WI0100230_DEEMED FILES_20160916

Ro gers, Michael
From: Rogers, Michael
Sent: Friday , September 16, 2016 1:13 PM
To: 'Altamont Environmental (Chemtronics Project)'
Subject: WI0100230 RE: Chemtronics -Upcoming Pilot Test Injections
OK, thanks. Please put this number in the subject line on all emails (so they can be searched) and
correspondence. Thanks.
From: Altamont Environmental (Chemtronics Project) [mailto :[e-mail]]
Sent: Friday, September 16, 2016 12:30 PM
To: Rogers, Michael <[e-mail]>
Subject: RE: Chemtronics -Upcoming Pilot Test Injections
Hi Michael,
It's North Carolina DEQ (formallyDENR) -Division of Water Resources Permit Number WI0100230.
Rob
Robert Cork,. PE, PMP
Altamont Environmental, Inc I 231 Haywood Street Asheville NC, 28801
P: 828.281.3350 I C: 828.450.6435 I E: [e-mail] I W: www.altamontenvironmentaLcom
From: Rogers, Michael [mailto:michael.rogers @ncdenr.gov]
Sent: Friday, September 16, 2016 9 :28 AM
To: Altamont Environmental (Chemtronics Project) <Chemtronics @altamontenvironmental.com>
Subject: RE : Chemtronics -Upcoming Pilot Test Injections
Would you please provide the permit number. Thanks.
From: Altamont Environmental (Chemtronics Project) (mailto:Chemtronics @altamontenvironmental.com]
Sent: Wednesday, September 14, 2016 2:44 PM
To: Jon Bornholm -U.S. E.P.A .(bornholm [e-mail]) <[e-mail]>
Cc: Robert Cork <[e-mail]>; Stu Ryman <s ry man @altamontenvironmental.com>; Hartzell,
Beth <beth.hartzell @ncdenr.gov>; Rogers, Michael <michael.rogers @ncdenr.g ov>; Watts, Debra
<debra.watts @ncdenr.gov>
Subject: Chemtronics -Upcoming Pilot Test Injections
Jon,
As we discussed recently on an August 9 call, and as described in the Final Feasibilit Stud Re ort (Geosyntec, July,
2016}, the Companies are planning additional injections at the Chemtronics Site to continue pilot tests in the B105, 8147
and DA 23/8116 pilot test areas in the Front Valley. The injections in the 8105 and 8147 pilot test area will be consistent
with the letter "Front Valle y Phase I Pilot Test Status and Pro posed Next Steps f or the 8105-139, 8147, and 8149 EISB
Pilot Test Areas" {Geosyntec, February, 2015). The injections in the DA 23/B116 pilot test area will be consistent with
the letter "Summary of Purge Test Results and Pro posed Aerobic Bioremediation Pilot Test in the DA 23/8116 Area"
(Geosyntec, June, 2015). The amendment types, locations and volumes planned for the upcoming field activities will be
consistent with those outlined in the above refer.enced letters. We expect the field activities to begin in late
September.
1
..
Please let us know if you have any questions.
Stu
2
Geosyntec f>
consultants
TO: UIC Program
vv J:-0 16 CJ 2. 3 0
RECEIVED!DENR!DWr:J
SEP 1 5 2015
Water Q~ality Regional
Operatmns Secticri
DATE: September 11, 2015
COMPANY Division of Water Resources
1636 Mail Service Center
PROJECT NAME: Chemtronics
PROJECT NO.: GR4943.07.7.l 1
Raleigh, NC
27699-1636
TRANSMITTAL
VIA: ACTION:
□ MESSENGER □ FOR APPROVAL 0 RESUBMIT
~ ENCLOSED □ FIRST CLASS MAIL ~ FOR YOUR USE □ RETURN CORRECTED
PRINTS
□ UNDER SEPARATE COVER □ SPECIAL DELIVERY □ AS REQUESTED 0 FOR COMMENT
□ AIRMAIL □ APPROVED
~ FEDEX □ APPROVED AS
NOTED
NO.OF DWG DESCRIPTION DATE COPIES NO.
1 Injection Summary Forms for Permit# WI0100230 Sept 11,
REMARKS:
COPY TO:
1255 Roberts Boulevard, Suite 200
Kennesaw, Georgia 30144
2015
FROM: Benjamin Amos (678.202.9597)
INJECTION EVENT RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Resources
Permit Number WI0100230
I. Permit Information
Chemtronics Inc.
Permittee
Chemtronics Su p erfund Site, DA 23/B116 Area
Facility Name
180 Old Bee Tree Road, Swannanoa, NC 28778
Facility Address
2. Injection Contractor Information
Geosy ntec Consultants of NC, P.C.
Injection Contractor/ Company Name
Street Address 1255 Roberts Boulevard . Suite 200
Kennesaw GA 30144
City State Zip Code
Were any wells abandoned during this injection
event?
D Yes [Kl No
If yes, please provide the following information:
Number of Monitoring Wells ______ _
Number oflnjection Wells. _______ _
Please include a copy of the GW-30for each well
abandoned.
4. Injectant Information
Hydrogen Peroxide
Injectant Type
Concentration 256 mg/L ------------
If the injectant is diluted please indicate the source
dilution fluid. Fire Hy drant
( 678 ) 202-9507
Area code -Phone number
3. Well Information
REce1veo10EN RJ D 1, n
SEP 1 5 2015
Total Volume Injected_---'2=4..;._4-'-'--"9=--=8=--4'---L=------
42,264 L (MW246-J36CD),
Volume Injected per well 74 338 L (MW248-136CD)
56,565 L (MW249-J36CD) Water Quality Regi, .n
Number of wells used for injection 4 Ooerat!o~s Sect/( 5. Injection History 71,817 L {MW277-136CD)
Injection date(s~uly 28-31, 2015, August 3-7, 2015, Well names MW246-J36CD, MW248-J36CD
MW249-J36CD, MW277-136CD
Were any new wells installed during this injection
.event?
D Yes [Kl No
If yes, please provide the following information:
Number of Monitoring Wells __ no_ne ___ _
Number oflnjection Wells __ n_o_n_e ___ _
Type of Well Installed (Check applicable type):
D Bored D Drilled D Direct-Push
D Hand-Augured D Other (specify) __ _
Please include a copy of the GW-1 form for each
well installed.
August 10-11, 2015
Injection number (e.g. 3 of 5)._=1 __,,oc,_f -=1~---
Is this the last injection at this site?
D Yes [R] No
I DO HEREBY CERTIFY THAT ALL THE
INFORMATION ON THIS FORM IS CORRECT TO
THE BEST OF MY KNOWLEDGE AND THAT THE
INJECTION WAS PERFORMED WITHIN THE
ST AND ARDS LAID OUT IN THE PERMIT.
~ ...... , X Av,,.; 'l/1v1,r
SJGNAT RE OF INJECTION CONTRACTOR DATE
ls-e"'-,et111,-;.,. K-A-v,,w.s l(C ff :d-O'll~l j
PRINT NAME OF PERSON PERFORMING THE INJECTION ,7r-20-z-,s-,1
Submit the original of this form to the Division of Water Resources within 30 days of injection.
Attn: UIC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-807-6464
Form UIC-IER
Rev. 8/5/2013
WELL CONSTRUCTION RECORD
Far EraeEmil Use Otr'LI.-
This norm can be: ewnd for single or multiple wells
1. Well Contractor Information:
Randy Phillips
Well Contractor Name
1 096-A
NC Well Contractor Certification Number
A.E.Drilling Services
Company Name
2. 'Well Construction Permit 4:
Lssr nil eppliraale ue'1lpernrtts (t.a. County, Stag
3. Well Use (check wen use):
Variance, ltslectrort, isle/
FROM
0
1, 14. WATER ZONES
FROM TO
lt.
1113CRWITON
l5. OUTER CASING for mulli-eased tvellsr OR LINER (if applicable)
DIAMETER THICKNESS i M erErn I.
TO
81.5 Ir.
PVC
1G INNER CASING OR TUBING tgeatlrrrwsl dose+Florrstl
FROM I ru
fr.
tF.
DLAAMif$
la.
THICKNESS
MATERIAL
I1. rt.
is
' I7. SCREEN
Wrier Supply Well:
❑Agricultural
❑Geothern al aleating/Cooling Supply)
❑ IndustrialJCemtmercial
°Irrigation
Non -Water Supply Well:
C Monitoring
❑ Mutticipal/Public
❑ Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Recovery
Injection Well:
°Aquifer Recharge
❑ Aquifer Storage and Recovery
°Aquifer Test
❑ Experimental Technology
°Geothermal (Closed hoop)
°Geothermal (Heatiog/Coolin Return)
4. Date We1;ts) Completed: 8123/1 3
Se. Well Location:
Chemtronics
Facility/Owner Name
f(ifoundwates Remediation
❑Salinity Barrier
❑S1onnwater Drainage
°Subsidence Control
°Tracer
°Other (explain under #21 Remarks)
WeBlly#i MW246-J36C❑
Facility 1119 (if epplicnblc)
180 Old Bee Tree Rd. Swannanoah
Physical Addis ;a, City, and Zip
Buncombe
PROM
TO
DIAMETER. s1.m slz E Tex -Kress
MATERIAL
81.5 it•
96.5 ft.
2 IL .010 sch 40
PVC
1& GROUT
FROM TO
MATERIAL
EMPLACEMENT METHOD & AMOIAIr
75,5 rt.
78.3 e'
chips
tremmie
0
ft.
75.5 ft
neat cement
tremmie
n. R.
19. SAND/GRAVEL?AOI lif applicable)
PROM TU ? a1ATEAIAL
78.3 n 199.8 R'
#1 sand
EMPLACEMENT METHOD
tremmie
ft.
rt.
20. DRILLING LOG tatterlr edditlet e1 sheets If accessary)
ra TU vF SCROTUM ienlar. bardaeu, winch. rvjlr,Lrda the, Mc.r
[t. ft.
R
ft.
ft.
f<.
21. REMARKS
ft.
rt.
ft
n.
it.
ft.
County Parcel irlemtfcanon No. it'IN)
Sb. Latitude and Longitude in degr'eeslmianteslsec.oadt or decimal degrees:
[Five! field, tine !Wong is sufficient)
N W
6. na (are) the well(s): Perm it:mat ur ❑Te mporan•
7. Is this a repair to an existing well: DYes or Ei No
!Reis is a repair. fill art l+rmea well consrmatiwr inforaratlarr and eolith, the nature of dhr
repair under k21 remarks section or on the hook of this/bens,
H. Number of wells constructed: 1
For smeih'pie injection or iron -water serpply wet& ONLY with the sante ran o-swi s, you can
ru.niil one form
9. Total well depth below land surface: 96.5 (ft,)
Fm' multiple wells Ha all drprhs i(diffenvn' (tann.ple- 3@ ell' and 2@lalr)
10. Static water level below top of rasing:
�Twater level iz above raeiog, use ''+.,
11- Borehole diameter: 8 fin.)
12. Well construction method: Auger / Core
(i,e. auger, rotary. Cable. direco push. ate.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
I3b. Disinfection type: Amount:
22. Certification:
j -€�' G - 12/18/14
Signature ofCt4 bed WeN Conrrecior Date
By signing thin Joan, I hereby art* that the K'ell{ai nos (there} con rurte:I in accordance
with 15.4 NCAC 02C.WlOO or 15A NCAC 02C.0200 3F'e!I Camp -notion Soanndanir wid that e
ropy oflhis record has been provided w thr upl aswi&
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site deceits or wall
constrnetiov details. You rosy also attach additional pages if necessary.
SUBMITTAL 1NST1JCTDONS
24a. For All Wag: Submit this form within 30 days of completion of well
construction to She following:
Division of Water Resources, Information Processing Unit,
1617 Mali Service Center, Rater„ NC 17699-I617
24b. For Iniection Welts ONLY: In addition to sending the form to the address in
24a above. also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Undergrunod injection Control Program,
1636 Mall Service Center, Raleigh. NC 27699-1636
24c. For Water Suprpi & Injection Wells:
Also submit one copy of this form within 30 days of completion of
well ecnstruction to the county health department of the county where
constructed.
Form GW-1
North C'aro1ina Department of Environment and Natural Resources - DIV13lon of Water Rescnarrs Revised August 2{:) 3

WELL CONSTRUCTION RECORD
Ibis Fenn aid brused far single errnwhinkwells
For internal Use ONLY:
I. Well Contractor Information:
Randy Phillips
Wel! Contractor Name
1096-A
NC Wea Contractor Certification Number
A.E.Drillin► Services
Company Mama
2. Well Coostruction Permit #:
Ual all uppliarrlrk nett permits (i.e. Cuanry, Slate, Vuiluir e, lnfecnoa. etc)
3. WeI Use (cheek well use):
Water Supply Well:
❑Agricultural
❑Geothemmi (Heating/Cooling Supply}
❑ Lndusitial/Commere ial
❑Irrigation
OMunicipal'Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
Monitoring
°Recovery
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑ Aquifer Test
°Experimental Tcchnoiogy
°Geothermal (Closed Loop)
❑ Geothermal (I-le~atimpCoolin Return!
4. Lute Well(s) Completed: 8i20-13
5a. Well Location:
Chemtronics
FacilityfOwner Name
180 Old Bee Tree Rd.
Physical Addrxsa. City. and Zip
Buncombe
❑Groundwater Remedistion
❑Salinity Barrier
OStormwater Drainage
❑Subsidence Conlin!
L Tracer
❑Other (explain under #21 Remarks)
Well mo MW249-J36CD
Facility IDIt (ifepplicablel
County
Parcel tdeatifcation No. (KW}
Sta. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
ghfweli Reid. one IaVlone is seificicm}
N W
6. is (are) tit wefl(s): @Perrtranent or ❑T mporary
7.1s this a repair to an eluting well: DYes or ENo
Jolts is n repair, fill out know; err.!/ rwtrrroction information mid explain the nature of the
repair fonder t1.1 remark ream or rot eke bark of Ibis form.
S. Nntttberof wells constructed:
For multiple injection a0 non-water.swrpply wells war with the sane emlatrrrction, you eat
sarinni( aria foyer.
9. Total well depth below land surface: 84.3 (ft.)
FOP uutlfiple Luella list oil depths if dffrrum msompl - 30)200' and 1LZt I00'1
10_ Static water level below top of caning: (ft.)
limiter level is draw curing, are "+
11. Borehole diameter. 8 {in-)
12. Well construction method: Auger / core
(i.e. auger, rotary, rabk, direct pray, etc.)
FOR WATER SUPPLY WELLS ONLY:
I3a. Yield (gam} Method of test:
13b. Disinfection type: - Amoudt:
14. WATER ZONES
FROM 7r]
ft..
1RESCRterio
ft.
1S. OUTER CASING (lt r mahl-cMed wells} OR LINER fifppIicabky
1IROM TO DIAMETER THICKNESS MATERIAL
0 fl. 69.5 1L 2 IR. sch 40 1 PVC
26. INNER CASING OR TUBING lentilerma! dnsed-leap
FROM TO DIAMETER THICKNESS
fi.
MATELIAL
In.
17. SCREEN
FROM
69.5 It.
rt.
TO
84.5 tt'
0.
DIAMETER SLOT SIZE
2 ia. .010
In.
THICKNESS
sch 40
PVC
18. GROUT
FROM TO
64 It. 67
ft.
ALEITDIAL
chlps
EMPLACEMENT METHOD & AMoCNt
tremmle
0
ft.
64 rt. neat cement
trernmie
ft fr.
19. SAND/GRAVEL PAM fir al/Amble]
FROM TO l MATERIAL
67 II. 184.5 fG #1 sand
EMPLACEMENT M1CTJIOD
lremmis
n. rt.
20. DRL1.LING to( (attach addttlonal sheets if aecessar)I
FROM
ft,
ft.
TO or -sr RIPTitiNrealer. humors.,mIYrneknpt. green dn. etc. t
tG
lu
ft.
f1.
ft.
ft.
re
rt.
ft.
n.
rt-
71. REMARKS
22. Certification:
Sig/were of Cenlilcd Well Contactor
12/18/2014
Date
8y signing this form. 1 hereby eerijfi' that the ,wdl(s) wear fuvere) consmrcretl !sr t t't rdpnee
with 9.54 NC.4C 02C .0100 or 13A h'CIC OIC.02ti0 well Corufrostio n Standards dtnd that a
copy of AO record hos hoot provided to the well owner:
23. Site diagram or additional well detafis:
You may use the back of this page to provide additional well site details or well
corkstroetion detain_ You may also attach additional pages if necessary.
SUBMITTAL D1STIfCf3ONS
14a. For All Wells: Submit this form within 30 days of completion of well
construction to the following.
Division of Water Resources, Information Processing Unit,
1617 Malt Service Center, Raleigh. NC 27699.1617
24b. For injection Wells ONLY: In addition to sending the form to the Address in
24a above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources. Underground injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c, For Water Svpplj & Injection Wells:
Also submit one copy of this form within 30 days ofccmpletion of
well construction to the county health department of tllc county where
constructed.
Form OW -I
Noah Carolina Depertmere of Environment and
Natural Resources - Division of Water Resourers Revised August 2O13

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
Randy Phillips
Well Contractor Name
2209-A
NC Well Contractor Certification Number
A.E.Drilling Services
Company Name
Z. Well Construction Permit#;
List all applicable well pe,wits (i.e. Co11nty, Slate, Val'ia11ce, lnjectio11. etc.)
3. Well Use (check well use):
Water Supply Well;
□ Agricultural □Municipal/Public
□Geothermal (Heating/Cooling Supply) □Residential Water Supply (single)
□Industrial/Commercial □Residential Water Supply (shared)
□Irri g ation
Non-Water Supply Well:
l!:IMonitoring □Recovery
Injection Well:
□Aquifer Recharge □Groundwater Remediation
□Aquifer Storage and Recovery □Salinity Barrier
□Aquifer Test D Storm water Drainage
□Experimental Technology □ Subsidence Control
□Geothe1mal (Closed Loop) □Tracer
□Geothermal (Heating/Cooling Return) □Other (ex plain under #21 Remarks)
4. Date Well(s) Completed: 3-11-14 Well ID# MW277-136CD
Sa. Well Location:
Chemtronics
Facility/Owner Name Facility ID# (if applicable)
180 Old Bee Tree Rd. Swannanoa, NC
Physical Address, City, and Zip
Buncombe
County Parcel Identification No. (PIN)
Sb. L11titude and Longitude In degrees/minutes/seconds or decimal degrees:
{if well field, one lat/long is sufficient)
700645.024 N 978735.505 w ------------
6. Is (are) the well(s): ~Permanent or □Temporary
7. Is this a repair to an existing well: □Yes or EJNo
If this is a repair.fill out hiown well constniction information and explain the flature of the
repair u>ider #21 remades sectio11 or on the back of this form.
8. Number of wells constructed: _1 __________ _
For multiple injection or non-water supply wells ONLY with the same co11str11ction, you can
submit 011eform.
9. Total well depth below land surface: _1_Q_O _________ (ft.)
Fo,· multiple wells list all depths /f'dijferent (e.xample-3@100' and 2@100')
10. Static water level below top of casing: ____________ (ft,)
If water lei,e/ is above casing, use "+ "
11. Borehole diameter: 9 (in.)
12. Well construction method: auger/core -----------------(i.e. auger, 1·ota1-y, cable, direct puih, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) ________ Method of test: ______ _
13b. Disinfection type: ______ _ Amount: ________ _
I
I
I For Internal Use ONLY:
14. WATER ZONES
FROM TO Df.S CRll'TI0:'11
ft. ft.
ft. ft.
15. OUTER CASJNG (for mulli-cased wells) OR LINER /if annUcablel
FROM TO 1>1.oa::rE R i THICKNESS ;1.IATERJAL
ft. ft. in.
16. INNER CASING OR TUBING ,eeothermal closed-looo )
FROM TO DIAMETER THJCK~SS MATERIAL
+3 ft. 80 ft. 2 in. sch 40 PVC
ft. ft. in.
17.SCREEN
FROM TO DIA.~TER SLOT SIZE THICK!\'ESS MATERIAL
80 ft. 100 ft. 2 in. .010 sch40 PVC
ft. rr. in.
lfi.GROUT
FROM TO MATERIAL l EJ\IPLACEl\1K'fT :\IETHOD & A.,mu~r
0 ft. 74 ft. neat cenent )tremmie
74 rt. 77 ft. chips /tremmie
ft. ft. I
U>. SAND/GRAVEL PACK if •nnlicable)
FROM TO MATERIAL EMPLACEMENT METHOD
77 ft. 102.4 ft. #1 sand tremmie
ft. ft.
20, DRILLING LOG/attach additional sbeetsifoe<:essa rv)
FROM TO DESCRlPT JO~ {color, hardness. soWrock n""De, araln size etc.)
ft, ft.
ft, ft.
ft. ft.
ft. ft.
ft. ft.
ft. ft,
ft, ft.
ll.REMARKS
22. Certification:
s:i:4 lf ~ctor
9/14/2015
Date
By signing this form, l hereby certify that the well(s) was (were) co1Jstructed in accorda>1ce
with 15A NCAC 02C . ()JD() or / SA NCAC D2C .020D Well Co11struclio11 Standards a11d tlwt a
copy of this record has hem provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this fonn within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells ONLY: In addition to sending the form to the address in
24a above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Sup plv & In jection Wells:
Also submit one copy of this form within 30 days of completion of
well construction to the county health depaitment of the county where
constmcted.
FonnGW-1 N011h Carolina Depru1ment of Environment and Natural Resources -Division of Water Resources Revised August 2013
WELL CONSTRUCTION RECORD
This Form can be aced For single or multiple wells
1. Well Contractor Information:
For [marnnt Use ONLY:
Randy Phillips
Well Contractor Name
2209-A
NC Well Contractor Certification *lumber
A.E.Drilling Services
Company Name
2. Well Construction Permit #:
List all applicable ,teti permits 6.e, County, Stale Variance, hrJecefart etc)
3. Well Use (check well use):
Water Supply Well:
f Agricultural
❑Geothe mial (Heating/Cooling Supply)
❑ In dustnal/Cornrnercial
❑ Irri gation
Non -Water Supply Well:
BMonitoring
ONfunicipa1JPnbtic
❑ Residential Water Supply (single)
°Residential Water Supply (shared)
❑Recovery
Injection Well:
❑Aquif r Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Taehnology
❑ Geothermal (Closed Loop)
❑Geothermal (1-1eatin1ICooling Return)
L3Gruuadwater Remechation
❑Salinity Barrier
OStormwater Drainage
7Subsidence Control
❑ Other (explain under #ill Remarks)
4, Date Well(s) Completed: 8-27-13 Wen 1nr► MW24$-J36C❑
Sa. Well Location:
Chemtronics
FacilirylOwoer Name Facility OE (it -applicable)
180 Old Bee Tree Rd. Swannanoa, NC
Physics'/ Address, City, and Zip
Buncombe
County Parcel Identification. No. (PIN)
5b. Latitude and Longitude in de greesftninutesiseeaads or decimal degrees:
Orwell field, one latlleng is suffiicieatt]
700716.497 N 978821.321
6. Is (are) the we1J(s): RI Permanent or ❑Temporary
7. Is this a repair to an exisdng well: []Yes or ElNo
If this' is a repair. fill out ksowrt well cwrshactlon information and erpiarn the nature of the
repair under 42) remarks' section or on the back of Mrs form.
S. Number of wells constructed:
For multiple injection or non -water supply wells ONL }' with the same confirmation. you ran
submit one farm.
1
9. Total well depth below land surface: 70 (ft.)
For muheple wellr lest all depths ifrliffer+ent (example. 3@100' and 2(5100)
10. Static water level below top of casing:
Ifwrner level is above casing, use
11. Borehole diameter: 8
(in.)
12. Well construction method: auger/core
ift.)
(i.e. auger, rotary_ cable, direct push, ere.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
14. WATER ZONES
FROM
TO
Drscntertml
ft.
[t.
ft.
rt.
IS. OUTER CASING tier
muitf.xased wens] DR LINER tit appllable)
bleb►t
TO
MASS
TRICiL.srras
MATERIAL
11.
ft.
in.
16.1NNER
CASING OR TURING
{geothermal dased-Foapl
FROM
TO
DiA2ETER THICKNRss
MATERIAL
+3 it
55 n.
2 in.
sch 40
PVC
17-SCREEN
_1
FRfM
TO
DIAMETER
r SL,o'rM171a
THiCKVESS
MATERIAL
55 1L
70 f
2 in.
.010
sch 40
PVC
h
Ft.
t
in.
18. GROUT
FROM
To
MATERIAL EMPLACEMENT METROS] & AMDtPr1
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I[. ft.
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2Z. REMARKS
22. Certification:
Signature of iced Well Cantraetor
9/14/2015
Date
By signing this foram, f hereby certft5i shot Tire welt(() was (were, constnicted In accordance
with J5A NCAC 02C .0100 or 13A NCAC C)C_0206 14'elf Confiraction Standarb and that a
[ropy of this record has bon provided to the well gunner.
23. Site diagram or additional well details:
You may use [be back of this page to provide additional well site details or well
construction 1 Iej1s. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For Ali Welk: Submit this halm Within 3d days Of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mall Service Center, Raleigh, NC 27699-1617
tab, For Injection Well€ ONLY: L1 addition to sending the form to the address in
24a above, also submit it copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24e. For Water Supply & Injection Wells:
Mso submit one copy of this form within 30 days of Completion of
well construction to the county health department of the county where
constructed.
Form OW-1
North Carolina Department of Environment and Natural Resources -Division of Water Resources Rrv:sed August 2013

Geosyntec
consultants
TO: UIC Program
COMPANY Division of Water Resources
1636 Mail Service Center
Raleigh, NC
27699-1636
TRANSMITTAL
DATE: December 10, 2015
PROJECT NAME: Chemtronics
PROJECT NO.: GR4943.07.7.11
® ENCLOSED
❑ UNDER SEPARATE COVER
VIA:
❑ MESSENGER
❑ FIRST CLASS MAIL
❑ SPECIAL DELIVERY
❑ AIR MAIL
® FEDEX
❑ FOR APPROVAL
® FOR YOUR USE
❑ AS REQUESTED
❑ APPROVED
❑ APPROVED AS
NOTED
ACTION:
❑ RESUBMIT
❑ RETURN CORRECTED
PRINTS
❑ FOR COMMENT
NO. OF
COPIES
DWG
NO.
DESCRIPTION
DATE
1
injection Summary Forms for Permit # WI0100230
Dec 10,
2015
REMARKS:
COPY TO:
RECENEDIDEt4RIDWR
UEC 1 11 5
pi QUAY 11111.1
wpatations S an
1255 Roberts Boulevard, Suite 200
Kennesaw, Georgia 30144
FROM: Benjamin Amos (678.202,9597)

• INJECTION EVENT RECORD
North Carolina Department of Environment and Natural Resources — Division of Water Resources
Permit Number WI0100230
. Permit Information
Chemtronics, Inc.
Permittee
Chemtronics Superfund Site, DA 23/8116 Area
Facility Name
180 Old Bee Tree Road, Swannanoa, NC 28778
Facility Address
Injection Contractor Information
Geosyntec Consultants of NC, P.C.
Injection Contractor / Company Name
Street Address 1255 Roberts Boulevard, Suite 200
Kennesaw
City
GA
State
30144
Zip Code
( 678 ) 202-9507
Area code — Phone number
. Well Information
Number of wells used for injection 5
Well names BW-4, MW245 J36CD, MW248-J36CD
MW249-J36CD, MW277-136CD
Were any new wells installed during this injection
event?
❑ Yes I No
if yes, please provide the following information:
Number of Monitoring Wells none
Number of lnjection Wells
none
Type of Well Installed (Check applicable type):
❑ Bored ❑ Drilled ❑ Direct -Push
❑ Hand -Augured ❑ Other (specify)
Please include a copy of the GW-1 form for each
well installed.
Were any wells abandoned during this injection
event?
❑ Yes x❑ No
If yes, please provide the following information:
Number of Monitoring Wells
Number of Injection Wells
Please include a copy of the GW 30for each well
abandoned.
4. Injectant Information
Hydrogen Peroxide
Injectant Type
Concentration 329 mg/L
If the injectant is diluted please indicate the source
dilution fluid. Fire Hydrant
Total Volume injected 225, 240 L
34,791 L (BW-4)
Volume Injected per well 15,701 L (MW246-J36CD),
64,761 L (MW248-I36CD)
45,451 L (MW249-J36CD)
64,534 L (MW277-I36CD)
Injection date(s) October 13-16 and 19-23, 2015,
November 11-13, 16-20 and 23-24, 2015
Injection number (e.g. 3 of 5) 1 of 1
Injection History
Is this the last injection at this site?
❑ Yes 1 No
I DO HERESY CERTIFY THAT ALL THE
INFORMATION�k ■ t HRRECT TO
TITEBESTOF i LOAT THE
INJECTION WAS PERFORMED WITHIN THE
STANDARDS LAID OA NITIIffi PERMIT.
- ' AblUDIASkly Rego 12/ij,j—
SIGNATURE OF INJECT cOWSCl 4ritt DATE
Arwio A%. PE 1 v 9123
PRINT NAME OF PERSON PERFORMING THE INJECTION
n- ?o z
Submit the original of this form to the Division of Water Resources within 30 days of injection.
Attn: UIC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-807-6464
Form UIC-TER
Rev. 8/5/2013

Ro gers, Michael
From:
Sent:
To:
Cc:
Subject:
Attachments:
Jon,
CJf c) I c?O J., 3 0
c_t:rz_c.~ zl[r--
Robert Cork <[e-mail]>
Tuesday , March 29, 2016 12:33 PM
Bornholm , Jon
Bentkowski, Ben ; Hartzell, Beth ; Stu Ryman ; Altamont Environmental (Chemtronics Project};
Rogers, Michael ; Watts, Debra
RE: Acceptance with Comments of the January 2016 Back Valley Enhanced In Situ
Bioremediation (EISB) Pilot Testing Report
2016-0323-Chemtronics-RTC on BV EISB Pilot Test Report.pdf; Acceptance with Comments
of the Back Valley Enhanced In Situ Bioremediat.... pdf
Please find attached a response to comments to the below referenced letter {which is also re-attached for
convenience).
This email also acts to provide a copy of the original report (related to UIC permit number WI0100230) to the NC UIC
program representatives Michael Rogers and Debra Watts. Michael and Debra can download the original report at th is
link, which will ex p ire in 7 da ys.
Please do not hesitate with further questions or if there are problems downloading the original report.
Regards
Rob
Robert Cork, PE , PMP
Alta mont Environme ntal, Inc I 231 Haywood Street I Asheville NC, 2880 1
P: 828.281.33 50 I C: 828.450.6435 I E: rco rk@alta m o ntenvi ro n m en t a l.com I W : www .alta mo n envi r o nment a l.com
From: Bornholm, Jon [mailto:bornholm [e-mail]]
Sent: _Tuesday, March 08, 2016 7:45 AM
To: Stu Ryman <[e-mail]>; Robert Cork <[e-mail]>
Cc : Bentkowski, Ben <Bentkowski.Ben@epa .gov>; Beth Hartzell (NCDEQ} ([e-mail]}
<beth [e-mail]>; Bill Mccollum ([e-mail]) <[e-mail]>
Subject: Acceptance with Comments of the January 2016 Back Valley Enhanced In Situ Bioremediation (EISB) Pilot
Testing Report
Stu/Rob,
Attached is letter approving with comments the January 2016 Back Valley Enhanced In Situ Bioremediation (EISB)
Pilot Testing Report. If you have any questions, please contact me .
Jon Bornholm
Remedial Project Manager
EPA -Superfund Division
(o} 404-562-8820
( c) 404-217-8565
bornholm .jon@epa .gov
1
Geosyntec C>
consultants
1255 Roberts Boulevard, Suite 200
Kennesaw, Georgia 30144
PH 678 .202.9500
FAX [phone]
www.geosyntec .. com
23 March 2016
Mr. Jon Bomholm
Project Manager
USEP A~ Region 4
Sam Nunn Atlanta Federal Center
61 Forsyth Street, S.W.
Atlanta, Georgia 30303-8960
Subject: Response to Comments on Approval with Comments of the January 2016 Back
Valley Enhanced In Situ Bioremediatioii (EISB) Pilot Testing Report for the
Chemtronics Superfund Site, Swannanoa, Buncombe County, North Carolina
Dear Mr. Bomholm:
Geosyntec Consultants of NC, P.C. (Geosyntec) has prepared this letter on behalf of Chemtronics,
Inc., Northrop Grumman Systems Corporation, and CNA Holdings, LLC (collectively "the
Companies") in response to your 8 March 2016 letter providing approval with comments of the
Report on Back Valley Enhanced In Situ Bioremediation (EISB) Pilot Testing (the Report) for the
Chemtronics Superfund Site, Swannanoa, Buncombe County, North Carolina. This letter provides
responses to comments from the United States Environmental Protection Agency . (USEP A) and
serves to document clarifications to the Report; a revised Report will not be submitted. The
North Carolina Department of Environmental Quality (NCDEQ) had no comments on the Report.
USEPA Comment #1:
Page 21, Sect;on 4.4 Pilot Test Pe,formance Monitoring Results, Microbial Molecular
Analyses, second paragraph third sentence: This sentence states the cell count declined.
Did the number of cells drop to the baseline level?
Geosyntec Response:
Cell counts for Dehalococcoides and Dehalobacter at monitoring well P-5B increased above
baseline levels following the injection event through Month 6 of the test (June 2015),
suggesting growth of these key microorganisms in the pilot test area (PT A). In Month 8
(August 2015) and Month 10 (October 2015) cell counts declined to levels below baseline,
however treatment of chlorinated volatile organic compounds (cVOCs) continued as
GR4943/2016-0323-Chemtronics-RTC on BV EISB Pilot Test Report
engineers I scie ntists I innovators
Mr. Jon Bornholm
23 March 2016
Page2
indicated by low and declining cVOC concentrations with sustained production of cVOC
daughter products. Microbial molecular data are summarized in Table 6 of the Report.
The declines in cell counts are not unexpected based on the cVOC results; as the cVOC
concentrations decrease they may sustain lower populations of Dehalococcoides and
Dehalobacter. As recommended in Section 5.3 of the Report (page 27), additional periodic
performance monitoring will include microbial molecular analysis during select sample
events. The additional molecular data will be used to evaluate cell count trends to confirm
conclusions regarding pilot test performance;
USEPA Comment #2:
Page 26, Section 5. 1 Conclusions from the Pilot Test, fourth bullet: This bullet states that
the pilot test generated design information for electron donor longevity. I do not recall
reading anything about this in the report. Where was this discussed in this report?
Geosyntec Response:
The presence of total organic carbon (TOC) and methane in the pilot test area, as well as
geochemical conditions (i.e., oxidation-reduction potential) that becomes progressively more
reducing through the bioactive zone, can be used as indicators for the continued presence of
electron donor. These parameters are discussed in Section 4.4 of the Report, page 18.
However, it is acknowledged that electron donor longevity and required frequency of
electron donor reinjection were not specifically discussed in the Report. These can be
inferred from the TOC and methane results, as well as other perfom,ance monitoring data to
date (e.g. significant levels of observed target compound treatment, production of daughter
products, and favorable geochemical trends). The monitoring data suggests that electron
donor longevity is at least IO months and potentially much longer. At many sites, long term
electron donors such as EHC-L ® last 2 to 5 years.
The additional periodic performance monitoring recommended in Section 5.3 of the Report
(page 27) will be used to evaluate longer-term performance, including electron donor
longevity and required frequency of electron donor reinjection. The additional monitoring
data may be used to refine full-scale EISB design, if this technology is selected as a remedial
measure for the Back Valley .
GR4943/2016-0323-Chemtronics-RTC on BV EISB Pilot Test Report
Mr. Jon Bomholm
23 March 2016
Page 3
USEPA Comment #3:
Page 2 7, Section 5.2 Implications for Groundwater Remediation, fourth bullet: This bullet
highlights the frequency of re injection events. I do not recall reading anything about this in
the report. Where was this discussed in this report?
Geosyntec Response:
See response to USEPA Comment #2.
USEP A Comment #4:
Page 27, Section 5.3 Pilot Test Status Summary and Path Forward, second paragraph: This
paragraph states that the Companies plan on continuing monitoring the pilot test. The
Agency concurs with this action. Does this effort include canying out another round of
injections if the data points in this direction?
Geosyntec Response:
Potentially (based on monitoring data), because we have established conditions favorable for
degradation (as reflected in sampling data) and want to maintain those conditions to further
evaluate design parameters over a longer period. Additional amendment injections may be
performed in the PTA based on performance monitoring results. Subsequent injection
events were included as a contingency in the approved Work Plan for Back Valley Enhanced
In Situ Bioremediation (EISB) Pilot Testing, Revision 1 (dated 17 December 2014). The
Companies will notify USEPA and NCDEQ prior to implementation of subsequent injection
events. For additional discussion of potential injection event(s), see Section 5.3 of the
Report (pages 27 and 28).
We trust that these responses address the comments provided by USEPA. Please feel free to
contact us if there are further comments or questions.
GR4943/2016-0323-Chemtronics-RTC on BY El SB Pilot Test Report
Mr. Jon Bomholm
23 March 2016
Page 4
Copies to: Ben Bentkowski, USEP A
Beth Hartzell, NCDEQ
Mike Rogers, UIC Program, NCDENR
Debra Watts, UIC Program, NCDENR
Companies' Representatives
Sincerely,
~-,4/_.., -
~,r~
Leah MacKinnon
Principal
--/ L./ ,' C£.;; r , · r-r,·(/,_p.~i &'-. . ~ . l , .,,
Todd Hagem eyer, P.O.
Senior Principa l
Stuart Ryman. Altamont Environmental, Inc.
G R4 943 /2016-0323-Chcmtroni~s-RTC on BV EISB Pil ot Test Report
<il� s,.. UNITED STATES ENVIRONMENTAL PROTECTION AGENCY
� REGION 4
i SAM NUNN ATLANTA FEDERAL CENTER
y Cr 61 Forsyth Street, S.W.
y�
Atlanta, Georgia 30303-3104
ri-
'- 44 aRa[ti
March 08, 2016
4SF-RSEB
Mr. Stuart Ryman
Aitamont Environmental, Inc.
231 Haywood Street
Asheville, North Carolina 28801
SUB]: Acceptance with Comments of the January 2016 Back Valley Enhanced In Situ
Biorernediation (EISB) Pilot Testing Report for the Cherntronics Superfund Site, Swannanoa.
Buncombe County, North Carolina
Dear Mr. Ryman:
The Agency received an electronic copy of the above referenced document from Altamont on January
25, 2016. This document was prepared by Geosyntec Consultants on behalf of the potentially
responsible parties (aka, the Companies) for the Chemtronics Superfund Site. This document was also
shared with North Carolina Department of Environmental Quality (NCDEQ) for the State's review and
Site file. A copy of this document was also shared with Ben Bentkowski, EPA/Region 4/Technical
Services Section. NCDEQ did not have any comments to offer on this report.
Comments:
1. Page 21, Section 4.4 Pilot Test Performance Monitoring Results, Microbial Molecular Analyses,
second paragraph third sentence: This sentence states the cell count declined. Did the number of
cells drop to the baseline level?
2. Page 26, Section 5.1 Conclusions from the Pilot Test, fourth bullet: This bullet states that the pilot
test generated design information for electron donor longevity. 1 do not recall reading anything about
this in the report. Where was this discussed in this report?
3. Page 27, Section 5,2 Implications for Groundwater Remediation, fourth bullet: This bullet highlights
the frequency of reinjection events_ 1 do not recall reading anything about this in the report. Where
was this discussed in this report?
4. Page 27, Section 5.3 Pilot Test Status Summary and Path Forward, second paragraph: This
paragraph states that the Companies plan on continuing monitoring the pilot test. The Agency
concurs with this action. Does this effort include carrying out another round of injections if the data
points in this direction?

If you have any questions, I can be reached at (o) 404-562-8820, (c) 404-217-8565, or
[e-mail].
cc: Ben Bentkowski, EPA
Beth Hartzell, NCDENR
Bill McCullum, SS-CAG
Sincerely,
Jon K. Bomholm
Remedial Project Manager
Geosyntec r
consultants
Mr. Jon Bornholm
Project Manager
USEPA, Region 4
Sam Nunn Atlanta Federal Center
61 Forsyth Street, S.W.
Atlanta, Georgia 30303-8960
1255 Roberts Boulevard, Suite 200
Kennesaw, Georgia 30144
PH 678.202.9500
FAX [phone]
wv. w. geosyntec, com
5 August 2015
Subject: Response to Comments on Approval with Comments to Initiate and Evaluate
Aerobic Enhanced In -Situ Bioremediation Pilot Test as Presented in the
June 03, 2015 Summary of Purge Test Results and Proposed Aerobic
Bioremediation Pilot Test on the DA 23/B116 Area Document for the
Chemtronics Superfund Site, Swannanoa, Buncombe County, North Carolina
Dear Mr. Bornholm,
Geosyntec Consultants of NC, P.C. (Geosyntec) has prepared this letter on behalf of
Chemtronics, Inc-, Northrop Grumman Systems Corporation (Northrop Grumman), and CNA
Holdings, LLC (CNA) (collectively "the Companies") in response to your 1 July 2015 letter
providing comments on proposed pilot testing activities described in the Summary of Purge
Test Results and Proposed Aerobic Bioremediatian Pilot Test in the DA 23/B116 Area
(Letter) for the Chemtronics Superfund Site, Swannanoa, Buncombe County, North Carolina
(Site). This letter provides responses to comments from the United States Environmental
Protection Agency (USEPA) and serves to document clarifications to the Letter; a revised
Letter will not be submitted. The North. Carolina Department of Natural Resources
(NCDENR) had no comments on the Letter.
USEPA Comment #t.l
Page 5, third paragraph, second sentence: Should this sentence be changed to read,
"._-wells to the east west (MW234-I37CD)... "?
Geosyntec Response:
USEPA's correction to the text is accurate. The corrected sentence is as follows:
"However, fluorescent dyes were not detected at select Zone CD wells to the west
(MW234-I37CD) or down valley (P-1B, DW-139; Figure 3), where transducer
data showed some hydraulic response over the same period (Figures 4 and 6)."
GR494312015-0805-Chemtronics-RTC on DA 23 13116 Aerobic Pilot'res't
engineers l scientists I innovators

Mr. Jon Bornholm
5 August 2015
Page 2
USEP A Comment #2:
Page 6, Discussion, second paragraph: This paragraph states that there are only two
1A101l<' tRW_Lf. nnt-l RW_ 1) iYI tho k'rnnt Fnl101J ,a,ith f'r>nf'oYlfrntinYJ<' nf' 7 ')_,-1;,-,h/nrnothnYJo .-.-.......... .._, \i..r,r I ..,.,,_,.,.._. _,,__,,,, OW/ _,,., 1,10, .... ..&. I 'lJIO,O, r ..,._.,.,_._,..)' rro,a,1a, -'-',-.. ._.,...,.,.__,, .....,_,.,._,,&-U 'IJ'J ...._,__, ._... ........... .,.._,, ..., ....... ,.,_,,.,.,_,
(1,2-DCA) above 1,000 micrograms per liter (µg/L). The data presented in this letter
report indicates that BW-4 and BW-5 are not hydraulically connected. Therefore, this
implies there are two sources of 1,2-DCA in this area, one source impacting
groundwater intercepted by BW-4 and another influencing the groundwater being
monitored by BW-5.
Geosyntec Response:
While the purge test results suggest that BW-4 [Zone Dwell in the DA 23/B116 area]
and BW-5 [Zone E well in the B139 area] are not directly hydraulically connected,
this does not preclude a single source contributing to 1,2-DCA at both locations. The
purge test evaluated potential connections between these two wells based on the
following: i) changes in water levels at BW-5 during groundwater extraction at BW-
4; and ii) observation of dye tracers released at select Zone CD monitoring wells in the
DA 23/B 116 area during the purge test. The results from these evaluations confirm
that there is limited hydraulic connection between BW-4 and BW-5 and slow transport
between these wells. This was not particularly surprising given that well BW-5
monitors a portion of bedrock absent of fractures with 100% rock quality designation
(RQD) as observed on the borehole log.
It is possible, however, that 1,2-DCA detected in the DA 23/8116 area migrated
toward building B139 and monitoring well BW-5 through alternative pathways than
those evaluated during the purge test. For example, historic data for the DA 23/Bl 16
area suggests that there was a historic shallow source of 1,2-DCA present in Zone AB
near the southwestern end of DA 23 which has subsequently attenuated. Furthermore,
1,2-DCA was also recently present in the Zone CD wells DW-139 (in the B139 area)
and MW234-I37CD (upgradient of the B139 area) and the 1,2-DCA concentrations at
these locations have also recently declined significantly. Nonetheless, the historic data
suggests that the 1,2-DCA detected in the DA 23 area is linked to the presence of 1,2-
DCA in well BW-5. The remedial approach for the DA 23/B116 and/or B139 areas
will be evaluated as part of the Feasibility Study.
G R494J/2015-0805-Chemtronics-RTC on DA 2J B 116 Aerobic Pilot Test
Mr. Jon Bornholm
5 August 2015
Page3
USEPA Comment #3:
Page 8, PROPOSED AEROBIC EISB PILOT TEST, Hydrogen Peroxide Injection,
first paragraph, second sentence: This sentence mentions the "monitoring oxygen
utilization rates". How and where will this be accomplished? Additional text needs
to be provided.
Geosyntec Response:
A biological respiration test will be initiated, after the aquifer is sufficiently aerated,
by suspending injection activities and monitoring for changes in dissolved oxygen
concentrations. The change in dissolved oxygen concentrations will be used to
estimate oxygen utilization rates. Details regarding the locations for monitoring are
provided in the section titled "Pilot Test Monitoring" on Page 10 of the Letter· and in
Table 4 referenced in that section. Field parameters (pH, dissolved oxygen, oxidation
reduction potential, specific conductance, turbidity, and temperature) will be measured
during the respiration test at BW-4 daily and at select other wells (BW-5, DTW-1,
MW250-J36CD, MW278-I36CD, P-1B, and STW-1) several times a week. Field
parameters will also be measured at other pilot test area wells at the beginning and end
of the test.
USEP A Comment #4:
Page 9, PROPOSED AEROBIC EISB PILOT TEST, Biosparging, first paragraph,
first sentence: As written, the only pilot test that will be conducted is the introduction
of hydrogen peroxide into the underlying groundwater (Zone CD). This section states,
"Biosparging may also be tested"; however, there is no discussion on what
criteria/parameters will be used to decide whether or not to implement the
biosparging pilot test. Additional text needs to be provided
Geosyntec Response:
Biosparging may . be tested if it is found that the hydrogen peroxide approach for
introducing oxygen in Zone CD groundwater in the DA 23/8116 area is ineffective at
increasing dissolved oxygen concentrations at BW-4 and nearby monitoring wells.
Depending on the ability of hydrogen peroxide to promote and sustain the desired
aerobic conditions (i.e., dissolved oxygen increased above baseline, positive oxidation
reduction potential), biosparging may also be evaluated. The field parameter
GR4943/2015-0805-Chemtronics-RTC on DA 23 B 116 Aerobic Pilot Test
Mr. Jon Bomholm
5 August 2015
Page4
measurements, referenced in the response to USEP A Comment #3, will be used as a
basis for quantifying changes in dissolved oxygen and evaluating the need for an
alternative approach to aerobic bioremediation at the Site. The Companies will notify
T T nT""'IT"'I,, .i. I .... Tf"'1T"'t.Y-,"l,.TT"\ • •1 • .., 1 • • ' 1 .., . _.• */" _. 1 u ;:")tr A ana 1'1 l.,U tJ"i K via emau pnor w omspargmg unp1ememanun, 11 warranteu
based on performance monitoring data.
USEPA Comment #5:
Figure 1 and 2: There are a number of wells that are included in Figure 2 that are
not included in Figure 1 (i.e., MW246, MW247, MW248, MW250 , MW277, and
MW278). Is there a reason?
Geosyntec Response:
Wells installed in the DA 23/B 116 area in 2013 and 2014 as part of Stage 1 a and Stage
1 b characterization were inadvertently not included in Figure 1. A revised version of
Figure 1 is attached. Given the number of monitoring well locations in the DA
23/B 116 area, the Stage la/1 b wells were not labelled in the revised Figure 1. This is
consistent with the purpose of Figure 1 (i.e., to identify the location of the DA
23/B116 area at the Site). Figure 2 is intended to provide further detail for the DA
23/B 116 area that cannot be included effectively in Figure 1.
USEP A Comment #6:
Figure 4: Between the dates of 11/19/2014 and 11/29/2014 along the x-axis there is
an increase in groundwater levels. Was this increase in water levels in response to a
major rain event?
Geosyntec Response:
The referenced increase in water levels corresponds to a daily rainfall total of a little
more than 2 inches on 23 November 2014, as recorded at the Asheville Regional
Airport 1. Similarly, a slight increase in water levels observed subsequently at select
locations correlates to approximately 0.5 inch ofrainfall on 26 November 2014.
1 Daily rainfall totals obtained from http://www.wunderground.com/history/airport/KA VL/ (accessed 6 July
2015).
GR4943/2015-0805-Chemtronics-RTC on DA 23 B 116 Aerobic Pilot Test
Mr. Jon Bornholm
5 August 2015
Page 5
We trust that these responses address the comments provided by USEPA. Please feel free to
contact us if there are further comments or questions.
Attachment 1 Figure
Copies to: Ben Bentkowski, USEPA
Beth Hartzell, NCDENR
Mike Rogers, UIC Program, NCDENR
Debra Watts, UIC Program, NCDENR
Companies' Representatives
Stuart Ryman, Altamont Environmental, Inc.
GR4943/2015-0805-Chemtronics-RTC on DA 23 BI I 6 Aerobic Pilot Test
Sincerely,
Leah MacKinnon,
Associate
r ? ~-;cad ,;+t~cv~ ~
.'/ ./
Todd Hagemeyer, P.G.
Principal
ZoneA Monitoring Well
Zone B Monitoring Well
Zone AB Monitoring Well
Zone C Monitoring Well
• Zone D Monitoring Well
to Zone CD Monitoring Well
• Zone E Monitoring Well
& Zone F Monitoring Well
• Zone EF Monitoring Well
& Extraction Well
• Zone AB Piezometer
4
B142
B1
169
I.l
143
43
B105-139 PTA
▪ 147-E (j
6147 ti
B109-137 `
r tes
11s�.1
~,
115•A
1i5 C
B115 IMW203-J36AB
11 B
MW234-I.3,7-C❑
147_D0
147- 147-5
B147PT
Ongoing Pilot Test Area (PTA)
Disposal Area (DA)
DA 1 0111
Target Evaluation Area
Evaluation Unit (EU) Area
Pond
Stream (Dashed Where Intermittent)
Road
Existing or Former Building Area
Chemtronics Property Boundary
STW-1
B114
BW 4
IMVV237-I37CD
DA 23
B110-111-112
DA 2316116 Area
'\B417
M85I -4
M85E71 B
P-1 S
128 "Q_
�P-1 D1
t h.
139,'
KM--1S
r.. B105-139 DW-139
105
9
145
1111
6119-12Q' -.
MW212=K36AB
MW1BD
— 13106
10a
B104-145
PTA
er46
14E
MW-1 BI
B121
121
B 150-151
B148
G
Ar
144
&
Bunker- SM- ubble
6123
y
119-A
B154
PS❑
ti
154_
BVl_
(Natural Pond)
300 150 0
124
8124-135 ,L�•
;Pond,3 ▪ c4
300 Feet
Note:
1- For clarity, select wells are not labeled in the DA 23/6116 Area.
Far reference, these wells are labelled in Figure 2
DRAFT FOR D1SCUSSiON PURPOSES ONLY
Confidential and Privileged: AttomeyClient and Work Product Privileges Asserted
Front Valley Evaluation Areas
Chemtronics Site
Swannanoa, North Carolina
Geosyntec
consultants
Kennesaw
August 2015
Figure
1

(;1,
RECEIVED/DENR/DWR
Geo syn.tee f>
consultants
TO: UIC Program
COMPANY Division of Water Resources
1636 Mail Service Center
Raleigh, NC
27699-1636
TRANSMITTAL
VIA:
□ MESSENGER
~ ENCLOSED □ FIRST CLASS MAIL
□ UNDER SEPARATE COVER □ SPECIAL DELIVERY
□ AIRMAIL
~ FEDEX
□
~
□
□
□
JAN 1 3 2015
Water Quality Regional
Operations Section
DATE: January 07, 2015
PROJECT NAME: Chemtronics
PROJECT NO.: GR4943.07.7.6E
GR4943.12.12.4
ACTION:
FOR APPROVAL 0 RESUBMIT
FOR YOUR USE 0 RETURN CORRECTED
PRINTS
AS REQUESTED 0 FOR COMMENT
APPROVED
APPROVED AS
NOTED
NO.OF DWG DESCRIPTION DATE COPIES NO.
1 Injection Event Record -BI 04 PT A for Permit# WIO 100230 ==-(and associated well construction record)
1 Injection Event Record -APA -P-5 PT A for Permit # WIO 10023 0
(and associated well construction records)
REMARKS:
COPY TO:
1255 Roberts Boulevard, Suite 200
Kennesaw, Georgia 30144
Jan. 07,
2015
Jan. 07,
2015
FROM: Benjamin Amos (678-202-9597)
INJECTION EVENT RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Resources
Permit Number WI0100230
1. Permit Information
Chemtronics Inc.
Permittee
Chemtronics Su perfund Site . 8104 PTA
Facility Name
180 Old Bee Tree Road, Swannanoa, NC 28778
Facility Address
2. Injection Contractor Information
Geosy ntec Consultants of NC, P.C.
Injection Contractor I Company Name
Street Address 125S Roberts Boulevard, Suite 200
Kennesaw GA 30144
City State Zip Code
~ 202-9597
Area code -Phone number
3. Well Information
Number of wells used for injection _1 ___ _
Well names MW227-J39EF
Were any new wells installed during this injection
event?
0 Yes [R] No
If yes, please provide the following information:
Number of Monitoring Wells _n_o'-n_e ___ _
Number oflnjection Wells __ n_o_n_e ___ _
Type of Well Installed (Check applicable type):
0 Bored O Drilled O Direct-Push
0 Hand-Augured O Other (specify) __ _
Please include a copy of the GW-1 form for each
well installed.
Were any wells abandoned during this injection
event?
0 Yes [R] No
If yes, please provide the following information:
Number of Monitoring Wells _n'""'o-'-n;..::e'---------
Number oflnjection Wells. __ n_o _n_e ____ _
Please include a copy of the GW-30for each well
abandoned.
4. lnjectant Information
Sodium Bicarb onate an d Sodium Lactat e_
Injectant Type
Concentration 586 mg/Land 2,150 mg/L
If the injectant is diluted please indicate the source
dilution fluid. extracted g roundwater
Total Volume Injected 4,911 Gallons
Volume Injected per well 4,911 Gallons
5. Injection History
Injection date(s) Dec 1 to Dec 12, 2014
I . 1. b ( 3 f S)Continuous injection nJec 10n num er e.g. o
over t h e reporte d period
Is this the last injection at this site?
0 Yes ~ No
I DO HEREBY CERTIFY THAT ALL THE
INFORMATION ON THIS FORM IS CORRECT TO
THE BEST OF MY KNOWLEDGE AND THAT THE
INJECTION WAS PERFORMED WITHIN THE
STANDARDS LAID OUT IN THE PERMIT .
~~ z_ a~ 117/ts
SIGNAlJRE OF INJECTION CONTRACTOR DATE
f>.w.1 o,~.;,,, /C. fr ,a411.f .fa'? f £ :I!-t,'/ J Z-3 '
PRINT NAME OF PERSON PERFORMING THE INJECTION
Submit the original of this form to the Division of Water Resources within 30 days of injection.
Attn: UIC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-807-6464
Form UIC-IER
Rev. 8/5/2013
WELL CONSTRUCTION RECORD
This form can h. used for sergk or emkiple wells
1. Well Conttxctur Information:
Randy Phillips
Weil C*nrrscrer Name
1096-A
INC Weal Coouecler Cectiftcarien Number
A. E. Drilling Services
Company Name
I. Well Construction Permit it:
are all applicable srfl permits li.e. Cnmrv. SYorc. Variance. beeadon. -1
3. Well Use (check well nsc):
Wider Supply Wen:
UAgricultural
❑Geothermal (Iieating/Caoling Supply)
L1 Industrial/Commercial
❑lrrmx:nion
LlMunicipal/Public
❑Residential Water Supply (single)
❑ Residential Water Supply (shared)
Non -Water supply Well:
❑Monitoring ❑Recoveiyy
Injection Well:
❑Aquifer Recharge
DAquifer Storage and Recovery
°Aquifer'['est
❑Experimental Technology
°Geothermal (Closed Loop)
❑Geothermal (Heating: Cooling Return)
4. Date WeU(s) Completed: 12-2G-201
5a_ Well Location:
Chemtronics
Facility/Owner Name
180 Ols bee Tree Rd.
❑Groundwater Retpediation
❑ Saiiaity Harrier
❑Stonnwercr Drainage
o Subsidence Control
C37 racer
13Other (explain molder #21 Remarks)
1 WritID# MW227-139EF
Facility al]e (if applicable)
Physical Address. City. end Zip
Buncombe
County
Pared ldcnrifcatimr No. (PIN)
3b. Latitude sad I .nngitude to degtere/minutealseeonds or decimal degrees:
[Qrwolf field. one Iatllong is suflisimty
N W
6. is (are) the walla): 7 Permmtoeot
or ❑Temporary
7- Is this a repair to an existing well: ❑Yes or KiNn
1frho f9 a repair, ft( out &o wr wd1 con ma- on hdor'marr m curd Eiplain therrofure of the
ri snr render e i remarks rerlioe or on to hart et i/i form
8. Number ofweits constructed: y
eon infection
n,feckan erlrwon-nter.supply wells ONLY with N e lams consCwerleur. uare err
1400 MG
9. Total well depth below lard surface: 142
For multiple wens list aft deprhr if didlereffl faa.rplr- 3.t ?00"ernd 2(ll001
()
i0. Static water level below tap of casing: (ft.)
If wafer level it above cos.*. use "+'
11. Borehole diameter: 12/8 (ij.)
12. WO construction method: Mud / Air Rotary
(i.e, auger. rotary, ante. direct puss; ere)
FOR WATER SUPPLY WELLS ONLY:
13n. Yield (gpui) Method of test:
I3b. Disinfection type: Amouot:
Fur Irgarurl filar ONLY'
u. WATER zONIS
FROM
70
natourrtort
!t.
VL
k. n.
1S. OUTRR CASING 'for molt( -eased with) OR LINER (if applicable)
FROM I TO PIAMETER THICKNEES MATERIAL
0 ft. 45 h• S Is. 322
Steal
le. INNER CASING OR TUBING w t real dowel -leapt
FROM 4 TO ' M T£R r THICKNESS
0 n• 122 °' 4 'e• sch 40
11. It.
17. SCREEN
MATERIAL
PVC
1t IOM Ttr
142 ' 122
le n.
SLOTa1TL
4 he.
THICKNESS
sch 40
IVITE11IAL
PVC
1S. GROUT
FROM
MATF]UAL
EMPLACEMENT METHOD & AMIIINT
117 n'
107 "•
chips
tremmie
0 tr.
fl.
107 IL
neatcement
tremmie
I9. SAND/GRAVEL PACK al applksblet
IRON TO MATESI/L
ENIFIACEMENT METEOD
145
f
117
fI.
#2 sand
tremmie
ft.
rt.
M. DRILLING WC (attach sdmdaaa1 aborts trucesasary) - -
PRU'.t TO niSCRIPTIo% reeler. hariiw, saafrrek OY4 Ot saes, e4-Z -•
rt. fL
D, rt.
rt.
i1.
tr.
ft.
rt.
R.
Ir.
A.
I7. REMARKS
22. Certifications
V
1/6/2015
Signature of craned Well Coarrdcmr Dare
8y rgnorg Mir form. f hereby uc.1 that the 11'0' r) was (mere) constructed ma accordance
uda+k f5A NCAC OZC'.0100 or 154NCAC O?C.02OO wdi Construction Randorsls and Char a
copy of this record leas been provided io rhr• nel! miner.
23. Site dingrem or additional well details:
You may use the back of this page to provide additional well site details or well
construction derails. You may amen attach additiomnl pages if necessary.
SI78MlTi`I'AL INSTUCEIONS
24a. Far All Weir: Submit this form within 30 days of completion of well
coustnlciion to the following:
Division of Water Resources, Information Processing limit,
1619 Mali Service Center, Raleigh, NC 27699-1617
24b. For i shiest Welk ONLY: In oddition to sending the form to time address in
24aabove, also submit a copy of this loan within 30 days of completion of well
construction to the following:
Division of Water Resource% lioderground Injection Control Program.
1636 Mail Service Center, Rdeigb, NC 27699-1636
24c, For Water Supply & ImJecdau Weirs:
Also submit one copy of this fotm within 30 days of completion of
well construction la the county ttaeitit department of the county where
eonsttncred.
Ear GW-I
North Caroline.0eparereet of Environment and Nnttmtl Reszx,recs flivieion of Water Resources Revised August :t0i3

RECEIVEDIDF_NR/DWR
INJECTION EVENT RECORD
Water Quality Regional
North Carolina Department of Environment and Natural Resources — Division of WateRt4402P$ Section
Permit Number W10100230
1. Permit Information
Chemtronics Inc.
Permittee
Chemtronics Superfund Site, APA - P-5 (Back Valley) PTA
Facility Name
180 Old Bee Tree Road, Swannanoa, NC 28778
Facility Address
2. Injection Contractor Information
Geosyntec Consultants of NC, P.C-
Injection Contractor / Company Name
Street Address 1255 Roberts Boulevard, Suite 200
Kennesaw
City
GA
State
30144
Zip Code
( 678 ) 202-9597
Area code — Phone number
3. Well Information
Number of wells used for injection 5
Well names IP-BV-1; -2; -3; -4; -5
Were any new wells installed during this injection
event?
• Yes ❑ No
If yes, please provide the following information:
Number of Monitoring Wells 2
Number of injection Wells 5 _
Type of Well Installed (Check applicable type):
❑ Bored ® Drilled ❑ Direct -Push
❑ Hand -Augured ❑ Other (specify)
Please include a copy of the GW-I farm for each
well installed.
Were any wells abandoned during this injection
event?
❑ Yes 0 No
If yes, please provide the following information:
Number of Monitoring Wells none
Number of Injection Wells none
Please include a copy of the GW--30 for each well
abandoned
4. Injectant Information
EHC-L®; Neutral Zone*; Sodium Bicarbonate; Sodium Lactat
S❑dium_SiIfite B-104 Plus
Injectant Type 39 g/L; 15 g/L; 16 g/L; 1.8 g/L;
Concentration 1.4 mg/L; 0.014%v/v
If the injectant is diluted please indicate the source
dilution fluid, city water and extracted g_rourndwater
Total Volume Injected__ 7 480 Gallons
Volume Injected per well 7,439 to 7,678 Gallons
5. Injection History
Injection date(s) Dec- 1- 17, 2014
Injection number (e.g. 3 of 5) 1 of 1
is this the last injection at this site?
❑ Yes EI No
I DO HEREBY CERTIFY THAT ALL THE
INFORMATION ON THIS FORM IS CORRECT TO
THE BEST OF MY KNOWLEDGE AND THAT THE
INJECTION WAS PERFORMED WITHIN THE
STANDARDS LAID OUT IN THE PERMIT.
SIGNATURE OF INJECTION CONTRACTOR DATE
PRINT NAME OF PERSON PERFORMING THE INJECTION
e;
Submit the original of this form to the Division of Water Resources within 30 days of injection.
Attn: LUC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636. Phone No. 919-807-6464
Form ULC-IUR
Rev. 8/5/2013

WELL CONSTRUCTION RECORD
This form can be used fur single or multiple wells
l. WeU Contractur Information:
Randy Phillips
Woll Contractor Nome
1096-A
NC Well Contractor Certification Number
A.E.Drillin g Services
Company Name
2. WeU Construction Permit#:
lift all ,rpplh:able well permits /i.e. Cou11{v. Stare, Variance, lnjectfor,, elc.)
3-Well Use (cheek well nse):
Water Supply WeD.:
□Agricultural □Municipal/Public
□Geothermal (Heating/Cooling Supply) □Residential Water Supply (single)
□rndustriaVCommercial □Residential Water Supply (shared)
□lrri l!ation
Non-Water Supply Well:
@Monitoring □Recovery
Injection Well:
□Aquifer Recharge □Groundwater Remediation
□Aquifer Storage and Recovery □Salinity Barrier
□Aquifer Test □Stomtwater Drainage
□Experimental Technology □Subsidence Control
□Geothennal {Closed Loop) □Tracer
□Geothermal (Heatine/Cooling Return) □Other (explain under#21 Remarks)
4. Date Well(s) Completed: 11/20/14 Well ID# IP-BV-1
5a. Well Location:
Chemtronics
Facility/Owner Name Facility ID/;! (if applical>le)
180 Old Bee Tree Rd. Swannanoah
Physical Address, City, and Zip
Buncombe
County Paree! Identification No. (PIN)
Sb. Latitude and Longitude in degreeslminutet!lseconds or decimal degrees:
(if well field, one lat/long is sufficient)
____________ N ______________ W
6. ls (are) thewell(s): @Permanent or □Tempora,y
7. ls this a repair to an existing well: □Yes or !!:!No
./f this is a repair.fl/I ml/ knowr, we// cm1$/n1ction i1(ormatiw1 a,,d expt,,;11 tire nalllre of t/1e
repair ,mdu #21 rem art. sr:ctiorr or on the back of tlrLY fo,-m.
8. Number of wells constncted; _1 __________ _
For multiple i11iectio,r or 11on-W11ter supply well, QNLY with tl,e ""''"' corutructian. you can
submit 011eform.
9. Total well depth below land surface: _9_2 __________ (ft.)
For 11111/tiple well• /j.,r all depth., if d"!/fen!ttl texa,uple-1@200' <lllll l@UHn
10. Static water-level below top of easing: _2_2_.1_7 _______ (ft,)
lf water level is abnve casing. 11.'it" ·•+"
11, Borehole diameter; 6 (in.)
12. Well constrllctioo method: Auger/ Core __ .;.,_ _____________ _
(L•-auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) _______ Method of test: _______ _
13b, Disinfeclion type: Amount:
I For Internal Use ONLY:
14. WATER ZONES
~ TO Dl!8CRll'TIO.~
ft, ft.
ft. ft.
15, OUTER CASING l for multi-cased wells) OR LINER f lf a ....uable
FROM TO I DIAMETER THICKNESS I MATIJUAL
0 ft. 72 ft. 2 in. sch40 PVC
16. INNER CASING OR TUBING t,;;;olhermal clmed-lot>nJ
FROM TO DIAMETER THICKNllSS MATERIAL
ft. rt. In.
ft. ft. in.
17. SCREEN
FROM TO DIAM.ETER SLOTSlZE THICKNESS MATERIAL
l7 2 ft, 92 ft. 2 in. .010 sch40 PVC
ft. ft. io~
18.GROUT
FROM TO l\lATERIAL EMPJ..AC!tMENT METHOD & AMOUNT
65.9 ft, 69.4 ft. chips tremmie
0 n. 65.9 ft. neat cement tremmie
n. ft.
J9. SAND/GRAVEL PACK l ifannlicablol
FROM TO M.IITERIAL EMl'LACF.MENT l\lETBOD
69.4 ft. 92 ft. #1 sand tremmie
ft. rt.
20. DRILLlNG LOG (attach additional ,heeh if 11,:c.,.5on,)
l'JtOM TO DESCRIPTIOV I color, bani••"· soil/rock !vDE. •,..In size, etc.)
fl. ft,
ft. ft,
ft. ft.
ft, ft.
ft. ft.
rt. It.
ft. ft.
21,REMARKS
··-
22. Certification:
Si~~fioo£::-12/18/14
Date
BJ• signi11g 1/,;s jorm, f hereby certify thaJ the ,..,,/J(s) ,..,.. (were) constructed in accordance
wirli 15A NCAC OlC .0/00 or 15A NCAC OU: _Ol{f(} Well Co11st111ctio11 Standards a11d that a
copy oftl1is record Ira.< been pro1•ided to the well owner .
23. Site diagram or additional well details:
You may use the back of this page ID provide additional well site details or well
consttuction details. You may also attach additiooal pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit 1his fonn within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Procesging Unit,
1617 Mail Senire Ceater, Raleigh, NC 27699-1617
24b. For lnjection Wells ONL V: ln addition to sending the form to the address in
24a above, al50 submit a copy of this fomt within 30 days of completion of well
construction to the following:
Division of Water Resu.rces, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Inlection Wells:
Also submit one copy of this form within 30 days of completion of
well consttuclion to the county health department of the county where
constructed.
FormGW-l North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised August2U13
WELL CONSTRUCTION RECORD
This furm can bo used for s;ngle o, multiple wells
1. Well Contractor (nformation:
Randy Phillips
Well Contrnctor Name
1096-A
NC Well Contraclrn-Certification Number
A.E.Drillin g Services
Company Name
2. Well Coostrudion Permit#:
Lisi alf applicable w,/l perfflils (i.e. Corm(>,·. Stare, Yaria,ice, h,jecti,,~. •1~)
3. Well Use (check well use):
Water Supply Well:
□Agricultural □Municipal/Public
□Geothermal (Heating/Cooling Supply) □Residential Water Supply (single)
□Industrial/Commercial □Residential Water Supply (shared)
□Irrigation
Non-Water Supply Well:
@Monitoring □Recovery
Injection Well:
□Aquifer Recharge □Groundwater Remediation
□Aquifer Storage and Recovery □Salinity Barrier
□Aquifer Test □Stonnwater Drainage
□Experimental Technology □Subsidence Control
□Geothennal (Closed Loop} □Tracer
□Geothermal (Heatinw'Coolin1: Return) □Other (explain under#21 Remarks)
4.Date Well(s) Completed: 11/13/14 Well ID# IP-BV-2
5a. Well Location:
Chemtronics
Facility/Owner Name Facility ID/I (if applicable)
180 Old Bee Tree Rd. Swannanoah
Physical Address, City, and Zip
Buncombe
County Paccel Identification No. (PIN)
Sb. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one latlloog is sufficient)
I For Internal Use ONLY:
l4. WATER ZONES
FROM TO D.l!.$CRIPTION
it. ft.
ft. ft.
15. OUTER CASJNG tlor multi-cased wells I OR LINER llf """Ueable
FROM I TO 1 DIAMETER THICKNESS I MAURIAL
0 ft. 72 ft. 12 in. sch40 PVC
16, INNER CASING OR TUBING f~eothermal clO!led..Joon)
FROM TO DIAMETER THICKNESS MATl!RIAL
ft. rt. in.
ft. ft. in.
17,SC.lU:EN
FROM TO DIAMETER SLOT SIZE TBICKNESS llfA'IEIUAL
72 fl, 92 ft. 2 In. .010 sch40 PVC
fl, ft. 111.
18.GROUJ'
FROM TO MATERIAL .EMPLACEMJo:NT ME1'lfOD & AMOUNT
67 ff. 70 ft, chips tremmie
0 ft. 67 ft. neat cement tremmle
ft. ft.
19. SAND/GRAVEL PACK tifaoutlcablel
FROM TO MATERIAL EMPLACEMENTMETIIOD
70 fL 92 ft. #1 sand tremmie
ft. ft.
20. DRILLING LOG /attach additional sheet., ii necesso.rvJ
FROM TO IIF.SCRll'TlO-i (<o lo ,, haNln•ss, .. 1vrnck ...., oralD 117.r etc.)
ft. ft.
~
ft. rt.
ft. ft.
ff. ft.
ft. rt.
ft. ft.
ft. rt.
21.REMARKS
22. Certification:
____________ N _______________ W Sigra~~lconttacmr 12/18/14
Date
6. ls (are) the well(s): laPermanent or □Temporary
7.Isthisarepairtoanexistillgwell: □Yes or !!'!No
if this Is a repair.fill m,t knawn well co11Stntclimr i'!formafim, mid exp/ai,r rhe 11t1h1n oft/re
repair um/er #21 rema,1<s seclion or 011 the bock t>f 1/,/s form.
8. Number olwells eonstruded: _1 _________ _
For multiple f11jettimr or non-water supply we/Lf ONLYwi/Jr die .same construction. yon ca,r
submit one form.
9. Total well depth below Iaad surface: _9_2 __________ (ft.)
Fo,-multiple wells li.,t all deptl,s if different (ermuple--3@100' and 2@1 (}/J')
10. Static water level below top of casing: _1_8_. 0_2 _______ (ft.)
ff ,wzter level h.-t1h,we casing. u.re .. +"
11. Borehole diameter: 6 (in.)
12. Well construction method: Auger/ Core
(i.e. auger, rota,:y, cable, direct push, -.IC-.}--='----------------
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) _______ Method oftest: _______ _
By sig,,ing this form. I hereby ~rtify tlrat the well(s) was (were) <:tJ11Struc1ed in aa,ordance
with 15A NCACO:ZC JJ/00 ur ISA NCA.C OlC.01()() Well Comnructim, Standards w1dthat a
copy of this record /rus 1,e,.., providlYl to the Wi!II m,11er.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. Y Oil may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
l4a. For All Wells: Submit this form within 30 days of completion of well
construction to the fullowing:
Division of Water Resourca, Information Processing Untt,
1617 Mail Senire Center, lhleigll, NC 27699-1617
24b. For Injection Wells ONLY: In addition to sending the form to the address in
24a above, also subnril a copy of thi!I form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Senire Center, Raleigh, NC 27699-1636
:Z4e. For Water S uppfy & In jection Wells:
Also submit one copy of this funn within 30 days of completion of
IJb. Disinfection type: Amount: well con&1rnction to the cOWity health department of the county where L:::::.=::::==::...:::~~======......:=::::::.:...:::=======:.l constructed.
FonnGW-1 North Carolina Department of Environment and Natllf1ll Resonn:es-Division ofWator Rcsourccs Revisod August 20.13
WELL CONSTRUCTION RECORD
This furm oan be used fur single or multiple we!Js
I. Wei Contractor Information:
Randy Phillips
Well Contractor Name
1096-A
NC Well Contractor Certification Number
A. E. Drillin g Services
Company Name
2. Well Constracliou Permit#:
Lisi all applicable,.,.,// permits (i.e. Co,mry, State, Variance, lnjectiu11, ~tc.)
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)
Dlnil!lltion
Non-Water Supply Well:
l!!!Monitoring □Recovery
Injection Well:
□Aquifer Recharge □Groundwater Remediation
□Aquifer Storage and Recovery □Salinity Barrier
□Aquifer Test DStonnwater Drainage
□Experimental Technology □Subsidence Control
□Geothennaf (Closed Loop) □Tracer
□Geothermal (Heatin g!Coolin1ot Return) □Other (explain w1der#21 Remarks)
4. Date WeU(s) Completed: 11 /7 / 14 we0 ID# IP-BV-3
Sa. Well Location:
Chemtronics
Facility/Owner Name Facility ID# (if applicable)
180 Old Bee Tree Rd. Swannanoah
Physical Address. City. and Zip
Buncombe
County Parcel Identification No. (PIN)
Sb. Latitude and Longitude in degree,i/minutes/seeonds or dedmal degrees:
(if well field, oue lat/long is sufficien1)
___________ N ______________ W
6. Is (are) the well(s): i;;tPermanent or OTemporary
7. Is this a repair to an emting weD: □Yes or e'.!No
Jf drill is a repair. _fill oul mo Kn well cmr.;tntetio11 informatio11 and e:cplai11 the natw"l! of the
repair 11nder #11 remark.< seaion or on !he back ofthi.v fom,_
8. Number of-wells conslraded: _1 __________ _
For m11/tip/r, i'!ir:clio11 or 11on-wt1te supply wells ONLY wUh tire same comlnlctu,n. you can
submit 011e fom1.
9. Total weU depth below land surface: _9_1_.5 _________ (ft.)
For multiple wet/.v /i.rl uJI depth< if differenl (example-3@2011' and 2@Jntf)
10. Statk water level below top of casing: _2_1_.9_6 _______ (ft.)
If water level is abrtve t:IISing. u.te "+"
l l. Borehole diameter: 6 {in.)
12. We11 construction method: Auger / Core
(i.e. augor, rotary, cable, direct push, e-tc-.)-----'---------------
FOR WATER SUPPLY WELLS ONLY:
13a, Yield (gpm) _______ Method of test: ______ _
I For Internal u.., ONLY:
14. WATER ZONES
FROM TO DE.'ICRIPTION
ft. ft,
ft. ft.
15. OUTER CASING lfor malti-ca!ed wells~ OR LINER l if eoolicable
FROM J TO DIA.'\t:l!TER THJCKNllSS MATERIAL
0 ft. 71.5 ft. 2 In. sch40 PVC
16. INNER CASING OR TUBING fveothermal cl08ed-loo-;;l
FROM TO DIAMflTl!R THICKNESS MATERIAL
ft. ft. in.
ft. rt. in.
17. SCREEN
FROM TO DIAMETER f SLOT SIZE THICKNESS MATERIAL
71.5 ft. 91.5 ft, 2 In. I .010 sch40 PVC
ft. ft. 1n. l
18.GROUT
FROM TO ~IATERIAL EMPLACEMENT METHOD & AMOUNT
66.5 ft. 69.5 ft. chips tremmle
0 ft. 66.5 ft. neat cement tremmle
ft. ft.
19. SANDIGRA VEL PACK If ••••!cable!
FROM TO MATERIAL EMPLACEMEN"TMETHOD
69.5 ft. 9 1.5 rt. #1 sand tremmie
ft. ft.
10. DRIL LING LOG lattlltll additional sheets If neceseanl
FROM TO o i;,;cRIPTIOS l 1:olor1 banlnc:s.s, 11,oil/~k h'Dt:. ll"'dln s•u. etc.)
ft. ft.
ft. ft.
ft. ft.
ft. ft.
ft. n-.
ft. rt.
ft. ft.
21.REMARKS
22. Certificmon: ,z~6 )ZL
Signature of C ;ficd Well Conllllctor
12/18/14
Date
By sigaing lhis Jornr, T l,ereby cenifj• that the well(s) KW (were) constn1cled in tl<!Corrlonce
11•i1h I 5A NCAC 02C _I/JOO or 15A NCAC 02C .0200 Well C011stnrctio11 Standards a11d that a
copy <if this record has /,ee,1 prnvided /Q the v...-11 owner.
23. Site <tiagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You. may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All WeDs: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells 01''L Y; [n addition to sending the fonn to the address in
24a above, also submit a Ctl!>Y of this furm within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Su pp lv & In fection Wells:
Also submit one copy of this form within 30 days of completion of
13b. Disinfection type: Amount: well construction to the county health department of the county where L..::::.====:...::~:..=======......:::::=:::.:-========:.J constructed.
FonnGW-1 North Carolin• Department of Environmen1 and Natural 11.esources -Division of Water Resources Revised August 2013
9. Total well depth below Nand surface:
WELL CONSTRUCTION RECORD
This Corm can be used for moue yr maniple wetly
1. Well Contractor Information:
Randy Phillips
VI ell Cantrector Name
109s A
NC Well Contractor Certification Number
A.E,Drilling Services
Company Naute
2. Well Constructive Permit IA:
List all applicable Irriperrniu lf.a. Canny. Safe, Vox/any. heatiSon, etc)
3. Well Use (check well use):
Water Supply Well:
❑Agrirniturai
❑Ceothermal (HeatingiC'.00ling Supply)
O lnduatda1tCom nercial
Obrigntion
✓ iMonicipaiJPublic
❑ Residential Water Supply (single)
❑Residential Water Supply (shared)
Not -Water supply Well:
glMcnitoring
o Recovery
Injection Well:
C1Aquiref Recharge
❑ Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
DGeathenmdl(Closed Loop)
DGeothumal I lcatineCooling Realm)
4. Date Weill(s) Completed: 11/13/1
5a. Well Location:
Chemtranics
❑Groundwater Rrsnediation
❑Salinity Beerier
RStonowater Drainage
❑Subsidence Control
[]Tracer
OOtrx (explain under #21 Remarks)
4 Wen ln# lP-BV-4
Facility:Owner Name Facility 1D F (ffappliicable)
180 Old Bee Tree Rd_ Swannanoah
Physical Address. City, and Zip
Buncombe
Cnwnty Parcel (dreathicat{nn No. (PIN)
5b. LAtittde and Loagittide in degrees/minutes/seconds or decimal degrees:
(ef well field, ale Itt1Ioog is SUR-1,,6cm)
N_
6. Is (are) the well(s): OPerraanent or CTemperrry
7. Is this a repair to in etihtii i well: °Yes or Rhin
if Mir ire repair, felt ant known rob ranarrrlrNan information and mrplultr the maim of the
report carder 4/21 rr+narks.src-eiv++ or urr the had of l Ir farm.
8. Number of wells constrteted:
For muhiple Irrjerelorr err aoq-waferRipply wells ONLY with the same con.Nr ictian.:vou can
sabwil anc form.
92 cm)
For osr ?k wells list all depths' If eielerenr►exarople-4 2O11'andgowil
ill, Static water level below tnp of casing 22.01
If water Ievel fx ahorr easing. urr ' •+
(IL)
tt. Borehole diameter. 6 [fa ]
12_ Well construction method: Auger 1 Core
i.e. auger, rotary, cable, ilftoCt push, ere.]
FOR WATER SUPPLY WELLS ONT.Y:
13a. Yield (gp i) Method of test:
13b. Disinfection type: _ _ Amount:
For InterteI clue ONLY:
14. WATER ZONES
PROM
TO
RESCRIPTION
►t.
&.
15.OUTER CASING (fartaalli-eased wells) OR LINER (RAp ty8lel
FROM TO DIAMETER f TTIICRIPIERS MA.
0 R' 72 H. 2 in- sch 40 PVC
16.INNFdt CASING OR TUBING (geothermal awed-Ionpe
Moat Ito
DIAMETER
TRICEPIEES
MATERIAL
n.
it.
ft.
1T. SCREEN
bL i
to.f
1
Ott I To
72 a• ! 92 tt.
BRACETER BRIT SIZE
2
i¢.
.010
taiciotEss
sch 40
MA'1Z RLAL
PVC
11.
18. GROUT
FROM
70
ARTERIAL
ASP Aa,,w rr iiirritOR & AMOUNT
67
n- 70
ft-
chips
Iremmie
0
tr. 167
ft.
nest cement
tremMie
R. It.
19. RAN DI GRAVEL PACK Of appRrshlel
PROM TO
MATERIAL
EMPLACE/4EnN&t9Oe
70
92
R
#1 sand
tremmie
ft.
R.
24 DRILLING LOG Iamb eddtttomnl data tt rreeasurr)
FROM TO MIWRIPITON (coiur. 4ordneas, soOraefc t?p.pvlu rtit, etc.5
re.
IL
1i.
(t.
it
fi.
rc
ft.
ft.
R.
R
f.
21.REMARKS
22. Certification:
12/18/14
Signature orCcrlifed Well Contractor lh[e
Br signing [his form, L hereby cur* that the mills) Wag (Were) constructed in acre: dance
with fMA NC4C 07C .0100 dr ISA NCte 02C .O400 WVdi Coortrsrchoe &urdurdr and Ara
ropy of t1 Ls recant fun berm prri wded to the %elf owner.
I3. Site diagram or additional well dersiia:
Your may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL. egsrucILOrS
24a. Far Ali Weil= Submit this form within 30 days of completion of welt
construction. to the following
Division of Water Resonreex, Information Processing Unit,
1617 Mai! Service Center, Raleig11,NC 27699-1617
24h. Fer Injection Weds ONLY: In addition to sending the form to the uddress ill
24a above, also submit a copy of this form within 30 days of completion of well
construction to the following:
DIvtsioe of Water Resources, Underground Injection Control Program,
1636 Mall Service Center, Raleigh, NC 27699.1636
24c. For Water Supply & Injection Wells:
Also submit one copy of this Form. within 30 days ofconviction of
well construction to the county health department of the county where
coastructed.
Form GW-I
North Carolina Departsisestt of Environment aid Nature! Resources - Division Di Water Resources Revised August 2i}13

WELL CONSTRUCTION RECORD
This Burnett be used for single or mubiple wells
1. Well Contractor Infw'tnnelon:
Randy Phillips
Weil Coenrcwr Name
1096-A
NC Woo CootractarCar4ffentian Number
A.E.Drilling Services
Company Name
2. Well Construction Pert #:
for &i,rrpff. tM.• nrllpe+wues {i.r. Catnip, Sfaea, VariascV kieViuur, reC./
3. Well Use (check well use):
Water Supply Weil:
OAgricuIIural
UCeothettnai (Heating/Cooling Supply)
❑ Industrial/Commercial
❑Irrigation
t7Municipal/Pubhc
❑Residential Water Supply (single)
°Residential Water Supply (shared)
Non --Water Supply Well:
rAMan;taring
E Recovery
Injection Wall:
°Aquifer Recharge
°Aquifer Storage and Recovery
❑Aquift:r Teat
°Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (I-lealing'Cooling Return)
❑Groundwater Rem ediation
°Salinity Barrier
QStartttwater Drainage
❑Subsidence Control
°Tracer
❑Other (explain under #21 Remarks)
For Internal Use ONLY:
14. WATER 7.0191<S
FROM TO
I
K
III ft.
l3. OUTER CASINO tfor mpirrsasiod was) OR LINER !Rap lisebleS
FROM TO mutt -raft 1 TN1CKNIMS MATERLAL
0 e- ,71 FL 2 in. sch 40 PVC
f6. INNER CASING OR TUBING (geothermal dosed -ism'
To
TGMETER VAC/MESS 1 MATERIAL
ff.
In.
ft.
17. SCREEN
PROM TO
71 it 91 ft
11. R.
OLMArrER , 3E07 E172
2 Ia, .010
ITOCENEEN
sch 40
18. GROUT
NATURAL
PVC
FROM
TO
MATERIAL
isrmApossitrir Mrrl1on £ AMQuirr
es
R.
69
chips
tremmie
66 tr neat cement tombs
li.
ft.
19, SAND/GRAVEL PACT{ Or applicably_
FROM ' TO 11IA'' RMAL
EMPLACEMENT METHOD
69
ft.
91
fL
#1 sand tremmie
ft.
ft.
ZQ DRILLING LOG (mach additional meets if necessary)
FROM 7O IW i (RIPT!O)Y icnkr. liarelners, so4rraeis nyre, rein slag, ego.
ft.
It.
4. Date Wel!(a) Completed: 91/10/14
5e. Well LLcelfee_
Chemtronics
WedT fi IP-BV-5
NCI lityfOwl Name Facility MP (ifappliesbkl
180 Old Bee Tree Rd. Swannanoah
Physical Askin .6. City, lip
Buncombe
County
Pam' Idcnrif cation No. (PIN)
9h. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if welt fifes, one GeilhMg is sufficient)
6. Is (arc) the wdl(s): 12Pernrrnent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or EiNo
litho is a rejvair_ fill oat bon n well raesrruclfar iaf.wria itar and erplein the nature of the
rt.pnk,urdrr 1121 +rrrr.rls ,section ar oa the bard o f this form.
8. Number dwells constricted: 1
Few multiply 6yeclloo Of inn -velar snppiy wefts ONLY ni1h the same ronshvrrian, lno run
sohnil one farm
9. Total well depth below land sorface: 91 (to
Formuitrpie wells fist ell depths.fdifirreut fi'xmmpin 34,12W1' aria O YI
it). Steak water level below top of casing: 22.1
If mart Intel es above raving, use "+
11. Borehole diameter. 6
12. WeB constructiaa method, Auger / Core
(fL)
S i.e. auger, rotary. etb1e, dten push. ate.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (Rpm) Method of test:
13b. Disinfection type: Amount:
ft.
1G
rt.
1t.
ft.
ft.
fL
ft
fL
21. BARKS
22. Certification:
size/owe or Well Coalmine
12/18/14
elate
Br signing Ale farm, r hoer*. eerikr that the wettfri twee (were/ conreritete d in accordance
with 15.4 NC,1C t[2c emu w /5.4 NC4C 02C.0200 mu Canraucttme Standards end that a
copy of this re..'.ml has Bern prowled to the ewli nrrtirvr.
23. Site diagram or additional well details:
You may use the back of Ibis page to provide additional well site details or well
conatt►tctioa details. You may afro attach additional pages if accessary_
SUBMITTAL IIKSTUCPIONS
24e. For All Wells: Submit this Form within 30 days of completion of well
consruction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mall Service Center. Raleigh. NC 27699-1617
24b. Fur Injection Wells ONLY: in addition to sending the form to the address in
24a above, also submit a copy of this Form within 30 days of completion of well
construction to the following:
Dhisien of Water Resources, Underground Injection Control Program,
1636 Mali Service Center, Raleigh, NC 27699-i636
24, For Water Supply & injection Wd19:
Also submit one copy of this Form within 3i3 days of completion of
well construction to the county health department of the county where
constnleted.
Farm OW -I
North Carolina Deportment of Environment
and Namur; Ravanrces - Division ai' Water Resourzcs
Revised August 2613

WELL CONSTRUCTION RECORD
This furm can be used for single or multiple wells
I. Well Co11tracmr lnformation:
Randy Phillips
Wdl Contracto< Name
1096-A
NC Well Contractor Certilicalioo Nwober
A.E.Drillin g Services
Company Name
2. Well Construction Permit#:
lisr all upp/icable well per,,.irs (i.e. Cormt,r, Stcrte, Variance, Injection, etc.)
3. Well Use (cheek well use):
Water Sapply Well:
□Agricultural □Municipal/Public
□Geothermal (Heating/Cooling Supply) □Residential Water Supply (single)
□Industrial/Commercial □Residential Water Supply (shared)
□Inigation
NOR-Water Supply Well:
~Monitoring □Recoveiy
Injection Well:
□Aquifer Recharge □Groundwater Remediation
□Aquifer Storage and Recovery □Salinity Barrier
□Aquifer Test □Stonnwater Drainage
□Experimental Techllology □Subsidence Control
□Geothermal (Closed Loop) □Tracer
□Geothermal (Heating/Cooling Return) □0ther(exp lainunder#21 Remarks)
4. Dare Well(s} Completed: 11/4/14 Well ID# MW279-M25CD
Sa. Well Location:
Chemtronics
Facility/Owner Name Facility ID" (if applicable)
180 Old Bee Tree Rd. Swannanoah
Physical Address, City, and Zip
Buncombe
County Parcel Identification No. (PIN)
Sb. Latitude am! Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, ooe lat/long is sllfficient)
___________ N ______________ W
6-Is (are) the well(s): liaPermaoent or □Temporary
7. Is this a repair to an existing well: □Yes ur l!lNo
If tl,is is a repair. fill orrt km>Mr well ctms1n,ctio11 informatiorr a11d e:rpfain the nature of tl,e
repair under #2 I remarks section or an rhe bade of this fonn.
8. Number of wens constructed; _1 __________ _
For multiple /11/eclltm or 11011-water supply well., ONLY with tire ¥Umt constractlo11, yo11 ca11
suhmil one form.
9. Total well depth below land surface: _9_3_.5 _________ (ft,)
Fa.-11111/riple wells li<t all dept/« !f<lifferenl ([e-mail]}' a,,J 2@1()/J')
10. Static water level below top of tasiog: ___________ (ft.)
ff water level is "bavecasing. us·e .. + ..
11. Borehole diameter: 6 (in.)
12. Well construction method: Auger / Core -----------------(i.e. auger, rotary, cable, direct pllllll, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) ______ _ Method of test: _______ _
13b. Disinfection type: Amount:
I For Internal Use ONLY:
14, WATER ZO-NES
FROM TO J1£SCRIPTION
t't. ft.
ft. ft.
1S. OUTER CASING-rfor molti--cased wellsl OR LffiER l if onnlfcable
FROM I TO I DIAMl!TEK THICKNESS I MA.TEll!AL
0 ft. 72 ft. 2 in. sch40 PVC
16. INNER CASING OR TUBING TvoothermaJ dosed-lo~
FROM TO DIAMETER THICKNESS MA.lERlAL
ft. ft. In.
fl. rt. in.
17.SCREEN
FROM TO DIAMETER I SLOT SIZE THICKNESS MATERIAL
72 ft. 92 ft. i 2 In. j .010 sch40 PVC
ft. n.1 lo. l
18.GROLIT
FROM TO MATERIAL EMPLACEMENT METHOD & AMOVNT
70 !'I, 67 ft. chips tremmie
0 rt. 67 ft. neat cement tremmie
0. ft.
19. SAND/GRAVEL PACK /if aunlirahlel
FROM TO MATERIAL EMPLACEMENT METHOD
70 ft. 93.5 ft. #1 sand tremmie
ft. ft.
20. DRILUNG r.or, (attaoh additional sheets lfnere!iSarvl
FROM TO DK~CRIPTIO.X (color, hardnn!L soil/rock f\'11~. era.in size, de..)
ft, ft.
fl. ft.
ft. ft.
ft. ft.
ft. fl.
ft. ft.
fl. fl.
21.REMARKS
22. Certtru:ation;
Zv~r£/,_ 12/18/14
sign,,!~ Well Conttactor Date
B)' signing rl,is fo,'fll. I hereby cen!Jj• tlral the wel/(s) ,..as (wem) constructed in accordance
with 15.A NCAC 01C .0100 or 15A NCAC 01C .rJ10() Well ConstrlJctio,r Sta,rdards and tlrat a
copy oft/Ifs record /,as been provided to the well ow11er.
23. Site dlagr11m or additiolllll well details:
You may use the back of this page to provide additional well site details or well
construction de1ai1s. You may also attach additional pages if necessary.
SUBMITTAL lNSTUCilONS
24a. For All Wells: Submit this fonn within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For bijection Wells ONLY: In addition 10 sending the form to the address in
24a above, also submit a copy of this fonn within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, .Raleigh, NC 27699-1636
24c. For Water Su pply & Injection Wells:
Also submit one copy of this form wilhin 30 days of completion of
well construction to the county healrh department of the county where
constructed.
FormGW-1 North Carolina Department of Environment and Natwal Resollfce• -Division of Water Resources Revised Augusr 2013
WELL CONSTRUCTION RECORD
This form can be used for aitiglu or multiple well.
L Well Contractor Iefarm tioa;
Randy Phillips
Welt Cantm. tar Hams
1096-A
NC Weil ContractorCartifictt:an Nitaahir
A.E.Drilling Services
Company Name
2. Well Construction Peron#: _
Lis$ all applicable well permits (i.e. Camay, State, iai ek (*Mon. etc.)
3. Well Use (check well use):
Water Simply Well:
❑Agricultural
°Geothermal (Heating/Cooling amply)
[I industria t1Com meet: ins
❑krigation
Nee -Water Supply Well:
121h4on=toring
OMunicipallPnhlic
C Residential Water Supply (single)
CIRes idenli al Water Sttppty (shared)
°Recovery
Nestle Well:
DAquifer Recharge
❑Aquifer Storage and Recovery
ClAquifer "lest
❑Experimental Technology
❑Cxottacrrnal (Closed Loop)
❑Geothermal (HcatingiConling Renato)
°Groundwater Remediatlon
°Salinity Barber
RStormwater Drainage
❑Subsidence Control
DTr cer
❑Other (explain under #21 Remarks)
4,Dem well(s) Completed: 11/19/14 wenwo MW280-M26CD
5a. Waft Location:
Chemtronics
Facility/Dwner Name
Facility IDA fif applicable)
180 Old Bee Tree Rd. Swannanoah
Physical! Arida:at, City. and Zip
Buncombe
County Pared Identification Ma. (FIN1
Sh. Latitude sad Longitude 6o degreeslmintueslsecondh ordecimal degrees:
(if well field, one tat/long is sufficient)
6. is (are) the wells): RiI'ermanent ur ❑Temporary
7. Is this a repair to en existing weak LiYes or Putter
If this is o rrp.i r, fill oar blow) well currsirr Irian inforaratiaod arid exploit' the nraurc lithe
repair under p21 remarks or au the back Oakes farnr.
S. Number of wells constructed: 1
Far multiple Merriam or nan-w ter supply w•elL. ONLY with der some wnsowerian, yak ran
,both one/neat
9. Total well depth below land surface: 92-5 (rt.)
Far m ultiple t.rllx lire oft depths if dWnmenr leaalo llr 3efil P0' and 2(g100')
IQ. Static water level below tap of casing: 20.25
jf watrer level it abore treeing, use "+"
(ft.)
11. Borehole diameter. 6 (la.)
12. Well constraclion method: Auger / Gore
(l.eauger, rotary. able. direct push. atc.l
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of teat:
13b. Dlslnfectlon type: _ Amount:
Fur Internal use ONLY:
14. WATER ZONES
mom nagottritcos
et. R
it. a.
i5. OUTER CASING tear multi -cased wells? UR LINER of aavticttble
FROM
TO
EMAMEIBR 7t1ICKMESs
MATERIAL
0 ft
72.5 s'
2 in. sch 40
PVC
16. INNER CASING OR TUIBINGjsatherma1
closed -lamp)
FROM f ro
r nusirrut T nitanNrss 1
MATERIAL
R,
17. st ztEF.?I
FROM To
72.5 IL 192.5 It-
2
la.
BLOT WEE TI;Y MOMS MAARRIAL
.010 sal, 40
PVC
11 It.
in.
IL GROUT
MOM ; TO
MATERIAL
EMPLACEMENTMET9lidaamen
166
R, 89
chips
tremmie
0
66
fL
neat cement
tremmie
19. SANDIGRAVEL PACK ill applicable)
FROM
69
ft-
To
92.5
M
#i sand
PLACEMENT J 1EToan
tremmie
ft.
20. DRILLING LOG (attach addltiaral sheets if memory,
FROM rn I DrNk w inrmv taller. hsredcn, adtrnea tyyt. grain stir. ercf
a.. rr.
R, h.
R. rt.
21. SI$IMARKKS
22. Certification;
12116/14
Sigoatum of ' • ' +cd cl! Contactor bate
2;y signing this forat. l herriiv rent rho+ the kd/(s) was fit 'rc) coamvrted in arcnndance
with 154 )1c4C 02C.0100 or 1.14 NC.€C' OZC .000 Writ Cur srri.crion Standards erns that a
4—WY of this' reran, hay barn provided to rho well awnrr.
23. Site diagram or additional weft details:
You may use the buck of this page to pmvidc addiriarul well site details or well
comma:lion details. You may also attach additional pages if necessary
sUBmITTAL lINSTUCTIUNs
24a. for All Was: Submit this form within 30 days of oompietion of well
construction to the following:
DI -vision of Water Resources, Information Processing Unit,
1617 ;visa Service Center, Raleigh, NC 27699-1617
24h. For Injection Wells ONLY: In addition to sending the form to the addrtet in
24a above, also submit a copy of this Form within 30 days of completion of welt
construction to the following:
Division of Walter Resources, Under'groand Injection Control Program.
1636 Mail Service Center. Raleigh, NC 27699-1636
24c. For Water Sulipfr & �ecdun wens:
Also submit ono copy of this fans within 30 days of eompletiou of
well consrniction m the county health department of the county where
constructed,
Faun G W .1
North Carolina Department of Environment and Natural Resources —Division of Water Rcteurces Revised August 2013

Geosyntec'
consultants
Y V
RECE1VEDIDENRIDWR
JAN 0 9 2015
Water Quality Regional
Operations Section
TO: Michael Rogers 1 MC Program DATE: January 6, 2015
COMPANY Division of Water Resources PROJECT NAME: Chemtronics
1636 Mail Service Center PROJECT NO.: GR4943.07.7.6E
Raleigh, NC
27699-1636
TRANSMITTAL
® ENCLOSED
❑ UNDER SEPARATE COVER
VIA:
❑ MP.SSENGER
❑ FIRST CLASS MAIL
❑ SPECIAL DELIVERY
❑ AIR MAIL
® FEDEX
❑ FOR APPROVAL
® FOR YOUR USE
® AS REQUESTED
❑ APPROVED
O APPROVED AS
NOTED
ACTION:
❑ RESUBMIT
O RETURN CORRECTED
PRINTS
❑ FOR COMMENT
NO. OF
COPIES
DWG
NO.
DESCRIPTION
DATE
1
Well Construction Records for Injection Summary Forms (Permit #
WI0100230) submitted in December 2014
various
REMARKS:
COPY TO:
1255 Roberts Boulevard, Suite 200
Kennesaw, Georgia 30144
FROM: Benjamin Amos

WELL CONSTRUCTION RECORD
t his bona CUP be used for single ar mutt lore wells
1. Wei Contractor Information:
Randy Philips
Welt Contrpcmr Name
1096-A
NC Well Contactor Csrtifrcacion Number
A. E. Drilling Services
Company Name
RECFIVFD/DENR/DWR
JAN 0 9 2015
Water Quality Regional
Uperattons Section
2. Well Construction Permit #_ - -
Lao all appYacahle writ permits (Le. Carus}. State. Varioner, 7rgeaion. dr j
3. Wctl Use (check well use):
Water Supply Well:
❑Agricultural
❑ Geothermal (Heating/Cooling Supply)
❑ rndustria (/Commercial
C1lrrigetion
QMunicipalfPubtic
❑ Residential Water Supply (single)
°Residential Water Supply (shared)
Non -Water Supply Well:
OMonitoring
❑ Recovery
Injection Well:
❑ Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑ E perimoral Technology
fJGeethermat (Closed Loop)
❑Groundwater Remediation
❑Salinity Barrier
❑Stormweter Drainage
❑Subsidence Control
DTracer
DGeothesmat (Heating/Cooting, Return) ❑Other (explain tinder N21 Remarks)
12-20-2011 MW227-J39EF
4. Dave wells) Completed: Well 1D#
5a. Well Location:
Chemtronics
Facility/awed Name
180 Ols bee Tree Rd.
Pack( IDS (ifapplirahle)
Fhyricat Address. City. and Zip
Buncombe
County Parcel idensi$ce[ion No. (P1N)
5h. Latitude and Longitude in degrees:Minotea/seconds or decimal degrees:
(if well Field, one lettlung is suWirieat
N W
6. is (are) the we➢(a): 2Permaoust or °Temporary
7.1s tide a repair to an existing well: °Yes or FIMo
If this is a repair, fill are faunal weal coostrucnon 1n(ormare n auderptatn rhenature of the
repair ender N2l remmicc section or aa; the (nick of this form_
S. Number dwells constructed: 1
Nor meHrple Peecriwr or non -water supply wells Q) WY with the sonar cnrrsrrncttoa. you can
solved ooefvr &
9. Total well depth below laud aurfacC 142 (ff.)
For rrcolriple rwJk Nat all depths if dif:rrur [example- 3g0700' and 2{Jl0p't
ill. Static water levet below top of casing:
.fjivererievel is above analog, cur "+ "
11. Borehole diameter: 12/8 (in.)
12. Well construction method: Mud / Air Rotary
{i.e. auger, rotary, cent. diced pad+, ere.)
FOR WATER SUPPLY WELLS ONLY:
13n. Yield (gpm) Method of teat;
13b. Disinfection type: _ _ Amount.
Form 0W-1
For Internal Use ONLY:
14. WATER ZONES
FROM
R.
To
rt.
LESCRIPTI0N
R.
It.
15. OUTER CASING Mir multi -ruled walls) OR LINER (ifswats)
FROM tap PL1M67ER 7111000K&S 1 MAMMAL
0 (1• 45 IL 8 a .322 1 Steel
16.I1' NER CASING OR TUBING rxentiermal claeed-loepl
FROM t 70 arAa1ETER
xslciancos
14A17tIAL
0
122
D.
I1.
ft.
4
in.
a.
sch 40
PVC
17. saucer
SR02d TO
142 R• 122 fL
R. ft.
MAdtIC=
In.
SLOTIAZg
.020
In.
THICKNESS
sch 40
adall6 tIAL
PVC
18. GROUT
aaom r -re
r
i ta-
r
- 3 l li C -x 4—
2
j 1
UNOttral
In
22. Certification:
1 /6/2016
Signature of9'eel led Walt Contractor Date
Ey Arles thks form, I hereby crnQ that the weeks) imos (were) minima's() la accordance
with 1SA NCAC 02C.0100 or 15A JVC4C t2C.a200 Wall Coxsarwi oar Srarrduds and char a
mpy of this record kas keen prauidad 1a the well orttrcr.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pagmi if necessary.
SLlBMITIAL INSTUCTIONS
24a. Fur Ail liteIll: Submit this form within 30 days or completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center. Raleigh, NC 27699-1617
24b. For Infection WeilrONLY_ in ndditinn to sending the form to the address in
24aabove, also tubntil a copy of this form within 30 days of completion of welt
constnlotion to the following_
Division of Water Resources, Underground injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & lnjecttao Wells:
Also submit once copy of this form within 30 days of completion of
well construction to the county health department of the county where
constructed.
Norm Carolina Depart -roam of Evritvnroeaat aid Nasal Resources - Division of Water Resources Revised August 1013

WELL CONSTRUCTION RECORD
firm r..e Fti wni Pig.wkie nx nluh plc ..c1 Ls
1. Well Contractor information:
Randy Phillips
Wen Contractor Name
1098-A
NC WO) Cnntractgr CcrtiFicaTivn Number
A.E.Drilling Services
Company Name
1. Well Construction Permit it:
LW all applicable mil permits rle, Cuwasy. Sae; Voricencre. ) lec*ioii. am".
3. Well Ilse (check well use):
Water Supply Well:
DAgricuitural
❑Geothermal (Heating/Cooling Supply)
Q lnduslrial/Cammercial
I°Irrigation
°Municipal/Public
°Residential Water Supply (aitlglc)
DResidenlial Water Supply (shared)
Non -Water Supply Well:
Monitoring
rilteoavwy
Injection Well:
❑ Aquifer Recharge
flAquiter Stirage and Recovery
°Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loopy
°Geothermal (Wining/Cooky Return)
❑Groundwater Reined iation
❑Salinity Barrier
QStortnwater Drainage
❑Subsidence Control
❑Tracer
QOthcr(cuplain wider #21 Remarks)
4. Date Weli(s] Ctirmpieted: 8/23/13 WtUID# MW246-J36C❑
5e. Wen Location:
Cherrltranics
Facility/0w1sr Name
Facility lop (if appticabI )
180 Old Bee Tree Rd. Swannanoah
Physical Address, City, end Zip
Buncombe
County Paacel identificeliaa No. (PIN)
Sh. Latitude and Longitude in degreea/nalnutcalsecouda ter declaim! dew:
Orwell field, toe ha/one is safieiera)
N W
6. is (are) the wcll(s): FEIPermatrent or °Temporary
T. Is this a repair to en existing wen: ❑Yes ur i'3No
{ill* fan repair. fir! ow kimono wall consrr+rcrioi information and erpialo the noire of the
repair Peeler ii2I rrmm *s section or on the buck of thin Jaw m.
1� Number of wens constructed: 1
Far multiple Injection or now -wrier supply Wefts ONLY with the some oons+ruclion. ran ran
Slibfnit one farm.
9. Total well depth Wow land surface; 96-5 (ft.)
Far multiple wells itst oft depths if di erear (example- 3{(d00' and 2 ialY)
14. Static water level below tip of casing: {fY.]
!Twofer level is nose owing, use "+
11. Borehole diameter_ 8 (in.)
12. Well eonstmetian method: Auger / Core
(i.e. auger, rotary, caste. diron push. err,}
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) _ Method of teat:
I3h. Disinfection type: Amount;
For internal Use ONLY:
14. WATER ZONE
FROM
ft.
TO
DESCRITTKPir
L5 OUTER CARING for nc111-cooed w.W) OR LINER Of apnikalgei
DIARY 6R THICIENti9 J MAYtftIAL
0 rt. 81,5 rt- 2 Iw sch 40 I PVC
FROM
TO
1b. INNER CASING OR TURING Hts4462rrsal doted -loopy
FROM
rt.
TO
ft.
DIAMETHH
ia.
THICKNESS
MATERIAL.
n. R.
is
17. SCREEN
FROM
TO
nlAMErEa I SLOTalrEiinorarros
111ATCEtAL
81.5 IL
96.5 n•
2 m. ! .010
R
IL
sch 40
PVC
1S. GROUT
FROM TO
75.5 n-
78.3 fL
MATERIAL EMFYACTAIRNFMETHOD &AMOUNT
chips tregnmie
0.
ft.
75.5 rt
neat cement
tremmie
ft.
n:
I9,SAN1)IGRAVt L PACK Of applicable)
PROM TO MATERIAL
78.3 it i99,8 n.
#1 sand
RAMrr.ACoMEMr METHOD
tremmie
20. DRQ.LING LOG (attach additional sheets if imagery)
TO DOCILE F. TrCIN +rnlor, marmlru. tolYrork rrpylr1Im Ike, sic.)
ft.
R.
fr.
n.
n.
11. RF.hIARICS
f
22. Certification:
12)18114
Sigrma= of bed Well Connector Date
Hy sigwf+tg rids farm. f hereby c+arr* rat Ike eels) xnr (were) cansalrrred In accordance
xshk 1.5.1 NCAC 02C.U100 or ISA NCdC 02C.040 We Cons7mrOon 5,anndard9 and that a
now of this record has been provided to the well owner.
23. Slte diagram or additional welt details:
You may use the hock of this page to provide additional well site details or wail
construction details. You may mist" attach additional pages if necessary.
SUBMITTAL LNSTIJCTUONS
14a. Fur A11 Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Precasting Unit,
1617 Moil Service Center. Raleigh NC 176994617
24b. JroInfection Weill ONLY: In wlditiou to sending the forin to the address in
24.aabove, also submit a copy of this form within 30 days of compietiun of well
co*Stnacthai to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mall Service Center, Raleigh. NC 27699-1636
24c. Fur Water Supply & lajeetfost Wells:
Also submit one copy of this form within 30 days of completion of
well cdnstructirm to the county health department of the county where
ccn5lri:ctsd.
Form GIY-1
North Carolina Depamaens erEmtironment and Nattett Resource - 0iriaio111 of Water Resources
Revised Angara 20l3

WFr•r. CONSTRUCTION RECORD
This Fmm can be used for simile o multiple wells
i. Wen Contractor Information:
Randy Phillips
Well Cormartar tame
1096-A
NC Well ConSalOr Coldficnliaa Number
A.E.Drilling Services
Company Name
2. Weil Couatrvetion Permit #:
Uri nfl applicebk emit permits (I.r_ Carinry, Stater. Vmiemx, illig Ii a. rte.)
3. Wen Vat (cheek wen use):
Water Supply Wen:
❑ Agricultural
IXiooths tonal (Heating/Cooling Supply)
° Indastrial/Commercial
❑hrigatian
Non -Water Supply Well:
Rivkn:toting
O Municipat/Public
D Residential Water Supply (single)
0 Residential Water supply (shared)
O Recovery
Injection Well:
°Aquifer Recharge
°Aquifer Storage and Recovery
UAquifer Test
I:Experimental Technology
DGeotheanal (Closed Loop)
❑ Ocotbcrmal {LleatioE.'Cooline Renim)
4. Date Well(a) Completed: 8•-20-13
So. Wee Location:
Chemtronics
Facility/Owner Name
180 Old Bee Tree Rd.
❑Groundwater Retnedisiion
]Salinity Harrier
❑Stor:ttwater Drainage
❑ Subsidence Coottnl
❑Tracer
gOther (explain under #21 Remarks.
wen Bo MW249-J36CD
1'ac[lity IDD#tfeppffatblal
Physical Adams. City. and zip
Buncombe
For finem! Use ONLY-
14. WATER 2UNE,4
PROM
TO
DESCRIETTON
11.
ft.
It.
n.
IS. OUTER CASING tMirita1d-timed rrelb} o1R LINER Uf lip Ikabre}
FROM TO ptAMETEtt TH1dLNESS MATERIAL
0 IL189.5 ft2 lg. I sit 40 PVC
16. INNER CARING OR T RING iathermal dosed-1oop1
FROM
TO D AMET P. TFILERNESS
MAMMAL
h
it.
it,
R.
17,SCREEN
FILMS l To
69.5 R. 84.5 rt
it.
1$. GROUT
FROM -
TO
Ia
id.
DIAMETER S3.01SIZE
2
la.
in.. I
MAT ERLA4
.010
THICKNESS
i sob 40
MATERIAL
PVC
EMFLArrameT METHOD& AMOUNT
64
ft.
67
ft.
chips
tremmie
4 n, 64 R.
neat cement
tremmie
ft. R.
L
14. SAND/GRAVEL PACK PFyv1kceb1el
FRrrM TO MATERIAL
67 f° 84.5 n• #1 sand
ENFLALE .mr'il METHOD
tremmie
rt. r6
10. ARII.1.tNG LOG (attach eddtdowt.heeh iraacaanry)
TO &ESCRirtIO% ceotoe krrdrtwr warm&Erype, polo ssrc, etc4
FROM
Fl.
iG
ft,
rt.
t.
[t.
rt.
rt.
rt.
n.
11.
2L REMARKS
County Parcel Wcmrificsciom No. [PIN)
5b. Latitude and Longitude in degreeslasttoteslacconds nr decimal dogma:
(if well field, one ]xtlluug rs sudheienny
N W
6.1a (lire) thewef(s): BPerm:meat or ❑Temporary
7. la this a repair to an exts[fng wen: DYer or lNo
Oft ea a repair. JTrf oar t rvnr Wet ronrstnrcliarr Itrjar nudes. and explain the Honor ofihe
repair ender 021 remark, section or nor die back of ibis fame.
8. Number nfvietls constructed:
Por multlptr l+jeclion or Iron -wafer anrppfy wctfr ONLY the were cnnctrrrdien, yea Tarr
submit nrre fora.
1
9. Total wen depth below loud surface: 84.3 (fL)
Farerrarriptewells list all drinks irdfrool(¢[e-mail], 3[aillif)
16. Static water level below top of easing: (ft.x
j1• eater bunt u above rasing r.sr "+"
1L borehole diameter: 8 an-)
12, Well construction method: Auger Core
ii.r. auger, rotary_ eabk. direct push, etc)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm)
13h. Disinfection types
Method of test:
Amount:
Form GW-I
22. Certification:
/2118/2014
Sigma:1m of Cea ficd Weil Contractor Date
ap sighing this fwror, it hereby cerrifr Mei Me well(r) arts (were) constructed it eceordorrs
with J3 L NCAC 02C.tilfd or 15,4 NCAC 01C MOGI iiaU Coi tmictiou Marrdards mod Mar rt
copy of e51s record has hem provided M Mc Holt °mar.
23. Site diagram or additional welt details:
You may use the hack of this page to provide additional well site details or %tit
construction details. You may also attach additional pages if necessary_
S UB_MITTAL INSTILC (IONS
24a. For An Wells: Submit this form within 30 days of completion of well
construction to the following:
D}vision of Water Resources, laforunition Processing Unit,
1617 mil Sennee Center, Raleigh, NC 27699-1617
241.. Fur Wierhn Wells ONLY: la addition to sending the form to the address In
24e above, nitro submit a copy of this Conn within. 30 days or completion or well
construction to the following.
Divisions of Water Resources, Uudergratmd Injection Control Program,
1636 Mall Service Center, Raleigh, NC 27699-163i
7..4c. For Water Supply & injecdoa Weis:
Alan submit one copy of this form within 30 days of completion of
well construction to the county health dcpttltmettt of the county where
constructed.
North Carolina Deportment or Environment and Natural Resources — Dieia;arof Waver Resources Revise] August 2G13

WELL CONSTRUCTION RECORD
This Form can be esed Tor age or multiple wells
1. Well Contractor Information:
A 17?,
Weg Contrec nt Name
35-7 /
NC We1i Coaaawm Certifiratien Number
I.J r,ii•Stl
Company Name
2. Weil Construction Permit ft:
as an apphcubfe well penults (l,e. Ca<mry, Slane, Variance, Injection, ere)
1 Wall Ilse (check well use):
f Water Supply Well:
❑Agricultural
©Geothermal (Heaiing/Cooling Supply)
❑ Indust riallComrnercial
❑ ni. lion
Nen-Water Supply Well:
0"Annitoring
°MunicipaVFubHc
❑Residential Water Supply (siagir)
LiResidenhal Wane' Supply (shared)
LIRecovery
Injection Weil:
°Aquifer Recharge
DAquifer Stooge and Recovery
°Aquifer Test
❑Experimental Technology
[Geothermal (Closed Loop)
4. Date Weil(s) Completed: 1-
fin. Welt Location:
Faeilirethener Name
0Groundwater Remediatiea
❑Salinity Barrier
IJStomiwater Drainage
0Sobsideno8 Control
°Tracer
13eothemsal (ABaftq 001iRg RCtum) ClOther ca tplaLi under #21 Ramada)
Weilwrf)G)-r?78-14
Pee -Airy 1D (IFam7:Whir)
Physical Address, City, and Zip
County Parcel identification No. (PIN)
Sh. Latitude and Longitude io degreeFs/minutes/seconds or decimal degrees-
(if well field, ens let/ong a auFfieteat)
]v - W
S. 1s (are) the weli(s): f rermaueat oc f7Temporory
7. Is this a repair to on existing well: El or L3;tia
if this it a impair, fill our loiawn weltcorsxhurrron infer union and txplahr the nature of a6e
repair ruiner 01 ncnarks mction eren the bock of liazfotas.
8, Number of wells constructed:
Far multiple utfertian or oar-watersuppfy wefts War ens saw roosrruclian, you eon
!Libel a olrafaar. 9. Total well depth below land surface: 117 • S (rt.)
For nudetple wefts list all depths ((derma' (erased le- 3 t1A' and 2T3I101
l8. Static water ]eve] below top of casing: A44 (ft)
If sower loaf Is above casing, use "+"
U. Borehole diameter: rh! (114)
12. Well construction method: Idwa o. i d , ( ct e ti
(i.a cages, retary, cable, direct push, err) `_
FOR WATER SUPPLY WELLS ONLY:
13a, Yield (gpm) Method of tart:
13b. Disinfection type: Amount:
Form GW-I
For Internal. Use ONLY'
14. WATER. ZONES
$7.011
rt.
nzsLRurrIOP!
A.
n.
B. OUTER CASING/for meltl-cased wens) OR LINER (f ap�Hyrable)
PEON
TO
DIAMLm.R II0C1SStl:ss i M T R .L
lt.
n.
In.
]
16. 1NNER CASING OR TUBING [reothermal eloredaoop)
PROM 7O r DLAMET6R 'Beier 6SS I ataTERIAL
11. ft. la.
ft. ft.
in.1
17. SCREEN
PROM TO
rs n, 1!5
R. lG
D!AM1tTt SLAT MI
T 7tactonns
t
Z. ut. r I tf
fn.
la. GROUT
FROM . -70 hioamRL 1. P914PLACENIMT ite$tHOD & AMOUNT I
ft,
i ft. 1 I.
MATERIAL
_Pk
IL
tl.
19. SMWIGRAYEL PACK or appika&le)
FROM TO 1 MATERIAL
a' ft'
1 It.
FAIPiACRi2ENT METHOD
tit
7E DRILLING LOG week Wale oat sheets ifnectar/ try)
FROM TO A>! SC airrrto. tors taardanrimnlna rue.. yara arse, eft!!
It.
tt.
it
ft.
iG
n.
It.
ft.
21. REMARKS
22. Certification:
,,
/�/:-
4 _ 3- 2(-;
siV 1We o Certified eft .h u Date
By s(gdtng this form, I herrky cergo their the wage) war (were) constructed in cccnrrlence
wdth iSd IVC'AC 02C.61913 or ISA IVC4C 02C .f1.WI fVst1 consysrcltan Standards and Char a
coop of this second has dean provided is the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
conwtruotion details. You may also atmek additional pages if necessary.
SUBNITI TAL E ISTUC770NS
24a. JrlbABWeili Submit this forth within 30 days of completion of well
construction to the following:.
Division of Water Realm rat, Information Processing Unit,
1617 Mail Service Center, Raleigh. IVC 27699-1617
24b. For Infection Wells ONLY: In addition to sending the form to the address in
24aabove, also submit a copy of this forrn within 30 days of completion of wet[
construction to the. following:
Division of Water Reno urce1, Underground Ia}ection Control Program,
1636Mail Service Center, Raleigls, NC 27699-1636
24c. For Water Supply & Inieetiun Wells:
Also submit Doc copy of this form within 30 days of completion of
well construction to the county health department of the county where
constructed.
North Camllna l]epartraenl of Environment and Natural Resoureea - Diviaten of Water Renounces Revised August 2013

RECEIVED/DENR/DWR
Geosyntecr
consultants Water Quality Regional
Operations Section
TO UIC Program DATE: December 10, 2414
COMPANY Division of Water Resources PROJECT NAME; Cherntronics
1636 Mail Service Center PROJECT NO.: GR4943.07.7.6E
Raleigh, NC
27699-1636
TRANSMITTAL
® ENCLOSED
❑ UNDER SEPARATE COVER.
VIA:
❑ MESSENGER
❑ FIRST CLASS MAIL
❑ SPECIAL DELIVERY
El AIR MAIL
• FEDEX
0 FOR APPROVAL
® FOR YOUR USE
❑ AS REQUESTED
❑ APPROVED
❑ APPROVED AS
NOTED
ACTION:
❑ RESUBMIT
❑ RETURN CORRECTED
PRINTS
❑ FOR COMMENT
NO. OF
COPIES
DWG
NO.
DESCRIPTION
DATE
1
Injection Summary Forms for Permit # WI0100230
Dec. 10,
2014
REMARKS:
COPY TO:
1255 Roberts Boulevard, Suite 200
Kennesaw, Georgia 30144
FROM: Benjamin Amos

INJECTION EVENT RECORD
RECEIVED/DENR/DWR
DEC 1 2 2014
North Carolina Department of Environment and Natural Resources-Division of Water ~RWGaality Regional
Permit Number WI0100230 Operations Section
1. Permit Information
Chemtronics Inc.
Permittee
Chemtronics Superfund Site, DA 23/B116 Area
Facility Name
180 Old Bee Tree Road, Swannanoa, NC 28778
Facility Address
2. Injection Contractor Information
Geosyntec Consultants of NC, P.C.
Injection Contractor/ Company Name
Street Address 1255 Roberts Boulevard, Suite 200
Kennesaw GA 30144
City State Zip Code
~ 202-9507
Area code -Phone number
Were any wells abandoned during this injection
event?
D Yes IE] No
If yes, please provide the following information:
Number of Monitoring Wells _____ _
Number oflnjection Wells. _______ _
Please include a copy of the GW-30for each well
abandoned.
4 . Injectant Information
Fluorescein (MW246-J36CD); Eosine (MW249-J36CD);
Rhodamjne WT(MW278-136D)
Injectant Type
Concentration 6050 mg/L; 5660 mg/L; 5045 mg/L,
respectively
If the injectant is diluted please indicate the source
dilution fluid. Fire Hydrant
Total Volume Injected_-=-9-=-0=-0 -=L'-------
(
3. Well Information
Number of wells used for injection -=3 ___ _
Volume Injected per well
5. Injection History
300 L (MW246-J36CD), --.. "I 0&
240 L (MW249-J36CD) :; {p "J 1 ~
360 L (MW278-136D) -~ q:; 1~
Well names MW246-J36CD, MW249-J36CD,
MW278-136D
Were any new wells installed during this injection
event?
D Yes IE] No
If yes, please provide the following information:
Number of Monitoring Wells _n_o;;_n-'e ___ _
Number of Injection Wells __ n_o_n_e ___ _
Type of Well Installed (Check applicable type):
D Bored D Drilled D Direct-Push
D Hand-Augured D Other (specify) __ _
Please include a copy of the GW-1 form for each
well installed.
Injection date(s) November 3 and 24, 2014
Injection number (e.g. 3 of 5)._=-1..,.,o_,_f-=-1 ___ _
Is this the last injection at this site?
D Yes [R] No
I DO HEREBY CERTIFY THAT ALL THE
INFORMATION ON THIS FORM IS CORRECT TO
THE BEST OF MY KNOWLEDGE AND THAT THE
INJECTION WAS PERFORMED WITHIN THE
STANDARDS LAID OUT IN THE PERMIT.
~~~o~~
IGNAllE OF INJECTION CONTRACTOR
12/10/I 1/
DATE
6'°.e"'-\c:tn-t•i,.. t<--. Amos ,A/c:.. Pt-#--O 'It 2.l'j
PRINT NAME OF PERSON PERFORMING THE INJECTION
Submit the original of this form to the Division of Water Resources within 30 days of injection.
Attn: UIC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-807-6464
Form UIC-IER
Rev. 8/5/2013
INJECTION EVENT RECORD
RECEIVED/DENR/DWR
fEC 12 2014
North Carolina Department of Environment and Natural Resources — Division of WaterWmuffIliy1 Regional
Permit Number WI0100230 Operations Section
1. Permit Information
Chemtronics Inc.
Permittee
Chemtronics 5uperfund Site, 8104 PTA
Facility Name
180 Old Bee Tree Road, Swannanoa, NC 28778
Facility Address
2. Injection Contractor Information
Geosyntec Consultants of NC, P.0
Injection Contractor J Company Name
Street Address 1255 Roberts Boulevard, Suite 200
Kennesaw GA 30144
City State Zip Code
( 678) 202-9507
Area code — Phone number
3. Well Information
Number of wells used for injection 1
Well names MW227-J39EF
Were any new wells installed during this injection
event?
❑ Yes ❑x No
If yes, please provide the following information:
Number of Monitoring Wells none
Number of Injection Wells none
Type of Well Installed (Check applicable type):
❑ Bored ❑ Drilled ❑ Direct -Push
❑ Hand -Augured ❑ Other (specify)
Please include a copy of the GW-I form for each
well installed.
Were any wells abandoned during this injection
event?
❑ Yes x❑ No
If yes, please provide the following information:
Number of Monitoring Wells none
Number of Injection Wells none
Please include a copy of the GW--30 for each well
abandoned.
4. Injeetant Information
Sodium Bicarbonate; Sodium Lactate KB-1 Plus®
Injectant Type
Concentration 325 mg/L, 3240 mg/L, 0.03 %v/v
If the injectant is diluted please indicate the source
dilution fluid. extracted groundwater
Total Volume Injected 9,577 Gallons
Volume Injected per well 9,577 Gallons
5. Injection Hlstary0ct. 20 to Nov. 7, 2014
Injection date(s) and Nov. 24 to Nov. 27, 2014
Injection number (e.g. 3 of 5)Continuous injection
over the reported period
is this the last injection at this site?
❑ Yes ❑x No
I DO HEREBY CERTIFY THAT ALL THE
INFORMATION ON THIS FORM 1S CORRECT TO
THE BEST OF MY KNOWLEDGE AND THAT THE
INJECTION WAS PERFORMED WITHIN THE
STANDARDS LAID OUT IN THE PERMfr.
SIalA1 RE OF INJECTION CONTRACTOR DATE
PRINT NAME OF PERSON PERFORMING THE INJECTION
Submit the original of this form to the Division of Water Resources within 30 days of injection.
Attn: 'RC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-807-6464
Form UIC-IER
Rev. 8/5/2013

INJECTION EVENT RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Resources
Permit N um WlO l0.023 ___ _ _ ______ _
l. Permit Information
·Chemtronics Inc.
Permittee
Chemtronics Superfunp Sitg, 8105:139 PTA
Facility Name ----
180 Old Bee Tree Road, Swannanoa, NC 28778
Facility Address
2. Injection Contractor Information
Geosy ntec Consultants o( N,CJ P:C.:.. --·-----
Injection Contractor/ Company Name
Street Address 1255 Roberts Boulevard, Suite 200
Kennesaw GA ---------------City State
( 678 ) 202-9507
Area code -Phone number
3. Well Information
30144
ZipC~de~-
Number of wells used for injection _1_6 __
Well names IP1Q5-1;-2;-3;-4-5;-6;-7;-8;-9;-10;-11
-12;-13;~14;-15;-16------
Were any new wells installed during this injection
event?
~ Yes D No
If yes, please provide the following information:
Number of Monitoring Wells _______ 5 _____ _
Number of Injection Wells ___ 16 ____ _
Type of Well lnstalled (Check applicable type):
D Bored [x] Drilled D Direct-Push
D Hand-Augured D Other (specify) ---
Please include a copy of /he GW-1 form for each
well installed.
Were any wells abandoned during this injection
event?
D Yes []I No
If yes, please provide the following information:
Number of Monitoring Wells ____ _
Number of Injection Wells ___ _ ----
Please include a copy of the GW-30/or each well
abandoned
4 . Jnjectant Information
Newman Zone®; KB-1 ®;sodium bicarbonate; Neutral
Zone~ __ . ____________ _
Jnjectant Type
Concentration 27g/L; 0.016%v/v; 25 g/L; 18 g/L
If the injectant is diluted please indicate the source
dilution fluid. Cit)'. water aQct.gfC>!,!ndwat~
Total Volume Injected _ 36,94!iiaJ1ons __
Volume Injected per well_§_36 t9 4,770 gallons
5. Jnjection History
Injection date(s) Dec. 5 -21, 2012 ___ _
Injection number (e.g. 3 of 5)._=1 -°"o'-'-f __,,,2 ___ _
ls this the last injection at this site?
0 Yes [E] No
I DO HEREBY CERTIFY THAT ALL THE
INFORMATION ON THIS FORM IS CORRECT TO
THE BEST OF MY KNOWLEDGE AND THAT THE
INJECTION WAS PERFORMED WITHIN THE
STANDARDS LAID OUT IN THE PERMIT.
;~~ .. , .. ,:-;!',Jf:J~~--_. -·-___ _ lt/s-//K_
SJGNAT\JRE OF INJECTION CONTRACTOR --DATE
kN\~~~E~ P~O~ p~~RMrN~-~;i~~:ET~ON"·
Submit the original of this form to the Division of Water Resources within 30 days of injection.
Attn: UIC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-807-6464
Fonn UIC-IER
Rev. 8/5/2013
INJECTION EVENT RECORD
North Carolina Department of Environment and Natural Resources — Division of Water Resources
Permit Number WIO10023IJ
1. Permit Information
Cherntronics, Inc.
Permittee
Cherntranics Superfund Site, B147 PTA
Facility Name
180 Old Bee Tree Road, Swannanoa, NC 28778
Facility Address
2. Injection Contractor Information
Ge4Lyntec Consultants Qf NC P,C,_
Injection Contractor/ Company Natnc
Street Address 1255 Roberts Boulevard, Suite 200
Kennesaw
City
GA
State
30144
Zip Code
( 678 ) 202-9507
Area code— Phone number
3. Well Information
Number ofwells used for injection 16
Well names IP147-1;-2;-3;-4-5;-6;-7;-8,•-9;-10;-11
-12;-13;-14;-15;-16
Were any new wells installed during this injection
event?
0 Yes ❑ No
If yes, please provide the following information:
Number of Monitoring Wells 4
Number of Injection Wells 16
Type of Well Insta}led (Check applicable type):
❑ Bored ❑x Drilled ❑ Direct -Push
❑ Hand -Augured ❑ Other (specify)
Please include a copy of the GW-1 form for each
well installed.
Were any wells abandoned during this injection
event?
❑ Yes LI No
If yes, please provide the following information:
Number of Monitoring Wells
Number of injection Wells
Please include a copy of the GW-30 for each well
abandoned
Injectant information
Newman Lone; PCB-18; sodium bicarbonate; Neutral
Injcetant Type
Concentration 15 g/L; 0.011% v/v; 15 g/L; 5 g/L
If the injectant is diluted please indicate the source
dilution fluid_ City water and groundwater -
Total Volume injected_ _ 58,280 galions
Volume Injected per well 1,351 to 6,080gallons
Injection History
Injection dates) Dec. 15, 2012 -Jan. 27, 2013
Injection number (e.g. 3 of 5) 1 of 2 —
Is this the last injection at this site?
❑ Yes E1 No
E DO HEREBY CERTIFY THAT ALL THE
INFORMATION ON THIS FORM IS CORRECT TO
TIIE BEST OF MY KNOWLEDGE AND THAT THE
INJECTION WAS PERFORMED WITHIN THE
STANDARDS LAID OUT 1N THE PERMIT.
SIGNATURE OF INJECTION CONTRACTOR DATE
ttlrl�Y
�E�- ww� •Lti !C 4yi'W_s Afe. at OW 27
PRIN1 NAME OF PERSON PERFORMING THE INJECTION
r
Submit the original of this form to the Division of Water Resources within 30 days of injection_ Form UIC-IER
Attn: UIC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-807-6464 Rev. 8/5/2013

INJECTION EVENT RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Resources
Permit Number W10100230 .
I . Permit Information
Chemtronics, Inc.
Permittee
Chemtronics Su o erfund Site, B149 PTA
·Facility Name · · · ·--
180 Old Bee Tree Road, Swannanoa, NC 28778
Facility Address
2. Injection Contractor Information
Geosyntec Consultants of NC, P.C.
injection Contractor/ Company Name ·
Street Address 1255 Roberts Boulevard, Suite 200
Kennesaw GA ~--·-----City · · State ·
l§BL) 202"~5{):.-7 ~-
Area code -Phone number
3. Well Information
30144
Zip Code
Number of wells used for injection _4 __ _
Well names IP149-1;-2;-3;-4
Were any new wells instal.led during this injection
event?
~ Yes D No
Jfyes, please provide the following information:
Number of Monitoring Wells. 3
Number of Injection Wells 4
Type of Well Installed (Check applicable type):
D Bored ~ Drilled D Direct-Push
D Hand-Augured O Other (specify) __ _
Please include a copy of the GW-1 form for each
well installed.
Were any wells abandoned during this injection
event?
D Yes []I No
If yes, please provide the following information:
Number of Monitoring Wells ~-----
Number of Injection Wells_~---~-
Please include a copy of the GW-30 for each well
abandoned.
4. lnjectant Information
Newman Zone8 ; KB-1 ®; sodium bicarbonate; Neutral
ZQne~~ -'-------· -~ __ _
lnjectant Type
Concentration 10 g/L; 0.02% v/v; 9.9 g/L; 11 g/L
lfthe injectant is diluted please indicate the source
dilution fluid.~ Clli''-~ater ari_d grol!ndwat~~
Total Volume Injected 41,949 all_o _n _s __
Volume Injected per well 9 ,486 to 11 ,808 !@!Lons
5. Injection History
Injection date(s)_~_2v. 28 -Dec. 1_9.._, 2_0_1'""2 __ _
Injection number (e.g. 3 of 5)~1~of~2 ___ _
ls this the last injection at this site?
0 Yes 0 No
I DO HEREBY CERTIFY THAT ALL THE
INFORMATION ON THIS FORM IS CORRECT TO
THE BEST OF MY KNOWLEDGE AND THAT TI-IE
INJECTION WAS PERFORMED WITHIN THE
STANDARDS LAID OUT IN THE PERMIT.
~~---~ ~Q~-------ll!~h'I
Sl<,'NATORE OF INJECTION CONTRACTOR DATE
·-~~•~S,,,__!:::_ ~.1 __ .. _ ~t:. f.f. .. !_~_t:t_tY'l
PRINT NAME OF PERSON PERFORMING THE INJECTION
Submit the original of this form to the Division of Water Resources within 30 days of injection .
Attn: UJC Program, 1636 Mail Service Center, Raleigh, NC 27699 -1636, Phone No. 919-807-6464
Form UJC-IER
Rev. 8/5/2013
INJECTION EVENT RECORD
North Carolina Department ofEnviromnent and Natural Resources -Division of Water Resources
Permit Number WI0100230
1. Permit Information
Chemtronics Inc.
Permittee
Chemtronics Superfund Site, B104 PTA
Facility Name
180 Old Bee Tree Road, Swannanoa, NC 28778
Facility Address
2. Injection Contractor Information
Geosyntec Consultants of NC, P.C.
Injection Contractor/ Company Name
Street Address 1255 Roberts Boulevard , Suite 200
Kennesaw GA 30144 ------~-----City State Zip Code
l.§.Z!U 202-9507
Area code -Phone number
3. Well Information
Number of wells used for injection _1 ___ _
Well names MW227-J39EF . , ................ , .... .
Were any new wells installed during this injection
event?
[gJ Yes D No
If yes, please provide the following information:
Number of Monitoring Wells 3 --~----
Number of Injection Wells __ n_o_n_e ___ _
Type of Well Installed (Check applicable type):
D Bored ~ Drilled D Direct-Push
D Hand-Augured D Other (specify)
Please include a copy of the GW-1 form/or each
well installed.
Were any wells abandoned during this injection
event?
D Yes IR] No
If yes, please provide the following information:
Number of Monitoring Wells _n_o_n_e ___ _
Number of Injection Wells _n_o_n~e~---~
Please include a copy of the GW-30 for each well
abandoned.
4 . lnjcctant Information
Sodium Bicarbonate; Sodium Lactate
lnjectant ·Type
Concentration 476 mgLL, 1121 mg/L
If the injectant is diluted please indicate the source
dilution fluid. extracted .groundwater -··-
Total Volume Injected 170,035 Gallons
Volume Injected per well 170,035 Gallons
5. Injection History
Injection date(s) Mar. 1-;7, 2014 to Sept. 29, 20!~
Injection number (e.g. 3 of:5)#1, continuous injection
over the reported period
ls this the last injection at this site?
D Yes IR] No
I DO HEREBY CERTIFY THAT ALL THE
INFORMATION ON THIS FORM IS CORRECT TO
THE BEST OF MY KNOWLEDGE AND THAT THE
INJECTION WAS PERFORMED WITHIN THE
STANDARDS LAID OUT IN THE PERMIT.
~~ 7. (2.,,,,,.._ 1us-11y
SIGNATURE OF INJECTION CONTRACTOR DATE
. ft~!S.~~ _ ~-. fh1'1~-. }le._ ff; fl o11J H 1
PRINT NAME OF PERSON PERFORMING THE INJECTION
Submit the original of this form to the Division of Water Resources within 30 days of injection.
Attn: UIC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-807-6464
Form UIC-IER
Rev. 8/5/2013
INJECTION EVENT RECORD .
North Carolina Depa11ment of Environment and Natural Resources -Division of Water Resources
Permit Number WI0100230
I . Permit Information
Chernfronics Inc ..
Permittee
_(:hemtronics Superfund Site, B104 PTA
Facility Name
180 Old Bee Tree Road, Swannanoa, NC 28778
Facility ·Address
2. I n_jection Contractor Information
_§~osy~te,:_Consultants of NC, P._c_. __ _
l_njection Contractor/ Compariy Name
Street Address 1255 Rob_erts B()ulevard, Suite 200
Kennesaw
-. City --
GA
State
W§__) 202~9507
Area code -Phone number
3. Well Information
30144
Zip Code
Number of wells used for injection_!_ ____ _
Well names MW227-J39EF
Were any new wells installed during this injection
event?
IB] Yes D No
If yes, please provide the following information:
Number of Monitoring Wells _3_~---
Number of Injection Wells__ none
Type of Well Installed (Check applicable type):
D Bored @ Drilled D Direct-Push
D Hand-Augured D Other (specify) __ _
Please include a copy of the GW-1 form for each
well installed.
Were any wells abandoned during this injection
event?
D Yes 0 No
If yes, please provide the following information:
Number of Monitoring Wei Is _n_o_n,._e;..__ __ _
Number of Injection Wei Is._. _n_o_n_e-'-. ____ _
Please include a copy of the GW-30 for each well
abandoned.
4. lnjectant Information
Fluore.scein; Potassium Bromide
T~}ectant Type .. . . --·-· -· -·-·
Concentration 832 mg/k)QQ, f!l~/_l,._. __
Jfthe injectant is diluted please indicate the source
dilution fluid. ext r a cte.c! gro undwat e...,.r __
Total Volume Injected _2725 L _______ ..
Volume Injected per well 2725 L'"-. ____ _
5. Injection History
Injection date(s) February 14, 2014
Injection number (e.g. 3 of5)._.,.,1..,,o<.!f~1,,__ __ _
Is this the last injection at this site?
0 Yes 0 No
I DO HEREBY CERTIFY THAT ALL THE
INFORMATION ON THIS FORM JS CORRECT TO
THE BEST OF MY KNOWLEDGE AND THAT THE
INJECTION WAS PERFORMED WITHIN THE
STANDARDS LAID OUT IN THE PERMIT.
s~~c~~~";NTRACTOR . II l~~ii
&,s .. -.-;. __ Ii. /'ir•i'lor __/,IC. It '·-·· r>'#t2l ')
PRINT NAME OF PERSON PERFORMING THE INJECTION
Submit the original of this form to the Division of Water Resources within 30 days of injection.
Attn: UIC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-807-6464
Form UIC-IER
Rev. 8/5/2013
INJECTION EVENT RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Resources
Permit Number WI0100230
I . Permit Information
Chemtronics Inc.
Perrnittee
Chemtronics Superfund Site, B104 PTA
Facility Name
180 Old Bee Tree Road, Swannanoa, NC 28778
Facility Address
2. Injection Contractor Information
Geosyntec Consultants of NC, P .c.
Injection Contractor/ Comp;;y Name __ _
Street Address 1255 Roberts Boulevard,_Suite 200
Kennesaw GA 30144
City State Zip Code
~ .. 202-9507
Area code -Phone number
3. Well Information
Number of wells used for injection __ l ___ ·-.-·
Well names MW227-J39EF
Were any new wells installed during this injection
event?
~ Yes D No
If yes, please provide the following information:
Number of Monitoring Wells ______ _
Number of Injection Wells __ n_o_n_e ___ _
Type of Well Installed (Check applicable type):
D Bored ~ Drilled D Direct-Push
0 Hand-Augured D Other (specify) __ _
Please include a copy of the GW-1 form for each
well installed.
Were any wells abandoned during this injection
event?
D Yes [Kl No
If yes, please provide the following information:
Number of Monitoring Wells ~ none
Number of Injection Wells none -··--_ . _
Please include a copy of1he GW-30for each well
abandoned.
4. lnjectant Information
KB-1® Plus
lnjectant Type
Concentration 100% v/v
If the injectant is diluted please indicate the source
dilution fluid. none ------------
Total Volume lnjected_~18~-~4~L~-~---
Volume Injected per well __ 1_8 _.4_L _____ _
5. Injection History
Injection date(s) ... April 3 , 2014 (l.4 L)'
May 19,°'2-014]Il-.--L..--. ---
Injection number (e.g. 3 of 5) 1 and 2 of 2
Is this the last injection at this site?
D Yes [Kl No
I DO HEREBY CERTIFY THAT ALL THE
INFORMATION ON THIS FORM IS CORRECT TO
THE BEST OF MY KNOWLEDGE AND THAT THE
INJECTION WAS PERFORMED WITHIN THE
STANDARDS LAID OUT IN THE PERMIT.
--~~.:;:.. A". (2..,..,... --·-·-·---IIJl"liy
SIGNATURE OF INJECTION CONTRACTOR DATE
~.L...y"' ........... It.. ,.fr-..., ____ N<.,,tf_ll'~11ru,
PRINT NAME OF PERSON PERFORMING THE INJECTION
Submit the original of this form to the Division of Water Resources within 30 days of injection.
Attn: UIC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-807-6464
Form UIC-IER
Rev. 8/5/2013
INJECTION EVENT RECORD
North Carolina Department of Environment and Natural Resources — Division of Water Resources
Permit Number W10100230
1 Permit Information
Chemtronics. ins.
Perini ttee
Chemtronics Superfund Site, B105-139 PTA_
Facility Naine
180 Old Bee Tree Road, 5wannanoa, NC 28778
Facility Address
Injection Contractor Information
Geosyntec Consultants of NC, P.C.
Injection Contractor 1 Company Name
Street Address 1255 Roberts Boulevard, Suite 200
Kennesaw
City
GA
State
30144
Zip Code
(r678 ) 202-9507
Area code — Phone number
3_ Well Information
Number of wells used for injection 4
Well names IP105-3;-6;-7;-11
Were any new wells installed during this injection
event?
L I Yes x❑ No
If yes, please provide the following information:
Number of Monitoring Wells
Nurnber of Injection Wells
Type of Well Installed (Check applicable typo):
❑ Bored ❑ Drilled ❑ Direct -Push
❑ Hand -Augured ❑ Other (specify)
Please include a copy of the GW-I farm for each
well installed
Were any wells abandoned during this injection
event?
❑ Yes ❑x No
If yes, please provide the following information;
Number of Monitoring Wells
N u inber of injection Wells
Please include a copy of the GW-30 for each well
abandoned
4. lnjectant Information
Sodium lactate; sodium bicarbonate;
sodium sulfite; KB-1®
Injectant Type
Concentration 5.6 g/L; 41 get; 7 mgll-; 0.036%vjv
If the injectant is diluted please indicate the source
dilution fluid. Citvwater and groundwater
Total Volume Injected 8,880 gallons
Volume Injected per well 1,896 to 2,587 gallons
Injection History
Injection dates)June 9 -19, 2014
Injection number (e.g. 3 of 5) 2 of 2
Is this the last injection at this site?
ID Yes ElNo
DO HEREBY CERTIFY THAT ALL THE
INFORMATION ON THIS FORM IS CORRECT TO
TI IC BEST OF MY KNOWLEDGE AND THAT THE
INJECTION WAS PERFORMED WITHIN THE
STANDARDS LAID OUT IN Ti IE PERMIT.
2 4 - �r [sN,
S1GNATLtI E OF INJECTION CONTRACTOR DATE
4 w+ K- *sad, Alt PE 0 gle39.
PRINT w�►NAME OF PERSON PERFORMNNO THE INJECTION
1
Submit the original of this form to the Division of Water Resources within 30 days of injection.
Attn: tJ1C Program, 1 636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-807-6464
Form U1C-1ER
Rev. 8/5/2013

NONRESIDENTIAL WEr.r. CONSTRUCTION RIPCORD
North Carolina Department of Environment andNatafal Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # S 7/
1. WELL CQNTRACTQIi:�
Well Contractor (individual) Name
R E DRILLING SERVICES: LLC
Weft Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
City or Town State Zrp Code
(864 ] 288-1986
Area code Phone number
2. WELL INFORMATION: C P - bS- a)
WELL CONSTRUCTION PERMIT*
OTHER ASSOCIATED PERMNfT#{If appllrahle}
SITE WELL. ID eV appttcabie)
3. WELL USE (Check One Box) Monitoring C Municipal/Public ❑
Industrial/Commercial 0 Agrlcuhural ❑ Recovery ❑ Injection t"}�
irrigation❑ Other ❑ (fist use)
DATE DRILLED 11— t6-1
4. WELL � lLOCATION:
(Sheet Name, Numbers, Community, Subdivision, Lot No., Parcet, Zip Cede)
CITY: COUNTY
TOPOGRAPHIC/ LAND SETTING: (check appropriate box)
❑Slope ❑Valley ❑Flat DRidge LJOther
LATTfUDE 36 " gars OR 3)tioccoCCXXX OD
LONGITUDE 75 " OMS OR 7,00a0o0ccoc OD
Latttudellongltuda source: Q3PS ]topographic map
(location of well must be shown on a USGS top° map andatiached to
this form if stet using GPS)
5. FACILITY (Name of the busfnes3 where the wail is located.)
(��arflD�11�5
Fad& Name Faciflly ID# (rf applicable)
o ate &e, Pd_
Street Address
14.'1/11ry [Ig / t� C' a2SS-65-
City or Town rr State Zip Coda
lftf�df} Gr�v:rgrlrerrori
Canted Name
..31 }- 1 ott 54-
Mailing Address
1��hru:li� �C .aviD2,1
City or Town State Zip Code
3356
Area code Phone number
S. VVEL.L DETAILS:
a. TCTAL DEPTH:
drirt-
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NOS
c. WATER LEVEL Below l'up of Csiny: _ 1/. 113 Fi
(Use "+" ['Above Top of Casing)
d. TOP OF CASING IS _7' FT. Above Land Surface'
`Top or casing terminated al/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): AI/4 METHOD OF TEST (0.44
f. DISINFECTION: Type t1)/i} Amount /P1117
g. WATER ZONES (depth): l
Top ,I /ir Botom 4/terAi'��
Top ! Bottom 1A
Top Bottom Top bottom
Top Bottom Top Bottom
Thicknessf
T. CASING' Depth Diameter Weight Nletteriai
Top Q' Bottom I)' FI. Z `i $ MQ PO D
Tap Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material
Top d 1 _ Rotiom� Ft. Carve 7
Top Bottom _ Ft
Tnp Bottom Ff,
Method
S, SCREEN: Depth Diameter Stet Size
Top i Bottom .27 ' Ft V In. .1 Q in..
Top Bottom _ Ft in. in.
Top Bottom _ Ft. in. in.
Material
U- (J ►Ptt
10. SAND/GRAVEL PACK:
Depth S i laterfail.
Top 101 Bottom ZSr a
Top Bottom R.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
1
1
1
1
1
1
12. REMARKS_
Formation De5crip io l
.SafroJr 7[
I Da HEREBY CEIfiiFY THAT THIS WELL WAS CONSTRUCTED FH ACC°ROANCE YNT}i
1 bA NCAC 2C WEJi CONSTRUCTION STANDARDS, AND THAT A COPY OF T H 5
R1CORAROVlp>1TOWELI_OWNEii.
111�—Iz
SIGNATU OF DE TIfIED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Farm GW-lb
Rev_ 2/09

7
1. WELL
NON RE'SI E11TIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 7S71
Well Contractor (Individual) Name
A E DRILLING SERVICES. LLG
WaN Contractor Company Name
TVVO UNITED WAY
Street Address
GREENVILLE
City or Town
(864 ) 288-1986
Area code Phone number
WELL INFORMATIO
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(Ir applicable)
SITE WELL ID *tit applicable)
SC 29607
State Zip Code
zitie
3. WELL USE (Check One Box) Monitoring E Municfpal/Publfc ❑
InduslrialiCommercial ❑ Agricui ural C Recovery d Injection D
Irrigation❑ Other ❑ (list use)
DATE DRILLED LI a —a.
4. WELL LOCATION:
flIcTrVtlYMIC
{Street Nama. Numbers, Community, Subdivision, Lot No.. Panel, Zip Code)
CITY: ,SI,t Nf1C-ClOci n COUNTY
TOPOGRAPHIC 1 LAND SETTING: (chock appropc ate box)
❑Slope ❑Valley iDFIat LRidge pother
LATITUDE 35 • DMS OR 3x.xxxxxxxxx Dp
LONGITUDE 75 "CMS OR 7}C,3p tAnaiOC DO
Latitude/longitude source: [IGPS Mropographic map
VocraYon of weir must be shown on a t1SGS topo map andattached to
this form if not using GPSJ
6. FACILITY (Name of the business where the well is loca{ed,)
Facility Name Facility ID# (if applicable)
ilY' tx+�L1 . a_t Tice
C2
Street Address
vq
City or Town
}1M«'.+
!�-Cr
State Zip Code
CJ�u �fpr �Iv wi ,+-'
Contact Nair'?
A►iLL)Ct ti C+-
Mailing Addres r�
if-vrI !C_
;SSnt
City or Town State Zip Code
f ba4 , 21 3356
Area code Phone number
6 WELL DETAILS:
a. TOTAL DEPTH:
27'
b. DOES WELL REPLACE EXISTING WELL? YES p NO ttr
c. WATER LEVEL Below Top of Casing: q, 1.7 FT_
;Use '+" if Above Top of Casing)
d. TOP OF CASING IS it I FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .011 B.
a, YIELD (gpm)- I1.1/1- METHOD OF TEST 11V
f DISINFECTION: Type Afir Amount
T. WATER (depth):
Too Bottom A��jft' Too_Wilk Bottom WM'
Top Bottom Top Bottom
Top Bottom Top Bottom
T. CASING: Depth
Top CO Bottom hi'
Top Bottom
Top Bottom
B. GROUT: Depth
Top b' .Bottom 91
Ft.
Ft.
FL
Diameter
NAL
Thickness/
Weigtrt Material
$ .9I£1 pot.
�r Material
Fi. Cenie4"
TOO Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth
Tap ■ $1 Bottom 'z$l
Method
Diameter Slat Size Material
Ft. Z a in. • 10 in. 65.1.90 AX.
Top Bottom FL
Top Bottom Ft.
In. In.
ln. In.
10. SAND/ORAVEL PACK:
Depth Sire M tell I
Top 1I' Bottom 21I' Ft.4t)
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
1
1
1
1
1
1
1
1
1
1
1
12. REMARKS:
Formation Description
100 HEREBY O5RTIFY THAT THIS WELL WAS CONSTRL'C1ED IN ACCORDANCE WITH
15q NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF TM!S
RECoR S BEEN PROVIDED TO E WELL OWNER
9 SIG RE 0 ERTIFIED WELL O TRACTOR DATE
PRINTED OF PERSON CONSTRUCTING THE 'WELL
//—/ -J 2_
Form OW-1b
Rev. 2109

WELL CONSTRUCTION RECORD
-nth iorm ran be ug,d far sins le oc multipie weal
I. Well Contractor Information:
Randy Phillips
Wail Contractor Name
2209-A
NC Well Cott actorCmliGcationNumber
A.E.Drilling Services
Company Rime
2. Well C.Ostracliou Permit #:
List al applicable well permit' (i.e. County. Store. Variance, Injection. etc;!
3. WeII Use (check well nee):
Water Supply Walt:
IJAgricuitvral
❑Gcothem:rl (I lcating/Cooling Supply)
O lnduntrial/Commercial
❑Irriigation
Non -Water Supply Well:
Ohicoiloring
°Municipal/Public
❑itesidential Water Supply (single)
°Residential Water Supply (shared)
°Recovery
/ejection Well:
°Aquifer Recharge
°Aquifer Storage and Recovery
❑Aquifer Test
[Experimental Technology
o G+othermal (Closed Loop)
❑Geothermal (licafinECooiing Return)
❑ Grmmdwater Remediatian
❑ Snhnity BeniE r
❑Storrnwater Drainage
❑Subsidence Cootml
❑Tracer
°Other (explain under 621 Remarks)
4. Dar WeU[s) 1*d:11 /27/12 w,uIDii IP 105-2
Sa. Well Lunation:
Chemtronics
Faclity/Owner Name Facility lf#t (if applicable)
180 Old Bee Tree Rd_Swannanoah 28778
Physic& Address. City, and rep
Buncombe
Camay Parcel Tdentifieeiion N'. (PrN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
rf veck] field, me fatllrntg is sufficient)
N
6- Is (are) the well(s): OPermeneut or ['Temporary
1. Is this a repair to an existing wit ❑Ycs or EJNo
If this ig a repair, fill oat known bell cwrrmerticor irrjarrratron mid erptain the mamma/ the
repair ender 021 remarks sertioll ar err the bark of e6is form.
6. Number of wells constructed:
For multiple iujccrie or non-aneersxpply %elk RPVLY vela thesar eraanrer ken, you can
motto* sae firm
9. Total well depth below had sarfaue: 28.0 (fLj
For seraph: was Au all depths ifdfrmag (example- 36701 ' ard7@l*0')
11i. Static water level below top pleasing:
Jfwarer level is ahoy casing use "+"
I1. Borehole diameter. 8
Um)
12. Well construction median: auger
th
(i.e. rum, rotary. cable. direct push etc.)
(ft.)
FOR WATER SUPPLY WELLS ONLY:
138<Yield (gpm) _ Method of to :
13h. fiblafecboa type: _ Amount:
Fur looms' Una ONLY:
14_ WATER EOM
FROM -
TO
N
It.
FL
ff.
it
15. OUTER CASING Ow taahli and welly OR WIER Of rppfmblet
FROM TO
DIAMETER
THICKNESS
MAMMAL
13 ft• +3.5 it
2 d-
soh 40
PVC,
N. INNER CASING OR TUBING
lenatheruW elnaeddoe
FHI3SI
TO
1MAAUCTEit
THICKNESS
MATERIAL
f1.
FL
to.
t.
11.
11. SCREEN
FRO61 TO
EnAMsrHR
'LC7 RZE
THICKNESS
MA7SR1AL
13 e..28 °-
2 l'
_010
sch 40
PVC
ft.
R.
i•.
prepack
1g. GROUT
FROM
70
MATERIAL
LMTLACEMENT ME7KOD & AMOttiWf~
11 rr:
9 rt
318 holeplug
pour
9 rt.
0 ri,
neat cement
pump
ft. ft.
J 9, SANI11GRAYEL PACK (If apt bk)
FROM
TO
MA Trmar_
verLACSM72.T METHOD'
29
11 ft
#1
pour
ft.
20- DRILLING
LOG iattscb
additional obsess if necessary)
I4 WM
TO
OrSCRIPTIuy [win , Ieerrlsesk sdYreiL ! pc. trait aiyrle4
fi.
R.
Ft.
ft.
tar
N.
it
[L
R.
n.
R.
It.
ft
act. RIZNIAlitnE
22. CerfrcaIgm:
Stgmrwc ufCrariGcd Well Ca ariclor
1I-97-rz
bare
By slgnseg this form. I hereby c flij ikn the arr1l(sy was (were) room -muted in ecrortionoe
with ISAIVCAC 02C .01019 or ISA NCIC OKC.0200 Writ Corbsrracflanr Standards and that e
to y o(thu record Rut beta provided to the self owner_
23. Site diagram or additional well delniia:
You may use the back of this page rn prvide additional well site details or well
construction details. You may also attach:additional pages if necessary.
SUBMITTAL 1NSTUCI'IONS
24a. For Ail Wells: Submit this form within 30 days of completion of well
construction to the following;
Division of Water Resources, Information Processing Unit,
1fi17 Mall Service Center, Releigh, NC 27699-t 617
246_ Fir Di fiction Wells ONLY: hi addition to sending the form to the address in
24aabove, also submit a copy of this foam within 30 days of completion of well
construction to the following:
Division of Water Resoarees, /inderground Injection Control Program,
1636 Mall Service Center, Raleigh, NC 27699-1636
24e. Fur Water Supply & Infection Welk:
Also submit one copy of this forme within 39 days of completion of
wcil construction to the county hcItlth department of the county whcrc
constructed.
Force GW-I
North Carolina IJeparerncar of Erwin:a men! and
Naomi Resources— Division of Wat r Resources Revised August 2f111

NON ON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION ## 3571
1. WELL. CONTRACTOR:
Well Contractor (Individual) Name
A E DRILLING SERVIGES.ILG
Weil Contractor Company Name
TWO UNITE WAY
Street CAddr ss
GREE MILE SG 2960
City or Town State Zip Code
(864 288-1986
Area code Phone number
2. WILL INFORMATION: a. or- 3
WEU. CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(tr applicable)
SITE WELL ID #{if applicable)
3. WELL USE (Check One Box) Monitoring QYMunlcipaliPubiic ❑
Industrlal/Commerc al ° Apricufturai CI Recovery 0 injection e
Irrigation❑ Other ❑ (list use)
DATE DRILLED I i- Z - 12-
4.WELL LOCATION_
EL,
(Street Name, Numbrss. Community. SubdMMislen, Lot No.. Parcel, ?Jp Cods)
CITY: Sea dfrt11QfGel COUNTY
TOPOGRAPHIC 1 LAND SO-TING: (check appropriate box)
I1Slope Valley °Flat ❑Ridge ❑Other
LATITUDE 3$ " OMS OR 3X.XXXXXXXXx DO
LONGITUDE T5 " DMS OR TX.XXx)Qoo Xx OD
Latitude/longitude source: C3PS :Topographic reap
(location of well most be shown on a USGS tops map endsttaahed to
this form if not using GPS)
S. FACILITY (Name of the business where the well is located)
Facility Name
I? C. 0 (GI •fie Trze ��tJ .
Str4.1 Artiness
S fs �r
iL
City
orlfTown
I�f7r-PvT.d1 4- ES)%ra tft1/4.0)-1-L.f
Contact Name rr
-) I 1.}aut,,cir,,A _t4-
Mailjng Address J
hev r) C
City or Town
r 4 S l s `335o
Area cede Phone number
S. WELL 1]E1AILS:
a. TOTAL DEPTH: all I
Facility IDA (if applicable)
State dip Code
State Zip Code
b_ DOES WELL REPLACE EXISTING WELL? YES ID
NOB'
c_ WATER LEVEL Below Top of Casing: l ) • Iv-- FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS 3 r FT- Above Land Surface'
'Top of rasing terminated at/or below land surface may roquirs
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (9pmJ: Nf* METHOD OF TEST 10I4"
f. DISINFECTION: Type "VA Amount ANA
g. WATER ZONES (depth):
Top J fP+' out`ivaii r__ �! tic � ;UP Top
Tap— — Bottom_ ^ Tap,. i Bottorn,_`
Top Bottom Top Bottom
Thickness/
T. CASING_ Depth Diameter Weight Material
Top Bottom Ft.
Top Bottom Ft.
Top _ Bottom. Ft..
2. GROUT: Depth Material Method
Top. it)' Bottom irir,.;
Tap Bottom FL
Top Bottom FL
9. SCREEN: Depth Diameter Slot Size Material
Top _ i3' Bottom 2R _ Ft. Z. in_ .10 In. iii.ktire,la
Top Bottom Ft. in. in.
Top_ _ - Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
Top _-Boliom_Ft.J,
Top i1' Bottom Zlt Ft. AV SAA4
Top Bottom Ft.
11. DRILLING LOG
Top Bottom Formation Description
1 Sap
-fe
1
i
r
1
1
1
1
1
1
t2. REMARKS:
!Do HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE YNTH
15A NCAC 2C. WELL CONSTRUCTION STANDARDS, AND THAT A COPY DF THIS
RECOROH. S BEEN peovi eo TO TH7. WELL Ovv'NER.
t
a
SIGNATURE OF CERTIFIED WELL CONTRACTOR [JAI E
'kJ g •s
PRINTED NAME OF PERSON CONS RUCTING THE WELL
Farm GIN -lb
Rev. 21A9
2

NON RESIDE NAL WELL CONSTRUCTION RECORD
North Carolina Depait:tent of Environment and Natural Resourtts- Division of Wader Quality
WELL CONTRACTOR CERTIFICATION # IC71
1. WELL CONTRACTOR:
Wail Contractor(Indlvfdual) Name
A E DRILLING SERVICES. L,LC
Well Contractor Company Name
TWQ UN ITEJ WAY
Street Address
GREENVILLE SQ 29607
City or Town State Zip Coda
,_864 ) 288-1986
Area code Phone number
2. WELL INFORMATION: lDS -.
WELL CONSTRUCTION PERMIT*
OTHER ASSOCIATED PERMIT# (ir a pp UcatIo)
SITE WELL ID #{ir applicable)
3. WELL USE (Check One Bax) Monitoring ❑ Municipal/Publicu
Industrial/Commercial ❑ Agricultural Recovery ❑ Injection Er.
Irrlgafien❑ Other ❑ (list use)
DATE DRILLED /1-
4. WELL LOCATION:
C Nt iLS
(Street Nerve, Numbers. Community. Subd:vbian, Lot No., Parcel, Zip Cods)
CITY_ 51..41f1rvInoa COUNTY
TOPOGRAPHIC I LAND SETTING:
OStops ❑Valley ❑Flat ❑Ridge
LATITUDE 36 '
LONGITUDE 75 •
Keck aplaoprtste boar)
❑ Other
DMS OR 3X.)00D0c0C4X DD
DMS OR 7x.)0u000ocxx DD
Latitude/longitude source: []CPS °Topographic map
(locallan of wall must be shown an a U$GS tap, map andattached to
Bois form if not using GPS)
S. FACILITY (Name of the business where the well is located.)
��Cl+flf+ORli 5
Facility Name Facility JDte (If applicable)
1 eo Dld &e I*:pEe a
w ar .1rIl
vfil
k bpi-.
City or Town
I�I+utain+ Eaurroiifrr, .kL
Oontact Name
Mat g Address �a
t fit r)(_ ,Y15 II
City or Town
(_E >' Jig J 336o
Area code Phone number
S. WELL DETAILS:
a- TOTAL DEPTH:
010(15
Stars Zip Code
Stale Zip Code
b. DOES WELL REPLACE EXISTINU WELL? YES ❑ NO d
c. WATER LEVEL actor/Top of Casing: _ j !: 7 �$ FT.
(Use +^ if Above Top of Casing)
d. TOP OF CASING IS 31 FT. Above Land Surface
`Top of casing terminated at/or below ;and surface may require
e variance in accordance with 15A NCAC 2C _0118.
e. YIELD (gpmr Nf METHOD OF TEST /»
f. DISINFECTION: Type A)/A Amount All
D. TER
NES
Top Agit Bottomep/efA9 Top J , Bottom ,d_iif^
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Wisteria!
Top #' Bottom 9 ` _ Ft. _V . Div P II (--
Top Bottom FL
Top Bottom Ft
B. GROUT: Depth Material t Method
Top. Dr Boticm�� Ft +�A+ttn i Ving Eta(
Top Bottom Ft. _
Top Bottom Ft _
S. SCREEN: Depth Diameter Slot Sfze Material
Top Jr Bottom 2 ' _ Ft. Z' in. . SO in. U tinge_ P
Top Batiom Ft In. in. —
Top Bottom Ft. !n. In. _V
10. SAND/GRAVEL PACK:
Depth Size
Top Pr Bottom FL�
Top Bottom FL
Top Bottom FL
Material
11. DRILLING LOG
Top Bottom Formation Description
1 rtt�
1
1
i
1
1
12. REMARKS:
I DO HERESY CERTF%THAT INS WE].L WAS CCNSTRUCTEa iN PdCGORDANCE WWrH
1SA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND/HATA COPY OF THIS
REC:ORO HAS BEEN FROMME) TOTHE WELL OWNER
SIGNATURE OF IEID WELL CONTRACTOR DATE
diC 1 1 ' WAl
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1 b
Rev. 2/09

NON RESIDENTLA.L WELL CONSTRUCTION RECORD
North Carolina Department ofF rvironment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3 /
7. WELL CONTRA�LCTTO • .44
Ab& 11-tCx-Gt;
Well Cords -actor (Individual) Name
A E DRILLING SERVICES. LLC
Well Contractor Company Name
TWQ UNITED WAY
Street Address
GREENVILLE
SC 29607
City or Town Slate Zip Coda
(864 ) 288-1986
Area code Phone number r
Z. WELL INFORMATION: �r — /05 — Se -
WELL CONSTRUCTION PERMIT
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID NCH' applicable)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public 0
Industrial/Commercial fl Agricultural 0 Recovery 0 Injection F�
Irrigationd Other 0 (list use)
DATE DRILLED //.J t_
4. WELL LOCATION:
hL rn !7?xu dS
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
f )L
CITY: SW5i)narZcA COUNTY
TOPOGRAPHIC! LAND SETTING: cc1eas appropriate box)
IJSIope ❑Valley °Flat ❑Ridge Ji Other
LATITUDE 36 I
" DMS OR 3x.xxloocccxx DD
LONGITUDE 75 "DAM DR 7X.xXxXxmocx DO
Latitude/longitude source: BPS Topographic map
(location of waif must he shown on a tISGS fop) map andattached to
this form if not using GPS)
6. FACILITY (Name of the business where the welt is located.)
Faculty Name _ Facility III# (if applicable)
Old Pic Irrrc J:!
Street Add ra.c a�GCJ
l4leUr �� _...�.i 1'� '
05.
City or Town State Zip Coda
11I4 on EN;ronrrwyki
Contact Name
etf6 !
Maiil g Address
�; I1r
City or Town State hip Code
(ePS ) age 335,
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:
r
b. DOES WELL REPLACE EXISTINEI WELL? YES 0 NO e
c. WATER LEVEL Below Trip of Casing: 6. P FT.
(Use "+" it Above Tap of Casing)
d. TOP OF CASING IS I' F7. Above Land Surface
"Top of casing temnfnated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gprn): #/' METHOD OF TEST A1/1I1
f. DISINFECTION: Type ,ti/ft Amount N/ft
g. WATER ZONES (depth): /�/
Top 'yi A Ecttcm .4// ! i� Tep £ i�A— Ann , Ikk4
11-
Top Bottom_ Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top e)' Bottum /7 Ft. g' 5c i-'i ' POD
Top Bottom Ft.
Top Sottem Ft
8. GROUT- Depth Material
Top DI Bottom f r Ft. atter&
Top Bottom Ft
Top Bottom FL
Method
1;:arf'►re
9. SCREEN: Depth �v+ blamater Slat Size Mlaterial [� Ir
Top /31 Bottom �0 FL ± in. 41/ In. /r - Ai: iv. hZ.
Top Bottom FL in. In.
Top bottom_ FL In. in.
10. SAND/GRAVEL. PACK
Depth Size
Top 11 Eloitom 25r Et./
Top Bottom Ft.
Top Bottom FL
11. ERILLING LOG
Top Boliom
1
1
1
1
1
1
1
1
1
1
12. REMARKS:
Material
Formation Description
I DO HEREBY VERIFY THAT THIS wELL WAS CONSTRUCTED IN ACCORDANCE vtTH
15A NCAC 2C, WELL CONSTRUCTION STAASJAROS, Mtn THAT A COPY OF THIS
RECARQHAS Es N ARCVN[1Er] TC THE 7GrcU.OWNER.
SICi{IAID FDJM6r
IFIER WELL CONTRAC1ORII
_ ER
DATE
NAME
E OF PERSON CONSTRUCTING THE WELL
Form GW-lb
Rev. 2109

1. WEU. C¢ifi+; 4ri ("t--
Weil Contractor (Indixiduaf) Name
A E DRILLING SERVICES. LLC
WeN Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE
City or Town
(864 l 288-1986
Area code Phone number
Z WELL INFORMATION:.F 'f c
WELL CONSTRUCTION PERMIT*
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of $avironment and Natural Re3Quraeg- D1visiaa of Water Quality
WELL CONTRACTOR CERTIFICATION # n
d. TOP OF CASING IS T FT. Above Land Surface'
*Top of casing terminated odor below land surface may require
a variance in acoardanc& with 15A NCAC 2C .0118.
e. YIELD (gpm): gig- METHOD OF TEST 4/fg
f. DISINFECTION: Type A//, Amount /1f,
g. WATER ZONES (depth); �¢
Top 1a✓ Bottom I�%W Top ,{//�Bontom ,%//
Top Bottom Top Bottom
Top _ Bottom Top Bottom
Thickness)
7. CASINO: Depth Diameter Weight Material
Top A` Bottom a Ft., a" A.'k1 A_
Top Bottom Ft
Top Bottom Ft
SC29607
State Z!p Code
OTHER ASSOCIATED PERMIT (d apploebte)_
SITE WELL ID s spplrable)
S. WELL USE (Check One Box) Monitoring 0 Municipal/Pubho ❑
industrial/Commercial ❑ Agricultural ❑ Recovery 0 Injection lY
lrrigationd Other 0 (list use)
DATE DRILLED 1r 4 f z
d. WELL LOCATION:
�1!C YI Ir of 5
>Street Name, Numbers, Community, Subdsamon, Lot No., Parcel, Zip Code)
CITY: [S(AYllYMOi AC COUNTY
TOPOGRAPHIC / LAND SEn iNG: (check appropriate box)
❑Slope ❑Valley ❑Flat 0Ridge DOther
LATITUDE 36
LONGITUDE 75
DMS OR 3x.xx (XxXxxx DO
' obis OR 7X.)000OCocO1 DID
Latitude/longitudeSuwea: CPS Eropogrephiemap
(location of well must 6e shown art a USGS fopo map ende!tacbed to
this form if not using GPS)
5. FA�CILITY](Name of the business where the well Is located.)
/C+4841% 0/1145
Facility Name
1g0 GId Pee T�-'�-
Street.'+dre1s
tuil}.
GI J AA w.l
N�Cr
Almanac- FilLtiron N io...
Facility 10# (if appltcabfe)
XROS
State Zip Code
Contact Na e
.23 1 f� 5+.
Malting Add
II( r-C WOW
City or Town
( PR) 3356
Area cede Phone number
6. WELL DETAILS: �}
a. TOTAL DEPTH: fir /
b. DOES WELL, REPLACE EXISTING WELL? YESp
c. WATER LEVEL Below Top of Casing: ?. 5
(Use "+" if Above Top of Casing)
s�113fN.1i?ii 3[ aa
�lit�a� Se
State Zlp Code
NO�f
FT.
8. GROUT: Depth r,� �1Materfai Ntetthhod
Top aA Bol om / Ft LOPAQM/ ram, of/
Tap Bottom _ Ft._ _
Top Bottom Ft.
S. SCREEN: Depth r Diameter Slot Sire Material
Top, f r _ Bottom 0747 Ft2 Jl In. AA) in. a !oj +
Top Bottom Ft. In. in.
Top Bottom Ft ip. in.
10. SAND/GRAVEL PACK:
, irial ,(
Top 1/' BottomDepth aY FL ' S/ze Mateea
Top Bottom Ff.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom Formation Description
i �r 1r
1
1
1
1
1
1
12- RBMRKS:
I DO Heiteev CERTIFY THAT THIS WEL- WAS CONSTRUCTED IN ACCORDANCE WITH
75A NCAC ZC, WET L CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD i 9 TO EWELL OWNER_
SIGNAT
CCNTRAC OR
DATE
PRIFLf'i D NA OF PER ON CONSTRUCTING THE WELL
Form GW-i'a
Rev. 2109

NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Envirortmcnt and Natural Resources- Div ision of water Quality
WELL CONTRACTOR CERTIFICATION # 3571
1. WELL CONTRACTOR:
Weil Contractor (Individual) Name
A E DRILLING SRVICES, LLC
Well ContractarCompany Warne
TWO UNITED WAY
Street Address
GREEN JILLE cr.
City or Town State
{ 864 ) 288-1986
Area code Phone number
2. WELL INFORMATION: 1 7
WELL CONSTRUCTION PERMIT-4i
20607
Zip Code
OTHER ASSOCIATED PERMIT#(irapplicanle)
SITE WELL ID *Of oPignehle)
3. WELL USE (Chock One Box) Monitoring ❑ Municipal/Public
Induslrtai/Ccmmercial p Agricultural CI Recovery ❑ Injection es
Irrigation0 Other ° Olst use)
DATE DRILLED i1_Iy12-
d- WELL LOCATION:
r' . 11��,1Ca• e.L
(Sweet Name, Numbers, Community, Subdivision, Lot Na„ Parcel, Zip Cock}
C
CiiY_ 110AiC COUNTY_
TOPOGRAPHIC/ LAND SETTING: (check appropriate box)
❑Slope ❑Valley °Flat ['Ridge °Other
LATITUDE 38 • DMs OR 3x.xxxxxxxio DD
LONGITUDE 75 - • DMS OR 7X,>Sxxxxxxxx OD
Latitude/longitude source: E PPS anpographic map
(location of well roust be shown on a 1JSGS topo map andattached to
this form it -not using GPS)
5. JLI
FACILITY (Marne of Ma business where the well is located-)
Facility Name
J 8 0 pIc1 Zee i-ce
Street Address
� iiIle ,A1.C_
Gi or Town State Zip Code
RI 1, -nr Evrcf,A\-m}rt 1
5-
Sl i, f 7C�'��
City or Town
( a ) L.431 3 366
Area code Phone number
6 WELL DETAILS:
a. TOTAL DEPTH:_ rt7
b. DOES WELL REPLACE EXISTING WELL? YES Q NO C3'
c. WATER LEVEL Below Top of Casing: It?.'i 5 FT.
(Use'+' if Above Top of Lasing)
Facility lD# (if applicable)
Contact Name
IVIailirlAddress
Slate Zip Code
d. TOP OF CASING IS 3' FT. Above Land Surface'
'Top of casing terminated at/or below rand surface may require
a variance In accordance with 15A NCAC 2C ,0118,
e. YIELD (gpm): Ae../A METHOD OF TEST � },A
f. DISINFECTION: Type f+I I0hAmount !Ld
g. WATER ZONES (depth):
Toy 44/4 Bodcra : 4 # Top Rrl rim aT
Top Bottom Top Bottom
Top Bottom Top Bottom
7. CASING: Depth Diameter
Top a' Bottom A/' FL Z°
Top Bottom Ft.
Top Bottom Ft
ThickneesJ
Weight Materiel
8. GROUT: Depth Material
Tap O Bottom 9' Ft._C b,lil--
Top Bottom Ft
Top Bottom Ft,
li, SCREEN: Depth Diameter Slot Size
Tap 1, Bottom 29' FL 2" In. . fD in.
TopBottom Ft. in. In.
Top Bottom Ft- in. in. _
Material
Mc-
10. SAND/GRAVEL PACK:
Depth Sipe
Top 11. Bottom 29' Ft. #/
Top Bottom Ff.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
1
1
1
1
1
1
1
1
i
1
1
12. REMARKS:
Material
r
Formation Description
,i'dii'�31r Orr
❑D M REBY CERTIFY THAT THIS WELL WAS CONSTRUCTED EYAcC0 UANCE WITH
1W. NCAC 2C, WELL CONSTRUCTrON STANOAR OS, AND THAT A COPY OF I KS
RECORD RE
11.541-1e VIELL OWNER.
Si XQF
G,E..137194VELL CONTRACTOR
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
DATE
Form GW-1 b
Rev. 2/09

NON RESIDENTIAL WELL CONSTRUCTION RECORD
North c HFOHnri Dcpaitnent of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION ## .5I/
1. WELL CONTRACT
•lr1.4J
We Contractor (Individual) Name
A E DRILLING SERVICES LLC
Well Contras . Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
City or Town State Zip Code
(864 ) 288-1986
Area code Phone number
2. WELL INFORMATION: SP Ins- --5
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(Ir� applicahte)
SITE WELL ID #(fF applicable)
3_ WELL USE (Check One Box) Monitoring [i Municipal/Public 0
Industrial/Commercial 0 Agricultural 0 Recovery 0 1nJectionlfr
frrigationp other ❑ (list use)
DATE DRILLED 11-141-49
4. i ELL LOCATION:
(Street Name, Numbers. Communion. Subdivision, Lot No., Parcel, Zip Code)
CITY: c .i.]5i/N.naAf1k it COUNTY
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
ESlope ❑Valley oFlat c1Ridge ❑Other
LATITUDE 3 " DMS OR 3x,xxxxx xxx OD
LONGITUDE 75 " DMS OR 7x.xxxxxxxxx Dl)
Latitude/longitude source: COPS ❑rapographic map
{Iocat'on °f we must be shown on a U$GS top° map andatfached to
this farm if not using GPS)
a. FACILITY (Name of the business where the well is located.)
eisapit.CAgmhrip-4;
Facility Name [��] Facillly IC* (if applicable)
I8O 00 eve Tr t.f 2A -
Street Address
im igte -A , StateSS
ri I lip Code
PI troll- +trnmen -. 1
Contact Name
;) 1 Eirt,.,�rj St
Mail ng Address
Ar4tville a of
City or Town State 2lp Code
( ) 1 1 3356
Area code Phone number
S. WELL DETAILS:
a. TDTAL. DEPTH:
zy1
tr. DOES WELL REPLACE EXISTING WELL? YES 0 NO Er-
e.. WATER LEVEL Below Top of Casing: - tit y-} FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASINO IS _a 1 Fr. Above Land Surface*
'Top of casing terminated atlorbelow land surface may require
a variance In accordance with 15A NCAC 2C .011 t3.
e. YIELD (gpmi: 4(ii' METHOD OF TEST
t'. DISINFECTION: Type A)/0" Amount
g. WATER ZONES (depth):
Top N1k Bottom At/,* Top
Top Eottern Top
Top Bottom Tap
otel
40, - Bottom .[174
7. CASING: Depth Diameter
Top 0° Bottom 1?' Ft 2"
Top Bottom Ft
Top Bottom Ft
Bottom
Bottom
Thickness/
Weight flrlaterlal
Sal.'Puy
EL GROUT: Depth material Method
+
Top O,�,n
% Sodom F' FL ►Ca�;1— �� ielot eR
Top Bottom FL _.
Top Bottom Ft. — —
S SCREEN: Depth Diameter Slot 9¢e Materia'lA
Top 13' Bottom 7.$' FL Z'' In .1D in. &hie Wilig
Top Bottom Ft. fn. in,
Tap Bottom
IS. SAND/GRAVEL PACK:
Ft in. in,
Depth Size
Top- �f r Bottom 2JI Ft. # / _
Top - Bottom Ft.
Top Sott= FL
11. DRILLING LOG
Top Bottom
1
1
11 REMARKS:
Material
Safi
Formation Desulpha n
& pr i; 4e
I CO HERESY CERTIFY THAT THIS Wt .L WAS CONSTRUCTED INACCORDANCE WITH
19A NCAC2C.'AEI-OONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROYIMPD TO THE WELL OWNER.
SIGRTUIICaltRT1FIE LZ GONTRAC
PR
D t• ME OF ' ERSON CONS
UCTING Ti-lE WELL
Form GW-.1b
Rev. 2/OS

1. WELL CONTRACTOR:
�i Mf44a111-
Wolf Contractor (Individual) Name
A E DRILLING SERVICES. LLC
Well Contractor Company Name
TWO UNITED WAY
Sheet Address
GREENVIi LE Sr
City or Town Slate Zip
(.864 ) 288-1986
Area code Phone number
2. WELL INFORMATION: +. ids-9
WELL CONSTRUCTION FERMI f#
OTHER ASSOCIATED PERMIT#(ff appr�ableJ
SITE WELL ID #(rapplfcacle)
3. WELL USE (Check One Box) Monitoring ° Municipsi/PutlIc❑� Industrial/Commercial D Agricultural Recovery 0 Injection p
Inlgatfon0 Other 0 (fiat use)
DATE DRILLED !I _/,3'
4. WELL LOCATION:
(Street Marna, Numbers, Community. Subdivision, Lot No., Parcel, Yip Code)
CITY: [JiCaNYiAAA COUNTY
TOPOGRAPHIC / LAND SETTING: peck appropriate box)°Slope ❑Valrey ❑Flat ❑Ridge ❑Other
LATITUDE 35 DM OR 3x.xxxxxx xx 1311
LONGITUDE 75 " OMS OR 7x.x ocx o ca DD
Latitirde/tDngltude source: 1233PS °Topographic map
(location of well mast be shown ona UJSGS topO map andattachad to
this tom: fnot using GPS)
S. FACILITY (Name of the business where the well Is located.)
Facility Name Facility ID# (#f applicable)
lig Old Eui Tire rei•
Street Address
A416 l le . c.
Ci n or Tow
State Zip Code
Contact Name.
,93 I lliOnr ii S4-
Mailing Address
A;,h1U1 [ IF n c AgOI
Clay or Town State zip Code
&ZS) $I 335o
Area coda Phone nurnber
6.WEELL DETAILS:
a. TOTAL DEPTH: %T O
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO
c_ WATER LEVEL Below Top of Casing: 7- 3 8 FT.
(Use '-f." if Above Top of Casing)
Coda
TRU NON RESIDENTIAL WELL cONSTIori RECORD
North Carolura Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3,r11
d. TOP OF CASING rS 31 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .O118.
o. YIELD ($pm): NA METHOD OF TEST
f. DISINFECTION: Type AlliA Amount
$. WAITR ZONES (depth):
t: 11 4f/4 A�f.� 29607 ToDo m Top .eott .. !WA
Top Bottom Top Bottom
Top Bottom Tap Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Tnp _ Boftum 1T- FL 2"
Top - Haltom Ft
Top Bottom Ft
tto
8. GROUT: Depth Matorlal Meth
Top, at Bottom fr Ft e'rJiii n1 r'' i
Top Bottom R.
Top Bottom Ft. - -
9. SCREEN: Depth Diameter Slot Size Materiel
Top 131 , Bottom ZR' Ft VI in. .1D In. U OW SScre PJJesj
Top Bottom FL fn. In. - -
Top Bottom Ft In, in.
10. SANDIGRAVEL PACK:
Depth Size matey/ I
TopIJBathom ZI' FL [ 2d
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom Fa Mali on Description
1
1
1
1
1
1
12. REMARKS:
} no t{*REeY CEBTtFY THAT rag 1 LL WAs IXMSTRucTEv IN ACCORLTANCE WITH
15A MCaC 2C, WELL CONSTRUCTION STANDARDS, AND THAT ACOPY OFT IS
REtX3Rn HIS BEEN P OVf6EQ • THE WELL OWNER
SIGNATURE OF CERTIFIED WELL
NTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-Th
Rev. 2/09

NON RESIDENTIAL WELL cortnnu rioN RECORD
North Ctmnlina Department D£Emrironment aid Natural Resources- Division Of Water Quality
WELL CONTRACTOR CERTIFICATION # Jrn
1. WELL Ct 7 RAC ifiTO d.f!
Well Contractor (Individual) Name
A E DRILLNG SERVICES, LLC
Well Contactor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
City or Town State Do Coda
(864 ) 288-1986
Area code Phone number ,� r
2. WELL INFORMATION: " �� " /Q
WELL CONSTRUCTION PERMiT1
OTHER ASSOCIATED PERMITS(lf appfhhable)
SITE WELL ID it(tt appemdte)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public
industrial/Commercial 0 Agricultural 0 Recovery ❑ rejection
Irrigation© Otter ❑ (Itst use)
DATE DRILLED
4. WELL LOCATION:
(Street Nlraf, Number,. Community, bubo lsion. Lot No.. Patcal, Zip Code)
MY: SIAYI Y-i►-,.-ett ( couNTY
TOPOGRAPHIC I LAND SETTING: (cheek apprroprlate drnq
❑Slope ❑Valley ❑Flat ❑Ridge ❑Other
LATITUDE 36 ' DAIS OR SX.)oocxX Xacx OD
LONGITUDE 75 ' DMS OR 7X,xXXXXXXXX DO
Latituda/lnngitude source: (33PS f]Papcgraphic map
(location of well must be shown on a USGS Mpg map andettechecl to
thisform ftnot rrsfng OPS)
R FACILITY (Name of the bualness where the well is located.)
NeerOnic5
Facility Name Facility loom applicable)
ISO C:Id PRe -Fre Pci
Stm t Address
Ashr,Ile .�j,G�
City orTom
Ai4e06n+ FliVifYrilvlr„rtRI
Contact Nar��tya� y f�
I HL L Ejd alit
Me}[rng Add
c g8o5
State Zip Code
)eVile Teri
City
�oo Town
(o 3 •9,'f 33:
Area code Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 029 "
State Zip Code
tr. DOES WELL REPLACE EXISTING WELL? YES 0
c. WATER LEVEL Below Top of Gaming: 4 6'1 FT.
(IJS° '+" it Above Top of Casing)
NO el
7_ CASING: Depth
Top a` Bottom
Top Bottom Ft.
Top Bogam Ft.
: d.
TOP OF CASING IS "f FT. Above Land Surface'
'Top of caring lerrnFnated attar below land outface may require
a vaifence in accordance with 15A NCAG 2C .0118.
e. YIELD (gpm): iii/A METHOD OF TEST
f. DtSINFECTlON: Type A/,t Amount
Top wA�Bottom
NES ep � Top Bottom
9.
Top Bottom Top _ Bottom _
Top Bottom Top Bottom
Thickness!
Diameter Weight Material
a' Ft. 2" Sej fl4 Ar.,
8. GROUT: Depth Material Metho1.
Top. 0' Bottom 9' Ft. &milt �iM;e
Tap Bottom_ Ft.
Top Bottom Ft_
9_ SCREEN: Depth Diameter Slot Size 'Astoria! q
Top lei Bottom a Ft e in. .r0 tn. I.)- (jail-1"OL
Top Bottom FL In. In.
Top Bottom FL in. in.
10. SAND/GRAVEL PACK:
Depth .�Siize material ,
Top it
Bottom Ft. 40/ _ 4,1 - -
Top Bottom Ft. _
Top Bottom Ft
11, DRILLING LOG
Top Bottom Formation Description
1r a
1
1
1
1
1
12. REMARKS:
DO HEREBY CERTSFYTHAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WUJI
IS4NCAC 20, WELL L70MSTROGnuN STANDARDS. AND THAT A COPY OF THS
RECORD WAS BEEN PROVrOFA TO THE WELL CNVNFR
SIGN, J F t RTIF1 WELCONTRAO DATE
PRINTED NA OF PERSON CONSTRUCTING THE WELL
Form OW-1 b
Rev. 2109

NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Lnvironmeni and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 0-7/
1. WELL cO TRACTOR:
tfti fr7` A..ri
Well Contractor (Individual) frame
A E DRILLING $ER]IIQES. LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE Sc 29607
City or Town State Zip Code
t 864 y 288-1986
Area code Phone number
2. WELL INFORMATION: T—P— lot`
WELL CONSTRUCTION PERMIT#
OT1-IER ASSOCIATED PERMIT#(If eppfleable)
SITE WELL II] *if appkcable}
3. WELL USE (Chards One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial Cl Agricultural ❑ Recovery [ Injection
Inigalian❑ Other ❑ Gist use)
DATE DRILLED t1-/S
a_ WELL LOCATION:
6tl4.:ftires
(Street Name, Number% Community, Subdivlslon. Lot No.. Parcel, Zip Code)
CITY: SLID/N 1GlAnc. Inc. COUNTY
TOPOGRAP1-{ICI LAND SETTING: (hecit eppmpjrela boxy
❑Sops ❑Valley ❑fiat ❑Ridge ❑Other
LATITUDE 35 " ORBS OR 3x.XXXXX Oacx ❑D
LONGITUDE 75 - DMS OR Txaoc000cc DD
Latttudseflongltude source: [3PS ©ropngrapitlo map
(location of well must be shown on a USGS fopo map andat[ached to
this form if not using GPS)
5. FACILITY (Name of the business where the well Is located.)
-I\trif1.4rcticic..S
Facility Name _� Facility ID# (if applicable)
Lego ❑ rd ice l rre
�41 aI rfI- vawl
Street Address
p,-,heici if_
L.lty or Town
a G5
State Zip Code
Contact Harry r�
,2 1,4 L C'TI eT-
Maipng Addrc
P ;1 le (c „Wgot
City or Town State Zip Code
c _ 3356
Area code Phone number
B. WELL DETAILS:
a. TOTAL DEPTH:t?
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top at Casing: i Pr $g __FT.
(Lase "+" ff Above Top of Casing.)
d. TOP OF CASING IS J FT. Above Land Surface'
*Top of rasing terminated atlor below land surface may require
a variance in accordance whit 15A NCAC ZC .0118.
e. YIELD (gpm): 1Oi1 METHOD OF TEST
f. DISINFECTION: Type 'v! e- Amount
g. WATER ZONES (depth):
Top .t.//e- Cc to-i 41/ Top .4/ - et:ttom dI•1/..
Top Bottom Top Bottom
Top Bottom Top
Bottom
Thickness/
T. CASING: Depth Diameter Weighs Material
Top /I' _Bottom Zt` Ft 211 ram} . PLC
Top Bottom Ft -
Top Bottom Ft
a. GROAT: Depth Materiald Metho
Top. a 4 Bottom. 91. L CAi I aFt 7,1 M►
Top Bottom Ft.
Top Bottom Ft-
9. SCREEN: Depth Diameter Slot Srm 'Material
Top_ /,a' ,Bottom vial FL . In. .It !n. fr Li Pt- NC,
Top Bottom
Top Bottom
Ft. in. in..
Ft. ie. in.
10. SANIWGRAVEL PACK
Depth Size Material
Top_ jr__--Bottom P9 1 Ft.i ,5E;.Iv'I
Top Bdtlam Ft
Top Bottom Ft.
11. DRILLING LOG
Tap Bottom Formetlen Description
or n
1
1
1
1
1
1
1
12. REMARKS:
I DO HERESY omen FYTHAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A AMC 20, WELL OONSTRLICTION STANDARDS, AND THAT ACOPY OF THIS
RECOROra�I�we>_L OWNER.
SIGNATURE F RTEFIEf3 WELL CONTRA TL R DATE
,4 e/A 04r
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1 b
Rev. 2109

WELL CONSTRUCTION REL.ORD
This Rum can be used far smgte or multi p$, was
L Well Contractor Information:
Rartdy Philips
Well Connecter Name
2209-A
IOC Weil Co tmctrr Codification umber
A.E.Drilling Services
Cornrow Name
2. Well Constraclion Puitdt #: _
Ilse all applth bL? well permits et a. C4' note}: S7arc, Variance, Injection, etc)
3. Weft Use (check wen use):
Water Supply Well:
❑Agricultural
OGeotheraud (nesting/Cooling Supply)
OhidusuialVCommercial
❑ Irrigation
[Monte ipal/Public
❑Residential Water Supply (single)
P Residential Water Supply (shared)
Non -Water Supply Well:
fdMonitaring
❑Recovery
lujecdlou Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑ Experimental Technology
o Geothermal (Closed loop)
°Geothermal (Floating/Cooling Rennet)
4, Date Well(s) Completed: 11 /27/12
5a. Well Location:
Chemimnlcs
Facility:DonisName
U('roetndwster Remediaiion
ClSalinity Barrier
❑Stnmtwater Drainage
o Subsidence Control
❑Tracer
❑ Other r aplain under #21 Remarks]
Wi11TDlr1P 105-12
Varney MN (if applicable)
180 Old Bee Tree Rd.Swannanoah 28778
Physical Adam. City. and rap
Buncombe
County Pourer rdmrlfuatian No. (PLN)
Sb. Latitude and Leng)tmde in degrees/minutes/seconds or decimal degrees:
Orwell field, one 'Wong is it5cieni)
N W
6. Is (are) the weals): era anent or °Temporary
7. Is this a repair to an er.isting well: ❑Yes or FWD
Phis Ls a repair. fill cue aeo nn well construction lnfarmatrwr and explain tier nature. of der
repair reenter 021 remarks .s c ins or um the bark ofehirform.
B. Number of wells constructed:
Far multiple Inftefion or non -water supply wells ONLY with the ammo 4eeurue60,1, yen can
Sabo, U one form.
1
9. Total well depth below land surface: 28 • Q
Fur multiple rwlls list all depths ##"different {esaraple- i 2OO' owl2%a 7t70)
lit. Stnle water level below top of easing
1fr9aeer lard is abrrve rasing, use '4'•
IL liorebole diameter: a (la)
12. Well (oattraction method: auger
OA.. imps: rotary, noose, dac i pub, ere.)
(mi)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield ((pia) _ Me thud of lest:
lib. Disinfection type: __ _ Amaunt:
For Wane] t•Jre ONLY.
14. WATER 7LOffl6
PROM
In
nlc9LnoriksV
R
t1.
LA. ouTgR CAKING
stir maltl-card wells) ORLWEB (kragpticable)
vanes : TO PrAM9TER. L TSICIRrENEMAT1J AL
13 rt j+3.5 f. 2
sch 40 1 PVC
14. INNER CASING Oft TUBING (geoftlermat dnred-loop)
Tenter
71a
11.
SiAMET N
to.
THICKNESS
MATERIAL
n.
17, SCRR:EN
FROM_ 7Q
MAMMA
13 ft. 28 It. 2 lo.
R. R
SLOT SIZE
.010
prepack
THICKNESS
sch 40
agATlsrAL
Pvc
13. CROW
FROM
TO
11 FL
fL
tr.
MATERIAL
3/8 holeplug
neat cement
EMPLAcEmENr NE7'800 A AMOUNT
pour
pump
19. SAND/GRAV11L PACK IR ligblej
C9,1
TO
MATFHIAL
EMPLACKHENTMKTHEIR
29 iL
ff.
11
rt.
rt.
#1
pour
ze. DRILLING LOG [Atha iddttievel,henry if wuxwary)
FROM
B
ft.
TO
fL
rt.
TIER (TijPniOy Icolor, usidow..ru'rara<trpr,pnisOat. srs)
ffi
ti
iti
11.
R
11.
. mitts
CerWReafopg
SigMturE e r n ti&ed Well Connacht(
I/- 27 — Fs
-
flee
By signing this forne, I herrby north. that the turf1(i) was (were) tful t tat in accordance
with ISANC4C O2C.OlOO or 154 NC.IC 02C .4200 Wrll Couseren do r Seaadardt erred dud a
rnpy ofthis record has burn provided ea the well mwrer.
23. Site diagram or additional well details:
Yaw may use the back of this page to ptnvide additional well site details or well
construction details. You may also stench additional pages if necessary.
SUBMITTAL I(NSTUCI1ONS
24a. For All Welts: Submit Otis form within 30 days of wrupletior of well
construction to the fallowing
Division of Water Resources, information Processing Unit,
1617 Mall Service Center, Raleigh, NC 27699-1617
24b. fsriojectina Wells ONLY: In addition ro sending the farm to- the address in
24a above, also sttbinit a copy of this form within 30 days of completion of well
consttuctian to the following:
Division of Water Resources, Underground Injection Control Program.
1436 Mall Service Center, Raleigh, NC 27699-1636
24c. For Water Su is & In colon Wells
Also submit one copy of this tarot within 30 days of completion of
well roiiwinictian to the county- health department of the county where
rxinstructed.
Fain GW-t
North Carolina Department of Fnvirunrunnn and Nauru! Resources — Rivise a orWalerResanrrea Revitad August 2013

NONRESIDENTIAL WELL cONsTRUcTioN RECORD
North Carolina Department of Environment End Natural Resolrroes- Division of Writer Quality
WELL CONTRACTOR. CERTIFICATION # 3E7
1. WELL CONTRACTOR:
A�y1 m&Cru;rt
Well Contractor (Individual) Name
A E DRILLING SERVICES. LLQ
Well Contractor Company Name
TWO UNITED WAY
Street Address
rREE.f+1VILi F
Gity or Town
(864 ) 288-1986
Area code Phone number
2. WELL INFORMATION: Y p j Dr- ti3
WELL CONSTRUCTION PERMIT
SC 29607
State Zip Code
OTHER ASSOCIATED PERMIT#{Irappo able)
SITE WELL ID *(if applicable)
3. WELL USE (Check One Box) Monitoring Municipal/Public ❑
Industrial/Commercial ❑ Agricultural 0 Recovery a In}ectianl
Irrigation❑ Other ❑ (list use)
DATE DRILLED 11.13 - i Z
4. WELL LOCATION:
CLrr [ir L
!Street Warne, Numbers, Cemmuney, Subdivision, Lot Nn_, Parcel. Zip Coda)
CITY: tA-0.1yZb 11-)C COUNTY
TOPOGRAPHIC! LAND SETTING: (check apprupr$ate fox)
DSlope EIValiey C1Flat ❑Ridge ❑Other
LATITUDE 36 " ` DMS OR 3x,xxxxX)0(XX LTD
LONGITUDE 75 " DMS OR 7X.XJ0CCC COC Ixi
Latttuda9Ongitvde source LOPS propographic map
(location of welt must be .shown on a USGS typo rnap andaftached hr
his form if not using GPS)
5- FACILITY (Name of the business where the well L3 located.)
CI rLLonies
FacilIty Name _ Fac]Itty ID* (if applicable)
} a ck r-ET,ce k.c.
C$....-. a l,r«......
{ lr u i f e , k) ,.0 1 a SC]
State Zip Code
u. 1 vwil
i11-moon4 ifw'ir C f en+*l
Contact Name
I1AL l_,t)Oa S4
Malling Address J
01 le ,)_go I
City or Town
L
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH; Z1'
State 21p Code
h. DOES WELL REPLACE EXISTING WELL? YES ❑ NO [d
c. WATER LEVEL Below Top of Casing: �_9 FT
(Use '4 - if Above Tap of Casing)
d. TOP OF CASING 1S r FT. Above Land Surface*
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e, YIELD Wpm): N t4 METHOD OF TE T iU/4
f. DISINFECTION: Type Amount A).01.
g. WATER ZONES (depth):
Tap AWI Bcttvm :L1 i-- Top & J:i" &dont Wet
Top_ Bottom Top Bottom
Ton Bottom Top Bottom
Thickness!
7. CASING. Depth Diameter Wetght Material
Top G° Bottom i Ft. Z.r ,fJ►.% AO..
Top Bottom Ft,
Top Bottom Ft.
8. GROUT: Depth
Top d' Bottom q Ft
Top Bottom. FL
Top Bottom Ft.
Material ►� Method
9. SCREEN: Depth Diameter Slot Size Material
Top `g t Bottom Z$t _ Ft._.2.1' In. 1./6 in. 11• Ci.] j tom. jr f CgA
til
Top Bottom Ft. In. In.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Matertii
lj Top ' Bottom 29' ____E4
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
1
1
1
1
1
1
1
1
1
1
12. RENMARFCS:
Formation Description
�:r�rr• ,I
DO HERESY CERTIFY THAT [HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A. NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF CERTIFIEDLL CONTRACTOR
1f I -/2
DATE
Akel
�.Lrt
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-lb
Rev_ 2/09

1. WELL CONTRACTOR:
A L l#Crutre_
Well Contractor (Individual) Name
A E DRILLING SERVICES. LLC
Welt Contractor Company Name
P VO UNITED WAY
Street Address
GREENVILLE SC 29607
Oily or Town State Zip Code
( 864 ) 288-1986
Area code Phone number
2. WELL INFORMATION: X' I DsPi
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERM T#(t(appliable)
SITE WELL It gigi epplicable)
S. WELL USE (Check One Box) Monitoring ❑ lainicipallPublic ❑
Ind ustrfa1iCflmmerclaf ❑ Agricuilural❑ Recovery ❑ Injection Er.
Irrigation❑ Other {fist use)
DATE DRILLED �t t 3 ^ 12.
4. WEIA,LOCATION: [r
(Street Name, Numbers, community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Stvvjpp0. J C couNTY- --
TOPOGRAPHIC f LAND SETTING: (check appropriate box]
❑Slope ❑Valley ❑Flat ['Ridge DOther
LATITUDE ae • • DMS OR 3x.X)0000000( DD
LONGITUDE 75 • • _ - _ * DMS OR 7)0000C000ps DD
Lalftudefongitude source: )PPS Dropographic map
(laralien of well must be shown on a (JSGS tope map arldaitac'fjed to
this form If not using GPS)
6. FACILITY (Name of tha businoSs where the welt is located.)
+
Faciti'Name (} Facility eV (d apptf to e)
1 b Old KC Tt€ CA
Stilsed Arrrimea.
City or Town State Zip Code
I4-kprpEf)tiironmeMz&J
Contact Name
.23I t 1-0y S4-
Main Addres
Ai,hPU;11e r)
Rol
City or Town State Zip Code
.S) c 1 3350 _
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 211
b. DOES WELL REPLACE EXISTING WELL? YFS D NO [Y
c. WATER LEVEL Below Top of Casing: �-' FT.
Nee "4 If Above Top alGasung)
NON ONRESID RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Departrzleut of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTThWAIIONT # 37I
of
d. TOP OF CASING LS .i FT. Above Land Surface'
"Top of casing terminated attar below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): N/Pp _ METHOD OF TEST
f. DISINFECTION: Type JW A— Amount
g. WATER ZONES (depth).
Top_agar_ Bottom AN* Top AVil- Bottom r
Top Bottom Top Bottom
Top Bottom - Top Bottom
Thieknessl
Weight Material
7. CASINO: Depth Diameter
Top 0' Bottom Ir'
Top Bottom Ft.
Top Bottom FL
P
& GROUT: Depth Material Method�t
Tap_0' Bottom_ Ft �- i nn4 eI7►t
Top Bottom Ft.
Top Bottom Ft - _
9 SCREEN: Depth Diameter Siot Size Material
Tope Bottom Fi. bra in. 10%10 h. W ►.e.. tatty
Top Bottom Ft in. in.
Top Bottom Ft_ in. in_ _
10, SAND1ORAVEL PACK:
Depth •f� I Size .etariaf
Top. ! I I Bottom-2
Top Bottom FL
Top Bottom FL
11. DRILLING LOG
Top Bottom
1
1
f
1
1
1
1
1
1
12. REMARKS:
Formation Description
1 6O HEREBY CERTIFY THAT THIS Wr7J, WAS CONSTRUCTED IN ACCORDANCE WMTH
15A NGAC 2C, WELLcams- RuCT:OW STANDARDS. APO THAT A COPY ❑F THIS
RECORDKAS BEEN PROVIDED TO THE WELL OWNER_
0.114
•
SIGNATURE OF CERTlFIE5 WELL CONTRA4`TOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-lb
Rey. 2I09

1, WELL CO
NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Deportment of Environment and Natural Resources- Division of Water QIta}ity
WELL CONTRACTOR CERTIFICATION # 3,7/
rudPP
Well Contractor (Individual) Name
A E DRILLING SERVICES,1..1.0
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
City or Town State Zip Code
(864 , 2B -1986
Area code Phone number
2. WELL INFORMATION: P tor- /jam
WELL GONE RUCTION PERMIT#
OTHER ASSOCIATED PERMfrt!!(ir applicable)
SITE WELL ID #('d applicable)
3 WEU. USE (Check One Box) Mant'ioring ❑ Municipai/Public❑
Lndustriai'CommercIal CJ Agricultural 0 Recovery 0 Injection
Irrigation Other p (list use)
DATE DRILLED
4. WELL LOCATION:
l_flelftii"4NLr
(Street Name. Numbers, Community. Strbdivlad n. Lot No., Parcel, bp Code)
CITY: St�Yf f•cii.Oe rC COUNTY
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
DSlope OValley LlRat oRidge ❑Other
LATrFUDE 3 " I7MS OR 3X-XXXXx xxx DD
LONGITUDE 75 " DMS OFR Tx.XXXXJ0000t OD
Latitude/longitude source: [CPS Dfopogrephic reap
(location of well must be shown on a USGS topo map node/lecher/ Io
this form if not using GPS)
S. FACILITY ( Name of the business where the vrell is located.)
C..-A fon r`/ttfi 1 �S
Facility Name Facility ID# RI applicable)
1q0( f �ir[ 2
Street Address �/� �^
fiCuiIk- t I"'L,rr
Crty or'rawn
A141'i1C -4 Ei U trr:PN coop 4-a
Contact Nam
J3 I i 16,11.,encA
Mailing Address-
Jishev+Ire lC caDl
,�Wo5
State Zip Code
City or Town State ZIp Code
( Sag) I 3350
Area code Phone number
6. WELL DEfAM LS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES [1 NO Mr'
s
c. WATER LEVEL Below Top oFCasing q. i `Fr.
(L)se '+' if Above Top of Casing)
d. TOP OF CASING IS
FT. Above Land Surface`
`Top of casing terminated at/or below land Surface may require
a variance in accordance with 16A NCAC 2C .0111'5.
e. YIELD (gpm): A/Mt METHOD OF TEST lY./
f, DISINFECTION: Type Amount /i
70419—
g. WATER NES (depth):
Top GaitOrn 4 Top 1� uifun, '
Top Bottom Top Bottom
Top Bottom Top Bottom
7. CASING: Depth Diameter Material
Top Q' Bettom JP r Ft. Z h p to Cr
Tap Battorn Ft.
Top Bottom Ft.
Thlcknoss!
Weight
5 h►•gti
$. GROUT: Depth Material Method
Top ❑` Bottom 41 Ft. Cern E.t l]. _Tor/ PA L
Top Bottom Ft.
Top Bottom R.
9. SCREEN: Depth Diameter Slot Sire Material
Top go Bottom Ft. In. In. Top /.' Bottom '` Ft, 2' in. Jr.? _ In. Liral—OPIle
Top Bottom FL. In. in.
10. SAND/GRAVEL PACK
Depth J 9tne Material
11 Top ' Bottom 4f Ft4/
Top Bottom Ft.
Top Bottom Ft
11. DRILLING LOG
Top Bottom Formation Description
1SeicroI,
1
1
1
12. REMARKS:
I DO HEREBY CERTIFY THAT THS WELL WAS CONSTRUCTED IN ACCORDANC WITH
I8A NCAC 2C, WEtt cC 1STRtICT/ON STANDARDS. AND THAT T A COPY❑w THIS
RECORD ItgS N PROVIDED TD THE weLL OWNER_
SIGNATUR l7F RTIF3EP WELL CONTRAC-h
�•/072
DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Fi!r:u 2100

1. WCONTRACTOR:
8AIr► c e
Weli Contractor (Individual) Name
A E DRILLING SERVICES. LLC
Well Contractor Company Name
TWO uNITEI WAY
Street Address
GREENVILLE SC 29607
City or YOWn
(864 288-1 986
Area code Phone number
2. WELL INFORMATION: P J or- i b
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(%applicable)
SITE WELL ID ;TV applrraNu}
3. WELL USE (Check Or. Box) Monitoring q Municipal/Public ❑
Industrial/Commercial 0 Agricultural L7 Recovery 1njecGon El—
lrrigation❑ Otter ❑ (fist use)
DATE DRILLED 1IlY fZ.
4. WELL LOCATION:
iliAn, 4i Ortii 45
Slate .Tip Code
(Street Name, Numbers, Community, Subdivision, Lot Na„ Parse!. Zip Code]
CITY. COUNTY _
TOPOGRAPHIC 1 LAND SETTING: (diet* appropriate box)
DSlope [Dailey 1Flat ['Ridge ID Other
tA11TUDE 36 - o is OR 3x.x00000o0o( oo
LCNGfTUDE 75 ^ DMS DR 7x.xp x xx ( DD
La[itudeltangtiude source: [GPS !JFopugraphic map
(location of well mute[ de shown on a USGS topo map andaitach$d to
this form if not rising GPS)
5. FACILITY (Name of the business wham the well is located.)
OWSPI _ ' f4S
Facility Name
I$D 01r.{
Street Address
X,het1A I e
City or Town II
RI ;~clnl 11+ E1)U,toNwi :- d
Contact Hama
•-Ac Oti S4.
'rye
/fir
Facility !D# (d applicable)
asNoS
Slate Ztp Code
Mailiqg Address'-'
( he It=lle r) c 2gg01
City er Town State Zip Code
I 5�
Area code Phone number
S. WELL DETAILS:
a, TOTAL DEPTH: D
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
C. WATER LEVEL Beiow Top of Casing: /1. FT.
(Use "+' if Above Top of Casing)
NON ON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina DepatAueni of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
4. TOP OF CASING IS 3 r FT- Above Land Surface'
`Top of caaing terrninated attar below land surface may require
e variance in accordance with 15A NCAC 2C __ 111�8.e
a. YIELD (gory):I� METHOD OF TEST 11�l/if
f. DISINFECTION: Type A/ Amount i
g. WATER ONES (depth):
Top "I/AV—Bottom /w '
•Top 8cttorn
Top _ Bottom
Top 4 Bottom j
Top Bottom
Top Bottom
Thicknas5J
T. CASING: Depth Diameter Weight Material
Top i' Bottom 13' Ft. 2"
Tap Bottom Ft.
Top Bottom Ft
&4. )06
8. GROUT: Depth f Material Method
Top. 6 1 _ Bottom I. _ Ft. Le�7Cr1"1-- /;-- mil e
Top 13attom Ft.
Top Bottom FL
8. SCREEN: Depth Diameter Slot Sae Material
Top LT'- Bottom lt Ft. Z° in. de) In. j.glaiFo
lop Bottom FL in. In.
Top Bottom FL In, in.
10. SAND/GRAVEL PACK:
Depth Size Material
Top '� r Bottom_ 74i Ft / "C�►hal
Top Bottom Ft.
Top Bottom Ft
11. DRILLING LOG
Top Bottom
12. REMARKS:
Format on Description
I DU HEREBY CERTIFY THAT TEAS WELL WAS CONSTRUCThC IN ACCORDANCE WITH
1SA NCAC 2O WELL CONSTRUCTION SrANDARDS, AND THATA COPY Of THIS
RECORD i LEN P V1 o 7HE w.awNER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR
DATE
4 I.ti
PRINTED NAME OF PERSON CONSTRUCTING TI IC WELL
Form GW-lb
Rev. 2/09
1

t. WELL COwrRAC1OR
Ahdl mf�u,(L•
Weil Contractor (individual) Name
A E DRILLING SERVICES. LLC
Welt Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607.
Clfy or Town State Zip Code
(804 288-1986
Area code Phone number , }
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(rr apprcad e)
BITE WELL 1D #(it applicable)
3. WELL USE (Check One Box) Monitoring I: Municipal/Public ❑
Industrie/Commercial ❑ Agricufturat 0
Irrigation❑ Other ❑ (list use)
DATE DRILLED iD. 23"It.
4. WELL LOCATION:
Gh 4rDF4t-3 (S
(Street Name, Numbers, Community, 8utdMsion, Lot No.. Patse% Zip Code)
A CITY: Vi N.C. COUNTY
Recovery ❑ Injection Er
TOPOGRAPHIC / LAND SETTING:
DSlope Di/alley [$Flat ❑Ridge
LATITUDE '
LONGITUDE 75 '
{died( appropriate ix) •
❑ Ott er
DMS OR 3x.)oocxxx COC DD
" DMS OR 7x.xxxx/D0x0 OD
Latitude/longitude source [pPS Dtopographic map
(location of well mustba shown on a USQS tape map andattached to
this form if not using GPS)
& FACILITY (Name of the business where the well is located.)
C! eNl4r6NL
Facility Name
Sheet Address
fkh01r
bee 2m4
Facility IL (ff applicable)
Clly or Town
[I 4, 1f C(J.rar,mt_f\
State Zip Code
Contact Name
I i
Mal ng Address
_As iolfill�
City or Town
(gag)2I—
54..
tic A36 Ir
State Zip Code
3S5
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH 3S'R .
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO d
c. WATER LEVEL Below Top of Casing: Ja FT.
(Use's' if Above Top of Casing)
NON RESIDENTL 1 L WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Wfficr Quality
WELL CONTRACTOR CERTIFICATION # 3171
d. TOP OF CASING 13 3 r FT. Above Land Surface'
*Top of casing terminated at/or below land surface may require
a valance in accordance with 15A NCAC 2C .0118.
e. YIELD (gem): 1141 METHOD OF TEST N%14
f DISINFECTION: Type A.VP1' Amount BOA
g. WATER ZONES (depth):
Tap A11H Bottom - A:C4 Top 11Jk Bottom Wit
Top Bottom Top Bottomrt
Tap Bottom Top Bottom
Tlllckneee/
T. CASING: Depth Diameter Weight Material
Tap fr. Bottom t Ft.
Top BottomYL3 s FL • clt ¥L l fit
Top, Bottom rt.
8. GROUT: Depth Material Method
Tap. D` Bottom 111V Ft P;.,.srk Tkwn i E
Top Bottom FL
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top j 7' Bottom 37° Ft. Z'' In. • 16 in. Wire. . LI rap POLY
Tap Bottom Ft in. in.
Top Bottom Ft. Jo. - In_
id. SANDIGRAVEL PACK
Depth
Top Jr Bottom
Size Material
S%' Sdon
Top Bottom Ft.
Top Bottom FL
11. DRILLING LOG
Tap Bottom
i
- i
1
I
i
l
12. REMARKS:
FormationDescription
/de
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15ANCAC:tC:, WELL CONSTRUCTION STANDARDS. AND THAT A CCPT OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SiGNAFURE OF CERT]FIED WELL CONTRAL5
DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Farm GW-1 b
Rev. 2103

NON QN RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Deparbneril c f Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # J5-7I
1. WELLCONTTRACTRR:
11'aECi`J 1 r<�
Well Contractor (Individual) Name
A E DRILLING SERVICES, LLC
Weil Contractor Company Name
DUO UNITED WAY
Street Address
GREEN V ILLE
City or Town
{864 } 288-1986
Area code Phone number
2. WELL INFORMATION: Irp— L41-2-
WELL CONSTRUCTION PERMIT*
SC
State
29607
Zip Code
OTHER ASSOCIATED PERMIT#(f applicable)
SITE WELL ID (if epplicabis)
3_ WELL USE (Check One Box) Monitoring Et Municipat/Public 0
IndustrfaVCommerctal 0 Agricultural ❑ Recovery 0 injection L—
Irrigation❑ Other 0 (Ilst use)
DATE DRILLED /.Ir T►Y 1 Z
4. WELLLOCAflON:
rJ �PIY3�k�[C
(Street Name, Numbers, Community, Subd)Vi ii, Lot N. Pence, Z$7 Code)
CITY: COUNTY
TOPoGRAANiC 1 LAND SETTING:
l7Slope ©Valley ❑Fiat ❑Ridge
LATJTUDE 36
LONGITUDE 75 °
(check aplmp box)
in Other
DMS OR 3x.xxOx xxxxx DD
" DMS OR 7x.xxxxxxxxx OD
Latitudeliong'riude source: D3PS ❑topographic map
(ccakon of well must be shorn an a USGS top° map andattechad to
this form if not using GPS)
S. F_}
FACILITY (Name of the business where the well is located
Ch ern trt?4
Facility Narna
r, o Did lie 1;:. P:i
Street Ada Tess
Cv;f Ie. 1
City or own
14� 4evocr.4 Enu;rcl x , i
Facility ID# Of applicable}
Contact Name
!'L L 04 -i
Maifin9 Address
•,��cvii. ( i C
City or Town
{g aZei-33
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:
State Zip Code
State Zip Code
b. DOES WELL REPLACE EXISTWG WELL? YES ❑ NO
e. WATER LEVEL Below Top of Casing /3.Cr7 FT.
(Use 't" if Above Top of Casing)
d. TOP OF CASING IS ,� r FT. Above Land Surface-
'Top of casing terminated at/or below land surface may require
a variance in acoordance with 15A NCAC 2C ..01113.
e. YIELD (gpma: i.4 METHOD OF TEST A-VA-
f. DISJNFECTION: Type A)/4 Amount JA.%%
g. WATER ZONES (depth):
rolr et3V1tt ffottom_ Ny1er Top bottom j4
Top Bottom Top Bottom
Top Bottom Top Bottom
7. CASING: Depth [7ismeter
Top Bottom /a* Ft iZ``
Top Bottom Ft.
Top Bottom FL
11. GROUT: Depth
Top DL Bottom ) 2— Ft.
Top Bottom FL
Top Bottom Ft
Thickness/
Weight Material
,Sc..A. Y►) pot__
Material - �' Method
it --a 7.f'/Alere.
9. SCREEN Depth Diameter SIet'SLze Material
Top f k' , Bottom 36' Ft. " in. .1D In. U-& E - P'-
Top Batton) FL In, in.
Top Bottom Ft. Inin.
in. SAND/GRAVEL PACK
Depth Size Material
Ft. ,�a rs�
Top Bottom Ft.
Top Eli' Bottom .*
Top Bottom Ft.
11. DRILLING LOG
Top Bottom Formation Description
1
!
12. REMARKS:
COHERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED Phi ACCORDANCE WrTH
75f1 r:CAC 2C, WELL CONSTRi1CT1ON STANDARDS, AND THAT A COPY DF THIS
RECORDHAS N P THE WELL OWNER
PR D NAME OF 'ORSON
DATE
STRUCTING THE WELL
Form GW-lb
Rev 2109

NON RESIDENTIAL WELL CONSTRUCTION RIPCORD
North Carolina Department of Ediy1Lonment Hod Natme i Resources- Division 0! Water Query
WELL CONTRACTOR CERTIFICATION* , 7j
1. WELL CD CTOR:
f�f.til�
Welt Contractor {individual) Name
A E DRILLING SERVICES.. LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVtLLE
City or Town
(864 ► 288-1986
Area code Phone number
2.1NELL INFORMATION: X P-•
WELL CONSTRUCTION PERMIT*
SC 29607
State Irp Code
OTl-HER ASSOCIATED PEF MlT#(G applicable)
SITE WELL If] *Of applicable)
3. WELL USE (Check One Box) Monitoring Q MunicipalIPublic 0
industrial/Commercial Q Agricultural CI Recovery Li Injection pi,'
Irrigation0 Other 0 (list use)
DATE DRILLED // 24- 42-
4. WELL LOCATION:
(Street Name. Numbers, Community, Sebdildalen, Laf No., Parcel. Zip Code)
CfTY: SW641,14rwtt j DC COUNTY
TOPOGRAPHIC ! LAND SETTING: (cheat appropriate box)
EISlope DVelley QFlat :Midge DOlher
LATTrUDE 35 "DMS OR 3}LxxxX3DOO x DD
LONGITUDE 75 ' . . - DMS OR 7x.xxloo 000t DD
Latttudellongitude source: ❑PPS Qrepographic map
(location of well mus[ be shown on a USGS tops map andattached tO
this kart if not using CPS)
S. FACILITY (Name of the business where the well is located,)
f"J► �. E'►�TrnAi L.er7
Facility Name
lgo oldht
s[
t Address
uiri�2 11) -( L
City } or Town CC it
Ai U a^id via:r)me!
Facility IDA Ofapplicable)
Contact Neme
a31 I+SR lnjc)c+d S4 .
Malting Addiees.)
A&L./ZI It r] 3 Sg
City or To1Yn
( ) ; 1 33 c
Area code Phone number
S. WELL DETAILS:
E. TOTAL DEPTH:
State Zip Code
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES Q NO [3�
c. WATER LEVEL Below Top of Casing: r I. 5a FT
(Use "+" if Above Top of Casing)
tlESziTI1'w .., ..di4'r 00
d.
TOP OF CASING ESQ FT. Above Land Surface"
'Top of casing terminated at/or below land surface may require
a variance in accordance wifh 15A NCAG 2C .0118.
e. YIELD (gpm): .L.W - METHOD OF TEST /did
f. DISINFECTION: Type/- Amount
g. WATER ZONES (depth):
Top 4t/%41— Bottom /file Top
Top Bottom Top Bottum
Top Bottom Top BOttOm
Thickness/
7_ CASING: Depth Diameter �W}e�ight Material
Tap �a r Bottom 1/..ii , Ft. -p - is' St Pee --
Top Bottom _ FL
Tap Bottom Ft.
/t)/iBottom
8. GROUT: Depth MaterialMethod
Top a Bottorrr 9h FL Ce Kedy ri .1la c-
rop Buttorn Ft.
Top Battorn Ft.
9. SCREEN: Depth Diameter Slot S ize Material
Top 004 Bottom FL#2 In. 6/() in. vFF� Ji I:' ar 0
Top /3S°Bottom 31S!Ft in. in.
Top Bottom Ft. in, in.
10. SAND/GRAVEL PACK
Deo:m.0 � Size
Ft
Top _Bottom FLt.
Top 0. i7t�Bottom 3�J:S FLAY_
Top Bnttn . '
Material
11. DRILLING LOG
Tap Bottom Formation Description
G�olOi rC
1
rf
I
12. REMARKS:
=HEREBYCERTIFY THATTH}S WELL WAS CONSTRUCTED tN ACCORDANCE WITH
15A NCAC2C. WED- CONSTR1JCTION STANDARDS, AND THAT A.CORY OF THIS
0 HAS r1EFr'IPROVIDED THE WELL OWNER.
/1 e / .
DATE
SIGNATURE OF CERFfFI STALL CONTROR
�17111:62're-
NAME OF PERSON CONSTRUCTING THE WELL
Fwm GW-lb
Rev. 2109

1, WELL CONTRACTOR:
Rh&l rniGietre..
Well Contractor (Individual) Name
A E DRILLING SERVICES, LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE Su
City or Town State Zip Code
(864 ) 288-1986
Area xnie Phone number
2. WELL INFORMATION: I P- 14n- q
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT;;c(E/appPcabte)
SITE WELL. 1D Cif applicants)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/PublicU
Irldustriai&Commercial ❑ Agriculture! 0 Recoveryl3In}action ❑
trrigatian❑ Other 0 (list use)
DATE DRILLED I0- t3 _IL
4. WELL LOCATION:
Ir- er1l fOnkS
(Street Name, Numbers, Community. SrbdM.eorr, Lot No., Parcel, ap Code)
CITY: 0 f 1e L COUNTY
TOPOGRAPHIC 1 LAND SETTING: (tecx appropriate. box)
D Slope II Valley 0 Fiat G`I Ridge ❑ Other
LATITUDE 36 " DMS OR 3X.iU0CC)ODOCX OD
LONGITUDE 75 DMS OR 7X.)o000ixxxx DD
Latitude/longitude source: ❑CPS [!Topographic map
(location of well must be shown on a USGS typo map andattached to
this form if not using CPS)
S. FACILITY (Name of the business where the well Is located.)
012014t`0nitS
Facility Name �:1 Facility ID# (ff applicable)
wee Tree 2d
Street Address
_,i(Wwv4ie.�.
City or Town State
A H+Morr1•- &1u t-ot~rn,r,-L 6
Zip Code
Contact Name
as I Itai I/CC)cxi S -
Maigrw Address
(.`R3O
City or Town Stale Zip Code
( ) '3tt)
Area code Phone number
6. WELL DETAILS:
a, TOTAL DEPTH: 3 4 i•
0-
b. DOES WELL REPLACE EXISTING WELL? YES NO M/
c. WATER LEVEL Below Top of Casing: H.FT
(Use `+" If Above Top of Casing)
NON ONRESIOENTIL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural IteSoUrCc - Division of Water Quality
WELL CONTRACTOR CERTIFICATION # SS-7 I
d. TOP OF CASING IS 31 FT. Above land Surface"
'Top of casing terminated atlor below land surface may require
e variance in aCxaordence with 15A NCAC 2C -0118.
e. YIELD (gpm): IWA METHOD OF TEST ILYA A
f. DfSINFECTION: Type rIWA Amount JIrt
g. WATER ZONES (depth):
29807 TOP Mit Bottom at WA . BottO : N!')
Top Bottom Top Bottom
Bottom Top Haltom
Thickness/
7, CASING: Depth Diameter Weight
Top 0 Bottom f 1' Ft. c:-.1'' ')L t iO
Top Bottom FL
Top Bottom Ft.
S. GROUT: Depth
Top D' Bottom 134 Ft.
Tap Bottom Ft.
Top Bottom Ft.
Material
t
Material
r&'(-
Method
S. SCREEN: Depth Diameter Srot Size Material
Top,1' Bottom 371 FL 2" in. A in. tare La -clot iD(- •
Top Bottom Ft. in. in.
Top Bottom Ft. in- In,
10. SAND/GRAVEL PACK:
Depth Sine Material!
Top _ iS' Bottom 32` Ft-� e�a+'►d
Tap Bottom Ft.
Top Bottom _ Ft.
11. DRILLING LOG
Top Bottom
1
1
1
1
1
_ 1
1
1
12. REMARKS:
Formation Description
'Stein 114-r'
CO i-P REBY CER11FY THAT THIS wall WAS CONSTRICTED IN ACCORDANCE WITH
16A NCAC 2C, WELL CONSTRUCTION STANDARDS. ANL) THAT A COPY OF THIS
RECORD HAS aEPJAA PROVTDEO Td THE WELL OWNER •IiIrrf
.
SIGNATURE OF CERTIFIED WELL
0NTRACTOR DATE
Abe I ^ OIL&�,<
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-lb
Rev. 2/09

NONRESIDENTIAL mu. coNsrlwcnoN CORD
Nardi Gnroline Down/scot ofEavironment and Natural Resource Division of Water Quay
WELL CONTRACTOR CERTIFICATION #
i. WELL
A�igtfrui
Well Cordractor (Individual) Name
A E DRILLING $ERVIcES. LLG
Wel CwnhrectorCompany Name
TWO UNITED WAY
Street Address
GREENVILLE
Ofly or Town
[phone]
Area code Phone number
2 WELL INFORMATION: xP - t y7,4 -
WELL CONSTRUCTION PERM/TO
SC 29607
stale Zip Cade
OTHER ASSOCIATED PERMI TS0 applicable)_
an - WELL ID #[frapplicable)
3. WELL USE (Check Ono Box) Monitoring p Municipal/Public El
todustrielfCommerclal p Agricultural ❑ Recovery 0 tntection pl
InigaitonD Other D {Gat use)
DATE DRILLED ZI—Z4-1Z
L. INELL LOCATION:
WQm-fop c
(Street Name. NMbers. ommunity, SubdMstan, Lot hap., Pastel, Zp Code)
CRY://15k yr de t + A_ COUNTY
TOPOGRAPHIC I LAND SETTING: (the* appropriate box)
❑Slope ❑Vafay °Rat °Ridge ❑DLher
LATTFuDE 36 • ._ _ _ • DMS OR .3t.,oaaL cocg DD
LONGITUDE 75 " DMS OR 7X 3000O0Qcxx OD
Lalttudallongltudesmote: COPS Qropographfcmap
(location of welt nwst be shown ono USGS tape map endattached to
this form if not using CPS)
S. FACILITY (Name of the business where the well Is located.)
c -If/0;4Z
FacilityName Facility 1Dtt Of ble)
if) 0Id ile€`ram �I
Street Additive _
-� Ity It Ili .G
i41or TSlate rfp Code
4cimen4 u i rmhva' L f
Contact Name
.231 r iv,. i 5,.r.
Mailing Address u
A: „lLo /1c aq&6i
City or Town
Slate Zip Code
Area code Phone number
a. WELL DETAIL.s:
0. TOTAL i}EPITh J Z S y
b. DOES WELL REPLACE EXISTING WELL? VEST) NO D
c. WATER LEVEL Below Top of Casing: �' L
(Use "4- if Above Top of Casing)
FT.
7. CASING: Depthiii Dtr
Top co Bottom Fl. as
Tap Bottom FL
Top Bottom FL
8_ GROUT: Depth
Top Cr Bottom ar FL
Top Bottom Ft
Top Bottom Ft
d. TOP OF CASING Is FT. Above Land SLrface"
•Top of casing terminslad affor below land steam may require
a variance In accordance 'eh 15A NCAC 2C .01I8.
o. YIELD (gpm): Met METHOD OF TEST .�.,�/ //��
I DISINFECTION: Type /WA Amount 4J1/Y-
T. WA xONESBoth (n_4 �am
Top ' Bothxat Top
Top_ Bottom , Top — Bottom
Top Bottom Top Bottom
Thickness/
Weight Matortal
PO
...�� �� Method
7
9. SCREEN: Depth Diameter Slot Size Material ,1
Top as- Bottom SAS.' a 40?in- -IC; in. 1.1+fre Att..
Top Bottom FL in. in.
Top Bottom- FL irti. In.
i . SAND/GRAVEL PACK
Depth Size
Top s ( Bottom + FL__ �L
Tap Bottom Ft.
Top Bottom FL
11. DRILLING LOG
Top Doltorn
1
1
1
1
1
1
1
12. REMARKS-.
Forrrlalion Deem -lotion
170 FERNY CERTIFY THATTHIS%ELL WAS CONSTRUCTED IN ACCORDANCE WTH
i4A ICAC 2gC�, wF71CDISTRUCTION STAPOPJin& J 0THAT A COPY OF T13S
RECORD ii �� WEVRAINEFt
SIGNATURE OF CERTIFIED�WELL cOP4TRAC'TRR DATE
did I [1em--
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1 b
Rev. 2Jn9

NONRESIDENTIAL WELL CONSTRLTCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CER`t'it''1CATION # !S 71
1. WELL CONTRACTOR'
bei M'tllre_
Well Contractor (individual) Name
A E DRILLING SRVICES, LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
;REENVILLE
City or Town
(864 l 288 -1986
Area cede Phone number
2_ WELL INFORMATION: xp-14.17
WELL CONSTRUCTION PERMIT#
�y 23607
State Zip Code
OTHER ASSOCIATED PERMIT#(Pr appicab!e)
SITE WELL ID *Or 9.peocabio
3. WELL USE (Checks One Box) Monitoring 0 MunEcipa /PublicCi
IndustrialfCommerdai D Agricuttura! ❑ Recovery ❑ Injection
Irrigation❑ Other p (list use)
DATE DRILLED ,✓1r I
4. WELL LOCATION:
(ILL N! 4fon i45
SStreet Name, Alberr . Cornmunrty, Subdivision, Lot No.. Parcel, hip Cada)
?e
CFTY_ u• (IC COUN rY _
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
DSlope °Valley 17FIat 0Ridge 0Other
LATITUDE 35 "[]Fu1S OR 3x.)ocanaoatx DD
LONGITUDE 75 " OMS OR 7x.x79QDCxi xx DD
LetitudeAongitude source: [J3PS ['Topographic map
(location or well must be shown on a USGS €opa map andeitached tee
IWs form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
514417,1111
Facility Name Facility Da (if app!lcable)
Oki �t
RITat Address
I-I]ti .L. 1.q£ccxs
City or Town Slate Zip Code
Rif 4 F U;rc11tia� 4 L
Contact Name 21
JI �'R\ L' 1 S+
Mailing Adrtress �]
Prsiupv-.k f C '2-kg'O1
CityerTown State Zip Code
( 2') 1-3.352)
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: J7. rll
h. DOES WELL REPLACE EXISTING WELL? YES ❑ NO M"
c. WATER LEVEL Below Top of Casing: /312_ FF.
(Use °+" If Above Top of Casing)
d. TOP OF CASING IS 3' FT_ Above Land Surface`
'Top (Arming terminated at/or below land steam may require
a variance in accordance with 15A NCAC 2C .0116.
O. YIELD Wpm): l III ��MyyETHOD OF TEST
DISINFECTION: Type f)//9 Amount
g. WATER ZONES (depth):
Top rL�{,t ' BoHun' Ail.rt Top +tr-i4 oo`to nn A
Top Bottom Top Bottom
Top Bottom Top Bottom
7. CASING: Depth Diameter
Top � Bottom "CS' FL Z"
Top Bottom Ft.
Top Bottom Ft.
Thickness/
Weight Material
5c40
8. GROUT: Depth %Material Method
Top d' Bottom 1i. s Ft. erat$ !14
Top Bottom Ft._
Top Bottom Ft _
9. SCREEN: Depth Diameter Slot Size Material ❑
Top i (. Bottom I ' Ftr t Z in. • 1D in. r1 r - r tic_
Top Bottom FL in. in.
Top Bottom FL In. In.
1O. SAND/[GRAVEL PACK:
Depth Size
Top /sls' Bottom s;cA isIFI. v
Top Bottom Ft,
Top Bottom Ft
11. DRILLING LOG
Top Bottom Formation Description
1(01; 4,
1
1
1
r
12_ REIVtARKS:
1 00 HEREBY C RTtFYTHAT TIS WWF Ll. WAS CONSTRUCTED IN ACCORoANCE WTH
15A NCAC 2C, WELL CONSTRUCnON STANDARDS, ANO'.HAT A cC PY OF THIS
REGORAYJS BAN F ,�pFRTO°T-tE WELL OWNER_
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
ram_
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1 b
Rev 2/OR

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Dot:mimeo of (Environment aodNalpta' Resources- Division ofWat r QuaTity
WELL CONTRACTOR CERTIFICATION # yr 7
1. WELL {+ /lmTt.t / Ie
Waft Contractor (Individual) Name
A E DRILLING SERVICES LLC
Walt Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29807
City or Town State Zip Code
(664 ) 288-1986
Area coda Phone number
2. WELL INFORMATION: Zp o i
WELL CONSTRUCTION PERi4ITIP
OTHER ASSOCIATED PERMIT#(If applcable)
SITE WEII ID Syr appicab1ej
3. WELL USE (Check One Box) Monitoring 0 Munfcipal/Pubfic ❑
lndustriaVCommercial Eli Agricultural 0 Recovery 0 Injection
irrigation° Other[] (list use)
DATE DRILLED_ ri 29
4. WELL LOCATION:
CMh} ian� c
(street Name. Numbers. Community. Subs M fan, Lot No., Parcel, zp Cede)
C>TY: ASLet; Letale ! 1C._
COUNTY
TOPOGRAPHIC I LAND SETTING: (check appropriate bo:y
❑Slope ❑Valley ❑Fiat ❑Ridge ❑Other
LATITUDE 86 ' DMS OR 3X.)000x70000( lJD
LONGrrutDE 75 ' - " DMS OR 7XJ000O000Of, OD
Latiturleitongltude source: [PPS pfopogrephic map
(Location of well roust be shown orr a USGS topo map andattached to
Irmo if not using GPM
lx FACILITY (Name of the business where the well le located.)
_ellealirein ;CS
Faclltty Na
l d Gld elee 7-Et 4
ter"---st Address
r4rjcv:r � 1V.C1
^ultyor own ,
J 1dr,f �fthfdflftt&A- r
Facility ID# [af applicable)
2 O5
State Zip Cade
Contact Name
23 ► Wart S+
MalTin ddress -
1 �P 1) r 217o
City or Town Slate Zip Coda
(Sig } 2gI - 2).56
Area code Phone number
B. WELL DETAILS: a TOTAL DEPTH: _N:yr
i
b. DOES WELL REPLACE EI1STINO WELLY
YES Et NOS'
r WATER LEVEL Below Top of Casing: , le7r)f{ FT
(Use"+" if Above Top of Casing)
d_ TOP OF CASING IS .�S FT. Above Land Surface'
'Top of casing terminated at/or bofow land surface may require
a variance in
accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): rt%f METHOD OF TESTt. DISINFECTION: Type IJ%If} Amount i)44
g. WATER ONES (depth):
Top .1.1PBottom A / - Top A)%13"Bottora /UM -
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth .s Diameter Weight �yMater€at
Top 0 ` Bottom /s-$ Ft. 2" St.A1Q
Top Bottom
Top Bottom
8. GROtrr: Depth
fop tt?� _ Bottom /0 '
Top Bottom
Top Bottom
et_eriiai Method
FL C�CAnC
Ft.
9- SCREEN: Depth Diameter Slot Size
Top NJ. Bottom,,WfFt, 24' In. , I0 fn.
Top Bottom Ft fn. In.
Top Bottom FL in. In.
Material
-1jea-
10. SANDIGRAVEL PACK:
Depth �r J.Size. Material
Top a s Bottom 3trFt. fir/ JiC�L1
Top Bottom Ft.
Top Bottom FL
11. DRILLING LOG
Top Bottom
1
1
1
• I
1
1
1
12. REMARK&
Formation Description
1 DO HERESY CERTIFY THAT THIS WL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NOW WELL CONSTRUCTION STANDARDS„ AND TiiATACOPY OF THIS
RECOrWDI1+&MEN PR:0=EDTI7THE LLOWNER.
SIGNA
C +NTRA TL OR DATE
NAME OF PEcSON CON I uCTMNG THE WELL
Form GW-lb
Rev. 2/09

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION If 35'71
1. WEiLf.=_ i'1TRACTni4:
f/7J[�]C, {l Inc ram.
Wet Contractor (Individual) Name
A E DRILLING SERVICES, LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GRE%VI i E SC 29607
City or Town State Zip Code
(864 288-1986
Area code Phone number -
WELL INFOR11dATTON: JE_ I yJ—€
WELL CONS RUCTION PERMIT#
OTHER ASSOCIATED PERMITOrapplicable)
SITE WELL ID #(lt applicable)
3. WELL USE (Check One Box) Monitoring D Municipal/Public ❑
Industrial/Commercial ❑ Agricultural D Re.cavery ❑ Injection f�
IrrigationE Other E1 (list use) _
DATE DRILLED Ii ,4 Z
d. WELL LOCATION:
{Street Name, Numbers. Community, SubdhrtsIvn, Lot No., Parcel, Zip Coda}
CITY, I-i;Itpv: fie PC COUNTY
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
DSlope ❑Valley ❑Fiat [Ridge IDOf>1er
LATITUDE 36 " DMS OR 3x.)0000ccoc t DO
LONGITUDE IT UDE 75 •- .. . DMS OR 7X xxXX.XXXXX DO
Latitude/longitude source: ❑GPS OTopographic map
(location of well must be shown on a USGS fop) map andattached k
this form if not using GPS)
5. FACt ITY (Name of the business WhBre the well is located.)
LJ1��f11I�
Fa oft Name Facility ID# (If applicable)
D 6✓<r I 17:E F�f.
StreeiAddress
16.ri rk 111) 28'xN 5
City or Town L j - State Zip Code
A[i: ±71d1T C71Uif0[1flr: t�r
Contact Name
23 54-
Flailing Address `"
City or Town
r ) - 3356
2ggc
State Zlp Coda
Area code Phone number
S. WELL DETAILS:
a. TOTAL DEPTH;_ rN._J
h. DOES WELL REPLACE EXISTING WELL? YES CI NO
c. WATER LEVEL Below Top of Casing: FT.
(use "+" if Above Tap of Casing)
d. TOP OF CASING I5 7 FT. Above Land Surface
"Top of casing terminated at/or below land surface may require
a variance in aecordanCe with I SA NCAC 2C 0118.
e. YIELD (gam); IJM— METHOD OF TEST
F. DISINFECTION: Typo Amount
g. WATER NES (depth):
Top Bottom ..Delf1 op 40 Bottom AV,
Top Bottom Top Bottom
Top__ Bottom Top Bottom
Thickness/
T. CASING: Depth Diameter Wight Material
iPOC.
Top 6' Bottom HSr 1 Ft. Z'!
Top
Top
Bottom FL
Bottom Ft.
8. GROUT: Depth Material
Top d" Bottom f Zs` FL + 4—
Top - Bolton Ft,
Top Bottom Ft.
Method
9. SCREEN: Depth i Diameter Slot Sizo Material
Tope Bottom 2V$ Ft. 2 in. . 10 lrl. L) i tL .
Top Bottom Ft. in. in. _.
Top Bottom FL in. _ in.
10. SAND/GRAVEL PACK
Depth Size
Top JZ.S Batton, [''14Et-#i
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
a►
12. REMARKS:
material
511
Formation Description
i DO FERE6Y CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15 . NCAC 2C. WELL CONSTRUCTION STA,NDAROS, AND THAT A COPY OF THIS
REcgRDMtsSPRr7V1 DEOTrZTHEW U.OWNER.
CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTI
FormGW-tb
Rev. ?Iao

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department ofarviinrroeot and Natural Resources- DMslou of Water Quality
WELL CONTRACTOR CERTIFICATION # .�
Well Contractor (Individual) Name
A E DR1LLUNCO SERVICES LLC
Well Contractor Company Name
TWOUNJTED WAY
Street Address
GREENVILLE SC 29607
City or Town Slate lip Code
f 864 f 288-1986
Area code Phone number��//��� `J
2. WELL INFOFtNMATIDN:1+r-1V7r 1
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMITV(iF appcoah1e)
SITE WELL ID Oki( epplIcabte)
3. WELL USE (Chet* One Box) Monitoring ❑ MunicipatfPublic
Irdustri&VC6mmercial ❑ Agricultural ❑ Recovery injection ;y/
Irriigatlon❑ Other ❑ (8stuse)
DATE DRILLED /t_- 7.047
4. WELL LOCATION:
(Street Name, Norabere. Community, SubOrvisten, Lot No., Parcel, zp Caae1
CITY: 5c,..sanclame, nc C011NTY
TOPOGRAPHIC! LAND SETTING: {oneck appropriate hold
t]Stope ❑Vaitey uFIal ❑Ridge L Other
tATRUi3E " DMS OR 3xa0000OCM DO
LONGITUDE 75 - " DMS OR 7x.00000000x DD
Latitude/longitude source: J3PS Ofopographic reap
(location of well must be shown on a USGS two map andattwohed to
ihra form if not using GPS)
FACILITY (Name of the business where the well is located-)
Facilitx Name
1 ' old bee 1,-c�
Street Address
City or own
AHwy' turf envi meD+RJ
Coated Name
144,-It'.
INalli�9Address
Fadllty !MT applicable)
asgo5
State Tp Coda
City or Town State Zip Code
'gag y .Sf ^ 335?
Area code Puna number
B. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Er
c. WATER LEVEL Below Top of Casing: _ _ 1 .
(Use "+" if Above Top of Casing)
-167;7,?t1tl� II:Serv`i
d. TOP OF CASING IS 3' FT. Above Land Surface'
'Top of casing terminated attar below land surface may require
a variance in accordance with 16A NCAC 2C .O118.
O. YIELD (gpm): WA' METIiOD OF TEST
f. DISINFECTION: Type Amount
g- WATER ZONES (depth):
Top +V44. Bottom WIi. Top
Tap Bottom Top Bottom
Tap Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight
Top p' Bottom! 20' _ Ff. 21 SqI>'.
Top Bottom Ft.
Top Bottom Ft
H. GROAT: Depth
Top 01 Bottom, /6' Ft.
Top Bottom_ FL
Top Bottom Ft.
MateriaCfneri�lly
Ca* Sodom fill
'Material
pi)L
Method
IFLxeld
9. SCREEN: Depth Diameter Slot Size Platelet
Top 26' Bottom 'ID` Ft Z" in. ri0 in. LJ =!e. Pk —
Top Bottom Ft. In. in.
Top Bottom Ft. in, in.
10. SA14DI[RAVEL PACK:
Depth Saxe
Tap lip" Boilom Ir Ft. 01
Top Bottum Ft.
Top Bottom Ff.
Smi,t
11. DRILLING LOG
Top Bottom Formation Description
1
1
1
r
I
1
I
I
1
1
12. REMARKS:
DO HEREBY CERTIFY via -rim WELL WAS CONSTRUCTED IN ACCORDANCE WTI
NCAC 2C, Vail CONSTRUCTION STANDARDS, AND 'HAT A COPY OF Ti
ft D HAS
H SBEEN
�PR
[ROVIDED TO THE WEti OWNE
k. = -/.'
SIGNATURE OF CERTIFIED WEE. CONTRACT DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
d_�_; tl /V��FllviSi'v`�t t5 a�yLQQ -( I{e lit I�t tirita r CCIc�SS
Form GW-lb
Rev. 2/09

NON RE3TDENTL4L wria, C NSTRUC RECORD
North Carolina Decertmeet ofFarvircomme andNateral. ReSourc s- Division of War Quality
WELL CONTRACTOR CERTIFICATION # 3.01
1. WELL GCIITRACTOR
A mrw
Wel Contractor {Inclienduary Fame
A E DRII LINO SERVICES, LLC
Wet Caltrartor company Nair
TWO UJVITED WAY
Street Addtess
GREENVILLE SC 29607
City orTawn Shale 7p Code
(864 ) 288-1986
Asa axle Phone )number
2. WELL INFORMATION _ . 1 q7-16
WELL CONSTRUCTION PERMTM
OTHER ASSOCIATED PERMIT applicable)
SITE WELL Id #ta apglicabie)
3. WELL USE (Check Ore Box) Mon3orrng Q Mun ffpatiFublic 0
tricluslriatiCommeraial ❑ Agricultural ❑ Recovery ❑ Injection le"'
Irrigriam° Other D Gist use)
DATE DRILLED it — 2.4- i'2.-
4. WELL LOCATION:
(Street N. Numbers, community, S+ti dM Ion, Lot Pia, Parr* zip cam)
crrt k ty - - - CITY
TOPOGRAPHIC / LAND SETTING: (dhow: appropriate boo
Q CIVattey ©Flat DFfidge 0Other
LATrUUDE 36 OR 3x.Xaoaoo0aoc on
LONGrwUDE 75 - ^ 0 MMS OR 7A,,kg 04t7nx DD
Latik.olcoong$ude source: MPS Dropngraphic map
(k tlfon of wed must be showy) an a' LAMS tapo In v andaltsched fo
this form ifnor uatng GPS)
6. FAC{LrfY (Nero or the business where the we! is located.)
t:
Name
i!ld t�9e `ryes LEI
Facilely io# (d applicable)
Street; Address
State Zip Code
nn � I
dui Y�hlnn� l:l`]ulic)f�fx-{t-rk.1
Oontaat Name
�?z l
/14
Meting Address -'
City or Town
fi.)g) !-3.15
State Zip Cade
Area code Phone number
ber
e. WELL DETAILS
R. TOTAI. DEPTH: 46'
b. DOES WELL REPLACE E STUIG WELL? YE.S0 NO B'
a MOWER LEVEL Below Top of Casing: ! ! rP FT.
(Use "+' ifAbove Tap of Casing)
= d. TOP OF CASING IS .3' FT_ Above Laird ;ice`
'Tap of casing terminated attar below land surface may require
e variance a1 acmetlance wit TSA NCPC ZC .Q118
e_ NEW (tom £VA METHOD OF TEST
f. OISINFECTIOIC Type h macaw IN
g. WATER ZONES (max
Top ll ti Botfsfrr. Tup
Top Bottum Top
Top Bohm Top
7. CASING: Depth
Top D' Bottom 20 f t
Tap Bptlem FL
Top Bottom Ft
Diameter
zr
&AV Bottom Age —
Bottom
&diem
Weight Material
4ii•q°
S GROUT: Depth Maiarial
Top- c Bottom r4 FL C..SMC+tii—
Top Bottom R.
rop Bo{tnm FL
Method
r4; e
9. SCREEN: Depth Diameter Slot Size Materiel
Top 2& Bofbom 'iD Ft Z" M. • t0 In_ t}- f,,3t rc.. * dt.
Top Bourn FL in. in_
Top Bottom FL IC. M.
10. SANDIGRAVEL PACK:
Depth Size
Tup I t' Boftarn_YL' Ft. L -
Top Bottom FL
Top_ Bottom FL
11. DRILLING LOG
Top Sodom
1
1
12. REMARKS:
Formagort Deealpllorr
HEREBY CERTIFY THAT llitS WELL v$coNSTRLICTEDIkACcORII0.kCcr$ ITN
i6Ah'CAC2C. WELL CCNSTRLGTION sTAHDARDs. APESTWO- ACOPY Cyr THIS
REccFID WLS THE WELL O ER.
S NAT[�RE OFx9YYGL CONrRAc Uri DATE
OF PERSON CONSTR JC TING THE WELL.
Farm GW-lb
Rev. 2 9

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina. Department of&ardroomealt and Natural Resources- Division of Water Quality
WELL CONTRACTOR CIRTEFICAT1ON # SSW
d. TOP OF CASING IS 7' FT. Above Land Surface*
Weft Ccnhachor (Indevidua) flame
A E DRILLING SERVICES: LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
_GREENVILLE 5C 29607
Cfly or Town Stare Zip Code
( 864) 288-1986
Area coda Phone number y
2_ WELL INFORMATION Xiall I'g
waL CONSTRUCTION PEiRM F# - _
OTHER ASSOCIATED PERM ITV applicable)
SITE WELL ID f {if app&oahec}� -
. WELL USE (Check One Box) Monitoring {7 lulunicipaliPubric p
Industrial/Commercial EI Agriv,&hurd q Recovery C7 Injection Lf
irrigation° Other O (hat use) _ _ _ _
DATE DRILWI IrI 21-/�
4. WELL LOCATION:
M4irohF
(Street Name. Nerneere. ecanreurtpy, S1OdlYieion, Lot No., Parcel, Zip Cadet'
Cfl"f: AsI.L,eIt TIC COUNTY
TOPOGRAPHIC/LAND SETTING: lenedt apprvpate booty
OStcpe °Valley ['Flat Ole IJOtller
LATITUDE 36 " OMS OR 3xiaoaoacxxx DO
LONg31TLIDE 75 •-_ " MIS OR 7X.X:x xxxxx t DD
Latitude/longitude source: CJGPS Qropograp hie neap
{location of weft most be shown nil a USGS tope map andetfachad to
this form ffnot using GAS)
e3 FACUFY (Name of the business where the well Is located.)
6e,121rQn
Fea Name
So old be( Tf-.
Surat Address
AS{.ev.1le_ t f
Clly or Towle •
rrriaE.i E7'lu41of\f+.o-6.-I
Contact Name
J1J.4%
Fad* 111E [II appLcabiej
awo5
State Zip Code
Malang 1,40dress
L6-+I iv 6 C d col
City or Town
;$j 35Sa
Area axle Phone number
State Zlp Code
6. WELL DETAILS:
a TOTAL DEPTH: st
b. DOES WELL REPLACE EXISTING WELL? YES p NO
c. WATER LEVEL Below Top of Casing: 17. Li • FT.
(Use "+• If Above Top of Casing)
`Top of casing terminated idler below land sulfa a may require
a variance In accordance with 15A NCAC 2C 2118.
e. YIELD (gpm): NM- METHOD OF TEST A
t DISINFECTION: Type filth Arnouet +t
g. WATER ZONES (depth): �}
Top 090- 6dfnm Top IL.2,*flotfam rlJ,/•1
Top Bottom Top Bottom
Top Bottom Top Bottom
7. CASING: Depth Diameter
Top lei' Bottom %' _ FL _
Top Bottom Ft
Top Bottom FL
1. GROUT: depth
Top._ D' Bum le
Top Bottom
Tap Bottom
S.SCREEN: Depth
'Top �I Bottom .
Top Bottom
Top Balm
Thickness!
Weight
Nlat rid!
1'ilR,r
Malarial yMethod
FL jJrierid— 2'len;e
FL
Ft.
DFameter Slat Sim Material
Ft.,i' in. ,.III in 0~ PIIt.
Ft in. iri_
Ft. in in.
10. SANt1IGRAVEL PAGE-
Depth
Top 41' Bottom
Top Ootfcml_ Ft
Top Bohm Ft
11. DRILLING LOG -
Top Bottom Fa nation Damon
i `Vr
I
t
1
1
1
1
12, REMARKS:
I t74HERESY t TIFYTwo-THIS WELL WAS CONSTRUC ED HI AcC n1ODPNcE wvfirl
NCkW2CG WELL CONSTRUCTION STATHIARt* AROTHAT A DOPY OF TINS
RECORD' $ BE$1l RINIDEDTO WEILONINER_
SIG3+IAT IijJ E DF CERTIFIED CCNiRAdOR DATE
Form GW-lb
Rev_ 2/0 1

1. WELL
NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Dent of Environment and Nab>ral Resourcet- Division of Witter Quality
WELL CONTRACTOR CERTIFICATION #
TI4R--Toa,rf.
We Contractor (individual) Name
A e DRILLING SERVICES. U-C
Well Contractor Company Name
TWO UNITED WAY
Sheet Address
GREEI4VILLE
City or Town
(864 ) 288-1986
Area code Phone minter
L WELL INFORMATION:=p 447- t-2-
WELL CONSTRUCTION PERMIT*
OTHER ASSOCIATED PERMIT:(if applicable)
SITE WELL ID 7f01appiloable)
3. WELL USE (Check One Box) Montlaring 0 Municipal/Public ❑
Industrial/Commercial ❑ Agriculture] d Rerxwery ❑ Injection Imo"
Irrigatienp Other ❑ (fist use)
DATE DRILLED !I- Z7—/
4, WELI. LOCATION:
(Street Name, NunMere. Community, Subdivision, Lot No., Ramer. Zip Code)
CrlY_ fl skk vi I It n C COUNTY
TOPOGRAPHIC! LAND SETTING: Ow* appropriate )
❑Slope ❑Valley D Flat i7 Ridge ❑ Other
LATfTUDE 36 • DAIS OR 3X.7DOXcotx oc OD
LONGITUDE 75 - DNS OR Tx.xx oc0000c DD
Latitude/longitude Source: LOPS Oropographiu map
ifocatorf of well must be shown on a USGS iopo map aradattsched to
this form tfnot utking GPS)
FACILITY (Name of the business where the well Is Iotafed.)
?1e41 "a:74 LS
FacMy(Name
Igo ❑y bee
Street Address
/45hc u,`I lr I j �•
City or Town -
J -HW) on-F- f t oaf
Contact Name
3 f f Si.2661 . SL-
Mall' Address
nG
SC 29607
State Zip Cade
Facility iCat (if applicable)
Slate ZIp Code
cigrcrTawrl
Area code Phone ni mbar
6. WELL DETAILS:
a, TOTAL DEPTH: Mr I
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO [-f
c. WATER LEVEL Below Top of Casing:_ /3- 4' FT
(Use"t if Ab eve Top of Casing)
State Zip Code
d. TOP OF CASING is , ' FT. Above Land Surface'
"Top of casing temtlnated at/or below land surface may require
a variance in accordance with 15A NCAC 2C 0118.
e. YIELD (gpm): J METHOD OF TEST /Li
f. DISlNPECfiOH: Type A%A Amount
g. WATER ZONES (depth):
Top r lJ8 8m �1.! "dap -thin Bottom
Top Dothan Top Bottom
Top Bottom Tres Bottom
Thickness/
7. CASING: Depth Diameter WelgM
Tope Bottom_ Ft. " £.
Top Bottom Ft
Top Bottom Ft.
8. GROUT Depth ,Material Method
Top O , Bottom 11 _ Ft- t 7rrem E"
Top Bottom FT.
Tap Bottom FL
9. SCREEN: Depth Diameter Slot Size Material
op t ef� is. v- " T � Bottom Ft " in. / � AG
Top Bottom Ft in In.
Top Bottom Ft. irr. in.
10. SAPID/GRAVEL PACK
Depth r
Top_JS' Bottom •�'i Ft
Top Bottom Ft
Top Bottom Ft.
11. DRILLING LOG
Top Bottom FwmrationDesaription
1 J l
/
1
1
1
1
1
1
1
1
12. REMARKS:
r co HEREBY cERTTFY THAT TFxS mat WAD coNSTRUCTEII IN ACCORDANCE WITH
IM NCAC 2C, WELL CC NSTRUC T1PN STANi3AROS, AND THAT A COPY OF THIS
MCORi3 WFLLOVYNER
E OF CERTIFIED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-lb
Rev. 2/09

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Caroling Department afEnvirlmmcat and Natural Resources -Division of War Quality
WELL CONTRACTOR CERTIFICATION # 3 Si)
1. WELL CONTRACTOR:
Am. 1 riliCTIAA re.
Wail Contactor (Individual) Name
A E DRILLING SERVICES. LI_C
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SL 29607
City or Town Stale Zip Code
(864 ) 288-1986
Area code Phone number
2. WELL INFORMATION: I 13
WELL CONSTRUCTION PERMIT*
OTHER ASSOCIATED PERMFT#(ifspotabre)
SITE WELL ID tiff applicable]
3. WELL USE (Check One Box) Monitoring ❑ MuniclpailPublic ❑
fndusfriaf1Cammercfal ❑ Agricultural 0 Recovery Injection p"
irrigation❑ Other 0 (IIst use)
DATE DRILLED SO.Z3-[Z
4. WELL LOCATION:
(street Name. Numbers. Community, Subdivision, Lot NO„ Pacei, Zip Cade)
CITY: 6AuaneittAack kV. COUNTY
TOPOGRAPHIC l tAND SETTING: (chock appropriate bar)
°Slope EiValley ❑Flat ❑Ridge ❑Other
LATTTUDE ` • DMS OR 3x.,000000ccx DD
LONGITUDE 75 ° • DMS OR 7x.xxxxxxxxx DD
Latitude/longitude source: COPS oropographlc map
(location of well must ba shown on a USGS topo map endattachsd to
[his /can if not using GPS)
S. FACILITY (Name of the business where tha well fs located.)
_C•Ilforlico
Faculty Name Fealty IDI# (If applloabla)
I .V) aid I
Street Address
,IggL�S
Oily or Town
_a1 1\1c4 571PfOf ftth LI
State Zip Code
Contact Name
c-,t3 1.145006,i S-i'
Mai ng Address
City or Town State Tip Code
S .R aSi -3 ,60
Area code Phone number
O. WELL DETNLS:
a. TOTAL DEPTH: 421
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IV
c. WATER LEVEL Below Top of Casing: }`],gy Fr.
(Use `+" IfAbove Top of Casing)
7. CASING: Depth
Top Bottom_ 2 _
Top Bottom
Top Sottom
d. TOP OF CASING IS 31 FT, Above Land Surface'
"Top of casing terminated atlor below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): pJIA METHOD OF TEST WA-
f. D$SINFECTION: Type f►f!h _ Amount Ail/
Top 111.)
9- WATE_R/ONES (depth):
f Bottom1L1% Top A.)JPr Bottom NM
Top Bottom Top Bottom
Top Bottom Top_ Bottom
Thickness/
Diameter Weight Materiel
Ft_ n
FL
Ft.
8. GROUT: Depth Material
Top Bottom 17' Ft. Cerer.AF
Top Bottom Ft.
Top Bottom Ft
PVC
Method
9- SCREEN Depth Diameter Slot Size Material
Tap_ 21' Bottom Ft 1ie In. . la in. in);Cco9 Pdr-
Top Bottom Ft in. In.
Top Bottom FL to In_
10. SAND/GRAVEL PACK:
Depth Size Tap L tBottom pia, Ft. �t Top Bottom Ft,
Top Bottom Ft.
11. DRILLING LOG
Top Bottum Formation Description
1 ,r,. •. l; a,
1
1
1
I
1
12. REMARKS:
1 E70 }ERE9Y CERT1PY THAT TIhIS WELL WAS CONSTRUCTED IN ACCORDANCE MATH
15A NCAC 2C, WELLCONSTRUCnON STANDARDS. AND THAT A COPY OF THIS
REMIND NAS BEEN PROVIDED TO TIE WELL OWNER
Slta�"1ATURE OF CEERTIFIWELL CONTRACTOR
Abel 1 O6ait�—
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-lb
Rev. 2109

1. WELL CONTRAC—OR:
A4J
Wail Contractor (indtvkluali Were
A E DRILLING SERVICES. LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREEN-MLLE SG 29607_
Cray or Town State rip Cade
(864 ) 288-1986
Area wile Phone rainbow
2. WELL INFORMATION:
WELL CONSTRUCTION PERMITS
OTHER ASSOCIATED PERMIT/0 rpppioable)
Bran WELL ID *I(Bappticahie)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural 0 Recovery ❑ Infection f
Irrigation❑ Other 0 (list use)
DATE DRILLED /I-21--i 2-
4, WELL LOCATION:
CiYrvi-irsn ice
{Street Name. Numbers, Communey, Subdivraion, Lot No., Parcel, 7lp Code)
CITY: 51/ifi ,oa f cranny
TOPOGRAPHIC! LAND SETTING: (check appropriate nook)
❑Slope QVatley El Flat ❑Ridge QOther
LATITUDE 35 " DMS OR 3)Lx0ooDDODQ( r r]
LONGITUDE 75 ' . - - - DMS OR 7X.)SaIoD000t DD
Lat;Wde/ianoitude sarnw: [PPS Oropngraphic map
(location of welt must be shown one [1SGS fopo map andettache cf to
this form if not using GPS)
6. FACILITY (Name of the buainegs wheat the wall is lord.)
Chem irbeile3
Fe Y Warne Fe alityr lr]#(it applicable)
nee-rrrrac�
Street dress
[i
City or Town
#f arezr]4- buire5r,p6e,
Contact Name� ,,+
�.� t 7�fR1pGy} N-
MaR g Address • J _
sill tc 3�L
gW65
Slate Zip Code
,;no
City or Town State rip Code
Area code Phone number
5. WELL. DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EGSI1NG WELL? YES Q NO Li-
ac. WATER LEVEL below Top of Casing: , t' ' 4 FT.
(IJse '+' if Above Top of Casing)
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department OfF.nvitotanent and Natuaai Resources- Division of Water Quality
WELL CON'L'itACTOR CERTIFICATION # 3 7/
d. TOP OF CASING IS 3' FT- Above Land Surface
"Top or easing terminated allor below !and rariice may require
a variance in accordance with 15A NCAC 2C _011 B_
e. YIELD (gpm): A%t D OF TEST J
L D{Sk111FECi1DN Type A/�7X Amount11/0
g. WATER ZONES WA):
Top NV Rotten+/'
Top tinhorn Top
op itlilHattvm /11iA---
Battrnn
Tap Bottom - Top Bollam
ThiCWreezd
7. CASING: Depth Diameter Weight Material
Top__-D'__Boftom _it FL Z° (UC.
Top Bottom Ft
Top Bottom Ft
8. GROUT: Depth Metrria l IU�eM
Top If' Bottom 17% FL 7ri + e
Top Bottom FL
Top Bottom Ft
9. SCREEN: Depth Diameter Scot Siza Malarial
Top ZI° Bottom t-i 1 - A.Fl._,AL4 In. r/Z in. J Li T f e• arm
Top Bottom FL in. In_
Top Bottom Ft lb. in_
10. SANDJGRAVEL PACK:
Depth Size
Top f p Bottom g2+ FL, rei
Top Bottom R.
Top Bottom Ft.
11_ DRILLING LOG
Tap Bolcom Formation Description
I
/
1
1
!
I
1
12. REMARKS:
1 n0 HEREBY CERTIFY THAT THLSWEI1. WAS CONSTRUCTED IN AccoRDANCE WITH
15ANCAC 2C. WELL f}ONFTRLICTi0NSTPNOARDS. MO THAT A ODFT OF THIS
RECORD HAS R
IrROViETFDRaT1->EWELL OWYt t
hi
SiGmTURE CERTIFIED CONTRAC OR DATE
i■'4.
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form OW -lb
Rev. Veit

NON RESIDENTIAL WELL corNsTzucT1ON RECORD
North Carolina Dcpartmcni of Environment and Nrtttir 1 Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # . f 7
1. WELL CONTRACTOR:
l�II,l� Oft M,R.
Well Contractor (individual) Name
A E DRILLING SERVICES, LLC
Well Contractor Company Name
TWO UNITED WAY
Skeet Address
GREENVILLE SC 29607
City or Town State Zip Dade
(864 ) 288-1986
lifea code Phone number
2. WELL INFORNIIATTON:XX 117-'1C
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMfTCfr applcaciej
SITE W E.J..L IE3 Cif *pm -able)
S. WELL USE (Check One Box) Monitoring ❑ Municipal/Public C]
lndustria&Commeroiaf ❑ Agricultural Recovery A9 q ❑ Injection
Irrgatonp Other ❑ (list use)
DATE DRILLED j1- ZO-
A. WELL LOCATION:
•
(Street Nerds. Numbers, Carrmrrrunrty, Subdveiue, Lot No., Parcel, Zip Cede)
CITY: —S.ia6NuroCk _DC Catkin( -
TOPOGRAPHIC 1 LAND SETTING: (check appfopriste box)
LiSlope DValley LFlat cRidge ❑Other
LATITUDE 35 P DMS OR 3X.X)acXXXXXX pE
LONGITUDE 75 " DMS OR 7x_xxxxxxxxx DD
Latitude/longitude source_ 03PS Qropographic map
00ca /on of well must be shown on a USGS I/opo map andatlached to
this form if not using GPS)
F. FACILITY (Name of the business where the well Is located.)
aced/bet riS
Facility Name
!20 �Iijer
Street Ari-N.,-
,[sixv� Ile.
y City w e ken"!
free p)
Facility ID# (if epplicaulej
En OirCit t ltrll7c. 1
Stale 4tp Code
Contact Name 1
3 I HfA4-1 Lill S+,
Maihn Address J
Vr 11, n L ,).ggc 1
City or Town State Zip Code
(5,),S) 'gig+ 335()
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REP( -ACE EXISTING WELL? YES ❑ NO le
c. WATER LEVEL Below Top of Casing. • rf, 1f FT.
(Use '4" if Above Top of Casing)
Top GRIP Bottom iff
d. TOP OF CASING 15 _7r FT. Above Land Surface'
"Top of casing terminated atlor below land surface may require
a variance in accordance with 15A NCAC 2C .011 B.
e. YIELD (9Pm): AO Ai
OF TEST
EDISINFECTION: Type_ �, Amount
-4/31—:
g. WATER ZONES (depth):
Top i111� Bottom 4':* fop 'VA Sattom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness!
7. CASING: Depth Diameter Weight Material
Top_e_ Bottom of * Ft. 2' Sch.0 /L (
Tap Bottom FL
Top Bottom
Ft.
8- GROUT- Depth Material
Top. G I Bottom I'll , F'I-�
Top Bottom Ft.
Top Bottom Ft.
Method
-7,75:0jJ E'.oJf
9. SCREEN: Depth Diameter Slat Size 'M�ate ial A
FLrr rn. •JO In. ✓ Wrte-F
Top Bottom Ft. In- in,
Top Bottom Ft.
10. SAND/GRAVEL PACK:
Depth Size Material
Top fS' Sottorni,a1
Top Bottom Ft.
TopBottom Ft.
11. DRILLING LOG
Top Bottom Formation Description
1tl'i�ir�f
1 1
1
1
1
1
1
1
1
12_ REMARKS:
00 HEREBY CERTIFY THAT THS WELL WAS CONSTRUCTED IN ACCOROANCE WITH
15A NCAC 2C, w5u CAH6TRJC11QF1 STANDARBS, AN] THAT A COPY OF THIS
RECORD
HAS RREEE<N PROVIDED TO THE WELL OWNER.
SEGNATURE 0
/,zs/
CERTIFIED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1 b
Rev. 2109

1. WELL CONTRACTOR:
SIG.;t i.
Well Contractor (Individual( Name
A E DRILLING SERVICES. LLC
Well Canlracfor Company Name
TWO UNITED WAY
NON R_ESIDEIVTLAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Envision of Water Quality
WELL CONTRACTOR CERTIFICATION # J S 7 i
d. TOP OF CASING IS 31 FT. Above Land Surface
"Top of casing Terminated at/or below land surface may require
a variance Ina Tdance with 15A NCAC 2C .0116.
e. YIELD Wpm): Nlk METHOD OF TEST -Wit
Street Address
y EENVILLE
City or Town
(864 ) 288-1986
Area code Phone number ++
2. WELL INFORMATION: Q,]4-7MH O
WELL CONSTRUCTION PERMIT*
SC 29607
Stale Zip Code
OTHER ASSOCIATED PERMfTS(irapprcable)
SITE WELL ID #tif applk:abla;
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
industrial/i ammerrial ❑ Agricultural ❑ Recovery El Injection
Irrigation❑ Other ❑ (lfst use)
DATE DRILLED iD-7-1.1-I2
4. WELL LOCATION:
(Street Name, Nurnbsrs, Community, Subdllesfon, Lot No., Parcel, Tip Code)
CITY; f SIV'VIIIt -4' COUNTY
TOPOGRAPIi1C / LAND SETTING: (check apprnprtete boxy
°Slope (Valley 0ETat L1Ridge ElOther
LATITUDE 36 rims OR 3x-xxxxxxxxx t?D
LONGITUDE 75 • " DHSS OR 7x.xxxxxxxxx DO
Latitude1ongitude source: COPS ['Topographic map
(location of wet/ must be shown on a USGS top° map andattached fa
this form if not using GPS)
6. FACILITY (Naive of Me business where the well is located.)
attivIrke.rilc.I
Facility NameA_
Ir 0 0Id akt° tee
Facility IDI (if applicable)
Street Address
City or Town
Ps- 1"ZtIvi
Contact Name
Mailing AddressI -
hQL'I�IP
rr 1 �► .� I
i��uit17i�iwFJVJ -J
�8?05
State Zip Code
av
City or Town State Tip Code
, 1 - 3366
Area co110 Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE BUSTING WELL? nYES �l NO '
c. WATER LEVEL Below Top of Casing: _ t - S__Jr L _ET.
(Use °+" if Above Trip of Casing)
f. DIStNFECT1ON: Type NA' Amount J M
g. WATER ZONES {depth):
Top jUI Bottom A.V14 Top $J/ Bottom wlfr
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
T. CASING: Depth Diameter Weight Material
Top 6 Bottorn„ Et d- k yi7 P U (-
Top Bottom FL
Top Bottom Ft
8. GROUT: Depth
Tap O . Bottom 17t FL
Top Bottom Ft
Top Bottom Ft.
Material
�nm+zr►�
Method
B. SCREEN: Depth Diameter Slot Size Material
Top,_, ' Bottom lit
Ft. V in. _JD_ in. Ii j t.. L&ofi P 0ca
Top Bottom Ft, in. in.
Top Bottom FL in. In.
10. SAND/GRAVEL PACTS:
Depth Size Mate fiat
Top /go Bottom
Top Bottom Ft..
Top Bottom Ft.
• 11. DRILLING LOG
Top Bottom Formation Description
1
1
1
1
1
1
1
1
12. REMARKS:
DO HEREBY CERTIFY THAT This WELL wA.S COtisTre1CTFD pi ACCORDANCE WITH
1raA NCAC 7C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD wis +BEN PROV?DED TO THE WELL OWNER
SIGNATURE OF CERTIFIED WELL CONTRACOR—
-fir-
DATE
A toe 1 f6-1,;s
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Rev. 2/09

1 ■ ONRESIDENT I ti, WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3S7I
1. WELL CONTRACTOR:
ALA! h►$&t4>s.
Well Contractor (IndNMdual) Name
A E DRILLING SERVICES, LLC
Wah Contractor Company Name
TWO UNITED WAY
Street Address
OREENVILLE SC 29607
Olty or Town State Zip Code
(864 288-1986
Area code Phone number
2. WELL INFORMATION: .p- I41 1
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMFT#(il apprcable)
SITE WELL ID #(if applicable]
3. WELL USE (Check One Sox) Monitoring D Municipal/Public❑
Industrial/Commercial ❑ Agricultural ❑ RecoveryD Injection Er'
tnigetion{] Other C (list use)
DATE DRILLED 7O-.2!, —rZ
4. WELL LOCATION:
rnervy 1r op ic_5
(Street Mama, Numbers, Community. Subdivision. Lot No., Parcel, Zip Code)
CITY: Atr5f1ttt+ - )N to COMITY
TOPOGRAPHIC 1 LAND SETTING:
°Slope °Valley °Flat ❑Ridge
LATITUDE 3 '
LONGFTUDE 75 "
(cite& appropriate boxy
t�Other
• DABS OR 3x.xxxx ocxxx OD
DMS OR Tx.xlotxxxxxx DO
LatibsieMongltude source: Cl3PS []topographic map
adoslion of wen must be shown on a 11SGS topo map andattached fist
#his farm if not using GPS)
8. FACILITY (Name of the business where the well Is located_)
Chem+ron.�.3
Facility Name Facility ID# (If applicable)
1 ID Old 8.21. Tree 1)-(1
Street Address;
City or Town State Zip Code
A lirw,m4 Far) r'or,cVV1;;+�1
Contact Name
3 I Oa. y+ 54
Ma ffirtg Address
t t z,. 1)c Jgee f
City or Town State Zip Code
( ) 021 - 3366
Area code Phone number
B. WELL DETAILS: 1
a. TOTAL DEPTH: £ 6 % �T
b. DOES WELL REPLACE EXISTING WELL?} YES ❑ NO -
c. WATER LEVEL Below Top of Casing: l 611 ET.
iLlsa `+" if Above Top of Casing)
d. TOP OF CASING IS 3 t FT. Above Land Surface -
"Top of casing terminated atlor below land surface may requlna
a variance in accordance with 1 bA NCAG 2C .0118,
e. YIELD (gpm): 1NJl METHOD OF TEST 0/11
f. t3ISINpECTION: Type ffj Amount iiii/49-
g. WATER ZONES (depth): NI Top liVA Bottom WA- Top A/in Bottom
l.
Top Bottom Top Bottom
Top Bottom Top Bottum
Thickness/
7. CASING: Depth Diameter Weight nMateriel
Top 0 Bottom iy La .a' c--qi r1�(
Top Battam FL
Top Bottom Ft.
8_ GROUT: Depth Material
Top S7 ` Bottom of
Top€_ Bottom 3q 5 FL re.yrIEA
Top Bottom Ft
Method�i try
9. SCREEN: Depth Diameter Slot Size Material irip ��
Top, fS` Bottom Ft ,' _in• . i�D M. !„ ;•e
Top_ Bothrn FL in. in. _
Top Bottom FL in. in. _
10. SAND1GRAVEL PACK:
Depth Size Mate:1.31
Top Sic Bottom S�� Ft. #) Selna
Top
Top
Bottom Ft
Bottom Fi..
11. DRILLING LOG
Top Bottom
r
1
I
I
I
I
12. REMARKS:
Formation Description
I co HEtEaY CERTIFY THATTttS WELL WAS D NSTRUCiEO tH ACCORDANCE WITH
ttdl NCAC 2C WELL OOTYSTRUCTtpti STAM ROS. AND THAT A COPY OF THIS
RECORD, HAS BEEN PRoyiCEC TO Trig WELL OWNER.
MM i
►r! �� n
SIGNATURE OF CERTIFIED ELL CONTRA1 OR DATE
It .-4-1Z
b i —44; r4
PRINTED NAME OF PERSON CONSTRUCTING THE WELL.
Farm GW-1
Ray. 2109

NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Nahum.] Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # ,?S7)
1. WELL CONTRACTOR:
Well Contractor (Individual) Name
A E DRILLING SERVICES, LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address �+�}T
V4YY i'�lLLE SC Lv�6Q7
City or Town Slate Tip Coda
(864 ) 288-1 986_
Area code Phone number
2.WELL INFORMATION: MIN,Z1S' 031 / D
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#{it applimme)
SITE WELL Ill #{RR applIcab1e}
3. WELL USE (Check One Box) Monitoring ❑ Mun1c pal/Pubi lc [�
lndustriaf/Commerrdal ❑ Agrioullural p Recovery ❑ Injection D
Irrigalion0 Other 0 (Gst use)
DATE DRILLED // 1
4. WELL LOCATION:
(Street Name. Numbers, Community,
Subdivision. Lot No., Parcel, ZJp Cods)
CITY: S&."7/1 a%]A'#iNE C COUNTY
TOPOGRAPHIC[ AND SETTING: (check appropriate box)
LISIope UValley []Flat ['Ridge °Other
LATITUDE 36 • " DMS OR 3X.XXXoWdp0t [DD
LONGf`fUDE 75 ^ OARS oft 7x.xxxxxlatxx OD
Latitude/longitude source: COPS QFapographic map
(location of well must he shown on a USGS repo map arrdet[ached to
ti718 Farm if not using GAS)
5. FACILITY (Name of the business v.,here the well is iccated.)
Facility Name Facility ID# (if applicable)
1 go Old
SI em.al o,f irpcc ��
Ashen Ile 'VC
r7on
City or ToWn State Zip Code
14II v iciIk tlli Ia�I
Contact Name
Maiiing Address
Ar5ikJic
lENO
47,
City or Town State Zip Coda
f 8) P) - 50
Area code Phone number
6. WELL DETAILS:
a_ TOTAL DEPTH; 11'
b. DOES WELL REPLACE EXISTING WELL? YES[]
c. WATER LEVEL Below Top of Casing: _ I1.
(Use `+" if Above Top of Casing)
NO 14(
Fr
d. TOP OF CASING 1S .� I FT. Above Land Surface'
`Top of casing terminated ebor below land surface may require
e variance In accordance with 15A NCAC 2C .0118.``
e. YIELD (gpm): NI» METHOD OF TEST N10
4. I315INFECTION: Type �f % Amount �r
g. WATER
RZi ZONES (depth):),1 J .4 r JJ
i op *i If Bak .01.. Top Bottom ; [ S
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness,
1. CASING: Depth Diameter Weight Material
Tap (? Bottom_ fr ( Ft. a Air
Top_ Bottom Ft,
Top Bottom FL
8. GROUT' Depth rM�aterial Method
Top CO Bottom L Ft. e el}.!
Top Bottom E.
Top Bottom Ft.
S. SCREEN: Depth Diameter Slot Size Material �t
TOP al Bottom/el Ft. Z' in. +1 D In. s. 44D POC--
Top Bottom Ft In. In,
Top Bottom Ft. In. in.
in, SANDIORAVEL PACK:
r Depth Size Ma not
Top to Boltom IT r Ft. #f i�1L
Top Bottom _ Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom Formation Description
1
1
1
1
1
1
1
12. REMARKS:
DID HEREBY CERTIFY TI-AT TFIS WELL WAS CANS[RllCr) IN ACCORDANCE WTII
1SA NCA',C 2C, WELL CONET RIJCTEON STANDARDS, AND THAT A COPY OF THIS
RECORD HAS N W LL OWNER.
SIGNA' O CERTIFIED
TIFIE D WELL CONTRACTOR
diE
FHSAJ
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
4L/ /2
DATE
Form GW-Tb
Rev. 2/09

NON ON RESIIJENTJAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 371
1.WELL CON
-_---
Q 1 . 4 re
Well Contractor rindivrduai) Name
A E DRILLING SERVICES, LLC
Wen Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE
City or Town
[phone]
Area code Phone number
2- WELL INFORMATION: ZR- /W 4Z
WELL CONSTRUCTION PERMIT#
SC 29607
Slate Zip Code
OTHER ASSOCIATED PERMIT#(ri appGose's)_-_
SITE WELL ID #(If apprcabrs)
S. WELL IJSE (Check One Box) Monitoring 0 Municipal/Pattie ❑
InduslrialtCarnmercia! ❑ Agricultural ❑ Recovery ❑ Injection Ifr
Irrigatlon0 Other ❑ (list usa)
DATE DRILLED 1 I7 31- /2.
4. WELL LOCATION:
heln Y'a'or-ir
(Street Nama, Numbers, Community■m , �Subbdivision, Lot No., Pvsr, Zip Code)
,M�
CITY: _ f�(�� E! �.r COUNTY_ --
TOPOGRAPHIC I LAND BETTING: (check appropriate box)
❑Slope DValley ❑Rat ❑Ridge QOther
LATITUDE Sfi ° " DMS OR 3X.XXXICXXXI0t DD
LONGITUDE 75 ' - ' DMS OR 7x.xxfxxxxxxx DD
Latthrdellongitudesource: Ci,GPS 1DTaprgraph1cmap
(location of wail must be shown ore a USGS Opp map endattached to
this form if not using GPS)
5. FACILITY (Name of the business where the wall is ficated.)
Hare, 41-bifiteS
Facility Name ❑
tS i"1 Old Lee I;et F[L
Street
Address
_NIX_CIvi Ile
City or Town
1C} boot E OM/Weida f
Contact Narnet
r 8 f pit 1t
Maiing Address
Facility IDA (if applicable)
State Zip Code
City or Town State Zip Code
(gag') _o)
Area code Phone number
B. WELL DETAILS:
a. TOTAL DEPTH: -ic',..r`
b. DOES WELL REPLACE EXISTING WELL? YES p NO Q
c. WATER LEVEL Below Top ()Mooing-- i° • 0 i Fr -
(Use'+° if Above Top of Casing)
d. TOP OF CASINO IS 31 FT. Above Land Surface°
"Top of casing terminated at/or below land surface may mquaa
a variance in accordance with 15A NCAC 2C .0118, /
e- YIELD (gpm)! /Vi1, METHOD OF TEST /
f. DISINFECTION: Type ► l./ft Amount eti
g. WATER ZONES (depth):
Top /V/* Bottom ► // - Top
Tap Bottom Top
Top . - Bottom Top
Ai/ Bottom Ag
T. CASING: Depth Dlamete
Top 6 Bottom 41 - FL c,.
Top Bottom Ft,
Top Bottom FL
Bottom
Bottom
Thickness/
r Weight Material
�a (VC
8. GROUT: Depth Materiel • Method Dial; 1Ie()
Top. .E Bottomf Ft. Ar : A CA'
Top_6!_ Bottom 31' Ft. C '�rr?07t e4 -
Top Bottom Ft.
8. SCREEN: Depth Diameter Slot Size Material
Tap sir Bottom ice Ft. 2" in. _.1 ❑ in. W;Frp LJ[ri p P OC.
Top Bottom Ft. In. In.
Top Bottom Ft. In. In.
18. SAND/GRAVEL PACK
Depth ea ea Size
Top 33 Bottom 704 Ft. */
Top Bottom Ft.
Top Bottom Ft
11. DRILLING LOG
Top Bottom
i
1
1
1
1
12. REMARKS:
Maternal
Formation Description
I CO HEREBY CERTIFY THAT TEAS WELL WAS CONSTRUCTED IN ACCORDANCE WM-1
15A MAC 2C, WELL CONSTRUCTION STAt&1ARO& AND THAT ACOPY or THE
RECORD HAS B5!N FROM ) TO THE WELL OWNER
SIGNATURE OF CERTIFIED WELL CONTRACTOR
k1-4-tz
DATE
PRINTED iLdiRSONCONSTRUC11NG E THE WELL
Form GW-1 b
Rev 21Oci

NON RES DE L WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natnrat Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3671
9. WELL CONTRACTOR:
Well Contractor (Individual) Name
A E DRILLING SERVICES. LLC
Weft Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29507
City or Town Stile Zip Code
(864 288-1986
Area code Phone number
2 WELL INFORMATION: x i. f LI 4-3
WELL CONSTRUCTION PERMIT*
OTHER ASSOCIATED PERMIT#(ir appricable)
SITE WELL ID #{d applicable)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural 0 Recovery ❑ Injection 0
Irrtgetion❑ Other ❑ (list use)
DATE DRILLED
4. WELL LOCATION:
L f1Cm �O�iCti
(Street Name. Numbers, Community, Subdivision. Lot No., Parcel, Zip Coca)
CITY: LOAlgft Aftba. fCOUNTY
TOPOGRAPHIC ! LAND SE! I ING: (check appropriate box)
oSlope ❑ Valley ❑Fiat ❑ Ridge DOther
LATTWDE 36 • DMS OR 3x xxxxt0000 ❑D
LONGITUDE 75 ' WAS OR TX,XXXX [Xxxx OD
Latitude(ongilude source: [BPS Dropngraphic map
{location of well must be shown on a (JSOS two map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located-)
C k&in-}rap-L3
Facility Name Fe City lr1# (if applicable)
18� £')I4 hiteTtc L J
Str! Aridmcs
}10.
City or Town
??8
State Tip Code
Contact Name
; Unit
MaIlinN Address lc F C geOt
City or Town Stale Zip Code
Area Coda Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: S.24°
b. DOES WELL REPLACE EXISTING WELL? YES ❑
NO��
c. WATER LEVEL Fielow Tnp of Casing: _ la l I FT.
(Else "+" if Above Top of Casing)
d. TOP OF CASING IS 3' FT. Abovc Land Surface'
'Top of casing terminated allor below land surface may require
a variance In accordance with 15A NCAC 2C .U118,
a. YIELD Wpm)! ,l1 * METHOD OF TEST I
f. DISINFECTION: Typo A/a' Amount al,
g. WATER ZONES (depth):
Top Bottom «/1 I op /14X Bottom ry f
Top Bottom Tap Bottom
Top Bottom_ Top Bottom
Thickness!
7. CASING: Depth Diameter Weight Material
Top 1') Bottom Li • Ft. t ` O PVC.
Top Bottom Ft
Top _-_ Bottom FL
8. GROUT, Depth r� Material �i Method
Top- 'Bottam S2S Ft A ti+![j I ten,
Top 6 Bottom 21:1S4 Ft.
Top Bottom F.
S. SCREEN: Depth Diameter Slot Size Material
Top a4 Bottom 39.4 `_ Ft. Ar In- . 1 u in. _4]: fe 0,012 P UL
Top Bottom Ft. in. _ in.
Top Bottom Ft. in. in
10. SAND/GRAVEL PACK:
Depth Size
Top Z7,4r Bottom, G.11 FL fr /
Top Bottom Ft.
TopBottum FL
Material r►4 j
Sq
11, DRILLING LOG
Top Bottom Formation Descriplion
1 /-/t""
1
1
1
1
1
1
1
1
12. REMARKS -
I DO FEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C. WELLCO+YSTRtJCTION STANCARDS, ANDTHA7 A COPY OF 1'HiS
RF.[xAio R S BEEN ±?RQVIDERTO 1 E WELL OWNER
/ld—aZ
SIGNATURE OF CERTIFIED LL CONTRACT DATE
PRIMED NAME OF PERSON CONSTRUCTING THE WELL
Forrn GW-1t
Rev- 2/09

1. WELL CONTRACTOR:
A 141f rs G..irt
Well Contractor Ilndhrldual) Name
A E DRILLING SERVICES. LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
City or Town Stabs Zip Coda
(864 288-1986
Area code Phone number
2. WELL INFORMATION: I P- I q i- 4-I
WELL CONSTRUCTION PERMIT*
OTHER ASSOCIATED PERMrr (itappAcabte)
SITE WELL ID #Irr applicable)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industria11Carmmercial Li Agricuttvra! 0 Recovery ° Injection le
Irrigation° Other 0 (list use)
DATE DRILLED I , 30-l7
4. WELL LOCATION:
fftdit./1iCS
(Street Name, Numbers, community, StININieron, Lot No., Parcel. Zip Code]
CITY: _ r,ketli i le ilL COUNTY
TOPOGRAPHIC / LAND SEffING: (check appropriate box)
❑Slope ❑Valley °FIaf :Ridge b0Other
LATITUDE 36 " DMS OR 3X.=0000 XX DD
L ONGITt)DE 75 " DMS OR 7X,)000x otxx DO
Latitude/longitude source: ❑3PS QropographIc; map
(location or well mvsf be shown an a USG Stopo map anciadzcahed to
this farm if not using CPS)
S FACILf7Y (Name of the business where the well Is }coaled.)
Facility Nams � 5 r Facility DO(lf applicable)
/30 old Le eve 1,{
coast AAA Fasts
ASIZUdie
State Tip Code
Contact !lame
Ma Iln Addr 6
g3a l
City or Town State 7ip Code
LtL�c_o 1$d 335�
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: IA.3
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO B
c. WATER LEVEL Below Top of Casing: _ Cl I i _ ET.
(Ilse .+• if Above Top of Casing)
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department at Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION it 33 7
d. TOP OF CASING IS 3* FT. Above Land Surface"
"Top of casing terminated attar below land surface may requtre
a variance in accordance with 15A NCAC 2C 4118.
e. YIELD Wpm). jf ji METHOD OF TEST, ► J/A _
L DISINFECTION: Type WA Amount
g. WATER ZONES (depth):
Top AVABottom pIA Top ALM- Bottom /t//t
Top Bottom Top Bottom
Top Bottom Top Bottum
Thickness!
7 CASING: Depth Dierneler Weight Material
Top C' Bottom / . L FL a 1. 9a PVC.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top_- • Bottom_ 1st Ff. aerieAT /74
Top
Top
Bottom FL
Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top AZ Bottom_ 3121 Ft. 2" in. .1 D in. L' i& Lirrip
Top Bottom, Ft. in. in.
Top Bottom Ft-
'O. SAND/GRAVEL PACK:
Depth Slze Material
Top r27a1 Bottom _ Ft..lP) _ Scat e4
Top Bottom Ft.
Top Bottom Ft.
11, DRILLING LOG
Top Bottum Formation Description
1
1
1
'fx REMARKS.
I DO HIERE3Y CeRTIFY MAT f4ISWEIL WAS CONSMUCTED IN ACCORDANCE WITFI
15A NCAC20, war. COW/RUCTION STANDARDS, AND THATA DOPY OF THIS
RECORD HAS ECM ?ROOM') TO THE WELL OWNER
G
SIGNLRE OF CERTIFIED LL CONTRAC'±
A-4-l2
DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-lb
Rev. 2109

NON RESIDENITIAI WELL CONSTRUCTION RECORD
Nartb Carolina Debut ofTsaviromment and Natural Resoureta- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # SO 1
4. WELL CONTRACTOR:
Alfa / &sk7
Welt Contractor (Individual) Name
A E DRILLING SERVICES. LLC
Well Contractor Company Nam
TWO UNITED WAY
Street AddreaS
GREENVILLE SC 29607
City or Town State Zip Coda
(864 ) 288-1986
Area code Phone number } a [�
2. WELL INFORMATION: M IM - z'y iq - 3 7 c D
WELL CONSTRUCTION PERMIT:
OTHER ASSOCIATED PERMIT0(s appncable)
SITE WELL ID #(it apprrcable)
3. WELL USE (Check One Box) Monitoring "MunIrtpal/Ptliic C7
IndustrialGornmerels/ D Agricultural ❑ Recovery 0 Irnjectian ❑
Irrigation❑ Other 0 (list use)
DATE DRILLED i1-Ce
4_ WELL LOCATION:
L�r►eri7 �'m,�-�
(Street Name, Numbers, Community, SubdM9ion, Lot No,, Parcel,1. p Code)
MY, SW. er0 1oatOilA L. COUNTY
TOPOGRAPHIC I LAND 5k i l ►NG: (check appmpfrote boat)
❑slope ❑Valley ❑Flat f=7Rtdga Daher
LATITUDE 3e " OMS OR 3x.)3CC000013C DD
LONGITUDE 75 "DMS OR 7x.xloocOVcx0c DD
LatihrdeI ongftude source: OOPS Orapographle map
{location of wet/ must be shown err a 11SGS tope map andatiechad to
this form if not using GPS)
6. FACIIJJ Y (Name of the business where the well is located.)
CI) foS fL e C_
Facdtty Noma
b Q 6)cic 'Tire c1.
Facility ID# (if applicable)
Strawf Address
,s�re, N <<. aReos
City norTown State Zlp Code
Eui/rnme:-)-c1
Contact Name
s1-3 i gauLowit. -
MailinAAddress J
-kvide 1)C
City or Town
0I
State Zip Code
c gaR) g1-3356
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: VI?. Y'
b. DOES WELL REPLACE EXISTING WELL? YES 0
c. WATER LEVEL Below Top of Casing: r1.
(Use "+" WAbove Top of Casing)
NOS.'"
Ff.
d. TOP OF CASING IS FT. Above Land Surface'
'Top of casing terminated attar below land surface may require
a variance fn accordance with 16A NCAC 2C ,0118.
a. YIELD [gpra): PV%t METHOD OF TEST
1 DISINFECTION: Type Nth Amount
g. WATER ZONES (depth):
Top Bottom Id/fr Top AV/ Bottom. fi%!r
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
T. CASING: Depth Diameter Weight Material
Tap 6 Bottom ►d 1_ Ft. " /-10 } `uC
Top Bottom Ft.
Top Bottom FI.
8. GROUT: Depth Material
Top 64 Bottom 32 ' Ft CP-01E14
Top Bottom Ft.
Top Bottom Ft.
Method
Wnewrci
9. SCREEN: Depth Diameter Slot Sixo
Top 3L. qm Bottoms. Ft.. _ in, .,ID In.
Top Bottom Ft. in, In,
Top Bottom Ft. In. in,
Material
p c.. Ss.%.•Y0
10. SANDIGRAVEL PACK
Depth Size Material
Top RV Bottom _ 4f f i Ft. -AN iv/
Top Bottom FL
Top Bottom Ft.
11. DRILLING LOG
Top Bottom Formation Description
1
1
I
1
r
12.. REMARKS:
I l HEREBY Wan' THRT THIS WESL WAS CONSTRUCTED IN ACCORCANCE WITH
t 5A NCAC 2G WEI3. GONSTRk3CT[ON STANDARD_". AND THAT A COPY OF TIAS
fiECpRO�Ft4 71124 VYF1LffVYNLi.
NRE 4CEEll CONTRA�R DATE
SIG A F CERTIFIED
PRINTED ME 0 P ON CDl3S'IFi ENG THEWELL
Form GW-lb
Rev_ 2/09

NON RESIDENTIAL WELL corisrRucrioN RECORD
North Carolina Department of Easviro miart and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3S 7 )
1. WELL CONTRACTOR:
Abut mG
Well Contractor (Individual) Name
A E DRILLING SERVICES, LLC
Well Contractor Company Name
T11VO UNITED WAY
Street Address
GREENVIILLE
City or Town
(864 ) 28B-1986
Sr• 29607
Stale Tip Cade
Area code Phone number
2, WELL INFORMATION; M - 2 43— P 39
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMFT#(ir spplicaNa)
BITE WELL ID #(Irappiicable)
3. WELL USE (Check One Pox) Monitoring tI MunicipaiJPubticQ
industrial/Commercial ° Agricultural ❑ Recovery ❑ Irpect on ❑
trrigationC Other f7 (fist use)
DATE DRILLED 11- 7-12
4. WELL LOCATION:
f !Yf1+17r'orlir`
(Street Name, Numbers, Community, SuhErmislon, Lot No., PareeL 71p Cede)
CITY: SL1/41_41kft 11;t}a�F M4 COUNTY_
TOPOGRAPHIC! LAND SETTING: (cheek eppropnete pop
❑ Slope Cj Valley ° Plat ❑Ridge ❑Olher
LATITUDE SB " DMS OR 3x.x)DCOLXXxX OD
LONGITUDE 75 " EMS OR 7x.X)0000000c t)Q
Latltudellongituds source: EPPS QTopagraphic map
{fiCetlon of well must be shown on a II5GS inpo map endaltached to
this form if nit using GPS)
S. FACILITY Name of the business where the well Is located_)
Facility Name Facility ID# (if applicable)
10 C!d Le %rer i; (5")
Street Address
City or Town State Zip Code
4 �Vr17Gr, `{- �r) v nor, pt11 rlLck 1
Contact Name
/ / �r)+i/ter 5q:
Mailing Address
,IVvi1[e Ia(. 2?5C31
City or Town State lip Code
r 1a .a.84- 3350
Area code Phone number
6 WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO -RI
FF
c. WATER LEVEL Below Top of Casin : 1•c2 Fl.
(Use 'r" if Above Top of Casing)
d. TOP OF CASING IS 3t FT. Above Land Surface'
`Top of casing terminated atlor below land surface may require
e variance In accordance with t 5A NCAC 2C .0118.
e. YIELD (gem): // METHOD OF TEST
f. DISINFECTION: Type /V�44 Amount
g. WATER ZONES (depthj): ,
Tap 4/471. t c ttorn /Writ Top iti! Bottm � J
Tap Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7_ CASING: Depth Diameter Weight Material
Top_ Bottom lift Ft
Top` Bottom_ i Z' Ft a 1.. V('
Top Bottom Ft.
B. GROUT: Depth Material �r Method
Top d Bottom Zg R. Cain i `;44-r i ect
Top Bottom Ft.
Top Bottom Ft. _
9. SCREEN: Depth Diameter
Top_ 3 Bottom i % Ft 2' in.
Top Bottom Ft.tn.
Top Bottom Ft.
10. SAND/GRAVEL RACK:
Depth Stile
Top " Bottom 9J Ft. tl
Top Bottom
Top Bottom
11. DRILLING LOG
Top Bottom
1
1
1
1
1
1
I
I
1
12. REMARKS:
Ft.
Ft.
SlotStae Material
e1D rn. SC)I4 9O P in.
In.
Allateria
Formation Description
>>Qrre
t b0 FIFRESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE voTH
15A NCAC 2C,'AELL CONSTRUCTION STANDARDS, AND 7l IAT A COR'Y OF IBIS
RECORDEO TO THE WELL OWNER
SIGNATUR
OF CEt3TFFrED W
%/$1Z
L CONTRACTOR DATE
PRINTED NAME CF PERSON CONSTRUCTING THE WEL1
Form GW-11)
Rev, 2/09

t
WELL CONSTRUCTION RECuRD
This form can be used for single or multiple wells
l Well C Inti oatracter ormation:
Randy Phillips
Well Contractor Name
2209-A
NC Well Conttactor Certiliclllioo Number
A.E.Drillin g Service
Coll1j)lllly Name
2. Well Comtnctioa Pennlt #:
list aJJ appucah/e ,i,dl p,m,.;,s (Le. Coun~·. Stare, Yariance, lnjectimi, nc.)
3. Well Use (c:kecli: well use):
Water Sapply wen:
OAgricultural □Manicipal/Public
DGeothermal (Heating/Cooling Supply) □Residential Water Supply (single)
Dlndustrial/Commereial □Residential Water Supply (shared)
□TrriJ1&tion
No11-Water Supply Well:
i!'JMonitoring □Recovery
Injeclfoa Well:
□Aquifer Recharge □Groundwater Remediation
□Aquifer Storage and Recovery □Salinity Barrier
□Aquifer Test DStonnwater Drainage
□Experimental Technology □Subsidence Control
□Geothermal (Closed Loop) □Tracer
DGeodiemial (H c:-aling/Cooling Return) □Other (explain Wider #21 Remarks)
4. Date Well(s) Completed: 9-18-13 Well ID# MW251-K39EF
Sa. Well Location:
Chemtronics
Faeility/0...•ner Name Facility ID# (if applicable)
180 Old Bee Tree Rd. Swannanoah 28778
Physical Address. City. and Zip
Buncombe
County Pan:el r.denlification No. (PIN)
Sb. Latitude and Longitude In degree.s/minntes/sec:onds or decimal. degrees:
(irwell field, one lat/long is sufficient)
___________ N ______________ W
6.1.s (are) the m:11(,): li1!Pa--n1:11t or □Temporary
7-Is this a repair to an existing well: □Yes or ~No
If this f• a rq,alr. fill rnlt bro,m wt!II connructio11 i'![onnation and cp/ai11 tu narur,: of ti,,:
repair under #2 J remarlcs se,:tion or on the back of this form.
8. Number orweDs constructed: _1 _________ _
Fur muJJip/e i,ljeclfon or non-Willer .wpply we/13 ONLY with the srune construction, you ca,i
6ubmil one farm.
I For Internal Use ONLY:
14. WATRRZONES
FIIOIII TO .P£SCRJP110N
ft. ft.
ft. ft.
15. OUTER CASING f tbr andlkued wells\ OR LINER (If •nnHcablol
FROM I TO 1 DIAMETER I TJflCKN&'IS MAT.lilUAL
0 ft. 83 ft. 8 In. .322 Steel
Ui. INNER CASJNG OR TUBING '-tlimnal doaed-loool
l!ROM TO ~ THICKNESS MA1l!JIIAL
+3 ft. 222 ft. 4 in. sch40 PVC
ft. ft. in.
17.SCREEN
FROM TO DIAMEJER SLOTSJZE TBICKNESS MA'llJUAL
222 ft. 242 fL 4 IL .020 sch40 PVC
ft. ft. ii,
18. GROUT
FROM TO MATIJUAL EMPLACEMENT METHOD & AMOUNT
291.5 ft. 252 rt. neat cement Pump
217 ft. 212 ft. 3/8 Hole Plug Pour
212 ft. 0 ft. neat cement Pump
19. SAND/GRAVEL PACK /If a nnlieablel
FROM TO MATERIAL EMPLACEMENT ME1HOD
252 fL 217 ft. #2 sand pour
ft. ft.
20. DRILLING LOG CatucJi ■ddl!loMI ,~..,ti if necea-■rv)
FROM TO Df..SCRIPT(ON ftolo r. h1rdnHa ,ollfrotk ll"IW, 2'•ht 1IUI!. etc.\
ft. ft.
ft. ft.
ft. ft.
ft. ft.
ft. ft.
ft. ft.
ft. It.
21.REMARKS
22. Certification:
Si~,£6: 9-18-13
Dale
By signing tAfs form. 1 hereby certify tlrat tire well(s) wa< (were) consJ~ted ;,. acconlance
with JS.A NCAC 02C .OUJO or ISA NCAC OlC .OlQO Well Co11srroctio" Sta"da.w 011d thal a
copy of tlus record has bttn pro-.ided to the well ow11u. ·
23. Site diagram or additional well details:
You may 115e the back of this .page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMfITAL INSTIJCilONS
9. Total wcll depth below land snrrace: _2_4_2 __________ (rt.) 24a. For AU Wells: Submit this fonn within 30 days of completion of well
Fonnrtltiple .,,..,11, li,t all depths if d!lfenml (exa,.,p/e-)@200' and 1@/tJO') construction to the following :
10. Static water level below lop of casing: ___________ (fL)
If water levrl is above casing. use '"+"
11. Bore.hole dimneter: 8 (in.)
12. Well construction method: Mud Rotary / Air Hammer
(i.e. auger, roeary, oeble, direct push, de.)
FOR WATER SUJ'PLY WELLS ONLY:
13a. Yield (gpm) _______ Method oftest: _______ _
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617 ···
24b. For lnjeetion Wells ONLY: In addition to sending the form to the address in
24a above, also submit a c~ of this funn within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mall Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & In (ectlon Wells:
Als:o submit one copy of this form within 30 days of completion of
13b. Disinfection type: Amount: well construction to the county health department of the county where t..::=====..::'..'".:.:.=======--....:.::==.:.::=======:J consttucted.
FonnGW-1 North Carolina Departmeat of Environment and Natural Resources -Division o f Water Resources Revised August 2013
WELL CONSTRUCTION RECORD
This limn can be usCil for single or multiple wells
1. Well Contraetor Jnformatloo:
Randy Phillips
Wen CootnJctor Name
2209-A
NC Well Conlractor Certificmon Number
A.E.Drilling Service
Company Name
l. Well Coostrudioa Penait #:
Lilt all applicab/,: ,veil penHits (i.e. Cmmty, State, Varianc:,,. mj«tion. etc.)
3. Well Use (cheek 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 Wdl:
~Monitoring □Recovery-
Injection Well:
□Aquifer Recharge □Groundwater Remediation
□Aquifer Storage and Recovery □Salinity Barrier
□Aquifer Test □Stonnwater Drainage
□Experimental Technology □Subsidence Control
OGcothcnnaJ (Closed Loop) □Tracer
□Geothmnal (HeatinglCoolinR Return) □Other (""nlain under #21 Remarks)
4. Date Well(s) Completed: 9-9-13 Well ID# MW252-J39EF
SL Well Location:
Chemtronics
Facility/Owner Name Facility !Dfl (if applicable)
180 Old Bee Tree Rd. Swannanoah 28778
Physical Address. City, a11d Zip
Buncombe
County Pan:,,I [defllification No. (PIN)
Sb. Latitude and Longitude i.a degrees/minutes/seconds or decimal degrees:
(if well field, one Jat/loog is sufficient)
___________ N ______________ W
6. II (are) the well(s): l.'IPermaoent or □Temporary
7. Is this a repair to an exiatingwell: □Yes or BNo
If this is a ~pair, fill mrJ known wt,// co,,stn,ction infon,ratio,1 and e:xp/ai,r /he rwh,re of the
repair uudu #:Z I remark.• .,ection or on the back of th/., fonn .
8. Number of wells constnacted: _1 _________ _
For multiple 11,jection or non-waler supply wells ONLY willr the ,,,,,e constr11cti011. Y"" ca,,
submit Me form.
I For lntemaJ Use ONLY:
14, WATER ZONES
FROM TO DESCIW'TION
ft. ft.
ft. ft.
lS. OUTER CASING lfor maltkaud we&l OR LINER (if 1nnlieablel
FROM I TO DIAM£TER TWCXNESS I MATERIAL
0 ft. 83 It. 8 ia. .322 Steel
16. INNER CASING OR TUBING f•eotl,enal dosed-Joonl
FROM TO DIAMETER THICKNESS MATERlAL
+3 ft. 235 ft. 4 ... sch40 PVC
n. ft. ia.
.17,S(;RKF.N
FROM TO SLOTSIZI! IBICKNESS MATERIAL
235 ft. 260 ft. 4 [n. .020 sch40 PVC
ft. ft. la.
18.GROUT
FROM TO MATERIAL EMPLACEMENT METHOD & AMOUNT
293 fl , 265 ft. neat cement Pump
229.4 n. 223 ft. 3/8 Hole Plug Pour
223 rt. 0 rt. neat cement Pump
19. SAND/GRAVEL PACK lifannUcablel
FROM TO lltATERIAL EMl'l..ACEMENT M'E"mOD
265 n. 229.4 ft, #2 sand pour
ft. ft.
20. DRILLING LOG laUaell additioaal sheets If ucen ■n,I
FROM ro DESCRIPTION '""lo• h ■nla..._ solll""'k ,..,,., . 2nla ,1,., etc.I
ft. ft.
n. ft.
ft. ft.
n. ft.
ft. ft.
ft. ft.
ft. ft.
21.REMARKS
22. Certification:
Si-%.~~ 9-9-13
Date
By signing tlrls Ji>rm.. I hereby cerlljj, that tire wd/($) was (were) conslrvct~d in uccurdanre
with 15.A NC.AC 02C .0100 or 15.A NC.AC 02C .0200 Well Constntctio11 Standards a11d tl,at a
copy of this record has been provided to tM well owner.
23. Site diagram or additional well detltils:
You may use the back of this page to provide additional well site details or well
construction details. You may 11lso attach additional pages ifnecessacy.
SUBMITTAL JNSTUCTIONS
9. Total well depth below land surface: _2_6_0 __________ (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells li,t all depth• if diffennr (r,x;ample-3@200' und :Z@l<Hf) co11struction to the following:
lO. Static water level below top of casing: ___________ (ft.)
If wat,r level is ubove ca.,ing. 11Se "+"
t t. Borehole diameter: 8 (in.)
12. Well construction method: Mud Rotary f Air Hammer
(Le. auger, rota,y, cable, diiecl push, etc.)
FOR WATER SUPPLY WELLS ONLY:
l3a. Yield (gpm) _______ Method of tut: _______ _
13b. Disinfection type: Amount:
Division of Water Resources, lnformation Processing Unit,
1617 MaU Service Center, Raleigh, NC 27699-1617
24b. FQ[ lplec:tlon WeU. ONLY: In addition to sending the form to tbe address in
24a above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Divbion of Water Resources, Underground Injection Control Proi:ram,
1636 Mail Servicr. Center, Raleigh, NC 27699-1636
24c. For Water Supplv & llljeetion Wells:
Also submit one copy of this form within 30 days of completion of
well construction to the cowity health department of the collnty where
constructed.
FormGW-1 North Carolina. Department ofEnvironmcnt and Nalurnl Resources-Division of Water Resoun::es Revised August 2013
WELL CONSTRUCTION RECOJ.d)
This bm can be used fur single or multiple welfs
1 Wall C tractn Info Ii oa r rma on:
Randy Phillips
Well ColJll'aCIW Name
2209-A
NC Well Conuactcr Certification NUDJhe,
A.E.Drilling Service
Company Name
z. wen CaDStnction Permit#:
List aTJ applkable 'lflell per,niU (i.e. Cmmty. Sratt!, Variance, lnj«:tiotz, etc.)
3. Well Use (dleck well ue):
Water Supply WeD:
OAgricultural □Municipal/Public
□Geothermal (HeatilJWCooling Supply} □Residential Waler Supply (single)
□Industrial/Commercial □Residential Waler Supply (shared)
□fnigation
NGn-Water Supply Well:
ri'IMODitoring □Recovery
Injection Well:
OAqnifur Recharge □Groundwater Remediation
□Aquifer Storage 8Qd Recovery □Salinity Barrier
□Aquifer Test □Stormwatcr Drainage
dEic.perimeutal Technology □Subsidence Control
□GeotbC1U1al (Closed Loop) □Tracer
□Geothennal ffiea tinivCoolinit Return) □Other (ex.p lain under #21 Remacb)
4. Date Well(•) Completed: 11 /28/12 Well ID# MW253-J39D
SL Well Location:
Chemtronics
Facility/Owner Name Facility ID# (if applicable)
180 Old Bee Tree Rd. Swannanoah 28778
Phyaical Addnais. City, and Zip
Buncombe
Cotlllty Parcel Identification No. (PIN)
Sb. Latitude anti Lonei-tude in degrees/minutes/seconds or decimal degrees:
(if"wcll field. one, lalllong is sufficient)
___________ N ______________ W
6. h (are) tile well(s): li1!Permaoent or □Temporary
7. Is this II repair to an emtlng well: □Yes or E'.INo
Q"this is a rt!pfJir,fi/1 ma know1I well ronstn,cdmr Information and explain the 11ature oft//e
rq,air u,lller #2 I remarks s«:tion or on the hack of tlus farm .
8. Nmnber of wells canslnreted: _1 _________ _
For multiple injection or non-Willer ,upply wells OIVLY 1<ith zl,e same construction, _vou ca"
sulmtit one /ornt .
9. Total well depth below land surface: _1_Q_O _________ (ft.)
For,nuftiple wells Ii.rt all depth, if ,l;fferer1t (ex.amp/.,.. J@ZOO" and 1@/DIY)
19. Static water level below top of aislng: ___________ (ft.)
If water level is ab,n,e ca.•ing. u.,e "+"
11, Borehole dl11Dlflter: 8 (in.)
12. wen construction method: Mud Rotary / Air Hammer
(te. auger, rotaiy, cable, direct push, ell:.)
FOR WATE.R SUPPLY WELLS ONLY:
13a. Yield (gpm} _______ Method oftest: _______ _
13h. Dixinfecdon lype: Amount;
I For Internal Use ONLY:
14. WATER ZONES
PROM TO DESCRJJ'110N
ft. ft.
ft. ft.
15. OUTER CASING lfor 11111ltkued wells\ OR LINER lif a-lioablel
FROM I ro I DIAMETl:k TJUCKNISS MATERIAL
0 ft. 74 ft. 8 IL .322 Steel
16. INNER CASJNG OR TUBING l•eotllermal dosed-lonnl
FROM TO DIAMETER TlllCKNESS MATERIAL
+3 ft. 80 ft. 4 In, sch40 PVC
ft. ft. In.
17.SCREEN
PROM TO DIAMETER SLOTSIZE IHICKNFSS MATERIAL
80 ft. 100 ft. 4 in. .020 sch40 PVC
ft. ft. ilL
Ill.GROUT
FROM 10 MATERIAL 11:MPlACRMENT METHOO & AMOIDIT
74 ft. 0 ft. neat cement Pump
77 ft. 74 ft. 3/8 Hole Plug Pour
ft. fL
19.SAND/GRAVEL PACK lifannllesblel
FROM TO 111ATERIAL EMPLACEMENT METHOD
103 ft. 77 ft. #2 sand pour
ft. ft.
20. DRILLfNG LOG fu t.ch additional 1lteet1 ifneceaanl
PR OM TO DESCRIPTION-1,o!or. hardru•u_ IDIUmck It'll<, e rau, lltt. etc.>
ft. ft.
ft . ft.
ft. ft.
ft. ft.
rt. ft.
ft. ft.
ft. ft.
2J.REMARKS
:U. Cutifitation:
~~ 11/28/12
By signi11g this f orm. l hLreby certify llial th• well(s) wa.r (were) conslrucled in accordance
with 15A NCAC 01C .0/QO or 15A NCAC OJC .0200 Well Constroctior1 St«ndtfTds and that a
copy of this rt cord /,as been provided to the well own tr.
23. Site dillgram or additional weU deClllls:
You may w;e the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For AU Wells: Submit this form within 30 days of compictioo of well
construction to the following:
Division of Water Reseurces, Infonnation Processing Unit,
1617 Mail Senice Center, Raleigh,NC 27699-1617
24b. For Injection Wci15 ONLY; fn addition to sending the form to the address in
24aabove, also submit a copy of this form within 30 d~ys of completion of well
conslluction to lhe following:
Divisl.oa of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh , NC 27699-1636
24c. For Water Supply & Injection Wells:
Also submit one copy of this form within 30 days of completion of
well construction to the county he!llth department of the county where
constructed.
FonnGW-1 North Carolina Department of Environment and Nalural Reoources -Di\"ision of Water Resoon:es Revised Augu.st 20 l3
NON_RESWEAT-12AL WELL CONSTRUCTION RECORD
North Carolina Depariment of Environment andNadural Resources- Division of Water Quality
WELL CONTRACTOR CEitTfFICATION # 3521
4P.
Well Contractor (Individual) Name
A E DRILLING SERVICES. LLC
Well Contractor Carnpany Name
TWO UNITED WAY
Street Addrems
GREENVILLE SC 2a6Q7
City or Town Stale 21p Code
i 864 1 288-1986
Area wde Phone number
2. WELL INFORMATION: no.. 2. 2 - tar 3$ +Ti
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERM fT V apphCahls)
SITE WELL ID ikre app4i ilnf
3. WELL USE (Check One Boar) Monitoring 0-Municipal/Public 0
fndusalalYCommerclai D Agricultural 0 Recovery 0 injection 0
Irrigalion0 Other El (list use)
DATE DRILED %1• Z/•
L. WELL LOCATION:
M r7i' c
(Street Name, Numbers, Community, ELbdiVEAon, Lot No., Pare Zip code)
CITY: G�50[r Ilr�r ;.a. I ,r_ COUNTY
TOPOGRAPHIC / LAND SETTING: (check appropriate boo)
❑Slope °Valley D Rat ID Ridge ❑ Other
LATITUDE 36 " DMS OR 3X.A0O000prX ❑D
LONGITUDE 75 -._ ' DMS OR TX./000OOOOcX DO
Latitude/longitude source: EPPS I:Topographic map
(location of waY must be drown on a USGS tope map anctoitached to
this form if not using GPS)
8. FAClU TY (Name of the business where the wen Is located.)
Facility Name
1'36 Old tee Tare .
Seat Address
. Askv;i1 e.
City or Town State Zrp Code
A/ITIMOr,f LnvironmPn r.
Contact Name
d3 AALJ d S
g Address
r.�Li, ry__
City or Town
(jAii a8! 3356
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:
Fat Jty W* (if applicable)
C. ag'gos
377'
State Z'ip Code
b. DOES WELL REPLACE EXISTING WELL? YES Q
c. WATER LEVEL Below Tap of Casing: i`). 3'2 "
(Use • - if Above Top of Casing)
NO re-
Fr-
d. TOP OF CASING IS 18 FT- Above Land Surface`
'Top of aasing tsrmhated at/or below land surface may require
a variance In accordance wffh ISA NCAC 2C .0118.
e_ YIELD {gprn): 4444, METHOD OF TEST
f. DISINFECTION: Type 44Amount' .45'41—
BoYGo�tnd ;) Trip .OThottom 47/1-
Top . 8otbn Top Bottom
Tap Bottom Top Bottom
Thickness/
7.CASING: Depth Diameter Weight Material
Top if 1. _ Bottom /7.7'Ft. 2 PI Sek
Top Bottom - Ft - - -
Tep _ Bottom R.
8. GROUT: Depth Material
Top Bottom /2frFt e"..01.4e"f
Top Bottom Ft - -
Top Bottom FL
Method
8. SCREEN: Depth Diameter Slot Size Material
Top /7•I'Bottom /MFt_2" in.40 in. • YV f
Top Bottum FL in. in
TopBottom • FL in. In.
ilk SAND/GRAVEL PACK:
Depth size
Top i : r' Eaitom' Ft.
Top Bottom FL
Top Bottom a
11. DRILLING LOG
Top Bottom Formation Description
1Storz.I
1
1
/
1
1
1
r
1
12. REMARKS:
1 CO KERIEBYcem1FYTArTl-ca WELL WAS CONSTUCTEDINACCORDANZEWITH
16A NCAC ZC WELL coNsnacr1CN sum: os. NS7 THAT A COPY OF THIS
REDDRD,PHONI ED TO TYE WELL meek
SIGNATU OF CERTIFIED WELL CONTRA -Lc -TOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Rev. 2/0

1 ■ ON .RESTDEIVTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTR4CTOR CERTIFICATION # 15 /
Well Contractor (Indtviduat) Name
A E DRILLING SERVICES, LLC
Welt Contactor Company Name
TWO UNITED WAY
Sheet Address
GREENVIL LE
City or Town
[ 864 1 288-1988
Area coda Phone number II
2. WELL INFORMATION: 1`)j )— a'f
WELL CONSTRUCTION PERMIT#
gC
State Zip Corte
29807
OTHER ASSOCIATED PERMIT#(a applicable)
SITE WELL ID 01 applicable)
3. WELL USE (Check One Box) Monitoring La" rurtnidpat/Pubtic ❑
IndustrieVeornmerciel b Agricultural ❑ Recovery C1 Injection 0
Irrigation❑ Other 0 Pei use) _
DATE DRILLED 11-'_Z9-/ Z
4. WELL/ �LOrCATION:
(Steel Name, jrNumbers, Community, Subdi ton, Lot N. Ps1ael, Zip Coda)
CITY: /-)SfeN;r}C COUNTY_
TOPOGRAPHIC 1 LAND S ET I dNG: plea appropriate box)
❑ Slope ['Valley ° Flat ❑ Ridge 0 Other
LATITUDE 36 „DtVIS OR 3X.X)OUD000Ot ❑D
LONGITUDE 75 " DMS OR 7), Q(XXXXx DD
Latitudell❑nattude source: 03P5 []Lop❑graphic map
(location of well must' be shown on a USGS repo map andaltached to
finis form if not usfrig GPS)
5. FACILITY (Name of the business where the well is located.)
L. tekarDiliLS
Facility Name (} Facility ID# (if applicable)
1 `(O 0( 114 Pi.e Rd
St { oririnkSS
7:1L iJ L
Le
City or Town
F I rt1116n1 EA u,lnnMrn `1zz I
Contact Name
Mailing Address •
.T114 / ( ? 6 I
City or Town State Zip Coda
Z 0
State Zip Code
J
) 2'1- 3356
Area code Phone number
O. WELL DETAILS:
■- TOTAL DEPTH:
Jr`
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOt
WATER LEVEL Below Top of Casing:_ 1111 FT.
(Use°+° tf Above lop of Casing)
d. TOP OF CASING IS 3 I FT. Above Land Surface'
`Tap of casing terminated attar below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
a. YIELD (9pnt): kVA- M HOD OF TEST
f. DISINFECTION: Type eV Amount
g. 111f 3 fr (depth): �/ "Of,
Top Bottom/�/ Top � � Bottom
Top Bottom Top Bottom
Top Bottom Top aattom
Thfcknessl
T. CASING: Depth Diameter Weight Material
Top_Q Bottom 164 Ft. 2*"
Top Bottom Ft.
Top
Bottom Ft.
B. GROUT: Depth
Top
Top Bottom FL
Top Bottom FL
MaterialMethod
—r�
Of Bottom I f _ FL Leaf � r'',1 OA' _
9. SCREEN: Depth Diameter Slot Sae Material
Top IS' Bottom + ' Ft 2" in. &Olt> �
In. in. .5+•ho y+7 per.
Top Bottom Ft.
Top Hottom Ft.
in. In.
10_ SANDIGRAVEL PACK:
Depth ar Size Material
Top dJ Bottom ..1 Ft. • 10 05aAd
Top Bottom Ft.
Top Bottom Ft.
11, DRILLING LOG
Top Bottom
1
1
1
1
1
1
12. REMARKS:
Formation Dr- cripiion
I DO HEREBY CFRfFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A+CAC 2C, WEU. CONSTRUCTION STANDARDS, AND THAT A CCPY OF THIS
RECC'RRHhS 6EEN OVt HE EVE OWNER
SIGNATURE 0 ERTIFIEU WELL CON' CTOR DATE
4Gei'9 4 f. r -
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-t b
Rev. 2/09

1. WELL NTRAC OR
du dell Contractor (Individual) Name
A E DRILLING SERVIt'ES, LLC
Well Contractor Company Name
TWO UNITED WAY
Skeet Address
GREENVILLE SC 29607
City or Town State Zip Code
t 864 J 288-1986
Area code Phone number
2. WELL INFORMATION: P % z4g
WELL CONSTRUCTION PERMri# OTHER ASSOCIATED PERMFT#{IF applicable)
SITE WELL ID #(It applicable)
NONRESIDENTIAL WELL coNSTRUCTION RECORD
Norm Carolrga Departrarzet ufEnvitviimealt and Natural Rsntuces- Division of water Quality
WELL CONTRACTOR CERTIFICATION # 17J
d. TOP OF CASING t5 3 r FT. Above Land Surface`
^Top of casing terminated at/or below land surface may require
a vanance in accordance with 15A NCAC 2C .0118.
e. YIELD Wpm): A(h# METHOD OF TEST
f DISINFECTION: Type "Wel- Armond AV
g. NES
Toe- ///f (depth):Bottom Top )'/ Bottom.%J�
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness!
Weight Material
3 WELL USE (Check One Bair) Monitoring aelituniclpallPubkc L7
EnduatrlalfGommercial I] Agrict+fturat ❑ Recovery LI Injection ❑
trrigaiion❑ Other 0 (Uat use)
DATE DRILLED 11-.20./pi
4, WELL LOCATION:
1 sC
(Street Name, Numbers, Community, Subdivision, Let No„ Parcel, ZIP Code)
CITY:
TOPOGRAPHIC ! LAND SETTING:
❑Slope ['valley OFlat ❑ Ridge
LATITUDE
LONGITUDE 75 '
COUNTY
(aherR appropriate box)
❑ Other
DMS OR 3X.XXX000OOOC DD
" DMS OR Tjt.xxxQJ xxx DD
Latitudetiong#tu1e Mite: CMFS propographlc map
[]aeration of well moat be shown on a USGS tops map andeached to
this form if not using GPS)
E. FACILITY (Name of the business where the well Is located.)
ilbaliSOIN151411 IOC /_ 71/-bel cs
Facility Name' Facility IDS (If applicable)
66 qd 7;1:
Street Address
+cu tier
City or Town 1�
4!4 Mon-1- EnUifti',I7mp1�t I
C.
aSsa5
State Tap Cade
Contact Name
a23I a�a� wrQd Sf:
Mailing Address,
Arrhf'uIIle her. .2ggc3i
City or Town Stale Zip Code
ggg ) �81 3356
Area code Phone number
a_ WELL DETAILS:
a. TOTAL DEPTH:
1r
d. DOES WELL REPLACE EXISTING WELL? YES 0 NO p'
c. WATER LEVEL Below Top of Casing: / . ° 3 FT.
(Use "+" if Above Top of Cawing)
7. CASING: Depth Diameter
Top if Bottom Z1' _ Ft. 2" .
Tap Bottom Ft.
Top Bottom Ft
sch• r& PLk1
a_ GROUT: Depth Material Method�
Top 011 Bottom 17 FL r •_e
Top Bottom Ft _
Tap Bottom Ft
S. SCREEN: Depth
Top 1' Bottom-
Top Bottom
Top Bottom
El tempter Slot Stse
Ft. alb In. . ID in.
Ft. In. In.
FL 1q. In.
Material
3e.11•4t0 p�C�
10. SAN01GRAVEL PACK:
Depth Sfza 114ahariel
Top 1 9 4 Bottom VZ' Ft.44 / Sr fie/
Top Bottom
Top Bottom
11. DRILLING LOG
Top Bottom
1
I
r
r
r
I
1
12. REMARKS.
Ft.
Ft.
Forrrmtion Description
ra. k
I IX/ HERESY CERTIFY THAT THIS WELL WAS CONSTRUCT©] iN ACCOHDANDE WITH
45A !CAC 2C, WELLC0HSTRIJCT1oN STANDARDS, AND THAT A COPY OF THIS
EY-t4P70 The W t.UW?
ADA %Z
S/ R�ILCONTRACTOR
PRINTED NAME OF PEfiSON CONSTRUCTING THE WELL
Form t3W-lb
Rev. 2109

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Dcpartmcat of Saviornnmles]t and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 35 /
CR L
Well Contractor (Individual) Name
AE_QRILL11'1O SERVICES, LLC
Weii Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE
City or Town
(864 ) 288-1986
Area code Phone number
.2. WELL INFORMATION: p--Ni— 1k3
WELL CONSTRUCTION PERMIT*€
Cr^
State Tip Coda
'—V'
OTHER ASSOCIATED PERMITi#(If appllcable)
SITE WELL ID RE applIcabie)
3. WELL. USE (Check One Box) Monitoring CiMunIcipal,Public
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection
Irrigation❑ Other ❑ gist use)
DATE DRILLED 11 24--IL
4. WELL LOCATION:
(Street Name, Numbers, Community, Subdhtsiort, Lot No., Parcel, Zip Coda)
CITY: COUNTY
TOPOGRAPHIC 1 LAND SETTING: {check appropriate box)
❑Slope ❑Valley ❑Flat ❑Ridge ❑other
LATITUDE 36 " DMS OR 3X.)0OOOa xxx DD
LONGITUDE 75 ' DMS OR 7 u(XX:owooc DD
Latitudeliongitude source: E GPS Qfopographfcmap
(location of well must be shown on e USGS tope mop ant/attached to
this form if not using GPS)
5, FACILITY (Name of the business where the well is faceted.)
aerri
Fav1Ity Name ❑ _
l'Q ofei ,k r 11lC J2 /
Street ddress
heak
City orr Town
_fi (4-rz ono +Pof1111P.ti- /
Contact Name
.-,221 RJRItLJe L-
MeiTin4s
-S6resfie �T T L ,��Enl
Facility ID! (if applicable)
IVf
Slate Zip Code
City or Town
( Di/) ..28/1 335C1
Area code Phone number
6. WELL DETAILS:
e. TOTAL DEPTH: w7�7
b. DOES WELL REPLACE EXISTING WELL? 'YES ❑ NO E3-
o. WATER LEVEL. Below Top of Casing_ _ /r7. 0 5 FT.
(Use '+" if Above Top of Casing)
State Zip Code
d. TOP OF CASING IS .71
FT. AtOve Land Surface"
'Top of casing terminated atlor below land surface may require
a variance inaccordancewith 15A NCAG 2C .0118.
e. YIELD Wpm); /'i.y/A METHOD OF TEST
f. DISINFECTION: Type Alflt Amount N�
g. WATER ZONES (depth):
Top : t' •-Dario ;! - Top
Top Bottom Top
Top Bottom _ Top
7. CASING: Depth Diameter
Top Bottom a- Ft ears
Top Bottom FL
Top Bottom Ft
Bcdom t
Bottom
Bottom
Thickness/
irelight
B. GROUT: Depth Material
Tap. lSl Bottom 1l' Ft 't i-
Top Bottom Ft.
Top Bottom FL
S. SCREEN: Depth Diameter
Top /6-4 Bottom 35 Ft. 2rr in.
Top Bottom Ft. In.
Top Bottom Ft. In-
10. SAND/GRAVEL PACK
Depth Size
Top 13, Bottom Ft.
Top ,Bottom_ Ft.
Top
Bottom Ft.
11. DRILLONG LOG
Top Bourn
1
1
1
12. REMARKS
TE-
Method
Slot Stze Material
. 10 In. qv lQ.
In.
in.
Maetorial
acJ
Formation Description
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED iN ACCORDANCE WITH
TEA NCAG 2C, }A+EU. CONSTR1 CTION STANDARDS. MD THAT A COPY OF THIS
RECORD D-iAS SEEH.PROVInmTO YI-iF /Dirt I OWNER.
//-20/4
SIG 7X RJOF CERTIFIED WELL CONTRAC — DATE
I] NAM OF PERSON CONSTRUCTING THE WELL
Form GW- a
Rev. 2/09

WELL CONSTRUCTION RECORD
This s rmo tan be cecd for tingle or ranitiple wells
I. Well Cnwtraelur Information:
Randy Philips
Well Connecter Name
2209 A
NC well Capkec[ni Certification Number
A.E.Drilling Service
Company Name
i. Well Construction Permit 0:
LW a!1 applicable wet permits (l.e. Comiy. State, Variance, hojection, etc.)
3. We/ Use (Check well are):
Water Supply Well:
CDAgr'icvllurel
°Geothermal (Heating/Cooling Supply)
InindustrialiCommercial
❑Irri ation
Nara -Water Supply Well:
f7Manitnring
I !Municipal/Public
°Residential Water Supply (single)
°Residemtia I Water Supply (she red)
❑ Recovery
Injection Well:
C lAquifes Recharge
°Aquifer Storage and Recovery
°Aquifer Test
❑Experimental Technology
OGeothen ial (Closed Loop)
°Geothermal (lientbag/Cooling Reran)
❑ Gran ndwater Remediation
°Salinity Barrier
t Stormwatcr Drainage
°Subsidence control
o Tracer
°Other i explain under la 1 Remarks)
4. Date Well(s) Completed: 9-9 1 3
Sea. Well Location:
Chemtronics
WeufL# MW252-J39EF
Facility/Owner Name F'ecillty iDtl (if applicable)
180 Old Bee Tree Rd. Swannanoah 28778
Physical Address, [Sty, and Tip
Buncombe
Comity Put41[4atifieetion No. GIN)
56. Lathade and 1.nngitude in degreesieninutesiseconda or declmat degrees:
(ifwell $eld, me taalbng is sutlecient)
N W
6. Is (are) the well(s)_ 121Perwanent or °T'emporary
7. is this a repair to en existing well: °Yea or Elfito
(r its is a repair, fill out itran►r i s / rtvmrrrnetion htjaneel/on and erpla&n the nature of the
repair under #2! t ,m rkr section won eke bock of itrf farm.
11. Nuintier of wells eonstnuted:
1
For multiple injection anion-walersuppfywrl& ONLTwick the same AAmslr iretiom. yauarN
submit one form
9. Total well depth below land surface:
For multiple %elk fat all depths Vdiffirrenr (unapt- 3@100' nod 2(41190')
260
ID Sark water level below top of casing: {R.)
Ij%vier level is above taring use "+"
Borehole diameter; 8 - (in.)
12 Wen construction method:Mud Rotary / Air Hammer
(Le. auger. rotary, cable, direct push, en:)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type _ Amount:
For Smeraal Lrsr c1NLY-
14. WATER ZONES
PROM
TO
DESCRIPTION
it.
H.
fr.
ft.
1s. OUTER
CASING (for
malls -eared wens) OR LINER Of ennacebkl
FROM
To
DIAMETER
'THICKNESS
MATERIAL
0 tG
83 ft.
8 ha
.322
Steel
Id. DINER
CASINO 0P TU&NC
beet ermal dosed -loop)
FROM
TO
DIAMETER
THICIdvRSS
MATERIAL
1-3 IL
235 11
4 1''
soh 40
PVC
ft.
It.
is
17. ROMEJI
PROM
To
DIAMETER
' SLOTSsze
TmcEnizasMATERIAL
235 II
260 '-
4 IL
.320
sch 40
PVC
II-
N. GROI1T
FROM
TO
MATERIAL
EMPLACE/HINT ML7HGa & AMOONP
293 re,
265'
neat cement
Pump
229.4 ft-
223 "•
3I8 Hole Plug
Pour
223 m
0 ft'
neat cement
pump
19. SAND/GRAVEL
PACKSf
applicable)
FROM
TO
eratuniAL
r EMPl.AcummeTrarr OD
265 ft•
229.4 ft'
#2 sand
pour
ft.
n.
111. DRILLING
WG Otto* acfdfdoast sheen if amesee f
FROM
TO or -scale -nos Valor. Inrdcni sailhvete arptArd, wk.)
ft.
ft.
fi.
ft
0I.
R.
It.
n.
ft.
h.
ft.
ft.
iL
R.
--
21_11231ARKS
22. Certification:
9-9-13
Were
By signing this jam, l hereby rerllfj' that the well(s) was (were) constructed in accnsdance
with lit NGt C 42C .woo or 1SA NCAC 02C .0200 IVrll Cowl —ruction Smndardr nod Chat rr
ropy of lhis record hag hem provided to eke well owner,
23. Site diagram or additional well details:
You may arse the beck of lhs page to provide additional well site details or well
crosstrncticm details. You msy also attach additional pages if accessary.
SUBMITTAL INSTUCl'IONS
24a For All Wells: Submit this form within 30 days of wmpietiun of well
construction to the following
Division of Water Resources, Ioturmation Processing Unit,
1 617 Mail Service Center, Raleigh, NC 27699-1617
24b. for tiikction Wells ONLY: hi addition to sending the forts to the address in
24e above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground injection Control Program.
1636 Mali Service Center, Raleigh, NC 27699-] 636
24e. For Wirer Sopplr & ioieetion Wells:
Also submit one copy of this form within 30 days of completion of
well construction to the county hc.lth department of the county where
constructed.
Form GW.i
Noah Carolina llepirimeni of Earviranmeer and Natural Raiowccs— Division of Water ResnLtrces Revised Aognst 2611

WELL CONSTRUCTION RECORD
This funn can be used for single or IDllltiple wells
1 WeUC Info 011tractor nnation:
Randy Phillips
Well ConttacmrName
2209-A
NC WeU Contractor Certificimou Number
A.E.Drilling Service
Company Name
l. Well Construction Permit#:
list aJ/ applicahle well permits (Le. Couno·. Srare. 1'11riance. mjectian, f!lc.)
3. Well Use (clleck well use):
Water Supply Well:
OAgricultural □Municipal/Public
□Geothermal {Heating/Cooling Supply) □Residential Water Supply (single)
□ Industrial/Commercial □Residential Water Supply (shared)
□Irril!lltion
Non-Water Supply Well:
@Monitoring □Recovery
Injection Well:
□Aquifer Recharge □Gmundwater Remediation
□Aquifer Storage and Recovery □Salinity Barrier
□Aquifer Test □Stonnwater Drainage
□Experimental Technology □Subsidence Control
□Geothermal (Closed Loop) □Tracer
□Geothennal (Heating/Cooling Return) □Other (cxolain wider #21 Remarks)
4. Date Well(s) Completed: 9-1 8-13 Well ID# MW251-K39EF
Sa. Well Location:
Chemtronics
Facility/Owner Name Facility JD# (if applicable)
180 Old Bee Tree Rd. Swannanoah 28778
J>hyskail Address, City. and Zip
Buncombe
ColD\ty Parcel Identification No. (PIN)
Sb. Latitude and Longitude in degrees/minutes/seconds OI' decimal degrees:
(if well field, one lat/long is sufficient)
___________ N ______________ W
6. Is (are) the well(1): li3Permaaent or □Temporuy
7. Is this a repair to an emting well: □Yes or E'lNo
Jfthis fs a repair.fill o,,t .l:no"" well co11stn,cum, infonnation 011d c.tplobi the natt,re oftl,e
repair under #2 J remarks secuor, or on the back of this fom1.
8. Number of wells constructed; _1 _________ _
For multiple i,ifection or nan-water .wpply wells ONLY with the sam~ construcfion. you cm1
submit o,,e form.
9. Total well depth below land surface: _2_4_2 _________ ,(ft.)
For mr,/tiple wells li.,t all depth< if differenr (example· 3@100 • and 2@/f/0')
10. Static water level below top of casing; ___________ (fL)
ff water levd is above casing. use .. +"
11. Borehole diameter: 8 (iu.)
12. Well construction method: Mud Rotary / Air Hammer
(i.e. auger, rolnry, cable, direct push, ecc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) ______ _ Method of test: _______ _
I For Internal Use ONLY:
14. WATER ZONES
Fl!OM TO D£SCRJP110N
ft. ft.
ft. ft.
15. OUTER CASING ffor fflllld.<:ased ,....,,., OR LINER flf •AnHcablel
FROM TO I DIAMETER T TIDCKNESS I MATKIUAL
0 ft. 83 ft. 8 in. .322 Steel
lfi. INNER CASING OR TUBING r .. eothennal dosed-loo.,\
FROM TO DIAMETl!:11. mJCKNESS MATERIAL
+3 ft. 222 rt. 4 In. sch40 PVC
ft. rt. in.
17.SCREEN
FROM TO DIAMETER SLOT SIZE IBICKNESS MA'JERIAL
222 ft. 242 rt. 4 In. .020 sch40 PVC
n. n. iD.
18.GROUT
FROM TO MATEIUAL EMPLACEMENT METHOD & AMOVNT
291.5 ft. 252 ft. neat cement Pump
217 ft. 212 rt. 3/8 Hole Plug Pour
212 fl. 0 rt. neat cement Pump
19. SANDIGRA VEL PACK lif aoolicablel
FROM 1U MATEl!IAL EMPLACEMENT METHOD
252 ft. 217 rt. #2 sand pour
ft. rt.
20. DRILLING LOG (attach additional &lleets if oecen•t'Y)
FROM TO. nESCRl l'TION (color. hardo..._ so!Urook l"1H . 2uln sltt etc.)
ft. ft.
ft. rt.
ft. ft.
ft. ft.
ft. ft.
ft. ft.
fl. ft.
21.REMARKS
22. Certification:
Si~~&:f:, 9-18-13
Date
BJ• s;gning this form, I hereby certify rhat the well(s) was (were) construcred in QCcordance
with 15.A NC.AC Q2C .QIQQ or 15A NC4C 02C .0100 Well Co11structio11 Standorm a,id tl1a1 a
copy of this record has 1,,..,, provided to the well ow1rer.
23. Site diagram or additional well details:
You may use the back of this page to provide additional weU site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this fonn within 30 days of completion of well
construction to the following:
Division of Water Resources., Information Processing U oit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells ONLY: [n addition to sending the form to the address in
24a above, also submit a copy of this form within 30 days of completion of well
constructiOII to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Ralelgh,NC 27699-1636
24c. For Water Supplv & Injection Wells:
Also submit one copy of this form within 30 days of completion of
13b. Disinfection type: Amount: well construaion to the county health departmer1t of the county where L.:::::..::=:=:::::...::~:..::======:__.:.::::::::::..::========-l constructed.
FonnGW-1 North Carolina Departme.nl of Environment and Narural Resoon:es -Division ofWaicr Resources Revised August 2013
I
WELL CONSTRUCTION RECuRD
Tlii lonn can be UJed ir single or multiple wells
1 Will Coatnicto Info r rmatien:
Randy Phillips
Well Conlraclllr Name
2209-A
NC Well Canbac101' Certification NuDJher
A.E.Drillin g Service
CompanyName
2. WeD Ccuistnclion Permit#:
Liff aIJ applicable well pennlU (i.e. Co""IY• Skue, l'arhtm:e. lllje,:tion, etc.)
3. Well Use (cheek well ate):
Water SUppJy WeD:
OAgricultural □Municipal/Public
□Geothermal {Heating/Cooling Supply) □Residc:ntial Water Supply (single)
Dfndustrial/Commercial □Residential Waler Supply (shared)
D&ril!llti on
No•Water Supply Well:
lt!Monitoring □Recovery ---.
Injection Well:
OAquifi:r Recharge □Groundwater Remediation
□Aquifer Storage aud Recovery □Salinity Barrier
□Aquifer Tc:st OStonnwatcr Drainage
OBxperimental Technology □Subsidence Control
□Oeothennal (Closed Loop) □Tracer
DGeothennaJ ffieatinwCoolin2 Return) □Other (explain under #21 Remades)
4. Date Well(1) Completed: 11/28/12 WelllDIIMW253-J39D
Sa. Well Location:
Chemtronics
Facility/Owner Name Facility ID# (if applicable)
180 Old Bee Tree Rd. Swannanoah 28778
Ph,Y1ical Addn:ss. City, and Zip
Buncombe
County Parcel [dcutification No. (PIN)
5b. Latitude and Longi.tinie in degrees/ndnutes/seconds or decimal degrees:
(if well field, one lalllong is sufficient)
___________ N ______________ W
6. h (are) the well(s): liilPermaoent or □Temporary
7. & this ll: repair to an existing well: □Yes or ~No
]f 1/ris 'is a repair.fill 011t mmm ,rel! amstntct/01t Information and explain the IUJttrre ~(t/Je
repair tmder #21 remarb s,,ction or on lhe bock of this farm .
8. Nmnber afwells COilstrurted: _1 ________ _
For multiple Inject/an or non-...iter Jupply we/& ONLY "vth tire ,ame con<tructian. _vou can
mbmit oMform.
!I. Total well depth below land surfaee: _1_0_0 _________ (ft.)
For JJWltiple welfr l<<I all depth.< if different (example-J@WO' rtnd l@l 00')
10. Static water level below top of ca5.ing: ___________ (ft.)
.if wate,· level ia abmie ca,ing. u.re "+"
11. Borehole diameter: 8 (In.)
12. Well coastnu:tion method: Mud Rotary / Air Hammer
(le. auger, rolllr:y, cable, direct push, etc.)
FORWATERSUPPLYWELLSONLY:
1.3a. Yield (gpm) _______ Method oftest: _______ _
13b. Disinfection type: Amount:
I For lotmial Use ONLY:
14. WATER.ZONES
FROM TO l>£SCJUPTIO,"II
ft. ft.
ft. ft.
15. OUTER CASING (£or mulli-aued wellsl ORLINER fif annlic:ablel
FROM I ro 1 DIAMETER THICKNESS MATERIAL
0 ft. 74 ft. 8 IL ,322 Steel
16. INNER CASING OR TUBING T.oot••rmal closell-loon1
FROM TO DIAMETER THICKNESS MATEKIAL
+3 ft. 80 ft. 4 In. sch40 PVC
ft. ft. In.
17,SCREEN
FROM TO D.IAMEfElt SLOTSJZK THICKNESS MATERIAL
80 n. 100 ft. 4 In. .020 sch40 PVC
ft. n. in.
IS. GROUT
F.ROM TO MATERIAL KMPI.ACRMENT METHOD & AMOIJXT
74 Ct, 0 ft. neat cement Pump
77 ft. 74 ft. 3/8 Hole Plug Pour
ft. rt.
19. SAND/GRAVEL l'ACK (if ■nnHoablel
FROM TO IIIAn:RIAL EMPLACEMl.l'ff METHOD
103 {t. 77 ft. #2sand pour
fl. ft.
20. DRILLING LOG (■llll ch addidoDAI •fl.1tts ir .,.c ... UYl
flROM TO DESCRll'TION rcolor. lardo ... ooll/rod!. n-. onwa .;.., etc.)
ft. ft.
ft. ft.
ft. n.
ft. ft.
ft. n.
fL ft.
ft. ft.
?I.REMARKS
22. Cenification:
~~_,,j-.,c..~=s.cll.::::C=--ontrac-to-r -----
11/28/12
D•le
By sil!"ing this Jonn. I hereby ccrtifj• tluzl the well(s) was (were) conslnu:ted in accordance
wit/1 IS.A NCAC OlC .0100 or 15A NCA.C O:ZC .0200 Well Cmutrocrio11 Standards and that a
copy of t/Jis record lllls been provided to the well awrier.
23. Site diagram or additional well details:
You may use the back of this page to provide: additional well site details or well
construction details. You IDllY also anach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit !his fonn within 30 days of completion of well
construction to the following:
Division of Water Resources. Information Processing Unit,
1617 Mail Service Center, Jbleigb, NC 27699-1617
24b. For In jection Wells ONLY: Jn addition to sending the form to the address in
24a above:, also submit a copy of this form within 30 days of completion o f well
constmction to the following:
Divislon of Water Re80Urces, Undergroand Injection Control Program,
·. 1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Su pp lv & Jn f ectfon Wells:
Also submit one copy of this form within 30 days of completion of
well construction to the county health department of the county where
constructc:d.
FormGW-1 Nor1h Carolina Department of Environment and Natural Resoun;es-Divisi<>n of Water Resowces Revised Augusl 2013
1. WELL CD
NONRESIDENTIAL WELL CONSTRU tram RECORD
North Caroline Department of Errvirminient and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # IS-1/
L
ij�
N
Welt Contractor (Individual) a me
A E DRILLING SERVICES, LLC
Well Conkac:Mr Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
City or Town State Zip Code
(864 ) 288-1986
Area code Phone number
i 1k - 2313k 3€ A4,8
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PER MiT#{irappiicahte)
SITE WELL ID Cif apcacebie)
3. WELL USE (Check One Box) Monitoring p�rrlunicipallPublic Q
Industrial/Commercial D Agricultural 0 Recovery ❑ Injection D
irrigation° Other 0 (OIst use)
CATE DRILLED
4. WELL LOCATION:
Chet, wkcfi iC s
(Street Noma, Numbers. Community. Subdivision, Lot No.. Portal, Zip Code)
CITY: S U }-tow-r O (( COUNTY
TOPOGRAPHIC/ LAND SETTING: (check appropriale bog
❑Slope ❑Valet' ❑Flat ❑ Ridge ❑ Other
LATITUDE 36 " CMS OR 37000000COtx oo
LONGITUDE 76 ' .... "OMS OR 7X.xxxxxxxxx AO
Latitude/longitude source: BPS Qropographicmap
{facetion of wet must be shown on a USGS kpo reap anda{taaired to
this form If not using GPS)
5. FACIL 1Y (Name of the business where the well Is located)M tram i r�S
Facllltliam Facility ID* (if applicable)
CM
Bee T-ee L .
Sire t Addrwmw
City or Town J State Zip Cade
A 1 61mcv-d- Gr kArlme i sir 1
Contact Name
c,73 l Li L.isoM Sr-.
Mein g Address
flciey'I{e fiL
Cltycr Taws
S.73) 2Si 335o
Area code Phone number
6. WELL DETIUL$:
a. TOTAL DEPTH:
0.■L
anor
Stale Zip Code
b. DOES WELL REPLACE EXISTI14G WELL? YES o NO t"
c. WATER LEVEL_ Below Tap of Casing: t FT
(Use"+• if Above Top of Casing)
d TOP OF CASING IS 1 r FT. Above Land Surface'
'Tap of casing terminated odor below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): Pee METHOD OF TEST IV/1
f. DISINFECTION: Type AVir Amount Ab/14
g. WATER ZONES (depth):
Top .(//77 Bottom (Wilt Top 4/4 - Bottom .(I I*
Top Bottom Top Bottom
Top Boltam Top Bottom
Title -knew/
7. CASING: Depth Diameter Weight Material
Topp_Dettom �i Ft.2 5•ft FIG
Top Bottom Ft
Top Bottom FL
8_ GROUT: Depth
Top_ Bottom
Top
Top
Material
7' Ft. C
Bottom Ft
Haltom
FL
5 SCREEN: Depth i Diameter Slot Size
Topes_ Bottom 24 FL z' in. _ Q in.
Top Bottom Ft. in. in.
Top Bottom Ft. In. in.
10. SAND/GRAVEL PACK:
Depth Sipe
Tap f r Bottom 071 FL 01
Top Bottom FL
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
Method
111
Material
Isl . AL
Material
SL-
Formation Description
1 -Cicnre
1
1
1
1
I
1
1
1
12. REMARKS:
i no I -I R9Y CERTIFY TriAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
75A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
e awpRGh11DEO TO THE WELL OWNER
OF GERT i LL CONTRA DR DATE
Abe � 6r,ir
PRINTED NAME O PERSON ❑ONSTRUCTING THE WELL
Farm GW-1b
Rev. 2109

NONRESIDENTIAL WELT, CONSTRUCTION RECORD
North Carolina Department of Eavironmelrt and Natural Resources- Division of Water Quality'
WELL. CONTRACTOR CERTIFICATION # 3 SW
1. WELL CONTRACTOR:
i e-1 Ar1t_6-eve.
Well Contractor (Individual) Name
A e PRILL1t ERVLCES_ LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENV ISLE
City or Town
j4
2960
State Zip Cade
f 864 ) 288-1986
Area code Phone number
2 WELL 1NFORMATION:fit U'Z3? 'oe
WELL CONSTRUCTION PERMIT*
OTI-}ER ASSOCIATED PERM1T#€(r7 epplcahte)
SITE WELL ID tifil eppilc.'abre)
S. WELL IJBE (Check One Box) Monitoring (3-MunicipaLiPublin ❑
Industrial/Commercial 0 Agricultural 0 Recovery ❑ Injection
Irrigation0 Other ❑ (list use)
DATE DRILLED Iti�S-r•3i
4_ WELL ++LOCATION_
C_ r ielYlYftGhi (S,'
(Street Name, Numhws. Community, SuMdMu1orr, Let Na., Parcel. Ziri Code)
CITY: CIIN '�f}C€-'. I COUNTY
TOPOt;rcAPH1C1 LAND SETTING: (check appropriate boxy
EISlope ❑Valley CJFtat []Ridge °Other
LATITUDE 3S ' DMS OR 3X.XXXXXXXXX OD
LONGITUDE 75 ' DMS OR 7X._xxXxxxXxx DD
Latitude/longitude source: IMPS propographlc map
{location of wall must be shawl on a LISGS Alpo map endettached to
Va. roan if ant using GPS)
5. F/�
A�C1 UTY [Name h of the business were the wet{ is located.)
air] Ito et
Facility Name Faculty ID# (If applicable)
IYL� (ki &
Street Address
Ast Ik. .,AJC1
C ty or Town State Zip Code
A 14aM0r4 Er1V i1 orrinek i
Contact Name
ail ia L.)ca S'-
Mailing Add
�`, e gcI
City or Town
COS() gl '.356
Area code Phone number
S.WELL DETAILS:
a. TOTAL. DEPTH: DS►I}}
State Zip Code
h, DOES WELL REPLACE EXISTING WELL? YES ❑ NO Er
c WATER LEVEL Below Top of Casing: Vi5`'f
(Ilse "+" If Above Top of Casing)
FT.
Top
d. TDP OF CASING IS / I FT Above Land Surface'
"Top of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2G .0115.
e. YIELD (gpm): WO METHOD OF TEST 4t
I. DISINFECTION: Type .did" Amount N
g. WATER ZONES (depth):
Tap _• ./ICY Bottom ,a ---Top
Top Bottom Top Bottom
Top Bcttorn Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0` Bottom if Ft. S" •r%d
Top Bottom Ft.
Top Bottom Ft.
8, GROUT: Depth Material Method
Top. 0 Bottom 11 FL Alcor frlAni'rd
Top Bottom Ft.
Trip Bottom FL
4r 'nauorn Aviv
Y. SCREEN: Depth Diameter Slot Size Material
Top 12. Bottom_' Ft- Z' in. di) in. 5c. . VO4itt.
Top Bottoms, Ft. in. in.
Tnp Bottom A. Iry. fn.
74.8ANQIGRAVEL PACK
Depth Size
II' Datum I9Ft. #
Top Bottom Ft.
Top Bottom FL
11. DRILLING LOG
Top Bottom
1
12. REMARKS:
Malarial
Sg,1
Formation Description
Je
1 DO HEREBY CEKHEY THAT THIS WELL WAS CONSTRLCTED INAC.CCRQANCE WITH
15A NCACIC. WELL CONSTRUCTION STAHDAeos. AND THATA CORYOFTHIS
RECO
• I ,/ N j 1:14kO TO
r THE WELL OWNER
SIGNATU'. OF CERTIFIED
LL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-Ib
Rev. 2/0

NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina DTartmeut of Euvirarnneatt and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3C71
1. WELL CONTRACTOR:
Well Contractor (Individual) al) Name
A E DRILLING SERVICES, LLC
Well Contractor Company Name
TWO UNITED WAY
Street Addn:ss
GREENVILLE
City or Town
(864 ) 288-1986
Area code Phone number r��► [� 7p
2. WELL INFORMATION: MW — 246— ! J D w
WELL CONSTRUCTION PERMIT#
SC 29607
Stale Zip Code
OTHER ASSOCIATED PERMIT#(ir applicable)
SITE WELL ID ?IV applicable)_
3. WELL USE (Check One Box) Monitoring [ MunicipalIPubIiic ❑
InduslriailCommercial D Agricultural ID Recovery ❑ Injection 0
Irrigation° Other Q(Ist use)
DATE DRILLED
4. WELL LOCATION:
(Sleet Nome, Numbers, CommunNy, Subdivision, Lai No., Parcel, lip Cede)
CITY: 51a14,4111,4 41k.not, A) ;L COUNTY
TOPOGRAPHIC 1 LAND SETTING:
°Slope CiVeIley CI Flat L7Ridge
LATITUDE 36
LONGITUDE 75 °
(check appfopries bo:0
❑Other
DMS OR 3x.lOOUCXx?UDi DO
" DMS OR 7x.xxx XXXXX DD
Latitudeflong1lude source: ©GPS [Topographic map
(laca#on of well must tie shown on a USGS tope map endatMched to
Vs form If not using GPS)
S. FACILITY (Name of the business where the well Is !scaled.)
CIIarn.4.roAk..S_
Futility Name
S o Gad Aee
Facility ID# (tfapplicable)
beet Address
l lxu:1_Ie _ r /f/4 JRSa
City or Town State Zip Code
Env►rpprvr;:`ji
Confect Name
Mailinrr--gAdd ap
City or Town State Zip Code
( Sa8) a 3356
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH; 71.1%
b. DOES WELL REPLACE EXISTING WELL? YES
c. WATER LEVEL Below Top of Casing: / (. tS
(Use "+" It Above Top of Casing)
NO
FT.
d. TOP OF CASING is 3' FT. Above Land Surface"
"Top of casing terminated atbor below land surface may require
a variance in accordance with 155A NCAC 2C .0118.
e. YIELD Igpm): NA METHOD OF TEST
f. DISINFECTION: Type Adfg- Amount Nf IF
g. WATER ZONES (depth):
Top ivifr Bottom AV/ Top N/O^ Bottom eV "
Top -- - Bottom Top Bottum
Top Bottom Top_ _ Bntiom
Thic mewl
7. CASING: Depth Diameter Weight Meterfat
Top D` Bottom)' Ft_ 2° Sc4 fl pit L-
Top Bottom - Ft.
Top _ Bottom Ft-
8. GROUT: Depth Material Method
Top, .Z Bottom_ Ft + en+ WV:6VA
Top Bottom FL _.
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Itaterlat
Top % Bottom 7 " Ft. Z in. AP_ In_ PVC. $+r •'j 0
Top Bottom Ft in. In.
Top Bottom FL in. in. _
10. SAND/GRAVEL PACK:
Depth Size Material
Top 02 Bottom -,dFL #C/ se.n
Top Bottom FL
Top Bottom Ft_
11. DRILLING LOG
Top Bottum
t
1
1
1
1
1
1
12. REMARKS:
Fomration Description
10V HEREBY CFRfIFY THAI THIS WELL %AS CONSTRUCTED INACCORDANCE WrrH
1S11 NCAC 2C, WELL CONSTRUCTION STANDARDS.. AND THAT A CCFY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNigi.
SIG3+WTiJOF CERTIFIED WELL CONTRACTOR DATE
Ail%�,.kc
FRUITED NAME OF PERSON CONSTRUCTING THE WELL
Ferro GW-11:i
ReV.2439

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # Y671
1. WELL CONTRACTOR:
WEIL Crntractor (individual) Name
A E DRILLING SERVICES. LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
G`iEENVILLE SC 29607
City or Town State Zip Code
( 864) 28B-1988
Area code Phone number {�
Z. WELL INFORMATION: �i - C OS- 1 A117
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(ir spplirable)
SITE WELL ID #{t applicable]
3. WELL USE (Check One Box) Monitoring t3'MunicipallAublic ❑
tneustnat/Cornmercial fl Agricultural ❑ Recovery ❑ Injection 0
Irrigation° Other ❑ (list use)
DATE DRILLED 1I.J1-/Z
4. WELL LOCATION:
C rlY1 Df1tC__S
{Street Name, Numbers, Community, Subdivision, Lot Na., Parcel, 7fp Code)
CITY: ][V'tC)Oci. C COUNTY
TOPOGRAPHIC / LAND SETTING:
LS1ope ❑Valley °Flat ORidge
LATITUDE 36
LONGITUDE 75
(check appropriate boxy
C Other
DMS OR 3X.X:CODlxxxx ❑D
" 0MS OR 7x.x)0xxCXXXX D0
Latitudeflangitude source: QPS °Topographic map
(location of well mu. be shown on a USGS tops map andat.ached to
this farm if not using CPS)
8. FACILITY (Name of the business .Mere the well Is located.)
Facility !Name Facility ID# (if applicable)
n old s { c ed.
StrHat Arid rw z
vlSe ',C,
City or Town
Stale lip Code
Contact Na
Mailing Address
Asieu a of
City or Town
( p,S )+ g350
Area code Phone number
6, WELt. DETAILS:
a. TOTAL DEPTH: Z !
b. DOES WELL REPLACE EXISTING WELL?
c. WATER LEVEL Below Top of Casing. 7+ q
(Use "+' If Above Top of Casing)
State Zip Code
YES f NO Re
FT.
d. TOP OF CASING IS / ;
FT. Above Land Surface"
*Top of casing terminated at/or below land surface may requiro
e variance in accordance with 15A NCAC 2C .Q118.
e. YIELD (gpm): 1VWA METHOD Of TEST AIW'
L. DISINFECTION: Type Ail* • Amount "
g. WATER ZONES (depth): _'�
Top Alit BuLiuffi�_L��yy, Top . 1 • Bottom %'�1
Top Bottom Top
Top Bottom Top
7. CASING: Depth Diameter
Top D' Bottom 13' Ft r
Top Bottom Ft.
Top Bottom Fi.
Bottom
Bottom
Thickness/
Weight
8. GROUT: Depth Material
Topes Bottom_ _ Ft ' ._
Top Bottom Ft
Top_ Bottom Ft. -
Material
Method(
rnf
8. SCREEN: Depth Diameter Slot Size Material
TopAA: Bollom 2 FL Z'" in. •jp _ in. SCl+ t{V P
Top Bottom
Top Bottom
FL
FL
In. in.
in. _._ in.
10. SAND/GRAVEL PACK:
Depth Size Material
Tap_Bottom e Ft.�(1'
Top Bottom Ft.
Top Bottom Ft
11. DRILLING LOG
Top Bottom FDrntatian Description
!,'e!r
i
12_ REMARKS:
1 DO HEREIN CERTIFY THAT THIS WELL WAS CONSTRUCTED UCTED IN ACCORDANCE WITH
15A !WAD 2C, WELT DOUSTRIKT IO N STANDARDS, AND THAT A COPY OF THIS
RECORD D1A$ EEFJy1 PROVIDED TO T-1>= WELL OY NIM,
c '
Arcp
SLGNpTURE OF CERTIFIED WELL CONTRACTOR
/lrrr'JC�
DATE
PRINTED NAME OF -Pc RSON CONSTRUCTING THE WELL
Form GW-tt;
Rev. 2100

Ro gers, Michael
From:
Sent:
To:
Subject:
Rogers, Michael
Monday, July 14, 2014 1 :59 PM
'[e-mail]'
WI0100230 Chemtronics
We rec'd the injection event record packet for the above permit. Thanks. However, there were two injections-lw/ 6
DPT and another w/8 DPT. Can you provide the lat and long for these two events to enter into our database. It is a large
area. Thanks.
Michael Rogers, P.G. (NC & FL)
Hydrogeologist
NCDENR-DWR
Water Quality Regional Operations Section
1636 Mail Service Center
Raleigh, NC 27699
Direct No. 919-807-6406
http:ljportal.ncdenr.org/web/wg/aps/gwpro/reporting-forms
NOTE : Per Executive Order No. 150, all e-mails sent to and from this account are subject to the North Carolina Public
Records Law and may be disclosed to third parties.
1
Ro gers, Michael
From:
Sent:
To:
Securence Mailer
Monday, July 14, 2014 3:41 PM
Rogers, Michael
Subject: Delivery Notification: Delivery has been delayed
Your message
To:
Subject:
"thagemey e r@g eos ynteac.com" <tha geme yer@g eos ynteac.com>
WI0100230 Chemtronics
Sent:
Securence ID:
Mon, 14 Jul 2014 17:59:19 +0000
1405360787038-013-00697515
did not reach the following recipient(s):
tha geme yer@g eos ynteac.com
Delivery failure reason: no destination servers currently available or none defined.
Delivery attempt history for your mail:
2014-07-14 13:01:01 (CDT}
2014-07-14 13:03:01 (CDT)
2014-07-14 13:07:01 (CDT)
2014-07-14 13:14:01 (CDT}
2014-07-14 13:28:01 (CDT)
2014-07-14 13:53:01 (CDT)
2014-07-14 14:41:01 (CDT)
The mail system will continue to try to deliver your message for an additional 7 days.
1
■ r
WELL CONSTRUCTION RECORD
This form can bo cacti for single :r multiple wells
1. Well Contractor Infbrnlation: cif —
Well Contractor Name
NC Well Contractor Certification Number
AEDa 7CGI1
Company Name
2. Well Construction Permit 6: 4I2A L.S ID'k694$f its�3
Liar all applicable well permits (7-e. County, State, Variance, Dejection, etc)
3. Weil Use (check well use):
Water Supply Well:
['Agricultural
❑ Geothermal (Heating/Cooling Supply)
❑ IndustrialYCtxnmercial
DIrrijation
Non -Water Supply Weil:
❑Monitoring
T°Municipal/Public
°Residential Water Supply (sing!e)
DRcsidcntia] Water Supply (shared)
°Recovery
Injection Well:
▪ Aquifer Recharge
▪ Aquifer Storage nod Recovery
°Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (HeatinglCoolingRetum)
RGroundwater Remcdiatioi
❑Salinity Barrier
ElStormwater Drainage
❑ Subsidence Control
❑ Tracer
O 0ther (explain under #21 Remarks)
4. Date Weil(a) Completed: O 1.3~ /50 Well LO#
5a. Well Location: _.
Arrlj� i',y.tfcj �E
Facility/Owiwr Name Facility ItNi (£applicable)
ii ivec FireG d �]LL�•lnd�t�� 1�[
Fhvxical Address, City, and Zip
County Parcel identification No, (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if west field, not let/long is sufficient)
N W
6. Is (are) the well(s): ['Permanent or of emporary
Ms this a repair to an existing well: ❑ Yes or 111tSro
If this is a repair, fill art knot ?' nrII roostrvtavn Information and explain the nature of the
repair under 1F21 remarks suction or on the hock of this/brim
S. Number of weirs constructed:
Par multiple Infection or non -water supply wells Lea I'teoh the same construction, you can
submit one farm.
9. Total well depth below land surface: .3
For multiple walls let all depths If different (example- 3@ .21h7 • and 1Q1401
10. Static water level below top of casing: 11J R (0.)
gwater fear[ is above casing use "1- "
11. Borehole diameter:
12. Well construction method:
auger, rotary. cable, direct push, etc.)
APT
(ft.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) _ Met hod of test:
13b. Disinfection type: Amount:
For internal Use ONLY:
13. WATER ZDNEs _ ti.
FROM
TO
DESCRIPTION
R
ft.
,
IS. OUTER CASING (for multi -caved wells) OR I,1NER,(If ap
Jowl: --
FROM
} TO
RNAANL"TLIt Tin I-KN[S$
.MATFiRLt1-
ft.
ft.
in.
l ,16.7VER.CASIAIG
ORT'i1BING(Ceotherine1
closed -WO
FROM
TO
DIAMETER
TI[ICKNEES -
MATERIAL
1r ft.
ft.
in.
ft.
ft.
In.
I7- SCREE
FROM '
TO
DIAMETER
SLOT SIZE TRTCKNESS
MATERIAL
ft.
ft
iit
ft.
ft.
In.
18..GROIt 1
FROM
To
MATERIAL
EMPLACEMENT METHOD & AMOUNT
ft.
ft.
Re
ft,
ft.
R
19. SAND/GRAYEL PACK or ipp limbic).
FROM
TO
MATERIAL EMPLACEMENT METIIOD
ft.
ft
ft.
ft.
20; DRI L LI
V G LOG (attach addlllaaal sheets Jr eecnsrat- )
FTlo%t
TO
DESCRIPTION leohe. 14tnr.ne, sviVme► h pg., ',tin lift, etc)
rt.
ft.
It.
ft.
ft_
ft.
ft.
ft.
ft.
ft.
ft.
R.
ft.
ft.
' 21. REMARKS
22. Certification:
signature noCenified Well Connecte
By signing this form. 1 hereby real that the weif(s) to (were) constructed in accordance
nfth 15A NCAC 02C.0100 or 151NCAC 02C.0200 Well Canstructian Standards and that a
copy of rkts record has been provided to the %eft owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTTONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following,
Division of Water Resources, Information Processing Unit,
1617 Mall Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells ONLY: In addition to sending the form to the addresa in
24a above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mali Service Center, Raleigh, NC 27699-1636
24e. For Water Supply & Injection Wells:
Also submit one copy of this form within 30 days of completion of
well construction to the county health department of the county where
constructed,
Form OW-1
North Carolina Department of Environment and Natural Resources - Division of Water Resources Revised Augu3t 20 t3

INJECTION EVENT RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Resources
Permit Number
Permit Information
6PA - Rya
Pertnittee
{rum J Ili w J1
acility ,Name r /
9.1ty ¢yet: 1 - leie
iii Address
Z. Injection Contractor information
Injection Contractor / Company Name
Street Address 2fle3 �ec..4
a7 �`► 3
City State Zip Code
[I�f) 671rF -- 0/ d
Area code - Phone numBer
n, Nco O S73I%
Well Information
Number of wells used for injection
Weil names Nr
Were any new wells installed during this injection
event?
N'Yes ❑ Na
If yes, please provide the following information:
Number of Monitoring Wells /1 A
Number of Injection Wells
Type of Well Installed (Check applica type):
❑ Bored ❑ Drilled Direct -Push
❑ Hand -Augured ❑ Other (specify)
Please include a copy of the GW-I firm for each
well installed.
Were any wells abandoned during this injection
ev t?
[Yes ❑ No
If yes, please provide the following information:
Number of Monitoring Wells IY ►ti'
Number of Injection Wells
Please include a copy of the GW-30 for each well
abandoned.
4. Injectant Information
. IYG, Grad. abichrb ,�. Add 7,yt,
Injectant Type _ f�,�.j•,,.
Concentration/J //) #/I42 I4& bia, 2I frii NZ
yo( th 7o e.[W,..,s Sl
If the injectant is diluted peas indicate the source
dilution fluid. psr.5,"frf. If / Amt..*
Total Volume injected 6ira
�,GLi�
2 ro
Volume Injected per welt
5, Injection History
Injection date(s)
�— /3 _/ct
Injection number (e.g. 3 of 5) P ills+
Is this the last injection s site?
❑ Yes No
I DO HEREBY CERTIFY THAT ALL THE
INFORMATION ON THIS FORM IS CORRECT TO
THE BEST OF MY KNOWLEDGE AND THAT THE
INJECTION WAS PERFORMED WITHIN THE
STANDA S1 3 OUT IN:THE PERMIT.
SIGNA OF INJECTION CONTRACTOR
DA
Ai 4 "4 1-- A Cif—P4-4 P•4
PRINT NAME OF PERSON PERFORMING THE INJECTION
Submit the original of this form to the Division of Water Resources within 30 days of injection.
Attn: ULC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-807-6464
Form UIC-IER
Rev. 8/5/2013

WELL ABANDONMENt -- ECORD
This form can bo used for single or multipk wells
For Intern! Usc ONLY:
1. Well Contractor Infornnition:
/Act t L .4 G 6-- A•t
Well ContrsctorRune (or well owner personally abandoning well on hisTer property)
/rcdc._ «rat— r3
NC Well Contactor Certi&cationNumber
Company Name
2. Well Construction Permit Oh E,'4 Ge6Ic't4,S / 1CPopialSgL
Liar all applicable we# permits (la Caarty, Stare, Variance, Injection, etc.) ifk+own
3. Well use (cheek well use):
Water Supply Well:
▪ Agricultural
❑Geothermal (Beating/Cooling Supply)
industrial/Commercial
❑ Irrigation
▪ Municipal/Public
❑ Residential Water Supply (single)
❑ Residential Water Supply (shared)
Non -Water Supply Well:
❑Irlrnitoring ❑Recovery
Injection Well:
❑Aquifer Recharge
RAquifer Storage and Recovery
❑ Aquifer Test
❑Experimentai Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
l rowtdwater Remedintion
O Saiinity Barrier
LlStonnwater Drainage
❑Subsidence Control
❑Tracer
❑Othcr(explain under 7g)
4. Date wells) abandoned:
5a. Well location:
74 $, Certification:
I-
`/7
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned:
For mnnrfipk injection or iron -wafer supply wells ONLY with the same
consrmctiapla6andnmament ymt cult submit one farts.
7b. Approximate volume of water remaining in wetl(s): fq*
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply
eatonitc Chips or Pellets
❑ Dry Clay
❑ Drill Cuttings
D Gravel
0 Other (explain under 7g)
❑ Neat Cement Groot
❑ Sand Cement Grout
0 Concrete Grout
❑ Specialty Grout
❑ Bentonite Shiny
7f. For each material selected above, provide amount of materials used:
2• fI 13irt44bk.eiks
7g. Provide a brief description of the abandonment procedure:
Ats faa?••e. 4i4— A-+.e
17‘4.- +.‘
Facility/Owner Name Facility ID# (if applicable)
,ro af42 & i Aft
Physical Address, City. and Zip I ::we11Twa11orignature ertified
Comity
By signing this form. I hereby certify that the well(s) was (were) abandoned in
Parcel identification No. (PTN) accordance with ISA NCAC 02C.0100 or 2C .0200 Weil Construction Standards
and that a copy of this record has been provided to the well owner.
Latitude and longitude In degrees/minutes/seconds er decimal degrees:
(if well field, one lot/lung is sufficient)
CONSTRUCTION t ETA*FS Or WELLfg'.PLElFG ABANDONED
Attach well comae:W.0m retard(} if available_ For multiple injection ar non -wirer supply
walla way with the some constructionlabaadosment, yam can sobtott oar farnm.
6a. Weil !DO:
/lirl-
6b. Tots! well depth: 3 O (ft)
6c. Borehole diameter:
6d. Water level below ground surface:
6e. Outer casing length (if ]mown):
6.f Inner casing/tubing length (if known):
6g. Screen length (if known):
Form GW-30
he it (ft.)
N
(ft-)
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,
SU NITrr A:. !NSTRUCTIOFtS •
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, informatioo Processing tinit,
1617 Mail Service Center, Raleigh, NC 27699-I617
1llb. For Infection Wells: in addition to sending the form to the address in 1Oa
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
10c. For Water Sunnis & Infection Wells: In addition to sending the font 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.
North Carolina Department of Environment end Natural Resources - Division of Water Resources Revised August 2011.

Ashville, NC
Work Plan and HASP
Figure 3. Injection Layout
B105-139 PTA
•-•
iteitiar
47-
B 5 L.
V
1
- 1 B*14
E11,7 #
X-
• itr.stzt, s
welt-a7/0-, '1!
13W-130
2-01843
1-43
I 4
--74.Y1ABJ
r
B147 PTA
Zoe,* Mg.-A:e.g. Wet
Zone Mredertvg Wet
Zone 4.13 Mon.110611
Zone C rWiI
Zor. D Igtoretagng wea
Zone CD TO entering Wel
Zone E Igcmax,‘
Zero F Illariberng W.
Lore V.F iikrivec 011,4
Etleactitrp Wil
• Wit AO Pummel*/
0.-gorv. Prato Pi Tare Arra
D. sorsa; &ma
Torso eVeral1c.1 4114
Evelio:um Uri {Ell) Area
t Pgetf
— Seeem
Reads
1 r,kijog or Form/ guiding Aria
Chantramn or7orefg Str,,dar/
re, Ar
1,440 der.JmErn Wire
4
• GI N.,- I j
4
8t?3 PAN I 311.N.V.A13,
4th
7.T9-0
W245-0
41/138.0241:0- G
6 r-
es.o3\
. SAO
cnr-r Fotiaton-so. IsuficOsEs
C.r.ro rm.". ,.....r,cram
1 lt 4
.—.;
B149 PTA
1/
11
eso
.‘ r
150
Phase 1 Freya Vous), Nick Test Arias
OrlalitVraft 3Pro
5.ounranpa. Nat, Csoina
Geo syntecp
.34.4Regb
WIPP% 201/1
1
Page 15 of 23

WELL CONSTRUCTION RECOicO
This form can be used for single or!multiple wells
1. Well Contractor Information:
13 L A- CZ-- A4 sl roe
Well Contractor Name
VICIC c/6 -13
NC Well Contractor Certification thltntrer
/e L:5)° �Gi4
Company Name
2. W'edl Construction Permit #:LA £CLS /q -M'DCO 1S4S Z
Lilt an' applicable xwnpermits (i.e. Coon &Me. ;WI MCC. Injection. etc.)
3. Well Use (check well use):
Water Supply Well:
❑ Agricultural
❑Geothermal (Heating/CooIiog Supply)
❑Industrial/Cornmerc ial
f]irrieation
❑MuoicipslUPublic
❑Residential Water Supply {single]
°Residential Water Supply (shared)
Non -Water Supply Well:
❑ Monitoring ❑Recovery
Injection Well:
▪ Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Ram)
rGmundwater Remediation
❑Salinity Barrier
❑Storsuwater Drainage
❑Subsidence Control
❑Tracer
l3Other (explain under #21 Remarks)
4. Date Weii(s) Completed: I- Well ID# N34-
5 . WeI1 Location: L-
r1W 1441/i3A IC o IS' 1.
1 FaeihtyfOwner Name Fa.Zity ID# (if applicable)
/gra ald'� zip 7 xe,e/ +Ida.fok if AtL
City,Physiad Address,
County Parcel Identification No. (PIN)
5b- Latitude end Longitude in degrees/minutes/seconds or decimal degrees:
Orwell field, one lstllong is sufficient)
N W
6. Is (are) the weli(a): ❑Permanent or of emporary
7. Is this a repair to an existing well: Des or lAio
ythir Le a repair, fill nul knatwr well construction information and explain the natuor of the
repair under #21 remarks section ar on the back of this erm f
8. Number of wells constructed: 6 l
For multiple nyection or non -water supply wells ONLY with the same construction. you can
submit' one farm.
9. Total well depth below land surface:
Jo (ft.)
Far multiple wells list all depths if dderent (example- 3%200' and 2®10fl)
I0. Static water level below top of casing: /VR (11.)
If wetter Ieve1 is above owing use "+ "
II. Borehole diameter: (in.)
12. Well construction method:
1}PT
(Le. augur. rotary, cable. direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of teat:
13b. Disinfection type: Amount:
For Internal UaeJ».LY1
7 WS"01.00 2 3 p
14. WATEttf41VES
_.-------
Fk0%t
TO
DESCRIPTION
rt.
1't.
ff.
rt.
tS. POUTER CASIyf:trooeia
t1taiedwrIls1Crtt LINE R'lif app
!cable)
FROM
TO
DIAMETER
THICRytt?S
MATERIAL
D.
ft.
Ia.
16.INNER
CAS!NG,QR TUBING
foEethe'rimat
closed-loebl
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
rt.
is
rt.
rt.
14
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
TrIICKWESS
MATERIAL
IL
IL
fn.
ff.
ft.
in.
1d: GROUT
FRAM
TO
MATERIAL
EMPLACEMENT METtKID & AMOUNT
ft.
ff.
ft
rt.
ft.
ft.
19a SAND/GRAVEL-PACK
fir ippllribitl
FROM
TO
MATERIAL
EMPLACEMENT METHOD
tL
rt.
ft.
ft.
2a. DRII.LLNG, LOG (attach addllinnil studs If opt mist))
FROM
To
DEsf. R i r r I O Y jco ID r, h e rdntl3..n dlrrkI. I Ypr. 4rIIn been etc.5
ft.
ft_
R.
R.
R.
[L
R.
R.
it.
ft.
ft.
rt.
I1. REMARKS
22. Cerlificatlon:
Signature of Certified Well Cuottacwr
By signing this farm, ! hereby certify that the a&H(r) was (here) constructed In accordance
with I SA NCAC 02C .0100 or 13A YC4 C 02C .0200 Well Construction Siundwrds and Merl a
copy of this record has been provided to the well uwiter.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUB:IITT TAL INSTUCTIONS
24a. For All Wells: Submit this Corm within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Moil Service Center, Raleigh, NC 27699-I617
24b. For Iniection Wells ONLY: In addition to sending the form to the address in
24a above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
I636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supph• & Injection Wells:
Also submit one copy of this form within 30 days of completion of
well construction to the county health department of the county where
constructed.
FormGW1
North Carolina Department of Environment and Natural Resources - Division of Water Resources Revised August 2011

Ashville, NC
Work Plan and HASP
Figure 3. Injection Layout
843..7
1.•
AS14
,loIWIE1.197R81 -I it .
11 Pry
pSN.1�
Lune A Nor ror.v W4l
Lana $ i�1.. '•n JiRY
• Zane A8 Manrtornp WeA
Zane C iAonlloin; Wet
Zoos D Moresarin Well 1177
ane CO 1.1010:061V
5 Z . E Mirk:aim; WRe ++ -
S Zur s F Naridarin'7> r
Lava Er tke.Varn WM
E •Mien Wed
•
Zola A9 P.ewra Wr
O+yeir a :ha3e 1 Pine 1 I Ansa 4?TA1
0•1•05 l Ana fogy
Tarps: avakon Arsa
P.aP.aban Um iE3Y}Araa
Pond
SVeam
Raub
Floss+ F.orrr'w Buidm Ana
O raaari53',wry 301.1•434-y
• h.Mr I.�'rf+Y�G W'J. i1u. ••i4fl*KM. e.
P:+r+u: r•
Q 1,1,61'-
1
Arks
R".: :+
1
eraMOP 191413atie]
r
— dli2
Draw owcq
1.0 r FOP P4r-011.. MRK5k5 MKT
C..e.Far ra n.grs /Awn-C.1.0.. r•rw F+*ais• a.wr
r.
s1w
E::
lrhae 1 Front Vaeelr PIM Test Arils
Swanis& North Casino
Geos}ntecr
arraarl:antu
1Wfytav
Page 15 of 23
•

Facility Address
INJECTION EVENT RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Resources
Permit Number
Permit Information
SPA - C'e.cs fp - AkDO/Ver/.”1.
Permittee
acility Name
/ro or. gL T tkiii ..4 . t k_
Injection Contractor Information
Injection Contractor / Company Name
Street Address c
Ate -
City State
ty,q ) 7— Di
Area code - Phone number
Well Information
Number of wells used for injection
Well names NAL
V a t3
Zip Code
Were any new wells installed during this injection
ev t?
• Yes ❑ No
If yes, please provide the following information:
Number of Monitoring Wells At A
Number of Injection Wells
Type of Well Installed (Check applica a type):
❑ Bored ❑ Drilled Direct -Push
❑ Hand -Augured ❑ Other (specify)
Please include a copy of the GW-I form for each
well installed.
Were any wells abandoned during this injection
even
Yes ❑ No
If yes, please provide the following information:
Number of Monitoring Wells Ay A
Number of Injection Wells
Please include a copy of the GW-30 for each well
abandoned.
4. Injectant Information J, r
Injectant Type �Q
AS7/hj EHV, S7 /ts piGCrb 541G
Concentration NZ et, 2S s cj, ii SA1
�C13 ] i; '-
.ti 06 I9
If the injectant is fluted pin indicate the spurcc
dilution fluid. y,S, gydr4 ,rr
Total Volume Injected 17 7411,,A.
Volume Injected per well g 0 — 4cru , 4.16,1
5. Injection History f
Injection date(s) --y 1 `'3 -
Injection number (e.g. 3 of 5) Riot, -
Is this the last injectioonkthis site?
❑ Yes f No
I DO THEREBY CERTIFY THAT ALL THE
INFORMATION ON THIS FORM IS CORRECT TO
THE BEST OF MY KNOWLEDGE AND THAT THE
INJECTION WAS PERFORMED WITHIN THE
STANDARI-ic?tt OUT IN THE PERMIT.
SIGNATIJ tFDF rNJECTION CONTRACTOR
U� r►-! LA Lit rZ A
PRINT NAME OF PERSON PERFORMING THE INJECTION
Submit the original of this form to the Division of Water Resources within 30 days of injection.
Attn: UIC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 9I9-807-6464
Forth UIC-IER
Rev. 8/5/2013
ccs7

'WELL ABANDONMENT ...ECDRD
For !menial Use ONLY:
This form can be used for single or muitiple wells
1. Well Contractor IInformation: / iiG 4—
Well Comm ctor Name (or well owner personally abandoning weli ❑n his/her property)
NCcc — cF / 67 - r3
NC Weil Conrrartor Certification Nutuner
Company Name
2. Well Construction Permit#:(CUfiCL,Y 'I - Alt AdySYS9SgZ
Liar all applicable well permits (i.e. County. State, Vanmrre, Infection, etc) if irrowtt
3. Well use (check well use):
Water Supply Well:
GAgricuitural
❑Geothenital (Heating/Cooling Supply)
D Industrild/Commercial
Clizrication
Nan -Water Snnply Well:
❑ Monitoring
Injection Well:
❑ Aquifer Recharge
0Aquifer Storage and Recovery
OAquifer Test
❑Experimental Technology
❑ Geothermal (Closed Loop)
❑Geothemtal (Heating/Cooling Return)
❑Municipal/Public
DResidential Water Supply (single)
EResidcntial Water Supply (shared)
L]Recovery
t'lGroundwater Remediation
❑Salinity Harrier
❑Stormwatcr Drainage
❑Subsidence Control
I]Tracer
❑Other(explain under 7g)
4. Date wells) abandoned: ‘- /3 - /ce
Sa. Well location:
hAt/ eh/ ►'iifi}A4 S: II-
actlity-,(gee
I`Facility1T) (ifupp[ksNe)
Offlee //71 - i40,( lid&44C-1i0L+/ Ale —
Physical Address, City, and Zip
County
WELL ABANDONMENT DETAIL
7a. Number of wells being abandoned:
Far mulliple infection or non -water suppty well' ONLY with The sane
ennsrrrrction/abandonment. you run aahm am form.
7b. Approximate volume of water remaining hi well(s): Al' (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c.'Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply]:
❑ Neat Cement Grout
G Sand Cement Grout
0 Concrete Grout
0 Specialty Grout
C� Pcnionite Slurry
'Bentonite Chips nr PeIIets
0 Dry Clay
❑ Drill Cuttings
❑ Gmvcl
0 Other ,explain under 7g)
7f. For each material selected above, provide amount of materials used:
7g. Provide
n
brief description of the abandonment procedure:
el Oil)
/: ti
A de
8. Certification:
3igrmturc 555E Ceni red Contractor or Weil Owner
e
Date
/el
By signing this form, 1 hereby certify that the swells) was (were) abandoned in
Pane[ Idenrificarion No, (PIN) accordance with 15,1 NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of his record has been pmvided to the well owner.
Sh. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one latflong is sufficient)
9. Site diagram or additional well details:
You may use the back of this page to provide additional welt site details nr wet/
N ti' abandonment details. You may also attach additional pages if necessary.
CONSTRUCTFON DETAILS OF WELL'S: BEING ABANDD-hED
Africk rrrl! caesrrurtiou recerd(s) r,'( mailable. For mukipte it0.1e "+r or nao-water .ruppty
welts ONLY with the same can stryrcliomlubaidonmenl. you run subrnif rote form.
6a. Well 1D4: /T 4
6b. Total well depth; 0 (it.)
6c. Borehole diameter: / e (in.)
6d. Water level below ground surface: A (ft.)
6e. Outer casing length (if known): (ft.)
6f. Inner easing/tubing length (if known): m 4 (ft.)
6g. Screen length (if known): /V4 (ft.)
Form G W30
t:UBM1TTAt INSTRUCTIONS
l0a. For All Wells: Submit this form within 30 days of completion of welt
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-16I7
!Oh. For Infection Wells: in addition to sending the form to the address in lea
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
110c. 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.
North Caroline Department of Environment and Natural Resources —Division of Water Resources
Revised Avgust /o i3

ut) to0232
ALTAMONT ENVIRONMENTAL, INC.
E NGiNEERiNG & H Y ❑ROGEOLOGY
231 1-HAYWOOD STREET, ASHEVILLE. NC 28801
TEL,828.281.3350 FAc.828.281.3351
W W W.A LTA MONTCNV I RON MENTA L.COM
MEMORANDUM
To: Jon Bornholm and Beth Hartzell
Date: Au«ust 23, 2013
Subject: Chemtronics — Report for Phase I Front Valle Enhanced in Situ Bioremediation (EISB) Pilot
Test Injection and Baseline Characterization Activities
Jon and Beth —
Enclosed please find electronic copies of the document referenced above. The document was prepared
by Geosyntec Consultants on behalf of the Companies responsible for the Chemtronics Site.
Thank you for your assistance with this project. Please contact me at [phone] if you have any
questions or if you require additional information.
Stuart A. Ryman, P. G.
Project Coordinator
RECETVED/DENrJDWO
' Fnmernil mr,
cc: Thomas Slusser
Company Representatives
Geosyntec
P:1Chemtronics - 2115\Task 201-Coordinate With FS ConsultantlReport For Phase I Front Valley EISB Pilot Test Injection And Baseline
Characterization Activities.Docx

INJECTION EVENT RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Resources
Permit Number WI0100230
1. Permit Information
Chemtronics, Inc.
Permittee
Chemtronics Superfund Site, 8105-139 PTA
Facility Name
180 Old Bee Tree Road, Swannanoa, NC 28778
Facility Address
2. Injection Contractor Information
Geosyntec Consultants of NC, P.C.
Injection Contractor/ Company Name
Street Address 1255 Roberts Boulevard, Suite 200
Kennesaw GA 30144
City State Zip Code
c...m_) 202-9597
Area code -Phone number
3. Well Information
Number of wells used for injection __ 16 __ _
Well names IP147-01, -02, -03, -04, -05, -06, -07,
-08, -09, -10, -11, -12, -13, -14, -15, -16.
Were any new wells installed during this injection
event?
0 Yes I!! No
If yes, please provide the following information:
Number of Monitoring Wells ______ _
Number of Injection Wells _______ _
Type of Well Installed (Check applicable type):
0 Bored O Drilled O Direct-Push
D Hand-Augured O Other (specify) __ _
Please include a copy of the GW-1 form for each
well installed.
Were any wells abandoned during this injection
event?
0 Yes ~ No
If yes, please provide the following information:
Number of Monitoring Wells -------
Number of Injection Wells. _______ _
Please include a copy of the GW-30 for each well
abandoned.
4. Injectant Information
A) Newman Zone®: B) Sodium Lactate: C) Neutral Zone®:
D) Sodium Bicarbonate; E) Sodium Sulfite; F) KB-1®
Injectant Type
A) 20 g/l; B) 4.9 g/L; C) 19 g/L ;
Concentration D) 19 g/L; E) 98 mg/L; F) 0.021 %v/v
If the injectant is diluted please indicate the source
dilution fluid. Potable water (hydrant) and groundwater
extracted from pilot test area.
Total Volume Injected_s_a,_ss_o_g_a1 _____ _
Volume Injected per well 292 to 8,253 gal (average 3,685 gal)
5. Injection History
Injection date(s) 11-Mar to 21-Apr, 2015
Injection number (e.g. 3 of5). __ 3_o_f_3 ___ _
Is this the last injection at this site?
0 Yes 0 No
I DO HEREBY CERTIFY THAT ALL THE
INFORMATION ON THIS FORM IS CORRECT TO
THE BEST OF MY KNOWLEDGE AND THAT THE
INJECTION WAS PERFORMED WITHIN THE
STANDARDS LAID OUT IN THE PERMIT.
B~~G"1,~ /<. /4-w,,s s/1,1 is-
A URE OF INJECTION CONTRACTOR DA TE
{jef\J"''"'"" f(. A..-.io..s-A(c.PE 41-o 'II 21,
PRINT NAME OF PERSON PERFORMING THE INJECTION
Submit the original of this form to the Division of Water Resources within 30 days of injection.
Attn : UIC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No . 919-807-6464
Fonn UIC-IER
Rev. 8/5/2013
1. WELL CONTRACTOR
MSITuire
Well Contractor (Individual) Name
A E DRILLING SERVICES, LLC
Well Contractor Company Name
TVVO UN[TED WAY
Street Address
GREENVILLE SC 29607
City or Town
(864 ) 288-1986
Area code Phone number 2. WELL INFORMATION: IP — 1447
` I
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT (If spp1fcable)
SITE W ELL ID dtii applioeblel
State Zip Code
3. WELL USE (Check One Box) Monitoring 0 Municipal/Public Q
Industria[ICammerciai ❑ Agricultural 0 Recovery 0 Injection g`
lrrlgation❑ Other ❑ (fiat use)
DATE DRILLED 1O U—;Z
4, WELL LOCATION:
Gh�tonic.s ntieux,AUL.1U
(Street Name, Numbers, Community, Subdivision, Lot Na.. Parc_ , ZZA Code)
CITY: v Ii£ a ism. COUNTY _
TOPOGRAPHIC / LAND SETTING: (check appropnete box)
❑Slope °Valley °flat EJRidge °Other _
LATITUDE gg " DMS OR 3x.xxxxxxxxx Do
LONG muDE 75 " DMS OR 7A,Kx?4 XX DD
Latllude/lorrgttude source: [BPS QfopographIc map
(tor tion of well must be shown on a USGS topo map endsttached rQ
Pile form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
�1Prv,�1_t�i
Facility Name/� Faculty ID# (If app[icable)
76 ITC
Ct
Street Address
awo.5
City or Town State Zip Code
(-7110 i{c I,4=-1
Contact Name
J , 1 i ai 1 + L+Ai L5-
Ma] rig Address -
A‹..hot i1 r)r.
City or Town
Area code Phone number
6 WELL DETAtLS:
a. TOTAL DEATH: 3$74 .
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES' Q NO Q
r�
c. WATER LEVEL Below Tap of Casing: -�� Q • ❑3 T.
(Use "+" ti Above Top of Casing)
_ :/ ,L-^ } it . 1 F n 0 n rT •.
RESIDENTL4L
•"17 SJLhi'(� _.vim/ "
NON RWELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3f7 1
d. TOP OF CASING is 3' FT. Above Land Surface"
'Top of casing terminated attar below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm) _IV/A aMtTHOD OF TEST �'
f. DISINFECTION: Type Avila• Amount IWA
g. WATER ZONES (depth):
Top NYC Bottom- ikUA Top AiJI!t Bottom A ,
Top Bottom Top Bottom
Top Bottom Top Both0m
Thickness!
7. CASING: Depth Diameter Weight Material
Top_ 5 _Bottom W Ft.
Top Bottom t FL
Tap Bottom Ft_
B- GROUT; Depth f c Material Method
Top D' Bottom FL Gvenr.fiT Y •+-i i t.
Top Bottom - Ft.
Top Bottom Ft.
9. SCREEN Depth Diameter Slot Size Material
Top 17' Bottom, 37' FL Z'' in, 1t' in. ii.146 1,.) rap POL
Top Bottom Ft. In. in.
Top Bottom Ft. irt. In.--
10. SAND/GRAVEL PACK:
Depth Size Material
Top Jr •Bottom 3%. Ft. 3k} . n
Top Bottom Ft.
Top Bottom Ft.
11, DRILLING LOG
Top Bottom
1
1
1
1
1
1
1
1
1
1
12. REMARKS:
Formation Description
[ DO HEREav CERTIr? THAT THIS Wt;L1_ WAS CONSTRUCTED IN ACCORDANCE Went
7EA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
( ,aQ MiG,Lnr,
SIGNNATUURRE OF CERTIFIED WELL CONTRACTOR RATE
PRINloc
TED NAM�P ON CONSTRUCTING THE WELL
Siibjllit vaitltin s0.[tays of to mi;IFtton. to:
t17. Mail 'Ser tce,Center,:Rainigh, NC 276991:54, orter', 8
Form GWTb
Rev. 2109

N ON _RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Diviaian of WAter Quality
WELL CONTRACTOR CERTIFICATION # J57)
1. WELL CONTRACTOR:
1 r L��L TI+Lf r•-s-
Well Contractor (individual) Name
A E DRILLING SERVICES, LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE
SC 29607
City or Town State Zip Code
(864 i 288-1986
Area code Phone number
2. WELL INFORMATION: Z, 141-4
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(ir applicable)
SITE WELL ID ?Aft applicable)
3. WELL USE (Check One Box) Monitoring 0 Muniwpal/Pubilc
InduatrtaltCommerrial C Agricultural C] Recovery ❑ injection I—
irrigationD Other I0 (list use)
DATE DRILLED 1 S f -'"
4. WELL L O[CATIION:
1 11E11'l7f'tYks��
(Street Name, Numbers, Community, Sabath/Lao; Lat No.. Parcel, 41 Code)
CITY: COUNTY
TOPOGRAPHIC 1 LAND SETTING: (cheek appropriate box)
❑Slope 0Valley ❑FIst 0 Ridge Q Otter
LATITUDE 35 " DMS OR 3x.xx x xxxxx DD
LONGITUDE T5 DMS OR 7x,xecKg, OD
Labluctediongltude source: COPS C ropvgraptlic map
(location of well must be shown on a USGS repo map arldattachad to
this farm if not using GPS)
& FACILITY (Name of the bustness where the well is located.)
C.b e rr ion; L5
Faclityy Name ( Facility tDO (Et applicable)
iOa Oki ec -Try'? 1
Street Address IVS-1 1.2M6
Slate Zip Code
City arTown
ki }-Enu'irtyy4
I
Contact. Name
Malang Address
P 4veul l(vt t- Grigg?)
City or town State Zip Code
( $�� I ,2Vt-,'3.D
Area coda Phone number
8. WELL DETAILS:
a. TOTAL DEPTH: ui e f
b. DOES WELL REPLACE EXISTING WELL? YES Et NO t
c. WATER LEVEL Below Top of Casing' /3,C7 FT
pee "+° if Above Top of Casing)
d. TOP OF CASING IS 3 IT. Above Land Surface'
'Top of casing terminated attar below land sur►ace may require
a variance in accordance with 15A NCAC 2C .0116
0. YIELD (gpm): 1tIM• METHOD OF TEST A)./i}-
f. DISINFECTION: Type r/i'r Alma nt JV/04^
g. WATER ZONES (depth).
Top- QJ* Bottom- A,Phr Top . A)kt Bottom
Top Bottom Tap Bottom
Top B ttom Tap Bottom
Thic(mass/
T. CASING: Depth Diameter Weight Material
Tvp A Bottom 1r Ft. Z" 5(.. '( POL.-
Top Bottom Ft
Top Bottom Ft.
8. GROUT; Depth Material �Method
Top6_ Bottom 13 _Ft [,�r,ra 7-0 rrli e'
Top Bottom _ Ft
Tap 8attorn Ft.
S. SCREEN: Depth Diameter
Tap f �i1 Bottom . Ft. Zr
Top Bottom Ft. in.
Top _ Bottom Ft. in
81o!•S1ze
• J in.
Material
V-4) ts- PIS
10. SAND/GRAVEL PACK
Depth Size Material
Top_Battvm_ Ft. SA
Top - Bottom Ft.
Top Bottom _ Ft.
11. DRILLING LOG
Top Bottom
1
f
/
f
f
12. REMARKS:
Formation DeScrtption
I; -Pe
I DO HEREBY CERTIFY THAT THIS WELL WAS CON3Tfi1JCTED !N ACCORDANCE WrrH
15A NCAC 2C, WELL CONSTRUCTnON STANDARDS, AND THAT A COPY OF THIS
RECORD HAS 9 y PF1aWDEme WELL OWNER
ELL CONTRACfc DATE
fiUCTING THE WELL
Form GW-lb
Rev. PIO9

1. WELL CON CTOR:
m tlitrre
Well Contractor (Individual) Name
A E DRILLING SERVICES, LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 2 607
City or Town Slate zip Code
(864 ) 288-1986
Area code Phore number
2. WELL INFORttIWITON: Z p-- r W 7^ 3
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(N applicabta)
SITE WELL ID Cif eppllcabla)
3. WELL USE (Check One Box) Monitoring ❑ MunicIpal/PubLc ❑
Industrial/Commercial ❑ Agricutturaf C Recovery C Injection 1 •
-
Irrigationq Other ❑ (list use)
DATE DRILLED /1- Z4-l1.
4. WE
L
L LOCATION:
hersi�1?I7 r ;
iBYreet Marne, Numbers, CummurlRy, Suncivirinkl• Lot No., Parcel Zip Code)
CITY: f)( COUNTY_
TOPOGRAPHIC / LAND SETTING: (.heck appropriate boxF
❑Slope JValley ❑Fiat ❑Ridge 0Other
LATITUDE 36 " OMS OR 3X.)0000X XX DO
LONGITUDE 75 "DMS QR 7x-XXxxXXXXX DO
Latitutle/longitude source: PCPS ElTopogrephic map
(location of well must be shown on a USGS topo map encfattach ct to
this form if not using GPS)
6. FACILITY (Name of the business where the well is located,)
CRerlbtnnie
Facility Name Facility ID# (if 3ppllosble)
Igo C/
Snot Address
I Slidt Ile •( L
n City or Town it StateZip Code
Al m60 6wi effoei)-Li
Contact Name
:3I I.ityyl�[CY .J
Ma{i(ng AddresrJ
sVle u; Ir r� Spa f
City or Town
( Fag ) J - 33d
Area code Phone number
6. WELL DETAILS: y� r
a. TOTAL DEPTH: 1]rJ •r] '
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES El ND [{�
c. WATER LEVEL Below Top of Casing: ! I 5.2. FT.
(Use "+" If Above Top of Casing)
NON ON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3671
d. TOP OF CASING IS FT. Above Land SurfaCo*
`Top of casing terminated atfur below land surface may require
a variance in accordance with 1 SA NCAC 2C .011 a.
e. YIELD (gpm}: 4JJp}- METHOD OF TEST e /1
f. DISINFECTION: Type rVl4' Amount )../n
g. WATER ZONES (depth):
Top_Itrri� Bottom f�" Top it Bottom AV*
Top Bottom Top Bottom
Top Bottom Top Bottom
7. CASING: Depth Diameter
met2er
Top G' Bottom h'$ , Ft
Top Bottom
Top Bottom
8. GROUT: Depth
Top t�' Bottom 91
Top
Ft.
Ft
Thickness/
Weight Malarial
Soh• Yo Arm
MaterialMethod
FL !®Iy ' 7-;; +fit+ e_
Bottom Ft.
Top Bottom Ft.
S. SCREEN: Depth Diameter Slot Size Material
Top Age Bottom FL'W2 in. ,,/11 In. t'J.'
s
Top 13.6`Bottom 3$.SFt. in, In.
Top Bottom Ft, in. In.
10. SANDIGRAVEL PACK
Depth Size
Too Botts FT
Top SIPSotiom1 Ft
Top / ✓ r Bottom .394.57 Et.
11. DRILLING LOG
Top Batton,
1
1Z REMARKS:
Material
£q
Formation Description
I CO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
F5A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COP' OF THIS
R£co 1r HASENPROVIDED TOWZHEE WELL OWtJER.
SIGAURE11iOF TIFI 17III LLCONTRAMOR DATE
`i.;,sue--
PRINT D NAME OF PERSON CONSTRUCTING THE WELL
Form OW-1b
Rev. 2/09

1. WELL CONTRACTOR:
Mkt' 1115G,,;cQ_
Well Contractor (Individual) Name
A E DRILLING SERVICES, LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE Se 29607
City or Town Slate Zip Code
(864 r 288-1986
Area code Phone number
2. WELL INFOR1bATlON: 7° r - I T/
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#{IrappIlcabte)
SITE WELL ID #(lr eppIk able)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public 0
tndustrietfCammerclaf D Agricultural ❑ Recovery erinjecbon ❑
Irrigation❑ Other ❑ (Ilst use)
DATEDRiLLED lg-7Z
a. WELL LOCATION:
fv�eNij1iniC,�
(SStreetmunne, Numbers, Communllyf.9ubdivision. Lot No.. Panel,Zip Cods)
CITY: 5
16;11k _ _ IN £ COUNTY
TOPOGRAPHIC 1 LAND SETTING: (check appropriate box)
❑Slope DVatlay (71FIat ❑Ridge DOlher
LATITUDE 36 " OMS OR 3X.k)0030btXX or)
LONGITUDE 76 ' .. " DMVIS OR 7K,xxxxxxx❑D
Lett udeiiongllude source: ❑GPS I:Topographic map
(location of well must be shown or: a tUSGS topo map andaHachec to
this farm if not using Gr S)
6. FACILITY (Name of the business where the well is located.)
Facility Name
Street Address
,.ez Tree- Pci
//
City or Town State Zip Code
/4 I` 4616) 4 >;L' J rroirui,-1I
Facility ID. (if applicable)
Contact Name
,Locrl
Mailfgg Address �+
Eaeutlle P L Rgt'li
City or Town r State Zip Code
car ?2 I -' 35a
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:
.3 -
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO l/
c. WATER LEVEL Below Top of Casing: 'r5 FT.
(Use "t" if Above Top of Casing)
NON. RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Emrironment and Natural. Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION it 3,5-71
d. TOP OF CASING 15 5 FT. Above Land Surface'
'Top of casing terminated et/orbeiow land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (wpm); NIA METHOD OF TEST ILVA
f. DISINFECTION: Type WA Amount IJAR
g. WATER ZONES (depth):
Top 01* Bottom ,% J4' Top J. /tt Bottom AIM
Top Bottom Top Bottom
Top Bottom_ Top Bottom
Thickness/
7. CASING: Depth Diameter Weight
Top 0 Bottom & Ft a" SL V
Top Bottom Ft -
Top Bottom Ft.
8. GROUT: Depth
Top__ _OL BottomJr___ Ft.
Material
C.•c
Top _ Bottom Ft.
Top Bottom Ft.
Material
PILL
Method
9. SCREEN: Depth Diameter Slat Sae Material
Top II aottem_13 ` FL 2" In. • 1p_ in. 1_4 re. Wrap? 191— •
Top Bottom FtIn. in.
Top Bottom FL In. in. --
10-SAHDIGRAVEL PACK:
Depth Size &kW rir11
Top, 5" otLom 32' Ft 4fl 4A01
Top Bottom Ft
Top Bottom Ft.
11. DRILLING LOG
Top Bottom Formation Description
Strld1tA-f
r'
1
12. REMARKS:
i DO I REPYCERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCQRDANGE WTti
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AN] THAT A COPY OF THIS
1tmom HAS SEEN PRovroEOTOTHE1M1 LON4t:R. qc.„1
_MAD cfq: SIGNATURE OF CERTIFIEED WELL CONTRACTOR DATE
Abe I
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-ib
Rev. 2/08

NONREsmENT! WELL CONSTRUCTION RECORD
North Cardin Department of Environment and Natural Resources_ Division of Water Quality
WELL CONTRACTOR CERTIFICATION # I7j
1.WELLCO
r fat
Well Contractor (Individual) Name
A E DRILLING SERVICES. LLC
Well Contractor Company None
TWO UNITED WAY
Stet Andress
GREENVILLE SC 29607
City or Town State DP Cade
(864 ) 288-1986
Area code Pion number
2. WELL INFORMATION: xP .. ty7-
WELL coramcT1DN PERMIT#
OTHER ASSOCIATED PERMI T#Oropro o*e}
SITE WELL ID #i(ir eppllcable)
3. WELL USE (Check One Box) Monlioring © Municipal/Public ❑
lndustriallCommery al ❑ Agnoultural ❑ Recoveq ❑ Injection
Irrigation° Other El {list use)
DATE DRILLED I. I— —IZ.
I. WELL LOCATION;
()tc'ff tf,;)
port teem.
Numbers. Continuity, euiovial in, Lot No., Pavel, Tip Code)
CITY: A5IV.Vi (It r flC C0UNTY_
TOPOGRAPHIC 1 LAND SETTING: (check appmprtede boat)
°Siope ❑Valley (}Flat °Ridge ❑Dlher
LATTIl1DE 36 ' DABS OR 3x.7t7000000 fx DD
LONGITUDE 75 • ' . _ " CMS DR 7x.xxxxx Uotx DD
Lalifudei1ongitude source: ©GPS 0ropographic map
(location of web must be Mom an a IISGS lop° map endRLteehed to
this farm if not using GPS)
8. FACILITY (Name of the business where the volt la located.)
• ChernifiliniciS
Podgy Name Fec1Hty 08 of appfirable)
WC) o?d Eta
Strre_et Andrei ss
C1tyor T } State Zip Code
/� f ulvtnn- E relnru.kn-t-4!
Coolant Name
,22 I Islast [4xa ri
Mailing Address l
A4PliAt C
aREZ
City or Town State Zip Cade
Area code Phone number
A. WELL DETAILS:
e. TOTAL DEPTH:
Vs"
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
c. WATER LEVEL Below Top of Casing:
(Lisa ° if Above Top of Casing)
FT.
d. TOP OF CASING IS .?r FT. Above Land Surface'
'Top of casing terminated aflor below land surface may require
a variance in sceardanOe with 15A NCAC 2C .0118.
e. YIELD tom): A.Y11- METHOD OF TEST /VA-
t. DISINFECTION: Type NO Amount AJ/14
• tWZtli►A ZONES (deplhj:
Top BottomTop Bottom AN.
Top — Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. WISING: Depth Dtemetsr Weight Materiel
Top Ce _ P.ottnm r Ft. 2 r 56)00 . Ply.,
Top Bottoa•t FL
Top - Bottom Ft_
8. GROUT: Depth Material
aottnm Ak.. FL el301 fib
Top Bodoni FL
Top Bottom Ft.
Method
77-i,r e
#. SCREEN: Depth Diameters Slot Size Material
Top iir. S Bottom S].I$t Ft. ri deign. •IO in_ C)-i+.:e'e PGr•.
Top Bottom Ft in, IL
Top Bottom FL ie. In.
10. SAND/GRAVEL PACK:
Depth Sias Male 1
fopfl ( Bottom AteFL _ •
Top Bottom FL
Top Bottom_ Ft
11. DRILLING LOG
Top Bottom Fosmallon Description
p.r r
I
/
1
f
12. REMARKS:
I n0 HAY CERTIFY THAT THIS WAs CONSTRUCTED 1NACCORDANCE WITH
16ANCAC2C, WELL CONSTRUCTION STANDARDS, ANDTt+RrACCF' OF THIS
Ri:CCRD�OI AMIN W MIER.
SIGNATURE OF CERTIFIED WELL C LTflR DATE
PRINTED NAME O PERSON CONSTRUCTING 171E WELL
Form OW -lb
Rev. 2109

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Envirozmaent and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 15-71
1. WELL CONTRACTOft
1� 1 nice
Well Contractor (individual) Name
A E DRILLING SERVICES. l.LC
Welt Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607.
City or Town State Zip Code
( 864 ) 298-1986
Area coda Phone number
2. WELL INFORMATION: XF i47 4
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMITit{r appitoiNe)
SITE WELL ID apprEceble)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public Q
Industrial/Commercial 0 Agricultural Q Recovery ❑ Injection I3^
Irrigation❑ Other 0 (bat use)
DATE DRILLED 04,
4. WELL LOCATION:
(street Name, Numbers, Cpmrrtuntly. SubOA:Ion, Lot Na., Parcel, Zip Code)
CITY: 1v U. lit f)( COUNTY
TOPOGRAPHIC / LAND SETTING: (check appropriate sox)
°Staye °Valley OFiaf ❑Ridge ❑Other
LATITUDE 36 " IDMS OR 3X.X)O0 XXX?t DD
LONGITUDE 75 "DMS OR 7x,xxxxxxxxx DD
Latitude/longitude source; COPs DFopographic map
(location of well must be shown on USGStcpo map andaftacbedto
this form if not using GPS)
5. FACILITY (Name of the business where the Well Is located.)
Cher rr�ni16
Facility Name Facility !DO (if applicable)
P7O Ck1k -1--Pee.
St stMdrese
City or Town State Zip Cade
Contact Name
2,
Mating Address
City or Town State Zip Code
Area cede Phone number
6. WELL DETAILS:
a. TOTAL. DEPTH: vs'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO If"
c. WATER LEVEL Below Top of Casing: /3 -11 _FT.
(Use "+° ii Above Tap of Casing)
: d. Tap OF CASING IS
FT. Above Land Surface'
"Top of casing terminated at/orbelow land surface may require
a variance in accordance wilt 15A NCAC 2C .0118.
e. YIELD (gpm): OA AAE' HOD OF TEST
T. DISINFECTION: Type Amount
g. WA:ITR ZONES (depth)1
Top NM Bottom ' Top ILJ Bottom Jt4'
Top Bottom Top
Top Bottom
Top
7. CASING: Depth _ Diameter
To G' Bottom /ors Ft Z"
Top Bottom
Tap Bottom
a. GROUT: Depth
Top d` Bottom Ir S"
Top Bottom
Top Bottom
9. SCREEN: Depth
Top 17•,�' Bottom 72?
Top Bottom
Top Bottom
Ft.
Ft.
Bottom
Bottom
Thickness!
Wei ht Material
Material
Ft. G.M &kr
Ft.
Ft.
Method
Diameter Slot Size Material
F€l Z in. a / I.} fn. 0444 Az'
FL in. tn.
in.
10. SAND/GRAVEL PACK:
Depth Size Top l�'Sr Bottom SaS R. Mari
Top Bottom _ Ft.
Top Bottom Ft
11. DRILLING LOG
Top Bottom Forma'.lon Description
/
1
1
1
1
i
1
iZ REMARKS:
f tic_
I E) HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCaRuANCE WITH
16A NCAC 2C, WELL CCNSTHucnoN STPNOARR S. AM) THAT A Copy OF Twos
esconTOTHEWE{LOWNER.
h
SIC NAT�UpREE OF CERTIFIED YE LL GCNTRAG`TOR DATE
"rL J ►l L+I°ar'trr
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
SuWilit•w+thin,30 days`o'.corripletiai+ ter ti
16i7. Mail Service: Center., Raleigh;::NC.27699:' 0. Phone :,( i9j 8f)T. 63
Form GW-1 b
Rev. 2/09

1- WELL COTRA2TOIn
NON SIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resource~- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 37/
d. TOP OF CASING IS 3 FT. Above Land Surface'
Well Contractor (Indivtduat) Name
A E DRILLING SERVICES. LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE
SC 29607
City or Town State Zip Code
0864 ) 288-1986
Area code Phone number
2. WELL INFORMATION: zp-. r47- 7
WELL CONSTRUCTION PERMIT*
OTHER ASSOCIATED PERMIT#[? apprroame)
SITE WELL 10 #(if applicable)
WELL USE (Check One Box) Monitoring 0 Municipal/Public 0
Industrial/Commercial ❑ Agricuitulal Li Recovery 0 injection
irrigation❑ Other 0 [list use)
DATE DRILLED /I—
4. WELL LOCATION:
ek0A)4; dn.:5
(Street Name. Numbers. Community, Sabdivi iQn, Lot No, Portal, Tip Code)
CITY iirid4ti, COUNTY
TOPOGRAPHIC ! LAND SETTING: (check appropriate box)
❑Slope ❑Valley p Flat q Ridge ❑Outer
LATITUDE 35 '
DMS OR 3x.xxxxxxxxx DD
LON01TJDE 75 ' ' DMS OR Tx.xxxxxxxXX DD
Latfud&longRude source. [UPS [(Topographic map
(location of well must be shown an a USGS lopo map andatrached to
this form If not using GPS)
5L I=ACILIiY (Name of the business where the well is located)
LIJeiviroA,GS
Feoility Nam?
/Y6 id. &( r.e
.S" --A Address
c:ftyorTowr► f +, 1) . C 1
Facility IDA {if applicable)
I)!46 11611-4 EnO(dilr}t31�' I
Contact Name
23I �Sri .Sf
1+Aalii Address -
State Zip Code
City or Town
( ) 2gf
Area code Phone number
E. WELL DETAILS'
a. TOTAL DEPTH: IY,5
b. DOES WELL REPLACE EXISTING WELL? YES[] NO
c. WATER LEVEL Below Top of Casing- f; ,') (e F r
(Use '+" if Above Top of Casing)
State Zip Code
"Top or casing terminated at/or below land surface may require
a variance in ac000rdance with 15A NCAC 2C .0116.
a. YIELD Wpm): //IT METHOD OF TEST Al/
f. DISINFECTION: Type i0i4- Amount AJJ4
g. WATER ONES (depth):
Top Bottom /O% " Tap A)/f'Botfom_ - i+t
Top Bottom To Bottom
Top Bottom Top Bottom
Thickness!
7. CASING: Depth Diameter Weight Material
Top I Bottom /2-54 Ft- .2"
Top Bottom FL
Top Bottom FL
_sai•YQ PI3
S. GROUT: Depth Material Method
Topes Bottom /10 ' _ Ft.__C/nr.ati f ti A11
Top Bottom Ft
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Sine Material
Top ler r Bottom .,i f Ft,. A" in. . !t> in. (.2-W: eg- At.
Top Bottom Ft. In. in.
Top Bottom Ft. in In
1e. SAND/GRAVEL PACK:
Depth �+ Sine Nlaberisi
Top IZS Bottom .«a Ft.%
Top Bottom Ft.
Top Bottom FL
11. IDRILLING LOG
Top Bottom
/
/
1
1
1
12. REMARKS:
Formation Description
k �r
U
CO HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THrs
RECORD Jt,4 BEEN PRCM DED i0 THE • Lt. OWNER.
SIGNA RE 'F CEi T i D V, LLLCZ�NTRA T DATE
kr�I I NAME OF PERSON CCNSTFCTING THE WELL
Form GW-lb
Rev_ 2/09

NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 73' /
1.1nrELR,�AN ACTo ft—
be4
Waifi[Coontractor (Individual) Name
A E DRILLING SERVICES. LLC
Well Contractor Company Name
TWO UNITED WAY
street Address
GREENVI SC 29607
City or Town State PIp Code
t 864 ) 288-1986
Area code Phone number- '
2. WELL rNFORMATtotk ID - J 47-
WELL CCNSTRUCTON PERMIT#
OTHER ASSOCIATED PERMIT/Ail appilcBID Eo)_
SITE WELL ID CR eppllcebEe)
3. WELL USE (Check One Box) Monitoring p Munlcipal/Publtc 0
lnduehl&iCommercial [] Agricultural ❑ Recovery 0 Injection lie
Irrlgatlon0 Other 0 (flat use)
DATE DRILLED 11. .10J
4. WELL LOCATION:
Attck6r1lQ
(Street Nam{�e,, Numbers. Comrnuniy, Sub liviNi m, Lot No., Parcel. Zip Code)
C1TV. >�-t5iou.Ile 11( COUNTY
TOPOGRAPHIC 1 LAND SETTING: (check appropriate box)
OS !ape ❑Valley ❑Fiat iJRidge 0Other
LATITUDE 36 " DMS OR 3x.X3CODC7CYJe DD
LONGITUDE 75 • " DMS OR 7x.xxx000:XX DO
Latitudellongltude source: ❑3PS Qf0pographic map
[locarfen of well must be shown on a USGS ropa map andattaehed to
this form If not using GPS)
5. FACIU Y (Name of the business where the wee is located.)
c.+ gA4rDfka
F Name
Id 6pr
Street Address
kv (k ►V.L.. Z SS(3S
City or Town State Zip Code
A J�cr:cis 4- G AebitA►r, ,4‹
Facility ID# (if applicable)
Contact Name { yw 3 2 ►Vn.1e°d5+
Mailing Address
1-kku 1-1 C ? S
City or Town
gni s-41- 3356
State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: _ .SiI•+�
h . DOES WELL REPLACE EXISTING WELL? YES ❑ NO ff..'
e. WATER LEVEL Selaw Top of Casing , S') FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 71
FT. Above Land Surface -
*Top of casing terminated at/or below Land airfare may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): ANA— METHOD OF TEST,
f. DISINFECTION: Type /Vlt Amount
g. WATER 3ENES (depth).
Top Alier6upom % Top 1litoi1t Bottom AV,
Tap Bottom Top _ Bottom
Top Bottom Top Bottom
Th3eivresal
7. CASING: Depth Diameter t�Weight 'Material
Top 01 Bottom Ft.�, 7[.+419t P0G
Top Bottom Ft.
Tap Bottom Ft
8. GROUT: Depth
Tap e, pottornir Ft.
Top Bottom Ft.
Top Bottom FL
Material
Method
Ttnn3 t .
9_ SCREEN: Depth Diameter Slot Size Material
Top Ate Settom 3Y.5" Ft_ 2" in. , !C in. c) 2 re ptx;
Top Bottum Ft_in. in.
Top Bottom FL In. in.
10. SAND/GRAVEL PACK:
Depth Size Materta
Top MirBottom
Top BottomFt.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom Formation Description
1/
1
1
1
1
1
1
1
1
1
1Z REMARKS:
I DO HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTEDJN ACCORDANCE WITH
1BA NCAC 2C, WELL CONSTRUCTION STAhCA& WS,ARO THAT A COPY CIF THIS r
RECORD 'ids BEEN PROVIDED TC.THE WELL OWNER.
SIFYE LYCQNTRACtoR DATE
`
ei
PRINTED NAME OF PERSON CONSTR G THEW WELL
Form GW-lb
Rev. 2/09

,.f 5o ure
Wall Contractor (individual) Name
A E DRILLING SERVICES. 1 LC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE
City or Town Slate Zip Cade
p Cade
(864 ) 288-1986
Area code Phone number
2. WELL INFORMATION: Ma 15/7—?
WELL CONSTRUCTION PERMIT-4
OTHER ASSOCIATED PERMIT(/ applieatrte)
SITE WELL ID Nil appitcable)
3, WELL USE (Check One Box) Monitoring ❑ Municipal/Public Q
Industrial/Commercial p Agricultural 0 Recovery 0 Injection["
Irrigation° Other ❑ (1Ist use)
DATE DRILLED /J..
A. WELL LOCATION:
(StPPet Name, Nurebme, Community, Subdiviaan, Lot No., Aortal, Zip Code)
CITY: 5 [if)41 AC et r/C COUNTY
TOPOGRAPHIC / LAND SETTING: {check appropriate box]
ri Slope [?Valley ❑Fiat ❑ Ridge ❑Other
LATITUDE 36 DMS OR 3x.x00000000c DO
LONGITUDE 75 " DAMS OR 7X.xXXxloo0ot DU
Letitud&&longitude source: [BPS Cfropographla map
(bestiary of well must be shown an a US 3S tope map anristrachet la
this Ivan if not using GPS)
0. FACILITY (Name of the business where the well is located.)
C ebo6
Fedlily NemOIed _ Facility ID! (if applfoable)
1 d
Street Address
City or Town
A +4nAin f►�i�nrfer��al
Contact Nana
. 3 +
Maiil g Address
]�1j �. 11C s '1
City or Town
fig) aSi — 335�
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTFf:__„W
b. DOES WELL REPLACE EXISTING WELL? YES CI NO
cWATER LEVEL Below Top of Casing: , Ro. 46 FT.
(Use °+" if Above Top of Casing)
Z 5
State Zip Code
State Zip Code
NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Neruml Resources- Division of Water Quality
WELL CONTRACTOR CRTIP'ICATION # 33-I1
d. TOP OF CASING IS J ' _ _ FT. Above Land Surface'
'Top of casing terminated at/or below lend surface may require
a variance in accordance with 15A NCAC 2C .0115.
9. YIELD (gpm)• WA- METHOD OF TEST
f. DISINFECTION: Typo Wit Amount
g. WATER ZONES (depth):
Top NI(, Bottom _ t/i1 _ Top WI* 9ottom
Top Bottom Top Radom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Wight Material
Top 0' Bottomr 2D' Ft. OIL pot,
Tour Bottom Ft. _
Top Bottom Ft,
0. GROUT: Depth Material Method
Top Q' Bottom 4' . Ft. C +- ;m: e el
Top Bottom Ft.
Top Bottom_ Ft. -
9. SCREEN: Depth Diameter Blot Sate Material �y
Top 2.OI Bottom li0` Ft. 2" in. .1D in. 0 ±t£... i `�-,
Top Bottom Ft_ in. in.
Top Bottom Ft. 1n. In.
10. SAND/GRAVEL PACK:
Depth Size
Top Ig` 8ottomt' Ft. 01
Top Bottom FL
Top_ Bottom Ft.
Ma
terial
11. DRILLING LOG
Top Bottom Formation Description
1
1
1
1
1
1
1
I
12. REMARKS:
DO HEREBY CERTIFY MATINS WELL WAS CONSTRUCTED IH ACCORDANCE Wlli-I
INN N CAC 2C, WE'LL COFt4TRUCTION STANDARDS, AND THAT A COPY OF THS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF CERTIFIED WET:.
—2S=4
CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE W ELL
iWs#a ;a VICatgc tr lltk ,u4
r''F?tiar`ia'a (0/)43pfi63
_z:`•i jam t�
Form GW-1 b
Rev. 2/09

1. WELL CONTRACTOR:
Abel
Well Ccfrraratdor (Individual) Nerve
A E DRILLING *ERVICES. LLC
Well Contractor Company Name
TWO UNITED WAY
Sheet Address
GREENVILLE SC 296o7
City or Town Slate zip Code
(864 j 288-1986
Area bode Phone number
2. WELL INFORMATION: If. 147-i0
WELL CONSTRUCTION PERMITS
OTHER ASSOCFATEl] PERMITIVI appl :a ge)
SITE WELL 1014 opptimule}
3 WELL USE (Check One Box) Monitoring D MunIdpal1Puhtic
Industrial/Cammerota1 L7 Agricultural l7 Rec o ry ID Injection ilr-
rrrigatlonQ Other U (souse)
DATE DRILLED i ••• 2. �"•
4. WELL. LOCATION:
L•s , f27+tCj
(StreetNarn*. NtlLrnbersyy, Caat®irlp. 8upolvFrlon,1.at Re, Pastel, tip Come)
CITY: t f 'i C COUNTY
TOPOGRAPHIC/ LAND SETTING: (deck appropriate box)
❑tope CA/alley DFiat ❑Ridge ❑Other
LATITUDE 36 " DMS OR 3x.)x oa000cx oo
LONGfTUDE 75 " OMS OR 7x30000c000( Da
LatidudellortgIbsde souse: 03PS Dropographlo map
(tocethm of well must be shown an a USGS typo map ands cached fv
this loon if not uairg GPS)
S. FACILITY (Name or the business whale the wen le located.)
ehdigitro.Nia
Fad)* Name
fir;) ; ;1cj i E r: y .1
Street Address
ee cunar 4 1-Ivirpnni.en-4 .i
Contact Name
Mall gAddess -
Fealty :De or applicable)
Xm Code
City arTctnf
State Zip Code
Area code Phone number
5. WELL DETAILS:
a TOTAL DEPTI4: *
b. DOES WELL. REPLACE EXISTING WELL7 YES ❑ NO GIB
s. WATER LEVEL Below Top of Casing: //ti FT.
(Use '+' ftAbove Top of Cooing)
1 ■ ONRESLOENTJAL REld, CONSTRUCTION RECORD
Nardi Carolina Deportment afEuvironment andNatmal Resources- Division of Wed = Quaky
WELL CONTRACTOR CERTIFICATION # 3 1
d. TOP OF CASING IS iv FT. Above Land Surface"
`Top of casing terminated allot below land surface may require
a variance in accordance with 15A !CAC 20 ATM
a_ YIELD (gprf): Ai/14 IIETROD OF TEST A VIT
I: DISINFECTION: Type AA Amount. .nVA
g. WATER ZONES {depth):
Top QM- scam ,NI&
Top Bottom,
Top Bottom
Top iW eotlorfl At4f —
Top Bum
Top Bottom
ThlafuteacI
7. CASING: Depth Diafrreior Weight Material
Top Cc Bottom ZO FL Z"
Top Rotten
Top Bottom
. GROUT': l7epth
Top O` $o;tem�
Top Bottom
Top Bottom
Ft.
FL
Af1102 P
Material Method
FL cjafikCrti1t- Tn r m; t,
Ft _
FL
S. SCREEN: Depth Diameter ShitSiize Material
Top 2t; _ Bottom 40 _Ft 241 in. • !b in. L}- Ilir>` %It%
Top
Top
Bottom
Bottom •
FL
Ft.
in_ ifL
in. in.
10. SAND/GRAVEL PACK:
Depth Sfax material
Top/Bottom w! r FL. / _ `rG/te)
Top Bottom Ft
Top Bottom
11. DRILLING LOG
Top Bottom
1
r
1
I
1
12. MAR CS:
Ft_
Formation Descripffon
nEr
bo H artEEY CERTIFY THAT MS WELL WAS CONSTRUCTED IN ReD0RDANCE WITH
1RA NCAr4o. WELL CON.s-TilucriON noirrARt>s. AIM THAT ACOPY OF Th85
RECO/OHM B N 'iCOTE WELL OWNER_
S1S3NA RE OFR/3 l L Ifs cONTRAcVQR DATE
•
• PR3 i OF PERSON CONSTRUCTING ThE WELL
FormfW1b
Ray. Z109

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Faviomonsut and Natural Resources- Division of water Quality
WELL CONTRACTOR CERTIFICATION # ,s+r
twEL/
Wel Contractor (lniliividuat) Name
A E DRILLING SERVICES. LLC
Well Contractor Company Neme
TWO UNITED WAY
Street Address
GREENVILLE SC 296Q7
Cyr or Town State Zip Code
(864 )288-1986
Area code Phone number WELL INFORMATION: ,-s/4/ry
;1/
WELL CON8TRUCTJON PERM T�
OTHER ASSOCIATED PERIIAIT4(it appGcshle)
SITE WELL ID #{e applicable)_
3, WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
htdustrisl/Commenpat ❑ Agr1 ittumt I7 Recovery ❑ Injection I '
irrigator❑ Other CI (list uaa)
DATE DRILLED 0-274 a-
d. WELL LOCATION:
r
(Street naive, Numbers. Corrizavaty, Subdivider, Lei Na.. Panel, ZIp Code)
DEFY: hed it k nC COUNTY
TOPOGRAPHIC/ LAND SETTING: Schedt appropriate box)
❑Slope °Valley ❑Fiat E1Ridge OOther
LATITUDE 36 " DMS OR 33LeDtX xxroot DO
LONGITUDE 75 ' . - - " DMS OR 7x,Xx 00000t DD
Latitude/longitude source: ❑CPS ❑Topographic map
(location &Pwen must be shown on a 115GS topo map endaftached to
this form +Tnot using GAS)
6. FACILITY (Name of the business where the welt Is located.)
FacesIry Name Faculty ID* (if applicable)
710 olj / ` v-Q
Street Address
vAe._
City or Tavel •
� mnnf �`71U�f�ni t4 -
State Pip Code
Canted Name
Mann tame
AC..
adoJ
City or Town State Zip Code
[ 2$1 - i 3SD
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:
b DOES WELL REPLACE EXISTING WNELL7 YES ❑ NO f
c. WATER LEVEL Below Tap of Casing: ie?. FT.
(Use °+" if Above Top of Casing)
d. TOP OF CASINO IS i a FT. Above Land Surface*
"Tap of casing terminated attar betow land surface may require
a variance In accordance wt h 15ANCAC2O.011&.
e. YIELD Wpm): Alin" METHOD OF TEST___, sd
f. DISINFECTION: Type [Iith Amount Aii
g. WATER ZONES (depth):
Top AO- Bottom /1)./A''" Top it2J4-8ottom
Top Bottom Top Bottom -
Top Bottom Tap Bottom
7. CASING: Depth Diameter
Tap 401 Bottom_ If Ft "
Top Bottom_ Ft
Top Bottum Ft
Thickness)
Weight MaterieI
&1►.g, tPIL
8. GROUT: Depth Material Method
Top, C' , Bottom I,S4 FL CeirteriFT i Aries
Tap Bottom Ft
Top Bottom FL
IL SCREEN: Depth �Diameter $tot 9Irm Material �}
Top Jr _ Bottom ,]5r � . Ft. A" I in i) to. V'�[t P Llc.
Top Bottom Ft. In. h.
Tap Bottom Ft. in. in.
10. SANDIGRAVEL PACK:
Depth Size
Top • I21' Bottam�
Top Bottom Ft
Top �Bottom Ft
11. DRIWNG LOG
Top Bottom
1
1
1
1
. 1
1
1
1
1Z. REMARKS:
1Aatlseirf
Formation Desctip5on
,;,. •oIr [e
I RD HEREBY CERTIFY THAT THIS WELL WAS 0ONELTFI TED ACCCRINUVE NTH
1SA NICAC 2C, WELL CONSTRUCTION STANDAR»S, AND THAT A COF' OF TM
RECORD H 6 OEF37 PROVIDED TO T WELL OWNER.
i •IL-4 2--
DATE
Form GW-1
Rev_ a/09

NONRESIDENTIAL WELL corrsTRUCITON RECORD
North Carolina Department of Environment andNatvrai Resources- Division of Webs y
WELL CONTRACTOR CERTIFICATION # mil
7.WElal�4;�
Weft entracter(Individual) Name
A E DRILLING SERVICES. LLC
Well Contractor Company Name
TWO UNITED WAY
Simel Address
GREENVILLE SC 29607
City or Town Shale Zip Code
864 y 288-1 986
Area code Phone number
2. WELL INFORMATION: X, -N47- L Z.
WELL CONSTRUCTION PERMIT#
OTHER ASSOCJATED P E RINIT#(tr applicable)
SITE WELL ID Wilt appllmhle)
3. WELL USE (Chock One Boxy Monitoring 0 Munlcipai/Public ❑
Indushial/Commercial ❑ Agricultural ❑ Recovery 0 Injection rea
lrrigattonp Other R [fiat use)
DATE DRILLED /I- ZI 12
4. WELL [[LOCATION:
dLer! kr'rF
(Street Na'm1a. Numbers, Comunmtiy, &rhaivirlvnt, Lot No., Parcel, 71p Cade]
CITY: ii,S411 I I< n c COUNTY
TOPOGRAPHIC! LAND SETTING: NG: (check appreprtate boxy
QSlope t7Vailey ❑Flat QRidge LJOther
LATITUDE 36 " tDIiAS OR 3Xa00000000[ DD
LONGITUDE 75 - - " DMs OR 7x.X xxx xOfx 00
Latitude/longitude source: ❑CPS I]Fopographic map
(location of we moat be shown an a USGS typo map aridattachad in
this farm itnotusing GPS)
6. FACILITY (Name of the business where the well is tocated.)
Fad#liyr Herne Old
I Facility rat [I! applicable)
17DCI OK! T7<e d
Street MMus
se
City or Town
Q
Zip Code
Contact Name
03 ! I ,[21 <<
imau Addreas
t. flC
Ctly or Town
(RBa4I-335?l_o
Area soda Phone number
8_ WELL DETAILS:
a. TOTAL DEPTH: , t
b. DOES WELL REPLACE EXISTING WELL? YES Q NO 1E'
c. WATER LEVEL Below Top of Casing: _ t3fl ' FT.
(Use °+° If Above Top of Casing)
State ZIp Code
ai..�� Cff:
d. TOP OF CASING IS FT, Above Lend Surface"
`Top of easing terminated odor betaw land surface may require
a variance in acan ance with 15A NCAC 2C .tPT 18.
e_ VELD (gpmj: itti4 ■■'�METHOD OF TEST
f. DISINFECTION: type ls+1A Amount
g., WATER ZONES (depth):
Top VA' Bottom Volt- Top -AM/ Bum
Top Bottom
Top Bottom
Top Bottom
Top Bottom
Thickness!
7. CASING: Depth Olameter Weight fpp erica
Tope BettornjiL
Top Bottom Ft.
Top Bottom FL
B. GROUT: Depth Matortal
Top d' ,Bottom 11 Ff. P
Top Bovom Ft.
Top Bottom FL
Method
T1.,iI IL
9. RCREEN: Depth Diameter Stot Stye Material
Top IS ` Bottom_ FL 21 In. des In.
Tap Bottom FL in. In.
Top Bottom FL In. In.
10. SAND/GRAVEL PACK:
Top /S SCOW AC_ Ft, .W/
Topm Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom Formation Description
12. REMARKS:
IOC RHEREMY CERTIFY THAT THIS WEEL WAS CONSTRUCTED fN ACCOFiOAi'lCE WITH
1t3A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT ACOPY OF THIS
RECORD HPS37LE D Iii''CHE WELL OWNER-
SIGT� E OF CERTIFIED WELL COIYTf7AC' 'OR— DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-7 h
Rev. 2/09

NONRESIDENTIAL WELL, CONSTRUCTION RECORD
North Carolina Department of Environment and Natural. Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3 S71
1. WELL CONTRACTOR:
Abet ( &4O[&
Well Contractor (Individual) Name
A E DRILLING SERVICES, LLD
Wee Contractor Company Nama
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
City or Town State Zip Code
(864 } 288-1986
Area code Phone number
2. WELL INFORMATION: I'_
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATE') FERMTf#(d epplicaWe)
SITE WELL ID #(ir adpl�cable)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
InduatriatlCommerclal ❑ Agricultural ❑ Recovery 0 InjecOon B�
Irrigation0 Other 0 (list use)
DATE DRILLED I D•43.12.
4. WELL LOCATION:
Fyjr'`�'TAf)i �
(Street Name, Numbers. Community, Subdlvlslvn, Lat Nd., Parcel, Zip Code)
CrrY: Saotteateinca, Mt. COUNTY
TOPOGRAPHIC / LAND SETTING: (check u pry w1ate box
❑Slope C]Valley ❑Flat ❑Ridge 0Other _
LATITUDE 56 . " DMS OR 3X.MGC00000C DD
LONGITUDE 75 ° " ❑MS OR 7,Ioa0000(Xx DD
Latitude/longitude source: [PPS ['Topographic map
(location of well must be shower On a USGS top° map errdatfeched to
this form rf not using GPS)
5. FACILITY (Name of the business where the wall fs located.)
C�+e.�n�rv.i ,ems
Facility Name
1 � old 6a ee Trr +
S. et ASINV4 lir 10.
City or Town 7— Slate Zip Celia
ai4l McA-T t n0f4nlrixA
Contact Name
Mallf ngAddrees
br 1�i II a
Facllfty IDir (if applicable)
Y1�
City or Town
Area code Phone number
B. WELL DETAILS:
a. TOTAL DEPTH 4Ze
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
r. WATER LEVEL Below Top of Casing: tra 4 FT.
(Use °+" if Above Top of Casing)
d- TOP OF CASING I5 3` FT. Above Land Surface`
"Top of casing terminated at/or below [and surface may require
a variance In accordance w+th 15A NCAC 2C .0118.
e . YIELD (gpm): —fs« METHOD OF TEST
f. DISINFECTION: Type /Wa Amount �IF3
g . WATER ONES (depth):
Top Ail Bottom A1/* Top iii'P}' Bottom !Jill).
Top Bottom Top Bottom
Top Bottom Tap Bottom
ThiCknesal
7. CASING: Depth Dlarneter Weight Mats rfal
Top o Bottom 2g.' Ft., r r` 5l. Vd PVC
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top e_ Bottom.$^ FL dt T lent eel
Top Bottom FL
Top Bottom Ft
9. SCREEN: Depth Member Slot: She
Top_____ZIL Bottom tot Ft. r in. .10 tie.
Top Bottom Ft. yr. In.
Top Balorri Ft Ill. In.
Material
..
(D
10. SAND/GRAVEL PACK:
Depth Size
Top. ip it` 8nitomm2_ Ft.,
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
n
Matey!
Formation Description
/ * rJ; 4
r
i
1
1
I
1
1
1
12. REMARKS:
1 OD HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE %HIM
15A NCAC 2C, W£-LCONSTRUCTI°N STANDARDS. AND TI-ATA COPY ❑F THIS
RECORD HAS PEEN PRovineD TO THE WELL QVVNER.
51G�TUREE OF CER IFI WELL CONTRACOI OI DATE
Ae1 MG •
PRINTS NAME OF PERSON CONSTRUCTING THE WELL
Form GW-lb
Rev. 2/09

1. WELL
.4 4 Oft:
G;rL
Well Contractor (Individual) Name
A E DRILLING SER11JCES.. LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GftEENVILLE SC 29607
City or Town State Zip Cade
(864 288-1986
Area code Phone number
2. WELL INFORMATION: Z J f7+r q
WELL CONSTRUCTION PERMITS
OTHER ASSOCIATED PERMITS[ applicable)
SITE WELL ID *W appHaebte)
3. WELL USE (Check One Bc t) 1 fa nitaring CI Municipal Public LI
Indust' al/Cornmerrad ❑ Agricultural ❑ Recovery D Injection 1 -�
InlgattDn0 Other 0 (fist use)
DATE DRILLED _ %I Z/—/ a-
4. WEU. LOCATION:
�lrr ci ,i LS
(Street Neme, Numbers, cam munthy, Suhdhdeinn, Lot No., Parcel, 74 Code)
CITY: =5G fiAIrian O ()( COUNTY
TOPOGRAPHIC 1 LAND SETTING: taws BPPropia1 �+4
❑Scope ❑Vasey 0Ftat L1Ridge 0Other
LATITUDE 36 ' " FJMS Ott ICY..1 x oo000L DD
LONGITUDE - - "DMS OR 7X,VOOCCQCCX DO
Latitude/longitude source: D3PS ❑ropographio map
«ocstian of well must be ahotw on e USGS boo map andetlscheer to
We form 17not using GPS)
O. FACILITY (Name of the business where the well is located.)
Fai Ii Rome
14 Gld roc err' LA
StreetVress
City or Town SSA Zip Cnsie
AI4ME uirnrwej
Contact Nam
I a�. al 54-
mow Address
Facility ff}>i= (if applicable)
City OrTownn State Zip Code
( gag) c)Ri 3,5a
Area code Phone number
6. WEU. DETAILS:
a. TOTAL DEPTH: fit
b. DOES WELL REPLACE EXISTING WELL? YES p NO 0
c. WATER LEVEL Below Top of Casing: , 1g `3L FT -
(Use'+' if Above Top of Casing)
NON.IILENIDEN'L4L Wti CONSTRUCTION RECORD
North Carolina Department of Euvironmi mt and Natural RasoTuces- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 37/
d. TOP OF CASING IS ?' FT- Abcre Land Surface'
'Top of casing temainated odor below land strface may require
a variance in ecaonlance with tbA NCAC 2C .0116.
e. YIELD [gpin}: 1�1 OF TEST ,d// _
f. DISINFECTION: Type d/lAmount' 1✓I
g. WATER ZONES (depthy:
Top A f4 Bottom ' Top A/lA-Bottom N/4-'
Top Bottom Top Bottom
Top Bottom Top Bottom
7. CASINO: Depth Clamatar
Top Q' BottomAL Ft Zit
Top Bottom Ft.
Top Botom Ft.
7hicItmaesf
Weigh# Mated&
P
8. GROUT: Depth Ilfat rial d
Top. • Bottom 17� FL 7ri
Top Bottom Ft.
Top Bottom FL
S. SCREEN: Depth Diameter slot Size Materiel
Top._11 Bottom L{ r Ft,_,,eµ ire. ate_ In. ) LJ I LeA411---;
Top Bottom FL in. in.
Top Bottom Ft. in, In.
10. SANDIGRAVEL PACK:
Bottom
, material
DeirtTop l / 42 Ft Rs'Y i(► .�
Top Bottom FL
Top Bottom Ft
11. DRILUNG LOG
Tap Bottom Fnlmallon Description
r
t
I
r
i
1
12. REMARKS;
r DO HEFSSY CERTIFY THAT THIS WELL WAS CONSTRUCTED iN ACCORDANCE WYTH
ISA NGAC 2C, WELL CONSTRUCTION STANDARDS, AND Th+AT A COPY OF THiS
RECORD HAS PRomoEDTO THE WE[! OWNER.
SS1131tfATURE- F CERTIFIED vv CONTRACTOR
DATE
Abeil i d' C
PRINTED NAM OF PERSON CONSTRUCTING THE WELL
Form GW-lb
Rev. ?leg

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # I
1. WELL CONTRACTOR:
to 1 /+is �i r: re.
Well Contractor (Individual) Name
A E DRILLING SERVICES,LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE
SC 29607
City or Town State Zip Code
(864 } 288-1986
Area code Phone number
Z WELL INFORMATION:/In 117 Ar
WELL CONSTRUCTION PERMTTA
OTHER ASSOCIATED PERMIT#(tr epplicebie)
SITE WELL U) #{erNap/icemen
3. WELL USE (Check One Scot) Monitoring 0 Municipal/Public ❑
IndustrfaI/Cammercial 0 Agricultural ❑ Recovery ❑ injection EE—
Irrigation❑ other 0 (list use)
DATE DRILLED jN ZD 1
4. WELL LOCATION:
(street Name, Numbers, Community, Suhdivieion, Lm No., Peroef, zip Code)
CITY: 5ik1Li f1(TdI1 oA fl C COUNTY
TOPOGRAPHIC / LAND SETTING: (oherx appropriate box)
❑Slope ❑Valley CI Flat IDRtdge pother
LATITUDE 30 ° " DINS OR 3x.xxXXXXXXX DD
LONGITUDE 75 DMS OR Tx.)paaaaaooc 0D
Latftudellongltude source: EPP5 GTopegraphlc map
(location of well roust be shown on a USGS topo map andettached to
this tam if notusing GPS)
5. FACILITY (Name of the business where the well is located.)
afoot/rail 3
Facility Name, 10 td Lee
Street Aelel
A:Sitisi f{E
Liey IA r unit
A I rtmoo+
Contact Name``
023 Het,LoB
Ise-J
Slate Zip Code
Euiru me.,-c,
Mailing Address
A-.tY C g of
Facility ID# (if applicable)
City orTown r State 21p Code
fg 1 $! 3354
Area code Phone number
6. WELL DETAILS: /� r
a. TOTAL DEPTH: 7rl'4
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO Fr
c. WATER LEVEL Below Top of Casing. / YI FT_
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS ,I' FT. ADovs Land Surface"
Top of casing terminated actor below land surface may squire
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 001,t1 METHOD OF TEST
f. DISINFECTION: Type, ii", Amount
g. WATER ZONES (depth):
Top Alin Bottom pt 4 Top, ellit Bottom AVA
Tap Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top ar Bottom Sr R. 2' Soli.» ft; L
Top Bottom FL
Top Bottom Ft.
S. GROUT: Depth
Top 4 r Bottom
Top Bottom
Top Bottom
Material Method
FL�. '710W e'�f
Ft.
F.
9. SCREEN: Depth�t I Diameter
Top aft _Bottom 7I Ftd m in.
Tep Bottom _ Ft.
Top Bottom Ft.
in.
in.
Slot Size [Meta I
.)D in. ►'rl���....
In.
in.
10. SAND/GRAVEL PACK:
Depth Size Materfa
Top it Bottom Yar Ft..01
Top Bottom Ft.
Top Bottom Ff.
11. CRILLING LOG
lop eolfom
1
I
1
1
1
1
1
1
72. REMARKS:
Formation Description
L•.6' ili'A l r 4r
I co HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE YiaTH
ISA NCAC2C, WEU c0 TRUCTIGN STANDARDS, AND THAT A CDT,Y OFTt-i'J
RECORD. I4AS BEEN PROVIDED i� LL OWNER
SIGNATURE OF CERTfF
D CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form G W-1 b
Rev. 209

1. WELL /CONTRACTOR:
Well Contractor (Individual)Name
A,E DRILLING SERVICES, LLC
Well Contractor Company Name
TWO UNITED WAY
NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Envinninteat and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3S 71
d. TOP OF CASING IE 3' FT. Above Land Surface`
'Top of using terminated atlor below :and surface may require
a veer ce in accordance with 15A NCAC 20.0118.
e. YIELD (gpm): N ik METHOD OF TEST NJk
f DISINFECTION: Type t I k Amount Alift
g. WATER ZONES (depth).
Top WA Bottom 04 Top N//. Bottomfa_
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Materiel
Top d Battorn2 ' Ft, c r. SA 116 f V 6
Street Address
GREENVILLE SC 29607
City or TWO State Zlp Code
(864 } 288-1986
Area code Phone number
2, WELL INFORMATION: P -141 l'.Q
WELL CONSTRUCTION PERMIT'*
OTHER ASSOCIATED PERMIT#(k appticeble)
SITE WELL ID #(d applicable)
S. WELL USE (Check One Box) Monitoring ❑ Munlcipal/Public D
Industria}1Commerciai ❑ Agricultural O Recovery p Infection B'
Irrigation❑ Other ❑ (list use)
DATE DRILLED IAa2R4-12-.
4. WELL LOCATION:
(Steel Name. Numbers. Communey, Sub/Mon, Loi Na., Parcel, Zip Code)
CITY: khe4 I t' 10•G COUNTY
TOPOGRAPHIC ( LAND SETTING: (aecrc appropriate Lox]
❑Slope: ClValley Er Flat ❑Ridge ❑Cther
LATITUDE 3S ° ' " DMS OR 3X.XxODO(MC ( DD
LONGITUDE 75 "❑f 1S OR 7x,X00QC0(RXX DD
Latitude/longitude source: BPS DiTopographIc map
(iacafion of well must be shown an a USGS top° map andatfached to
Ibis Form If not using GPS)
8. FACIUTY (Name of the businesa where the well is located.)
GIs Tre* iL�
Facility Name
zO GId Lee
Street Address
ArSheU;11� I.(. 1?05
Facility ID# (it applicable)
City or Town j ! State Zip Code
II I"lVtjrrzf EiN1Vili�ilC�Al� iG�1
Contact Name
h' jtA:Dar�1 647.
Mafitng Address y q p
City or Town State Zip Code
(gN3358
Area code Phone number
8. WELL DETAILS:
a. TOTAL DEPTH:
iLt
b. DOES WELL REPLACE EXISTING WELL? YES n No we
c. WATER LEVEL Below Top of Casing: )°1.3' FT.
(Use "+" it Above Top of Caeing)
Top Bottom Ft
Top Bottom Ft.
8. GROUT: Depth Material
Top Oil Bottom- i71 FL Cd,rr►iilt
Top Bottom Ft.
Top Bottom Ft.
Method
9_ SCREEN: Depth Diarnater Slot Stye Material Top AtBottom qt Ft. V in. „ID In. L IL A 14tap Y R.
Top Bottom Ft in. in. _
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Meta rla
Top j i. m 9�S Botto ' 1=t- _ A41o1
Tan _ Bottom Ft.
Top Bottom Ft,
11. DRILLING LOG
Top Bottom Formation Descripilon
1 .0[)rr.!1 �r
1
1
1
I
1
1
12. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CUNSM TEf IN ACCORDANCE WrIH
15A NCAC2C, WELL CD I TR.UCTICer STANDARDS, AND THAT A COPY OF THIS
RECOeo HAS BEEN PROVrDED TO THE WELL OWNER.
SIGNATURE OF CERTIF WELL CONTRA* DATE
Agee e_
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Farm GW-lb
Rev. 2109

1 ■ ONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3S7J
1. WELL CO TRACTO
1 &44 fQ
Well Contractor (individual) Name
A E DRILLING SERVICES, LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
City or Town State Zip Code
864 ) 288-1986
Area code Phone number
2. WELL INFORMATION: i7-
WELL CONSTRUCTION PERMIT# 1 In i 0-1 73 0
OTHER ASSOCIATED PERMIT#{if applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Monitoring 0 Municipal/Public ❑
lndustrial/Commerciai 0 Agricultural [] Recovery D Injection Er.'"
irrigation❑ Other 0 (list use)
DATE DRILLED /1-Z� I�
4. WELL LOCATION:
i'loh, on-c5
(Street Name, Numbers, Community, Subdiviaion, Lot No., parcel, Zip Code)
CITY: ►r f'>u, f1: 1 1( COUNTY
TOPOGRAPHIC / LAND SETTING: tcheck appropriate box)
LSlope ❑Valley ❑Flat ❑Ridge DOther
LATfTUDE 36 " DMS OR 3x.xx)o(xxxxx DD
LONGITUDE 75 " DMS OR 7X.xxxxXXxXX DD
Latitudeliongitude source: CGPS []Topographic map
(location of well must be shown on a USGS fopo map andattached to
this farm if not using GPS)
5. FACILITY (Name of the business where the well is located.)
ehenii-ro„;„,
Facility Name
l ,'U C-/It.e
Address
uity or own ,
Contact Name
3i SI-
Maft819 Address '
J��'r Uir�a 11 •
City or Town
) 2g i c,
Facility ID# (if applicable)
2'cu
State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: ____ `
b. DOES WELL REPLACE EXISTING WELL?
State Zip Code
YES L;` NO Er'
C. WATER LEVEL Below Top of Casing: _ j3, 4'
(Use "+- if Above Tap of Casing)
FT.
d. TOP OF CASING IS .31 FT. Above Land Surface'
"Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0t 18.
re. YIELD (gpm): NM" METHOD OF TEST ,11)'
f. DISINFECTION: Type /OM- Arnaunt A)_JA-
g. WATER 2014E9 (depth):
Top "44/4- Bottom /0/14-- Top A)/Bottom Al/at.
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness!
7. CASING: Depth Diameter Weight �Maaterial
Top. Q ` Bottom /254_ Ft. 21. .SJ,.VU ll,,
Tap Bottom Ft.
Top Bottom Ft.
8, GROUT: Depth Material
Top__k Bottoms Ft. t Al t
Top Bottom Ft.
Top Bottom Ft.
Method
Tire
9. SCREEN: Depth Diameter Slot Size Material nn
Top %'it$ Bottom , rFt. 2'. in. .IL) in. 2-24: fQ- P''
Top B08arrr Ft. in in.
Top _ Bottom _, Ft in. in.
10. SAND/GRAVEL PACK:
Depth rSize_ Material
Top 12•� Bottom r�SJ+ Ft. %�j
Top_ Bottom FL
Tap Bottom Ft. _
11. DRILLING LOG
Top Bottom Formation Description
•z1=rk 1'
1
1
1
1
1
1
1
1
1
/
12. REMARKS:
Do HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD AA$ BEEN PROVr0ED TO THEY LL OWNER.
t
SIGNA
TED NAME OF PERSON CONST
N7 RACTOR DATE
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
..TING THE WELL
Form GW-1 b
JAI1, Z013
information Processing iJno
DWQ/EIQ G

1. WELL CONTRACTOR:
� �iTu1C�
Well Contractor (individual) Name
A E DRILLING SERVICES. LLC
Well Contractor Company Name
TWQ UNITED WAY
Street Address
GREENVILLE SC 29607
City or Town State Zip Code
1864 ) 288-1986
Area code Phone number
2. WELL INFORMATION: YP-147-62
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT/4R applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Monitoring D Municipal/Public q
IndustrtaNCommerCial ❑ Agricultural {] Recovery 0 Injection fir
irrigationq Other ❑ (list use)
DATE DRILLED 'f"'Zi
4. WELL LOCATION:
.Ivki-iIarsi��
(street Name, Numbers, Cornmunily, Subdivision, Lot No., Parcel, nip COO
CITY: 1 � .I.• . fZ I ?t- GOUNTY
TOPOGRAPHIC 1 LAND SETTING: (check appropriate box)
0Slope LJValley ❑Flat ❑Ridge L}Other
LATITUDE 36 " DMS OR 3X.xxxxxxxxx DD
LONGITUDE 75 " DMS OR 7x.XXxxxxxxx DEI
Latitude/iongitude source: (PS Otopographic map
(Ideation of well most be shown on a USGS topo map anda#ached to
this form if not Using GPS)
5. FACILITY (Name of the business where the well is located.)
Ohendrani f.,s
Facility Nagle Facility ID# (if applicable)
1'.IU GI,I T,,c
Sfr eti'ttaAddress a� •�• s] c
pity or Tovvn State Zip Code
Contact Name
?I I s.� . it)r� 7 S
Mailing Address
City Or Town State Zip Code
(75) 2�l- 56
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:_-_-,
b_ DOES WELL REPLACE EXISTING WELL? YES ti] NO Ifr
c. WATER LEVEL Below Top of Casing. _ ) 3 FT.
(Use "+" if Above lop of Casing)
Subbtnitwithin30days afcompletion to:, Division of Water quality' In#orrratiinPracessing,
1617 Mail Service Center, Raleigh, NC 276.99-161., Phone: [phone] '
.
NON ON ESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # .5 7/
d. TOP OF CASING IS 3' FT. Above Land Surface'
'Top of casing terminated attor below land surface may require
a variance ��J inaccordancewith 15A NCAC 2C -U118.
e. YIELD (gpm): ■ ME HOD OF TEST
I. DISINFECTION: Type Amount
g. ATER
thy
Topw>)/A ZONES
Eo Bottom (epA/f Top x[J//1 Bottom
Top Bottom_ Top
Top Bottom Top
7. CASING: Depth Diameter
Top 0' Bottom /-iS' F• t. Z."
Top Bottom Ft
TopBottom Ft.
Bottom
Bottom
Thickness/
Weight
8- GROUT: Depth Material
Top O Bottom /J 7r • F• t. [ /of )
Top Bottom Ft.
Top Bottom Ft-
9. SCREEN: Depth Diameter
lop'7 Bottom 225' F• t` 'Z in.
TopBottom Ft. in.
Top Bottom Ft. in.
10. SAND/GRAVEL PACK:
Depth Size
Top /rr Bottom Ja A.r Ft. #I
Top
Top
Bottom
Bottom
11. DRILLING LOG
Top Bottom
1
1
1
1
1
1
12. REMARKS:
Ft.
Ft.
Al
Material
p vc_
Method
Slot Size Material
•l t) In. v 1.$):
in.
in.
G
Formation Description
I DO HEREBY CERTIFY THAT THIS WELL WAS CONS"( RUCiED 1N ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORR lS BEN PyOFfI TO THE WELL OWNER
SIGNATURE OF CERTIFIED V LL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-lb
elr�
_FA` 8 1013
s� a
infer rpafiol, u..as; ro+-, Lln:l

1. WELL ON RACTOR:
NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3571
d. TOP OF CASING IS 3' FT. Above Land Surface`
Well Contractor{Individual) Name
A E DRILLING SERVICES, LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
City or Town
(864 ) 288-1986
Area code Phone number- '
2. WELL INFORMATION; rj_ 147-8
WELL CONSTRUCTION PERMIT#
State Zip Code
OTHER ASSOCIATED PERMIT#(ir applicable)
SITE WELL !D #(if applicable}
3. WELL USE (Check One Box) Monitoring l7 Municipal/Public Li
Industrial/Commercial ❑ Agricultural Ca Recovery ❑ Injection
Irrigation❑ Other 0 (list use)
DATE DRILLED Ih17'I z..
4. WELL LOCATION;
; Ik+r,',�rylCS
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: J SIVif e Il[ COUNTY
TOPOGRAPHIC / LAND SETTING: (Check appropriate box)
❑Slope ❑Valley ❑Flat ❑Ridge ❑Other
LATITUDE 36 " DMS OR 3X.xxxxxxxxx DO
LONGITUDE i5 " DMS OR 7X30xx0(XXXX DD
Latitude/longitude source: EGPS Diopographlc map
(location of weft must be shown on a LISGS fopa map andatteched fo
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
C.J1 arkikr 71R ► CS
Fac�Eity� a 0 �[� f rY T^r[
Street Address
Facility ID# (if applicable)
rI 1.41-
City or Town State Zip Code
rL a* c:r a -F Ldurea(tl)r.
Contact Name
3 1 i'1.1 yr.:lr:c.c.( 5+
Mailing Address
(a- d . l rC 2 S't� I
City or Town
( 5 ] 'j- 33 5+O
Area code Phone number
6. WELL DETAILS: -y
a. TOTAL DEPTH: 3505
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES© NO
c. WATER LEVEL Below 7 op of Casing: ILI.'5O FT.
(Use "*" It Above Top of Casing)
r± i1_27)2
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): AO— METHOD OF TEST
f. DtSINFECTION: Type /V//} Amount
T. WATER NESA(depth):
Top Bottom_
m_ J►/119''
Top Bottom
Top Bottom
T. CASING: Depth Diameter
Top d` Bottom � Et-
Top Bottom Ft.
Top Bottom Ft.
Top A/JIt1 Bottom Age
Top Bottom
Top Bottom
Thickness/
Weight Material
$s1�,c10 COL
8. GROUT: Depth Material
es_ TopBottom J Z•S�a
. Ft. 1,-,e tes+-
Top_ Bottom Ft.
Top Bottom _ Ft.
Method
9_ SCREEN: Depth Diameter Slot Size
Top /iS1 Bottomj,S Ft. ar. in. r iO In
Top Bottom Ft. in.
Top Bottom Ft. in.
ln.
Material
V —14 re„fi
in.
10. SANDIGRAVEL PACK:
Depth Size Materia
Tap-) Botta m 1 'i.5 Ft. _CL_4
Top_ Bottom Ft. _.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
1
1
1
1
1
1
1
1
12. REMARKS:
Formation Description
r
10O HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C. WELL CONSTRUCTION STANDARDS, AND THAT A COPY Or THIS
RECORD AS SEEN PROVIDED TO THE WELL OWNER.
SIG r1A
TIFIED 1TJEZLrCCNTRACTOR DATE
PRINTED NAME OF PERSON CONS'i"R Jl CR T?FtG THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh. NC 27699-161, Phone : [phone]
Form GW-lb
21M98 2013
fnformatia0 Proct:ssing Unit
D WQ1LBOG

1 ■ ON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Wafer Quality
WELL CONTRACTOR CERTIFICATION # 35-7/
T. WELL CONTRA TO
19k 5.M91
Well Contractor (Individual) Name
A E DRILLING SERVICES. LLC
Weil Contractor Company Name
TWO UNITED WAY
Street Address
GF EENVILLE SC 29607
City or Town State Zip Code
(864 ) 288-1986
Area code Phone number
2. WELL INFORMATION:=P 4 7 4Z+
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(irappricable)
SITE WELL 1D #[ltapprcable)
3. WELL USE (Check One Box) Monitoring D MunicapailPubtic C]
industrial/Commercial ❑ Agricultural D Recovery 0 Injection L
IrrigationD Other q (list Use)
DATE DRILLED ►i- Z7—i'�
4. WELL LOCATION:
L .i �a krf •fi r
{Street Name, Numbers, Community, Subdivision. Lot No., Parcel, Zip Cade)
CITY_ �-4 � h kv p i t (\ C COUNTY
TOPOGRAPI !IC / LAND SETTING: (check appropnate box)
['Slope flValley DFlat ❑Ridge ClOther
LATITUDE 36 " DMS OR 3x.xx)000000c DD
LONGITUDE 75 " DMS OR 7xaoacxxxxxx DD
Latitude/longitude source: EPPS plopographic map
(location of well must be shown on a LISGS fopo map andattached to
this form if not using CPS)
5. FACILITY (Name of the business where the well is located.)
i 71ri ji s
Facility Name Facility ID# (if applicable)
JUL� Old Le INe Ir1
Street Address
Ali(
City or Town I
77t/r1'I: -I L li I4 Y f
State hip Code
Contact Name
c23 I
Mailing Address -�
?)C- )gRol
City or Town
State Zip Code
Area code Phone number
S. WELL DETAILS:
ter!
a. TOTAL DEPTH: au
b. DOES WELL REPLACE EXISTING WELL? YES D NO Q'
c_ WATER LEVEL Below Top of Casing: , /3 :6-14.' Fr
{Use "-f" if Above fop of Casing)
t%ttl ax 4
d.
sJ1l is 3ltiatp: QuaIi_,
/'t1 51
TOP OF CASING IS f FT- Above Land Sir -Pat -xi'
"Top of casing temiinated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST A.)f. DISINFECTION: Type _ Amount
g. WATER ZONES (depth): /�
Top .4%/, ' Bottom A fir Top :J►%// T Bottom
Top Llottom Tvp — Bottom
Top Bottom Top Bottom
Thickness)
7. CASING: Depth Diameter Weight . Material
Top d` ,Bottom AI" Ft. 21' l kV7 T Ix'
Top Bottom FL
Top Bottom Ft.
8. GROUT: Depth Mate
dMaterial
Top ' Bottom. 11 FL Crw`I �w
Top Bottom Ft.
Top Bottom Ft.
Method
9. SCREEN: Depth , Diameter Slot Size �Mfaterilal
Top /$1 Bottom up' Ft. 2" in. ale) in. v-rili �"� .]
Top Bottom Ft. in. in.
Top Bottom Ft. in. ifs.
10. SANDIGRAVEL PACK:
Depth Size Niateria
Top /S Bottom +n? FL ,T `%
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom Formation Desrxiption
I
f
1
r
J
12. REMARKS:
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD Fy4.S BEEHE WELL OWNER,
SIGt47 T E OF CERTIFIED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
'•.5-'-; �'''�'�' ForrrmGW-lb
�11<rlaticib Processing; JA408 %_
113
inii rrrIatior Prr e.m;riin:1 Unit

NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department ofEnvironment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
1. WELL CO
Weil Contractor (Individual) Name
A E DRILLING SERVICES, LLG
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE
SC 29607
City or Town State Zp Code
(864 ) 288-1986
Area code Phone number
2. WELL INFORMATION:27).-14T`f'
WELL CONSTRUCTION PERMIT$
OTHER ASSOCIATED PERMIT#(# eppscable)
SITE WELL ID kirappricable) -.
3. WELL USE (Check One Box) Monitoring 0 Municipal/Public 0
Industrial/Commercial 0 Agricultural 0 Recovery ❑ Injection F '
InigatIonO Other 0 (list use)
DATEDF4ILLED 11--27^/7-
4. WELL LOCATION:
CBernOAi
(Street Narne, Numbers, Community, Subdivisian, Lot No., Faroe!, Tip Cade}
CITY: I i ", Le ;11.?_ COUNTY
TOPOGRAPHIC! LAND SETTING: (chock appropriate box)
['Slope LlVatley ❑Fiat ❑Ridge ❑Other
LATITUDE 36 . DMS OR 3X.xcooa0000c DD
LONGITUDE 75 _ . -... " DMS OR 7X.)000Qoocxx DO
LatltudeRongitude source: I3WS [topographic map
(location of well must be shown on a USGS topo map andettached to
this form if not using GPS)
S. FACILITY (Name of the business where the well is located.)
Facilltdr Name Facirrty ID* Of applicable)
/ 80 01,1 &c ` ,- r • {
Street Address
City or + State Tip Cade
41-1-crY,.& o f Eru l
Contact Name-
.7, i I.is�- �,, ,i '5 +
Mailing Address
A C ;gto
City or Town
Area code Phone number
S. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL?
State Zip Code
YES NO'
a_ WATER LEVEL Below Top of Casing: ��]. 9 _ FT.
(Use "+^ if Above Top of Casing)
' f111 lilrr
Iritqli•Cr_7' :Se
O 3iY.lS Qh1',bfWater uWi ln`or abon PmcessiAj.
41 250
d. TOP OF CASING IS r FT. Above Land Surface
`Top of oasmg terminated atlor below land surface may require
a variance in accordance with 15A NCAC PC _0118.
e. YIELD (gpm): iti/%f` METHOD OF TEST
f. DISINFECTION: Type /v& Amount'
g. WATER ZONES (depth):
Top O Bottom AL4/4"r Tap /1.21411ottom 4T
Top Bottom Top Bottom
Top Bottom Top _ Bottom_ —
7. CASING: Depth Diameter
Top 01 Bottom %•f. Ft. din
Top Bottom FL
Top Bottom Ft
Thickness)
Weight Material
,,yc) Pik
8_ GROUT: Depth Material Method
Top Dt Bottom J(' . Ft. p �ri taie.
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth
Top_ if j Bottom
Top Bottom
Diameter Slot Size
Ft gI in. • .1 D in.
Ft. in. tn.
Material
p UL
Tap Bottom Ft. in.
in.
10. SAND/GRAVEL PACK:
Depth Size MateryI
Top •/7' Bottom_ Ft. .� n J
Top • Bottom
Ft.
Top Bottom Ft,
11. DRILLING LOG
Top Bottom
1
1
I
1
1
1
1
1
12. REMARKS:
Formation Description
r ] fblr -k
DO HEREBY CERTEFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
1SANCAC2C. WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS 8EF2r PROVIDED TO THE WELL OWNER.
SIGN, F CERTIFIED WELL CDNTRAGtOR DATE
PRINTED NAME OF PERSON CONSTRUCTING T}tE WELL
JAN Anal
roformatiosl f'incessirrg
kD WQIBOG

NON RESIDENTIAL WILL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
1. WELL CONTRACT ft
Abel
Well Contractor (Individual) Name
A E DRILLING SERVICES, LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
City or Town ctara 7rp Crtdo
(864 ) 288-1986
Area code Phone number
2. WELL INFORMATION: ,rp / /f
WELL CONSTRCICTION PERMIT
OTHER ASSOCIATED PERMIT#(trapplicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial © Agricultural ❑ Recovery ❑ Injection 1 r
trrigationII1 Other ❑ (fist use)
DATE DRILLED 1 0-S1- jZ
A. WELL LOCATION:
r !` fr]ii:r]r
(Street Name, Numbers, community, Subdivision, Lot No., Parcek, Zip Code)
CITY: �^j`ydti; it /Ot t COUNTY_
TOPOGRAPHIC I LAND SETTING: (check appropriate box)
❑Slope LIValley LFlat ❑Ridge ❑Other
LATITUDE 36 " DMS OR 3X,XXXXXXxxx Uti
LONGITUDE 75 " DMS OR 7X.XXXXXXXXX DD
Latitude/longitude source- LOPS Dropographic map
(location of well must be shown on a USGS topo wrap andattached to
this corm if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Facility Name
Facility ID# of applicable)
Street Address
_ 4 ile i1/4).C-
City or Town
4€w. o,i• -
Cantact Name
x,ionvow ,-lei 1
State Zip Code
Mailing_Address
r�•SU 'a'- ri i
City or Town
( {'c ) ,1S) 3 3 C,
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: S.2. S'
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑
c. WATER LEVEL Below Top of Casing; ) . {
(Use "+' it Above Top of Casing)
NO ❑
FT.
Top 33 Bottom
Top Bottom Ft.
Top Bottom Ft-
3S'7L
411249
et. TOP OF CASING is 2' FT- Above Land Surface`
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2G .0113.
e. YIELD (gpm): 1L1%A METHOD OF TEST IV./
f. DISINFECTION: Type WI, Amount #1,6
g. WATER ZONES (depth):
Top A/ f Bottom w'7- Top AM,— Bottom iWi-
T ❑p` _ Bottom Tup Buuorli
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top £ , Bottom /.1 Ft. o .' 6- V6
Top Bottom Ft.
Top Bottom Ft.
S. GROUT: Depth Material • Method 7ti+a1
Top it,S' Bottom Q Ft. &AC�iedeamcgriaptiftc
Top CV Bottom 3 it Ft-J_fIttr' 7: r+'li t4
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top , ' Bottom ' Ft. 2" in. .►D_ in- LA3;te L.3 .p Pik.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Materia
,IG.S Ft. *V
11. DRILLING LOG
Top Bottom Formation Description
1
1
1
12. REMARKS:
r DO HEREBY CERTIFY THAT THIS WELT. WAS CONSTRUCTED rN ACC:OROANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS SEEN PROvluty TO THE WELL OWNER-
NlG
�-G>,. Ile
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCT ING THE WELL
Submit within 30 s,la's of corrtpletion to Division pf Water 'duality - .Inforr iatioirProsessing
1617•Maii Service C.enter,,•Raleigh, NC27699-;161 Phone : pis) 807-6390 +'
Cry __,�� ..
Form t3W-1 b
Rev_ 2/09
JAN 2 8 ?nil
nforrnatron r oce,s fitly' ono

1. WELL CONTRACTOR:
NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # S 71
Well Contractor (lndividuaf) Name
A E DRILLING SERVIC
Wen Contractor Company Name
TW UNITED WAY
Street Address
GREENVILLE
City or Town
Area code Phone number --------
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(:i apprlcable)
SITE
WELL !D *o
f aivicablej
3. WELL USE (Check One Box) Monitoring LI Municipal/public p
Industriaf/Commerclal ❑ Agricultural 0 RecoYery 0 injection [�
In-igationp Other (fist use)
DATE DRILLED_______
Zip Code
4. WELL LOCATION:
(Street Name. Numbers, Commurtty, Subdivision, Loi Ne,
Parcel, Zip Corse)
CITY: 1Si1Ci1} tie
COUNTY
TOPOGRAPHIC LAND SE !NG
°Slope °Valle (check appropriate box)
Y � Flat ❑Ridge 0 Other
LATf7i1I}E 36 e ,
" DMS OR 3x_x� DO
Witt/de/longitude source. ~~11 CMS OR 7 DD
(location of well must be shown on a UPS /SGS for o map a en
this form if not using GPS) ° p andahached fa
5. FACILETY (Name of the business where the well is located.)
�r F
LONGITUDE 75
grv1
raw tcA.iifress ,,� 9 /}
alai /il��• d(rF
State Zip Cade
Contact Na,rte
Mailing Address
City or Town
tree code Phone number
WELL DETAILS:
�- TOTAL DEPTH:
�r r
Facility If1# (if applicable)
State
DOES WELL REPLACE EXISTING WELL? YES ❑ NO
WATER LEVEL Below Top of Casing: q, + R
t
(Use ' ' if Above Top of Casing — FT.
SIG
Top
Top
41, ,
d. TOP OF CASING IS 3‘ FT_ Above Land Surface'
'Top of casing terminated attar below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm)' AMA METHOD OF TEST AM
+/A
f. DISINFECTION: Type IWJI
Amount
g. WA�TlER ZONES {depth}:
Top IVIA 8olrom Top ../A Bottom
Top
Top
Bottom
Bottom
T. CASING: Depth Diameter
Top C> Bottom_ 1 = Ft. + _
Top Bottom Ft
Top Bottoms Ft.
Bottom
Bottom
r+Ufl�
Thickness/
Weight Material
S.a. Lib 1VC
8. GROUT: Depth Material
Bottom Ft. C-ritef1
Top Bottom) Ft.
Top Bottom�� Ft.
9. SCREEN: Depth Diameter
Top 29,Z Bottom. Ft. 2" in.
Top Botiorn Ft.
TopBottoms Ft.
in.
in.
10- SAND/GRAVEL PACK:
Depth Size
Top QV' Bottom ij_ Ft. $�1
Top Bottom Ft
Top_ Bottom Ft-
11_ LJIQILLING LOG
Top Bottom
1
/f
1
I
J
•
12. REAItAMD<S:
Method
«7
Slot Size Material
.) D in. i+ jrt O►rp
in,
in.
Mate 'al
Formation Description
DO HEREBY G� F2TIFY THAT -INS WELL WAS CONSTRUCTED INACCaR1 ACCORDANCE WiTrr
YSA NCAC 2G. L'\i� Li-COSTANt7A8p5• � THAT A COPY OF THISREG'ORD t-►RS a "PROVIDED TO THE WELT- OWNER.
TLJ. E OF CERTIFIED LL t�C �CTQR DATE
•
PRINTED 1+J�41'111E-
dF PERSON CONSY ACTING THE WELL
witb n 34.dayof complefiort to: ❑ij - ,
• yiston: if water Q-4/rsf r
ICE@ ter . Rates h, ]VC 2��9g_4 fib, Phone:_.arc,, o ,:. -

' TRZAcroR:
mS
C'tor {Irrd�du
3 f al} Narrie
EA:Vir•E I I C
ctarCom
na.YiVarne
'ss
LV
'ne number
'NATION:
CCTt°NF' RMT jL1'7—
GATEDP IT
(rraOmicab Q Mtart aPplicabtej
deck ~-- -- -
�Re Box) Monitoring -_�
ereia! fJ Municipal/
'ggricu Ural F'ubtic
er V{list used Rt a Recovery © Enjection Q
Ohl:
NONRESIDENTS WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL. CONTRACTOR CERTIFICATION #
.off.
ers Co
1e •nGr+jty, Subdivision. Lot No., parC , p Code)ar•�N� SE77'► Cnl3Nry
Sr la[ Qtia9 hectc appropriate box]
o ""I (DR 3x.)400(XX DD
t►rCe:
'st b� �� �5 Cv ic
7X-XXXXXX*Cx DD
qh �usi .enntes ClS�S c1Dc�hmap andattached to
why r- th f N.ev 11 is located.}
State
Zip Code
F cility $D# (if applicable)
State Zip Code
Stale Zip Code
3
vp p .. 1iVELL? YES El NO Er
TQ� - �: /a-ba Er-
a sing}
3571 Ali n4r-1
k
FT. Above Land Surface`
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): A YR METHOD OF TEST ANA
1, DISINFECTION: Type 1011? Amount AIL
g. WATER ZONES (depth):
Top NJ,, Bottom r,irA Top
d. TOP OF CA$!NG IS 3'
Top
Top
*MA. Bottom :WM-
Bottom Top
Bottom Top
7. CASING: Depth
Top ls'
Top
Top
Diameter
Top Botom_ !r Ft._
Top C Bottom ? i ' Ft.
Top Bottom Ft.
8. GROUT' Depth
Top b' Bottom
Top Bottom
Top Bottom
9. SCREEN: Depth
Top 17' Bottom 371
Top
Top
Bottom
Bottom
10. SAND/GRAVEL PACK:
Depth Size
Bottom 38' Ft.
Ft. in.
Ft. in.
Bottom
Bottom
11. DRILLING LOG
Top Bottom
1
1
1
1
1
1
I
12. REMARKS:
Ft.
Ft.
Material
Ft- to fek ek
Ft.
Ft.
Bottom
Bottom
Thicknessf
Weight Material
(`G'{
��h iI c i
Method
`rr'Inrai@.
Diameter Slat Size Material p oL,
L]raf2 Ft. 2 in. .:O W:cr in.
in -
in_
Material
Formation Description
AGE W1Tri
00 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED INAC( C) 1--i15
15A NCAC 2C, WELL. coos T RUCTION STANDARDS, ANO THAT AC]PY �
RECORD HAS BEEN PRUVIDS0 TO THE WELL OWNER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR
PRINTED NAME PERSON CONSTRUCTING
nir►isson of WaterQuali y'- Irifpr+iiation'i�rocess9'rig;
Rev- 2109
I i M 2 8 2013

NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3 S71
1. WELL CONTRACTOR:
Abel ME rruur+"
Well Contractor (Indlviduai) Name
A E DRILLING SERVICES. LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
City or Town State Zip Code
(864 ) 288-1986
Area code Phone number `
2.. WELL INFORMATION: =p-1 q7 ~ 1
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(if eppGcabie)
SITE WELL ID #(if app[icabfe)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public Q
Industrial/Commercial t] Agricultural G Recovery D injection a
irrigation❑ Other 0 (list use)
DATE DRILLED JO. 7., -IZ
4. WELL LOCATION:
I. 0 c_ (SLAJr np,yrg�--rr �
(Street Name. Numbers. Community, Subdivision, Lot No.. Parce^, Zip Cade)
CITY: frdle M Ile h 0.C. COUNTY
TOPOGRAPH{C / LAND SETTING: (check appropriate box)
❑S&'ape LlValiey flat ❑Ridge GOther
LATITUDE 36 " DMS OR 3X.XXXXXXXXX 0i0
LONGITUDE 75 " DMS OR 7x.xx 000aoa DO
Latitude/longitude source- ❑GPS Ellopographic map
(locatrori of well must be shown on a USGS fop° map andatteched to
this form ifnot using GPS)
S. FACILITY (Name of the business where the welI is located.)
Facility Name
I -. 0 k hit Tre f 'r{.
Street Address
1=1-4.t: TIP
,C
City or Town
I l l i, , i ,f (--A 'tanl,•<', �r 1
Contact Name
-.'' l
1 ! ,. ': Cfti 15 I.
Mai{ing Address' -`
City or Town
( g) �gi — 335U
Area code Phone number
S. WELL DETAILS:
a. TOTAL DEPTH:
Facility ID# (if applicable)
a?(.),
State Zip Code
dUO
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES D NO2'
c. WATER LEVEL Below Top of Casing- /8- g3 FT
(Use "}" if Above Top of Casing)
4 uE r iiuithin .dasp -C m a tab'' to Division of Water"
14-Ti7 iV ail 5envire lG.e !f, 1+y}�',: 769J-'E.61y �'laarie: (9:'9_y1'
.a ........ �b L .�.►�ir .. ..=..n.....a.._...- _.s-�-- - - _. • i.... 5..�'.7LW�
41 i.. h
d. TOP OF CASING IS ,3' FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (giant): !WA METHOD OF TEST ANA
f. DISINFECTION: Type AJJ Amount NIA
g. WATER ZONES (depth):
Top AA Bottom Wit Top OM Bottom Ili%
Top Bottom Top Bottom
Top_ Bottom Tap 6ortom
7. CASING: Depth Diameter
Top_ Bottom_ t1 Ft_
Top f_) Bottom .Lit Ft.
Top Bottom FL
Thickness)
Weight Material
1. yd IIU�..
8. GROUT: Depth Material
Top 0 ` Bottom 1 Ft. et...Ax
Top Bottom Ft.
Top Bottom_ Ft.
Method
9. SCREEN: Depth Diameter Slot Size Material
Top )7` Bottom_ 37' Ft. Zs' in. , dp in. W;ra_13r4p P "-
Top Bottom Ft. in- in- --
Top Bottom Ft. in_ in-
10. SAND/GRAVEL PACK: al
Depth Size Matey` 1
Top is' _Bottom 3 S' Ft- y C ' Qn
Top Bottom Ft. _ -
Top Bottom Ft. -
11_ DRILLING LOG
Top Bottom
1
1
I
1
I
1
1
1
1
t
12. REMARKS:
rorrnafion Description
=.5(0/4]
UAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WI7ii
I Da HEREBY CERTIFY .NSTRUCT!ON STANDARDS, AND THAT A COPY OF THIS
1sA NCAC 7C, WELL COWIDED TO THE WELL OWNER.
RECORD HAS BEEN PR(
4 iYI.CITIFIED WELL CONTRACTOR__ lIpA E -a--
SIGNATURE OF GE ,
PRIE`- y G DN CONSTRUCTING THE WELL
D NS'�AMEtOF PE,
• .iiiferrsia�t�ril�rc�'
Rev:2i09 ==
JAN282013
'nffOernBtlrira a+•,�,.n_,

1 ■ ONRESIDENTJAL WELL CONSTRUCTION RECORD
North Carolina Department ofEnvironment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 71
1. WELL CONTRACTOR:
1J iiAltasr�
Well Contractor (Individual) Name
A E DRILLING SERVICES, LLG
Welt Contractor Company Name
TWO UNITED WAY
Street Address
GREEN V ILLE 5C 29607
City or Town State Zip Code
c864 j 288-1986
Area code Phone number
2. WELL INFORMATION: 2 P- 4
WELL CONSTRUCTION PERMITS
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if appllcable)
3. WELL USE (Check One Box) Monitarnng ❑ Municipal/Public [3
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection C'
Irrigation❑ Other Q (tist use)
DATE DRILLED iD^30-17_
4. WELL LOCATION: •
{street,. (J'+ iY11i flxC`.
}ame, Numbers. Community. Subdivision, Lot No., Percel, Zip Code)
CITY: _ ktui J le
/ LAND SING: (check appropriate box)
❑Flef rlPidgP Mother
LATITUDE DE 36
TOPOGRAPHCOUNTY
(Slope QValley
LONGITUDE 75 "�
" DMS OR 3x.xxxxxxxxx DD
DMS OR 7x.xxxxxxxxx DD
i]fopographic map
t1SGS tope map andatfached[o
•re the well is located.)
Latitude/Longitude source:
(location of well must be shown o&N
this form if nal using GPS) ' a
5. FACILITY (Name of the business wht
t-.+'ht-ItLSrtIcS
Facilityrr77Name
'CA
�{
Cwae! Arlrlres$
•
Contact Name
trti
FacilitylD# (if applicable)
State Zip Code
Ma'lling Address
City or Town
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: dT`
b. DOES WELL REPLACE EXISTING WELL? YES CI
c. WATER LEVEL Below Top of Casing; �3
(Use "+" if Above Top of Casing)
State
Zip Code
NO BF
FT.
411248
d. TOP OF CASING IS 3` FT. Above Land Surface`
"Top of casing terminated aflor below land surface may require
a variance in accordance with 15A NCAC 2C .01 '18.
e. YIELD (gpm): IWA NM METHOD OF TEST J �A},
f. DISINFECTION: Type Amount LTA
g. WATER ZONES (depth)
Top 113flt_ Bottom &J Top
Top Bottom Top I3oltom
Top Bottom Top Bottom
Thickness!
7. CASING: Depth Diameter Weight Material
1 tIID [LlL
Top_ (.-) Bottom_ /L- F _
Top Bottom Ft.
Tap Bottom _ Ft. -_
8. GROUT: Depth
Tap_ p' Bottom 2S 2' Ft,
Top Bottom Ft.
Top Bottom FL
ll114 Bottom
MaterialCe_rrieAyy
�^ Method
i-;+"!ic
9. SCREEN: Depth Diameter Slot Size
Top AZ Bottom 31.2i Ft 2" in. .1 D in.
Top Bottom Ft. in. - in.
Top Bottom _ Ft. in. in.
Material
ia]�rs 4]rep PVC.
10. SAND/GRAVEL PACK:
11Anlh Size Mate ial
Top € V` Bottom titan Ft..,0.) ;_GA
Top Bottom Ft. _
Top Bottom Ft.
11. DRILLING LOG
Top Bottom Formation Description
1
1
1
1
12, REMARKS:
1 Do HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED iN A000ROANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS SEEN PROVIDED TO THE WELL OWNER.
Jr` 4- /
SIGN TURF OF CERTIFIED LL CONTRACTOR DATE
1 1; -
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
$domit within 30days of campie4s Division of 1Nater� u .Ii'• :Information Processliti
1617;Mail seryc ra ice ter;,Raleigh' N- 27699=.461,,'Pnone :-(919 63o ." '
s^ hlTv_ ib
•RFpeZ!1}3i
JAI 2 8 2.011
li•;TT I'n 5allf :�l rY.,�.:acrin.-. i

NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Quoi na Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERT�ICATION # 71 11
1. WELL T
Welt Contractor (Individual) Name
A E DRILLING SERVICES. LLC
Well Contractor Company Name
TWO UNITED WAY
Steel Address
GREENVILLE
City or Town
(864 ) 288-1986
Area code Phone number
2. WELL INFORMATION: x¢ — R ► 7.6--
WELL CONSTRUCTION PERMIT#
SC 29607
State Tip Code
OTHER ASSOCIATED PERMIT# applir ble)
SITE WELL ID ('d appIIcaal) - -`
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public °
Industrial/Commercial ❑ Agricultural E1 Recovery p Injection p".
irrigation° Other E (list use)
DATE DRILLED !< L- Z` - i Z
4. WELL [LOCATION:
(Street Name. Numbers. Communittr, Subdivision. Lot No., Parcel, Zip Code)
CITY: 1 -d1 vi 11L r 1[ COUNTY
TOPOGRAPHIC/ LAND SETTING:
°Slope °Valley El Flat ❑Ridge
LA -ETUDE 36
LONGITUDE 75 " - - ,.
(theck appropriate box)
❑Other
CMS OR 3X.)00004OOO( DD
" DINS OR 77L)3Q00000O1 DD
Latitude/longitude source: IJ3PS DFopographic map
°ocedon awe!! must be shown on a USGS repo map andeitacrhed to
this form if not using GPS)
5_ FACILITY (Name of the business where the well is located.)
. �hParn}tc�y-�
Facility Name j j [� Facility ED# (if applicable)
i i. � 014 Ete e 1` ' r I
Street Address
Vain IO L
City or Town State Zip Code
Contact Name
+!(
Mailing Address
)\ II. ilc Via+
City or Town
SDg) ?. - 3
Area code Phone number
S. WELL DETAILS:
a. TOTAL DEPTH:
State Zip Coda
b_ DOES WELL REPLACE EXISTING WELL? YES)] NO ❑
c. WATER LEVEL Below Top of Casing:
(Use '+' it Above Top of Casing)
FT.
d. TOP OF CASING IS FT_ Above Land Surface`
'Top of casing terminated at/or below land surface may rsgtire
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gm): AZ/n METHOD OF TEST 4-
f. DISINFECTION: Type /1)/ - Amount 424
g. WAM ZONES (depth):
�,��
Top BoHornA Top_��Bottom
Tap • Bottom Top _ Bottom
Top -- BottomTop Bottom
7. CASING: Depth A r Diameter
Top 0' Bottom liati Ff. 41
Tap Bottom Ft
Top Bottom Ft.
Thickness/
Weight Material
.5ck•YO Alt,
8. GROUT: Depth �r Maateri I Method
Top d` Bottom I •J F• t &AWN ►e
Top Bottom FL
Top _ Bottom Ft
9. SCREEN: Depth Diameter Slot Size Material
Top a J Bottom 82 r . F• t. ete , IQ in. (�"wat ePLL
Top Bottom FL in. in.
Top Bottom Ft- in. _ in_
10. SAND/GRAVEL PACK:
Depth Size
Top 161f.Bottorraekr F• t. 47*/
Top Bottom Ft_
Top Bottom Ft
11_ DRILLING LOG
Top Bottom
1
1
1
I
1
1
1
1
1
1
1
12. REMARKS:
.i
Forma5on Descrlptton
Rai; -1
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
i&A NCAC 2C. WELL CCNSTRUCTt0N STANDARDS, AND THAT A COPY OF THIS
RECORD HBS 9EENPROVIPSP TO THE WELL JY NER.
•
ik.Z91z
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRI.ICTINGTHE WELL
Submit. within 30 days af-completion'to: Division Cif Water Quality :. infartnat on Pfa., sinr3,
$617Mail Service Center, Raleigh:NG e7593_'i61-r.
Phorte. {919) 807-6300 ''
Form GW-lb
JAN 2t8 Z4t3
'71�OrrflPiIQ F•' • .
11lvt.)r

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Divisan of Water Quality
WELL CONTRACTOR CERTIFICATION # 3611
1. WELL CONTRACTOR
A bel fn1x3GtA
Welt Contractor (Individual) Name
A E DRILLINQ SERVICES. LLC
well Conhadjr Company Name
TWO UNITED WAY
Street Address
GREENVLLLE SC 29607
City o Town Sty Zip Code
(864 ) 288-1986
Area code Phone number
L WELL. INFORMATION: I P- 1 `'i7-1 d
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATE. D PERMIT#(ff appnaable)
SITE WELL ID #(1 applicable)
a. WELL USE (Check One Box) Monitoring l7 Municipal/Public 0
industrial/Commercial 0 Agricultural ❑ Recovery ❑ Intectlon 13�
Irrigation❑ Other q (list use)
DATE DRILLED — j
4. WELL LOCATION:
rirkF4.ci),c
(Street Herne, Numbers. Caanmunky, Subdivision, Lot No, Pavel, Zip Oorle)
CITY: A5t1 'v' (1 C COUNTY
TOPOGRAPHIC / LAND SETTING. (;heck appropriate box)
❑Slope ❑Valley 0Fiat 0Ridge ❑Other
LATITUDE 36 " DMS OR 3x.xxx>O0000c DO
LONGITUDE 75 " DMS OR 7x.JdOG0000OC OD
Latitude/longitude source: EI;PS E topographic map
(location of well must be shown on a USGS topo map andattaahed to
this torn if not using GPS)
5. FACILJTY (Name of the lousiness wham the well Is located.)
irontrs
FaciTrty Name
l .!I' , '\A
Street Address
Faciity ED# (if applicable)
vine D-$01Y-3
City or Town State Zip Code
+
Centad Name
�4
Maiing Address
c:agg0
City or Town
(ig) I-
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 46%
StateZ.tp Code
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO i Y
c. WATER LEVEL Below Top of Casing: j'7, j 47 _FT.
(Use '+• if Above Tap of Casing)
41124C.
d. TOP OF CASING IS 1` FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 16A NCAC 2C .D118_
O. WELD (gpm). AVA METHOD OF TEST im
E DISINFECTION: Type 4 ►�rnount 1�.�
g. WATER ZONES (depth):
Top Kf A• Byrn F) in— Top 04" Bottom ?JJI
Top
Top
7. CASING: Depth
Top O
Top
Top
Bottom _ Top Bottom
Bottom Top Bottom
Thickness/
Diameter Weight Material
Bottom Zel. ` Ft V. • &J $ PLC.
Bottom FL
Bottom Ft_
8. GROUT: Depth Material Method
Top o` Bottom 14 FL LQc"I `Tr+• A►S
Top Bottom Ft.
Top Bottom FL
9. SCREEN: Depth Diameter Slot Size
Top T Bottom 40C FL Z" in. • LO
Top _ Bottom Ft i i in_
Top Bottom Ft in_ in. -
1 D. SANDIGRAVEL PACK'
Depth Size
Top It Bottom FL /
Top Bottom FL
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
1
1
1
1
1
1
1
12- REMARKS:
Material
�7 631re-. iP vC
!Malaria
Formation DescnpLon
ti 'n -dr
I CO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED INACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
REOORn HAS QTHE WELL OWNER_
SIGNATURE OF WELL CONTRACTOR DATE
,L
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Farm GW-ib
Rev. 2/00
JAN2820t3
41l'arrnai;r,,,

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
1. WELL CONTRACTOR:
Well Contractor (Individual) Name
A E DRILLING SERVICES, LLC
Weil Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
City or Town State Zip Code
(864 _) 288-1986
Area code Phone number p
2. WELL INFORMATION: LP- t� #— 1
WELL CONSTRUCTION PERMIT*
OTHER ASSOCIATED PERMIT/WI applicable)
SITE WELL ID*Or applicable)
3. WELL USE (Check One Box) Monitoring ID Municipal/Public J
IndustrialJCommercial D Agricultural ❑ Recovery El Injection a"
irrigation0 Other 0 (list use)
DATE DRILLED 117-•2I;-jZ
4. WELL LOCATION:
rCr
(Street Name. Numbers, Community, Subdivision, lot No.. Parcel. hip Code)
CITY• �yr l _ VOL GOuNTY
TOPOGRAPHIC 1 LAND SETTING: (check appropriate box)
EJSlope ['Valley ['Flat DRsdge ❑Other
LATITUDE 36 " DMS OR 3x.xxxxxxxxx DO
LONGITUDE 75 DMS OR 7x.xxxxxxxxx DO
Latitude/longitude source: EGPS Qropogrephic map
(location of well roust be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where Erie well is located.)
Chem+r0ditcAL
Faciii Name Facility nit (if applicable)
O Id 12)2e Ire d
Stre�e�trAdrldrr:.1cs dq r
City or Town _ State Zip Code
g 1-famdf i I�ly a; I�zr,l.�r +A
Contact Name
}
Mailing Address
14( V e NC 1
City or Town
A21 3 3 C1
State Zip Code
Area code Phone number
6. WELL DETAILS: 1
a. TOTAL DEPTH: 46' j+
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO13-
c. WATER LEVEL Below Top of Casing: 51 FT.
(Use "+" if Above Top of Casing)
Top 3i5"
3571
611244
d. TOP OF CASING IS S r FT. Above Land Surface`
'Top of casing terminated al/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): NIA METHOD OF TEST 11081
f. DISINFECTION: Type 1 J Amount tJd9-
g. WATER ZONES (depth): Iw
Top N'14 Bottom WA- Top AIM Bottom._
Top Bottom Top Bottom
Top Bottom Tao Bottom
Thickness!
Weight Material
7. CASING: Depth Diameter
Top 0 Bottom I ( Ft. c - _
Tap Bottom - Ft
Top Bottom FL
8. GROUT: Depth
Top SII Bottom tCe Ft
Top ra' Bottom vir
Top Bottom Ft.
Material ORS
Method 1. Lr, *c)
9. SCREEN: Depth Diameter Slot Size Material
Top 5/..1Bottom 'Ix Ft. ,./.. in. , i0 _ In. Li:te Lap PUS'
Top Bottom Ft. - in. in. -
Top Bottom Ft. in. in.
10. SANDIGRAVEL PACK:
Depth
Bottom
Side
SI• F t otti
Mate " 1
SAf1
Top Bottom Ft. -
Top Bottom Ft
11_ DRILLING LOG
Top Bottom Formation Description
r
1
I
1
1
1
1
1
1
1
12. REMARKS:
I no HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE VY1TH
15A NCAC 2c, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
M t
i CERTI �
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
}Ube I.1;`rTu:rA
11--4-)2
PRINTED NAME OF PERSON CONSTRUCTING
-. - --_- .,__...-:. - -- _---�-,.:.. .-:.. �a-,Q•�� -� __. _gym- -1ts °,�.�a�
iiabmit Within.10d4,g-of corripletion ta: Dii is"stsin of'Wate.-r Qt{arty - Inforrnatian:Prwcessing, 1 JAN 2
S17 Mali Se vice' p of Raleigh,NC 27,699_ 161, Phone,:(s' .) 807-6300.

3
}
1. WELL CoNr
IU , RACTOR:
Well Contractor (Individual) me
Ati^EF�� ,I L SERVICES, LLC
T- a "pillar C.;,�Yq^� name
Street Addr T
city o Towri
NVILLE
gL e code 288-1986
bone number
2. WELL INFC1RMATION: $ - 147 119
WELL CONSTRUCTION PERMIT#
OTHER ASSpOIATEO PERMIT#{ir applicable)
SITE WELL 1p aPPlicable)
3WELL us (Check One Box) Monitoring ❑ Municipal/Public ❑ Industrial/ ornmercial ❑ Agricultural ❑ Recovery D Injection
lmgatran� Other
DATE ❑ {fist use)
E °RILLEDz IO^'244-!Z..
4- WELL LOCATION:
{Street Names • . • �
' Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITYv-
T- t COUNTY
❑O QG VR_A P H IC I LAND SETTING: (check appropriate box)
°pe (]Valley 171Flat ❑Ridge ❑Other
WTITU 36
LONGIT-VUE 75
Latit 4 " DMS OR 7X.X)C(X fXXXX DD
ode!{ongitude source: i3PS QTopographic map
dlhos ftt of weIl must be shown on a USGS topo map andattached to
6. F tea-► if not using GPS)
aCtu-ry
(Name of the business where the well is located.)
Fact+'—}tun't.S
1Bfl-
Str 4e dr�� }~`
h' or` "Town,
rttaNarne
gatiress ] ,1
{ty �r Town r).i C,
State Zip Code
arel
sr�� ��de Phone number
L QlETAILS:
TCr",L DEPTH:
I:)" bps WEt REPLACE EXISTING WELL?
1 ■ ON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of ,Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3S 71
1
DMS OR 3X.700(xxxxxx DD
Env,rr.i)i
SC 29607
State Zip Code
Facility ID# (if applicable)
aE?Ct
State Zip Code
YES
NO
r_
• AT- ER LEVEL Below Top of Casing: T �_3AFT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 3' FT. Above Land Surface`
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD Igpmj: NIk METHOD OF TEST f0'4
f. DISINFECTION: Type ilk Amount NIt
g. WATER ZONES (depth):
Top INN_ Bottom
Top Bottom
Top Bottom
Too Bottom
Top Bottom
Top_ Bottom
Thickness)
Diameter Weight Material
7. CASING: Depth
Top C Bottom___2,2-
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material L
Top J* Bottom 171 Ft. C4-M�1
Top BottomFt.
Top Bottom Ft.
Method
7-4";#11‘itik
9. SCREEN: Depth i Diameter Slot Size Material
Top-_ )' Bottom 41 _ Ft. 20 in. . tD in. _LAW_ IurAp f OC.
Top Bottom Ft. in. in,
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
Top jet* Bottom 9o11 Ft. ;+ *. fir]
Top Bottom_ Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
1
1
1
1
1
1
1
1
r
12. REMARKS:
Formation Description
� ii 1r
I D0 HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WRT:d
15A NCAC 2C, WELL CONSTRUCTION STANDARDS', AND THAT A COPY DF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER,
STGNAT URE OF CERTIFIED WELL CONTRACTOR DATE
4,aeJ PA•.;1L
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
within 30 days of completion to: Division of Water Quality Information Processing,
NC 27699-161., Phone [phone] _
•
Form GW-lb
JAN $e62413
itt or[Tlaiiq ProcAsLin[ Unit

1 ■ ON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3S%J
1. WELL C_ONTRACTOR
t
Well Contractor (Individual) Name
A E DRILLING SERVICES. LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
City or Town Slate Zip Code
(864 ) 288-1986
Area code Phone number
2. WELL INFORMATION: ZP- 103 -1 q
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(ir applicable)
SITE WELL ID #(ir epplioable)
3. WELL USE (Check One Box) Monitoring la Municipal/Public Q
Industrial/Commercial p Agricultural 0 Recovery Q Injection T
irrigatlonD Other 0 (list use)
DATE DRILLED lb- 1Z~
4. WELL LOCATION:
r,r IY 1 n on cj
(Street flame, Numbers, Community, SubdMeton, Lot No., Parcel, Zip Code)
CITY: nrun_oet COUNTY
TOPOGRAPHIC / LAND SETTING:
El Slope ❑Valley °Flat °Ridge
LATITUDE 36 °
LONGITUDE 75 '
(check appropriate box)
I<] Other
DMS OR 3X.xx'ntxxXxx DD
" DINS OR 7X.xxxx7ooncx DD
Latitude/longitude source: MPS aopographic map
((oration of well must be shown on a USGS top) map andattarhed to
this form if not using GM
5_ FACILITY (Name of the business where the well is located.)
C► e roniss
Facility Name �h Facility ID# (if applicable)
�'L Old '� first &J
eel miss
City or Town
1 1 Did- Env; re, narrrirX
Contact Name
: � �G�L,Ls]or•�t f;.
Niaiii[hg Address •JJ
! evilk fC ?,R61
City or Town
( ) J 1 335ib
Area code Phone number
S. WELL DETAILS:
e. TOTAL DEPTH: `] •
c8So5
State Zip Code
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES p NO er
c. WATER LEVEL Below Tap of Casing: , ,< j78 _FT,
(Use "+" if Above Top of Casing)
7. CASING: Depth
Top (j' Bottom 4'
Top Bottom
Top Bottom
411281
d. TOP OF CASING IS 7' FT. Above Land Surfaor
'Top of casing terminated at/ar below land surface may require
a variance in accordance with 15A NCAC 2C .8118,
e. YIELD (gprn): 1Ul1f METHOD OF TEST N/1
f. DISINFECTION: Type A/th Amount AY"
g. WATER ZONES (depth):
Top "Of Bottom Top *'Jfr Bottom ,irl}-
Top Bottom Top Bottom
Top Bottom Top Bottom.
Thickness/
Diameter Weight Material
Ft.
Ft.
Ft.
8. GROUT: Depth Material
Top O. Bottom '1 Ft. &nen r
Tap Bottom Ft.
Tap Bottom Ft.
9_ SCREEN: Depth Diameter
Bottom ze' Ft. Z" in.
Top Bottom Ft. In.
Top Bottom Ft. in.
PuL.
Method
Pfit
Slot Size Material
.iQ in. UL4ir� Pf ,
in.
in.
18. SAND/GRAVEL PACK:
Depth Size Material
Top _Bottom Z9' Ft, ay -ea
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
1
12. REMARKS:
Formation Description
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCONDANCE WITH
15A NCAC 2c, WELLCCNSTRUCTION STANDARDS. AND THAT A COPY OF THIS
REcot a HAS BEEN PROVIDEO TO THE WELL OWNER.
SIGNATURE OF CERT IEOD WELL CONTRACTOR DATE
FZO Pr !� �aG4r ► rt
_ PRINTED NAME OF PERSON CONSTRUCTING THE WELL
'vi itiiin 3 da :tjf _G Tin ie n t�' ajv!s r .ii I7iQ n Pro
1 tgrtit6 gh t46: 76 9- oI1 ';orie 9' . 07a 1/-_
Rev F/p9
NI
2 8 2013
} 3
I"31'r;nl� .s,...'?'F'ssirlo

NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
1, WELL CONTRACTOR:
ftifta-u.14t
Well Contractor (tndividuar) Name
A E DRILLING SERVICES, LLC
Weil Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
City or Town State hip Cade
(864 j 288-1986
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMITir€Qi applicable)
SITE WELL ID #ttr applicable)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public
lndustriat/Commercial 0 Agricultural ❑ Recovery D injection
IrrigationO Other p (fist use)
DATE DRILLED 1l— -Va
4. WELL LOCATION:
j eiY!?i e. 0; C �
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, hip Cade)
CITY' 5'k olY 'f\r.A COUNTY
TOPOGRAPHIC / LAND SETTING:
DSiope C}Valley El Fiat ❑Ridge
LATITUDE 36 °
LONGITUDE 75 '
(check appropriate box)
D Other
DMS OR 3x.XxxxxxxxX DO
OMS OR 7x.XXXXXXxxx DD
Latitude/longitude source: OGPS [topographic map
(location of well must be shown on a USGS topo map andat-ached to
this form if not using GPS)
5. FACILITY (Name of the business where the wail is located.)
Faciij Name _
I () C}f� t• Ffr'r,
Street Address
1\4,0•rl le Q, C.
Citx or,
Town State Zip Cade
,•..,N1011f bn U;rc,, +&I
Facility ID# (if applicable)
Contact Name f OaLAtx.�,t-Ei
Mailing Atddres``s
F-17�lf.kii Ike � C FOCI}
City or Town
Area code Phone number
6, WELL DETAILS:
a. TOTAL DEPTH:
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES p NO Er".
c. WATER LEVEL Below Top of Casing: "7_ 3 g FT -
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 3'
FT. Above Land Surface`
'Top of casing terminated auor below land surface may require
a variance in a'fccordance with 5A NGAC 2C .0118.
e. YIELD (gpm): /WA. METHOD OF TEST
f. DISINFECTION: Type /WA Amount
g. WATER/ZONES (depth):
Top AO Bottom AVA Top, iV _ i3oitam
Top Bottom Top_ Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top O` Bottom
Top_
Top
Bohan'
Bottom
Et.
Ft.
8. GROUT: Depth Material Metho
Top Ci' Bottom r Ft. �fNiPf1fr
r,
Top Bottom Ft. _
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top 13' Bottom 28' Ft. Zr in. . it, in. 1) L+S:<<. SrXPenfd
Top Bottom Ft. in.
Top Bottom Ft. in. in.
tn-
10. SAND/GRAVEL PACK:
Depth Size Mated I
Top 1 1' _ Bottom Z '
Top Bottom Ft.
Top Bottom Ft. -
11. DRILLING LOG
Top Bottom Formation Description
1 rt +Il
1
1
1
1
1
1
1
12. REMARKS:
I NO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NGAC 20. WELL CONSTRUCTION STANDARDS, ANO THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TCi THE WELL_ OWNER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
5ubniit within 3o days of'completiort tOf Division of. Water Quality ir'ifon iatiari=procesiilg; I
1.617 Mail Service Center, .Raleigh; NC 27699-161, Phone: t (919) 807-534D , •` _'
+)t0trr rOn f r3CeSSin ilr:ir
owrsiRnn
•Forl n
JRN28 j2/09
013

NON RESIDENTIAL WEI L CONSTRUCTION RECORD
North Cammlina Department of Enviromment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 357
1. WELL CONTRACTOR:
Well Contractor (Individual) Name
A E DRILLING SERVICES,_ LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
Gity or Town State Zip Code
f 864 ) 288-1986
Area code Phone number
2. WELL INFORMATION: P 1 c -11
WELL CONSTRUCTION PERMIT
OTHER ASSOCIATED PERMIT#(ir appticable) _
SITE WELL ID 40-applicable)
S. WELL USE (Check One Box) Monitoring ❑ Municipal/Public C7
Industrial/Commercial p Agricultural p Recovery p Injection Er°
irrigation❑ Other ❑ (list use)
DATE DRILLED ;1-13 - Z
4. WELL LOCATION:
C iYrkc.r is
(Street Neme, Numbers, Ca mmundy, subdivision, Lot No., Parcel, Zip Code)
CITY: Strut,*7l1Gti (i)C COUNTY
TOPOGRAPHIC i LAND SETTING:
DSlope tl Valley ❑ Flat E Ridge
LATITUDE 38 _
LONGITI.1DE 75
(check appropriate box)
❑Other
" DMS OR 3X.XXXXX OOOC DD
" DMS OR 7?S.)O00ooCxxX DD
Latitude/longitude source: COPS []Topographic map
(location of wet/ most be shown on a USGS fopo map andattteched to
this form if not using GPS)
S. FACILITY (Name of the business where the well is located.)
CkeA IT Del
FacilityName _ Facility ID# (if applicable)
lC)�d
L�{Yd-i A.1......,...
AS).,C U i f le- I A) L.
Lally VI I f1Wll
1-'\1+Ci (l\4 &tv'r c Aw.,lr
State Zip Code
Contact Name
31 't1At wr1[SG1 S4
Mailing Address ._S
l.1,VwUrletry. aggro
City or Town
(22) ,ag1 .335b
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES p NO F
c. WATER LEVEL Below Top of Casing. FT.
(LAB"4- If Above Top of Casing)
411277
d. TOP OF CASING IS S' FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm); NMETHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
Top I4.I4 Bottom /1}IJr Top NIA- Bottom ► V&_
Top Bottom Top _ _ Bottom
Top_ Bottom Top Bottom
Thickness(
7. CASING: Depth Diameter Weight Material
Top a` Bottom fit, Ft. Z„ .Sett-`!l POL
Top Bottom FL
Top Bottom Ft.
8. GROUT: Depth �rMaterial Method
Tap CO Bottom 9t Ft. f 71"f i tf'J
Top Bottom FL
Top Bottom Ft.
9. SCREEN: Depth Diameter Sint Size Material
Top 1 ? t Bottom 28' Ft. 2" in. . I b In. V" 0; r+z. , ,r r etimi
Top Bottom Ft.
Top Bottom _ Ft.
in. _ in,
in. In.
10. SAND/GRAVEL PACK:
Depth Size Material
Top tit Bottom 29 Ft. p/ii)
Top
Bottom Ft.
Top Bottom _ Ft-
11. DRILLING LOG
Top Bottom
1
1
12. REMARKS:
Formafro n Description
I CO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
1SA NCAC 2C. WELL CONSTRUCTION STANDARDS, AND THAT A COPY Of THIS
RECORD HAS BEEN PRONDEO TO THE WELL OWNER,
- SIGNATURE OF CERTIFIED ELL CONTRACTOR DATE
l'1t?' t rt
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
ECE i ED
AN..-. -_::: .. - ... ,.._: _ = - - ..,�;_ ,,•: _..,.w_ .r -,6n FFormGW-1b
4.SUktrrlf#'within `3Q dayybr+ ainplefiOn, tQ . it vis orj of--Ntf rQua!' - iit9 .1 r 0 ` ��+7I Rev. 2/09
0117 Mail:Service C,640a. tgh, ?7699161` Phitne 91" �,8O7=6a4
{ r9 0..

NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3;7/
1, WELL CONTRACTOR:�+
l ,l ' Abo ACiakt re.
Well Contractor (individual) Name
A E DRILLING SERVICES. LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE
City or Town
(864 y 288-1986
Area code Phone number 2. WELL INFORMATION: Xp !Os-- I
SC 29607
State Zip Code
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(;t applicable)
SITE WELL ID #(it applicable)
3. WELL USE (Check One Box) Monitoring 0 Municipal/Public
Industrial/Commercial Li Agricultural El Recovery Li Injection L
Irrigation❑ Other (IIst use)
DATE DRILLED �^� 3 ^ I2
4. WELL LOCATION:
(Strut Name, Numbers, Community, Subdivision, Lot NO.. Parcel, Zip Code)
CITY: :.I,k_anrSckl,QG 1,(_ COUNTY
TOPOGRAPHIC ! LAND SETTING: (check eppropnate box)
pslope DValley ❑Fiat 0Ridge ❑Other
LATITUDE 36 " DMS OR 3x.)0XxXXXXX DD
LONGITUDE 75 " DMS OR 7x.xxxxxX)00( DD
Latitude/longitude source: [j3PS :Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the wet! is located.)
Facility Narne - Facility iD# (if applicable)
I6i-' Cki 1'rc Ire. I.,1
St Pt Arlr{rp g
City or Town State Zip Code
1AI-kb \o;-4 Env 1
Contact Name
j 3 S J S(L
-t't z+ --
�
Mailing Addres
City or Town State Zip Code
3Sr�
Area code Phone number
6- WELL DETAILS:
a. TOTAL DEPTH: 011
b. DOES WELL REPLACE EXISTING WELL?
YES O NOt"
c WATER LEVEL Below Top of Casing' q- FT
(Use "+" if Above Top of Casing)
d 1 276
7e
d. TOP OF CASING IS 3 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2G .0118.
e. YIELD (gpm) WA- METHOD OF TEST
f. DISINFECTION: Type Amount ul
g. WATER ZONES (depth):
Top MIA —Bottom A)/k Top Obi Bottom kVA—
Top Bottomw Top_ Bottom
Top Bottom Top Bottom
7. CA91NG: Depth
Top Q� Bottom
Top 6ottorn
Top Bottom
Diameter
Ft. z"
Ft.
Ft -
Thickness/
Weight Material
&A.4 i �tX�
8- GROUT: Depth Material Method
Top O Bottom qt Fi�i _ -77^-i
Top Bottom Ft. _
Top Bottom Ft
S. SCREEN: Depth Diameter Slot Size Material
Top i 3` _ Bottom 2$` Ft. Z" in. "droll, in. L ► rle- L3(0.12
Top Bottom Ftin. in -
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size aterial
Top III Bottom ACT Ft.
: Top Bottom Ft.
Top_ Bottom Ft.
11. DRILLING LOG
Top Bottom Formation Description
/ `�r�, IlI1-
1
1
12. REMARKS:
I co HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS SEEN PROVIQED TOTHE WELL OWNER.
a II-4-IZ_
SIGNATURE OF CERTIFIE WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within'3O days '•o1 completion to; Illylsion of Water Ciiiality - Iiiforniation.Processingi
1617 Mail Service Center, Raleigh, NC 27699- 61 Phone 9t9 807-!5300
r"ry r
FSrmOV11b
Rev_ 2/D9

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Nontral Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
1. WELt. CONTRACTOR:
Well Contractor (Individual) Name
A E DRILLING SERVICES. LLC
Wall Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
Ctty or Town State Zip Code
(864 a 288-1986
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#{if appficatsle)
SITE WELL TO #(if applicable)
3. WELL USE (Check One Box) Monitoring 0 Municipal/Public ❑
Industrial/Commercial d Agricultural 11 Recovery 0 Injection
Irrigation❑ Other 0 (fist use)
DATE DRILLED .11—./ /2-
4. WELL !!LOCATION:
rilervh- Gig+CC
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: ArvArWtierL GEC COUNTY
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ©Valley ❑Flat [)Ridge QOther
tAT1TUDE 36 " OMS OR 3X.)CXXXX)(XXX OD
LONGITUDE 75 " DMS 0R Tx.KCCOD J(x DO
Latitude/longitude source: iL•GPS I:Topographic map
(location of well must be shown on a USGS topo map andstfached to
ibis Form if not using GPM
5. FACILITY (Name of the business where the well is located.)
utJf't}le l r-C S
Facility Name
1 3C Old
Street Address
l k e
City or Town
Ei)U•ifnfliY1%
Contact Name
): I 1' t-/A. I{
Mailing Address'
J\5he •L M( ('7 C
Facility ID# (if applicable)
Stale Zip Code
City or Town State Zip Code
) I ,_s356
Area code Phone number
S. WELL DETAILS:
a, TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO Er"
c WATER LEVEL Below Top co Casing:: • ill _FT
(Use "+" if Above Top of Casing)
3-rir
d. TOP OF CASING IS 3 r FT Above Land Surface'
'Top of casing terminated al/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118-
e. YIELD Igpmj: Aeftt METHOD OF TEST /101//
f. DISINFECTION: Type/ Amount 41./i
g. WATER ZONES (depth):
Top Ill ottom ,V/ Top lW�j`— Bottom r�/%f_
'Top Bottom Top Bottom
Top Bottom Top Bottom
7. CASING: Depth
Thickness!
Diameter Weight Material
Top iY Bottom /3' Ft. 2n 10e-
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material .-� Method
Tap 40 BottomFt. Ceoleerif I f': 01l'E+?)
Top Bottom Ft._
Top Bottom Ft.
9. SCREEN: Depth Diameter
Top ►,) ' Bottom zr Ft. VI in,
Top Bottom -. Ft. in.
lop Bolcom Et. in.
Slot 'S„ize Material
Ala
� in p
in.
in.
10. SANDIGRAVEL PACK:
Depth Size Material
Top 111 Bottom Z9 Ft,41 Sc..41
Top Bottom ft.
Top Bottom Ft, - —_
11. DRILLING LOG
Top Bottom
12. REMARKS:
Formation Description
_f} roJ'
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, ANOTrHAT A COPY OF THIS
RECORD f-iy4S eEkN P QV1 tf O i'HE WELL OWNER.
11-4.-/Z
SIGNATURE OF CERTIFIED LL CONTRACTOR DATE
ALL( - c_
PRINTED NAME OF PERSON C UUTING THE WELL
-� _.q• 77.--r -•• .. _; - �. � ' �" ^Form GW-lb
Subrnit within Clays of cornpfetion to.: Division of Water•Qtiality'- r{rifp tfrt"Procesi iN 2 8 Rev. 2109
16'17 Mail Service Geliter, Ralefghi; NC 27699 161, Phone : [phone]D _ 'Q..? ' Z �� l.�
zan " I'0C655inp Unit
UING/9rN;

1. WELL CONTRACTOR:
1 ■ ON R.ESIDE.NT.AL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # JS71 /1 S f 27
3
Well Contractor (Individual) Name
A E DRILLING SERVICES. LLC
Weil Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
City or Town State Zip Code
(864 288-1986
Area code Phone number
2. WELL INFORMATION: Td9] O - 7
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#tif applicable)
SITE WELL ID #(ir applicable)
3. WELL USE (Check One Box) Monitoring L] Municipal/Public 0
Industrial/Commercial IJ Agnculturat G Recovery 0 injection Fr'
IriigationD Other ❑ (fist use)
DATE DRILLED /I IS% /Z
4. WELL LOCATION:
(Strad Name, Numbers, Community, Subdivision, Lot life., ParceE, Zip Cade)
CfTY: Stcxu',nC, cowry
TOPQGRAPI I1C / LAND SETTING:
❑ Slope ❑ Valley ❑ Flat L7 Ridge
LATITUDE 36
LONGITUDE 75 °
(check appropriate box)
❑ Other
" DMS OR 3x.Xxxxxxxxx DD
DMS OR 7x.xx 00000 x DD
Latitude/longitude source: LIPS Drapographic map
(location of well must be shown on a USGS topo map andaftached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located-)
#ionic,
Facility Name p Facility ID# (if applicable)
I ter
er 4 �� ; 41
Street Address
%heu Ile , /J• f -
City or Town State Zip Code
A 1-413']G11 I Etw v INyvv IA f
Contact Name
d31 Hci,102(6 Si-
-7
Mailing Address -
1 �1� t i d.n ❑
City or Town
( _) r-gI ;33C
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 429'
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES CI NOB"'
c. WATER LEVEL Below Top of Casing: /t) C15 �FT
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS Jr FT. Above Land Surface`
'Top of casing terminated atfor below lanrt surface may require
a variance in accordance with 15A NCAC 2C .01111,�6.
e. YIELD (gpm): A4/4 �METHOD OF TEST Ail ./
f. DISINFECTION: Type AJ49 Amount /i.4k
g. WATER ZONES (depth}
Tap A/ Bottom A!/ft Top 440 Bottom AY4-
Top Bottom__ Top Bottom
Lap Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top Q' Bottom hi" Ft. Zr' SCA-4 � _ PU[,
Top Bottom Ft -
Top Bottom Ft.
8. GROUT: Depth Material Metho
Tap O Bottom 9' Ft. e 'Ali
Top Bottom Ft.
Top i_Bottom Ft-
9. SCREEN: Depth Diameter Slot Size Material
Top_ 13' bottom Z9' Ft. Z° _in. .10 in- MR- [vhep
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top 11 Bottom Z 9' Ft._ 0l
Top
Top
Bottorn
Bottom
11. DRILLING LOG
Top Bottom
1
1
/
1
1
1
1
J
12. REMARKS:
Ft.
Ft,
Materia
Formation Description
I DO HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARoS, AND THAT A COPY OF THIS
RECORD FJAA$ eEF PRQvp D rrl7HE WELL OWNER.
74417 /' J /e_
SIGN AT IRE OF o// , � CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING Tye W LL
Form GW-lb
Quality information
JA-N,w78 o
•.. 1.�
. �+�a! I ncrl.lUl � i�r
����nSi I,N I.
ln/f)III(.4;
Processing,
807-6300
Submit within 30 days of completion to: Division of Water
1617 Mail Service Center, Raleigh, NC 27699.161, Phone - (919y

1_ WELL CONTRACTOR:
/,,I'If .;1.4
Wall Contractor (Individual) Name
A E DRILLING SERVICES, LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
City or Town State Zip Code
(864 ) 288-1986
Area code Phone number
2. WELL INFORMATION: T P "—
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(If epptcable)
SITE WELL ID #(II applicable)
3. WELL USE (Check One Box) Monitoring p Municipat/Pubfic ❑
IndustriarICommercial ❑ Agricultural ❑ Recovery ❑ InjectTon—
Irrigation❑ Other D (list use)
DATE DRILLED fir %Y I2
4. WELL LOCATION:
i (WIT cnic_=
(Street Name. Numbers, Community, Subdivision, Lot No., Parcel, Zip Cntle)
CITY: •SiA IAA iL ft COUNTY
TOPOGRAPHIC 1 LAND SETTING: (check appropriate box)
❑Slope ❑ Valley ❑Fiat D Ridge ❑Other
LATITUDE 36 " DMS OR 3x.xxxxxxxxx DO
LONGITUDE 75 " DMS OR 7X.XXXXxxxxX DD
Latitudeflongitude source: LAPS QfopographTc map
(location of well must be shown on a LISGS topo map andattached to
this form ifnot using GPS)
6. FACILITY (Name of the business where the well is located.)
ams4hvehemh-041-45-
Facility Name Facility ID# (if applicable)
cM Ere T r, 128 _
Street Address
,� ARCS
�IryJorJ l own f
Contact Name
.72-3; j,Quy. 0rri 5+-
Maifing Address
►�<,i <U;11 I I(
State Zip Code
0I
City or Town State Zip Code
C ❑•S } 1.<1
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL?
c. WATER LEVEL Below Tap of Casing: /r.
(Use "+° if Above Top of Casing)
YES t7 NO I8
FT.
NON ONRESIDENTJAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # f/
d. TOP OF CASING IS 3 ' FT. Above Land Surface`
'Top of casing terminated al/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118
e. YIELD (gpm): 4%%q' METHOD OF TEST
/111272
f. DISINFECTION: Type Aelt Amount
g. WATER ZONES (depth):
Top N/r Bottom AO- Top Ieoffr Bottom
Top Bottom Top
Top Bottom Top
T. CASSNG: Depth Diameter
Top O. Bottom ■.i Ft. 2'6
Top Bottom
Top _ Bottom
Ft.
Ft.
Bottom
Bottom
Thickness/
Weight
8. GROUT: Depth Material
Top ❑ Bottom ?' Ft. CY.146rd
Top Bottom Et.
Top Bottom FL
Material
Method
11
;Mi�q
9. SCREEN: Depth Diameter Slot Size Material
Top.[ _ Bottom' R. Z" in. . JD in. CJi/e. Li
Top Bottom Ft. in_ in.
Top Bottom Ft. in_ in•
10. SAND/GRAVEL PACK:
Depth
Top 4' Bottom Zf' Ft. #/
Top Bottom Ft.
Top Bottom F1.
11. DRILLING LOG
Top Bottom
r
1
1
1
I
1
12. REMARKS:
Size
EMaterfa I
.59AL
Formation Description
n
ccil�[^O N C
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF CERTIFEE
ELL CONTRACTOR DATE
/jf L►r,�.
PRINT _D tJ ME OF ERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
f'Tnmi SA14tFb �F D
�: Rev'21a9 " t:r
. f A N 9 717 °
.1iiorrnatlOi
_.-i; 1_1n1$

NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3S7/
Weil Contractor (Individual) Name
A E DRILLING SERVICES. LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 22607
City or Town State Zip Code
(864 ) 288-1986
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCT/ON PERMIT#
OTHER ASSOCIATED PERMIT#(iI applicable)
SITE WELL ID #(If applicable)
3. WELL USE {Check One Box) Monitoring 0 MunicipaUUPubliC
Industrial/Commercial ❑ Agricultural ❑ Recovery CI Injection E.—
Irrigatian❑ Other D (list use)
DATE DRILLED
4. WELL LOCATION:
C ycillel1 i
(Street Name, Numbers, Community. Subdivision, Lot No., Parcel, Zip Code)
CITY: nL COUNTY
TOPOGRAPHIC / LAND SETTING: (check aCprnpriate hnx)
❑Slope ED/alley ❑Flat ❑Ridge DOther
LATITUDE 36 DMS OR 3X.X)00000a(x DD
LONGITUDE 75 - " DMS OR 7X.xxxX? xxxx DD
Latitude/longitude source- BPS DLopographic map
(location of well most be shown on a USGS topo map andatteched fo
this farm if not using GPS)
5. FACILITY (Name of the business where the well is located.)
L4r.,o} !rco a
Facility Name
II rr r
2,1
Street Address
-- Rshevi I le
Facility ID# (if applicable)
/t/, Cr ,Q.c6,705
City or Town +
411'00,, I1UI �: .i}'u-t1TCt.1
Contact Nam
Mailing Address 6._ fir n of 1e I t u��l
State Zip Code
City or Town State Zip Code
) ;?I 33 c:
Area code Phone number
6. WELL DETAILS:
I I
a- TOTAL DEPTH: F
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO r'
c. WATER LEVEL Below Top of Casing- Cif.1 '7 FT
(Use "*" if Above Top of Casing)
d. TOP OF CASING IS
e. YIELD (gpm):
1r .
FT. Above Land Sur7aue-`
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118-
METHOD OF TEST I1140
/Vri.fr Amount
f. DISINFECTION: Type
g. WATER
Top
Top
Top
NES (depth): Bottom #4 Top �`/`/
Bottom "1„,/€
Bottom Top Bottom
_ Bottom Top Bottom
7. CASING: Depth Diameter
Submit within 3D.d4ys:ofc mpletion to: Division of WaterQtrality - Information Processlna;,
,16117 Serniicf Ceriter, Ra1etg1,:.NC-27699061, Phone: t919j 897,6300 •
.".---:ti__.::...-
Top
: Top
Top
Thickness!
Weight Material
Top Q' Bottom I3 Ft. 2„ 5e.h•th) v OC•
Top Bottom
Top Bottom
FI
Ft.
8. GROUT: Depth Material Method
Top ` Bottom. ` T Ft. en.� 7I1!+1 f Ip I
Top Bottom Ft.
TopBottom Ft.
9. SCREEN: Depth
Top At. Bottom
Top /)' Bottom
Top Bottom
10. SAND/GRAVEL PACK:
Depth G Size Material
Bottom FI./O�
Diameter Slot Size Material
Ftin. in, , i
'' Ft. 2„ in. 10_ in- i{li1 p.--Lairde
Ft. in. in
Bottom _ Ft.
Bottom Ft.
11. DRILLING LOG
Top Bottom
I
I
f
12. REMARKS:
Formation Description
I DO HEREBY CERTIFY Ti-IAT THIS'NELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC ZC, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF TFIIS
RECORD F AEE � OVIDEOTO THE WELL OWNER.
SIGNATUR t7FTt� F!E9 WELL CONTRACTOR DATE
/1 / I U.rf l t'
PRINTED NAME OF PERSON CONSTRUCTING
Fgr. GW-1I,
I,1farrnal.i60

NON RESIDENTIAL WELL CONSTRUCTION RECORD
Norte? Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3 71
1. WELL.CONTRACTOR:
diet� g
Well Contractor (Individual)t3ame
A E DRILLING SERVICES, LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
City or Town State Zip Code
(864 ) 288-1986
Area code Phone number
2. WELL INFORMATION: ZP-10 11
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #{if applicable)
3. WELL USE (Check One Box) Monitaring p Municipal/Public 0
industrial/Commercial 0 Agricultural 0 Recovery Q Injection Igo
Irrigation❑ Other 0 (list use)
DATE DRILLED 11-IS /Z
4. WELL LOCATION:
(Street Name, Numbers, Community. Subdivision, Lot No., Parcel, Zip Code)
CITY: Sik- J\11Ctj\fLr_ (C COUNTY
TOPOGRAPHIC / LAND SETTING: (check appropriate bo>�
❑Slope ❑Valley ❑Flat ❑Ridge ❑Other
LATITUDE 36 " IDMS OR 3X.x 000aotxx DD
LONGITUDE 76 " DMS OR 7X.l00000000t DO
Latitude/longitude source: CDPS ❑topographic map
{location of well must be shown on a USGS topo map andattached to
Otis form if not using GPS)
S. FACILITY (Name of the business where the well is located.)
Ct+lenk4ron tc--c
Facility Name Facility ID# (if applicable)
I RG Old ie (ice
ce
Street Address
_ ph5heo I le .l /V I . ISt 65
Lary or f own State Zip Coda
a lIev lust Env; Pc ; ,ru} al
Contact Name
3 ! 1•6,v2occi Seee+
Malang Address
)eviIlle lr)C Se-oi
City or Town State Zip Code
( ) ,G I 1356
Area code Phone number
B. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO V
c. WATER LEVEL Below Top of Casing' — Pe q FT.
(tile "+" if Above Top of Casing)
411269
d. TOP OF CASING IS 1' FT. Above Land Surface*
'Top of casing terminated atlor below land surface may require
a variance in accordance with 15A NCAC 2C .0116.
e. YIELD (gpm): /Olt METHOD OF TEST h/�4
I. DISINFECTION: Type otOr Amount
g. WATER ZONES (depth):
Top .I% Bottom W/1 Top 4J/1 Bottom
Top Bottom Top Bottom
Top Bottom Top _ Bottom
Thickness!
7. CASING: Depth Diameter Weight Material
Top /I' -Bottom if' Ft. z'i _$Ck Ie LUc
Top Bottom Ft.
Top Bottom Ft.
r1
8. GROUT: Depth �/++ Material Method
Top DI Bottom ' 1 Ft (2Il7 7iI Mr Ed
Top Bottom Ft
TopBottom Ft.
IL SCREEN: Depth Diameter
Top %I' Bottom c Ft. ,drl In.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK
Depth Size
Top 11 Bottom Z9' P1. g
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
I
1
1
1
1
1
1
12. REMARKS:
Slot Size Material
,10 in. a ); ev2.- Arc_
Materinj
Formation Description
I DO I-EREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD RAS Ht Ell PRTOTO g.WELL OWNER,
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to! Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699.16i, Phone : (9191 8U1.63OO
,71 E ' _'Form GWl b' D
Rev. eras
JAM 8 2011
?.'Y(J.:.NS$In'1 !Unit
- Arr.ibr 5r:

NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # is-7/
1. WELL CTRAM&
[ - (alp
Well Contractor (Individual) Name
A E DRILLING SERVICES. LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
City or Town State Zip Code
(864 288-1986
Area code Phone number _
2. WELL INFORMATION: ' �- ray /0
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT appil:.abie)
SITE WELL ID #(if applicable)
3. WELL USE (Check One Sax) Monitoring L] Municipal/Public
industrial/Commercial D Agricultural ❑ Recovery 0 injection
IrrigationD Other D (list use)
DATE DRILLED N /S-a-
4. WELL LOCATION:
(Street Name, Numbers, Community, subdivision, Lot No., Parcel, Zip Code)
CITY: S L& IN`r.14 `•C h.,C COUNTY
TOPOGRAPHIC I LAND SETTING: (check appropriate box)
D Slope ❑ Valley Q Flat °Ridge °Other
LATITUDE 36 " DMS OR 3x.xxxxxxxxx OD
LONGITUDE T5 " DMS OR 7X.XXXXxxxxx DD
Latitude/longitude source: 1:i3PS ['Topographic map
(location of well must be shown on a L)SGS topo map endattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located_)
�I[U) its
Facility Name Facility ID# (if applicable)
IRe; G1d tSee Tee
Streat Address
Ahev-Ole j,Ct L g2G5
City or Town 1.
�!lI-6 e1i,i /-DV;f�xs:i -�tt
Contact Name
.3 i
Mailing Address -
Pc
State Zip Code
City or Town State Zip Code
ail 2,356
Area code Phone number
6_ WELL DETAILS:
a. TOTAL DEPTH:
Qv;
b. DOES WELL REPLACE EXISTING WELL? YES L I NO 0
c. WATER LEVEL Below Top of Casing: ' 6ti FT.
(Use "4" if Above Top of Casing)
Elf ti68
d. TOP OF CASING IS .21 FT. Above Land Surface`
'Top of casing terminated atlor below land surface may require
a variance in accordance with 15A NCAC 2C .0116.
e. YIELD (gpm): Ali METHOD OF TEST
f. DISINFECTION: Type 4f/d Amounts
g. WA ONES (depth)' �% �]
Top Bottom // Top 're Bottom /1J r
Top flnttnm Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top a` Bottom at Ft. 2" C_ ► .ie WC__
Top Bottom Ft. _
Top Bottom Ft.
8, GROUT: Depth Material Metho
Top 4' Bottom 9' Ft. 'ir+e fly ►e
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material n
/! BottomZr .►4 Uj_ (,4j:ram Poc
Top � Ft. � in. in.
Bottom Ft- _in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth .2S�ize Materials
Top ,1� Bottom Oft Ft. ��a' .S O
Top Bottom Ft.
Top Bottom FL
11. DRILLING LOG
Top Bottom Formation Description
r or ¢ I,
1
1
1
1
1
r
: 12. REMARKS:
t DO HEREBY CERTIFY THAT THIS V LL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDETO TF WELL OWNER.
- SIGN CE�RTIFIEE❑ WELL CONTRACTOR
�I ' 12' fit! !'e
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Subrnitwithin 30.days ofcompletlon to: Division of Water Quality - Information Processing,
1617 Mail Service Centerf-Raieigh,;1C Z7699-1fi1, Phone : (919) 897-G3{i0.
DATE
,) 77: ft r- t 4
- FormGW=1h-' .)
Rev_ 2IU9
•IANI `? R 2ll11
• •I
irsi!

NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 557/
1. WELL 4i
Well Contractor (Individual) Name
A E DRILLING SERVICES, LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE
City or Town
(864 288-1986
Area code Phone number n
2. WELL INFORMATION: Z�`
WELL CONSTRUCTION PERMIT
OTHER ASSOCIATED PERMIT#(inapplicable)
SITE WELL ID It -(if applicable)
SC 29607
State Zip Code
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural 0 Recovery a Injection r —
Irrigation❑ Other ❑ (list use)
DATE DRILLED -iz
4. WELL LOCATION:
1 I). ,5,41)5 S
CITY: L:Y. '/. 1 et/ IC n ( COUNTY
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley ❑Flat ❑Ridge E7Other
LATITUDE 36 " DMS OR 3x.xm00000cx DD
LONGITUDE 75 " DMS OR 7X.:00000D000 ❑D
l atitudeflongitude source: ❑PPS Llropographic map
['ocean of well must he shown on a LISGS tops map andattached to
this form ff not using GPS)
5. FACILITY (Name of the business where the welt is located)
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
exam /tonics
Facility Name Facility ID# (if applicable)
1,;6 GibISee e Pd.
Street ' rid ress
j-tecr i It
CRy 41 1 41,91
A-k inb,,.4- End i rt,PA1e1 its 1
Contact Name
F .23 i c_C.(J1 s+.
Mailing Addree
I; II+ f )C d-C143I
State Z.rp Code
City or Town
State zip Cade
. i 3356
Area code Phone number
6. WELL DETAILS: Gj
a. TOTAL DEPTH: f7L 9
b. DOES WELL REPLACE EXIS11NG WELL? YESD NO
c. WATER LEVEL Below Top of Casing: 5 FT.
(IJse `+' if Above Top of Casing)
411267
d. TOP OF CASING IS J FT_ Above Land Surface*
"Top of casing terminated attar below land surface may require
a variance in accordance with 15A NCAC 2C .0118./
e. YIELD (gpm): /Vie `METHOD OF TEST 1/W
f. DISINFECTION: Type Avf,T Amount AV
g. WATER ZONES (depth):
Top fr'* Bottom ft/4 Top di/Bottom
Top
Top
Bottom Top Bottom
Bottom Top Bottom
7. CASING: Depth Diameter
Top d Bottom 13 Ft; E •r - Top Bottom Ft.
Top Bottom FL
Thickness/
Weight Material
,'4.7 A .
S. GROUT: Depth Material /
Top D* Bottom Ft. (, e/Velif
Top Bottom Ft.
Top Bottom Ft.
Method
S. SCREEN: Depth r� r Diameter Slot Size
Top_ Bottom_ 07/ Ft. 2 ±► in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. In.
Material
10. SAND/GRAVEL PACK:
Depth Size
Top II* Bottom Oi Ft. #1
Top Bottom Ft.
Top Bottom Ft.
Material
11. DRILLING LOG
Top Bottom Formation Description
1 r1r: ro ii 4r
1
1
1
1
1
12. REMARKS:
I Do HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS FEEN PRO En TO11- E WELL OWNER.
SIGNAT RE OF CERTlFSED WELL CONTRACTOR DATEPRI ED hEA'fIAE OF PERSON CONSTRUCTING TH WELL
Submit within 30 days of completion to: Division of Water Quality - information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
r»47rrnatd{.+n '�f Yr`r Salt.{ (_Hitt

NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3aj %f
1. WELL CONTRACTOR:
Well Contractor (Individual) Name
A E DRILLING SERVICES. LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
City or Town State Zip Code
( 864 ) 288-1986
Area code Phone number
2. WELL INFORMATION: �r ■ 05-- — S—
WELL CONSTRUCTION PERMIT
OTHER ASSOCIATED PERMIT#(ir applicable)
SITE WELL ID#(PI applicable)
3. WELL USE (Check One Box) Monitoring L2 Municipal/Public D
IndustriaYYCommercial t7 Agricultural q Recovery Cl injection
irrigatIonu Other D {list use)
DATE DRILLED /7-4/ Z-
4. WELL LOCATION:
Ilc i rriro+- r ES
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: S{As11AQ4 I)C COUNTY
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley
LATITUDE 36 " DMS OR 3x.xxxxxxxXX DD
LONGITUDE 75 ° " DMS OR 7x,xxxxxxxxx DD
Latitude/longitude source: [ 3PS Eropographic map
(location of well roust be shown Orr a USGS topo map andatteched to
this fort if not using GPS)
5. F
AC
` Chef,/ I
LTY
(Name of the business where the well is located.)
Chef,/7f Ji7JC1
Facility Name _ Facility iD# (if applicable)
V15 Old firE� Tire
❑ Flat d Ridge ❑Other
Street ' Adr1rrc
" f9
City
1orrTTown
r`' 1L+1Y1On EN+Meru fed f
Contact Name
F723 t I' un.
Mailing, Address
/ I f.) 13o ��1 --
State Zip Code
City or Town State Zip Cade
( ) I 3356
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:
(21r
b, DOES WELL REPLACE EXISTING WELL? YES ❑ NO e
c. WATER LEVEL Below Top of Casing- 6.:-2
i T.
(Use "+" if Above Top of Casing)
i
/11266
d. TOP OF CASING IS . a FT. Above Land Surface'
"Top of caning terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
YIELD (gpm): N/S METHOD OF TEST Aiht
f. DISINFECTION: Type /t!/# Amount (!//R
g. WATER ZONES (depth):
Top /I/ /A Bottom N%/¢—
Ton Bottom
Top Bottom
Top WA— Bottom
Too
Top
Nf
Bottom
Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top a' Bottom %1 Ft. 2'
Top Bottom Ft.
Top - Bottom Ft.
8. GROUT: Depth t� Material Method
Top Ot Bottom I Ft.e-RT 7#1,01.1-e
Top Bottom Ft.
Top Bottom_ Ft.
9.. SCREEN: Depth a Diameter Slot Sire Material �I
Top 131 _ Bottom Ft. 2 in. it/ in. L� ` id; t r
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth , Size Material
Top 11' Bottom 25 Ft. Of
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
1
1
1
1
1
1
1
12 REMARKS:
Formation Description
100 HEREBY CERTIFY Ti 1AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND ThAT A COPY OF THIS
RECOR4 HAS BEEN PROViOEO ► THE • • LL OWNER-
51
ATUIgE FCERTIFIED WELL CONTRACTOR
et/ FM t!6'41 rt
NAME ❑F PERSON
CONSTRUCTING
PRINTSTHE WELL
DATE
— — • - •. '!~ Form GW-1 b
S1141TI t=wit)iin ,O daysot compleUon•to: Division of Water iiallity -" Irifornnation P>rocesstng, ; 20
v. 2/09
,.;�°�
:j0'[1 Mail�5ei[i�e Cei�iter, .i�aleigl;f�G 21699=7 6i, Phone , E919{+ BQT,63D4 �':•� • 7 g AN
.. __..._..__�-n a_[�- !L�_. .. '�' _.. _._r."... ..-.f. r .�.•v .a-S..n
sr;lormation Processing
:1WR1Fro

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- es- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # .5 7/
1. WELL CONTRt4CTQ€i frif., i(al--
Well Contractor (Individual) Name
A E DRILLING SERVICES, LLC
Well Contractor Company Name
ZVVO UNITED WAY
Street Address
GREENVILLE
City or Town
t 864 ) 288-1986
Area code Phone number
2. WELL INFORMATION: Pr loS - J
WELL CONSTRUCTION PERMIT#
SC 29607
State Zip Code
OT!-tER ASSOCIATED PERMIT#(ir applicable)
SUE WELL ID #(ir applicable)
3. WELL USE (Check One Box) Monitoring 0 Municipal/Public D
Industrial/Commercial ❑ Agricultural ❑ Recovery L1 Injection f�
Irrigation❑ Other D (list use)
DATE DRILLED Ir- 1 - /
4. WELL LOCATION:
Lf1dyr,�1�.nG=.
(Street Name, Numbers. Cammunity, Subdivision, Lot No., Parc$ 21p Code)
CITY: COUNTY
TOPOGRAPHIC / LAND SETTING: (check appropriate boxy
['Slope ❑Valley ❑Flat CI Ridge ❑Other
LATITUDE 36 " DMS OR 3X.)OC xxx x x DD
LONGITUDE 75 ° " DMS OR 7X,XX xxxxxx DD
Latitude/longitude source: J3PS Qropographic map
(location of well must be shown on a USGS tope map endattached to
this form if Rot using GPSJ
5. FACILITY (Name of the business Where the well is located.)
Cliewifcan 5
Faddy Name
£ -free-
Street
Address
l sk►cv:l!e 1l'4" .2gg5
City orTown
`ethiOn`- tEnv:ronfulykl
Contact Name
23I I�a4kxcd S�
Mailing Address -
A - he C
Facility ID# (if applicable)
City or Town
agi-35
Area code Phone number
B. WELL DETAILS:
a. TOTAL DEPTH:
State Zip Code
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Q'
c. WATER LEVEL Below Top of Casing: '7• 0, FT.
(Use "+" if Above Top of Casing)
Top /2 ' Bottom n27` Ft. 2.`
Top_ Bottom Ft.
Top Bottom Ft. In. In.
411265
d. TOP OF CASING I5 J FT. Above Land Surface*
`Top of casing terminated attar below land surface may require
a variance in accordance with 15A NCAC 2G .0118,
e. YIELD (gpm): AIM METHOD OF TEST /2/4
f. DISINFECTION: Type AM} Amount /l%/l?
g. WATER TONES (depth): ��??
Top ,r �� Bottom N// Top 4),O Bottom A4
Top Bottom _ Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Ft. $11 0 PO
Top. 01 Bottom a
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material
Top b 1 Bottom $1 Ft. C.a.,'ell,
Top Bottom Ft.
Top Bottom Ft.
Method
►t71itn
9. SCREEN: Depth Diameter SlntSize Material
in. .00 in_ t..) . rtt_ in. In. !�
1o. SAND/GRAVEL PACK:
Depth Size Material]j
Top ID Bottom Z$' Ft. #� 54n64
Top • Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom Formation Description
1
1
1
1
1
1
1
1
1
12. REMARKS:
' 1 DO 11ER€ev CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
REOORL eEE1! PROVIDED TO THE WELL OWNER.
JL/ —JZ—
SIGNATU OF CEI�T1 ED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GW-1b
Rev 2S Oh
'reformation Pet ssin; Urn
Ow4d/F4 ry,.,

NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3571
1. WELL CON,T{�RACTOR:
Well Contractor (individual) Name
A E DRILLING SERVICES, LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
City or Town State Zip Code
( 864 ) 288-1986
Area code Phone number
2_ WELL INFORMATION: X/ / -* /
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#( applicable)
SITE WELL ID #(rf applicable}
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public 0
IndusMalVCommercial ❑ Agricultural ❑ Recovery ❑ injection Et -f
Irrigation❑ Other ❑ (list use)
DATE DRILLED JI 2/^I 2--
At. WELL LOCATION:
.r,en-,4nics
(Street Name, Numbers, Community, Subdivision. Lot No., Parcel, Zip Code)
WY: C� ,Ckfv)A OCR. }(. COUNTY
TOPOGRAPHIC / LAND SING: (check appropriate box)
['Slope ❑ Valley ❑ Flat ❑ Ridge E t Other
LATITUDE 36 DMS OR 3X.XX 000cXXX DD
LONGITUDE 75 - - .. " DMS OR 7X.xXX)CCOOCX DD
Latitude/longitude source: COPS QTopographic map
(location of well must be shown on a USGS topo map andattachred (0
this form if not using GPS)
9. FACILITY (Name of the business where the welt is located-)
61er+i
Fealty Name
t (: CIO i'e 7:! v i
Street Address
Pae►s� J I E /Ai
City or Town State Zip Code
Facility ID# (if applicable)
o
Contact Name' J
Mailing Address
,1-1 12 i'1 L
g1
City or Town State Zip Code
}I .56
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO OF
c. WATER LEVEL: Below Top of Casing_ 7R ` 4-- FT.
(Use "+^ if Above Top of Casing)
it;rntitl inraDsdays ct
411262
d. TOP OF CASING IS 31 FT- Above Land Surface'
`Top of rising terminated attar below land surface may require
a varianre in arxmrrtanrxa with 15A NCA(: 2C 01118.
e. YIELD (gpm): Af/' METI]O4
D OF TEST A/
f. DISINFECTION: Type WI/ Amount
g. WATER ZONES (depth):
Top /11J4 entiom_LIZZik Top
Top Rrdrnm Top
Top Bottom Top
Mr
/V//'-Bottom / /4--
7. CASING: Depth Diameter
Top' Bottom: 2ir Ft. Zrr
Fop Bottom Ft
TopBottom FL
Rnffnm
Bottom
Thickness!
Weight Material
..cl. gib i OL
8- GROUT: Depth Material Meth d
Top 01 Bottom 17' Ft 1 7ra<A al
Tap Bottom Ft.
Top Bottom - Ft
9. SCREEN: Depth Diameter Slot Size
Top 214 Bottom 4f Et. _ r in. AD_ in.
Top Bottom FL in. in.
Top Bottom Ft_ in.
10. SAND/GRAVEL PACK:
Depth Sine
Top I! Bottom 421 Ft. dl
Top Bottum
Top Bottom
11. DRILLING LOG
Tap Bottom
it
1
i
1
1
f
12. REMARKS:
PL
PL
Nlatorial
ga R
Material
tie-•J
Formation Description
5L1^'_r 14r
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
75ANCAC2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER
11 C
F CERT IFIED W CONTRACTOR DATE
•
PRINTED NAM) OF PERSON CONSTRUCTING THE WELL
ut•npletion to: Di i sion of Wate ii I.}tyem,: irriorrrraiian iProces-sing. -.
e?Ig�T; HG 276.9-:161, Phozc; [t> 6
r Farm GW=ih
Rev. 2/09
.J A N 2 8
..inrl; :-..,t;;, ,

NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # j,71
1_ /rI! was
Well Contractor (Individual) Name
A E DRILLING SERVICES, LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE
City or Town
(864 ) 288-1986
Area code Phone number Q
2_ WELL INFORMATION: EP-15/7—
WELL CONSTRUCTION PERMIT#
SC 29607
State Zip Code
OTHER ASSOCIATED PERMIT$(if applicable)
SRE WELL ID #(ii applicable)
8_ WELL USE (Check One Box) Monitoring 0 Municipal/Public 0
Industrial/Commercial 0 Agricultural ❑ Recovery ❑ Injection
Irrigatianp Other ❑ (list use)
DATE DRILLED //-W /
4. WELL LOCATION:
Cheiiy litrkr
(Street Name, Numbers, Community, Subdivision, Lot No„ Parcel, Zlp Code)
CITY: 3 ), it,f]CGL t7C COUNTY
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
['Slope ❑Valley ❑ Flat ❑Ridge ❑other
LATITUDE 36 ' " DMS OR 3X.X;c0C CCOC DD
LONGITUDE 75 ' • " DMS OR Tx COOCOOOOC DD
Latitud&tongitude source: BPS []Topographic map
(location of well must be shown on a USGS topo map andalteched tv
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
eh erikoilic-5
Facility Namle b,, _
d
Street Address
ASbe
City
'}orrr�ITown
Afl'1s',I+-i 3T
f�ll.Cr
a- ril1lmen+mil
Contact Name j
411Q I{. YY11 ST_
Malllj9�g Address
I
Facility ID# (if applicable)
gO 5
State Zip Code
City or Town I
( ) �41-35
Area code Phone number
E. WELL DETAILS:
a. TOTAL DEPTH: 30C'
b_ DOES WELL REPLACE EXISTING WELL? YES ❑ NO IR'
c. WATER LEVEL. Below Top of Casing: /4. yS FT.
(Use "+" if Above Top of Casing)
State Zip Cade
-S t ► fin1h 101.c ; of dgtiipI4tipt o�v � r gr'1 �lt6r ;Y,..,
--1
17 tItla"}k 1i a I ertzR;cc�aleigii; �5;.37,„99- i;:Pn4n (9� 9j 8 7-6Z0O
4112f3
d. TOP OF CASING IS 3' FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): Ai/( METHOD OF TEST
f_ DISINFECTION: Type Wit Amount
g. WATER ZONES (depth).
Top A►/ Bottom//4 Top
Top Bottom Top
Top Bottom Top Bottom
A//fr
Bottom
7. CASING: Depth
Top 0' Bottom? 201 Ft.
Top Bottom Ft.
Top Bottom Ft.
B. GROUT: Depth
Top d' Bottom 41 Ft
Top Bottom Ft.
Top Bottom Ft.
Material
Material
Method
9. SCREEH: Depth Diameter Slot Size
Top 21 Bottom MO' FL 2" In. .het in.
Top Bottom FL in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Top ig' Bottom 41' Ft.
Top _ Bottom Ft.
Top Bottom Ft.
11, GRILLING LOG
Top Bottom
1
12. REMARKS:
Material
zze IIAai
Formation Description
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WrrH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT ACOPY OF TFRS
RECORD HAS BEEN PROVIDED TO THE WELL 0WNER
t
u
SIGNATURE OF CERTIFIED WEL
Thickness/
Diameter Weight
2'
CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
stein p is rAtn:
•
Form GW-{t4N 2 8 ?or
Rev, 2109
'r�iOrlYlatir3i]':rn,7

NON RESIDENTL L WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # , , f
1, WELL CONTRACTOR:
4.e1 / rr(;��.
Well Contractor (Individual) Name
A E DRILLING SERVICES, LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE Sc 29607
City or Town State Zip Code
(864 ) 288-1986
Area code Phone number
2. WELL INFORMATION:V.-1 Y7 Ir
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID*(it applicable)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public
Industrial/Commercial ❑ Agricultural ❑ Recovery t Injection '
Irrigation❑ Other ❑ (list use)
DATE DRILLED jj • it, / 2
4_ WELL LOCATION:
Cyr;1}I lri L.
(Street Name, Numbers, Community. Subdivision, Lot No., Parcel, Zip Code}
CITY: � L,Izti o', A 7( COUNTY
TOPOGRAPHIC / LAND SETTING: (check spproprlate box)
11151ope IDVailey ❑Flat DRidge Li Other
LATITUDE 36 ° " OMS OR 3X.XXXXXXXXX ❑D
LONGITUDE 75 ° " DMS OR 7X.xxXXXxxXx DD
Latitude/longitude source: [PPS DTopographic map
{location of well must be shown on a USGS topo map andattached to
ibis form if not using GPS)
5. FACILITY (Name of the business where the well is located-)
Cit row ;16.
Facility Name
/i fee fret -
Street Arirlro�^
City Vi IUnit p
Facility lD# (if applicable)
State Zip Code
Contact Name
Mailing Address
City or Town State Zip Code
Area code Phone number
6_ WELL DETAILS:
e. TOTAL DEPTH: 7f
b. DOES WELL REPLACE EXISTING WELL? YES r] NO H`
c. WATER LEVEL Below Top of Casing: ,'61, // FT
(Use "+" If Above Top of Casing)
/I1126O
d. TOP OF CASING IS J FT_ Above Land Surface`
'Top of casing terminated at/or betow land surface may require
a variance in accordance wi#h 't5A NCAC 2C .0118.
e. YIELD (gpm): itJ//4 METHOD OF TEST
f. DISINFECTION; Type Amount %I
g. WATER ZONES (depth):
Top AJ).4' Bottom A/4 Top 4/4" Bottom
Top Bottom Top -. Bottom
Top Bottom Top Bottom
Thickness)
7. CASING: Depth Diameter Weight Material
Top Dr _ Bottom gie Ft. Zr 501.0 ft)
Top Bottom Ft.
TopBottom Ft.
Nl4-
8- GROUT: Depth Mateia! Method
Top # t Bottom- l L I Ft.� j�1 e
Top Bottom Ft.
Top Bottom Ft
9. SCREEN: Depth i11 Diameter Slot Size Mate ial �i
Top_/1 Bottom '77 Ft.d" lo. •10 in. �+leLk"
•
Top Bottom Ft- In. in.
Top Bottom FL In. in.
10. SAND/GRAVEL PACK:
Depth Size Material
Top If' Bottom 1 Ft.
Top Bottom Ft.
TopBottom Ft-
11. DRILLING LOG
Top Bottom Formation Description
1
1
1
1
1
1
1
12. REMARKS:
1 ❑O HEREBY CERTIFY Tl- 4T THIS WELL WAS CONSTRUCTED IN ACCORDANCE W1T1-I
7 5A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED Tfl THE WELL OWNER
SIGNATURE OF CERTIF ED
ELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
ubniitwithin-30 days of c'omp1efgon to: Division of-W_ Water Du iIIty - In€orrr ai cin ProAe4irib,
' 1&17,MailSetvice .t ter, Bale h, NC.27699-101,'Phprie. (41!) 801•-634U t•
L44.!i.... ' e` .e..'-.�.
FormGW-1b
Rev. 2/D9
JAN 2 8 ;Ili?.
IrlfGrrriat{0r: "1•4y,r.142:1010 Line
g..1/f1/p r.n

NON ON RESIDENTJL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
1. WELL CONTRACTOR:
Adel rnrGe�lft..
Well Contractor (Individual) Name
A E DRILLING SERVICES, LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE
City or Town
f 864 3 288-1986
Area code Phone number
2. WELL INFORMATION: iv. !tn- 13
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERM1T#(Irapplicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Monitoring D Municipal/Public ❑
Industrial/Commercial ❑ Agricultural 0 Recovery D Injection t r
IrrigationD Other 0 (list use)
DATE DRILLED ID-23-i 7-
4. WELL LOCATION:
, 44111 r '-.
SC 29607
State Zip Code
(Street Name, Numbers, CommunIty, Subdivision, Lot N6., Parcel, Zip Code)
CITY: Sat" rtAOgoo 14)4 COUNTY
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope QValfey QFlat QRidge QOlher
LATITUDE 36 " DMS OR 3x.xxxxxx cxx DD
LONGITUDE 75 "DMS OR 7x.xxxxxxxxx DD
Latitudellongitude source: E33P5 ❑Topographic map
(location of well must be shown on a USGS topo map andettached to
this form if not using GPS)
5. FACILITY (Name of the business where the well Is located.)
`.wl4Con;tS
Facility Name Facility ID# (if applicable)
Old r6
Street Address
City or Town State Zip Code
Contact Name
Li I S4- -
Mai`OAddress - gAddre
01.1 nc 3230I
City or Town State Zip Code
agi 336c
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:
qz
b, DOES WELL REPLACE EXISTING WELL? YES 0 NO
c. WATER LEVEL Below Top of Casing- raji FT.
(Use "+" if Above Top of Casing)
Top
Top
Top
3 1
' d. TOP OF CASING IS FT. Above Land Surface'
'Top of casing terminated at/or beiow land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm) pjlA METHOD OF TEST WA-
f. DISINFECTION: Type_ Amount «1
g. WATER ZONES (depth):
Top AA' Bottom$
Top Bottom
Top Bottom
7. CASING: Depth
t-' Bottom_ 26• _ FL a
Bottom Ft.
Bottom Ft.
Top AMA' sottorn
Top Bottom
Top Bottom
Thickness/
Diameter Weight Material
8 GROUT: Depth Material Method
Topes Bottom Ft. Ce 77-; "xi &el
Top Bottom Ft. — - - - - 1
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Sae Material n
Top_ 2.1' . Bottom &I• _ FL�in. . 10 in. li„];l'e r th]tsp
Top Bottom Ft. in. In.
Top Bottom Ft. in. in. _
10. SAND/GRAVEL PACK:
Depth �sSize M�ateri4
Top 19' Bottom 4 a1` Ft. 4* ((
� iiRf1 J'
Top Bottom Ft_
Top Bottom_ Ft.
11. DRILLING LOG
Top Bottom Formation Description
• it 4r
1
12. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCONDANCE WITH
SSA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND TtWT A COPY OF THIS
RECCRD HAS BEEN PROVICEDTO THE WELL OWNER.
SIGG+IATURE OF CYERTIFI WELL CONTRACTOR istaaAJ �� DATE
46E1 f"IEirsll411A--.
PRINTED NAME OF PERSON COIRtiCdINplia.►ou. I 1
r x�:'.�..ri-,axAotic'loil. #a visjiiqr,.aQ=. q
6..xfa`foZ'ri Pigiek5.1ng,.Stdih,'+ f r eg .2a.
9
....t_I4ria § •::r- :::_..e..=......e. .....r.:w...ii.i m..-1 .j 16 ti iaCentet,Ral NC•ITS99 •SPt� .. 0-t6 _zitiiiti ' :_3 "s.3....... 13LiDn }rQCiSirlJr�j
D> /Q'BQ

NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3S7)
1. WELL CONTRACTOR:
Iy1 1,fe
Well Contractor (Individual) Name
A E DRILLING SERVICES. LLC
Welt Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
City or Town State Zip Code
(864 288-1986
Area code Phone number
2. WELL INFORMATION: P-fLi7-3
WELL CONSTRUCTION PERMIT#
OTHER ASSUL:IA7 ED PERM! f #{ff applicable)
SITE WELL ID #(i[ appticatafe}
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial G Agricultural ❑ Recovery ❑ Injection t-
Irrigation❑ Other ❑ (list use)
DATE DRILLED JI^"'/Z-
4. WELL LOCATION:
V De } rii'f-•151`C i
(Street Name, Numbers, Community, Subdivision, Lot No.. Parcel, Zip Code)
CITY: LG'sr,,� Sr'.c l 1( COUNTY
TOPOGRAPHIC / LAND SETTING: tcherk appropriate boil
❑Slope ❑Valley ❑Flat DRidge ©Other
LATITUDE 36 " DIMS OR 3x.xxxxxxxxx OD
LONGITUDE 75 " DMS OR 7X.xxxxxxXxx DD
Latitude/longitude source: LJ3PS ❑Topographic map
(location of well must be shown on a USGS fnpo map andattached to
this form if not using GPS}
5. FACILITY (Name of the business where the well is faceted.)
t_. kens:17(6611A
Facility Name
iitc 0/c1 die / rfC
5tr et Address
Pr/
City orTown +/1
hl' 4-al),EriL'rfr,r}frifl?�c�
Facility ID# (if applicable)
Contact Name
a3 i 4
Mailing Address.
fik'.I k' V a l Ir _i ' I ( cL YO
State Zip Code
City or Town Stale Zip Code
{ D)il ) ..i I L}J (D
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: teal
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO L3-
c. WATER LEVEL Below Top of Casing L.5 a FT.
(Use"+" if Above Top of Casing)
Submit within 30 dax s of compiet4on to: Division of'Water Quality information;Processing,
•1617 Mail Service Center, Raieign, NC.27699='t61, Phone [phone] . .
4' L)
d. TOP OF CASING IS , r FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e_ YIELD (gpm): L)J/)- METHOD OF TEST r)/dd
f. DISINFECTION: Type /Ol- Amount ,/
g. WATER ZONES (depth):
Top itkl— Bottom if.)/it Top , /4 eottoni 440
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth /M + Diameter Weight Material
Top ❑' Bottom �..7 Ft. Z2- � Yti �+
Top
Top
Bottom
Bottom
Ft.
Ft.
8. GROUT: Depth Material Methodet
Top aBottom 91 Ft. ( !�_fACid J e.'41+ C.-
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Top One t3ottom Ft.#2 in. Material
in. Material
t r a'
Top 13,S' Bottom as .is 5 Ft. in. _ in.
Top _ Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
Top _Bottot Ft
Top igirtBottom it t.
Top /I r?r' Bottn m nix Ft. 74EI _ S no/
11. DRILLING LOG
Top Bottom
1
rt
1
J
i
12. REMARKS:
Formation Description
ir
I D4 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGMA
URE OF CERTIFIED p9ELL CONTRACTOR DATE
ei
PRIN1 f. D NAME OF PERSON CONSTRUCTING THE WELL
L r 6 ' —ry r c
Form GW-lb
R.PA g!F1 82013
information: Cri:.�s3ine Uinir
i)WQIF30(_

NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # J571
1. WELL CONTRACTOR:
Atnei yYL 6-M l r► -
Well Contractor (Individual) Name
A E DRILLING SERVICES LLC
Well Contractor Company Name
TWO UNITED WAY
Street Address
GREENVILLE SC 29607
City or Town State Zip Code
(864 ) 288-1986
Area code Phone number nn
2. WELL INFORMATION: MF— 141-a
WELL CONSTRUCTION PERMIT*
OTHER ASSOCIATED PERMIT#(ir applicable)
SITE WELL ID #[it applicable)
3. WELL USE (Check One Box) Monitoring ❑ MunicipallPubtic p
Industrial/Commercial D Agricultural ❑ Recovery ❑ injection (—
Irrigationll Olher D (list use)
DATE DRILLED a3 ?►t i Z
4. WELL LOCATION:
(Street Name, Numbers, Community, subdivision, Lot No.. Parcel, Zip Code)
CITY: COUI+fY
TOPOGRAPHIC / LAND S1 TTiNG• (check appropriate box)
['Slope ❑Valley °Flat ❑Ridge L7Other
" DMS OR 3x.xxxxxxxxx DD
LONGITUDE 75 " DMS OR 7x,xxxxxxxxx DD
Latitude/longitude source: OOPS QFopographic map
[location of well must be shown on a USGS topo map andattached to
this Farm if riot using GPS)
5_ FACILITY (Name of the business where the well is located.)
Ch err, f ron k .5
Facility Name/ j J y J Facility IDfk (if applicable)
;Id r_�[[ 7Iri I-L"
Street Address
etil le
City or Town State Zip Code
Contact Name
I 11 ... Sri 5
Mailing Address
LATITUDE 36
City or Town
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:
J'5
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES NO Q.
r.. WATER LEVEL Below Top of Casing: _ t3•07 FT.
(Use "+" if Above Top of Casing)
411257
d. TOP OF CASING IS 3 ' FT. Above Land Surface'
"Top of casing terminated atlor below land surface may require
a variance in accordance with 15A NCAC 20 .0115.
e. YIELD (gpmj: V/l METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
Top- /0/40- Bottom_ ,4}J r Top . dt14 Bottom
Top Bottorn Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top_ Bottom �a Ft fir' t• y'S pOc__
Top Bottom Ft_
Top Bottom Ft.
8. GROUT' Depth
Top L Bottom ) Z-- Ft.
Top Bottom
Top Bottom
Ft.
Ft.
Material Method
Ce .ef& 7(01ie•
9. SCREEN: Depth Diameter Slot Size Material �y
Top�r Bottom 34' Ft. ZI ` in. .1❑ in. _[}-& ' -- P t -
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
r Depth
Top Pig Bottom .11' Ft.
Top Bottom Ft.
Size
Material
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
1
1
1
1
1
1
I
1
1
12. REMARKS;
-Formation Description
I DO HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
t5A NCAC 2C. WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS RE N Pi• DER THE WELL OWNER
PR ED NAME OF ^ ERSON
5u Tniit within 3.D lull of 'comp tiani to': afslilfater CaI .-' info
7.ly ail -Ellice c'e ter,Rai4kgnA+fC.27 9=i61t .Phvn n,
�ar:..�_..'„_.,..?=s•�•i..3?-:.sxnta..:ca.s.._�t-. .caeaz':t
ELL CONTRACTOR DATE
STRUCTING THE WELL
�- ter•-- t. �. .:..,.. ;
a# 9 PTMssirlC
•
.JAN E? 8 201'•
Iriformatlo-i Ciocassinn I'nit

Pat McCrory
Governor
NA NCDENR
North Carolina Department of Environment and Natural Resource
Division of Water Quality
Thomas A. Reeder
Acting Director
January 24, 2014
CERTIFIED MAIL# 7010 0780 0001 7057 3101
RETURN RECEIPT REQUESTED
Frances Phillips
Post Office Box 686
Hillsborough, NC 27278
Subject: Notice of Expiration (NOE)
5A7 Geothermal Injection Well
Permit No. Wl0500203
Orange County
Dear Mr. Phillips:
John E. Skvarla, Ill
Secretary
The Underground Injection Control (UIC) Program of the North Carolina Division of Water
Resources (DWR) is entrusted to protect the groundwater quality and resources of the State of North
Carolina, and is responsible for the regulation of injection well construction and operation activities
within the state. Our records indicate that the above-referenced operating permit for the underground
injection well system located on your property at 2424 Woods Loop Road in Hurdle Mills, NC,
which was issued to you on July 31, 2009, and expires on June 30, 2014, is soon due for renewal. If
you wish to keep this permit and operate the injection well system, the permit must be renewed and
issued in your name.
If Your Injection Well is Currently Inactive:
If the injection well system is no longer being used for any purpose, it must be permanently
abandoned according to the regulatory requirements listed under NCAC Title 15A, Subchapter 2C,
Section .0214. When each well is plugged and abandoned, the well abandonment record (Form GW-
30) must be submitted to our office to certify that the abandonment was properly conducted.
If there has been a change of owttership of the property, an lnj~ction Well Permit Name/Ownership
Change Form must also be submitted. The GW-30 and Name/Ownership Change forms can be
found at http://portal.ncdenr.org/web/wg/aps/gwpro/permit-applications.
If Your Injection Well is Currently Active:
If the injection well system is still active and you wish to renew your permit, the renewal application
must be submitted within 120 calendar days of the expiration of your permit. According to our
records, you must submit your permit renewal by March 2, 2014.
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 512 N. Salisbury St., Raleigh, North Carolina 27604
Phone: [phone] I FAX: 919~07-M96
Internet www.ncwaterguality.org
An Equal Opportun ity I Affirmative Action Employer
In order to comply with the regulatory requirements listed under North Carolina Administrative Code
(NCAC) Title 15A, Subchapter 2C, Section .0211, you must submit one of the following enclosed
forms:
A. Application for a Permit to Construct or Operate Injection Wells — Open Loop Geothermal
Injection Wells (Renewal) if the injection well system on your property is still active.
-OR-
B. Status of Injection Well System if the injection well system is inactive or has been temporarily
or permanently abandoned.
PIease submit the appropriate forms to:
Division of Water Resources
UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Failure to submit these forms in a timely manner may result in the assessment of civil penalties in
accordance with North Carolina General Statute 87-94. For your convenience, a renewal application
and a IMC well system status form are enclosed. The above referenced forms are also available on-
line at the DWR website at http:llportal.ncdenr.ora/weblwglapslgwprolpermit-applications_
Thank you in advance for your cooperation and timely response. If you have any questions, please
contact me by phone at [phone] or by email at eric.g.smith n ncdenr.cov.
Sincerely,
Eric G. Smith, P.G.
Hydro geo]ogist
Enclosures
cc: Raleigh Regional Office — WQROS wio enclosures
Central Files - Permit No. WI0500203 w/o enclosures
2

From: Slusser, Thomas
Sent: Friday, June 28, 2013 3:49 PM
To: Hartzell, Beth
Subject: RE: UIC Permit, Chemtronics Site
Greetings Beth,
I think that such an approach would be just fine and makes sense. lnjec,tion activities involving the extraction,
treatment, and reintroduction of contaminated groundwater into the subsurface will need to follow the
regulatory requirements in 15A NCAC02T .1600 (after clicking on rule hyperlink scroll down to bottom of
webpage). If the contaminated groundwater is partially treated or just mixed with reagent then it would need
to be injected within the plume and there would be an associated compliance boundaries as described in the
groundwater standards of 15A NCAC 02l .0107. Of course, if the contaminated groundwater is treated to 2L
standards then it could be injected outside the plume.
It may be worthwhile to have a meeting or conference call with you and the consultant to discuss ways to
meet rule requirements, describe remedial actions, and how to compile and present for review all that
information. What do you think?
-Thomas.
ph# 919-807-6412 I fax# [phone]
Mailing Address: 1636 Mail Service Center, Raleigh, NC 27699-1636
Physical Address: Room 640M, Archdale Building, 512 N. Salisbury St., Raleigh, NC 27604.
Internet Address: http ://portal.ncdenr.orw web/wq/a ps/gwpro
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties unless the
content is exempt by statute or other regulation.
From: Hartzell, Beth
Sent: Tuesday, June 25, 2013 3:51 PM
To: Slusser, Thomas
Subject: FW: UIC Permit, Chemtronics Site
Hey Thomas,
The contractor for the Chemtronics site has sent the email below to me requesting submittal of a general UIC
per"mit for the site to cover a range of conditions. Is this something you would consider approving? As a
reminder they are a CERCLA site. They plan to conduct several pilot tests at the site as part of the remediation
effort there and are trying to streamline the process. If you have any questions give me a call.
Thanks for your consideration,
Beth
Elizabeth A. Hartzell
State Environmental Project Manager
Superfund Section, Federal Remediation Branch
NCDENR
[phone]
1646 Mail Service Center
Raleigh, NC 27699-1646
*******************************************************************************
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and
may be disclosed to third parties.
*************************************************************************************
From: Stu Ryman [mailto:[e-mail]]
Sent: Friday, June 21, 2013 4:01 PM
To: Hartzell, Beth; Jon Bornholm
Cc: Todd Hagemeyer; Evan Cox; Ben Amos; Leah MacKinnon; Amy Huffman; Robert Hastings; Stu Ryman
Subject: RE: UIC Permit
Beth,
As we discussed during our June 5, 2013 meeting in Asheville we are providing you with this request for the
NCDENR UIC program to consider streamlined approaches for reviewing and approving a range of planned
additional pilot tests at the Chemtronics Superfund site in Swannanoa, NC. As you know, Geosyntec (on
behalf of the Companies) submitted a UIC permit application in October 2012 to perform three enhanced in
situ bioremediation (EISB) pilot tests. In a letter dated November 1, 2013, NCDENR stated that our three
proposed pilot tests meet the state regulatory requirements for construction and operation of injection wells
and since the site is a CERCLA site, the states administrative permitting requirements have been waived. We
have initiated these three pilot tests.
We anticipate a series of additional EISB pilot tests at one or more pre-determined Areas of Interest (AO ls) at
the Chemtronics site over the next few years as part of the Feasibility Study (FS) process to support remedy
selection and design. These pilot test are anticipated to be similar in nature to the pilot tests approved and
underway. They will involve the injection of (1) similar amendments to promote EISB, including electron
donors (i.e., emulsified vegetable oil [EVO], sodium lactate, EHC), buffers/bases (i.e., sodium bicarbonate,
calcium carbonate, magnesium hydroxide), (2) similar bioaugmentation cultures (i.e., KB-1, KB-1 Plus), and (3)
commonly used tracers (i.e., sodium bromide, sodium chloride, fluorescent dyes) all of which are on the NC
DEN R's approved injectant list. They will involve one of two general injection approaches: either (1) direct
injection using permanent injection wells or direct push injection tools; or (2) groundwater extraction,
amendment of remedial fluids to extracted groundwater, and reinjection of this treated groundwater using
permanent extraction and injection wells.
Going forward, to streamline the NCDENR UIC application, review, and approval process, for the Chemtronics
site, would it be possible to submit a general site UIC application to cover a range of specific conditions?
Adopting such an approach would provide us flexibility to perform the additional tests at the site without
additional applications and approval so long as the additional test are within the bounds defined by the
general site apptication.
Regardless of the application, review, and approval process, we would provide NCDENR with well construction
and injection event records and reports summarizing the project and monitoring data upon completion of each
phase of the testing.
Please let us know if this proposed alternative approach would be acceptable, or if there is another approach
that we could take that would provide more a streamlined U IC process for the FS activities related to this site.
Thanks for your assistance on the Chemtronics project.
Stu
Stuart A. Ryman, PG
Altamont Environmental, Inc.
�j�.e- ►ter.tivie 0023o
North Carolina Department of Environmental Quality — Division of Water Resources
INJECTION EVENT RECORD (l ER)
Permit Number q/I O!(OJ 3 6
- Permit Information
Ckertiri_r : ,rt.1 CS
Permitter
(_3,!:.2 n-us S A -A/t5-J3' Pill
Facility NqureC
Facility Address (nclude County)
2. Injection Contractor Information
130f1;d Verreii &.lode I r 11 r A
Injection Contractor / Company Name
Street Address Ati) r, 1•nd(s f] r.
City State Zip Code
tq !!
Area code —none umber
3. Well Information
Number of wells used for injection in
Well Ills -27©/ ^ 14)
Were any new wells installed during this injection
event?
® Yes ❑ No
If yes., please provide the following information_
Number of Monitoring Wells
Number of Injection Wells_ - % i
Type of Well Installed (Check applicable type):
❑ Bored ❑ DrilIed ® Direct -Push
❑ Hand -Augured ❑ Other (specify)
Please in+elydp a copy of the GW-I form for each
well installed,
Were arty wells abandoned during this injection
event?
® Yes ❑ No
If yes, please provide the following information_
Number of Monitoring Wells
Number of Injection Wells I 0
Please include a copy of the GW-30 for each well
abandoned
4. Injectant Information
ENC,AieJrIzoiw
Injectant(s) Type (can use separate additional sheets
if necessary
Concentration
If the injectant is dillited please indicate the source
dilution fluid. t r)4e,r
Total Volume Injected (gal)_ 360 a
Volume Injected per well (gal) 16,0
Q
5. Injection History /
Injection date(s) 7/511 r�" 9,41 -
Injection number (e_g 3 of 5) f P! k 1 •e: y
Is this the last injection at this site?
❑ Yes ® No
1 DO HEREBY CERTIFY THAT ALL THE
INFORMATION ON THIS FORM IS CORRECT TO
THE BEST OF MY KNOWLEDGE AND THAT THE
INJECTION WAS PERFORMED WITHIN THE
STANDARDS LAID OUT IN THE PERMIT.
LQ2.) e. 9//01
SIGNATURE OF IN1ECf1ON CONTRACTOR DATE
to ref re.rrtJi
PRINT NAME Of '�f FR ORMING THE INJECTION
Submit the original of this form to the Division of Water Resources within 30 days of injection.
Alin UIC Program, 1636 Maul Service Center, Raleigh, NC 27699-1636,1 'hone No. 919-807-6464
Form UIC-TER
Rev. 3-1-2016

Print Form
WELL CONSTRUCTION RECORD (GW- 1)
1. Well Contractor Information:
Daniel Ferrell
Well Contractor None
3221-B
NC Wet! Contactor Certification Number
Cascade Drilling
Company blame
2. Well Construction Permit #: W10100 30
List e11 applleable v.rJcoadruerionpe►mit* Ce. WC, Camay, Stale. Variance, rlc)
3. Well Use (check well use):
For Internal Use Only:
Water Supply Welk
Agricultural
Geothermal (1Dratirtg/Cooling Supply)
Industrial/Commercial
Il Irrigation
Nom-Water Supply Well:
lr-tM°nilonng
Injection Well:
DAguifer Recharge
DAguifer Storage and Recovery
DAyuifes Test
JExperi,r tat Technology
8{'�outhi mil (Closed Loop)
Geothermal (Heating/Cooling Rehm i
f MunicipallPuhlic
f Reside Dal Water Supply (single)
QResidcotial Water Supply (shared)
riRecowiY
EiGroundwnterRe mediation
DISalmity Barrier
flstumiwater Drainage
DSuhsidence Control
OTrauer
110tlra explain under 421 Remarks)
4.1alm Wei(s) Completed: 9t9118
5e. Well Location:
Chemtronics
Well Ii)# IPd)tthru IP-1a
Facifity/GwrrrNew Facility IDS (if I hie)
180 Old Bee Tree Rd., Swannanoa, NG 28778
Physical >City, end Zip
Buncombe
County Parte! IdentiScation No. (PIN)
Sh_ Latitude and longitude in degrees/ads otcslsecends or decimal degrees:
(if well field, one tat/long is sufficient)
35 37' 31.8" 82 26' 18.1" R,
6. Ls(are) the well(s)fllrermaeeat or ®ITemporary
7_ Is this a repair to an er isting well: OW% or I}No
If this is o repair. fill out b owrn well cusstreeetian ;aforra riam and eplaua the nature of to
repair under 421 remarks section or an the back el Mix firm.
8. Far GeoprohelDPT or Closed -Loop Geothermal WeHa having the same
coostiu Sion, only ! GW-1 is needed_ indicate TOTAL NUMBER of wells
drilled: 1 Q
9. Total well depth below land aerface: 29.5 (max)
For multiple wells tilt ell depths !f eliffereoi (example- 3Qa 200' mar! 2(414t7)
(f)
10. Static water level below top of casing: (EL}
If outer level is above rasing. use "+"
11. Borehole diameter: 2-25 On-)
12. Well constrtlellan method: Direct Push
{le. auger. rotary, cable, direst per. cue)
FOR WATER SUPPLY WELLS ONLY:
13a.Yiield (gprlr) Method of test-.
13h- Disinfection type Amount
14. WATERZONES
mom re
IIRSCRIPTION
e.
>t
ft.
ft.
13.OUTER CASINC Dear multi—edwelts) ORUNER or us)
'FRf1D! TO DLO, FTER :> ' '7r ENS ! MATE=tI
It. f1=' in.
mama LNNER citsmaratuftwo New banal dosed teem
FROM TO DIAMETER TIOGROOSS
MATERIAL
R.
ft.
in.
1L
1I
ZA
17. SCREEN
i 11 Tt7
SILOFSEIZ MEICIIIESS
MATERIAL
IL
it.
ir.
IL
R
to.
1a GROUT
FROM TO
MAMMAL
IMITLAOIMEtlf METHOD & amenNr
ft.
ft.
IR
19_SANDI/GRAVEL PACK applicaak)
FROM
TO MATEMTeL
11/61PLACHME74TMEl6on
ft.
ft.
FL
DI. DRILLING LOG (Inacb atlditfeed Mires ft- mer an')
FROM
R.
TO otSC7tw tON Kolar. vrdeds. Idrtnan! Ns, v'. etch
R
ft-
ft.
ft-
R.
lt_
It.
et.
IL.
ft.
21. REMARKS
22.Certification:
�Jc
Sigoerme 0C fled Well Cunaactar Gale
By signing this farm, 1 hereby rerift Ahat Ana ue l(s) was (scum) consoracied in accordance
swift ISA NCIC 02C.6IQ l or 1SA NCAC D2C.021113 Wail Construction Stmrdmdtr and ilea a
copy ofthis rocord has heat provides! to the wdlowner.
9119118
kay
23. Site diagram or additional welldeiaBs:
You may use the back of this page to provide additional well site details or well
construction details You may also attach additional pages ifnecessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this farm within 34 days of compietiun of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injectiva Wells In addition to sending the farm to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of WaterRcauereer., Underground Injection Control Program,
1636 Mali Service Center, Raleigh, NC 276994636
24c. For Water Supple & Inlet -den Wells: In addition to sending the force to
the address(es) above, also submit one copy of this form within 30 days of
completion of well cttctian to the county health departmextt of the county
where constructed_
Farm GW-1
North Castilla Department ofEnriranmenpl Quality - Division of Watts Resources
Revisor! 2-22 201S

WELL ABANDONMENT RECORD
For Internal Use ONLY:
Physidd Addinxi, City. mud Zip
Buncombe
1. Well Contrsettor Information:
Daniel Ferrell
Wet] Contactor Name (or well owner personally abandoning well on his/her property)
3221-B
NC Well Contractor C.eitifiereion Number
Cascade Drilling
Company Nam
2. Well Construction Permit #:
tint all ayoplicoble taetlecrnxfr m per niir {ce. LUC Coxwl}. &tie, VaciurmcC. *1C) fbmwa
W10100230
3. Weil use (check well use):
Water Supply Well:
°Agricultural
❑Geothermal (Iirstity/Gnaliog Supply)
D1DdustriaMMCo mucial
❑ Irri eatitr i
Non -Water Supply Well:
❑ Monitoring
❑MuniapallPublic
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
0-Recovery
Injection Well:
▪ Recharge
DAgtufer Storage and Recovery
❑ Aquifer Test
0Experrimental Technology
❑Geathe mai (Closed Loop)
°Geothermal (I3eatingjCooling Rearm)
tic rutmtlwater Retmediatiem
OSalinity Barrier
EiStormwater Drainage
❑Subsidence Control
°Tracer
DOther t explain under 7g)
d. Date well(s) abandoned: 9/9/ 18
Sit. Well location:
Chemtronics Inc.
Facility/Ownd- Nance
Facility IMO cifapplicable)
180 Old Bee Tree Rd.,Swannanoa,NC 28778 41�) e.7/�
Signature of Certified Well Contractor or Well Owtrr
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 TOTA1. NUMBER of
wells abandoned: 10
7b. Approximate volume of water resnainiag in well(:):
FOR WAXFR SUPPLY WELLS ONLY:
7c. Type of disinfeclaut used:
741. Amount of diinrectunt used:
7e. Sealing materials used (cheek all that apply):
0 Bentonite Chips or Pellets
El Dry Clay
° Drill Cuttings
❑ Gravel
0 Other (explain trader 7g)
0 Neat Cement Grout
0 Sand Cement Caput
in Concrete Grout
Specialty Grout
R Bentonite Slurry
7L For each material selected above. provide amount of materials used.:
Cement/bentonite slurry/3.5 gallons
7g. Provide a brief description of the abandonment procadur.
Gravity
County Paned Identification No. (PTN)
Sb. Latitude and longitude m degrees/minutes/seconds or decimal degrees:
(if welt field, urn tatflong is saluki's)
3537'31.8" N 8226' 18.1"
W
CONSTRIIC1I0Pi DETAILS OF WELLIS) BEING ABANDONED
Attach wellcans-tnerrtrna rimed(:) ifinerilrabk Fornrultipleinjection ar+tan-anrersupply we.*
ONLY- with the same cvnstrvetianfabartdaenaea►, you can =trall one jwm.
6a. well Ibtk IP-01 thru IP-10
6b-Total well depth: 29-5 (max) (fL)
6c. Borehole diameter: 2.25 (m)
6d. Water level below ground surface: (ft.)
6e. Outer wag length (if lmown): (ft.)
6f_ Inner ca.vingjtuhing length (if ltrtowu): (ft.)
6g. Screen length (if known): (fL)
roar UW-30
S_ Certification:
9/19/18
Date
l;y signing this faro, I hereby certifi, that the well(s) ,vas (were) abandoned in
accordance with ISA NCAC 02C .0I00 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 dkails. You may also attach additional pages if necessary.
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
lot. Fur Infection Wells: In addition to sending the form to the address in Ica
above, also submit one copy of this farm within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mali Service Center, Raleigh, NC 27699-1636
10e For Water Supvh• & Injection Wells: In addition to srr drug 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.
North Cal -Willa tlepertrnent of EnvironrnenInt Quality - Di'isioe of Wator Resources Revised 2-22.2016

ATA
FbENR
North Carolina Department of Environment and Natural Resources
Division of Water °uality
Beverly Eaves Perdue Charles Wakild, P. E. Dee Freeman
Governor Director Secretary
November 1, 2012
Todd Hagemeyer, P.G.
Geosyntec Consultants
1255 Roberts Boulevard, Suite 200
Kennesaw, GA 30144
RE: Chemtronics, Inc. CERCLA Site
Swannanoa, Buncombe County, NC
Dear Mr. Hagemeyer:
The Underground injection Control Program has reviewed the enhanced bioremediat'ion pilot test
workplan for the subject site, which was received ❑n October 17, 2012. The proposed injection project
as presented in the workplan meets relevant state regulatory requirements (15A NCAC 2C.0200) for
construction and operation of injection wells.
Due to the site's coverage under the Comprehensive Environmental Response, Compensation, and
Liability Act (CERCLA), the state's administrative permitting requirements have been waived for this
project. However, to ensure continued compliance with applicable injection well regulations, please
submit well construction and injection event records as well as a technical report summarizing the
project and monitoring data upon completion of the injection project.
Please contact me at 919-807-6412 or thomas.slussernncdenr.gov if you have any questions.
Best Regards,
Atay4
Thomas 5lusser, L.G.
Underground Injection Control Program Manager
cc: Elizabeth Hartzell, Superfund Section - Division of Waste Management
Landon Davidson, Aquifer Protection Section — Asheville Regional Office
W10100230 Permit File
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699.1617
Location: 512 N. Salisbury St Raleigh, North Carolina 27604
Phone: 919.e07-6464 I FAX: [phone]
Internet: www.ncwatercuality.orQtweblwalaas
No thCarolina
aturallff
An Equal °paortunlly I Affirmative Action Employer

Permit Number WI0100230
Program Category
Ground Water
Permit Type
Injection In situ Groundwater Remediation Well
Primary Reviewer
thomas.slusser
Coastal SW Rule
Permitted Flow
Facilit
Facility Name
Chemtronics Inc
Location Address
180 Old Bee Tree Rd
Swannanoa
Owner
Owner Name
Chemtronics Inc
Dates/Events
NC 28778
Scheduled
Orig Issue App Received Draft Initiated Issuance
10/17/12
Central Files : APS_ SWP_
10/18/12
Permit Tracking Slip
Status
In review
Project Type
New Project
Version Permit Classification
Individual
Permit Contact Affiliation
Todd Hagemeyer
1255 Roberts Blvd
Kennesaw GA
Major/Minor
Minor
Region
Asheville
County
Buncombe
Facility Contact Affiliation
Owner Type
Unknown
Owner Affiliation
Charles Lynn Miller
2107 City W Blvd
Houston
Public Notice Issue
TX
Effective
30144
77042
Expiration
Regulated Activities Re quested/Received Events -=----------------------
RO staff report received
RO staff report requested
Outfall NULL
Waterbody Name Stream Index Number Current Class Subbasin
Beverly Eaves Perdue
Governor
ATA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Waste Management
Dexter R. Matthews
Director
September 25, 2012
Mr. Thomas Slusser
UIC Program Manager
Aquifer Protection Program.
1636 Mail Service Center
Raleigh, NC 27699-1636
Reference: Chemtronics, Inc Site
Swannanoa, NC
Dear Mr. Slusser:
Dee Freeman
Secretary
This letter is to certify that the clean up being conducted at the Chemtronics, Inc site in Swannanoa is being
conducted under the CERCLA program. Per N.C.G.S. I30A.310 (e) "For any removal or remedial action
conducted entirely on -site under this Part, to the extent that a permit would not be required under 42 U.S.C. §
9621(e) for a removal or remedial action conducted entirely on -site under CERCLA/SARA, the Secretary may
grant a waiver from any State law or rule that requires that an environmental permit be obtained from the
Department." Per this statute, the Cbemtronics, Inc. site would like to obtain a Letter of Consent for this clean
up rather than a Class 51 UIC Permit. The completed application for the Chemtronics, Inc. site should arrive in
your office in the next two weeks.
If you have any questions or need any additional information contact me at [phone].
Sincerely,
Elizabeth A. Hartzell
Environmental Engineer
NC Superftmd Section
cc: Stu Ryrnan. Altamont Enviroiunentai, Inc.
1646 Mail Service Center, Raleigh, North Carolina 27699-1646
Phone/Fax: [phone]I Intemel: http;llportai.ncdenr.orgfwebiwmf
One
NorthCarolina
An Equal Opportenity 1 Alnrmalive Action Employer

Geosyntec C>
consultants
RECE\VEDIDENR/DWQ
OCT 1 7 2012
Aquifer Protection Section
1255 Roberts Boulevard, Suite 200
Kennesaw, Georgia 30144
PH 678.202.9500
FAX[phone]
www.geosynt;:c.com
28 September 2012
Mr. Thomas Slusser
UIC Program Manager
Division of Water Quality -Aquifer Protection Program
North Carolina Department of Environmental and Natural Rt:;sources
1636 Mail Service Center
Raleigh, NC 27699-1636
Subject: Underground Injection Control (UIC) Permit Application for Enhanced
In Situ Bioremediation (EISB) Pilot Testing
Chemtronics Site,
Swannanoa, Buncombe County,
North Carolina
Dear Mr. Slusser:
Geosyntec Consultants of NC, P.C. (Geosyntec) has prepared the attached Underground
Injection Control (UIC) permit application for the Chemtronics Site located in Swannanoa,
Buncombe County, North Carolina (the Site). Geosyntec has prepared this application on behalf
of Chemtronics, Inc., Northrop Grumman Systems Corporation (Northrop Grumman), and CNA
Holdings LLC (CNA) (together the Companies). Enhanced In Situ Bioremediation (EISB) pilot
tests, as described in this permit application, are planned at the Site in support of the Remedial
Investigation/Feasibility Study (RI/FS) currently being completed under the Comprehensive
Environmental Response, Compensation, and Liability Act (CERCLA) program (EPA CERCLIS
ID: NCD095459392).
Ms. Elizabeth A. Hartzell of the Superfund Section, Division of Waste Management (DWM) in
the North Carolina Department of Environmental and Natural Resources (NCDENR) has
provided a letter under separate cover to certify that cleanup activities at the Site are being
conducted under the CERCLA program. As summarized by Ms. Hartzell, the Companies
request a Letter of Consent, as opposed to a Class 5IUIC Permit, for the proposed pilot tests per
N.C.G.S. 130A.310 (e).
Groundwater compounds of potential concern (COPCs) at the Site include volatile organic
compounds (VOCs), nitroaromatics, and energetics (perchlorate). EISB was identified during
feasibility screening of candidate technologies as a promising remedial technology given Site
conditions (i.e ., COPC mixtures and distribution, groundwater geochemistry, hydrogeology,
GR4943/2012 _ 0928_ Chemtronics_ 0 _ Cover Letter_ UIC Application.docx
engineers I scientists I innovators
Mr_ Thomas Slusser
28 September 2012
Page 2
etc,). Three EISB pilot tests, which are the subject of this UIC permit application, are proposed
to generate design and performance data to support the eventual selection of appropriate
technologies for source mass reduction and/or plunge migration control within key areas of the
Site.
EISB is accomplished by stimulating microbial degradation through the injection of a
biodegradable organic carbon source (electron donor) and/or amendment of a bioaugmentation
culture. The EISB pilot tests will consist of injecting a biodegradable emulsified vegetable oil
(EVO) (Newman Zone®, an EVO product that also includes 4% sodium lactate) solution into a
total of 36 permanent injection wells. For two of the pilot tests, a bioaugmentation culture (KB -
le Plus, which is a mixture of KB-14' and WBC-2 bioaugmentation cultures) and buffer will also
be injected. Potable water will be used to provide additional water for dilution and injection of
the EVO solution. Another electron donor, EHC®, will be used to generate anaerobic conditions
in the injection fluid prior to injection. Implementation of EISB utilizing EVO as a carbon
source/electron donor and a bioaugmentation culture is a safe and environmentally sound
remediation technology that is widely practiced. The planned injectants are on the UIC
Program's list of approved injectants. Specific details of the injection fluid composition,
injection rationale and procedure, and proposed monitoring plan are provided in the attached
UIC application. The pilot tests are evaluating an in situ remedy; as such, contaminated
groundwater will not be extracted, treated ex situ, and then re -injected into the aquifer.
Geosyntec looks forward to working with the Division of Water Quality during their review of
the UIC permit application. If you have any questions regarding the Site, the proposed EISB
pilot tests, or the attached application, please do not hesitate to contact the undersigned_
RECEIVEL»DF.
!,
Attachment: UIC Application
0R494312012_0928_Chemfronics_ll Cover Letter_UIC Application.docx
Sincerely,
Leah MacKinnon, M.A.Sc.
Senior Scientist
fe "Mae
R. Todd Hagemeyer, P.G.
Associate
engineers I scienli tw I innovators

RECElVEO/DENR/DWQ
OCT 1 7 2012
Aquifer Protection Section
UNDERGROUN D INJECTION CON TROL
(IDC) PERMIT A PPLICA TION FOR
E N HANCED IN S ITU BIOREMEDIA TION
PILOT TE S TING
CHEMTRONICS SITE,
SWANNANOA, BUNCOMBE COUNTY,
NORTH CAROLINA
EPA CERCLIS ID: NCD 095459392
Prepared by
Ceosyntec
consultants
mgineer,:; I scientists I innovators
1255 Roberts Boulevard, Suite 200
Kennesaw, Georgia 30144
Project Number GR4943
September 2012
PERMIT APPLICATION
North Carolina Department of Environment and Natural Resources
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR INJECTION
In Situ Groundwater Remediation I Tracer Injection
Do not use this form for the following:
• in situ remediation, tracer, or aquifer test injection wells permitted by rule (ref. 15A NCAC 02C .0217)
• remediation systems that reinject treated contaminated groundwater (ref. 15A NCAC 02T .1600)
Application Number (to be completed by DWQ): ·~o l 0<2Q:3o RECEIVED/DENR/DWQ
OCT 1 7 2012
I. APPLICATION INFORMATION
1. Project is: [X] New [ ] Modification [ ] Renewal without modification
Aquifer Protection Section
[ ] Renewal with modification
2 . If this application is being submitted for renewal or modification to an existing permit, provide:
existing permit number _________ and the issuance date ___________ _
For renewal without modifications, fill out sec;tions I & II only, sign the certification on the last page of this form, and obtain
the property owner's signature to indicate consent (if the applicant is not the owner).
For all renewals, submit a status report including monitoring results of all injection activities to date.
II. WELL OWNER (generally the responsible party)
III.
1. Name: Chemtronics. Inc.
2. Signing Official's Name*: Charles Lynn Miller Title:_V~1~·c_e_P~r~es~id~e~n=t ______ _
* Signing Official must be in accordance with instructions in part IX on page 5.
3. Mailing address of applicant: c/o Rebecca Moring, Halliburton Enerl!V Services. Inc.
4.
5.
1.
2 .
3.
4.
2107 CitvWestBlvd.
City: Houston State: Texas Zip: 77042-3051
Telephone number: 713.839.2179 Email: rebecca.moring@ halliburton.com
Status (choose one): __ Individual__x_Business/Org. __ Federal __ State __ County __ Municipality
PROPERTY OWNER (if different than well owner)
Name: SAME AS ABOVE
Physical address: _________________________________ _
City: ______________________ _ State: ___ Zip: ______ _
Mailing address: __________________________________ _
City: ________________________ State: ___ Zip:. ______ _
Telephone number: ________________ Email: ______________ _
Iill. PROJECT CONTACT-Person who can answer technical questions about the proposed injection project.
1. Name: Todd Hageme yer (N .C. P.G. #1703 ) Title:~A=s~so~c~i=at~e _______ _
2. Company: Geosyntec Consultants of NC. PC
3. Address: 1255 Roberts Boulevard. Suite 200
4. City: Kennesaw State:_G~A~----Zip: 30144
5. Telephone number:_6=-7'--'8::..:..2=0=2=.""'-9"'-50=9'-----_____________ Email: THagemeyer@ Geosyntec.com
Revised 5/1/2012 UIC-5I/5T Page 1 of 5
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR INJECTION
In Situ Groundwater Remediation I Tracer Injection
V. FACILITY INFORMATION
1. Facility name: Chemtronics. Inc. Ph#: 281.575.4425
2. Mailing address: 180 Old Bee Tree Road
City: Swannanoa County: ___ Buncombe __ State:NC Zip:~2=8~7~7~8 ___ _
3. Geographic Coordinates: Latitude: __ 3""5"----0--"3'---'-7_'--'1__,,_0=.3'-"_.N'-'--___ Longitude: _....,8=2'-0....,2...,6'-' .... 4""'.0""'8._"_W....__ _____ _
Reference Datum: __ --'N""'"'A'-"=D .... 8=3'------~Accuracy: __ _.A'--"<'-p""'pr=o=x=im=a=t=e ____ _
Method ofColiection: Estimated coordinates of site entrance using Arciviap GiS software
4. Brief description of business:_~fi=o~rm~e~r~m~an~u~f:~a~ct~u~ri~n..,.g__,_p~la~n~t ___________________ _
VI. INCIDENT DESCRIPTION
1. Source and date of contamination: The Site was used for industrial pumoses from the early 1950s until
1994. The primary products manufactured at the Site were explosives, incapacitating auents. and chemical
intermediates. Chemicals of Potential Concern (COPCs) have been identified in 2:roundwater. surface water,
sediment. and soil in association with various manufacturing and waste disposal areas at the Site.
2. List all contaminants present in soils or groundwater at the site (contaminants may be listed in groups, e.g., gasoline,
diesel, jet fuel, fuel oil, chlorinated ethenes, chlorinated ethanes, metals, pesticides/herbicides, etc):
COPCs include trichloroethene (TCE). tetrachloroethene (PCE). 1.2-dichloroethane ( 1.2-DCA). chloroform (CF).
vinyl chloride (VCt research department explosive (RDX). hi!!h meltinQ explosive (HMX). 2.4.6-trinitrotoluene
(2.4.6-TNT). and perchlorate.
3. Has LNAPL or DNAPL ever been observed at the site ( even if outside the injection zone)?
[ ] Yes If yes, list maximum measured separate phase thickness: _________ feet
[X] No If no, list maximum concentration of total VOCs observed at site: 380.000 ppb
4. Agency managing the contamination incident:
[] UST Section [X] Superfund Section (including REC Program and DSCA sites)
[] DWQ Aquifer Protection Section [] Solid Waste Section
[] Hazardous Waste Section [ X] Other:-=E=P"-"A-=-=-R=e=g=io=n"-'I=--V........aaS-=u..,pe=r=fu=n=d=---------------
5. Incident manager's name: Ms. Elizabeth A. Hartzell. NC Superfund Section Ph#:--'9 ..... 1=9~.7~0~7~.8=3....a3....a5 ______ _
Mr. John Bornholm. EPA Re2.ion IV Superfund Ph#:_4_0_4_.5_6_2_.8_8_2_0 _____ _
6. Incident number or other incident mgmt. agency tracking number: EPA CERCLIS ID: NCD095459392
VII. PERMITS
List all applicable permits or construction approvals issued for the facility or incident:
1. Hazardous Waste Management program permits under RCRA: __________________ _
2. DWQ Non-Discharge or NPDES permits: ________________________ _
3. County or DEH subsurface wastewater disposal permits: ____________________ _
4. Other environmental permits required by state or federal law: MSD NSIU Permit No. G-006-08:
Conditionall Exempt Small Quantity Generators Pennit No. NCD095459392
Revised 5/1/2012 UIC-5I/5T Page 2 of5
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR INJECTION
In Situ Groundwater Remediation I Tracer Injection
5. FRACTURING PLAN (if a pp licable)-Submit a detailed description of the fracturing plan that includes the following:
(A) Material Safety Data Sheets of fracturing media including information on any proppants used;
(B) a map of fracturing well locations relative to the known extent of groundwater contamination plus all buildings,
wells, septic systems, underground storage tanks, and underground utilities located within the Area of Review;
(C) a demonstration that buildings, wells, septic systems, underground storage tanks, and underground utilities will
not be adversely affected by the fracturing process;
(D) injection rate and volume;
(E) orientation of bedding planes, joints, and fracture sets of the fracture zone;
(F) performance monitoring plan for determining the fracture well radius of influence; and
(G) if conducted, the results of geophysical testing or pilot test of fracture behavior conducted in an uncontaminated
area of the site.
6. WELL CONSTRUCTION DETAILS -Submit the following information in tabular .or schematic form as appropriate
for each item:
(A) number and depth of injection wells;
(B) number and depth of borings if using multi-level or "nested" well systems;
(C) indication whether the injection wells are existing or proposed;
(D) depth and type of casing;
(E) depth and type of screen material;
(F) depth and type of grout;
(G) indication whether the injection wells are permanent or temporaty "direct push" points; and
(H) plans and specifications of the surface and subsurface construction details.
7. MONITORING PLAN -Submit a monitoring plan that includes the following:
(A) target contaminants plus secondaty or intermediate contaminants that may result from the injection;
(B) other parameters that may serve to indicate the progress of the intended reactions;
(C) a list of existing and proposed monitoring wells to be used; and
(D) a sampling schedule to monitor the proposed injection.
Monitoring wells shall be of sufficient quantity and location to detect any movement of irifection fluids, injection process byproducts,
or formation fluids outside the injection zone. The monitoring schedule shall be consistent with the proposed injection schedule, pace
of the anticipated reactions, and rate of transport of the inject ants and contaminants.
8. WELL DATA TABULATION -Provide a tabulation of data on all existing or abandoned wells within the area of
review of the injection well(s) that penetrate the proposed injection zone, including monitoring wells and wells proposed
for use as injection wells. Such data shall include a description of each well's type, depth, and record of construction or
abandonment.
9. MAPS AND CROSS-SECTIONS -Provide scaled, site-specific site plans or maps depicting the location, orientation,
and relationship of facility components including the following:
(A) area map based on the most recent USGS 7.5' topographic map of the area, at a scale of 1 :24,000 and showing the
location of the proposed injection site;
(B) topographic contour intervals showing all facility related structures, property boundaries, streams, springs, lakes,
ponds, and other surface drainage features;
(C) all existing or abandoned wells within the area of review of the wells listed in the well data tabulation that
penetrate the proposed injection zone;
(D) potentiometric surface map(s) that show the direction of groundwater movement, existing and proposed wells;
(E) contaminant plume map(s) with isoconcentration lines that show the horizontal extent of the contaminant plume
in soil and groundwater, and existing and proposed wells;
(F) cross-section(s) to the known or projected depth of contamination that show the horizontal and vertical extent of
the contaminant plume in soil and groundwater, major changes in lithology, and existing and proposed wells; and
(G) any existing sources of potential or known groundwater contamination, including waste storage, treatment, or
disposal systems within the area of review of the injection well or well system.
Revised 5/1/2012 UIC-5l/5T Page 4 of5
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR INJECTION
In Situ Groundwater Remediation I Tracer Injection
VIII. ATTACHMENTS -provide the following information in separate attachments. The attachments should be
clearly identified and presented in the order below to expedite review of the permit application package.
1. INJECTION ZONE -Specify the horizontal and vertical portion of the subsurface within which the proposed injection
activity will take place and beyond which no violations of groundwater quality standards shall result from the injection as
determined by an approved monitoring plan. The determination shall be based on the hydraulic properties of the specified
zone. Provide any supporting documentation in a separate attachment.
2. HYDROGEOLOGIC EVALUATION -Provide a hydrogeologic evaluation of the injection zone that includes all of
.•. :a___ C-..11---•!-~.
Lllv J.UHUVV 111~.
(A) Regional and local geology and hydrology;
(B) Changes in lithology underlying the facility;
(C) Depth to bedrock; ·
(D) Depth to the mean seasonal high water table;
(E) Hydraulic conductivity, transmissivity, and storativity, of the injection zone based on tests of site-specific
material, including a description of the test(s) used to determine these parameters;
(F) Rate and direction of groundwater flow as determined by predictive calculations or computer modeling; and
(G) Lithostratigraphic and hydrostratigraphic logs of any existing test and injection wells.
3. INJECTANT INFORMATION -List each injectant in the space below and provide the following information for each
injectant. NOTE: Approved irijectants can be found online at http://portal.ncdenr.org/weblwqlapsl~pro. All other substances
must be reviewed by the Division of Public Health, Department of Health and Human Services. Contact the UIC Program for
more information (Ph# 919-807-6496).
Each of the proposed injectants are on the approved list: (i) Newman Zone®. an emulsified vegetable oil (EVO) with
4% sodium lactate: (ii) KB-1 ® Plus. which is a mixture of KB-I® and WBC-2 bioaugmentation cultures: (iii)
buffer and/or base (sodium bicarbonate. calcium carbonate. mae.nesium hydroxide): and (iv) EHC®.
(A) MSDS, concentration at the point of injection, and percentage if present in a mixture with other injectants;
(B) The source of fluids used to dilute, carry, or otherwise distribute the injectant throughout the injection zone. If
any well within the area of review of the injection facility is to be used as the fluid source, then the following
information shall be submitted: location/ID number, depth of source, formation, rock/sediment type, and a
chemical analysis of the water from the source well, including analyses for all contaminants suspected or
historically recognized in soil or groundwater on the site;
(C) A description of the rationale for selecting the injectants and concentrations proposed for injection, including an
explanation or calculations of how the proposed injectant volumes and concentrations were determined;
(D) A description of the reactions between the injectants and the contaminants present including specific breakdown
products or intermediate compounds that may be formed by the injection;
(E) A summary of results if modeling or testing was performed to investigate the injectant' s potential or susceptibility
for biological, chemical, or physical change in the subsurface; and
(F) An evaluation concerning the development of byproducts of the injection process, including increases in the
concentrations of naturally occurring substances. Such an evaluation shall include the identification of the specific
byproducts of the injection process, projected concentrations of byproducts, and areas of migration as determined
through modeling or other predictive calculations.
4. INJECTION PROCEDURE -Submit a table with a detailed description of the proposed injection procedure that
includes the following:
(A) The proposed average and maximum daily rate and quantity of injectant;
(B) The average maximum injection pressure expressed in units of pounds per square inch (psi); and
(C) The total or estimated total volume to be injected.
Revised 5/1/2012 UIC-5I/5T Page 3 of5
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR INJECTION
In Situ Groundwater Remediativn I Tracer Injection
IX. CERTIFICATION* (to be signed as required below or by that person's authorized agent*)
NCAC 15A 02C .0211(e) requires that all permit applications shall be signed as follows,
1. for a corporation: by a responsible corporate officer
2. for a partnership or sole proprietorship: by a general partner or the proprietor, respectively
3. for a municipality or a state, federal, or other public agency: by either a principal executive officer or
ranking publicly elected official
4. for all others: by the well owner.
*If an authorized agent is signing on behalf of the applicant, then supply a letter signed by the applicant
that names and authorizes their agent.
"1 hereby certtfy under penalty of law that I have personally examined and am familiar with the information
submitted in this document and all attachments therein, and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate, and
complete. I am aware that there are penalties, including the possibility offines and imprisonment, for submitting
false information. I agree to construct, operate, maintain, repair. and if applicable, abandon the injection well(s)
and al! related appurtenances in accordance with the approved specifications and conditions of the Permit. "
Printed Name and ' i le: CNA&ij 2. MW22 1!r
Signature: 441
Date: 4/ A 7.2OIZ
X. CONSENT OF PROPERTY OWNER (if the property is not owned by the permit applicant)
"Owner" means any person who holds the fee or other property rights in the well being constructed. A well is real
property and its construction on land shall be deemed to vest ownership in the land owner, in the absence of
contrary agreement in writing.
"As owner of the property on which the injection well(s) are to be constructed and operated, I hereby consent to
allow the applicant to construct each injection well as outlined in this application and agree that it shall be the
responsibility of the applicant to ensure that the injection well(s) conform to the Well Construction Standards
(Title 15A NCAC 02C .0200). "
Printed Name and Title:
Signature: Date: _
Submit TWO copies of the completed application package, including all attachments, to:
DWQ - Aquifer Protection Section
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
RECEIVED/DENPIDWQ
Aquifer Protection Section
Revised 511/2Q 12 UIC-5II5T Page 5 of 5

ATTACHMENT 1
INJECTION ZONE
1. INJECTION ZONE
1.1 Overview
The Chemtronics Site (Site) is located in Swannanoa, Buncombe County, North Carolina and is
divided into two geographic areas commonly referred to as the Front Valley and · Back Valley
(see Figure 9-1 of Attachment 9). Enhanced In Situ Bioremediation (EISB) has been identified
as the candidate technology with the broadest applicability to the Front Valley groundwater
Areas of Concern (AOCs), and the most likely to have remedial success given the Front Valley
conditions (i.e., Compounds of Potential Concern [COPC] mixtures and distribution,
groundwater geochemistry, hydrogeology, etc.). Site COPCs include volatile organic
compounds (VOCs), nitroaromatics, and energetics (perchlorate), whose concentrations in
groundwater exceed applicable Federal and State standards.
Pilot tests are planned . in support of the Remedial Investigation/Feasibility Study (RI/FS)
currently being completed under the Comprehensive Environmental Response, Compensation,
and Liability Act (CERLCA) program (EPA CERCLIS ID: NCD095459392). The proposed
injection activities will be evaluated per the monitoring plan described in Attachment 7. The
pilot tests are intended to confirm the ability of EISB to effectively degrade the target COPCs to
appropriate end products under actual field conditions. The pilot tests will also be used to
generate design and performance data for potential scale-up of the EISB technology at these pilot
test areas (PT As).
EISB pilot tests are planned at three areas within the Front Valley including: the Building 105-
139 Area (B105-139), Building 147 Area (B147) and Building 149 Area (B149). The locations
of these PTAs are shown in Figures 9-2 and 9-3 of Attachment 9. The pilot tests will be
conducted to evaluate the efficacy of treating the following CO PCs using EISB:
• Groundwater Area B105-139 -Elevated concentrations of chlorinated volatile organic
compounds (cVOCs), particularly trichloroethene (TCE; up to 23,000 micrograms per
liter [µg/L]), in Zone AB 1;
• Groundwater Area B147 -Perchlorate (up to 480 µg/L); and
• Groundwater Area B149 -TCE (up to 350 µg/L) in the partially weathered rock in
Zone C.
The following subsections describe the horizontal and vertical portion of the subsurface within
which the proposed injection activities will occur.
1 The surficial aquifer exists in unconsolidated material (referred to as Zones A and B) and partially weathered rock
(PWR) (referred to as Zone C), extending from the water table to the competent bedrock surface. The highly
fractured upper portion of the bedrock aquifer is referred to as Zone D. For further information, refer to
Attachment 2.
1.2 Pilot Test Area Bl0S-139
Target Treatment Area and Depth
The target treatment area (TTA) for the B105-139 pilot test will measure approximately 70 feet
(ft) by 70 ft (see Figure 9-4b of Attachment 9). The proposed target treatment depth (TTD),
which is within Zone AB of the surficial aquifer, has been selected to extend from 13 to 28 ft
below ground surface (bgs), as shown in Figure 9-6b of Attachment 9. The TTD was chosen to
coincide with the screen interval of well MW-180-H38AB, where the highest concentrations of
TCE in the B105-139 area have been detected.
PTA Layout
The PT A layout will consist of an array of 16 injection wells (IW s ), as shown in Figure 9-4b of
Attachment 9. This layout assumes an anticipated effective radius of influence (ROI) of 11 ft
for each IW, so that wells would be spaced on 22 ft centers. The ROI was selected to create a
reasonable distribution of emulsified vegetable oil (EVO) in the subsurface while maintaining
reasonable target injection volumes. The injection volume to achieve this ROI (injection
volumes are discussed in Attachment 3) has been calculated based upon the TTD described
above, an effective porosity of 0.2, and assumes that the injection fluid will replace about 40% of
the effective pore volume. It is anticipated that the ROI will be achievable in the soil/saprolite of
the Zone AB surficial aquifer.
Two existing AB monitoring wells (MW231-H38AB and MW180-H38AB) and one existing CD
monitoring well (MW200-H38CD) are present within the proposed PTA, while one existing AB
monitoring well (MW230-H38AB) is present outside the PTA. These wells will be used for
EISB performance monitoring as described in Attachment 7. The monitoring network will be
supplemented with two additional AB monitoring wells, one additional CD monitoring well, and
two AB piezometers, as shown in Figure 9-4b of Attachment 9. The locations and number of
proposed IW s as well as the locations of the proposed monitoring wells and piezometers may be
adjusted based on spacing of existing Site features (i.e., trees) in the PT A. The refined layout
and number of wells will not exceed the current design parameters as described above by more
than 50%.
1.3 Pilot Test Area B147
Target Treatment Area and Depth
The TTA for the Bl47 PTA will measure approximately 70 ft by 70 ft (see Figure 9-4b of
Attachment 9). The proposed TTD, which is within Zone AB of the surficial aquifer, has been
selected to extend from 15 to 35 ft bgs (see Figure 9-6c of Attachment 9). The TTD was
chosen to extend from the water table (at approximately 15 ft bgs) to the bottom of the MW-147-
1 screen interval (at 35 ft bgs). The proposed TTA and depth for the B147 PTA are based on
currently available perchlorate data but may be refined in the field based on groundwater
samples to be collected for COPC analysis following initial installation of the four comer PT A
injection wells (see Attachment 7).
PTA Layout
The PTA layout consists of an array of 16 IWs (see Figure 9-4b of Attachment 9). The IWs
were spaced approximately 22 ft apart, yielding an effective ROI of 11 ft. The rationale for this
spacing is the same as described for the well spacing at B105-139 PTA. One existing AB
monitoring well (MW-14 7-1) is present within the proposed PT A, while one existing AB
monitoring well (MW-147-2) is present outside the PTA. These wells will be used for EISB
performance monitoring as described in Attachment 7. The monitoring network will be
supplemented with two additional AB monitoring wells and two AB piezometers. The locations
of the proposed piezometers were selected based on the regional groundwater flow, as shown in
Figure 9-4b of Attachment 9. The locations and number of proposed IWs, as well as the
locations of the proposed monitoring wells and piezometers, may be adjusted in the field based
on spacing of existing Site features (i.e., trees, berm) in the PTA and after additional data
collection, as described above. The refined layout and number of wells will not exceed the
current design parameters as described above by more than 50%.
1.4 Pilot Test Area B149
Target Treatment Area and Depth
The pilot test will target Zone C near well MW-149-1 (see Figure 9-4c of Attachment 9). The
proposed TT A will measure approximately 60 ft by 60 ft. The pilot test is intended to target the
PWR above the competent bedrock in the B 149 area. The thickness of the soil and saprolite
above the PWR varies in the B 149 PT A, and thus the proposed TTD is the 10 ft interval above
the competent bedrock, with a total anticipated depth of between 20 and 50 ft bgs (see Figures 9:..
6d/6e of Attachment 9).
PTA Layout
The layout will consist of 4 IWs (see Figure 9-4c of Attachment 9). The layout assumed _an
anticipated effective ROI of 19 ft for each IW, so that wells would be spaced on 38 ft centers.
The design ROI for B149 PTA is greater than the design ROI for the B105-139 and B147 PTAs
since the PWR of Zone C and the highly fractured upper portion of the bedrock aquifer (Zone D)
are expected to have greater permeabilities than the Zone AB aquifer material, facilitating greater
injection distribution. The injection volume to achieve this ROI (injection volumes are discussed
in Attachment 3) has been calculated based upon the TTD described above, an effective
porosity of 0.2, and assumes that the injection fluid will replace about 60% of the effective pore
volume. Two existing Zone CD monitoring wells (MW-149-1 and MW183-O39CD) are present
within the proposed PTA. These will be used for EISD performance monitoring as described in
Attachment 7. To supplement the monitoring network, two additional Zone CD monitoring
wells are proposed (see Figure 9-4c of Attachment 9). One additional Zone C monitoring well
is also proposed to characterize the shallow groundwater above the TI A. The locations and
number of proposed IWs and the locations of the proposed monitoring wells may be adjusted
based on spadng of existing Site features (i.e., trees) in the PTA.
ATTACHMENT 2
HYDROGEOLOGIC EVALUATION
2. HYDROGEOLOGIC EVALUATION
2.1 Geology and Hydrogeology
The Chemtronics Site lies within the Blue Ridge Physiographic Province (Horton and Zullo,
1991). The Blue Ridge Province is predominately composed of igneous and metamorphic rocks
that have been complexly folded and faulted in a northeasterly direction, parallel to the regional
trend of the mountains. These structural imprints are reflected in the topographic and drainage
patterns within the region. The predominant rock type underlying in the area are high-:grade
metamorphic rock of the Ashe Metamorphic Suite.
The geology of the Site is typical of that found in the Blue Ridge Province and consists of soil
and saprolite overlying a partially weathered rock (PWR) transition zone which grades into
competent bedrock with depth (Altamont, 2010). A generalized depiction of the primary
components of the hydrogeologic system is presented in Figure 2-1 (Harned and Daniel, 1992).
Unconsolidated material overlying bedrock and extending to the surface is typically known as
overburden. In western North Carolina and other parts of the southern Appalachians, most of the
overburden is derived from in-place weathering of bedrock, although some is from deposition by
streams and rivers (alluvium) or deposition from mass wasting (colluvium). As show in Figure
2-1, the Site is underlain by overburden consisting of soil, saprolite, and weathered rock
overlying bedrock.. Soil at the Site typically contains high percentages of clay, silt, and fine
sized particles and thus is anticipated to have relatively low permeability of about 10-2 feet/day
(ft/day),. based on literature values for similar materials. The saprolite, which generally ranges
from 2 to 65 ft thick, is highly weathered with variable permeability while the PWR layer
(generally 5 to 10 ft thick) covers the bedrock and is anticipated to have moderate permeability
of about 10·1 ft/day, based on literature values for similar materials. The permeability of the
PWR can be locally variable depending on mineralogy and structure. The predominant bedrock
underlying the Site is muscovite-biotite gneiss while garnet-muscovite schist has also been
encountered (Altamont, 2010). Cross-sections depicting the thickness of the overburden and the
depth to bedrock are shown in Figures 9-6a to Figure 9-6e of Attachment 9.
The majority of the Site is situated within one of two local watersheds which are separated by a
prominent ridge. · These watersheds are the Unnamed Branch and Gregg Branch, which are
commonly referred to as the Front Valley and Back Valley, respectively. Both of these
watersheds are part of a larger watershed (Bee Tree Creek) and a regional watershed (Swannanoa
River; Figure 9-1 of Attachment 9).
Two primary aquifer systems exist at the Site; the surficial aquifer and the bedrock aquifer. The
aquifers are likely interconnected throughout the Site, but each has distinctly different
characteristics that define the groundwater flow paths within them. The surficial aquifer exists in
unconsolidated material (referred to. as Zones A and B) and PWR (referred to as Zone C),
extending from the water table to the competent bedrock surface. The highly fractured upper
portion of the bedrock aquifer is referred to as Zone D. The deeper bedrock aquifer (referred to
as Zones E and F) consists of sparsely interconnected joints and fractures within the competent
bedrock.
Potentiometric surface maps for Zone AB and Zone CD, including the locations of the pilot test
areas (PTAs), are shown in Figure 9-4a through Figure 9-4c of Attachment 9. The
potentiometric surface maps for Zone AB and Zone CD indicate that the predominant
groundwater flow direction is generally down-valley towards the southeast. Average
groundwater flow velocities of approximately 0.15 ft/day have been estimated for both the AB
and CD zones of the Front Valley of the Chemtronics Site. This groundwater flow velocity has
been estimated by dividing the specific discharge, calculated using Darcy's Law, by a literature
derived estimate of the effective porosity of the system. These parameters are fairly similar for
Zone AB and Zone CD. The specific discharge was calculated using a hydraulic conductivity
value of 1.17 ft/day, which was estimated from a recent long-term pumping test in the Front
Valley, and a hydraulic gradient of 0.025 ft/ft, which was calculated from groundwater levels
measured in wells in the Front Valley of the ~ite for Zones AB and CD. A value of 0.21 was
used for the effective porosity and was obtained from a published value for fine sand (Fetter,
1994).
Groundwater elevations were measured within each PTA in April 2012. The recorded depths to
water were: (i) 9.4 ft below ground surface (bgs) at MW180-H38AB in B105-139 PTA; (ii) 12.4
ft bgs at MW-147-1 in B147 PTA; and (iii) 7.75 ft bgs at MW-149-1 in B149 PTA. Review of
historical groundwater level measurements indicates that, in general, the various aquifer zones
respond to seasonal and annual changes in precipitation similarly (Altamont, 2010). Temporal
changes in water-level vary across the Site with a range of a few feet in the Front Valley surficial
aquifer to as much as 6 ft in the bedrock aquifer.
2.2 References
Altamont, 2010. Remedial Investigation/Feasibility Study (RI/FS) Work Plan -Work Plan
Overview. Chemtronics Site, Swannanoa, Buncombe County, North Carolina. January, 2010.
Fetter, C.W., 1994. Applied Hydrogeology, 3rd edition, Prentice-Hall, New Jersey.
Hamed, D.A., and Daniel, C.C., III, 1992. The transition zone between bedrock and regolith:
Conduit for contamination?, in Daniel, C.C., III, White, R.K., and Stone, P. A., eds., Ground
Water in the Piedmont, Proceedings of a Conference on Ground Water in the Piedmont of the
Eastern United States, Charlotte, N.C., Oct. 16-18, 1989: Clemson, S.C., Clemson University, p.
336-348.
Horton, J.W., Jr. and Zullo, V.A., 1991. The Geology of the Carolinas, Fiftieth Anniversary
Volume, Carolina Geology Society, The University of Tennessee Press/Knoxville.
ATTACHMENT 2 FIGURE
Water Table
Zone A
Zone B
Zone C
Zone Q
Zones
E and F
Note: Modified from Harned and Daniel, 1992
Soil Zone
Saprolite
Partially Weathered Bedrock
(Transition Zone)
Competent Bedrock
(Fractured Gneiss)
Bedrock Fabric {Foliation}
Fracture
Primary Components of the Hydrogeologic System
ChemLronics Site
5wannanoa, North Carolina
Geosyntee t
consultants
Figure
2-1
Kennesaw, Georgia
September 2012

ATTACHMENT 3
INJECTANT INFORMATION
3. INJECTANTINFORMATION
This attachment provides information on the proposed injectants for the Enhanced In Situ
Bioremediation (EISB) pilot tests. The proposed injectants include: (i) Newman Zone®, an
emulsified vegetable oil (EVO) which wili serve as an electron donor; (ii) KB-1® Plus, which is
a mixture of KB-1® and WBC-2 bioaugmentation cultures; (iii) buffer (sodium bicarbonate,
calcium carbonate) and/or base (magnesium hydroxide) for pH control; and (iv) EHC®, a slow
release electron donor containing zero-valent iron. Each of the proposed injectants is on the
North Carolina Department of Environment and Natural Resources (NCDENR), Division of
Water Quality (DWQ), Aquifer Protection Section (APS), Underground Injection Control (UIC)
Program's list of approved injectants2 • Material Safety Data Sheets (MSDSs) for each proposed
injectant are provided in Attachment 3-A.
3.1 Pilot Test Design and Implementation Overview
The EISB approach will be to inject a food-grade, slow-release electron donor (EVO that
includes 4% sodium lactate [Newman Zone®]) into the target aquifer zone (either Zone AB or
Zone C, as defined for each pilottest area [PTA] in Attachment 1) to establish a biologically
active zone (BAZ) to promote in situ biodegradation of target compounds of potential concern
(COPCs). For the B105-139 and B149 PTAs, a commercially available bioaugmentation culture
(KB-I® Plus) comprised of natural dehalorespiring bacteria, will also be injected to mediate the
full biodegradation of trichloroethene (TCE) to ethene. Bioaugmentation will not be
implemented at the B 14 7 PT A since the microorganisms necessary for complete biodegradation
of perchlorate, the target COPC in this PTA, are anticipated to be already present in the
subsurface (they are believed to be ubiquitous).
The target pH range for the B105-139 and B149 PTAs will be between 6.5 and 8.3. The pH in
Bl05-139 and·Bl49 PTA has been observed to be as low as 4.9 and 5.5, respectively (pH data
provided in Figure 9-Sa and Figure 9-Sc in Attachment 9). Therefore, a buffer (i.e., sodium
bicarbonate, calcium carbonate) and/or base (i.e., magnesium hydroxide) will also be injected
into the B105-139 and Bl49 PTA groundwater along with the electron donor to establish and
maintain suitable pH conditions during the pilot tests. In the B 14 7 PT A, the pH has been
observed to be as low as 6.1 (pH data provided in Figure 9-Sb in Attachment 9). Since bacteria
responsible for reduction of perchlorate, the target COPC in this PT A, remain active at lower pH
levels ( compared to the microorganisms responsible for transformation of TCE, the target COPC
in the other PT As) and the background pH is somewhat higher in this PT A, buffer will not be
added to the B 14 7 area.
2 http://portal.ncdenr.org/c/document_library/get_file?uuid=f0c4520b-a93d-4b0d-92ab-
098e5650f18e&groupid=38364
Injection of EVO, buffer and, as appropriate, the bioaugmentation culture, into the subsurface
will be performed using a series of injection wells (IWs) distributed across each PTA. The
layouts, target areas, and target depths for each PT A are discussed in Attachment 1.
3.2 Injectant Volumes and Concentrations
This section describes injectant volumes and concentrations. The injectant volumes outlined
below and in Table 3-1 are based on the proposed pilot test layouts, which may be adjusted in
the field based on site conditions andior additional data coiiection (see Attachment 1).
Therefore, the injectant volumes may be less than outlined below or, if greater, will not exceed
the outlined quantities by more than 50%.
Electron Donor
The total mass of EVO to be injected in each PTA is a function of: (i) the number of IWs per
PTA (see Table 3-1); (ii) the target treatment volume; and (iii) the target EVO concentration.
The target treatment volume for each injection point was estimated to be approximately 3,450
gallons (gal), 4,600 gal, and 10,600 gal for the B105-139, B147, and B149 PTAs, respectively.
These estimates assumed design radii of influence (ROis) and target treatment depths (TTDs) as
specified in Table 3-1 and a porosity of 0.20. A target EVO concentration of 0.5%
(volume/volume [v/v], as oil) was selected for the Bl47 and B149 PTAs. A target EVO
concentration of 1.0% (v/v, as oil) was selected for Bl05-139, as this PTA contains higher
COPC concentrations than the other PTAs. Based on performance at other sites, these EVO
concentrations are sufficient to provide electron donor to treat Site COPCs but low enough to
minimize methane production which can occur if the electron donor is over-dosed and if the
resulting oxidation-reduction potential (ORP) is driven too low (i.e. methanogenesis).
Based on the defined ROis and target concentrations, approximately 260, 175, and 400
kilograms (kg) of EVO will be injected into each IW in the B105-139, B147, and B149 PTAs,
respectively, with a total of 8,500 kg of EVO planned to be injected during the pilot testing. In
addition, up to 210 kg of a slow release electron donor (EHC®) will be added to potable water
that will be used as the injection fluid for bioaugmentation (the EHC® will help make the water
anaerobic, to accommodate the anaerobic microorganisms in the bioaugmentation culture).
Bioaugmentation Culture
KB-1® Plus (which is a mixture of KB-1® and WBC-2 bioaugmentation cultures) is a
commercially available remediation culture provided by SiREM, will be used as the
bioaugmentation culture to promote TCE dechlorination. The total volume of KB-1 ® Plus
culture recommended by SiREM to provide sufficient microbial mass to stimulate reductive
dechlorination is 32 liters (L) each for the BlOS-139 and B149 PTAs (see Table 3-1). The
volume of culture will be distributed equally between the IWs in each PTA.
Buffer
Groundwater pH measured in the B105-139 and B149 PTAs is typically below or on the low end
of the range (pH 6.5 to 8.3) for effective biodegradation of chlorinated volatile organic
compounds (cVOCs) (pH data provided in Figure 9-Sa and Figure 9-Sc in Attachment 9). A
buffer (i.e., sodium bicarbonate, calcium carbonate) and/or base (i .e., magnesium hydroxide) will
be amended to the injection fluid to provide pH control in the B105-139 and B149 PTAs. A
bench test with soil cuttings generated during well installation will be completed to confirm the
appropriate dose of amendment( s) for pH control for the pilot tests, as the dose will be dependent
on the Site geochemistry. Concentrations are anticipated to be up to 10 g/L for sodium
bicarbonate, 20 g/L for magnesium hydroxide, and 80 g/L for calcium carbonate. It is expected
that lower concentrations may actually be used, pending the results of the bench test. As
discussed above, buffer addition in the B 14 7 PT A is not planned.
Dilution Water
The injection fluid will be prepared by diluting the EVO to the target concentration with potable
water from the local municipality, with a total volume of up to 55,200, 73,600, and 42,400 gal to
be injected into B105-139, B147 and Bl49 PTAs, respectively, during the pilot test.
3.3 Anticipated COPC Transformations
Laboratory and field demonstrations over the past decade have shown that microorganisms in
subsurface environments (e.g., groundwater) can degrade cVOCs, perchlorate and research
department explosive (RDX) to environmentally acceptable end products (DOD~ 2004; Hawari et
al., 2000, Crocker and Indest, 2006, Cox et al., 2000). While these biodegradation reactions can
occur under a range of environmental conditions, the · dominant biodegradation mechanism
employed in EISB applications for these COPCs is reduction, which occurs under anaerobic
conditions (absence of oxygen). In each case, the COPCs serve as electron acceptors, and are
reduced, while organic carbon substrates ( e.g., EVO) serve as electron donors.
For cVOCs, such as TCE, the dominant biodegradation mechanism used in EISB applications is
reductive dechlorination, which involves the sequential replacement of chlorine atoms on the
alkene molecule with hydrogen atoms. Under reducing conditions, TCE is dechlorinated to cis-
1,2-dichloroethene (cis-1,2-DCE) then to vinyl chloride (VC) and finally to ethene. Hydrogen,
typically produced during the bacterial metabolism of simple organic carbon compounds such as
alcohols, organic acids, sugars or edible oils, serves as the electron donor in the dechlorination
reactions. Figure 3-1 shows the common biodegradation pathways for chlorinated ethenes,
including TCE.
Perchlorate biodegradation results from microbially-mediated redox reactions where perchlorate
serves as the electron acceptor and is reduced to chlorate and then to chlorite (Figure 3-2).
Chlorite then undergoes a biologically mediated dismutation reaction, producing chloride and
oxygen.
Anaerobic biodegradation of RDX can proceed through a number of pathways, which include
two-electron reduction, single-electron reduction ( or denitration), and direct enzymatic ring
cleavage (Figure 3-3). Biological breakdown products of RDX include carbon dioxide (CO2),
methane, nitrous oxide, hydrazine, and dimethyl hydrazines.
3.4 Anticipated Injectant Transformations
The following subsections describe the injectants' potential for or susceptibility to
transformation in the subsurface.
Electron Donor
Newman Zone® is a biodegradable EVO product that contains both fast-and slow-release
electron donors. In the subsurface, Newman Zone® is anticipated to undergo microbial
biodegradation, producing volatile fatty acids (VF As) ( e.g., lactate, acetate) and dissolved
hydrogen. VF As and dissolved hydrogen are necessary to stimulate microbial reductive
dechlorination of chlorinated organic compounds; VF As and dissolved hydrogen get consumed
during the process. Total organic carbon (TOC) analysis, as discussed in Attachment 7, will be
used as an indication of changes in EVO and VF A concentrations. Following injection, it is
expected that the EVO will remain essentially stationary in the subsurface, and will serve as a
long-term source of electron donor to promote biodegradation of the COPCs in these areas.
Similar transformations are anticipated for EHC®; the zero-valent iron in EHC®, which is not
anticipated to be injected itself, is anticipated to react with dissolved oxygen in dilution fluids to
produce anaerobic water.
Bioaugmentation Culture
In the subsurface, the microbial populations within KB-1 ® Pius are anticipated to grow as they
consume the electron donor/carbon source (Newman Zone®) and transform the chlorinated
organics via reductive dechlorination. Once the chlorinated solvents are degraded, the microbes
no longer have the necessary energy source to continue growing, resulting in the death of the
microbial populations. KB-1 ® Plus is not expected to undergo chemical or physical
transformation in the subsurface.
Buffer/Base
The addition of a buffer (i.e., sodium bicarbonate, calcium carbonate) or base (i.e., magnesium
hydroxide) are anticipated to neutralize pre-existing acidic groundwater conditions and the
influence of VF A production on groundwater pH.
3.5 Potential Byproduct Formation
In addition to the anticipated transformations of COPCs and injectants discussed in Sections 3.3
and 3.4, respectively, EISB may result in the formation of additional byproducts. For example,
anaerobic conditions established during EISB can enhance the mobility of naturally occurring
iron and manganese. Additionally, EISB can result in the formation of methane. As discussed
above, the proposed EVO concentrations are anticipated to be sufficient to provide electron
donor to treat Site COPCs but low enough to minimize methane production. Dissolved metals
and methane are included in the monitoring program as discussed in Section 7.
3.5 References
Cox EE, Edwards E, Neville S. 2000. In situ bioremediation of perchlorate in groundwater. In
Urbansky ET, eds, Perchlorate in the environment. Kluwer Academic, New York, NY.
Crocker and Indest, 2006, Biodegradation of the cyclic nitramine explosives RDX, HMX, and
CL-20, Appl. Microbiol. Biotechnol. 73:274.
DOD, 2004 . Principles and Practices of Enhanced Anaerobic Bioremediation of Chlorinated
Solvents. August, 2004.
Hawari, J., A. Halasz, T. Sheremata, S. Beaudet, C. Groom, L. Paquet, C. Rhofir, G. Ampleman,
and S. Thiboutot. 2000. Characterization of metabolites during biodegradation of hexahyd~o-
1,3,5-trinitro-1,3,5-triazine (RDX) with municipal anaerobic sludge. Appl. Environ. Microbiol.
66:2652-2657.
ATTACHMENT 3 TABLE
TABLE 3-1: EISB PILOT TEST INJECTION DETAILS
Chemtronics Site, Swannanoa, NC
Geosyntec Consultants
TargetCOPC
Zone
New AB Zone Monitoring Wells
New C/CD Zone Monitoring Wells
Estimated Number ofEVO Injection Wells
Porosity
Target Average Biobarrier Thickness [ft)
Theoretical Radius ofEVO Injection2 [ft]
Anticipated Effective Radius ofEVO Injection 3 [ft]
Target %-oil
Mass of Slow Release Electron Donor per well [kg]
Volume of Slow Release Electron Donor (EVO) per well [gal]
Target Injection Volume per well [gal]
Estimated Injection Rate per well [gpm]
Minimum Estimated Time to Inject Per well (assumes 6 hr/day injection time) [days]
Notes:
COPC -compound of potential concern
TCE -trichloroethene
EVO -emulsified vegetable oil
ft-feet
kg -kilogram
gal-gallons
gpm -gallons per minute
PTA -pilot test area
L -liters
na -not applicable
Bioaugmentation volume per well [L]
EHC mass per well [kg]
PTA#l
B105-139
ICE
AB
2
1
16
0.20
15
7
11
1.0%
259
69
3,450
1.5
6.4
2 -
4
PTA#2 PTA#3
B147 B149 Totals1
Perchlorate ICE na
AB C na
2 0 4
0 3 4
16 4 36
0.20 0.20 na
20 10 na
7 15 na
11 19 na
0.5% 0.5% na
172 397 8,500
46 106 2,300
4,600 10,600 171,200
1.0 1.5 na
12.8 19.6 na
0 8 64
6 12 210
1 -Totals represent the sum for all three pilot tests. Totals were calculated by first multiplying the per-well quantities by the number of wells. PT A quantities are estimates based on the
pilot test conceptual design and may be refined based on baseline characterization results and/or performance during injections.
2 -This radius of influence assumes that 100% of the pore volume will be replaced by the injection fluids.
3 -Based on experience at other sites, it is anticipated that the effective radius of influence will be greater than the theoretical radius of influence because replacement of the pore volume
will be less than I 00%.
2012_0928_Chemtronics_6b_Attachment 3_Table 3cl.xlsx 09.28.2012
ATTACHMENT 3 FIGURES
Aerobic Conditions
~ cometabolism ~ lmethanotrophs)
I toluene oxidizers)
/propane oxidizers)
!ammonia oxidizers)
I phenol oxidizers)
fethene oxidizers)
I
Tetrachloroethene
(PCE)
♦
reductive
dechlorination
Trlchloroethene
ITCE)
♦
reductive
dechlorination
las f~r T~E) (cis-1,2-DCE) G cometabolism cls-1.2-Dlchloroethene
or ox1dat1on
♦
reductive
dechlorination
Anaerobic Conditions
anaerobic oxidation ~
(manganese reducers) ~
~ (as for TCE) Vinyl Chloride anaerobic oxidation G cometabolism . G
or ox1oa11on (VC) !iron reducers) CO2
reductive
dechlorination
♦ G o,ddattoo Ethene 1----------B
Pathways for the Degradation of Chlorinated Ethanes
Chemtronlcs Site
Swannanoa, North Carolina
Geosyntece>
consultants Figure
3-1 ~
~ JI I Kennesaw I I I September 2012
CIO (Perchlorate)
Electron Donor
(reduction)
} CO,2H2O, Biomass
CI03 (Chlorate)
Electron Donor
(reduction)
yY CO2, H20, Biomass
C102 (Chlorite)
(chlorite dismutation)
Electron Donor
CI" + 02 l CO2, H20,
Biomass
Pathway for the Anaerobic Degradation of Perchlorate
C ierntronics She
5wannanoa, North Carol i na
Geosyntec °
consultants
Figure
3-2
Kennesaw September 2012

E
3
5
2e- reduction
RDX
le- reduction
MNX
2e- reduction
Hydroxylamino
RDX Derivative
McOH
HCHO
Bio_tf-ransforma_tiio_ n
■ ■
Carbon Dioxide
Methane
I
Ring Cleavage
Dimethyl
Hydrazines
Two -Electron
Reduction
Hydrazine
Ring Ring
Cleavage Cleavage
MDNA
Spontaneous
decomposition
in water
Abiotic
Nitrous
Oxide
Hydrolysis
Formaldehyde
Biotransformation
1
Carbon
Dioxide
Methane
Enzymatic Cleavage
NO2-
MDNA
Unknowns
Spontaneous
decomposition
in water
Nitramines
1
A biotic
■_
Nitrous
Oxide
HCHO
Biatransformation
4,
Carbon
Dioxide
Methane
Single -Electron
R edu cti on/D a nitriti o n
Legend
DNX - dinitroso compound derivative
MNX - monnnitroso compound derivative
TNX-trinitroso compound derivative
e- - electron
RDX-1,3,5-trinitro-1,3,5-triazine
(Research Department Explosive)
MDNA-methylenedinitramine
SPINA-bis{hydrnxytmethyl)nitramine
HMNA- hydroxymethylnitramine
HCHO - formaldehyde
McOH- methanol
Source:
1. Howori et al, 2000. Rppl. Environ. Mrcroblol.662652.
2. Crocker and lndest,2006, Appt. Microbial. Biota -hoot 73:274.
Pathways for the Anaerobic Degradation of RDX
Chemtronics Site
Swannanoa, North Carolina
Geosyntec D
consultants
Kennesaw September 2012
Figure
3-3

ATTACHMENT 3-A
MATERIAL SAFETY DATA SHEETS
MODIFIED MATERIAL SAFETY-DATA SHEET: USA
Remediation and Natural Attenuation Se r vices Incorporated
6712 West River Road
Brooklyn Center, MN 55430
Page 1 of 3
Product Information: 763-585-6191 Issue Date: February 5, 2010
---------------------------------------.----------------------------------
Section 1: IDENTIFICATION
1.1 Product Name: Newman Zone -Standard Formulation 190-6722
1.2 Product Type: Edible Industrial Nutri~nt foi Microbial Organisms
1_.3 Hazard Rating:, Health: 1 Fire: 1 Reactivity: 1
1.4 Formula: Proprietary
Substances Subject to SARA 313 Reporting Are Indicated by"#"
It is our opinion that the above named product does not meet the definition of "hazardous Chemical" as defined in
the OSHA "Hazard Communication Standard" r egulation 29 CFR 1910.1200. This material Safety Data Sheet is provided
as general information for heal th a _nd safety guidelines.
=================~===========-==============-=-==-------------------------
Section 2: INGREDIENTS/COMPOSITION
Soybean Oil (food grade)
Sodium-L-Lactate
CAS No.
8001-22-7
867-56-1
(mg/m3 )
% PEL TWA
46 15(Mist) l0(Mist)
4
Food Additives/Emulsifiers/Preservatives (Proprietary) <10
Water <45
EMERGENCY ONLY, 24-HOUR SERVICE: CHEMTREC: 1-800-424-9300
=-========-=-==-=============--=-=====-=====------------------------------
Section 3: PHYSICAL AND CHEMICAL CHARACTERISTICS
This section completed per formulation ingredient data unless stated.
• Solubility: Dispersible in water (product)
• PH: 7.0 (product)
• Specific Gravity: 0.99 (product)
• Boiling Point: NA
• Vapor Pressure: NA
• Vapor Density: NA
• Percent Volatile By Volume (%): NA
• Evaporation Rate: NA
• Viscosity: 23. 6 cps @ 68°F (Brookfield) (product)
• Product Appearance and Odor: White-colored liquid, vegetable oil odor.
Page 2 of 3
Section 4: FIRE AND EXPLOSION HAZARDS
This section completed per formulation ingredient data unless stated .
4.1 Special Fire Hazards: Product -none, does not support combustion .
Flash Point: >540 degrees F (Pure Soybean Oil Closed Cup).
Flammable Limits
LEL ND
UEL ND
4.2 Fire Fighting Methods: Use method appropriate for surrounding fire.
4.3 Extinguishing Media: Dry Chemical or CO 2 Preferable; water may cause
spattering or spreading.
Section 5: HEALTH HAZARD DATA
5.1 THIS PRODUCT IS USED FOR SOIL AND GROUND WATER REMEDIATION BUT IS
FORMULATED USING FOOD AND FOOD GRADE ADDITIVES. PROCESSING, PACKAGING,
SANITATION AND STORAGE OF THE PRODUCT FOLLOWS THE BEST PRACTICES USED
FOR FOOD PRODUCTS.
5.2 Effects of Overexposure: NA
5.3 Emergency and First Aid Procedures : If inhaled, remove from
contaminated atmosphere . For eye contact immediately flush eyes with
large amounts of water. Ensure rinsing entire surface of eye & under
lid. For skin contact wash affected areas thoroughly with soap and
water. Seek medical help for persistent irritation.
5.4 Hydrolyzed soy protein has been identified by the United States Food
and Drug Administration as a food allergen. Symptoms include swelling
of the lips, stomach cramps, vomiting, diarrhea, skin hives , rashes ,
eczema and breathing problems.
5.5 Occupational Exposure Limits [8-hour time weighted averages (TWA)]:
Soybean Oil (food grade )
Section 6: REACTIVITY DATA
CAS No.
8001-22-7
mg/m3
OSHA PEL/ACGIH TLV
15(Mist)/10(Mist)
This section completed per formulation ingredient data unless stated.
6.1 Stability: Stable under normal conditions.
6.2 Conditions to Avoid: NA
6.3 Incompatibilities: None known
6.4 Hazardous Decomposition Products: Product -None identified.
Ingredients -Carbon oxides. Biological decomposition (spoilage) may
result in offensive odors.
6.5 Hazardous Polymerization; None known
Page 3 of 3
====--===========--==-========-===-===-===----=--==--==-------------------
Section 7: SPILL OR LEAK PROCEDURES
This section completed per formulation ingredient data unless stated.
7.1 Spill Response: Water dispersible. Same as for vegetable oil spills:
isolate spill, prevent from entering waterways, and sewer systems. Sorb
or remove spilled materials as soon as possible. Oils and specific
quantities of oils may be reportable under federal, state, or local
regulations.
7.2 Waste Disposal Method: This product is not hazardous, however, wastes
must be disposed in accordance with local, state or federal
regulations. Consult with local sewer authority, or solid waste
facility prior to disposition.
====--==-============-================-====-===-===-----------------------
Section 8: SPECIAL PRECAUTIONS
No protective equipment is necessary under normal use conditions.
8.1 Eyes: If splashing may occur, eye protection recommended.
8.3 Skin: Wear impervious gloves for prolonged or repeated exposure.
8.4 Respiratory: Avoid breathing mists of this product
------===------==-====--==-=======---==-===-===---------------------------
Section 9: TRANSPORTATION PRECAUTIONS
This section completed per formulation ingredient data unless stated.
9.1 Transportation Considerations: This product is not classified as
dangerous in the meaning of transport regulations. Shippers and
transporters may need to meet packaging and transportation requirements
for certain oils and respective quantities under CFR 49 Part 130.
The above information is believed to be correct with respect to the formula
used to manufacture the product in the country of origin. As data,
standards, and regulations change, and conditions of use and handling are
beyond our control, NO WARRANTY, EXPRESS OR IMPLIED, IS MADE AS TO THE
COMPLETENESS OR CONTINUING ACCURACY OF THIS INFORMATION.
~REM '.;> ~!ecovery&Management
130 Research Lane, Suite 2 Guelph•Ontario • NlG 5G3 •Canada• Tel: [phone] • Fax: [phone]
KB-1® Plus Material Safety Data Sheet
Section 1: Material Identification
Trade Name: KB-1® Plus
Chemical Family: bacterial mixture
Chemical name: No IUC name for mixture is known to exist
Manufacturer/Supplier: Si REM
130 Research Lane, Suite 2,
Guelph, Ontario,
Canada N1 G 5G3
For Information call: 519-822-2265 / 1-866-251-1747 x236
Emergency Number: 519-822-2265
Description: Microbial inoculum (non-pathogenic, non-hazardous)
Trade .Name: KB-1®Plus
Product Use: Bioremediation of contaminated groundwater.
Date Prepared: 23 October 2008
Section 2: Com position , Information on Ingredients
KB-1® Plus is a microbial culture grown in a dilute aqueous mineral salt solution media containing
no hazardous ingredients.
The microbial composition of KB-1® Plus is listed in Table 1.
Table 1. Major Microbial Groups Identified in KB-1® Plus Microbial lnoculum
Acetobacterium
Acidaminococcaceae
Dehalobacter sp.
Deha/ococcoides sp.
Desu/fovibrio sp.
· Methanomethylovorans sp.
Section 3: Hazards Identification:
A review of the available data does not indicate any known health effects related to normal use of
this product.
Section 4: First Aid Measures:
Avoid direct contact with skin and eyes. In any case of any exposure which elicits a response , a
physician should be consulted immediately.
Eye Contact: Flush eyes with water for at least 15 minutes, occasionally lift upper and lower
eyelids, if undue irritation or redness occurs seek medical attention.
P:\PRJ\SiREM\Hea lth and Safety\MSDS\Bioaugmentation Culture MSOSs\KB-1 PLUS MSDS .doc
,,-;:::; REM ,~ fJ.KOfffJ&~ment
130 Research Lane, Suite 2 Guelph•Ontario • NlG 5G3 •Canada• Tel: [phone] • Fax: [phone]
Skin Contact: Remove contaminated clothing c;1nd wash skin thoroughly with water and
antibacterial soap . Seek medical attention if irritation develops or open wounds are present.
Ingestion: Do not induce vomiting, drink several cups of water, seek medical attention.
Inhalation: Remove to fresh air. If not breathing give artificial respiration. In case of labored
breathing give oxygen. Call a physician.
Section 5 -Fire Fi ghtin g Measures:
Non-flammable
Flash Point: not applicable
Upper flammable limit: not applicable
Lower flammable limit: not applicable
Section 6 -Accidental Release Procedures
Spilled KB-1® Plus should be soaked up with sorbant and saturated with a 10% bleach
solution (prepared by making a one in ten dilution of diluted standard bleach [normally
sold at a strength of 5.25% sodium hypochlorite] to disinfect affected surfaces . Sorbant
should be double bagged and disposed of as indicated in section 12. After removal of
sorbant, area should be washed with 10% bleach solution to disinfect. If liquid from the
culture vessel is present on the fittings, non-designated tubing or exterior of the stainless
steel pressure vessel liquid should be wiped off and the area washed with 10% bleach
solution .
Section 7 -Handlin g and Storage
KB-1® Plus is shipped in stainless steel pressure vessels in a protective over pack. KB-
1® Plus should be handled with care to avoid any spillage . Vessels are shipped with 1
pound per square inch (psi) pressure; valves should not be opened until connections to
appropriate lines for subsurface injection are in place.
Storage Requirements: Avoid exposing stainless steel pressure vessels to undue
temperature extremes (i.e., temperatures less than 0°C or greater than 30°C may result
in harm to the microbial cultures and damage to the vessels). All valves should be in the
closed position when the vessel is not pressurized or not in use to prevent the escape of
gases and to maintain anaerobic conditions in the vessel. Avoid exposure of the culture
to air as the presence of oxygen will kill dechlorinating microorganisms.
Section 8 -Ex posure Controls/Personal Protection
Personal protective equipment:
Skin: Protective gloves (latex, vinyl or nitrite) should be worn.
Eye Protection: Wear appropriate protective eyeglasses or goggles when opening
pressure vessels, valves, or when pressurizing vessels to inject contents into the
subsurface .
Respiratory: No respiratory protection is required.
Engineering Controls: Good general room ventilation is expected to be adequate .
P:\PRJ\S IREM\Health and Sarety\MSOS\Biaaugm entatlon Cu lture MSDSS\KB--1 PLUS MSDS .doc
~REM
'.:, ~!~OffiY~Nffllgtmtnl
130 Research Lane , Suite 2 Guelph•Ontarlo • NlG 5G3 •Canada• Tel: [phone] • Fax: [phone]
Section 9: Physical and Chemical Properties:
Physical State : liquid
Odour: skunky odour
Appearance: dark grey, slightly turbid liquid under anaerobic conditions, pink if exposed
to air (oxygen).
Specific gravity : 1
Vapor pressure : not applicable
Vapor density : not applicable
Evaporation rate : not determined
Boiling point: ~100° C
Freezing point/melting point: ~ 0°c
pH: 6 .5-7 .5
Solubility : fully soluble in water
Section 10 -Stability and Reactivity Data
Stable and non-reactive .
Maintain under anaerobic conditions to preserve product integrity.
Materials to avoid : none known
Section 11 -Toxicological Information
Potential for Pathogenicity:
KB-1® Plus has tested negative (i.e ., the organisms are not present) for a variety of pathogenic
organisms listed in Table 2 . While there is no evidence that virulent pathogenic organisms are
present in KB-1® Plus, there is potential that certain organisms in KB-1® Plus may have the
potential to act as opportunistic (mild) pathogens, particularly in individuals with open wounds
and/or compromised immune systems. For this reason standard hygienic procedures such as
hand washing after use should be observed.
Table 2, Results of Human Pathogen Screening of KB-1® Plus
Organism Disease{s) Caused Test result
Salmonella sp . Typhoid fever, gastroenteritis Not Detected
Listeria monocytogenes Listerioses Not Detected
Vibrio sp., Cholera, gastroenteritis Not Detected
Campylobacter sp., Bacterial diarrhea Not Detected
Clostridia sp., Food poisoning , Botulism, tetanus, gas gangrene Not Detected
Bacillus anthracis Anthrax Not Detected
Pseudomonas aeruginosa Wound infection Not Detected
Yersinia sp., Bubonic Plague , intestinal infection Not Detected
Yeast and Mold Candidiasis , Yeast infection etc. Not Detected
Fecal coliforms Indicator organisms for many human pathogens diarrhea , Not Detected
urinary tract infections
Enterococci Various opportun istic infections Not Detected
P:\PRJ\SiREM\1--tealth and Safety\MSDS\Bioaugmentation Culture MSDSs\KB-1 PLUS MSDS .doc
Sitf iwrorrry g Yamag eM
131:1 Research Lane, Suite 2 Guelph•Ontario • N1G 5G3 • Canada • tel: [phone] • Fax: [phone]
Section 12. Disposal Considerations
Material must be disinfected or sterilized prior to disposal. Consult local regulations prior to
disposal.
Section 13 — Transport Information
Non -hazardous, non-pathogenic microbial inoculum
Chemicals, Not Otherwise Indexed (NOI), Non -hazardous
Not subject to TOG or DOT guidelines.
Disclaimer:
The information provided on this MSDS sheet is based on current data and represents
our opinion based on the current standard of practice as to the proper use and handling
of this product under normal, reasonably foreseeable conditions.
Last revised: 21 May 2010
P• PP,JVS:RFMHcehh anu SeatyWISDS'91vaurgmnlatlon GOILIM MSOS B- PLUS MSS .doc

-FMC
Material Safety Data Sheet
EHC®
MSDS #: EHC-C
Revision Date: 2012-04-30
Version I
This MSDS has been prepared to meet U.S . OSHA Hazard Communication Standard 29 CFR 1910.1200
and Canada's Workplace Hazardous Materials Information System (WHMIS) requirements.
1. PRODUCT AND COMPA NY IDENTIFICATION
Product name
Recommended use
Manufacturer
FMC CORPORATION
FMC Peroxygens
1735 Market Street
Philadelphia, PA 19103
Phone: + 1 215/ 299-6000 (General
Information)
E-Mail: [e-mail]
2. Hazards identification
Emergency Overview
CONTAINMENT HAZARD:
EHC®
Bioremediation product for the remediation of contaminated soil and groundwater only. Not for use
in potable drinking water.
Emergency telephone number
For leak, fire, spill or accident emergencies, call:
+ 1 703-527-3887 (CHEMTREC)
+ 1 303 / 595 9048 (Medical -Call Collect)
Any vessel that contains wet EHC must be vented due to potential pressure build up from fermentation gases
Potential health effects
Acute Toxicity
Eyes
Skin
Inhalation
Ingestion
Chronic Toxici ty
No significant health effects anticipated
Product dust may cause mechanical eye irritation.
None known .
Inhalation of dust in high concentration may cause irritation of respiratory system.
Ingestion may cause gastrointestinal irritation, nausea, vomiting and diarrhea.
No known chronic effects of components present at greater than 1 %.
3. Composition/information on ingredients
I ct· n 11 re 1ents
Chemical Name CAS-No Weight%
Iron 7439-89-6 18-48
Organic Amendment Proprietan 52-82
Page l / 6
EHC®
4. First aid measures
Eye contact
Skin contact
Inhalation
Ingestion
5. Fire-fighting measures
Flammable properties
Suitable extinguishing media
Explosion Data
Sensitivity to Mechanical Impact
Sensitivity to Static Discharge
Specific hazards arising from the
chemical
NFPA Health Hazard
NFPA/HMIS Ratings Legend
6. Accidental release measures
Personal precautions
Methods for containment
Methods for cleaning up
7. Handling and storage
Handling
Storage
MSDS #: EHC-C
Revision Date: 2012-04-30
Version 1
In case of contact, immediately flush skin with plenty of water. Get medical attention if irritation
develops and persists.
Wash off with soap and water.
Remove person to fresh air. If signs/symptoms continue, get medical attention.
Rinse mouth with water and afterwards drink plenty of water or milk. Call a poison control center or
doctor immediately for treatment advice.
Combustible material.
Dry chemical, CO , sand, earth, water spray or regular foam.
2
not applicable
not applicable
Dry or powdered ingredients are combustible. Dispersal of finely divided dust from products into
air may form mixtures that are ignitable and _explosive. Minimize airborne dust generation and
eliminate sources of ignition.
Flammabili ty 1 Stabilitv 0 Special Hazards -
Severe = 4; Serious = 3; Moderate= 2; Slight= 1; Minimal= 0
Avoid dust formation. For personal protection see section 8.
Cover powder spill with plastic sheet or tarp to minimize spreading and keep powder dry.
Sweep or vacuum up spillage and return to container.
Minimize dust generation and accumulation. Keep away from open flames, hot surfaces and sources
of ignition. Refer to Section 8.
Keep tightly closed in a dry and cool place. Keep away from open flames, hot surfaces and sources
of ignition. Any vessel that contains . ? must be vented due to potential pressure build up from
fermentation gases.
8. Exposure controls/personal protection
Exposure guidelines Local nuisance dust standards apply.
Occu pational ex posure controls
Page 2 /6
EHC®
Engineering measures
Personal Protective E qui pment
General Information
Respiratory protection
Eye/face protection
Skin and body protection
Hand protection
Hygiene measures
MSDS #: EHC-C
Revision Date: 2012-04-30
Version l
None under normal use conditions. Provide appropriate exhaust ventilation at places where dust is
formed.
If the product is used in mixtures, it is recommended that you contact the appropriate protective
equipment suppliers, These recommendations apply to the product as supplied
Whenever dust in the worker's breathing zone cannot be controlled with ventilation or other
engineering means, workers should wear respirators or dust masks approved by NIOSH/MSHA, EU
CEN or comparable organization to protect against airborne dust.
Safety glasses with side-shields
No special precautions required.
No special precautions required
Handle in accordance with good industrial hygiene and safety practice. Wash hands before breaks
and immediately after handling the product. ·
9. Physical and chemical properties
Appearance
Physical state
Odor
pH
Melting Point/Range
Freezing point
Boiling Point/Range
Flash Point
Evaporation rate
Autoignition Temperature
Flammable properties
Vapor pressure
Vapor density
Density
Water solubility
Percent volatile
Partition coefficient:
Viscosity
Oxidizing properties
Light-tan powder
solid
odorless
5.6 (as aqueous solution)
No information available.
No information available
not applicable
not applicable
not applicable
No information available.
Combustible material
No information available
No information available
0.80 g/mL
practically insoluble
No information available
not applicable
No information available
not applicable
Page 3 / 6
EHCG
MSDS 0: EHC-C
Revision Date:- 2012-04-30
Version 1
10. Stability and reactivity
Stability Stable.
Conditions to ovoid Heat, flames and sparks
Materials to avoid Oxidizing agents Strong acids
Hazardous decomposition products None known
Hazardous polymerization l lazardous polymerization does not occur
11. Toxicological information
Acute effects
Remarks
Eye irritation
Skin irritation
LD50 Ural
LD5O Dermal
1.C50 Inhalation:
Chronic Toxicity
Chronic Toxicity
Carcinogenicity
12. Ecological information
The product has not been tested. Data is based on component.
No data available for the formulation. Non -irritating (rabbit) (based on components)
No data available for the formulation. Non -irritating (rabbit) (based on components)
Iron: 98.6 g/kg (rat)
No information available
Iron: > 100 mg/m3 6 br (rat)
No known chronic effects of components present at greater than 1%.
Contains no ingredient listed as a carcinogen.
Ecotoxicity
The environmental impact of this product has not been fully investigated
Chemical Name
Toxicity to algae
Toxicity to fish
'Toxicity to microorganisms
Toxicity to daphnia and other
aquatic invertebrates
Iron
LC50= 13.6 mg/L Morone
saxatiiis 96 h LCSt= 0.56 mg/L
Cyprinus carpio 96 h
Page 416

EHC®
13. Disposal considerations
Waste disposal methods
Contaminated packaging
14. Transport information
DOT
TDG
ICAO/IATA
IMDG/IMO
15. Regulatory information
International Inventories
MSDS #: EHC-C
Revision Date: 2012-04-30
Version 1
This material, as supplied, is not a hazardous waste according to Federal regulations (40 CFR 261).
This material could become a hazardous waste if it is mixed with or otherwise comes in contact with
a hazardous waste, if chemical additions are made to this material, or if the material is processed or
otherwise altered. Consult 40 CFR 261 to determine whether the altered material is a hazardous
waste . Consult the appropriate state, regional, or local regulations for additional requirements
Dispose of in accordance with local regulations
not regulated
not regulated
not regulated
not regulated
TSCA Inventory (United States of America)
DSL (Canada) Complies
Complies
Complies
NDSL (Canada)
EINECS/ELINCS (Europe)
ENCS (Japan)
IECSC (China)
KECL (Korea)
PICCS (Philippines)
AICS (Australia)
NZioC (New Zealand)
U.S. Federal Regulations
SARA313
Complies
Complies
Complies
Complies
Section 313 of Title III of the Superfund Amendments and Reauthorization Act of 1986 (SARA). This product does not contain any chemicals
which are subject to the reporting requirements of the Act and Title 40 of the Code of Federal Regulations, Part 372.
SARA 311/312 Hazard Categories
Acute Health Hazard
Chronic Health Hazard
Fire Hazard
Sudden Release of Pressure Hazard
Reactive Hazard
CERCLA
no
no
no
no
no
This material, as supplied, does not contain any substances regulated as hazardous substances under the Comprehensive Environmental
Response Compensation and Liability Act (CERCLA) (40 CFR 302) or the Superfund Amendments and Reauthorization Act (SARA) (40 CFR
355). There may be specific reporting requirements at the local, regional, or state level pertaining to releases of this material.
Page 5/6
EHC®
International Regulations
Mexico -Grade
Canada
No information available
MSDS #: EHC-C
Revision Date: 2012-04-30
Version 1
This product has been classified in accordance with the hazard criteria of the Controlled Products Regulations (CPR) and the MSDS
contains all the information required by the CPR.
WHMIS Hazard Class
not determined
16. Other information
HMIS Health Hazard 1 Flammnbilit Stabilit 0 Special precautions -
NFP A/HMIS Ratings Legend Severe= 4; Serious= 3; Moderate= 2; Slight= 1; Minimal= 0
Revision Date: 2012-04-30
Reason for revision: No information available.
Disclaimer
FMC Corporation believes that the information and recommendations contained herein (including data and statements) are accurate as of the date
hereof. NO WARRANTY OF FITNESS FOR ANY PARTICULAR PURPOSE, WARRANTY OF MERCHANTABILITY OR ANY OTHER
WARRANTY, EXPRESSED OR IMPLIED, IS MADE CONCERNING THE INFORMATION PROVIDED HEREIN. The information provided
herein relates only to the specified product designated and may not be applicable where such product is used in combination with any other materials or
in any process. , Further, since the conditions and methods of use are beyond the control of FMC Corporation, FMC corporation expressly disclaims
any and all liability as to any results obtained or arising from any use of the products or reliance on such information.
Prepared By
FMC Corporation
FMC Logo and EHC -Trademarks of FMC Corporation
© 2012 FMC Corporation. All Rights Reserved
End of Material Safety Data Sheet
Page 6 / 6
ASTRO PRODUCT CODE # 15046
MATERIAL SAFETY DATA SHEET
Sodium Bicarbonate
c
MSDS Ref. No.: 144-55-8
Date Approved: 01I2.6/2004
Revision No.: 3
This document has been prepared to meet the requirements of the U.S. OSHA Hazard Communication
Standard, 29 CFR 1910.1200; the Canada's Workplace Hazardous Materials Information System (WHMIS)
and, the EC Directive, 2001/58/EC.
1. PRODUCT AND COMPANY IDENTIFICATION
PRODUCT NAME:
SYNONYMS:
GENERAL USE:
MANUFACTURER
FMC Wyoming Corporation
Alkali Chemicals Division
1735 Market Street
Philadelphia, PA 19103
[phone] (General Information)
Sodium Bicarbonate
Baking Soda, Bicarbonate of Soda
Leavening agent, cleaner ingredient, bath salt ingredient, water
softener; diaper rinse ingredient, feed additive.
This chemical is certified to ANSI/NSF Standard 60, Drinking Water
Chemicals -Health Effects (as packaged in the original, unopened
container). The maximum dosage level for this chemical is 100 mg/L
EMERGENCY TELEPHONE NUMBERS
[phone] (CHEMTREC - U.S_)
[phone] (]MIeriical - Call Collect)
[phone] (Plant - Green River, WY)
2. HAZARDS IDENTIFICATION
EMERGENCY OVERVIEW:
• Whits, odorless, granular solid.
' Product is non-combustible.
▪ Reacts with acids to release carbon dioxide gas and heat
POTENTIAL HEALTH EFFECTS: No significant health effects anticipated.
Page 1 of

ASTRO PRODUCT CODE # 15046
Sodium Bicarbonate (144-55-8) Date: 01/26/2004
3. COMPOSITION/ INFORMATION ON INGREDIENTS
Chelllical Name CAS# WL% ECNo. EC Class
Sodium Bicarbonate 144-55-8 1CO 205-633-8 Not classified as hazardous
4. FIRST AID MEASURES
EYES: Flush with plenty of water. Get medical attention if irritation occurs and persists.
SKIN: Wash with plenty of soap and water. Get medical attention if irritation occms and pe;sists.
INGESTION: Drink plenty of water. Never give anything by mouth to an unconscious person. If any
discomfort persists, obtain medical attention.
INHAIA TIO N: Remove to fresh air. If breathing difficulty or discomfort occurs and persists, obtain
medical attention.
NOTES TO MEDICAL DOCTOR: Internal to'l\.icity is low. Treatment is symptomatic and
supponive.
5. FIRE FIGHTING MEASURES
EXflNGUISHING MEDIA: Water, water fog, carbon. dioxide (CO2), dry chemical
FIRE I EXPLOSION HAZARDS: None
FIRE F[GH'f!NG PROCEDURES: None
FLAMMABLE LIMITS: Not applicable
HAZARDOUS COMBUSTION PRODUCTS: None
SENSITIVITY TO Th1PACT: None
SENSITIVITY TO STATIC DISCHARGE: None
Page2 of9
ASTRO PRODUCT CODE # 15046
Sodium Bicarbonate (144-55-8) Date: 01)26/2004-
6. ACCIDENTAL RELEASE MEASURES
COMMENTS: PERSONAL PRECAUTIONS: Refer toSection8 "Exposure Controls /Personal
Protection".
CLEAN-UP: This product, if spilled, can be recovered and re-used if contamination does not present a
problem. Vacuum or sweep up the material. If the spilled product is unusable due to contamination,
consult state or federal environmental agencies for acceptable disposal procedures and locations. See
Section 13 "Disposal Considerations".
NOTIFICATION REQUIREMENTS: Federal regulations do not require notification for spills of this
product. State and local regulations may contain different requirements; consult local authorities.
7. HANDLING AND STORAGE
HANDLING: Use air conveying}mechanical systems for bull:: transfer to storage. For manual
handling of bulk transfer use mechanical ventilation to remove airborne dust from railcar, ship or truck.
Use approved respiratory protection when ventilation systems are not available. Selection of respirators is
based on the dust cloud generated.
STORAGE: Store in a cool dry area, away from acids.
COMMENTS: Use general room dilution or local exhaust ventilation when excessive dust is
expected in the wor:k environment.
8. EXPOSURE CONTROLS/ PERSONAL PROTECTION
ENGINEERING CONTROLS: Where possible, provide general mechanical and/or local
exhaust ventilation to prevent release of airborne dust into the wor:k environment.
PERSONAL PROTECTIVE EQUIPMENT
EYES AND FACE: Appropriate eye and face protection equipment (ANSI 'Zl?,7
approved) should be selected for the particular use intended for tbis material. Safety glasses with
side shields are recommended.
RESPIRATORY: Whenever dust in the worker~ h;eathing zone cannot be controlled with
ventilation or other engineering means, workers should wear respirators or dust masks approved by
NIOSH/MSHA, EU CEN or comparable certification organization to protect them against airborne
dust.
PROTECTIVE CLOTHING: Dry product is generally non-irritating to intact skin.
However, this product can be irritating where skin has been damaged and can create skin irritation
Page3 of9
ASTRO PRODUCT CODE # 15046
Sodium Bicarbonate (144-55-8) Date: 01/26/2004
after Jong exposures when. moisture is present. Under such conditions, gloves and lon.g-sl eeved
clothing are recommended to minimize skin contact.
COMMENTS:
ADDITIONAL EXPOSURE GUIDELINES:
Federal guidelines treat the ingredient(s) in this product as a nuisance dust, as no product-specific
guidelines have been issued for exposure. As with all nuisance dusts, worker breating zone concentrations
should be measured by validated sampling and analytical methods. The following limits (OSHA and
MSHA) apply to this material:
Particulates Not Otherwise Regulated:
OSHA (PEL/TWA): 15 mg/m3 (total dust); 5 mg/m3 (resp fraction)
MSHA(PEL/TWA): 10 mg/m3 (total dust)
The information noted above provides general guidance for handling this product. Specific work
environments and material handling practices will dictate the selection and use of personal protection
equipment (PPE).
9. PHYSICAL AND CHEMICAL PROPERTIES
ODOR:
APPEARANCE:
AUfOIGNITION TEMPERATURE:
BOILING POINT:
COEFFICIENT OF OIL/ WATER:
DENSITY/ WEIGHT PER VOLUME:
EVAPORATION RATE:
FIASH POINT:
MELTING POINT:
ODOR THRESHOLD:
OXIDIZING PROPERTIES:
PERCENT VOLATILE:
pH:
SOLUBILITY IN WATER:
SPEaFIC GRA Vl'IY:
VAPOR DENSITY:
Odorless
Whlte, granular solid.
Not applicable
Not applicable
Not available
0.88g/mL
Not applicable (Butyl Acetate = 1)
Non-combustible
Decomposes
Not applicable
Not applicable
Not available
8.3 (1 % solution)
% by wt. @ 20·c (68°F): 9.0
(H20 = 1) 2.20
Not applicable (Air= 1)
Page4 of9
ASTRO PRODUCT CODE# 15046
Sodium Bicarbonate (144-55-8) Date: 01/26/2004
VAPOR PRESSURE: Not available
10. STABILITY AND REACTIVITY
CONDmONS TO A VOID: Contact with acids except under controlled
conditions.
STABILITY: Stable
POLYMERIZATION: Will not occur
INCOMPATIBLE MATERIALS: Reacts with acids to release carbon dioxide gas and
heat.
HAZARDOUS DECOMPOSfflON PRODUCTS: None
11. TOXICOLOGICAL INFORMATION
EYE EFFECTS: Non-irritating (rabbit) J. Amer. Coll. Toxicol. 1987
SKIN EFFECTS: · Non-frritating (rabbit) J. Amer. Coll. Toxicol. 1987
DERMAL LDso: No data available for the product.
ORAL LDso: 20% slurry: 4,300 mg/kg (rat)
50 % slurry: 6,000 mg/kg (rat)
Gosselin, Smith & Hodge, Clinical Tox. of Comm. Products, 1984
INHALATION LCso: So data available for the product.
TARGET ORGANS: None
ACUTE EFFECTS FROM OVEREXPOSURE: Thisproduct, when dry, is generally
non-irritating to intact skin. However, when moisture is present, it can be irritating to damaged skin and
can create irritation after long exposures. This product is approved for \lSe as a food ingredient and is
Generally Recognized As Safe (GRAS). No significant acute toxicological effects expected.
CHRONIC EFFECTS FROM OVEREXPOSURE: Administration of large doses of
sodium bicarbonate to patients with renal insuff.ciency can produce systemic alkalosis.
Page5 of9
ASTRO PRODUCT CODE# 15046
Sodium Bicarbonate (144-55-8)
CARCINOGENICITY:
NTP:
IARC:
OSHA:
OTHER:
Not listed
Not listed
Not listed
(ACGIH) Not listed
12. ECOLOGICAL INFORMATION
Date: 01/26/2004
ECOTOXICOLOGICAL INFORMATION: 48 hr LC50 = 2000 mg/L (Culex sp. larvae
or mosctuito)
CHEMICAL FATE INFORMATION: No data available for the product.
13. DISPOSAL CONSIDERATIONS
DISPOSAL METHOD: When this product is discarded or disposed of, as purchased, i~ is
neither a characteristic nor a listed hazardous waste according to US Federal RCRA regulations ( 40 CFR
261). As a non-hazardous waste the material may be disposed of in a landfill in accordance with
government regulations; check local or state xegulations for applicable requirements prior to disposal. Any
processing, usage, alteration, chemical additions to, or contamination of, the product may alter the disposal
requirements. Under Federal regulations, it is the generator's responsibility to determine if a waste is a
hazardous waste.
14. 1'RANSPORT INFORMATION
U.S. DEPARTMENT OF TRANSPORTATION (DOT)
PROPER SIDPPING NAl.'vIE:
PRIMARY HAZARD CIASS / DIVISION:
UN/NA NUMBER:
IA8EL(S):
PIACARD(S):
MARKING(S):
ADDITIONAL INFORMATION:
Page6 of9
Not regulated
Not applicable
None
Not applicable
Not applicable
Not applicable
Hazardous Substance/RQ: Not applicable
49 STCC Number: Not applicable
ASTRO PRODUCT CODE# 15046
Sodium Bicarbonate (144-55-8) Date: 01/26/i004
INTERNATIONAL MARITIME DANGEROUS GOODS (IMDG)
ADDITIONAL ltl.:'FORMATION: . Not regulated
ADR -EUROPEAN AGREEMENT CONCERNING THE
INTERNATIONAL CARRIAGE OF DANGEROUS GOODS BY ROAD
ADDITIONAL INFORMATION: Not regulated
15. REGULATORY INFORMATION
UNITED STATES
SARA TITLE ID (SUPERFUND AMENDMENTS AND REAUTHORIZATION ACI')
SECTION 302 IDITREMELY HAZARDOUS SUBSl'ANCES (40 CFR355, APPENDIX A):
Not listed
SECTION 312 THRESHOLD PIANNING QUANTITY (40 CFR 370):
The Threshold Planning Quantity (TPQ) for this product, if treated as a mixture, is 10,000 lbs;
however, this product contains the following ingyedients with a TPQ of less tban 10,000 lbs.:
No TPQ for this product
SECTION 313 REPORTABLE INGREDIENTS (40 CFR 372):
Not listed
CERCIA (COMPREHENSIVE -ENVIRONMENI'AL RESPONSE COMPENSATION AND
LIABILITY AC1)
CERCIA DESIGNATION & REPORTABLE QUANTITIES (RQ) (40 CFR 302.4):
Not applicable
TSCA (fOXIC SUBSTANCE CONTROLAC1)
TSCA INVENTORY STATUS (40 CFR 710):
Listed
RESOURCE CONSERVATION Al\'D RECOVERY ACT (RCRA)
RCRA IDENTIFICATION OF HAZARDOUS WASTE (40 CFR261):
Waste Number: Refer to Section 13 "Disposal Considerations" for RCRA status.
Page 7 of9
ASTRO PRODUCT CODE # 15046
Sodium Bicarbonate (144-55-8) Date: 01/26/2.004
CANADA
WHMIS (WORKPLACE HAZARDOUS MATERIALS INFORMATION SYSTEM):
Product Identification Number: None
Hazard Classification / Division None
Ing diCzzf Disclom rc List: Nit Listed
COMMENTS:
CLEAN WATER ACT (CWA) - SECTION 307 / 311
Not listed as a hazardous pollutant (40 CFR 116), nor as a toxic pollutant (40 CFR 401.15)
CLEAN AIR ACT (CAA) - SECTION 112
Not regulated under the chemical accident prevention provisoins (40 CFR 68)
16. OTHER INFORMATION
HMIS
Health
0
0
Flammability
Physical Hazard
0
Personal Protection (PPE)
B
Protection = B (Safety glasses and gloves)
HMIS w Hazardous Materials Identification System
Degree of. Hazard Code:
4 = Severe
3 = Serious
2 -.Moderate
1 Slight
0 = MIninml
NFPA
Health
0
Flammability
0
Reaetivit'r
0
Special
None
No special requirements
N PA = National. Fire Protection Association
Degree of Hazard Code:
4 = Extreme
3=High
2 = Moderatt
1 = Slight
0 = Insignificant
Page 8 of 9

ASTRO PRODUCT CODE # 15046
REVISION SUMMARY:
. Changes in information are as foEows:
New Format, as well as text changes and/or updates to one or more Sections of this MSDS.
FMC Logo -FMC Corporation Trademark
© 2004 FMC Corporation. All Rights Reserved.
FMC Corporation believes that the information and recommendations contained herein (including data and
statements) are accurate as of the date hereof. NO WARRANTY OF FTI'NESS FOR ANY PARTICL'LAR
PURPOSE, WARRANTY OF MERCHANTABILITY, ORAWOTHER WARRANTY, EXPRESSED
OR IMPLIFD, IS MADE CONCERNING THE INFORMATION PROVIDED HEREIN. The information
provided herein relates only to the specific product designated and may not be applicable where such
product is used in combination with any other materials or :n any process. It is a violation of Federal law to
use this product in a manner inconsistent with its labeling. Further, since the conditions and methods of use
are beyond the control of FMC Corporation, FMC Corporation expressly disclaims any and all liability as
to any results obtained or arising from any use of the product or reliance on such information.
Page9 of9
Fire Il
Reactivity 0
Personal
Protection
Material Safety Data Sheet
Calcium carbonate MSDS
Section 1: Chemical Product and Company Identification
Product Name: Calcium carbonate
Catalog Codes: SLC1141, SLC4720, SLC4438, SLC1645
CAS#: 471-34-1
RTECS: FF9335000
TSCA: TSCA 8(b) inventory: Calcium carbonate
CI#: Not available.
Synonym:
Chemical Name: Calcium Carbonate
Chemical Formula: CaCO3
Contact Information:
Sciencelab.com, Inc.
14025 Smith Rd.
Houston, Texas 77396
US Sales: 1-800-901-7247
International Sales: 1-281-441-4400
Order Online: ScienceLab.corrl
CHEMTREC (24HR Emergency Telephone), call:
1-800-424-9300
International CHEMTREC, call: 1-703-527-3887
For non -emergency assistance, call: 1-281-441-4400
Section 2: Composition and Information on Ingredients
Composition:
Name
Calcium carbonate
CAS #
471-34-1
Toxicological Data on Ingredients: Calcium carbonate: ORAL (LD50): Acute: 6450 mg/kg [Rat].
% by Weight
100
Section 3: Hazards Identification
Potential Acute Health Effects:
Hazardous in case of eye contact (irritant). Slightly hazardous in case of skin contact (irritant), of ingestion, of inhalation.
Potential Chronic Health Effects:
CARCINOGENIC EFFECTS: Not available. MUTAGENIC EFFECTS: Not available. TERATOGENIC EFFECTS: Not available.
DEVELOPMENTAL TOXICITY: Not available. The substance may be toxic to kidneys. Repeated or prolonged exposure to the
substance can produce target organs damage.
Section 4: First Aid Measures
Eye Contact:
Check for and remove any contact lenses. in case of contact, immediately flush eyes with plenty of water for at least 15
minutes. Cold water may be used. WARM water MUST be used. Get medical attention.
p, 1

Skin Contact: Wash with soap and water. Cover the irritated skin with an emollient. Get medical attention if irritation develops.
Serious Skin Contact: Not available.
Inhalation:
If inhaled, remove to fresh air. If not breathing, give artificial respiration. If breathing is difficult, give oxygen. Get medical
attention .
Serious Inhalation: Not available.
Ingestion:
Do NOT induce vomiting unless directed to do so by medical personnel. Never give anything by mouth to an unconscious
person. Loosen tight clothing such as a collar, tie, belt or waistband . Get medical attention if symptoms appear.
Serious Ingestion: Not available.
Section 5: Fire and Explosion Data
Flammability of the Product: Non-flammable.
Auto-Ignition Temperature: Not applicable.
Flash Points: Not applicable.
Flammable Limits: Not applicable.
Products of Combustion: Not available .
Fire Hazards in Presence of Various Substances: Not applicable.
Explosion Hazards in Presence of Various Substances:
Risks of explosion of the product in presence of mechanical impact: Not available . Risks of explosion of the product in
presence of static discharge: Not available.
Fire Fighting Media and Instructions: Not applicable.
Special Remarks on Fire Hazards: Will ignite and burn fiercely in contact with fluorine
Special Remarks on Explosion Hazards:
When a mixture of calcium carbonate and magnesium is heated in a current of hydrogen, a violent explosion occurs.
Section 6: Accidental Release Measures
Small Spill:
Use appropriate tools to put the spilled solid in a convenient waste disposal container. Finish cleaning by spreading water on
the contaminated surface and dispose of according to local and regional authority requirements.
Large Spill:
Use a shovel to put the material into a convenient waste disposal container. Finish cleaning by spreading water on the
contaminated surface and allow to evacuate through the sanitary system . Be careful that the product is not present at a
concentration level above TL V. Check TL V on the MSDS and with local authorities.
Section 7: Handling and Storage
Precautions:
Do not ingest. Do not breathe dust. Avoid contact with eyes. Wear suitable protective clothing . If ingested , seek medical advice
immediately and show the container or the label. Keep away from incompatibles such as oxidizing agents, acids.
Storage: Keep container tightly closed . Keep container in a cool, well-ventilated area. Hygroscopic
Section 8: Exposure Controls/Personal Protection
p.2
Engineering Controls:
Use process enclosures, local exhaust ventilation, or other engineering controls to· keep airborne levels below recommended
exposure limits. If user operations generate dust, fume or mist, use ventilation to keep exposure to airborne contaminants
below the exposure limit.
Personal Protection:
Splash goggles. Lab coat. Dust respirator. Be sure to use an approved/certified respirator or equivalent. Gloves.
Personal Protection in Case of a Large Spill:
Splash goggles. Full suit. Dust respirator. Boots. Gloves. A self contained breathing apparatus should be used to avoid
inhalation of the product. Suggested protective clothing might not be sufficient; consult a specialist BEFORE handling this
product.
Exposure Limits:
TWA: 10 (mg/m3) from ACGIH {TLV) [United States] Inhalation Total. TWA: 10 STEL: 20 (mg/m3) [Canada] Inhalation
Total. TWA: 5 (mg/m3) from OSHA (PEL) [United States] Inhalation Respirable . TWA: 15 from OSHA (PEL) [United States]
Inhalation Total.Consult local authorities for acceptable exposure limits.
Section 9: Physical and Chemical Properties
Physical state and appearance: Solid. (Powdered solid.)
Odor: Odorless.
Taste: Chalky
Molecular Weight: 100.09 g/mole
Color: White.
pH (1% soln/water): Not available.
Boiling Point: Not available.
Melting Point: 825°C (1517°F)
Critical Temperature: Not available.
Specific Gravity: 2 .8 (Water= 1)
Vapor Pressure: Not applicable.
Vapor Density: Not available.
Volatility: Not available.
Odor Threshold: Not available.
Water/Oil Dist. Coeff.: Not available.
lonicity (in Water): Not available.
Dispersion Properties: Not available.
Solubility:
Very slightly soluble in cold water. Soluble in dilute acid. Insoluble in alcohol.
Section 10: Stability and Reactivity Data
Stability: The product is stable.
Instability Temperature: Not available.
Conditions of Instability: Incompatible Materials
p. 3
Incompatibility with various substances: Reactive with oxidizing agents, acids.
Corrosivity: Non-corrosive in presence of glass.
Special Remarks on Reactivity:
Hygroscopic. Will ignite and burn fiercely in contact with fluorine . Incompatible with acids, alum, ammonium salts, mercury +
hydrogen, aluminum and magnesium
Special Remarks on Corrosivity: Not available.
Polymerization: Will not occur.
Section 11: Toxicological Information
Routes of Entry: Inhalation . Ingestion .
Toxicity to Animals: Acute oral toxicity (LD50): 6450 mg/kg [Rat].
Chronic Effects on Humans: May cause damage to the following organs: kidneys .
Other Toxic Effects on Humans: Slightly hazardous in case of skin contact (irritant), of ingestion, of inhalation.
Special Remarks on Toxicity to Animals: Not available .
Special Remarks on Chronic Effects on Humans: Not available.
Special Remarks on other Toxic Effects on Humans:
Acute Potential Health Effects : Skin : Causes skin irritation. Eyes: Dust causes eye irritation. Inhalation : Excessive inhalation
causes respiratory tract and mucous membrane irritation . Low hazard for usual industrial handling . Ingestion: Ingestion of
large amounts may cause gastrointestional tract disturbances with nausea and possibly constipation . Expected to be a low
hazard for usual industrial handling. Chronic Potential Health Effects: Chronic ingestion may affect kidneys, and may cause
hypercalcemia with alkalosis.
Ecotoxicity: Not available .
BODS and COD: Not available .
Products of Biodegradation:
Section 12: Ecological Information
Possibly hazardous short term degradation products are not likely. However, long term degradation products may arise.
Toxicity of the Products of Biodegradation: The product itself and its products of degradation are not toxic.
Special Remarks on the Products of Biodegradation: Not available .
Section 13: Disposal Considerations
Waste Disposal:
Waste must be disposed of in accordance with federal, state and local environmental control regulations.
Section 14: Transport Information
DOT Classification: Not a DOT controlled material (United States).
Identification: Not applicable .
Special Provisions for Transport: Not applicable.
p. 4
Section 15: Other Regulatory Information
Federal and State Regulations: TSCA B(b) inventory: Calcium carbonate
Other Regulations: EINECS: This product is on the European Inventory of Existing Commercial Chemical Substances.
Other Classifications:
WHMIS (Canada): Not controlled under WHMIS (Canada}.
DSCL (EEC):
R36-Irritating to eyes. S2-Keep out of the reach of children. S46-If swallowed, seek medical advice immediately and show
this container or label.
HMIS (U.S.A.):
Health Hazard: 2
Fire Hazard: 0
Reactivity: O
Personal Protection: E
National Fire Protection Association (U.S.A.):
Health: 1
Flammability: O
Reactivity: 0
Specific hazard:
Protective Equipment:
Gloves. Lab coat. Dust respirator. Be sure to use an approved/certified respirator or equivalent. Splash goggles.
Section 16: Other Information
References: Not available.
Other Special Considerations: Not available.
Created: 10/10/2005 08:15 PM
Last Updated: 06/09/2012 12:00 PM
The information above is believed to be accurate and represents the best information currently available· to us. However, we
make no warranty of merchantability or any other warranty, express or implied, with respect to such information, and we assume
no liability resulting from its use. Users should make their own investigations to determine the suitability of the information for
their particular purposes. In no event shall ScienceLab. com be liable for any claims, losses, or damages of any third party or for
lost profits or any special, indirect, incidental, consequential or exemplary damages, howsoever arising, even if ScienceLab.com
has been advised of the possibility of such damages.
p. 5
Health 1
Fire
0
Reactivity 0
Personal
Protection
Material Safety Data Sheet
Magnesium hydroxide MSDS
Section 1: Chemical Product and Company Identification
Product Name: Magnesium hydroxide
Catalog Codes: SLM2437, SLM3811, SLM1663
CAS#: 1309-42-8
RTECS: 0M3570000
TSCA: TSCA 8(b) inventory: Magnesium hydroxide
CI#: Not available.
Synonym:
Chemical Name: Not available,
Chemical Formula: Mg(O1-I)2
Contact Information:
Sciencelab.com, Inc.
14025 Smith Rd.
Houston, Texas 77396
US Sales: 1-800-901-7247
International Sales: 1-281-441-4400
Order Online: ScienceLab.com
CHEMTREC (24HR Emergency Telephone), call:
1-800-424-9300
International CHEMTREC, call: 1-703-527-3887
For non -emergency assistance, call: 1-281-441-4400
Section 2: Composition and Information on Ingredients
Composition:
Name
Magnesium hydroxide
Toxicological Data on Ingredients: Not applicable.
CAS #
1309-42-8
% by Weight
100
Section 3: Hazards Identification
Potential Acute Health Effects: Slightly hazardous in case of skin contact (irritant), of eye contact (irritant), of ingestion, of
inhalation.
Potential Chronic Health Effects:
CARCINOGENIC EFFECTS: Not available. MUTAGENIC EFFECTS: Not available. TERATOGENIC EFFECTS: Not available.
DEVELOPMENTAL TOXICITY: Not available. Repeated or prolonged exposure is not known to aggravate medical condition.
Section 4: First Aid Measures
Eye Contact: Immediately flush eyes with running water for at least 15 minutes, keeping eyelids open. Cold water may be
used
Skin Contact:
After contact with skin, wash immediately with plenty of water. Gently and thoroughly wash the contaminated skin with running
water and non-abrasive soap. Be particularly careful to clean folds, crevices, creases and groin. Cover the irritated skin with an
emollient. If irritation persists, seek medical attention.

Serious Skin Contact: Not available.
Inhalation: Allow the victim to rest in a well ventilated area. Seek immediate medical attention.
Serious Inhalation: Not available.
Ingestion:
Do not induce vomiting. Loosen tight clothing such as a collar, tie, belt or waistband. If the victim is not breathing, perform
mouth-to-mouth resuscitation. Seek immediate medical attention.
Serious Ingestion: Not available.
Section 5: Fire and Explosion Data
Flammability of the Product: Non-flammable.
Auto-Ignition Temperature: Not applicable.
Flash Points: Not applicable.
Flammable Limits: Not applicable.
Products of Combustion: Not available .
Fire Hazards in Presence of Various Substances: Not applicable.
Explosion Hazards in Presence of Various Substances:
Risks of explosion of the product in presence of mechanical impact: Not available. Risks of explosion of the product in
presence of static discharge: Not available.
Fire Fighting Media and Instructions: Not applicable.
Special Remarks on Fire Hazards: Not available .
Special Remarks on Explosion Hazards: Not available.
Section 6: Accidental Release Measures
Small Spill:
Use appropriate tools to put the spilled solid in a convenient waste disposal container. Finish cleaning by spreading water on
the contaminated surface and dispose of according to local and regional authority requirements.
Large Spill:
Use a shovel to put the material into a convenient waste disposal container. Finish cleaning by spreading water on the
contaminated surface and allow to evacuate through the sanitary system.
Section 7: Handling and Storage
Precautions: No specific safety p_hrase has been found applicable for this product.
Storage:
No specific storage is required . Use shelves or cabinets sturdy enough to bear the weight of the chemicals. Be sure that it is
not necessary to strain to reach materials, and that shelves are not overloaded.
Section 8: Exposure Controls/Personal Protection
Engineering Controls:
Use process enclosures , local exhaust ventilation, or other engineering controls to keep airborne levels below recommended
exposure limits. If user operations generate dust, fume or mist, use ventilation to keep exposure to airborne contaminants
below the exposure limit.
p.2
Personal Protection: Safety glasses. Lab coat. Dust respirator. Be sure to use an approved/certified respirator or equivalent.
Gloves.
Personal Protection in Case of a Large Spill:
Splash goggles. Full suit. Dust respirator. Boots. Gloves. A self contained breathing apparatus should be used to avoid
inhalation of the product. Suggested protective clothing might not be sufficient; consult a specialist BEFORE handling this
product.
Exposure Limits: Not available.
Section 9: Physical and Chemical Properties
Physical state and appearance: Solid.
Odor: Not available.
Taste: Not available.
Molecular Weight: 58.32 g/mole
Color: Not available.
pH (1% soln/water): Not available .
Boiling Point: Not available.
Melting Point: Decomposes.
Critical Temperature: Not available.
Specific Gravity: 2.36 (Water= 1)
Vapor Pressure: Not applicable.
Vapor Density: Not available.
Volatility: Not available.
Odor Threshold: Not available.
Water/Oil Dist. Coeff.: Not available.
lonicity (in Water): Not available .
Dispersion Properties: Not available.
Solubility: Very slightly soluble in _cold water.
Section 10: Stability and Reactivity Data
Stability: The product is stable.
Instability Temperature: Not available.
Conditions of Instability: Not available.
Incompatibility with various substances: Not available.
Corrosivity: Non-corrosive in presence of glass.
Special Remarks on Reactivity: Not available.
Special Remarks on Corrosivity: Not available.
Polymerization: No.
Section 11: Toxicological Information
p. 3
Routes of Entry: Not available.
Toxicity to Animals:
LD50: Not available. LC50: Not available.
Chronic Effects on Humans: Not available.
Other Toxic Effects on Humans: Slightly hazardous in case of skin contact (irritant), of ingestion, of inhalation.
Special Remarks on Toxicity to Animals: Not available.
Special Remarks on Chronic Effects on Humans: Not available.
Special Remarks on other Toxic Effects on Humans: Not available.
Ecotoxicity: Not available.
BODS and COD: Not available.
Products of Biodegradation:
Section 12: Ecological Information
Possibly hazardous short term degradation products are not likely. However, long term degradation products may arise.
Toxicity of the Products of Biodegradation: The products of degradation are as toxic as the original product.
Special Remarks on the Products of Biodegradation: Not available .
Section 13: Disposal Considerations
Waste Disposal:
Section 14: Transport Information
DOT Classification: Not a DOT controlled material (United States).
Identification: Not applicable.
Special Provisions for Transport: Not applicable.
Section 15: Other Regulatory Information
Federal and State Regulations: TSCA 8(b) inventory: Magnesium hydroxide
Other Regulations: Not available ..
Other Classifications:
WHMIS (Canada): Not controlled under WHMIS (Canada).
DSCL (EEC):
This product is not classified according to the EU regulations.
HMIS (U.S.A.):
Health Hazard: 1
Fire Hazard: 0
Reactivity: 0
p. 4
Personal Protection: E
National Fire Protection Association (U.S.A.):
Health: 1
Flammability: 0
Reactivity: 0
Specific hazard:
Protective Equipment:
Gloves. Lab coat. Dust respirator. Be sure to use an approved/certified respirator or equivalent. Safety glasses.
Section 16: Other Information
References: Not available.
Other Special Considerations: Not available.
Created: 10/10/2005 08:22 PM
Last Updated: 06/09/2012 12:00 PM
The information above is believed to be accurate and represents the best information currently available to us. However, we
make no warrantyof merchantability or any other warranty, express or implied, with respect to such information, and we assume
no liability resulting from its use. Users should make their own investigations to determine the suitability of the information for
their particular purposes. In no event shall ScienceLab. com be liable for any claims, losses, or damages of any third party or for
lost profits or any special, indirect, incidental, consequential or exemplary damages, howsoever arising, even if ScienceLab.com
has been advised of the possibility of such damages.
p. 5
ATTACHMENT 4
INJECTION PROCEDURE
4. INJECTION PROCEDURE
4.1 Injection Approach
For the B105-139 and B147 pilot test areas (PT As), the injection approach will consist of a two-
stage process, whereby one set of injectio.n wells will be injected with amendments, while the
remaining set of injection wells (IWs) will be used to monitor the radius of influence (ROI) of
the injections within the PTA. As target injection volumes are met at the first set of IWs,
injection will transition to the remaining IWs. The number of IWs simultaneously receiving
amendments will be adjusted to accommodate field conditions and will balance data needs (i.e.,
assessment of ROI) with observed field conditions (e.g., injection rates and pressures) and
equipment (e.g., number of channels on the injection manifold). For the B149 PTA, where there
are fewer IWs, the proposed injection strategy is to simultaneously inject into all 4 IWs. The
injection quantities into individual IWs in each PTA may be adjusted based on the results from
additional data collection activities during and subsequent to well installation.
4.2 Injection Procedure and Equipment
During injections, one set of injection equipment (storage tanks, transfer pumps, manifold and
hosing) will be used in each PTA to allow simultaneous injection into multiple IWs. A typical
schematic of the injection equipment to be used is presented in Figure 4-1. At each IW the order
of injection will be: 1) several hundred gallons (gal) of emulsified vegetable oil (EVO) solution,
2) a small volume of anaerobic water, 3) the bioaugmentation culture KB-1 ® Plus, 4) a second
volume of anaerobic water, and 5) the remainder of the EVO volume for the injection well. The
anaerobic water is used to protect the KB-I® Plus from oxygen exposure. Anticipated iajectant
volumes 3 and concentrations, as detailed in Attachment 3, include approximately 3,450 gal,
4,600 gal, and 10,600 gal of a 1-2% (volume/volume [v/v]) EVO solution (0.5 to 1 ¾v/v as oil)
per injection well for the B105-139, B147, and B149 PTAs, respectively. The total injection
volume for all three PTAs is approximately 171,000 gal. The total volume of KB-I® Plus
proposed is 32 liters (L) each for the B105-139 and B149 PTAs distributed equally between the
IWs in each PTA. Further details regarding the bioaugmentation procedures are provided in
Attachment 4-A.
An anticipated average injection rate of 1.5, 1.0 and 1.5 gallons per minute (gpm) per injection
well has been assumed for the EVO injections at the B105-139, B147 and B149 PTAs,
respectively, based on the anticipated geology and target thickness of the treatment zones. At
these injection rates and assuming injection for 6 hours per day to account for daily
setup/takedown of equipment and to switch between injection fluids (EVO solution, KB-I® Plus,
3 Proposed injectant volumes, which were detailed in Attachment 3, are based on the proposed pilot test layouts,
which may be adjusted in the field based on site conditions and/or additional data collection (see Attachment 1).
Therefore, the injectant volumes may be less than outlined in the attachment or, if greater, will not exceed the
outlined quantities by more than 50%.
anaerobic water), the anticipated average daily injection rate per IW is anticipated to be
approximately 540 gal, 360 gal, and 540 gal for the B105-139, Bl47, and B149 PTAs,
respectively. At this average daily injection rate and assuming that injection occurs in
approximately 50%, 50%, and 100% of the 16, 16, and 4 IWs in Bl05-139, B147, and B149
PTAs, respectively, the average daily injectant rate per PTA is anticipated to be approximately
4,300, 2,900, and 2,200 gallons per day. At the average daily injection rate for the EVO solution
volumes listed above, it is anticipated that injection event will be approximately 6, 13, and 20
limitations in injection rates are possible. It is expected that at least 4-6 weeks of field work will
be required to inject the full volume for the PT As at these rates.
The average maximum injection pressure is anticipated to be maintained at or below 20 pounds
per square inch (psi). Higher injection rates, and correspondingly higher daily injection rates and
lower injection durations, may be used if it is found to be practical at this average maximum
pressure.
4.3 Injection Monitoring
One of the objectives of the pilot testing is to evaluate ROI. An estimate of ROI and the
variability of ROI between IWs may be used to refine well spacing for potential technology
scale-up. During EVO injection, ROI monitoring will consist of collecting grab samples from
surrounding locations not receiving injections. These grab samples will be visually inspected
for EVO, which has a milky white color, and field tested for conductivity and turbidity, which
increase when EVO is present.
During injection, the injection rate, cumulative volume and injection pressure will be monitored
for each IW. Monitoring will also include measurement of water levels in and around the IWs
and visual observation for short-circuiting/daylighting to ground surface. The operational data
will be used to support any adjustments in injection rates or pressures, and to confirm that overall
injection targets are met. Should the monitoring data indicate that short-circuiting and/or
daylighting at the ground surface is occurring, the injections will be temporarily stopped and
injection rates/pressures will be decreased and/or injection re-configured.
ATTACHMENT 4 FIGURE
FROM PUMP/ POTABLE
WATER
12" MANWAY
STORAGE TANK
r
TRANSFER
PUMP
CONVEYANCE Jr.
SYSTEM
LEGEND
Mfg i:LE%tBLE HOSE
FLOW METER WITH TOTALIZER
cxi VALVE
PRESSURE GAUGE
FILTRATION SYSTEM (10 mrn)
(AS NEEDED)
PROPORTIONAL FEED PUMP
INJECTION WELLHEAD FITTI4p
MULTI —CHANNEL
INJECTION MANIFOLD
Fir
COMPRESSION
FITTING
=-6=. f L_,--
1-6
L
TYPICAL
0.
DISPOSABLE TOTE
EMULSIFIED
VEGETABLE OIL
PVC CASING --
SLOTTED PVC
SCREEN
INJECTION WELL
Injection Equipment Schematic
Chemtronics Site
5wannanoa, North Carolina
Geosyntec
consultants
Figure
4-1
Kennesaw September 2012

ATTACHMENT 4-A
KB-1 ® PLUS INJECTION PROCEDURE
REM
:Gov braver, & alaarlw st
TO: Ben Amos, Geosyntec Consultants
FROM: Sandra Dworatzek, SiREM (sdworatzek@a slremlab.corn)
DATE: 17 February 2011
SUBJECT: fnjection Procedure for KB-1"/ KB-1 Plus
List of Equipment
Pressurized cylinder of compressed gas (argon or nitrogen) — locally sourced
13D Research Lane, Suite 7
Guelph, Ontario H IG SG3
Phone: LS 19) 822.2265
Fax [phone]
www-i1r mlab.Cus11
The injection field kit provided by SiREM containing equipment and materials required
for injection:
• Stainless steel vessel containing KB-1° or KB-1 Plus
• Appropriate regulator for compressed inert gas
• Tubing with appropriate fittings for transfer of gas to vessel and inoculum
from vessel to well.
• Tubing to inject culture into subsurface.
• Digital scale (to measure injection volumes )
Summary of Method
SIREM ships all required equipment and materials to the site prior to the scheduled
injection date. The bioaugmentation technician inspects the vessel integrity upon
arrival at the field site and confirms that all valves are closed and all connections are
secure. The pressure in the vessel and vessel weight are checked to ensure that
they have not changed since leaving the laboratory. The vessel is shipped under slight
positive pressure (1 pound per square inch [psi]).
The injection technician proceeds with the injection by placing the injection tubing in the
well/drive point to the desired injection depth and purges the well/drive point with argon
or nitrogen gas to displace oxygen from the well column and maintain an inert gas
blanket in the well above the water table. A 5 minute purge is recommended.
The culture is then injected into well/drive point using compressed gas. There are
four stainless steel stems on SiREM vessels: the pressure relief and pressure gauge
port (to monitor pressure and pressure relief for safety); the purge port (for purging or
venting the vessel); the inoculation port (culture line into subsurface); and the
pressurization port (connected to compressed gas to pressurize vessel and push culture
into the ground) shown in Figure 1, The bioaugmentation technician connects the tubing
so that the compressed gas is used to pressurize the vessel (typical maximum
pressure required is up to 30 psi for injection depths up to 30 feet below ground surface)
and push the culture into the injection tubing and into the well/drive point at the
desired

130 Re5ean:h l.~ne, Sulte 2
Bftryf Malli~ment ------------------------------G-ue-lp-h,_O,...c.1ta-rlo-Ni_G_SG-3
Phone: [phone]S
depth interval. The required volume is metered into the ground and the injection
equipment moved to the next injection as required until all locations are completed.
The bioaugmentation technician facilitates the return of all materials and equipment to
SiREM following completion of the bioaugmentation.
Health and Safety Considerations:
Appropriate protective eyeglasses or goggles are to be worn when opening
vessels valves or pressurizing vessels when injecting contents in to groundwater.
Disposable latex or nitrile gloves should be worn when handling and disposed of after
use .
Spilled liquid should be soaked up with a sorbant and saturated with a 10% bleach
solution (1/10 diluted standard bleach). Sorbant should be double bagged and disposed
of in garbage. After removal of sorbant, area should be washed with 10% bleach
solution to disinfect. If liquid from the culture vessel is present on the fittings, non-
designated tubing or exterior of the culture vessel liquid should be wiped off and the area
washed with 10% bleach solution.
Fax:(S19)822-3151
www.slremlab .com
33"
KB-16 Vessel
Empty Weight = 27 Ibs
Full Weiah1 = 77 Ibs
hid
KH-1 1"01-4
Pressurization
Port (Red)
9-3"
Purge Port (Green)
28" 44"
KB-1• Vessel Shipping Case
Empty Weight = 28 Ibs
full Weight with KB-1 Vessel = 105lbs
18
Pressure Relief and
Pressure Gauge Port
Inoculation
Port (yellow)
KB-16 Vessel and Shipping Case
Feb.2009 Figure:1
(jREM
icorery aiWu�erx�w

ATTACHMENT 5
FRACTURING PLAN
5. FRACTURING PLAN
Fracturing is not planned for the Enhanced In Situ Bioremediation (EISB) pilot tests.
ATTACHMENT 6
INJECTION WELL CONSTRUCTION
DETAILS
ATTACHMENT 6 FIGURES
6-inch boring
2-inch PVC riser
Neat Cement Grout
between Riser and
Boring
4
Legend
Neat Cement Grout
Bentonite Chips
- Sand Pack
NOT TO SCALE
6-inch boring —a
Thickness B
2- inch PVC
screen
PTA# 1
B105-139
PTA#2
B147
Thickness A {feet)
9
11
Thickness B (feet(
15
20
Thickness A
2- inch PVC riser
2-foot minimum
(bentonite seal)
2-3 foot maximum
sand above screen)
25-foot maximum
1-foot minimum
(sand below screen)
Typical Well Construction Details Zone AB Wells
Chemtronics Site
Swannanoa North Carolina
Geosyntec D
Conti zants
Figure
6-1
Kennesaw September-2012

8-inch boring
2-inch PVC riser
8-inch boring —I.-
Thickness B
2- inch PVC
screen
I Illcl:ness A
Ilicai I'V[' RSer
2-foot minimum
(bentonite seal)
:t ti v T2-3 foot maximum
i ` — ;Ai (sand above screen)
r;;—_
is —f1-'1
ti =
'•4=_ l 2 5-foot
ir•c —?: ▪ maximum
r`
F5��
M�ti tic
Neat Cement Grout in
overdrilled borehole
Legend
Neat Cement Grout
Bentonite Chips
Sand Pack
NOT TO SCALE
PTA# 1
B105-139
PTA#3
B149
Thickness A (feet'
53
6 to 36
Thlekness B [feet)
15
10
Competent bedrock surface
Typical Well Construction Details Zone C Wells
Chemtronics Site
Swannanoa North Carolina
Geosyntec
Consultants
Figure
6-2
Kennesaw
September-2012

ATTACHMENT 6 TABLE
Number of Total Depth Total Dept
Pilot Test Injection Injection of Injection Injection\
Area Well ID Wells Wells Boringi
(ftBLS) (ft BLS
BlOS-139 IP105-l nt
to 16 28 29
IP105-16
B147 IP147-l nt to 16 35 36
IP147-16
B149 IP149-l Int to 4 TBD 1 TBD
IP149-4
Notes:
Refer to Figure 6-1 (8105-139 and B147 Pilot Test Areas) and Fi!
BLS = below land surface.
PVC= Polyvinyl chloride.
NA= Not applicable.
TBD = To be determined.
ft= feet.
1 = Surface of bedrock is variable and is estimated to be between~
2 = Neat cement grout to contain up to 5 percent(%) bentonite.
2012 _ 0928 _ Chemtronics _9 _ Attachment 6 _ Well Construction I
Geosyntec Consultants
Depth of Depth of Depth of Sand
Grout Bentonite Seal Above Screen Surface
(ft BLS) (ft BLS) (ft BLS) Completion
Locking steel
0-9 9 -11 11 -13 protective
casing
Locking steel
0-11 11 -13 13 -15 protective
casing
Locking steel
TBD 1 TBD 1 TBD 1 protective
casing
09.28.2012
ATTACHMENT 7
MONITORING PLAN
7. MONITORING PLAN
This attachment provides information on the proposed monitoring plan. Baseline, injection, and
performance monitoring of groundwater will be performed over time and analyzed to measure
biodegradation of target compounds of potential concern (COPCs), consumption of amendments,
changes in geochemical conditions, and emergence/disappearance of degradation intermediates
and end products (see Attachment 3 for additional details regarding degradation intermediates
and end products). The results from these tests will be used to evaluate the field implementation
of enhanced in situ bioremediation (EISB).
Lancaster Laboratories, Inc. (LLI) will analyze groundwater samples for target COPCs (i.e.,
volatile organic compounds [VOCs], perchlorate), Research Department Explosive (RDX),
dissolved hydrocarbon gases (DHGs; i.e., methane, ethane and ethene), anions (chloride, sulfate,
sulfide, nitrate, nitrite), total organic carbon (TOC), and dissolved metals (iron, manganese), as
presented in Tables 7-1 and 7-2. In addition, select samples will be submitted to SiREM, for
microbial analysis. The proposed ·baseline, injection, and performance monitoring schedules are
described in Sections 7.1, 7.2 and 7.3, respectively.
7.1 Baseline Monitoring
Baseline groundwater sampling will be conducted at the monitoring wells and injection wells
(IWs) to characterize the groundwater chemistry prior to implementation of the injection
activities in each pilot test area (PTA). The baseline characterization program is presented in
Table 7-1 and the sample handling and analytical details are presented in Table 7-2.
Baseline groundwater sampling will be completed using low-flow purging and sampling
techniques. Field measurement of pH, dissolved oxygen (DO), oxidation reduction potential
(ORP), specific conductance, turbidity and temperature will be completed during well purging
and groundwater sample collection. Water levels will be measured to evaluate groundwater flow
directions. The analytical suite for each PTA is described in the following sections.
Pilot Test Area B105-139
Groundwater samples will be collected for baseline VOC analysis from the 16 IWs and the
newly installed Zone AB and Zone CD wells (MW238-H38AB, MW239-H38AB, MW240-
H38CD), to gain a better understanding of the distribution of VOCs in the PTA groundwater.
Groundwater samples will also be collected for VOCs, DHGs, anions, TOC, perchlorate, RDX
from each of the existing wells (MW180-H38AB, MW230-H38AB, MW231-H38AB, MW200-
H38CD), and the three newly installed monitoring wells. Samples for microbial molecular
analysis (i.e., vinyl chloride reductase gene) and dissolved metals analysis will be collected from
the one new Zone AB well (MW239-H38AB) and MW180-H38AB. Dissolved metals have
been included in the analytical suite because the anaerobic conditions established during EISB
can enhance iron and manganese mobility.
Pilot Test Area Bl 47
The four comer IWs will be sampled for baseline analysis of voes, perchlorate and RDX.
Based on the results of the additional baseline perchlorate data from the four comer IWs, the
number, depth, and layout of injection and monitoring locations may be refined in B147 PTA, as
discussed in Attachment 3. Additional IWs, which will be installed after refinement of the PTA
layout, will be sampled for perchlorate alone. Groundwater samples will also be collected for
voes, anions, TOe, and perchlorate from each of the existing monitoring wells (MW-147-1,
MW-147-2), and from the newly-installed Zone AB wells (MW241-G38AB and MW242-
G38AB). Dissolved metals samples will be collected from well M'vV-147-1 and one of the newly
installed Zone AB wells.
Pilot Test Area Bl 49
Groundwater samples for baseline voe analysis will be collected from the 4 IWs as well as the
new Zone e monitoring well (MW245-O39e). Groundwater samples will also be collected for
voes, DHGs, anions, TOe, perchlorate and RDX from each of the existing monitoring wells
(MW-149-1, MW183-O39eD), and newly-installed transgradient and downgradient Zone CD
monitoring wells (MW243-P39eD and MW244-P39eD). Samples for microbial molecular and
dissolved metals analysis will be collected from wells MW-149-1 and MW183-O39eD.
7.2 Injection Monitoring
One of the objectives of the pilot testing is to evaluate radius of influence (ROI). An estimate of
ROI and the variability of ROI between IWs may be used to refine well spacing for potential
technology scale-up. During emulsified vegetable oil (EVO) injection, ROI monitoring will
consist of collecting grab samples from surrounding locations not receiving injections (i.e.,
inactive IWs, monitoring wells, and/or piezometers). These grab samples will be visually
inspected for EVO, which has a milky white color, and field tested for conductivity and turbidity,
which increase when EVO is present.
During injection, the injection rate, cumulative volume and injection pressure will be monitored
for each IW. Monitoring will also include measurement of water levels in and around the IWs
and visual observation for short-circuiting/daylighting to ground surface. The operational data
will be used to support any adjustments in injection rates or pressures, and to confirm that overall
injection targets are met. Should the monitoring data indicate that short-circuiting and/or
daylighting at the ground surface is occurring, the injections will be temporarily stopped and
injection rates/pressures will be decreased and/or injection re-configured.
7.3 Performance Monitoring
The purpose of the performance monitoring program is to track and document the progress of
EISB in each PT A. The groundwater monitoring program for the pilot test will include four
quarterly monitoring events following the injections, with a pilot test duration of 1 year. The
performance monitoring schedule is presented in Table 7-1. The sample handling and analytical
details are presented in Table 7-2. The following subsections present the approach, methods and
schedule to complete performance monitoring for the pilot tests.
The approach and methods to collect and analyze groundwater samples for the performance
monitoring program will be similar to that described for the baseline sample event (Section 7 .1 ).
Field measurement of pH, DO, ORP, specific conductance, turbidity and temperature will be
completed during well purging and groundwater sample collection. Water levels will be
measured during each monitoring event to evaluate flow directions. The analytical suite and
schedule for analysis for each PT A is described in the following subsections.
Pilot Test Area B105-139
Groundwater samples will be collected on a quarterly basis for the one year pilot test duration for
analysis ofVOCs, DHGs, anions, and TOC from each of the existing monitoring wells (MW180-
H38AB, MW230-H38AB, MW231-H38AB, MW200-H38CD), and the newly-installed Zone
AB and CD monitoring wells (MW238-H38AB, MW239-H38AB, MW240-H38CD). Samples
for microbial molecular analysis will be collected on a quarterly basis from well MW180-
H38AB only. Samples for analysis of dissolved metals will be collected during the fourth
quarter monitoring event, from well MW180-H38AB and one new Zone AB monitoring well
(MW239-H38AB).
Pilot Test Area B147
Groundwater samples will be collected on a quarterly basis for the one year pilot test duration for
analysis of perchlorate, anions and TOC from each of the existing monitoring wells (MW-147-1,
MW-147-2), and the newly-installed Zone AB monitoring wells (MW241-G38AB and MW242-
G38AB). Samples for analysis of dissolved metals will be collected from well MW-147-1 and
one of the new Zone AB wells during the fourth quarter monitoring event.
Pilot Test Area Bl 49
Groundwater samples will be collected on a quarterly basis for the one year pilot test duration for
analysis of VOCs, DHGs, anions, and TOC from each of the existing monitoring wells (MW-
149-1, MW183-O39CD), and the . two newly-installed Zone CD monitoring wells (MW243-
P39CD and MW244-P39CD). A sample for microbial molecular analysis will be collected from
well MW-183 ,.Q3 9CD during each of the quarterly monitoring events. Samples for analysis of
dissolved metals will be collected from MW-149-1 and MW183-039CD during the fourth
quarter monitoring event.
ATTACHMENT 7 TABLES
TABLE 7-1
PROPOSED PERFORMANCE MONITORING SCHEDULE
Chemtronics Site, Swannanoa, NC
Event Baseline
I I
o3 I .., o3 > 1d ~ "O > ,._ .., ~ N "' ,t
"' 0 "3 .?; .. ,,, ~ N "' ,._ "' "' 0 "' :a "' <.J .... "' .., u C § .., 0 «i .., u 1d 0 u u 0 "' 1d p... 0 ::r: ~ 0 .... "' 0 Tu 0 Pilot Test Area (PT A) Well ID :::: .., ~ 0 :s: ""' > Q E-< 0.. s >
BlOS-139 MW180-H38AB ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
Pilot Test Area # 1 MW230-H38AB ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
MW200-H38CD 7'7 ✓ ✓ ✓ ✓ ✓ ✓ ✓' ✓ ✓
MW23 l-H38AB ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓1 ✓ ✓
Proposed ✓ ✓ ✓
I
✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓1 ✓ ✓
MW239-H38AB
If inside PTAl
Proposed ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
MW238-H38AB
I !(outside PTA)
Proposed ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
MW-240-H38CD I
Injection Wells 8 ✓ ✓ ✓ I ✓ I
Bl47 MW-147-1 ✓ ✓ ✓ ✓ ✓ ✓ I ✓ ✓ ✓ i
Pilot Test Area #2 MW-147-2 ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
Proposed ✓ ✓ ✓ ✓ ✓ ✓ ✓12 ✓ ✓
MW241-G38AB
Proposed ✓ ✓ ✓ ✓ ✓ ✓ ✓12 ✓ ✓
MW242-G3 8AB I
Injection We!ls 9 ✓ ✓ ✓ I ✓ ✓ I ✓
Bl49 MW-149-1 ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
Pilot Test Area #3 MW183-O39CD ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
Proposed ✓ ✓ ✓ ✓ ✓ ✓ ✓1 ✓ ✓ ✓ ✓
MW243-P39CD
(trans gradient) I
Proposed ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
MW244-P39CD
( downgradient) I I I
Proposed ✓ ✓ ✓ I I I
MW245-039C I I
Injection Wells10 ✓ ✓ ✓, I ✓
I
Notes:
All samples are groundwater except where specifically indicated
1 Field Parameters (FP) are pH , dissolved oxygen, oxidation-reduction potential, specific conductance, turbidity and temperature
2 VOCs are Volatile Organic Compounds
3 DHGs are Dissolved Hydrocarbon Gases and include methane, ethane, ethene
4 Anions include chloride, sulfate, sulfite, nitrate, nitrite
5 TOC is Total Organic
6 Research Department Explosive
7 Dissolved metals are m anganese and iron
8 16 Injection wells will be installed and sampled
"' C ::c
Q
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
Quarterly
I I ..,
1d
,t ....
"' 0
0 "' :2 0 u u ~ ~ 6
0..
✓ ✓ I
✓ ✓
✓ ✓
✓ ✓
✓ ✓
✓ ✓
✓ ✓
I
✓ I ✓ ✓
✓ ✓ ✓
✓ ✓ ✓
✓ ✓
✓ ✓
✓ ✓
I
✓ ✓
I
I I
a "O
'3
..,
> ..
"' u 0 "' § .., 'Ei 0 "' "' ..,
::E 0 s
I ✓
I
I
I
I
I
I
✓
I
I
I
9 16 Injection wells will be insta lled. The 4 comer injection wells will be sampled for VOCs, perchlorate and RDX , other injection wells will only be sampled for VOCs.
10 4 Injection wells will be insta lled and sampled for baseline parameters
11 PTA is Pilot Test Area
12 One ofMW241-G38AB or MW242-G38AB will be sampled for dissolved metals according to the schedule indicated.
2012_0928_Chemtronics_!0b_Attachment 7 _Table 7-Lxlsx
Geosyntec Consultants
Final (Quarter 4)
I I I I o3 ..,
> 1d a "O
~ ,t .... '3
..,
N .. "' 0 .?; "'"' .... "' ,, .:: "' :2 "' u
~ u 0 §I
.., 0 'Ei 0 u u ~ "' Tu 0 tr: ~ 0 .... U') ..,
~ .., i5 > ~ E-< 0.. e
✓ ✓ ✓ ✓ ✓ ✓ I I ✓ ✓
✓ ✓ ✓ ✓ ✓ ✓ I I
✓ ✓ ✓ ✓ ✓ ✓
✓ ✓ ✓ ✓ ✓ ✓
✓ ✓ ✓ ✓ ✓ ✓ ✓
I I
✓ ✓ ✓ ✓ ✓ ✓
I I
✓ ✓ ✓ ✓ ✓ ✓
✓ I I
✓ ✓ ✓ ✓ .✓ I I ✓
✓ ✓ ✓ ✓ ✓
✓ ✓ ✓ ✓ ✓ ✓12
✓ ✓ ✓ ✓ ✓ ✓12
.✓ I
✓ ✓ I ✓ ✓ ✓ ✓ ✓
✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
✓ ✓ ✓ ✓ ✓ ✓
✓ ✓ I ✓ ✓ ✓ ✓
✓
2012.09.28
TABL E 7-2 : SUMMARY OF GROUNDWATER SAMPLE HANDLING AND ANALYTICAL DETAILS
Chemtronics Site, Swannanoa, NC
Sample
Matrix Parameter
Volatile Organic
Compounds
Anions ( chl oride, nitrate,
nitrite, sulfate)
Di ssolved Hydrocarbon
Ga ses ( ethene, ethane,
methane)
,.
i: .. Perchlorate :r;
"O = = = Nitroaromatic s and ,.
" Amines
Dissolved Man ganese and
Iron'2
'
Total Organic Carb on
Vinyl Chloride Reductase
(vcrA)
Notes:
mg/L • milligrams per liter
µg/L -micrograms per liter
mL -milliliters
HCL -hydrochloric acid
H3PO, -phosphoric acid
Analytical Method Method
Number<•>
Gas Chromatography S W-846, 8260B /Mass Spectrometry
Ion Chromatography EPA 300 .1
Gas
Chromatography/ RSK-175 or EPA
Flame Ionizing 80158
Detector
Ion Chromatography EPA 31 4.0
High Performance
Liquid EPA 8830 Chromatography
with UV detection
Inductively Coupled
Plasma/Atomic 6010B Emission
Spe<:trometry
Combustion or EPA415 .I Oxidation
Polymerase chain NIA reaction
<•i United States Environmental Protection Agency Method Number
cz i Groundwater samples will be field filtered prior to preservation
201 2 _ 0928 _ Chemtroni~s_lOc_Attnchment 7 _Tnble 7-2.xlsx
Practical
Quantitation Sample Container Preservative
Limit
5 to 20 µg/L 3x40mLVOA HC~ cool to 4°C
0.5-5 mg/L 2x40mL VOA cool to4°C
15 µg/L
(m ethane), 5 3x40mL VOA HC ~ co ol to 4°C µg/L ( ethene and
ethane)
2 µg/L 250 mL plastic cool to 4°C
0.6-18 µg/L 2 x 1 L amber glass cool to4°C
0.05-0.15 mg/L 500 mL plastic nitric acid to
pH <2
lmg/L 500 mL plastic H3P04. cool to
4•c
3.9 x 103 gene 1000 mL plastic Sterile technique,
no head space, copies/L or field filter cool to4°C
Geosyntcc Con$Uhants
Holding
Time
14 days
28 days (48
hours for
nitrite)
14 days
28 days
?days
60 days
28 days
24 hours
2012 .09.28
ATTACHMENT 8
WELL DATA TABULATION
8. WELL DATA TABULATION
A tabulation of well data is included in this attachment, including: (i) proposed injection wells,
monitoring wells, and piezometers (Table 8-1), (ii) existing monitoring wells (Table 8-2); and
(iii) abandoned wells (Table 8-3). Table 8-2 lists existing wells within the B105-139, B147, and
B149 Target Evaluation Areas, as defined in Figure 9-3 of Attachment 9. Table 8-3 lists
abandoned wells within the Bl05-139, B147, and B149 Target Evaluation Areas, as defined in
Figure 9-3 of Attachment 9. Additionally, Table 8-3 lists select abandoned wells outside of
Bl49 Target Evaluation Area but between Pilot Test Area B149 and Pond 2 (see Figure 9-3 of
Attachment 9). Well construction records for the existing wells listed in Table 8-2 are provided
in Attachment 8-A, while available well abandonment records are provided in Attachment 8-B.
ATTACHMENTS TABLES
TABLE 8-1
PROPOSED INJECTION WELL, MONITORING WELL, AND PIEZOMETER CONSTRUCTION DETAILS
Cltemtronics Site, Swunnanoa, NC
PTA
Welt 1D
Type
Status
Date
Installed
Easting
(ft NAD83)
Northing
(ft NAD83)
Top of Casing
Elevation
(ft NAVD88 )
Ground
Elevation
(ft NAVD88}
Well
Diameter
(inches)
Total Depth
(ft BLS)
Screened
Inlervat
(R BLS)
Semen
length
(ft)
B105-139
MW238-I138AB
Monitoring
Proposed
TBD
97844924
700280.45
TBD
I'BI)
2
29
13 to 28
15
MW239-H38AB
Monitoring
Projosed
TBD
978458.95
700197.79
TBD
TVD
2
29
13 to 28
15
1V1W240-1138CD
Monitoring
Proposed
TBI)
978440.44
700242.68
TBD
TBD
2
72
57 to 72
i5
1P105-1
Injection
Proposed
TBI)
978417.54
700262.35
TBD
TBD
2
29
13 to 28
15
lP105-2
Injection
Proposed
TBD
978437,79
700255.00
TBD
TBD
2
29
13 to 28
- 15
1P105-3
Injection
Proposed
TBD
978458.03
700249.01
TBD
TBD
2
29
13 to 28
15
IP105-4
Injection
Pmposed
TBD
978478.40
700243.58
TBD
TBD
2
29
13 to 28
15
IP105-5
Injection
Proposed
TBD
978412.10
700243.87
TBI]
TBD
2
29
13 to 28
15
I1'105-6
Injection
Proposed
TBD
978432.35
700236.52
T1313
TBD
2
29
13 to 28
15
IP105-7
Injection
Proposed
TBD
978452.60
700230.53
TBD
T111
2
29
13 to 28
15
1P105-8
Injection
Proposed
TBD
978472.96
700225.10
TBD
TBD
2
29
13 to 28
15
IPI05-9
Injection
Proposed
TBD
978405.44
706222.85
TBD
TBD
2
29
13 to 28
15
IP105-10
Injection
Proposed
TED
978425.68
700215.50
TBD
7BD
2
29
13 to 28
15
IP105.11
injection
Proposed
-IBA
978445.93
700209.51
TBD
TBD
2
29
13 to28 *
15
1P105-12
Injection
Proposed
TBD
978466.30
700204.08
"1-8D
TBI)
2
29
13 to 28
15
IP105-13
Injection
Proposed
TBD
978460.00
70020437
TBD
TBD
2
- 29
13 to 28
15
1P105-14
Injection
Proposed
TBD
978420.25
700197 02
1131)
TBD
2
29
13 to 28
1.5
IPI05-15
Injection
Proposed
TBD
978440.50
700191,03
TBD
TSD
2
29
13 to 28
15
IP105-16
Injection
r Proposed
TBD
978460.86
700185.60
TBD
TBD
2
29
13 to 28
15
PI0S-1A13
Piezometer
Proposed
TBD
978393.51
700252,32
TBD
TBD
2
29
13 to 28
15
P105-2AB
1'iezomeler
Proposed
TBD
978423.22
700172.67
TBD
TBD
2
29
13 to 28
15
B147
MW241-G3SAB
Monitoring
Proposed
TBD
978313.56
700161.34
TBD
TBD
2
36
15 to 33
20
MW242-G38AB
Monitoring
Proposed
TBD
978296.97
700119.17
I131)
TBD
2 _
36
15 to 35
20
19147-1
Injection
Proposed
TBD
978280.10
700167.68
TBD
TBD
2
36
15 to 35
20
1P147-2
Jection
Proposed
TBD
978301.55
700168.70
TBD
'fBD
2
36
15 to 35
20
1P147-3
Injection
Proposed
TBD
978322.48
706170.97
TBD
TBD
2
36
15 to 35
20
IP147-4
Injection
Proposed
TBD
978343.31
700173.80
TBD
TBD
2
36
15 to 35
20
IP147-5
Injection
Proposed
TBD
978282.24
700148.51
T13D
TBD
2
36
15 to 35
20
IP147-6
Injection
Proposed
TBD
978303.70
700149.52
TBD
TBD
2
36
15 to 35
20
1P147-7
Injection
Proposed
TBD
978324.62
700151.79
'fBD
TBD
2
36
15 to 35
20
I11147-8
Injection
Proposed
TBD
978345.45
700154.62
TBD
TBD
2
36
15 to 35
20
IP147-9
Injection
Proposed
TBD
978284.23
700126.52
TBD
TBD
2
36
15 to35
20
IP147-10
Injection
Proposed
TBI)
978305.68
700127.54
'TED
TBD
2
36
15 to 35
20
1P147-11
Injection
Proposed
TBD
978326.61
700129.81
TBD
TB)
2
36
15 to 35
20
1P147-12
injection
Proposed
TBD
978347.43
700132.64
TBD
TBD
2
36
15 to 35
20
1P147-13
injection
Proposed
'TBD
978286.37
700107 35
TBD
TBD
2
36
15 to 35
20
IP147-14
htection
Proposed
TBD
978307.82
700108.36
TBD
TBD
2
36
15 to 35
20
11'147-15
Injection
Proposed
Till)
978328.75
700110.63
TBD
TBD
2
36
15 to35
20
IP147-16
injection
Proposed
T131)
978349,58
700113 46
TBD
TBD
2
36
15 to 35
20
P147-1AB
Piezometer
Proposed
TBD
978297.50
700189.58
TBD
TSD
2
36
15 to 35 _
20
P147-2Ai3
Piezometer
Proposed
TBD
978268.93
700100.11
TBD
TBD
2
36
15 to 35
20
B149
MW243-P39CD
Monitoring
Projosed
TBD
980347.66
699946.95
TBD
TBD
2
20 to 50'
TBD'
10
MW244-P39CD
Monitoring
Proposed
TBD
980329.37
699896,40
TBD
TBD
2
20 to 50t
TBD'
10
MW245-039C
Monitoring
Proposed
-113D
980295.59
699955 64
TBD
TBD
2
TBD2
TBD
_10
IP149-1
ln, on
Proposed
TBD
980276.86
699948.33
TBD
TBD
2
20 to 50t
TBD'
10
1P149-2
Injection
Proposed
TBD
980312.27
699962.46
TBD
TBD
2
20 to 501
TBD'
10
IP149-3
Injection
Proposed
TBD
980291.94
649910.57
TBD
TBD
2
20 to 50'
TBD'
10
1P149-4
Injection
Proposed
TBD
980327.34
699924.71
TBD
TED
2
20 to 50t
TBD'
10
Notes:
PTA =Pilot Test Area,
'= Coordinates provided are approximate.
ft = feet.
NAD83 =North American Datum (1983).
NAV1788=North American Vertical Datum (1988).
BLS = below land surface.
I BD = fo be detemtined.
1= Surface of bedrock is variable and is estimated to be between 20 and 50 ft BLS. Wells will be inslalIed so that the total depth i5 coincident with the competent bedrock surface.
2 = WeII screen will be installed to intercept the water table.
Conatrucnon details reg., total depth, screen interval, and screen length) for the proposed injection wells, monitoring wells, and piezometers are subject to change based an field conditions.
Geosyntec Coasnitanlr
2012 0928 Chemtrontes_i ia_Atlachmcnt 8 Proposed Well Data Tabulation Table 8-1.xlsx 09.28.2012

PTA Well ID
Bl05-139 BW-5
DW-139
MW180-H38AB
MW181-I37AB
MW200-H38CD
MW218-J3 8CD
MW230-H38AB
MW231-H38AB
B147 MW-147-1
MW-147-2
MW-147-3
Bl49 MW-149-1
MW183-039CD
MW184-N38AB
MW219-039CD
MW235-P39CD
SW-149
Notes:
PTA= Pilot Test Area.
ft= feet.
Type
Monitoring
Monitoring
Monitoring
Monitoring
Monitoring
Monitoring
Monitoring
Monitoring
Monitoring
Monitoring
Monitoring
Monitoring
Monitoring
Monitoring
Monitoring
Monitoring
Monitoring
NAD83 = North American Datum (1983).
NA VD88 = North American Vertical Datum (1988).
BGS = below ground surface.
Status
Existing
Existing
Existing
Existing
Existing
Existing
Existing
Existing
Existing
Existing
Existing
Existing
Existing
Existing
Existing
Existing
Existing
TABLE 8-2
EXISTING MONITORING WELL CONSTRUCTION DETAILS
Chemtronics Site, Swannanoa, NC
Date Easting Northing Top of Casing Ground
Installed (ftNAD83) (ftNAD83) Elevation Elevation
(ftNAVD88) (ftNAVD88)
3/18/1986 978686.74 700345.87 2271.20 2271.60
3/26/2002 978781.19 700298.70 2273.56 2270.71
1/7/2000 978454.22 700234.42 2291.65 2288.78
1/27/2010 978698.79 700341.93 2274.27 2271.52
1/27/2010 978416.28 700200.97 2291.58 2288.71
1/25/2011 978863.27 700112.02 2276.71 2274.72
12/6/2011 978501.93 700213.80 2291.13 2288.12
12/6/2011 978414.06 700222.63 2291.61 2288.88
8/3/2005 978333 .31 700136.36 2302.14 2299.04
4/25/2000 978243.77 700176.38 2296.17 2296.29
4/25/2000 978173.64 700177.44 2300.01 2300.34
7/31/2000 980302.81 699944.52 2234.42 2232.62
1/29/2010 980301.19 699915.32 2233.44 2230.81
1/8/2010 980093.58 700131.29 2271.30 2268.24
2/1/2011 980134.20 699957.95 2254.51 2251.68
12/9/2011 980454.14 700098.04 2234.38 2231.58
3/19/2002 980212.75 700123.11 2262.81 2259.96
1 = This deep bedrock well contains an open 3 in. (nominal) borehole from 79.5 to 122.7 ft BLS (open borehole length of 43.5 ft).
2012_0928.:._Chemtronics_llb_Attachment 8_Existing Monitoring Well Data T abulation_Table 8-2 .xlsx
Geosyntec Consultants
Well Total Depth Screened Screen Diameter (ft BGS) Interval length (ft) (inches) (ftBLS)
3 122.7 79.5 to 122.7 I 43.5 I
2 44.0 39.0 to 44.0 5
2 28.0 13..0 to 28.0 15
2 23.4 7.8 to 23.4 15.6
2 73.0 -57.8 to 72.5 14.7
2 24.0 14.0 to 24.0 10
2 25.0 10.0 to 25.0 15
2 25.0 10.0 to 25.0 15
2 35.0 25.0 to 35.0 10
2 20.0 10.0 to 20.0 10
2 20.0 10.0 to 20.0 10
2 21.8 10 to 20 10
2 42.5 27.8 to 42.1 14.7
2 49.0 34.0 to 49.0 15
2 84.0 69.0 to 84.0 15
2 30.0 20.0 to 30.0 10
2 43.0 33.0 to 43.0 10
09.28.2012
TABLE 8-3
ABANDONED WELL DATA TABULATION
Chemtronics Site, Swannanoa, NC
PTA Well ID
Bl05-139/B147 TW-3
Bl05-139 TW-147D
TW-14
SW-5
B149 TW-17
TW-18
TW-16
Notes:
PT A = Pilot Test Area.
ft= feet.
Type
Monitoring
Monitoring
Monitoring
Monitoring
Monitoring
Monitoring
Monitoring
NAD27 = North American Datum (1927).
Status
Abandoned ( date unknown)
Abandoned ( date unknown)
Abandoned ( date unknown)
Abandoned (11/27/2009)
Abandoned ( date unknown)
Abandoned ( date unknown)
Abandoned ( date unknown)
NA VD88 = North American Vertical Datum (1988).
BLS = below land surface .
NA = not available.
2012_0928_Chemtronics_llc_Attachment 8_Abandoned Well Data Tabulation_Table 8-3.xlsx
Easting Northing Date Installed (ftNAD27) (ftNAD27)
12/17/2001 978331.72 700187.73
2/25/2002 978433.99 700227.53
12/18/2001 978477.73 700255.71
4/26/1986 978635.64 700281.90
12/19/2001 980292.44 699900.51
12/19/2001 980244.57 699826.81
12/19/2001 980286 .31 699854.09
Geos y ntec Consultants
Top of Casing Well Total Screened
Elevation Diameter Depth Interval
(ftNAVD88) (inches) (ft BLS) (ftBLS)
2289.63 1 NA 5 to 15
2285.40 1 NA 30 to 40
2284.03 1 19.9 8 to 18
2271.96 1 51.3 13.8 to 48.8
2229.23 1 15.6 5 to 15
2229.05 1 15.3 5 to 15
2227.23 1 NA 5 to 15
9.28.2012
ATTACHMENT 8-A
RECORDS OF CONSTRUCTION FOR
EXISTING MONITORING WELLS
,.r
/"/_ I • Project Abbrev. 1,,,,r;.1 rr.-rn,r., -~--: Date (, /z /fl,
Proje~ No. I 3~ I Logg.?d by C. 5,61 .:," f.
LOG OF ROCK CORE
Boring No. B W-5
Depth of Boring /; :J. 'l i-f
Size of Core NO -1 110 in.
Type of Core Barrc'I dn,1b/11 fu.b,
Location J),,,,r.th·o,-J __ ;,.,,.-t,_ A.h .. ~3
Boring Elev. -::J P 11 , g {, Qr nrd S',l r 4,!e •·id +-
E!ev. Top of Bedrock /OJ 14-f..1-"bd .o ,,t) O rt)I/ nd..
Elev. Groundwater ;,,t
Rut1 Rec011erv AQO G,ac:,hic Fractures t.ithology No. " " Log
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METCALF & EDDY, INC.
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No.
rhp 0 1r¢1-7 i t,$ . Date 6 / JZ6
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METCALF & £owe

WELL CONSTRUCTION RECORD
Nord Carolina Department of Env rortment and Natural Resources - Divesio[a of Water Quality
WELL CONTRACTOR (LNDI IDUAL) NAME (print) MARK GETTYS
WE[.L CONTRACTOR COMPANY NAME GEOLOGIC EXPLORATION. INC.
STATE WELL, CONSTRUCTION 1'ELQMITT - ASSOCIA rE0 WQ i lT#
(if applicable)
(if applicable)
kec21FTCATION* 2345
1,Hor,iE 4 704 )
872-7E8S
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public El Industrial © Agticuiturai ❑
Monitoring El Recovery 0 Hest Pomp Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town.: SWANNONOA
180 OLD BEE TREE ROAD
county EIUNCOMBE
(Sere t•Name, Numbers, Cotwnuuity, Subdivision. La Na., Zap Cade)
3. OWNER: CHEMTRONICS, INC.
Address 180 OLD BEE TREE ROAD
'Prod or Jtotste No.)
SWANNONOA NC 28778
City or Tama State Zip Code
C
Area cads- Puma cuiiabe
4. DATE DRILLED os,osros
5. TOTAL DEPTH: a5n Fr
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 10.0 Ft
(Use "+" if Above Tap of Casing)
8. TOP OF CASING IS 2• 5 FT. Above Land Surface
"Tog or casing reraninatrd afar Maw Teen uarfooe requires a
variance la accordance wills I5A NCAC 2C Al l3.
9. YIELD (gpm): N/A METHOD OF TEST NIA
10. WATER ZONES (depth): NIA
11. DISINFECTION: Type NJA
12. CASING:
Depth Diameter
From 0,0 To 2s.a Ft 2 INCH
From To Ft.
From To Ft.
Amount
Wail Thickness
or Weight/Ft Material
SCH.40 PVC
13. GROUT: Depth Material Mcthod
From 0.0 To 19.0 FL Dupre xaeultO ITE SLURRY
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From 25.13 To 35.0 FL2.O in. .010 in, PVr
From To FL in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 23•0 To 35,0 Ft.20.40
From To Ft.
FINESILICA SAND
Topographic/Lind setting
ORidge OSlope ©Valley 0F1at
(cheek appropriate box)
Latitudellangitude az we11 location
oeve&atiaa►cslsesoodsl
Latitudellongitade source:©GPS❑Topographic map
{obrulk box)
DEPTHPRI'LLFNQ LOG
From To Formation Description
0.0 10.0
10.0 18.0
i 8.0 35.0
BRAWN SILTY CLAY -
RED/BROWN S1L1Y CLAY
BROWN CLA YEY SILT
LOCATION SKETCH
Show direction and distance in miles From at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS: MW-147-1 REP BENTONITE SEAL FROM 19.0 TO 23.0 FEET.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1 SA NCAC 2C, WELL
CONSTRUCTION STANDARDS1,ANDHAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TI-IE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
�l s. €
DATE
Submit the original to the Division of Water Quality, Attn: Information Management, 1617 WA' Service Center -
Raleigii, NC 27699-1617, phone No. [phone], within 30 days.

I
MONITORING WELL COMPLETION DIAGRAM
DATE INSTALLED: 8/03/2005 j cLIENT: Chemtronlcs Inc I PROJECT NO: 2085.10
WELUBORING NO: MW-147-1REP PLANE COORDINATES:
NORTH
PROJECT NAME: Chemtronlcs Inc. EAST
ADDRESS: Swanrianoa, NC
TOP OF SLAB ELEVATION:
WELL CONTRACTOR: Geologic Exploration Inc. TOP OF CASING ELEVATION:
CONSTRUCTION DATA
WELL SCHEMATIC CASING INFORMATION
TOP OF CASING -+-MATERIAL: liJ PVC □STAINLESS O CARBON -□ PROTECTIVE CASING -= OTHER
DIAMETER: Ii:) 2" 04" Os·
I Toe DF coNCRET::l. LENGTH OF STICKUP I □OTHER IN .
3.0 FT. JOINTS: Ii] THREADED □WELDED
GROUND SURFACE '7 c .. □SCREWED □COUPLED ~-□OTHER
SCHEDULE:
SCREEN INFORMATION
MATERIAL: Ix) PVC
I CEMENT/BENTON ITE I---□STAINLESS
GROITT DEPTH TO □TEFLON
BASE OF □ OTHER
GROUT SEAL DIAMETER: Ix) 2"
~ FT. □ 4"
□ 6"
TOTAL BOREHOLE □OTHER IN
BOREHOLE DIAMETER SLOT: Ix) 0.010
DEPTH ______J!,Q__. IN. LENGTH □ 0.020
FROM OF □ OTHER IN
GRADE RISER
~ FT . --~ FT . CENTRALIZER: □YES (x]NO
t SHOW LOCATION OF CENTRALIZER(S) ON SCHEMATIC
BENTONITE SEAL
4.0 FT. FIL TEB ft!CK MATERIA!,
20/40 SAND Ix]
-t OTHER □
TOTAL
WELL SECONDARY FILTER P8 C IS M ATERIAL
:::~::: -~ --DEPTH SUGAR SAND □
:::~::: FROM OTHER D
~:~§ ( GRADE
··•i--.·• ~FT.
• ·.i,.... •• • BENTONITE WELL SEAL . • ·.i,...... •• •
FILTER . ·,i,.-,·, LENGTH lx]1/2-INCH PELLETS .·,i--.·•
PACK
,·,1---,·•
OF 0114-INCH PELLETS :::t:::::
-E:L FT. :::~::: SCREEN □CHIPS
~ FT. □OTHER )~) _L ~!.!BE8CE PBOTECTION • CONCRETE PAD :(x] 2'X2' J -:-_,:-:~ 04'X4' --Li~ □OTHER FT
ALL ELEVATIONS ARE IN FEET NGVD
I WELL SUMP/CAP I· WELL SUMP/CAP
ALTAMONT ENVlRONl\:IENTAL, INC.
I ENGINE ERll'fO & HYO RO GEOLOGY)
.50 COLLEGE STREET,ASHEVILU!, NC 28801
TRL. ll282813lSO FAC. 828.2111.33.:U
www .altamontenvirol\n,cntalcom
lx)YES
□NO
LENGTH 0.17 FT.
Prepared By; __ _
P:/Chcmtronics-Hol/Jl.epl1.""""11 o!MW-11 3-1 147-l "'•ll dd;_ls Checked By ; ___ _
North Carolina • Oepartrent of Enviror;i-lent and Natural Rasources • Division of Water Quay • G; r.. wa:ar $action
1635 4111 service Center - Raleigh. N.C. 276g9-1636-Pone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: - FO• 1oCx]
WELL CONTRACTOR CERTiFIC AT1CN n: 6 75
STATE WELL CONSTRUCTION FERMI T R:
N1 W I L f
1. WELL USE (C7eck.+;0ica.:. 3c4 Residnntia! ❑ Munic:p&i El Industr! 1 ❑ Agric;tlt:sral ❑ 1�'.�ni:�rnr�
Recovery ❑ 1-teat Pump Water Injection ] ❑filler ❑ If Other, Lis: Use:
2. V/Eli_ LOCATION: (Shaw skett:: of the tccaticn be:o.v)
-
S .,4WA/ A/0,�Cl
(Pcza Tax :._ lvcx.zen. Cc......':�. or SL' C:v sicn ana t=i No.)
OWNER
Address c e) 1; e-e
City or Town 5::ate Zip Code
". DATE CRP LEO !!25/o0
5. T O T Al ❑=� —{
6. CUTTINGS COLLECTED YES ❑ NON.2Z1
7. DOES WELL P.EPLACE EXtS T 1NG WELL? YES E} NO- I
6. S T A T iC WATER t_='/EL E3iCw Tca of Cas+n;: f ' FT.
-
0(use'+'il Ach
e Tap of Cas -;}
TOP OF CASING IS FT. Ptnvs Land Surface.
i op ❑r casing ter-lina:sd a,'cr SaIzw land ssr:aea requires a va:iar,ce in ac.or-
dar.cs with ISA NCAC 2C.C113
10. YIELD {gpm): h'E rCO OF TEST
11. WATER ZONES (.ept;t)•
DAP , 1Nr, L
0 2 d - ChfilNGE _'fc 7Y
12. CHLORINATION: Type Pr -cunt
13. CASiNG:
Wait ihlc:c-ass
Des" Q:arnetsr cr 51 :'.a:arat
From Two !(or . at' S'tf{go PVC-
Frc^ To =t.
From To F•
14. GROUT:
Dap;h• gg� a'..rdal M thc•!
Frorn To •
,.> L='LANpGI�
FromTo ='
15. SCREEN:
1i .s ;:se
LOG:--T:ON: Sl':FTC=
(S by v t'irec'`c;is:2n-ze a::ass:...c
: :;;v:r..a7 refere.:s
peplh 1 Dia�� deter Slot Size t ,ater,21
From /Q t To. _ Ft 9. _ in. (3,. c i in e5_
From To Ft. in. In
From To FL
16. SAND/GRAVEL PACK:
3Lo'
Maeral
From ' Ft - 30 S1 C/' co...,,,
From To FL
17. REMARKS:
•
1 DO HEREBY CERTIFY THAT MIS WELL WAS CONSTR
CONSTRUCTION STANDARDS, ANO THAT A COPY ¢f,
FOR OFFICE USE ONLY
Goad No:
& dal No.
iN CCORDA1+10E WITH 15A NCAC 2C, WELL
RD H S BEEN ROVIO=D TO THEW WELL OWNER.
"7/ ad
SIGNATURE ❑ PERSON CONS UCT1NG THE wELL 11AT E
Submit oricinai to Division of Water Quality, Give .t:water Section within 30 days
CW1 REV. 1219

163i3 ma Service Center - Ra?sih. N.C. 2769g-1626-Phone (et S)7333-3221
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
L _' _ ` �� WELL CONTRACTOR CERTIFICATION x: 617‹
rf 1 1
STATE WELL CONSTRUCTION PERMITR:
1. WELL USE (Cneck Applicable Ho* Residential ❑ Municipal ❑ Industrial ❑ Agricultural 0 Mc dlarnr,R,l
Recovery ❑ Heat Pump Water Injsdtion 0 Other It Other, List Use:
2. WELL LOCATION: (Show ska dj or !he Icc cr. dslow
Naa.•es: Tow;:. �i,V A N , Al OZ. C} � �s 1,/ (-X? 1
(r,aac Name aftv. Nu ters, C .ram riri• at Sut:M31.1.1 ]c.]
3. OWNER
Address lee
City or Tzwn
4, DATE GRILL=D 4IJ Z
5. TOTAL DEPTH tar
6. CUTTINGS COLLECTED YES ❑ N
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO'
8. STATIC WATER LEVEL Below Top of Casing:
(::sa '+' i[.L`cve Tco ;' Casa;)
S. TOP OF CAS„.IG IS L' FT. Above Lenz' Surface'
'Top of casing terminated atror below lard surface requi; .s s •rat iarca in ecca:-
dance with 1SA HCAC 2C .011a
10. YIELD (gpm): METHOD Or TEST
it WATER ZONES (depth).
DRILLING LOG
Syte Zp Noce
00
12. CHLORINATION: Type F -^uni
13. CASING:
From
From
From
14. GROUT:
From 0
Depth _ Dia.neler ar We-. ri '�:.
To_ Ft 2►r 564 YQ PVC.'
From
To Ft.
To _ r'
Oepih Ia:sri_! lVfe`ha
To . S' Ft J�LAIlstn�
To Ft
15. SCREEN:
Dept Diameter Slot Size
From /D r Tot' Ft 7. in. CVO in.
Materiel
.94
From _ To Ft in. _ _ It
Frorn To FL in in
16. SANO/GRAVEL PACK:
Sizs, Material
From .
Ta____Ft 2 0 .i0 5 1--f _
From To FL
17. REMARKS:
CEP-..
It addido„a?space s r:eedet! i22 e.?fS
LOCATION S1 EiCri
(Snow di.a .:;cn distance frcri a: Iasa: ta
.s, p'Y' A ? .
I DO HERESY CERTIFY THAT THIS WELL WAS CONSTR
CONSTRUCTION STANDARDS. AND THAT A COPY
FOR OFFICE USE ONLY
Quad No:
Sariat No.
1N) CCORDANCE WITH 15A NCAC 2C, WELL
BEEN ROVIDED TO THE WELL OWNER.
SIGNATUREOPERSON CONS
Submit original to Division of Water Quality. Gm
UCTING THE WELL /ATE
crater Section within 30 days
GW-1 REV. t2'4B

t
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nat1uurjal Resources - Division of Water Quality - Groundwater Section
WELL CO;NTR,� TOR (INDIVIDUAL) NAME (print) '�) Id S L Levi-,_) r CERTIFICATION r of 1n
• WELL CONTRACTOR COMPANY NAME r riF4[ _C21 PHONE 1F Sao'—�r�
STATE lYELL CON5TtiLCiION PERMITN .ASSOCIATED WQ PERMIT*
(if applicable) (if a. Dlicable)
I. WELL USE (Check licable Box): Residential 0 Municipal/Public 0 industrial ❑ Agricultural D
Monitoring ceovery 0 Heat Pump Water injection ❑ Other ❑ If Other, List Use
?. WELL LOCATION:
Nearest Town: 5tvart rrO4NO0. County 81.141 COPia-+k
/4'c a'� Jew s
(Street Nome. Numbers, Community, Subdivision, Lot No,. Zip Code)
3.OWNER.: �i►71dS
Address /Pc reQ/
(Srteet or Route No.)
r
_ &ci rirk a..A'o0—
City or Town . State Zip CO{
( )-
Topographic/Land setting
©Fta� Ridge ©Slope ❑Valley
(check appropriate box)
Latitude/longitude o f well location
(degree sitn inu teslseco ads)
Latitude/longitude source:❑GPSDTopogrztphic map
(check box)
DRILLING LOG
Forma 9Sr th n , ption
SAf�D
DEPTH
From To
Area coda- Phone number
4. DATE DRILLED ,.=—/9--0Z
5. TOTAL DEPTH: ./3
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO lam'
7. STATIC WATER. LEVEL Below Top of Casing: FT.
(Use "'+" if Above Top of Casing)
8. TOP OF CASING 13 E FT. Above Land Surface'
*Top of easing terminated astar bduw land surface requires a
variance in accordance with 15A NCAC IC .O113.
• 9. YIELD (gprn): METHOD OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From ( To 3 3 Fr_`f
From To Ft.
From To FL
13. GROUT: Depth
From 0 To 7`9 Fr.
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material •
Sal t!o PV c.
.?o-113
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
•
NlatIri1 Method
��ct~ Ic.$,vtl'A ire rr► m VP-)
14. SCREEN: Depth Diamztcr Skit Silt: Material
From 3 3 To t•-13 FL a - 0 10. in. PVC.
From To_ Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Frocn 3 1 To ti 3 Ft, flO [
From To Ft.
16. REMARKS:
1 10
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH l5A NCAC 2C, WELL
CONSTRUCTION STAD T TA COPY OF THIS .COLD HAS BEEN PROVIDED TO II -LE WELL OWNER
SICNATt I OF PERSO i.ONSTRUCCING THE WELL DATE
Submit the original to the Division or Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 R_EV. 07/2001

183E Mail Service Center . Raleigh, N.C. 27699.1536-Phone [phone]
WELL
11
LL CONSTRUCTION ` RECORD
N9- 111`" 1
WELL CONTRACTOR; PI�l .T- vOul,FF
WELL CONTRACTOR CERTIFICATION #: / 3. A .(- U
STATE WELL CONSTRUCTION PERMITTh
1. WELL USE (Check Applicable Boxy: Residential ❑ Municipal ❑ industrial ❑ Agricultural ❑ Monitoring
Recovery ❑ Heat Purnp Water Injection 0 Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Towrr:51.4dt.11.1A1q'Dd County' FLAW COt4?
(Road Name and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG
3. OWNER Ct-1t-ATEON EC From To
5u17-PA— S•0
Address (TO OW BED TIME. LOAD
(Street or Route No.l
;taA141\IA tC♦A NC
City or Town ` State Zip Code
4. DATE DRILLED 1/'1! 2(1c
5. TOTAL DEPTH 11.0
6. CUTTINGS COLLECTED YES [�%] NO❑
7. DOES WELL REPLACE DUSTING WELL? YES El
8. STATIC WATER LEVEL Below Top of Casing: 1,4, o'
1 (Usa '4 if Above Top of Casing)
9. TOP OF CASING IS 2..0 FT. Above Land Surface'
lop or casing terminated et/or below land surface squires a variance In accor-
dance with 15A NCAC 2C .01113
10. YIELD (gpmj METHOD OF TEST
11. WATER ZONES (depth):
12. CHLORINATION: Type Amount
13. CASING:
Wall Thickness
, Depth Diameter or Weight/Ft, Material
From `f.vTo sv+RcacE Ft sc1_+ yo r,�c
From To Ft.
From _ To Ft.
14. GROUT:
From
From
Depth Material Method
1.0 To 5,RFAm Ft CfltargtisY 4a11fL
To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From t7. d To 1• ° Ft _ i in • O I ° in Pq c
From To Ft In. . in.
From . To Ft In. In
16. SANOIGRAVEL PACK:
Depth
From 11-3f To 5 • p - Ft
From S.d . To •°, Ft %" SEOT. 0,11125
Size
Material
SAr+lf1
17. REMARKS: SEA 11'� 1- tF alb L'oc TiO1'J.
-5,O1 - t"t-C
NO[
Fr.
DEPTH
Formation Description
6V-01.0N CSC) MKoiS-r /1)9-, j
911 F 1.1A9-0 SirT 1 C1.ALi
BQoitti1 I Wes'=
kJ�ATW P C r QoG
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANOAFIDS, AND THAT A PY OF THIS R ORD HAS BEEN PROVIDED TO THE WELL OWN.
�� �ER
FOR OFFICE USE ONLY " —^ 1 {"3' 1 2oo0
1 I
Submit orilinailo Division of Water Quality, Groundwater Section Within 30
Quad No; SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
GW-t REV. 12r99
Serial No.

WELL CONSTRUCTION RECORD
North Carolina.- Department of Environment and Na csources - Division of Water Quality - Groundwater Section
r
WELL. MI -ENACTOR (WDMDUAL) NAMEE (print) 0lI� �,.7.-CA fP? laze CE.ITEICATrors g o r%
WELL CONTRACTOR COMPANY NAME 5if F17r9C-Ga r'nortE .S ) 0471`' 9/9�
STATE WELL coe sTRucrLo 1 PERMTCS ,ASSOCIATED WQ ?ERMITg
(if =plirable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential ❑ Municipal/Pubiic ❑ Industriai • Agiculniral 0
Monitoring I3--Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Usc
2. WELL LOCATI N:
Nearest Town: , WO N1 act ;„,_ County 4) L,l tJC.Of iB E
1 c-bf 7 a L
tem Flame, Numbc a, Community, Subravision, Lat Na., Z.cp Code)
.3. OWNER:
I CS
Address / t_ 00
{Sue=t nr Roam No.
(Oa/VA/Q 110R ' C
Thy or Town Sew Zip Coda
Ares colt- Mae nut:•^
4. DATE DRILLED
5. TOTAL DEPTH: • ►
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO iY
7. STATIC WATER LEVEL Below Top of Casing: FT.
.
+ (Use "+" if Above Top orCasing)
a. TOP OF CASING IS FT. Above Land Surface'
'Top araslac termlazted agar below toad surface requires a
raCfsata la sscardance wide I5A NCAC 2C A118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth):
Topographic/Land setting
°Ri.dge PSlope ❑Valley 0FIat
(ehcck a rprvpriam box)
L atitudellongitude of well location
• (dege=re lexa, Ersceaeds)
Latitudelloregitude source:❑CGS❑Topographic map
(cheek box)
DEPTH .ARILLING LOG
From. To C ormation D sc pt}an
It. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Diameter orWeight/FL Zte dal.
From 0 To t39 I. Ft
From To FL
Frame _To FL
13. GROUT: Depthk
Fran 0 To,FL
Ftam To FL
14. SCR.E Depth Diameter - Slot Size
From'? _ To cf CI' FL 2" _in. O. 01
From To FL in.. in.
15. SAND/GRAVEL PACK:
Depth Sirs Material
From �i 1 r To `t �-' EL ? SJ t s.Civ
Froca To Ft.
16. REMARKS: -` e-.UTQ/4 r j ► S T3
Material
I DO HERESY CERTIFY THAT
CONSTRUCTION STAND S, At
f
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the toad
numbers and common road •names.
TELL WAS CONSTRUCTED IN ACCQRDA.NOE WITH I SA NCAC 2C, WELL
4AT A GC?Y 0= 7-15 RECORD ILLS BEEN PROVIDED TO THE WELL. OWNER
3— -oz.--
SIGNATURE OF PE
SON CONSTRI1L LING THE WELL DATE
Submit :.pie original to the Division of Water Quality, Groundwater Section,1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. (9.9) 733•-3221, within 30 days. GW-I REV. 07/2001

I
MONITORING WELL CONSTRUCTION DATA
DATE INSTALLED: 1/7/2010 lcuENT: Chemtronics, Inc. I PROJECT NO: 2115.117
WELL/BORING NO: MW180-H38AB PLANE COORDINATES:
NORTH 700176.63
PROJECT NAME: Chemtronics, Inc. EAST 978383.00
ADDRESS: Swannanoa, NC
TOP OF SLAB ELEVATION: 2288.78
WELL CONTRACTOR: AE Drilling Services TOP OF CASING ELEVATION: 2291.65
CONSTRUCTION DATA
WELL SCHEMATIC CASIN~ I1'-!FOBMATIQl"J
TOP OF CASING -+-MATERIAL: [Kl □ STAINLESS □ CARBON PVC
~ -□ OTHER := DIAMETER: [xi 2" 04" 06"
TOP OF CONCRETE PAD I-LENGTH OF STICKUP I □ OTHER IN.
~ FT. JOINTS: [xi THREADED □WELDED
GROUND SURFACE ti • □ SCREWED □COUPLED
·--11 ---□ OTHER -·-SCHEDULE: 40
SQBJ;J;t:J I1'-!EQBMhllQl"J
MATERIAL: [xi PVC I CEMENT/BENTONITE ~ □ STAINLESS
GROUT DEPTH TO □ TEFLON
BASE OF □ OTHER
GROUT SEAL DIAMETER: [R] 2"
~ FT. □ 4"
□ 6"
TOTAL BOREHOLE □ OTHER IN
BOREHOLE DIAMETER SLOT: [x] 0.010
DEPTH ~ IN. LENGTH □ 0.020
FROM OF □ OTHER IN
GRADE RISER
~FT. ---~ FT. CENTRALIZER: □YES Ii] NO
~ SHOW LOCATION OF CENTRALIZER(S) ON SCHEMATIC
FILTER PACK MATERIAL .
20/40 SAND
OTHER [x] GP#1 -TOTAL
WELL SECO[::JDARY FILTER PACK MATERIAL
-----DEPTH SUGAR SAND □ F FROM OTHER □
GRADE
28.0 FT.
BENTONITE WELL SEAL
FILTER LENGTH 01/2-INCH PELLETS
PACK OF 01/4-INCH PELLETS
17.0 FT. SCREEN [R]CHIPS
~ FT. □OTHER
-_l_ SURFAQE PRQTECTIQl"J
CONCRETE PAD:[x] 3'X3' -""-□ 4'X4'
----"-□ OTHER FT --
I WELL SUMP/CAP I WELL SUMP/CAP
[x] YES
□ NO
LENGTH 0.40 FT.
ALL ELEVATIONS ARE IN FEET NGVD
:\JI \\1l 1, I l· '\ 11,ll'-. \11 '-. I \I, h< .
~k4,i {"tt.Af.NC a t:i TOA(H)L OLOO.Y _
2:3_1' 'HA"TWooa. S'fllU(T ~.~~l:'l'tL.L-.f: N'C :l!G8(1t
TH.e~e 2e•. 3350 1<Ac•;,8-2e,:us1 .,,s1
WW"w.~1.Ta. .. ON'l'e."v,lltO ■Ma:"'1'"'-1..cG"
P:\Chemtronics-2115\Task 140-154 RIFS Pt'II Tech Memo\A.ppendiXC-Boring logs and well details\
Well Construction Diagram MW1SO-H38AB.:ids
MONITORING WELL CONSTRUCTION DATA
DATE INSTALLED: 1 /27/201 ❑
CLIENT_ Chemtranics, Inc.
PROJECT NO: 2115.117
WELIJBORING NO: MW181-137AB
PROJECT NAME: Chemlmnics, Inc.
ADDRESS: Swannanaa, NC
WELL CONTRACTOR: AE Drilling Services
PLANE COORDINATES:
NORTH 700284.18
EAST 978627.56
TOP OF SLAB ELEVATION: 2271.518
TOP OF CASING ELEVATION: 2274.27
WELL SCHEMATIC
PROTECTIVE CASING 1
TOP OF CONCRETE PAD
I GROUND SURFACE
CEMENTIBENT0N1TE
GROUT
TOTAL
BOREHOLE
DEPTH
FROM
GRADE
23.4 FT.
BOREHOLE
DIAMETER
8.0 IN.
SEAL
2.2 Fr.
FILTER
PACK
18.2 FT.
r
ALL ELEVATIONS ARE IN FEETNOVO
TOP OF CASING
LENGTH OF STICKUP
Z75 FT
DEPTH TO
BASE OF
GROUT SEAL
3.0 FT.
LENGTH
OF
RISER
7.8 FT.
LENGTH
OF
SCREEN
15.6 FT.
WELL SUMP/CAP
TOTAL
WELL
DEPTH
FROM
GRADE
23.4 FT.
CONSTRUCTION DATA
CASING INFORMATION
MATERIAL: ❑x PVC ❑STAINLESS ❑CARBON
❑ OTHER _
DIAMETER: ® 2' ❑�4' ❑s'
❑ OTHER IN.
JOINTS: ® THREADED © WELDED
❑ SCREWED ❑ COUPLED
❑ OTHER
SCHEDULE; 40
SCREEN INFORMATION
MATERIAL: ® PVC
❑ STAINLESS
n TEFLON
❑ OTHER
DIAMETER: ® 2"
❑ q,.
❑ 8"
❑ OTHER
SLOT' ® 0010
❑ 0.020
❑ OTHER
IN
IN
CENTRALIZER: ❑ YES © NO
s oW LC ATION OF CENTRALQER{S} ON SCHEMATIC
FILTER PACK MATERIAL
20140 SAND
OTHER ® GP#1
SECONDARY FILTER PACK MATERIAL
SUGAR SAND ❑
OTHER
BE.NTONITE WELL SEAL
❑ 712RNCH PELLETS
❑ 1,4-INCH PELLETS
®CHIPS
❑OTHER
UREACE PROTECTION
CONCRETE PAD:® 37,0
❑ 4'x4'
❑ OTHER
WELL SUMP/CAP
❑ YES
❑ NO
LENGTH 0.60 FT.
rT
C Pi 4.. 4lllc 0 p •Alr .. [IkC 4■
351 11400.045 S w*NZYlclt AC 0ISL1
•_/pf R01 35fl w a 0311.30l 1151
Wwr.w1rrwwl'aw9l.•0w
P.IC h emkenics- 2115ffask 140-154 RIFE Phl Tech MhmoWppe db[ C- Boring lops end well dala@s1
w uJ Cchswdan ofaprenl RAIN 81-DTABAs

MONITORING WELL CONSTRUCTION DATA
DATE INSTALLED: 112512010
CLIENT: Chemtronics, Inc.
PROJECT NO: 2115.116
WELUBORING NO: MW183-039CD
PROJECT NAME: Chemtranics, Inc.
ADDRESS- Swannanoa, NC
WELL CONTRACTOR: AE Drilling Services
PLANE COORDINATES:
NORTH 699857.75
EAST 980230.01
TOP OF SLAB ELEVATION: 2230.81
TOP OF CASING ELEVATION: 2233.44
PROTECTIVE CASING
WELL SCHEMATIC
TOP OF CONCRETE PAD I -
GROUND SURFACE hi
CEMENTBENTONITEI
GROUT
TOTAL
BOREHOLE
DEPTH
FROM
GRADE
43.6 FT.
BOREHOLE
DIAMETER
10 & 5 IN.
SEAL
2.2 fT.
FILTER
PACK
18.6 FT
ALL ELEVATIONS ARE IN FEET NGVD
TOP OF CASING
i
LENGTH OF STICKUP
2,83 FT.
DEPTH TO
BASE OF
GROUT SEAL
22.8 FT.
i
LENGTH
OF
SCREEN
14.7 FT.
LENGTH y
OF
RISER
II 27.4 FT
WELL SUMP/CAP
TOTAL
WELL
DEPTH
FROM
GRADE
42.5 FT_
CONSTRUCTION DATA
CASING INFORMAILON
MATERIAL: ® PVC ❑STAINLESS El CARBON
❑ OTHER
DIAMETER: ® 2" ❑i" El6'
❑ OTHER IN
JOINTS: ® THREADED ❑ WELDED
❑ SCREWED ❑ COUPLED
❑ OTHER
SCHEDULE 40
SCREEN INFOR 11 TION
MATERIAL- ® PVC
❑ STAINLESS
❑ TEFLON
❑ OTHER
DIAMETER: ® 2"
❑ 4"
❑ s„
El OTHER IN
SLOT: ® 0,010
❑ 0.020
❑ OTHER
IN
CENTRALIZER: ❑ YES © NO
SHOW LOCATION PF CENTRALIZER(S) ON SCHEMATIC
FILTER PACK MATERIAL
20/40 SAND
OTHER IX
S NDARY FILTER PACK MATERIAL
SUGAR SAND ❑
OTHER ❑
BENTONITE WELL SEAL
❑i12-NCH PELLETS
©114-INCH PELLETS
©CHIPS
❑OTHER
*SURFACE PROTECTION
CONCRETE PAD-® 310'
❑ 4'X4'
❑ OTHER
WELL SUMP/CAP
® YES
❑ NO
LENGTH 0_47 FT.
GP #1
FT
Eaa...ssrun iR k!"" ' .vrfl.r
Orr nA.rane ara.r,, aswwsrc wC 211.801
,SL•Ail 911r ?14.0 r4s 51S tal y3•*
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PAChanitrnnt.s- 21151Tasic 14O- 5.1 REFS P+I Tack Memo1Appandix C. Boling toy& end "EMI de(4Js1
Well Corislrw6d0 Diagram 14W163-039C1/1fs%

MONITORING WELL CONSTRUCTION DATA
DATE INSTALLED: 118I2010
CLIENT: Chemtronics, Inc
PROJECT NO: 2115.117
WELL/BORING NO: MW184-N38AB
PROJECT NAME: Cherntronics, Inc,
ADDRESS' Swannanoa. NC
WELL CONTRACTOR' AE Drilling Services
PLANE COORDINATES:
NORTH 700073.70
EAST 980022.37
TOP OF SLAB ELEVATION: 2268.24
TOP OF CASING ELEVATION: 2271.30
JPROTECTNE CASING
WELL SCHEMATIC
TOP OF CONCRETE PAD
GROUND SURFACE
mein
CEMENT/BENTONITE 1
GROUT
TOTAL
BOREHOLE
DEPTH
FROM
GRADE
49.0 FT.
BOREHOLE
DIAMETER
0.0 IN.
SEAL
2.5 FT
FILTER
PACK
18.5 FT
ALLELEVATIONS ARE IN FEET NGVD
TOP OF CASING
LENGTH OF STICKUP
3.06 FT.
DEPTH TO
BASE OF
GROUT SEAL
28.0 Fr.
LENGTH
OF
SCREEN
15.0 FT.
34.0 FrlLENGTH
OF
RISER
34,0 FT:
WELL SUMP/CAP
TOTAL
WELL
DEPTH
FROM
GRADE
49.0 FT.
CONSTRUCTION DATA
CASING INFQBMLkTION
MATERIAL: ® PVC ❑STAINLESS ❑CARBON
❑ OTHER
DIAMETER: ® 2" ❑4' Or
E OTHER IN
JOINTS: ® THREADED ❑ WELDED
❑ SCREWED ❑ COUPLED
❑ OTHER
SCHEDULE: 40
SCREEN INFORMATION
MATERIAL: ® PVC
❑ STAINLESS
[� TEFLON
❑ OTHER
DIAMETER: © 2"
❑ 4"
❑ 8"
❑ OTHER
SLOT: NI 0.010
❑ 0.02a
❑ OTHER
IN
IN
CENTRALIZER. E YES © NO
SHOW LOCAl70N OF CENTRALIZER(S) ON SCHEWATIC
FILTER PACK MATERIAL
20/40 SAND
OTHER ® GP #1
SECQNOPRY FILTER PACK MATERIAL
SUGAR SAND ❑
OTHER ❑
BENTONITE WELL SEAL
0 11F-INCH PELLETS
❑ 1/4-INCH PELLETS
©CHIPS
❑OTHER
SURFACE PROTECTION
CONCRETE PAD:® 3•X3'
[� 4 (4'
❑ OTHER
WELL SUMPICAP
® YES
❑ NO
LENGTH 0.40 FT.
FT
1111110211
[ Mask.c.111a_■ MjAUSuswiO4.
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e �.�as 251 3151 ••C O211. i61.5 11
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Wall Conshuclfan Diagram MW164-NSBABAs

MONITORING WELL CONSTRUCTION DATA
DATE INSTALLED: 1/28/2010 (CLIENT: Chemtronics, Inc.
(PROJECT NO: 2115.118
WEWBORING NO: MW200-1138CD
PROJECT NAME: Chemtronics, Inc.
ADDRESS: 5wannanoa, NC
WELL CONTRACTOR AE Drilling Services
PLANE COORDINATES:
NORTH 700143.18
EAST 978345.06
TOP OF SLAB ELEVATION: 2288.7
TOP OF CASING ELEVATION: 2291.58
WELL SCHEMATIC
PROTECTIVE CASING I
TOP OF CONCRETE PAD
GROUND SURFACE *�
CEMENT/BENTONITE
GROUT
TOTAL 1 BOREHOLE
BOREHOLE DIAMETER
DEPTH 10 & 5 IN.
FROM
GRADE
74.0 FT.
SEAL
2.2 FT.
FILTER
PACK
20.0 FT.
ALL ELEVATIONS ARE IN FEET NGVD
TOP OF CASING
LENGTH OF STICKUP
288 FT.
DEPTH TO
BASE OF
GROUT SEAL
51,8 FT.
LENGTH
OF
SCREEN
14.7 FT,
LENGTH
OF
RISER
57.8 FT
WELL SUMP/CAP
TOTAL
WELL
DEPTH
FROM
GRADE
73 0 FT,
CONSTRUCTION DATA
CASING INFQRMAT ION
MATERIAL: ® PVC ❑STAINLESS El CARBON
❑ OTHER
DIAMETER: ® 2" ❑ 4" ❑ 6
❑ OTHER IN.
JOINT$: ® THREADED ❑ WELDED
❑ SCREWED I] COUPLED
❑ OTHER
SCHEDULE: 40
SCREEN INFORMATION
MATERIAL: ® PVC
❑ STAINLESS
❑ TEFLON
❑ OTHER
DIAMETER: ® 2"
❑ -0"
❑ g,
❑ OTHER IN
SLOT: ® 0.010
❑ 0.020
❑ OTHER
IN
CENTRALIZER ❑ YES © NO
SHOW LOCATION CF CENTRALQERIS7 ON SCHEMATIC
FILTER PACK MATERIAL.
20/40 SAND
OTHER ® GP #1
SECONDARY FITTER PACK MATERIAL
SUGAR SAND 0
OTHER D
BENTONITE WELL SEAL
Oita -INCH PELLETS
❑ 114-INCH PELLETS
I (1cHIPS
❑ OTHER
SURFACE PROTECTION
CONCRETE PAD:® 3'%S'
❑ 4 X4'
❑ OTHER
WELL SUMP/CAP
© YES
❑ NO
LENGTH 0.48 FT.
FT
1.0I41 a01.1.s. dP F110,142 , 9.
221 MArWgeq %%%%%%, 00.1141•1.LF !aC 2na01
a1• 0.0.0 1.1 71120 P.c ■a/.ari ale'.
VIM_. 1 % • 1 MCC•
1.-.1Ghemlpoelm - 2115LTssk 140.154 RIFS PlITech Mama4AppendaC- Boling logs and well deleiKi
Well can:m .Wnn Dlegrom MVl400-1438C0.kax

MONITORING WELL CONSTRUCTION DATA
DATE INSTALLED: 01-25-11
CLIENT: Chemtronics Inc
PROJECT NO: 2115.161
WELLIBORING NO: MW218-J38CD
PROJECT NAME: Chemtronics Inc.
ADDRESS Swannanoa, NC
WELL CONTRACTOR: AE Drilling Services
PLANE COORDINATES:
NORTH 700054.28
EAST 978792.07
TOP OF SLAB ELEVATION: 2274.716
TOP OF CASING ELEVATION: 2276.71
PROTECTIVE CASING
WELL SCHEMATIC
TOP OF CONCRETE PAD
GROUND SURFACE n
CEMENTIBENTONRE
GROUT
TOTAL
BOREHOLE
DEPTH
FROM
GRADE
24.7 FT_
BOREHOLE
DIAMETER
10.0 IN.
SEA3.0 FT.
rFILTER
PACK
12.7 FT.
ALL ELEVATIONS ARE IN FEET NGVO
TOP OF CASING
--t
LENGTH OF STICKUP
3 FT.
a f
•
DEPTH TO
BASE OF
GROUT SEAL
9.0 FT_
LENGTH I
OF
SCREEN
10.0 FT.
IN
LENGTH
OF
RISER
14.0 FT.
WELL SUMP/CAP
TOTAL
WELL
DEPTH
FROM
GRADE
24.0 FT.
CONSTRUCTION DATA
CASING INFORMATION
MATERIAL. ® PVC ❑STAINLESS ❑CARBON
❑ OTHER
DIAMETER: ® 2" ❑ 4" ❑ 6'•
❑ OTHER N.
JOINTS: ® THREADED ❑ WELDED
❑ SCREWED ❑ COUPLED
❑ OTHER
SCHEDULE: 40
SCREELLINEQSMATION
MATERIAL ® PVC
❑ STAINLESS
❑ TEFLON
❑ OTHER
DIAMETER- ® 2-
❑ 4"
❑ s'
❑ OTHER
SLOT: ® 0-910
❑ 0.020
❑ OTHER
IN
IN
CENTRALIZER: ❑ YES © NO
SHOW LOCATION OF CEMWiLIix7T(S) tlN fiCNEMATIC
FILTER PACK MATERIAL.
20140 SAND
OTHER [1
SECONDARY FILTER PACK MATERIAL
SUGAR SAND ❑
OTHER ❑
BENTONITE WELL SEAL
❑112-INCH PELLETS
❑114-INCH PELLET$
EICHIPS
❑OTHER
:SURFACE: PROTECTION
CONCRETE PAO:IjJ 3•Y.3•
❑ 4%41
❑ OTHER
WELL SUMP/CAP
❑ YES
❑ NO
LENGTH 0_30 FT
GP #1
FT
At !ANION,' T F-tivIRc1N ,I I.41., Itil..
I • •21s:r K a 1,rVne_nr +zT
al HST*'OCO ETR .tt. 52022•c2t, NC 2E501
122.8/0 Eel 1100 rIO I1a.5M1 71i5
12551-0212.05152522229255141251.52,22•22
P.1Cho-mtronic. Data E-Library120101FieldlPhase IIIW&I Construciion1MW21fiJ35CD,XIS

MONITORING WELL CONSTRUCTION DATA
DATE INSTALLED: 02-01-11
CLIENT: Chemtronlcs Inc
PROJECT Na 2115,161
WELLIBORING NO: MW219-039CD
PROJECT NAME: Chemtronics Inc.
ADDRESS' Swannanoa, NC
WELL CONTRACTOR: AE Drilling Services
PLANE COORDINATES:
NORTH 699900.3E
EAST 990063.01
TOP OF SLAB ELEVATION: 2251.681
TOP OF CASING ELEVATION' 2254.51
[PROTECTIVE CASING
WELL SCHEMATIC
TOP OF CONCRETE PAD
GROUND SURFACE hi
mobil
CEMENT/BENTONITE
GROUT
TOTAL
90REHOLE
DEPTH
FROM
GRADE
86.0 FT.
BOREHOLE
DIAMETER
10,0 IN.
SEAL
3.0 FT.
FILTER
PACK
20.0 FT_
ALLELEVATIONS ARE IN FEET NGVD
TOP OF CASING
LENGTH OF STICKUP 1
3
FT.
DEPTH TO
BASE OF
GROUT SEAL
63.0 FT.
LENGTH
OF
SCREEN
15.0 FT
LENGTH
OF i
RISER
69.0 FT
WELL SUMP/CAP
TOTAL
WELL
DEPTH
FROM
GRADE
84.0 FT
CONSTRUCTION DATA
CASING INFORMATION
MATERIAL:
[I[J PVC []STAINLESS ❑ CARBON
O OTHER
DIAMETER: ® 2' ❑ 4" ❑ 6"
❑ GTHER IN
JOINTS: ® THREADED ❑ WELDED
O SCREWED El COUPLED
❑ OTHER
SCHEDULE: 40
=REEN INFORMATION
MATERIAL: © PVC
❑ STAINLEsS
❑ TEFLON
❑ OTHER
DIAMETER: ❑x 2„
❑ 4"
❑ 8"
❑ OTHER IN
SLOT: ® 0.010
❑ u.02u
D OTHER IN
CENTRALIZER: ❑YES © NU
HOW LOCATION OF OENITOUZ!R(S) ON SCHEMATIC
FILTER PACs[ MATERIAL
20/40 SAND
OTHER IA
tSEC1QNDA]2Y FIt.TER PACK MATERIAL
SUGAR SAND f_j
OTHER ❑
BENTONITE WELL SEAL
O 1I2-INCH PELLETS
❑ 114-INCH PELLETS
® CHIPS
❑ OTHER
SURFACE PROTECTION
CONCRETE PAD:37.3
❑ WM'
❑ OTHER
WELL SUMP/CAP
® YES
❑ NO
LENGTlI 0.30 FT.
GP #1
FT
e_ 4 L1.Praolu.I fl
uavwpgp$ ¢RnAi
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W ww.atf /!Asl.s+n..walnA4.eeo
P 1Che mlronics Data E-LIbrary120101F7eIMPhase iRWaII Construclion1MW219039CD.xis

MONITORING WELL CONSTRUCTION DATA
DATE INSTALLED: 12/6/2011
CLIENT, Chemtr0nics Inc
PROJECT NO: 2115.207
WELLIBORING NO: MW230-H38AB
PROJECT NAME: Chemtronics Inc.
ADDRESS: Swannanoa, NC
WELL CONTRACTOR: AE Drilling Services
PLANE COORDINATES:
NORTH 700156,02
EAST 978430.71
TOP OF SLAB ELEVATION: 2288.12
TOP OF CASING ELEVATION: 2291.13
PROTECTIVE CASING
WELL SCHEMATIC
!TOP OF CONCRETE PAD
GROUND SURFACE
rCEMENT/BENTONITE
GROUT
TOTAL
BOREHOLE
DEPTH
FROM
GRADE
25.0 FT.
BOREHOLE
DIAMETER
8.0 IN.
SEAL
2.0 FT.
FILTER
PACK
17,0 F7-
ALL ELEVATIONS ARE IN FEET NGVD
TOP OF CASING
LENGTH OF STICKUP
3 FT.
DEPTH TO
BASE OF
GROUT SEAL
6.0 FT.
LENGTH
OF
SCREEN
15.0 FT
LENGTH
OF
RISER
10.0 FT
WELL SUMPICAP
TOTAL
WELL
DEPTH
FROM
GRADE
25.0 Fr.
CONSTRUCTIONDATA
CASING INFORMATION
MATERIAL: 0 PVC ❑ STAINLESS ❑ CARBON
L] OTHER
DIAMETER: ®2" ©4" ❑s"
❑ OTHER IN.
JOINTS. ® THREADED ❑ WELDED
El SCREWED ❑ COUPLED
❑ OTHER
SCHEDULE: 40
SCREEN INFORMATJON
MATERIAL: III PVC
❑ STAINLESS
❑ TEFLON
❑ OTHER
DIAMETER: ® 2"
❑ 4"
❑ a'
❑ OTHER
SLOT: ® 0.01O
❑ 0.020
❑ OTHER
iN
IN
CENTRALIZER: ❑YES © NO
S 1OW LOCRTION OF CENTRALIZER{S} ON SCHEMATIC
FILTER PACK MATEf2.AL
20140 SAND
OTHER ® GP #1
SECONDARY FILTER PAQUTATERIAL
SUGAR SAND ❑
OTHER El
BENTONITE WELL SEAL
O 112-RICH PELLETS
1/ 4-NCH PELLETS
© CHIPS
❑ OTHER 3/8-inch holeulu
$LIRFACE PRQTECTION
CONCRETE PAD_® 3'R3'
❑ 4'M'
OTHER
WELL SUMP/CAP
❑ YES
❑ NO
LENGTH 0.40 FT_
FT
1'Nb I WI, [RIP. d a 1-1-g2.t, A4{,
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MONITORING WELL CONSTRUCTION DATA
DATE INSTALLED: 1216/2011 CLIENT: Chemtronics Inc
PROJECT NO: 2115.207
WELL/BORING NO: MW231-H38AB
PROJECT NAME: Chemtronics Inc.
ADDRESS: Swannanoa, NC
WELL CONTRACTOR: AE Drilling Services
PLANE COORDINATES-
NORTH
EAST
TOP OF SLAB ELEVATION:
TOP OF CASING ELEVATION:
700164.84
978342,84
22se.88
2291.61
PROTECTIVE CASING
WELL SCHEMATIC
TOP OF CONCRETE PAD H
GROUND SURFACE
CEMENTIBENTONITE
GROUT
TOTAL
BOREHOLE
DEPTH
FROM
GRADE
25.0 FT,
BOREHOLE
DIAMETER
8.0 IN,
SEAL
3,0 FT.
FILTER
PACK
17.0 FT.
ALL ELEVATIONS ARE EN FEET NGVO
TOP OF CASING
t
LENGTH OF STICKUP
3 FT,
3
DEPTH TO
BASE OF
GROUT SEAL
5.0 FT.
LENGTH
OF
RISER
10.0 FT
LENGTH
OF
SCREEN
15.0 FT
WELL SUMP/CAP
TOTAL
WELL
DEPTH
FROM
GRADE
25.0 FT.
DIAMETER:
CONSTRUCTION DATA
CASING INFORMATION
MATERIAL
DIAMETER:
® PVC ❑STAINLESS ❑CARBON
❑ OTHER
I 2" ❑ 4
❑ OTHER
JOINTS: ® THREADED
❑ SCREWED
O OTHER
SCHEDULE: 40
❑ e"
SCREEN INFORMATION
MATERIAL: Ij
0
El
0
SLOT: I I
PVC
STAINLESS
TEFLON
OTHER
4,
OTHER
0.010
0.020
OTHER
CENTRALIZER: OYES
0 WELDED
❑ COUPLED
IN
© NO
IN
SHOWLOGATICN OFCENTRALIZER(S) ON SCHEMA TIC
FILTER PACK MATERIAL
20(40 SAND
OTHER
SECONDARY FILTER PACK MATERIjIL.
SUGAR SAND ❑
OTHER ❑
BENTONITE WELL SEAL
O 1f2-INCH PELLETS
❑ 1/1-INCH PELLETS
❑ CHIPS
DOTHER
GP *1
318-inch hole;,lua
SURFACE PROTECTION
CONCRETE PAD,® 3')f3'
❑ 4'%4'
❑ OTHER
WELL SUMP/CAP
O 'YES
O NO
LENGTH
SA0 FT.
FT
7\1'I11M(1\3' EN1'I1tC11:11E' f:1f, I`<[..
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WWW.01.1►w..•..r Inv ,..mimeo
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MONITORING WELL CONSTRUCTION DATA
DATE INSTALLED: 12/9/2011
CLIENT: Chemtronics Inc
PROJECT NO:
2115.20E
WELLJBORING NO: MW235-P39CD
PROJECT NAME: Chemtronics Inc.
ADDRESS: Swannanoa, NC
WELL CONTRACTOR: AE Drilling Services
PLANE COORDINATES
NORTH
EAST
TOP OF SLAB ELEVATION:
TOP OF CASING ELEVATION:
700040.49
980382.94
2231.56
2234,38
!PROTECTIVE CASING
WELL SCHEMATIC
TOP OF CONCRETE PAD
GROUND SURFACE
CEMENTIBENTONITE
GROUT
TOTAL
BOREHOLE
DEPTH
FROM
GRADE
31.5 FT.
BOREHOLE
DIAMETER
10_0 IN.
SEAL
1.9 FT.
FILTER
PACK
13.5 FT.
BackIill 31.5-30 0 with 41 sand
ALL ELEVATIONS ARE IN FEET NGVD
TOP OF CASING
LENGTH OF STICKUP
3 FT.
11111110
DEPTH TO
BASE OF
GROUT SEAL
16.1 FT.
LENGTH
OF
SCREEN
10.0 FT,
1
LENGTH
OF
RISER
20.0 FT.
WELL SUMP/CAP
TOTAL
WELL
DEPTH
FROM
GRADE
30.0 FT.
CONSTRUCTION DATA
CASING INFORMATION
MATERIAL:
DIAMETER:
JOINTS:
® PVC ❑STAINLESS ❑CARBON
❑ OTHER
® 2" ❑4"
❑ OTHER
® THREADED
❑ SCREWED
0 OTHER
SCHEDULE: 40
❑ 6"
IN.
❑ WELDED
❑ COUPLED
SCREEN iNFQRMATIQN
MATERIAL: ® PVC
❑ STAINLESS
❑ TEFLON
❑ OTHER
DIAMETER: ® 2"
❑ 4"
E 6"
❑ OTHER IN
SLOT: ® D,DID
❑ 0.020
❑ OTHER IN
CENTRALIZER: OYES ❑ NO
SHOW LOCATION OF CENTR.ALQER[S) ON SCHK MAT1C
FILTER FACIE MATERIAL
20/40 SAND
OTHER IA GP #1
SESONOARY FILTER PACK MATERIAI,
SUGAR SAND ❑
OTHER ❑
BENTONITE WELL SEAL
0112-INCH PELLETS
❑114-INCH PELLETS
❑CHIPS
❑OTHER 3/B-inchhoI pluu
SURFACE PROTECTION
CONCRETE PAD:® 3'X3'
❑ 00r.4'
© OTHER
WELL SUMP/CAP
I] YES
0 NO
LENGTH 0A0 FT
FT
I 1 l'.11 IN. I I . .
@N41 q 21r1107 A Nep A•P O�e1�l�s.r
131 IIAYWOOO tirllf. R 611 NC 1rtC1
+u..7.0 701 72sa 4-00 070.2N1 4501
■-wa&.eNpi�erl err
P:1ChemIronlcs Data E-Li braly120111Feld\Phase ill RIFSLWe11 Construction LogsLMW235P39CD.xtss

ATTACHMENT 8-B
WELL ABANDONMENT RECORDS
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL ABANDONMENT RECORD WELL CONTRACTOR Abel McGuire ---------------
We II ID#: SW-5 WELL CONTRACTOR CERTIFICATION# _3_5_71 ______ _
1. WELL USE (Check Applicable Box): Residential □ Municipal □ Industrial □ Agricultural □ Monitoring @
Recovery D Heat Pump Water Injection D Other D If Other, List Use: _____________ _
2. WELL LOCATION: (Show a sketch of the location on back of form.)
Nearest Town: Swannanoa County _B_u_n_co_m_b_e __________ _
180 Old Bee Tree Road
(Road Name and Number, Community, Subdivision , Lot No.)
3. OWNER: Chemtronics -------------------
Quadrangle No.
4. ADDRESS:_s_a_m_e_a_s_a_bo_v_e _____________ all!IWE!!l!!!!!!!!!IL!!ILl!!D!!l!IA!l!ll!G!!ll!!RAM!!!l!l~:ll!!!D!llr■aw-a•dl!lle■tall!lil!llllell!ld■sk!lllle•tclll!h■o■f!!lthl!llllle
D D D D D well showing total depth, depth and diameter of
5. TOPOGRAPHY: draw, slope, hilltop, valfey, flat screens remaining in the well, gravel interval,
(circle one) intervals of casing perforations, and depths and types
6. TOTAL DEPTH: 88.6' DIAMETER 2"
7. CASING REMOVED:
feet
8. DISINFECTION:
------of fill materials used.
diameter
12/14/2009
----------------(Amount of 70% hypochlorite used:)
9. SEALING MATERIAL:
Neat Cement Sand Cement
bags of cement _4 __ _ bags of cement __ _
gallons of water_14 __ _ gallons of water __
Other
Type material ______________ _
Amount __________________ _
10. EXPLAIN METHOD EMPLACEMENT OF MATERIAL.
Tremie Method
11. DATE WELL ABANDONED 11-21-09 ----------
I do hereby certify that this well was abandoned in accordance with 15A NCAC 2C, well construction
standards, and that a copy of the record has been provided to the well owner.
Signature of person abandoning the well _________________ Date 12/14/2009
WELL LOCATION: Draw a location sketch on the reverse of this sheet, showing the direction and distance
of the well to at least two (2) nearby reference points such as roads, intersections and
streams. Identify roads with State Highway road identification numbers.
Submit origina] to the Division of Water Quality, Attn: Information Management-_ 1617 Mail Service Center -_Ra]eigh, NC
27699-1617, Phone No. [phone], and one copy to the owner within 30 days from comp1etion of abandonment.
GW-30 Revised 09/2004
ATTACHMENT 9
MAPS AND CROSS-SECTIONS
Location of Buncombe County
in North Carolina
Chemtronics, Inc.]
0 2.5 5
i� 1vtires
N
y
Chemtronics Property Boundary
County Boundary
Primary Roads
Secondary Roads
Notes:
1. PTA - Pilot Test Area
2. County boundaries and roads obtained from NC Department of Transportation.
3.Topograph map for USGS Craggy Pinacle and Oteen 1:21.000 topographic quadrangle (dated 2011 and 2010, respectively) obtained from USGS National Map (2012).
Hydrogeologic Area (HGA)
,� • ` 4m1t7
! ' I_ }� I ryr f•r f f,x. ' Iti�t �l ' / '.' ��. '.
I I ` Knob ' )\. f 'Or by
,B147 PTA
.1
1,000 2,000
..."'�'�� Feet
L, Bp( k
Chemtronics, Inc.
nt Vailey
,,-
~,_
Cove —
Area Map
Chemtronics Site
Swannanoa, North Carolina
Figure
9-1

Lo.t:
B147 PTA
DA 1 arti 00°-
N ate:
1. PTA- Pilot Test Area.
2 Topographic contours are on 25 ft intervals.
Pond 3
(Natural Pond)
B149 PTA
= Pilot Test Area (PTA) Chemtronics Property Boundary
Stream Former Building Location
Pond n Still standing
Roads USGS Surface Elevation Contour
Disposal Area (DA)
Hydrogeologic Area (HGA)
780 390
Site Map
Chemtronics Site
Swannanoa, North Carolina
Geosyntec
consultants
Kennesaw
27-Sep-2012
780
Feet
Figure
9-2

9 Extraction Well
B105-139 PTA
B109-137
9
B115
B 144
Aft3j43
B155
\\ J, 'j1V1W181-137AB
_
B107 ` % ►,
B147
TW-14
T11,V=:147 D
MW231-H38AB
MW-147-3 /
MW-14T-2
MW-147-1
9 Zone A Monitoring Well A Abandoned Well
9 Zone B Monitoring Well 1= Pilot Test Area (PTA)
9 Zone AB Monitoring Well I= Disposal Area (DA)
Zone C Monitoring Well IME Target Evaluation Area
9 Zone D Monitoring Well ; i Evaluation Unit (EU) Area
9 Zone CD Monitoring Weil ; Pond
9 Zone E Monitoring Well — — Stream
9 Zone F Monitoring Well -1 Roads
Zone EF Monitoring Well • Existing or Former Building Area
Chemtronics Property Boundary
IBW--5j
•Y
r
B1y3.
8110-111-112
Q
`�-
A
I... fle r6-12B 9
I
B 105-1 a9
MW180-H38ABI
MW230=1438AB
MW200-H38CD ti~ MW218-J38CD
ry
DW-139
17
.8119-12
[
1121
B1.Ob
BW471{$5
Q 9 <`'_ . A.. 41, &
' AA 1
■
144
B 154
Bunker-ESM-Rubble
MW184-N38ABI—
r Y
i B122
BVL
•
:Pnnd3 •
(Natural Pond) %%
•••"'•--� �f
//
if/
I,
11
li
N
/,
300 150 0 300 Feet
Proposed Phase I Front Valley Pilot Test Areas
Chemtronics Site
Swannanoa, North Carolina
Geosyntec
consultants
Kennesaw
27-Sep-2012
Figure
9-3

ti
3
B105-139 PTA
HGA 1
B147 PTA
0 150 300
MW-
600
Feet
Potentiometric Surface Map - Zone AB
�11W213J33AB
MW-113-
21 A8' �29❑�
W 04- 4
W29-13 r 82-K39A
i M J 191-K4 AB 1W 514
as
'sW-1
HGA'
sw
g } 1-2
SW-} 1-i
MW 53.1
131-TW-1
Pr
((Valid
B149 PTA
Pond 2
SW152-3
°gv l W-152-3
Pond 1 '11-Dy�
/. MW167.044A
NiVV 155-P44A
B105-139 PTA
B147 PTA
150 300
• Zone A Monitoring Well (Water Table) Groundwater Contour Interval (5 ft Contours)M Pilot Test Area (PTA)
S Zone B Monitoring Well (Intermediate Saprolite) --1110 Approximate Groundwater Flow Direction J Disposal Area (DA)
rr Zone AB Monitoring Well J Existing or Former Building Location 1 Hydrogeologic Area (HGA)
Zone C Monitoring Well (Transition Zone) Stream Chemtronics Property Boundary
▪ Zone D Monitoring Well (Upper Bedrock( Pond USGS Surface Elevation Contour
xr Zone CD Monitoring Well
Potentiometric Surface Map - Zone CD
20 -H3$CD
600
Feet
218J3
Notes:
1- Regional groundvvaler contours based on June 1-2, 2011
sitewide monitoring evont IAllamont, 2011).
2- Groundwater elevations in feet above mean sea level (ft msl)-
17-J • OCO
MW
� MW
M
M 219-03 • !1
HGA 3
dw-is
�Z3a
-L41 Dj
HGA 2
P
(Natu
B149 PTA
B149 PTA
❑
MW. 4Si�12
W221•046CD
MW 193-g40C C
-152-37
24-N4
7-129"- 272-N42C
MW 46-IN43C
MW1 1M 43C
46
1i� 1 Sp-M44C
j
My 59-L45C
44C
x - ! 'IF BW-13
iIrjr NNY192-P41CC
Pontf 1 •1WW155-P43C
22a5�
MW1 fit -K4SC
11
MVV1,54-044C
Potentiometric Surface Maps
Chemtronics Site
Swannanoa, North Carolina
Geosyntec t>
consultants
Kennesaw
27-Sep-201 2
Figure
9-4a

1
2
B147 Area
•
(7
•
•
Proposed Pilot Test Piezometer
Proposed Pilo! Test Injection Well
Proposed CID Pilot Test Monitoring Welt
Proposed NB Pilot Test. Monitoring Well
MW216-G37
M-147-3 MW-147-2)
B147 Pilot est Area
7-C
B147 PTA
Monitoring Locations:
Inside PTA:
MW--147-1
proposed new AB well
proposed new AB well
Perchlorate
480
NA
NA
Outside PTA:
MW-147-2 69
proposed piezometers NA
61 Monitoring Welt - Detection Limit Exceeds Screening Value(s)
l Monitoring Wep - Exceeds Screening Value($
6 Monitoring Welt- Data NotAvailabie
0 CD.
C:} 0
0 0.0
Target Evaluation Area
Stream
Groundwater Contour Interval (5 ft Contours)
9 Former Building Area
Pilot Test Area (PTA)
Approximate Groundwater Flow Direction
B105-139 PTA
Monitoring Locations:
Inside PTA:
MW1B0-H3BAB
MW231-H3BAB
MW200-H38CD
proposed new AB well
proposed new CD well
Outside PTA:
MW230-H38AB
proposed new AB Well
proposed piezometers
TCE (.tg/L)
23,000
6,600
160
NA
NA
B105-13
Pilot Test Area
30-H38AB
Holes:
1_ TCE - Trichlorasthyiene
2. NA- Not Applicable
3. pgtL - microgramalliter
4. PTA- Pilot Test Area
5. Regional groundwater contours based on June 1-2, 2011
sitewide monitoring event (Altamont. 21111y_
E. Groundwater elevations in feet above mean sea level (R mst).
DVV-139
MW218-J38C❑
B105-139 Area
60 Feet
B105-139 and B147 Pilot Test Area Layouts and
Potentiometric Surface Map - Zone AB
Chemtronics Site, Swannanoa, North Carolina
Geosyntec °
consultants
Kennesaw
27-Sep-2012
Figure
9-4b

0 Proposed Pilot Test Injection Well
Proposed C Pilot Test Monitoring Well
• Proposed C!D Pilot Test Monitoring Well
19 Monitoring W&N - Detection Limit Exceeds Screening Value(s) O Target Evaluation Area
• Monitoring Wetl- Exceeds Screening Value(s) — — Stream
• Monitafing Well- Data NotAvarable
Groundwater Contour Interval (5 it Contours)
Former Building Area
Pilot Test Area (PTA)
.1111. Approximate Groundwater Flow Direction
B149 PTA
Monitoring Locations:
Inside PTA: TCE {rfglL)
MW-149-1 (Zone D) 350
MW183-039CD 310
proposed new C well NA
Outside PTA:
proposed new CD well NA
proposed new CD well NA
Pond 2
Notes:
Pond 1. TCE - TrichToroelhy€ene
2. NA - Wol Applicable
a µtyL - microgramslliler
4_ PTA - Ptot Test Area
5. Regional groundwater contours based on June 1-2, 2611
sitewide monitoring event(AIEamont, 2011).
6. Grcurxiaeter elevations in feet above mean sea level (ft msit,
60
30
0
60 Feet
B149 Pilot Test Area Layout and
Potentiometric Surface Map - Zone CD
Chenttronics Site, Swannanoa, North Carolina
Geosyntec °
consultants
Kennesaw
27-Sep-2012
Figure
9-4c

G3:
113;
B105-139 Pilot Test Area
B147 Pilot Test Area
1 7 A
G39
137
139
MW237-1371ip
J39
K39
�MVV227•J09EF
1 0 C
50
0•
100 feet
it
Well - Data Not Available
f9 Monitoring Well - Detection Limit Exceeds Screening Vatue(s)
& Monitoring Well - Exceeds Screening Value(s)
Target Evaluation Area
Stream
TCE Plume in AB Aquifer
RDX Plume in AB Aquifer
Perchlorate Plume in AB Aquifer
1,2 DCA Plume in AB Aquifer
EZI Pilot Test Area (PTA)
Proposed Pilot Test Injection Well
Data Table Notes:
Groundwater results in isgli.
100 Result does not exceed screening criteria
100 Anafyte not detected but detection limit
exceeds screening criteria
100 Result exceeds screening criteria
SLs (Screening Levels) for groundwater based
on NC 2L Standards.
Note-
1) Groundwater plume contours reflect the North Carolina
2t standards.
Key Map
1 Rcar5
---- Aa Pot -Surfaces' Contours
1 Property Boundary
Latest Groundwater Data Around Area B105-139
Con 1,2- Chloro 2,4.6- Perch -
Sample GW duct DCA forrn PCE TCE VC TNT HMX RDX ]orate
Location Zone Date pH rarity ORP DO f3Ls:0.4 70 0.7 3 0.03 1.2 350 0.32 2
BW-5 E 09/2008 7.26 0.234 7.1 3.26 1,300 1 U 1 U 2.4 J 1.7 J 0.2 U 0.65 U 0.2 U 0.2 U
DW-139 C 09/2008 5.36 0.066 102 2.14 5,100 10 11 9.4 1.3 0.2 U 0.65 U 2.5 0.72 J
MW-147-1 B D8/2008 6.15 0.038 79,3 2.05 1.6 0.2 J 0.1 U 23 0.1 U 0.2 U 8.7 16 480
MW180-H38AB AB 03/2010 4.87 0.065 192.2 0.67 17 6.6 J 2 U 36000 12 0.2 U 2.1 NJ 29 47
MW181-137AB AB 02/2010 5.37 0.079 204 1.97 0.1 U 0.1 U 0.1 U 0.2 J 0.3 J 0.2 U 0.65 U 6.9 3.3
J1/44W-1BD E. 08/2008 0.1 U 13 U 021 J
MW-1BD E 10/2010 0.3J 0.1U0.1U 0.1U 0.2 U 0.2 U
MW-1Bl D 08/2006 0.1 U 13 U 0.2 U
MW1B1 D 10/2010 0.8 0.1U0.1U 0.1U 0.2 U 0.2 U
A W-1 S A 09/2008 0.4 J 5 U 0.2 U
MW-'1s A 10/2010 0.1 U 0.1 U 0.1 U 0.1 U 0.2U 02U
MW200-H38CD CD 03/2010 5.99 0.062 72.7 2.95 0.2 U 0.2 U 0.2 U 160 0.2 U 0.2 U 16 J 2.9 J 2.1
MW218-J38CD CD 03/2011 0.1 U 3.8 0.3 J 1 0.1 U 0.2 U 0.65 U 0.2 U 0,21 J
Nl.VV227-J39 Er 01/2012 540 31000 69 16 J 10 U 4 J 0.65 U 0.2 U 0.2 U
Groundwater Plume Contours in Subject Area
Roads
Ell Areas
Stream
MoniloAng and Extraction Wags
- 1,2 DCA Flom in AB Aquifer
Perchlnrata Plume MAB Aguilar
Rax PM me RIAU Aquifer
TCE Plume in AS Aquifer
© Otsposal Area
MW-15 Y� P_1 12-K36Ae
M 16-G37AB
Area B105-139 Contaminant Plume Map - Zone AB
Chemtronics Site
Swannanoa, North Carolina
Geasyntee °
consultants
Kennesaw
27-Sep-2012
Figure
9-5a

Z
F31 "\..G37IIItW216-G3TA8 MW226-G37CD
H37
MW 174-F38EM4V174•F38F
'10
E 38
F36
147•E
t47
G38
147-C
MW-1 7-3 MW-147�
9 S __
7-B
1 7P
B105-139 Pilot Test Area
KAW1.80- •8AB
38 1 , •1
UMVV 0-H38AN
B147 Pilot Test Area
E 39
F39
G39
H39
Well - Data Not Available
Monitoring Well - Detection Limit Exceeds Screening Value(s)
19 MVionitoring Wet - Exceeds Screening Value(s)
Target Evaluation Area
Stream
TCE Plume in AB Aquifer
- RDX Plume in AB Aquifer
Perchlorate Plume in AB Aquifer
- 1,2 DCA Plume in AB Aquifer
O Pilot Test Area (PTA)
. Proposed Pilot Test injection Well
Data Table Notes:
Groundwater results in pgO.
100 Result does not exceed screening criteria
100 Analyte not detected but detection limit
exceeds screening criteria
100 Result exceeds screening criteria
EMI
SLs (Screening Levels) for groundwater based
an NC 2L Standards.
Note:
1) Groundwater plume contours reflect the North Carolina
2L standards.
Roads
AB Pot-Surface-5' Contours
Property Boundary h
Latest Groundwater Data Around Area B147
Con 1,2- Chloro 2,4,6- Perch -
Sample GW duct DCA farm PCE TCE VC TNT HMX RDX lorate
Location Zone Date pH ivity ORP DO JSLs:0.4 70 0.7 3 0.03 1.2 350 0.32 2
MW-147-1 8 0812008 6.15 0.038 79.3 2.05 1.6 0.2 J 0.1 U n 0.1 U 0.2 U 8.7 16 480
MW-147-2 B 0612008 4.4 0.017 81 1.72 0.1 U 0.1 U 0.1 U 0,6 0.1 U 0.2 U 0,65 U 3.4 69
MW-147-3 B 0712007 0.1 U 0.1 U 0.1 U 0.2 J 0.1 U 0.2 U 0.65 U 0.2 U 79
MW174-F38E E 08/2008 4.97 0.053187.9 4.29 0.1 U 0.1 U 0.1 U 0.1 U 0.1 U 0.2 U 0.65 U 0.2 U 1
MW174-F38F F 09/2008 7.5 0.091 -46 1.4 0.1 U 0.1 U 0.1 U 0.1 U 0.1 U 0.2 U 0.95 UJ 0.2 UJ 0.27 J
MW180-H38AB AB 03/2010 487 0.055192.2 0.67 17 6.61 2 U 36.000 12 0.2 U 2.1 NJ 29 47
MW200-H38CD CD 0312010 5.99 0.062 72.7 2.95 0.2 U 0.2 U 0.2 U 160 0.2 U 0.2 U 16J 2.9 J 2.1
MW216-G37AB AB 0312011 0.1 U 0.1 U 0.1 U 0.1 U 0.1 U 0.2 U 0.65 U 0.2 U 2 U
MW226-G.,J%'D_CD 03/2011 0.1 U 0.7 0.1 U 0.1 U 0.1 U 0.2 U 0.66 U 0.38 U 2 U
[Groundwater Plume Contours in Subject Area.
1-1 loads
l I
Ell Areas
Stream
Monitoring and Extraction Weis
12 DCA Plume In AB Aquifer
Perchlorate Name in AB Aquifer
RDX Plurrla it AB Aguilar
TCE Plume in AB Aquirer
Disposal/yea
W-1
0
250
500
1,000
Feet
aunker-Esd.au. it
13151
Area B14T Contaminant Plume Map - Zone AB
Chemtronics
Swannanoa, North Carolina
Geosyntec °
consultants
Kennesaw
27-Sep-2012
Figure
9-5b

rr2 7
122
N3 3
N39
037 P37
038
iveirograjogiokNotpy
a
i�w18a-N3E.A
S 5W=149
oro
/
P38
WA/ 235-P390 D.
149
MW219-1739CD
rr 039
MW183-q Cp.
037
9-1
39
B149 Pilot Test Area Pond
Q39
'+7v 50 0 1C0 loot
Watt - Data NotAvailable
• Monitoring Well - Detection Limit Exceeds Screening Value[=
• Monitoring W511- Exceeds Screening Value(s)
Target Evaluation Area
Stream
TCE Plume in CD Aquifer
- RDX Plume in CD Aquifer
Perchlorate Plume in CD Aquifer
- 1,2 DCA Plume in CD Aquifer
Pond
Pilot TestArea (PTA)
Proposed Pilot Test Injection Well
Data Table Notes:
Groundwater results in pgll.
100 Resu It does not exceed screening criteria
log Analyte not detected but detection limit
exceeds screening criteria
100 Result exceeds screening criteria
SLs (Screening Levels) for groundwater based
on NC 2L Standards.
Note:
1) Groundwater plume contours reflect the North Carolina
2L standards.
alley Map
1
1
7 Roads
CD Aquiter-5' Contour
u. .. Property Baandary
Latest Groundwater Data Around Area B149
Con 1,2- Chloro 2,4,6- Perch -
Sample GW duct DCA form PCE TCE VC TNT HMX RDX orate
Location Zone Date pH ivity ORP DO f SLs:0.4 70 0.7 3 0.03 1.2 350 0.32 2
MW-149-1 D 0812008 6.22 0.075 84.3 0.93 0.1 U 15 0.2 J 350 0.1 U 0.2 U 0.65 U 2.4 U 0.61 J
MW183-039C❑ CD 0312010 5.5 0.063 155.2 5.45 1 U 1.1 J 15 360 1 U 0.2 U 0.7 U 5.2 67
MW184-N38AB AB 03/2010 5.29 0.048 149.8 4.5 0.1 U 0.2 J 0.2 J 2.5 0.1 U 0.2 tJ 2.4 7,2 0.91 J
M1J219-Q ,9CD CD 02/2011 0.1 U 03 J 0.5 J 15 0.1 U 02U 0.65 U 4.5 2.8
SW-149 B 0712007 0.1 U 0.1 U 0.3 J 0.1 U 0.1 U 0.2 U 0.65 U 0.2 U 0,8 J
J
Groundwater Plume Contours in Subject Area
0
0142
00
SW-1
31e)
MW179 H
NW215 038
W218-G37AB
DA 10(11
Roads
! Eli Areas
�. WIMP Straam
Monitoring and Exlra:Oen Wells
DO Disposal Area
TCE Plume in CO Aquifer
- RDX Plume in cDAqu.10r
Perchlorele Mae in CO Aquifer
- 1,2 DCA Plume in CDAquae(
vv
-15 MW21216EIAB
MW-t
0
M s-1s'*f
� l
MA 2
W-152-3sw 2.1
P. r
1
7♦ Pond 1
' `"Flritje74
1
P14A
9YL
:,ram
r
Pond 3. %
/Natural Pon fij' '•""
I i
1, '
Area B149 Contaminant Plume Map - Zone CD
Chemtronics Site
Swannanoa, North Carolina
Geosyntec D
consultants
Kennesaw
27-Sep-2012
Figure
9-Sc

HGA 2
0
B105-139 PTA
MW231-H38AB
0
B 0
B147 PTA
DA 10111
'N,
9J
BW5
441
DA 23
Li__
O
,,,f
„,.
MW180-H38AB
MW-147-1
MW212-K38AB
MW-iB1
MW-1BD
r3
HGA 1
IMW221-04QC.� •.
4�
CP
13IW-152-z
IS1nF152-21
HGA 3
Pond 2
IMW224-N42CD1
MW147-H42C
MW1T7-M44D1
MW177-M44FI
rMN204-1_45E1--\ MW1&t-M44C
M 1e9-L45C--ter
MW222-K46EF -
MW1e1aK46C
Br
m
II
Pond 1
O
Pond 3
(Natural Pond)
0
MW187.039CAJ
MW194-Q3BC0I
i Zone A Monitoring Well I=1 Pilot Test Area (PTA)
O Zone B Monitoring Well Stream
O Zone AB Monitoring Well Pond
Zone C Monitoring We!! Roads
9 Zone!) Monitoring Wen 1=1 Disposal Area (DA)
O Zone CD Monitoring Weil T— Hydrogeologic Area (FICA)
A Zone E Monitoring Well Chemtronics Property Boundary
9 Zone F Monitoring Well I I Former Building Location
Zone EF Monitoring Well n Still standing
• Extraction Well 250-ft by 250-ft Reference Grid
>• Cross -Section Line
Note:
1- PTA - Pilot Test Area
500 250 0 500
Feet
Plan View of Cross -Section Locations
Chemtronics Site
Swannanoa, North Carolina
Geosyutec c>
consu!tantS
Kennesaw
27-Sep-201 2
Figure
9-6a

\CADD\C\CHEMTRONICS\FIGURES\A-A' X-SECTION7
Northeast Southwest
A
ELEVATION
(feet)
2500
2400
2300
2200
2100
2000
A'
NDN
ND, /
ND !
9-2J
C
3
3
2
3
a Inset A
- B105-139
Proposed
n Injection
Zone
500
DISTANCE (feet)
0
3
D
x
— f
.--R147
1
1
1
/
I
1000
Proposed
In jectlon
Zone
8105-139
Proposed
Injection Zone
EVBC
ru
w
1
iJ
co
a
-B 147
Proposed
Injection Zone
a
Inset A
y
Lithologic Codes
Overburden material
Bedrock
Water level
Contaminant Color Codes
TCE
1,2-DCA
PCE
Chloroform
Notes
1, Vertical Exaggeration = 2,5x
2, )EIndicates 2011 sampling data
where available
3, Concentrations are in
Micrograms per liter (pg/L)
4, Cross-section developed by
Altamant (2011)
5, Locations of proposed
monitoring wells and injection
zones are approximate and
ray be adjusted to
accommodate field conditions
CROSS-SECTION A -A`
VOLATILE ORGANIC COMPOUNDS
CHEMTRONICS SITE
SWANNANOA, NORTH CAROLINA
Geosyntec°
consultants
Kennesaw, GA
05-Sept-2012
Figure:
9-6b

L:\CADD\C\CHEIATRONICS\F1GURES/A-A' X-SECTION-2
Northeast Southwest
A
ELEVATION
<feet)
2500
2400
2300
2200
2100
2000
V9E>I-2T2MW
NDx
2.6
L1 L.I
0
Li:
Inset A
B105--139 —
Proposed
Injection
Zone
500
xx x
run) 1
Ul �o
b -
I I I
1zs I
CO COCO
wIXIJ
13)71
2.9J
ES'
/0,0 f1
207Uri} 0 0/
ono rat ri
-c-c /
InDo a n
rrirn td,td
tJ
wow z z
00U Mm
zzz /r-,a—
/
rnm
I-�
r-r-rn
rrr-
rr-r
C7
0
3
DISTANCE (feet)
1000
B147
Proposed
Ir�,jection
Zone
:1O5-139
Proposed
Injection Zone
r147
Proposed
Injection Zone
x
1
1
Inset A
Lithologic Codes
Overburden material
Bedrock
z Water level
Contaminant Color Codes
HMX
RDX
Perchlora t'=
Notes
1, Vertical Exaggeration = 2,5x
2, *Indicates 2011 sampling data
where available
3, Concentrations are in
micrograms per liter (pg/L)
4, Cross-section developed by
Altamont (2011)
5. Locations of proposed
monitoring wells and injection
zones are approximate and
may be ad justed to
accommodate field conditions
CROSS-SECTION A -A'
-IMX, RDX, AND PERCHLORATE
CHEMTRONICS SITE
SWANNANOA, NORTH CAROLINA
Geosyntec
consultants
Kennesaw, GA
05-Sept-2012
Figure:
9-6c

x-SFC lQN
CMTRQNlcs\F1cuR_s/e-A
U
a
T-6bT—rIW
— B 149
Proposed
Injection Zone in
Zone C
(Transition Zone)
Inset A
Lithologic Codes
Overburden
material
Bedrock
Water level
I
/I
I r
J r
I
r
Northeast
B
0
Contaminant Color Codes
TCE
1,2-DCA
PCE
Chloroform
500
1000
1500
DISTANCE (feet)
Notes
1, Vertical Exaggeration = 2,5x
2, *Indicates 2011 sampling data where
available
3, Concentrations are in micrograms per liter
(Ng/L)
4. Cross-section developed by Altamort (2011)
5, Locations of proposed monitoring wells anoi
injection zones are approximate and may be
adjusted to accommodate field conditions
2000
Southwest
B'
2500
2500
2400
2300 r�-
Fri
rD
2200" o
2100
2000
CROSS-SECTION B-B'
VOLATILE ORGANIC COMPOUNDS
CHEMTRONICS SITE
SWANNANOA, NORTH CAROLINA
Geesyntec
consultants
Figure:
9-6d
Kennesaw, GA
OS-Sept-2012

\CADO\C\CHEMTRCNPCS\EIGuREs\B—B' X—SEC7IQN- 2
i-6tii--P'IW
aE6E0-E8IMW
- 8149
Proposed
Injection Zone in
Zone C
(Transition Zone)
Inset A
Lithologic Codes
Overburden
material RDX
Perchlorate
Northeast
r
� j r
J/f i r
I '
ND
'ND
0. 3J
0
500
Contaminant Color Codes Notes
Bedrocl
s Water level
HMX
14,
230
1000
ND
0.9J
l.B
1500
DISTANCE (feet)
1. Vertical Exaggeration = 2.5x
2, KIndicates 2011 sampling data where
available
3. Concentrations are in micrograms per liter
(ag/L)
4. Cross-section developed by Altamont (2011)
5. Locations of proposed monitoring wells and
injection zones are approximate and may be
ad justeoT to accomroolate Meld conditions
ND'
ND
ND ND#
ND/ND
ND NO
/
2000
Southwest
B'
2500
ND
ND
0.2 J
NVNI3
ND ND
ND/ND
2500
ND -
ND
N3]�
2400
2300 P
r0ID D
c
2200`r z
2100
2000
CROSS-SECTION B-B'
HMX, RDX, AND PERCHLORATE
CHEMTRONICS SITE
SWANNANOA, NORTH CAROLINA
Geosyntec
its
Kennesaw, GA
05-Sept-2012
Figure:
9-6e