-sQ
BUI
+ OBSERVATION WELL
® RECOVERY WELL
SOIL VAPOR EXTRACTION WELL
TYPE II MONITORING WELL
%%'1
TYPE III MONITORING WELL
\ %N a
nk, %
1
�— Y—Y —■ FENCE
\� r`� !
• POWER POLE
!off — OVERHEAD LITILITY
GRASS AREA 1 ?tA
j �7i
-----=----• CORRUGATED METAL PIPE
i i
----=CP----• REINFORCED CONCRETE PIPE
DRAINAGE DITCH
jQ
WATER SUPPLY WELL
FORMER 2,000 GAL. UST
SCALE
0 10 20 30 40 50
FEET
SITE MAP
3RAWLEY CONSTRUCTION CO. FIGURE 2
954 OAK RIDGE FARM HWY
MOORESVILLE, NC

LEGEND
WELL LOCATION
SME
66W!%Wm�
0 200 4DO
FEET
SITE I.D. NO. 0-017375 POTABLE WELL LOCATION W
CBM PROJ. NO. 10459
DRAWN BY: AWS BRAWLEY CONSTRUCTION CO. FIGURE 3
. . . . . . . . . . .... ............. . .. .. .......
954 OAK RIDGE FARM HWY
. .. .... INC. CHECKED BY: JW
MOORESVILLE. NC
....... .....
DWG DATE: 01/27/98

sazsdi
a XIQAiaddd

TABLE 1
SUMMARY OF LABORATORY ANALYSES'
SOIL SAMPLES
BRAWLEY CONSTRUCTION
CONSTITUENT
SB-1.
�3,�),:
SB=1A
(8 10') ....
SB=2 _
�3'�.. ,
SB 2A
i8: �0') ...
SB 3A
5�10).. `
SB-3B':
., ,., .�5.,�'),,
SB-3B
(10 12:')
SB-3C
"(0 2') <,
SB-3C
; (8-10')
SB-4
(10')
SB-4A
(0-2')
MSCC?
7/18/96
4/13/98;
7/18/96
:4/13/98
ti _ _..�x,�......
7/19/96
�11/25/96
1.1/25%96
4/R13/98'
4/13/98
7/19/96:
4/13/98
Benzene
NR
ND
NR
0.640
NR
NR
NR
ND
ND
NR
2.300
0.0056
Toluene
NR
ND
NR
73.000
NR
NR
NR
0.034
ND
NR
150.000
7
Ethylbenzene
NR
ND
NR
71.000
NR
NR
NR
0.061
ND
NR
110.000
0.24
Xylenes
NR
ND
NR
440.000
NR
NR
NR
0.560
ND
NR
550.000
5
MTBE
NR
ND
NR
ND
NR
NR
NR
ND
ND
NR
ND
0.92
IPE
NR
ND
NR
ND
NR
NR
NR
ND
ND
NR
ND
0.37
Naphthalene
NR
ND
NR
270.000
NR'
NR
NR
0.076
ND
NR
35.000
0.58
TPH 5030
ND
ND
12,600
2,200
41,400
ND
ND
3
ND
ND
1,400
NS
TPH 3550
NR
NR
NR.
NR
ND
ND
ND
NR
NR
ND
NR
NS
n-Butylbenzene
NR
ND
NR
15.000
NR
NR
NR
0.018
ND
NR
12.000
4
sec-Butylbenzene
NR
ND
NR
3.000
NR
NR
NR
ND'
ND
NR
2.100
3
Isopropylbenzene
NR
ND
NR
7.800
NR
NR
NR
0.009
ND
NR
6.400
2
p-Isopropyltoluene
NR
ND
NR
6.800
NR
NR
NR
0.008
ND
NR
4.400
NS .
n-Propylbenzene
NR
ND
NR
35.000
NR
NR
NR
0.041
ND
NR
41.000
NS
1,2,4-Trimethylbenzene
NR
ND
NR
200.000
NR
NR
NR
0.220
ND
NR
220.000
8
1,3,5-Trimethylbenzene
NR
ND
NR
230.000
NR
NR
NR
0.470
ND
NR
250.000
7
Acetone
NR
ND
NR
ND
NR
NR
NR
ND
ND
NR
ND
NS

TABLE 1 (cont'd)
SUMMARY OF LABORATORY ANALYSES'
SOIL SAMPLES
BRAWLEY CONSTRUCTION
CONSTITUENT ..
SB-4A
(4-6.').
SB-S
(4 6'):;
- SB=6
(6-8')
SB=7
(6 8')
SB'=8.
:(6 8');
SB=9
:(.6-8') .
MW-1
; (14-1.6') ;
MW-2
.. (14')
MW-3
(14')
MW-4
(14')
MW-5
(14')
MSCC
4/1.3/9.8 .,
, 4/13/98
4/13/98
4/13%98
4/13/98.
,4/30/98 ,
%11/25/96,
P/29/97
1/29/97
1/29/97
1/29/97
Benzene
ND
ND
2.200
0.069
0.010
ND
NR
NR
NR
NR
NR
0.0056
Toluene
1.600
0.063
190.000
0.180
0.062
0.010
NR
NR
NR
NR
NR
7 .
Ethylbenzene
1.100
0.069
75.000
ND
0.023
ND
NR
NR
NR
NR
NR
0.24
Xylenes
7.100
0.640
480.000
0.240
0.170
0.066
NR
NR
NR
NR
NR
5
MTBE
0.230
0.014
0.860
0.410
0.011
0.120
NR
NR
NR
NR
NR
0.92
IPE
0.150
0.025
1.900
0.520
0.180
0.094
NR
NR
NR
NR
NR
0.37
Naphthalene
0.500
0.073
6.500
0.059
0.015
0.041
NR
NR
NR
NR
NR
0.58
TPH 5030
58
5
3,500
94
2
2
3,220
NR
NR
NR
NR
NS
TPH 3550
NR
NR
NR
NR
NR
NR
ND
2,320
32.4
616
ND
NS
n-Butylbenzene
ND
ND
3.300
ND
ND
ND
NR
NR
NR
NR
NR
4
sec-Butylbenzene
ND
ND
ND
ND
ND
ND
NR
NR
NR
NR
NR
3
Isopropylbenzene
ND
0.007
.1.600
ND
ND
ND
NR
NR
NR
NR
NR
2
p-Isopropyltoluene
ND
ND
1.100
ND
ND
ND
NR
NR
NR
NR
NR
NS
n-Propylbenzene
0.220
0.033
7.000
ND
ND
ND
NR
NR
NR
NR
NR
NS
1,2,4-Trimethylbenzene
2.300
0.300
180.000
0.074
0.046
1 0.051
NR
NR
NR
NR
NR
8
1,3,5-Trimethylbenzene
2.600
0.310
210.000
ND
0.047
0.029
1 NR
NR
NR
NR
NR
7
Acetone
1.300
ND
ND
ND
ND
ND
I NR
NR
NR
NR
NR
NS
Notes:
1. Analyses for volatile organics by EPA 8260; analyses for gasoline -range TPH by EPA Method 5030/8015M; analyses for diesel -range TPH by
EPA Method 3550/8015M; soil samples SB-1, SB-2, SB-3A, SB-3B, SB-4, and MW-1 through MW-5 were collected by SPATCO
Environmental, Inc.; all analyses reported in mg/kg.
2. Soil -to -Groundwater Maximum Soil Contaminant Concentrations.
3. Sample collection date.
4. Analyses not requested.
5. Not detected at or above the method detection limit specified in the laboratory report.
6. Results in bold face type indicate concentrations that exceeded the MSCC for soil.
7. Not specified.

- TABLE 2
SUMMARY OF GROUNDWATER ELEVATION DATA
NOVEMBER 20, 1997 .
BRAWLEY CONSTRUCTION COMPANY
Well
No.
Top of Casing
Elevation")
Depth to _
Groundwater,.'
Groundwater
Elevation "
Well
Depth
Screened
Interval
MW-1
103.12
14.902
8827
18
8-18
MW-2
101.85
15.60
86.25
20 -
10-20
MW-3
101.28
15.40
85.88
19
9-19
MW-4 ,
101.84
15.72
86.12
20
10-20
MW-5'
105.37
17.28
88.09
19
9-19
MW=6 ,
107.82
18.87
88.95
21
11-21
MW-7:.:`:-
102.97
18.20
84.77,
21
11-21
MW4 ': •
98.50
15.87
82.63.
21
11-21
MW-9
96.21
14.13
82.08
20
10-20
MW-10.:
91.26
11.95
79.31
17.5
7.5-17.5
MW 111` �
90.83
11.03
79.80
15.5.
5.5-15.5
MW.=:12
92.93
13.01
79.92
17
7-17
MW-13
98.35
14.71
83.64
16.5
6.5-16.5
MW=14
103.46
15.75
87.71
21
11-21
MW=15
85.41
8.11
77.30
20
10-20
MW=16 g
88.53
11.60
76.93
16
6-16.
98.65
15.40
83.25
21
11-21
MW-18
101.63
19.27.
82.36
20
10-20
MW=19
91.81
12.76
79.05
22
12-22
TW;-1,, _. _. '
102.68
16.43
86.25
38
31-38
Notes:
1. Top of casing elevations relative. to a temporary benchmark with an assumed datum of 100.00 feet; data
reported in feet.
2. Depth to water corrected for the presence of 0.07 feet of free product.

TABLE 3
SUMMARY OF LABORATORY ANALYSES'
GROUNDWATER SAMPLES
BRAWLEY CONSTRUCTION COMPANY
Well
Date
Sampled
lJoiuene I, . Ethylbenzene Xylene!s ,;MTBE . IPE Total VOCs EDB
Lead
mg/L
MW-1
12/6/96
1,530
7,680
1,860
12,300
NW
NR
23,370.
NR
0.097
1/31/97
622
5,520
736
6,190
129
230
13,427
ND
ND
9/16/97
FP
FP
FP
FP
FP
FP
FP
FP
FP
MW-2
1/31/97
1843
7,390
1,610
11,900
ND
30.50
21,114.50
ND
ND
9/16/97
180
5,700
980
9,100
ND
ND
15,960
ND
0.028
MW-3
1/31/97
3,260
10,900
952
6,240
50
231
21,633
ND
ND
9/16/97
5,700
27,000
1,600
12,000'
ND
1,000
47,300
ND
0.089
MW-4
1/31/97
37.3
538
77.7
579
ND
7.4
1,239.4
ND
ND
9/16/97
300
1,500
120
960
8
100
2,988
ND
0.025
MW-S.:''.:`
1/31/97
18
35.5
1.1
13.4,
4.95
294
366.45
ND
ND
9/16/97
30
62
ND
50
ND
49
191
ND
ND
MW-6
9/16/97
ND4
ND
ND
ND
ND
ND
ND
ND
0.038
MW-7.
9/16/97
120
260
12
110
ND
28
530
ND
0.14
MW-8
9/16/97
1,400
3,100
740
1,600
38
209
7,087
ND
0.019
MW-9-
9/16/97
2
ND
ND
ND
10
31
43
ND
ND
11/18/97
27
ND
ND
ND
10
23 '
60
NR
0.096
MW=10
9/16/97
88
3
ND
ND
49
140
280
ND
ND
IGIW4T,-
9/16/97
14.
ND
ND
ND
72
140
226
ND
ND
MW-12
9/16/97
37
8
1
150
ND
14
210
ND
0.044
MW-13
9/16/97
ND
ND
ND
ND
ND
ND
ND
ND
0.047
MW-14
9/16/97
ND
ND
ND
ND
ND
ND
ND
ND
0.025
11/18/97
ND
ND
ND
ND
ND
ND
ND
NR
ND
-16.
11/18/97
ND
ND
ND
ND
32
7
39
NR
ND
r-15
47,.
11/18/97
840
4,900
470
2,600
81
210
9,101
NR
ND
-18
11/18/97
98
12
ND
68
ND
39
217
NR
0.022
-19
11/18/97
ND
ND
ND
ND
ND
ND
ND
NR
ND
TW-1
1/31/97
6.02
50.1
10.5
70.3
1.79
3.41
142.12
NR
ND
9/16/97
12
45
12
74
6
ND
149
NR
0.33
530n
200..,;
.:70,..,,
.,. " ��
a
;4.OX10.
0.015
Notes:
1. Laboratory analyses for BTEX constituents, IPE, and MTBE by EPA Method 601/602; EDB by EPA Method 504.1;
. lead by Method 6010 with Method 3030C.
2. Concentrations in bold face type exceedec the MAC.
3. Analysis not requested.
4. Not detected.
5. Free product.
6. Maximum allowable concentrations.

APPENDIX C
EQUIPMENT SPECIFICATIONS

6
C O R P O R A T I O N
SPECIFICATION
PRE -SEPARATOR - MPX
With Optional Moyno Pump
----------------------
------------
Mvael: PS-7.5-M PS-2o-)tii FS-3o••M . I`S-40-M Z'S-60-1-I
Design Flow (GPM): 7.5 20 30 40 60
Design Features:
Separation Tank: Carboxt steel construction.
Size: 80 gal. 8U gal. eft? gal. 11U gal. 1200.
Pump: progressive cavity pump, direct or gear motor drive, for 10 ft discharge head
with a 10 or 30,60 Hz., TEFC or XP motor. Cast iron construction with
chrome plated stainless steel rotor and elastometric stator.
Electrical:
Horsepower: 1/2 3/4 1 11/2 3
Motor Speed (RPM): 1200 1200 1200 1200 1200
Voltage (10): 115/230 115/230 115/230 115/230* 115/230*
Voltage (30): 230/460 230/460 230/460 230/460 230/460
*115V With TEFC only.
Column Switch:
- High and low level pump control switches.
- High level alarm switch to shut down liquid ring vAmmm rump on high
separator tank water level.
Skid Mounting:
Equipment is factory mounted and piped on a steel skid. All piping is
of galvanized carbon steel construction.
Inlet Cvzuiectiun:
3"Fes' 3" FI, T 3" IT'T 3" l I'1' 4" FPT
Valves-.'
eall and check valves on pump suctiun, gate valve vxt FvULP discharge, gate
valve on recirculation line.
Intesconnecting Hose:
Suction hose with quick disconnects to MPX skid.
Options:
- Motor starter, supplied and wired to energize pump on high water level and
de -energize pump on low water level. Weatherproot or explosion proof
available. Can also be supplied loose for client to mount & wire.
Approximate
Dimensions: L X W:
V-0" XT-0" 4'-0" X4,-0" 4,-0" X4,-0" 4'-0" X4'-0" 4'-0" X4'-0"
7-91,
Height:
6'-51/2" 6'-51/2" 6'-51/2„ 7-9"
Shipping Weight (lbs):
530 540 560 525 595
Availability:
4-6 Weeks
Drawing Number:
S-2650 S-2650 S-2650
7/30/98
*SP-850/0
- 1'.nITVY1)17'1) 1(%71STY v`) P1jQi;i. Rh,qI 'yj *�,?5

Ac . 2•;. 1998 3;2)8FM UkK: TYM (.uxrvs.kI iwi ,,, - -.

� LI
J
DRAIN
POL'
SEAL WATER T
PIPE OUT
AIR DISCHAF
OUTLE
WATER DISCHA
M 18'
ELIMIN/
LEVEL SWITCH
VACUUM Hurt
MOTOR STARTER
LpPTIONAL)
LY SKID
JUM
,CTOR
G
aE
INLET
LVYE SEAL WATER
r`
BALL VALVE STRAINER FLO-RESTRICTOR
Cn
N
Qz
4
a
W 8
W
MIST
COS
m
OWG
PIPE ELIMINATOR a N
AIR
DISCHARGE
SEAL WATER W
MAKE UP
/VACOSELU
WATER VAC GAGE V
f N
DISCHARGE x �
LU
W a
0
� W
60 GAL POLY ~ Z
SEAL WATER TANK
oLEVE;4!WYE
L SWITCHJ
9SEALWATER
•TYPE
INERVACUUM HOu U WBASE wPLATE cn❑
POLY SKID SAI. L VAI.VE STRAINER FLO•RESTRICTOR
,, , . U A 7 TIfxTn; N nI 'iflil.i.A?i'71 866I i i, '2pl.

IEFOFI�ATIIo N CARBYROL
C O R P O R A T I O N
MPXE MULTIPHASE EXTRACTOR
Model:
MPXE-75 MPXE-100 MPXE-130 MPXE-200 MPX&300 WXE-400
Air Plow 10 25" Xg (ACFM);
70 100 115 225 260 450
Water Capacity (gpm):
7.5 15 20 30 40 60
(direct feed)
Design Features:
Exhauster:
Liquid ring vacuum pump, of sparkproof construction, with cast iron housing and
hardened aluminum bronze rotor, direct drive, and'I2.ale explosinnprnnf mntnr.
Electrical:
Motor HP:
5 7.5 10 15 20 30*
Motor Speed (RPM):
1750 1750 1750 1150 1150 1150
Voltage: 230V/10 or 230/460V/30 230/460V/30 230/460V/30 230/460V/30 230/460V/30
2M/460V/30 '`(2) Q 15 HP
Seal Water Tank:
Construction:
Polyethylene construction with low level switche and seal water makeup
float valve.
Size:
60 gal. 60 gal. 60 gal. 80 gal. 80 gal. 80 gal.
Valves;
Manual seal water adjustment valve. .
Instrumentation:
One (1) inlet vacuum gauge (0-30" Hg)
Connections:
Inlet:
2" M 2" FPT 2" l-PT 3" FPS' 3" FPT 4" FPT
Water Discharge:
2" FPT 2" FPT 2" I'T'T 3" FPT 3" M 3" FPT
Air Di sch -
4" FIT 4" FPT 4" 1 W 6" M 6" 1W 6„ FF-1
Skid Mounting;
All the above equipment is factory piped and skid mounted. Piping is
of galvanized carbon steel and PVC eonstructiort.
Options:
- Motor starter in a weatherproof or explosinnprnnf Pnrin.qTire, wired to the exhauster
motor.
- Seal water tank disrhargP pimp with level switches, to automatically pump
accumulated water to the next treatment step.
- SPaI water heat exchanger.
- Free Product Skid to remove free product upstream of the liquid ring pump.
- Flow indication, extra vacuum, temperature or prcoaurc gauges, sample ports.
Dimensions: L X W:
4'-0" x 3'-6" 4'-0" x 3'-6" 4'-0" x 3'-6" 4%61' x 4'-0" 4'-6"x 4'-0" 6'-6" x
Height:
3'-6" 31-6•, 3'-5" XX„ XX" XX"
Shipping Weight (lbs.):
400 425 475 900 1100 1500
);
4-6 4-6 4-6 b-8 6-8 6-8
Dra•A ng Number..
S-3617' S-3617 S-3617 - - -
6/26/9$
*SP-8501#11
f-:AT -T jr. r,.rr *ntr
G�

OIL WATER SEPARATOR - OWS
FEATURES
• Easy to dean -
AII piping is on the sides including the vent line.
This allows the cover to be easily removed.
Two coalescing Hydropaks are provided.
Each fHfydropak can be separately removed and
cleaned.
- Entrained air release -
Inlet header is designed fur release of entrained air.
- Spedrfically designed for groundwater applicatinns
• Removal of free product down to 10 ppm of
druplets greater than 20 microns.
COMPONENTS
(2r REMOVABLE An]USTARLE
• Polyethylene construction, tIN resistant.
• Polypropylene Hydropaks.
• Fiberglass sealing cover.
• Adjustable oil skimmer,
S PECIFICATIQNS
2-91 INLET COVER 1 114-0 VMUL,%;I
pI9,HA.AGE
4 W
or90HAR0e
Approximate Dimensions
LenC Ith
Vdicth_-
Hei
YVP-iah
IL
I1I
r
Ali
---• 15 GPM 48"
22°
30"
175 #
i rl
I I
r
30 GPM 46"
42"
30"
350 #
1 ' I
' I • I
I 11
t r
r
50 GPM 48"
42"
48"
650 #
o�.RAN i
I
MOUNTING POQT
+..
t00 GPM 90"
42"
48"
140q #
QWS-15
Typical Arrangement
.• �. � �
..,
:...::i-�...,.
,
,,.-'.`�:��"'.. ,•. °�''a;; ,`';'fir.";'•:,, ;';..�:`:.`:, ... ,..... , .:.�,..
•.... :.. , .
..`'"' .'
-
51 Riverside Avenue, Westport, CT 06860-1-8oa242-1160 - [phone]
C"V� ��
n
T 1 0
0
N
0 Copyright 1002 Carbirol Corporation - 7/30/9B
AT- 1010/41
r, p a v o R

CARBTROL
CORPORATION
SPECIFICATION
------------------------------
Or. WATER SEPARATOR
Model
-----------------------
O'ws -15
OWS-30
OWS-50
---
OWS-100
Design Flow - maximum (GM:
15
30
50
100
Design Features:
Construction:
Tank:
polyethylene
Lid:
FRP
Hydropalc Frames:.
Aluminum
Hydropak Media:
Polypropylene
Piping Assemblies:.
PVC
Approximate
'
Tanis Dimensions:
Length:
41_0n
4'.0"
4' 0"
7'-6"
Width:
1'-10"
3'-6"
3'-6"
3'-611
Height:
2'-6"
2'-6"
4'-01'
4'.0"
Connections:
Inlet:
2" pipe Stub
2" pipe stub
2" piYn Stub
3" pipe stub
Outlet:
4" pipe stub
4" pipe stub
4" pipe stub
6" pipe stub
Free Product Drawoff.
1 1 /4" FPT
1.1 /4" nT
1-1 /4" FPT
1-1/4" FYI'
Drains:
(2) 2" FPT
(2) 2" FPT
(2) 2" FPT
(2) 2" FPT
Vent:
2" r'I'T
2" FPT
2" FPT
2" FPT
Removal Capacity:
Options:
Shipping Weight (Ibs.):
A�. ftif*iiity.
Drawing Number:
7/30/98
Free product removed down to 1U ppm of
oil droplets > 20 microns.
- OWS tank level switch, available in
weatherproof or explosionproof enclosure.
--. p— - OWS stand, pressure -treated lumber
construction.
---�• - Free Product tank, steel construction, 3bW 55 gallon
capacity.
----11- - Level switch for free product tank in an
explosionproof enclosure.
- Steel construction.
----� - Pump Sump System with integral sump and level
switches. Transfer Pump supplied lnnse.
175 350 650 1400
3-weeks
S-1664 5-1904 S-2855 5-3580
rI ,. . 'r r,rrr r 'A1r
901 T.VXO�Ml 8661 'Lc '�'''

COUNTERFLOW PLATE STRIPPER
COMPONENTS
• Multiple stacked aeration plates.
• Centrifugal fan for low noise.
• Pre -piped and wired for ease of installation.
• Full motor and control options available!
- Skid mounted for ease of installation,
CAReTROL's low profile Counterflow Plate
Strippers are designed to provide the highest
efficiency stripping in a low profile package. The
units are skid mounted, pre -piped and arrive at
your site ready to operate.
APPLICATIONS
• Groundwater Remediation
• Storm Water Runoff
• Wastewater Treatment
FEATURES
High Removal Rates - To 99.99 % V00 removal
Efficient
- Counter current stripping
for highest efficiency.
Low Profile
- et stage unit less than
8 feet height.
Corrosion Resistant
- High density polyethylene
construction.
Multiple Stages
- o stages and air
wafter rumber aft o varied to meet
treatment requirements.
Easy to Clean
Easy ess to aeration
plates without disassembly.
14Y,T1;_._.-_--
0 51 Riverside Avenue, Westport, CT M80.1-80.0.242-1150 • (2o3) 226-5642
CARBTROAT-900/41
c o R P o R A T o N (b Copyright 1995 Carbtrol Corporation - 1/30/95
Penn i
➢.id' C ; C.

GQU NTERFLOW PLATE STRIPPER
4'-0'
2' WATER IN
OPTIONAL
LEVEL
r1 41 O"
CPS-50-309
60
3w
CPS-50-60Q
50
600
CPS-100-400
100
ex
CPS 100 1100
100
1200
CARW ROIL
C. a R P 0 R A 7 t 0 N
r M/M Ct'DA L-^
r
I.
4'-0"
I
i
OPTIONAL
OUT
tI- PUMP
e0
1100lbs.
51 Riverside Avenue, Westport CT 06880.1-800-242-1150 • [phone]
^, r.r 1, r,erT '^lT
Page 2
KTiirTK�Tr'..;i(11 I()I AV , p:f: RfifiI ',, J •"lly

CARBTROL"
SPECIFICATION C 0 R P 0 R A T 1 0 N
COUNTERFLOW PLATE STRIPPER
Model: CPS-300 CPS -boo CPS-1200
Design Flow (GPM): 50 100 100
Number of stripping plates: 2 to 4
Tank & plate construction: Polyethylene, with four (4) clean out ports per plate, sump level
sight tube, aria gravity discharge vacuum breaker.
Blower: Cantrifugal far,, direct drive, ..-itli TEFC motor, inlet s1idu bate
valve and discharge pressure gauge.
Electrical:
Motor Horsepower: 2 plates: 2. 3 5
3 plates: 2 3 7.5
— &r a plates: 3 5 7.5
Available Voltages (TEFC): 230/460 V/30 for all motors.
115/230V/10 for motors:Q HP.
230V/10 for & 7.5 HP mntnrg.
Sldd Mounting: Counterflo w Plate Stripper tanks, plates, and blower are factory
mounted, piped and wired on two skids.
Ovetall DIULemsions:
Length:
Width:
Height: 2 plates:
3 plates:
—o.— 4 plates:
Piping Connections:
ktlet:
Outlet:
Drain:
Vent (flexible coupling):
7'-0"
4'-0"
6'-2"
7'-0"
7'-10"
2" FYI*
6" pipe stub (for gravity discharge).
2" FPT
10"
10"
Options: - Motor Starter.
--->~ - Explosi+ one per-oopj electrical system.
—� - Pump Sump System. O-PS P SS - L'P - ZO.
�.—p.- - High and Low Pressure Switches.
- High/High Water Level Switch.
Shipping Weight (lbs.): 2 plates: 900
3 plate%: 1000
4 plates: 1100
A-V ltila:bility: 4-6 Wee
Drawing Number: S-2305
7/9/96
"SP-900/#1
18"
.n
rnrr -A I} VOITYA 4',401 'iflN.UX`i'1 li�yE 866r '�� oT:-

CARBTROL
Co R P 0 RAT I O N
SPECIFICATION
PUMP SUMP SYSTEM - CPS
CPSPSS Model:
LP-20
LP-50 LP-100 HP-10 HP-30
HP-50
HP-100
Design Flow (GPM'/;
20
50 100 10 30
50
100
Discharge Pressure (psi):
18
18 26 50 50
50
50
Design Features:
Pump Tarok:
Polyethylene sump, 4'-T 0, integral to CPS unit.
Pump.
Centrifugal pump, direct drive, Kith a lO or 3O, 60 Hz. , ' XPmotor.
HP units have staged centrifugal puutps.
Electrical:
Horsepower (TEFL): 1/2
1 2 3/4 1-1/2
3
7.5
-- Horsepower (XP):
voltage (10):
3/4 1.1/2 3 3/4 2
115/230 115/230 115/230 115/230 115/230
3
115/230
7.5
230* ,
___-j..Voltage (30):
230/460 230/460 730/460 230/4w 230/46U
1d0/460
230/460
"TEFC only
Column Switch: Hi/Lo level switch.
Hi/Hi level switch to shut down client-s pump on high sump tank water level -
Valves & Hose: Ball valve on pump suction, gate and check valves on pump discharge. 8 feet of
discharge hose. -
Motmtingr Pump is factory mounted and piped on the CPS blower skid. Level switches are
mounted in the CPS sump tank.
Option: Motor starter, supplied and wired to energize pump on high water roof
level and de -energize pump on low water 1PVP1. Weatherproof or explosionp
available. Can also be supplied loose for client to mount & wire.
51lippirtg Weight** (lbs.): 70 75 90 95 115 165 105
t t } t t t t
TEFC:
Expjosionproof: t I t 10-12 Wks. 10.12 Wks. 10-12 Wks. 10.12 Wks
* * Additional to CPS weight.
t Within CPS lead time.
8/7/98
`SP-604/45
., 1.elrT k, ?nriIfXTA�7ij'1 It) Ui X`l 'K. 661, 'uG

CA,RBTROL
coRroa�r�or+
SPECIFICATTON
PREFILTER - BAG TYPE
Muaml: YFB-10 PFB-50
Design Flow (GPM):
Pressure Drop O'Design Flow
- Clean (psi). -
Design Features:
Housing:
Filter Media:
Connections:
Size -Inlet & Outlet.
- Drain:
Location - Inlet & Outlet:
- Drain:
10 50
0.2 0.4
Bag type filter, carbon steel construction, with clamp -on lid.
Three (3) polyester felt filter bags,100 mirmn capacity.
1-1/4"Fn
7' FPT
1 /2" FPT
1/2" FPT
Side
Side
Bottom
Boft=
Pressure Gauge: One (1) 0-15 psi pressure gaugo located car► the housing lid.
Drain Valve: One (1)1/4" drain valve to prevent spillage during Lag
changeout.
Support; Carbon steel support stand.
Options: - Interconnecting piping to connect two units in parallel, so that
ucre urui be run while the other is being changed out.
- Pressure control valve to limit pressure downstream of the filter(s).
Slipping Weight (lbs.): 25 40
Drawing Number: 5-1297
4/29/94
*SP-1300/#1
r�..r •, r.rr* •r.�r �rnr_t.��n,��n� 1(lii.i.F?iY'1 �id9f.•£ °BBI •u.;'Ci.',

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CARBTROL
C 0 R P 0 F A 7 1 O N
SPECIFICATION
PIPING KYr1'
TWO CANISTERS IN SERIES
Model:
Design Flow (GPK:
Number of Canisters per Train:
Number of Trains in Parallel:
Total Number of Canisters Piped:
Design Features:
Interconnecting Piping:
Fittings:
Pressure Gauge:
Sample Port -
Shipping Weight (lbs.):
4/29/94
'SP 1100,1102,1103,1104,1105,1106
PK-10
PK-20
PK-30
PK-40
PK-50
PK-60
10
20
30
40
50
60
2
2
2
2
2
2
1
2
3
4
5
6
2
4
6
8
10
12
1-1/4" flexible PVC tubing.
1.1/4" PVC inlet and outlet fittings for each canister.
One (1) 0-15 psi pressure gauge per train located on the inlets)
of first canister(s).
One (1) 1/4" sample port per train located between the primary
and secondary eanister(s).
15 30
-F3eAraMek.
45 60 75 90
a9E. 66 I -1,-'

WATER PURIFICATION CANISTER L _ 1
200 POUND ACTIVATED CARBON
SPECIFICATIONS
DRUM:
CARBON:
SHIPPING WEIGHT:
INLET:
OUTLET:
INTERNAL PIPING:
DRAIN:
PRESSURE DROP:
MAX. OPERATING
PRESSURE:
The CARBTROL L-1 (liquid) Canister
handles up to 10 gP m.
FEATURES
• 200 pounds of high activity carbon.
• Large 1 1/4" internal piping. Low
pressure drop allows operation of
three canisters in series.
i • Standard FPT couplings for easy
installation - saves time and money.
• Special "no leak" lid gasket.
24" 0 x 34" high,
mild steel, epoxy
phenolic internal
coating with
polyethylene liner.
200 lbs.
250 lbs.
1 1/4" FPT, steel
1 1/4" FPT, steel
1 1/4" PVC
3/4" bung
1.25 psi @ 10 gpm
10 psi
• Heavy duty steel drums. Acceptable
for transport of hazardous spent carbon.
• Piping design eliminates channeling.
P
R 4
E
s
5
D
R
0 2
P
F
T
H 0
2 0 0 5 10
FLOW --GPM
P
R
1.5 E
s
s
1.0 D
R
0
0.5 P
_ ._. ... . r.., :ii"mi,, - -t pr . f,.. r�..'�r�-T••- i f'. •:T.T"'I, :•..C. -.�,. �-.''�....f ....... i,�.,I;.'�$7d a:r.f �'i,. �•�,:r.;r r r.
'�-�",.�"-r'��-�t'�i'; _a .�� •P..:... '.:... .., ... ., a :�r�..._�� i"''^l �� 'n •s:m.. 'S :- .............. _. ,.. :'d :�.k�.. .-,. ::U.;. �:•ta�-.i �w
„�,,j„�.:.;L.-..'!;5,. a.... :\aru•�:lvu���ai'n..'i:1n.::..:..:Ji-! . � .....'.`1 !" ;.. '"�'�n
41%
�� ROU 51 Riverside Avenue, Westport, CT 06880.1-800-2424150 ■ [phone]
vST
C o R P O R A S 1 o N m Copyright 1991 Carbtrol Corporation - 11/15/96 AT-10042
li ION
ru r, I. I. H�T04 A f �) ION !. il.��rl

WATER PURIFICATION CANISTER
200 POUND ACTIVATED CARBON
COU -Lwo d
v.• out
,
SS MUM XT 17C
4,•VA. ■34'DR .
WITH POMMMENE
r WQR
OMLV CONNEC7171
FLLKI IIC WRH `
L=1
OPTIONS
Interconnecting Piping Kit
Flexible 1 1/4" diameter PVC tubing
with hose damps. Includes inlet
pressure gauge and intermediate
sample valve.
Pre -filter for
Suspended Solids Removal
Pre -fitter consisting of a basket filter
piped and mounted on support frame.
Filter is of carbon steel construction.
ARRANC,EMENT (3) L-1 Canisters in series for 10 gpm flow (Contact time @ 10 wt-n-15 minutes)
PREFILTER / L-1
PRESSURE
GAUGiES
TYPICAL INSTALLATION
CARBON CANISTERS
L 1 L-1 EMFLUIENT
SAMPLE INFERCCNIdECTING
VALVE TUBING
,d," ;Ca�y�e.j..�e ... ,. .,� .t,- •... n ...n, t ^rtR.-Y•. a .�...�i..Yp. ♦-'r7• � .-
. •,,......-..... �.. .n ....., .,:,t„,a1.:-4"w..:f,�i;n.at.,.iiL.i�c���.1a,L��.:.�.,.:i.'vi�..a.:u:cn...nF.:ati.:.�.: �:.t.r.::'.. t, eSv:`L ..:. ,.,, : '6............i.,. .�.. , r, 't:� . .. a ...
�� ������ 51 Riverside Avenue, Westport, CT 0�6880 ■ 1-800-242-1150 ■ [phone]
C 0 R P O R A T 1 0 N Page 2
;�,.,, 1 r.rrr `nl7 �rnrTWV"tJ•.r�� JrIVW n1 r C C::Rf 'I '^ri.

a= •
SYSTEMS CONTROL PANELS
STANDARD FEATURES
GARBTROL's basic control panels are of
NEMA 4 mnstruction and are built to the
highest quality standards. Each panel is
supplied with an electrical wiring and logic
diagram to aid in field installation. A11 panels
are shop tested prior to shipping to .insure a
minimum of start-up problems. For simpler
systems local mount motor control boxes can
be provided.
CARBTROL manufactures a complete line of
systems control panels to support our remedial
treatment equipment packages. CARBTROL
control panels are designed to minimize electrical
control complexity and to provide for ease of
fault diagnosis. CARBTROL control panels are
designed and manufactured under ft
supervision of our staff of electrical engineers.
In-house capability allows us to assume
complete system responsibility and provide
technical support services for installation and
problem diagnosis.
PANEL OPTIONS
• Basic and computerized telemetry options
• lightning surge protection
■ Elapsed time meters
• Local and remote alarms
• Multi -pump and delayed restart features
• Custom electrical configurations
• Electrical/Pneumatic interfacing
LAR13TROIL
c o R P Q R A T I 0 N
s1 Riverside Avenue, VVestport, CT 06880.1-800-242.1150 • [phone]
0 Copyright 1994 Carbirol Corporation - 6S94 AT-UU/#5
i 111w.ff I'd!, In.mT';7', . N'4'Q.0,. AF. 7 7, '.L

HIGH EFFICIENCY
MULTI PHASE EXTRACTION SEPARATOR
P178SURE RATED TANK
is PSI PRESSURE
EPDXY COAT'110STIMLTANKFOR "EMOA
FULL VFX=M
COAT WONRESIST]MJ
JLTR O16CiLAliGE
AJFVWA7ER mer PRDYims WIXIKAN LKMD
l7EMOfAL DUE 70 TANGENTIAL INLET AND
HI7H EFFI" IENCT M95T EUWHAYOR
CENTAIFUGALMVfl fDEMENT DESIGN
LCi( J1TEA It191D6 SEPARATOR TANK
PRDVIDINQ 7AN13NUM SUAFACElLAEA
WAMR SEALED LIQUID AING VACUIDA PUMP
US=SMECHA*nCAL SEALS AND CRYDE
SERYICEDINTHEREto - - �—
VACULIM BLEED ASSEUBLY
FREVEYTS MOTCH O4" LOAD
VACUUM`6AOE
VACUUM
7NROrXJNG V&VE
JI
OILCOX SCINa MEDIA/LLLOMY! FOR
AGGLOMERATION OF SMALL OIL DPIOPtETS
FREE PR000a OR&% OFF
I
NTERFACESERSORALLOWS ITOR J
ACCUMUURKNN AND DRAW OFF OF
FREE lROma(
�4
TEUPf7TATL10l£ _
GAGE
CLM OUT PORT TO PRC/V WE ACCESS
TO fW EMAL LOST ELD&HATC"
him
— M
SIGI TT IUCEILEWL SYWCH ASSEUDLY LOCATED
OUTSIDE TANK TO ! F&I ENT MAIFUMCLION DLE TD
_ a sauosroK.RULDUP
SEAL WATER MAKE UP VALV u -
\\ tl AUTONATICAL11' ADDB WA b b
ON LOW LEVEL CONOt"
F NOW
' / rISiIOIJTfORTIFlO'Y1DiS
ORU POR RD 0VING AW
/ OOLM! NULDUP MTANK
STFUINER CHECK AL E CO �D� iVATEII
1141N DR CYTONKDITJS I�TEiI'�j� w i��1,6,�NpTpC�OIL[CSiON CrwreEA PnEVEM'3
stitAlNEA 11�}+1 fROM GLO[IUIN(3 SELL. WATER
LItWID'AING VACFr
VACUUM PUMP `�
• : Nakao �9 T E
TRANSFER PUMP
CARBTRCL EXTRACTION SYSTEM

VACUUM BL=ED ASSEMBLY
PREVENTS MOTOR oven LDAD
tACInIMt2A(1F ,
GAIT STRANER PREVENTS
\
PLMPERCSION \
'I-,' I--, 4 _
WHY CARBTROL MPX SYSTEMS ARE THE BEST
AVAILABLE OIL OR WATER SEALED
NIGH EFFICIENCY PRE -SEPARATOR
ANWATER INLETPROVIDES MAXMUM LIQUID
ScMOVALDUETOTAHOENTIALII STAND
CE14TRIFU3AL "INGEMENT DESCIN (TYPICAL)
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