WI0300469_Permit (Issuance)_20220120

APEX
January 7, 2022
Ms. Shristi Shrestha
Division of Water Resources
North Carolina Department of Environmental Quality
512 North Salisbury Street
Raleigh, North Carolina 27699
Subject: Notification of Intent to Construct or Operate Injection Wells
SR 2448 / Pipeline ROW
Huntersville, Mecklenburg County, North Carolina
NCDEQ Incident No. 95827
Dear Mr. Watson,
Apex Companies, LLC (dba Apex Engineering, P.C.; Apex) is submitting the attached updated Notification
of Intent to Construct or Operate Injection Wells (NOI) on behalf of Colonial Pipeline Company (CPC).
This updated NOI encompasses all existing 22 air sparge (AS) wells in addition to all existing 18 soil
vapor extraction (SVE) wells for which a NOI was submitted on 1/21/2021, as well as up to 60 additional
proposed SVE locations required for soil remediation activities.
The purpose of the AS wells is to prevent migration of dissolved phase contamination while the purpose
of the SVE wells is to recover vapor from vadose zone soil. A site location map is provided as Figure 1,
and a site map is provided as Figure 2. An existing AS/SVE layout map is provided as Figure 3. The
proposed SVE points layout is provided as Figure 4. Well construction will vary in depth, depending on
groundwater depth at each location. However, well construction will occur in accordance with the typical
Well Details diagram provided as Figure 5. As-builtwell boring logs and GW-1 forms are included as an
attachment.
If you have any questions or concerns, please do not hesitate to contact the undersigned at (704) 936-
6394.
Sincerely,
Apex Companies, LLC
Prepared By:
Andrew Street, RSM, CHMM
Senior Project Manager
Enclosure
cc: Mr. Jeff Morrison - CPC
Mr. John Wyatt - CPC
Tom Naumann, PG
Senior Scientist
Apex Companies, LLC • 5900 Northwoods Business Pkwy, Ste 5900-0 • Charlotte, NC 28269 • T 704.799.6390 • F 704.799.6395 • apexcos.com

NOTIFICATION OF INTENT TO CONSTRUCT OR OPERATE INJECTION
WELLS
A
APEX

NC Department of Environmental Quality — Division of Water Resources (DWR)
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 (NOTE: This form must be received at least 14 DAYS 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 (Note: Injection Event Records (IER) do not need to be
submitted for replacement of each sock used in ORC systems).
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 is 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.
5) In -Situ Thermal Wells (IST) — Used to `heat' contaminated groundwater to enhance remediation.
Print Clearly or Type Information. Illegible Submittals Will Be Returned as Incomplete.
DATE: January 7 , 2022
by DWR)
PERMIT NO. (to be filled in
NOTE- If this NOI is being submitted as notification of a modification of a previously issued NOI for this site (e.g.,
different injection wells, plume, additives, etc.) and still meets the deemed permitted by rule criteria, provide the
previously assigned permit tracking number and any needed relevant information to assess and approve injection:
Permit No. WI Issued Date:
A. WELL TYPE TO BE CONSTRUCTED OR OPERATED
(1) X Air Injection Well... Complete sections B through F, J, M
(2) Aquifer Test Well... Complete sections B through F, J, M
(3) Passive Injection System... Complete sections B through F, H-M
(4) Small -Scale Injection Operation Complete sections B through M
(5) Pilot Test... Complete sections B through M
(6) Tracer Injection Well... Complete sections B through M
(7) In -Situ Thermal (IST) Well... Complete sections B through M
B. STATUS OF WELL OWNER: Business/Organization
Deemed Permitted GW Remediation NOI Rev. 2-17-2020 Page 1

C. 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:
Name(s): Colonial Pipeline Company — John Wyatt— Environmental Manager
Mailing Address: 4295 Cromwell Road #311
City: Chattanooga State: TN Zip Code: 37421 County: Fulton
Day Tele No.: 423-713-7568 Cell No.: 440-713-9270
EMAIL Address: [e-mail] Fax No.: 770-754-8119
D. PROPERTY OWNER(S) (if different than well owner/applicant)
Name and Title: Mecklenburg County (Oehler Nature Preserve)
Company Name Mecklenburg County
Mailing Address: 600 E 4th St, 1 lth Floor
City: Charlotte State: NC Zip Code: 28202 County: Mecklenburg
Day Tele No.: N/A Cell No • N/A
EMAIL Address: N/A Fax No.: N/A
E. PROJECT CONTACT (Typically Environmental Consulting/Engineering Firm)
Name and Title: Andrew Street - Senior Project Manager
Company Name Apex Companies, LLC.
Mailing Address: 5900 Northwoods Business Pkwy, Suite 5900-0
City: Charlotte State: NC Zip Code: 28269 County: Mecklenburg Day Tele No.:
704-936-6394 Cell No.:
EMAIL Address: [e-mail] Fax No.:
F. PHYSICAL LOCATION OF WELL SITE
(1) Facility Name & Address: 14511 Huntersville-Concord Rd
City: Huntersville County: Mecklenburg Zip Code: 28078
(2) Geographic Coordinates: Latitude**: 35° 24' 51.03" or °.
Longitude**: 80° 48' 21.42" or °.
Reference Datum: NAD 83 Accuracy: 15 feet Method of
Collection: GPS
**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
Land surface area of contaminant plume:
Land surface area of inj. well network: square feet (< 10,000 ft2 for small-scale injections)
Percent of contaminant plume area to be treated: (must be < 5% of plume for pilot test injections),
Deemed Permitted GW Remediation NOI Rev. 2-17-2020 Page 2

H. INJECTION ZONE MAPS — Attach the following to the notification.
(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.
I. DESCRIPTION OF PROPOSED INJECTION ACTIVITIES AT THE SITE — Provide a brief narrative
regarding the cause of the contamination, and purpose, scope, goals of the proposed injection activity:
J. WELL CONSTRUCTION DATA
(1) No. of injection wells: 82 (SVE) Proposed 22 Air Sparge/18 SVE Existing (provide NC Well
Construction Record (GW-1) for each well)
(2) Appx. injection depths (BLS): Variable 30-50 ft. (drilled to bedrock and screened 2 feet above)
(3) 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):
(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
K. INJECTION SUMMARY
NOTE: Only injectants approved by the epidemiology section of the NC Division ofPublic 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-injectants. All other substances must be reviewed by the DHHS prior to use.
Contact the UIC Program for more info if you wish to get approval for a different additive. However, please
note it may take 3 months or longer.
Injectant: Total Amt. to be injected (gal)/event:
Injectant: Total Amt. to be injected (gal)/event:
Injectant: Total Amt. to be injected (gal)/event:
Injectant: Total Amt. to be injected (gal)/event:
Injectant: Total Amt. to be injected (gal)/event:
Deemed Permitted GW Remediation NOI Rev. 2-14-2020 Page 3

Amt. Water to be injected (gal/event):
Total Amt. to be injected (gal/event):
No. of separate injection events: Est. Total Amt. to be injected (gal):
Source of Water (if applicable):
L. 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.
M. SIGNATURE OF APPLICANT AND PROPERTY OWNER
Well Owner/Applicant: "1 hereby certify, under penalty of law, that 1 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 wellynd all related appurtenances in accordance with the 15A NCAC 02C 0200 Rules."
Si dattire of Applicant
�o inn.) M. lAfituL4. FAA], ?raArovi l M5,�
Print or Type rim Name and Title
Property Owner (if the property is not owned by the Well Owner/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.
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.
Please send 1 (one) hard color copy of this NOI along with a copy on an attached CD or Flash Drive at least
two (2) weeks prior to injection to:
DWR — UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone: [phone]
Deemed Permitted GW Remediation NOI Rev. 2-14-2020
Page 4

FIGURES
A
APEX

Checked By:
Created By:
Scale:
Date/Time:
Project No.:
AS
JC
1"=754FT
12/28/2020; 14:58
CPC20126
Site Location Map
Colonial Pipeline Company
2o2o-Li-SR2448 Release
Huntersville, North Carolina
0 405 810 1,620 2,430
Feet
Figure
1
{ Release Site
APEX

MW-10I
I PV-17l
I AS-21 O
J MW-56I
M W-57Dj
J MW-97DI
M W-94I
MW-95 r
RW-72
MW-03 RW-83
RW-931
R~W73� MW-07I
RW-92MW-54 � V I RW-33
M W-36
RW-74 RW�61 MW-26R
RW57-60 V I RW-94 J MW-20i
l R\
/(/'
RW-75- RW-84� r RW-621 J RW-98
RW-32
MW-22R J MW-63I
• RW-31 I RW-87-- — RW-59I W R-27i RW-96I .
RW-76 MW-3BI ) RW-971
■ I RW-86 l 1 RW-58I
RW-906- I RW-881 RW-6J
MW-37RI I3 FRW-68 / ^I RW 67i RW-29 J RW-95I J MW-1BR
�\•
I RW-89RW-65 , MW-72R1
® < RW-64
f RW-07I
/� ,
• MW-25DI
RW-30( I RW-633 L
RW-69
MW-48I
`-- RW-23I
RWB1
MW-43I H RW-80I
RW-03I ,
1 MW-831 >MW-40I ,.
MW-85I 1
f MW-84 • AMU
•
•
•
•
•
•
•
PV-16I
Data Sources: Mecklenburg County GIS (Streets)
MW-81D
PV-12I
MW-81I
RW-100I
I MW-90DD
J RW-131
I RW-20
MW-91 DD�
RW-02r
RW-46I J RW-45I
RW-12I
0
RW-08
RW-17I 0
RW-53I RW-52
MW-62I
RW-44I
fRW-34I
_J
1 RW-78I
J RW-77I yJ
/!lw MW-93
MW-88I
MW-89DI
11) RW-36I
RW-35
MW-61
RW-481 1 MW-61D
MW-42
1 MW-68I S-14
R ] AS-121
W28
ilk PV-09I I AS-13 PV-10\
J MW-50I
RW-56
PV-08 SMC-02
W-461 MW-49
I AS-101._ / MW-14DI
MW-14
PV-06] H AS-09I
MW-66I
MW-65DI
Checked By:
Created By:
Scale:
Date/Time:
Project No.:
AS
CW
1"=150FT
12/29/2021; 09:15
CPC20126
0
Document Path: E:Wpex\Huntersville\Figu es\MXDs\Figure 2-Site Plan_Portrait.mxd
Site Plan
Colonial Pipeline Company
2o2o-Li-SR2448 Release
Huntersville, North Carolina
150 300
Feet
Release Site
-- Pipeline
Monitoring Well
ilk Monitoring Well (Bedrock)
11, Recovery Well
Hydraulic Control Well
Air Sparge
Vapor Point
Piezometer
Notes:
Installed well points that have been
surveyed are currently depicted.
APEX
FIGURE
2

HUNTERSVILLE-CONCORD
PV-18
ItH AS-22
SVP-14 H pV-17
H AS-21
PV-16
Lj AS-20
Lj PV-15
SVP-15
AS-197
Data Sources: Mecklenburg County GIS (Streets). US Geological Survey (Elevation Products)
PV-14
AS-18
PV-13(� �N
AS-17
SVP-12
SVP-10
AS-16
HAS-02
H AS-03
Gj PV-01
HAS-04
Lj PV-02
SVP-13
Lj PV-06
-1 AS-08
SVP-07
SVP-08
®� �r a.f+
SVP-02
SVP-01
AS-13
SVP-05
SVP-03
,SVP-04
SVP-06
A
PV-11
Checked By:
Created By:
Scale:
Date/Time:
Project No.:
AS
CW
1"=100FT
12/28/2021; 12:17
CPC20126
Air Sparge System Layout
Colonial Pipeline Company
2o2o-Li-SR2448
Huntersville, North Carolina
0 100 200 300
Feet
Release Site
�m Pipeline
Air Sparge Well
Soil Vapor Extraction Well
Soil Vapor Monitoring Point
AreaRae Monitoring Station
Note: The following locations were inactive during the period of 8/23-9/10:
AS-15, PV-11, AS-14, PV-10, AS-13, PV-09, AS-12, AS-11, AS-10
APEX
FIGURE
3

MW-02'':.'
MW-04D' MW-04
,41210470.
-11D: 1949102
%e. lenburg County
ntersville-Concord Rd
D t S •M kl b rs t (-lie St t
a a ources. ec en urg oun y ( ree s) EEL. F
i
T
HUNTERSVILLE-CONCORD RD
Infnrmatinn depicted is subject to change hacarl nn ft au Ira city anti ,itiac
Checked By:
Created By:
Scale:
Date/Time:
Project No.:
TN
CW
1 " = 80 FT
01/05/2022; 08:59
CPC20126
Document Path: E AApex\Huntersville\Figures\MXDs\Requests\Figure X-SVE Soil Samples.mxd
Proposed SVE System Locations
Colonial Pipeline Company
2o2o-Li-SR2448
Huntersville, North Carolina
0 80 160 240
Feet
Legend
Release Site
=•=•=0 Pipeline
9 Monitoring Well O Proposed SVE
(Bedrock) System Location
Recovery Well
Hydraulic Control
Monitoring Well Well
Proposed SVE Pipe
System
Proposed Phase 1
SVE System Areas
APEX
FIGURE
4

-12" STD. ROUND
MANHOLE
H 3"
FINISHED GRADE
1" SDR 11 HDPE
2" SCH 40
SLP. TO
FNPT ADAPTOR
1" HDPE TO .SCH 40
TRANS. FITTING
2" DIAMETER SCREWED
PVC WELL RISER
CEMENT/BENTONITE GROUT
BENTONITE
SEAL
10/30 SAND PACK
2", 0.010-INCH SLOT
PVC WELL SCREEN
END CAP
NOTES:
1. VAULT COMPLETION SHOWN.
2. AIR SPARGE (AS) WELLS BY OTHERS.
3. CONTRACTOR TO EXCAVATE AROUND WELL TO INSTALL
PIPING AND VAULT.
4. CONCRETE MUST EXTEND BELOW AND ENCASE
BOTTOM OF VAULT.
-2" SCH 40
MNPT PLUG
BARRIER AS WELL DETAILS
(N.T.S. - TYPICAL OF 22 WELLS)
CONCRETE
APRON
FINISHED GRADE
3" MIN. #57 STONE
0
2" TEE (SLP. X SLP. X SLP.)
1" BALL VALVE
2" SCH 40
I I \ I MNPT PLUG
3"
2" SDR 11 HDPE
2" SCH 40
SLP. TO
FNPT ADAPTOR
2" HDPE TO 2"Xl" REDUCER
TRANS. FIT11NG
BOREHOLE
2" DIAMETER SCREWED
PVC WELL RISER
CEMENT/BENTONITE GROUT
BENTONITE
SEAL
10/30 SAND PACK
2", 0.010-INCH SLOT
PVC WELL SCREEN
CONCRETE
APRON
0
2"X2"X1" TEE (SLP. X SLP. X SLP.)
3" MIN. #57 STONE
NOTES:
1, VACUUM LINE DIRECTS BACK TO THERMAL OXIDIZER.
2. WELLS FINISHED APPROXIMATELY 2 FT. ABOVE WATER TABLE AT TIME OF DRILLING.
PV WELL DETAILS
(N.T.S. - TYPICAL OF 100 WELLS)
GENERAL NOTES:
1. MAGNETIC TAPE SHALL BE INSTALLED 3-INCHES ABOVE ALL NONFERROUS PIPING.
2. ALL EXCAVATED AREAS SHALL BE RESTORED TO THEIR ORIGINAL GRADE AND CONDITION.
3. NO PIPING SHALL BE BACKFILLED WITHOUT APPROVAL FROM OWNER'S REPRESENTATIVE.
4. USE ORIGINAL EXCAVATED MATERIAL AS PIPE BACKFILL. COMPACT AND REGRADE TO ASSURE THAT EXCAVATED
AREA DOES NOT SETTLE BELOW ORIGINAL GRADE.
5. TRENCH WIDTH FOR PIPING SHALL BE MINIMUM PRACTICAL WIDTH TO PERMIT QUALITY PIPE
FUSION/INSTALLATION ACTIVITIES.
AREx
SCALE: N.T.S
D XX XX
REVISION DESCRIPTION
BY
DATE
1
2
3
WELL DETAILS
CPC HUNTERSVILLE
HUNTERSVILLE, NORTH CAROLINA
FIGURE:
5
BY: JGR
DATE: 1/E/2021

WELL CONSTRUCTION DIAGRAMS
APEX

ABORING NUMBER AS-02
Apex Companies
APEX
CLIENT Colonial Pipeline PROJECT NAME 2020-L1-SR2448
PROJECT NUMBER CPC21018 PROJECT LOCATION Huntersville, NC
DATE/TIME STARTED 12/9/2020 COMPLETED 12/9/2020 GROUND ELEVATION 724.39 ft TOP OF CASING 695.39 ft
DRILLING CONTRACTOR Parratt-Wolff EQUIPMENT CME-850X
DRILLER Kevin White GROUND WATER LEVELS AND TIME:
LOGGED BY Kyle Zigler BOREHOLE DIAMETER 2 in. DURING DRILLING ---
METHOD Hollow Stem Auger 8.25" AFTER DRILLING ---
© DEPTH
(ft)
SAMPLE TYPE
NUMBER
ENVIRONMENTAL
DATA
GRAPHIC
LOG
MATERIAL DESCRIPTION
COMMENTS
WELL DIAGRAM
Casing Type: 2
- -
- -
- -
5
j
LEAN CLAY, (CL) red brown,
moist
5.0
719.4a.
:4
a ;
:4°
as
4 ^
a ;
4
.
- -
- -
10
j
LEAN CLAY, (CL) pale red
brown, moist
Soil sampleA9 (10-12')
5/26/2021 at 1425
:4
as
s•
_4^
as
•
^
:4 ^
as
_4^
a ;
' �-
Type S Cement
- -
- -
- -
- -
15
j
j
700.4
=4
°
-4e
a;
:4^
°
'4e
a;
:4:
—
[4'
a
-4
a^
:4^
a.
:4
a^
:4:
: %!
2-in. Sch 40 PVC
casing
^
^
Bentonite
GP-1 sand
- -
20
'j/240
- -
25
SILTY SAND, (SM) yellow brown,
moist
- -
- -
29.0
695.4
;
—
_
2-in. Sch 40 PVC
0.010 slotted screen
Refusal at 29.0 feet.
Bottom of borehole at 29.0 feet.

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
Kevin White
Well Contractor Name
2973
NC Well Contractor Certification Number
Parratt-Wolff, Inc.
Compam Name
2. Well Construction Permit#:
List all applicable well permits (i.e. (ouiiiv, State, Variance, Injection, etc)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ industrial/Commercial
❑ lrrigati on
❑Municipal/Public
❑.Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
0 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 #21 Remarks)
4. Date Well(s) Completed: 12-9-20 Well ID# AS-02
5a. Well Location:
Colonial Pipeline Company
Facility/Owner Name Facility JD# (if applicable)
14511 Huntersville-Concord Road, Huntersville, NC 28078
Physical Address, City, and Zip
Mecklenburg
County Parcel identification No. (PiN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.412792 N-80.806405
6. is (are) the well(s): OPermanent or ❑Temporary
w
7. Is this a repair to an existing well: ❑Yes or ENo
If this is a repair,.lill out known well construction information and explain the nature a/ the
repair under ,21 remarks .section or on the hack of this form_
8. Number of wells constructed::
For multiple injection or non -water supply wells ONLY nrilh the same construction, vas can
.submit one form.
9. Total well depth below land surface: 29 (ft)
/ or multiple wells list all depths if different (example- 3 «200' and 2 u l00')
10. Static water level below top of casing: 27 (ft.)
If eater level is above casing, use "• '
11. Borehole diameter: 2 (in.)
12. Well construction method: 8 1/4 HSA
(i e auger, rotary, cable, direct push, etc-)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
I3b. Disinfection type: Amount:
For Internal Use ONLY:
14. WATER ZONES
FROM
TO
DESCRIPTION
27 ft.
29 ft.
wet
ft.
ft.
15. OUTER CASING (for multi -cased wdfs OR LAN ER (if ap irnble)
FROM
TO
DIAMETER
11IICKNE.SS
MATERIAL
ft.
ft.
In.
16. 1NNER CASING OR TUBING (geothermal rinsed -loop)
FROM
TO
DIAMETER
THICKNESS'
MATERIAL
0 ft.
27 ft.
2 in.
sch40
pvc
ft.
ft.
in.
17. SCREEN
FROM
TO
E IAMETER
SLOT SIZE
THICKNESS
MATERIAL
27 it.
29 ft-
2 in.
.010
sch40
pvc
t't.
ft.
in.
1& GROUT
FROM
TI)
MATERIAL
EMPLACEMENT MR111OD & AMOUNT
0 ft.
23 it
Portland Cem
Tremie
23 ft.
25 ft.
Bentonite Chii
Tremie
ft.
ft.
19. SAND/GRAVEL PACK of applicable)
FROM
TO
'I.sIERI:tL
EMPLACEMENT METHOD
25 ft.
29 it.
#1 Sand
Tremie
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION Icahn-, haw&nrsy.uilhvr1i irpr. grain size, etc-1
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
fr.
21. REMARKS
No cover
22. Certification:
Signature ofCerlified Well Contractor
('CJ\
Date
By signing This form, 1 hereby cerlifv that the well(s) was (were) constructed in accordance
with 15.4 NCAC 02C.0100 or 15,4 NCAC 02C.0200 Well ('anslnnclion 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 AR :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 lnieetion Wells ONLY: In addition to sending the form to the address in
24aabove, 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 form within 30 days of completion of
well construction to the county health department of the county where
constructed,
Foim GW-I North Carolina Department of Environment and Natural Resources- Division of Water Resources
Revised August 2013

ABORING NUMBER AS-03
Apex Companies
APEX
CLIENT Colonial Pipeline PROJECT NAME 2020-L1-SR2448
PROJECT NUMBER CPC21018 PROJECT LOCATION Huntersville, NC
DATE/TIME STARTED 12/9/2020 COMPLETED 12/9/2020 GROUND ELEVATION 723.66 ft TOP OF CASING 723.49 ft
DRILLING CONTRACTOR Parratt-Wolff EQUIPMENT CME-850X
DRILLER Kevin White GROUND WATER LEVELS AND TIME:
LOGGED BY Kyle Zigler BOREHOLE DIAMETER 2 in. DURING DRILLING ---
METHOD Hollow Stem Auger 8.25" AFTER DRILLING ---
© DEPTH
(ft)
SAMPLE TYPE
NUMBER
ENVIRONMENTAL
DATA
f GRAPHIC
LOG
MATERIAL DESCRIPTION
COMMENTS
WELL DIAGRAM
Casing Top Elev: 723.49 (ft)
Well Diameter: 2
_ _
5
jLEAN
d50
CLAY, (CL) red brown, dry
.
7187a•
:4
a:
4e
4
4
�.
- -
_
-
- -
10
SILTY SAND, (SM) red brown,
dry
:4
°;
:4"
a°
:4^
a
a°
:4^
°
.
' a
:4^
a°
4
.;
:4°
a°
:4^
a°
a .° '-
:4^
' a °
.
:4^
a•
Type S Cement
_ _
- -
-
- -
15
703.7
:4 .
a^
:4^
a°
:4^
a°
.'
'"
1
.
:4 .
a^
:4^
a°
:4^
a °
.'
a •
2-in. Sch 40 PVC
casing
- -
- -
- -
20
: 20.0
- -
25
4
Bentonite
GP-1 sand
- -
- -
28.0
695.7
::
:•:.:`-:•:.:
::
2-in. Sch 40 PVC
0.010 slotted screen
Refusal at 28.0 feet.
Bottom of borehole at 28.0 feet.

WELL CONSTRUCTION RECORD
This form can be uscd for single or multiple wells
1. Well Contractor Information:
Kevin White
Well Contractor Name
2973
NC Well Contractor Certification Number
Parratt-Wolff, Inc.
Company Name
2. Well Construction Permit #:
List all applicable well permits (1,e. County, Slate, 1 ariance, Injection, 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:
❑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 #21 Remarks)
4. Date Well(s) Completed: 12-9-20 Well ID# AS-03
5a. Well Location:
Colonial Pipeline Company
Facility/Owner Name Facility ID# (if applicable)
14511 Huntersville-Concord Road, Huntersville, NC 28078
Physical Address, City, and Zip
Mecklenburg
County Parcel identification No (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.412731 -80.806410
6. is (are) the well(s): ©Permanent or ❑Temporary
w
7. Is this a repair to an existing well: ❑Yes or 1No
//This is a repair,,/ill out known well constreclion information and explain the nature o/'the
repair under 21 remarks section or on the back of this fornn.
8. Number of wells constructed: 1
For multiple injection or non -water supply wells ONLY with the same construction, you can
.submit one_Jorm.
9. Total well depth below land surface: 28 (ft.)
For multiple wells list all depths if different (example- 3@200' and 2a /0(J')
10. Static water level below top of casing: 26 (ft.)
If water level is above casing, use " "
11. Borehole diameter: 2 (in.)
12. Well construction method: 8 1/4 HSA
(i e. auger, rotary. cable, direct push, etc )
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
For Internal Use ONLI':
14. WATER ZONES
FROM
TO
DESCRIPTION
26 it.
28 ft.
wet
ft.
ft.
1S. OUTER CASING (for multi -caged welts) OR LINER (if app ieo Me)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING (geothermal dosed -imp)
FROM
TO
DIAMETER
THICKNE.S.S
MATERIAL
0 it.
26 ft.
2 in.
sch40
pvc
ft.
ft.
in.
17. SCREEN
FROM
1'0
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
26 ft-
28 ft.
2 in.
.010
sch40
pvc
ft.
ft.
in.
IS. GROUT
FROM
TO
MATER4RL
EMPLACEMENT NI ETHOD ., AMOUNT
0 ft.
22 ft•
Portland Cem
Tremie
22 ft.
24 ft•
Bentonite Chi
Tremie
ft.
ft.
19. SAND/GRAVEL PACii
(if applicable
FROM
TO
MATERIAL
EMPLACEMENT METHOD
24 it
28 ft,
#1 Sand
Tremie
ft.
ft.
20. DRILLING LOG (attoch additional sheets if necessary)
FROM
TO
DESCRIPTION iculur. hardness, soil/rock type, grain dze, etc.)
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
No cover
22. Certification:
�w f
Signature of Certified Well Contractor
-Z�
Date
By signing this Jam, / hereby cern& that the ire//(s) was (were) constructed in accordance
with 15-I NCAC 02C.0100 or 15A NCA(' 02(',0200 Well Construction Standards and that a
copy of this record has been provided to the we// 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 Injection Wells ONLY: in addition to sending the form to the address in
24a above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & injection Wells:
Also submit one copy of this form within 30 days of completion of
well construction to the county health department of the county where
constructed.
Form GW- I
Noitlt Carolina Department of Environment and Natural Resources — Division of Water Resources Revised August 2013

ABORING NUMBER AS-04
Apex Companies
APEX
CLIENT Colonial Pipeline PROJECT NAME 2020-L1-SR2448
PROJECT NUMBER CPC21018 PROJECT LOCATION Huntersville, NC
DATE/TIME STARTED 12/9/2020 COMPLETED 12/9/2020 GROUND ELEVATION 723.37 ft TOP OF CASING 723.06 ft
DRILLING CONTRACTOR Parratt-Wolff EQUIPMENT CME-850X
DRILLER Kevin White GROUND WATER LEVELS AND TIME:
LOGGED BY Kyle Zigler BOREHOLE DIAMETER 2 in. DURING DRILLING ---
METHOD Hollow Stem Auger 8.25" AFTER DRILLING ---
© DEPTH
(ft)
SAMPLE TYPE
NUMBER
ENVIRONMENTAL
DATA
f GRAPHIC
LOG
MATERIAL DESCRIPTION
COMMENTS
WELL DIAGRAM
Casing Top Elev: 723.06 (ft)
Well Diameter: 2
_ -
- -
-
5
j
j
LEAN CLAY, (CL) red brown, dry
713.4
:4
°s
-4
a.
_4
a;
°
a:
:4.
a^
a^
_4e
Q^
_4e
a.
4
4:
4.
4
a:
:4
a .
a.
•4 N
a ^
:4:
a.
T e S Cement
yp
-
-
-
110
j
410.0
- -
- -
-
15
703.4:
•4
a •
_4^
a°
_4^
a .
. ,
_4^
a°
_4^
a°
, -.1•4
,
a •
:4^
a•
:4^
a
. ,
:4^
•
•.
:4^
a•
•
, 2-in. Sch 40 PVC
casing
Bentonite
A
-
20
20.0
j
LEAN CLAY WITH GRAVEL,
21.0 (CL) gray brown, dry
.
7024
::'
=:
,:
: ;
GP-1 sand
- -
22.0
701.4
—
2-in. Sch 40 PVC
0.010 slotted screen
Refusal at 21.5 feet.
Bottom of borehole at 22.0 feet.

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
Kevin White
Well Contractor Name
2973
NC Well Conti actor Certification Number
Parratt-Wolff, Inc.
Comport) Name
2. Well Construction Permit#:
List al/ applicable well permits (i_e. County, Stare, I arianee, bryection, ein)
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 Retum)
❑ Groundwater Remediation
❑ Sal inity Barrier
❑ Stormwater Drainage
❑Subsidence Control
❑ Tracer
❑ Other (explain under #21 Remarks)
4. Date Well(s) Completed: 12-9-20
5a. Well Location:
Colonial Pipeline Company
Facility/Owner Name
Well ID# AS-04
Facility 1Dt1 (if applicable)
14511 Huntersville-Concord Road, Huntersville, NC 28078
Physical Address, City, and Zip
Mecklenburg
County Patcel identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.412578 N-80.806386
6. is (are) the well(s): ©Permanent or ❑Temporary
7. is this a repair to an existing well: ❑Yes or ONo
117hi.s is a repair,, Jill out known well construction information and explain the nature oldie
repair order -21 remarks section or on the back of this, form.
8. Number of wells constructed: 1
For multiple in/eclion or non -water supply wells ONLY with the same construction, you can
submit one form.
9. Total well depth below land surface: 22 (ft,)
For multiple wells list all depths if di lerenl (example- 3@200' and 2 ct 100')
10. Static water level below top of casing: 20 (ft.)
if water level is above casing, use "- "
11. Borehole diameter: 2 (in.)
12. Well construction method: 8 1/4 HSA
(i.e. auger, rotary. cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type:
Amount:
For Internal Use ONLY:
I-L WATER ZONES
FROM
TO
rwscuIPTI0N
20 ft.
22 ft.
wet
ft.
ft.
15. OUTER CASING (for tntdti-cased wells) OR LINER IifsppHumble)
FROM
TO
DIAMETER
THICKNESS i AI.ATER IA
ft.
ft.
in.
!j
16. INNER CASING OR TIRING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft'
20 ft,
2 in•
sch40
pvc
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
20 ft.
22 ft•
2 in.
.010
sch40
pvc
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft.
16 ft.
Portland Cem
Tremie
16 ft•
18 ft.
Bentonite Chi
Tremie
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
18 ft.
22 ft.
#1 Sand
Tremie
ft.
ft.
20. DRILLING
LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION [color. Ilardnv .. anirlroek rype, Brain site, etc.)
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
No cover
22. Certification:
&• A
Signature of Certified Well Contrretor
(- 13•aL
Date
By signing this foram, 1 herehy certify that the well(%) was (were) constructed in accordance
with 15A NCAC 02(' .0/00 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. Fur All Well: 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 Welis.ONLY: In addition to sending the form to the address in
24aabove, 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 form within 30 days of completion of
well construction to the county health department of the county where
constructed.
Forst GW-1
North Carolina Department of Environment and Natural Resources - Division of Water Resources
Revised August 2013

APEX
CLIENT
PROJECT
DATE/TIME
DRILLING
DRILLER
LOGGED
METHOD
A BORING NUMBER AS-05
Apex Companies
Colonial Pipeline PROJECT NAME 2020-L1-SR2448
NUMBER
STARTED
CONTRACTOR
Kevin
CPC21018 PROJECT LOCATION Huntersville, NC
12/9/2020 COMPLETED 12/9/2020 GROUND ELEVATION 723.65 ft TOP OF CASING 723.60 ft
Parratt-Wolff EQUIPMENT CME-850X
White GROUND
WATER LEVELS AND TIME:
DURING DRILLING ---
BY BOREHOLE DIAMETER 2 in.
Hollow Stem Auger 8.25" AFTER DRILLING ---
© DEPTH
(ft)
SAMPLE TYPE
NUMBER
ENVIRONMENTAL
DATA
GRAPHIC
LOG
MATERIAL DESCRIPTION
COMMENTS
WELL DIAGRAM
_ _
10
Well Construction
Details Pending
20
30
40
50

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
Kevin White
Well Contractor Name
2973
NC Well Contractor Certification Number
Parratt-Wolff, Inc.
Company Name
2. Well Construction Permit #:
List all applicable well permits (i.e. County, State, Variance, Injection, etc,)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
El Geothermal (Heating/Cooling Supply)
❑industrial/Commercial
❑Irrigation
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
El Mon itoring
❑Recovery
Injection Well:
❑ Aquifer Recharge
❑ Aquifer Storage and Recovery
❑ Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Retum)
❑Groundwater Remediation
❑ Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑ Tracer
❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: 12-9-20
5a. Well Location:
Colonial Pipeline Company
Facility/Owner Name
Well ID# AS-05
Facility ID# (if applicable)
14511 Huntersville-Concord Road, Huntersville, NC 28078
Physical Address, City, and Zip
Mecklenburg
County Parcel Identification No (PEN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one Iat/Iong is sufficient)
35.412535 N-80.806399
6. Is (are) the well(s): 171Permanent or ❑Temporary
W
7. Is this a repair to an existing well: ❑Yes or ENo
1/ this is a repair,, fill out known well construction in/hrntation and explain the nature of the
repair under '21 remarks .section or on the back of this form.
8. Number ofwells constructed: .1
For multiple injection or non -water supply wells ONLY with the same construction, _von can
submit one_form.
9. Total well depth below land surface: 27.5 (R,)
For multiple wells list all depths if different (erantple- 3@200' and 2@100')
10. Static water level below top of casing: unknown
lfwater level is above casing, use "- "
11. Borehole diameter: 2 (in.)
12. Well construction method: 8 1/4 HSA
(ft.)
(i.e. auger, rotary, cable, direct push, etc )
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
For Internal Use ONLY:
14. WATER ZONES
FROM
TO
➢E,SCRIPrIDN _
ft.
ft.
ft.
ft.
15. OUTER CASING (for multi -tamed wells) OR LINER (if op liable)
FROM
TO
DIAMETER
THICILNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING (geothermal dosed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
25.5 ft.
2 in.
sch40
pvc
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLUT SIZE
TIIICkNESS
MATERIAL
25.5 ft•
27.5 ft•
2 in.
.010
sch40
pvc
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft.
20.5 ft•
Portland Cem
Tremie
20.5 ft•
23.5 ft•
Bentonite Chi
Tremie
ft.
ft.
19. SANDIGRAVEL PACK
(if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
23.5 ft•
27.5 ft•
#1 Sand
Tremie
ft.
ft.
2I. DRILLING LOG (attach additional sheep if neceasery)
FROM
TO
DESCRIPTION Koine-, hardness, soil/rack type. grain siQ,el r.I
ft.
ft.
ft.
ft. 1
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
No cover
22. Certification:
Signature of Certified Well Contractor
Date
By signing this form, 1 hereby cerliifv that the ire/l(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 Welts: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells 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 form 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

ABORING NUMBER AS-06
Apex Companies
APEX
CLIENT Colonial Pipeline PROJECT NAME 2020-L1-SR2448
PROJECT NUMBER CPC21018 PROJECT LOCATION Huntersville, NC
DATE/TIME STARTED 12/8/2020 COMPLETED 12/8/2020 GROUND ELEVATION 725.34 ft TOP OF CASING 725.28 ft
DRILLING CONTRACTOR Parratt-Wolff EQUIPMENT CME-550X
DRILLER Kevin White GROUND WATER LEVELS AND TIME:
LOGGED BY Kyle Zigler BOREHOLE DIAMETER 2 in. DURING DRILLING ---
METHOD Hollow Stem Auger 8.25' 1 AFTER DRILLING 33.00 ft / Elev 692.34 ft
© DEPTH
(ft)
SAMPLE TYPE
NUMBER
ENVIRONMENTAL
DATA
GRAPHIC
LOG
MATERIAL DESCRIPTION
COMMENTS
WELL DIAGRAM
Casing Top Elev: 725.28 (ft)
Well Diameter: 2
- -
-
- -
- -
5
j
j
LEAN CLAY, (CL) red brown,
moist
5.0
720.3
:4
as
4°
a ^
a °
4 ^
a
4
d:
-
- -
- -
10•
•
•
:
POORLY GRADED SAND WITH
SILT, (SP-SM) brown, dry
_a
_4^
a •
_4^
a •
_4
a •
_4 ^
a ^
•
_4
i4
4
4
a
:4^
a n
•4
a n
:4
a °
•^
Type S Cement
- -
-
- -
- -
15
•
.:
-
- -
- -
- -
20
•
695.3
a ^
_4^
a^
_4^
_4^
a,,
_4^
a;
_4^
a;
_4
—•'•i+d-GP-1
a ^
4
a^
:4^
:4^
a,
:4^
a;
:4^
a,,
4�
2-in. Sch 40 PVC
casing
Bentonite
sand
-
- -
- -•
25
•
.:
- -
- -
30
E .''
' '
30.0
-
- -
- -
/'
,./
�'
'
'• .
CLAYEY SAND, (SC-SM) brown
gray, moist
34.5
690.8
'":*••;
:' `=:'
`2-in. Sch 40 PVC
0 010 slotted screen
Refusal at 34.5 feet.
Bottom of borehole at 34.5 feet.

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
Kevin White
Well Contractor Name
2973
NC Well Contractor Certification Number
Parratt-Wolff, Inc.
Company. Name
2. Well Construction Permit 4:
List all applicable well permits (i.e. County, Slate, Variance. Injection, etc,)
3. Well Use (check well use):
Water Supply Well:
['Agricultural
['Geothermal (Heating/Cooling Supply)
❑industrial/Commercial
❑ lrrigati on
❑Municipal/Public
❑ Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
❑� Monitoring ❑Recovery
Injection Well:
['Aquifer Recharge
❑ Aquifer Storage and Recovery
Aquifer Test
['Experimental Technology
❑Geothermal (Closed Loop)
['Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed: 12-8-20
5a. Well Location:
Colonial Pipeline Company
['Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
['Subsidence Control
❑ Tracer
['Other (explain under #21 Remarks)
Well ID# AS-06
Facility/Owner Natne Facility Mt! (if applicable)
14511 Huntersville-Concord Road, Huntersville, NC 28078
Physical Address, City, and Zip
Mecklenburg
County Parcel identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one tat/long is sufficient)
35.412317 N-80.806364
6. Is (are) the well(s): IZZPermanent or ❑Temporary
W
7. Is this a repair to an existing well: ❑Yes or IENo
1/ /his is a repair, fill out known well construction it formation and explain the nature al the
repair under =21 remarks section or on the back of this form.
8. Number of wells constructed: 1
For multiple injection or non -water supply wells ONLY with the same construction, you can
.submit one/brit.
9. Total well depth below land surface: 33 (ft.)
For multiple wells list a// depths ifdi/Jerent (example- 3@200' and 2 a l00')
10. Static water level below top of casing: 35 (ft.)
If water level is above casing, use „- "
11. Borehole diameter: 2 (in.)
12. Well construction method: 8 1/4 HSA
(i.e. auger, rotary, cable, direct push, etc )
FOR WATER SUPPLY WELLS ONLY:
I3a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
1Forinternal Use ONLI'
14. WATER ZONES
FROM
TO
DESCRIPTION
33 ft.
35 ft.
wet
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if app ieable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
33 ft•
2 in.sch40
pvc
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
33 ft•
35 ft•
2 in.
.010
sch40
pvc
ft.
ft.
in.
IS. GROUT
FH ON!
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT 1
0 ft.
29 ft•
Portland Cem
Tremie
29 ft•
31 ft•
Bentonite Chi
Tremie
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT ME'rloD
31 ft•
35 ft.
#1 Sand
Tremie
ft.
ft.
20. DRILLING LOG (attach additional sheen if necessary)
FROM
TO
DESCRIPTION (color, hardnccs. %oilfunrk type. grain size. etc.l
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
No cover
22. Certification:
Signature of Certified Welt Contractor
•
Date
By signing this fvrnt, / hereby certify that the well(s) was (here) constructed in accordance
with l5A NC.4(' 02('.0100 or I5A NC'.9C 02C.0200 Well Construction Standards and deal a
ropy 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 Welk: 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. Far Infection Was ONLY: In addition to sending the form to the address in
24aabove, 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. Fur Water Supply & Injection Wells;
Also submit one copy of this form within 30 days of completion of
well construction to the county health department of the county where
constructed.
Form GW-I North Carolina Department of Environment and Natural Resources - Division of Water Resources
Revised August 2013

ABORING NUMBER AS-07
Apex Companies
APEX
CLIENT Colonial Pipeline PROJECT NAME 2020-L1-SR2448
PROJECT NUMBER CPC21018 PROJECT LOCATION Huntersville, NC
DATE/TIME STARTED 12/6/2020 COMPLETED 12/7/2020 GROUND ELEVATION 726.45 ft TOP OF CASING 726.23 ft
DRILLING CONTRACTOR Parratt-Wolff EQUIPMENT CME-550X
DRILLER Kevin White GROUND WATER LEVELS AND TIME:
LOGGED BY Bill Jones BOREHOLE DIAMETER 2 in. DURING DRILLING ---
METHOD Hollow Stem Auger 8.25' AFTER DRILLING ---
© DEPTH
(ft)
SAMPLE TYPE
NUMBER
ENVIRONMENTAL
DATA
GRAPHIC
LOG
MATERIAL DESCRIPTION
COMMENTS
WELL DIAGRAM
Casing Top Elev: 726.23 (ft)
-
r
DPT
CLAYEY SAND, (SC) dark brown,
dry
72de
6
a ^
s
a
4
a ^
4^
v,
5
5.0
_ _
r
DPT
CLAYEY SAND, (SC) dark brown,
dry
71.5
a "
a
6•
1 "
a ;
a• •
10
;
10.0
-
DPT
t '
CLAYEY SAND, (SC) dark brown,
dry
711.5
;
a•
.a•
a°
• "
a•
a•
a°
"
- -
15
DPT
15.0
-
- -
20
r
DPT
III
II
%%
LEAN CLAY WITH SAND,
(CL-ML) gray, dry
20.0
706.5.
.a •
a ^•
a e•
.4 •
a "
. •Sch
•a,,
Type S Cement
40 PVC casing
-
-
- -
25
00
#/
LEAN CLAY WITH SAND,
(CL-ML) gray, dry
25.0
701.5
a °
•a•
a"
•
a °
:a•
a"
a •
-
- -
- -
- -
30
LEAN CLAY WITH SAND,
(CL-ML) gray, dry
30.0
696.5
. ,
.a •
a^
a••
• ^
"
a •
a^
•
a ^
-
_ _
35
LEAN CLAY WITH SAND,
(CL-ML) gray, dry
35.0
691.5
.a
a " •
I
•:'.
•
.a
"
I-
•
Bentonite
.
-
- -
LEAN CLAY WITH SAND,
(CL-ML) gray, dry
38.0
688.5
•',—
—!
�'::;
: --
• •';
GP-1 sand
Sch 40 PVC 0.010
slotted screen
Bottom of borehole at 38.0 feet.

WELL CONSTRUCTION RECORD
This form call be used for single or multiple wells
1. Well Contractor Information:
Kevin White
Well Contractor Name
2973
NC Well Contractor Certification Number
Parratt-Wolff, Inc.
Compam Name
2. Well Construction Permit#:
List all applicable well perinitc (i,e. County, Stale, Variance, Injection, eic..)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) Residential Water Supply (single)
❑industrial/Commercial ❑Residential Water Supply (shared)
❑ Irrigation
Non -Water Supply Well:.
M Monitoring ❑Recovery
Injection Weil:
❑Aquifer Recharge ❑Groundwater Remediation
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑ Experimental Technology ❑Subsidence Control
❑Geothermal (Closed Loop) ❑Tracer
❑ Geothermal (Heating/Cooling Retum) ❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: 12-7-20 Well ID# AS-07
5a. Well Location:
Colonial Pipeline Company
Facility/Owner Name Facility ID# (if applicable)
14511 Huntersville-Concord Road, Huntersville, NC 28078
Physical Address, City, and Zip
Mecklenburg
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.412277 N-80.806163
6. Ts (are) the well(s): ElPermanent or ❑Temporary
w
7. Is this a repair to an existing well: ❑Yes or ENo
1/ this is a repair,, fill aat known well construction in%ornlalion and explain the nature of the
repair under - 2/ remarks section or on the back of this faros..
8. Number of wells constructed: 1
For multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
For Internal Use ONLY:
14. WATI'R ZONES
FROM
TO
DESCRIPTION
36 ft-
38 ft.
wet
ft.
ft.
15. OUTER CASING (for multi -rued wtllsl OR LINER (if ap licable)
FROM
TO
DIAMETER
THICKNESS MATER1AL
ft.
ft.
in.
I. INNER CASING OR TUBING (Reuthern
al cicortWoop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL.
0 ft.
36 ft.
2 in.
sch40
pvC
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
36 ft.
38 ft•
2 in.
.010
sch40
pvc
ft.
ft.
in.
1S. GROUT
FROM
TO
MATERIAL
EMPLACEIVIENTMETHOD &AMOUNT
0 ft.
32 ft•
Portland Cem
Tremie
32 ft•
34 ft•
Bentonite Chi', Tremie
ft.
ft.
19. SAND/GRAVEL PACK (if appliuhle)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
34 ft•
38 ft•
#1 Sand
Tremie
ft.
ft.
29. DRILLING
LAG lattach
ad did anal sheets if necessary
FROM
TO
DESCRIPTION Icolor. hardness, snit/rock type, grain size, etc.)
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
No cover
22. Certification:
Signature of Certified Well Contractor
(•(3•zk
Date
lfy signing this farm, l hereby certify that the wet/(s) was (were) constructed in accordance
with 15A NC.4(' 02C.0/00 or 15A N('AC 02C.0200 Well Construction Standards and that a
cope alibis record has been prorided 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
9. Total well depth below land surface: 38 (ft.) 24a. fur All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths if different (example- 3 a 200' and 2@l00') construction to the following:
10. Static water level below top of casing: 36
limner level is ahore casing, use "-
11. Borehole diameter: 2 (in.)
12. Well construction method: 8 1/4 HSA
(ft.)
(i.e, auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type:. Amount:
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
24aabove, 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 form 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

APEX
CLIENT
PROJECT
DATE/TIME
DRILLING
DRILLER
LOGGED
METHOD
A
Apex Companies
Colonial Pipeline
PROJECT
PROJECT
GROUND
BORING NUMBER AS-08
NAME 2020-L1-SR2448
NUMBER
STARTED
CONTRACTOR
Kevin
CPC21018
LOCATION Huntersville, NC
11/22/2020 COMPLETED 11/22/2020
ELEVATION 724.25 ft
TOP OF CASING
724.25 ft
Parratt-Wolff
EQUIPMENT
GROUND
1
CME-550X
White
WATER LEVELS AND TIME:
DURING DRILLING ---
BY Bill Jones BOREHOLE DIAMETER 2 in.
Hollow Stem Auger 8.25"
AFTER DRILLING 40.75 ft / Elev 683.50 ft
© DEPTH
(ft)
SAMPLE TYPE
NUMBER
ENVIRONMENTAL
DATA
f GRAPHIC
LOG
MATERIAL DESCRIPTION
COMMENTS
WELL DIAGRAM
Casing Top Elev: 724.25 (ft)
Well Diameter: 2
-
_
10
030
�8.0
SANDY LEAN CLAY, (CL) red
Well install initially named
AS-03 but later completed
as AS-08
721.3
.4
a
, .
:4
:4e
^
:4^
° ^
a:
a•
a ^
a:
^
•
:4
. ^
'
:4
° ^
a°
•4 ^°
•
• ' •
••:.
4 •
1
^
4 •
:4:
°a
:4•
F
SANDY LEAN CLAY, (CL) brown
716.3°
SANDY LEAN CLAY, (CL) brown
13.0
711.3
-
_ _
- -
_ _
20
^
•
_..
_.'-+silica
�.':
;
a:
a:
.4!-
a ^
a:
^
•
:4 •
° ^
•
:4 •
° ^
a '
•4 •
°.
2-inch Sch 40 PVC
casing
grout
bentonite
sand #2
SANDY LEAN CLAY, (CL) gray
18.0
706.3.4s
SANDY LEAN CLAY, (CL) gray
23.0
701.3r
_ _
- -
_ _
30
•
' 1
It.26.0
WELL GRADED GRAVEL, (GW)
gray
698.3'
•
CLAYEY GRAVEL, (GW-GC) tan
gray, moist
696.3
°�.0
',
::28
ee`t'C
•.':
CLAYEY GRAVEL, (SW -SC)
gray, moist
33.0
691.3A
- -
-
-
40
CLAYEY GRAVEL, (SW -SC)
35.0 gray, moist
689.3
686.8;
ow
•' •
WELL GRADED GRAVEL, GW
( )
37.5 gray, dry
38 0 SANDY CLAY,
r
I
686 3
LEAN (CL) gray,
moist
683.3
50
41.0 2
r •:.'
2-inch Sch 40 PVC
0.010 slotted screen
Bottom of borehole at 50.0 feet.

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
For Internal Use ONLY;
I. Well Contractor Information:
Kevin White
Well Contractor Name
2973
NC Well Contractor Certification Number
Parratt-Wolff, Inc.
Compam Name
2. Well Construction Permit #:
List all applicable well permits (i.e. County, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑Industrial/Commercial
❑Irrigation
Non -Water Supply Well:
0Monitoring
❑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)
4. Date Well(s) Completed:1
2-$ 20
Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
Subsidence Control
0 Tracer
❑Other (explain under #21 Remarks)
Well ID# AS-08
5a. Well Location:
Colonial Pipeline Company
Facility/Owner Name - Facility TD# (if applicable)
14511 Huntersville-Concord Road, Huntersville, NC 28078
Physical Address, City, and Zip
Mecklenburg
County
Parcel Identification No (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one ladlong is sufficient)
35.412517 N,-80.805756
6. Is (are) the well(s): OPermanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ENo
11 this is a repair,•fill out known well construction information and explain the nature oldie
repair under =21 remarks- section or on the back of this form.
S. Number of wells constructed: 1
For multiple injection or non -water supply wells ONLY with the same construction, you can
.submit one form.
9. Total well depth below land surface: 41
For multiple wells list all depths i/ different (example- 3@200' and 2 rt /00')
(ft.)
10. Static water level below top of casing: unknown (ft.)
Ifwaler lerel is above casing, use " "
11. Borehole diameter: 2 (in.)
12. Well construction method: 8 1/4 HSA
(i e auger, rotary, cable, direct push, etc )
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
la. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING {for multi -cased wells) OR LINER (if applicable)
FROM
TO
DIAMETER
` THICKNESS MATERIAL
ft.
ft.
in.
In. INNER
CASING OR TIMING
(geothermal closed-Ioapl
FROM
TO
DIAMETER
TI1ICKNF_S.S
MATERIAL
0 ft.
39 ft.
2 in.
sch40
pvc
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIA I.
39 fL
41 ft•
2 in.
.010
sch40
pvc
ft.
ft.
in.
IL GROUPS
FROM
TO
MATERIAL
EMPLACEMENT MET} OD & AMOUNT
0 ft.
34 ft•
Portland Cem
Tremie
34 ft•
37 ft•
Bentonite Chi
Tremie
ft.
ft.
19. SAND/GRAVEL PACK
(ifapplicahle)
FROM
TO
:LATER I.AL
EMPLACEyt ENT METHOD
37 ft•
41 ft.
#1 Sand
Tremie
ft.
ft.
20. DRILLING
LOG (attach additional 'beets if necessary)
FROM
TO
DESCRIPTION tcelnr. hardness. sni I/1 nrlc tyre. grain time. rtc.1
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
No cover
22. Certification:
Signature of Certified Well Contractor
3• a2- z\
Date
By .signing this./arm, I hereby certify dial the well(s) was (were) constructed in accordance
with 15A NCAC 02C ,0100 or 15A NCAC 02(' .0200 Well Construction Standards and that a
copy of Ibis 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. 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
24aabove, 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 form within 30 days of completion of
well construction to the county health department of the county where
constructed.
Fort GW-I
North Carolina Department of Environment and Natural Resources — Division of Water Resources Revised August 2013

ABORING NUMBER AS-09
Apex Companies
APEX
CLIENT Colonial Pipeline PROJECT NAME 2020-L1-SR2448
PROJECT NUMBER CPC21018 PROJECT LOCATION Huntersville, NC
DATE/TIME STARTED 12/6/2020 COMPLETED 12/6/2020 GROUND ELEVATION 722.38 ft TOP OF CASING 722.23 ft
DRILLING CONTRACTOR Parratt-Wolff EQUIPMENT CME-550X
DRILLER Kevin White GROUND WATER LEVELS AND TIME:
LOGGED BY Bill Jones BOREHOLE DIAMETER 2 in. DURING DRILLING ---
METHOD Hollow Stem Auger 8.25" AFTER DRILLING ---
© DEPTH
(ft)
SAMPLE TYPE
NUMBER
ENVIRONMENTAL
DATA
GRAPHIC
LOG
MATERIAL DESCRIPTION
COMMENTS
WELL DIAGRAM
- -
- -
-
5
II
jj
SANDY LEAN CLAY, (CL-ML)
red brown, dry
5.0
717.4
•4
a •
•4
a ,,
•
4 ^
a ;
4^
• ,
-
-
10
SANDY LEAN CLAY, (CL-ML)
red brown, dry
10.0
712.4.4
.
a ^
:4
a^
^
4 ^
a
:4 ^
a^
'4 ^
-
- -
_ _
15
//
SANDY LEAN CLAY, (CL-ML)
brown, dry
15.0
707.4
a ;
:4^
a^
- *4
a ;
:4•
a^
•
a
-
- -
20
SANDY LEAN CLAY, (CL-ML)
brown, dry
20.0
.
'^
_4 ^
i4
4 !
°
Type S Cement
702.4
a ,
a ,
Sch 40 PVC casing
-
-
25
//
II
SANDY LEAN CLAY, (CL-ML)
brown, dry
/ 25.0
697.4,
:4:4;
a^
.
a^
.
-
- -
-
30
J�/
/
SANDY LEAN CLAY, (CL) gray,
dry
30.0
692.4
687.4
:4 ^
a�
:4•
a^
.. °
a •
:• .
••-.•
•:C
—.•
:4
a�
•4•
a^
:4
a •
•
^
Bentonite
GP-1 sand
.
_ _
- -
- -
_ _
35
/
/
SANDY LEAN CLAY, (CL) gray,
dry
35.0
_/
_
-
40
SANDY LEAN CLAY, (CL) gray,
moist
//A40.0
682.4
•
•:
Sch40PVC0.010
slotted screen
Refusal at 40.0 feet.
Bottom of borehole at 40.0 feet.

WELL CONSTRUCTION RECORD
For Internal Use ONLY:
This form can be used for single or multiple wells
1. Well Contractor Information:
Kevin White
Well Contractor Name
2973
NC Well Contractor Certification Number
Parratt-Wolff, Inc.
Compam Name
2. Well Construction Permit #:
List all applicable well permits (i,e- County, State, Variance, hnjection, 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:
❑O Monitoring
Recover
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
OOther (explain under #2l Remarks)
14. WATER ZONES
FROM
TO
DESCRIPTION
38
ft.
40
ft.
wet
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if applie ablel
THICKNESS I MATERIAL
lj
FROM
ft.
TO
ft.
n.
16. INNER CASING OR TUBING (geothermal lased -loop)
FROM
TO
DIAMETER
TIFICKN'LSS
MATERIAL
0
ft.
38
ft.
2
in.
sch4,0
pvc
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAM FTFR
SI,OT SIZE
THICKNESS
MATERIAL
38 fL
40 ft•
2
in.
.010
sch40
pvc
ft.
ft.
in.
is, GROUT
FROM
TO
MATERIAL
Ern PLACEM ENT METHOD & AMOUNT
0
ft.
34
ft.
Portland Cem
Tremie
34
ft.
36 fr.
Bentonite Chi
Tremie
ft.
ft.
I . SAND/GRAVEL PACK (if Applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
36
ft.
40
ft.
#1 Sand
Tremie
ft.
ft.
20. DRILLING LOG (attach additional sheets if memory)
FROM
TO
DFSCRI PT ION leolnr. hard nc.s, soil uck type. un-ain sue, ete.l
ft.
ft.
4. Date Well(s) Completed: 12-6-20
5a. Well Location:
Colonial Pipeline Company
Facility/Owner Name
Well ID# AS-09
Facility 1D# (if applicable)
14511 Huntersville-Concord Road, Huntersville, NC 28078
Physical Address, City, and Zip
Mecklenburg
County
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.412477 N-80.805891
6. Is (are) the well(s): lZPermanent or ❑Temporary
7. Is this a repair to an existing well: OYes or ENo
if this is a repair, fill out known well construction iyfiirnlalion and explain the nature of the
repair under r21 remarks section or on the hack of this,/ornt
8. Number of wells constructed: 1
For multiple injecting or non -water supply wells ONLY with the same construction, you can
submit one lbrin
9. Total well depth below land surface: 40 (ft.)
(Or multiple wells list all depths ifdi/frrent (example- 3 a 200' and 2@I00')
10. Static water level below top of casing: 38 (ft.)
1/'water /ere/ is above casing, use "- "
11. Borehole diameter: 2 (in.)
12. Well construction method: 8 1/4 HSA
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
I3a. Yield (gpm)
Method of test:
13b. Disinfection type:
Amount:
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
No cover
22. Certification:
Signature of Certified We lt f ontractor
l•1�. 7�
Date
By signing Ibis firm, I hereby certify that the wells) was (here) constructed in accordance
with 15A N('AC 02C'MOO or 15A NCAC 02('.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 Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells ONLY: In addition to sending the form to the address in
24a above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells:
Also submit one copy of this form within 30 days of completion of
well construction to the county health department of the county where
constructed,
DIAMETER
Form GW-I North Carolina Department of Environment and Natural Resources — Division of Water Resources
Revised August 2013

A BORING NUMBER AS-10
Apex Companies
APEX
CLIENT Colonial Pipeline PROJECT NAME 2020-L1-SR2448
PROJECT NUMBER CPC21018 PROJECT LOCATION Huntersville, NC
DATE/TIME STARTED 12/5/2020 COMPLETED 12/5/2020 GROUND ELEVATION 722.38 ft TOP OF CASING 722.30 ft
DRILLING CONTRACTOR Parratt-Wolff EQUIPMENT CME-550X
DRILLER Kevin White GROUND WATER LEVELS AND TIME:
LOGGED BY Bill Jones BOREHOLE DIAMETER 2 in. DURING DRILLING ---
METHOD Hollow Stem Auger 8.25' AFTER DRILLING ---
© DEPTH
(ft)
SAMPLE TYPE
NUMBER
ENVIRONMENTAL
DATA
GRAPHIC
LOG
MATERIAL DESCRIPTION
COMMENTS
WELL DIAGRAM
Casing Top Elev: 722.30 (ft)
_ _
-
5
jf
/
%�
•
SANDY LEAN CLAY, (CL) red
brown, dry
5.0
717.4•a
:4
a ,,
:4
a^
4 "
•
4 •
a^
4"
-
-
- -
�//
�io.o
SANDY LEAN CLAY, (CL) red
brown, dry
712.4;
707.4
a ;
:a.
a^
:4 "
a^
:4"
a'
1 ;
•
a^_4e :10
as
:4 "
a
:4"
a'
-
- -
-
15
A
SANDY LEAN CLAY, (CL-ML)
dark brown, dry
15.0
_ _
- -
20 _
697.4
•4 "
a•
:4 ^ "
a•
.
_4"
a^
' •
a°
:4"
a ^ •a.
f�
.4!-
a•
a•
.^
•4"
a^
a°
:4"
Type S Cement
Sch 40 PVC casing
- _
- -
-
25
/
SANDY LEAN CLAY, (CL) gray,
moist
25.0
-
- -
30
/
/
SANDY LEAN CLAY, (CL) gray,
moist
30.0
692.4
687.4
:4
.
"
.
:4
. 1
;,F
"
Bentonite
-
_ _
35
SANDY LEAN CLAY, (CL) gray,
moist
35.0
-
SANDY LEAN CLAY, (CL) gray,
moist
37.0
685.4
:,:
':.;•
s
.
.
..:.
.:.;:
..,:.
:: ,
GP-1 sand
Refusal at 37.0 feet.
Bottom of borehole at 37.0 feet.

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
Kevin White
Well Contractor Name
2973
NC Well Contractor Certification Number
Parratt-Wolff, Inc.
Company Name
2. Well Construction Permit#:
List all applicable well permits (i.e. ('amity, ,Sale, Variance, Injection, ele)
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:
OMonitoring
❑ Recovery
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑ Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑ Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed: 12-5-20
5a. Well Location:
Colonial Pipeline Company
Facility/Owner Name
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑ Tracer
❑Other (explain under #21 Remarks)
Well ID# AS-1 0
Facility iD# (if applicable)
14511 Huntersville-Concord Road, Huntersville, NC 28078
Physical Address, City, and Zip
Mecklenburg
County
Parcel Identification No. (PiN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.412585 N-80.805748
6. is (are) the well(s): OPermanent or ❑Temporary
w
7. Is this a repair to an existing well: ❑Yes or ENo
Ifthis is a repair,,lill out known well construction information and explain the nature of the
repair under '21 remarks .section or on the hack of this /item.
8. Number of wells constructed: 1
For multiple injection or non -crater supply wells ONLY with the same construction, you can
submit one_/orin.
9. Total well depth below land surface: 37
For multiple wells list all depths q rlylrrent (exaalple- 3@200' and 2@ /00')
(ft.)
10. Static water level below top of casing: 35 (ft.)
/f water level is above casing, use " • '
11. Borehole diameter: 2
(in.)
12. Well construction method: 8 1/4 HSA
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY;
13a. Yield (gpm) Method of test:
13b. Disinfection type:
Amount:
For Intei nal Use ONLY:
11. WATER ZONES
FROM
TO
DESCRIPTION
35 ft.
37 ft.
wet
ft.
ft.
15. OUTER CASING Our multi -eased wells) OR LINER (ifap Gtable)
FROM
TO
DIAMETER
TIICKNESS MATERIAL
ft.
ft.
in.
Ih. INNER CASTNG OR TURING (geothermal closed -/nap)
FROM
TO
DIAMETER
TN IC6'NESS
MATERIAL
0 ft.
35 ft.
2 in.
sch40
pvc
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
35 ft.
37 ft.
2 in.
.010
sch40
pvc
ft.
ft.
in.
13. GROUT
FROM
TO
MATERIAL
ENT PL►CEMENT METHOD & AMOUNT
0 ft.
31 ft-
Portland Cem
Tremie
31 ft.
33 ft•
Bentonite Chi
Tremie
ft.
ft.
19. SAND/GRAVEL PACK
(if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
33 ft.
37 ft.
#1 Sand
Tremie
ft.
ft.
20. DRILLING
LOG (attach additional sheen if necessary)
FROM
TO
DESCRIPTION !color. hailing., uuil/reeh type. grain size, eft.)
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
No cover
22. Certification:
4..�a . i19
Signature of Certified Well Contractor
Date
By .signing this,/Orm, l hereby certi(i' that the well(A) was (were) constructed in accordance
with 15A NCAC 02C.0100 or 15,4 NSA(' 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. f r•Ati Wtfla: 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 Iniection 'Wells ONLY: In addition to sending the form to the address in
24a above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & injection We11s:
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 Resources
Revised August 2013

APEX
CLIENT
PROJECT
DATE/TIME
DRILLING
DRILLER
LOGGED
METHOD
A BORING NUMBER AS-11
Apex Companies
Colonial Pipeline PROJECT NAME 2020-L1-SR2448
NUMBER
STARTED
CONTRACTOR
Kevin
CPC21018 PROJECT LOCATION Huntersville, NC
11/22/2020 COMPLETED 11/22/2020 GROUND ELEVATION 725.98 ft TOP OF CASING 725.98 ft
Parratt-Wolff EQUIPMENT CME-850X
White GROUND
WATER LEVELS AND TIME:
DURING DRILLING ---
BY BOREHOLE DIAMETER 2 in.
Hollow Stem Auger 8.25" AFTER DRILLING ---
© DEPTH
(ft)
SAMPLE TYPE
NUMBER
ENVIRONMENTAL
DATA
GRAPHIC
LOG
MATERIAL DESCRIPTION
COMMENTS
WELL DIAGRAM
10
Well Construction
Details Pending
20
30
40
50

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
Kevin White
Well Contractor Name
2973
NC Well Contractor Certification Number
Parratt-Wolff, Inc.
Compam Name
2. Well Construction Permit #:
List all applicable well permits (i.e. County, State, Variance, Injection, 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
❑Recovery
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Retum)
4. Date Well(s) Completed: 11-22-20
5a. Well Location:
Colonial Pipeline Company
Facility/Owner Name
❑Groundwater Remediation
Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 Remarks)
Well ID# AS-1 1
Facility ID# (if applicable)
14511 Huntersville-Concord Road, Huntersville, NC 28078
Physical Address; City, and Zip
Mecklenburg
County
Parcel Identification Na (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.412856 N-80.805488
6. Is (are) the well(s): 2Permanent or ❑Temporary
W'
7. Is this a repair to an existing well: Yes or ENo
//this is a repair,./ill out known well construction to formation and explain the nature of the
repair tinder 21 remarks .section or on the hack o/'this form.
8. Number of wells constructed: 1
For multiple injection or nut -water .supply wells ONLY with the same construction, you can
.submit one firm
9. Total well depth below land surface: 41 (ft.)
For multiple wells list all depths if di//erent (example- 3@200' and 2 a.100')
10. Static water level below top of casing: 38 (ft.)
//'water level is above casing, use " "
11. Borehole diameter: 2
(in.)
12. Well construction method: 8 1/4 HSA
(i e auuer, rotary, cable, direct push, etc)
FOR WATER SUPPLY WELLS ONLY:
I3a. Yield (gpm) Method of test:
13b. Disinfection type:
Amount:
For Internal Use ONLY:
14. WATER ZO<vFS
FROM
TO
DESCRIPTION
38 ft-
41 ft.
wet
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if applicable)
FROM
TO
DIAMETER
THICKNESS MATERIAL
ft.
ft.
in.
16. INNER
CASING OR TUBING
(geothermal dosed -loop)
FROM
TO
DIAMETER
THICh'NFSS
MATERIAL
0 ft.
40 ft.
2 1n.
sch40
pvc
ft.
ft.
J
in,
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
39 ft.
41 ft.
2 in.
.010
sch40
pvc
ft.
ft.
in.
1S. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft.
36 ft•
Portland Cem
Tremie
36 ft.
38 ft.
Bentonite Chi
Tremie
ft.
ft.
19. SAND/GRAVEL
PACK
of applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
38 ft.
41 ft.
#1 Sand
Tremie
ft.
ft.
20. DRILLING LOG (attach addieiottalsheets if necessary)
FROM
TO
DESCRIPTION tculur. hardness. soit/rocktype. grain rrer. etch
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
No cover
22. Certification:
5igrdtturc ufCcntlied Well Contractor
Date
By .signing this )(brut, 1 hereby certify that the wel(s) was (were) constructed in accordance
with 15A N('A(' 02C.0100 or /SA N('AC 02C.0200 Well Construction Standards and that a
copy ollhis record has been prorided 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 Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For [Median Wefts ONLY: In addition to sending the form to the address in
24aabove, 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 form within 30 days ofcompletion 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 Resources Revised August 2013

A BORING NUMBER AS-12
Apex Companies
APEX
CLIENT Colonial Pipeline PROJECT NAME 2020-L1-SR2448
PROJECT NUMBER CPC21018 PROJECT LOCATION Huntersville, NC
DATE/TIME STARTED 12/14/2020 COMPLETED 12/15/2020 GROUND ELEVATION 731.85 ft TOP OF CASING 731.78 ft
DRILLING CONTRACTOR Parratt-Wolff EQUIPMENT CME-550X
DRILLER Kevin White GROUND WATER LEVELS AND TIME:
LOGGED BY Bill Jones BOREHOLE DIAMETER 2 in. DURING DRILLING 40.00 ft / Elev 691.85 ft
METHOD Hollow Stem Auger 8.25" AFTER DRILLING ---
© DEPTH
(ft)
SAMPLE TYPE
NUMBER
ENVIRONMENTAL
DATA
GRAPHIC
LOG
MATERIAL DESCRIPTION
COMMENTS
WELL DIAGRAM
Casing Top Elev: 731.78 (ft)
Well Diameter: 2
/50
LEANCLAYWITHSAND,(CL-ML) red, dry
726.9.
a
-
10
LEAN CLAY WITH SAND,
(CL-ML) red, dry
10.0
721.9°,,
a "
_4
1 "
4•
a^
- -
LEAN CLAY WITH SAND, (CL)
brown, dry
15.0
716.9'
:4
f
'
4 •
° ,
'
- -
-
20
LEAN CLAY WITH SAND, (CL)
brown, dry
20.0
711.9'4•
706.9,
'4
° ^
_4e
.
:4 •
°a
q
,4 •
°
.
- -
_ _
LEAN CLAY WITH SAND,
(CL-ML) gray, moist
25.0
- -
-
30
LEAN CLAY WITH SAND,
(CL-ML) gray, moist
30.0
701.9.4
:4e
a "
:4 •
a "
'
'4 ,
Type S Cement
- -
LEAN CLAY WITH SAND,
(CL-ML) gray, moist
35.0
696.9°
° "
:4
;
..e
A
:4 •
° ;
Sch 40 PVC casing
- -
-
40
LEAN CLAY WITH SAND,
(CL-ML) dark gray, moist
40.0 p
691.9'
:4
° ,,
'
:4 •
. ,
'
- -
j
LEAN CLAY WITH SAND,
(CL-ML) dark gray, moist
45.0
686.9
'4
° ^
'
4
°a
a e
- -
-
50
LEAN CLAY WITH SAND,
(CL-ML) dark gray, moist
50.0
681.9
_4e
' .
,4 •
°.
- -
- -
LEAN CLAY WITH SAND,
(CL-ML) dark gray, moist
55.0
676.9.4
:4
a ^
:4 •
a ^
'4 ^
- -
-
60
LEAN CLAY WITH SAND,
(CL-ML) dark gray, saturated
60.0
671.9
° ,,
1
'•.
° ,,
.'
Bentonite
-
LEAN CLAY WITH SAND,
(CL-ML) dark gray, wet
"
—
.' :�-
GP-1 sand
.
..
Sch 40 PVC 0.010
65.0
totted screen
666.9
Bottom of borehole at 63.0 feet.

WELL CONSTRUCTION RECORD
For Internal Use ONLY:
This form can be used for single or multiple wells
I. Well Contractor Information:
Kevin White
Well Contractor Name
2973
NC Well Contractor Certification Number
Parratt-Wolff, Inc.
Company Name
2. Well Construction Permit#:
List all applicable well permits (i.e. ('aunty, State, Parlance, Injection, ern)
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:
0 Monitoring
❑Recovery
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
Aquifer Test
DExperimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Retum)
4. Date Well(s) Completed: 12-12-20
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑ Tracer
❑Other (explain under#21 Remarks)
5a. Well Location:
Colonial Pipeline Company
Facility/Owner Name
Well 1D# AS-12
Facility iD# (if applicable)
14511 Huntersville-Concord Road, Huntersville, NC 28078
Physical Address, City, and Zip
Mecklenburg
County Parcel identification No (PiN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.413038 N-80.805552 W
6. is (are) the well(s): t21Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ENo
If this is a repair, Jill mu known well construction infornmlion and explain the nature o/ the
repair under z21 remarks section or on the back of this Jorm.
8. Number of wells constructed: 1
For multiple in/eclion or non -water supply wells ONLY with the same construction, you can
submit one farm
9. Total well depth below land surface: 63
For multiple wells list all depths tl different (example- 3 a 200' and 2@ 100')
(ft.)
10. Static water level below top of casing: unknown (ft.)
If water level is above casing, use "
11. Borehole diameter: 2 (in.)
12. Well construction method: 8 1/4 HSA
(i.e, auger, rotary, cable, direct push, etc )
FOR WATER SUPPLY WELLS ONLY:
I3a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
IS. OUTER CASING (for multi -cased wills) OR LINER (if op Q
icahle]
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
lb.1N"NCB
CASING OR TUBING (geothermal clued -loop[
FROM
TO
DIAMETER
THICKNFSS
MATERIAL
0 ft.
61 ft.
2 in.
sch40
pvc
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
61 ft.
63 ft.
2 in.
.010
sch40
pvc
ft.
ft.
in.
IL GROUT
FR ON!
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft.
56 ft.
Portland Cem
Tremie
56 ft.
59 ft.
Bentonite Chii
Tremie
ft.
ft.
19. SAND/GRAVEL PACK tit applicable)
FROM
TO
MATERIAL
EMM AEFIITENTMETAOD
59 ft.
63 ft.
#1 Sand
Tremie
ft.
ft.
20. DRILLING
LOG tatty
ty additional sheets if necessary)
FROM
TO
DESCRIPTION (role r. li41rdness, suillrnck type, grain sire. etc)
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARICS
No cover
22. Certification:
Signature of Certified Well Contactor
Date
By signing this form, I hereby cernfi' that the fret/(s) was (were) constructed in accordance
with I5A NCAC 02('_0100 or 15A N('AC 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. 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 Inirrtion Welk 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 form within 30 days of completion of
well construction to the county health department of the county where
constructed.
Form GW- I North Carolina Department ofEnvironment and Natural Resources — Division of Water Resources
Revised August 2013

ABORING NUMBER AS-13
Apex Companies
APEX
CLIENT Colonial Pipeline PROJECT NAME 2020-L1-SR2448
PROJECT NUMBER CPC21018 PROJECT LOCATION Huntersville, NC
DATE/TIME STARTED 12/17/2020 COMPLETED 12/18/2020 GROUND ELEVATION 729.74 ft TOP OF CASING 729.55 ft
DRILLING CONTRACTOR Parratt-Wolff EQUIPMENT CME-550X
DRILLER Kevin White GROUND WATER LEVELS AND TIME:
LOGGED BY Bill Jones BOREHOLE DIAMETER 2 in. DURING DRILLING ---
METHOD Hollow Stem Auger 8.25" AFTER DRILLING ---
© DEPTH
(ft)
SAMPLE TYPE
NUMBER
ENVIRONMENTAL
DATA
f GRAPHIC
LOG
MATERIAL DESCRIPTION
COMMENTS
WELL DIAGRAM
Casing Top Elev: 729.55 (ft)
- -
j
/
SANDY LEAN CLAY, (CL-ML)
red brown, medium grained, moist
5.0
724.7'
•4
a •
.
4 ^
a
- -
- -
10
SANDY LEAN CLAY, (CL-ML)
brown tan, dry
10.0
719.7'
a •
4^
1
4:
-
- -
SANDY LEAN CLAY, (CL-ML)
brown tan, dry
, 15.0
714.7
,
_4
a ^
;
4^
a
- -
20
�20.0
SANDY LEAN CLAY, (CL) gray,
dry
709.7
4•
•a °
•4•
a.
-
-
SANDY LEAN CLAY, (CL) gray,
dry
.4 ^
a •
•4 ^
a •
-
30
SANDY LEAN CLAY, (CL) gray,
moist
30.0
699.7
a •
a
a
;+
-
SANDY LEAN CLAY, (CL) gray,
moist
35.0
694.7
a
a
Type S Cement
6
^
4 ^
"
.P
.
4 ^
as
Sch 40 PVC casing
_ _
- -
40
/740.o
SANDY LEAN CLAY, (CL) gray,
moist
-
- -
j
%
SANDY LEAN CLAY, (CL) gray,
moist
45.0
684.7
a
a' ;
4 ^
a
-
_ _
50
SANDY LEAN CLAY, (CL) gray,
moist
50.0
679.7.4
'4 ^
° ^
^
:4 ^
:4 ^
-
-
SANDY LEAN CLAY, (CL) gray,
moist
55.0
674.7
a ,,
a •
a
a.
- -
- -
SANDY LEAN CLAY, (CL) gray,
moist
60.0
669.7
4 ^
a ^
•60
4 ^
a
-
SANDY LEAN CLAY, (CL-ML)
gray tan, fine to medium grained,
moist
65.0
664.7
Bentonite
659
_
_�
..
GP-1 sand
;
_ _
7.7
0
SANDY LEAN CLAY, (CL) gray,
saturated
70.0
71 0
• .
Sch 40 PVC 0.010
Bottom of borehole at 71.0 feet.
otted screen /

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
Kevin White
Well Contractor Name
2973
NC Well Contractor Certification Number
Parratt-Wolff, Inc.
Compam Name
2. Well Construction Permit #:
List all applicable well permits (i.e. County, Slate, 1 aria ice, 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)
Irrigation
Non -Water Supply Well:
2 Monitoring ❑Recovery
Injection Win:.
❑Aquifer Recharge ❑Groundwater Remediation
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control
❑Geothermal (Closed Loop) ❑Tracer
❑Geothermal (Heating/Cooling Retum) ❑Other (explain under #21 Remarks)
4. Date Wells) Completed: 1 ZI17I2O Well ID# AS-1 3
5a. Well Location:
Colonial Pipeline Company
Facility/Owner Name Facility ID# (if applicable)
14511 Huntersville-Concord Road, Huntersville, NC 28078
Physical Address, City, and Zip
Mecklenburg
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.412977 N-80.805078
6. Is (are) the well(s): ZPermanent or ❑Temporary
w
7. Is this a repair to an existing well: ❑Yes or 1No
If this is a repair, fill out known well construction information and explain the nature ofthe
repair under r:21 remarks .section ar on the buck o/'this_/brut
8. Number of wells constructed: 1
For multiple injection or non -water supply wells ONLY with the same construction, you can
submit one prim
9. Total well depth below land surface: 71 .(Bo
For multiple wells list all depths if different (example- 3 m200' and 2 rc100')
10. Static water level below top of casing:
If -water level is above casing, use " • "
11. Borehole diameter: 2
(in.)
12. Well construction method: 8 1/4 HSA
(ft.)
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
For Internal Use ONLY:
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (fur multi-cordwelL4 OR LINER (If appticahic)
FROM
TO
DIAMETER
THICKNESS MATERIAL
ft.
ft.
in.
lb. INNER
CASING OR TUBING
(grottier -mud dosed -loop)
FROM
TO
DIAMETER
Tt1ICKNF_SS
MATERIAL
0 ft.
69 ft.
2 in.
sch40
pvc
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOTSIZE
THICKNESS
MATERIAL
69 ft.
71 ft.
2 in.
.010
sch40
pvc
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLICEM ENT METHOD & AMOUNT
0 ft.
60 ft.
Portland Cem
Tremie
60 ft.
64 ft
Bentonite Chi
Tremie
ft.
ft.
19. SAND/GRAVEL PACK
(if auplicablc)
FROM
TO
%IATFR IAI.
EMPLACEMErNr METHOD
64 ft.
71 ft.
#1 Sand
Tremie
ft.
ft.
20. DRILLING
LOG (efeeeh
a ldidam/ sheen if aeceesary)
FROM
TO
DESCRIPTION 'color. hardness, .oil/ruck type, gain sixe, erel
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
No cover
22. Certification:
(i
Signature of Certified Well Contractor
Date
13v signing this Jorm, I hereby certify that the welt(s) was (were) constructed in accordance
with I5A NCAC 02(' .0100 ar 15A NCAC 02('.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 Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells ONLY: In addition to sending the form to the address in
24aabove, 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 form within 30 days of completion of
well construction to the county health department of the county where
constructed
Forst GW-I
Noith Carolina Department of Environment and Natural Resources - Division of Water Resources Revised August 2013

ABORING NUMBER AS-14
Apex Companies
APEX
CLIENT Colonial Pipeline PROJECT NAME 2020-L1-SR2448
PROJECT NUMBER CPC21018 PROJECT LOCATION Huntersville, NC
DATE/TIME STARTED 12/18/2020 COMPLETED 12/18/2020 GROUND ELEVATION 725.07 ft TOP OF CASING 724.82 ft
DRILLING CONTRACTOR Parratt-Wolff EQUIPMENT CME-550X
DRILLER Kevin White GROUND WATER LEVELS AND TIME:
LOGGED BY Bill Jones BOREHOLE DIAMETER 2 in. DURING DRILLING ---
METHOD Hollow Stem Auger 8.25' AFTER DRILLING ---
© DEPTH
(ft)
SAMPLE TYPE
NUMBER
ENVIRONMENTAL
DATA
GRAPHIC
LOG
MATERIAL DESCRIPTION
COMMENTS
WELL DIAGRAM
Casing Top Elev: 724.82 (ft)
j
SANDY LEAN CLAY, (CL-ML)
red, fine to medium grained, dry
5.0
720.1
:4
a
:4
4 "
a
4"
_ _
1010.0
r
7
SANDY LEAN CLAY, (CL) brown,
medium grained, dry
715.1•
°s
4
°^•
°a
4"
°^
0
�15.0
SANDY LEAN CLAY, (CL) brown,
medium grained, dry
710.1.4^
'4
a^
4 "
a•
•4"
-
20
4
%i`
SANDY LEAN CLAY, (CL) gray,
fine to medium grained, dry
20.0
705.1
700.1
a ^
°4^
a •
•4 "
• ^
r '
a ^
•4"
•4
° 44-
Type S Cement•
,�
/�
SANDY LEAN CLAY, (CL) gray,
fine to medium grained, dry
25.0
-
30
'//�
t�
SANDY LEAN CLAY, (CL) gray,
fine to medium grained, dry
30.0
695.1�4e
'4"
'4"
' 4 "
4
�/�
SANDY LEAN CLAY, (CL) gray,
fine to medium grained, dry
35.0
690.1
_4 ^
•
a.
��
•4 "
°.
Sch 40 PVC casing
-
40
040.0
SANDY LEAN CLAY, (CL) gray,
medium grained, dry
685.1
:4"
A
_4^
•4
as
'4"
- -
SANDY LEAN CLAY, (CL) gray,
medium grained, moist
45.0
�°
680.1
^
:4 •^
° ^
°
•
q•
°.
46.0 SANDY LEAN CLAY, (CL) gray,
679.1
' '
-
47.0
\ wet r
678.1
675.1
`4 "
° 4 "
SANDY LEAN CLAY, (CL) I
50
50.0 LEAN CLAY, (CL) tan
gray, r
I medium to coarse grained I
670.1
lib
I;
I
kb
Bentonite
Slough
sand
-
_
SANDY LEAN CLAY, (CL) gray,
saturated
55.0
_
_ _
60
SANDY LEAN CLAY, (CL) gray,
moist
�160.0
SANDY LEAN CLAY, (CL) gray,
••Sch
063.1
• . •
° •
40 PVC 0.010
' G2.0 1 saturated F
�otted screen
Bottom of borehole at 61.5 feet.

WELL CONSTRUCTION RECORD
For Internal Use ONLY
This form can be used for single or multiple wells
1. Well Contractor Information:
Kevin White
Well Contractor Name
2973
NC Well Contractor Certification Number
Parratt-Wolff, Inc.
Compare Name
2. Well Construction Permit#:
List all applicable well permits (i.e. County, State, Variance, I /eclion, ek•,)
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
❑Aquifer Storage and Recovery
❑Aquifer Test
Experimental Technology
❑ Geothermal (Closed Loop)
❑ Geothermal (Heating/Cooline Return)
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑ Tracer
❑Other [explain under #21 Remarks)
4. Date Well(s) Completed: 12I18/20 Well ID# AS-1 4
5a. Well Location:
Colonial Pipeline Company
Facility/Owner Name Facility ID# (if applicable)
14511 Huntersville-Concord Road, Huntersville, NC 28078
Physical Address, City, and Zip
Mecklenburg
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field. one IatJlong is sufficient)
35.413007 N-80.804950
6. Is (are) the well(s): OPermanent or ❑Temporary
W
7. Is this a repair to an existing well: ❑Yes or ENo
If this is a repair, fit out known well construction in/ormalion and explain the nature ol•the
repair under ,21 remarks section or on the hack a/ this firm,
8. Number of wells constructed: 1
For multiple hl/eclion or non -water supply wells ONLY with the same construction, you can
submit one,/orm.
9. Total well depth below land surface: 61.5 (ft.)
For multiple wells list all depths it dijerent (example- 3@200' and 2@100')
10. Static water level below top of casing: (ft.)
1/ staler level is above casing, use " • '
11. Borehole diameter: 2
(in.)
12. Well construction method: 8 1/4 HSA
(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
ft.
ft.
ft.
ft.
15.OUTER ('ASING (tor multi -cased we0a1 OR LINER (if ap lies hiel
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING (geothermal dosrd•Iuop)
FROM
TO
DIAMETER
Ti IICKNESS
MATE RI AL
0 ft.
59.5 ft.
2 in.
sch40
pvc
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
59.5 ff
61.5 ft
2 in.
•010
sch40
pvc
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENTMETROD & AMOUNT
0 ft.
54 ft.
Portland Cem
Tremie
54 ft•
57 ft.
Bentonite Chi'
Tremie
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
57 ft•
61.5 ft-
#1 Sand
Tremie
ft.
ft.
20. DRILLING
LOG latdch
additional sheets ifnecessary)
FROM
TO
DESCRIPTION Ieolor. hardness. soitlruck type. rain site. eft.)
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
2I. REMARKS
No cover
22. Certification:
Signature of Certified Well Contractor
Date
11y signing this,/arm, I hereby certi/v that the we//(s) was (here) constructed in accordance
with 15A N('A(' 02C.0100 or 15,4 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 !NSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells ONLY: In addition to sending the form to the address in
24a above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells:
Also submit one copy of this form within 30 days of completion of
well construction to the county health department of the county where
constructed.
Form GW-I
North Carolina Department of Environment and Natural Resources - Division of Water Resources Revised August 2013

ABORING NUMBER AS-15
Apex Companies
APEX
CLIENT Colonial Pipeline PROJECT NAME 2020-L1-SR2448
PROJECT NUMBER CPC21018 PROJECT LOCATION Huntersville, NC
DATE/TIME STARTED 12/18/2020 COMPLETED 12/20/2020 GROUND ELEVATION 723.49 ft TOP OF CASING 723.31 ft
DRILLING CONTRACTOR Parratt-Wolff EQUIPMENT CME-550X
DRILLER Kevin White GROUND WATER LEVELS AND TIME:
LOGGED BY Bill Jones BOREHOLE DIAMETER 2 in. DURING DRILLING ---
METHOD Hollow Stem Auger 8.25" AFTER DRILLING ---
© DEPTH
(ft)
SAMPLE TYPE
NUMBER
ENVIRONMENTAL
DATA
GRAPHIC
LOG
MATERIAL DESCRIPTION
COMMENTS
WELL DIAGRAM
Casing Top Elev: 723.31 (ft)
_ _
- -
5
j
.
SANDY LEAN CLAY, (CL) red
brown, medium to coarse grained,
dry
5.0
718.5
.4
a ^
•
4 ^
as
•
_
- -
_ _"7.
- -
10
SANDY LEAN CLAY, (CL) red
brown, medium to coarse grained,
dry
10.0
713.5
708.5
:4
° ;
•4
4^
a •
°°
. ,
4 ^
°a
4:
4^
a
°°
' 4 ^
- -
- _
- -
15
SANDY LEAN CLAY, (CL) brown,
medium grained, dry
15.0
_
_
20
%l .'
SANDY LEAN CLAY, (CL) brown,
medium grained, dry
20.0
703.5
a ^
.
a ^
a ^
.
Type S Cement
698.5
^
'
6•
^
°•
Sch 40 PVC casing
_
_
25
! ;
SANDY LEAN CLAY, (CL) brown
gray, fine to medium grained, dry
25.0
_
-
30
#
#
#
#�
SANDY LEAN CLAY, (CL-ML)
gray, fine to medium grained, dry
30.0
693.5
683.5
• •
_4
°;
a
•4
..
••'.
^
^
—
.:
4
°;
°
4
;••'.
^
^
Bentonite
GP-1 sand
_
- -
35
/
/��
�%
/
SANDY LEAN CLAY, (CL-ML)
gray, fine to medium grained, dry
- -
_ _
40
�%
��
�
40.0
41.0 SANDY LEAN CLAY, (CL-ML)
';
682.5
!.'; ;
Sch 40 PVC 0.010
_
gray, fine to medium grained, F
—•• _'
lotted screen
saturated I
Refusal at 41.5 feet.
Bottom of borehole at 41.5 feet.

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
For Internal Use ONLY:
1. Well Contractor information:
Kevin White
Well Contractor Name
2973
NC' Well Contractor Certification Number
Parratt-Wolff, Inc.
Company Name
2. Well Construction Permit #:
List all applicable well permits (r. _.County, Stale, Variance, Injection, elca
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑Industrial/Commercial
['Irrigation
Non -Water Supply Well:
OMonitoring
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑ Recovery
lnjec lion Well:
❑ Aquifer Recharge
❑ Aquifer Storage and Recovery
❑ Aquifer Test
❑Experimental Technology
['Geothermal (Closed Loop)
['Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed: 121201*20
❑Groundwater Remediation
❑Salinity Barrier
❑ Stormwater Drainage
❑ Subsidence Control
['Tracer
['Other (explain under #21 Remarks)
5a. Well Location:
Colonial Pipeline Company
Facility/Owner Name
Well ID# AS-15
Facility TD# (if applicable)
14511 Huntersville-Concord Road, Huntersville, NC 28078
Physical Address. City, and Zip
Mecklenburg
County
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field. one lat/long is sufficient)
35.413028 -80.804823
6. Is (are) the well(s): ©Permanent or ❑Temporary
W
7. Is this a repair to an existing well: ❑Yes or ONo
If this is a repair, fill out known well construction its/ormation and explain the nature of the
repair under :=21 remarks .section or on the hack of this form.
8. Number of wells constructed: 1
For multiple injection or non -water supply wells ONLY with the same construction, you can
submit one. form,
9. Total well depth below land surface: 41 01,)
For multiple wells list all depths if -different (example- 3 m200' and 2 tt 100')
10. Static water level below top of casing: (ft.)
water level is above casing, use "-
1l. Borehole diameter: 2 (in.)
12. Well construction method: 8 1/4 HSA
(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
ft.
ft.
ft.
ft.
'STOUTER CASING (tor multi -sated wells) OR LINER (ft Ica hie)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
lb. INNER CASING OR TUBING (geothermal rinsed -loop),
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
39 ft.
2 in.
sch40
pvc
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
39 ft'
41 ft
2 In.
.010
sch40
pvc
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOU.1.A•MOIUNT
0 ft.
33 ft.
Portland Cem
Tremie
33 ft•
36 ft
Bentonite Chi)
Tremie
ft.
ft.
19, SAND/GRAVEL PACK if applicable)
FROM
TO
M.ATERrgi.
FM1fPLAC£5IENT MFTHOD
36 ft•
41 ft.
#1 Sand
Tremie
ft.
ft.
2(1. DM LiNG
LOG (attach
additional sheen if necessary)
FROM
TO
DESCRIPTION (color. hardness, soil/rock tvpe. grain size, etc_)
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
No cover
22. Certification:
Sian nurc of Certified Well Contractor
/-(•zl
Date
By signing this form, / hereby certify that the well(.) was (were) constructed in accordance
with 15A NCAC 02C.0100 or 15A NCA(' 02C.0200 Well Construction Standards and that a
copy ol'titis 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. Fur All Was: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells 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 form 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

A BORING NUMBER AS-16
Apex Companies
APEX
CLIENT Colonial Pipeline PROJECT NAME 2020-L1-SR2448
PROJECT NUMBER CPC21018 PROJECT LOCATION Huntersville, NC
DATE/TIME STARTED 6/17/2021 COMPLETED 6/17/2021 GROUND ELEVATION TOP OF CASING
DRILLING CONTRACTOR Parratt-Wolff EQUIPMENT CME 550X
DRILLER Kevin White GROUND WATER LEVELS AND TIME:
LOGGED BY Nia Watson BOREHOLE DIAMETER 8.25 in. DURING DRILLING ---
METHOD Hollow Stem Auger 8.25" AFTER DRILLING ---
© DEPTH
(ft)
SAMPLE TYPE
NUMBER
ENVIRONMENTAL
DATA
GRAPHIC
LOG
MATERIAL DESCRIPTION
COMMENTS
WELL DIAGRAM
Casing Type: 2
- -
- -
- -
5
:4
a°
.fi
:4
a°
.fi
:4
a°
.:
:4
a°
:4 •
a°
.fi
:4 •
•
°;
:4 •
a°
is-0-Lehigh
4
�.
.,
4
a°
.,
4
a°
:4
a °
:4 ^
a°
.,
:4 ^
°;
:4 ^
a°
Type I/II
-
-
- -
- -
10
-
- -
_ _
- -
15
a ^•
•
4
a•
:4 •
a°
:4 •
a°
:4 •
a•
:4•
a°
:4•
a°
.: °:�:•
a ^
•
4
a;
:4
a°
:4
a°
:4
a;
:4^
a°
:4^
a°
a01-#1
I Portland Cement
2-in. Sch 40 PVC
casing
^
^
^
Sodium Bentonite
3/8" Chips
Grade Silica Sand
'
_
-
- -
-
20
- -
- -
25
- -
- -
30
.'•
'•_
2-in. Sch 40 PVC
0.010 slotted screen
and Cellar

WELL CONSTRUCTION RECORD
Fur Internal Use ONLY:
This form can be used for single or multiple wells
1. Well Contractor Information:
Kevin White
Well Contractor Name
2973
NC Well Contractor Certification Number
Parratt-Wolff, Inc.
Compam Name
2. Well Construction Permit #:
List all applicable well permits (i.e. ('aunty, Stale, Variance, Injectimr, 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 Welk
R1Monitoring
❑ Recovery
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑ Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Retum)
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑ Tracer
▪ Other (explain under 1421 Remarks)
4. Date Well(s) Completed: 6-17-21
5a. Well Location:
Colonial Pipeline Company
Facility/Owner Name
Well ID# AS-16
Facility ID( (if applicable)
14511 Huntersville-Concord Road, Huntersville, NC 28078
Physical Address, City, and Zip
Mecklenburg
County
Parcel identification No (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(dwell field, one lat/long is sufficient)
35.412252 N-80.806403
6. Is (are) the well(s): ©Permanent or ❑Temporary
W
7. Is this a repair to an existing well: Yes or ENo
/J'dris is a repair, Ji/I out known well construction information and explain the nature of the
repair under ,21 remarks .section or on the hack of this form.
8. Number of wells constructed: 1
For multiple injection or non -water supply wells ONLY with the same construction, vou can
submit one firm.
9. Total well depth below land surface: 30 (ft.)
For multiple wells list all depths i/'di/ferenr (example- 3@200' and 2 a 100')
10. Static water level below top of casing: None (ft.)
If water lerel is above casing, use " '
11. Borehole diameter: 2 (in.)
12. Well construction method: 8 1/4 HSA and 2" spoons
(i e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
I3a. Yield (gpm) Method of test:
I3b. Disinfection type:
Amount:
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
1S. OUTER CASING (for multi•eased wens} OR LINER (if applicable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING 'geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft'
28 ft.
2 in.
sch40
pvc
ft.
ft.
in.
17. SCREEN
FROM
•ro
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
28 ft.
30 ft.
2 in.
.010
sch40
pvc
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft.
24 ft•
Portland Cem
Tremie
24 ft•
26 ft•
Bentonite Chi'
Tremie
ft.
ft.
19. SAND/GRAVEL PACK irapplicable)
FROM
TO
MATERIAL
EMPLACEMENT M FTHOD
26 ft•
30 ft.
#1 Sand
Tremie
ft.
ft.
20. DRILLING
LOG launch
2dditiuna1 sheets if necessary)
FROM
TO
DES CR II'C ION (color. hardness, %all/rack type. krmn Kite, elc. 1
ft.
ft.
ft.
ft.
rt.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
12" Cover
2 X 2 pad
22. Certification:
Sigltuldre of Certified Well Contractor Date
By signing ihisJorm, l hereby cerli/y that the well(s) was (were) constructed in accordance
with 15A NCA(' 02('.0100 or 15A N('A(' 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 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 form within 30 days of completion of
well construction to the county health department of the county where
constructed
Form GW-I North Catolina Department of Environment and Natural Resources- Division of Water Resources
Revised August 2013

APEX
CLIENT
PROJECT
DATE/TIME
DRILLING
DRILLER
LOGGED
METHOD
A BORING NUMBER AS-17
Apex Companies
Colonial Pipeline PROJECT NAME 2020-L1-SR2448
NUMBER
STARTED
CONTRACTOR
Kevin
CPC21018 PROJECT LOCATION Huntersville, NC
6/18/2021 COMPLETED 6/18/2021 GROUND ELEVATION TOP OF
CASING
Parratt-Wolff EQUIPMENT CME 550X
White GROUND
WATER LEVELS AND TIME:
DURING DRILLING ---
BY Nia Watson BOREHOLE DIAMETER 8.25 in.
Hollow Stem Auger 8.25" AFTER DRILLING ---
© DEPTH
(ft)
SAMPLE TYPE
NUMBER
ENVIRONMENTAL
DATA
GRAPHIC
LOG
MATERIAL DESCRIPTION
COMMENTS
WELL DIAGRAM
Casing Type: 2
!4
a '
.fi
4 ^
a ,'
.
-
!4
4 ^
- -
a'
a'
5
!4
4 ^
- -
a , .
.
. ,
- -
=4
:4^
- -
a' fi
.
a' ,
.
10
'4^
'4^
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a'
a'
-
- -
_
'4^
a' fi
.
:4^
a°
. ,
15
'4^
a'
'4^
a'
-
'4^
:4^
-
a °
a
Lehigh Type I/II
_
.
\ Portland Cement
20
:4 ^
a ;
:4 ^
a ;
2-in. Sch 40 PVC
casing
-
:4 ^
:4 ^
- -
a'
a'
25_
:4^
a '
.fi
4^
a '
.,
- -
:4 ^
:4 ^
- -
a'
.fi
'
.,
30 _
:4s
a fi
.
:4e
a
. ,
-
- -
:4^
fi a '
.
:4^
a '
.,
- -
:4 ^
:4 ^
35
a;
a;
_ _
'
I-
So3/8" diumChips Bentonite
40
:..:.—:.
!
#1 Grade Silica Sand
- -
'r
••'_':
2-in. Sch 40 PVC
0 010 slotted screen
IsSpnd Cellar

WELL CONSTRUCTION RECORD
For Internal Use ONLY:
This form can be used for single or multiple wells
1. Well Contractor Information:
Kevin White
Well Contractor Name
2973
NC Well Contractor Certification Number
Parratt-Wolff, Inc.
Compam Name
2. Well Construction Permit#:
List all applicable ire// permits (i.e. County, State, I ariance, 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)
El Irrigation
Non -Water Supply Well:
ZMonitoring ❑Recovery
Injection Well:
❑Aquifer Recharge ❑Groundwater Remediation
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control
❑Geothermal (Closed Loop) ❑Tracer
❑Geothermal (Heating/Cooling Return) ❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: 6-18-21
5a. Well Location:
Colonial Pipeline Company
Facility/Owner Name Facility ID# (if applicable)
14511 Huntersville-Concord Road, Huntersville, NC 28078
Well ID# AS-17
Physical Address, City, and Zip
Mecklenburg
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field. one lat/long is sufficient)
35.412265 -80.806462
6. Is (are) the well(s): I2Permanent or ❑Temporary
w
7. Is this a repair to an existing well: Lilies or ENo
[phis is a repair, Jill out known well construction information and explain the nature of the
repair under =2/ remarks section or on the back aphis form.
8. Number of wells constructed: 1
For multiple injection or non -crater supply wells ONLY with the same construction, you can
submit one faro:,
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (far multi -rased wells) OR LINER (trip icablr)
FROM
TO
DIAMETER
THICKNESS 1
M:TERIAL
ft.
ft.
in.
. 16. INNER CASING OR TUBING (geothermal dosed -loop)
FROM
TO
DIAMETER
TEIICKNESS
M.TERIAL
0 ft'
40 ft.
2 in.
sch40
pvc
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
TIIICh'NESS
MATERIAL
40 rt.
42 ft'
2 in.
.010
sch40
pvc
ft.
ft.
in.
IL GROUT
FROM
TO
MATERIAL
EMPL_ACEM ENT MITI OD Se AMOt NT
0 ft.
36 ft.
Portland Cem
Tremie
36 ft.
38 ft-
Bentonite Chi
Tremie
ft.
ft.
19. SAND/GRAVEL PACK of appliraite)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
38 ft.
42 ft.
#1 Sand
Tremie
ft.
ft.
20. DRILLING
LOG tussah additimud ahem if necessary)
FROM
TO
DESCRIPTION (rain, Isar tiness..oiflrnrk iypc, run sire, ctr.l
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
12" Cover
2 X 2 pad
22. Certification:
S 1gnnlun of Certified Well Contractor
iZ�
Date
By .signing this Jarm, / hereby certify that the well([) was (were) consintaed in accordance
with I5A NCAC 02C.0/00 or 15A NCAC 02(',0200 Well Construction Standards and that a
copy of llri.s 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
9. Total well depth below land surface: 42 tft.) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths ifdi(feren( (example- 3@200' and 2 tt /00') construction to the following:
10. Static water level below top of casing: 30
II water level is above casing, use " -
11. Borehole diameter: 2 (in.)
12. Well construction method: 8 1/4 HSA and 2" spoons
(ft.)
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniectiun 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 form 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

APEX
CLIENT
PROJECT
DATE/TIME
DRILLING
DRILLER
LOGGED
METHOD
A BORING NUMBER AS-18
Apex Companies
Colonial Pipeline PROJECT NAME 2020-L1-SR2448
NUMBER
STARTED
CONTRACTOR
Kevin
CPC21018 PROJECT LOCATION Huntersville, NC
6/22/2021 COMPLETED 6/22/2021 GROUND ELEVATION TOP OF
CASING
Parratt-Wolff EQUIPMENT CME 550X
White GROUND
WATER LEVELS AND TIME:
DURING DRILLING 26.00 ft
BY Nia Watson BOREHOLE DIAMETER 8.25 in.
Hollow Stem Auger 8.25" AFTER DRILLING ---
© DEPTH
(ft)
SAMPLE TYPE
NUMBER
ENVIRONMENTAL
DATA
GRAPHIC
LOG
MATERIAL DESCRIPTION
COMMENTS
WELL DIAGRAM
Casing Type: 2
- -
'4
a•
.fi
4 ^
a•
.,
:4
4 ^
- -
a°
. fi
. ,
- -
:4
a°
4 ^
a°
-
:4
•4^
10
°;
a °
•4^
•4^
- -
a•
a.
- -
:4 ^
a•
:4 ^
a°
-
•4^
a•
.fi
•4^
:4^
a°
.,
•4^
20
. x
a .-
Lehigh Type I/I I
' •
1A
'
Portland Cement
- -
'4 ^
x
'4"
. '
I 2-in. Sch 40 PVC
casing
-
•4^
a•
'4^
a°
- -
SZ
- -
'4^
a•
.fi
'4^
a°
.,
30
'4 ^
a°
!4 ^
a°
- -
:4^
a°
:4^
a°
-
•4^
a•
.fi
•4^
:4^
a°
.,
•4^
- -
a•
a.
40
•
- -
i
Sodium Bentonite
3/8" Chips
- -
—
.•+
#1 Grade Silica Sand
••.:
2-in. Sch 40 PVC
0.010 slotted screen
and Cellar

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
For Internal Use ONLY:
I. Well Contractor Information:
Kevin White
Well Contractor Name
2973
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)
❑Irrigation
Non -Water Supply Well:
!Monitoring ❑Recovery
Injection Well:
❑Aquifer Recharge ❑Groundwater Remediation
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑ Experimental Technology ❑Subsidence Control
❑Geothermal (Closed Loop) ❑Tracer
❑Geothermal (Heating/Cooling Retum) ❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: 6-22-21 Well ID# AS-18
5a. Well Location:
Colonial Pipeline Company
Facility/Owner Name Facility ID# (if applicable)
14511 Huntersville-Concord Road, Huntersville, NC 28078
Physical Address, City, and Zip
Mecklenburg
County Parcel Identification No (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.4123284 N-80.806907
6. Is (are) the well(s): EZPermanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ElNo
'Phis is a repair, Jill out known well construction information and explain the nature nl the
repair under :-21 remarks section or on the hack of this firm.
8. Number of wells constructed: 1
For multiple inleclion or non -water supply wells ONLY with the same construction, ,vnu can
.submit one firm.
14. WATER ZONES
FROM
TO
DESCRIPTION
37 ft.
46 ft.
Wet
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if applicable)
FROM
TO I DIAMETER
THICKNESS MATERIAL
ft.
ft.
C in.
16. INNER
CASING OR TUBING (geothermal closed-1"op)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
44 ft
2 in.
sch40
pvc
ft.
ft.
in.
17. SCREEN
FROM
TO
I IAMFTER
SLOT SIZE
THICKNESS
MATERIAL
44 ft
46 ft•
2 in.
.010
sch40
pvc
ft.
ft.
in.
1& GROTYS
FROM
TO
MATERIA1.
EMPLACEMENT METI OD C. AMOUNT
0 ft.
40 It.
Portland Cem
Tremie
40 ft.
42 ft•
Bentonite Chit
Tremie
ft.
ft.
I4. SAND/GRAVEL PACK
(if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
42 ft
46 ft•
#1 Sand
Tremie
ft.
ft.
20. DRILLING
LOG (attach
additional sheets if necessary)
FROM
TO
DESCRIPTION I come. haws)ncss. soilerork type, grain s c, ctc.1
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
12" Cover
2 X 2 pad
22. Certification:
DilEo-etif d
Sigllra Well Contractor
Date
By .signing dos firm, / hereby certi/y that the trel/(s) was (were) constructed in accordance
with 15,4 NC'A(' 02C,0100 or 15A NC'AC 02('.0200 Well Construction Standards and/ drat a
copy of this record has been prorided 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
9. Total well depth below land surface: 46 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
for multiple wells list all depths if di//irent (example- 3@200' and 2 a 100') construction to the following:
10. Static water level below top of casing: 37 (ft)
If water level is above casing, use " "
11. Borehole diameter: 2 (in.)
12. Well construction method: 8 1/4 HSA and 2" spoons
(i.e, auger, rotary, cable, direct push, etc )
FOR WATER SUPPLY WELLS ONLY:
I3a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For injection Wells ONLY: In addition to sending the form to the address in
24a above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. Fur Water Supply & Injection Wells:
Also submit one copy of this form within 30 days of completion of
well construction to the county health department of the county where
constructed.
Foi GW-I North Carolina Department of Environment and Natural Resources - Division of Water Resources
Revised August 2013

APEX
CLIENT
PROJECT
DATE/TIME
DRILLING
DRILLER
LOGGED
METHOD
ABORING NUMBER AS-19
Apex Companies
Colonial Pipeline PROJECT NAME 2020-L1-SR2448
NUMBER
STARTED
CONTRACTOR
Kevin
CPC21018 PROJECT LOCATION Huntersville, NC
6/23/2021 COMPLETED 6/23/2021 GROUND ELEVATION TOP OF
CASING
Parratt-Wolff EQUIPMENT CME 550X
White GROUND
WATER LEVELS AND TIME:
DURING DRILLING 24.00 ft
BY Nia Watson BOREHOLE DIAMETER 8.25 in.
Hollow Stem Auger 8.25" AFTER DRILLING ---
© DEPTH
(ft)
SAMPLE TYPE
NUMBER
ENVIRONMENTAL
DATA
GRAPHIC
LOG
MATERIAL DESCRIPTION
COMMENTS
WELL DIAGRAM
Casing Type: 2
:4
4 ^
- -
a°
a°
-
_4
a .
4^
1 .
_4
4^
a°
.^
a°
.^
10
_4
a°
:4^
a°
- -
_4^
:4^
a°
a°
-
_4^
:4^
- -
a°
a°
_4^
:4^
-
a °
a.
20
_4^
:4•
a°
a°
- -
• ^
•
•''Portland
4- Lehigh Type I/I I
Cement
I2-in.
-4"
,4 ^
Sch 40 PVC
casing
- -
_4^
:4•
a°
a°
- -
_4^
:4^
30
a•
°;
_4•
:4•
-
a°
a °
-
_4•
:4•
a°
a°
_4^
:4^
- -
a°
a°
40
_4•
:4•
a°
a°
- -
I
Sodium Bentonite
3/8" Chips
—'•:'r+
#1 Grade Silica Sand
- -
=
•.: ;
2-in. Sch 40 PVC
•
0.010 slotted screen
S nd Cellar

WELL CONSTRUCTION RECORD
For Internal Use ONLY:
This form can be used for single or multiple wells
I. Well Contractor Information:
Kevin White
Well Contractor Name
2973
NC Well Contractor Certification Number
Parratt-Wolff, Inc.
Compam Name
2. Well Construction Permit#:
List all applicable well permits (i.e. County, Stale, Variance, !Mecum, 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)
❑ Irrirati on
Non -Water Supply Well:
0 Monitoring ❑Recovery
Injection Well:
❑Aquifer Recharge ❑Groundwater Remediation
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control
❑Geothermal (Closed Loop) ❑Tracer
❑Geothermal (Heating/Cooling Retum) ❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: 6-23-21 Well ID# AS-19
5a. Well Location:
Colonial Pipeline Company
Facility/Owner Name Facility ID# (if applicable)
14511 Huntersville-Concord Road, Huntersville, NC 28078
Physical Address, City, and Zip
Mecklenburg
County Parcel identification No (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(dwell field one lat/long is sufficient)
35.412371 N-80.807127
6. is (are) the well(s): OPermanent or ❑Temporary
w
7. Is this a repair to an existing well: ❑Yes or ONo
/f this is a repair, fill out known we// cunstruclion ilrformalion and explain Me nature oldie
repair under ==21 remarks section or on the back of this Pro,.
8. Number of wells constructed: 1
For multiple injection or non -water supply wells ONLY with the same construction, you can
.submit one/ornl,
9. Total well depth below land surface: 49 (ft)
For multiple wells list all depths if dilfirenl (example- 3(200' and 2 a,100')
10. Static water level below top of casing: 30 (ft.)
If uater level is above casing, use " "
11. Borehole diameter: 2 (in.)
12. Well construction method: 8 1/4 HSA and 2" spoons
(i.e auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
I3b. Disinfection type: Amount:
14. WATER ZONES
FROM
TO
DESCRIPTION
30 ft.
49 ft.
Wet
ft.
ft.
15. OUTER CASING (for multi -cased welts) OR LINER (if op linable)
FROM
TO
DIAMETER
THICKNESS lIAT ER I.AI_
ft.
ft.
in.
16. INNER CASING OR TUBING (grathc[mal closed-Inap)
FROM
TO
DIAM£'rr,R
THICKNESS
MATERIAL.
0 rt.
47 ft.
2 in.
sch40
pvc
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
47 ft.
49 ft.
2 in.
.010
sch40
pvc
rt.
ft.
in.
IS GROUT
FROM
TO
MATERIAL
FM PI_ ACEM ENT M ETH OD & AMOUNT
0 ft.
43 ft
Portland Cem
Tremie
43 ft•
45 ft
Bentonite Chi
Tremie
ft.
ft.
19. SAND/GRAVEL PACK
Inapplicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
45 ft
49 ft.
#1 Sand
Tremie
ft.
ft.
20. DRILLING LOG (attach additional sheen if nrceaarry)
FROM
TO
DESCRIPTION 'color. hardness.. soil/rock type, grain size. etc.)
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft
ft.
ft.
ft.
ft.
ft.
21. REMARKS
12" Cover
2 X 2 pad
22. Certification:
10-- -7. 1-2-1
Signature o Ceritficd. Well Contractor Date
By signing this, form, i hereby certify that the well(s) was (were) constructed in accordance
with 15A NCA(' 02('.0100 or 15A NCAC 02('.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 Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells ONLY: In addition to sending the form to the address in
24a above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Welh:
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,
Forst GW-I
North Carolina Department of Environment and Natural Resources - Division of Water Resources Revised August 2013

APEX
CLIENT
PROJECT
DATE/TIME
DRILLING
DRILLER
LOGGED
METHOD
A BORING NUMBER AS-20
Apex Companies
Colonial Pipeline PROJECT NAME 2020-L1-SR2448
NUMBER
STARTED
CONTRACTOR
Kevin
CPC21018 PROJECT LOCATION Huntersville, NC
6/28/2021 COMPLETED 6/28/2021 GROUND ELEVATION TOP OF
CASING
Parratt-Wolff EQUIPMENT CME 550X
White GROUND
WATER LEVELS AND TIME:
DURING DRILLING ---
BY Nia Watson BOREHOLE DIAMETER 8.25 in.
Hollow Stem Auger 8.25" AFTER DRILLING ---
© DEPTH
(ft)
SAMPLE TYPE
NUMBER
ENVIRONMENTAL
DATA
GRAPHIC
LOG
MATERIAL DESCRIPTION
COMMENTS
WELL DIAGRAM
Casing Type: 2
:4
4 ^
- -
a°
a°
-
_4
a .
4^
1 .
_4
4^
a°
.^
a°
.^
10
_4
a°
:4^
a°
- -
_4^
:4^
a°
a°
-
_4^
:4^
- -
a°
a°
_4^
:4^
-
a.
a.
20
_4^
:4^
a°
a°
- -
• ^
• ''
4- Lehigh Type I/I I
Portland Cement
I2-in.
-4"
,4 ^
Sch 40 PVC
-
• as
casing
- -
_4^
:4^
a°
a°
- -
_4^
:4^
30
a•
a °
_4^
:4^
- -
a°
.^
a°
.^
-
_4^
:4^
a°
a°
_4^
:4^
- -
a°
a°
40
_4^
:4^
a°
a°
- -
I
Sodium Bentonite
3/8" Chips
—'•:'r+
#1 Grade Silica Sand
- -
=
•.: ;
2-in. Sch 40 PVC
•
0.010 slotted screen
S nd Cellar

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
Kevin White
Well Contractor Name
2973
NC Well Contractor Certification Number
Parratt-Wolff, Inc.
Company Name
2. Well Construction Permit#:
List all applicable well permits (i.e. County, State. Variance, Injection, etc )
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑industrial/Commercial
❑irrigation
Non -Water Supply Well:
R1Monitoring
❑ 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
❑Subsidence Control
❑Tracer
['Other (explain under #21 Remarks)
4. Date Wells) Completed: 6-24-21
5a. Well Location:
Colonial Pipeline Company
Facility/Owner Name
Well iD# AS-20
Facility ID# (if applicable)
14511 Huntersville-Concord Road, Huntersville, NC 28078
Physical Address, City, and Zip
Mecklenburg
County Parcel Identification No (PiN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(dwell field one lat/long is sufficient)
35.412599 N -80.807156
For Internal Use ONLY
fi. WATER ZONES
FROM
TO
DESCRIPTION
40 ft.
49 ft.
Wet
ft.
ft.
15. OUTER CASiNNG (far mtth i-eased we0a) OR LINER (if app
icable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING faeathermal closed -loop)
FROM
TO
DIAMETER
THICI: NESS
MATERIAL
0 ft.
47 ft.
2 in.
sch40
pvc
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOTSIZE
THICKNESS
MLATERIAL
47 ft.
49 rt.
2 in.
.010
sch40
pvc
ft.
ft.
in.
1S. GROUT
FROM
TO
MATERIAL
EMPL►C-EMENT METHOD Si AMOUNT
0 ft.
43 rt.
Portland Cem
Tremie
43 ft.
45 fL
Bentonite Chi
Tremie
ft.
ft.
19. SAND/GRAVEL PACk_/if appIkahle)
FR DM
TO
MATERIAL
EMPLACEMENT METHOD
45 ft.
49 ft.
#1 Sand
Tremie
ft.
ft.
20. DRILLING
LOG )attach
addidannl sheets If oeeeasary)
FROM
TO
DESCRIPTION (color. hardn�..,oilltnek type. grain .ice. etc j
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21, REMARKS
12" FMC
2x2 Pad
22. Certification:
w11,1/440.4
6. is (are) the well(s): 2lPermanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or VINo
//'this is a repair, Jill out known wet/ construction information and explain the nature ql the
repair under :21 remarks section or an the back of this,/arm.
8. Number of wells constructed: 1
For multiple injection or non -water supply wells ONLY with the same construction, yaa can
submit one, fornn.
9. Total well depth below land surface: 49 (ft)
For multiple wells list all depths if different (example- 3 rt 200' and 2 a i00')
10. Static water level below top of casing: 40 (ft.)
1/ water level is above casing, use " "
11. Borehole diameter: 2 (in.)
12. Well construction method: 8 1/4 HSA
(i.e. auger, rotary. cable, direct push, etc )
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
Stgi re oFCertitied Well Contractor
d
Date
By signing this form, / hereby cerli[V Mat the well(s) was (were) constructed in accordance
with 15A N('AC 02C.O/00 or ISA N('A(' 02(',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 Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. Inc injection Wells ONLY: In addition to sending the form to the address in
24a above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells:
Also submit one copy of this form within 30 days of completion of
well construction to the county health department of the county where
constructed.
Fotm GW- 1 North Carolina Department ofEnvironment and Natural Resources — Division of Watet Resources
Revised August 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
I. Well Contractor Information:
Kevin White
Well Contractor Name
2973
NC Well Contractor Certification Number
Parratt-Wolff, Inc.
Company Name
2. Well Construction Permit#:
List all applicable well permits (i,e, County, Stale, r ariance, Injection, 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:
OMonitoring 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
DOther (explain under #21 Remarks)
4. Date Well(s) Completed: 7-1-21
5a. Well Location:
Colonial Pipeline Company
Well ID# AS-22
Facility/Owner Name Facility ID# (if applicable)
14511 Huntersville-Concord Road, Huntersville, NC 28078
Physical Address, City, and Zip
Mecklenburg
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.413085 N-80.807237
6. Is (are) the well(s): OPermanent or ❑Temporary
w
7. Is this a repair to an existing well: ❑Yes or ONo
//7his is a repair, fill out known well construction information and explain the nature oldie
repair under 2I remarks section or on the back of this farm
8. Number of wells constructed: 1
for multiple injection or non -water. supply wells ONLY with the same construction, you can
submit one firm.
9. Total well depth below land surface: 70 (ft.)
For multiple wells list all depths if different (example- 3 200' and 2 ct /00')
10. Static water level below top of casing: 40 (ft.)
l/ water level is above casing, use " "
1 I. Borehole diameter: 2
12. Well construction method:. 8 1/4 HSA
(Le. auger, rotary, cable, direct push, etc )
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
I3b. Disinfection type; Amount:
For Internal Use ONLY:
14. WATER ZONES
FROM
TO
DESCRIPTION
40 et.
70 ft.
Wet
ft.
ft.
15. OUTER CASING (for mnlei-need went) OR LINER (Rap
iub1tt
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING (geothermal dosed -loop)
FROM
TO
DIAMETER
TIIICKNESS
M.ITER' IL
0 ft.
68 ft.
2 in•
sch40
pvc
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
68 ft•
70 ft
2 in.
.010
sch40
pvc
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD &AMOUNT
0 ft.
61 ft•
Portland Cem
Tremie
61 ft•
66 ft•
Bentonite Chil
Tremie
ft.
ft.
19. SAND/GRAVEL
PACK {if applicable),
FROM
TO
MATERIAL
EMPL.ICEsIENT METHOD
66 ft.
70 ft.
#1 Sand
Tremie
ft.
ft.
28. DRILLING
LOG lattaeh additional sheets if 'memory)
FROM
TO
DESCRIPTION {Color. luircknrss. soiVrork type. train Aim, eir.l
ft
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
12" FMC
2x2 Pad
22. Certification:
Signature of Certified Well Contractor Date
By .signing This firm, I hereby certi& that the well(s) was (were) constructed in accordance
with l5A NCAC 02C_0I00 or ISA NCAC 02C.0200 Well Construction Standards and that a
copy o/ 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 ifnecessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For infection Wells ONLY: In addition to sending the form to the address in
24aabove, 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 form within 30 days of completion of
well construction to the county health department of the county where
constructed.
Foim GW- I North Carolina Department of Environment and Natural Resources— Division of Water Resources Revised August 2013

ABORING NUMBER AS-21
Apex Companies
APEX
CLIENT Colonial Pipeline PROJECT NAME 2020-L1-SR2448
PROJECT NUMBER CPC21018 PROJECT LOCATION Huntersville, NC
DATE/TIME STARTED 6/30/2021 COMPLETED 6/30/2021 GROUND ELEVATION TOP OF CASING
DRILLING CONTRACTOR Parratt-Wolff EQUIPMENT CME 550X
DRILLER Kevin White GROUND WATER LEVELS AND TIME:
LOGGED BY Nia Watson BOREHOLE DIAMETER 8.25 in. DURING DRILLING 26.00 ft
METHOD Hollow Stem Auger 8.25" AFTER DRILLING ---
© DEPTH
(ft)
SAMPLE TYPE
NUMBER
ENVIRONMENTAL
DATA
GRAPHIC
LOG
MATERIAL DESCRIPTION
COMMENTS
WELL DIAGRAM
Casing Type: 2
_
PID = 10.3
PID = 13.5
I
LEAN CLAY, SILTY, (CL) red brown
1 OR 4/6, dry, trace mica, no odor,
4.p saprolite
AS-21 (18-20'), 6/29/2021
at 0950
6
a ^
•
a •
. ^
°^
_6
. ^
a ^
a•
• ;
a
.
a^
•
_a ^
a ^
_a ^
a ^
_a^
a ^
.a ^
a ,•
_ 6 ^
a
• :
'
a •
•
_6^
a°
.^
_6 ^
a°
4
a ^
^
°•
:4
.
.a
a•
•
a
.
.a^
a^
a
a
a
a ^
,a^
a ^
'
.4
• '
a
°
•a
a
°
:a^
a°
.^
•
%!-#1
^
;
^
^
r- Lehigh Type I/II
Portland Cement
2-in. Sch 40 PVC
casing
^
Sodium Bentonite
3/8" Chips
Grade Silica Sand
-
DPT
PID = 13.5
PID=16.2
SILT, CLAYEY, (ML) red 10R 4/8, dry,
no odor, saprolite, micaceous
10
PID = 16.2
DPT
PID = 17.6
12.0
-
DPT
PID = 17.5
PID=12.1
SILT, CLAYEY, (ML) red yellow 5YR
6/6, dry, trace mica, no odor, saprolite•
16.0
- -
20
v
DPT
PID = 19.8
PID = 20.7
SILT, CLAYEY, (ML) strong brown
7.5YR 4/6, dry, no odor, saprolite,
micaceous, dioritic, foliation at 20'
-
y
DPT
PID=20.3
PID=18.9
24.0
-
-
DPT
PID = 16
PID = 17.9
SILT, CLAYEY, (ML) brown 7.5YR 4/3,
Z wet, no odor, saprolite, dioritic, oxidation,
28.0 micaceous
30
PID = 14.9
'•.:'•
:,
SILT, SANDY, (ML) brown 7.5YR 4/3,
wet, no odor, saprolite, dioritic, oxidation
DPT
PID =17.2:'.::32.0
-
DPT
PID = 14.7
PID = 11.5
.:'
;'
:.
SILT, SANDY, (ML) very dark gray
brown 10YR 3/2, wet, no odor, saprolite,
36.0 dioritic, oxidation
- -
40
1r
DPT
PID = 8.5
PID = 10.6
:.:
SILTY SAND, SILTY, (SM) dark gray
brown 10YR 4/2, wet, no odor, saprolite,
:;;40.0 dioritic, trace oxidation
DPT
PID = 8.2
-•;':
SILTY SAND, (SM) very dark gray
42.5 brown 10YR 3/2, coarse grained,
DPT
saturated, no odor, saprolite, increased
coarse
grains
-
50
_
60
2-in. Sch 40 PVC
Bottom of borehole at 61.0 feet.
0.010 slotted screen
and Cellar

WELL CONSTRUCTION RECORD
This form can be used foi single or multiple wells
1. Well Contractor information:
Kevin White
Well Contractor Name
2973
NC Well Contractor Certification Number
Parratt-Wolff, Inc.
Company Name
2. Well Construction Permit#t
Lis, al/ applicable well permits (i.e. ('aunty, Stale, l ariance, Injection, 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
❑Recovery
Injection Well:
DAquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑ Experimental Technology
❑ Geothermal (Closed Loop)
❑ Geothermal (Heating/Cooling Return)
4. Date Wel1(s) Completed: 6-30-21
52. Well Location:
Colonial Pipeline Company
Facility/Owner Name
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 Remarks)
Well ID# AS-21
Facility ID# (if applicable)
14511 Huntersville-Concord Road, Huntersville, NC 28078
Physical Address, City, and Zip
Mecklenburg
County Parcel identification No (PiN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.412834 N-80.807217
6. Is (are) the well(s): OPermanent or ❑Temporary
W
7. is this a repair to an existing well: ❑Yes or ONo
If this is a repair, fill out known MI construction inlirmation and explain the nature oldie
repair under -2/ remarks section or on the hack o/'this ,lirnn.
S. Number of wells constructed: 1
Fur multiple infection or non -water supply wells ONLY with the same construction, you can
submit one,/hrm,
9. Total well depth below land surface: 61
For nndliple wells list all depths if different (example- 3@200' and 2 a 100')
(ft.)
10. Static water level below top of casing: 40 (ft.)
If water level is above casing, use " - "
1 I. Borehole diameter: 2 (in.)
12. Well construction method: 8 1/4 HSA
(i.e. auger, rotary, cable, direct push, etc,)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
For Internal Use ONLY:
14. WATER ZO 1FS
FROM
TO
DESCRIPTION
40 ft.
61 ft.
Wet
ft.
ft.
15, OUTER CASING (for multi -caged writ!) OR LINER Of ap iluble)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
IA, 1NNER CASING OR TUBING (axwthermal clnud-Inep)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
59 -- ft.
2 in.
sch40
pvc
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOTSIZE
THICKNESS
MATERIAL
59 R.
61 IL
in.
.010
sch40
pvc
ft.
ft.
in.
IS. GROi]T
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft.
52 ft•
Portland Cem
Tremie
52 ft.
57 ft.
Bentonite Chii
Tremie
ft.
ft.
19. SAND/GRAVEL PACK
(if applicable)
FROM
TO
PATERIAL
EMPLACFMENT METHOD
57 It•
61 ft.
#1 Sand
Tremie
ft.
ft.
20. DRILLING
LAG (attach ad dig anal shred if necMsarp)
FROM
TO
DESCRIPTION leulur. harJucss, .eillroek type, %rain sire. ere.l
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
12" FMC
2x2 Pad
22. Certification:
Sigma Atr2 of Certified Well Contractor
Date
By signing this firm, l hereby certify that the well(s) was (here) constructed in accordance
with 15A N('AC 02(' 0l00 or l5A NCAC 02('.0200 Well Construction Standards and that a
copy of this record has been prorided to the ire// 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 Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells ONLY: In addition to sending the form to the address in
24a above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells:
Also submit one copy of this form within 30 days of completion of
well construction to the county health department of the county where
constructed.
Fours GW-I North Carolina Department of Environment and Natural Resources— Division of Water Resources
Revised August 2013

ABORING NUMBER AS-22
Apex Companies
APEX
CLIENT Colonial Pipeline PROJECT NAME 2020-L1-SR2448
PROJECT NUMBER CPC21018 PROJECT LOCATION Huntersville, NC
DATE/TIME STARTED 7/1/2021 COMPLETED 7/1/2021 GROUND ELEVATION TOP OF CASING
DRILLING CONTRACTOR Parratt-Wolff EQUIPMENT CME 550X
DRILLER Kevin White GROUND WATER LEVELS AND TIME:
LOGGED BY Nia Watson BOREHOLE DIAMETER 8.25 in. DURING DRILLING 26.00 ft
METHOD Hollow Stem Auger 8.25" AFTER DRILLING ---
© DEPTH
(ft)
SAMPLE TYPE
NUMBER
ENVIRONMENTAL
DATA
GRAPHIC
LOG
MATERIAL DESCRIPTION
COMMENTS
WELL DIAGRAM
Casing Type: 2
- -
PID =12.7
PID = 17.6
/4.0
j
LEAN CLAY, SILTY, (CL) ) red brown
10R 4/6, dry, no odor, saprolite,
micaceous
AS-22 (18-20), 6/29/21 at
1100
'4
a •
.
:4
•DPT
as
'4
:4
a •
;.
a•
:4"
a •
a•
.
:4"
° • •
' "
4"
• ,
4 "
as
4"
_4"
a
a °
:4"
a
a
:4 "
°•• '
Lehigh Type I/II
Portland Cement
- -
PID = 15.2
PID = 19.1
/
j
LEAN CLAY, SILTY, (CL) red 1 OR 4/8,
8.0 dry, trace mica, no odor, saprolite,r
micaceous
-
10
PID = 19.5
SILT, CLAYEY, (ML) red brown 1OR
r
DPT
PID = 20.8
12.0 4/6, dry, no odor, saprolite, micaceous
- -
y
DPT
PID = 19.1
PID=18.9
SILT, (ML) yellow red 5YR 5/8, dry,
trace clay, no odor, saprolite, micaceous
- -
20
y
DPT
PID = 12.4
PID = 25.2
20.0
- -
DPT
PID = 24.6
PID=22.2-
SILT, CLAYEY, (ML) yellow red 5YR
5/6, moist, no odor, saprolite, micaceous
- -
y
DPT
PID = 16.8
PID=11.1
Q
28.0
30
PID = 8.4
SILT, CLAYEY, (ML) dark red gray 5YR
DPT
PID = 13.4
4/2, wet, no odor, saprolite, micaceous,
slightly dioritic
-
PID = 14.2
34.0
=4"
• "
4 "
a •
.4 "
a •
-
4 "
a •
:4"
a°
°4"
a•
°4"
a•
°
.4"
;'
-
•--
`
• '
4
•
°
.4
a
:4
a
:4"
a°
:4"
a°
:4"
a°
.4"
" \2-in. Sch 40 PVC
casing
"
"
"
Sodium Bentonite
3/8" Chips
#1 Grade Silica Sand
. "2-in. Sch 40 PVC
- -
DPT
PID = 16.3
SILT, CLAYEY, (ML) brown 10YR 5/3,
PID = 14.6
saturated, no odor, saprolite, micaceous,-
38.0 dioritic
- -
40
y
DPT
PID = 15.5
r
40.0 SILT, SANDY, (ML) brown 10YR 4/3,
- -
DPT
PID = 11.8
saturated, no odor, saprolite, micaceous, j
dioritic I
y
PID = 9.6
44.0 SILT, SANDY, (ML) dark yellow brown-
-
DPT
I 10YR 4/6, saturated, no odor, saprolite, r
micaceous, dioritic I
- 50
- -
- -
- -
- -
60
_
- -
- -
70
Bottom of borehole at 70.0 feet.
0.010 slotted screen
nd Cellar

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
I. Well Contractor Information:
Kevin White
Well Contractor Name
2973
NC Well Contractor Certification Number
Parratt-Wolff, Inc.
Company Name
2. Well Construction Permit#:
List all applicable well permits (i,e, County, Stale, r ariance, Injection, 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:
OMonitoring 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
DOther (explain under #21 Remarks)
4. Date Well(s) Completed: 7-1-21
5a. Well Location:
Colonial Pipeline Company
Well ID# AS-22
Facility/Owner Name Facility ID# (if applicable)
14511 Huntersville-Concord Road, Huntersville, NC 28078
Physical Address, City, and Zip
Mecklenburg
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.413085 N-80.807237
6. Is (are) the well(s): OPermanent or ❑Temporary
w
7. Is this a repair to an existing well: ❑Yes or ONo
//7his is a repair, fill out known well construction information and explain the nature oldie
repair under 2I remarks section or on the back of this farm
8. Number of wells constructed: 1
for multiple injection or non -water. supply wells ONLY with the same construction, you can
submit one firm.
9. Total well depth below land surface: 70 (ft.)
For multiple wells list all depths if different (example- 3 200' and 2 ct /00')
10. Static water level below top of casing: 40 (ft.)
l/ water level is above casing, use " "
1 I. Borehole diameter: 2
12. Well construction method:. 8 1/4 HSA
(Le. auger, rotary, cable, direct push, etc )
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
I3b. Disinfection type; Amount:
For Internal Use ONLY:
14. WATER ZONES
FROM
TO
DESCRIPTION
40 et.
70 ft.
Wet
ft.
ft.
15. OUTER CASING (for mnlei-need went) OR LINER (Rap
iub1tt
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING (geothermal dosed -loop)
FROM
TO
DIAMETER
TIIICKNESS
M.ITER' IL
0 ft.
68 ft.
2 in•
sch40
pvc
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
68 ft•
70 ft
2 in.
.010
sch40
pvc
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD &AMOUNT
0 ft.
61 ft•
Portland Cem
Tremie
61 ft•
66 ft•
Bentonite Chil
Tremie
ft.
ft.
19. SAND/GRAVEL
PACK {if applicable),
FROM
TO
MATERIAL
EMPL.ICEsIENT METHOD
66 ft.
70 ft.
#1 Sand
Tremie
ft.
ft.
28. DRILLING
LOG lattaeh additional sheets if 'memory)
FROM
TO
DESCRIPTION {Color. luircknrss. soiVrork type. train Aim, eir.l
ft
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
12" FMC
2x2 Pad
22. Certification:
Signature of Certified Well Contractor Date
By .signing This firm, I hereby certi& that the well(s) was (were) constructed in accordance
with l5A NCAC 02C_0I00 or ISA NCAC 02C.0200 Well Construction Standards and that a
copy o/ 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 ifnecessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For infection Wells ONLY: In addition to sending the form to the address in
24aabove, 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 form within 30 days of completion of
well construction to the county health department of the county where
constructed.
Foim GW- I North Carolina Department of Environment and Natural Resources— Division of Water Resources Revised August 2013

APEX
CLIENT
PROJECT
DATE/TIME
DRILLING
DRILLER
LOGGED
METHOD
A BORING NUMBER AS-23
Apex Companies
Colonial Pipeline PROJECT NAME 2020-L1-SR2448
NUMBER
STARTED
CONTRACTOR
Kevin
CPC21018 PROJECT LOCATION Huntersville, NC
6/4/2021 COMPLETED 6/4/2021 GROUND ELEVATION 724.5 ft TOP OF
CASING
Parratt-Wolff EQUIPMENT CME 550X
White GROUND
WATER LEVELS AND TIME:
DURING DRILLING 50.00 ft / Elev 674.50 ft
BY C. Reeves BOREHOLE DIAMETER 8.75 in.
Hollow Stem Auger 8.25" AFTER DRILLING ---
© DEPTH
(ft)
SAMPLE TYPE
NUMBER
ENVIRONMENTAL
DATA
GRAPHIC
LOG
MATERIAL DESCRIPTION
COMMENTS
WELL DIAGRAM
—
Casing Type: 2
e4
•4 ^
a•
a.
_4
•4^
-
a•
a°
_ 10
_4"
•4^
a°
a°
_ _
a °
�
4•
2-in. Sch 40 PVC
casing
-
_4^
:4^
- -
a•
a.
20
_4^
:4^
_ _
a•
a°
-
_4^
:4^
_ _
a•
a°
3 0
a °
a °
+Lehigh Type I/II
-
_4 ^
:4 ,
Portland Cement
- -
a•
a'
-
_4^
:4^
- -
a•
a•
40
_4^
:4^
a•
a'
-
_4^
:4^
- -
a•
a•
- -
_4^
:4^
50
Q
° ,,
° ,,
- -
_4,,
a•
.^
:a,
a'
.^
- -
_4,,
a•
.^
:a,
a'
.^
60
_4^
:4^
a•
.^
a'
.^
_ _
Sodium Bentonite
3/8" Chips
—:
%+#1
Grade Silica Sand
- -
—"
`2-in. Sch 40 PVC
0.010 slotted screen
nd Cellar

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
I. Well Contractor Information:
Kevin White
Well Contractor Name
2973
NC Well Contractor Certification Number
Parratt-Wolff, Inc.
Company Name
2. Well Construction Permit#:
List all applicable well pernries (i.e, County, Slate, I'ariance, Injection, 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:
M Monitoring
❑Recovery
Injection Well:
❑Aquifer Recharge
❑ Aquifer Storage and Recovery
❑ Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
❑Groundwater Remediation
El Salinity Barrier
❑Stormwater Drai nage
❑ Subsidence Control
❑ Tracer
❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: 6-10-21
5a. Well Location:
Colonial Pipeline Company
Facility/Owner Name
Well DO AS-23
Facility iD# (if applicable)
14511 Huntersville-Concord Road, Huntersville, NC 28078
Physical Address, City, and Zip
Mecklenburg
County Parcel Identification No. (PiN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.413298 N-80.807262
6. is (are) the well(s): OPermanent or ❑Temporary
w
7. Is this a repair to an existing well: ❑Yes or 1No
/J ihis is a repair,,lill our known well construction in/ormation and explain the nature of the
repair under -21 remarks section or on the hack of'thisibrm,
S. Number of wells constructed: 1
har multiple infection or non -water supply wells ONLY with the same construction, you can
.submit one torn',
9. Total well depth below land surface: 69
For multiple wells list all depths ifdi/(lerent (example- 3@200' and 100')
10. Static water level below top of casing: 32 (ft.)
1.1lrater level is above casing, use "
11. Borehole diameter: 2
(in.)
12. Well construction method: 8 1/4 HSA
(i.e. auger, rotary, cable, direct push. etc )
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
For Internal Use ONLY
N. WATER ZONES
FROM
TO
DESCRIPTION
32 ft.
69 ft.
Wet
ft.
ft.
15. OUTER CASING (for muhi-eased wells} OR LINER (if Itpp ieable)
FROM
TO
DIAMETER
THICKNESS 1
MATERIAL
ft.
ft.
in.
16_ INNER CASING OR TUBING (geothermal dined -Loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft-
49 ft.
2 in.
sch40
pvc
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
M.&TKREAI.
49 ft.
69 ft
2 in.
.010
sch40
pvc
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD &-AMOL'NT
0 ft.
61 ft
Portland Cem
Tremie
61 ft.
65 ft
Bentonite Chii
Tremie
ft.
ft.
19. SAND/GR-AVEL PACK
(if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
65 ft
69 ft.
#1 Sand
Tremie
ft.
ft.
20. DRILLING
LOG (attaeh
addir tmat sines if necesnttr�]
FROM
TO
DESCRIPTION [color, hardness, sniArnck type. grain six, etc l
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
I1- REMARKS
12" FMC
2x2 Pad
22. Certification:
Si nslls�V
wj
n•e u}'C'crti cll Contractor
Date
•ZZ- Z.I
By signing this _farm, 1 hereby certify that the well(s) was (were) constructed in accordance
with 15A N('AC 02C _0100 or 15A NCA(' 02(' ,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 [his 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 Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells ONLY: in addition to sending the form to the address in
24aabove, 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 form 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

APEX
CLIENT
PROJECT
DATE/TIME
DRILLING
DRILLER
LOGGED
METHOD
A BORING NUMBER PV-01
Apex Companies
Colonial Pipeline PROJECT NAME 2020-L1-SR2448
NUMBER
STARTED
CONTRACTOR
CPC21018 PROJECT LOCATION Huntersville, NC
12/9/2020 COMPLETED 12/9/2020 GROUND ELEVATION 723.36 ft TOP OF CASING 722.83 ft
Parratt-Wolff EQUIPMENT
GROUND
WATER LEVELS AND TIME:
DURING DRILLING ---
BY Kyle Zigler BOREHOLE DIAMETER 8.25 in.
Hollow Stem Auger 8.25' AFTER DRILLING ---
© DEPTH
(ft)
SAMPLE TYPE
NUMBER
ENVIRONMENTAL
DATA
GRAPHIC
LOG
MATERIAL DESCRIPTION
COMMENTS
WELL DIAGRAM
5
Well construction details
pending.
10
15
20
25

WELL CONSTRUCTION RECORD
For internal Use ONLY
This form can be used for single or multiple wells
1. Well Contractor Information:
Kevin White
Well Contractor Name
2973
NC Well Contractor Certification Number
Parratt-Wolff, Inc.
Compam Name
2. Well Construction Permit #:
List all applicable hell permil.v (i,e. County, Stale, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑industrial/Commercial
❑irrigation
Non -Water Supply Well:
IZMonitoring
❑ 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
❑Subsidence Control
❑Tracer
❑ Other (explain under #21 Remarks)
4. Date Well(s) Completed: 12-9-20
5a. Well Location:
Colonial Pipeline Company
Facility/Owner Name
Well iD# PV-01
Facility ID# (if applicable)
14511 Huntersville-Concord Road, Huntersville, NC 28078
Physical Address, City, and Zip
Mecklenburg
County Parcel identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.412634 N-80.806396
6. Is (are) the well(s): ©Permanent or ❑Temporary
w
7. Is this a repair to an existing well: ❑Yes or ONo
If this is a repair, fill out known well construction falarmotion and explain the nature of the
repair under -,21 remarks section ar on the hack of this farm.
8. Number of wells constructed: 1
For multiple injection or non -water supply wells ONLY with the same construction, you can
submit one farm
9. Total well depth below land surface: 25
(ft)
For multiple wells list all depths if different (example- 3 a 200' and 2 a 100')
10. Static water level below top of casing: None • (ft.)
If water level is above casing, use "
11. Borehole diameter: 2 (in.)
12. Well construction method: 8 1/4 HSA
(Lc 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
ft.
ft.
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LiNER Of ap icable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING (geothermal clmed-loop)
FROM
TO
DIAMETER
TIIICKN ESS
MATERIAL
0 ft.
10 ft'
2 in.
sch40
pvc
ft.
ft.
in.
17. SCREEN
FROM
f0
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
10 ft'
25 ft•
2 in.
.010
sch40
pvc
ft.
ft.
in.
IS. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft.
6 f►•
Portland Cem
Tremie
6 ft.
8 ft.
Bentonite Chi
Tremie
ft.
ft.
1.9. SAND/GRAVEL PACK (if applicablel
FROM
TO
MATERIAL, '
EMPLACEMENT METHOD
8 ft.
25 ft.
#1 Sand
Tremie
ft.
ft.
20, DRILLING LOG (attach additional sheers if ueesasary)
FROM
TO
DESCRIPTION f color. hardness-sol1rock type. Rezin size. etc]
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
No cover
22. Certification:
Signature of Certified Well Contractor
Date
By signing t111. farm, / hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02('MOO or ISA 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. Far 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 Injection Wells ONLY: In addition to sending the form to the address in
24a above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells:
Also submit one copy of this form within 30 days of completion of
well construction to the county health department of the county where
constructed.
Form GW- I North Carolina Department of Environment and Natural Resources — Division of Water Resources
Revised August 2013

APEX
CLIENT
PROJECT
DATE/TIME
DRILLING
DRILLER
LOGGED
METHOD
A BORING NUMBER PV-02
Apex Companies
Colonial Pipeline PROJECT NAME 2020-L1-SR2448
NUMBER
STARTED
CONTRACTOR
CPC21018 PROJECT LOCATION Huntersville, NC
12/9/2020 COMPLETED 12/9/2020 GROUND ELEVATION 723.3 ft TOP OF CASING 722.92 ft
Parratt-Wolff EQUIPMENT
GROUND
WATER LEVELS AND TIME:
DURING DRILLING ---
BY Kyle Zigler BOREHOLE DIAMETER 8.25 in.
Hollow Stem Auger 8.25' AFTER DRILLING ---
© DEPTH
(ft)
SAMPLE TYPE
NUMBER
ENVIRONMENTAL
DATA
GRAPHIC
LOG
MATERIAL DESCRIPTION
COMMENTS
WELL DIAGRAM
5
Well construction details
pending.
10
15
20

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
Kevin White
Well Contractor Name
2973
NC Well Contractor Certification Number
Parratt-Wolff, Inc.
Compam Name
2. Well Construction Permit#:
List all applicable irel/ permits (i.e. County, Slate, I'aricurce, Injection, 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:
2 Monitori ng
❑Recover'
injection Weli:
❑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 Remarksj
4. Date Well(s) Completed: 12-9-20
5a. Well Location:
Colonial Pipeline Company
Facility/Owner Name
Well ID# PV-02
Facility 1D# (if applicable)
14511 Huntersville-Concord Road, Huntersville, NC 28078
Physical Address, City, and Zip
Mecklenburg
County Parcel identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.412529 N-80.806391
6. is (are) the well(s): OPermanent or ❑Temporary
w
7. Is this a repair to an existing well: ❑Yes or ENo
/J ibis is a repair, fill out known well construction information and explain the nature of the
repair under -'21 remarks section or on the hack of this firm.
8. Number of wells constructed: 1
I•iu multiple injection or non -water. supply wells ONLY with the same construction, you can
submit one
9. Total well depth below land surface: 22.5
(fL)
For multiple wells list all depths idifferent (example- 3 «200' and 2@10O')
10. Static water level below top of casing: None (ft.)
water level is above casing, use " "
11. Borehole diameter: 2 (in.)
12. Well construction method: 8 1/4 HSA
(i.e. auger, rotary. cable, direct push, etc )
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
For Internal Use ONLY:
14. WATER ZONES - _
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LiNER (if applicable)
FROM
TO
DIAMETER
THICKNESS j MATERIAL
ft.
ft.
in.
Ij
16. INNER
CASING OR TUBING
(geothermal dosed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
7.5 ft.
2 in.
sch40
pvc
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
7.5 ft
22.5 IL
2 1n.
.010
sch40
pvc
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft.
3.5 fL
Portland Cem
Tremie
3.5 ft.
5.5 ft.
Bentonite Chi
Tremie
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
5.5 ft.
22.5 ft.
#1 Sand
Tremie
ft.
ft.
20. DRILLINC
LOG (attach
NIMBI: aural sheets if necessary)
FROM
TO
DESCRIPTION (color. hardness. oil/rock type, gain size, eie.I
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
No cover
22. Certification:
LD
Signature of Certified Well Contractor
Date
By .signing this form, 1 hereby cern&y that the well(s) was (were) constructed in accordance
with 15A N('A(' 02C _0100 or 15A N('AC 02('.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 Resources, information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells ONLY: In addition to sending the form to the address in
24a above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells:
Also submit one copy of this form within 30 days of completion of
well construction to the county health department of the county where
constructed
Faint GW-I North Carolina Department of Environment and Natural Resources- Division of Water Resources
Revised August 2013

APEX
CLIENT
PROJECT
DATE/TIME
DRILLING
DRILLER
LOGGED
METHOD
A BORING NUMBER PV-03
Apex Companies
Colonial Pipeline PROJECT NAME 2020-L1-SR2448
NUMBER
STARTED
CONTRACTOR
CPC21018 PROJECT LOCATION Huntersville, NC
12/8/2020 COMPLETED 12/8/2020 GROUND ELEVATION 724.12 ft TOP OF CASING 723.63 ft
Parratt-Wolff EQUIPMENT
GROUND
WATER LEVELS AND TIME:
DURING DRILLING ---
BY BOREHOLE DIAMETER 8.25 in.
Hollow Stem Auger 8.25' AFTER DRILLING ---
© DEPTH
(ft)
SAMPLE TYPE
NUMBER
ENVIRONMENTAL
DATA
GRAPHIC
LOG
MATERIAL DESCRIPTION
COMMENTS
WELL DIAGRAM
5
Well construction details
pending.
10
15
20
25

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
Kevin White
Well Contractor Name
2973
NC Well Contractor Certification Number
Parratt-Wolff, Inc.
Companm Name
2. Well Construction Permit#:
List all applicable well permits (i.e. County, Stale, I'ariattce, Injection, ele.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑ industrial/Commercial ❑Residential Water Supply (shared)
❑ Irrigation
Non -Water Supply Well:
❑O Monitoring ❑Recovery
Injretion Well:
❑Aquifer Recharge ❑Groundwater Remediation
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control
❑Geothermal (Closed Loop) ❑Tracer
❑ Geothermal (Heating/Cooling Realm) ❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: 12-8-20 Well ID# PV-03
5a. Well Location:
Colonial Pipeline Company
Facility/Owner Name Facility ID# (if applicable)
14511 Huntersville-Concord Road, Huntersville, NC 28078
Physical Address, City, and Zip
Mecklenburg
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.412339 N-80.806358 . 41\6<— - 10
Signature of Certified Well Contractor Date
By signing this.fortn, 1 hereby certify that the well(s) was (were) constructed in accordance
ith 15,4 NCA(' 02('.0100 or 15A NC1C 02C.0200 Well Construction Standards and that a
7. Is this a repair to an existing well: ❑Yes or ENo copy of this record has been provided to the well owner.
If this is a repair, fill out known well construction in/ormatian and explain the nature of the
repair under =21 remarks .section or on the hack of thisfirm_
8. Number of wells constructed: 1
For Internal Use ONLY:
6. Is (are) the well(s): tPermanent or ❑Temporary
For multiple injection or non -ureter supply wells ONLY with the same construction, you can
submit oneArm_
9. Total well depth below land surface: 25 (ft.)
For multiple wells list all depths ifdi//erent (example- 3@.200' and 2 a 100')
10. Static water level below top of casing: None (ft.)
If'water level is above casing, use "-
11. Borehole diameter: 2 (in.)
12. Well construction method: 8 1/4 HSA
(Le. auger, rotary, cable, direct push, etc )
FOR WATER SUPPLY WELLS ONLY:
I3a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (for multi -mud welltt OR INNER (JIB
Inablel
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
lb. INNER CASING OR TUBING (geothermal dosed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
10 ft•
2 in.
sch40
pvc
ft.
ft.
in.
17, SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
10 ft'
25 ft.
2 in.
,010
sch40
pvc
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft.
6 ft.
Portland Cem
Tremie
6 ft.
8 ft.
Bentonite Chi'
Tremie
ft.
ft.
1.9, SAND/GRAVEL PAC KJif applicable)
FROM
TO
AS ATFRr:AI.
rMPI.ACF%IFNT METHOD
8 ft.
25 ft.
#1 Sand
Tremie
ft.
ft.
20. DRILLING
LOG (attach
additional sheet if neeessary)
FROM
TO
DESCRIPTION (color. hardness, soil/rock type. Brain size, etc.)
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
No cover
22. Certification:
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 A11 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 Injection Wells ONLY: In addition to sending the form to the address in
24aabove, 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 form within 30 days of completion of
well construction to the county health department of the county where
constructed.
Form GW- I North Carolina Department ofEnviionment and Natural Resources — Division of Watei Resources
Revised August 2013

APEX
CLIENT
PROJECT
DATE/TIME
DRILLING
DRILLER
LOGGED
METHOD
A BORING NUMBER PV-04
Apex Companies
Colonial Pipeline PROJECT NAME 2020-L1-SR2448
NUMBER
STARTED
CONTRACTOR
CPC21018 PROJECT LOCATION Huntersville, NC
12/8/2020 COMPLETED 12/8/2020 GROUND ELEVATION 725.92 ft TOP OF CASING 725.49 ft
Parratt-Wolff EQUIPMENT
GROUND
WATER LEVELS AND TIME:
DURING DRILLING ---
BY Kyle Zigler BOREHOLE DIAMETER 8.25 in.
Hollow Stem Auger 8.25' AFTER DRILLING ---
© DEPTH
(ft)
SAMPLE TYPE
NUMBER
ENVIRONMENTAL
DATA
GRAPHIC
LOG
MATERIAL DESCRIPTION
COMMENTS
WELL DIAGRAM
5
Well construction details
pending.
10
15
20
25

WELL CONSTRUCTION RECORD
For internal Use ONLY::
This form can be used for single or multiple wells
I. Well Contractor Information:
Kevin White
Well Contractor Name
2973
NC Well Contractor Certification Number
Parratt-Wolff, Inc.
Company Name
2. Well Construction Permit .
List all applicable well permits (i.e. County, State, Variance, hrjectiotr, etc.)
3. Well Use (check well use):
Water Supply Well:
❑ Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ lrrigati on
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
OMonitoring
Recovery
Injection Well:.
❑ Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑ Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Retum)
4. Date Well(s) Completed: 12-8-20
5a. Well Location:
Colonial Pipeline Company
Facility/Owner Name
❑Groundwater Remediation
❑ Salinity Barrier
❑ Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 Remarks)
Well ID# PV-04
Facility JD# (if applicable)
14511 Huntersville-Concord Road, Huntersville, NC 28078
Physical Address, City, and Zip
Mecklenburg
County Parcel Identification No (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.412317
N-80.806316
6. Is (are) the well(s): ©Permanent or ❑Temporary
w
7. Is this a repair to an existing well: ❑Yes or ONo
1/ this is a repair, fill out known well construction Information and explain the nature of the
repair under ,2I remarks section or on the hack of this form.
8. Number of wells constructed: 1
For muhiple injection or non-watersupply wells ONLY with the same construction, you can
submit one Arm
9. Total well depth below land surface: 25 (ft.)
For multiple wells list all depths it dyjeren (example- 3 tt 200' and 2 ct /00')
10. Static water level below top of casing: None (ft.)
If water level is above casing, use "
11. Borehole diameter: 2 (in.)
12. Well construction method: 8 1/4 HSA
(i.e. auger, rotary. cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
I4, WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. W rER CASING (for multi -cased wells) OR LINER (if app tca615)
FROM
TO
DIAMETER
THICKNESS 1
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TURING {eeorhermal Boned -loop)
FROM
TO
DIAMETER
THICKNFSS
MATERIAL
0 ft.
10 ft.
2 in.
sch40
pvc
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
10 ft.
25 ft.
2 in.
.010
sch40
pvc
ft.
ft.
in.
1S. GROUT
FROM
TO
MATERIAL
EMPLACE,NENT METHOD & AMOUNT
0 ft.
6 ft.
Portland Cem
Tremie
6 ft.
8 It
Bentonite Chit
Tremie
ft.
ft.
19. SAND/GRAVEL
PACK
(if applicable}
FROM
TO
MATERIAL
EMPLACE]I ENT METHOD
8 ft.
25 ft.
#1 Sand
Tremie
ft.
ft.
20. DRILLING
LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION !color. hardness soil/rock type, Brain sire. etel
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
No cover
22. Certification:
Signature of Certified Well Contractor
(.
Date
By signing this form, I hereby certifj, that the well(s) was (were) constructed in accordance
with 15A N('A(' 02C .0100 or l5A N('A(' 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 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. Fur Water Supply & Injettion Wells:
Also submit one copy of this form within 30 days of completion of
well construction to the county health department of the county where
constructed.
Form GW- I
North Carolina Department of Environment and Natural Resources — Division of Water Resources Revised August 2013

APEX
CLIENT
PROJECT
DATE/TIME
DRILLING
DRILLER
LOGGED
METHOD
A BORING NUMBER PV-05
Apex Companies
Colonial Pipeline PROJECT NAME 2020-L1-SR2448
NUMBER
STARTED
CONTRACTOR
CPC21018 PROJECT LOCATION Huntersville, NC
12/7/2020 COMPLETED 12/7/2020 GROUND ELEVATION 725.44 ft TOP OF CASING 725.11 ft
Parratt-Wolff EQUIPMENT
GROUND
WATER LEVELS AND TIME:
DURING DRILLING ---
BY Kyle Zigler BOREHOLE DIAMETER 8.25 in.
Hollow Stem Auger 8.25' AFTER DRILLING ---
© DEPTH
(ft)
SAMPLE TYPE
NUMBER
ENVIRONMENTAL
DATA
GRAPHIC
LOG
MATERIAL DESCRIPTION
COMMENTS
WELL DIAGRAM
5
Well construction details
pending.
10
15
20
25

WELL CONSTRUCTION RECORD
For Internal Use ONLY:
This form can be used for single or multiple wells
1. Well Contractor information:
Kevin White
Well Contractor Name
2973
NC Well Contractor Certification Number
Parratt-Wolff, Inc.
Company Name
2. Well Construction Permit #:
List all applicable well permits (i.e. County, 5'lale, i'ariance, b jecii)n, 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:
IZ 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 #21 Remarks)
4. Date Well(s) Completed: 12-7-20
5a. Well Location:
Colonial Pipeline Company
Facility/Owner Name
Well ID# PV-05
Facility iD// (if applicable)
14511 Huntersville-Concord Road, Huntersville, NC 28078
Physical Address, City, and Zip
Mecklenburg
County
Parcel identification No, (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(dwell field, one sat/long is sufficient)
35.412244 N-80.806048
6. Is (are) the well(s): ElPermanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ENo
I/ this is a repair,/ill out known well construction in/hrmation and explain the nature of the
repair under --2I remarks section or on the back o/ this_/hrm.
8. Number of wells constructed: 1
For multiple injection or non -water. supply wells ONLY with the same construction, you can
submit one,/orm.
9. Total well depth below land surface: 25 (ft)
For multiple wells list all depths if di /erem (example- 3 a 200' and 2 a /00')
10. Static water level below top of casing: None (ft.)
If water /ere) is abore casing, use
11. Borehole diameter: 2 (in.)
12. Well construction method: 8 1/4 HSA
(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
ft.
ft.
ft.
ft.
I5, OUTER CASiNG (for multi -cased welts) OR LINER (if a , . irable)
FROM
TO
DIAMETER
'TRICKINESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING (geothermal rinsed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft'
10 ft.
2 in.
sch40
pvc
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOTSI7F
THICKNESS
MATERIAL
10 ft.
25 rt.
2 in.
.010
sch40
pvc
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD Sc .AMOt'Nr
0 ft'
6 ft.
Portland Cem
Tremie
6 ft.
8 ft•
Bentonite Chi(
Tremie
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
8 ft.
25 ft.
#1 Sand
Tremie
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIFiloi !tutor, hard ness,.,tt/:sck rvpr, grain size, eu.l
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
iI. REMARKS
No cover
22. Certification:
f mot' _ c8
Signature of Certified Well Contractor
(•(zz\
Date
By signing )his form, I hereby certify that the wet/(s) was (were) constructed in accordance
with 15A N('AC 02(' _0/00 or hA NCAC 02('.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 Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells ONLY: In addition to sending the form to the address in
24aabove, 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 form within 30 days of completion of
well construction to the county health department of the county where
constructed.
Farm GW-I North Carolina Department of Environment and Natural Resources— Division of Water Resources
Revised August 2013

APEX
CLIENT
PROJECT
DATE/TIME
DRILLING
DRILLER
LOGGED
METHOD
A BORING NUMBER PV-06
Apex Companies
Colonial Pipeline PROJECT NAME 2020-L1-SR2448
NUMBER
STARTED
CONTRACTOR
CPC21018 PROJECT LOCATION Huntersville, NC
12/7/2020 COMPLETED 12/7/2020 GROUND ELEVATION 723.3 ft TOP OF CASING 722.87 ft
Parratt-Wolff EQUIPMENT
GROUND
WATER LEVELS AND TIME:
DURING DRILLING ---
BY BOREHOLE DIAMETER 8.25 in.
Hollow Stem Auger 8.25' AFTER DRILLING ---
© DEPTH
(ft)
SAMPLE TYPE
NUMBER
ENVIRONMENTAL
DATA
GRAPHIC
LOG
MATERIAL DESCRIPTION
COMMENTS
WELL DIAGRAM
5
Well construction details
pending.
10
15
20
25

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
I. Well Contractor Information:
Kevin White
Well Contractor Name
2973
NC Well Contractor Certification Number
Parratt-Wolff, Inc.
Company Name
2. Well Construction Permit#
List all applicable well permits (i, e, ('aunty, State, Variance, Injection, 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:
OMonitoring
❑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 #21 Remarks)
4. Date Well(s) Completed: 12-7-20
5a. Well Location:
Colonial Pipeline Company
Facility/Owner Name
WelllDl PV-06
Facility 1Di: (if applicable)
14511 Huntersville-Concord Road, Huntersville, NC 28078
Physical Address, City, and Zip
Mecklenburg
County
Parcel identification No (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.412452 N-80.805930
6. Is (are) the well(s): OPermanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ENo
/J this is a repair, fill out known well construction inlbrmalion and explain the nature oldie
repair under :-21 remarks section or on the back of this prin.
8. Number of wells constructed: 1
For multiple injection or non -water. supply spells ONLY with the same construction, you can
submit one Earns.
9. Total well depth below land surface: 25
(fl )
ldrr multiple wells Iry all depths ll tiller -eta (e.eornplr- 3 a 200' and 2 a i00')
10. Static water level below top of casing: None (ft.)
1f water level is above casing, use "
11. Borehole diameter: 2 (in.)
12. Well construction method: 8 1/4 HSA
(i.e. auger, rotary, cable, direct push, etc )
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm)
13b. Disinfection type:
Method of test:
Amount:
For Internal Use ONL'l':
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (for molh-tused watt) OR LINER (if ap . icuble)
FROM
TO
DL.AM£TER
THICKNESS
MATERIAL
ft.
ft.
in.
lei. INNER CASING OR TUBING (gentile rmat dmnl-loop) _ _
FROM
TO
Dr:1METER
THICKNESS
MATERIAL
0 rt.
10 ft.
2 in.
sch40
pvc
ft
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
10 ft.
25 ft.
2 In.
.010
sch40
pvc
ft.
ft.
in.
10. GROUT
FROM
TO
MATERIAL
EMPLICEM ENT METHOD & .AMOI NT
0 ft.
6 rt.
Portland Cem
Tremie
6 ft.
8 ft.
Bentonite Chii
Tremie
ft.
ft.
19. SANDIGRAVEL PACK (if Applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
8 ft'
25 ft.
#1 Sand
Tremie
ft.
ft.
20. DRILLING LOG (Attach additional sheets Knecessary)
FROM
TO
DESCRIPTION ludo,: hardness, soiUrork type. grain size. etc.)
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS - -
No cover
22. Certification:
Signature of Certified Well Contractor
Date
By signing this fbrn, / hereby certify that the well(s) was (were) constructed in accordance
with 15,1 N('AC 02C.0100 or 15A NCA(' 02('.0200 Well Construction Standards and that a
copy of this record has been prorided 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 Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells ONLY: In addition to sending the form to the address in
24a above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Weal:
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.
Foi GW- I Noith Carolina Department of Environment and Natural Resources — Division of Water Resources
Revised August 2013

I` II BORING NUMBER PV-07
Apex Companies
APEX
CLIENT Colonial Pipeline PROJECT NAME 2020-L1-SR2448
PROJECT NUMBER CPC21018 PROJECT LOCATION Huntersville, NC
DATE/TIME STARTED 12/6/2020 COMPLETED 12/6/2020 GROUND ELEVATION 722.03 ft TOP OF CASING 721.50 ft
DRILLING CONTRACTOR Parratt-Wolff EQUIPMENT
DRILLER GROUND WATER LEVELS AND TIME:
LOGGED BY Bill Jones BOREHOLE DIAMETER 8.25 in. DURING DRILLING ---
METHOD Hollow Stem Auger 8.25" AFTER DRILLING ---
© DEPTH
(ft)
SAMPLE TYPE
NUMBER
ENVIRONMENTAL
DATA
GRAPHIC
LOG
MATERIAL DESCRIPTION
COMMENTS
WELL DIAGRAM
Casing Type: 2
- -
-
a .
.6
a°
.a
.a •
a°
'
1 .
a°
.a
. ."�-
.a •
a°
:
Lehigh Type I/I I
Portland Grout
-
_
10
^
..
.a
a
""r
:
a°
•
�:0-#1
2-in. Sch 40 PVC
casing
Sodium Bentonite
3/8" Chips
Grade Silica Sand
15
- -
20
- -
- -
25
—•
r
r
r'.
:, ;,
:'
2-in. Sch 40 PVC
0.010 slotted screen

WELL CONSTRUCTION RECORD
For Internal Use ONLY:
This form can be used for single or multiple wells
1. Well Contractor Information:
Kevin White
Well Contractor Name
2973
NC Well Contractor Certification Number
Parratt-Wolff, Inc.
Compam Name
2. Well Construction Permit #:
List all applicable well permits (i.e. County, Stale, f ariance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑ Agricultural
❑Geothennal (Heating/Cooling Supply)
❑industrial/Commercial
❑Irrigation
❑ Municipal/Public
❑Residential Water Supply (single)
❑ Residential Water Supply (shared)
Non -Water Supply Well:
E Monitoring
Recovery
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothennal (Heating/Cooling Return)
4. Date Well(s) Completed: 12-6-20
5a. Well Location:
Colonial Pipeline Company
Facility/Owner Name
Groundwater Remediation
❑ Salinity Barrier
❑ Stormwater Drainage
❑Subsidence Control
❑ Tracer
❑Other (explain under #21 Remarks)
Well ID# PV-07
Facility ID# (if applicable)
14511 Huntersville-Concord Road, Huntersville, NC 28078
Physical Address, City, and Zip
Mecklenburg
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(dwell field, one lat/long is sufficient)
35.412497 N-80.805866
6. Is (are) the well(s): OPermanent or ❑Temporary
W
7. Is this a repair to an existing well: ❑Yes or V1No
Ifdtis is a repoir,,fll ma known well construction it fin9nalion and explain the nature a/ the
repair under ,2/ remarks .section or on the hack of this fire[.
8. Number of wells constructed: 1
For multiple injection or non -water .supply Wells ONLY with the same construction, you can
.submit one_jorm,
9. Total well depth below land surface: 28 (ft.)
For multiple wells list all depths if different (example- 3 cl 200' and 2 a 100')
10. Static water level below top of casing: None (ft.)
If wafer level is above casing, use " "
11. Borehole diameter: 2 (in.)
12. Well construction method: 8 1/4 HSA
(i.e auger, rotary, cable, direct push, etc )
FOR WATER SUPPLY WELLS ONLY:
I3a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
14, WATER ZONES
FROM
TO
DESCRIPTION
rt.
ft.
ft.
ft.
IS. OUTER CASING {for multi -cued welts) OR LINER (if app icable)
tHICKNE5S llj A1,ATER1.AL
FROM
ft.
TO
rt.
in.
16. INNER CASING OR TUBLNG (geothermal el nerd -leap'
FROM
TO
DIAM ET£R
THICKNESS
MATERIAL
0
ft.
13
ft.
2
in.
sch40
pvc
ft.
ft.
in,
17. SCREEN
FROM
TO
DI.AMETER
SLOT SIZE
THICKNESS
MATERIAL
13 ft.
28 ft.
2
in.
.010
sch40
pvc
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL.
EMPLWCEMENTMETFI OD & AMOUNT
0
ft.
9
ft.
Portland Cem
Tremie
9
ft.
11
ft.
Bentonite Chi
Tremie
ft.
ft.
19, SAND/GRAVEL PACK (if applicable)_
FROM
TO
MATERIAL
EMPLACEMENT METHOD
11
ft.
28
ft.
#1 Sand
Tremie
ft.
ft.
20. DRILLING LOG (attach additional sheets ifneceaearyl
FROM
ft.
ft.
TO
ft.
ft.
DESCRIPTION (color. hardness. soil/rock type. grain size. etc.)
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
No cover
22. Certification:
Signature of Certified Well Contractor
Date
By .signing this fore[, I hereby cerli/y Mat the well(s) Was (Were) constructed in accordance
with I5A N('A(' 02C.0100 or Lis N('A' 02C.0200 WcII Construction Standard, 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 Wellk: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells. 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 form within 30 days of completion of
well construction to the county health department of the county where
constructed.
DIAMETER
Form GW- I North Carolina Department ol'Environment and Natural Resources — Division of Water Resources
Revised August 2013

ABORING NUMBER PV-08R
Apex Companies
APEX
CLIENT Colonial Pipeline PROJECT NAME 2020-L1-SR2448
PROJECT NUMBER CPC21018 PROJECT LOCATION Huntersville, NC
DATE/TIME STARTED 12/7/2020 COMPLETED 12/7/2020 GROUND ELEVATION 723.67 ft TOP OF CASING 723.29 ft
DRILLING CONTRACTOR Parratt-Wolff EQUIPMENT
DRILLER GROUND WATER LEVELS AND TIME:
LOGGED BY Bill Jones BOREHOLE DIAMETER 8.25 in. DURING DRILLING ---
METHOD Hollow Stem Auger 8.25" AFTER DRILLING ---
© DEPTH
(ft)
SAMPLE TYPE
NUMBER
ENVIRONMENTAL
DATA
GRAPHIC
LOG
MATERIAL DESCRIPTION
COMMENTS
WELL DIAGRAM
Casing Type: 2
- -
-
a .
.4
a°
•4
'
•4 •
a°
•4
4•
1 .
4 •
a°
.4 •
. °-0-
•4 •
a°
:4 •
Lehigh Type I/I I
Portland Grout
_
_
10
a ;
•4
a
"r
•
:4
a°
�:0-#1
2-in. Sch 40 PVC
casing
•
Sodium Bentonite
3/8" Chips
Grade Silica Sand
15
- -
20
- -
- -
25
—
r
r
r'.
:, ;,
:'
•
2-in. Sch 40 PVC
0.010 slotted screen

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor information:
Kevin White
Well Contractor Name
2973
NC Well Contractor Certification Number
Parratt-Wolff, Inc.
Company Name
2. Well Construction Permit #:
List all applicable hell permits (i.e County, Stale, 1'ariance, Infection, 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)
❑irrigation
Non -Water Supply Well:
O Monitoring ❑Recovery
Injection Well:
❑ Aquifer Recharge ❑Groundwater Remediation
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control
❑ Geothermal (Closed Loop) ❑Tracer
❑ Geothermal (Heating/Cooling Return) ❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: 12-7-20 Well ID# PV-08R
5a. Well Location:
Colonial Pipeline Company
Facility/Owner Name Facility [D# (if applicable)
14511 Huntersville-Concord Road, Huntersville, NC 28078
Physical Address, City, and Zip
Mecklenburg
County Parcel identification No. (PiN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(dwell field, one lat/long is sufficient)
35.412703 N-80.805753
For Internal Use ONLY:
1.4, WATER ZONES
FR DM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15, OUTER CASING (fur multi -eased wells} OR LINER (If apEiisable)
FROM
TO
DIAMETER
THICKNESS I AI.ATERIAL
ft.
ft.
in.
16. INNER
CASING OR TUBING
(geothermal closed -loop)
FR DM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
13 ft.
2 in.
sch40
pvc
ft.
ft.
in.
17. SCREEN
FROM
TO
' DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
13 ft.
28 ff
2 i°'
.010
sch40
pvc
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMP€_ACEMENT METHOD Sr AMOUNT
0 ft.
9 ft.
Portland Cem
Tremie
9 ft.
11 ft•
Bentonite Chi
Tremie
ft.
ft.
19. SAND/GRAVEL
PACKJif applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
11 ft'
28 ft.
#1 Sand
Tremie
ft.
ft.
20. DRILLING LOG (attach
additional sheen if necessary)
FROM
TO
DESCRIPTION (colas, hardness. soiVrock hype, grain size, etc.l
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
No cover
6. Is (are) the well(s): 2Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or (No
/f this is a repair, Jill out known well cotstnucvimh infihnnalion and explain the nature of the
repair under =21 remarks .section or on the back of this form.
8. Number of wells constructed: 1
For multiple infection ar non -haler supply hells ONLY with the same construction, you can
submit one forum.
9. Total well depth below land surface: 28
l•or multiple wells list all depths if different (example- 3@200' and 2 a l00')
(f1)
10. Static water level below top of casing: None (ft.)
If water level is above casing, use " • "
11. Borehole diameter: 2 (in.)
12. Well construction method: 8 1/4 HSA
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
I3b. Disinfection type: Amount:
22. Certification:
Signature of Certified Well Contractor Dute
By signing this form, I hereby certify that the well(s) teas (here) constructed in accordance
with I5A N('AC 02C.0100 ar 15A NCAC 02('.0200 Well Construction Standards and that a
copy ol'this record has been prorided 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 Alt 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 form within 30 days of completion of
well construction to the county health department of the county where
constructed.
Foim GW-I
North Carolina Department of Environment and Natural Resources — Division of Watei Resources Revised August 2013

I` II BORING NUMBER PV-09
Apex Companies
APEX
CLIENT Colonial Pipeline PROJECT NAME 2020-L1-SR2448
PROJECT NUMBER CPC21018 PROJECT LOCATION Huntersville, NC
DATE/TIME STARTED 12/15/2020 COMPLETED 12/15/2020 GROUND ELEVATION TOP OF CASING
DRILLING CONTRACTOR Parratt-Wolff EQUIPMENT CME 550X
DRILLER Kevin White GROUND WATER LEVELS AND TIME:
LOGGED BY Bill Jones BOREHOLE DIAMETER 6 in. DURING DRILLING ---
METHOD Hollow Stem Auger 8.25" AFTER DRILLING ---
© DEPTH
(ft)
SAMPLE TYPE
NUMBER
ENVIRONMENTAL
DATA
GRAPHIC
LOG
MATERIAL DESCRIPTION
COMMENTS
WELL DIAGRAM
Casing Type: 2
. .
•
a.
. fi
•a
a°
.
1 .
:
. a ,
:a
a°
.
-
_
-
_ _
10
;
a.a °
; ;a°
a
a;
•a
a°
•a
a°
1
.
a
• .
a
a;
:4
a°
:
a°
2-in. Sch 40 PVC
, casing
�- Lehigh Type I/I I
Portland Grout
^
Sodium Bentonite
3/8" Chips
-
-
15
-=
_
20
25
-
30
..�
`:•!+-#1
..
2-in. Sch 40 PVC
0.010 slotted screen
Grade Silica Sand
35

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
I. Well Contractor Information:
Kevin White
Well Contractor Name
2973
NC Well Contractor Certification Number
Parratt-Wolff, Inc.
Compam Name
2. Well Construction Permit#:
List all applicable well permits (i.e. County, Stale, I arimrce, In/eclion, 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:
OMonitoring
❑ Recovery
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (IleatingICtxsling Return)
4. Date Well(s) Completed: 12-15-20
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Otherje+tpiainunder #21 Remarks)
5a. Well Location:
Colonial Pipeline Company
Well iD# PV-09
Facility/Owner Name Facility ID# (if applicable)
14511 Huntersville-Concord Road, Huntersville, NC 28078
Physical Address, City, and Zip
Mecklenburg
County Parcel Identification No (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field one Iat/long is sufficient)
35.412954 N-80.805325
6. Is (are) the well(s): 2Permanent or ❑Temporary
W
7. is this a repair to an existing well: ❑Yes or ONo
/f this is a repair, fill out known well construction information and explain the nature of the
repair under ,21 remarks section or on the hack of Misfit —no.
8. Number of wells constructed: 1
For multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
9. Total well depth below land surface: 37
For multiple wells list all depths ij different (example- 3@200' and 2 « L00')
10. Static water level below top of casing: None
If water level is above casing, use "- "
11. Borehole diameter: 2 (in.)
12. Well construction method: 8 1/4 HSA and 2" spoons
(ft.)
(ft.)
(i.e auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
I3a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
For Internal Use ONLY:
14. WATER ZONES
FROIAT
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15, OLFF R CASING (far
multi -eased wells! OR LINER (if ep limbic)
FROM
TO
DIAMETER THICKNESS
MATERAAI.
ft.
ft.
in.
1
16. INNER C.'.15ITrG OR TUBING (aeolhermal dosed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
22 ft-
2 in.
sch40
pvc
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
22 ft.
37 Ft,
2 in.
.010
sch40
pvc
ft.
Ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD& AMOLNr
0 ft.
16 ft.
Portland Cem
Tremie
16 ft.
18 ft'
Bentonite Chi
Tremie
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
18 ft•
37 ft.
#1 Sand
Tremie
ft.
ft.
MI, DRILLING
LOG (attach
add Masud sheets if necessary)
FROM
TO
DESCRIPf ION [color. hardn ' ,,itlnick lypc. grain Mae, etc.]
ft
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
No cover
22. Certification:
Sipes is ofCertit7?e W e11 Contractor
Date
By signing this torn,, / hereby cerlifiv that the wel/(s) was (were) constructed in accordance
with 15A N('AC 02(' .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
cow oflhis 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 Weill: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection We1lk ONLY: in addition to sending the form to the address in
24aabove. 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 & lgjection Wells:
Also submit one copy of this form within 30 days of completion of
well construction to the county health department of the county where
constructed.
Form GW-I
North Carolina Department of Environment and Natural Resources — Division of Water Resources Revised August 2013

APEX
CLIENT
PROJECT
DATEITIME
DRILLING
DRILLER
LOGGED
METHOD
A BORING NUMBER PV-10
Apex Companies
Colonial Pipeline PROJECT NAME 2020-L1-SR2448
NUMBER
STARTED
CONTRACTOR
Kevin
CPC21018 PROJECT LOCATION Huntersville, NC
12/20/2020 COMPLETED 12/20/2020 GROUND ELEVATION TOP OF CASING
Parratt Wolff EQUIPMENT CME 550X
White GROUND
WATER LEVELS AND TIME:
DURING DRILLING ---
BY BOREHOLE DIAMETER 8.25 in.
Hollow Stem Auger/Split Spoon AFTER DRILLING ---
© DEPTH
(ft)
SAMPLE TYPE
NUMBER
ENVIRONMENTAL
DATA
GRAPHIC
LOG
MATERIAL DESCRIPTION
COMMENTS
WELL DIAGRAM
5
Well construction details
pending.
10
15
20
25

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
I. Well Contractor Information:
Kevin White
Well Contractor Name
2973
NC Well Contractor Certification Number
Parratt-Wolff, Inc.
Company Name
2. Well Construction Permit#:
List all applicable well permits (i.e. County, State, l iiriance, Injection etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑Industrial/Commercial
❑irrigation
Non -Water Supply Well:
1 Mon itori ng
❑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 .((IemineJCouling Return)
4. Date Well(s) Completed: 12-20-20
5a. Well Location:
Colonial Pipeline Company
❑Groundwater Remediation
❑Salinity Barrier
❑ Stormwater Drainage
❑Subsidence Control
❑Tracer
❑ Other (explain under #21 Remarks)
Well ID# PV-10
Facility/Owner Name Facility 1Dtt (if applicable)
14511 Huntersville-Concord Road, Huntersville, NC 28078
Physical Address, City, and Zip
Mecklenburg
County Parcel identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field one lat/long is sufficient)
35.412952 N-80.804931
w
6. Is (are) the well(s): LZPermanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or IZ1No
IJ this is a repair./ill out known well conslrucvian itjorntation and explain the nature oldie
repair under :2! remarks section or on the hack of this Jornt.
8. Number of wells constructed: 1
For multiple injection or non -water supply wells ONLY with the same construction, you can
.submit one form.
9. Total well depth below land surface: 37 (ft.)
for multiple hells list all depths it di/Jerenl (example- 3 a 200' and 2 a 100')
10. Static water level below top of casing: None (ft.)
If water level is above casing use " -
11. Borehole diameter: 2 (in.)
12. Well construction method: 8 1/4 HSA and 2" spoons
(i.e auger, rotary, cable, direct push, etc.)
For Internal Use ONLY
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (for mull -cased weds) OR LINER (if a !kohlr)
FROM
TO
DIAMETER
TH1CK"NFSS
M.LTF.R1:1L
ft.
ft.
in.
16. INNER CASING OR TUBING (geothermal cloud -loop)
FROM
TO
DI.A:1IETER
THICKNESS
,IkTERIAL
0
ft.
22
ft.
2
in.
sch40
pvc
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
TH1CKNESS
MATERIAL
22 ft.
37 ft.
2
in.
.010
sch40
pvc
ft.
rt.
in.
10. GROUT
FROM
TO
MATERIAL
EMPLACEMENT M LTHO D & AM 01 iNT
0
ft.
16
ft.
Portland Cem
Tremie
16
ft.
19
ft.
Bentonite Chii
Tremie
ft.
ft.
19. SAND/GRAVEL PACK ffaPpfieab1c)
FROM TO MATERIAL
19 37 ft• #1 Sand
ft.
ft.
ft.
EMPLACEMENT METHOD
Tremie
20. DRILLING LOG 'attach additional sherts if neecasar7)
FROM
ft.
ft.
TO DESCRIPTION I ruin r, hardness, .oitfruc k type. train size. rtc.l
ft.
ft.
ft.
ft.
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type:
Amount:
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
No cover
22. Certification:
Signature of Certified Well Contractor
( .2(
Date
By srgnrag thft,frrm, / hereby certi%y Mut the ue//fsl was (were) can.sl nIefetl in accordance
with /Sr1 ,V('A(' 0 .('.0/00 or 15A NCrIU' 02C .0200 We!! Cottslructkrti Standards and that u
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 Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells ONLY: In addition to sending the form to the address in
24aabove. 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 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 ofEnvironment and Natural Resources- Division of Water Resources
Revised August2013

APEX
CLIENT
PROJECT
DATEITIME
DRILLING
DRILLER
LOGGED
METHOD
A BORING NUMBER PV-11
Apex Companies
Colonial Pipeline PROJECT NAME 2020-L1-SR2448
NUMBER
STARTED
CONTRACTOR
Kevin
CPC21018 PROJECT LOCATION Huntersville, NC
12/20/2020 COMPLETED 12/20/2020 GROUND ELEVATION TOP OF CASING
Parratt Wolff EQUIPMENT CME 550X
White GROUND
WATER LEVELS AND TIME:
DURING DRILLING ---
BY BOREHOLE DIAMETER 8.25 in.
Hollow Stem Auger/Split Spoon AFTER DRILLING ---
© DEPTH
(ft)
SAMPLE TYPE
NUMBER
ENVIRONMENTAL
DATA
GRAPHIC
LOG
MATERIAL DESCRIPTION
COMMENTS
WELL DIAGRAM
5
Well construction details
pending.
10
15
20
25

WELL CONSTRUCTION RECORD
For Internal Use ONLY
This form call be used for single or multiple wells
1. Well Contractor Information:
Kevin White
Well Contractor Name
2973
NC Well Contractor Certification Number
Parratt-Wolff, Inc.
Company Name
2. Well Construction Permit#:
List all applicable well permits (i.e. County, Slate, Variance, Injection, 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;
❑O Monitoring ❑Recover'
Injection Well:
❑ Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑ Geothermal (Heating/Cooling Retum)
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
Tracer
Other (explain under #21 Remarks)
-1. Date Well(s) Completed: 12-20-20 Well ID# PV-1 1
5a. Well Location:
Colonial Pipeline Company
Facility/Owner Name Facility ID# (if applicable)
14511 Huntersville-Concord Road, Huntersville, NC 28078
Physical Address, City. and Zip
Mecklenburg
County Parcel Identification No_ (PTN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field_ one lat/long is sufficient)
35.412952 N-80.804931
W
6. Is (are) the well(s): )Permanent or ❑Temporary
7. Is this a repair to an existing well: Yes or ENo
/f7his is a repair,.fill out known well construction information and explain the nature of the
repair under 2/ remarks section or on the back of This Juror.
8. Number of wells constructed: 1
For multiple injection or non -water supply hie/Is ONLY with the same construction, you can
submit one fOrtn.
9. Total well depth below land surface: 37
For multiple wells list all depths if tidier -en' (example- 3 ,200' and 2(4100')
10. Static water level below top of casing: None
II -water level is above casing, use "-
11. Borehole diameter: 2 (in.)
12. Well construction method: 8 1/4 HSA and 2" spoons
(IL)
(ft.)
(Le. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
I3b. Disinfection type: Amount:
I4. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (far mniti-rased wellsl OR LINER (1r a 3cabte)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING (geothermal eloaed-loop)
FROLl
TO
DI.I METER
ill ICKtiFSs
MATERIAL
0 ft.
22 ft.
2 in.
sch40
pvc
ft.
ft.
In.
1:7. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
NLTTERIAL
22 ft.
37 ft
2 1n.
, 010
sch40
pvc
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT Mtill IOD & AMOUNT
0 ft.
16 ft
Portland Cem
Tremie
16 1t.
19 ft•
Bentonite Chi'
Tremie
ft.
ft.
19. SAND/GRAVEL PACK
(if applicable]
FROM
TO
MATERIAL.
EMPLACEMENT METHOD
19 ft
37 ft.
#1 Sand
Tremie
ft.
ft.
20. DRILLING
LOG (attach 'Maidotaal sheets if necessary)
FROM
TO
DESCRIPTION ieolo r. bar Inesi, soil/rork rype, gala rate, elr-I
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
No cover
22. Certification:
Signature ofCertifled WeII Contractor
By signing this farm, / hereby cern& that the well(%) was (were) constructed in accordance
with /SA N('AC 02(' .0100 or I5A N('A(' 02(' _0200 Well Construction Standards and that a
copy al this record has been provided to the ae// 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 Resources, Information Processing Unit,
1617 Mali Service Center, Raleigh, NC 27699-1617
24b. For 1njcctinii Wells ONLY: In addition to sending the form to the address in
24aabove, 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 VI'eliis
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 Resources
Revised August 2013

I` II BORING NUMBER PV-12
Apex Companies
APEX
CLIENT Colonial Pipeline PROJECT NAME 2020-L1-SR2448
PROJECT NUMBER CPC21018 PROJECT LOCATION Huntersville, NC
DATE/TIME STARTED 6/17/2021 COMPLETED 6/17/2021 GROUND ELEVATION TOP OF CASING
DRILLING CONTRACTOR Parratt-Wolff EQUIPMENT CME 550X
DRILLER Kevin White GROUND WATER LEVELS AND TIME:
LOGGED BY Nia Watson BOREHOLE DIAMETER 8.25 in. DURING DRILLING 25.00 ft
METHOD Hollow Stem Auger 8.25" AFTER DRILLING ---
© DEPTH
(ft)
SAMPLE TYPE
NUMBER
ENVIRONMENTAL
DATA
GRAPHIC
LOG
MATERIAL DESCRIPTION
COMMENTS
WELL DIAGRAM
Casing Type: 2
-
5
•
a°
:�
.
•
•a
a•
.
Lehigh Type I/I I
^ Portland Grout
2-in. Sch 40 PVC
casing
Sodium Bentonite
3/8" Chips
#1 Grade Silica Sand
10
15
-
20
—
'«.kSand
2-in. Sch 40 PVC
0.010 slotted screen
Cellar
25
Q

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
Kevin White
Well Contractor Name
2973
NC Well Contractor Certification Number
Parratt-Wolff, Inc.
Compam Name
2. Well Construction Permit #:
List all applicable well permits (i.e. County, Sole, Variance, Injection, 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:
L Mon itori ng
❑Recovery
Injection Well:
❑ Aquifer Recharge
❑Aquifer Storage and Recovery
❑ Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
['Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed: 6-17-21
5a. Well Location:
Colonial Pipeline Company
Facility/Owner Name
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
['Subsidence Control
0 Tracer
['Other (explain under#21 Remarks)
Well ID# PV-12
Facility ID1 (if applicable)
14511 Huntersville-Concord Road, Huntersville, NC 28078
Physical Address, City, and Zip
Mecklenburg
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field one lat/long is sufficient)
35.412246 �,-80.806439
6. Is (are) the well(s): WIPermanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ElNo
If this is a repair, fill out known well construction injbrmauon and explain the nature of the
repair under =2/ remarks .section or on the back of this fbrnl,
8. Number of wells constructed: 1
l br multiple injection or non -water supply wells ONLY with the same construction, you can
.submit one form
9. Total well depth below land surface: 25
For multiple wells list all depths if -different (example- 3 ,200' and 2 rr 100')
(ft.)
10. Static water level below top of casing: None (ft.)
If -water level is above casing, use " -
11. Borehole diameter: 2 (in.)
12. Well construction method: 8 1/4 HSA and 2" spoons
(Le. auger, rotary, cable, direct push, etc )
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
For Internal Use ONLY
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING 'for multi-caaed walls} OR LINER (1f a &able)
FROM
TO
DIAMETER
THICKNESS MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING (neolhereial [kited -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft'
10 rt•
2 in.
sch40
pvc
ft.
ft.
in,
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
L MATERIAL
10 ft.
25 ft.
2 in.
.010
sch40
pvc
ft.
ft.
in.
IS. GROUT
FROM
TO
MATERIAL
EMPL►CEM ENT METHOD & AMOUNT
0 ft.
6 it
Portland Cem
Tremie
6 ft.
8 It
Bentonite Chi
Tremie
ft.
ft.
19, SANE1/GRAL' EL PACK:
(if applicable)
FROM
TO
MATERIAL
EMf 1..:►CEME'sr METHOD
8 ft.
25 ft.
#1 Sand
Tremie
ft.
ft.
20. DRILLING
LOG Oltaeh additional sheets If necessary)
FROM
TO
DESCRIPTION Icahn, ti Liminess. soitrrock type. gain iim, etc.)
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
12" Cover
2 X 2 pad
22. Certification:
Si11nit to of Certified Well Contractor
7r(•z�
Date
Hy signing this farm, I hereby certify That the well(s) was (were) constructed in accordance
with 15A N('A(' 02C,0100 or 15A N('AC 02C.0200 Well Construction Standards and that a
copy (Otis 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 Welk: 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
24aabove, 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 Welk:
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-I North Carolina Department of Environment and Natural Resources — Division of Water Resources
Revised August 2013

ABORING NUMBER PV-13
Apex Companies
APEX
CLIENT Colonial Pipeline PROJECT NAME 2020-L1-SR2448
PROJECT NUMBER CPC21018 PROJECT LOCATION Huntersville, NC
DATE/TIME STARTED 6/22/2021 COMPLETED 6/22/2021 GROUND ELEVATION TOP OF CASING
DRILLING CONTRACTOR Parratt-Wolff EQUIPMENT CME 550X
DRILLER Kevin White GROUND WATER LEVELS AND TIME:
LOGGED BY Nia Watson BOREHOLE DIAMETER 8.25 in. DURING DRILLING 26.00 ft
METHOD Hollow Stem Auger 8.25" AFTER DRILLING ---
© DEPTH
(ft)
SAMPLE TYPE
NUMBER
ENVIRONMENTAL
DATA
GRAPHIC
LOG
MATERIAL DESCRIPTION
COMMENTS
WELL DIAGRAM
Casing Type: 2
-
-
-
5
6
a°
.6
a°
.
4 °
,a
a°
. -c-
Lehigh Type I/I I
.a
a ^
..
.a
a•
—
.—:.:;
v
I Portland Grout
2-in. Sch 40 PVC
casing
Sodium Bentonite
3/8" Chips
0-#1 Grade Silica Sand
- -
10
15
- -
20
25
_�
�::
;::
2-in. Sch 40 PVC
0.010 slotted screen
- Sand Cellar
-
a

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
I. Well Contractor Information:
Kevin White
Well Contractor Name
2973
NC Well Contractor Certification Number
Parratt-Wolff, Inc.
Company Name
2. Well Construction Permit #:
List all applicable well permits (i.e. ('aunty, Stale, 1-irriance, Ifectionn, etc.)
3. Well Use (check well use):
For Internal Use ONLY
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (for multi -cued wilts) OR LINER (if op Stable)
TIHCiiT1E5S 1 MATERIAL
FROM
rt.
TO
ft.
DIAM ETER
in.
16. INNER CASING OR TITHING (geothermal rimed -loop]
FROM
0
ft.
TO
13
ft.
DIAMETER
2
in.
TI I ICSNESS
sch40
MATERIAL
pvc
ft.
ft.
in.
17; SCREEN
Water Supply Well:
El 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
El 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 (o>:p]:un under #21 Remarks)
4. Date Well(s) Completed: 6-22-21
5a. Well Location:
Colonial Pipeline Company
Facility/Owner Name
Well ID# PV-13
Facility IDit (if applicable)
14511 Huntersville-Concord Road, Huntersville, NC 28078
Physical Address, City, and Zip
Mecklenburg
County Parcel Identification No (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field. one Iat/long is sufficient)
35.412365 N-80.807066
6. Is (are) the well(s): (Permanent or ❑Temporary
W
7. Is this a repair to an existing well: ❑Yes or ENo
lfthis is a repair, fill out known well construction in/brmation and explain the nature oldie
repair under :21 remarks section or on the back of this Prot.
8. Number of wells constructed: 1
For multiple ilyeclion or non -water supply ur/ls ONLY with the same construction, you can
submit one form
9. Total well depth below land surface: 28 (ft.)
For multiple wells list all depths ((/different (example- 3@200' 200' and ? a l00')
10. Static water level below top of casing: None (ft.)
11 water level is abore casing, use " "
11. Borehole diameter: 2
(in.)
12. Well construction method: 8 1/4 HSA and 2" spoons
(i.e. auger, rotary, cable, direct push, etc )
FOR WATER SUPPLY WELLS ONLY:
I3a. Yield (gpm) Method of test:
I3b. Disinfection type: Amount:
FROM
TO
DIAMETER
SI.OT SIZE
THICKNESS
MATERIAL
13 it.
28 ft.
2
in.
.010
sch40
pvc
ft.
ft.
in.
1S. GROUT
FROM
TO
MATERIAL
EMPL{CEM ENT METHOD & AMOUNT
0
ft.
6
ft.
Portland Cem
Tremie
6
ft.
11
ft.
Bentonite Chii
Tremie
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERLAL
EMPLACEMENT METHOD
11
ft.
28
ft.
#1 Sand
Tremie
ft.
ft.
211. DRILLING LOG (attach addidonal Idreela If neemaary)
FROM
ft.
TO
ft.
DESCRIPTION lcolnr. h:wJn, s. coil/rork1ypm grpin siee.etc.1
ft.
ft.
ft.
ft
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
12" Cover
2 X 2 pad
22. Certification:
Si ure of Certified Well Contractor
Date
I �l
By signing This fOrm, / hereby certify that the fret/(.c) was (were) constructed in accordance
with 15A N('AC 02('_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 Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. Far Injection Wells ONLY: In addition to sending the form to the address in
24aabove, 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. Fur Water Supply & Injection Wells:
Also submit one copy of this form within 30 days of completion of
well construction to the county health department of the county where
constructed.
FormGW-1 North Carolina Department of Environment and Natural Resowces — Division of Water Resources
Revised August 2013

A BORING NUMBER PV-14
Apex Companies
APEX
CLIENT Colonial Pipeline PROJECT NAME 2020-L1-SR2448
PROJECT NUMBER CPC21018 PROJECT LOCATION Huntersville, NC
DATE/TIME STARTED 6/17/2021 COMPLETED 6/17/2021 GROUND ELEVATION TOP OF CASING
DRILLING CONTRACTOR Parratt-Wolff EQUIPMENT CME 550X
DRILLER Kevin White GROUND WATER LEVELS AND TIME:
LOGGED BY Nia Watson BOREHOLE DIAMETER 8.25 in. DURING DRILLING 26.00 ft
METHOD Hollow Stem Auger 8.25" AFTER DRILLING ---
© DEPTH
(ft)
SAMPLE TYPE
NUMBER
ENVIRONMENTAL
DATA
GRAPHIC
LOG
MATERIAL DESCRIPTION
COMMENTS
WELL DIAGRAM
Casing Type: 2
- -
- -
5
.a
° ;
`
.a
_..,--•
°
.a
'
•
:":JkSand
Lehigh Type I/II
Portland Grout
2-in. Sch 40 PVC
casing
Sodium Bentonite
3/8" Chips
#1 Grade Silica Sand
2-in. Sch 40 PVC
,. 0.010 slotted screen
Cellar
10
15
- -
- -
20
25
a

WELL CONSTRUCTION RECORD
For Internal Use ONLY
This form can be used for single or multiple wells
1. Well Contractor Information:
Kevin White
Well Contractor Name
2973
NC Well Contractor Certification Number
Parratt-Wolff, Inc.
Compam Name
2. Well Construction Permit #:
List all applicable well permits (i.e. County, State, Variance, Infection, 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)
❑Irrigation
Non -Water Supply Well:
1 Mon itori ng ❑Recovery
Injection Well:
❑Aquifer Recharge ❑Groundwater Remediation
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control
❑Geothermal (Closed Loop) ❑Tracer
❑Geothermal (Heating/Cooling Return) ❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: 6-17-21 Well ID# PV-14
5a. Well Location:
Colonial Pipeline Company
Facility/Owner Name Facility ID# (if applicable)
14511 Huntersville-Concord Road, Huntersville, NC 28078
Physical Address, City, and Zip
Mecklenburg
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(dwell field. one lat/long is sufficient)
35.412341 N-80.807009
6. Is (are) the well(s): t2Permanent or ❑Temporary
7. is this a repair to an existing well: Yes or ONo
I/ this is a repair, Jill out known well construction information and explain the nature oldie
repair under =21 remarks section or on the hack of unapt-tn.
8. Number of wells constructed: 1
For multiple injection or non -water .supply wells ONLY with the same construction, you can
submit one, form,
9. Total well depth below land surface: 25 (ft:)
For multiple wells list all depths if dilferenl (example- 3 a 200' and 2@l00')
10. Static water level below top of casing: None (ft.)
IJ water level is above casing, use " "
1 I. Borehole diameter: 2 (in.)
12. Well construction method: 8 1/4 HSA and 2" spoons
(i e auger, rotary, cable, direct push, etc )
FOR WATER SUPPLY WELLS ONLY:
I3a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (for moth -cased we'll) OR LINER (irappticable)
FROM
TO
DIAMETER
THICKNESS MATERIAL
ft.
et.
in.
16. INNER
CASINO OR TUHINC
{geothermal r]uerdanop)
FROM
TO
DIAMETER
THICKNESS
M:tTER FA
0 ft.
9 ft.
2 In.
sch40
pvc
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
10 tt
25 ft.
2 in.
.010
sch40
pvc
ft.
ft.
in.
1tt. GROUT
FROM
TO
MATERIAL
EMPLACEMENT MErt OD & AMOUNT
0 ft.
2 ft.
Portland Cem
Tremie
2 ft.
7 ft.
Bentonite Chij
Tremie
ft.
ft.
19. SAND/GRAVEL
PACK
(ifapplicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
7 ft.
25 ft.
#1 Sand
Tremie
ft.
ft.
20. DRILLING LOG (attach additional abre4 if neeplary)
FROM
TO
DESCRIPTION trolnr, ha, Linos,. soil/rnci: typr, grin .iac, cre.}
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
12" Cover
2 X 2 pad
22. Certification: (1Q
Signature of Certified Well Contractor
Date
By signing this,fum, I hereby certify that the well(s) was (were) constructed in accordance
with 15A NCA(' 02C.0100 or /SA N('AC 02('.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 Resources, information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells ONLY: In addition to sending the form to the address in
24a above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. Fur Water Supply & Injection Wells:
Also submit one copy of this form within 30 days of completion of
well construction to the county health department of the county where
constructed.
Rum GW-I North Carolina Department of Environment and Natural Resources- Division of Water Resources
Revised August 20I3

APEX
CLIENT
PROJECT
DATE/TIME
DRILLING
DRILLER
LOGGED
METHOD
A BORING NUMBER PV-15
Apex Companies
Colonial Pipeline PROJECT NAME 2020-L1-SR2448
NUMBER
STARTED
CONTRACTOR
Kevin
CPC21018 PROJECT LOCATION Huntersville, NC
6/22/2021 COMPLETED 6/22/2021 GROUND ELEVATION TOP OF CASING
Parratt-Wolff EQUIPMENT CME 550X
White GROUND
WATER LEVELS AND TIME:
DURING DRILLING ---
BY Nia Watson BOREHOLE DIAMETER 8.25 in.
Hollow Stem Auger/Split Spoon AFTER DRILLING ---
© DEPTH
(ft)
SAMPLE TYPE
NUMBER
ENVIRONMENTAL
DATA
GRAPHIC
LOG
MATERIAL DESCRIPTION
COMMENTS
WELL DIAGRAM
5
Well construction details
pending.
10
15
20
25

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
Kevin White
Well Contractor Name
2973
NC Well Contractor Certification Number
Parratt-Wolff, Inc.
Company Name
2. Well Construction Permit #:
List all applicable well permits (i.e. ('amity, State, I ariance, 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)
❑Irrigation
Non -Water Supply Well:
ElMon itoring ❑Recover•
Net riot! Well:
❑Aquifer Recharge Groundwater Remediation
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑ Experimental Technology ❑Subsidence Control
❑ Geothermal (Closed Loop) ❑Tracer
❑Geothermal (Heating/Cooling Return) ❑Other (explain under #2 Remarks)
4. Date Well(s) Completed: 6-24-21 Well iD# PV-15
5a. Well Location:
Colonial Pipeline Company
Facility/(Tuner Name Facility ID# (if applicable)
14511 Huntersville-Concord Road, Huntersville, NC 28078
Physical Address, City, and Zip
Mecklenburg
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field one lat/long is sufficient)
35.412969 N-80.807252
6. Is (are) the well(s): OPermanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ENo
If this is a repair,,lill out known well construction inlnrnmtion and explain the nature of the
repair under r:21 remarks' section or on the hack of this
8. Number of wells constructed: 1
For multiple injection or non -water supply wets ONLY with the same construction, you can
submit one brnh.
9. Total well depth below land surface: 25
For multiple wells list all depths if dilferem (example- 3 a 200' and 2 a 100')
10. Static water level below top of casing: None
11 water level is above casing, use " "
11. Borehole diameter: 2 (in.)
12. Well construction method: 8 1/4 HSA and 2" spoons
For Internal Use ONLY:
14. WATER ZONES
FROM
TO
DESCRIPTION
ft
ft.
ft.
ft.
IL OUTER CASING (far multi -cased wells) OR LINER jir applicable)
FROM
TO
DI:IMETER
TthICHNESS MATERIAL
ft.
ft.
in.
Ia. iNN'ER CASING OR TUBING Weibel -nod clnseda"op)
FROM
TO
DIAMETER
TIIICI-LESS
MATERIAL
0 ft.
10 ft.
2 in.
sch40
pvc
ft.
ft.
in.
17. SCREEN
FROM
TO
DLAM EFER
SLOT SIZE
TH1CKNFSS
MATERIAL
10 ft•
25 IL
2 in.
.010
sch40
pvc
It.
ft.
in.
IS. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft.
3 ft•
Portland Cem
Tremie
3 ft.
8 ft.
Bentonite Chi
Tremie
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
8 ft.
25 ft.
#1 Sand
Tremie
ft.
ft.
. 20. DRILLING LOG !attach additional sheets if necessary)
FROM
TO
DESCRIPTION Irolur. hardness, uo4Vrotk tope, Grain area. etcl
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
12" Cover
2 X 2 pad
22. Certification:
Signatulrof(erlitied Well Contractor
Date
Hy signing this forum, 1 hereby certi/v that the we/l(s) was (were) constructed in accordance
with 15A N('A(' 02C .0100 or 15,4 NC, -IC 02('.0200 Well Construction Standards and Mai a
copy q/ this record has been provided io 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
(ft.) 24a. Far All Wel(s: 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 iniettion 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:
(ft.)
(Le auger, rotary, cable, direct push, etc )
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
Division of Water Resources, Underground injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply Sc Injection Wells:
Also submit one copy of this form within 30 days of completion of
well construction to the county health department of the county where
constructed.
Form GW-I Noith Carolina Department ofEnvitonntent and Natural Resources— Division of Water Resources
Revised August 2013

I` II BORING NUMBER PV-16
Apex Companies
APEX
CLIENT Colonial Pipeline PROJECT NAME 2020-L1-SR2448
PROJECT NUMBER CPC21018 PROJECT LOCATION Huntersville, NC
DATE/TIME STARTED 6/24/2021 COMPLETED 6/24/2021 GROUND ELEVATION TOP OF CASING
DRILLING CONTRACTOR Parratt-Wolff EQUIPMENT CME 550X
DRILLER Kevin White GROUND WATER LEVELS AND TIME:
LOGGED BY Nia Watson BOREHOLE DIAMETER 8.25 in. DURING DRILLING ---
METHOD Hollow Stem Auger/Split Spoon AFTER DRILLING ---
© DEPTH
(ft)
SAMPLE TYPE
NUMBER
ENVIRONMENTAL
DATA
GRAPHIC
LOG
MATERIAL DESCRIPTION
COMMENTS
WELL DIAGRAM
Casing Type: 2
-
-
5
a•
•
•
a•
:�
.
•
•a
a•
.
Lehigh Type I/I I
^ Portland Grout
2-in. Sch 40 PVC
casing
Sodium Bentonite
3/8" Chips
#1 Grade Silica Sand
10
15
-
20
—
'«.kSand
2-in. Sch 40 PVC
0.010 slotted screen
Cellar
25

WELL CONSTRUCTION RECORD
This Ibrm can be used for single or multiple wells
I. Well Contractor information:
Kevin White
Well Contractor Name
2973
NC Well Contractor Certification Number
Parratt-Wolff, Inc.
Company Name
2. Well Construction Permit#:
List all applicable ire// permits (i, e, County, State, 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)
❑lrriRation
Non -Water Supply Well:
❑O Monitoring ❑Recover'
Injection Well:
❑ Aquifer Recharge Groundwater Remediation
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control
❑Geothermal (Closed Loop) ❑Tracer
❑Geothermal (Heating/Cooling Return) ❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: 6-24-21 Well ID# PV-16
5a. Well Location:
Colonial Pipeline Company
Facility/Owner Name Facility ID# (if applicable)
14511 Huntersville-Concord Road, Huntersville, NC 28078
Physical Address, City, and Zip
Mecklenburg
County Parcel Identification No. (PIN)
Foi Internal Use ONLY:
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
IS. DiTCFR CA.S1NG (tor multi -cued wells) OR LINER: (if applicable)
FROM
TO
DIAMETER
THICKNESS MATERIAL
ft.
ft.
in.
16.1NNER CASING OR TUBING (geothermal dosed -Loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
10 ft.
2 in.
sch40
pvc
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
AERIAL
10 ft•
25 ft.
2 in.
.010
sch40
pvc
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT :METHOD Sr AMOUNT
0 ft.
4 ft
Portland Cem
Tremie
4 ft.
9 ft.
Bentonite Chi
Tremie
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
9 ft.
25 ft.
#1 Sand
Tremie
ft.
ft.
20. DRILLING
LAG tattach additional sheen if necessary) •
FROM
TO
DESCRIPTION I color. h:wdnrsa, soil/rock ispr, grain kixr,etr,I
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22. Certification:
(if well field one rat/long is sufficient)
35.412988 N-80.807169 W. Cl �• I._
Signature of Certified Well Contractor Date
By signing this firm, l hereby cerli/y that the we//(s) was (were) constructed in accordance
with 15A N(',-K' 02(',0100 or 15A N('AC 02(',0200 Well Construction Standards and that a
7. Is this a repair to an existing well: ❑Yes or E No copy of this record has been provided to the well owner.
If this is a repair, Jill ow known well construction in/hrntation and explain the nature oldie
repair under 21 remarks- section or on the hack oJ'thisfornh,.
8. Number of wells constructed: 1
6. Is (are) the well(s): tPermanent or ❑Temporary
For multiple injection or non -paler supply, wells ONLY with the same construction, you can
submit one firm,
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
9. Total well depth below land surface: 25 (ft.) 24a. For All Walls: Submit this form within 30 days of completion of well
For multiple wells list all depths if different (example- 3@200' and 2 I00') construction t0 the following:
10. Static water level below top (pleasing: None (ft.)
if water level is above casing, use "
11. Borehole diameter: 2 (in.)
12. Well construction method: 8 1/4 HSA and 2" spoons
(i e. auger, rotary, cable, direct push, etc )
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Nlethod of test:
I3b. Disinfection type: Amount:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For ln[cction 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 tollowing:
Division of Water Resources, Underground Injection Control Program,
1636 Nlail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells:
Also submit one copy of this form within 30 days of completion of
well construction to the county health department of the county where
constructed.
Foi m GW-I North Carolina Deportment of Environment and Natural Resources — Division of Water Resources
Revised August 2013

APEX
CLIENT
PROJECT
DATE/TIME
DRILLING
DRILLER
LOGGED
METHOD
A BORING NUMBER PV-17
Apex Companies
Colonial Pipeline PROJECT NAME 2020-L1-SR2448
NUMBER
STARTED
CONTRACTOR
Kevin
CPC21018 PROJECT LOCATION Huntersville, NC
6/24/2021 COMPLETED 6/24/2021 GROUND ELEVATION TOP OF CASING
Parratt-Wolff EQUIPMENT CME 550X
White GROUND
WATER LEVELS AND TIME:
DURING DRILLING ---
BY Joel Schlavolt BOREHOLE DIAMETER 8.25 in.
Hollow Stem Auger/Split Spoon AFTER DRILLING ---
© DEPTH
(ft)
SAMPLE TYPE
NUMBER
ENVIRONMENTAL
DATA
GRAPHIC
LOG
MATERIAL DESCRIPTION
COMMENTS
WELL DIAGRAM
5
Well construction details
pending.
10
15
20
25

WELL CONSTRUCTION RECORD
This form can be used for single or multiple Hells
For Internal Use ONLY
1. Well Contractor Information:
Kevin White
Well Contractor Name
2973
NC Well Contractor Certification Number
Parratt-Wolff, Inc.
Company Name
2. Well Construction Permit#:
List all applicable well permits (i.e. ('onnht State, f ariance, Injection, 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:
1ZMonitoring ❑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 #21 Remarks)
4. Date Well(s) Completed: 6-30-21
5a. Well Location:
Colonial Pipeline Company
Facility/Owner Name Facility ID# (if applicable)
14511 Huntersville-Concord Road, Huntersville, NC 28078
Well ID# PV-17
Physical Address, City, and Zip
Mecklenburg
County Parcel Identification No. (PTN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field one lat/long is sufficient)
35.413062 N-80.807213 W
6. Is (are) the well(s): ©Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ENo
'Phis is a repair, Jill out known well construction in/ormalian and explain the nature oldie
repair under 21 remarks section or on the back o/ this firm.
8. Number of wells constructed: 1
l,or multiple injection or non -pater supply we/Is ONLY with the same construction, you can
submit one form,
9. Total well depth below land surface: 25 (ft.)
For multiple wells list all depths iJ'dii/Jerent (example- 3@200' and 2 ct J00')
10. Static water level below top of casing: None (ft.)
water level is above casing. use " • "
11. Borehole diameter: 2 (in.)
12. Well construction method: 8 1/4 HSA
(i.e. auger, rotary, cable, direct push, etc )
FOR WATER SUPPLY WELLS ONLY:
I3a. Yield (gpm) Method of test:
I3b. Disinfection type: Amount:
14. WATER ZONES
FROM
TO
DES(Z(I PT ION
ft.
ft.
ft.
ft.
15. OUTER CASING (for multi -cased wells] OR LINER (if op ties hie)
FROM
TO
DIAMETER
THICKNESS MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING (geothermal dosed -loop)
FROM
TO
DI:IMETER
THICKNESS
MATERIAL
0 ft.
10 ft'
2 in.
sch40
pvc
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
%LATERIA I.
10 ft.
25 It
in.
.010
sch40
pvc
ft.
ft.
in.
1& GROUT
FROM
TO
MATERIAL
EMPLACEMENT METH OD & AMOUNT
0 ft.
3 rt.
Portland Cem
Tremie
3 ft.
8 ft.
Bentonite Chit
Tremie
ft.
ft.
19. SAND/GRAVEL
PACK
(if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
8 ft.
25 ft.
#1 Sand
Tremie
ft.
ft.
20. DRILLING LOG (attach additional shecb if necessary)
FROM
TO
DESCRIPTION kola r. ha rdnrs%. suitlrnctc iypc. grain sixr, ric.l
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
12" Cover
2 X 2 pad
22. Certification:
�
Sig uture of Certified Well Contractor
Jr.
Date �• ��
By signing Iltisfirm, J hereby certify that the ire//(s) u'as (here) constructed in accordance
with 15A NCAC 02('.0100 or 15A NCA(' 02(',0200 Well Construction Standards and that a
copy o/ Ibis 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 Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells ONLY: In addition to sending the form to the address in
24a above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells:
Also submit one copy of this form within 30 days of completion of
well construction to the county health department of the county where
constructed.
Foim GW-1 North Caiolina Department of Environment and Natural Resources — Division of Water Resources
Revised August 2013

ABORING NUMBER PV-18
Apex Companies
APEX
CLIENT Colonial Pipeline PROJECT NAME 2020-L1-SR2448
PROJECT NUMBER CPC21018 PROJECT LOCATION Huntersville, NC
DATE/TIME STARTED 6/7/2021 COMPLETED 6/7/2021 GROUND ELEVATION 723.36 ft TOP OF CASING
DRILLING CONTRACTOR Parratt-Wolff EQUIPMENT CME 550X
DRILLER Kevin White GROUND WATER LEVELS AND TIME:
LOGGED BY Kyle Zigler BOREHOLE DIAMETER 8.25 in. DURING DRILLING 32.00 ft / Elev 691.36 ft
METHOD Hollow Stem Auger 8.25" AFTER DRILLING ---
© DEPTH
(ft)
SAMPLE TYPE
NUMBER
ENVIRONMENTAL
DATA
GRAPHIC
LOG
MATERIAL DESCRIPTION
COMMENTS
WELL DIAGRAM
Casing Type' 2
j
j
LEAN CLAY, SILTY, (CL) dark
red 2.5YR 3/6, dry, trace gravel,
trace roots, no odor
2 5
SPT collected at 5'
samplesea
intervals from 5' below
ground surface to boring
termination. 720.9.E
a ^
.
4 "
^
4 "
5
LEAN CLAY, SILTY, (CL) red
2.5YR 5/8, dry, no odor
5.0
718.4a
716.4
as
'6•
:a •
• ^
as•
4"
?
'-c-Lehigh
:a "
^
Type I/II
Portland Grout
-
"SPT
PID = 0
SILT, CLAYEY, (ML) red 2.5YR
5/8, dry
7.0
10
711.4
:a"
a°
'6"
° ^
'a"
a°
'4"
°
Sodium Bentonite
3/8" Chips
PID = 0
SILT, CLAYEY, (ML) red 2.5YR
5/8, dry, trace mica, no odor
12.0
"SPT
706.4
.
• ;••
_
.'
• •
•:
2-in. Sch 40 PVC
casing
15
PID = 0.2
SANDY SILT, SANDY, (ML)
strong brown 7.5YR 5/8, dry, no
17.0 odor, saprolite, micaceous
H
SPT
701.4
':::
-'::
_ #1 Grade Silica Sand
20
PID = 0.2
SANDY SILT, SANDY, (ML)
strong brown 7.5YR 5/6, dry, no
22.0 odor, saprolite, micaceous, diorite
"SPT
696.4.
•• '
;—
=•:.••
•
2-in. Sch 40 PVC
0.010 slotted screen
25
PID = 0.1
SANDY SILT, SANDY, (ML)
brown yellow 10YR 6/6, dry, no
27.0 odor, saprolite, micaceous, diorite
H
SPT
Cellar
30:::...Sand
PID = 0.4
SANDY SILT, SANDY, (ML)
brown 10YR 5/3, dry, no odor,
32.0 p saprolite, micaceous, diorite
691.4
'
SPT Bottom of borehole at 32.0 feet.

WELL CONSTRUCTION RECORD
This foim can be used foi single or multiple \sells
I. Well Contractor Information:
Kevin White
Well Contractor Name
2973
NC Well Contractor Certification Number
Parratt-Wolff, Inc.
Company Name
2. Well Construction Permit #: •
List all applicable well permits (i.e. ('aunty, Stale, Variance, Injection, 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:
0 Monitoring
❑Recover v
Injection Well:
❑Aquifer Recharge
Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑ Geothermal (Heating/Cooling Retum)
4. Date Well(s) Completed: 6-30-21
5a. Well Location:
Colonial Pipeline Company
Facility/Owner Name
❑Groundwater Remediation
❑Salinity Barrier
Stormwater Drainage
❑Subsidence Control
❑Tracer
❑ Other.(explain under #21 Remarks)
Well ID# PV-18
Facility ID# (if applicable)
14511 Huntersville-Concord Road, Huntersville, NC 28078
Physical Address, City, and Zip
Mecklenburg
County Parcel Identification No (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.413195 N-80.807544
6. Is (are) the well(s): EZPermanent or ❑Temporary
w
7. Is this a repair to an existing well: ❑Yes or ENo
I/ i/is is a repair,_/ill out known well construction in/brmalion and explain the nature q/ the
repair under = 21 remarks section or on the hock of this farm
8. Number of wells constructed: 1
For multiple injection or non -water supply wells ONLY with the same construction, you can
submit one./orm
9. Total well depth below land surface: 30 (ft.)
For multiple we/Ls list all depths if different (example- 3 c@200' and 2 c@ l00')
10. Static water level below top of casing: 25 (ft.)
If water /ere/ is above casing, use "
11. Borehole diameter: 2
(in.)
12. Well construction method: 8 1/4HSA & 2" spoons
(i.e. auger, rotary, cable, direct push, etc )
FOR WATER SUPPLY WELLS ONLY:
I3a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
For Internal Use ONLY!
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15.O1TPER CASING (far mulls-eamed wills) OR LINER Cif applicable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
I. INNER
CASING OR TEEING (>;rnthern
al dosed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft
15 ft
2 in.
sch40
pvc
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
I'HICIiNESS
MATERIAL
15 ft-
30 ft.
2 U.
.010
sch40
pvc
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD &AMOUNT
0 ft.
4 f.
Portland Cem
Tremie
4 ft.
a
11 ft•
Bentonite Chi
Tremie
ft.
ft.
19. SAND/GRAVEL PACE (If ■pplica61e)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
11 ft.
30 ft.
#1 Sand
Tremie
ft.
ft.
20. DRILLING
LOG (attach additional abeam it accessary)
FROM
TO
DESCRIPTION { coif! r.luirdneas.anil/rock lypr. grwin siar. vie.)
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REM.ARKS
22. Certification:
Signature of Certified Well Contractor
7s (0 Z I
Date
By signing Ibis firm, 1 hereby cerli/j? that the well(s) was (were) constructed in accordance
with 15A N('AC 02C .0100 or 15A NCA(' 02(' .0200 Well Construction Standards and llral 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 91I Was: 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 Iniectian Welk 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. far Water Supply & Injection Wells:
Also submit one copy of this form within 30 days of completion of
well construction to the county health department of the county where
constructed.
Form GW- I North Carolina Department of Environment and Natural Resources— Division of Water Resources
Revised August 2013