WI0600036_Injection Record_20081001

INJECTION EVENT RECORD - F-RFICEIVED;".
North Carolina Department of Environment and Natural Resources - Divisi of W VQ0aBt;008
Permit Number W10600036
1. Permit Information
Mr. Gregg Bean, Director of Public Works
Permittee
Ft. Bragg Directorate of Public Works
Facility Name
Building 3-31137 Butner Rd, Ft. Bragg
North Carolina, 28310
Facility Address
2. Injection Contractor Information
Parsons
Injection Contractor / Company Name
Street Address 1700 Broadway, Ste 900
Denver CO 80290
City State Zip Code
303 764-1940
Area code - Phone number
3. Well Information
Number of wells used for injection 62
TA"
through TAt-10; TA2-2 through TA2-16; TA3-1 through TA3-15;
Well names TA4-1 through TA4-10; TA5-1 through TA5-12
Were any new wells installed during this injection
event?
0 Yes ❑ No
If yes, please provide the following information:
Number of Monitoring Wells
Number of Injection Wells
62
Type of Well Installed (Check applicable type):
❑ Bored ❑ Drilled 0 Direct -Push
❑ Hand -Augured ❑ Other (specify)
Please include two copies of the GW-lb for each
well installed.
ON-FAYETUILLE REG101VAL OFFICE
Were any wells abandoned during this injection
event?
❑ Yes 0 No
If yes, please provide the following information:
Number of Monitoring Wells
Number of Injection Wells
Please include two copies of the GW-30 for each
well abandoned.
4. Injectant Information
Soybean oil, Newman's Zone, Neutral Zone, Water
Injectant Type
Soybean oil - 4.4%; Newman's Zone - 0.9%;
Concentration Neutral Zone - 0.7%; Water 94%.
If the injectant is diluted please indicate the source
dilution fluid. Ft. Bragg Fire Hydrant
Total Volume Injected 114,684
TA-1 - 1429; TA2 - 1491;
Volume Injected per wel1TA3 - 1491: TA4 - 1706: TA5 - 1499
5. Injection History
Injection number (e.g. 3 of 5) 1 of 3
Is this the last injection at this site?
❑ Yes X❑ No
I DO HEREBY CERTIFY THAT ALL THE
INFORMATION ON THIS FORM IS CORRECT'T-O
THE BEST OF MY KNOWLEDGE AND THAT THE
INJECTION WAS PERFORMED WITHIN ' THE
STANDARDS LAID OUT IN THE PERMIT.
9IGN<TUKE OF INJECTION CONTRACTOR DATE
Dan Griffiths and Kevin Smith
PRINT NAME OF PERSON PERFORMING THE INJECTION
Submit the original of this form to the Division of Water Quality within 30 days of injection. Form UIC-IER
Attn: UIC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-733-32 ]] RECEIVED 1 / DWPev, 11/06
JbUIFPR-PR(1T` N SFCTION
OCT

NONRESIDENTIAL WE 7• CONSTRUCTION RECORD
North Carolina Department of Environment andNatuial Resowpes-:Division of Water Quality.
WELL CONTRACTOR CERTIFICATION N 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (Individual) Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO Box 1169
Dacula GA 300019
City or Town State Zip Code
7f 70 t-868-5407
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(dapplicable) f ��
WELL CONSTRUCTION PERMIT#(dapplkxble) N/A
OTHER ASSOCIATED PERMIT #(If applicable) NIA
3. WELL USE (Check Applicable Box)Monitoring[] Municiol/Pub—lp
IndustriaUCoinmercialB AgricultumID Recoveryg _ injecuonar
Irrigationl3 Other13 (Iist use)
DATE DRILLED I) - a� TIME COMPLETED 11.11C AMER"EPMD
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301'
(Street Name, Numbers, Community, Subdivision, Lot No., Pamel, Zip Code)
TOPOGRAPHIC / L6ND SETTING:
0 Slope 13 Valley Er Flat 13 Ridge 0 Other,
(check appropriate box) May be m degrees,
LATITUDE 35.15 491945 miautes,seconds or
LONGITUDE -78.98 293615 in xdecimal.format
Latitude/longitude source: j( GPS 0 Topographic map
(location of wellmust be shown on a USGS topo map and
attached to fhls form Ynot using GPS)
5. FACILITY- Ism name orthe business where the well Is located.
FACILITY ID #(If applicable) N/A
NAME OF FACILITY Fort Bragg
STREETADDRESS Building 3-1137 Butner Rd.;
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State; Zip: Code .
91t 0 .396-7432
Area code - Phone number
6. WELL DETAILS: i
a. TOTAL DEPTH: 5 I • _
b. DOES WELL REPLACE EXISTING WELL? YES13 - NOe
c. WATER LEVEL Below Top of Casing: 41.19 FT;
. (Use +° !f Above Top of Casing)
d.. TOP OF CASING IS . FT: Above Land Surface'
*Top:of casing terminated at/or_below land surface may require
a'variance:in accordance. with 15A NCAC 2C. 1:18..
e; YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From____:_To
From To From To
From To From To
7„ CASING: Depth Diameter ThicknessM&ight .Material
From 4(j To 0..
Ft '
p✓C
From Tc
Re
From To
Ft.
8. GROUT., Depth
Material
Method
FronLL3z"! To d
Ft ^(igT 1
rtC&
From _2g 2 To 32-T
Ft
i� �MAZ6
From Tod
Ft.
:9. SCREEN: Depth
Diameter Slot Size Material
FrorrL51" To Z{14 _
Ft r in.. -- a 1 a. in. ArC
From To
Ft. !n. in.
From To
Ft. . in. in:.
10. SAND/GRAVEL PACK:
Depth Size Material
Front Jr t-, To 5'Z Ft '# of Add
From To
Ft
FrarrA To
Ft.
11.DRILLING LOG -
From To
Formation. Description
12. REMARKS:
PRINTED:NAME
IN ACCORDANCE WITH
A COPYOFTHIS
•DATE
Submit the original to the Division of Water Quality within 30 days. Attn: Information MgtMEIVED / DENRfiaB{t4,l .1b
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568. AQUIFFR-PPnTFrTI(11$ bN
OCT 16 2n08

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment andNatural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (IndhriduaD Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO BOX 1169
Dacula GA 300019
City or Town State Zip Code
7t 70 t.868-5407
Area code. Phone number
2. WELL INFORMATION:
SITE WELL ID #(dapplicable)—
WELL CONSTRUCTION PERMIT#(ifappiicabie) N/A
OTHER ASSOCIATED PERMIT #(dapplicabie) N/A
3. WELL USE (Check Applicable Box) Monitoring[) Municipal/Publi
Industrial/CommercialI3 Agricultural[] Recovery[] InjectionEr
Irrigatiori l Other[] (list use)
DATE DRILLED p' 1/- DY
TIME COMPLETED - It- d Y AMB' PMCI
4. WELL LOCATION:
CITY, Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NO 28301
(Street Name, Numbers, Community, SubdMsior4 Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING: •
B Slope 0 Valley 9,'F1at D Ridge [] Other
(check appmpriate box)
Maybe is degrees,
LATITUDE 35.15 489174 minutes, seconds or
LONGITUDE -78.98 290468 madecimalformat
Latitude/longitude source: N GPS C ' Topographic map
(location of we0 must be shown on a USGS (opo map and
attached to this form if not using GPS)
5. FACILITY- is the tame of the business where the well Is located
FACILITY ID #(if applicable) N/A
NAME OF FACILITY Fort Bragg
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NO 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
91t 0 }- 396-7432
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 5 �
b. DOES WELL REPLACE EXISTING WELLY YES[] NOR""
c, WATER LEVEL Below Top of Casing: 40.85 FT -
(Use "+' if Above Top of Casing)
d. TOP OF CASING IS 2-9 FT. Above Land Surface*
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type
Amount
g. WATER ZONES (depth):
From To
From To
From To
From To
From To _
From To.-
F. CASING: , Depth Diameter Thickness&Wight
Material
11.
From k t -To d Ft.
From To FL
From To FL
8. GROUT: Depth
Material
Method
Front 31-7, To— O FL J4 to T t fn c �:J�
From .- • _ To Ft, 995.4Y -46—me
From To FL
9. SCREEN: . , Depth
Diameter
Slot Size material
From •i_To_y),l_FL
.')5 in.
•#q) in. f�'C
From To
Ft in.
in.
From To
Ft in.
in.
10. SAND/GRAVEL PACK:
Depth
Size
Material
From 5l, -To..33-9 FL
From To
FL
From To
FL
11.DRILLING LOG
From To Formation Description
12. REMARKS:
I DO HEREDYAUTIFYTTTHISWELLWACOU TINACMRDA14CEWiTH
A ELL CON Wn N NOARDD AOOPYOFTHIS
EN PRD T L O
t A E OF CERTIFIED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division, of Water Quality within 30 days. Attn: Information Mgt, Form Gw 1b
1617 Mail Service Center— Raleigh, NC 276994617 Phone No. [phone] ext 568. Rev.12/07

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (Indtvtduan Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO BOX 1169
Dacula GA 300019
City or Town State Zip Code _
7f 70 - 868-5407
Area code- Phone number
2. WELL INFORMATION: Ap
SITE WELL ID #(if applicable)
WELL CONSTRUCTION PERMIT#(if appiicable) NIA
OTHER ASSOCIATED PERMIT #(d applicable) N/A
3. WELL USE (Check Applicable Box) Monitoringl3 Municipal/PublIcI3
Industrial/CommerctalD Agricultural0 Recovery0 InjectionEK
Inigatiora Otherp (list use)
DATE DRILLED V (I d y
TIME COMPLETED -II-VV AMePMB
4. WELL LOCATION:
cay, Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdhrision, Lot No., Parcel, Zlp Code)
TOPOGRAPHIC / L5ND SETTING:
0 Slope 0 Valley IN Fiat D Ridge 0 Other
. (check appropriate box) 1V&y be in defies,
LATITUDE 35.15 486519 minutes, seconds or
LONGITUDE-78.98 287315 inadecimal format
Latitude/longitude source: A GPS 0 Topographic map
(location of well must be shown on a USGS topo map and
attached to this form H not using GPS)
5. FACILITY- is the name orthe business where the wag is bcata&
FACILITY ID #(if applicable) NIA
NAME OF FACILITY Fort Braqq
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
(910 . 396-7432
Area code - Phone number
S. WELL DETAILS: _
a. TOTAL DEPTH: `j O.1P —/
b. DOES WELL REPLACE EXISTING WELL? YES13 NORI
c. WATER LEVEL Below Top of Casing: 3.00 FT,
(Use '+^ if Above Top of Casing)
d. TOP OF CASING IS .S FT. Above land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 20 .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type
Amount
g. WATER ZONES (depth):
From To
From To
From To
From To
From To
From To
7. CASING: Depth
Diameter ThicknessWeight Material
From ©.b To a
Ft. .7$ Pvt
From To
Ft.
From To
Ft
8. GROUT: Depth
Material Method
Fro rR 3IrtTo b
FL Af6"'&-46/T _fv2m
Fr.Mjgz_To'51-EFt.
From To
FL
8. SCREEN: Depth
Diameter Slot Size Material
FrorrL- 0,40_To !faio_Ft. •7S in. iatd In. Ae
From I To
Ft. In. In.
From To
Ft —In. In.
10. SAND/GRAVEL PACK:
Ela^th
Size Material
Fro n SOLG' To 3_Ft. a +�
From To
Ft.
From To
Ft
11.DRILLING LOG
From TO Formation Description
12. REMARKS:
IDO C TIFYT1iATTHISWELLVIWSCONSTRI�TE�INACCORDANCEWITH
1 ElLC RUCTItAdST DARDS.AN ACOPYOFTHIS
PRINTED NAME OF
IIr
DATE
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form GW-1b
1617 Mail Service Center— Raleigh, NC 276994617 Phone No. [phone] ext 568. Rev.12/07
I
i

NONRESIDENTIAL WELL coNSTRumoN RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (Individuaq Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO BOX 1169
Dacula IGA 300019
City or Town State Zip Code
(770 - 868-5407
Area code- Phone number
2. WELL INFORMATION: _ �J
SITE WELL ID #(ifappricable) (A. 1' -t
WELL CONSTRUCTION PERMIT#(fapplicable), N/A
OTHER ASSOCIATED PERMIT #(if applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring[] Municipal/Publj
IndustriallCommercial[I AgricutturaI13 Recoveryl7 Injection
IrrigatiorG Otheril (list use)
DATE DRILLED S-'— it-d /
TIME COMPLETED J'-II- 0 AMl3 PMI]
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision. Lot No.. Parcel, Zip Code)
TOPOGRAPHIC / L6ND SETTING:
3 Slope 13 Valley, Or Flat 13 Ridge 0' Other
(check appropriate box) jvby be in dcFacs,
LATITUDE 35.15 483754 minutes, seconds or
LONGITUDE -78.98 284143 in a decimal formal
Latitude/longitude source: R GPS U Topographic map
--�Wcahon�7/mus76e shown an —a VSGS i m p ann — -
attached to this form If not using GPS)
5. FACILITY- Is the name cabs business Mtlerema Men is located
FACILITY ID #Qf applicable) N/A
NAME OF FACILITY Fort Bra99
STREETADDRESS _Building 3-1137 Butner Rd.'
Fort Bragg NC 28301
City or Town state Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
91( 0 ).396-7432
Area code - Phone number
6. WELL DETAILS: j
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES0 NOM
c. WATER LEVEL Below Top of Casing: 40.47 FT.
(Use °+" if Above Top of Casing)
d. TOP OF CASING IS `• 1 FT. Above Land Surface -
'Top of casing terminated atfor below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm):
METHOD OF TEST
f: DISINFECTION: Type
Amount
g. WATER ZONES (depth):
From Tc
From To
From Tc
From To
From Tc
From To
7. CASING::: Depth
Diameter ThicknessMbight Material
From -1 I"� To 6
Ft. , 75- rye
From To
Ft
From To
Ft
B. GROUT: Depth
Material Method
Fro rr�33•� To_
Ft + -1 C�6jl 1�✓RL'f� ?l3
From SN; To_3311
Ft CN-y '7?EMrizt
From Tc
Ft
9. SCREEN: Depth
Diameter Slot Size Material
_ 3t,
nVFo._r�,
in✓�_Olb in.
From To
Ft in. in.
From Tc
Ft in. in.
10. SAND/GRAVEL PACK:
Depth
reve Material
From 51,? —To 354,_
Ft• aZ SfW'
From To
Ft'
From To
Ft.
11.13RILLING LOG
.--From-- -To- --- —
.---Formation-Description- . ---
—
12. REMARKS:
15A.t00HC IWdL%nRU ITfrDNS�NDARDS.MIR/TH A ACCORDANCE
WELL CONTRACTOR DATE
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,, Form GW 1b
1617 Mall Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 668. Rev.12/07

NONRESIDENTIAL wELL coNSTRycum RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (IndividuaQ Name
Geo Lab, Inc.
Well Contractor Company Name
STREET ADDRESS PO BOX 1169
Dacuia GA 300019
City or Town State Zip Code
7( 70 .868-5407
Area code- Phone number
2. ,WELL INFORMATION:
SITE WELL ID #(dapplicable) r A
WELL CONSTRUCTION PERMIT#(if.applicable) N/A
OTHER ASSOCIATED PERMIT#(If applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring0 MunicipaUPubli
Industrial/Commerclal[] Agriculturall] Recoveryd Injection
Irrigation$] Otherp (list use)
DATE DRILLED
TIME COMPLETED `�l"d y AMe PMD
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
0 Slope 0 Valley IrFlat d Ridge a Other
(check appropriate box) ]&y be in degrees,
LATITUDE 35.15 481006 minutes, seconds or
LONGITUDE -78.98 280994 in a decimal format
Latitude/longitude source: 111 GPS 13 Topographic map
(locaffon of well mustbe shown on a USGS topo map and
attached to this form. Anot using GPS)
5.FACILITY Is the name orthebusiness wherathenellIslocated
FACILITY ID #(If applicable) N/A
NAME OF FACILITY Fort Bra-=
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301.
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
t 910 - 396-7432
Area code - Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: S-O-S
b. DOES WELL REPLACE EXISTING WELL? YESp NOW"
c. WATER LEVEL Below Top of Casing: 40.42 FT -
(Use "+" if Above Top of Casing)
d, TOP OF CASING IS <3 FT. Above Land Surface*
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C',0118.
e. YIELD (gpm): METHOD OF TEST
E DISINFECTION: Type Amount
g. WATER ZONES (depth): .
From To From To
From To From To
From To From To
7. CASING: Depth Diameter ThicknessivVeight Material
From Nay To D Ft 75 JC
From To Ft
From To Ft.
a. GROUT: Depth I Material Method
Frort2$, To0 _ Ft. law e-en er ro4[e9;pa
From 30-3_ To_ Zg _ Ft t --C T d^nz
From To Ft
9. SCREEN: Depth Diameter Slot Size Material
FromEO.6- To �0• � Ft. + 74in. r 01() In. p✓C
From To Ft. in. in.
From To Ft In. in.
10. SAND/GRAVEL PACK:
Depth S' a Material
From s 6.5- To 3D-3-Ft.a
From Tc Ft. —
Fro rrTo Ft.
11.DR1LLING LOG
From To Formation Descriptioh
12. REMARKS:
IDO ERTIFYTHATTHISWEL WAS CON WIi IN ACCORDANCE 16 C C WELL LICT ANDARDS, APP ACOPYOPTHIS
Fit(D BEEN D DT TH ELLOW
SIGNATURE OF CERTIFIED WELL CONTRACTOR OATE
llc`vV,4 Q&be-E/
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form GW-1b
1617 Mail Service Center— Raleigh, NC 276994617 Phone No: [phone] ext 568. Rev.12/07

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1, WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (Individual) Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO BOX 1169
Dacula GA 300019
City or Town State Zip Code
7( 70 .868-5407
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) T CO
WELL CONSTRUCTION PERMIT#(dapplicable) N/A
OTHER ASSOCIATED PERMIT#(ifapplicable) N/A
3. WELL USE (Check Applicable Box) Monhodngl3 Municipal/Publicl3
Industrial/Commefclal0 Agricultural[] Recovery[] Injectior>8"v
Irrigation0 OtherO Qlst use)
DATE DRILLED
TIME COMPLETED AMePMQ
4. WELL LOCATION:
CITY Fayetteville COUNTY �Cumberiand
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community. Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LfJWD SETTING:
❑ Slope [] Valley U Flat D Ridge 0 Other
(check appropriate box)
May be in degrees,
LATITUDE 35.15 491849 minutes, seconds or
LONGITUDE-78.98 290528 in a decimal format
LatitudeQongitude source: 9 GPS 0 Topographic map
(location of well mustbe shown on a USGS topo map and
attached to this form if not using GPS)
6. FACILITY- is the name of the business where the well Is located.
FACILITY ID #(if applicable) N/A
NAME OF FACILITY Fort Braga
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
91( 0-396-7432
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: J 3
b. DOES WELL REPLACE EXISTING WELL? YES[] NOtif
c. WATER LEVEL Below Top of Casing: 40.76 FT,
(Use'+" WAbove Top of Casing)
d. TOP OF CASING IS J• 1 FT. Above Land Surface`
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To
From To
From To
From To
Front To
From To
7. CASING: Depth
Diameter ThicknessWeight Material
From q9S To
From To
Ft.
From To
Ft
8. GROUT: Depth
Material
Method
FrorrL-31_,To_ d
/l 01 ' 64"r
ro4C8, =:y.
—Ft.
FrorrL3✓4-3 Tc 3Z
Ft.
-r
'T.(CA14►aE
From To
Ft.
9. SCREEN: Depth
Diameter Slot Size Material
From 3 To qu'.3.
R. +xin.
adit) In. PVC
From To
Ft. In. "
in.
From To
Ft_' In.
in.
10. SAND/GRAVEL PACK:
Depth Size
From 50,-3, To 36.3 Ft. 4.2
Material
From To
Ft.
From To
Ft.
11.DRILLING LOG
From To Formation Description
12. REMARKS:
IC0 ERTIF/ TTHI$WELL AS CON IN ACCORDANCEWITH
� G . ELL UCTI , NDARDS, ATACOPYOFTFtl3
ENP ID .T TH ELLOW
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
&-Z4 1?
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form GW-1b
1617 Mall Service Center — Raleigh, NC 276994617 Phone No. [phone] ext 568. Rev.12/07

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Caroling Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (Individual) Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO BOX 1169
Dacula GA 300019
City or Town State Zip Code
7( 70 1.868-5407
Area code- Phone number
2. WELL INFORMATION:
SITE WELL iD #(trapplicable) TA I
WELL CONSTRUCTION PERMIT#(ifappiicabie) N/A
OTHER ASSOCIATED PERMIT#(if applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring(] Municipal/Public[l
Industrial/Commerciaip Agriculturai0 *RecoveryD Injection
Irrigation[] Other[] (list use)
DATE DRILLED
TIME COMPLETED "I�-OY AMe PMCI
4. WELL LOCATIONr
CITY. Fayetteville COUNTY .Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC /D SETTING:
d Slope ElValley Er Flat 13 Ridge D Other
(check appropriate box) hby be is degrees,
LATITUDE. 35.15 48907 minutes, seconds or
LONGITUDE -78.98 287296 in a decimal format
Latitude/longitude source: A GPS 0 Topographic map
(/ocatlon of well must be shown on a USGS (opo map end
aftached to thls form if not using GPS)
S. FACILITY is the name of the business where the weA Is looted
FACILITY ID #(if applicable) N/A
NAME OF FACILITY Fort Bragg
STREET ADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Barris
MAILING ADDRESS Same
City or Town State Zip Code
91( 0 - 396-7432
Area code - Phone number
S. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YESD NOV
c. WATER LEVEL)I3elow Top of Casing: 39.84 FT.
(Use -+- if Above Top of Casing)
d. TOP OF CASING IS _L•i�7 FT. Above Land Surface -
'Top of casing terminated aUor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From Tc From To
From To From To
7. CASING: Depth Diameter Thickness/Might Material
From LKA To 0 Ft. 75 Pal
From To Ft:
From To Ft
8. GROUT: Depth
Material Method
From3'S To O
Ft 7 CE`I rJ'r �«L�
From To 33AEFt.
19,4T
From To
Ft.
9. SCREEN: Depth
Diameter Slot Size Material
From 60A _'To�TD-�
Ft r 75 in. . 0) D In, �dfr
From To
Ft_Jn. in.
From To
Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
From60-c{_To %--'
a Material
FL o?- SAN9
From To
Ft
From To
Ft.
11.13RILLING LOG
From To Formation Description
J
12. REMARKS:
I DO HER C i1FY THIS WELL S CONSiR IN ACCORDANCE WITH
16A N C L CON
UCTI ST DARDS, AN A COPYOF TMS
R EN PR
D TO E ELL OWN
lE WELL CONTRACTOR DATE
SIGNAT/U�RE OF CERTIj
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, FormGW-1b
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev.12/07

NONRESIDENTIAL WELL CONSTRUMONRE60RD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
I. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (Individuaq Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO Box 1169.
Dacula GA 300019
City or Town State Zip Code
7l 70 .868-5407
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
WELL CONSTRUCTION PERMIT#(ifapplicable) N/A
OTHER ASSOCIATED PERMIT#(if'appiicable) N/A
3. WELL USE (Check Applicable Box) Monitoring13 Municipal/Publicp
IndustriaUCommerciall7 AgricufturalD RecoveryJ3 InjectionEK
IrrigatioNj 61her13 (list use)
DATE DRILLED
TIME COMPLETED . d AMePMB
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumberland
, Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code),
TOPOGRAPHIC i LAND SETTING:
13 Slope 13 Valley ErFlat 13 Ridge 0 Other
(check appropriate box) hd y be is degrees,
LATITUDE 35.15 486374 minutes, accoads cr
LONGITUDE-78.98 284195 in a decimalfonuat
Latitude/longitude source: K GPS i] Topographic map
(location ofwe#must be shown on a USGS topo map and
attached to this form if not using GPS) '
5. FACILITY- is the name of the business where the wen Is located.
FACILITY ID #(if applicable) N/A
NAME OF FACILITY Fort Bragg
STREET ADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
an nn
City or Town State Zip Code
91t 0 .396-7432
Area code - Phone number
6. WELL DETAILS: ' _
a. TOTAL DEPTH: S O. /
b. DOES WELL REPLACE EXISTING WELL? YES13 NOS'
c. WATER LEVEL Below Top of Casing: 40.00 FT,
(Use "+" If Above Top of Casing)
d. TOP OF CASING IS 3.1 FT. Above Land Surface'
'Top of casing terminated atfor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
E DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
7. CASING: Depth Diameter ThiclmessWeight _ Material
From A-i To-6 Ft. Js WC.
From To Ft.
From To Ft-
B.: GROUT: Depth Material Method
Frorr�LF'o1_To 6 Ft
From a,• Z To _;LS Ft ('✓v'f '�4£+�M2E
From To Ft.
9. SCREEN: Depth Diameter S1otSize Material
From .d-' To y8.1 Ft, ,-7rin, - C 16 in. PdL
From To FL in. in.
From To FL in. in.
10. SANDIGRAVEL PACK:
De th S e Material
FromNAK To AS•�Ft a XJW-4
From To Ft.
From To Ft
11.DRILLING LOG
From To, Formation Description
12. REMARKS:
1.1 H C C.NJHLLCANS.(F3UCTIONSTMARDS,/WON D'11fAj"/A . FTMCEWITH
122iI'm 9I`JJrC��
CONTRACTOR DATE
Submit the original to the Division of Water Quality within 30 days. Attn: information Mgt., Form GW-1b
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] exY568. Rev.12107

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Ewhronment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor QndividuaQ Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO Box 1169
Dacula GA 300019
City or Town State Zip Code
7( 70 .868-5407
Area code- Phone number
2. WELL INFORMATION: A a
SITE WELL ID W appricable)
WELL CONSTRUCTION PERMIT#(ifapplicable) N/A
OTHER ASSOCIATED PERMIT #(ifapplicable) N/A
3. WELL USE (Check Applicable Box) Monitoring[] Municipal/PublicQ
Industrial/Commerciall] Agricultural[] RecoveryD Injectione
IrrigationO OtherO Qist use)
DATE DRILLED a )a'd Y
TIME COMPLETED o fI}-Gdl AMV PMO
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC! WD SETTING:
[] Slope [] Valley IT Flat D Ridge [] Other
(check appropriate box) Tyy be in degees,
LATITUDE 35.15 483593 minutes, seconds or
LONGITUDE -78.98 280983 in a decimal format
Latitude/longitude source: lilt GPS D Topographic map
(location of wellmustbe shown on a USGS topo map and
attached to this form ifnot using GPS)
S.FACILITY Isom name otthabusinesswhere the well Islocated.
FACILITY ID #(If applicable) NIA
NAME OF FACILITY Fort Brann
STREET ADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
91( 0 _396-7432
Area code - Phone number
S. WELL DETAILS:
a. TOTAL DEPTH• ✓ d"'y /
b. DOES WELL REPLACE EXISTING WELL? YES[] Nos --"
WATER LEVEL Below Top of Casing: 40.22 FT,
(Use '+° ii Above Top of Casing)
d. TOP OF CASING IS -lei FT. Above Land Surface'
'Top of casing terminated atfor below land surface may require
a variance in accordance with 15A NCAC 20.0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To
From To
From Tc
From To
From To
From To
7. CASING: Depth
Diameter ThicknessMleight Material
From &�d To d
Ft. r 7s Pa
From To
FL
From To
Ft-
8. GROUT: Depth
•Material Method
Fron,35 J To_ d
Ft. 4 -f talGZ .7-I?.
From 3C•� To . 3357Ft.�Llt�'M1T�
From To
Ft-
9. SCREEN: Depth
Diameter Slot Size Material
From <0- ,_ To yC •
FL .7'r in. r 010 in. AQ
From To
FL in. in.
From To
FL in. in.
10. SANDIGRAVEL PACK:
Depth
S' a Material
From so,� Tc 35•
Ft S416
From To
Ft -
From To
Ft.
11:DRILLING LOG
From TO Formation Description
12. REMARKS:
I N
DO HERE THAT IS WELL CONSTR I CCORDANCE WITH
15A C CONSr ON AN ARDS, AND OPY OF THIS
RECO PROVID W LOWNER
c
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: information Mgt., Form GWAb
1617 Mail Service Center — Raleigh, NC 27699 1617 Phone No. [phone] ext 568. Rev.12/07

N0NRESIDENTL4L WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (Individuaq Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO BOX 1169
Dacula GA 300019
City or. Town State Zip Code
7( 70 ).868-5407.
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) —TA �-� d
WELL CONSTRUCTION PERMIT#(llapplicable) N/A
OTHER ASSOCIATED PERMIT #(if applicable) N/A
3. WELL USE (Check.Applicable Box) Monitoring[] Municipal Publicd3
Industrial/CommercialB Agricutturalp Recoveryp Injection8/
Irrigatiorlp Olheri3 Qist use)
DATE DRILLED F-- Gk-61 Y J
TIME COMPLETED Ij'Q Y AMi7 PMD
4. WELL LOCATION:
CITY Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / L8ND SETTING:
i] Slope 13 Valley IT Flat 0 Ridge 0 Other
(check appropriate box) lvfay be in degrees,
LATITUDE 35.15 480944 minutes, seconds at
LONGITUDE -78.98 277641 in a decimal format
Latitude/longitude source: X GPS 0 Topographic map
(loca5on ofwe#must be shown on a USGS topo map and
attached to this form if not using GPS)
5. FACILITY Is the name or the bminesswhara lhewell is located
FACILITY ID #(rf applicable) N/A
NAME OF FACILITY Fort Bragg
STREET ADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
Cityor Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
91r 0 ).396-7432
Area code - Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: SO. 9-
b. DOES WELL REPLACE EXISTING WELL? YES13 NOt�
c. WATER LEVEL Below Top of Casing: 39.67 ' FT.
(Use '+' If Above Top'of Casing)
d. TOP OF CASING IS A-1 FT. Above Land Surface'
'Top of casing terminated atror below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
7. CASING- L • Depth Diameter Thiolaress/Weight Material
From !LD To--6_ Ft'. I S 1fi
From To Ft.
From To Ft.
8. GROUT: Depth
Material
Method
fero�Lty To 6
Ft. /J� T
From , 7. To`% Ft OJT
72&mf
From To
Ft.
9. SCREEN: Depth
Diameters Slot Size Material
From 50.. To y0• / Ft.. 2 in.
•y1 d in.
From To
Ft. in.
in.
From •To
Ft In.
in.
10. SAND/GRAVEL PACK:
Death
Fro 0, To
S e
FtA
Material
sMl,
From To
Ft.
From To
Ft.
11.DRILLING LOG
From To Formation Description
i
12.REMARKS:
I DOAROY RTIFYTHAT I WELLWA NSTRU RDANCEWITH
N 2C ELL CONST ON AN DS, AND A OPYOFTHIS
R HA PROVID D TH W OWNER
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
PRINTED NAME OF.PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., FormGW-1b
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev.12/07

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 3527
1. WELL CONTRACTOR:
Richard Marshall Bumett
Well Contractor (Individual) Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO Box 1169
Dacula ' GA 300019
City or Town State Zip Code
7f 70 - 868-5407
Area code- Phone number
2. WELL INFORMATION: 11
SITEWELLID#(I1appficabie) T�oZ — t
WELL CONSTRUCTION PERMrr#(N applicable) N/A
OTHER ASSOCIATED PERMIT#(Wapplicable) N/A
3. WELL USE (Check Applicable Box) Monitoring[] Municipal/Publi
Industrial/CommercialI3 Agricultural13 Recoveryp Injection
Irrigationl] Otheiii gist use)
DATE DRILLED 13- D Si
TIME COMPLETED b' i3'O AMB' PMB
4. WELL LOCATION:,
CITY Fayetteville COUNTY Cumberland
Fort Bragg.Fayetteville, NC 28301
(Street Name, Numbers, Community, SubdHision, Lot No., Parcel, Zip Code)
TOPOGRAPH 10 1 LoWD SETTING:
13 Slope 13 Valley B'Fiat 13 Ridge 0 Other
(check appropriate box) N y be is degrees,
LATITUDE 35.15 629228 ,nututes, seconds or
LONGITUDE-78.98 _374543 madccitnalfonnst
Latitude/longitude source: K GPS a Topographic trap
(location of well mustbe shown on a USGS topo map and
atfached to this.fonn if not using GPS)
5. FACILITY Is the name of the buslnessWherathe tnell Is located
FACILITY ID #Ctf applicable) N/A
NAME OF FACILITY Fort Bragg
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
91� 0-396-7432
Area code - Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: 3.Y•
b. DOES WELL REPLACE EXISTING WELL? YESp NOR
c. WATER LEVEL Below Top of Casing: 27.21 FT.
(Use "+° if Above Top of Casing)
d. TOP OF CASING IS Z. _ FT. Above Land Surface•
'Top of casing terminated atlor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm):
METHOD OF TEST
f. DISINFECTION: Type
Amount
g. WATER ZONES (depth):
From To.
Flom To
From To
From To
From To
From To
7. CASING: Depth Diameter Thickness/Weight Material
From J47 To &
Ft. - 75' Ax
From To
FL
From To
Ff_
8. GROUT, Depth
Material Method
From 22.1 To n _
FL of&* C'r�^tLu9 lrvlff�3-
From JL� 8 To �+ l
Ft,
6,eK7
From To
FL
8. SCREEN:
Diameter SlotSlze Material
d�Depth
From b.-� To ffP? Ft,
.-%fin. in. , p✓Z
From To
Ft,
in. - in.
From Tc
FL
in. In.
10. SAND/GRAVEL PACK:
De tth
.5
S�i'za Materi
#f�-- ' 2148-
From •SY,%Tc-1
Ft,
From To
Ft.
From To
Ft,
11.DRILLING LOG
From To
Formation Description
12. REMARKS:
I DO H"EL-N
i
sW CONSTRUCT IN RDANCE WI M
1 ARDS, AND A OFTHIS
L ONMER
.
SIGNATU E OF CERTIFIED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt; Form GW-1b
1617 Mail Service Center— Raleigh, NO 27699-1617 . Phone No. [phone] ext 568. Rev.12/07

NONRESLOENTIALWELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
I. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (individual) Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO BOX 1169
Dacula GA 300019
City or Town State Zip Code
7f 7d-868-5407
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(If applicable)_
`rya -�
WELL CONSTRUCTION-PERMIT#(dappiicable) N/A
OTHER ASSOCIATED PERMIT #(If applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring[] Municipal/Publi
Industrial/Comerciall3 Agrieultural0 Recovery0 Injection m
Irrigation) OtharU �01st use) d -
DATE DRILLED 13-0 r
TIME COMPLETED " 13 - V i( AMB'-' PM13
4. WELL LOCATION:
cmr: Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No.; Parcel, 27p Cade)
TOPOGRAPHIC / LAND SETTING:
0 Slope 0 Valley Flat 0 Ridge 0 Other
(check appropriate box) May be in drl;rces.
LATITUDE 35.15 629219 minutes, seeoads or
LONGITUDE -78.98 369945 in a decimal format
Latitude/longitude source: A GPS 0 Topographic map
(/ocadon of well mustbe shown on a USGS topo map and
attached to this form if not using GPS)
5.FACILITY is the nameofthebusinessMemthe Nelllslocated
FACILITY ID #(iif applicable) N/A
NAME OF FACILITY Fort Braga
STREETADDRESS Building 3-1131 Butner Rd.
Fort Bragg NC . 28301
City or Town State = Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City cr Town State Zip Code
91t 0 t- 396-7432
Area code - Phone number
S. WELL DETAILS: {/
a. TOTAL DEPTH: a e
b. DOES WELL REPLACE EXISTING WELL? YESO NOB/
c. WATER LEVEL Below Top of Casing: 27.61 FT.
(Use "+• if Above Top of Casing)
d. TOP OF CASING iS -1.1 FT. Above Land Surface•
'Top of casing terminated atlor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From Tc From To'
From To From To
7. CASING: /Depth Diameter ThicknessM/eigld Material
From X.7 To D Ft. r 5" P►rC
From To Ft"
From To Ft
8. GROUT. Depth Material Method
Fro �Z"'fTo� Ft, tit McJY _iowp
From 2- ToFL b^r:] -r TR6^1�2�
From To Ft
9. SCREEN: Depth Diameter Slot Size Material
From 3�7To �S%7 Ft .7fin. Oi0 in.�_
From To Ft in. in.
From To Ft in: In.
10. SAND/GRAVEL PACK:
Depth Si a Material
From 3 �7To Ft �
From To Ft.
From To Ft
11.DRILLING LOG
From To Formation Description
12. REMARKS:
IDOH"EL
THISYyEII ASCONSTRu ACCORDANCEWITH
15RUCTI ST DARD ,AND T OFTHIS
RECOE T E ELL OWN
l
SIG ATURE OF CERTIFIED WELL CONTRACTOR DATE
tmcee
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: information Mgt, Form GW-1b
1617 Mail Service Center— Raleigh, NC 276994617 Phone No. [phone] ext 568. Rev.12/07

NoNRESLDEN77AL wELL.CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources=. Division of Water;Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Bumett
Well Contractor (Individual) Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO Box 1169
Dacula GA 300019
City or Town State. Zip, Code
71 70 U.868-5407
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID#(Ifapplicable) f Xc2
WELL CONSTRUCTION PERMIT# if applicable) N/A
OTHER ASSOCIATED PERMIT #(if applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring[3 Municipal(Publi
IndustfiailCommorcialEl AgriwtturalI3 Recoveryl.7 Injection
IrrigatlorG Otherp plst use)
DATE DRILLED J ' 13— 01
TIME COMPLETED AMe PMI]
4. WELL LOCATION:
CITY. Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LA,PD SETTING:
13 Slope 0 Valley WFlat 0 Ridge 0 Other,
(check appropriate box)
Maybe in degrees,
LATITUDE 35.15 629291 minutes, seconds or
LONGITUDE -78.98 365092 in a decimal fonnat
Latitude/longitude source: H GPS 0 Topographic map
(location of weft must be shown on a USGS topo map and
attached to this fomr lfnot using GPS)
5.FACILITY isthe.no=afthebusinesswherethexellistocatod.
FACILITY ID #(If applicable) N/A
NAME OF FACILITY Fort Braga
STREETADDRESS. BUllding 3-1137 BUtner.Rd.,
Fort Bragg NC 2M01'
City.or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS. Same
City orTowri State ZIp:Code
f 910 1.:396-7432
Area code Phone number
S. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELLY YESD NOR-,'
c. WATER LEVEL. Wow Top'of Casing: .27:49 Fr.
(Use '+" If Above Top of Casing)
d. TOP OF CASING IS .3
FT. Above Land Surface'
'Top of casing terminated atlor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm):
METHOD OF TEST
f. DISINFECTION: Type
Amount
g. WATER ZONES (depth):
From To
From To
From To
From To
From To
From To
7. CASING: Depth. Diameter ThiclmessMelght Material
Foott> i FT.. 6
Ft .r S/
P✓�
From To
Ft.
From To
Ft.
S. GROUT: Depth
Material
Method
From 20 To , Ft 16W &"&d
FiL&.0 --tw5,
From ZZ+3 To Z O
Ft. 46-�-r
--71E+•w2F
From To
Ft.
9. SCREEN: Depth
Diameter SlotSfze
Material
From 3 ZyTo-ZFWFt. -I5 in. .010
ln. P✓c
From To
Ft in.
in.
From To
Ft in.,
in.
10. SAND/GRAVEL PACK:
Depth Sqjo Material
A 4,
FromLJOU To 7.2-+3
Ft -<A
From To
Ft
From To
Ft.
11.DRILLING LOG
From' To Formation Description
12: REMARKS:
I DO FY THIS WELL W CONSTRUCTED I CE Wmi
15 CA W LCO UCTI ST ARDS,AND YOFTHIS
R B EN PR I E O E LOWNER
SIG ATURE OF CERTIFIED WELL CONTRACTOR DATE
Zvv zzabca
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days.:Attnt Information Mgt., Form 'GW--1b
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. (919) 7334015 ext•568. Re v.'12/07

.NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (IndividuaQ Name
Geo Lab, Inc.'
Well Contractor Company Name
STREETADDRESS PO Box 1169
Dacula GA 300019
City or Town • State . Zip Code
(770 .668-5401
Area code- Phone number
2. WELL INFORMATION: --r^
SITE WELL ID*(Ifapplicable)
WELL CONSTRUCTION PERMrr#(if appticebie) N/A
OTHER ASSOCIATED PERMIT #(if applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring❑ MunidpaUPubA
IndustriallCommercial0 Agriculturaid RecoveryD Injection
IrrigationO OtherO gist use)
DATE DRILLED f`1.3'0Y
TIME COMPLETED 0-13 - O. AM81-IPMI3
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / L6ND SETTING:
D Slope D Valley g Flat i] Ridge D Other
(check appropriate box) )„ �y be is degrees.
LATITUDE 35.15 629314 minutes, seomils or
LONGITUDE-78.98 36052 iaadecimal format
Latitudellongitude source: ll( GPS 13 Topographic map
(location ofwell must be shown one USGS fopo map and
attached to this form Nnot using GPS)
S. FACILITY- lathe name cr the business where the wall Is located.
FACILITY ID #('rf' applicable) N/A
NAME OF FACILITY Fort Draw
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
9110 - 396-7432
Area code - Phone number
S. WELL DETAILS:,
a. TOTAL DEPTH: 3 •! /
b. DOES WELL REPLACE EXISTING WELL? YESD NORM
c. WATER LEVEL Below To p of Casing: 27.38 • FT.
(Use '+" tf Above Top of Casing)
d. TOP OF CASING IS 3, r FT. Above Land Surface -
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST_
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To
From To
From To
From To
From To
From To
7. CASING: Depth
Diameter ThiclmessM/elght Material
From a' Y9To 6
Ft—,
From To
Ft.
From To
Ft.
9. GROUT: Depth
Material Method
From `�Z" To a
Ft. �__ ? �►'r i"y?CEA 1'dS.
From �r To 20
Ft (�F�►'f' T/ :1=
From To
FL
9. SCREEN: Depth
Diameter Slat Size Material
FrorrL3Y af%? Ft r W in. , 610 in. _A/C
Frorn___.l,_ To
FL in. In.
From To
Ft in: in.
10. SANDIGRAVEL PACK:
°eJ . '
From • To as
tZa sater
Ft fl
From To
Ft -
From To
Ft.
11.DRILLING LOG
From To Formation Description
12. REMARKS:
IDD FYTHAT ISVYELLWAS STRUCT RMNCEVdTI•i
1 N ELL CON ION AN DS,AND or -THIS
PR( OT TH OYQNFR
c
SIG ATURE FCERTIFIEDWELL CONTRACTOR DATE
.�it9bCEY
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form GW-1b
1617 Mail Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev.12/07

NONRESIDENTIAL wELL coNSTRIICTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Bumett
Well Contractor (Individual) Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO Box 1169
Dacula GA 300019
City or Town State Zip Code
7( 70 .868-5407
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if appficable) "
WELL CONSTRUCTION PERMIT#(irappllcable) NIA
OTHER ASSOCIATED PERMIT#(if applicable) NIA
3. WELL USE (Check Applicable Box) Mon1toringl3. Munidpal/Publl<p
Industrial/Com merciall7 Agricuiturall3 Recovery[] Injection[]'
Irrigation[] Other[] (list use)
DATE DRILLED
TIME COMPLETED AMW' PM13
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301 "
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAD SETTING:
0 Slope 13 Valley Fl Flat 13 Ridge 13 Other
(check appropriate bcx) My be in degrees,
LATITUDE ' 35.15 629541 minutes, aeconds or
LONGITUDE -78.98 355802 in a decimal format
Latibude/longitude source: X GPS 13 Topographic map -
(locaSon of well must be shown on a USGS topo map and
attached to this form ifnot using GPS)
6.'FACILITY left name of the business Mierethe sell Is located.
FACILITY ID #(If applicable) NIA
NAME OF FACIL'ITy Fort Bragg
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven, Harris
MAILING ADDRESS Same
City or Town State Zip Code
f 910 .396-7432
Area code - Phone number
6. WELL DETAILS: p�
a. TOTAL DEPTH:
J b. DOES WELL REPLACE EXISTING WELL? YES[] NOR/
c. WATER LEVEL Below Top of Casing: 27.73 FT.
(Use "+- if Above Top of Casing)
d. TOP OF CASINO IS 11 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with I SA NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From To
From Tc From To
7. CASING: Depth Diameter ThiclmesslWeight Material
From 42 fi�To d Ft. e 7 S� p✓C
From To Ft.
From To Ft.
8. GROUT: Depth Material Method
From To D Ft E44? CN1Erf-t I�acl*o �..I3,
.From 2 To •q Ft -4-r T2E-1124
From To Ft
9. SCREEN: Depth Diameter Slot Size Material
From -?X5To a ASFt . Sin. .4010 in. Prc
FroffL. To Ft, in. In.
From . To Ft. in. in.
10. SAND/GRAVEL PACK:
Depth r S' a Material
From 3 FsSTo a�K�Ft� �iA�J�
From To Ft
From To Ft
11.13RILLING LOG
From To . Formation Description
12. REMARKS:
IDO ERTIFYTHA MWELLW SCONSTRUCTED'I ACCORDANCEW"
1 LCON R O ARDS,AND T COPY OF THIS:
PR D E LOWNER.
S GNATU}RE OF CERTI I ED ELL CONTRACTOR DATE
/&-✓yf fALey
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water, Quality within 30 days. Attn: Information Mgt, Form GW 1b
1617 Mail Service Center— Raleigh, NC 27699-1617J Phone No. [phone], ext 568. Rev.12/07

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Bumett
Well Contractor (individuap Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO BOX 1169
Dacula GA 300019
City or Town State Zip Code
77( 0 ). 868-5407
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID#(Ifapplicable) �T a'
WELL CONSTRUCTION PERMIT#(fapplicable) N/A
OTHER ASSOCIATED PERMIT #Qf applicable) -N/A
3. WELL USE (Check Applicable Box) Monitorins0 Municipal/Publi
Industrial/Commerciall] Agricultural0 Recoveryp Injection
Irrigationp Otherp (list use)
DATE DRILLED . O '►3'6'
TIME COMPLETED 13 �% y AMePM1
4. WELL LOCATION:
CITY, Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301 -
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Tip Code)
TOPOGRAPHIC / L5ND SETTING:
0 Slope 0 Valley ErFlat 0 Ridge 0 Other
(check appropriate box) Nby be in degtses,
LATITUDE 35.15 626245 minutes, seconds or
LONGITUDEJ8.98 37237 inadecimalformat
Latitude/longitude source: N GPS i] Topographic map
(locefion of well must be shown on a USGS top* map and
. attached to this loan if not using GPS)
5. FACILITY- is the name ofthe business where tha well Is roeated
FACILITY ID #Qf applicable) N/A
NAME OF FACILITY Fort Bragg
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
91t 0 t-396-7432
Area code - Phone number
6. WELL DETAILS: �r
a. TOTAL DEPTH: AT+S /
b. DOES WELL REPLACE EXiSTINt3 WELL? YESO i�Y � NO
c. WATER LEVEL Below Top of Casing: 28.09 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS -S&7- FT. Above Land Surface -
'Top of casing terminated atior below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD.OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
7. CASING: Depth Diameter ThicknessNWeight Material
From dle.STo 6 Ft. , IS Pit
From To Ft.
From To Ft.
8. GROUT: Depth Material Method
Front aa'�-To_ 4 Ft. ''i &I 4'Y Yv'21f� Z4
FrorrL Lq S- Tom°� FL ,"T
From To Ft.
9..SCREEN: Depth Diameter Slot Size Material
From 3Y�To �V-�;-Ft. .%Sin. r 6i6 In. Prc
From To Ft in, in.
From To Ft. in. in.
10. SAND/GRAVEL PACK:
Depth ize Material
From �3Y.STo ,5q.5 Ft,SA.16
From To Ft.
From To Ft.
11.13RILLING LOG
From To Formation Description
12. REMARKS.-.
I DO WAj& FY THA
IS WELL WAS smucTED I RDANCE WRH
15 ELL CO
U ON AND DS,ANDTHAT OFTHIS.
R PROV
TO EL WNER.
CERTI IED WELL CONTRACTOR DATE
SIGNATU''R
..O``F
zi
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form GW-1b
1617 Mail Service Center — Raleigh, NC 27699-1611 Phone No. [phone] ext 568. Rev.12107

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTTEICATTON If 3527
C WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (IndhriduaD Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO Box 1169
Dacula GA 300019
City or Town State Zip Code
7` 70 '.868-5407
Area code- Phone number
2. WELL INFORMATION: � a -
SITE WELL ID #of applicable) „?
WELL CONSTRUCTION PERMIT#(dapplicable) N/A
OTHER ASSOCIATED PERMIT #(if applicable) N/A
3. WELL USE (Check Applldable Box) Monkoring0 Munidpal/Publi
Industrial/Commercial[l AgriculturalO Recoveryp Injection
]rrigation(I OtherO (Ilst use)
DATE DRILLED f = 13-6Y
TIME COMPLETED - 13 -03' AM1d' PMj]
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdlvislon, Lot No., Parcel, Zfp Code)
TOPOGRAPHIC / LA D SETTING:
0 Slope 13 Valley ErFlat D Ridge 0 Other
(check appropriate boot) Nlay be in degrees,
LATITUDE 35.15 626434 minutes, seconds or
LONGITUDE-78.98 367576 in a decimal format
Latitude/longitude source: X GPS El Topographic map
(locatfon oftellmust be shown on a USGS topo map and
attached to this form if not using GPS)
6. FACILITY IS the name otme business Meretha woU Is located.
FACILITY ID #pf applicable) N/A
NAME OF FACILITY Fort Bragg
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
910 ). 396-7432
Area code,- Phone number
S. WELL DETAILS: e�
a. TOTAL DEPTH. �o •
b. DOES WELL REPLACE EXISTING WELL? YES13 NOR/
c. WATER LEVEL Below Top of Casing: 28.08 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS .3 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To
From To
From Tc
From To
From Tc
From To
CASING:
Diameter ThIckness(AMght Material
l dDepth
From i7+.4To 16
Ft , 7 Aft
From To
Ft.
From 'To
Ft.
8. GROUT: Depth Material Method
From �To Q Ft.4641 L Y 41C& --rW
From 54To .e + Ft E-4-r Est`
From To Ft
9. SCREEN: Depth Diameter Slot Size Material
From J OW Ta o2 Y9 Ft, . 7� In. L in. P✓C.
From Tc Ft.- in. .:in.
From To Ft - in. in.
10.: SAND/,GRAVEL.PACK.
Dep r S' Material
From%q To �3. Ft.
From To Ft.
From Tc Ft.
11.DRILLING LOC3
From To Formation Description
12. REMARKS:
I DO ERTIFYTHATHISWELL CONSTRU ED ACCORDANCE WRH
1 C , ELL CO UCrIC DS,AND COPYOFTHIS
PRO D E W L OWNE
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
4aJ At -et
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form GW-1b
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext S68. Rev.12/07

NONRESIDENTIAL wELL coNsTRUCTIoN RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (Individual Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO Box 1169
Dacula GA _ 300019
City or Town State Zip Code
7( 70 .868-5407
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(d applicable}
WELL CONSTRUCTION PERMIT#(dapplicable) NIA
OTHER ASSOCIATED PERMIT #(if applicable) NiA
3. WELL USE (Check Applicable Box) Monkoring0 MunlclpallPubi
IndustriallCommercialEl Agricultural[] Recovery[] Injectlon
Irrigatioritl Other[] (list use)
DATE DRILLED y t3"d _
TIME COMPLETED AMC"/ PM1
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumbsdand
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zp Code)
TOPOGRAPHIC f LA D SETTING:
0 Slope 0 Valley RFlat U Ridge 0 Other
(check appropriate box) Maybe in ckgreea,
LATITUDE 35.15 626379 minutes, seconds or
LONGITUDE-78.98 362954 in a deeimal format
Latitude/longitude source: ➢i GPS 0 Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
6. FACILITY- is V* name of the businesswhere the wen is located
FACILITY ID #(if applicable) N/A
NAME OF FACILITY Fort Bragg
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg - NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
91t 0 y.396-7432
Area code - Phone number
S. WELL DETAILS: d q
a. TOTAL DEPTH: Of r /,
b. DOES WELL REPLACE EXISTING WELL? YES13 NOR
c. WATER LEVEL Below Top of Casing: 28.11 FT.'
(Use "V H Above Top of Casing)
d. TOP OF CASING IS J FT. Above Land Surface'
'Top of casing terminated atfor below land surface may require
a variance in accordance with 1SA NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From ' To From To
From To From To
From • To From To
7. CASING: Depth Diameter ThicknessNVeight Mnnaterial
From A19 To 0 Ft. 1 7S Yt/C
From To Ft
From To Ft
8. GROUT: Depth Material Method.
Fro�a3 To ID Ft it&, er Fipw
From To�— Ft b4� �771C^wSe
From To Ft
8. SCREEN: Depth Diameter Slot Size Material
From �Y+9 To FL - S in. .611) in.
P61
From To Ft ln. in.
From To Ft. in. in.
10. SAND/GRAVEL PACK:
Depth S e Material
From�To a�S•�jFt
From To Ft
From To Ft
11.DRILLING LOG
From To . Formation Description
12. REMARKS:
IDOH C FYTHAT WELL WA"STRU119 DANCEWnH
15A1t{{ LCONSTR siFTHIS
RECO PROVIDE T E E
SIGNA URE OF CERTIFIED WE L CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form GW-1b
1617 Mall Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev.12/07

NONRESIDENTIAL wizu cONSTRUCTIONRECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTII� ICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (Ind(viduaQ Name
Geo Lab, Inc.
Weli Contractor Company Name
STREETADDRESS PO BOX 1169
Dacula GA 300019
City orTown state ' Zlp Code
7f 70 - 868-5407
Area code- -Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
WELL CONSTRUCTION PERMIT#(dapplicable) N/A
OTHER ASSOCIATED PERMIT#(if applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring[] Municipal/PublicEl
Industrial/Commercial0 Agriculturall] Recovery0 InjectionBO�
Irrigationp Otherp Qist use)
DATE DRILLED P 1.3-0'd
TIME COMPLETED / 3' 6Y AM[KPM13
4. WELL LOCATION:
ciw. Fayetteville COUNTY Cumbsdand
Fort Bragg Fayetteville, NO 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC ! LAUD SETTING:
a Slope p valley wFiat 0 Ridge 0 Other
(check appropriate box) May be in degrees,
LATITUDE 35.15 626585 minutes, seconds or
LONGITUDE -78.98 358358 in a aeoitnst format
Latitude/hongitude source: A GPS 0 Topographic trap
(location of well must be shown on a USGS topo map and
attached to this form f not using GPS)
6. FACILITY- Is to name of the business where the well Is located
FACILITY ID #(if applicable) N/A
NAME OF FACILITY Fort Bragg
STREETADDRESS Building 3-1137 Butner Rd.
_Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Stever) Harris
MAILING ADDRESS Same
City or Town State Zip Code
91f 0 .396=7432
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: A. 0
b. DOES WELL REPLACE EXISTING WELL? YESO NO�
e. WATER LEVEL Below Top of Casing: 28.61 FT.
(Use'+' if Above Top of Casing) -
d. TOP OF CASING IS J .
FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm):
METHOD OF TEST
f. DISINFECTION: Type
Amount
g. WATER ZONES(depth):
From To
From To
From To
From To
From To
From To .
7. CASING: Depth Diameter Thicknessi bight Material
From a S;$1To O Ft. 1 _75- VC
From To Ft
From To FL
8. GROUT. Depth
Material Method
From Lj#yTc
O Ft. (41 &0"64-r §:�tCO y1J,
From 6Lf3To m -2Ft Q6+T T/1�.►v�5:C
From To
Ft
9. SCREEN: Depth
Diameter . Slot Size Material
From Dy3 To
-2 V V FL . _)fin. 416 in. Q✓C
From To._
FL in, in.
From , To
Ft in. in.
10. SAND/GRAVEL PACK:
Depth ..
size Material
From To
aJ • AFL A.Z,
From To
Ft
From To
Ft
11.DRILLING LOG
From To
Formation Description
12. REMARKS:
I TIFY TTHISWELL AS CONSTRUCT IN ACCORDANCE WITH
N C WELL N RUCTI N DARDS,AN TACCPYOFTHIS
BEENP ID T LOWNE
SIGNATUR OF CERTIFIED WELL CONTRACTOR DATE
K"i 1"'eY
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form cWAb
1617 Mail Service Center— Raleigh, NC 276994617 Phone No. (919) 733 701S extS68. Rev.12/07

NONREADEN714L wELL coNSTRucuw RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (IndividuaD Name
Geo Lab, Inc.
Well Contractor Company Name
STREET ADDRESS PO Box 1169
Dacula GA 300019
City or Town State Zip Code
7( 70 I.868-5407
Area code- Phone number
2. WELL INFORMATION: --�
SITE WELL ID #(If applicable)
WELL CONSTRUCTION PERMIT#(trappllcabie) N/A
OTHER ASSOCIATED PERMIT#(if applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring(] Munidpal/Publigp
Industrial/Commercialll Agricultural0 Recovery[] Injection
IMgationp Other[] (list use)
DATE DRILLED r- i3- oY TIME COMPLETED -13-6y AMLTr
PM13
4. WELL LOCATION:
CITY.- Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision; Lot No., Parcel, Zip Code)
TOPOGRAPHIC/ UWD SETTING:
D Slope 0 Valley 9rFlat 0 Ridge 0 Other
(check appropriate box)
Ivray be is degrees,
LATITUDE 35.15 627031 minutes, scainds or
LONGITUDE-78.98 353966 inadecimal format
Latitude/longitude source: III GPS 0 Topographic map
flocetion ofwellmustbe shown on a USGS tope map and
attached to this form ffnot using GPS)
S. FACILITY- Is the name of the busInew where the xell Is located
FACILITY ID #(if applicable) N/A
NAME OF FACILITY Fort Braga
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
91� 0 1.396-7432
Area code - Phone number
G. WELL DETAILS:
a. TOTAL DEPTH: 2151.12 /
b. DOES WELL REPLACE EXISTING WELL? YES0 NOB'
c. WATER LEVEL Below Top of Casing: 27•90 FT.
(Use •-V if Above Top of Casing)
d. TOP OF CASING IS -? FT. Above Land Surface*
*Top of casing terminated atfor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From Tc From To
From To From To
From To From To
7. CASING: Depth Diameter ThicknessNvelght Material
From JZho d Ft +^%� ✓C
From To Ft.
From To Ft.
8. GROUT: Depth Material Method
From V To_ V ^ Ft. E� r CC-4 ! F4 e6 ;—kg,
-25 To Po1i_ Ft 64-f '711F 2F
From To - Ft
9. SCREEN: 'Depth Diameter Slot Size Material
From K3Ft_Zin. .atd in. rye -
From To Ft in. in.
From Tc Ft____in. in.
10. SANDIGRAVEL PACK:
Depth S' a Material
From 3�Aho � Ft� S44(
From • To Ft.
From To Ft.
11.DRILLING LOG
From To, Formation Description
12. REMARKS:
ACCORDANCE WITH
MPY OFTHIS
OF CERTIFIED WELL CONTRACTOR DATE .
E OF PERSON CON
Submit the original to the Division of Water Quality within 30 days. Attn: information Mgt, Form GW-1b
1617 Mail Service Center — Raleigh, NC 27699-1617 . Phone No. [phone] ext 568. Rev.12107

I
.NONRESIDENTIAL wELL coNSTRUCTIONRECORD
North Carolina Department of Environment and Natmal Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELLCONTRACTOR:
Richard Marshall Burnett
.Well Contractor (Individual) Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO Box 1'169
Dacula GA'' 300019
City or Town State Zip Code
7( 70 .868-5407
Area code- Phone number
2. WELL INFORMATION: AA q
SITE WELL ID#(ifapplicable) —T-4 — j i
WELL CONSTRUCTION PERMIT#(dappricable) N/A
OTHER ASSOCIATED PERMIT #(if applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring[] Muniapal/Publi
lndustriallCommerclall] Agriculturalp Recovery0 Injection
Irrigationp Other)] Qist use)
DATE DRILLED F. Jai- O
TIME COMPLETED jf- ry-Oy AMIT PMD
4. WELL LOCATION:
CITY: Fayetteville COUNTY CUmbedand
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / SETTING:
13 Slope 0 Valley. ff Flat 0 Ridge Q Other
(check appropriate box) May be in degrees,
LATITUDE 35.15 604057 minutes, seconds or
LONGITUDE -78.98 367403 in a decimaiformat
Latitude/longitude source: X (3PS 0 Topographic map
(/oca6on of we//musf be shown on a USGS topo map and
attached to this form Nnot using GPS)
5. FACILITY- is the name otthe business wheretne Men Is located
FACILITY ID #Qf applicable) N/A
:NAME OF FACILITY FCI`t Braga
STREETADDRESS Building 3A 137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON 'Mr. Steven Harris
MAILING ADDRESS:.Same
City or Town State: Ztp�Code
9 a( 0 - 3.96=7432
Area code - Phone number
S. WELL DETAILS: �a , 5
a. TOTAL DEPTH.-
b. DOES WELL REPLACE EXISTING WELL? YES13 NOR"
c. WATER.LEVEL Below Top of Casing: 31:33 FT,
{USe "'V d Above Top of Casing)
d. TOP OF CASING IS 2• i3 FT. Above Land Surface*
"Top of casing terminated atlor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. . DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To
From To
From To
From To
7. CASING: Depth
Diameter ThiclmesslWeight Material
From -? '5'To d
Ft . %S
From To
Ft._
From To
Ft.
8. GROUT: I Depth
Material Method
FronI To ti
FL /' 44 41 DES TidS,
From aL- To70d'7
Ft.�_ TiM^tzk
From To
FL
9. SCREEN:: Depth
Diameter Slot Site Material
From l.Z S To -1 IFFt. +-7fin. A16�— in. Are.
From To
Ft. in. in.
From Tc
Ft. in. in.
10. SANDIGRAVEL PACK:
De��jjth .
From U'L -To
Site Material
FL —4
From To
Ft.
From To
FL
%DRIWNG LOG
From To Formation Description
12. REMARKS:
WTHIS WASCONSTR INACCORDANCEWITH
R ION ANDARDS TACOPYOFTHIS
WELLO
SIGNATURE OFC TIFIED WELL CONTRACTOR DATE
&Z"i kdiceq
PRINTED NAME OF PERSON CONSTRUCTING THE'WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form GW 1b
1617 Mail Sertiice Center — Raleigh, NC 276994617 Phone No. [phone] ext 568. Rev.12/07

NONRESIDENTIAL wELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water,Quality
- WELL CONTRACTOR CERTIFICATION # 3527
1, WELL CONTRACTOR:
Richard Marshall Bumett
Well Contractor (Individual) Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO BOX 1169
Dacuia GA 300019
City or Town State Zip Code
7( 70 - 868-5407
Area code- Phone number
2. WELL INFORMATION: p
SITE WELL ID #(if applicable)
WELL CONSTRUCTION PERMIT#(ifapplicable), N/A
OTH ER ASSOCIATED PERMIT #(ifapplicable) N/A
S. WELL USE (Check Applicable Box) Monitoring❑ MunicipaUPubli
IndustriaUCommercialD Agrlcuiturall] Recovery0 Injection
Irdgatiorip OtherI3 gist use)
DATE DRILLED r)q-dy TIME COMPLETED y tN"dy AM0
J PMD
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumbedand
Fort -Bragg -Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC /LAND SETTING:
D Slope O Valley Er Flat D Ridge 0 Other
(check appropriate box) 1�yy be in do Fes,
LATITUDE 35.15 605232 minutes, seconds or
LONGITUDE -78.98 363806 m a decimal format
Latitude/longitude source: X GPS . 0 Topographic map
(locafon of well mustbe shown on a USGS topo map and
attached to this form lfnot uslng GPS)
6. FACILITY Is the name of the business where the well Is located
FACILITY ID #(If applicable) N/A.
NAME OF FACILITY Fort BraQQ
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City cr Town State Zip Code
t 910 .396-7432
Area code - Phone number
6. WELL DETAILS: r�•
a. TOTAL DEPTH: J
b. DOES WELL REPLACE EXISTING WELL? YESO NO)S
c. WATER LEVEL Below Top of casing: 33.14 Fr,
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 3,3 FT. Above Land Surface'
'Top of casing teuninatad atlor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
7. CASING: ' Depth Diameter ThlcknessWelght Material
From 3107 Tc 6 Ft.Are
From To Ft
From To Ft.
13. GROUT: rDepth Material Method
From a`iO' 7 To 0 Ft. 426^ZJ1 14465 ?I
Ff. m`_To °' FIL
From To Ft.
9. SCREEN: Depth Diameter Slot Size Mtatte�rial
Fro �� _To 3/,9_ Ft.
o1i in.
.6110 in. PI/C
From To Ft
in.
in.
From To Ft.
in.
in.
10. SAND/GRAVEL PACK:
De th
From °9 Toes 7 Ft.
S e
4�
Material
From To Ft
From To Ft
11.DRILLING LOG
From To Formation Description
12. REMARKS:
I R71FY fTrITH
ISWELL SDAOSR NACCODNCEWITH
E C ELLCO N COPYOFTHIS
R BEEN PR ELLOWN t
SI NATURE OF CERTIFIED WELL CONTRACTOR DATE
ItAN7'
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attic: information Mgt., Form GW-1b
1617 Mail Service Center— Raleigh, NC 276994617 Phone No, [phone] ext568. Rev.12107

NONRESIDENTIAL wELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527 .
1. WELL CONTRACTOR:
Richard Marshall Bum"ett
Well Contractor QndNMduao Name
Geo Lab, .Inc.
Well Contractor Company Name
STREETADDRESS PO'Box 1169
Dacula GA 300019
City or Town State Zip Code
7f 70 1.868-5407
Area code- Phone number
2. WELL INFORMATION: �1 1
SITE WELL ID #(if applicable)
WELL CONSTRUCTION PERMIT!/(dapplicabie) N/A
OTHER ASSOCIATED PERMIT #(if applicable) N/A
3. WELL USE (Check Applicable Box) Monkoring[3 Municipat/Publi
Industrlal/CommercialD Agricuituralti Recoveryu •Injection
Irdgadorij Other] Qist use)
DATE DRILLED C���' �Y
TIME COMPLETED a -N-Of AMn' PM13
4. WELL LOCATION:
CITY. Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivislon, Lot No.; Parcel, Zip Code)
TOPOGRAPHIC 11.8ND SETTING:
13 Slope 13 Valley Er Flat O Ridge 0 Other
(check appropriate box) Nby be in degrees,
LATITUDE 35.15 606501 minutes, secands or
LONGITUDE-78.98 359771 inadecimal format
Latitude/longitude source: M GPS 0 Topographio map
(location of we0 must be shown on a USGS topo map and
etteched to thla form Nnot rasing GPS)
5. FACILITY- is me name of the business where me r vl( is iocatea
FACILITY ID #of applicable) N/A
NAME OF FACILITY Fort Bragg
STREET ADDRESS Building 3-1137 Butner Rd. .
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON. Mr. Steven Harris
MAILING ADDRESS Same
City or Town State , Zip Code
91i 0 t- 396-7432
Area code - Phone number
A. WELL DETAILS: L�
a. TOTALDEPTH• r �s
b. DOES WELL REPLACE EXISTING WELL? YEsp NOBO"
c. WATER LEVEL Below Top of Casing: 33.13 FT,
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS _ ? FT. Above Land surface* -
`Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
E DISINFECTION: Type Amount
g. WATER ZONES(depth):
From Tc From To
From To From To
From To From To
7. CASING: Depth j Diameter ThicknessllAreight Material
From 3 1.; To -0 Ft. Pyre -
From To Ft
From To Ft.
8. GROUT: Depth Material Method
From gj3=5 To , Ft X -
FromTo Zj- Ft
From To Ft
9. SCREEN:
Diameter_ Slot Size. Material
,D1epth
From.I'7 To_31 _
Ft. r%5 in. .016 in.
From To
Ft. , in. in.
From Tc
Ft. in. in. .
10. SAND/GRAVEL PACK:'
DershS'a Material
fg
�+.�
Fro To .r.5o9 Ft:
From To
Ft
From To
Ft..
11ARILLING LOG
From To
Formation Description
12. REMARKS:,
I D ER FY THtS WELL W STRt1CTED N DANCE Willi
7 N ELL CON IJCTION AN DS,ANDT1iA OFTWS_
RC -CO PR D D O OWNER.
l
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
«ce
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form GW-lb
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev.12/07

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # .3527
I. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (individual) Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS . PO BOX 1169
Dacula GA 300019
City or Town state Zip Code
7( 70 t- 868-5407
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(I applicable)
WELL CONSTRUCTION PERMIT#(f applicable) N/A
OTHER ASSOCIATED PERMIT #(if applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring[. Municipal/Pub1b'c�.
Industrfal/Commercialp Agriculturall] Recoveryp 19jeccontr
Irrigationp OtherO 01st use)
DATE DRILLED
TIMECOMPLETED AMiPMO
4. WELL LOCATION:
CITY. Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 21 301
(Street Name, Numbers, Community, Sutxfrvision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
B Slope 0 Valley ErFlat - D Ridge 0 Other,
(check appropriate box)
LATITUDE 35.15 601311 Ivfaytiein
_ _ minutes, seconds or
LONGITUDE-78.98 36383 in a decimalfonnat
Latitude/hongitude source: 9 GPS Q Topographic map
(location of well must be shown on a USGS topo map and
attached to this form /f not using GPS)
5. FACILITY- is uu name of the business where the wen is iocsted
FACILITY ID #(1f'applicable) N/A
NAME OF FACILITY Fort Bragg
STREETADDRESS. Building.3-1137 Butner Rd:_
Fort Bragg NC 28301
City or To.". State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City orTown State': Zip Code
91t 0 l_ 396-7432
Area code - Phone number
S. WELL DETAILS: J
a. TOTAL DEPTH: HE'S
b. DOES WELL REPLACE EXISTING WELL? YESD NON'
c. WATER LEVEL Below Too ofCasing;. 33.23 FT.
(Use "+• If Above Top of Casing)
d. TOP OF CASING IS J FT. Above "Land Surface"
'Top of casing terminated atlorbelow land surface mayrequire
a variance in accordance with 15A NCAC.20.6118.
e. YIELD (gpm):
METHOD OF TEST
f. DISINFECTION: Type
Amount
g. WATER ZONES (depth):
From Tc
From To
From To
From To
From Tc
From To
7. CASING: Depth Diameter 'ThicknessNUeight Material
From 32,5To d Ft: , -%3!
pV�'
From To Ft.
From To Ft
8. GROUT: Depth Material
Method
Fror1L 3° Z To„Q_ Ft /fE%}T CE"�.J7
tset(� S✓J',
FromaS•S To o� Ft jjd "r
'T4E^Axf
From To Ft
S. SCREEN: Depth Diameter Slot Size
Material
From N�+�o-3oZ•�t_�i5 In. .610
in. Pre
From Tc Ft, in.
In.
From To Ft. in.
in:
10. SAND/GRAVEL PACK:
Depth _ Size Material
From LLOFo • Ft. ,#a-
From To Ft
From To Ft.
11.DRILLING LOG
From To Formation Description
12. REMARKS:
I ELPi
THAT ISZtA-
SIqNATUREOFCERTCCORDANCEWITH
A N IOPYOFTHIS
T
�I ED.WELLCONTRACTOR DATE
�or:�Y .
PRINTED NAME:OF PERSON :CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within'30 days. Attn: Information Mgt., Form GW-1_b:
1617 Mail Service Center— Raleigh, NC 27699-1617 . Phone No. ,[phone] ext 568. Rev.12/07

NON l DEMENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (IndividuaQ Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO BOX 1169
Dacula GA 300019
City or Town State Zip Code
7( 70 t- 868-5407
Area code- Phone number
2. WELL INFORMATION: �.
SITE WELL ID #(lfapplicablel �a- % S
WELL CONSTRUCTION PERMIT#(6applicable) N/A
OTHER ASSOCIATED PERMIT #(if applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring[] Municipal/Publt
lndustrial/Commercial13 AgdculturalD Recoveryll injection
Irrigationp OtherO Qist use)
DATE DRILLED Y'�Y TIME COMPLETED l�1'cY AMt7r
PMD
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumbetiand
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LVD SETTING:
D Slope D Valley ErFlat D 'Ridge D Other.
(check appropriate box) 1%by be is degrees,
LATITUDE 35.15 604214 . minutes, seconds or
LONGITUDE -78.98 35642 is a decimal format
Latitude/longitude source: 3 GPS D Topographic map
(location ofwellmustbe shown on a USGS topo map and
attached to this form Ynot using GPS)
5. FACILITY- is the name of the business where the well Is located.
FACILITY ID #(if applicable) N/A
NAME OF FACILITY Fort Bragu
STREET ADDRESS Building 3-1187 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
91r 0 • t-.39S-7432.
Area code - Phone number
S. WELL DETAILS:
a. TOTAL.DEPTH: -�' a'
b. DOES WELL REPLACE EXISTING WELL? YESD Now
c. WATER LEVEL. Below Top of Casing: 33.82 FT.
(Use'+• if Above Top of Casing)
d. TOP OF CASING IS 3d FT. Above Land Surface.
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm):
METHOD OF TEST
f. DISINFECTION: Type
Amount
g. WATER ZONES (depth):
From Tc
From To
From Tc
From To
From To
From To
7. CASING: Depth Diameter, ThicknesslWeight Maaterial
From 3aTo 6 Ft_-7s
>P✓Z
From To Ft
From To Ft.
8. GROUT, Depth Material Method
From ��� To F a-f 4 AIVO ?iJs
Fror;;t To atl,ry Ft 'r Lf
From To Ft
8. SCREEN: Depth Diameter Slot Size Material
From likZTo 3a•2Ft_,735-in..6146 in. ✓L'
From To Ft in. in.
From Tc Ft. in. in.
10. SAND/GRAVEL PACK:
Depth -Wze Material
From Ft --a S916
From To Ft
From To Ft
11.DRILLING LOG
From To Formation Description
12. REMARKS
NAME OF'
Submit the original to the Division of Water Quality within 30-days. Attn: information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
NTRACTOR DATE
'UCTING THE WELL
Form GW-1b
Rev.12107

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (Individual) Name
Geo Lab, .Inc.
Well Contractor Company Name.
STREETADDRESS PO: BOX 1169
Dacula GA 300019
City or Town State Zip Code
7( 70 .868-5407
Area code- Phone number
2. WELL INFORMATION:. _^^
SITE WELL ID #(if applicable)
WELL CONSTRUCTION PERMIVKifappficable) N/A
OTHER ASSOCIATED PERMIT #(q applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring[] MunicipaUPubli
Industrial/Commercial[] Agriculturall] Recoveryl] Injectio
Wgationl3 Otherhh (list use)
DATE DRILLED �
TIME COMPLETED ' J�'dY AMR PM[]
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301 -
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC f LA��FD SETTI NG:
h7 Slope D Valley 8'Flat B Ridge 13 Other
(check appropriate box) hby be in degrees,
UD LATITE 35.15 604214 minutes, seconds or
LONGITUDE-78•98 35642 in a decimal format
Latitude/longitude source: 19 GPS 0 Topographic map
(location of weffmust be shown on a USGS topo map and
. attached to this form if not using GPS)
6. FACILITY- is the name aithe twsinesswhere the van Is located
FACILITY ID #of applicable) N/A
NAME OF FACILITY Fort Bragg
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State ZIp:Code
94( 0 ).396-7432
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: �� • a -/
.b. DOES WELL REPLACE EXISTING WELL? YESO NOR
c. WATER LEVEL Below Top of Casing: - 33.82 FT.
(Use W If Above Top of Casing)
d. TOP OF CASING IS _%A. FT. Above Land Surface'
*Top of casing terminated atfor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type
Amount
g. WATER ZONES (depth):
From To
From To
From To
From To
From To
From To
7. CASING: Depth Diameter ThiclmessMteight
(Material"
From�ate%To O Ft 7.S Pve
From To Ft:
From To Ft.
8. GROUT: Depth
Material Method
From a4"A-To_ FL
61-7 Y iPaLG% Tda-.
From a(o, _ To a, ° �- Ft
� lRf ZE
From To FL
9. SCREEN: Depth Diameter Slot Size Material
FrorrL -iv2%�o 3a•o�Fi.
r 7sIn. r OtO in. Aire
From To FL
in. In.
From To FL
iq. In.
lo. SAND/GRAVEL PACK:
Depth -
4'?.•'ZTo 4
I e Material
K?
From o Ft.
CYAN),
From To FL
From To Ft
111.1)RILLINO LOG
From TO
Formation.Description
.12. REMARKS:
IDO ERTIFIr IS LwA CONSTRUCT I CCOROANCEWITH
1 2 LCON ON AN DS,AND OPYOFTHIS
EENPROV DT W LOWNIM
C
SIG ATE OF CER FIED WELL CONTRACTOR DATE
YZE-1 lslzqhc&
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30'days. Attn: information Mgt, Form GW-1b
1617 Mail Service Center -'Raleigh, NC 276994617 Phone No. [phone] ext 568. Rev.12107

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resoun;es- Division of Water, Quality
WELL CONTRACTOR CERTIFICATION # 3527
I. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (Individuate Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO Box 1169
Dacula GA 300019
City or Town . State Zip Code
7( 70 .868-5407
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) Ti�3 —1
WELL CONSTRUCTION PERMIT#(Irapplicable) N/A
OTHER ASSOCIATED.PERMIT#(Ifapplicable) N/A
3. WELL USE (Check Applicable Box) Monitoring[3 . MunidpaUPubti
Indusbial/Commercial0 AgriculturalO Reooveryp Injection
IrrigatioriD OtherU (list use)
DATE DRILLED i-I61-off
TIME COMPLETED Yt 41-d -' AMV PMO
4. WELL LOCATION:
CITY. Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision. Lot No., Parcel, Zip Code)
?POGRAPHIC / LAND SETTING:
Slope 0 Valley 0 Flat 0 Ridge p Other,
(check appropriate box) hby be in degrees,
LATITUDE 35.15 7636 • minutes, seconds or
LONGITUDE -78.98 160701 m a decimalfozmat
Latitude/longitude source: A GPS 0 Topographic map
(location of well must be shown on a USGS topo map and
attached to ihls form ffnot using GPS)
S.FACILITY Is the nameofthebusiness where theweglslocated
FACILITY ID #(if applicable) N/A
NAME OF FACILITY Fort Bragg
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
91L 0 .396-7432
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES[] NOI7
c. WATER LEVEL Below Top of Casing: 14.30 Fr,
(Use `+" i( Above Top of Casing)
d. TOP OF CASING IS J+'T FT. Above Land Surface`
'Top of casing terminated atfor below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To
From To
From To
From To
From To
From_ _ To
CASING: Depth
Diameter ThicknesslMight Material
From -1 2 .*o d
Ft •7y �t�e
From To
Ft ---
Fro mTc
Ft
8. GROUT: Depth Material
Method
From 1315To_4 /40-f dE"tr'�T fOMO ors.
_-ft
From fl✓• 9 To I'3•S Ft Bb✓t
—n2go--tE
From To Ft
9. SCREEN:Depth Diameter Slot Slze
From 4' YTo a�jFt .7Sin. .016 in,
Mrrial
�C '
From To Ft. in. in.
From To Ft. in. in.
10. SAND/GRAVEL PACK:
Depth size. Material
Frorn 3a2'/ • To !sE Ft '
From To Ft
From To Ft.
11.DRILLING LOG
From To Formation Description
12. REMARKS:;
gtBEE
fY WIE
L SCONSTRU NACCORDANCEWITH
CO T DARDS,AND AOOPYOFTHIS
PR L WNER
NAT/U�E OF CER/�IFIED WELL CONTRACTOR DATE
C�✓1J 4SI1.G� t�Y
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form GW-1b
1617 Mail Service -Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev.12/07

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTI!` ICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (Individual) Name
IS& Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO Box 1169
Dacula GA 300019
City or Town State Zip Code
7C 70 - 868-5407
Area code- Phone number
2. WELL INFORMATION: SITE WELL ID #(ff applicable) 7/43 62
WELL CONSTRUCTION PERMIT#(trappligble) N/A
OTHER ASSOCIATED PERMIT#of applicable) N/A
3. WELL USE (Check Applicable Box) MonitoringJ3 Municipal/Publ
Industrial/Commerclalr] Agricultural[] Recovery[] Injection
Irrigatior0 Other[] (fist use)
DATE DRILLED Y Iq- 0�
TIME COMPLETED t} �' d AMEI/PMQ
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301'
(Street Name, Numbers, Community, Subdil slon, Lot No., Parcel, Zip Code)
T OGRAPHIC / LAND SETTING:
Slope 0 Valley 13 Flat 13 Ridge [] Other
(check appropriate box)
Maybe in degrees,
LATITUDE 35.15 761477 minutes, seconds or
LONGITUDE -78.98 156835 in a decimal format
Latitude/longitude source: K GPS B Topographic map
(location ofwe//mustbe shown on a USGS topo map and
attached to this form if not using GPS)
6. FACILITY- Is the name or the buslnea wherethe well Is located
FACILITY ID #(rf applicabie) N/A
NAME OF FACILITY, Fort Bragg
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Barris
MAILING ADDRESS Same
City or Town State Zip Code
91t 0 1.396-7432
Area code - Phone number
S. WELL DETAILS: q
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES[] NO)/
c. WATER LEVEL Below Top of Casing: 10.59 FT.
(Use '+' if Above Top of Casing)
d. TOP OF CASING IS �, 8 Fr. Above Land Surface'
'Top of casing terminated atlor below (and surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATERZONES(depth)-
From To From To
From To From To
From To From To
7. CASING: Depth Diameter Thickness Weight Material
From fl+y,_ To 6
Ft
From To
Ft
From To
Ft
8. GROUT: Depth
Material
Method
From ±�_S To_0 _
Ft 'r &^
Ate& ifJ.
From 1G,SS To y'
Ft. &-Ir
From To
Ft
9. SCREEN: Depth
Diameter Slot Size Material
From��'9rq To i9,9
Ft 75 in, r01D in. C
From To
Ft. In.
in.
From To
Ft. in.
in.
10. SAND/GRAVEL PACK:
Depth
S e
Material
Fro 2I j To
Ft.r v
Ft.
From To
Ft
From To
Ft.
11.DRILLING LOG
From To Formation Description
12. REMARKS:
1 CERT]FY TTHIS ASCONS
TRUC INACCORDANCEWITH
C WELL LCT NS DARDS,AN ACOPYOFTHIS
RD BEEN P Ov T L OWNER.
c
SIGNAZUE
OF CER/TTIFIED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within. 30.days. Attn: Information Mgt..,, Form GW 1b
1617 Mail Service Center — Raleigh, NC 276994 617 Phone No. (919) M-7015 eXt:568. Rev.l2j07

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527,
1. WELL CONTRACTOR:
Richard Marshall Burnett Well Contractor Qndividual) Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO BOX 1169
Dacula GA 300019
City or Town State Zip Code
L770- .868-5407
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #Qf applicable) T1a-3 - 3
WELL CONSTRUCTION PERMIT#(Rapplkabie) N/A
OTHER ASSOCIATED PERMIT#(If applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring(] Municipal/Publ'
Industrial/Commeralall3 Agricuitural[3 Recovery0 Inlectio
Irrigatiorlp Otherl] Qist use)
DATE DRILLED. 11 ' Of
TIME COMPLETED Y I p'"D� AMVPM13
4. WELL LOCATION:
CITY. Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC /LAVD SETTING:
13 Slope 13Valley R Flat 13 Ridge 13 Other
(check appropriate box) May be in dew,
LATITUDE 35.15 758942 minutes, secondaor
LONGITUDE -78.98 152087 in a decimal format
Latitrrdeibngitude source: N GPS 13 Topographic map
(locaffon of well must be shown on a USGS fop* map and
attached to this form if not using GPS)
S. FACILITY- is the name of the bushe=Mere the vnell Is located
FACILITY 1D #(If applicable) N/A
NAME OF FACILITY. Fort Braga
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Sallie
City or Town State Zip Code
91( 0 1.396-7432
Area code - Phone number
S. WELL DETAILS: �
a. TOTAL DEPTH: Jo° /
b. DOES WELL REPLACE EXISTING WELL? YES13 N09
c. WATER LEVEL Below Top of Casing: 11.77 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS J.5 FT. Above land Surface,
`Top of casing terminated atfor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type 'Amount
g. WATER ZONES (depth):
From To From- To
From To From' To
From To From To
7. CASING: Depth Diameter ThicknesslWeight Material
FromAD,B To b Ft.. �s Pic
From Tc Ft.
From To Ft:
6. GROUT: Depth Material Method -
From 14, 8 To 6 _ Ft. &= C6"2&-t #41W0 $
From=,l Tq_/ •- , Ft 96ff 'YQ "1-d
From To Ft
9: SCREEN: Depth Diameter SlotS¢e Material
Fro .50•g To_,Zag Ft.. ^%S-in. .DI O in. y�
Frorrt. To Ft ih. in.
From To Ft in. in.
10. SAND/GRAVEL PACK:
D#--th Size Material
Fro O• __To Ft
From Ta Ft
From Tc Ft
11.DRILLING LOG
From To Formation Description
12. REMARKS:
I H CERTI TTHIS AS CONSTR N ACCORDANCE WITH
SA 2 ,WELL O Sr ANDARDS,AN OFTHIS
R RD SBEEN D T TH ELLOWNER.
SIGNATUR OF CERTiFIE WELL CONTRACTOR DATE
�f7
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Duality within 30 days. Attn: Information Mgt, Form GW-1b
1617 Mail Service Center — Raleigh, NC 276994617 Phone No. [phone] ext 568. Rev.12107

NONRESIDEN7M WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527'
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (IndMduaD Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO Box 1169
Dacula GA 300019
City or Town State Zap Code
7( 70 .868-5407
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(If applicable)_,
WELL CONSTRUCTION PERM IT#(fTappiiewel N/A
OTHER ASSOCIATED PERMIT #(if applicable) N/A
3. WELL USE (Check Applicable Box) Monftoringj3 Munfclpal/Publf
Industrial/Commerciale AgricultumII3 Recoveryi3 InjectionBI
Irrigational Otherp (listuse)
C
DATE DRILLED / 'IP',O%" _/
TIME COMPLETED -If AM[a PMD
4. WELL LOCATION:
CITY: _Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301.
(Street Name, Numbers, Community, Subdivision, Lot No.. Parcel, Zip Code)
TOPOGRAPHIC L3XD SETTING:
13 Slope 11 Valley Iff Flat i3 Ridge D Other
'(check appropriate box)
Mny be in degrees,
LATITUDE 35.15 757223 minutes, seconds or
LONGITUDE -78.98. 148496 in a decimal format
Latitude/longitude source: R GPS 0 Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
S. FACILITY- is the name of the bbaflness wherethe xefl Is located.
FACILITY ID #(If applicable) N/A .
NAME OF FACILnY Fort Braga
STREETADDRESS _Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
f 910 . 396-7432
Area code - Phone number
S. WELL DETAILS: 2 (�
a. TOTAL DEPTH-
b. DOES WELL REPLACE EXISTING WELL? YES13 NOff
c. WATER LEVEL Below Top of Casing: 11.72 FT.
(Use "+" If Above Top of Casing)
d. TOP OF CASING IS _f # -> FT. Above Land Surface*
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From_ To
From To From To
7. CASING: Depth Diameter ThicknessWelght
MaterialFron
201fg_To a Ft,, %S
PI(`
From To Ft.
From To I Ft.
8. GROUT: Depth Material
Method
From /S' -To92 Ft CyT C.tE#'rf
From To I S.ZFt. &-r T2&-Az
E
From Tc Ft
9. SCREEN: Depth Diameter Slot Size
M to ' I
na
Frorr. �' To �'`� Ft . %S In. .AID in.
_
p
From Tc Ft fn. In.
From To Ft in. In.
10. SAND/GRAVEL PACK:
Depth S, Material
Frorr 3D'9. To L � f Ft. 70- 54-/,
From To Ft
From To Ft
11.13RILLING LOG
From To Formation Description
12. REMARKS:
I ERTI, TTHITASCONSMU IN ACCORDANCE WITH
N C WELL DARDS,AN ACOPYOFTHIS
R 1 BEEN F RC I L OWN
Si NA''TT/URE OF CERTIFIED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING TH E WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, ) , Form cW-1b
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568. ' Rev.12/07

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Bumett
Well Contractor (Individual) Name
Geo Lab, Inc:
Well Contractor Company Name
STREETADDRESS PO Box 1169
Dacula GA 300019
City or Town State Zip Code
7c 70 - 86M407
Area code- Phone number
2. WELL INFORMATION: _
SITE WELL ID#(dapplicable) 1/U1s
WELL CONSTRUCTION PERMIT#(if applicable) N/A
OTHER ASSOCIATED PERMIT #(if applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring Munlcipal/Pubii
Industrial/Commerciale Agricultural4 Recovery[]InjectiortV
Irrigation!] Other❑ (listt use)
DATE DRILLED /
TIME COMPLETED �Y 6Y AmE PMB
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumbedand
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / L60D SETTING:
a Slope a Valley Flat 0 Ridge 0 Other
(check appropriate boot) My be is degrees,
LATITUDE 35.15 755508 minutes, seconds or
LONGITUDE -78.98 144985 in a decimal format
Latitude/longitude source: R GPS ❑ Topographic map
(locaf/on ofwapmustbe shown on a USGS topo map and
attached to this form if not using GPS)
5. FACILITY- Is the mama of the buslnesa where the Nell is located.
FACILITY ID #(d applicable) N/A
NAME OF FACILITY Fort Bragg
STREETADDRESS .Building 3-11.37 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven. Harris,
.MAILING ADDRESS Same
City or Town State Zip Code
91( 0 t-.396-7432
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: /
b. DOES WELL REPLACE EXISTING WELL? YES❑ NOM
c. WATER LEVEL Below Top of Casing: 10.79 Fr.
(Use;+" if Above Top of Casing)
d. TOP OF CASING iS 0&-7 FT. Above Land Surface
*Top of casing terminated at/or below land surface rrmy require
a variance in accordance with ISA NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type
Amount
g. WATER ZONES (depth):
From Tc
From To
m FroTc
From To
From To
From To
7. CASING: Depth Diameter ThicknessNVeight Material
From %9_ /- To 0
FL . ?S
From To
Ft.
From To
FL
8. GROUT: Depth
Material
Method
From 3+6 To C)
Ft �4ft�
Fv2G ��
From / ,q To,3,lo
Ft�
^►yZE
From To
R.
9. SCREEN: Depth
Diameter Slot Size
Material
'(' 94
S
From To
Ft - in. -010
in. - t/C
From To
Ft in.
in.
From To
Ft in.
in.
10. SAND/GRAVEL PACK:
Depth
Size Material
From• Zgr(o To /S' % Ft #A 5 --h
From To
Ft
From To
Ft
11.DRILLING LOG
From To Formation Description
12. REMARKS:
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 668.
IN A00MI)ANCE WITH
A COPY CF THIS
4 DATE
HE WELL
Form GW-1 b
Rev.12/07

NoNREADENTM WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (IndividuaD Name
Geo Lab, Inc.
Well Contractor' Company Name
STREETADDRESS PO BOX 1169
Dacula GA 300019
City or Town State Zip Code
7( 70 .868-5407
Area code- Phone number
2. WELL INFORMATION: 7
SITE WELL ID #(IfappAcable) `rA3—( D
WELL CONSTRUCTION PERMIT#(dapplicable), N/A
OTHER ASSOCIATED PERMIT #(if applicable) NIA
3. WELL USE (Check Applicable Box) Monitoring[] MunlcipaUPubli
lndustrial/Commerciall]i Agdcukural0 Recovery[] Injection
Irrigations Othed3 Qist use)
DATE DRILLED dy, /
TIMECOMPLETED • Fj-IV-d F AMB" PMO
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TJ�POGRAPHIC / LAND SETTING:
Slope 0 Valley 0 Fiat 0 Ridge D Other
(check appropriate box) May be in de11reei;6
LATITUDE 35.15 758707 minutes, seconds or
LONGITUDE -78.98 160816 m+decimal format
Latitude/longiWde source: K (BPS 0 Topographic map
(location of well must be shown on a USGS /opo map and
attached to this form if not using GPS)
6. FACILITY- Is the name ofthe business wherethe well Is locates
FACILITY ID #(if applicable) NIA
NAME OF FACILITY Fort Bragg
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC. 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State ZIp'Code
91r 0 .396-7432
Area code - Phone number
S. WELL DETAILS -
a.
a. TOTAL DEPTH: 35' v /
b. DOES WELL REPLACE EXISTING WELL? YESB NOlit'
c. WATER LEVEL Below Top of casing: 16.07 FT,
(Use "+" i( Above Top of Casing)
d. TOP 'OF CASING IS . L FT. Above Land Surface'
'Top of casing terminated atfor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATERZONES (depth):
From. To From To
From To From To
From To From To
7. CASING: Depth
Diameter ThicknesslNleight Material
From 254 To b
Ft. ,,- 3 PA!
From To
Ft
From Tc
Ft.
8. GROUT: Depth
Material Method
From o O'7.To D
Ft r46-► ro((C&3 X4T
From 4A. ✓'To JO.1 Ft �^MtsB
From To
Ft
9. SCREEN: Depth
Diameter Slot Size Material
From ,0To A-41'Ft JS in. .611b in.
From To
FL in. in.
From Tc
FL in. In.
10. SAND/GRAVEL PACK:
Depth
Size Material
.35f From To JA S Ft. #.2 .'SAeb
From To
Ft
From To
FL
11.13RILLING LOG
From To
Formation Description
12. REMARKS:
I ERTIFYTHAT IS WA ffUltDANCEWITH
1 N 2 ELLCONSr ION AN 0.SFTHIS
RECO EEJ PROVI OWN
C
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form GW-1b
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev.12/07

.NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett .
Well Contractor (Individua9 Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO Box 1169
Dacula GA 300019
City or Town . State ZIp.Code
7� 70 .868-5407 .
Area code- Phone number
2. WELL INFORMATION: —2 7
SITE WELL ID #(ff applicable) +�1`J"
WELL CONSTRUCTION PERMIT#((f applicable) NIA
OTHER ASSOCIATED PERMIT #(d applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring[] Munlcipal/Publi
Industrial/Commerciall] Agricultural[] Recovery[] In)ectio
Irrigatiorlil Other] gist use)
DATE DRILLED
TIME COMPLETED AMV PMB
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, ZJp Code)
2POGRAPHIC / LAND SETTING:
Slope [] Valley [] Flat 0 Ridge [] Other
(check appropriate box) I,y be is degrees,
LATITUDE 35.15 75706 minutes, seconds or
LONGITUDE-78.98 156981 in a decimal format
Latitude/longitude source: J1 GPS 0 Topographic map
(loceBon of well must be shown on a USGS topo map and
attached to this form /f not using GPS)
5. FACILITY- Isthe name oitm baslnesswhem thewen la Located.
FACILITY ID #(If applicable) N/A
NAME OF FACILITY Fort Braga
STREETADDRESS Building 3-1137 Butner Rd.
_Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State, Zip Code
91{ 0 )_ 396-7432
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES[] NOLrI
c. WATER LEVEL Below Top of Casing: 12.35 T.
(Use "+' if Above Top of Casing)
d. TOP OF CASING IS -go i) FT. Above Land Surface'
'Top of casing terminated atlor below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From Tc
From To
From Tc
From To
From To
- From To
7. CASING: Depth
Diameter Th oknesah%ight Material
From To O
Ft. . i f I'k
From To
Ft
Front To
Ft
8. GROUT: Depth
Material Method
Fro rrl � � To u
`
Ft. If�T day l�o' � W.3,
From �7 Toll, ri
Ft.� T4�*01tE
From To
Ft.
9. SCREEN: Depth
Diameter Slot Size Material
From 3Z•ff To gZ'
Ft. �%3 in. ,610 in. Ptrc
From To
Ft. in. in. '
From To
Ft. in. In.
10. SAND/GRAVEL PACK-
D-oth
S' g Material
f'
From 2Z'q To j6�
Ft. "�
From To
R.
From To
Ft.
11.DRILLING LOG
From To
Formation Description
12. REMARKS:
I "SE
TTHIS WELL"DARDSAND
ACCORDANCE WITH
5AI SCOPYOPTHIS
REC T E
t
SI NATURE OF C2""ay
TIRED WELL CONTRACTOR DATE
40:d
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form GW-1b
1617 Mail Service Center— Raleigh, NC 276994617 Phone No. [phone] ext 568. Rev.12107

NONRESMENTIAL wELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (IndividuaQ Name
Geo Lab; Inc. _
Well Contractor Company Name,
STREIETADDRESS PO Box 1169
Dacula GA 300019
City or Town State Zip Code
7[ 70 U- 868-5407
Area code- Phone number,
2, WELL INFORMATION � 9 C/
SITE WELL ID #(dapplicable) [ /i I ' d
WELL CONSTRUCTION PERMIT#(dappllcabie) N/A
OTHERASSOCIATED PERMIT #(ifapplicable) N/A"
3. WELL USE (Check Applicable Box) Monitorina13 Municipal/PublicP
Industrial/Commarclall] Agrieultural0 Recovery0 Injection
Irrigationll Otherl3 (list use)
DATE DRILLED
TIME COMPLETED O ' 1 ' Di AMI/ PM13
4. WELL LOCATION:
-ciTY: Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC I SETTING:
Slope 0 Valley IT Flat 13 Ridge"13 Other
(check appropriate box) �y be in degrees,
LATITUDE 35.15 755378 minutes, seconds or
LONGITUDE -78.98 152561 in a decimal format
Latitude/longitude source: K GPS 0 Topographic map
(location of weft must be shown on a USGS topo map and
attached to this fumy ifnot using GPS)
S. FACILITY- Is the name of the business where the well Is located
FACILITY ID OR applicable) N/A
NAME OF FACILITY Fort Bracts
STREET ADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING.ADDRESS Same.
Citypr Town State. Zip Code
91( 0: t.396-7432
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH-
b. DOES WELL REPLACE EXISTING WELL? YESO NOS**""
OS*
c. WATER LEVEL Below Top" of Casing:. 1:1.69
(Use '+' if Above Top of Casing)
d. TOP OF CASING IS .3if FT. Above Land Surface.
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 20.0118.
e. YIELD (gpm):
METHOD OF TEST
f. DISINFECTION: Type
Amount
g. WATER ZONES (depth):
From To
From Tc
From To
From To
From . To
From To
7. CASING: Depth Diameter Thickne&WVelght Material
FrorrL,. _To 0 Ft . CIS Pyt
From To Ft
From To Ft.
8. GROUT: Depth Material Method
From )j- IE�7 To_0 Ft.I��7 Cd� f'�
From /rrL-_ 7 To o�E Ft
From To Ft.
9. SCREEN: Depth Diameter SiotSlze Material
From D.J� To-2D-S—Ft , 7� in. r010 in. P ✓C
From To _ Ft in. In.
From To Ft. in. in.
10. SAND/GRAVEL PACK:
Depth S' Material
From° To" Fk So%D
From To Ft
From To Ft
11.DRILLING LOG
From To Formation Description
12. REMARKS:
JELL AS CONSTRU IN ACCORDANCE WITH
N DARDS,AN ACOPYOFTHIS
liE LOWNE
WELL CONT T.OR DATE
4 CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Fort GW-1b
1617 Mail Service Center— Raleigh, NC 276994617 Phone No. [phone] ext 568. Rev.12107

NONRESIDENTIAL wELL coNsTRUcTioNREcom)
North Carolina Department of Environment and Natural Resources-. Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (Individual) Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO Box 1169
Dacula GA 300019
City or Town State Zip Code
7�. 868-5407
Area code- Phone number
2. WELL INFORMATION:
SITE WELL 1D #(ifapplicable)
WELL CONSTRUCTION PERMIT#(ff applicable) N/A
OTHER ASSOCIATED PERMIT#(if applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring[] MunicipaUPubli
Indu5tdaIJCOmmeroiall3 AgriculturalI3 Recovery0 lnjectionW
Irrigatiorill OtherO Qist use)
DATE DRILLED /
TIME COMPLETED �' l DY AMF7 PM❑
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAID SETTING:
p Slope O Valley rFlat 13 Ridge 0 Other
(check appropriate box)
May be in degrees,
LATITUDE 35.15 753703 minutes, seconds or
LONGITUDE -78.98 148875 in a decimal fomtat
Latitude/longitude source: K GPS 0 Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS) .
5. FACILITY Is the name of the business where the well Is located
FACILITY ID #(if applicable) N/A
NAME OF FACILITY Fort Bragg
STREETADDRESS _BUllding 3-1137 Butner Rd.
Fort Bragg NO 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
(910 . )_ 396-7432
Area code - Phone number
6. WELL DETAILS: d
a. TOTAL DEPTH: 3or a /
b. DOES WELL REPLACE EXISTING WELL? YESU NOM
c. WATER LEVEL Below Top of Casing: 12.29 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS Si Z) FT. Above Land Surface•
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To
From To
From To
From To
From To
From To
7. CASING: Depth
Diameter Thickness/Might Material
Fro.,2D4 To 0
Ft
From To
Ft
From To
Ft
8. GROUT: Depth
Material Method
From L; STo 0
Ft EA 1 ( y 4C 1'
From 17 To I.S
Ft ,F•J-e Y/�/►ynz
From To
Ft
9. SCREEN: Depth
Diameter SlotSize Material
From3a• To 30ti n.Ft
,2si...O16 in. ✓C
From To
Ft in. in.
From To
Ft in. in.
10. SAND/GRAVEL PACK:
Death
S In Material
From v-8 To %% Ft '
From To
Ft
From To
Ft
11.13RILLING LOG
From To
Formation Description
12. REMARKS:
I ERTlfY
THIS WELL CONSTRUCT
IN ACCORDANCE WITH
1 C L
LICnO�jHE
COPYOFTFiIS
R ENPR
I
�ST OWNEND
LOYYNER
C
SIGNATURE OF CERTIFIED WELL CONTRAC
R DATE
PRINTED NAME OF PERSON CONSTRUCTING TH E WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt:, Form GW-1b
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev.12/07

NONRESIDENTIAL wELL coNsmucnm RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION N. 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (Individual) Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO Box 1169
Dacuia GA 300019
Cityor Town State Zip Code
(770 _ 868-5407
Area code- Phone number
2. WELL INFORMATION:
SITE WELLIDlt(irapplicable)
WELL CONSTRUCTION PERMIT#(dapplicable) N/A
OTHER ASSOCIATED PERMIT #(if applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring0 MunlcipaUPubll
Industrial/ComercialD Agricultural0 Recovery0 Injection m
Irrigationil Other13 Qist use)
is
DATE DRILLED I -el
TIME COMPLETED 'a3I v Y AMe PMD
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / D SETTING:
D Slope 13 Valley'fFiat D Ridge 11 Other
(check appropriate box) h&y be in degecs,
LATITUDE 35.15 732777 mimites, seconds or
LONGITUDE-78.98 172729 in a decimal format
Latitude/longitude source: 19 GPS D Topographic map
(location ofwell mustbe shown on a USGS topo map and
attached to this form if not using GPS)
5. FACILITY- Is the name ofthebusiness whom the vVellis,opted i
FACILITY ID #(if applicable) N/A
NAME OF FACILITY Fort Bragg
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILINGADDRESS Same
CityorTown State Zip Code
t 910 .396-7432
Area code - Phone number
S. WELL DETAILS: /%,,,,
a. TOTAL DEPTH: 51 ", 7
b. DOES WELL REPLACE EXISTING WELL? YESi3 NO31
c. WATER LEVEL Below Top of Casing: 33.20 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS Jo FT. Above Land Surface-
-Top of casing terminated aUor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATERZONES.(depth):
From To From To
From To
From To
From To
From To
7. CASING:' Depth
DiameterThicknessNveight Material
r From ZAI To 0
Ft !-WrrJe
From To
Ft.
FroriT To
Ft.
9. GROUT: Depth
Material Method
From j,5 To 45
Ft. 411944 &--1647 1;2tt0li,X,
From Aw To 3�.5 Ft. T?L %-Zze
From To
Ft.
9. SCREEN: . Depth
Diameter Slot Size Material
FrorrL56°7 _ To i - I
_ Ft aS in. r,616 in.. • .t' 1%r-
From To •
R. in. in.
From To
FL in. in.
10. SAND/GRAVEL PACK:
D.Mh S, a Material
From-5�1 To� Ft ��
From To
Ft.
From To
Ft:
11.DRILLING LOG
From To Formation Description
12. REMARKS:
1 DO ERTIFY T THIS L A3 CONSTR N ACCORDANCE WITH
1 C ELL N R I
NDARDS,AN ACOFYOFTHIS
I
ELL OWNER
WELL CONTRACTOR DATE
Sl NATURE OF CERTIFIED
&z i ia*s c"Y
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: information Mgt, Form GW-1b
1617 Mail Service Center —Raleigh, NC 27699=1617 Phone No. (919) 733 701a ext 568. Rev.12/07

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (individual Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO Box 1169
Dacula GA 300019
City or Town State Zip Code
7( 70 I .868-5407
Area code- Phone number
2. WELL INFORMATION: _
SITE WELL ID#(ifapplicable) �M3'1I
WELL CONSTRUCTION PERMIT#(1applicable) N/A
OTHER ASSOCIATED PERMIT #(If applicable) N/A
3, WELL USE (Check Applicable Box) Monitoring[] Municipal/Publi
Industrial/ommercialD Agriculiurall3 Recovery[] Injection C
irrtgatlorig Other[] (1ist use)
DATE DRILLED a5 "dY -'/
TIME COMPLETED �� - U y AMID PMCI
4. WELL LOCATION:
CITY. Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Commuft Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / L6WD SETTING:
D.Slope [] Valley Er Flat 13 Ridge [] Other
(check appropriate box) May be in de6nma,
LATITUDE 35.15 72908 minutes, Second+ or
LONGITUDE -78.98 171479 to a decimal format
Latitude/longitude source: N GPS 0 Topographic map
(location of well must be shown on a USGS topo map and
atfached to this farm if not using GPS)
S. FACILITY- Is the name of II* buslnesswhemthe well Is located,
FACILITY ID #(f applicable) N/A
NAME OF FACILITY Fort Bragg
STREET -ADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING'ADDRESS Same
City, or Town State Zip Code
91t 0 - 396-7432
Area code - Phone number
S. WELL DETAILS:
a. TOTAL DEPTH; /
b. DOES!WELL REPLACE EXISTING WELL? YES[] NOM
c. WATER LEVEL Below Top of Casing: 33.07 FT,
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS .2 FT. Above Land.Surface•
'Top of casing terminated atior below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
7. CASING: -Depth Diameter ThicknessIMIght Material
From 3'7+ _To 6 Ft ,'7S FYC
From To Ft.
From To Ft.
8. GROUT, Depth Material
Method
Fr rn. a To_ 0_ F -t CE^64-e
MC6 --ZLS.
—246"-rze
From Z5'if_ To 2-34P Ft &-{
From To Ft
9. SCREEN: Depth Diameter. Slot Size
Material
From 47,S To aZS Ft, 7S in. r 6I0
in.
From To Ft in,
in.
From To Ft in.
in.
10. SAND/GRAVEL PACK: -
DeMh Material
From 757To�'gFt 4_2 -544,
From To Ft.
From To Ft
11.13RILLING LOG
From To Formation Description
12. REMARKS:
I DOH";FYTHAT-WISWELLWA"STRUGMTED DANCEWITH
15AON AF THIS
SIGNATURE OFCERTIFIEDWELLCONTRACTOR. DATE
4 iIA4b tea: Y
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form GW-1b
1617 Mail Service Center -Raleigh, NC 27699-1617 Phone No.� [phone] ext 568. Rev.12/07

NONRESIDENTIAL. WELL CONSTRUCTION RECORI)
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (Individual) Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO BOX 1169
Dacula GA 300019
City or Town State Zip Code
7( 70 - 868-5407
Area code- Phone number
2. WELL INFORMATION: I a
SITE WELL ID #pf applicable)
WELL CONSTRUCTION PERMIT#(if applicable) N/A
OTHER ASSOCIATED PERMIT #(if applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring[] Municipal/Publicp
Industrial/Commercial0 AgriculturalEl Recoveryp Injectioniil'o"
IrrigationU Otherp Gist use)_
DATE DRILLED �.Xfi - 0 i
TIME COMPLETED 4P-aS"- 0 Y AMR'*�PMO
4. WELL LOCATION:
CITY Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAID SETTING:
Slope 0 Valley $"Flat 13Ridge 0 Other
(check appropriate box)
May be in degrees,
LATITUDE 35.15 725572 minutes, seconds or
LONGITUDE-78.98 17021 in a decimalfoanat
Latitude/longitude source: N GPS d Topographic map
(location of we# must be shown on a USGS topo map and
attached to this form If not using GPS)
5. FACILITY is the name of the business where the wall Is located
FACILITY ID #(d applicable) N/A
NAMEOF FACILITY Fort Braga
STREETAADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Barris
MAILING ADDRESS Same
City or Town State Zip Code
f 910 - 396-7432
Area code - Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: /
b. DOESwELL REPLACE EXISTING WELL? YES13 NOff
c. WATER LEVEL Below Top of Casing: 32.69 FT.
I (Use "+" if Above Top of Casing)'
d. TOP OF CASING IS J+"L FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From Tc
From To From To
7. CASING: Depth Diameter ThicknessNVeight Material
From b('� To
From To Ft
From To Ft
8. GROUT: Depth Material Method
From �� To Q Ft. 69-r 1 f'OtCO -D
Fro ,3 To— Ft.
From To Ft.
9. SCREEN: Depth Diameter Slot Size Material
From 43 To 36e!a Ft . S in. +610 in. N't-
Frorri To Ft in. in.
From To Ft, in. in.
10. SAND/GRAVEL PACK:
Depth p Size Material
From �► / To Z8° 3 Ft i� -54► j
From To Ft.
From To Ft
11.DRILLING LOG
From To Formation Description
12. REMARKS:
IDO"EEN
IS WELL CONSTRUCTED N CCDRDANCEWITH
1 NCTI ST �ARQS,AND A OF THIS
R O E LOWNER
SIGNATUREOFCERTIFIED ELL CONTRACTOR DATE
/�1111 91bL6
PRINTED NAME OF PERSON CONSTRUCTING THE -WELL
Submit the original to the Division of Water Quality within 30 days. Attn: information Mgt, Form GWAb
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568. RevA2107

N.ONREsmENTIA.L wELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (IndividuaQ Name
Geo Lab, Inc.
Well Contractor Company Name
STREET ADDRESS PO Box 1169
Dacula GA 300019.
City or Town State Zip Code
7t 70 1- 868-5407
Area code- Phone number
2. WELL INFORMATION: ^
SITE WELL ID#(I{appiicable) ��,�'i3
WELL CONSTRUCTION PER MIT#(Ifapplicable) N/A
OTHER'ASSOCIATED PERMIT #(if applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring)] Municipal/Public
Industrial/CommercialEl Agriculturall] Recovery0 Injectionl
Irrigat(or[I OtherI3 (I(sttuse)
DATE DRILLED
TIME COMPLETED �3 "Oi AMePMO
4. WELL LOCATION:
cny. Fayetteville COUNTY CUmbOdand
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
0 Slope 13 Valley ErFlat 13 Ridge 0 Other
(check appropriate box) Ivby be in dogrces.
LATITUDE 35.15 721602 minutes, seconds or
LONGITUDE -78.98 16882 in a decimal format
Latitude/longitude source: X GPS 0 Topographic map
(locaffon ofwell mnustbe shown on a USGS topo map and
attached to this form ffnot LWng GPS)
S.FACILITYIsUrename efthebusinesawhere the we11Islocated.
FACILITY ID #(if•applicabie) N/A
NAME OF FACILITY Fort Bragg
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
91f 0 ,1.396-7432
Area code - Phone number
6. WELL DETAILS: 14
a. TOTAL DEPTH: /
b. DOES IWELL REPLACE EXISTING WELL?. YEsO NOM
c. WATER LEVEL Below Top of Casing: 31.18 FI•_
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS ce-`r FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e: YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type
Amount
g. WATER ZONES (depth):
From To
From To
From To
From To
From To
From To
7. CASING: . Depth Diameter Thicknesw Weight Material
From Ty To d
Ft,
From To •
Ft
Frorn_ To
Ft
8. GROUT: Depth
Material
Method
Fro n, 04V To_i� Ft 0-7 E�6+'r AfZ6 =.T
From asp To o'1G�(^ Ft M41 TQEZ E
From To
Ft
9. SCREEN. Depth
Diameter Slot Size
Material
Front '24' �/ To -3 j
Ft r 79- in, r d'i 0 in.
1 ��
From To
Ft in. in.
From Tc
FL in. In.
10. SAND/GRAVEL PACK:
De pth a Material
From YV To�Ft *Z SArr5
From To
Ft
From To
Ft.
11:DRILLING. LOG
From To Formation Description
12. REMARKS:
VItCEERT1 FY TTHISWELL 8CONSTRU ACCORDANCEWITH
CO UCilO DARDS.AND COPYOFTMS
PR VI ED O E ELLOWNER
SIGNA�TfURE OF CER IFIED WELL CONTRACTOR DATE
vsnl c_Y
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form GW-1b
1617 Mail Service Center — Raleigh, NC 276994617 Phone No. [phone] ext 568. Rev.12107

NONRESIDENTIAL wELL coNsTRUcTIoN RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (IndividuaQ Name
Geo Lab, Inc.
Well Contractor•Company Name
STREETADDRESS PO BOX 1169
Dacula GA 300019
City or Town State Zip Code
7L 70 �. 868-5407
Area code- Phone number
2. WELL INFORMATION: nw
SITE WELL ID #(If applicable)
WELL CONSTRUCTION PERMrr#(if applicaus) N/A
OTHERIASSOCIATED PERMIT #(if applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring[] Municipal/Public
Industrial/CommercialD Agricultural[] Recovery[] Injection
Irrigatiorb Other[] . Vistt use)
st
DATE DRILLED O . - dy /
TIME COMPLETED i AM9 PMI3
4. WELL LOCATION:
CITY Fayetteville COUNTY CUmberiand
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers,.Community, Subdivision, lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAy D SETTING;
13 Slope p Valley IXFIat 13 Ridge 0 Other
! (check appropriate box) Tfyy be in degree,
LATITUDE 35.15 717895 minutes, seconds or
LONGITUDE -78.98 167681 a decimal formal;
Latitude/longitude source: X .GPS 0 Topographic map
(location ofweffmust be shown on a USGS topo map end
attached to this faun if not using GPS)
5. FACILITY b Ore name of the business where the yen is rorared.
FACILITY ID #Qf applicable) N/A
NAME OF FACILITY Fort Bragg
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Toms State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING', ADDRESS Same
CityorTown State Zip Code
91( 0 ! 1- 396-7432
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: -, , /
b. DOESiWELL REPLACE EXISTING WELL? YES[] Noe'
c. WATER i LEVEL Below Top of Casing: 31.22 FT,
(Use'+" if Above Top of Casing)
d. TOP OF CASING IS ot'S FT. Above Land Surface -
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
7. CASING: Depth
Diameter ThicknesslWeight Material
From 3 raTo d
Ft--..
I S- �VC.
From To
Ft:
From To
Ft.
8. GROUT: Depth
Material Method
From 9-5 1'q To_ Q
Ft.
4&4 CE^t&'T 604ddtj --ni
Fro e7+ To u` Ft.
64"r T%iii-AzE
From To
Ft.
9. SCREEN: Depth
Diameter SlotSlze Material
From �il — .j ' '�Ft. , is In. . D1 I. r ✓L'-
From To
Ft.
in. in.
From To
Ft.
in. in.
10. SAND/GRAVEL PACK:
Depth
From H;S'Toa�°7
_ Ft.
S).8 Material
2
From' To
Ft.
Frorrl To _
Ft.
11.13RILLING LOG
From To
Formation Description
12. REMARKS:
j
ID HER THAT WELL WAS C NSTRUCTm IN A CE WITH
150N C L tJSr ONST ND ANDTHA7A OFTHIS
RECORD OVIO E ELL ER
SIGNA RE OF CERTIFrED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: information Mgt., Form GWAb
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev.12107
I .

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-: Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
I. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (Ind)viduaQ Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO Box 1169
Dacula GA 300019
City or Town State Zap Code
7( 70 1 - 868-5407
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID#(dapplicable] 1'T
WELL CONSTRUCTION PERMIT#(dapplicable) N/A
OTHER ASSOCIATED PERMIT #(if applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring[] Municipal/PublicO
Industdal/Commerciali7 AgriculturalD RecoveryI3 Injec ionli(/
Irdgationp Otherl] (list use)
DATE DRILLED a -G
TIME COMPLETED-�) D� AMFi PMD
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC /D SETTING:
13 Slope D Valley IF Flat 13 Ridge D Other
(check appropriate bon) hf2 y be in degrees,
LATITUDE 35.15 714273 minutes, ecconds or
LONGITUDE-78.98 166348 in a decimal format
Latitude/hongitude source: 11 GPS I] Topographic map
(location ofwellmustbe shown on a USGS topo map and
attached to this form if not using GPS)
I
S. FACILITY m the name of the businesswherethe xe4 Is located
i
FACILITY ID #(d applicable) N/A '
NAME OF FACILITY Fort Bragg
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
Cky or Town State Zip Code
91t 0-396-7432
Area code - Phone number
G. WELL DETAILS:
a. TOTAL DEPTH: /
b. DOES WELL REPLACE EXISTING WELL? YES13 NOM
c. WATER LEVEL Below Top of casing: 31.58 Fr.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 2A FT. Above Land Surface-
-Top of casing terminated atior below land surface may require
a variance in accordance.with 15A NCAC 2C .0118,
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From • To From To
From To From To
7. CASING: Depth Diameter ThicknessM/eight Material
��'� d
iS
P✓f-
From To
Ft. a
From To
Ft.
From To
Ft.
8. GROUT: . Depth
Material
Method
From A3`& To
Ft 1(6n C&t&-r fa�[E9 s^+J3
From sS�9-Tom4'Ft
964-1
-R&^ASd
From To
Ft
9. SCREEN:: Depth
Diameters SlotSlze
M tonal
From -147- To TT•
FL , /s in. &61 G1 in.
_ -y C-
From To
Ft in. in.
From To
Ft-- In. In.
10. SAND/GRAVEL PACK:
Death. ,
VFQ Material
From 009 To ZS• 1
Ft *a
From To
Ft.
From To
Ft.
11.DRILLING LAG
From TO Formation Description
12. REMARKS:
IN ACCORDANCE WITH
A COPY OF THIS
DATE,
THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form GW-1b
1617 Mail Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568. _ Rev.12107 .

L r ONRESIDENTIAL WELL CONSTRUCTION RECORD
North'Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Bumeft
Well Contractor (IndividuaQ Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO BOX 1169
Dacula GA 300019
City or Town State Zip Code
7( 70 � .868-5407-
Area code- Phone number
2. WELL INFORMATION:
SITE WELLID #(N applicable),
WELL CONSTRUCTION PERmrr#(fapplicable) N/A
OTH ER ASSOCIATED PERMIT #(f appliicable) N/A
3. WELL USE (Check Applicable Box) Monitoring[3 Municipal/Pubrt
Indu"UCommercial(] Agrieuttural13 Recovery0 , injection
Irrigation] OtherO (fist use)
DATE DRILLED' i�Xo-O y
TIME COMPLETED 1(0' Y AMI�' PM13 .
4. WELL LOCATION:
CITY: `Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
13 Slope!O Valley Flat 13 Ridge 13 Other
(check appropriate box)
35.15 846424 May be in degrees,
LATITUDE _ minutes, seconds or
LONGITUDE -78.9$ 325037 in a decimal format
Latitude/longitude "source: X GPS 0 Topographic map
(location of weNmustbe shown on a USGS topo map and
attached to this farm If not using GPS)
S. FACILITY- is the name of the bwnesswhere the wen Is located
FACILITY ID #(if applicable) N/A
NAME OF FACILITY Fort Bragg
STREETADDRESS Building 3-1137 Butner Rd..
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harrls
MAILING ADDRESS Same
City or Town State . Zip Code
(910 . 396-7432
Area code - Phone number
G. WELL DETAILS: 1
a. TOTAL DEPTH: X) ` /
b. DOES WELL REPLACE EXISTING WELL? YESO NO2
c. WATER LEVEL Below Top of Casing: 21.81
(Use W if Above Top of casing)
d, TOP. OF CASING IS A?,- FT. Above Land Surface -
*Top of casing terminated atfor below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From Tc From To
From To From To
From Tc From To
7. CASING: Depth Diameter ThicknessNVeight Material
From ,LZ4 f To
0 Ft. r7 S f Y C
From To
Ft.
From To
Ft
S. GROUT: Depth
Material Method
From (3 To_
C— Ft 11641 Lr�+ >�ti+� 44C0 TN'
From 15,3_To i3 Ft. T4&--r2F
From To
FL
9. SCREEN: Depth
Diarr:'ter Slot Size Material
From 2_7-40
-2-24t .DIIO' in, Art
From To
Ft fn. in.
From '-- To
Ft. in. in.
10. SANDIGRAVEL PACK:
Dept; I
From .f To
S e Material
15.3 Ft - - �
From To
Ft,
From To
• Ft,
11.DRILLING LOG
From To
Formation Description
12. REMARKS:
I DO C RTIFY THAT IS WELL WAS NSTRUCTED IN A RDANCE wrrH
1 N ELL CON ST N ,AND THATAC PYOFTHIS
RE D EN PROVI TO E EL ER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
Plevoi
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form GW-1b
1617 Mail Service Center— Raleigh, NC 276994617 Phone No. [phone] ext 568. Rev.12/07

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (Individual) Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRES3 PO BOX 1169
Dacula GA 300019
City or Town State Zip Code
7L701). 868-5407
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(it applicable) -rA q—o?
WELL CONSTRUCTION PERMIT#(ifapplicable) NIA
OTHER ASSOCIATED PERMIT#(If applicable) NIA
3. WELL USE (Check Applicable Box) Monitoring❑ MunicipaUPubli
Industrial/Commercialp Agricutturall3 RecoveryD Injection
Irrigatlon0 Otherl] (list use)
'DATE DRILLED pXv'OY
TIME COMPLETED g c OY AMV PMO -
4. WELL LOCATION:
CITY Fayetteville` COUNTY "Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Communit)4 Subdivision, Lot No., Parcel. Zip Code)
TOPOGRAPHIC! LV�1D SETTING:
D Slope D Valley IrFlat D Ridge D Other
i (check appropriale.box) Bay be in degrees,
LATITUDE 35.15 843978 minutes, seconds or
LONGITUDE -78.98 : 321646 in a decimal format
Latitude/longitude source: X GPS D Topographic map
(locadon of well must be shown on a USGS topo map and
attached to this form if not using GPS)
5. FACILITY- Is the name of the business where the wen Is located
FACILITY ID #(If applicable), N/A
NAME OF FACILITY Fort Bragg
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
91( 0 )- 396-7432
Area code - Phone number
6. WELL DETAILS:
I
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YESD Nola
c. WATER LEVEL Below Top of Casing: 19•54 FT.
(Use "+" If Above Top of Casing)
d. TOP OF CASING IS -3 .iJ FT. Above Land Surface*
'Top of casing terminated atfor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpri): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To
From To
From To
From To
From To
From To
T. CASING: Depth
Diameter ThicknessMfeipht
Material
From �-% To 6
Ft . -%s
P✓C
From To
Ft•
From To
Ft
B. GROUT: . Depth
Material
Method
From 13.4' To Ft_Id66j G&%V 1 Atte x.
From LS, 7 To 13.E Ft 9&4-f
1140 M A
From To
Ft:
9. SCREEN: Depth
Diameter Slot Size Material
From 343 To L1.7
Ft ,%jEin.
:OiO In. ArC
From To
Ft.__in.
in.
From To-
Ft in:
.in.
10. SAND/GRAVEL' PACK:
Depth:
Size
Material
From ,. jj To 1S,7
.Ft ,—
SSA 3
From To
Ft
From To
Ft
11.DRILIJNG LOG
From To Formation Description
12. REMARKS:
IDOH FYTHATTHISWELLWA RUC I ANCENTH
1 A 2C LCON ON AN D3 AND77 OFTHIS
RECO PROM TOTH OWNER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
//
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form GW-1b
1617 Mail Service Center -Raleigh, NC 27699-1617 Phone No: [phone] ext 568. Rev.12/07
i

NONRESIDENTIAL WELL cONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL. CONTRACTOR CERTIFICATION# 3527
1- WELL CONTRACTOR:
Richard Marshall Burnett "
Well Contractor (Individual) Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO BOX 1169
i
Dacula GA , 300019
City or Town State" .Tip Code
7L 70 . 868-5407
Area code- Phone number
2. WELL INFORMATION: -
SITE WELL ID #(rrapplicable) 4
WELL CONSTRUCTION PERMIT#(Ifapplicable). N/A
OTHER ASSOCIATED PERMrr #(if applicable) N/A
3. WELL USE (Checlr Applicable Box) Monitoring0 MunicipaltPublic0
lndustriaUCommerciall7, AgriculturalO Recovery0 Injectione
Irrigatioil0 Others] (list use)
DATE DRILLED
TIME COMPLETED ,f--,1'7-d It AMV PMD
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumberland
FortBragg Fayetteville, NC 28301
(Street Name, Numbem, Community, SubdivisioR Lot No., Parcel, Zip Code)
TOPOGRAPHIC /L8W D SETTING:
O Slope,0 Valley Er Flat p Ridge O Other
I (check appropriate boot) Maybe in degrees,
LATITUDE 35.15 84158$ minutes, seconds or
LONGITUDE -78.98 318191 In. adecimal format
Latitude/longitude source: [ GPS I Topographic map
(location ofwelimust be shown on a USGS top* map and
i attached to this farm if not using GPSy
{
5. FACILITY- Is ore name afthe bolness where the Neil Is located,
FACILITY ID #(if applicabie) N/A
NAME OF FACILITY Fort Bram
STREET ADDRESS Building 3-1137 Butner Rd.
_Fort Bragg NC 28301 "
CltyorTown state. Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
9t 10 i .3967432
Area code - Phone number
6. WELL DETAILS: g
a. TOTAL DEPTH:+b /
b. DOES WELL REPLACE EXISTING WELL? YESD NOT
c. WATER LEVEL Below Top of Casing: 17.74 1`7r,
(Use '+" if Above Top of Casing)
d. TOP OF CASING IS A 2 FT. Above Land Surface*
'Top of casing terminated atlor below land surface may require
a variance in accordance with 15A NCAC 2C •0118.
e. YIELD (gpm) METHOD OF TEST,
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To ' From To
From To From To
7. CASING: Depth " Diameter Thickness %igM Material
,From iq� �. To �
Ft2 pre
From To
Ft.
From" To
Ft
8. GROUT: Depth
Material Method
From f+•Z' To O
Ft./� 7 f'O�ILE1 2J?,
From .l b.'S To 14E---?r_
Ft_- "7�IF�►+srZcr
From To
Ft `
9. SCREEN: Depth
Diameter Slot Size Material
From 3�.6 To (�•�r
Ft-L�i n. O16 in. PVC
From To
Ft.- in. in. "
From To
Ft in, in.
10. SANDIGRAVEL PACK:.
Depth
From 3�.�o To ICe.�S
sg e_ Material
Fl ,2
From To
Ft:
From To °
Ft "
11.DRILLING LOG
From To.
Formation: Description
12. REMARKS:
IDOH FYTHAT ISWELL CONSTRUCTED RDANCEWITH
MAN C2 LCONSr TION T DS,ANDTHA OFYOFTHIS
RECCIRD PROV W OWNER.
e
SIGNA/TPRE OF CERTIFIED WELL CONTRACTOR DATE
>"i!o t6Y - -
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form GWAb
1617 Mail Service Center - Raleigh, NC 27699 1617 Phone No. [phone] ext 568. Rev.12107

NONREM ENTIAL WELL CONSTRUCTION RECORD
North Carolina` Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTmcATION # 3527
1. WELL CONTRACTOR:
.Richard Marshall Burnett
Well Contractor pndividuaD Name
Geo Lab, Inc,
Well Contractor Company Name
STREET ADDRESS PO BOX 1169
Dacula GA 300019
City or Town State Zip Code
(770 � . 868-5407
Area code- Phone number
2. WELL INFORMATION: �-
SITE WELL ID #(if applicable)
WELL CONSTRUCTION PERMITN(ifapplicable) NIA
OTHER,ASSOCIATED PERMIT#(ifapplicable) NIA
3. WELL USE (Check Applicable Box) Monitoring[] Municipal/Publi
Indust ial/Commercialp Agricultural[] Recovery[] Injection
Irrigation! Other[] (list use)
DATE DRILLED Y'.�� •cy
TIME COMPLETED dy AMD PMO
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / L6ND SETTING:
D Slope D Valley @'Flat D Ridge [] Other
(check appropriate box) tray be is degrees,
LATITUDE 35.15 839199 minutes, seconds or
LONGI7 DE-78.98 314.796 inadecimal format
Latitudellongitude source: K GPS [I Topographic map
(locaffotr of wegmust be shown on a USGS topo map and
aHached to this form Hnot using GPS)
i
5. FACILITY is the name of the business where me wen is located.
FACILITY ID #(if applicable) N/A
NAME OF FACILITY Fort Bragg
STREErADDREss Building 3-1137 Butner Rd.
_Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Saute
City or Town State Zip Code
(910 1 : 396-7432 "
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: /
b: DOES WELL REPLACE EXISTING WELL? YES[]
I
c. WATER LEVEL Below Top of Casing: 16.82 FT,
(Use "+^ If Above Top of Casing)
d. TOP OF CASING IS �• �- FT. Above Land Surface -
*Top of casing terminated atlor below land surface may require
a variance an accordance with 15A NCAC 2C .0118.
e. YIELD (gpm):
METHOD OF TEST
f. DISINFECTION: Type
Amount
g. WATER ZONES (depth):,
FrowL TcL
From To
From To
From To,
From To
From To
7. CASING: Depth
Diameter ThicknessWelght Material,
From L'R, S To O
Ft, 0 S i*YC
From Tc
Ft
From To
Ft.
6. GROUT: Depth
Material Method
From (n�I- 17o d
Ftl Adtt#>
From ..tb To 12.
Ft, 641,1-r —m&-Axe
From To -
Ft
9. SCREEN: Depth
Diameter Slot Size Material
From '3,f'5 To
Ft •'7CIn. •01D in. �
From To
Ft In. in.
From To
Ft. -in. in.
10. SAND(GRAVEL PACK:
Depth
From 3' To 145 (.
S* Material
Ft.
From To
FL
From To
Ft.
11.DRILLING LOG
From To
Formation Description
12. REMARKS:
I DO"ELLN
L W CONSTRUCT ACCORDANCE WITH
1 CI ST ARDS,AND COPYOFTHIS
RO E LOWNER.
c
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
lea-zi Ei 6LE i
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attu: Information Mgt., FormGW-1b
1617 Mail Service Center —Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev.12/07

NONRESIDENTIAL WELL CONSTRUCTION RECORD,
North Carolina Department of Environment and Natural Resources= Division of Water Quality
WELL CONTRACTOR- CERTIFICATION # 3527
1. WELL
Well Contractor (IndividuaD Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO Box 1169 .
Dacula GA 300019
City or Town State Zip Code
7f 70 )- 868-5407
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(Ifapplicable)
WELL CONSTRUCTION PERMIT#(ifapplicable) N/A
OTHERASSOCIATED PERMIT #(ifapplicable ) N/A
8: WELL USE (Check Applicable Box) Monitoring[3 Municipal/Publicp
industriaUCommeraaiB Agriculturall] Recovery0 injecttonB�
Irrigationp Other13 (fist use)
DATE DRILLED vY
TIME COMPLETED �'�Z�'G Y AMEK PMB
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC /D SETTING:
17 Slope 0 Valley ir Flat i7 Ridge 0 Other
(check appropriate box) lvtay be in degrees,
LATITUDE 35.15 836522 mimilim, seconds or
LONGITUDE -78.98 311331 in a decimal format
Latitade/longitude source: X GPS 0 Topographic map
(16cadon of well must be shown on a USGS topo map and
attached to this form ff not using GPS)
6. FACILITY- is tla tame of the business where the well Is located
FACILI7 ID #(if applicable) N/A
NAME OF FACILITY Fort Bragg
STREET ADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City -or Town State ZIp Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS, Same
i
City or Town. State Zip Code
f: 91 Q I _ 396=7432
Area code - Phone number
i
s. WELL DETAILS:
a. TOTAL DEPTH: 2A - 9
b. DOES WELL REPLACE EXISTING WELL? YESO NOW'
c. WATER LEVEL Below Top of Casing: 1.5.92 FT.
(Use:"+' 0Move Top of Casing)
d. TOP OF CASING IS
-3, VFT: Above Land. Surface`
"Top of casing terminated
'aVorbelow land surface may require
a vadanee in accordance with 15A.NCAC 20.0118.
e. YIELD (gpm):
METHOD OF TEST
f. DISINFECTION: Type
Amount
g. WATER ZONES (depth):
From To
From To
From To
From To
From To
From To
?.-CASING. Depth
I Diameter ThiclmessWelghI Material
From t 22 ,To Q Ft. 17 Si ✓C
From To Ft.
From To Ft.
U. GROUT: Depth I Material Method
From 14+ ( To_d Ft�I-AT C6,n64 IKgao Z./�
From; l fc. 4 To%, C I _FtUA-f '74ki►N+z E
From To Ft.
9. SCREEN: Depth Diameter Slot Size Material
From Z9•� To I9,q Ft .2S-in. -010 in. QYC
From • To Ft in. in.
From To Ft in, in.
10. SANDIGRAVEL PACK: i
Depth Size Material
Fro C 9 To 14-4 Ft. W .Z 544i
From To Ft
From To Ft.
11.DRILLING LOG
From To Formation Description
12. REMARKS:
1 DOH FYTHAT S WELL WAS NSTRUCTED I RDANCE WITH
15A LCONSr TION DS,ANDTHAT YOFTHS
RECORD PROM D O FL ER.
SIGNATU E OF CERTIFI D LLCONTRACTOR DATE
Y,4
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 clays. Attn: Information Mgt., Form GW 1b
1617 Mail Service Center— Raleigh, NC 276994617 Phone No. [phone] ext 568. Rev.12/07

NONRESIDENTIAL wELL cONSTRUMON RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (Individuaq Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO BOX 1169
Dacula GA 360019
City or Town State Zip Code
(770 , . 868-5407
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) —r-/4 &
WELL CONSTRUCTION PERMIT#(if applicable) N/A
OTHER' ASSOCIATED PERMIT #(ifapplicable) N/A
3. WELL USE (Check Applicable Box) Monitoring(] Municipal/PubliZ
Industrial/Commercial13 Agrieulturall3 Recoveryl3 Inject(or&*-
Irrigationl3 Otheri3 (list use)
DATE DRILLED p� 'UY -
TIME COMPLETED - l ' li'd Y AMe PMO
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301 .
(Street Name, Numbers, Community, Subdivision, Lot No., Potosi, Zip Code)
TOPOGRAPHIC / LAND SETTING:
11 Slope 13 Valley E flat D Ridge 0 Other,
(check appropriate box) . My be in degrees,
LATITUDE 35.15 847334 minutes, seconds or
LONGITUDE-78.98 320825 in a decimal format
Latitude/longitude source: K GPS 11 Topographic map
(location ofwellmustbe shown on a USGS topo map and
affached to this form if not using GPS)
6. FACILITY- Is the name of the business where the well Is located
FACILITY ID #f(If applicable) N/A
NAME OF FACILITY Fort Bragg
STREETADDRESS Building 3-1137 Butner Rd.
_Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
}
City or Town State Zip Code
91f 0 1,. 396-7432
Area code - Phone number
6. WELL DEraLS:
a. TOTAL DEPTH: C)
b. DOES WELL REPLACE EXISTING WELL? YESC NO8-.*'
c. WATER LEVEL Below Top of Casing: 21.32 FT,
(Use "V' if Above Top of Casing)
d. TOP OF CASING IS J o `i' FT. Above Land Surface -
*Top of casing terminated atfor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.'
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From Tc From To
From Tc From To
From To From To
7. CASING: , Depth
Diameter Thicknes"12ht Material
From •� To . d
FL_ i if _
From To
Ft
From To
FL
8. GROUT; Depth
Material
Method
From R"'I To 6
Ft.gjw
Fromm (g To ((0.7
Ft. tfl'r
From To
Ft.
a. SCREEN: Depth
Diameter Slot Size
Material
From .30,q To 2(•4
FL i�-in. Nfl d
in. A✓C
From To
Ft, in.
in.
From Tc
FL in.
in.
10. SAND/GRAVEL PACK:
Death
Sze Material
From 3c-,.9 To 19
FL .2 -54,4lh
From To
FL
From To
FL
11.DRILLING LOG
From To Formation Description
12. REMARKS:
I DO iIFY
THIS WELL
ACCORDANCE Wmi
1 2 ,
ELL CO
UCTI srCOPY
OFTHis
R
BEEN PR
I
"AND
O E
SIGNATURE CERTIFIED WELL CONTRACTOR DATE
-OF
Kam✓ .z4
tJ "
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
I
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center — Raleigh, NC 276994 617 Phone No. [phone] ext 568.
Form GW-1b
Rev.12107

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION 0. 3527
1. WELL CONTRACTOR:
i
Richard Marshall Burnett
Well Contractor,(Individuan Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO -Box 1169
Dacula GA' 300019
City or Town State . Zip Code
7( 70 t.868-5407
Area code- Phone number
2. WELL INFORMATION: �)
SITE WELL ID#(Napplicable)��'1'
WELL CONSTRUCTION PERMIT#(ifapplicable) N/A
OTHERASSOCIATEDPERMIT #(fapplicable) N/A
3. WELL USE (Check Applicable Box) Monitoring 1] Muniapal/Public❑
Industrial/Commercial❑ Agricultural[] Recoveryq Injection
Irrigatlorl0 Otheri7 (list use)
DATEDRILLED
TIME COMPLETED �G'oY AMB'PM❑
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community. Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAYD SETTING:
❑ Slope 0 Valley Flat ❑ Ridye 0 Other
(check•appropriate box) May be in deli,
LATITUDE 35.15 844759 minutes, seconds or
LONGITUDE'78.98 31761 ;nadecimalfoimat
Latitudoongitude source: id GPS 0 Topographic map
(locaffon ofwaffmustbe shown on a USGS topo map and
attached i6 this form if not us/ng GPS)
i
6. FACILITY is me name of the business where the well is located.
FACILITY ID #(if applicable) N/A
NAME OF FACILITY Fort Bragg
STREET ADDRESS Building 3-1137 Butner Rd.
_Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILINGADDRESS Same, -
City or Town State Zip Code
91t 0 .396-7432
Area code - Phone number
S. WELL DETAILS:
a. TOTAL DEPTH-
b. DOES WELL REPLACE EXISTING WELL? YES13 NOW*'
C. WATER LEVEL Below Top of Casing: 19.32 FT.,
(Use +" if Above Top of Casing)
d. TOP OF CASING IS .J. G FT. Above Land.Surface'
'Top of casing terminated atfor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpmr METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From _- To From To
From Tc From To
From To_`_ From To
7. CASING: Depth Diameter ThicknessMfelgM Material
From To 0
Ft.—, 2 s
Nee -
Ft
From To
Ft.
8. GROUT: Depth
Material
Method
From 1 -9 To D
Ft. /&A-f
7 Alf IWO
Fro 1. ,S To (3..3
Ft. EN't
Tit—Lelmyf
From Tc
Ft.
9. SCREEN: Depth
Diameter Slot size Material
From u- la' To I(„ G
Ft._! -)Sin. . 010 in. P✓�
From To�
Ft. in.
in.
From Tc
Ft in.
in.
10. SANDIGRAVEL PACK:
Depth
S e
Material
From ZG-( _To 14. S
Ft. -*-2
J'AIID
From To
Ft.
From To
Ft.
11.DRILLING LOG
From To Formation Description
12. REMARKS:
I DO CERTIFY TTHIS AS CCNSTR IN ACCORDANCE WITH
1 WELL ON ANDARDS,AN ACOPY OFTHIS
D BEEN P O I WELLOWN
t
SIGNATURE OF CERT FI D WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING TH E WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Informatlon Mgt, Form GW-1b
1617 Mail Service. Center— Raleigh, NC 276994617 Phone No. [phone] ext 568. Rev.12107

NONRESIDENTUL WELLL :CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources= Division of Water Quality
WELL CONTRACTOR CERTIFICATION 0 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (Individual) Name
Geo Lab, Inc.
Well Contractor Company Name .
STREETIADDRESS PO Box 1169
Dacula GA' 300019
City or Town State: Tip Code .
7��-868-5407
Area code- Phone number
2. WELL INFORMATION: q
SITE WELL ID#('dapplicable)
WELL CONSTRUCTION PERMIT#(Ifapplicable) N/A
OTHER ASSOCIATED PERMIT #(•IFapplicable) N/A
3. WELL USE (Check Applicable Box) Monitoring[] MunlcipaVftbli�]
Industri6VConmlercial13 AgriculturalI3 Recoveryp InjectioniY
IrtigationG Otherl3 gist use)
DATE 'DRILLED
TIME.COMPLETED 'C. AMEK PM(a
,4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumberiand.
Fort Bragg Fayetteville.., NC 28301.
(Street Name, Numbers. Community Subdivision, Lot No,;,Parcel,;Zip Code)
TOPOGRAPHIC /D8ETTING:
13:Slope p Valley IT Flat. D Ridge p Other
I (check appfopriate box) be in de
LATITUDE 35.15 842371 mimrtes, seco
LONGITUDE -78.98 314187 is°decimal format
Latitudehongitude source: i4 GPS 0. Topographic map
(/ocaffon of xreUmustbe shown on a USGS topo map and
attached to Mis form ffnot using GPS)
I
S. FACILITY- Is the name of dw business Mere the well Is located
r . FACILITY ID #(d applicable) N/A
NAME OF FACILITY Fort Bragg
STREETIADDRESS Building 3-1137 Butner Rd.
CONTACT PERSON Mr. Steven Harris
MAILING,ADDRESSSame
Cilyor Town: State Zip Code
t,910 ,t.396-7432
Area code - Phone number
6. WELL DETAILS:
a., TOTAL DEPTH: Z wv
b. DOES'WELLREPLACE: EMSTiNG WELL? YES13 NOR0
11,
c. WATER LEVEL Below Top of Casing: 17.74 FT,
(Use "+• if Above Top of Casing)
d. TOP OF CASING IS -3 • Z) FT. Above Land Surface*
'Top of casing terminated at/or below land surface may require
a variance in accordance wIth,15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
7. CASING: Depth Diameter ThicknesMWIght Material
From ZZ 6`ro D Ft. • 7s t'Y
From Tc ,Ft
From To Ft
8. GROUT: Depth Material Method
From 14'• S To�_ Ft, t!A-1 MCA Ll?
FronLj ToJA_-5 Ft 6a-( T2Cz
From To . Ft,
S. SCREEN: Depth Diameter Slot Size Material
From 32.To Ft.% —in. -010 In, Pee
From To Ft. in. - in.
From To Ft. in. in. -
10. SAND/GRAVEL.PACK:
Depth Stze Material
From gtTo /� g_ Ft_AX
From To Ft:
From To Ft
11.DRILLING LOG
From To Formation:Description:
12, REMARKSt
V
FYirtA #I�A
W CANs7RUCT I CCDRtMNCEwITH
L CON R ARDS,AND OFTHIS
PROV T LOWNER.
'SIGNATUREOF'CERTIFIEDWELL.CONTRACTOR 7 DATE
c� -4 hV0 Ley
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form
1617 Mail SeIrvice Center— Raleigh, NC 276994617 Phone No. [phone] ext 568. Rev.12►o71b
j

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (Individual) Name
Geo Lab, Inc.
Well Contractor Company Name
STREET ADDRESS PO Box 1169
Dacula GA 300019
City or Town State Zip Code
(770 )- 868-5407
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID#(ifapplicable) 7�N'Q
WELL CONSTRUCTION PERMrr#(dapplicable) N/A
OTHER ASSOCIATED PERMIT #(if applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring[3 Municipat/Public0
Industrial/Commercial13 Agriculturalll Recoveryp Injectiong"
irrigatiord OtherB (Iistuse)
DATE DRILLED 7-J-7. of
TIME COMPLETED -»' d )1 AMe pMO
4. WELL LOCATION:
CITY. Fayetteville COUNTY CUmbsdand
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
13 Slope 13 Valley 9"Flat [3 Ridge 13 Other
(check appropriate box)
Maybe in degrees,
LATITUDE 35.15 839962 minutes, seconds or
LONGITUDE -78.98 ' 310856 in a decimal format
Latitude/longitude source: H GPS 0 Topographic map
(location o/well must be shown on a USGS topo map and
attached to this form if not using GPS)
S. FACILITY is the name of the business where the well Is located.
FACILITY ID #Qf applicable) NIA
NAME OF FACILITY Fort Bragg
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City'or Town State Zip Code
CONTACT PERSON Mr. StevenHarris
MAILING?ADDRESS Same
City; or Town State Zip Code
91( 0 ):396-7432
Area code - Phone number
S. WELL DETAILS:
a. TOTAL DEPTH-
b. DOES WELL REPLACE EXISTING WELL? YES13 NOS---"
c. WATER LEVEL Below Top of Casing: 16.31 FT.
(Use '+' if Above Top of Casing)
d. TOP OF CASING IS 3. L FT. Above land Surface -
*Top of casing terminated atlor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From Tc
From To From To
7. CASING: Depth Diameter ThlcknessM/eight Material
From Ft
From To Ft
From To Ft
8. GROUT., Depth Material Method
From 12-9 To d Ft 6-7 C&110:1 rvcGF> ylj
From 13 Z To 12. 9 FL '=!-f i2N`nXe
From To Ft
9. SCREEN: Depth
Diameter Slot Size Material
From .2p'3 To
I I-3 Ft.
113 in. Of O in. W
From To
Ft
in. in.
From To
Ft
in. in.
10. SAND/GRAVEL PACK:
Depth
From a % 3 To
/.Z Ft
S' a Material
7.2
From To
Ft
From To
Ft.
11.DR1LLING LOG
From To
12. REMARKS,
Formation Description
I DD FY THA 1 IS WELL WA CONSTRUCTED IN CCORDANCE WITH
15A CA 2 , LCONST T10N AN DS,AND OPYOFTHIS
RBCORD PROM D TH W ovvNER.
SIGNA U&RO F CERTIFIED WELL CONTRACTOR DATE
1. d ho—b
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Aft:: Information Mgt, Form GW-1b
1617 Mail Service Center — Raleigh, NC 27699-1617 Phone No. [phone] extZ68. Rev.12/07

NONRESIDENTIAL WELL coNmucum RECORD
North Carolina Department of Environment and Natural Resources-, Division of Water Quality
WELL CONTRACTOR CERTIFICATION 0 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor pndividuan Name
Geo Lab, Inc.
Well Contractor Company Name
STREET ADDRESS PO BOX 1169
Dacuia GA 300019
City or Town State Zip Code
7( 70 , t.868-5407
Area code- Phone number
2. WELL INFORMATION: .1 y'�
SITE WELL ID #(if applicable) 1 V
WELL CONSTRUCTION PERMIT#(tf applicable) N/A
OTHER' ASSOCIATED PERMIT#(tf applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring[] Municipal/Public(]
Industrial/Commeroial[I Agricuttural0 Recoveryi3 In)ectiortl�
Irrigatiorll] OtherD past use)
DATE DRILLED Yow-oY
TIME COMPLETED AMEK PM[]
4. WELL LOCATION:
CITY Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community. Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC! LOAD SETTING:
D Slope 13 Valley Er Flat 0 Ridge D Other
(check appropriate box)
1vlay be is degrees,
LATITUDE 35.15 837497 minutes, seconds or
LONGITU
afitaDE-78.98 307542 in a decimal format
Lde/longitu de source: X GPS 13 Topographic map
(/ocaBon of well must be shown on a USGS fopo map and
attached to Brls firm if not using GPS)
S. FACILITY- Is the name of the business wherethe well Is located
FACILITY ID #(d applicable) N/A
NAME OF FACILITY Fort Braga
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City, or Town State Zip Code
t 910 i .396-7432
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: as /
b. DOES WELL REPLACE EXISTING WELL? YES[] Noe
c. WATER LEVEL Below Top of Casing: 15.19 FT,
(Use '+• if Above Top of Casing)
d. TOP OF CASING IS J+ FT. Above Land Surface*
`Top of casing terminated atlor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From►_ To
From Tc From To
From To From To
7. CASING: Depth Diameter ThicknesslWetght Material
From Rr- To 0
Ft. r l s
p►' c
From Tc
Ft
From To
Ft
8. GROUT: Depth
Material
Method
Fron�gE9 To
Ft.
C9T C
t Aeo �zj
From 12, Z To ` -,'f _
Ft.
+7
r�b•rws E
From To
Ft.
9. SCREEN: Depth
Diameter . Slot Size klaterial
From dfI To 15'
Ft
+7s in.
+ 010 in.
From To
Ft
in.
in.
From To
Ft.
in.
in.
10. SAND/GRAVEL PACK:
Depth
o
From �0,t To s Z Ft
S
2
Material
S44
From To
FL
From To
Ft
11.DRILLING LOG
From To Formation Description
12. REMARKS:
I DO FY THAT IS WELL WAS STF2UCTED IN DANCE WITH
1 ELLCONST ON ND ANDTHAT OF THIS
RECO HA PROVI TO EL WNER.
SIGN TIU�EOFCERQTIFIEDW LLCONTRACTOR DATE
/� �►'Int �5/IJ 4 cee
PRINTED NAME OF PERSON' CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 276994617 Phone No. [phone] ext 568.
Form GW-1 b
Rev.12107

NONRESIDENTIAL 'WELL CONSTRUCTION RECORD
North CarolinaDepartment of Enviromnent and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (Individual) Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO BOX 1169
Dacula GA 300019
City or Town State Zip Code
7f 70 , - 868-5407
Area rode- Phone number
2. WELL INFORMATION:
SITE WELL ID#(ifapplicablej TA
WELL CONSTRUCTION PERMIT#(Kapplicable) N/A
OTHER ASSOCIATED PERMIT #(if applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring j3 Municipal/Pub11ccl
Industrial/CommerciaJ13 Agricultural!] Recovery0 Injectionv,
Irrigation0 Othera (list use)
DATE DRILLEDD 'do'621
TIME COMPLETED y'JO- O y AMePM11
4. WELL LOCATION:
CITY. Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC I L6ND SETTING:
Cl Slope p Valley Er Flat 13 Ridge 0 Other
j (check appropriate box)
Ma
35.16 007538 Ybe;s
LATITUDE _ _ minutes, secondcoedss or
LONG(7UDE-78.98 130864 isadc`imalro'mat
Latitude/longitude source: lit GPS 0 Topographic map
(/ocadon of well must be shown on a USGS topo map and
attached to this form if not using GPS)
6. FACILITY- is the name of the business where the yell Is located.
FACILITY ID #(d applicable) N/A
NAME OF FACILITY Fort Braw
STREET ADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or; Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
Cityor Town State Zip Code
(910 '�-396-7432
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: tiO. S
b. DOES WELL REPLACE EXISTING WELL? YESO NOp-'
c. WATER LEVEL Below Top of Casing: 21.33 FT,
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS SJP A FT. Above Land Surface'
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .01118.
e. YIELD (gpm):. METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From Tc From To
From Tc - From To
7. CASING: Depth Diameter Thicknes;W*ight Material
From To b
Ft
From To
Ft.
From To
Ft.
8. GROUT: Depth
Material
Method
From `o 915-To D
Ft I C414E
7 &,WO yf-iJi;'
From a_ 1 Z To-S•S
Ft
T/t[+z E
From To
Ft.
9. SCREEN: Depth
Diameter Slot Size Material
!C
From ! To -�!.3
Ft . 2Ln.
-016 in.
From To
Ft In.
in.
From To
Ft in.
In.
10. SAND/GRAVEL PACK:
Deppth
S�'ge
72
Material
From 90,5 To 2%r%
FL
SAO
From To`
Ft
From To
Ft
%DRIWNG LOG
From TO
Formation Description
ika;TEu"; .111f4
I DOH FY THAT SWELL WAS ONSTRUCTED INAACORDANCENTH
1tiA LCONST C ONST N 0.S,ANOTHAT OFTHIS
RECO . PROVID D O WNER.
SIGNATUR OF CERTIFIED WELL CONTRACTOR DATE
KW dew ee
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: information Mgt., Form GW-1b
1617 Mail Service Center— Raleigh, NC 276994617 Phone No. [phone] ext 568. Rev.12/07

.NONRESIDENTIAL WELL colsimuCTl w REcoRD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
WeILContractor Qndividual) Name
Geo Lab, Inc.
Well Contractor Company Name
STREET ADDRESS PO Box 1169
Dacula GA 300019
City or Town State Zip Code
(770 U . 868-5407
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) cz
WELL CONSTRUCTION PERMIT#(itapplirabieI N/A
OTHERASSOCIATED PERMIT#(ifapplicable) N/A
3. WELL USE (Check Applicable Box) Monitoring[] Municipal/Publi
Industrial/Commerciall] Agriculturali] Recovery(] Injectionl
Inigationil Other(] Qist use)
DATE DRILLED p'-P70' LT Y
TIME COMPLETED AMe PM0-
4. WELL LOCATION:
CITY. Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name. Numbers, Community, Subdivision, Lot No., Parcel. Zp Code)
TOPOGRAPHIC J LA
jJD SETTING:
13 Slope (] Valley UrFlat D Ridge (] Other
(check appropriate box) . My be is degrees,
LATITUDE 35.16 003961 minutes, seconds or
LONGITUDE -78.98 128645 in a decimal format
Latitude/longitude source: X GPS 0 Topographic map
(location of well must be shown on a USGS topo map and
attached to this form If not using GPS)
5. FACILITY Is the name of the businesswhere the vall is located
FACILITY ID #Qf applicable) N/A
NAME OF FACILITY Fort Bragg.
STREET ADDRESS Building 3-11.37 BUtner.Rd.
Fort Bragg NC q 28301
City oiTown StateZip;Code
CONTACT PERSON Mr. Steven' Hams
MAILING!ADDRESS Same
City, orTown. State.' Zip Code
.91( 0 ').396-7432;
Area code - Phone number
S. WELL DETAILS:
a. TOTAL DEPTH-
b. DOES!WELLREPLACE EXISTING WELL? YES(] NOi3"
c. WATER LEVEL Below Top of Casing: 20.72 FT,
, (Use •+' if Above Top of Casing)
d. TOP OF CASING IS 11 FT. Above land Surface*
'Top of casing terminated atlor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD�(gpm): METHOD OF TEST.
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From - To
From To From To
From To From To
7. CASING: Depth Diameter Thicknessmleight Material
Fro_fio_� Ft' i 73 -
Frdm To Ft:
From To Ft.
8. GROUT: Depth Material
Arc
Method
From e�3rG To G Ft.xc"t C�ME.H ><CE� Tiii3.
Fron>_,a5'r`1 To a3. - Ft. C64-1
T/1Lv"Se
From To FL
9. SCREEN: Depth Diameter Slot Size Material
. qbi -FroY. To A-4-Ft .-X In. ..dfd
in. Arc
From To Ft in,
in.
From To ;Ft in.
in.
10. SANDJGRAVEL PACK:
Depth Pe :
Material
Fro 0-, .ToAt� Ft-.!t_-2
544.6
From To Ft —
Fro mTo Ft.
%DRILLING LOG
From To Formation
Description
12. REMARKS:.
IDOH FYYFIATTHISWELLWAS STRUCTE01 DANCEWITH
15A N L CON oN & AN os, aND THA opY OF THIS
RECORD PROVID T OWNER .
SIGNATU _E OF CERTI I D WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THEWELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form GW-1b
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev.12107

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTMCATJON # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (Individual) Name
Geo Lab, .Inc.
Well ContractorCompany Name
STREETADDRESS P(U'BOX 1169
Dacula GA 300019
Cityor Town State Zip Code
770 ,, - 868-5407
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(((applicable) 'Tj�S" 3
WELL CONSTRUCTION PERMIT#(fapplicable) N/A
OTHER ASSOCIATED PERMIT #(ifapplicable) N/A
3, WELL USE (Check Applicable Box) Monhoringl3 MunieipallPubl(
IndustriallCommerclal13 Agrieuitural0 Recoveryp Injecuo
Irrigatlori0 OtherO gist use)
DATE DRILLED /
TIMECOETE MPLD p'�' G1� AMS' PMD
4. WELL LOCATION:
CITY: Fayetteville COUNT( Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
0 Slope Q Valley WFlat 13 Ridge O Other
(check appropriate box) Mey be to degrees,
LATITUDE 35.16 000062 minutas, 8ecizods or
LONGITUDE -78.98 124916 inadecimal fotmat
Latitude/longitude source: X GP5 0 Topographic map
(location ofwell mustbe shown on a USGS topo map and
attached to thisfomr ifnot using GPS)
S. FACILITY- is the name of the business wham the wen Is locates
FACILITY ID #(tf applicable) N/A
NAME OF FACILITY Fort -Braga
sTREETADDRESS Building 3A 137.Butner Rd.
Fort Bragg NC 28301
City.or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City:orTown State ZIp Code
91�^�_ 396-7432
Area code -, Phone number
I
8. WELL DETAILS:
a. TOTAL DEPTH: �y S
b. DOES WELL REPLACE EXISTING WELL? YES13 NOS"
c. WATER LEVEL Below Top of Casing: 20.03 FT,
(Use •+" If Above Top of Casing)
d. TOP OF CASING IS .3r 7 FT. Above Land Surface'
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST_
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From_ . To
7...CASING: Depth Diameter ThlcknessN.01614 Material
From 30 -S To O Ft ..7s' r"✓C
From . Tc Ft
From To Ft.
8. GROUT: Depth Material Method
From Sli •7 To b R. I�iW4, a -6+-f A tco :r.r(j
From.;3, To 5172 Ft. Urr►Z 74C.."se
From To Ft.
9: SCREEN: Depth. Diameter Slot Size Material
From ND:f To 30.D Ff. ,73 tn.. r0�t3,:Inpy
C
From To Ft. in. in..
From To. Ft In. in.
10. •SAND/GRAVEL.PACK:
Depth _ S' Material
From tJO -S To 9 Ft. 72
From To Ft
From Tc Ft.
11.DRILLING LOG
From To Formation Description
12. REMARKS:
Submit the original to the Division of Water Quality within 30 days. Attn: information Mgt., Form GWAb
1617 Mail Service Center— Raleigh, NC 276994617 Phone No. [phone] ext 568. Rev.12107

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (Individual) Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO BOX 1169
Dacula GA 300019
City or Town State Zip Code
770 t.868-5407
Area code- Phone number
2. WELL INFORMATION: ` rA-S SITE WELL 1D #(if applicable)
WELL CONSTRUCTION PERMIT#(Iramucalble) N/A
OTHER!ASSOCIATED PERMIT #(if applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring 13 Munlcipal/Publi
Industrial/Commercial0 Agricultura10 Reeovery0 Injectionlr
Irrigationa Otherl3 Ulst use)
DATE DRILLED yd(J-dIl,
TIME COMPLETED IP--k' OY AM4�_/
PMI]
4. WELL LOCATION:
CITY:_ Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC] LAID SETTING;
13 Slope 0 Valley ErFlat 13 Ridge 13 Other,
(check appropriate boxfftinaudecimal
be in degrees,
LATITUDE 35.15 996719 tes, seconds or
LONGITUDE -78.98 121481 format
Latitude/longitude source: A GPS 0 Topographic map
(location of well must be shown on a USGS topo map and
attached to this farm ifnot using GPS)
5. FACILITY Isthe mneofthe business wherethe we0lslocated.
FACILITY ID #(If applicable) N/A
NAME OF FACILITY Fort Braqq
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bi*agg NC 28301
City of Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
t 910 . 396-7432
Area code - Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: r a
b. DOES WELL REPLACE EXISTING WELL? YESO NOW"
e. WATER LEVEL Below Top of Casing: 19.56 FT,
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS -2*aA- FT. Above Land Surface'
'Top of casing terminated atfor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): , METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From To
From Tc From -To
7. CASING: Depth Diameter ThiclmessNveight Material
From ?OJ& To 6
Ft —,IS- pvc
From To
Ft.
From To
Ft.
8. GROUT., Depth
Material Method
Froni�flffljl_To_O
Ft.A0-r C",� � Ad�i+rT.
From y(•c'/ ro + /
Ft. !%'+J4 -TiZ61AtE
From To—m—�
Ft
S. SCREEN: Depth
Diameter Slot Size Material
qtl,! 10,&
m �C
From To
Ft. in. 616 in.
From To .
Ft in. in.
From To
Ft. in. in.
10. SAND/GRAVEL PACK:
Death S' a Material
From iOr4a To Lam_ Ft. 544
From To
Ft.
From To
Ft
11.DRILLING LOG
From To
Formation Description
12. REMARKS:
IDO "IONISWELLw ONSTRUCTED N DANCEWTH
1 CA C,TAN DS,AND FYOFTHIS
RECO T W OWNER.
C
SIGNATU E OF CER FLED, WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTINGTHE WELL
Submit the original to the Division of Water Quality within 30 days. Attn:.information Mgt, Form GWAb
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev.12/07

NONRESIDENTML WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR cERTEncATION # 3527
1. WEL(CONTRACTOR:
Richard Marshall Burnett
Well Contractor (Individual) Name
i
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO Box 1169
Dacula GA 300019
City or Town State Zip Code
770 1 -). 868-5407
Area code- Phone number
'2. WELL INFORMATION: .1.-
SITE WELL ID #(If applicable) ___ f,? S-
WELL CONSTRUCTION PERMIT#(fapplirabie) N/A
OTHER ASSOCIATED PERMIT #(if applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring[] Munlcipal/Publi
Industrial/Commerclat13 Agricultural[] Recovery[] Injectio
InigatioiV OtherO (list use)
DATE DRILLED a0-0 y TiME COMPLETED k d0 -OX AMGr/ PM11
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC? LAND SETTING:
[] Slope 0 Valley Erfiat 13 Ridge 0 Other
(check appropriate box) .
May be in degrees,
LATITUDE 35.15 994606 minutes, seconds or
LONGITUDE -78.98 117351 in a decimal format
Latitade/longitude source: K GPS 17 Topographic map
(location of wellmustbe shown on a USGS topo map and
atlached to this fonn if not using GPS)
i
6. FACILITY. Is the name of the business where the v eO is located.
FACILITY ID #(if applicable) N/A
NAME OF FACILITY Fort Braga
STREETADDRESS Building 3-1137 Butner Rd.
Fort -Bragg NC 28301
City of Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILINGIADDRESS Same
City,or Town State Zip Code
91( 0 ' 1.396-7432
Area code - Phone number
I
S. WELL DETAILS: 'I
a. TOTA I DEPTH: /
b. DOES�WELL REPLACE EXISTING WELL? YESO NOB'
c. ' WATER LEVEL Below Top of Casing: 19.85 FT,
(Use "-V if Above Top of Casing)
d. TOP OF CASING IS +2 1 FT. Above.Land Surface'
'Top of casing terminated atfor below land surface may require
a variance In accordance with 15A NCAC 2C .0118. .
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
7. CASING: Depth Diameter, ThicknessWelght Material
From .P.7 To 0
Ft 1-A— Ave
From To
Ft —
From To
Ft
8. GROUT: Depth
Material Method
From STo
Ft. ? CEn�CI' �eafi��j ?JS,
From &kA ToA r
Ft��_-110PAzf
From To
Ft
9. SCREEN: Depth
Diameter Slot Size Material
From 90,7 To,�P,-7
Ft.+7V in. tolb in. Aj-e
From To
Ft In. in.
From To
Ft. in. in.
10. SAND/GRAVEL PACK:
booth jize Material
From v' �To•� Ft�
From To
Ft.
From To
Ft.
11.DRILLING LOG
From To
Formation Description
12. REMARKS:
I DO C THAT IS WELL WA CONSTRUCTED I DANCE WITH
15A W CON 710N DS.AND OPYOFTHIS
R RD BE PROM T W L C V74M
SIGNAZTIE OF CER IFIED WELL CONTRACTOR DATE
.� �� cam/
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., FormGW-1b
1617 Mail Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev.12107
I

.L r ONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
i
Richard Marshall Bumett
Well Contractor (Individual) Name
Geo 'Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO BOX 1169
i
Dacula GA 300019
City or Town State Zip Code
7( 70 i _ 868-5407
Area code- Phone number
2. WELL INFORMATION: T�1 /
SITE WELL ID #('dapplloable) r4 �- (O
WELL CONSTRUCTION PERMIT#(ff applicable) N/A
OTHER ASSOCIATED PERMIT#(if applicable) N/A
& WELL USE (Check Applicable Box) MonitoringJ3 Municipal/Publicl3
industriallCormnerciaU Agdoulturalp Recoveryp Injection
Irrigatioro Other13 gistt use)
DATE DRILLED 4 '.10`0:
TIME COMPLETED AMI' PM13
4. WELL LOCATK)N:
CITY: Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, SubdlvWon, Lot No., Parcel, Zlp Code)
TOPOGRAPHIC / LAJJD SETTING-
0 Slope 0 Valley Fiat 11 Ridge p Other
(check appropriate box) bby be is degrees,
LATITUDE 35.15 99278 minutes, seconds or
LONGITUDE -78.98 113435 in a decimalformst
Latitude/longitude source: A GPS 13 Topographic map
(locatfon ofwe#mustbe shown on a USGS topo map and "
aHached -to this form ifnot using GPS)
S. FACILITY- Is the reme of the buslneae wherethe neA Is located.
FACILITY ID #(d applicable) N/A
NAME OF FACILITY Fort Bragg
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City of Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
i
City or Town State Zip Code
(910 - 396-7432
Area code - Phone number
i
S. WELL DETAILS: _
a. TOTAL DEPTH. q6, S
b. DOES WELL REPLACE EXISTING WELL? YE613 NOBS
c. WATER LEVEL Below Top of Casing: 19.19 Fr.
(Use "+" If Above Top of Casing)
d. TOP OF CASING IS FT. Above Land Surface"
'Top of casing terminated it/or below land surface may require
a variance in accordance with 15A NCAC 26.0118.
e. YIELD (gpm): "METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From To
From Tc From To
7. CASING: Depth Diameter ThiclmessNVeight Material
From 3a.s To f) let ,7S
From To . Ft
From To Ft.
8. GROUT. Depth Material Method
Fromm 2 To O FIL /Jf4-f 46'11-J T Fg fe,0 Zu3
Fron(a%8 - To- -S Ft 66+-1T&-%^J:6
From To Ft
9. SCREEN: Depth Diameter Slot Size Material
From y0-y To .?O.S Ft. %min. .GIO in. P✓C
From To Ft in, in.
From To Ft in. in.
10. SAND/GRAVEL PACK:
Depp�th S!w�j Material
From '7�. To ✓% Ft. �.Z rSAW4
From To Ft
From To Ft.
11.DRILLING LOG
From To Formation Description
12. REMARKS:
I DO "PROVI
L W CONSTRUC ACCORDANCE WITH
16ATA ARDS, AND T COFrY Or THIS
RW L OWNER
4.
SIGNA UR%� OF CER�jIFIED WELL CONTRACTOR DATE
lC�v "j YES /I�r I
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: information Mgt., Form GW-1b
1617 Mail Service Center- Raleigh, NC 276994617 Phone No. [phone] ext 568. Rev.12/07
I

NONRESIDENTIAL wELL CONSTRUCTIONRECORD
North Carolina Department of Environment and Natural ResoutCes-Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1'. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor'(IndividuaQ Name
Geo Lab, :Inc.
WellContrador Company Name
STREETADDRESS'PO BOX 1169
Dacuia GA 300019
City or Town State Zip Code
7t 70 ti.868-5407
Area code- Phone number
2. WELL INFORMATION: -
SITE WELL ID #(if applicable)_ 64 5 '
WELL CONSTRUCTION PERMIT#(ifapplicable) WA .
OTHER ASSOCIATED PERMIT#(if applicable) N/A
3. WELL USE (Check.Applicable Box) Monitoring[] Municipal/Publyil]
IndustriallCommercial13 Agricultural[] Recovory[] InjectlonQ
Irrigationp Otherl3 Qist use)
DATE DRILLED r "%- D Y
TIME COMPLETED P,70 : Ar AM8"PM0
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC f LAND SETTING:
13 Slope I] Valley WFlat 13 Ridge 0 Other
(check appropriate box) Nby be in degrees,
LATITUDE 35.16 010272 minutes, seconds or
LONGITUDE -78.98 128825 iaadecimalformat
Latitude/longitude source: A GPS 13 Topographic map
(location, ofweAmustbe shown on a USGS topo map and
attached to this farm if not using GPS)
5. FACILITY is the name of the business where the well is located,
FACILITY ID #(d applicable) N/A
NAME OF FACILITY'FOrt Bragg
STREET -ADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Ztp Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
91f 0 t.,396-7432..
Area code - Phone number
S. WELL DETAILS:
a: TOTAL DEPTH: Ila J /
b. DOES WELL REPLACE EXISTING WELL? YESO NOS
c. WATER LEVEL Below Top. of, Casing- 21.10 FT.
(Use '+' if Above Top of. Casing):
d: TOP OF CASING IS SPA- FT. Above Land Surface*
`Top of casing terminated atfor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
I. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
7. CASING: Depth Diameter ThiclmessWeight Material
Fro30,. To d Ft, r 7s P✓e-
From To Ft.
From To Ft.
8. GROUT: Depth Material
From vZS•L To O�1f Ft.Cb—'f
_ L•t
—7
FromA-7,j To ,k Ft 06--1
From To Ft
Method
rir3.
S. SCREEN: Depth Diameter Slot Size Material
From YO, W To -30 k Ft�in. 016 in. PSG
From Tc _.. Ft in. in.
Frorq To Ft._in. In.
10. SANDIGRAVEL PACK:
Denth material
Fro 0s�_To_f Ft-2
go
From To Ft
From • To Ft
11.DRILLING LOG
From To Formation Description
12. REMARKS:
I DO HER TIfYTHA HIS WELL WA STRUCTED A DANCE WITH
16A CON R ON AN DS,ANDTHAT OFTHIS
RECO PROVI E T W OWNER. -
1
SIGNATUREOF-CERTIFIED WELL CONTRACTOR DATE
PRINTED NAME.OF PERSON CONSTRUCTING'THE;WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form GW-1b
1617 Mail Service Center- Raleigh, NC 276994617 Phone No. [phone] ext 568. Rev.12107

NoN RESMENT M WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR: d. TOP OF CASING IS FT. Above Land Surface -
Richard Marshall Burnett `Top of casing terminated atfor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
Well Contractor (indMduan Name
e. YIELD (gpm): METHOD OF TEST
Geo Lab, Inc.
Well Contractor Company Name f. DISINFECTION: Type Amount
STREET ADDRESS PO Box 1169 g. WATER ZONES (depth):
Dacula GA 300019
City or Town State Zip Code
7( 70 .868-5407
Area code- Phone number
2: WELL INFORMATION: ^/�
SITE WELL ID #(If applicable) —TA S `Opr
WELL CONSTRUCTION PERMIT#(ifapplicable) WA
OTHER ASSOCIATED PERMIT #(if applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring 13 Municlpal/Public[j
Industrial/Commerclal[] AgriculturalD RecovoryD inleetionl9"
irrigatioril OtherD (list usa)
DATE DRILLED
TIME COMPLETED AMO-'PM[i
4. WELL LOCATION:
CiTY. Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, umbels, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LVD SETTING:
13 Slope p Valley ErFlat 13 Ridge D Other,
(check appropriate box)
35.16 006847 Z&ytx demo
LATITUDE mimites, seeoads or
LONGITUDE -78.98 126752 is a decimatfonnat
Latitude/longitude source: It GPS 13 Topographic map
(locaffon of well mustbe shown on a USGS topo map and
attached to this fomi if not using GPS)
6.FACILITY-is the name orthebusinewwhere the wall islocated '
FACILITY ID #(If applicable) N/A
NAME OF FACILayfort!Bragq
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr Steven Harris
MAILINGADDRESS -Same:
City orTown State Zip Code
f'910-3%-7432
Area code - Phone number
6. WELL DETAILS: u
a. 'TOTAL DEPTH: LID, + Z-
b.. DOES WELL,RgPLACE E.YISTIN,G WELL? YESD. NOS/
c. WATER LEVEL Below Top of Casing: 21.015 FT.
(Use "+" If Above Top of Casing)
From To From To
From To From To
From To From To
7. CASING: Depth Diameter ThicimessMkight Material
From Di To Q Ft. 1%- p► e
From To Ft
From Tc Ft
8. GROUT: Depth Material
Method
From ' To D Ft d r"
- 9 A-Z& xd7
FrorcL'� To 2 Ft E.J'f
ia6+-,t4
From To Ft
9. SCREEN: Depth Diameter Slot Size Material
From° Z r To_JDo Z Ft 75In.
i 10 tO in. ✓ C
From To ` Ft. in.
in.
From To Ft. in.
in.
10. SAND/GRAVEL PACK:
Depth a
Material
From aTOZ+7 Ft
From To Ft
From To Ft.
11.DfULLING LOG
From To. Formation Description
I DO FYTHAT IS WELT. WAS STRUCiED RDANCE WITH
15A CON ON AN ANDTHA OF THIS
RECORD B PROVID D TH ER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR " DATE
PRINTEDNAME OF PERSON -CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attic: Information Mgt., Form GW-1b
1617 Mall Service Center -- Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev.12107

NONRESIDENTIAL WELL CONSTRUCTION RECORD:
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor pndividuaQ Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO BOX 1169
Dacula GA 300019
City or Town State . Zip Code
7( 70-868-5407
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID#(ifapplicable)
WELL CONSTRUCTION PERMIT#(ifapplicable) N/A
OTHER ASSOCIATED PERMIT #(if applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring❑ Municipal/PubilcO
Industrial/Commerciall3 AgdculturaiQ Recoveryp Injection
Irrigation(] Otherp (Ilst use)
DATE DRILLED p-ai-d Y
TIME COMPLETED f"cN a Y AMC/ PM13
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / UjND SETTING:
0 Slope 0 Valley Er Flat 13 Ridge p Other
. (check appropriate box) hby be is degrees.
LATITUDE 35.16 003505 minutes, seconds or
LONGITUDE-78.98 124697 in a decimal format
LatitudeQongitude source: 1( GPS 13 Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
6, FACILITY- is the name orthe businesswhere the wen Is located
FACILITY ID #of applicable) N/A
NAME OF FACILITY Fort Bragg
$TREETADDRESS Building 3-1137 Butner Rd.
:Fort Bragg NG ,28301
City. or Town State Zip Code
CONTACT PERSON Mr. Steven. Harris
MAILING ADDRESS Same
Cityor:Town State Zip Code
91( 0 396-7432
'Area code' Phone number
6. WELL DETAILS:
a: TOTAL DEPTH.,. /
b. DOES WELL REPLACE E(Y XISTING WELL? YESO NO
a. WATER LEVEL Below Top of,Casing: 21.31. FT,
(Use '*" if Above Top of.Casirig)
d. TOP OF CASING IS Ja I FT. Above Land Surface*
'Top of casing terminated atfor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From ToL From To
From To From To
From To From To
7. CASING: Depth Diameter Thickness/Weight Material
From'e0-1- To d Ft ,i$ PYC
From To Ft:
From To Ft.
8. GROUT: Depth Material
FtortyX�'7 To 0 Ft14-4'l �"rd+'t
FrortZ.gi�.—T422-�7_ Ft._ -f _
From. Tc Ft:
Method
Fvica ZdS.
"7716-iNa E
8. SCREEN: Depth Diameter $lotSize Material
Fro. d. _TojJL,i _Ft. ►dJO in. rC
From To Ft. in. in.
From To Ft. In. in.
10. SAND%GRAVEL. PACK:
DOnth. S Material
From D4 To 2-3 :Ft.SSVb
From To Ft.
From - To Ft.
11.DRILLING LOG
From To Formation Description
12. REMARKS:
I DO HER "MID
WELL WAS C STRUCTED IN CORDANCEVM
15A N ON STA D , AND THA OF THIS
RECOR nW L ER
t
SIGNAT R OF CERTtF1,P WELL CONTRACTOR DATE
PRINTEDNAME. OF PERSON CONSTRUCTINGTHE:WELL
Submit the original to the Division of Water Quality within 30 days. Attn:_Information Mgt., Farm GWAb
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev.12/07

NONRESIDENTIAL wELL coNsTRvcnON RECORD
North Carolina Department of Environment and Natural Resources -.Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (IndividuaQ Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO BOX 1169 .
Dacula GA 300019
City cr Town State Zip Code
7( 70 - 868-5407
Area code- Phone number
2. WELL INFORMATION: r ^
SITE WELL ID #(if applicable)_
WELL CONSTRUCTION PERMIT#(dappiicabie) N/A
OTHER ASSOCIATED PERMIT #(ifapplicable) N/A
3. WELL USE (Check Applicable Box) Monitoring[] MunicipaUPublic]3
Industrial/Comnierola113 AgriculturalD RecoveryD In)ectionEr
IrrigationD OtherD (list use)
DATE DRILLED r-al-"
TIME COMPLETED 1?-a' -O % AMV PM13
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
D Slope D Valley eFlat D Ridge D Other
(check appropriate box) b4ey be in degrees,
LATITUDE 35.15 .999847 minutes, seconds or
LONGITUDE -78.98 12121 in a decimal format
Latitude/longitade source: N GPS CI Topographic map
(locetion of well must be shown on a USGS topo map and
attached to this form if not using GPS)
5. FACILITY- b the name of the buslnesswhere the well Is located
FACILITY ID #(if applicable) N/A
NAME OF FACILITY FOrt:BraOQ
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same:
City or Town State Zip Code
91,L 0 .396-7432
Area code - Phone number
6. WELL DETAILS: '
a. TOTAL DEPTH: "TWA /
b. DOES WELL REPLACE EXISTING. WELL? YESD NOB'
o. WATER LEVEL Below Top of Casing:. 19,74 Fr.
(Use 'W if Above.Tgp of Casing)
d. TOP OF CASING IS Si i FT. Above Land Surface -
'Top of casing terminated atfor below land surface may require
a variance in accordance with 15A NCAC 2C .011a.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From Tc From To
From To From To
7. CASING: Depth Diameter ThicknessA feight Material
From �3 To.
Ft r %S
Pit'
From To
Ft.
From To
Ft.
8. GROUT: Depth
Material
Method
From g", To_
Q^ Ft -0-1
6ceA 1 yJ:
From ZS.9 To 23.b Ft �r'r_
—l1�'►v+sE
From To
Ft
9. SCREEN: Depth Diameter
Slot Size Material
From AGS To 30-3 Ft •7Sin.
•D/0 IrL [�iC
From To Ft in.
in.
From To. Ft in.
In.
10. SANDIGRAVEL PACK:
Depth S
Material
From+3_To �S: Ft. a
�ANii
From To Ft -
Frorh To Ft.
11MP LLING LOG_
From To Formation Description
12..REMARKS: v
1 DO"Fy THAT 13 WELLWA STRUCT I Cr:ORDANCEWITH
15ACONSr TION AN OS, AND OFTH13
RECPROVID TH W OWNER.
SIGNA UR OF CERTIFIED ELL CONTRACTOR DATE
./e,,L;1�a'Y
PRINTED NAME:OF PERSON CONSTRUCTING. THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form GW-1b
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev.12/07

NON.RENIDENTML WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Nahual Resources -Division of Water Quality
WELL CONTRACTOR CERTMCATION # 3527
i WELL. CONTRACTOR:
Richard Marshall Burnett,
Well Contractor (Individual Name
Geo Lab, Inc.
l
Well Contractor Company Naive
STREETADDRESS :PO BOX 1169,
Dacula GA 300019
City or Town State Zip Code
r 770 ,-8SM407
Area code- Phone number
2. WELL INFORMATION: SITE WELL ID#Of applicable) �_
43-- 11
WELL CONSTRUCTION PERMIT#(If applicable) N/A
OTHER ASSOCIATED PERMIT #(If applicable), NIA
3. WELL USE (Check Applicable Box) Monitoringl] Municipal/Publi
Industrial/Commerciali] Agricultuml0 Recoveryp Injection
Irrigationp Otherl] (list use)
DATE DRILLED �'�1 • aY
TIME COMPLETED AMGK PMO
4. WELL LOCATION:
CITY Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPH IC / L 6N D SETTI NG:
17 Slope 13 Valley Flat El Ridge 0 Other
(check appropriate box) hry be in degrees,
LATITUDE 35.15 997842 minutes, seconds or
LONGITUDE -78.98 117272 in a decimalfotmat
Latitude/longitude source: 11 GPS D Topographic map
(location ofwell must be shown on a USGS iopo map and
adached to this form if not using GPS)
5, FACILITY -Is the name of the buskress"are the vngislocated.
FACILITY ID #0 applicable) N/A
NAME OF FACILITY Fort: Bragg
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301 T
City or Town _ State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
Cky'orTowm - State Zip Code
91( 0 t- 396-:7432'
Area code - Phone number
6. WELL DETAILS: e!
a. TOTAL DEPTH; Td • 3
b. DOES WELL REPLACE EXISTING WELL? YESI3 NOi 1
c. WATER LEVEL Below Top of Casing: 19.10 FT,
(Use'+^ if Above Top of Casing)
d. TOP OF CASING 1S S. G FT. Above Land Surface`
'Top of casing terminated atfor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): " METHOD OF TEST
J. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From Tc
From To
From Tc
From To
From Tc
From To
7. CASING: Depth Diameter ThicknessNVeight Material
From -30" 3 To: (5 Ft
P✓
From To Ft
From To Ft
-
8. GROUT: Depth
Material Method
From To &_ Ft.,4&-1
&AE-11 1 4C M yJ;
Fromm .1LTo 23oS Ft. 6641'"-IMA-rZE
From To Ft.
9. SCREEN: Depth Diameter Slot Size Material
From %.3'To- �0.3 Ft.
•%Sin.,,400 in. P✓C.
From To Ft.
in. in.
From To Ft.
in. in.
10. SAND/GRAVEL PACK:
De th
Z.-9
Size Material
42
FrorrL4d-1 To Ft,
JVAMA
From To Ft.
From To Ft.
11.DRILLING LOG
From To
Formation Description
12. REMARKS:
I DOH THAT WELL AS STRUCTED 1 DANCE WITH
15AN 2C L NSTR 1 Sr ANDTHAT YOFTHI6
RECO OVIDE T E EL WNE L
SIGN. U "E.OF CERTIFIED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTROCTING;THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form GW-1b
1617 Mail Service Center— Raleigh, NC 276994617 " Phone No. [phone] ext 568. Rev.12107

.NONRESIDENTIAL wELL coNsTT uenoNREcoRD.
`North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor QndividuaQ Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO Box 1169
Dacula GA s 3006..10
City oe Town State Zip Code
7( 70 y- 868-W7
Area code- Phone number
2. WELL INFORMATION: -7
SITE WELL ID#(ifapplicable) "? S" �e2
WELL CONSTRUCTION PERMIT#(if applicable) N/A
OTHER ASSOCIATED PERMIT #(ifapplicable) N/A
3. WELL USE (Check Applicable Box) Monitoring[] MunicipaUPublic
Ind6striaUConmercial0 Agricultural0 Recoveryp Injectlorff
InigationG Otherl3 Qist use)
DATE DRILLED
TIME COMPLETED ai�Y AMV PMd
4. WELL LOCATION:
CITY: Fayetteviile COUNTY CUmberland
Fort Bragg Fayefteville, NC 28301
(Street Name, Numbers, Community, Subdivislon, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAID SETTING:
Slope 0 Valley IrFlat 0 Ridge 0 Other
(check appropriate bmo 2%&y be in degmes,
LATITUDE 35.15 995707 minutes, seconds or'
LONGITUDE -78.98 113494 in a decimal format
Latitude/longitude source: It GPS 0 Topographic map
(location of well musfbe shown on a USGS tope map and
attached to this form ifnot using GPS) . -
5, FACILITY- Is the name or the businesswherethe well Is located.
FACILITY ID #(if applicable) N/A
NAME OF FACILITY Fort Bragg
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris'
MAILING .ADDRESS Same
City.orTown :State Zip Code:
(910 .396=7432
Area code - Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: �0 s 4
b. DOES WELL REPLACE EXISTING WELL? YESO NOR/
c. WATER LEVEL Below Top of Casing: 21.04 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASINO IS .f + S FT. Above Land Surface'
'Top of•casing terminated atlor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm):
METHOD OF TEST
f. DISINFECTION: Type
Amount
g. WATERZONES (depth):
From To
From To
From Tc
From To
From . Tc
From To
7. CASING: Depth
Diameter ThicknessN*ight Material
From -J? A To 0
FL , 7 S • C
From To
FL
From To
Ft.
B. GROUT: Depth
Material Method
Fro�---�-To 6
FL T C%hf-i-f .v2t V:;
From 7.i.`+' To 4
Ft. 6&1 T/1�i'w+zE
From To
FL
9. SCREEN: Depth
Diameter Slot Size Material
From tb-Aj �.4
Ft..-75' in. r4116 in. PI(e-
From To
Ft in. in.
From To
Ft. in. in.
10. SANDIGRAVEL PACK:
Depth
a Material
SA11,6
From To
. Ft.
From To
Ft:
11.DRILLING LOG
From r To
Formation Description
12. REMARKS:
I IN
OA."L",
IS WA NSTRUCT � DANCEWITH
1 O R ION AN DS,AND OF THIS
RECPROP W OWNER
a
SiGNATU/RR F CERTIFIED ELL.CONTRACTOR DATE
Is
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days.. Attn; Inforrhafion,Mgt., Form GW-1b
1617 Mall Service Center- Raleigh; NC 276994617 Phone No.:(910) 733: 7015 ext;568: Rev.12107