WI0800564_Notification of Intent (NOI) – GW Remediation_20230303

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 (Note: Injection Event Records (IER) do not need to be
submitted for replacement of each sock used in ORC systems).
2) Small -Scale Injection Operations — Injection wells located within a land surface area not to exceed 10,000
square feet for the purpose of soil or groundwater remediation or tracer tests. An individual permit shall be required
for test or treatment areas exceeding 10,000 square feet.
3) Pilot Tests - Preliminary studies conducted for the purpose of evaluating the technical feasibility of a
remediation strategy in order to develop a full scale remediation plan for future implementation, and where the
surface area of the injection zone wells 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: March 1, 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: Municipal Government
C. WELL OWNER(S) — State name of Business/Agency, and Name and Title of person delegated authority to
sign on behalf of the business or agency:
Name and Title: Joshua W. Ray, Jacksonville City Manager
Company Name City of Jacksonville, NC
Mailing Address: P.O. Box 128
City: Jacksonville State: NC Zip Code: 28541 County: Onslow
Day Tele No.: 910.938-5221 Cell No.:
EMAIL Address:_ irgygjacksonvillenc.gov Fax No.: NA
Deemed Permitted GW Remediation NOI Rev. 8-28-2017 Page 1

D.
E.
PROPERTY OWNER(S) (if different than well owner)
Name and Title: Joshua W. Ray, Jacksonville City Manager
Company Name City of Jacksonville, NC
Mailing Address: P.O. Box 128
City: Jacksonville State: NC _ Zip Code: 28541 County:_Onslow
Day Tele No.: 910.938.5221
EMAIL Address: 'ra jacksonvillenc. ov Fax No.:
Cell No.: NA
PROJECT CONTACT (Typically Environmental Engineering Firm)
Name and Title: David B. Wells, Geologist, Managing Member
Company Name Cape Lookout Environmental Sciences, PLLC
Mailing Address: 8005 Clear Brook Drive
City: Raleigh State: NC _ Zip Code: 27615 County: Wake
Day Tele No.: 919.880.6801 Cell No.: 919.880.6801
EMAIL Address: davidwells n,capelookoutenv.com Fax No.: NA
F. PHYSICAL LOCATION OF WELL SITE
(1) Facility Name & Address: City of Jacksonville Fleet Maintenance Facility
350 S. Marine Boulevard
City: Jacksonville County: Onslow Zip Code: 28540
(2) Geographic Coordinates: Latitude": or _ 34 0.754853
Longitude": or 77.44 147
Reference Datum: Accuracy:
Method of Collection: Google Maps
"FOR AIR INJECTION AND AQUIFER TEST WELLS ONLY: A FACILITY SITE MAP WITH PROPERTY
BOUNDARIES MAY BE SUBMITTED IN LIEU OF GEOGRAPHIC COORDINATES.
G. TREATMENT AREA
Land surface area of contaminant plume:_-12.480 square feet
Land surface area of inj. well network: —4.400 __square feet (< 10,000 fe for small-scale injections)
Percent of contaminant plume area to be treated:_8.4% (must be < 5% of plume for pilot test injections)
H. INJECTION ZONE MAPS — Attach the following to the notification from the Corrective Action Plan.
The attached maps are from the CSA prepared by Engineering and Environmental Science Company (E2S).
(1) Contaminant plume map(s) with benzene isoconcentration lines (Figure 7) show the horizontal extent
of the benzene contaminant plume in groundwater. existing monitoring wells, and existing injection
wells for proposed use are shown on Figure 26R; and
(2) Cross-section(s) locations are shown on Figure 28 and the profiles are presented on Figures 29 and 30
that depict the known or projected depth of contamination and estimate the horizontal and vertical
extent of the contaminant plume in soil and groundwater, and changes in lithology. The existing
monitor wells, and the injection wells for proposed use are shown on Figure 26 Rev.
(3) The potentiometric surface map(s) (Figure 26) indicates the direction of groundwater movement, plus
existing monitor wells.
(Note: The potentiometric surface is presented on Figure 26 from measurements made by E2S. The
groundwater seepage velocity is estimated to be 0.024 feet per day to the north-northeast.
Deemed Permitted GW Remediation NOI Rev. 8-28-2017 Page 2

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.
The purpose of the injection is to flush and emulsify adsorbed gasoline from the aquifer material and
subsurface soil to recover gasoline by total fluids extraction from the water table that is approximately feet
below the ground surface. Once the injectant is introduced to the source area soil and contacts the gasoline
contaminated zone, the surfactant will flush gasoline adsorbed to the soil form an emulsified liquid of
injectant and gasoline that will move by gravily or by vacuum enhanced recovery to the water table where it
may be recovered with vacuum enhanced extraction or total fluids extraction pumps Over two feet of ash
NAPL on the water table has been measured in several source area wells. The estimated injection rate per
well will be approximately 1 5 to 3 0 gallons per minute (gpm) Based on the plume area approximately
35,000 gallons of injectant solution will be introduced to the treatment area in a time frame of a minimum
of 3 days to up to 5 days based on injection rates and maintaining low injection pressures and using up to
four injection pumps per day.
J. APPROVED INJECTANTS — Provide a MSDS for each injectant. Attach additional sheets if necessary.
NOTE: Only injectants approved by the NC Division of Public Health, Department of Health and Human
Services can be injected. Approved injectants can be found online at http://deq.nc.gov/about/divisions/water-
resources/water-resources-permits/wastewater-branch/ground-water-protection/ground-water-approved-injectants
All other substances must be reviewed by the DHHS prior to use. Contact the UIC Program for more info
(919-807-6496).
Injectant: Aerosol OT 75
Volume of injectant: 2,500 pounds maximum
Concentration at point of injection: 1% maximum
Percent if in a mixture with other injectants: 0.5%-1.0% surfactant and 99.5 % to 99% potable water
Injectant: Municipal Potable Water
Volume of injectant: 497,500 pounds maximum
Concentration at point of injection: 99% minimum
Percent if in a mixture with other injectants: 0.5%-1.0% surfactant and 99.5 % to 99% potable water
Injectant:
Volume of injectant:
Concentration at point of injection:
Percent if in a mixture with other injectants:
K. WELL CONSTRUCTION DATA
(1) Number of injection wells: 38 Proposed 0 Existing (provide GW-ls)
(2) For Proposed wells or Existing wells not having GW-Is, provide well construction details for each
injection well in a diagram or table format. A single diagram or line in a table can be used for
multiple wells with the same construction details. Well construction details shall include the
following (indicate if construction is proposed or as -built):
(a) Well type as permanent, Geoprobe/DPT, or subsurface distribution infiltration gallery
(b) Depth below land surface of casing, each grout type and depth, screen, and sand pack
(c) Well contractor name and certification number
Deemed Permitted GW Remediation NOI Rev. 8-28-2017 Page 3

L. SCHEDULES — Brieflv describe the schedule for well construction and injection activities.
Documentation for existing injection wells that were installed before February 28 2023 is provided with this
"Notice". No modifications to the well network are required therefore the injection is tentatively scheduled
for as earl' as March 16, 2023.
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.
Groundwater quality monitoring will begin after the extraction of approximately 1 5 times the injection
volume of liquids is recovered or 45 days after the injection is performed The post injection monitoring
program will include collecting liquid level measurements from up to 37 accessible network injection wells at
the time of each post-iniection source area monitoring event to observe for LNAPL on the water table
Groundwater from 10 injection well locations will be sampled at approximately 30 days, 60 days and 90 days
after the post -injection AFVR is performed Groundwater from these wells will be analv7xd for aromatic
volatile organic compounds (Method 624 or equal) and total dissolved solids (TDS)The purged groundwater
from injection wells sampled will also be monitored for field parameters that will include but may not be
limited to pH. temperature specific conductance ORP and/or dissolved oxygen After 90 days and if no free
product rebound is observed -monitoring at the site will follow the Groundwater Quality Monitoring Plan
submitted in the Corrective Action Plan for the site. The ten wells that will be sampled mgy include: MW-
MR-1 IR-8 IR-10 MW-15/IR-14 IR-20. MW-9/IR-25 IR-28 IR-35 and IR-36. Alternate well locations
may be used if wellheads are not accessible at the time of sampling Note that total fluids recovery from the
source area will be performed following the post -injection AFVR event to remove residual LNAPL and to
recover dissolved phase petroleum reported in the groundwater.
N. SIGNATURE OF APPLICANT AND PROPERTY OWNER
APPLICANT: "I herebi� c•ertifvlty , under penaof law, that I am familiar ii,ith 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. "
David B. Wells Pro'ect Manager
Signature of Applicant Print or Type Full Name and Title
PROPERTY OWNER (if the property is not owned by the permit applicant)
"As owner of the property on ivhich the injection ivell(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 wells) conform to the Well Construction
Standards (I >A NC'AC 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.
aignaturc (if different from applicant) Print or Type Full Name and Title
*9n access agreement belt een the applicant and property owner niav be submitted in lieu of a signature on this form.
Please send this NOI electronically to Shristi.Shrest hxillncdenr jsoy AND one hare] copy to:
DWR — UIC Program
1636 Mail Service. Center
Raleigh, NC 27699-1636
Telephone: [phone]
Deemed Permitted GW Remediation NOI Rev. 8-28-2017 Pie

Table 2: Monitoring Well Construction, Groundwater, and Free Product Elevation Data
Revision Date: 12/09/2022 Incident Number and Name- 95739 / Tark.Rnnvillp. Fleet Maintenance Fnpility \Jnt
. . . . ... . ..
.x*
tit
.
......
•
. . . . .
. ....
.40
-X
X, 44H
J1rOOT*'X-'
D.
X!YW'4r�'N
-:XT
MW-1
IR-1
3DEr/3162-A
12/5-9/22
12/9/22
1 2
5
5 to 15
15
99.23
9.67
9.84
0.17
89.71
Not Assigned
IR-2
RPS/3322-A
12/5-9/22
12/9/22
2
7
7 to 22
22
NM
9.99
9.99
0
NC
Not Assigned
IR-3
RPS/3322-A
12/5-9/22
12/9/22
2 -----7-
7 to 22
22--
NM
9.91
9.91
0
NC
Not Assigned
IR4
RPS/3322-A
12/5-9/22
12/9/22
2
7
7 to 22
22
NM
11.15
11.15
0
NC
Not Assigned
02-5
RPS/3322-A
12/5-9/22
12/9/22
2
7
7 to 22
----
22
NM
9.95
9.95
0
NC
Not Assigned.
IR-6
RPS/3322-A
12/5-9/22
12/9/22
2
7
7 to 22
22
NM
10.03
10.03
0
NC
Not Assigned
IR-7
RPS/3322-A
12/5-9/22
12/9/22
2
7
7 to 22
22
NM
9.81
9.81
0
NC
Not Assigned
IR-8
RPS/3322-A
12/5-9/22
12/9/22
2
7
7 to 22
22
NM
9.93
9.93
0
NC
MW-5
IR-9
3DEI/3162-A
5/25/21
12/9/22
2
5
5 to 15
15
99.17
9.21
11.35
2.14
91.80
Not Assigned
IR-10
RPS/3322-A
12/5-9/22
12/9/22
2
7
7 to 22
22
NM
11.45
11.45
0
NC
Not Assigned
IR-I I
RPS/3322-A
12/5-9/22
12/9/22
2
7
7 to 22
22
NM
9.98
9.98
0
NC
MW-6
IR-12
3DE113162-A
5/25/21
12/9/22
2
5
5 to 15
15
99.23
9.32
11.4
2.08
91.69
Not Assigned
IR-13
RPS/3322-A
12/5-9/22
12/9/22
2
7
7 to 22
22
NM
9.86
9.86
0
NC
MW-15
IR-14
3DEI/3162-A
5/26/21
12/9/22
2
5
5 to 15
15
99,17
9.81
10.04
0.23
89.56
MW-12
IR-15
3DEI/3162-A
5/25/21
8/24/21
2
5
5 to 15
15
98.81
9.59
9.59
0
89.22
MW-8
IR-16
3DEI/3162-A
5/25/21
8/24/21
2
5
5 to 15
15
98.88
9.14
11.25
2.11
91.55
MW-2
IR-17
3DEI/3162-A
3/17/21
8/24/21
1 2
5
5 to 15
15
99.15
1 9,36
11.55
2.19
91.67
MW-7
IR-18
3DEL/3162-A
5/25/21
12/9/22
2
5
5 to 15
15
99.02
9.78
9.78
0
89.24
Not Assigned
IR-19
RPS/3322-A
12/5-9/22
12/9/22
2
7
7 to 22
22
NM
9.2
11.54
2.34
NC
Not Assigned
IR-20
RPS/3322-A
12/5-9/22
12/9/22
2
7
7 to 22
22
NM
9.97
9.97
0
NC
Not Assigned
IR-21
RPS/3322-A
12/5-9/22
12/9/22
2
7
7 to 22
22
NM
9.95
9.95
0
NC
Not Assigned
IR-22
RPS/3322-A
12/5-9/22
12/9/22
2
7
7 to 22
22
NM
10.13
I0A3
0
NC
Not Assigned
IR-23
RPS/3322-A
12/5-9/22
12/9/22
2
7
7 to 22
22
NM
10.17
10.17
0
NC
Not Assigned
IR-24
RPS/3322-A
12/5-9/22
12/9/22
2
7
7 to 22
22
NM
10.39_
10.39
0
NC
MW-9
M-25
3DEI/3162-A
5/25/21
8/24/21
2
5
5 to 15
15
98.88
9.13
11.81
2.68
92.05
MW-11
IR-26
3DEI/3162-A
5/25/21
8/24/21
2
5
5 to 15
15
98.9
9.78
9.92
0.14
89.24
Not Assigned
IR-27
RPS/3322-A
12/5-9/22
12/9/22
2
7
7 to 22
22
NM
9.49
10.99
1.5
NC
Not Assigned
IR-28
RPS/3322-A
12/5-9/22
12/9/22
2
7
7 to 22
22
NM
1 10.91
10.91
0
NC
Not Assigned.
IR-29
RPS/3322-A
12/5-9/22
12/9/22
2
7
7 to 22
22
NM
10.22
10.22
1 0
NC
Not Assigned
IR-30
RPS/3322-A
12/5-9/22
12/9/22
2
7
7 to 22
22
NM
10.3
10.3
0
NC
Not Assigned
IR-31
RPS/3322-A
12/5-9/22
12/9/22
2
7
7 to 22
22
NM
10
10.18
0.18
NC
Not Assigned
IR-32
RPS/3322-A
12/5-9/22
12/9/22
2
7
7 to 22
22
NM
11.78
11.78
0
NC
MW-16
IR-33
3DEI/3162-A
5/26/21
8/24/21
2
5
5 to 15
15
99.34
9.9
12.25
2.35
91.46
Not Assigned
IR-34
RPS/3322-A
12/5-9/22
12/9/22
2
7
7 to 22
22
NM
9.7
9.7
0
NC
Not Assigned
IR-35
RPS/3322-A
12/5-9/22
12/9/22
2
7
7 to 22
22
NM
11.84
11.84
0
NC
Not Assigned
IR-36
RPS/3322-A
12/5-9/22
12/9/22
2
7
7 to 22
22
NM
10.63
10.63
0
NC
Not Assigned
IR-37
RPS/3322-A
12/5-9/22
12/9/22
2
7
7 to 22
22
NM
11.01
11.91
0.9
NC
MW-3
Not Assigned I
3DE113162-A
3/17/21
12/9/22
2
5
5 to 15
15
99.19
9.8
9.8
0
89.39
MW4
Not Assigned
3DEf/3162-A
3/17/21
12/9/22
2
1 5
5 to 15
15
99.54
9.89
9.89
0
89.65
MW-10
Not Assigned
3DEI/3162-A
5/25/21
12/9/22
2
5
5 to 15
15
99.08
10.19
10.19
0
88.89
MW-17
Not Assigned
3DET/3162-A
8/9/21
12/9/22
2
5
5 to 15
15
99.55
9.37
9.37
0
90.18
MW-18
Not Assigned
3DEI/3162-A
8/9/21
12/9/22
2
5
5 to 15
15
99.5
8.45
8.45
0
91.05
MW-19
Not Assigned
3DEI/3162-A
8/9/21
12/9/22
2
5
5 to 15
15
99.44
11.01
11.01
0
88.43
MW-20
Not Assigned I
3DEY3162-A
8/9/21
12/9/22
2
5
5 to 15
15
98.18
9.49
9.49
0
88.69
MW-21
Not Assigned
3DEU3162-A
8/9/21
12/9/22
2
5
5 to 15
15
97.06
9.1
9.1
0
87.96
MW-22
Not Assigned
3DET/3162-A
8/9/21
12/9/22
2
5
5 to 15
15
96.81
10.04
10.04
0
86.77
MW-23
Not Assigned
3DEU3162-A
8/9/21
12/9/22
2
5
5 to 15
15
98.47
10.56
10.56
0
87.91
MW-24
Not Assigned
3DET/3162-A
8/9/21
12/9/22
2
5
5 to 15
15
98.53
10.41
10.41
0
88.12
MW-25
Not Assigned
3DEI/3162-A
8/10/21
12/9/22
2
5
5 to 15
15
97.48
NM
10.91
NC
86.57
MW-26 I
Not Assigned f
3DEI/3162-A
11/10/21
12/27/21 1
2
5
5 to 15 1
15 1
97.77
NM
10.97
NC
86.80
MW-27
Not Assigned
3D 1/3162-A
11/10/21
12/27/21
2
5
5 to 15
15
95,43
NM
8.78
NC
8665
MW-28
Not Assigned
3DET/3162-A
11/10/21
12/27/21
2
5
5 to 15
15
95.71
NM
9.16
NC
8655
DW- I
Not Assigned
3DET/3162-A
11/10/21
12/27/21
2
50
50-60
60
96.98
NM
10.08
None
86.90
Ft BGS = feet below ground surface
Based on arbitrary datum of 100 feet
If free product is present in a well, groundwater elevation is calculated by: [Top of Casing Elevation - Depth to Water] + [free product thickness x 0.8581]
3DE1= 3D Environmental Investigations LLC, Walter L. Davis
RPS Regional Probing Services, Inc, Lawrence Opper

WELL CONSTRUCTION . -RECORD
This funn can be used for single Qr multiple wells
I. Well Contractor Information:
Lawrence D. Opper
Well commotorNarno
NC3322-A
'4C Well COntrador Certification Number
Regional Probing Services
Company Name
Z. Well Construction Permit #-,
List all applicable well pet7n 11s, (i.e. Cwvjt�,, 310te, Variance, 11;1
"—
p,)
3, Well Use (check well use):
Water Supply Well-
OAgticultwul
F JGeothermal (Heating/Cooling Supply)
01ndustrial/Commercial
Well:
O.Aquifcr RechwV
OAqUi-&T StOr-,dgC and Recovery
ClAquiller Test
OExperimental Technology
©Geothermal (ClowdLoop)
OMunicipall?ubfic
UResidential %ter Supply (single)
OResidentialWater Supply {shared)
OGioundwater Reinediation
OSalinity harrier
OStormwater Drainage
MubsidenccControl
OTraccr
under
4. Date Wells) Completed: 12/5/2022 -12/8/2022
5. Well Location:
Jacksonville Fleet Maintenance
Facility owner Narm. F11614YIDN (if applicable)
350 South Marine Blvd, , Jacksonville
Physical Address, City, and Zip
Onslow
Coutrty Parcel Identification No. (PK,)
5b< Latitude and Longitude in degrees/minutes/seconds or decimal degrees.
(if well field, one lavlong is sufficient)
34.754772757 77.447521
N —W
6. Is (are) the weff(s): .Permanent or OTemporary
7. Is this a repair to an existing well: ONAs or EINo
If is a repair,, lf out known well construction ittformation mid eAplain the mature of dre
repair under fill remarks section or on the back
Qfthjs'/brm
8. Number of wells constructed: 24
For muftiok injection or suppit"WAS ONI YWith ffieVMC you eop
submit (me form.
For Internal Use ONLY:
14:WATEXWNES
ERMA
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0 ft'
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DL3hiETLY#I
%rA1T.Q7',V, I
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sch4(l
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Is. GROUT
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M-Eni 1 0 1) & A,81 0 m4 T
0 ft
3 ft.
cement grout
pour
3 I'L
6
bentonite
pour
FROM
I TO
FMA-MRIAt. _F
16 ft'
22 ft.
#2sand
prepack/pour
ft.
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204.DRILLING
LOG (attach
additional sheetq ifueemaryl
FROM
TO
OMCRIIIFION(rotor, hardnew, souttiKk type, zrwa size, t1c.)
0 ft.
0.5 ft.
Pavement over crushed stone
U ft22
ft.
Inter bedded Silt, Sand and Clay
ft.
ft.
ft.
ft.
IR Wells: IR-2, 3, 4, 5, 6, 7, 8,10,11,13,20, 21,22,
22, 23,24,28,29,30, 31, 32,34,35,36,37
22. Certification.
Lawrence Opper
12/30/20PP
Si nature Of cedified well Cbntmckyr Date
Rv siping this form, I hemby ewdh that t1w Was (were) constructed in aexwdance.
with 1MJVC.,lC 02C,0100 or 114 NCWC 02C.0200 Mell Construction Ntandarfkv and 1hat a
copy qf Aix rwordhax been provided ia the swIlowner,
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 necessa­y,
24. Submittal Instructions.
9. Total well depth below land surface: 22 ft.) 24a. Lor All Wells. Submit this form within 30 I
For multiple. weltsweltslist all depths (krample- 3@200 ' and 2@1100') construction to the following, days of completion of well
10. Static water level below top of casing: approx 9
if riveter level iv above casing, use
11. Borehole, diameter: 4 (in,)
12, Well construction method: Geoprobe DPT
(i.e. auger, rotaq, cable, direct push, etc.)
(ft.) Division of Water Quality,,, , Information processing Unit,
1617 Mail Service Center, Raleigh, NC 276.99-1.617
24b. For Injection Wells: in addition to sending the foam 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,
13. FOR WATER SUPPLY NNT.LLS ONLY- 1636 Mail Service Center, Raleigh, NC' 276"-1636
13a. Yield (gpm) Method of test- 24c. For Water Suftniv & Geighermal Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
136. Disinfection type- Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-1 North Carolina Depmunew of rZovironniell andNalural Resources -Division 0i"A"wer Quality
Revised Jan,'2013

L Well Contractor Information-
..........
3162-A
NC Well Coutrador Certification Number
3D Environmental Investigations LLC
caropmy'Kawe
12. Well Construction Permit
Ust al-faMikable well rwotrnctioll perM114 (1.r VIC, an te , a My, State, Vari
3. Well Use (rheekwell use):
Nyater 6upjjjj we -a -
]Agricultunil Dmonicipamblic
3CTC0111crival (Healhig/Coolingr Supply) [3Residontial Water Suplity (single)
IaadustriallCanatuerciul[33kcsidential Water Supply (shared)
irriaatlon
Non -water supply Well.
Aquifer Recharge
:)Aquitbr Storage and Rtcovery
:)Aqui&rTest
:,)Experimental Technology
Geothermal (Closed Loop}
Geothermal (Heatin Loopi)ine (3"O'he'a'a"C (Closed �a(IcOthOrinal (Eicatein tCooling Retunt)
.g, Ri
DGroundwater ,omediation
D'38finity Barrier
E)Stonvnvotcr Drain age*
[subsidence Control
Tracer
other (ex lain Under #21 Remarks)
4. Date Well(s) Compleje& 2-3-21
Wejl1D# Mkt-1
Sa. Well Location.
iacitlwowncr Nalne 'Facility ID9 (if vplicahjo)
300S Marine Blvd Jacksonville NC
Mysical Address, City, alit lip
Founty
PAMCI Identification No. (PK)
51>-Latitudeand longitude in degreestwinutedseconds ordecimuldegrees:
(it vdt field, one 140ong is sufficient)
N
W
6. 16(alv) the ivell(s) , Operinafleat or OTemporary
7, Is this a repair to an wfisting well; E)yes or 01-40
Ifillis iir a rePalr.ftll 0111 kROMI W11 COM&-don iftforntafiva and evluin the mitre of the
tePff irnAder 0.11 rtftwh swilon or tm the back of fid4fom.
S. For Geoprobe/M or Closed -Loop Geotherinal Wells having the swine
construction, only I GW-1 is needed, Indicate TMAL N(IMBER ofAvells
drilled,
9. Total well depth below land aurlaet:
10. Static Ivater level below top of euaefag:
11"Wer la.?d it above otuing, live 11,
11-Borchole diameter, a
A uger
12. Well construction method.. 'A
auger, rotuy, 0.*10' dipWit, cm.)
1*'or Inttmal Ike Only:
BY signing lhis 10rfnI h-TtY -n!6� 11101 the Ivelf(i) ims (here) wnsinteled in
with 15A AVAC 02C,0100err 1544 NCAC 02(.1,m,&) ivell (,,onsyrijollon Sjnoards and ilot a
copy A/11AV recor4 has been provided to the cell owner.
23. Site diagram or additional well detalls.-
YOU MY use the back Of this page to provide addifional %yell site details or well
constmetion details. You may also attach additional pages ifnecessary.
SURNIUL-1 M,;rrRTJCrl NS
�AL INSTRUM
24a. FqLA! Wells. Submit this form within 30 days of completion of wVIl
coristmcdon to the Ibilowing:
Dividon of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27( ;99-1617
24b. For Thiettion Well,,. In addition to sendhig Me form to tile addms in 24a
above, also submit One cOPY Of this form within 30 days of completion of well
constmation to lhie followirig-
FOR WATMI SUPPfy WELLS ONIV. MvWon of Water Resources, Underground Injection Control Program,
1436 Mail Service Center, Raleigh, NC 27699-1636
Da. Yield (gPin) Method of lest: 24c. For Water Supply & biLetion Wcjj$: In additioa to sending the, form to
the address(es) above, also submit one col)y of this form within 30 days of
13b.DLsinfectiou type: Amount-, COMPICtiOn Of well constnietion to the county healti, (lep
artiltent of !lac county
Where constmeted.
Foun OW-1 North Carolina Department ofBaviromental Quality- 1)ivlsioa
I Ro�qsvd2-22-2016

MOM
1. Well Contractor bdoruntiou:
a
Well Contractor Nanto
3162-A
NC ky-01 Coxga'aor
3D Environmental Investigations LLC
I Well Construction Pertalt4;
U0411'applIcable (I--, UIC, County, Stole, Varkmec, 7t—e)
J. Vvelt Use fettock well use).
0municipw/ptiblic
(14taking/CoofingSuppty) DResidential Water Supply (single)
louncicial DResidential Water Supply (shared)
Nowlynter supply Well.
Rcdiargc
0Groundwater Remediaticit
Storage and Recovery
0Salinity Barrier
Test
0swanwater Drainage
rental Technology
E3Subsidence Control
final (Closed Loop)
DI'm wr
Aqfficating/Cooling izetum)
nouter (explain under #21 F
4, Date Well(s) Conwicted- C-25-21 W 41 ID# Inv-5thrul 3
$a. Well TAcodon-
FucitityfChvaerirnatae Facility 100 (if2pplitable)
300 S Marine Blvd Jacksonville NC
Physical Addrfts, City, and Zip
County Paml Id=fification No, (NN)
gb, faatltffde ant] lot%4tuda In degmus/roinates/seconds or dochnal degivos.,
(ifwell field, otto h0ong is aufficiont)
N —w
ms(rtro) thewoll(R)MI-erout-ent or DT-ntparory
7. Is this a -repair loan existing well- Year or No
11Ws
8.'For GeoproixIDIT or Closed -Loop Goothernmi Wells having the same
Construction, only I GW-1 is needed, indicate TOTAL NUMBER ofwtlls
9. Total well depth below laird surfs 9@15 (ft.)
For wuNple writs list aft depths �f diffierem (example, 3@200'4rd2@100�
10. Slade wator lovel below top of wing- 1M*1 It abov casing, toe
11. Horehole dianittev 6
Ciao
or.Internal U-so Only:
14. WATER -ZONES
-!It —
TO
it.
ft.
CASING Paz
utti-cumt wdb) OR LINER (if st licabie-)
I DIAMM11 I
THICKNIM
ATERIAL
16. INNER
CASING OR i3RING f2tof
closed -loop)
MOM
TO
DYAMSTM I
TIUMN
I KmTfmfil�
0tt.
fits
2
sch 40
PV
TO I
DLOM
SLOrsin
TmCK?*-'S
NIATMAL
15 rt.
2
- ---------
010
--
40
Ia. GROUT
FROM
0 rl.3
TO
r.
Cement
4 fit
bentanite
1% SANDIGRAVEL
PACK
(if opull=b1c)
fto
—m
RIAI'
4 ft.
15 IL
#2sand
20. D
LOG attai>
tr additional shcets if twm&"")
FROM
TO
ft.
ft,
ft.
ft.
ff.
ft.
-L.RFMARRS
22. Cerifficotion:
5-27-21
Well Contractor Daft
By signing daft fume, I AmAy ewyy that the iorflft) wvu in occordancr
wadi BANCAr WCAIM or JSA;&CAC 02C,0200 1144 Consimcdon Sjojdwth anti Imu a
cti,py ofthivrecard Im been prmd&d to the wil owner,
23. Site diagmto or additiortul well details:
You may use 0w,, back ofthis Paso loptovide additional well site details or well
construction details. You may also attach additional pages ifnecessary.
"UMNUTT6:INSTRUCTIONS
24a. For All Welb Submit this form within 30 days of completion of well
construction to the following:
DivisJun of Whter.Rewurew, Intbrmfien. Frocessing Vnit,
1617 bWl Serylee Center, Raleigh, NC 27699-1617
24b. Fkbdecttou Wells: In addition to sending the form to the address in 24a
ei .1 j, �Ii �r A,: r- *1 9 .1.
12, Well comitruction meahod.. above, — submit — copy s rm NY 4 1 k 30 days of compiction of well
0;4, w9er, Mw)� mble, dirta ptuh, tic.) con=ction to the following.
Division of NVatur Xtmouvm-vt Undurground Injection Counrolkregraw,
FOR WATER SUP -PLY WELLS ONM 1436 Mall Service Center, Raleigh,NC 17094636
13% Yield (gWo) Method of test- 24c. Foator S-upply & hkigtion WAAls: In addition to sending the form to
the adtitess(es) above, also submit one copy of this funn within 30 days of
13b. Disinfection type., zkaaxtunt COMPIction Of Well construction to the wtmly health departwot of the county
-hem constructs d.
rona aw- t Nmilt cmfina Dti-witsw ofBilvirnawwalm (,)tuifity- Di'dsioa ofWaterRawarres Rtvistd 222-2016

WE LL CONSTRUCTION RECORD (GWA)
I. Well Contractar Infon"adom
Weil ctintcao'.v Nmac
3162-A
NC Well Coafractor Certification Number
3D Environmental Investigations LLC
Company 14=*
Z Well Coustraction Wrinit #.
Mj f all applIcah fe a w It com frua [on p ern dis ( i ,e, VIC, Co wy. Slate, Var Janco-, etc.)
a. Weil Use (check welt use),
Water Supply Well:
Agricultural
oNfurticipaypublic
Geothcrtnal (licatinglCooling Supply)
f3flesidentiat Water Supply {singje)
lndustriafA.�otnmcrcial
EIRcsidential NValer&ipply (shared)
Nan -Water Supply Wel 1:
)( Monitoring
DRecovery
111jectjon well:
Aquifer Rctharge
E3Groundwatcr Itanediation
Aquifer Storage and Recovery
E)Saffidty Barrier
AquiWTcst
ostornmAraterorlinage
Expt6tntnlal Tealinalogy
0SUb5idimce Conw
Geothcraial (Closed Loop)
0Other (explain under #21 Remarks)
4.Da1eWeI1(4)Campletvl,- 5-26-21 Weil it Mw-UW16
$a. Well Location,
Facilitylowncr Name Facility TD# (if applicablo)
300 S Marine Blvd Jacksonville NC
Mysival Address, Cip y. and Zip
0mly Pamal identification No, (111H)
51& Latitude and longitude in degmes/rulante-sifseconds or dedraul degms-
(ifivell fidd, atia tafflong is aufficitut)
N _W
4. yx(am) the NVOIT(s);0Per ownent or El'remporwy
oTres or No
'tihin Ira repoi-' fill Mir kpown well wiltmiction fnftvnwdon md explahl the njnme 4 the
rvpafr vntlerl2l rwtRvrkx.ierj10 or on the IAw* stfrhlvje,7m.
8. For GeoproheMM or Closed-Loap (Icothmnal Well.9 having the same
construction, only I GNV-1 is needed. lndicztj.-� TOTAL IMMBEIt of wells
drilled:
9, Total well depth helo-or land surface. 3@15
rormulliple tivlh list all depths 3@200'mrI2 @100)
I D. Static water level helow top of easing:'
If UW ter lm! i h ab 0 ivpwing, use
i1.i3ot�ht)itrRli:Rirtctarr: (in.)
121, Well comtrudian method: -Auger
(Le, auger, romy, rable, dimpt pmh, do.)
orinternal[Ise Only.
14.)VATERZONES
FRONT
TO
DESCRIATION
10, OUTER
FROM MCKNEVS
,SSA' FIUAL
ft-
1.
.......
KIMU
CASING OR
ING f enfizernwI
....
elowd400v)
.-MIDINI
TO
D101MR
unclea—IS9
MA` VRIM
0
2 In.
sc 4n
pvc
17. SCREEN
I
'ro
puhlmg
I StOTSM8
I T1110KNIM
I M TRIALet..
1 010-140
1 RV_Q
L04,
MOM
Ta
MATERIAL
EMPLACEMM MRMOID AMODW
e t
3
4
bentanite
410
19. SAND/GRAVEL
PACK
(it milleabW
FROM
I TO
hfATIMIAL
em Ifflunr =1101a
4
#2sand
INVEMEMSONNNM
220.
FROM
TO
2 h REMAW
. ......... .
en
22.
ZI; r'4' ZV4-" 5-27-21
Sipatwe oftatffitil Well Cmtmator I'Aft
fly signing this farm, I hereby certify that the imellfs) mv (iwre) con-amded it) arcmdaixy
Mth 15A NCAC 02C R100 or IM XCAC 02C.0200 }fell Ctrnstrrrttfnta Statxiard r and Thu a
Cqpy of1bb reeard has 1,een provitiod 1(i the twil owmr.
23. Site d6gramor aildifloval weltdotalls:
You may use the back of this page to provide additional %vell site details or wolf
wnstmotion details. Ybii may also attach additional }sage:, ifnece5sary.
SUDMMAL IDEMILCTIONS'
24a. For Ali W,-16: Submit this faint Nvithin 30 days of completion of well
'Qonstrudion to
Division of Water Resourcea, processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b, For Inlectlan Wells., In addition to sending the form to the address in 24a
above, also subrait one copy of this fban within 30 days of completion of Nvoll
construction to the fallowing:
Dlvlalon of Water Iteaeurcts, Underground lix3sx1lon Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail SexMce Center,11alodgil, XC 27699.106
13a. Yield (xpm) Method of test: 24c. For Water Supply & Injection Wells In addition it) sending the form to
the addms(4s) above, alno submit one copy of this forth within 30 days of
13b. Disinfection type; Amount: mripIttion of well construction to the county health depqrtment of the eonnty
wilev; coustructmL
.Form GW-1 North Carolina Dcparfrnent of Envirwimeotal Qtullity -.Division of Water Rosourcos kevisvl 2-22-7016

- € MW-1/IR-1
3 IR-2
Approximate
Diesel Fuel
Dispensing
Pumps
LEGEND
i� ®1 APPROXIMATE FREE PRODUCT AREA
APPROXIMATE INJECTION LOCATION
Approximate
Gasoline
Dispensing
Pumps
o � 1
SCALE
(FT) N orth
SITE MAP
A
Job No.:
22-111
Cape Lookout
Scale:
As Shown
JACKSONVILLE FLEET MAINTENENACE
Environmental Sciences-
Date:
February 27, 2023
350 SOUTH MARINE BLVD.
8005 Clear Brook Drive
Fig. No.:
26R
JACKSONVILLE, NC
Raleigh, NC 27615

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