WI0501064_Notification of Intent (NOI) – GW Remediation_20230223

0 Mid Atlantic
LLO
February 23, 2023
Mr. Michael Rogers
Hydrogeologist
North Carolina Department of Environmental Quality
Underground Injection Control Program
1636 Mail Service Center
Raleigh, NC 27699-1636
409 Rogers View Court
Raleigh, NC 27610
office 919.250.9918
facsimile 919.250.9950
MAAONLINE.COM
Subject: NOTIFICATION OF INTENT TO CONSTRUCT OR OPERATE INJECTION
WELLS
WILLOW SPRINGS ELEMENTARY SCHOOL
WILLOW SPRINGS, NORTH CAROLINA
UST INCIDENT NO. 39689
MID -ATLANTIC JOB NO. R2647.11
Dear Mr. Rogers:
On behalf of the Wake County Public School System, Mid -Atlantic Associates, Inc. is
pleased to submit the attached Notification of Intent to Construct or Operate Injection
Wells for the Willow Springs Elementary School. Please note that injections were
previously approved for this site under permit numbers W10501034 and W10501064. If you
have any questions or need additional information, please feel free to contact me at (919)
250-9918.
Sincerely,
MID -ATLANTIC ASSOCIATES, INC.
0 " S S 4 - L
Raymond S. Marchant, III, P.G.
Principal Geologist
Enclosures: Notice of Intent to Construct or Operate Injection Wells
Attachment A — Injection Zone Maps (Section H)
Attachment B — Safety Data Sheet (Section J)
Attachment C — Well Construction Information (Section K)
R2647.11 /RSM/bro
EXPERIENCED CUSTOMER FOCUSED INNOVATIVE

NOTICE OF INTENT TO CONSTRUCT OR
OPERATE INJECTION WELLS
Mid Atlantic

North Carolina Department of Environmental Quality — Division of Water Resources
NOTIFICATION OF INTENT (NOI) TO CONSTRUCT OR OPERATE INJECTION WELLS
The following are "permitted by rule" and do not require an individual permit when constructed in accordance
with the rules of 15A NCAC 02C .0200. This form shall be submitted at least 2 WEEKS prior to injection.
AQUIFER TEST WELLS (15A NCAC 02C .0220)
These wells are used to inject uncontaminated fluid into an aquifer to determine aquifer hydraulic characteristics.
IN SITU REMEDIATION (15A NCAC 02C .0225) or TRACER WELLS (15A NCAC 02C .0229):
1) Passive Injection Systems - In -well delivery systems to diffuse injectants into the subsurface. Examples include
ORC socks, iSOC systems, and other gas infusion methods.
2) Small -Scale Injection Operations — Injection wells located within a land surface area not to exceed 10,000
square feet for the purpose of soil or groundwater remediation or tracer tests. An individual permit shall be required
for test or treatment areas exceeding 10,000 square feet.
3) Pilot Tests - Preliminary studies conducted for the purpose of evaluating the technical feasibility of a
remediation strategy in order to develop a full scale remediation plan for future implementation, and where the
surface area of the injection zone wells are located within an area that does not exceed five percent of the land
surface above the known extent of groundwater contamination. An individual permit shall be required to conduct
more than one pilot test on any separate groundwater contaminant plume.
4) Air Injection Wells - Used to inject ambient air to enhance in -situ treatment of soil or groundwater.
Print Clearly or Type Information. Illegible Submittals Will Be Returned As Incomplete.
DATE: February 23, 2023 PERMIT NO.
(to be filled in by DWR)
A. WELL TYPE TO BE CONSTRUCTED OR OPERATED
(1) Air Injection Well......................................Complete sections B through F, K, N
(2) Aquifer Test Well.......................................Complete sections B through F, K, N
(3) Passive Injection System...............................Complete sections B through F, H-N
(4) X Small -Scale Injection Operation ......................Complete sections B through N
(5) Pilot Test.................................................Complete sections B through N
(6) Tracer Injection Well...................................Complete sections B through N
B. STATUS OF WELL OWNER: Business/Organization
C. WELL OWNER(S) — State name of Business/Agency, and Name and Title of person delegated authority to
sign on behalf of the business or agency:
Company Name Wake County Public School System
Delegated Signatory Authority: Mr. Todd Kneller
Mailing Address: 1551 Rock Quarry Road, Bldg B
City: Raleigh State: NC Zip Code: 27610 County: Wake
Day Tele No.: 919-588-3633 Cell No.: 919-669-9635
EMAIL Address: [e-mail] Fax No.: 919-508-0831
Deemed Permitted GW Remediation NOI Rev. 3-1-2016 Page 1

C
E.
F.
G.
PROPERTY OWNER(S) (if different than well owner)
Company Name
Same as Well Owner
Mailing Address:
City:
State: Zip Code:
County:
Day Tele No.:
Cell No.:
EMAIL Address:
Fax No.:
PROJECT CONTACT (Typically Environmental Engineering Firm)
Name and Title:
Raymond S. "Trey" Marchant, III, Principal Geologist
Company Name
Mid -Atlantic Associates, Inc.
Mailing Address:
409 Rogers View Court
City: Raleigh
State: NC Zip Code: 27610
County: Wake
Day Tele No.: (919)
250-9918 Cell No.:
[phone]
EMAIL Address:
[e-mail] Fax No.:
[phone]
PHYSICAL LOCATION OF WELL SITE
(1) Facility Name & Address: Willow Springs Elementary School
6800 Dwijzht Rowland Road
City: Willow Springs County: Wake Zip Code: 27592
(2) Geographic Coordinates: Latitude": 35 ° 35 ' 37 "or. 35.593508 "N
Longitude": -78 ° 43 ' 41 "or -78.7280240 W
Method of Collection: GooLyle Earth Pro Software
"FOR AIR INJECTION AND AQUIFER TEST WELLS ONLY: A FACILITY SITE MAP WITH PROPERTY
BOUNDARIES MAY BE SUBMITTED IN LIEU OF GEOGRAPHIC COORDINATES.
TREATMENT AREA
Note: There has been a release of heating oil from a UST at this site. The site is currently regulated by the
North Carolina Department of Environmental Quality (NCDEQ), Division of Waste Management (DWM),
Underground Storage Tank (UST) Section. Removal of free product is necessary to move the site towards
closure and prevent potential spreading of the plume (water supply wells are located nearby). Heating oil free
product remains present on the water table at wells RW-I, RW-2, RW-3, and MW-3. As such, the "area of the
contaminant plume" indicated below refers to the approximate area of the heating oil free product plume. This
area is roughly equal to the area of an ellipse with dimensions 45ft by 25ft, or 900 square feet [A=7r(a)(b),
where (a) and (b) are half the length of the longest and shortest axes].
Land surface area of contaminant plume: 900 square feet
Land surface area of inj. well network: 900 square feet (< 10,000 ft2 for small-scale injections)
Percent of contaminant plume area to be treated: 100% (must be < 5% of plume for pilot test injections)
Deemed Permitted GW Remediation NOI Rev. 3-1-2016 Page 2

H. INJECTION ZONE MAPS — Attach the following to the notification. Provided in Attachment A. Please
note that DEQ has only required limited assessment at this site. Groundwater isoconcentration maps are not
available (other than the one provided) and soil assessment maps are not available. Contaminated soil likely
remains in the vicinity of the UST (which was closed in place due to the presence of underground utilities over
and around the tank). However, no soil contaminant maps currently exist.
(1) Contaminant plume map(s) with isoconcentration lines that show the horizontal extent of the
contaminant plume in soil and groundwater, existing and proposed monitoring wells, and existing and
proposed injection wells; and
(2) Cross-section(s) to the known or projected depth of contamination that show the horizontal and
vertical extent of the contaminant plume in soil and groundwater, changes in lithology, existing and
proposed monitoring wells, and existing and proposed injection wells.
(3) Potentiometric surface map(s) indicating the rate and direction of groundwater movement, plus
existing and proposed wells.
I. DESCRIPTION OF PROPOSED INJECTION ACTIVITIES — Provide a brief narrative regarding the
purpose, scope, and goals of the proposed injection activity. This should include the rate, volume, and
duration of injection over time.
Residual heating oil free product remains present on the water table at the site at wells MW-3, RW-1 and RW-
3 (approximate thicknesses of 0.03 ft, 0.05 ft and 0.04 ft, respectively). Free product has been present in well
RW-2 in the past (2019). We propose to inject surfactant prior to performing an Aggressive Fluid Vapor
Recovery (AFVR) event. Mid -Atlantic proposes to inject Biosolve Clear at the site to enhance free product
recovery during the AFVR. Injection will be performed at wells MW-3, RW-1, RW-2, and RW-3, and RW-4
(only if product is present). BioSolve is a common cleanup/mitigation agent that can be applied as both an
emulsifying agent for free product recovery and biosurfactant for dissolved -phase groundwater remediation. It
is estimated that up to 125 gallons of 4% solution of BioSolve will be gravity injected into the above -
referenced wells over an estimated period of up to 8 hours on -site. An 8-hour AFVR event will then be
conducted at the site approximately one week following completion of the surfactant injection event, with
post-AFVR free product gauging activities conducted approximately two to four weeks following completion
of the AFVR event.
J. APPROVED INJECTANTS — Provide a MSDS for each injectant. Attach additional sheets if necessary.
Provided in Attachment B
NOTE: Only injectants approved by the NC Division of Public Health, Department of Health and Human
Services can be injected. Approved injectants can be found online at hllp://deq.nc.aov/about/divisions/water-
resources/water-resources-hermits/wastewater-branch/ground-water-Drotection/ground-water-aDDroved-ini ectants.
All other substances must be reviewed by the DHHS prior to use. Contact the UIC Program for more info
(919-807-6496).
Injectant: BioSolve Clear solution
Volume of injectant:
Concentration at point of injection:
Percent if in a mixture with other injectants:
K. WELL CONSTRUCTION DATA GW-1s for existing wells MW-3, RW-1, RW-2, and RW-3 are
provided in Attachment C.
(1) Number of injection wells: 0 Proposed 4, maybe 5, Existing (provide GW-1s)
(2) For Proposed wells or Existing wells not having GW-1s, provide well construction details for each
injection well in a diagram or table format. A single diagram or line in a table can be used for
multiple wells with the same construction details. Well construction details shall include the
following (indicate if construction is proposed or as -built):
Deemed Permitted GW Remediation NOI Rev. 3-1-2016 Page 3

(a) Well type as permanent, Geoprobe/DPT, or subsurface distribution infiltration gallery
(b) Depth below land surface of casing, each grout type and depth, screen, and sand pack
(c) Well contractor name and certification number
L. SCHEDULES - Briefly describe the schedule for well construction and injection activities.
No wells will be constructed for this injection event. The injection event is currently scheduled for Friday.
April 14, 2023 The AFVR is scheduled to be conducted on Friday, April 21, 2023. It is anticipated that the
surfactant injection will take approximately 8 hours for completion. The AFVR is expected to run for
approximatelygpproximately 8 hours. Post-AFVR free roduct gauging will be conducted-amroximately two to four weeks
followinp, completion of the AFVR event.
M. MONITORING PLAN - Describe below or in separate attachment a monitoring plan to be used to determine
if violations of groundwater quality standards specified in Subchapter 02L result from the injection activity.
The site is currentl +�regulated by the NCDEQ DWM UST Section. Samplin of site monitoring wells (not
containing free product) will be performed once free product has been removed from the water table, with
results reported to the UST Section dassuminp- sampling is pre -approved by the UST Section). The injection
activi is not anticipated to result in violations of the NCG S for additional compounds other than those
already noted from the previous fuel oil release.
N. SIGNATURE OF APPLICANT AND PROPERTY OWNER
APPLICANT: "I hereby certify, under penalty of law, that I am familiar with the information submitted in
this document and all attachments thereto and that, based on my inquiry of those individuals immediately
responsible for obtaining said information, I believe that the information is true, accurate and complete. I am
aware that there are significant penalties, including the possibility of fines and imprisonment, for submitting
false information. I agree to construct, operate, maintain, repair, and if applicable, abandon the injection well
and all related appurtenances in accordance with the 15A NCAC 02C 0200 Rules. "
Signature of Applicant Print or Type Full Name and Title
PROPERTY OWNER if the propeAy is not owned by the permit licant :
"As owner of the property on which the injection well(s) are to be constructed and operated, I hereby consent
to allow the applicant to construct each injection well as outlined in this application and agree that it shall be
the responsibility of the applicant to ensure that the injection well(s) conform to the Well Construction
Standards (1 SA NCAC 02C .0200). "
"Owner" means any person who holds the fee or other property rights in the well being constructed. A
well is real property and its construction on land shall be deemed to vest ownership in the land owner, in
the absence of contrary agreement in writing.
Not applicable
Signature* of Property Owner (if different from applicant) Print or Type Full Name and Title
''An access agreement between the applicant and property owner may be submitted in lieu of a signature on this form.
Submit the completed notification package to:
DWR - UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone: [phone]
Deemed Permitted GW Remediation NOI Rev. 3-1-2016 Page 4

ATTACHMENT A
INJECTION ZONE MAPS
(SECTION H)
Mid Atlantic

REFERENCES:
1. ANGIER, NC DIGITAL RASTER GRAPHIC, USGS. SCANNED FROM
1:24,000-SCALE GREEN LEVEL, NC TOPOGRAPHIC MAP, PUBLISHED 2013, USGS.
2. INSET MAP DIGITAL DATA FROM 2002 NATIONAL TRANSPORTATION ATLAS,
BUREAU OF TRANSPORTATION STATISTICS, WASHINGTON, D.C.
3. PROPERTY BOUNDARY DATA FROM WAKE COUNTY GIS.
SCALE: 1:12,000
500 1,000
DRAWN
TOPOGRAPHIC SITE MABY:
P DRAFT
Mid Atlantic WILLOW SPRINGS ELEMENTARY SCHOOL CHECK:
Engineering & Environmental Solutions 6800 DWIGHT ROWLAND ROAD ENG.
WILLOW SPRINGS, NORTH CAROLINA CHECK:^
APPROVAL:
Feet
2,000
DATE:
APRIL 2016
JOB NO:
OOOR2647.0B
GIS NO:
04G-R2647.OB-1
DWG NO: 1

ti
rr
. 4­4
4.
-0
I
(92.8
vv_hK
3.08�
'('Vv N)'
MW-44
(92.93)
4-0
Legend
MONITORING WELL LOCATION
ESTIMATED GROUNDWATER ELEVATION CONTOUR
ESTIMATED GROUNDWATER FLOW DIRECTION
TRIBUTARY TO TERRIBLE CREEK
A&­
Y - "' w"'•.^ r'�:`%'�� 'j r' r1� SUBJECT PROPERTY BOUNDARY
NM=NOT MEASURED
ESTIMATED GROUNDWATER TABLE
t-: WILLELEVATION CONTOUR MAP (3-31-16)
OW SPRINGS ELEMENTARY SCHOOL
Mid Atlantic 6800 DWIGHT ROWLAND ROAD
759 Engineering & Environmental Solutions WILLOW SPRINGS, NORTH CAROLINA
REFERENCE: 2013 AERIAL IMAGERY FROM NC ONE MAPS. PROPERTY BOUNDARY, ROAD, WATER, SEWER, HYDROLOGY GIS FROM WAKE COUNTY GIS. MID -ATLANTIC FIELD NOTES.
Fee-
40 80 120 160
DRAWN BY: DATE: APRIL 2016
DRAFT CHECK JOB NO.: 00OR2647.OB
BY:
ENGINEER CHECK GIS NO.: 04G-R2647.OB-3
BY:
APPROVED
BY: 0�lln DRAWING NO.: 3

Legend
9 MONITORING WELL LOCATION
5,000-GALLON HEATING OIL UST
0.01' = FREE PRODUCT THICKNESS (FEET)
FREE PRODUCT CONTOUR F
ND = NOT DETECTED . A
0 20
1 inch equals 20 feet
Feet
40
FREE PRODUCT THICKNESS MAP
DRAWN BY: RDC
DATE: DECEMBER 2019
DRAFT CHECK
BY:
JOB NO.: 00OR2647.05
_
• a`
Mid Atlantic
POST-AFVR - NOVEMBER 11, 2019
WILLOW SPRINGS ELEMENTARY SCHOOL
Engineering & Environmental Solutions
6800 DWIGHT ROWLAND ROAD
ENGINEER CHECK
BY:
GIS NO.: 06G-R2647.05-4
APPROVED
DRAWING NO.: 3.1
WILLOW SPRINGS, NORTH CAROLINA
BY:
REFERENCE: 2013 AERIAL IMAGERY FROM NC ONE MAPS. PROPERTY BOUNDARY, ROAD, WATER, SEWER, HYDROLOGY GIS FROM WAKE COUNTY GIS. MID -ATLANTIC FIELD NOTES.

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

4f
qw
Legend
Q Recovery Well Location
Monitoring Well Location
Free Product Contour
5,000-Gallon Heating Oil UST
■
2 14
�MW-2
(ND)
$-RW-2
(ND)
ND = Not Detected 1 inch equals 20 feet
0.03' = Free Product Thickness (Feet) Feet
0 20 40
FREE PRODUCT THICKNESS MAP DRAWN BY: MRH DATE: SEPTEMBER 2022
POST-AFVR - SEPTEMBER 13, 2022 B : CHECK JOB NO.: 000R2647.08
WILLOW SPRINGS ELEMENTARY SCHOOL ENGINEER CHECK
t �• Mid Atlantic 6800 DWIGHT ROWLAN D ROAD BY: GIS NO.: 05G-R2647.08-4
Io
WILLOW SPRINGS, NORTH CAROLINA BYPROVED DRAWING NO.: 3
REFERENCE: LATEST AERIAL IMAGERY FROM NC ONE MAPS. PROPERTY BOUNDARY, ROAD, WATER, SEWER, HYDROLOGY GIS FROM WAKE COUNTY GIS. MID -ATLANTIC FIELD NOTES.

TABLE 2
SUMMARY OF HISTORICAL LIQUID LEVEL MEASUREMENTS
WCPSS WILLOW SPRINGS ELEMENTARY SCHOOL
WILLOW SPRINGS, NORTH CAROLINA
MID -ATLANTIC JOB NO. R2647.08
WELL ID
DATE
TOC
ELEVATION
(FT)
DTP
APPARENT
FP
THICKNESS
FT
DTW (FT)
BTOC
CORRECTED
DTW (FT)
SWLE (FT)
MW 1
3/29/2016
101.64
NM
NM
NM
NM
NM
5/1 /2017
7.94
2.4
10.34
8.59
93.05
7/27/2017
9.56
1.88
11.44
10.07
91.57
11/11/2017
11
0.49
11.49
11.13
90.51
12/8/2017
11.3
0.15
11.45
11.34
90.30
7/6/2018
10.99
0.21
11.20
11.05
90.59
7/31 /2018
11.24
0.17
11.41
11.29
90.35
9/27/2019
0.10a
10/12/2019
11.56
11.56
90.08
11/11/2019
11.48
11.48
90.16
4/27/2020
9.01
9.01
92.63
12/16/2020
8.18
8.18
93.46
12/22/2020
7.91
7.91
93.73
12/30/2020
7.70
7.70
93.94
2/15/2021
6.50
6.50
95.14
6/3/2021
10.33
10.33
91.31
10/13/2021
10.92
10.92
90.72
10/28/2021
11.04
11.04
90.60
11 /2/2021
11.97
11.97
89.67
12/13/2021
11.64
11.64
90.00
3/25/2022
7.98
7.98
93.66
9/13/2022
11.47
11.47
90.17
MW-2
3/29/2016
101.94
8.12
8.12
93.82
11/11/2017
11.48
11.48
89.72
7/6/2018
11.28
11.28
89.92
7/31/2018
11.58
11.58
89.62
9/27/2019
10/12/2019
11.87
11.87
90.07
11/11/2019
11.81
11.81
90.13
2/15/2021
7.89
7.89
94.05
6/3/2021
10.55
10.55
91.39
10/13/2021
11.22
11.22
90.72
10/28/2021
11 /2/2021
12.55
12.55
89.39
12/13/2021
11.95
11.95
89.99
3/25/2022
8.64
8.64
93.30
9/13/2022
11.75
11.75
90.19
Page 1 of 3

TABLE 2
SUMMARY OF HISTORICAL LIQUID LEVEL MEASUREMENTS
WCPSS WILLOW SPRINGS ELEMENTARY SCHOOL
WILLOW SPRINGS, NORTH CAROLINA
MID -ATLANTIC JOB NO. R2647.08
WELL ID
DATE
TOC
ELEVATION
(FT)
DTP
APPARENT
FP
THICKNESS
FT
DTW (FT)
BTOC
CORRECTED
DTW (FT)
SWLE (FT)
MW-3
3/29/2016
98.73
5.23
5.23
92.81
5/1 /2017
5.95
5.95
92.09
11 /11 /2017
8.28
0.28
8.56
8.36
90.37
12/8/2017
8.54
0.01
8.55
8.54
90.19
7/6/2018
8.18
0.68
8.86
8.36
90.37
7/31 /2018
8.41
0.53
8.94
8.55
90.18
9/27/2019
0.38a
10/12/2019
8.75
8.75
89.98
11 /11 /2019
8.67
0.02
8.69
8.68
90.05
4/27/2020
6.26
0.37
6.63
6.36
92.37
12/16/2020
5.52
0.59
6.11
5.68
93.05
12/22/2020
5.29
0.30
5.59
5.37
93.36
12/30/2020
4.48
4.48
94.25
2/15/2021
3.90
0.01
3.91
3.90
94.83
6/3/2021
7.46
0.47
7.93
7.59
91.14
10/13/2021
9.02
0.60
9.62
9.18
89.55
10/28/2021
8.12
0.62
8.74
8.29
90.44
11 /2/2021
8.12
0.13
8.25
8.16
90.57
12/13/2021
8.81
8.81
89.92
3/25/2022
5.36
5.36
93.37
9/13/2022
8.60
0.03
8.63
8.61
90.12
MW 4
3/29/2016
98'90
5.25
5.25
92.93
11 /11 /2017
7.92
7.92
90.26
7/6/2018
8.36
8.36
89.82
7/31 /2018
8.57
8.57
89.61
9/27/2019
10/12/2019
8.84
8.84
89.34
11 /11 /2019
8.79
8.79
89.39
4/27/2020
6.29
6.29
92.61
2/15/2021
3.64
3.64
95.26
6/3/2021
7.62
7.62
91.28
10/13/2021
7.94
7.94
90.96
10/28/2021
11 /2/2021
10.04
10.04
88.86
12/13/2021
8.81
8.81
90.09
3/25/2022
4.87
4.87
94.03
9/13/2022
7.79
7.79
91.11
RW-1
9/27/2019
99.74
0.10a
10/12/2019
9.69
9.69
90.79
11 /11 /2019
9.59
0.01
9.60
9.59
90.15
4/27/2020
7.23
0.13
7.36
7.27
92.47
12/16/2020
6.82
0.14
6.96
6.86
92.88
12/22/2020
6.23
0.15
6.38
6.27
93.47
12/30/2020
6.31
0.06
6.37
6.33
93.41
2/15/2021
4.71
0.02
4.73
4.72
95.02
6/3/2021
8.43
0.15
8.58
8.47
91.27
10/13/2021
9.05
0.17
9.22
9.10
90.64
10/28/2021
9.12
0.19
9.31
9.17
90.57
11 /2/2021
9.09
0.05
9.14
9.10
90.64
12/13/2021
--
9.79
9.79
89.95
3/25/2022
6.99
6.99
92.75
9/13/2022
�_9,_5710.05
1 9.62
1 9.58
90.16
Page 2 of 3

TABLE 2
SUMMARY OF HISTORICAL LIQUID LEVEL MEASUREMENTS
WCPSS WILLOW SPRINGS ELEMENTARY SCHOOL
WILLOW SPRINGS, NORTH CAROLINA
MID -ATLANTIC JOB NO. R2647.08
WELL ID
DATE
TOC
ELEVATION
(FT)
DTP
APPARENT
FP
THICKNESS
FT
DTW (FT)
BTOC
CORRECTED
DTW (FT)
SWLE (FT)
RW-2
9/27/2019
99.94
0.20a
10/12/2019
9.88
9.88
90.80
11 /11 /2019
9.80
0.01
9.81
9.80
90.14
4/27/2020
7.40
7.40
92.54
12/16/2020
6.52
6.52
93.42
12/22/2020
6.14
6.14
93.80
12/30/2020
6.04
6.04
93.90
2/15/2021
4.93
4.93
95.01
6/3/2021
8.66
8.66
91.28
10/13/2021
9.28
9.28
90.66
10/28/2021
9.33
9.33
90.61
11 /2/2021
9.28
9.28
90.66
12/13/2021
9.93
9.93
90.01
3/25/2022
6.24
6.24
93.70
9/13/2022
9.78
9.78
90.16
RW 3
12/22/2020
98'97
5.39
5.39
93.56
12/30/2020
5.22
5.22
93.73
2/15/2021
4.18
4.18
94.77
6/3/2021
7.71
0.03
7.74
7.72
91.25
10/13/2021
8.28
0.04
8.32
8.29
90.68
10/28/2021
8.38
0.02
8.40
8.39
90.58
11 /2/2021
8.33
8.33
90.64
12/13/2021
9.01
9.01
89.96
3/25/2022
5.48
5.48
93.49
9/13/2022
8.80
0.04
8.84
8.81
90.16
RW 4
12/22/2020
98.53
4.96
4.96
93.55
12/30/2020
4.75
4.75
93.76
2/15/2021
3.61
3.61
94.90
6/3/2021
7.28
7.28
91.25
10/13/2021
7.85
7.85
90.68
10/28/2021
7.97
7.97
90.56
11 /2/2021
7.91
7.91
90.62
12/13/2021
8.54
8.54
89.99
3/25/2022
5.02
5.02
93.51
9/13/2022
8.33
8.33
90.20
Notes: TOC - Top of Casing BTOC - Below Top of Casing
FT - feet SWLE - Static Water Level Elevation
DTP - Depth to Product a FP thickness estimated by technician
FP - Free Product
DTW - Depth to Water
Page 3 of 3

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MONITORING WELL LOCATION e3 Yr. r
SUBJECT PROPERTY BOUNDARY
4V#*
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0 40 80 120 160"
Mid Atlantic
Engineering & Environmental Solutions
MONITORING WELL LOCATION MAP
WILLOW SPRINGS ELEMENTARY SCHOOL
6800 DWIGHT ROWLAND ROAD
WILLOW SPRINGS, NORTH CAROLINA
DRAWN BY: "'r DATE: APRIL 2016
DRAFT CHECK JOB NO.: 000132647.013
BY:
ENGINEER CHECK GIS NO.: 04G-R2647.0B-1
BY: q5
APPROVED BY: fKmDRAWING NO.: 2
11 REFERENCE: 2013 AERIAL IMAGERY FROM NC ONE MAPS. PROPERTY BOUNDARY, ROAD, WATER, SEWER, HYDROLOGY GIS FROM WAKE COUNTY GIS. MID -ATLANTIC FIELD NOTES.

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ATTACHMENT B
SAFETY DATA SHEET
(SECTION J)
0 Mid Atlantic

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

Bib,Solve"'
COMP' N`f
Safety Data Sheet
Section 4 — First Aid Measures
hiOSON�
CLEARS
HYDROCAARDN M1740A7404 Ar EN r
Page 2 of 6
Eyes: Immediately flush eyes with water for at least 15 minutes. Hold eyelids
apart while flushing to rinse entire surface of eye and lids with water.
Seek medical attention for lasting irritation.
Skin: Rinse exposed area and wash with mild soap and water for several
minutes. Seek medical attention if irritation develops.
Ingestion: Seek medical attention in the event of serious or persistent abdominal
discomfort, nausea or diarrhea.
Inhalation: Inhalation of concentrated vapors resulting from spraying or heating in
confined or poorly ventilated areas may cause irritation of nose and
throat. Remove person to fresh air and seek medical attention if
irritation persists.
Section 5 — Fire Fighting Measures
Suitable Extinguishing Media: None required; BioSolve products are non-flammable
Special Protective Equipment for Firefighters: None necessary
Unusual Fire or Explosive Hazards: None
Section 6 — Accidental Release Measures
In case of accidental release, breakage or leakage: Eliminate or contain source with inert
material, such as sand, earth, absorbent pads, etc. Transfer liquid to suitable containers
for recovery, re -use or disposal. Wipe up or mop up using water. Hard surfaces (e.g.,
floors, driveways) may be slippery; use care to avoid falling.
Rinse area with water. Avoid flow of run-off to surface waters. Always check with
local regulations before discharging effluent to storm drains or sewers.
Section 7 — Handling and Storage
Handling: Minimize periods of exposure to extreme temperatures. Keep from
freezing. If frozen, separation may occur; thaw and stir thoroughly
prior to use. Freezing will not affect product performance.
Precautions: Chemical resistant gloves and eye protection are recommended while
mixing and using.
Incompatibilities: Avoid contact with strong acids or strong oxidants.
Storage: Recommended storage temperature: 35° — 120° F (1° — 48° C).
Shelf Life: If unopened, more than 10 years.

Bio'',Solve"'
COMP'N`f
Safety Data Sheet
hiosolvb
CLEARS
HYDROCAARDN M1740A7404 Ar EN r
Page 3 of 6
Section 8 — Exposure Controls / Personal Protection
Eyes Protection: Safety glasses; chemical goggles or face shield recommended when
spraying to protect against backsplash and drift.
Skin Protection: Rubber or latex gloves recommended.
Respiratory None required, except if application results in significant misting of
Protection: product. If so, use of an approved air purifying respirator is
recommended.
Engineering For indoor use or for use in a confined space, normal ventilation is
Controls: generally satisfactory.
Section 9 — Physical and Chemical Properties
Appearance: Light golden
Odor: Mild, pleasant sassafras fragrance
Concentration: —32% active ingredients as sold
Boiling Point
2650F/1290C
Vapor Pressure mm/Hg
Not available
Melting/Freezing Point
28°F/-20C
Vapor Density (Air=1)
Not available
Flash Point
Non-flammable
Surface Tension*
29 Dyne/cm 25°C
Flammability Limits
Not applicable
Viscosity (concentrate)
490 centi oise
Reactivity with Water
None
Viscosity (6% solution)
1.5 centi oise
Evaporation Rate
Not determined
Solubility in Water
100%
Specific Gravity
1.01 gms/cc
VOC Content
Not determined
8.43 lbs/U.S. gal
pH
9.1 +/- 0.3
*6% solution
Section 10 — Stability and Reactivity
Chemical Stability: Stable; will not decompose if used according to manufacturer's
directions.
Conditions to Avoid: Prolonged exposure to heat may cause product degradation. Freezing
should also be avoided as discussed in Section 7.
Incompatible Normally unreactive. Avoid strong alkalis, strong acids, strong
Materials: oxidizing agents and materials with reactive hydroxyl compounds.
These materials could damage the product and reduce its effectiveness
Hazardous
Decomposition
Products:
Hazardous
Polymerization:
during application.
None are known.
Will not occur.

Bib,Solve"'
COMP' N`f
Safety Data Sheet
Section 11 —Toxicological Information
hioso1v�
CLEARS
HYDROCAARDN M1740A7404 Ar EN r
Page 4 of 6
Overview: No adverse acute or chronic health effects expected if product used in
accordance with manufacturer's directions.
Carcinogenicity: No ingredient has been shown to cause cancer in laboratory animals.
Specific Organ None are known.
Toxicity:
Section 12 — Ecological Considerations
Persistence and The total of the organic components contained in this product is not
Degradability: classified as readily biodegradable (OECD-301 A-F). However, this
product is inherently biodegradable with 60% degradation in 28 days
(OECD-301B) and estimated >95% degradation in 120 days.
Bioaccumulation The bioaccumulation factor in fish has been estimated to be low,
Potential: ranging from 87 to 344.
Mobility: No data available
Aquatic Toxicity: LC50 of Concentrate (As shipped)
Mysidopsis Bahia
48-hours
3.6 mg/L
Menidia beryllina
96-hours
6.4 mg/L
LC50 of 3% Dilute Solution
(As Used)
Mysidopsis Bahia
48-hours
185 mg/L
Menidia beryllina
96-hours
247 mg/L
LC50 of 6% Dilute Solution
(As Used)
Daphnia magna
48-hours
287 mg/L
Pimephales promelas 96-hours 124 mg/L
Onchorhynchus mykiss 96-hours 177 mg/L
Section 13 - Disposal
DO NOT DUMP INTO STORM DRAINS OR INTO ANY BODY OF WATER. All
disposal practices must be in compliance with all Federal, State/Provincial and local
laws and regulations. As manufactured, BioSolve products do not meet the definition of
a hazardous waste. Small quantities of unused and uncontaminated product may be
discharged to a qualified wastewater treatment facility. Always obtain approval from
local and Federal regulatory agencies prior to discarding this product into public sewers.
As your supplier, we have no control over your handling and use of this product.
However, the intended use of this product as a remediation and/or surface washing agent
may produce wastewater containing emulsified or dispersed hydrocarbons that may be
classified as a hazardous waste and should be treated and disposed of accordingly.

Bib,Solve"'
COMP' N`f
Safety Data Sheet
Section 14 — Transportation Information
hiosolve
CLEAR
HYDROCAARDN M1740A7404 Ar EN r
Page 5 of 6
USDOT Freight Class 55 (Liquid Cleaning Compound, Non -Hazardous)
This product is not regulated by USDOT or Canadian TDG when shipped
domestically by land.
North American Industry Classification System (NAICS) # 325613
U.S. ITC, Harmonized Tariff Schedule B Classification: 3402.90.30.00
Section 15 — Regulatory Information
This product is considered non -hazardous as defined by CERCLA, according to OSHA,
Massachusetts Right to Know Law and California Prop 65.
Toxic Substances All components of this product are on the TSCA inventory or are
Control Act: exempt from TSCA Inventory requirements under 40 CFR 720.30.
CEPA — Domestic All substances contained in this product are listed on the Canadian
Substances List: Domestic Substances List (DSL) or not required to be listed.
Canadian CPR This product has been classified in accordance with the hazard criteria
Compliance: of the Canadian Controlled Products Regulations (CPR) and the SDS
contains all the information required by the CPR
WHMIS D2B
Classification:
Eye or skin irritant
Regulatory requirements are subject to change and may differ from one location to
another; it is the buyer's responsibility to ensure that its activities comply with Federal,
state or provincial and local laws.

Bia'',Solve"'
COMP' N`f
Safety Data Sheet
Section 16 — Other Information
HMIS Rating
NFPA Rating
Health Hazard:
Fire Hazard:
Reactivity:
Personal Protective
Equipment:
Health:
Flammability:
Reactivity:
Other Hazard:
SDS Effective Date: May 12, 2016
1 (Eye/Skin Irritant)
0
0
Rubber gloves, safety
glasses or face shield
1 (Eye/Skin Irritant)
0
0
None
hiosulvb
CLEARS
HYDROCAARDN M1740A7404 Ar EN r
Page 6 of 6
The information contained herein is accurate to the best of our knowledge. The
BioSolve Company makes no warranty of any kind, express or implied, concerning the
safe use of this material in your process or application or in combination with other
substances.
For more information, visit: www.blosolve.com

ATTACHMENT C
WELL CONSTRUCTION INFORMATION
(SECTION K)
Mid Atlantic

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
James D. Barker
Well Contractor Name
3106A
NC Well Contractor Certification dumber
Quantex, Inc.
Company Name N R
2. Well Construction Permit #:
List all applicable well construction permits (i.e. County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑Industrial/Commercial
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed loop)
❑Geothermal (Heating/Cooling
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
[]Tracer
❑Other (explain under #21
3/25/16 MW-3
4. Date Well(s) Completed: Well IDII
5a. Well Location:
Willow Springs ES NA
Facility/Owner Name Facility m# (if applicable)
6800 Dwight Rowland Rd., Willow Springs 27592
Ph ica1 Address, City, and Zip
Make NA
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one latllong is sufficient)
35,593527 N 78.728177 w
6. Is (are) the well(s): ®Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ONo
Ifthis is a repair, fill out known well construction information and explain the nature ofthe
repair under #21 remarks section or on the back of this form.
one
8. Number of wells constructed:
For multiple injection or non -water supply wells ONLY with the same construction, you can
submit oneform. 14'
9. Total well depth below land surfacer (ft.)
For multiple wells list all depths irdierent (example- 3@200' and 2Q1001
NA
10. Static water level below top of casing:
If water level is above casing, use
pin
11. Borehole diameter:y 0-)
12. Well construction method: Auger
(i.e. auger, rotary, cable, direct push, etc.)
(ft.)
For Internal Use ONLY:
14. WATER ZONES
FROM
TO
DESCRIPTION
5 &
6 It.
Light Brown Sandy SILT
ft.
ft.
15. OUTER CASING for multi cased wells OR LINER if a licable
FROM
TO
DIAbIETER
THICKINESS
MATERIAL
-t fL
16. INNER CASING OR TUBING(geothermal closed-loo
FROM
TO
D1A.NIETER
THICKNESS
MATERIAL
0 tt.
4 ft.
2 in.
Sch 40
PVC
fL
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
IA
MATERL
4 ft.
14 ft.
2 in.
0.010
Sch 40
PVC
ft.
%
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
fL
ft.
0 fL
3 ft.
neat cement
145 lbs. - pour
3 %
3.5 ft.
bentonite
30 lbs. - pour
19. SAND/GRAVEL PACK ifapplicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
3.5 %
16 %
#2 sand
Pour
fi.
fL
20. DRILLING LOG attach additional sheets if necessary)
FROM
TO
DESCRIPTION color, hardnes soiV:ock 13pe, gram situ etc.
0 fL
0.5 ft.
ground cover - Reddish Tan SILT
0.5 fL
3 ft.
Reddish Brown Clayey SILT
3 fL
14 ft.
Light Brown Sandy SILT
1L
ft
ft
ft.
fL
ft.
fL
fL
21. REMARKS
22. CertifR: 'on: 6, 1!2L
3/28/16
Signature of ertified Well Contractor Date
By signing t is form, I hereby certify that the wells) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy ofthis record has been provided to the well owner.
2.3. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount completion of well construction to the county health department of the county
where constructed.
Form OW-1 North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 2013

LOG OF BORING: MW-3
Atlantic ''�"`"`1 k.,i.�r. vc_reto
� E„ x E 1 s m-. Ph, 14004wasae
Page: 1 of 1
Direct Push and
Site Name: Willow Springs ES Drilling/Boring Method: Hollow Stern Auger Total Boring Depth (ft): 14.0
Project Number: R2647.OB Sampling Method: NA Top of Casing Elev. (ft): 98.04
Location: Willow Springs, NC Subcontractor/Drillers: Quantex Latitude: 35.593527
Date Started: 3/25/2016 Driller: J.D. Barker Longitude:-78.728177
Date Completed: 3/25/2016 Monitoring Equipment: Technician: G. Fischer
E
�
w
?
Odors
°
L
SOIL DESCRIPTION (cobr.texwre.muiswre.ete.)
Construction Deatails
a
m
G.
�u
3
Light Orange CLAY w/ Fine to Medium -Grained Sand
2
2
0
z
Bentonk
4
Light Grey/Red-Orange and Light Brown Very Fine to Fine -Grained Sandny CLAY
4
6
Depth to
water 5.!3n
6
`
r
c
Light Orange and Light Grey Very Fine -Grained Sandy CLAY
8
a
8
o°
o
o
z
_
Light Brown and Light Grey CLAY w/ Fine -Grained Sand
o
e
10
a
10
ca
0
12
vs
o
v
Tan and Light Grey Clayey -SAND
12
7
W
14
Light Grey CLAY (Stiff)
14
16
16
18
18
20
20
22
22
24
24
26
26
28
28
30
30
COMMENTS: in - indicates inches N/A - indicates not applicable to this boring
It - indicates depth in feet ppm - indicates pans per million
ft BLS - indicates feet below land surface

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
For Internal Use ONLY:
1. Well Contractor Information:
James D. Barker
Well Contractor Name
3106A
NC Well Contractor Certification Number
Quantex, Inc.
Company Name
2. Well Construction Permit #: N R
List all applicable well construction permits (i.e. County, State, Variance, etc)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothemtal (Heating/Cooling Supply)
❑ lndustrial/Commercial
❑ Irrigation
Non -Water Supply Well:
El Aquifer Recharge
El Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
❑Municipal/Public
El Residential Water Supply (single)
❑Residential Water Supply (shared)
El Groundwater Remediation
❑ Salinity Barrier
❑ Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 F
4. Date Well(s) Completed: 9/27/19 Well ID# RW-1 + RW-2
5a. Well Location:
Willow Spring Elmntry NA
Facility/Owner Name Facility ID# (if applicable)
6800 Dwight Rowland Rd., Willow Spring 27592
Physical Address, City, and Zip
Wake
NA
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.593559 N 78.728093 W
6. Is (are) the well(s): ❑E Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ZNo
If this is a repair, fill out known well construction information and explain the nature of the
repair under #21 remarks section or on the back of this form.
8. Number of wells constructed: two
For multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
9. Total well depth below land surface: 15'
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing: 1 1 .5'
If water level is above casing, use
11. Borehole diameter:
9"
12. Well construction method: _
(i.e. auger, rotary, cable, direct push, etc.
Auger
(ft.)
14. WATER ZONES
FROM
TO
DESCRIPTION
10 ft•
11 ft•
Light Brown Clayey Sand
rt.
rt.
15. OUTER CASING for multi -cased wells OR LINER if a licable
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING eother at closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
5 rt.
4 in
SCh 40
PVC
ft
fL
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
5 ft•
15 ft'
4 in.
0.020
Sch 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
ft.
ft.
0 rt.
3 rt.
neat cement
145 Ibs. - pour
3 ft'
4.5 ft.
bentonite
30 Ibs. - pour
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
4.5 fL
15 ft
#3 sand
Pour
rt.
rt.
20. DRILLING LOG attach additional sheets if necessary)
FROM
TO
DESCRIPTION color, hardness, soil/rock type, grain size, etc.)
0 rt.
0.5 rt•
ground cover - Reddish Tan SILT
0.5 rt.
7 rt.
Reddish Brown Clayey SILT
7 ft.
15 ft.
Light Brown Clayey Sand
rt.
rt.
rt.
rt.
ft.
ft.
rt.
rt.
21. REMARKS
22. Certifrc 'on:
_ 6, 614,,-, 9/30/19
Signature of ertified Well Contractor Date
By signing t is form, I hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-1 North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used fa single or multiple wells
I. Well Contractor Information:
Virgil Wilson
Well Contractor Name
4473
NC Well Contractor Certification Number
Parratt-Wolff, Inc.
Company Name
2. Well Construction Permit#:
List all applicable n'ell pe'rrnrilr (i.e. ('ounit', Stale,
1'ariance, lnle'cllolr, etc.)
3. Well Use (check well use):
Water Supply ►Fell:
❑Agricultural
❑Municipal/Public
❑Geothermal (Heating/Cooling Supply)
❑Residential Water Supply (single)
❑industrial/Commercial
❑Residential Water Supply (shared)
❑Irri ation
Non -Water Supply Well:
0 onitoring '
❑Recovery
❑Aquifer Recharge
❑Groundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
❑Stormwater Drainage
❑Experimental Technology
❑Subsidence Control
❑Geothermal (Closed Loop)
❑Tracer
❑Geothermal (Heating/Cooling Retum)
❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: 12/16/20 Well ID# RW-3
5a. Well Location:
Wake County Board of Education Willow Springs Elementary
Facility/(Tuner Name Facility iD# (if applicable)
6800 Dwight Rowland Road, Willow Springs, NC
Physical ,address, City, and Zip
Wake 0687007938
County Parcel Identification No (PiN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field_ one tat/long is sufficient)
35.593151 N-78.728098 W
6. Is (are) the well(s): Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Y'es or ONo
it this is a repair,,lill out knou n ireh construction hilorntmion and explain the nature (y'lhe
repair under 21 rentarkv section or on the back cjthis,/orm.
8. Number of wells constructed: 1
For multiple hyeclion or non -haler supply ire/h ONLY ivith the same construction, you can
submit oneJorm.
9. Total well depth below land surface: 14 (ft.)
For multiple irells lisl all depths iij'dilferem (example- 3 a 200' and 2@100')
10. Static water level below top of casing: 5 (ft.)
1/'iraler level is above casing, use "- "
It. Borehole diameter: 10 5/8 (in.)
For Internal Use ONLY:
14. WATER ZONES
FROM TO I DESCR]PT10N
5 ft' 14 ft. wet
ft. It.
I", OII'TER CASING; for multi -cased wefts)OR LINER if a kicable
FROM TO DIAMETER AIATERI IL
ft. ft. in.
16. INNER CASING OR TUBING eothe rm&I closed -I pop
FROM TO DIAM£TFR I THICKNESS MATERIAL.
0 it. 4 ft. 4 in SCh40 I pvC
ft. I R, in.
. 17. SCREEN
FROM TO DIAMETER Sl_Olf SIZE 1•HICKNE5.4 MATF,RIA1.
4 fr. 14 ft' 4 in. .020 1 sch40 I pvc
ft. ft. in.
1& GROUT
FROM TO MATERLAL EMPLACEMENT METHOD &AMOUNT
0.5 fr. 2 fr• Portland Cem Tremie
2 ft. 3 ft- Bentonite Chil Tremie
ft. ft.
19.SANDIGR.AVELPAC K(Na llcshle)
FROM I TO MATERIAL EMPLACEMENTMETHOn
3 ft. 14 ft. #1 Sand Tremie
ft. I ft.
21L DRILLING LOG IsuAch additional sheets if necesearr
FROM TO DE5CR IPTION kola r, lk—f. ese, yoil'rock F• e. exam liar. curl
ft. ft.
ft. ft.
ft. ft.
ft. ft.
ft. ft.
ft. ft.
ft. ft.
21. REMARKS
24" sonotube with 8" FMC
22. Cer 'Fi scion:
Signature of 'crtitied Well Contractor Date
By signing lhis.lorm, I Hereby certify that the ivell(s) irar (mere) constructed in accordance
inch i5A NCAC 02C .0N10 or I5A N('AC 02C .0200 Well Construction Standards and that a
copy ql this record has been provided to the well ouvter.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages ifnecessarv.
SUBMITTAL iNSTUCTIONS
24a. Fur All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For In eclion Well% ONLY: In addition to sending the form to the address in
24aabove, also submit a copy of this form within 30 days of completion of well
12. Well construction method: HSA construction to the following:
(i a auger, rotary, cable, direct push, etc )
Division of Water Resources, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Injection Wells. -
Also submit one copy of this form within 30 days ofcompledon of
13b. Disinfection type: Amount: well ounstfuction to the county health department of the county where
constructed.
Foi ni G W- I North Carolina Department of Environment and Natural Resources- Division of Water Resources Revised August 2013

409 Rogers View Ct.
IQ Mid Atlantic Raleigh NC27610
LOG OF BORING: RW-3
Engineering & Environmental Solutions Ph: [phone]
Page: 1 of 1
Willow Springs
Site Name: Elementary Drilling/Boring Method: Hand Auger and HAS Total Boring Depth (ft): 14'
Project Number: 000112647.06 Sampling Method: N/A Well Depth (ft): 14'
Location: Willow Springs, NC Subcontractor/Drillers: Parratt-Wolff, Inc. Screen Depth (ft): 4-14'
Date Started: 12/16/2020 Driller: Virgil Wilson DTW: 5' Below TOC
Date Completed: 12/16/2020 Monitoring Equipment: N/A MAA Field Staff: Gary Fischer
a
w
Sampling
Interval, Odors
5
A
SOIL DESCRIPTION (color, texture, moisture, etc.)
Construction Details
w
a
w
Light brown silty clay 0-0.5'
Gravel 0.5'-3'
Sand: 3'-14'
Screen: 4'-14'
5
Light orange slightly sandy clayey silt
V
5
N/A
N/A
Strong odor
10
Tan fine sandy silt
10
Tan slightly sandy clay
15
Boring terminated at 14 ft-bgs
15
20
20
COMMENTS: in - indicates inches N/A - indicates not applicable to this boring
DTW - Depth to Water 1 ft - indicates depth in feet ppm - indicates parts per million
HAS - Hollow Stem Auger ft-bgs - indicates feet below ground surface TOC - Top of Casing

WELL CONSTRUCTION RECORD
This form can be used for single or multiple "el Is
1. Well Contractor Information:
Virgil Wilson
Well Contractor Name
4473
NC Well Contractor Certification Number
Parratt-Wolff, Inc.
Compam Name
2. Well Construction Permit#:
Li.rf all applicable well pernNec (i.e. County, State, Variance. /rrjec•tion, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial ❑Residential Water Supply (shared)
Non -Water Supply Well:
R Monitoring ❑ Recovery
❑Aquifer Recharge
❑Groundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
❑Stormwater Drainage
❑Experimental Technology
❑Subsidence Control
❑Geothermal (Closed Loop)
❑Tracer
❑Geothermal PleatlnJCoolin2 Return)
❑Other(eNDlain under #21 1
4. Date Well(s) Completed: 12/16/20 Well ID# RW-4
5a. Well Location:
Wake County Board of Education Willow Springs Elementary
Facility/Owner Name Facility ID# (if applicable)
6800 Dwight Rowland Road, Willow Springs, NC
Physical Address, City, and Zip
Wake 0687007938
County Parcel Tdentification No (PTN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one lat/long is sufficient)
35.593151 N-78.728098
6. Is (are) the well(s): ©Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Y'es or [?]No
# this is a repair, fill out known well consiruction iglbrntation and explain the nature of the
re/xur under :21 remarks section or on the back gfthis,/brit.
8. Number of wells constructed: 1
hor multiple injection or non-waler svpp/v wells ON/ Y with the same construction, yort can
.subtna one,/itrm.
9. Total well depth below land surface: 14 A)
1•'or nniltiple wells list all depths if di/Jerent (emnrple- 3 u 200' am! 2 a /00')
10. Static water level below top of casing: 5 (ft.)
l f water level is above casing, use " - -
11. Borehole diameter: 10 5/8 (in.)
12. Well construction method: HSA
(i.e. auger, rotary, cable, direct push, etc.)
For Internal Use ONLY:
14. WATER 'ZONES
FROM TO DESCRIPTION
5 ft. 14 ft. wet
ft. ft.
I5. OIITER CASING (for mniti-eased welts
FEtOM TO OR LIN£R ifs 1e
1EDIAMETER TnIChNFS4 IAL
ft. ft. in,
t6. INNER CASING OR TUBING ecthermal tlmed4napl
FROM TO DL111ETER T111CIoNE.SS MATERIAL
0 ft. 4 ft, 4 sch40 pvc
ft. ft. in.
17. SCREED
FROM TO DIAMETER SLOFSIZE THICKNESS MATERIAL
4 ft. 14 ft. 4 in..020 Sch40 pvc
ft. ft. in.
I& GROUT
FROM TO MATERIAL £M PLACEM ENT M ErI IOD & AM 011141'
0.5 ft. 2 fr. Portland Cem Tremie
2 fr. 3 fr. Bentonite Chil Tremie
ft. ft.
19. SAND/GRAVCML PACK a hle
FROM TO MATERIAL EMPLACEMENT METHOD
3 fL 14 ft. #1 Sand Tremie
ft. ft.
20. DRILLING LOG (attach additional shrel>< if ncce"a
FROM TO DFSCRIPTION teolur. hardness, -Wrnrk r yp,iu sire, emj
ft. ft.
ft. ft.
ft. ft.
ft. ft.
ft. ft.
ft. ft.
ft. ft.
21. REMARKS
24" sonotube with 8" FMC
22. Cert' lualion:
�/� J- (A) /-5=,,7o 2/
5r L•rrata R' ol' Certified Well Contractor Date
By signing this fbrm, 1 hereby certi/y that the i ell(s) tras (irere) constructed in accordance
with 15A NCAC 02C .0100 or 15.4 NCAC 02(' .0200 Well Conslruclion Standards and Ihai a
copy of this record has been provided in the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Infection !fells ONLY: In addition to sending the form to the address in
24aabove_ also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield m Method of test: 24c. For Water Supply & Injjection Wells:
(gP ) Also submit one copy of this form within 30 days of completion of
13b. Disinfection type: _ Amount: well construction to the county health department of the county where
constructed.
Form GW-I North Carolina Department of Environment and Natural Resources- Division of Water Resources Revised August 2013

409 Rogers View Ct.
MidAtlantic Raleigh NC27610
LOG OF BORING: RW-4
Engineering & Environmental Solutions Ph: [phone]
Page: 1 of 1
Willow Springs
Site Name: Elementary Drilling/Boring Method: Hand Auger and HSA Total Boring Depth (ft): 14'
Project Number: 000112647.06 Sampling Method: N/A Well Depth (ft): 14'
Location: Willow Springs, NC Subcontractor/Drillers: Parratt-Wolff, Inc. Screen Depth (ft): 4-14'
Date Started: 12/16/2020 Driller: Virgil Wilson DTW: 5' Below TOC
Date Completed: 12/16/2020 Monitoring Equipment: N/A MAA Field Staff: Gary Fischer
a
a
°A
a
w
Sampling
Interval, Odors
g
g
A
SOIL DESCRIPTION (color, texture, moisture, etc.)
Construction Details
w
W
Gt+
Light brown slightly sandy silty clay
Sand: 3'-14'
Gravel
Screen: 4'-14'
5
Light orange slightly sandy clayey silt
V
5
N/A
N/A
Strong Odor
10
Tan fine sandy silt
10
Tan slightly sandy clay
15
Boring terminated at 14 ft-bgs
15
20
20
COMMENTS: in - indicates inches N/A - indicates not applicable to this boring
DTW - Depth to Water 1 ft - indicates depth in feet ppm - indicates parts per million
HAS - Hollow Stem Auger ft-bgs - indicates feet below ground surface TOC - Top of Casing