HISTORICAL

INJECTION EVENT RECORD
1
North Carolina Department of Environment and Natural Resources — Division of Water
t --
Permit Number W10600037
1. Permit Information
Mr. Greg Bean, Director of Public Works
Pennittee .
Fort Bragg Directorate of Pubic Works
Facility Name
Building 3-1137 Butner Road, Fort Bragg,
North Carolina, 28310
Facility Address
2. Injection Contractor Information
Parsons
Injection Contractor / Company Name
Street Address 1700 Broadway, Ste 900
Denver CO 80290
City State Zip Code
3( 03) 764-1940
Area code — Phone number
3. Well Information
Number of wells used for injection 36
103-A1 thru 103-A6; 103-B1 thru 103-B6; 103-C1 thru 103-C6;
Well names 103-D1 thru 103-D6; 103-E1 thru 103-E6; 103-F1 thru 103-F6
Were any new wells installed during this injection
event?
® Yes ❑ No
If yes, please provide the following information:
Number of Monitoring Wells 0
Number of Injection Wells 36
Type of Well Installed (Check applicable type):
❑ Bored ❑ Drilled ® Direct -Push
❑ Hand -Augured ❑ Other (specify)
Please include two copies of the GW-lb for each
well installed.
Were any wells abandoned du 'ng this�i�j gol 2008
event?
❑ Yes ® No DEtdR—FAYEMILLEREGIONAL
If yes, please provide the following information:
Number of Monitoring Wells
Number of Injection Wells
Please include two copies of the GW-30 for each
well abandoned.
4. Injectant Information
Soy Bean Oil, Newman Zone, Neutral Zone, Water
Injectant Type
Soy bean oil: 6.7%, Neutral Zone: 1.0%
Concentration Newman Zone: 1.1 %, Water: 91.2%
If the injectant is diluted please indicate the source
dilution fluid. Fort Bragg Pipe Hydrant
Total Volume Injected 75,035 gallons
Volume Injected per well 2,084 gallons
5. Injection History
Injection number (e.g. 3 of 5) 1 of 3
Is this the last injection at this site?
❑ Yes X❑ No
I DO HEREBY CERTIFY THAT ALL THE
INFORMATION ON THIS FORM IS CORRECT TO
THE BEST OF MY KNOWLEDGE AND THAT THE
INJECTION WAS PERFORMED WITHIN THE
STANDARDS LAID OUT IN THE PERMIT.
OF INJECTION CONTRACTOR
DATE
Dan Griffiths and Kevin Smith
PRINT NAME OF PERSON PERFORMING THE INJECTION
RECEIVED / DENR I DWQ
Submit the original of this form to the Division of Water Quality within 30 days of injection. AQ1J1FFR'PRnTF(.TIC1iarEgiTOlt-IER
Attn: UIC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-733-3221 OCT 2008 Rev. 11/06

- 4
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (Individual) Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO Box 1169
Dacula GA 300019
City or Town State Zip Code
7( 70 - 868-5407
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID#(Ifapplicable)
­ Al
WELL CONSTRUCTION PERMR#(ifapplicable) N/A
OTHER ASSOCIATED PERMIT #(If applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring❑ Municipal/Pub"
Industrial/CommercialE3 AgricuituralI3 Recovery0 Injection
IrrigatiorG Othed3 Qlqt use d
DATE DRILLED D
TIME COMPLETED D AMD PM1d
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumb8dand
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code),
TOPOGRAPHIC / D SETTING:
13 Slope 0 Valley 15 Flat 0 Ridge 0 Other
(check appropriate box) Nby be in degrees,
LATITUDE 35.14 169994 minutes, seconds or
LONGITUDE -U3Z 604698 in a decimal format
Latitude/longitude source: 9 GPS 0 Topographic map
(location of well mustbe shown on a USGS topo map and
attached to this form if not using. GPS)
6. FACILITY- is the name of the Wshess where the well Is located
FACILITY ID #Qf applicable) N/A
NAME OF FACILITY Fort Braqq
STREET ADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Barris
MAILING ADDRESS Same
City or Town State Zip Code
(910 )- 396-7432
Area code - Phone number
6, WELL DETAILS:
I
a. TOTAL DEPTH: SS l
b. DOES WELL REPLACE EXISTING WELL? YESO NONK*
c. WATER LEVEL Below Top of Casing: 33.01 FT.
(Use °+" if Above Top of Casing)
d. TOP OF CASING IS ._ FT. Above Land Surface,
'Top of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To
From To
From To
From To
From To
From To
7. CASING: Depth i
Diameter I7hicknessMkight Material
From ije _ To ©
Ft.� 3?vL
From To
Ft.
From To
Ft
8. GROUT. Depth-
Material Method
From8 To_0 Ft Pof-Vav,A �y�n� Fade
From To
Ft
FromL To
Ft "
9. SCREEN: Depth
Diameter Slot Size Material
'Ss qr
From To
Ft I in. -� in, I�VL
From To
Ft in. in.
From To
Ft in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
Fromi­!�57 To v r Ft.4�k SAT&'P
From To Ft.
From To Ft.
11.DRILLING LOG
From To Formation Description
12. REMARKS:
I DOH ,FOI; CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
1 C, WELL CONSTRUCT N STAND ANDTHAT A COPY OFTHIS
BEEN OVI T THEW ER
SIG ATURE CERTIFIED WELL CONTRACTOR DATE
Lr,vv voo�� �e
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: InformatiorR ED / DENR / DWQForm GW-lb
1617 Mail Service Center— Raleigh, NC 276994617 Phone No. [phone] ext 568-AQUIFFR'PRnTFrTION SFCM1412/07
OCT 16 2008

i
NONRESIDENTIAL WELL CONSTRUCTION RECORD.
North Carolina Department of Environment and Natural Resources- Division of Water Quality 'I
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (individual) Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO BOX 1169
Dacula GA 300019
City or Town State Zip Code
7( 70 1- 868-5407
Area code- Phone number
-2. WELL INFORMATION: ��
SITE WELL ID #(if applicable)
WELL CONSTRUCTION PERMIT#('dapplicable) N/A
OTHER ASSOCIATED PERMIT #(if applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring[] Municipal/Publild3
IndusWaVCommerclalU Agriculturall] RecoveryO Injection
Irrigationp Others gistuse)
DATE DRILLED O
TIME COMPLETED 009 AMU PMe
4. WELL LOCATION:
CITY: Fayetteville COUNTY `Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / L5ND SETTING:
U Slope U Valley Ir Flat U Ridge 17 Other,
(check appropriate box) NUy bc in degrees,
LATITUDE 35.14 170636 minutes, seconds or
LONGITUDE -78.97 599654 in a decimal format
Latitudefiongitude source: K GPS 0 Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
5. FACILITY is the name of the business where the cell Is located
FACILITY ID #(if applicable) N/A .
NAME OF FACILITY Fort Bragg
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
CityorTown State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
91t 0 t- 396-7432
Area code - Phone number
9. WELL DETAILS:
a. TOTAL DEPTH: 5 ( r
b. DOES WELL REPLACE EXISTING WELL? YESU NOW/
c. WATER LEVEL Below Top of Casing: 32.83 FT.
(Use "-W lf Above Top of Casing)
d. TOP OF CASING IS FT. Above Land Surface*':',
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm)'. METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONTS (depth):
From
To
From
To
From
To
From
To
From
To
From
To
7. CASING:
Depth
Diameter
ThicknessNVeight Material
From 1- 0 To V Ft j 15 1P`fL
From To Ft
From Tc . Ft
8. GROUT: Depth Material Method
From To.�_ Ft'Vf4-limyA-
From J To, Ft.
From To Ft
9. SCREEN: Depth Diameter Slot Size Material
From To Ft ��7 in. in.
From To Ft in. in.
From To Ft. in. in.
10. SANDIGRAVEL PACK:
Depth Size Material
FromTo_ Ft�_ 5rw9
From To Ft
From To Ft
II.DRILLING LOG
From To Formation Description
12. REMARKS:
.a,
nCFR
TIFYWEBEEN OVID T E WELL C �N
SIGNATURE OF ERTIFIEDtt�tWELL CONTRACTOR DATE
uff't�D .r 1l�c\�
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
i
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form GW-ib
1617 Mail Service Center— Raleigh, NC 276994617 Phone No. [phone] ext568. Rev.12/07

NONRESIDENTIAL wELL cONsTRUCTIONRECORD
North Carolina Department of Environment and Natural Resounes- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # , 3527
1. WELL CONTRACTOR:
Richard Marshall Bumett
Well Contractor (Individual) Name
Geo Lab, Inc,
Well Contractor Company Name
STREETADDRESS PO BOX 1169
Dacula GA 300019
City or Town State Tip Code
7( 70 .868-5407
Area code- Phone number
2. WELL INFORMATION: 1
SITE WELL ID#(itapplicable) -3
WELL CONSTRUCTION PERMIT#(ii applicable) N/A
OTHER ASSOCIATED PERMIT #(If applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring❑ Municipal/Public❑
Industrial/Commercial❑ Agricultural0 Recovery❑ InjecdonB/
IrrigationO Otherl] (lis use .
DATE DRILLED DOS r
TIME COMPLETED -i O AM❑ P e
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville,. NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC I�ND SETTING:
13 Slope 13 Valley Flat ❑ Ridge 13 Other
(check appropriate box) 1%&y be in degrees,
LATITUDE 35.14 171276 minutes, seconds or
LONGITUDE -78.97 594521 in a decimal format
Latitude/lonetude source: MOPS 13 Topographic map
(location ofwell must be shown on a USGS topo map and
attached to this form if not using GPS) ,
5. FACILITY. is the name or the business where the well is located
FACILITY ID #(If applicable) N/A
NAME OF FACILITY Fort Bragg
STREET ADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
(910 - 396-7432
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 57t0
b. DOES WELL REPLACE EXISTING WELL? YES0 NOR/
c. WATER LEVEL Below Top of Casing: 32.81 T.
(Use W if Above Top of Casing)
d. TOP OF CASING IS _t FT. Above Land Surface*
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
7. CASING:: Depth Diameter ThiclvressfMight Material
From '7% To Ft. Ft. r1 51 H gib VL
From Tc Ft.
From To FL
8. GROUT: Depth Material Method_
FromL—��� , t. I Nr V-(LiV%?k.M
From q To10 R. Wan- C mtxr >ra¢cr�D tNS.
From To Ft._
9. SCREEN: Depth - Diameter Slot Size Material
From T To �(� Ft..�5 in. d in. P V G
From To Ft in. in.
From To Ft in. in.
10. SANDIGRAVEL PACK:
Depth Size Material
From _TA?- _ Ft �� NG
From To Ft
From To Ft.
11.13RILLING LOG
From To
12. REMARKS:
Formation Description
I DOatim;
THIS WELL W CONSTRUCTED 1 ACCORDANCE wrrH
15 UCTI ARDS,AND THAT COPY OF THIS
LOWNER
SI A URE OF CERTIFIED WELL CONTRACTOR DATE
ui,V 4 Db-D tz
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt:, Form GW-1b
1617 Mail Service Center-- Raleigh, NC 276994617 Phone No. [phone] ext 568. Rev.12/07

.NONRESIDENTIAL WELL coNS ucnoN REcoRD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Bumett
Well Contractor (Individual) Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO Box 1169
Dacula GA 300019
City or Town State Zip Code
7� 70 .868-5407
Area code- Phone number
2. WELL INFORMATION: n
SITE WELL ID#(ffapplicable) A
WELL CONSTRUCTION PERMITWapplicabie) N/A
OTHER ASSOCIATED PERMIT *(ifapplicable) N/A
3. WELL USE (Check Applicable Box) Monitoring❑ MunicipaI/PublicI3
IndustriallCorvnerclaIM Agricultural0 Recovery[] Injection
Irrigation[] OtherI3 (Ilst se)
DATE DRILLED OS
TIME COMPLETED d AM13 PMM
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Communiq, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC /�ND SETTING:
13 Slope p Valley Flat [] Ridge 0 Other
(check appropriate box)
May be in degrees,
LATITUDE 35. 14 17194 minutes, seconds or
LONGITUDE-78. 97 589341 in a decimal format
Latitude/longitude source: I GPS [] Topographic map
(location ofwellmustbe shown on a USGS topo map and
attached to this form if not using GPS)
5. FACILITY- is the nano of the business where the well is located
FACILITY ID #(if applicable) N/A
NAME OF FACILITY Fort Bragg
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
t. 910 - 396-7432
Area code - Phone number
6. WELL DETAILS: q� ,
a. TOTAL DEPTH: �0
b. DOES WELL REPLACE EXISTING WELL? YES13 NOD
c. WATER LEVEL Below Top of Casing: 32.77 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS . FZ_ FT. Above Land Surface -
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From
To
From
To
From
To
From
To
. -.
1.
FronrL
To
From
To
7. CASING:
Depth
Diameter
Thtokness0eight .
Mafi vial.,
From to To 0 Ft, s-) J L%y q_D 'plL
From
To
Ft.
From
To
Ft.
8: GROUT:
Material Method
�tDepth
From ? 15' 4-
Ft._ t&11- S .
From,
—TO
R. tom- C mN l &D tiNf
FromL
To
Ft.
9. SCREEN: Depth Diameter Slot Size Material
From Sg To g Ft —in. in. _ 4
From To Ft. in. in.
From To Ft in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
From g To—jj— . Ft. k2
From' To Ft:
From To Ft.
%DRILLING LOG f
From To Formation Description
i
i
r
12. REMARKS:
I DO Ht72 C TIFY THIS WELL S CONSTRU ED IN ACCORDANCE WITH
15A N L CON UCr10 ST DARDS, AND A COPY OF THIS
R PRO I DTO E1 LOWNER.
SIGNATURE OF CERTIFIED
1cW`ELLCONTRACTOR DATE
PRINTED NAMEt01'PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Mgt.
ty y Form GW-16;:
1617 Mail Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev.12/07' ;'.

NONRESIDENTIAL wELL coxsTRumm REcoRD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 3527
I. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (Individual) Name
Geo Lab, Inc,
Well Contractor Company Name
STREETADDRESS PO Box 1169
Dacula GA 300019
City or Town State Zip Code
7( 70 - 868-5407
Area code- Phone number
2. WELL INFORMATION: S
SITE WELL ID#(ifapplicable)
WELL CONSTRUCTION PERMIT#(ifapplicable), N/A
OTHER ASSOCIATED PERMIT#(ifapplicable) N/A
3. WELL USE (Check Applicable Box) Monitoring[] Municipal/PublicEl
Industrlal/Commercial13 Agricuiturall] Recovery[] Injectione
Irrigation[] Other[] p t Upe)
DATE DRILLED 7 301G6_ ,/
TIME COMPLETM ED�.,7jt)' D$� AMB PM
4. WELL LOCATION:
CITY. Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC I VND SETTING:
D Slope [] Valley IN Flat I] Ridge p Other
(check appropriate box) 1%by be in degrees,
LATITUDE 35.14 172396 minutes, seconds or
LONGITUDE-78. 97 583909 in a decimal format
Latitude/longitude source: X GPS 0 Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
5.FACILITY istrwnameol'thebuslnesswhere the well Islocated.
FACILITY ID #(if applicable) N/A
NAME OF FACILITY Fort Braga
STREETADDRESS Building 3-1137 Butner Rd. .
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
91c 0 )- 396-7432
Area code - Phone number
6. WELL DETAILS: r
a. TOTAL DEPTH: Co /
b. DOES WELL REPLACE EXISTING WELL? YESD NOV
c. WATER LEVEL Below Top of Casing: 32.56 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 1 3 ' Fr. Above Land Surface'
'Top of casing terminated atlor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
4
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To
From To
From To
From To
7. CASING: Depth
Diameter ThicknessWeight Material
From To b
Ft.J.LL JLRAD V ..,
From Tc
FL
From To
Ft.
8. GROUT: Depth
Material Method
a tut
FrorrL4.8 To '7C
Ft. �L^1- 1MM
'j�•
Frorr- _
>_� _ To__0
FL t6af QltT V096V4N-
From To
Ft.
9. SCREEN: Depth
Diameter Slot Size Material
From To Sa
Ft in.
From To
Ft In. in.
From To
Ft in. in.
10. SAND/GRAVEL PACK:
Depth
Size Material
From6_a_To 48 ,
FL—A-2_ !jANYi
From To
Ft.
From To
FL
11.13RIL.LING LOG
From To
Formation Description
12. REMARKS:
I DO HER FY THAT THIS WELL WA CONSTRUD W ACCORDANCE WITH
15A NC 2C CONS[ ION ST DS, AND COPY OF THIS
REC PROM E TO E LOWNER.
SIGNATURE OF CERTIPIED WELL CONTRACTOR DATE.,;;:,
PRINTED NAM OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form Gw 1b
1617 Mail Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev.12/07

NONRESIDENTIAL, wELL coxsmumoN REcom
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION 9 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (Individual) Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO Box 1169
Dacula GA 300019
City or Town State Zip Code
7( 70 .868-5407
Area code- Phone number
2. WELL INFORMATION: ��
SITE WELL ID #(If applicable)
WELL CONSTRUCTION PERMIT#(ifapplicable) N/A
OTHER ASSOCIATED PERMIT #Cd applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring[] Municipal/PublicEl
Industrial/Commercialp Agricultural] Recovery] Injections"
Irrigation(] Other] Qist use
DATE DRILLED
TIME COMPLETED 7 i�iJ � 68 AM13 PMi3
4. WELL LOCATION: '
CITY: Fayetteville COUNTY Cumberiand
. Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC ! ND SETTING:
13 Slope E3 Valley 11 Flat Ll Ridge ] Other
(check appropriate box) - 1„ tay be in degrees,
LATITUDE a 14 173124 minutes, seconds or
LONGITUDE -78. 97 578615 in a decimal format
Latitude/longitude source: I GPS - 13 Topographic map
(location of well mustbe shown on a USGS topo map and
attached to this form if not using GPS)
6. FACILITY Is the name at the business where the wen is ioxated.
FACILITY ID #(d appficable) N/A
NAME OF FACILITY FOrt Bragg
STREETADDRESS Building.3-1137 Butner Rd.
_Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
f 910 - 396-7432
Area code - Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: 1V�rr✓ /
b. DOES WELL REPLACE EXISTING WELL? YES] NO9'
c. WATER LEVEL Below Top of Casing: 31.76 FT.
(Use "+" N Above Top of Casing)
d. TOP OF CASING IS FT. Above Land Surface"
"Top of casing terminated at/or below land surface may require
a variance in accordance.with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type
Amount
g. WATER ZONES (depth):
From To
From
To
From Tc
From To
From To
From
To
7. CASING: Depth Diameter
ThicknessWeight
Material
From_,V5_3%-Aro_Ft.
,ZS�Lb
'.
From To Ft.
From To Ft
8. GROUT: Depth
Material
Methoi_'_.
From -.5L Tc '% Ft
From To_ 0 Ft.ts�CYYINI-
From To Ft
9. 'SCREEN; Depth Diameter Slot Size Material
From J+STo s �Ft.�in. .b O in. �%f-
From To Ft in. in,
Frorn To Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
From to3 To,� Ft.9� SPYtj D
From To Ft
From To Ft
11.13RILLING LOG
From To Formation Description
12. REMARKS:
IDO RTIFY TTHIS AS CONSTRUCTEIM ACCORDANCE WITH
is 2 . ELL RU N NDARDS,AND ACOPYOFTHIS
ft EEN P ID ED ELL OWNER
SI NATURE OF CERTIFIED WELL ONTRAC OR DATE
r. a(. C�. 0I> l 'Ae-
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form GW-1b
1617 Mail Service Center— Raleigh, NC 276994617 Phone No. [phone] ext 568. Rev.12/07

NONRESIDENTIAL wELL coxsmucnm RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Bumett
Well Contractor (Individual) Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO Box 1169
Dacula GA 300019
City or Town State Zip Code
7( 70 1- 868-5407'
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
—
WELL CONSTRUCTION PERMIT#(ifapplicable) N/A
OTHER ASSOCIATED PERMIT #of applicable) N/A
3. WELL USE (Check Applicable Box) Monkoring[3 MuntdpaUPubli
Industdal/Commercial0 Agricultural[] Recovery[] In'JectionlF
Irigationl] Otherl3 (list use)
DATE DRILLED '7h)IoS
TIME COMPLETED :113)109, AMA PMV
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Patcel, Zip Code)
TOPOGRAPHIC / L$ND SETTING:
13 Slope [] Valley [ff Flat 0 Ridge 0 Other
(check appropriate box) �&y be in degrees,
LATITUDE 35.14 163426 minutes, seconds or
LONGITUDE -78.97 60354 in a decimal format
Latitude/longitude source: p GPS 13 Topographic map
(location of well must be shown on a USGS topo mop and
attached to thisform ifnot using GPS)
5. FACILITY- Is the name of the Wslness where the well Is located
FACILITY ID #Of applicable) N/A
NAME OF FACILITY Fort Braga
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
Cdy or Town State Zip Code
f 910 1.396-7432
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: tl S
b. DOES WELL REPLACE EXISTING WELL? YES[] NO2/
c. WATER LEVEL Below Top of Casing: 33.21 Fr.
(Use "+" If Above Top of Casing)
d. TOP OF CASING IS ..7, Fr. Above Land Surface`
`Top of casing terminated aUor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type
Amount
g. WATER ZONES (depth):
From To
From To
From To
From To
From To
From To
7. CASING: Depth
Diameter Thickness/Weight Material
From y5 To 0-
Ft .75 5CH ND:
From To
Ft
From • To
Ft
8. GROUT. Depth
Material Method
From *V To�Ft.
b6Nr Tl4AW16
From_,;To
Ft r'Wiiir CYVI Or
From Tc
Ft.
S. SCREEN: Depth
Diameter Slot Size Material
From To —LIE —Ft.—,
% in. . o in.Ci
From ._ To
Ft. in. in.
From To
Ft. in. In.
10. SAND/GRAVEL PACK:
Depth
Size Material
From �� To4
Ft�_
From To
Ft.
From To
Ft.
11.DRILLING LOG
From To Formation Description
12. REMARKS:
I DO HER ERTIFY THAT THIS WELL FL
CONSTRUCT IN ACCORDANCE WITH
15A ELL CO UCTIO STRDS, AND A COPY OF THIS
BEEN PR I EDTO E OWNER
r
SI NATURE OF -CERTIFIED W LL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
...t. .
Form GW-1 b -
Rev.12/07

NONRESIDENTIAL wELL coNsTRUcuoNREcORD
North Carolina Department of Environment and Natural )tesources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 3627
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor pndividuaq Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO BOX 1169
Dacula GA 300019
City or Town State Zip Code
7( 70 - 868-5407
Area code- Phone number
2. WELL INFORMATION: tz SITE WELL ID #(if applicable)
—
WELL CONSTRUCTION PERMIT#(inapplicable) N/A
OTHER ASSOCIATED PERMIT #(if applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring[] Municipal/Pub
Indusbial/Commerclal0 Agriculturall7 Recovery[] Injection
Inigationil Other[] pi t use)
DATE DRILLED 1 J
TIME COMPLETED qi 0 AMId PM13
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
13 Slope [] Valley Fj Flat i] Ridge p Other
(check appropriate box) hby be in degrees,
LATITUDE 35.14 164347 minutes, seconds or
LONGITUDE -78.97 598378 in a deeimal format
Latitude/longitude source: I GPS 0 Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
5. FACILITY- Is the name arthe bWnesswhere the vtieU Is located
FACILITY ID #(tf applicable) N/A
NAME OF FACILITY Fort Bragg
STREET ADDRESS Building 3-11.37 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code ,
91� 0 )- 396-7432
Area code - Phone number
6. WELL DETAILS: a. TOTAL DEPTH:---5—k9— /
b. DOES WELL REPLACE EXISTING WELL? YES[] NON
c. WATER LEVEL Below Top of Casing: 33.17 FT.
(Use "+^ if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface
'Top of casing terminated at/or below land surface may require;,i
a variance In accordance with 15A NCAC 2C .0118, r tyJr
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
7. CASING: Depth Diameter Thicknes&IMIght Material
Froth To_)_ Ft-257 :5Z&0 L _
From To Ft.
From To Ft.
3. GROUT: Depth
Material Method
From To
Ft. &W-r T(L�,A?Atf
..Z,S
From. S To�_
Ft. N4trT CYYiNI �2cE if VJ
From To
Ft.
9. SCREEN: Depth
Diameter Slot Size Material
From 5 r 5 To 46.5
Ft ► 7 J{ in. r b in. P VL .
From To
Ft. in. in.
From To
Ft tn. in.
10. SAND/GRAVEL PACK:
Depth.
Size Material".
From —% To 42.,5
Ft. f!a 512fr"9
From To
Ft
From Tc
Ft
11.13RILLING LOG
From To Formation Description
12. REMARKS:
IDO E CERTIFY THAT THIS WASCON ED IN ACCORDANCE WITH -
1 NC WELLC SrRUCn AWARDS, TA COPY OF THIS
BEEN IDE O WELL OWN
IGNATURE OF CPERTIFIED WELL CONTRACTOR DATE= >"
PRINTED NAME OF DEMON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form GW-1b
1617 Mail Service Center— Raleigh, NC 276994617 Phone No. [phone] ext 568. Rev.12/07

n:
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (Individuan Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO BOX 1169
Dacula GA 300019
City or Town State Zip Code
7( 70 - 868-5407
Area code- Phone number ��
2. WELL INFORMATION:
SITE WELL ID #(ifapplicable)
WELL CONSTRUCTION PERMIT#(if applicable) N/A
OTHER ASSOCIATED PERMIT#(ifapplicable) N/A
3. WELL USE (Check Applicable Box) Monitoring[] Munlcipal/Publi
Industrial/Commerciail] Agricultural[] Recovery[] Injection
Irrigatiorill Otherl] Qist ise
DATE DRILLED �/'
TIME COMPLETED AMU PMO
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LOND. SETTING:
0 Slope 0 Valley 9 Flat 13 Ridge [] Other
(check appropriate box) May be in degrees
LATITUDE 35.14 164855 minutes, seconds or
LONGITUDE -78.97 593394 iaadecimal format
Latitude/longitude source: N GPS 0 Topographic map
(/ocaflon of well must be shown on a USGS topo map and
aftached to this tom? ifnot using GPS)
5. FACI LITY- is the name of the business where the well Is located.
FACILITY ID #(Jf applicable) N/A
NAME OF FACILITY Fort Bracicl
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code'
910 - 396-7432
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: • Ivy
b. DOES WELL REPLACE EXISTING WELL? YES[] NO)(
c. WATER LEVEL Below Top of Casing: 33.06 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS - _ FT. Above Land Surface•
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type
Amount
g. WATER ZONES (depth):
From To
From To
From To
From To
From To
From To
7. CASING: Depth
Diameter ThicknesuMbIght Material
From _&To�_Ft. r7at
5 3114q) rL
From To
Ft
From To
Ft_
0. GROUT: Depth
Material Method
Front To 3 3- ,Ft �cNT' "S:t4-nkn�E
From;, 33 'ro_b _
Ft tl ff lr A T VW -CV I Ni
From To
Ft.
9. SCREEN: Depth
Diameter Slot Size Material+'"`.._ ,
From LiY To 3 Y
Ft . '15in. s&W in. W(-'
From To
Ft in. in. -
From To
Ft in. in.
10. SAND/GRAVEL PACK:
Depth
FrorrL of To 36 •
Size Material
Ft-- � S %n`tr> i
FronrL Tc
Ft
From To
Ft.
11.13RILLING LOG
From To Fdrmation Description
12. REMARKS:
„a l j'-
VSEC
FY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ELL CON RUCTIOA
RDS, AND THAT PY OF THI5
PRO I EDTOOWNEROF CER IFI D``ONT ACTO DATE
LA irr-L, Dt> a ) t —i \ e-
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form GW-1b
1617 Mail Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev.12107

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (IndividuaQ Name
Geo Lab, Inc.
Well Contractor Company Name
STR EET ADDR ESS PO Box 1169
Dacula GA 300019
City or Town State Zip Code
7( 70 - 868-5407
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(itapplicable) 1�
WELL CONSTRUCTION PER MIT#(d applicable) N/A
OTHERASSOCIATED PERM IT#('rfapplicable) N/A
3. WELL USE (Check Applicable Box) Monitoring[] Municipal/Publi
Industrial/Commerclal[3 Agricultural17 Recover.— Injection
Irrigatior10 Otherd (II t use)
DATE DRILLED 911102
TIME COMPLETED I D AMtr! PM[3
4. WELL LOCATION:
CITY Fayetteville COUNTY Cumberland .
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC /�ND SETTING:
0 Slope I] Valley Flat I] Ridge 0 Other
(check appropriate box) i„ tay be in degrees,
LATITUDE 35.14 165617 minutes, seconds or
LONGITUDE -78.97 58827 in a decimal format
Latitude/longitude source: I GPS Q Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
6. FACILITY Is the name of the buslnesswhere the cell Is located
FACILITY ID #(If applicable) N/A
NAME OF FACILITY Fort Bragg
STREET ADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
91L 0 1- 396-7432
Area code - Phone number
s. WELL DETAILS: yy�� +
a. TOTAL DEPTH: 654
b. DOES WELL REPLACE EXISTING WELL? YESO NOO(
c. WATER LEVEL Below Top of Casing: 34.01 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS " FT. Above Land Surface`
*Top -of casing terminated atior below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To
From To
From To
From' To
7. CASING: Depth
Diameter ThicknessNVeight Material;
From � o
_�-"T O
�� S�.K kID
Ft. '
From To
Ft.
From To
Ft.
8. GROUT: Depth
Material Method
From .aqt/lSTo.�
Ft. d2Nr 'S'd4J�Mr�
From 1%S To D
Ft.t+9r GmAlt' F04241= IWl
From To
Fk
9. SCREEN: Depth
Diameter Slot Size Material
From 55 5 To 9 S5Ft. ] in. . b in. �1 L
From To
Fk in. In.
From To
Ft in, in.
10. SAND/GRAVEL PACK:
Depth Size Material
From 5-5 STo N2,'YFt.D St>
From To
Ft
From To
Ft.
11.DRILLING LOG
From To
'Formation Description
12. REMARKS:
IDOHER C TIFYTHATTHISWELLWAS CONSTRUCTED NACCORDANCEWITH
15A N L CON D ST DARDS, AND THV7A COPY OF THIS
R S EN PROVI TO E LOW
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
UIW4 ono
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 276994617 Phone No. [phone] ext 568.
Form GW-1 b
Rev.12/07.
L'vid:

.NONRESIDENTIAL wELL coNSTRUcnm REcoRD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (Individual) Name
Geo Lab, Inc,
Well Contractor Company Name
STREETADDRESS PO Box 1169
Dacula GA 300019
City or Town State Zip Code
7c 70 .868-5407
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(dapplicable)
WELL CONSTRUCTION PERMrr#(ifapplicable) N/A
OTHER ASSOCIATED PERMIT #(if applicable) N/A
3. WELL USE (Check Applicable Box) Monitoringo MunicipaVPubli
Industrial/CommercialD AgriculturaID Recovery] injection
Irrigation] Other] (his use
DATE DRILLED )ot
TIME COMPLETED -I-�i IOC l AMA PMV
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community. Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC/ 4ND SETTING:
0 Slope 0 Valley 13 Flat D Ridge 0 Other
(check appropriate box) 1„by be in degrees, _
LATITUDE 35.14 166599 minutes, seconds or
LONGITUDE -78.97 58175 in a decimal format
Latitude/longitude source: A GPS 13 Topographic map
(location of well must be shown on a USGS topo map and
attached to this form /f not using GPS)
5. FACILITY Is the name of the business where the wall is located.
FACILITY ID #(d applicable) N/A
NAME OF FACILITY Fort Bragg
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
(910 _ 396-7432
Area code - Phone number
S. WELL DETAILS: L r
a. TOTAL DEPTH: . /
b. DOES WELL REPLACE EXISTING WELL? YES] No
c. WATER LEVEL Below Top of Casing: 33.05 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS .Z FT. Above land Surface'
`Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm):
METHOD OF TEST
f. DISINFECTION: Type
Amount *-
g. WATER ZONES (depth):
From To
From To
From To
From To
From To
From To
7. CASING: Depth
Diameter Thickness/Vftht Material
Fror 37 To�
Ft. 14 PVL
From To
Ft.
From To
Ft.
8. GROUT: Depth
Material Method
FrorTL,W - To 3z
Ft. ft
From j2. To
Ft.KArCMNr FD Reg I PA
Front, To
Ft.
9. SCREEN: Depth
Diameter Slot Size Material
From 41 To 37
Ft. '7s in.o in. PVC —
Fro rqTo
Ft. in. in.
From To
Ft. in. in.
10. SAND/GRAVEL PACK:
: I
Depth t
From 47 To 3S
Size Material
Ft._ S�lrx�
From To
Ft. i
From To
Ft.
11.DRILLING LOG
From TO
Formation Description
12. REMARKS:
WHFYTHATTHISWELL WAS CONSTRU IN ACCORDANCEWITH
CO UCTI ST AR%AND ACOPYOFTHIS
PR MT O E LOWNER
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn:.Information Mgt, Form GW-1b
1617 Mail Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev.12/07

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION 0 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (Individual) Name
Geo Lab, Inc.
Well Contractor Company Name
STREET ADDRESS PO BOX 1169
Dacula GA 300019
City or Town State Mp Code
7( 70 1- 868-5407
Area code- Phone number
2. WELL INFORMATION: Q
SITE WELL ID #(if applicable)_ J�
WELL CONSTRUCTION PERMIT#(if applicable) N/A
OTHER ASSOCIATED PERMIT #(if applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring[] Municipal/Publ(
Industdal/Commercial(] Agricultural0 RecoveryI3 InjectionlF
Irrigationll Otherl3 use)
Qls
DATE DRILLED 0
TIME COMPLETED 1131ICK AM13 PMR
4. WELL LOCATION:
CITY:* Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Tip Code)
TOPOGRAPHIC / LIAND SETTING:
0 Slope 13 Valley 13 Flat 0 Ridge 0 Other
(check appropriate box) l„ �ay be in degrees,
LATITUDE 35.14 166834 minutes, seconds or
LONGITUDE -78.97 577159 in a decimal format
Latitude/longitude source: is GPS [] Topographic map
(/oca6on of wel/must be shown on a USGS topo map and
attached to this form ifnat using GPS)
5. FACILITY is the name of the businesswhere the Nell Is located
FACILITY ID #(if applicable) N/A
NAME OF FACILITY Fort Bragcl
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
r City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
91r 0 1.396-7432
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES13 NOV"'
c. WATER LEVEL Below Top of Casing: 32.75 Fr.
(Use'+' if Above Top of Casing)
d. TOP OF CASING IS �_ FT. Above Land Surface'
`Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
7. CASING: Depth Diameter ThicknessMFeight Material
From 9-1 To Ft .15
From To Ft
From To Ft
8. GROUT. Depth Material
FronL'S -To 40 Ft. &srT
Frorn4?,--- To V Ft. N� ,,T
From To Ft
Q�L
Methad , S
T�innm�t=
f 7rNT
9. SCREEN: Depth Diameter Slot Size Material
From To4� Ft. in. fb Din. PVG
From To Ft. in. in.
From To Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material ;
From 51 To 4l•S Ft.� SHcv�
From To Ft.
From To Ft.
11.DRILLING LOG
From To Formation Description
f
i
12. REMARKS:
I DOH CERTIFYTHATTHISblELL WAS CONSTRUCT ACCORDANCE WITH
16 ,WELL 5rRU ONS DARDS,AND ACOPYOFTHIS
i BEial VIDED TH ELL OWNER
SI NATURE OF CERTIFIED
�j LL CONTRACTOR DATE
LA,rr- 1/ool�" t-
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form GW-1b
1617 Mail Service Center — Raleigh, NC 276994617 Phone No., [phone] ext 568. Rev.12/07

NONRESIDENTIAL wELL coNSTRIICTIoN REcmp
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor QndividuaQ Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO Box 1169
Dacula GA 300019
City or Town State Zip Code
7( 70 - 868-5407
Area code- Phone number
2. WELL INFORMATION: I
SITE WELL ID #(if applicable)
WELL CONSTRUCTION PERMIT#(dapplicable) N/A
OTHER ASSOCIATED PERMIT #(dapplicable) N/A
3. WELL USE (Check Applicable Box) Monitoring[] MunicipaUPubli
IndustriaUCommercial[] Agdculturall7 Recovery[] Injection
Irrigation[] Other[] Qi t se)
DATE DRILLED A
TIME COMPLETED I 61 AME PMD
4. WELL LOCATION:
ciTY Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC /LAND SETTING:
13 Slope 0 Valley 18 Flat 13 Ridge [] Other
(check appropriate box) 1„by be in degrees,
LATITUDE 35.14 157489 minutes, seconds or
LONGITUDE -78.97 603046 in a decimalfom►at
Latitude/longitude source: R GPS 0 Topographic map
(location of well must be shown on a USGS topo map and
affached to this form if not using GPS)
5. FACILITY- Is the name of the business where the well Is located.
FACILITY ID #(if applicable) N/A
NAME OF FACILITY Fort Brasld
STREET ADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
91t 0 - 396-7432
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH :� 5
b. DOES WELL REPLACE EXISTING WELL? YES[] NOS
c. WATER LEVEL Below Top of Casing: 33.38 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 6 FT. Above Land Surface'
'Top of casing terminated aUor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e, YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
FrorrL To From To
From To From To
7. CASING: Depth Diameter ThicknessMlelght . Matenal,
)F(00, 44( To__Q_ Ft. ?5 SW 40 PvG
From To Ft.
From To FL
8. GROUT: Depth Material Method
From 'r0 '",7 Ft Iz,4, TRrrl�lnAlE.,
From t40 To O Ft.Nf�YT Ll ir-A- 'FORCE_ tr f
From To FL
9. SCREEN: Depth Diameter Slot Size Material
FrorrL5.V To -AAzL Ft. Lin. � C� o in. �yC'
From To Ft.in, in.
m FroTo FL in. in.
10. SANDIGRAVEL PACK:
Depth Size Material
From O %S To ELL Ft. W a SR N
From To Ft.
From To FL
11.DRILLING LOG
From To Formation Description
d4
12. REMARKS:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
is WELL CONSTRUCTION STANJ�4RDS, ANDrT A COPY OF THIS
�COR� ENPR0nl EDTO1HEy�(EXLOWNER. A
SI'G-RAT69EOFC T1FIE 6 iNE'L—L CON TR OR DATE
fr��6A\1 4
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-1b ,
Rev.12107':'
'V.
'::au

NONRESIDENTIAL WELL CONSTRUCTTON RECORD -
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (IndividuaQ Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO Box 1169
Dacula GA 300019
City or Town State Zip Code
7( 70 .868-5407•
Area code- Phone number
2. WELL INFORMATION: �t
SITE WELL ID #(if applicable) l•
WELL CONSTRUCTION PERMR#(ifapplicable) N/A
OTHER ASSOCIATED PERMIT#(1fapplicable) N/A
3. WELL USE (Check Applicable Box) Monitoring[] Munidpal/PublyiO
Industrial/CommercialD Agriculturalp Recoveryp Injectlong
Irrigationp OtherO (lit e)
DATE DRILLED Si b J
TIME COMPLETED (% AMID PMD
4. WELL LOCATION:
CITY, Fayetteville COUNTY Cumberland'
Fort Bragg Fayetteville, NC 28301'
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / ND SETTING:
13 Slope 0 Valley 51 Flat 13 Ridge q Other
(check appropriate box) 1%&y be in degrees,
LATITUDE 35.144 158002 minutes, seconds or
LONGITUDE -78.97 597391 in a decimal format
Latitude/longitude source: 14 GPS 13 Topographic map.
(location of we0 must be shown on a USGS topo map and
attached to this farm Ynot using GPS)
5.FACILITY is the nameofthebusiness where the weillslocated.
FACILITY ID #('d applicable) N/A
NAME OF FACILITY Fort Bragg
STREETADDRES$ Building 3-1137 Butner Rd.
Fort Bragg NC -28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
91( 0 ).396-7432
' Area code - Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: Li 5 /
b. DOES WELL REPLACE EXISTING WELL? YESG NC'�1
c. WATER LEVEL Below Top of Casing: 33.85 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS�FT. Above Land Surface'
'Top of casing terminated atlor below land surface may require:;
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
7. CASING: Depth Diameter Thiclmes&&*Ight
Material
From Ja-S To_Q _ Ft. L7 %K 94d
Ptk,
From To Ft.
From To Ft.
8. GROUT: Der.:', Material
Method
FromaEr ToAga ' Ft eyt'sr 'TOAMMIe
From 33 To ti Ft.t-vzq-i ClylnrT4V
n35
From To Ft.
9. SCREEN: Depth Diameter Slot Size
Material
�7p $
fit"
From %STo Ft. �7S in: •Oin.
From To Ft. in. in.
From To Ft. in. in.
_
<4 r
10. SAND/GRAVEL PACK:
Depth Size Material
>r.Y.
From yg,5 To ZS Ft.li�­ SRN9
From To Ft.
From To Ft.
11.DRILLING LOG .
From To Formation Description
12. REMARKS:
I DO HERE TIFYTHATTHIS WELL WAS CONSTRUCTED IN 4tCORDANCECNITH`;
15A L CONS; ON STAN DS, AND A79 Y OF THIS', i �""
R O PROM DTO EW OWNER
SIGWATUIWOF CERTIFIED W L C NTRACTOR DATE
La vrx,
PRINTED NAME -OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form GW-1b
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev.12107

NONRERDENML wELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (Individuaq Name
Geo Lab, Inc.
Well Contractor Company Name
STREET ADDRESS PO Box 1169
Dacula GA 300019
City or Town State Zip Code
7( 70 - 868-5407
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(Ifapplicable),
WELL CONSTRUCTION PERMIT#(ffapplicable), N/A
OTHER ASSOCIATED PERMIT #(if applicable) NIA
3. WELL USE (Check Applicable Box) Monkorine0 Municipal/Publi
Industrial/Commerciall3 Agricukurall3 Recovery0 Injectioriff
IrrigatiorrQ Other-13 (Ilst s )
DATE DRILLED . 0%
TIME COMPLETED 8 t{ b AMH PM3
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301.
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / L,%ND SETTING:
13 Slope 0 Valley If Flat 13 Ridge El Other
(check appropriate box) hby be in degrees,
LATITUDE 35.14 158711 minutes, seconds or
LONGITUDE -78.97 592271 in a decimal format
Latitude/longitude source: K GPS 0 Topographic map
(locaBon of well must be shown on a USGS topo map and
attached to this form if not using GPS)
5. FACILITY is the name of the business where the well Is located
FACILITY ID #(if applicable) N/A
NAME OF FACILITY Fort Bragg
STREET ADDRESS Building 3-1137 Butner Rd.
Fort Brag NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
91t 0 ).396-7432
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: V
b. DOES WELL REPLACE EXISTING WELL? YESD NOR/
c. WATER LEVEL Wow Top of Casing: 33.22 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS J& 1) _ . FT. Above Land Surface -
*Top of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type
Amount
g. WATER ZONES (depth):
From' To
From To
From To
From To
From To
From To
7. CASING: Depth
Diameter Thickness/Weight Material
From y_ To .0
Ft. -75-SOH 4O l�L
From To
Ft.
From To
Ft. i
8. GROUT: Depth
Material Method
From 4-& _ T0_33.7
Ft. &l4r "i (MMIE
FroLnL7 To-0—
Ft.L4 C1Mf� TOM- INS ,
From To
Ft '=
9. SCREEN: Depth
Diameter Slot Size Material'
From 54_5 To yy�s
Ft -1 in. L
From To
Ft In. in.
From To
Ft rn. in.
10. SAND/GRAVEL PACK.
Depth
Size Material
Fromffj_5_To--ft�­ FL —A --a— SAID
From To
Ft.
From To
Ft.
11.DRILLING LOG
From To Formation Description
12. REMARKSc
I DO"CWELL
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15TRUCTON ANDARDS, TACOPYOFTHIS
RID T TH W0.LOWNE
SIGNATUREOFCERTIFIED
-WELLCONTRA TOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within.30 days. Attn: Information Mgt., Form GW-1b
1617 Mail Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev.12/07

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
. WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor Qndividual) Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO Box 1169
Dacula GA 300019
City or Town State Zip Code
7( 70 .868-5407
Area code- Phone number
2. WELL INFORMATION: 1
SITE WELL ID #(if applicable) 1
WELL CONSTRUCTION PERMIT#(ifapplicable) N/A
OTHER ASSOCIATED PERMIT #(idapplicable) N/A
3. WELL USE (Check Applicable Box) Monitoringl3 Muniapal/Publi
Industrial/Commercial0 Agriculturalp Recovery(] Injection
Irrigation[) Otherp (li It use)
DATE DRILLED
TIME COMPLETED Ad PMp
4. WELL LOCATION:
CITY: Fayetteville COUNTY CUn beriand
Fort Bragg Fayetteville; NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / ND SETTING:
13 Slope a Valley Flat Cl Ridge 13 Other
(check appropriate box) May be in dcV—.
LATITUDE 35.14 159394 minutes, seconds or
LONGITUDE -78.97 587018 in a decimal format
Latitude/longitude source: I GPS 0 Topographic map
(location ofwe0must be shown on a USGS tope map and
attached to this farm lfnot using GPS)
5. FACILITY is the name of the business where the well is located,
FACILITY ID #('ri appiicabie) N/A
NAME OF FACILITY Fort Bragg
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg_NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
91c 0 )- 396-7432
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:;, 5-1151-
b. DOES WELL REPLACE EXISTING WELL? YESO NOD
c. WATER LEVEL Below Top of Casing: 33.22 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS FT. Above Land Surface*
`Top of casing terminated atlor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type
Amount
g. WATER ZONES (depth):
From To
From
To
From To
From
Tp
From To
From
Tc
7. CASING: Depth
Diameter ThicknesslWeight Material
From ti5 . To O
Ft --7
'5 D P *4
From To
Ft
From To
Ft.
8. GROUT: Depth
Material
Method
Frorr 4a To = 7 Ft
From 3?j'7 To 0 Ft, NiftT Uyltsi
From To Ft
9. SCREEN: Depth Diameter SlotSize Material
From ToL1 5 - Ft -� in. . O O in.
From To • Ft in. In.
From To Ft in. In.
10. SAND/GRAVEL PACK:
Depth Size Material
Frorr , SS To� Ft_ S19r�t�9
From Ta Ft
From To Ft'
11.DRILLING LOG
From To Formation Description
i
12. REMARKS:
I DO CERTIFY TTHIS ELL S CONSTRU ACCORDANCE WITH
1ti WELL N RUCTI Si DARD$,AND COPYOFTHIS
BEEN P O IDED T E ELL OWNER
SIGNATURE OF CERTIFI DWELL CONTRACTOR D— ATE
PRINTED NAME OP PERSON CONSTRUCTING THE WELL--, "
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form GW-1b
1617 Mail Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev.12/07

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Divisibn of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
I. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor Qndividual) Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO Box 1169
Dacula . GA 3000.19
City or Town State Zip Code
7� 70 - 868-5407
Area code- Phone number
2. WELL INFORMATION: i
SITE WELL ID #(ifapplicable) -s
WELL CONSTRUCTION PERMIT#(if applicable) N/A
OTHER ASSOCIATED PERMIT #(if applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring[] Muniapal/Publi
Industrial/Commercialp Agricultural[] Recovery[] Injection
Irrigation[] Other[] Qist se)
DATE DRILLED EI=
TiME COMPLETED AMD PMO
4. WELL LOCATION:
CITY Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel; Zip Code)
TOPOGRAPHIC / WD SETTING:
13 Slope 0 Valley WFlat 13 Ridge 0 Other
(check appropriate box)
Maybe is degrees,
LATITUDE 35.14 160171 minutes, seconds or
LONGITUDE -23.97 581626 in a decimal format
Latitude/longitude source: X GPS [] Topographic map
(location of well must be shown on a USGS topo mep and
attached to this form if not using GPS)
5. FACILITY Is the name of the businesswherethe well is located
FACILITY ID #(if applicable) N/A
NAME OF FACILITY Fort Bragg
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
91( 0 )- 396-7432
Area code - Phone number
6. WELL DETAILS:
157
a. TOTAL DEPTH: , 0
b. DOES WELL REPLACE EXISTING WELL? YES[] NOO
c. WATER LEVEL Below Top of Casing: 33.24 FT.
(Use °+^ if Above Top of Casing)
d. TOP OF CASING IS .'k FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From To
From ? To From To
7. CASING: Depth Diameter ThiclmessNVeight Material
From To d Ft 6tH Zi0 VL
From Tc Ft.
From To Ft
8. GROUT: Depth Material Method
Frorr>LL&_To ifo.7 FL ii�/ fr T2ernet of
From !40,'7 To 0 Ft. 'F012cE INT-
From To Ft.
9. SCREEN: Depth Diameter Slot Size Material
From 5 To quo Ft 7S in. , Die in. Q VG .
From To Ft in. in.
From To Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
From Sao To Ll� FL-k-a— S MOD
From To Ft
From To Ft.
11.DRILLING LOG
From To Formation Description
12. REMARKS:
_yuciY
RDO�PRo FYTHA THIS WELL WAS CONSTRUCTED IN WITH�L�,D N�AgOPYOFTHIS
ToHL DAN// .:
SI NATURE OF CERTIFIED V&trCONTRACTOR DATE
L&r''rt1 --DOy UAI c
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form GW-1b
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev.12107

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor pndividuaD Name
Geo Lab, Inc.
Well Contractor Company Name
'STREET ADDRESS PO Box 1169
Dacula GA 300019
City or Town State Zip Code
7( 70 - 868-5407
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID#(ifapplicable)
WELL CONSTRUCTION PERMIT#gfapplicabie) N/A
OTHER ASSOCIATED PERMIT #(if applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring0 MunicipaUPubli
IndustriaUCommercial[3 Agricultural[]Recovery[] Injection
IC
Irrigatiori0 Other[] pit use)
DATE DRILLED d Dl �/
TIME COMPLETED OSi AIA PMO,
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC I LAND SETTING:
0 Slope 0 Valley D Flat 13 Ridge 0 Other
(check appropriate box) 11sy be in dew,
LATITUDE NJ4 160966 minutes, seconds or
LONGITUDE -78.97 576457 in a decimal format
Latitude/longitude source: R GPS 13 Topographic map
(locafion ofwellmustbe shown on a USGS topo map and
attached to this form if not using GPS)
5. FACILITY- Is the name of the business where the weOls located.
FACILITY ID #pf applicable) N/A
NAME OF FACILITY Fort Braga
STREET ADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
Cityor Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
91( 0 )- 396-7432
Area code - Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: 5S• S
b. DOES WELL REPLACE EXISTING.WELL? YES[] NOG
c. WATER LEVEL Below Top of Casing: 32.75 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 0 FT. Above Land Surface•
`Top of casing tenninated atfor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type
Amount
g. WATER ZONES (depth):
From To
From To
From To
From To
From To
From To
7. CASING: Depth Diameter ThicknessNNeight Matepal,
Fronn To O Ft -75- 5C61 UiC P Z%
From To Ft
From To Ft
8. GROUT: Depth Material
From_ Ya Tom? Ft �i2f�
From W 0,7 To__o Ft faArrjMl Ni
From To Ft
Method
fE
V 46I
9. SCREEN: Depth Diameter Slot Size Material
From To q6.5 Ft1]5�­in. - OtO Im FVC
From Tc Ft tn. in.
From Tc Ft in. in.
10. SANDIGRAVEL PACK:
Depth Size Material
From'96 To y22Ft.A_ 5I0r)_
From To Ft.
From To Ft
II.DRILLING LOG
From To Formation Description
12. REMARKS:
Tom9y=
WAS 5TRUCTID IN C RDANCE WITHD ,AND THAT OF THISELL WNER.0
SI NATURE OF CERTIFIED WELL
`C�ONTRACTOR DATE
Lo.rr*c. l_Joo�iy-t��
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit. the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-1b
Rev.12/07
lt,
'tif�v

NON RESIDENTIAL wELL coNsTRuCTiON RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor pndividuap Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO Box 1169
Dacula GA 300019
City or Town State Zip Code
7( 70 t- 868-5407
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
WELL CONSTRUCTION PERMIT#(ff applicable) N/A
OTHER ASSOCIATED PERMIT #(ifapplicable) N/A
3. WELL USE (Check Applicable Box) Monitoring[3 Municipal/Publi
Industrial/Commercial- . Agricultural- Recovery- Injection
Irrigational Other- pis u e)
DATE DRILLED I'i b
TIME COMPLETED AMH PM[3.
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
0 Slope - Valley - Flat I] Ridge - Other
(check appropriate boxy be is degrees,
LATITUDE 35.14 151056 minutes, seconds or
LONGITUDE -78.97 601489 inadecimal Format
Latitude/longitude source: X GPS 0 Topographic map
(locadan of well must be shown on a USGS topo map and
aftached to this form if not using GPS}
5. FACILITY Is the name otthe business where the well Is located.
FACILITY ID #(if applicable) N/A
NAME OF FACILITY Fort Bragg
STREET ADDRESS Building 3.1137 Butner Rd.
Fort Bragg. NC 28301
City or Town State Zip Code -
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
91L 0 1- 396-7432
Area code - Phone number
6. WELL DETAILS: c
a. TOTAL DEPTH. 4 Q V .
b. DOES WELL REPLACE EXISTING WELL? YES- NOD
c. WATER LEVEL Below Top of Casing: 33.64 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS _ I FT. Above Land Surface*
'Top of casing terminated aUor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount �_"•'. `'
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
7. CASING: Depth Diameter ThicknessWeight Material
From 385 To�Q Ft 7G -JL
From To Ft
From To Ft-
B. GROUT. Depth Material Method
From 3,6 To 3 �"7 Ft �j
From 33►7 To O Ft t�j! Clrir-ft-
From To Ft.
9. SCREEN: Depth
Diameter Slot Size Material
From To 36 •S Ft L�S In. - 40 in.
From To
Ft in. in.
From Tc
Ft in. in.
10. SAND/GRAVEL PACK:
Depth:
Size Material
Fromqt,s To-�
Ft i�,-�- cg�
From To
Ft.
From To
Ft.'
11.DRILLINO LOG
."
From To
Formation Description
12. REMARKS:
imffWELLEH7
CORDANCE WITHPY OF THIS
E
SIGNATURE OF CERTI`FIE W `LL CONTRACTOR DATE
PRINTED NAME OF.PERSON CONSTRUCTING THE WELL.
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form GW-1b
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev.12/07

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (Individual) Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO BOX 1169
Dacula GA 300019
City or Town State Zip Code
7( 70 - 868-5407
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) D i-
WELL CONSTRUCTION PERMIT#(if applicable) N/A
OTHER ASSOCIATED PERMIT #(If applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring❑ MunicipaUPublicp
IndustriaUCommercial[l AgricutturalO Recovery13 Injection
Irrigation0 Otherl3 (list Ise a
DATE DRILLED�I 60
TIME COMPLETED O AM13 PMD
4. WELL LOCATION:
CITY Fayetteville COUNTY Cumbetiand
Fort Bragg Fayetteville, NO 28301
(Street Name, Numbers, CommunU Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
13 Slope 13 Valley WFlat 13 Ridge 13 Other
(check appropriate box) My be is degrees,
LATITUDE 35.14 151633 minutes, seconds or
LONGITUDE -78. 97 596184 is a decimal format
Latitude/longitude source: 11 GPS 13 Topographic map
(/ocadon of well must be shown on a USGS topo map and
attached to this form if not using GPS)
S.-FACILITY- Isthe name ofthe brnlnesswherethe well Is located.
FACILITY ID #(rf applicable) N/A
NAME OF FACILITY Fort Brano
STREET ADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
f 910 - 396-7432
Area code - Phone number
16. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YESU NOO
c. WATER LEVEL Below Top of Casing: 33.90 FT,
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS •_ G _ FT. Above Land Surface*
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From Tc
7. CASING: 'Depth Diameter ThicknessNVeight Material
FFOnL_3-'L To 0 Ft.--7 5- -56H tfD
Fiom To FIL
From To Ft
8. GROUT: Depth Material
From ,-5Q To Z?. 7
Fro 747 To C _ Ft t*& CEMN`
From To Ft.
pvG
Method
19. SCREEN: Depth Diameter Slot Size Material
From t-i�l To 3g FL�in..d�D in. t' "L
From To Ft in. in.
From To Ft in. in,
10. SAND/GRAVEL PACK:
Depth Size Material
From t S Tc —S0 Ft—*-;L— SPaN b
From To Ft.
From To Ft.
I1.DRILLING LOG
From To Formation Description
I r..!EPR
TTHIS WELL W CONSTRUCTED 1 ACCORDANCE WITH
1 RUCTI7-�Mg
COPY OF THIS
R DEDT
SIGNATURE OF CERTIF ED``�ELL CONTRACTOR DATE
UAI(f4 DOD 1Dille
PRINTED NAM OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form GW-1b
1617 Mail Service Center- Raleigh, NC 27699-1617 Phone No..[phone] ext $68. Rev.12107

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (Individual) Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO BOX 1169
Dacula GA 300019
City or Town State Zip Code
7( 70 ).868-5407
Area code- Phone number
:2. WELL INFORMATION: 7
SITE WELL ID #(if applicable) D3
WELL CONSTRUCTION PERMIT#(ifapplicable) N/A
OTHER ASSOCIATED PERMIT #(If applicable) N/A
'3. WELL USE (Check Applicable Box) Monitoring[] Muniapal/Publi
Industrial/Commercial17 Agricuftural0 Recoveryp Injection
Irrigation[I OtherD Qi t us )
DATE DRILLED o$
TIME COMPLETED S O$ AM13 PMD
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LIjtJD SETTING:
13 Slope 13 Valley fir Flat 0 Ridge 0 Other
(check appropriate box) l&y be in degrees,
LATITUDE 35.14 15244 minutes, seconds or
LONGITUDE -78.97 590935 inadecimal format
Latitude/longitude source: H GPS 0 Topographic map
(location of well must be shown on a USGS tope map and
affached to drls form if not using GPS)
6. FACILITY Is the name of the business where the well Is located
FACILITY ID #(if applicable) N/A
NAME OF FACILITY Fort Bragg
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
91r 0-396-7432
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: �90 r /
b. DOES WELL REPLACE EXISTING WELL? YES13 Nola/
c. WATER LEVEL Below Top of Casing: 33.74 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS o
i FT. Above Land Surface*
*Top of casing terminated
atfor below land surface may require
a variance in accordance
with 15A NCAC 2C .0118.
e, YIELD (gpm):
METHOD OF TEST
f. DISINFECTION: Type
Amount
g. WATER ZONES (depth):
From To
From To
From To
From To
From To
FrorrL To
7. CASING: Depth
Diameter ThicknessNVelght Material
From i-i3 To b Ft 1-75 Sf44 Ll0 V(1
From To FL
Flom To._ Ft
6. GROUT: Depth Material • Method
.r6. 3517Ft
From .35 7 To 6 Ft t -'t c_MP
From' To Ft
$. SCREEN: Depth
53 t43
Diameter Slot Size Material
0
From To
Ft a in. -0 in.
From To
Ft in. in.
From To
Ft. in. in.
10. SAND/GRAVEL PACK:
De
From 6� To 8
Size Material
Ft tQ - 56'If)
From To
Ft
From To
Ft
11.DRILLING LOG
From To
Formation Description
12. REMARKS:
100 H ERTIFYTH T THIS WELL W CONSTRU IN ACCORDANCE WnH
1 C ELL RUCiI ST ARDS,AND ACOPYOFTHIS
BEENP V TO E LOWNER.
t
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
LaIftr IJOo(1 Mk
PRINTED NAME Op PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form GW-1b.-
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev.12107``

NONRESIDENTM wELL coNSTRucnm RECORD
North Carolina Departmeut of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (Individual) Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO BOX 1169
Dacula GA 300019
City or Town State Zip Code
7( 70 )- 868-5407
Area code- Phone number
:2. WELL INFORMATION: h
SITE WELL ID #(ifapplicable) {�
WELL CONSTRUCTION PERMIT#(if applicable) N/A
OTHER ASSOCIATED PERMIT #(if applicable) NIA
3. WELL USE (Check Applicable Box) Monitoring[] Municipal/Public
IndustriallCommercial0 AgriculturalO Recovery0 Injection
IrngationD Otherp (list use)
DATE DRILLED log1
TIME COMPLETED O AMiO PMl]
4. WELL LOCATION:
CITY Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC! LAND SETTING:
13 Slope 13 Valley 10 Flat 13 Ridge 0 Other
(check appropriate box) May be is degrees,
LATITUDE 35.14 15324 minutm,secondaor
LONGITUDE -78.97 585791 in a decimal format
Latitude/longitude source: Jij GPS 0 Topographic map
(location of well must be shown on a USGS topo map and
attached to this form ifnot using GPS)
5. FACILITY is the name otttie businesswhere the hell is located
FACILITY ID #(tf applicable) N/A
NAME OF FACILITY Fort Bragg
STREETADDRESS Building3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
91( 0 .396-7432
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: �7 S
b. DOES WELL REPLACE EXISTING WELL? YESO NOG
c. WATER LEVEL Below Top of Casing: 33.46 Fr. .
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS _0, FT. Above Land Surface
'Top of casing terrninated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From Tc From To
From Tc � From To
7. CASING: Depth Diameter ThlcknesWMIght Material
Front `'S To Q Ft. • 7S �JG
From To Ft
From Tc Ft.
8. GROUT: Depth Material Method
From g4STom92,7 Ft. -T94ANAEr
From L2..?Z To_ (Z_ Ft. a cMrfi
From To Ft
9. SCREEN:, Depth Diameter Slot Size Matedal _:� _-
From To_N Ft i in. LOP in. PV
From To Ft in. in.
From To R. in. in.
10. SANDIGRAVEL PACK:
Depth Size Material
From_IL_To W& Ftji -, - SAND
From To Ft
From Tc Ft.
11.13RILLING LOG
From To Formation Description
12. REMARKS:
I DO HER C FY THIS WELL W CONSTRUCTED 1 ACCORDANCE WITH
15A 4C L CO Si UCTI A ACDS, AND 7 COPY OFTHIS
R HAS EN PR VID TO E W LL OWNER
SIGN TURE OF -CERTIFIED WELL CONTRACTOR DATE
l.a r rLj
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form GW-1b
1617 Mail Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev.12107

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (Individual) Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO Box 1169
Dacula GA 300019
City or Town State Zip Code
7( 70 .868-5407
Area code- Phone number
:2. WELL INFORMATION:• D
SITE WELL ID #(itapplicable)
WELL CONSTRUCTION PERMIT#(dapplicable) N/A
OTHER ASSOCIATED PERMIT #(if applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring(] Municipal/Publi
Industrial/Commercial0 Agricultural0 Recovery- INectionIr
Irrigation- OtherI3 (lis ushO
DATE DRILLE5/TIME COMPLETED AMH PMI]
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / L66ND SETTING:
0 Slope - Valley If Flat 0 Ridge 0 Other,
(check appropriate box) May be in degrees,
LATITUDE 35.14 15416 minutes, seconds or
LONGITUDE -78.97 580763 in a decimal format
Latitude/longitude source: I GPS 13 Topographic map
(/ocaSon of we# must be shown -on a USGS topo map and
attached to this form if not using GPS)
5. FACILITY Is the name of the business where the well is located.
FACILITY ID #(if applicable) N/A
NAME OF FACILITY Fort BraA9
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
91c 0 _ �. 396-7432
Area code - Phone number
6. WELL DETAILS: r
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YESO NOD
c. WATER LEVEL Below Top of Casing: 33.16 FT.
(Use W if Above Top of Casing)
d. TOP OF CASING IS O FT. Above land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
L DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To
From To
From To
Front To
From To
From To
7. CASING: Depth
Diameter ThicknesafflWight Material
Fro S S TOP—
Ft. .75 `a 0
From To
Ft.
From To
Ft
8. GROUT. Depth
Material Method=
From _40t1 To 3% $
Ft. &U-1- Tct.4.(jnrj _
From7, S� To—
Ft. 1`viA� CWI �RfG idJS
From To
Ft.
9. SCREEN: Depth
Diameter Slot Size Material
Fro m55 �5 To r-i i-
Ft. L7 in. 010 in. V L
From To
Ft. in. in.
From_____ To
Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Size Material
From 95.S To_4&1
FtAc?— StWID
From To
Ft.
From To
Ft.
11.DRILUNG LOG
From To Formation Description
12. REMARKS:
IDOFj�tEBY ERTtFYTHATTHISWELLWASCONSTRUCiEDINACCORDANCEWITH
16DA�OAC2 WELLCONSdiRUCTIONSTADlbmos.AND W*ACOPY OFTHIS
BEEN
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
Loutrw DDOANQ-
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form GW-1b
1617 Mail Service Center — Raleigh, NC 276994617 Phone No. [phone] ext 568. Rev,12/07

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality b:
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor Undividual) Name
Geo Lab, Inc.
Well Contractor Company Name
STREET ADDRESS PO Box 1169
Dacula GA 300019
City or Town State Zip Code
7( 70 - 868-5407
Area code- Phone number
, 2. WELL INFORMATION:
SITE WELL ID #(If applicable)
WELL CONSTRUCTION PERMIT#(rfapplicable) N/A
OTHER ASSOCIATED PERMIT #(if applicabie) N/A
3. WELL USE (Check Applicable Box) Monitoring[] Municipal/Publ!03
Industrial/CommercialD Agdculturall3 Recovery[] Injection
Irrigation[] Other[] Qi uu e)
DATE DRILLED V 5 ©$ J
TIME COMPLETED AMid PMD
4. WELL LOCATION:
CITY: Fayetteville COUNTY Curnbsdand
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / L/(ND SETTING:
D Slope [] Valley 9 Flat D Ridge 0 Other,
(check appropriate box) Nisy be in degrees,
LATITUDE 35.14 154778 minutes, seconds or
LONGITUDE -78.97 575362 in a decimal format
Latitude/longitude source: A GPS 0 Topographic map
(locaSon of well must be shown on a USGS topo map and
attached to this form if not using GPS) .
5. FACILITY is ttre name of the business where the sell Is located
FACILITY ID #(if applicable) N/A
NAME OF FACILITY Fort Bragg
STREETADDRESS Building 3-1137 Butner Rd.
Fort Braga NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
91t 0 .396-7432
Area code _ Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 49
b. DOES WELL REPLACE EXISTING WELL? YES[] NO,(
c. WATER LEVEL Below Top of Casing: •33.01 . FT.
(Use "+" If Above Top of Casing)
d. TOP OF CASING IS FT. Above Land SurfaC@`.,:
'Top of casing terminated at/or below land surface may requite
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From To
From Tc From To
7. CASING: Depth Diameter Thickness/Might Material
From To D Ft. --75 i i 0 'PIX "
From To Ft.
From To FL
8. GROUT: Depth Material Method
Front_ To $3 -1 Ft P -i'(2-S.0%M�G
Fron S ;7 ToU _ Ft �FAi" fJMNi 1=Dtt[E I N3
From To FL
9. SCREEN: Depth Diameter Slot Size Material
From To 3`i FL •-7S in. • O O in. py�
From To Ft in. in.
From To Ft in. in.
10. SAND/GRAVEL PACK:
Dept Size Material
From �9To 3 b Ft. ` fu_4�
From To Ft.
From To Ft.
11.DRILLING LOG
From To Formation Description
12. REMARKS:
I DOH ERTIFY TTHIS WELL W CONSTRUCTED IN A CORDANCE WITH
15 2C LCO RLM
STA ARDS,AND TA
OFTHIS
ECO HA EEN PR VI ED O
E L OWNER
'.
4?i%a -.
SIGNATURE OF CERTIFWb
WELL CONTRACTOR
DATE,'_,'
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form GW-1b
1617 Mail Service Center— Raleigh, NC 276994617 ' Phone No. [phone] ext 568. Rev.12/07

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor QndNlduaQ Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO BOX 1169
Dacula GA 300019
City or Town State Zip Code
7( 70 .868-5407
Area code- Phone number
'2. WELL INFORMATION:
SITE WELL ID #(if applicable)
WELL CONSTRUCTION PERMIT#(if applicable) N/A
OTHER ASSOCIATED PERMIT#(if applicable) N/A
3. WELL USE (Check Applicable Box) Monitodng0 Municipal/Publiyp
Industrial/Commercial❑ Agricultural0 Recovery0 Injection
Irrigatiorlli OtherI341r0L--:::
)
DATE DRILLED JTIME COMPLETED AM® PMO
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, SubdNislon, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / L"D SETTING:
13 Slope [] Valley IV Flat D Ridge i] Other,
(check appropriate box) 2)4ay be in degrees,
LATITUDE 35.14 144862 minutes, scconds or
LONGITUDE -78.97 600542 in a decimal format
Latitude/longitude source: j( GPS U Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
5. FACILITY- is the name of the buslness where the wail Is located.
FACILITY ID #Qf applicable) N/A
NAME OF FACILITY Fort Bragg
STREET ADDRESS Building 3-1137 Butner Rd.
Fort Brag NC 28301 .
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
91l 0 )- 396-7432
Area code - Phone number
6, WELL DETAILS:p� /
a. TOTAL DEPTH: "T 0 /
b. DOES WELL REPLACE EXISTING WELL? YES13 .. NOW
c. WATER LEVEL Below Top of Casing: 33.72 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS _0_ FT. Above Land Surface -
*Top of casing terminated atfor below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount '
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
7. CAS ING• Depth Diameter ThicknesslMight Material
From a_ To�_ Ft - ?S PVL
From To Ft
From To Ft
8. GROUT: Depth Material Method
From MA' To Mf
it Ft �fLl� T'R�MM1E ;
Fror i s To—.E Ft, jyi:R1�CIVINT- FORCE INT;,
From To Ft
9. SCREEN: Depth Diameter Slot Size Material `:'.
From­-41 To-D U Ft_a Sin. •010 In. `C7yL
FroffL To Ft in. in.
From Tc Ft in. in.
1t1. SAND/GRAVEL PACK:
Depth Size Material
From­_1%4jg To 31•R Ft.�?NZ_
From To Ft
From To Ft.
11.DRILLING LOG
From To Formation Description
'i.
12. REMARKS:
IDO ERnIFIR
HISWELLW CONSTRV NACCORDANCEWITH
C L CTIO ST ARDS, AND A COPY OF THIS
R S ETJDTO E L OWNER.
SI NATURE OF CERTIFIED WELL CONTRACTOR DATE
LAV-14 DoOIA"
PRINTED NAMLrOF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form GW-1b
1617 Mail Service Center — Raleigh, NC 276994617 Phone No. [phone] ext 568. Rev.12/07

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (Individuan Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO BOX 1169
Dacula GA 300019
City or Town State Zip Code
7( 70-868-5407
Area code- Phone number
2. WELL INFORMATION: SITE WELL ID #(If applicable) Ca
WELL CONSTRUCTION PERMIT#(if appli able) N/A
OTHER ASSOCIATED PERMIT#(if applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring[] Municipal/Publi
Industrial/CommerclaI13 A,griculhrral0 Recovery0 Injection
Irrigatiorfl OtherO gist s )
DATE DRILLED 510
TIME COMPLETED 4 AMd PM13
4. WELL LOCATION:
ciw. Fayefteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, SubdMslon, Lot No., Parcel, Zip Code)
TOPOGRAPHIC /D SETTING:
0 Slope 13 Valley 9 Flat i] Ridge O Other
(check appropriate box) h&y be•ia dcgrm.
LATITUDE 35.14 145495 minutes, seconds or
LONGITUDE -78.97 59503 in a decimal format
Latitude/longitude source: j1 GPS 13 Topographic map
(locahbn ofwe/l must be shown on a USGS topo map and
attached to this form if not using GPS)
5. FACILITY Is ft name of the businesewhere the well is located'
FACILITY ID #gf applicable) N/A
NAME OF FACILITY Fort Bragg
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
CityorTown State Zip Code
91( 0 )_ 396-7432
Area code - Phone number
6. WELL DETAILS: l i r
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YESO NOp
c. WATER LEVEL Below Top of Casing: 34.02 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS - Z FT. Above Land Surface*
'Top of casing terminated avor below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To FroffL To
From To From To
From ToL From To jy °; .
7. CASING: Depth Diameter ThicknesslWeight Material`
From­7�_j. To O Ft. +7
From To FL
From To Ft.
p. GROUT: Depth Material Method
From 3—, Z; Z To`I Z: q Ft �� TV1W M1F�
Fror.. Z`1—q To_ _ Ft.N01117AMyr. 'F� 101T
From To Ft
9. SCREEN: Depth Diameter Slot Size Material
From q 9 To_31_ Ft �in. + b in.
From To Ft. in. in.
From To Ft._in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
Fromq9--To-3 7w, -4 Ft. SHNl7
From To Ft.
From To Ft.
11.13RILLING LOG
From To Formation Description
12. REMARKS:
RE OF
THATTHIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
)NMLJCTICNSTANDARDS. AND Tj:IA ACOPYOFTHIS
DATE
",rrti -)Dv oft A e
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form G1Nr1ub a
1617 Mail Service Center — Raleigh, NC 276994617 Phone No. [phone] ext 568. Rev.12107c ;_

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTMCATiON # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (IndividuaD Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO BOX 1169
Dacula GA 300019
City or Town State ZIp Code
7( 70 .868-5407
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID#(ifapplicable)
WELL CONSTRUCTION PERM IT#(dapplicable) N/A
OTHER ASSOCIATED PERMIT#(if applicable) N/A
3: WELL USE (Check Applicable Box) Monitodng[3 MunicipallPul l
Industrial/Commerciall] AgriculturalD Recoveryi3 Injection
Irrigationp Others (list use
DATE DRILLED
TIME COMPLETED TJ5107 AMU PM13/
4. WELL LOCATION:
CITY Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC I WD SETTING:
13 Slope D Valley Ef Flat 13 Ridge D Other
(check appropriate box)
Maybe in degrees,
LATITUDE 35.14 146364 minutes, seconds or
LONGITUDE -78.97 589715 in a decimal format
Latitudellongitude source: R GPS 17 Topographic map
(location ofwell rrrustbe shown on a USGS topo map and
attached to this form if not using GPS)
5. FACILITY- isthe name of the business wherethe mi Is located.
FACILITY ID #(if applicable) N/A
NAME OF FACILITY Fort Bragn
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State _ Zip Code
91� 0 - 396-7432
Area code - Phone number
6. WELL DETAILS: (� a
a. TOTAL DEPTH: Li 9
b. DOES WELL REPLACE EXISTING WELL? YESD NOD
c. WATER LEVEL Below Top of Casing: 34.27 FT,
(Use °+" if Above Top of Casing)
d. TOP OF CASING ft •E• FT. Above Land Surface'
`Top of casing terminated at/or below land surface may require..
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From Tc From Tc
From To From To
7. CASING: Di
o, Depth ameter ThicknessNVeight Material
From � 1 To_0 Ft. .�i J~ Sit �O
From To Ft.
From To . Ft.
8. GROUT: Depth Material Method
From < 6A To Zi, l Ft. %bSN� �iT.7rNlrri t�%
From I To O Ft. tSEAV C..W)N i FOP-CE ItA
From To Ft.
9. SCREEN: C Depth Diameter Slot Size Material
From l To 3q Ft. •�s in. .0 O in.L
Frorq To Ft. in, in.
From To Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
From q9 To ?J(-A Ft_ °uHND
From To Ft —
From To Ft.
11.DRILLING LOG
From To Formation Description
12. REMARKS:
IDOH ERTIFYTHATTHIS LL CONSTRUCT IN ACCORDANCE WITH-•
16 A ELL CON UCTIO ST ARDS, AND A OFTHIS
EC BEEN PR TO E LOWNER. `;
Sl NATURE OF CERTIFIEb VV5LL CONTRACTOR DATE{
UA r,rl., D.o �N"'TT\T—
PRINTED NAME'OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days: AUn: Information Mgt,
1617 Mail Service Center— Raleigh, NC 276994617 Phone No. [phone] ext 568.
Form GWA b
Rev.12/07 f,
:. I.

NONRESIDENTIAL wELL CoNSTRucnmRECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Bumett
Well Contractor (Individuaq Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO Box 1169
Dacula GA 300019
City or Town State Zip Code
7( 70 - 868-5407
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(inapplicable)
WELL CONSTRUCTION PERMIT#(if applicable) N/A
OTHER ASSOCIATED PERMIT #(If applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring[] Municipal/Public13
Industrial/CommercialD Agriculturail3 RecoveryO Injection[]
Irrigationil Otherl3 (list s
DATE DRILLED O$
TIME COMPLETED 6,06 AMU PMI/
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Sheet Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC 1 WD SETTING:
13 Slope I3 Valley f( Flat D Ridge 13 Other
(check appropriate box) ray be in degrees,
LATITUDE 35.14 147131 minutes, seconds or
LONGITUDE =78.37 584596 in a decimal format
Latitude/longitude source: Ja GPS 0 Topographic map
(location ofwell must be shown on a USGS topo map and
attached to this fann if not using GPS)
5. FACILITY- Is the name ofthe business wherethe well Is located.
FACILITY ID #(if applicable) N/A
NAME OF FACILITY Fort Bram
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
(910 ).396-7432
Area code - Phone number
S. WELL DETAILS: I f
qa. TOTAL DEPTH: 1
b. DOES WELL REPLACE EXISTING WELL? YESl3 : NOB
c. WATER LEVEL Below Top of Casing: 34.11 FT.
(Use '+' if Above Top of Casing)
d. TOP OF CASING IS E F • FT. Above Land Surface*
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
If. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
7. CASING: Depth Diameter ThicknessN&igN Material
From-3`� To 0 Ft: +7 S -oCH IL10 PVL
From To Ft.
From To Ft-
B. GROUT: Depth Material Method -
From ' ,9 To Ft. �SJ`� 'TR�G.ry8M t�
Frorr;, t, Tom Ft I�rf�i-C>Et1N1' Fi7QCt=_ 1t�S:
From To Ft-
9. SCREEN: , Depth Diameter Slot Size Material -
From To_S9 Ft: ,15 in, �0 0 in. V �'
From To Ft. in. in.
From Tc Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
From L _Tc, 52 Ft.
� ��
From To Ft —
Fro rrLTo Ft
11.13RILLING LOG
From To Formation Description
:s
12. REMARKS:
100 HERE EI TIFY T THIS WELL WA CONSTRUCT IN CCORDANCE WITH
1 L RUCTIO STA ARDS,AND PYOFTHIS
R I BEEN P V DEDTO 1E LOWNER.
J
S TURE OF CER IFIED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form GW-1b
1617 Mail Service Center — Raleigh, NC 276994617 Phone No. [phone] ext 568. Rev.12/07

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor QndMduaQ Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO Box 1169
Dacula GA 300019
City or Town State Zip Code
7( 70 .868-5407
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
WELL CONSTRUCTION PERMIT#(dapplicable) N/A
OTHER ASSOCIATED PERMIT #(if applicable) N/A
3. WELL USE (Check Applicable Box) Monitodng[3 Municipal/Publi
IndustriaUCommercia[13 Agricultural Recoveryp Injection
Irrigation0 Otherl] Qist use)
DATE DRILLED 69 /
TIME COMPLETED OS AMD PME
4. WELL LOCATION:
CITY Fayetteville COUNTY Cumberland'
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC /�ND SETTING:
13 Slope 0 Valley Flat 13 Ridge i3 Other
(check appropriate box) A&y be in degrees,
LATITUDE 35.14 147906 minutes, seconds or
LONGITUDE -78.97 579399 a decimal format
Latitude/longitude source: 19 GPS (3 Topographic map
pocaffon of well must be shown on a USGS topo map and
attached tc this form ff not using GPS)
5. FACILITY. is the name orthe business where the well Is located.
FACILITY ID #(d applicable) N/A
NAME OF FACILITY Fort Bragg
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
91t 0 t- 396-7432
Area code - Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: J b
b. DOES WELL REPLACE EXISTING WELL? YES13 N013
c. WATER LEVEL Below Top of Casing: 33.69 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS_.L_ FT. Above Land Surface
'Top of casing terminated atfor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To
From To
From— To
From To
From To
From To
7. CASING: Depth
Diameter ThicknessWeight Material:
From To 0
Ft. 05 seQ 40
From To
Ft.
From To
Ft
8. GROUT: Depth
Material Method .
From Li3 To �� �Ft
Vd IM:NAft
From 'LAk-7To" 0
Ft f #T LiM(IT 7-6Q lWT
From To
Ft
9. SCREEN: Depth
Diameter Slot Size Material
From ff To 44O_
Ftj]5—in. -b10 in. C'
From To
Ft In. in.
From Tc
Ft. in. in.
10. SANDIGRAVEL PACK:
De th
Size Material
From T6 To t'� 3
Ft.. *QL s
From To
Ft —
Fro rrTo
Ft
11.DRILLING LOG
From To Formation Description
12. REMARKS:
THIS WELL W CONSTRUCTED ACCORDANCE WMi
tUCTIQN STAr415Ai2DS. AND 7UT A COPY OF THIS
SIGNATURE OF CE IFIED WELL CONTRACTOR DATE
L_a,rn,� sli A\ 2
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: information Mgt,
1617 Mail Service Center — Raleigh, NC 276994617 Phone No. [phone] ext 568.
Form GW-1 b
Rev.12/07�

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor QndividuaQ Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO Box 1169
Dacula GA 300019
City or Town State Zip Code
7( 70 1- 868-5407
Area code- Phone number
2, WELL INFORMATION: 66
SITE WELL ID#(itappiicableh
WELL CONSTRUCTION PERMIT#(dapplicable) N/A
OTHER ASSOCIATED PERMIT#(ifapplicable) N/A
3. WELL USE (Check Applicable Box) Monitonng[3 Municipat/Publi
Ind6strial/CommercialD AgriculturalO Recoveryp Injecdonff
Irrigation!] Otherp Qi t a)
DATE DRILLED O
TIME COMPLETED tg AMU PMI(
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / L8AD SETTING:
D Slope U Valley V Fiat U Ridge 0 Other
(check appropriate box) �&y be in degrees,
LATITUDE 35.14 149205 minutes, seconds or
LONGITUDE -78.97 574526 in a decimal format
Latitade/longitude source: R GPS 0 Topographic map
(location ofwel/mustbe shown on a USGS topo map and
ofiached to this form if not using GPS)
S. FACILITY• is the name orthe business where the well Is located
FACILITY ID #Qf applicable) N/A
NAME OF FACILITY Fort Braqq
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
f 910 . 396-7432
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YESO • NOO
c. WATER LEVEL Below Top of Casing: 33.63 FT.
(Use "+" If Above Top of Casing)
d. TOP OF CASING IS ® FT. Above Land Surface',':.,`c:..
'Top of casing terminated at/or below land surface may requ, e :
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type
Amount
g. WATER ZONES (depth):
From To From
To
From To From
To
From To From
To
T. CASING: Depth Diameter
ThicknessN%bight Material
From ffb T6__0 _ Ft •7 S
�O )> V �'
From To Ft.
From Tc Ft.
8. GROUT: Depth IMaterial
Float q To 3-7 • (n Ft. i1-41'
From 3 • (o To O Ft„ 1y�RT GVVI"
From To Ft
Method
Toemyvvc-
FoQ.CF Irj t-
' 9. SCREEN: Depth Diameter Slot Size Material
From S]6 To_L o. Ft •757In. .6 O in, (PVC•
From To Ft in. in.
From To Ft. in. in,
10. SAND/GRAVEL PACK:
Depth Size Material
From .D, To j� Ft.ii�
From To Ft
From To Ft.
11.DRILLING LOG
From To Formation Description
12. REMARKS:
ARRDCERTIFY TTHISWELL CONSTRUCTEDIN RDANCEWITHWELL CO UC ST DARDS,AND A pYOFTHIS'BEEN PR V DE T E 0.LOWNER '
S GNATURE OF CERTIFIED WELL CONTRACTOR DATE
i�tr'rti'D 60VzA\\P2
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form GW-1b
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev.12/07

NONRESIDENTIAL WELL CONSTRUMON RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Bumett
Well Contractor QndividuaD Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO BOX 1169
Dacula GA 300019
City or Town State Zip Code
7( 70 )-868-5407
Area code- Phone number
1 2. WELL INFORMATION:
SITE WELL ID #(if applicable)_ El
WELL CONSTRUCTION PERMIT#(ifapplicabi N/A
OTHER ASSOCIATED PERMIT #(if applicable) N/A.
3. WELL USE (Check Applicable Box) Monitoring13 Municipal/Pub
lndustriaUCOmmerclalp Agricultural[] Recovery[] Injection
Irrigatioriil Other[] Qist us
DATE DRILLED �d�
I TIME COMPLETED O AMPMD
4. WELL LOCATION:
CITY Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code).
TOPOGRAPHIC /D SETTING:
Q Slope [IValley 9 Flat U Ridge 13 Other
(check appropriate box) h&y be in degrees,
LATITUDE 35.14 138354 minutes, seconds or
LONGITUDE -78.97 599266 in a decimal format
Latitude/longitude source: i( GPS 0 Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
6. FACILITY is the name of the business vmerethe veil Is located.
FACILITY ID #Qf applicable) N/A
NAME OF FACILITY Fort Brans
STREETADDRESS. Building 3-1137 Butner Rd.
Fort Brag NC 28301
- City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
91t 0 1- 396-7432
Area code - Phone number
.6. WELL DETAILS: 22 r
a. TOTAL DEPTH:! �7
b. DOES WELL REPLACE EXISTING WELL? YES[] NOG
c. WATER LEVEL Below Top of Casing: 34.10 FT.
(Use °+^ if Above Top of Casing)
d. TOP OF CASING IS A— FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e, YIELD (gpm):
METHOD OF TEST
f. DISINFECTION: Type
Amount
S WATER ZONES (depth):
From To
From To
From To
From To
From To
From To
7. CASING: Depth
Diameter Thickness/Weight Material
From u 3 To d
Ft.. S ►���'
From Tc
Ft
From To
Ft
8. GROUT: Depth
Material Method
From -g-=� "7ni31e.+{
Ft. Milk TRf wy -3E
From Tom Ft. NfAC GMa0C Fvtu E taJS:
From To
Ft. =f
9..SCREEN: Depth
Diameter Slot Size Material
From S3 To 43
Ft •7S(n. .1 0 in. PuL
From To
Ft in. in.
From To
Ft In. in.
1o. SAND/GRAVEL PACK:
Depth
Material
size material
From S3 To 3g.7
Ft. :-50A>
From Tc
Ft
From To
Ft.
11.DRILLING LOG
From To.
Formation Description
c,
12. REMARKS:
1 C FY TTHISWEtA
WAS NSTRUCTEDIN CORDANCEYM
1 N ELL CO UCTIONND DS,ANDTHAT OFTHIS
PR EDT THEL ER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
l-AV'�i 1-JOO�1`7T1Q ___
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form GW-1b
1617 Mail Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev.12/07

NONRESIDENTIAL wELL coxsTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Bumett
Well Contractor (Individual) Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO BOX 1169
Dacula GA 300019
City or Town State Zip Code
770 -'868-5407
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
WELL CONSTRUCTION PERMIT#(ifapplicable) N/A
OTHER ASSOCIATED PERMIT #(if applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring[] Munidpal/Publi
Industrial/Commercia113 Agricultural[] RecoveryD Injection
IrrigationD OtherD (list use
DATE DRILLED 01
TIME COMPLETED b AMD PM[]
4. WELL LOCATION:
CITY.. Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC /D SETTING:
17 Slope D Valley Flat d Ridge D Other
(check appropriate box) �&y be in degrees
LATITUDE 35.14 139031 minutes, seconds or
LONGITUDE -78.97 59398 in a decimal format
Latitude/longitude source: 1( GPS D Topographic map
(location of well must be shown on a USGS topo map and
attached to this thrm ifnot using GPS)
5. FACILITY is the name of the business where the well Is located.
FACILITY ID #('d applicable) N/A
NAME OF FACILITY Fort Bragg
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Mp Code
CONTACT PERSON Mr: Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
91c 0 ).396-7432
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: S /
b. DOES WELL REPLACE EXISTING WELL? YESD NO(9'
c. WATER LEVEL Below Top of Casing: 34.01 FT.,
(Use "+" if Above Top of Casing)
d. TOP OKCASING IS ; ° Z FT. Above Land Surface*
*Top of casing terminated atfor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount �n
g. WATER ZONES (depth):
From To From To
From To From 70
From To From To
7. CASING: Depth
Diameter Thickness/Weight Material
From ytL To
Ft. •_75 SCH cfv
From To
Ft
From To
Ft
9. GROUT: Depth
Material Method
From 3q.-S -ro,
Ft___! r 13 nnnnlG
From 17-2- 'off_
Ft N�-T
From To
Ft
9. SCREEN: Depth Diameter
From Tim To . - Ft..'7.S- In
From To Ft in.
From To Ft in.
10. SAND/GRAVEL PACK:
Slot Size Material
. 0
J-0 in. PW,
in.
in.
Depth Size Material
Frorr>1 _To 315 Ft 5/W7
From Tc Ft.
From To Ft.
11.DRILLING LOG
From To Formation Description
12. REMARKS:
I DO FY THAT IS WELL WAS CONSTRUCTED IN ACC DANCE WITH
15 2 ,W LCONSr U IONSTA DTHATA FTHIS
R O PROM ;4EWL O ER.
�j
SIGNATURE OF CERTIFIED WELL7C01MXCTOR DATE
Do 0 1wte— r
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form GW-1b
1617 Mail Service Center —Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev.12107

NON RESIDENTIAL WELL coNSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (IndividuaQ Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO B0X 1169
Dacula GA 300019
City or Town State Zip Code
7( 70 )_ 868-5407
Area code. Phone number
'2. WELL INFORMATION:
SITE WELL ID #(If applicable)
WELL CONSTRUCTION PERM IT#(dapplicable) N/A
OTHER ASSOCIATED PERMIT #(if applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring[] Municipal/Pubilc0
Industrial/Commercial[j AgriculturalD Recoveryl7.ln)ectionEl
Irrigation OtherO (list Se)
DATE DRILLED 6 0
TIME COMPLETED fo 09 AMI7 PMD
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC /�ND SETTING:
13 Slope p Valley Flat 13 Aidge 13 Other
(check appropriate box) My be is degrees,
LATITUDE 35.14 139966 minutes, seconds or
LONGITUDE -78.97 588696 in a decimal format
Latitude/longitude source: K GPS 0 Topographic map
(location ofav#must be shown on a USGS fopo map and
attached to this form if not using GPS) I
6. FACILITY. Is the name of the business where the well Is located
FACILITY ID *(if applicable) N/A
NAME OF FACILITY Fort Bragg
STREETADDRESS -Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Sallie
City or Town State Zip Code
91( 0 ).396-7432
Area code - Phone number
6. WELL DETAILS: ,, jj
a. TOTAL DEPTH: i
b. DOES WELL REPLACE EXISTING WELL? YES13 NOV
c. WATER LEVEL Below Top of Casing: 34.18 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS e _ FT. Above Land Surface' Y=
'Top of casing terminated atfor below land surface may require= -.:-
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To .
From To From To
From To From To
7. CASING: Depth Diameter ThtcknessNVeight Material
From_ Ng ToFt. I SIR q0 WL
From To Ft.
From To Ft.
8. GROUT: Depth Material Method
From y#%•STo 3_.ZFt..P.�� 'TO-Wit'16
From,Z To b Ft f" 1r C►11f`ri qRL0 INS
From To Ft-
-ff. SCREEN: Depth Diameter Slot Size Material i
From 5� To Ft. 75 in. b1pin.
From To Ft. in. in.
From To Ft in. in.
>: -;
10. SAND/GRAVEL PACK:
Depth Size Material _ r
From _To s Ft SfVC1.0 .
From To Ft.
From To Ft.
I1.DRILLING LOG
From To Formation Description
12. REMARKS:
WAS OO OTED IN
MDARD MDTHATA
BEEN
S GNATURE OF C TI IED ` `ELL CONTRACTOR DATE
t&CI L4 DVD %--\F*m.
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form cw-1b .•`
1617 Mail Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev.12/07
f'

NONRESIDENTIAL WEIL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor pndividuaq Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO BOX 1169
Dacula GA 300019
-City or Town State Zip Code
7770 .868-5407.
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
WELL CONSTRUCTION PERMIT#r!(ifapplicable) N/A
OTHER ASSOCIATED PERMIT #('if applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring[] Municipal/Publi
Industrial/Commeroial0 Agriculturall3 Recoveryl3 Injection
Irrigation] Others] (lis use)
DATE DRILLSD�o O
TIME COMPLETED AMID' PMl3
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville; NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Tip Code)
TOPOGRAPHIC / LAND SETTING:
13 Slope 13 Valley 0 Flat 13 Ridge 0 Other
(check appropriate box) y be m degrees,
LATITUDE 35.14 140885 minutes,,semnds or
LONGITUDE -78.97 583407 a decimal format
Latitude/longitude source: ja GPS 0 Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
6. FACILITY is the name of the business where the well is located.
FACILITY ID #('R applicable) N/A
NAME OF FACILITY Fort Bragg
STREET ADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
91t 0 - 396-7432
Area code - Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: 53 . S /
b. DOES WELL REPLACE EXISTING WELL? YESa NOIF
c. WATER LEVEL Below Top of Casing: 34.49 FT.
(Use'+• if Above Top of Casing)
d. TOP OF CASING IS •'J, - FT. Above land Surface'
'Top of casing terminated a✓or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
FrorrL To From To
From To From To
7. CASING: Depth Diameter ThlcknessWelght Material'
From y3,S To O Ft •75 SLN 4D
From To Ft
From To Ft. _
8. GROUT: Depth Material
Method
From ,' &.7 To - Ft 7% e T
Fromm To--Q___ Ft. Nr�T
%%zee INS .
From To Ft
9. SCREEN: Depth Diameter Slot Size
Material
From '_3' To_q3_S__ Ft.,7� in.
in. PVC,
From To Ft in.
in.
From Tc Ft. in.
in.
10. SAND/GRAVEL PACK:
Depth Size Material
From53, '__Tc 343 Ft_ t;;1- STom_
From Tc Ft.
From To Ft.
11.DRILLING LOG
From To
12. REMARKS:
Formation Description
1 DO C TIFYTHAT THIS WELL CONSTRU IN ACCORDANCE WITH
NCA , W L CON UCrI ST ARDS, AN T COPY OF THIS
RECO ENPR ID DTO E LOWNER
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
PRINTED NAME OP PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt:,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
•ii
Form GWAb
Rev.12/07 ;!
7:

1 r ON RESIDENTM WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (Individual) Name
Geo Lab, Inc.
Well Contractor Company Name
STREET ADDRESS PO Box 1169
Dacula GA 300019
City or Town State Zip Code
7( 70 1.868-5407
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID Of applicable) S
WELL CONSTRUCTION PERMIT#Qfapplicable) N/A
OTHER ASSOCIATED PERMIT #(if applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring❑ MunicipattPubli
IndustriaUCommerciall3 Agriculturall3 Recoveryi] Injection
Irrigation0 OtherI3 ([It t use)
DATE DRILLED D
TIME COMPLETED Q8 AMR( PM❑
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
13 Slope p Valley 13 Flat 13 Ridge 13 Other
(check appropriate box) lby be in degrees,
LATITUDE 35.14 141692 minutes, seconds or
LONGITUDE -78.97 578327 in a decimal format
Latitude/longitude source: ill GPS 13 Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
5. FACILITY is the name of the buslness where the well Is located.
FACILITY ID #(if applicable) N/A
NAME OF FACILITY Fort Bragg
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
91( 0 1.396-7432
Area code - Phone number
6. WELL DETAILS: Cif
a. TOTAL DEPTH: ✓ t J
b. DOES WELL REPLACE EXISTING WELL? YES[] NOId
c. WATER LEVEL Below Top of Casing: 34.24 FT.
(Use -+" if Above Top of Casing)
d. TOP OF CASING IS 5 FT. Above Land Surface'
*Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
T. CASING: Depth Diameter Thickness/Weight Material
From y L1 To--�2_ Ft. , %S UH PV& "
From To Ft.
From To Ft.
8. GROUT: Depth Material Method
From L O To ?2_ Ft. 6f r4'r TrLC& tXA%F.
From To 10 Ft t�Pr1"U11Ni� INS
From To Ft.
9. SCREEN: Depth Diameter Slot Size Material
From Toqq Ft. r 7S in. , D 10 in.
From To Ft. in. in.
From To Fte in. in.
10. SAND/GRAVEL PACK:
Depth Size
Size Material
From s'7 To Lit Ft.:0�_ s (it`rD
From To Ft.
From To Ft.
11.13RILLING LOG
From To Formation Description
i
12.'REMARKS:
CONSTRUCTED
,RDS, AND T1T
OWNER.
SIGNATURE OF CERTIFIED WL" CL CONTRACTOR DATE
Ca rat --Dac Q-
PRINTED NAME ()If PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn:,Information Mgt.,
1617 Mail Service Center — Raleigh, NC 276994617 Phone No. [phone] ext 568.
Form GW-1b
Rev.12/07

I
.f�t'e'.� s,f
:'A,: ..
NONRESIDENTIAL WELL CONSTRUCTION RECORD t
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (IndividuaD Name
Geo Lab, Inc.
Well Contractor Company Name
STREETADDRESS PO BOX 1169
Dacula GA 300019
City or Town State Zip Code
7f 70 - 868-5407
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID#(ifapplicable) l�
WELL CONSTRUCTION PERMIT#(ifapplicable) N/A
OTHER ASSOCIATED PERMIT#(if applicable) N/A
3. WELL USE (Check Applicable Box) Monitoring- Municipal/Publi
Industrial/CommercialE3 Agricultural- Recovery- Injection
Irrigation- Other-j86L1tb0__::
DATE DRILLED
TIME COMPLETED AM CIt PMB
4. WELL LOCATION:
CITY. Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name, Numbers, Communfty, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
13 Slope - Valley - Flat i] Ridge - Other
(check appropriate box) INay be in degrees,
LATITUDE 35.14 142817 minutes, seconds or
LONGITUDE -78.97 573164 in a decimal format .
Latitude/longitude source: 9 GPS - Topographic map
(location of well must be shown on a USGS topo map and
attached to d7is form if not using GPS)
5. FACILITY- Is the name of the business where the well Is located.
FACILITY ID #pf applicable) N/A
NAME OF FACILITY Fort Bragg
STREETADDRESS Building 3-1137 Butner Rd.
Fort Bragg NC . 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
91t 0 ).396-7432
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 57
b. DOES WELL REPLACE EXISTING WELL? YES- NOS/
c. WATER LEVEL Below Top of Casing: 34.25 FT.
(Use '+' if Above Top of Casing)
d. TOP OF CASING IS ` _ FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .011B.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To
From To
From To
From To
From To
From To
7. CASING: Depth
Diameter Thickness/Weight Material
From To O
Ft.
From To
Ft.
From To
Ft. i
B. GROUT: Depth
Material Method,
From To__�g_
Ft. C+rT irs�rN I�
From To 0
_i9
Ft. �� rmt- - Fbjtcx ,`I►N j-
From To
Ft.
S. SCREEN: Depth
Diameter Slot Size -Material
From I To_� -7
Ft. •75- in..0-L-V. in.
From_ To
Ft, in. in.
From To
Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Size Material
Fro !, ToLA q_ Ft.-*�_ 1,ffiN�
From To
Ft.
Front To -
Ft.
11.DRILLING LOG
From To Formation Description
1t
12. REMARKS:
WREEN
RnFYTH TTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH.
ELL CO RUCTI ST DS, AND T OPY OF THIS
PR I EDTO E OWNER.
f
S GNATU RE OF CERTIFIED WELL CONTRACT09 DATE
l�0.rrti l/e o�t�12
PRINTED NAME Or PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form GW-1b
1617 Mall Service Center— Raleigh, NC 276994617 Phone No. [phone] ext 568. Rev.12107

NONRESIDENTUL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3527
1. WELL CONTRACTOR:
Richard Marshall Burnett
Well Contractor (Individuao Name
Geo Lab, Inc.
Well Contractor Company Name '
STREETADDRESS PO Box 1169
Dacula GA 300019
City or Town State Zip Code
7f 70-868-5407
Area code- Phone number
2. WELL INFORMATION: . /
SITE WELL ID #(if applicable) A1.W - rf
WELL CONSTRUCTION PERMIT#(if applicable) NIA
OTHER ASSOCIATED PERMIT #(if applicable) N/A
3. WELL USE (Check Applicable Box) Monitoringemunicipal/Public[I
Industrial/Commercialp Agricuiturali3 Recoveryl3 Iniection0
Irrigatior13 Otherl3 (list use)
DATE DRILLED 9- I-r '0 1, /
TIME COMPLETED O ��'dY AMO PMit_ �'
4. WELL LOCATION:
CITY: Fayetteville COUNTY Cumberland
Fort Bragg Fayetteville, NC 28301
(Street Name. Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC 1 SETTING:
0 Slope p Valley Flat 13 Ridge 0 Other
(check appropriate box) May be in degrees,
LATITUDE 35.14 014035 minutes, seconds or
LONGITUDE-78.97 20003 in adccimalformat
Latitude/longitude source: I GPS 13 Topographic map
(location of well must be shown on a USGS topo map and
attached to thls form tf not using GPS)
5. FACILITY is the name of the business where the Kell Is located.
FACILITY ID #(d applicable) N/A
NAME OF FACILITY Fort Bragg
STREETADDRESS Building 3-1137 Butner Rd.
_Fort Bragg NC 28301
City or Town State Zip Code
CONTACT PERSON Mr. Steven Harris
MAILING ADDRESS Same
City or Town State Zip Code
91( 0 .396-7432
Area code - Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 'I /
b. DOES WELL REPLACE EXISTING WELL? YESp NO
c, WATER LEVEL Below Top of Casing: 11.92 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS --'S FT. Above Land Surface'
'Top of casing terminated atfor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm):
METHOD OF TEST
f. DISINFECTION: Type
Amount
g. WATER ZONES (depth):
From To
From To
From To
From To
From To
From To
7. CASING: Depth
Diameter Thickness/Might Material
From 3, To D
Ft.
a t'✓f
From To
Ft.
From To
Ft.
8. GROUT: Depth
Material Method
From l3,9 To_, O
Ft.
' -rC T r004 j 5;4J
From { , To :.
Ft.
61-r
From To
Ft.
9. SCREEN: Depth
Diameter Slot Size Material
7
016 Pr C
Fromm_ To
Ft.
d2 In. • in.
From To
Ft.
in. in.
From To
Ft,
in. in.
10. SAND/GRAVEL PACK:
De th
f A%+%
Si;e2 Material
�j x4
From • To
Ft.
From To
Ft.
From Tc
Ft
11.DRILUNG LOG
From To Formation Description
12. REMARKS:
AND
'ram S"t.6Y
DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: information Mgt, Form GW-1b
1617 Mail Service Center -- Raleigh, NC 27699-1617 Phone No. [phone] ext 568. Rev.12107