Well Construction Records Rutherford 2 CY2000

To DENR DIVISION OF WATER QUALITY, GROUNIFrorn: ALAN S. GANTT 828-286-8787 01102fOl 19.09:52 Page 4 of 4
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North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section 223255
1636 Mail Service Center - Raleigh, N.C. 27699 - 1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: CAROLINA WELL DRILLERS. INC.
WELL CONTRACTOR CERTIFICATION # : 2584
STATE WELL CONSTRUCTION PERMIT # :
I. WELL USE (Check Applicable Box) : Residential Ej Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: (Show sketch of the location below)
Nearest town LAKE LURE County: RUHERF'ORD
470 CONNOR RD.
(Road, Community, or Subdivision and Lot No.) DEPTH DRILLING LOG
3. OWNER JOHNSTROUD FROM TO Formation Description
ADDRESS 15 HICKS CHAPLE CIRCLE
LAKE LURE NC 28"46
City or Town State zip Coac
4. DATE DRILLED 12/27/00 USE OF WELL RESIDENTIAL
5. TOTAL DEPTH 400
6. CUTTINGS COLLECTED YES ❑ NO Q
7. DOES WELL REPLACE EXISTING WELf-? YES ❑ NO
8. STATIC WATER LEVEL Below Top of Casing: 60 FT_
(Us, --^ If Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Laud Surface"
'Casing Tmrmiated aVor blow land sofa« is u issued
m a«ordmm< wish 15A NCAC 2C .9t to
to. YIELD(gpm): 1 METHOD OF TEST ARD%l
It. WATER ZONES (delah): 370
C
87 CLAY
400 CONSOLIDATED ROCK
O
_
o
C—
^�
^' m
Z
n
Cam,
�
OG
TsG
V52
O
---I
0
Z
12. CHLORINATION: Type HYPOCHLORITE Amount II Oz. IhddiGosul spun u ne<d<d use back of fours
11 CASING. LOCATION SFEfCH
Wall Thickness (Shaw direction and distance from at least two Stale
Depth Diameter or WeighbFt_ Material Roads, or other map reference powers)
From 0
To
95 Ft.
—
14. GROUT
Depth
From 0
To
20 Ft.
13. SCREEN
Depth
Dianete'
From NA
To
Ft.
to. S.ANI /GRAVEL PACK:
Depth
From NA
To
Ft,
17. REN555 S:
—
61/4" SDR21 PVC
Material Method
SAND MIX GRAVITY
Slot Size Nfaterial
in. In
Size Material
BILL'S CREEK RD
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15.A NCAC'_C, WELL
CONSTRUCTION STANDARDS, AND TIIAT A COPY OF TIIIS RECORD H.A.S BEEN PROVIDED TO TTIE WELL OWNER.
FOR OFFICE US -ONLY ,
1. I
Quad No
Serial No
693 is
12/27/00
iF PERSON CONSTRUCTING TIQ W'E L Date
Division of Was<r Quility, Gomrdwat<r S<ction wimwn 30 Dsyc

To'. DENR DIVISION OF WATER QUALITY, GROUNIFromALAN S. GANTT 828-286-8787 01/02/01 19'.09.10 Page 3 cf 4
Sent by the Award Winning Cheyenne Bitware
??.3?54
North Can olina - Depaament of Environmrnt, and Natural Resources -Division of W'ata- Quality - GroundwatnSection
1636 Mail Service Center - Raleial4 N.C. 27699 - 1636 - Phone [phone]^_^_t
WELL CONSTRUCTION RECORD WELL CONTRACTOR: CAROLINA WELL DRILLERS. INC.
WELL CONTRACTOR CERTIFICATION # : 2584
STATE WELL CONSTRUCTION PERMIT # :
L WELL USE (Check Applicable Box) Residential ❑ Murucipeu ❑ Industlial ❑ Apiculmial ❑ Morulueurg ❑
Recovery ❑ I [eat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION- (Show sketch of the RCafion below)
Nearest tmvn: LAKELURE County RI-THERFORD
1040 GIRL SCOUT CAMP RD
(Road, Community. or Subdivision and Lot No
3. OWNER DON RESPESS
ADDRESS 1040 GIRL SCOUT CAMP RD
IS.-, o. Rou(, No_)
LAKE LURE NC
Cityor form Stale Zip Code
I. DATE DRILLED 12/22/00 USEOFWTLL RESIDENTIAL
5. TOTAL DEPTH 400
6. CUTTINGS COLLECTED YES ❑ NO El
'/. DOES WELL REPLACE EXISTING WELL Yh:S ❑ NO
8. STATIC WATER LEVEL Below Top of Casing'. 35 FT.
(Us, -," If Abov< Toy cf Castel,)
9. TOP OF CASING IS 2 FT. Above Land Sol Faces
'Casug Tovwumd at'or below Load snda<e is dl<gal mdess a rmimme is issn<d
in ucordansc wide 15A VCAC 2C.I1118
to, YIELD (q)m): 2 METHOD OF TEST ARDNI
11, WATER ZONES (depth)'. 350
n
DEPTH DRILLING LOG
FROM 10 Formation Description
42 CLAY
400 CONSOLIDATED ROCK
0
O
0
nt
I
oC
"rn
Ed
Dc
m�
A
O
0
12. CHLORINATION: Type HYPOCHLORffE Amount 10 OZ. If ad�Gtional:pace is n«des us< bock of foon
13 CASING. LOCATION SKETCH
Wall Thickness (Show direction and distance from at least two Slate
Depth Doildr or Wctgbt/FL Material Roads. or other map icenct/ce points)
From 0 To 51 It 6 111 " SDR 21 PF'C
w. GROUT:
Depth Material Method
From 0 To 20 Ft. SAND MIX GRAVITY" � GHRL SCOUT CAN'1P RD
15. SCREEN
Depth Diainetn Slot Size Material
From NA To Ft.
16. SAND GRAVEL PACK:
Depth Size Material
TO LAKE LURE >
Fmm NA To Ft,
1 RE\LARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TF AT A COPY" OF TI IIS RECORD HAS BF.i.N PROVIDED TO TI IE WELL OW'NTR.
FOR OFFICE USK4WL4-00
12,3 ,'
Quad No. CDate
Se1'ial No. 9. 1 lF" DF PERSON TING TILE WELL
Sub�mr ga;l,t Division of0.mer Quabty Gomrdwm<r S«ami xrdun lO Daa
GW"I REt'. 1299
692

To: DENR DIVISION OF WATER QUALITY, GROUNIFrom ALAN S. GANTT 828-286-8787
Sent by the Award Winning Cheyenne Bitware
12/26/00 7.2236 Page 9 of 1 O
r
North Carolina- Department of Environment. and Natural Resources - Division ofWalcrQuality- GroundwataSation w ( / 1
1636 kiai1 Sm'ice Center - Raleigh, N.C. 27699 - 1636 - Phone (9l9) 733.3221
WELL CONSTRUCTION RECORD WELL CONTRACTOR: CAROLINA WELL DRILLERS, INC.
WELL CONTRACTOR CERTIFICATION # : 2584
STATE WELL CONSTRUCTION PERMIT # :
1. WELL USE (Check Applicable Box): Residential ❑ municipal ❑ Industrial ❑ Alpiculluial ❑ monitoring ❑
Recovery ❑ I teat Pump Water Injection ❑ Other ❑ If Other, List Use'.
WELL LOCATION: (Show sketch of the location below)
Nearest town'. RUPHERFORDTON County: RUI'I JERI ORD
268 DAVE SIMS RD
(Road, Cmmrnmity, or Subdivision and Lot No.)
3. OWNER FLEERVOOD HOMES
ADDRESS 1920 HW'Y 74 BYPASS
(Sa-1 or Rom< No.)
FOREST CITY NC 28013
City or Totmt State Zip Code
4. DATE DRILLED 12,6100 USE OF WELL RESIDENTIAL
5. TOTAL DEPTH 490
6. CUTTINGS COLLECTED YEs ❑ NO El
7. DOTS WI(I.I. REPLACE EXIS"PING WFLW YES ❑ NO
8.STATIC WATER LEVEL Below Top of Casing'. 20 FT.
ulsa "*" If Above Top of Caving)
9. TOP OF CASING IS 2 FT. Above Land Sudaa*
-Cuing T<nwrzt<d aU., bdow End —f-,,, Jkgal mJ<as a vana— i, hso<d
in aewrd— with 15A NC AC 2Co 118
to. STELD(gTm): 2 METHOD OF TEST ARD%T
11, WATER ZONES (dgtW): 450
El
DEPTH
FROM U
0 55
55 180
DRILLING LOG
Formation Description
CLAY
CONSOLIDATED ROCK
O
K
O
re*i
Ao
r
IV
znr
J
t={
ern
A
O
M
r"o
— '
Art
CJ
O—
Z
12. CHLORINATION: Typc HYPOCHLORII'E Amount 13 OZ. Ifoddirional,poc< n. .da„book of fan.
13 CASING. LOCATION SKETCH
Wall Thickness (Show direction and distance from at least two State
Depth Diainem' or Weighi,Ft. Matea'ial Roads. or other map reference points)
Pram 0 To 60 rt. 6 1,1 " SDR 21 PVC COOPERS GAP RD
IT GROUT:
Depth
From 0
To 20 Ft.
I,. SCREEN
Depth Dia,der
From NA
To Ft.
16. SAND GRAVEL PAC1,'.
Depth
From NA
To Ft.
IZ REMARKS'
Material Method
SAND MD: GRAVITY
Slot Size Material
in. in
Size Shan at
DAVE SLMS RD.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH I SA NCAC 2C. WELL
CONSTRUCTION STANDARDS, AND Tf TAT A COPY OF TI US RECORD HAS BEEN PROVIDED TO TI IT WTLI, OWNTR.
0
US 64'74 N
FOR OFFICE USE ..�� 12/14(00
Quad No. r i((. Date
Scrial No. "IRURE OF rl- SON CONSTRUCTNG ME WELL
Subnut wiguml to31;i.4rionpf Warr Q.alirv. Gomdwat<r S<c.wr widwr to Dry=
I � plRl REY. L;99

To: DENR DIVISION OF WATER QUALITY, GROUN[Frorn ALAN S. GANTT 828-286-8787
Sent by the Award Winning Cheyenne Bitware
12/26/00 7:21:54 Page 8 of 10
North Carolina - Department of Environment. and Natural Resources- Division of Wm a Quality- Groundwater, Section •^'�27 2
1636 Mail Service Center- Raleigh, N.C. 27699 - 1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: CAROLINA WELL DRILLERS, INC.
WELL CONTRACTOR CERTIFICATION # : 2584
STATE WELL CONSTRCCTION PERMIT # :
1. WELL USE (Check Applicable Box) : Residential 1] Municipal ❑ industrial ❑ Apiculuual ❑ Monitoring ❑
Recovery ❑ I [eat Pump Water Injection ❑ Other ❑ If Other, List Use'.
2_ WELL LOCATION-(Showskelchofthclocationbelo%v)
Nearest town. RUPHERFORDTON County: RU'I'I IERFORD
819 TRIXIE COURT
(ROml, Community. or Subdivision and Lot Net DEPTH DRILLING LOG
3. OWNER FLEETWOOD HOMES FROM TO Formation Description
.ADDRESS 1920 HW Y 74 BYPASS
FOREST CITY NC 28043
Cityoe'1'own State Zip Cod
J. DATE DRILLED 11/27/00 USE OF WELL RESIDENTIAL
y TOTAL DEPTH 640
6. CUTTINGSFE COLLECD YES ❑ NO E]
7, DOSS WELD. RFPI.ACI±HxISING WE111 YES ❑ M1
8. STATIC WATER LEVEL Below Top of Casing'. 92 FT.
(Use `+" If Lb)vz Top of CasbsD
9. TOP OF CASING IS 2 Fr. Above Lard Surface-
-Cmu, T,.marcd .", bdoor Imrd smfaac is Jkgal rudees a vamoo- is issued
ino.cordv¢e widr liA NCAC 2C .011E
to. ITELD (gpm): 11/' METHOD OF TEST ARDM
11, WATER ZONES (depRi): 550
0
e
50
50
610
CLAY
CONSOLIDATED ROCK
12. CHLORINATION: Type HYPOCHLORHE Amount 17 OZ. If addirional space s a«dad ue< backefaun
13. CASING. LOCATION SKETCH
Wall Tlrekness (Shme direction aid distance from at least tw'o State
Depth Dimneter er Weight'Ft. ➢im,nal Ronk, or other map reference points)
Frain 0 To 52 Ft, 6 I/I " SDR 21 PVC
14. GROL7r',
Depth
From 0
To
15. SCREEN
-
Depth
From NA
To
16. SPACK. .kNEGRAVEL PAC
Depth
Floor NATo
17. REb41RKS:
Material Method
20 Ft. SAND MIX GRAVITY
Dianetn' Slot Size Material
Ft. in. in.
Ft.
Size 'Mmo ial
BE\\ET RD
D.ARLL\GTO\ RD
I DO H ER-EBY CERTIFY THAT TIES WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC'C.1t'ELL
CONSTRt7CQON STA\T.ARDS, AV'D TI UT A COP}' OF TIHS RFCORD HAS I3Ef1 PROVIDED TO Ti R: bkT1.1, 0t\-NT.R.
W m
H
FOR OFFIC r Is1':org7 /7z 12/14/00
Quad No. ls' IJ 2 �J Date
Sei'Inl No ' ±w OF PERSON CONSTRUCTING nIT WELL
p 'so r a dw Di.io—.fNara Quaury Ganndavm<r 5<crion.aidmr 3p Daa<
6b7 rrr':, — o cwa REY. 1399

To DENR DIVISION OF WATER QUALITY, GROUN[Fronn ALAN S. GANTT 828-286-8787 12/26/00 7.21'.10 Page 7 of 10
Sent by the Award Winning Cheyenne Bitware
North Carolina- Department of Environment. and Nalural Resources -Division of Waler Quality- Groundwater Section -277 /�
1636 Mail Service Center - Raleigh,KC. 27699 - 1636 - Phone [phone]^_21 �2
WELL CONSTRUCTION RECORD WELL CONTRACTOR: CAROLINA NVELL DRILLERS, INC.
R'ELL CONTRACTOR CERTIFICATION # : 2584
STATE WELL CONSTRUCTION PERMIT # :
1. WELL USE tCheck Applicable Box) : Residential E Municipal ❑ Industrial ❑ Apgicullwal ❑ Monilefutg ❑
Recovery ❑ heat Pump Water Injection ❑ Other ❑ If Other, List Use.
2- WELL LOCATION: (Show imtdi ofthe location below)
Nnrestto...i LAKE LORE ('punt}" RU'I'IILRFORD
114 CONNOR RD.
(Road, Comrmatory-or Subdivision mtd Lot No.)
3, OWNER DANIEL BROWN
ADDRESS POB 41l
(6bce ur Rout, No)
MIDDLEBURG FL 32050
Of, or 1'o.vn State 7.ip Cnde
4. DATE DRILLED ILlhr00 USE OF WELL RESIDENTIAL
s. TOTAL DEPTH 340
6. CUTTINGS COLLECTED lES ❑ NO R
7, DOLS,Mill. It F.PI.ACE IAIS'I'ING WFLI:7 1'FS ❑ NG El
8. STATIC WATER LEVEL Below Top of Cuing'. FT.
to "*" If Above Top of C.,iap
9. TOP OF CASING IS 2 FT. Above Land Surface'
-C... , TcmJnacd aC., blow Imid ±urt... i+ ilk,al mile, a vmisac is ;send
m..... dv,ac wi0, UA NCAC 1C.0118
to. YIELD tpim: 3 bf1HOD OF TEST ARD%l
IL WATER ZONES(dgpfbn, 240
DEPTH
FROM ro
0 162
162 310
DRILLING LOG
Formation Description
CLAY
CONSOLIDATED ROCK
12. CHLORINATION: TyPe HYPOCHLOR IE Amount 9 OL,. vod�erianm,9ac. i:n«d.d n;c bock ortom,
U. CASING: LOCATION SKETCH
Wall Thickness (Show direction and distance from at least two State
Depth Diameter or Weight/Ft. Material Roads, anther map referencepointy
From 0 To 170 Fr 6 U t " SDR 21 PVC
It. GRWF
Depth
From G
To
1�. SCREETi
Depth
From NA
To
16. SAM GRAVEL PACK:
Depth
From NA
To
1'. RONUR6S^
Material Mdhod
20 FL SAND MIX GRAVITY
Dimnder Slot Size Material
Ft in in
Ft.
Size Material
CONNORRD
BILT.'S CREEK RD.
TO RUMERFORDTON COVE RD
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED L\ ACCORDANCE WITH 13A NCAC 2C. WELL
CONSTRUCTION STA%-DARDS, AND H UT A COPY OF TI US RECORD HAS REN PROWDED TO TI IF IsT,LI, OW',T.R.
FOR OFFICE
Quad No.
Se1-Ial No.
ER -g
CONSTRUCTING TIQ WELL
ner Qnaliry. Goundwarcr Section will., 30 Days
11,116100
Date
GM 1 REV.IL➢9

To. DENR DIVISION OF WATER QUALITY, GROUN[From ALAN S. GANTT 828-286-8787
Sent by the Award Winning Cheyenne Bitware
12/26/00 7.19 02 Page 4 of 10
"2777 North Carolina - DepMmrnt of EnvirorvnaV. and Natural Resources - Division of Wald Quality' Groundwater Section
1636 Mail Service Center- RaICIQII. N.C. 27699 - 1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: CAROLINA WELL DRILLERS, INC.
WELL CONTRACTOR CERTIFICATION If: 2584
STATE WELL CONSTRUCTION PERNIFE # :
1. WELL USE (Check Applicable Box): Residential ❑ Mmucipal ❑ Industrial ❑ ApIkullural ❑ Mormcni rg ❑
Recovery ❑ heat Pump Water Injection ❑ Other ❑ If Other, List Use.
±. WELL LOCATION. (Show sketch of the location below)
Ncaresttow;r CLIFFSIDE Coro) RU'fHERE ORD
347 ]TINES RE)
(Road, Continuum or Subdivision and Lot No.)
3. OWNER RUSTY WILSON FROM
ADDRESS 347 HINES RD
DEPTH
TO
(Suaatrr Roma Nut 0
85
MOORESBORO NC 28111 85
205
City or'Imn State Zip Code
a. DATE DRILLED 10.19/00 USE OF WELL RESIDENTIAL
5. TOTAL DEPTH 205
6. CUTTDIGS COLLECTED YES ❑ NO El
7.DOUSWP:I.I. REPI.ACl7 nXIS IIN(i WHIP YES ❑- NO ❑
8. STATIC WATER LEVEL Below Top of Casing'. 50 FT-
(U,, "-' If Aboce Top of Cahn
9. TOP OF CASING IS 2 FT. Above Land Surface'
'C'ashtg Taardnacd atbr balow Imut surfacer i+dkgat milt, avo wlcc is issuad
m aewrdanca with 15A NCAC 2C 01IS
lo-YTE.LD(gpm): 30 11ETHOD OF TEST ARDM
It. WATER ZONES (depth). 200
12. CHLORINATION. T3Pc HYPOCHLOREFF Amount 50Z. rfadaieonal,pa«ia nudadt
13. CASING. LOCATION SKETCH
Wall Thickness (Show direction and distance from at least two State
Depth Diameter or Weelit PC Material R.rdks or othe,rtsp reference points)
DRILLING LOG
Formation Description
CLAY
CONSOLIDATED ROCK
Fram 0
14. GROUT
To 92 Ft. 6 IN " SDR 21 PVC
Depth
From 0
To 20 Ft.
13. SCREEN
Depth Dimneter
From NA
To Ft,
16. S.ANDYGR.A\'EL PACT::
Depth
FIVOI NA
To Ft,
17. RLroIARRs.
—
Material Method
SAND MIS GRAVITY
Slot size Material 347
in. in.
Size Material
HIti ES Rll
IRVY 221 S
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH I sA NCAC 2C, WELL
CON'STRUC11ONSTA
RECORD[LAS BEE\PROVIDF.DTOTIIEWTI.I.OWTT.R.
5RS
Nell ILL555
FOR 0''
USE oNLr
� � �� �� 12i26,/ 00
Quad
—
'. Date
SPrlalI
SIG .ATURE. OF PERSON CONSTRUCTING TILE WELL
Sub; t mightal m Division of Water Qualip'. Gotmdwamr Sntion witlwt l0 Dacs

To DENR DIVISION OF WATER QUALITY, GROUN[FromALAN S. GANTf 828-286-8787
Sent by the Award Winning Cheyenne Bitware
12/26/00 718'.20 Page 3 of 10
North Carolina - Department of Environment, and Naturat Resources - Division of Watn' Quality - Groundwale' Section 1636 Mai l SenviceCente'-Raleiolt.N.C. 27699.1636-Phone[phone] f— ��7 I I
V
WELL CONSTRUCTION RECORD WELL CONTRACTOR: C kROLINA WELL DRILLERS. INC.
WELL CONTRACTOR CERTIFICATION # : 2584
STATE WELL CONSTRUCTION PER..NIIT#:
I. WELL USE (Check Applicable Box) : Residential ❑ Municipal ❑ Industrial ❑ Apicullinal Q Ntertacling ❑
Recover}' ❑ I feat Pump Water Injection ❑ Other ❑ If Other, List LCse
z WELL LOCATION: (Show sketch ofthe [.tali.,, below)
Nearest loon: SPINDALE County: RLTIILRFORD
437 OLD ROSS RD
(Road, Community. or Subdivision and Lot No)
l OWNER RICK LANCASTER
ADDRESS 43' OLD ROSS RD
SPINDALE NO 28t60
Cny'or'I'oeot Slate Zip Code
a. DATE DRILLED 10AS'00 USEOFWELL RESIDENTIAL
i. TOTAL DEPTH MO
6. CUTTINGS COLLECTED YES ❑ NO Q
Z DOI!S WI(LI. I(p.P[.A('F l:XLS HNC WOOL" YFS ❑' M)
8. STATIC WATER LEVEL Beloo' TOP of Casing: FT.
(Osa '+' UAW— Top or Cosbsp)
9. TOP OF CASING IS 9 FT. Above Land Surface'
'Casurg Tanammd AW bd— laul .... b,, is dlapal mdcss a u manic is 000d
yr aecoldmce wadi 11A FCAC 2C 0118
10. NTELD La)1m): 5 METHOD OF TEST ARD\f
11. WATER ZONES IdepUQ; 230
0
DEPTH
FROM f0
p 7t
75 260
DRILLING LOG
Fonnation Ucsci ption
CLA'i
CONSOLIDATED ROCK
Ln 1
Z
11CHLORLNATION. Typc HYPOCHLORLE Amount OZ. If oddirioa qsi- is.,s&duse bock oMn.
13 CASING. LOCATION SKETCH
Wall Thickness (Shoo direction and distance from at least too State
Depth Diamrte' or WeiglaTt. Material I Roads. or other map refeiencel int;l
Prom 0 To 8o rt. 61/1" SDR 21 PVC I ,1j7
14. GROUT
Depth
From 0
To 20 Ft.
1<. SCREEN
Depth Disneter
From NA
To Ft.
16. S.AND GRAVEL PACK:
Depth
From NA
To FL
17, RLR4IRI7
—
Material Melhod
SAND MIX GRAVITY
Slot Size Mataivl
in. in.
Size Nfatet ntl
RD
I DO HEREBY CERTIFY THAT Tins WELL WAS CONSTRUCTED LN ACCORDANCE WFM 13A NCAC 2C, WELL
CO\STRUCIION STANDARDS, A'M THAT A COPY OF THIS RECORD I IAS BEEN PROHDED TO TI f]'. WT:LI. OW1T'R.
FOR OFFICE USE ONLY
Quad No. M
Serial No. V
682
OF PERSON CONSTRUCTING TtIE WELL
o Division of Water Quality, Grmmdwatcr Section %idwr 30 Dac<
OLD ROSS RD
Hi-TMOkI RD
I2,'26'00
Date
GW-1 REV. 1299

To: DENR DIVISION OF WATER QUALITY, GROUN(Frorn ALAN S. GANTT 828-285-8787
Sent by the Award Winning Cheyenne Bitware
12/26/00 7.17:36 Page 2 of 10
2'779
Notch Carolina - Department of Environment. and Natural Resources - Division of Winer Quality - Groun&am Section
1636 Mail Service Center - Raleiolr. N.C. 2699 - 1636 - Phone [phone]
WELL CONSTRUCTION RECORD «'ELL CONTRACTOR: CAROLINA «rELL DRILLERS, INC.
IN ELL CONTRACTOR CERTIFICATION # : 2584
STATE WELL CONSTRUCTION PERNIFF # :
1. WELL USE (Check Applicable Box) : Residential ❑ N1ur 6psl ❑ Indusllial ❑ Apaicultutal ❑ Nicrimulitlg ❑
RecovelY ❑ I leat Pump Water Injection ❑ Other ❑ If Other, List Use
2. W E LL LOCATION'. (Show sketch of the location below)
N"re,t to. UNION MILLS (caner" RE IHERE 'ORD
64, IIUDLOW RD
(Road, Coinmmnity- or Subdivision and Lot No
DEPTH DRILLING LOG
3. OWNER GUS PATTON FROM
TO Fonflat Description
ADDRESS 642 HUDLOW RE)
I Snore or Rom, No. t 0
68 CLAY
UNION MILLS NC 68
260 CONSOLIDATED ROCK:
City or'I own State Zip Code
4. DATE DRILLED 1016.'00 USE OF WELL RESIDENTIAL
s. TOTAL DEPTFI 260
p
6. CUTTINGS COLLECTED YES ❑ NO Q
CD CD
p
4. J)ULS W'IQ.I. It FPI.ACI f VMS I NG WFLLr YFS Q NO ❑
0
Men
a. STATIC WATER LEbEL Beloty rep of l'a,ing: 65 FT.
C')
Cm
(Tl, "+"If Aboae Toy of C'a.uipl
n
s. TOP OF CASING IS 2 FT. Above Luul Swfice'
y C
-C.,., Tanwwsd at'., bdo.v land nn ta,c I41,al .do,, a vmimuo L� land
p
3
M C
ern
m aoeordmice with 11A NC.AC 2C 0118
Ce`
`D
m�
to YIELD i2j m}. 9 METHOD OF TEST ARDM
fs
—Ci
u. WATER ZONES(deplt): 245
W
O
12. CHLORIN.ATION. Type HYPOCH LORI'I'E Amount 6 OZ,
lfaddiriond,ya., isn„dada:, back of form
13 CASING'.
LOCATION SKETCH
Wall Thickness
(Show direction arld distance Gam at lead two State
Depth Diameter or WeicJNFT, Material
Roads. or other map refel'ence points)
Frota 0
To , Pt.
IJ. GROUT'.
Depth
From 0
To 20 Ft,
Ic, SCREEN
Depth Dianelei
From NA
To Ft.
16. S.AN-5GRAVEL PAC'K'.
Depth
From NA
To Ft.
17, RD. L S:
61i1" SDR11 PAC
material method
SAND MIX GRA\TTY
Slot Size material
in. in.
Size Mak'ial
US 221
I DO FIEREBY CERTIFY TH.ATTFIS WELL WAS CONSTRUCTED IN ACCORDANCE 14TFH 13A NCAC ^_C. W'ELL
CMSTRIiCT nN STANDARDS, AND TI TAT A COPY OF TITS RFCORD HAS BEEN PROVIDED TO TIIB WTLL OWNTR.
FOR OFFICE USE ONLY �� � 1126'00
Quad No. I6 Dine
_
SePhd No. ,-..-.SLGZiLc TURW OF PERSON CONSTRUCTING TIQ WELL
—ti} Sabi t Sq} m �rcr,iaa of Rm ar Quabrv. Gsmdwma S„n w liortlwJO Day,
ew.1 Re, law
681 i I1

To DENR DIVISION OF WATER QUALITY, GROUNIFrom ALAN S. GANTT 828-286-8787
Sent by the Award Winning Cheyenne Bitware
12/04/00 2033.18 Page 11 of 11
North Ciao I ina, - Dcpariment of Environment, and Natural Rceourccs -Division of Watn' Quality - Groundwater Swim
1636 Mail Service Centel. Raleigh, N.C. 27699 - 1636 - Phone [phone]
4''A 261
WELL CONSTRUCTION RECORD WELL CONTRACTOR: CAROLINA NFELL DRILLERS. INC.
WELL CONTRACTOR CERTIFICATION # : 2584
STATE WELL CONSTRUCTION PERVII'F # :
L WELL USE (Check Applicable BoN): Residential ❑ Municipal ❑ Industrial ❑
Recovery ❑ I lest Pump Water Injection ❑ Other ❑ If Other, List Use
WELL LOCATION`. (Show eknch of the location below)
Nezrearlrnvn'. LAKE LURE (cia,t). RU HERFORD
684 CONNER RD
(Road, Community, or Su6divkion acid Lot No.) DEPTH
3. OWNER BRUCE PARTON FROM TO
ADDRESS 1 L2 SPRUCE ST.
BLACK MOUNTAIN NC
cq ar'rown State Zip Code
J. DATE DRILLED 10'T4'00 USE OF WELL RESIDENTIAL
5. TOTAL DEPTH 200
6, CUTTINGS COLLECTED ITS ❑ NO
DUI!ti W'1':LI. It I!PI,A('li ISXIS'TING W'E:LI::' YES ❑ NO
S. STATIC WATER LEVEL Belocv Top of Casing: 32 FT.
(Use '-" If Abovr Top of Cvsurgl
9. TOP OF CASING IS 2 FT. Above Land Surface-
'Cannz Tandnated aVor bdoo Imsd snrfacs o dlegal in&ss a vaia¢c is issued
m .....dance wltlr 15A NCAC 2C .011%
10. YIELD(eepm)'. 8 METHOD OF TEST ARD)d
11. WATER ZONES (dgAILv 100
C'
0 85
85 200
Apicullural ❑ Murulolilo; ❑
DRILLING LOG
Formation Description
CLAP
CONSOLIDATED ROCK
12. CHLORINATION: Te)c Hl POCHLORITE Ainount (, OZ. avddiional zyase iensvkdn;e bask o f Pori
1I. CASING'. LOCATION SKETCH
Wnll lltid:ness (Show direction and distarice from at least tvvo State
Depth Diwneter or W'enditiFt Material Roads- i other nrap reference Points)
From 0 To 9- Ft- 6 1/ 1 SDR 21 PVC 0 1
IJ. GROUT
Depth
From 0
To
I,. SCREEN
Depth
Front NA
To
16. S.ANDiGRAVEL PACK:
Depth
From NA
To
17. REINCV S:
Material Method CO\NOR
20 Ft SAND MIS GRAVITY
Diameter Slot Size
Ft. in.
Size
Ft.
m
Material
BTLL'S CREEK RD
COVE
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC " C, WELL
CO\STRUCTION STANDARDS, AND TI TAT A COPY OF TI ITS RECORD HAS BEEN PRO1TnGD TO TI IF WT.LT. OW]TR.
FOR OFI'
Quad No.
Serial No.
OF PERSON CONSTRUCTING THE WELL
m Division of Warcr Qua6y. Gmmdavatcr 5nrion w16, 30 Days
TO RUTITERPORDTON
12iO4'00
Date
GW-1 RE\'. 12 99
10

To. DENR DIVISION OF WATER QUALITY, GROUNIFrorn ALAN S. GANT? 828-286-8787 12/04/00 20 32: 36 Page 10 of 11
Sent by the Award Winning Cheyenne Bitware
Noi9c C arolina - Department of Envirormoso. and Natural Resources - Division of W'ataQuality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699 .1636 - Phone [phone]
WELL CONSTRUCTION RECORD NI ELL CONTRACTOR: CAROLINA WELL DRILLERS, INC.
N\ ELL CONTRACTOR CERTIFICATION # : 2M 4
STATE R'ELL CONSTRUCTION PERMIT # o
I- WELL USE (Check Applicable Box): Residential ❑ Municipal ❑ Industrial❑ Apicullmal ❑ Nloniloling ❑
Recovuy ❑ I leat Punip Water Injection ❑ Other ❑ If Other, List Use:
z WELL LOCATION (Sltow,ketch ofthe location below)
N.,s,,l tours. RUTHERFORDTON county-. RUN HERFORD
1911 DARLINGTON RD
(Road, Community. or SubdicisionandLo(No.) DEPTH DRILLING LOG
1. OWNER THOMAS STOVER FROM 10 Fovnation Description
ADDRESS 1888 DARLINGTON RD
(srm r,r Rim. No_)
RUFHERFORDTON NC 28t%9
Cityor 1'— Sale /sp Code
J. DATE DRILLED 10'9(00 USE OF "'ELL RESIDENTIAL
5. TOTAL DEPTH 240
6. CUTTINGS COLLECTED ITS ❑ NO El
1, DOES W'1!1,1. RFPLA('F EXIS PING WP:I.IP YES ❑ NO
8. STATIC WATER LEVEL Below Top of Casing: 51_ FT.
(Us, "+" 1(Above Toy of C ub,,l
9. TOP OF CASINO IS 2 FT. Above Land Surface*
-Cas., Tcuwmomd ado, bd., tm,d usE.s is dlagal rW ass a vananca is o,au d
m a .... dvm< odds 15A NCAC 1C XI19
ta. YIELD Igpm): 7 METHOD OF TEST ARDII
11, WATER ZONES (dq,do: PG
L
0 8i CLAY"
81_10 CONSOLIDATED ROCK
12. CHLORINATION: Type HYPOCHLORffE Amount 6 OZnuddhi,solsy.s, is n..dedo
13. CASINO LOCATION SKETCH
Wall Thickness (Shmc cla action and distance from at least two State
Depth Diameter or Weight/Ft. Material Roa(s- or other map reference poa1N)
Prom 0
To 98 Pt. 6 I'll, SDR 21 PVC COVE RD
14, GROUT:
Depth
From 0
To 20 Ft,
I<, SCREEN
Detrth Diameter
From NA
To Ft.
16. SAND/GRAVEL PACK:
Depth
From NA
To Ft,
17. REMARKS:
Islalesial Method
SAND MIS GRAVITY
Slot Size Mata'ial
n. in.
Size Material
7
EART,T'GTON RD.
II VY 64 74 TO RUTIIERFORDTON
[DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TT IAT A COPY OF TIRS RECORD HAS BEEN PROWDED TO THE WILL OW'NT.R.
roRorrl �{s o t
Quad No
Serial No.
679
12, 04 00
Date
OF PERSON CONSTRUCTING TILE WELL
o Di.ision of �l'at<r Quolity. Groaudxmn Swrion uitlwi 50 Dacs
cw.1 Rev. 11:99
0

To: DENR DIVISION OF WATER QUALITY, GROUN(Frorn ALAN S GANTT 828-286-8787 12/04/00 20 31 52 Page 9 of 11
Sent by the Award Winning Cheyenne Bitware
North Carolina - Department of Environment, and Natural Resourcce - Division of Wma Quality - Groundwater Section ti 2 1 25 9
1636 Mail Service Center - Ralei all. N.C. 27699 -1636 - Phone (919)'33.3221
WELL CONSTRUCTION RECORD «°ELL CONTRACTOR: CAROLING NVELL DRILLERS- INC.
R"ELL CONTRACTOR CERTIFICATION # : 2584
STATE WELL CONSTRICTION PERMIT # :
I- WELL. USE (Check Applicable Box) : Residential E) Ntwticipal ❑ Imlushial ❑ ANicullwal ❑ blurlitoling ❑
Recovety ❑ I lent Pump Water Injection ❑ Other ❑ If Other, List Use
WELL LOCATION (Shoo aketdr of the loralmn below)
Nearest to. FOREST CITY Colony. Rl--Fl URFORD
21811 & L DRIVE
(Road, Community, or Subdivision and Lot No-)
3. OWNER PHILLIP MURRAY FRUM
ADDRESS 218 H & L DRIVE
DEPTH
TO
(Aaa o, Rowe No_) G
54
FOREST CITY NC 28011 54
d00
Cary or't oxn State Zip ('nde
4. DATE DRILLED 10/4/00 USE OF WELL RESIDENTIAL
5. TOTAL DEPTH 400
6. CUTTINGS COLLECTED YES ❑ NO Ej
ZDOI'IS WIiLI. REPLACE EXISTING WELL )E-s ❑ NO ❑
a. STATIC WATER LEVEL Below Top of Casing: 62 FT.
(U,, -+- If Above iop of C'azuigl
9. TOP OF CASING IS 2 FT. Above Land Swfaae*
-Casbrg T,mrarn J at'or bdoa IwW swfan is Jk;al mdnz o,-- o issued
um aecardaua wide 13A NCAC 2C'.01IS
10. STELD(epm)'. I NETHOD OF TEST ARD%l
11, WATER ZONES WepW): 250
DRILLING LOG
Fla vnvtion Dcen'iptioo
CONSOLIDATED ROCK
12. CHLORINATION'. Type HYFOCHLORFIE Amount 12 OZ. If addidond,,—lzne<dcd,—bockoffom-
U. CASING. LOCATION SKETCH
Wall Daickness (Show direction mrd distance f orn at leaen two Slate
Depth Diwn&. or Weight: FL Material Road,. orodsnnap.df, ence polnts)
p
O •E
O A
From 0
14. GROU
To
61 D. 6 1, 1 " SDR 21
PVC
H&:L DR.
Depth
Material
Method
From 0
To
20 Ft. SAND MIX
GRAVITY
I,. SCREEN
ROLLNS RD.
Dc7dh
Diwneter Slot Size
Material
From NA
To
Ftin.
in.
16- SANDiGRAVEL PACK:
MT PLF,.4SANT CH RR
Uryrth
size
Material
From NA
To
Ft.
-
HWY2o1A
17.RE-V,ITd S:
I DO HEREBY CERTIFY THAT TEAS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC'_C, WELL
CONSTRUCTION STANDARDS, AND TI IAT A COPY OF TI ITS RECORD IIAS BEEN PROVIDED TO TI IF. WTH. OWNER
FOR OFFICE USE ONLY f' 120400
Quad No
_r �yie�3v
r
OfE
GWATUTtL PERSON CONSTRUCTING TI WELL Date
Serial ND -- _ .
tUyt' �qv d r Divinon of Wality. aHr Qu. G' J aro- 5eauon wrtlwJO Lm$
ai f Y OW.I RE\'. l'99

To DENR DIVISION OF WATER QUALITY, GROUNIFrom. ALAN S. GANTT 828-286-8787 12/04/00 203108 Page 8 of 11
Sent by the Award Winning Cheyenne Bitware
North Carolina - Department of Environment. and Nahn'al Rcsourecs -Division of Water Quality - Groundivata' Section 2 , 2 5 8
1636 Mail Service Center - Raleigh, N.C. 27699 - 1636 - Phone [phone]
WELL CONSTRUCTION RECORD NFELL CONTRACTOR: CAROLINA NVELL DRILLERS, INC.
WELL CONTRACTOR CERTIFICATION # : 2584
STATE WELL CONSTRICTION PERMIT # :
I. WELL USE(Check Applicable Box): Residential ❑ Elmucipul ❑ Indummil❑ Aynicultriod ❑ Montiolitlg ❑
Recovery ❑ I lent Pump Water Injection ❑ Other ❑ If Other. List Use
2. WELL LOC ATIO\` (Show skdch of the local ion below)
Ndo dittown'. RL7HERFORDTON Coonry: RLTIIERFORD
136 CHILI BOWL RD
fRoad,Community. or Subdivision and Lot No DEPTH DRILLING LOG
3 OWNER JAMES T. DICK FROM "IC) Formation Dcen'iplton
ADDRESS POB98
Isk-1 r•, Rom< No) 0 75 CLAY
BOSTIC NC 20818
City or'Ibu 1 State %ip Code
A. DATE DRILLED 10.2,00 USE OF WELL RESIDENTIAL
5. TOTAL DEPTH 140
6. CUTTINGS COLLECIED ITS ❑ NO Q
7DOliSWEI.I.RIiPI.A(11f ISXIS'IIN(i Wlil.la YES ❑ NO 0
it STATIC WATER LEVEL Below Top of Casing'. 62 FT.
(Cn "* If 9boc< Top of Casbrgt
9. TOP OF CASING IS 9 FT. Above Lad Surface*
"Carer% Ta ninmcd aver W., and mid-s i; JI<gat a &i, a vmivao o inn<d
in a.aordmua w ili IiA NC .AC 2C.0118
to. YELD(epm r. Is METHOD OF TEST ARD%I
11 WATER ZONES (deplh): 130
12, CHLORINATION'. T7pc FiY POCHLORIIE
I3. CASEVG.
Dgrth
From 0
To
1-r GROUT:
—
Depth
From 0
To
If. SCREEN
Depth
From NA
To
16. $.AN ,GRAVEL PACE:
Depth
From NA
To
I- REMAV_ S
75 Ito CONSOLIDATED ROCK
4 OZ_ If additianal±pan it ncad<d ura baak of fomr
LOCATION SKETCH
Wall TlacMess (Show direction and distance from at least two Slate
Diamder or Weight/Ft. Material Bettis, or otlid mapieferencepointo
81 Ft. 6 1,1 " SDR 21 PVC �US HWY '_DIN
Material Method
20 Ft_ SAND MIX GRAVITY
Dianete+' Slot Size Material
Fr in. in.
Ft,
Size \lantlal
CHMIBORI.RD.
GU BOA CH. RD.
e-�
O
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5.A NCAC ^_C. WELL
CONSTRUCTION STANDARDS, AM TI ]AT A COPY OF TI RS RECORD I IAS BEEN PROVTDED TO TI IF, 14T1A. OW\TR.
FOR OFFICE USE ONLY �j/f t� 12%04,00
Quad No. - Date
Serial No. — SIGNATURE OF PERSON CONSTRUCTING THE WELL
Snbnrb onpnd /o Di.iriun of warcr Quality. Goundwmcr Sn�ion widw� l0 Dayr
12 99677

To DENR DIVISION OF WATER QUALITY, GROUN[From. ALAN S. GANTT 828-286-8787 12/04/00 2030'.26 Page 7 of l l
Sent by the Award Winning Cheyenne Bitware
North Carolina - Dcpahmrnt of Environment. and Natural Resources - Division of Water Quality - Groondwatcr SlXmM 42,1257
1636 Mail Service Center - Raleilri, N.C. 2-699 .1636 - Plione (919) 7333221
WELL CONSTRUCTION RECORD WELL CONTRACTOR: CAROLINA WELL DRILLERS. INC.
R ELL CONTRACTOR CERTIFICATION # : 2584
STATE WELL CONSTRUCTION PERMIT # :
1. WELL USE(Check Applicable Box): Residential ❑ Dimucipal ❑ Industciel❑ Aptticultmal ❑ Monilolug ❑
Recacely ❑ heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: (Show ekddr of the location below)
Nearest In. CLIFFSIDE Count)': RU HERFORD
1235 HANIES RIDGE RD.
(Road, Community, or Subdivision vlid Lot No
I. OWNER JOSH L.AW'ING
ADDRESS 284JONAS RD. LOT 4
ISnae or Rnnla No)
RUFHERFORDTON NC 29139
City oi'1'oon State Zip Code
4. DATE DRILLED 9,29,00 USE OF WELL RESIDENTIAL
e. TOTAL DEPTH 2(0
6. CUTTNIGS COLLECTED YES ❑ NO El
7 I)O S WELL If I[PLACE EXIS' I'ING WRI.Il1 ,'IS ❑ NO
8.ST.ATIC W'ATERLEbELBelow Tap of Casiniz 46 FT.
(U,, ^•" Ir Aboae Toy of Cosung)
9. TOP OF CASING IS 2 FT. Above Land Surface*
'Ca,utg Tmwtawl actor Ldo.v Im�d sutra<ie vl.gd ndass .. vmimmv i, issued
ar msordmme widr 1IA NCAC' 2C' 0119
in NFIELD(Rpm): 5 METHOD OF TEST ARD%f
I I. WATER ZONES plepllo. Ili
El
DEPTH
FROM to
75 260
DRILLING LOG
Formation Dcsn'iption
COSSOLIDATED ROCK
I,. CHLORINATION: Type HY POCHLORI'I'E Amount 8 OZ. Rad,idwml,yaca i, a,—Iod.no Lark of fora
13 CASING. LOCATION SKETCH
Will Thickness (Show direction and distance from at least two State
Depth Dnmotia or weight FL Material Reads. or other snap reference point,I
From o To 80 Ft. 6 1, 4 " SDR 21 PVC I / OLD �Ri CH. RD
14. GROUT:
Depth Material Method
From 0 To 20 Ft. SAND NIX GRAVITY
1<, SCREEN
Depot Dianne[,,
From NA To Ft. in.
16. S.ANEGRAVEL PACK'.
Depth Sze
From NA To FL
17. RE-N Ad W
Slot Size Material
in.
Slate ral
FORD RD. 11
33IA TO CLIFFSIDE
A G
O
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH 15A NCAC ^_C WELL
CONSTRUCTION STANDARDS, ANT) T1IAT A COPY OP TIPS RECORD I IAS TEEN PROVIDED TO D IF "T.LL OWNER.
FOR OFFICE USE ONLY y�12i0400
Quad No. Date
Serial No SIGNATURE OF PERSON CONSTRUCTING TILE WELL
SoN rut �alv Disi,ion of Watar Qualiry G Idwmar Suoion.mdmt 30 Dn,
s. 7G7.1 REl'. llA9
676
V

To DENR DIVISION OF WATER QUALITY, GROUNIFrom- ALAN S. GANTT 828-286-8787 12/04/00 202942 Page 6 of 11
Sent by the Award Winning Cheyenne Bitware
North Carolina - Department of Environmctn. and Natural Resources - Division of Water Quality - Groundwater Section 421256
1636 Mail Smvice Cmlef- Raleigh, N.C. 27699 - 1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: CAROLINA NVELL DRILLERS, INC.
IN ELL CONTRACTOR CERTIFICATION # : 2584
STATE WELL CONSTRUCTION PERMIT #
1. WELL USE (Check Applicable Bov Residential ❑ Murkipal ❑ Indushial ❑ Apiculluial ❑ Nlenitonrin ❑
Recovery ❑ I Teat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION- ('Show sketch of the location below)
Neared town: ELLENBORO c oinfl) RUI1 ILRFORD
69OLD BOSTIC RD.
(Road. Cotrununity, or Subdivision and Lot No
3. OWNER JOHN DAVID SELF
ADDRESS POB-Ili
BOSTIC NC 28018
City or'1'0— State Zip Code
J. DATE DRILLED 912T00 USE OF WELL RESIDENTIAL
e. TOTAL DEPTH 300
6. CU=GS COLLECTED lES ❑ NO 0
v-DOFS WL1,L ItIPI.ACP: I• AS PING WFLI I )'nS ❑ NO
8. ST:ITIC WRIER LE\ELBelow Top of Coxing: 22 FT.
(L4c "+- If Above Toy of Cabin
9. TOP OF CASING IS 2 FT. .Above Land Sn fim,'
'Caen,¢ T<n,Wmtad al'or b<low Imd Snrfa<t IS dkgal uNae a wam ic< a ,e±n<d
m a.emdvma wW, OA 6CAC 2CnO8
to. YIELD(Qpm)'. 8 METHOD OF TEST ARD%f
11. WATER ZONES 0,1,110 $2 190 MO
DEPTH
FROM TO
0
31
31
300
DRILLING LOG
Formation Dcwtijaml
CLAY
CONSOLIDATED ROCK
13. CHLORINATION : Type HY POCHLORLI'E Amount 9 OZ. Ifaddidoval ryon it nxsdadu,. Lack o rfonn
u. CASING: LOCATION SKETCH
Wall Thickness (Shone direction artd distarae ftont at leant two State
Depth Dnoricter or WCL_Wlt Ft_ Naterial Roads. m' other nnay 1 clerence Imalkl
Prom 0
To 38 FL 61%1" SDR21 PVC
14, GRO T:
Depth
From 0
To '20 Ft.
IJ. SCREEN
Depth Diaictei
From NA
To Ft.
I& S.ANDIGRA\EL PACK'.
Depth
Front NA
To Ft.
Iv. REMARKS:
—
Material Method
SAND MIN ERA\"ITY
Slot Size Maleinil
in. in.
Size Material
OLD BOSTIC RD
0
7 Io Nfl.
PL\EY MTN CH. RD.
O
8
TO ELLENI30R0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRICTION STANDARDS, ANT) HTAT A ('OP}' OF TITS RECORD I61S BEEN PROVIDED TO TI IF NTH, OWNER.
11
FORTF4W�ITIC LT�S'q A � ��� r im
QDalii12'0400
_."" - 1 y
�L +I i Dale
S+IGNATL72E OF PERSON CONSTRUCTING TIIEWCLL
Sl'.1-lit# I „brut oiazaito Di —too ofc mar Q1Liih Grmmdomn Sc0i idwJO Da.

To DENR DNI&ON OF WATER QUALITY, GROUNIFrom. ALAN S GANTT 828-286-8787 12/04/00 2029-00 Page 5 of 11
Sent by the Award Winning Cheyenne Bitware
North Cite olim - Derailment of Enviranmcnt. and Natural Resources - Division of Water Quality - GroundeztoSection 4 C.,. 2 55
1636 Mail Service Center - Ralcidl, N.C. 27699 - 1636 - Plmne [phone]
NVELL CONSTRUCTION RECORD R ELL CONTRACTOR: CAROLING WELL DRILLERS, INC.
IN ELL CONTRACTOR CERTIFICATION # : 2584
STATE WELL CONSTRUCTION PERMIT # :
I. WELL USE (Check Applicable Boi): Residential ❑ Municipal ❑ Industrial ❑ Apicultural ❑ Morino ing ❑
Reeovety ❑ I lent Pump Water Injection ❑ Other ❑ If Other, List Gse.
,.WELL LOCATION (Show aketdtohhe loaatiou belmc)
Neamat Moo ELLENBORO (bunt} RU'I'I tM URD
632 SEABOARD ST.
(Road, Corrununirc- or Suhda mon and Lot No.) DEPTH
).OWNER NELLIE KIMBRELL FROM Tu
ADDRESS SEABOARD ST.
tsean oR.mz N,,.) 0 32
ELLENBORO NC 28010 32 160
6norls.n State hp Code
J. DATE DRILLED 9/22,00 USE OF WELL RESIDENTIAL
e. TOTAL DEPTH 160
o. CUTTINGS COLLECTED YES ❑ NO
7. DOES WELL REPLACE EMS ING WELL' PIS ❑ NO
8. STATIC WATER LEVEL Beloa' Top of Cosine- 3; FT.
(C'se I' If Abo.z Top of C'e.uip)
9. TOP OF CASING IS 2 FT. Above Land Surface`
-Czsuc, Tmwrmzd atlor bd., 1a0,.v6ce i, Jlegal ud<ss a vmmnc m ueuul
in ..cord.— with 15A NCAC 2C DI is
to. YTELD(gprin 8 Y@ ODOFTEST ARDYI
0. WATER ZONES (dgnlQ'. 140
12. CHLORINATION : T)Te HY'POCHLORII'E Amount
u. CASING'.
0
d OZ- If udditionvl spoee u nezA<d r
LOCATION SKETCH
DRILLING LOG
Foirralmn Doniptian
CONSOLIDATED ROCK
Wall Tlticknesa (Show dnectmn and dimance from at leavt two Stme
Depth Danichi or We, 2JlrFt. Material Roadk or other inn, reference
points)
From 0 To 35 Pr 6 IA " SDR 21 PVC
14. GROUT:
Depth Material Method
From 0 To 20 Ft. SAND MIX GRAVITY I1NY ?-D.
1<. SCREEN
Dgrth Dimneter Slot Sim Material SE.NBOARD ST.
PPNRY N Tip.
From NA To F:, in. in.
CHURCH RE
to. S.WD,GRAVEL PACK:
Depth SIZC %liacrtnl
Froth NA To Ft.
17, RrNlA S:
TO ELLEIN,
I DO HEREBY CERTIFY' TIL\I' THIS WELL WAS CONSTRUCFED LN ACCORDANCE 14TFH 15A NCAC 2C. WELL
CONSTRUCTION STANDARDS, .AND TI TAT A COPY OF TIOS RECORD I LAS RCIN PROMED TO TI IF, RT.LL DRIER.
�!
FOR orrlcE USE ONLY ���3,���
I2104100
QD• t
Date
Sell 1 SIGNATURE OI PERSON CONSTRUCTING TIC WELL
Sabum ilt Dowwu f\t mer Q,,Aq Gonndwmer Seztlm wdwi 300ay.
LAN

To. DENR DIVISION OF WATER QUALITY, GROUN[From'. ALAN S. GANTT 828-286-8787 12/04/00 2027:32 Page 3 of 11
Sent by the Award Winning Cheyenne Bitware
North Carolina - Depa tmcnt of Em'irortmcnt. and Natural Resources - Division of Watcr Quality - Ground,sater Scction y 2
1636 Mail Service Center - Raleio i. K.C. 27699. 1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: CAROLINA R'ELL DRILLERS, INC.
WELL CONTRACTOR CERTIFICATION # : 2584
STATE NN ELL CONSTRUCTION PERM( r # :
I. WELL USE (Cheek Applicable Boxl : Residential ❑ MwiJuipal ❑ Industrial ❑ Ap7icultural ❑ Nonitotutp ❑
Recoeeiv ❑ I teat Pump Water Injection ❑ Other ❑ If Other, List Use
WELL LOCATION'. (Slww sketch oftbe location below)
Ncarcst tmvnDNION MILLS Connty: RU'I'HER[ ORD
SS9 NANNYCOAI'N RE)
(Road, Conununin'. or Subdis ision and Lot Net DEPTH
3. OWNER SHARON CONNER FROM TO
ADDRESS 1624 FI 221 N.
UNION MILLS_ NC 28167
Cs, ..'fora Slalc Zip Code
4. DATE DRILLED 911100 USE OF WELL RESIDENTIAL
s. TOTAL DEPTH 240
6, CUTTINGS COLLECTED YES ❑ NO (]
r. DOES Wl!LI, IUTLACIf P:XIS'1'ING A4P:1,1.^ 1'FS ❑ NO
8.ST:ATIC WATER LEVEL Below Top of Cuing: 41 FT.
(L,, "*" If Abo < Toy of Caabipl
9, TOP OF CASING IS 0 FT. Above Land Smface"
"Csmg T<mwm�<d m: m halos -laid surfea< it d'cal t d<es a ....... + ieamd
m a..ordvn< wish I+AN( 'AC' 2C' .01 to
to. ITELD (epin) 7 METHOD OF TEST ARD%T
11, WATER ZONES IdepHil: Ito 225
0
82
82
310
DRILLING LOG
Formation De,cnption
CLAY
CONSOLIDATED ROCK
12, CHLORIN.ATION'. Type HYPOCHLORI'I'E Amount 6 OZuaddbbnd sy­­,akdu4, bask ofrann
U. CASNG LOCATION SKETCH
Wall Thickness (Shoo, direction and distance Ilnm at least to o State
DqA, Dianider oiWetohtFf Alate,,at Roads, or other nq), d Irene points)
From 0 To 81 Ft. 61 1" SDR31 PVC liS IAVY 221 A
14 GROUT
Depth
From 0
To
11. SCREEN
Depth
Pam NA
To
t6. S.AND GR.AbEL PACK:
Depth
From NA
To
17 RERLARICS'.
Material Method
20 Ft. SAND MIX GRAVITY
Diatnder Slot Size Metaiat
FIin It
Size Material
FL
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C. WELL
CONSTR UCTION SI:ANT)ARDS. ANT) TI TAT.A COP) OFTIHSRFCORDIfASBT:F:NPROIIDE)TOTIIF:A4TI.I.OW^,,T.R.
FOR OF r,JAN
Quad NSerialN
1'*rnnAwafc-.ar'iH
NANNEYTOW N RD
TO RL'TFIERF'ORDTON
12,0400
Date
TURL OP PERSON CONSTRUCTING TILE WELL
.il �o Oivieion of R'amr Quatip Gonndwma Ssar nlw]o Da.a
oM I REc. 1299

Toa. DENR DIVISION OF WATER QUALITY, GROUN(From. ALAN S. GANTT 828-286-8787 12/04/00 20. 2650 Page 2 of 11
Sent by the Award Winning Cheyenne Bitware
Depth
From 0 To
�
NotUt Carolina - Dcp:utmrnt of Em,irorunrnt. mud NaRuai Rcsou¢cs -Division of W'at nQuality - Goundwattt Seam, '1252
1636 Mail Service Center - Raleigh, N.C. 27699 - 1636 - Phone [phone]
WELL CONS'CRUCTION RECORD WELL CONTRACTOR: C.4ROLINA NVELL DRILLERS. INC.
WELL CONTRACTOR CERTIFICATION # : 2584
STATE \YELL CONSTRCCTION PERIIIT # :
1. WELL USE (Check Applicable Box): Residential ❑ Municipal ❑ Industrial❑ Apicullural ❑ Mcluloline ❑
Rccocery ❑ I Ieat Pump Wale, Iniectton ❑ Other ❑ df Other, List Use.
±.WELL LO('ATIL IN (Sho,v s1,dch of the locat'mn be low)
Nea,e,ttn,rn RUT'HERFORDTON Cont-): RU'I'I IERR) RD
10� HENDERSON RD
(Road. Camunmirc. or Subdk ision and Lot No.l
3, OWNER FERREL COSDREV
ADDRESS TO HENDERSON RD.
I So cn o� Rome Nu_J
RLTHERFORDTON NC 78139
co'., loon SIM, Zq, Code
i. DATE DRILLED 9l11,00 USE OF WELL RESIDFNTIAL
,. TOTAL DEPTH 160
6. CUT-ITNGS COLLECTED YES ❑ NO Q
7_DOIiS%VIiLI, RI YLAtT I,XIS' I'IN O TV] :LI.) Yrs Ej NO ❑
E.SD\TIC WATER LEVEL Bela,' Top of Casing: 70 IT
(Ose `t' If Abov-e Top of Cas6,y)
9. TOP OF CASING IS _ FT. Abm e Land Suffice`
`Ca,ute T—.,.m d A- L1I.1 laud =udus is &',a nniese o vwivtae is i:e,ud
iau —dwma wish 15A FC'AC' 2C -0118
to. YIELD (ginli: 1 1'2 METHOD OF TEST ARD%f
11, WATER ZONES (de7)[10: 145
DEPTH
FROM TO
360
11CHLORNA:11UN. Imn Hl'POCHLORI I'E Anlonnt 9 OL. Ifodda.,,alspacaiso—Ld
u. CASNG LOCATION SF:......
Shots direction and dislonce Bon at leant nvo Slate
Roadk or other map reference pointx I
_DRILLING LOG
Fomodion Desa'iptlon
CLAY
CONSOLIDATED ROCK
_ o
O o
177 cp
r
CR
(Jj O,n
BCD
_ yo
�o
Wall Thickness
Douneter orWetide Ft Material
90 Ft. 6 1/1 " SDR 21 PVC
14. GROUT:
Depth Material
From 0 To 20 Ft. SAND MIX
m SCREEN
Depth Diameter
A'oin NA To Ft. in.
I6. S:1NDGRAVEL PACIi:
Depth Size
From NA To FL
17. RE\LARKS.
Method
GRAVITY
Slot Size Material
in
Material
HENDERSON DR.
F
TO SPLNMALE
%Y RD
POORS FORD RD.
I DO FQREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORD.ANCE NFIH 15A NCAC _C. ll'ELL
CONSTRUCTION STANDARDS, AND TI TAT A COP}' OP'DRS RECORD I I.AS BFTiN PROVIDED TO TI Ili WEI.I. OR^TR.
FOR 0, � 1204,00
Quad N Date
Serial N SIGNATURE OF PERSON CONSTRLCTNG ITIE WTLL
s.lowt oijaujal to lA.i.ioo of0.ater Quoo Groonvhvaur Saetiou akin, 30 Dm,
G\f_I REV. 1 999

To. DENR DIVISION OF WATER QUALITY, GROUN[From ALAN S. GANTT 828-286-8787 10/22/00 20'07'. 32 Page 11 of 11
Sent by the Award Winning Cheyenne Bitware
• n r n
North c'mnfina - Drylanmmal of Enrirorlmrnt w¢I Nahtral Rr-.ourrc - Diviaion of lV"Ater Qualiy - GroundwolaSeel [oil
1636 Nail Service Center - Raleivlt. N.C. 1 699 - 1636 - Phone tole) -3332_ I
WELL CONSTRUCTION RECORD WELL CONTRACTOR: CaROLI-NA \I -ELL DRII.L>' RS, INC.
IN -ELL CONTRACTOR CERTIFICATION 0: 2584
STATE IN ELL CONSTRUCTION PERNIII- III:
I. WELL. :SE (Check Applicable Boil: Residential ❑ Dlulucipal ❑ Induscial ❑ Al icullur:d ❑ Molulelutg ❑
RecoceLv ❑ I lent Pump Water Injection ❑ Collor ❑ If Othei, List [.so
�. WELL LOCATION- (Sbow eke(rL of the Ixntion belou'1
Ncarcel tov,o h11LL SRRIA'GS ('aum-. RUI'IILRPORD
PE.A RIDGE RD
(Road. Co,a a aaIN. or Subdieiaion and Lot No
3-01VNER LEROSSTALEI"
ADDRESS RT T BON 309B
DEPTH
FROM TO
DRILLING LOG
I .,malion Dc,a Ila ion
(vl,a,.t R.tnc N,) 0
8i CLAY
RLTHEIZFORDI'OS NC 28119 Si
100 COSSOLID.A"FED
ROCK
c'iK or Tox'n Sla(c ZIP Code
A. DATE DRILLED y'S'pO USE OF WELL RESIDENTIAL
5. TOTAL DEPTH :too
6 CLTTINGS COLLECTED YES ❑ NO Q
Q
- DOI[SWI:I J. RFPI.ACP AIS'IIN(i hill.(:' US ❑ N(1 ❑•
CD
8.S"I"ATIC WATER LEVEL Belov, Top of C,,ine'. 8j FT.
�l -
(L->e-."IfALmv Top of co±utgl
;tiJ __
9. TOP OF CASING IS FT. Above Land Su,iare"
Tammamdar'I"... lmal±ut ha. is Weal mJ._-e a.mtwuc r, t,.ucdUA
. —dmm< xitL I+A NCAC' 2C 0118
to. YIELD (emir. 3 -NP"FHOD OF TEST ARDlt
it W.ATERZONESIdcp(10. _j3
G1 p
I_.CHLORLNAHUN' T,e H)"POCHLORFFL Alnotm( 9 OZ.
1(vddniond yaa i=a«d<d a±<Laal: o((o,m
13 CASING.
LOCATION SKETCH
Wall lhickneee
(Shoe' direction and dietmae (loin at left two State
Depth Diameter orWe,&Ft btatenal
Roads- orother n,ap,4@rencepo1n(e)
rrnm o r9
1i caolrc
Depth
Fmm 0 To
I'. SCREEN
Depth
From NA "Fa
I6. S.ANTSGR.AVEL PACK:
Depth
F, ... N\ Tu
1'. RL\URI:S.
8- Fr (11 1 ^ SDR 11 PVC US Htl l 74
Material Method
?o Ft_ SAND IC N GRAVITY PEA RIDGE RL)
Dimue(a Slot Siae Nlalerial
It in. in.
Size :Material
Ft.
Ili
To FOREST CITY
I DO FPREM CEWITFp THAT THIS 4%T.L WAS CONSTRUCTED N ACCORDANCE WFHI 15A NCAC 2C, IVELL
COWI2CCTON STANDARDS- AND TI FAT A COP) OF THIS RECORD NAS BFTS PRWDED TO 11 IF: IVRI.I. OWNTR.
FOR OFFICE USE ONLY �- si`'�'`� 10: 22 00
Quad NO. b Date
Selial NO. SIGN :\TL(RE OF PERSON CON$TRUCT1Nn TIP WELL
Snbudt otiAuil to Di<i_+iomt of \\'mer Qnalita. Goundaamr Smtion witlwt M Doc.

To DENR DIVISION OF WATER QUALITY, GROUNIFrom- ALAN S. GANTT 828-286-8787 10/22/00 20 06:08 Page g of 11
Sent by the Award Winning Cheyenne Bitware
North Cuolina - Depmtmmot of Em aotmtent. Health and Natural Re,ot"
Diri,ion of Encironmen[al \7anagenteut Gmundwoter SWIM
F.O. 13o,9555 - Raleigh. SC. '-'6'_6 0535
Phone r9I91 -1T-{'_'_I
FOR OFFICE USE O\Lr
QUAD, NO. SERLIL NO. _--
Lat. Lone. RO
Minor l4nsin
Bain Code _
H,,a,16 Era, Be. —
WELL CONS RCCTION RECORD
DRILLING CONTRACTOR: CAROLINA NV'ELL DRILLERS. INC.
STATE YELL CONSTRUCTION
DRILLER REGISTRATION NUMBER: IRON PERMIT NUMBER:
I. R'ELL LOCATION. IShon'skHdt oF[he loeatiou beloul
Ncmzet townELLENBORO Count}-. ROTHERI'ORD
TACIN CREEKS SC H[M ISION L01-
IRoad.Cotmnunin--or Subdiciaion and Lot NoJ DFPTH DRII.I.IN'(i LOG
OWNF1< FLEETVl"OOD HOMES F"ROV 'I'O Ponnalion De+aiptinn
.-ADDRESS 19'0 ILACS -4 M PASS
nn<m or Rsol 0
-_ CLAP
FOREST CM NC 28011 55
lip NSOLIDA FED ROCK
City or lo,,,i Stale zip Cnne
J. D.\TE DRILLED 8: 3000 USE OF WELL RESILIEN' II.AI.
1-'1'0 F.AL DEPITI 125
E. CUTIT]GS COLLECTED 1TS NO Q
\�
p
C,001SW I:I, k I FIACL ITS I S I I NO 1V I f I L' 11!S ❑ NO El
© -
'.S"IAII( WATER LEVEL. Below Top of Casing'. 42 FT.
IL"!c'"If dbace Toy of C'a.ina
ko.-
o�
6. TOP OF i'ASLN"G IS _ FT. Abo, e Lmtd Surfaoe*-
C _ Camiinn I r bim. lad_ i oM'gd and', n.a„mn<d
1$
m a.am Aoirse v�itb L`d FCAC 't'.0113
� r"�'�
9. )LELD(21xu) _- NtE MOD OF TEST ARDAI
N
10. WATER ZONES tdepll¢ 63
-
ILC'HLORISAITON. Tlpc HT'POCHLORI'1'E Arnonnt j Oz
If adAitianvl syac<ie n<M:d �r,<bvaE of [om�
Ll. CASLNG.
LOCATION SKETCH
Wall 716clule,e
tShos' I ireatiou m¢I diemnre from a1 Ica=l nro Slate
Depth Diameter orW,t0,1FL Material
Road,, or othennap refereo¢ poinln
From 0
To
13UROLI
Depth
From 0
To
IJ SCREEN
DepiL
From NA
Ta
I'. SAND DRA\TiL P:1CK'.
Dopth
Front NA
To
m REVIAPvAS.
60 Ft- 61'1" SDR21 PVC OLD
\fOORE'sBORO
6lat eri al Method
20 PI. SAND MIA GRAVITY
Dimmeter Slot Size Alaterinl
Ft in. in.
Ft.
SLc Alat'nal
I IR'Y 7 t
E
T\iV CREEK SGB
IM1 I_Ii
I DO M REBti CERTIFti nU,1 DES W"ELI. WAS CONSTRUCTEDIN ACCORDANCE WITH 15A NCAC'_i', WELL
COSS'fP.I T'"f10N SI'.LCDARDS. lND 11 LAT A COPS 017 TI0S RECORD 1 LAS BEEN PRO\TDED TO TIFF. WTLL OWNTR.
668 cif 10 2200r
Gll'-I REC. 9 9l SIGNATURE OF CONTRACTOR OR AGENT Oak
.Snbnut ai waol ro Di ision of Encvoivnan. H<dth vd Nannvl R<soatca=

To DENR DIVISION OF WATER QUALITY, GROUN[From. ALAN S. GANTT 828-286-8787 10/22/00 20 05 26 Page 8 of 11
Sent by the Award Winning Cheyenne Bitware
;_:i9`,36
FOR Orrp,E USE O\lY
QUAD. NO. SF.RLILNO. _.
Lal. Lon¢. RO
Nonni Caroliti, Depailmentot En<It"otVnCnt.Ifealtllaiti Natural Reeource,
Minn,
Dix i,on of Enairomnentnl Jilwtaeeinern Groundwater Section
Basin Code _ — - -
PO. Bax 203�-Rakich. SC^_'6^_6-053
llrader Ful. G\V.I Ent.
Phone[phone]'1
NVELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: CAROLINk NI'ELL DRILI,ERS.
INC.
STATE 1A"ELL CONSTRUCTION
DRILLER RF.GISTRA PION NUMBER: 180-5
PERMIT NI \IBER:
I.NELL LLICATI(-)N (Shmcsi,.etd1 ofthelocationbelou9
Ncnrc,l lnrm'. ELLENBORO c'nunn-.
RL I'IILRFORD
TVV'IN I'M LRS SCDDIA ISM"' LOT H
(Roar, Community-- et Subdiciaion Tid Lot\bl
DFP,IH DRII.I_JNG LOG
�.(IVNFR FLEETW'OOD HOLIES
FROM 'I'u Fmnmtion 1),criptlnn
ADDRESS 19_OIRCPTJ BYPASS
Ise<n or an1<S:n.1
0 6' CLAY
FOREST CITY NC 38011
61- 1-5 CONSOLIDATED ROCS:
C." of Ix—i Stale /it, ("Ac
3. DATE DRILLED 8._900 USE OF WELL RLSIDLN'I'IAL
I. TO`LkLDEP'Tl 135
±. CLTI'RGS COLLECTED 1 ES ❑ NO Cl
[. UOIC:AVRLI.RI.I'I A('I'. I':SIti rW (i AVP:I,I,', 1t IS ❑ `.O
❑ f� -
-. SL\T3C' WSITER LEVEL Below Top of ,`mine _; FT.
U J
--
-
IC-az"%'If Aboaz Toy o[Co,'urel
n
x_TOFOFC'ASLNGIS _ Fr - Above Lmld Solfaoe'-
'C'n,ing'Canninor.dm: or bd— land nu t", Jlagd unla., auvimtau is L-Load
GA -
-
m... orduna<aiib IA Ni AC'C i-M
— —
9. 1TELD(e1nn[ METHOD OF TEST ARFAI
�-
la.WATER ZONFS(deptl0'. -_(--
41 LI
H. CHLORLNATION-"I\'pc III 1'POCHLORII'E Amount <OZ.
Ifnddidn�td,vna L-n«d<d u.<booF:o[foun =
I'. CASLN6
LOCATIO\ S6EICH
Beall Tltl'In vs
IShotc direction ar1d di±tmlce trove at lea-t Mo State��,,,,.�..�•^_
Depth Dizlneler or I%eiely Ft. AIat"u'l
Ronds_arotherump"telence 1pyy�r-.•--- IT r
Frnnt 0 To (- Ft.
Depth
Pram 0 To 'r0 Ft.
It SCREE
Depth
Prom NA 'ro
L•. SAAND GRAV'Eh P:1CIi'.
Dcpllt
Iiom NA '1'o R.
16. REVl.-ARRS.
61 1" SDRTI MC
Mntn'ial Method
SAND 6IIN GRAV ITV"
Divneta SlotS"c Slatzriol
Pt n, in.
S"c Vlotc, oI
OI.D AV
\10ORESSORO RE _ `y 1 74
}
T%\T�l CR ' CB
Fit`"`
(Ili' 1 1'l l
I DO FELREB}" CER'I U'11LAT TIES WELL IVAS CONSTRUCTED L\ .ACCORDANCE WITH I5A NC'AC _C'-IVELL
CO\"STRCCrION Sl'A\D.ARDS. A\TJ TIL\T A COPti Or TTUS RECORD ILAS I PROVTDED TO 17Q WTLL OWNER
667 ������ 10'1600
SIGNATLRE OF CONTRACTOR OR AGENT )a1c
Subux, m<wtcl to ID,'i=ion of Fnewmnm(, H<ilth IIA Normal 111n11,

To. DEER DIVISION OF WATER QUALITY, GROUN[FromALAN S. GANTT 828-286-8787 10/22/00 2004.42 Page 7 of 11
Sent by the Award Winning Cheyenne Bitware
North CoUiaa-DepmUncnt of En�irmmicnt-and Natural Resource,- Division ofWatcr Quality -Groundwater Scclioll i-. 1 9J J :�
1636 Mail Sol,,c Caner - R,,Iei Jl. N.C. ^_-,699 - 1636 - Phone (919) 't33-3:2I
IN FILL CONSTRUCTION RECORD WELL CONTRACTOR: CAROLINA IVELL DRILLERS. INC.
R-ELI, CONTRACTOR CERTIFICATIOS # : 2584
STATE WELL CONSTRUCTION PERMIT # :
I. RILL USE (Check Applicable Bost Residential ❑ Llulucipal ❑ Industrial ❑ ALnicullmTd ❑ Alonilulutg ❑
Recover, ❑ Ileat Pump Rater Injection ❑ Other ❑ If Other, List Use
t\YELL LOCATIO\ 1Show \kodlofthe location belo\c)
Nu, C,l tnlcu_ LAKE LURE ('nnn)" RL I'ItEREORD
SILCN'I FORCSTLANE
t Road. Cotnlmwip'. or Subdivision nnd Lot No. )
1 OWNER IA\ETNI'ALKER
ADDRESS I tb BILLS CREEK RE)
(Sb tut m R-1, `li- )
LAKE LURE INC
c,tl .. foan State yip ( Mc,
J. DATEDRQ.LED 91800 USE 01:WELL RESIDENTIAL
_. TOTAL DEPTH 366
a CL'ITLNGSCOLLECIED YES ❑ NO ❑
7UOf:S WLLI.RI:PLACE: N AIS'IIW\VFI.Ns )IN ❑ w ❑
s. STATIC WATER LF% RE B&, 1.1, of Canine- 70 FT.
(6,<'*" If Ah— joy o!C'asW
9. TOP OF CASING IS _ F'1, Above Laud Swface"
C'N %U1,kii Ila „, L,l,, Nut f1,1+iaced,il__ ivu.„u.uad
un v.m dsnce ,vidi I+A NCAC'AC 0118
to. )]ELD(epm) J \E'THODOFTEST ARD\I
I I. WATER ZONES nlgnln: ^_63
I_'. CM.ORLNNUUN. T)pc M POCH
u CASING
Depth
rl'otn o
To
I I GRUUT'.
—
Depth
From 0
To
IS SCREEN
DgaL
From NA
To
Ifi. S:\NND'GRACEL PACE'
Depth
Frow N:A
To
I-. Rll\L\RKS.
_ORLI'E Aniourn 11 Oz.
Wall TLichleae
Dimneter o,%%,l�&Ft AIalerial
6- FI C, G1" SDR21 P%C
^0 Ft.
Dinu,eter
Ft
Ft,
Material Method
SAND MIS GRAVITY
Slot Size Nlatnivl
in. in
Size Material
DEPTH DRILLING LOG
FROM 'fU Fmmetion Dc'mplmn
0 60 CLAY
60 160 CONSOLIDl,TED ROCK
CJ
N
1
C
N
--�
0
I! vdditienm space is nad<d sae back of form
LOCATION SRFT_CH
Bhom direction m¢I dietmtce fl'om m teal bso Stale
Rond,. or othcnnap re@rence poml.l
BILLS CREF,K RD.
I DO IIF:REHS' CERTIFY TROT TT US WELL WAS CONSTRUCTED L\ ACCORD.iNCF. I\TIH I SA NCAC'C. WE L.I.
('O\STR Ii`fl ON STANDARDS AND TI LYE A COPY OF Ti Its RECORD I INS IIFFN PR 06'IDFD TO TI Ir 1LELI, OW"NT. R.
10 22 00
TOR OFFICE USE ONLY — z--`
Quad No. Date
Serial NO. SIGNAAT2D OF PERSON CONSTRUCTTN(,117E WELL
6uUinit miwW to Di,isimi a!R'atn Quilin'. aunndavncr Saaumi cvidwi ID Day

To. DENR DIVISION OF WATER QUALITY, GROUNIFromALAN S. GANTT 828-286-8787 10/22/00 20 02.34 Page 4 of 11
Sent by the Award Winning Cheyenne Bttware
Nn I Carolina - Depatiment of Gtiranmmrit. I Ieallh and Natural Resources
DI\15101, o f En cirolu.. t.1 \tmmsemenl- Gtoundw'ala' Section
P.O. Boy 2o539 - Raleiilr N C.—6^_6-0435
Phone 0191-13-i'_'_1
FOR OFFICE USE ON'L1
QUAD. NO SERLNL NO.
Let. LoneAO
Mai, ISmin
Baain Code
li.,&, Ent.
953''
R-ELL CONSTRUCTION RECORD
DRILLING CONFRACTOR: CAROLINA NN-EI,I, DRILLERS, INC.
STATE TTELL CONSTRUCTION
DRILLERS PEGISTRATION NI-NI13ER: 180.5 PERMIT NI NIBER:
1. R'I: LI, LOC_ATIUA: f Slm1c -Veld, of ll,e Ixatiou Lelolc]
Ncarc+l lnnY. RETRERFORD"EON ('n,tA RLf
I1WR1'ORD
Iran I1111' IN
(RomLCo,nn..firN.or Suhdicinion w¢I Lat No_ I
DEPTH DRILLING LOC,
1. (M FB HORTON HOMES
FROM '1'0 Fmmalmn Uc=criplinn
ADDRESS
Isn::t".
CLAP
RL-IIIERFORDTON NC'
I IS 310 CONSOLIDATED ROCK
C.,. Ionn Slate ].ip Codu
3. D:\TE DRILLED 8 1600 USE OF WELL RE SI D LN'I IAL
C7 "
L IOTAI. DEPTI1 1T0
C-J -
SCL'FITNGSCOLLECTED YES ❑ NO ❑
6_D01 SVb'I:II kII'lA,I IS XIS I IN(11Y 111.1:' 11S ❑ LO ❑
_
-. STATIC' W:LTF:R LE�'EI. Relolc Top of Qt+ino. =0 FT.
f1 _
\OC
6_ i'OP OF C1SL\u IS _ FT. dbm'e L.mJ Surl'nce'
a Qpl
Te.in" T.mwo¢d ocor bolmv IyrA ludna. it illcal ud..± a caiun.a is isuaJ
�� N --S ;�v
e Gee
nr o.wdmrae mitt L.l SC AC tC WIN
.
y, YIELD Iepn,l: i N[E[HOD OF TEST ARDM
to WATER ZONES ¢Ieplhl: 15l
11. tHLORINATION. TSRe HSPOCIILORttE .mount 10 OZ.
If oddhiorml..... k n...kd.— book offova
u. CASLNO
LOCATION SKETCH
W'all'ILieDless
(SIIovc direction .v¢I dinlvlce from at least tvco Slate
Depth Dhmicler orwt,"JitU Material Roads_ 0, olhenuap refe oepoinle,
Fort 0 To 120 F't. 61'1" SDR 71 P1NC
_ r n Ywrr
❑. GRIICI':
Depth Material Me,hod-
F,'om 0 'fo 10 Ft, SAND VIN GRAVITY
I I. SCRELT
Depth Diameter Slot Siza Material
Ron, NA 'fo Ft.
I±. SAND GRA\EL PACEUcpth
D.—z
SimIluw
NA To Il,
Aonr
16. RP\LVthS
1,111t'f!It'1Y 11Ftl=./.'1111).LN
FtirIFiFX!-'(JNl>"Cl.n1 C��llti )'v Nf.
1 P012-REBY CERTIFS TIHAI TITS WELL NVAS CONSTRUCTED L\ ACCORD.i\CE WITH I5A NCAC 2C, WELL
i'OSSTRI CIION S'CAN-D.aRDS_.4\D TI LM A W PS OP TIES RECORD I L\S BEEN PROWDED 10 TI ID WELL OW NTR.
663 y�%s 10 22 00
c,N\ IRSIGNATURE OF CONTRACTOR OR AGENC Unlc
Subtlul oti¢int mDivision ofF-uomrmm.HaahhatdNsnnulRmoi.—

To DENR DIVISION OF WATER QUALITY, GROUN[From. ALAN S GANTT 828-286-8787 10/22/00 2001 54 Page 3 of 11
Sent by the Award Winning Cheyenne Ditware
FOR OFFICI I:SE OSLS
QUID. NO. SFRLV. NO
EA. Lon,RO
NoOhCarolina- DepaeinentorEnvironment, health.0 Nntural Rcaourret Mlnor❑rill _ ___
Diu isirnl of Encirotunental Nlumeemenl - Ground,vater Section Buein Code
PO.B.,'9535- Ralei:J, N.C.'_l6'_6.0535 Heade,Eu(. G!N'-IEul
Phase 1919) 'S4-i'_]I
AN'ELL CONS I RVC"I ION RECORD
DRILLING CONI RACTOR: C:a120LIN A WELL DRILLERS, INC. 3STATEA� ELL COPS7RLC7lON
DRILLERS REGISTRATION NI`NIBER: 1805 PERNTITNI NIRER:
I.ANTLL LOCATUJ\ t Sltmc ,ketch ofthe localiuu belo„'1
Near�'t tote¢ Rl-'CHERFORDTON ['annte RL'I'I I ERI'OKI)
J;Fo 11A',y ION
Road. Covun... m'. ar Subdivision .A Lot No. I
OWNFK 6kAVNE RICHARDS
ADDRESS 11001MR Ing
fSucn ,. Rau¢ No t
RLTHERFORI)TON NC
C."o'lmm State 7.ip Code
I. DATE DRILLED 8'1000 USE OF WELL RESIU Li NI ILA I,
I. TOTAL.DEPTII I-0
s. CLTITV6SCOLLFC'IED }ES ❑ NO ❑
GU(IP:SIN'I'.I.LRILPI.ACI[ I' XISHNGWII I.I:' 11is El M) ❑
STdTIC WATEK LEVEL. Belo,v Top of Cnaine I FT.
C.e" I(Abece Top of Casugl
8. TOP OF CASING IS _ FT. Above Ladd S... f,, *
"Caa rg T... l—.ed et'or balo,c I.A -- lfn.a L Ill -al III,—, I I.Ile a
in .--U— e'ah IJd N( AC 3C .0111
,. }TFLD I,ptnc p 1RINODOF "TEST ARDAI
IoDATER ZONES tdep011- 130 145
DF PTI I
FROM TO
0 i0
�0 1-0
DRILLING LOX i
FDnnation Uc¢rlpllon
CLA)
COMOLIDATED ROCK
co
G�
N
ca
ON
II -CI U RLNA'IION'. T)pe H}'POCHI.ORCFE Amount S OZ 1(uddiviand ±poca l=nzzdzA a=e book of (omr
11 CASINGLW ATION SI:L IV EI
MIT 711"1 me, tsho" direction and distmtce @onl It lea, nvo Sute
Depth DISllder or N6'et&t R- NLalerIII Raadk. or ether map reference poinRI
From 0 To il Fr 6I'I SDR'-1 PVC
O. GKOUI'-
Ueplh
Fvau1 0
To '0 Pt.
I . SCRFEn
Depth IJiNueln
Flom NA
To Ft.
I . SANT) OR:AC Fl. PA(7
Depth
F'Ion1 NA
'Ib Pt.
M RFNNRRS.
Nlaterinl Method
SAND AI]S GR_APIT}
slotS"' Material
in in
she NIT[ nial
PT.F,-AS!\NT FITLI, RD
RUIHERFORDTOA
I DO HLKEB}' ('I RTTF1 TINT TFOS WELL WAS CONS'FRUCTF.D IN ACCORD.9NCE WTFFIT 15A SCAC _C. NN'ELL
CONSTR1 C11()N S'FAND1RDS-.AND DIRT A COP)' OF 11➢S R[CnRD INS BETE PROMED TO TI IF WELL ONNLR
662 i�� 1022 00
c-u- I R 9t SIONATLTE nF CONTRACT'OR OR AGENT'
tV'. 9 Unto
Submit olignil to Lniian o(Fn,wonmmt. Hedtb wed \artirol Raowae•

To DENR DIVISION OF WATER QUALITY, GROUN[FromALAN S. GANTT 828-286-8787 10122/00 2001-.12 Page 2 of 11
Sent by the Award Winning Cheyenne Bitware
FOR OFFI('r USE ON-L
QUAD. ]O. _ SERIAL NO _.
Lal. Tune. RO
Notlh Carolina-Depmhnentul'Gn'ironn¢nL llenhh and Aanirnl lteaoumca liinor ltmw
DivInlon of Eo, llotiiriental Vlmmaetnent - Gi ound, atci Section Bain C ode
P.QI3o,"_9i39-Raleiu1i\.C.'_-6^_6-0535 Hrnder Eot Em.
Phnne(9191
AN ELL CONSTRCCITON RECORD
DRILLING CON I RACTOR: CAROLINA NVELL DRILLERS, INC.
Sl kTE N1 ELL COSS'IRUCHON
DRILLERS REGISTRATION" V1-NIBER: 1805 PERMIT Nt MBER:
I.AVCLLIf( C.-ATL )A I Slmn'sket dt of the location bdo,,
"can'tmrvtr I_N[OS MILLS Coimn" RL'1I I RFOR1)
-110 CONIa' ISLaSD RD
IRotd_ Coummnitc. or Subdicinmi mid Lol M
UvV'N[k FRANK McKINAE1'
ADDRESS J 10 CONEY ISLAND RD
(Suzo arRance V,t
L A'IOV MILLS
NC
Gtpm'Io,v:
State 7.IpCode
3 DAI'E. DRILLED 8 -;00
USE OF4bELL RLSIDENIIAL
I. T'O"D1L DEPTH :00
,_ CU'CIT\GS (OLLE(- FD )ES
❑ NO ❑
6. Mir SU'I:L. R L FI.A0 9XIS I NO
MHAW )IS ❑ AU
-. SI= [-o RATER LF%IiL Belot Top
of Cni,no, _IC FT.
Iliaz'I' If:At,,, fop of ( ., :,I
E. TOP OF CASING IS _
FC. Abuse Lmid SW'1U[ek
(`:gTn=dua lrrbdoa laid-r-i,
Wzzalmii_ ..i:sled
m a.eo:dmaz aiiL L.1 ]C.\C A'.01 t8
9. ITELD Irsnt' R METHOD OF TEST ARDM
to R;31'ERZOATSl deptli) 6f
1-1 280
El
DEPTH
FROM
0
60 300
nRn,LIyc Lorl
Pnmiatinn Iletcrlption
CLAP
CONSOLIDATED ROCK
�J
r,
H.(HLOI(LN.VITOS.
Ups
H)'POCHLORII'E .bnount
8 OZ
unddbianw,po.r i. n=.d:d n,. boob off
rz CAS60.
LOCATION SKETCH
Will Thodmeae
(Sim" direction m¢I diHance from nt leaa too Stme
Depth
Dimndn oi'16'eiely F[.
Matennl
Rondv_ or other ump rfaeuce pninbt
Prune 11
lb
60 Ft. 61.1" SLR -'I
PV'C
u GRULI
Delnh
Atmerif
Method
Ftom 0
To
?0 FL SAND AITS
GRAVITY
u_scRE
CONED ISL:AA� ED
Dapth
Dlanet. Slot Size
Nate A
1'roul S:A
To
R. in.
in.
I s Ins ti,^Ix
15. SA\D ORA%I.I. PACE.
Ucpih
Sire
�Alntcrial
NA
'Ic
Ft.
RL'THERFORDTON
16. REMAMS.
1 DO HEREI3} C YR"I'IF'1' ITLAT I I IIS WELL WS S CONSTRUCTED L\ ACCORDANCL RTITI 1 SA \CAC'_C WELL
COSS'IRt'C'Fl(IS STrV A,\RDS. AND 'II TAT A COPY OP TI ITS IID'ORD I IAS BEES PROVIDED TO TI II1 %YELL O\S1TR
601 %f�� � 10: 22 00
uv.l RP:. 7911 SIOSATURE OF CONTRACTOR OR AGF.N7 Ua1c
Sobndr --,il m Dig i,wn of Fin ummwm, Ha,lk mA ]aurd Rcont<zs

I to GLNN UN S ON OF WATER C'.,A_'TY, GROJN[From ALAN S. GANTT 826-286-8787 09I25100 20 56 i8 Page 11 of 1 1
Sent by the Award Winning Cheyenne Bitware
"18008
North Carolina - Depimment of Em9rownent. health and Natural Resources
Division of Envit-ontremal Mmaeernont - GroundwaterSection
P O_ Bat 29535 - R ].WF. N.C_ 2626-0535
P110nc(919)733-3221
FOR OFFICE USE ONLY
QUAD, NO. SERIAL NO.
Lot. Lone. RO
,M rFo' ISasio _
Basin Code
Heaol rEnt. GW-1 Ent. _ ---
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: CAROLINA WELL DRILLERS. INC.
STATE 31 ELL CONSTRUCTION
DRILLERS REGISTRATION NUMBER: 1805 PERMIT NINIBER:
F WELL LOCATION. (Show,ketch of the location below)
Ncarot town ELLENBORO C'mint)' RLI'1'1IERFORD
354 DOBBINS RD
(Road Conununity. or Snbdici�ionmid Lot No.I DEPTH DRILLING (-G
1, OWNER ROBERT DOBBINS FROM '1'0 Forman.. Deed iption
ADDRESS
POD 839
ELLENBORO NC
OF, or loon State
3. DATE DRILLED 8; D'00 USE OF WELL
d. TOTAL DEPTH I A5
5. CUTTLNGS COLLECTED YES
6_ UOP:S VVI',1.1, 12GPLACG I!XIS"I'NG W e:LL,'
0 53
28010 58 115
hp Code
RESIDGNLIAL
o NO
7. STATIC WATER LEVEL BeIary Top of Cosine: 42 FT_
IF,' If db,,< Toy of Caeurgl
8. TOP OF CASING IS 2 FT. Above Lmd Surface"
'Ca,u, Tarnurand aVor below Ivrd eurfuo o dlagal unlace a vmiance i, ts,uol
m auorda¢< will 15A NCAC' 1L' .0118
NO I]
YES
9. YIELD (epm)'. 30 1IETHOD OF TEST
10, WATER ZONES(deptl0- 142
ARFAT
0
CLAY
CONSOLIDAI ED ROCK
FTI
—n
N
I r—
W
O
11 CHLORINATION', Typc
HYPOCHLORI'1'E Amount 4 0Z.
IfadOfionW>va«L-oe<d<d n,�back of loan
12. CASING.
LOCATION SKETCH
Wall Tlrickne'es
(Show direction and distmce flour at leaal nvo State
Depth
Dmleler or Weight Ft_ Material
Road, or other map Feferenm points)
From 0 To
60 Ft 6 1, 1 SDR 21 P\'C
8`-1
13. GROUT:
—
Deptlr
Material Method
DOBBLM R-D
From 0 To
20 Ft. SAND MIX GRAVITY
14, SCREEN
Depth
Dimietet Slot She Material
From NA To
Ft.
15.S.v15,GRA EL PACK
ELLEN"'CAROLEENId
Depth
She 1lattrinl
From NA To
Ft.
16. RElIARICS:
TO ELLENBC RO
I DO HEREBY CERTFFY TROT THIS WELL WAS CONSTRUCTED IN ACCORDANCE M11H 15A NCAC 2C, WELL
CONSTRI TC'nON STANDARDS, ,4\-D THAT A COPY OF TI➢S RECORD I1AS BEEN PROMED TO TI IP WELL OWNER
660
GW"1 REV. 9'91
09,25r00
SIGNATURE OF CONTRACTOR OR AGENT Oale
PIPIT Suball Iuutr Did,iok of Etnv omnan Holtb mid Noma) Rasoure<a
L^
3
I 1

To. DENR DIVISION OF WATER QUALITY, GROUN[FrornALAN S. GANTT 828-286-8787 09/25/00 20-.56. 16 Page 10 of 11
Sent by the Award Winning Cheyenne Bitware
North Carolina - Department of Environment. and Natural Rc>ources- DMkion ofWate,'Quality- Groundwater Section �A S007
1636 NlaiI Service Caster - Ralc,,L, N.0 27699 - 1636 - Plmne (9191 733d 2'_ I
WELL, CONSTRUCTION RECORD WELL CONTRACTOR: C.AROLINA R'ELL DRILLERS I\C
FELL CONTRACTOR CERTIFICATION # : 2584
SIAI E WELL CONS'IRL'C'IION PER,Nll l # :
1- WELL USE (Check Applicable Box) : Residential ❑ Nulueipal ❑ Industrial ❑ Agliculrulal ❑ Monitoring ❑
Rocovcn' ElLIM Pump Water Injochon ❑ Other ❑ If Oihcr, List llse
2 WFLI. LOCATION (Show sketch of the Incatinn below)
Newest t.,,m RLI'f11ERPORD'ION Count}- RLTHERFORD
239 McENTYRE RD.
(Road, Cotmuuuih. or Subdivision and Lot No DEPTH
3, OWNER MARSHALL BURCIESS FROM TO
ADDRESS 33c7 McE�'I'YRE RD.
(fitted err Ronk N�.1
0 Ijj
RL-I'HERFORDTON NU 28119 155 280
City m To. n State Zip Code
4. DATE DRILLED 7/20%00 USE OF WELL RESIDENTIAL.
5. TOTAL. DEPTH 280
6. CUTTLNGS COLLECTED YES ❑ NO ❑
". DOES WELL REPLACE EXTSTNG WELL'? ]ES ❑ NO
8. STATIC WATER LEVEL Below Top ofCa;ing: ''0 FT.
(Cx1v"IfAl—Top of(l.,mg)
9- TOP OF CASLNC IS FT- Above Land Sud'ace"
'C'e•mg'1 aminvted at'or bdoa Ind ...lose i5 It,,a n,d<s a ra,imm< is fanned
,n a'—dmm< wh615A NCAC X 0118
10- YIELD (Arm). 8 METHOD OF TEST ARDM
11. WATER ZONES(depth) 185 193 210
12. CHLORF,ATION'. THre
13 CASNG:
Depth
From I 'I'n
IJ. GROUT'.
Drnh
Prom 0 To
I<. scluLN
Depth
From NA To
I& S.AND'GRAIEL PACK:
Depth
From NA To
I7. REMARKS'
0
IISPOCIILORITE Amoum 8 OZ. uaadhiond"<i=n«eed n,. baeA ortn„n
LOCATION SRETCI I
Wa1111iic1aiess (Slmw direction and tlishu¢e Gum al Ieael duo Sla('
Dinmeler nr We'ghtII Material Roads, or allermap referencepnmN)
160 Ft. 6 14 ^ SDR 21 P%lc COVE RD
DRILLING LCG
Fcn.Alon Desa ipt inn
CLAY
CONSOLIDATED ROCK
Nlaterial Nlellmd
20 Ft- SAND MIX GRAVITY
Diameter Slnl Size Material
Ft in. in
Ft.
Size Nlaterial
i S 64'74
I DO HEREBY CERTIFY THATTIIS WELL WAS CONSTRUCTED LN ACCORDANCE WFIl-1 I5A NCAC'_C. WELL
CONS'IRUCUON S"1'ANDARDS, AND'tFLAI"A COPY OF "I HIS RECORD HAS BEEN PROVIDED'10'1'HE WELL OWNER.
FOR OFFICE USE C NIr+B'
QunclNo. I FI ' cam'
Serial NO i SI4.k, rFKE OF PERSON CONS'I RUCI INU IHF WELI.
F': = Sub,
fmii$lAl to Dwvmn f W min Q'ohq, G d vata Section wvdw, 30 Da,
f"n
—
hl
McENTYRE F.L
TO RITHF,F:FDRDTON
09.25i00
Date
GP'd RF'. 1:99

I o UzIVr U VAS ON OF WATER QUALITY, GROUN[From ALAN S. GANTT 828-286-8787 09/25/00 20 54.54 Page 8 of 11
Sent by the Award Winning Cheyenne Bitware
180A
North Carolina - Department -f Environment, 11ea1th and Nahmal Remurceti'
Division of Environmental \fanggemenl -Groundwater Section
P.O. Bat 29535 - Raleiplr N C. 2.6.6 0535
Phone [phone]
FOR OFFICE USE ONLY
QUAD. NO _ SERL1L NO.
Lat. Long. _ RO
Minor Ifasin
Basin Code
Hcadn'EnL CA I Ent.
RILL CONSTRUCTION RECORD
DRILLING CONTRACTOR: CAROLIN'A WELL DRILLERS. INC.
STATE R'ELL CONSTRUCTION
DRILLER REGISTRATION NUMBER: INW) PERMIT NUMBER:
1. WELL LOCATION (Show,ketchofthelornlion belo«9
Ncarc4 torn- UNION MILLS Comnry' RUI'IILRFOIiD
670 NANNY TOWN RD
(Road, Community, or Subdivision and Lot No DEPTH
2OWNER WAYNE AMMONS FROM TD
ADDRESS 670 NANNY TOWN RE)
UNION MILLS NC 2816"
C',q or loam State ;. p Code
3. DATE DRILLED 7116/00 USE OF WELL RESIDENPIAL
d. TOTAL DEPTH 420
5. CUTTINGS COLLECTED YES ❑ NO 0
6.DO1SW III, R YLACF I:XIS'fW0 WII 1,1, 1 YFs El NO ❑
r. STATIC WATER LEVEL BeIosv Top ot'Cisin¢ii FT.
(C"a< "-' If Abov, hop of C'asugl
8. TOP OF CASING IS ? IT Above Land Sol dce"'
'Casing T<ohmoatcd at or below food sun fac, to iaagal talus, a Iariarma is oe aad
ah... ordan,c arch ISA NC AC 2C.01IS
9. YIELD(epart) 6 METHOD OF TEST ARDAf
10. WATER ZONES (depth): 410
SS
TN
DRILLING ,OG
I ormat inn De.n iphon
CONSOLIDATED ROCK
O
FTI
iri
fV
_
Gl
`tea
m
W
r,
1t. CHLORINATION'. Type HYPOC HLORI'I'E Amours 11 O/. If adds ional spa.. i. nr.d.d n>e hok oIf ..
11 C.ASNG:
LOCATION SKETCH
Wall Tlriclalese (Show direction and dietarme from at Ica,t ttvo Statc
Depth Diameter or Weidit It Nfaterinl Roads- ca other map reference poinlel
From 0
To
60 Ft. 61 1 " SDR 21
PVC
U. GRUGI':
Depth
M1tate'inl
Method
From 0
To
20 FL SAND MIk
GRAI'ITY
6711
Id, SCREEN
Depth
Diameter Slot Size
Material
From NA
T.
Ft,
L', S.AND/GRAVEL PACK:
vANNV TOWN, f:F
Ueptli
Size
Malcrial
-RUfI4ERF0RDT0\
From NA
To
FL
„—
i.'S H1 .
R'1'
16. RENLIRI:S:
I DO HEREBY CERTIFY THAT THIS %4ELL WAS CONSTRUCTED IN ACCORD:UNCE 1VrEH l!A NC.4C'_C, WELL
CONSTRUCITON STANDARDS, ,AND TI LAT A COPY 01' "H ES RECORD I LAS BEEN PRO\TDED TO TI IF WELL OWNER.
657
n Sdtam
\TIRE OF CONTRACTOR OR AGENT
onpo al1. Do ision of Emu omn, a, Hall of Nmral R,,aarues
09,'25rOG
Date

To OENR DIVISION OF WATER QUALITY, GROUNIFrom. ALAN S. GANTT 828-286-8787
Sent by the Award Winning Cheyenne Bitware 09/25/00 20: 54'.12 Page 7 of I
North Ciao l ina - Deportment of Enviromnent.I Ierlth and Naurral Re000rcee
Division of Erivii oninertal Mana¢etnenl - Groundwater Section
P.O. Boz 20535 - RA,igh, N.C. 26'6 0531
Phnne(919) 933-12'1
�18011
FOR OFFICE USE ONLY"
QUAD. NO. SEFi NO. _
LnL Loge. RO
Ninnr Hain _
Baain Code
Heada'Ent. GW.l Ent. -.
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: CAROLIN.A WELL DRILLERS INC.
DRILLER REGISTRAT-ION NII\1RF.R: 181K STATE WELL. CONSTRUCTION
PERMIT NUMBER:
I. WELL LOCATION: (Shoe sketch of the location below)
Ncnrest tnn'm RLTHERFORDTON CountyRUT HERFORD
523 ANTLER TRAIL
(Road Cmrvnunlp. or Subdivision arrd Lot No. t
DEPTH
I.uWUER FRANK DOTSO\�
PRUAI U
ADDRESS pOp gs3
RLTHERFORDTON NC 28139
City or Town Stale Zip Code
1, DATE DRILLED 6,'2- 00 USE OF WELL RES10E&N I I A L
-I. TOTAL DEPTH 590
5. CUTTINGS COLLECiED YES ❑ NO 0
fi. DUP:S 4Vlil.l. RI!PLA('I! ISXIS'fIG lVfa.l rl 1'IfS 0 NO 0`
s. STATIC WATER LEVEL Below Top ofCasins: 132 FT.
(Cse 't' If Lbov< Sap of C'osbgl
8, 70P OF CASING IS _ FT. Above Land Sw'foo-
'Ceshrg Tc:mbnmd A', bdow lard stufa« ie Tagil udcse v caiane is..m<d
yr v.... den,, vith 15A 6C'AC 3C'.0118
9. 5TELD(glmil'. 11/2 ),UMOD OF TEST ARDVf
m. WATER ZONES ldgltli)'. 580
85
590
DRILLING ING .CCi
Fmmahnn Oe' iptmn
CLAY
CONSOLIDATED ROCK
11 C'HLORL\ATION. Typc
HYPOCHLORI"I'In Amount 13 OZ.
_
If vdiIi,maid space is..... do,e bank of form
. '.
12 CASING
Wall T{tidmese
_
LOCATION SKI
Depth
(Shoo' direction arld distance from at least [tvo Slat,
Diameter or Wei¢hl;Ft. Material
Ronde_ or other map reference poinls)
From 0 To
90 F1 61,1" SDR21 PVC
13 GROUC:
—
Depth
Material Method
From 0 To
'r0 Ft. SAND MIX GRAVITY
HUDLOW' RD
td_ SCREEN
Depth
Diameter Slot Size 6leta'ial
CONT-,Y ISI.AM RD
Front NA To
FL in.
in.
15. SANITGR.AVEL PACK:
.ANTLER
Depth
Size atafcnnl
—� TRAH,
Fmur NA To
FL
R1,71HERFORDTO
16. REMARKS'.
_
LTS Inky 121
I DO HEREBY CERTIFY THAE FEES WELL WAS CONSTRUCTED I ACCORDANCE WTITI 15,A NCAC'C WELL
CON'STI2CCROA' STANDARDS, -k1T) Tf L4T A COP}- OF TI DS RGCORD I AS BQEV PRO\1DED TO TI fP WELL OWNER.
656
09, 25,00
cloI H% 9r91 SIONATURE OF CONTRACTOR OR AGENT
Subuul miwwl to Division o(Emvomn<nr. H<dtb aid Maid Reso:uves )).to

To. DENR DIVISION OF WATER QUALITY, GROUWFrom ALAN S GANTT 828-286-8787 09/25/00 20'51:26 Page 3 of 11
Sent by the Award Winning Cheyenne Bitware
North Caro Ene-DepmLnenl ctEtmircnn,w Ilenith and Natural Revourcee
Division of E.rrvironmernal M1Tm1,1¢nnent - Groundwater Section
P_O. Box 29535 -Ruleiuln NC. 2'66-6535
Phone(919)-33-3^21
� 18015
FOR OFFICE USE ONT,Y
QUAD. NO. SERIAL NO.
Lm. Ltntu. RO
\Imar lfain
Basin Code --
HnaderEvL GR'-I Eut.
R'h:LL CONSTRUC770N RECORD
DRILLING CONTRACTOR: CaROLI:NA NVELL DRILLERS INC.
S'LkTE R-ELI, CONSTRICTION
DRILLER REGISTRATION NUMBER: 1811-5 PERMIT NI'VIBER:
I. WELLLOCATION fSLowdketdt oCthe location below)
Neme,t «m'. RUTHERFORDTON ('mmt)-: RUlTIL RFORD
118 IIAMILTON RD
(AoxA, Conmmnip', or Subdiciaion anA Lol Not
DEPTH nRn_LrnG
'-. otvNER FLEE'R600D HOMES
_cG
FROM TG C'nnnAtmn DcatCpt
ion
ADDRESS 19_0II\4 1 J BA PASS
ISlrca or Ronk Vo_J 0
86 CLAl
FOREST CITY NC 28013 86 130
COSS0LIDATEDROCR
Ciq of 'town
Stale Zip Code
—
3. DATE DRILLED 6; 1TO USE OF WELL RLSIDENTIAL
—
LTOTAL DEPTH ;pp
_
5. CUTTINGS COLLECTED YES ❑ NO Q
_
6D01IS 1V I J. RFPLACH EMS' I'IN(i%VI':IJ,I )k's AO O
-
-. STATIC WATER LEVEL Bel.,, Top oCCasing. 9: FT
it"=.'-' If dboo. Top of C'autgl
—
8. TOP OF CASING IS ? FT Aboer L.0 Surface"
—
`Caur¢ T<nrvtwwd aVor balow laid ntrlacc is IDcgal oNc: v. aia,u. 1_ �,uzd
—
m a.wnlaa wIdl 15.1 NC'AC' 2C' 0118
_
V. YIELD L¢InnP. METHOD OF TEST ARDAI
—
10. WATER ZONES algrtln: 47S
—
IL CHLORINATION: TN pe MPOCHLORNIF Amount 11 OL. IfadditinnA,vo«I: nz<dal n=z bock nflm,
12. CASING.
LOCATION SKETCH
—
R'a1lThickneaa IShon-directiormd(Intmice Cromat lea[I two Stale
CD
Depth Dlmneter or WeiPfrl'Ft. Material Roads or other mapreCerenae polnKl
C:, .-.
From 0 To 88 FI. 6 li 1 " SDR 21 PVC
rTl -
13. GRUCC:U
-
Depth HAMILL t ON KD
I M1la[erinl Method
0) .,
From 0 To 20 Ft. SANDNIIA GRAVITY
14. SCREEN
to
Depth Dimnelei Slot Slze Ylaterial
c
From NA To -
Ft. In. In.
_
I5. SAND ORAIEL PACK'.
N
c
Depth SIJC %licen Al
Fran NA To FI.
1e. ItEaLARRs: i`S I -I VY 6-1 74 TO RU7'HERF ORDTON
I DO HEREBY CERTIFY' THATTHIS WELL WAS CONS"FRUC'TED I AC'CORD.ANCE
RTIH DA NCAC'_C, WELL
CO\"STRL"C'1TONSTANDARDS.ASDTILATACOPS OFTIES RECORD
IDS BEL'N PROFTDEDTO THE ROLLMIT,-ER.
652
09'22:0('
ffff �i�
GYY 1 RE 9 SIGNATURE OF CONTRACTOR OR AGENT
a S b NI nnzh W t I) umn of E nvomnem Heoltlt and Nztttd R.±ante.. Ume
t

To. DENR DIVISION OF WATER QUALITY, GROUN[From. ALAN S GANT- 828-286-8787 09/25/00 205C-44 Page 2 of 11
Sent by the Award Winning Cheyenne Bltware
North Cm'olina - Department M EnviromrmnL I Ieal[h Imd Na wal Reeourm
Division of Envirorrnental Manaeemenl - Grmmdwaln' Section
P.O. Be, 2995 - RAI, c N.0 2'6.6-0135
Phone[phone]
'41,18016
FOR OFFIrE USE ONLY
QUAD. NO. SERIAL NO.
Lvl, Lone. RO
Minor Basin
Basin Corte
He,,&, Ent, GAV-I Eni.
R"ELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: CAROLINA NVELL DRILLERS^ ISC.
SLUE NI ELL CONSTRUCTION
DRILLER REGISTRATION NUMRER: 180-5 PER3IIT NI:'\IRER:
(.WELL LOCATM (Shoesketchofthelocationbeloe9
Ncaresnoem CLIFFSIDE Cmmty- RL!7 IILRIfORD
LOTS 12. 13 S 1-1 ON LIONEL RD
(Roarl Corrununib. or Subdivision and Lot No.I DEPTH DRILLING
XCr _
2OW'NF.R PENNYb100RE FR0AI 'I'(1 Pnmlalinn llcniplmn
,ADDRESS 5012 B BOW"EN DR.
(61 .eaor Rma<No.) 0 33 CLAY
SHELBY NC 28liO 38 165 CONSOLIDATED
ROCK
City or To.an Stale Zip Cnde
3. DATE DRILLED 5, 29,00 USEOFl4ELL RLSIUEN'HAL
i. TOTAL DEPTH 16S
5, CUTTINGS COLLECTED YES ❑ NO []
6. DONS 4VI:1.1.121YI.ACIi FXIS'I'INri %Vl'I.l.' }'FS ❑ NO Q
7.STATICWr:1TERLEFE1,Beiory Topof Canine: 92 IT.
tl3< "+" If Above Top of Cashel
8, TOP OF CASING IS 2 FT. Above Lemd Surface'
^C�mg Tmwmead ac'or balow Iwml mrfvac � Jleeal oidre a r unwr.< a n:uad
m a.cordam<witL 15A FC'AC' _'C .0t18
q. YIELD Ppml'. I5 \E-:THOD OF TEST ARD}I
to. WATER ZONES IdeplW: 145
IL CHLORINAl10N. T}be H YPOCHLORl'1'L' Anlmlrll 4 OZ. Ifvddieiond,pa«;, n«d<d u,<bo<k of form
12. CASING'. LOCATION SKETCH
Wall thickness (Shoe' ([irerection and diPiuice from al least Rvo Stmc
Depth Dianeler or Weight: Fl. Material Roads- m other nmpreferencepointo
Prom n To I' Ft_ 6V1" SDR'_1 PVC
13 GROUP:
Depth Material Method 1.OTS
Q ;.
From 0 To 20 Ft, SAND.MIX GRAVITY I'',13;I4
� G
LIOVEL RD
c")
l,. SCREEN
-
Depth DianeoI Slot Size Material
-
N =
From NA To Ft. in. III
-_
C'nRR RID
15. SIN5 R.AAEL PACR.
1%I'th Sbe Material
—.. �'—
Frmn NA To FL F:5 Flll'1^ 121 \
16. RE\LARKS:
i\1
_
CJ
1 DO HEREBY CERTIFI' THAT THIS WELL WAS CONSTRUCTED E\ ACCORDANCE WITH 1 <A NCAC " C. WELL
ti
COSSTRUC'HON ST.AND.AItDS. AND TILAT A COP}' OF 11 US RECORD ILAS BEE\ PROVIDED TO TT IF IVCLL CANNER.
651 , f 09;25 OG
par,"1 q X SIGNATURE OF CONTRACTOR OR AGE\-T
Dale
f1jJj" ",^ �,� Aibnut �Wto Di,i,ian of £nwmunar H<ohi wed ]annul Resomwv
Cmarrwa:- Seci!;n
psheviiie,(ie"larva{ �,;r -

To: NCDEH&NR N C. Dept. of Env. Health & Nat. Re:Frorn: ALAN S. GANTT 828-286-8787
Sent by the Award Winning Cheyenne Bitware
07/16/00 -1 `0.44 Page 4 of 8
North Coin ling - I )gmdtncnt of Pnvironmml, Health and Nahual Resources
Division of Environmental Management - Groundwater Section
P.O. Bas 29535 -Raleigh. N.C. 27626-0535
Phone [phone]
3952
FOR OFFICE I SF OM.Y
QUAD. NO. SERIAL NO,
Lat. Long. RO _
Minor Basin
Basin Code
Header Ent. GW-I Ent.
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: CAROLINA NVELL DRILLERS. INC.
S IAl'E W ELL CONSTRUCTION
DRILLER REGISTRATION NUIIIBER: 1805 PERMIT NUMBER:
I. WELL LOCATION (Shoct sketch at the location below,
Neaeesticavo. GREENHILL County: RLTHERFORD
f IS H W Y 64%74
(Road,Couonuuity, or Subdivision hmd Lot No-)
DEPTH DRILLING .CO
l OWNER ROBBIE COOK FROM
TO Fommtion Desniptlon
.ADDRESS FIWY64/74 N.
(sncna, Pont, No.) 0
75 CLAY
RUTHERFORDTON NC 28119 95
200 CON SOLIDAI'E1) ROCK
ciryon To... State Zip Codc
3. DATE DRILLED 5/5/00 USE OF WELL RESIDENTIAL
4. TOTAL DEPTH 200
3. CUTTINGS COLLECTED YES ❑ NO ❑
6. DOES WELL REPLACE EMSTIJG WELL't YES Q NO
7. STATIC WATER LEVEL Below Top of Casing: 7I F7.
O
t
(Uyz -t' HAW- Toy of C'a,ing)
8. TOP OF CASING IS 2 FT. Above Land Sucice"
C
�j m
'
Errl
'C'v,uhy'fmtrwhvwd vUor ad... lwhd ,urfv<z is ilkgd aNza=a vmiwrez Eimmd
m azaoiaon,, 5dh 13ANCAC 3C.0113
9. YIELD (gllno: 6 METHOD OF TEST ARDSI
f,.i
—��
to. WATER ZONES (deptl0'. 120 I d 2 155
m
ma
c-�
ii. CHLORINATION'. T\Re IIYPOC'IILORITE Amount A OZ.
If.+hao,A,yvzz i, hw<d<dhrz Lv<kcffonn —QED
GJ
_
o
IL CASING
LOCATION SKETCII
Wall Thickness
(Shoe du colon mid dktat¢e from A least nzo Stat,
Depth Diamem' nr WeiglslLD Material
R,,iak or allhntrap ree,,,a, p,aaw
From o "1'a 80 1'1. 6 I'A " SDR 21 PVC
HWY 64'74N
13. Griou :
Depth Matehial Method
From 0 To 20 Ft. SAND MIX GRAVITY
Id. SCREEN
❑
Depth Diameter Slot Size Material
From NA To Ptin. in.
15. S.ANIE-GRAVEL PACR:
MOUNTAIN CRK --
Depth Size Maenal
Prom NA To Ft,
16- RI'AITRKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED LN ACCORDANCE NVI TH I s A NCAC 2C, WEELL
CONS'I R( ICI' ION STANDARDS, .AN[) I'HA'I' A ('011 V OF'I'HIS RflCORD HAS MF:N PROVIDH:D "1'0 1 HF. NVHI.I, OWNER
646
G0.'�1 REV. 9'91
SI( NA 11.RIt OF (ON I'RAM OR OR AOIN
Sabana n,owl to Tim fErvuomne t H,,Ai mud Nzmol Raemu.n
Date 1

To: NCDEH&NR N.C. Dept. of Env. Health & Nat. Re From ALAN S GANTT 828-286-8787 06/17/00 15.3300 Page 10 of 10
Sent by the Award Winning Cheyenne Bitware
FOR OFFICE USE ONLY QUAD, NO. SERIAL NO. r 4
Lat. Long RO
Notlh Carofinv -Deportment of Environnien[, health and Nvnnal Reeourcea Minor 1iasin _
Division of Envirorunental Managnnent - Groundwater Section Basin Code
P O_ Bos 29535 - Ral6itlr N.C2'626-0535 HradnEnt. GW-1 Ent.
Phone[phone]
R-ELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: CAROLINA NVELL DRILLERS, INC.
STATE R ELL CONSTRUCTION
DRILLER REGISTRATION NUMBER: 1805 PERMIT N17NIBER:
I- WELL LOCATION lShow aketdi oC the location below)
Ncarc,t tmvn- ELLENBORO C'nunh^ RU't'HLRFORD
TWIN CREEKS SUBDIVISION LOT 5
Road, Corirnunit , or Subdivision and Lot No i DEPTH DRII.I.ING X G
s. OWNFK FLEET%VOOD HOLIES FKokl TO Formation Ucucriplinn
ADDRESS 1920 HWY 74 BYPASS
(Sheet or Route No.)
FOREST CITY NC 28013
CS,, or Imo State Zip Code
3. DATE DRILLED 5r3,00 USE OF'WELL RLSI DENTI.AL
d. TOTAL DEPTH ISi
5, CUTTINGS COLLECTED ITS ❑ No ❑
6. DOES W 11.1, R I! PI.ACIi IXS"1'INO WRI.Ill 1'RS ❑ ]O
7STATIC WATER LEVEL Belo, Top of Casing: 42 FT.
C ,,'+''If Above Top of C,il,)
e. TOP OF CASING IS 2 FT. .Above Lmld Surf tce"
'C... io Ien,utimad uC., bdo, and oufaoo b iitagd u,dass a.anmi.. a c. ud
ut veaoidmw<md, IS\ NCAC' 2C.0118
v. WELD lgptnl'. 2i METHOD OF TEST ARD%l
10. WATER ZONES IdepHn: 180
0 6�
6i 18c
CLA1
CONSOLIDATED ROCK
11.CHLORLNAEON'. TPc HYPOCHLORI'I'E All 5 OZ If vdditiond ryvee ianndM ua<baak of coon
12. C.ASING. LOCATION SKETCH
Wall Thicktie,s (Silo,' direction and distatice Crom at least two Stara
Depth Diameter or Weight Ft, Material Roadsor other trap iefei mccl irtvl
From 0
To
u. GKOU"1':
Depth
From 0
To
14 SCREEN
Depth
From NA
To
15. S.ANFGR.AVEL P.ICK'.
Depth
Fiom NA
To
16, RE\LARKS:
71 Ft. 61/1 SDR21 PVC
Material Method
20 FL SAND MIX GRAVITY
Diameter Slot Size Material
Ft. in.
FL
Sivc Mateial
0
OLD
M00RESB0R0R IR%Y 74
T%Vr� CREEK SUB
HlA 7" 12S) --
I DO IIEREBY CERTIFS' THAT TMS 14'ELL W'AS CONSTRUCTED LN ACCORDANCE WTF H 15A NCAC'_C. WELL
CONSTRUCEON STAKD.ARDS..AN'D TILAT A COP}' OP TINS RECORD I/US/BEE•)/E\ PROITDED TO TI LLWELL OW%'NT...RR 6Y� . ,N/
OVi 17/00
Y.�" Asti✓
cw 1 RDv 9;91 SIGNATURE OF CONTRACTOR OR AGENT ;)"to
Submit onyiil to Di.i:mn of Eninviunan, Heddi mtd \amid Rc ovroe;
n.
0

To NCDEH&NR N.C. Dept. of Env. Health & Nat. Re From ALAN S. GANTT 828-286-8787
06/17/00
158218 Page 9 of 10
Sent by the Award Winning Cheyenne Bitware
FOR OFFICE USE ONLY
QUAD. NO.
SERLAL NO.
L'at.
Lone RO
North Crack.- Depmiment of Environment- I[ealth and Natural RC4onree9
Environmental m:magement
Alinor Basin
��
f%�j �
Division of - Groundwater Section
Basin Code
!_
P.O. Bos 29535- Raoiotlt N.C. 27626-0535
Header Ent.
GW IEnl
_
Phone(919)'t33-3'_21
-
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: CAROLINA R ELL DRILLERS. INC.
STATE RBLL CONSTRUCTION
DRILLER REGISTRATION NUMBER: 1805 PERNIFF M NIBER:
t. WELL LOCATION (Show sAetd�ofthe location helms)
Nearest town: RUTHERFORDTON Co))nT: RL'HILRFORD
140 BROOKS LAKE RD
(Road, Commmnih. or Subdivision and Lot No,) DEPTH
I.OWNER SHANNON SPENCER FRD6e 0
ADDRESS 340 BROOKS LAKE RD
RUTHERFORDTON NC 28119
city.' ro,,,t sn to Zip Code
3. DATE DRILLED 4,'0_6%00 USE OF WELL RESIDENTIAL
d. TOTAL DEPTH 220
e. CUTTINGS COLLECTED SES FT NO 7
6_ DOES WELL RFPI.ACD EXISTING WFLLI 1'Ii.S 0 NO
-. STATIC WATER LEVEL Below Top of Casine: s> Fi.
(Cora `+' If Above Top of Cribs)
8. TOP OF CASING IS 2 FT Above Leal SurGae'
"Casing Tan n�.nd at!orbdoa lad surl.,,L M,al nnlaa a vaiaua n issued
w..cordama wi0t 15A NCAC IC.0118
a YIELD Igpml'. 1< METHOD OF TEST ARD\I
to. WATER ZONES Idepto: 74 2Ii
l l.CHLORN.ATION: T}pc HMCHLORHE Amount
12. CASING:
4 OL.
W nII Thickneee
Depth Diameter or WeidNFt
From 0 To 71 Ft. 6 Ld " SDR 21
13. GROIfl':
Depth
From 0
To 20 Ft.
14. SCREEN
Depth Diameter
From NA
To Ft.
D.S.AND�GRANELPACE:
Depth
From NA
To FL
t6. RE-NIARKS.
68
M
IN
spuce is needed use
DRILLING LOG
Formation Dceaip)ion
CLAY
CONSOLIDATED ROCK
(Show direction and distarme from at leae't two Stalc
Naterial Road, or other mapreference point,)
PN'C 340 US HW't 221 N-
L3ROOKS L-AK�E RD.
Material Method
SAND NHY GRAVITY
Sla sae material
in. in.
S17C %I"tmal
D.ART,T\GTO\ RD
RL?HERFORDFUN
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C. WELL
CONSTRUCTION STANDARDS. AVD TILAT A COPY OF TIES RECORD ILAS BEE\ PROI'mED TO UIE WTLL OA6•NER.
644 '�i x zs- 06117i00
Gw.l REv. v,vt SIGNATURE OF CONTRACTOR OR AGE\T
Sobnw o,,,J io Division of En,vomnent. Holth and Nat R—t..., Date

Material Method
20 R SAND MIX GRAVITY
Slat Size Material
in. n.
Sivc Matta A
To. NCDEHBNR N C. Dept. of Env. Health & Nat. Re From ALAN S. GANTT 828-286-8787 06/17/00 15.31 M Page 8 of 10
Sent by the Award Winning Cheyenne Bitware
FOR OFFICE USE ONLY
QUAD. NO. _ SERLIL NO.
Lon. Loge. RORO 2
Noah Carolina - Dcpattment of Ern rornnent. health and Naito at Resources LaL Basin _
Division of Env iron mental Management-G 626-0535 Stt[ion Basin Code _
P.O.Bo<n_9535-Ral)13V.C. '_'6=6-0535 Heeler Enl. GW-I Ent.
Phnnc (919) r333?31 _ -
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: CAROLIIN'A NVELL DRILLERS. INC.
STATE R ELI. CONSTRCCTION
DRILLER REGISTRATION NUMBER: 1805 PERMIT MAIBER:
I. WELL LOCATION. (Shore sketch of the location below)
Neal cato,,n R1,`THERFORDTON (bum-. RUFFHLRI'ORD
966 CONEY ISLAND RD_
(Road, Cotmnunity, or Subdivision arld Lot No.)
I. OWNER MICHAEL CONNER
ADDRESS 966 CONEY ISLAND RD
(Suet or Ronna No.) 0
RLTHERFORDTON NC 28139
Cip'or 1oa-n State Zip Code
8. DATE DRILLED 4'24,00 USE OF WELL RESIDLN'CIAL
i, TOTAL DEPTH 295
5. CUTTINGS COLLECTED YES ❑ NO Q
6 DOFS WI:I.I, RP:PI.ACI: EXISTING VJI!LL3 YEAS Q NDEl
I. STATIC WATER LEVEL Belov, Top of Casing: 42 FT.
art<.,t'.Ifaw�e rap arca,�t�t
S. TOP OF CASING IS FT. Above Umd SurPaw*
'Casutg Tanwmmd au'or blow lard swlaa< is Jlaaal nd<ss a vvimu< is iuuad
ut a<cordvia wilt lM NCAC _IC.0118
9. YIELD I)n)ml'. IS KETHOD OF TEST ARDV
10. WATER ZONES(dgvlp'. 85 230 290
DEPTH
FROM
Ch
295
DRILLING ,CG
Fntmatinn Dcsniption
CLAY
CONSOLIDA"I'ED ROCK
O�
O
r
ILCHLORLVATION: TH)c HYPOCHLORI"I'E Amount 6 OZ. Ir addaional,va«is n«d<d ns<bo.k of font
13. CASV\G: LOCATION SKETCH
Wall Thickness (Showdirection and dislmwe froth at least nvo Slnt(
Dg)th Dianetcr or W(Ield: FL Material Roadk o. othennaprefi,ocepei,lt,)
Froth 0
11. GROUT:
To 59 Ft. 6I'l SDR21 PVC
Depth
From 0 To
IJ. SCREEN
Depth Dianeta'
From NA To Ft.
15..SANDF GRAVEL PACK.
Depth
Frmo NA To FI,
16. REMARKS:
RLTRFORDTON
COON-ti" TSLAND RD
HAVY 331 N.
Or.]
I DO HEREBY CERTIFY THAT THIS WELL IVAS CONSTRUCTED INACCORDANCE WTI'H 11A NCAC'C WELL
CONSTRUCTION STANDARDS —AND TI L\T A COPY OFTI ES RECORD I L4�SSBEEfEN PR0%TDED'f0'FIH WELL. OWNER.
643 06; I7, 0(t
6 --
cwd REV. 991 SIGNATURE OF CONTRACTOR OR AGENT Date
Snbnut mignal to Division of&nuo unaic H<dth wad Nernst Rcoona

To NCDEH&NR N C. Dept. of Env. Health & Nat. Re From ALAN S. GANTT 828-286-8787 07/16/00 `EO 02 Page 3 of 8
Sent by the Award Winning Cheyenne Bitware
213901
FOR OFFICE: USE ONLY
QUAD. NO. SERBIL NO.
Lat. Lonu. RO
North Carolina - Dcpatlment of Environment, ]IealHt anA Natural Resources - _ -- _--- Minot ode _
Division of Envirorunental Afanagemerrt - Groundwater Settion Basin Code
P.O. Box 29535. Raoigh. N.C. 276'_6.0535 Header Ent. GW-I EnI
Pinne(919)731.322I - ---- — - -
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: CAROLINA NVELL DRILLERS. INC.
STATE \TELL CONSTRUCTION
DRILLER REGISTRATION NUMBER: 1805 PERNTIT NUMBER:
I. WELL LOCATION (Show sketch of the location below)
Neared roen RLITHERFORDTON chanty-. RUflILRFORD
758 PLEASANT HILL, LOOP RD.
(Road, Community, or Subdivision and Lot No.) 1)F. PTH DRILLING .CG
a. OWNER WESLEY HUTCHINS FRONI "10 Famainn Dcsc' Thnn
ADDRESS 1691IILDERDRAND DR.
(Sued or Route No.) 0�—
RUTHERFORDTON NC 28139
City or [own Slate %.ip Code
3. DATE DRILLED 4/12/00 USE OF WELL RESIDEN'ITAL
,i. TOTAL DEPTH 720
5. CUTTINGS COLLECTED YES I] NO Ej
6, D015 WELL IZFPI.A('F IAIS'I'ING WFLL1 YES ❑ NO
7. STATIC WATER LEbEL Below Top of Casing: >300 FT.
(U,> .',,' I(AWvc Tay of C'.,hip)
s. TOP OF CASING IS 2 FT. Above Laid Surface*
'Cafag Tonwi.ud n., bdow land snrfma i, Jkgal uda, a vananc i, i,nnal
ai ...axlo,,,e wilh 15A SCAC IC .ova
9. YIELD(gpim 1 1/2 METHOD OF TEST ARDM
m. WATER ZONES (deptho: 710
iLCHLORI\ADON'. T>Pc MPOCHLORHE .Amount 10 OZ.
II. CASING'.
Wall Thickness
Depth Diameter .,Weight/Ft.
From 0 To
D. GROUP:
Depth
Ft, 6 1/-1 " SDR 21
0
75 720 CONSOLIDATED ROCK
If additional epu, i, n,,drd uez Soak of Eo u
(Show (in ection and distarice from at least ttvo St atc
Material Road. or other nap refa'ence points)
PVC \ E8
Qlaterial Method
From 0
To 20 Ft. SAND MIX
GR.AXIT)
PLLASANIIII.L
u. SCREEN:
LOOP RD
Deah Dianeter Slot Size
Matenal
From NA
To Ftin.
in.
I,. SAND/GRAVEL PACk.
Depth Sim
67a1a'ial
Frmn NA
To Ft.
US H% Y 108
16. REMARKS.
COULD NOT MEASURE WATER LEVEL.
WELL IS NOT IN USE
I DO HEREBY CERTIFY THAT II-➢S WELL WAS CONSTRUCTED L\ ACCORDANCE WITH I'A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TI LAT A COPS' OP "DllS RECORD I LAS BEEN PROWDED TO TI E WELL OWNER.
IIQ.L CII. RD
642a�����,
DI GW'-t REV. 9191
SIGNATURE OF CONTRACTOR OR AGF\'I' Dalc
Sub 1 �i�ml m Oirie on of E nuo,mm n, Health vul pan rat Ramm.cs

To NCDEH&NR N.C. Dept. of Env. Health & Nat. Re From ALAN S. GANTT 828-286-8787
Sent by the Award Winning Cheyenne Bitware
07/16/00 ''. 49.20 Page 2 of 8
North Carolina - Department of Ervirorm¢nL Ilea It and Natural Reaoorca
Division of Ertworanemal mainbeement - Groundwater Section
P.O. Be, 9535 " R:deigh. N.C. 2"626-0535
Phnnc (919) 1113221
2i3950
FOR OFFICE USE ONLY
QUAD. NO. SERIAL NO.
Lat. Long. RO
\l inor Ilist n
Brain Code — ---
He,ul. Ent. GW-I Ent.
R-ELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: C.AROLINA HELL DRILLERS, INC
STATE WELL CONSTRUCTION
DRILLER REGISTRATION NUMBER: 1805 PERMIT NUMBER:
1. WELL LOCATION: (Shmv eketdt oC the location below)
Nenrest tom: RLTHERFORDTON C.inim'. RLTHLRFURD
-98 PLEASANT HILL LOOP RD.
(Road, CommunE. or Subdivision and Lot No.)
z OWN'FR NESLEI" HOTCHINS FROM
ADDRESS 169 H[LDERBRAND DR.
DF PT"H
--_— 10
(Street or Rome NoJ 0
R17HERFORDTON INC 28139 29
520
City or'fown State 7.ip Code
3, LATE DRILLED TWOU USE OF WELL REST ULN I IAL
I TOTAL DEPTH 520
5, CUTTINGS COLLECTED YES NO I]
6_ DOES WI11,1. REPLACE FMIING WELL' 1'ItS (] NO ❑`
�.STATICWATER LEVEL Bela, Top ofCacing: NA FT.
(USe' —" If above Toy of C'ashig,
8. TOP OF CASING IS 2 FT. Above Luid SurC¢e'
'Casing Tavmmted swop blow Imrd a ,fiwo i= Jlegd odor a vmianw ix isued
m oeaordmwe wide 15A NCAC 2C.0118
9, SgLD(gpm): 0 METHOD OF TEST ARD%I
10. WATER ZONES OIejalo NA
DRILLING_ ,C 0
Formation )c..'c yi nn
CLAY
CONSOLIDAI ED ROCK
— O
tr
J
�m
—
^o
ITt�
Z
IL C'I-E.ORCVAIlOV: TyPc h'iPOC'HLORHE Amotmt NA OZ. Ifadditiowl Syoeeieueededruebaekoffonn
12 CASING: LOCATION SKEFCH
Wall Thickness (Shmv direction and distance from el least love, Stoic
Depth Dimnetei or Weiglit Ft Aateiial Roads, of other map reference points]
From 0 To 32 Fr 6 1' 1 " SDR 21 PVC \ 958
0, GKOUI:
Depth
From 0
To 20 Ft.
Ia. SCREEN
Depth Dieureter
From NA
To Ft.
I'.. SANFGKANEL PACE:
Depth
Florin NA
To Ft.
16. REMARKS:
DRY\6'ELL
Matetial Method
SAND MIX GRAVITY
Slot Size Material
in. in
Sic % atmial
PLEASANT I lbL
LOOP RD
US Hl6Y 108
I DO HEREBY CER'11FY T1 TAT THIS WTLI. WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C WELL
CONSTRUCTION STANDARDS" AND TI LIT A COPY OF 11❑S RECORD 1 [AS BEEN PR03TDrD TO TI III WELL OWNER.
642
GT1 REV. 9'91
SIGNATURE OF CONTRACTOR OR AGENT
Subndt migutd to Di.ision of F.oirmunent, Health vtd \Smol Remnrr>
IIQLL CII. RD
071 I6'00
1
Date
idly

To NCDEHBNR N.C. Dept. of Env. Health & Nat. Re:FromALAN S. GANTT 828-286-8787 06/17/00 153054 Page 7 of 10
Sent by the Award Winning Cheyenne Bitware
FOR OFFICE USE ONLY
QUAD. NO. SERIAL NO. _
o La — Loug./—^��_
North Cm'olina- Dry)artment oCEnvirormlrnt. Health and Naluml Resources Lat. tasin /•(=J [t7J
Division of Environmental Manaeernent - Groundwater Section Bnsln Code
P.O.Box'_9535-Raleigl i. N. C. 2626-0535 He,Aer Ew GW-1 Ent
Phnnc(919)133-32^_1
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: CAROLINA WELL DRILLERS, INC.
STATE WELL CONSTRUCTION
DRILLER REGISTRATION NIIpIRER: 180-5 PERMIT NUMBER:
1. WE LL LOCATION, (Show akdcli of the location below)
Nearest low'¢ RL7HERFORDTON counh: RU'I'HER[ 'ORD
7610 IIW Y 231 N.
(Road, Comrnunity. or Subdit-ision and Lot No:) DEPTH DRILLING ,CG
1. OWNER LESTER DOWDLE FkO%I TO Fomntinn UCsci ption
ADDRESS 2610 H W Y 221 N.
RLTHERFORDTON NC 28139
Cityo+Tmn Stole Zip (lode
3. DATE DRILLED 3,29:00 USE OF WELL RESIDENT IAL
d. TOTAL DEPTH 360
3. CUTTINGS COLLECTED YES ❑ NO 0
6_DOES WLILL R[TI.ACH EMS PING IVEI.I;! AFS Q NO
.STATIC WATER LEVEL Below Top of Casing: 83 FT.
(V,e +"If Above ToyofCmu+B)
B. TOP OF CASING IS 2 FT. Above Latd Swfuce'
"CasmB Ta+ninaad auor balow and ,nda« it i0agal ndne a.mianca i. ieeu<d
m u«ordvm. with tlA NCAC _+C .0118
9. YIELD (epm)'. 3 NIETHOD OF TEST ARDM
10. WATER ZONES (dryad)'. 350
0 95 CLAY
95 360 CONSOLIDATED ROCK
I
H. CHLORINATION ' Type
HIPOCHLORI'I'E Amount
9 OZ.
tf aaanio�+al eya«ism«d.d n,. back orfonn
11. CASING:
LOCATION SKETCH
Wall71)ickr)ess
(Show direnion and distance from at lead nvo Slac
Dept
Dlaneter aWcaglNFt.
Mnterml
Roads. or ollm mop reference points)
From 0
To
9S Ft. 6 1:.1 " SDR 21
PVC
^6111
13. ORUUf:
Depth
material
Method
From 0
EN
To
20 Ft. SAND NIIR
GRAVI"1'Y
GILKLI SCHfRD.
u. SCRE
Depth Diameter
From NA
To Ft.
L. SAND --GRAVEL PACK:
Ugllh
Fran) NA
To Ft.
16. RE\LiRKS.
—
Slot Slze Material
in.
Si,c Material
I IXY 221 N.
I DO HEREBY CER-rTY THATTIRS WTTL IVAS CONSTRUCITD N ACCORD.YNCE \bTFH I SA NCAC'_C, 3VELL
CONSTRUCTION STANDARDS, ANT) TILAT A COPY OF If US RECORD ILAS BELN PROVFDFD TO TI IF WELL OR'NER.
640 �p y� ���� 0617/00
GW1 RE\'. 9N1 SIGNATURE OF CONTRACTOR OR AGENT Date
Subndt oni ww t to Divilmn of En.umunnn, Hohh aA Nola) R«oavr,

To. NCDEH&NR N.C. Dept. of Env. Health & Nat. Re From ALAN S. GANTT 828-286-8787
06/17/00
152E 32 Page 5 of 10
Sent by the Award Winning Cheyenne Bitware
FOR OFFICE USE ONLY
QUAD, NO,
SERIAL NO.
Lin.
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North Carolina - Depetlmenl of Environment, l lealth and Natm'al Renounce,
Dii Environmental Management Gfoundwmer Section
Minor[0,n
I i
7
Sion o' -
P.O. Box 29535- Raleigh. N.C. 2'626-0535
Basin Code
Header Ent
GW-1 Ent.
Phone 1919)'/33-1221
NN ELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: CAROLINA WELL DRILLERS, INC.
STATE \\ ELL CONSTRUCTION
DRILLER REGISTRATION NITNIBER: 1805 PERMIT Nl )IBER:
1. WELL LOCATION. (Show skeldn of the looahco below)
Ncnrcvt tnev: RUTHERFORDTON Cnnnt3'- RI I'IIGRFORD
WILLOW'LAKESSUB LOT 30
(Rood, Corrnmuniti. or Subdieiai.o mid Lot No DEPTH DRILLING ,CG
I. OWNER DAVID GRESS FROM TO Finninon Dcea9pl Inn
ADDRESS 818 MAPLE CREEK RD
(Snen or Rmno No_)
RCTHERFORDTOV NC -8139
cot or'towu Stine ZIP Cole
3. DATE DRILLED _1/2"i00 USE OF WELL RESIDLN'I'IAL
a. TOTAL DEPTH 250
s. CUTTINGS COLLECTED YES ❑ NO
6. DOIS WITH, R LPLA(T. B AS PING WELL' )'IS ❑ NO
7, STATIC WATER LEVEL Below Top of Casing: 67 IT
(Use `<' If Above Top of Co=vigl
s. TOP OF CASING IS 3 BY Abave L:md Surface'
'Casug Tmwnmd A blow Imrd surface o la.gd nnt.a a. mimnc le Lsocd
ua a,im dmma wim 11.1 NC AC 1C.0118
Y. YTELD (¢pm)'. _9 METHOD OF TEST ARDYI
10. WATER ZONES (depth) Idi 148
0 83 CLAY
82 "0 CONSOLIDATED ROCK
❑ { —O
it. CHLORINATION' TNx HYPOCHLORHE Amount 6OZ. lfaddiimmi epu, knc<ded u:< backoffmio
I]. CASING. LOCATION SKETCH
Wall'Q)iclmesn (Shore direction mid dimming from nt least two State
Depth Dimneter of Weiedd/FL Material Roads_ or other mapreferuncepoints)
From 0 To
13. GRUU'I':
Depth
From 0 To
14 SCREEN
81 Ft. 61111, SDR 21
PVC
Material Method
20 FL SAND MIN GRAA IT)
Deldh Dimneter Slot S"c Material
From NA To Ftin. in.
1�. S.NND/GRAIEL PACK:
Depth
Fmut NA To Ft.
16. REJLIRLCS:
sign Y9ina'inl
jll
OBSERVATION DR
BAYBERRY DR.
1LLOl\ LAKLk DR,
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED L\ ACCORDANCE IITFH 1 SA NCAC'_C. WELL
COSSTRUCTLON STANDARDS, .ANT) TI LAT .A COPY OF TI IS RFCORD I LAS BEEN PROVIDED TO TIID WELL OW'NLR.
639 1 y� zsK I `/ 1 06-17 0(--
Gw.t Rev. 9rnl SIGNATURE OF CONFR4CTOR OR AGES'r Untc
Subnm m,,.d ne Dbirwn of Ensmoma-1. Hedah it Namrd R... mill

To NCDFH&NR N.C. Dept. of Env. Health & Nat. Re From ALAN S. GANTT 828-286-8787 06/17/00 152F.50 Page 4 of 10
Sent by the Award Winning Cheyenne Bitware
FOR OFFICE USE ONLY
QUID, NO, SERIAL NO. _
North CaoIina- Department of Em irowent, I lealth mid Nartn'al Resources Lnl. Lune �22 2
q B ...ii Roam C L�_N
Division of Enairorunenml \Innagemerrt - Groundwater Section eosin Code
P.O. Be\ 29535 - Raleigh, N.C. T1626A53 s Headar, Ent. GW-I Ent.
Phnne(919)733-3221
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: CAROLINA N ELL DRILLERS INC.
STATE 11 ELL CONSTRUCTION
DRILLER REGISTRATION NiINIBER: 1805 PERMIT NUIIBER:
1. WELL LOCATION. (Show sketch ofthe location below)
Nearest rown. FOREST CITY RUfHLRFURD
9?0 BETHANY CHURCH RD
(Road, Cotwunin. or Subdivision and Lot No.) DE FT H
>..OWNER HORTON HOMES, HUMPHRIES FR11%I TO
ADDRESS 342 HWY 74A
(Sneeor Roam No.)
0 42
RUTHERFORDTON NC 28139
J'_ 220
crty or'ibrnr Shtte Zip Code
3. DATE DRILLED 1, 24:00 USE OF WELL RESIDENTIAL
d. TOTAL DEPTH "0
CUTTINGS COLLECTED I -ES NO ❑<
6 OGG9 WELL IiPFl..4CP: I!TR ZING 1YISL1 ^ 1115 El \O []
7.STAIC. WATER LEVEL Belo,' Top of Casinz: 81 FT.
`t
(U,," If Above Tap o f C'astirg)
_
a. TOP OF CASING IS 2 FT. Above Lmid Surface`
`C.m, Ta.iw,.nd m or below Iwrd i . i, dlsg:d n d .c a omad
m a.eordwi�a r�idr UA FCAC' 2C.9118
9. YIELD (eprn): IS METHOD OF TEST ARDM
to, WATER ZONES(depthr 1-0 210
ii.CHLORNATION'. T)pc HYPOCHLORNF Anton" = OZ.
12. CASING.
Depth
Front 0 To
U. UKUUr:
Depth
From 0 To
14 SCREEN
Wall Thickness
Diameter or Weigl)UFt.
DRILLING .CG
Fmmmion Do,,, iptinn
CLAY
If adJ',tiond ,pace i, needed me b.,k of form
LOCATION SKETCH
1Shoa- direction mtcl distance front of level mo State
Material Roads. or other mop reference points)
Is Ft. 6 U l SDR 21 PVC
Maiel'ial Method
20 FL SAND NHS GRAVITY
Depth Dimmeter
From NA To Ft. in.
16, S.4Er GRAVEL PACK:
Ogvh SVC
Front NA To Ft.
m. RENI4 S'.
Slot Size Material
in.
Mot" ,,I
0 V1 L:1\-D N.
US HYCI 74 Bi PASS
I DO HERF.BS CERTTFY TFLAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE %VITH IS:A NCiC'_C WELL
CONSTRL-C (.)N ST.A\U.1RDS, AND TILAT A COPS' OF TIQS RECORD HAS BEEENPRPRRMIDED In THE WELL OWNER.
638 �y 06 170(, RE9. 9 91 SIGNATURE OF CONTRACTOR OR AGE, F Datc
Subnut o.ouA w Diri,ioo of Eavuommut Heiltb mat Semml Resew ea,

Material Method
SAND MIN GRAVITY
Dimneto Slot Size Material
It, in. in.
S.7c Material
Ft.
To. NCDEH&NR N.C. Dept. of Env. Health & Nat. Re From ALAN S. GANTT 828-286-8787 07/16/00 ' 5208 Page 6 of 8
Sent by the Award Winning Cheyenne Bitware
13954
FOR OFFICE USE ONLY
QUAD. NO. SERLV. NO.
_
North Cuolina- Dcp:utmmt of Environment, health mtA Nanval ResourLat. Long, NO
ces Alamr Ifa,m _
Division ofEnOromnental Management-GrounAwota Section Basin Co _
de
P.O. Box 29535 -Raleigh, N,C. 27626-0535 Holder Ent GW-
Phonet919)733-3221 1&rt-
IVELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: CAROLItNA WELL DRILLERS, INC.
STATE R'ELL CONSTRUCTION
DRILLER REGISTRATION NITNIBER: 18(h PERMIT NUNIBER:
1. R'E LL LOCATIOK: (Show skdclt of the location belou)
Nearcnrttnn'n. CLIFFSIDE Cmmry" RUTHERFORD
119 I TAN E Y DR. -
tRcad,Cornnrunaty. or SublivisionanALa No.) DEPTH DRIIAANG'.,GG
i OWNER BYRON STATE FROM 'I'O Fmmilinn Oc", iprmn
ADDRESS 149 HANEY DR_
(Socet or Roma No) O
35 CLAY
MOORESBORO NC 1_811_I 35
380 CONSOLIDATED
ROCK
C'ityorl'own State Zip Code
3. DATE DRILLED 3'15'00 USE OF WELL RFSIDEN'FI.AL
i. TOTAL DEPTH 380
5. CUTHINGS COLLECTED YES ❑ NO E
O
e_IIUF;S 4VF:1.1. Rf:PLA('L ISXIS'I'ING 1VIil.l' )'ES ❑ NO ]
_
0
7. STATIC WATER LEVEL BeIoty Top of Caving. SS FT.
` n.-ct
,�
(Llz'"'If,16ov<Tap oCCosu}n)
� C a
8. TOP OF CASING IS ? FT. Above Laid Surface`
'�
'Caship Tzmmzamd aVor bdnw 1-d eorfaoa is W,,J oa,, a vanamz i, iunzd
'-L7
m o.cordw— wilt ILl NC'AC 2C 011B
H
a �r
9, YIELD(gpm)'. 5 METHOD OF TEST ARDNT
_N
to, WATER 20NES(dgIW): 361
a
O
11. CHLORINATION: Tepc HYPOCHLORII'E Amount G OZ.
If addiuond ,pvzi,n«dzd aa. balk of form
12, CASING:
LOCATION SKETCH
Wall Hnclmeas
(Show direction and dislarae front at least two Slatc
Depth Dimueter or WogllbFt Mrto'A
Road,, or other map referencepoialo
From 0 To 38 Ft 6 Vi " SDR31 PVC
�-LANE]. DR-
U. GROU"1':
Depth
From 0 To 20 Ft.
if SCREEN
Depth
From NA To
1'. SANITGRA VEL PACK:
Octal
From NA To
t6. REMARKS.
TO Rurf ERFORDTON
GREEN ACRES RD
HWY 74
H1VY Y
HIVI 120
I DO HEREBY CERTIFY THAT THIS \SELL WAS CONSTRUCTED IN ACCORDANCE WITH I'A NCAC'_C WELL
CONSTRUCTION STANDARDS, .AND TILAT A COPY OF 7111S RECORD HAS BEENPROVIDEDTO THE WELL O,VT TR.
648 i � 07/16,00
v
GWI REV. 9 911 SIGNATURE OF CONTRACTOR OR AGES"I' ; Uatc
Submoii� it td to Divi,ion.f E,omo.nzm, H<dth mm 4ad rtuRasotvers

To: NCDEH&NR N.C. Dept. of Env. Health & Nat. Re From ALAN S. GANTT 828-286-8787 03/29/00 22:CO 34 Page 6 of 6
Sent by the Award Winning Cheyenne Bitware
FOR OFFICE USE O - 0 <r
QUAD. NO. SERIAL NO.
Lat. Long. RO
North Carolina- Deponmeot of Environment, health and Natural Resources Minor Basin
Division of Environmental Management - Groundwater Section Basin Code
P.O. Box 29535-Raleith, N.C. 27626-0535 Header Ent. GW-I Ertl.
Phone[phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: C AROLINA WELL DRILLERS, INC.
STATE WELL CONSTRUCTION
DRILLER REGISTRATION NUMBER: 1801 PERAIIT NUMBER:
t. WFLL LOCATION: (Show sketdl of the location below)
Ncnrest town: ELLENBORO Calmly- RLrIHERP)RD
201 WALKER STORE RD
(Road, Community, or Subdivision and Lot No.)
'.OWNER BETTY MOORE
ADDRESS PUB 398
(Street or Ronl< No.)
McBEE SC 29101
City or'Tosmt State Zip Code
3. DATE DRILLED 3/1V00 USE OF WELL RESIDENTIAL
d. TOTAL DEPTH 185
5. CUTTINGS COLLECTED tES ❑ NO 0
6_ U016S WI:I,I, REPLAOI: I:XIS'I'ING lYlfl.la YDS Q NO
7. STATIC WATER LEVEL Below Top of Casing: 3 FT.
(Use ✓'If Above Top of C'azing)
8, TOP OF CASING IS 2 FT. Abose Land Surface'
-C'mbze Trn<wiaeed ate, below land s,. iz dl,sl unless a vadanee is i n<d
at vu<ordmtee wish 15t NC'AC 2C.0118
9. YIELD (gpm): 30 3dEfHOD OF TEST ARDM
10. WATER ZONES (depth): 180
DEPTH
FROM f0
0 37
37 185
DRILLING .CG
Formation Dos, ip-mrt
CONSOLIDATED ROCK
11, CHLORINATION: Tjpc HYPOCHLORI'TE Amount 6 OL. If additional sp.et is n«dtd use bask of to.
12. CASING', LOCATION SKETCH
Wall Thickness (Show direction and distance from al least Iwo Slalt
Depth Diameter or Weight/Ft. Materiel Roads. or other map reference pointo
From 0 To 42 FI. 6 114 " SDR 21 PVC SOLO GAP RD
13, GROUT:
Depth
From 0
To 20 Ft.
LI, SCRBEN
Depth Diameter
From NA
TO Ft,
15. SAND-GRAIEL PACK:
Dcplh
Frum NA
To Ft,
16. REMARKS:
Material Method
SAND MIX GRAVITY
Slot Size Material
in in. 201
517C Malorial
ALDER STORE RD SR 1915
MILLS AVEN
UE
I DO HEREBY CERTIFY TKAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC'''C, WELL
CONSTRUCTION STANDARDS, AND TILAT A COPY OF TI➢S RECORD ILYS BEEN' PROVIDED TO TIIC WELL OWNER
635 03 29 01
OW SIGNATURE OF CONTRACTOR OR AGENT
1 REV. 9�91 U:rtc
&+� rn.` +. Sabnkl odpu-al to Diriaion of Emvomnurt, H<dth and Vartval A<zoia<m

To: NCDEH&NR N.C. Dept. of Env. Health & Nat. Re From ALAN S. GANTT 828-286-8787
03/29/00 21:59:52 Page 5 of 6
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QUAD. NO,
FOR OFFICE USE ohT,
SERIAL NO. 1
Lat.
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- - --
North Carolina-D Department of Environment, health and Natural Rnources
4
Mnor Basin
_
Division ofEmironmental M1f:nagement-Groundwater Section
Basin Code
P.O. Box 29535 -Raleigh, N.0 27626-0535
Headt, Ent.
GW--1 Ent.
Phone [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: CAROLINA WELL DRILLERS. INC.
STATE WELL CONSTRUCTION
DRILLER REGISTRATION NUMBER: 1805 PERMIT NUMBER:
1. WELL LOCATION: (Show sketch of the location below)
Nearest town RCTHERFORDTON County: RUIHERFORD
10' ISHAM DR.
(Road, Community, or Subdivision and Lot No.) DEPTH DRILLING C0
2, OWNER CHRIS GIBSON FROM TO Formation Dcscildmn
ADDRESS 10' ISHA\f DR
(van or R—kNo.) 0 71 CLAY
RLTHERFORDTON NC 71 320 CO\SOLID.AIED ROCK
Ciryor T'o..n Stale Zip Code
3. DATE DRILLED 3/13/00 USE OF WELL RESIDENTIAL
a. TOTAL DEPTH 320 _
5. CUTTLNGS COLLECTED YES ❑ NO
6 DOES WELT. REPLACE EXIS'[NG WELL:? YES Q NO I] —
7. STATIC WATER LEVEL Below Top ofCtsin_:'. 80 FT.
(Usz If Abw< Top of Casur)
8. TOP OF CASING IS 2 FT. Above Laird Surface"
'Casale Tanwand atlor below land sm6uc is dl,d net<ss a.ar — is isen<d
m v.<ordare wirh 15A NCAC 3C .0118
9. YIELD (9jam. d \=OD OF TEST ARDNI
to. WATER ZONES (depth): 315
11.CHLORNATION. Type HYPOCHLORI'lE Amount 8 oz. tf odgriond spa.<is v«d<d nee ba.k of 6mr
12. CASING: LOCATION SKETCH
W all Thickness (Show direction and distance from at least two Start
Depth Diameter o-WeighLD, Material Roads. or other map reference pointo
ISHAM DR_
From 0 To 75 Ft- 6 U l " SDR 31 PVC
13. GRGIU 'ML,LISTON DR.
Depth Material Method
From 0 To 20 Ft. SAND MIX GRAVITY
14, SCREEN
Depth Diane(ci Slot Sne Material
From NA To Ft. in. in. H\VY 64.74
I SANUGRA\EL PACK:
Dqd Size Ntatorial
From NA To Ft.
16. RE\LIRICS:
I DO HEREBY CERTIFY THAT TIES WELL WAS CONSTRUCTED IN .ACCORDANCE WTTH 15A NCAC 2C WELL
CONSTRUCTION STANDARDS, AND TILAT A COPY OF TIDS RECORD I IA.S BEEN PROVmED TO THE WELL OWNER.
634 .r 03, 29 00
Gu'.I BET'. 99t r SIGNATLRE OF CONTRACTOR OR AGENT Dar t
MAY 2
SaL�nr on�id ro Dihswn oF&uwoannrc, HaaIIL aul Nan rd A<sowces

To: NCDEHBNR N.C. Dept. of Env. Health 8: Nat. Re:Fronn ALAN S. GANTT 828-286-8787 03/29/00 21:E 9:10 Page 4 of 6
Sent by the Award Winning Cheyenne Bitware
FOR OFFICEUSEQ jr, 0
QUAD. NO. SERIAL NO. 4
_
Nodh Ca'oliw-Dcpmtmrnt of Environment. Health anANahrzal Resources Minor Hasin
Division of Environmental Management - Groundwater Section Basin Code
P.O. Box 29535 - R41ei0h S.C. 276'_6A535 Head. Ra. GW.1 Ent,
Phone[phone]_I -
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: CAROLINA WELL DRILLERS, INC.
STATE WELL CONSTRUCTION
DRILLER REGISTRATION NUMBER: 180i PERMIT NUMBER:
T WELL LOCATION: (Show sketdi of the location below)
Nearest town: RLTHERFORDTON County: RUTHERFORD
141 WOODVIEW DR.
(Road, Community, or Subdivision and Lot No.) DEPTH
x. OWNER JOYCE PORTER FROM TO
ADDRESS 143 WOODVIEW DR.
RLTHERFORDTON NC
Ciry or Tom State Zip Code
3. DATE DRILLED 3;9/00 USE OFWELL RESIDENTIAL
-1. TOTAL DEPTH 400
1. CUTTINGS COLLECTED YES ❑ NO
6. DOES WEII, REPLACE EXISTING WELL' YIS 0 NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Ust'-` Ifnbovo Toy of Casing)
8, TOP OF CASING IS 2 FT. Above Laud Surface`
•Caeu,, T<.aawad at'or bdew Imul an(u. ie dcpd unl—. whom. L Issued
w auordwncwir ISA NC AC 2C.0118
v- YIELD (gpm): 3 METHOD OF TEST ARDNI
10. WATER ZONES (depth): 180 360
0
83
83
400
DRILLING X G,
F'ovmation Desc.iption
CLAY
CONSOLIDAIED ROCK
It CHLORINATION: TN)c MPOCHLORPI'E Amount 10 oz. Ifoddivionol synee isneeded... bmkoffonn
12. CASING. LOCATION SKETCH
Wall Thickness (Show direction and distance from at lean two Starc
Depth Diameter or Welghtrt. Material Roads. or other nmp reference poim )
From 0
13. GROUT:
To 87 Ft, 61/4" SDR21 PVC
Depth
From 0
To
14. SCREEN
Depth
From NA
To
ts. S.AENTJ/GRAVEL PACK:
Dcplh
From NA
To
16. RENI i S:
Material .Method
20 FL SANDMIX GRAVITY
DiametnSlot Size Material
Ft. in. in. WOODN-'IEINDR.
S17c %latorial
Ft.
D.\RLLNG'10_\ RD
If A, I' „I
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH 15A \CAC 2C, WELL
CONSTRUCTION ST.AN-DAI DS. ANM TELAT A COPY OF TINS RECORD E LAS BEEN PROVIDED TO THE WELL OWNER
633 03290(,
GW'.1 REv 9 9t SIGNATURE OF CO' TRACTOR OR AGENT U�tc
- - Sabuut onmd to Division of Envhmunenp Health and Nnnad R<sowx<s

To NCDEH&NR N.C. Dept. of Env. Health & Nat. Re:Frorn. ALAN S. GANTT 828-286-8787 03/29100 2 1.`830 Page 3 of 6
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QUAD. NO. SERLALNO.
Lat. _ Lone. _ _ RO
Noah Cmolira-D ,tmmtof Enviro=mt.Ilealthand Natural Resources ep• Minor Basin
Division of Environmental Management - Groundwater Section Basin Cade _
P.O. Box 29535- R:deiodt. N.C. 27626-0535 Heade'Ent. GW-1 Ent.
Phone [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: CAROLINA «-ELL DRILLERS, INC.
STATE WELL CONSTRUCTION
DRILLER REGISTRATION NUMBER: 1805 PERMIT NUMBER:
L WELL LOCATION: (Show sketch of the location below)
Nmrc,t to,m FORESTCITY County RUM ERFORD
401 OLD ROSS RD
(Road,Communil). or Subdivisionand Lot No.) DEPTH DRILLING _CGi
2. OWNER WALTERHODGE FROM 'I'U Formation Dcsciprn. on
ADDRESS 401 OLD ROSS RD
(Suet or Route No_) 0 54 CLAY
FOREST CITY NC 28043 54 ISO CONSOLIE.a7 E7 ROCS
City or Tutvn State 2.ip Code
3. DATE DRILLED 3/7/00 USE OF WELL RESIDENTIAL
A. TOTAL DEPTH ISO
5. CUTTNGS COLLECTED YES ❑ NO Q
6. DOGS WELL R17PI,ACF. HXISTING WELL') YES 0 NO ❑
9. STATIC WATER LEVEL Below Top of Caning: 45 FT.
(Use -I- If Above Top of C.unn
8. TOP OF CASING IS 2 FT. Above Land Surface*
`Casing Tesmu med a I., bdo.v Imtd nahm is 81cgd tabus a vmia ec it i,-ed
4...... daoe< veldt Ih1 NCAC 2C.0118
9. YIELD(gpm): IS METHOD OF TEST ARDYI
10. WATER ZONES (dgdtt): 85 1 75
I I. CHLORINATION: Type HYPOCHLORI'1'E Amount 5 OZ. If eddiuo al sp.ce is uced,d t,e 6..k off.,
12. CASING : LOCATION SRECCT-I
Wall TLiclmess (Shmv direction and distance from aa, least mt State
Depth Diameter or Wei2lifft Material Roadk or other map refnmce point,)
From 0
To
13. GROUT:
—
Depth
From 0
To
IA. SCREE\
Depth
From NA
To
M SAN-DGRA4EL PACK
Depth
Frorn NA
To
16. REA15 S:
60 FL 61/1" SDR2I PVC
Material Method
20 FL SAND MIS GRAVITY
DiamelnSlut Size Material
Ft, in. in.
FL
Sire Atotcrial
RALLP.ARK
RD ❑
OLD ROSS RL
HWY 74 BUSLAESS
I DO HEREBY CERTIFY THAT TFQS WELL WAS CONSTRUCTED IN ACCORD.ANCE WITH 15A NCAC 2C. WELL
CONSTRUCTION STANDARDS..AND TILAT A COPY OT THIS RECORD I1AS BELT PROVIDED TO TI Q WELL O W".ER.
632 03 _y 0(
GR'-I P.Ev. 9.91 SIGNATURE OF CONTRACTOR OR AGENT Da
Submit miguid to Ditision of Envbmuaem, Haldt and Namrd Rusow<o
' MAY - 2 0

To. NCDEH&NR N.C. Dept. of Env. Health & Nat. Re:From: ALAN S. GANTT 828-286-8787
03/29/00 2 1 E 7:48 Page 2 of 6
Sent by the Award Winning Cheyenne Bitware
FOR OFFICE USE ONLt 0
QUAD. NO.
SERIALNO. __
Lat.
Long, RO
North Carolina-D artmentofEnvirorunmt,FlealthmdNatural Resources
ep
_ _
Basin
- _ _ _ _ _
Division of Environmental Management -Groundwater Section
Basin
Basin Code
P.O. Box 29535- Raleigh. N.C. 2'626-0535
Heudm'Ent.
GW-1 Ent.
Plume [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: CAROLINA WELL DRILLERS, INC.
STATE WELL CONSTRUCTION
DRILLER REGISTRATION NUMBER: 1805 PERMIT NUMBER:
t. WELL LOCATION (Show sketchofthe location below)
Nearest tors: RUTHERFORDTON County: RUTHERFORD
148 KENDRICK FARM LANE
(Road. Communit)', or Subdivision and Lot No,)
2. OWNER DAV'ID ALLEY
ADDRESS 148 KENDRICK FARM LANE
RLTHERFORDTON NC
City or T'oaws State Zip Code
3. DATE DRILLED 7;6;00 USE OF WELL RESIDENTIAL
d. TOTAL DEPTH 185
). CUTTINGS COLLECTED YES NO 0
6. DOHS 4VH1,L REPLACE EXISTING\YELL.? YL:S 0 NO
7. STATIC WATER LEVEL Belo\v Top of Casing'. 45 FT.
(Us< r- If Abor< Top of Casing)
8, TOP OF CASING IS T FT, Above Laid Swfaces
'Caaug Tsnommud n'or bdow land mnfa s u JI<ga) uNm, as aoi.—, i, uud
us a.<ordwme wits I5A NG\C 2C.01 t8
9- YrELD (gin): ^, 1l2 NIE-IHOD OF TEST ARDNI
to. WATER ZONES (le )m): 77
n
DEPTH
FROM TO
0 72
72 185
DRILLING ,CG
For -nation Dcsniptiou
CLAN
CONSOLIDATED ROCK
ti. CFRARLNATIO`Y. Ttpc HTPOCHLORH E Amount 5 OZ. If oddidonal ya.<i; n«d<d n;e back of form
12. CASING: LOCATION SKETCH
Wall Thickness (Show direction and distance from at least two State
Depth Diameter of WeigNFt_ Material Roads. of othermaprefermcepoints)
From 0 To
U. GROUT:
Depth
75 Ft. 6 1/-1 " SDR 21 PVC
From 0 To 20 FL
1,4. SCREEN
Dgrih Diameter
From NA To Ft.
Material Method
SAND NITR GRAVITY
Slot Size Material
in. in.
Is, SANITGRAVEL PACK KENDRICK' S
OCIA S17C Matmial FARM LN.
Ftnrrt NA To Ft,
15. RENLiRIiS-.
0
PAP\TGRS GAP RD.
PINEY KNOB Rll,
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE V4Tl'H 15A NCAC 2C. WELL
CONSTRUCTION STANDARDS, AND TI LAT A COPY OF THIS RECORD I US BEEN PROVIDED TO TI IE WELL OWNER.
631 03;'29 0C,
l�1 REV 9 SIGNATURE OF CONTRACTOR OR AGENT Date
oo Subtrut onend to Division of Enrd'ormtent, Health and Nauaal Rasomc<s

To: NCDEH&NR N.C. Dept. of Env. Health & Nat. Re From ALAN S. GANTT 828-286-8787
Sent by the Award Winning Cheyenne Bitware
03/16/00 2C:18: 34 Page 11 of 11
QUAD. NO.
FOR OFFICEll,USE OR}f077 (1
North Carolina-DepartmentofEra llaivnmt, health and Nahrznl Resources
Lat'- __
SERIAL {. " —
- Lone, _ _ RO
Division ofEnviriminmtal Nfanagemml- Groundwater Section
Minor Won
P.O. Bax 29535 - Raleigh. N.C. 27626.0535
Basin Code
--
Phone [phone]
HciolrEnt.,
GW-1 Ent.
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: CAROLINA WELL DRILLERS INC.
STATE WELL CONSTRUCTION
DRILLER REGISTRATION NUMBER: 1805 PERMIT NUMBER:
I. WELL LOCATION: (Shmv sketoh oFthe loontion below)
Ncmcat sown: RLTHERFORDTON County: RUI'HIRI'ORU
JERICO WOODS SUBDIVISION LOT Id
(Road,Community. or Subdivision and Lot No.)
DEPTH
2. MINER JOHN DIVITTORIO
DRI[d,ING ,O(i
FROM .L(t
Fbmafi on List,
ADDRESS LOT 14 JERICO WOODS SUBDIVISION
RLTHERFORDTON NC
City or'1'ana Stale
Zip Code
3. DATE DRILLED 3/3/00 USE OF IN -ELL RESIDENTIAL
J. TOTAL DEPTH 105
5. CUTTINGS COLLECTED TES ❑ NO E]
6-DCILSWI:LI, REPLACE EXISTING NVEILt YFS ❑ NO 0
7. STATIC WATER LEAEL Below Top of Cnsing: 87 FT.
(Ull " If Abov<. Toy of Casing)
8. TOP OF CASING IS FT. .Above Lard Suduce'
'Caaurg T<mwumd at or blow land surfa<a is dii;al udaas a vaimrc<ie Iseu<a
m... ordar,r rit, 15A NCAC'_'C'.0118
9. YIELD (2pm): 3 1 Z h[E�FHOD OF TEST ARDM
10. WATER ZONES (5—'1 : 110
CL.11'
CONSOLIDATED ROCK
11. CHLORINATION: Tpac HYYOCHLORI'CE Amount 8 OZ. If vdaitionw svn«is n.<d<a a:<4a<k.f o—
12, CASING:
LOCATION SKETCH
Wall Tluclmeas (Shoe direction and distance from at least Iron Statc
Depth Dimneto orNIcislit Ft. Material Road,. or other map r,ferenm po... ,
From 0 To
13. GROUT -
Depth
From 0 To
ld. SCREEN
27 Ft. 61/1 SDR21 PVC
Matoial Method
20 FL SAND MIX GRAVITY
Dryah
From NA To
15. S.AND;GR.AAEL PACK:
Depth
From NA To
16, REX1ARRS.
Diame[o'
Ft.
FL
Slot Size Material
Size Matoial
JACKIE DRIVE
JERICO DR.
HWY 221
- o=)
_
'a -
Z7
Or
C11
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE 1LTFH 15A NCAC 2C, DELL
CONSTRUCTION STANDARDS, AND TILIT A COPY OP It US RECORD I LAS BEEN PROVIDED TO TI ID WELL OWNER.
630
41 03/16 0C
GW-1 REV, 9-9-11 SIGNATURE OF CONTRACTOR OR AGENT
pp4))- t Sumo
Lnut oneal to Divi.�mt of Fmv. n<np Hmltil atvl Natural R...... a Dale
&r©DntlWx
I ?.Ashur I'asoanxi,
J^O
CO
GO .[
M)

To NCDEH&NR N.C. Dept. of Env. Health & Nat. Re:From: ALAN S. GANTT 828-286-8787
Sent by the Award Winning Cheyenne Bitware
03/16/00 20.17'.12 Page 9 of 11
FOR OFFICE USE ONLY
QUAD. NO.
SERIAL, NO.
North Cmolina- Depvlment of Environment, Ilealtband Nahnd Resources Lot
-Long .— _ _RO
_
Divon of Emit-camental Mmmgement- Groundwater Section Minor Basin
Division
---' -- --
P.O. Bos29535-RIcigh V.C. 27626.0535 Basin Code
--
Phme(919)733-3221 Header&I.
_.. _GW-1Ent, --
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: C4ROLINA WELL DRILLERS INC,
STATE NVELL CONSTRUCTION
DRILLER REGISTRATION NUN IBER: 1805 PERMIT NUMBER:
1. WELL LOCATION: (Show,kelchofthelocation below)
Ncnresttown: FOREST CITY County: RUIHERFORD
,51 OLD ROSS RE
(Road, Conanniury, or Subdivision and Lot No.)
DEPTH
a. OWNER BOB MORGAN
DRHAANC, .CG
FROM To
Fnnnannn Dcsn ipnon
ADDRESS r5l OLD ROSS RU
I In <a or Aom< No.)
°
_
95
cL.aY
FORESTCITY NC 750-03 95 =25
CONSOLIDATED ROCK
City., ]'o", state Zip Code
3. DATE DRILLED 2;29'00 USE OF WELL RESIDENTIAL
L TOTAL DEPTH 205
5. CUTTINGS COLLECTED SEs ❑ NO EJ
6_ DOES WELI, REPLACE: EXISTING WELL' YES
7. STATIC WATER LEVEL Below Top of Casing'. 5°
it 1< If.Abm.< Topof C'asmg.
a. TOP OF CASING IS I FT. Abuve Laid So fiwe-
'Casug Toi wland aCor blow laid nrzto<v o ID(aal iW _ a vanmm< is ism<d
m aaao�dmiaa with 15A NCAC 2C.011&
9. YIELD Npm: 6 \IEfHOD OF TEST
10. WATER ZONES (depth): 123 015
IL CHLORINATION: Type IT POCHLORI'I'E
12. CASING:
❑ NO ❑ _1ZS
O
FT.—3---Rt
_ 4
ARDYI
IV y
[o Q
nmt 6 OL [f oddi�iond spa«ie n«d<d ae<La<k of form
LOCATION SRETC[{
Wall Thicknoss
(Show direction mrd distance from at least two Slat(
Depth
Diameter or Weigln:R Matm'inl
Roade, or other' map reference points)
From 0
To
102 Ft 6 I/-1 " SDR 21 PVC
13. GROUT':
Depth
Material Method
7i
From 0
To
Ft. SAND MIN GRAVITY
u. SCREEN
OLD ROSS RD
Depth
Diameter Slot Sim Material
From NA
To
Ft. tn. in.
HLDLOW
I5. SAN; GRAVEL
PAJK
)epth
S17C Material
Fiotn NA
To
Ft.
HW'Y 74 BUSLNESS
16. RENI:V2RS:
I DO HEREBY CERTIFY THAT THIS WELL w.AS CONSTRUCTED L\ ACCORDANCE IVITH I5A NCAC 2C WELL
CONSTRUCTION STANDARDS, AND TILAT.A COPY- OF THIS RECORD J U S BEEN PROWDED TO THE WELL OWNER.
628
03;16M,
6W.1 REv, 9191 SIGNATURE OF CONTRACTOR OR AGENT
Subnut onyui,d to Division of Em4omnatn Health and Smual R<soma<a Dae
fet '

To: NCDEH&NR N.C. Dept. of Env. Health & Nat. Re:From: ALAN S. GANTT 828-286-8787 03/16/00 20.1.`:46 Page 7 of 11
Sent by the Award Winning Cheyenne Bitware
FOR OFFICE USE ONT v�
QUAD. NO, SER AL NO.
North Caroliw.Dep:utmentof[nvirorunmt, health and Natural ResouLat. Long. ROrces _ — ---_ ---------_- _-
Minor Basin __
Division ofEnvironmrnml Management -Groundwater Section Basin Code
P.O. Bos 39535 - Raleigh. V.C. 17626A535 --
Phone[phone]'_21 Header Ent. GW.I Ent.
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: CAROLINA WELL DRILLERS, INC.
STATE WELL CONSTRUCTION
DRILLER REGISTRATION NUMBER: 1805 PERMIT NUMBER:
L NVELL LOCATION: (Shur sketch of the location beloav)
Nearest mavn. RLTHERFORDTON County: RU'LItERFORD
1888 DARLINGTON RD
(Road. Community, or Subdivision and Lot No.)
2 OWNER THOMAS STOVER
ADDRESS t888 D.ARLINGTON RD
(Sal ac Root, No_)
RLTHERFORDTON- INC 28139
City or'I'maaa State Zip Cnde
3. DATE DRILLED 2(16,00 USE OF WELL RESIDENTIAL
4. TOTAL DEPTH 241
5. CUTTINGS COLLECTED YES ❑ NO 1]
6. DOES WELL IZFPI.ACE F.XISIING WELL° 1'PS NO
7, STATIC WATER LE%EL Below Top of Casing: , _ FT.
(Lz<'�" If Abac<iop of C'aeva�l
8, TOP OF CASING IS 2 FT. Above Land Surface'
Tanwated aeba bduw Imul smfae, ie Jkgal tWcaa a vaimwa lei —d
m a.aordmwe with 15A NC'AC 2C.0118
9. YIELD (gpm): 6 METHOD OF TEST ARDM
10. WATER ZONES(&Ttlir 175 218
IL CHLORINATION'. Type
12. CASING.
Depth
From 0 To
13 GROU"1':
Depth
From 0 To
L, SCREEN
Depth
From NA To
15. SAND'GRA\'EL PACK:
Depth
From NA To
16. RENCU S:
DEPTH
FROM TO
153 2.15
a
DRILLING ,C(,
Formation Dcsn ipt inn
CLAY
CONSOLIDA9'ED ROCK
r -a
co
c`
c i
G
M POCHLORfIE Amount 6 OZ. If adatinotul:yace i, needed ram book of form
LOCATION SKETCH
Wall T1dckness (Shmv direction and distance from at leas tavo State
Diameter or Weigla'Fl. Material Roll(k or other nap reference pointy
162 Ft, 61/1" SDR 21 PVC E7
0
Material Method
20 Ft. SAND MIX GRAVITY
Dia icter Slot Size Material
Ftin. in.
S"C Material
Ft,
N
DRI\T,WAF
O
DARLNGTON RD.
L S Ilk
I DO HEREBY CERTIFY THAT THIS "ELL WAS CONSTRUCTED LN ACCORDANCE 14TIH 15A NC.AC'_C, WELL
CONSTRUC ION STANDARDS -AND T1 PIT A COPY OF TI US RECORD I HAS BEENPROVIDED TO III ]E WELL OWNER.
626 03; 16 0CI
aT—i RFV.991 � _ SIGNATURE OF CONTRACTOR OR AGENT Unle
APR' F Sub a oniaal to Divl.wn a(Envuomnan, Health and Namo1 R,s.,u, ,

To. NCDEH&NR N.C. Dept. of Env. Health & Nat. Re From ALAN S. GANTT 828-286-8787 05/17/00 163848 Page 2 of 2
Sent by the Award Winning Cheyenne Bitware
r
FOR OFFICE USE ONE%' ' j, '..;•, ,'.�
QUAD. NO. SERIAL NO,
Lot. Lon¢. RO
North Carolina -Department of Environment, Health and Natural Resources Minor Basin
Division of Environmental Management - Groundwater Section Basin Code
P.O. Box 29535- Raleipli. N.C. 1626-0535 Header Ent. GW.1 E'ul.
Phone[phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: CAROLINA WELL DRILLERS, INC.
STATE WELL CONSTRUCTION
DRILLER REGISTRATION NUDIBER: 1805 PERMIT NU\TBER:
t- WELL LOCATION. (Show sketch of die location below)
Nearest town RUTHERFORDTON County: RUI'IIERFORD
890 GR.ASSEY KNOB RD.
(Road, Community. or Subdivision and Lot No.) DEPTH DRILLING:_OG
2.OWNER TI.M STEP FROM "f0 Formation Dewi ption
ADDRESS 890 GRASSEY KNOB ROAD
RLTHERFORDTON NC 28139
Cityor Tmwh State ZIP Code
3. DATE DRILLED 2,8i00 USE OF WELL RESIDEN'r1AL
J. TOTAL DEPTH 420
5. CUTTINGS COLLECTED YES ❑ NO 0
6. DOES WELL It EPLACE EXISTING WELLi Y1:S ❑ No Q
7. STATIC WATER LEVEL Below Top of Casing: 36 FT.
(V,,, "*" If At., Top of Cosing)
a. TOP OF CASING IS 2 FT. Abmz Land Surface'
'Casusg Temwuteci Woo blow land surface is 1,isi onlca a va mcc is issued
it, ooeordw,ce w1d, 15A NCAC 2C .0118
9. YIELD(Bnn): 2 NIETHOD OF TEST ARDNT
to. WATER ZONES (del)tlil: 325
Il. CHLORINATION: THhc HYPOCHLORCFE
12. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0
To it Ft.
13. GROUT:
Depth
From 0
To 20 Ft.
14, SCREEN
Depth Diameta
From NA
To Fl.
15. S.3ND�GRAVF.L PACK'.
Depth
D out NA
To Ft,
I& REND S:
—
61 1 " SDR 21 PVC
Material Method
SAND MIX GRAVITY
Slot Size Material
in. in.
SI]e Material
0 38
38 420
If additional syaca is needed
CLAY
CONSOLIDATED ROCK
LOCATION SKETCH
(Show direction and distance from at lean two State
Roads. or other map reference points)
ROCKY SPRL\G
Rll.
GRASSEY K]NOB RD
US H%VY 22t
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TI IAT A COPY OF TI IS RECORD HAS BEEN PROVIDED TO TI IF WELL OWNER.
624
0> 17,00
JUN 19 2000 V NATLREOFCONTRACTORORAGENT Date
nut ou�id to IT,is�on o(Emvomnart, HsdW vhJ Namrai Resources
O
O O

To: NCDEH&NR N.G. Dept. of Env. Health & Nat. Re From. ALAN 5. GANTT 828-286-6787 03/15/00 20.1 :44 Page 4 of 11
Sent by the Award Winning Cheyenne 31tware
PVK Q111CL LSL QNLjJ
t LIAU. NO, SLIUAL NO l
Nor(humvliw-Ugrs'hnvrit,rLrrviforvnnrl. l kdth;md N al ur:Il&,Qunsv La(. Long. k0 --
Uimior, oC Lnvirorunerdal ➢1:maennttA - Unvndwnler Sn1hrtl h1mor IIUriu
PO.IJo.V 2'l!35- 1t:dciliI. N.0 27626-05 L:rsin Cock --
Atonc(9D)7?3-2221 llraJn'Lnt GIV lLnl. WELL C'ONSTRISTIO _RECORD
DRILLING CONTRACTOR: C _AROLINA WELL DRILLERS INC'.
STATE WELL CONSTRUCTION
DRILLER REGISTRATION NUMBER: 180-5 PERMIT NUMBER:
I_ W I:LI. 1 J 1(',I 1111N_ (Show ektt<h of ncc hxn lon clow,
Nc;u'cvt (own: TT.T.r\60RO County- KU'I'HE1LP'UAll
TMN C+RTrRS SI-r7DTVJ )N LOT i
(Boud. Ccuununih', or Suhdivivion ;md "A Rn.) DrPTTr
DulmlMci .CCi
�. ptvNIDt Tr.RP.T6000D 11r
1r0S L1lny 1tl
t'onnulion Ucea qnn+u
AUU1tLSS I`J^01rW'} 7I R}pA9S
i li—t m lmm<N.,i 0 II CLAY
FOREST CITY NC 18011 11 120 COASO_TT T)AIT1 RO( T;
Cif, m lawn Shltl,
Lip CaJc
J. 0111L UlULLLL) 21'00 USLU1'WLLL RTMOT.NTIAT,
I. 1 O LU OLP'111 120
!. CQI I L\GS CUILLC,TL YES NU Q
6DOL'S IVL'LL RL'PLAC'L LAR11Nc lvLLL, TLS ❑ NO El
7_S'I A'IY WA ILK LGYL'L lldow I oCClrving: 1^. to
I CSc-- lfdbmc lop ofC_.)
6. '101`f 11 UA,SLCG LS 2 1 L :Above Land Sur Care'
'Cmug lun�w+m.J slbr brluw IuuJ ��rGar ie Jl.;d uWrrr ,+.matur +. uarrd
m.rrwdmrr will Ld NC'AC A .U116
u, 1ILLU(grn): 20 MIL IIplD 01"I'LSI'
1U_ WNILK ZUNLS (dgI(h)c i1 11.5
ARDbf
o
_
O
—T
�
—
1
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11 (A11.(UNAIVJN'. 'type
11}-POCTR.ORiTC Aruourd i OZ.
year mr
lfuddilion:J. a Jnl m. b.a. of fonu
L. CASING:
LUC:1l1VN S1ti CCll
Willil}lirlmc"
('Show dal,, ;utd ditsac Crow ;rt Ica>I hrc:ilatc
Dcpfll
Dmmctm' nr WeivlmFt. Material
Rmik nr orhnnlnp 1 elcrcuuc p+,ird;I
1'nan 0 'Co
'1,1 1'l. 6 1/1 SDR 21 PVC
01.0
n_GKuui':
MUORP:SHURO RIEC) 74
Ugrdl
Ahrtnial Ndhod
Fmm 0 To
20 Ft. SANDMIX G12A1'1Iy
la. SC'RFFN
nc,rh
I
nimnncr Slnt Sivc 'vfarcrinl
Frnm N,\ Tn
F,. in. in.
I<_ SANITC RAVFT. PAi K
Dcprh
SUC Material
From NA To
Ft.
IAV1 12Q
In. RFNrARKi
r D(i HFRF.RPi FRTIFV THATTTS WFr.H. lVASi0NS7RUC'TRn n ACT 0Rr)ANi'F. 1LTrTi I AVC'AC'_C'. WFI.I.
CYICSTRUCT10A!STA\-DARDS, A\T) THAT A i V IPA- OF TWf RFC'CIRD HAS RFF\ PRC)VInF.n TO THE WFI.i. OW'\TR
p (% / r 03160G
SRNATIRF OF C'O\TRACtIR OR A(iF\T
S +Emit lk ➢'vi.lno of i+r rn, neq ❑<nMund Nam nl R<mnren Dnh
:I WR _ 4 C

To NCDEH&NR N.C. Dept. of Env. Health & Nat. Re From ALAN 5. GANTT 828-280-8787
c
Sent by the Award Winning Cheyenne Bitware
03/16/00 20.1-:04 Page 3 of 11
t INiy� f� r'(i
l (1tSL1tL1L
QUAD. NU.
NI )L 7
Nodfl Cia Idina- llgruQncnt of L...a unenl.11c:dlh uul Nidurd l(cxcun'rs
Lui.
Lml6_ I((1_--
Diei,ion of Lmirorunadal ]Curgttuad - Groundw:der Station
[.furor Basin
--
Y.t 1. Lax'_!n c <.1(alciidr. S,C, 27626-05 t}
basin Cod,
--
Yfwuc('919) 733-Ml
11"alia Lilt.
011'-1 Lnl. --
AVELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: C_:1ROLINA NVELL DRILLERS INC.
STATE 11<ELL CONSTRUCTION
DRILLER REGISTRATION NUMBER: 1805 PERMIT NUMBER:
I.\V 1: 1. I. U)CA'1I I; A (Shaw+knchofthc LICIM111 hcLnv)
Ni,.,A tow¢ III I NO' UO (burl J1
Y Rl HEKkU1217
TWIN CRRLfLS AORDIVISION LOT 3
(iWad. Couunuruly. or SuLdiu N111i land Lvl No
DEPTri
3. OWNUI 7L1.177W06T) llobiP.S
DRiLLIR(1 .(-C
1uQM TO
14nwahon llcsrnpt:nu
twll1CLSS 1920 riR'Y r I RVPASS
1su�.1 or l:uum u�.1 0 25
n -
RFST(.IT) NC 25013
Lit, w Io.0 Slafc
Zap CuJo
J. DATL LAULLLL) V2S-00 U5101 iVLLL RFSIDFNTIAI.
1. I01ALDEP111 260
). CUl'11INGSCGLLLUED ILS 0 NG
D
6 DOL'S VVLLL RLPLU L ENS I LNG R'LLL I
US NU
7SLiI1('WAtU(LL`,LLBclom l op of Cutiug
3S 1-L
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'Cusug l LrrvWUlvd x'or Ld+� Imd nuf.vv a dI.;.J uW.e...aimw ie i.eu.d
u, it. wr drama will ISA i, 'AC' 3C .ullS
Y. I1l:LU(LI..n 15 \1L11 UJll ofILSI
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260
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q
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ra
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o
11. C11LORINARON'. lypc IrYPOCIi.ORrTD Amount 7 OZ. 1h dJili�rul ry... ie ncad.A wo 6.<I. of fvrm
U. CASING: _
LI A':1 fl(I,N SF1:1C11
Null AL1111¢w (Show direction land Jishmoc fnnn el Ica=[ I++o S1al<
Dcprh D(mmocr nI WeiphvFr. Marc, ill Ronde, nr other nlni, l'dcrcnce poinr;)
1`nrm V
13, GROILT.
it, 30 I t. 6 M " SDR 21 PVC
Dgnh
Frmn 0
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U. SCREEN
rkall
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HELL CRSE1<ST-D
InVY 1'_I1
i r)C) HF.RFRY C FRTrFY THAT THIS 4LFIS. WAS CI M7Rl7C'TFD rN AC TVADANC F W1774 15A NC'AC ^_C. WELL
C'ONSTRIYTiON STANDARDS. A\T) THAT A COPY tlF THIS RFC'ORD HAS RFFN PRO17h`FD Ti 1 TFiF ILF.L7, OWNFR.
622 r 03 16 K
i 19 I RRV n1.01 STONATtRF OF CONFIRALTOR OR ACiF\7 --
p�py���p� 5q SJrmrt Ir ❑viol + 1F + n. IT,01, v,,11nm'al Re.nn1'c<a Tint,t,
11 ��.f � •ee e. F4 /r r. i�:

To: NCDEH&NR N.C. Dept. of Env. Health & Nat. Re:From'. ALAN S. GANTT 628-286-8787 03116/00 20. 1.:22 Page 2 of 11
Sent by the Award Winning Cheyenne Bitware
VOR 1.1117CL USL UNLY _
QUAD.W. SLIUALNU
Norlllf]u olina-Ugru4nrnl aCLnviroruneut.11edth :ulJ h'n0.iral l<a'ouaes Lal. Lon¢. KC� ( lJ 0
llivisien vCLncinrtvnnM1al M.vmecrumt - birnor
U.11U 114-,tlnSection U
aeln C"dnd,
BU. Uva 29535 - ltnleiydt. N.C. 27625-V53 s 1leaJcr Lnl. --
YhoneQ)19) 75e.)221 OVV-1 lint.
WELL C:ONSTRUC:TION RECORD
DRILLING CONTRACTOR: C-AROLINa NVELL DRILLERS. INC'
STATE IV'ELL C'ONSTRUC:TION
DRILLER REGISTRATION NUMBER: 1805 PERMIT NUMBER:
1. \V 1:1.1. I.11)L'A'I'I(:1\_ (Show;ketch of the Iucnnnn hdow) --
NnualKnvrr (-TIXF)' Couut)'. RI ITTTFRFORD
1011 P.T.LTOT RD.
(14411LCvuvnonily. or Suhdlvieivn lid Lot No.) DFPTIT DRILT.TNO .C. Ci
!. OIVNLA TTAROTT)TM LTY IKUM 'lU I'Will'dtlon L)nal ipliou
AUUICLSS POTt In0
yr c,mlu Nv 1
INTON b11T13 NC 2S167
CSly u�low„ SC,rtc Lip Cod,
7. U.A'1'L DIULLLU 1'20100 101'WLLL RRSTDFNTTAI.
i.1 t ¢AL UliY 111 510
!. rfU1TL%(OSCOLLLCfLD US ❑ NO
G. UULSFVLLLIUPL9CLLllSCLNUIVLLL' ILS ❑ NO
'. S1Alg•µ'a1li1C LLVLL Uvbo I'opvf Casino' 1S FI:
L'ac if Abwc luy d CsmrC)
6_ TUP IIP CASINU IS _ 17: Above Ladd Surface'
'C'mun l anmrnad stb+ b.luw 4m,J ,urfac i. dl<Fd od..+ s .vimrra 6 isuul
m ++wulmue wilh 15A NCAC !G VII'o
S_ 7ll:LU (tpcn) 111 MU111VU Oil 1Lsf ARDVT
10_ WA ILK ZONLS(,dgtth): 55 M
( IT.A}'
(MOT.TDAI-I)RO(K
O
O
ILCIILUl(LWC11U]: 1';pc Ti}-POCTILORTTfi iVIKUi I] 07. if uddilimd ryua.uu..J<J u.<bsd. oMuu
C, CAMNU: LO! A MIN S11 L'Ir'l l
Wall 11hrArle"= (Shore dint lion ,id diHsu'c lhoar (Ic,rel btu Slat,
Depth Diameter or Weight, Fr. Marcrinl RoarL;. nr mlicrmep rdcmicc poim*)
Irtan a lb .50 11, n 1/h1 " VA 21 PVC,
ll. Ul QLT
V'[Ah
Front 0
Ti) 20
u. Si'RFFR
ncprl
From N,\
Tn
14. SA\Tf); t:R AVFT. PACK
Depth
Fnuu NA
To
In. RFMARFS:
M'Aciml 9ldhod
Fr. StANOMIX GILI%'I1'Y'
Dinnuacr SIM S17C bintcrinl
Fr. in. in. -
S17c Mntc[ iI]
FT'
PAINILRS (, AP RI)
t DO HF.RFRS- CF.RTIF`- THAT THIS ITT i. WAS i l INSTRITi'TFD iN ACC ORrW\0F. WITH I 5 A WAIL' 2i: WR 1.
i TNSTRHC9T(!N STANDARDS. A\T) THAT A C't1P)' OF THIS RFCII IRD HAS RFFN PRl ATF)FD TO TiiF W',FI 7. ORTTR.
-.1.1.10I KI)
-�3U(11'Uti
PI -Y KN(- D 1u)
621 i' 0316'W
31i NATPRF OF CONTRACTOR OR Al ENT Dvtc
Subirn:+nl rn ❑'v: n+ ntm innn<v. n<Id vl YnnnnlRnniusu

To: NCDEH&NR N.C. Dept. of Env. Health & Nat. Re,FromALAN S. GANTT 828-286-8787 02/28/00 21 23: )2 Page 11 of 11
Sent by the Award Winning Cheyenne Bitware
FOR OFFICE USE 0'.Vf 0
QUAD. NO. SERIAL NO.G �J
Let. Loge. RO
Noilh Cuolina- DepMment of Environment Slealfh and Nahval Resources - - ---- - —
Minar Hnsin
Division of Environmental 3lanaeement - Groundwa[n' Section Basin Cade
P.O. Box 29535- Raleigh. N.C. 27626.0535 Header Ent. GW-I EnI.
Phone[phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: CAROLINA WELL DRILLERS. INC.
STATE WELL CONSTRUCTION
DRILLER REGISTRATION NUMBER: 180) PERMIT NUMBER:
L WELL LOCATION (Slow eketchofthe location below)
Ncucst town: RUTHERFORDTON Cnnnly: RUI'HERFORD
WILLISTON DRIVE LOT I
(Rowl.Community, or Subdivision and Lot No.) DEPTH DR ILLINO '.CG
2. OWNER EUGENE SMITH FROM TO Fomtation Dcsaiptmn
ADDRESS 222 HODGE ST.
RUTHERFORDTON NC
City or'I own Stith Z.ip Code
3. DATE DRILLED 1/6/00 USE OF WELL RESIDENTIAL
4. TOTAL DEPTH 360
5. CUTTINGS COLLECTED YES NO Q
6.U(IIiS 4Vp:Lt. I21;PLACF D:FIS'IING WCLI:i 'iF:S Nil
7.ST,ATIC WATER LEVEL Below Top of Casing: 95 FT.
(Um " [f Above Top of Cwuin
a. TOP OF CASING IS 2 FT. Above Lutd St., f ue'
'C'asiog Tanwmted.Vor blow Ivd snfaze isdleojnde... avotoo. is issuwl
a......dame widi 15A NCAC 2C.0118
9. YIELD (gpm): 5 MEIHOD OF TEST ARDM
10. WATER ZONES (depth): 325
It. CHLORINATION'. Type HYPOCHLORPfE Amount
12. CASING.
0
5
12
12 l8
18 360
8 OL.. If.dditioo.l spo<e isneededo
LOCATIO\ SKETCH
Wall Thickness (Show direction end distance from at least to,, Statc
Depth Di.moer or WeightFL Material Roads. or ctlrennryV referevicepointei
CLAY
CONSOLIDAIE7 ROCS
CLAY
CONSOLIDATED ROCK
From 0
To ,10 Ft.
13. GROUT':
Depth
From 0
To 20 Ft.
14. SCREEN
Depth Divnoet
From NA
To Ft.
15. SA.NE GRAVEL PACK:
Depth
F.-In NA
To Ft,
16. REM;U S'.
G
0
o
6 1/4 " SDR 21 PVC MVY 74/64 "' 5 MI TO RL"CHERFORDT ti >
Material Method
SAND MIX GRAVITY
Slot Size Material
in. in.
Size Mitn'i nl
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE l4TFH 15A NCAC 2C. WELL
CONSTRUCIIDN STANDARDS, AND TILAT A COPY OF TI ES RECORD IIAS BEEN PROVIDED TO TI IF WELL OW-.T:R.
620 �9 02 28 00
Ow.1 REV. 9:➢F . SIGNATURE OF CONTRACTOR OR AGENT Die
Submit on�nol to Dlahion of Enviroiwetit, Heelth and Sowed Resources

To NCDEH&NR N.C. Dept. of Env. Health & Nat. Re From. ALAN S. OANTT 828-256-8757 03/16/00 20.14:26 Page 5 of 11
Sent by the Award Winning Cheyenne Bitwaie
ortQUAD. NO. PURSLI2LLL NO. cINLi- it �) Q
Nh Cvoliw DITmlrnml"r Lmiromnrrrl,lk:dlh mul h.M1ur,J Rcvoumc= LM. Long. RU �J —j
llivieicn oCLnvinrtunndal .lhutaeanrnl - UruundmM1cr Snliou Afinor U;min ----
P.U. Uu.S PI}3J-1Laleigh. N.('. 27625 0535 Uasirt Codc
Phollcoic))733.3011 Ilctdn'Lut OW'-1 UA. WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: C'AROLINA WELL DRILLERS INC.
STATE WELL CONSTRUCTION
DRILLER REGISTRATION NLINIBER: 180-5 PERMIT NUMBER:
I,1: CAII'IC7NI: IShow eknch oPthc lornrinn hclow)
Nevest t,1111 Count
) RLrraLxPolm
------------
(Hued, Covununit). or Subdivision ;mJ Lol No`) DEPTH
1. OWNLlt
I1Xum TO
AUll1t1:SS
ur Auul. N. I
N('
c'ily v, "..0 Sink Zip Cud,
J. ll.VIL DIULLD USL Q1 WELL RESMENTiAT.
1.'I'OLAL DLP I11
1. CU i-1'ING5 CULLLCILD 1LS ❑ NO 0
6. UOLS WLLL RLPLVU CUS I LNG \VLLL't )LS ❑ No 0
7. S1i1l1C W.TI LA LEV'LL ❑claw lop ofc;t,ingI I
(Uru- If Abo.v leyef Lehw1
S. 1 OF Ul' CASING IS ? 1''f. Above LwIJ Surf'ncc"
'l'au�p l anwnmJ utbr 6.Ivw Iv,d nn6., i, dl..:d wd... a vmi.�o-v it i.rv.d
m .vwnlm., with 15A NC'AC'!C' .U1IE
u. YLLLD(L1)m) ALIIIU0011LS'f
10. WAIEC WNLS (depUi)
ARFM
r)RIT.LTNt7 .00
I'crtnutiun llcnn tru"I,
Ca,A1'
CO\SOLiDAT GD ROCK
C3
rn;;:
-�
� 4
ti
Fri
co
IL CI11,0ILLN:1Tlr_t,N'. l;epc TT POCTMORTTR Nnourtl 07. it-,ldi&.,J d.A ue. baa: of bnu
yea a n..
L(Ir,41(I\ S1tiL1'Cll
Null lllidatcs' (Show dire,tio i uul di Luu'c 0'om nt ka,l Iuo StA,
DcVtlt Diamacr nl'wmllt"Ft Mnrcrinl Ron&, nr other mop rrtcicnccpninh'I
horn U
1J. GROUT,-- —
Dcplh
From Tn
la. Sc
6 li'I^ SDR^-1 PVC
Mahi;J 6klhuJ
30 R SAND MIX UR Wl'l'1'
Dcnnt ninu,cm
Frent N,1 To F,.
Ic. SANDICiRAVTT. PACK'
ncl,m
Front NA To Fc
In. REMARKS
Slot 5i�u Marcv-inl
in. in
Si, Nrntcrixl
RE)
UKASSF:1" KNOB KI)
US HWY 221
f DO HF,RFRP C'ERTIFV THAT THfS 15717. WAS CONSTRUC'TF.D n ACC ORDANC F. Wrrri I iA WAC ^_C'. lMJ,
- )NSTRIiC TII1NSTAINTIARDS,ACDTHATACOPS'OFTHISRFC'I)RDHASRFFCPRCILTDF,DTCITHE1VFi.T.Clw'\FR.
03/16/U�'
w I R❑ r191;, � STCiNATS'RF.OF t uN7RAt TI iR UR ACiF , r --
:e{dpy �-- Sub nit n'lnl rn D'v fot nfF ,nen, lienhh nvl Rom-nl Fe.mvnr Dele

To: NCDEH&NR N.C. Dept. of Env. Health & Nat. Re:From ALAN S. GANTT 828-286-8787 03/16/00 20 1 F:06 Page 6 of 11
Sent by the Award Winning Cheyenne Bitware
FOR OFFICE USE ON-L2 0 "Ir'Y A
QUAD. NO. SaUAL NO. !� �l i
NorthCuolinz- Departmrnl ofIIneironment. Flealth and Natural Resource, Longs _"— ----- -- - -
Minor Basin _
Division ofEnrirom 9535 Management - Ground-053s Section Basin Code
P.O. Box 29535 -919) 73 N.C. p?626-0535 Hcmde Ent, GW-I Ent. Phone(919) ]33-i2^I ----- WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: CAROLINA WELL DRILLERS, INC
STATE Ii"ELL CONSTRUCTION
DRILLER REGISTRATION NUMBER: I811> PERMIT NITINIBER:
I. WELL LOCATION: (Show sketch of the I ... tion below)
Ncarczl town'. Connty': RUPHLRFORD
(Road, Cctnmuniml of Subdivisionand Lot No)
DEPTH DRILLING
,CC1
Z. OWNER
FROM '1'0 Fommtion Dcsn
iptioa
ADDRESS
I Amn or MA, No.)
0 CL.gY
—
NC
CONSOLIDA9'ED
ROCK
City or I..m State Zip Code
—
1. DATE DRILLED USE OF WELL RESIDENTIAL
—
1. TOTAL DEPTH
—
I CUTTINGS COLLECTED YES 0 NO
—
6. DOI:S WI:1,I. RI':PI.AOI. F:XIS'I'N(i W11,1,-' lES \O
—
Q
o. STATIC WATER LEVEL Belm. Top of Casing' FT.
—�
If Aboa. Toy of Cosine)
8. TOP OF CASING IS ? FT. Above L:m;l Surface'
"Casing Ta.wimed ar'or blow Imd nubs is JLgN nNas a vmivm. is i=su.d
---s-T
U -_
m.... rdm —id, ISA NCAC3C'.0119
v. YIELD (gprnc METHOD OF TEST ARDV
lo. WATER ZONES (dqpUp:
n
1V 21—
1 t. CEII.ORINAT[ON. T.1 H1 FOC'HLORIIE Amount OZ.
Ifaddilionol spaso a.ododus. ba.koffonn
m
Z
IS, CASING.
LOCATION SKETCH
Wall Thicknee
(She. dire[tion mid dislmme from at least Iwo Stale
Depth Dimneler or Weight.11 Material
Roads. or m1nrntapreferenaepolnts)
From 0 To Ft_ 6 1,1 SDR 21 PVC
BILL'S CREEK RD.
u.ceuuT:
Depth
From B
To
14, SCREEN
Depth
From NA
To
15, SAND: GRAIEL PACK:
opth
From NA
To
16. RE\fARIiS
Material Method
20 Ft. SASDMIX GRAVITY
Dimneter Slot Size Material
Ft. in. in.
Ft.
S17C MNcnal
ffi'� 221
I DO HEREBY CERTIFY TFLATTI S WELL WAS CONSTRUCTED U ACCORD.kNCE WITH I5ANCACC WELL
CONSTRUCTION STANDARDS..AND D LAT A COPY OF T1 QS RECORD I LiS BEEN PROVED TO TIE WELL OWNER.
t-- 03'IGO(�
Ow -I —UV-9 9 l SIONATLTIE OF CO\ -TRACTOR OR AGENT Untc
$��g��[, Submlt original to Divl>lon of Etnvomnarc, H.dth and Nmno. l R.sow.a
AP`F,
i �'rosadmzts� "�c^ian
REF

To: NCDEH&NR N.C. Dept. of Env. Health & Na' "
Sent by the Award Winning Cheyenne Bitware
;787 02/28/00 21 22. 22 Page 10 of 11
Nash Carolina - Department of Environment. health and Nat
Division of Environmental Management - Groundwate
P.O. Box 29535 - Raleigh, N.C. 27626.0535
Phone [phone]
FOR OFFICE USE ONLY
uT SERIAL NO. �}��
_ Lena. _ — /--
MinorBvsin - -- _—
Basin Code --
HeuderEnl. GW-1 Ent.
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: CAROLINA WELL DRILLERS, INC.
STATE WELL CONSTRUCTION
MILLER REGISTRATION NUMBER: 1805 PERMIT NITNIRER:
L WELL LOCATION: (Show sketch of the location below)
Nearcat town'. ELLENBORO County: RUTHERFORD
534 SOC'O GAP RD.
(Road, Community. or Subdivision and Lot NO DEPTH DRILLING -LOG
2 OWNER HOYLE SCRUGGS FROM TO Formation Ucscipttor,
ADDRESS 534 SOCO GAP RD_
(soem ur Roat' No.) 0 57 CLAY
ELLENBORO NC 280-10
City or lo.ni State Zip Code
9. DATE DRILLED 12/3(T99 USE OF WELL RESIDENTIAL
d. TOTAL DEPTH 240
±. CUTTINGS COLLECTED }ES ❑ NO El
fi_ DOES WhLI, RITLACL' EXISTING WFI,I.4 YES ❑r NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 56 FT.
(Cse -+' If Above Top of Casinto
8, TOP OF CASING IS 2 FT. Above Land Solace'
'Caahig Tunawarad allor bdow laid swfaa is 11,99 miles a vonaucc i$ usual
m....,dame vici15ANCAC2C 0118
9. YIELD (_apm,): 20 METHOD OF TEST ARDM
10. WATER ZONES (dg)th): 80 210
2d0 CONSOLIDATED ROCK
It. CHLORINATION: Type hMCHLORITE Amount 6 OZ. rfadd'niond,w=< encoded n,< bul, ofform
12, CASING: LOCATION SKETCH
Wall Thieknes (Show direction and distance from at least nco Stare
Depth Diameter or Weight/Ft Material ,toads. or other map reference point,I
From 0 To
U. GROUC
61 Ft 6 1/4 " SDR 21 PVC
Depth
From 0
To 20 Ft.
14. SCREEN
Depth Dioneter
From NA
To Ft,
15. SAND%GRAVEL P.ACF'.
Depth
From, NA
To Ft,
16, RE:vG1RICS:
—
Material Method
SAND MIX GRAVITY
Slot Size Material
in. is US HA Y 74
SI)e Material
534
SR- 1930
SOLO GAP RD
I DO HEREBY CERTIFY THAT THIS NVELL WAS CONSTRUCTED IN ACCORDANCE INTTH 15A NCAC 2C. IVELL
CONSTRUCHON STANDARDS. AND THAT A COPY OF TI IS RECORD HAS BEEN PROVIDED TO FIF. WELL OINT ER.
619 02280(,
GW.1 REc. 9N4 _ SIGNATURE OF CONTRACTOR OR AGEN7 Dalc
._ Submit o*nd to Di lsion of En.tromnou, Hcddr and Normal Rromcm

To NCDEH&NR N.C. Dept. of Env. Health & Nat. Re From ALAN S. GANTT 828-286-8787 02/28/00 21 20: 58 Page 8 of 1
Sent by the Award Winning Cheyenne Bitware
FOR OFFICE USE ONLY�(1 (�
QUAD. NO. SERL.II. NO.— 11 —0 Q
Let. Lone. RO
NorthCal'olina-Depa mentofCnvironmmt,llealthandrN-alonl Resources Nlinor Basin
Division of Environmental N[anagemml - Groundwater Section Basin Code --
P.O. Box 29535- Raleigh.N.C. 27626.0535 Header Ent. GW-I Ent.
Prom(919) 733-3221
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: CAROLINA WELL DRILLERS, INC.
STATE WELL CONSTRUCTION
DRILLER REGISTRATION NUMBER: 1811i PERMIT NUMBER:
t. WELL LOCATION: (Show sketch of the location below)
Nearest town' FORESTCITY County: RUFHERFORD
472t LIS HWb'Y 221 FOREST CITY NC
(Road, Communiry. or Subdivision and Lot No.) DEPTH DRILLING ".CG
2. OWNER HARVEY HARRIS FROM TO Formation Ve.=ription
ADDRESS d773 i rS IRVY'221
FOREST CITY NC
City or Town Slate Rip Code
i. DATE DRILLED 12/27!99 USE OF WELL RESIDENTIAL
,I. TOTAL DEPTH 1_00
S. CUTTINGS COLLECTED YES ❑ No El
6. DOES W11L REPLACE Eh9S LING WIiLL" SLS ❑ No Q
7.STATIC WATER LEVEL Below Top of Casing: 52 FT.
(U,se. "If Above Top of Casing)
s. TOP OF CASING IS 2 FT. Above Land Surface'
'Cason, T<mwmted atlor below load surface is illegal nokss a vmivtm le issmd
ne..... dwtce.vldrt5ANCAC2C 0118
9. YIELD term): 8 ',=OD OF TEST ARDM
to. WATER ZONES(dq)00: 80 ISO
u. CHLORLNATION'. Type
12. CASING.
Depth
31 CLAY
220 —CON SOLID.ATE:)ROCK
M
o^•
fV
�—
lD
�
r
s
H)POCHLORII'E Amount S oz. Ifaddirrnal spaceonerd<J use buck ff.,..
LOCATION SKETC`i
Wall Tlucla ess (Show direction and distat:ce from az least n.r State
Diameter or Weigh FL Material Roads. or other map refn mcr poll1w
From 0
To
34 Ft.
U. GRUUI':
Depth
From 0
To
20 FL
1J, SCREEN
Depth
Divneln'
From NA
To
Ft.
I!. S.4'JDiGRAWEl PACK:
Depth
Fmm NA
To
Ft.
16. RENLARKS.
—
61/4" SDR21 PVC
Material Method
SAND MIX GRAVITY
Slot Size Nfaterial
in. in.
SnC Material
] 1\\T =' 1
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND TI LAT A COPY OF TFQS RECORD I L1S BEEN PRONDED TO TI IE Wri i OW'.-TR
617 if) _ -.0 02'-SV
SIGNATURE OF CONTRACTOR OR AGENT hac
G'i - Subrrea n hail to N ision of Envirorvnenr. Heddr and N.hr.l Rrowa<s