Po CY2003

272852
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON
RED BIRD LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DR JIM BAKER
Address RED BIRD LANE
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(828) — 859-5055
Area Code Phone number
4. DATE DRILLED 04/03/03
5. TOTAL DEPTH: 445
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 12
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 60 Ft. 6-1/4" SDR21 PVC
From To _ Ft.
From To _ Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To Ft. _ in. in.
From _ To _ Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To Ft. _
From To Ft.
16. REMARKS
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9S. FROM MILL SPRING. RT. ON HWUY.
#14. RIGHT ON RED FOX RD. GO PAST THE
COUNTRY CLUB. RT. ON BLUE BIRD LANE. LEFT
ON RED BIRD LANE.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE 15A-NCAC2C,_WEI.i
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PR TO THE WELL OWNER
DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Serpce Center _Raleigh, NC_
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
L_-

WELL CONSTRUCTION RECORD 272850
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON
66 ASHLYN LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ED ROBERTSON
Address 66 ASHLYN LANE
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(828) — 863-0963
Area Code Phone number
4. DATE DRILLED 04/16/03
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 7.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 165 Ft. 6-1/4" 188 GALV
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From To _ Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To _ Ft.
From To Ft. _
16. REMARKS:
Topographic/Land setting
0 Ridge ❑ Slope 0 Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. LEFT ON
SANDY PLAINS RD. LEFT ON ASHLYN LANE.
HOUSE ON RT. AT SHARP CURVE.
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1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CON UCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN P
SIGNATURE 0 PERSON CONSTRUCTING THE LL DATE
L
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. I GRf111KV- 07/2001 _
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272848
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery- ❑ Heat Pump Water Injection ❑ Other ❑ if Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING County POLK
SMITH WALDROP 1tD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CHARLES TUBBS
Address 1642 SMITH WALDROP RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 894-0683
Area Code Phone number-
4. DATE DRILLED 04/22/03
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
S. 1 OP OF CASING IS 1-1(2 r 1. Above Land Surface"
"Top of casing tc ninated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Tvpc CHLORYTE Amount 16.5
12. CASING: Wall Thickness
Depth Di nicict of \VeighiCi,
From 0 To 100 Fi.6-1/4" SDR.21 PVC
From To Ft.
I'r0111 _ To FL
13. GROUT: Depth Material Method
From _0 To 20 Ft. QUIKRETE POURED
Prom To H.
14.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From _ To Fi.
I5_ SAND/GRAVEL PACK:
Depth Size Material
Froni To _ Ft. _
From To FI.
16. REMARKS:
Topographic/Land setting
❑ Ridge 0 Slope ❑ Valley- ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. RT. ON SMITH
WALDROP RD. DRIVE ON LEFT APPROX. 1-1/2
MILES. (BOX #1642)
13
CJ
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C. WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PR4V1I t TO TITE W€LL OyVN€}tt T— 1
SIGNATURE OFIPERS N CONSTRUCTING THE WELL DATE 111
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
27699-1636 Phone No. (919) 733-322 i, wWiin 311 days. GW-I REV U /2UUi-

272837
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial D Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON
CROOKED CREEK LANE
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: ARTHUR CORN
Address CROOKED CREEK LANE
(Street or RouteNo.)
TRYON NC 28782
City or Town State Zip Code
(828) — 894-3405
Area Code Phone number
4. DATE DRILLED 04/24/03
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9 YIELD (gpm): 2 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
Zip Code)
11. DISINFECTION: Type CHLORYTE Amount 7.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 30 Ft. 6-1/4" SDR.21 PVC
From _ To Ft.
From _ To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From To Ft _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. RIGHT ON
HUGH CHAMPION RD. RIGHT ON PENIEL RD.
LEFT ON HENDERSON RD. CROSS THE CREEK
TURN LEFT ON CROOKED CREEK LANE. TAKE
1ST LEFT. THEN TAKE THE NEXT RIGHT.
FOLLOW DRIVE UP TO THE HOUSE.
-D
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W
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 PERS N CONSTRUCTING THE WEL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

27 835
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERI IF !CATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: SALUDA
HWY. #176
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: GEORGE DELWORT
Address 5008 HWY. #176
(Street or Route No.)
SALUDA NC 28773
City or Town State Zip Code
(828) — 749-2272
Area Code Phone number
4. DATE DRILLED 04/01/03
5. TOTAL DEPTH: 265
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO EI
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 80 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 6.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 60 Ft. 6-1/4" SDR21 PVC
From To _ Ft.
From _ To _ Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To Ft.
From _ To _ Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
in. in.
in. in.
From To _ Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #176 FROM TRYON. 1ST DRIVE ON RT.
PAST BEAR CREEK DR
—o
a
tV
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PRO 1 ` s rr 1I. WELL U WNbkt
SIG ATURE OF PERSON CONSTRUCTING WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service 4enteq — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. G
I, I
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Aa WILL k U' ,AL CFIFICG

272833
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERIIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON County POLK
RED FOX COUNTRY CLUB
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ANN CRANDALL
Address 392 RENARD RD.
(Street or RouteNo.)
TRYON NC 28782
City or Town State Zip Code
(926) - 516-6861
Area Code Phone number
4. DATE DRILLED 04/24/03
5. TOTAL DEPTH: 405
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 4 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: T)
12. CASING:
Depth
From 0 To 130
e CHLORYTE Amount 10.5
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 6-1/4" SDR.21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. QUIKRETE
From To Ft.
14.SCREEN: Depth Diameter
From To Ft.
From To _ Ft. _
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
Method
POURED
Slot Size
in. _
in.
Material
Material
n.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. RIGHT ON
LANDRUM RD. RIGHT ON RED FOX RD. RIGHT
INTO MAIN ENTRANCE TO RED FOX COUNTRY
CLUB. GO APPROX. 3/4 MILE. TURN LEFT ON
RENARD RD. 3/10 MILE ON RIGHT.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THt)T A COPY OF THIS RECORD HAS BEEN PROVIDED Tn TH WELL D.WNER --
Cam./���
S GNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service denier - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 R>!4V. 07/2001

272829
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery' ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
HARMONY LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JEFF HARMS
Address HARMONY LANE
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 625-1611
Area Code Phone number
4. DATE DRILLED 04/01/03
5. TOTAL DEPTH: 47
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 37 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 4.6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 47 Ft. 24" CEMENT
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CEMENT
From _ To Ft.
14.SCREEN: Depth Diameter
From To Ft. _
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From 37 To 47 Ft. 78M GRAVEL
Method
POURED
Slot Size Material
in. _ in.
in. in.
From To Ft.
16. REMARKS:
Topographic/Land setting
0 Ridge ❑ Slope El Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 E. FROM MILL SPRING. LEFT ON
BIG LEVEL RD. LEFT ON POWELL RD. LEFT ON
HARMONY LANE APPROX. 6/10 MILE ON RT.
-o
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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
)3 577
SI NA OF
SrtRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Servic
27699-1636 Phone No. [phone], within 30 days. G
E.
[ d. ter—iRaleigh,NC
N-1 REV. 07/2001
SECTION
A HEWLLE REGIOI,jAL Oi HOE

Columbus
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeremy H. Bowman ' - CERTIFICATION 92809
WELL CONTRACTOR COMPANY NAME D Rnwman We1 1 Dr 1 1 1 Tnr• PHONE # A 78 757-7779
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED WO PERMIT#
(if applicable) (irapplicable)
276016
1. WELL USE (Check Applicable Box): Residential LY Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Mi 11 spring County Polk
Deer Meadow Subdivision; Buck Drive
(Street Name, Numbers, Communiry, Subdivision, Lot No., Zip Code)
3. OWNER:
Stephen Pettyjohn
Address P.O. Box 1352
(Street or Route Q,L
28732
City or Town State Zip Code
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
Lot # 5 (check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
( )-
Arca coda Phone number
4. DATE DRILLED 3/25/03
5.TOTAL DEPTH 220'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IX
7. STATIC WATER LEVEL Below Top of Casing: 601 FT
(Use "+" if Above Top of Cuing)
S. TOP OF CASINO IS 1 • 4 FT. Above Land Surface'
•Tap of casing terminated actor below land surface requires a
variance In accordance with 15A NCAC 3C.0118.
9. YIELD(gpm)• 20 METHOD OF TEST E.rotary air
I0. WATER ZONES (depth): 220'
11. DISINFECTION: Type tablet
12. CASINO:
Depth Diameter
From 0 To 72 Ft.bt /8
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20 FL
From To
14. SCREEN: Depth Diameter
From To Ft. in
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Amount 6
Wall Thickness
or Weight/Ft. Material
Sch_8D pvr
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. e=
w
Material Method
concrete gravity flow
Ft.
Slot Size Material
in,
in.
Material
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
! • ^ • •' !YARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
r�l } � „ti ,,.�� .1 2c/0
11,E C t 1 SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
..I J i I I
Submit the original to theAlllivlsion of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
i 27699-1636 Phone No. (S 19) 733-3221, within 30 days. OW -I REV. 07/2001
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WELL CONSTRUCTION RECORD
North Carolina - Dcpartnent of Environment and Natural Resources - Division of Water Quality • Groundwater Sxnon
WELL CONTRACTOR (INDIVIDUAL) NAME. (print) /3a y4t Smit
CERTIFICATION •-�'°_'
/ rr��
WELL CONTRACTOR COMPANY NAME GIt"f.Qn \S��Vff ENV (� 5 NrY)Q PHONE
WQ PERMIT%
STATE WELL CONSTRUCTION PERMIT% ASSOCIATED(if applicable)
(if applicable) '
rani ri Y_12 OC
I WELL USE (Check Applicable Box): Residential O*---MunicipaUPublic 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use —.
2 WELL LOCATION:
Nearest Town: Sit lbkj/i-
County aifilk
City or Town State
(50)- etb— Ex1L13
Area code- Phone number
4. DATE DRILLED G �, `03
5 TOTAL DEPTH: / t C
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO LTA
STATIC WATER LEVEL Below Top of Casing: J C FT.
(We "+" if Above Top of Casing)
8 TOP OF CASING IS / FT. Above Land Surface'
•Top or cuing terminated atior below land surface requires s
variance In accordance with ISA NCAC 1C .0118.
9 YIELD (gpm): 2 D METHOD OF TEST /ir
10 WATER ZONES (depth): /'7''C
(Strrct Nome, Numbers, Communi , Subdivision, Lot No., Zip Code)
3 V Q\ GZ
OWNER: Address 3 r tr,DN,1l 0c-.
(Street or Route No.)
INV49 3tl I
,zip Code
I I. DISINFECTION: Type H%H
12. CASING:
Depth Diarrieter
From / To ¥9 Ft. eq
From I' S To es Ft L ii
From To Ft.
13. GROUT: Depth Material
From 0 Tom Ft. 6 t/cahfk
Amount
Wall Thickness
or Weight/Ft. Material
2 7 v�
2f •L
Cn
276130
Topographic/Land setting
❑Ridge ❑Slope pVallcy ❑Flat
(check appropriate box)
Latitudelongin;de of well locafior.
36°t1'5YA1 (62 °ZO 3C6.4.2
(degrees/minutes/seconds)
Latitude/longitude source:E'3dPS❑Topographic map
(check box)
DR LUNG LOG
FormationCe$rtrtion
Method
tP 0t
From To Ft.
14. SCREEN: Depth. Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To Ft.
pEPTH
From To
O — /0
/0- 39
3D - G0
Gr9— /e 5--
LOCATION SKETCH
Show direction and distance in miles from a: least
two State Roads or County Roads. Include the roar
numbers and common road names.
16. REMARKS
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, THA A W
COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Y
//y�,. 16 -Z •5 -03
- SIGNATURE OF PERSON CONSTRUL I ING THE WELL DATE
Submit Oleo
27699-1057
ji Inal to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center Raleigh, 20C
`.
se No. [phone], within 30 days.

WELL CONSTRUCTION RECORD 2 3
North Carolina - Department of Environment and Natural Resources
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME C-1 1-,0 n R)The III `P Il S
- Division of Water Quality - Groundwater Section /7
CERTIFICATION « oR / 1
Pump Cn PHONE # (Lq3-12OC
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural L3'
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest To pitI 5
County P6-3 OC
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: r{yu- R PQC •
Address 1 a k (,L7 i n(4 &I)nQt l.3n3.0
(Street or Route No.) A../
•J
,re-rkctursor)0 Ii%e./VC a k2°ra
ity or Town State
s `3 /iS Zip Code
Arta code- Phone number
4. DATE DRILLED / • /O ' °3
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO C7`
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface•
•Top of cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): O METHOD OF TEST
10. WATER ZONES (depth):
/ii rt
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Qflat
(check appropriate box)
Latitude/longitude of well location
SS °!he /3 H/ 08.2` in /GU)
(degrees/minutes/ nds)
Latitude/longitude source:QGPS❑Topographic rnap
(check box)
DEPTH DRILLING LOG
From To Formatiop DDsscription
0 RAJ 6—O — /icy .504..01
/10 /tea" Mbromc
12S— - f1O6— C6Iilie11FF
11. DISINFECTION: Type
12. CASING:
Depth Dial -peter
From / To 70 Ft. G Y
From 70 To /3 0 Ft. L
From To Ft.
13. GROUT: Depth
From o To .2. 0
Amount
Wall Thickness
or Weight/Ft. Material
21.! P✓!i
ZL Pvcr
Material
Ft. $thtrtrtr
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
LOCATION SKEtCU f"
Show direction and distance inpgiles f#ofn at least
two State Roads or County Roa Inctvde. the road
numbers and common road names
Method
/N:y %-Pflo/&
Slot Size Material
in.
in.
16, REMARKS:
.1 DO'HEREE RTIFY THAT THIS WELL WAS C
CONSTit d tI�l STANDARDS, AND THAT A CO
�origl
hors N
tri
• STRUCI hD IN ACCORDANCE WITH 15A NCAC 2C, WELL
t`r OF THIS, CORD HAS BEEN PROVIDED TO THE WELL OWNER
IGNATURE OF PERSON CONSTRUCTING THE WELL
I- /0 - 0,3
DATE
Submit th al to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
------Yf6vU-inao o. [phone], within 30 days. GW-1 REV. 07/2001

276122
. WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
`
WELL CONTRACTOR (INDIVIDUAL) NAME (print) A�- afah, CERTIFICATION. 02J-77 / / /
WELL CONTRACTOR COMPANY NAME C-irp,p n R'IVI t VskU S P.,&mp (n PHONE # 021) G 43- 1200
STATE WELL CONSTRUCTION PERMIT" ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public O Industrial ❑ Agricultural IB
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: i" i l\ p 5ri1�Q
iI p-fBoad I
County Co Ie__
(Street Name, Community, Communi, Subdivision, Lot No., Zip Code)
v/1
3. OWNER: t t ek-kuI r] i.
Address t ? `r (d2 ii VKf con cl u.3-vC1
(Street
c or Route No.)
ity or Town $tat, . Zip Code
Area code- Phone number
4. DATE DRILLED / f - 0 3
5. TOTAL DEPTH: '7 L SJ
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I "
7. STATIC WATER LEVEL Below Top of Casing: 4 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface•
*Top of cuing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): C METHOD OF TEST Ai R..
10. WATER ZONES (depth): / 20
11. DISINFECTION: Type IW YN
12. CASING:
Depth,'' Diameter
From To£ Ft.
From Z. g To_i_a Ft
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. SHA/itie
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
v
Method
M. S-
p
16 REMARKS:
IQO HERFIBY.CE
CONSTRUCT! e N
1-1
Submit the_original tc
,E,7.4?9+1536 Ph¢ne No. (
Topographic/Land setting
ORidge ❑Slope ❑Valley It
(check appropriate box)
La jtude/longitude of well location
lax/ etc cc *to
(degrtWminutes/seconds)
Latitude/longitude source:C'3dPSOTopographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From (1iTo
0 470-40
O - pop
/ Do - ler
LOCATION SKETCH
Show direction and distance in mitID frotJat least
two State Roads or County Roads.hOciudmthe road
numbers and common road names= - _
0 C-..
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
DARDS, AND L T A COP OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SI
OF PERSON CONSTRUC LING THE WELL DATE
the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
19) 733-3221, within 30 days. GW-1 REV. 07/2001

276423
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # 2 1 1 A
rmp' c WP11 & Primp Pn Tnc PHONE w 2R 454-7422
ASSOCIATED WQ PERMIT#
(if applicable)
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James la Camp, Jr.
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public O Industrial ❑ Agricultural ❑
Monitoring O Recovery O Heat Pump Water Injection O Other O If Other, List Use
2. WELL LOCATION•
Nearest Town: & 1 w a ti County
PiingN\f4. i. 17;J.-Eill io/{de
(Street Nano, umbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: F'{Y 1 Dees
) t) D Ke r a'fia 1)r.
reel or Rdute No,)
fV�c€Jtik FL 3otS�s,
Address
City or Town Suns Zip Code
( )-
Area code- Phone number
4. DATE DRILLED l'
5. TOTAL DEPTH: <a D .5 -
6. DOES WELL REPLACE EXISTING WELL? YES O NO
7. STATIC WATER LEVEL Below Top of Casing: 6 5 FT.
(Use''" if Above Top of Casing)
S. TOP OF CASING IS 1 FT. Above Land Surface*
`Top of casing terminated aUor below land surface requires a
" variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): in METHOD OF TEST
10. WATER ZONES (depth): 57,-0
Air
11. DISINFECTION: Type ('h 1 nri np
12. CASING:
Depth
From Q To 6 0
From To
From To
13. GROUT: Depth
From_o To 2 0 Ft.
Diameter
Ft. 6_ 1/4
Ft.
Ft.
Material Method
N at Cement IIand
Amount CLJ'
Wall Thickness
or Weight/Ft. Material
elm?1 PVC
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Slot Size Material
in.
in,
16. REMARKS:
Topographic/Land setting
Ridge ❑Slope ❑Valley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
n (�U and, e
An ri50lld ateA (cC
LOCATION SKETCH
Show direction and distance in miles from at least
two State {toads or County Roads. Include the road
numbers : d common road napes. c
at —lv-
r
tV
L
0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 15ANCAC 2C, WELL
NSTRUCTIQN-STAN➢AR110,`,A'f1t THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
(r-44 � . 7 - li - 03
! I
vi (// siNATURE OF PE9 N CONSTRUCTING THE WELL ✓ % DATE
L
SuI mit the original tg the lllvisior of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27694-111362h6neNo. 4I9;,733-3221 within 30 days. GW-1 REV. 07/2001

276421
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
James w
ramrs' 4 wall
Camp, Jr CERTIFICATION# 2 1 I R
R Primp Co Tnr PHONE #82S) 4c2-7122
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential EY/Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION'
Nearest
t� T�owfn:S�-Lyrl,l p County
G AYY \ Utfrt. ._ S,1 a, (%t.lA Lll (1`^
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CeA d � 1 V C^ CM
Address tiK 7F
(Street or Route No.)
CXDr/Cki -1 %C
City or Town State Zip Code
( Area code- Phone numb?:
4. DATE DRILLED la • 3,1 D 2
5. TOTAL DEPTH: .2i ko 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO C
7. STATIC WATER LEVEL Below Top of Casing: (0 D FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S 1 FT. Above Land Surface`
'Top of casing terminated at/or below land surface requires a
variance to accord nce with 15A NCAC 2C .0118.
9. YIELD (gpm): (: ME HOD OF TEST p y�
10. WATER ZONES (depth): J 4 0
11. DISINFECTION: Type rh 1 nr i np Amount 1 Ut "'\P
12. CASING: Wall Thickness
Dep Diameter
From p To FL 6 1 / 4
From To 10 Ft.
From To Ft.
13. GROUT: Depth
From_? To 2 0 Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft,
From To Ft.
or WeigM/tk. Material
SDR21 PVC
Material
Ncvt Cement
CONSTRUCTION STAND
Slot Size
in.
in
Material
Topographic/Land setting
E Midge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑GPS ❑Topographic map
(check box)
pRILLING LOG
Formation Description
3-Y TAX Ste,INA
DEPTH
From To
70
).v
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include
numbers and common road names.
TTHIS WFI i WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFI T
S, AND THAT A COPY 0 THIS RECORD HAS 13EEN PROVIDED TO THE WELL OWNER
a.44 d , ( /wy ,�'7J
SIGNATURE OF PERS,(%N CONSTRUCTING THE WELL / DATE
u-
1.=P,Sillittilfigotigtnarto the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
="_ P rarre o. 19) 733-3221, within 30 days. GW-1 REV. 07/2001
eu

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) JameS w Capp Jr CERTIFICATION# 21 38
276420
WELL CONTRACTOR COMPANY NAME (*actin I a WP11 R Primp rn _Inc. PRONE #62A) dS-I -7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 1/Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearees�tTppwn: MI' !I 5,//✓l County po IK
[rj/h/7es1de off Deer- RI' ciee
(Street Name, Numbers, Community, Subdivision, Lot No.- Zip Cale)
3.OWNER: R.E. McGala-
AddressI 'tit_ K()
C0 4(ut(S �or Rout�N4.)_
City or Townh State V� Zip Code
( )-
Area code- Phone number
4. DATE DRILLED �0 -.9144-0 - G
5. TOTAL DEPTH: ;;Z 4.7
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
7. STATIC WATER LEVEL Below Top of Casing: ,54 FT,
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface`
'Top of casing terminated at/or below land surface requires a
variance in accordant th 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST Air
10. WATER ZONES (depth): ;20
11. DISINFECTION: Type ('h 1 nri na Amount cup
12. CASING: Wall Thickness
Depth , Diameter or Weight/Ft. Material
From p To 25 Ft. 6 1 / 4 eDR21 PVC
From To Ft
From To Ft.
13. GROUT: Depth
From_ To p Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Material
Neat Ccment
Method
IIand
Topographic/Land settingf
�z
DRidge ❑Slope ❑Valley gdiat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Forma tioa Description
(t /g aitl SA ld, y vatic,
24s C,)(solidated (oc-K
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
X
0
0
r'_
16. REMARKS:
ill 0HEREBY .CERTIFY THAT i'I't1 WELL WAS CONSTRUCIED IN ACCORDANCE WITH JSANCAC 2C, wi.
d ION -STANDARDS, THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
it-y✓ (jP14, ilD3
S(7
i.' y SIGNATURE OF PERN CONSTRUCTING THE WELL / DATE
Submit -the original to the Sivisioh of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
276Q9-1636 Phone No.(919) 733-322i, within 30 days. - GW-I REV. 07/2001

218188
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of
Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMJS (print) �.3Rpn e5 l� • M. p. r
U . CERTIFICATION1Nat 3 S
WELL CONTRACTOR COMPANY NAME I.Li Y11�S Well V PU Wtl1 `D.rIL C PHONE # fg g) 321-1
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: i\%tt 1) County
\Jj b3s ?_A &t k 'a
(Street Name, Numbs Community, Subdivisi t No., Zip Code)
3. OWNER:" Lre 1 {c—l 0)f,
Address C. 0 ' L\ `a. S
.�/p� (Street or Route No.)
SP,(AAX 1IA 5- c act k C
•
City or Town Zip Code
(stl,U )- S A 3_ I S U
Area code- Phone number
4. DATE DRILLED re 0 .135. TOTAL DEPTH: b S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO M
7. STATIC WATER LEVEL Below Top of Casing: Lv U FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): ,� I) METHOD OF TEST 0 wA
10. WATER ZONES (depth): b 0
11. DISINFECTION: Type (
12. CASING:
Depth Diameter
From 0 To ti.15 Et.�_
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From D To .2t9 Ft. need Cemevtt (karat
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.'
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
_SAR1\ not
16. REMARKS:
Topographic/Land setting
[Midge ❑Slope Ifalley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To
Fottgn Description
LOCATION SKETCH 0
Show direction and distance in miles from aUlteast
two State Roads or County Roads. Include road':_i
numbers and co on road names.
0
cn
Cs)
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS I CORD HAS BEEN PROVIDED TO THE WELL OWNER
e_ 11(
SIGATURE OF PERSON CON
Submit the original to the Division of Water Quality, Grou
27699-1636 Phone No. [phone], within 30 days.
x \ o3
WELL �TE
er Section, 1636 Mail Servi Cr - Raleigh, NC
-1 REV. 07/2001
6RCL'N=:V;,,,;,..r
ncur-tni : e11!H
irr

218187
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMA (print)� W3\0. fl e 6 V� • IA In p r TJ Y. CERTIFICAT�IION,1 # k( 3 e
WELL CONTRACTOR COMPANY NAME LaLaWlp.5 e I PM help I D.I 171C PHONE # e�inl 4S'73;2
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Dr Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: p
NearestTown:N\tU S etiy..� County ` Q
CuIA 'rA 4 si/
(Street Name, Numbers, Community, Subdivision, Lot
-No., Zip Code)
3. OWNER:.cQn . Ai(?�AA t,�-ot
rrt
Address \CJC (j / `'S
(Street or. Routo o.)
Vilita ba& w \N
fl) h, or T `\ owa S.
a o Zip Code
City
Area code- Phone numbe
4. DATE DRILLED
5. TOTAL DEPTH: R US
6. DOES WELL REPLACE EXISTING WELL? YES,0 NO t
7. STATIC WATER LEVEL Below Top of Casing: IS () FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance In accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): % METHOD OF TEST Cl n.A
10. WATER ZONES (depth): .2A
LOCATION SKETCH
11. DISINFECTION: Type \pt A Amount o2 (,Lt P- Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
or eight/Ft. ate numbers and common road names.
Topographic/Land setting
DRidge 3.51ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
J 1\Iu S.ly/n,,t) £.c tjvn0
ixtoks
Depth Diameter
From 0 To No Ft. __
From To Et.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 217 Ft neat Ceinevlt ket Yvd
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS CORD HAS BEEN PROVIDED TO THE WFI I OWNER
SICATURE OF PERSON CON -" W I1fGVF1B: WEI!,;I.—'- ATE
Submit the original to the Division of Water Quality, Grou {'r Sect n ion,_1636 Mail Service Cuiter -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. �I I �� -9VV-1 REV. 07/2001
l.tJ
07
W
CD
IOS

278185
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Dnivision of Water Quality - Groundwater Section
a' 3 e
WELL CONTRACTOR (INDIVIDUAL) NAM/�F�yl� (print) �'0\0.1rmr,€LS Vi • CAk ^��'r' CERTIFICAT/I�ON`#
WELL CONTRACTOR COMPANY NAME (,+Nlit Oe It V PM tnp Co.1 �.LkC PHONE# f,Y�.dl 'rs3-73;4'2
ASSOCIATED WQ PERMIT#
(if applicable)
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential Inunicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO :
Neatest Town:
QM
County 1 0&
(Street Name, Numbers C mliagg, Subdivision, Lot No., Zip Code)
3. OWNER:W tit) ()M
Address -\S
cG
(Street or Route No.) ��
TAAi
City T wn +� Stet;Zip Code
WSJ- x �3 3
Area code- Phone numbeei
4. DATE DRILLED u 0 3
5. TOTAL DEPTH: 5 0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO AY
7. STATIC WATER LEVEL Below Top of Casing:
(Use'•+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A�THOD OF TEST
CAC 2C .0118.
9. YIELD (gpm): OAJ�
10. WATER ZONES (depth): S S
11. DISINFECTION: Type c.3a.
12. CASING:
Topographic/Lsetting
❑Ridge ❑Slope QIVa11ey ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From s
grma on Description
1'�'L
Depth
From 0 To ' 5 Ft.
From To Ft.
LOCATION SKETCH
Amount ) C,V.e Show direction and distance in miles fromAt leash
Wall Thiclmess two State Roads or County Roads. IncludrYth
eter orrW�eig t/Ft. aerial numbers and common road names. _ r.
CI Et
no coi
O t=ri
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. need CeMea.}- kkr
From To Ft. f - �� i
r.,o
r17
14. SCREEN: Depth Diameter Slot Size Material/ W
From__ To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth . Size Material
From To Ft.
From To Ft.
Tra
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCIhD IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
p
�1 -----r- : i� • ) .J.
4...a/m-2�— -./• 11
7 dd
S101AATURE OF PERSON COf i� IR�f'O HE WELL DATE
W �•' �•I
Submit the original to the Division of Water Quality, G (dl irtt}water Section, 1636 Mail 9eevike Ceenteri REV Raleigh,
NC 2001
27699-1636 Phone No. [phone], within 30 days. U {.1 ,...
L

278182
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality -
WELL CONTRACTOR (INDIVIDUAL) NAM() (print) .7a rvk es ui . CA M. NOT .
WELL CONTRACTOR COMPANY NAME IA ell l l Pm iv C. (�11 C
•
Groundwater Section
CERTIFICATIONnIt J 3 g
PHONE # aabl 45.3-i3022
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential "Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT19N
Nears Town.
J`IM
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
County \ (9—t\
3. 1 Q
OWNER: ^\kM'A '
Address j !JJ v t r
(Street or Route No.)
`2-g113
City or Town State :Lent-
Zip Code
n
( ' 4 C1
Area code- Phone number n V�
4. DATE DRILLED `f d
5. TOTAL DEPTH: 4 O S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO lib
7. STATIC WATER LEVEL Below Top of Casing: 4 U FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surfaces
flop of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 1 METHOD OF TEST a-lA.
10. WATER ZONES (depth): 9i (')U
11. DISINFECTION: Type CI\.
12. CASING:
Depth
FronL__Q____ To Z U
From To
From To
13. GROUT: Depth
From 0 To .2 D
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth ,. Size
From _ To Ft.'s'
Diameter
Ft. (t1.lc
Ft.
Ft.
Amount citAte
Wall Thickness
orWeeight/Ft. Material numbers and common road names.
_San\ U
Material Methopd
Ft.)1eat cone vvd
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
From To Ft.
Material
r
Topo phic/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic trap
(check box)
DRILLING LOG
Forman Description
PEPTIi
From To
0 �V
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
o z
w
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS ' CORD HAS BEEN PROVIDED TO THE WELL OWNER
L
SI e , ATURE OF PERSON CON
Submit the original to the Division of Water Quality, Grou
27699-1636 Phone No. [phone], within 30 days.
A'
ectfon,T637Mat' S r i Cle ter -Raleigh, NC
9. -1 REV. 07/2001
171

278178
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality -
WELL CONTRACTOR (INDIVIDUAL) NAMA (print) 5,e �• CaM .
WELL CONTRACTOR COMPANY NAME I.Lt Yt'tf1S W10... e II t PUrp Co. ILc
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ PERMIT,/
(if applicable)
(if applicable)
Groundwater Section
CERTIFICATIONIAA,/ a13 e
PHONE ,/ 1g g 4S3-73)2
1. WELL USE (Check Applicable Box): Residential "Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION.',/
Ne est Town: t liLl C$AA/r•t1 Cpunty
(Street Name, Numbers, Community, Subdivision,
Lot N�o.Z'ip Code)
3. OWNER: 4)_�./,�Y�ifl'
Address • t) t��.t/� t
or oute No.) VC_
9-cS 1 s
City ojf Town
1 ,, `$) ratte } 1 Zip Code
(_)- U0 .y as1i c
Area code- Phone n b
4. DATE DRILLED I. 1 • n 3
5. TOTAL DEPTH: 5 0 S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 1 D 0 1.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In actorjnce with 15A NCAC 2C .0118.
9. YIELD (gpm): Jam\ — METHOD OF TEST (t N:
10. WATER ZONES (depth): LA VX)
11. DISINFECTION: Type l` 1n A
12. CASING:
Amount
Wall Thickness
Depthp� Diameter or Weight/Ft. Material
From 0 To f ° Ft. Vic
s _\
From To Ft.
From To Ft.
13. GROUT: Depth Material 1 Method
From 0 To ,2O Ft. heat C e?h1e rut V ,a Via
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth . Size Material
From To Ft.''
From To Ft.
16. REMARKS:
Topographic/Land setting
`fudge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Fptmr Boot Description
0 70 ti_t.n J�
g PA
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and co n road names.
kVA-
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRU(:1ED IN ACCORDANCE WITH 15A NCAC 2C, WFI T
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS R CORD HAS BEEN PROVIDED TO THE WELL OWNER
-\Q b3
SIGIAATURE OF PERSON C
Submit the original to the Division of Water Quality, G1
27699-1636 Phone No. [phone], within 30 days.
ti!a 11 G HE WELL 1 n'1DATE
it
idwater Section, 1636 Mad SarMee'Center - Raleigh, NC
' GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 2797 OD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1.
WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery' ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: SUNNYVIEW
IIWY.#9 N.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BILLY GIBES
Address HW. #9 N.
(Street or Route No.)
SUNNYVIEW NC 28756
City or Town State Zip Code
(828) — 625-8136
Area Code Phone number
4. DATE DRILLED 08/04/03
5. TOTAL DEPTH: 37
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO EI
7. STATIC WATER LEVEL Below Top of Casing: 22 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 6.9
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 37 Ft. 24" CEMENT
From To Ft. _
From _ To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From _ To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. in.
15. SAND/GRAVEL PACK:
Depth Size
From 22 To 37 Ft. 78M
From To Ft.
16. REMARKS:
Material
GRAVEL
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. GO Twau
SUNNYVIEW. ON THE LEFT STRAIOMT OSS
FROM GRASSY KNOB RD.
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I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUL 1'ED IN ACCORDANCE WITH 15A NCAC 2C, WPE
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WE 0
CK a� /
SIGNA7 `s (,E 'ERN 9� CONSTRUCTING THEgf7r'Y� DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

County POLK
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. 1/2 MILE ON
RT. PAST HWY. #14.
r
c
G
w
nr
nz
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDAN '�C WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIG ATURE F PEROI4 CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
2'78B99
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1 WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
HWY. #9 S.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: KEN SAVAE
Address HWY. #9 S.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 863-4480
Area Code Phone number
4. DATE DRILLED 08/4/03
5. TOTAL DEPTH: 55
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 35 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 55 Ft. 24" CEMENT
From To Ft.
From _ To _ Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. in. _ in.
From _ To _ Ft. in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 35 To 55 Ft. 78M GRAVEL
From To Ft.
16. REMARKS:
(a

276696
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON
JOHN WATSON RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: HORACE WATSON
Address JOHN WATSON RD.
(Street or Route No.)
TRYON N C 28782
City or Town State Zip Code
(828) - 287-3970
Area Code Phone number
4. DATE DRILLED 08/11/03
5. TOTAL DEPTH: 33
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO tgl
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 13 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 5.98
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 33 Ft. 24" CEMENT
From _ To Ft. _
From To _ Ft. _
13. GROUT: Depth Material
From 0 To 20 Ft. CEMENT
From To Ft.
14.SCREEN: Depth Diameter
From _ To Ft. _
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From 20 To 33 Ft. 78M GRAVEL
From To Ft.
Method
POURED
Slot Size Material
in. in.
in. in.
Topographic/Land setting
❑ Ridge 0 Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #221 S. FROM RUTHERFORDTON. RT. ON
COXE RD. ABOUT 8 MILES. LEFT ON JOHN
WATSON RD. GO 1-3/10 MILES, IT WILL BE 1ST
DRIVE ON RT. PAST PAVED DRIVE.
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16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS RUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IGNA RE QF3ERSON CONSTRUCTING THE aLL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service
27699-1636 Phone No. [phone], within 30 days. G
V. 07/2001
LIL ;

2'78688
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK
SURPENTINE DR.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: STEWART GWINN
Address 351 SURPENTINE DR
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) - 894-2207
Area Code Phone number
4. DATE DRILLED 08/22/03
5. TOTAL DEPTH: 625
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To 20 Ft.
From _ To Ft.
From _ To _ Ft.
13. GROUT: Depth
From 0 To 20 Ft.
From _ To Ft.
14.SCREEN: Depth Diameter
From _ To Ft.
From _ To Ft. _
15. SAND/GRAVEL PACK:
Depth Size
From _ To Ft.
From To Ft.
CHLORYTE Amount 18
Wall Thickness
Diameter or Weight/Ft. Material
6-1/4" SDR.21 PVC
Material
QUIKRETE
16. REMARKS:
Method
POURED
Slot Size Material
in. _ in.
in. in.
Material
Topographic/Land setting
0 Ridge ❑ Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HOUSTON RD. FROM COLUMBUS. LEFT ON
SKYUKA RD. RT. ON SKYUKA MTN. DR GO TO
TOP OF MTN. & LEFT ON MORNING RIDGE RD.
LEFT ON SURPENTINE DR 1/4 MILE ON LEFT.
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I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCOIpDAi WIT,H ISA NCAC`2C` WE L
CONSy13UCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAI EENPROVIDED TO THE WELL OWNER
o.{i %J ` i �/ G21'•ra cr ' ai
SIGNAjURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

278685
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CER1IFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
W
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED _ PERMIT #
applicable)
(if applicable) (if pP
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING County POLK
LAKE ADGER PARKWAY
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CARROLL DANIELS
Address LAKE ADGER PARKWAY
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
7. 04) — 263-8294
Area Code Phone number
4. DATE DRILLED 08/27/03
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated atlor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 16.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 100 Ft. 6-1/4" SDR.21 PVC
From To Ft_
From _To_Ft._
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
Diameter Slot Size Material
Ft. _ in. in.
Ft. in. in.
I4.SCREEN: Depth
From _ To
From To_
15. SAND/GRAVEL PACK:
Depth Size
From _ To _ FL _
From _ To _ Ft.
16. REMARKS:
Material
Topographic/Land setting
❑ Ridge 0 Slope 0 Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. LEFT ON
SILVER CREEK RD. GO PAST CHURCH & RT. ON
LAKE ADGER PARKWAY. 2ND DRIVE ON RT.
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I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORl ANC,E'WITH'15A
CONSTRUCTION STANDARDS,
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE
SIGNATURE OF PERSON ONSTRUCTING THE WELL DATE
. WELL
WELL OWNER
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

278684
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
HUNTVIEW LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MITCHELL CONLEY
Address HUNTVIEW LANE
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(423) — 586-8820
Area Code Phone number
4. DATE DRILLED 08/28/03
5. TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IZ
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 4.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 100 Ft. 6-1/4" SDR.21 PVC
From To Ft.
From To _ Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To Ft. _ in. in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To Ft.
From To Ft.
16. REMARKS:
County POLK
Topographic/Land setting
❑ Ridge 0 Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
FROM COLUMBUS GO OUT WALKER ST.
RIGHT ON PENIEL RD. LEFT ON SMITH DAIRY
RD. GO APPROX. 3/4 MILE THEN LEFT ON
HUNTVIEW LANE. 1ST LOT ON RIGHT.
i
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN AC RD}11w3fWl'I7315A-NGAC 2E4VELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
fl 4, .. J
OF PERSON CONSTR CTING THE WELL
NATURE IYATE
if ce7-
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING. LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
2'78683
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
STONEYBROOK SUBDV.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: RON CAPLE
Address BENT OAK DR
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
VI)) — 859-6390
Area Code Phone number
4. DATE DRILLED 08/29/03
5. TOTAL DEPTH: 185
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO CZ
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 9 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To 100 Ft.
From _ To _ Ft.
From To _ Ft.
13. GROUT: Depth
From 0 To 20 Ft.
From _ To Ft.
14.SCREEN: Depth Diameter
From _To_Ft.
_
From _ To Ft. _
15. SAND/GRAVEL PACK:
Depth Size
From _ To _ Ft.
From To Ft.
County POLK
CHLORYTE Amount 4.5
Wall Thickness
Diameter or Weight/Ft. Material
6-1/4" SDR21 PVC
Material
QUIKRETE
16. REMARKS:
Method
POURED
Slot Size Material
in. _ in.
in. in.
Material
Topographic/Land setting
0 Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
FROM COLUMBUS GO OUT WALKER ST.
RIGHT ON PENIEL RD. GO APPROX. 2 MILES.
TAKE THE THIRD ENTRANCE TO THE RIGHT
INTO STONEYBROOK ONTO BENT OAK DR LOT
IS APPROX. 3/10 MILE ON RIGHT. f
O o
w
-D 'V cc
c''
orn
F' �n
>o
rno
cn
NZ
0A
0
z
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCOIWDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGIbIATURE OF PERSO)4 CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD
%/ �?7 $.43
WELLCONTRACTOR• If)e �Ve1/ Jee e/ uv ice
WELL CONTRACTOR CERTIFICATION #:. °V @
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential al Municipal ❑ Industrial ❑ Agricult
Recovery ❑ Heat Pump Water Injection Q Other D If Other, List Use:
2. WELL LOCATION: Show sketch of the location below)
Nearest Town: ire / County:
fQ mt
(Road NameLand Numbers, Cpw nunity, r Subdivision and Lot No.)
3. OWNER estr / ,/ed-td ,i r \J
Address i1.72 Ohl ' 7 /7
(Street or or tee.)
779
City o Town L�r� State Zip Code
4. DATE DRILLED - Z C/�
5. TOTAL DEPTH 0
6. CUTTINGS COLLECTED YES El NOa
7. DOES WELL REPLACE EXISTING WELL? YES ��+ NOn
8. STATIC WATER LEVEL Below Top of Casing: ; , , FT.
(Use'+ if Move Top of Casing)
9. TOP OF CASING IS �! FT. Above Land Surface'
'Top of casing terminated aVor below land surface requires a variance In accor-
dance with 15A NCAC 2C.011a
10. YIELD (gpm): MET OD OF TEST /P
11. WATER ZONES (depth)• �6 ' Z C, PMt
Qn k
DRILLING LOG
From To
a /s
/j S i/y
vzll
•
12. CHLORINATION: Type N //"
13. CASING:
Amount 10 Z
Walt Thickness
Depth (/ Di m or Wet h51(�FI. Material
From To ��` Ft '<r ��
From To Ft
From To Ft
14. GROUT:
Inl
uratll Monitoring U ,j
i J 6:
L
b Oil
AST;.I Lr ! CE
DEPTH
F
o
rmation Description
T v_ o e/CL
r2G
s'crai�/Scz .,
/nett-, Y_ drD Cv
c
If additional space is needed use back of log p
Depth _ MMter;l / Method
From 0 To Z.-% Ft Jew /'rC.6 Cat
From To Ft
15.SCREEN:
From
From
From
Depth Diameter Slot Size Material
To Ft in in
To Ft in in
To Ft In in
16. SAND/GRAVEL PACK:
Depth
To
To
From
From
17. REMARKS:
Ft
Ft
Size Material
CN a=
LOCATION SKETCH - cm
(Show direction and distance from at least two Se n
Roads, or other map reference points)
•tip
MO
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.
02G ^
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
G71.1 r1EV. I7./93
FOR OFFICE USE ONLY
Quad No:
Serial No.

277643
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Piiblic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
BLUE BIRD LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: STEVE GRITTON
Address BLUE BIRD LANE
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 859-5579
Area Code Phone number
4. DATE DRILLED 07/23/03
5. TOTAL DEPTH: 505
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 13.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 110 Ft. 6-1/4" SDR21 PVC
From To _ Ft. _
From _ To _ Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To _ Ft. in. _ in.
From _ To Ft. _ in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To _ Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HYW. #9 S. FROM MILL SPRING. RIGHT ON
HWY. #14. RIGHT ON RED FOX RD. RIGHT ON
BLUE BIRD LANE. 1ST LOT ON LEFT.
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 PERSON CONS
'I 11i
Submit the original to the Division of Water Quality, Groundiatp¢Sectron,1636 Mail Se '
27699-1636 Phone No. [phone], within 30 days.
. A , `-;G-?,--ns:—, '7. 2 3 - c .3
ATE
titter — Raleigh, NC
:i REV. 07/2001

277642
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK
WHITE OAK LANE (FOXWOOD HILLS)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ROY GIBSON
Address WHITE OAK LANE
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(864) — 430-5250
Area Code Phone number
4. DATE DRILLED 07/21/03
5. TOTAL DEPTH: 365
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing tenninated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 6 METHOD OF JEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 9.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 120 Ft. 6-1/4" SDR21 PVC
From To
From To
13. GROUT: Depth
From 0 To 20
From To
I4.SCREEN: Depth
From To _ Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From _ To _ Ft.
16. REMARKS:
Ft.
Ft.
Material Method
Ft.QUIKRETE POURED
Ft.
Diameter Slot Size Material
in. _ in.
in. in.
Material
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. RIGHT ON
HUGH CHAMPION RD. RIGHT INTO FOX WOOD
HILLS ONTO WHITE OAK LANE. 1ST LOT ON
THE RIGHT. AT END OF PAVEMENT. (LOTS #10 &
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CON5QRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
J` i _.It �iLrt_G�n/h 0 �-
SIGNATUREERSON CONSTRUCT k WELT, j r; �TE
Submit the original to the Division of Water Quality, Groundw4ter, tion,1636 Mail Servicei1e r — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GWt1i V. 07/2001

277639
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town. MILL SPRING
SUNRISE DR
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: SADIE WILSON
Address 72 SUNRISE DR
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 6254182
Area Code Phone number
4. DATE DRILLED 07/15103
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 1-1/2 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 16.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 50 Ft. 6-1/4" SDR.21 PVC
From _To_Ft.
_ _
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. QUIKRETE
From To Ft.
14.SCREEN: Depth Diameter Slot Size
From _ To _ Ft. _ in. _
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
From
From To Ft.
16. REMARKS:
Method
POURED
Material
in.
in.
Topographic/Land setting
0 Ridge ❑ Slope ❑ Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. LEFT ON
OWL HOLLOW RD. GO APPROX. 1/2 MILE. RIGHT
ON SUNSHINE DR. BARE RIGHT AT BOX #72.
FOLLOW NEW DRIVE UP TO THE TOP OF THE
HILL.
IJ
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONtUCTION STAND S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Q. St/1-
SIGNATURE OF PERSON CONSTR'J 'I]ING,T
Submit the original to the Division of Water Quality, Ground etcr Section, 1636 Mail Servj
27699-1636 Phone No. [phone], within 30 days.
/r=6
TE
nter — Raleigh, NC
1 REV. 07/2001

277626
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON County POLK
COXE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DON KELLER
Address 4590 COXE RD.
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(828) - 863-4511
Area Code Phone number
4. DATE DRILLED 07/03/03
5. TOTAL DEPTH: 43
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 28 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
11. DISINFECTION: T
12. CASING:
Depth Diameter
From 0 To 43 Ft. 24"
From To _ Ft. _
From _ To Ft. _
13. GROUT: Depth Material
From 0 To 20 Ft. CEMENT
From To Ft.
14.SCREEN: Depth Diameter
From To _ Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size
From 28 To 43 Ft. 78M
From To Ft.
CHLORYTE Amount 6.9
Wall Thickness
or Weight/Ft. Material
CEMENT
Method
POURED
Slot Size Material
in. in.
in. in.
Material
GRAVEL
Topographic/Land setting
0 Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #221 S. FROM RUTHERFORDTON. RT. ON
COXE RD. 2 STORY WHITE HOUSE ON LEFT.
r
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRICTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
(r( 2< crn _ 9. 3 c 3
bb &.L4TTIrWrELZDATE CTflV
SIGNATURE F PER
Submit the original to the Division of Water Quality
27699-1636 Phone No. [phone], within 30 day
I * b- dwater SecWon,1636 ai
�u L�
rvice Center - Raleigh, NC
GW-1 REV. 07/2001
GROLINLx
ie,N

277623
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERPIH!CATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
JOHN FOSTER RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BRAD FOSTER
Address 1189 JOHN FOSTER RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 859-6015
Area Code Phone number
4. DATE DRILLED 07/14/03
5. TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 4.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 60 Ft. 6-1/4" SDR21 PVC
From To Ft.
From _ To _ Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To _ Ft. in. _ in.
From _ To _ Ft. _ in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To Ft.
From To Ft.
Topographic/Land setting
❑ Ridge ❑ Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HOUSTON R FROM COLUMBUS. LEFT ON
SKYUKA. GO OVER I-26. RT. ON JOHN FOSTER
RD. 1ST DRIVE ON LEFT.
16. REMARKS:
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
71 %t
S1O'IATU1 E OF PERSON CONS
i, Q— 2— / s/— 6,3
Ef.L ' DATE
Submit the original to the Division of Water Quality, Grout¢ r Section, 1636 Mail Servrcenter — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
G 1 REV. 07/2001
r

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
277622
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
NORTH HIGHLAND RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DICK DEAL
Address NORTH HIGHLAND RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(843) - 521-1321
Area Code Phone number
4. DATE DRILLED 07/11/03
5. TOTAL DEPTH: 425
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-112 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 11
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 100 Ft. 6-1/4" SDR21
From _ To Ft. _
From To _ Ft. _
13. GROUT: Depth Material
From 0 To 20 Ft. QULKRETE
From To Ft.
14.SCREEN: Depth Diameter
From To Ft.
From _ To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
PVC
Method
POURED
Slot Size Material
in. in.
in. in.
From To _ Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge 0 Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. LEFT ON
SILVER CREEK RD. RIGHT ON LAKE ADGER RD.
LEFT ON NORTH HIGHLAND RD. LOT IS
STRAIGHT AHEAD AT CUL-DE-SAC. LOTS (& 10.
0
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
SIGTAA OF PERSON CON clime
Submit the original to the Division of Water Quality, Gr
27699-1636 Phone No. [phone], within 30 days.
l---
Center - Raleigh, NC
W-1 REV. 07/2001

277619
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
HIGHLAND VIEW LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: WENDY GATES
Address 880 HIGHLAND VIEW LANE
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(704) — 588-8743
Area Code Phone number
4. DATE DRILLED 07/07/03
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated aUor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 8 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: T,
12. CASING:
Depth
From 0 To 80
From _ To
From _ To
13. GROUT: Depth
County POLK
CHLORYTE Amount 7.5
Wall Thickness
Diameter or Weight/Ft Material
Ft.6-1/4" SDR21 PVC
Ft.
Ft.
Material
Method
From 0 To 20 Ft.OUHCRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size
From To Ft. in.
Material
in.
From To Ft. in. in
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To Ft.
From To Ft.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. LEFT ON
SILVER CREEK RD. RT. ON LAKE ADGER RD.
LEFT ON HIGHLAND VIEW LANE. APPROX. 3/4
MILE ON RT.
11d 0- NW CO
s
rV
m.
ct
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS,( AND THAT COPY OF THIS RECORDCO�HAS BEEN PROVIDED TO THE WELL OWNER
SIG A OF PERSON CONST1fUCTING'I�T-I�E WELL 'DATE
Submit the original to the Division of Water Quality, Grouridvtaier Section, 1636 Mail Seryiqu Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. OW-1 REV. 07/2001
J L )
t

279795
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING County POLK
NORTH PARK LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: GEORGE BOWLAND
Address 32 NORTH PARK LANE ���IIIIII '— — —1
(Street or Route No.) (degrees/minutes/seconds t_.)).
MILL SPRING NC 28756 Latitude/longitude source: 0 GPS ❑ op() _ j
City or Town State Zip Code (check box) i ? Fit i
DEPTH I i
(828) — 859-6445 From To v
Area Code Phone number
4. DATE DRILLED 09/30/03 [ t
5. TOTAL DEPTH: 465 DRILLING LOG
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ® From To
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 12.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
Ft. 6-1/4" SDR.21 PVC
Ft.
Ft.
Material Method
Ft. QUIKRETE POURED
Ft.
Diameter Slot Size Material
From 0 To 180
From To
From To
13. GROUT: Depth
From 0 To 20
From To _
14.SCREEN: Depth
From _ To
From _ To
15. SAND/GRAVEL PA
Depth
From To
From To
Ft.
_ Ft. in. _ in.
CK:
Size Material
Ft. _
Ft.
in. in.
Topographic/Land setting
0 Ridge 0 Slope ❑ Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
LOCATION SKETCH
Show direction and distance in miles r m at 1eark----
Two State Roads or County Roads. In lude the rdad�=EE12
number and common names
HWY. #9 N. FROM MILL SPRING. LEFT ON
SILVER CREEK RD. RIGHT ON LAKE ADGER RD.
RIGHT ON PARKWAY NORTH. GO APPROX. 1
MILE. THEN LEFT ON NORTH PARK LANE.
APPROX. 2/10 MILE ON LEFT.
0
0
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16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSIBUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Wera'r-ems '9/3 te)% s
SIGI(IATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

279808
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING County POLK
GREEN RIVER COVE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: AL STREET
Address GREEN RIVER COVE RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town Stale Zip Code
(704)— 954-3776
Area Code Phone number
4. DATE DRILLED 09/08/03
5. TOTAL DEPTH: 245
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 90 Ft. 6-1/4" SDR21 PVC
From To _ Ft. _
From To _ Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. y
From To Ft.
16. REMARKS:
Topographic/Land setting
0 Ridge 0 Slope ❑ Valley El Flat
(check appropriate box)
Latitude/longitude of well location
JC
(degrees/minutes/seconds) r----�-�''
Latitude/longitude source: 0 GPS ❑ Topographic map DT ,
(check box)
DEPTH _
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles f#om at leash--__'_____.
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. LEFT ON
SILVER CREEK RD. LEFT ON GREEN RIVER
COVE RD. NEW DRIVE APPROX. 8 MILES ON
LEFT.
0
W
0
0
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
t4—e-• Ca
SI A OF PERSON CONSTRUCTING THE
rl7/7Q 7— 02— 0 ,3
LL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-16,36 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

279807
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERI IFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK
STONEY BROOK -LOT #13
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JOCELYN DAVIS
Address STONEY BROOK
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) - 863-1303
Area Code Phone number
4. DATE DRILLED 09/09/03
5. TOTAL DEPTH: 185
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I SA NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 4.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 110 Ft. 6-1/4" SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QULKRETE POURED
From To Ft.
14.SCREEN Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. _
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well 1pration ------ ---
1�
(degrees/minutes/seconds) _
Latitude/longitude source: ❑ GPS 4 Topographic maa -Tu
(check box) t _
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH'
Show direction and distance in mil g1_s�from at kt: ar
Two State Roads or County Roads. Inct fde t1- road —
number and common names
FROM COLUMBUS, GO OUT PENIEL RD. TURN
RIGHT ON SPRINGBROOK LANE. LOT #13 ON
RIGHT.
0
W
O
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
pTIN THE
GWELL DATENA NA OF PERSON CONSTRUC
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

279806
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
I WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
OLD MELVIN HILL RD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: EDDIE KEENAN
Address 1205 OLD MELVIN HILL RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(864) — 457-5633
Area Code Phone number
4. DATE DRILLED 09/18/03
5. TOTAL DEPTH: 385
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of' Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/orbelow land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 50 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 10.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
0 To 100 Ft. 6-1/4" SDR.21 PVC
From
From
From
13. GROUT:
From 0
From
14.SCREEN:
From
To Ft. _
To Ft.
Depth Material
To 20 Ft. QUIKRETE
To Ft.
Depth Diameter
To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Method
POURED
Slot Size Material
in. in.
in.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic niat )
(check box) - -
DEPTH Er,1
I
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. ;Include t1t ioad
number and common names J
HWY. #9 S. FROM SANDY PLAINS. CROSS
STATE LINE INTO SC. GO APPROX. 1/8 MILE.
TURN RIGHT ON OLD MELVIN HILL RD. NEW
DRIVE APPROX. 500 YARDS ON RIGHT.
c
W o
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
SIGGNATURE"OF PERSON CONSTRUCTING THE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

279804
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1 WELL USE (Check Applicable Box): Residential Z MunicipalPublic ❑ Industrial D Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON
MEADOWLARK LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: RICK MEHTA
Address MEADOWLARK LANE
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(864) - 375-0994
Area Code Phone number
4. DATE DRILLED 09/25/03
5. TOTAL DEPTH: 245
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 100 Ft.6-1/4" SDR.21 PVC
From To Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. in. _ in.
From To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To Ft.
From To Ft.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/secondsj :—
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH 1 v
_i
From To
DRILLING LOG
From To
LOCATION SKETCH "
Show direction and distance in mileslfrom at leisJ�
Two State Roads or County Roads. 'dude the roat
number and common names
HWY. #108 W. FROM COLUMBUS. RT. ON HWY.
#176 IN TRYON. RT. ON WARRIOR RD. LEFT ON
MEADOWLARK LANE. DRIVE 1.3 MILES ON
LEFT.
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fr
16. REMARKS:
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
A OFPE ON CONSTRUCTING THE WELL DATE
SIGa 3
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

279802
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON County POLK
EDNEY RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: THRUMAN KUYKENDALL
Address 70 EDNEY RD.
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(828) — 859-9727
Area Code Phone number
4. DATE DRILLED 09/11/03
5. TOTAL DEPTH: 80
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 12 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 3
12. CASING: Wall Thickness
or Weight/Ft. Material
SDR.21 PVC
Depth Diameter
From 0 To 60 Ft. 6-1/4"
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. OUIKRETE
From To _ Ft.
14.SCREEN: Depth Diameter
From _ To Ft. _
From _ To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
Method
POURED
Slot Size Material
in. in.
in. in.
From _ To Ft.
From To Ft.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well locatiorj
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topogia
(check box)
DEPTH
From To
DRILLING LOG
From To
c mar
i
LOCATION SKETCH L:
Show direction and distance in miles from
Two State Roads or County Roads. Include the road
number and common names
HWY. #176 W. FROM TRYON. APPROX. 3
MILES. LEFT ON EDNEY RD. CROSS BRIDGE. 1ST
HOUSE ON RT.
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W
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73
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16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS'WUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Ada � Z i ire _ i-
SIGNATURE 0 PERS N CONSTRUCTING THE TLL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

279800
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING County POLK
HIGHLAND VIEW LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: PAUL MULLETT
Address HIGHLAND VIEW LANE
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) - 894-2754
Area Code Phone number
4. DATE DRILLED 09/05/03
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELD YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9 YIELD (gpm): 3 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 16.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 100 Ft. 6-1/4" SDR.21 PVC
From _ To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location r t—?
(degrees/minutes/seconds) 1. _...._.
Latitude/longitude source: ❑ GPS ❑ Tbj otipiphiccap `1 ` L;
(check box) �n
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH i
Show direction and distance in miles huirrarka,t
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. LEFT ON
SILVER CREEK RD. RT. ON LAKE ADGER
RD.LEFT ON HIGHLAND VIEW LANE. GO
STRAIGHT ON PAVED DRIVE AT CUL-DE-SAC.
WHEN PAVEMENT ENDS TAKE RT. FORK. THIS
IS HOUSE SITE.
m
o-o c
rm
t o<
cJ 0- 0
�c
uric
^ern
cnz
O
-v
3
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGN TURE OF PERSO CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® MunicipalPublic ❑ Industrial ❑ Agricultural D
Monitoring D Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING County POLK Topographic/Land setting
COOPERS GAP RD. 0 Ridge 0 Slope ❑ Valley ❑ Flat
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) (check appropriate box)
3. OWNER: JOE OWENS Latitude/longitude of well location---„ _
Address 3400 COOPERS GAP RD. I ` `
1731
(Street or Route No.) (degrees/minutes/seconds) r,,4 [_. '--,
MILL SPRING NC 28756 Latitude/longitude source: 0 GPS ❑ opdgraphic map JI
City or Town State Zip Code (check box)
(828) — 883-4985 DEPTH
Area Code Phone number From To
4. DATE DRILLED 09/18/03
5. TOTAL DEPTH: 605 DRILLING LOG
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ® From To
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface* , L- —
LOCATION SKET H )
*Top of casing terminated at/or below land surface requires a Show direction and distance in ' es from at l.C.L_,T)
variance in accordance with 15A NCAC 2C .0118. Two State Roads or County Roads. Inc u e "ivad=
9. YIELD (gpm): 0 METHOD OF TEST ARD number and common names
10. WATER ZONES (depth): HWY. #9 N. FROM MILL SPRING. LEFT ON
COOPERS GAP RD. NEW DRIVE 3.4 MILES ON
11. DISINFECTION: Type CHLORYTE Amount 16.5 RIGHT.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 70 Ft. 6-1/4" SDR.21 PVC
From To Ft. _
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To Ft. _ in. _ in.
From _ To _ Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From _ To _ Ft.
279799
61 .£ bid 6-130 CO
r-
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS TI JCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
J% f .
SIGNATURE OF PERSON NSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION. RECORD Z"r 11.' 1
(if applicable)
1. WELL USE (Check Applicable Box): Residential ❑
Recovery ❑ Heat Pump Water Injection 0
2. WELL LOCATION:
Nearest town: MILL SPRING
620 GIRL SCOUT CAMP RD
North Carolina - Department of Environment, and Natural Resources -Division of Water Quality - Groundwater Section
WELL CONTRACTORiNDIVIDUAL) NAME (print) SCOTT GANTT CERTIFICATION # 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMTT #
(if applicable)
Municipal ❑ Industrial ❑. Agricultural ❑ Monitoring ❑
Other ® If Other, List Use: CAMP GROUND
Topographic/Land setting
0 Ridge M Slope ❑ Valley 0 Flat
Latitude/Longitude of well location
35.24.475 / 82.12.777
County POLK
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER JIM MARSENGILL
ADDRESS 620 GIRL SCOUT CAMP RD
(Street or Route No.)
MILL STUNG
City or Town
828 625:1138
NC
State
Area Code -Phone Number
4. DATE DRILLED 8/20/03
Zip Code
5. TOTAL DEPTH 360
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 21
7. STATIC WATER LEVEL Below Top of Casing: 45 FT.
(Use "+" If Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance in
accordance with I5A NCAC 2C 0118
9. YIELD (gpm): 50 METHOD OF TEST ARDM
10. WATER ZONES (depth): 360
(degrees/minutes/seconds)
Latitude/longitude source: ® GPS ❑ Topographic map
DEPTH
From To
DRILLING LOG
Formation Descryuon
0 94 Clay
94 360 Consolidated Rock
I1. DISINFECTION: TYPE HYPOCHLORITE Amount 10
12. CASING:
Depth
From 0 To 99
13. GROUT:
Depth
From 0 To
14. SCREEN
Wall Thickness
Diameter or Weight/Ft Material
Ft. 61/4" SDR21 PVC
n o
wa
ra
P1
v
cm
tV' �c
oz LOCATION SKETCH -p
Show direction and distance in miles from at leash
Material Method
20 - Ft. GRAVEL MIX. GRAVITY
Depth
From NA To Ft.
15. SAND/GRAVEL PACK:
Depth
From NA To Ft,
16. REMARKS:
Diameter
in.
Size
Slot Size Material
in.
Material
-I
ma
rr
two State Roads or County Roads. Includetheread y�
numbers and common road names. w
G% co
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 WFI i OWNER.
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001

(tf appjicable)
I. WELL USE (Check Applicable Box) : Residential El
Recovery 0 Heat Pump Water Injection 0
WELL CONSTRUCTION RECORD '��'s
North Carolina- Department of Environment, and Natural Resources Division of Water Quality - Groundwater SectioD
WELL CONTRACTOR jINDIYIDUAL) NAME (print) SCOTT GAN'I"C CERTIFICATION # 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT
(if applicable).
Municipal 0 Industrial ❑ Agricultural 0
Other 0 If Other, List Use:
2. WELL LOCATION:
Nearest town: MILL SPRING County POLK
314 MILL SHOALS RD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER RANDAL HODGE (degrees/minutes/seconds)
ADDRESS 314 MILL SHOALS RD Latitude/longitude source: ® GPS ❑ Topographic map
Monitoring 0
Topographic/Land setting
0 Ridge -13 Slope [Valley ® Flat
Latitude/Longzitude otjvell location
35.22.797 / 82.11.806
(Street or Route No)
MILL SRPTNG NC
State
City or Town
828-625-2442
Area Code - Phone Number
4. DATE DRILLED 8/18/03
S. TOTAL DEPTH 220
28756
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below 'fop of -Casing: . 60 FT.
Rise "1" If Above Top of Cuing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
prop of ca®gte®mmed at/orbelow1mdsrtrbce requites -a variance in
accordance with ISA NCAC 2C.0118
9. YIELD (gpm): 15 METHOD OF TEST ARDM
10. WATER ZONES (depth): 210
DEPTH
From To
DRILLING LOG
Formation Description
0 92 Clay
92 220 Consolidated Rpck
t 1. DISINFECTION: TYPE HYPOCHLORITE, Amount 6
12. CASING:
Depth
From 0 To 99
13. GROUT:
Depth
From 0 To
14. SCREEN
Depth
From NA To
Diameter
Ft. 6 1/4 "
Wall Thickness
or WcightTt. Material
SDR21 PVC
Oz
Material Me)hod
20. Ft. GRAVEL MIX GRAVITY
15. SAND/GRAVEL PACK:
Depth
From NA To
16. REMARKS:
Diameter
Ft. in
Size
Fi,
Slot Size Material
in
Material
C
0 ['1
W
Nco
171
LOCATION SKETCH
N c"
'"t7
Show direction and distance in miles from at lei
two State Roads or County Roads. Include the di_
numbers and common road names.
C.>
C
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL I
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
8/19/©3
Date
SIGNATURE OF PERSON CONSTRUCTTNG.THE.WELL -
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
IGW-1 REV. 07 2001I
1

279:81
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAM (print) .3cr_rTk€s 1ic) • eck/Y�v\p. �. CERTIFICATION #a(3S
WELL CONTRACTOR COMPANY NAME wt./aS�e if t PM M p I D.r'lr�A-Yl C . PHONE # i'&R\ 4s -73)2
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT# —
(if applicable) / (if applicable)
GY
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION,: /l
Nearest Tto S ' t County e 1k
/VCYtin 4YK ,)
(Street Name, Numben, Community, Subdivision, Lot No., Zip Code)
3. OWNER: PYYYI e rc Hordes
Address 9:30 5f,L(•rtrvee Lane.
s0
(Street>'�ite�r Routelc a s 75%
M� it
City or Town J Ste Zip Code
( )-$71Ac7¢-7a53
Area code- Phone number
4. DATE DRILLED -,/` I - 03
5. TOTAL DEPTH: 0
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Xl,
7. STATIC WATER LEVEL Below Top of Casing: R O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of wing terminated at/or below land surface requires •
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): /00 METHOD OF TEST (2 I Y
10. WATER ZONES (depth): a2 7 0
11. DISINFECTION: Type Chi o Y i et e Amount I c u p
12. CASING: Wall Thickness
Depth _ Diameter or Weight/Ft. Material
From�_To elb Ft 1 �'1 5DRZ( VUr—
From To Ft
From To Ft.
13. GROUT: Depth Material MethoQd
From 0 To 20 Ft.heat Cement Pia
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size y Material
From To Ft. ,'t
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC1;DIN ACCORDANCE WITH 15ANCAC 2C, WFI L
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS CORD HAS BEEN PROVIDED TO THE WELL OWNER
,71'�rne� Gr),��rr-���yy���� 9- ID-D3
SICII}IATURE OF PERSON CONSTRUC*ING HE WELL DATE
Submit the original to the Division of Water Quality, Groundwater SecVVVVVction,1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
/ Topographic/Land setting
I Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
LIT
(degrees/minutes/seconds) - --
Latitude/longitude source:❑GPS❑Topograjhidmap, —___ _
(check box) i (—_--3 j.
DEPTH DRILLIN r LOG —_--
FromTo Formation Description
17 qy 9f0.Uel 5anrl ��{l;et
'l5 3o5 Con'Mltriated r zk
o
Cw)
o<
a
:C - -c
_ �o
▪ rn
J rr'i • x
tTI --1
LOCATION SKETCH pp �
Show direction and distance in miles from at leastz
two State Roads or County Roads. Include the road
numbers and common road napes.

279.E_33
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ja ma s t.L Camp Jr CERTIFICATION% 7118
WELL CONTRACTOR COMPANY NAME Camp' c W P 1 1 R Primp en Tnr PHONE %$9A) d51-7122
STATE WELL CONSTRUCTION PERMIT% ASSOCIATED WQ PERMIT%
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential bi Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use 1 f'
2. WELL LOCATION. Jf (�
Nearest Town: A it-t0a f/ CountyCP'_IK
ass fIQNQ rnqq �voc✓[ . -t1Te IvI.JA d �ytn
(Street Name, Numbers, Chmtndnity, Subdivision, Lot No., Zip Code)
3. OWNER: M61YDYt SYl'ta/l
Address l D (a Gold N u�9 e it 1 ✓n i t
`II (�SRCet or Routo No.)
IvSQeritY SG ggIotri
City or Town ////// State Zip Code
Area codo- Phone number
4. DATE DRILLED - 1 g-63
5. TOTAL DEPTH: 3 N S
6. DOES WELL REPLACE EXISTING WELL? YE 0 NO kJ,
STATIC WATER LEVEL Below Top of Casing: ea-
7. 0 FT.
(Use 'Y." if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface"
' 'Top of casing terminated atior below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): ZA METHOD OF TEST D it
10.. WATER ZONES (depth): 1-i f o
11. DISINFECTION: Type rh 1 nr i n p
12. CASING:
Depth Diameter
From_0 To Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth
From p To 2 0
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
Ft.
Ft.
Amount ili} eltAC
Wall Thickness
or Weight/Ft. Material
QBF21 PVC
Material Method
Neat Cement Hu
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size
Ft.
Ft.
Material
TopographicJL d setting
❑Ridge ❑Slope alley ❑Flat
(check appropnate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude sotrce:❑GPS❑Topographic -Hip L-
(check box)
DEPTH DRILLING LQCa
From To
O
70__ 45
Formation Description
YAtlell dirt
1450Am ieL cc
cs2
t't
-D
O
rn
zrn
o<
CFI r,t
•ra.o
raw
m
7-7111
LOCATION SKETCH
Show direction and distance in miles fr' ' east
two State Roads or County Roads. In•' - the road
numbers and common road names.'
Of
-I1 G
z
c
N
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUU thD IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY O THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
G4Y6'1�d ( , C,�8 (� 7n' t . 2- l l -r
SIGNATURE OF PERSON CONSTRUCTING THE WELL ✓ ' DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeremy H. Bowman ' CERTIFICATION S/ 2809
WELL CONTRACTOR COMPANY NAME D RnwmAn Well nri 11 ing, Tnr PHONE Y A7R 257-7779
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS/
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential 11 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: Polk
Nearest Town Mi1lSpring County
Rnund Top Rd Lot 20: Land of Lakes Subd.
(Sireet Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: Tommy Messer
Address Rt. 22, Box 225A
(Strcct or Route No.)
Hendersonville NC 28792
City or Town State Zip Code
)'
Area code Phonc number / 1 6 / 03
4. DATE DRILLED
5.TOTAL DEPTH: 260r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO X
7. STATIC WATER LEVEL Below Top of Casing: 1 0 e FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS 1 • 4 FT. Above Land Surface`
'Top of casing terminated aUor below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD(gpm): 60 METHOD OFTEST'- rotary air
10. WATER ZONES (depth): 260'
II. DISINFECTION: Type tablet Amount 6
12. CASING: Wall Thickness
or WeighUFt. Material
Srh 80 Pyr
Diameter
From Ft.51 /8
From _ To Ft.
From To Ft.
11. GROUT: Depth
From 0 To 20
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in,
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size _ Material
From To Ft.
From To Ft.
0 Depth80
To
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope OValley OFlat
(check appropriate box)
Latitude/longitude of well location
' (degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O
r,nl
— rrn
LOCATION SKETCH — �` eo r-
Show direction and distance in miles froi t le i
two State Roads or County Roads. Includicthe
numbers and common road names. N a'=
• :n
Material Method
Ftconcrete gravity flow
278951
e-4
0
0
eC
111
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phonc No. [phone], within 30 days. GW-I REV, 07/2001

WELL CONSTRUCTION RECORD
278950
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jerepty H. Bowman CERTIFICATION S/ 2809
WELL CONTRACTOR COMPANY NAME n PnwmAp Well T1ri 1 1 i ngf Tnr PHONE S/ R78 257-7779
STATE \YELL CONSTRUCTION PERMITS/ ASSOCIATED WQ PERMITS/
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential a Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2 WELL. LOCATION:
Nearest Town: Mi 1 1 sDring County Polk
194 Buck Branch Rd. Deer Meadows
(Scree' Name, Numbers, Community, Subdivision, Lot No., Zip Code)
William Smits
194 Buck Branch Road
3. OWNER:
Address
(Street or Route No.)
Mi115Dring NC 28792
City or Town State
)-
Arca code- Phone number
4. DATE DRILLED 7/1 5/04
5. TOTAL DEPTH: 770
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO Dit
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use'+" if Above Top of Cuing)
8. TOP OF CASING IS 1 ' 4 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
Zip Code
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
Subd . (check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
air
9. YIELD (gpm): 20 METHOD OF TEST rotary
10. WATER ZONES (depth): 1 80, 200'
1 I. DISINFECTION: Type tablet Amount 6
12. CASING: Wall Thickness
Depth Diameter or WeighUFt. Material
From 0 To 40 Ft.F1 /8 Sch 80 PVC'
From To Ft.
From To Ft.
I3. GROUT: Depth
From 0 To 20
C
rn
LOCATION SKETCH
Show direction and distance in miles from lea�pt4�
two State Roads or County Roads. lncludabe raazP
numbers and common road names. N Nemi73
Material Method
R. concrete gravity flow
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. '
From To Ft.
16. REMARKS:
C
c.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1
es --
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. OW -I REV. 07/2001

I,._ 9 ... 1 w ToNC Dept of Env- and Na Resour
003 Time: 9:38:34 PF".
280449
WELL CON STRU( a;`,
• (';.r `'--'rent of Environment. and Natural Resources
41 EL L CO FR/ `OR (INDIVIDUAL)NAME (print) SCOTI C.t`:T1
ELI. Co\ R__OTC;R COMPANY NAME CAROLINA WE
1,7-7,1 I CONSTRUCTION PERMIT
be:>: Rest`eana' C�J- S tcas_
!mai isocp cton ❑ r..er L
VG Co:IInn} POLE
y.Sut:::viaim. Lot No,. Zip Code)
OF RI THERFORDTON
3F SS
:_S: \O WELL.
YES ❑ NO
60 37
To i.ping)
ARO31
RECORD
i-ztcr Quality - Groundwater Sectian
CERTIFICATION
rION
PHONE # [phone]
ASSOCIATED WQ PERMIT#
ORapplicable)
....-.,] AgucultaralI
Topoaraohic. Lana setciry
Ridge ❑ slope a __ -._.
Lo ,eitude of",sell ...,
3_ I8.940 / S3.Oi_42
Riereea:minuba0econcs,
longitude source' R; CPS n Tor.sccer.isi
ERTiol DRIL_Ii I _.
794
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Wsif Tfr.ckness
or 6,9eh3/Ft- flue -
STIR. 21 MSc
Slut Size bile( >:'.
in
S CONSIBL'C -ED.
Copy OF THIS FORSIOS.
SIGNATURE OF PERSON CON
niblill. the vi .t,--..I ru ase Lrvt.ioa of Wther Quality, Groundwater
322 't I)la 33 days.
LOCATION SKETCH
ssolen and distance in miles ..
n.r.
s cr Cocp.t R a6_S :� n�
tJ
comion road rraf^.Zes. U1
DTOTHE R'EL
Dice
e-vice center - Raleigh, NC
J

280861
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James w
WELL CONTRACTOR COMPANY NAME f amp' q Tarp. 11 R.
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
Camp, Jr. CERTIFICATION# 71 3R
Primp en TnC PHONE #/7R1 AC1 712.2
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential V Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION
Nearest T wn
\il>. C- SJSL•
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:r \--1I
D'
Address \ . D \ tiff
County_
(Street or Route No.)
Rat 91t c ra Sit'
City or Towu t Zip Code
60S)- "uq i tkQ
Area code- Phone number
4. DATE DRILLED G - \ 5. 1; 3
5. TOTAL DEPTH: \ 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: L\ U FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): \ 00 METHOD OF TEST D it
10. WATER ZONES (depth): to • I N.)
11.DISINFECTION: Type chi nrina Amount ( .�
Wall Thickness
Diameter orWeight/Ft. Material
6 1/`� SDR21 PVC
12. CASING:
Depth
From 0. To V; .` Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
Fromo To 2 0
Ft.
Topographic/Land setting
Ufidge (]Slope ❑Valley 0Flat
(check appropriate box)
Latitude/longitude of well location -;
(degrees/minutes/seconds)
Latitude/longitude source:DGPSOTopogt$phic_map_.:'.-__._.
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
caS
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Material Method
�n 2pf
Ncat Cctaent Iian
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Slot Size Material
in.
in
16. REMARKS:
c
wc
O
y,rn
O rn=
CJ
CD
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUGIED IN ACCORDANCE WITH 15ANCAC 2C, WFI r
CONSTRUCTION STANDARDS, AND THAT A COPY O THIS RECORD HAS )SEEN PROVIDED TO THE WELL OWNER
G 'H - ((/) . r/^v ,�' �n (j/j1_' /� -- /D - G 3
SIGNATURE OF PERVN CONSTRUCTING THE WELL ✓ /D DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

230858
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J a mn g y, Camp, J r CERTIFICATION # 7 1 3 R
WELL CONTRACTOR COMPANY NAME ('amp' ¢ wnl l R Pimp Crt Tn. PHONE it R7R) 4Si-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT'S
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION','?
Nearest Town: (l',�Urlm�iA.(h-
CRSAAu4t
(Sweet Name, Nun -leis, Community, Subdivision, Lot No., Zip Cade)
County ? (vM\
3. OWNER:0 Glut—Q f %
Address \(600 "S
(Swett or Rorie No.)
(e) I IKJr t-LA \kJ
City or Town Sate
( )-
Area code- Phone number
4. DATE DRILLED G' • ei C 3
5. TOTAL DEPTH: R c
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO f11
7. STATIC WATER LEVEL Below Top of Casing: cpD FT,
(Use '4" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
rariance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): SO METHOD OF TEST pit
10. WATER ZONES (depth): ;7 �� ()
11. DISINFECTION: Type rh 1 nri nn Amount V l
12. CASING: Wall Thiclmess
or Weight/Ft. Material
Depth Diameter
From p To Sh Ft6 .1/4 GDR-21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From p To 20 Ft. N at Ccmcnt Hand
From To Ft.
14. SCREEN: Depth Diameter Slot Size Materia)
From To Ft. in in.
From To Ft. in, in.
15. SAND/GRAVEL PACK:
Depth Size . Material
From To Ft.
From To Ft,
16. REMARKS:
Topographic/Land setting
ORidge ❑Slope OValley ❑Flat
(cheek appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPSOTopographic _map
(check boa) ---
DRILLING LOG
Formation D,ts/ si
F(/
DEPTH
From To
n�
J.00ATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and cottton road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCIED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY o THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
LCA
SIGNATURE OF PERSC/N CONSTRUCTING THE WELL
DATE
Jo /D -63
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
JamAs UL Camp, Jr.
CERTIFICATION % 7 1 3 R
WELL CONTRACTOR COMPANY NAME ('amp' c Win 11 R Pump Co , Tnr PHONE %$7R) dR.7,-7. ..27
STATE WELL CONSTRUCTION PERMIT% ASSOCIATED WQ PERMIT#
(if applicable) (if applicable) .
1. WELL USE (Check Applicable Box): Residential MunicipaUPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCAT N
Nearest To County
ALA
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: l (SM
Address - a (34p4 1 03
(Street or Rome No.)
S-(7.X1 11G )
Rv)
City or Town Stare Zip Code
OCAS). g321,
Area code- Phone numbit
4. DATE DRILLED Li .. • 0 3
5. TOTAL DEPTH: .Q0 S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO it,
7. STATIC WATER LEVEL Below Top of Casing: 110 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
`Top or casing terminated at/or below land surface requires a
" variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 2, 0 METHOD OF TEST 4 - r
10. WATER ZONES (depth): tSi7
11. DISINFECTION: Type rh 1 nri na Amount \ (J
12. CASING:
Depth Diameter
From Q To U O Ft 6 1/ 4
From To Ft.
From To Ft.
13. GROUT: Depth
From_0_ To 0 Ft.
Wall Thiclmess
or Weight/Ft.
GRF-71
Material
N at Ccment
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Material
PVC
16. REMARKS:
Topographic/Land setting
❑Ridge tlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
1E� 1 DRILLING LOG
From To Formation D ri ton
o LIo St,r V
'l oLos lyt Xt
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Method
Hurrd
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRU(.IED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS2EEN PROVIDED TO THE WELL OWNER
may/
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
/0 -to

WELL CONSTRUCTION RECORD 2 8 U 8 4 8
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jame Cazvp, Jr CERTIFICATION(L.2]..3..8
WELL CONTRACTOR COMPANY NAME Camp' ct WP1 1 R Pnmp Cry Tnr PHONE S$7R) c1 4-7322
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential T Municipal/Public 0 Industrial O Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIQN.
Nearest To : ].U' i County
(Sneer Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 1 e�f2�� c\AC At LA
Address �' it •'(Jf ` \
p (Strett,or Route No.)
I ��L�.-Vn �YAVI C
Ciry or TTit o [$tare Zip Code
Area code- Phone number
4. DATE DRILLED q • -
5. TOTAL DEPTH: t e LAC
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Di
7. STATIC WATER LEVEL Below Top of Casing: %fl FT
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
" variance In accordance with 15A NCAC 2C .0118.
9. YIELD ()Wm): ,$ METHOD OF TEST Sir
10. WATER ZONES (depth): tr 20
11. DISINFECTION: Type Ch 1 nr i nR Amount a1 ".1'D.
12. CASING: Wall Thic)aiess
Depth Diameter or Weight/Ft. Material
From o To \Ah Ft.6 1 / 4- eDR.21 PVC
From To Ft
From To Ft.
13. GROUT: Depth Material
From e To 20 Ft. Neat Cement Hand
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in in
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS'
Topo��++pphic/Land setting
ORidge L9§lope OValley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographir_map
(check box)
DEPTH rDRILLTN4 LOG
From To F3mation DescriptionAAAA
to
J.00ATION SKETCH
Show direction and distance in miles front at least
two State Roads or County Roads. Include the road
umbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFI
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS •EEN PROVIDED TO THE WELL OWNER
1-41 ll r
SIGNATURE OF PERSON CONSTRUCTING THE WELL / 'D DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jarnmm so Camp, JC.
WELL CONTRACTOR COMPANY NAME
Camr'q Wall R Pimp f'n Tnr•
280911
- Groundwater Section
CERTIFICATION # 2 1 3 R
PHONE fn =11Z2
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 'Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT
Nearest To
Ulk Lau4 O w Uk3e
County clv-
(Street Name, Nuihbd"n, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address t - 0_ 0
(Street S.r Route No.) tsbiku,
City or Town tare. Zip Code
Area code- Phone number
4. DATE DRILLED q • 21 • l 3
5. TOTAL DEPTH: /-21y ¶
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO [�
7. STATIC WATER LEVEL Below Top of Casing: 4 0 FT
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordsrflth 15A N CAC 2C .0118.
9. YIELD (gpm): J� THOD OF TEST a ; r
10. WATER ZONES (depth): -t I 0
11. DISINFECTION: Type f'h 1 n r i n a
12. CASING:
Depth
From p To 1 I
From To
From To
13. GROUT: Depth
FroiL_a_ To 2 0 Ft.
Amount
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 61/4
Ft.
Ft.
cDR21 PVC
Material
Neat Cement
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS•
Method
Hand
Slot Size Material
in.
in.
Topographic/Land setting
Pc.idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box) _...._.
DEPTH DRILLING LOG
From To FRrmakon Description
0 1U
iu 4,5
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
\\l
MaterialSAY64
n
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCIED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
am 11t/) , C l D—/ D--D 3
S,Ci SIGNATURE OF PERN CONSTRUCTING THE WELL I� DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

281382
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial D Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: GREEN CREEK
JOHN WATSON RD.
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: CHRIS LYLES
Address 3079 JOHN WATSON RD.
(Street or Route No.)
GREEN CREEK NC 28722
City or Town State Zip Code
(803) — 894-4643
Area Code Phone number
4. DATE DRILLED 11/20/03
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 1/2 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
Zip Code)
11. DISINFECTION: Type CHLORYTE Amount 16.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 50 Ft. 6-1/4" SD1L21 PVC
From _ To _ Ft.
From To _ Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To _ Ft. _ in. in.
From To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To Ft.
From To Et.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) r-----.___
Latitude/longitude source: 0 GPS ❑ Top4graphic
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH •
Show direction and distance in miles frfin a least
Two State Roads or County Roads. Inclpdie the
number and common names
HWY. #221 S. FROM RUTHERFORDTONZUGHT---
ON COXE RD. GO PAST AMERI-CON MATERIALS
AND TURN LEFT ON JOHN WATSON RD. GO
APPROX. 2 MILES.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1 4LP' 6) ti ��eY? '—o C — 6 ,
SI NA OF PERSON CONSTRUCTING WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

281380
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
SOUTH COVE RD. LAKE ADGER
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: DENNIS LESAGE
Address SOUTH COVE RD. LOT #32
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 697-0971
Area Code Phone number
4. DATE DRILLED 11/03/03
5. TOTAL DEPTH: 265
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
Zip Code)
11. DISINFECTION: Type CHLORYTE Amount 6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 60 Ft. 6-1/4" SDR.21 PVC
From _ To _ Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. in. _ in.
From _ To _ Ft. in. _ in.
15. SAND/GRAVEL PACK:
Depth
From To
From To Ft.
16. REMARKS:
Size Material
Ft.
r
Topographic/Land settinj_ —
❑ Ridge ❑ Slope ❑ Valley ❑t at
(check appropriate box) Jti
Latitude/longitude of well looatio_pll
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Tope
(check box)
DEPTH
From To
TT 7
raphic map
DRILLING LOG
From To L_
���
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County. Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. LEFT ON
GARRET DR RIGHT ON GREENHH,L,DR:..EFT
ON SOUTH COVE RD. 1ST DRIVE LEFT.
o _.
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
11
SIGNATURE OF P RSO CONSTRUCTING THE LL
(27ti1
// C 3 - 0 .3
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

North Carolina - Department of Environment and Natural Resources - Division of Water Quality Groundwater Section
1636 Mail Service Center • Raleigh, N.C. 27699-1636-Phone [phone]
281141
WELL CONSTRUCTION RECORD WELL CONTRACTOR• �'
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential Er Municipal ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch�of thebelow) /J
Nearest Town: eC�.l1�� iic' County:--L-G-�
Sa P,
(Road Name and"misers, C�o%'uni%or Subdivision and Lot No.) DRILLING LOG
3. OWNER "lt2Fe2t'+f'-1ct7 4t'4j ' From To
Address wtoe7 G. r� G1f /2Y
«eet or Route No.) rf Zf�
City or To . ' State zip Code Z i G(:C�
4. DATE DRILLED
5. TOTAL DEPTH -�G
6. CUTTINGS COLLECTED YES NOE
7. DOES WELL REPLACE EXISTING WELL? YES El NOQ✓
8. STATIC WATER LEVEL Below Top of Casing: 2yz FT.
(Use'.' if Above Top of Casing)
9. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): METHOD OF TEST Ytt:el
11. WATER ZONES (depth): r112 S.rl-cr
12. CHLORINATION: Type /'%/low' 4'/ Amount it...re
13. CASING:
Wall Thickness
'1�' � Depth Diaeter or Weight/Ft. Material
From—/ To Ft GYNmUI) latti )f/G
From To Ft
From To Ft
14. GROUT:
From
From
15. SCREEN:
Depth Material Method
G To i�-G1 Ft Bede 'dam T rrrc
To Ft
Depth Diameter Slot Size Material
From To Ft - in in
From To Ft in in.
From _ To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
GROUNDWATER SECT
ASHEVILLE REGIONAL GFFICE
DEPTH
Formation Description
f(7 ch
,eccc
�4-44.4/z, c .ecc,C
CI
If additional space is needed use back o,
cru
LOCATION SKETCH
(Show direction and distance from at least tw€f%tateS
Roads, or other map reference points)
lilt y /ey
;
3
CO
c
cn
o
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF IS RECORD HAS BEEN PROVID TO THE WELL OWNER.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12199
FOR OFFICE USE ONLY
Quad No:
Serial No.

283216
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J aan es s•> Camr, JL_
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
CERTIFICATION # 21 18
Camp' c Wel l R Pnmp ('n TnC PHONE #(117Fr) ASi-7i2,2
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ Industrial ❑ Agricultural III
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: F' YCS Ci Tk/ County a I
I- ;fee V( GK• l on rn.
k
(Street Name, Numbers,--be�Community,TSubdivision, Lot No., Zip Code)
3.OWNER: �)0.N'le5 I�Yve✓
Address 44-61 PectLktree RA.
(Street or Route No.)
he5 nee 5 C 02 j3a3
City or Town State 2 Zip Code
(P��-)- 512 �3 3
Area code- Phone number
4. DATE DRILLED ID -) '7- 0-3
5. TOTAL DEPTH: r2b
6. DOES WELL REPLACE EXISTING WELL? YES
7. STATIC WATER LEVEL Below Top of Casing: 1
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 5-0 METHOD OF TEST a i r
10. WATER ZONES (depth): 240
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑F1t
(check appropriate box)
Latitude/longitude of well location 1
(degrees/minutes/seconds) ,
c tr
Latitude/longitude source:❑GPS❑Topographiap
(check box) I
DEPTH DRILLING
From To Formation Des
n 5aK4 dirt
Coo 5 Crue l dot
NOg
D Ft
11. DISINFECTION: Type r h I n r i n
12. CASING:
Depth Diameter
From p To (0 Ft. 6
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20 Ft. Neat Cement
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Amount I c. k1a
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Material Method
Size Material
16. REMARKS:
o r.
w
-n
LOCATION SKETCH v.
fV
Show direction and distance in miles from atast
two State Roads or County Roads. Include t1joadG,
numbers and common road names.
\-1
S-oLguAsscAtnulwA1?-`1
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFI i
CONSTRUCTION STANDARD , AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1/414,,d_ /A). .twiAL,,711I11 t171- —D3
I SIGNATURE OF PERSON CONSTRUPTINb TkE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

Ins To: NC Dept of Env. and Na Resour
�_.,. 1111R'2003 Time: G:14:26 PM
281937
WELL CONSTRUCT Y
earnarent of Environment, and Natural Resources -
if IOR (INDIVIDUAL) NAME (print) SCOTT G
III: CC,Ni P.ADTOR COMPANY NAME CAROLINA WELL DR
-II: t:LI.:-.TNSiRLCT1ON PERMIT#
le)
Box) : Residential (111 Muni ioa rL
Heat Pump Water Injection ❑ Other ❑
SPRING
County POLK
_ SabC.im=ion, Lot No. Zip Code)
` tORROC.
NC
State
ID 7/03
.__ EXiS clioc ELL? YES ❑ NO El
if Above Tog of Casing)
ET. Above Land S:12ace'"
mi
N4FTIOD OF TEST ARDM
50 115
RECORD
of ). =te: Quality - Groundwater See - ion
CERTIFICATION tr 2 84
j_NC. PHONE # [phone]
ASSOCIATED WO PERMIT"
(if applicable)
❑ Agri ulrural ❑ ,ioe _..
L sl Use:
Topographic:Land setting
❑ Ridge ❑ Slope ❑ Valley;
Latitude/Longitude of well iocali nt
35.19.461 : 82.12.Sill
(deseee:minu1e seconzs;
21N dz r c e: ❑ G S f _ _ 1 :
DEPTH
To
50
120
Formahea
Clay
L,
CO
cisT
HYPOCHLORITE Amount 2 oe
llial:r;a
Wall Tn ckne s
GI Weight:Weight:EL Almeria!
SDR 21 PVC
Nlaterial Method
GRAVEL MIX GRAVITY
Diameter Slot Size Materia
LOCATTCS SKETCH
N n 7,7
`
til
:No—
aand d. -. ..esrrl *r - -I mr
:CS or COL o Roads include Dr PSS
Ci
rn
v
m
rt
:S TT1_A3 THIS WELL WAS CONSTRUCTED IN
LARDS, AND THAT A COPY" OF TIII S RECORD 1 SS
SIGNATURE OF PERSON CON S
• the DisIs on of Water Quality, Groundwater Sect'_er:,
?;.,.:. `. e. [phone], within 30 days.
VI IS A NCAC 2C. WELL
LO';IL)ED TO TILE WELL OMPO12
10 15'03
enter - Raleigh, NC

From To Ft.
From To Ft.
13. GROUT: Depth Material Method
283223
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J mag W Cam Jr CERTIFICATION µ_n3.13
WELL CONTRACTOR COMPANYNAME ramp' c Wa11 R Primp On Tnn PRONE µ$2A) d4'i-7322
STATE WELL CONSTRUCTION PERMMITµ ASSOCIATED WQ PERMITµ
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 14/ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: L ✓1 f
�{ooKe✓ }.
County PO I IC
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: /O K'I 3CYE l Vct
Address PO I/ }3 o X C-7 7
(Sneet or Rote No.)
City Lr Towu Suit Zip Code
( )- �)1-O,.ZD
Area code- Phone number
4. DATE DRILLED lG - y - 03
5. TOTAL DEPTH: LI-n c
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: Las FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface`
• 'Top of casing terminated ator below land surface requires a
rariance In accordance with ISA NCAC IC .0118.
9. YIELD (gpm): S U METHOD OF TEST p i r
10. WATER ZONES (depth): �i 80
11. DISINFECTION: Type rh1 nri n
12. CASING:
Depth Diameter
From 0 To I Dci Ft. 6 1/ 4
Amount ,2 cup
Wall Thickness
or Weight/Ft. Material
BR21 PVC
14.
From—o__To 30 Ft. N at Ccmont Hand
From To Ft.
SCREEN:
From
Depth
To
From To
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in in.
16. REMARKS:
/ Topographie/Land setting
Midge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographicaha_p
(check box)
DEPTH PRILLING LOV
From To For ation Dcscrip ion
0 1 05- end 9 ravel
IDS t-{-D5 CknSo'),dAted rock
0
0
CO
LOCATION SKETCH
Show direction and distance in miles from at lefts?
two State Roads or County Roads. Include the
numbers and common r... names.
9,
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC ItD IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
14-), II-l� D3
SIGNATURE OF PERS{JN CONSTRUCTING THE WFi T /✓ / DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 90 days. OW-1 REV. 07/2001
0
7

283218
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James ur Carp Jr
WELL CONTRACTOR COMPANY NAME ramp' R Wa 11
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
& Pnmp Co ,
CERTIFICATION # 21 R 8
Tnc PHONE 8} R) 451-7' 22
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:rt /1
Nearest Town: �l AA SLR
ck A01.:\0.1,41
(Sheet Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: S X1m.ww Littei
Address i LllL
County ea
411L (Sheet or RoCure No.) ac 1
l ry ° ki _ i\th Zip Code
Area code- Phone (number L S
4. DATE DRILLED IIr I b to 0 3
5. TOTAL DEPTH: R1? S�
6. DOES WELL REPLACE EXISTING WELL? YES I37 NO 0
7. STATIC WATER LEVEL Below Top of Casing: 1 (1 FT.
(Use "f" if Above Top of Casing)
8. TOP OF CASING IS i FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordagcc with 15A NCAC 2C .0118.
9. YIELD (gpm): 1 V METI; OD OF TEST
10. WATER ZONES (depth): bcOI)
11. DISINFECTION: Type rhl nri nn Amount (i4
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From p To_15-__ S Ft. 6 1/ 4
From To Ft.
From To Ft.
13. GROUT: Depth
Frotn_g_ To 2 0 Ft.
From To Ft.
Sir
Ra21 PVC
Material
Neat Cement
Method
Hand
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in,
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley lDlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) 1-E
Latitude/longitude source: ❑GPS❑Topographi ;Trim;
(check box) r"
DEPTH DRILLING
From To
0 41s
FArmatjon Dcscri
(5 t40 .Aat
CJ
c E
LOCATION SKETCH -- r'
Show direction and distance in miles from attleast
two State Roads or County Roads. Include Soad'
numbers and common road names. u
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCIhD IN ACCORDANCE WITH 15A NCAC 2C, WET 1
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Cl� ll-ID or-
A.-tSIGNATURITSF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

283215
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James ar Ca mr, Tr- CERTIFICATION It 71 "I8
WELL CONTRACTOR COMPANY NAME ('amps R WP11 & Pnmp ('n Tnr' PHONE #$➢R) 4S1-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential IV—Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT ON: o
Nearest Town: 1 , . CountyV_
- Ca 0nit". 40.M
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: A�a
G
Address 5�
p (Street rRoute No.)
, It V-(_`���
City or Town State Zip Code
Area code- Phone number r
4. DATE DRILLED -‘4".- u �3
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES la' NO 0
7. STATIC WATER LEVEL Below Top of Casing: (0 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordce with 15A NCAC 1C .0118.
9. YIELD (gpm): ,2fl M HOD OF TEST Air
10. WATER ZONES (depth): S t-LS.
11. DISINFECTION: Type f' h 1
12. CASING:
Depth
From 0 To 15 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From 9 To 20 Ft.
From To Ft
14. SCREEN: Depth
From To Ft. in
From To Ft. in
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
nri na Amount
Wall Thickness
Diameter or Weight/Ft. Material
6 1/4 GBR21 PVC
16. REMARKS:
Size
Material
Method
N at Ccment Hand
Diameter Slot Size
in.
in.
Topographic/Land setting
\Eftidge ❑Slope ❑Valley C
(check appropriate box)
Latitude/longitude of well locat
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topo
(check box)
DEPTH
From To
ag3i c map
11s 412 5- �c bt,$t
O
Pei
0
,
CP
Show direction and distance in miles from aqsast
two State Roads or County Roads. Include tklrtoa
numbers and common road names.
Material 04
1
LOCATION SKETCH
i0 F 1 a i
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 W4ELL OWNER
It 11
S� IGNATT OF PERSO CONSTRUCTING THE WELL I DATE O
3
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

283213
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James w Cam Jr
WELL CONTRACTOR COMPANY NAME ('amp' c Wnl 1 R Pnmp ('n Tnr•
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERh1IT#
(if applicable)
(if applicable)
CERTIFICATION # 21 4 R
PHONE #832A) d'1_7322
1. WELL USE (Check Applicable Box): Residential W Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
WELL LOCAT
2. Neaz tTown: N Co ty 1-(tC.1�
(Street Name,
�Numbers, Community,, Subdivision, Lot No., Zip Code)
3. OWNER l✓-tt\ .1/YYu 1G`lCI�j*C
Address Q l '%(< \ as -
(Street or Route No.)
C, ity or Tow cu S Q- Cod3 0
City or Town d State Zip Code
Area code- Phone number
4. DATE DRILLED 10- 3 0
5. TOTAL DEPTH: \•.1‘=)
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
8, TOP OF CASING IS 1 FT. Above Land Surface•
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 100'A ME,T OD OF TEST 4ir
10. WATER ZONES (depth): DU
FT.
11. DISINFECTION: Type r h 1 nr i n
12. CASING:
Depth Diameter
From 0 To In Ft.6 1 /4
From To Ft.
From To Ft.
13. GROUT: Depth
From-0 To 20 Ft.
Material
Pleat
From To _ Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount raL`
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Cement
Method
Hand
Slot Size Material
in,
in.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope 132'Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographicirnap
(check box)
DEPTH DRILLIN4 LOG
From To Formation DesAription
0 . {1M.Q \�
I0s
CO
:r
CZ r
LOCATION SKETCH
Show direction and distance in miles from ata2ast LT
two State Roads or County Roads. Include t�e road„
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCI hD IN ACCORDANCE WITH Y5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S19NATURE OF ERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

283212
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James w Camp, Jr
WELL CONTRACTOR COMPANY NAME Camp' S Wel 1 R. Pump CO ,
CERTIFICATION # 21 4 R
Tnr PHONE#82,2R) dS3-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential l$d Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION.
Nearest Town: l r I1 ) / /-PY A / County o /K
Al±11 Po;tit - ) c
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ,)jkM wU 1yL V /LoC
Address P ( l3 o X q l A 5
(Street or Route No.)
S, el/ld-nllt-tYy 5 C
c(ty or Town Stale Zip Code
Area code- Phone number
4. DATE DRILLED it)- „ZO - D 3
5. TOTAL DEPTH: 0 5-
�����,,,.{{{{{
6. DOES WELL REPLACE EXISTING WELL'? YES 0 NO FT
7. STATIC WATER LEVEL Below Top of Casing: %
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): ?o METHOD OF TEST_Air
10. WATER ZONES (depth): / `'L'
.29305
11. DISINFECTION: Type rh 1 nr1 np Amount (cato
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From_O___To 2,/Z Ft. 6 1 / 4 gDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From_c____ To 20 Ft. Neat Cement Hand
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Lan setting
:Midge ❑Slope alley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map - -----
(check box) j-
DEPTH DRILLING-I,Q -----
From IT�o Formation Description
'T
n = di t
f3 ,�05 (r»rs'GdaiedYolk
L
O
LOCATION SKETCH -D m
Show direction and distance in miles from at legit
two State Roads or County Roads. Include thettoad �U, i\!\-}y\
n
numbers and common road names. /1v —,
rn 3 n CD Ire
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFI f
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
P4 12i. ( /I-I1-03
S NATURE OF PERSON CONS CTIN THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

283210
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J ina S ra Camp. Tr CERTIFICATION 2138
WELL CONTRACTOR COMPANY NAME Camrr a Wrx11 R Pump Cr)._ Tnr PHONE #$7R) 4 R-.7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(ifapelicable)
-_7_ � �r
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural -:-
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
(if applicable)
2. WELL LOCATI
Ne esk Town:
(Street Name, Numbers, Community, subdivision, Lot No., Zip Code)
County \ tt.A
3. OWNER:
Address
5-
(Street or Route No.)
V�I c
City or Town State
Zip Code
( )-
Area code- Phone number
4. DATE DRILLED S) • `) . 0 .1
5. TOTAL DEPTH: c 4 S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 114
7. STATIC WATER LEVEL Below Top of Casing: L\ 1 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm):METHOD OF TEST
10. WATER ZONES (depth): .0-0 L
air
11. DISINFECTION: Type it 1 n r i nP
12. CASING:
Depth
From._()To S tl
From To
From To
Diameter
Ft. 61/4
Ft.
Ft.
Amount C i T"
Wall Thickness
or Weight/Ft. Material
q R.)1 PVC
13. GROUT: Depth Material Method
Frortt_0__To 20 Ft. N at Cement Hand
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
1,� Topographic/Land setting
tlltRldge ❑Slope ❑Valley ❑F14t
(check appropriate box) .-- I
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map FF.
(check box)
DEPTH DRIL G LOG I ______)
From To ormatio
D so Q r.Q
Li OLLINS AAA M.
-c e
J.00ATION SKETCH
Show direction and distance in miles from atast ram.-=
two State Roads or County Roads. Include tte oadt„
numbers and common road names. ry rn
4) o
I DO HEREBY CERTIFY THAT THIS WFI WAS CONSTRUCT bp IN ACCORDANCE WITH 15A NCAC 2C, WFI
CONSTRUCTION
^NSSTANDARDS, AND THAT
(�A�,COWNER�OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL f
/ 1� v a Pn\d4NATURE OFPERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

283209
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jam2S to Camp, Jr
CERTIFICATION # 71 3 R
WELL CONTRACTOR COMPANY NAME (mmp' a Wp11 R pimp Cr) TnC PRONE #ffi7R1 45"1-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 12- MunicipaiPublic 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIONp
Nearest Town: R,t A Q -� County t
(Street Name, Numbers, Community, Subdivision�Lot No., Zip Code)
3. OWNER: l Id C L(.l 0ax 4.r.1-
Address e (} _ q ( s
(Street of Route No.)
o R Sin �n t vv t ,a S l S 8_
City or Town St, Zip Code
Area code- Phone number
4. DATE DRILLED (u - k t ti
5. TOTAL DEPTH: 2 fl
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic trap
(check box) .. __ --
DRILLING LOG
Fotmat�y'on Description
DEPTH
From To
0 45'
AA
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 6c
7. STATIC WATER LEVEL Below Top of Casing: :ZO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface"
*Top of casing terminated at/or below land surface requires a
variance In accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): E (t METHOD OF TEST 81 r
10. WATER ZONES (depth): 3 00
11. DISINFECTION: Type r h 1 n r i n p
12. CASING:
Depth Diameter
From__ To. L� S' Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20 Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Amount CIA
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Material Method
Neat Cciucnt Hand
16. REMARKS:
Slot Size Material
in.
in.
Material
GS R 15--
Show direction
two State Ro
numbers an
CO
0
w =
SCa ON C -4
lance in miles from at Ir$t r-t
or Cty Roads. Include theNad �,,'.�-.
coralptln road names.
-> O
omq N
to o
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
SIGNANRE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

282348
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1
2. WELL LOCATION:
Nearest Town: TRYON County POLK
OVERHILL DR
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MIKE DEVERE
Address 111 OVERHILL DR.
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(828) — 859-6260
Area Code Phone number
4. DATE DRILLED 10/23/03
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 1 SA NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To 90 Ft.
From _ To Ft.
From To _ Ft.
13. GROUT: Depth
From 0 To 20 Ft.
From To Ft.
14.SCREEN: Depth
From _ To F
From To
CHLORYTE Amount 15
Wall Thickness
Diameter or Weight/Ft. Material
6-1/4" SDR21 PVC
Material
QUIKRETE
Method
POURED
Diameter Slot Size Material
t. _ in. in.
t. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To Ft.
From To Ft.
16. REMARKS:
WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
Topographic/Landse.
❑ Ridge 0 Slope 0 Vallesf50 Flat
(check appropriate box, -c c�
Latitude/longitude of well los 4 n
(degrees/minutes/second
Latitude/longitude source: ❑ GPS
(check box)
DEPTH
From To
DRILLING LOG
From To
Topogmpt�t`map-7�
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
GO DOWN 74 BYPASS W. GET OFF AT PEA
RIDGE EXIT. TURN RIGHT ON PEA RIDGE RD. GO
1/4 MILE. RIGHT ON JOHN SHEHAN RD. GO 1
MILE. LEFT ON MOORE RD. GO APPROX. 13/4
MILE. LEFT ON OVERHILL DR 2ND DRIVE ON
LEFT.
0
w
0
0
-o
0
N
m
0
c _
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONDUCTION STANDARDS, AND THAT A C PY OF THIS
RECORD
HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

28231f)
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
GRASSY KNOB RD.
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: ROY MCGUINN
Address GRASSY KNOB RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 287-4239
Area Code Phone number
4. DATE DRILLED 10/20/03
5. TOTAL DEPTH: 105
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
Zip Code)
11. DISINFECTION: Type CHLORYTE Amount 3
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 50 Ft. 6-1/4" SDR21 PVC
From To Ft.
From _ To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter
From _____To _____ Ft.
From To _ Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
Slot Size Material
in. _ in.
in. in.
From _ To _ Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope 0 Valley
(check appropriate box)
Latitude/longitude of well loca
J;
d, Slat
tion
(degrees/minutes/seconds) c: _2
Latitude/longitude source: ❑ GPS ❑ Topc€g aphic map
(check box)
DEPTH
7
ll
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. RIGHT ON
GRASSY KNOB RD. 1 MILE ON LEFT.
9 :C 14d a AOU CO
r✓
c._
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 PER ON CONSTRUCTING THE WELL
//A //o.�
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

282345
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1 WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK
HEMLOCK TRAIL
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ELLIS M. FINCHER
Address HEMLOCK TRAIL
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(864) - 457-4278
Area Code Phonc number
4. DATE DRILLED 10/24/03
5. TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 4.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 40 Ft. 6-1/4" SDR21 PVC
From To Ft.
From To _ Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QULKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley
(check appropriate box)
Latitude/longitude of well loc
(degrees/minutes/seconds) r. �'.l
Latitude/longitude source: ❑ GPS El ptuphic map in
(check box) '
DEPTH --
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 W. FROM MILL SPRING. RT. ON
HOUSTON RD. RT. INTO WHITE OAK MTN. LEFT
ON HEMLOCK TRAIL NEW DRIVE 1 MILE ON RT.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
i
.��.-IN «—zt-, L / (/DAT
% SIGNATURE OF PERSON ONS CTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phonc No. [phone], within 30 days. GW-1 REV. 07/2001

2823444
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK
BLACK WOOD RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JAMES SHEHAN, JR
Address BLACKWOOD RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(864) - 457-2077
Area Code Phone number
4. DATE DRILLED 10/23/03
5. TOTAL DEPTH: 185
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 4.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 70 Ft. 6-1/4" SDR21 PVC
From To _ Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To Ft. _ in. _ in.
From _ To _ Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To _ Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting ,-
❑ Ridge ❑ Slope ElValley F
(check appropriate box) _
Latitude/longitude of well 1oc4
a'
(degrees/minutes/seconds)
Latitude/longitude source: D GPS ❑ T
(check box) -- -
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. LEFT ON OLD
CHESNEE RD. LEFT ON BLACKWOOD RD. 3/4
MILE ON RT. HABITAT SIGN.
93 :C Wd 'I- AON CO
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PER ON CONSTRUCTING THE WE
L
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

282343
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery El Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING County POLK
3400 COOPERS GAP RD.
(Street Name, Numbers, Commwity, Subdivision, Lot No., Zip Code)
3. OWNER: JOE el(j/c✓< ,v ej
Address 3400 COOPERS GAP RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 883-4985
Area Code Phone number
4. DATE DRILLED 10/22/03
5. TOTAL DEPTH: 805
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 300 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 2-1/2 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 22.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 60 Ft. 6-1/4" SDR21 PVC
From _ To
From _ To
13. GROUT: Depth Method
From 0 To 20 POURED
Ft.
Ft.
Material
Ft. QUIKRETE
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To Ft. _ in. _ in.
From _ To Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting'_
❑ Ridge ❑ Slope ❑ Valleys
(check appropriate box;
Latitude/longitude of well 14icca
(degrees/minutes/second
Latitude/longitude source: ❑ GPS
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. LEFT ON
COOPERS GAP RD. NEW DRIVE 3/4 MILES ON RT.
83 :C ild h- MN CO
u
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS,
ANNDD THAT A COPY�OF THIS RECORD HAS
_/(BEEENN PROVIDED TO THE WELL OWNER
I PA'I'URE OF PERSON CONSTRUCTINGWELy�G DATE / U /��L . / o �'5
SIG
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

28'33"s
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
MELVIN HILL RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ROGER 04011819SC ,AC
Address MELVIN HILL RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) - 697-2126
Area Code Phone number
4. DATE DRILLED 10/02/03
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 16.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 110 Ft. 6-1/4" SDR.21 PVC
From To _ Ft.
From _ To _ Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. QUIKRETE
From _ To Ft.
14.SCREEN: Depth Diameter
From To _ Ft.
From To Ft. _
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To Ft.
From To Ft.
Method
POURED
Slot Size Material
in. _ in.
in. in.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley
(check appropriate box)
Latitude/longitude of well loca
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ T
(check box)
DEPTH
From To
DRILLING LOG
From To
rim
rc
That
rJ
ibfra
cn
c-1
n
n
flograPlut
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 FROM MILL SPRING. LEFT ON OLD
CHESNEE HWY. RIGHT ON MELVIN HILL RD.
LEFT ON MELVIN HILL AT FORKS. ORANGE
GATE JUST PAST A WILSON RD. ON RIGHT.
0
0
0
--D
w
rt.)
to
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCCTTIION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
(;ax o /Q 6.3
SIGN TURE OF PERSO CON TRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

28233E
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON County POLK
SKYVIEW DR LOT 40 & 41
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: S. BROWN SANDERS, III
Address SKYVIEW DR
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(843) — 571-6591
Area Code Phone number
4. DATE DRILLED 10/25/03
5. TOTAL DEPTH: 705
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 19.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 80 Ft. 6-1/4" SDR21 PVC
From To Ft.
From _ To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. in.
From _ To _ Ft. _ in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From
From
To Ft.
To Ft.
16. REMARKS:
Topographic/Land setti
❑ Ridge ❑ Slope ❑ Valle
(check appropriate box)
Latitude/longitude of well 1
(degrees/minutes/second
Latitude/longitude source: ❑ GPS ❑
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 W. FROM COLUMBUS. RIGHT ON
HOWARD GAP RD. RIGHT ON OLD HOWARD GAP
RD. GO TO TOP OF HILL. RIGHT ON INDIAN
MTN. RD. STAY STRAIGHT INTO MILLER MTN.
APPROX. 3/4 MILE AFTER PAVEMENT ENDS.
TURN LEFT ON SKYVIEW LANE. LOT APPROX.
1/4 MILE ON LEFT.
0
w
0
0
i
S
CO
N
lD
0
n
c
Cf>7-3
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THATA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ATURE OF PERSON CONSTRUCTINGi THE WELL
/6
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
i
17177
r

28233G
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring 0 Recovery D Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING County POLK
SILVER CREEK RD.
(Street Name, Numb..is, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JIMMY SEARCY
Address 477 SILVER CREEK RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 894-3736
Area Code Phone number
4. DATE DRILLED 10/14/03
5. TOTAL DEPTH: 405
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 10.5
12. CASING: Wall Thickness
Depth or Weight/Ft. Material
From 0 To 70 SDR21 PVC
From To
From To
Diameter
Ft. 6-1/4"
Ft.
Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUHCRETE POURED
From _ To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. in. in.
From _ To _ Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land se
❑ Ridge ❑ Slope 0 Val
(check appropriate bo
Latitude/longitude of well
(degrees minutes/secon
Latitude/longitude source: 0 GPS
(check box)
DEPTH
From To
DRILLING LOG
From To
CJ
graphic ma
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. LEFT ON
SILVER CREEK RD. APPROX. 1/2 MILE ON LEFT.
6Z :C Wd 1- MIN £0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TTFHS RECORDDJJHAS BEEN PROVIDED TO THE WELL OWNER
S NA OF PERSON CONSTRUCTING WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
rfI

12. CASING:
Depth
From 0 To 84
282332
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK
GOLF COURSE RD. -LOT #6
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: WALLACE HUGHES
Address GOLF COURSE RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 778-4275
Area Code Phone number
4. DATE DRILLED 10/02/03
5. TOTAL DEPTH: 84
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 64 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 9.2
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 24" CEMENT
From _ To _ Ft.
From To _ Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To _ Ft. in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 64 To 84 Ft. 78M GRAVEL
From To Ft.
Topographic/Land settin
❑ Ridge 0 Slope 0 Valley
(check appropriate box)
Latitude/longitude of well 1
(degrees/minutes/seconds
Latitude/longitude source: ❑ GPS ❑
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. RIGHT ON
LANDRUM RD. RIGHT ON GOLF COURSE RD.
APPROX. 2/10 MILE ON RIGHT.
16. REMARKS:
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
/0% L— h' 1-) vl -e -
SIGNATUR$ OF P O CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION #__7 13S
Tnc PHONE#t7R1 /151-7427
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
Camp
James to Camp, Jr
I G
wP1 1 E pump CZ ,
ASSOCIATED WQ PERMIT#
(if applicable)
284478
1. WELL USE (Check Applicable Box): Residential UYMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCH N f�
Nearest T %ounty `) (
iesAn C1 iJl
(Street Name, N bers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: \)v
Address (.t1 ^i �bff3
(Street or Route No.)
-takAAI11 t c
60- CityI t-t- nSZip Code
1 U
Area code- Phone number
4. DATE DRILLED • U
5. TOTAL DEPTH: O 5 -
6. DOES WELL REPLACE EXISTING WELL? YE 0 NO
7. STATIC WATER LEVEL Below Top pf Casing: 0 FT.
- (Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 Ft Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST air
10. WATER ZONES (depth): [P Q
11. DISINFECTION: Type rh 1 nr i np
12. CASING:
From
From
From
Depth Diameter
To 13 Ft. 6 1 / 4
To Ft.
To Ft.
Amount 0.-k-4'
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Topographic/Land setting
ffidge ❑Slope ❑Va11ey 0F14
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑TopograpL is map i
(check box)
DRILLING LOG
Ficoi n Description
DEPTH
From To
n '5-
1
c_
c)
a —
LOCATION
N n�
ern
LOCATION SKETCH -Es "o
Show direction and distance in miles from aleastN
tw• ,St to Roads or County Roads. Include 9 rotf o
nu I b. s and common road names. o 0
13. GROUT: Depth Material Method
From_p To 20 Ft PI at Cement Hand
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From_ To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material �1
From To Ft
From To Ft.
16. REMARKS:
.11
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFi 1
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL 0
k-o�.oy
NATURE OF It: RSON CUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

284473
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # 2 1 3 R
PHONE lt$7Rl AS33-7322
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James Id Camp, Jr
WELLCONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMITS
(if applicable)
Camp'a Un11 $ Pump Cr-,4
ASSOCIATED WQ PERMIT#
if applicable)
Tnc
1. WELL USE (Check Applicable Box): Residential CYMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO :
Nearest Town WL County
Polk
0 A, S,, p FF--�&
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
rAikid
3. OWNER: (�(M)Jt4- t
Address \\\rV SPrt A kI) LOW..t+' p
> n((Street or Route No.)
TVCityy orlTown State Zip CodeA
( )-
Area code- Phone number
4. DATE DRILLED l)- • 01-0 3
5. TOTAL DEPTH: 6 X S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO LtY
7. STATIC WATER LEVEL Below Top pf Casing: I 0 O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT_ Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accord n e with ISA NCAC 2C .0118.
9. YIELD (pm): — METHOD OF TEST
10. WATER ZONES (depth): 'S 0 0
11. DISINFECTION: Type Ch 1 n r i n p Amount 1
12. CASING: Wall Thickness
Depth, , Diameter or Weight/Ft. Material
From p To \S Ft.6 1-/4 SDR21
From To Ft.
From To Ft.
13. GROUT: Depth Material
From,_g To 2 0 Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C, WEI T
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
t� to•o3
A it
Topographic/Land setting.
❑Ridge ❑Slope ❑Valley latclat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographicmap
(check box)
DEPTH DRILLING LOG
From `ToS FgkmatignDeseription-- - -_. ULLA-
c
O
r
0
c'r^
rZ ra ri
± rn
72.0
0
LOCATION SKETCH -o r—'.,
Show direction and distance in miles from aFeast^
two Sta Roads or County Roads. Include Mt roa'ia
number and common(oad/ryames.
N✓ O 0
z
SIGNA OF PERSONCONSTRUCTINGTHE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. . GW-1 REV. 07/2001

283817
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON
111 OVERBILL DR.
(Street Name, Numbcis, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MIKE DEVERE
Address 111 OVERBILL DR.
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(828) — 859-6260
Area Code Phone number
4. DATE DRILLED 12/23/03
5. TOTAL DEPTH: 585
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 12 METHOD OF TEST ARID
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To 80 Ft.
From _ To _ Ft.
From _ To _ Ft.
13. GROUT: Depth
From 0 To 20 Ft. QUIKRETE
From To Ft.
14.SCREEN: Depth Diameter Slot Size
From To Ft. in.
From _ To Ft. in. _
15. SAND/GRAVEL PACK:
Depth Size Material
County POLK
From To _ Ft.
From To Ft.
16. REMARKS:
CHLORYTE Amount 16.5
Wall Thickness
Diameter or Weight/Ft. Material
6-1/4" SDR.21 PVC
Material Method
POURED
Material
in.
in.
Topographic/Land setting
0 Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) [—_
Latitude/longitude source: 0 GPS 0 TopOap Itic map
(check box) _
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH I "
Show direction and distance in miles fro$t at least
Two State Roads or County Roads. Include -the -mad----
number and common names
BY-PASS 74 W. FROM FOREST CITY. GET OFF
AT PEA RIDGE EXIT. LEFT (n, STOP SIGN. RT. ON
JOHN SHEHAN RD. LEFT ON MOORE RD. LEFT
ON OVERBILL DR. 2ND DRIVE ON LEFT. C2
0
Gw xa
A c-
cm
1 `SE
N
yc
Zrn
r
NZ
rna
z
0
(71
N
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONS CTION STANDARD
S, ND THAT OF $ 1 S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
(Fe/7j
SIGNATURE OF PER NSTINGWELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

283815
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # __ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK
OLD CHESNEE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: TONY MATHIS
Address OLD CHESNEE RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 863-4115
Area Code Phone number From To
4. DATE DRILLED 12/03/03
5. TOTAL DEPTH: 165
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 3.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 70 Ft. 6-1/4" SDR.21 PVC
From To Ft. T
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To _ Ft. _ in. _ in.
From To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well locatiort.__.
(degrees/minutes/seconds) ? r
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box) - I
DEPTH
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles fr m at least!..` --- _--
Two State Roads or County Roads. Incl d-
--
number and common names
HWY. #9 S. FROM MILL SPRING. LEFT ON OL
CHESNEE RD. DRIVE ON RT. APPROX. 5 MILES.
P1
7'.
0
01
N
0
0
Cl
7:3m
cCD
cm
z_
>0
rn
rn
mo
7:1m
m:a
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS UCTION STAND S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�' l_a l:' dC+✓l n�f!'2^- L4 / d - L% 3 O 2
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

283814
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1.
WELL USE (Check Applicable Box): Residential ® MunicipallPublic ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
GOLF COURSE RD.
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: MASTON HOMES
Address GOLF COURSE RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(864) - 457-3855
Area Code Phone number
4. DATE DRILLED 12/02/03
5. TOTAL DEPTH: 705
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 1 METHOD OF TEST ARD
10. WA 1 ER ZONES (depth):
County POLK
Zip Code)
11. DISINFECTION: Type CHLORYTE Amount 19.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 80 Ft. 6-1/4" SDR21 PVC
From To Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter
From To Ft. _
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Slot Size Material
in. in.
in. in.
16. REMARKS:
Topographic/Land setting
0 Ridge ❑ Slope 0 Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) r-- -.- - —
Latitude/longitude source: 0 GPS ❑ Toppgt phic map
(check box) _
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles front at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. RT. ON HWY.
#14. RT. ON GOLF COURSE RD. NEW DRIVE 2
MILES ON RT.
O
L
N
a
7G
0
CJ1
N
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CON/S�TRUCTION STANDARDS, AND THAT COPY O THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
- 3
SIGNATURE OF PERSON CONSTRUCTING TIC WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

283811
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON County POLK
S. GREENWAY RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: G.A. STEPHENS
Address S. GREENWAY RD.
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(828) — 2134
Area Code Phone number
4. DATE DRILLED 12/03/03
5. TOTAL DEPTH: 59
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 39 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 59 Ft. 24" CEMENT
From _ To Ft. _
From _ To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To _ Ft. in. _ in.
From To _ Ft. _ in. in.
15. SAND/GRAVEL PACK:
Depth Size
39 To 59 Ft. 78M
To Ft.
From
From
16. REMARKS:
Material
GRAVEL
Topographic/Land setting
❑ Ridge ❑ Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ 'tigpogr hi
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH ,'.
Show direction and distance in miles kr6m at lea
Two State Roads or County Roads. Intilude the rokilt
number and common names
HWY. #9 S. FROM MILL SPRING. LEFT ON
SANDY PLAINS RD. RT. ON FLOYD BLACKWELL
RD. RT. ON SOUTH GREENWAY RD. DRIVE ON
LEFT APPROX. 1 MILE. (419 ON BOXU
t o
b - Cm
cm
t CC-1 <
Nm
yc
ma
xm
rn
0
— I
0
U1
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS? CTION STANDARDS, AND THAT A COPY OF miSS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/ c 54_, V �1//i'l %n�(�`' .�%/ �i7 — l cR - - C. 3i
SI NATURE F PER ONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

283810
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SRING County POLK Topographic/Land setting
FOX BRIAR DR. 0 Ridge 0 Slope ❑ Valley 0 Flat
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) (check appropriate box) r_
3. OWNER: MICIIAEL PATTERSON Latitude/longitude of well location
Address FOX BRIAR DR
(Street or Route No.) (degrees/minutes/seconds), "
MILL SPRING NC 28756 Latitude/longitude source: 0 GPS ❑ topographic map
City or Town State Zip Code (check box) L-
(828) - 247-0055 DEPTH
Area Code Phone number From To
4. DATE DRILLED 12/01/03
5. TOTAL DEPTH: 39 DRILLING LOG
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ® From To
7. STATIC WATER LEVEL Below Top of Casing: 22 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
LOCATION SKETCH
Show direction and distance in miles fio,u at leas[
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 W. FROM MILL SPRING. LEFT ON
FOX BRIAR DR (MEADOWBROOK SUBDV) 3/10
11. DISINFECTION: Type CHLORYTE Amount 4.6 MILE ON RIGHT.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material t 0
From 0 To 32 Ft. 24" CEMENT r— a,'
m
From _ To _ Ft. Z acp
n
From To Ft. t
13. GROUT: Depth Material Method NI nc
From 0 To 20 Ft. CEMENT POURED a m,
s —c
From _ To _ Ft. -.d"'
14.SCREEN: Depth Diameter Slot Size Material a �s
From To Ft. _ in. _ in. c!7 --I
From _ To _ Ft. in. in. N z
15. SAND/GRAVEL PACK:
Depth Size Material
From 22 To 32 Ft. 78M GRAVEL
From To Ft.
16. REMARKS:
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
( SIG A F PERSON CONSTRUCTING WELL DATE
Submit the original to the Division of Water Quality/ taadidwater Section, 1636 Mail Service Center- Raleigh, NC
21699-1636 Phone No. [phone], within 30 daft. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J amo S so
WELL CONTRACTOR COMPANY NAME Camp' c W1 1 R
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
Camp, Jr.
Piimp Cn
ASSOCIATED WQ PERMIT#
(if applicable)
283414
CERTIFICATION #21 3.R
Tnr PHONE #$2R) d5'1-722
1. WELL USE (Check Applicable Box): Residential lid Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT N: n ( n
Nearest Town: �4 Coun 4C,
CA P4 nn vAAJS v A. `-‘ \
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: G-&`' & C X t
Address l 3 L1 P\ S C.:.) CI el sA-
(Sunctrpr Route No.)
y'V\ A Air\ VI— • 3;31
City or Town State Zip Code
E> a- 3k— S0\
Area code- Phone number
4. DATE DRILLED `( •a 1 .0 g
5. TOTAL DEPTH: zz
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO it
7. STATIC WATER LEVEL Below Top of Casing: S6 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
* variance in accordaqi with 15A NCAC 2C .0118.
9. YIELD (gpm): ME,TH D OF TEST
10. WATER ZONES (depth): •1
Topoggra�hic/Land setting
❑Ridge C13Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type Ch1nrina Amount C f,An
12. CASING: Wall Thickness
or Weight/Ft. Material
�/4 SDR21 PVC
Depth Diameter
From g To t. A Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From g To 2 0 Ft.
From To Ft.
Material
Method
Neat Ccmcnt 11u
14. SCREEN: Depth Diameter
From To Ft. in
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Slot Size Material
in.
in.
From To Ft.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from a
two State Roads or County Roads. Include t
numbers and common road names.
S
TeR
16. REMARKS:
1 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
,AN m -\vC - Its oc
/ IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) la m e S r^1
Camp, Jr
WELL CONTRACTOR COMPANY NAME ramps s Wel 1 R Pnmp Crt_ Inn
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
283413
- Groundwater Section
CERTIFICATION # 2 1 3 R
PHONE #/8!2R) 453-7322
r
1. WELL USE (Check Applicable Box): Residential GYMunicipal/Public 0 Industrial 0 Agricultural 0 '-
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearest Town:
M
Coun
(Street Name, Numbers, Community, Sub vision, Lot No., Zip Code)
3. OWNER:
Address
i�.
>A. V \ '\.I> 9,, i�XR Sk
^ c It�(Sveµpr R `ate) �� a?, „ou
1` JCIty r Ta n `r the ` Zip Code
(u�w 4 \ _ ��s
Area code- Phone number
4. DATE DRILLED 1,0 • :I - 0 '
5. TOTAL DEPTH: y
6. DOES WELL REPLACE EXISTING WELL? YES NO Eil,
7. STATIC WATER LEVEL Below Top of Casing: )0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface"
*Top or casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 1 METHOD OF TEST Air
10. WATER ZONES (depth): L-L\1
11. DISINFECTION: Type rh 1 nri nn Amount`) LQ t )
12. CASING: Wall Thickness
Depth c� `i Diameter or Weight/Ft. Material
From 0 To' Ft. 6 '1 / 4 SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
Frorn 0 To 20 Ft. Neat Cement
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From. To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge LISTope ❑Valley ❑lit,=!
(check appropriate box) =„
Latitude/longitude of well locatidr
(degrees/minutes/seconds) -
Latitude/longitude source:❑GPS❑TopogjaphiCh3p;= _--
(check box)
DEPTH — _
DRILLING LAB
From To Formon Description
0 S
S S t S .✓`,t p \\AXI.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Includcihe roil
numbers and common road names.
0
ITT
0
1
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC'1 hD IN ACCORDANCE WITH 1 SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
'k_ 51GNATURE O PERSON CONSTRUCTING THE WELL DATE
L_)
Z
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-I REV. 07/2001

283412
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
Jamec
WELL CONTRACTOR COMPANY NAME Camp' s Wm 1
STATE WELL CONSTRUCTION PERMIT/0
(if applicable)
w Camp, Jr.
R Primp CO ,
CERTIFICATION K 21 3 R
T n r PHONE it 2R) dS3-7322
ASSOCIATED WQ PERMITN
(if applicable)
1. WELL USE (Check Applicable Box): Residential lU-Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ if Other, List Use
2. WELL LOCAT 4N: 1 t ( n
Nearest Town: .1.�. ♦ County
Q hr.
(Street Name, Numbers, Community, Subdi ton, Lot No., Zip Code)
3. OWNER:—%e�;1't�.t�(C
Address kg1 -t\. \'1L\
(Street or Route No.) �S
City or Tow t State Zip Code
(
Area code- Phone number
4. DATE DRILLED Tk S t)
5. TOTAL DEPTH: J C�
6. DOES WELL REPLACE EXISTING WELL? YE ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: rE FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface"
*Top of casing terminated at/or below land surface requires a
variance In accordancq with 15A NCAC 2C .0118.
9. YIELD (gpm): )3 METHOD OF TEST Sir
10. WATER ZONES (depth): .L
CS
11.DISINFECTION: Type rhlnrina Amount ({")
12. CASING:
Depth Diameter
From r) To Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth
From p To 2 0 Ft.
From To Ft.
Wall Thickness
or Weight/Ft. Material
SDR21
Material
Neat Cement
Method
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in,
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge U8'lope ❑Valley ❑Ffar
(check appropriate box) 1i,.
Latitude/longitude of well locatidn..
(degrees/minutes/seconds) `
Latitude/longitude source:❑GPS❑Topog4aphic rnapi
(cheek box)
DEPTIT DRILLING
From To FrtFoona'onDescription
'01 '0..J .
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common names.
GY
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCIND IN ACCORDANCE WITH 15A NCAC 2C, WFf
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
\I\1(N-ti�
S1GNATUPtE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GW-1 REV. 07/2001
27699-1636 Phone No. [phone], within 30 days.

283411
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James Camp, Jr- CERTIFICATION# p118
WELL CONTRACTOR COMPANY NAME Camp' c We11 R Prime ('n Tnc PHONE #[phone] ___�
STATE WELL CONSTRUCTION PERhIIT# ASSOCIATED WQ PERMIT# 4
(if applicable) (if applicable) C--�-
1. WELL USE (Check Applicable Box): Residential Dr-Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELLLOCAT SN:
Nearest Town: ....LL.. panty
Lf YjlJ
(Street Name, Numbers, Community, Su vision, Lot No., Zip Code)
3. OWNER: ..S-O Q>
Address \.c(N JCV� Lti
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED l ` - O 3
5. TOTAL DEPTH: % C S ��
6. DOES WELL REPLACE EXISTING WELL? YES ❑ Napa
7. STATIC WATER LEVEL Below Top of Casing: 3 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): \0 METHOD
THOD OF TESA;
10. WATER ZONES (depth): l)
Topographic/Land setting
❑Ridge i]5fope ❑Valley OF at; '
(check appropriate box)
Latitude/longitude of well locationi-, i
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topogr phic map
(check box)
DEPTH DRILLING LOG
From SITS rasa$ on Description
p /
Is Sus GC&
11. DISINFECTION: Type rh1 nri na
12. CASING:
Depth Diameter
Amount (.l4
Wall Thickness
or Weight/Ft. Material
From_q To 1 S Ft. 6 1/ 4 g81:4,21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From__o___To 20 Ft. Neat Cement Hand
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
Size Material
Ft.
Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
C&, ,NN `ca-u-1
rr.
cn —
m
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCIBD IN ACCORDANCE WITH ISA NCAC 2C, WFr r
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ivl�rw C )2a3
SIGN OF PERSONCONSTRUCTING THE WELL DATE
V
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
•t

283410
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Tames to Cmp-, Jr CERTIFICATION# 21 38
WELL CONTRACTOR COMPANY NAME Camp' c Wp1) R Pump fin Tnc
STATE WELL CONSTRUCTION PERh1IT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
PHONE #
r _ f--
1. WELL USE (Check Applicable Box): Residential VMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIONr
Nearest Towne r I.t.�y�.J.
T�a/Ci
(Street Name, Number, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address { Cl >1a4 `E \
pp (Street or Route No.)
c.ti XAt.Qa1 �i L 0- Si
City or Town State Zip Code
( )-7/47- ...State__ Zip
County
Area code- Phone numb
4. DATE DRILLED ) I • 0 S. O
5. TOTAL DEPTH: C� 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NA, ❑
7. STATIC WATER LEVEL Below Top of Casing: ? 0 FT.
(Use '4" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface`
• *Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): `E MHODOFTEST & i r
10. WATER ZONES (depth): .o U
Topographic/Land setting ``
fdffidge ❑Slope ❑Valley ❑F at
(check appropriate box) -`
Latitude/longitude of well locatiot , -
(degrees/minutes/seconds) F
Latitude/longitude source:❑GPS❑Topographic maple— 7
(check box)
DRILLING LOG
To c,FormauyRnDescn�j'on
n a 0 .ituti,L ` ii
G o •`I 0 5 ./3.-.1. m. k
DEPTH
From
11. DISINFECTION: Type C h 1 n r I n p
12. CASING:
Depth Diameter
From p To C�_U__ Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth
From_0 To 2 0 Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in
From To Ft. in.
15. SAND/GRAVEL PACK:
Amount (._,1..-,
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Material Method
Neat Cement —He -Frei --
From
From
Depth
To Ft.
To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Slot Size Material
in.
in.
Size Material
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C WFI
CONSTRUCTION STANDARDS, A THAT A COPY Of THIS,RECORD HASBEEN PROVIDED TO THE WELL OWNER
IGNATURE OF PERSON CONSTRUCTINGWELL DATE
—63
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalTResources - Division/�of
Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM, (print) r.o.10. Yl'1,e s {CIA)• Ca. 0-0 . CERTIFICATION # At 3g
WELL CONTRACTOR COMPANY NAME lA Kips l,V e I1 V Y Ll mp 1 D • I I LYl C PHONE # f,YAdl 453' ! 3022
STATE WELL CONSTRUCTION PERMIT# / ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
2. WELL LOCATION:
Ne{�CestTown : /
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0 r
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
mcn
Topographic/Land setting 1
❑Ridge ❑Slope bcaley ❑'late
(check appropriate box) rr' �3
Latitude/longitude of well locatie t7,
County C t
(Street )acne, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: C.
Address V � J; -tY> jf
)1l,CjX� t(Sneet%� )
or
Routallo.)
,�t,
er�1J.x;ttVI c T/
City or Town State Zip Code
( Area code- Phone flambe(
4. DATE DRILLED \‘1sY b
5. TOTAL DEPTH: S
283405
(degrees/minutes/secoods)
Latitude/longitude source:❑GPS❑Topo
(check box)
DEPTH
From To
tO �U
r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO LI
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a
variance In accorda` a�,with 15A NCAC 2C .0118.
9. YIELD (gpm): —METHOD OF TEST WY -
variance
10. WATER ZONES (depth): 0 0
11. DISINFECTION: Typ
12. CASING: Wail Thickness
j Diameter Q,r etghUFt.4.4ate
From 0 DepTo 0a Ft. \3 Yes •.1tk�)-\ an,.Q . N.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To D Ft.Yleat C(rheKt
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft. k`
e �— Amopnt
From To
16. REMARKS:
Ft.
Meth d
I'ta Method
Slot Size Material
in.
in.
Material
JOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
n
O
cJ1
OD
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFT r
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS CORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGh1ATURE OF PERSON CONSTRUOI'Il'(% HE WFi i DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001

•
1
North Carolina • Department of Environment and Natural Resources - Division of Water Duality • Groundwater Section
1636 Mail Service Center • Raleigh, N.C. 27699-1636-Phone [phone]
292591
WELL CONSTRUCTION RECORD WELL CONTRACTOR. Er C • Awefp, •
WELL CONTRACTOR CERTIFICATION A: oZ %-1
STATE WELL CONSTRUCTION PERMITS:
1. WELL USE (Check Applicable Box): Residential ErMunicIpal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Infection ❑ Other Ej If Other, List Use:
l
2. WELL LOCATION1: (Show sketch of the location below) / J
Nearest Town. ^� Alt 14R P county: ',r'
6 7 /,4R >' ?d.
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER /j/ % a a' e.
Address /r(Skfl 9 Jf /.2 �
2- /4 /2_otahp . a.[J.C... e7 to
City or Town Stale Zip Code
4. DATE DRILLED /.i- 6.- 63
5. TOTAL DEPTH /2. H f'-r
6. CUTTINGS COLLECTED YES n NOrf
7. DOES WELL REPLACE EXISTING WELL? YES D NO{'
8. STATIC WATER LEVEL Below Top of Casing: ,r " FT.
(Use N.'II Above Top of Casing)
9. TOP OF CASING IS � FT. Above Land Surface'
-Top of casing terminated eVor below land surface requires a variance In accor-
dance with 15A NCAC 2C .0116
10. YIELD (gpm): METHOD OF TEST 2,4 r it)?
11. WATER ZONES (depth)• // 4 �f
ex Pa.
DRILLING LOG
DEPTH
From To Formation Descd. lion
12. CHLORINATION: Type e- `0_2 k
y.
13. CASING:
44100,/
Amount
Wall Thickness
Depthr� Diameter or Weight/FL Material
Ft lc
From To Ft.
From To Ft
14. GROUT:
Depth \\ �Ma Material
From �/ To 02 U FI
From To FI
15. SCREEN:
Depth Diameter Slot Size
From To __ FI In
From To Ft In
From To Ft In
r
A HJ
o
-fl a)
iv'CO CC
i 0
1v y0Q
'O m`
I1 additional space Is needed use back of fors,
LOCATION SKETCH ap
(Show direction and distance from at least two State
Roads. or other map relerence points)
TRe M y 4A
e.
Method 1 _ % Eli k 4/,
$ t 3 i /tc , l c At4 /u
2, c /= r d N ! R A/e-7
.A) a 6 ?
^• rrt
cnz
m_to
Material
In
In
In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
O
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
NATURE OF PERSON CONSTRUCTING TITE WELL - DATE
Submit original to Division of Water Ouallty, Groundwater Section within 30 days
GW-1 REV. 12/99
FOR OFFICE USE ONLY
Ouad No:
Serial No

268617
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James m_ Camp, Jr.
WELL CONTRACTOR COMPANY NAME ramp ct Wa11 Tine— PHONE #$9R) d54-7122
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
CERTIFICATION # 21 18
1. WELL USE (Check Applicable Box): Residential lid" Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: In / I 5�7/ ✓l q County Po I k
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: t)r_lvile 5 JVIill
Address 'RI Tit{ t 4 IP •
Sweet or Route No.)
AShe!),Ile Nc 2 ' 3
City or Town State Zip Code
( Area code- Phone number
4. DATE DRILLED I — `I -D3
5. TOTAL DEPTH: / u
6. DOES WELL REPLACE EXISTING WELL? YES 6/NO 0
7. STATIC WATER LEVEL Below Top of Casing: fin FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
• variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST n
10. WATER ZONES (depth): 1 7 O
4Aopographic/Land setting
ge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longittide of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
52 ndr- (a!
cfn l4h Cci3otri ttd vtck
EP
From To
n eft)
11. DISINFECTION: Type r'h 1 nr i n a
12. CASING:
Depth Diameter
From 0 To 'To Ft. 6 1 y 4
From To Ft
From To Ft.
13. GROUT: Depth
From_ n To 2 0 Ft.
Amount I Ctlf1
Wall Thickness
or Weight/Ft. Material
GDR -' PVC
Material
Method
Neat Cement Hand
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Slot Size Material
in.
in.
Size Material
16. REMARKS:
r- TII6UC`FIERBSY CER 1Fl`T
f CQNSTRTION STAND
rC
LL
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads, Include the road
numbers and common road names.
•
X
o r� i ey-1
4, 'iLGt {
5000 ry,=GQ J�r(e.,
N3 --I
HIS WELL WAS CONSTRU(7ED IN ACCORDANCE WITH 15ANCAC 2C, WEI I
AND THAT A COPY 0 THIS RECORD HAS FEN PROVIDED TO THE WELL OWNER
' d Ca,/ . . -10 - D3
1GNATURE OF PERSL9N CONSTRUCTING THE WELL d/ 7 DATE
Submit the original to th4 Divi ion of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
12-76914636 Phone No ,(49) 733-3 21, within 30 days. GW-1 REV. 07/2001
rHriz
c

268622
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James W
Camp, Jr.
CERTIFICATION # 2 1 3 8
WELL CONTRACTOR COMPANY NAME ('amps c Wa11 & Primp rn_ T n r- PRONE #8)9Al 4c'1-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential fd Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCAT1 • ``��
Nearest Town: U'/ tt Q 4C ✓(I TC Y1 County P�
J/ M1
l-ct T�' G(eevt R ✓e✓ /4-tgklattd5
(Street Name, Numbers, Community, Subdivision, Lot No./Zip Code)
3. OWNER: 5 t1C`y/ 1./0 � I I 6
Address ( t) /t oX
Snect °utoute No)
_Dark de (��eact 5C aCt S1lry
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED / D - D 3
5. TOTAL DEPTH: 5 05
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO A
7. STATIC WATER LEVEL Below Top of Casing: 4'5 FT.
(use "+" if Above Top of Casing)
8. TOP OF CASING IS 1
FT. Above Land Surface`
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD (gpm): /J METHOD OF TEST i,; r
10. WATER ZONES (depth): ifiV
Topa phic/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Set nri)d;4
(rriSr1ldated rock
11. DISINFECTION: Type rh 1 n r i na Amount (29,,J, Cot/%
12. CASING: Wall Thickness
Depth h Diameter or Weight/Ft. Material
_ Fromo To %O Ft.6 1 / 4 SDR21 PVC
From To Ft.
From - To Ft.
13. GROUT: Depth Material Method
From-_p_To 20 Ft. Neat Cement Hand -kO
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
16. REMARKS:
L
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common roacynames.
t /
3
;1;1! 5e,
Gr (rl;
R;Irr
0
co
ir
vC0RA
(V
aan/c / 1
HEREBY CER'ILIFY+I'H rT
S'Fi jdnai.stAr kibsl
r--
LL WAS CONSTRUCIhD IN ACCORDANCE WITH 15ANCAC 2C, WFI I
THAT A COPY 0 THIS RECORD HAS BEEN PROVIDED TO THE WFI I OWNER
w
TURE OF PERSON CONSTRUCTING THE WELL
DATE
Subrut the original to the .Dh Sion f Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
276994636 Phone No. [phone], ithin 30 days. GW-1 REV. 07/2001

2679{0
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1.
WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
HWY. #9 N.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ABBY MCCOOL
Address 7602 HWY. #9 N.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 899-0555
Area Code Phone number
4. DATE DRILLED 01/06/03
5. TOTAL DEPTH: 65
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ei
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 6.9
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 65 Ft. 24" CEMENT
From To Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To Ft.
I4.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. in. _ in.
From To Ft. _ in. in.
15. SAND/GRAVEL PACK:
Depth Size
50 To 65 Ft. 78M
To Ft.
From
From
County POLK
Material
GRAVEL
Topographic/Land setting
❑ Ridge ❑ Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. APPROX. 3/4
MILE ON RIGHT. PAST GRASSY KNOB RD. (BOX
#7602)
0
w
-rt
rn
0-1
40
IN)
t
nT
0•717-
•
c�
0
16. REMARKS:
no HFRF.HY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
.(ONSTRUCTION STA PD s, AND THAT A COPY OF THIS RECORDHAS BEEN PROVIDED TO THE WELL OWNER
ref -"2d / 63
OF PE
ONS UCTING THE WELL
DATE
Sgbmit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone PTO: (9T9) 73
-3221, within 30 days. GW-1 REV. 07/2001

267966
WELL CONSTRUCTION RECORD
rth Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
:LL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATI PHONE # [phone]
:LL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC
ATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
WELL LOCATION:
Nearest Town: COLUMBUS
MEADOWBROOK RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
OWNER: RODNEY LUCKADOO
Address MEADOWBROOK RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 863-4873
Area Code Phone number
DATE DRILLED 01/08/03
TOTAL DEPTH: 72
DOES WELL REPLACE EXISTING WELL? YES 0 NO ►:
STATIC WATER LEVEL Below Top of Casing: 52 FT.
(Use "+" if Above Top of Casing)
TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
WATER ZONES (depth):
. DISINFECTION: Type
. CASING:
Depth
From 0 To 72 Ft.
From _ To _
From To
GROUT: Depth
From 0 To 20
From To _ Ft.
!.SCREEN: Depth Diameter Slot Size Material
From To _ Ft. _ in. _ in.
From To _ Ft. _ in. _ in.
5. SAND/GRAVEL PACK:
Depth Size Material
From 52 To 72 Ft. 78M GRAVEL
From To _ Ft.
CHLORYTE Amount 9.2
Wall Thickness
or Weight/Ft. Material
CEMENT
Diameter
24"
County POLK
Ft. _
Ft. _
Material
Ft. CEMENT
Method
POURED
Topographic/Land setting
0 Ridge ❑ Slope 0 Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
POORS FORD RD. FROM SHILOH. LEFT ON
2ND MEADOWBROOK RD. 1/2 MILE ON LEFT.
0
6. REMARKS:
DO HEREBY CERTIFY THAT THIS TELLHATAACOPOYNOACCORDANCESTRUCTED IN
F THIS RECORD HA BN PROV DED TO THE WELL OWNER
ONS�FR c..� ,
CONSTRUCTING THE WELL DATE
SIGNAT OF PE
;
,ubmit the original to the Divisioln of ater Quality, Groundwater Section, 1636 Mail Service
GW-1 REV. 0aleigh NC
7699-1636 Phone -No. (919) 733-�221, (within 30 days.

267940
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
S. WILSON HILL RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MARTY MCGUINN
Address 4444 S. WILSON HILL RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 625-4005
Area Code Phone number
4. DATE DRILLED 01/09/03
5. TOTAL DEPTH: 445
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 12
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 80 Ft. 6-1/4" SDR.21 PVC
From _ To Ft.
From To _ Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
I4.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. in. in.
From To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From
From
To _ Ft.
To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. RT. ON
MCQUINN RD. RT. ON BIG LEVEL RD. RT. ON S.
WILSON HILL RD. APPROX. 2 MILES ON LEFT.
(BOX NOT MARKED)
3
0
c'o
0
0
1CONA.
"�� > ia;! I EBi4' grit
I _) STRUCTIOW S'
II'
ft L
L
Stilt the otigiial'ttdthe Dir ision of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
.Aiiro tLiti Pliniie'N'ii'r019)'33-3221,within30days. GW-1 REV. 07/2001
MAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ATKE OF PERSON CONSTRUCTING THE WELL DATE

267955
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town- MILL SPRING
GREEN RIVER COVE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JOHN CRITIKOS
Address GREEN RIVER COVE RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(704) - 866-4797
Area Code Phone number
4. DATE DRILLED 01/09/03
5. TOTAL DEPTH: 345
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 100 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 9
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 140 Ft. 6-1/4" SDR.21 PVC
From _ To _ Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
From
From
Depth
To
To Ft.
16. REMARKS:
Size Material
Ft.
Topographic/Land setting
❑ Ridge 0 Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. LEFT ON
SILVER CREEK RD. LEFT ON GREEN RIVER
COVE RD. APRROXILE ON LEFT. (#10280 ON POST
AT DRIVE)
0
CO
rn
rn
v
r
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
fF6N$,TRRUCTION]STANPAI .i1ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1 I rri4-12 /- 9-
E OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Di ision
2769971636 Phone No.(919 33-3
of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001

267947
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Z Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
LAKE ADGER
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: SHEENA KING
Address SPRING HILL LANE
(Street or Route No.)
MILL SPRNG NC 28756
City or Town State Zip Code
(864) — 288-7424
Area Code Phone number
4. DATE DRILLED 01/09/03
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 16.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 80 Ft. 6-1/4" SDR.21 PVC
From _ To _ Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUEKRETE POURED
From _ To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. in. _ in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY, #9 N. FROM MILL SPRING. LEFT ON
SILVER CREEK RD. RT. ON LAKE ADGER RD.
LEFT ON HIGHLAND VIEW. GO 7/10 MILE8r. LEFT
ON MTN. SPRING LANE. RT. ON SPRRG HILL
LANE. LEFT ON DRIVE AT CUL-DE- C. _>—
rn
cciE
1 E3
o
▪ _
fV </
O G
SIGNA
iu ; :J/,
hubmit the original to the Divisilit Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
7699=1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
L.
County POLK
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
-o
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
N STANDARDS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1.1
F PERSON CONSTRUCTING THE WELL DATE

267946
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
US. HWY. #9
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: PHILLIP GUFFEY
Address US. HWY. #9
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 863-4433
Area Code Phone number
4. DATE DRILLED 01/10/03
5. TOTAL DEPTH: 225
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 70 Ft. 6-1/4" SDR.21 PVC
From To _ Ft. _
From To _ Ft. _
13. GROUT: Depth Material
From 0 To 20 Ft. QUIKRETE
From To Ft.
14.SCREEN: Depth Diameter
From _ To Ft. _
From To _ Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
Method
POURED
Slot Size Material
in. in.
in. in.
From _ To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge 0 Slope 0 Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. LAST DRIVE
ON LEFT BEFORE INDEPENDENCE DR.
U 1:Z Wd 9- dad CO
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
EO} ISdRUCTIQN STANDARD AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
C77-
SIG
L.
Submit the original to the Divts n
127699-1636 Phone No. (919)S33-3
(i777ko_ /-/0-
OF PERSON CONSTRUCTING THE WELL DATE
f Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001

267951
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Z Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON
HUNTING COUNTRY RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DEAN CULBRETH
Address HUNTING COUNTRY RD.
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(828) — 817-2906
Area Code Phone number
4. DATE DRILLED 01/28/03
5. TOTAL DEPTH: 405
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 121
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 12 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 10.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 100 Ft. 6-1/4" SDR.21 PVC
From _ To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft, QULKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
FROM COLUMBUS GO OUT PENIEL RD. TURN
RIGHT ON RED FOX RD. TURN RIGHT ON
HUNTING COUNTRY RD. APPROX. 3/10 MILE ON
RIGHT.
Ih:Z Nd 9-833E0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
`SONS RRUZ;I10N S1 S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
)II _
r+
$ RE OF PERSON C
Submit the original to the Divi ion of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
±76994636 Phone No. (9119) 7 3-3221, within 30 days. GW-1 REV. 07/2001
/ • c),R
NSI`RUCTING THE WELL DATE

267959
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
WILD TURKEY LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ADRWNNE OTTO
Address WILD TURKEY LANE'
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(843) — 270-6126
Area Code Phone number
4. DATE DRILLED 01/29/03
5. TOTAL DEPTH: 49
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 31 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated al/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 18 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 8.28
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 49 Ft. 24" CEMENT
From To Ft.
From _ To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From _ To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To Ft. in. _ in.
From To Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 31 To 49 Ft. 78M GRAVEL
From To Ft.
16. REMARKS:
Topographic/Land setting
0 Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S, FROM MILL SPRING. RT. ON HWY.
#14. RT. ON BURGANDY LANE. LEFT ON WILD
TURKEY LANE. 1/10 MILE ON RT.
0
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rn
m
0\
-D
ri-1 L)O H R BY CUt(t It;-Y
()INSTRUCTION`: STANL
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
S, AND THAT�AA COPY OF THIISS RECORDDD HAS BEEN PROVIDED TO THE WELL OWNER
N CONSTRUCTING THE WELL
i.-77nr' .
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699,1636 Phone No. (919) 7311-3221, within 30 days. GW-1 REV. 07/2001

267944
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
HOUSTON RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: STACY BRADLEY
Address 2650 HOUSTON RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 899-1199
Area Code Phone number
4. DATE DRILLED 01/29/03
5. TOTAL DEPTH: 705
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 19.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 140 Ft. 6-1/4" SDR21 PVC
From To _ Ft. _
From _ To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To Ft. in.
From _ To Ft. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To _ Ft.
From To Ft.
16. REMARKS:
S
2
in.
in.
Topographic/Land setting
0 Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HYW. #108 W. FROM MILL SPRING. RT. ON
HOUSTON RD. DRIVE APPROX. 1-1/2 MILES ON
LEFT. (2650 ON BOX)
0
CO
1
m
CO
—o
0
C ION S"I{ANDARD4
SIGNA
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�jOF PER ON C STRUCTING THE WELL DATE
bmit the -original -to the Di of ater Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
6994636 Phone No. (919) h33r3221 within 30 days. GW-1 REV. 07/2001

269390
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CER 11FICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
SCHOOL RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DAWN LYNCH
Address 50 SCHOOL RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) - 625-2806
Area Code Phone number
4. DATE DRILLED 02/06/03
5. TOTAL DEPTH: 505
6. DOES WELL REPLACE EXISTING WELL? YES ® NO 0
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 13.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 140 Ft. 6-1/4" SDR.21 PVC
From _ To Ft. _
From To _ Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To _ Ft. _
From To Ft.
Topographic/Land setting
❑ Ridge 0 Slope 0 Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N . FROM MILL SPRING. RT. ON
SCHOOL RD. 1/10 MILE ON RT.
0
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CO
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E;
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC 1 ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPYOFTHIS RECORD HASASBEEN PROVIDED TO THE WELL OWNER
/ .�✓!�(i - �L .7 1?-7•-e-
'URE ¢
OFPERSON CONSTRUCTING THEWELL
Submit the original to the livrsi n of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No.._(919) 733 3221, within 30 days. GW-1 REV. 07/2001

269388
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
I�
Submit the original to t Div
27699-1636 Phone No; 19) 7:
SCE
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
SKYUKA MTN. RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BOB WILSON
Address SKYUKA MTN. RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
( 828) — 894-5729
Area Code Phone number
4. DATE DRILLED 02/20/03
5. TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
County POLK
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 4.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 60 Ft. 6-1/4" SDR21 PVC
From _ To _ Ft.
From _ To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUQCRETE POURED
From To Ft.
I4.SCREEN: Depth Diameter Slot Size Material
From To Ft. in _ in.
in. in.
From To _ Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From _ To _ Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HOUSTON RD. FROM COLUMBUS. STAY
STRAIGHT ON SKYUKA RD. RT. ON SKYUKA
MTN RD. APPROX. 2.2 MILES ON LEFT (BOX #224)
TURN LEFT ON DRIVE.
W
_
O
--a
.w
rn
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CUN {)C1'1O1I;IS' 1pvN S. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
CONSTRUCTING
Tf� dvEi� x - (-20 - t� . R
&TURE OF ERS CONSTRUCTING *ELL DATE
sion of Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001

t
269385
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
HOUSTON RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: STACY BRADLEY
Address 2650 HOUSTON RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
8( 28) — 899-1199
Area Code Phone number
4. DATE DRILLED 02/05/03
5. TOTAL DEPTH: 705
6. DOES WELL REPLACE EXISTING WELL? YES ® NO 0
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: T
12. CASING:
Depth Diameter
From 0 To 180 Ft. 6-1/4"
From To _ Ft. _
From To _ Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. QUIKRETE
From To Ft.
14.SCREEN: Depth Diameter Slot Size
From To _ Ft. in. _
From To Ft. in. _
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
County POLK
CHLORYTE Amount 19.5
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
16. REMARKS:
Method
POURED
Material
in.
in.
Topographic/Land setting
❑ Ridge ❑ Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 W. FROM MILL SPRING. RT. ON
HOUSTON RD. DRIVE APPROX. 1-1/2 MILES ON
LEFT.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
+
Srrbmit'the original to the
27699-1636 Phone No. (91
OF PERSOMCONSTRUCTING THE WELL
DATE
rvisi n of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
733 3221, within 30 days. GW-1 REV. 07/2001
6
r•ICE

WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
269380
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: SALUDA
CABBAGE PATCH LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CHARLIE HALL
Address CABBAGE PATCH LANE
(Street or RouteNo.)
SALUDA NC 28773
City or Town State Zip Code
(13t4) — 942-7507
Area Code Phone number
4. DATE DRILLED 02/03/03
5. TOTAL DEPTH: 225
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 6
12. CASING: Wall Thickness
Depth Diameter or Weight/FL Material
From 0 To 50 Ft. 6-1/4" SDR.21 PVC
From _ To _ Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QULKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
El Ridge D Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. 176 W. FROM TRYON. GO APPROX. 1/2
MILE PAST BEAR CREEK AND TURN LEFT ON
CABBAGE PATCH LANE. RIGHT AT FIRST FORK
RIGHT AT 2ND FORK. 1ST DRIVE ON LEFT,,
o
Co
�o
0
c
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CQNSTPIICTroN CTANDAPDS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
a
SIC,*TA PURE OF PERSON CONSTRUCTING WELL DATE
i
- Submit the original to the m c
27499-1636 Phone No.(919) 733
E
n of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
3221, within 30 days. GW-1 REV. 07/2001

ram,.
269379
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING County POLK Topographic/Land setting
LAKE ADGER PARKWAY ❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) (check appropriate box)
3. OWNER: JOE LAUDISIO Latitude/longitude of well location
Address 3825 LAKE ADGER PARKWAY
(Street or Route No.) (degrees/minutes/seconds)
MILL SPRING NC 28756 Latitude/longitude source: ❑ GPS ❑ Topographic map
City or Town State Zip Code (check box)
(843) - 671-4161 DEPTH
Area Code Phone number From To
4. DATE DRILLED 02/04/03
5. TOTAL DEPTH: 505 DRILLING LOG
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ® From To
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 1 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 13.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 120 Ft. 6-1/4" SDR.21 PVC
From To Ft. _
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To Ft. _ in. _ in.
From _ To _ Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To _ Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. LEFT ON
SILVER CREEK RD. RIGHT ON LAKE ADGER
PKWY. APPROX. 1-2/10 MILE ON RIGHT. LOT #29.
0
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TJ
.770
v
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rn
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
rt yS,, AND TH/AT//A COPY OF THIS RECORD
RDD/JL
HAS BEEN PROVIDED TO THE WELL OWNER
ATURE OF PERSON CONSTRUCTING THEVELL DATE
Submit the original to t a Div sion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1h36-Phone-No 19) 733-3221, within 30 days. GW-1 REV. 07/2001

2693'77
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
HWY. #108 E.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JESSE FOY
Address 564 HWY. #108 E.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 894-3858
Area Code Phone number
4. DATE DRILLED 02/19/03
5. TOTAL DEPTH: 165
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpnt): 12 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 3
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 165 Ft.6-1/4" 188 GALV.
From To _ Ft. _
From _ To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From 125 To 165 Ft. 6-1/4 in. 20 in. GALV.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 120 To 165 Ft. 78M GRAVEL
From To Ft.
16. REMARKS
Topographic/Land setting
0 Ridge 0 Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
nmmber and common names
HWY, #I08 W. FROM MILL SPRING. LAST
DRIVE ON LEFT BEFORE MTN. RANGE RD.
O HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
DATE
Submit the original to the Di ision of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-] REV. 07/2001

I, DOlIEREBY CERTIFY TY a
CONSTRUCTION STANDARD
270383
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James w Calrip, Jr
CERTIFICATION # 2 1 3 R
WELL CONTRACTOR COMPANY NAME ('ampc Wel 1 R.Pnmp Crtjnr PHONE #$2R) 451-7322
STATE WELL CONSTRUCTION PERMIT#
ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential12( Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIONi
Nearest I I<
Town: Id ( 1''MY ounry � O
C-,teen ) Jef FtigkIni��l�5 )J�1e
mv.
(Street Name, Numbers, Comunity, ubdivision, Lot No., Zip Code)
3. OWNER: h'11-14• C✓(�k RttJ Devi
Address 1 3 1 Hf' i i Ta 4 c Ur
I((Street or Route No:)""'
ke.3 nrc%ly iV C- S
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: I /10
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: 341 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
" variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 7'7 METHOD OF TEST AS r
10. WATER ZONES (depth): J 5 C
-17-6+3
11. DISINFECTION: Type ('h 1 n r i n a Amount 1
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From 0 To .3(--- Ft 6 1 / 4 S DR 71
From To Ft. _
From To Ft.
13. GROUT: Depth Material Method
From_a____ To 20 Ft. Neat Cement Hand
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
c
Material
PVC
Topogx$hic/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box).
DEPTH DRILLING LOG
From To Formation Description
f) J6 th r "f
- c 1170 ('nn4o/;datc-d rock
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
<3
16. REMARKS: i{ ,.�
WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WFI T
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
a4i le f-
Si@IATURE OF PERSON CONSTRUCTING THE WELL ✓ ��% DATE
L U
§ubmit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone. No. [phone], within 30 days. GW-1 REV. 07/2001
�y
)Ll-6_3

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jamey ur_ Camp, Jr.
WELL CONTRACTOR COMPANY NAME Camp' s Wa11 & Pnmp rn_
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ PERMIT%
(if applicable) (if applicable)
27038n
CERTIFICATION % 7 1 3 R
Tnr PHONE 887R) 453-7322
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 11 'If Other, List Use c_ktcY c}�
WELL
2 Nearest TDwnT 1:; )1 �7)YIitj County Pb Ik
fEtLRRKKId e 'I
(Stn:et Name, Numbeers,mun1y, Subdivision, Lot No., Zip Code)
3. OWNER: , it ti lu- CY. e e k C�IUYC
Address C/c Ir141a5 Eci 11.4 J' !
Li f (SIr7i or Routte�N c
I t-' C? 5 (� I 'lhYr l Y
City or Town State
( )-
Area code- Phone number
4. DATE DRILLED _ 1 9 L
g&tf 3
Zip Code
/Topographic/Land setting
l Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
HHC{r 'c e Latitude/longitude source:❑GPS❑Topographic map
(check box) -
DRILLING LOG
Formation Description
cL+rt
n)n4oI;cate reek
5. TOTAL DEPTH: I r
6. DOES WELL REPLACE EXISTING WELL? YES 63' NO 0
7. STATIC WATER LEVEL Below Top of Casing: `f G' FT.
(use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): I CC METHOD OF TEST Air
10. WATER ZONES (depth):
ED PTH
From To
6f
11. DISINFECTION: Type C'h 1 nr i n a
12. CASING:
Depth Diameter
From p To AD Ft. 6 1/ 4
From To Ft.
From To Ft.
13. GROUT: Depth
From_%__ To 2 0 Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To
From To Ft.
Amount C to
Wall Thiclmess
or Weight/Ft. Material
G9B21 PVC
Material Method
Noat Cement Hand
Ft.
Slot Size Material
in.
in.
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
-r
Go
0
16. REMARKS:
I DO HEREBY CERTIFY THAT
CONSTRUCTION STANDARDS,
-
LL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
'HAT A COPY 0 THIS RECORD H EEN PROVIDED TO THE WELL OWNER
SIGNIAjrURE OF PERSON CONSTRUCTING THE WELL / DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No.(919) 7333221, Within 30 days. GW-1 REV. 07/2001

270454
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J an s
Camp, Jr- CERTIFICATION# 711E
WELL CONTRACTOR COMPANY NAME ('amps c WP11 R Pump Cn
Tnc PHONE #$2R) 453-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential "Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIO
Nearest Town: lll ("fit) County County OI
nkrtit Pa rK
(Street Name, Numbers, Community, Subdivision, lot No., Zip Code)
1
3. OWNER: D !; A RC 4ue C$ 5t
Address • OZ TT— `J Y✓U 1-14
Saeet or Rout Ng.) 6 vilnia s N ( �rfi 9;54a
City or Town State Zip Code
k
Area code- Phone number
4. DATE DRILLED — 1-3 03
5. TOTAL DEPTH: g a 9--
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 4-9)
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): :2 b METHOD OF TEST Dix
10. WATER ZONES (depth):& C
11. DISINFECTION: Type (`h 1 nr i np
12. CASING:
Depth
From p To / LC
From To
From_ To
13. GROUT: Depth
From_p To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
Ft. 6
Ft
Diameter
t/4
Ft.
Amount f < t.t )..7)
Wall Thickness /
or Weight/Ft. Material
gDR21 PVC
Material Method
Ft. plot
Ft.
Cctacnt Hand
Diameter
Ft. in.
Ft. in.
Size
Ft.
Ft.
Slot Size
in.
in.
Material
Material
Topo phic/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box). -
DEPTH. pRILLING LOG
From Toi Fpprtnation Descitption
f1C(q Sand
eoMo/icLced rock
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
O
W
7.20
CO
O
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCIED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS SEEN PROVIDED TO THE WELL OWNER
Li
Submit the original to the
27699-1636 Phone No. (941
IGNATURE OF PERS
' 6z-4/ 4-
CONSTRUCTING THE WELL
3-1 -b3
DATE
sion of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001
c.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James Camop, Jx-
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT( ASSOCIATED WQ PERMIT(
(if applicable) (if applicable)
270450
CERTIFICATION s 2 1 3 8
Camp's
UPI 1 R Piimp Cn Tnc PHONE Al 451-7322
I. WELL USE (Check Applicable Box): Residential 15 Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION.
Nearest Town: A e
Gret9iJ v10 1 R,
(Sweet Name, Numilers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: P S;CGi Yt-to
Address
�( A 5ktiHoiDr, Alf• i
D}-D K(SVice� Route N4 r"'4
County Po I
Ci[y/or Town State Zip Code
Area code- Phone number
4. DATE DRILLED I .% D3
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES_❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 12'7 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface`
•Top of casing terminated at/or below land surface requires a
' variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): jR METHOD OF TEST Air
10. WATER ZONES (depth): 2C o
11. DISINFECTION: Type ('h 1 nr i n a
12. CASING:
Depth
From 0 To r%S
From To
From To
13. GROUT: Depth
From_0 To 2 p Ft
From To Ft
14. SCREEN: Depth
From__To Ft
From To Ft
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
Diameter
Ft.6 ./4
Ft.
Ft.
Amount I C I.lti
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Material
Ncat Ccmcnt
Method
Hand
Diameter Slot Size Material
in. in.
in. in.
Size Material
Ft.
Ft.
Topo�g�}rApPhic/Land setting
❑Ridge 6�Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)-
pEPTH DRILLING LOG
From To Formation Description
n 7C 7e4 flay
77 ,9$25 /ONSDJ;dr,IfieO rock
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
CP
fJ s
ler
F J.1 ..I (t� ;o, U,�
I 1'
S&bmit.tlte.orivinal to the Divisit
2i7g0-4fi3611hinieNu. 919N733-32�
t 10E
WFI I WAS CONSTRUCIED IN ACCORDANCE WITH 15ANCAC 2C, WELL
THAT A COPY 0 THIS RECORD HAS pEEN PROVIDED TO THE WELL OWNER
ATURE OF PERSCIN CONSTRUCTING THE WELL % - DATE
n of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
1, within 30 days. GW-1 REV. 07/2001

270868
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) as maa ry
Camp, Jr.
CERTIFICATION # 2 1 4 R
WELL CONTRACTOR COMPANY NAME Camptc Wall (C Pinar CrL Tnr PRONE #Ai2A) d5'I-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential M Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATI
Nearest Town: I I`/ County
�S Rikebe RA. o— 4#4
(Sneer Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:%IP-Yl 1 *lc K
Address 1) /2ddbeit Ids/ [scn Ra •
M/ I 3uect or1 Route ( 2g
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED /
TopogrOhiciLand setting
❑Ridge 07Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑GPS ❑Topographic map
(check box)
DRILLING LOG
Formation Descri on
divl sand r.a
35" c5nsc1;dated yv
DEPTH.
From To
n 35"
5. TOTAL DEPTH: / v
6. DOES WELL REPLACE EXISTING WELL? YES NJ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 4' 8" FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
•Top of casing terminated at/or below land surface requires a
' variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 4 METHOD OF TEST A i r
10. WATER ZONES (depth): 5 00
11. DISINFECTION: Type rhl nri na
12. CASING:
Depth Diameter
From r) To 36" Ft. 6 1 / 4
From_ To Ft.
From To Ft.
13. GROUT: Depth
From___0_ To 2 0
From To
Amount Gaps
Wall Thickness
or Weight/Ft. Material
r)R21 PVC
Material Method
Fi. No Cornont Hand
Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Slot Size Material
in.
in.
16. REMARKS:
•
Iop'FIER BY 'CERTIFY THAT:
'CONSTRUCTION STANDARDS' • u
SIGN
Submit the original to the Division
27699-1636 Phone No. (919) 733-322 ,
N
7,
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road 40 ✓.
numbers and common road names.
LL WAS CONSTRUCIhD IN ACCORDANCE WITH ISA NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1 t Lei. Alk94 /0 — 03
OF PERSON CONSTRUCT1NCnHE DATE
y CO
Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
ithin 30 days. GW-1 REV. 07/2001

From: Stott Gantt To:
Date: 4/6/2003 Time: 10:48:52 PM Page 7 of 10
2
WELL CONSTRUCTION RECORD r
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GANTT CERTIFICATION # 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box)- Residential Ni Municipal D Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town SUNNYVIEW
114 SILVER SPUR RD
County POLK
(Street Name, Numbers, Community, Subdivision Lot No,. Zip Code)
3. OWNER RICK MCG(IINN
ADDRESS 114 SILVER SPUR RD
(Street or Route No.)
MILL SRING
City or Town
828-625-2212
NC
State
Area Code - Phone Number
4. DATE DRILLED 3/5/03
5- TOTAL DEI°TH 500
6. DOES WELL REPLACE EXISTING RILL^
7. STATIC WATER LEVEL Below Top of Casing'.
YES ❑ NO
0 FT.
(Use "«" If Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface"
•Tap of casing terminated at'or below laid surface requires a variance in
accordance with l5A NCAC 20.0118
9. YIELD (Sp'rr): DRY METHOD OF TEST ARDM
lo. WATER ZONES (depti,): NA
28756
Zip Code
Topographic'Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
Latitude/Longitude of well location
35.22.050 / 82. 11.540
(degees'minutes'seconds)
Latitude/longitude source: D GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 85 Clay
s5
500 Consolidated Rock
N 1. DISINFECTION: TYPE HYPOCHLORITE Amomlt 10
12. CASING: Wall Thickness
Depth Diameter or Weigbt/Ft. Material
From 0 To 94 FI. 61/4" SDR 21 PVC
u_ GROUP'.
Depth
From 0 To 20 FI.
14. SCREEN
Depth
From NA To
U. SAND/ GRAVEL PACK:
Depth
From NA To
l6. REMARKS. DRY WELL
Diameter
Ft.
Ft,
Size
Dz.
Material Method
GRAVEL MIX GRAVITY
Slot Size Material
in.
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads_ Include the road
numbers and common road naves. O
HWY 9
SILVER SPUR RD
BILL JACKSON RD
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C-WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
3/6 03
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Date
Submit the original to the Division t • • , Groundwater Section, 1636 Nlail Service center - Raleigh, NC
27699-
Te Nqf ,(91?) 733t3223 within
s.
ust
GW. 1 REV. 0- 2001
(2

271563
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) Of applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
BIG LEVEL RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LEONARD BAILEY
Address 3350 BIG LEVEL RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 625-4423
Area Code Phone number
4. DATE DRILLED 03/04/03
5. TOTAL DEPTH: 345
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 6 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: TyI
12. CASING:
Depth
From 0 To 40
From To
County POLK
e CHLORYTE Amount 9
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 6-1/4" SDR,21 PVC
Ft.
From _ To _ Ft. _
13. GROUT: Depth Material
From 0 To 20 Ft. QUIKRETE
From _ To Ft.
14.SCREEN: Depth Diameter
From _ To Ft.
From To _ Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From
From
Method
POURED
Slot Size Material
in. _ in.
in. in.
To Ft.
To Ft.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
13W. #108 E. FROM MILL SPRING. LEFT ON BIG
LEVEL RD. APPROX. 3 MILES ON RT. (1ST DRIVE
ON RT. PAST PALLET YARD) 1ST HOUSE ON
LEFT AFTER TURNING ON THIS 15I4IVE.'
0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
F-£ONS RUMOt STAN$ THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
I P'
NA
Submit the original to the Divisio
27699-1636 Phone No. (919).733-:
OF PERSON CONSTRUCTING WELL DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001

271560
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection D Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
LOT #21
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: GLEN BRADY
Address HANNA DR
(Street or Route No.)
MILL SPRING NC 28786
City or Town State Zip Code
(828) — 894-6110
Area Code Phone number
4. DATE DRILLED 03/12/03
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO EZI
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 7.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 80 Ft. 6-1/4" SDR21 PVC
From To _ Ft. _
From _ To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To Ft.
14.SCREEN. Depth Diameter Slot Size Material
From To
From _ To
15. SAND/GRAVEL
Depth
From To
From To
16. REMARKS:
Ft.
_Ft._
PACK:
Size
Ft.
Ft.
in.
in.
Material
in.
in.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. LEFT ON
GARRETT RD. RIGHT ON GREENHILLS DR.
(LAKE ADGER) LEFT ON LAKE ADGER PKWY.
GO APPROX. 1/2 MILE. RIGHT ON HANNAH DR.
1ST LOT ON LEFT.
I DO HEREBY CERTIFY-?
CONSTRUCTIQN STAND
a SI!
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
« -/ - 6
OF PERSON CONSTRUCTING TFIE WELL DATE
S bmit the original to thej)ivisi n of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
277 94636 Phone Ne:,(919) 733 221, within 30 days. GW-1 REV. 07/2001
F

271554
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® MunicipalWublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
SITYTLE RD.
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: RHONDA SITYTLE
Address 414 SITYTLE RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 863-2658
Area Code Phone number
4. DATE DRILLED 03/04/03
5. TOTAL DEPTH: 67
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 47 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County POLK
Z
p Code)
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth or Weight/Ft. Material
From 0 To 67 CEMENT
From _ To
From _ To
13. GROUT: Depth Method
From 0 To 20 Ft. CEMENT POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To _ Ft. _ in. in.
From _ To _ Ft. in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 47 To 67 Ft. 78M GRAVEL
From To Ft.
16. REMARKS
Diameter
Ft. 24"
Ft.
Ft.
Material
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. LEFT ON
CHESNEE RD. RT. ON PRINCE RD. RT. ON
SHYTLE RD. 1/2 MILE ON RT. (#414 ON BOX)
I DO NFRFRY CERTIF
LCQINSUCTION',ST
M A
Submit the original to the ivision of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
Gf27699-1636 Phone No. (919 733-3221, within 30 days. GW-1 REV. 07/2001
ASHEVI'_ i
FIAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1GNATtJRE Ok'1'�kS'ONTONS
err
TRUCTI G THE WELL DATE

271552
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERI IFICATION if 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public El Industrial 0 Agricultural ❑
Monitoring ❑ Recovery D Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
GREEN CREEK FARM
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: HUBERT METCALF
Address GREEN CREEK FARM
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) - 863-4905
Area Code Phone number
4. DATE DRILLED 03/12/03
5. TOTAL DEPTH: 55
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 35 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 55 Ft. 24" CEMENT
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To Ft.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size
From 35 To 55 Ft. 78M
From To Ft.
in. in.
16. REMARKS:
Material
GRAVEL
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING.M LEFT ON
SANDY PLAINS RD. LEFT INTO GREEN CREEK
FARMS. 1ST HOUSE ON RIGHT.
0
0
I DO HEREBY-CERTIFY`Pf
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDA, AND THAT A COPY/OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGSIA F PE 7 OOONSTRUCTING THE WELL DATE
Su¢mit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
1 2709-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
1
42
C

271 46
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of' Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERI tt•ICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Mtmicipal/Public ❑ Industrial D Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
GAIL RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ROBBIE BLACKWELL
Address 488 GAIL RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 894-2125
Area Code Phone number
4. DATE DRILLED 03/10/03
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 7.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 160 Ft. 6-1/4" SDR21 PVC
From _ To Ft.
From To _ Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. in.
From To _ Ft. in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To Ft.
From To _ Ft.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. RT. ON HUGH
CHAMPION RD. RT. INTO FOXWOOD HILLS. RT.
ON GAIL DR STAY LEFT AT FORKS TO
DEADEND.
16. REMARKS:
f 1 DOMEREBY.CFRTIFY • T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CCONStRUCTION STAN!1 s\ ►l S • 1 THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�� �f1��. 3-/�� -6,-2
SIGNATURE OF PERSON CONSTRUCTING THE LL DATE
_Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
4 27699-1636 Phone No. (919) /33-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CER I itiICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural D
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING County POLK Topographic/Land setting
SILVER CREEK RD.' ❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) (check appropriate box)
3. OWNER: BILL REDDEX Latitude/longitude of well location
Address 1132 SILVER CREEK RD. (degrees notes/seconds)
(Street or Route No.) m
MILL SPRING NC 28756 Latitude/longitude source: ❑ GPS 0 Topographic map
City or Town State Zip Code (check box)
(828) — 894-7071 DEPTH
Area Code Phone number From To
4. DATE DRILLED 03/10/03
5. TOTAL DEPTH: 265
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 100+ METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 6.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 60 Ft. 6-1/4" SDR21 PVC
From _ To _ Ft. _
From ____ To_Ft.
_
13. GROUT: Depth Material
From 0 To 20 Ft. QUIKRETE
From To _ Ft.
14.SCREEN: Depth Diameter
From To Ft.
From To Ft. _
15. SAND/GRAVEL PACK:
Depth Size Material
From _To_Ft. ____
From To Ft.
Method
POURED
Slot Size Material
in. in.
in. in.
16. REMARKS:
Y ERTIhY'I�WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WELL
I N STAI+IDARDku`, THAT A COPY OF THIS RECORDCHAS BEEN PROVIDED TO THE WELL OWNER
/Li �L/ .�%_ // t• 3 -/d - is
SIGNA 1 Ufft. OF PERSON CONSTRUCTING THE WELL DATE
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. LEFT ON
SILVER CREEK RD. APPROX. 1 MILE ON RIGHT.
RT. ON DRIVE AT BOX #1132.
submit the original to the Division Of Water Quality, Groundwater Section, 1636 Mail Service
enter — ter. Raleigh NC
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERI1bICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
SKYUKA MTN. RD.
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: BOB WILSON
Address 3111 SKYUKA MTN. RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 894-5729
Area Code Phone number
4. DATE DRILLED 03/13/03
5. TOTAL DEPTH: 805
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
Zip Code)
11. DISINFECTION: Type CHLORITE Amount 22.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 60 Ft. 6-1/4" SDR21 PVC
From To Ft.
From To _ Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To _ Ft.
From To Ft.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrres/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HOUSTON RD. FROM COLUMBUS. STAY
STRAIGHT ON SKYUKA RD. RT. ON SKYUKA
MTN. RD. APPROX. 2.9 MILES ON LEFT.
0
16. REMARKS:
f I,DO HEREBY T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
['CONSTRUCTION STANq S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
NATURE OF PERSON CONSTRUCTING THE WELL
er 3 /3-Ua
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
C476194-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

271.5
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
HOOKER RD.
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: ANTHONY MOSS
Address HOOKER RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(864) — 457-2774
Area Code Phone number
4. DATE DRILLED 03/25/03
5. TOTAL DEPTH: 425
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
, Zip Code)
11. DISINFECTION: Type CHLORYTE Amount 11
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 160 Ft. 6-1/4" SDR.21 PVC
From _ To Ft. _
From To _ Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
14.SCREEN Depth Diameter Slot Size Material
From _ To Ft. _ in. _ in.
From _ To _ Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 W. FROM COLUMBUS. LEFT ON
HWY. #19. RT. ON HOOKER RD. APPROX. 3/4 MILE
ON LEFT -NO BOX #-DRIVE JUST PAST CEDAR
HOUSE ON LEFT.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
SONSTR1jCT-1ON-S DS, THAT A COPY OF S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
a�m� D ,�/
OF � .�2c� c.. , n�n-e� � - a 5 � n _ R
SIGNA OF PERSON ONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
76991636 Phone No. (919) 43-3221, within 30 days. GW-1 REV. 07/2001
A`

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
WELL CONTRACTOR (INDIVIDUAL) NAM Otter
WELL CONTRACTOR COMPANY NAME J5Ot tyer
STATE WELL CONSTRUCTION PERAIITt I C17/ ASSOCIATED WQ PERMITS
(if applicable)
272258
atural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION/OW
PHONE N
(if applicable)
alga -1MM
1. WELL USE (Check Applicable Box): Residential E" Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 if Other, List Use
2. WELL LOCATI NII:
Nearest Town:i County
Moujnrd ap'Coad
(Street Name, Numbers, ommuniry, Subdivision, Lot No., Zip Code)
3. OWNER: IIC)hn art e1I,I
Address q;:O• • 01( 3 7
Sahida
City or Town State Zip Code
► >- 744- 560a)
Area code- Phone number
4. DATE DRILLED 3—I Q —03
5. TOTAL DEPTH: RO r
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO W
7. STATIC WATER LEVEL Below Top of Casing: e9O' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I.33 FT. Above Land Surface'
Top of casing terminated at/or below land surface requires a
variance in accordant with 15A NCAC 2C.0118. TEST-i
9. YIELD (gpm): ___ METHOD OF TEST
10. WATER ZONES (depth):
3y rap installer
DISI PECTION: Type
(Slice or Route No.) aggem-o as
Topographic/Land setting
❑Ridge ❑Slope ❑Valley IS}flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latituda lorg!tude sonrce'C'.CIPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
iJ
Amount
12. CASING: Wall Thickness
From /$
Depth Diann}ter or Weight/Ft. Nlaterial
V
To_Eb _
Ft. (-r ( 05n ) £iCz
From To Ft.
From To Ft.
13. GROUT: Depth A Material
From To r—?O Ft. Laer4le
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
Methpd
Marlon(
slot Size
in.
in.
Material
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at.lrastr,_.
two State Roads or County Roads. Include (ha road -
numbers and common road names. iV _
�50�UdCI = H.
�rorx- Salad<Tr(k $% -fa o-
rickJ bn-Lo Howard Gap )Road.
ear -Fo -f h,° ri yh.t and go
apProxiYkat.e ly a nu I -es. 7-
0.)(:
0, left on. cue voad . 4-L
house ors the left.
.-s)5 / 4 Dp H j2EBY ( HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S t'"CO TRUdtlON,StAN?D RDS, AND TIIAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-PI 0 3 l
SIGNATURE OF PERSON CONSTRU
TING THE WELL DATE
L_Submit the original to t'ie Division of Water Quality, Croondo(ater Section, 16..h M sil Service Center- Raleigh, NC
27699-I636 Pl(unc-No. [phone], within 30 days. GW-1 REV. 07/2001

2'72220
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jamns w Camp, Jr. CERTIFICATION # 71 3A
WELL CONTRACTOR COMPANYNAh1E ramp s Wn11 R Pomp lrz_ Tnc PHONE #$75:31 d53-7122
STATE WELL CONSTRUCTION PERMIT(' ASSOCIATED WQ PERMIT#
(if applicable) (if pplicablel
1. WELL USE (Check Applicable Box): Residential gJi Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELLLOCATIONA, t • Nearest Town: / " i 1' SDf 1 f1 County P O IK
# c( N (. 7; III St�I .
(Street Name, Numbers, Community, Subdivision, t No,, Zip Code)
3. OWNER: 14)Q3/Vie L` /f1 0.W1.5
Address P Lo F P' II (0
(Street or Rouse No.)
l� I 5p,r I a� L- ,�g75.
City or Tow, ^ Scat, 0 n / Zip Code
�- 1 Gl I o
Area code- Phone number
4. DATE DATJ r FD . 5 -
5. TOTAL DEPTH: D Si
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: t FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface`
'Top of casing terminated at/or below land surface requires a
' -variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 2 O METHOD OF TEST p jr
10, WATER ZONES (depth): / KO
11. DISINFECTION: Type chi r
12. CASING:
Depth Diameter
From_q To AO Ft. 6 1 / 4
From To Ft.
From_ To Ft.
13. GROUT: Depth
From. To 2 0 Ft.
np Amount (-LAf
Wall Thickness
or Weight/Ft. Material
SDP21 PVC
Material
Neat Cement
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
Method
Hand
TopographicJLan setting
❑Ridge. ❑Slope galley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)...
DEPTH DRILLING LOG
From To Formation Description
0 U r i✓ti 54 r* d
n 2.0(7 1.005o)/!Ater/ Yo4(
Slot Size Material
in.
in.
16. REMARKS:
JOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
117-
r—ais
ERSTIV
S CONSTRUC ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
TIW BCT4ON T S, 1 i WELLTHAT AACOPY 0 THIS
�yRECORD HAS j3 EN PRO TO THE WELL OWNER C�
i
L! T � Liy. NATURE OF PE
CONSTRUCTING THE WELL
DATE
Submit the original to the ivisit n of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699;1C34'Ptipde;1 K9161033-3221,within 30days. GW-1 REV. 07/2001
pc'-'-''';' E .-JNLL UFFICE

2'72219
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
Camp, Jr CERTIFICATION 71 3$
PRONE #$7Al g C.I-7322
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James 10
WELL CONTRACTOR COMPANY NAME
r'a mlte Wm11 &
Primp f n_
Tnr-
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential f ' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 if Other, List Use
2. WELL LOCATIO
Nearest( Town:
1vltA V QpnXt W
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
G
Address t'11 t ertua
(Street or Route No.)
i-0\11 ‘t\i1/4M S. L,
City or Town State
61�3 )- 5U4(- () 1Sk
Area code- Phone number
4. DATE DRIT i FD 3 - 0
5. TOTAL DEPTH: 7i () S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: t) 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
' -variance In accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): E, METHOD OF TEST
10. WATER ZONES (depth):
County P'L-��
Y.�
P
1Cj')DC6
Zip Code
it
Topographic/Land setting
id%idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreeshniwtes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)-
DRILT.ING LOG
Form on Description
From�II To
w3 'QS-
11. DISINFECTION: Type rill n r i rim
12. CASING:
Depth Diameter
From o To L' Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From_- To 20 Ft. Neat Content Hand
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size - Material
From To Ft
From To Ft.
Amount
Wall Thiclmess
or Weight/Ft. Material
SDR21 PVC
Slot Size Material
in.
in.
16. REMARKS:
I
1..1 L. J �1 1GNATURE OF PERSON CONSTRUCTING THE WELL / � DATE
I-Submit1he ori.g_tnal to tt a Div sion of Water Quality,itGroundwater Section, 1636 Mall Service Center- Raleigh, NC
i7699-1646 halidi 73hlM9) 733 221, within 30 days. GW-1 REV. 07/2001
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Ca
w
0
0'
S WELL WAS CONSTRUCIhD IN ACCORDANCE WITH 15ANCAC 2C, WELL
QD THAT A COPY 0 THIS RECORD HAS rEN PROVIDED TO THE WELL OWNER
W
1/01

2'7 r2 "218
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) JaniP S 1.1 C aror, Tr-. CERTIFICATION It 21 "l 8
WELL CONTRACTOR COMPANYNAE ('amp' c WP11 R PPrimpf'r> Tnr• PHONE #�9A1 LS4-7322
M
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential <$' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: Nearest Town: hilll �,✓t v1R County f' k
e c� cK‘ Ifxl AdE
(Street Name, Numbers, Community,11Subdivisiojn Lot
No., Zip Code)
d
3. OWNER: gY e {v11 e ✓ -0 HP Me S
Address .'3 0 3 a I3'lrv'l ✓ )ran e
ril cir Roe oL 117 5G
S ( g� o -1 — /xS
3 Zip Code
Area code- Phone number
4. DATE DRILLED 3 3
5. TOTAL DEPTH: 3 L '5 �{
6. DOES WELL REPLACE EXISTING WELL? YES 0, uI, NO
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
-variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): tt) METHOD OF TEST
10. WATER ZONES (depth): 3 CO
air
11. DISINFECTION: Type rh l nr i n
12. CASING:
Depth
From_( To 7 5 Ft 6
From To Ft.
From To Ft.
13. GROUT: Depth
From_p To .2 0 Ft.
Diameter
Amount I4 C up
Wall Thiclmess
or Weight/Ft. Materiel
1/4 .S9R3-1 PVC
Material
Neat Cement
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size - Material
From To Ft.
From To Ft.
Topographic/Land setting
'Ridge ❑Slope ❑Va11ey ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)- -
I/UM FRILLING LOG
From o Formation Description
ciatitittkel
5 3N5 ectisell'rletted Peck
Method
Hand
Slot Size Material
in,
in.
16. REMARKS:
JOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
CO
w
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WFI 1
, AND THAT A COPY OE THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
DATE
SIGNATURE OF PE CONSTRUCTING THE WELL
LSubmit the originallttShe Di /ision of Water Quality, Groundwater Section, 1636 Mali Service Center - Raleigh, NC
c,(069§-16361.hone4.1bQ ,19)733-3221,within30days. GW-1 REV. 07/2001

2 7221'7
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) JamnS w CaInh, Jr -
WELL CONTRACTOR COMPANY NAME ramp Is Wa11 R Aninp_"n Tnr, PHONE #67R) 4S4-7R22
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable.) (if applicable)
1. WELL USE (Check Applicable Box): Residential IPr Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Neaze Town
Nm (IA
County 1 (L
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: v(��
Address R7) Cfiit.l' i11A/r �t
(SateI or Route No.)
v- \NAh
c
City or Town State
7699 1 16 Pn 733-3
GROUNDWATER SECT OI
ASHEVILLE REGIONAL OFFICE
((�o� ` Zip Code
AA
lnV L- o) S tur
Area code- Phone number
4. DATE DRIJ r FD - y 3
5. TOTAL DEPTH: LA a-S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Pd.
7. STATIC WATER LEVEL Below Top of Casing: SS D FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
" -variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): S METHOD OF TEST air
10. WATER ZONES (depth):
CERTIFICATION # 2 1 3 R
Topographic/Land setting
11;146dge ❑Slope ❑Valley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box) -
DEPTH DRILLING LOG
From To Fortion Description
n 10 p
10 E s ACtin,,-t
11. DISINFECTION: Type r'h1 nri na
12. CASING:
Depth Diameter
From p To Ft. 6 1 / 4
Froth To Ft.
Frorq To Ft.
13. GROUT: Depth
From_# To .20 Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
Froth To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
eDR21 PVC
Material Method
Neat Cement Hand
16. REMARKS:
MAY -- 7
ubmit the original to thDivi ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001
J.00ATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Size .
Slot Size
in
in,
Material
1S WELL WAS CONSTRUC1hD 1N ACCORDANCE WITH 15A NCAC 2C, WEI i
AND THAT A COPY O THIS RECORD H JS SEEN PROVIDED TO THE WELL OWNER
y/
IGNATURE OF PE' aN CONSTRUCTING THE WELL
DATE
0
r.0
0
rn

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jarn s t+r-
WELL CONTRACTOR COMPANY NAME
272216
CERTIFICATION N 21 38
ramp' ¢ Wa11 R Primp (`n Tnc PHONE #VA) d53-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential W Municipal/Public 0 industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELLLOCATI - /
Neare¢t Town: 4 1 I- . Y I h County
IN0r+6� fats �P fit
(Sneer Name, Numbers, Community, Subdivision/Lot No., Zip Code)
3. OWNER: 0.1'1 0. G
Address el e,7 'arvtpu5/ ,;?co NPret Dr,
(street orE. we Ndd)
pc I PI/1r. sd IN L ;2_ 6 1,�
try or Town State Zip Code
(70- sa5-l.rs
Area code- Phone number
4. DATE DRILLED '5 LJ - V 3
5. TOTAL DEPTH: 3 Ca
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: 7,0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
`Top of casing terminated at/or below land surface requires a
-variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST Air
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box) -
DEPTH DRILLING LOG
From .TS o Formation Description
pp !% C-l0.y 5gqtiS
trig3OS Con4clicla%rl rock
11. DISINFECTION: Type rh 1 nr i n
12. CASING:
Depth Diameter
7 From o To ,I Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth
From_ To .2 0 Ft.
Amount 1 � (-u p
Wall Thickness
or Weight/Ft. Material
RDR-21 PVC
Material
Neat Cement
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From__To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size . Material
From To Ft.
From To Ft.
Method
Hand
Slot Size Material
in.
in.
J.00ATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
I DO HFREBY CERTIFY THAT THIS WELL WAS CONSTRUL LED IN ACCORDANCE WITH 15ANCAC 2C, WFI i
R r q p THAT A COPY 0 THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�N �f v I ll — 10 -D3
S NATURE OF PE CONSTRUCTING THE WELL DATE
S bmit the orig(nal fo (be Do2 of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27 99-1636 Phone No. (919) 7.3-322 , within 30 days. GW-1 REV. 07/2001
GRIrv.,' TiOfV

273538
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM, (print) .3RM es W. CA.CA.A.p CERTIFICATION p R(✓3S
WELL CONTRACTOR COMPANY NAME Ut Wlf15JDell t�Ur t 'SMO U%/i�i1C - PHONE N e�nl `r53-73,2A
STATE WELL CONSTRUCTION PERMITS' ASSOCIATED WQ PERMIT'S
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Q Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: 1/
Nearest Town: ,m t t. Y I hq County 17 I K
roX RrlaY' ft1
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
)I
3. OWNER: (-IAA les eG✓t'
Address lal FaX YIA✓ Lb✓
1 (Street or Rpocd 8 /Nn.)
; / um INS
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED it- bit- os
5. TOTAL DEPTH: aag
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO tZt
7. STATIC WATER LEVEL Below Top of Casing: cg FT
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST a I ✓
10. WATER ZONES (depth): I cf.S
11. DISINFECTION: Type hell ets Amount /4 top
12. CASING: l Wall Thickness
/� Depth Diam.y� 'ter or Weight/Ft. Material
From_Q Ft ( To 10 )(' 5 D R R I P V L
From To Ft.
From To Ft.
13. GROUT: Depth Material �" Methopd
From 0 To ,20 Ft. he at CCYnerrt ✓lAvLot
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in in.
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth ... Size Material
From To Ft.
From To Ft.
TopogSa�phic/Land setting
❑Ridge CliS1ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
red n/ayy1 sand
enn5olirlatrd YOLK
DEPTH
From To
o go
q0 2X5
0
0 0
co
—G t,,,
C71 �rn
rn
➢0
u m�
o
J.00ATIONSKETCH fV rnz
Show direction and distance in miles from aF sast 1
two State Roads or County Roads. Include thetroae
numbers and common road names. 1 z
H&j c9
16. REMARKS:
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Lam'
SIGNATURE OF PERSON CONSTR CT1NG THE WELL DATE
Submit the original to the Di rision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
GRuur;U4m
27,¢9? 1§�.6F1ter�,t4y t9) 733-3221, within 30 days. GW-1 REV. 07/2001
vAi[St�0
ASHEVILLE REGIONAL OFFIC

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalrResources��- Division of —Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMA (print) f.lm e5 ti"' l is h.\ Pt-rTy. CERTIFICATIONli# a( 3S
WELL CONTRACTOR COMPANY NAME IA Y4•tpS Vlle 11 t PU h13 (D6 JLC • PHONE N fAad) 453-93)2
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public 0 Industrial 0 Agricultural
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: C ,
Nearest Town: N) 1I Jprl Vl q County Po I K
1.1Yge55 Rd. J
(Street Name, Numders, Community, Subdivision, Lot No., Zip Code)
3. OWNER I I ly $ C AYCV
Address 0 P5DX +5 I
•o I 1 (Str5 NCeet or Rqute No, a D ! a � urn u
Zip Code
( )- ,?1'1-O610
Area code- Phone number
4. DATE DRILLED 7 - �3 - Da_
5. TOTAL DEPTH: . 65
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO (�
7. STATIC WATER LEVEL Below Top of Casing: 45- FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S I FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm)• KO METHOD OF TEST Gifr
10. WATER ZONES (depth): 4 5-
11. DISINFECTION: Type nE I [et Amount G ct to
12. CASING: I Wall Thickness
Depth Diameter or Weight/Ft. „Material
From 0 To 3D Ft. 8 aCri . 1'. ) C
From__ To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. heat Cevne.tl
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft in, in.
15. SAND/GRAVEL PACK:
Depth . Size Material
From To Ft.
From To Ft.
Meth d
tiav•
� 2d.
273537
Topographic/Land setting
❑Ridge ❑Slope ❑Valley
(check appropriate box)
Latitude/longitude of well location
lat
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH QRILLING LOG
From To Formation Description
0 30 irt !rim.,
3o 2 - ft»5o/;dated rocK
0
U1
LOCATION SKETCH N
Show direction and distance in miles from at leap a
two State Roads or County Roads. Include the row
numbers and common road names.
City or Town State
16. REMARKS:
_ WO MERFjBX,
(9N`rdCT
ft5
D7
Pl j: L�a'/
Erg!
L&TTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WFI T
FADS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
frt.eL. W. 6tAttti 5-0\-03
SIGNATURE OF PERSON CONS UCTING THE WELL DATE
i,,,, i/ v
Submit the original o the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1616 Phnne Nn 1(919) 733-3221, within 30 days. GW-1 REV. 07/2001
GR.OUNDbVATER SECTION
ASHEVILLE REGICRAL OFFICE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources��- Divisionnof Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM, (print) [AT- Yin e5 ""' Ca. p CERTIFICATION # aI 3e
WELL CONTRACTOR COMPANY NAME Camps Wel( t PU mp (U. 11i1C • PHONE # (MA 45-37- 3,22
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
273536
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION,{' ,
Nearest Town: I° I 1 1 by Y al County Po � C
TaL 1(5 rt Rd .
(Street Name, Numbers,
�Community,
, Subdivision, Lot No., Zip Code)
3. OWNER: kJ, /`IC6LA- lYtVt
Address 57) /Y e 7 U i Yl F'i ' R
(Street or Route N
C-0U4YeYIu4 �IVV C- A0r/i; y
O.
City or Town State
( ) 863-A10Zo
Zip Code
Area code- Phone number
4. DATE DRILLED A{ - 1 - 63
5. TOTAL DEPTH: 50 0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO W
7. STATIC WATER LEVEL Below Top of Casing: flit FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface"
*Top of casing terminated at/or below land surface requires a
variance In accordant pith 15A NCAC 2C .0118.
9. YIELD (gpm): Ir2. METHOD OF TEST G1 I I
10. WATER ZONES (depth): 4 5 i
11. DISINFECTION: Type pe 1l e
12. CASING: Depthp Di
tt>_0 To_L— Deter
Fro To 5 Ft.
From To Ft.
Frorg To Ft.
13. GROUT: Depth
From 0 To 20
Amount , Ctip
Wall Thielmess
or Weight/Ft. Material
SDR21 PUG
Material
Ft. heat Cemer\t
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth ... Size Material
From To Ft.
Methii d
tia �
Slot Size Material
in.
in.
From To Ft.
16. REMARKS:
D,
1;
J �i V -.J
Submit the original to tt e Div sion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-163SPhune Leto/ (9#i) 733 221, within 30 days. GW-1 REV. 07/2001
cl
Topographic/Land setting
❑Ridge ❑Slope itrValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH PRILLING LOG
From To Formation Description
D 85" clay , qral)e
C50o CoAgo IiAAted ro(,k
O
W
^0
LOCATION SKETCH
Show direction and distance in miles from at last
two State Roads or County Roads. Include th
numbers and common road names.
1 r7'
(e1J-`-Lli-a _t's
Lic
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IGNATURE OF PERSON CoNSTRf ING THE WELL DATE

WELL CONSTRUCTION RECORD
273534
North Carolina - Department of Environment and Natural-y---Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM) (print) e.10. m( eLS t�0. l a i . CERTIFICATION N al 3S
WELL CONTRACTOR COMPANY NAME LaWlf15�e 11 V Purl ivy lint . PHONE a 18dti5'1-13a2
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential IF7/ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: 1 0 I f�
Nearest Town: 6u Iu d0. County / K
Lot aY whir-Pe/el Co✓e
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: L�kt1 ieId Coot Su$7�i /15)0lA
Address O) C X O 9
(Street or Eoute No.)
)a)u(i�t N G ;2' 7'13
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED I b3
5. TOTAL DEPTH: O 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S ) FT. Above Land Surface"
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST /2)
10. WATER ZONES (depth): ?A o
11. DISINFECTION: Type e Il et
12. CASING: J
Depth Dianne,ter
From_Q_-_To 4 3- Ft. (e7`i
From To Ft
From To Ft.
13. GROUT: Depth Material Mcthppd
From 0 To ,aO Ft. heat C.emeitt karya
Amount I / L Cup
Wall Thickness
or Weight/Ft. Material
spa)] P'c
From To Ft.
14. SCREEN: Depth Diameter
Front To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth ,.i Size Material
From To Ft
From To Ft.
Slot Size
in.
in.
Material
16. REMARKS:
Topogiiphic/Land setting
❑Ridge DS1ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
dirt
snt,5r1;dated rocK
DEPTH
From To
n 4*
4a 3o5
CJ
S+
c
G
7
ti
,i h
>.
CI S. r
Crl
LOCATION SKETCH cox
Show direction and distance in miles from aast
tWo State Roads or County Roads. Include tgroad_"
numbers and common road names. ?
L
4;
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
T18N STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON STRUCTING THE WELL DATE
Submit the original to u!f ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. (9 9) 733-3221, within 30 days. GW-1 REV. 07/2001
iiFFICE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources
- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME, (print) rt (� -lin ee 6 ""' CA Yvl (3 CERTIFICATIONC//tl Ai 38
WELL CONTRACTOR COMPANY NAME La HipS We It �7 PIA mio, CD. 1�11C • PHONE itf$r�Adl 45-3- 7342
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
273533
1. WELL USE (Check Applicable Box): Residential kri Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring l7 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCNearest Town: iv 01)j n I I J 0 (I YI1 County 'Po 14
(Street Name, Numbe's, Community,�Subdivision, Lot No., Zip Code)
3. OWNER: C.j I-A.CK
Address 9 v+ H ".J C. 5
(Street or Route .)
Mill 3Pf#111 C , SI
City or Town St3 Zip Code
( )- gel 4
Area code- Phone number
4. DATE DRILLED li 3
5. TOTAL DEPTH: 2. r
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: /12�
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): r9.O METHOD OF TEST a t ir
10. WATER ZONES (depth): 0.0
Topographic/Land setting.�/
❑Ridge ❑Slope ❑Valley f]Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH PRILLING LOG
From To Formation Desrtription
d O P-i AS 0.nd
20 k25 Iida edYock
v
r�
a
N rtz
nZ
LOCATION SKETCH N ji
11. DISINFECTION: Type I e 11 v t Amount S/-1 C Lip Sho Stdieow irectiRoods nand
C unty distance
in milds. Is from atcllde the ?ast
12. CASING: Wall Thickness
road
Depth Diameter or Weight/Ft. Mate aal numbers and common road names.
FromQ_ To gO Ft. /(, Y4 n R al
From To Ft.
From To Ft.
13. GROUT: Depth Material McthyQd i D f
From 0 To 20 Ft.neat Cement kavvd
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAND A S, AND THAT A COPY OF Tlj{S RECORD Ii)AS BEEN PROVIDED TO THE WELL OWNER
I},
Submit the original to
,. 2769 .1636 Phone No. (91
L
LE RE
SECTION
"J_ OFFICE
IGNA,
TURE OF PERSON CONS CT I G THE WELL DATE
ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
?221, within 30 days. GW-1 REV. 07/2001

11 it
v ..
273531
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME, (print) 'a0.me5 14• CA- PIA p CERTIFICATION
�1S (
l/)A PHONE # frV�ib) `rs.3-73;2
WELL CONTRACTOR COMPANY NAME Wl(lS We II V Pimp ID• I�Y1C
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Ili
Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELLLOCATIQ4: I/
Nearest Town: L'Yes r,
Nearest Pc
ilk
( yen ��� der- it igti)at�s Lot .53
(Street Name, Numbers, Community, Strbdivision, Lot No., Zip Code)
3. OWNER: C-11k(k Celt, to
Address / /o,)-/FO 51J r/Cj 4k 7E i ✓�[ e
M(Street oar No.) )a. )n/ 33 3
City or Town State Zip Code
(tO5- 'c8D-6GBI
Area code- Phone number ''tt
4. DATE DRILLED `t
5. TOTAL DEPTH: 4 S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 4)- FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): eaD METHOD OF TEST O. 1 Y
10. WATER ZONES (depth): Z 2C
11. DISINFECTION: Type )e)IEf
12. CASING:
Depth Diameter
From 0 To '';? Ft /r V4
From To Ft.
From To Ft
13. GROUT: Depth Material Method
From 0 To 20 Ft.Yleat Cement 140.v.
Amount A cite
Wall Thickness
or Weight/Ft. Material
6PRa-I Pic -
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth .., Size Material
From To
Slot Size
in.
in.
From To Ft.
16. REMARKS:
Topographic/Land setting� /
❑Ridge ❑Slope ❑Valley WF'1at
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Fotmatio Description
0 :5fi dirt f/ay
'3£45 Consolidated ruck
W o
= am
LOCATION SKETCH —4 cm
Show direction and distance in miles from aMast E
two State Roads or County Roads. Include the road o
V - —�
NL
IV --
tV o
z
numbers and common rid names. r
Material
ufri
U)O,Ljt.RLBY CI IF T(,L
o ,$7Rl.ILLCT L N A ddffggll
r
"HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WET r
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
n
(vine-4_
GNATURE OF PERSON CONS CTlfi5-- THE WELL DATE
,4769946a6Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
-{9•A..» 6�„ ...:.r.:., an days. GW-1 REV. 07/2001
yhone_ itt.
J

273800
WELL CONSTRUCTION RECORD
North Car tm - Department otfm uaanent and N Resources - vtaayaf Water Quality - Gtocndwatec Section p
WELL camA TCR t�mmUA14 NAME
Q2TrIl ICAUQNe-gC00
J
WELL CONTRACTOR COMPANY NAME G� t a G -
STATE wELL CORSrRvCrlotPRR}UT. & a.LTID WQIERWCW
(tf arsiiame)
(ifapptiwble)
I. WELL USE (Check Applicable Box)_ Residential �MunicipaIw.blic O Indwuisi E Agriailnnal 0 Monitoring 0 Recat try ID Heat Pump Woke Injection ❑ Other 0 If Other, List L"ae
2. WELLLOCA'
NetreessdtToowa
lSmedtss.n. Mobs, Camarabs3ti$bv4im ia<xo.. Zip ode)
3. OWNER: f X//' cy C ftPLI-
Address 72 5Cn 1 e'W J QJ
oraaamN.r
xiit-MV ,1/t '
Hay a' Tax Sat Lp Code
Area ado- Phone nabsn
4. DATE DRILLED g v� o f
1�
s TOTAL DEPTH- 3 -9
6. DOES WELL REPLACE EXISTING WELL" YP p NO Ir
7. STATIC WATER. LEVELBdowTop of Casing:
pet.' if abort Top a[CW oD
v�G S. TOP OF CASIIS L/`l pet.' FT. Above Land Space`
flop .4 sort tasaand rile, slow bed =deee reins a
rims is a[411(•aaC . "tCAC2C.atta. .. .
9. 'YIELD (pprt>): Op OF TEST
IO. WATER ZONS (depth): / O
Topographic/Land staging
CRidge [$Dope QValley IJFbt
ubcdt wryer box)
LsSudellasgitade of null location
DEen
From To
0
tmovicmassumeottom
(clack bs)
DRAM* LOG
Formation Description
cr- eft
rTi
k-rjl JQrP( 3..&
rr,�� LOCATION SKETO[
:1. DISINFECTION:T)�ptJ 11 aaN Amount it CAL- Show d'aoctioaand distance utmiles from atleast
12. CASING: WaR Thickness two Shoe Roads or County Roads. Ioclade the road
tar or Weigle/Ft Material nmmbas and common road names.
.I i ,4wv
Fraatl_To
Yrom To Ft.
Frog To Ft
13. GROUT- Depth Maria
From � To .`� � Firta lj`.'.vivt/ jv
Fcmm To Ft
14_ SCREEN: Depth Diameter Slot Sec Malarial
From To
From To Ft -...to. vt
19_ SANTO/GRAVEL, PACK:
Depth She
From_To Ft.
Frow.,__To Ft.
16. REMARKS-
usenial
ter
3
CD
La
l DO HEREBY CERTIFY THAT Tf]S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION SIA DARDS, AND TEAT A COPY(Op]1TI3 RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
eel /7 at4� S l� C73
SIGNATURE OF P il(.T7N0 THE WELL DATE
JUL
a
N
O
n ,
c,T
c<
3tit
am
Submit the wipnal to the DlvSan of tter Quality, Groundwater Section, I4MMMau spice censor -Raleigh, NC tv c
7233221, within 30 dqs. GW-1 REV. 07/2001 C.
f Not-of2Y- -/f
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

274090
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK
HOOPER CREEK FARMS -LOT #3
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BOBBY RUFF
Address HOOPER CREEK FARMS
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 894-3594
Area Code Phone number
4. DATE DRILLED 05/14/03
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 16.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 110 Ft. 6-1/4" SDR21 PVC
From To _ Ft. _
From _ To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUHCRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To _ Ft. in. _ in.
From _ To _ Ft. _ in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. RT.ON-IIWY.
#14. RT. ON RED FOX RD. APPROX. 2 1/2 WILES,
RT. ON HOOPER CREEK FARMS. 1/I1ILE-ON
LEFT. LOT #3.
c
I DO HEREBY CERTIFY TEIATTHIS 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
OF PERSON CONSTRUCTING THE WEL DATE
SI
3
Submit the original-to_4heDivision of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 PhtineSO. (90 733-3221, within 30 days. GW-1 REV. 07/2001

274086
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1 WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
HAYES RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JIM WEICKER
Address HAYES RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 894-8911
Area Code Phone number
4. DATE DRILLED 05/21/03
5. TOTAL DEPTH: 345
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
"Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 8 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 9
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 100 Ft. 6-1/4" SDR21 PVC
From To _ Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From To Ft. in_ in.
15. SAND/GRAVEL PACK:
Depth
From _ To
From To
Size Material
Ft.
Ft.
Topographic/Land setting
❑ Ridge ❑ Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 W. FROM MILL SPRING. LEFT ON
PEAK ST. IN COLUMBUS. STAY STRAIGHT ON
PEAK ST. WHEN IT TURNS INTO HAYES RD. 2ND
DRIVE ON RT. AFTER CROSSING BRIDGE.
c
0
0
0
i
16. REMARKS:
Y CEW'IFi THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
T1Li nag o, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
tS' _O —+� �F�1n. �9leYYx C ,.? /— <1- 3
S _ ATURE OF SSERSON CONSTRUCTING THE LL DATE
Submit the 'cmgjnftt tithe Divis on of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phoi id)F(r9M$Z73-3221, within 30 days. GW-1 REV. 07/2001

274085
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERI IFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON County POLK
WINTERSET TRAIL -LOT #8
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BRIAN MADEY
Address WINTERSET TRAIL
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(8) - 461-8254
Area Code Phone number
4. DATE DRILLED 05/13/03
5. TOTAL DEPTH: 585
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 15.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
0 To 120 Ft. 6-1/4" SDR21 PVC
Ft.
From
From
From
13. GROUT:
From 0
From
14. SCREEN:
From
To
To
Depth
To 20
To
Depth
To
Ft. _
Material Method
Ft. QUIKRETE POURED
Ft.
Diameter Slot Size Material
Ft. in. in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To _ Ft.
From To Ft.
16. REMARKS
Topographic/Land setting
0 Ridge 0 Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. RIGHT ON
PENIEL RD. LEFT ON RED FOX RD. RIGHT ON
HUNTING COUNTRY RD. RIGHT ON MORGAN
CHAPEL RD. RIGHT ON WINTERSET MAIL: 4TH
DRIVE ON RIGHT. ce
r_ ^
C
ca
CO
Y CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
NSTRUCTION STST m •�°cr� AND THAT A COPY OF jS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
—/ 3
27699916.
ASHEPILLG R
OF PERSON CONSTRUCTING THE WELL DATE
n of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3221, within 30 days. GW-1 REV. 07/2001

274084
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
SOUTH NC #9 HWY.
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: TY CANTRELL
Address SOUTH NC #9 HWY.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 8634278
Area Code Phone number
4. DATE DRILLED 05/14/03
5. TOTAL DEPTH: 565
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
, Zip Code)
11. DISINFECTION: Type CHLORYTE Amount 15.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 90 Ft. 6-1/4" SDR21 PVC
From To _ Ft.
From _ To _ Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To Ft. _ in. _ in.
From To Ft. _ in. in.
15. SAND/GRAVEL PACK:
Depth
From To_
From To
16. REMARKS:
Size Material
Ft.
Ft.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
FROM MILL SPRING. GO DOWN IOLVY. 0 S.
2ND DRIVE ON LEFT PAST THE LIMP BARBER
SHOP. "TY CANTRELL LAND SURV fl R SIGN
BESIDE DRIVE. (#8325 ON POST AT
�D c
C2'1
w
m
E C( ISI[ tiij1 Ij i
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S,AANND THAT A COPY OF THI RECOO//RD HAGS BEEN PROVIDED TO THE WELL OWNER
ck
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original t L the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
Gf09B99VICSi &Pliers p [phone], within 30 days. GW-1 REV. 07/2001
ASHEVILLE REGIONAL OF: i(,E

274083
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON
MILLER MTN.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: GLEN KEYS
Address 1955 MILLER MTN.
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(843) - 722-4100
Area Code Phone number
4. DATE DRILLED 05/20/03
5. TOTAL DEPTH: 705
6. DOES WELL REPLACE EXISTING WELD YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 140 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9 YIELD (gpm): 1 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 19.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 50 Ft. 6-1/4" SDR21 PVC
From To _ Ft.
From _ To _ Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft.OUIKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To _ Ft. _ in. _ in.
From To _ Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From
From
To Ft.
To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 FROM COLUMBUS. RT. ON
HOWARD GAP RD. RT. AT END OF ROAD. GO
PAST REXHAVEN & TO TOP OF MTN "Mni.
RIDGE PARTNERSHIP" c4
(-. --r,
C
1
JD
w
rn
Fri
c
m
G
1 DC) 1-IFRFRY CFRTITV THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
r -:\CONSTRUCTION STAND. •`t S, AND THAT A COPY OF THIISS9RECORD HAS BEEN PROVIDED TO THE WELL OWNERW
-fl`�"'--r-.�m 9CP�, � //7%)..sZ , `7� o� Ci -
i TURF OF PERS CONSTRUCTING TIM WELL DATE
1
Submit the original to thg Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone Nd: (919) 7313-3221, within 30 days. GW-1 REV. 07/2001

274078
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
GREENFIELDS SUBDV.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: SANDY BISHOP
Address GREENFIELDS SUBDV.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(207) - 838-5809
Area Code Phone number
4. DATE DRILLED 05/21/03
5. TOTAL DEPTH: 505
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 4 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFELI ION: Type CHLORYTE Amount 13.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 155 Ft. 6-1/4" SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To _ Ft. _ in. _ in.
From To Ft. _ in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To _ Ft.
From To Ft.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. RIGHT ON
LANDRUM RD. LEFT INTO GREENFIELDS-SUBDV.
1/4 MILE ON LEFT. w o
c
c
w
CO
16. REMARKS:
Ii('ttr �:1
CcuOtu sx
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY
LOF// THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
0 PERSON CONSTRUCTING THE WELL DATE
SudmiLthe,orieal-te visio i of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699 Ift3 P1pine 1: (0 1733- 221, within 30 days. GW-1 REV. 07/2001

274068
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT 4
(if applicable) (if applicable)
1
WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING County POLK
RUFF ACRES LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JAMES RUFF
Address RUFF ACRES LANE
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) - 894-5327
Area Code Phone number
4. DATE DRILLED 05/30/03
5. TOTAL DEPTH: 66
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 46 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 66 Ft. 24" CEMENT
From ____ To _ Ft.
From _ To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From _ To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To _ Ft. in. _ in.
From To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 46 To 66 Ft. 78M GRAVEL
From To Ft.
16. REMARKS:
Topographic/Land setting
0 Ridge ❑ Slope 0 Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. GO APPROX.
3/4 MILE. TURN RIGHT ONTO RUFF ACRES LANE.
LEFT ON DRIVE AT WOOD FENCE. LOT ON LEFT
AT DEAD END.
8 I :8 Wd 6- unr CO
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
J L v
Supmit the original to the tvisi
27699-1636 Phoney 733
ONSTRUCTING THE WELL DATE
n of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3221, within 30 days. GW-1 REV. 07/2001
OFHGE

275644
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CER111'!CATION PH023 NE # [phone]
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box)' Residential // Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON County POLK
RED FOX CIRCLE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ANDY & JI.L PIHL
Address 586 RED FOX CIRCLE
(Street or Route No.)
TRYON . NC 28782
City or Town State Zip Code
(864) — 297-6439
Area Code Phone number
4. DATE DRILLED 06/25/03
5. TOTAL DEPTH: 365
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
"Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 9
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 143 Ft. 6-1/4" SDR21 PVC
From_ To_Ft. _
From _ To _ Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. __ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To _ Ft.
16. REMARKS
I DO HEREBY CERTIFY
UQTION ST
S' bmit the original to th
2Qf1e1Qp„
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9S. FROM MILL SPRING. RIGHT ON
LANDRUM RD. RIGHT ON RED FOX RD. RIGHT
ON HOOPERS CREEK RD. LOT ON LEFT AT
CORNER OF HOOPERS CRK. & 2ND RED FOX
CIRCLE.
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A CO ,Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
TURE OF PERSON CONSTRUCTING THE VSELL DATE
ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
-3221, within 30 days. GW-1 REV. 07/2001

OF PE ON NSTRUCTING THE WELL
275643
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATIONPHONE # [phone]
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
GREEN MEADOWS LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: KAREN NORMAN
Address GREEN MEADOWS LANE
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 290-3434
Area Code Phone number
4. DATE DRILLED 06/26/03
5. TOTAL DEPTH: 205 •
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 10 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 12 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: T
12. CASING:
Depth
From 0 To 60 Ft
Diameter
County POLK
CHLORYTE Amount 4.5
Wall Thickness
or Weight/Ft. Material
6-1/4" SDR21 PVC
From To Ft.
From _ To _ Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. QU KRETE
From To _ Ft.
14.SCREEN Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From To _ Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Method
POURED
From To _ Ft.
From To Ft.
16. REMARKS:
El
Topographic/Land setting
0 Ridge ❑ Slope 0 Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9S. FROM MILL SPRING. RIGHT ON
HWY. #14. LEFT INTO GREENFIELD SUBDV. RT.
ON GREEN MEADOWS LANE. 1/10 MILE ON RT.
(LOT #3)
0
Z
I DO HEREBY CERTIFY THAT THIS
WELLEE
THAT A COPY OF THIS RECORD HAS PROVIDED TO THE WELL
LL
ANDCE WITH 15A NCAC OWNER
II
iJ
Sgbmit the original to the pivisi n of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
2716191636 Phone_ No4919) 733 3221, within 30 days. GW-1 REV. 07/2001
DATE

275641
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® MunicipaUPublic ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
GREEN RIVER HIGHLANDS
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: GLENN GAULT
Address GREEN RIVER HIGHLANDS
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(843) — 757-2690
Area Code Phone number
4. DATE DRILLED 06/02/03
5. TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing 10 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 4.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 60 Ft. 6-1/4" SDR.21 PVC
From To _ Ft. _
From _ To _ Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUH{RETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. in. _ in.
From _ To _ Ft. in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
0 Ridge ❑ Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in [Hiles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #221 S. FROM RUTHERFORDTON. RIGHT
ON COX RD. CROSS INTO POLK COUNTY. RIGHT
INTO GREEN RIVER HIGHLANDS. APPROX. 3/4
MILE ON LEFT. (LOT #21)
I DO HEREBY CERTIFY THAT Y-HS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
Y'IICTION[STAND AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
- .2 - C-) 3
SIGHRE OF PERS N CONSTRUCTING THE WELL DATE
i I
Subgait the original to the Sisionof Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699Tb3G�hone No. (91Q) 733-3 21, within 30 days. GW-1 REV. 07/2001

275640
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
SAPPHIRE LANE
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: LARRY HOLBERT
Address SAPPHIRE LANE
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 685-8752
Area Code Phone number
4. DATE DRILLED 06/09/03
5. TOTAL DEPTH: 585
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 12 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
Zip Code)
11. DISINFECTION: Tvpe CHLORYTE Amount 16
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
12. CASING:
Depth Diameter
From 0 To 150 Ft. 6-1/4"
From
From
13. GROUT:
From 0
From
14.SCREEN
From To _ Ft. _
From To _ Ft. _
15. SAND/GRAVEL PACK:
Depth Size
From _ To Ft.
From To Ft.
16. REMARKS:
To _ Ft.
To Ft.
Depth Material Method
To 20 Ft. QUIKRETE POURED
To Ft.
Depth Diameter Slot Size Material
in. in.
in. in.
Material
Topographic/Land setting
0 Ridge ❑ Slope ❑ Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #64/74A W. FROM RUTHERFORDTON.
LEFT ON ROCK SPRINGS RD. GO APPROX. 3
MILES AND TURN LEFT ON SAPPHIRE LANE. ON
LEFT AT DEAD END.
0
0
C-
CD
0
cn
N
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTR , AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
OF PERSON CONSTRUCTING THE WELL DATE
Sithmit the original to the Thvrsr
27 99-1636 Phone No. (919) 733-$221, within 30 days. GW-1 REV. 07/2001
of Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC

275632
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
MANUS CHAPEL RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: RAY GARRETT
Address 2346 MANUS CHAPEL RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 894-2501
Area Code Phone number
4. DATE DRILLED 06/02/03
5. TOTAL DEPTH: 245
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IZ
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 50 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 80 Ft. 6-1/4" SDR21 PVC
From To Ft. _
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. OIIH{RETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
BY-PASS 74 W. FROM FOREST CITY. EXIT AT
PEA RIDGE RD. LEFT OFF OF EXIT. RIGHT ON
ABRAMS-MOORE RD. LEFT ON MANUS CHAPEL
RD. NEW DRIVE 1/2 MILE ON LEFT.
0
01
N
ut
0
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
JRE"OF PERSON CONSTRUCTING WELL DATE
�En TL r„ ivisioa of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
274% $i ei1yo. 1733-Y221, within 30 days. GW-1 REV. 07/2001

275630
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON
RIXHAVEN-LOT #64
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: JAN CASKEY
Address RIXHAVEN
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(828) - 859-5003
Area Code Phone number
4. DATE DRILLED 06/18/03
5. TOTAL DEPTH: 405
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 4 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
, Zip Code)
11. DISINFECTION: Type CHLORYTE Amount 10.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 105 Ft. 6-1/4" SDR.21 PVC
From _ To _ Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. in. in.
From _ To _ Ft in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To _ Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 W. FROM COLUMBUS. RIGHT ON
OLD HOWARD GAP RD. RIGHT ON HOWARD GAP
RD. RIGHT ON INDIAN MTN. RD. LEFT INTO
RIXHAVEN ON RIXHAVEN DR. LAST LOT ON
RIGHT.
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
T17RE OF PERSON CONSTRUCT1NCi THE WELL DATE
AUG 6 2 93 V
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-3e No (Q19)J 6-Phon33-3t21, within 30 days. GW-1 REV. 07/2001
G OUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

From. Semi Gantt To'. Date: 6/11/2003 Time. 1 :07.18 PM
275000
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
\ti ELI, CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GANTF CERTIFICATION # 2584
\', ELL CONTRACTOR CONIPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
[i ..ATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
Cif pliable) • (if applicable)
AI J. USE (Cloak Applicable Box): Residential © Municipal ❑ indusniat❑ Agricultural ❑ A-onito.ir
•cer; ❑ Heat Pump Water Injection ❑ Other ❑ if Other List Use_
WELL LOCATION:
2 rc•t ro,e::. MILL SPRING
BIJHOP LANE LOT 19
County POLK
Dat t et Name. NLode: :. Community. Subdivision. Lot No, Zip Code)
O\,NE6. iiORT' 1N HONIES OF RLITHERFORDTON
ADD:RLSS 312 h\\ Y 74A BY-PASS
e_ or Route No.)
I HER R I ORDTON
Topographic/Land setting
❑ Ridge ❑ Slope ❑ \"alley -.`! F:r.
Latitude/Longitude of well location
35.19.156 ' 52. 13.301
(degeesminutes seconds)
Latitude longitude source: E GPS ❑ Topog:apbic zit!:
DEPTH DRILLING L,^,1
NC 23139 Fro:r, To Formation Dacric ..r.
State Zip Code 0 140 Cln)
Vnn (brie -Phone Number
PATE i)kIILeD 519;03
Tol'al. HI }tip 230
Ia1-V_S rrT.li. REPLACE EXISTING WELL?
A..AILP Cn:: EL Below Top of Casing:
YES ❑ NO
70 F.
(Inc "' If Above Top of Casing)
FT. Above Land Surface*
'ueln.. Ia.A au face rcgniree a variance in
CG.LD,:lath 12 b1E11-1OD OF TEST ARDM
1:- w,-!ER ].ONES plepdo: 220
110 230 Consolidated Rod.
t!11INFE(T,DN:TYPE HYPOCHLORITE Amount 5
C'nSING.
Wall Thickness
D n,Ri Diameter or Weigle/Et. Material
150 It 6 LA " SDR 21 PVC
Depth
Ft.
c. telttiRA' EL P.AC6-
Oz
Material Method
Fr GRAVEL MIX GRAVITY
Diameter Slot Size Material
Size Material
LOCATION SKETCH
Show direction and distance in miles from at leant
two State Roads or County Roads. Include the road
members and common road manes.
LYL I LERLB Y CTR DEN THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I_ A NCAC 2C. WELL
_Dal KL 1 UNSI.ANDARDS, AND THAT A COPY OF THIS RECORD It S HEEN PROVIDED TOTHE WELL OWNER.
6 11:03
SIGNATURE OF PERSON CON SIRu '. :]GI THE: WEI. I. Date
5uir^�� the m isin. ! to the Division of Water Quality, Groundwater Section, 1636 Mail Service center- Raleigh, NC
ro FI o y 1, within 30 days.
Itn
r% ,
1II I
II i'
GW-i IL\

2. WELL LOCATION:
Nearest Town:tvA9t Almo/ County
(-'usb , I g
(Street Name, Numbers, Community, Subdivision, Lo o., Zip Code)
3. OWNER: 'J,r+'` SANS. a/1-c`-.
Address f) C FioX L) !2A
( tree[ or Route No.)
Y
/City or Town Sta Zip Code
(ZG4)- SRC—K;Ca
Area code- Phone number_
4. DATE DRILLED -6MS . O 2a
5. TOTAL DEPTH: a-'4 S
6. DOES WELL REPLACE EXISTING WELL?
274713
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
WELL CONTRACTOR (INDWIDUAL)NAME (print) Jamee TA?, Camp,Tr
WELL CONTRACTOR COMPANY NAME ramp( G Wm' 1 R Pnmp Cn_ Tnr- PHONE #t87A) d54_7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
CERTIFICATION # 7 1 18
1. WELL USE (Check Applicable Box): Residential Pi Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
bt (✓j SC C.i
YES
NO
7. STATIC WATER LEVEL Below Top of Casing: J FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS t FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): '1 Ca METHOD OF TEST a t r
10. WATER ZONES (depth): \ OU 2u 1 h S
11. DISINFECTION: Type r'h 1 nri na Amount
12. CASING: Wall Thiclmess
Depth Diameter or Weight/Ft. Material
From_ To .4) Ft.6—i-4- SDR21
From To Ft.
From. To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. Neat Cement
From To Ft.
PVC
Method
Hand
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Material
16. REMARKS:
diumtganE
RUCTION STAND
Su 276p)¢� .}/616h'8Nt8gt al1
Topographic/Land setting
ORidge OSlope LDV'dhey OFIat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box}
DEPTH DRILLING LOG
From To FormationFC���In�D'ppesc tion
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. w -z
rn__.
r- -
3
1/4
WELL WAS CONSTRUCIhD IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
ATURE OF PERS
N CONSTRUCTING THE WELL DATE
ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
, ithin 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James Camp, Jr- CERTIFICATION # 213E
WELL CONTRACTOR COMPANY NAME Camp' c Wr 11 R Pump_ Cry Tnc PHONE #019Rl dC't_7122
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMLTW
(if applicable) (if applicable)
274712
I. WELL USE (Check Applicable Box): Residential CYMunicipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:A
Nearest Town: A X I SAIr , County
ree✓_ � ,- hir1 ie✓e I Rr
(Street Name, Numbers, Community, Subdivision, Lot No/ Zip Code)
3. OWNER \ .' -
Address fi D I3o X I zS
�F (§nett or Route No.)
S �1Ylav�{our 5C- kg3a5
try or T St4 Zip Code
)_ �li�3 -- S i 3 �
Area code- Phone number
4. DATE DRILLED s• 1), 0
5. TOTAL DEPTH: U 11.
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO i`6.
7. STATIC WATER LEVEL Below Top of Casing: 2 U FT
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
. variance In accord ce with 15A NCAC 2C .0118.
9, YIELD (gpm): �'$I�THOD OF TEST n 5 r
10. WATER ZONES (depth): n'- 00
11. DISINFECTION: Type Ch1 nri na Amount Lt., 1i
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From p To L O Ft. 6 1/ 4 eDF21 PVC
From To Ft.
From - To Ft.
13. GROUT: Depth Material Method
From -0 To 20 Ft. PI at Ccmc
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Lang setting
❑Ridge DSlope Malley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
-
DEPTH pRILLING LOG
From To
iron Description
0-S• r hutt
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY o THIS RECORD H EEN PROVIDED TOTHE WELL OWNER
/�V71V �
�h �' 6O d- Gl�f'v� l - 6
3
ATURE OF PEES N CONSTRUCTING THE WELL / DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
within 30 days. GW-1 REV. 07/2001

274710
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James nL
Camp, Jr. CERTIFICATION # 21 32
WELL CONTRACTOR COMPANY NAME Camp' a Wn1 1 R Piimp ert.
jnr PHONE#87A) d5T-7322
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: yn,1 County Po
43 2/ l,Ie rc,'E t c ; yc / e -
(Sheet Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: /a_y'v(ara E 11
Address 6 (1a51) e i t ,
(Street or R ute No.) 1)9
City or Town State Zip Code
( )- 9612-o113
Area code- Phone number
4. DATE DRILLED ,� -2'7- tit 3
5. TOTAL DEPTH: 321
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO g 7. STATIC WATER LEVEL Below Top of Casing: 7 R
(Use"+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): ,7?o METHOD OF TEST Air
•10. WATER ZONES (depth): .3 *.0
11. DISINFECTION: Type Ch 1 nri na
12. CASING:
Depth Diameter
From o To /_30 Ft. 6 1 / 4
From To Ft
From. To Ft.
Depth
To 20
13. GROUT:
From
Amount I /X Ca(
Wall Thickness
or Weight/Ft. Material
RDR'1 PVC
Material
Method
FL Ne,at Ccmcnt Hand
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material 'J
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)-
DEPTFF DRILLING LOG
From To Formation Despription
n 30 clay, Sand
/3D '34S Con solidaled rock
JOCATION SKETCH
Show direction and distance in miles from at lea is
two State Roads or County Roads. Include the mad
numbers and common road names.
) pp"
o
N
J
rT \,
Ce
c
(lwilt
16. REMARKS:
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WFI I
, A'D THAT A COPY OTHIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
L.iiabIATURE OF PERSLON CONSTRUCTING THE WELL
aa�rLr, t�,ha ?r4.0y�� 0 ivisiam of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
2'�¢�Y��jy9 -Yr140� f'- 1"`I r-elGb -3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ala me s "L Camp, Jr. CERTIFICATION # 21 3R
WELL CONTRACTOR COMPANY NAME ramps Ws11 R Pump r'n Tnr PHONE #g2Fit 4 C 3 - 7 3 2 2
ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
STATE WELL CONSTRUCTION PERMIT#
274705.
1. WELL USE (Check Applicable Box): Residential 0/Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearest Town: & .A
\t 4t )rr.
(Street Name, Numbers, Community, Subdivisi
on, Lot No., Zip Code)
3. OWNERe,�IIr(wlt
Address v) •:()
(Street or Route No.)
C�n1 'V L 5-‹
City or Town StatO Zip Code
County eC-XIi)--
Area code- Phone number _
4. DATE DRILLED S- 13 • 03
5. TOTAL DEPTH: '-t' b'
6. DOES WELL REPLACE EXISTING WELL? YE 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: v 1} FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface"
*Top of casing terminated atior below land surface requires a
• variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): ' METHOD OF TEST
10. WATER ZONES (depth): .3\ coil)
Air
11. DISINFECTION: Type rh 1 nri np Amount Cu9
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From p To `\ Ft.6 t/4- SDR21 PVC
From______ To Ft.
From - To Ft. _
13. GROUT: Depth
Frorn_o To 2 p Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Material
Neat Cement
Method
Hand
16. REMARKS:
Topographic/Land setting
❑Ridge lt�Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box}
DEPTH DRILLING LOG
From To 0 on Description
n b' (Formation
CA/
9 S
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
\OD
0
c.)
L
v
tV
v
'"'HIS WFI I WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
5, AND THAT A COPY OF THIS RECORD HAS $EEN PROVIDED TO THE WELL OWNER
JCtJt'0 tFi9ginfilftu the Div
A/116 g-lita f tihn cc 14fis 711-
IGNATURE OF PER/9 CONSTRUCTING THE WELL +t DATE
sion of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001

274703
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James r+L
Camp'
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMITN
(if applicable)
Camp, Jr CERTIFICATION] 7138
R Pnrap_ On_ .
ASSOCIATED WQ PERM1Tp
(if applicable)
PRONE#878) AC1-7322
1. WELL USE (Check Applicable Box): Residential Cl/Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection O Other 0 If Other, List Use
2. WELL LOCATAOAN: 11
Nearest Town: \ A A �?A County t f� A)--
'A c. VUIx • ci..)vvy �V
(Street Name, Numbers, Community, Subdivis on, Lot No., Zip Code)
3. OWNERS
Address 4 \A U
(N(-Stree�t or Route
r C �`
City or row Stee IV
No.)
C 9-10
Zip Code
Area code- Plume number
4. DATE DRILLED S- 22, . U 1)
5. TOTAL DEPTH: R C
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO L�
7. STATIC WATER LEVEL Below Top of Casing: \-f- L7 FT.
(Use '4." if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
-variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 00- METHOD OF TEST D jr_
10, WATER ZONES (depth): .20
11. DISINFECTION: Type C h 1 n r i n
12. CASING:
Depth Diameter
From__ To.\ $T Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth
From g To 30 Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From, To Ft.
From To Ft.
WP11
I." CSIAQp4..).ty PA,
Amount (it A a fp
Wall Thiclatess
or Weight/Ft. Material
Rna21 PVC
Material
Neat Cement
Method
Slot Size Material
in.
in.
Tnr
Topographic/Land setting
[Ridge ❑Slope ip)tt1ey [Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: OGPSOTopographic map
(check box).
DEPTH DRILLING LOG
From To FormationDescriptio
10 5— J. C4.^C\JA
�O r.14-- S,Vt /1A dln
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
yU1U 1S,0J- 2t.
16. REMARKS: L4
O
CO
L
C
CZ;
c
rr
tV
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WELL
AND THAT A COPY Of THIS RECORD HAS EEN PROVIDED TO THE WFI I OWNER
Submit the original to tine Dr
(2960d9636 )s1io68NiTICk 19) 733
ASHEV'U_E REGICRAL OFFICE
SIGNATURE OF PE
a-4p
N CONSTRUCTING THE WELL
lv x
DATE
ision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
3221, within 30 days. GW-1 REV. 07/2001
//

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality -
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
James 10_ Camp, Jr
WELL CONTRACTOR COMPANY NAME ramp s Wal 1 R Primp Cry Inr
STATE WELL CONSTRUCTION PERMIT$
274702
Groundwater Section
CERTIFICATION it i 1 3 A
PHONE $$(7A) d'1_7322
ASSOCIATED WQ PERMIT$
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential QrMunicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: i?
\AAVA X (j
(Sneet Name, Numbers, Community, Subdivision, Lot No., Zip Code)
County \ Imo`
3. OWNER:)( �lip�QOsyyin{ CRI
Address, (aJ>1KCAN
(Street a ot/oute No.)
lV\ A��A�o,,
t
%3ci
Ci ZipCode
61(�)h leas `(C I �.
Area code- Phone number 4. DATE DRILLED 6-22 Q%
5. TOTAL DEPTH: a 0 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Cl(
7. STATIC WATER LEVEL Below Top of Casing: ,l U FT.
(Use '4" if Above Top of Casing)
S. TOP OF CASING IS 'I FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
.variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 1 0 METHOD OF TEST air
10, WATER ZONES (depth): t ` (1
11. DISINFECTION: Type rh 1 nri na
12. CASING:
Depth,Diameter
From_ To Ft. 6 1 / 4
From To Ft
Amount
Wall Thickness
or Weight/Ft. Material
cDP.21 PVC
From To Ft.
13. GROUT: Depth Material Method
From_41__To 'S0 Ft. Neat Cement Hand
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft
Slot Size Material
in -
in.
Topographic/Land setting
Uftiidge ❑Slope ❑Valley 0Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box}
DEPTH DRILLING LOG
From To lion Description
3S t
�5 42 -0 S -t AA A
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common r d names. / c
o
w
nT
CArY+4/ C
to -are (
,
0
Dr.
1 —0 r=j^
(V i 1, l-Ls (.u01
--1 c,C 0
L
xv
16. REMARKS:
0
RI
I V T 'rr T
WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
/s &&
TURE OF PE • CONSTRUCTING THE WELL DATE
Su4mit the original to the lei ision
2769%1 I6PIthorte NO.4913,)(^ 3221
J�., _E ,EP+f_VF ILE
of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
within 30 days. GW-1 REV. 07/2001

274700
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James co Carp.#, Jr CERTIFICATION # 71 18
WELL CONTRACTOR COMPANY NAME ('amp' c Wa11 R. IS amp r'n T n r PHONE I81?Rl d53_7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 2'Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: f�
Nearest Town: County P
t
RfUAt
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 'Z (} Vt' (v Y .
^r LA
Address f
street or Routs No.)
dayizy or o u c nS a �- p Co /ei G
Area codo- Phone number 'I
4. DATE DRILLED �' 2 ` 0 �?
5. TOTAL DEPTH: -. (n S-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 50 FT
(Use '4" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
.variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 1 0 METHOD OF TEST pi
10, WATER ZONES (depth):
Topographic/Land setting
midge 0Slope ON/alley [Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: OGPSOTopographic map
(check box)-
DRILTING LOG
rmation pescriptio❑
From
G
00
11. DISINFECTION: Type CH 1 nri na
12. CASING:
Depth Diameter
From p To Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth
From__0____ To 20
From To
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Ft.
Amount CL..,.g
Wall Thickness
or Weight/Ft. Material
gDR71 PVC
Material
Method
Neat Ccmcnt Hand
Slot Size Material
in
in.
16. REMARKS:
Ft.
11�0HY CF.R FYr3'.
,O11J 1 KUL 11UN S I AND
.. k a f t �01 .ecyY(r4e Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
1. 16${1oo.i 005733-3:21,within30days. GW-1 REV. 07/2001
LOCATION SKETCH
Show direction and distance in miles from at leas
two State Roads or County Roads. Include the • ad
numbers andreommon road names.
S
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY 0THIS RECORD HASEEN PPROVIDED TO THE WRIT OWNER
a-
� %S ( (r-
G J
GNATURE OF PERS(JN CONSTRUCTING THE WELL DATE
Cr,
c
n

WELL CONSTRUCTION RECORD 274695
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jame s va— Camp, Tr CERTIFICATION it 21 3R
WELL CONTRACTOR COMPANY NAME Camp s VIP 11 R Pimp CrL T n r- PHONE #$2Rl el 1-7322
STATE WELL CONSTRUCTION PERtv1IT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential tV Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:p f�
Nearest Town: f\),,k CpAAA County'+ —oh
CAA1 �'v,V.wl 0
(Steer Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: F/t.i.(_ A.1.1A0'Qr (k)-
Address 1 L11) V"kA A TMAAS-A P—..(I
City or Town
(Street or Route No.)
S to
State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED S •-3 U 200
5. TOTAL DEPTH: ;Z Cl S
6. DOES WELL REPLACE EXISTING WELL? YES LYNO 0
7. STATIC WATER LEVEL Below Top of Casing: y U FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS t FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
• variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 1 U METHOD OF TEST
10, WATER ZONES (depth): S°
Air
11. DISINFECTION: Type rh 1 nri np
12. CASING:
Depth .r Diameter
From 0 To AkS Ft. 6 1 / 4
From To Ft
From To Ft.
13. GROUT: Depth Material Method
From p To 20 Ft. Neat Cement IIand
From _ To Ft.
Amount Ld
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in in.
From To Ft. in. in,
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/L setting
❑Ridge ❑Slope &Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box) -
DE TH DRILLING LOG
From To ...p nnatry, i�Descriptio¢
p 4 5 � l la u.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
IV r-,o
c>
I DO HEREBY CERTIFY THAT TH S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
1:I 11WC TON-STA ID�yRDS�A HAT A COPY 0� THIS RECORD HEEN PROVIDED TO THE WELL OWNER
(Lyn _ AS , �GPr1 1 i . (o - /-2 63
DATE
S1 NA JRE OF PERSON CONSTRUCTING THE WELL
I� II L —, U
# the original io the7Sivislon of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
7699- 636 Phone No. (919) 733-3 1, within 30 days. GW-1 REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

WELL CONSTRUCTION RECORD
274694
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J ames w Came, jr CERTIFICATION# 2 13A
WELL CONTRACTOR COMPANY NAME (`amp' ¢ WP11 R Pump Tnc PHONE #$9R) d54-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential N1 Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: County
6-7iePrt R'✓e — F')
(Sneer Name, Numbers, Community, Subdivision, Lot No., -Zip Code)
3. OWNER: J AJje' t'n..3Ur- Mil/it •
Address 7 C c' X 1 S
(ueet or Route No.)
SP)aytanh v 4C_ L93DS
City or Town Stale Zip Code
(BP))- s?3 s IS o
Area code- Phone number
4. DATE DRILLED Lk
5. TOTAL DEPTH: 5 0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: Lk is FT.
(Use '4" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface"
`Top of casing terminated at/or below land surface requires a
.Variance In accordance with 15A NCAC IC .0118.
9, YIELD (gpm): 0 METHOD OF TEST L i r
10. WATER ZONES (depth): 2.N l) 0
11. DISINFECTION: Type rh 1 nr i na
12. CASING:
Depth Diameter
From_0____ To "6 Ft.6 1 / 4
From______ To Ft.
Froth To Ft.
Amount ").
Wall Thickness
or Weight/Ft. Material
eDan 1 PVC
13. GROUT: Depth Material
From_0____, To 80 FL N at Cement Hu
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft. _
16. REMARKS:
]T fvpN!.T r a
ILA
AUG - 5 2CO3
Su mit the original to the
27
GSOn1 ^F
ASHCi. G :I (:FFICE
Method
Slot Size Material
in.
in.
Size Material
Topographic/Land setting
❑Ridge ❑Slope [blialley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box
DEPTH DRILLING LOG
From To Formatipn Description
AX (>
asi 5.0s AN
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
r'
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFI
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WFI 1 OWNER
6--I -03
ATURE OF PERSON CONSTRUCTING THE WELL
o
CO
of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
within 30 days. GW-1 REV. 07/2001

STATE WELL CONSTRUCTION PEILMITN
(if applicable)
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -
WELL CONTRACTOR (INDIVIDUAL) NAME (
pri�n
t)
WELL CONTRACTOR COMPANY NAME Oat -ter
/D`t 71
272597
Division of Water Quality - Groundwater Sectionggyp
CERTIFICATION gnc) m
PHONE tpl•/p )h'n7 %
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential It"---Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIQN:""'_�
Nearest Town: O/(Lr,C,Fllrs County
e}<en/a 51.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: .2a/ic,�ryVr Anis
Address POOOX ///✓3
(Street or Route No.)
�aJua/a. A/ Pi 011 73
City or Town State Zip Code
( )-
Area code- Phone number n.
4. DATE DRILLED it C
5. TOTAL DEPTH: 33n
•
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Fr
7. STATIC WATER LEVEL Below Top of Casing: cPO z FT.
2 (Use "+" if Above Top of Casing)
8. TOP OF CASING IS /'eFT. Above Land Surface'
•Top of casing terminated at/or below land surface requires a
variance in accorda,p esryth ISA NCAC 2C .0118.
9. YIELD (upm): /b /2 METHOD OF TEST //Me!A
I0. YTER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley la
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Descripgon
,-/ate o /ratkiler
I I. DISINFECTION: Type Amount
12. CASING: Wall Thickness
n Depth/ �ty eter or Weight/Ft. N 'aerial
From (/ To 63 Ft.(Oni 40Q2-/ ✓
From To Ft.
From To Ft.
13. GROUT: Depth �� Material Method
From 0 ToFt.�i�'i('_✓ty& ,4 rrc/
From To Ft.
14. SCREEN: Depth Diameter Slot Size Matcnal
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
W O
1.41
oc
I xm
m
y.. 7:2o
rnt
r -4
CA o
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
F,vnc �✓e/2d �ony/Ue -itr1Ce
¢✓ . /76 it. Sa1udo . 7/07c-
/t2 02 tee/a..6tret_t. 6„
afp(oxioca_tcl Mule. /40usc
/5 On. -+—t/he rl' kt -gust Ctcrass
Eton, 5''f l cf—u n aare_ Net/itL
Celt -ter - hew lfy l(1oust
16. REMARKS:
r
3
FAa,RE 4' OERt'1'iFYItHi.
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
NATURE OF PERSON CONSTRUCTING T
S _ r(?i,iilµt,,,Ti snd fg11 )g ivisitn of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
2/709,1636 Pli6)16lhtler'-(9I93-32 I, within 30 days. GW-I REV. 07/2001