WM0601153_Monitoring Wells_20200624

RO`! COOPER
jo vern nr-
MIC-I-I EL S. RED,_ A^l
secretary
3. DANIEL SMITH
Director
Mr. Frank A. McNeill, Jr., President
McNeill Oil Company, Inc.
P.O. Box 396
Aberdeen, North Carolina 28315
NORTH CAROL INA
Environmental Quality
June 24, 2020
SUBJECT: Well Construction Permit No. WM0601 153
Two (2) monitoring wells: Clark Chevrolet - Cadillac site
35 Dundee Road (P.I.N. # 856200086123)
Pinehurst, Moore County
Mr. McNeill;
In accordance with the application prepared by Geological Resources Incorporated dated 19 June 2020 and
received in the Fayetteville Regional Office on 19 June 2020, we are forwarding herewith Well Construction
Permit No. WM0601153 dated 24 June 2020 issued to McNeill Oil Company, Incorporated for the
construction of two (2) monitoring wells located on property owned by Clark Chevrolet - Cadillac (P.I.N. #:
856200086123) in Pinehurst, North Carolina.
This Permit will be effective from the date of its issuance for one year and shall be subject to the
conditions and limitations as specified therein.
Please note that according to North Carolina Administrative Code, Title 15A, Subchapter 2C, Section
.0105 (g), "it is the responsibility of the well owner or his agent to see that a permit is secured prior to the
commencement of construction of any well for which a permit is required."
Issuance of this permit does not constitute approval of the subject wells for reimbursement from Trust
Funds.
If any parts, requirements, or limitations contained in this Permit are unacceptable to you, you have the
right to an adjudicatory hearing before a hearing officer upon written demand to the Director within 30
days following receipt of this Permit, identifying the specific issues to be contended. Unless such demand
is made, this Permit shall be final and binding.
Sincerely,
DocuSignedby: _
. OO-11.1(P ,
tigakmaegional Supervisor
Division of Water Resources — Water Quality Programs
Enclosure
cc: FRO Files
Moore County Health Department
Clark Chevrolet - Cadillac Geological Resources, Incorporated
North Carolina Department of .1-Invirannicntai'
a yerrevillo is- i __.. ._� 'i, 5reerl Jtro r, S1:1i:' 714 I o _ _ evilie. i21or(4 Caro ina 23301

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES — WATER QUALITY PROGRAMS
PERMIT FOR THE CONSTRUCTION OF A MONITORING WELL
In accordance with the provisions of Article 7, Chapter 87, North Carolina General Statutes, and other
applicable Laws, Rules and Regulations.
PERMISSION IS HEREBY GRANTED TO
MCNEILL OIL COMPANY, INCORPORATED
FOR THE CONSTRUCTION OF A MONITORING WELL SYSTEM consisting of two (2) monitoring
wells owned by McNeill Oil Company, Incorporated located at 32265 US Hwy 1 South, Aberdeen, North
Carolina. The monitoring wells will be located on property owned by Clark Chevrolet - Cadillac at 35
Dundee Road (P.I.N. #: 856200086123) in Pinehurst, Moore County, North Carolina. This Peirnit is
issued in accordance with the application received on 19 June 2020 in conformity with specifications and
supporting data, all of which are filed with the Department of Environmental Quality and are considered
integral parts of this Permit.
This Permit is for well construction only, and does not waive any provision or requirement of any other
applicable law or regulation. Construction of any well under this Permit shall be in strict compliance with the
North Carolina Well Construction Regulations and Standards (15A NCAC 02C .0100), and other State and
Local Laws and regulations pertaining to well construction.
If any requirements or limitations specified in this Permit are unacceptable, you have a right to an adjudicatory
hearing upon written request within 30 days of receipt of this Permit. The request must be in the form of a
written petition conforming to Chapter 150B of the North Carolina General Statutes and filed with the Office
of Administrative Hearings, 6714 Mail Service Center, Raleigh, North Carolina 27699-6714. Unless such a
demand is made, this Permit is final and binding.
This Permit will be effective for one year from the date of its issuance and shall be subject to other specified
conditions, limitations, or exceptions as follows:
1. Issuance of this Permit does not obligate reimbursement from State trust funds, ifthese wells are being
installed as part of an investigation for contamination from an underground storage tank or dry cleaner
incident.
2. Issuance of this Permit does not supersede any other agreement, permit, or requirement issued by
another agency.
3. The well(s) shall be located and constructed as shown on the attachments submitted as part of the
Permit application.
4. Each well shall have a Well Contractor Identification Plate in accordance with 15A NCAC 02C
.0108(o).
5. Well construction records (GW-1) for each well shall be submitted to the Division of Water Resources
Information Processing Unit within 30 days of the well completion.
6. When the well is discontinued or abandoned, it shall be abandoned in accordance with 15A NCAC
02C .0113 and a well abandonment record (GW-30) shall be submitted to the Division of Water
Resources Information Processing Unit within 30 days of the well abandonment.
Permit issued the 24th day of June 2020
FOR THE NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
,r—DocuSiggnnedd by:
•fl_b
Trent A4141-1„1:',f,g,iodatil2Supervisor
Division of Water Resources — Water Quality Programs
By Authority of the Environmental Management Commission
Permit No. # WM0601153

lREc'A 6/i ) 2-4) 447- /; 3Z/6/11
NORTH CAROLINA DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
DIVISION OF WATER QUALITY — AQUIFER PROTECTION SECTION
APPLICATION FOR PERMIT TO CONSTRUCT A MONITORING OR RECOVERY WELL SYSTEM
PLEASE TYPE OR PRINT CLEARLY
In accordance with the provisions of Article 7, Chapter 87, General Statutes of North Carolina and regulations pursuant thereto,
application is hereby made for a permit to construct monitoring or recovery wells.
1. Date: June 19, 2020
2. County: Moore
FOR OFFICE USE ONLY
PERMIT NO. OM D Co oil S3 ISSUED DATE (d Z9 /20
3. What type of well are you applying for? (monitoring or recovery):
4. Applicant: McNeill Oil Company, Inc.
Monitoring
Telephone: [phone]
Applicant's Mailing Address: •Post Office Box 396, Aberdeen, NC 28315
Applicant's Email Address (if available): NA
5. Contact Person (if different than Applicant): William Regenthal
Telephone: [phone]
Contact Person's Mailing Address: 113 W. Firetower Road, Suite G, Winterville NC 28590
Contact Person's Email Address (if available): WIr(C�geologicairesourcesinc.com
6. Property Owner (if different than Applicant): Clark Chevrolet -Cadillac Properties, LLC Telephone: [phone]
Property Owner's Mailing Address: Post Office_ Box 1890, Pinehurst, NC 28370
Property Owner's Email Address (if available):
7. Property Physical Address (including zip code) and PIN Number PIN# 8562000861 23; 35 Dundee Rd, Pinehurst, Moore Count)
ze37y
8. Reason for Well(s): Assessment
(ex: non -discharge permit requirements, suspected contamination, assessment, groundwater contamination, remediation, etc.)
9. Type of facility or site for which the well(s) is(are) needed: UST
(ex: non -discharge facility, waste disposal site, landfill, UST, etc.)
10. Are there any current water quality permits or incidents associated with this facility or site? If so, list permit and/or incident no(s).
UST Incident 5532
11. Type of contaminants being monitored or recovered: Petroleum
(ex: organics, nutrients, heavy metals, etc.)
12. Are there any existing wells associated with the proposed well(s)? If yes, how many? Yes; 4
Existing Monitoring or Recovery Well Construction Permit No(s).: NA
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): —25'
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? No
If yes, give distance(s): NA
15. Well Contractor: Justin Radford Certification No.: 3270
Well Contractor Address: 3502 Hayes Road, Monroe NC 28110
PROPOSED WELL CONSTRUCTION INFORMATION
1. As required by 15A NCAC 02C .01 05(f)(7), attach a well construction diagram of each well showing the following:
a. Borehole and well diameter e. Type of casing material and thickness
b. Estimated well depth f. Grout horizons
c. Screen intervals g. Well head completion details
d. Sand/gravel pack intervals
Continued on Reverse

PROPOSED WELL CONSTRUCTION INFORMATION (Continued)
2. Number of wells to be constructed in unconsolidated 5. How will the well(s) be secured? Locking cap
material: 2
3. Number of wells to be constructed in bedrock: 0 6. Estimated beginning construction d e: June 2020
4. Total Number of wells to be constructed: 2 7. Estimated construction completion da June 2020
(add answers from 2 and 3)
1.
ADDITIONAL INFORMATION
As required by 15A NCAC 02C .0105(f)(5), attach a scaled map of the site showing the locations of the following:
a. All property boundaries, at least one of which is referenced to a minimum of two landmarks such as identified roads,
intersections, streams, or lakes within 500 feet of the proposed well or well system.
b. All existing wells, identified by type of use, within 500 feet of the proposed well or well system.
c. The proposed well or well system.
d. Any test borings within 500 feet of proposed well or well system.
e. All sources of known or potential groundwater contamination (such as septic tank systems, pesticide, chemical or fuel
storage areas, animal feedlots as defined in G.S. 143-215.10B(5), landfills, or other waste disposal areas) within 500 feet
of the proposed well or well system.
SIGNATURES
The Applicant hereby agrees that the proposed well(s) will be constructed in accordance with approved specifications and conditions of
this Well Construction Permit as regulated under the Well Construction Standards (Title 15A of the North Carolina Administrative Code,
Subchapter 2C) and accepts full responsibility for compliance with these rules
ignature of Ap
Ca95i!! 4%( Gitaff7
t or *Agent c5
t..�.WL
Printed name of Applicant or *A
ent
Pr r,,i i r'_.c,-t / " 14-0, a; .""
Title of Applicant or *Agent
* If signing as Agent, attach authorization agreement stating
that you have the authority to act as the Agent.
If the property is owned by someone other than the applicant, the property owner hereby consents to allow the applicant to construct
wells as outlined in this Well Construction Permit application and that it shall be the responsibility of the applicant to ensure that the
well(s) conform to the Well Construction Standards (Title 15A of the North Carolina Administrative Code, Subchapter 2C).
Please see attached RTE agreement
Signature of Property Owner (if different than Applicant) Printed name of Property Owner (if different than Applicant)
DIRECTIONS
Please send the completed application to the appropriate Division of Water Quality's Aquifer Protection Section Regional Office:
Asheville Regional Office
2090 U.S. Highway 70
Swannanoa,•NC 28778
Phone: [phone]
Fax: [phone]
Fayetteville Regional Office
225 Green Street, Suite 714
Fayetteville, NC 28301-5094
Phone: [phone]
Fax: [phone]
Mooresville Regional Office
610 East Center Avenue
Mooresville, NC 28115
Phone: [phone]
Fax: [phone]
Raleigh Regional Office
3800 Barrett Drive
Raleigh, NC 27609
Phone: [phone]
Fax: [phone]
Washington Regional Office
943 Washington Square Mall
Washington, NC 27889
Phone: [phone]
Fax: [phone]
j + win¢tan,Sa sri L
f4faOr/ sv'le• ;
47(
Fig r
\ Wilr tngton
Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, NC 28405
Phone: [phone]
Fax: [phone]
Winston-Salem Regional Office
585 Waughtown Street
Winston-Salem, NC 27107
Phone: [phone]
Fax: [phone]
•iolgigh' '
GW-22MR (Rev. 7/11)

RIGHT TO ENTER AGREEMENT
FOR
CONDUCTING SUBSURFACE INVESTIGATIONS
STATE OF NORTH CAROLINA
COUNTY OF MOORE
We, the undersigned, being all of the fee simple owners of certain tracts or parcel designated as
856200086123 of the County of MOORE, recognizing the benefits to said properties by reason of
conducting subsurface investigations hereby grant to McNeill Oil Company and the agents the right to
enter said property in accordance with the requirements of the State of North Carolina. McNeill Oil
Company's agents may include Geological Resources, Inc.
The undersigned hereby covenant and warrant that they are the sole owners of said property; that they
solely have the right to grant this right to enter for conducting subsurface investigations against the
lawful claims of all persons whomsoever.
It is agreed that McNeill Oil Company shall be responsible for restoring any damage done to the ground
of said property by its employees or its agents during the subsurface investigation and monitoring
period, and that McNeill Oil Company shall abandon monitoring wells on said property in accordance
with NCDEQ requirements at the conclusion of the monitoring period.
It is agreed that McNeill Oil Company shall hold harmless the owner of the aforementioned property for
any personal injury that might be sustained during the course of conducting or proximately resulting
from the conduct of subsurface investigations.
Right to Enter denied.
Right to Enter granted.
phone : 10, v 5 .. t ?.-dal
Date

6/19/2020
ConnectGlS Feature Report
Moore_mgd
Printed June 19, 2020
See Below for Disclaimer
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IS DISCLAIMER MI the information contained on this media is prepared for the inventory of real property found within Moore County. All data is compiled from
ecorded deeds, plats, and other public records and data. Users of this data are hereby notified that the aforementioned public primary information sources should be
onsulted for verification of the information. All information contained herein was created for the County's internal use. Moore County, its agents and employees make
NO warranty as to the correctness or accuracy of the information set forth on this media whether express or implied, in fact or in law, including without limitation the
implied warranties of merchantability and fitness for a particular use. Any resale of this data is strictly prohibited in accordance with North Carolina General Statute 132-
10. Grid is based on North Carolina State Plane Coordinate System NAD83 (feet).
https://mooregisweb.moorecountync.gov/ConnectGlS_v6/DownloadFile.ashx?i=_ags_map13606105835d4f5090e94e0a8b5a877fx.htm&t=print 1/1

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PCNEHURST, NC

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Geological Resources, Inc.
June 19, 2020
Mr. Trent Allen
NCDEQ, Division of Water Quality
Fayetteville Regional Office
225 Green Street, Suite 714
Fayetteville, North Carolina 28301
Re: Monitoring Well Permit Application
Bill Clark Chevrolet
35 Dundee Road
Pinehurst, Moore County
Incident No: 5532
Dear Mr. Allen:
Please find enclosed a monitoring well permit application for the installation of two Type II monitoring
well at the Bill Clark Chevrolet facility located at 35 Dundee Road in Pinehurst, Moore County. GRI plans
on installing the monitoring wells immediately upon receipt of the approved well permit.
Your prompt attention to this matter will be greatly appreciated. If you have any questions or require
additional information please do not hesitate to contact me at [phone].
Sincerely,
William Regenthal, P. G.
Project Manager
enclosures
cc: file
3502 Hayes Road • Monroe, North Carolina 28110
113 West Firetower Road, Suite G • Winterville, North Carolina 28590
Phone [phone] • [phone] • Fax [phone]

Barber, Jim
From:
Sent:
To:
Subject:
Attachments:
William Regenthal<[e-mail]>
Friday, June 19, 2020 1:32 PM
Barber, Jim
[External] Well Permit Application - Bill Clark Chevrolet
Permit Application Package Mailed_06192020.pdf
rnal email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to
v
Mr. Barber,
Attached is the well permit application for the Bill Clark Chevrolet site in Pinehurst, Moore County. We plan on installing
the wells immediately upon receipt of the well permit. Please let me know if I missed anything. A hard copy will be
mailed to your attention.
William Regenthal, P. G.
Branch Operations Manager - Winterville
Geological Resources, Inc.
113 W. Firetower Road, Suite G., Winterville, NC 28590
Main [phone] Office [phone] Fax [phone]
[e-mail]
www.geologicalresourcesinc.com igeologicalresourcesinc.com]
NCPCM 2015 Vendor of the Year Recipient [ncpcm.orgl
Business North Carolina Magazine 2015 Small Business of the Year Runner-up Recipient [businessnc.coml
1

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Parcel ID Short:
856200086123
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Owner's Name:
A
CLARK CHEVROLET-CADILLAC
PROPERTIES, LLC
Owner's Name 2:
PO BOX 1890
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17S PU 39614 96288
Transaction Date:
Comparable Search
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Parcel ID Short:
856200086123
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Local Coordinates
CLARK CHEVROLET-CADILLAC
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PO BOX 1890
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North Carolina Secretary of State Search Results Page 1 of 1
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Add Entity to My Email Notification List • View Filings • Print a Pre -Populated Annual Report form • Print
an Amended a Annual Report form
Limited Liability Company
Legal Name
CLARK CHEVROLET-CADILLAC PROPERTIES II, LLC
Information
Sosld: 1016182
Status: Current -Active
Date Formed: 12/10/2007
Citizenship: Domestic
Annual Report Due Date: April 15th
CurrentAnnual Report Status:
Registered Agent: Clark, Troy D.
Addresses
Principal Office Reg Office Reg Mailing
35 Dundee Road 35 Dundee Road PO Box 1890
Pinehurst, NC 28374-8809 Pinehurst, NC 28374-8809 Pinehurst, NC 28370
Mailing
PO Box 1890
Pinehurst, NC 28370-1890
Company Officials
All LLCs are managed by their managers pursuant to N.C.G.S. 57D-3-20.
Manager
Troy D Clark
35 Dundee Rd
Pinehurst NC 28374
https://www.sosnc.gov/online_services/search/Business_Registration_Results 6/22/2020

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Add Entity to My Email Notification List • View Filings • Print a Pre -Populated Annual Report form • Print
an Amended a Annual Report form
Business Corporation
Legal Name
CLARK CHEVROLET-CADILLAC, INC.
Prev Legal Name
Clark Chevrolet, Cadillac, Geo, Subaru, Inc.
Prev Legal Name
Clark Chevrolet-cadillac, Inc.
Information
Sosld: 0029242
Status: Current -Active
Date Formed: 7/30/1971
Citizenship: Foreign
State of Incorporation: DE
Fiscal Month: December
Annual Report Due Date: April 15th
CurrentAnnual Report Status:
Registered Agent: Corporation Service Company **Note load times may be long**
Addresses
Reg Office Reg Mailing Principal Office
2626 Glenwood Ave Ste 550 2626 Glenwood Ave Ste 550 35 Dundee Road
Raleigh, NC 27608 Raleigh, NC 27608 Pinehurst, NC 28374
Mailing
PO Box 1890
Pinehurst, NC 28370
Officers
https://www.sosnc.gov/online_services/search/Business_Registration_Results 6/22/2020

North Carolina Secretary of State Search Results Page 2 of 2
President Vice President Secretary
Troy D. Clark William C. Clark , Jr. Sherri Smith
50 Ponte Vedra Drive 4508 Mangrove Point Road 34 Westlake Pointe Ln
Pinehurst NC 28374 Bradenton FL 34210 Pinehurst NC 28374
Treasurer
Sherri Smith
34 Westlake Pointe Ln
Pinehurst NC 28374
Stock
Class: 99 SEE CERT
Shares: 0
Par Value 0
https://www.sosnc.gov/online_services/search/Business_Registration_Results 6/22/2020

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an Amended a Annual Report form
Business Corporation
Legal Name
McNeill Oil Company, Inc.
Information
Sosld: 0093079
Status: Current -Active
Date Formed: 6/4/1962
Citizenship: Domestic
Fiscal Month: May
Annual Report Due Date: September 15th
CurrentAnnual Report Status:
Registered Agent: McNeill Jr, Frank a
Addresses
Principal Office Reg Office Reg Mailing Mailing
32265 US Hwy 1 South 32265 US Hwy 1 South PO Box 396 PO Box 396
Aberdeen, NC 28315 Aberdeen, NC 28315 Aberdeen, NC 28315 Aberdeen, NC 28315
Officers
Secretary Vice President President
V Davis Clark , Jr. V Davis Clark , Jr. Frank A. McNeill , Jr
PO Box 396 PO Box 396 PO Box 396
Aberdeen NC 28315-0396 Aberdeen NC 28315-0396 Aberdeen NC 28315-0396
Treasurer
Frank A. McNeill , Jr
PO Box 396
Aberdeen NC 28315-0396
https://www.sosnc.gov/online_services/search/Business_Registration_Results 6/22/2020

Geological Resources, Inc.
June 19, 2020
Mr. Trent Allen
NCDEQ, Division of Water Quality
Fayetteville Regional Office
225 Green Street, Suite 714
Fayetteville, North Carolina 28301
Re: Monitoring Well Permit Application
Bill Clark Chevrolet
35 Dundee Road
Pinehurst, Moore County
Incident No: 5532
Dear Mr. Allen:
Ntt;tivtu
DEQIDINR
JUN 2 3 2020
VA/OROS
AYETTF VI! L _ PPnInivAL OFF1C
Please find enclosed a monitoring well permit application for the installation of two Type II monitoring
well at the Bill Clark Chevrolet facility located at 35 Dundee Road in Pinehurst, Moore County. GRI plans
on installing the monitoring wells immediately upon receipt of the approved well permit.
Your prompt attention to this matter will be greatly appreciated. If you have any questions or require
additional information please do not hesitate to contact me at [phone].
Sincerely,
William Regenthal, P. G.
Project Manager
enclosures
cc: file
3502 Hayes Road • Monroe, North Carolina 28110
113 West Firetower Road, Suite G • Winterville, North Carolina 28590
Phone [phone] • [phone] • Fax [phone]

NORTH CAROLINA DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
DIVISION OF WATER QUALITY - AQUIFER PROTECTION SECTION
APPLICATION FOR PERMIT TO CONSTRUCT A MONITORING OR RECOVERY WELL SYSTEM
PLEASE TYPE OR PRINT CLEARLY
In accordance with the provisions of Article 7, Chapter 87, General Statutes of North Carolina and regulations pursuant thereto,
application is hereby made for a permit to construct monitoring or recovery wells.
1. Date: June 19, 2020
2. County: Moore
FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery):
Monitoring
4. Applicant: McNeill Oil Company, Inc. Telephone: [phone]
Applicant's Mailing Address: 2Post Office Box 396, Aberdeen, NC 28315
Applicant's Email Address (if available): NA
5. Contact Person (if different than Applicant): William Regenthal
Telephone: [phone]
Contact Person's Mailing Address: 113 W. Firetower Road, Suite G, Winterville NC 28590
Contact Person's Email Address (if available): WlrQgeologicalresourcesinc.com
6. Property Owner (if different than Applicant): Clark Chevrolet -Cadillac Properties, LLC Telephone: [phone]
Property Owner's Mailing Address: Post Office Rox 1890, Pinehttrst, NC 28370
Property Owner's Email Address (if available):
7. Property Physical Address (including zip code) and PIN Number PIN# 856200086123; 35 Dundee Rd, Pinehurst, Moore Count)
8. Reason for Well(s): Assessment
(ex: non -discharge permit requirements, suspected contamination, assessment, groundwater contamination, remediation, etc.)
9. Type of facility or site for which the well(s) is(are) needed: UST
(ex: non -discharge facility, waste disposal site, landfill, UST, etc.)
10. Are there any current water quality permits or incidents associated with this facility or site? If so, list permit and/or incident no(s).
UST Incident 5532
11. Type of contaminants being monitored or recovered: Petroleum
(ex: organics, nutrients, heavy metals, etc.)
12. Are there any existing wells associated with the proposed well(s)? If yes, how many? Yes; 4
Existing Monitoring or Recovery Well Construction Permit No(s).: NA
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): '"'25'
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? No
If yes, give distance(s): NA
15. Well Contractor: Justin Radford Certification No.: 3270
Well Contractor Address: 3502 Hayes Road, Monroe NC 28110
PROPOSED WELL CONSTRUCTION INFORMATION
1. As required by 15A NCAC 02C .0105(f)(7), attach a well construction diagram of each well showing the following:
a. Borehole and well diameter e. Type of casing material and thickness
b. Estimated well depth f. Grout horizons
c. Screen intervals g. Well head completion details
d. Sand/gravel pack intervals
Continued on Reverse

RIGHT TO ENTER AGREEMENT
FOR
CONDUCTING SUBSURFACE INVESTIGATIONS
STATE OF NORTH CAROLINA
COUNTY OF MOORE
We, the undersigned, being all of the fee simple owners of certain tracts or parcel designated as
856200086123 of the County of MOORE, recognizing the benefits to said properties by reason of
conducting subsurface investigations hereby grant to McNeill Oil Company and the agents the right to
enter said property in accordance with the requirements of the State of North Carolina. McNeill Oil
Company's agents may include Geological Resources, Inc.
The undersigned hereby covenant and warrant that they are the sole owners of said property; that they
solely have the right to grant this right to enter for conducting subsurface investigations against the
lawful claims of all persons whomsoever.
It is agreed that McNeill Oil Company shall be responsible for restoring any damage done to the ground
of said property by its employees or its agents during the subsurface investigation and monitoring
period, and that McNeill Oil Company shall abandon monitoring wells on said property in accordance
with NCDEQ requirements at the conclusion of the monitoring period.
It is agreed that McNeill Oil Company shall hold harmless the owner of the aforementioned property for
any personal injury that might be sustained during the course of conducting or proximately resulting
from the conduct of subsurface investigations.
Right to Enter denied.
Right to Enter granted.
phone :
Date

6/19/2020
ConnectGlS Feature Report
Moore_mgd
TGISPrinted June 19, 2020
WEB HOSTING See Below for Disclaimer
Address
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GIS DISCLAIMER All the information contained on this media is prepared for the inventory of real property found within Moore County. All data is compiled from
recorded deeds, plats, and other public records and data. Users of this data are hereby notified that the aforementioned public primary information sources should be
consulted for verification of the information. All information contained herein was created for the County's internal use. Moore County, its agents and employees make
NO warranty as to the correctness or accuracy of the information set forth on this media whether express or implied, in fact or in law, including without limitation the
implied warranties of merchantability and fitness for a particular use. Any resale of this data is strictly prohibited in accordance with North Carolina General Statute 132-
10. Grid is based on North Carolina State Plane Coordinate System NAD83 (feet).
https://mooregisweb.moorecountync.gov/ConnectGlS_v6/DownloadFile.ashx?i=_ags_map13606105835d4f5090e94e0a8b5a877fx.htm&t=print 1/1

CLARK CHEVROLET
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GENERAL SITE M
r.T.
PROJECT NO.:
CHEVROLET
DRANAING t40.:

Type II. -Monitoring Well
TypIc : t Construction befalls _
concrete pad
ground surface
grout cement
bentonite seal
filter �a � ^ � J
sand f pack•
-• manhole cover
looking well cap
2 !nob dixn ter
schedule 40 PVC casing
iP + , •
0,01-0 inch Witted 21noh dlxmeler
*alit dui° (0 PVC wean
,� .
• .
And cap

WFT L CONSTRUCTION RE ET
bruma tor tramliOL
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FROM TO ga.c.g.gwurv7
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lit„, ': iit. ! DIAMMER i TRICRICESS / MATERIAL
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2. Zialialraagam114&,.coa
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3. Well Itsf „Advt.,* wen ,x,N19°
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E2Aggictatearli
(I LIGautIrgin to xi faitemi4EmiCiosoliing SnyjnA-1)
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W=Ier 'Atsar-le-dt)
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1 LIAquifeT Storage ar36 Recovery OSalinity BarriCr,
f,, 7_11kki,* '6ar aeir,' ii-=`",iiimutswmw- Utalaaae
iLlithTER TANclassil 17...SAnaidermx teat:ta
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:=-wf6tvzord 43-1=Draprodinz Rem= .:70tiltm-twgrrefica undo- OM TiRovi) 6
2.C..170,,rJR egOING illW4L. i(watoomma AARafy-&-g-
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DIAMETER THICKNESS 1 IIA"TERIAL
TYt- 172 SCH
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WITIMIII T i
10 25
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„ID IL .1:15
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5 Dundee Roads
,Of
TFikadli*,
gnehurst, NC '28374
County
35620
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123
Parezi identification -No. (19N)
swgri.1,ff .m4,3,...4AtiLccerF:Zii{gg- einTro-,t1c.
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"itaaac wittata- itaggs. a-c.g) (01.co.:415g:-.
gt,mutoriArni... abovir
11. 3rehole diameter: 6 (in.)
112.WitE z.v..o-ttia2.1f11U rzaZki. „Rfi:.' Angel
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,%TER Sfi:WLY7f1.5
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1 .1-_-_„.fertit.wa *pr.: Am.oarca:
i U. TORMLING LOG (attach adth6onal sheets if netessavy) I
fireavoi q WO ,i ZADRIETTRIOR. vimidur. litaintibum.swillftina topt, =mint mikEe.arm4
1 1 1
..5 St IfisphaVGravell j
ft. i 1
TanXirawn „Medium Sand
tit.
ii 0-r-earveilkamin San* Clay
ft. i Gray Course Clay,ey, Sand
a- 25
Piinik.Whibe Sam:IVO*
tiL :1„ ft. 1
Fined Fiksh
C.;argiMaatiefa:
y
Comnrachm
ligaingl-lins, form. heresTr,1 sartts ihet, Ihe- -tea. imw,..-1,11, lonstrfetad. in, tur.7*,,trea
mi.ith 15.41 .1,VC:4K wr .4t f01.1(7. igiN149 W401 Cianatataivili lhr&& hi 61
dvoi.4411.A red.imhikaA)Itaimpnwiilia ).t.o lAtv &wool:
gargmoi allefftr 73k-lr ante&
umic tilac i/ mat to, larANikik:
faurr &Dail& allgilitieggal. '144..fifies,i-
\‘.
SUBMITTAL INSTUCTIONS
24.s. Era Riitmlifk- tliDiis &gam 7,*
anaviaagaieo tie
g hi art 36 aims of
Etti-NLTem eia:tateu- Thtimirram.. Firraemst
kir liat :miat Cemsgr,. Ttaik44.*Nf 2761044ir
2413. For Injection W ONLY: In addition to sending the form. to the .address in
24.a sInwe.„ masso., saImpa. a 17.Z?: 3,7 fOaks farn3 v.„-ifklia sys„ of agigStafeingll wall
comattmusethiomtn tike
TJAwki(eol effWegiv:Fteak.„-viz adblvg FIL4pitcrm comma 17eqvam,
UElf. Sfintil'Zt CfraMir,, Tt-ffsith: NE" 27:107,1--) 1161S
24e. Far Water Supply & itkieclion Wells:
Also subagt owe owy dais time wain 30 days of corripleVera of
maainsoikua rip ttix •QilLEVNi• (iiitivauttovat tit cr.mtoty
ceoraynrugued_
RPM GW-il Nan& Cagagra: 15.Tjungruml1t oif Erworonminv jail en01I KeRRIEWS — DIMENDUI eir,Cmizr 11•%13ourf.

1. Well Contractor Information:
WELL ABANDONMENtIQR9
EQ!DWR
Justin Radford ;)p 4 7020
Well Contractor Name (or well owner personally abandoning well on his/her property)
3270-A WQR
OS
NC Well Contractor Certification NuiiilAyFrrizvi
Geological Resources, Inc.
Company Name
2. Well Construction Permit #:
N/A
List all applicable well construction permits (i.e. UIC, County, Slate, Variance, etc) ifknown
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑ Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
Non -Water Supply Well:
® Monitoring
Injection Well:
DAquifer Recharge
0Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Recovery
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
0 Tracer
❑Other (explain under 7g)
4. Date well(s) abandoned: 09/30/2020
5a. Well location:
Bill Clark Chevrolet 0-0000020665
Facility/Owner Name Facility ID# (if applicable)
35 Dundee Road, Pinehurst, NC
Physical Address, City, and Zip
Moore
8562-0008-6123
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.200000 N 79.466618
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non -water su Lii
ONLY with the same construction/abandonment, you can submit one form.
6a. Well ID#: URN- 1 R
6b. Total well depth: 25.29 (ft.)
6c. Borehole diameter: 3.5 (in.)
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): 1 .82
(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 0 Bentonite Chips or Pellets
O Sand Cement Grout
® Concrete Grout
O Specialty Grout
O Bentonite Slurry
0 Dry Clay
0 Drill Cuttings
0 Gravel
0 Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
90 Ibs of concrete
7g. Provide a brief description of the abandonment procedure:
tremmie
8. Certifi . ion:
Signa �f of Certified Well wner
Date
By signing this form, 1 hereby cert5' that the well(s) was (were) abandoned in
accordance with 15A NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
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.
UBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
?n,��bandonment to the following:
�'�� kyo, Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
1;)°s✓ 0
4..,1� �,`3t%°i`► sect '
0\ 10b. For Injection Wells: In addition to sending the form to the address in l0a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d. Water level below ground surface: 14.15 (ft.)
(ft.)
6f. Inner casing/tubing length (if known): 1 0 (ft.)
6g. Screen length (if known): 15 (ft.)
6e. Outer casing length (if known): n/a
W
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Supply & Injection Wells: In addition to sending the form to the
address(es) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
abandoned.

WELL ABANDONMEN
1. Well Contractor Information:
Justin Radford
DEC 14 2020
Well Contractor Name (or well owner personally abandoning well on his/her property)
3270-A WQROS
NC Well Contractor Certification Number
,,Pd_►_rR'EG QNtr.f.OFF CE
Geological Resources, Inc.
Company Name
2. Well Construction Permit #: N/A
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.) if known
3. Well use (check well use):
Water Supply Well:
❑Agricultural
DGeothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
Non -Water Supply Well:
IRMonitoring
❑ Municipal/Public
❑ Residential Water Supply (single)
❑Residential Water Supply (shared)
Recovery
Injection Well:
❑Aquifer Recharge
DAquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
DGeothermal (Closed Loop)
DGeothermal (Heating/Cooling Return)
❑Groundwater Remediation
❑Salinity Barrier
0 Stormwater Drainage
0 Subsidence Control
0 Tracer
❑Other (explain under 7g)
4. Date well(s) abandoned: 09/30/2020
5a. Well location:
Bill Clark Chevrolet 0-0000020665
Facility/Owner Name Facility ID# (if applicable)
35 Dundee Road, Pinehurst, NC
Physical Address, City, and Zip
Moore
8562-0008-6123
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.200000 N 79.466618
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) if available. For multiple injection ornon-water s
ONL Y with the samecconnsttruction/abandonment, you can submit one form. .1/44
6a. Well ID#: M V V -2
6b. Total well depth: 1 9.09 (ft.)
6c. Borehole diameter:
4
W
nGe,
`c,�Pcocc><,on
6d. Water level below ground surface: 1 4.96 (ft.)
6e. Outer casing length (if known): n/a (ft.)
6f. Inner casing/tubing length (if known): 4.5 (ft.)
ells
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): 1.5 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
0 Neat Cement Grout Bentonite Chips or Pellets
❑ Sand Cement Grout
® Concrete Grout
❑ Specialty Grout
O Bentonite Slurry
❑ Dry Clay
0 Drill Cuttings
❑ Gravel
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
25 Ibs of Bentonite
80 Ibs of concrete
7g. Provide a brief description of the abandonment procedure:
tremmie
8. Certif ° ; tion:
Signa, e of Certified W= 1 Contra;'.r or Well Owner
0//
Date
By signing this form, 1 hereby certi that the well(s) was (were) abandoned in
accordance with 1 5A NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Injection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Supply & Injection Wells: In addition to sending the form to the
address(es) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
abandoned.

1. Well Contractor Information:
Justin Radford
WELL ABANDONMENWB,'
DEGEIDWR
1 g ?ion
Well Contractor Name (or well owner personally abandoning well on his/her property)
3270-A
NC Well Contractor Certification Nuiabgy WQROS
Geological Resources i -- • -. � 0
Company Name
2. Well Construction Permit #:
N/A
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.) if known
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
PMonitoring
▪ Recovery
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
❑ Groundwater Remediation
❑Salinity Barrier
0 Stormwater Drainage
❑Subsidence Control
❑ Tracer
❑Other (explain under 7g)
4. Date well(s) abandoned: 09/30/2020
5a. Well location:
Bill Clark Chevrolet 0-0000020665
Facility/Owner Name Facility ID# (if applicable)
35 Dundee Road, Pinehurst, NC
Physical Address, City, and Zip
Moore
8562-0008-6123
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.200000 N 79.466618
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED 5,
Attach well construction record(s) ifavailable. For multiple injection or n - ()14
c1414,
ONLY with the same construction/abandonment, you can submit org
p /�, q / 10a. For All Wells: Submit this
V' 6a. Well ID#: ' V V -3 isIf& abandonment to the following:
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): 1 •5
(gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
O Neat Cement Grout a Bentonite Chips or Pellets
❑ Sand Cement Grout
P Concrete Grout
O Specialty Grout
❑ Bentonite Slurry
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
25 Ibs of Bentonite
80 Ibs of concrete
7g. Provide a brief description of the abandonment procedure:
tremmie
8. Certification:
Signatur:'of Certified Well Contractor ell Own r
/0
Date
By signing this form, I hereby certin, that the well(s) was (were) abandoned in
accordance with 15A NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
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.
6b. Total well depth: 20.06 (ft.)
6c. Borehole diameter: 4 (in.)
ISUBMITTAL INSTRUCTIONS
eSg1C�g Division of Water Resources, Information Processing Unit,
3ClOn 9 O C ;On 1617 Mail Service Center, Raleigh, NC 27699-1617
form within 30 days of completion of well
1�+CQ" `p\Nse
6d. Water level below ground surface: 1 6.20 (ft.)
6e. Outer casing length (if known): n/a (ft.)
6f. Inner casing/tubing length (if known): 5 (ft.)
10b. For Injection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Supply & Injection Wells: In addition to sending the form to the
address(es) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
abandoned.
Kir CrrPan Inri`,th (if Irnnwn\• 1 5 (ft

WELL ABANDONMENtaletiRp
DENDWR
1. Well Contractor Information:
Justin Radford DEC 1 4 2020
Well Contractor Name (or well owner personally abandoning well on his/her property)
3270-A WQROS
NC Well Contractor Certification Ng4YETTFVILLE REGIONAL OFFICE
Geological Resources, Inc.
Company Name
2. Well Construction Permit #: N/A
List all applicable well construction permits (Le. UIC, County, State, Variance, etc.) if known
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑Irrigation
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
O Monitoring
❑ Recovery
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑ Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑ Tracer
❑Other (explain under 7g)
4. Date well(s) abandoned: 09/30/2020
5a. Well location:
Bill Clark Chevrolet 0-0000020665
Facility/Owner Name
Facility ID# (if applicable)
35 Dundee Road, Pinehurst, NC
Physical Address, City, and Zip
Moore 8562-0008-6123
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.200000 N 79.466618
W
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): 1 •35 (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
O Sand Cement Grout
e Concrete Grout
O Specialty Grout
O Bentonite Slurry
O Bentonite Chips or Pellets
❑ Dry Clay
❑ Drill Cuttings
O Gravel
O Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
80 Ibs of concrete
7g. Provide a brief description of the abandonment procedure:
Tremmie
8. Certification:
Signat of Certified Well ontractor ' Well Owner
Date
7zo
By signing this form, 1 hereby certin, that the well(s) was (were) abandoned in
accordance with 15A NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED 1UBMITTAL INSTRUCTIONS
Attach well construction record(s) if available. For multiple injection or non -wale i ly�v �
ONLY with the same construction/abandonment, you can submit one for
���11 bs4�
6a. Well ID#: M W-4 R
6b. Total well depth: 24.31 (ft.)
6c. Borehole diameter: 2 (in.)
It 10a. For All Wells: Submit this form within 30 days of completion of well
2o1 abandonment to the following:
�t11
�e� iDivision of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
Son PcQ tQri
\00"; o\NIR 10b. For Infection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d. Water level below ground surface: 1 6.04 (ft.)
(ft.)
6f. Inner casing/tubing length (if known): 1 0 (ft.)
6e. Outer casing length (if known): n/a
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Supply & Injection Wells: In addition to sending the form to the
address(es) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
abandoned.

WELL ABANDONME • tailth
DEQ/DWR
1. Well Contractor Information:
Justin Radford DEC 1 4 2020
Well Contractor Name (or well owner personally abandoning well on his/her property)
3270-A WQROS
NC Well Contractor Certification Nile •YET EVIL! F R EG 0 A) OFFICE
Geological Resources, Inc.
Company Name
2. Well Construction Permit #:
N/A
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.) if known
3. Well use (check well use):
Water Supply Well:
❑ Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
❑ Municipal/Public
❑ Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
• Monitoring
❑ Recovery
Injection Well:
❑ Aquifer Recharge
DAquifer Storage and Recovery
❑Aquifer Test
❑ Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
❑Groundwater Remediation
❑ Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑ Tracer
❑Other (explain under 7g)
4. Date well(s) abandoned: 09/30/2020
5a. Well location:
Bill Clark Chevrolet 0-0000020665
Facility/Owner Name Facility ID# (if applicable)
35 Dundee Road, Pinehurst, NC
Physical Address, City, and Zip
Moore 8562-0008-6123
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.200000 N 79.466618
W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non -water supply wells
ONLY with the same construction/abandonment, you can submit one form.
MW-5 sj
oF�
6a. Well ID#:
6b. Total well depth: 22.30 (ft.)
6c. Borehole diameter: 4 (in.)
6d. Water level below ground surface:
19.25
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): 0.50
(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 • Bentonite Chips or Pellets
❑ Sand Cement Grout
• Concrete Grout
❑ Specialty Grout
❑ Bentonite Slurry
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
25 Ibs of Bentonite
80 Ibs of concrete
7g. Provide a brief description of the abandonment procedure:
Tremmie
8. Certif tion:
Si ure of Certified ell Cont or or Well O ner Date t
By signing this form, 1 hereby certf that the well(s) was (were) abandoned in
accordance with 15A NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
i� `j\11r
®GeSS �J lOb. F
#3 13C C C>{'Oc\1above also submit
niection
0\t4V' e abandonment to the
6e. Outer casing length (if known): n/a
(ft.)
(ft.)
6f. Inner casing/tubing length (if known): 1 0 (ft.)
6g. Screen length (if known): 12 (ft.)
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
For I Wells: In addition to sending the form to the address in 10a
one copy of this form within 30 days of completion of well
following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Supply & Injection Wells: In addition to sending the form to the
address(es) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
abandoned.

WELL ABANDONMEI��'�V
1. Well Contractor Information:
Justin Radford
DEC 1 4 2020
Well Contractor Name (or well owner personally abandp�i�.yvN tiller property)
3270-A V�� ��ii
OFFICE
NC Well Contractor Certification Number
Geological Resources, Inc.
Company Name
2. Well Construction Permit #:
N/A
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc) if known
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
❑ Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
IPMonitoring
❑ Recovery
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
❑Groundwater Remediation
❑ Sal inity Barrier
❑ Stormwater Drainage
❑ Subsidence Control
❑ Tracer
❑Other (explain under 7g)
4. Date well(s) abandoned: 09/30/2020
5a. Well location:
Bill Clark Chevrolet
Facility/Owner Name
0-0000020665
Facility ID# (if applicable)
35 Dundee Road, Pinehurst, NC
Physical Address, City, and Zip
Moore
8562-0008-6123
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.200000 N 79.466618
W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) if available. For multiple injection or no Cycp ye
ONLY with the .same construction/abandonment, you can submit one>�
^ Oa. For All Wells: Submit this form within 30 days of completion of well
VL, andonment to the following:
Division of Water Resources, Information Processing Unit,
kj{`11 d,On 1617 Mail Service Center, Raleigh, NC 27699-1617
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): 4.41 (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
O Sand Cement Grout
PI Concrete Grout
O Specialty Grout
O Bentonite Slurry
O Bentonite Chips or Pellets
O Dry Clay
O Drill Cuttings
O Gravel
0 Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
180 Ibs of concrete
7g. Provide a brief description of the abandonment procedure:
tremmie
8. Certification:
Sign. i're of Certified Well Co"tractor o>Jell Owner
C /27. 0
Date
By signing this form, 1 hereby cent that the well(s) was (were) abandoned in
accordance with 15A NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
6a. Well ID#: M V V -7
6b. Total well depth: 71.35 (ft.)
6c. Borehole diameter:
2
6d. Water level below ground surface: 44.30
(ft.)
6e. Outer casing length (if known): n/a (ft.)
6f. Inner casing/tubing length (if known): unknown (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.
IIBMITTAL INSTRUCTIONS
10b. For Injection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Supply & Injection Wells: In addition to sending the form to the
address(es) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
abandoned.

i a �
WELL ABANDONIVIa.. JRD
DEQ!DWR
Justin Radford DEC 1 4 2020
1. Well Contractor Information:
Well Contractor Name (or well owner personally abandoning well on his/her property)
3270-A WOROS
NC Well Contractor Certificafi .Y aETP=E1/f [ I E REGI0NA , OFFICE
Geological Resources, Inc.
Company Name
2. Well Construction Permit #: N/A
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.) if known
3. Well use (check well use):
Water Supply Well:
DAgricultural
❑ Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑Irrigation
Non -Water Supply Well:
®Monitoring
❑ Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑ Recovery
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑ Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
❑Groundwater Remediation
❑Salinity Barrier
❑ Stormwater Drainage
0 Subsidence Control
0 Tracer
❑Other (explain under 7g)
4. Date well(s) abandoned: 09/30/2020
5a. Well location:
Bill Clark Chevrolet 0-0000020665
Facility/Owner Name Facility ID# (if applicable)
35 Dundee Road, Pinehurst, NC
Physical Address, City, and Zip
Moore
8562-0008-6123
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.200000 N 79.466618
CONSTRUCTION DETAILS OF WELL(S) BEING A
Attach well construction record(s) ifavailable. For multiple injectio
ONLY with the same construction/abandonment, you can submit one form.
6a. Well ID#: M V V -8
6b. Total well depth: 20.62 (ft.)
6c. Borehole diameter: 2 (in.)
6d. Water level below ground surface: 14.71
6e. Outer casing length (if known): n/a
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): 0.96 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
O Neat Cement Grout
❑ Sand Cement Grout
® Concrete Grout
❑ Specialty Grout
O Bentonite Slurry
0 Bentonite Chips or Pellets
❑ Dry Clay
0 Drill Cuttings
0 Gravel
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
80 Ibs of concrete
7g. Provide a brief description of the abandonment procedure:
tremmie
S. Certificatio
/pa?
Signaturf Certified Well C.'tractor or Owner Date
By signing this form, I hereby certi that the well(s) was (were) abandoned in
accordance with 1 5A NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
you may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
4SUBMITTAL INSTRUCTIONS
waters•u 144A ,
C, �o\r All Wells: Submit this form within 30 days of completion of well
?coc,a,S4 bandonment to the following:
(ft.)
(ft.)
6f. Inner casing/tubing length (if known): unknown (ft.)
(� Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Injection Wells: In addition to sending the form to the address in l0a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Supply & Injection Wells: In addition to sending the form to the
address(es) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
abandoned.
i iniennwin

WELL ABANDONMEN
1. Well Contractor Information:
Justin Radford
DEC 14 2020
Well Contractor Name (or well owner personally abandoning well on his/her property)
3270-A WQROS
FAYETTEVIL 1_F REGJONAI OFFICE
NC Well Contractor Certification Number
Geological Resources, Inc.
Company Name
2. Well Construction Permit #: N/A
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.) if known
3. Well use (check well use):
Water Supply Well:
El Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑Irrigation
Non -Water Supply Well:
I IMonitoring
❑Municipal/Public
❑Residential Water Supply (single)
❑ Residential Water Supply (shared)
❑ Recovery
Injection Well:
❑Aquifer Recharge
DAquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
DOther (explain under 7g)
4. Date well(s) abandoned: 09/30/2020
5a. Well location:
Bill Clark Chevrolet 0-0000020665
Facility/Owner Name Facility ID# (if applicable)
35 Dundee Road, Pinehurst, NC
Physical Address, City, and Zip
Moore
County
8562-0008-6123
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.200000 N 79.466618
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) if available. For multiple injection or non -water
ONLY with the sam/etconns'truction/abandonment, you can submit one form.
nV V 6a. Well ID#: ' `r' -9
6b. Total well depth: 53.13 (ft.)
6c. Borehole diameter: 2 (in.)
6d. Water level below ground surface: 42.74
Co
\0:3C\-C% (5tip$cje
6e. Outer casing length (if known): n/a
(ft.)
(ft.)
6f. Inner casing/tubing length (if known): unknown (ft.)
W
s
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): 1 •69 (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 0 Bentonite Chips or Pellets
❑ Sand Cement Grout
II Concrete Grout
❑ Specialty Grout
❑ Bentonite Slurry
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
150 lbs of concrete
7g. Provide a brief description of the abandonment procedure:
tremmie
8. Certification:
���� / Z-43
Signatu of Certified Well C 6ntracto f Well Owner Date
By signing this form, I hereby cert' that the well(s) was (were) abandoned in
accordance with 15A NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Injection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Supply & Injection Wells: In addition to sending the form to the
address(es) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
abandoned.
inhnnwnin

WELL ABANDONMEREitit
OAR 1
1. Well Contractor Information:
Justin Radford
DENVV6;
DEC 1 4 202.0
Well Contractor Name (or well owner personally abandoning well on his/her property)
3270-A WQROS
NC Well Contractor CertificationWTTEVI !NF REGIONAL OFFICE
Geological Resources, Inc. ��
Company Name
2. Well Construction Permit #:
N/A
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.) if known
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
IMonitoring
Recovery
Injection Well:
❑ Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑ Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 7g)
4. Date well(s) abandoned: 09/30/2020
5a. Well location:
Bill Clark Chevrolet 0-0000020665
Facility/Owner Name Facility ID# (if applicable)
35 Dundee Road, Pinehurst, NC
Physical Address, City, and Zip
Moore
County
8562-0008-6123
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.200000 N 79.466618
W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non -water supply wells.
ONLY with the same constructionabandonment, you can submit one form.
6a. Well ID#: V -2
6b. Total well depth: 11.22
6c. Borehole diameter:
2
6d. Water level below ground surface:
(ft.)
dry
DECBSGE11\1.°
. R ‘6\2o
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): n/a (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 0 Bentonite Chips or Pellets
❑ Sand Cement Grout
P Concrete Grout
0 Specialty Grout
❑ Bentonite Slurry
0 Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
40 Ibs of concrete
7g. Provide a brief description of the abandonment procedure:
tremmie
S. Certification:
Signature o rtified Well Cont ctor or V f1 Owner
Da/6-7/71°
te
By signing this form, I hereby cert that the well(s) was (were) abandoned in
accordance with 15A NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
�ytitUb. For Injection Wells: In addition to sending the form to the address in l0a
pfocesS,�� above, also submit
a onment to the following:
(ft.)
6e. Outer casing length (if known): n/a (ft.)
6f. Inner casing/tubing length (if known): unknown (ft.)
band
one copy of this form within 30 days of completion of well
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Supply & Injection Wells: In addition to sending the form to the
address(es) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
abandoned.
i inknnwm

WELL ABANDONMENT wartvEp
DEQIi3WR
nFr, 4 2f170
1. Well Contractor Information:
Justin Radford
Well Contractor Name (or well owner personally abandoning well on his/her property)
3270-A
WOROS
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
NC Well Contractor Certification Number 7b. Approximate volume of water
YM.
Geological Resources, Eno '�_�.;•- E '( aeT#ff
Company Name
2. Well Construction Permit #:
N/A
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.) if known
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
❑ Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
UMonitoring
❑ Recovery
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
❑ Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑ Tracer
❑Other (explain under 7g)
4. Date well(s) abandoned: 09/30/2020
5a. Well location:
Bill Clark Chevrolet 0-0000020665
Facility/Owner Name
35 Dundee Road,
Facility ID# (if applicable)
Pinehurst, NC
Physical Address, City, and Zip
Moore
County
8562-0008-6123
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.200000 N 79.466618
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) if available. For multiple injection ornonwpt,
ONLY with the same construction/abandonment, you can submit one f
R -
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
remaining in well(s): 0. 0
(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 ❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
e Concrete Grout
O Specialty Grout
❑ Bentonite Slurry
O Dry Clay
O Drill Cuttings
O Gravel
O Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
40 Ibs of concrete
7g. Provide a brief description of the abandonment procedure:
tremmie
8. Certificatio
/')
Signatures' Certified Wel % ontra 4r or Well Owner Date
By signing this form, I hereby certiA, that the well(s) was (were) abandoned in
accordance with 15A NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
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.
lsmiMITTAL INSTRUCTIONS
\ / 10a. For All Wells: Submit this
6a. Well ID#: V -3 Q n(' andonment to the following:
6b. Total well depth: 1 0. 58 (ft.)
6c. Borehole diameter: 2 (in.)
6d. Water level below ground surface: 9.95 (ft.)
6e. Outer casing length (if known): n/a (ft.)
6f. Inner casing/tubing length (if known): unknown (ft.)
r. yy
�SvCtt3 �1��Division of Water Resources, Information Processing Unit,
o10�,f: 1617 Mail Service Center, Raleigh, NC 27699-1617
., -c,3,.rt sec ,On
11 iy�C ®`'N 10b. For Injection Wells: In addition to sending the form to the address in l0a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
form within 30 days of completion of well
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Supply & Injection Wells: In addition to sending the form to the
address(es) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
abandoned.
unknown