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HomeMy WebLinkAboutWI0600062_Permit Application_20100715-z- MCDENR Borth Carolina Department of Environment and natural Resources Division of Water Quality Beverly Eaves Perdue Coleen H. Sullins Governor Director July 15, 2010 Robert Crumpler 13931 Spivey's Corner Highway Newton Grove, NC 28366 Subject: Acknowledgement of Application No. WI0600062 Lila Jackson Property Injection In situ Groundwater Remediation Well (5I) Sampson Dear Mr. Crumpler: Dee Freeman Secretary The Aquifer Protection Section of the Division of Water Quality (Division) acknowledges receipt of your permit application and supporting materials on July 13, 2010. This application package has been assigned the number listed above and will be reviewed by Michael Rogers. The reviewer will perform a detailed review and contact you with a request for additional information if necessary. To ensure the maximum efficiency in processing permit applications, the Division requests your assistance in providing a timely and complete response to any additional information requests. Please be aware that the Division's Regional Office; copied below, must provide recommendations prior to final action by the Division. Please also note at this time, processing permit applications can take as long as 60 - 90 days after receipt of a complete application. If you have any questions, please contact Michael Rogers at 919-715-6166, or via e-mail at michael.rogers@nddenr.gov. nddenr.gov. If the reviewer is unavailable, you may leave a message, and they will respond promptly. Also note that the Division has reorganized. To review our new organizational chart, go to htip:Hl12o.enr.state.nc.us/documents/dwq_orechart.odf. PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUIRIES ON THIS PROJECT. Sincerely, '_ �� for Debra J. Watts Supervisor cc: �Fayettevl0Regiorial-Office;ALquiierProteetion Section- �' Raj Shah (Agra Environmental - 1517 Old Apex Rd, Ste 100, Cary, NC 27513) Permit Application File WI0600062 AQUIFER PROTECTION SECTION 1636 Mail Service Center, Raleigh, North Carolina,27699-1636 - Location: 2728 Capital Boulevard, Raleigh, North Carolina 27604 Phone: 919-733-3221 1 FAX 1: 919-715-0588; FAX 2: 919-715-60481 Customer Service: 1-877-623-6748 Internet: www.ncwaterauality.org An Equal Opportunity 1 Affirmative Action Employer One N ®rdi Carolina 17 �� `State of North Carolina Department: of Environment and Natural Resources Division of Water,Quality ' APPLICATION -FOR PERMIT.TO CONSTRUCT AND/OR USE A.WELL,(S) FOR INJECTION `Type 5I Wells -In Situ Groundwater. emediation / Type' 5T Wells —Tracer Injection • Do notuse this -form fof remediation systems that extract eontaminated groundwater, treat it, and reinject the .treated groundwater Submit TWO copies of the completed application and all attachments :to the address on the last page of.this form. Any changes made to this form will result in the: applicationpackagebeing returned., Application Number (to be completed by DWQ).. CC ( I. = GENERAL- INFORMATION. - . -1:. Applicant's Name (generally the responsible party):`. 2: ROBERT SHERMAN'CRUMPLER..' 3: Signing Official's Name*: ROBERT SHERMAN CRUMPLER Title `Owner .:*. Signing Official must be in accordance, with'instructions,in part VI. -on page'7:. 4. .Mailing address of applicant: 13931 Spivey's Corner Highway City: Newton Grove State. NC Zip:,." 28366' Telephone number: ,91,0-21,4-9841 Fax number: 5. ..Property Owner's Name (if. different from Applicant):, ROBERT.SHERMAN CRUMPLER _ -6. ' Property Owner's mailing address: 13931 Spivey's Corner Highway City: Newton Grove . State: NC Zip:28366- . 7. Name and -address of contact person who can answer questions about:the proposed injection project: Name: Raj Shah 'Title: Technical Director Company: Agra Environmental Address: 1517 Old Apex Road,_, Suite 100 ,City: Cary -State: NC Zip:27513 "Telephone_number:"919-858-5350 ext 105 Fax -number:-858=5351 Email Address: rbshaligagraenvironmental:com - - l3ECEIVED / D ENR/pVy� H. PERMIT-qu, .INFORMATIOM. ferProtection """�ir'W Ju 1. .Project is:, New. .2. '.If this "application is,being. submitted for "renewal or modification to ,an ekisting permit, provide: existing permit number and the, issuance date = .'-For renewal without modifications, fill, out- sections I & ]II only,. sign the certification onalie last page' of,thi , form, and obtainthe property; owner's -signature to indicate'consent. (if the applicant is not the.owner). , Revised 6/09`: k-SI/5T" _ Page l:.of 10 .. RECEIVED I DENR 1 DWO, State of North -Carolina AGU{FFR P D�ECTI� T{ON Department of -Environment and Natural Resources Division of Water Quality, . APPLICATION FORTE'RMIT TO CONSTRUCT AND/OR USE A WELL(S) -FOR-INJECTION Type 5I Wells —In Situ Groundwater Re mediation 1 Type .5T_Wells Tracer Injection Donot use this form for remediation systems that extract contaminated groundwater, treat -it' and re 'ect the treated groundwater. ' Submit TWO copies of the completed application and, all attachments to the address on the last paa of this.form. . • . Any changes made_ to this form will result in the. applicationpackage being returned: Application Number (to be completed by DWQ): I. GENERAL INFORMATI I.," Applicant's Name (generally the- sponsible party): 2. Ajzra Environmental Inc 3. -Signing Official's Name*:Ra' Shah Title: Technical Director * Signing Offici must be in accordanc ith instructions in part V1 on page 7: 4.: Mailing address of applicant: 1517 Old ex Road, Suite 100 City: Cary Telephone number: 919-858-5350 5. „Property Owner's Name (if different from App scan 6. Property Owner's mailing_ address: l 31 Spivey's City: Newton Grove 7. , Name and address of contact person w o can answer qu Name: Raj Shah Company: Agra Environmental Address: 1517 Old Apex Road, uite 100 City: Cary Telephone number:-919-85-5350-ext 105 State: NC Zip: 27512 Fax number: 919-858-5351 ROBERT SHERMAN CRUMPLER ner Highway State: NC' Zip:283.66 s•about the proposed injection project: Title: Technical Director State: NC Zip:27513 " . Fax -number: 858-5351 Email Address: rbshah a aenvironmental.com H. PERMIT INFORMATION: 1. . Project is- New . 2. If this application is being submitted for renewal or modification to, an existing permit, provide: , existing.permi"t number and the issuance'dafe, _ For renewal without .modifications,; fill out sections I &]El .only, sign the certification on the last page of this form, and obtain the property owner's'signature to indicate consent (if the, applicant is not the owner). Revised 6/09 UIC=SI/ST` Pagel of 1 APPLICATION FOR PERMIT.TO CONSTRUCT AND/OR"USE A'WELL(S) FOR INJECTION- Type 5I Wells -In Situ Groundwater Remediation / Type 5T.Wells —Tracer Injection III. INCIDENT &&'FACILITY DATA. - A: FACILITY INFORMATION 1. Facility name: Former Lila Jackson Property 2. Complete physical address'of the facility: 13931.Spivey's Corner Highway," _ City: Midway County: Sampson County State: ,NC . Zip: 28366 _ B. INCIDENT -DESCRIPTION 1." Describe the source of the contamination: One 500 ,gallon and one 1.,000 gallon gasoline underground' storage tanks (USTs) are believed to be the primary source of petroleum soil and -groundwater contamination detected at the site. The USTs have been removed, however, soil and groundwater contamination remain.. Agra excavated approximately250 tons of impacted soil and groundwater but, contamination remains under the existing structure. Agra proposes to treat the -groundwater adjacent to the" excavation and structure with chemical oxidants, 2. List all contaminants present in soils or groundwater at the site (contaminants may be listed in groups, e.g.,. gasoline, diesel, jet fuel, fuel oil, chlorinated ethenes, chlorinated ethanes, metals, pesticides/herbicides, etc): . Gasoline 3. Has LNAPL or DNAPL ever been observed at the site (even if outside the injection zone)? No If no, list maximum concentration of total VOCs observed at site: 33,.772 ppb. 4. Agency managing the contamination, incident: (X)'UST Section Superfund Section : ( DWQ"Aquifer Protection Section (.Solid Waste Section (Hazardous Waste Section (Other: 5. Incident managers name: Mark Petermann and phone number 919-733- 1331 6. Incident number or other site number assigned by the 'agency managing the. contamination incident: 5986 APPLICATION FORPERMIT TO..CONSTRUCT:AND/OR USE A WELL(S) FOR INJECTION - Type 5I Wells -"In Situ. Groundwater Remediation / Type 5T.Wells "Tracer Injection• IV. INJECTION DATA, A.'INJECTION FLUID DATA. 1" List all proposed injectants. NOTE. Any substance to be -injected as.a tracer or to'promote'in.situ remediation must be,.i-eviewed by the: Occupational and Environmental EpidemiologySection (ORES) oj,`the Division "-of Public'Health, Department of . Health and Human Services. Review thelist of approved injectants-or contact the UIC.Program:to determine if the injectants you are proposing have been reviewed by OEES. - . ' Inj ectant: sodium persulfate (Klozure CR) Concentration at point of injection: 27.6% by weight _ Percent if in a mixture.with. other injectants: Inj ectant: Concentration at point of,irijection: Percent if in a mixture with other inj ectants: Iiij ectant: Concentration at point of.injection: Percent if in a mixture with'otherinj ectants: Inj ectant: - Concentration at point of injection: Percent if in a mixture with other inj ectants: 2. Source of fluids used to dilute or chase the inj ectants listed above: ( None :. (X)-Municipal water supply _- = ( Groundwater from private well or any well within % mile of injection siteAir . =:... .. ( Other: _ 3. If any well within mile 'of injection site, a private well, or surface water is to be used as the fluid source, supply, the following information: a. Location/ID number of source: b. Depth of source:. c. Formation: d. Rock/Sediment type: e. In Attachment C, provide a -current;. complete chemical analysis of the -water, from well, including • analyses -for all contaminants suspected or historically recognized in soil orgroundwater on the site. NOTE: If contaminated groundwater is to be used as the dilution. -or chase fluid • this -is not the proper permit . application form. Yoa! must apply fora closed -loop groundwater rerriediatio`n permifusing implication form G "S. Revised 6/09 UIGSUST Page 5 of 10 APPLICATION FOR.PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR INJECTION Type. 5I Wells —In Situ Groundwater Remediation / Type.5T Wells'- Tracer Injection, B. PROPOSED OPERATING PARAMETERS 1. Duration of Injection: time necessary to inject 75 gallons of a Klozur CR/water mixture per well in six wells . while maintaining 20 psi or less for each injection event= . a. Maximum number of separate injection events: 2.events b. Expected"duration of each injection event: 1 day to inject into 6. injection wells c. Expected duration between events. (if more than one event): 2 weeks 2. Injection rate per well: maximum pumping rate of 5 gal per minute or less per well while maintaining an injection pressure of 20 psi or less 'gallons per minute (gpm) 3.. Total Injection volume: 75 gallons total permell, (6 wells) gallons per day (gpd); 450 gallons per event (if separate events) 4. Injection.pressure: 20 psi or less pounds/square inch (psi)' 5. Temperature at point of injection:' temperature of groundwater and ambient air temperature at the time of injection, —OF 6. Briefly describe how the above parameters will. be measured and controlled: 75 gallons of Klozure CR/water mixture will be mixed in a tank and then"pumped through an inflatable packer; pumping will not exceed 5 gallons per minute and the pressure during puniping_will not exceed 20 psi. This process'will be repeated for each injection well and for each injection event. 7. Estimated hydraulic capacity of the well: 5 gallons per minute = gpm . C. INJECTION WELL CONSTRUCTION DATA 1... Injection will be via: (X) Existing well(s) proposed for use as an injection well. Provide the data in (2) through (6) below to the best of your knowledge. ( Proposed well(s) to be constructed for use as an injection well. Provide the data in (2) through (6) below as proposed construction specifications. 2. Well Drilling Contractor's Name: Mark Creel NC Well Contractor Certification number: 402914 .3. Date to be constructed: 5/7/2010 - Number of borings: 6 . Approximate depth of each boring (feet): 10 feet 4. Screened interval/Injection interval of.injection wells: Depth: .5 to 10_ feet below ground surface (if multiple intervals, indicate shallowest and deepest depth). 5. Well casing (N/A if.injectiori is through direct push rods):.. Type: ` (X) PVC ( Stainless steel( Other: Casing depth: _0 to 10 'ft. Revised 6/09 UIC-5I/5T - Page 6 of 10 APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR INJECTION . Type'5I Wells In Situ Groundwater Remediation./ Type 5T Wells'— Tracer Injection V. ATTACHMENTS Provide the following items as separate attachments with the given headings: A. SITE HISTORY Provide a brief description of the site history.including: (1) site usage historically and present, = (2). origin of the contamination, (3) previous remedial action(s). . NOTE: G.S. 89E-18 requires that any geologic plans, reports; or documents in which the performance is related to the public welfare or safeguarding of the environment be prepared by a licensed geologist or subordinate tinder their direction. G.S. 89E-1-3 requires that all drawings, reports,.or documents involving geologic workprepared or approved 'by a licensed geologist, or.a subordinate tinder their direction, be signed and.sealed by the licensed geologist. B. HYDROGEOLOGIC DESCRIPTION ' Provide a hydrogeologic description, soils description, and cross section of the subsurface to a depth that includes the known or projected depth of contamination. The hydrogeologic'description shall include: (1) thexegional geologic setting;. (2). significant changes in lithology; (3) the hydraulic conductivity, transmissivity, and specific yield of the aquifer to be used for injection, including a description of the test(s) used to determine these parameters; and . (4) the depth to the mean seasonal high water table. C. INJECTION FLUID COMPOSITION Describe the chemical, physical, biological and radiological, characteristics of each injectant. Attach the Material Safety Data Sheet (MSDS) for each injectant.'If a private well or a well within- % mile of the injection site is used as the source well, include chemical ,analysis of source -fluid here. D. - INJECTION RATIONALE Attach a brief description of the rationale for. selecting the injectants and concentrations proposed for injection, including: (1) , "goals of the injection project;. (2) explanation and/or calculations of how the proposed injectant volume and concentration were determined; (3) a description of the reactions -between the injectants and the contaminants present including specific_ breakdown. products or intermediate compounds that may formed by the injection; and (4) summary results of modeling or testing performed to investigate the injectant's potential or susceptibility to change (biological, chemical or physical) in .the subsurface. E. -INJECTION PROCEDURE AND EQUIPMENT Provide a detailed description -of all planned activities related to the proposed injection including but not limited to- (1) , . construction plans and materials; (2) operation procedures; (3) a detailed diagram of the sutface and subsurface portions of the "system; and (4) . a planned injection schedule. Revised 6/09 UIC-5I/5T Page 8 of 10 APPLICATION FOR PERMIT TO CONSTRUCT, AND/OR USE A WELL(S) FOR INJECTION Type 5I Wells — In Situ Groundwater Remediation / Type 5T Wells —.Tracer Injection F. MONITORING PLAN Provide,a plan for monitoring the results of thediijection, including: (1) a list of existing and proposed -monitoring wells to be used,. (2) • a list of monitoring parameters. and analytical methods to be -*used; and ' (3) a schedule for sampling to monitor the proposed injection'. NOTE: The selected monitoring wells must be located so as to detect any movement of injection fluids, process by= products, or formation fluids outside the injection area or zone: The monitoring parameters should include the,target contaminants as well as secondary or intermediate contaminants which may result from the injection - and other parameters .which may serve to indicate the progress of the intended reactions, such as pH, ORP, dissolved oxygen, and - other electron acceptors and donors. The monitoring schedule should be consistent with .thepace. of the anticipated reactions and rate of transport of the injectants and contaminants. G. 'WELL DATA Provide .a tabulation, of data on all existing or abandoned wells within % mile of.the injection well(s) which penetrate the proposed injection zone, including, but not limited to,,monitoring wells and wells proposed for use as injection, wells. Such data shall include a description of each well's use (water supply., monitoring, etc), total depth, screened or -open borehole depth interval, and well construction or.abandonment record, if available. H. MAPS Attach the following scaled, site -specific maps: (1) Area map based on the most, recent USGS 7.5' topographic map of the area, at a scale of 1:24,000 and showing the location of the proposed injection site: (2) Site map including: ' a. all property boundaries; b. all buildings within the property boundary; C. existing and proposed injection wells'or well field(s) d. ' any existing sources of potential or known groundwater contamination; including waste storage, treatment or disposal systems within 1/ mile of the injection well or well system; e. all surface water bodies within % mile'of the injection well or well system; and . f. all existing or abandoned wells within % mile of the injection well(s) which penetrate the proposed injection zone, including, but not limited to, monitoring wells and wells proposed, for use as injection wells. (3) Potentiometric surface map(s) including: a. direction of groundwater movement b. , existing and proposed monitoring wells c. existing and proposed injection wells (4) Contaminant plume map(s) including: a. the horizontal extent of the contaminant -plume, including isoconcentration lines b. existing and proposed monitoring wells c., existing and proposed injection wells (5) . Cross-section(s) to the known.or projected depth of contamination, including: a: horizontal and vertical extent of the contaminant plume,..including isoconcentration lines b. major changes in lithology, c, existing and proposed monitoring wells d. existing and proposed injection wells Revised 6/09 .. UIC75I/5T Page.9 of 10 APPLICATION FOR PERMIT TO 'CONSTRUCT AND/OR USE A WELL(S) FOR INJECTION. Type 5I Wells =In Situ Groundwater Remediation / Type 5T Wells — Tracer Injection VI.. CERTIFICATION (to be signed as required below or by that person's authorized' agent) NCAC 15A,2C .02.11(b) requires that"all permit- applications shall be signed, as follows: l . - for a corporation:. by a responsible corporate officer, 2. for a partnership or sole proprietorship: by a generaTpartner or the proprietor;.respectively :3. for a municipality or a state; federal, or other public agency: by either a principal executive officer or ranking publicly elected -official . , 4. for all others: by the well owner: ; If an authorized agent is signing on behalf of the applicant, then supply a letter signed by the applicant that names and authorizes their agent. I .hereby certify under penalty of law that I have personally examined and am familiar with the information submitted in this document and all attachments therein, 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 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(s) and all related appurtenances in accordance with'the approved specifications and conditions of the Permit. Printed Name and Title:_ - IP, b . ✓T 2. e L /7 D f . Signature: zz_Date: r-- VII. CONSENT OF PROPERTY -OWNER (if the property is not owned by the applicant) ("Owner" means any person who holds the fee or other property rights in the well being constructed. -4 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.) Asowner 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 . (Title 15A NCAC 2C .0200). RECEIVED 1 DENR 1 I)WQ Printed Name and Title: - AgVifer Protection Section - J 1 3. DID Signature: Dater Submit TWO copies_ of the completed application package, including all'attachments, to: UIC Program Aquifer Protection Section IVED"I DE IDWQ North Carolina DENR-DWQ AQUIFFR �TF ON SECTION 1636 Mail Service Center ' ` RECEIV I DE I DWQ JU . Zola' _ Raleigh, NC 27699-1636 _ ku'ifer Prat n Section Telephone (919) ,733-3221 - JUL 0 Revised 6/09 UIC-5I/5T Page 10 of 10' ATTACHMENT A SITE HISTORY A vacant one-story. cinder block building (formerly the gas station/store) currently exists towards the front..of the property adjacent,to the highway (Figure 1, Figure 2, and.Figure 3). The structure .is in fairly poor -.condition. and is presently not in: use. -The roof. of the building had been removed and, only the cinderblock walls remain. A trailer .home,. . currently -occupied by the property owner, is located near the back of the property. One active on -site water supply well • (WSW) is located approximately 300 feet from the source of the release (Figure 4 and Table. 1). The. WSW is currently being used as a drinking water source. One 500. gallon gasoline underground storage tank (UST) and one 1,000 gallon gasoline UST were excavated and removed from the site in September.of 1991. Five shallow groundwater monitoring -wells were reportedly installed in October of 1991 by the. North Carolina Division of Waste Management (DWM) UST'section. Subsequent groundwater sampling and analyses conducted by Richard Catlin and Associates, Inc. and Aquaterra . Environmental Consultants. (Aquaterra) confirmed that 'groundwater had been, impacted with petroleum contaminants that exceeded North" Carolina NCAC. 21L groundwater standards (groundwater standards). Envirochem Remediation Services, Inc. presented a report dated January 15, 1993 to the DWM.UST section that -described the removal and disposal of 449.19 tons of petroleum contaminated soil. Samples were collected prior to the backfill of.clean soil that showed that petroleum contamination remained at the site along the walls of the excavation and in the groundwater. Aquaterra installed a remediation system consisting of .11 air sparging points (11 feet deep with 2 feet of screen) and 'a soil vapor extraction trench (5 to 5.5 feet deep).,at the site and .prepared an Air-Sparge Remediation.System Design Report dated July.7; 1994. .The system is presently not in use. Law Engineering and Environmental'Services: (Law) in a' Groundwater Assessment, and Remedial Activities- report -dated December Z, 1994 stated' -that one of the monitoring wells installed by the .DWM UST. section had been destroyed,(MW-4-) and that Aquaterra had previously installed five. additional monitoring wells. On October 17, 200.8, Withers & Ravenel conducted a receptor survey of the site and surrounding properties and sampled seven monitoring wells and the three -nearest water supply wells. - They concluded that groundwater had been impacted with petroleum compounds that exceed their groundwater standards in one monitoring' well. Municipal -water is available in the vicinity of the site, however, several private potable water supply wells are located within 1000 feet. Agra Environmental, Inc. (Agra) conducted water supply well sampling events at the Lila Jackson site on July 8, 2009 and August 20, 2009. Agra returned to the site on October 8, 2009 to -install soil borings and one monitoring well and to sample the groundwater in monitoring wells and water supply wells. The water table is present between 1.41 to 4.41 ' feet below the ground surface (BGS). The local groundwater is. flowing to the north. Free product was -not present in any wells during .these groundwater sampling events. Agra conducted a Phase II Limited Site Assessment (LSA) at the Lila Jackson site during the week of March 9, 2010. Agra installed nine soil borings, two new shallow monitoring wells and two deeper Type III monitoring_ wells using air rotary drilling equipment. Additionally, two monitoring wells that had been previously destroyed were also replaced. Soil and groundwater at the site were found to be'impacted .with petroleum contaminants at concentrations that exceed . the NC DWM UST section, soil to _ groundwater maximum soil contaminant concentrations (MSCCs) and the N.orth.Carolina NCAC 2L groundwater standards (groundwater. standards), respectively. On May 5, 2010 through May 7, 2010 Agra returned to the site and excavated 249 tons of petroleum 'impacted . soil adjacent. to the former store , (Figure 3) where _ the highest contaminant concentrations of soil and groundwater had been previously detected. Prior :2 ATTACHMENTS _ HYDROGEOLOGIC DESCRIPTION According.to the Geologic Map-'ofNorth Carolina (1985), the site is located in the Black Creek Formation within the Coastal Plain ' Physiographic Region. The Black Creek Formation consists of gray to black; lignitic clay and contains thin beds and laminae of fine grained, micaceous sand and -thick lenses of cross -bedded sand. Agra encountered four. general soil types while excavating contaminated- soil: Black organic silty sand was present from the surface to a depth of.l to 1.5. feet below the surface. A1.0 foot thick layer of white, silty sand was present beneath the black sand. The :white sand was -underlain by light brown,. slightly orange, clayey, silty sand.to a depth of between 4. and 6 feet. Red and orange, sandy, silty clay was .encountered: in the excavation below the, brown. sand down to the base of the excavation at approximately 10 feet. Previous site investigations have determined that the. base of the clay interval is. approximately 15 feet below, the ground surface.and that it is underlain by a fine to coarse sand with some pebbles to a depth of at least 39 feet below the ground surface. Figure 5 shows the location of two cross sections, cross- section A -A' (Figure 6) and cross section. B-B', (Figure 7), that transect the. excavation/backfill .and injection locations and show the.. soil profiles and backfilled sand: The latest depths to -groundwater measured by Agra in the on -site and off-site.Type II, monitoring wells ranged from 1.41 feet below the ground surface to 4.41 feet. The depth . to groundwater in the Type III monitoring wells ranged from 9.91 feet to_ 12.32 feet The significant difference between the water table in the. shallow wells and the water. table in the deeper wells suggests that the clay layer may.be acting as a confining or semi -confining unit. A'groundwater.potentiometric surface map of the.shallow aquifer is included `in Figure 8. In general, the ground water flow within .the; shallow aquifer is towards the northwest. The depth ;to water in the, vicinity of the injection wells is, { ATTACHMENT C INJECTION FLUID COMPOSITION A-persulfate product that Agra anticipates using for this.project is called Klozur CR. Klozur CR' is a single; formulated trademarked .product consisting of high'pH -.activated Klozur Persulfate. and PermeOxPlus, an engineered -calcium peroxide, - that combine chemical oxidation with biostimulation to treat. the contaminant source zone and the down -gradient plume. The product will be applied adjacent.io the source area to initially use chemical oxidation -and then promote biological activity on the .remaining contaminants in the source area and in the down gradient plume. The field-tested formulation promotes activation of the persulfate anion to the sulfate free radical (SO4*) without additional mixing' and labor..PermeOx® Plus decomposes in - contact with moisture .to produce alkalinity and ,hydrogen peroxide with calcium hydroxide as a byproduct. The,pH will rise and when it exceeds approximately 10.0, the.. " persulfate anions convert to the free radical state. The hydrogen peroxide will degrade " into oxygen at pH greater than 7; . Besides decomposition of target organic compound(s), one ,can expect. some degree of natural organic matter decomposition.. The by-products of the decomposition and other. reactions are typically conducive. to . enhanced bioremediation: sulfate, oxygen; , calcium, water and molecular fragments of molecules ,otherwise 'too large, complex or recalcitrant. to be readily, assimilated via natural biological action.` These by-products, can provide a short-term boost.." to 'increasing microbial assimilative .capacity. Base or . high. pH-. activation; produces, conditions conducive to the destruction of contaminants. Additional information about, the,.Klozurg CR and.. the MSDS are included ,in the Appendix. ' . A slurry- mixture of water and Klozur CR (75 gallons of approximately 27.60% w/w Klozur CR per injection point) 'will be injected into each.injection well.. The water will. be taken from a city water supply source near. the site and in Cary; North Carolina. ..,-ATTACHMENT D 'INJECTION RATIONALE` Agra excavated 249 "tons of petroleum impacted soil adjacent to'the former store (Figure 2) where the highest contaminant concentrations of soil and groundwater had been previously detected. Prior to backfilling with clean sand, Agra installed six injection wells (INJ-1, INJ-2, TNJ-3, 7NJ-4, INJ-5, and-INJ-6) a.nd.replaced two of three monitoring wells (MW-7R and MW-4R) that had been- destroyed during the excavation activities (Figure 3). Agra also installed 10 mil plastic tarps -along the east and west walls of the excavation. The tarps are expected to channel groundwater- originating under the former • store where the highest soil and groundwater contamination concentrations likely remain. The groundwater will .be channeled into the excavation area where it will be treated with Klozure CR. Agra proposes to use in- situ chemical oxidation by injecting Klozure CR into the six injection wells. A second injection event (into the six wells) will be implemented- two weeks. later. The purpose of this work is to remediate the contaminants present at the source ,area and thereby decrease overall groundwater" remediation time. The- soil excavation has .significantly reduced contaminant levels but additional reduction is desired. The injections should lower contaminant .concentrations adjacent .to, and under, the. former . store. Agra proposes to use Klozur CR, a single, formulated trademarked product consisting of high pH - activated Klozur Persulfate and-PermeOxPlus, an engineered calcium peroxide, that combine chemical oxidation with biostimulation to ,treat the contaminant source zone and 'the down -gradient 'plume. Past*concentrations of groundwater contaminants measured in the .monitoring wells (TW-7 and MW4) that were formerly •located in .the excavation area (and -have since been replaced with monitoring wells MW-4R and MW-7R) are included in .Table 2 along • with other site monitoring well coritaminant'sampling results. TW-7 and MW-4 have historically had the highest groundwater contaminant concentrations. Based on the results of the most recent ground water monitoring'event (Table 2), the'total concentration of the VOCs in the local groundwater is approximately 17.6 mg/l, while the aquifer volume estimated to be impacted is 44,184 gallons. Total ,oxidant (Klozurg CR) demand, is calculated -to be 1,426 lbs. Agra proposes.to inject a 27.6% w/w Klozur® CR per injection well. This will require a solution of 1,425 lbs of Klozur®' CR.in 3,744 lbs of water (7450'gallons). Klozure CR will react with organic material it encounters .in the subsurface. However' becausethe fill placed in the excavation was predominantly clean sand, it is anticipated that much -of the Klozure CR will react with the petroleum contaminants.„ Sulfate`will precipitate as a breakdown product. The predominant precipitant is calcium sulfate. or gypsum. Alcohols and ketones can be produced as breakdown products.' The alcohols and ketones are produced at very small concentrations most likely .below laboratory detection limits initially and are also attenuated' within a few feet of the well. Besides sulfate, the injectate will. not .change into anything, once injected, that remains longer than a few seconds. With the addition .of lime as a catalyst, the sulfate precipitates out within the aquifer matrix as gypsum. ' 2 'ATTACHMENT. E INJECTION PROCEDURE AND EQUIPMENT Approximately 1; 425 'pounds of oxidant in' 450 gallons of solution will be injected through an inflatable packer into the 6 injection wells (INJ-1 through INJ-6) screened from 10 feet to 5 feet below the ground surface within an approximate 20 feet by 30 feet surface area (Figure 3). Construction details of the-2 inch PVC injection wells are shown in Figure 9.. The water table is. at approximately 4 feet. Agra will inject at pressures less than 20 psi and at a maximum pumping.rate of 5 gallons per minute. Agra will repeat. the injection event through the six injection wells. approximately 2 weeks later. Injection, activity will be conducted using equipment mounted on a trailer and a pickup truck and brought to the site for the injection activities: The equipment will be removed immediately after use. Schematic diagrams of proposed injection equipment to be used above ground are shown in Figure 10. Agra will begin injection activities within three weeks of receiving the permit. A second injection event is planned approximately two weeks after the first. ATTACHMENT F MONITORING PLAN Monitoring. wells. MW-4R and MW-7R (Figure 3) will be monitored- during the,injection process.- Upon obtaining an Underground Injection Control Permit, Agra will mobilize at the site in order. toinject a slurry mixture "of water and Klozur CR (75 gallons_ of approximately 27.60% w/w Klozur CR per injection point) into each injection well (INJ- 1 through.INJ-6). Before and after injecting, Agra will measure dissolved oxygen (DO) , levels- in monitoring wells MW-7R and `'MW-4R' and in the six -injection wells. In addition, groundwater samples will be collected from monitoring ,wells MW-79 and MW74R before injection and the samples will be analyzed using EPA method 6200B. This process will be repeated approximately two weeks later.: Before and after injecting, Agra will measure dissolved oxygen (DO) levels in monitoring wells MW-7R and MW- 4R and -in the. six injection wells, although no groundwater samples will be collected for analysis. Approximately one month after :the second injection, verification sampling will be performed by obtaining groundwater samples from monitoring wells MW-7R and MW- 4R. The samples will be analyzed 'by a North Carolina certified laboratory using. EPA method 6200B . Based on the laboratory results, if the, concentrations of the dissolved constituents are still above the regulatory requirements', additional chemical oxidation'. treatment may be' conducted at the site. Table 2 Current and Historical Groundwater Results I ila .lacksnn # 5988 _ Benzene Toluene EthylbenzenE Xylenes MTBE Naphthalene EDB IPE 1,2,4-lrimethylbenzen ,3,5-lrimethylbenzen n-propylbenzenE Isopropylbenzen n-butylbenzene Total VOC Mass MW-1d 812412005 " BDL BDL BDL - BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL , 10/17/2008 BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL ..10/8/2009 BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL 3/9/2010 BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL - BDL BDL MW-2 8/24/2005 BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL 10/17/2008 BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDI. ' 10/8/2009 BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL 3/9/2010 BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL' BDL MW-3 8/24/2005 NS NS NS NS NS NS NS NS NS' NS NS NS NS NS 10/17/2008 NS NS NS NS NS NS NS NS NS NS NS NS NS NS MW-3r' 10/8/2009 BDL 1 387 903 BDL 140 BDL BDL 960. 79.6 133 69 23 2694.63 3/9/2010 BDL BDL 57 140 BDL 23 BDL BDL 140 38 19 11 11 439 MW-4 8/24/2005 NS NS NS NS NS NS NS NS NS NS NS NS NS . NS 10/1712008 NS NS NS NS NS NS NS NS NS NS NS NS 'NS NS -1018/2009 NS NS NS NS NS NS NS NS NS NS NS NS NS NS 3/9/2010 23 1100 " 1500 9000 BDL 720 BDL BDL 3700 950 350 130 89 17562 MW-7d 8/24/2005 NS NS, NS NS NS NS NS NS NS NS NS NS NS NS 10/17/2008 NS NS,-. NS NS NS NS NS NS NS NS NS • NS NS NS 10/8/2009 NS NS NS NS NS NS NS NS NS NS NS NS NS, NS 3M2010 0.55 14 18 190 BDL 11 BDL BDL 73 23 5.6 2.2 BDL 337.35 MW-8 8/24/2005 NS NS NS NS NS NS NS NS NS NS NS NS NS SN 10/17/2008 NS NS NS NS NS NS NS NS NS NS NS NS NS - NS' 10/8/2009 NS NS NS NS NS NS NS NS NS NS NS NS NS NS 3/9/2010 BDL BDL 710 1,824 BDL. 250 BDL BDL 1600 530 320' 130 87 5451 MW-8d :8124/2005 NS NS NS NS NS NS NS NS NS NS NS NS NS NS 1011712008 NS NS NS NS NS NS NS NS NS NS NS NS NS NS ' 101812009 NS NS NS NS NS NS NS NS NS NS NS NS NS NS 3/9/2010 BDL BDL 2.70 44.58 BDL 4.1 BDL BDL 43 16 1.8 0.87 BDL' 113.05 NCAC 2L Standards 1 1 600 600 500 20 6 0.02 70 400 400 70' - 70 ,70 . Table 2 (continued) Current and Historical Groundwater Results ' I ila .larkcnn tt SQAA ' Benzene Toluene EthylbenzenE Xylenes MTBE Naphthalene EDB IPE 1,2,4-trimethylbenzen 1,3,5-lrimethylbenzen n-propylbenzene Isopropylbenzene n-bulylbenzene Total VOC Mass TWA 8123/2005 BDL BDL BDL BDL BDL BDL BDL BDL 7.3 2.3 1.1 BDL BDL BDL 10/17/2008 NS NS NS NS NS NS NS NS NS NS NS NS NS' NS 10/812009 BDL 42.60 BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL 3/9/2010 BDL BDL,. BDL BDL. BDL BDL 'BDL -BDL BDL BDL BDL - BDL BDL BDL TW-3 8/23/2005 BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL 10/17/2008 BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL 10/8/2009 BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL 3/9/2010 BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL TW-4', 8/24/2005 NS NS NS NS NS NS NS NS NS NS NS NS NS NS 10/17/2008 • NS NS NS NS NS NS NS NS NS NS NS NS NS NS 10/8/2009 NS NS NS NS NS NS• NS NS NS NS NS NS NS -NS TW4r 3/9/2010 BDL 0.77 1.2 7.6 BDL BDL BDL BDL 5.3 1.8 0.64 BDL BDL BDL TW-5 8/23/2005 BDL BDL BDL. BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL 10/17/2008 BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL 1018/2009. BDL 1 BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL 1 3/9/2010 BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL TW-6' 8/23/2005 1 BDL 18 151.8 BDL 68 BDL 110 360 72 43 .6.7 2.4 832.9 10/17/2008 NS NS NS. NS NS NS NS NS NS NS NS NS NS NS ` 1018/2009. NS NS NS NS NS NS NS NS NS NS NS NS NS NS TW-6R ' 3/9/2010 BDL 0.94 510 107.70 BDL 210 BDL BDL 2000 550 310 120 100 3968.64 TW-7 8/23/2005 370 12000 1400 9 BDL BDL 510 BDL 1400 380 100 BDL BDL. 16169 10/17/2008 80 ' 3100 1700 10000 BDL BDL 680 BDL 2200 570 210 94 BDL 18634 • 19/8/2009 72.30 • 2,820 1,370 8,180 BDL 484 BDL BDL • 1.690 388 145 -88.50 BDL 15237.8 - 3/412010. 36 1,300 430 2,770 BDL 150 BDL BDL 810 350 82 34 BDL 6,962 TW-8 8/23/2005 BDL BDL BDL BDL BDL BDL BDL BDL BDL - BDL - BDL BDL BDL BDL 10/17/2008 BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL • .10/8/2009 BDL ' BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL . BDL - 3/9/2101 BDL BDL" BDL BDL BDL BDL BDL BDL BDL, BDL BDL BDL BDL BDL TW-9 8/23/2005 NS NS NS NS NS NS • NS NS NS NS NS NS NS NS 10/17/2008 NS NS NS NS NS NS NS NS NS NS NS NS NS NS 101812009 _ BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL - 3/9/2010• BDL' BDL BDL BDL BDL BDL BDL BDL BDL BDL - BDL BDL BDL BDL TW-10 812312005 BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL-' BDL 10/17/2008 BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL 10/812009 BDL BDL BDL BDL BDL BDL -BDL BDL BDL BDL BDL BDL BDL BDL 3/9/2010 BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL NCAC 2LStandards 1 600 600 500 20 6 0.02 70 400 400 70 70 70 'All results are in ug/l NA=Not Available . ND=Not Detected (Below Detection Limits) NS=Not sampled or the well did not exist - .=TW-4 and TW-6 were replaced with TW-4r and TW-fir, respectively on 3/9/10 Map Property -Owner's WSW WSW ID # Property -Owner _ Address Property Address (Status) Distance to Site: 1 CRUMPLER, ROBERT 13931 Spivey's Corner Hwy 13931 Spivey's Corner Hwy - Crumple'; WSW 300 ft SITE SHERMAN Newton Grove, NC 28366 Newton Grove; NC 28366: (Active). . 2 BASS, ANTHONY CRAIG 3610 WOODSIDE RD NA PSW-2 330 ft GARNER, NC 27512 . (Unknown) 3 CRUMPLER, JONATHAN 101 NORTH.6TH ST NA (Woodland)- NA NA B CRUMPLER, ALLISON J ERWIN, NC 28339 . 4 WILLIAMS, SARAH 701 WESTBROOK AVE NA PSW-1 - 500 ft TEACHEY. DUNN, NC 28334: (Unknown) 5 WILLIAMS, CECIL 701 WESTBROOK AVE `- Unknown PSW-6 . 410 ft EDWARD - DUNN, NC 28334- . (Unknown). - 6 -WILLIAMS, SARAH 701 WESTBROOK AVE NA (Vacant Lot) NA NA TEACHEY DUNN, NC 28334 7 BASS, JAMES HORACE 13818 SPIVEYS CORNER HWY " NA, PSW-3 200 ft BASS, WILMA B NEWTON GROVE, NC 28366 (Inactive) 8 BASS, JAMES HORACE 13818 SPIVEYS. CORNER HWY 13962 SPIVEYS CORNER HWY PSW-3 200 ft BASS, WILMA B NEWTON GROVE, .NC 28366 NEWTON GROVE, NC 28366 .,(Inactive) 9 BASS, ELIZABETH M 13890 SPIVEYS CORNER HWY 13890 HW 421 PSW-7 Unknown - NEWTON GROVE, NC 28366 NEWTON GROVE, NC 28366 (Abandoned) 10 ROYAL, LINWOOD RAY . ' 14076 SPIVEY'S CORNER HWY' 13890 HW 421 PSW-5 400 ft ROYAL, EVA LEE NEWTON GROVE, NC 28366 NEWTON GROVE, NC 28366. (Unknown) 11 JACKSON, W. C. 1375 STRAW POND SCHOOL RD NA (Farm Land) NA NA ROSEBORO, NC 28382 . 12 JACKSON, W. C. 1375 STRAW POND SCHOOL RD NA (Farm Land) NA, NA • ROSEBORO, NC 28382 13 JACKSON,, W. C. - 1375 STRAW POND SCHOOL RD NA (Farm Land). NA NA ROSEBORO, NC 28382' 14 JACKSON, W CORTELL . 1375 STRAW POND SCHOOL RD 1375 STRAW POND SCHOOL RD NA NA ROSEBORO, NC 28382 ROSEBORO, NC 28382 • 15 SUNRISE PROPERTIES & 3260'FAYETTEVILLE HWY - 13865 SPIVEYS CORNER Hwy. - PSW-10 500 ft RENTALS, LLC DUNN, NC 28334. NEWTON GROVE, NC 28366 (Active) 16. HONEYCUTT, EARL . 1375 STRAW POND SCHOOL RD .. 13853 SPIVEY'S CORNER HWY PSW-4 500 ft HONEYCUTT, CAROL ROSEBORO, NC'28382 NEWTON GROVE, NC 28366: (Unknown) 17 BASS, JAMES H. 13818 SPIVEYS CORNER HWY 13818 SPIVEYS CORNER HWY Unknown Unknown NEWTON GROVE, •NC 28366 NEWTON;GROVE, NC 28366 18 JONATHAN CRUMPLER 1011 WEST COLE STREET SPIVEY'S CORNER HIGHWAY Auto Body WSW 750 ft & BILLY CRUMPLER .. DUNN, NC 28334. NEWTON GROVE, NC 28366 (Unknown).. Date: 5/13/10 Table 3 Monitoring Well Construction Information Lila Jackson, #5986 . Well ID: Date Water Level Measured; Well • . Casing'Water- Depth (ft. BGS) .Bottom of Well (ft.. BGS) Top of. Casing: Elevation (ft.) Depth to from Top :of Casing (ft Free Product Thickness (ft.) Groundwater ; ''Elevation " 'MW,-10 3/9/10 40 40 97.11 12.32 NA 84.79 MW=2 -- ' 3/9/10" 15 " IS 100.59 4:41 NA ; 96.18 MW-3R 3/9/10 9 9 .98.36 1:77 NA.. 96.59 MW-4 3/9/10 1 11 .99.675. 1.63 NA 98.045 MW-4R 5111110 . 5 . 10 Not Measured 4.69 NA NA `MW-7D 3/9/10 34.32 39.32 99.30. 10.43 NA 88.87 MW-8 3/9/10 1 11 99.56 1.83 NA 97.73 MW-8D 3/9/10 34.46 39.46 99.61 9.91 NA 89.7 TW-1 3/9/10 .7 7 101.39 3.31 NA 98.08 TW-3 3/9/10 8 8 99.70:. 3.48 NA 96.22. TW-4R 3&10. 1 10 100.52 1.77 NA 98.75 TW-5 3/9/10 10• 10 101.36 4.36 NA 97.00 TW-6R 3/9/10 2" 11 99.86 1.53 NA 98.33 TW-7 3/9/10. 9 9 99.85 1.41 NA 98.44 MW-7R 5/11/10 ' 5 10 Not Measured Not Measured. NA NA TW-8 3/9/10 .8. 8 99.45. 1.46 NA 97.99 TW-9 3/9/10 9 9 NM 1.93 NA NM TW-10 � 3L9/10 7 7 •99.44 1.51 . NA 97.93 " 'Measurements based on assumed benchmark elevation of 100.60 feet. Ft BGS = feet below ground surface NM = not measured ' '" '- 3' Yak •�. J � 1� � � e t "a1 r Gorn MOW - ro1 .` a �' t S, Ir fi•'' i .- y ~ t f � { : � � ,. � 1 r I .. - - .. 4 4 f 1 . `•.� - tom: ��i L . a � y�,� ' �� �•� �'•�.. � a'1.� y 'r ~' r �IYSp*.g�.-- � �`• 4� �; r��4..:. ��� . L» 1 � anr. kt. �e a C "•'-.� •,,_ � d` _ err_ -,.., _�' ' *� r - � F } F. CPfT ',r P , r N. }pnx r S •• .. 1 r ��ggL °a[.�• gs".�r.. t ! f ^'y * J- k ! rw- J i t SOo-ft radlusl a aalr ...... l,000 ft 4.s Kati li • -:7 i � r l � � 11 r c -•f � Yl�' I "1 i. 1 1 Pal OF ... � .•` , � iy � � .nA I'. t' ll ?/ "+_^'+ O' � �,: `'fib \ Jf+f �� l�' � 1 F ,1 � S � l ' l�• �� � 1 � y J - �,�" �j, 1 ! A ,i c � i it j( � -a_ _ �•``qv., + _ ` ,F.-^_r 1 .'� , •_ � ���''.a'Ps"".�fr•�w� trI x� "Iti } .�.-.e. _' _rl u ;,•. fA v �- 0 ft 1000 ft 3D TopoQuads.Copyright 1999 Delome Yarmouth, ME 04096 Source Data:USGS1 Deatil: 14-0 Datum:WGS84 Site Location Map Lila Jackson Property, 5986 , Agra Environmental, Inc. Spivey's Corner Highway (US.: Highway 421') Midway, Sampson County, :Ivc P.O. Box 5611 Cciry,, NC 27512 Figure No:. Scale: ' Drawn. -By: Checked By: Date: Project No: 1 'As' Shown CJH RS 3/31./1.0 . N d- ry Cn . (BDL) WOODED �MW-3R MW-1D -� PROPERTY (BDL) ANTHONY BASS WOODED MW-3 " (DESTROYED) (BDL) TW=613 MW— MW-8D (BDL) TW-6 0 (2W T p p (DESTROYED) ' 0 0 Q MW-4R MW-7D Destroyed)' THIS AREA ENLARGED MW-7R �(o. ppb) IN FIGURE. 3 TW-7 O (36 ppb) TW-1 Pp (BDL)`w FORMER LILA JACKSON TW--10 BDL TW-8 (BDL") TW-2 (DESTROYED) TW- 9 (BDL) LEGEND, O 50 -100. C INJECTION WELL PRIVATE WATER SUPPLY WELL -MONITORING WELL ScDle .in Feet 0 MONITORING WELL Site Map and Benzene. Contamination .Plume. AgraEnvlronmen.tal, 1nC. Lila Jackson, Property _.:: Spi,vey's Corner Highway: (US Highway 421') '. 'P. 0. Box 5611 Cary, NC.'-2 7,512- Newton, Grove, Sdmp-son. County,- NC Figure No: Scale: ;. Drawn By. _ ,. Checked By:. Dote: Project• No: , , 2 As' Shown .: CJH RS _LEGEND . O INJECTION WELL 1 20 40 MONITORING WELL -SCALE IN FEET Injection -Wells and Excavation .Location M,ap ; A ra •EnvirOnmental_; -Inc. Lila Jackson Property , g 'Spivey's Corner _Highway (US .-Highway 421) Midway, Sampson, ,County ,'.NC•: P:O: Box -5611 ' Car-y; NC 27512 Figure No: Scale: Drawn -.By.'.,Checked By: Date: Project- No: 3 As. -Shown JMR•- RS 5/13/10.. :1,000 ft }odius. Sinclair Lake Rood " Auto Eody WSW 1 SO• - - .. • PSW-1 4 .3 y Q 5 , -6 . ,off 6 . 4 500 ftradius 0- 2 0 PSW=3 o g . .. 14 rumpler WSWP 9' Site PSW-7 - .. " - - - 11 10 . 0• Ps .. - 12. 13, 17 .. PSW-10 O 15 o Building/Residence 0 ft 500 ft ,.. 1,000 ft 1 ".Property.ID # (Table 3), • Water Supply Well PSW-7 Water Supply Well' ID # (Table 3). - Surrounding Property Map=-. Lila Jackson Property, 5986 Agra -,,Environmental, Inc. Spivey's Corner Highway (US Highway, 421). R.0., Box ` 5611 Cat'y; NC 27512 Midway, Sampson" County; ,NC Figure No: Scajl.e: Drawn By: .< Checked.,By:. Date::, Project No: 4 .:. As .Sh own , "" CJH RS .... , 3/31 "0 .°".: �. n- A / \ North South Black Sand Block Sand White Sand Medium to Coarse .Sand Fill — White" Sand Brown -Sand Water. Tab_Ie 30 ppb, Brown Sand 20 PPb-. = Red and Orange Clay Red and Orange Clay SR 1811 „ AUTO BODY SHOP WSW I F CECICS- STORE = ' I -PETROLEUM AST'S _ I PETROLEUM UST's PSW-1 WOODED I SARAN WILLIAMS i _ I. PROPERTY ':� —� NO LONGER -PRESENT I' CECIL , ' WILLIAMS .. I .PROPERTY- WOODED . - N _ ________ PSW-6. 9 40�@ N 93 S " PSW— 2 +TW— 9�. ' •' . . ABANDONE r—� l'—NO LONGER PRESENT. CHAPEU HOUSE I TW-3—,• ` I (94.25) I MW-3R 94. 50 L—_I ANTHONY.(��. MW-1D �(94.45 ®. P,SW-3 BASS'WWOOODED PROPERTY DESOYE D I ABANDONED TW-6' . DESTROYEMW-4 D F I E J,BUILNNG TW-4 DESTROYED O'} I TW-7sEzfaroled) I (94.8 ') TW-1 .LAMES (94.84') I BASS PROPERTY ROBERT CRUMPLER TW-1 S ROBERT CRUMPLER RESIDENCE '�' to7_9 � - , l 061 WSW TW-$ I (95.09') . I ITW-2 BENCHMARK .FOR ELEVATION I DESTROYED , - TW-9 j .. .. I I ABANDONED - I PSW-7 ELIZABETH . I BASS. . PROPERTY I PSW-5 ' HONEYCUTT` I' q I SUNRISE PSW-1O WATER SUPPLY / WELL - I NOT IN'SERVICE RENTAL / I (UNOCCUPIED/NO POWER) PROPERTY PSW-4 I LINWOOD ROYAL WELL NOT PRESENT' It PROPERTY_ LEGEND 1 EARL \ PRIVATE -WATER SUPPLY WELL HONEYCUTT 100 0 50 - 100 200 PROPERTY -.TEMPORARY MONITORING WELL 0 MONITORING, WELL Scale in Feet - (9330') GROUNDWATER ELEVATION . Potentiometric Map- Agra',Envir'onmenta1, InC. Lila "Jackson Property Midway, Sampson County,' ; NC. . .,' 27512 Figure`No:, . SCole:. Drawn By: Checked By: bate:' Project.No: 8 As' Shown MAC' RS 11./04/09 0 PROJECT NAME: Lila Jackson Property Figure 9 Typical Well Construction -PROJECT LOCATION: Midway, Sampson County Details Not INJECTION WELLS: IN&I through INJ-6 DATE: 5/14/10 to Scale INJECTION WELL CONSTRUCTION DETAILS PROTECTIVE CASING AND " CONCRETE -PAD CASING MATERIAL PVC CASING DIAMETER' 2 INCHES FT.BGL- CASING LENGTH 10 FT PAD DIMENSIONS 1FT x 1 FT Ground HEIGHT ABOVE GROUND - 0 FT' OCKABLE CAP 0.5 WELL RISER. MATERIAL PVC SCH40 DIAMETER 2 INCHES JOINT TYPE THREADED - LENGTH 5 FEET ACKFILL AROUND RISER - MATERIAL Concrete Grout THICKNESS 2 FOOT 2 4 5 10 TYPE OF SEAL BENTONITE THICKNESS 2 FEET FILTER PACK TYPE OF FILTER 20/40 SAND DISTANCE ABOVE SCREEN 1 FOOT WELL SCREEN SCREEN MATERIAL PVC SCH- 40 DIAMETER 2 INCHES LENGTH 5.' FEET SLOT SIZE 0.010 INCHES DEPTH TO BOTTOM OF 11 FEET MONITORING WELL DEPTH TO, BOTTOM OF 11 FEET FILTER SAND . Z WELL -CON TRACTOR CERTIFICATION #"4029 B7_17- auta 1 WELL CONTRACTOR d' TOP OF CASING,;IS FT Above Land'Surtace Marl< A. Creel = Top of casing terminated at/orbelow land surface may require Well Contractor (Individual)"Name <.. •. -_ a variance in accordance with 5A NCAC 2C'.01.18: - ' Agra EnVlrOnmentai.: inC e. YIELD (gpm) N/A METHOD OF TEST NLA Well Contractor Company Name =- . 1517'Old° Apex:Road�•. - • .- f !DISINFECTION 'Type NIA Amount N/A ? StreetAddress:_ g,` WATERZONES'(depth) ` Car , ; NC . :.27513 Top 4 5 ' Bottom 1-0 ' Top Bottim Cityor Town State , ' Zip Code Top Bottom Top Bottom 9�1 ' 858-5350' Top Bottom Top Bottom Area code Phone number - Thicknessf 2 WELLINFORMATION 7.' CASING Depth Diameter Weight Material ; WELL CONSTRUCTION PERMIT# NIiAV Top 0. Bottom' 5 Ft 2 kh 40 :;. PVC OTHER ASSOCIATED:PERMIT#(rfapplicable)•N�A' .. Top Bottom' SITE WELL ID #(if applicable) I NJ 1 ;TOO ' Bottom Ft 3 WELL USE (Check ';One Box),Monitonng ❑ Murircipal/Public ❑ 8: GROUT. Depth, Material . Method lridustrial/Commercial❑ 'Agricultural p' Recovery ❑ Injei tion p Top 2: Bottom 4 Ft Belitonite , Tremie ' Imgation(j Other,j(Ilstuse),IfIIECtIOn• Top 0. Bottom 2 Ft Grout Trerriie. DATE DRILLED 5�6�10 ' . .Top Bottom FL 4 WELL -LOCATION : 9: SCREEN Depth Diameter Slot Size Material Sive"v1s Corner HlQhwav (US Hwv421) - ToP 5 . BottDiri. 10 : Ft 2 in-- 0:01 in. ;PVC (Street Name, -Numbers, Community,SubdMsion Lot No.; Parcel,:Zlp.Code)TO Bottom "' Ft In.` .. -. 'CITY:'Mid COUNTY San1DSOn In; Top Bottom .:' Ft in . in ' TOP OGRAPHIC•••ILAND SETTING ;(check appropriate box).; ' ,'"• . ❑'Slope pUalley flat ❑Ridge ❑Other '. 10 SAND/GRAVEL' PACK 491$TCp- 36_. CLROR 3Fr�6fr26€r^^.CC Depth _ Size Material Top 4 Bottom 1O Ft 2 med Sand ' XNMFKTCD7`J j^^nnffinnan^nn^I'CL ROR � 6i ��^^. CC ' -Top.. Bottom• Ft. LatitudeAOngitudesource: "RGPS: ❑Topographic map -, Top Bottom Ft (location:of well musf be shown on a USGS topo.map andaftached to` tfiisformrfnotusing:GPS) •. 11 DRILLING LOG' 2i 5 FACILITY.(Name of ttie business where the well:is located.) Top Bottom . FormaiiomDescnption' ' `•i .lackS�n 'PrnnPrfv ; 0' Medium and - Facility Name ? Faollity ID# (if applicable) /to SniyPv'4'C'nrnPrAin Hwav 7l')S Hwv 4211 -/ Street Address / • ., Mtdwav NC' City of Town :State Zip. Code , / Contact -Name NZA .'Mailing. Address . - / City or Town State Zlp Code 12 REMARKS f } Are de Phone number j B-WELL DETAILS&DOHEREBYCERTIFYTHATTHIS :WELLWAS•CONSTRUCTEDIN.ACCORDANCEWITH .:t -•.� - - .'�>' -RECORDFIAS: EELLC NSTEDTOTHEWELL0INNERDT _ O HATACOPY.OFTHIS a; TOTAL DEPTH 'I O f :. b ".DOES WELL REPLACE EXISTING WELLI YES NO 4. Lw a/ :- ❑ - — SIGNATURE OF, CERTIFIED WELL NTRP CTOR DATE-- c -WATER LEVEL Below Top of Casing: 4 5 FT �- l7 Cam, (Use +,;if Above Top of Casing) .. _ PR INTED NAME OFPERSON CONSTRUCTING THE WELL xj,�-^. wn 30 days of.completion to Division of Water Quality Information Processing; "Rev i1oa: ISeivtce Center,kRaleighYNC 27699 161, Phone x(919) 807 6`300, k x ,wry pp s' •• CONSTRUCTION ,'�RJKC ORF 'o Erv0kornfi6iA,­d!' �.6p#t*ht: f Natural R DiVislowo -J� WELL O L-CONTRACT*o�e La i,'S u*rface�--,"'. .;IS-- d..'TOP ,OF CASING Ab Creel ing:teftninated.atlor t *Top`8 f.cas` W _.�al) Niame ell* '-..' Contractor ih:'pccor anceyvith:-j5 :NcAc�c618: A Agr E:n"vironmOnIt-'a'l�,;'�l'n.c..,- Well 'Company THOD-0��TE§Tj --,: - -Contractor.' Name .. ... ... % I .15.17bdAD2X<ROaCj ,DISINFECTION TvPb-N A Arrount�41 "Street Address gi.-WATERZONES ES (depth).­ .-C T 4 Cary ;�-NQ --','.-'2751_. 5 Bottom 10 Top Bottom -Q4.orTownState ,Zip eCOd -Top -Bott6m`­:-Bo, om, .-. ),858- 0 '535 _Op. -7 Bottom Top Bottom - Areacode number., Thickneisl:.,.. CASING.�­Depth,�:;L_­ 2 WELL INFORMATION 7 tWeight Material j -.WEEC CoNsTkudnbN P _:T6' 0 ER IT# sc4.4 ilVl 'N/A -,B 'tto 5 Ft. 2 p Bottom VC P OTHER �J /A Top -ASSOCiATEDPE�M[Tfti(t f aoplidabl T -1 ottom - Ft; 1: Tpp B&to 3.WELL 'USE {CKeckb*ne Box MonitoringM6nidip6YPubIic1­3 8 `G_RO_UT-_ Depth '. Material Method Industrial/Commercial [ Agricultural [,.RecoVey'0;16j6ction r7002B6�6 4FtBentonite:.- remid -Irrigati6i Top 'Other V(Iist- s& niebtibri-L IT n 0 u .0 Bottom rernie." DATE DRILLED, 5/6110 Top Bottom Ft. - .4. WELLLOCATION.:9-SCREEW Depth.. iannater Slot Size ateriiF Sive'v's tbr6erdidh-Wav (.US:HAv 4211 To'p­5' BottomQ Ft' 2 Pic (Street Name; Numbers, Community, SubdiVi§ibn, Lot No.., .Parcel; Zip Code)� -.. , "T' - B Bottom in in brry: Mid Y 8 Top COUNT. ampsbn in.. Bottom: 'Ft. TOPOGRAPHIC /:LAND.,SETTiNG�_ (check appropriate 'box) e [:iValley 1jrVIat ❑Ridge, EjOther . -: - '; .: *:101.,SAND/GRAVEL "PACK q .'-.Depth Material - 36 a "A&AAAI�AA.Ae66 C 11CL R,6k-3&4'&&2 A A 6 : Top. 4- b6ttorfi0., :�Ft. #2 med. -Sand.' rAAA&AAAAAO�AAJ, CL M W I$T.CD -75 �.R Ok -78146 77 - 'Bottom TopL-, .grap ic.mi p Ldtit6de/lon-gitude source':', .[Tob6 P_ Bottom Ft To -(Ioba on, of weffrnust.b6. shown on. 6 USGS to' h ot po map:an.dattace this - form i f not using GPS) 7.. A I. DRILLING LOG 5.'FACILIT--Y (Name of bus'in'dss whbre.the'well js l6batedl,'.. 'T __..op. ..Bottom Formation;Descnp oti,n: 10, 'Medium -Sand Facility Name: Facility !D#'(if applicable Sniv Cnrn*pr!Hieihinla'v-'(I"l','-"H';-'�-4?wl')':, Street:Address - -- - - — ----------------- — - Cit -n - y-orTo State -Zip Code N/A' Contact Name: 7 NIX 7 v-, Mailing , Address w City ,orTown : State Zip Code 2, 2; REMARKS:: - Area-codePhone number 6 WELL AILSI DO HEREBY -tERTI�Y:THXT'THIS"VECCVAS�C6�St U&TEb'INA6f6RDA6iWITH" -15A. cAb kWELL CONSTRUCTION STANDARDS -H COPY OFTHIS 4AT A I S a -RECORD HAS BEEN P VIDEDTOTHEWELL -OWNER r X bb, 6' WELL REPLACE EXISTING NG .-DOES WELLS YES ATLIFT5.0FC CERTIFIED ..-SIGK ERTI ":DATE E LBelow as E ATER "L LETop"01-c-. ing VEPRINTED US if0 0 Ab e f Casing) P__ NAME OF.PERSON CONSTRUCTING THE WELL 7-* :- it SVVAL IRA, all Service 7. NON. � R N. C . RECORD.. North Cap 1ir1 D of Environment and ap �4� epartiment .... . .. ... �; WELL CONTRACTOR EIRT J 7 .1-WELL CONTRACTOR. "-d- :FT Mdrk, �..Too'bfc6sirgtterm terminated atfor below k may require Wandsurface ell d uB1).Na'me, e :Contractor (IndiW a in' accordance with 15A NCAC,2C. - 0118 A dr:a E�hvironmenfnl 'NIA "MET e, YIELD W0#1).. L H db 6�'TES- e Contractor W 11 Company Name - - ..f ;DISINFECTIO N '817 "bid' A R" ' d Dex. oa SS'. -�Street 'Add' ; ., ;" " : " t,qi-"_..".AT�RZONE& depth): C aw.. :27513 ':Top 4.5 - 136ttorn Q T Bottom,. OPL�� F CIty:or.T6vvn State* -­Zip:C6de' B Otto T Bottom (9-19 858-5350- Top ttom TOp4 code,.' Phone number .�_Area iq ness,.. 2;WELL iWokilviATiON.:.-;�. ;CASING Depth, Diameter Weight,;;, Weight,,: M i _ % at �Iai" I. WELL . CO NSTRQttION:0ERMIf# WA 9131 0 Bottom 5. Ft 2 Sdh.4 bTHER.ASSOCIATED PERMIT 7777 -7 TopB161:66ni ' SITEOWELL ID. #V ap, P11cablej. IN r Top . Otto Ft 3. WELL USE (Check One :13ok)j onitoring Ei MunicipalTubli C:E3 Material Method 8;4-, ROUT- Depth, Andistri/Commercia1_ AgrcultutaIC'Recovery E3'. Inject-on,[ top' 2 Botr,f4.Ft Bbnfo n. iite I. (list s lIng ationEl.. other lie, UP e)- 14hi6ctioM. op 0' Bottom Ft.'. 0 ;T -T rout rernie DATE DRILLED5/6).10 TOP Bottom FC-- ----------- 4.,.WELL:LOCATION:,'- 9: 'SCREEN- - Depth,'. .,Diameter .* Slat Size Material sivevis Corner HiahWavW&HWV1421-V Top BotioM 10 Ft 2. in i n P C (Street Name, Numbers, Community, Subdivision, Lot No.,.ParceliZip Code), Top - Bod"0 m­'.­' - Ft.' in. MidWav". COUNTY SaITIDSon n., a- --- ---- ,Top- Bottom` oftom' Ft in. in., TOPOGRAPHIC I LAND'SETTING,' (check a p--ro,Pfi,ate4b6x)�,. P CSlooet-oValley. Mat Ll Ridge' [30th6r.: 10, 7ZANDIGRAVELPACK: 36 - e. Ize iia I Top Bottom 4� Ft. #2 nie Sand d A 9"A CC A;%AXAI--dLA6k478.46880 T* Bo ttom' ottom --.Ft Ud A e ongitudesourcb' !WPS' aboogra0hib map.. Top 'Ft- - op Bottom mus,tb,� shown- 6h d'U�6S. to' to (location of well. po map. andattac I if not, using thirir this form -GPS) I I DRILLING FACILITY ss where . eVellis -s..�FA I ne Ofi.ht� b6,i.-elocated:)."Bottom Formation Obscripti ]JI., ckson"Fir',bhefty'- ja 0' 6i� WdiurnSandt: 'Facility Name -'Facility ID#:.(if-appl!,cabIe) '6 . "Hit -1 C' Rn v _q nrher in 'wA\j L IS 'Hwv 4711 Street Address Mi M RV. - NC L -city or Town ;.State "...Zip Code.. V N/A Contact Name., -N/A j .4 M aiin g.,�ddress' ityOrTown C* State ,�;,:;�!p.C.bde j, 2.REIVIAR A e, Area: cod -Phone:number 15 WELL DE TAILS - 7-777- 7-7---7- -.I.D0 HEREBY CERTIFY. THAT -THIS WELL CONSTRUCTED IN ACCORDANCE YVITH..,. 15AINCAC 2C , WELL CONSTRUCTIONSTANDARDS, -AND T+LAT-A COPY.OF THIS, I TOTAII;DEP�H:::1 0 :RECORDMA HE'WELL:OWNER.- - DED�TRT DOES WELL tREPLACE EXISTING YES _JNO:Ef: t GNA`IT5RE 0 F LICO CERTIFIED WEL NTRACTOR WATER LEVEL Below Top.of Casing:' (UseAbove Top of -Casing) PRINTED NAME OFRERSON CONSTRUCTING THEWELL�, W�, 6 ys ForrnGWMIJ-'�`,' R 0 eV r ion; :7 r",;- �­`--, ._. ;_,;!�_ ;.' '' .';N AE­-.:. . .SI�.D . .tENT,-- - ZA — .E,.-­ ! , . .'�, , ." :W,�'E-.. � .I ' -" - 'I L!". . -.:L-­C0­,N.... . §j, t,AfC . I N`k �- .­-R Ee— _; '" �7� f , C' '- " ­ O J , R.'. - D .: ".. , oith-Ciolifid'D&itn6rt'6f Environment dftffieit�and,4��.ie86uic6SDivision .6f�t6�,Qtaiy 1. .�. , -.. ECONTRACTOR',CERTIFICATION 9 4029�0"`, I' - - -­,..­.,. k j I .-�-.-I..,. E I�L.*:"LCONTRACTOR d-"b..._.. .. IN.1.Tk A C T�.., ._6 -� d.R Land-Surface ­ . ' .­ - . * ,-O..' F F.T.- . A;, b_z�.�� ov_ e. L..:a�. nd S u k �' �c," -�. cAsING`IS"�-JOP . Creel " Top of casing terminated at/or land re q-.-- �,.u,'�.i -WellrC6ntra:tor.(Ind!Vidual)-Nambp vadafi6h-accordaccordance h,15NCAC�C, i 8 ,Aara'7nv.ronmenta(.�In,:7. .,; - � �.':. ............, �� . �-.. ,� ,-- p ,,......, *. �I.. ....��.1 .-..,-..M _ .- � "� �'. :- , ....................... . - 1 - ­ �.,._. - -- ., -!_ ".�'�.­ --""""" !:-.-,:! .-........._..-, �MM ----­ . �- - ­.' ;--........-.­,:, ,;. . --.: -,,:iP *..%.. ,``. 4 : �. - *_ -, -'- ,-. ,..� ..�. -';: ... .- - ' � ; . �".'_- .-� .... _ . —.. .­ .� I.­ '� ,­ ,-�- ...- . ­ - -- " _.�..­ .;', " - - , ... -�"..-.. '. ': - :.. � .I' M 1.-�` .. ., ..� ," �. e1�t : "_ .... - I ,.i -. 1 1" .- .,�.- . , i,..,*......... ..- � .b , - .11 ! . 1 ; . 1 : ,., I�.. ,. ' � II; :­ 1, ��,.. M ." I i d b4 Vi1..1 , .: .1!!I I - . � i I I.. I. . : � .I I 1e�,�fELb.(��NIA OF TESTh . 1Well Contractor Company Namp i617�oi&AQex Road f DISINFECTIONType N/4k a , I Street Address ,g., WATER ZONES Cary N6,2751-� t0P4 ��bo�:16:�. rOP BPfton City:or,TbwState Zip Code �OP Bottom. �op",Bottom 9�19­ .858�5350OP Bottom , Top 6otonXrea'codPhone :number , 1: iWLLINFORMATION. CASINd:bibih Diameter ThWeightsl, Vaeral ;.: • WELL CONSTRUCTION PERMIT#IA- Top Soto5 Ft-2_ ach.40:," PVC . OTHER OCIATED�PER�IT*ifi��le) N/A TopBottom'_ Ft top B9ItomFtSITE WELLlb#'Cif applicable) IM-4 1. 3WELL USE �6hedk-One�3.)Mo6i arng,tUui 1Ra!UPtbficEGROUTDepth - , MateralMethod .- rdusiaVC mer6ial'C;Agricultdral'Ea,R cve-0 InjectionM3 ,TP 2o om4Ft Sehtbnto Trmie .- T. op0 Boftbm 2Ft Grout,. Imgaiibn6;btherie(II§tLse),nibbb00t Tremie DATE DRILLED 6/6110Top Bottom - Ft I 4WELL LOCATION:" ,I i" , 9;- s�REENDe. Diameter SlotSke"� � Material I .vev s C6rn6e.HidhWav WS�HwV4 t op 5Bottom. 10 Ft2in_0.0.1 in. PVC - (Street Name:NumberzCommunity,.Subdvsion,10t No:,.P6rcelZip'Code) i I 1 1 ..,. lo - : toPB66om tIn- :. , : I'' 1b.iTY- WidwavCOUNTY &a!Tc�6nM .� �TO Bo om Ft in' in. TOPOGRAPHIC / appropriatePAb SETTING Ic� K bo) 3SIop6�1jVaIiey,i�ibi0Ri ge0Oher0 SAND/GRAVEL PACK KO �fCD.36--YAAAaAA.nA'j;CR-OR.3SI 61 ACC Depth Sizeate Top 4 Bottom: 16 F#2m6-�-8468 rial: '-!-,�x�AAIAAAi�AAkIIKNMFIS7,CD.75 CL��6�-�646 9ccI .. -. To66t6m Ft ,Latitudell6ngitudEsource wPS1,oT;*grap ;(]Topographic map (location, of well musfbe.shot46,6hd USGS top6 map aicadhe� t?-Top Bottom' Ft;.Iils'tormlrbt:jsingGPS) 11 DRILLING LOG - LFACILITy (Name oitheb6�ihess.whe�eJ6weilis-Iocated.).Top b0ttOn� For- ti�PFs�p.p on -� -� - :II I � :I .�. . H14'J ,kshn Prnnmrtv 0. /1a Medium Sand ',. .. Facility _.. .Facility applicable) j-, _ , _ , 8�f'&er­HidhWv i-iIs HWv.A?l) /. Strbet-Address,.1 :Midway . NC / ., City or . ,, StateZip Code, _ : : [1 Contact ame .:" �N/ .. .1 Mailing Address.. . ,; .... ,T.. Cit .or Town. ;State Zip Code 12.RtMAAkS " i L I,. Arpp;pp(e. Phone nu.ber , dM - 6 WELL DETAILS - - ACCORDANCE WITH 00 HEREBYCERTIFYTHATTH18WELLWAS CoNS� UCTEDW, 15ANCAC2CWELLCO�STRUCTI,"STA"AI.SAND THATAcopy&THIS RECORD HAS BEEN Q HE WELL OWNER ?TOTAL DEPTH b;DOES WELLREPLACE EXISTINGELL?,YES ovNOD X/9 , / .� I , .RE�OF CERTIFIED ;f1NTRA T-OR DATE C.:WATER :LEVEL BeloWTop.ofCasing' '4-5 FTP I7A, : , . , �Os4"�-ff A`0�e op 9fCain""PRINTED NAME OF,PERSON CONSTRUCTING E WELL } ­i�'�i,,i"_i,�A1I . 1_t66M�t.Vit� _�adays e�!O�Mlion �,6 m G. . ,.,'k", " �o, ,, ...., _."- , 1I I I 1II.* , , !I �..Ib -_"-"_­ -.,�. - , Ib",center, ����v�"�e7`e ,"' ,��,''�,2 w —`--1_,__``_7-­*I" . . -_"-"_­ -.,�. - , Ib",center, ����v�"�e7`e ,"' ,��,''�,2 w —`--1_,__``_7-­*I" . . 'WELL E 1 WELL TRACTOR. C r4el M'4rk:A- z!- ASINGis­n: Well-Cohtr-Actor(IiqdiviqpB1)�Nam �7­ Ce,wl :_15,�`JNCAC-2C;��0118 ".-A"'" E ara nvironmenta,."'Mc'. YlLI-b-(6 METHOD Welt Contractor Company Name :1.7b1dAJ'e"xAbaid f DISINFECTION' e, A mount Str etAddress-" ­W 'T' A ER ZONES (depth.) Gary C '2751:3 Top Bottom, 10: op:BottomCity or,Town State-..-**, . Code. Zip-C d'�� a Dp* m T Botto MM Top Top . - Bottom Top Bottom Area code. Phone number M Thickhess1:.'-.-: ol ."!2: WELCINFORMATiON- 2. 7..,CASI iSeli Diameter .:, h WELL CONSTRUCTION PER I M: T� % :Ft. L2 9PL "Bottom 5 I "�plj.�ble):N/A ASSOCIATED _­ IPERMTop-Ft .. .OTHER SITE E WELL ID_#(if,bp-pIicab- NJ To - p Bottom Ft 7 3WELLUSE (Check -One Box) Monitonng:p zl[P6b1i`c [ 8" GROUT: 'Depth Ma:t&al Method n .us i�/d6mftercial,d Agncultura E'.'Recovey, o-,Injection j Top 2' Bottom,'4 F�Bento te'. Tre"m" I :Other(1is-t.Usej 1h: iection P.".Q_ '60ftom, 2 Tre"'m" fe 7-77777 &4TE'bklLLED 516/1 G T'DID Bottom .,.:Ft -'%-4: WELL LOCAMN: Diameter . Slot -Depth'... D .... . . 9.' SCREEN Wkerial 'SiveV Hidhwa M8 -H 42T),' W`v S Corn6r, v 5* Bottom I Top 0 FIE '2 ifi.: 0.01 in .(Street.Name, Numbers, Community, SubdiAsion,.Lot No.,,Parcel , Zip Code) : Ft. Bottom 'in n., my..MdWav TY OLIN Sa mmson' -'Top 77-7. Bottom'` Ft ToI5*� M, in. TOPOGRAPH I LAND SETTING'_: (check :app"m.od-ate'-box);;.,... J, El Ridge �0 Other: SAND/GRAVEL0461k` 36, ..'�AjkK&AAAAAAAA VCL ROR 3&4&5266%:AA k9i&cb CC:.- Depth 7 .'Siie '-'Nfaterial- 6tiorn'. 10.. . FL-#2 iiie 866d: 1" 1.0 75 Y-IAAA&�AA A`AXA' Al 'KNfvF-:MTCD i ..CL R'OR M14681-289AA` cc Top Botto'M Ff..4-1 Latitude e/longitude.s6urce:! hiphi,c: map M Tope Bottom Ft ..(location'6fwell 'iTi64-be"shown 6'n'a U SG S topo inaganda6'c 7 IS' (?rTn 'ifhot &sJhgG )S) - this form 1;1`DRILLING LOG' A­ FACILITY FA -me- olfihe'business Where the well ' 0" -isrl cated op., '--'B 'If T' Bottom t, afi�n Description 0, 10, Me Um.-, _ij n Q'Pi� 'Sai�d'. Pr Facility;N ame: Facility ID#* (if applicB4 e S sbi,�� 5i 'c`�rnpr, in WRv ((j iv\ 'Street Address Midw;Rv - N C, % -,City I o :`.State- r,ToWn. i�, Zip:Code 'N/ :`-Contact Name . j, 'Mailing Ad dress, 7 .. :-iCity oir. Town StateZipe 'Cod % -12'.REMA RKP f %..Ared codd-, Phone number. .G. WELL DETAILS I DO HERE BY CERTIFY. T HAT, THiS.ViiELIWAS C NSTRUCTED. IN AC �o C RDANCE WITH,,;. .1 5A,.NCAC2C� 'WELC6ONSTRUCTION STANDARDS, AND THAT A COPY OFTHIS a , 1() : M: . . *: � 41 TOTALIDEPTH., : - ORD.HAS D WE OW -_:-REC -BEENIP IER. . ?.- .. , ­- 1: WELL REPLACE. EXISTING LL?.,,. YES Ev 7 DOES WELD ..'NO 0 L �� opi�r.URE�OF,CERTIFIED.WELL.CIDITTRACTOR - DATE' C" :WATER Casind: F7. r 0, (i:f 17 ..(Use +--if Abwd.Tdb of Casing) -;PRINTED NAMEOFPERSONCONSTR UCTING THEMELU— _0 -wit fil 3MUM- "'t' F C' -A- "imt&�NDiVi t; 866 i fi I h0iii O&Ji 99i 1, -_­ ...�, _ , . I , , , �; - . ,.,.�',, : ,.�'"'! �, 'i,, .1� , .. .., ,4 �,, � '. . .. . � . I � f . " �. :­,-.��, � ,.�,, , � -, ._� �-. , � . ".., . . . , . . . , " - - , � _� . 1­­: ,; ." -,'-,, ,Lz­*.`�: ., , - , �, , .. "; .,-:�:_ � - I ..." , ,�-, % !� - z:l " - , - ..." -'.­�,, �.I.'. " : 4 ?"..." �,� !, ;..;-,.,..-,- ..." "'..'. "; '. ", , � �-. , Z, . - --. ,�.� -., - . . ,�'�-.�, � - '.i�. , : ',� , , , , , -`,".. ... '. - , .� �, . .. , � , , f" , �-, '. .. �. , � . - . -, �. " M _.. ­,:h­ "'., " - - . - . - � '. C�, n " ,7 : . -­ - '' _ ; j - -' - ,!t_� - ' t ;VNESIDE .,Wt CONSTRUCTIONTR02TI6,kECbkb orili.cin�b6naftM6ntofEnvironment a ahrf escurbe§­ . w. -. , 'J : .. % -v. ., ._. .','. ­ , I i �..t ; :; ; .s�''.-..: ; �o,*._ W .;.. .. A -% f� *:. i '.--.:�:..:..:I.""�—, a.-:� ; �_ _ ..*.,- ,i i, I :Y im�V. -. �..-­ WELLCONTUCT6k-CERTIFICATION 4 4029-B; 1­ .:,..."" � " ­ ........". I!��­ - - .-��,- �­ ..­". , ::. .- .I:..�_. -...:..::.�....: , �-. �`....�­ . ­ ­.. ._-. ._I� Y:- ,­ .�..Z.' , � -- :.� .-. .-_.- I..� , ,-"-i,.,,.,.. 0, .. -- --_� I.- ".4. I- : ­ - .. .. � . ., , 1­ : - 4 I:—.. .- , ; -,.. �,. I - — I..I.j1 , ,,, i1 ..-. ,� " ... : .. 1 ­ , I, 1 . ... i I..� .. I - ; ' � ..- � - I1 :�- ., ; I. 1WELLCONTRACTORd,TOP OFC�ilN6l�,i4,-"::�T.A66�eLand 1 lMark A-Crbb1"top of casing terminated a or below land'turface.may require I,Well -Cohractor'(Individual) ayanance iaccordance with I5ANCAC2b0118 AdhaEnv.f0ntdhtbI .1r6N/A , I. '�Well Contractor,qompany ame * 6.YlELD_(q0mYNt METHOD OF TESt­N/ . 1517idIAbexoa . DISINFECTION NI Amount: 'N/A Street Address - , -9.' WATER ZC gi.(aeptfi) C�i�:. NC.:275I8"t30 46 Botom I0 Top Botom ,'CityorTown State Zip Code -6p, - -- Bottom -, .Top , BottomI .-..-, 9(19AH&5350 TOP Bottom op Bd Dr Area codePhone number . .hickn6si 2 WELLINFORMATIONiCASING: Depth '-_iameterTWeightLMaterial l.,,,.. .. F. 'i, - I. WELL CTRUcio�mif# N/A:- �_p 0 Bottom '5 ,t2 sh.40':.PVC , % OTHER ASSOCIATED PERMIT#(if aO,lid�bld�T90ttom-. ,-F�)/A­p- 1 SITEWELL ID iO..Oplibi)1N -6 too Boffon '. Ft . 3 MELL.USE.(Ch6ck OneBox) Monitoring ❑6'MunicipalPubIJcE8-GROUT, DFPth*" Mat n` . Neth d i .. I lndUStral/C6h6reiiIE�gri6.lt6,�i.6,:�6b6�q[;Injecti99-0TOO 'm 4 k Se�t6hite I Trefiie Imat1n3-'.the�.V(iisiusey IniebtionTop Bottom Ftrout- TrJmjq1. : -.- ,,DATE DRILLED 5/6/10.. -. Top " Bottom - .Ft : , .l 4- WELL LOCATION: .-IS." SCREEN Depth.' --Diameter'Slot-Siz6 - . Material :- !Sivev s-Corner HiahwaV WEHWV421) T03E".' E0 on0Ft-2n0;01 In_PVC'. ,I(Street,Nane;.Nunbers, CodnOnity,'Subdivision, Lot No., Parcel "p Code)' -: TopBct6h CITY. MidWav . ..COUNTY �8MQSbn `� ,IoP ottom ': Ftin.. lin. TOPOGRAPHIC /AND'SE7TING:. (check appmpinatebox) - , : `,. I 1.,­F810pb..dValle� hat jkidge'tLOtfi�r' 10- SAND/GRAVEL PACK-: i ,j.Depth­.Size Maidria K@ISTCD .,36_ ,.)AAA&AAAAAAAAI CL R 6�,4�2&AA CC - Top 4 Bottom-10f�:med.,:Sa'd.., MMFISTCD 5 jAAAJ&AAAAAAAAJ'CL R OR:M 468809�Ai CC Top B tom.Ft Lmtftudongitude source ,WPSETppogYaphicmap—_ �op 36fton- Ft — . ,(16caiibnofveifm6stbe'shown bn'a'USG�opb��7 andattachedlo'� 61s.horm ifhotviingGPS). F III DRILLING LOG . I 5.FACILITy (Name-6f ili6 buinbs-where the w6IIis:Idtd.)`TOP Bottom Forratoescrtionl .-, , ,. .,� -; ilq.I rksbn Pr6pertv ,.,, ­_,`'_"1-10,.!Medium `S6nd . I'-.FaciIiName -.:.., ,, - FaciliyID#.(if.aplidabI .;., ../-.'. tTI t, p� s s6i 4V.�-nhrh�HihhwR\.(I,I�HW-4�l')t_ .!: ,0 Street Addres-I.* ' i. .. CityorTowa. ' , 1StateZip Code -/ . Nlk- J "Contact�Name /.:.Z_" N/ ;: / Mailing Address I .. !.:� ,* : /l Cior T9�ty State,Zip�code, . .2.REMARKS 1.: AreacodePhon6 number 1 6WELL DETAILS I DO HEREBY CERTIFY THAT Tiis WELL IN ACCORDANCE wl�H`I 1A.NCACICI.WELLCONSTRUCTIONSTANDARDS:AND,THATACopyOFTHIS :1 a ­ TOTAL tPfk-1 01. RECORD HAS BEEN 2QED TO THE WELL OWNER DOES VELL-REPLACE'EXISTINGWELL?.4YEOVNO 0sINATUR�OF CERTIFIED DAM - I.:'. WATER LEVEL tel6W Top of Casing:. 4-1FT , IV (Use + if:Above top of . I: j ., PRINTED NAME OFRERSON CONSTRUCTINGTHEWELL . � i ­ "1-.�.— .�. I—' � .-2 v`-� r .,.__._._'.,.q7 ..-�.�v r, , ,"- - _ �._? FI,�'_,.,,. - :'I,,- -. _, _­ - .. _�...� , -_. -, - `` "--e"..r: .l . , �_ -l-_M­_ k.l ,1---,' , -..�� 6r , "_ _".7 �l­"- -_-_'-. ;,_- --,1 �- _ ".l �:­ �__ -.- ., ­- _._,�­`."� -i.------- 1_ - F.......................... � O.1����������������I ' . ,.�Im---_ ,--" ­ ­ -",`','­�r 7.�,.,.',,,,.,.,.,.,.,.z�.:,I._..-._.............. .. ., ' .`. .. . 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