WI0501034_Application_20211007

•.
Mid Atlantic
Engineering & Environmental Solutions
October 7, 2021
Ms. Shristi Shrestha
Hydrogeologist
North Carolina Department of Environmental Quality
Underground Injection Control Program
1636 Mail Service Center
Raleigh, NC 27699-1636
409 Rogers View Court
Raleigh, NC 27610
office 919.250.9918
facsimile 919.250.9950
MAAONLINE.COM
Subject: NOTIFICATION OF INTENT TO CONSTRUCT OR OPERATE INJECTION
WELLS
WILLOW SPRINGS ELEMENTARY SCHOOL
WILLOW SPRINGS, NORTH CAROLINA
UST INCIDENT NO. 39689
MID -ATLANTIC JOB NO. R2647.08
Dear Ms. Shrestha:
On behalf of the Wake County Public School System, Mid -Atlantic Associates, Inc. is
pleased to submit the attached Notification of Intent to Construct or Operate Injection
Wells for the Willow Springs Elementary School. Please note that 2019 and 2020
injections were previously approved for this site under permit numbers WI0501034 and
WI0501064, respectively. If you have any questions or need additional information, please
feel free to contact me at [phone].
Sincerely,
MID -ATLANTIC ASSOCIATES, INC.
QatrtS
Raymond S. Marchant, III, P.G.
Principal Geologist
Enclosures: Notice of Intent to Construct or Operate Injection Wells
Attachment A — Injection Zone Maps (Section H)
Attachment B — Safety Data Sheet (Section J)
Attachment C — Well Construction Information (Section K)
R2647.08/RSM/bro
EXPERIENCED CUSTOMER FOCUSED INNOVATIVE

NOTICE OF INTENT TO CONSTRUCT OR
OPERATE INJECTION WELLS
Mid Atlantic
Engineering & Environmental Solutions

North Carolina Department of Environmental Quality — Division of Water Resources
NOTIFICATION OF INTENT (NOI) TO CONSTRUCT OR OPERATE INJECTION WELLS
The following are "permitted by rule" and do not require an individual permit when constructed in accordance
with the rules of 15A NCAC 02C .0200. This form shall be submitted at least 2 WEEKS prior to injection.
AQUIFER TEST WELLS (15A NCAC 02C .0220)
These wells are used to inject uncontaminated fluid into an aquifer to determine aquifer hydraulic characteristics.
IN SITU REMEDIATION (15A NCAC 02C .0225) or TRACER WELLS (15A NCAC 02C .0229):
1) Passive Injection Systems - In -well delivery systems to diffuse injectants into the subsurface. Examples include
ORC socks, iSOC systems, and other gas infusion methods.
2) Small -Scale Injection Operations — Injection wells located within a land surface area not to exceed 10,000
square feet for the purpose of soil or groundwater remediation or tracer tests. An individual permit shall be required
for test or treatment areas exceeding 10,000 square feet.
3) Pilot Tests - Preliminary studies conducted for the purpose of evaluating the technical feasibility of a
remediation strategy in order to develop a full scale remediation plan for future implementation, and where the
surface area of the injection zone wells are located within an area that does not exceed five percent of the land
surface above the known extent of groundwater contamination. An individual permit shall be required to conduct
more than one pilot test on any separate groundwater contaminant plume.
4) Air Injection Wells - Used to inject ambient air to enhance in -situ treatment of soil or groundwater.
Print Clearly or Type Information. Illegible Submittals Will Be Returned As Incomplete.
DATE: October 7, 2021
PERMIT NO. (to be filled in by DWR)
A. WELL TYPE TO BE CONSTRUCTED OR OPERATED
B.
C.
(1) Air Injection Well Complete sections B through F, K, N
(2) Aquifer Test Well .Complete sections B through F, K, N
(3) Passive Injection System Complete sections B through F, H-N
(4) X Small -Scale Injection Operation Complete sections B through N
(5) Pilot Test Complete sections B through N
(6) Tracer Injection Well Complete sections B through N
STATUS OF WELL OWNER: Business/Organization
WELL OWNER(S) — State name of Business/Agency, and Name and Title of person delegated authority to
sign on behalf of the business or agency:
Company Name Wake County Public School System
Delegated Signatory Authority: Mr. Todd Kneller
Mailing Address: 1551 Rock Quarry Road, Bldg B
City: Raleigh State: NC Zip Code: 27610 County: Wake
Day Tele No.: 919-588-3633 Cell No.: 919-669-9635
EMAIL Address: [e-mail] Fax No.: 919-508-0831
Deemed Permitted GW Remediation NOI Rev. 3-1-2016 Page 1

D. PROPERTY OWNER(S) (if different than well owner)
Company Name Same as Well Owner
Mailing Address:
City: State: Zip Code: County:
Day Tele No.: Cell No.:
EMAIL Address: Fax No.:
E. PROJECT CONTACT (Typically Environmental Engineering Firm)
Name and Title: Raymond S. "Trey" Marchant, III, Principal Geologist
Company Name Mid -Atlantic Associates, Inc.
Mailing Address: 409 Rogers View Court
City: Raleigh State: NC Zip Code: 27610 County: Wake
Day Tele No.: [phone]
EMAIL Address: [e-mail]
F. PHYSICAL LOCATION OF WELL SITE
Cell No.: [phone]
Fax No.: [phone]
(1) Facility Name & Address: Willow Springs Elementary School
6800 Dwight Rowland Road
City: Willow Springs County: Wake Zip Code: 27592
(2) Geographic Coordinates: Latitude**: 35 ° 35 ' 37 " or 35.593508 °N
Longitude**: -78 ° 43 ' 41 " or-78.728024° W
Method of Collection: Google Earth Pro Software
**FOR AIR INJECTION AND AQUIFER TEST WELLS ONLY: A FACILITY SITE MAP WITH PROPERTY
BOUNDARIES MAY BE SUBMITTED IN LIEU OF GEOGRAPHIC COORDINATES.
G. TREATMENT AREA
Note: There has been a release of heating oil from a UST at this site. The site is currently regulated by the
North Carolina Department of Environmental Quality (NCDEQ), Division of Waste Management (DWM),
Underground Storage Tank (UST) Section. Removal of free product is necessary to move the site towards
closure and prevent potential spreading of the plume (water supply wells are located nearby). Heating oil free
product remains present on the water table at wells RW-1, RW-2, RW-3, and MW-3. As such, the "area of the
contaminant plume" indicated below refers to the approximate area of the heating oil free product plume. This
area is roughly equal to the area of an ellipse with dimensions 45ft by 25ft, or 900 square feet [A=n(a)(b),
where (a) and (b) are half the length of the longest and shortest axes].
Land surface area of contaminant plume: 900 square feet
Land surface area of inj. well network: 900 square feet (< 10,000 ft2 for small-scale injections)
Percent of contaminant plume area to be treated: 100% (must be < 5% of plume for pilot test injections)
Deemed Permitted GW Remediation NOI Rev. 3-1-2016 Page 2

H. INJECTION ZONE MAPS — Attach the following to the notification. Provided in Attachment A. Please
note that DEQ has only required limited assessment at this site. Groundwater isoconcentration maps are not
available (other than the one provided) and soil assessment maps are not available. Contaminated soil likely
remains in the vicinity of the UST (which was closed in place due to the presence of underground utilities over
and around the tank). However, no soil contaminant maps currently exist.
(1) Contaminant plume map(s) with isoconcentration lines that show the horizontal extent of the
contaminant plume in soil and groundwater, existing and proposed monitoring wells, and existing and
proposed injection wells; and
(2) Cross-section(s) to the known or projected depth of contamination that show the horizontal and
vertical extent of the contaminant plume in soil and groundwater, changes in lithology, existing and
proposed monitoring wells, and existing and proposed injection wells.
(3) Potentiometric surface map(s) indicating the rate and direction of groundwater movement, plus
existing and proposed wells.
DESCRIPTION OF PROPOSED INJECTION ACTIVITIES — Provide a brief narrative regarding the
purpose, scope, and goals of the proposed injection activity. This should include the rate, volume, and
duration of injection over time.
Residual heating oil free product remains present on the water table at the site at well MW-3 (approximate
thickness of 0.47 ft) and is also present in well RW-1 and RW-3 at thicknesses of approximately 0.15 ft and
0.03 ft, respectively. Free product has been present in well RW-2 in the past. We propose to inject surfactant
prior to performing an Aggressive Fluid Vapor Recovery (AFVR) event. Mid -Atlantic proposes to inject
Biosolve Clear at the site to enhance free product recovery during the AFVR. Injection will be performed at
wells MW-3, RW-1, RW-2, and RW-3. BioSolve is a common cleanup/mitigation agent that can be applied as
both an emulsifying agent for free product recovery and biosurfactant for dissolved -phase groundwater
remediation. It is estimated that up to 125 gallons of 4% solution of BioSolve will be gravity injected into the
above -referenced wells over an estimated period of up to 8 hours on -site. An 8-hour AFVR event will then be
conducted at the site approximately one week following completion of the surfactant injection event, with
post-AFVR free product gauging activities conducted approximately two to four weeks following completion
of the AFVR event.
J. APPROVED INJECTANTS — Provide a MSDS for each injectant. Attach additional sheets if necessary.
Provided in Attachment B
NOTE: Only injectants approved by the NC Division of Public Health, Department of Health and Human
Services can be injected. Approved injectants can be found online at http://deq.nc.gov/about/divisions/water-
resources/water-resources-permits/wastewater-branch/ground-water-protection/ground-water-approved-inj ectants.
All other substances must be reviewed by the DHHS prior to use. Contact the UIC Program for more info
(919-807-6496).
Injectant: BioSolve Clear solution
Volume of injectant: 125 Gallons
Concentration at point of injection: 4%
Percent if in a mixture with other injectants:
K. WELL CONSTRUCTION DATA GW-ls for existing wells MW-3, RW-1, RW-2, and RW-3 are
provided in Attachment C.
(1) Number of injection wells: 0 Proposed 4 Existing (provide GW-1s)
(2) For Proposed wells or Existing wells not having GW- 1s, provide well construction details for each
injection well in a diagram or table format. A single diagram or line in a table can be used for
multiple wells with the same construction details. Well construction details shall include the
following (indicate if construction is proposed or as -built):
Deemed Permitted GW Remediation NOI Rev. 3-1-2016 Page 3

(a) Well type as permanent, Geoprobe/DPT, or subsurface distribution infiltration gallery
(b) Depth below land surface of casing, each grout type and depth, screen, and sand pack
(c) Well contractor name and certification number
L. SCHEDULES — Briefly describe the schedule for well construction and injection activities.
No wells will be constructed for this injection event. The event is currently scheduled for Thursday. October
28, 2021. The AFVR is scheduled to be conducted on Tuesday_ November 2, 2021. It is anticipated that the
surfactant injection will take approximately 8 hours for completion. The AFVR is expected to run for
approximately 8 hours. Post-AFVR free product gauging will be conducted approximately two to four weeks
following completion of the AFVR event.
M. MONITORING PLAN — Describe below or in separate attachment a monitoring plan to be used to determine
if violations of groundwater quality standards specified in Subchapter 02L result from the injection activity.
The site is currently regulated by the NCDEO DWM UST Section. Sampling of site monitoring wells (not
containing free product) will be performed once free product has been removed from the water table, with
results reported to the UST Section (assuming sampling is pre -approved by the UST Section). The injection
activity is not anticipated to result in violations of the NCGQS for additional compounds other than those
already noted from the previous fuel oil release.
N. SIGNATURE OF APPLICANT AND PROPERTY OWNER
APPLICANT: "I hereby cert, under penalty of law, that I am familiar with the information submitted in
this document and all attachments thereto and that, based on my inquiry of those individuals immediately
responsible for obtaining said information, I believe that the information is true, accurate and complete. I am
aware that there are significant penalties, including the possibility of fines and imprisonment, for submitting
false information. I agree to construct, operate, maintain, repair, and if applicable, abandon the injection well
and all related appurte ances in accordance with the 15A NCAC 02C 0200 Rules."
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Signature of Applicant
/0 IP0 1Cv1/L L er.,� 4194004pv
Print or Type Full Name and Title
PROPERTY OWNER (if the property is not owned by the permit applicant):
"As owner of the property on which the injection well(s) are to be constructed and operated, I hereby consent
to allow the applicant to construct each injection well as outlined in this application and agree that it shall be
the responsibility of the applicant to ensure that the injection well(s) conform to the Well Construction
Standards (15A NCAC 02C .0200)."
"Owner" means any person who holds the fee or other property rights in the well being constructed. A
well is real property and its construction on land shall be deemed to vest ownership in the land owner, in
the absence of contrary agreement in writing.
Not applicable
Signature* of Property Owner (if different from applicant) Print or Type Full Name and Title
*An access agreement between the applicant and property owner may be submitted in lieu of a signature on this form.
Submit the completed notification package to:
DWR — UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone: [phone]
Deemed Permitted GW Remediation NOI Rev. 3-1-2016 Page 4

ATTACHMENT A
INJECTION ZONE MAPS
(SECTION H)
Mid Atlantic
Engineering & Environmental Solutions

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WITHIN WAKE COUNTY
REFERENCES:
1. ANGIER, NC DIGITAL RASTER GRAPHIC, USGS. SCANNED FROM
1:24,000-SCALE GREEN LEVEL, NC TOPOGRAPHIC MAP, PUBLISHED 2013, USGS.
2. INSET MAP DIGITAL DATA FROM 2002 NATIONAL TRANSPORTATION ATLAS,
BUREAU OF TRANSPORTATION STATISTICS, WASHINGTON, D.C.
3. PROPERTY BOUNDARY DATA FROM WAKE COUNTY GIS.
SCALE: 1:12,000
0 500 1,000
Feet
2,000
SEngineering & Environmental Solutions
Mid Atlantic
TOPOGRAPHIC SITE MAP
WILLOW SPRINGS ELEMENTARY SCHOOL
6800 DWIGHT ROWLAND ROAD
WILLOW SPRINGS, NORTH CAROLINA
DRAWN
BY:
DRAFT
CHECK:
ENG.
CHECK:
APPROVAL: (1
DATE:
APRIL 2016
JOB NO:
000R2647.0B
GIS NO:
04G-R2647.0B-1
DWG NO: 1

lir6.1
Or
Mid Atlantic
Engineering & Environmental Solutions
MW-1
(FP)
ND = NOT DETECTED
FP = FREE PRODUCT
ESTIMATED ISOCONCENTRATION CONTOUR MAP
BENZENE IN SHALLOW GROUNDWATER
WILLOW SPRINGS ELEMENTARY SCHOOL
6800 DWIGHT ROWLAND ROAD
WILLOW SPRINGS, NORTH CAROLINA
Legend
• MONITORING WELL LOCATION
20— ESTIMATED BENZENE ISOCONCENTRATION CONTOUR
-FP— ESTIMATED FREE PRODUCT CONTOUR INTERVAL
ESTIMATED BENZENE ISOCONCENTRATION CONTOUR
1 0— FOR N.C. GROUNDWATER QUALITY STANDARD
DRAWN BY:
DRAFT CHECK
BY:
ENGINEER CHECK
BY: M
APPROVED
BY: M
DATE: APRIL 2016
JOB NO.: 000R2647.0B
GIS NO.: 04G-R2647.0B-3
DRAWING NO.: 4
i
REFERENCE: 2013 AERIAL IMAGERY FROM NC ONE MAPS. PROPERTY BOUNDARY, ROAD, WATER, SEWER, HYDROLOGY GIS FROM WAKE COUNTY GIS. MID -ATLANTIC FIELD NOTES.

AtnilatcMid
�
Engineering & Environmental Solutions
NM=NOT MEASURED
ESTIMATED GROUNDWATER TAB|EELEVATION CONTOUR MAP(3_31_16)
WILLOW ELEMENTARY SCHOOL6800DW|GATROVV| 4NDROAD WILLOW KJ[l�TA�4�O| |N� ^^'^-�^^^' SPRINGS, ''—''�. _ _ _��
Legend
MONITORING WELL LOCATION
ESTIMATED GROUNDWATER ELEVATION CONTOUR
� ESTIMATED GROUNDWATER FLOW DIRECTION
TRIBUTARY TOTERRIBLE CREEK
F 1GUBJECTPR{)PERTYB{}UNDARY
REFERENCE: 2013 AERIAL IMAGERY FROM NC ONE MAPS. PROPERTY BOUNDARY, ROAD, WATER, SEWER, HYDROLOGY GIS FROM WAKE COUNTY GIS. MID -ATLANTIC FIELD NOTES.
o
DRAWN BY:
DRAFT CHECK
ENGINEER CHECK
APPn0vso
Q�^
DATE: APR|L2018
JOB NO.: 000R2647.OB
G|8NO.: 04G-R2647.OB-3
DRAWING NO.:
3

Legend
MONITORING WELL LOCATION
5,000-GALLON HEATING OIL UST
0.01' = FREE PRODUCT THICKNESS (FEET)
FREE PRODUCT CONTOUR
ND = NOT DETECTED
1 inch equals 20 feet
Feet
0 20 40
"_
a`1111
Ilr_''
;� M id! Atlantic
Engineering & Environmental
Solutions
FREE PRODUCT THICKNESS MAP
POST-AFVR - NOVEMBER 11, 2019
WILLOW SPRINGS ELEMENTARY SCHOOL
6800 DWIGHT ROWLAND ROAD
WILLOW SPRINGS, NORTH CAROLINA
DRAWN BY: RDC
DATE: DECEMBER 2019
DRAFT CHECK
BY:
JOB NO.: 000R2647.05
ENGINEER CHECK
BY:
GIS NO.: 06G-R2647.05-4
APPROVED
BY:
DRAWING NO.: 3.1
REFERENCE: 2013 AERIAL IMAGERY FROM NC ONE MAPS. PROPERTY BOUNDARY, ROAD, WATER, SEWER, HYDROLOGY GIS FROM WAKE COUNTY GIS. MID -ATLANTIC FIELD NOTES.

ti
Legend
Recovery Well Location
Monitoring Well Location
5,000-Gallon Heating Oil UST
Free Product Contour
ND = Not Detected
0.01' = Free Product Thickness (Feet)
9 -1
0 •
v9
RW-
MW-3 FriP
RW-4
(ND
(0.01')
- ;-
(ND
(ND
1 inch equals 20 feet
Feet
0 20 40
.;;
II
���\
i.+ Atlantic
FREE PRODUCT THICKNESS MAP
POST-AFVR - FEBRUARY 15, 2021
WILLOW SPRINGS ELEMENTARY SCHOOL
6800 DWIGHT ROWLAND ROAD
WILLOW SPRINGS, NORTH CAROLINA
DRAWN BY: GCH
DATE: FEBRUARY 2021
DR
BY:
JOB NO.: 000R2647.06
ENGINEER CHECK
ENGINEER
BY:
GIS NO.: 06G-R2647.06-4
APPROVED
BY:
DRAWING NO.: 3
REFERENCE: LATEST ORTHOIMAGERY FROM NC ONE MAPS. PROPERTY BOUNDARY, ROAD, WATER, SEWER, HYDROLOGY GIS FROM WAKE COUNTY GIS. MID -ATLANTIC FIELD NOTES.

TABLE 2
SUMMARY OF HISTORICAL LIQUID LEVEL MEASUREMENTS
WCPSS WILLOW SPRINGS ELEMENTARY SCHOOL
WILLOW SPRINGS, NORTH CAROLINA
MID -ATLANTIC JOB NO. R2647.06
WELL ID
DATE
TOC
ELEVATION
(FT)
DTP
APPARENT
FP
THICKNESS
(FT)
DTW (FT)
BTOC
CORRECTED
DTW (FT)
SWLE (FT)
MW-1
3/29/2016
101.64
NM
NM
NM
NM
NM
5/1/2017
7.94
2.4
10.34
8.59
93.05
7/27/2017
9.56
1.88
11.44
10.07
91.57
11/11/2017
11
0.49
11.49
11.13
90.51
12/8/2017
11.3
0.15
11.45
11.34
90.30
7/6/2018
10.99
0.21
11.20
11.05
90.59
7/31/2018
11.24
0.17
11.41
11.29
90.35
9/27/2019
--
0.10a
--
--
--
10/12/2019
--
--
11.56
11.56
90.08
11/11/2019
--
--
11.48
11.48
90.16
4/27/2020
--
--
9.01
9.01
92.63
12/16/2020
--
--
8.18
8.18
93.46
12/22/2020
--
--
7.91
7.91
93.73
12/30/2020
--
--
7.70
7.70
93.94
2/15/2021
--
--
6.50
6.50
95.14
6/3/2021
--
--
10.33
10.33
91.31
MW 2
3/29/2016
101 94
--
--
8.12
8.12
93.82
11/11/2017
--
--
11.48
11.48
89.72
7/6/2018
--
--
11.28
112.80
89.92
7/31/2018
--
--
11.58
11.58
89.62
9/27/2019
--
--
--
--
--
10/12/2019
--
--
11.87
11.87
90.07
11/11/2019
--
--
11.81
11.81
90.13
6/3/2021
--
--
10.55
10.55
91.09
MW-3
3/29/2016
98.73
--
--
5.23
5.23
92.81
5/1/2017
--
--
5.95
5.95
92.09
11/11/2017
8.28
0.28
8.56
8.36
90.37
12/8/2017
8.54
0.01
8.55
8.54
90.19
7/6/2018
8.18
0.68
8.86
8.36
90.37
7/31/2018
8.41
0.53
8.94
8.55
90.18
9/27/2019
--
0.38a
--
--
--
10/12/2019
--
--
8.75
8.75
89.98
11/11/2019
8.67
0.02
8.69
8.68
90.05
4/27/2020
6.26
0.37
6.63
6.36
92.37
12/16/2020
5.52
0.59
6.11
5.68
93.05
12/22/2020
5.29
0.30
5.59
5.37
93.36
12/30/2020
--
--
4.48
4.48
94.25
6/3/2021
7.46
0.47
7.93
7.59
94.05
MW-4
3/29/2016
98.90
--
--
5.25
5.25
92.93
11/11/2017
--
--
7.92
7.92
90.26
7/6/2018
--
--
8.36
8.36
89.82
7/31/2018
--
--
8.57
8.57
89.61
9/27/2019
--
--
--
--
--
10/12/2019
--
--
8.84
8.84
89.34
11/11/2019
--
--
8.79
8.79
89.39
4/27/2020
--
--
6.29
6.29
92.61
6/3/2021
--
--
7.62
7.62
94.02

TABLE 2
SUMMARY OF HISTORICAL LIQUID LEVEL MEASUREMENTS
WCPSS WILLOW SPRINGS ELEMENTARY SCHOOL
WILLOW SPRINGS, NORTH CAROLINA
MID -ATLANTIC JOB NO. R2647.06
WELL ID
DATE
TOC
ELEVATION
(FT)
DTP
APPARENT
FP
THICKNESS
(FT)
DTW (FT)
BTOC
CORRECTED
DTW (FT)
SWLE (FT)
RW 1
9/27/2019
99 74
--
0.10a
--
--
--
10/12/2019
--
--
9.69
9.69
90.79
11/11/2019
9.59
0.01
9.60
9.59
90.15
4/27/2020
7.23
0.13
7.36
7.27
92.47
12/16/2020
6.82
0.14
6.96
6.86
92.88
12/22/2020
6.23
0.15
6.38
6.27
93.47
12/30/2020
6.31
0.06
6.37
6.33
93.41
6/3/2021
8.43
0.15
8.58
8.47
93.17
RW-2
9/27/2019
99.94
--
0.20a
--
--
--
10/12/2019
--
--
9.88
9.88
90.80
11/11/2019
9.80
0.01
9.81
9.80
90.14
4/27/2020
--
--
7.40
7.40
92.54
12/16/2020
--
--
6.52
6.52
93.42
12/22/2020
--
--
6.14
6.14
93.80
12/30/2020
--
--
6.04
6.04
93.90
6/3/2021
--
--
8.66
8.66
92.98
RW-3
12/22/2020
98.97
--
--
5.39
5.39
93.56
12/30/2020
--
--
5.22
5.22
93.73
6/3/2021
7.71
0.03
7.74
7.72
93.92
RW-4
12/22/2020
98.53
--
--
4.96
4.96
93.55
12/30/2020
--
--
4.75
4.75
93.76
6/3/2021
--
--
7.28
7.28
94.36
Notes: TOC - Top of Casing BTOC - Below Top of Casing
FT - feet SWLE - Static Water Level Elevation
DTP - Depth to Product a - FP thickness estimated by technician
FP - Free Product
DTW - Depth to Water

0
Legend
MONITORING WELL LOCATION
SUBJECT PROPERTY BOUNDARY
1:480
■ Feet
40 80 120 160
•
•
Mid Atlantic
Engineering & Environmental Solutions
MONITORING WELL LOCATION MAP
WILLOW SPRINGS ELEMENTARY SCHOOL
6800 DWIGHT ROWLAND ROAD
WILLOW SPRINGS, NORTH CAROLINA
DRAWN BY:
DRAFT CHECK
BY:
ENGINEER CHECK
BY: GSM
APPROVED
BY:
DATE: APRIL 2016
JOB NO.: 000R2647.0B
GIS NO.: 04G-R2647.0B-1
DRAWING NO.: 2
REFERENCE: 2013 AERIAL IMAGERY FROM NC ONE MAPS. PROPERTY BOUNDARY, ROAD, WATER, SEWER, HYDROLOGY GIS FROM WAKE COUNTY GIS. MID -ATLANTIC FIELD NOTES.

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oft1-40NT A L SCALE 1

ATTACHMENT B
SAFETY DATA SHEET
(SECTION J)
116 Mid Atlantic
Engineering & Environmental Solutions

Bi'aSolvehiosIvit
CLEAR�
' IA `.' HYOROCAfl O N ACIT!GATd0 H AGENT "
Safety Data Sheet
Page 1 of 6
Section 1 — Chemical Products and Company Identification
Product Names: BioSolveClear
Product Uses: Remediation of hydrocarbon (oil, fuel, petrochemical) contamination,
including: impacted soils, suppression of VOCs, surface cleaning of
equipment and protective clothing.
Manufacturer: The BioSolve Company
24 Victory Lane
Dracut, MA 01826 USA
Contact Information: [phone] US, Canada, Mexico and Puerto Rico
[phone] All other locations
Section 2 — Hazards Identification
Health Hazards:
Eye Contact: Causes transient eye irritation
Skin Contact: May cause mild, transient irritation
Ingestion: May be harmful if swallowed; can cause
gastrointestinal irritation, nausea, vomiting and/or
diarrhea
Hazard Mitigation: Wear protective gloves and eye/face protection
Avoid prolonged breathing of spray
Environmental Moderately toxic to aquatic life. Avoid discharge to storm drains and
Hazards: waterways
GHS Classification: Toxic to aquatic life, Acute Category 2
Section 3 — Composition/Information on Ingredients
Proprietary formulation with nonionic surfactants (32% active ingredients in water)
BioSolve products contain no caustic, d-limonene or hydrocarbon solvents.
BioSolve products do not contain any hazardous ingredients as defined by CERCLA,
Massachusetts Right to Know Law and California Prop 65. All ingredients are TSCA compliant.

II P ■
th e,., biosaive:
CLEAR
HYDRCICAG BOW P. IT40AT10H dG EIJT
{rOMF'A J f
Safety Data Sheet
•
Page 2 of 6
Section 4 — First Aid Measures
Eyes: Immediately flush eyes with water for at least 15 minutes. Hold eyelids
apart while flushing to rinse entire surface of eye and lids with water.
Seek medical attention for lasting irritation.
Skin: Rinse exposed area and wash with mild soap and water for several
minutes. Seek medical attention if irritation develops.
Ingestion: Seek medical attention in the event of serious or persistent abdominal
discomfort, nausea or diarrhea.
Inhalation: Inhalation of concentrated vapors resulting from spraying or heating in
confined or poorly ventilated areas may cause irritation of nose and
throat. Remove person to fresh air and seek medical attention if
irritation persists.
Section 5 — Fire Fighting Measures
Suitable Extinguishing Media: None required; BioSolve products are non-flammable
Special Protective Equipment for Firefighters: None necessary
Unusual Fire or Explosive Hazards: None
Section 6 — Accidental Release Measures
In case of accidental release, breakage or leakage: Eliminate or contain source with inert
material, such as sand, earth, absorbent pads, etc. Transfer liquid to suitable containers
for recovery, re -use or disposal. Wipe up or mop up using water. Hard surfaces (e.g.,
floors, driveways) may be slippery; use care to avoid falling.
Rinse area with water. Avoid flow of run-off to surface waters. Always check with
local regulations before discharging effluent to storm drains or sewers.
Section 7 — Handling and Storage
Handling: Minimize periods of exposure to extreme temperatures. Keep from
freezing. If frozen, separation may occur; thaw and stir thoroughly
prior to use. Freezing will not affect product performance.
Precautions: Chemical resistant gloves and eye protection are recommended while
mixing and using.
Incompatibilities: Avoid contact with strong acids or strong oxidants.
Storage: Recommended storage temperature: 35° — 120° F (1° — 48° C).
Shelf Life: If unopened, more than 10 years.

B,,.,,s
o ve biosaive;
CLEAR
HYDRCICAG BOW P. ITIGAT1Ch4 dG EIJT
COMF'N
Safety Data Sheet
•
Page 3 of 6
Section 8 — Exposure Controls / Personal Protection
Eyes Protection:
Skin Protection:
Respiratory
Protection:
Engineering
Controls:
Safety glasses; chemical goggles or face shield recommended when
spraying to protect against backsplash and drift.
Rubber or latex gloves recommended.
None required, except if application results in significant misting of
product. If so, use of an approved air purifying respirator is
recommended.
For indoor use or for use in a confined space, normal ventilation is
generally satisfactory.
Section 9 — Physical and Chemical Properties
Appearance: Light golden
Odor: Mild, pleasant sassafras fragrance
Concentration: —32% active ingredients as sold
Boiling Point
265°F/129°C
Vapor Pressure mm/Hg
Not available
Melting/Freezing Point
28°F/-2°C
Vapor Density (Air=1)
Not available
Flash Point
Non-flammable
Surface Tension*
29 Dyne/cm @25°C
Flammability Limits
Not applicable
Viscosity (concentrate)
490 centipoise
Reactivity with Water
None
Viscosity (6% solution)
1.5 centipoise
Evaporation Rate
Not determined
Solubility in Water
100%
Specific Gravity
1.01 gms/cc
VOC Content
Not determined
8.43 lbs/U.S. gal
pH
9.1 +/- 0.3
*6% solution
Section 10 — Stability and Reactivity
Chemical Stability:
Conditions to Avoid:
Incompatible
Materials:
Hazardous
Decomposition
Products:
Hazardous
Polymerization:
Stable; will not decompose if used according to manufacturer's
directions.
Prolonged exposure to heat may cause product degradation. Freezing
should also be avoided as discussed in Section 7.
Normally unreactive. Avoid strong alkalis, strong acids, strong
oxidizing agents and materials with reactive hydroxyl compounds.
These materials could damage the product and reduce its effectiveness
during application.
None are known.
Will not occur.

II P ■
th e,., biosaive:
CLEAR
HYDRCICAG BOW P4IT40AT10H dG EIJT
{rOMF'A J f
Safety Data Sheet
•
Page 4 of 6
Section 11 — Toxicological Information
Overview:
Carcinogenicity:
Specific Organ
Toxicity:
No adverse acute or chronic health effects expected if product used in
accordance with manufacturer's directions.
No ingredient has been shown to cause cancer in laboratory animals.
None are known.
Section 12 — Ecological Considerations
Persistence and
Degradability:
Bioaccumulation
Potential:
Mobility:
Aquatic Toxicity:
The total of the organic components contained in this product is not
classified as readily biodegradable (OECD-301 A-F). However, this
product is inherently biodegradable with 60% degradation in 28 days
(OECD-301B) and estimated >95% degradation in 120 days.
The bioaccumulation factor in fish has been estimated to be low,
ranging from 87 to 344.
No data available
LCso of Concentrate (As shipped)
Mysidopsis bahia 48-hours
Menidia beryllina 96-hours
LC50 of 3% Dilute Solution (As Used)
Mysidopsis bahia 48-hours
Menidia beryllina 96-hours
LC50 of 6% Dilute Solution (As Used)
Daphnia magna
Pimephales promelas
Onchorhynchus mykiss
48-hours
96-hours
96-hours
3.6 mg/L
6.4 mg/L
185 mg/L
247 mg/L
287 mg/L
124 mg/L
177 mg/L
Section 13 - Disposal
DO NOT DUMP INTO STORM DRAINS OR INTO ANY BODY OF WATER. All
disposal practices must be in compliance with all Federal, State/Provincial and local
laws and regulations. As manufactured, BioSolve products do not meet the definition of
a hazardous waste. Small quantities of unused and uncontaminated product may be
discharged to a qualified wastewater treatment facility. Always obtain approval from
local and Federal regulatory agencies prior to discarding this product into public sewers.
As your supplier, we have no control over your handling and use of this product.
However, the intended use of this product as a remediation and/or surface washing agent
may produce wastewater containing emulsified or dispersed hydrocarbons that may be
classified as a hazardous waste and should be treated and disposed of accordingly.

BioSolve
{rOMF'AF.J f
Safety Data Sheet
biosaive
CLEARS
HYDRCICAG BOW P4IT40AT10H dG EIJT
•
Page 5 of 6
Section 14 — Transportation Information
USDOT Freight Class 55 (Liquid Cleaning Compound, Non -Hazardous)
This product is not regulated by USDOT or Canadian TDG when shipped
domestically by land.
North American Industry Classification System (NAICS) # 325613
U.S. ITC, Harmonized Tariff Schedule B Classification: 3402.90.30.00
Section 15 — Regulatory Information
This product is considered non -hazardous as defined by CERCLA, according to OSHA,
Massachusetts Right to Know Law and California Prop 65.
Toxic Substances All components of this product are on the TSCA inventory or are
Control Act:
exempt from TSCA Inventory requirements under 40 CFR 720.30.
CEPA — Domestic All substances contained in this product are listed on the Canadian
Substances List:
Canadian CPR
Compliance:
Domestic Substances List (DSL) or not required to be listed.
This product has been classified in accordance with the hazard criteria
of the Canadian Controlled Products Regulations (CPR) and the SDS
contains all the information required by the CPR
WHMIS D2B Eye or skin irritant
Classification:
Regulatory requirements are subject to change and may differ from one location to
another; it is the buyer's responsibility to ensure that its activities comply with Federal,
state or provincial and local laws.

{rOMF'A J f
o ve biosaive;
CLEAR
HYDRCICAG BOW P. ITIGAT1Ch4 dG EIJT
Safety Data Sheet
•
Page 6 of 6
Section 16 — Other Information
HMIS Rating
NFPA Rating
Health Hazard:
Fire Hazard:
Reactivity:
Personal Protective
Equipment:
Health:
Flammability:
Reactivity:
Other Hazard:
SDS Effective Date: May 12, 2016
1 (Eye/Skin Irritant)
0
0
Rubber gloves, safety
glasses or face shield
1 (Eye/Skin Irritant)
0
0
None
The information contained herein is accurate to the best of our knowledge. The
BioSolve Company makes no warranty of any kind, express or implied, concerning the
safe use of this material in your process or application or in combination with other
substances.
For more information, visit: www.biosolve.com

ATTACHMENT C
WELL CONSTRUCTION INFORMATION
(SECTION K)
Mid Atlantic
Engineering & Environmental Solutions

WELL CONSTRUCTION RECORD
For Internal Use ONLY:
This form can be used for single or multiple wells
1. Well Contractor Information:
James D, Barker
Well Contractor Name
3106A
NC Well Contractor Certification Number
Quantex, Inc.
Company Name
NR
2. Well Construction Permit #:
LW all applicable well construction permits (i.e. County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
▪ Geothermal (Heating/Cooling Supply)
❑hidustrial/Commercial
O h -ligation
❑ Municipal/Public
❑ Residential Water Supply(single)
❑Residential Water Supply (shared)
Nan -Water Supply Well:
IaMenitoring
[Recovery
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
DGeothennal (Closed Loop)
DGeothennal (Heating/Cooling Retum)
❑Groundwater Remediation
❑ Salinity Barrier
❑ Stormwater Drainage
❑ Subsidence Control
❑Tracer
❑Other (explain under #21 Remarks)
3/25/16
4. Date Well(s) Completed:
5a. Well Location:
Willow Springs ES
MW-3
Well ID#
NA
Facility/Owner Name Facility ID# (if applicable)
6800 Dwight Rowland Rd., Willow Springs 27592
Ph ical Address, City, and Zip
Wake
NA
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one Iat/long is sufficient)
35.593527 78.728177
N
6. Is (are) the well(s): ®Permanent or ❑Temporary
W
7. Is this a repair to an existing well: ❑Yes or lelNo
If this is a repair, fill out known well construction information and explain the nature of the
repair under #21 remarks section or on the back of this form.
one
S. Number of wells constructed:
For multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form. 141
9. Total well depth below land surface:
For multiple wells list all depths if dierent (example- 3@200' and 2Q100')
(ft)
NA
10. Static water level below top of casing: (ft.)
If water level is above casing, use "1"
811
11. Borehole diameter: v (in.)
12. Well construction method:
Auger
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm)
13b. Disinfection type:
Method of test:
Amount:
14. WATER ZONES
FROM
TO
DESCRIPTION
5 ft.
6 ft.
Light Brown Sandy SILT
rt.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if applicable)
FROM
TO
DIAMETER
THICKNESS 1 MATERIAL
ft
ft.
in.
16. INNER
CASING OR TUBING
(geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
4 ft.
2 in.
Sch 40
PVC
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
4 ft.
14 ft.
2 in.
0.010
Sch 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
ft.
ft.
0 it.
3 ft.
neat cement
145 lbs. - pour
3 ft.
3.5 ft.
bentonite
30 lbs. - pour
19. SAND/GRAVEL
PACK
(if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
3.5 rt.
16 ft.
#2 sand
Pour
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/ rock type, grain size, etc.)
0 ft.
0.5 ft.
ground cover - Reddish Tan SILT
0.5 ft.
3 ft.
Reddish Brown Clayey SILT
3 ft.
14 ft.
Light Brown Sandy SILT
fL
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
22. Certific 'on:
Signature ofenified Well Contractor
3/28/16
Date
By signing this form, I hereby certify that the wa(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 We!! Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW-1
North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 2013

Atlantic74. t eooawasee " "`"`1
Ph.
OF BORING: MW-3
Page: 1 of 1
Direct Push and
Site Name: Willow Springs ES Drilling/Boring Method: Hollow Stem Auger _ Total Boring Depth (ft): 14.0
Project Number: R2647.0B Sampling Method: NA Top of Casing Elev. (ft): 98.04
Location: Willow Springs. NC Subcontractor/Drillers: Quantex Latitude: 35.593527
Date Started: 3/25/2016 Driller : J.D. Barker Longitude: -78.728177
Date Completed: 3/25/2016 Monitoring Equipment: Technician: G. Fischer
w
?
c
Odors
FID (ppm)
Recovery (ft.)
SOIL DESCRIPTION (rotor.texwre.moisture.W.)
Construction Deatails
t»
q
c
—
2 —
c
Not Measured
3
Light Orange CLAY w/ Fine to Medium -Grained Sand
!LT
Screened 4-14 ft
3
— 2
—
o
z
—
4 —
Light Grey/Red-Orange and Light Brown Very Fine to Fine -Grained Sandny CLAY
-
— 4
6 —
—
8 —
Strong Petro Odor
Full Recovery
Light Orange and Light Grey Very Fine -Grained Sandy CLAY
— 6
—
— 8
—
—
Light Brown and Light Grey CLAY w/ Fine -Grained Sand
—
10
12 —
Full Recovery
Tan and Light Grey Clayey -SAND
— 10
— 12
14 —
Light Grey CLAY (Stiff)
— 14
16 —
18 —
20 —
22 —
24 —
26 —
28 —
30 —
— 16
— 18
— 20
— 22
— 24
— 26
— 28
— 30
COMMENTS: in - indicates inches N/A - indicates not applicable to this boring
ft - indicates depth in feet ppm - indicates parts per million
ft BLS - indicates feet below land surface

WELL CONSTRUCTION RECORD
For Internal Use ONLY:
This form can be used for single or multiple wells
1. Well Contractor Information:
James D. Barker
Well Contractor Name
3106A
NC Well Contractor Certification Number
Quantex, Inc.
Company Name
2. Well Construction Permit #: N R
List all applicable well construction permits (i.e. County, State, Variance, etc.)
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
ZRecovery
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 #21 Remarks)
4. Date Well(s) Completed: 9/27/19
5a. Well Location:
Willow Spring Elmntry
Well ID# RW-1 + RW-2
NA
Facility/Owner Name Facility ID# (if applicable)
6800 Dwight Rowland Rd., Willow Spring 27592
Physical Address, City, and Zip
Wake
NA
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.593559 N 78'728093
6. Is (are) the well(s): OPermanent or ❑Temporary
W
7. Is this a repair to an existing well: ❑Yes or ZINo
If this is a repair, fill out known well construction information and explain the nature of the
repair under #21 remarks section or on the back of this form.
8. Number of wells constructed: two
For multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
15'
9. Total well depth below land surface: (ft.)
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing: 11 ' S' (ft.)
If water level is above casing, use "+"
11. Borehole diameter: 9
12. Well construction method: Auger
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
14. WATER ZONES
FROM
TO
DESCRIPTION
10 ft.
11 ft.
Light Brown Clayey Sand
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if ap licable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
5 ft.
4 in*
Sch 40
PVC
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
5 ft.
15 ft.
4 in.
0.020
Sch 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
ft.
ft.
0 ft.
3 ft.
neat cement
145 lbs. - pour
3 ft.
4.5 ft.
bentonite
30 lbs. - pour
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
4.5 ft-
15 ft.
#3 sand
Pour
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
0 ft.
0.5 ft.
ground cover - Reddish Tan SILT
0.5 ft.
7 ft.
Reddish Brown Clayey SILT
7 ft.
15 ft.
Light Brown Clayey Sand
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS '
22. Certifrc
Signature ofjrertified Well Contractor
9/30/19
Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW-1
North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
For Internal Use ONLY:
This form can be used for single or multiple H ells
I. Well Contractor information:
Virgil Wilson
Well Contractor Name
4473
NC Well Contractor Certification Number
Parratt-Wolff, Inc.
Compam Name
2. Well Construction Permit#:
List all applicable well permits (i.e. County, Stale, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural ❑Municipal/Public
❑ Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial ❑Residential Water Supply (shared)
0-Irrigation
Non -Water Supply Well:
EMonitoring ❑Recovery
Injection 'Well:
❑Aquifer Recharge El Groundwater Remediation
❑ Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑ Experimental Technology ❑Subsidence Control
❑ Geothermal (Closed Loop) ❑Tracer
❑Geothermal (Heating/Cooling Return) ❑Other (explain under#21 Remarks)
4. Date Well(s) Completed: 12/16/20 Well ID# RW-4
5a. Well Location:
Wake County Board of Education Willow Springs Elementary
Facility/Owner Name Facility fD# (if applicable)
6800 Dwight Rowland Road, Willow Springs, NC
Physical Address, City, and Zip
Wake
0687007938
County Parcel Identification No (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field. one lat/long is sufficient)
35.593151 -78.728098
6. Is (are) the well(s): ©Permanent or ❑Temporary
7. Is this a repair to an existing well: Oyes or V1No
If this is a repair, fill out known well construction u(lormmion and explain the nature of the
repair under ,21 remarks .section or on the back of this form.
8. Number of wells constructed: 1
J or multiple injection or non -water supply rolls ONLY ividt the same construction, you can
.submit one farm.
9. Total well depth below land surface: 14
For multiple wells list all depths if dif ferent (example- 3 u 200' and 2 a l00')
(ft.)
10. Static water level below top of casing: 5 (ft.)
II -water level is above casing, use " - "
11. Borehole diameter: 10 5/8 (in.)
12. Well construction method: HSA
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
I3a. Yield (gpm) Method of test:
13b. Disinfection type: _ Amount:
1.1. WATER ZONES
FROM
TO
DFSCRIPTION
5
ft.
14
ft.
wet
ft.
ft.
15. OUTER CASING (for multi -cased wdlsl OR LINER (if ap licable)
FROM
TO
DIAM ETER
TH ICKN F_SS
MATERIAL
ft.
ft.
In.
16. INNER CASING OR TUBING (geothermal closed-lnupl
FROM
0
ft.
TO
4
ft.
DAIETER
4
in.
THICK -NE -SS
sch40
MATERIAL
pvc
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
4
ft.
14 ft.
4
in.
.020
sch40
pvc
ft.
ft.
in.
1S. GROUT
FROM
0.5 ft.
TO
2
ft.
MATERIAL
Portland Cem
EMPLACEM ENT :METHOD s .IMOt,ti '�
Tremie
2
ft.
ft.
3
ft.
ft.
Bentonite Chi
Tremie
19. SAND/GRAVEL PACK (WappUcahle)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
3
ft.
14
ft.
#1 Sand
Tremie
ft.
ft.
20. DRILLING LOG (attach additional sheet, if nrcesattry)
FROM
ft.
ft.
TO DESCRIPTION {color. hardness, soil/fork type. grain sire, etr.I
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
24" sonotube with 8" FMC
22. Cert. catiun:
Signamrc of Certified Well Contractor
Date
By signing this torn, I hereby certify that the well(s) was (here) constructed in accordance
with /5A N('A(' 02(' .0100 or 15,4 N('A(' 02(' .0200 Well ('onslruclion Standards and that a
copy of this record has been provided to the aril owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. Fur All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells ONLY: In addition to sending the form to the address in
24a above. also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells:
Also submit one copy of this forth within 30 days of completion of
well construction to the county health department of the county where
constructed.
Form GW-I North Carolina Department of Environment and Natural Resources- Division of Water Resources
Revised August 2013

Ilra• 409 Rogers View Ct.
Mird Atlantic Raleigh NC27610
Engineering &Environmental Solutions Ph: [phone]
LOG OF BORING: RW-4
Page: 1 of 1
Willow Springs
Site Name: Elementary Drilling/Boring Method: Hand Auger and HSA Total Boring Depth (ft): 14'
Project Number: 000R2647.06 Sampling Method: N/A Well Depth (ft): 14'
Location: Willow Springs, NC Subcontractor/Drillers: Parratt-Wolff, Inc. Screen Depth (ft): 4-14'
Date Started: 12/16/2020 Driller : Virgil Wilson DTW: 5' Below TOC
Date Completed: 12/16/2020 Monitoring Equipment: N/A MAA Field Staff: Gary Fischer
,
w
ing
IntSamplOdors
PID (ppm)
FID (ppm)
SOIL DESCRIPTION (color, texture, moisture, etc.)
Construction Details
at
w
—
Light brown slightly sandy silty clay
Sand:3'-14'
—
_
Gravel
Screen: 4'-14'
5 —
N/A
N/A
Light orange slightly sandy clayey silt
—
— 5
—
10 —
Strong Odor
Tan fine sandy silt
—
—
—
— 10
Tan slightly sandy clay
15 —
20 —
Boring terminated at 14 ft-bgs
— 15
— 20
COMMENTS: in - indicates inches N/A - indicates not applicable to this boring
DTW - Depth to Water V ft - indicates depth in feet ppm - indicates parts per million
HAS - Hollow Stem Auger ft-bgs - indicates feet below ground surface TOC - Top of Casing

ATTACHMENT D
SIGNATURE AUTHORITY EMAIL
(SECTION N)
Mid Atlantic
Engineering & Environmental Solutions