WI0700021_Other Correspondence_20050309

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross Jr., Secretary
Alan W. Klimek P.E., Director
OINA1
�O QG
I7
Division of Water Quality
Aquifer Protection Section
Location: 2728 Capital Blvd.
Raleigh, NC 27604
Mailing Address: 1636 Mail Service Center
Raleigh, N.C. 27699-1636
FAX: [phone]
[phone]
Date: 3 r 9/ o 5-
FAX TO: bit', 26;j r1 ew T. Kab..1c,
FROM: 3eSSt W's�"^a^
PHONE: (co(I) - v , vrL
FAX NUMBER: ('1‘(.)6(,0 - SZ 19
NO. OF PAGES INCLUDING THIS SHEET:
E,n e1oSa 5 `)'k-t_ 5.k-oliv-S t6 r✓l^ `t4,Cft t,sc
lAvv c _r -1,,.k_ Ulf C-- Pe, r4 1-G- 1' . V 10 ` r ©6 0 21 , T ) e
1
,NOuArX 6, I-44 1 AS kr.`eO, --1-(/taa,ks e.r LioK,r
If you receive this fax by mistake call: Aquifer Protection Section @ 919-733-3221

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
January 27, 2005
Dr. Zbigniew J. Kabala
Associate Professor of Civil Engineering
Duke University School of Engineering
Box 90287
Durham, NC 27708-0287
Ref: UIC Permit No. WI0700021 Issued to Dr. Zbigniew J. Kabala
Dear Dr. Kabala:
The Underground Injection Control (UIC) Program of the North Carolina Division of Water Quality is responsible for
regulating injection well construction and operation activities within the state. Our records show that the injection well
permit referenced above expired on August 31, 2002.
You must submit the enclosed form, Status of Injection Well System (form GW-68) to indicate the current status of your
injection well system within 30 days of the date of this letter. If you intend to conduct additional injections or pursue any
injection -related activities that are beyond the scope of the permit referenced above, you must submit a letter requesting
amendment of the permit that describes in detail the procedure, locations, volume and frequency of injected material, and
any other pertinent information regarding the proposed activity.
If any injection well is no longer being used for any purpose, it must be temporarily or permanently abandoned according
to the regulatory requirements specified in the North Carolina Administrative Code Title 15A Subchapter 2C Section
.0214, and the UIC Program must be notified within 15 Days of abandonment. Notification of permanently abandoned
wells must be submitted using the enclosed Well Abandonment Record (form GW-30).
Please contact Thomas Slusser at [phone] or myself at [phone] if you have any questions regarding this
correspondence, your permit, or injection well rules and regulations.
Sincerely,
fr.. ..
Jesse Wiseman
Processing Assistant
UIC Program
cc: Washington Regional Office
CO-UIC Files
Enclosure
None Carolina
Naturally
Aquifer Protection Section 1636 Mail Service Center Raleigh, NC 27699-1636 Phone [phone] Customer Service
Internet: http://h2o.enr.state.nc.us 2728 Capital Boulevard Raleigh, NC 27604 Fax [phone]
Fax [phone]
An Equal Opportunity/Affirmative Action Employer— 50% Recycled/10% Post Consumer Paper

Re: tracer studies at Lizzie Site
Subject: Re: tracer studies at Lizzie Site
From: Zbigniew Kabala <[e-mail]>
Date: Wed, 02 Jun 2004 15:08:18 -0400
To: Thomas Slusser <[e-mail]>
Hi,
I apologize for getting back to you earlier.
At this point we are not conducting any injections, as my students who worked on the project involving the Lizzie
site have both graduated. I expect to have another student next fall to do further research at this site.
The first permit served us very well, and we do not intend to renew it at this time. With its help, we have
discovered that Rhodamine WT has two isomers, one sorbing an order of magnitude stronger than the other one.
Consequently, RWT undergoes chromatographic separation in groundwater tracer tests. We were thus able to explain why
researchers routinely see in the extraction wells only about 50% of the mass injected in the injection wells.
We find Fluorescein a much more useful tracer for groundwater studies. Consequently, I would like to renew the
second permit next year.
Please let me know if you need a formal report on the status of our research, or perhaps, a list or copies of
publications that came out of it.
Best regards,
Z.J. Kabala
Zbigniew J. Kabala, Associate Professor
and Director of Graduate Studies
Department of Civil & Environmental Engineering
Pratt School of Engineering
Duke University
Box 90287
Durham, NC 27708-0287
Phone: [phone] Fax: [phone]
E-mail: [e-mail]
http://ceelab4.egr.duke.edu/--kabala/index.html
Thomas Slusser wrote:
Greetings Dr. Kabala,
I am with the NC Dept. of Environment and Natural Resources and writing
to follow up on two permits issued on your behalf for injecting
Rhodamine WT dye for tracer studies at the Lizzie Intensive Study Site
in Greene County. -Permit # WI0700021,-expired Ch 8/31/2002 and permit #
1 of 2 10/12/2004 9:01 AM

Re: tracer studies at Lizzie Site
wio-No0:29 i4diqgto € x ire
The information I am seeking concerns the status of injection activities
associated with these permits: are injections currently being
conducted? are injections planned for the future?
I primarily need to know about activities associated with the expired
permit, such as if you plan to renew it for future studies or if it has
served its purpose and our office can officially close the file. All
injection wells that are not planned for use must be properly abandoned
in accordance with regulatory requirements.
Please call me at 919-715-6166 or reply by email if you have any
questions or need more information. Thank you for your time and
efforts.
Best Regards,
-Thomas Slusser
Division of Water Quality
Groundwater Section
Underground Injection Control Program
2 of 2 10/12/2004 9:01 AM

PIFIr ..
I; Carolina - Department of Environmer,_. Iealth, and Natural Resources
Division of Environmental Management - Groundwater Section,
P.O. Box 29535 - Raleigh, N.C. 27626-0535
Phone [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: i) C
DRILLER REGISTRATION NUMBER: 1 -p; rTh
FOR.OFFICE USE ONLY '- QUAD. NO. L=1.2 'SERIAL NO. /4'4 6?
Lat Long • 'pc
Minor Basin
Basin Code
Header Ent .. GW-1 Ent.
STATE WELL CONSTRUCTION
PERMIT NUMBER:
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town: ihoe 1 County: G- Reef e
S2 l73s
(Road, Community, or Subdivision and Lot No.)
2. OWNER A.) Cr. 71714J
ADDRESS
(Street or Route No.)
R,
City or Town State Zip Code
3. DATE DRILLED 1-r-93 USE OF WELL
4. TOTAL DEPTH (I8 _
5. CUTTINGS COLLECTED YES ./r NOf
6. DOES WELL REPLACE EXISTING WELL? YES n NO
7. STATIC WATER LEVEL Below Top of Casing: I g.y 7 FT. a3-, 4 ;rz,=-, << a ; W) C j
DEPTH
From To
DRILLING LOG
Formation Description
e -.1
- 'J-O;-�v "� 1. C r7w� ✓�iTr-, 5f-....."11
,J-o Coi=tr C f _
3- 1 �'- i G R ram, .�.z.rJr.�-�.� .� � ��•�'� r ' c....
,3 C-rz (j , - ;y- ni
(Use "+" if Above Top of Casing) er:f.- ? �, F' S v i / /A r:
8. TOP OF CASING IS 3-'7 FT. Above Land Surface* "33_,le- �, Q4. c ;P� ,,; S.' L►P
as -tea
Casing Terminated at/or below land surface is illegal unless a variance is issued
in accordance with 15A NCAC 2C .0118
9. YIELD (gpm)' 5 METHOD OF TEST A 2 L C4
p0. WATER ZONES (depth): 5I- S 9
-11. CHLORINATION: Type
12. CASING:
Zg
- �i 3 �r.a., (_)c•.. $'',119 9.4 S‘-'"Q
a3-4g- -Sa-J n° SPiCAr" i€
yg- S3 - -eJ rvo "
s:3 -S6
�/74
Amount ^f /A If additional space is needed use back of form 0 Ue
Wall Thickness
Depth Diameter or Weight/Ft.
From 0 To Vic, Ft. c:J.. L . J
From To Ft.
From To Ft.
13. GROUT:
LOCATION SKETCH
_Material (Show direction and distance from at least two State
Roads, or other map reference points)
Depth Material Method
From 0 To a' Ft. c--,.,,2^-+4 '.,- C''''"--";
- From
14. SCREEN:
Depth Diameter Slot Size Material
From . To -CI. Ft ' in. • o I J in P:j c
From To Ft in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 3-7 To 6' Ft. ru.N. Y,t -`z,
To 3 '7 Ft. C ^ :2c P,rsi
5 t>? 133.;
I511.t;4s
From To Ft.
16. REMARKS: T-I P - 5 aq ��tic lm.oi,:••
LZL
I-a.X2PJc
I DO 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.
GW-1 REV. 5/91
'-Q 47
SIGNATURE OF CONTRACTOR OR AGENT DATE
Submit original to Division of Environmental Management and copy to well owner.

North Carolina - Department of Environment, Health, and Natural Resources
Division of Environmental Management - Groundwater Section
P.O. Box 29535 - Raleigh, N.C. 27626-0535
Phone [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR:
FOR OFFICE USE ONLY ,-
QUAD. NO. n/-). ,. g - / % SERIAL NO / 4J)
Lat Long. RO
Minor Basin
Basin Code
Header Ent GW-1 Ent
STATE WELL CONSTRUCTION
DRILLER REGISTRATION NUMBER: /G'C° PERMIT NUMBER: L jzZi c_ _
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town: 74-e "-> J County: ; "'
(Road, Community, or Subdivision and Lot No.)
2. OWNER
ADDRESS
(Street or Route No.)
City or Town State Zip Code
3. DATE DRILLED /- 7 ? USE OF WELL
4. TOTAL DEPTH 3
5. CUTTINGS COLLECTED YES-1 NOD
6. DOES WELL REPLACE EXISTING WELL? YES n NO'f
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 3 o FT. Above Land Surface*
' Casing Terminated at/or below land surface is illegal unless a variance is issued
in accordance with 15A NCAC 2C .0118
9. YIELD (gpm): -/ef METHOD OF TEST _. rl z+-
10. WATER ZONES (depth): ;/ - �� / v /2 —/Q
DEPTH DRILLING LOG
From To Formation Description
I"l ^"" - r�
.
];,ice-�.�.:J i, d�•:,
�
A�n�iti �
_��- J
\ Amount
11. CHLORINATION: Type
12. CASING:
From
From
From
13. GROUT:
Depth Diameter
To // •/ Ft.
To Ft.
To Ft
Wall Thickness
or Wei tiFt.
/J
Depth Material
From ,() To Ft.
From To 3?' Ft. /44:-.--4,04-
J
If additional space is needed use back of form
_ y
sR Is4r
CA_TIQN SwF-IA-Ell'
wFTr.K
Material -- (Show direction and distance from at least two State
���. ,=.,,'Roads, or other map reference points)
Method
7y,,[1rr.r
14. SCREEN:
Depth Diameter Slot Size
From 1-/J To / Ft T in. '6/6 in
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth
From To , 25/
From To
16. REMARKS: o•rn .,-„;) /
in.
in.
Size
Ft.
Ft.
•
Material
in.
•'
in r-
Material ,,
.14
4
c j _mot`
—r
I DO 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.
GW-1 REV.9/91
SIGNATURE OF CONTRACTOR OR AGENT DATE
Submit original to Division of Environmental Management and copy to well owner.

DEPTH
from to
,/ ` /-
—f�
-re
/ / 7?
.27 /_9,4
- -7
f
/
DRILLING LOG
formation desc.
Figure 12 Typical Well Types For Above Ground Installation
Lne.los C.,,WUA
W •N C..Ine (V.nl.nl -
! r.1, On O..l.,d.
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i ,. J .'.Aleut Ci.nol.l
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q3 lent nl.
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</_51
3
/
/
/
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•
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lee. MO Coo..
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well C .1n0 Iv.nl•nl
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obul or' 1 On."O. Orl -
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. L.•A•eexa
01,.l la•, Hill. ! rt.
Ovur C..1ng T: N.
lees.. 0.0 rl. Inl•
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• rt. P.le. 01..14t••
O..tn CI C•wtnl..e.n
.4n..•r I. 611.110...
.....•d ..dell..
oe•n seen Hel ,. / \
Net: C•n l• -� - 1Ser••n/I� 1,l•-
Leon\
-`Bedrock
Oe.n Hot.
Figure 13 Typical Well Types For Below Ground Installation
,:.
Wee,. r Oul..•rein. P.• CUM.-1
e WT
a [ 1-
•II •e
1 B - Unconfined
Q B - Confined
L. nn 6nrl.e• -
Well lee
••• Hell
en.•nl
— n.emurn.ert.
f oes.• Cl.,ne
L Poonnl1-..
Growl 6.0
.I.!rl.
. $sale. C...• to
wCO � 1. Into
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or • I. Bern. Ore.,
••1 o•et Or Content.
In•Ilen WMen.••r
H 6nuln.e.
`•l•nlenn•
pr O.evl 6u1
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i- ..1 r1 n4.. 7..r Lr. -
,.'-.
yy land Pete ! ft... L -
�" / ./tAo•T Screen. • / _ -
L L1LL�� `.met.... .It,1.-1 ,
on.n nee: Nel�� ijr /r�,/•.-r-%-•-"-.r.—;1
•
Open lege \r ( ( 1 •
•
-r� •- ,•: ,
L.�/
QI B -Bedrock

✓`nu) r/)
North Carolina - Department of Environment, Health, and Natural Resources
Division of Environmental Management - Groundwater Section
P.O. Box 29535 - Raleigh, N.C. 27626-0535
Phone [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR:E.%r,
DRILLER REGISTRATION NUMBER:
FOR OFFICE USE ONLY ) r p
QUAD. NO /V-?6. 69 /O SERIAL NO. l 6'4
Lat. Long. RO
Minor Basin
Basin Code
Header Ent. GW-1 Ent.
STATE WELL CONSTRUCTION
PERMIT NUMBER: L/22. - - RES -S
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town: % -5W--/
County:r/i/ ,.:-•
(Road, Community, or Subdivision and Lot No.)
2. OWNER
ADDRESS
(Street or Route No.)
City or Town State Zip Code
3. DATE DRILLED -29-9 USE OF WELL ofx �.
4. TOTAL DEPTH 5-; '
5. CUTTINGS COLLECTED YES (11N0(l
6. DOES WELL REPLACE EXISTING WELL? YES n NO-
7. STATIC WATER LEVEL Below Top of Casing: 2, �O FT.-/3
DEPTH DRILLING LOG
From To Formation Description
_ �J
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS - "6 FT. Above Land Surface* /3
* Casing Terminated at/or below land surface is illegal unless a variance is issued
In accordance with 15A NCAC 2C .0118
9. YIELD (gpm): ,0 METHOD OF TEST !'u
10. WATER ZONES (depth): 20 ' .' f / p_ ►�-�
-.2 9Z"-s.f
11. CHLORINATION: Type -%, Amount If additional space is needed use back of form
12. CASING:
0
�� \✓' ter.//✓/r•
Depth
From To-3°
From To
From To
13. GROUT:
d
Wall Thickness LOCATION SKETCH
Diameter or Weight/Ft. Material (Show direction and distance from at least two State
Ft. ' ��'���� ' ,L0 Roads, or other map reference points)
Ft. SR :
Ft r
i
Depth
From 4 To 1 Ft
From 1_ To .27• Ft
14. SCREEN:
Method
P ti
Depth Diameter Slot Size Material
From 24 To // /Ft -2 in. /..P_LL in Pill-_
From To Ftin. in.
From To Ftin. in
15. SAND/GRAVEL PACK:
Depth Size
From ry?7 e To S.1' Ft. -=r,
From To Ft.
16. REMARKS:/fr.y, //f 4-
r"
•
Material
I DO 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.
SIGNATURE F CONTRACTOR OR AGENT DATE
Submit original to Division of Environmental Management and copy to well owner.

DEPTH DRILLING LOG
from to formation desc.
/—
/ P-.., , •
11• _/4/7
/
1-f7 /1/9
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
Al7 r. (_, re (0,1
J ...• • rt. MM.
' •enlenlre
f.Cav�..�
V'-` :
1 o 'Y.rl•• 7 R•• •n •
•
C..v...'_,
..0•0 C • C.nrwnn
won C..In• (.•nbdl -
r•a On OnIeld•
•red sarl•.e
1•p
..;. �1f' i
•ml •
••nlnnll• O.eu1
Or,
Comm. fVdrre•
S3 • • •
Figure 12
Typical Well Types For Above Ornurld Inslallallnn
toc.+n• C.e,wun
W •• C••I.• (v..l•dl
T.• On
V •.b•. 'i I .V.rOn
M•
•
A'- UnConlinnd
r.nd •a.f•e:
o.b. R.eu.U.. C••Ine
•t
Mn•r C.•In•
Mtn Cenllnlne'
Unit
ehdir.c+
dfY Re.
MM,A•:.1 •
erMion
ILA-.Ce.rillned
Lecun, C.n,wIln
w.n Cnlno (.•n..nl
I •a .+n O....d•
L
C11.n1.•1.
In l.nnlen•
1
10_!
e on ea. la.
N •o: Con ••
'Op•n Ilnl•O'
fi
r
Figure 13 Typical Well Types For Below Ground Installation
wal t.• i 1
18 - Unconfined
Oul•r ..e.•en•• C.•In•-
•end •eleaon
In
: rl. Min.' Ala.!1.I •acre• TI , .
Oeme
1 _
Q B - Confined
toed s.•r••• .
. Men! e•:M
• 1 MUM.
bin*. C•.ln.
L11•••n.n —
Orn.l •••I irm. 7 r..
•
O.I•r Ct.ln, ea •e
' •••eed •.• II. Info
7, .un•r.d .oboe. O.
• PI. ••Io.• area•..
o ..m Of C•n..rin•nen
nlenmee I. •nennera
L w .•.n...d •.d.ee.
Und 11.nmn..-
w•I. 1.•
w ile Me•a
0.....l
— O.e.l MM• . rl.
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r ▪ 77.
.
fee te...1 •
eon Her. MeliF 1 l'"!, •i .- 1r
Me. •: Can •• %r.lnunl .1•p_!_ . f.
te. Or 1'
L1 ` r m B - Bedrock

,ri Carolina - Department of Environment, ,ealth, and Natural Resources
Division of Environmental Management - Groundwater Section
P.O. Box 29535 - Raleigh, N.C. 27626-0535
Phone [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: /1) C_
DRILLER REGISTRATION NUMBER: I D tD D
FOR.OFFICE USE ONLY - " q
QUAD. NO. L-a2- SERIAL NO. /4/4 f 6
Lat • Long. Pc
Minor Basin
Basin Code
Header Ent. GW-1 Ent.
STATE WELL CONSTRUCTION
PERMIT NUMBER:
WELL LOCATION: (Show sketch of the location below)
Nearest Town: 711 Ali I County.
S2 )335
(Road, Community, or Subdivision and Lot No.)
2. OWNER
ADDRESS
1r eee•N z
(Street or Route No.)
Rr. Y9 t
'_�zz,e fl..2j Ccl S�0.
DEPTH DRILLING LOG
From To Formation Description
i
Q � 3 - T ©`-: J , — l' C / %5 N1 ✓ l p r':.1 •=f IT
City or Town ' State Zip Code
3. DATE DRILLED 1-r-93 USE OF WELL `S
4. TOTAL DEPTH L/
5. CUTTINGS COLLECTED YES "7"- NO❑
6. DOES WELL REPLACE EXISTING WELL? YES El
7.
:1-L7 �J+--=Fr CC Ia-. '7
L)A., -rr, rr
NO,/t.`tR-v3 6-gn t_14�,-:n+.'..7Sr',/;.,,1 r;A, p-% a0Z
STATIC WATER LEVEL Below Top of Casing: i g . y 7 FT. ?3-,48 a.Po, � 1 cN !.-4)0,.;
(Use "+" if Above Top of Casing) c:•p- ? 7 GA,, c fry j / S /ir / /A Ag fi s
8. TOP OF CASING IS -70 FT. Above Land Surface' S r
* Casing Terminated at/or below land surface is illegal unless a variance is issued u
in accordance with 15A NCAC 2C .0118 . 38- 43 Gr,r.„ c10,_ ,-,I S -,r,� ..- , , e4 s i 1
43-1-17- w -Sz�49 n10 SPJi-SPOaru s-Amei4
s 10. WATER ZONES (depth)• ''i'- S 9 y8_- 53 - c.ei S No
s3 -S 8 is e6-- c L-. 9 YV) . , , , , ,
9. YIELD (gpm)• S METHOD OF TEST P l .
11. CHLORINATION: Type
12. CASING:
v/74
Amount ^f IA
Wall Thickness
Depth Diameter or Weight/Ft. Material
From To �`' Ft. C.C. `' ''uc
From To Ft.
From To Ft.
13. GROUT:
Depth Material Method
From 0 To ;- Ft c-,_-^-2---+ = '-
From To 3 ? Ft. 3/;? C A-c —Q.c P , - ' t,
14. SCREEN:
Depth Diameter Slot Size
From . `.1 To S5 Ft in. .()I' . in
From To Ft. in. in
From To Ft in. in
15. SAND/GRAVEL PACK:
Depth
From 31 To (, g' Ft r�
From To Ft
16. REMARKS: 4 P ,,1? - 5 ?q_ r.- 1,110.0! 0 - -I- el., ?vC-
•
If additional space is needed use back of form
0ue2
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
r•+ob;l �
1SP-1;45
Sc21335
Size
Material
c
Material
L3L
1- .1X. L.;C
I DO 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.
GW-1 REV. 5/91
SIGNATURE OF CONTRACTOR OR AGENT DATE
Submit original to Division of Environmental Management and copy to well owner.

_ r,
North Carolina - Department of Environment, Health, and Natural Resources
Division of Environmental Management - Groundwater Section
P.O. Box 29535 - Raleigh, N.C. 27626-0535
Phone [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: / L/j?
DRILLER REGISTRATION NUMBER: /' ' d
FOR OFFICE USE ONLY
QUAD. NO. II/-)..q_/7SERIALNO. /�
J,,
Long. RO
Lat
Minor Basin
Basin Code
Header Ent. GW-1 Ent
STATE WELL CONSTRUCTION
PERMIT NUMBER: L/z_ziF_
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town: County: <4'-" ^_
(Road, Community, or Subdivision and Lot No.)
2. OWNER
ADDRESS
(Street or Route No.)
City or Town State Zip Code
3. DATE DRILLED '-- 9 USE OF WELL
4. TOTAL DEPTH ,./pg
5. CUTTINGS COLLECTED YES-1 NOn
6. DOES WELL REPLACE EXISTING WELL? YES NO'7
7. STATIC WATER LEVEL Below Top of Casing:K0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 3.. o FT. Above Land Surface*
* Casing Terminated at/or below land surface is illegal unless a variance is issued
in accordance with 15A NCAC 2C .0118
9. YIELD (gpm): _/d METHOD OF TEST._L rl_= -
10. WATER ZONES (depth): u/
11. CHLORINATION: Type � -R\
12. CASING:
From
From
From
13. GROUT:
From
Depth
To /7/ Ft.
To Ft.
To Ft.
Diameter
Amount -
Wall Thickness
or Wgigl7t/Ft.
Depth Material
To Ft
From 2 To .3 7/ Ft.
DEPTH DRILLING LOG
From To Formation Description
3
r
Y f
-� i'•- ,•A/1 u
<7' // J ,i-- %,,,.. 7,
2•/..•,, rr=r- J,
) � 1
If additional space is needed use back of form-
1 " S]P ,s9S
���J.���'- � �N •SKETC
Material (Show direction and distance from at least two State
, 'Roads, or other map reference points)
.g i
\• ram._
Method 1 '��
r
+ram
14. SCREEN:
Depth Diameter Slot Size
From - /! To / / Ft ' in. ' 6 /d
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth / Size,�
From l5 To Ft /��x t
From To Ft.
in
in.
in t.
•
Material,-
i
16. REMARKS: C .47 /
•
1
7
1
5-R
I DO 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.
GW-1 REV. 9/91
SIGNATURE OF CONTRACTOR OR AGENT DATE
Submit original to Division of Environmental Management and copy to well owner.

DEPTH
from to
DRILLING LOG
formation desc.
!.`�••.T^91 l l!
/f T•a On 0u I.Id.
c.i-
end Surf.e. yf
ILD. '• ±h•.Arevle:'Ti�j
J e.
I n, ulrlti...
Lee\Mf C•n,WNll
W. C..Ing /v.nl.e) -
3 /_.?/C a,„ .k/
��� ram•, 46( .4L
/33
/
�'Vane. 2 /1. MM. Ale.. /Person.
9nn1nnW maul
or
C.+.•nl Oi dr1•.)
f rl. MM.
e.nl nu•
r•.
.Lt/y2 a, , < .e /2,�d
/-? /2/l�
1-
/43
/
/
/
A .
(2,0 r'cv
•
�Q.
Figure 12 Typical Well Types For Above Ground Inslnllallnn
•
111'- Unconfined
1 F1.1.11,
e•nl .Ila
/Pond/m•..1 Poe\
• varl.• MM. 01
1 F1, Ale.• /Per••. .•.
•
Flours 13
Wa) rag
,4y ri::6
Flail.. en.,":‘,.:"
CEO..I111.
1 8 - Unconfined
Locking Caelwel,
W.. C..Ing rv.nadl
Tag On
Inner Ca61ne
Mlo Cenllnlna I
OM/
Lec•In. Can?W ))I.
W.n C..Ina IV.nr.al
7
r•o On 0ur.l0
reut /Pell
I\
,dl! rl.• C.•nl.11•
MIn.Ale.. • In Ll.n•.Ien.
ICA. -• Conlined
Oe•n ear. Hem
Nolo: Can e.
ee Le.n Nelaor
:
8! A `Bedrock
L1n. l.•1..•_
r
Oreut C... `r
1A:MM.
a:... CMS...
L A•aeau
/Olnvl !•.l urn, 1 Ft.
Out. CaMoo ,• f•
w•un•r.d a.ine. 0,
f rl. P.I,. Or..M.t
0.0,6 01 C.11.n16. Iron
Q.k 1. 10.6116.•1
Typical Well Types For Below Ground Installation
Oul•r Prer.en.• Culna
W•n La
1. 1 CMn leg'
Unlri. '
.0 w:::Nag
II 8 - Conlined
' I Cider. ,:
eaeunl r
.
-1 Oi ell /
Pelnl
Of Inn•. 1
Auo•r a•Itt
0e•n ea.• Ne0
Lend e,..11et .,
W•u Teo
C:nt•n)
— Ctnvl u.. 1 ft.
III 8 - Bedrock
L a..nnln-.

North Carolina - Department of Environment, Health, and Natural Resources
Division of Environmental Management - Groundwater Section
P.O. Box 29535 - Raleigh, N.C. 27626-0535
Phone [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR:, , Z
FOR OFFICE USE ONLY �.
QUAD. NO. Al Aro. ©- /;7 SERIAL NO. � .' i A.
Lat Long. RO
Minor Basin
Basin Code
Header Ent. GW-1 Ent
STATE WELL CONSTRUCTION
DRILLER REGISTRATION NUMBER: ) PERMIT NUMBER: L/za .= -./Z S-s71-4 .
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town: 77;42-u f County: / J'' i,
(Road, Community, or Subdivision and Lot No.) DEPTH
2. OWNER From To
ADDRESS
(Street or Route No.)
City or Town State Zip Code
3. DATE DRILLED '- 29. 9 q USE OF WELL . /Ps.,
4. TOTAL DEPTH S '
5. CUTTINGS COLLECTED YES !� NOT-1
6. DOES WELL REPLACE EXISTING WELL? YES n NO�
7. STATIC WATER LEVEL Below Top of Casing: 9, �p FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS fd FT. Above Land Surface*
Casing Terminated at/or below land surface is illegal unless a variance is issued
In accordance with 15A NCAC 2C .0118
9. YIELD (gpm): & METHOD OF TEST fa_;_A_
10. WATER ZONES (depth): 30 ' yS
DRILLING LOG
Formation
Description
-.
4. /!. , ,,..,/
2 {fi r,/ •--.-�.r._ !,= / /�
-/ _3
/3 f/d
11. CHLORINATION: Type
12. CASING:
Depth
From <7 Tod°
From
From
13. GROUT:
?/1
Diameter
Ft. To Ft.
To Ft.
Depth
From 4 To Ft
From _L_ To -27• a Ft
14. SCREEN:
Depth Diameter Slot Size
From 14 To /, /Ft in. <D /.
From To Ft
From To Ftin. in.
15. SAND/GRAVEL PACK:
Depth Size
From .,%7 To 3' Ft. f=�
From To Ft.
16. REMARKS:,
/ U `'
Amount 4/11
Wall Thickness
or Weight/Ft.
Material
Material
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
. `o Roads, or other map reference points)
Method
In^ c/ 4,/ aGi a•ln.-
' , w L ,; 3
i ----.�t
Material
in ,PJ�� ,
in. in.
Material
I DO 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.
5,R 13 Di
3 °
�- 3
GW-1 REV. 9/91
C/ SIGNATURE nJF CONTRACTOR OR AGENT
Submit original to Division of Environmental Management and copy to well owner.
DATE

DEPTH DRILLING LOG
from to formation desc.
/
3, /<
/
/I)
/'-ten
/4/7 ..aCr
1. % / C •. r'Jr•,J 6a_I
f n (i,
,. � � J OJT, e..-r
V
Ic
/
/
/
/
/
/
/
/
/
/
/
/
/
/
r
l ne•Ine C.n/Wlln
W •l C..In. (V.nlndl
T•p On Oul•Id•
and lurlee•
eenlnnnl maul
Or. •
C.n.•nl (V 4.1•.
• 1 Fl. MM.
• e.nlenlu
none/Ore.•I ien<
'VI
nee.. emoon
S3
t.nd eurlep:
Oul., r,el•ell.o C..Ine
Flguro 12 Typical Well Typos For Above Ground Inslnll,llnn
Lock., C•nornn
W.II Coming IV.,Iedl
Ted On
I•
moon Vogl*. 8en*nes.
Vogl*. Yr
I A'- Unconfined
e onlenll• Or•y1
er C•In•nl (V•rl••)
s.nd,or...I reel
• Verl•. Mln. 01
! ft. ser.pn
•
Inn•. Coln.
NIO C enlInIn, I
Un11
LOC.,e•nrWne
.n C•.Inp Ivan...) 7
1.0 On 0.11.10
Oro.Front .I^• . ,
•... — ann.
0.11.421ml O
Inns
I(Pen. 580
/•menlr•
d/ 1 11.
11..A10.i •
le.:•n
1LA-,COnllned
•
I
lease .. .
Crn•. Cana..
i
Oil r C..Ine
d•.ol.n —
1•.1 WI , . rl.
OW. C.•In. 1. 1.
4•d•d e./ F I. Wile
e P1I0:I:: a ..t..°r
p•*..,n O:L ,I .k..11•n
•^� ,I,.nn..•
L W••In•r•d scree.
•t i 1 s�rS•p f_ i f
\'_ ..e� sue.
M. A-iedrock
Figure 13 Typical Well Types For Below Ground Installation
OWN, rreloen.• C.•Inp -�
d r-- Valli 1..
W•II r..
1 B - Unconllned
n one
• rou
'.
: Fr. Min.'
Apes, •
/ e n
II B - Conllned
Land e•...•e• -
W.II Ted
-� M B - Bedrock