GW1 - Carteret 2018

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
RECEIVED/NCDENR/DWR
For Internal Use Only:
Jason P{ Morton
Well Contractor Name
2953-A
NC Well Contractor Certification Number
Morton Diriiling
Company Name
DEC 3 12018
Water Quality Regional
Operations Section
W+Jfffington Regional -Office
Ill 1 L
List all applicable well construction permits (i.e. UI County, State, Variance, etc.)
2. Well Construction Permit #:
3. Well Use (check well use):
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
Non -Water Supply Well:
�IMonitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothennal (Closed Loop)
Geothennal (Heating/Cooling Return)
Municipal/Public
esidential Water Supply (single)
Residential Water Supply (shared)
Recovery
Groundwater Remediation
OSalinity Barrier
fStormwater Drainage
0Subsidence Control
Tracer
Other (explain under #21 Remarks)
4. Date Well(s) Completed: !' !I
5a. Well Location:
Facility/Owner Name
Physical Address, City, and Zip
County
Well iD#
Facility 1D# (if applicable)
vvid-
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one laf/long is sufficient)
t
°y30•7b°5Y t/l6rZ-J W
6. Is(are) the well(s)
Permanent or DTemporary
7. Is this a repair to n existing well: fYes or o
If this is a repair, fill out known well construction information arfd explain the nature of the
repair under #21 remarks section or on the back of this.form.
-R. For-Geoprobe/DP-T-or-Glesed-Loop-G-eothermat-Wells-having-tyre-cart
construction, only 1 GW-1 is need. Indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface:
For multiple wells list all depths if different (example- 3 d700 and 2@100')
10. Static water level below top of casing: le
If water level is above casing, use'
11. Borehole diameter: " G , (in.)
40-/-4-gy
12. We11 construction method:
(i.e. auger, rotary, cable, direct push, etc.)
(ft.)
(ft)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) SV Method of test: `/
136. Disinfection typed ] 1 'Q i7`,/V D
Amount: , r 0
14. WATER ZONES .
FROM
TO
DESCRIPTION
1 tpf t.
6
6-0 ft.
g� Lr_
15, OUTER CASING (for multi -cased wells) OR LiNER (if ap licable)
FROM
TO
DIAMETER
I THICKNESS
MATERIAL
ft.
ft.
in.
llr
16. INNER
CASING OR TUBING
(geothermal closed -looms
FROM
TO
DIAMETER
THIC ESS
MATERIAL
j ft.
ft.
in,
��{r1
, V �- -
ff,
ft.
in.
17. SCREEN
FROM
TO
DIAN ETER
SLOT SIZE
NESS
TH41D
MATERIAL
I (f1ft.
7 Vft.
1 /,.!eft,
1�fjft.
in.
ZcO
tcr
'pc_
m.
18. GROUT
FROM
1'O
MATER�I�fL
EMPLACEMENT MET OD & AMOUNT
0 ft'
�v ft'
Be i'i�v{L(,i,„
fhvre d / `)41
ft,
fL
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
iv
4,0 ft,
c -,c%
?au r,ed
fL
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
'to
DESCRIPTION (color, hardness, soil/rock type, grain size, ctc.)
E ft.
5 ft..541
/i 14
ft,
/ 0-0 ft,
942,,C C
0 Zit.
/zil brt.
L i(.a-v��
11 oft.
/4?v«.
AVl<ft.
t7
:
ft.
ft,
�
ft.
It.
- 2O1 7
21. REMARKS
ion T t d, 6*'AVJ U
woogF
22. Certification:
iri7k
at re of Curti led Well Contractor
Date
By signing this forts, 1 hereby certify that the well(v) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15,4 NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You-may-usrihe back of this-frage-1 --provide-a-ddttiatlnt'WEll site deta l-S or well -
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For iniection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Iniection Wells: in addition to sending the form to
the address(es) above, also subunit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed,
Form OW- I
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL CONSTRUCTION RECORD (GW-1
iCEIVEMCRCIR
al
1. Well Contractor Information:
Jason P Morton
Well Contractor Name
2953-A
NC Well Contractor Certification Number
Morton Drilling
Company Name
2. Well Construction Permit #:
List al! applicable well construction permits (i.e. UIC, County, State, Variance, etc)
3. Well Use (check well use):
\N Operations Sectional
Oi�-inn Rebional Otlice
tf�f t1tl1N .
.'(ol q
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
Non -Water Supply Well:
Monitoring
:]Municipal/Public
®if Residential Water Supply (single)
Residential Water Supply (shared)
11
fl Recovery
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Retum)
Groundwater Remediation
DISalinity Barrier
EIStonnwater Drainage
DSubsidence Control
Tracer
Other (explain under #21 Remarks)
4. Date Well(s) Completed: 11-q- ($ Well iD#
5a. �eS ell Location:
1 1 e 7/ t1 i-N s
Name pr+ke(-
Facility/Owner aFacility ID# (if applicable)
42p1 6- AVAS ey L / f l id jiG
Physical Address, City, an Zip
Carteret
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one !at/long is sufficient)
.59°551yt90 tt N? °5�/ `/�1.3e
it
W
6. Is(are) the well(s)71Permanent or JITemporary
7. Is this a repair to an existing well: []Yes or 11No
If this is a repair, fill out known well construction information an explain the nature of the
repair under #21 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is need. Indicate TOTAL NUMBER of wells
drilled:
01
9. Total well depth below land surface:
For multiple wells list all depths if different (example- 3@200' and 2@l00')
10. Static water level below top of casing:
If water level is above casing, use ' + _
11. Borehole diameter:
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
/go
zv
(in.)
> ot;2 7'
(ft.)
(ft.)
For Internal Use Only:
.45548
14. WATER ZONES
FROM
TO
DESCRIPTION
j/Oft.
1 ICJ
v } ft.
kW
ie�
ft.
ft.
15. OUTER CASINO (for multi -cased wells) OR LINER (if a livable)
FROM
TO
DIAMETER
THICKNESS MATERIAL
ft.
ft.
in.
4
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
I ft,
/6 O ft,
q in.
C/I( ciQ
J
`
�,i 4
ft.
ft.
in,
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
AV C-
1 LA ft.
w
1 tO ft.
i / in.
`�
v
. A y-
ft.
ft.
in.
18. GROUT
FROM
TO
MATE IAL
EMPLACEMENTNIETIIOD
ft.
Zft.�-/NrC�/
zV
V(,/4
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK: (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT
EMPLACEMENT METHOD/
METHOD,
)
1 b v ft,
1 SA) ft.
43447. r,d-
�a?1 f e
ft.
20. DRILLING LOG (atta h additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardgess, soil/reek type, grain size, etc.)
t5 ft.
3 ate ft.
S C..-
- ft.
el 0 ft.
S
00ft.
/ b ) ft.
i
t_ ri
/1ft.
1 .�O ft.
ft.
ft.
>>
ft.
ft.
. --
ft.
ft.
lV© yr
lV
21. REMARKS 3
si,•. ra(1.........: - -
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm)ii'.
13b. Disinfection typ�fl 10 RI �e
Method of test:
Amount:
fkl 12-
Z.,v G---
22. Certification:
re o Certified Well Contractor
Date
By signing this: fwtn, i hereby certify that the welt(,) was (were) constructed in accordance
with 15A NCAC 02C .0/00 or ISA NCAC 02C .0200 Well Construction Standards and that a
copy of this 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For [niection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
consunction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c, For Water Supply & Inlection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
R Pureed 9_99_9n IF

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Jason P{ Morton
RECEIVEDINCDENROR
Well Contractor Name
2953-A
NC Well Contractor Certification Number
Morton Diriiling
Company Name
2. Well Construction Permit #:
NOV 27 2018
Water Quality Regional
Operations Section
iilmington 1-tegioi411 :fficc
7 0„5.
List all applicable well COHSMICIIOII permits
3. Well Use (check well use):
(i.e. UIC, County. State. Variance, etc.)
Water Supply Well:
0 Agricultural
Geothermal (Hcating/Cooling Supply)
Industria VCommerc i al
Irrigation
1Non-Water Supply Well:
Monitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
s!I
unicipal/Public
esidcntial Water Supply (single)
Residential Water Supply (shared)
DRecovcry
Groundwater Remediation
fISalinity Barrier
EjStormwater Drainage
DISubsidence Control
(Tracer
(Other (explain under #21 Remarks)
4. Date Well(s) Completed:
5a. Well Location:
Facility/Owner Name
12 5 `M k t n^ iJ
Physical Address, City, and Zip
Well1D#
Facility iD# (if applicable)
i Gu,q_cir^T
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one latilong is sufficient)
IN
`_S,5'.?ll1i8 1t N .211>g` 37, w
6. Is(are) the well(s)
Permanent or t©ITemporary
7. Is this a repair to an existing well: /AL es or ENo
If this is a repair, fill out known well constructs, information and explain the nature of the
repair under 021 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is need. Indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface:
For multiple wells list all depths ifdifferent (example- 3@200'and 2@100')
10. Static water level below top of casing:
If water level is above casing, use "+"
11. Borehole diameter:
f O
12. Well construction method:
(Le. auger, rotary, cable, direct push, etc.)
(ft.)
(ft.)
For Internal Use Only:
456647
14. WATER ZONES '
FROM
TO
DESCRIPTION
j 10 C t.
I
f V O ft.
(2....._ 0 cam
ft.
ft,
15. OUTER CASING (for multi -cased wells) OR LINER (if aiplicable):
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TOr
DIAMETER
THIC NESSS
MATERAL
ft.
f Yp G ft.
r
in.
S c 7 0/
i f !.
ft.
ft.
tn,
17. SCREEN
FR M
TO
DIAMETER
SLOT SIZE THICKNESS
MATERIAL
ft.
) st)ft.
i.
2(SC"l N l7
f V C_
ft.
ft.
in.
18. GROUT r. , . ... .
FROM
TO
ATEIVAL
EMPLACEMENT & AMOUNT
C� ft.
2 v fit.
^t/1,
06vt. l4
4' 11ETHOD
JJ if )(le c
/ 7r(/�Cl i(
ft.
ft.
ft,
ft.
19. SAND/GRAVEL PACK Of applicable)
FR M
TO
MATERIAL (
EMPLACEMENT MET`IOD
0 ft.
1 j i2 C ft.
�A,,1 a
pb U +se G
ft.
ft.
20. DRILLING
LOG (attach additional sheets ifnecess.ary�
TO
DESCRIPTION (color, hardnesJs, soil/rock type,_grain size, etc.)
FItOM
ft.
5 fir.
, rTmotr _ C-
5 ft.
ft.
< i.<4'%,1
✓
t.
i fit.
j
�t�
1 'V 1 ft.
Oft.
it
JZ
ft.
ft,
ft.
ft.
l t r §'•
r rY• a
ft.
ft.
21. REMARKS NOV I ; �,E 2018
`d?:: Tti.3iCioc1 F tLi:-,.•.... . ..
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm)
13b. Disinfection typed{ bAA VOL
Method of test:
Z..
17
Amount:
22. Certification:
aturc of Certified Well Contractor
Date
By signing this form, 1 hereby certify that the wells) was (were) constnrcted in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy of this 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
constntction to the following:
Division of Water Resources, information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Infection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW-1
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
-64C5`0A) 0. tvoiz4,,&)
Well Contractor Name REC
02 q S Aq q 20i8
NC Well Contractor Certification Number �QV 2r 7
Company Name r Quality Kegiunal
7 0 5 operations Section
2. Well Construction Permit #: entn�rton Regjonal OffiC
List all applicable well construction permits (Le. WC, Coun}��11 Stalt: Variance, etc)
3. Well Use (check well use):
Water Supply Well:
Agricultural
DGeothermal (Heating/Cooling Supply)
In Industrial/Commercial
(irrigation
Non -Water Supply Well:
[Monitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothennal (Closed Loop)
Geothermal (Heating/Cooling Return)
;4.
unicipal/Public
csidential Water Supply (single)
Residential Water Supply (shared)
DRecovery
Groundwater Rernediation
QiSalinity Barrier
DIStonnwater Drainage
FISubsidence Control
Tracer
F Other (explain under 421 Remarks)
4. Date Well(s) Completed: / is P
1 Well ID#
Sa. Well Location:
fivn .SAe i-P I C,0) -e_
Facility/O�rner Name / Facility ID# (if applicable)
9,b 3 L xf C-
Physical Address, City, alnd Zip
ahe‘-`12)"
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if
[well
/field, one lat/tong is sufficient) /
Z/,2'I !t N-26 ar`%j,
`
6. Is(are) the well(s)
41,
Permanent or OTemporary
r1
7. Is this a repair to an existing well: DYes or No
If this is a repair, fill out known well construction infornation d explain ilre nature of the
repair under #21 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is ceded. Indicate TOTAL NUMBER of wells
drilled: t'
9. Total well depth below land surface:
For multiple wells list all depths if different (example- 3Q200' and 2@100')
10. Static water level below top of casing: 1 5
If water level is above casing, use /
11. Borehole diameter: t7 e2 (in.)
(So
(ft.)
(ft.)
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
For Internal Use Only.'`:.,
55646
14. WATER ZONES
FROM
TO
DESCRIPTION
art.
1{ D
k VDt.
, _ C , _
ft.
ft.
t ,
15, OUTER CASING (for multi -eased wells) OR LINER (if a
ticable) '.
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL, _
ft.
I
%j_ e ft.
t f(J
9. in.
40
547
tt �i V
ft.
ft.
in.
IT. SCREEN.
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
rvon.
f i oft.
Lf in.
(
2-D
S'--t 4 o
PU L.
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHO& AMOUNT
0 ft.
2,0 ft.
04.0�
U (e Yee/
n,
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIALEMPLACEMENT
M ltiOD
/66) ft.
"g d ft.
,A.,..ri
(,-f
(6i! re
ft,
ft.
20. DRILLING LOG (attach
additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, sySVrock type, grain size, etc.)
ft.3
ft.
�' 1 L`_/
ft.
(C•
rt
� .
�/
�� / sT
q.� rt.
'b d ft.
mil,.
/ �ft.
{ g ft.
iq
ft.
rt.
, E Ft E ry}f >
ft.
ft.
tyg���
ft.
ft.
NOV 1 9 201(1
21. REMARKS
r?A'1•�T• •L
i.,igo'friis�
o it (�,
FOR WATER SUPPLY VVEL S ONLY:
13a. Yield (gpm) C Method of test:
13b. Disinfection type:0 lt,041/$ Amount: 2•Q U/
0
22. Certification:
of Certified Well Contractor
Date
By signing this,forur, 1 hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 1 SA NCAC 02C .0200 Well Construction Standards and that a
copy of this 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, 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 one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also subunit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
ne..a,+.,.e... nr Fnvimnmental O,,nliw - Division of Water Resources
Revised 2-22-2016

WELL CONSTRUCTION RECORD (GW-1)
For Internal Use Only:
1. Well Contractor Information:
Jason P Morton
Well Contractor Name
2953-A
RECEIVEDIRGU R/1MR
NC Well Contractor Certification Number
Morton Drilling
Company Name
2. Well Construction Permit #: �/•
List all applicable well construction permits
3. Well Use (check well use):
NOV 2 7 2018
Water Quality Regional
Operattons Seetino
b,1,(,
lgin ton Regional Office
(i.e. U`/C.`County.. Stole. Variance, etc.)
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
Non -Water Supply Well:
Monitoring
DMunicipal/Public
esidential Water Supply (single)
Residential Water Supply (shared)
►_ti
lip
0Recovery
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothennal (Heating/Cooling Return)
Groundwater Remediation
Salinity Barrier
OStormwater Drainage
Subsidence Control
DTracer
Other (explain under #21 Remarks)
4. Date Well(s) Completed: 9'- J ! ' J eB
Well 1D#
5a. Well Location:
Jf4 PckS
Facility/Owner Name Facility ID# (if applicable)
l /q/All1 A -C-
Physical Address, City, and Zip
Carteret
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one latllong is sufficient)
'�"116 0, rslu 11 N '-'7C 1/, & "
6. Is(are) the well(s)Permanent or DTemporary
7. Is this a repair to an existing well: Yes or ONo
If this is a repair, fill out known well construct, i information and explain the nature of the
repair under #21 remarks section or on the bac of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW- 1 needed. Indicate TOTAL NUMBER of wells
drilled: �7V
9. Total well depth below land surface:
For multiple wif ells list all depths different (example- @200 and 2@I00')
10. Static water level below top of casing:
If water level is above casing, use "+"
11. Borehole diameter: .�
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
(ft.)
(ft,)
FOR WATER SUPPLY WELLS ONLY: c
13a. Yield (gpnl) ("( Method of test: )7
13b. Disinfection type:L1 �O l++` 1 N e , Amount:
7,0 c-/-
556 45
14. WATER ZONES . :
FROM
TO
DESCRIPTION •
ig ft,
f �U /y ft.
.& --
ft.
ft,
15. OUTER CASING (for multi -cased welts) OR LINER (if a
lieable) >',
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
In.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIA/h
r ft.
I ` (� ft.
/ J
[1 in.
1
(/,� `mil
4+ ci v
J�
n
.V C___
ft.
ft,
in,
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE THIC NESS
MATERIAL
/ :0ft,
f 70 ft.
/
i�'1 , in.
9i� �c. t ye)
pV L
ft.
ft.
in.
18, GROUT
FROM
TO
MATE IIALL
EMPLACEMENT METHOD & AMOUNT
ft.
L
2v7 ft.
/
J. 'j,,
yr
V"�
�'jr 1 S AO ff d j�
"/"
ft.
ft.
J
d
ft.
ft.
19. SAND/GRAVEL
PACK (if applicable)
FROM
TO
MATERIAL
MATERIAL
EMPLACEMENT METHOD
I9ft.
j.0 ft.
SAZ'rd ItA
P e )
ft.
ft.
20. DRILLING LOG (attach additional sheets If necessary)
FROM
TO
DESCRIPTION (color, hardness soilrock type, grain size, ete.)
0 ft.
3 5 ft.
rerY1 d
rt.
rt.
Sn (..c„)--
q Oft.
(ye,ft.
�--9 �
l �Vi'ft.
j 1 $ .
fL
ft.
ft.
ft,
i j S/ '-^ '
ft.
21, REMARKS NOV 1 9 ,Q1a
22. Certification:
Date
By signing this form, 1 hereby certify that the well() was (were) constructed in accordance
with 15A NCAC 02C .0/00 or I SA NCAC 02C .0200 Well Construction Standards and that a
copy of this 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
constriction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
constntction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
/4
Form GW-1
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
For Internal Use Only:
456625
1Non-Water Supply Well:
Monitoring
1
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothennal (Closed Loop)
Geothennal (Heating/Cooling Return)
Jason P Morton
RECEIVED/SICDENR/DWR
Well Contractor Name
2953-A
NC Well Contractor Certification Number
Morton Drilling
Company Name
2. Well Construction Permit #:
NOV 272.018
Water Quality Regional
operations Section
Wilmington Regional Office
70
List all applicable well construction permits (i.e.
3. Well Use (check well use):
UIC, County, State, Variance, etc.)
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
I Irrigation
Municipal/Public
AC sidcntial Water Supply (single)
Residential Water Supply (shared)
Recovery
Groundwater Remediation
JSalinity Barrier
JStonnwater Drainage
DSubsidence Control
Tracer
Other (explain under #21 Remarks)
4. Date WeII(s) Completed: / O--/ 0 _1 Well ID#
Sao. Well Location
f� W/%1 NA-Reir -ctrJ
Facility/Owner Name Facility ID# (if applicable)
b�l ti �f2� 13 2 - ,V C
Physical Address, City, and Zip
Carteret
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
P./ 1# 136rQ3 N "26 t9 Q045
W
6. Is(are) the well(s)JPermanent or DTemporary
7. Is this a repair to an existing well: QYes or No
If this is a repair, fill out known well construction information and explain the nature of the
repair tinder #21 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1_i�npWed. Indicate TOTAL NUMBER of wells
drilled: (�/l)
9. Total well depth below land surface:
For multiple wells list all depths if different (example- 3@200' and 2@100)
i® 6
10. Static water level below top of casing:
If water level is above casing, use "+
11. Borehole diameter:
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
t
(ft.)
(ft.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm)
13b. Disinfection type: Chlorine
Method of test: AIR
Amount:
ol`
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
(J
j� �{
( 17 ft.
CO2
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if a licable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
I) (/ C
/ ft.
ft.
J`�"` l in.it_
�� f "
e
ft.
ft.
in.
17. SCREEN
F OM
TO
DIAMETER
_ SLOT SIZE
THICKNESS
MATERIAL
ft.
/O ft.
if in.
2.0
SG p r `�)
`7(O
IV �
ft.
ft,
in,
18. GROUT
FROM
TO
MATE IAL
EMPLACEMENT METHOD & AMOUN
O ft.
2V ft.
004�t
-La_
pe,o(ci *i/li
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPL�CEMmNTMETHOD
C
` V ft.
ft
f °° .
65
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DFSCRIPTI N (color, ardness, soil/rock type, grain size, etc.)
®ft.
35 ft.
0.
.S+ l�1t.
5-7 ft.
�J 6-C ,yA„K
5(R'7cJ
rt.
8� rt.
vY
C.I.-(
Roft.
t 2) v ft.
A`V ,�
ft.
ft.
ft.
ft.
.
ft.
ft.
0
21. REMARKS
22. Certification:
/747(
Si:; �ureofCertiftcd Wel1C
Date
--i211
signing this form, 1 hereby certifi, that the well(s) was (were) constructed in accordance
with 1 SA NCAC 02C .0100 or ISA NCAC 02C.0200 Well Construction Standards and that a
copy of this 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, 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 one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mall Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form G W-1
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor information: RECEIV 11�1CDM/DO
Jason P Morton tt 1
Well Contractor Name
2953-A
NC Well Contractor Certification Number
Morton Drilling
Company Name G�
2. Well Construction Permit #: 2 2' %0 (1 / 0
List all applicable well construction permits (i.e. UIC, County. State, Variance, etc)
3. Well Use (check well use):
Nov 27 2018
Water Quality Regional
Operations Section
Wilmington ,Zeglo. a
Water Supply Well:
Agricultural
Geothermal (IIcating/Cooling Supply)
Industri a I/Commercial
Inigation
Non -Water Supply Well:
Monitoring
Municipal/Public
Residential Water Supply (single)
Residential Water Supply (shared)
['JRccovery
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
Datoundwater Remediat ion
jISalinity Barrier
flStonnwater Drainage
0Subsidence Control
Tracer
EIOther (explain under #21 Remarks)
ig
4. Date Well(s) Completed: t I- 1
5a. Well Location:
/ika`lSOF I-1-Arho,J�
Facility/O nerNante
l i18 Covcn�Y�` C1�� 12a
Physical Address, City, an Zip
Carteret
Well ID#
Facility iD# (if applicable)
9u4c
County Parcel Identification No, (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one IaIllong is sufficient)
26 " N
76c931 OR '2-2 rl
W
6. Is(are) the well(s)MPerinanent or ElTemporary
7. Is this a repair to an existing well: JYes or No
q'this is a repair, fill out known weU construction information a d esplain the nature of the
repair under #21 remarks section or on the buck of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-I is needed. Indicate TOTAL NUMBER of wells
drilled: EON ✓:
9. Total well depth below land surface:
For multiple wells list all depths if different (example- 3@200' and 2@l00)
10. Static water level below top of casing: % (ft.)
If water level is above casing, use "+"
l6'
11. Borehole diameter: '7 ..)‹i)
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
(in.)
L
(ft.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) ! 5 Method of test: /F i IZ
13b. Disinfection type(/ 1 I 0 ( Amount:
For Internal Use Only:
455621
14. WATER ZONESIx-
FROM
TO
DESCRIPTION
/ a ft,
) 8_6 ft.
i
/ZOC�
ft.
ft,
15. OUTER CASING (for multi -eased wells) OR LINER (if a liable)
FROM
TO
DIAMETER
TBICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING (geothermal closed -look
FROM
TO
DiAAt TER
TIiICC MESS
MATERIAL
t
I
ft.
ft.
in,
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THIC ESS
MATERIAL
/' v�
%
[ [%Sit.
�� i'ft.
in.
)
r�
v0
ft.
rt.in.
18. GROUT
FROM
To
MATE AL
EMPLACEMENT r�ETHOD & AMOyry T
7� ft.
A tb ft.
' 4.)f
(feC q (h s
ft.
ft,
ft.
ft,
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
y
EMPLACEMENT METRQD
L5ft.
Cl
/,()�Y5 ft,
,, ,
S/2/IC-t
f �of r-» d-
ft.
ft.
20. DRILLING
LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hard ss, soiUrock tyE, grain size, etc.)
U ft.
ft.
S/ 1i
" ft.
- ft.
s,`,v`01 / % ,
�% w/
n eft.
ft.
C...
llhSfL
/(� ft.
/ tJ
/��v'ice
ft.
ft.
ft.
ft.
ft.
= ft. ;
21. REMARKS • '
.r:
22. Certification:
c of ertilic We 1 Contracto
Date
By signing this form, ! hereby certify that the well(r) was (were) constructed in accordance
with I5A NCAC 02C .0100 or I5A NCAC 02C .0200 Well Construction Standards and that a
copy of this 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, 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 one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW-1
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL CONSTRUCTION RECORD
This form call be used for single or multiple wells
1. Well Contractor Information:
Wesley J. Sorrells
RECEIVED/MCDENRIDWR
Well Contractor Name
3577
NC Well Contractor Certification Number
NOV 2 ri 2018
Water Quality Regional
on
Terraquest Environmental Consultafft 1t�� Wenall Office
Company Name I nling t) �
2. Well Construction Permit #:
List all applicable well permits (i.e. County, State, Variance, Infection, eta)
3. Well Use (check well use):
Water Supply Well:
DAgricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
Non -Water Supply Well:
OMonitoring
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Recovery
Injection Well:
DAquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Retum)
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
DOther (explain under #21 Remarks)
4. Date Well(s) Completed: 11/8/18
5a, Well Location:
Margret Mills
Well ID# MW1
Facility/Owner Name Facility ID# (if applicable)
102 S. 26th St. Morehead City
Physical Address, City, and Zip
Carteret
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
34.723096 N-76.738521
6. Is (are) the well(s): 171Permanent or OTenrpor•ary
7. Is this a repair to an existing well: ❑Yes or ❑No
If this is a repair, fill out known well construction information and explain the nature of the
repair under #21 remarks section or on the back of this form.
8. Number of wells constructed: 1
For multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
9. Total well depth below land surface: 13 (ft.)
For multiple wells list all depths if different (example- 3@200' 200' and 2@100)
10. Static water level below top of casing: 3'62 (ft.)
If water level is above casing, use "+"
11. Borehole diameter: 8'25 (in.)
12. Well construction method: Hollow Stem Augers
(i.e. 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:
455600
:14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15: OUTER CASING (for multi -cased wells) OR LINER'(if tip licable)'
FROM
TO
DIAMETER
THICKNESS MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING,( geothermal' closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
ft.
ft.
in.
17, SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
3 ft.
13 ft,
in.
.010
Sch. 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
ft.
ft.
Portland
Pour
1 ft.
2 ft.
Bentonite
Pour
ft.
rt.
19. SAND/GRAVEL PACK if applicable) _
FROM
TO
MATERIAL
EMPLACEMENT METHOD
2 ft'
13 ft.
No. 2 Sand
Pour
ft.
ft.
20. DRILLING'LOG
(attach adtfitonal sheets ifnecessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
0 ft.
13 ft
Sand
ft.
ft
ft.
ft.
ft.
ft.
?�2F�' v'
'-1a > .
ft.
rt
ft.
ft.
NOV 1.5 2018
ft.
ft.
t
21:'REMARKS i.{!i7 } t lit `•s:t I- r : ,,
22. Certification:
on.n.a.iwi,mn asw
Signature of Certified Well Contractor
Date
By signing this form, 1 hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or ISA NCAC 02C .0200 Well Construction Standards and that a
copy of this 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. Fot' An Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells ONLY: 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
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells:
Also submit one copy of this form within 30 days of completion of
well construction to the county health department of the county where
constructed.
mticd
Form GW-1
North Carolina Department of Environment and Natural Resources — Division of Water Resources Revised August 2013

WELL CONSTRUCTION RECORDAEGiwp1REKDNR/DWR
1. Well Contractor Information:
Jason P Morton 18
Well Contractor Name
2953-A
NC Well Contractor Certification Number
Morton Drilling
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC, County. State. Variance, etc.)
3, Well Use (check well use):
Water Supply Well:
Agricultural (Municipal/Public
Geothermal (Heating/Cooling Supply) OResidential Water Supply (single)
Industrial/Commercial Residential Water Supply (shared)
Irrigation
Non -Water Supply Well:
Monitoring DRecovety
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
fGeothennal (Heating/Cooling Return)
Water Quality Regional
Operations Section
Wilmington Regional Office
For Internal Use Only:
Groundwater Remediation
Salinity Barrier
£Stonnwater Drainage
Subsidence Control
Tracer
Other (explain under #21 Remarks)
4. Date Well(s) Completed: ID 2'?4 U Well ID#
5a. Well Location:
Gorr, /rtL-"4
FacilityIOwn4r Name Facility 104 (if applicable)
Physical Address, City, and
Carteret
p
County
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
y°tie 52, as 66V1136t2-0
Parcel Identification No. (PIN)
6. Is(are) the well(s)JPermanent or 0ITemporary
7. Is this a repair to an existing well: jYes or JNo
IO is a repair, fill out known well construction information and explain the nature of the
repair under h21 re,narkr section or on the back of this form.
8. For CeoprobelDPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is negdL Indicate TOTAL NUMBER of wells
�/�g
drilled: )
9 Total well depth below land surface:
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing:
If water level is above casing, use "+„
7'40.
11. Borehole diameter:
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
(in.)
P°''/
FROM
FROM
14, WATER ZONES
TO
/20. ft.
DESCRIPTION
45;439
ft.
ft.
15. OUTER CASING (for multi -cased wefts).ORT INNER (if.a 'feeble)
DIAMETER THICKNESS ] MATERIAL
ft. in.
FROM TO
rt. 1
16. INNER CASING OR TUBING (geotheritial Closed -loop)
FROM TO DIAMETER THICKNESSin.
ft. ft. �� �V
ft, ft. in.
1
17. SCREEN
FROM
19 vt.
r
ft.
TO
1 r ` .
ft.
I8. GROUT
FROM
n.
ft.
ft.
TO
20 rt.
DIAMETER SLOT SIZE
ft.
ft.
t f in.
in.
MATER AL
Aem
MAT
THIC NESS
MATEIt1AJ„
EMPLACEMENT MTROD&AMOUNrT
119. SAND/GRAVEL PACK (if applicable)'
MATERIAL EMPLACEMENT mErioo
)
art.
ft.
TO
(ft.)
(ft.)
ft.
S
20. DRILLING LOG (attach additional sheets If necessary)
FROM
ft.
35 ft.
jn ft.
f 2ft.
ft.
ft.
TO
ft.
G ft.
21. REMARKS
ft.
ft.
ft.
DESCRIPTION (color, hardness, oiVrock type, grain size, etc.)
sSietnciv
"" QQ•
R
uP
0.44
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) q 0 Method of test: AIR
f'I v
22. Certification:
Sire ofCertified•' Contractor
signing this form, 1 hereby certify that the walks) was (were) constructed in accordance
with 15,4 NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy of this 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
cnnstntction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, 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 one copy of this form within 30 days of' completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Infection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
. ,. ,. ., ._..__ ._ .t._ ..,........ t.,,..1.1. , ,,n.t, ,,t of thn rnnnt,
CL-,
Date

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
RECEIVED/NCDENR/DWR
Jason P Morton
Well Contractor Name
2953-A
NC Well Contractor Certification Number
Morton Drilling
NOV 1 3 2018
Water Quality Regional
Operations Section
Company Name
2. Well Construction Permit #: /T / /0
Wilrnirr ton Regional Office
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
Non -Water Supply Well:
Monitoring
IjMunicipal/Public
16 is
1
esidential Water Supply (single)
Residential Water Supply (shared)
Recovery
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothennal (Closed Loop)
Geothermal (Heating/Cooling Return)
DGroundwater Remediation
Salinity Barrier
JStonnwater Drainage
DSubsidence Control
Tracer
ElIOther (explain under #21
Remarks)
4. Date Well(s) Completed:` / p
5a. Well Location:
-Vi 6 %LI cG, eft
Well ID#
Facility/Owner Name Facility ID# (if applicable)
Il 5 Geettoiti kers- 1c(virck/ 3
Physical Address, City, and Zip
Carteret
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one latlllo//ng is sufficient) z
-Vie?V 1 /`Pr�17 tr . N6 3q q3,
6. Is(are) the well(s)IJPermanent or DTemporary
7. Is this a repair to an existing well: QIYes or No
If this is a repair, fill out known well construction it formation d explain the nature of the
repair under #21 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, onjl �I� W/-1 ipeeded. Indicate TOTAL NUMBER of wells
drilled: 62
9. Total well depth below land surface: / Q (ft.)
For multiple wells list all depths if different (example- 3 200' and 2@100')
10. Static water level below top of casing:
If water level is above casing, use "+
11. Borehole diameter: ? 6 (in.)
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
(ft.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm)
13b. Disinfection type: Chlorine
Method of test: AIR
Amount: /
For Internal Use Only:
455433
14. WATER ZONES
FROM
TO
DESCRIPTION
. ft.
`�i "
/ 7rY1 ft.
r�
/��
I
ft.
ft.
15. OUTER
CASING (for
multi -cased wells) OR LINER (f applicable)
FROM
TO
DIAMETER
THICKNESS
I MATERIAL
ft.
ft.
in.
16. INNER
CASING OR TUBING
(geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
/ ft.
p �� ft.
r
i rL in.
'
r• a i l Lv
�� t Y
pj
r
ft.
ft.
l in.
17. SCREEN
FROM.
TO
DIAM
TER
SLcOyT
THIC ESS�
MATERIAL
!
' ft.
in.
/r
5 ````77LL
1
)
ft.
ft.
in.
18. GROUT
FROM
TO
MATE
METHOD DU
Cft.
O ft,
19�W®�
f.
ft.
ft,
rt.
19. SAND/GRAVEL
PACK
(if applicable)
FROM
TO
MATERIAL
EMPLACEMENT ME HOD
4.5 f.
1%%f.
oi
ore d
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness%soittrock type, grain size, etc.)
00a ft.
ft.
? 7 2c
35 ft.
ft,
S
J 0 ft
J t.
/ .0.
t //t.
X
ft.
ft.
ft.
ft.
ft.
ft.
r z e ('
21. REMARKS
1.:0V 0 8 2018
22. Certification:
re ofCertified Well t ontoactor
>'xr'i:t!ion Yrccew .i,•"';
�/'11O/ c h� vG
:signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy of this 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contracor Information: -
Well Contractor Name
2 CA 5 /
NC Well Contractor Certification N rnbcr
Company Name W ter Quality Regiona
`` ,, �j rations Section
2. Well Construction Permit #: r� L j� J�f. )t') {,� � Tonal Off
List all applicable well construction permits 6,e. U1C, aunty. t Alp Ft r
3. Well Use (check well use):
For Internal Use Only:
45524 3
rl
NOV 13 2018
Water Supply Well:
lAgricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
Non -Water Supply Well:
Monitoring
Municipal/Public
esideutial Water Supply (single)
Residential Water Supply (shared)
f Recovery
Injection Well:
[Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed:
IJGroundwater Rentediation
QlSalinity Barrier
JStormwater Drainage
DSubsidence Control
UTracer
riOther (explain under N21 Remarks)
61'27') U Well ID#
5a. Well Location:
36 SP2 L (V') > k)
Facililiitty/Owner Naa!mey� �J �' 2 Facility IDN (if cable)
2t/ 7 / J f" e 1 ' ' L `d
Physical Address.,, City,Ciand Zip
CA- QtC.&•t
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient) r
LI712Li' Lg" N�i�5Zt 50,05 )/ W
6. Is(are) the well(s)
>' 1il
ermanent or DTemporary
7. Is this a repair to an existing well: Dyes or ri', o
If this is a repair, fill out known well construction information and explain the nature oldie
repair under #21 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is need. Indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface:
For multiple wells list al! depths it -different (example- 3@200' and 2(ct)100')
10. Static water level below top of casing:
!f water level is above casing. use "+" C
Al t
11. Borehole diameter: /
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
deg
ft
(ft.)
(ft.)
114, WATER ZONES
ROM To
DESs fur'TION
rA ft.
ft.
1 0 6 rL
n.
15. OUTER CASING (for multi -cased wells) OR LINER (if applicable)
FROM
ft.
TO
>
AMETEK THICKNESS
in.
16, INNER CASING OR TUBING (geothern al closed -loop)
FROM TO DIAMETER THICKNESS
MATERIAL
MATERAAI.
ce
ft.
ft.
u.
ft.
ft.
in.
17. SCREEN
FROM
ft.
TO
o(J ft.
DIAMETER
ft.
2 in.
SLOT SIZE
TIT SS
Y
.o
MATERIAL
Y
In.
18, GROUT
FROM
TO
2- R.
ATER A.
EMPI AC; 'Ai r:V'I' ME I OD & AMOUNT
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM TO MAT lAl.
OP /
ft.
fL
I .\II'I (1RM1IENT MErIiQD
lf3U r 42,
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM TO DESCRIPTION (calor, tumbles, so;Vrurk type grain size, etc.)
ft.
g~ ft.
ft.
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type h 10 A Pict.
Amount: ©/
ft.
26 rt.
/©y't.
%- d t( C
ft.
ft.
ft.
21. REMARKS
rt.
RECSIVErn
NOV 0 5 2013
22. Certification:
er7
99dd rT11��/'�r�'ationmrclliu`�
Inc of Certified Well onuncio'
Date
By signing this .form, / hereby cevif that the nr1ts) was t',eercr ronstruc'tcd ire accordance
with I5A NCAC 02C.0/00 or 1 SA NCAC 02C .0200 Wed! (',nerirea )ion Standards mid that a
copy of this 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells: In addition to sending the litrm to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Infection Wells: In addition 10 sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
of Fnvirnnncental Duality - Division of Water Resources Revised 2.222 2016

t-
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
� �W
Well Contractor Name
a
NC Well Contractor Certificati n Number
NCDENR/DWR
WID'')��)��������� Q ({ 1N` (�.�r N O V 13 2 018
Company Name ater Quality Regional
? 1(./Operations Section
2. Well Construction Permitn is �t It } �, MX,1)•)iVi Office
List all applicable well construction permits (i.e. inc. C +l %rile• iVa'i
3. Well Use (check well use):
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
Non -Water Supply Well:
Monitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
unicipallPublic
csidential Water Supply (single)
Residential Water Supply (shared)
DRccoveiy
Groundwater Remediation
QlSalinity Barrier
©IStonnwater Drainage
DSubsidence Control
DTracer
ElOther (explain under #21 Remarks)
4. Date Well(s) Completed: 10`►[�`�
5a. Well Location:
Facility/Owner Name
Well 1D#
For Internal Use Only:
45524Z
Facility ID# (if applicable)
Pec 1 , HC. A)C
Physical Address, City, and Zip
14. WATER ZONES
FROM TO
[port. MO rt.
ft.
rt.
oescatrTloN__/��/,
15. OUTER CASING (for
FROM 9'O
ft.
ft.
utll.cased wells) OR LINER (if applicable
DIAMETER THICKNESS- 5L(T£RIAt
16. INNER CASING OR TUBING (geothermal aose(1.iuup)
FROM
TO
DIAMETER
'I'll! :KN4:SS
MATERIAL
ft.
1
fp �rt.
(
L1.L in.
(
5 /L D
7
? V C-
R.
ft.
in.
Parcel Identification No. (PIN)
County
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one laVlong is sufficient) , f 1
? N 76Eyi{ /9
6. Is(are) the well(s)
iw
ermanent
or JITemporary
7. Is this a repair to an existing well: )r es or ONo
If this is a repair, fill out known well constructinformation and esplahi the nature o(the
repair tender #21 remarks section or on the buck of this form.
8. For Geoprobe/DPT or Closed-LooP Geothermal Wells having the same
construction, only 1 G snee . Indicate TOTAL NUMBER of wells
/�
drilled: T
9. Total well depth below land surface:
For multiple wells list all depths if different (example- 3(1,1200' and 241OO)
10. Static water level below top of casing:
11 water level is above casing. use "+;�;
11. Borehole diameter: (�(in.)
0 hq're/
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
17. 6(.Kt.r,ry
FROM
TO
DIAM TER
aLoT siZETints
¢: �'1:SS�
M1tA
/
v
v -
IL
ft,
In•
IS. GROUT
rROM
TO
Ft{!'
[.M£rHODl0
alhJ ft.
V ft.
}�.yy,
_rVVVn//ri'
tk
gp0r' ��/6.:"•
ft.
ft.
ft.
ft.
PACKsif applicable)
19. SAND/GRAVEL
FR M
'10
MATERIAI.
I'I.ACF.NI F..NI \ll• '1100
ft.
hp ft.��
..
0 re
/ R.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO DESCRIPTION (color, to rduess. s ilh...ek typPe�_rnin size, etc.)
0 ft.
`r-1.r. ft. d,r/( C J-
5 n,
6 6 rt. <j' Y1 �`"
J6V ft.
Ib' ft. CAL
jbb ft.
V
1 1343rt. fi ,1-
ft.
ft. _
ft.
ft. C 1V . f
ft.
ft.
032013
1\11
21. REMARKS
)1:111{COVVOMCG
l idnPfoc
(ft.)
(ft.)
22. Certification:
964 zo- /8
arc of Codified Well Contractor Dale
y signing this form, I hereby ceriili' that the wellto wits tweet.; av,nstrue•hal in aceurdeau:e•
with 15,1 NG4CO2C .0100 or ISA NC/IC 02C' .0200 Well Cnnsuvntion Standards and that a
copy et( this record liar been provided to the well Owner.
23. Site diagram or additional well details:
You may use the back of this page to provide add itnuaI rvell site details or well
construction details. You may also attach additional pages i1 necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Ralci; h. NC 27699-1617
24b. For Infection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 3o drys of completion of well
eon0tnlction 10 the following:
Division of Water Resources, Underground ltt,icclion Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells: lit addition to sending the form to
the address(es) above, also submit one copy of this furor within 30 clays of
completion of well construction to the county health department of the county
where constructed.
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
(OA UI 1[ - Amount:;-
13b. Disinfection typ
North Carolina Department of Environmental Quality - Division of Water Resources
Revised 2-22-2016

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Jason P Morton
RECEIVED/NCDENR/DWR
Well Contractor Name
2953-A
NC Well Contractor Certification Number
Morton Drilling
Company Name
2. Well Construction Permit #:COM
OCT 292018
Water Quality Regional
Operations Scction
W`� beo etgional Office
List all applicable well construction permits (i.e.
3. Well Use (check well use):
Water Supply Well:
Agricultural
Geothernal (Hcating/Cooling Supply)
Industrial/Commercial
irrigation
iInjection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
WC. Como.. State. Variance, etc.)
[]Municipal/Public
aResidential Water Supply (single)
QlResidential Water Supply (shared)
Non -Water Supply Well:
Monitoring [ itccovecy
Groundwater Rcinediation
DISalinity Barrier
QiStornlwater Drainage
[Subsidence Control
Tracer
DOther (explain under #21 Remarks)
4. Date Well(s) Completed: / - 1 g Well ID#
5a. Well Location:
4MI'\ (- � � Id
Facility/Owner Name
Facility IDit (if applicable)
rt"wfl 0 e Q- -� t N �-
Physical Address, Cit , and Zip
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
Orwell field, one lat/long is sufficient)
?y°1/47'.Ss 7/ f' N77`5
4/'55, ,2
6. ls(are) the well(s)ermanent or Q1Temporary
c
7. Is this a repair to an existing well: IYes or gij o
oh, se a repair. fill oat known well cons(,,(/u)n inlornla(i,n ad explain the nanu'e of (he
repair under #2I remarks section or on the back of this foam.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:
C7N
9. Total well depth below land surface: y C)
For multiple wells list all depths if different (example- 3(1.a200'and 2(o 111(J')
(ft.)
10. Static water level below top of casing: / _5 (ft.)
((Miter level is above casing. use
"]+"
11. Borehole diameter: (in.)
12. Well construction method:
/ < D >.
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm)
13b. Disinfection tygc Yl I 0 12t IV f' Amount:
Method of test:
Al f Z
FROM
For internal Use Only:
14. WATER ZONES
FROM TO
-iv rt.
ft.
CrL) rt.
ft.
DESCRIPTION
15. OUTER CASING (for multi -cased wells) OR LINE It or applicable)
lROaI TODIAMETER'I"I Het: VI(5l A.�\'I'tiLV,
16. INNER CASING OR TUBING (geothermal closed-Ioo,
DIAMETER THICKNESS T-_____ R_:u.
r�o1 -C-
ft.
TO
.")0 ft.
11.
17. SCREEN
FROM TO
'70t.
n. n.
I8. GROUT
rt.
DIAMETER
/L in.
in.
Ire.
in.
sit) r SI%I: I TIIIC6\
2 > [5c1
FRO0I
0 ft.
rt.
1'O
.o n,
ft.
nt.cr�.0
eie VI,vZ't(
'1.\(:t_\It: \I(:rt (ill l('.\:\Ifll'\'1'
�t)rfcl I 400 I:oS
ft.
n.
19. SAND/GRAVEL PACK (if applicable)
FROM
7O It,
ft.
TO
L•) ft.
ft.
MATT:RL,r.
i
L
20. DRILLING LOG (attach additional sheel.c if neeessar, )
FROM
ft.
ft.
ft.
5 �
->av ft.
TO
33- ft,
50 ft,
'v 0,
q fl,
DESCRIPTION (`1,Inr. 1.111112 .nil rncl, t Lin .iic_a _.
Siny,dy cG->
e L >`t-1-2�
n.
ft.
ft.
ft.
21. REMARKS
n.
OCT 2 3_2°18
22. Certification: l 14mot 1v, °ram
A2 t _2-
SiY(ref e of Certified Well Contractor
signing this Jiro. I lrerebr cerrifi• than rhr vrlllel wise nrrrr, n,ns,rnr7r,! u: ,nr,n•danrr
with /5.1 A'C.4C (12C .'1/00 or 15.4 MAC ll2(' (121n1 Il i•1/ (',ua.a'nro,uw .Goo Intl. ,aid that a
copy al this rcrurd hose',cell provided to Mc well owner
Date
23. Site diagram or additional well details:
You may use the back of this page to provide additional ,v.11 site dcuoi,, or ,cell
construction details. You may also attach additional hages ifncc s;n}.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form wilhin 10 days 01 completion id well
construction to the following:
Division of Water Resorrr cgs, Information Processing Unit.
1617 Mail Service Center, Raleigh..\( 27699-1617
Z4b. For Injection Welts: In addition to sending Ih Ii,rnt lu the address in 24a
above, also submit one copy of this form wilhin 30 days of completion of well
construction to die following:
Division of Water Resources, Underground Injection ['ontrol Program,
1636 Mail Service Center, Raleigh, \( 27699-1636
24c. For Water Stuf111v & Injection Wells: In addition to ;cndiva the liver to
the address(es) above, also submit one CI pr of 1h1'. 1'on1, wid,in ;(I flays of
completion of well construction to the cw,uniy health dcpartment of the county
whcic constructed.
Form GW.1 North Carolina Department of Environincnial Quality - Division of IVnler Rcsourecs 20Ifi

1. \Veil Contractor Information:
Jason P Morton
well Conti -aeon Manx
2953-A
NC Well tnntractur frnifi �:!„u Number
Morton Drilling
Company Xa na
2. Well Construction fermi[ #:
list a// rep/,iir vh;r "r:! , I,r..+n presort., (i.e. f /('. ('aunts. State. Yarianrt•. err.)
F Ltd., t.VrrJ I t<LA I Ill:\ 1c1,1.V1VJ (I,YY-1/
RECEIVED/NCDENR/DWR
OCT 292018
Water Quality Regional
Operations Section
ifrnington Regional Office
3. Well Llse (check hell use):
1\Voter Supply Welt:
IAgricultul'al
IGeolhcratal it-l.:m ('oolint: Supply)
Ilnduslrinl Commercial
l lrric:!Lion
Non -\water .Supply %\'ell:
'Monitoring
Injection Well:
'Aquifer Recharge
!Aquifer Storage and Recoccry
:Aquilcr'rest
Experimental Teelimil,t•.",
tGeothermal I( Inned I :alit
nGeother,ua! (I1.ntinp:t't'4 hI1,; I:'lurnj
4. Dale Well(s) Completed:
Sa. ',Veil Location:
_113Ai) s
1Jo
El Municipal/Public
MResidential Water Supply (single)
tResidcnlial Water Supply (shared)
• U Recovery
Groundwater Rencediation
L Salinity Barrier
DStorntsvater Drainage
QiSubsidence Control
OTracer
n!Other (explain under #21 Remaiks)
Well ID#
Facility !Dt! (if applicable)
33 /NCt'''Prw'l p t
I'Irysical \ride.,,. t'n,.:,:ui !:p
County
Parcel Identification No. (PIN)
5b. L.alitudc and longitude in degrees/minutes/seconds or decimal degrees:
well licit!. oil.: laliun7. is.ufliiwilt)
6. Is(are) the uelks)]{YtPermanent or DTemporary
7. 1s this a repair ID au c\isting Well:Yes or DNo
I(rhr. e, :::rf,ur. fill „err ,:rr , „r ,�..;l , ..err inze;.t t infr,raaion and explain the MIMI, Of the
main. rout.. ••_'1 r,•mur1. ,, , n, ,:.,r nu tor• huca n(t11is faun!.
S. For (;eOpro w/1)P 1 or Closed -Loup Gewhcrnial \VcIIs having the same
construction, only I OW -I is needed. Indicate •rOTALNUMBER of wells
(frilled: Q l J (�
9, "Total well depth helms land surlt/itce: O
Pal anal:pie ...Hy list an depth. ;r dill: row rexamplc- 11 200' and 20o/00')
10. S):!IiC w:!ter level helots IN) of casing:
// u1urr ;reel u' uhurr, ,nun:. roe - -.
11. Borehole diameter: (in.)
12. \1'eil eonslruction Rtrlhntl:
(i.r•:mere. riitar. athl...hrii! 1+1:,11. cie l
(ft.)
FOR \V:\'IER SUPPI.\ \V1•:I..I.ti ON IN:
13a. Yield (gent) rJ`_. Method of test: //}-j/2
13 b. Disinlecliun rypt h 1 p?? (,tie Atnount: (! S
rue Illlla'llal U1e l/ut)'.
45511.E
14. WATER ZONES
FROM
TO
DESCRIPTION
1 t� l CI.
/ Q��'rt.
,c-6-c-
fl.
rl.
15. OUTER CASING (for multi -cased wells) OR LINER (if aprlicable)
FROM
To
DIAMETER
THICKNESS
MATERIAL
16. INNER CASING OR TURING (Eeolhern
al closed -loop)
FROM
TO
DIAMETER
'I'IIICKNESS
MATERIAL
ft.
rt.
In.
rt.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THIC NESS
MATERIAL
/M'
/ S7Lr1.
: in,
ZJ
s_e. vO
/) V G
I'I
rt.
in.
1S. GROUT
FROM
TO
MA"fl':RIA .
EMPLACE NT METI OD & AMOUNT
0 II'
v R.
4'etifoxf
..., 0r c/ i/e,le ZA
ft.
ft.
ft.
ft.
19. SAND/('RA1- EL PACK (If applicable)
mom
41)
MATERIM.
EMPLACEMENT ME'F OD
' f fL
/ ,s II.
!�
ER-7--e e
✓ 7
Pour e d
rt.
rt.
20. DRILLING LOG (altath additional sheets If necessary)
FROM
'1'O
DESCRIPTION ((color, harness, suit/rock type, aroIn size, etc.)
--) rt.
L
J , ft.
-.S/ 17oc/
R.
q D rl.
L (g(��
9) ft.
j ` c) ft.
����
/ , rt.
/!V iz ft.
-�(((�
2t2-
ft.
ft.
^" A r
rt.
ft
E. 1 ..
21. REMARKS ry{'T 61P a4 08
lakoligttjon i'IIL+K..a/44,4 a4 aai ('
22. Certification:
Si rcrofCilicd Wcl Co radar
Date
By signing MIs Jarnr. / hereby cet'tr(i' that the well(s) was (were) constructed in aecardarce
with (5.4 NCAC 02C .0100 or 15A NCAC 02C .0200 N'cll Construction Standards and that a
copy (1/ this record has been provided /0 the well owner.
23. Site diagram) or additional well details:
You may use the hack of this page to provide additional well site details or well
construction details. You (hay also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS •
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
above. also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For \Vater Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Fern, I I\1 -: North Carolina Department of Environmental Quality - Division of Water Resources
Revised 2-22-2016

WELL CONSTRUCTION RECORD 1�/
This form can be used for single or multiple weli1C(,FI\!Ej/NCDENR/DWR
1. Well Contractor Information:
Joey Thigpen
Well Contractor Name 4.T 2 �r
NC Well Contractor Certification Number
Thigpen Well Drlling
-?4Z018
tier .luality Regional
::,aerations Section
;viin)inr•.ton Regional Office
Company Name
2. Well Construction Permit #: W10800494
List all applicable well permits (i.e. Couniy, State, Variance, Injection, etc)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ IndustriaUCommercial
❑ irrigation
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
❑Monitoring
ORecovery
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
❑Groundwater Remediation
❑Salinity Barrier
❑Stomwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 421 Remarks)
4. Date Well(s) Completed: 7-27-2018 Well ID#
5a. Well Location:
Paul Newby
Float, LLC
Facility/Owner Name Facility EDi( (if applicable)
445 Maritime Place, Atlantic Beach 28512
Physical Address, City, and Zip
Carteret 634408999859
County Parcel identification No. (PiN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
n/a N n/a
6. Is (are) the well(s): ❑Permanent or ❑Temporary
w
7. Is this a repair to an existing well: ❑Yes or 0No
If this is a repair, fill out known well construction information and explain the nature of the
repair under k21 remarks section or on the back of this form.
8. Number of wells constructed: 4
For multiple injection or non -water supply wells ONLY with the same construction. you can
submit one form.
9. Total well depth below land surface: 255
For multiple wells list all depths ifdifferent (example- 3@200' and 2@/00')
10. Static water level below top of casing: n/a
If water level is above casing, use •'+•'
11. Borehole diameter: 5 (in.)
12. Well construction method: Mud Rotary
(i.e. auger, rotary, cable, direct push, etc.) •
For Internal Use ONLY:
it,vy'l AO
14. WATER ZONES
FROM
TO
DESCRIPTION
000 fL
ft
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if applicable)
FROM
TO
DIAMETER
THICKNESS MATERIAL
n/a ft'
ft.
in.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
000 fL
255 ft.
1 in'
SDR 11
HDPE
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
n/a ft,
it
in.
ft.
ft.
in.
I8. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
000 ft•
255 ft.
Bentonite
Pump/Tremmie
ft.
ft.
-
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEM ENT METHOD
n/a ft
fL
ft.
ft.
20. DRILLING
LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
000 ft
its rL
Sc J.
iav ft.
� fL
5 .�;�, p.-7/�
�I fL
(f
ems- ft.
-CG-e,C
ft
ft
fL
ft.
fL
ft.
fL
ft
21. REMARKS
Drilled 4255' boreholes and set 1" geothermal loop
@ 250' in each. Grouted entire borehole from bottom
22. Ce cation:
ature of ►,t i eel Welljj'ontractor Date
y signing this form, 1 hereby cert that the wells) was (were) constructed in accordance
with i5A NCAC 02C .0100 or iSA NCAC 02C .0200 Well Construction Standards and that o
copy of this 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
• 1617 Mail Service Center, Raleigh, NC 27699-1617
r1 t�i{ttt. For injection Wells ONLY: In addition to sending the form to the address in
above, also submit a copy of this form within 30 days of completion of well
O l7 construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells:
Also submit one copy of this form within 30 days of completion of
well construction to the county health department of the county where
constructed.
(ft.)
_(ft.) '
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm)
Method of test:
13b. Disinfection type: Amount:
Form r:w_ 1
North r2rnlinn rlenarnnenr of Fnv,rnnment anti Namr,l Rrcnnrrre - rlivicinn of Wot.r RPen„mPe F.,dr.,t m 1 a

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
RE„{IlED/NCDE{dR/DWR
1. Well Contractor Information:
Joey Thigpen
Well Contractor Name
NC Well Contractor Certification Number
Thigpen Well Drlling
SEP 0 4 2018
',Water Quality Regional
Operations Section
Wilmington Regional Office
Company Name
2. Well Construction Permit 0: W10800480
List all applicable well permits (i.e. County, Stale. Variance, injection, etc)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ industrial/Commercial
❑Irrigation
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
❑Monitoring
❑Recovery
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
OGeothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 1121 Remarks)
4. Date Well(s) Completed: 8-1-2018 Well ID#
5a. Well Location:
Catherine Williams
Float, LLC
Facility/Owner Name Facility iDN (if applicable)
402 South 13th St, Morehead City 28557
Physical Address, City, and Zip
Carteret 638618408471000
County Parcel Identification No. (PiN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
n/a N n/a
W
6. Is (are) the well(s): laPermanent 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 oldie
repair under 421 remarks section or on the back of this faro.
8. Number of wells constructed: 4
For multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
9. Total well depth below land surface: 200 (ft.)
For multiple wells list all depths if different (example- 3®200' and 2@I00')„
10. Static water level below top of casing: n/a k • '
If water level is above casing. use "` "
11. Borehole diameter: 5 (in.)
12. Well construction method: Mud Rotary
.)
3 �(f2.010
For internal Use ONLY:
ALs
14. WATER ZONES
FROM
TO
DESCRIPTION
000 ft
ft
ft.
ft.
15.O11TER CASING (for multi -cased wells) OR LINER (if a iicable)
FROM
TO
DIAMETER
THICKNESS MATERIAL
Na ft.
ft.
in.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
000 ft'
200 ft-
.75 in'
SDR 11
HDPE
ft.
ft
in.
17.SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
n/a ft,
ft.
in.
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
000 ft
205 ft-
Bentonite
Pump/Tremmie
ft.
ft
.
ft
ft
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
n/a e.
ft.
it.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION color, hardness, soiVrock type, grain size, etc.)
000 ft
36. ft
!.-
30 ft.iff
d f.
5A /�
Q ft.
gv ft
.' 4.1--oe
ft.
'i,vift.
(4
ft
ft.
/
it.
ft.
ft.
ft
21. REMARKS
Drilled 4-205' boreholes and set .75" geothermal loop
@ 200' in each. Grouted entire borehole from bottom
22. Ce
Lion:
ture of Ce
Date
By signing this form, 1 hereby cert fy that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy of this 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Resources, information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
2411..For Injection Wells ONLY: In addition to sending the form to the address in
•<'24a'a1ove, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells:
Also submit one copy of this form within 30 days of completion of
well construction to the county health department of the county where
constructed.
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
tau _1
�r,...r, r,...l;..., rl...,.,.....a ..PG....:m......,., ,..d U,,,...,I A. .......... .......:......OUL.... o..........

RECEIVED/NCDENR/DWR
WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor information:
Joey Thigpen
SEP 0 4 2018
Well ontractor Name
NC Well Contractor Certification Number
Thigpen Well Drlling
Water Quality Regional
Operations Section
Wilrningtoll Regional Office
Company Name
2. Well Construction Permit #: W10800499
List al! applicable well permits (i.e. County, State, Variance, Injection, etc)
3. Well Use (cheek well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ industrial/Commercial
❑irrigation
❑Municipal/Public
❑Residential Water Supply (single)
(=Residential Water Supply (shared)
Non -Water Supply Well:
❑Monitoring
❑Recovery
Injection Well:
❑Aquifer Recharge
❑ Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
ElGeothermal (Closed Loop)
DGeothermal (Heating/Cooling Return)
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: 7-1 5-2018 Well ID#
5a. Well Location:
Robert Rice
Facility/Owner Name Facility IU# (if applicable)
123 Sea Isle Dr., Indian Beach 28512
Physical Address, City, and Zip
Carteret
634405080322
County Parcel identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one Iat/long is sufficient)
n/a
N n/a
W
6. Is (are) the well(s): IIPerntanent 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 121 remarks section or on the back of this form.
8. Number of wells constructed: 5
Far multiple injection or non -water supply wells ONLY with the same construction. you can
submit one form.
9. Total well depth below land surface: 255
(ft.)
For multiple wells list all depths if different (example- 3@200' and 2 a 100)
10. Static water level below top of casing: n/a (ft.)
If water level is above casing, use "4 "
11. Borehole diameter: 5 (in.)
12. Well construction method: Mud Rotary
(i.e. auger, rotary, cable, direct push, etc.)
AUG2018
FOR WATER SUPPLY WELLS ONLY tnfcr`; =" `� •" `
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
For Internal Use ONLY:
14. WATER ZONES 4 aa
FROM
TO
DESCRIPTION
000 ft'ft
ft.
ft.
15. OUTER
CASINGffor
multi -cased wells) OR LINER (if applicable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
n/a ft
fL
in.
16. INNER
CASING OR TUBING
(geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
000 ft'
250 ft
1 in'
SDR 11
HDPE
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
n/a fL
ft.
in.
ft.
ft.
in.
1 S. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
000 ft'
255 ft
Bentonite
Pump/Tremmie
ft.
ft.
.
ft.
ft.
19. SAND/GRAVEL
PACK
(if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
n/a ft.
ft.
ft.
ft.
20. DRILLING LOG (attach additional beets if necessary)
FROM
TO
DESCRIPTION (color, hardness, solOrock type, grain size, Ha)
000 ft.
f oa ft.,-O'/
tee ft.
�t?d ft-
57,... e_ J411.r/&.
"ldd ft.
/5—ft,
i! AAA.•'",
2/c ft.
')�t.
�1
...„car-- d
ft
ft.
ft.
ft.
ft.
ft.
21. REMARKS
Drilled 5-255' boreholes and set 1" geothermal loop
@ 250' in each. Grouted entire borehole from bottom
22. C
cation:
Well
gnatureof ifie Con ctor
Da rim
!iv signing this form, l hereby certify that the well(s) was (were) constructed in accordance
with 1SA NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy of this 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniecton Wells ONLY: 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
construction to the following:
Division of Water Resources, Underground injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells:
Also submit one copy of this form within 30 days of completion of
well construction to the county health department of the county where
constructed.
Fnrm OW-1
North Carolina rh.nar,mrnt oft:n,nr,.nm.nt ,n,l N,n,n.l 17.rmvrno

Print Form
WELL CONSTRUCTIONRECE VE /NC G!}ENR/UWR
1. Well Contractor Information:
Jason P Morton
Well Contractor Name
2953-A
NC Well Contractor Certification Number Water Quality Regional
Operations Section
Wilmington Regional Office
Morton Drilling
AUG
Company Name C�
2. Well Construction Permit #: val 0 W v O
List all applicable well cansrruelwn p✓rnrits (i.e rl1C. C'marty. Stare, Variance. etc.)
3. Well Use (check well use):
Water Supply Well:
0Agricultural
Geothermal (Heating/Cooling Supply)
DIndustrial/Commercial
Irrigation
Non -Water Supply Well:
Monitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
Municipal/Public
Residential Water Supply (single)
Residential Water Supply (shared)
L__i Recovery
QGroundwatcr Remcdiation
fSaIinity Barrier
jStorrnwater Drainage
Subsidence Control
JTraccr
[Other (explain under #21 Remarks)
4. Date Well(s) Completed: 7-1 9 f g
5a. \\'ell Location:
Rat`i
Cote
welt ID#
FacilitylOwncr Name Facility IDe (it'applicable)
J I w.3 Nri N - r'a . / ea) pa 12 1- tie
Physical Address, City, and Zip
Carteret
County Parcel Identification No. (PIN)
5b, Latitude and longitude in degrees/minutes/seconds or decimal degrees:
unwell field, one Inl/lung is sufficient)
6. Is(are) the welt(s)iPermanent or EjTemporary
7. Is this a repair to an existing well: OYcs or ONo
If this is a repair,.fill out known well construction infrn•na lion and explain the nature of the
repair under k21 remarks secliorr or on the back of this form.
S. For Ceoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only I GW-I is needed. Indicate TOTAL NUMBER of wells
drilled:6,,/e
9. Total well depth below land surface:
For multiple wells list all depths ifdi(lerent (example- 3@)200' and 2@,100')
10. Static water level below top of casing:
If wetter !ever is above casing, use "t r
11. Borehole diameter: 1 h
12. Well construction method:
(i.e. auger, rotary, cable, direct push. etc.)
90
g
(ft.)
(ft,)
For Internal Use Only:
453380
14. WATER ZONES
FROM
'1'0
DESCRIPTION
,7 D ft.
9 0 ft.
,24., /r_
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if ap Ilcable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
rt.
In.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
r h.
V ft.
q in.
f•d 1 I4t)
1) Vc___
rt.
ft.
in.
17. SCREEN
FROM
TO
IIAMETEK-
Si.OrSIZE
THICKNESS
MATERIAL
ft.
9 J ft.
1
tom{. in.
1
V
S C ''1 t..f o
iJV C."
ft.
ft.
in.
18. GROUT
FROM
3'0
MATERIAL
EMPLACEMENT METI OD & AMOUNT
0 n.
Z- 0 ft.
.3c?A /14 l -}- 4-
/°01)re LJ d4 I
n.
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT MET IOD
'0 fl•
q ft-
S f D ,2 z-
pov r-e
rh
ft.
20. DRILLING LOG (attach additional sheets If necessary)
FROM
TO
DESCRIPTION (color, hardness, soiVrock type, grain size, ele.)
0 ft.
,L3 ft.
_5O-;AJ 1,
_35 ft.
So it.
ri y C___L a,--x-2
50 n,
e 7 ft.
C.---(.--
r� Jt.
Gf n.
_ ar,.. r'., f.. >,
ft.
ft.
�.4„ns •' '
It,
ft.
AUG 1 0 2°18
rt,
ft.
,
21. REMARKS kf4NV't-3:``' ' .',-{-`.
FOR WATER SIJPPLi'' WELLS ONLY:
13a. Yield (gpm) 5 0 Method of lest: ) i Z.
13b, Disinfection type` h )0t - Pe Amount: /
22. Certification:
ire ofCC�ficdWell Contra r�r
Date
By signing this faint, I hereby ceriiJj' that the well("s) was (were) con tract. / or acconirrnce•
with 15.4 NCAC OK:.0100 or 15A NCAC 02C .0200 We Construction Standards and that a
copy nl this 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the lollowing:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For htiection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this torn within 30 days of completion of well
construction to the following:
Division or Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & injection Wells: hi addition to sending the turns to
the address(es) above. also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
FormGW-I
North Carolina Department of Ent-ironmenral Quality - Division of Water Resources Revised 2-22-2016

Print Form
WELL CONSTRUCTION RECORD (CW-1)
1. Well Contractor Information:
Jason P Morton
For Internal Use Only:
RECEIVED/NCDENR/DWR 14. WATER ZONES
Well Contractor Name
2953-A
NC Well Contractor Ccnitication Numbcr
Morton Drilling
Company Name
2, Well Construction Pertnit #:
AUG 202018
Water Quality Regional
Operations Section
f t�li��►j�g+ gton Regional Office
List all applicable ,tell construction permits (i.e. UIC. County. State. Variant e, etc.)
3. Well Use (check well use):
Water Supply Well:
jAgricultural
QGeothermal (Heating/Cooling Supply)
Qlndusirial/Commercial
Irrigation
Non -Water Supply WeII:
Monitoring
Municipal/Public
'Residential Water Supply (single)
0Residential Water Supply (shared)
DRecovery
Injection Well:
3Aquifcr Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
QGroundwater Rcmcdiation
DSalinity Barrier
EJStormwater Drainage
Subsidence Control
Tracer
Other (explain under #2l Remarks)
4. Date Well(s) Completed: '7- f* 2-1 0 Well ID#
5a. Well Location:
Facility/OwAer Name Facility. ION (if applicable)
22-q L(Gje P)�vt° t gin
Physical Address. City. and Zip /
Carteret
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/Iong is sufficient)
321 `tlY .3 z rl N `'30C) � y5' le" e W
6. Is(are) the well(s)lX Permanent or DTemporary
7. 1s this a repair to an existing well: QYes or X,No
toms is a repair. fll out known well construction i nfarutalion and etplain the nature of the
repair under #21 remarks section or on the buck of this form.
8. For Geoprobe/DPT or Closcd-Loop Geothermal Wells having the same
construction, only I GW-I getjetl- Indicate TOTAL NUMBER of wells
drilled: (l/V F�
9. Total well depth below land surface: ( (ft.)
For nurltiple erilt list all depths rJdiJJerent (example- 3 2 and 2CI00')
10. Static water level below top of casing:
!tinter level is above casing, use "4•
11. Borehole diameter: (in.)
12. Well construction method:
(i.e. auger, rotary, cable, direct push. etc.)
/
(ft.)
FOR WATER SUPPLY W$LLS ONLY:
I3a. Yield (gpm) V t7J
1313. Disinfection type:L.0 LD.VT.%L(e, Amount:
Method of test:
)/
/ • s-
O
453379
FROM
rt.
'r0
fart.
DESCRI r'IION
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if ap Iicable)
FROM THICKNESS MATERIAL
TO
ft.
ft.
DIAMETER
in.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
ft.
rt.
TO
ft.
ft.
DIA5IF.TER
In.
in.
TIII .KNESS
l tf(
MATERTAL
pJ
17. SCREEN
FROM
g7y'jt.
ft.
'ro
t.
( ft.
DIANI Elilt
in.
in.
SI.O r SIZE
THICK ,ss
� tf0
MA'1'FRIAI.
18. GROUT
FROM
ft.
R.
TO
n.
rt.
MATE 21AJ...
BC41
l.:\GEM Eh ENT METHOD & AmouNT+
C\ 01)JI
1,L
fr.
ft.
19. SAND/GRAVEL PACK Of applicable)
FROM
so ft.
ft.
TO
(©D ft.
rt.
MATERIAL
EMI'L CEMENT METIIOt)
/)Oy re" Gi-
20. DRILLING LOG (attach additional sheets if necessary)
FROM
r0
d ft. ft.
OF:SCRIP flON (color, hardness, sr Ilrock type, grain size, tie.)
5r40-7
3 Sft.
0
ft.
ft.
rt.
y�ri C-G
C Let/
oz
fL
fl.
ft.
f1.
21. REMARKS
AUG
1 0 2013
22. Certification:
C,%
Si s._ Arcot Ccnificd Well ontracto
in*l-,fi'lt9l}0fh P:
•
�- 7- Zv
Date
y signing this form, 1 herein• certify that the rre/lfsl was (were) constructed in accordance
with ISd NCAC 02C.0100 or 15.4 NCAC' 02C .0200 Well C'o',slvction Standards and that n
copy of this 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a, For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this furnt within 30 days of completion of well
constriction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well constriction to the county health department of' the county
where constructed.
Form GW-I North Carolina Department of Environmental Quality- Division of Water Resources
Revised 2-22-2016

Print Form
WELL CONSTRUCTION
1. Well Contractor information:
Jason P Morton
RECORD (CW-1)
RECEIVED/NCDENR/DWR
Well Contractor Namc
2953-A
NC Weft Contractor Certification Numbct
Morton Drilling
Company Name
2. Well Construction Permit #:
AUG 2 0 2018
Water Quality Regional
Operations Section
Aipiklyqe,iianal Office
State. List ull applirahle well construction permits (i t. 1.11 , (orurh, Sty te. rarre, etc.)
3. Well Use (check %yell use):
Water Supply Well:
EAgrieultural
Geothermal (lleating/Cooling Supply)
RIndustrial/Commercial
Irrlgal ion
Non -Water Supply Well:
OMonitoring
injection Well:
0 Aquifcr Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed:
QMunicipalfPublic
Residential Water Supply (single)
Residential Water Supply (shared)
Recovery
JGroundwater Remediation
Salinity harrier
DStormwater Drainage
3Suhsidence Control
Di -racer
r3Olher (explain under #21 Remarks)
Well ID#
5a. Well Lgcatinn:
5`'(?ir1:Uui+ek n od-Kr. C1u�'���
Facility/Owner Name JFaaciility ID:! (if applicable)
{
Physical Address. City. and Zip
Carteret
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
Orwell field, one laVlong is sufficient)
-3y`yy y, - i " N "71/3:3' J/•'5i ' W
6. Is(are) the weIl(s)IPcr anent or DTemporary
7. Is this a repair to an existing well: DYes or XZ No
Itlris ix n repair. li!! oat knoun rvef rorffi't'ra•tian in;Ju a utirm mrd explain rite rlrrtrn'e a/ the
repair ender #21 remarks seslior, or en the bacA o/ ibis form.
8. For Geoprobc/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW:I, is ne dp.L Indicate TOTAL NUMBER of wells
drilled: Fi �.,
9. Total well depth below land surface:
For multiple wells list all thighs if di/lerenr trranrp/r- 3 q-200' and 2 rt l00'I
10. Static water level below top of casing:
1( miter /evel is above rasing. use "'•,�
11. Borehole diameter: e
12. Well construction method:
(i.e. auger, rotary, ruble, direct push. etc.)
l (ft.)
(in.)
Pv -
For internal Use Only:
' '
14. WATER ZONES
FROM
TO
DESCRIPTION '
IL
CV/
✓/
ft.
ft.
15. OUTER
CASINO(for multi
-cased wells) OR LINER (if applicable)
FROM
TO
DIAMETER
THICKNESS ljl MATERIAL
rt.
ft.
in.
16. INNER
CASING OR TUBING
(geothermal closed -loop)
FROM
TO
DIA\1 E'CF.R
MATERIAL
1S II.7
U.
70
r r in.
"�
> o
�
rt.
ft.
in.
17. SCREEN
FROM
To
IIAMFTFR
SLOE SIZE
THICKjVESSS
h1ATf.RIAh
7,. ft.
qv ft.
it in,
.Z v
56. ! 6
pv
ft,
ft.
in.
18. GROUT
FROM
T
MATERM
1
Eh11'4� '�ETI OD &
ft,
ft.
�E�E
J
YO l 10
ft.
IL
f6
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIIAAL�-,
£MPLACE4N,IENTME'CII D
�U ft.
ft.„--
'
�u C -e
fr.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
'/r
5 -i'l J `"_ A'"-------
..5-ft,
t/%
0JJ ft.
11./A
(!
rig LV
ft,
fL
n.
rt.
G.... 1�n rr. t ', ... .. L.
21. REMARKS
en
AUG 10 ZOI8
3.:
FOR WATER SUPPLY WELLS ONLY:
I3a. Yield (gpm)
13b. Disinfection type:Cel /MI de Amount: 1. S -
rj v Mcthud of test: A-)
22. Certification:
J/447;
lturc of -Certified V ell Contractor
Date U
ily signing this form, l herein• certify that the nrn(r) was (nrre) constructed in accordance
with 15.4 NCAC 02C .0100 or 1 SA NCAC 02C .0200 Well Construction Standards and that a
copy of this 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of cornpletion of well
construction to the following:
Division of Water Resources, Inforntation Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of' well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Font GW-I
North Carolina Department of Environmental Quality - Division of Water Resources Rcviscd 2-22-2016

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor information:
Well Contractor Name
NC Well Contractor Certification Number
„�0tOrdtAi l) IAA A�, (plater Quality Regional
f t 1 Operations bection
Company Name *Mj n Regional Office
•
2. Well Construction Permit #: •"IT
List all applicable well permits (i.e. County, Slate, Variance, injection, etc.)
3. Well Use (check well use):
IFor internal Use ONLY:
452el 0
Inv r cD/NCDENR/DWR
JUL 232018
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑Industria1/Commercial
❑Irrigation
Non -Water Supply Well:
❑Monitoring
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothenmal (Heating/Cooling Return)
O unlcipal/Public
• sidential Water Supply (single)
❑Residential Water Supply (shared)
❑Recovery
❑Groundwater Remediation
❑Salinity Barrier
❑Stonnwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 Remarks)
4, WATER ZONES
FROM
TO
DESCRIPTION
A tta ft.
A )11) ft.
fC t.
ft.
ft.
15. OUTER CASING for multi -cased wells) OR LINER (if applicable)
MATERIAL
FROM
TO
DIAMETER
THICKNESS
ft.
ft.
in.
,
4. Date Well(s) Completed: 1- -1 `' �1 ` Wcll ID#
5a. Well Location:
64- ,e' IN-1-cl r ks t1$fIN LAAJ — Wt.
Facility/Owner Name Facility ID!! (1' applicablc)
i h l[it t `tom -66t1 Ct : ' b
(, iJ
Physical Ad fens, City, and Zip
10. 11111e.R,f.3,..v
FROM
v -
TO
....._
DIAMETER
TIIICKNESSK
MATERIAL
/
ft.
D ft.
'(
in.
' :
144 >1 li
J L
rt.
ft.
in.
County Parcel identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field. one fat/long is sufficient) ! ,
341` /3' 51i,71,t l 7 '.3 7' t13- Pt,
6. Is (are) the wctl(s): 1�l'erntanetlt or ❑Temporary
7. Is this a repair to ane��xisting well: ❑Yes or o
si
!f this is a repair, fill out known well construction information an!! explain the nature of the
repair under 112! remark' .seetiun or Oil the back of this farm.
8 Number of wells constructed:
viva
W
For multiple injection or non -water. supply wells ONLY with the stone construction, you can
submit one form.
9 Total well depth below land surface:
FROM
17. SCREEN
FROM
TO
DIAMETER
SLOf SIZE
THICKNESS
ft.
Yv / A'
MATERIAL
ft.
ft.
t n.
1S. GROUT
FROM
L
ft.
TO
fit.
ft.
MATER AL EMPLACEMENT METHOD & AMOUNT
fI.
ft.
46/414
19. SAND/GIt.AVEI, PACK (if applicable)
10 MATERIAL
ft.
EMPLACEMENT METHOD
ft.
ft.
(ft.)
For multiple wells list all depths ifdiferen! (example- 3Q200' and 2(w100)
i.� (ft.)
10. Static water level below top of casing: �(
!f water level is above casing. use "+ "
11. Borehole diameter: 7 . ' ' (in.)
n �'12. Well construction method: JlVOr
(i.e. auger, rotary, cable, direct push, etc.)
20. DRILLING LOG (attach additional sheets if necessary)
FROM TO DESCRIPTION (color, hardness, solVrock type, grain she, etc.)
t) ft.
r ft.
ft.
11) ft.
ft.
rt.
G� 31 R.
ft.
.6,-4
S it /)m-; 1AOCk-
d ✓� --
�Nt �� f' �� d- . }•mot
y ,
2l. REMARKS
22. Certification:
tits of Well Contractor Date
(Bf signing this prin. 1 hereby certifr that the well(s) was (were) constructed In accordance
with I.SA NCAC 02C .010o or 15A NCAC 02C.0200 Well Construction Standards and !hat a
copy of this record bus been p, uvided to the sisal owner.
23. Site diagram or additional well details:
YOU may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For MI Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells ONLY: 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
construction to the following:
Division of Water Resources, Underground injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells:
Also submit one copy of this form within 30 days of completion of
well construction to the county health department of the county where
constructed.
FOR WATER SUPPLY WELLS ONLY:
Al
13a. Yield (gpnl) 6.'1 Method of rest:
�t u�
13b. Disinfection type: r "i - Amount: ..„3_, b
Form GW-1
North Carolina Department of Environment and Natural Resources -- Division of Water Resources

For Internal Use Only:
Nrinl hullo
a
1
11�
1�
WELL CONSTRUCTION RED OC DCu/n EMIR/DWR
1. Well Contractor Information:
Jason P Morton
Well Contractor Name
2953-A
NC Well Contractor Certification Number
Morton Drilling
Company Name
2. Well Construction Permit #:
List all applicahle well construction permits (i.e. U1C. County, State, Variance, etc.)
3, Well Use (check well use):
Water Quality Regional
Operations Section
Wilmington Regional Office
Water Supply Well:
1
a
1
11M
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Irri ation
Non -Water Supply Well:
Monitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (lieatin: Cooling Return)
Municipal/Public
Residential Water Supply (single)
Residential Water Supply (shared)
Recovery
Groundwater Remcdiation
I{jSalinity Barrier
EJStormwater Drainage
Subsidence Control
DTracer
Other (ex lain under #21 Remarks)
4. Date Well(s) Completed: i "/
5a. Well Location:
Well ID#
F 'lily/Owner Nam. Facility ID# (if applicable)
P s' . 28 5 t) D
acl /�
2(I (it-(lCl1l
Physical Address, City, and Zip
Carteret
Parcel Identification No. (PIN)
County
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
Orwell field, one lat/long is sufficient)
N7b b
6. Is(are) the well(s)OPennauent or DTemporm'y
7. Is this a repair to an existing well:
Yes or No
if'his is a repair, fill out known well construction inforrnarion d explain the nature of the
repair wider #21 remarks section or on the back of this ,Orlin.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 t ©-1 is,nded. Indicate TOTAL NUMBER of wells
drilled:
I
9. Total well depth below land surface: � d eft.,
For multiple wells list all depths ifdijji+renr (eranrple- 3 a 200' and 2(it,.100')
10. Static water level below top of casing: (ft.)
if wilier level is abore easing, use
11. Borehole diameter: a ' (In.) f/
/'O"
ft
W
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
Method of test: AIR
13a. Yield (gpm)
Chlorine
13b. Disinfection type:
3 ft.
G ft.
21. REMARKS
22. Certification:
rt7 Amount:
A52'7F-
DISCRII''1'ION color, hardness, solltrockapsilzaln size etc.)
57471d
L-
c�G,
L�t~Zr%t
re of Certified Well Contractor
y signing this farin, I hereby certify that the well(.r) was (were) constructed in accordance
with /5.4 NCAC 02C .0100 or /SA NGAC 02C .0200 6Vei1 Conslructlon Standards and that a
copy of this record has been provided to the well owner.
23. Site diagrain or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
in 24a
24b. For lniecl wells In addition to nwhin30 daysof completion of wellswitthe form to the hin 30 address
above, also submit one copy of this roan
constntction to the following:
Division of Water Resources, Underground injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Sup».Iy & trrieetion Wells: in addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Date
Form GW-1
Noah Carolina Department of Environmental Quality - Division of Water Resources
Revised 2.22-2016

Print Form j
WELL CONSTRUCTION RECORD (GW-1)
RECEIVED/NCDENR/DWR
1. Well Contractor Information:
Jason P Morton
Well Contractor Name
2953-A
NC Well Contractor Certification Number
Morton Drilling
Company Name
2 Well Construction Permit #:
JUL 2 3 2018
Water Quality Regional
Operations Section
Wilmington Regional Office
247504
List all applicable well construction permits (Le. WC, County, Stare, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
irrigation
Non -Water Supply Well:
Monitoring
injection Well:
Aquifer. Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Coolin; Return)
4. Date Well(s)5/3/18 Completed: _
5a. Well Location:
Ricky Lewis
DMunicipal/Public
Residential Water Supply (single)
Residential Water Supply (shared)
[]Recovery
[Groundwater Reniediation
Salinity Barrier
DStormwater Drainage
Subsidence Control
IT'racer
Other (explain under #21 Remarks)
Well1D#
Facility/Owner Name Facility IN (if applicable)
185 Waters Ln Gloucester, NC 28528
Physical Address, City, and Zip
Carteret
C- ounty
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient) C
5�y3;2/,:f8'1 N 6132'i/
For Internal Use Only: 't 52 7 `' S
14. WATER ZONES
FROM
TO DESCRIPTION at
t. Gs rt.
tQ (� ft. CS �Ll' t2� `
1�
ft.
ft.
I. OUTER
CASING (for multi -cased wells1OR LINER (if aPp1licable)
FROM
I TO
DIAMETER
THICKNESS MATERIAL
ft.
ft.
in.
16. INNER
CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
l U rt.
�i
t L in.I
D
v
ft.
ft.
in,
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
(✓' O rt.
ig 0 ft.
/j in.
Z v
�x h (�
v "
rt.
ft.
IS. GROUT
FROM
TO
MATERIAL.
EMPL CEMENT METHOD & AMOUNT
0 a,
2U ft.
vlIv •
[�t.c. r e 6 r L o f.
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
c ft.
Ll ft.
_,'
v v t� d
cs ft.
ft.
LOG additional sheets if nceessaryl
_ 20. DRILLING
FROM
(attach
'1'O
DESCRIPTION (color, hardness, soi /rock type, grain size, etc-)
u ft.
3 t� ft.
c, c% - a di___
ft.
y; ft.
"y V-1 t4.1 G_ ,'-'-'-).—
_ S ft.
6 of ft.
!l i
/ f 2ft.
3o ft.
R cr-LJ
ft,
fL
ft.
ft.
C. ^ I.s (r, T
1, (q e
Parcel Identification No. (PIN)
6. Is(are) the well(s)0Permanent or cTcmporary
7. Is this a repair to an existing well: [)Yes or INo
If this is a repair, fill out known well construction information a explain the nature of the
repair -under 1121 remarks section or an the back of this form.
R. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:
9. Total Well depth below land surface:
For multiple wells list all depths if different (example- 3 .200' and 1 a).100')
10. Static water level below top of casing: _ 1 62
if water level is above casing, use" t
11. Borehole diameter: 1, :•' (in.)
12. Well construction method: r\L''-1-71'r' .I
(i.e. auger, rotary, cable, direct push, etc.)
(ft.)
(ft.)
21. REMARKS
22. Certification:
Sign° bt ertihed Well Contractor ▪ Date
ate
signing this form, 1 hereby certify that the well(s) was (were) constructed in accordance
with 1SA NOW 02C .0100 or iSA NCAC 02C .0200 Well Construction Standard and that a
copy of 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 rvlail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Sunnly & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
FOR WATER SUPPLY WELLS ONLY:
13n. Yield (gpm) 50 Method of test: AIR
chlorine
13b. Disinfection type:
Amount: 1'50 oz
Fonn GW-1
North Carolina Department ofGnvironmental Quality -Division of Water Resources
Revised 2-22-2016

WELL CONSTRUCTION REC�tu'ND,ENR/DWR
For internal Use Only:
Nrintl-orm
4 27 tf
I. Well Contractor Information:
Jason P Morton
Well Contractor Name
2953-A
NC Well Contractor Ccnification Number
Morton Drilling
JUL 2 3 2018
Water Quality Regional
Operations Section
Wilmington Regional Office
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. WC, County. Sarre. variance. etc.)
3. Well Use (check well (Ise):
Water Supply Well:
D Agricultural DMunicipal/Public
Geothermal (Heating/Cooling Supply) esidential Water Supply (single)
DIndustrial/Commercial •' esidential Water Supply (shared)
rill -ligation
Non -Water Supply Well:
°Monitoring
Injection Well:
bAquifcr Recharge DGroundwater Rcmediation
Aquifer Storage and Recovery DSalinity Barrier
Aquifer Test DStonnwater Drainage
Experimental Technology DiSubsidence Control
Geothermal (Closed Loop) DTracer
Geothermal (Heating/Cooling Retum)_DG�Other (explain under #21 Remarks)
4. Date Well(s) Completed: I- / 3 / Q� Well ID# _
Recovery
14. WATER ZONES
FROM
DESCRIPTION
id ft.
�30 ft.
�U' G
ft,
ft.
C f r multicased we11s)AR LINER (If appncable
15. uuTER
FROM
CASfn (o
'f0
-
DIAMETER
-
THICKNESS MATERIAL
ft.
ft.
in.
16. INNER CASINO OR TUBING (geothermal
closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERiAL.
ft.
ID rt.
q in.
...caltf v
/' nv 6-
ft.
ft,
in.
17. Nt.t(CLt,
FROM
To
DIAMF. rAt
SI.OTSIZE
THIICKNEFSS
MA'I'E.RIAI.
7'0 ft.
f!
°I ft-
7in.
L
'i
2N °
Sch 7fl
Alt �"
ft.
n.
in.
18. GROUT
FROM
0 ft.
TO
O ft.
MATE AL EMPLACEMENT METHOD & AMOUNT
'j'
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
TO MATERIAL
l
FROM
qr) ft-
EMPLACEMENT METHOD
®or (' d
ft.
ft.
5a. Well Location:
N1\�� 1 }il htf'Se
Facility/Owner Name Facility ID# (if applicable)
3t % `'C uk CO V - Gs. l i� t'_ e �'tt' t' iti
Physical Address, City, and Zip
Carteret
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
19JZJ /rN Lf3, qi3 w
6. Is(are) the well(s) XDPermanent or DTemporary
7. is this a repair to an existing well: EJYes or No
If this is a repair. fill out known well construction infiumation and explain the nature of the
repair under #21 remarks' section or on the bark of this form.
8. For GeoprobeIDPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-I is needed. Indicate TOTAL NUMBER of wells
drilled: ___ 4,4Vg
9. Total well depth below land surface: 90
For multiple wells list all depths ifdittereat (example- 3C200' and 2C100')
10. Static water level below top of casing:
((water level ix (,have easing, use
11. Borehole diameter: -7 4A (in.)
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
/ LrAx
(ft.)
(ft.)
20. DRILLING LOG (attach additional sheets if. necessary)
FROM
'10
aH,
- - ft.
t )'ti ft.
ft.
ft.
S rt.
DESCRIPTION (color, hardness, soil/ruck ape, grain size, etc.)
5 'tom
Safi -; C L am_
ft.
ft.
ft.
Fps
�w g •.
ft.
21. REMARKS
ft.
71 ZO'Q
22. Certification: /{/'^///1�
Si cfia of Certified Well Contractor
Date
.y signing this form. 1 hereby ccrlify that the wells) was (were) constructed in acco,dance
with 1 SA NCAC 02C .0100 or 1 SA NCAC 02C .0200 Well Coustnrction Standards and that a
copy of this 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this tbrm within 30 days of completion of well
construction to the following:
Division of Water Resources, information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Ittiection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
constniction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & lniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this fonn within 30 days of
completion of well eonstnrction to the county health department of the county
where constructed.
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) .5 0
• >1.
Chlorine
13b. Disinfection type: Amount: r
Method of test: AIR
Forum GW-1
Noah Carolina Department of Environmental Quality - Division of Water Resources
Revised 2-22-2016

L
WELL CONSTRUCTION RECORD (GW-1)
1, Well Contractor Information:
Jason P Morton RECEIVED NCDE
Well Contractor Name
2953-A
NC Well Contractor Certification Number
Morton Drilling
JUL 232018
atet Quality Regional
Company Name Operations Section
2. Well Construction Permit #: 26528$yilmington Regional Office
List all applicable well conslruc•tiolr permits (i.e. UIC. Cotutty, State. Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
(Agricultural
IGeothelmal (Heating/Cooling Supply)
1J lndustriaUCommercial
Irrigation
Non -Water Supply Well:
Monitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Ileating/Cooling Return)
DMunicipaUPublic
Residential Water Supply (single)
DResidential Water Supply (shared)
Recovery
For internal Use Only:
11
14. WATER ZONES
FJWM •I.O
f4 t rt.
'12?
0 ft.
ft. ft.
DESCRIPTION4.el
15. OUTER CASING (for multi -cased wells) OR LINER Of a licabte)
FROM TODIAMETER THICKNESS
MATERIAL
ft. t in.
ft. I
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
/ ft.
ft.
rt.
ft.
DIAMETER
l i in.
in.
THICKNESS MATERIAL
5c114%t p
17. SCREEN
FROM
%1 0 ft.
ft.
f
TO DIAa1F;l'FR
`� o rt. fl in,
i ft. �j in,
SI.O'I' SIZE, THICKNESS
zv Soli VD vrc�
18. GROUT
FROM
j+} ft.
ft.
TO
w fL
ft.
MATERIA EMPLACEMENT HOD & AM
OUNT
MOUNT
lr N t'pLG1 G h U `r < a ,404.)
jGroundwater Rcmediation
DSalinity Barrier
DStorntwater Drainage
Subsidence Control
tTraccr
[Other (explain under #2l Remarks)
4. Date Well(s) Completed:
66127118
5a. Well Location:
Sandra Capps
Facility/Owner Name
605 Farrm Ct Morehead City, NC 28557
Well ID#
Facility IDii (if applicable)
Physical Address, City. and Zip
Carteret
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lot/long is sufficient) "
le 4 fI53sgI w
6. Is(are) the well(s)DPermancnt or DTemporary
7. is this a repair to an existing well: IYes or Di o
If this is a rchole, !iN out known well construction information and explain the nature o1•Nre
repair under 82i remarks section or on the back of
8. For Ceoproho/DPT or Closed -Loop Geothermal Wells having the same
construction only 1 GW-1 is n led. Indicate TOTAL NUMBER of wells
drilled:_ tf 1"
A Total well depth below land surface:
ft.
ft.
NDICRAVEL PACK (if applicable
sr. JA
FRO
TO
rt.
Ms•ress+••
von. ,�RarFv iFTHO
T�
,N'/
l/
r
ft.
It.
i
C) (ft.)
if
For multiple wells list all depths different (example- 3l rr 200' and 2 ca100')
f-5
10. Static water level below top of casing:
If water level is above casing, nse "+"
11. Borehole diameter: / (in.)
/2iZ7
12. Well construction. method:
(i.e. auger, rotary, cable, direct push, etc.)
l h
20. DRILLING LOG (attach additionaseets if necessary)
FROM TO DESCRIPTION (color, hardness, soiVrock type. grain site, etc.)
ft.
5 ft.
!2/*1,/ C)(
. ft
q
qD ft.
�i� G.l ►J---;.7J
.55,
q o n.
r
a 6 fl.
.Lit-,-2.---
v rt.
! G) H,
did( 4 .19Z k- .-
ft.
ft.
.,,-., t.
ft.
ft.
'y. 2��
21. IZEntaRtcs
0- UTA
c��
(ft.)
22. Certification:
Si fire of Certified Well Cbfitractor Date
y signing this .form, 1 hereby eerlijy that the well(s) was (were) constructed in accordance
with 1 SA NCAC 02C .0100 or 1 SA NC.AC 02C .0200 WVe1! Construction Standards and that a
capy Q17his 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Suouly & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) '/ fJ
13b. Disinfection type: `1)o 1` I Ai
Method of test:
Ale
Q � �i~
Amount: v' >
s
MATERIAL.
Form CW-I
North Carolina Dept tmcnt of Environmental Quality - Division of Water Resources
Revised 2.22-2016

For Internal Use Only:
41525F5
I Print Form I
WELL CONSTRUCTION RECORD (CW-1)
RECEIVED/NCDENR/DWR
1. Well Contractor Information:
Jason P Morton
Well Contractor Name
2953-A
JUL 23 2018
NC Well Contractor Certification Number Water Quality Regional
Morton Drilling Operations Section
Wilmington -Regional O ffi L e
Company Name 223736
2. Well Construction Permit #:
List all applicable nrll construction permits (Le. WC, County. State, Variance. etc.)
3. Well Use (check well use):
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Ind ustrial/Commercial
Irrigation
Non -Water Supply Well:
Monitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed: 04/30/18 Well LD#
5a. Well Location:
Richard Stevens
DMunicipaUPublic
DResidential Water Supply (single)
Residential Water Supply (shared)
0 Recovery
DGroundwater Remediation
Salinity Barrier
[:Stonnwater Drainage
Subsidence Control
DTracer
rOther (explain under 1121 Remarks)
Facility/Owner Name Facility ID# (if applicable)
533 Deer Creek Dr, Cape Carteret, NC
Physical Address. City, and Zip
Carteret
County Parcel identification No. (PIN)
5b. Latitude and longitude In degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
N77°03t��'�� W
6.1s(are)the well(s)1 Permanent or DTemporary
7. Is this a repair to an existing well: fYes or IjNo
lfthis is a repair, Jill out know+ well cansUaclion i,Jannatio,+ and explain the nalnre'ajllre
repair under t121 renarks section or mr the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the seine
construction, only 1 GW-I is need d. Indicate TOTAL NUMBER of wells
drilled: Y7i
155
9. Total well depth below land surface:
For multiple wells list all depths ifd erenr (example- 3C200"araf 2@I00')
10. Static water level below top of casing: 20 (ft.)
If water level is above casing, use "+"
11. Borehole diameter: 7 7/8 (in.)
(ft.)
14. WATER ZONES
FROM
To
DESCRIPTION
ft.
/ ZJ
/ '7 ft.
v
/�
n,
ft.
15.OUTER
CASING (for
multi -eased wells) OR LINER (if a licable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
In.
16. INNER
CASING OR TUBING
(geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
1j ft.
13 D ft.
it in.
ct�1i '1iJ
` f E-
ft.
«.
In.
17. SCREEN
FROM
'1'0
DIAMF7ER
SI.O r SIZE
THICKNESS
MATERIAL
( J lc, ft.
; f6) ft,
In.
y
V V
5C. /, t f D
P k.,'
ft,
ft,
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENTj�})M�-kTHOD & AMOUNT
/'� ft.
t/
7 c) fa
L
/�Oan tr/1 t1
(}t/r t
f
�t ".. 1 ed. � oa t
ft.
ft.
ft,
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT M$THOD
/ /t0 ft.
`'
/ S�) rt.
_ ; -3
/111 r e d
ft.
ft.
20. DRILLING LOG (attach additional sheets if nece sary)
FROM
"f0
DESCRIPTION (color, hardness, soll/rock type, grain size, etc.)
at} ft.
ft.
S AV/`-1'l
Z j ft.
�(n ft.
.S.A? �t cit1 t
/3n. f1,.
7J
`.7 oft.
/ (,iyi-
^� _
I. � ft.
) ft.
1/4:51
R.
rt.
I 0
ft.
ft.
'3' - 'a te
ft.
ff.
21. REMARKS®.
Rotary
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 50
Method of test: Air
Chlorine Amount: 2,00z
13b. Disinfection type:
22. Certification:
Si_ of Certified Well ContFactc
5
Date
JO-if
By signing dais form, 1 hereby certifj, that the u•ell(.r) was (were) constructed in accordance
with 15A NCAC 02C.0100 or ISA NCAC 02C.0200 Well Construction Standards and that a
copy of this record has been prv,vialod to the well owner,
23. Site diagram or additional well details:
You may use the hack of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, 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 one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Foot GW-I
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL CONSTRUCTION RECORD (GW-1)
runt FIJI ltl
For internal Use Only:
1. Well Contractor Information:
Jason P Morton
RECEIVED/NCDENR/DWR
Well Contractor Name
2953-A
NC Well Contractor Certification Number
Morton Drilling
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (l.e. UFC. County. State. Variance, etc.)
3. Well Use (check well use):
JUL 2 3 2018
Water Quality Regional
Operations Section
WilplinLgt 13egy:51Office
Water Supply Well:
0 Agricultural
DGeothermal (Heating/Cooling Supply)
JIndustrial/Commercial
(irrigation
Non -Water Supply Well:
°Monitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Rocovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
DMunicipal/Public
Residential Water Supply (single)
[Residential Water Supply (shared)
0 Recovery
DGroundwalcr Rcmcdiation
Salinity Barrier
JStormwater Drainage
JSubsidence Control
Tracer
Other (explain under #21 Remarks)
4. Date Well(s) Completed:`Gl 461
Well 1D#
5a. Well Location:
�1� + R 1 ( 1'Y4- 5 4--rn t' Facility/Owner Name Facility Mil (if applicable)
A.) C
Physical Address. City, and Zip
Carteret
452564
14. WATER ZONES
FROM
/ ID
ft.
ft.
ft.
DESCRIPTION
County Parcel Identification No. (PiN)
5b. Latitude and longitude in degrees/nlintttes/seconds or decimal degrees:
(if well field, one Iatllong is sufficient)
3y°yI I (7 ,D5 N 7? °o3 `2+' ` 97_ w
6. is(are) the well(s)JPermanent or ¶Temporary
7. is this a repair to an existing well: QY'es or ONo
!phis is a repair. Jill out knonw sell construction iiij ri aiion and eAplain are nature of the
repair under 82! remarks section or on the back of this./bt'en.
8. For Ceoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction only 1 GW-I is needed. Indicate TOTAL NUMBER of wells
drilled: , 0 Ai
9. Total well depth below land surface:
For multiple wells list all depths ifdif)ereat (example- .i er 200' and 2 @ l00')
10. Static water level below top of casing: I 8 (ft.)
!(ueNer level is above casing. use
-4- '
11. Borehole diameter: - 1 (in.)
J70
IS. OUTER CASINO (for multi -cased wells) OR LINER (If applicable)
THICKNESS i MATERIAL
FROM
TO
DIAMETER
ft. ft. in.
16. INNER CASING OR TUBING (geothermal closed -loop)
THICKNESS
FROM
TO
DIAMETER
( ft.
ft.
u)n.
ft.
in.
-A L(0
MATERIAL
v
17. SCREEN
FROM
jet.
ft.
'1'0
I YIP
ft.
UTAMF,IT.R
q in.
SLOT SIZE
'THICKNESS
40
MATERIAI,
in.
18. GROUT
FROM
rt.
TO
2_V ft.
MATERIAL
ft.
ft.
rt.
ft.
EMPLA MENT MIETHOD & AMOUNT
(ed
av
19. SAND/GRAVEL PACK (if applicable)_
FROM
/Z0 ft.
ft.
'TO
j 4/U ft.
MATERIAL�}
J /9 S
Es1PLACF.MEN'rM THOU
'puce�%
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
(ft.)
20. DRILLING LOG (attach additional sheets if necessary)
DIISCRie t ION (color, hardness, soil/rock type, grain sine, etc.)
FROM
ft.
'1'O
ft.
10-1)".
rt.
0-0 ft.
J ft.
y
ft.
ft,
ft.
fl.
21. REMARKS
tl�iti{.11lt)tl �'fCG9lB�'�
22. Certification:
Si re of Certified Well Con ractor Date
a.'rigning this forty,, I hereby certify that the well(s) ens (we're) constructed in accordance
with 1 SA NCAC 02C .0100 or 1 .4 NCAC 02C .0200 Well Construction Standards and that u
copy of this 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
241). For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Stitmly & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gym) 3-D
13b. Disinfection type(( i O/ ('4 (
Method of test:
Amount:
Form GW-1
North Carolina Department of Environmental Quality - Division of Water Resources
Revised 2-22-2016

WELL CONSTRUCTION RE +D jNR/DWR
I. Well C ntr ctor Information:
Hajec JUL 03 2018
Well Contractor Name
La(o1-A
2. Well Construction Permit #:
Water Quality Regional
NC W II C' ntractur C rt fication Number Operations Section
���c( We [I �Wilitnerton Regional Office
r� i �� r L�
Company name
25 ogs.
List all applicable well construction permits (i.e. (,YC, County, State, Variance, etc)
3, Well Use (check well use):
Water Supply Welk
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
OIn strial/Commercial
rrigation
Non -Water Supply Well:
❑Monitoring
Injection Well:
❑Aquifer Recharge
OAquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothcntral (Closed Loop)
OGeothennal (Heating/Cooling Return)
OMunicipal/Public
❑Residential Water Supply (single)
OResidential Water Supply (shared)
ORecovery
OGroundwater Remediation
❑Salinity Barrier
OStormwater Drainage
❑Subsidence Control
OTracer
❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: 6— /5 /?
5a. WellTLocation:
Datfid O�; Vet"-
Facility/Owner Name
Weir ID#
' /� Facility iD# (if applicable)
ogao ak br. Flue ll 5V,0025
Physical Addrfess, City and Zip
Car ere`(t 5I1v 927Wae
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/lng is sufficient) r�-�
/
/. 3�y2' 1on. ll �r N D yt ac '5
a2 t•
6. is(are) the well(s): V4ermanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or iO
If this is a repair, fill out known well construction information and explain the nature of the
repair under =21 remarks section or on the back of this form.
8, For Geoprobe/DPT or Closed -Loop Geothermal Wells having the saute
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of was
drilled:
9. Total well depth below land surface:
For multiple wells list all depths ifdifferent (example- 3@200' and 2 tt�00')
10. Static water level below top of casing:
If water level is above casing, use "
11. Borehole diameter: ? L
IGO
12. Well construction method:
(in.)
W
(ft.)
(ft.)
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY
13a. Yield (gpm)
13b. Disinfection type: C.
LLS ONLY:
•
Method of test: 4t r
Nor Amount: 3 el
IFor lnternal Use Only:
14, WATER ZONES
4514".
1
FROM
1.soft.
f.
TO
fgp ft.
ft.
-DESCRIPTION
A _
4iir _Tf N'-'tr
15. OUTER CASING (for multietasetwells) OR LINER if a !feeble)
FROM 157310 kisIAMETER 1111 KNFSS MAT F.tfIAI.
t 1 f'in a ft. a p t)6,
16. INNER CASING OR TURIjyG teeothernial closed -loop)
DIAMETER
FROM
ft.
TO
ft.
in.
THICKNESS
MATERIAL
ft.
17. SCREEN
FROM TO
isp ft.
ft.
15. GROUT
FROM
fr.
In.
1ftil ft.
ft.
DIAMETER SLOT SIZE
In.
THICKNESS
Sefl. (qv
MATERIAL
3
0 ft,
ft.
TO
Opp
3
ft.
ft.
It.
MATE L
01NG
EMPLACEMENT METHOD & AMOUNT
SLoopow 1
19. SAND/GRAVEL PACK (it applicable)
FROM ... TO .. MATERIAL
ft.
ft.
EMPLACEMENT METHOD
rt.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
TO
FROM
0 fL
6D ft.
4 --7 ft.
120ft.
(3 ft,
)60tt
ft.
151 ft.
ft.
1.20 ft.
139 ft.
ft.
DESCRIPTION (color, Gardner, soll/roek type, grata sire, etc.)
`3\\re_ c-o:
11
5t,
ram- .,I,.Q_
21. RE??fARKS
a
JUN % 5 2018
gnature of Certified We onvactor L'`s Dine._i
By signing this form, hrreb. "erirh' that the well(s) was (were) constructed in accordance
with iSA NCAC 02C .0100 or ISA NCAC 02C .0200 Well Construction Standards and that a
copy of this 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, 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 one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Infection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Fonn GW-1
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL CONSTRUCTION RECORD (_GW-1)
1. Well Contractor Information:
Jeovany Bautista
Well Contractor Name
4125 A
NC Well Contractor Certification Number
A C Schultes of Carolina, Inc.
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (Le. UIC. County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
Agricultural
©Geothermal (Heating/Cooling Supply)
Q Ind ustrial/Commercial
"") Irrigation
Non -Water Supply Well:
xDMonitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
EJ Aq ui fer Test
QExperimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed: 5/17/18
5a. Well Location:
NC DEQ
DMunicipal/Public
Residential Water Supply (single)
Residential Water Supply (shared)
JRecovery
QGroundwater Remediation
DSalinity Barrier
0Stonnwater Drainage
Subsidence Control
Tracer
Other (explain under #21 Remarks)
Well ID#X1903
WC WC
Facility/Owner Name Facility ID# (if applicable)
4102 NC-24 Newport, NC 28570
Physical Address, City, and Zip
Carteret
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
34.715696 N-76.986060
W
6. Is(are) the well(s)0Permanent or 17 jTemporary
7. Is this a repair to an existing well: QYes or X®No
If this is a repair, fill out known well construction in/brmarion and explain the nature of the
repair under 421 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the salve
construction, only 1 GW-I is needed, Indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface: 290
For multiple wells /ist all depths if different (example- 3@200' and 2 a,100)
10. Static water level below top of casing: 25.75
ljwater level is above casing. use "+
11. Borehole diameter: 9 7/8 (in.)
12. Well construction method: Mud Rotary
(ft.)
(ft.)
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
Form G W -
For Internal Use Only,
450.
14, WATER ZONES
FROM
TO
DESCRIPTION
275 it•
285 fI
Sand
a.
ft.
15. OUTER CASING (for mutt] -cased welts); OR LINER (ifap licable)
FROM
TO DIAMETER
,THICKNESS MATERIAL
0 ft.
35 ft.
10 r"'
Sch 80 PVC
16. INNER
CASING OR TUBING
(geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
+3 ft.
275 ft-
4 in'
SDR 17
PVC
285 ft.
290 ft.
4 in.
SCH 80
PVC
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
275 ft.
285 ft-
4 i"'
.020
SS
ft.
ft.
in.
1S. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft.
265 ft.
Bentonite
j
pumped
265 ft'
267 ft.
Bentonite
poured
ft.
ft.
19. SAND/GRAVEL
PACK
(if applicable)
FROM
TO
MATERIAL
EMPLACEM ENT METHOD
267 rt.
290 ft.
#1 gravel
poured
ft.
ft
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRI rrION (color, hardness, soiVrock type, grain size,etc.)
0 e.
32 rt.
Sand
32 ft.
45 ft.
Clay.
45 ft•
110 ft.
Sand, shell
110 ft'
141 ft.
Clay
141 ft.
290 ft.
Limestone, sand
ft.
ft.
r' 1
ft.
ft.
E 44rs" C: k..
21. REMARKS
JUN " 7 Z01a
.,.a neraitfl' Pr..
22. Certification:
`v 01 iSCi'
!� 5-31-18
Signal a of Certified Well ContractorDate
By .signing this form, 1 hereby certini that the well(t) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy al -this 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this Iona within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this fonn within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells: In tafd�d1i�t.io❑n �to� �senr • ,
the address(es) above, also submit one copy oRCelE4t1't1171i <i;a [ •�,'
completion of well construction to the county health department of the county
where constructed.
North Carolina Department of Environmental Quality - Division of Water Resources
J U N 1ei0e22115016
Water Quality Regional
Operations Section
Wilmington Regional Office

WELL CONSTRUCTION RECORD (GW-1)
1. WeII Contractor Information:
Jeovany Bautista
Well Contractor Name
4125 A
NC Well Contractor Certification Number
A C Schultes of Carolina, Inc.
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. (BC. County, Stale, Variance, etc)
3. Well Use (check well use):
Water Supply Well:
For Internal Use Only:
Print Form
45Q4M
14. WATER ZONES
FROM
340 a.
TO
DESCRIPTION
350 ft.
Sand
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if ap licable)
FROM DIAMETER THICKNESS MATERIAL
0 10 in. I Sch 80 PVC
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM DIAMETER
ft,
+3 ft.
TO
3
TO
ft.
340 ft.
4
in.
THICKNESS
SDR 17
350 ft.
355 u•
4
in.
DAgricultural
DGeothermal (Heating/Cooling Supply)
Q Industrial/Commercial
Irrigation
Non -Water Supply Well:
xDMonitoring
Injection Well:
Aquifer Recharge
BAquifer Storage and Recovery
Aquifer Test
QExperimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed: 5/29/18
5a. Well Location:
NC DEQ
DMunicipal/Public
OResidential Water Supply (single)
Residential Water Supply (shared)
❑Recovery
DGroundwater Remediation
Salinity Barrier
IStormwater Drainage
Subsidence Control
Tracer
[Other (explain under #21 Remarks)
Well ID#X1902
WC WC
Facility/Owner Name Facility IDN (if applicable)
4102 NC-24 Newport, NC 28570
Physical Address, City, and Zip
Carteret
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(i f well field, one !at/long is sufficient)
34.715696 N-76.986060
W
6. Is(are) the well(s)Jx Permanent or DTemporary
7. Is this a repair to an existing well: QYes or xONo
If 'his is a repair, fill out known well construction information and explain the nature of the
repair under it21 remarks section or on the back 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: 355
For multiple wells list all depths if different (example- 43200' and 2 tt,100')
(ft.)
10. Static water level below top of casing: 25 (ft.)
If water level is above casing, use ••+"
11. Borehole diameter: 9 7/8 (in.)
12. Well construction method: Mud Rotary
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
Fonn GW-I
17. SCREEN
FROM
SCH 80
MATERIAL
PVC
PVC
340 ft.
ft.
TO
350 a•
ft.
DIAMETER
4
in.
in.
SLOT SIZE
.020
THICKNESS
MATERIAL
SS
18. GROUT
FROM
0 ft.
328 ft.
ft.
TO
328 rt•
330 ft.
ft.
MATERIAL
Bentonite
Bentonite
19. SAND/GRAVEL PACK (if applicable)
FROM
330 ft-
ft.
TO
355 fL
ft.
MATERIAL
EMPI ACEMENT METHOD & AMOUNT
pumped
poured
#1 gravel
EMPLACEMENT METHOD
poured
20. DRILLING LOG (attach additional sheets if necessary)
DESCRIPTION teeter. hardness, soil/rock type, grain size, etc.)
Sand
FROM
0 ft.
TO
32 rt.
32 ft.
45 ft.
Clay
45 rt.
110 ft.
110 ft.
141rt.
Sand. shell
Clay
141
ft.
355 rt•
ft.
Limeston n
Iy
ft.
21. REMARKS
ft.
JUN 0 7 ?ow
. r)$ rtr
22. Certification:
(°45vt�
Signs re of Certified Well Contractor Date
5-31-18
By signing this form, / hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NC'AC 02C .0200 Well Construction Standards. and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You tray use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Subinit this fonn within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this fonn within 30 days of completion of well
Construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells: In addition to sending the fonn to
the address(es) above, also submit one copy of this font ‘.' bags.. p p
completion of well construction to the county health d-t•r tr it 1R/0WR
where constructed.
North Carolina Department of Environmental Quality - Division of Water Resources
JU"IVd12z12o 018
Water Quality Regional
Operations Section
Wilmington Regional Office

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor information:
Jeovany Bautista
Well Contractor Name
4125 A
NC Well Contractor Certification Number
A C Schultes of Carolina, Inc.
Company Name
2. Well Construction Permit €1:
List all applicable well construction permits (i.e. UIC. County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
QAgricultural
DGeothermal (Heating/Cooling Supply)
l )industrial/Commercial
f) irrigation
Non -Water Supply Well:
DMonitoring
injection Well:
Aquifer Recharge
DAquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed: 5/22/18
5a. Well Location:
NC DEQ
DMunicipal/Public
DResidential Water Supply (single)
DResidential Water Supply (shared)
QRecovery
QGroundwater Remediation
Salinity Barrier
EiStonnwater Drainage
Subsidence Control
Tracer
Other (explain under #21 Remarks)
Well I13nX1904
WCWC
Facility/Owner Name Facility IDt1 (if applicable)
4102 NC-24 Newport, NC 28570
Physical Address, City, and Zip
Carteret
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
34.715696 N-76.986060
W
6, Is(are) the well(s)Jx Permanent or OTemporary
7. is this a repair to an existing well: ©Yes or xINo
If this is a repair, fill out known well construction information and explain the nature alike
repair under 421 remarks section or on the back of dii.s.farur.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW- I is needed. Indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface: 1 70
For multiple wells list all depths rfdifferent (example- 3@200' and 2 .100')
10, Static water level below top of casing: 26.34
if voter level is above casing, use "+"
11. Borehole diameter: 9 7/8 (in.)
12. Well construction method: Mud Rotary
(ft.)
(ft.)
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
Form GW-1
For Internal Use Only:
Print Form
14, WATER ZONES
FROM
TO
DESCRIPTION
155 11.
165 f'
Sand
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if ap licable)
FROM
TO DIAMETER
THICKNESS
MATERIAL
0 D.
35 ft, .�•
Sch 80
PVC
16. INNER
CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
+3 ft.
155 ft.
4 in.
SDR 17
PVC
165 f''
170 ft•
4 , i"•
SCH 80
PVC
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
150 r1.
160 ft.
4 i"'
.020
SS
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METI OD & AMOUNT
0 ft143
f'•
Bentonite
pumped _
143 ft.
145 ft.
Bentonite
poured
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEM ENT M ETHOD
145 ft.
170 ft.
#1 gravel
poured
ft.
ft.
20. DRILLING
LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hominess, soiVroek type, grain size, etc.)
0 ft.
32 fL
Sand
32 f'•
45 ft•
Clay
45 ft.
110 ft.
Sand. shell
110".
141 ft•
Clay
141 ft.
170 f'•
Limestone, sand
ft.
ft.
ft.
ft.
_ a,
21. REMARKS t°•^ "`
0 7 2�
JUN
r f•, '1;NI
22. Certification:
Signatu of Certified Well Contractor
5-31-18
Date
By .signing this form, I hereby certify that the wen(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or i5A N('AC OZC .0200 Well Construction Standards and that a
copy of this record has been provided ro 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: in addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells: in addition to sending the form to
the address(es) above, also submit one copy of this fonn within 30 days of
completion of well construction to the county gm¢pt terrain
where constructed. ret� �'yy�t�u//�n�l� 1IR//�Dj�th/f�
North Carolina Deparhnent of Environmental Quality - Division of Water Resources Revised 2-22-2016
JUN 1 1 2018
Water Quality Regional
Operations Section
Wilmington Regional Office

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Jeovany Bautista
Well Contractor Name
4125 A
NC Well Contractor Certification Number
A C Schultes of Carolina, Inc.
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. (I/C. County, Stare. Variance, etc)
3. Well Use (check well use):
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
Non -Water Supply Well:
Monitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed: 5/11 /18
5a. Well Location:
NC DEQ
Mun icipal/Publ is
Residential Water Supply (single)
Residential Water Supply (shared)
© Recovery
QGroundwater Remediation
Salinity Barrier
❑Stormwater Drainage
Subsidence Control
Tracer
Other (explain under 421 Remarks)
Well ID# X 1905
WC WC
Facility/Owner Name Facility 1D# (if applicable)
4102 NC-24 Newport, NC 28570
Physical Address, City, and Zip
Carteret
County Parcel Identification No. (PiN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one latflong is sufficient)
34.715696 N-76.986060
W
6. Is(are) the well(s)0Permanent or DTemporary
7. Is this a repair to an existing well: DYes or DINo
If this is a repair, fill out known well construction information and explain the nature of the
repair under /21 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface: 110
For multiple wells list all depths ifdieren! (example- 3@200' 200' and 2 rr,100)
10. Static water level below top of casing: 1 1.84
lfwater level is above casing. use +"
11. Borehole diameter: 9 718 (in.)
12. Well construction method: Mud Rotary
(ft.)
(ft.)
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
I3b. Disinfection type: Amount:
FormGW-1
For Internal Use -Only:.- -.
450
IPrint Form
14. WATER ZONES
FROM
TO
DESCRIPTION
90 ft.
100 ft'
Sand
ft.
rt.
15. OUTER CASING.,(foe multi-cased.wells).OR LINER (ifap licable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
+3 rt'
90 ft•
4 in.
SDR 17
PVC
100 ft.
105 ft•
4 in.
SCH 80
PVC
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
90 ft.
100 ft.
4 in.
.020
SS
ft.
ft,
in.
I8. GROUT
FROM
TO
MATERIAL
EMPLACEMENT META OD&AMOUNT
0 ft'
78 ft.
Bentonite
pumped
78 ft•
80 ft-
Bentonite
poured
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
80 fL
110 ft.
#1 gravel
poured
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (calor, hardness, soil/nick type, grain size, etc.)
0 ft'
32 ft•
Sand
32 ft.
45 ft•
Clay
45 ft.
110 fL
Sand, shell
a.
ft.
ft.
ft.
�yy 9 Y fa +Y `
ft.
rt.
t.
s f
+ 1. 1
ft.
ft.
°t 201I/
21. REMARKS J��
22. Certification:
Signature ofCerti ed Well Contractor
5-31-18
Date
By signing this form, 1 hereby certify that the well(s) wax (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NC'AC 02C .0200 Well Construction Standards and that a
copy of this 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a, For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b, For Injection Wells: 1n addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells: In addition to sendingtheform to p the address(es) above, also submit one copy of y 1x�(bt'lfi l'1T[��Wil
completion of well construction to the county hea i d e county
where constructed.
North Carolina Department of Environmental Quality - Division of Water Resources
JUNRe} 42- &i
Water Quality Regional
Operations Section
Wilmington Regional Office

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Jeovany Bautista
Well Contractor Name
4125 A
NC Well Contractor Certification Number
A C Schultes of Carolina, Inc.
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. WC, County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply %VeII:
]Agricultural
�Geothennal (Heating/Cooling Supply)
Ind ustrial/Commercial
Irrigation
Non -Water Supply Well:
Monitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
'Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed: 5/7/18
5a. Well Location:
NC DEQ
DMunicipal/Public
Residential Water Supply (single)
Residential Water Supply (shared)
Recovery
DGroundwater Remediation
Salinity Barrier
fStonnwater Drainage
Subsidence Control
Tracer
Other (explain under #2I Remarks)
Well 113#X1906
WCWC
Facility/Owner Name Facility IDff (if applicable)
4102 NC-24 Newport, NC 28570
Physical Address, City, and Zip
Carteret
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
34.715696 N-76.986060
6. Is(are) the well(s)CI1Permanent or DTemporary
7. Is this a repair to an existing well: DYes or ONo
/f this is a repair, fill out known well construction information and explain the nature of the
repair under #21 remarks section or on the back 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: 35
For multiple wells list all depths ifdifferent (example- 3@200' and 2@l00)
10. Static water level below top of casing: 7.32
1f water level is above casing, use "+"
11. Borehole diameter: 9 7/8 (in.)
12. Well construction method: Mud Rotary
(ft.)
(ft.)
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
Fort G W-I
Print Form
For Internal Use Only:
450946
14. WATER ZONES
FROM
TO
DESCRIPTION
25 ft.
35 fL
Sand
ft.
ft.
IS. OUTER CASING (formulti-casetweib).Q(JR MER(ifap licable)_
FROM
TO
DIAMETER THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
+3 ft.
25 rt.
4 in.
SDR 17
PVC
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
25 ft-
35 ft.
4 in.
.020
SS
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METI OD & AMOUNT
0 ft
18 ft.
Bentonite
_
pumped
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable]
FROM
TO
MATERIAL
EMPLACEMENT METHOD
18 ft.
35 ft.
#1 gravel
poured
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
0 ft.
35 ft.
Sand
ft.
ft.
pq�
t: s' �, . do
ft.
ft.
'. 'hEC
ft.
ft.
�UN `i 2012
4'trr•. ''' "a
ft.
ft.
st 4 C13l.- -'
i1`:.f CV; ',
21. REMARKS
22. Certification:
Signa re of Certified Well Contractor
5-31-18
Date
By signing this form, 2 hereby certify that the well(s) was (mere) constructed in accordance
with /SA NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy of this 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
constnrction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one cia fa�1�jtjnag{��j} p of
completion of well construction to the cotblt 4t rtt'bf' ht e county
where constructed.
North Carolina Department of Environmental Quality - Division of Water Resources
J U N 1 1 l0'TU 2-22.2016
Water Quality Regional
Operations Section
Wilmington Regional Office

Print corm
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Jason P Morton
Well Contractor Name
2953-A
RECEIVED/NCDENR/DWR
NC Well Contractor Certification Number
Morton Drilling
Company Name
2. Welt Construction Permit #
List all applicable well construction permits (i.e.
3. Well Use (check well use):
MAY 28 2018
Water Quality Regional
Operations Section
:VI
i gionalOffice
INC, County, State, Variance. etc.)
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Ind ustri al/Com me rc ial
Irrigation
Non -Water Supply Well:
Monitoring
injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
X Geothermal (leating/Cooling Return)
DMunicipaUPublic
Residential Water Supply (single)
Residential Water Supply (shared)
LJ Recovery
Groundwater Remediation
Salinity Barrier
DStormwater Drainage
]Subsidence Control
Tracer
Other (explain under fl2l Remarks)
4. Date Well(s) Completed: - '3' w Well 1Dti
5a. Well Location: , ZL f025Crii
Michael Raines SDr s
Facility/Owner Name Facility ION (if applicable)
e 1611.4. .,Q.3. (f et
Physical Address. City, and Zip
Carteret
For internal Use Only:,
45O3:12
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/tong is sufficient) tf
2;qt9 III' qb'' � 'r N l � G t 1eir t'7 ►Y
6. Is(are) the well(s) Permanent or DTemporary
7. Is this a repair to an existing well: QYes or 'No
If thus is a repair, fill out known well construction information
repair under )121 remarks' section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface:
For multiple wells list all depths' !f different (e.vomple- 3Q00' and 2Q100')
l4e)
xplain due nature of the
10. Static water level below top of casing:
If wafer level is above casing, use "+� _
11. Borehole diameter: 7' " f )
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
(in.)
14. WATER ZONES
TO
FROM
DESCRIPTION
/i!�U•. ft.
)TO
/ h C ft.
t,-G
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if a licable)
FROM
TO
DIAMETER THICKNESS 1 MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
�' ft.
ry
% L` i/ ft.
f
1./1 in.
��� ' �L2
�1 [%
ft./
ft.
in.
17. SCREEN
-. --- I r,, c-rrn 1 CI (IT SISIZE'.I THICKNESS I MATERIAL
IIUft'
ft.
/0 ft.
/ ft.
ti in.
m.
.z2
(ft.)
4n FOR WATER SUPPLY WELLS ONLY:I
113a. Yield (gpm) 50 Method of test: 47 I
13b. Disinfection type: a ftL t`L. Amount: ( ' / S
18. GROAT
FROM
TO
MATERIAL
ft. . -Q ft. ; f
ft. ��tvt� �/
ft.
EMPLACEMENT METHOD & AMOUNT
fed (o(I/
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT MFiTHOD
/ ' ft.
ft.
ft.
547.....'Z-->r)c) G e
20. DRILLING LOG (attach additional sheets if necessary)
TO DESCRIPTION (color, hardness, soiVrock type, graie size, etc.)
FROM
e a.
JZ;v ft.
ft.
� ft.
C ft. ( 6
1 e, ft.
/ 6 Un*
ft.
ft.
ft.
ft.
ft.
C
RE
GENE)
ft.
21. REMARKS
ft.
MAY 2 3 2018
information Prc t.ii trg Unit
22. Certification:
re of Certified Well Contractor Date
y signing this form, I hereby certify that the well(s) was (were) constructed In accordance
with 1 5A NCAC 02C .0100 or i SA NCAC 02C .0200 Well Construction Standards and that a
copy ofdris 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL iNS'rRUCTiONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, 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 one copy of this form within 30 days of completion of well
construction to the following:
J
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Sunnlv & Iniection Wells: In addition to sending the form to
the address(es) above, also subunit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Fonn G W - I
North Carolina Department of Environmental Quality -Division of Water Resources
Revised 2.22.2016

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
I. Well Contractor Information:
Lawrence D. Opper
RECEIVED/NCDENR/DWR
Well Contractor Name
NC3322-A
NC Well Contractor Certification Number
Regional Probing Services
Company Name
2. Well Construction Permit it:
MAY 282018
Water Quality Regional
Operations Section
Wilmington Regional Office
Lis/ all app/kahle ire/1 construction permits (i.e. ('osint •. Mate, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geotherrnal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑Irrigation
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
El Monitoring ❑ Recovery
injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geotherrnal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
❑Groundwater Remediation
❑Salinity harrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #2I Remarks)
For Internal Use ONLY:
4501.n3
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if applicable)
FROM TO DIAMETER THICKNESS MATERIAI.
fr. 1 tt.
in.
16. INNER CASING OR TUBING (geothern al closed -bow
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0
ft.
2
ft.
2
in.
sch 40
PVC
ft.
ft.
in.
17. SCREEN
FROM
T'O
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
2
ft.
12 ft.
2
in.
.010
sch40
PVC
ft.
ft.
in,
IS. GROUT
FROM
0 ft.
TO
ft.
MATERIAL
cement grout
EMPLACEMENT METHOD & AMOUNT
pour
ft.
1.5
ft.
bentonite
pour
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
1.5 ft.
12
ft.
#2 sand
Prepack/pour
n.
ft.
20. DRI LLING LOG (attach additional sheets if necessary)
FROM TO DESCRIPTION (color, hardness, soiUrock type, grain size, etc.)
0 ft. 12 It Silty Sand
4. Date Well(s) Completed:4/10/2018 Well ID=MW-1
5. Well Location:
Chadwick Brothers Marina
Facility/Owner Name Facility ID11(if applicable/
1604 Harker's island Rd., Straits, NC
Physical Address. City. and Zip
Carteret
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/Iong is sufficient)
34.724239 N 76' 573933
6. is (are) the well(s): E Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ElNn
(/'this is a repair. /(ll out known well construction ity'brmaliun and explain the nature of the
repair under '!21 remarks section or on the hack of tlus•Jornt.
8. Number of wells constructed: 1
Par multiple inlecvion or non -water supply wells ONLY with the saute construction, you can
subunit one firm.
9. Total well depth below land surface: 12 (ft.)
bin multiple well list all depths if dil/erent ('example- 3(41200' and 2Q1011)
10. Static water level below top of casing: -2 (ft.)
Ifuuler level is above casing use "
11. Borehole diameter: 4.25 (in.)
12. Well construction method: Auger -DP
(i.e. auger, rotary, cable, direct ptish. etc.)
13. FOR WATER SUPPLY WELLS ONLY:
13a. field (gpm) Method of test:
I3h. Disinfection type: Amount:
ft.
ft.
ft.
ft.
ft.
ft.
ft.
fr.
ft.
ft.
ft.
ft.
21. REMARKS
,i D re....,e �' a,� ■ a n�
MAY_1. 7 2018
)nfarma.tton Proviesing t
DWQ/EE OG
� fir
gi
By .riguil; this firm. / hereby cerli/i' that the well(s) was (uerc) constructed in accordance
with / iA N('A(' 02(. 0100 or 19A Alf '.4(' 02(' .0200 Well Construction Standards and that a
copy of this rec•urd has hcen proridci; to the a eII owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
5/6/2018
Certification: Lawrence
per
Certified Well Contractor
24. Submittal instructions:
D,sful9signed M W.,e„ce upper
ott p,=iewre,xe npprr. n=se0iona
robing sadce,.ow
F- W,Ye'r egbru kroUng.co,n
e.en
Dale:101005.06 a.01A6.0.00'
Date
24a. For All Wells: Submit this I''om 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 torm to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Geothermal Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW I North Carolina Department of Environment and Natural Resources - Division of Water Quality
Revised Jan. 2013

Print Form
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor information:
Jason P Morton
Well Contractor Name
2953-A
NC Well Contractor Certification Number
Morton Drilling
Company Name
262325
2. Well Construction Permit #:
RECEIVED/NCDENR/DWR
APR 2 1 2018
Water Quality Regional
Operations Section
Wilmington Regional Office
lot all applicable well cnnslruainn permits (i.e. UIC.
3. Well Use (check well use):
County, Slate, Variance, elc.)
Water Supply Well:
[Agricultural
Geothermal (Heating/Cooling Supply)
D Industria UCommercial
OP irrigation
Non -Water Supply Well:
Monitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
unicipal/Public
Residential Water Supply (single)
Residential Water Supply (shared)
Recovery
DGroundwater Remediation
QSalinity Barrier
LJStormwater Drainage
DSubsidence Control
Geothermal (Closed Loop) DTraccr
Geothermal (Heating/Cooling Jtetur) Other (explain under 021 Remarks)
4. Date Well(s) Completed. .1 TIP- Well ID#
5a. Well Location:
Del ma Morris
Facility/Owner Name Facility ID# (if applicable)
452 Morris Brothers Rd Stella, NC 28582
Physical Address, City, and Zip
Carteret
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
3a' N77°08f/5,/17 t1
6. Is(are) the well(s)1Permanent or DTemporary
7. Is this a repair to an existing well: L. I Yes or xON°
If this is a repair, fill out known well construction information and exploit? the nature of the
repair under i121 remarks section or an the back of this firm.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled: 7/1 ,c-
9. Total well depth below land surface: / 2 5
For multiple wells list all depths ifdifjerent (example- 3@200' and 2@ 100)
10. Static water level below top of casing: 10
limner level is above casing. heir "+ "
11. Borehole diameter: 7 7/8 (in.)
12. Well construction method: rotary
(i.e. auger, rotary, cable, direct push, etc.)
d/
(ft.)
(ft.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 55
13b. Disinfection type: chlorine
Method of test: Air
Amount: 1.75 oZ
For Internal Use Only:
sco 3
14. WATER ZONES
FROM
TO
DESCRIPTION
%05 ft.
as ft.
'OG /c
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if a licable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
oZ ft.
%o 5 ft.
1[ in. 5c1 S D
f
_
p V �
n.
rt.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
I L ft.
r !
2 C ft.
!
L [ i n.
�
Z�
5 -% VD
V -
ft.
ft.
in.
le
8. GROUT
1FROM
TO
MATERIAL
EM ETIIOD OUNT
t / ft.
vV
b ft.
.{-
,04,0 H f e,
�..0
O (1 r L° / ^� )
J� �{ U 20,
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
/ 0 5 ft.
/ Z5 ft.
g/'o/
Poored
ft.
ft.
20. DRILLING
LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (enter, hardness, soil/rock type, grain sise, etc.)
D ft.
7 L ft.
.40r,�
3 5- ft.
(00 ft.
_5;4,, C4/ (Csee'v
l
/ a rt.
(L 5 f t.
_b c-- /i--
ft,
ft.
m A q , ..
ft.
ft.
, 12 i ar
n.
ft.
f R 19 20%
21. REMARKS
P=er ,St's`.
n.Cti:t:Ta4:irl
OW0it30G
22. Certification:
Si '"re of Certified Well Contractor Date
signing this form, i hereby certify that the well(s) was (were) constructed in accordance
with 15.4 MAC' 02C .0100 or 1 S.4 NCAC.' 02C .0200 Well c'onsnn:cti::rr Standar& and that a
copy of this record has been provided to the well owner.
V-/b -/8
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRLJCrIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the fonn to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Sunnis, & Injection Wells: In addition to sending the form to
the address(es) above, also subunit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Fonn OW- I
North Carolina Department of Environmental Quality - Division o1' Water Resources Revised 2-22-201 6

WELL CONSTRUCTION RECORD (GW-1)
For Internal Use Only:
Print Form •
1. Well Contractor Information:
Jason P Morton
Well Contractor Name
2953-A
NC Well Contractor Certification Number
Morton Drilling
RFCEIVEDNCDENR/DWR
APR 21 2018
Company Name
Water Quality Regional
2473 gperations Section
2. Well Construction Permit #: mingto Re iOtnAt Qfj'
List all applicable well construction pernits (i.e. UIC, County, Slate, ar a
3. Well Use (check well use):
Water Supply Well:
Agricultural
'Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
Non -Water Supply Well:
Monitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
OMunicipal/Public
DResidential Water Supply (single)
Residential Water Supply (shared)
QRecovery
DGroundwater Remediation
Salinity Barrier
[JStormwater Drainage
DSubsidence Control
Tracer
Other (explain under #2I Remarks)
4. Date Well(s) Completed: 3-9-18 Well ID#
Sa. Well Location:
Eric Gillikin
Facility/Owner Name Facility ID# (if applicable)
130 Sweeten Ridge Ln Beaufort, NC 28516
Physical Address, City, and Zip
Carteret
County Parcel Identification No. {PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
311.Y5 S6a.05 N
6. Is(are) the well(s)JPermanent or )Temporary
7. Is this a repair to an existing well: OVes or 1No
If this is a repair, fill out known well construction information and explain the nature of the
repair under 1121 remarks section or on the hack of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:
t%A1.0'
9. Total well depth below land surface: 90
For multiple wells list all depths indifferent (example- 3@200 a and 2@I00)
10. Static water level below top of casing: 15
1/woter level is above casing, use "t "
11. Borehole diameter: 7 718
12. Well construction method: rotary
(i.e. auger, rotary, cable, direct push. etc.)
(in.)
(ft.)
(ft.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 50 Method of test: air
13b. Disinfection type: chlorine Amount: 1.50 oZ
44$912
14. WATER ZONES
FR�OLM.
TO
DESCRIPTION
DESCRIPTION
J� ft.
/il
/� ft.
(/
f/� IT1h-'
ft.
ft.
f
15. OUTER CASING (for
for multi -cased wells OR LINER If applicable)
FROM
TO
DIAMETER
THICKNESS 1 MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING (geothermal closed -IOW
FROM
TO
DIAMETER
THICKNESS
MATERIAL
1 ft.
1
-ID ft.
q in.
sh vo
VC/
Y
ft.
ft.
in.
17. SCREEN
FROM
TO
DIA�'}�TER
SLOT SIZE
TRIC NESS
MATERIAL
•IV ft.
(
9 D ft.
(.� in.
i
V
� T
c c ' �/
i
/ V C
ft.
rt.
in.
18. GROUT -
FROM
O
MAT RIA`Lj�
EM LACEME METHOD & AMQUNT
ft.
� ft.
y, Qil trt9�
j5 ma--qD() r/jJt S
ft.
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
MATERIAL
EMPLACEMENT M/�'�f110D
0 fl.
D ft.
1
.}�
�r I /r Tf
f u re
ft.
ft.
20,.LDRILLING
I..OG (attach additional sheets if necessary)
FROpiM
TO
DESCRIPTION (color rdness, soil/rock type, grain size, etc.)
ft.
i � ft.
S(�C(
3 s ft.
5--d ft.
CyXI„'�
J ��t.���
�0 ft.
� h ft.
G
76 ft.
90 ft.
___ _ �/� _
iJ �'��
ft.
ft.
ft.
ft.
21. REMARKS A
n 1 9 2018
lflforp7l thin 1 (O t' sCS
ITV'cy CY '
22. Certification:
iureofCertified Well Contractor
m,rA
Date
By signing this form, 1 hereby eery that the well(s) was (were) constructed in accordance
with 15A NCAC 02C.0100 or 1.54 NCAC 02C.0200 Well Cnnsrrrrtion Standards and that a
copy of this 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, information Processing Unil,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Sunnly & Injection Wells: In addition to sending the form to
the address(es) above, also subrnit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Fonn GW-I
North Carolina I)epsrtn,,,,t orP, vironmenttd ()utility - Division of Water Resources Revised 2-22-2016

WELL CONSTRUCTION RECORD (GW-1)
Print. Form
For Internal Use Only:
1. Well Contractor Information:
Jason P morton
RECEIVED/NCDENR/DWI
Well Contractor Name
2953-A
NC Well Contractor Certification Number
Morton Drilling
Company Name
2. Well Construction Permit #: 259
APR 2 1 2018
Water (duality Regional
Operations Section
1 20Wilmington Regional Office
List all applicable well construction pernits (i.e. 111C. Coumty, Stare, Variance, ere.)
3. Well Use (check well use):
Water Supply Well:
]Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
irrigation
Non -Water Supply Well:
Monitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
JMunicipa1/Public
Residential Water Supply (single)
DResidential Water Supply (shared)
Recovery
Groundwater Remcdiation
Salinity Barrier
fStonnwater Drainage
Subsidence Control
Tracer
Other (explain under #21 Remarks)
4. Date Well(s) Completed: 4/4/18 Well ID#
5a. WeII Location:
Ramie Perkins
Facility/Owner Name Facility ID# (if applicable)
385 Firetower Rd Beaufort, NC 28516
Physical Address, City, and Zip
Carteret
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one 1M/tong is sufficient)
3&/' q7t c ), oy rt N7V331 Z b, / ? t t W
6. Is(are) the well(s)0Permanent or DTemporary
7. Is this a repair to an existing well: xYes or jNo
1f this is a repair, fill out known well construction information and explain the nature of the
repair under #?1 remarks section or on the hack of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled: /,A/e
9. Total well depth below land surface: 90
For multiple wells list all depths if d/erent (example- 3(200' and 2©a 100')
10. Static water level below top of casing: 15 (ft.)
If water level is above casing, use '-t "
11. Borehole diameter: 7 7/8 (in.)
12. Well construction method: rotary
(i.e. auger, rotary, cable, direct push, etc.)
(ft.)
FOR WATER SUPPLY WELLS ONLY:
130. Yield (gpm) 45 Method of test: Air
13b. Disinfection type: chlorine Amount: 1.50 oz
22. Certification:
14. WATER ZONES
FROM
TO
DESCRIPTION
/ v ft.
`�(] ft.
12 o c k.
ft.
ft.
15: OUTER
CASING (for
multi -cased wells) OR LINER (if a
licable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER
CASING OR TUBING
(geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
( ft.
76 ft.
I
in.
�" .1 - Ya
PVC-
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLAT SIZE
TIIICIQVESSSS
MATERIAL
70ft.
(76 ft.
q in.
7
,0
5e4 fd
,�t✓
ft.
ft.
in.
t8. GROUT
FROM
TO
MATERIAL _
EMPLACEMENT METHOD & AMOUNT
ft.
Zft,
V.)a
i, x,„.,
?cure 14- n 1 h-
rs.
ft.
ft.
ft.
19. SAND/GRAVEL
PACK
(if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
iU ft.
4o ft.
Si5r1 d
PC s.l Ire A.
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain siee, etc.)
fa
p
3 S ft.
S,47n c/
*� ft.
37) ft.
, ierYl. Grt-r a ra" f-1„--
S) ft.
D ft.
GL✓•.►-a?,/
(-0 rt.
9 ft'
r41 a--C.,
ft.
ft.
ft,
ft.
ft.
ft.
; C._: 44
21. REMARKS , 4z
APR 1 9 2018
t-r4C.: Ly ag Uri?
0liWWQ f jQ
2k-zi
ature of Certified Well Co ctor
Date
By signing r/tls form, 1 hereby cert(/ that the well(s) was (were) constructed in accordance
with 1SA NCAC 02C .0100 or 1SA NCAC 02C .0200 Well Construction Standards and that a
copy of this 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
constnlction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells: In addition to sending the t'onn to the address in 24a
above, also subunit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Slimly & Infection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW-1 North Carolina Department of Environmental Quality • Division of Water Resources
Revised 2-22-2016

Print Form
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Jason P Morton
Well Contractor Name
2953-A
NC Well Contractor Certification Number
Morton Drilling
RECEIVED/NCDENR/DWR
APR 2 1 2018
Water Quality Regional
Company Name 242450
2. Well Construction Permit #: OpP.rafipris Section
List all applicable well construction permits (i.e. f1i�jQ}igjli r�,��Fl�t I fa�t�CG
3. Well Use (check well use): 5
Water Supply Well:
()Agricultural
DGeothennal (Heating/Cooling Supply)
D Industrial/Commcrc ial
[Xjlrrigation
Non -Water Supply Well:
Monitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed: 4-12-18
5a. Well Location:
Charles Stephenson
Facility/Owner Name Facility 1D# (if applicable)
DMunicipal/Public
Residential Water Supply (single)
DResidential Water Supply (shared)
0 Recovery
DGroundwater Remediation
DSalinity Barrier
DStonnwater Drainage
Subsidence Control
Tracer
Other (explain under #21 Remarks)
Well ID#
529 Neptune Dr Cape Carteret, NC 28594
Physical Address, City, and Zip
Carteret
County Parcel identification No. (PiN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/longgis sufficient) r r
3t f d i I of s "l s rN p 0 3 r
W
6. Is(are) the well(s)jPermanent or fTempoi ary
7. Is this a repair to an existing well: QYes or DNo
If this is a repair, fill out known well construction information and explain the nature of the
repair under 1121 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-laisileded. Indicate TOTAL NUMBER of wells
drilled: ( / Y---
9. Total well depth below land surface: 145
For multiple wells list all depths if different (example- 3@200' and 2@100)
10. Static water level below top of casing: 18 (ft.)
limner level is abnve casing, use " "
II. Borehole diameter: 7 7/8 (in.)
rotary
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
For Internal Use Only:
14
97 0
14. WATER ZONES
FROM
TO
DESCRIPTION
/ Zft.
J
/ q 5 ft.
6 /2
ft.
ft.
15. OUTER
CASING (for
multi -cased wells) OR LINER (if a
Iicable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER
CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
1 ft.
fa y ft.
f '[ t in.
5c1l "�
..l (i
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
MATERIAL
/25".
l L7
+itsft.
1 [
1, in.
-r
2 0
(THi/CK�NLESS
7�r1 eio
iV </
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT E1110D & AMOUNT
O ft.
10 a.:Wk140
rit
�'(r 6. 40 o I6
R,
ft.
n.
ft.
19. SAND/GRAVEL PACK
(if applicable)
FROJ p
TO
EMPLACEMENTMETHOD
P o'! V r
7 5 ft.f
( C•
4. ft
l
,1MATERIAL
S A' d1
ft.
ft.
20. DRILLING
LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
0 ft.
6 ft.
ss fi,., d
3 ft.
6 0 ft.
S P d-7 .0 km/
ft.ft
C
6 ft.
�
% L - ft.
!T
i3 v �
ft.
ft.
ft.
ft.
el: r..:%r-t
rt.
(t.
.-_ t.:,a L.m i F
21.REMARICS © 2018
APR 1
',n }-r. rt `'..
(ft.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 55
Method of test: Air
13b. Disinfection type:
chlorine
Amount: 1.75 oz
22. Certification:
4,441
ewe of Certified We Contractor
Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance.
with 15.4 MAC 02C .0100 or 154 NCA.' 02C .0200 Well Construction Standards and that a
copy of this record has been provided /o 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a, For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this forth within 30 days of completion of well
construction to the following:
Division of NVater Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county hcalth department of the county
where constructed.
Form GW-I
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

Print corm
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Jason P Morton
Well Contractor Name
2953-A
NC Well Contractor Certification Number
Morton Drilling
RECEIVED/NCDENR/DWR
APR 14 2018
Company Name
24783$Vater Quality Regional
2. Well Construction Permit #: kiga Cgr�1i1' n( ()nice
tin all applicable well construction permits (i.e. IBC Wi(C n •n FRteegllrona 6
3. Well Use (check well use):
Water Supply Well:
]Agricultural
DGeothermal (Heating/Cooling Supply)
Industrial/Commercial
rrip,atinn
Non -Water Supply Well:
Monitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
DMunicipaVPublic
DResidential Water Supply (single)
DResidential Water Supply (shared)
Recovery
Groundwater Remediation
jSahnity Barrier
DStormwater Drainage
Subsidence Control
DTracer
Other (explain under #2I Remarks)
4, Date Well(s) Completed:
1 /26/18
Sa. Well Location:
Mathew Fitzpatrick
Well ID#
Facility/Owner Name Facility ID# (if applicable)
205 Friendly Rd MHC,NC 28557
Physical Address, City, and Zip
Carteret
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat./long is sufficient)
5q° /3'Yy•z�N lb'Vbr�1.L� !
6. Is(are) the weIl(s)JPermanent or Temporary
7. Is this a repair to an existing well: Yes or tNo
If this is a repair, fill out known well construction information and explain the nature of the
repair under 1121 remarks section or on the back of this forth.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is ne ded. indicate TOTAL NUMBER of wells
drilled:
I ga (ft.)
9. Total well depth below land surface:
For multiple wells list all depths !f different (exanrple- 3@200' and 2 n 100')
10. Static water level below top of casing: 1 5 (ft.)
',bluster level is above casing, use n'
11. Borehole diameter: 7 �g
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
(in.)
Rod
For Internal Use Only:
L .14821
14. WATER ZONES
FROM
TO DESCRIPTION
/ 0 fL
((/
^
, tQt ft, /ZGre
D v
f
ft.
ft.
IS. OUTER CASING (for multi -cased wells) OR LINER (if a
licable)
FROM TO
DIAMETER I
THICKNESS
MATERIAL
ft. ft.
in.
Ir
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
/ ft.
/6 0 ft.
ar
If in.
'(
sc4 4/ D
/L 7
G% �
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
TTHI/CKNESS
MATERIAL
' ft.
/+QD ft.
fl in.
Z.z,
Jcf1 V
f V C
ft.
L�� ft.
T in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
© a.
7° ft.
i+ i
`�ua'e4- Voe.)/6.r
ft.
ft.
D.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL EMPLACEMENT METHOD
le0 ft.
/ () f.
5 D �IOvre- d
ft.
ft.
20. DRILLING LOG (attach additional streets if necessary)
FROM
TO DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
a ft.
2S ft. 5,n,,Zd
3 5 ft.
/„ 0 ft. 5;4' 1 _ Y
�D ft.
�.y�C
i3v ft. �"' 'r
(3a ft.
,6a ft. ??mac 6.I 5 2 d
[ ft. ft.
ft.
;E
21. REMARKS
I E
..�
FEB0-8 2018
22. Certification:
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) � Method of test:
/41
�.t �/ Amount: J0 �
13b. Disinfection type t)
nature of Certified Well Contractor
By signing this throe, 1 hereby cerrifj+ Mat the well(s) was (were) constructed in accordance
with 15A NCAC 02C.0I00 or l5A NCAC 02(.'.0200 Well Construction Standards and dun a
copy of this 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a, For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Iniection Wells: In addition to sending the form to
he addresses) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Information )P( y,- i jr4i
Date
Fonn GW-1
North Carolina Department of Environmental Quality - Division of Water Resources
Revised 2-22-2016

WELL CONSTRUCTION RECORD
This fomt can be used for single or multiple wells
1. Well Contractor Information:
D.T. Chalmers, Jr.
Well Contractor Name
4146A
NC Well Contractor Certification Number
RECCW€D/NCDENR/DWR
CATLIN Engineers and Scientists
Company Name
APR 14 2018
Water uuality Keglonal
Operations Section
2. Well Construction Permit #. N/A Wilmington Regional Office
List all applicable well permits (i.e. County, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Nell:
❑ Agricultural
❑ Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
❑ Municipal/Public
❑ Residential Water Supply (single)
❑ Residential Water Supply (shared)
Non -Water Supply Well:
® Monitoring
Injection Well:
❑ Aquifer Recharge
0 Aquifer Storage and Recovery
❑ Aquifer Test
❑ Experimental Technology
❑ Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
0 Recovery
❑Groundwater Reinediation
❑ Salinity Barrier
❑ Stormwater Drainage
❑ Subsidence Control
O Tracer
❑ Other (explain under #21 Remarks)
4. Date Well(s) Completed: 01/22/18
5a. Well Location:
MCAS. Cherry Point
Facility/Owner Name
Well ID#: MW-2R
Facility ID# (if applicable)
MCOLF, ATLANTIC, NC
Physical Address, City, and Zip
CARTERET
County
Parcel Identification No. (PIN)
For Internal Use ONLY:
448219
I4. WATER ZONES
FROM
10
DESCRIPTION
ft
n.
ft.
n.
15. INNER CASING OR TUBING (geothermal
loop) .
FROM
TO
DIAMETER
THICKNESS
mATERLAl,
0 rt.
3 rt.
2 in.
Sch. 40
PVC
16. OUTER CASING (for mulll-cased welts) OR LINER (If applicable
FROM
TO
DIAMETER
THICKNESS
MATFRL\I.
ft.
ft.
in.
ft.
ft.
in.
D. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
, THICKNESS
MATERIAL
3 ft.
13 rt.
2 in.
Slot .010
Sch. 40
PVC
ft.
ft.
in.
1S. GROUT .
FROM
TO
MATERIAL
EMPLACEMENT Is IETHOD & AMOUNT
0 n.
0.5 rt.
Portland Cement
_
Surface Pour
0.5 a.
a.
1 ft.
ft.
Bent. Pellets
Surface Pour
19. SANDIGRAVEI.
PACK (it
applicable)
FROM
TO
MATERIAL
EMPLACEMENT ME111OD
1 a.
13 ft.
Torpedo Sand
Surface Pour
ft.
ft.
20. DRILLING
LOG (attieb additlonal
elieW If necessary)
FROM
TO
DESCRPTION (color, hardness, soil rock type,grain size, etc.)
n.
rt.
ft.
ft.
ft.
s et,
ft.
ft.
r1F,'c
ft.
_
E C E R, r
21. REMARKS x
FED -U 2418
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22. Certification:
(if well field, one latllong is sufficient)
34.88307
N-76.35031 W
6. Is (are) the well(s): ®Permanent or OTemporary
7. Is this a repair to an existing well: DYes or ®No
If this is a repair, fill out known well construction information and explain the nature of
the repair tinder #21 remarks section or on the back of this form.
8. Number of wells constructed:
For multiple injection or non -water supply wells ONLY with the same construction, you
can submit one form.
9. Total well depth below land surface: 13 (ft.)
For multiple wells list all depths in different (example- 3 rt 200' and 2@1009
1
10. Static water level below top of casing: (ft.)
If water level is above casing, use "
11. Borehole diameter: 2 (in.)
12. Well construction method: HSA
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
Signature of Certified Well Contractor
inkvmstiori iarOC{:i,
l 0.
1/31/2018
Date
By signing this form, I hereby certifP that the well(s) was (were) constructed in accordance with
/SA NCAC 02(' .0100 or ISA NCAC 02C..0200 Well Construction Standards and that a copy of
this 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells ONLY: 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 construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells:
Also submit one copy of this form within 30 days of completion of well
construction to the county health department of the county where constructed.
Adapted from Form GW-1
North Carolina Department of Environment and Natural Resources - Division of Water Resources Revised 2-22-2016

CATLIN
Engineersand Scientists
WilELL
Wlmingtan. NC
mington. SHEET 1 OF 1
LOG
PROJECT NO.: 217085
STATE: NC
COUNTY: CARTERET
LOCATION: ATLANTIC
PROJECT NAME: MCOLF ATLANTIC
LOGGED BY: Corey Futral
WELL ID:
MW_2R
DRILLER: D.T. Chalmers, Jr.
NORTHING: 422975
EASTING: 2794532
CREW: Eddie Swain
SYSTEM: NCSP NAD 83 (USft)
BORING LOCATION: Wooded area at Spray Field
_
T.O.C. ELEV.: 15.56
DRILL MACHINE: Diedrich D-25
METHOD: HSA
0 HOUR DTW: N/A
TOTAL DEPTH: 13.0
START DATE: 01/22/18
END DATE: 01/22/18
24 HOUR DTW: N/A
WELL DEPTH: 13.0
DEPTH
BLOW
0.5ft
0.5ft
COUNT
0.5ft
0.5ft
OVA
(ppm)
LAB
o
S
L
c
SOIL AND ROCK
DEPTH DESCRIPTION ELEVATION
WELL
DETAIL
0.0 LAND SURFACE 13.6
2.0
0.0
0.0
—
4
4
a
4
132.2
W
,7,.•,
Li. �� "r
(ML) - Root Mat
0.6 13.0
II 1 1 III 1 1 1 IF
'w w
0 0
2" Slot .010 2" Sch. 40 PVC
Sch. 40 PVC
11111111111111111111111111111111111111111111I111111111ILLLL 4 ll I.IIJIILLLLLl11111J M W 10 11111!
0
0 N
::.
••
:•
(SP) - Black grading to dark brown, f. SAND.
RECEIVED/NCDENR/DWR
APR 14 2018
Water Quality Regional
Operations Section
Wilmington Regional Office
13.0 0.6
—
5.0
_
—
4
'
6
6
1.5
Sat.::::::::
10.0
Grab
Sample
2.2
Sat.
13.0
-
BORING TERMINATED AT ELEVATION 0.6 ft in f.
SAND.
LjPortland Cement
:0•d.
Bentonite Pellets #2 Medium Sand

Print Form
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Jason P Morton
Well Contractor Name
2953-A
NC Well Contractor Certification Number
Morton Drilling
RECEIVEIVEDENR/DWR
APR 142018
Company Name 235968 Water Quality Regional 2. Well Construction Permit #: Operations Section
List all applicable well construction pennies (i.e. LAC, dAlnijaufalgtOlarUegiovtal Office
3. Well Use (check well Ilse):
Water Supply Well:
Agricultural
Geothennal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
Non -Water Supply Well:
Monitoring
DMunicipal/Public
QResidential Water Supply (single)
Residential Water Supply (shared)
Recovery
Injection Well: Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
QGroundwater Remediation
Salinity Barrier
IJStonnwater Drainage
[]Subsidence Control
Tracer
Other (explain under #2 l Remarks)
4. Date Well(s) Completed: 4/3/18 Well ID#
5a. Well Location:
Cathy Garner
Facility/Owner Name Facility ID# (if applicable)
170 center st Newport, NC 28570
Physical Address, City, and Zip
Carteret
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(dwell field, one lat/long is sufficient)
3V° '21. '31 tt N 76 `55 3e, 9. it11 w
6. Is(are) the well(s)jPermancnt or OTemporary
7. Is this tl repair to an existing well: ales or Cho
lfthis is a repair, fill ow known well construction information and explain the nature of the
repair under H21 renrarks• section or on the bock of this form.
8. For GcoprobeMPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of welts
drilled: Z9f
9. Total well depth below land surface: 90 (ft.)
For multiple wells list all depths if different (erennple- 3 a 200' and 2(3100')
10. Static water level below top of casing: 12 (ft.)
If water level is above casing, use "-I "
11. Borehole diameter: 7 7/8 (in.)
rotary
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
For internal Use Only:
14. WATER ZONES fW;
FROM
TO
DESCRIPTION
C
f
ft.
ft.
IS. OUTER CASINO (for multi -cased wells) OR LINER (if a t !Kahle)
FROM
TO
DIAMETER
THICKNESS 1 MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
MATERIAL
R.
-7 /) ft.in.
V
CTHICKNESS
/C�'/ ro
? V C
fit.
ft.
itt.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE THICKNESS
MATERIAL.
'70 ft.
Ci"0 ft,
/
i.f, In.
l
L (.� �! 440
pv (i
ft.
ft,
in.
18. GROUT
FROM
TO
MATEERI'AL
EMPLACEMENT
ETHOD & AMOUNT
a ft'
z v ft'
1
&3,71 /614(,i'a..
:ire
,5 s 0 I,4
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACES' ENT ME HOD
7 fit.
qo ft.
Ol/)
`Dco f -e
ft.
ft.
211. DRILLING
LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soiVrock type, grain siu, ctc.)
1.I.
'
''2 { 1t.
J
5;�,.7..-7r?'
ft.
g-6-
'1 %% tt.
/'_
cOWC .6p C.- r"i
SD ft.
fit.
L(�L.,
0,4 �L,,..
fit.
ft.
ft.
ft.
APR ( 2011.1
21. REMARKS
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 50 Method of test: Air
chlorine 1.75 oz
136. Disinfection type: Amount:
22. Certification:
Suture of Certified Well Contractor
v
Date
By .signing this form, 1 hereby cent fy that the well(s) was (were) constructed in accordance
with 1 SA RAC 02C .0100 or 15A MAC 02C .0200 Well Construction Standards. and that a
copy of this 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24h, For infection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Nlail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Infection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW-1
North Carolina Department of Environmental Quality - Division or Water Resources Revised 2-22-2016

Water Resources
ENVIRONMENTAL QUALITY
April 9, 2018
GRADY W. FULCHER — PROPERTY MANAGER
GENESIS CONDOMINIUM OWNERS' ASSOCIATION, INC.
301 SALTER PATH ROAD
PINE KNOLL SHORES, NORTH CAROLINA 28512
Dear Mr. Fulcher:
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
LINDA CULPEPPER
Interim Director
RECEIVED/NCDENR/DWR
APR 1 1 2018
Water Quality Regional
Operations Section
Subject: Permii t*Ogobi ce
Permit Renewal Notification
Genesis Condos WWTP
High -Rate Infiltration System
Carteret County
Division of Water Resources' records indicate that Permit No. WQ0006863, which was issued July
9, 2010, expired May 31, 2016. To date, the Division has not received a renewal application. It is a
condition of your permit and required by administrative code 15A NCAC 02T .0109 to request renewal of
your permit at least 180 days prior to its expiration.
As the Permittee, you are responsible for renewing and maintain this permit. Accordingly, please
complete and submit the attached Non -Discharge System Renewal application (Form: NDSR 06-16). This
form has been prefilled for your convenience.
Once the application is received, staff from the Wilmington Regional Office will conduct a site
visit and inspect your treatment and disposal system. Upon completion of the site visit and review of your
application, a new non -discharge permit will be issued in your name for a length of five years.
Please complete and submit the attached application within 30 days of receiving this
notification. Be advised that operation of the subject facilities without a valid permit is a violation of
General Statute 143-215.1, and may subject you to appropriate enforcement actions in accordance with
General Statute 143-215.6A-6C. Civil penalties of up to $25,000 per day per violation may be assessed for
failure to secure a permit as required by General Statute 143-215.1.
If you need additional information concerning this letter, please contact me at [phone] or
nathaniel.thomburgc ncdenr.gov.
Sincerely,
Nathaniel D. Thornburg, Branch C
Division of Water Resources
cc: Wilmington Regional Office, Water Quality Regional Operations Section
Central Files
"!"Nothing Compares'
State of North Carolina I Environmental Quality I Water Resources I Water Quality Permitting I Non -Discharge Permitting
1617 Mail Service Center I Raleigh, North Carolina 27699-1617
919-807-6332

Print Form
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor information:
Jason P Morton
Well Contractor Name
2953-A
NC Well Contractor Certification Number
Morton Drilling
Company Name
2. Well Construction Permit #:
'Igo qr
List all applicable well construction permits i.e. WC, Cotuuy, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
Agricultural
)Geothermal (Heating/Cooling Supply)
(c- Industrial/Commercial
Irrigation
Non -Water Supply Well:
Monitoring
Q Municipal/Public
Residential Water Supply (single)
Residential Water Supply (shared)
Recovery
Injection Well:
BAquifer Recharge
Aquifer Storage and Recovery
D Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
Groundwater Remediation
jSalinity Barrier
QStormwater Drainage
DSubsidence Control
Tracer
Other (explain under #21 Remarks)
4. Date Well(s) Completed: 3 —1 19" l (6 Well ID#
5a. Well Location:
51-i V ktJ P RU,t -rk
Facility/Owner Name Facility ID# (if applicable)
tq llo i d f ox 141012,ellana/JC
Physical Address, City, and Zip
Carteret
County Parcel Identification No. (PiN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
y° yy t L 2 t `t3 ,f N 1(Qd Nat rlo r2tt 1t
6. Is(are) the well(sOi
)Permanent or DTemporary
7. Is this a repair to an existing well: QYes or No
/f this is a repair, fill out known well construction information on xplain the nature of the
repair under 1121 remarks section or on the back of this form!.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the some
construction, only 1 GW-I isAr e4 Indicate TOTAL NUMBER of wells
drilled: fU!'J�
9. Total well depth below land surface: (a V (ft.)
For tnultiplr wells list all depths iidrlgerent (example- 3(4200' and 20/00')
10. Static water level below top of casing:
If wager level is above casing, use "+"
11, Borehole diameter: 7 7/8
(in.)
Rotary
12. Well construction method:
(i.e. auger, rotary. cable, direct push, etc.)
ILr?
(ft.)
For Internal Use Only:
147881
14. WATER ZONES
FROM
TO
DESCRIPTION
7a ft.
!Std ft.
ft.
ft.
15. OUTER CASING (tor multi -cased wells) OR LINER (if a
licabte)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING. (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
t ft.
` f �T ft,
(�
q, in.
CN! 7 V
t� v t�
rt.
ft.
in.
17. SCREEN
EKrO !
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
t v c--
! t•
/ () r� ft.
�tS
r L in.
"[
2 D
5-cl i yzi
rt.
ft
in.
IS. GROUT
FROM
TO
MATERIAL
EMPLACEMENTMETIIOD&AMOUNT
D rt.
Z0 ft.
�tY
ibored 400 (b r
ft.
ft.
rt.
rt.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
/10 f.
I� rt.
Spa
-POOye d.
ft.
ft.
20. DRILLING LOG (attach additional streets if necessary)
FROM
TO
DESCRIPTION (color, hardness, sail/rock type, grain sf>.e, etc.)
0 rL
J C ft.5
4"71 �f r,
ci 4l
J D 4, ft.
{ 7b ft
LL � !
/70 ft.
/ I Dft.
.°1--C /---
ft.
ft.
ft.
ft
21. REMARKS MAR
2 1 2018
1tifOrh'Ibi1Ctl1 it" ro:;.. •- : , :+
FOR WATER SUPPLY WELLS ONLY:
l(' 13a. Yield (gpm) J Method of test: Air
13b. Disinfection type: Chlorine
Amount: f `�
22. Certification:
Gv�
ature of Certified • ell Contractor
?�L";�lf✓OG
Date
By signing this form, 1 hereby eery that the well(s) was (were) constructed in accordance
with ISA NCAC 02(.7.0100 or ISA NC'AC 02C.0200 Well Construction. Standards and that a
copy of lhiv 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
construction details. You may also attach additional pages i necessary.
248, For All Wells: Submit this form within 30 days i wnrjetion gkjvell
construction to the tollowing: o
Division of Water Resources, Information Proei s 101
nit, Cn
1617 Mail Service Center, Raleigh, NC 27692- t• 1 No a). '($Q
24h. For Infection Wells: In addition to sending the form 2)s iddressii924a
above, also submit one copy of this form within 30 days o colrjletion of well
construction to the following: m
SUBMITTAL INSTRUCTIONS
Division of Water Resources, Underground injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Infection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
shci e constructed.
it
dM0/NN30011/03A13O311
Fonn GW-1
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

Print Form
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information: yrra
Jason P Morton RECEIVED/NCDENR/DWR 7
4
Well Contractor Name
2953-A
NC Well Contractor Certification Number
MAR 1 9 2018
Morton Drilling Water Quality Regional
Company Narne Oper.atio Secti a0 lC� 1b i O 3 Wilmyi jr i
2. Well Construction Permit #:
List all applicable well construction permits (i.e. f1/C, ('aunty, State, Variance. elc)
3, Well Use (check well use):
Water Supply Well:
DAgricultural DMunicipal/Public
DGeothermal (Heating/Cooling Supply) DResidential Water Supply (single)
Industrial/Commercial DResidential Water Supply (shared)
X irrigation
Non -Water Supply Well:
Monitoring
injection Well:
DAquifer Recharge
DAquifer Storage and Recovery
DAquifer Test
DExperimental Technology
DGeothermal (Closed Loop) DTracer
DGeothermal (Heating/Cooling Return) DOOther (explain under 0/21 Remarks)
4. Date Well(s) Completed: i2 'Z i") ! / Well ID#
5a. Well Location:
DRecovery
54P be KN
Facility/Owner Name Facility iD# (if applicable)
530 Rra-m S 40(p) N G
DGroundwatcr Remediation
DSalinity Barrier
DStormwater Drainage
DSubsidence Control
2),(ff
Physical Address, City, and Zip
Carteret
County Parcel identification No. (PIN)
5b. Latitude and longitude In degrees/minutes/seconds or decimal degrees:
(if well field, one Iatilong is sufficient)
34/.a1/8r2gt94 tN 76°5y'53,39 fl w
6. Is(are) the well(s)LPermanent or DTemporary
7. Is this a repair to an existing well: ©Yes or xDNo
1f this is a repair, ft1l ow known well construction information and explain the stature glare
repair under 1121 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW11 is needed. Indicate TOTAL NUMBER of wells
drilled: 0,' e-
9. Total well depth below land surface: 620 (ft.)
For multiple wells list all depths if d different (example- 31 200' and 2 cl100)
10. Static water level below top of casing:
If water level is above casing, use
11. Borehole diameter:
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
g
(itt.)
Ro
(ft.)
For internal Use Only:
14.(j�WATER ZONESM
t
TO
DESCRIPTIS
DESCRIPTION
f
�j1 ft.
�Q/ V
rt.
O
L /1 4- Aal�
'f�!
ft.
fL
15. OUTER CASING (for multi -cased wells) OR LINER (if a licable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
rt.
rt.
in.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
I ) ft.
6 D ft.
y in.
S� �
Ai 1 C/
_�-
i ft,
ft,
in.
17. SCREEN
TO
DIAMETER
SLOT SIZE
THI KNESS
MATERIAL
/
L'r U ft.
fro
KO ft.
t�
1/ in.
`�
2 a
P s L
ft.
ft.
in.
18. GROAT
FROM
TO
MAN� EMPLACEMENT METHOD AMOUNT
? L[n`bor'e el oCJi 1
O ft.
Zv II.
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK
Of applicable)
FROM
TO
MATERIAL
EMPLACEMENT METH,
4� ft.
�rri rt.
ov
t'�
,ev io d-
ft.
ft.
20. DRILLING LOCjattach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
b ft.
75 fl.
/.4a7-1 2* -
35 ft.
06 ft.
5447-1 d y c L.aZ.v..---
yo ft-
60 ft-
C L��
60 rt.
130 ft.
Rc- G L 4- She / I
fL
ft.
ft.
ft.
ft.
'RECEIVED
21.REMARKS
o g 2018
FEB
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) J0 Method of test: i�
/^ 1 � Z
13b. Disinfection type:` 1 / 0ft4 P ./ Amount: 1 • 0
22. Certification:
ore of Certified Well Contrlfctor
fvnstian Promseit 9 Uf�m
DWQ OG
/z r22-/•7
Date
y signing this form, 1 hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy a f this 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, 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 one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Sunnis' & Iniection Wells: in addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW-1
North Carolina Department of Environmental Qualify - Division of Water Resources Revised 2-22-2016

Print Forrn.
WELL CONSTRUCTION RECORD (GW-1) 4474
1. Well Contractor Information:
�� 0 of t�
Well Contractor Name
5S
NC Well Contractor Certification Number
Company Name
2. Well Construction Permit #: {{{{'
List all applicable well construction permits Sl•!Se
(i.e.
RECEI D�/NNCbENR/DWR
MAR 1 9 2018
lei1L/N 6-
3. Well Use (check well use):
Water Quality R gional
�rtflsp�nrct5tilon
.�(�o�IdIO.Sr I %Y"aY1GTP�co
Water Supply Well:
Agricultural
DGeothennal (Heating/Cooling Supply)
1 Industrial/Commercial
1 rrigation
'Non -Water Supply Well:
°Monitoring
injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Retum)
©Municipal/Public
Residential Water Supply (single)
Residential Water Supply (shared)
ED Recovery
Groundwater Remediation
Salinity Barrier
EJStormwater Drainage
LJ Subsidence Control
ElTracer
Other (explain under #21 Remarks)
4. Date Well(s) Completed: /e — / /Well 1D#
Sa. Well Location:
476 (&ol, ,L
3Ir3J—,
Facility/Owner Name Facility ID# (if applicable)
("w &kkleoff- b/2 P 5 f� C
Physical Address, City, and hip
(472_"-e
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
Y ° ya ' to, IN' 76 �S' e22e Y2 W
6. Is(are) the well(s)
ermanent or DTemporary
7. Is this a repair to an existing well: ©Yes or No
!/this i.s a repair, jiil out known well construction information id explain the "^'ure Cf the
repair under 1121 remarks section or on the hack of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled: Q N
9. Total well depth below land surface: /
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing:
If wafer level Ls above casing, use "+"
11. Borehole diameter:
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
/0
(in.)
0rt1 r
(ft.)
(ft.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) S 5 Method of test: /I- 1
n �
13b. Disinfection type:( ) d 1Z) N e Amount:
e
4of Internal Use Only:
•l 1
14, WATER ZONES
FROM
TO
DESCRIPTION
/ (gyp ft.
op o ft.
f2 2 C /
ft.
ft.
15. OUTER CASING (for multi -cased wells OR LINER (if a ) licable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
/ ft.
i 110 ft.
,,...-{ in.
5'G4 ctc-C/
P ✓ C..--
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
i.i1Yv ft.
f 60 ft.
LI in.
Z 0
scil to
p ✓ e-.
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
O ft.
Z v iL
I?ey1 40124
?p c, ( e J Lion ) (o
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
/ too ft.
I, m 0 ft.
S',4,rt
po C >- e d
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rack type, grain sire, etc.)
U R.
j C ft.
5,-Q%� ) j
/
7.
7 0 ft.
/ (/ U ft.
C.. t! v� tI
/ 4/ oft.
1 b 0 ft.
/ L e::' e k....---•
ft.
ft.
rt.
ft.
R I
c
21. REMARKS Al 0 9 2018
JAN
rt"tatiorl Prcu::-.:.ei•tng ui'it1
22. Certification:
01�lG31t3t rt�
/0 'lb --I
Date
y signing this jaunt, 1 hereby cert), that the well(s) was (were) constructed in accordance
with 15A NCAC 02C:.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a
copy of this 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL. INSTRUCTIONS
24a. For All Wells: Submit this torm within 30 days of completion of well
construction to the following:
Division of Water Resources, 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 one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
r
Form G W-
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

Print Form
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor information:
Bobby Allred
For Internal Use Only:
4471430
Well Contractor Name
2610-A
NC Well Contractor Certification Number
A C Schultes of Carolina, Inc.
RECEIVED/NCDENR/DWR
Company Name
2. Well Construction Permit #:
uw, coMateleCNEitityRetonaI
Operations Section
Wilmington Regional Office
0 Municipal/Public
Residential Water Supply (single)
Residential Water Supply (shared)
List all applicable well construction permits (i.e.
3. Well Use (check well use):
Water Supply Well:
0Agricultural
DGeothennal (Heating/Cooling Supply)
Dindustrial/Conunercial
I 1 Irrigation
Non -Water Supply Well:
J Monitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
DAquifer Test
DExperimental Technology
DGeothermal (Closed Loop)
DGcothennal (Heating/Cooling Return)
4. Date Well(s) Completed: 7/1 7/17
5a. Well Location:
W Carteret Water Corp
DRecovery
Groundwater Remediation
Salinity Barrier
DStonnwater Drainage
ID Subsidence Control
DTracer
DOther (explain under 421 Remarks)
PW-8
Well 1 D#
Facility/Owner Name Facility ID# (if applicable)
4102 Hwy 24, Newport, NC 28570
Physical Address, City, and Zip
Carteret
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
34.71 556 N 76.98 461 \\
6. Is(are) the well(s)10Permanent or DTentporary
7. is this a repair to an existing well: ©Yes or x❑No
If this is a repair, fill out known well construction information and explain the nature of the
repair under 421 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
constniction,only 1 GW-t is needed. indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface: 295
For multiple wells list all depths if different (example- 3@200' and 2 « l00')
(ft.)
10. Static water level below top of casing: 25 (ft.)
If morel- level is above casing, lice " "
11. Borehole diameter: 23 (in.)
12. Well construction method: mud/reverse rotary
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
I3a. Yield (gpm) 1220 Method of test: Pumping
13b. Disinfection type: HTH Amount: 10 Ibs
14. WATER ZONES
FROM
TO
DESCRIPTION
197 f'•
237 I'•
limestone
270 ft.
290 l''• _
_
limestone
15.OUTER CASING (for multi -cased wells) OR LINER (if ap licable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL.
0 ft'
50' f'•
24 '°.
.375
steel
_
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
197 f'
"
12 in.
sch 10
304 ss
245 ft•
270 f'•
12 in.
sch 10
304 ss
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
197".
237 ft.
12 '°'
.050
n/a
304 ss
270"
290 ft.
12 '°'
.050
n/a
304 ss
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft.
50 f'•
cement
Tremmie
0 ft
165 f'•
cement
Tremmie
245 fr.
255 f'•
bentonite
Tremmie
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
187 ft.
245 ft
#3 gravel
Tremmie
255 ft
295 f'•
#3 gravel
Tremmie
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rod( type, grain sae, etc.)
0 ft'
10 f'•
sand & clay
10 ft
30 ft.
clav & fine sand
30 ft'
51 f''
clay
51 ft.
60 ft
sand, shells and limestone
60 ft
145 f'•
gray clay
145 ft.
190 f'•
sand & shells
190 ft.
300 f'•
limestone
21. REMARKSR.
iF . H" q r„'
t'®n.i
la...e yi;� s /pR d
_
nwri d __._
22. Certification:
2 inforilf{ai)on Proci-o-N {g Urfit
exidud
Vev
Signature ofCinified Well Contractor Date
9/7/17
By signing this form, 1 hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C.0100 or ISA NCAC 02C.0200 Well Construction Standards and that a
copy of this 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a, For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For infection Wells: In addition to sending the fonn to the address in 24a
above, also submit one copy of this fonn within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Infection Wells: In addition to sending the fonn to
the address(es) above, also submit one copy of this fonn within 30 days of
completion of well construction to the county health department of the county
where constructed.
FOint GW- I North Carolina Department of Environmental Quality - Division of Water Resources
Revised 2-22-2016

Water Supply Well:
Agricultural
'Geothermal (Heating/Cooling Supply)
Ind ustrial/Commercial
Irrigation
Non -Water Supply Well:
Monitoring
injection Well;
WELL CONSTRUCTION RECORD (GW-1) 4 4 2
1. Well Contractor Information: 1 7
Bobby Allred
Well Contractor Name
2610-A
NC Well Contractor Certification Number
A C Schultes of Carolina, Inc.
Company Name
2. Well Construction Permit it:
List all applicable well constniction permits (Lc. 1/1C', Cotwatiat Queti teJ. g4onal
3. Well Use (check well use): Operations Section
Wilmington Regional Office
xDMunicipal/Publ is
[Residential Water Supply (single)
DResidential Water Supply (shared)
RECEIVED/NCDENR/DWR
MAR 19 2018
DRecovery
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
}Groundwater Remediation
Salinity Barrier
DStormwater Drainage
DSubsidence Control
Tracer
Geothermal (Heating/Cooling Return) iOther(explain under t121 Remarks)
4. Date Well(s) Completed: 10/30/1 7 Well ID#1 PVV 7
5a. Well Location:
West Carteret Water
Facility/Owner Name Facility ID# (if applicable)
4102 Hwy 24 Newport, NC 28570
Physical Address, City, and Zip
Carteret
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
34.72.551 N 76.97.937
6. Is(are) the well(s):% Permanent or DTemporary
7. Is this a repair to an existing well: EJYes or rho
If this is a repair,./ill out known well eanstruction atformation and explain the nature (Ville
repair under 42/ remarks .section or an the back of ibis, 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: 270
For multiple wells list all depths if different (example- 3@,200' and 2 cr 100')
W
(ft.)
10. Static water level below top of casing: 35 (ft.)
If water level is above casing, use " -f."
1l. Borehole diameter: 19 (in.)
12. Well construction method: mud/reverse rotary
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 1 o 1 Method of test: Pumping
I3b. Disinfection type: HTH .mount: 10 Ibs
0 ft'142
FROM
TO
For Internal Use Only:
14. WATER ZONES
FROM
71 ft•
201 ft.
TO
131 ft-
281 ft
DESCRIPTION
Limestone
Limestone
1
15. OUTER CASING (for multi -cased wells) OR LINER (if ap r1'ca ble)
DIAMETER I THICKNESS MATERIAL
ft. 20 i 1.375 steel
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
0 ft.
243 ft-
17. SCREEN
FROM
TO
203 ft-
255 a•
DIAMETER
10 in'
10 in.
THICKNESS MATERIAL
sch 10 304 ss
sch 10 304 ss
Print Form
203 ft.
255 ft.
18. GROUT
FROM
TO
243 ft-
265 ft
DIAMETER
10
10 in.
SLOT SIZE THICKNESS MATERIAL
.050 n/a 304 ss
.050 n/a 304 ss
0 ft.
TO
42 ft.
MATERIAL
cement
EMPLACEMENT METHOD & AMOUNT
tremmie
0 ft.
177 ft.
cement
tremmie
177 ft.
187 ft.
bentonite
19. SAND/GRAVEL PACK (if applicable)
FROM
187 ft-
ft.
tremmie
TO MATERIAL
247 ft- #3 gravel
ft,
EMPLACEMENT METHOD
tremmie
20. DRILLING LOG (attach additional sheets if necessary)
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
FROM
0 ft.
TO
10 ft-
10 ft.
51 ft'
71 ft.
51 it.
71 ft'
131 ft.
clay & fine sand
sand & shells
limestone
131 ft.
181 ft,
181 ft
201 ft•
clay with sand
clay with shells
201 ft,
281 ft-
limestone & sand
21. REMARKS
22. Certification:
n 4.0 O.L
Signature ofCertilW d e ontractor
5 2017
ifltormation a't t1( a. • s ri'lii
By signing this form. 1 hereby certify that the well(s) was (were) constructed in accordance
with I SA NCAC 02(' .0100 or I5A NCAC 02C .0200 Well Construction Standards and that a
copy of This 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this fonn within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Fonn G W - I
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Bobby Allred
RECEIVED/NCDENRIDWR 44
Well Contractor Name
2610-A
NC Well Contractor Cenification Number
MAR 1 9 2018
A C Schultes of Carolina, InWater Quality Regional
ODeratinnc section
Company NameWilmington Regional Office
2. Well Construction Permit#:
List all applicable well construction permits (i.e. WC, County, State, Variance, etc)
3. Well Use (check well use):
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
Non -Water Supply Well:
Monitoring
D Municipal/Public
[Residential Water Supply (single)
[Residential Water Supply (shared)
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
Recovery
['Groundwater Remediation
❑(Salinity Barrier
EiStormwater Drainage
Subsidence Control
IJTracer
Other (explain under #21 Remarks)
4. Date Well(s) Completed: 10/30/17 Well ID# PW-7
5a. Well Location:
West Carteret Water
3-6
Facility/Owner Name Facility ID# (if applicable)
4102 Hwy 24 Newport, NC 28570
Physical Address, City, arid Zip
Carteret
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
34.72.551 N 76 97 937
6. Is(are) the well(s)Jx Permanent or OTempoti •y ,,,
7. Is this a repair to an existing well: QYes or DIVioZC 2
0 6 4O17
f this is a report, fill out known well construction information and .aplain the nature of the
repair under #21 remarks section or on the hack of this form. fp qSf%iOft +� rl'L e'�' �:ti j
��nC
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells have lne
construction, only 1 GW-I is needed. Indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface: 270 (ft.)
For multiple wells list all depths if different (c.vomple- 3@,200' and 2 100')
10. Static water level below top of casing: 35 (ft.)
/f water level is above casing, use '
11. Borehole diameter: 19 (in.)
12. Well construction method: mud/reverse rotary
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 7 0-1
Method of test: Pumping
13b. Disinfection type: HTH Amount: 10 Ibs
Print Form
For Internal Use Only:
7428
14. WATER ZONES ,=--
FROM
TO
DESCRIPTION
71 ft•
131 ft.
Limestone
201 ft.
281 ft.
Limestone
is. OUTER CASING (for multi -cased wells) OR LINER (if ap licable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft'
I 42 ft.
I 20 in.
.375
steel
16. INNER
CASING OR TUBING
(geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
265 fr•
270 ft.
10 in.
sch 10
304 ss
ft.
ft.
in.
17. SCREEN -
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
ft.
ft.
in.
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
247 rt.
249 ft.
bentonite
tremmie
ft.
ft.
ft.
ft.
-
19. SAND/GRAVEL PACK
(if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
ft.
ft.
ft.
ft.
20. DRILLING
LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
0 ft'
10 ft.
40 P SO; I
10 ft.
51 ft.
clav & fine sand
51 ft.
71 ft.
sand & shells
71 ft.
131 ft.
limestone
131 ft-
181 ft.
clay with sand
181 "-
201 ft.
clay with shells
201 ft.
281 ft•
limestone & sand
21. REMARKS
t
22. Certification:
Signature ofCertifietell Contractor Date
By signing thus form, 1 hereby certify that the well(s) was (were) constructed in accordance
with 1SA NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been prodded to the +cell owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For lniection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also subunit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW-I
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

Print:For 71:
WELL CONSTRUCTION RECORD (GW-1) 4474
--)11 a >z To iJ
RECEIVED/NCDENR/DWR
1. Well: Contractor Information:
Well Contractor Name
NC Well Contractor Certification Number MAR 19 2018
Mo��o� �P iLL/» 6-
Company Name
2. Well Construction Permit #: 2.3 5 Ia'per/Quality Regional
List all applicable well construction permits (i.e. UIC, C.o r, 4ftNr lar§,U9t10n
viinlington Regional Office
3. Well Use (check well use):
Water Supply Well:
['Agricultural
Geothennal (Heating/Cooling Supply)
IIndustrial/Commercial
rrigation
JJJJJJ���n-Water Supply Well:
Monitoring
Injection Well:
['Aquifer Recharge
['Aquifer Storage and Recovery
['Aquifer Test
['Experimental Technology
['Geothermal (Closed Loop)
()Geothermal (Heating/Cooling Return)
['MunicipaLfPublic
Residential Water Supply (single)
Residential Water Supply (shared)
d Recovery
['Groundwater Remediation
['Salinity Barrier
['Stonnwater Drainage
['Subsidence Control
['Tracer
Jj0ther (explain under #21 Remarks)
4. Date Well(s) Completed: O'/ t / 7 Well 3t1
5a, Well Location:
?kwt �s
Facility/Owner Name
Facility iD# (if applicable)
sly FIneriLd 2k ifile/tatd d'/e
Physical Address, City, and Zip
(.AR+e..e V
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
yo.l0-1-N 7,°5?/9. Zc2"
6.1s(are) the well(s)Permanent or ['Temporary
7. Is this a repair to an existing well: ['Yes or ONo
if this is a repair, Jill out known well construction Information e d explain the nature ojdre
repair under 1121 remarks seclion or on the back ojthis form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled, AI G
9. Total well depth below land surface: V5
For multiple wells list all depths ljd�erent (exanrpie- 3 rat 200' and 2Q100')
10. Static water level below top of casing:
1f water level is above casing, use "-I-I. "
11. Borehole diameter: l7 e (in.) /
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc,)
(ft.)
(ft.)
.7 internal Use Only:
14. WATER ZONES
FROM
'rO
DF:SCRIPTION
A65fL
205 ft.
/0
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER. (if a rlicable).
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TIMING (geothermal closed-1oop
FROM
TO
DIAMETER
THICKNESS
MATERIALMATERI`AII../
/ rt.
l
24.5 ft.
le in.
56A VV
p V c.
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SiZE
THICKNESS
MATERIAL
ZG5ft.
225ft.
il in'
Zp
SGR4O
Pw -
ft,
ft,
' in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
O n.
$ O ft.
g am„ f to
t:SLR, fly fRj/r?in',e-
n.
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
24,5 ft.
Z8 S rt.
541-a
Po u r.e d
rt.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain siren eta)
o ft.
yO ft.
5A-N
p ft.
/4/0 ft.
_5A-tidy G G
20 rt.
(Q0V ft.
E,
sfief! 4- S: 71 zt
�i(�o ft.
, t/d ft.
e- 4t>4 y
9_/�It.
7/_<i ft.
[ �
Nth icy c-GA
2 6 S n.
2.g 5 ft.
, :
21. REMARKS
ICU G 0 i 2017
-s..e..,rwncalIntl Prb,,cf`"=S`-
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) ' 60� j Method of test: i 12
13b. Disinfection type�'t7 0 12-i NP. Amount: Z . O 0I./.
22. Certification:
Sf re of Certified WellContractor
DWO/Biwa
F-30 -f 7
Date
By signing this farm, l hereby certii, that the Well IV was (were) constructed in accordance
with 15A NCAC 02C .0100 or 1 SA NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the xrli owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Inleclion Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Sunni's, & Infection Wells: In addition to sending the form to
the address(cs) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW-I
North Carolina Department of Environmental Qualify - Division of Water Resources Revised 2-22-20 16

Print Form
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
RECEIVED/NCDENR/DWR
Well Contractor Name
2c .3
NC Well Contractor Certification Number
iviolz ?N be/Lb/A) \tiLl 9 L
018
Company Name
?% cit of'9
Q Ilty Regional
2. Well Construction Permit #: era nS SCcipn
List all applicable well construction permits (i.e. f11(:.`q l(rrml.Suu6.� ReidnaY office
3. Well Use (check well use):
Water Supply Well:
'Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
Non -Water Supply Well:
Monitoring
DMunicipa1/Public
tesidential Water Supply (single)
Residential Water Supply (shared)
['1 Recovery
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Retum)
QGroundwater Remediation
cSalinity Barrier
Stormwater Drainage
Subsidence Control
DTracer
f Other (explain under #21 Remarks)
4. Date Well(s) Completed:/2/ /J' ell iD#
51.,Well Location:
m (Ng de& .+,JPt
Facility/Owner Name Facility iD# (if applicable)
j 15 i -.1-rot-) H -, i Beato -1U
Physical Address, City, and Zip es
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one latnong is sufficient)
3 °yb'z9r1/6 rrN ?6°y. ` 3/, 32
W
11 6. Is(are) the well(s) Permanent or DTemporary
7. Is this a repair to an existing well: es or DNo
If this is a repair, fill our known well consrructio information and explain the nature of the
repair under 1121 remarks section or on the back of this form.
8. For Geoprobc/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled: °Ng-
9. Total well depth below land surface:
/U v
For multiple wells list all depths if different (example- 3(200' and 2©100')
10. Static water level below top of casing:
If water level is above casing, use
11. Borehole diameter:
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
5
(in.)
Rl9-ham-y
(ft.)
(ft.)
For internal Use Only:
+4 7
14. WATER ZONES
FROM
TO
DESCRIPTION
p ft.
4 g 11'
/
4 ifo--c.
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if applicable)
FROM
TO
DIAMETER
THICKNESS MATERIAL
ft.
ft.
in.
16. INNER
CASING OR TUBING
(geothermal closed -loop _
FROM
TO
TER
DIAq
THIC FSS
MATERIAL
h.
6 p ft.
in.ft.
7
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THIC NESS
MATERIAL
50 ft,
'�t,
��/ft.
if in.
/�
(/
. o
Y
ft.
in.
18. GROUT
FROM
TO
M, ATER1 L
EMPLAEMENT ME HOD & AMOUNT
,b ft.
v
L/� z. ° ft.
(C��„r kr yule-
�`l ,, ffba e Jlb
ft.
t
ft.
ft.
ft.
19. SAND/GRAVEL
PACK
(if applicable)
FROM
TO
MATERIAL ,
EMPLACEMENT METHOD )
ft.
an rt.
"
&/'QY(ct
/013 i P 6-
t
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
D ft.
3 5 ft.
5-.--7 d
ft
110 ft.
1 la ft.
0-e--4----
ft.
ft.
ft.
ft.
14 2°1g
21. REMARKS ��
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) tC°
Method of test:
4(2
13b. Disinfection type:(%( (OR 1,4/e.O- Amount: S�
22. Certification:
/ 7 vv
cofCertified Well Contractor
/h
B signing this form, I hereby certifii that the wells) was (were) constructed in accordance
with 1SA .N(.AC 02C.0100 or iSA NCAC 02C.0200 Well Construction Standards and that a
copy of this 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For lniection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this forth within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24e. For Water Sunoly & Injection Wells: In addition to sending the forth to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW-1
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contra
ctor Information:
. e1 yVA P• : 6(dtW
Well Contractor Name
y- /1- ECEIVED/NCDENR/DWR
NC Well Contractor Certification Number
/OR J'4/ r fL j (. 0/A6R 1 9 2018
Company Name
2. Well Construction Permit #: Water Quality Regional
List all applicable well construction permits (.e. UiC, ConniO pertaik a9n. wtion
Wilmington Regional Office
3. Well Use (check well use):
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
Non -Water Supply Well:
Monitoring
Municipal/Public
esidential Water Supply (single)
Residential Water Supply (shared)
Recovery
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Retum)
Groundwater Remediation
}Salinity Barrier
DStormwater Drainage
Subsidence Control
Tracer
Other (explain under #21 Remarks)
4. Date Well(s) Completed: 9 / Well ID#
5a. Well
Location:
• 4f /e1Q-k 4 d 1T 14
Facility/Owner Name Facility ID# (if applicable)
Lf (90 L t 4-4-Le beet C e eL IJ o 0 -1'
Physical Addre s, City, and Zip
City*ee
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient) ~j/
,5����J Os�.�f( N !(9 d50t z-L. iZ. Ir W
6. Is(are) the well(s)Permanent orr.�t)Temporary
7. Is this a repair to an existing well: p\pYes or DNo
If this is a repair, fill out known well constructio r formation and explain the nature of the
repair under 01 remarks section or on the back of this form.
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: C) /'
9. Total well depth below land surface:
12-
For multiple wells list all depths if different (exatnple- 3@200' and 2@100')
10. Static water level below top of casing: g`
If water level is above casing, use "+4
11. Borehole dianteter: 7 F (in.)
go -OA--Ay
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
(ft.)
(ft.)
FOR WATER SUPPLY WELS ONLY:
13a. Yield (gpm) 1s j I
Ob. Disinfection type: (r'1 1 6 a- I lit- Amount:
Method of test: (' ' 12,
14. WATER ZONES
FP^Rr
TO
DESCRIPTION .�
D ft.
ft.
{��p
S'/'tC•GC �0Z,&.-.-
ft.
ft.
15. OUTER
CASING (for
multi -cased wells) OR LINER (If a licable)
FROM�T^
DIAMETER THICKNESS
MATERIAL
ft.
ft.
in. •
i
16. INNER
CASING OR TUBING
Geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
I
(
�y i12 ft.
r. in.
5' l t`iD
J1 4- C.
/�
ft.
ft.
in.
17.SCREEN
FROM
TO
DIAMETER
SLOT SIIZE
THICKNESS
MATERIAL
6.;„ j . r1 rt.
tl V
C�% 0 ft.
a
s ji in.
`�
L. (j
5c....),
(-' % 7 d
V L
ft.
ft.
m.
t
18. GROUT
FROM
TO
EMPLACEMENT METHOD & AMOUNT
(o ft-
V
/
-r l� ft-
/MjA�JTERR,I,AL7
/"Seahi'-t)
r
r.C,
f t'ti /e (jj .
ft.
ft.
J
rt.
ft.
19. SAND/GRAVEL PACK
(if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
I, 0 ft.D
�l
ft.
SA vt f1,
k
((•) f e 6-
rt.
ft.
20. DRILLING
LOG (attach additional sheets if necessary)
PROM
TO
DESCRIPTION (eater, hardness, soiltreek type, grain size, etc.)
77 ft.
3 6 ft.
- S i.ave'7 C'
O •
(f 6)ft.
I •yt c4 CI 1'a'
To ft.
('r) 0 ft.
C. L 6/
/RP ft.
ft•
/'
$L,(1L' •1 14(�'Zk/
ft.
ft.
J
ft.
ft.
. _ _
�. �
y'.
R.
ft.
' . ._� v r
,� f q
21.REMARKS
0-CT 2 3 zrri7
fci.,:ra(ion hto =s,-E'iri-i
22. Certification:
&;Lervt
urcofCcnified Well -Contractor
Date
Sy signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 1SA NCAC 02C .0100 or ISA MCA(' 02C.0200 Well Construction Standards• and that a
copy alibis 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, 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 one copy of this form within 30 days of completion of well
construction to the following:
Division or Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Sunnis & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW-1
North Carolina Department of Environmental Quality • Division of Water Resources Revised 2-22-2016

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Well actor Name
RECEIVED/NCDENR/DWR
NC Well Contractor Certification Number
)5 t-L(#J 6-
. mAR 9 2018
t�Zp 2
Company Natne
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC.. County
State,
to e, Variance,
etc.)
c
Operations
water Section
Wiifllingtorr Zegiotlal Office
3. Well Use (check well use):
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
�Industrial/Commercial
Irrigation
Non -Water Supply Well:
Monitoring
11
Municipal/Public
tt esidential Water Supply (single)
Residential Water Supply (shared)
Recovery
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed:
Sa. Well Location:
QGroundwater Remediation
DSalinity Barrier
DStormwater Drainage
Subsidence Control
}Tracer
Other (explain under #21 Remarks)
q-b-i1
Well ID#
MAR k f41<e-S
Facility/Owner Name Facility ID# (if applicable)
4133 Ltge fwek Fd 2o, et? 1C
Phy 'jccal Address, City, and+ Zip
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
3L/ q `32, zz'N 1b °30' r//r 971,
w
6. Is(are) the well(s)1Permanent or )Temporary
7. Is this a repair to an existing well: 0 Yes or ptNo
If this is a repair, f It out known well construction it formation explain the nature of the
repair under 1121 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 CG� isi eeded. Indicate TOTAL NUMBER of wells
drilled: 4
9. Total well depth below land surface:
For multiple wells list all depths if different (example- 3 tr 00' and 2@/00)
10. Static water level below top of casing: / Z''
if water level is above casing, use "+ "
11. Borehole diameter: V (in.)
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
Y
(ft.)
(ft.)
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
6
° ft.
!/
tIi Ie Y /I �i
/`,
1
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if a livable)
FROM
TO
DIAMETER
THICKNESS MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESSS
MATERIAL
_
0 ft.
ft.
Q
44 in.
/
. 1:1/ilv
I ft.
ft.
in.
17.SCREEN -
FROM
TO
DIAMETER
SLOT SIZE
THIC ESS
MATERIAL
/1 ft.
gC) ft,
fit in.
�c2
,' /1/o
p({" 6....,6(/
ft.
ft.
in.
18. GRO(1T
FROM
TO
EMPLACEMENT METHOD & AMOUNT
0rt
/ ft.tieviGv-
MATERIAL
Vaii2✓ /VIiiilf,- p
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
S: 2/ A4tAed
�D ft.
r � ft.
5 n
ft.
ft.
20. DRILLING
LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness. soil/rock type, grain size, etc.)
D ft.
.3 i ft.
5 ,/ d
g 5 ft.
co ft.
/O
3-���i%fl%, ! C..�Li >l
�0 ft.
t� ft.
C• 142-1� j►/, Qj
Sc) rt.
U
(�D n.
S/1. /L 0Z/ _._
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
SEP 1 ? 7017
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) �V Method of test:
13b. Disinfection typeall6 f.LP/ Amount:
22. Certification:
Si: • . of Certified Well Contractor Dite
',ping this form, I hereby cert fy that the well(s) was (were) constructed in accordance
with 15A N(:AC 02C .0100 or 1SA NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to she 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells: In addition to sending the forth to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
2 c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW-I
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-20I6

Print Form
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
akc0N' Y) 111 0 -Th
Well Contractor Name
RECEIVED/NCDENR/DWR
NC Well Contractor Certification Number
719,(LL/A (VAR 1 9 2018
Company Name
pilqj
2. Well Construction Permit #: p ate
tY Regionyyal
List all applicable well construction permits (I.e. f( i b egionaSI§aI'Office
3. Well Use (check well use):
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
Non -Water Supply Well:
Monitoring
unicipal/Public
esidential Water Supply (single)
Residential Water Supply (shared)
DRecovery
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
Groundwater Remediation
Salinity Barrier
0Stormwater Drainage
Subsidence Control
EJTracer
( Other (explain under #21 Remarks)
4. Date Well(s) Completed: _9 --).7 Well 1D#
5a. Well Location:
P)1411.0 MO At)
Facility/Owner Name
704 tigeew P6 )141 I of S7 .
Physical Address, City, and Zip
Facility ID# (if applicable)
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well fiend,, one lat/long�is sufficient)
/ /� `/ �ClQ tie 2
f 7/N �G Li/ t lb ' I
W
6. Is(are) the we1l(s)gPermanent or DTemporary
7. Is this a repair to an existing well: i Yes or i]fihi;
If this is a repair, fill out known well cwnstrucIic information i-d ccxplain the nature of the
repair under 1121 remarks section or on the hack of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled: c,v
9. Total well depth below land surface: 1 Z (ft.)
For multiple wells list all depths if different (example- 3 , 00' and 2Q100)
10. Static water level below top of casing: 15 (ft.)
If Rater level ix above casing, use "+" ,n
11. Borehole diameter: 1 /e
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
(in.)
/20t R/
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 5 e Method of test: i1 )
13b. Disinfection type:C k 0 -i NC Amount: 0Z- 0
For Internal Use Only:
14. WATER ZO-INTEs ' in .."..
1O
UESCRIPTION
�FRRpOyM
`QO ft.
7 Z0 ft.
Cs
/. ©Cr
f
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if a elicable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS'/
MATERIAL
1!
!!!
f
ft-
ft.
r in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
Zee, ft.
.Z zc jt.
: in.
rJ�/56.4
/L
PI I + - .
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACE ENTMETI OD&AMgLINT
b ft.
� ft.
.&44t
/ red gJV ! b
fL
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
_
EMPLACEMENTMETjiOD
�d0 ft.
azr0 ft.
S, d
AV r( d
D.
ft.
20. DRILLING LOG (att.i.h additional sheets if necessary)
FROM
TO
DESCRIPTION (color, Ifardness, soil/rock type, grain size, eta)
O rt.
5 ft.
C7f
3 5 ft.
g< ft.
5/ e-ye„
i00ft.
�i//Le
� a,�,Jt,
g.,Oft.
rs i /� ft.
C�IIJ
Ls
4orki1fL
ft.
- _ . ._
..
ft.
ft..
-.
21. REMARKS
SEF' '%: `' 2017
22. Certification:
Sign
ofCetified Well Contractor
g /t 17
Date
Bi' signing this join,, I hereby cert , that the well(.$) was (were) constructed in accordance
with I5A JVCAC 02C .0100 or 1 tut N(:AC 02C .0200 Well Construction Standards and that a
copy , f this record has been provided at 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
construction details. YOLI may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the fonn to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Frail Service Center, Raleigh, NC 27(199-1636
24c. For Water Simply & injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Funn G W -
North Carolina Department of Environmental Quality - Division or Water Resources Revised 2.22.2016

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
tts0 P. 2)oR4rAt
Well Contract29 3 [RECEIVED/NCDENR/DWR
NC Well Contractor Certification Number
0/21p 4ki /1 -19 2-018
Company Name
2. Well Construction Permit #: �tf�l 'di
List all applicable well construction permits (i.e. U!C. C}{iIAi peratlonS /Section
3. Well Use (check well use): Wilmington Regional Office
Water Supply Well:
Agricultural DMunicipal/Public
Geothermal (Heating/Cooling Supply) residential Water Supply (single)
Industrial/Commercial Dkesidential Water Supply (shared)
irrigation
Nor. -Water Supply Well:
' Monitoring
Recovery
Infection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Retum)
Groundwater Remediation
,Salinity Barrier
OStormwater Drainage
Subsidence Control
gTracer
Other (explain under #21 Remarks)
4. Date Well(s) Completed: 1 Z / (7 Well ID#
5a. Well Location:
7k n14'S �-ll. P_A�e
Facility/Owner Name Facility ID# (if applicable)
r 1/3 6i kik/ •arm /ee 6 aattA - Af G
Physical Address, City, and Zip
County
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
Parcel Identification No. (PIN)
.34°il(0'So•'(l't N76°3yt5 7•Lo
tt
W
6. Is(are) the well(s)Permanent or ()Temporary
I
I
7. Is this a repair to an existing well: LiVes or No
If this is a repair, fill out known well construction i yiformation a explain the nature of the
repair wider 1121 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. 1ndici}te TOTAL NUMBER of wells
drilled:
e
9 Total well depth below land surface:
L - l'rmt l-orm 1
14. WATER ZONES
FROM
TO
DESCRIPTIONC A
ft.
ti/Y,f }Nit,
,����,���I/(�j
ft.
ft.
15. OUTER
CASING (for
multi -cased welts) OR LINER (if a licable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER
CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
i ft.
J
() ft.
p/ in.
5 IL t)
(a /
ft.
ft. ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICt(J�VESS
MATERIAL/
,v V
go ft.
tv/
/00 ft.
t / in.
`�j'
z�
1
56._ Ci'c
�C
ft.
ft.
in.
18. GROUT
t
T%
EMPLACEMENT�e IL &AMI NT
0MATO
ft.
0 ft.
✓
Ill
MIv
��(J�V ` `t �t�
R.
ft./
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
ft.
to
/0ID ft.
5 yam„ d a
P0r.c. J
ft,
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness eoittrock type, grain size, etc.)
Oft.
3 ft.
/42't Ce/
3 c ft.
L'S/^ 0 ft.
-9
.'i'a7,7 Cy CC c-c-'.-
ft.
gO ft.
(�CG4--2-��
5 D
j Od
, Q�
/ 0- j?
ft.
ft.
�9
ft.
ft.
; ,..,. ft.'" fi.,:,, . s
f.
ft.
ft.
< .. ... . .
21. REMARKS ti E f' f 2 7 017
it}'q.cari?. Kt5 . Fit.. ._ .,.
(ft.)
For multiple wells list all depths if different (exam ?le- 3@a 2(h7' and 22©100)
10. Static water level below top of casing:
If water level is above casing, use ''''
11. Borehole diameter:
12. Well construction method:
(i.e, auger, rotary, cable, direct push, etc.)
(in.)
(z1
(ft.)
22. Certi , tion:
FOR WATER SUPPLY WELLS ONLY
U
13a. Yield (gpnr) Method of test:
13b. Disinfection type(}J'1O% =' I Amount:
I
ure of Certified Well Contractor
7- 2-Y-f t
Date
6v signing this. farm. 1 hereby ceri( that the well(s) was (were) constructed in accordance
with ISA MAC 02C .0100 or 1SA NCAC 0. :.0200 Well Construe/ion Standards and that a
copy of this record has been provided so 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, 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 one copy of this Conn within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW-1
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2.22-2016

Print Form
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Jason P Morton
Well Contractor Name
2953-A
NC Well Contractor Certification Number
Morton Drilling
RECEIVED/NCDENR/DWR
MAR 1 9 2018
Water Quality Regional
Company Name Operations Section
244064imington Regional Office
2. Well Construction Permit #:
List all applicable well construction permits (i.e. 1J1C, County, State, Variance, etc.)
3. Well Use (check well use):
44
Water. Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
Non -Water Supply Well:
Monitoring
Municipal/Public
xoResidential Water Supply (single)
Residential Water Supply (shared)
El Recovery
injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
'Experimental Technology
Geothermal (Closed Loop)
1Geothermal (Heating/Cooling Return)
Groundwater Remediation
Salinity Barrier
13Stormwater Drainage
13 Subsidence Control
Tracer
Other (explain under #21 Remarks)
4. Date Well(s) Completed: 12.._ 1 1 1
5a. Well Location:
(,fRed. Srphev s
Facility/Owner Name
Well ID#
Facility ID# (if applicable)
/35 I el,cArii'47 lmf c 15f �
Physical Address, City, and Zip
(ctypr`rp re 4-
County
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lancing is sufficient)
/ 53131 Nt -G °31/' i2O 6 1 ` w
6. Is(are) the well(s)
Fi'
Parcel Identification No. (PiN)
ermanent or DTemporary
7. is this a repair to an existing well: ®Yes or ONo
If this is a repair, fill out known well construction information and explain the nature of the
repair under 021 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled: eNg
9. Total well depth below land surface: X U (ft.)
For multiple wells list all depths if d eretn (example- 3®�200' and 2(§100')
10. Static water level below top of casing:
If water level is above casing use "+"
11. Borehole diameter:
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
cs
(in.)
�vfP� g
(ft.)
to412 ILta1 Use Only:
14. WATER ZONES
FROM
TO
DESCRIPTION
ikp ft.
/Q 6 ft.
(J
-
ft,
ft.
1S. OUTER CASING (for multi -cased wells) OR LINER (if a licablel
FROM
TO
DIAMETER
THICKNESS MATERIAL
ft.
ft.
in.
1
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
// 9 fft.V
/(�
in.
7
sem/I �(V
s' r
j'&IAV
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THIC
MATERIAL
/b19ft.
/6jDft.
!
1�. in.
_j
Z0
/NESS
SG Yv
_pl�c-,
ft.
ft.
in.
18. GROUT
FROM
TO
MATE
IMh
EMPLACEME3 METHOD & AMOUNT
Dft.
2,0 ft.
es/to
�r ( re -/ /3 s
Y�� tz'
ft,
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM�
TO
MATERIAL
EMPLACEMENT METHOD
/fY v ft.
) WI f L
I
s ci
POW' 4I,
n-
ft.
20. DRiLT,TNC LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain sere, eta.)
0 n.
; S ft.
5 A d \.
A 5 ft.
is- ft.
,.6--Arlo c"'-",yn
r ft.
!/ 9V ft.
(er
/ , oft.
/ /,Vft.
9/ley- S/Cieq- 5-jY1e ti(
'oaf:
18a ft.
`<49- '
w
ft.
ft.
n.
ft.
p..- $ c''
21. REMARKS r" 4
S ('.e ,
. fir.. `
thlg1A2018
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) !l Method of test:
13b. Disinfection type:C I/l0/21 /- e_ Amount:
At 12
d `'t,=-'41l
t
22. Certification:
atior
eke!' - 1r
nature of Certified Well Contractor
Date
By .signing this farm, l hereby cert fy that the weeks) was (were) con.structe.d In accordance
with 15,4 NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy eftlds record has been provided to the well owner.
23. Site diagram or additional well details:
You inay use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this forma within 30 days of completion of well
construction to the following:
Division of Water Resources, information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Sunnly & Injection Wells: In addition to sending the form to
e address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Fonn GW-1
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22.2016

Print Form'
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Jason P Morton
Well Contractor Name
2953-A
NC Well Contractor Certification Number
Morton Drilling
RECFIVUIrJ/NCDENR/DWR
MAR 1 9 2018
Company Name
2256300 er
Water Quality Regional
2. Well Construction Permit #: p rations Section
List all applicable well construction permits (i.e. (W).)h9hRgtOrtaR ? kromi office
3. Well Use (check well use):
Water Supply Well:
DAgricultural
QGeothennal (Heating/Cooling Supply)
fj Ind u st ri al/Co m mere ial
nirrigation
Non -Water Supply Well:
°Monitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Retum)
4. Date Well(s) Completed `) �- -- ? ; U Well ID#
Sa. Well Location:
Patricia Godwin
JMunicipal/Public
OResidential Water Supply (single)
Residential Water Supply (shared)
[Recovery
QGroundwater Remediation
Salinity Barrier
DStormwater Drainage
0 Subsidence Control
FTracer
Other (explain under #21 Remarks)
Facility/Owner Name Facility ID# (if applicable)
955 Crow Hill Rd Beaufort, NC 28516
Physical Address, City, and Zip
Carteret
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decintal degrees:
(if well field, one lat/long is sufficient)
3g°«V'77r33 /t N ��G`'3yt 24.,Z-%'
6. Is(are) the Well(s)JPermancnt or OTemporary
7. Is this a repair to an existing well: )Yes or QNo
If this is a repair, fill out known well construction information and explain the nature of the
repair under 01 remarks section or on the hack of this, form.
8. For Ceoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-I is needed. Indicate TOTAL NUMBER of wells
drilled: ONE
9. Total well depth below land surface: f %L•'
For multiple wells list all depths it -different (example- 3@200' and 2©100')
10. Static water level below top of casing:
if water level is above casing, use "-F "
11. Borehole diameter: ! / (in.)
't
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
f1-
(ft.)
(ft.)
For Internal Use Only:
447546
14. WATER ZONES
FROM
TO
DESCRIPTION
i
e.
rt.
15. OUTER CASING (for multi -cased welistOR LINER (if aalicable)
FROM
TO
DIAMETER
TIIICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING (geothern al closed -loop)
FROM
TO
DIAMETER
THIC NESS
MATERIAL
il ft.
7 v ft.
(
j� in.
`(
LI:i•
X• t i
»ki C_.
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNES[S/�
MATERIAL
7`lft.
Oft.
j` in.
�I
.j`
(,/]• 7V
f& C'
ft.
ft.
in.
' H. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft.
•) .6) ft.
C :,( i (t;
j I
•():`i.iY [ i,1-t,,l J/, ..(
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLAACEMENTMETHOD/
pow
7Uft.
tfU ft.
� 1
3/`li'l,-f-
ft.
20. DRILLING LOG (attach additional sheets if nece sary)
FROM
TO
DESCRIPTION (color, hardness, soiVrock type, grain size, etc.)
j) ft
ft.
V.
.s S ft.
U ft-
;,T/4� ("di.a- 1-0r-
?v ft.6,0-c.,-5z.
.
/ ft.
ft.
RECEIVED
rt.
ft.
ft.
ft.
A� '�(�jQ
21. REMARKS Ma 1 2 2 V 18
Unh
Itlttm41EFtiutr I'roCi9SoA'.Q
DWO/ OG
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm)
Method of test:
13b. Disinfection type: (tgOk�4cl �(
Amount: l i 7 I)
22. Certification:
SiaAOr I
aatture of Certified Well Contractor
G%Li
-S
Date
l/
By signing this form, I hereby certib• that the we/l(s) was (were) constricted in accordance
with I SA NCAC 02C .0100 or 1 SA NCAC 02C .0200 Well Construction Standards and that a
copy of this 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24s. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, 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 one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water SunDly & lrtiection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
v<here constructed.
Fonn G W - I
North Carolina Deparnnent of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL CONSTRUCTION RECORD (GW-1)
For Internal Use Only:
Print Form
1. Well Contractor Information:
Jason P Morton
Well Contractor Name
2953-A
NC Well Contractor Certification Number
Morton Drilling
RECEIVED/NCDENR/DWR
MAR 1 9 2018
Company Name rQt i R Tonal
2. Well Construction Permit #: P ian
List all applicable well construction permits (i.e.' [ ilifigtonckivanskOffiae
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
Non -Water Supply Well:
Monitoring
QRecovery
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothennal(Closed Loop)
Geothermal (Heating/Cooling Return)
❑Groundwater Remediation
DSalinity Barrier
IiStormwater Drainage
Subsidence Control
Tracer
Other (explain under #21 Remarks)
4. Date Well(s) Completedy-- 1 - / S
5a. Well Location:
`7-g/i %Z%_-S Gti Lcc
Facility/Owner Name
Well ID#
Facility ID# (if applicable)
�Ci/P-kri.:ecj_ Zvi %'1 HC /VC 2?..-SS r
Physical Address, City, and Zip
Carteret
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one latllong is sufficient) { [ r
31/°"7'7 3 2 il.'rFN/ETC'f7 . :'7iog) at �r
6. Is(are) the well(s)1ermanent or ETentporary
r,
7. Is this a repair to an existing well: Yes or NO
If this is a repair, fill out known well con.srruction information a�d`'explain the nature of the
repair under #21 remarks section or on the hack of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:
dN
9. Total well depth below land surface: I f -1
For multiple wells list all depths ifdyTerent (example. 3@200' and 2(a.I00')
10. Static water level below top of casing:
If water level is above casing, use " 1 "
11. Borehole diameter: 7 7/8
12. Well construction method: Rotary
I -'--
(ft.)
(ft.)
(i.c. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpnl) .- i .5 Method of test: Air
13b. Disinfection type: Chlorine Amount: • 1)
447545
14. WATER ZONES
FROM
TO
DESCRIPTION
r.
/
/
ft.i
rt.
15. OUTER CASING (for multi -cased wells) OR LINER (if a licab]e)
FROM
TO
DIAMF:fER
THICKNESS MATERIAL
ft.
ft.
in.
1
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
T111CKNESS
MATERIAL
ft
/ `i ( '` ft.
in,
l ,, ( it: T)
/ lie,
ft
ft.
in,
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
I-1ft.
v
4, 7f.
1.71 in,
.!+ J
C
5,A y0
j%)il C:
ft
ft.
in.
18. GROUT
FROM
1.0
EMPLACEMENT M/ETIIOD & AMOUNT
/MAT�AL
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT MuTIIOD
ft.
I / 6 1
-' ft.
1
/1 /V
1
Pea re Gc..
ft
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, foiVrock type, grain size, etc.)
t ft.
ft.
�i -74 CIC
, -41
Ti.
; 4 // ft.
t� . s v ���
/ 0 -ift
1 1 y 7 ft.
rJ
/ era__
i. .
ft
ft.
ft.
ft.
RECEIVED
ft,
rt.
MAR 1 2
21.REMARKS CU18
klieg- 4`fOCbSolty •
tjrltt
DWcW CG
22. Certification:
L/1/711 t
ture of Certified Well Contractor
Date
y signing this /rem, i hereby cert fy that the rrent's) was (were) constructed in accordance
with ISA A'(.'AC 02(:.0100 or iSA NCAC 02C..0200 WeIi Construction Standards and that a
ropy of this record bus 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the fonn to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Snook, & Infection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
sr hare. constructed.
L
Form GW-1
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Jason P Morton
RECEIVED/NCDENR/DWR
Well Contractor Name
2953-A
NC Well Contractor Certification Number
Morton Drilling
Company Name
2. Well Construction Permit #:
MAR 1 9 2018
Water Quality Regional
Operations Section
7 li7il)�;t o Regional Office
list all applicable well construction permits (i.e. 111(; Cotorty. Stare, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
In dustrial/Commercial
Irrigation
Non -Water Supply Well:
Monitoring
injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothem,al (Heating/Cooling Return)
Q Municipal/Public
Residential Water Supply (single)
Residential Water Supply (shared)
[]Recovery
[]Groundwater Remediation
Salinity Barrier
JStormwater Drainage
DSubsidence Control
DTracer
Other (explain under #21 Remarks)
4. Date Well(s)Completed:."" 7" ) f1 %Veil 1D#
5a. Well Location:
e?I\ C)ritkJ \f
Facility/Owner Name Facility 113# (if applicable)
'6 014.- 01))/it�)4IL. ;_)><' f iNt:i(s
Physical Address, City, and Zip
Carteret
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
•
lttc � I _i3. i( ,t N-76u 5 1t/7, �-+' f r W
6. ls(arc) the well(s)Permanent or DTemporary
7. Is this a repair to an existing well: DYes or No
If this is a repair, fill our known well construction information a explain the nature of the
repair under 1121 remarks section or on the back of this farm.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-)pis nee ed. indicate TOTAL NUMBER of wells
drilled: C ) /1
9. Total well depth below land surface: --2..) 4i lJ (ft.)
For multiple wells list all depths ifdif Brent (example- 30)200' and 2Q100')
10. Static water level below top of casing: f 8 (ft.)
If water level is above casing, use ".I."
11. Borehole diameter: 7 718 (in.)
12. Well construction method: Rotary
(Le. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 6 Method of test: Air
13b. Disinfection type: Chlorine 1Amount:,j' t -? v/
Signature of Certified Well Coutrac or
For Internal Use Only:
447544
Print Form
14. WATER ZONES
FROM
TO
DESCRIPTION
3z.c,ft.
3 y0 ft.
f,?C'( 4:
ft.
ft.
IS. OUTER CASING (for
multi -cased wells) OR LINER (if all
licable)
FROM
TO
DIAMETER
THICKNESS
I MATERIAL
ft.
ft.
in.
I_
16. INNER
CASING OR T
)BING (geothermal closed -loop)
FROM
'1.0
DIAMETER
THICKNESS
MATERIAL.
! ft.
32 J ft.
ti in.
•. j y d
-(�7
/y9 Y
ft.
ft.
in.
I7. SCREEN
FROM
TO
DIAMETER
SLOE SIZE
THICKNESS
MATERIAL
3l0'ft.
7 t/l; ft.
in.
/j
LL%
5Ct(1 5,0
12 V c-~
f1.
ft.
in.
18. GROUT
FROM
TO
ATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft.:.
ft.-pi
r/
.-7
ft.
ft.
rt.
ft.
19. SAND/GRAVEL PACK
(if applicable)_
FROr,I
TO
MATERIAL
EMPLACEMENT METIIyOD
• it; fi.
ft.
S/b- d
/4)0 re d_.
ft.
ft.
20. DRILLING LOC (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
e ft.
L/ 0 ft.
C.; ri-7--1 d
• • ft.
;jt,, ft.
q...; GC .r
cf a D.
/ ci (..) ft.
C - .4-1, _ .,
i q 0 ft....
3z.Ci'ft.
/.',,, el' 'tp,/we 5itP)c!i/ C-1-y.W
C 7
r: L.' f1.
j �, ft.
/ Z 0 t: I(.-
ft.
ft.
ft.
ft.
RECEIVED
21. REMARKS
MAR 1 2 2018
te,hnKi.atioft Peocerei 4.i 1 001
22. Certification: tWQ/13OG
i l i
Date
1:y signing this form. l hereby certify that the wells) was (w,•rr) constructed in accordance
with 15A NCAC 02C .0100 or ISA NCAC 02C .0200 Well (Construction Standards and that a
ropy aphis 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this torn within 30 days of completion of well
construction to the tollowing:
Division of Water Resources, 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 one copy of this torn within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Infection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
tthcre constructed.
Fos,n Gtv-I
Nort1, Carolina Department of environu,eutel Quality - Division of Water Kesourees Revised 2-22.2016

WELL CONSTRUCTION RECORD(GW-I)
RECEIVED/NCDENR/DWR
1. Well Contractor Information:
Jason P Morton
Well Contractor Name
2953-A
NC Well Contractor Certification Number
Morton Drilling
Company Name
2. Well Construction Permit #:
FEB 13 2018
Water Quality Regional
Operations Section
Wilmington Regional Office
O %5
List all applicable well construction permits (t.e, (EC, Couniv, State, Variance. etc.)
3. Well Use (check well use):
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
'X Irrigation
Non -Water Supply Well:
Monitoring
DMunicipa1/Public
DResidential Water Supply (single)
Residential Water Supply (shared)
• (Recovery
injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Groundwater Remediation
DSalinity Barrier
FjStormwater Drainage
(Subsidence Control
DTracer
Geothermal (Heating/Cooling Retum) EOther (explain under #21 Remarks)
4. Date Well(s) Completed: (2 .-2 Imo) 1 Well ID#
5a. Well Location:
Facility/Owner Name Facility FD# (if applicable)
530 R.--„ A s 'J 7 z--t- N
Physical Address, City, and Zip
Carteret
County Parcel identification No. (PiN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one Iatllong is sufficient)
34/a y8 t Z e. 9q tN
7b°5, t 53. 3 9 "w
6. 'stare) the well(s) JX Permanent or DTemporary
7. Is this a repair to an existing well: DYes or XONo
If this is a repair, fill our known well construction information and explain the nature of the
repair under 1121 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only I GWr1 is needed. Indicate TOTAL NUMBER of wells
drilled: ON e-
9. Total well depth below land surfacer eJ (ft,)
For multiple wells list all depths ifdifferent (erarnple- 3@200' and 2@100')
10. Static water level below top of casing:
If water level is above casing, use ..
11. Borehole diameter: I yg (in.)
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
(ft.)
FOR WATER SUPPLY WELLS ONLY: /�� �j
13a. Yield (gptn) J0 Method of test: 4 1 rl,..-
13b. Disinfection type:` 1 OVAtom/ Amount: 1 t 0 �
Print Form
For Internal Use Only:
46710
14.([WA'TER ZONES
F
O
Tgp
DESCRIPTION��
(�71 ft.
A� t/
ft.
46
ft.
ft.
15.OUTER CASING (for multi -cased welts) OR LINER (f a licable)
FROM
TO
DIAMETER _
THICKNESS
MATERIAL
ft.
ft.
in.
1G. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
I 1 ft.
6 D ft.
in.
Uch (746
)
VV Pr C/
ft.
ft.
in.
17. SCREEN
TO
DIAMETER
SLOT SIZE
THI KNESS
MATERIAL
/
fro ft.
E 1!
UFFROM
'0j ft.
in.
g
C ID
Jff���
^ J c,
r
ft.
fft.in.
18. GROUT
FROM
TO
MATE Ip
EMPLACEMENT ME 'HOD & AMOUNT
6) ft.
20 ft.
i.30.44t• fL/�IA��`^y+r�
f:bore d/ oo/
ft.
It.
ft.
ft.
19. SAND(GRAVEL. PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METROjI
ft.
stO ft.
/gore �rJ
ft,
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
'fO
DESCRIPTION (color, hardness, soiVrock type, grain size, etc.)
b ft.75-
ft.
J
3,6 ft.
(R) ft.
5q- i ciy 6 6
y0 rt•
,50 fL
CI-
/_ 0 ft.
(J
, 0 It.
[/
RO- G k1 4-.. S J e 1 t
n,
ft.
ft.
ft.
f
ft.
Its ED
�`�J
MARKSAKKS @@@���
21. REREC
0 8 2018
FED
22. Certification:
tune of Certified \Ve11 Cone
Ctor
tntorvostiort e4 t Uni
Q1B0
/-ZZ-i.7
Date
:y .signing this form, I hereby certify that the well(c) was (were) canstrucled in accordance
with 1 SA NCAC 02C .0/00 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided !o 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, 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 one copy of this form within 30 days of completion of well
construction to the following
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply K Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
hut. constructed.
Form GW-1 North Carolina Department of Environmental Quality - Division of Water Resources
Revised 2-22-201G

Print corm
For internal Use Only:
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Jason P Morton
Well Contractor Name
2953-A FEB 13 2018
NC Well Contractor Certification Number
Morton Drilling Water Quality Regional
Operations Section
Company Name 247838 Wilmington Regional Office
2. Well Construction Permit #:
List all appUcable well construction pennits (i.e. 111C, County. Stale, Variance, etc)
3. Well Use (check well use):
RECEIVED/NCDENR/DWR
Water Supply Well:
]Agricultural
DGeothermal (Heating/Cooling Supply)
Industrial/Commercial
rrigation
Non -Water Supply Well:
(Monitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed:
1 /26/18
QMunicipal/Public
E3Residential Water Supply (single)
Residential Water Supply (shared)
446709
14. WATER ZONES
FROM
TO
DESCRIPTION
/ fO ft.
0 ft.
,COL
�
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if a licable)
FROM TO
DIAMETER
THICKNESS ] MATERIAL
ft. ft. in.
MANNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS MATERIAL
/ ft.
/ N L ft.
v
(I in.
f/ -(4 7 /v v c-i
ft.
ft.
in.
17. SCREEN
........ I OI nmAMF.TER I SLOT SIZE THICKNESS MATERIAL
Recovery
Groundwater Remediation
]Salinity Barrier
DStormwater Drainage
DSubsidence Control
Tracer
Other (explain under #21 Remarks)
Well ID#
5a. Well Location:
Mathew Fitzpatrick
Facility/Owner Name Facility ID# (if applicable)
205 Friendly Rd MHC,NC 28557
Physical Address, City, and Zip
Carteret
County
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(dwell field, one Iaat/long is sufficient)
;4`
° /3) /9. 2 N 1b Vb i(97,,
Parcel Identification No. (PIN)
//09 f
ft.
18. GROUT
FROM
ft.
ft.
in.
in.
TO
7
ft.
ft.
MATERIAL EMPLACEMENT METHOD & AMOUNT
ee✓1 ;tf.1 70/eel- Va.)/6
n.
ft.
19. SAND/GRAVEL PACK (if applicable)
T MATERIAL l EMPLACEMENT t1,ETHOD
FROM
ro
/ba ft.
ft.
ft. 5/q-$J 121
ft.
Po'Ur�
6. ls(are) the well(s)!Permanent or DTemporary
7. Is this a repair to an existing well: ]Yes or QNo
If this is a repair, fill out known well construction information and explain the nature of the
repair under 1121 remarks section or an she back of skis form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is ne ded. Indicate TOTAL NUMBER of wells
drilled:_`.,
9. Total well depth below hind surface:
18O (ft.)
For multiple wells list all depths if different (example- 3 ,200' and 2 t©100')
10. Static water level below top of casing:
) 5 (ft.)
If water level Is above casing, use n'"
11. Borehole diameter: 7 /�
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
(in.)
Rod
20. DRILLING LOG (attach additional sheets if necessary)
TO DESCRIPTION (color, hardness, 3oil/rock type, grain she, etc.)
35 ft. S,�1d-
S ^/ C
Aoc l<.
FROM
D ft.
35 ft.
t7 0 ft.
a ft.
LSO ft.
/ % a ft.
1�ft'
O ft. / 4t5t.
n.
rt.
ft.
22. Certification:
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) ,� � Method of test:/�
(} I 1&' Amount: + "`t/
13b. Disinfection type
ft.
Information rPc r��^tl
Date
nature of Certified Well Contractor
By signing this form, ! hereby cerrifP that Wewell(s)was (were) constructed in accordance
with 1 SA NCAC 02C .0100 or ISA NCAC 02C .0200 Well Construction Standards and than a
copy of this 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, 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 one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Sunnlv & Injection Wells: In addition to sending the forrn to
me address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
FormGW1
North Carolina Department of Environmental Quality - Division or Water Resources
Revised 2-22-2016

WELL CONSTRUCTION RECORD
For Internal Use ONLY:
This fonn can be used for single or multiple wells
1. Well Contractor Information:
D.T. Chalmers, Jr.
Well Contractor Name
4146A
NC Well Contractor Certification Number
RECEIVED/NCDENR/DWR
FEB 13 2018
CATLIN Engineers and Scientists Water Quality Regional
Operations Section
Company Name Wilmington Regional Office
2. Well Construction Permit #: N/A
List all applicable well permits (i.e. County, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
D Agricultural
❑ Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
❑ Municipal/Public
❑ Residential Water Supply (single)
❑ Residential Water Supply (shared)
Non -Water Supply Well:
CO Monitoring
Injection Well:
DAquifer Recharge
❑ Aquifer Storage and Recovery
❑ Aquifer Test
❑ Experimental Technology
❑ Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
0 Recovery
❑ Groundwater Remediation
❑ Sal inity Barrier
❑ Stormwater Drainage
❑ Subsidence Control
❑ Tracer
DOther (explain under #2I Remarks)
4. Date Well(s) Completed: 01/22/18
5a. Well Location:
MCAS, Cherry Point
Facility/Owner Name
Well ID#: MW-2R
Facility ID# (if applicable)
MCOLF, ATLANTIC, NC
Physical Address, City, and Zip
CARTERET
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/Iong is sufficient)
34.88307 N - -76.35031
6. Is (are) the well(s): ®Permanent or ❑Temporary
7. Is this a repair to an existing well: OYes or No
!f this is a repair; fill out known well construction information and explain the nature of
the repair under #21 remarks section or on the back of this farm.
8. Number of wells constructed: 1
For multiple injection or non -water supply wells ONLY with the sane construction, you
can submit one form.
9. Total well depth below land surface: 13 (ft.)
For multiple wells list all depths in different (example- 3@200' 200' and 2 a l00')
10. Static water level below top of casing: (ft.)
If water level is above casing, use "+ rr
11. Borehole diameter: 2 (in.)
12. Well construction method: HSA
(i.e. auger, rotay, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
446708
14. WATER ZONES .
FROM
TO
DESCRIPTION
ft.
n,
ft.
rt.
,.a INNER C
SING OR TUBING (geothennal closed -loop)' , :
FROM
TO
DIAMETER
THICKNESS
MATERIAL.
0 ft.
3 ft.
2 in.
Sch. 40
PVC
. 16.OUTER CASJI
G (for Multi -eased wells) OR LiNER{if applicable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
ft.
ft.
in.
.17.SCREEN
FROM
TO
DIAMETER
SLOT SIZE
TIHCKNESS
MATERIAL
3 ft.
13 n.
2 in.
Slot .010
Sch. 40
PVC
ft.
ft.
in.
•18.GROUT.
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 n.
0.5 n.
Portland Cement
Surface Pour
0.5 rt.
ft.
1 rt.
n.
Bent. Pellets
Surface Pour
19. SAND/GRAVEL
PACK (tf
applicable) -
FROM
TO
MATERIAL.
EMPLACEMENT METHOD
1 n.
13 rt.
Torpedo Sand
Surface Pour
n.
ft.
<20. 0tALiNG LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soirrock type. grain sine, etc.)
IL
ft.
A.
ft.
s let
ft.ft.
ft.
p‘CINA
n.01'
n.
n,
rt.
dr
I /
21. REMARKS
.
FED 05 2018
22. Certification:
Signature of Certified Well Contractor
rrtlormatiOf ProC's;
s WO/0
1/31/2018
Date
By signing this, form, I hereby certiif . that the well(s) was (were) constructed in accordance with
ISA NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a copy of
this 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
construction details. You may also attach additional pages it'necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells ONLY: 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 construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Svaply & Infection Wells:
Also submit one copy of this form within 30 days of completion of well
construction to the county health department of the county where constructed.
Adapted from Form GW- I
North Carolina Department of Environment and Natural Resources - Division of Water Resources Revised 2-22-2016

CATLIN
Engineers and Scientists
21inELL
YUlrnminglon. NC
SHEET 1 OF 1
LOG
PROJECT NO.: 217085
STATE: NC
COUNTY: CARTERET
LOCATION: ATLANTIC
PROJECT NAME: MCOLF ATLANTIC
LOGGED BY: Corey Futral
WELL ID:
MW_2R
DRILLER: D.T. Chalmers, Jr.
NORTHING: 422975
EASTING: 2794532
CREW: Eddie Swain
SYSTEM: NCSP NAD 83 (USft)
BORING LOCATION: Wooded area at Spray Field
T.O.C. ELEV.: 15.56
DRILL MACHINE: Diedrich D-25
METHOD: HSA
0 HOUR DTW: N/A
TOTAL DEPTH: 13.0
START DATE: 01/22/18
END DATE: 01/22/18
24 HOUR DTW: N/A
WELL DEPTH: 13.0
DEPTH
BLOW
0.5ft
0.5ft
COUNT
0.5ft
0.5ft
OVA
(Wm)S
LAB
o
o
G
SOIL AND ROCK
DEPTH DESCRIPTION ELEVATION
WELL
DETAIL
0.0 LAND SURFACE 13.6
2.0
0.0
0.0
-
-
4
4
a
a
132.2
W
'{'"".
!!>'11
(ML) - Root Mat
0.6 13.0
1 i 1 i i i 1 i i 1 r r i I I 1 1
W
0 0
2" Slot .010 2" Sch. 40 PVC
Sch. 40 PVC
111111JLJI1111111I1111111111J1I1111111J11IIIIL11J1(111111111 IIIIILIIJ1..LLIIIIIJli11111_11.J11111111
p
0 o in
•
;::
.::::::
(SP) - Black grading to dark brown, f. SAND.
RECEIVED/NCDENR/DWR
FEB 13 2018
Water Quality Regional
Operations Section
Wilmington Regional Office
13.0 0.6
-
-
5.0
—
a
'
6
6
1.5
Sat.
10.0
Grab
sample
2.2
Sat.
13.0
BORING TERMINATED AT ELEVATION 0.6 ft in f.
SAND.
Portland Cement
iLL1
Bentonite Pellets n#2 Medium Sand

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Jason P Morton
Well Contractor Name
2953-A
NC Well Contractor Certification Number
Morton Drilling
Company Name
2. Well Construction Permit #: 244061
List all applicable well construction permits (i.e. WC, County, Slate, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
]Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
Non -Water Supply Well:
Monitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Retum)
4. Date Well(s) Completed: 12' ( a
Sa. Well Location:
/1- tF ed. S 'ph e.;v s
Facility/Owner Name
Municipal/Public
kiResidential Water Supply (single)
Residential Water Supply (shared)
Q Recovery
Groundwater Remediation
Salinity Barrier
DStonnwater Drainage
Subsidence Control
OTracer
Other (explain under #21 Remarks)
WelllD#
Facility ID# (if applicable)
135 f g/1c I hoR ?k c. 15 0 A �-
Physical Address, City, and Zip
Cc vcre c e 4-
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
G'Sat3rN`�G '‘,201o7r` IY
6. Is(are) the well(s)
Yl
ermanent or DTemporary
7. Is this a repair to an existing well: Yes or £No
If this is a repair, fill out known well construction information and explain the nature of the
repair under #21 rentnrks section or on the back of this form.
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: e7t%E'
9. Total well depth below land surface:
For multiple wells list all depths ifd different (example- 3 a®200' and 2 a i00)
!Bb
(ft.)
10. Static water level below top of casing: (S (ft.)
If water level is above casing, use "r "
11. Borehole diameter: /
12. Well construction method:
(i.e. auger, rotary, cable. direct push, etc.)
(in.)
�o fps R
FOR WATER SUPPLY 1VELLS ONLY:
13a. Yield (gpnt)
Method of test:
13b. Disinfection type:(1'/'D/2.J /D e- Amount:
AI 2
[J1
to
For Internal Use Only:
Print Form
446188
14. WATER ZONES
FROM
TO
DESCRIPTION
/60 rt.
46 ft.
l p
It.
ft.
15.OUTER
CASING (for
multi -cased wells OR LINER (if applicable
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER
CASING OR TUBING
(geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
"/l ft.
(j C/
(f in.
7
s�J� �/.f7
�f� i V
j3t]i
�f
ft.
ft.
m.
17. SCREEN
-
FROM
TO
DIAMETER
SLOT SIZE
THIC ESS
MATERIAL
/IVft.
/0/tft.
! �j
11 in.
Z°
,50 VI)
PVC'
ft.
ft,
in.
18. GROUT
FROM
TO
MATE
EMPLACEMENT METI OD&AMOUNT
O ft.
2n ft.
C1 V
cbaye
_
t Lod /k S
ft.
ft.
ft.
ft.
19. SAND/GRAVEL
PACK
(if applicable)
FROM
TO
MATERIAL
EMPLACEMENTMETIIOD
/120 ft.
/ ft.
547.14
>oa111-411
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain sUR, etc.)
O ft.
g S ft.
5 A--v) d
c�.
J} !' ft.
1 S ft.
,. i4'Y1ci ... �
ft.
// y0 ft.
C(...e:e----(,..' -
!t,o.
ft.
ft.
ft.
ft.
21. REMARKS (-, 7.
1 1.
F. `.-I.,t
IAN1A2018
22. Certification:
ature of Certified We Contractor Date
By .signing this form, 1 hereby certify that the well(s) was (were) constructed in accordance
with 15A NOW 02C .0100 or I5A NCAC 02C .0200 Well Construction Standards and that a
copy of this 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
constnlction details. You may also attach additional pa syftressary.
SUBMITTAL INSTRUCTION HIV010NR
24a. For All IVells: SubmitW form within 30 days of completion of well
construction to the following: ��NN 2Q`$
Division of Water Resource),'lliformation Processing Unit,
1617 Mail Service Center, Raleigh, NcZE G17
t���6 K
24b. For Injection Wells: In additiggakefel 4r3eF Cgddress in 24a
above, also submit one copy of this fo TA. #i,13�I completion of well
construction to the following: 1fJ1\t111110
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Iniection Wells: In addition to sending the form to
to address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW-I
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL CONSTRUCTION RECORD (GW-1)
i. Well Contractor Information:
- i? 'n / / 0o)2 ,k
Well Contractor Name
2 (75 3
NC Well Contractor Certification Number
f'vzo g tzw T) 1a I L L/ io c) -
Company Name
2. Well Construction Permit #: Z / b°! 7
List all applicable well construction permits (i.e. 1IIC, County, State, Variance, etc)
3. Well Use (check well use):
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
irrigation
Non -Water Supply Well:
Monitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
]Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
MunicipalPublic
esidential Water Supply (single)
DResidential Water Supply (shared)
D Recovery
Groundwater Remediation
Salinity Barrier
0Stonnwater Drainage
Subsidence Control
DTracer
ri Other (explain under #21 Remarks)
4. Date Well(s) Completed:/2 / ! "l14K+e11 ID#
.,Weil Locatio :
W1 Wedc���+,�P,.
Facility/Owner Name Facility 1D# (if applicable)
j 15 i-h ro' , R Belo, -ik -
Physical Address, City, and Zip
Ci s `tie 4-
County Parcel Identification No. (PiN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one kit/long is sufficient)
347/4'yb t zcr119 "N 76°Yo f 3/ 32." W
6. Is(are) the well(s) Permanent or DTemporary
7. Is this a repair to an existing well: es or ONo
If this is a repair, fill out known well constructio information and explain the nature of the
repair under N21 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled: ONE-
9. Total well depth below land surface:
For multiple wells list all depths if different (example- 3 n 00' and 2@100)
10. Static water level below top of casing:
lfwater level is above casing, use '"
11. Borehole diameter: 4%
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
15
(in.)
+>ariz
(ft.)
(ft.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm)
50
Method of test:
13b. Disinfection typeeh (OR i,dt° Amount: ,'_ Sr) O Z
Print Form
For Internal Use Only:
446182
14. WATER ZONES
FROM
TO
DESCRIPTION - -_
go ft.
l W O II.
- ' 4 4,--c
ft.
ft.
15. OUTER
CASING (for
multi -cased wells) OR LINER (if a licabte)
FROM
TO
DIAMETER
THICKNESS MATERIAL
ft.
ft.
in.
]
• 16. INNER
CASING OR TUBING
(geothermal closed -loop)
FROM
TO
DIAq
TER
THIC ESS
MATERIAL
ift,
(
6, p ft,
tn.
C i1v
�/ 7
n✓ G
i
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
50 ft.
V
/ Lot.
f L/�ft.
Li In.
ri i
C/
S`� / , o
,J(�(�j 7V
9 v c/ -
ft,
in.
18. GROUT
FROM
TO
MA,T,E�RI L
lit
EMPLA5EMENTMETHOD &AMOUNT
,b ft.
ft.
1 bU d e d j-reS t
ft.
ft.
ft.
ft.
19. SAND/GRAVEL
PACK
(if applicable)
FROMTO
MATERIAL ,
EMPLACEMENT
ft.
,� ft.
S��/lyj��t,(J/�
PP rsPMETHOD
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain site, etc.)
b ft.
S ft.
5.-a7--2 d
36' ft.
6 ft.
L
66) ft.
ft.
.5747.7
yo ft.
A)ft.
A ozL__
ft.
ft.
jr.::
ft.
ft.
R C .1 LA)
R
ft.
ft.
pp�� (�
1 6 2018
21. REMARKS JAN
� UfII
io, : dl;iCf.;i
r+���pa..��rr��11
22. Certification:
(Certified Well Contractor
Bjfsigning this form, I hereby eery that the well(s) was (were) constructed in accordance
with 1SA NCAC 02C .0100 or 1 SA NCAC. 02C.0200 Well Construction Standards and that a
copy of this 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
construction details. You may also attach additional pars if necessary.
SUBMITTAL INSTRUCTIONS nn``�� VNRPw'
24a. For All Wells: Sulypity Cl�llnwithhiin 30 days of completion of well
construction to the follo
Division of Water Resou ms, Ort i` nn Processing Unit,
1617 Mail Service aelnr, Raleigh, NC276 9-1617 0
24b. For Iniection Wells: In addition to seS4 ,Bryn tope address in 24a
above, also submit one copy of jkii�t�-1Say� ig @ yQ�IcCSmpletion of well
construction to the following: V� OpeCait �eglon
Division of Water Resources(rground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Sunnly & Infection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
hS
Form GW-I
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Jason P Morton
Well Contractor Name
2953-A
NC Well Contractor Certification Number
Morton Drilling
Company Name
2. Well Construction Permit #: 244726
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc)
3. Well Use (check well use):
Water Supply Well:
' Agricultural
Geothennal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
For internal Use Only:
14. WATER
FROM
60
ft.
ft.
ZONES
foOft.
15. OUTER CASING
FROM TO
ft.
ft.
DESCRIPTION
for multi -cased wells
DIAMETER
ft.
in.
446839
OR LINER
Print Form
if a licable
TIIICKNESS MATERIAL
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM TO DI
/ ft.
ft.
4$t. ft,
ft.
AMETEK TIIICKNESS
in. J %7
MATERIAL
Non -Water Supply Well:
Monitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed: /V ` -5
5a. Well Location:
Michael McGee
Municipal/Public
xOResidential Water Supply (single)
Residential Water Supply (shared)
Recovery
Groundwater Remediation
]Salinity Barrier
EjStonnwater Drainage
Subsidence Control
Tracer
Other (explain under 1421 Remarks)
0 -I Well1D#
Facility/Owner Name Facility [D# (if applicable)
167 McGee Rd Beaufort, NC 28516
Physical Address, City, and Zip
Carteret
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one latflong is sufficient)
3y6 Ill/' i7/4/ N 7b°33r /Otby t`
6. Is(are) the well(s)ix Permanent or Temporary
7. Is this a repair to an existing well: f iYes or ONo
If this is a repair, fill out known well construction information and explain the nature of the
repair under #21 remarks section or on the bock of this form.
8. For Gcoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only I GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled: One 0 i /
9. Total well depth below land surface: 100 (ft.)
For multiple wells list all depths if different (example- 301200' and 2@I00)
10. Static water level below top of casing: 12 (ft.)
If water level is above casing, use "+
11. Borehole diameter: 77/8
(in.)
12. Well construction method: Rotary
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpnt) 50 Method of test: Air
13b. Disinfection type: Chlorine
Amount: 1.25 oz
17. SCREEN
FROM
got'.
ft.
18. GROUT
FROM
V ft.
ft.
TO
DI
/a 0.
ft.
AMETEK SLOT SIZE
in.
P v
THICKNESS MATERIAL
Pv
TO
Z t� ft.
ft,
MATERIAL
/, vll�rl.vt 1
_ EMPLACEMENT METHOD & AMOUNT
POO e'e
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
MATERIAL EMPLACEMENT MET OD
FROM
ft. /00 ft. 41� DOv r e c
ft. ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM DESCRIPTION (color, hardness, soil rock t
�pe, main size, etc.)
St'a-7,A
D ft.
3 5 ft.
67 fL
8e0 ft.
ft.
ft.
TO
3 6 ft.
'4L ft.
21. REMARKS
7
G ft.
�.'� ft.
22. Certification:
ft.
ft.
ft.
RECE \/Ec
JAN 0 9 2018
In ort mtton l fL _ o:-;:. ; ..•
LYWU/t3U.G
/C l LDS
ture of Certified Wail Contractor
��-/-I�
Date
By signing this fors, I hereby cent& that the well(s) was (were) constructed in accordance
with ISA NCAC 02(.' .0100 NCAC 02C .0200 Well Construction Stardards and that a
copy of ibis record has been p ,��ii, the well owner.
23. Site diagram or additionart! ctails:
You may use the back of this page t:a{ ..vide additional well site details or well
construction details. Yt also atta 1; itional pages if necessary.
SUBMITTAL 4 STRUCTIt''IU
24a. For 'i,_ ► . s: 4Submit thfst.F
constntction t ,t . R('
Division o
1617 Mai
within 30 days of completion of well
grccs, Information Processing Unit,
1R40/4/C9iilter, Raleigh, NC 27699-1617
24b. For Injection Wells: In dttion to sending the form to the address in 24a
above, also submit one copy of this Corm within 30 days of completion of well
construction to the tollowing:
Division of Water Resources, Underground Injection Control Program,
1636 flail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply &Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form OW-1
North Carolina Department of Environmental Quality - Division of Water Resarces
Revised 2-22-2010

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Jason P Morton
Well Contractor Narne
2953-A
NC Well Contractor Certification Number
Morton Drilling
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. 111C, County, Stale, Variance, etc.)
3. Well Use (check well use):
242040
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
lndustriaUCommercial
Irrigation
Non -Water Supply Well:
Monitoring
f Municipal/Public
x)Residential Water Supply (single)
Residential Water Supply (shared)
Recovery
injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothennal (Closed Loop)
Geothennal (Heating/Cooling Retum)
4. Date Well(s) Completed: 10-31-17
5a. Well Location:
Regina McGee
QGroundwater Remediation
Salinity Barrier
�Stormwater Drainage
Subsidence Control
Tracer
Other (explain under #21 Remarks)
Well 1D#
Facility/Owner Name Facility ID# (if applicable)
110 McGee Rd Beaufort, NC 28516
Physical Address, City, and Zip
Carteret
County Parcel identification No. (PiN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
5116liy1'5iN 76 0 _61W
6. Is(are) the well(s)OPermanent or 0Tenrporary
7. Is this a repair to an existing well: DYes or x[]No
IJthis is a repair, fill out known well construction information and explain the nature of the
repair under 1121 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is need d. Indicate TOTAL NUMBER of wells
drilled: One 0
9. Total well depth below land surface: 100 (ft.)
For multiple wells list all depths if different (example- 3@200' and 2(7a 100')
10. Static water level below top of casing: 12 (ft.)
if water level is above casing, use "+"
11. Borehole diameter: 77/8 (in.)
12. Well construction method: Rotary
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 50 Method of test: Air
13b. Disinfection type: Chlorine Amount: 1.25 OZ
Print Form
For internal Use Only:
44683
14. WATER ZONES
FROM
TO
DESCRIPTION
S10 D.
in ft.
R 0 C IC
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if applicable)
FROM
TO
DIAMETER
THICKNESS I MATERIAL
ft.
ft.
in.
lI
16. INNER
CASING OR TUBING
(geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
J(I vt
V V
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE THICKN�ErSS
MATERIAL
"4 ft.
7
1 ft.
-
�[ in.
+
i D SUij `I i�
v ei
ft.
fL
in.
i
18. GROUT
FROM
TO
MMA��T''••ERI
EEMJ%LACEMENT METHOD & AMOUNT
7) ft.
2_0 ft.
((//
/ �vl we
(rLI / ( �D U I P d j iV
R.
ft.
ft.
ft.
19. SAND/GRAVEL
PACK
(if applicable)
FROM
TO
MATERIAALL.,,�
c--7 ' 4
EMPL/ACEMENTMETII�gI,D
,XIovY� (�
e0ft.
c�
%/0 ft.
I [/
ft.
rt.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION Omit,... hardness, soiVrock type, grain sae, etc.)
e.:,`y ft.
3 i n.
A-5 A-/ t
ft.
b o ft.
SA ?? 7 C L -),r
CJ ft.3?ft.
L-a---
ft.
rt.
*
`.
ft.
ft.
JAN 0 9 2018
21. REMARKS -
Information Proc rl•,-j U4*st
22. Certification: "Gr
C /
By signing this form, 1 hereby/ r r that the well('f� Lire) constructed in accordance
with 1 5A NCAC 02C .0100 or 1SA2C .0200 Well ednstruclion Standards and that a
copy of this record has been pravidedio x9 j4 owner.
Yj/t3 V 23. Site diagrtp.o f t t ItipI well detail
You may use dig %/(iag provide additional well site details or well
construction details. +tI 3116o additional pages if necessary.
@a • Ct/p /1a/
SUBMITTAL INSTRUCTIONS ,
24a. For All Wells: Submit this formC«ithin 30 days of completion of well
construction to the following:
Division of Water Resources, information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. Fur Injection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells: in addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
%there constructed.
um of Certified Well Contractor
• Date
/D S
�� f - (7

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
//P Alor A1
Well Contractor Name
NC Well Contract Certificate7,LL/AJ&'
mber
OR
Company Name [/
2. Well Construction Permit #:
List all applicable well construction permits (i.e. (//(., County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
Agricultural
Geothennal (Heating/Cooling Supply)
industrial/Commercial
"}irrigation
Non -Water Supply Well:
Monitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
QM icipal/Public
esidential Water Supply (single)
Residential Water Supply (shared)
fRecovery
EJCroundwater Remediation
Salinity Barrier
QStonnwater Drainage
QSubsidence Control
Tracer
JGeothennal (Heating/Cooling Return) /JOther (explain under #21 Remarks)
4. Date Well(s) Completed: S- 3 I / Well ID#
5a. Well Location:
dhuseLlt
FacilityfOtvner Name Facility iD# (if applicable)
7z( N , i.C% 612 M 116 c-
Physical Address, City, and Zip
County Parcel identification No. (PiN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one 1st/long is sufficient)
3 O � / + , 74/IN 7b 1)17Y r 51, W
6. Is(are) the well(s) ernlanent or DTenlporary
7. Is this a repair tt-an existing well: EjYes or No
fish's is a repair, fill out known we!! construction information d explain the nature of the
repair under GI remarks section or on the back of this form.
8. For Geoprobe/DI'T or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled: ON ,
9. Total well depth below land surface: f3(.3 (ft.)
For multiple wells list all depths iifdii different (example- J 00' and 2 tr l00)
10. Static water level below top of casing:
Ifwater level is above casing, use "+"
11. Borehole diameter:
7
12. %VelI construction method:
(i.e. auger, rotary, cable, direct push, etc.)
e (in.)
RV 1-74/2
(ft.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpnt)
r �' Method of test:
13b. Disinfection type: �/ )2- j Amount:
lts"-O
TO
23. Site diagram or additional w I details i•14
You may use the back of this p provide a
construction details. You may also Sumac, additional p
SUBMITTAL iNS1U <D
24a. For All Wells: ra. ' rm within 30 days of completion of well
construction to the followin_./j OS 4P
RPQ6Pc00./-
For internal Use Only:
14. WATER ZONES
FROM TO
to
ft.
ft.
aft.
ft.
Print Form
446836
15. OUTER CASING for multi -cased well OR LINER if a slicabte
FROM TO
ft.
ft.
DIAMETER
in.
16. INNER CASING OR TUBING
FROM TO
ft.
ft.
17. SCREEN
FROM
2 ft.
ft.
18. GROUT
FROM
ft.
ft.
ft.
TO
TO
0
ft.
ft.
et.
ft.
eothermal closed -too
DIAMETER
DIAM ETER
!,1 ft.
ft.
ft.
THICKNESS
MATERIAL
111111111...1.111.1111111
SLOT SI'LE a"
in.
MA'1'ER IA
19. SAND/GRAVEL PACK if a t tlicable
FROM
/..oft.
ft.
TO
MATERIAL
ft.
20. DRILLING LOG
FROM
ft.
ft.
(attach additional sheets if necessary)
DESCRIPTION color, hardness, a.'Uroek t , rain sae, etcENERMIRMAWARIERIIIM
ft. ft.
21. REMARKS
it
JAN 0 9 2018
22. C [cation:
8
UM of Certified ell Contrac or
.y signing this form, I hereby certify e
with iSA NCAC 02C .0i00 or 15A N(.A
copy ufthis record has been provided to the ,d
.. .c4.4esing Unit
DVVQ/BUG
(
to
well(s) was (were) constructed in accordance
'200 Well Construction Standards and that a
41,
'S
// p°r 4)0
well site details or well
2iecessary.
Division of Water Reso'If'l f4trio'Finiation Processing Unit,
1617 Mail Service Center;:,R sleigh, NC 27699-1617
/CP
24b. For Infection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Sunnis' & ti iection Wells: In addition to sending the form to
E1te address(es) above, also submit one copy of this form within 30 days Of
completion of well construction to the county health department of the county
where constructed.
Fomi GW-1
North Carolina Department of Environmental Quality - Division of Water Resources
Revised 2-22-2016

WELL CONSTRUCTION RECORD (GW-1)
I. Well Contractor Information:
1 l" s cof f .
Well Contractor Name
NC Well Contractor Certification Number
Company Name
2. Well Construction Permit #:
012.10 v
RlGLry 6-
Z--W93 -7
List all applicable well construction permits (i.e. IIIC, County, .State, Variance, ere.)
3. Well Use (check well use):
Water Supply Well:
FROM
For internal Use Only:
t.446835
Print Form . .
14. WATER ZONES
FROM
TO
DESCRIPTION
f ye) ft.
0 ft.
fz�c
ft.
ft.
15, OUTER CASING (for multi -cased wells) OR LINER (if ap licable)
THICKNESS MATERIAL
ft.
TO DIAMETER
ft. in.
16. INNER CASINO OR TUBING (geothermal closed -loops
FROM DIAM ETER
f ft.
TO
070 ft.
r I in.
THICKNESS
5cl1�F7
MATERIAL
p✓L
Agricultural
Geothermal (Heating/Cooling Supply)
Industrial/Commercial
Irrigation
on -Water Supply Well:
Monitoring
DMunicipal/Public
DResidential Water Supply (single)
DResidential Water Supply (shared)
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
]Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Retum)
Recovery
0Groundwater Remediation
Salinity Barrier
0Stormwater Drainage
}Subsidence Control
Tracer
Other (explain under #21 Remarks)
4. Date Well(s) Completed: / 2 - f / We111D#
5a. Well Location:
Av 6e a •r Coot e .Z
Facility/Owner Name Facility ID# (if applicable)
%'7o &W /tetf 1)n P 5 N
Physical Address, City, and Zip
erhzte,L c r
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
31:7° I/ l fG, 8) V / 2, 2 w
6. Is(are) the well(s)
ermanent or DTemporary
7. Is this a repair to an existing well: 1Yes or
1f this is a repair, fill out known well construction information al explain the nature girlie
repair under 1111 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled: Q /t! >~
9. Total well depth below land surface: / 6 e2
For multiple wells list all depths lfdifferent (example- 3@200' and 2@100')
10. Static water level below top dosing:
If water level is above casing, use "+ "
11. Borehole diameter:
n (in.)
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
/e
I vr'-tr7
(ft.)
(ft.)
FOR WATER SUPPLY WELLS ONLY:
I3a. Yield (gpnt) /nSf5 Method of test: f ) a.
13b. Disinfection type -11 r d 12 I N e_
s o -z.
Amount: % I
ft.
17. SCREEN
ft.
in.
7ve,ft.1
i6pft.
FROM TO
ft. ft.
18. GROUT
FROM
DIAMETER
1. in.
in.
SLOT SIZE TFIICKNF.SS MATERIAL
2v SC11�o p✓�.
ft.
ft.
TO
z ft.
ft.
MATERIAL
�C44' Qfl4 j
rt.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
1 t�0 ft,
ft.
TO
r IL U ft,
ft.
MATERIAL
EMPLACEMENT METHOD & AMOUNT
A Lfod ) la
EMPLACEMENT METHOD
pr e
20. DRILLING LOG (attach additional sheets if necessary)
TO DESCRIPTION (color, hardness,soil/rock type, grain size, etc.)
FROM
rj ft.
2 fr.
7 U ft.
i yvft.
ft.
ft.
.7 6 ft.
lc/0
ft.
f b ft.
ft.
ft.
ft.
ft.
ft.
RECEIVED
21. REMARKS
Ja
P4 9 2018
l(of11 t1On Proe':s3t'i i9 unit
22. Certification:
eofCertified Wel
/o "*.ia -)
ContractoDate
43y signing tins form40 reby cert jy that the wells) was (were) constructed in accordance
with 1 SA NC'AC 02C ...rf I SA NCAC 02C .0200 Well Construction Standards and that a
copy of this record has he /vlded to the well owner.
23. Site diagram or addition t f details:
You may use ther C of this pa: ,.rovide additional well site details or well
constructjon details.q i may also a . r:.ditional pages if necessary.
. INSTRUCM'I.QIVS
Submit this form within 30 days of completion of well
DivisioWo4AVAjgr1Usources, Information Processing Unit,
1617 Nriillfrvice Center, Raleigh, NC 27699-1617
cC�
24b. For Injection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Snooty & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
r
Form GW-I
North Carolina Department of Enviroarnemal Quality - Division of Water Resources Revised 2-22-2016

WELL CONSTRUCTION RECORD (GW-1)
Print Form
For Internal Use Only:
1. Well Contractor Information:
Jason P Morton
Well Contractor Name
2953-A
NC Well Contractor Certification Number
Morton Drilling
Company Name
2. Well Construction Permit #: 228116
List al! applicable well construction permits (i.e. WC, County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
Agricultural Municipal/Public
Geothermal (Heating/Cooling Supply) DResidential Water Supply (single)
]Industrial/Commercial DResidential Water Supply (shared)
Irrigation
Non -Water Supply Well:
Monitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed: 11/17/17
5a. Well Location:
EJ Recovery
rGroundwatcr Remediation
}Salinity Barrier
jStormwater Drainage
JSubsidencc Control
DTracer
Other (explain under #21 Remarks)
Well iD#
(t )i PeL>,1> 2
Facility/Owner Name A�?,J' Facility 1D# (if applicable)
log Sick( /` 1, 'poi ' N-'
Plsysical Address, Cit / and Zip
Carteret
County Parcel identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
59 I/31 9,59 rIN
W
6. Is(are) the well(s)1JPermanent or DTemporary
7. Is this a repair to an existing well: Yes or IJNo
If this is a repair, flu old known well construction information and explain the nature of the
repair under 1121 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled: ONE
9. Total well depth below land surface: / 5 (ft.)
For multiple wells list all depths ifdiiffere nt (example- 3@200' and 2 a 100)
10. Static water level below top of casing: 12 (ft.)
!f water level is above casing, use •'+ "
11. Borehole diameter: 7 7/8
12. Well construction method: rotary
(in.)
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 55 Method of test: air
136. Disinfection type: chlorine Amount: 1.5 oz
.146613
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
4�tY
/0 �! l ft.
rock
ft.
ft.
15. OUTER
CASING (for
multi -cased wells) OR LINER (if applicable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER
CASING OR TUBING
(geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL.
1 ft.
dj0 ft.
Y
4 in.
sch40
pvc
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL.
iai) ft.
i fg/ft.
4 in.
20
sch 40
pvc
ft.
Et.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft.
20 ft.
bentonite
poured pelletsIbs
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK
(if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
1t() ft.
lf,; ft.
sand
poured
ft.
ft.
20. DRILLING
LAG (attach additional sheets if nectssary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc)
b ft.
x,5 ft.
pa-Yt d
ft.
!r ) ft ! .
c 1-
! ti-i) ft.
/ g 01 ft.
t)' -
r
gp �. i
ft.
ft.
JAN 0 1 Zilio
21. REMARKS
nt r waffon ProProcvs6ing Unit
DcAtoitIOG
22. Certification:
7714.7
% -r / ' /t
si
e of Certified Well Contractor
11/27/17
Date
13y .signing this form, 1 hereby certify that the we11(s) was (were) constructed in accordance
with 1 SA NCAC 02C .0100 or I SA NCAC 02C .0200 Well Construction Standards and that u
copy of this 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells. Submit this form within 30 days of completion of well
construction to the following: //s�
Division of Water Res6li®®��rlt t����
Et't}j( DEj WDUnit,
1617 Mail Service Center, Raleigh, NC 2TGIM7
24b. For Iniection Wells: In add itior m n the form to the address in 24a
m above, also suhit one copy of this fr i�iI 3t2&b8 of completion of well
construction to the following:
Division of Water Resources,Wa(Itnf ISry, ec ctionion Control Program,
1636 Mail Service Ce01964L�S 1 Q��.163G
��
24c. For Water Supply & Iniecfuano�ifA `'v :RBgt(Aida%Q#f nding the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Fonn G W - t
North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Jason P Morton
Well Contractor Name
2953-A
NC Well Contractor Certification Number
Morton Drilling
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. 111C, County, State, Variance, etc.)
3. Well Use (check well use):
228116
Water Supply Well:
Agricultural
Geothermal (Heating/Cooling Supply)
IndustriaUCommercial
Irrigation
Non -Water Supply Well:
Monitoring
Injection Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Geothermal (Heating/Cooling Return)
(Municipal/Public
DResidential Water Supply (single)
Residential Water Supply (shared)
0Reco:•ery
OGroundwater Remediation
Salinity Barrier
JStormwater Drainage
Subsidence Control
DTracer
EOther (explain under #21 Remarks)
4. Date Well(s) Completed: 11/17/17 Well ID#
5a. Well Location:
Daniel Allen
Facility/Owner Name Facility IDH (if applicable)
143 Sherwood Rd Newport, NC 28570
Physical Address, City, and Zip
Carteret
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
34483852 N 76522349
6. Is(are) the well(s)ix Permanent or DTemporary
7. Is this a repair to an existing well: QYes or DNo
ff this is a repair, fill out known well construction information and explain the nature of the
repair under 1121 remarks section or on the back of this form.
8. For Geoprohe/APT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled: ONE
9. Total well depth below land surface: 100
For multiple wells list all depths ffd ferent (example- 3(a;200' and 2 a 100)
12
(ft.)
10. Static water level below top of casing: (ft.)
limner level is above casing, use ' 1 "
11. Borehole diameter: 7 7/8 (in.)
12. Well construction method: rotary
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 55 Method of test: air
13b. Disinfection type: chlorine Amount: •5 oz
For Internal Use Only:
Print Form
446&I2
14. WATER ZONES
FROM
TO
DESCRIPTION
80
ft.
100 ft.
rock
ft,
ft.
PROM
15.OUTER CASING (for multi -cased wells) OR LINER (if a 1 Iicable)
TIIICKNESS MATERIAL
FROM
ft.
TO
ft.
DIAMETER
in.
16. INNER CASING OR TUBING (geothermal closed -loop)
MATERIAL
1 ft.
pvc
TO
80
ft.
DIAMETER
4
in.
THICKNESS
sch 40
ft.
17. SCREEN
FROM
a.
in.
80 rr.
TO
100 ft.
4 in. 20
DIAMETER
SLOT
SIZE
THICKNESS
sch 40
MATERIAL
pvc
ft.
ft.
in.
18. GROUT
FROM
0 ft.
TO
20 fl.
MATERIAL
bentonite
EMPLACEMENT METI OD & AMOUNT
poured pellets 300 lbs
rt,
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
80 ft.
TO
100 ft.
MATERIAL
sand
EMPLACEMENT METHOD
poured
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM TO
;O:
60
ft.
DESCRIPTION (color, hardness, soil/rock type, grain sire, etc.)
ft.
1., v ft.
ft.
fl.
c, ft.
ft.
ft.
ft.
n.
ft.
ft.
rt.
21. REMARKS
s+it tifirflatiCAI 1-)rt.7tAat4 s
NAirI4ACK
22. Certification: •
•1-k
• gnr�ature of Certified win Contractor
By signing this form, 1 hereby certify that the well(s) was (were) constructed in necordance
with 1.5,1 MAC 02C .0100 or 15A ,VCAC 02C .0200 Well C'onsttmction Standards and that a
copy t f thin 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
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a, For All Wells: SubmiLAIlis form within 30 days of completion of well
construction to the tbllowing: CEI" D/NCDENR/DWR
Division of Water Resources, Information Processing Unit,
1617 Mail Service Cep r„ Ra a h,N 27699-1617
24b, For Infection Wells: In addition to sending11t prorm to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following: Water((��QualityRegional
Division of Water Rcsou����yy Pat �tM C Control Program,
1636 Mail Servittfl�aa �l{)�I�[1636
24e. For Water Sunnis, & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
rshcre constructed.
/-7 - ,� j. 11/27/17
Date
Fonn G W-I
North Carolina Department of Environmental Quality • Division of Water Resources Revised 2-22-2016