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:(//$%$1'210(175(&25' 7KLVIRUPFDQEHXVHGIRUVLQJOHRUPXOWLSOHZHOOV )RUP*: 1RUWK&DUROLQD'HSDUWPHQWRI(QYLURQPHQWDQG1DWXUDO5HVRXUFHV±'LYLVLRQRI:DWHU5HVRXUFHV 5HYLVHG$XJXVW :HOO&RQWUDFWRU,QIRUPDWLRQ :HOO&RQWUDFWRU1DPHRUZHOORZQHUSHUVRQDOO\DEDQGRQLQJZHOORQKLVKHUSURSHUW\ 1&:HOO&RQWUDFWRU&HUWLILFDWLRQ1XPEHU &RPSDQ\1DPH :HOO&RQVWUXFWLRQ3HUPLW /LVWDOODSSOLFDEOHZHOOSHUPLWVLH&RXQW\6WDWH9DULDQFH,QMHFWLRQHWFLINQRZQ :HOOXVHFKHFNZHOOXVH :DWHU6XSSO\:HOO Ƒ$JULFXOWXUDOƑ0XQLFLSDO3XEOLF Ƒ*HRWKHUPDO+HDWLQJ&RROLQJ6XSSO\Ƒ5HVLGHQWLDO:DWHU6XSSO\VLQJOH Ƒ,QGXVWULDO&RPPHUFLDOƑ5HVLGHQWLDO:DWHU6XSSO\VKDUHG Ƒ,UULJDWLRQ 1RQ:DWHU6XSSO\:HOO Ƒ0RQLWRULQJƑ5HFRYHU\ ,QMHFWLRQ:HOO Ƒ$TXLIHU5HFKDUJHƑ*URXQGZDWHU5HPHGLDWLRQ Ƒ$TXLIHU6WRUDJHDQG5HFRYHU\Ƒ6DOLQLW\%DUULHU Ƒ$TXLIHU7HVWƑ6WRUPZDWHU'UDLQDJH Ƒ([SHULPHQWDO7HFKQRORJ\Ƒ6XEVLGHQFH&RQWURO Ƒ*HRWKHUPDO&ORVHG/RRSƑ7UDFHU Ƒ*HRWKHUPDO+HDWLQJ&RROLQJ5HWXUQƑ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Ƒ1HDW&HPHQW*URXWƑ%HQWRQLWH&KLSVRU3HOOHWV Ƒ6DQG&HPHQW*URXWƑ'U\&OD\ Ƒ&RQFUHWH*URXWƑ'ULOO&XWWLQJV Ƒ6SHFLDOW\*URXWƑ*UDYHO Ƒ%HQWRQLWH6OXUU\Ƒ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✔ 3/23/2023 Handy House 3 00-0-0000011113 6742 US Hwy 70, Newport, NC 28570 Carteret 633820900892000 34.77793 -76.871506 MW-1,2,3 18' each 2" Varies 3' 15' 3 1.7 gal each ✔ 1.5 bags of bentonite Bentonite pellets were poured into the well to top of casing, saturated with H2O then capped with cement. 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Henry Nemargut Digitally signed by Henry Nemargut DN: cn=Henry Nemargut, o, ou=Henry Nemargut Engineering, email=henrynemargut@bellsouth.net, c=US Date: 2023.04.17 12:26:32 -04'00'4/17/2023 :(//$%$1'210(175(&25' 7KLVIRUPFDQEHXVHGIRUVLQJOHRUPXOWLSOHZHOOV )RUP*: 1RUWK&DUROLQD'HSDUWPHQWRI(QYLURQPHQWDQG1DWXUDO5HVRXUFHV±'LYLVLRQRI:DWHU5HVRXUFHV 5HYLVHG$XJXVW :HOO&RQWUDFWRU,QIRUPDWLRQ :HOO&RQWUDFWRU1DPHRUZHOORZQHUSHUVRQDOO\DEDQGRQLQJZHOORQKLVKHUSURSHUW\ 1&:HOO&RQWUDFWRU&HUWLILFDWLRQ1XPEHU &RPSDQ\1DPH :HOO&RQVWUXFWLRQ3HUPLW /LVWDOODSSOLFDEOHZHOOSHUPLWVLH&RXQW\6WDWH9DULDQFH,QMHFWLRQHWFLINQRZQ :HOOXVHFKHFNZHOOXVH :DWHU6XSSO\:HOO Ƒ$JULFXOWXUDOƑ0XQLFLSDO3XEOLF Ƒ*HRWKHUPDO+HDWLQJ&RROLQJ6XSSO\Ƒ5HVLGHQWLDO:DWHU6XSSO\VLQJOH Ƒ,QGXVWULDO&RPPHUFLDOƑ5HVLGHQWLDO:DWHU6XSSO\VKDUHG Ƒ,UULJDWLRQ 1RQ:DWHU6XSSO\:HOO Ƒ0RQLWRULQJƑ5HFRYHU\ ,QMHFWLRQ:HOO Ƒ$TXLIHU5HFKDUJHƑ*URXQGZDWHU5HPHGLDWLRQ Ƒ$TXLIHU6WRUDJHDQG5HFRYHU\Ƒ6DOLQLW\%DUULHU Ƒ$TXLIHU7HVWƑ6WRUPZDWHU'UDLQDJH Ƒ([SHULPHQWDO7HFKQRORJ\Ƒ6XEVLGHQFH&RQWURO Ƒ*HRWKHUPDO&ORVHG/RRSƑ7UDFHU Ƒ*HRWKHUPDO+HDWLQJ&RROLQJ5HWXUQƑ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Ƒ1HDW&HPHQW*URXWƑ%HQWRQLWH&KLSVRU3HOOHWV Ƒ6DQG&HPHQW*URXWƑ'U\&OD\ Ƒ&RQFUHWH*URXWƑ'ULOO&XWWLQJV Ƒ6SHFLDOW\*URXWƑ*UDYHO Ƒ%HQWRQLWH6OXUU\Ƒ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✔ 3/23/2023 Handy House 3 00-0-0000011113 6742 US Hwy 70, Newport, NC 28570 Carteret 633820900892000 34.77793 -76.871506 MW-4 19' 2" 7.56 4' 15' 1 1.7 gal ✔ 1.5 bags of bentonite Bentonite pellets were poured into the well to top of casing, saturated with H2O then capped with cement. Henry Nemargut Digitally signed by Henry Nemargut DN: cn=Henry Nemargut, o, ou=Henry Nemargut Engineering, email=henrynemargut@bellsouth.net, c=US Date: 2023.04.17 12:28:27 -04'00'4/17/2023 :(//$%$1'210(175(&25' 7KLVIRUPFDQEHXVHGIRUVLQJOHRUPXOWLSOHZHOOV )RUP*: 1RUWK&DUROLQD'HSDUWPHQWRI(QYLURQPHQWDQG1DWXUDO5HVRXUFHV±'LYLVLRQRI:DWHU5HVRXUFHV 5HYLVHG$XJXVW :HOO&RQWUDFWRU,QIRUPDWLRQ :HOO&RQWUDFWRU1DPHRUZHOORZQHUSHUVRQDOO\DEDQGRQLQJZHOORQKLVKHUSURSHUW\ 1&:HOO&RQWUDFWRU&HUWLILFDWLRQ1XPEHU &RPSDQ\1DPH :HOO&RQVWUXFWLRQ3HUPLW /LVWDOODSSOLFDEOHZHOOSHUPLWVLH&RXQW\6WDWH9DULDQFH,QMHFWLRQHWFLINQRZQ :HOOXVHFKHFNZHOOXVH :DWHU6XSSO\:HOO Ƒ$JULFXOWXUDOƑ0XQLFLSDO3XEOLF Ƒ*HRWKHUPDO+HDWLQJ&RROLQJ6XSSO\Ƒ5HVLGHQWLDO:DWHU6XSSO\VLQJOH Ƒ,QGXVWULDO&RPPHUFLDOƑ5HVLGHQWLDO:DWHU6XSSO\VKDUHG Ƒ,UULJDWLRQ 1RQ:DWHU6XSSO\:HOO Ƒ0RQLWRULQJƑ5HFRYHU\ ,QMHFWLRQ:HOO Ƒ$TXLIHU5HFKDUJHƑ*URXQGZDWHU5HPHGLDWLRQ Ƒ$TXLIHU6WRUDJHDQG5HFRYHU\Ƒ6DOLQLW\%DUULHU Ƒ$TXLIHU7HVWƑ6WRUPZDWHU'UDLQDJH Ƒ([SHULPHQWDO7HFKQRORJ\Ƒ6XEVLGHQFH&RQWURO Ƒ*HRWKHUPDO&ORVHG/RRSƑ7UDFHU Ƒ*HRWKHUPDO+HDWLQJ&RROLQJ5HWXUQƑ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Ƒ1HDW&HPHQW*URXWƑ%HQWRQLWH&KLSVRU3HOOHWV Ƒ6DQG&HPHQW*URXWƑ'U\&OD\ Ƒ&RQFUHWH*URXWƑ'ULOO&XWWLQJV Ƒ6SHFLDOW\*URXWƑ*UDYHO Ƒ%HQWRQLWH6OXUU\Ƒ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✔ 3/23/2023 Handy House 3 00-0-0000011113 6742 US Hwy 70, Newport, NC 28570 Carteret 633820900892000 34.77793 -76.871506 MW-10 17' 2" 7.87 7' 10' 1 1.7 gal ✔ 0.5 bags of bentonite Bentonite pellets were poured into the well to top of casing, saturated with H2O then capped with cement. Henry Nemargut Digitally signed by Henry Nemargut DN: cn=Henry Nemargut, o, ou=Henry Nemargut Engineering, email=henrynemargut@bellsouth.net, c=US Date: 2023.04.17 12:30:44 -04'00'4/17/2023 :(//$%$1'210(175(&25' 7KLVIRUPFDQEHXVHGIRUVLQJOHRUPXOWLSOHZHOOV )RUP*: 1RUWK&DUROLQD'HSDUWPHQWRI(QYLURQPHQWDQG1DWXUDO5HVRXUFHV±'LYLVLRQRI:DWHU5HVRXUFHV 5HYLVHG$XJXVW :HOO&RQWUDFWRU,QIRUPDWLRQ :HOO&RQWUDFWRU1DPHRUZHOORZQHUSHUVRQDOO\DEDQGRQLQJZHOORQKLVKHUSURSHUW\ 1&:HOO&RQWUDFWRU&HUWLILFDWLRQ1XPEHU &RPSDQ\1DPH :HOO&RQVWUXFWLRQ3HUPLW /LVWDOODSSOLFDEOHZHOOSHUPLWVLH&RXQW\6WDWH9DULDQFH,QMHFWLRQHWFLINQRZQ :HOOXVHFKHFNZHOOXVH :DWHU6XSSO\:HOO Ƒ$JULFXOWXUDOƑ0XQLFLSDO3XEOLF Ƒ*HRWKHUPDO+HDWLQJ&RROLQJ6XSSO\Ƒ5HVLGHQWLDO:DWHU6XSSO\VLQJOH Ƒ,QGXVWULDO&RPPHUFLDOƑ5HVLGHQWLDO:DWHU6XSSO\VKDUHG Ƒ,UULJDWLRQ 1RQ:DWHU6XSSO\:HOO Ƒ0RQLWRULQJƑ5HFRYHU\ ,QMHFWLRQ:HOO Ƒ$TXLIHU5HFKDUJHƑ*URXQGZDWHU5HPHGLDWLRQ Ƒ$TXLIHU6WRUDJHDQG5HFRYHU\Ƒ6DOLQLW\%DUULHU Ƒ$TXLIHU7HVWƑ6WRUPZDWHU'UDLQDJH Ƒ([SHULPHQWDO7HFKQRORJ\Ƒ6XEVLGHQFH&RQWURO Ƒ*HRWKHUPDO&ORVHG/RRSƑ7UDFHU Ƒ*HRWKHUPDO+HDWLQJ&RROLQJ5HWXUQƑ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Ƒ1HDW&HPHQW*URXWƑ%HQWRQLWH&KLSVRU3HOOHWV Ƒ6DQG&HPHQW*URXWƑ'U\&OD\ Ƒ&RQFUHWH*URXWƑ'ULOO&XWWLQJV Ƒ6SHFLDOW\*URXWƑ*UDYHO Ƒ%HQWRQLWH6OXUU\Ƒ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✔ 3/23/2023 Handy House 3 00-0-0000011113 6742 US Hwy 70, Newport, NC 28570 Carteret 633820900892000 34.77793 -76.871506 MW-11 15' 2" 5.66 5' 10' 1 1.4 gal ✔ 0.5 bags of bentonite Bentonite pellets were poured into the well to top of casing, saturated with H2O then capped with cement. Henry Nemargut Digitally signed by Henry Nemargut DN: cn=Henry Nemargut, o, ou=Henry Nemargut Engineering, email=henrynemargut@bellsouth.net, c=US Date: 2023.04.17 12:32:36 -04'00'4/17/2023 :(//$%$1'210(175(&25' 7KLVIRUPFDQEHXVHGIRUVLQJOHRUPXOWLSOHZHOOV )RUP*: 1RUWK&DUROLQD'HSDUWPHQWRI(QYLURQPHQWDQG1DWXUDO5HVRXUFHV±'LYLVLRQRI:DWHU5HVRXUFHV 5HYLVHG$XJXVW :HOO&RQWUDFWRU,QIRUPDWLRQ :HOO&RQWUDFWRU1DPHRUZHOORZQHUSHUVRQDOO\DEDQGRQLQJZHOORQKLVKHUSURSHUW\ 1&:HOO&RQWUDFWRU&HUWLILFDWLRQ1XPEHU &RPSDQ\1DPH :HOO&RQVWUXFWLRQ3HUPLW /LVWDOODSSOLFDEOHZHOOSHUPLWVLH&RXQW\6WDWH9DULDQFH,QMHFWLRQHWFLINQRZQ :HOOXVHFKHFNZHOOXVH :DWHU6XSSO\:HOO Ƒ$JULFXOWXUDOƑ0XQLFLSDO3XEOLF Ƒ*HRWKHUPDO+HDWLQJ&RROLQJ6XSSO\Ƒ5HVLGHQWLDO:DWHU6XSSO\VLQJOH Ƒ,QGXVWULDO&RPPHUFLDOƑ5HVLGHQWLDO:DWHU6XSSO\VKDUHG Ƒ,UULJDWLRQ 1RQ:DWHU6XSSO\:HOO Ƒ0RQLWRULQJƑ5HFRYHU\ ,QMHFWLRQ:HOO Ƒ$TXLIHU5HFKDUJHƑ*URXQGZDWHU5HPHGLDWLRQ Ƒ$TXLIHU6WRUDJHDQG5HFRYHU\Ƒ6DOLQLW\%DUULHU Ƒ$TXLIHU7HVWƑ6WRUPZDWHU'UDLQDJH Ƒ([SHULPHQWDO7HFKQRORJ\Ƒ6XEVLGHQFH&RQWURO Ƒ*HRWKHUPDO&ORVHG/RRSƑ7UDFHU Ƒ*HRWKHUPDO+HDWLQJ&RROLQJ5HWXUQƑ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Ƒ1HDW&HPHQW*URXWƑ%HQWRQLWH&KLSVRU3HOOHWV Ƒ6DQG&HPHQW*URXWƑ'U\&OD\ Ƒ&RQFUHWH*URXWƑ'ULOO&XWWLQJV Ƒ6SHFLDOW\*URXWƑ*UDYHO Ƒ%HQWRQLWH6OXUU\Ƒ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✔ 3/23/2023 Handy House 3 00-0-0000011113 6742 US Hwy 70, Newport, NC 28570 Carteret 633820900892000 34.77793 -76.871506 VEW-1 77' 2" 22.04 60' 67' 10' 1 9 gal ✔ 1.5 bags of bentonite Bentonite pellets were poured into the well to top of casing, saturated with H2O then capped with cement. Henry Nemargut Digitally signed by Henry Nemargut DN: cn=Henry Nemargut, o, ou=Henry Nemargut Engineering, email=henrynemargut@bellsouth.net, c=US Date: 2023.04.17 12:43:45 -04'00'4/17/2023