WI0600060_Well Records_20110908

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V8 (WTRACTOTZ C-k Cwft#3476-
'I: WELL. C61NITKAO-O- R-t
Randy Hoffman
WeIL;ContracCor(Indiy�dual) Name'
SAEDACCO Inc
Well Contractor:Com an Name
90RA Northfied Dr.
'Sti6ei'Ad&696,
Ft. Mill S. C. 29707
City Or"Toqq. State Zip Gode:
[phone]____
Area code;Ph 2.:;WELL, INFORMATION
w!ELL,CONSTRUCTION `RtRM IT#:
QIATIED.'-PER JT#Qf,,Ap01(6a014 :'OTHEWA'S$O.M
SITE
tLL t2d
t3.'W ...... ... . . EL -.US -.(Che 1 drin In
unicipa
du Agricultural; --
'k 'a iIOhM OthefPk
. ..... l �Ifif
:- - .-
DATE bg!LLED.; 9-8-11 10:30
-A? YV4InL. 1-PPvT!9w
Highway 211 East
COUNTY'(Street Name, IJurritiers ,Cornmuntty';SubtliwsionPLot No' ParcehZiq Code):
:
TOPOGRAPHIC./--T-T w,�XM 0,'�WtPb#
R Vafle,y. :.M. t:: pRicJge r
LATITUDE -DMS-.,.'OR:a*X,-.k)(kkXX 651
'L-QN'C0TuPF:, _7 J)D
Laii*iud�6ii"ond,i't6de-,-source. bGO§'- 4n& dtopo "Ic.map ... grapK...--
this farm rf no( tq
.§ys A -h T..Y,,(
--.CSX Derailment Site . .. .... . .... -
F6f61l1Name Facility IDf# (if !applicable)
same as on
Eity or Town -'State
;Zip Cade
AMEC Earth and Environmental -Raleigh.
Contact Name;
2200 Gateway Centre Boulevard Suite 205
Mail %Addiress�
Morrisville N. C...
27560
City or T6Wh :State.
:Zip Cotle
La,L--j 1 447-2750
Area code Ph61fi&:d*fiib6r';
6;.WELL :DETAILS;
TOTAL DE
PTH W,' 25
.b.,..DQES WELL. REPLACE EXISTING, WELL? Y -11n: 0N 99
`c..WATER :LEVEL ii6iow'*Top 46,asing-- FT.
TOP OF CASING IS V.T.- A- PY�) PP-4:09
2. 5 rfade*,
.To f6_ape '- May require' .O�Qf- si j�WiN46 8 variance in accordance with 15AYIELD,(gpmj;... ;METHOD OF TEST
DISINFECTION. -:Type �.,4raourit:
TAp
�Bottorrm'
Tops
.Bottom
Top:.
Top _`Bq#qrk_.
Top>
Bottolin.,
7lick.,.nesil
7. CASING _ Depth;
iame er
Weight`
Ma#e�ial
sch40 pvc
TPA
tat GROUT,
Depth,
Mefenal Method,
,T
.130ttbrn_LG
pour
jop
ttom ....
0i,
bCAIEEtCw b-6'otfi
Diameier,
SLOW -slid, ,Ivlaft6zriil.
T!,qp-2-0--,,
P. -Mi*49m
ru,
Depth
Size
Material`
:qt) 8,
Bd t6rw!l 5
rf,��20/30
#3 SILICA
fba
saftbriv
11 DRILLING LOG'
TOO Sottorra
'k MAkK
-�'orrna 'fib
e8!
tan silt to brown sand
fa
—I d0f.H5R06iCiEkTJFY`,fHA THIS WEILWAS GON57RUCTED,'IN 'AdcoAbAr4de*1TH
cti6tsl- DARb;5;`AN1)THAj,:A. 6# Y�Tms*
a REEC-1514A- Ej—;J'PROVIDE-D TO:- WELL OWNER
SIGNATURE F,CERTIFIED.'?.WELL,.CONTFZN PR::
Randy Hoffman
PRINTEIDAAMEOF -PERSON; CONSTRUCTING THEzWELL
For6GVMb'

Randy Hoffman
SAEDACCO Inc.
Well Gontractar 00 agg . Narne,
9088 Nc)rthfipc3 Dr.
Street Addiika,
Ft- Mill S-C. 29707
City or. Town .State Zrp Code `
[phone]
;Plea code:. Phbn� number
' WtUCONSTRUCTION*,PERMIT -
OTHERAS IATr=C(.:PERMI TA(if00 l-i ir bf L, t2s
,3: WEL
oX oriliolring',0. unibipaYR0116[j,
Ag0Culturalg oq*.Q�j
bb`h*❑ 'Oilier ",i':­ temp well
9;30
Highway 211 East
(Street Name
3, x
. .. ... .... '!DMSOR'­X`Xk$� k3bb(tdl
JDP
..L,9.N'qlT,U 7 :kxxlxx
LpMudbA'qn' fiide.-sq'urce; pGPS b6pCwp,phJqMv
"t",A d", FACILITY {Name of the fiusrness
CSX Derailment Si
Facility .,Name same as one
City or Town
AMEC Earth and Environmental -Raleigh
State Zip Code:
Contact Name
... 2200 Gateway Centre Boulevard Suite
205
qress.
a��s!' Address.
:; .: Z.
Morrisville
N. C. 27560
" 447-2750
Area ode
C.-WEL.L.DETAILS'
WELL .. ... 1. 1. o
a. TOTAL, DEPTH . 15
'b.. ..DOES:VVELL. REPLACE EXISTINGELL?- .YES W ,' a�10 1@:
t. WAT
ER LEVEL Below Top......... FT.-
I SWW. if.A66V6t'
p Of
3476
d TOP OF CASING IS 2.5 FT Abase ..,Land Surface"
'M
foasing, errT Mb'dt605t.:b�dfi land 'if may I require- p—,
a variance in. accordance wlfh 6A
DiSINFEdTIO We Amdiint:
Top.
Bottom
lap:
l3otkom.
I,, JCMINd-, Depth;;W
Mate[ m
"i
sch40 pvc
Top .
Bottom
Ft'
Method;
hour
'tc'ReM, bopth Diameter016faffij
10Boom15
pvc
Size: iVlatenal°
S. Pfi.�20/30 #3 SILICA
,......DRI :'UNGIOG'.
lop, Bottom Fo lnation P"00(jk
0
tan silt to brown sand
r.
Pro
U16
S:.T.RUPT!(?N�pj�"Q�A DSjiAN T 6TAof OFTHIS,
REC -DIHA^ a -PRQVl E0 TO;.TMEI LLONINER
'
i,.S4GNATQRE;.,QF10ERT jFIEQ-..5W DATE; IELLCQNTR,�,if
Randy Hoffman
o:PRINTED, NAMEOF P. E -T WELL
F,.ZqQN..Q.ON$TRUCING.7 5
Forffi.,G,W16, ,
P-'ev- ?to '

REE
NOV 2 12011
DJENR 4AYETTDALLE RECICINIAL OFFICE

WrA W Rt�sburcc�il� b ivisloub, fWalldf*(wait nA� d:N
3476:—.: -
Randy Hoffman
SAEDACCO Inc
:w 11 con.tractor: 0
1. . - R- -�'- � C. 4.me,
90AR Nnrthfiptl Dr
S-fre'eAddress„ Street:'
Ft. Mil S.C. 29707
Zip
t Y.: or T 0. w q -..,p
,.[phone]
.Area code; Phone�numbei-
; NVELOWN8T ON:PERM[W..
.�'OTHEWASS PC,'IATEq-PERMI bi w ELL ID lfca
m
E t
8.ox* -.6nHonng, unp.paVPWbflb�..o**
IndustriaUCordritercial Agncultutaip
`Irn'ga* i6no'. . th6fMI.: lis temp well
9-8-1 8 3 0
+4.: WELL
LOCATtQtV"
Highway 211 East
6664T Y
L
op
N
T
Fl
LATITUDE , -
0 X;,X)�*6(
a 'oca to
s form if not using GPS
FACILITY
Sx Derailment Site
cam
FacMij: . ItY#,,#f:4Pplid*bbje'j,.-
AR one
Street Address::
-
City or Tawri.
Stale -Z�p Code
AMEC Earth.and Environmental -Raleigh
Contact ;Name
2200 Gateway Centre Boulevard Suite
205
Maitrng Address'.
Morrisville
N. C... 27560
City oc Town
State :Z�p Code::' N— .
919 447-2750
Arbacode P.4666buffib6f-
61-WELL.PETAIM
�A,TOTAL, DEPTH ., 25
�b..,:DQES',WEL.L.R.EP-LAC9:EXIS N.,GWE L?-:; YE$�,t-
L N
C.. WATER .,LEVEL ,Below '�Top of-.Ib'6smg
UsW"+7 if.Abo*Ve T60.6fcarind),
op.b .s,qffapqmay require'
a-.V;Arfan.pe-fR.*accordance -Wlt
(gp*
'Affi6u"fif
=Bottom'
Top:
M:
Bottom
CASING;
; beth.i -p
.
. Pliffi ei
w6W 'wit0hao
P--L_*4oT
10
Ft 1"
sch40 pvc
11" - , I.,
. bi IdM6 1 t6r,
SCREEN '-D'Oth Wbielii
251
�ft
-- 22 - 0 p,,
6
Q'.SANOlGRAVEL PACK:':
Maferial
0/3 #3 SILICA
R P,
7 op Bottom
Fo,�mahpn Dtloh-,
Randy Hoffman
���.�P,RINTED..:NAMiE�Q,F-PERSON .!C , STRUCTNOTHEWELL
F;b GW-'l b

NOV 2 12011
DENR -FAYETTEM LLE REGIONAL OFFICE

-Z
CL.C61
W CTOWl
Randy Hoffman
Well .Coniractor(IridiVldiaij_ Nate
SAEDACCO Inc
Well Contractor Company Name '
9089Northfied Dr-
.Strdef Addii§s,,
Ft. Mill S.C. 29707
City or Tawn Slate Zip Code
(_)'(704) 622-47 0
:Area cads;; Phanenumber.
`WELL GbtJSTRt)CT10N.PERMIT#<:
`PE�RM THER-A=Q1ATEQIT#(i6w A
(c.
—tS
4:-W ELLUSE-I
rqga onq temp well
DATE .DRILLED L-9 - 8 -_I 173 o
-WE-L-,q4p6N- -
ION K
Highway 211 East
(Street Name,VOir.iVdj#,- rtjmLthq-., W06,
D-M-Sb jW3'X-�')b(Xikk3(x).(,
LATJTUDE,;:�,
q - AA
(locatron of well iglu r USGS,'.+taro lwodOtb& krtp
FACILITY Name of the bus)Resswhereth well'is located
X—Derailment Site
e)same as one
-,
Street
City or Town State ,��ip Code
AMEC Earth and Environmental -Raleigh..
Contact: ;Name:
2200-Gateway.Centre Boulevard Suite 205
Ma),Ais dd�e��
-.
Morrisville N.C...-- 27560
01(y. or Town
RWn
( 219
Ar6a:66db
q,..WELLDET.AiL$'-.
:a�. TOTALDEPTH-;:15
—
�b.,:DOES',Y.VELLREPLACE EXISTING'WeLL,?. YE,$,,Ej N01g:
c: WATER LEVEL Below`Top of Casing.: 6;;-,*- d:Abo T.,
,Casffi,d)
3476
Yb, CASING PF, t 7.r
Top bt'dasih-g lermlQatecl attor below land surtace may require'
,&, variance
I.
T
p
BottomeBottom:' Top_ Bottom`
$ottom• Top: ,
.Atf i,Bbttdffi
4"noisii
b• jrr,C.i,,+igortianct pour
tcAltEN— Depth I ftimete'r, Sldtl'�,
10 Botorra 15 FL, i PVC
Depth ; ib MaterFal
dtbrif'15'
Fi;,L2 0 3 0 #3 SILICA
Fo6n'G.W- 4b'

Pi EC E i�,
DEVR-FAYETTEMLLE RECITAL UNCE

6Al.-x- 11 All-
-ifrd ni'D (iii&i Ens 1Mnment, anaNatural burct%-. Dr usl&
c W
44T '3476.
'C'W8CLc'bNTAA&T R:"
Randy Hoffman
Well ,.-c nt
SAEDACCO Inc
w6i'Man"o Company -
;.., —.1 ... "p, Y.amp
,..N;4:—
9nRA Northfied Dr
Street Address
Mill S.C. 297Q7
CI or Tov✓t
(704) 62274750
Area ' de Ph--
."W.ELL ,'CONSTP,U'C,T]CiN;'t?'ER, MlT#l---
b
SITE WELL ID #{If:appl�cablr j i6d
&WE IC—
eci,00 Bdk)`.,M&h—1 brlA �R-U...nidipal PUbldo!
li'n�g—ail-66b` O,,t*h& lu
PATE DfiJLI.ED 9-7-11 4 :-3 0
Highway 211 East
;(Street Name, iJumt%ers ,Corr}tt}untty 4,
CITY bblffd -e - — — - — -
N
LATITUDE 36 - XAXX-Xk-xj(xx-:&d,
-LDXQJTUPE-? ;. Q<: QMSWA XkxXxxpQ
`Ocat
his form if not: using GPI
CSX Der -ent Site
Fbfcil0,.Nar'
same as one
e bl" 11
City *Town
AMEC Earth and Environmental -Raleigh.
:;Slate Flip Code''
potapt NO*
2200 Gateway Centre Boulevard Suite
205
Morrisville
N. C. 27560
City or ToWrt
State- °Zcp Cone'
2750
Area cotle Phone riumtier`
C-WELLDETWILS1
a. TPTA4.,DEFT.W.. 21
.b.",.DIOIE!S.WELLREP.LACE,.'EXl.4T!N..G:W,ELL.? YES< - NOE]::
'It.. WA ER LEVEL :96iow -Tb b Casing �9 FT,
(Use iU , T 6Casing)
'S!j
.t 6 14 .
XT
-06�
'Top afcasing
r
"t t/ b equire
variance 1n accordan.ce�-,.with'
DISINFECTION i
WAY t I k I kO'N E* S 0-6-6- th)-
P-1
M'!
pBottom
Bottom
*'anosO
,CASINW' biiotli-
Vame er
el M0- A)
p 0
Bottom is
Ft.t2"
sch40 pvc
Bottom
p
Bottom
V,�
GROUT
ri-portland
pour
b0,01504#;:Depth
Diameter 51ofSlze Material;
P--L-5,
Pp#qn21
-020
-pvc
p 17-
S1lIJDIGRA
6ykl�.FACKi:
Me
60i"ItDrif Is
-.Ff,,20/30
#3 SILICA
Botto
mFormation
-;A
'PROVIDEDTHE -T9,W NER:
9-7-11
SlG4ATQREl0FCERT-
jFIEOWELLCQNTRACT70W
Randy Hoffman
PRjNTED,�NAMElQF PERSON .CQNSTTRUCTIN. HENVELL
F66h.G W--1 b
Rey.-:2105

2 12011
OEWR=FXYCTTE\ALLE REGIO'N'ALOM

NaturalRN csourccs�- " 2666-if W . [dr Q.uaLty v
t W&'4'."3476-
T. WELLtbNT
Randy Hoffman
Well ,"C6 t0j(Iq&kdUaly.,Niki6e.
SAEDACCO.Inc
Well Contractor. Company tVamg,
c)QAQ Nor thfig-d n�,
2Strbet'Addi6is-
Ft.., Mill S.C. 29707
C�fy or Town Sta""#er Zip Cycle:
L____j(704) 622-4750
code;Area
Phonenumber
INFORMATION .
'WELL.CONMWCTION PERMIT4,.:
:OTHER Ii0.SSOCiAT
SITE W ELL #
it#e) r1i6.
3::WELL;USE (Check One &)Wbfiltbringunicipal Wbllcu,
n
It tio - n.Q Oth6f
DATE DRILLED 9-7-11 3:30
Highway 211 East
i�N*Mll*(
q"NU. '-ft-ierpyr bd j . - .,M
"-DNIS..OR'-' XAXXX XXXXDD,
AM.QM xg.xxx DQ
LOJ: d 17" 11 source _.ograp Or "Jc.ma'p .,b
.111-1 f -W-
thrs form if not using GPSj
Ty ([tame of n
CSX Derailment Site
Fkilit* ' " ' -Narrie
Y.
bi
Street AcJciress::State
t�,:p To n pf d i.?
Ip Code;
AMEC Earth and Environmental -Raleigh
Cphtact Name
... -2200 Gatewav-Centre Boulevard Suite
205.
a re Ps;
.. �kR - Address;
Morrisville
N. C... 27560
City or Town
Area sddb P'.fi6'h.
i,WELLDETAILS.;
a., TOTAL DEPTH is
�b-.,DPESVELL:g"LAQE.E;KIS INq-W%L Y
T NO.M.
u T,
sib".+: ifAboVb161'p.0UC,6!§ing
TOP -O!:::CASING ;!§, 2 - 5 t=
T Above Land'Surface*
*Tap of;casin'.A­j—tidaUor.below land ­".
aqqpayxequire'
- , a variance accordance .. w I 5
-
AjiSINFECT .,p
Tdp' __-�B
I cit . tdt.n'- -,
Top:
.bottom
rrt.-:
T,
Top
POO
I Andssf
7-6-
Pja e er
ig aeral
Material
sch40 pvC
TWO
roe
Bottom
FI:
GROUTt*p**
Method
B046ryi 6,
FtPortland
pour
TOP—
WPM—
lRtMt *'Ah '. D'
M',tC -' - pp
Diameter,
816
.
ToptoBolcom
Is I51FtLL'—lR,,
0 2 0 -Arf,* pvc
u.
#3 SILICA
T.
'D fib
Bottoffi
0
J
RlIFYTHAT,t. it WELL,,W A -0QsTKU
ACCORDANCE :WiTFi
T A COPY�OF THIS:
.�:AE�'L'HAL-'Br--F-"'PRC�Y.IDED'.TO.T E WELL ONJNER
9-7-11
SJ.GNAT.URE',',QFCERT- 1Y'WELLJ0QNTi;WC
IFIE TOR DATE
Randv Hoffman
;-PRINTED.NAME-OF PER S QN:CQNSTRUCTJNG ViE-WELL
T
FbriWPW-:lb
ReY.-2/09

rl"EzOEM
j,-,jUV ? 12011
DENR-.FA:f'L7TTE\flLL'",'iEG�C„'AL OMOC

Randv Hoffman
SAEDACCO Inc
W611'Contractor Company
9088 Nnrt-hfipd nr
Street.
Mill S-C- 29707
City is
Y, 1p
-'(-----j,T704) 62274750
-,Area dode Phone. numbee
:3476---
ti TOP OF CASING IS .z s FT Above LandSurf'ace`
'Top ofcasingaerminafed atJorbelow land M ffa pefMayrequire ..
W 1.
TEST
"A" U. lASlNFEdT-lO Ty I rr(ount.
, 1.
"W.t:LL,-CONtT.f,z',Uc,T'iONPER , Ml .,
OT'HER,*".ASSQC,IATED�P-ERMI.T#(if,�o..�oir bl'
SITE
yv, _
b,).i rliS.dpp
,3:,WELCUSE'. {Check O — nicip . al I !Ublic',0;
Irngatlonp 0th L
4ii'DRIkLEV 9-7-11 2 30
AT
Highway 211 East
L,A-tjt,(j' A36`-
LATITUDE 14 . DMS OR":'X-'xxkkkX-X-X'X2**&[5l'
'ONOWPE', 7 X '14WR O"
Latltudeltongttudesouree 0008": Or6pogra #hrs form if not usrn� GP
FACILITY S located
�p
CSX Derailment Site
Ficillt -y . Naive
—same aG one
strept-Ad&o.ko-
City or Tflwn.-:State -
AMEC Earth and Environmental -Raleigh
Contact Name ,
2200 Gateway Centre Boulevard Suite 205
M,ajlih9- di
Morrisville N. C. 27560
City --6-eT Wh ;State' rZlp Cone'
447-2750
Area code Phohb.'aWffibeir"
&'WELLDETAILS;
,a. TOTAL DEPTH 21
.b....D.O.ES:,WELL..REP.LACE.EXIS N�P;W -L Y Tj .EC N
t. WATE.R.LEVEL.B61ow.'T,615(it,'C'ijsihg�:
FT.,
si;.e­`;'� d.Above'­ -Td 0. 0 f Casing)
;bottom: Tap' .Bottom
,.Bott6rft-_- 'Top Bottom,
Diameter 4iYerglit=-Material
s6h4o �Vc
GROUT Depth Material Method;
'Portland pour
p Bottom Fr.
SSCREEN:De-jit' Diameter, SIof Size a 15. 2 0 pvc
Itom
8'
brie. Material;
)/30 43 SILICA
-'7.-Al.-DRILLING:LAG..
ottom Formation Qescnpfion=
STANDARDS,1 DO HEREBY CERTIFY THAT'THiS WEl';LWAS CONSTRUCTED IN ACCORDANCE YJITH
FTHI&
7A t�
-- ...�,T
�-REZ-, ",A-BF-F--ti`PROVIDED jVIE w, ER
9 -7-11
DATE.
Randy Hoffman
�.p.RINTEDNAME=QF PERSON CQNSTR CT
M INGTHEMELL
Fp GWl':lb

Pam► i� � r--�
NOV ? 12011
DENR-FAY7TEVILLE REGICNAL OFf7CE

i; WELL d0NTkAcT.*bw
Randy Hoffman
Well -Con
SAEDACCO Inc
WeII Contractor Company Name,
90R8 Nort-hfipa nr
Street Address_
Ft- Mi11 S. C. 29707
Crtyar Town :State,'Zip. p
(704) 62274750
)Area cod -jphp
'WELLGQNSTRUCTION<ERM1T#,;.
OTHERA$$QQiATEqP.ER
Icab
SITE WELL r1i5s
`3; WELLUSE {Check 6fii bringEl MW
g .Uc!pa17Pu lid:o:
'8r,64mo-fift-6--
n Ultu
.
-­
rtig6fib ono'. the-r'!Q (Is use,
DATE DRILLED; 9-7-11 1:30
_AT
Hicrhw;;,V 911
-— R..t
,(Street Name Numbers Cort)muntty •Sut�d�h�lon,Lni No. ,t'aresl,. ZiP fade}
Cf,TY. R.�indale i
--CSX Derailment Site . . ....
Fkillry:Nakrfe
Ramp as one
City
AMEC..Earth and Environmental -Raleigh
Ppritatt Naftid.
­2200 Gateway Centre Boulevard Suite 205
Marling - d s
Morrisville N. C. 27560
919 447-95n
Area r _06i; ,7PWdnbliumbef,
6. WELLDETAILS"
;_a-:. TOT-6L,.QEPTW..,- is
b. �OOESWELL REPLACE,:
"1ST1NG.VV%L7 No I@
.c. WATER. LEVEL Below
Gasrng:
'FT.
of
3 , 0- 'a' 2 -6 6
TOPPFCASING IS 2.5 FT `Above l 'hd
below .:land surface may require'
pyq6nceih,-.accordance,,with 5
* T. 'Ount.
ypq—
,.AM "WATER BONES a"i'MM.-
41: Top
�B'Oftd'n
P;
Bottom .
M°
P
Bottom
Top
Bottotri`_
,4. 1
Thickness/"
CASING:`;: Depth;'
.JoP--L
Bottom i o
Ft,: 2
sch40 pvc
`TaP ------------ ------
Bottom
Ft
.......GROUT
17epfti
Material,. Method
T' `p o
BOttOIn-6'Fti:
Portland
pour
�ToP—
9040"!--
Ft
SCREEN:
'b*fi
t16f."t" MA dii
-.020 pvc
Tap
Bottom
Ft;: inr:;
1
P KV
Djpp..h
Stze
Ma eral
J�,70p 8
E ottorh.1 51
-fff.,,20/30
#3 SILICA
= Top;
Bottom
ft a q Q -,p
- 0 /. 1.5
tan silt to hrnwn —H
Randy Hoffman
PRINTEO.'N-AMjE',OF P. ERSQN.-,CQN I :T $TRVCT NG ijE WEL.L
Re.v;:21.09'

N'OV A 12011
DENR-FAYL:TiEWLLEREG,,C,vAL OFFC

RECORD;
1. WELL dONTRAdTbRI:
Randy Hoffman
O.-O."Wme..
SAEDACCO Inc.
'W61FContractor Company
13088 Nort-hfipd Dr
Street; Address,;
Ft. Mill SC_ 29707
,c,it -br.'Tbw..n State: Zip Cede:
(704) 622 4 50
,Area .-code, Phone number
'WELL ,-CON8Tjk 'Q-,T�JONP� � M
U I' j R 1,T#,
",ttk tuj 's * , 6
1-II.I.. q
M., ro. Opp
M-i.- I/P
WELL'
EL
Agncultural
frngationp Other p (list use)'
DATE DRILLED .9-7-11 12:30
Highway 211 East
(Street vName ...,,N4 6i Community ',
,5ubdmsion; Lot Na, ParcelxZilS,Cod@}
CITY _ Ro�. ie-
lf&j i
T.
0 LAND SETTING ,.(check appropr�ale box).
op ;,OV 11 M
.-F
.3k. X)bUkkx
LONGITUDE ;75
LafitudOVjor)*9.'tqAp,'sqppq#, D3P;5.,- EjT6p.qgrapfi*(c.m
(locatron�ofwe!l�rrtusfbe shown on
W .Kppt!using GPS
5'FACILITY Name of the esS the s:locatbd;)
CSX Derailment Site
FklfltY:NaiMe
_ same ac one
Facility ID#,(f'applicab7e
$treptA,ddrqss,
City i-Town
AME C Earth and Environmental -Raleigh
Pbhtbdt NaMd
2200 Gateway
a teway-Centre-Boulevard Suite-205
Mailin d
Morrisville
N. C. 27560
447-2750
Ar6a,codb PKOhd";fiu m'be'r
6.'WELL.DETAIL.S-.
,a,TOTAL, j).ETTW'.- 21
b....DOES,WELL- REP.LACE. EXISTIN _GWELLJ QUO::
:C. WATER:.iIeViL" iow.T%0.of-ba;in:- -
I FTIC
i AbdVb Td.0 of
CASINGF7
-2.5 FT ?yOLand Surface*
I, 56ai; si ip-g'.3i e r m in'- 'a"' - Te -d
Allor`;betow�land 4d",661may qlir
a variance .:nac rdance with'15A NCAC 2G 611
YIELD
f DISINFECTION. Type Amount
'
'op
�Boftom
Top
Bottom
'0
.00
Thicknessl
la
W166 ,kii,
WiAdw Uandfi6i
sch40 pvc
op
13ot3ocn
Ft;
op 0
fn—L—
�:vortiana
pour
SCREEN:
e th
p
Slof',gki
:.Mitdria-1,
0 isOtOm
21
lft.`
21
0 2 0 pvc
op
Bottom
Ft:
iri4
o
OL tpin—,.,
;
P',.AM. DIPR.A.VEL PACK;
Depth
See
iNate�lal`
Op 81
0 �/3 0
#3 SILICA
RP
Bottom
Z=1.
op
Botiom
h,
lop,
f3attom
ti t oft i -DesdiDtioh,,
RMapdy Hoffman
P.RINTED;NAME OF PERS NLONSTURUCTI NP:TNF-'WEIL
F6rm',GW-;Ib
Rev.:2109

300JO IV"0,93� 31101D--�l MN30

WM-CON
Randy Hoffman
t W lltb rab �-(JrOAO - OP. - -(0 . !YW*
SAEDACCO Inc
Mell'Con
-.-I.. .;,:-"9tor-Company '-.1-9"'
90RR Nnrt-hfjpcj T)r
Str6et Addr696-
Ft. Mill S.C. 29707
City or Tflwn s*0". Zip Code
}.[phone]
Area cotle; dryiVe'.
2. WELL RM
WELL lON:lP­,**E , R MIT
OTHER ASSOCIATED:FERNIIT#(it bi
E 06 rli3s
I ' appllcalA
h
h 0 -, Other
rriga 16 us
DATE.DRILLED= 9-7-11 11:30
Hiahway 211 East
(Street Name
N-UMW dnirpunf..N ��
L 36
LATITUDE
;LONGITUDE
7. -DD
grap'- 1q.M4 p
W
S: FACILITY Name of the-businesstwfierethe611. sl
CSX Derailment Site
dt"O �tA4
City or Town
AMEC Earth and Environmental -Raleigh
State Zlp'Coder'
POMbOt IN60-6
2200 Gateway Centre Boulevard Suite
205.
Mailing Address.
Morrisville
N. C... 27560
city.. zi; TownState'
:ZipCod'e_'
LUZ--j - %-497 - 2 7 5-9
Are6 code Rh"onis;riumtSer`
6.'. W-ELLPETAIM.
A... TOTAL DEPTH,15
.b..,D.OE!S'V.VELL.REPLACE'EXISTING 'WELL-?jYE,,.[I N '.00
C.. WATEI,i,LEVEL . Below :Top cjf.Casing :
FT.
ove Top of Casing.);
-TO Suif�lde'-
*Top
F,QF - - �12.5
'pr
.bf.casing wermir)ai AVbtibelow land ,- y requ,re
a variance in accordance with 1'5A. 1 t8i,
YIELD -igp
DISINFECTION Type Airiourit:
`Tdo� 13ott6rli
'Tpp sottorp
7-P ':CASING - - D*R.: Diameter- elgjhC Material
w:
Top o Bottom
10 42-- sch40 pvc
Method;
0 Bbq&Tn-L,
Fl.-.: port land pour
p— 664M
P— APUOM--
Ft
to
'T
10.Bottom —151TE,--2L—,R-?,
-020 -,,pv.
M
Il DRIJ-INGibdlop; Batiorn
'ru
'v
Sue .Material,
0/30 113 SILICA
.tan silt to brown sand
PE -
Nil
essina Unit
f00 HEREBY :Tlf;,Y -16HRTTIilSWELL-.,WAS.dt4tffkU 'b'tTtb,*ii�'AdCO DANC'E-'WIT'
'.-"A D: -OFTHIS,
PPNP�f5u,ctp�.�STANDARDS, 'k t
N : PROVIDED TO Tfl. R E
9-7-11
SJ-PNAT
MATE,
Randv Hoffman
:PRINTED" NA.MOF -PERSOWCONSTRMWE
LL
ELL
l.

DENR -FAY,7;TEWLLI-

VO �U Tmv 3 4 7 6
Randy Hoffman
well,:
SAEDACCO Inc
Well P C qntr-�dt&: o pppy,Na.me'.
90AR Nnrthfipd Dr..
:Street: Address„
Ft. Mill_ S.C. 29707
c1tv offown Zip Code`
L---J-1704j 622-475o
Area code; Phone°number
2..WELL INFORMATION„
OTHER: ASSOCIATED: RMJT 0
SITE csx-30d
WELL O"A
tLLUSE (tfieWUn; M"
[Z unibl0a PUbf,
!ndqg mmercial p.; Agncultural
1'ist, ruse
DATE D 9-7-11 10:30
1 East
gUiNV—O'
.Is
1_;6j-jT',U- ­ `36-
DMS---'W-' X;',X566XXXXX•
LONOTODF
Latitude/longdudesource
DGP§;: Or p.ogrqpWq,Tn,4p:
- PjcOtipn.-:bfW' �4 644#4 - Q: Cb OJI j
R b s ness, fe e-14wlocated
y
....CSX-.Derailment Site
Facility Name Facility ID# (if,`appllcable�
—same ac one
Street Address::
City ,-*-Town. Stale Zip Code
AMEC..Earth and Environmental -Raleigh
2200 Gateway Centre Boulevard Suit e 205-
Morrisville N.C.. 27560
919
Area -bode PWfi&4.iUffi66e-
6:W.ELLDETAIM
A-1 T1pTAjp9pTW 25
b..,D-OES;,VVELL.REPLAQE`EX1S N,.q,WELL?; Y T11 NOS
C.WATER LEVELIB6,1ow,*60,Casing
FT.
Ojio *:J.AbdV& Top - of Casing}'
TOP ,PF!C
•Top A-fc a'! iq"g- I d ypr�pe!q�(:! trhir.jijtcd*at/or , ale
—sprfA'p�:'may, req
a - variance ih-.accordance .,.with ISA-.NC, ZC011.8.-,`
YIELD TEST
L—
NMINIF '&IOW -E i-iType
,Am"Wirit.
'p kBattoni:—
'14
p— z Oqtt
j3ottom—;-
4 n6sii
JOAMN.0-1-::, D.ePth;'
Daiiiefer
Weight? Material
P-2—A 10
sch40 pvc
Bottom
Ft
GROUT Depih
Material
Method:
0 BWW16
7
:F(.: port land
pour
P—Bottom —Ft--
SCREEN "Depih
btglirikik W6f,"tki Vitidit
251
1 rj, -.22o J.n•. pvc
7
An.
P/.PR".EL PACK!.-
D,epth
Site
Material
8-bottbrkI5
Ff-,20/30
#3 SILICA
Otto
--------------
pi Bottom Formation escribildn,'
0 25 tan silt to brown sand
processitlij
Inforrnaflon
L)Vq UV D,-LO
r
, .-NI,OOAR
l DO HEREBY CERTIFY 7HAT THIS LL:.AS.CPNSTRUP "TEb1R.A(fdoRpANCE-1NITH
YOFTHIS,
STANDARDS P�
'T
. . .... .kp�qTOT H ,W.-LOYN;
R
.
9-7-11
S J.GMTPRE',QFQ ER. .T )IFIEDWELL-�COWW QR. DATE;
Randy Hoffman
PRINTED NAME F PS ER QN :CQRSTRUCTINQTH-E WELL
Forffi.GW-Ab*
l Rbw�/'bq`
- 1

r
ECE
NOV 2 12011
DENR --FAYETBULE RECIC-NAL OFHGE

otth Carolmx Departtric,nt o1'�ny tronment dnc! Natural Resources .Divi:,ron of Later Quality' / �
3476
Randv Hoffman
SAEDACCO Inc
Well 'Contractor 0
90RR Nnrthfied Dr
iStreet Addiets-
Ft. Mill
29707
City .prTown
),[phone]
Area cotle; Phone pumber
: QTHEWA$$OQATEQ. -PERMITOU,�� - ' W '
'SITE WELL 0.#( CS--30S
indugo'Itg
Jj
DATE DULLED.: 9-7-11 9:30
Highway 211 East
t
(Street
Name
s� Lot No
Rosindale Bladen—
'Lj�lppp. Uyjpey, :Wt;lpt, RR - ,pottier
DMS OW' X.-k-kk
DD
zitIt4d0/16pgjtq0q- �qg;: OjPS*,. Mpo 'ftic.m p.
69pafion_q'f /A Ub ..WplquA,* q.,:q p.W $G.S.t6p6in
'this 'form JfnblijsLnq..9M,
m o
FACILITY �-. business where the well is: ocatedi)
CSX Derailment Site
-F6c"iIN'AD9If a -pp ':;46,abI6
same as �n
Street Address; •'
City ,*:0rTown ;State Zip Code-
AMEC Earth and Environmental -Raleigh
2200 Gateway Centre Boulevard Suite 205
'Ma d
Morrisville N.C.. 27560
. i"C'.-
City be TOWh "S W6 zp. : Ode'!
LaL—� -447-2750
Area code PNdhd'.iiultbier
6:,W.. ELLIDETA1.0;
-a..TOTAL, DEPTH; - iE;.
b. DOES' WELLREPLACEEXISTING WE
c. WATEk''
.,,.LEVEL BeIqW,.,T.
FT, -
(Use ..if.Ab6 t6'0'-6f."ba's'l ihd,),
.0 OF CASINGI .2.5 FT Above Land Surface*
qq,qqe_,Tdy require
el-ylariancek in . accoidance., with '15A 'NCAC.;2'C71 0 8;,
;YIELD 9pto)-., METHOD OF TEST
.DiSlNFEd.TioN.'--TV,'Pi 'Affib"Unit"
�p
Bottom:'
`Top
Bottom
p
Bottom`"T
Bbttdffi
�-Tnjckness/
Material
P�-0
13Qtt !p 10
2
sch46 pvc
Bcittom
Ft
GR4�UT�
Depth,
Maieriat
Method.
portland
pour
p:
Bottom
t;
p
Bottom
Ft:
SCREEN
`Depth
:Diameter, Sidt"'Skii Material:
P, 10
BOfiom 15
Ft L'ir�,. ;L�2
incpvc
u+IpIGRAVEt. PACK:;
040th Srze IVlateriai
8' BOttOrSl15, 0 3 0 #3 SILICA
Scittoll, FQrmahon
.tan silt to brown sand
w
�ro
g
InforM21T alolt(G
sin
w­-
Randy Hoffman
PRIN_TED.NAMEOF PERSQN..(
19 D�QNSTRUCTINGTHEMELL
Forffi.GW*'Ib

WELL 3476
1. WELL CdNTkkctbR:
Randy Hoffman
WeILContractq� (Individual) Name
SAEDACCO Inc
Well Contractor Company Name
90PR Nnrthfipd Dr
Ft. Mill S-C. 29707
City or<Tovgn tatd�! Zip Code
)-,,(704) 622-47 0
:Area code Phone numtjer.. '
OTHERK-',AS5.QcZiA NIT Ou"APOR 016
SITE
WELL . D
. )�,g � 1 jaRp;i-blo)*'�. csx-29d
"a; W U -''tieck One 136 ky
R%lonitoring,M Mdrildipa /PUbljc
Irrigation❑
DATE DRILLED., 9-7-11 8:30
A,.,WELL LOCATION;,
Highway 211 East
,(Ptrb*-N
uktitUbt.- 36 bbi
R7X.XXXXXXXXXD,
Q
w,
Latitude/longitade source E)GP8,: o..6pp a r phk.map
fhrs'formrf not using GPSl
5: FACILITY Name of the business where the well
'10ca
C$X Derailment Site
Fk Nsiffile
Game as one
5trqgtAOdress;
City prTown
AMEC Earth and Environmental -Raleigh...
State ;dip Code
-
P.6-ritq-Ot Name:
.2200 Gateway Centre Boulevard Suite-205--
Maii� clrep�!F
RN
Morrisville
N. C. 27560
Qfy)U T-
State tie,
916 - '447-2750
AreacodePff6fi&Ijurn:b6f-
6:.W.ELL DETAIL&
A., TOTAL DEPTH:, 25
,b.-D'OES'.WELL.REP.LAC;l�-M$TINP.WELL?'� YES',b
c WATER .-.LEVEL ,Below Top ,of.Casing. '*
P. of"cdShid),
sq4�`jf:Abo
TOP 60P CASING IS 2. 5 FT Above Land;SurfaCe*
Oplot 'tit 'i'Ootbbl6W ILI
"T­— Whi4efffiffi- ed land
,�g..ape;T y require
a -. variance J hiaccordbrice, eYIELDz"
.. (gpm) METROD OF TEST
f .DISINFECTION Type %knount,
Top:
ottom
'f icknesi)
CASKOV:!
b4*:
Diameter
:Weighf` :Material
10
2
6ch46 PVC
GROUT
6e o
130t Tl 16.Ff.
Portland
pour
p
Bottom
. Ft
SOREERC15 ei"V - l'Eyl 8-- I am6ter sldC 146 witolil
�2O pvc
Depth Size, Material
erial
8' i,.Bo toth..,15, ',FL�.20/30 #3 SILICA
!"T.' bRit"LL-INK G­`12bO-­-1'
TPA Bottom
0 l 25
E AP.
GQNSTRUETED IN
WITH
THIS.
REC WELL k
�917> HA-8P7"'PRqVID
u
�p TO THEW, E
I ; AM E`�
',SIGNATURE',, F,QERT)FI.EQ.".WiELL,.cQt4TT�ACTQR.� PATE:,
Randv Hoffman
to
.tan silt to brown sand
Q�PRINTED ..NAME QFP:.ER ON - .CONSTRUCTING
:THF,,WELL
PERSON

E�aEC;Ei t,`ED,
NIaV ? 12011
DENR-FAYETTEMLLE REMINAL OFHCE

6fth-c I
aiv wif c artinent:OcEnvifbiMent
Randy Hoffman
W.011-pot :060A D.Noffi,6*
SAEDACCO Inc
Well -C�trpqtK .o. r, 99MP aTp
JLQ nr.
Street - Address,,'p1
- Ft. Mil] 29707
City
[phone]
.Area q
WELL't; ON8T.R U
OTHER-'.A$$0C,1ATEa.PERM I ,#j T.(t* pphca .e
SITE WELL ID #�ifapphcable) csx-z9s
1: W* Ubgt'
E blic unidjpa/.,U ES,
P \
rnga on[]- .0,thierL]`.-ffi'sf�
]PPLT. DRILLED_� 9-7-11 7;30
;y4.,WELL LOCATION:
Highway 211 East
couN
Bladen-Lz
Rosindale TY
LAND MN
TOP10 It
pSlope;p
ET 'Qqf� "'AOX, .01pi6j..11
("bt 16::_
DMOR""' X_XXXXkkX_k)(_.6d,�
­� -VPNQjTuD ... Xxx X.XX - 'n
. ..... _grapK
(location of welt rxtusf be shown'o�i; a topo map
:!Nq.form `!fvt,:Pq-Ak!9 qp-5P
5r FACILITY M e=of the ,. §qpe s - sh -,"tfi!well Jslocated;
SX.De-railment Sit
Ni6flft
Yi lidbli1q..,
—same as one
City or Towri. State ;�rp Codes
AMEC Earth and Environmental -Raleigh
Contact: Name
2200 Gateifflay Centre Boulevard Suite 205
Malmg;Address.;
Morrisville N. C... 27560
Cj'tY'6FTdWh stite, I "12 , 70 6 '.Q
Lau__J'', 447-2750
Area -C'Odb P46fi&Jiij'nib&f,
q..:. WELLDETAILS;
i. TO 15
TPkl�DEPTH�
b..,JDOESMELL REPLACEMST[149 WELL YE$-,[!
NO S
c. RIO'
FT_
�U�e 64Y
d. TOP OF CASING IS 2 -.5
. FT Above d Surface*
terminated at/or below land surface may require
py n ,4 anmin -accord'ance, Mjitl .-6A:.N
-e"
Ab dunt
Ip bottom
Op
.9p
rn_�
Th'iAnossf'
Diameter
►Nerght Material
P_L_*ftoM 10
:2"
sch40 pvc
t
i3ottom
PP� ft
GROUT Depfti
Material �MAt)d I
portland
pour
0— ROM
bo"kEiMi 'Dd—p—th,
;Diameter
Sidt.Si ze Ntaterial
ftom 15
_.PVC
p %6
Ft : 16,-
.... . .....
S.ANDIGRAVEL-F
Depth
Size
Nlateriatr
B 15'
#3 SILICA
�, --liFE-1.11. I.L., —,
T1' DRI - 'LINGi -OG,-;
Bottom Formation Description:
1 DO HEREBY CERTIFY THAT THIS VVELL;WAS CONSTRUCTEDIN ACCORDANCE;
.AND THAT.KCOPYOFTHIS.
R-E-a2-L' _HA^BF7_r.­k'I, PROVIDED TO THE F
R
- .'!
9-7-11
$JGNATURE; -,CERTe WELL. QQNTi�W DATE:: ... _QF: _,,IFIEU..
Randy Hoffman -
,,.-PR1lSlTEQNAME...QF PERSQN-,.CQN.STRUCTlNQ THEMELL
F6rir,2
GVV-;1b'

/V
ic T RT JIQ
A 2675
1 WELL CONTRACTOR':'
Robert Miller
Well: C06trattbe
SAEDACCO.Inc.
Vefl-'Contractor-Company
go RR.Nr )rthfipc3 Dr
..-Str6Of Address;,
Ft. mill S.C. 29707
s 04.9r� Town
,.[phone]
- Area Phone number
:CO ST YCTIO,
RU -,RERM1
. ItgA -
RW - 1
`S: N 'LL U'SE-J(Qh'&'bk'On'd,� 60'�A66 6-ii VE unicipa M66116'.b*
m Opp, p 'El Recovery
;:0 .0
tfier ❑ list Use)`
DATE.D;RIL'LED) 9-6-11 3:00
.4.,WE _ ,
East
�Highway 211 ". 'Q- Z1'
.,N�OF eg
Pf -*66
LATITUDE -.363X -X)(X)bCg
LONGITUDE,t XkX-X-,Y(X DD
Labtudellon
f I
'this formlt riot_.vsrng!.Iqp
5 ;FACILITY Name oflhe bus)
pes Slocated j
,
CSX Derailment Site
Fibcliflt'.Nir�e .y, F (fapplisabfe
same as g2_
.$tfe..etAc!d
Cityot Town. :Z!
Code.
AMEC Earth and Environmental -Raleigh,.
Contact Nafrii,
2200 Gateway CentreBoulevardSuite 205
MailingAddressr
Morrisville N. C... 27560
City or Town vsf&b z i p". C 6d'd
Lw_)447-2750
Area code PWde..'fiuni66f.
6: WELL, DETA10!
TOTALPEFTW� 2 9
.
,b.., D.OESWELL REPLACE E)OSTIN _OWELL? YEs..[3,
c.. WATER,LEVEL.B61b
TOP OF CASING IS 2. 5 . FT Above Land SUrfike
'd— d­ ' surface. asi-gg ermfn�te ;AV.
a.-.vartance..,Ih,..'accor.dance-..,wlfh 15A NCAC460118­:
yj iL6'
."t:WSINFEdTIOMZ.
Type
AnOunt
ffi - WATERIONEVdi"et)' 1.
p
Bottom:'
Tope
:Bottom'
T "nL xssl
CASING
Depth;;
p 0
$Otto.M 4
sch40 pvc
Top
Method 04­7 pour
.SCREEN Depth '."D, ei�_'
_Pth metdr, Stdtlid Material.
4'
�10 "An, ...pvc
Bottom -Ft: 6_11 in
tt
Size. Material
91 Ft,20/30 42 SILICA
Bottom FormatlonDescripton
tan silt to brown sand
-gray si.l.t.y glay
,,l bentonite seal from 21 to 31
LL WAS CONSTRUCT:Ei3 IN ACCORDANCE 1!N'ITH
. STANDARDS AND .tOFTHIS.
PROVIDED TO THE: WELL ER:'
...SjPNATU.!3F".,QF�CERTjjzlEDYVELL..CQNTRA R'.
GTO :DATE;
Robert Miller
'.P.R1NTEP..NAMjE-..QF PER -so, WCONSTRUCTiNGTHEMELL
R ew-2tb9-

r
N!OV 19. 12011
Oft=PAORVILLE REGICNAL OFnGE