WI0700323_Injection Inspection Repot_20220429

North Carolina Department of Environment and Natural Resources
Division of Water Quality — Aquifer Protection Section
INJECTION FACILITY INSPECTION REPORT
PERMIT NO. WI0700323
DATE OF INSPECTION: 4/27/22
INSPECTOR: R. Sipe w/ WQROS-WaRO
NAME OF PERMITTEE(S) Jonathon & Melynda Oliver
MAILING ADDRESS OF PERMITTEE 1409 Potomac Dr., Chocowinity, NC 27817
PHYSICAL ADDRESS OF SITE (if different than above) same as above
PERSON MET WITH ON -SITE Jonathon Oliver ; TELE NO. [phone]
WELL(S) STATUS:
XExisting and operating Class V Well
Existing well proposed to be converted to Class V well
Proposed/not constructed
LAT/LONG OF WELL(S) 35.492293N, 77.047070W
Appx. distance of well to property boundaries: —30 feet
Appx. distance of well from foundation of house/structure: —60 feet
Appx. distance of well from septic tank/field (if present): No Septic system onsite. Area served by municipal
WWTP.
Appx. distance of well to other well(s) (if present): —60 feet to supply well
Appx. distance to other sources of pollution: _None known
Flooding Potential of Site: high moderate X low
Comments: _The conditions observed during the site visit were consistent with the last visit. Based on
observations of the wells during the site visit, it appears both the wells are in good condition and operating
adequately.
Injection Facility Insp. Report (Rev. Sept 2009) Page 1 of 3 Pages

See Attached Map
DRAW SKETCH OF SITE ABOVE (Show property boundaries, buildings, other wells, septic tanks/drain fields, other
potential pollution sources, roads, approximate scale, and NORTH arrow)
See attached GW-1 form
Draw Schematic of well above showing TD, casing depth, grout, etc.
Injection Facility Insp. Report (Rev. Sept 2009) Page 2 of 3 Pages

Well Construction Information
Date Constructed: 10/15/15
Well Contracting Company: Magette Well & Pump Co.
Well Driller Name: Bill Magette
NC Well Cert. No.: 2299 — A
Address: 2342 US 13, Ahoskie, NC 27910
Telephone No.: [phone] ; Cell No.:
Email Address:
Proposed Depth of Well(s): 160 feet
Total Depth: 160 Total Depth of Source Well, if present: 160
Casing:
Depth: 140 feet ; Diameter: 4 inch ; Type (gay. steel, PVC, etc.): PVC Stick Up: 1.0 ft
Grout:
Depth: 120 feet ; Type (cement, bentonite, etc.):Bentonite_ Placement (pumping, press. etc.): tremie
Well ID Plate Present (Y or N): Y_; Heat Pump ID plate present (Y or N): N/A
Influent spigot (Y or N): Y ; Effluent spigot (Y or N): Y
Well Sampled? (Y or N): Y ; If Yes, Lab Sample ID numbers: Influent (Supply) Effluent (Injection)
Static Water Level: Not Meas. 26 feet BLS reported on GW-1
Injection Information (if applicable):
Injection Rate: NM GPM
Injection Pressure: NM PSI
Injection Volume: NM GPD
Temperature- Summer: NM F°
Temperature- Winter: NM F°
Comments/Notes The wells appeared to be in good condition and Mr. Oliver stated that the system had been working
well since he purchased the property. Samples were collected from the supply well (Influent) and injection well
(Effluent) and lab reports for the sampling event will be provided to the Central Office and Mr. Oliver when they are
received by WaRO.
Injection Facility Insp. Report (Rev. Sept 2009) Page 3 of 3 Pages