WI0300503_Notification of Intent (NOI) – GW Remediation_20231006

Mh
APEX
October 5, 2023
Mr. Blake Buthcher
Division of Water Resources — UIC Program
North Carolina Department of Environmental Quality
1636 Mail Service Center
Raleigh, North Carolina 27699-1636
Subject: Notification of Intent to Construct or Operate Injection Wells
Colonial Pipeline Company- Charlotte Delivery Facility
Charlotte, Mecklenburg County, North Carolina
NCDEQ Incident No. 6162
Dear Mr. Butcher,
Apex Companies, LLC is submitting the attached Notification of Intent to Construct or Operate Injection
Wells on behalf of Colonial Pipeline Company (CPC). The purpose of the injection wells is to operate a
biosparge system that was approved by North Carolina Department of Environmental Quality
Underground Storage Tank Section on November 7, 2018. The 13 biosparge wells will be used to reduce
dissolved phase BTEX and MTBE concentrations in groundwater associated with historic releases in the
Tanks 731 through 734 diked area (NCDEQ Incident Number 6162). It is anticipated that the biosparge
system will be operational on November 1, 2023.
If you have any questions or concerns, please do not hesitate to contact the undersigned at (704) 936-
6394.
Sincerely,
Apex Companies, LLC
Prepared By:
Andrew Street, RSM, CHMM
Senior Project Manager
Enclosure
cc:
Mr. Jeff Morrison - CPC
Ms. Maribeth Hughes - CPC
Apex Companies, LLC • 5900 Northwoods Business Pkwy, Ste 5900-0 • Charlotte, NC 28269 • T 704.799.6390 • F 704.799.6395 • apexcos.com

NOTIFICATION OF INTENT TO CONSTRUCT OR OPERATE INJECTION
WELLS
APEX

NC Department of Environmental Quality (DEQ) — Division of Water Resources (DWR)
NOTIFICATION OF INTENT (NOI) TO CONSTRUCT OR OPERATE INJECTION WELLS
The following are `permitted by rule" and do not require an application to be submitted and an individual permit
be issued when constructed in accordance with the rules of I5A NCAC 02C.0200 (NOTE: This form must be
received at least 14 DAYS prior to injection)
GROUNDWATER (GW) REMEDIATION INJECTION PERMIT TYPES:
(1) IN -SITU GW REMEDIATION PERMIT TYPE (15A NCAC 02C .0225)
• In -Situ Passive Injection Systems - In -well delivery systems to diffuse injectants into the subsurface. Examples include
ORC socks, iSOC systems, and other gas infusion methods (Note: Injection Event Records (IER) do not need to be
submitted for replacement of each sock used in ORC systems).
• In -Situ Small -Scale Injection Operations — Injection wells located within a land surface area not to exceed 10,000
square feet (SF) for the purpose of soil or groundwater remediation or tracer tests. If area to be treated exceeds 10,000
SF do not use this NOI; an injection Permit application shall be submitted, and a Permit issued per 15A NCAC
02C .0225(f).
• In -Situ Pilot Tests - Preliminary studies conducted for the purpose of evaluating the technical feasibility of a
remediation strategy to develop a full-scale remediation plan for future implementation, and where the surface area of
the injection zone wells is located within an area that does not exceed five percent of the land surface above the known
extent of groundwater contamination. Also, if pilot test is going to be conducted on separate groundwater
contaminant plumes do not use this NOI; a Permit application shall be submitted, and a Permit issued as per
15A NCAC 02C .0225(f).
• In -Situ Thermal (IST) — IST wells `heat' contaminated groundwater in -situ to enhance remediation.
(2) AIR INJECTION PERMIT TYPE (15A NCAC 02C .0225)
These permit types are used to inject ambient air to enhance treatment of soil or groundwater.
(3) TRACER WELL PERMIT TYPE (15A NCAC 02C .0229)
These permit types are used to inject substances for determining hydrogeologic properties of aquifers.
(4) AQUIFER TEST PERMIT TYPE (15A NCAC 02C .0220)
These permit types are used to inject uncontaminated fluid into an aquifer to determine aquifer hydraulic characteristics.
DATE: October 5, 2023 NOI TRACKING NO. W10300503
o be filled in by DWR)
DIRECTIONS- Submit this NOI only for (1) New deemed `permitted by rule' injection project or (2) If there is going
to be a different permit type (listed above) used for a previously issued NOI.
NOTE- After this NOI is processed and acknowledged, any supplemental or additional injections still meeting the
criteria referenced in Section G below shall be reported using Injection Event Records (IERs) and using the NOI
tracking number provided by DWR.
A. WELL TYPE TO BE CONSTRUCTED OR OPERATED
(1) X Air Injection Well ....................................... Complete sections B through F, J, M
(2)
Aquifer Test Well .......................................
Complete sections B through F, J, M
(3)
Passive Injection System ...............................
Complete sections B through F, H-M
(4)
Small -Scale Injection Operation ......................
Complete sections B through M
(5)
Pilot Test .................................................
Complete sections B through M
(6)
Tracer Injection Well ...................................
Complete sections B through M
(7)
In -Situ Thermal (IST) Well ...........................
Complete sections B through M
Deemed Permitted GW Remediation NOI Rev. 3-1-2023 Page 1

B. STATUS OF WELL OWNER: Business/Organization
C. WELL OWNER(S) — State name of Business/Agency, and Name and Title of person delegated authority to
sign on behalf of the business or agency:
Name(s): Colonial Pipeline Company- Jeff Titus, Operations Manager
la
E.
Mailing Address: PO Box 87
City: Charlotte State: NC Zip Code: 28130 County: Mecklenburg
Day Tele No.: 704-393-6822 Cell No.: Same as Day Tele No.
EMAIL Address: JTitus(&colpipe.com Fax No.:
PROPERTY OWNER(S) (if different than well owner/applicant)
Name and Title: Same as above
Company Name
Mailing Address:
City:
Day Tele No.:
EMAIL Address:
State: Zip Code:
Cell No.:
Fax No.:
PROJECT CONTACT (Typically Environmental Consulting/Engineering Firm)
Name and Title: Andrew Street- Senior Proiect Manager
County:
Company Name Apex Companies, LLC
Mailing Address: 5900 Northwoods Business PIM, Suite 5900-0
City: Charlotte State: NC Zip Code: 28269 County: Mecklenburg
Day Tele No.: 704-936-6394 Cell No.: Same as Day Tele No.
EMAIL Address: Andrew. Street(c gpexcos.com Fax No.:
F. PHYSICAL LOCATION OF WELL SITE
(1) Facility Name & Address: Charlotte Delivery Facility, 7524 Kenstead Circle
City: Charlotte County: Mecklenburg Zip Code: 28130
(2) Geographic Coordinates: Latitude**: " or 35_°.286035
Longitude**:
Reference Datum:
° I
NAD
" or-80_0.934835
Accuracy:10 ft.
Method of Collection: Google Earth
* *FOR AIR INJECTION AND AQUIFER TEST WELLS ONLY: A FACILITY SITE MAP WITH PROPERTY
BOUNDARIES MAY BE SUBMITTED IN LIEU OF GEOGRAPHIC COORDINATES.
G. TREATMENT AREA
Land surface area of contaminant plume: square feet
Land surface area of inj. well network: square feet (< 10,000 W for small-scale injections)
Percent of contaminant plume area to be treated: (must be < 5% of plume for pilot test injections)
Deemed Permitted GW Remediation NOI Rev. 3-1-2023 Page 2

H. INJECTION ZONE MAPS — Attach the following to the notification.
(1) Contaminant plume map(s) with isoconcentration lines that show the horizontal extent of the
contaminant plume in soil and groundwater, existing and proposed monitoring wells, and existing and
proposed injection wells; and
(2) Cross-section(s) to the known or projected depth of contamination that show the horizontal and vertical
extent of the contaminant plume in soil and groundwater, changes in lithology, existing and proposed
monitoring wells, and existing and proposed injection wells.
(3) Potentiometric surface map(s) indicating the rate and direction of groundwater movement, plus existing
and proposed wells.
I. DESCRIPTION OF PROPOSED INJECTION ACTIVITIES AT THE SITE — Provide a brief narrative
regarding the cause of the contamination, and purpose, scope, goals of the proposed injection activity:
J. WELL CONSTRUCTION DATA
(1) No. of injection wells: 13 Biosparge Wells Proposed N/A Existing (provide NC
Well Construction Record (GW-1) for each well)
(2) Appx. injection depths (BLS): Approximately 45' or to the top of the bedrock interface
(3) For Proposed wells or Existing wells not having GW-ls, provide well construction details for each
injection well in a diagram or table format. A single diagram or line in a table can be used for
multiple wells with the same construction details. Well construction details shall include the
following (indicate if construction is proposed or as -built):
(a) Well type as permanent, Geoprobe/DPT, or subsurface distribution infiltration gallery
(b) Depth below land surface of casing, each grout type and depth, screen, and sand pack
(c) Well contractor name and certification number
K. INJECTION SUMMARY
NOTE: Onlv iniectants annroved by the enidemioloQv section of the NC Division ofPublic Health. Department
of Health and Human Services can be infected. Approved iniectants can be found online at
http: //deq.nc. gov/about/divisions/water-resources/water-resources-permits/wastewater-branch/ground-water-
protection/ground-water-approved-injectants. All other substances must be reviewed by the DHHS prior to use.
Contact the UIC Pro ream for more info if you wish to approval for a different additive. However, please
note it may take 3 months or longer. If no injectants are to be used use N/A.
Injectant: Total Amt. to be injected (gal)/event:
Injectant: Total Amt. to be injected (gal)/event:
Injectant: Total Amt. to be injected (gal)/event:
Injectant:
Total Amt. to be injected (gal)/event;
Deemed Permitted GW Remediation NOI Rev. 3-1-2023 Page 3

Injectant: Total Amt. to be injected (gal)/event:
Total Amt. to be injected (gal/event):
No. of separate injection events: Total Amt. to be injected (gal):
Source of Water (if applicable
L. MONITORING PLAN — Describe below or in separate attachment a monitoring plan to be used to determine
if violations of groundwater quality standards specified in Subchapter 02L result from the injection activity.
M. SIGNATURE OF APPLICANT AND PROPERTY OWNER
Well Owner/Applicant: `I hereby certify, under penalty of law, that I am familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and
complete. I am aware that there are significant penalties, including the possibility of fines and imprisonment,
for submitting false information. I agree to construct, operate, maintain, repair, and if applicable, abandon the
injection well and all related appurtenances in accordance with the 1 SA NCAC 02C 0200 Rules. "
Signature of Applicant
Jeffrey Titus, Manager, Operations
Print or Type Full Name and Title
Property Owner (if the property is not owned by the Well Owner/Applicant):
"As owner of the property on which the injection well(s) are to be constructed and operated, I hereby consent to
allow the applicant to construct each injection well as outlined in this application and agree that it shall be the
responsibility of the applicant to ensure that the injection well(s) conform to the Well Construction Standards
(1 SA NCAC 02C C. 0200). "
"Owner" means any person who holds the fee or other property rights in the well being constructed. A well
is real property and its construction on land shall be deemed to vest ownership in the land owner, in the
absence of contrary agreement in writing.
Signature* of Property Owner (if different from applicant) Print or Type Full Name and Title
*An access agreement between the applicant and property owner may be submitted in lieu of a signature on this form.
Please send 1 (one) hard color copy of this NOI along with a copy on an attached CD or Flash Drive at least
two (2) weeks prior to injection to:
DWR — UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone: [phone]
Deemed Permitted GW Remediation NOI Rev. 3-1-2023 Page 4

GW-1 Forms
:1
APEX

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
NICHOLAS HAYES
Well Contractor Name
A - 4121
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #:
List all applicable well consimcrion pernnis (i.e. County, Stale. Variance. etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural ❑Municipal/public
❑Geotherma€ (Heat iug/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial ❑Residential Water Supply (shared)
[Irrigation
Non -Water Supply Well:
❑Monitoring [-]Recovery
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
DGeothermal (Closed Loop)
❑Geothermal (HeatiaglCooIing
4. Date Well(s) Completed:
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
[]Tracer
®Other (explain under 4211
10/03/17 Well ID# AS-1
5a. Well Location:
COLONIAL PIPELINE
Facility/Owner Name Facility 1DA (if applicable)
7524 KENSTEAD CIRCLE CHARLOTTE 28214
Physical Address, City, and Zip
MECKLENBURG
County Parcel Idemification ND. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one Iatllong is sufficient)
350 17' 08.43" N 800 56' 05.46" W
6. Is (are) the well(s): ©Permanent or ©Temporary
7. Is this a repair to an existing well: ❑Yes or EINo
If this is a repair, fill out known well construction information and explain the nature of the
repair under d21 remarks section or an the hack gf'lhis fart.
1
For Internal Use ONLY:
W. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft,
ft.
15, OUTER CASING for malti wells OR LINER if a ticable
FROM
TO
cased
➢]AMETEK
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING(geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0.0 ft
40.0 ft.
2.0 in.
SCH 40
PVC
ft.
ft.
i><k•
17, SCREEN
FROM
TO
DIAMETER
$LOT SIZE
THICKNESS
MATERIAL
40.0 ft.
45.0 ft
2.0 in-
.010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
FROM
To
MATERIAL
EMPLACEMENT METHOD 8i AMOUNT
0.0 ft-
32.0 ft-
Pcnuanoeenranae
SLURRY
ft.
ft.
ft.
ft.
19, SANDIGRAVEL PACK if a Hcable
FROM TO
MATERIAL
EMPLACEMENT METHOD
38.0 ft• 45.0 "'
20A0
FINE SILICA SAND
ft. ft.
20. DRILLING LOG attach additional sheets if necessa
FROM
TO
DESCRIPTION color, hardness, soil/mck , glain sim, etc.
0.0 Ft'
21.0 Ft-
BROWN SILT
21.0 ft•
45.0 ft•
GREEN SILT
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. RFMARKS
BENTONITE SEAL FROM 32.0 TO 38.0 FEET
***AIR SPARGE***
22. Certiflcition:
-/4/10i31117
ZA��
S;gnawu e o c ell Contractor 1#41 Date
By signing this fora, I hereby cert� that the well(s) was (were) constructed in accordance
with IAA NCAC 02C .0100 or 15A NCAC 02C.0200 Well Construction Standards and Thai a
copy of'lhis record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
S. Number of wells constructed: construction details. You may also attach additional pages if necessary.
For multiple, infection or non -water supply wells ONLY with the same construction, you can
subtrul one form. SUBMITTAL INSTUCTIONS
9. Total well depth below land surface: 45.0
For multiple wells list all depths ifdiierem (example- 3@200' and 2 a 100')
10. Static water level below top of casing; 12.0 (ft.)
!f water level is above casing, use "+"
11. Borehole diameter: 6.0 (in.)
Alp
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
t3a. Yield (gpm) Method of lest: 24c. for Water Supply & Injection Wells: In addition to sending the form to
the addresses) above, also submit one copy of this form within 30 bays of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-1 North Carolina Department of Environment and Natural Resources -Division of Water Quality Revised Ian. 2013

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
JOHNNY BURR
Well Contractor Name
A - 3098
NC Well Comracior Certification Number
GEOLOGIC EXPLORATION
Company Name
2, Well Construction Permit #:
Lim all applicable well eansiruclion permits (i. e. (11C. Caunly. Scare, Varian". etcJ
3. Well Use (check well use):
Water Supply Well:
❑Agricultural ❑Municipal/Public
❑Geolhennal (Heating/Cooling Supply) ©Residential Water Supply (single)
❑industrial/Commercial ❑Residential Water Supply (shared)
❑Irrigation ❑Wells 100,OOOGPD
Non -Water Supply Well:
❑Aquifer Recharge
[]Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geolhennal (Closed Loop)
❑Geothermal (Heating/Cooling
❑Groundwater Remediation
❑Salinity Barrier
OStormwater Drainage
❑Subsidence Control
❑Tracer
001her (explain under 421 F
4. Date Well(s) Completed: 04/20/23 Well ID# BS-1
5a. Well Location:
COLONIAL PIPELINE
Facility/Owner Name Facility IDi! (ifapplicable)
7524 KENSTEAD CIRCLE CHARLOTTE 28214
Physical Address, City, and Zip
MECKLENBURG
County.
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lalllong is sufficient)
350 17' 18.35" N 80a 56' 21,59" W
6. Is(are) the well(s): ©Permanent or ❑Temporary
7. Is this a repair to an existing well: 01'es or 19No
1)'thi.s it a repair. Jill out kotown ur11 cnrsiruc ion infurnrraron and explain the nanere of the
repair ender 11 remarks lemon or on the hack gfllris farm.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only l GW-I is needed Indicate TOTAL NUMBER ofwells
drilled'
9. Total well depth below land surface: 45.0 IN
1•irr mrdGple irells list all depdrs tfdi, ferern (example- 3Q200' and 1 rCi 1W )
For Internal Use Only:
14. WATER
ZONES
FROM
TO DESCRIPTION
ft.
it.
ft.
ft.
ts. OUTER CASING for
mutti-cased wells OR LINERlivable
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
R.
in
16. INNER CASING OR TUBING(geothermal closed -lop
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0.0 h.
42.0 ft,
2.0 in'
SCH 40
PVC
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOTSIZE
I THICKNESS
I nrATER1AL
42.0 �'
45.0 f"
2.0 r"
.010
SCH 40
PVC
R.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD&AMOUNT
2.0 ft.
35.0 ft'
PORTLANn1AIVONITE
SLURRY
ft.
ft.
ft.
ft.
19. SANDIGRAVEL PACK ira Ileable
FROM
TO
MATERIAL I
EMPLACEMENTMETHOD
40.0 fr-
45.0 fl-
20-40
FINE SILICA SAND
0.0 f"
2.0 ft'
20-40
FINE SILICA SAND
20. DRI LLING LOG attach additional sheets if necessary)
FROM
TO
DESCRIPTION color. hardaem soillrork type, zmin sim, elr-
0 0 A.
8.0 ft.
OPEN HOLE (SOFT DUG BY OTHERS)
8.0 ft
45.0 ft•
BROWN PWR
n.
n.
ft.
it.
ft.
ft.
ft.
ft,
R.
ft,
21. REMARKS
BENTONITE SEAL - 35.0 - 40.0 FEET
... TOP 2' FILLED WITH SAND FOR FUTURE VAULT INSTALLATION ...
22. Certification- n
""'� 05/01/23
Signature of Certified Well Contractor Date
A) signarg ilusJorm, I hereby certify char;hv a ell(s) win eircm) raesrrrrcndre acrareMnrr a nh
15A NCAC 02C 0100 or 15A N(A(' 1)2(' UIW Weirl Conspuvimt ';ranllards and duo a cats
r f ilim reread has been provided is the Trail mrner
23. Site diagram or additional well details:
You may use the back of this page to provide additional v.Tll construction info
(add'See Ovee in Remarks Box). You may also attach additional pages if necessar-,
24. SUBMITTAL INSTRUCTIONS
Submit this GW-I within 30 days of well completion per the following:
10. Static water level below top of casing: 20.0 (ff) 24a. For All Wells: Original form to Division of Water Resources (DWR).
l/'+rarer lerel is above casing, use "- " Information Processing Unit, 1617 MSC, Raleigh, NC 27699-1617
11. Borehole diameter: 6.0 (in.) 24b. For Injection Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC, Raleigh, NC 27699-1636
12. Well construction method: AIR
24c. For 1Vater Su I ' and O en-Loo Geothermal Return Wells: Copy lathe
(i,e. auger, rotary, cable, direct push, etc.) county environments heatdepartment of the county ;Were costa ed
FOR WATER SUPPLY WELLS ONLY: 24d. For Water Wells roducin over 100 000 GPD: Copy to DWR, CCPCIi A
Perin Program, I I M Ra .11 , N 276 i l l
13a. field (gpm) Method of test:
1311. Disinfection type: Amount:
Fornl GW-I North Carolina Department of Environmental Quality - Division of Water Resounes Revised 6-6-2018

WELL CONSTRUCTION RECORD (GW-1)
I. Well Contractor Information:
JOHNNY BURR
Well Contractor Name
A - 3098
NC Well Contractor Cerlification Number
GEOLOGIC EXPLORATION
Company Name
2. Well Construction Permit #:
l.isr edl npplicahle hell <•mnsrrtirdon perndrs (i.e. WC, Caonty ,10ale, Variance, etc)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Ind ustrial/Commercial
❑irrigation _
Non -Water Supply Well:
IDMonitoring
❑Aquifer Recharge
❑Aquifer Storage and Recovery
OAquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geollicrinal (HealmIt/Cooline
❑MunicipaVPublic
OResidenlial Water Supply (single)
❑Residential Water Supply (shared)
❑ Wells > 100.000 GPD
OGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (exDlain under #21 P
4. Date Wells) Completed: 04/26/23 Well iD#
BS-2
in. Well Location:
COLONIAL PIPELINE
Facility/Owner Nana; Facility IDA (if applicable)
7524 KENSTEAD CIRCLE CHARLOTTE 28214
Physical Address, City. and Zip
MECKLENBURG
C"uult' Parcel-dentifrcauon No. (PIN)
5b. Latitude and longitude in degrees+minutes/seconds or decimal degrees:
(if w;it field ,fur IaULnguxullierent)
350 17' 18.35" N 800 56' 21.59" W
6. Is(are) the well(s): IMPermanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or nNo
iJ rlus i' a repair. Jill ow knowir aril consrruchon inJormanon and explain the nature of the
reprur under: 21 remarks sec•rion or on the bac k r f this farm.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
constriction, only I GW-I is needed Indicate TOTAL NUMBER ofwells
drilled:
9. Total well depth below land surface: 29.0 (ft.)
l oM rrnduple wells list all depths ifdifferent (emruple- 3 a 200' orui 1@10i0)
For internal Use Only:
14. WATER
ZONES
FROM
TO
DESCRIPTION
ft.
rr.
15. OUTER CASING for
multi -cased wells OR LINER if a ticable
FR0111
TO
DIAMETER THICKNESS MATERIAL
ft.
fr.
in. I i
16. INNER CASING OR Ti1BING(geothermal
closed -loop)
TO
DIAMETER
THICKNESS
MATERIAL
PFROM
h•
P.
26.0 h•
2.0 in.
SCH 40
PVC
rr.
n.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOTSIZE I THICKNESS
MATERIAL
26.0 ft
29.0 h'
2.0 in.
010 SCH 40
PVC
h.
h.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD &Aa1gt NT
2.0 rr.
21.0 fl•
PORTWNDaENTONITE
SLURRY
ft.
h.
n.
ft.
19. SAND/GRAVEL PACK tfa licable
FROM
TO
MATERIAL
I EMPLACEMENT METHOD
24,0 ft•
29.0 n'
20-40
FINE SILICA SAND
0.0 n•
2.0 ft-
20-40
FINE SILICA SAND
20. DRILLING
LOG attach additional sheep ifnecessary)
FROM
To
DESCRIPTION color, hardn saatro6oypr, 2rain size, err.
0.0 fl•
8.0 n.
OPEN HOLE (SOFT DUG BY OTHERS)
8.0 n
20.0 ft-
BROWN PWR
20.0 n
29.0 n'
GRAY PWR
ft,
fr.
ft.
ft.
n.
ft.
ft,
h.
21. REMARKS
BENTONITE SEAL -• 21.0 - 24.0 FEET
*** TOP 2' FILLED WITH SAND FOR FUTURE VAULT INSTALLATION '**
22. Certification:
� 05/01/23
Signature of Certified Well Contractor Date
hysigning ihcs firm. I hereby ceri fy rhar the nell(s) was (irere) constriscred in ac•carilam w, on
15A NCAC 021' 0100 ar 15A N{ AC 02C .0200 (Veil Corrsrruc•riarr SrandanA and 11m a
mf rhis retard has been prarided ar the hell amner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional vvell construction into
(add'See Over in Remarks Box). You may also attach additional pages if necem v%
24. SUBMITTAL INSTRUCTIONS
Submit this GW-1 within 30 days of well completion per the following:
10. Static water level below top of casing:
6.0 (ft.) 24a. For All Wells: Original form to Division of Water Resources (DWR)
1l x*ikr lerel is above casing, use "- "
IL Borehole diameter: 6.0
information Processing unit, 1617 MSC, Raleigh, NC 27649-1617
24b. For Injection Wells: Copy to DWR, Underground Injection Control (IL1C)
Program, 1636 MSC, Raleigh, NC 27699-1636
12. Well construction method: AIR
24c. For Water Supply and Open -Loop Geothermal Return Wells: Copy to tic
(i.e. auger, rotary, cable, direct push, etc.) county environmental health department o t e county where installed
FOR WATER St PPLY WELLS ONLY: 24d. For Water Wells roducin over 100 000 GPD: Copy to DWR, CCPCUA
Permit Program, 1 11 M Ra e.1 NC 27649-1611
13m. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
(in.)
Form GW-1 North Carolina Department of Environmental Quality -Division of Water Resources Revised 6.6.20 P8

WELL CONSTRUCTION RECORD (GW-1)
I. Well Contractor Information:
JOHNNY BURR
Well Contractor Name
A - 3098
NC Well Contractor Cenification Number
GEOLOGIC EXPLORATION
Company Name
2. "'ell Construction Permit #:
Litt all applicable well cons rtNion perniiis (t, e.
I X ('ounry. Mare. Variance, ere.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Municipal/Public
❑Geothermal (Heating/Cooling Supply)
❑Residential Water Supply (single)
❑Industrial/Commercial
❑Residential Water Supply (shared)
❑ Irrigation
❑ Wells > 100.000 GPD
Non -Water Supply Well:
C
❑Aquifer Recharge
❑Groundwater Remediation
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test
❑Stormwater Drainage
❑experimental Technology
❑Subsidence Control
❑Geothermal (Closed Loop)
❑Tracer
❑Geothermal (Heating/Cooling
Retum) ❑Olher (explain under #21 F
04/20/23 BS-3
4. Date Well(s) Completed:
Well ID#
5a. Well Location:
COLONIAL PIPELINE
Facility/Owner Name Facility IDH (ifapplicable)
7524 KENSTEAD CIRCLE CHARLOTTE 28214
Physical Address, City, and Zip
MECKLENBURG
County parcel Identification No (PIN)
5b. Latitude and longitude in degrees/minuses/seconds or decimal degrees:
(Twell field. one lattlong is sufficient)
350 17' 18.35" N 80" 56' 21.59" W
6. ls(are) the well(s): (MPermanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or f5No
rfr1NA' !ti [7 R'p:Nr, Jill our kran'rr well cunchucnan nrJdrntaran ar[1 explain tlanature n1 r1i�
rvlxur muler 21 rermrrks secli[nr or on the back of this Jirrerr
8. For Geoprobe/DFT or Closed. Loop Geothermal Wells having the same
construction, only I GW-I is needed. Indicate TOTAL NUMBER of wells
drilled,
9. TolaI well depth below land surface: 45.0 (ft.)
1 'or nudirl* 1140% list all depths iJ di,(/erem (example 31?,200'and tar -100')
10. Static water level below top of easing: 20.0
.Y watcr le rsi i - fo 44we Casing ase "
11. Borehole diameter: 6.0 (in,)
12. Well construction method: AIR
(i,c. auger, rotary, cable, direct push, etc )
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
For Internal Use Only:
fr. ft.
ft. ft.
FROM
TO
DIAMETER THICKNESS
MATERIAL
fit,
fit.
16. INNER
CASING OR
TUBING eolherrrrat closed -too
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0.0 tr•
42.0 ft-
2.0 In
SCH 40
PVC
R.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
42.0 "'
45.0 fir•
2,0 '-
.010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD&AMOUNT
2.0 ft'
35.0 ft-
PORTtAN06ENTONrrE
SLURRY
R.
fir.
19. SAND/GRAVEL PACK ifa licablt
FROM
TO
MATERIAL
£MPLACEMENTMETHOD
40.0
f •
45.0
ft•
20-40
FINE SILICA SAND
0.0
D
2,0
f •
20-40
FINE SILICA SAND
20. DRILLING
LOG
4anaach additional sheets if necessary)
FROM
TO
DESCRIPTION colorhaedtim"iiliwk type, Cmin sit, tic.
0.0
ft.
&0
ft-
OPEN HOLE (SOFT DUG BY OTHERS)
8.0
R•
20.0
fit'
BROWN PWR
20.0
f '
45.0
fir'
GRAY/GREEN PWR
ft.
ft.
ft.
n.
ft.
ft.
BENTONITE SEAL - 35.0 - 40.0 FEET
**" TOP 2' FILLED WITH SAND FOR FUTURE VAULT INSTALLATION *••
22. Certification:
�J 05/01 /23
Signature of Certified Welt Contractor Dale
)V s.-gnrng 1hisiorm 1 herebycertifp dint the irell(s) was (mere) constructed to accorthince irah
1 SA AY AC 02C .011MI or 15A N(. A(• 02C .0200 Well ('ensiruction Saralards and dna it cagr
of dtis recanl has .hrrrr pnmrded 10 the u'eff owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well construction milt
(add'See Over' in Remarks Box). You may also attach additional pages if necessarn
24. SUBMITTAL INSTRUCTIONS
Submit this GW-1 within 30 days of well completion per the following:
24a. For All Wells: Original form to Division of Water Resources (DWR),
Information Processing Unit, 1617 MSC, Raleigh, NC 27699-1617
24b. For Infection Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC, Raleigh, NC 27699-1636
24c. For Water Supply and Open -Loop Geothermal Return Wells: Copy to the
county environmental health department O t e county where installed
24d. For Water Wells producing over 100,000 GPD: Copy to DWR, (:(:I'CUA
Permit Program, 1611 MSC, Raleigh, NC 27649-:6,11
Form GW-I North Carolina Department of Environmental duality - D:vision of Water Resnurcec Revised 6-6-2018

WELL CONSTRUCTION RECORD (GW-1)
I. Well Contractor Information:
JOHNNY BURR
Well Contractor Name
A - 3098
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION
Company Name
2, Well Construction Permit 0:
Lisr all applicable n'ell conrfniciion lxrnriry (i.e. UIC , C'ounry. irate, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
OGeothermal (HeatinglCooling Supply)
❑ 1 nd usl r i a l/C om m e rc ial
L
15Mon
injection well.
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquitcr Test
❑Experimental Technology
❑Geothermal (Closed Loop)
CGeothermal (Heating/Cooling Return)
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Wells > 100.000 GPD
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
001her (explain under #21 Remarks)
4. Date Well(s) Completed: 04/18/23 well IDl! BS-4
5a. Well Location:
COLONIAL PIPELINE
Facility/Owner Name Facility IDN (ifnpplicable)
7524 KENSTEAD CIRCLE CHARLOTTE 28214
Physical Address, City, and Zip
MEC_KLENBU_ RG
County Parcel Identification No (PIN)
5b. I.alitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one Jaillong is sulTicienl)
35" 17' 18.35" N 80° 56' 21.59" ►v
6. Is(are) the well(s): [51"ermanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ®No
1f this is a repair, fill our kewtrn well cottsrruc hoer hilbrnronon and explain the nature of the
repair umler -21 remarks sedan or on the back aJ'this farm '
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only I GW. I is needed. Indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface: 43.0
i i,r nndtple ire/Is list all di pats f doo rent (example- 3 a W' and 2l(¢ 100 )
For Internal Use Only:
14. WATER ZONES
FROM
TO
DESCRIPTION
ft,
R.
ft.
ft.
15.OUTER CASING for
mull -cased wells OR LINER if a
licablr
FROM
To
DIAMETER THICKNESS
MATERIAL
ft.
R.
in
16. INNER CASING OR TUBING eothermal closed -lop
FROM
TO
DIAMETER
THICKNESS
I MATERIAL
0.0 n
40.0 t'
2.0 '"
SCH 40
PVC
17. SCREEN
FROM
TO
DIAMETER
SLOTSIZE
THICKNESS
MATERIAL
40.0 t''
43.0 n'
2.0 in'
.010
SCH 40
PVC
re.
ft.
tn.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD&AM1IOI'NT
2.0 R.
33.0 ft-
PORTLANDBENIONDE
SLURRY
ft.
ft.
R.
n.
19. SANDIGRAVEL
PACK
if a licable
FROM
TO
MATERIAL I
EMPLACEMENTMETHOD
38.0 R
43.0 tt'
20-40
FINE SILICA SAND
0.0 tt•
20 R
20-40
FINE SILICA SAND
20. DRILLING
LOG attach additional sheets if necessary)
FROM
TO
DESCRIPTION color, hardnesi, soilfn kqpe, train size, etc.
0.0 R
8.0 ft.
OPEN HOLE (SOFT DUG BY OTHERS)
8.0 R
23.0 R'
BROWN PWR
23.0 t'
28.0 n.
GRAY PWR
28.0 t'
1 43.0 tt•
BROWN/GRAY PWR
ft.
ft.
ft.
ft.
21. REMARKS
BENTONITE SEAL -- 33.0 - 38.0 FEET
'+* TOP 2' FILLED WITH SAND FOR FUTURE VAULT INSTALLATION
22. Certification;
05/01/23
Signature ol'Certifred Well Contractor Date
b)- signing rhiv Jarne, I hereby c•errlfi, drat dre ire/l(s) eras (irere) consirucied in aceanlance nvrh
15A NC AC 01C 0100 or 15A NCAC 02C.0100 Well Consirrecuon ,Statalarets and that a rant
of this retard has been premided io the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well construction inib
(add'See Over in Remarks Box). You may also attach additional pages if necessary
24. SUBMITTAL INSTRUCTIONS
Submit this GW-1 within 30 days of well completion per the following:
10. Static water level below 1013 of casing: 20.0 (I'Ll 24a. For All Wells: Original form to Division of Water Resources (DWR),
l; „ , F level rc above camig, ucc ' "
11. Borehole diameter: 6.0
(in,)
Information Processing Unit, 1617 MSC, Raleigh, NC 27699-1617
24b. For Injection Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC, Raleigh, NC 27699-1636
12. Well construction method: AIR
24c. For Wafer Supply and O en-Loo Geothermal Return Wells: Copy to the
(i.e. auger, rotary, cable, direct push, etc.) county environmental health epartment o t e countywhere installed
FOR WATER SIIPPLY WELLS ONLY: 24d. For Water (Yells producing over 100,000 GPD: Copy to DWR CCPCUA
13a. Yield (gpm) Method of test: Permit Program, 1611 MSC, RaleiAli,NC 27699-1611
13b. Disinfection type: Amount:
Fonn GW-1 North Carolina Department of Environnxnial Quality - Division of Waler Resoun es Reviscd4.6-2019

WELL CONSTRUCTION RECORD (GW-1, )
1. Well Contractor Information:
JOHNNY BURR
Well Contractor Nate
A - 3098
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION
Company Name
2. Well Construction Permit #:
List all applicuble well cw"strucnan pernitts (i.e. U/C. ('aoiay. State, Variance, ene)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Wating/Coohng Supply)
❑ Industrial/Commercial
❑Irri alion
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
E)Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (HeatinglCooling
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑ Wel Is > 100.000 GPD
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 921 1
4. Date Well(s) Completed: 04/21/23 Well 1DN
521. Well Location:
COLONIAL PIPELINE
BS-5
Facility/Owner Name Facility IDH (ifapplicable)
7524 KENSTEAD CIRCLE CHARLOTTE 28214
Physical Address. City, and Zip
MECKLENBURG
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
of well field, one lat/long is sufficient)
35" 17' 18.35" N 80" 56' 21.59" W
6. Is(are) the well(s): IDPermanent or ❑Temporary
7. Is this a repair to on existing well: ❑Yes or l9No
1f'rhts rs a repair. fill ota known trell co nsirtiction infbrnrarion and erplaur the nature afthe
relwir railer -21 remarks .secrirm or on the back gf'dric f trnr.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only I GW-I is needed. Indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface: 37.0
l-iur tinrhiple well, list all depdrs if'dijlirenn (exaruple- 3 r�r IM' and 2 a l Ull')
For Internal Use Only:
14. WATER ZONES
FROM
TOI
DESCRIPTION
ft.
ft.
fl.
ft.
I5. OUTER CASING for multi -cased wells
OR LINER if r
lieable
FROM
70 DIAMETER
THICKNESS
MATERIAL
ft.
ft, in.
16. INNER
CASING OR
TUBING(geothermal closed -too
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0.0 H
34.0 f'•
2.0 i"
SCH 40
PVC
ft,
".
in.
17. SCREEN
FROM
TO
DIAMETER
SLOTSIZE
THICKNESS
MATERIAI
34.0 R•
37.0 ft
2.0 in-
010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENTMUROD&AMOUNT
2.0 ft'
27.0 ft-
PORTIANDBENTONRE
SLURRY
n.
ft.
19. SAND/GRAVEL PACK if a lieable
FROM
TO
MATERIAL I
EMPLACEMENTmeTHOD
32.0 f'
37.0 rt.
20-40
FINE SILICA SAND
0.0 f<
2.0 fL
20-40
FINE SILICA SAND
20. DRILLING
LOG ■torch additional sheets if necessr
FROM
TO
DESCRIPTION ealw, hardness, s*iUrac4 rain sire, e1c.
0.0 f'
8.0 n'
OPEN HOLE (SOFT DUG BY OTHERS)
8.0 f'
23.0 &
BROWN SILTY PWR
23.0 h'
37.0 ft'
RED/BROWN SILTY PWR
ft.
ft.
ft.
ft,
R.
ft.
ft.
ft.
21. REMARKS
BENTONITE SEAL - 27.0 - 32.0 FEET
"` TOP 2' FILLED WITH SAND FOR FUTURE VAULT INSTALLATION *"
22. Certification:
05/01 /23
Signature of Certi bed Well Contractor Date
Hy signing this form. 1 hereby cert f , that the irell(s) eras (teere/ ewnsinxied nr accordance with
13A N(AC 02C .0100 or 15A NrAC U2' .0200 Well Construction .Srainlords and chat it eopi
of rhis record 1w.5 been pmoded !a the im/1 ou•rrer.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well construction info
(add'See Over in Remarks Box). You may also attach additional pages if necessa:w,
24. SUBMITTAL INSTRUCTIONS
Submit this G1 A within 30 days or well completion per the following:
10. Static water level below top of casing:
20•4 (ft.) 24a. For All Wells: Original form to Division of Water Resources (DWR).
!flrwer level is above caving, use "•
11. Borehole diameter: 6.0
Information Processing Unit, 167 MSC, Aweigh, NC 27699 1617
24b. For Injection Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC, Raleigh, NC 27699-1636
12. Well construction method: AIR
24c. For Water Su VIM
O en-Loo Geothermal Return Wells. Copy to the
(i.e. auger, rotary, cable, direct push, eic.) county environments! heir 1department ot the county where installed
FOR WATER SUPPLY WELLS ONLY: 24d. For Water ramWells roducin over 100 "' GPD: Copy to DWR, CCPCI,A
It Program, , C 27 ] I
13a. Yield (gpm) Method of test: Perm1611 MSCR. eigh, N
13b. Disinfection hype: Amount:
(in.)
Form GW-I Noah Carolina Department of Environmental Quality - Division of Water Rc"gKcs Revised 6.6.2018

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
JOHNNY BURR
Well Contractor Name
A - 3098
NC Well Contractor Cenllicauon Number
GEOLOGIC EXPLORATION
Company Name
2. Well Construction Permit M
dia all applicable uvell camsirvendin peritnis (r. e. U/C. (.'aunty. Stare. Variance. err)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural ❑Municipal/Public
OGeothermal (FleatinglCooling Supply) ❑Residential Water Supply (single)
Olndustrial/Commercial ❑Residential Water Supply (shared)
❑Irrigalion ❑Wells> 100,000GPD
Non -Water Supply Well:
OAquiter Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
0Experimental Technology
GGeothermal (Closed Loop)
❑Groundwater Remediation
❑Salinity Barrier
OStormwater Drainage
❑Subsidence Control
❑Tracer
OOther (explain under 921 F
4. Dale Weil(s) Completed: 04/18/23 Well ID#
5a. Well Location:
COLONIAL PIPELINE
BS-6
FacilitylOwnerName Facility ID# (ifapplicable)
7524 KENSTEAD CIRCLE CHARLOTTE 28214
Physical Address, City, and Zip
MECKLENBURG
County
Parcel Identification No (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwcl ficd. tic latnouq; is sufficient)
35° 17' 18.35" N 800 56' 21.59" W
6. Is(are) the well(s): 191'ermanenl or ❑Temporary
7. Is this it repair to an existing well: ❑Yes or MNo
11 ihts is a relnur. Jill our irrunivr twit consirricuon inJarmmtian and explain dre nature rif fie
repedr under .:21 rs•n+arks secricur ar au din back ql llik formr
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only I GW-I is needed. Indicate TOTAL NUMBER of wells
9. Total well depth below land surface: 28•0 (ft.)
f-ar owdelple hells Irst ail depills if di,(jereur (esaraple. 3 ii1 00 and 2g 10f1')
For Internal Use Only:
14. WATER
ZONES
FROM
TO DESCRIPTION
ft.
ft.
15. OUTER CASING far
multi casrd welts OR LINER Ifa
licable
FROM
TO
DIAMETER THICKNESS
MATERIAL
ft.
I
in.
16. INNER CASING OR TUBING eolhermal closed-loo
FROM
TO
DIAMETER
THICKNESS
I MATERIAL
0.0 ft-
25.0 ft.
2.0 in.
SCH 40
PVC
n.
ft.
In.
17. SCREEN
FROM
TO
DIAMETER
SLOTSIZE THICKNESS
MATERIAL
25.0 ft.
28.0 ft•
2.0 in.
010 SCH 40
PVC
R.
ft.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT AIETHOD&AMOt Nr
2.0 ft'
18.0 f •
PORTLAND8ENTONnt
SLURRY
ft.
ft.
ft.
R.
19. SANDIGRAVEL PACK if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
23.0 f'
28.0 ft'
20-40
FINE SILICA SAND
0.0 ft•
20 ft
20-40
FINE SILICA SAND
20. DRILLING
LOG attach additional sheets if necessary)
FROM
TO
DESCRIPTION color, hardn wilfrock type, ti-nin sin, etc.
0.0 ft.
8.0 ft.
OPEN HOLE (SOFT DUG BY OTHERS)
8.0 ft.
28.0 f •
BROWN PWR
n.
n
n.
n.
ft.
ft.
ft.
n.
ft.
n.
21. REMARKS
BENTONITE SEAL - 18.0 - 23.0 FEET
TOP 2' FILLED WITH SAND FOR FUTURE VAULT INSTALLATION
22. Certification:
R-J 05/01 /23
Signature ofCeruried Well Contractor
Hy signing this ffrrm. I hereby certify Mai the well(c) a'as (mere) comirrrecied hl accardinur with
15A k •AC 02C 0100 or 1 SA N( AC 02C .0200 ivell Cousirrrction Siarulanls arrel llat a raps
of Ary reeard has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional %veil construction into
(add'See Ovee in Remarks Box). You may also attach additional pages if necessan
24. SUBMITTAL INSTRUCTIONS
Submit this GW-I within 30 days of well completion per the following:
10. Static water level below top of casing:
20.0 {fl.) 24a. For All Wells: Original form to Division of Water Resources (DWR).
1J wafer level is above curing, use •' -
I L Borehole diameter: 6.0
Information Processing Unit, to 17 MSC, Raleigh, NC 27699-1617
24b. For Injection Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC, Raleigh, NC 27699-1636
12, well construction method: AIR
24c. For Water Supply and OMn-Looe Geothermal Return Wells: Copy to the
Q.c auger, rotary, cable, direct push, etc.) county environmental eat department o the county where costa led
FOR WATER SUPPLY WELLS ONLY: 24d. For Water Wells roducin over 100 000 GPD: Copy to DWR, CCPCUA
Permit Program, 161 I MSC, Raleig , NC 276 9 161 1
13a. Yield (gpm) Method of lest:
13b. Disinfection type: Amount:
(in.)
Form GW-I North Carolina Department of Environmental Quality - Division of Water Resources Revised 6.6-2018

WELL CONSTRUCTION RECORD GW-1
L Well Contractor Information:
JOHNNY BURR
Well Contractor Name
A - 3098
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION
Company Name
2. Well Construction Permit #:
Listailapphcable ,roil eanrrrncdan pxrndn (i.e. WC, (•onnir. Spare. Variance. eit J
3. Well Use (check well use):
Well:
OAgricultural
❑Geothermal (Heating/Cooling Supply)
O Industrial/Commercial
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Wells > 100.000 GPD
[i
❑Groundwater Remediation
❑Salinity Barrier
❑Slormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 1
4. Date Well(s) Completed: 04/19/23 Well ID# BS-7
5a. Well Location:
COLONIAL PIPELINE
Facility/Owner Name Facility ID#(ifapplicable)
7524 KENSTEAD CIRCLE CHARLOTTE 28214
Physical Address, City, and Zip
MECKLENBURG
Counly Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwcll field, one IatAong is sufficieno
350 17' 18,35" N 800 56' 21.59" W
6. Is(are) the well(s): fPermanenl or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or TINo
If this is a repair, Jill ores known well cansirticuon information and explain dx riantre of die
repair under 21 reiunrits section or on the back rf?his form.
8. For GeoprobelDPT or Closed -Loop Geothermal Wells having the same
construction, only I GW-I is needed. Indicate TOTAL NUMBER ofwells
drilled:
9. 'total well depth below land surface: 40.0
For muhip>le wells Nsi all depths if thfjerem (example- 3@200 • and 1 a 100 )
For Internal Use Only:
14. WATER
ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft,
n.
15.OUTER CASING for multi -cased wells OR LINER Ra licable
FROM TO
DIAMETER
THICKNESS
MATERIAL
ft. I ft.
I is
16. INNER
CASING OR
TUBING eothermal
closed-loa
FROM
TO
DIAMETER
THICKNESS
I MATERIAL
0.0 fi-
37.0 n
2.0 la
SCH 40
PVC
ft.
%
In.
17. SCREEN
FROM
TO
DIAMETER
SLOTSIZE THICKNESS
116IATERIA4
37.0'1'
40.0 fr•
2.0 lo.
.010 SCH 40
PVC
in.
I& GROUT
FROkt
TO
MATERIAL
EMPLACEMENT A1FfHOD&AMOUNT
2.0 ft.
30.0 fl,
POF-moBENTONITE
SLURRY
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK lfa licable
FROM
TO
MATERIAL
EMPLACEMENT METHOD
35.0 ft-
40.0 ft-
20-40
FINE SILICA SAND
0.0 ft.
2.0 fE•
20-40
FINE SILICA SAND
20. DRILLING
LOG attath
additional sheers if necessa
FROM
TO
DESCRIPTION color, hardneia, saillroek type, gmin sire, cit.)
0.0 ft.
8.0 ft•
OPEN HOLE (SOFT DUG BY OTHERS)
&0 fr•
40.0 ft•
BROWN SILTY PWR
n.
R.
ft.
n.
ft.
n.
n.
n.
21. REMARKS
BENTONTTE SEAL - 30.0 - 35.0 FEET
"*' TOP 2' FILLED WITH SAND FOR FUTURE VAULT INSTALLATION .""
22. ClrllftCa110n:
05/01/23
Signature ofCertifred Well Contractor Dale
Bysigiring this farm• 1 hereby cerr& that the rrell(s) was (were) ronstructrd in accardnnru ,rirlr
15A NCAC OX.0100 or 15A Nr AC 0X • .0200 Well Consirucnmr ,Standards ant rhat a vapi
ofthis record has been provided io tire ire/lon•ner.
23. Silo diagram or additional well details:
You may use the back of this page to provide additional well construction info
(add'See Over' in Remarks Box). You may also attach additional pages if nccessary
24. SUBMITTAL INSTRUCTIONS
Submit this GW-1 within 30 days of well completion per the following:
10. Static water level below lop of casing 1$•0 24a. For All Wells: Original form to Division of Water Resources (DWR),
ll +,wrier &•vel is above casing. use "- ••
11. Borehole diameter; 6.0 (in.)
12. Well construction method: _
0 e. auger, rolary, cable, direct push, etc.)
AIR
(it,) Information Processing Unit, 1617 MSC, Raleigh, NC 27699-1617
24b. For Injeclion Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC, Raleigh, NC 27699-1636
24c. For ►Voter Su [ and O en -Lou Geothermal Return Welts: Copy to the
county envtronmenla eallh department of the county w ere installed
FOR WATER SUPPLY WELLS ONLY: 24d. For Water Wells producing over
13a. field (gpm) Method of less: 100 "0 UP:, Copy to DWR, CCPCt. A
Permit Program, 1611 MSC, Raleigh, N 7699-161 I
13b. Disinfection type: Amount:
Farm GW.I North Carolina Department of Environmental Quality - Division of Water Resources Revised 44f 201ft

WELL CONSTRUCTION RECORD (GW-1)
I. Well Contractor Information:
JOHNNY BURR
Well Contractor Name
A - 3098
NC Well Contractor Certificalion Number
GEOLOGIC EXPLORATION
Company Name
2. Well Construction Permit H:
Lisr all applicahie nr11 anastrucrian peraurr (i.e. UIC. Caun4% State, I'ariance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
O industrial/Commercial
❑ 1 rdeat ion
OAquifer Recharge
❑Aquifer Storage and Recovery
OAquiter Test
OExperimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heal inp/Cooling
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑ Wells > 100.00O GPD
❑Groundwater Remediation
❑Salinity Barrier
OStormwater Drainage
OSubsidence Control
❑Tracer
001her (explain under #21 F
4. Date Well(s) Completed: 04/19/23 Well IDN
ME
Sa. Well Location:
COLONIAL PIPELINE
Facility/Owner Name Facility ID10 (ifapplicable)
7524 KENSTEAD CIRCLE CHARLOTTE 28214
Physical Address, City, and Zip
MECKLENBURG
County
Parcel ]dentificalion No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one Iatilong is sufficient)
350 17' 18.35" N 800 56' 21.59" 11,
6. Is(are) the well(s): IMPermanenl or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ONo
Ij iris rs a repair. fill nut krnnrtr s-ell crmstracimir mfornrarian atul erplaitr the nature s fthe
repair under -21 reemarks .sec nau ar on the hack of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only I GW-I is needed. Indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface: 43.0 (ft.)
For naihtple hrelh lrst all depths if different (trample- 3 0100' and 1 a 100')
For Internal Use Only:
14. WATER ZONES
FROM TO
DESCRIPTION
R. R.
15. OUTER CASING for multi -eased wells OR LINER if ■ licablc
FROM
TO DIAMETER
THICKNESS
MATERIAL
ft.
I R. I in
16. INNER CASING OR TUBING(geothermal
closed -too
FROM
TO DIAMETER
THICKNESS
MATERIAL
0.0 ft.
40.0 R' 2.0 in-
SCH 40
PVC
ft.
to. in.
17. SCREEN
FROM
TO
DIAMETER
SLOTSIZE
THICKNESS
MATERIAL
40.0 ff.
43.0 R
2.0 In'
.010
SCH 40
PVC
R.
R.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD&AMOUNT
2.0 ft-
33,0 ft-
PORRANDBENTONITE
SLURRY
ft.
R.
ft.
ft.
19. $ANDIGRAVEL PACK 1'a livable
FROM
I TO
MATERIAL
EMPLACEMENT METHOD
38.0 ft-
43.0 fit.
20-40
FINE SILICA SAND
0.0 ft.
2.0 ft.
20-40
FINE SILICA SAND
20, DRILLING LOG fatiach additional sheets if necessary)
FROM
TO
DESCRIPTION color. hardness. soil/mck type, grain size, etc.
0.0 ft.
8.0 fl,
OPEN HOLE (SOFT DUG BY OTHERS)
8.0 fr.
43.0 ft-
BROWN SILTY PWR
ft.
ft.
ft.
ft.
R.
R.
rr.
rr.
R.
R.
2L REMARKS
BENTONITE SEAL - 33.0 - 38.0 FEET
•" TOP 2' FILLED WITH SAND FOR FUTURE VAULT INSTALLATION ...
22. Certification: Q,
d-� 05/01 /23
Signalure of Certified Well Contractor Dale
Ry.sigiring ilris jhrai, I hereby certify drat the well(s) u'os (were) ransrrucred in accorrkurce vitr
15A N(A(' 01(' 0100 or 15A N(AC 02C.0100 Well ('onstruciian 8taralanis nerd oiler/ a copi
ofibu record has been provided is rile well miner.
23. Site diagram or additional wet] details:
You may use the back of this page to provide additional well construction info
(add'See Over' in Remarks Box). You may also attach additional pages ifnecessan
24. SUBMITTAL INSTRUCTIONS
Submit this GW-1 within 30 days of well completion per the following:
10. Static water level below lap of casing:
18.0 {f1 ) 24a. For All Wells: Original form to Division of Water Resources (DWR).
1l waver /ere! is ahore casing. use " - "
11. Borehole diameter: 6.0
Information Processing Unit, 1617 MSC, Raleigh, NC 27699-1617
24b. For Injection Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC, Raleigh, NC 27699-1636
12. Well construction method. AIR
24c, For Water Su I and Open -Loop Geothermal Return Wells: Copy to the
(i.e auger, rotary, cable, direct push, ere.) county environmental heatdepartment of the county where Installed
FOR WATER St.PPLY WELLS ONLY: 24d. For Water Wells producing over
13a. field (gpm) Method of test: 100 000 GECopy Copy to DWR, CCPCUA
Permit Program, 1611 MSC, Raleigh, N 76 9 161
13b. Disinfection type: Amount:
(in.)
Fonn GW-I North Carolina Department of Environmental Quality- Division of Waler Resources Rcviscd 6-6-2018

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
JOHNNY BURR
Well Contractor Narne
A - 3098
NC Well Contractor Certification Ne tuber
GEOLOGIC EXPLORATION
Company Narne
2. Well Construction Permit #:
List all applicable urll constriwimn permits (t e. If/C. C ouniy. Stale, Variance, etc.)
3. Well Use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
I Non -Water
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Tesl
❑Experimental Technology
❑Geothermal(Closed Loop)
❑Gcothermal (Heating/Cooling
OMunicipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
OWells > 100-000 GPD
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwaler Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 F
4. Date Well(s) Completed: 04/26/23 Well ID#
Sa. Well Location:
COLONIAL PIPELINE
BS-9
Facility/Owner Name Facility ]DM (ifopplicable)
7524 KENSTEAD CIRCLE CHARLOTTE 28214
Physical Address, City, and Zip
MECKLENBURG
County
Parcel Identification No. (PIN)
Sb. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(irwell field, one ladlong is sufficient)
350 17' 18.35" N 800 56' 21.59" W
6. Is(are) the well(s): 09Permanent or =empornry
7. Is this n repair to an existing well: I IYes or MNo
1f, dus -s a relxrir filluta kmnrlr yell cmrsrnu No+r it f+rnratia+r and exploin dtr nature Ey'die
rcrwir under 21 renrarks seertair or tin the back to rha farm.
S. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only I GW- I is needed. Indicate TOTAL NUMBER of'ells
drilled:
9. Total well depth below land surface: 27.0 (ft.)
biT nndtiple• wells bsr all depths i1 iha�rent (example- 3@100 `and 1(r 19& )
III. Static water level below top of casing: 17.0 (ft.)
Jfvaier herel is abeire caving. use
11. Borehole diameter: -6.0 (in.)
For Internal Use Only:
14. WATER
ZONES
FROM
TO
DESCRIPTION
ft.
ri.
ft.
to.
I5. OUTER CASING for multi -cased wells OR LINER if a
livable
FROM
TO
DIAMETER
THICKNF$$
MATERIAL.
ft.
ft.
in,
16. INNER
CASING OR TUBING(geothermal closed -too
FRO
TO
DIAMETER
THICKNESS
MATERIAL
0.0
124.0 ft1
2.0 in•
SCH 40
PVC
ft.
h.
in.
17. SCREEN
FROM
TO
DIAMLTER
SLOTSIZE
THICKNESS
MATERIAL.
24.0 "'
27.0
2.0 in'
.010
SCH 40
PVC
ft.
R,
in.
I& GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD&AMOUNT
2.0 ft'
15.0 ft.
PORILAND BENTONVE
SLURRY
n.
ft.
f.
ft.
19. SAND/GRAVEL PACK if a licable
FROM
TO
MATERIAL
EMPLACEMENTMET1101)
22.0 ft•
27.0 ff
20-40
FINE SILICA SAND
0.0 ft.
2.0 ft'
20-40
FINE SILICA SAND
20. DRILLING
LOG attach additional sheet If necessary)
FROM
TO
DESCRIPTION color, hardness, solUmck rain sin, etc.
0.0 n•
8.0 ft.
OPEN HOLE (SOFT DUG BY OTHERS)
8.0 ft•
22.0 n.
TAN PWR
22.0 D•
27.0 ft'
GRAY/TAN PWR
ft.
ft.
ft,
ft.
21. REMARKS
SENTONITE SEAL -• 15.0 - 22.0 FEET
- TOP 2' FILLED WITH SAND FOR FUTURE VAULT INSTALLATION ***
22. Certification: 4
� 05/01/23
Signature ofCertifred Well Contractor Date
8y,vgninl; this firrnr, 1 hereby c erijj, that Tire ire/1(s) vas (aere) constructed in accordance vide
15A NCAC 02C 0100 or 15A Nt A(' 02C .0200 Well Construction Sta+ulanls and that it cr+pr
t f this record has been provided to the well ou ner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well construction ml'o
(add'See Ovice in Remarks Box). You may also attach additional pages if necessary
24. SUBMITTAL INSTRUCTIONS
Submit this GW-1 within 30 days of well completion per the following:
24a. For All Wells: Original form to Division of Water Resources (DWR),
Information Processing Unit, 1617 MSC, Raleigh, NC 27699-1617
24b. For Injection Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC, Raleigh, NC 27699-1636
12. Well construction method: AIR
corn For Water Su I and Open -Loop Geothermal Return Wells: Copy to the
(i.e. auger, rotary, cable, direct push, etc.) county environment. eatdepartment ot the county where installed
FOR 1VATER SUPPLY WELLS ONLY: 24d. For Witter Wei Is producing over 10
I3a. field (gpm) Method of test: 0,000 GPD:, Copy to DWR. CCPCUA
Permit Program, 1611 MSC, Raleigh, NC 27699.161 I
13b. Disinfection type: Amount:
Form GW-1 North Carolina Department of Environmenial Quality - Division of Water Resources Revised 6-6-2018

WELL CONSTRUCTION RECORD (GW-l}
I. Well Contractor Information:
JOHNNY BURR
Well Contractor Name
A - 3098
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION
Company Name
2. Well Construction Permit it:
Live all applicable irell construction pernrils (i.e. (//(', County. Ntote, l'orianee, etc)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ industrial/Commercial
Non-WaterSunnlr Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Healing/Cooling
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Wells> 100.000 GPD
❑Groundwater Remediation
❑Salinity Barrier
❑Slormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under f/21 F
4. Date Well(s) Completed: 04/17/23 Well ID# BS-10
5a. Well Location:
COLONIAL PIPELINE
Facilily/Chvner Name Facility ID# (ifapplicable)
7524 KENSTEAD CIRCLE CHARLOTTE 28214
Physical Address, City. and Zip
MECKLENBURG
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one latllong is sufficient)
350 17' 18.35" N 800 56' 21.59" W
6. Is(are) the well(s): 'BPermanent or ❑Temporary
7. Is this a repair to an existing well: Oyes or MNo
.)'this is s repair. Jig orrt smnrn well c wistruetion a fornmioon aird exploor the natury rf the
ryf .ir raider 21 rrnmris sr:vw) or wl .he back of this firrm.
8. For Geoprobe/DPT or Closed. Loop Geothermal Wells having the same
construction, only l GW I is needed Indicate TOTAL NUMBER ofwells
drilled:
9. Total well depth below land surface: 45.0 (ft.)
i 4rr mlNple ut•!Ls (+st n!! deprin rJ drfjereur (example• 3 re 1(Hi' and 2 re 1(Nl')
For Internal Use Only:
14. WATER ZONES
FROM
TO
DESCRIPTION
fr.
ft.
n,
ft.
15. OUTER CASING for multi -cased wells OR LINER If a livable
FROM
TO DIAMETER
TItICKNFSS
MATERIAL
ft,
I ft. is
16. INNER
CASING OR TUBING eothermal
dosed -too
FROM
TO DIAMETER
THICKNESS
MATERIAL
0.0 ft
42,0 ft 2.0 I°'
SCH 40
PVC
ft.
I R. in.
17. SCREEN
FROM
TO
DIAMETER
SLOTSIZE
Tt11CKNF.55
AIATERIA[
42,0 ft'
45.0 R'
2.0 1O'
.010
SCH 40
PVC
ft.
R.
in.
I& GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD&Amowr
2.0 ft.
35.0 ft.
PORTtANDeENTONITE
SLURRY
ft.
tt.
ft.
fr.
19. SANDIGRAVEL PACK ifs licable
FROM
TO
MATERIAL
EMPLACEMENTIVILTHOD
40.0 R•
45.0 ft-
20-40
FINE SILICA SAND
0.0 n•
2.0 D•
20-40
FINE SILICA SAND
20. DRILLING
LOG attach additional sheets if necessary)
FROM
TO
DESCRIPTION color. hardness. soilhnrk type. zmin sire. eir.
0.0 f'
8.0 ft
OPEN HOLE (SOFT DUG BY OTHERS)
8.0 ft-
22.0 ft-
BROWN PWR
22.0 f •
45.0 ft'
HARD BROWN PWR
n.
ft.
R.
ft.
ft.
ft.
21. REMARKS
BENTONITE SEAL - 35.0 - 40.0 FEET
*** TOP 2' FILLED WITH SAND FOR FUTURE VAULT INSTALLATION
22. Certification: n
w� 05/01/23
Signature ol'Certified Well Contractor
teate
By signing this Jiwm, 1 herebycerllfy that the wellft) was (mere) constructed err occorrknrcr n rib
1 SA NCAC 02C .0100 or 1 SA NCAC 02 • .0200 Well Consiruc Lion Nmrrdarrls and drat a copr
ofihis record has been provided to the well ouner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well construction info
(add'See Over in Remarks Box). You may also attach additional pages ifnecessan
24. SUBMITTAL INSTRUCTIONS
Submit this GW-I within 30 days of well completion per the following:
10. Static water level below top of casing:
15.0 (ft.) 24a. For All Wells: Original form to Division of Water Resources (DWR),
4 wirive lerel is ahc re c asrnn. e " .
11. Borehole diameter: 6.0
Information Processing unit, lot I MSC, Raleigh, NC 27699-161 1
24b. For Infection Wells: Copy to DWR, Underground injection Control (IUC)
Program, 1636 MSC, Raleigh, NC 27699-1636
12, Welt construction method: AIR
24c. For Water Supply and Open -Loop Geothermal Return Wells: Copy to the
(ie. auger, rotary, cable, direct push, eta) county environmental health department o [he county ere costa ed
FOR WATER St; PPLY WELLS ONLY: 24d. For Water Wells roducin over 100,000 GPD: Copy to DWR, CCPCUA
Permit Program, 1611 M Ra eig , NC 27699-161
13a. field (gpm) Method of test:
13b. Disinfection type: Amount:
(in.)
Form GW-I Nonh Carolina Department ofEnvironinenial Quality- Division of Water Resources Revised 6-6-2018

WELL CONSTRUCTION RECORD (GW-1)
I. Well Contractor Information:
JOHNNY BURR
Well Contractor Nana
A - 3098
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION
Company Narne
2. Well Construction Permit #:
l ist all applicable net/ Construction pernrirs #.. e. VA.' Comtm. ,Prate, Variance. etc.)
3. Well Use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ 1 mealion
❑Municipal/Public
❑Residential Water Supply (single)
❑ Residential Water Supply (shared)
❑ Wells> 100.000 GPD
u
Injection weu:
❑Aquifer Recharge
❑Groundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
❑Stormwaler Drainage
❑Experimental Technology
❑Subsidence Control
❑Geothermal(Closed Loop)
❑Tracer
❑Geothermal (Heating/Cooling Return) ___
001her (explain under #21 Remarks)
4. Date Well(s) Completed: 04/25/23 Well 1D# BS-11
in. Well Location:
COLONIAL PIPELINE
FacilitylOwner Narne Facility IDk (ifopphcable)
7524 KENSTEAD CIRCLE CHARLOTTE 28214
Physical Address, City, and Zip
MECKLENBURG
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
350 17' 18.35" N 800 56' 21.59" W
6. Is(are) the weli(s): (91'ermanenl or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or RNo
lf7his Is a repair, fill our kuatrn well consinrcrion tgtarma ian and explain (lie nature q/ lire
repair ntrder =11 remarks section ar art the hack (fOhir Jarni.
S. For Ceoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only I GW-1 is needed. Indicate TOTAL NUMBER of wells
9. Total well depth below land surface: 39.5 (ft.)
l itr aoditple wells list all depilis rf'dijjerent (example- 3 a 2&W and 1(a too')
For internal Use Only:
14. WATER
ZONES
FROM
TO
DESCRIPTION
ft,
ft.
ft.
ft.
15. OUTER CASING for multi eased wells OR LINER if a licable
FROM
TO
DIAMETER THICKNESS
MATERIAL
fr.
I R.
in
16. INNER CASING OR
TUBING eothermal
closed -loon)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0.0 ft-
36.0 R
2.0 in.
SCH 40
PVC
ft.
ft.
in.
17. SCREEN
FROM TO
DIAMETER
SLOTSIZE
THICKNESS
MATERIAL
36.0 R• 39.5 a•
2.0 in.
.010
SCH 40
PVC
ft. R.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOt NT
2.0 ft.
29.0 ft.
PORTIANDaENTONnE
SLURRY
n.
n.
n.
n.
19, SANDIGRAVEL PACKWapplicablO
FROM
TO
MATERIAL
EMPLACEMENT METHOD
34.0 ft.
39.5 ft'
20-40
FINE SILICA SAND
00 ft-
2.0 it.
20-40
FINE SILICA SAND
20. DRTLLING LOG lattach
additional sheets if necessary)
FROM
TO
DESCRIPTION color, hardness, mi0rock type, tmin size, etc.
0.0 R
8.0 it•
OPEN HOLE (SOFT DUG BY OTHERS)
8.0 it•
23.0 n.
BROWN PWR
23.0 n.
39.5 if
GRAY PWR
n.
R.
fr.
fr.
21. REMARKS
BENTONITE SEAL - 29.0 - 34.0 FEET
*** TOP 2' FILLED WITH SAND FOR FUTURE VAULT INSTALLATION'*'
22. Certification: v -
� 05/01/23
Signature ofCenilied We0 Contractor Date
Hy signing this fora, 1 hereby certify dear the ivell(s) tray (acre) tongfucted in areardaty ii-ab
1 SA N(`A(' 0N' .0100 or 15A N(AC 02C 0100 Well Consirur1ron Standards and ila) u s ry
e f thts record has been prar•ided ra the well on•ner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well construction mt'o
(add'See Over' in Remarks Box) You may also attach additional pages if necessan
24. SUBMITTAL INSTRUCTIONS
Submit this GW-1 within 30 days of well completion per the following:
10. Static water level below top of casing: 16.0 (ft) Information
For All Wells: Original form to Division of Water Resources (DWR).
1) water lerel is above rasing, me - Information Processing Unit, 1617 MSC, Raleigh, NC 27699-1617
11. Borehole diameter: 6.0 (in.) 24b. For Injection Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC, Raleigh, NC 27699-1636
12. Well construction method: AIR
24c. For Water Su 1 and 0 en-Loo GeDthermal Return !Veils: Copy to the
{i.e. auger, rotary, cable, direct push, etc) county environments hea th department o the county where costatied
FOR WATER SUPPLY WELLS ONLY: 24d. For Water Wells producing over 100,000 CPD: Copy to DWR. CCPCUA
13a. Yield (gpm) Method of test: Permit Program, 1 611 MSC, Ra etg , NC 27699-1611
13b. Disinfection type: Amount:
Fonn GW-I North Carolina Department of Envirorunental Quality - DIYISiOn of Water Resources Revised Gfi-20I$

WELL CONSTRUCTION RECORD GW-1
1. Well Contractor Information:
JOHNNY BURR
Well Contractor Name
A - 3098
NC Well Contractor Cenifrcadon Number
GEOLOGIC EXPLORATION
Company Name
2. Well Construction Permit 4:
LAf all applicable n'ell consirm(wan permits (i.e. TIC. CourN}: Stale, Variance. etc)
3. Well Use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
O Industrial/Commercial
❑ Irrivat ion
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Wells> 1MOW GPD
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 1121 F
4. Date Well(s) Completed: 04/25/23 Well IDq BS-12
Sa. Well Location:
COLONIAL PIPELINE
Facility/Owner Name Facility ID# (ifapplicable)
7524 KENSTEAD CIRCLE CHARLOTTE 28214
Physical Address, City, and Zip
MECKLENBURG
County
Parcel Idenlificalion No. (PIN)
Sb. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field. one latllonb is sufficient)
35° 17' 18.35" N 800 56' 21.59" W
6. Is(are) the well(s): IJPermanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or (5No
ljdrrr is a repair, fill nor known irell ronstrucrian h!Ji nrairm and explain fire nature ofllie
rrpair under: 21 remarks secriar or on the back of Airs jorm.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only I GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled.
9. Total well depth below land surface: 40.0 (ft.)
1•irr mohrpk wells list all depilrs ifd jjireni (example- 3@200' and 2Q1iff)
For Internal Use Only:
14. WATERZONES
FROM
TO
DESCRIPTION
IS. OUTER CASING for
multi -eased wells OR LINER ifs
Ficablc
FROM
To
DIAMETER
THICKNESS
MATERIAL
ft.
I
in
16. INNER
CASING OR
TUBING(geothermal
closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0.0 n'
37.0 n•
2.0 I"'
SCH 40
PVC
h.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
I SLOTSIZE
THICKNESS
I MATERIAL
37.0 ft'
40.0 A'
2.0 '
010
SCH 40
PVC
ff.
It.
1S. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOt-Yr
2.0 n
30.0 ft'
PORTLANDBENTONITE
SLURRY
n.
n.
ft.
n.
19. SANDIGRAVEL PACK
Ff a livable
FROM
TO
I MATERIAL I
EMPLACEMENT METHOD
35.0 ft-
40.0 f"
20-40
FINE SILICA SAND
0.0 n'
2.0 ff-
20-40
FINE SILICA SAND
20. DRILLING
LOG attach additional sheets if necessary)
FROM
TO
DESCRIPTION color, hardnesi4 saillmek type, ilmin size, tic.
0.0 ft•
8.0 it•
OPEN HOLE (SOFT DUG BY OTHERS)
8.0 h
24.0 it•
BROWN PWR
24.0 h'
40.0 it'
GRAY PWR
rr.
rr.
ft.
h.
ft.
ft.
21. REMARKS
BENTONITE SEAL -- 30.0 - 35.0 FEET
•'• TOP 2' FILLED WITH SAND FOR FUTURE VAULT INSTALLATION ***
22. Certification- n
,'�/j A4*1'� 05/01 /23
Signature ofCertifted Well Contractor
vats
A}'.signing this farm, 1 berebycerr fy rbaf the irell(y) eras (irere) consfrucred in aceerrdance uvth
l5A Nr AC 02' 0100 or 15A M :AIL' 02' .0210 Well r •an.Hrurnron .Sraalarrls and 11krf a o ipi
aflhis record has been prorlrk d nr the hell owner
23. Site diagram or additional well details:
You may use the back of this page to provide additional well construction info
(add'See Over' in Remarks Box). You may also attach additional pages if necessan
24. SUBMITTAL INSTRUCTIONS
Submit this GW-I within 30 days of well completion per the following:
10. Static water level below top of casing: 16.0 (ft.) 24a. For All Wells: Original form to Division of Water Resources (DWR),
1r iraq'r IV%rl is abore cat nig. use "
11. Borehole diameter- 6.0
12. Well construction method: _
(ix- auger, rotary, cable, direct push, etc.)
AIR
Information Processing Unit, 1(y17 MSC, Raleigh, NC 27699-161 1
24b. For Injection Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC, Raleigh, NC 27699-1636
24c. For Water Supply and Opt n-Loo Geothermal Return Wells: Copy to the
county environmental health department o the county where installed
FOR WATER SUPPLY WELLS ONLY: 24d. For Water Wells producing over 100 000 GPD: Copy to DWR, CCPCUA
13m. field (gpm) Method of Pest: Permit Program, 161 I MS , Raleigh, N 7 I I I
13b. Disinfection type: Amount:
Forin GW-1 North Carolina Department of Environmenial Quality - Dn ision of Water Rcsau-c c% Revised 6-6-2019

FIGURES
:1
APEX

{= J Ill
f !I I ':ski iFf "Y II
4-- S'
R
SITE LOCATION
M1- r
• ` POZZ€ f5 ftRBY
V.
rr; I'
Afec klel ihor¢ f{ r
:1", !' � USGS The National Map: National Bdundaries Dataset, 3DEP Elevation,
Program, Geographic Names Information System, National Hydrography
N Dataset, National Land Cover Database, National Structures Dataset, and
0 1,000 2,000 National Transportation Dataset; USGS Global Edosystems; U.S. Census
Bureau TIGER/Line data; USFS Road Data; Natural -Earth Data; U.S.
Feet Department of State Humanitarian Information Unit; and -NOAA National
Centers for Environmental Information, U.S. Coastal Relief Model. Data
refreshed June, 2022.
CHECK BY: AS IFIGURE
DRAWN BY: CW
DATE: 2/24/2023
SCALE: 1 in = 2,000 ft
CAD NO.: CPC21013-001
PRJ NO.: CPC21013-001
SITE LOCATION MAP
COLONIAL PIPELINE COMPANY
CHARLOTTE DELIVERY FACILITY
PAW CREEK, NORTH CAROLINA
APEX
nent Path: Z:\GIS_Repository\Charlotte\CPC-CharlotteDF\Charlotte DF\CPC21013\CPC21013\Annua1 Report 2022\Figure 1 - Site Location.mxd

11 - -'.: A
Q-
co
MW-36
MW-15
ry - INCIDENT NO. 6162 TREATMENTSYSTEM
NORTHERN
-}_ . -; PLUME AREA
, J-4
r • MW-14 MW-13 �I MW-21A
MW-46 RW-4 ...
713 715
- .1' 717 " 711
ETROLEUM CORPORATION i�W
MOUNT HOLLY ROAD) 716 710 731 732 733 734 f ,
MW-51 MW-49 o�v
MW-48D o
MW-4/ MW-47 ?
.�.
751. 75 730't 735 736 -- 737. MW-50 RW-3
.r
761 - MW-16
INCIDENT NO. 14994
- 762 MW-53 MW-45 MANIFOLD AREA
MW-52 iF': P-1
MW-54t . MW-34
MW-31
-.. 6 =.dry, .., `,, ti ti MW-28D
MW-57 MW-39i
. INCIDENT NO. 19510..., 'fix. ° MW-35 ,{
4 RELEASE SOURCE AREA MW-56D ~
MW-40 MW-32
i. �L,.
LEGEND
® MONITORING WELL SITE BOUNDARY
GROUNDWATER EXTRACTION WELL PROPERTY LINE
REMEDIATION SYSTEM LINES
Z
0 100 200 400
Feet
CHECK BY: AS
DRAWN BY: CW
DATE: 2/24/2023
SCALE: AS SHOWN
CAD NO.: CPC21013-001
PRJ NO.: CPC21013-001
VIM
MW-28
SITE PLAN
COLONIAL PIPELINE COMPANY
CHARLOTTE DELIVERY FACILITY
PAW CREEK, NORTH CAROLINA
1�I
T
City of Charlotte
FIGURE
i`
2
APEX

F I
w1i `�FF
k _
_ 7�
L; ;
+'
- #
Trunk line Trunk line Trunk line Trunk line Trunk line Trunk line'
Trunk line
-. Trunk line Tru_ nk line �-
Trunk line Trunk e BS-10
7A 1 7 Berm Berm Trunk line
x crossing 1 crossing 2 .
BS-1 BS-7 BS-11
Ir
BS-8
r
Y
BS-2/AS-1 BS-9 - BS-12
} BS
71 731 BS-3 732 733 r 7 BS-13
0S-4
3
4i
78 735 s
760 x
CHECK BY: AS FIGURE
LEGEND DRAWN BY: CW
' PROPOSED REMEDIATION SYSTEM LINES PROPERTY LINE Z DATE: 4/26/2023 TRENCHING PLAN ^
APEX
SCALE: AS SHOWN COLONIAL PIPELINE COMPANY ' j
SITE BOUNDARY 0 50 100 200 CAD NO.: CPC21013-001 CHARLOTTE DELIVERY FACILITY v
Feet PRJ NO.: CPC21013-001 PAW CREEK, NORTH CAROLINA
1 INCH = 100 FEET
Document Path: Z:\GIS Repository\Charlotte\CPC-CharlotteDF\Charlotte DF\CPC21013\CPC21013\Requests\Figure 2 - Trench Plan - RFP - v2.mxd