WI0600086_GEO THERMAL_20120130

Permit Number
Program Category
Ground Water
Permit Type
WI0600086
Injection Water Only GSHP Well System (5QW)
Primary Reviewer
eric.g.smith
Coastal SW Rule
Permitted Flow
Facilit
Facility Name
S&S Partners LLP
Location Address
155 Grant St
West End
Owner
,Owner Name
S & S Partners LLP
Dates/Events
NC 27376
Scheduled
Orig Issue
01/30/12
App Received Draft Initiated Issuance
11/23/11
Regulated Activities
Heat Pump Injection
Outfall NULL
Central Files: APS_ SWP_
01/30/12
Permit Tracking Slip
Status
Active
Project Type
New Project
Version
1.00
Permit Classification
Individual
Permit Contact Affiliation
Randall Cutter
6105 Rest Home Rd
Claremont NC
Major/Minor
Minor
Region
Fayetteville
County
Moore
Facility Contact Affiliation
Owner Type
Unknown
Owner Affiliation
Christoph Diasio
195 W Illinois Ave
Southern Pnes
Public Notice Issue
01/30/12
NC
Effective
01/30/12
28610
28387
Expiration
Waterbody Name Stream Index Number Current Class Subbasin
Aw*FirvA
lir1CDENR.
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakiid, P.E. Dee Freeman
Governor Director Secretary
January 31, 2012
S&S Partner LLP
Dr. Cluistoplt Diasio
195 West Illinois Ave
Southern Pines, NC 28387
Subject: Acknowledgement of Intent to Construct Type 5QW Injection Well System
Permit No. W10600086
155 Grant Street, West End, NC 27376
Dear Dr. Diasio:
On November 23, 2011, the Aquifer Protection Section (APS) received notification of your intent to construct a closed -loop water -
only geothermal injection well system for the operation of a ground -source heat pump located at the address referenced above. An
individual permit is not required for the construction and operation of this type of geothermal injection well system as Tong as the
following conditions are met:
1. The injection well system contains only potable water,
The injection well system is constructed in accordance with well construction standards specified in North
Carolina Administrative Code Title 15A Section 2C Subchapter .0213, and
The required notification form and associated maps have been completely and accurately submitted.
Failure to comply with all of these conditions constitutes a violation of the North Carolina Well Construction Act and North Carolina
Administrative Code Title 15A Section 2C Subchapter .021I(u)(2). Additionally, you should contact the Moore County Health
Department as they may have additional requirements for this type of system. Noncompliance with applicable state, county, or
municipal rules and regulations may result in the assessment of civil penalties.
Please contact Mike Rogers at [phone] or Michael.Rottersfa'ncdenr.uov if you have any questions.
Sincerely,
,forte bra W
Supervisor
cc: Fayetteville Regional Office - APS
APS Central Files - Permit No. W10600086
Moore County Health Dept.
Go! Green Drilling; Randall Critter)
Sunbelt Mechanical. l,i.0 (Chuck Ferrell)
AQUIFER PROTECTION SECTION
1636 Nail Sen+ice Center, Raleigh, North Carolina 27699.1636
Location: 512 N. Salisbury St., Raleigh, Nonh Carolina 27604
Phone: [phone] I FAX: [phone]
Internet www.ncwateraua[[tv.orci
An Equal Qppequnity I Affirmative Action Employer
One
NarthCarolina
Vaiiiraiy

RErEIVarrO. M INA)
NORTH CAROLINA A3LuIFFIi'PRnirr.-rim 1>� 0 1iog
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES (NCDENR) 7 n 1!
NOTIFICATION OF INTENT TO CONSTRUCT A CLOSED -LOOP GEOTHERMAL
WATER -ONLY INJECTION WELL SYSTEM:
TYPE 5-QW WELL(S)
In Accordance with the provisions of NCAC Title 15A: 02C.0200, please
complete this notification and mail to address on the back page (please Print or Tyne information).
DATE: NO V 17 , 20 / 1 .p k 12)(0
Well Type Confirmation: Does the proposed system circulate potable water onl\ (no additives) in
continuous piping that completely isolates the fluid from the environment (i.e.
closed -loop)?
Yes X Continue completing this form.
No Do Not complete this form. Complete other UIC application forms for installing either a
5A7 well (open -loop well injecting potable water into the aquifer) or a 5QM well (closed -loop
well containing additives such as R-22, ethanol, or other antifreeze or corrosion inhibitors).
A. PROPERTY OWNER(S)/A.PPLICANT(S)
List each Property Owner Iisted on property deed (if owned by a business or overninent agency, state name of
Si-S Ar4ncte54 LLB
1
entity and a representative w/authority for signature):
l)r C - t —h?44h C (A.si
(1) Mailing Address: ° 5 DIY e. st Till n o is
City: SOf1 PII 61 State:1 Zip Code: S 5 $i
Home/Off ce Tele No.: 1 10 - (Ica ^ A hI Cell No.:
Email Address: Website:
County: MVDry
(2) Physical Address of Well Site (if different than above):
City: 0 L+ e \ct State: NI C2ip Code: .,?131(62 County: 1\O0r(---1
155 Ei rL n+ 3t- .
Home/Office Tele No.: Cell No.:
S. AUTHORIZED AGENT OF OWNER, IF ANY (if the Permit Applicant does not own the subject property,
attach a letter from the property owner authorizing Agent to install and operate UIC well)
Company Name:
Contact Person: EMAIL Address:
Address:
City: State: Zip Code: County:
Office Tele No.: Ce11 No.:
Website Address of Company, if any:
GPU/U1C 5QW Notification of intent Form (Revised 8/2008) Page 1

C. WELL DRILLER INFORMATION
Company Name: ___ G=o=!~G=r""e=en==D=ri=ll=in=g..,_. =In=c"-. _____________ _
Well Driller Contractor's Name: Randall E. Cutter ----'~=~~=~----------------
NC Contractor Certification No.: --~2~8~1~8-~A~-------------------
Contact Person"-: __ __,R=a=n=d=al=l--=C=u=tt=er'-------------=EMA==I=L....a.A=d=d=re=s=s:'--"r=an=d==-'v->.::@:;;.:.g~o::..:al!=re=e=n=dr=il=li=n..,_g.=c=om=---
Address: __ ~6 =10=5~R=e=s"'"t =H=om=e-=-R=d"'--. _______________________ _
City: Claremont Zip Code: 28610 County: ----=C=a=ta'-'-w"""b=a _____ _
Office Tele No.: ___ 8~2~8-~3~67~-~12=9~3 ____ Cell No.: 828-228-1695
D. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
CompanyName: Sunbe.t+ Mcchan(caL. } L.L-(:,,,
Contact Person: t hu e.IL, Rrrtl \ EMAIL Address: Sun\?el+Clr\utll-~ V'il-,'l.dsheo,n.ntt
Address: po 00 ( 2 (.p [t"J
City: fl°ntn u6t ZipCode:~mff County : ___ M_OO_r-_~------
OfficeTeleNo.: 9 10 ,,. qi.-fl-J-~0 4-/ CellNo.: __________ _
E. STATUS OF APPLICANT
Private: __ _ Federal: __ _ Commercial:__x
State: __ Municipal: __ Native American Lands: __ _
F. INJECTION PROCEDURE (briefly describe how the injection well(s) will be used)
G. WELL CONSTRUCTION DATA
(1) Proposed date to be constructed: __ "'"'A=S=A=P ____ Number of borings: ---=2'-'-4 __ _
Approximate depth of each boring (feet):___,2=0-=-0 ______ _
(2) Type of tubing to be used (copper, PVC, etc): Hi gh Densi ty Pol yethelene
(3) Well casing. Is the well(s) cased? (check either (a.) Yes or (b.) No below)
(a) Yes __ if yes, then provide casing information below
Type: __galvanized steel __ black steel _plastic _other (specify)
Casing depth: From ___ to ___ feet (reference to land surface)
Casing extends to above ground __ inches
(b) No __x__
(4) Grout Info (material surrounding well casing and/or piping):
Grout type: Neat Cement __ Bentonite
Grout placement: Pumping __x_ Pressure
Other (specify) Thermal Grout
Other
(a)
(b)
(c) Grout depth of tubing (reference to land surface): from ___,O'---_ to 200 (feet)
If well has casing, indicate grout depth: from to __ (feet)
GPU/UIC 5QW Notification of Intent Form (Revised 8/2008) Page2
H. INJECTION -RELATED EQUIPMENT
Attach a diagram showing the engineering layout or proposed modification of the injection equipment and exterior
piping/tubing associated with the injection operation. The manufacturer's brochure may provide supplementary
information.
I. LOCATION OF WELL(S)
Attach two copies of maps showing the following information:
(1) Include a Site Map (can be drawn) showing: buildings, property lines, surface water bodies, potential
sources of groundwater contamination and the orientation of and distances between the proposed well(s) and
any existing weil(s) or waste disposal facilities such as septic tanks or drain fields located within 200 feet of
the geothermal heat pump well system. Label all features clearly and include a north arrow.
(2) The Site Map must show the subject property in relation to the surrounding area by using at least two fixed
reference points such as roads, streams, and/or highway intersections.
.f. CERTIFICATION
Note: This Permit Application must be signed by each person appearing on the
recorded legal property deed.
"I hereby certify. under penalty of law, that I have personally examined and am familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and complete.
I am aware that there are significant penalties, including the possibility of fines and imprisonment, for submitting
false information. I agree to construct, operate, maintain, repair, and if applicable, abandon the injection well and
all related appurtenances in accordance with the approvr41 specif tions and conditions of the Permit."
RECEIVED t ►;���i
ficom opnrre, ovr scam
NOV 23 2041
Signature of Property Owner/Applicant
aft.s.ieh R. aras;it
Print or Type ku11 Name and title
MO Fivifi
Signature of Property Owner/Applicant
Print or Type Full Name and title
Signature of Authorized Agent, if any
Print or Type Full Name and title
Please return two copies of the completed Application package to:
North Carolina DENR-DWQ
Aquifer Protection Section-UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
GPU/U1C 5Q W Notification of Intent Form (Revised 8/2008) Page 3

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES (NCDENR)
RECEIVED r DtNR t DWQ
AQUfr=;::R PROTFr.T/()N SF:CT/ON
NOV "'') 2011.
NOTIFICATION OF INTENT TO CONSTRUCT A CLOSED-LOOP GEOTHERMAL
WATER-ONLY INJECTION WELL SYSTEM:
TYPE 5-0 W WELL (S)
In Accordance with the provisions ofNCAC Title 15A: 02C.0200, please
complete this notification and mail to address on the back page (please Print or~ information).
DATE: Nbv 17 20 // , -
Well Type Confirmation: Does the proposed system circulate potable water only (no additives) in
continuous piping that completely isolates the fluid from the environment (i.e.
closed-loo p)?
Yes X Continue completing this form.
No __ Do Not complete this form. Complete other VIC application forms for installing either a
SA 7 well (open-loop well injecting potable water into the aquifer) or a SQM well (closed-loop
well containing additives such as R-22, ethanol, or other antifreeze or corrosion inhibitors).
A. PROPERTY OWNER(S)/APPLICANT(S)
List each Property Owner listed on property deed (if owned by a business or government agency, state name of
entity and a representative w/authority for signature): S 1-S P 0. (--}-V'\ l ( S L. L--f
Dr-. e, hv--1 s-t-o ph u, c'-~ \.D
(1) Mailing Address:, _ __,)c_°l__:_5_· _V_Vl_~_+_· _T_. _\1 _1 ·_n_o_is __ A-_v_l, ______ _
City: Sou-\1'etf\ Pi,'\CS State:NUzipCode: ~'B'3i7 County: M 00 re..,,,
Home/Office Tele No.: _ _,9'---J=Q_-_(;=--i_q=Ji'--.---"-~-'-L/--'----'l/--L/'-------'c=e=ll _.c.._N=o,_,_.: ________ _
Email Address: _________ Website: _____________ _
(2) I c:::5 6 r a ii\-t · c-;t-• Physical Address of Well Site (if different than above): _ _. _ _:.,,::....:::...._ __ :...:_:__,_ ,_..J _____ _
City: VV a-f t f"\d. State : N ~ip Code: ;;J7 21 (o County: (V\ QJ((_..,,
Home/Office Tele No.: ____________ Cell No.: __________ _
B. AUTHORIZED AGENT OF OWNER, IF ANY (if the Permit Applicant does not own the subject property,
attach a letter from the property owner authorizing Agent to install and operate UIC well)
Company Name: _____________________________ _
Contact Person.,_: -------------~E=M'-'-=-A=I=L-=-A=d=d=re=s=s: __________ _
Address: ________________________________ _
City: _________ State: __ ZipCode: ______ County: _______ _
Office Tele No.: Cell No.:
Website Address of Company, if any: ______________ _
GPU/UIC 5QW Notification oflntent Form (Revised 8/2008) Page I
C. WELL DRILLER INFORMATION
Company Name:. ___ G=o=!'-G=r=e=en=-=D-'-'ri=ll=in=g.,_. =In=c.._. _____________ _
Well Driller Contractor's Name: --'--R'--"a=n=d=a=ll =E~. =C=utt=e=r ________________ _
NC Contractor Certification No.: ------=2=8'-'-l -=-8--=-A..__ __________________ _
Contact Person.~: ___ R~an=d=a=ll ~C'--"u=tt=er~-----~E=M=A=I=L~A-=d=d=re=s=s:~r=an=d=--yw..@.,.g""o""gr,.,_e=e=n=dn~·1=1i=n..,.g_.c=om~_
Address: ___ 6=-l=-.,0=5~R-=e=st.:..CH'--". =om=-e..:..R=d"---. ______________________ _
City: Claremont Zip Code : 28610 County: --~C=a=ta~w~b=a _____ _
Office Tele No.: --~82=8'--'-3=6'--'-7~-1=2=-9=-3 ____ Cell No .: 828-228-1695
D. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company Name: S' u n be. 1 + Mc c ha n i' c a..L i L-L-0 .
Contact Person: (1 hu CIL, ft(re l l EMAIL Address: Sun~l+(nutl(..... ~ v,11·,"ld~hecirn.(ltt
Address: P O '20 K 3 lp <t ~
City: ~itY.h.u6t ZipCode:~Wli# County: ___ M_oo_r_~-------
OfficeTeleNo.: (j 10 ~ qyl-J-~0 4=/ Cell No.: __________ _
E. STATUS OF APPLICANT
Private: __ _ Federal: __ _ Commercial :__x
State: __ Municipal: __ Native American Lands: __ _
F. INJECTION PROCEDURE (briefly describe how the injection well(s) will be used)
G. WELL CONSTRUCTION DATA
(1) Proposed date to be constructed: __ .,_A=S<.:..A=P ____ Number of borings: --=2::...,4c__ __
Approximate depth of each boring (feet):--=2'--"0-'-0 ______ _
(2) Type of tubing to be used (copper, PVC , etc): Hi e:h Densi tv Pol yethelene
(3) Well casing. Is the well(s) cased? (check either (a.) Yes m: (b.) No below)
(a) Yes __ if yes , then provide casing information below
Type: __galvanized steel _black steel _plastic _other (specify)
Casing depth: From ___ to ___ feet (reference to land surface)
Casing extends to above ground __ inches
(b) No _x_
( 4) Grout Info (material surrounding well casing and/or piping):
(a) Grout type: Neat Cement __
(b) Grout placement: Pumping __x_
Bentonite
Pressure
Other (specify) Thermal Grout
Other
(c) Grout depth of tubing (reference to land surface): from O to 200 (feet)
If well has casing, indicate grout depth: from ___ to __ (feet)
GPU/UIC 5QW Notification of Intent Form (Revised 8/2008) Page2
I3. INJECTION -RELATED EQUIPMENT
Attach a diagram showing the engineering layout or proposed modification of the injection equipment and exterior
piping/tubing associated with the injection operation. The manufacturer's brochure may provide supplementary
information.
1. LOCATION OF WELL(S)
Attach two copies of maps showing the following information_
(1)
Include a Site Map (can be drawn) showing: buildings, property lines, surface water bodies, potential
sources of groundwater contamination and the orientation of and distances between the proposed well(s) and
any existing well(s) or waste disposal facilities such as septic tanks or drain fields located within 200 feet of
the geothermal heat pump well system. Label all features clearly and include a north arrow.
(2) The Site Map must show the subject property in relation to the surrounding area by using at Least two fixed
reference paints such as roads, streams. and/or highway intersections,
J. CERTIFICATION
Note: This Permit Application must be signed by each person appearing on the
recorded legal property deed.
"I hereby certify, under penalty of law. that I have personally examined and am familiar with the information
submitted in this document and all attachments thereto and that, based an my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and complete_
I am aware that there are significant penalties, including the possibility of fines and imprisonment. for submitting
false information. I agree to construct, operate. maintain, repair, and if applicable, abandon the injection well and
all related appurtenances in accordance with the approvr it speciftions and conditions of the Permit."
AqRet.61 Vet) u{rh 1FFri+
1�R; iiN
Signature of Property Owner/Applicant
R . VA)O
Print or Type Full Name and title
Signature of Property Owner/Applicant
Print or Type Full Name and title
Signature of Authorized Agent, if any
Print or Type Full Name and title
Please return two copies of the completed Application package to:
North Carolina DENR-DWQ
Aquifer Protection Section -[TIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
OPU/UIC 5QW Notification of Intent Form (Revised 8/2008) Page 3

Ro gers, Michael
From:
Sent: ·
To:
Cc:
Subject:
Attachments:
Randall Cutter [[e-mail]]
Sunday, February 19, 2012 11 :37 AM
Mark Stewart
Chuck Ferrell; Rogers, Michael; Charles Riggs
Completion Reports for Sandhills Pediatrics
Sandhills Pediatrics #WI0600086 GW-1a -GL-1.pdf; Sandhills Pediatrics #WI0600086
GW-1a -GL-2.pdf; Sandhills Pediatrics #WI0600086 GW-1a -GL-3.pdf; Sandhills Pediatrics
#WI0600086 GW-1a -GL-4.pdf; Sandhills Pediatrics #WI0600086 GW-1a -GL-5.pdf;
Sandhills Pediatrics #WI0600086 GW-1a -GL-6.pdf; Sandhills Pediatrics #WI0600086
GW-1a-GL-7.pdf; Sandhills Pediatrics #WI0600086 GW-1a -GL-8.pdf; Sandhills Pediatrics
#WI0600086 GW-1a -GL-9.pdf; Sandhills Pediatrics #WI0600086 GW-1a -GL-10.pdf;
Sandhills Pediatrics #WI0600086 GW-1a -GL-11.pdf; Sandhills Pediatrics #WI0600086
GW-1a -GL-12.pdf; Sandhills Pediatrics #WI0600086 GW-1a -GL-13.pdf; Sandhills
Pediatrics #WI0600086 GW-1a -GL-14.pdf; Sandhills Pediatrics #WI0600086 GW-1a -
GL-15.pdf; Sandhills Pediatrics #WI0600086 GW-1a -GL-16 .pdf; Sandhills Pediatrics
#WI0600086 GW-1a -GL-17.pdf; Sandhills Pediatrics #WI0600086 GW-1a -GL-18.pdf;
Sandhills Pediatrics #WI0600086 GW-1a -GL-19.pdf; Sandhills Pediatrics #WI0600086
GW-1a-GL-20.pdf; Sandhills Pediatrics #WI0600086 GW-1a -GL-21.pdf; Sandhills
Pediatrics #WI0600086 GW-1a -GL-22.pdf; Sandhills Pediatrics #WI0600086 GW-1a -
GL-23.pdf; Sandhills Pediatrics #W10600086 GW-1a -GL-24.pdf; Sandhills Pediatrics
#WI0600086 GW-1a -GL-25.pdf; Sandhills Pediatrics #WI0600086 GW-1a -GL-26.pdf;
Sandhills Pediatrics #WI0600086 GW-1a -GL-27.pdf; Sandhills Pediatrics #WI0600086
GW-1a -GL-28.pdf; Sandhills Pediatrics Borehole Coordinates.docx; Sandhills Pediatrics
Borehole Locations.jpg
NCDENR Permit# WI0600086
Moore County Permit# 110872
Attached are the Completion Reports, Loop locations and loop GPS Coordinates for the geothermal loops at the
following address:
Sandhills Pediatrics
155 Grant Street
West End, NC 27376
Hard copies have been mailed to the following address:
Thanks,
Division of Water Quality -Information Processing
1617 Mail Service Center
Raleigh, NC 28699-161
Randall E. Cutter, CGWP
IGSHPA Accredited
Go! Green Drilling, Inc.
6105 Rest Home Rd.
Claremont, NC 28610
828-367-1293 (office)
828-228-1695 (cell)
[e-mail]
www .GoGreenDrilling.com
1
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2818-A
1. WELL CONTRACTOR:
Randall E. Cutter
Well Contractor (individual) Name
Go! Green Drillina. Inc.
Weil Contractor Company Name
6105 Rest Home Rd,
Street Address
Claremont NC 28610
City or Town
( 828 a 367-1293
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10600086
Slate Zip Code
OTHER ASSOCIATED PERMIT#(if applicable) 110872
SITE WELL ID #(irapplicabie) GL-1
3. WELL USE (Check Applicable Box): Residential Water Supply 0
DATE DRILLED 12/01/2011
TIME COMPLETED 3:00 AM ❑ PM lit
4- WELL LOCATION:
CITY: West End couNTY Moore
155 Grant Street 27376
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑ Valley tifFlat ❑Ridge ❑ Other
LATITUDE 35 " DMS OR 35.265813 DD
LONGITUDE 79 " DMS OR -79.584478 Do
Latitude/longitude source: [&PS Qropographic map
(location of well must be shown on a USGS topo map andsttached tc
this fvrrn if not using GPS)
5. WELL OWNER
S&S Partners LLP. . Dr. Christooher Diasio
Owner Name
195 West Illinois Ave.
Street Address
Southern Pines NC 28387
City or Town State Zip Cade
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 165'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO pf
G. WATER LEVEL Below Top of Casing: N/A FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING Is N/A F'f, Above Land Surface*
'Top of casing terminated attar below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): N/A METHOD OF TEST N/A
f. DISINFECTION: Type NIA Amount N/A
Top NIA
g. WATER ZONES (depth):
Top NIA Bottom NIA
Top Bottom
Top Bottom
7. CASING: Depth
Top N/A Bottom N/A Ft.
Top Bottom Ft.
Top Bottom Ft.
Top Bottom
Top Bottom
Top Bottom
Thickness/
Diameter Weight
8, GROUT: Depth Material
Top 0 Bottom 165 Ft, Bentonite
Top Bottom Ft.
Top Bottom Ft.
Material
Method
Tremie
9. SCREEN: Depth Diameter Slot Size Material
Top NIA Bottom N/A Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. tn. in.
10. SANDIGRAVEL PACK:
Depth
Bottom N/A
Top Bottom
Top Bottom
11. DRILLING LOG
Top Bottom
0 140
40 /44
44 /70
70 /76
76 /90
90 194
94 /140
140 /155
155 /165
165 /
1
1
Ft.
FL
Ft_
Size Material
Formation Description
Medium Course Sand
Gray Clay
Course Sand
Medium Course Sand (Hard}
White Clay & Sand
Hard Fine sand
White & Gray Clay & Sand
Brown Clay and Sand
Hard Fine Sugar Sand
Sandstone
12. REMARKS:
Cetco Geothermal Grout was used. Borehole caved and
loop was set toff 164'.
I DO HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER.
2(18l12
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
Randall E. Cutter
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Farm GW-la
Rev. 2/09

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2818-A
1. WELL CONTRACTOR:
Randall E. Cutter
Well Contractor (Individual) Name
Got Green Drillina. Inc.
Well Contractor Company Name
6105 Rest Horne Rd.
Street Address
Claremont
City or Town
c 828_ y 367-1293
Area code Phone number
NC 28610
Slate Zip Code
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# WID600D86
OTHER ASSOCIATED PERM1T#[ii applicable) 110872
SITE WELL ID #cifapplicable)_GL-2
3. WELL USE (Check Applicable Box): Residential Water Supply 0
DATE DRILLED 12/02/2011
TIME COMPLETED 4:00 AM 0 PM Eve
4. WELL LOCATION:
CITY: West End COUNTY Moore
155 Grant Street 2737.6
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
Slope ❑Valley &let EiRidge ❑Other
LATITUDE 36 '
LONGITUDE 75 °
" DMS OR 35,265851 DD
^ DMS OR -79.584525 aD
Latitude/longitude source: MPS Dropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. WELL OWNER
S&S Partners LLP. . Dr. Christopher Diasio
Owner Name
195 West Illinois Ave.
Street Address
Southern Pines
City or Town
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 165'
NC 27387
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES rl NO tii
WATER LEVEL Below Top of Casing: N/A FT.
(Use -+° If Above Top of Casing)
d, TOP OF CASING IS N/A FT. Above Land Surface'
"Top of casing terminated at/or below Land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): N/A METHOD OF TEST N/A
f. DISINFECTION: Type NIA Amount NIA
g. WATER ZONES (depth):
Top NIA Bottom N/A
Top Bottom
Top Bottom
7. CASING: Depth Diameter
Top N/A Bottom N/A Ft.
Top Bottom Ft.
Top Bottom FL
Top Bottom
Top Bottom
Top Bottom _
Thickness/
Weight Material
8. GROUT: Depth Material
Top 6 Bottom 165 Ft, Bentonite
Top
Bottom Ft. _
Top
Bottom Ft.
9. SCREEN: Depth
Top NIA Bottom N/A
Top Bottom
Top Bottom _
Method
Tremie
Diameter Slot Size Material
Ft. in. in.
l=t. in. in.
Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Top N/A Bottom NIA Ft.
Size Material
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 145
Formation Description
Medium Course Sand
45 156 Gray Clay
56 / 75 Medium Course Sand
75 198
98 1157
157 /165
I
i
I
1
I
1
/
White Clay & Sand
Brown Clay & Sand
Sandstone
12. REMARKS:
Cetco Geothermal Grout was fled.
100 HEREBY CERTIFYTHAT THIS WELL WAS CONSTRUCTED IN
ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER.
2/18/2012
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
Randall E. Cutter
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - information Processing,
1617 Mail Service Center, Raleigh, NC 27699.161, Phone : (919) B07-6300
Form GW-la
Rev. 2/©9

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2818-A
1. WELL CONTRACTOR:
Randall E. Cutter
Well Contractor (Individual) Name
Go! Green ❑rillina. Inc.
Well Contractor Company Narne
6105 Rest Home Rd.
Street Address
Claremont NC 28610
City or Town State Zip Code
828) 367-1293
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# WI0600086
OTHER ASSOCIATED PERMtT#(il applicable) 1 10872
SITE WELL ID #(ir applicabte) G L-3
3. WELL USE (Check Applicable Box): Residential Water Supply ❑
DATE DRILLED 12/06/2011
TIME COMPLETED 3:30 Amp Pa
4. WELL LOCATION:
CITY: West End couNTY Moore
155 Grant Street 27376
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC f LAND SETTING: (check appropriate box)
❑ Slope q Valley kiFlat ❑ Ridge ❑Other
LATITUDE 36
LONGITUDE 75
DMS oR 35.265888 DD
DMS OR -79.584569 DD
Latitude/longitude source: IghPS [(Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. WELL OWNER
S&S Partners LLP.. Dr. Christopher Diasio
Owner Name
195 West Illinois Ave.
Street Address
Southern Pines NC 28387
City or Town State Zip Code
t f
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 170'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Igr
c. WATER LEVEL Below Top of Casing: N/A FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS N/A FT. Above Land Surface`
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0115.
e. YIELD (gpm): N/A METHOD OF TEST N/A
f. DISINFECTION: Type NIA Amount NJA
g. WATER ZONES (depth):
Top N/A Bottom N/A Top Bottom _
Top_ Bottom _ Top Bottom
Top Bottom_ Top _ Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top N/A Bottom N/A Ft,
Top Bottom Ft.
Top Bottom Ft.
S. GROUT: Depth Material
Top 0 Bottom 170 Ft. Bentonite
Top Bottom Ft
Top Bottom Ft.
Method
Tremie
9. SCREEN: Depth Diameter Slot Size Materiat
Top N/A Bottom N/A Ft. in. in. _
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Top N/A Bottom N/A
Top
Top
Size Material
Ft.
Bottom Ft.
Bottom Ft.
11. DRILLING LOG
Top Bottom
0 144
Formation Description
Medium Course Sand
44 154 Gray Clay
54 178 Medium Course Sand
78 /95
95 /130
130 /155
155 /170
1
1
1
White Clay & Sand
Brown Clay & Sand
Brown Clay
Sandstone
12. REMARKS_
Cetco Geothermal Grout was used.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER.
2/18/2012
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
Randall E. Cutter
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality -
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Information Processing,
Form GW- I a
Rev. 2/09

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION it 2818-A
1. WELL CONTRACTOR:
Randall E. Cutter
Well Contractor (IndividUef) Name
Go! Green Drillina. Inc,
Wel] Contractor Company Name
6105 Rest Home Rd.
Street Address
Claremont NC 28610
City or Town
( 828) 367-1293
Area code Phone number
2. WELL INFORMATION_
WELL CONSTRUCTION PERMIT# WI0600086
OTHER ASSOCIATED PERMfT#(if appiioabie) 110872
SITE WELL ID #(It appicable) GL-4
State Zip Code
3. WELL USE (Check Applicable Box): Residential Water Supply E
DATE DRILLED 12/12/2011
TIME COMPLETED 3:30 AM D PM y
4. WELL LOCATION:
CITY: Seven Lakes couNTY Moore
155 Grant Street 27376
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC 1 LAND SETTING' (check appropriate box)
❑Slope EValley VFW IIRidge L]Other
LATITUDE 36 " DMS OR 35.265929 DO
LONGITUDE 76 " DMS OR -79.58419 OD
Latitudeilongitude source: liPS OTopographic map
(location of well must be shown on a USGS topo map andaffached to
this form if not using GPS)
5, WELL OWNER
S&S Partners LLP.. Dr. Christopher Diasio
Owner Name
West Illinois Ave.
Street Address
Southern Pines
NC 28387
City or Town State Zip Code
�)
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 175'
b. DOES WELL REPLACE EXISTING WELL? YES r? NO Mf
c. WATER LEVEL Below Top of Casing: N/A FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS N/A FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): N/A METHOD OF TEST N/A
f. DISINFECTION: Type NIA Amount N/A
g. WATER ZONES (depth):
Top N/A Bottom N/A
Top
Top
Bottom
Bottom
7. CASING: Depth
Top NIA Bottom N/A
Top Bottom
Top Bottom
8. GROUT: Depth
Top 0 Bottom 175
Tap_ Bottom
Top Bottom
9. SCREEN: Depth
Top N/A Bottom NIA
Tap Bottom
Top Bottom
Ft,
Ft,
Ft.
Top Bottom_
Top _ _ Bottom
Tap Bottom
Thickness!
Diameter Weight Material
Material
Ft. 8entonite
Ft.
Ft.
Method
Tremie
Diameter Slot Slze Material
Ft. in. in.
Ftin. in.
Ft. irs. in.
10. SANDIGRAVEL PACK:
Depth
Tap NIA Bottom NIA Ft.
Top Bottom Ft.
Size Material
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 /35
35 138
Formation Description
Medium Course Sand
Gray Clay
38 /80 Medium Course Sand
80 198
98 /110
110 /160
160 /175
175 /
I
1
I
1
I
I
White Clay & Sand
Brown Clay & Sand
Course Sand & Brown Clay
Hard Fine Sand
Sandstone
12, REMARKS:
Cetco Geothermal Grout was used.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
ACCORDANCE WITH 1SA NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER.
2/18/2012
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
Randall E. Cutter
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Rafelgh, NC 27699-161, Phone : [phone]
Form GW-la
Rev. 2/09

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carotina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2818-A
1. WELL CONTRACTOR:
Randall E. Cutter
Well Contractor (Individual) Name
Go! Green ❑rillina. Inc.
Well Contractor Company Name
6105 Rest Home Rd.
Street Address
Claremont NC 28610
City or Town Stale Zip Code
( 828 } 367-1293
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# WI0600086
OTHER ASSOCIATED PERMIT#(ir applicable) 110872
SITE WELL ID #(If appliesble) GL-5
3. WELL USE (Check Applicable Boxy Residential Water Supply ❑
DATE DRILLED 1/10/2012
TIME COMPLETED 1:00 AM ❑ PM
4. WELL LOCATION:
CITY: West End COUNTY Moore
155 Grant Street 27376
{Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING: [check appropriate box]
CSlope OValley VrFlat ERidge QOther
LATITUDE 36 " OMS OR 35.265961 DD
LONGITUDE 75
DMS OR-79.584675 DD
Latitude/longitude source: [it PS topographic map
(location of well must be shown on a IJSGS topo map anrlattached To
This form if not using GPS)
5. WELL OWNER
S&S Partners LLP. . Dr. Christopher Diasio
Owner Name
195 West Illinois Ave.
Street Address
Southern Pines
City or Town
Area code Phone number
6, WELL DETAILS:
a. TOTAL DEPTH: 1 70'
NC 28387
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES NO g.
c WATER LEVEL Below Top of Casing: N/A Fr.
(Else "+" if Above Top of Casing)
d. TOP OF CASING is N/A FT. Above Land Surface'
"Top of casing terminated at/or below tend surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): N/A METHOD OF TEST N/A
f. DISINFECTION: Type NIA Amount N/A
0 15
5 118
18 /38
38 /48
48 183
83 /87
87 /110
110 1165
165 1170
1
1
g. WATER ZONES (depth):
Tap NJA _ Bottom NIA Top Bottom
Top Bottom Top Bottom
Top Bottom Top _ _ Bottom
Thickness!
7. CASING: Depth Diameter Weight Material
Top NIA Bottom NIA Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material
Top 0 Bottom 167 Ft, Bentonite
Top Bottom Ft.
Top Bottom FL
9. SCREEN: Depth
Top NIA
Top Bottom
Top Bottom
Bottom N/A
10. SAND/GRAVEL PACK:
Depth
Top N/A Bottom N/A
Top
Top
Bottom
Bottom
11. DRILLING LOG
Method
Tremie
Diameter Slot Size Material
Ft. in. in.
Ft. in. In.
Ft. in. in.
Ft.
Ft.
Ft.
Size Material
lop Bottom Formation Description
Medium Course Sand
Gray Clay
Gray Clay & Sand
Medium Course Sand
White Clay & Sand
Hard Medium Course Sand
Brown & White Clay w/Sand
Hard Medium Course Sand
Hard Brown Sand
12. REMARKS:
Coco Geothermal Grout was used.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION
STAN DARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER.
211812012
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
Randall E. Cutter
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
161? Mail Service Center, Raleigh, NC 27699-161, Prone : [phone]
Form GW-la
Rev. 2/09

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION if 2818 A
1-WELL CONTRACTOR:
Randall E. Cutter
Weil Contractor (individual) Narne
Go! Green Drillina. Inc.
Well Contractor Company Name
6105 Rest Home Rd.
Street Address
Claremont NC 28610
City or Town State Zip Code
( 828 ) 367-1293
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10600086
OTHER ASSOCIATED PERMIT#(ifapplicab1e] 1 10872
SITE WELL ID /tiff applicable) GL-6
3. WELL USE (Check Appllcabie Box): Residential Water Supply ❑
DATE DRILLED 12/13/2011
TIME COMPLETED 5:00 AM ❑ PM L1(
4. WELL LOCATION:
CITY: West End COUNTY Moore
155 Grant St. 27376
(Street Name. Numbers, community, Subdivision. Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑Valley SrFIat ❑ Ridge ID Other
LATITUDE 36
LONGITUDE 75
DMS OR 35.265777 DD
DMS OR-79.584524 DD
Latitudellongitude source: gftPS ['Topographic map
(tocatlon of well must be shown on a USGS topo mep endetteched to
this form if not using GPS)
5. WELL OWNER
S&S Partners LLP.. Dr. Christopher Diasio
Owner Name
195 West Illinois Ave.
Street Address
Southern Pines
City or Town
(_)
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 175'
NC 28387
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES i7 NO lgf
c. WATER LEVEL Below Top of Casing: N/A FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING is N/A FT, Above Land Surface'
"Top of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .01113.
e, YIELD (gpm): N/A METHOD OF TEST N/A
f. DISINFECTION: Type N/A Amount N/A
g. WATER ZONES (depth):
Top NIA Bottom NIA Top
Top Bottom Top
Top Bottom_ Top_
7. CASING: Depth Diameter
Top N/A Bottom NIA Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material
Top 0 Bottom 175 Ft. Bentonite
Bottom
Bottom
Bottom
Thickness/
Weight
Top Bottom FL
Top Bottom Ft.
9. SCREEN: Depth
Top N/A Bottom N/A
Top Bottom
Top Bottom_
Material
Method
Tremie
Diameter Slot Sire Material
Ft. in. in.
Ft. In. In.
Ft. in. In.
10. SAND/GRAVEL PACK:
Depth
Top N/A Bottom N/A Ft
Top Bottom Ft.
Top Bottom FL
Slxe Material
11. DRILLING LOG
Top Bottom
0 /35
35 /38
38 / 80
80 /98
98 1110
110 /160
160 /175
175 /
1
1
1
1
Formation Description
Medium Course Sand
Gray Clay
Medium Course Sand
White Clay & Sand
Brown Clay & Fine Sand
Course Sand & Brown Clay
Hard Fine Sand
Sandstone
12, REMARKS:
CetcoGeothermal Groii wos toed,.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER.
2/18/2012
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
Randall E. Cutter
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GW-la
Rev. 2/09

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2818 A
1. WELL CONTRACTOR:
Randall E. Cutter
Weil Contractor (Individual) Name
Go! Green Drilling. Inc.
Well Contractor Company Name
6105 Rest Home Rd.
Street Address
Claremont NC 28610
City or Town Stale Zip Code
( 828) 367-1293
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# WI0600086
OTHER ASSOCIATED PERMIT#(if applicable) 110872
SITE WELL ID Of eppllcebie) GL-7
3. WELL USE (Check Applicable Box): Residential Water Supply p
DATE DRILLED 12/14/2011
TIME COMPLETED 3:00 AM 0 PM d
4. WELL LOCATION:
CITY: West End couNTY Moore
155 Grant Street 27376
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC I LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley IiliFlat ❑ Ridge ❑ Other _
LATITUDE 35 " DMS OR 35.265815 DO
LONGITUDE 75 " DMS OR -79.584572 DD
Latitude/longitude source; [itPS ❑ropagraphic map
(location of well must be shown on a USGS fopo map andattached to
Phis Iona if not using GPS)
5. WELL OWNER
S&S Partners UP_ . Dr_ Christopher Diasio
Owner Name
195 West Illinois Ave.
Street Address
Southern Pines NC 28387
City or Town State Zip Code
Area code Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 175'
b. DOES WELL REPLACE EXISTING WELL? YES E] NO
c. WATER LEVEL Below Top of Casing: N/A FT_
(Use "+" if Above Top of Casing)
d. TOP OF CASING is N/A FT. Above Land Surface'
`Top of casing terminated atlor below land surface may require
a variance in accordance with t5A NCAC 2C .0115.
e. YIELD Wpm): N/A METHOD OF TEST N/A
f. DISINFECTION: Type N/A Amount N/A
g. WATER ZONES (depth):
Top NA Bottom NIA Top
Top_ _ Bottom Top
Top Bottom Top
7. CASING: Depth Diameter
Top NIA Bottom NIA Ft
Top Bottom Ft
Top Bottom Ft.
8. GROUT' Depth Material
Top 0 Bottom 175 Ft. Bentonite
Top Bottom Ft.
Top Bottom Ft.
Bottom
Bottom
Bottom
Thickness/
Weight Material
9. SCREEN: Depth Diameter
Top N/A Bottom N/A Ft. in.
Top Bottom Ft. in.
Top Bottom Ft. in.
Method
Tremie
Slot Size Material
10. SAND/GRAVEL PACK:
Depth
Top NIA Bottom NIA Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 VI
10 /42
42 /48
48 /83
83 /87
87 I160
160 /175
175 /
1
1
I
1
in.
in.
in.
Size Material
Formation Description
Medium Course Sand
Gray Clay
Medium Course Sand
White Clay & Sand
Hard Medium Course Sand
Brown & White Clay w/ Course Se
Hard Fine Sand
Sandstone
12. REMARKS:
Cetco Geothermal Grout was used.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
ACCORDANCE WITH 15A NCAC 2C. WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER.
2/18/2012
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
Randall E. Cutter
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mali Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GW-la
Rev. 2109

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2818-A
1. WELL CONTRACTOR:
Randall E. Cutter
Well Contractor (Individual) Name
Go! Green Drillina. Inc.
Well Contractor Company Name
6105 Rest Home Rd.
Street Address
Claremont NC 28610
City or Town State Zip Code
( 828) 367-1293
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W I0600086
OTHER ASSOCIATED PERMIT/Inapplicable) 110872
SITE WELL ID # Iapplicable) GL-8
3. WELL USE (Check Applicable Box): Residential Water Supply ❑
DATE DRILLED 12/15/2011
TIME COMPLETED 3:00 AM ❑ PM Cif
4. WELL LOCATION:
CITY: West End COUNTY Moore
155 Grant Street 27376
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC f LAND SETTING: (check appropriate box)
['Slope D Valley VFlat ❑Ridge q Other
LATITUDE 36 " DMS OR 35.265852 DI)
LONGITUDE 75 " DMS OR-79.584618 DO
Latitude/longitude source: [3PS ❑topographic map
(location of well must be shown on a LISGS topo map andattached to
this form if not using GPS)
5. WELL OWNER
S&S Partners LLP. . Dr. Christopher Diasio
Owner Name
195 West Illinois Ave.
Street Address
Southern Pines NC 28387
City or Torn State Zip Code
Area code Phone number
8. WELL DETAILS:
a. TOTAL DEPTH: 175'
b. DOES WELL REPLACE EXISTING WELL? YES p NO it
c. WATER LEVEL Below Top of Casing: N/A FT.
(Use '+' if Above Top of Casing)
d, TOP OF CASING IS NIA FT. Above Land Surface'
"Top of casing terminated allor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): N/A METHOD OF TEST N/A
f. DISINFECTION: Type NIA Amount N/A
g. WATER ZONES (depth):
Top NIA Bottom NIA _
Top_ Bottom_ —
Top Bottom
7. CASING; Depth
Top NIA Bottom NIA Ft,
Top Bottom Ft.
Top Bottom Ft.
Top
Top
Top
Diameter
8. GROUT: Depth Material
Top 0 Bottom 175 Ft. Bentonite
Bottom
Bottom
Bottom
Thickness/
Weight
Top Bottom Ft
Top Bottom _ Ft.
9. SCREEN: Depth
Material
Method
Tremie
Diameter Slot Size Material
Top N/A Bottom N/A Ft In. in.
Top Bottom Ft. in. in.
Top _ Bottom Ft. in. in.
10. SANDIGRAVEL PACK:
Depth Size Material
Top N/A Bottom N/A Ft.
Bottom Ft.
Top
Top
Bottom Ft.
11. DRILLING LOG
Top Bottom
0 I5
5 118
18 138
38 /48
46 183
83 187
87 I160
160 /175
I
1
I
1
I
I
Formation Description
Medium Course Sand
Gray Clay
Gray Clay & Sand
Medium Course Sand
White Clay & Sand
Hard Medium Course Sand
Brown & White Clay w/Sand
Hard Brown Sand
12. REMARKS:
Cetco Geothermal Grout was used.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER,
2f 1 B/2012
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
Randall E. Cutter
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mali Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GW-la
Rev. 2l09

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2818 A
1. WELL CONTRACTOR:
Randall E. Cutter
Well Contractor (Individual) Name
Go! Green Drillina. Inc.
Well Contractor Company Name
6105 Rest Horne Rd.
Street Address
Claremont NC 28610
City or Town
( 828) 367-1293
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10600086
State Zip Code
OTHER ASSOCIATED PERMIT#(It applicable) 110872
SITE WELL ID #{'rf applicable) GL-9
3. WELL USE (Check Applicable Box): Residential Water Supply ❑
DATE DRILLED 12/16/2011
TIME COMPLETED 4:00 AM ❑ PM i(
4. WELL LOCATION:
CITY: West End COUNTY Moore
155 Grant Street 27376
{Street Name, Numbers, Community, Subdivision, Lot No., Parcel, hip Cade)
TOPOGRAPHIC ! LAND SETTING: {check appropriate box)
❑Slope ❑Valley aFlat EIRidge El Other
LATITUDE 36 " DMS OR 35.265892 DD
LONGITUDE 75 . DMS OR -79.584668 DD
Latitude/longitude source: 3GPS Cifopographic map
(location of well must be shown on a USGS topo map andettached to
this form if not using GPS)
5. WELL OWNER
S&S Partners LLP. Dr. Christopher Diasio
Owner Name
195 West Illinois Ave.
Street Andress
Southern Pines NC 28387
City or Town State Zip Cade
{ i
Area code Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: 175T
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IV
c. WATER LEVEL Below Top of Casing: N/A FT.
{Use "+^ if Above Top of Casing)
d. TOP OF CASING IS NIA _ FT. Above Land Surface"
*Top of casing terminated at/or below Land surface may require
a variance in accordance with 15A NCAC 2C ,0118,
v. YIELD {gpra): NIA METHOD OF TEST N/A
f. DISINFECTION: Type N/A Amount N/A
Top NIA
Top
Top
Top
0 14
g. WATER ZONES (depth):
Top N/A Bottom N/A
Top Bottom _
Top Bottom Top Bottom
Tap Bottom _ Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top N/A Bottom N/A Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Tap 0 Bottom 175 Ft. Bentonite Tremie
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top N/A Bottom N/A Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
Bottom N/A Ft.
Bottom Ft.
Bottom Ft.
11. DRILLING LOG
Bottom Formation Description
Medium Course Sand
4 /18
18 138
38 148
48 /83
83 /87
87 /160
160 /175
1
1
1
/
/
Gray Clay
Gray Clay & Sand
Medium Course Sand
White Clay & Sand
Hard Medium Course Sand
Brown & White Clay w/Sand
Hard Brown Sand
12. REMARKS:
Cetco Geothermal Grout was used.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER.
2/18/2412
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
Randall E. Cutter
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - information Processing,
1617 Mali Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GIN -la
Rev. 2/09

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2818 A
1. WELL CONTRACTOR:
Randall E. Cutter
Well Contractor (Individual) Name
Go! Green Drillina. Irlc.
Well Contractor Company Name
6105 Rest Home Rd.
Street Address
Claremont NC 28610
City or Town State Zip Code
828 3 367-1293
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# WI0600086
OTHER ASSOCIATED PERMIT#(1fapplicable) 110872
SITE WELL ID #(if applicable) GL-10
3. WELL USE (Check Applicable Box): Residential Water Supply ❑
DATE DRILLED 1 /12/2012
TIME COMPLETE] 2:30 AM ❑ PM Pit
4- WELL LOCATION:
CITY: West End COUNTY Moore
155 Grant Street 27376
(Street Name, Numbers, Community. Subdivision, Lot No., Parcel. Zip Code]
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Volley ScFlat ❑Ridge ©Other
LATITUDE 36 n DMS OR 35-265926 DD
LONGITUDE T5 ' " DMS OR -79-584724 Do
Latitude/longitude source: I ;PS Qropographic map
(location of well most tre shown on a IJSGS repo map andattached to
this form if nor using GPSJ
5. WELL OWNER
S&S Partners LLP. . Dr. Christooher Diasio
Owner Name
195 West Illinois Ave.
Street Address
Southern Pines NC 28387
City or Town State Zip Code
{
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 170'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Pr
c, WATER LEVEL Below Top of Casing: N/A FT.
(Else "+" if Above Top of Casing)
d. TOP OF CASING IS NA FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): N/A METHOD OF TEST N/A
f. DISINFECTION: Type NIA Amount N/A
g. WATER ZONES (depth):
Top NM Bottom N!A
Top Bottom_
Top Bottom
7. CASING: Depth
Top -NIA Bottom N/A Ft
Top
Top
Top
Diameter
Top Bottom Ft.
Top Bottom Ft
8. GROUT: Depth Material
Top 0 _ Bottom 170 Ft. Bentonite
Top Bottom
Top Bottom
Ft.
Ft.
Bottom
Bottom
Bottom
Thickness)
Weight Material
9. SCREEN: Depth Diameter
Top N/A Bottom N/A Ft. irt.
Top Bottom Ft. in.
Top Bottom Ft. in.
Method
Tremie
Slot Size Material
in.
in.
in.
19. SAND/GRAVEL PACK:
Depth Sire Material
Top N/A Bottom NIA Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 /5
5 /18
18 138
38 148
48 /83
83 /87
87 1110
110 /125
125 1145
145 1170
1
1
1
1
Formation Description
Medium Course Sand
Gray Clay
Gray Clay & Sand
Medium Course Sand
White Clay & Sand
Hard Medium Course Sand
Brown & White Clay w/Sand
Sandstone
Fine to Medium Course Sand
Hard Sand Clay
12. REMARKS:
Cetco Geothermal Grout was used.
I DD HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER.
2/18/2012
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
Randall E. Cutter
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality -
1617 Mali Service Center, Raleigh, NC 27699481, Phone : [phone]
Information Processing,
Form GW-la
Rev. 2/09

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2$18 A
1, WELL CONTRACTOR
Randall E. Cutter
Well Contractor (Individual) Name
Go! Green Drillina. Inc.
Well Contractor Company Name
6105 Rest Home Rd.
Street Address
Claremont
City or Tovvn
( 828) 367-1293
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMfT# WI0600086
NC 28610
State Zip Code
OTHER ASSOCIATED PERMIT#(If applicable) I 10872
SITE WELL ID Nit applicable] GL-11
3, WELL USE (Check Applicable Box): Residential Water Supply 0
DATE DRILLED 12/20/2011
TIME COMPLETED 2:00 AM p PM II V
4. WELL LOCATION:
CITY: West End COUNTY Moore
155 Grant Street 27376
(Street Name, Numbers, Community, Suudivisloii, Lot No, Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING: (check appropriate boxy
❑Slope ❑Valley 1Flat ❑Ridge oOther
LATITUDE 36 '
LONGITUDE 75
Latitude/longitude source: VhFS
(location of well must be shown an
this form if not using GPS)
DMS OR 35.265733 oo
•DMS OR -79.584583 D❑
[Topographic map
a USGS topo map andattached to
5. WELL OWNER
S&S Partners LLP.. Dr. Christopher Diasio
Owner Name
195 West Illinois Ave.
Street Address
Southern Pines
City or Town
()
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 180'
NC 28387
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO
c. WATER LEVEL Beiow Top of Casing: N/A FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING 1S N/A FT. Above Land Surface'
`Top of casing terminated aVor below land surface may require
a variance in accordance with I5A NCAC 2C .0118.
e. YIELD (gpm): N/A METHOD OF TEST NIA
r. DISINFECTION: Type NIA Amount N/A
g. WATER ZONES (depth):
Top NIA Bottom NIA_
Top Bottom
Top _ _ Bottom
Top Bottom
Top Bottom Top
7. CAS1NG: Depth
Top N/A Bottom NIA
Top Bottom
Top Bottom
Bottom
Thickness/
Diameter Weight Material
Ft.
Ft.
Ft.
8. GROUT' Depth Material
Top D Bottom 180 FL Bentonite
Top Bottom Ft.
Top Bottom Ft.
Method
Tremie
9. SCREEN: Depth Diameter Slot Size Material
Top NIA Bottom N/A Ft_ in. in.
Top Bottom Ft. In. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Top N/A Bottom N/A Ft. _
Top Bottom Ft.
Top Bottom Ft_
11. DRILLING LOG
Top Bottom
0 15
5 118
18
38
48
83
87
160
/38
/48
/83
/87
/ 160
1180
1
1
1
Size Material
Formation Description
Medium Course Sand
Gray Clay
Gray Clay & Sand
Medium Course Sand
White Clay & Sand
Hard Medium Course Sand
Brown & White Clay w/Sand
Hard Brown Sand
12. REMARKS:
Cetco Geothermal Grout was used._
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED iN
ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER.
2(1812012
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
Randall E. Cutter
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality -
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Information Processing,
Form GW-la
Rev. 2109

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2818-A
1. WELL CONTRACTOR:
Randall E. Cutter
Well Contractor (Individual) Name
Go! Green Drillina. Inc.
Weil Contractor Company Name
6105 Rest Home Rd.
Street Address
Claremont NC 28610
City or Town State Zip Code
( 828 y 367-1293
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# WI0600086
OTHER ASSOCIATED PERMIT#tst applicable) 1 10872
SITE WELL ID Of applicable) GL-12
3. WELL USE (Check Applicable Box): Residential Water Supply
DATE DRILLED 12/21/2011
TIME COMPLETED 2:30 AM E PM a(
4. WELL LOCATION:
cITY: West End cOUNTY Moore
155 Grant Street 27376
(Street Name, Numbers, Community, Subdivision, Lot No, Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑valey Ft Flat ❑Ridge ❑ Other
LATITUDE 36 " DMS OR 35.265777 DO
LONGITUDE 75 " CMS OR -79.584622 DD
Latitude/longitude source: VGPS ['Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. WELL OWNER
S&S Partners LLP. . Dr. Christooher Diasio
Owner Name
195 West Illinois Ave.
Street Address
Southem Pines
City or Town
[ l
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 175'
NC 28387
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO gy
c. WATER LEVEL Below Top of Casing: N/A FT.
(Use'+" if Above Top of Casing)
d. TOP OF CASING IS N/A FT. Above Land Surface'
'Top of casing terminated attar below land surface may require
a variance in accordance with 15A NCAC 2C .0118,
o. YIELD Wpm): N/A METHOD OF TEST N/A
f. DISINFECTION: Type N/A Amount N/A
g. WATER ZONES (depth):
Top NIA Bottom NIA Top.
Top Bottom Top
Top_ Bottom Top
7. CASING: Depth
Top N/A Bottom N/A
Top Bottom
Top Bottom
8, GROUT: Depth
Top 0 Bottom 175
Top Bottom
Top Bottom
Ft.
FL
FL
Bottom
Bottom
Bottom
Thickness/
Diameter Weight Material
Material
FL Bentonite
Ft.
Ft,
Method
Tremie
9. SCREEN: Depth Diameter Slot Site
Top N/A Bottom N/A Ft. in. in.
Top Bottom Ft. in, in.
Top Bottom Ft. in. In.
10. SAND/GRAVEL PACK:
Depth
Top N/A Bottom N/A Ft.
Top Bottom Ft.
Top Bottom Ft.
Site Material
11. DRILLING LOG
Top Bottom
0 /5
5 /18
18 / 38
38 /48
48 /83
83 /87
87 1120
120 /160
160 /175
Material
Formation Description
Medium Course Sand
Gray Clay
Cray Clay & Sand
Medium Course Sand
White Clay & Sand
Hard Medium Course Sand
Brown & White Clay wfSand
Hard Medium Course Sand
Hard Brown Sand
12. REMARKS:
Cetca Geothermal Grout was used.
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
ACCORDANCE WITH 15A NCAC 2C. WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER.
2/18/2012
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
Randall E. Cutter
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality -
1617 Mall Service Center, Raleigh, NC 27699-161, Phone : [phone]
Information Processing,
Form GW-ta
Rev. 2/09

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2818 A
1. WELL CONTRACTOR:
Randall E. Cutter
Well Contractor (Individual) Name
Go! Green Drillina. Inc.
Well Contractor Company Name
6105 Rest Home Rd.
Street Address
Claremont NC 28610
City or Town State Zip Code
( 828) 367-1293 _
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# WI0600086
OTHER ASSOCIATED PERMIT#(if applicable) 110872
SITE WELL ID #(il applicable) G L-13
3. WELL USE (Check Applicable Box): Residential Water Supply 0
DATE DRILLED 12128/2011
TIME COMPLETED 330 AM ❑ PIN Ill
4. WELL LOCATION:
CITY: West End COUNTY Moore
155 Grant Street 27376
(Street Name, Numbers, community, subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC 1 LAND SETTING: (check appropriate box)
Slope ❑ Valley SdFlat 0 Ridge E Other
LATITUDE 36 " DMS OR 35.285815 DD
LONGITUDE 75 ° DMS OR -78-584667 DO
Latitude/longitude source: ly PS [Tropographlc map
(location of well must be shown on a UISGS topo map andaftached to
This form if not using GPS)
5. WELL OWNER
S&S Partners LLP. . Dr. Christopher Diasio
Owner Name
195 West Illinois Ave.
Street Address
Southern Pines
City or Town
Area code Phone number
B. WELL DETAILS:
a. TOTAL DEPTH: 175'
NC 28387
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES Q NO Mr
c. WATER LEVEL Below Top of Casing: N/A FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS NIA FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpmy: N/A METHOD OF TEST NIA
1. DISINFECTION: Type N/A Amount N/A
g. WATER ZONES (depth):
Top N/A Bottom NIA
Top
Top
Bottom- -. _
Bottom
Top
Top
Top
Bottom_
Bottom
Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top N/A Bottom N/A Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GRO JT: Depth Material
Top 0 Bottom 175 Ft. Bentonite
Top Bottom FL
Top Bottom FL
9. SCREEN: Depth Dieter
Top N/A Bottom N/A Ft. in.
Top Bottom Ft. in.
Top Bottom Ft.
10. SAND/GRAVEL PACK:
Depth
Top NIA Bottom NIA Ft.
Top Bottom Ft.
Top Bottom Ft.
Method
Tremie
Slot Size Material
in.
in.
in.
Size Material
11. DRILLING LOG
Top Bottom
0 15
5 /18
18 /38
38 146
48 183
83 /87
87 /110
110 /165
165 /175
1
1
1
1
1
Formation Description
Medium Course Sand
Gray Clay
Gray Clay & Sand
Medium Course Sand
White Clay & Sand
Hard Medium Course Sand
Brown & White Clay w/Sand
Hard Medium Course Sand
Hard Brown Sand
12. REMARKS:
Cetco Geothermal Grout was used.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER_
2/18/2012
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
Randall E. Cutter
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GW-la
Rev. 2109

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 281 & A
1, WELL CONTRACTOR:
Randall E. Cutter
Well Contractor (Individual) Name
Go! Green Drillina. Inc.
Well Contractor Company Name
6105 Rest Home Rd.
Street Address
Claremont NC 28610
City or Town State Zip Code
( 828) 367-1293
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# WI0600086
OTHER ASSOCIATED PERMIT#(itapplicable) 110872
SITE WELL ID #(Irapplicable) GL-14
3. WELL USE (Check Applicable Box): Residential Water Supply 0
DATE DRILLED 1/20/2012
TIME COMPLETED 12:00 AM 0 PM ii
4. WELL LOCATION:
CITY: West End couNTY Moore
155 Grant Street 27376
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC! LAND SETTING: {check appropriate box)
❑ Slope ❑ Valley Igriat ❑ Ridge D Other
LATITUDE 36 °
LONGITUDE 75
Latitude/longitude source: IMPS
(location of well must be shown on
this form if not using GPS)
" DMS OR 35.265855 DD
" DMS OR -79.584716 DD
[]topographic map
a VSGS topo map anrdattached to
5. WELL OWNER
S&S Partners LIP.. Dr. Christopher Diasio
Owner Name
195 West Illinois Ave.
Street Address
Southern Pines NC 28387
City or Town State Zip Code
(_)
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 180'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top or Casing: N/A FT.
(Use "+" it Above Top of Casing)
d. TOP OF CASING IS N/A FT. Above Land Surface'
"Top or casing terminated atlor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e, YIELD (gpm): N/A METHOD OF TEST N/A
f. DISINFECTION: Type NIA Amount N A
g. WATER ZONES (depth):
Top NIA Bottom N/A _ Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight
Top N/A Bottom N/A Ft
Top Bottom Ft _
Top Bottom Ft.
8. GROUT: Depth
Top 0 Bottom 180
Top Bottom
Top Bottom
Material
Ft, Bentonite
Ft.
Ft.
9. SCREEN; Depth Diameter Slot Size
Top NIA Bottom NIA Ft. in.
Top Bottom Ft. in.
Tap Bottom Ft. in.
10. SAND/GRAVEL PACK:
Depth
Top N/A Bottom N/A Ft,
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 /5
5 /18
18 138
38 148
48 /83
83 /87
87 I110
110 1125
125 /145
145 1170
170 /180
1
1
Materia I
Method
Tremie
Material
Size Material
Formation Description
Medium Course Sand
Gray Clay _.._
Gray Clay & Sand
Medium Course Sand
White Clay & Sand
Hard Medium Course Sand
Brown & White Clay w/Sand
Sandstone
Fine to Medium Course Sand
Hard Sand & Clay
Hard Brown Clay & Rock
12. REMARKS:
Cetco Geuther -raj Grout was used.
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
ACCORDANCE WITH 15A NCAC 2C. WELL CONSTRUCTION
STANDARDS, AND THAT A COPY CF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER,
2/18/2012
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
Randall E. Cutter
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GW-la
Rev. 2/09

RESIJJENTJAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 281 8 A
1. WELL CONTRACTOR:
Randall E. Cutter
Weil Contractor (Individual) Name
Go! Green Drillina. Inc.
Well Contractor Company Name
6105 Rest Home Rif_
Street Address
Claremont NC 28610
City or Town State Zip Code
( 828) 367-1293
Area code Phone number
2, WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10600086
OTHER ASSOCIATED PERMIT#(if applicable) 110872
SITE WELL ID #(if applicable) GL-15
3_ WELL USE (Check Applicable Box): Residential Water Supply ❑
DATE DRILLED 1 / 16/2012
TIME COMPLETED 1 1 :30 AM d PM 0
4. WELL LOCATION:
CITY: West End COUNTY Moore
155 Grant Street 27376
(Street Name. Numbers, Community, Subdivision, lot No., Parcel, Yip Code)
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑ Valley Flat ❑ Ridge ❑ Other
LATITUDE 36 " DMS OR 35.265887 DD
LONGITUDE 75 " DMS OR -79.584773 DD
LatitudeRangitude source: RGPS [Topographic map
{location of well must be shown on a USGS IIopo map andattached to
this form if not using GPS)
5. WELL OWNER
S&S Partners LLP. . Dr. Christopher Diasio
Owner Name
195 West Illinois Ave.
Street Address
Southem Pines
NC 28387
City or Town State Zip Code
tip
Area code Phone number
B. WELL DETAILS:
a. TOTAL DEPTH: 180'
b. DOES WELL REPLACE (MISTING WELL7 YES ❑ NO gr
c. WATER LEVEL Below Top of Casing: N/A FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS N/A FT. Above Land Surface'
-Top of casing terminated attar below land surface may require
a variance In accordance with 15A NCAC 2C ,0118.
e. YIELD (gpm): N/A METHOD OF TEST N/A
r. DISINFECTION: Type N/A Amount NIA
Top
Top
11. DRILLING LOG
Top Bottom
0 I5
5 /18
18 / 38
38 /48
48 183
83 /87
87 /110
110 /125
125 /145
145 / 170
170 /180
1
1
g. WATER ZONES (depth):
Top NIA Bottom N/A_ _ Top _
Top --- _ Bottom Top
Top Bottom Top _ Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top N/A Bottom N/A Ft.
Top Bottom Ft.
Top Bottom Ft.
Bottom
Bottom
8. GROUT: Depth Material
Top 0 Bottom 180 Ft Bentonite
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter
Top N/A Bottom N/A Ft. In.
Top Bottom Ft. in.
Top Bottom Ft. in.
Method
Tremie
Slot Size Material
in. in.
10. SAND/GRAVEL PACK:
Depth
Top MIA Bottom NIA Fi.
Bottom Ft.
Bottom Ft.
I
in.
Size Material
Formation Description
Medium Course Sand
Gray Clay
Gray Clay & Sand
Medium Course Sand
White Clay & Sand
Hard Medium Course Sand
Brown & White Clay w/Sand
Sandstone
Fine to Medium Course Sand
Hard Sand & Clay
Hard Brown Clay & Rock
12. REMARKS:
Cetco Geothermal Grout was used.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED EN
ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE W ELL OWNER.
2/18/2012
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
Randall E. Cutter
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 38 days of completion to: Division of Water Quality - Information Processing,
1617 Mall Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GW-la
Rev. 2/09

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Departtnenr of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2818-A
1. WELL CONTRACTOR:
Randall E. Cutter
Well Contractor (Individual) Name
Go! Green Drillina. Inc.
Well Contractor Company Name
6105 Rest Home Rd.
Street Address
Claremont NC 28610
City or Town State Zip Code
( 828 ) 367-1293
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# WI060O086
OTHER ASSOCIATED PERMIT#Crf applicable) 110872
SITE WELL ID #(If eppllrable) GL-16
3. WELL USE (Check Applicable Box):
DATE DRILLED 1/4/2012
TIME COMPLETED 1:30
Residential Water Supply ❑
AM ❑ PM Cif
+4_ WELL LOCATION:
crrY: West End COUNTY Moore
155 Grant Street 27376
(Street Name, Numbers, Community, Subdivision, Lot No., Fermi. Zip Code)
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope OValley RiFlat 0Ridge pother _ _
LATITUDE 36
° " DMS OR 35.265701 DD
LONGITUDE
75 DMS OR -79.584625 DO
Latitude/longitude source: it PS ❑ropographic reap
(location of well must be shown on a USGS topo map andettached to
this form if not using GPS)
5. WELL OWNER
S&5 Partners LLP. , Dr. Christopher Diasio
Owner Name
195 West Illinois Ave.
Street Address
Southern Pines
City or Town
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 175'
NC 28387
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO it
c. WATER LEVEL Below Top of Casing: N/A FT.
(Use '+• if Above Top of Casing)
d. TOP OF CASING IS N/A FT, Above Land Surface"
'Tap of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD Wpm): N/A METHOD OF TEST N/A
f. DISINFECTION: Type N/A Amount N/A
g. WATER ZONES (depth):
Top NIA Bottom N/A Top
Top Bottom Tap_
Top Bottom Top
7. CASING: Depth Diameter
Top NIA Bottom N/A Ft.
Top Bottom Ft
Top Bottom Ft.
8. GROUT; Depth Material
Top 0 Bottom 175 Ft. Bentonite
Top Bottom
Top Bottom
Ft.
Ft.
Bottom
Bottum
Bottom
Thlcknessl
Weight Material
Method
Tremie
9. SCREEN: Depth Diameter Slot Size Material
Top N/A Bottom N/A Ft. in. in.
Top Bottom Ft. In. in.
Top Bottom Ft. in. in.
10. SANDIGRAVEL PACK:
Depth Size Material
Top N/A Bottom NIA Ft.
Top Bottom Ft.
Top Bottom Ff.
11. DRILLING LOG
Top Bottom
0 /5
5 118
18 /38
38 /48
48 / 83
83 187
87 /110
110 /165
165 /175
1
/
/
1
1
Formation Description
Medium Course Sand
Gray Clay
Gray Clay & Sand
Medium Course Sand
White Clay & Sand
Hard Medium Course Sand
Brown & White Clay w/Sand
Hard Medium Course Sand
Hard Brown Sand
12. REMARKS:
Cetco Geothermal Grout was used.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER.
2/18/2012
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
Randall E. Cutter
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GW-la
Rev. 2109

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Wafer Quality
WELL CONTRACTOR CERTIFICATION # 2818-A
1. WELL CONTRACTOR:
Randall E. Cutter
Well Contractor (tndividual) Name
Go! Green Drilling. Inc.
Well Contractor Company Name
6105 Rest Home Rd.
Street Address
Claremont NC 28610
City or Town Stale Zip Code
( 828) 367-1293
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# WI0600086
OTHER ASSOCIATED PERMIT#(If applicable) 1 10872
SITE WELL ID #(ii app'lcable) GL-17
3. WELL USE (Check Applicable Box): Residential Water Supply [1
DATE DRILLED 1/6/2012
TIME COMPLETED 1:30 AM ❑ PM t
4. WELL LOCATION:
CITY West End couNTY Moore
155 Grant Street 27376
(Street Name, Numbers. Community. Subdivision. Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING: (check appropriate has)
❑Slope ❑Valley VF1at CRidge IJOther
LATITUDE 36 DMS OR 35.265740 DD
LONGITUDE 75 " DMS OR -79.584671 DD
Latitudellongitude source: RCPS OTopagraphfo reap
(locatran of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. WELL OWNER
S&S Partners LLP.. Dr. Christopher Diasio
Owner Name
195 West Illinois Ave.
Street Address
Southern Pines
City or Town
( )
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 180'
NC 28367
State Zip Cade
b. DOES WELL REPLACE EXISTING WELL? YES +❑ NO Mr.
c. WATER LEVEL Below Top of Casing: N JA _FT.
(Use "+^ if Above Top of Casing)
d. TOP OF CASING IS N/A FT. Above Land Surface'
'Tap of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e, YIELD (gpm)' NIA METHOD OF TEST N/A
f. DISINFECTION: Type NIA Amount N/A
g. WATER ZONES (depth):
Top NA Bottom N/A Top_ _ Bottom.
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top N/A Bottom N/A Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom 180 Ft. Bentonite Tremie
Tap Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth
Top NIA Bottom N/A
Diameter Slot Size Material
Ft.
Top Bottom Ft.
Top Bottom Ft. in.
10. SAND/GRAVEL PACK:
Depth
Top N/A Bottom N/A
Top Bottom
Top Bottom
11. DRILLING LOG
Top Bottom
0 15
5 118
18 138
Ft.
Ft.
Ft.
in. in.
in. In.
in,
Size Material
Formation Description
Medium Course Sand
Gray Clay
Gray Clay & Sand
38 /48 Medium Course Sand
48 /83
83 187
87 1110
White Clay & Sand
Hard Medium Course Sand
Brown & White Clay w/Sand
110 /165 Hard Medium Course Sand
165 /175
175 /180
1
1
1
1
Hard Brown Sand
Hard Brown Rock & CIIy
12. REMARKS:
Cetco Geothermal Grout was used.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR
Randall E_ Cutter
2/18/2012
DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GW-1a
Rev. 2/09

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2818-A
1. WELL CONTRACTOR:
Randall E. Cutter
Well Contractor (Individual) Name
Go! Green ❑rillina. Inc.
Well Contractor Company Name
6105 Rest Home Rd.
Street Address
Claremont NC 28610
City or Town State Tip Code
828 367-1293
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10600086
OTHER ASSOCIATED PERMIT#(if applicable) 110872
SITE WELL ID Cif applicable) GL-18
3. WELL USE (Check Applicable Box): Residential Water Supply ❑
DATE DRILLED 1/24/2012
TIME COMPLETED 2:30 AM ❑ PM 1
4. WELL LOCATION:
CITY: West End COUNTY Moore
155 Grant Street 27376
(Street Neme, Numbers, Community, Subdivision, Lill No., Parcel. Zip Code)
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Stope ❑ Valtey tifTFlat II Ridge ID Other
LATITUDE 36 " DMS OR 35.265777 DD
LONGITUDE 75 ° " DMS OR-79.584717 DD
Latitudettongitude source: MPS Dropographtc map
(location of wail must ha shown on a USGS tope map andaftached to
this Ibnn if not using GPS)
5. WELL OWNER
S&S Partners LIP. , Dr. Christopher Diasio
Owner Name
195 West Illinois Ave.
Street Address
Southern Pines
City or Town
( )
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 180'
NC 28387
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO gr
c. WATER LEVEL Below Top of Casing: N/A Fr
(Use "#' if Above Top of Casing)
d. TOP OF CASING 1S N/A FT_ Above Land Surface"
'Top of casing terminated attar betow tend surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): N/A METHOD OF TEST N/A
f. DISINFECTION: Type N/A Amount N/A
g. WATER ZONES (depth):
Top N/A Bottom N/A Top Bottom
Top _ _ Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
Diameter Weight
7. CASING: Depth
Top NA Bottom N/A Ft
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material
Top 0 Bottom 180 Ft. Bentonite
Top Bottom Ft
Top Bottom Ft
9. SCREEN: Depth
Top NIA Bottom NIA
Top Bottom
Top Bottom
Material
Method
Tremie
Diameter Slot Size Materiel
FL in. in.
Ft in. in.
Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Top NIA Bottom NIA Ft.
Top Bottom Ft.
Size Material
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 /5
5 I18
18 138
Formation Descripfon
Medium Course Sand
Gray Clay
Gray Clay & Sand
38 /48 Medium Course Sand
48 183
83 187 Hard Medium Course Sand
White Clay & Sand
87 1110
110 /125
Brown & White Clay w/Sand
Sandstone
125 /145 Fine to Medium Course Sand
145 /170
170 1180
1
Hard Sand & Clay
Hard Brown Clay & Rock
12. REMARKS:
Deco Geothermal Grout was used.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
ACCORDANCE WITH 15A NCAC 2C. WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR
2/18/2012
DATE
Randall E. Cutter
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27689-161, Phone : {919) 807-6300
Form GW-la
Rev. 2/09

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Deparbnent of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2818 A
1. WELL CONTRACTOR:
Randall E. Cutter
Well Contractor (individual) Name
Go! Green Drillina. Inc.
Well Contractor Company Name
6105 Rest Horne Rd.
Street Address
Claremont NC 28610
City or Town Stale Zip Code
( 828) 367-1293
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10600086
OTHER ASSOCIATED PERMIT#(if applicable) 110872
SITE WELL ID #(if applicable) GL-19
3. WELL USE (Check Applicable Box): Residential Water Supply IA
DATE DRILLED 1/10/2012
TIME COMPLETED 4:30 AM LI PM Pit
4. WELL LOCATION:
CITY: West End COUNTY Moore
155 Grant Street 27376
(Street Name, Numbers, Community, SubdMMsion, Lot No., Parcel, Zip Code)
TOPOGRAPHIC I LAND SETTING: (check appropriate boxy
D Slope ❑ Valley if Flat ❑ Ridge ©Other
LATITUDE 36 "DMS OR 35.265817 DD
LONGITUDE 75 " DMS OR -79.584766 DO
Latitude/longitude source: ( 3PS ['Topographic map
(location of well must be shown on a USGS typo map andatteched to
this form if not using GPS)
5. WELL OWNER
S&S Partners LLP.. Dr. Christooher Diasio
Owner Name
195 West Illinois Ave.
Street Address
Southern Pines
NC 28387
City or Town State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL_ DEPTH: 180'
b. DOES WELL REPLACE EXISTING WELL? YES © NO 14
c. WATER LEVEL Below Top of Casing: N/A _ _ _ FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS N/A FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): N/A METHOD OF TEST N/A _
1. DISINFECTION: Type N/A Amount N/A
g. WATER ZONES (depth):
Top NIA Bottom N/A Top Bottom
Top Bottom Top Bottom
Top_ Bottom Top _ Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Ft
Top N/A Bottom N/A
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom 180 FI, Bentonite Tremie
Top Bottom FL
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Ft. in. in.
Top Bottom FL in. in.
Top Bottom Ft. In. in.
Top N/A Bottom NIA
10. SAND/GRAVEL PACK:
Depth
Tap NIA Bottom NIA FL
Top Bottom Fi.
Top Bottom - Ft.
Sire Material
11. DRILLING LOG
Top Bottom
0 I5
5 118
18 138
38 148
48 / 83
83 187
87 /110
110 /125
125 /145
-145 /170
170 /180
1
I
Formation Description
Medium Course Sand
Gray Clay
Gray Clay & Sand
Medium Course Sand
White Clay & Sand
Hard Medium Course Sand
Brown & White Clay w/Sand
Sandstone
Fine to Medium Course Sand
Hard Sand Clay
Hard Brown Clay & Rock
12. REMARKS:
Cetco Geothermal Grout was used.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
ACCORDANCE WITH 15A NCAC 2C. WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR
Randall E. Cutter
2/18/2012
DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mad Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GW-la
Rev. 2109

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2818 A
1, WELL CONTRACTOR:
Randall E. Cutter
Well Contractor (individual) Name
Go! Green Drilling. Inc.
Well Contractor Company Name
6105 Rest Home Rd.
Street Address
Claremont
City or Town
( 828) 367-1293
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT## WI0600086
OTHER ASSOCIATED PERMIT#(if applicable) 110872
517E WELL ID #(it applicable) GL-20
NC 2861Q
State Zip Code
3. WELL USE (Check Applicable Box): Residential Water Supply ❑
DATE DRILLED 1/26/2012
TIME COMPLETED 12:30 AM 0 PM [1
4. WELL LOCATION:
CITY: West End_COUNTY Moore
155 Grant Street 27376
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, tip Code)
TOPOGRAPHIC! LAND SETTING: (check approprtaate box)
❑Slope ❑ Valley EtFlat D Ridge ❑Other
LATITUDE 36
DMS OR 35.265%50 DD
LONGITUDE 75 OMS OR -79.584683 DD
Latitudelttongilude source: IjifrS Qropographic map
(location of well must be shown on a USGS tape map andattached to
this form if not using GPS)
5. WELL OWNER
S&S Partners LLP. L Dr. Christopher Diasio
Owner Name
195 West Illinois Ave.
Street Address
Southern Pines
City or Town
)
Area code Phone number
NC 28387
State Tip Code
B. WELL DETAILS:
a. TOTAL DEPTH: 180'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO i r
c. WATER LEVEL Below Top of Casing: N/A FT.
(Use "+^ if Above Top of Casing)
d. TOP OF CASING IS N/A FT. Above Land Surface"
"Top of casing terminated allor below land surface may require
a variance in accordance with ISA NCAC 2C .0118.
e. YiELD wpm): N/A METHOD OF TEST N/A
f. DISINFECTION: Type N/A Amount N/A
g. WATER ZONES (depth):
Top N/A Bottom N/A Top
Top Bottom Top
Top Bottom Top
7. CASING: Depth
Top N/A Bottom N/A Ft.
Top Bottom Ft.
Top Bottom Ft.
Diameter
B. GROUT: Depth Material
Top 0 Bottom 180 FL Bentonite
Bottom
Bottom_
Bottom
Thickness[
Weight Material
Top Bottom Ft.
Top Bottum Ft.
Method
Tremie
9. SCREEN: Depth Diameter Slot Size Nlaterlal
Top N/A Bottom N/A Ft. in. in.
Top Bottom Ft. in. In.
Top Bottom Ft. in. in.
10. SANDIGRAVEL PACK:
Depth
Top N/A Bottom N/A Ft,
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 15
5 /18
18 138
38 148
48 183
83 1 B7
87 /110
110 /125
125 /145
145 1170
170 /180
1
Size Material
Formation Description
Medium Course Sand
Gray Clay
Gray Clay & Sand
Medium Course Sand
White Clay & Sand
Hard Medium Course Sand
Brown & White Clay w/Sand
Sandstone
Fine to Medium Course Sand
Hard Sand & Clay
Hard Brown Clay & Rock
12. REMARKS:
Cetco GegLhArmrout was used.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER.
2/18/2012
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
Randall E. Cutter
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mall Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GW-la
Rev. 2/0S

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina .Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2818-A
1. WELL CONTRACTOR:
Randall E. Cutter
Wei! Contractor (Individual) Name
Go! Green Drfllina, inc.
Well Contractor Company Name
6105 Rest Home Rd.
Street Address
Claremont NC 28616
City or Town State Zip Code
( 828) 367-1293
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10600086
OTHER ASSOCIATED PERMIT#(ifapplicable) 110872
SITE WELL ID #(ifapplicabie) GL-21
3. WELL USE (Check Applicable Box): Residential Water Supply El
DATE DRILLED 1/27/2012
TIME COMPLETED 1:3O AM ❑ PM ;Tr
4. WELL LOCATION:
CITY: West End COUNTY Moore
155 Grant Street 27376
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC 1 LANE] SETTING: (check appropriate aox)
L: Elope O Valley IgrF1at ❑ Ridge ❑ Other
LATITUDE 36 ° DMS OR 35.265702
LONGITUDE 75 " DM5 OR -79.584721
DD
DD
Latitude/longitude source: itPS OTopographic map
(location of well must ba shown on a USGS topo map andattached to
this form if not using GPS)
5. WELL OWNER
S&S Partners LLP. , Dr. Christopher Diasio
Owner Name
195 West Illinois Ave.
Street Address
Southern Pines
City or Town
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 180'
NC 28387
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO d
c. WATER LEVEL Below Top of Casing: N/A FT.
(Use "+' if Above Top of Casing)
d. TOP OF CASING IS N/A _ FT. Above Land Surface"
"Top of casing terminated at/or below land surface may require
a variance in accordance with T5A NCAC 2C .O118.
e. YIELD (gpm): N/A METHOD OF TEST N/A
f. DISINFECTION: Type N/A Amount N/A
g. WATER ZONES (depth):
Top NIA Bottom NIA Tap
Top Bottom Top
Top _ Bottom Top
7. CASING: Depth
Top NIA Bottom N/A Ft.
Top Bottom Ft.
Top Bottom Ft.
Diameter
Bottom
Bottom
Bottom
Thickness/
Weight
8. GROUT' Depth Material
Top_Q Bottom 180 Ft. Bentonite
Top _ Bottom Ft.
Top Bottom FI.
Material
Method
Tremie
9. SCREEN: Depth Diameter Slot Size Material
Top NIA Bottom N/A Ft, in. in,
Top Bottom FL in_
Tcp Bottom Ff. in. in.
10. SAND/GRAVEL PACK:
Depth
Top N/A Bottom NIA Ft.
Top Bottom Ft.
Tap Bottom Ft.
11. DRILLING LOG
Top Bottom
0 15
5 118
18 /38
38 148
48 /83
83 187
87 /110
110 /123
123 114E
145 /150
150 /175
175 /180
Size Material
Formation Description
Medium Course Sand
Gray Clay
Gray Clay & Sand
Medium Course Sand
White Clay & Sand
Hard Medium Course Sand
Brown & White Clay w/Sand
Sandstone
Fine to Medium Course Sand
Hard Sand & Clay
Sandstone
Hard Brown Clay & Rock
12_ REMARKS'
Cetco Geothermal Grout was used.
i DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD 1-IAS BEEN
PROVIDED TO THE WELL OWNER.
2/18/2012
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
Randall E. Cutter
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 clays of completion to: Division of Water Quality - Information Processing.
1617 Mail Service Center. Raleigh, NC 27699-161, Phone : i919) 807-6300
Form GW-1a
Rev, 2149

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2818 A
1. WELL CONTRACTOR:
Randall E. Cutter
Well Contractor (Individual) Name
Go! Green Drilling. Inc.
Well Contractor Company Name
6105 Rest Home Rd.
Street Address
Claremont NC 28610
City or Town State Zip Code
( 828 _) 367-1293
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# WI0600086
OTHER ASSOCIATED PERMIT#(if appiicabie) 1 10872
SITE WELL ID #(If applicable) GL-22
3. WELL USE (Check Applicable Box): Residential Water Supply ❑
DATE DRILLED 1/31/2012
TIME COMPLETED 5:30 AM ❑ PM dt
4. WELL LOCATION:
ciTY- West End couNTv Moore
155 Grant Street 27376
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
CI Slope E] Valley dFlat C] Ridge a Other
LATITUDE 36 ' ❑MS OR 35.265739 DO
LONGITUDE 75 " ^ DMS OR -79.584766 OD
Latitude/longitude source: [ PS D[opographic map
(location of well must be shown on a USGS tops map andaftached to
this form if riot using GPS)
5, WELL OWNER
S&S Partners LIP.. Dr. Christooher Diasio
Owner Name
195 West Illinois Ave.
Street Address
Southern Pines
City or Town
L )
Area code Phone number
$. WELL DETAILS:
a. TOTAL DEPTH: 180'
NC 28387
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES [I NO i
c. WATER LEVEL Below Top of Casing: N/A FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING 18 N/A T. Above Land Surface"
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gem): N/A METHOD OF TEST N/A
I. DISINFECTION: Type N/A Amount NIA
g. WATER ZONES (depth):
Top NIA Bottom NIA Top Bottom
Top Bottom Tap Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top N/A Bottom N/A Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material
Top 0 Bottom 180 Ft. Bentonite
Top _ Bottom _ Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter
Top N/A Bottom N/A Ft. in.
Top Bottom Ft. in.
Method
Tremie
Slot Size Material
in.
in.
Top Bottom Ft. in. In.
10. SAND/GRAVEL PACK
Depth Sire Material
Top N/A Bottom N/A Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 15
5 /18
18 138
38 /48
48 183
83 /87
87 /110
110 /123
123 /145
145 /150
150 /175
175 /180
1
Fommation Description
Medium Course Sand
Gray Clay
Gray Clay & Sand
Medium Course Sand & Gravel
White Clay & Sand
Hard Medium Course Sand
Brown & White Clay w/Sand
Sandstone
Fine to Medium Course Sand
Hard Sand & Clay
Sandstone
Hard Brown Clay & Rock
12. REMARKS:
Cetcu Geothermal Grout was used.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
ACCORDANCE WITH 15A NCAC 2C. WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER.
2/18/2012
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
Randall E. Cutter
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GW-la
Rev. 2/09

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2818-A
1. WELL CONTRACTOR:
Randall E. Cutter
Well Contractor (Individual) Name
Go! Green Drillina. Inc,
Well Contractor Company Name
6105 Rest Home Rd.
Street Address
Claremont
City or Town
( 828) 367-1293
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10600086
NC 28610
State Ztp Code
OTHER ASSOCIATED PERMFT#(if applicable) 110872
SITE WELL ID #(if applicable) GL-23
3. WELL USE (Check Applicable Box): Residential Water Supply ❑
DATE DRILLED 2/2/2012
TIME COMPLETED 1:30 AM ❑ PM
4. WELL LOCATION:
CITY: West End couNnr Moore
155 Grant Street 27376
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPI-ltC 1 LAND SETTING: (checkappropnate box)
❑ Slope ❑ Valley UrFlat ❑ Ridge ❑ Other
LATITUDE 36 ^ DMS OR 35,265780 DD
LONGITUDE 75 " DMS OR-79-584815 DD
Latitude/longitude source: lit PS ['Topographic map
(location of well must be shown on a USGS topo reap andartached to
Vs form if not using GPS)
5. WELL OWNER
S&S Partners LLP. . Dr. Christopher Diasio
Owner Name
195 West Illinois Ave.
Street Address
Somthern Pines
City or Town
(_)
Area code Phone number
B. WELL DETAILS:
a. TOTAL DEPTH: 180'
NC 28387
State Zip Cade
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Mr
c. WATER LEVEL Below Top of Casing: N/A FT.
(Use "+' it Above Top of Casing)
d. TOP OF CASING IS N/A FT. Above Land Surface'
"Top of casing terminated at/ar below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): N/A METHOD OF TEST NIA
f_ DISINFECTION: Type N/A Amount N/A
g_ WATER ZONES (depth):
Top NIA Bottom NIA Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness!
7_ CASING: Depth Diameter Weight Material
Top NIA Bottom N/A Ft,
Top Bottom Ft,
Top Bottom Ft.
8. GROUT: Depth Material
Tap 0 Bottom 180 Ft. Bentonite
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size
FI. in. in.
Top Bottom Fl. in. _ in.
Top Bottom Ft. in. In.
Top N/A Bottom NIA
Method
Tremie
10. SAND/GRAVEL PACK:
Depth Size Material
Tap N/A Bottom N/A Ft.
Top
Top
Bottom Ft
Bottom Ft,
11. DRILLING LOG
Top Bottom
0 15
5 /18
18 /38
38 /48
48 /83
83 /87
87 /110
110 /123
123 /145
145 /150
150 /175
175 /180
1
1
Material
Formation Description
Medium Course Sand
Gray Clay
Gray Clay & Sand
Medium Course Sand & Gravel
White Clay & Sand
Hard Medium Course Sand
Brown & White Clay w/Sand
Sandstone
Fine to Medium Course Sand
Hard Sand & Clay
Sandstone
Hard Brown Clay & Rock
12. REMARKS:
Cetco Geothermal Grout was used.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER.
2/1812012
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
Randall E. Cutter
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GW-la
Rev. 2/09

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2818-A
1. WELL CONTRACTOR:
Randall E. Cutter
Well Contractor (individual) Name
Go! Green D131lina. Inc.
Weil Contractor Company Name
6105 Rest Horne Rd_
Street Address
Claremont NC 28610
City or Town State Zip Code
( 828) 367-1293
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# WI0600086
OTHER ASSOCIATED PERMIT#(I applicable) 110872
SITE WELL ID #(if applicable) GL-24
3. WELL USE (Check Applicable Box) Residential Water Supply ❑
DATE DRILLED 2/3/2012
TIME COMPLETED 1:30 AM ❑ PM
4. WELL LOCATION:
cum West End COUNTY MOO re
155 Grant Street 27376
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING: (check apprupriate box)
❑Slope f] Valley 74FIat !Ridge El Other
LATITUDE 36 "DMSOR 35.265820
LONGITUDE 75 " DM5 OR -79.584863
DD
DD
Latitude/longitude source: ghPS [topographic map
(location of well must he shown on a USGS topo mop errdaltached to
this form if not using CPS)
5. WELL OWNER
S&S Partners LLP. _ Dr. Christooher Diasio
Owner Name
195 West Illinois Ave.
Street Address
Southern Pines
City or Town
Area code Phone number
b. WELL DETAILS:
a. TOTAL DEPTH: 180'
NC 28387
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES[ NO pS
c. WATER LEVEL Below Top of Casing: N/A FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS NIA FT, Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C A118.
e. YIELD (gpm): N/A METHOD OF TEST N/A
f. DISINFECTION: Type N/A Amount N/A
g. WATER ZONES (depth):
Top N/A Bottom N/A Top Bottom
Top Bottom Top Bottom
Top Bottom
7. CASING: Depth
Top N/A Bottom N/A
Tap Bottom
Tap Bottom
8. GROUT: Depth
Top 0 Bottom 180
Top _ Bottom
Thickness/
Diameter Weight Material
Ft.
Ft.
Ft.
Material
Ft, Bentonite
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth
Top N/A Bottom N/A
Top Bottom
Top Bottom
Method
Tremie
Diameter Slot Size Material
FL In. in.
FL in. in.
Ft. In. in.
10. SAND/GRAVEL PACK:
Depth
Top N/A Bottom N/A Ft.
Size Material
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 /5
5 /18
18 /38
38 /48
48 /83
83 /87
87 /110
110 /123
123 /145
145 /150
150 /175
175 /180
Formation Description
Medium Course Sand
Gray Clay
Gray Clay & Sand
Medium Course Sand & Gravel
White Clay & Sand
Hard Medium Course Sand
Brown & White Clay w/Sand
Sandstone
Fine to Medium Course Sand
Hard Sand & Clay
Sandstone
Hard Brown Clay & Rock
12. REMARKS:
Cetco Geothermal Grout was used.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER.
2/18/2012
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
Randall E. Cutter
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : p919) 807r6300
Foram GW-la
Rev. 2/09

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2818—A
1. WELL CONTRACTOR:
Randall E. Cutter
Well Contractor (Individual) Name
Go! Green Drilling. Inc.
Well Contractor Company Name
6105 Rest Home Rd.
Street Address
Claremont NC 28610
City or Town State Zip Code
( 828) 367-1293
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10600086
OTHER ASSOCIATED PERMIT#(if applicable) 110872
SITE WELL ID #(ifapplicable) GL-25
3. WELL USE (Check Applicable Box): Residential Water Supply ❑
DATE DRILLED 2/7/2012
TIME COMPLETED 10:30 AM II' PM p
4, WELL LOCATION:
cup: West End coutkirt Moore
155 Grant Street 27376
(Street Name. Numbers. Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC 1 LAND SETTING: (check appropriate box)
O Slope ❑Valley 4Ftat L] Ridge u Other
LATITUDE 36
LONGITUDE 75
• DMS OR 35.265611
DO
DMS OR -79.584741 OD
Latitude/longitude source: I3PS l ropographic reap
(location of well must be shown an a USGS topo map endettached to
this corm if no! using GAS)
5. WELL OWNER
S&S Partners LLP. . Dr. Christopher Diasio
Owner Name
195 West Illinois Ave.
Street Address
Southern Pines NC 28387
City or Town State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 180'
b. DOES WELL REPLACE EXISTING WELL? YES NO Pf
c. WATER LEVEL Below Top of Casing: N/A FT.
(Use "+" If Above Top of Casing)
d. TOP OF CASING IS N/A FT. Above Land Surface"
'Top of rasing terminated at/or below land surface may require
a variance in accordance with 1SA NCAC 2C 0118.
e. YIELD (gpm): N/A METHOD OF TEST N/A
f. DISINFECTION: type N/A Amount NIA
g- WATER ZONES (depth):
Top NIA Bottom N/A Top Bottom
Top Bottom Top Bottom
Top Bottom Top_ Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top N/A Bottom NIA Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material
Top 0 Bottom 180 Ft. Bentonite
Top Bottom Ft.
Top Bottom Ft.
Method
Tremie
9. SCREEN: Depth Diameter Slot Size Material
Top N/A Bottom N/A Ft in. in.
Top Bottom FL in. in.
Top Bottom Ft. in. In.
10. SAND/GRAVEL PACK:
Depth
Top NIA Bottom N/A Ft.
Top Bottom Ft.
Size Material
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 15
5 118
18 /38
38 /48
48 /83
83 /87
87 /110
110 1123
123 /145
145 /150
150 1175
175 /180
1
1
Formation Description
Medium Course Sand
Gray Clay
Gray Clay & Sand
Medium Course Sand & Gravel
White Clay & Sand
Hard Medium Course Sand
Brown & White Clay w/Sand
Sandstone
Fine to Medium Course Sand
Hard Sand & Clay
Sandstone
Hard Brown Clay & Rock
12. REMARKS:
Cetco Geothermal Grout was used.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER.
2/18/2012
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
Randall E. Cutter
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : (919) 807"6300
Form GW-la
Rev. 2109

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2818 A
1. WELL CONTRACTOR:
Randall E. Cutter
Well Contractor (Individual) Name
Go! Green ❑riliina. Inc.
Well Contractor Company Name
6105 Rest Home Rd.
Street Address
Claremont NC 28610
City or Town State Zip Code
( 828 ] 367-1293
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# WI0600086
OTHER ASSOCIATED PERMIT#(if applicable) 110872
SITE WELL ID #(if applicable) GL-26
3. WELL USE (Check Applicable Box): Residential Water Supply ❑
DATE DRILLED 2/8/2012
TIME COMPLETED 12:30 AM ❑ PM CIl'
4. WELL LOCATION:
cm West End COUNTY Moore
155 Grant Street 27376
(Street Name, Numbers, Community, Subdivision, Lat No., Parcel, Zlp Code)
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Stope ❑ Valley 'FIaI ❑ Ridge ❑ Other
LATITUDE 36 " DMS OR 35.285664 DD
LONGITUDE T5 - " DMS OR-79.584770 no
Latitudellor:gttude source: [3PS Uropographic map
(location of well must be shown on a tJSGS tope map andattached to
this form if not using GPS)
5. WELL OWNER
S&S Partners LLP.. Dr. Christopher Diasio
Owner Name
195 West Illinois Ave.
Street Address
Southern Pines
City or Town
(_)
Area code Phone number
B. WELL DETAILS
a. TOTAL DEPTH: 180'
NC 28387
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Or
c. WATER LEVEL Below Top of Casing: N/A FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS N/A FT. Above Land Surface`
'Top of casing terminated atior below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): NIA METHOD OF TEST NIA
1. DISINFECTION: Type NIA Amount N/A
g. WATER ZONES (depth):
Top NIA Bottom N/A Top Bottom
Top Bottom Top _ Bottom
Top Bottom Top Bottom
Thickness!
7_ CASING: Depth Diameter Weight
Top N/A Bottom N/A Ft,
Top_ Bottom FI.
Top Bottom Ft. _
S. GROUT: Depth Material
Top 0 Bottom 180 Ft. Bentonite
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth
Top NIA Bottom NIA
Top Bottom
Top Bottom
Material
Method
Tremie
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Top NIA Bottom N/A Ft.
Top Bottom Ft.
Top Bottom Ft.
Size Material
11. DRILLING LOG
Top Bottom
D /5
5 /18
18 /38
38 148
48 /83
83 /87
87 /110
110 /123
123 I145
145 /150
150 /175
175 /180
I
r
Formation Description
Medium Course Sand
Gray Clay
Gray Clay & Sand
Medium Course Sand & Gravel
White Clay & Sand
Hard Medium Course Sand
Brown & White Clay w/Sand
Sandstone
Fine to Medium Course Sand
Hard Sand & Clay
Sandstone
Hard Brown Clay & Rock
12. REMARKS:
CetcLo Geothermal Grout was tried
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
ACCORDANCE WITH 15A NCAC 2C. WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER.
2/18/2012
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
Randall E. Cutter
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GW•la
Rev. 2/09

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2818-A
1. WELL CONTRACTOR:
Randall E. Cutter
Weil Contractor (Individual) Name
Go! Green ❑rillina. Inc.
Well Contractor Company Name
6105 Rest Home Rd.
Street Address
Claremont NC 28610
City or Town State Zip Code
( 828 } 367-1293
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# WI0600086
OTHER ASSOCIATED PERMIT#(trf applicable) 110872
SITE WELL ID #(if applicable} GL-27
3. WELL USE (Check Applicable Box): Residential Water Supply ❑
DATE DRILLED 2/9/2012
TIME COMPLETED 55:OO AM ❑ PM lI
4. WELL LOCATION:
crrr• West End COUNTY Moore
155 Grant Street 27376
(Street Name, Numbers, Community, Subdivision. Let Ne., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING' (check appropriate box)
❑Slope ❑Valley 4Flat ❑Ridge ❑Other
LATITUDE 36 4 '
LONGITUDE 75
Latitude/longitude source: R PS
(location of well must be shown on
this form if not using GPS)
DMS OR 35.265702 DD
" DMS OR -79.584816 DD
Dropographic map
a USGS topo map andattached to
5. WELL OWNER
S&S Partners LLP.. Dr. Christopher Diasio
Owner Name
195 West Illinois Ave.
Street Address
Southern Pines
City or Town
Area code Phone number
B. WELL DETAILS:
a. TOTAL DEPTH: 180'
NC 28387
Stale Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES a NO ilk
c. WATER LEVEL Below Top of Casing: N/A FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS N/A FT. Above Land Surface"
"Top of casing terminated atlor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e- YIELD (gpm): NIA METHOD OF TEST NIA
f. DISINFECTION: Type NIA Amount NIA
Top NIA
g. WATER ZONES (depth):
Top NIA Bottom NIA Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom_ _
7. CASING: Depth
Top N/A Bottom NIA
Top
Top
Bottom
Bottom
8. GROUT: Depth
Top 0 Bottom 180
Top Bottom
Top Bottom
Diameter
Ft.
Ft.
Ft.
Material
Ft. Bentonite
Ft.
Ff.
Thickness/
Weight Material
Method
Tremie
9_ SCREEN: Depth Diameter Slot Size Material
Top N/A Bottom NIA Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. In. in.
10. SAND/GRAVEL PACK:
Depth
Bottom N/A
Top Bottom
Top Bottom
11. DRILLING LOG
Top Bottom
0 /5
5 /18
18 /38
38 148
48 /83
83 187
87 1110
110 1123
123 1145
145 1150
150 1175
175 /180
1
1
Size Material
Ft.
Ft.
Ft.
Formation Description
Medium Course Sand
Gray Clay
Gray Clay & Sand
Medium Course Sand & Gravel
White Clay & Sand
Hard Medium Course Sand
Brown & White Clay wlSand
Sandstone
Fine to Medium Course Sand
Hard Sand & Clay
Sandstone
Hard Brown Clay & Rock
12. REMARKS:
Cetco Geothermal Grout was used.
I DO HEREBY CERTIFYTHATTHIS WELL WAS CONSTRUCTED IN
ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR
Randall E. Cutter
2/18/2012
DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mali Service Center, Raleigh, NC 27899-161, Phone : [phone]
Form GW-le
Rev. 2109

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 281 B A
1. WELL CONTRACTOR:
Randall E. Cutter
Well Contractor (individual) Name
Go! Green Drillina. Inc.
Well Contractor Company Name
6105 Rest Home Rd.
Street Address
Claremont NC 28610
City or Town State Zip Code
( 828) 367-1293
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#WI0600086
OTHER ASSOCIATED PERMIT#('rf applicable) 110872
SITE WELL ID #Cif applicable) GL-28
3. WELL USE (Check Applicable Box): Residential Water Supply ❑
DATE DRILLED 2/11/2012
TIME COMPLETED 11 :30 AM 11 PM 0
4. WELL. LOCATION:
CITY: West End couim Moore
155 Grant Street 27376
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope DValley gnat E Ridge pother
LATITUDE 38 " DMS OR 35,265742 D❑
LONGITUDE 75 ° " ❑MS OR -79.584864 ❑❑
Latitude/longitude source: [ 3PS Drapographic map
(location of well must be shown on a USGS topo reap andattached to
this form if not using GPS)
5, WELL OWNER
S&S Partners LLP. . Dr. Christopher Diasio
Owner Name
195 West Illinois Ave.
Street Address
Southern Pines
City or Town
Area code Phone number
8. WELL DETAILS:
a. TOTAL DEPTH: 180'
NC 28387
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO pit
c. WATER LEVEL Below Top of Casing: N/A FT.
(Use '}° if Above Top of Casing)
d. TOP OF CASING IS N/A FT. Above Land Surface'
"Top of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0116.
e. YIELD (gpm): NIA METHOD OF TEST N/A
f. DISINFECTION: Type NIA Amount N/A
g. WATER ZONES (depth):
Top_N/A Bottom NIA
Top Bottom
Top Bottom
7. CASING: Depth Diameter
Top NIA Bottom N/A Ft.
Top Bottom Ft.
Top Bottom Ft.
Top Bottom _
Top Bottom
Top Bottom
Thickness)
Weight Material
8. GROUT: Depth Material Method
Top 0 Bottom 180 Ft. Bentonite Tremie
Top _ Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Sire Material
Top N/A Bottom NIA Ft. In. in.
Top Bottom Ft In. in.
Top Bottom Ft In. in.
10. SAND/GRAVEL PACK:
Depth Size Materiel
Top N/A Bottom N/A Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 15
Formation Description
Medium Course Sand
5 118 Gray Clay
18 /38 Gray Clay & Sand
38 /48 Medium Course Sand & Gravel
48 /83 White Clay & Sand
83 /87 Hard Medium Course Sand
87 1110 Brown & White Clay w/Sand
110 /123 Sandstone
123 1145 Fine to Medium Course Sand
145 /165 Hard Sand & Clay
165 /180 Sandstone
1
1
1
12. REMARKS:
Ce s:a Geothermal Grout was used.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER.
2/18/2012
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
Randall E. Cutter
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Fora} GW-1 a
Rev. 2/Q9

Sandhills Pediatrics Borehole/Loop Coordinates
GL-1 35.265813°
-79.584478°
GL-2 35.265851°
-79.584525°
GL-3 35.265888°
-79.584569°
GL-4 35.265929°
-79.584619°
GL-5 35.265961°
-79.584676°
GL-6 35.265777°
-79.584524°
GL-7 35.265815°
-79.584572°
GL-8 35.265852°
-79.584618°
GL-9 35.265892°
-79.584668°
GL-10 35.265926°
-79.584724°
155 Grant Street
West End, NC
GL-1135.265733°
-79.584583°
GL-12 35.265777°
-79.584622°
GL-13 35.265815°
-79.584667°
GL-14 35.265855°
-79.584716°
GL-15 35.265887°
-79.584773°
GL-16 35.265701°
-79.584625°
GL-17 35.265740°
-79.584671 °
GL-18 35.265777°
-79.584717°
GL-19 35.265817°
-79.584766°
GL-20 35.265650°
-79.584683°
Go! Green Drilling, Inc.
6105 Rest Home Rd.
Claremont, NC 28610
828-367-1293
www.GoGreenDrilling~com
GL-2135.265702°
-79.584721 °
GL-22 35.265739°
-79.584766°
GL-23 35.265780°
-79.584815°
GL-24 35.265820°
-79.584863°
GL-25 35.265611°
-79.584741°
GL-26 35.265664°
-79.584770°
GL-27 35.265702°
-79.584816°
GL-28 35.265742°
-79.584864°
air
gL-9
GL-6
(§3RA2 97 !
tap9 @I
gloil
{ 5
� Il
® 1 g
GL-4
G,L-8
GL-9
(01196
*pilD 1
SandhiiUs
L-28
L-24