Ru 1 CY2003

279793
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 # 25ONE # [phone]
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC
WQPERMIT #
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED (if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential ® Mnnicipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: BOSTIC County RUTH
PEA RIDGE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DAVID JONES
Address PEA RIDGE RD. (Street or Route No.) (degrees/minutes/secondsr---
BOSTIC NC 28018 Latitude/longitude source: ❑ GPS 0rT4ogmphic ma
City or Town State Zip Code Phone (check box)
DEPTH
(828) — 287-2429From To
Area Code Phone number
4. DATE DRILLED 09/16/03
5. TOTAL DEPTH: 48
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 33 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
or Weight/Ft. Material
CEMENT
Depth Diameter
From 0 To 48 Ft. 24"
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 33 To 48 Ft. 78M GRAVEL
From To Ft.
16. REMARKS:
Topographic/Land setting
0 Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well 1
DRILLING LOG
From To
LOCATION SKETCH �t 7�}
Show direction and distance in mils from at rl-;. ' _1
Two State Roads or County Roads. Include the road
number and common names
BUS. 74 E. FROM FOREST CITY. LEFT ON
BOSTIC/SUNSHINE HWY. LEFT ON PEA RIDGE
RD. NEW DRIVE APPROX. 1 1/4 MILE ON LEFT.
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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
R
ATURE F PE afJ C 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

279792
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATI PHONE # [phone]
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1.
2
3
City or Town
(828) — 247-1237
Area Code Phone number
4. DATE DRILLED 09/17/03
5. TOTAL DEPTH: 40
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO EI
7. STATIC WATER LEVEL Below Top of Casing: 25 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 40 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 25 To 40 Ft. 78M GRAVEL
From __ To _ Ft. __
WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
WELL LOCATION:
Nearest Town: ELLENBORO
SEABOARD RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
OWNER: MIKE DUNCAN
Address 231 SEABOARD RD.
(Street or Route No.)
ELLENBORO NC
State
County RUTH
16. REMARKS:
28040
Zip Code
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
f
(degrees/minutes/seconds) r___---
Latitude/longitude source: ❑ GPS ❑ pogmc_m phiaj3
(check box)<
DEPTH
From To
1
DRILLING LOG
From To :,
i�
�,
LOCATION SKETC] R
i
Show direction and distance in mil c; r st fr
Two State Roads or County Roads. elude
number and common names FROM BUS. 74 IN ELLENBORO GO OUT PINEY
MTN. CH. RD. LEFT ON TINEY RD. LEFT ON
SEABOARD RD. APPROX. 3/10 MILE ON LEFT.
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I 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 PROVIDED TO THE WELL OWNER
a a_,�jn/)_o . 9 . /7 -o
SIGNA1uR> RSON CONSTRUCTING THE WE 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
L

279809
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: BOSTIC County RUTH
BOSTIC/SUNSHINE HWY.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JOHN HENDERSON
Address BOSTIC/SUNSHINE HWY.
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code
(864) — 461-2748
Area Code Phone number
4. DATE DRILLED 09/05/03
5. TOTAL DEPTH: 505
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IM
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): 1-1/2 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 13.5
12. CASING: Wa11 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
From 0 To 20 Ft. QUIKRETE
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From ____ To _ Ft. in.
From _ To _ Ft. in.
15. SAND/GRAVEL PACK:
Method
POURED
From
From
Depth Size
To Ft.
To Ft.
16. REMARKS:
Material
in.
in.
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 ❑ Topographic map
(check box) (_
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in tinted from at lets( -
Two State Roads or County Roads. Include the road
number and common names
BUS. 74 E. FROM FOREST CITY. LEFT ON
BOSTIC/SUNSHINE HWY. GO THRU SUNSHINE.
RT. ON GRAVEL DRIVE BETWEEN CHERRY MTN.
F.D. & DUNCAN'S CREEK RD. HOUSE AT DEAD
END.
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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
44
SIGN OF PERS 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

279805
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 ® MunicipalPublic 0 Industrial 0 Agricultural
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: HARRIS County RUTH Topographic/Land setting
GT WELLS DR 0 Ridge ❑ Slope 0 Valley ❑ Flat
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) (check appropriate box)
3. OWNER: ROBERT GRACE Latitude/longitude of well location
Address GT WELLS DR
(Street or Route No.)
HARRIS NC 28074
City or Town State Zip Code (check box)
(828) — 453-0911 DEPTH
Area Code Phone number From To
4. DATE DRILLED 09/19/03
5. TOTAL DEPTH: 305 DRILLING LOG
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ® From To
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):
11. DISINFECTION: Type CHLORYTE Amount 7.5
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. QU1KRETE 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`leasii ----
Two State Roads or County Roads. Inchfde the roam°
number and common names
HWY. #221 S. FROM RUTHERFORD. RIGHT ON
HOGAN RD. GO APPROX. 3 MILES. LEFT ON
SAPPLING DR. LEFT ON GT WELL DR. 1ST LOT
ON LEFT.
(degrees/minutes/seconds) r -
Latitude/longitude source: 0 GPS 0 Topograchic tpapt—
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 '1 OF PERSON CONSTRUCTING 1 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

279801
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Qiiplity - 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: RUTHERFORDTON County RUTH Topographic/Land setting
COVE RD. ❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) (check appropriate box)
3. OWNER: ERNEST DUSTMAN Latitude/longitude of well locdtion r'
Address COVE RD.
(Street or Route No.) (degrees/minutes/seconds)'
RUTHERFORDTON NC 28139 Latitude/longitude source: ❑ GPS ❑ '1'dpogjaphic-4llap `
City or Town State Zip Code (check box) •
(111.§) - 378-6944 DEPTH -'
Area Code Phone number From To
4. DATE DRILLED 09/02/03
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ei
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): 5 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From 0 To 50 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
From _ To Ft. _
From To Ft. _
15. SAND/GRAVEL PACK:
CHLORYTE Amount 7.5
Wall Thickness
or Weight/Ft Material
SDR21 PVC
Depth
From To
From To Ft.
16. REMARKS:
Method
POURED
Slot Size Material
in. in.
in. in.
Size Material
Ft.
DRILLING LOG
From To
-JC7
;.5
LOCATION SKETCH'
Show direction and distance in miles'iom at last ---
Two State Roads or County Roads. Include the road
number and common names
HWY. #64/74A W. FROM RUTHERFORDTON.
RT. ON COVE RD. 1ST DRIVE ON LEFT PAST FIRE
DEPT. (ABOUT 7 MILES)
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I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER y � 9- a-
v`�
SIG ATURE OF PE ON 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
l5
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279798
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: LAKE LURE County RUTH
SEARCY RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: HAROLD BIRD
Address SEARCY RD.
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
(828) — 6254726
Area Code Phone number
4. DATE DRILLED 09/22/03
5. TOTAL DEPTH: 125
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):
11. DISINFECTION: Type CHLORYTE Amount 3
12. CASING: Wall Thickness
Depth Diameter or Weight/FL Material
From 0 To 80 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 Slot Size
From To _ FL _ in.
From To _ Ft. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To _ Ft.
From To Ft.
16. REMARKS:
Method
POURED
Material
in.
in.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box
Latitude/longitude of well location L. 7 1`7
(degrees/minutes/second ), ii
G-L.RI
Latitude/longitude source: 0 GPS Dil'opograpW mapj
(check box) ':. _3 a)t5'3
DEPTH 1 [li .]
From To , 'i P.,
i
DRILLING LOG
From To
LOCATION SKETCF
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 WEST. RIGHT ON BILL'S CREEK
RD. LEFT ON CEDAR CREEK RD, GO APPROX. 1/4
MILE THEN LEFT ON SEARCY RD. 1ST LOT ON
RIGHT. STRAIGHT ACROSS FROM BIRDS ROOST.
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I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSICTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/,-,S, /2>& 9- a a - 6
SIGN?ITURE OF PERSONSTRUCTING 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

279'796
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 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: LAKE LURE
PROCTOR RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MICHAEL HAMM
Address PROCTOR RD.
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
(704) — 607-0860
Area Code Phone number
4. DATE DRILLED 09/26/03
5. TOTAL DEPTH: 345
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): 25 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 9
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. 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 ❑ T pographic map]
(check box)
n
DEPTH
From To711
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles totnLleast- Two State Roads or County Roads. In4lude the rgad
number and common names
HWY. #64/74A WEST FROM RUTHERFORDTON.
LEFT AT LAKE LURE INN ON ARCADE RD. THEN
RIGHT ON PROCTOR RD. APPROX. 1.4 MILE ON
RIGHT. GREEN GATE AT DRIVE.
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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
frt )C�'�/ fir. if 7 %�a� 94' n2 e -
SIGNA OF PERSON 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

WELL CONSTRUCTION RECORD 280162
North Carolina - Department of Environment and/Nattural Resources - Division of Water Quality - Groundwater Section)
WELL CONTRACTOR (INDIVIDUAL) NAME (print) i14Ctf 5054!C6 CERTIFICATION 1 / Ca
WELL CONTRACTOR CON1PANY NAMIE )tli(tC 9 0 )PLC r:ct 1 PHONE # ea? -7Zc1--9, 4$
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: '�t n , O / (� `
Nearest Town: %gun/, et N1 County F- U'YLt grA
f Ka- d-ot,e (2d
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: . f, 1 v1A r A5 O L- `-
Address 1O/4p1/ef-v.1 ot.3or
(Street or Route No.)
/°
�j�•
z7Sa 2 ...'
(1f_)iry •31aor z.- Viz`/ Stateode
Area code- Phone number
4. DATE DRILLED 5p / 2D03
5. TOTAL DEPTH: /
I a
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO C
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / 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 SV IDii
10. WATER ZONES (depth):
topographic/Land setting
tdge ❑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
Q..2f
11. DISINFECTION: TypeCio,erAmount i3OZ once
12. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To ‘ 7 FL 6kg/ L/a G�
From /n j To 40 5- Ft. (o ('r / fl"c? CyN CY
From To Ft.
13. GROUT: Depth Material
From To Ft.
From 0 To Zo Ft. ia/
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
LOCATION SKETCH 4s-.
Show direction and distance in miles from 4 least
two State Roads or County Roads. Include the road
numbers and common road names.
a
Method 1-1"COCu
la ��An_Thizial
It����(�R ZZ-�
F G'., tT
irtria
n
CA ~ i
to
16. REMARKS: i
y Material
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDAQDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
E 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. (9I9) 733-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION. RECORD 279180
North Carolina - Department oLEnvironm.ent, ansiNatural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) SCOTT GANTf CERTIFICATION)/ 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS. INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (ifapplicabte)
1. WELL USE (Cheek Applicable Box): Residential la Municipal ❑ Industrial 0 Agricultural ❑ Monitoripg ❑
Recovery 0 Heat Pump Water Injection D Other 0 If Other, List Use:
2. WELL LOCATION:
Nearest town: RUTHERFORDTON
LOT 42 GREEN RIVER HIGHLANDS
County RUIi-IERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER ART KING
ADDRESS 586 OLD WAGY RD
LStreet or Route No.).
FOREST CITY
Citynr Town
828-245-0716
NC
State
Area Code - Phone Number
4. DATE DRILLED 8/8/03
5. TOTAL DEPTH 220
28043
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES [] NO 1E1
7. STATIC WATER LEVEL Below Top of Casing: 30.. FT.
(Use"+" fAbovel'op of Casing)
8. TOP OF CASING IS 2 FT. Above Land Sutiac.n
Sop of casing terminated at/orbdowland surface requires a variance in
accordance with 1 SA NCAC 2C0118
9. YIELD (gpm): 10 METHOD OF TEST
10. WATER ZONES (depth):
u-DISINFECTION: TYPE HYPOCHLORITE
12. CASING.
Depth
From 0 To, 55
13. GROUT:
ARDM
Topographic/Land setting
0 Ridge ® Slope [Walley 0 Flat
Latitude/Longitude of well location
35.17.374 /82.02.485 ,
(degrees/minutes/seconds)
Latitude/longitude source:® GPS [] Topographic map
DEPTH DRILLING ING OG
From To Formation Desert Lion
0 49 Clay
49 220 Consolidated Rock..
Diameter
Ft. 61/4."
Depth
From 0 To 20 Ft.
14. SCREEN
Depth
from NA To
15. SAND/GRAVEL PACK:
From
Depth
NA To
to. REMARKS
Amount 6
Wall Thickness
orWeight/Ft. 'Material
SDR21 .PVC
Or
Material 454130,1
GRAVEL MIX. GRAVITY
Diameter
ft. in.
Size
Ft,
Slot Size Material
IR
Material
0
1
—17
a '
N
0rr�
LOCATION SKETCH >C
Show direction and distance in miles from at lat `r'i m
two State Roads or County Roads. Include thef'ad_. m z
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED INACCORDANCE. WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
—
CD o
SIGNATUREOF PERSONCONSTRUCTING-THE WELL ' Date
Submitthe original to the Division of WaterQuatity, Groundwater Section, 1636 Mail Service center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001

WELL CONSTRUCTION RE-CORW " l l "r 9
North Carolina -Department of Environment,andNatural Resources - Division of Water Quality - Groundwater Section
WELL_CONTRACTOR(INDIVIDUAL)NAME (print) SCOTF GANTE - CERTIFICATION-# 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED W9 PERMIT #
(jfappliicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal 0 Industrial 0 Agricultural ❑. Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use:
2. WELL LOCATION: Topographic/Land setting
Nearesttown: RUII-IERFORDTON County RUTHE.RFORD Et Ridge 0 Slope ❑ Valley ® Flat
114 SAWGRASS RD Latitude/Longitude of well location
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip elide) 35.16.385 / 81.54.279_
3. OWNER WILKINS HOME CENTER (degrees/minutes/seconds)
ADDRESS 1920 HWY 74A BYPASS Latitude/longitude source: 21 OPS QTopographic map
(Street or Route No.) DEPTH DRILLING LOG
FOREST CITY NC 28043 From To Formation Description
city or Town State Zip Code 0 II0 Clay
828-286,3647
Area Code - Phone Number
4. DATE DRILLED 8/16/03
5. TOTAL DEPTH 500
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing:
YES ❑ NO
0 FT.
(Use "+" If Above Top of Cuing)
8. TOP OF CASING IS 2 FT. Above Land Surfaces -
Mop ofcaging terminated at/orbelowland surface requires a amiancem
accoretoneawsch ISA NCAC 2C01IS
9. YIELD (gpm):. 0 METHOD OF TEST ARDM
10. WATER ZONES (depth): NA
110 500 Consolidated Rock
11. DISINFECTION TYPE HYPOCHLORfIE Amount 15
12. CASING: Wall Thickness
Depth Diameter or WeightiFt. Material
From 0 To 119 Ft. 61/4" SDR21 PVC
13. GROOT
Depth
From 0
14. SCREEN
oz
Material Rohm]
To 20 Ft . GRAVEL MIX GRAVITY
Depth Diameter Slot Size Mytcria1
From NA To Ft. in in.
15. SAND/GRAVEL PACK:
Depth Size Mgterial
From NA To Ft,
16- REMARKS. SECOND DRY HOLE
rn o
V rrl
r__
LOCATION SKETCH N grri
>c
Show direction and distance in miles from at least mo
two State Roads or County Roads.include the at_
zv, i
numbers and common road names. l;? r1
0
W
co o
T
m
m
01
ra
C,
0
I DO HEREBY CERTIFY THAT TFIIS WELL WAS CONSTRUCTED INACCORDANCEWITH ISA NCAC 2C, WELL.
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BFFN PROVIDED TO THE WELL OWNER.
8/14/03
fk�
CC
G
SIGNATURE OF PERSON CONSTRUCTING THE WELL.. Date
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigt, NC
27699-1636 Phone No. [phone], within 30 days.
-GW-] REV. 07/2001

CERTIFICATION# 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WEI.I USE (Check Applicable Box): Residential Municipal Q Industrial Q Agricultural Q
Recovery ❑ Heat Pump Water injection ❑ Other Q If Other, List Use:
WELL CONSTRUCTIQN RECORD r.1
North Carolina = Department of Environment, and NaturaLResources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) SCOTT GANTT
2 WELL LOCATION:
Nearest town: LAKE LURE
LOT 45 SPARROW WAY, RIVERBEND RESORT
County , RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER RIDGELINE DEVELOPMENT CORP.
ADDRESS 112 COCOPLUM CIRCLE
(Sleet orRoute No.)
ROYAL PALM BEACH
City or Town
561-798-2729
Area Code - Phone Number
4. DATE DRILLED 8/25/03
FL
State
5. TOTAL DFPTH 600
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing:
33411
Zip Code
YES ❑ _ NO
300 FT.
(Use"+" IfAbowe Top at Casing)
s. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated at/arbelowland surface requires a sariance in
accordance with 15A NCAC 2C.0118
9. YIELD (gpm): 10 METHOD OF TEST ARDM
10. WATER ZONES (depth): 590
it DISINFECTION! TYPE HYPOCHLORITE Amount 10
12_ CASING:
Depth
From 0 To.. 47 Ft.
13. GROUT,
From 0
Depth
To
14. SCREEN
Depth
From NA To
20 Ft.
15. SAND/GRAVEL PACK:
Depth
From NA To
16. REMARKS:
Diameter
6 1/4 "
Wall Thickness
orWeight/Ft. Material
SDR21 -- PVC
Monitoring Q
Topographic/Land setting
© Ridge ❑ Slope [] ValIey ® Flat
Latitude/Longitude of well location
35.25.929 / 82.09.704
(degrees/minutes/seconds)
Latitude/longitude source: 21GPS ❑- Topographic map
DEPTH DRILLING.LOG
From To Formation Desorption
40 Clay
40-
600 Consolidated Rock
O
a
Oz LOCATION SKETCH
Material Method
GRAVEL MIX GRAVITY
Diameter Slot Size Material
F4in. in.
Ft,
Size Material
r3
Show direction and rhstance in miles from at le%
two State Roads or County Roads. Include the r27d
numbers and common road names. IV
W
rm
0<
»0
--tom
MO
73n
N2
n�
T
m
m
N Gu
ry
()
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED. IN ACCORDANCE WITH. I5ANCAC 2C, WELL yy'n �--- __..._
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNE(C. �I _ `J
8127103 Il
SIGNATURE OF -PERSON CONSTRUCTING THE WELL Date
Submit the original to the Division_of Water t ality, Groundwater Section, 1636 Mail Service center- Raleigh, NC
27699-1636 Phone No. (919) 733-322I, within 30 days.
[GW-1 REV. 07/2001

Diameter Slot Size Material
Ft in.
Ft,
WELL CONSTRUCTION RECORD 279176
North Carolina- Department of Environment, andNatvralResources - Division of Water Quality— Groundwater Session
WEI I CONTRACTOR (INDIYIDUAL)NAMESprint} SCOTT GANTT CERTIFICATION# 2584
WFI 1 CONTRACTOR COMPANY NAME - CAROLINA WELL DRILLERS, INC. PHONE]!L(7041434-7277
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMTT if
(if applicable)_
1. WFI I USE (Check Applicable Box) : Residential
Recovery ❑ Heat Pump Water Injection ❑
2. WELL LOCATION:
Nearest town: RUTHERFORDTON
114 SAWGRASS RD
(if applicable)
Municipal 0. Industrial [Q Agricultural Q Monitorigg ❑
Other 9 If Other, List Use:
County RITIHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER WILKINS HOME CENTER
ADDRESS 1920 HWY 74A BYPASS
(street orRouteNo.)
FOREST CITY
Ciry or Town
828-286-36412
NC
State
Area Code - Phone Number
4. DATE DRILLED 8/13/03
5. TOTAL DEPTH 600
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing:
28043
Zip'Code
YES [] NO tg
0 FT.
(Use "+' I(Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface --
`?opoE<asn.g i-^^m*tra sit ortietawti98-996ireswpimesa varianecm
accordance with 15A NCAC 2C.0I18
9. YIELD (gpm): 0 METHOD OF TEST ARDM
to. WATER ZONES (depth): NA
Topographic/Land setting
0 Ridge [1 Slope Q Valley ® Flat
LatitudelLongtude of well location
35.16.395 / 81.54.275
(degrees/minutes/seconds)
Latitude/Iongtude source: ® GPS 0 Topographic map
DEPTH DRILLING LOG
From To Formation DescriQtiQn
0 IO2 Clay
102
600.. Consolidated Rock
1 L DISINFECTION: TYPE HYPOCHLORITE Amount 20
12. CASING:
Depth
0 To
13. GROUT:
Depth
From 0 To
14. SCREEN
Depth
From NA _ To
Diameter
108 Ft. 61/4"
Wall Thickness
or Weight/Ft. Material
SDR21 . PVC
Oz
Material Method
20 Ft. GRAVEL MIX GRAVITY
15. SAND/GRAVEL PACK:
Depth
From NA To
Size
Material
m
n
^� tT
2
N dr.,
—n
LOCATION SKETCH 3
Show direction and distance in miles fromatleaV
two State Roads or County Roads. Include the tog
numbers and common road names.
m�
7Jr1
td,
Cr,
O
—71
r-
r—
rn (cS c
CO
rs
U
CD
w-,
16. REMARKS: DRY HOLE
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL I_._=1
CONSTRUCTION STANDARDS, AND THAT A COPY OF TI HS RECORD HAS BEEN PROVIDED TO THE WELL OW 4ER.
8114/0-3
SIGNATURE OF PERSON -CONSTRUCTING THEWELL. - Date
Submit the orig uaLto the Division otWater Quality, Groundwater Section,-.1636 Mail Service center.- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
OW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 279175
North Carolina - Department of Environment, and_Naiural. Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVH)UAL)NAME (print) SCOTT GANIT 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 ® Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: LAKE LURE County RUFHERFORD
142 PINEY CREEK DR.
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER HORTON HOME OF RUTHERFORDTON
Topographic/Land setting
0 Ridge ❑ Slope 0 Valley ® Flat
Latitude/Longitude of well location
35.28.348 / 82.08.131
(degrees/minutes/seconds)
ADDRESS 342 HWY 74 BYPASS Latitude/longitude source: ® GPS ❑ Topographic map
(Street or Route No.)
RUTHERFORDTON NC
City or Town State
828-287-3366
Area Code - Phone Number
4. DATE DRILLED 8/1/03
5. TOTAL DEPTH 600
DEPTH DRILLING LOG
28139 From To Formation Descr)tion
Zip Code 0 95 Clay
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 23
7. STATIC WATER LEVEL Below Top of Casing: 260 FT.
(lIse,"*" 1LAbo'¢ Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
"Top of casing tera.inared error below, land m.f4.e .,0nizesayariaar-in
accordance with 15A NCAC 2C.0118
9. YIELD (gpm): 3 METHOD OF TEST ARDM
10. WATER ZONES (depth): 520
95 600 Consolidated Rock
t t. DISINFECTION: TYPE HYPOCHLORITE Amount 11
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 102 Ft. 6 1/4 " SDR 21 INC
13. GROUT:
From 0
Or
Depth Material Method
To 20. Ft. GRAVEL MD( GRAVITY
14. SCREEN
Depth Diameter Slot Size Material
From NA To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Myterial
From NA To Ft,
16. REMARKS:
C
Q Ei
B
_� L7
frl rm0
LOCATION SKETCH
o<
Show direction and distance in miles from at'ast jmo
two State Roads or County Roads. Include the3Tad rrl o
numbers and common road names. ^'
z
IV m:-C
CJ —r
0
T
m
CO
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL 0
9/4K)3
SIGNATURE OF PERSON CONSTRUCTING THE WELL Dale_
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

WELL CONSTRUCTION RECORD 279174
North Carolina - Department of Paivironment, and Natural Resources - Division of Water Quality Groundwater Section
WELL CONTRACTOWUNDIVIDUAL) NAME (print) _SCOTTGANTT CERTIFICATION# 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS. INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(ifapplicabJe) _ (if applicable)
1. WFI 1 USE (Check Applicable Box) : Residential ® Municipal ❑ Industrial ❑. Agricultural U Monitoring ❑
Recovery © Heat Pump Water Injection Q Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: RUTHERFORDTON
214 WOODVIEW CT
County RUIi-IERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
Topographic/Land setting-
0 Ridge 0 Slope 0 Valley ® Flat
Latitude/Longitude of well location
35.26248 / 82.01.722
3. OWNER CHERYL SHEW (degreeslninutes/seconds)
ADDRESS 214 WOODVIEW CT Latitude/longitude source: N GPS 0 Topographic map
(Street or Route No_) DEPTH DRILLING LOG
RUTHERFORDTON NC 28139 From To Formation Description.
City or Town State Zip Code 0 40 Clay
828-286-4587
Area Code - Phone Number
4. DATE DRILLED 8/28/03
5. TOTAL DEPTH 550.
6. DOES WELL REPLACE EXISTING WELL?
T. STATIC WATER LEVEL Below Top of Casing:
YES ❑ NO
200 FF
(Use"+" IfAbow Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface`
'Top of casing terminated arior below find surface re. uvesa-iariance in
accordance with 15A NCAC 2C.0118
9. YIELD (gam): 20 METHOD OF TEST ARDM
10. WATER ZONES (depth). 540
40 550 Consolidated Rock
it.DISINFECTION: TYPE HYPOCHLORITE Amount 10
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 47 Ft. 61/4" SDR2I PVC
13. GROUT:
From 0
Oz
Depth Material Meethod
To 20 Ft GRAVEL MIX GRAVITY
t4. SCREEN
Depth Diameter Slot Size
From NA To Ft. in is
15. SAND/GRAVEL PACK:
From
Depth
NA To
16. REMARKS:
Ft,
Size
Material
Material
v p
p
t..
'V Tm
OG
N Do
—o
N
Show direction and distance in miles from at let
two State Roads or Comity Roads. Include the Si
numbers and common road names.
LOCATION SKETCH
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 OWN
8/29/03
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Late
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.
5
N
O
O
GW-1 RE V. 07/2001
Inn
e

279 85
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural—r—Resources - Divisionnof Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM/P�! (print) ',J .YY1,2t.5 f�v". `a/np 7. CERTIFICATION it 3e
WELL CONTRACTOR COMPANY NAME CQ)titi$ Welt �1 PiAmp ID, Tnc PHONED 'CS 45-3'/3).Q
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ PERMIT,/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential (YMunicipal/Public 0 industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Neare Town:
C rLXJ t. Commnls
(Street Name, Numbers, Comm(unity, Subdivision,t�Lot No., Zip Code)
3. OWNER: .) 1J.JU Q PcJ ti
Address - C ').t^4 S1-t4
(Snttt o; C uto No.)
City or Town State
Area code- Phone number
4. DATE DRILLED • 1-1V 3
5. TOTAL DEPTH: 6 0 S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: \' l) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
County P�- t 14L,9
2g-)u
Zip Code
*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 MO\
10. WATER ZONES (depth): t\xO
11. DISINFECTION: Type Amount (.l.41)
12. CASING: Wall Thiclmess
Depth O Dieter orcW�i t/Ft. !AIL
From
�C�To S Ft U ajY 21 Y
From To Ft.
From To Ft.
13. GROUT: Depth Material ._1- Method
From 0 To 20 Ft. neat CftrieA {7aYJ
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. A.
From To Ft.
16. REMARKS:
Topo hi.c/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topogtaphic map(.--
(check box)
pRILLIN�r tt T
nation Description
AA....77�r
O is
is
m
-D "rt.r>
rn
DEPTH
From To
n l 1I)
1U()
SIB 5�
rn
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rm
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rn
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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.
I DO HEREBY CERTIFY THAT THIS WFT I 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
awn-e.a `3 1 D - D '5
SIGIATURE OF PERSON CONSTRUC*IN'G/yHE 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

279 84
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMA (print) _T0. VIA e (AI 1 a/P�v� p. ^�7T� , CERTIFICATION/�It a(3 g
WELL CONTRACTOR COMPANY NAME LQWI�S�e [I t PIA trip I D•r'1r�LYlC PHONE Y f9adl YS - 930 a
ASSOCIATED WQ PERMITS
(if applicable)
STATE WELL CONSTRUCTION PERMITS
(if applicable)
1. WELL USE (Check Applicable Box): Residential of Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCA ON:
Nearpst Town:
(Street Name, Num▪ ber
bo
, C • munity, Subdivision, Lot No., Zip Code)
3. OWNER:�a a S 00)1 Q UltSLi
Address it t{ S4Q
�(Stint or cvRou- COCO)
.t
City or Town State
Area code- Phone numb
4. DATE DRILLED fj• ) 0 3
5 TOTAL DEPTH DS
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO oi
7. STATIC WATER LEVEL Below Top of Casing: i 0 U FT
(Use '4" 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 accorda ce with 15A NCAC 2C .0118. (�p �
9. YIELD (gpm): MEETI D OF TEST ft k}
10. WATER ZONES (depth): WYLKOk.21te,
11. DISINFECTION: Type e x Amount s2 (.t- A
12. CASING: Wall Thickness
Dep Diameter or Weight/Ft. Material
p_ From_ o ToFt. c( SQ. 2. \ P t1P
From To FL
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft neat CC vnert ha NA
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
idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude longitude source:❑GPS❑Topographic temp =—
(check box) I L.—___--)
DEPTH DRILLING 1.GQ,
From To
0 et
(—J
Hos
Form4tionDe�cnr 'ption
0
0
LJ
c.s
rn zm
rt
-O cm
0<
Q1 —.m
qo
'v m'
eg
LOCATION SKETCH J rx$
Show direction and distance in miles from east-d
two State Roads or County Roads. Include the roa
numbers and common road names.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WFI I WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TILE WELL OWNER
iin2A t11Yt 0 "a
SI ATURE OF PERSON CONSTRU IN HE 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
Tu

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of
Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM/§I (print) 33- Yin,,eL5 f�1� • C.
in AL .
WELL CONTRACTOR COMPANY NAME La MpS�e it V t'U t p 1 D,t1,/Ylc
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
279 83
CERTIFICATIONpl!11# a 13 g
PHONE # f2ad) 453-,3a2.
1. WELL USE (Check Applicable Box): Residential 6fi Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI y
Nearest Town: I.(f'tie✓ ✓d cvt County u (f (--c✓
Nets rest /1trt., off a cet
(Street Name, Numbers,Community, Subdivision, Lot No., Zip Cdc
R: e)
3. OWNER: KO pat)!S
Address I vet k q! i I
f�wb(S for Ro ne No.)
oYo NC a7o b
City or Town State Zip Code
( Area code- Phone number
4. DATE DRILLED 0 — 8 -3
5. TOTAL DEPTH: '0 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO A
7. STATIC WATER LEVEL Below Top of Casing: 6 0 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 accordanse with ISA NCAC 2C .0118.
9. YIELD (gpm): b METHOD OF TEST 4I r
10. WATER ZONES (depth): 34
11. DISINFECTION: Type
12. CASING:
Depth,
From_a__ To If
From To Ft.
From To Ft.
o he Amount / CLir
Wall Thickness
Di eter or Weight/Ft. Material
Ft. 5DR2J PVc
13. GROUT: Depth Material Methppd
From 0 To .20 Ft. heat CePIA ert havtd
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.
16. REMARKS:
Slot Size Material
in.
in.
opographic/Land setting
dge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic
(check box) \ L..
DEEMDRILL G) e —
From To Formation Description
0 4'7 dirt
4'7 Rio 5 (ott5ol idatedeec
Cs)
rn
m
oc
Lfl .. rn
qo
-o
rn a
"r.
n -
n? m�
in
LOCATION SKETCH "' z
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC1hD IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS CORD HAS BEEN PROVIDED TO THE WELL OWNER
r_ giykrue-4- i.., f -it-33
SIQI TURF OF PERSON CONSTRUC*IN'GIHE 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 279382
North Carolina - Department of Environment and Natural Resources��- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM, (print) �..Tc-Yrl CS ") (Th »\p 7. CERTIFICATION�Aft a(.}3g
WELL CONTRACTOR COMPANY NAME lA W INS W ell t PLl YV p (D . r1T�Y(C . PHONE It ii ) 4 3j- (3s22
STATE WELL CONSTRUCTION PERMIT$ ASSOCIATED WQ PERMIT$ --
(ifapplicable) (if applicable)
1. WELL USE (Check Applicable Box): Residentialt Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use -'
2. WELL LOCATION: j
ee eal ;t Town mi+.A�.l t.-
County 1V.lX AC1,i..i
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address a q
(1 \(Stree orC ouzo No.)
IXl City or Town 1 VStare Zip Code
( Area code- Phone number
4. DATE DRILLED b- 3. D 3
5. TOTAL DEPTH:. 0 S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO X_
7. STATIC WATER LEVEL Below Top of Casing: �-l) FT.
(Use •4" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface'
`Too of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): ,i 0 METHOD OF TEST IR.IJ-.
10. WATER ZONES (depth): D'10
11. DISINFECTION: Type 0 Amount (`g'
12. CASING: Wall Thickness
D_-JJ O LI D
Depth Diameter
From 0 To 1 S Ft. _
From To Ft.
From To Ft.
13. GROUT: Depth Material j� Method
m Fro0 To �O Ft. neat Cement r NA
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
From To Ft.
or Weight/Ft. Material
S Q: R.'a\
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope l2Valley ❑Fear
(cheer appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude soLuce:❑GPS❑Topogr$phic-map--+
(check box)
DEPTH PRfid T13O T Orr
Fro l li/,�� To FRrmatipn Description
3o S- A
r",
CA)
c
rn GI
7;)
� ....en
zm
o/Z
Ol ern
>o
-0
s m
LOCATION SKETCH ttyy Nz
Show direction and distance in miles from arteast rm-,=
two State Roads or County Roads. Incl{tde tgroat
numbers and common road names. I =
!�Q
rto
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS R,CORD HAS BEEN PROVIDED TO THE WELL OWNER
a4 rLeA-- lrl1, (,'//�,'-�'( y�^n�'I
SI MATURE OF PERSON CONSTRU6TIN{G HE WFII
q - h - 0 3
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

From 0
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
From To
From To
279380
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division off Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM (print) .3;- ell es W l.A%Wk (1 -vT-'-. CERTIFICATION0list Ai 33.�g
WELL CONTRACTOR COMPANY NAME Ca W e' I I V PU Mp I D •f it c•PHONE if yoan1 Y� l �q"^-- --i` -� �
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W Q PERMIT#
(if applicable) —1
(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 LOCATION: ,
Nearest Town: /nit CT ( 1)Li/
i
)31 )4knit Cr:LLYT
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: - f 1 !e U
Address /3/7 file i'i (o uyT
County Pather7aYd
(Street or Rqute No.
/ 2 Keii t- Celtr , /3os755c
City or Town State Zip Code
( )-
Area coda Phone number
4. DATE DRILLED X _ 11 - 0 5
5. TOTAL DEPTH: .30 S /
6. DOES WELL REPLACE EXISTING WELL? YES l$ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: i/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 accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): ;90 METHOD OF TEST ct.I Y
10. WATER ZONES (depth):
Topo aphic/Land setting
Midge rapaglope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) ; ice, ,J
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH pRILLIN(O LOCI
From To Formation Description
0 65 dirt. c(14
GS 305 (lin5olr ate c Eck
11. DISINFECTION: Type t k l o Y i tie
12. CASING:
Depth Diameter
To L 5 Ft. / /4
Ft.
Ft.
Material
Ft. heat Cement
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Amount 1 C u p
Wall Thickness
or Weight/Ft. Material
51)12PVc-
Mcthppd
V*.d
16. REMARKS
Size ; Material
Ft
Ft.
el C
w
'72
'-o
r
c^
h
0<
". na
LOCATION SKETCH 3 r^o
Show direction and distance in miles fron ja 1eai , z
two State Roads or County Roads. Includee r
numbers and common road names. 93 o
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE
CONSTRUCTION STANDARDS, AND THAT A COPY OF jTHIS R CORD HAS BEEN PR
d— l/IJ C /�iTt�1
SIGGIATURE OF PERSON CONSTRu0''IN'GiHE WELL
TH 15A NCAC 2C, WELL
VIDED TO THE WELL OWNER
1, b'-/0-03
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) NAMFA (print) ('�,0. YYl eS tit/• CA m p V r. CERTIFICATION�# Al 3 g
WELL CONTRACTOR COMPANY NAME LA nips [Jell ' PIA nap rob o' !L cf�adl. PHONE # l 453-73
STATE WELL CONSTRUCTION PERMITS ASSOCIATED W Q PERMIT#
(if applicable) / (if applicable)
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: j� ,ex J I
Nearest Town: gait P i ✓c *o n County � `� In f r l aCa
). t 108 Cal en Valle L5Iale5
(Street Name, Numbers, Community, SublIdivisi ff Lot No., Zip Code)
3. OWNER: H I AJL 114ia 11
Address 710 J4 n r✓ i ng S� 1
(Sweet or Route No.) -1
POIumtil0. 5C qID -;LAI I
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED $ • I r� ` p3
5. TOTAL DEPTH: 0 ti
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 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): .ii METHOD OF TEST fl le
10. WATER ZONES (depth): 550
11. DISINFECTION: Type 0 JAY i r1 e
12. CASING:
Depth
Front Q__ To /10
Frot To
From To
Diameter
Ft. 6'/4
Ft
Ft.
Amount 1 c.uf
Wall Thickness
or Weight/Ft. Material
1PRal inc.
279378
/ Topographic/Land setting
ORidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(deprees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING Intl
From To Formation Descttption
t0 go dirt,i(alie
4o i. (36 r"ovlc)(Idafid Ycck
13. GROUT: Depth Material Methopd
From 0 To 2D FtMCcCt Cement kay.d.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Front To Ft. in. in.
From_ To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
w c
73
- n
o.
tT "a.n
Show direction and distance in miles from at least>a
two State Roads or County Roads. Include v roaT'�
numbers and Common road names.
/
/
/
LOCATION SKETCH
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC1hD IN ACCORDANCE WITH 15A NCAC 2C, WELL'
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS =CORD HAS BEEN PROVIDED TO THE WFI L OWNER
��7-���y��• 9- ID-D3
SIO7>ATURE OF PERSON CONSTRUOtIN'GJ HE 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--rr—Resources�j- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM) (print) -J0.rrl e5 v"' CA I4\g, ) . CERTIFICATION p^�I 3S
WELL CONTRACTOR COMPANY NAME 4.Ll sups e 11 d- Pu MO (D, IT-1-n c . PHONE a /8A?) 321R
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT%
(if applicable) (if applicable)
279387
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
WELL LOCATION: ^
2. Nearest Town: Ka. l t'te d Ia n County <tt+k /lc/
F Ha v1nibIA_ RA .
(Street Name, Numbers, Com unity, Subdivision, Lot No., Zip Code)
3. OWNER: � R 1Je1L)%4 J_11c
Address .57> W •
�strees orRoutol•o.)
h ✓e5t L; N L ,28� `}3
City or Town _ haseeZip Code
( )- ri A 5J - 1161
Area code- Phone number
4. DATE DRILLED ' -49‘a-63
5. TOTAL DEPTH: 'fob —/
6. DOES WELL REPLACE EXISTING WELL? YES 63 NO 0
7. STATIC WATER LEVEL Below Top of Casing: 0 FT
(Use "4" 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 1C .0118.
9. YIELD (gpm): • l� METHOD OF TEST GLI ✓
10. WATER ZONES (depth): 31, D
11. DISINFECTION: Type Ch
Frorrl
From To Ft. in.
12. CASING:
Depth,
From G b To O
From To
From To
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
To Ft. in.
° Y i n1e Amount ooi4
Di
Ft.
Ft.
Wall Thickness
eter orWeight/Ft. Material
Ral PVC_
Ft.
Material
Ft. neat eetrievkt
Ft.
Diameter Slot Size
in.
in.
Method
Ala
Material
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 solute:❑GPS❑Topographic map
(check box)
DEPTH (check
LOG
From o Formation Desc 'ption
0 'lo rt q�{cWCJ
�fo N-os Con otdAle YocK
V y_
s—m .
rr7z
LOCATION SKETCH �•~
Show direction and distance in miles from atcast y r J (`_�
two State Roads or County Roads. Include the-road--_�--"~--
numbers and common road names. ° ' `-
X
J.A. No, rn p'1� n.
RA
dRd
I DO HEREBY CERTIFY THAT THIS WFi l WAS CONSTRUC IED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS R CORD HAS BEEN PROVIDED TO THE WELL OWNER
44vt-t4--- II//}}- �,'' yynn�•
S1 ATURE OF PERSON CONSTRUO'I'IANG HE WELL DATE
� - 10-D3
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

VC Dept of Env. and Na Resour
292 Time: 9:36:34 PM
ti i I. COOTF.
....., 1\ E: i.
WELL CON STR't. C.
e'. 31 on'nent, and Natural Besour e>-
'7DIVIDLAL) NAME (print) SCOTT (ITT., -
CO3IPANY NAME CAROLINA WELT.
R"': ION PERYii_ #
Lir
_nential
p Fcater inienon ❑
SC:-
Cow,ty R F_!FP.f.i
YES ❑ \J _
S0
-SFCODGF TEST ^.RDM
Tr-Lips:f Amount 2
'.Va!l mickrcs
OE 4Veight/Fi. �Lealic'.
SDR 21
lo: Size
280444
!iitc- GrounduaLerSec,is-n.
CERTIFl r,GN= ..
NONE # (704) 434-72277
-L i FED L%Q PERMIT #
I i= applicable)
ag icu!tu:-al L
Topom-aphic-Lane; settisci
❑ Slope ❑
_r.,_ Lonsimde o: ccce'_cc L .
.;25252 82.:,..if 5
2:Padssoiree: ❑ c- 5 I -..
To
4
140
0
w
0
0
1
-J
U1
C1
,S CQNSTRi CT FD
COPY OF THIS E-r: )
i.4211Elf OF PolfS 2-z
'� isior of .dater Quaiitp, Groundwater
e3
732-3221, yc;as:-. i0 daps.
VCAC 2u.`o'L i.
9
_enter- Raleigh. AC

2 on To' NC Dept of env. and Na Sescur
-„ne' ,..3534 PM
280445
WELL COSSTR1` '_ It='. RECORD
:`rii'. r .. an of Fnirc.,n-enc, and Natural Resources H. < :r. -. Quality - Groundwater S eozi :n
WELL CONT -CTOP (\DPJ?DUAL) NAME (print) SCOTT GANTT CERTIFICATION -_24
r ._,,, CO, 'O\IPAAP NAVE. C:AROLINA 6 ... .Si. INC. PHONE # [phone]
.:Cii I. CC Nii ISO: CT".ON PERMIT # i 002.1.1TED WQ PERMIT tt
tifapplicabigi
Azricuitsal L
J3; F [IRS a.'1 !. .
_ ii2l ❑ A4_eioi
=a; Puiru n?e;tion ❑ C r .cr
Court' RITHERF
Code)
YES ❑ N'O
55
-_ __._ D Or TEST ARD\7
210
1'POCHInCrN P Ammmt 6
Wr!I Thickness
L vt'elehEF: MEd'
SDR 21 .-
1.12E 2.a
GRE , 1 ....
SIN Snc Vero rE
n
_1:1S_ ANDtHA.__ COPY OF THIS LCC.r •_
SIGNATURE OF PERSON ON Tt,.'
ae _ilrisio_, of Water Quality, Gronnd«ater 3ezi;o::.
33- 3221, n iS$a 33 flays.
iopc_aphac Lan sin
j Pidae ❑Scope ❑'�-r._
Lonsanttle of well _coat...
3526.624 l =152.456
LOC A. ION SKETCi;
.! distance ni ¢;tics _oc p..
nsmes.
01
.AAis.-iC7C_U'EL
: D TO THE WELL O ' E7.
9.. rOS'
ELL Date
ter- Raleigh, NC
t1 L-1I

280446
WELL C &ems
iroamenT, and Natural Resources
. mN z«w SCURF GAN-R-
GONIPANVNAMm CAROL . WEIR. ..,:
f ION PERMIT #
B.Residential n
YES
e
ARQNI
w: +': S. n».
wee <cTHIS
:n er Quality,muv mc:
u a,nOcnz days.
D
llry - Groundwarar Sebbelbb
CERTIFIC mo>_
«a» (704)ate _
e WQ PERMff# _
K m«
Lai »te e
Topographic.Land wy
2<m Smm 2 w«
z
o CPS
NS <H
ILVIRERBROCulb
»m
ISA xx «WELL
;<?
-1
/
«
r
rm

Flom oiin fic To: NO Dept of Env. and Na Resour
2S0447
seurecl x:2>
Sf
WELL CONSTi : y
z:= :m and Naturalll- «: m- 'Groundwater
v »ma«— «m ,N !c w ac«« _ m,
,e:wv :wmw vw a_»A WELL PHONE , as
x'.7 '.1CT1ON PERMIT #
SOCA-TED PERMIT tt
(IT -applicable)
:B , Red1DeutiD1 Muntabba, ? an ,2 ATicultaral
Pump :bucctiono :m?<
C'D'InrY RUT
YES o NO
6,3
ARDM
Amount 4
Wall Thiclutes,
Sve
w CiUNSTRUCTELi:
b OF THIS
ision:ter Q +Gro Groundwater v «m»:
33-3221, w 30 days.
CF. FT
-
fel
X
LOCATION c : @ -/2
. and v,>aL c w e 2
e 5. •«i «� 2
centerce Raleigh,v

I`-.-:+. Caro.ns. e°.'r. ;no To: NC Dept of Env. and Na Resour
'ere a'1912003 Time' 7 37''52 PM P=_e 3 of
WELL CONSTR.T ( -
lri (—rise - D? n. r ient of Environment, and Natural Resour os -
E1,10 C( `R :OR (0NDINIIDITAL) NAME (print) SCOTT C _N 1
F I.I, CONTR.aC, f OR CO)IPANY NAME CAROLINA WEI.I, DE.
S l A IE l: L- LL :'O\STRUCTION PERIIIT #
=lea
r '-Box) Residential ® Yt r.pril
1'ecoCory i_' ieat Pump Warer injection ❑ er
_. r.._ County'
s:
Zip Code)
NC
Sta:e
YES
,... = if Abo.c Top of Casing)
,ve Land Surface'
.., rcgev.v7_avcm
METHOD OF TEST ARDM
ac
HYPOCHLORITE Amount
Wall Thickres
D'mce orweig vFt _ .: r'i,T
Ft. 614 SDR21 r-,..
Material ]vhcl
GPACEL MIX ., 11
280897
}RECORD
- er Quality - Groundwater Section
CERTIFICATION # 2524
INC. PHONE # [phone]
ASSOCI_ATED WQ PERMIT #
(if applicable) _
-:al. ❑ Agricultural ❑ Mor torn.e
Topographic./Land setting
:die ❑ Slope ❑ 1 a ey
_.@mdeLonsdude ofwet! Meaux
3535 291 /82.0930-
(de(y'ce:miner es ccon
22i=hide source: ❑ GPS ❑ Topen_ splec
DEPTH DRILLING LOC
To Formatir:. _. erica±:..
2' Clay
100 Conaohdred Rock
LOCATION SKETCH
L - tca v'::nt L 1 . i
or C unty- Roads inelLic.:__ .._..
_ common road names CCD
O
0
fV
O
O
0
iH?,T THIS WELL WAS CONSTRUC L)':L_ - --
S Rl r ')`, 5 r> 11RDS, AND THATA COPY OF THIS RLCO t r 6 L.•
SIGNAILRE OF Pc :SJ] C
„Dwit 111e _. he Division of Water Quality, Grounds _".. -
3T099-i 635 P. n .a. 919) 733-3221, within 30 days.
i 5 _A N C AC 2 C, WELL
1A IDED TO THE WELL OWV ER.
10 19 03
Date
.cr-center Raleigh, NC

rc 0o: NO Dept of Env. and Na Rescuer
'7073 Time: 7:37:52 PM race cor 7
280898
WELL CONS RL,C TI(1 RECORD
1,:c t}l c arch. _ Doniiir;ent of Environment, and Natural Resources - Diiiii..._ ' .ter Quality - Groundwater Section
P'tilii'• CONTRACTOR (INDIVIDUAL) NAME (print) SCOTT CAN) T CERTIFICATION # 2584
3VELL CONTRAC tOR COMPANY NAME CAROLINA WELL DR,L(ERN INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable)
' i-' ", iculraral ❑ A`.aritorin?
:ort_ . e dential ❑
Pump \V ier Injection ❑ Cti hc-t
eon -, _ ::.ur.oin. No,. Zip Code)
NC
Sate
_, ,:iCGei rLL2 YES ❑ 0 —
...._.___.,a.vTo!icfCasinp: 90 ET
:L : - f(doom Top ofCas6�)
.. 0.ove Land S_cftce"
ARDM
Amount
Wall TTnckces;
Diameter or Weight/Ft
6 i 7 " SDR 21
\lateria!
GRAVEL MIX
Gamete: Slot Size
LT
Topographic/Land setting
dge ❑ slope ❑ Vr➢e
dmde/Loneimde of well lec:ria::
35.26. 310 182 09.35'
(dereeshninutesisecond_i
oneitade source: ❑ GPS ❑ Tonoeaphic snap
.)_PlY. DRt:TANG LOG
To Forms^, De>.r.9.5 `
Clay
Consoli 1z: ed }lock
I.CCATION SSETCH
rind distance in miles from at. test
Dads or County Roads. Include the. road c
1 conmion road names. • C
OI c �'
N o
•C
• r^.
n
CD rr
en
O —,
. i4T[HIE WILL WAS CONS r_: F t t .,t_I;a NCAC 2CVVELL
- tT09, AND -.LUKEACOPY O- "I 'tti , LL.0. 191.7.0.O THE ICELLORILR.
10' 19;03
SIGNATURE OF VERSION 5'
' /E LL Date
:vrr a 'P ":..'t;Division of Water Quality, GroundwaterS_-ion.- "::;' '-twice center - Raleigh,NC
,7i:99 1 i:38 PhD_, N_. (9I9) 733-3221, within 30 days.
RF\

la co CarGoa Wan Dn:l ers I,rc To: NC Dept of Env. and Na Resour
6.-0C3 Time: 737'52 PM
Pace 5
WELL CONSFR CSit
'Corth Carol .Ea Department of Environment, and Natural Resources -D
P ILI. CUT[RA:: t=OR (INDIVIDUAL) NAME (print) SCOTT Ce,S
WED. CONTRACTOR COMPANY NAME CAROLINA WEI,L. D.
-4?ATE 1). ELI,_ _oABTRtICTION PERMIT#
ele Bad Residential Q
Heat Pump Water Injection ❑
Other
RE County RC iIDRF04.c
St itd. ottoy L,ot No,. %Ip Code)
NC
State
'Ss al WELL'
Too-: of Sastre:
YES ❑ No
160
-' tfALov: fop of Casing)
above Land. Surfaces
r:que s cisia.c v�
:LTROD OF TEST ARDN!
H:'POC'HLORITE Amount 8
Wall Thnitramc
it meter or WcighnFt • ant
6I'4 SDR21 PVC
D: c te;er
Material 3LuhcJ
GRAVEL MIX OR.-AVIi `_
Slot Size
in.
280S99
1tECORD
` tVa'er Quality - Groundwater Section
CERTIFICATION # 2584
INC. PHONE # [phone]
a.SSOCIATED WQ PERMIT #
(if applicable)
Urn ❑ Agricultural ❑ Monitoring _
use
Topographiciand setting
❑ Ridge ❑ Slope ❑ Valley ❑ Fl.t
Latitude/Longitude of n ell location
3536.846182. 10.013
(degreerminr:tesaeconas)
_imde source. ❑ GPS ❑ Topoeraphic n:ap
DiULL',N G LOC
To _ cnnaficn Desoiin nn
SO Clay
400 Consolidated -Rock —
LOCATION SKETCH
:I End distance ni nines Iron', sill-SIDE-5
.v or Count- Roads. Include the road ('')
^,lop road nacres. C8
—4
O
CO
O
-: THIS WELL WAS CONSTRUCTER as la_..
DS, AND THAT A COPY OF THIS E.ECUIED I LAS
SIGNATURE OF PLod:dr: CJI.
:._ .. AID. is oa of Rater Quality, Group heaie _
r r` 733-3221 v. thin 30 days.
I la Ili: 1LANC.AC 2C.WELL
CHROVIELED TO THE WELL OWNER.
10,19'03
Date
er Raleigh, NC

r:rr'. Caro)r, ‘,Vet Dnear, Inc To'. NC Dept of Env. and Na Resour
'(ll-3!2003 Time: 7:37:52 PM
ebo"7
280900
WELL CON STR1i C i''_ 13
aft merit of Environment, and Natural Resources - I?) €I A, ('O\l i &C t CR (r DIVIDUAL)NAME (print) SCOTT G tN 2
7 LT, <'O1 I OR COMPANY NAME CAROLINA WELL v—
St if Ell. CONSTRUCTION UCTION PERMIT #
r , 1:; ,p a'Box; : Residential El
. Pump Water Injection ❑
cle
E S
County RURUT-HEREHE.
Evisioa. Lot No,. Zip Code)
OF RUTHERFORDTON
TASS
NC
State
YES 7 NC;i elate l tip of Cnelng'' 65
Ifabovc Top ofC Casing)
FT Above Lard Surface*
:cc in
\roo-I DOF TEST ARDM
: i _POCIiLORITE Amami 8
Wall Tridce_,
Direr.._ orI4eigh . Material
SDR 21 P C
@iaterial
GRAVEL MIX
GRAY :A:
Dirsee�c Slot Size Mat
L
�� C"ORD
ter Quality - Groundwater Section
CERTIFICATION # 2=84
tiC PHONE # [phone]
SSOCIATED WQ PERMIT#
(if applicable)
r. 1 D Ag'icultnral ❑ Monitoring
se,
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley El Flat
:rode; Longirrde of location
35.26.751 181.48.628
(dep eslminutesaecorDs)
noatude source: L] GPS ❑ Topographic map
22111 DRILLING LOC
Tc Formation Description
85 Clay __..—_...
300 Consolidated Rook
LOCATION SKETCH
ancl. distance, to miles from r. least O
sor County Roads. Include the road Ca.
dram road r:atnes.
O
CO
O
N
D;I' THiS33 ELL WAS CONSTRUCTED _L11E)2
S, AND THAT A COPY OE TEES _
scs
S ICAATERI-: OF t'ESS INC: EN -
1. Eft"-, _ 15ANCAC 2C, WELL
J I)ED TO THE WELL OWNER.
Natural; Via. _. .* -D -c;ra of Water Quality, Groural ..,*_..,,,. ...
Pd:cre `-:;. (6M3) 733-3221, within 30 days.
10' 19 /03
Date
Hier - Raleigh, N C

F C_. _Ilea f re'. 3 _ lec To: NC Deoi of Env. and Na Rescur
0 '2303 Time: 7:37:52 PM
Pace 7 et 7
280901
• WELL CON SIR).
Carolina - Department of Environment, and Natural Resources - A,
\V1?Id. CONTRACTOR (INDIVIDUAL) NAME (print) SCOTT CA'r-iT
V: ELI. CONTRACTOR COMPANY NAME CAROLINA WELL `RI Lti
S EAT WELL CONSTRUCTION PERMIT#
(it applicable)
r:.LI 7 c7E.:71I asBox): Residential ❑ Nt iciEa
Heat Pump Water Injection ❑ O(`_ei L2
- 12 i;35C�
a-rzer'sodr.c.
County RL.Tb:E
ay, S b±viuon. Lot\o,. Zip Code)
iFF.V.T1 RSirNG WELL?
CT _TIC AV .1 :: Li: 3ciow Top of Casing:
(Us: If Above Top of Caine)
.-\bout Land Surfaces
? 0"ES7 ARUM
120 210
'YPOCHLORITE Amount
Wall Thickness
Diameter or Weight:Ft Mt a ia'.
6 U4 ^ SDR 2 i PPS
YES ❑ NO _
65 FE
61ateria:
GRAVEL MIX
Slot Size ?Saar....
Sae
RLi ORD
f Water Quality - Groundwater Section
CERTIFICATION # 2584
RS, INC. PHONE # [phone]
ASSOCIATED WQ PERMIT#
(if applicable)
Agicultural ❑
L
Monitoring
Topomaphiciand scuba,
_c;dge ❑ Slope ❑ Valle ❑ Flat
L atifideLongimde of sce11 location
35.23.673! 8149.935
(decrees/minutes seconds)
leneitude sauce: ❑ GPS ❑ Topographic map
DEPTH DRILLING LOG
To For :a]on Description
123
220 Coi solidated Rock
LOCATION SKETCH
L
O
—radan end distance in miles from at leactte
Keatu n: County Roads. Include the t
sed crn:anon mad names- '—'i
O
co
O
MIS WELL WAS CONSTRUCTFO _7
}PIS, AND THAT A COPY OF THIS . C_
\CAC2C, WELL
IDED TO THE WELL
1019/03
SIGNATURE OF PERSON C ONSTRL C --.7
tiulrnai the uric..: a' t ifse D*.ision of Water Quality, Groundwater Seot o _-
`.7$99-i g3h Phuz a. (9;9) 733-322i, ssithin 30 days.
Dare
rice center - Raleigh, NC
1 CW-1 REV. 07.2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
J rrt s w Cam(, Jr
WELL CONTRACTOR COMPANY NAME ramp' v Wn11 x, Pump On_ Tnn
STATE WELL CONSTRUCTION PERMIT/0 ASSOCIATED WQ PERMITW
(if applicable) (if applicable)
280860
- Groundwater Section
CERTIFICATION/it 7 1 i 8
PHONE p,Ql7Ft) dei R_7'j22
1. WELL USE (Check Applicable Box): Residential 0 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 Olt
Nearest Tgwn: Coun(,I�G 13ty
l-tc al v, 1 \A 0-tt,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
""""
3. OWNER: 11I)-t C3W
Address "'l SU fi
ect or Route .R0o.)
JLO i
City r Town State Zip Code
6k9S)- lSla- )-1 \u
Area code.- Phone number
4. DATE DRILLED �1 • iJ 3
5. TOTAL DEPTH: C 5
s
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO tl
7. STATIC WATER LEVEL Below Top of Casing: \ U FT.
(Use "t" 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 METHOD OF TEST Ai r
10. WATER ZONES (depth): JAI)
Topographic/Land setting
Ctl1idge ❑Slope (Walley OF1at,
(check appropriate box)
Latitude/longitude of well location
(degrees/minu¢s/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING Li -Oa --
From To Formation Description
0.L
s
31 5
1l. DISINFECTION: Type Chi nri na
12. CASING:
Depth Diameter
From p To t
From To
From To
13. GROUT: Depth
From—0— To 2 0
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS'
Amount C. Q
Wall Thickness
or Weight/Ft. Material
Ft. 6 1 / 4 cDR-71 PVC
Ft.
Ft.
Ft.
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Material
Neat Cement
Method
Hand
Size
Ft.
Ft.
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.
_AL,(, `—L so
o c
c,
c>_
O
0
IV
0
0
w
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC IED IN ACCORDANCE WITH 15A NCAC 2C, WFI r
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HASEEN PROVIDED TO THE WFI I OWNER
gyp L , (
SIGNATURE OF PERSCJN CONSTRUCTING THE WELL I
10-la-CS
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
f
00
0

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James yr- Camp Jr. CERTIFICATION ii21 3R
WELL CONTRACTOR COMPANY NAME ramps s Wall & Pnmp ('ram Tnr PHONE #$2R) c5R _7122
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 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:
Cn0t4tM
County
(Street Nam; Numbers, Comntimiry,Suubbdiivision, Lot No., Zip Code)
3. WNER'L S/
A1M�U�Rh.
ddrzss
(Stra or Route No.)
SJ. VAA -k-i .`),() ,)-L\
City or Town State Zip Code
'L('/ln)- 6,(2.--2oc)en
Area code- Phone number
4. DATE ORD. r FD q
5. TOTAL DEPTH: L1 a S
6. DOES WELL REPLACE EXISTING WELL? YES t NO 0
7. STATIC WATER LEVEL Below Top of Casing: (o 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 1SA NCAC 1C .0118.
9. YIELD (gpm): 1 Q METHOD OF TEST 4, r
10. WATER ZONES (depth): L( 0 U
11. DISINFECTION: Type ('h 1 n r i n a
12. CASING:
Depth Diameter
From p To rL 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 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 C)p
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Material
N at Cement
Method
Ha
16. REMARKS:
280856
Topographic/Land setting
\Ridge OSlope OValley ❑Plat'
(check appropriate box)
Latitude/longitude of well location.
(degrees/minutes/seconds)
Latitude/longitude source:OGPS❑Topographic trap
Dam PTH (cheek box)
PRILTSN�'r LOG
From To Fgrmat{on D
gs Q;15
LOCATION SKETCH
Show direction and distance in miles from at
two State Roads or County Roads. Include
numbers and common road
f
O
0
—4
rV
0
a
-S
0
w
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC IED IN ACCORDANCE WITH 15A NCAC 2C, WFl
CONSTRUCTION STANDARDS, AND THAT A COPY 0THIS RECORD HLI/)AS BEEN PROVIDED TO HE WELL OWNER
C_TII
�J4 tea i SIGNATURE OF PERS, QN CONSTRUCTING THE WELL /
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
DATE
/6- iD-c3

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James sir Tr. CERTIFICATION if 7118
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMITN
(if applicable)
ramp' s WP11 R Pump f'- 7 Tnr-
ASSOCIATED WQ PERM1Tt
(if applicable)
280857
PHONE Mf{7A) dsl_7322
1. WELL USE (Check Applicable Box): Residential (LY-Municipal/Public ❑ Industrial 0 Agricultural 0 .
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI Mnn •. (n� liW ()
Nearest Town: LA -KS/ `O.31 �i Countya
17.r4•
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: C'Q1 \\ ZAIa
Address a,G-.a i<1.
(Street or Route No.yI
1-TZ 11.3 N
City or Town State
(41C0- .-2L\ S - Sri 5 Le
Area code- Phone numb�5.
4. DATE DRILLED d f D 3
5. TOTAL DEPTH: �1 S
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YE b'NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 30 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 with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST a ; r
10. WATER ZONES (depth): 10
11. DISINFECTION: Type r'h 1 nr i n P Amount
Wali Thic)mess
or Weight/Ft. Material
clDR-21 PVC
12. CASING:
Depth, " Diameter
From_ To O Ft 6 1 / 4
From To Ft.
From - To Ft.
13. GROUT: Depth
From 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.
Material
Neat Cement
From To Ft.
16. REMARKS:
Method
Hand
Topographic/Land setting
❑Ridge ❑Slope DValley OFlat
(check appropriate box)
Latitude/longitude of well location-.
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Fo tion scription'
f) U )1
-
SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
T( ` -aJ F\Cam'
a
0
r�
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS 13EEN PROVIDED TO THE WELL OWNER
a.44 le_id. 1A1 , ra, v, ) 0 ) C — Li
SO SIGNATURE OF PER�iaa 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
c
0

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J a mats D' Camp , Jr -
WELL CONTRACrORCOMPANY NAME rater' c Wa1 1 R Primp Cn Tnn PHONE #$?ill) 4Si_ 7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) r.,/ (ifapplicable)
to
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 LOCH ON: ,p� (�� �
Nea�(es(,Tgwri:0 X-t Counry' .L \\„1, 4/u
A
(Street Name, Numbers, Communay,,SS,u��bdivision, Lot No., Zip Code)
3. OWNER: UCCJ l^ C
Address PkC.C,I
(Street of Rome No.)
Cityv{ own State
- IOS— S1L%-
Area code- Phone number
4. DATE DAD' fFD q-fi. D 3
5. TOTAL DEPTH:1 0 S
Zip Code
280850
CERTIFICATION # 7 1 13
Topographic/Land setting
❑Ridge ❑Slope Valley ❑Flat)
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From T o F typn Descpprion
0
U PA AA
a- 7us J
6. DOES WELL REPLACE EXISTING WELL? Y4 0 NO clq
7. STATIC WATER LEVEL Below Top of Casing: 0 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 accords a with 15A NCAC 2C .0118.
9. YIELD (gpm): MET D OF TEST i
10. WATER ZONES (depth): 11 A`\l"
11. DISINFECTION: Type rh1 nri nat Amount ,� (J
12. CASING: Wall Thiclsess
Depth Diameter or Weight/Ft.
From p To 5 0 Ft. 6 1/ 4 Qpa? 1
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 Sizc 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:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the roa
numbers and common road names,
O
w
O
0
N
0
0
co
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUL IED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY O THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PER$9N CONSTRUCTING THE WELL
/a to -b.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

280SSt
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J me sot catnipJr CERTIFICATION # 213R
WELL CONTRACTOR COMPANY NAME Camp' c Wa11 R Primp f n Tnr PRONE Na?,?Al 451-7322
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERM1Tti
(if applicable) (ifapplicable)
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 T wn: ON: County
n` p (\
Ne es T wn: Court 1 1-L"4_ i..4VU
(Suect Name, Number, CommItInl Subdivision, Lot No., Zip Code)
3. OWNER: (! ICA�� y
Address �i.�f M l-
\SOft�w...CAA '�. \ylJ J
QOX (Socc� RCouto No.) j`70
City or Town Stain Zip Code
Area code- Phone number
4. DATE DRILLED t 3
5. TOTAL DEPTH: 60 S
6. DOES WELL REPLACE EXISTING WELL? YEAS 0 NO
7. STATIC WATER LEVEL Below Top of Casing: j 0 0 FT.
(Use " i-" 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 accordancse with 1SA NCAC 2C .0118.
9. YIELD (gpm): ` . MET�$p O1D OF TESr d
10. WATER ZONES (depth): \A &ur\ T
11. DISINFECTION: Type f'h 1 nr i na
12. CASING:
Depth Diameter
From p To 2-Pk Ft. 6 1 / 4
From To Ft.
From To Ft
13. GROUT: Depth
Amount / 2
Wall Thickness
or Weight/Ft. Material
W1,21 PVC
Material Method
From p To 20 Ft. Noat 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.
Size .
Slot Size Material
in.
in.
Material
Topographic/Land setting..
❑Ridge (2 1ope ❑Valley DFiat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box) ..
DEPTH DRILLING 1.O0
From To Fo ones p oni
n Ai{ Sti
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.
,lt VMt\ �I
�u t
CD
c C`
z='
-'r r„
as
_ ate.
9
cn e_
rn -
o G
16. REMARKS: z
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC1hD IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 00 THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
6144'te4 w ' (ot,ly
SIGNATURE OF PERSC/N CONSTRUCTING THE WELL
DATE
—i
f
O
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) —J arnn s W Caw rtr Jr -
WELL CONTRACTOR COMPANY NAME ("amp' c Wn1 1 R Pnmp C'n Tnr'
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ PERMIT,/
(if applicable) (if applicable)
28(1841
- Groundwater Section
CERTIFICATION if 71 3 R
PHONE ,/$S7R) 3_7322
1. WELL USE (Check Applicable Box): Residential dr Municipal/Public ❑ Industrial 0 Agricultural 0 j,
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCH IO�I:
Nest Town: AU
�/�QAJAtAn'n
County \\ (.1 4.1/.,tP
(Suter Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ' A.
Address k"- . \ 1S Cl, 0
--(sweet or Route No.)
<< 3, C Iv ( K o Lk
City o Town tam Zip Code
( - `-Xt, ..)-4nI 5
Area code- Phone number
4. DATE DRILLED - L - 0vS
5. TOTAL DEPTH' J'G 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO scicl
7. STATIC WATER LEVEL Below Top of Casing: 1\ k) 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 accord nee with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST air
10. WATER ZONES (depth): 3U 0
11. DISINFECTION: Type rh 1 nr i na
12. CASING:
Depth , Diameter
From p To 55 Ft. 6 t /
From To Ft.
From To Ft.
13. GROUT: Depth
From o To 2 0 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.
Amount 1,
Wall Thickness
or Weight/Ft. Material
RDP21 PVC
Material
Neat Cement
Method
IIand
Topographic/Land setting.
:Midge ❑Slope ()Valley artPlat,
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source;❑GPS❑Topographicmap.
(check box)
DEPTH DRILLIIOG-
From To r_Fo tion Description
n c i i ADA
S 9,I-) �a
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers apd cod mon road names.
Q
ituk
16. REMARKS: AO -(
fuA
I DO HEREBY CERTIFY THAT THIS WFI I WAS CONSTRUCLED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0THIS RECORD HEEN PROVIDED TO THE WELL OWNER
CD
G244 tG i
SIGNATURE OF PERSCIN CONSTRUCTING THE WELICIE4Y 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
0
0
fd 10—(
V
7y

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James TOCamp, Tr CERTIFICATION# 21 38
WELL CONTRACTOR COMPANY NAME ramp' ¢ Wm 1 & Pump Cn_ Tnn PHONE #832A) d.Si-7 =;22
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential NT Municipal/Public O Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATJ0t
Nearest Town: Uz, �J,i.'�1 County S,
(Sweet Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: � I Xh 9 X Ct,M QX Le —
Address \,?t f (`�W,..,.s.,,\ l
\AiA.)- � / Cute NO.) 1(A
City)- or T wu SrateqZC\ Zip Code
( �SL C.
Area code- Phone number
4. DATE DRILLED q n. 0
5. TOTAL DEPTH: ? CI S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E0
7. STATIC WATER LEVEL Below Top of Casing: LSD 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 cg with 15A NCAC 2C .0118.
9. YIELD (gpm): 0D OF TEST Sir
10. WATER ZONES (depth): /U
11. DISINFECTION: Type rh 1 nr i na Amount (`t
12. CASING: Wall Thiclmess
Depth _ Diameter or Weight/Ft. Material
From 0 To .1 S Ft 6 1 / 4 SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From p To 20 Et. Neat Ccment 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.
Topographic/Land setting
ORidge ❑Slope ij3Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreesiminureslseconds)
Latitude/longitude source:OGPSOTopographic map .-
(check box) `
DEPTM pRILLINd I OG
From To ormajLon Description
0 --1 S v k
1 S S picoh
J.00ATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers Qrd common road names.
371.
O
16. REMARKS:
O
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCIE.D IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERS9N CONSTRUCTING THE WELL
/0—Jo-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

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Tams ur _ C alp lvr Jr - CERTIFICATION # 21 3 R
WELL CONTRACTOR COMPANY NAME ramp' G Wa1 1 X, Pump en_ Tnr
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential tir Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT ON,
(Sneer Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Q3tLQX C4,11(Q
Address\,7iV t (S,1,t,t~.I-6,,,1 (, l
28(1S(1 s
PHONE #tt7R) d53_7322
Nearest Town:
(Saw or Route .)
\AN \l0.nx. tJ C r Yc L
ry oLIT o Srarc Zip Code
(i2KCi)- S' q � Ll \
Area cedePhone number
4. DATE DRILLED Q" n, l)
5. TOTAL DEPTH: Q D
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 t FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance in accord cp with 15A NCAC 2C .0118.
9. YIELD (gpm):M1JiOD OF TEST
10. WATER ZONES (depth): 1Ss
11. DISINFECTION: Type rh 1 nr i n
12. CASING:
Depth Diameter
From A To'l S Ft.6 7 /4
From To Ft.
From To Ft.
13. GROUT:
Depth Material
From 0 To 30 Ft. N at 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.
Amount Ci
Wall Thiclaess
or Weight/Ft. Material
e9R21 PVC
Method
Hand
Slot Size Material
in.
in.
From To Ft.
Topographic/Land setting
DRidge ❑Slope 1E:Walley ❑Flat
(cheek appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:DGPSDTopograplilc map
(check box)
DEPTH DRILLING LOG
From To
n S 0 on Description------
`I
- -oS
J.00ATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
sum);erg Id common road names.
*.ru
Q Q%A.IL.-CL J
CD
C3
CD
b
9
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WFI I WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL �� DATE
0
10--/0-0_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

SIG CONSTRUCTING THE WELL
281385
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 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: LAKE LURE County RUTH
BILL'S CREEK RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MICHAEL GRAHAM
Address 4365 BILL'S CREEK RD.
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
(561) — 968-6373
Area Code Phone number
4. DATE DRILLED 11/10/03
5. TOTAL DEPTH: 605
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 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 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:
Topographic/Land setting
0 Ridge 0 Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) 17±1
ti�
Latitude/longitude source: ❑ GPS ❑ Toppgtaphrc map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles rom at lea.
Two State Roads or County Roads. In Jude th,,,uad
number and common names
HWY. #64/74A W. FROM RUTHERFORDTON.
RIGHT ON COVE RD. LEFT ON BILL'S CREEK RD.
APPROX. 1/4 MILE ON LEFT.
0
CO
r)
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
�n_ �l i�
NATURE OF PE ON CONSTR 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 30 days. GW-1 REV. 07/2001
3
t�tr
Sc

281384
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: FOREST CITY
FREEMAN RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip
3. OWNER: NORVIN CLONTZ
Address 649 FREEMAN RD.
(Street or Route No.)
FOREST CITY NC 28043
City or Town State Zip Code
(828) - 288-8076
Area Code Phone number
4. DATE DRILLED 11/18/03
5. TOTAL DEPTH: 510
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO EI
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): 60 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
Code)
11. DISINFECTION: Type CHLORYTE Amount 13.5
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. 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 ❑ Tgt pograph crm4 —� (check box) `
DEPTH
From To G'
DRILLING LOG
From To
LOCATION SKETCH • -
Show direction and distance in miles f oni
Two State Roads or County Roads. Include
number and common names
C— 7i
FROM BOSTIC. GO OUT PEA -=-
ON WHITESIDE RD. RIGHT ON FREEMAN RD. 1
MILE ON LEFT. WINDOVER FARMS
CC :01 UV 1- 030 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 WELL OWNER
S GNATURE RSON CONSTRU TING WELL//D TE 6�
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

281383
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
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑
2. WELL LOCATION:
Nearest Town: ELLENBORO County RUTH
DOBBINSVILLE EXT.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: KATHY CULBERTSON
Address DOBBINSVILLE EXT.
(Street or Route No.)
ELLENBORO NC 28040
City or Town State Zip Code
(828) — 245-5681
Area Code Phone number
4. DATE DRILLED 11/11/03
5. TOTAL DEPTH: M 305
6. DOES WELL REPLACE EXISTING WELL? YES ® NO 0
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): 100 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 7.5
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. 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:
0 Industrial 0 Agricultural 0
If Other, List Use
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) t' C
Latitude/longitude source: 0 GPS ❑ Topographic rga—
(check box) i -2 t,_. r
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles frm at
Two State Roads or County Roads. Inch4de the roaE T TJ
number and common names
BUS. 74 E. FROM ELLENBORO. RT. ON RACE
PATH CHURCH RD. LEFT ON DOBBINSVILLE
EXT. 2ND HOUSE ON RT.
(,:
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND T,HAQT�A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
( , li �/ %Q—n-41--- try-(7-Ne / f -/I-6.3
SKJNATURE OF PERSON CONSTRUCTINWELL 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

281379
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: BOSTIC County RUTH Topographic/Land
LAKE WAY DR CHERRY RIDGE SUB. ❑ Ridge ❑ Slope ❑
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) (check appropriate
3. OWNER: LISA MILLER Latitude/longitude of w
Address LAKE WAY DR
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code
(828) — 287-4239
Area Code Phone number
4. DATE DRILLED 11/04/03
5. TOTAL DEPTH: 185
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IZ
7. STATIC WATER LEVEL Below Top of Casing: 4 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):
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To 40 Ft.
CHLORYTE Amount 5.5
Wall Thickness
Diameter or Weight/Ft. Material
6-1/4" SDR21 PVC
From _ To Ft.
From To _ Ft. _
13. GROUT: Depth Material
From 0 To 20 Ft.OULKRETE
From To Ft.
14.SCREEN: Depth Diameter
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Sizc
To _ Ft.
To Ft.
From
From
16. REMARKS:
Method
POURED
Slot Size Material
in. in.
in. in.
Material
From
g_I
]ley ❑Flat —_,�
M)
Vibetion
1
(degrees/minutes/sec Iids)I
Latitude/longitude source: ❑ GPS 0.?Topographic
(check box
DEPTH i
From
DRILLING LO
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
BUS. 74 E. FROM FOREST CITY. LEFT ON
BOSTIC/SUNSHINE HWY. RIGHT ON SALEM CH.
RD. LEFT INTO CHERRY RIDGE. GO AS 1a HE
LAKE AND TURN RIGHT ON LAKEY DR
APPROX. 1/4 MILE ON LEFT.
0
n
0
ca
M11
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS CTION STANDARDS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
e-e� J �K�a ,✓/1�2�e—n-,/mot_ 71�� // -o 3
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

281378
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 ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use t
2. WELL LOCATION:
Nearest Town: UNION MILLS CountyRUTH
Topographic/Land setting
HUDLOW RD. 0 Ridge 0 Slope 0 Valley:
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) (check appropriate box
3. OWNER: SYLVIA PIMENTEL Latitude/longitude of well ]pcaritjn
Address 6207 HUDLOW RD. ,
(Street or Route No.) (degrees/minutes/secondk),
UNION MILLS N C 28167 Latitude/longitude source: 0 GPS q Topographic ma
w(
'
City or Tow
n State Zip Code check box)
(828) — 287-5327 DEPTH
Area Code Phone number From To
4. DATE DRILLED 11/17/03
5. TOTAL DEPTH: 460
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): 100 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 12
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 75 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
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:
Material
DRILLING LOG
From To
)±
Flat 1 G-fi
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 N. FROM RUTHERFORDTON. RIGHT
ON HUDLOW RD. APPROX. 1/10 MILE ON RIGHT.
PAST POST OFFICE.
UV 't-330CC
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
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

28137'i'
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 ❑ 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: ELLENBORO
PINEY MTN. CHURCH RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: COLIN ADAIR
Address 816 PINEY MTN. CH. RD.
(Street or Route No.)
ELLENBORO NC 28040
City or Town State Zip Code
(828) — 245-7351
Area Code Phone number
4. DATE DRILLED 11/10/03
5. TOTAL DEPTH: 65
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 45 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 RUTH
11. DISINFECTION: Type CHLORYTE Amount 9.2
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
From 0 To 20 Ft. CEMENT
From To Ft.
I4.SCREEN: Depth Diameter
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size
From 45 To 65 Ft. 78M
From To Ft.
16. REMARKS:
Method
POURED
Slot Size
in.
in.
Material
in.
in.
Material
GRAVEL
Other
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley! ❑ Oat
(check appropriate box)
Latitude/longitude of well location!
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Tlopggtaphic map
(check box)
DEPTH cT
CC=?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 the road
number and common names
BUS. 74 W. FROM ELLENBORO. RT. ON PINEY
MTN. CH. RD. DOUBLE -WIDE ON RT. ACROSS
FROM NEW SCHOOL
0
CO
0
0
c�
ti
CO
CO
rV
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TFIAT A COPY
OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/r(t-cam %1 cJy' --e C/ c� WC7 7�_. // —/ G —Q,
SIGNA RSON 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

281376
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 D Industrial ❑ Agricultural D
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
LAZY CREEK DR.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JOSH ELLIOTT
Address LAZY CREEK DR.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 429-0219
Area Code Phone number
4. DATE DRILLED 11/25/03
5. TOTAL DEPTH: 57
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
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): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 57 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 37 To 57 Ft. 78M
From _ To _ Ft.
16. REMARKS:
Material
GRAVEL
Topographic/Land setting r ---
❑ Ridge ❑ Slope ❑ Valley 0 Flat —) L.T.
(check appropriate box) , r-__ L—'~—
Latitude/longitude of well locatOn j I G
(degrees/minutes/seconds) t ;
Latitude/longitude source: 0 GPS ❑ Topo1rathic map
(check box)
DEPTH
From To 1 i
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 COOPERS GAP RD. APPROX. 6 MILES.
RT. ON LAZY CREEK DR. LEFT ON 2ND DRIVE.
1/10 MILE ON RT. c
o
0
rfl
0
w
N
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
C i
SIGNAOFON CONSTRUCTING THE WELL t DATE
r/79--e //- 2
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

281375
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: BOSTIC County RUTH
SELF RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LANDON RICE
Address 251 SELF RD.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box ,
Latitude/longitude of well 1Qcation r R
(Street or Route No.) (degrees/minutes/secondlyf
BOSTIC NC 28018 Latitude/longitude source: ❑ GPS ❑ITgAgraphii:map
City or Town State Zip Code (check box) ,
(828) - 893-0838 DEPTH
Area Code Phone number From To --.
4. DATE DRILLED 11/26/03
5. TOTAL DEPTH: 48
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 33 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 48 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 33 To 48 Ft. 78M
From To Ft.
16. REMARKS:
Material
GRAVEL
DRILLING LOG
From To
LinI,
LOCATION SKETCH \L
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
BUS. 74 E. FROM FOREST CITY. LEFT ON
BOSTIC/SUNSHINE HWY. LEFT ON LUCKADOO
MTN. RD. GO APPROX. 1/10 MILE. LEFT ON SELF
RD. 3RD. HOUSE ON LEFT.
0
0
rD
c-)
0
0
N
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
T 6 / A- , // - 6 o_
IGNA OF N STRUCTIN3 THE WEL 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

281178
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RICHARD MCCRARY CERTIFICATION # 2010
WEr7 CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INCJBARKER WELL & PUMP PHONE # (828) fig 2283
STATE WELL CONSTRUCTION PERMrr# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable,
1. WELL USE (Check Applicable Box): Residential El Municipal/Public O Industrial O Agricultural O
Monitoring O Recovery O Heat Pump Water Injection O Other O If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS County RUTHERFORD
HWY. 74E , TAYLOR-WATKINS ROAD
(Sheet Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JO ELLEN TAYLOR
Address PO BOX 32
(Street or Route Na)
MILL SPRINGS NC 28756-0032
City or Town State Zip Code
( 828 )_ 899-9714
Area code- Phone number
4. DATE DRILLED NOVEMBER 21, 2003
5. TOTAL DEPTH: 405'
6. DOES WELL REPLACE EXISTING WELLS YES O NO El
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF' CASING IS 1.33 FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .011&
9. YIELD (gpm): 2% METHOD OF TEST TIMED
10. WATER ZONES (depth):
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth
To 61 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CONCRETE
From 0
Topographic/Land setting."g
DRidge ®Slope ❑Valley mFlat�
(check appropriate box) •
Latitude/longitude of well loca�.tor
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOT graphic mt '
(check box) _
DEPTH DRILLING LOG
From To Formation Description
c=`
c
o =_
tar
o
ET] ;
d.=
D ri
c
r.,
t CA _-
ram"
LOCATION SKETCH cn -"
Show direction and distance in miles from at leastrr
two State Roads or County Roads. 'Include the road
Diameter or Weight/Ft. Material numbers andncommon road names. mo,�t]/ rf L
61/8 SOR21 PVC Likent c-:6dgin/brrd f'0P4 ylwy./LrE. Qf
,vCatarnoiz �( aka s. 9 uJk Lz
.A- i raw - 40 hotel QOI.OLI tLa y 7
3/1n l}uDoe to-Zna /watt 0)T_ At At ,Gl.ViC,t__.
okr_ sfitilin. la A .1//0 . do RP
CIS ft e ale Gc,(A.tlzt t.e. IQ . J10 aQ�1/w tut.
Ja a z1 muili uX* Qd• d,{-t7 Va /xt2C,
�xQ�atkvw�� J�o ito
at- /ua hr t Zll . tawio dlc hak74/
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.
Slot Size
in.
in.
Material
16. REMARKS:
Method
POURED
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COI' OF THLS RECORD/ BEEN PROVIDED TO TIDE WELI/OWNER
•
SIGNNFIJRE OF PERSON CONSTRIICTIN EiE WELL / DA
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

281012
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
Ios+ia `q
WELL CONTRACTOR COMPANY NAME J(�C�'r F (_ e.C.Z- Qrt t L1'$ 9 PHONE *Id1'�7$ ( ) 720
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
CERTIFICATION #
O
STATE \\'ELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential IV—Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
WELL LOCATION:
Nearest Town: B Af(mtle
flu �Ii
County ite-ittefierld
(Street Name, Numbers, Comnmunit)f, Subdivision, Lot No., Zip Code)
3. OWNER: IC) .n SJe Le-1» ti
Address #/te L)Uelc\r' \ft`1rA J; PiQ-.
(Street or Route No.)
rr,<\--t\cc:Y- .N\(
City or To,s state
(3t43 )- 514-1Lot
z
Area code- Phone number O J O.�
4. DATE DRILLED /(9_ Z
5. TOTAL DEPTH: 5- O $-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 4/0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / 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 Pile
10. WATER ZONES (depth): 3chinn t1 For
Zip Code
11. DISINFECTION: Type Cttot;; Ne- Amount 8 0 2-
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Match
From (.9 To /06 Ft. 6 4'6
From /00 To /yv Ft. ey 8 46 Al
From /c/o To/9'1 Ft, oyy ls6g
13. GROUT: Depth Material
From To Ft.
From 0 To f/o Ft. 'Cr
14. SCREEN: Depth Diamete/' Slot Size
From To Ft. in. in.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
/j t4 c/c
Method
Topogra is/Land setting
❑Ridge lope ❑Valley CI Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:fGPSDTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
o-/00
(6/2— > 00
ZOO-S-DO
u-
S ,fr t )44-,1
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. !
// *'t l54"'v/ LL 2,
73
49Y �1
Material L
�111'lr'
in. in.
Material
From To Ft.
16. REMARKS:
Pah
N
ir
N
rn
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC
CONSTRUCTION STANDARDS, AND 1 AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE
THE
SIGN UREO' PE .ONCONSTRUCTING THE WELL D
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ce
27699-1636 Phone No. [phone], within 30 days. Ca
n
-
LL �-
OWNER
7.0
aleigk4C
V. R/2001

283226
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 ('amp' a Wn11 R Pnmp (an_ Tnr`
STATE WELL CONSTRUCTION PERh1IT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
James TAT
Capp, Tr
CERTIFICATION # 71 3 R
PHONE #$7R) d53-7'22
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public (Si Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: �� n
Nearest Town: KL( tf 1-`vYid oVCounty Riltite Vic Yci
1160 bi n it Pa
(Street Name, Numbers, -Community, Subdivision, Lot No., Zip Code)
3. OWNER: ti)e a I PO I Vl l p 51- C Y u rc
Address IA Yi ovt Rd .
�.(Scree or Route No.)or-fpw /\)L r2?f39
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED / 0 - 3) - D 3
5. TOTAL DEPTH: 3 D j
6. DOES WELL REPLACE EXISTING WELL? YES 4d NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 6,5 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): 5G METHOD OF TEST &i r
10. WATER ZONES (depth)• 7D
11. DISINFECTION: Type ('hl nrI na
12. CASING:
Depth
From 0 To 5; O
From To
From To
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:
Depth Size
From To Ft.
From To Ft.
Diameter
Ft.6 1 /4
Ft.
Ft.
Amount j AX Cap
Wall Thickness
or Weight/Ft. Material
DR71 PVC
Material Method
Ncat Consent Hand
16. REMARKS:
Slot Size Material
in.
in.
Material
Topographic/Land settin
❑Ridge ❑Slope ❑Valley l�Flat
(check appropriate box)
Latitude/longitude of well location'
(degrees/minutes/seconds) 'i-
Latitude/longitude source:❑GPS❑Topographic reap ,
(check box) ll
DEPTH DRILLING LOG
From To Formation Description
fl 75D dirt
5ft -ADS CDVl5aiidrtled YoLK
ram?
LOCATION SKETCH —
Show drection and distance in miles from at gist
two Sta e Roads or County Roads. Include thcmad ;=: --
numbers and common road names.
N)
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCIhD IN ACCORDANCE WITH 15A NCAC 2C, WFI
CONSTRUCTION STANDARDS, AND THy�JJ�' A COPY OF THIS RECORD
�'HAS
��BEEN PROVIDED TO THE WELL OWNER
SIGNATfdRE`OF PERSON CONSTRUCTINGtI'HE Wf L D TE , G'`J
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
0
!"-
� r

s, Inc To, NC Dept of Env. and Na Resour =r-_ ' :t10'2T03 Time: 9:14.26 PM
WELL CONSTRUCTION RECORD
Carci Department of Environment, and Natural Resources- Dlyieyeii of L?iater Quality - Groundwater Section
-i t, CONTRACTOR (INDIVIDUAL) NAME (Print) SCOTT O `_ CERTIFICATION t 25S4
, I LI, CON N FR AC TOR COMPANY NAME CAROLINA WELL. J I INC. PHONE # [phone]
.)t'1 -r . CO2,STRUCTION PERMIT# -OSOCIATED WQ PERMIT #
-_ ) (if applicable)
:.
P.
_.. to able Bo:.): Residential ® Municip I ..:.i,an FT AoPicultizat ❑ iititias a.
Heat Puap Water Injection ❑ Other '❑ C _st
County RLITEERFOR.D
-didie t. Inds a., Co. nt.ity, Subdivision, Lot No, Zip Code)
,RTiN
NC
State
YES ® NO 71
i, Beloit. Top of Casing: 50 FT.
else "ff.1.bovc Top of Ca mg)
FT Abate Land Surface'
vanance in
bLTfHOD OF'tF.Sf ARDNI
379
11YPOCHLOR1TE Amount 10
Wall Thickness
Diameter or Weight/FL Material
SDR21 PVC
Material Method
20 Et- GRAVEL MIX GRAVITY
Die netts
Slot Size Materiel
in.
Size Metz -Val
281941
Topoteraphic/Land setting,
❑ Ridge ❑ Slope ❑ Valley Lij
Latitnde:Longitude of well loeoctort
35.25.471 182.09.590
I degecs. nrra:tes's ec osd_
gitude source: 0 GIPS ❑ Tapo_
Dtri= G
105 Clay
3S3 Consohc
c
___ :v 'ILA I THIS WELL WAS CONSTRUCTED IL_ _-
Da S NQARDS. AND THAT A COPY OF THIS RECORD
LOCATION SKETCH
erion and distance in. nixes fec'n. e.la
-
Roads or County Roads. Include the
.. _ e,.-nOn road n-nnes.
nC
1-
m
oz
r—
I ' =H 1`A itsCa.0 2a. WELL ro
lOViDED TO THE WELL OWN az
m
10/25
SIGNATURE OF PERSON CnNC '.:
;ELL Date
t. ;int'. the Division of Water Quality, Groundwater Sec`, ... -ice center- Raleigh, NC
Pooee 0 [phone], within 30 days.

F; r, 0 ro:ina We!: Drillers. Inc To: NC Deot of Env. and Na Resour
3/2003 Time: 9.14:28 PM
281939'
WELL CONSTRUCTs9�5
pcpatta.rittent of Environment, and Natural Resources -
.. _IL CONTRACTOR (INDIVIDUAL) NAME (print) SCOTT C .-Nr
t.!_ CONTRACTOR COMPANY NAME CAROLINA WELL DP 1
, CONSTRUCTION PERMIT
':SP Inbeeld Adolicahie Pox) : Residential
Heat Pump Water Injection ❑
Munieipo
Other L
2.. ERFORDTON County RUTHERFCRTT
c?DIN DIVER HIGHLANDS
Subdivision, Lot No_ Zip Code)
SPI PO _- OD D°VI_aRIS CARRALLO
FL
State
IC' 10'03
E FNtSTLIG WELL?
YES ❑ NO
To7 of Casing: 40 FT-
(P.e -r` Ifsbovc Tap of C'ss6,y)
_ FT. Above Land Surface*
Ind end_ce rc5tUIn a variance in
YTELT
MffTHoD Cf TEST ARDM
120 330
HYPOCHLORITE Amount 9
Wall Thickness
Diara.e:e or Weight/Ft. Matena:
b li4" SDR21 PVC
0:
Material Method
:0 Ft. GRAVEL MIX GRAVITY
Diareter
Size
Slot Size Material
NLtci:_1
RECORD
.r_ 1Vster Quality - Groundwater Section
CERTIFICATION 8' 2 ES
t.p_t_r0C.. PHONE # [phone]
ASSOCIATED IATED \VQ PERMIT `A
(if applicable)
;izl ❑ A-icultural ❑ Mott n is
Lit Use:
TopographiciLand soiling
Ridge ❑ Slope ❑ \Taliey
r numduLo aeitude oft 11
35.1 T.7801 SO 02.111
(dearees,minele secon
..ludo o rcr:❑CPSF TopozocIrdcr it
DISPTF DRi:?_i\(, i.
Isonnufdrn
50 Clay
340 Consolidntec
0
CdO
U
N
LOCATION SKETCH
. - and dist:L ce in miles from a t .0[ 01
rIs or Cottfay Roods. InclarTe t'ae_ __
_ . ommor. road nay es.
`T
tb
23
T. TT
0
r
0
o<
r
c
2Jy;
Tel :TT
rt
CT
G
i
i:I
:HAT T HIS WELL WAS CONSTRUCTED IN A_
LARDS, AND THAT A COPY OF THIS RECO'_',libbb
r1Ct tv.i H15ANCAC2C-WELL
TT.OVIDED TO THE WELL, OWNER.
10r 16/03
SIGNATURE OF PERSON CON t =t;
Divisioc of Water Quality, Groundwater Seek;:,
9) 733-3221, within 30 days.
n
Dare
Raleigh, NC

i r.;a. C_..aira V Nell D:oa Inc To: NC Dept of Env. and Na Resour
'!1912003 Time 5:14'.26 PM
WELLCONSTRUCTLC: RECORD 281938
inniment of 'Environment, and Natural Resources -
:_ COS: R 1C FOR (INDIVIDUAL)NAME (print) SCOTT CANT=a
. CON i Ls.CTOR COMPANY NAME
11 AS =: LL CONSTRUCTION PERMIT #
Quality - Groundwater Section
CERTIFICATION n 3+3'
CAROLINA WELLDSaL_,i i;3. INC. PHONE # [phone]
ASSOCIATED WQ PERMIT #
schci-k isiRnissnie Box) Residential ❑ Municipal
Hear Pump Water Injection E Other I_
_ ::R:ORDTON Camay RUTHERFO5:3
,S::bdisicion, Lot No. Zip Code)
JME OF RLTIiERFORDTON
LiniPASS
NC
Stole
_Cl/..,-.. "S CXISLNO WELL?
os cpe Casino:
plot t" Ii Above Top ofC
FT. Above Land Surface*
cgvG . , vanar..e m
YES ❑ NO r0
60
: E .DD o: TEST ARDM
150
3YPOCHI,ORITE Amount 4
Wall Thickness
Diameter orWeightFt. Material
SDR 21 PVC
Material Method
Ft. GRAVEL MIX GRAVITY
Diameter
Slot Size Matcria
in.
Material
cads or Courit- Roads. include fir
an: common road riemes.
(if applicable)
❑Gr.,ia; ❑ Agricultural ❑
iLse.
Litarc
Topouaphic/Land settir,_
Ridge ❑ Slope ❑ VaLer
1.at5tude'Loneimde of well locaro
3521840/82.015533
(daces/minute seconds/
ionOi ud e so'vice: Lt GPS ❑ T2 . ._rs pJ{
DEPTH DRILLING
�. To Formacion.. _.
50 Clay
163 Consols::
—ER—
LOCATIONS{ETC :
5a and distance in miles nunss,:Lr:-t tr t_':
CO m
01
cc. Li
;' 33
s- H.
!'FkTPS" THAT THIS WELL WAS CONSTRUCTED !S,4.0100
.\DADS, AND THAT a COPY OF THIS RECOTD -
TH 15A NCAC 2C. WELL
._D TO 1 HD WELL 055,4_
10 15,3;
Hrr
SIGNATURE OF PERSON CODS. Ift '
the. Dir'ision of Water Quality, Groundwater Secrien, P _2
[phone], within 30 days.
Date
nice center- Raleigh, NC

,he—s, Inc Tc: NC Dept of Env. and Na Resour It 1.2003 Time'. 9:14:25 PM
281936
WELL CON STRLc '_�lf_i`N E:. L:ORD
n 6 Carolina - Department of Environment and Natural Resources - D isici: oi'dite: Quality - Groundwater Section
tV Le: Li,CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GANTT CERTIFICATION #_a:
ViTad. CONTRACTOR COMPANY NAME CAROLINA WELL HRH,:,t:IRS. INC. PHONE # [phone]
1 ATM. 1:S 8LL CONSTRUCTION PERMIT # .ASSOCIATED WQ PERMIT #
applicable) (if applicable)
t aic Hsu:: : Residential ❑ Mimi • r:n1 ':1 Agricului-al ❑
Heal Pump Wager Injection ❑ Other n
AI<E. LURE.
11 RESORT
County RUTHERFORD:O`.
leer. Camreunity. Subdivision, Lot No,. Zip Code)
'C isOLPE iT DEVELOPMENT CORP
NC
State
0
=N.ISTING WILL?
w To of Casing:
YES ❑ NO L
40 FT.
ICs<'T" If Above Top of Casing)
-i. A'boce Land Sur face"
?UTHOD OF TEST ARDM
110
HYPOCHLORITE Amount 4
Wall thickness
Diameter or Weight/Ft. Material
6114" SDR21 Pvc
Du -under
Material Method
GPAVELMALT: GR:3LITV
Slot Size Material
Size MD
I THIS WELL WAS CON STS F.D s.
RIDS, AND THAT A COPY OF THIS RFC H. ;-'-
Topogaphic Shiva Z.
11 Ridge ❑ Slope n1 Mahe
Lf dntdc/Loneimde of well loco:.
35.25 346. 82.09 431
(decrees minutes. second
_ nizitud_ source: E. GPS ❑ T.P'.eyice I
DEPTH DRILLi' ; 1.G.'
Tel Foe —tack. _..
40 Ca'
126
SIGNATt1RE OF PERSOTi C07STRi.
LOCATION Sly% T RI-:
_cn and distance L. miles from at :ec
_1sorCou iyR ads. Include si
]i eZemrnon. road names.
Dot NC. 2l WELL
r_1
;:D TO THE WELL 0OCUE
cY
m
1101,0
D_;e
V11
'risk; t I origin :ir the Division of Water Quality, Groundwater Section. :Cali Service center- Raleigh. NC
?Lone u. [phone], within 30 days.

fiudE Carolina§Vela. Dnl'=s. He To: NC Dept of Env. and Na Resour
116'2003 Time: 2:14:26 PM
WELL CONIST LC
Department of Environment, and Natural Resources - .
Li. CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT 0,-;2, I'
Lt. COI RAC l'OR COMPANY NAME CAROLINA WELL
i i E WEI.- (:'O \STRLC T iON PER/LIT #
l i t appliaah1o) USE , � �o�is.,r.:p51eBo>v): Residential ❑i Municipal
:� ❑ Heat Pump Water Injection ❑ Other
Coarity RULE'ERr
Sate diviaiori, Lot No,. Zip Code)
-. CA-F CENTER
192091 Y'.A BYPASS
°GREET CITY
NC
Sta:c
WELL?
LTon of Casing_
iocc =• If Ahovc Top of Casi,
Atove Land Surface*
:yuc, a.a mcem
6STIIOD OF TEST ARDM
330
YES 0 NO 01
60 FT
31 1.3_ IiYPOCHLORITE .'moan`: 9
Wall P+id:neaz
E arneter or \VeighoFc M eial
6 llJ" SDR21 PVC
Ft.
Matn'iti Method
GRAVEL MIX GRAVITY
Slot See Alion
ia.
Size
na
rF.f'ORD
Quality - Groundwater Section
CERTIFICATION R
INC. PHONE # [phone]
IATED WQ PERMIT i{_
(ifapplicable)
a' ❑ A-uulmral ❑ .. _. c_i
281935
Topographic 'Lund setting
kicbe ❑ Slope E
i ^mdelLonsimde ofwell loeo4on
35.19.019. 8153.430'
(derees;minuwe1 seco-dr1
.16oginidc source: (7., GP LJTotocifiraf Flo cop
EPT
To
91 Ciy
DRI`..LING LG la
340
Consolidate
LOCATION SHE JCL'
O
disaapEe in miles from 0: :EFs t CJ
or CouraT Roads Mclada, __ _ ' a
a;nmon roes nr^es.
N
O
a
CO
01
aL3'iE'L E0 THAT THIS WELL WAS CONSTRUCTED i0-__0
D A?.DS, AND THATACOPY OF THI4 RECTO,�
SIGNATURE OF PERSON
..,.E:i't the noig; tint to the Disision of Water Quality, Groundwater S&ecnt ,..._
Phone No (i19) 733-3221, within 30 days.
-a 15A ACA" 2C. AA'ELL
CLD TO TIE WILL OWNER.
11 i/O3
nter R ieigh. NC

283225
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) T
Rt 5 r' CERTIFICATION g ? 1 A,
WELL CONTRACTOR COMPANY NAME
_ Camp' WAS p
STATE WELL CONSTRUCTION PERMITS c ---_ PHONE S �{ 9 p) d 5 1- 7 3 2 2
(if applicable) ASSOCIATED WQ pERhI1T8
(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 Ke Lu re CountyRu key `o Vd
/-0f `I - IKe Ipec k5
(Saver Name, Numbers,{ Community, Subdivision, Lot No., Zip Code)
3. OWNER: Cl/1 i{qIe (�P5Dtit PS
Address in? a4-O k) IN(15 MJd
p4 I I N ('frector_ApuNo.) �j�0$
TY
City or T wo StateZip Code
(%5
�-)- /5— /P a3
Area code- Phone number
4. DATE DRIJ r FD o - /4 - 03
5. TOTAL DEPTH: D.S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO gI
7. STATIC WATER LEVEL Below Top of Casing: 1po FT.
(l)se "+" 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): ? C
11. DISINFECTION: Type Ch1nrines Amount /IP\ Or
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From__p___ To/ba Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth
From_0_____ To .' 0 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.
Gnv21 PVC
16. REMARKS:
Material
Neat Cement
Method
Hand
Topographic/Land setting
ORidge ❑Slope OValley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTop°graphic map- L
(check box)
EP DRI IN nG
From To Formation Dcscpipiton
IDS YAJCII 3&itfl
{ pr {btisoIIdated hock
CO
O
r
w
LOCATION SKETCH -0
Show direction and distance in miles from at lea
two State Roads or County Roads. Include the Wad
numbers and common road names. NJ
r])
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC1hD IN ACCORDANCE WITH 15A NCAC 2C, WFI 1
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSCIN CONSTRUCTING THE WELL �✓ 'A 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
Lot
)1-A-b3
rn
O

283224
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ja me 47 C amp Tr CERTIFICATION It 21'IR
WELL CONTRACTOR COMPANY NAME ramp' q WP11 R P1inip r n Tnr PHONE 082R) 4iS"1-7122
STATE WELL CONSTRUCTION PERMIT'S ASSOCIATED WQ PERMIT,/
(if applicable) (if applicable)
/
1. WELL USE (Check Applicable Box): Residential fed Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIONI
Nearest Town: 1nglk-‹ Lu re
La-i- 1-5 1 Pea kS
County ?Ake br4
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Y OYtga1C Re50Ll✓CP5
Address %`% ro tt)I via Hi .
�rt N (Sneei or Route Nn.)cA9 o g
iry o q e:it/23
� (5
Zip Code
Area coda Phone number
4. DATE DRILLED %D -16 -p3
5. TOTAL DEPTH: `f 05
6. DOES WELL REPLACE EXISTING WELL? YES O NO X
7. STATIC WATER LEVEL Below Top of Casing: Lob FT.
(Use 'Y" 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
''ariance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): `,? METHOD OF TEST Air
10. WATER ZONES (depth): 3 7
11. DISINFECTION: Type Chi n r i n a
12. CASING:
Depth Diameter
From p To 14O Ft. 6 1 / 4
From To Ft.
From - To Ft.
13. GROUT: Depth Material Method
From 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
Amount I -Cups
Wall Thickness
or Weight/Ft. Material
gDR..21 PVC
From To Ft.
From To Ft.
, 16. REMARKS:
7 Topographic/Land setting
Di Ridge ❑Slope OValley OF1at
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude
DEPTH
From 1 To
1 Jo /-*05
source:OGPSOTopographic map
(check box)
DRILLING I. 0
Formation DescriFpilon- --__
gO1,rauel sand
irlated roc.(
[9
LOCATION SKETCH _a
Show direction and distance in miles from at lea -sr
two Sti4 Roads or County Roads. Include the Read
numbers) d common road names. ry
H-c �'<e .i,
I DO HEREBY CERTIFY THAT THIS WFI I WAS CONSTRUC 1 ED IN ACCORDAA CE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
a.44 J.
SOp I/-14-b3
SIGNATURE OF PERSON 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

WELL CONSTRTJCTION RECORD
North Carolina - Department of Environment and
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME Camp'
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
283222
Natural Resources - Division of Water Quality - Groundwater Section
James t.r Camp, Tr
CERTIFICATION H 2 1 3 f)
Tnr• PHONE nai7A) 453_7322
ASSOCIATED WQ PERMIT%
(if applicable)
s Wa1 1 R Pttmp Pry
1. WELL USE (Check Applicable Box): Residential II Municipal/Public 0 Industrial 0 Agricultural D
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use III
2. WELL LOCATION: v
Nearest
L Town: t e Lu a County P a / lP rgvci
acre I 1 d'kes Lo )-
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Soh 1.11. II n�
Address 3 S ti 0 Re Ill c �� M1 t.
(Street or Route No.)
LJ
L..l h41 tl ',tech H
pity or Town Sate Zip Code
(70 )- 9011— a U. `(
Area code- Phone number
4. DATE DRIIIFD (O-a)-o3
5. TOTAL DEPTH: 4 �{
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO .4
7. STATIC WATER LEVEL Below Top of Casing: 55 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
*ariance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): So METHOD OF TEST Air
•10. WATER ZONES (depth): D 0
11. DISINFECTION: Type h 1 nr i n a
12. CASING:
Depth
From p To g0
From To
From To
13. GROUT: Depth
From p To 2 0
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Diameter
Ft. 6 1 / 4
Ft.
Ft.
Ft.
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in in,
Material
?Iotat
Amount
Wall Thickness
or Weight/Ft. Material
SDR7I PVC
Topographic/Land setting
DRidge UaSlope OValley OFlat
(check appropriue box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSDTopographic map;
(check box)
DEPTH PRILLTNG LOG;; L
From To Formation Description
n Ro qqva✓el, L)a
So a¢S Zit15o)ifia—ea rec.
w
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the gd
numbers and common road names.
T�akrLa,
Method
Ccmont Hand
Depth Size Material
From To Ft.
From To Ft
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCIED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
CL-'fp a
SIGNATURE OF PER$Q'N 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
II—I4-o3
DATE
t7
0

283220
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James w Camr, Jx- CERTIFICATION it 7138
WELL CONTRACTOR COMPANY NAME ramp' c Wal 1 g, Primp Cry r TnC PHONE #87R) 4 ,3_7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential lVI Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use 1?�.
2. WELL LOCATIO
Nearest Town: 1 County
? INr{1ev
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
at)er vA
O l�
k*er )rd' or utAte � C ��' 3 el
( CityorTown —_I. State I
Area code- Phone number r'
4. DATE DRILLED I O — 1 `t- ` 03
5. TOTAL DEPTH: , 2 D
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO J
7. STATIC WATER LEVEL Below Top of Casing: t-+-O 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): 90 METHOD OF TEST &i r
10. WATER ZONES (depth): / R 0
717-f-1 Clad<
Address R 7 ISK_
ke' 1-0
Zip Code
11. DISINFECTION: Type rhl nri nn
12. CASING:
Depth Diameter
From 0 To I I `J Ft. 6 1/
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 10 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.
N tat
Amount I ,- 1 la
Wall Thickness
or Weight/Ft. Material
DR",1 PVC
Cement
Slot Size
in.
in.
Material
16. REMARKS:
/Topographic/Land setting
CBRidge ❑Slope ❑Valley ❑Flat'
(check appropriate box) 1
Latitude/longitude of well location,.
Latitude/longitude source:❑GPS❑Topogra: hie -map
(check box)
DEPTH D ILLING L OG
From To Formation Des ription
I 1 5- 20� fBl �llciated Koc)(
(degrees/minutes/seconds)
0 f 1 5-�I, r
W
C
LOCATION SKETCH —O r—=
Show direction and distance in miles from .yeast �,
two State Roads or County Roads. Include • e road;
N)
0) E
numbers and common road names.
cif `t))- ,L C.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TIjAT' A COPY OF THIS RECORD HAS BEEN PRQVIDED TO THE WELL OWNER
SIGNATj?JtE OF PERSON CONSTRUCTING T
//—l1-63
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

283219
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ja mpS w Cam(+, Jr CERTIFICATION a 71 3A
WELL CONTRACTOR COMPANY NAME ramp' s Wp1 1 & Piimp Cm_ ,
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 'Municipa1/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: ((�� ty n
Nearest Town: C ,�h.,i�A Coun ""'—'\
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: QtQ�pl,xA
Address ^ -- S MM.t RA 2,(rA \
nU A (� Allt or Route No.)
City or Town State Zip Code
( Area code- Phone number n
4. DATE DRILLED (y� .1Q s
1) 3
5. TOTAL DEPTH: .0
6. DOES WELL REPLACE EXISTING WELL? YES.10 NO a
7. STATIC WATER LEVEL Below Top of Casing: 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 accord c h 15A NCAC 2C .0118.
9. YIELD (gpm): MET/IQD OF TEST p 1 r
10. WATER ZONES (depth): \ '6 0
11. DISINFECTION: Type r h 1 nr i np
12. CASING:
Depth Diameter
From_ Tom` Ft. 6 t / 4
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From,_q_To 20 Ft. Noat Cement Hand
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material ;\ ,
From To Ft. in. in. h
From To Ft. in. in. kiek"C
15. SAND/GRAVEL PACK: S n .
Depth Size Material �l
From To Ft.
From To Ft. S
Amount 1.1
Wall Thickness
or Weight/Ft. Material
SDR,21 PVC
0
Tnr PHONE #$7A) 45'2_7322
Topographic/Land setting ,' ,
❑Ridge t2glope ❑Valley OF at
(check appropriate box)
Latitude/longitude of well locatioti'.
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING JOG
From „ToFo�rnatig(t Detcription
10 ' l �InJC
bus
CO
v
t
CO
LOCATION SKETCH -0 rn��'
Show direction and distance in miles from at least
two State Roads or C¢unty Roads. Include the'ad ci
numbers and comm gft road names. N
O) z
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC1hD IN ACCORDANCE WITH ISA NCAC 2C, WFi i
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE` F PERSON CaNSTRUCTING THE WELL DATE
1 - // -63
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

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J mec m Camp, Jt. CERTIFICATION N 71 iR
WELL CONTRACTOR COMPANY NAME ('pmprc Wp11 R Primp Cn Tnr• PHONE #878) 4S1_7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): ResidentialOrMunicipal/Public 0 Industrial 0 Agricultural £
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIOJ ALL&
Neaze;(T 1.. County
(Street Name, umbers, Community, Subdivision, lot No., Zip Code)
3. OWNER:
Address - 0
(S e11t or Route No.)
A Spy A C
City oY Towo State Zip Code
( Area coda- Phone number
4. DATE DRILLED IQ nt •
5. TOTAL DEPTH: S O S
Topographic/Land setting
❑Ridge ❑Slope `UE'alley ❑Flay
(check appropriate box)
Latitude/longitude of well loca ion-
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Top
(check box)
DEPTH D • ILL G OG l
From�T(/ tnnvi tion aescnptsi
6. DOES WELL REPLACE EXISTING WELL? YE 0 NO Eil
7. STATIC WATER LEVEL Below Top of Casing: (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 I5A NCAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TEST_Liz_____
1 r
10. WATER ZONES (depth): R O L
11. DISINFECTION: Type nil n r i rip
12. CASING:
Depth Diameter
From-__p__ To-\_ Ft. 6 1 / 4
Ft.
To Ft.
Depth Material Method
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
From To Ft.
From To Ft.
From To
From
13. GROUT:
From o
Amount 4
Wall Thickness
or Weight/Ft. Material
gDR21 PVC
Material
Th
m,tx
LOCATION SKETCH
rn
{ E 171
u
Show direction and distance in miles from ate. st
two State Roads or County Roads. Include the?oad c-.
N
numbers and common road names. -
rn
1
ti •
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUChD IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIG TURF OF PE ON CONSTRUCTING THE WELL
11- l -DZ
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

282342
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 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
GREEN RIVER HIGHLANDS -LOT #95
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: GERALD PRUDHOMME
Address GREEN RIVER HIGHLANDS
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(305) — 978-4682
Area Code Phone number
4. DATE DRILLED 10/08/03
5. TOTAL DEPTH: 305
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): 5 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 7.5
12. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 40 Ft. 6-1/4" SDR.21 PVC
From To Ft.
From To _ Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. QULKRETE
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.
16. REMARKS:
Method
POURED
Material
in.
in.
Topographic/Land setting
❑ Ridge ❑ Slope 0 Valley
(check appropriate box)
Latitude/longitude of well locati
(degrees/minutes/seronds)
Latitude/longitude source: ❑ GPS 0 To
(check box)
DEPTH
From To
DRILLING LOG
From To
r) T
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. RIGHT
ON COXE RD. RIGHT INTO GREEN RIVER
HIGHLANDS. STAY STRAIGHT ON MAIN RD.
APPROX. 3/4 MILE. TURN RIGHT ON ETHAN DR.
2ND LOT ON LEFT.
0
w
0
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS CTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
TURE F O PERSON COIQSTR TING THE
lnrY� _ / o — j'D 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
WELL
SIGNA

282341
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 ® MunicipalPublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: FOREST CITY
HINES RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ROBERT BRADLEY
Address HINES RD.
(Street or Route No.)
FOREST CITY NC 28043
City or Town State Zip Code
(828) — 245-8298
Area Code Phone number
4. DATE DRILLED 10/07/03
5. TOTAL DEPTH: •165
6. DOES WELL REPLACE EXISTING WELL? YES 0 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 I5A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 3.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 90 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
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 ❑ Valley
(check appropriate box)
Latitude/longitude of well locat on
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ To
(check box)
DEPTH
From To
DRILLING LOG
From To
o
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. LEFT
ON HINES RD. 1/10 MILE ON RIGHT. NEW DRIVE.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS AND THAT A COPY OF S RECORD HAS BEEN PROVIDED TO THE WELL
J,OWNER
llik-.i1 -�/ 1 -7'h� �iir iYO.� . (7 i /6 A / Ll
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
CC

282340
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 # (
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: LAKE LURE County RUTH
HOLMES RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: STEVE PADGETT
Address HOLMES RD.
(Street or Route No.)
LAKR LURE NC 28746
City or Town State Zip Code
(704) — 538-8741
Area Code Phone number
4. DATE DRILLED 10/03/03
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): 20 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 7.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 55 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
From _ To
From To Ft.
16. REMARKS:
Size Material
Ft.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley i
(check appropriate box) '— c)
Latitude/longitude of well loca
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ To
(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 RUTH. GO UP HWY. #64/74A. RIGHT ON
HOLMES RD. (AT MTN. LAKE REALTY) 1/4 MILE
ON RIGHT.
fn
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
SIGN TURE OF PERS N CONSTRUCTING THE WEL 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

282337
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: RUTHERFORDTON County RUTH
BIG ISLAND RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: RICHARD MACE
Address BIG ISLAND RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 286-3404
Area Code Phone number
4. DATE DRILLED 10/23/03
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): 6 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To 40 Ft.
CHLORYTE Amount 6
Wall Thickness
Diameter or Weight/Ft. Material
6-1/4" SDR.21 PVC
From To _ Ft.
From _ To Ft. _
13. GROUT: Depth Material
From 0 To 20 Ft. QULKRETE
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To Ft.
Method
POURED
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 0 Slope 0 Valley
(check appropriate box)
Latitude/longitude of well locati
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 0 To++'`•.nbhic
(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
POORS FORD RD. LEFT ON BIG ISLAND RD. GO
SEVERAL MILES & CROSS RIVER. 1ST DRIVE ON
RIGHT AFTER YOU PASS BLUE SKY WAY=
0 -
co
o
co
u).
r-i sk
G
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 F PERSON CONSTRUCTING THE 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

282335
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 # 256
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # 828 -453
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: ELLENBORO County RUTH
RALEIGH LEDBETTER RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JOE CARSON
Address RALEIGH LEDBETTER RD.
(Street or Route No.)
ELLENBORO NC 28040
City or Town State Zip Code
(828) — 287-4239
Area Code Phone number
4. DATE DRILLED 10/22/03
5. TOTAL DEPTH: 57
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
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): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Atnount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
0 To 57 Ft. 24" CEMENT
To _ Ft. _
To _ Ft.
Depth Material Method
To 20 Ft. CEMENT POURED
To Ft.
Depth Diameter Slot Size Material
From To _ Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size
From 37 To 57 Ft. 78M
From To Ft.
From
From
From
13. GROUT:
From 0
From
14.SCREEN:
16. REMARKS:
in. _ in.
in. in.
Material
GRAVEL
Topographic/Land se
❑ Ridge ❑ Slope ❑ Valle* Flat
(check appropriate box I
Latitude/longitude of well ltirtn
(degrees/minutes/second
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 ELLENBORO GO DOWN
ELLENBORO/HENRIETTA RD. GO APPROX. 1/4
MILE AFTER YOU CROSS 74 BYPASS. TURN
RIGHT ON RALEIGH LEDBETTER RD. 2ND
HOUSE ON RIGHT.
6?:£ Wd h-AON£0
fl
O
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS,��yyAND THAT A COPY
/OFQTHIIISSS RR�E/C/ORD HAS
SBBEEN PPRyJO�VIID�E1D TO THE WELL OWNER
, -fie'--s.—) \i Cu 1_ A 41 / i( 9Lh _ig- %// �` `V%� /e)/2 2//3
SIG ATURE F PERSWC 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
EnT

282334
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 (838) 1
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: RUTHERFORDTON
PINEY KNOB RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: PHILLIP NIX
Address PINEY KNOB RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 287-4288
Area Code Phone number
4. DATE DRILLED 10/20/03
5. TOTAL DEPTH: 64
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 49 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 RUTH
11. DISINFECTION: Type CHLORYTE Amount 6.9
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 64 Ft. 24" CEMENT
From
From
13. GROUT: Method
From 0 POURED
From
14.SCREEN:
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size
From 49 To 64 Ft. 78M
From To Ft.
To Ft.
To Ft.
Depth Material
To 20 Ft. CEMENT
To Ft.
Depth Diameter Slot Size Material
16. REMARKS
in. in.
in. in.
Material
GRAVEL
Topographic/Land se
❑ Ridge ❑ Slope ❑ Vali r,
(check appropriate bo.
Latitude/longitude of well dt ion
T
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS rl Topngrapinrmap
(check box)
DEPTH
From To
Flat
DRILLING LOG
From To
1.
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 N. FROM RUTHRFORDTON. LEFT
ON SCHOOL HOUSE RD. LEFT ON PAINTERS GAP
RD. LEFT ON PINEY KNOB RD. 3RD DRIVE ON
LEFT APPROX, 1/4 MILE
63 :£ Wd h— AON CO
cn
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
SIG
6/ .1 c4 YLa /D /7 O4
ATURE O PERS ONSTR TING 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

282333
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 ❑ N
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: FOREST CITY
WHITESIDES RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DAN ROYAL
Address 3399 WHITESIDES RD.
(Street or Route No.)
FOREST CITY NC 28043
City or Town State Zip Code
(828) — 286-0318
Area Code Phone number
4. DATE DRILLED 10/13/03
5. TOTAL DEPTH: 64
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 44 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 RUTH
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 64 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 44 To 64 Ft. 78M GRAVEL
From To Ft.
16. REMARKS:
Topographic/Land settitijn-1.
❑ Ridge ❑ Slope ❑ Vall
(check appropriate box
Latitude/longitude of well I
(degrees/minutes/secon
Latitude/longitude source: 0 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
BUS. 74 E. FROM FOREST CITY. LEFT ON
BOSTIC/SUNSHINE HWY. LEFT ON PEA RIDGE
RD. LEFT ON WHITESIDES RD. APPROX. 3/4 MILE
ON RIGHT. (3399 ON MAILBOX)
--o
W
fV
c
0
0
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
COUCTION STANDARDS, tl THAT A COPY OF THIS RECORD HAS BEEN PROVIDED � 3LL OWNER
0
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

282331
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 ❑ Agricultural [�
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use j
2. WELL LOCATION:
Nearest Town: HENRIETTA County RUTH Topographic/Land se
HENRY JENKINS RD. ❑ Ridge ❑ Slope 0 Vall
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) (check appropriate box
3. OWNER: MICKY BLANTON Latitude/longitude of well 1
Address HENRY JENKINS RD.
(Street or Route No.) (degrees/minutes/second
HENRIETTA NC 28076 Latitude/longitude source: ❑ GPS
City or Town State Zip Code (check box)
(828) — 657-9262 DEPTH
Area Code Phone number From To
4. DATE DRILLED 10/01/03
5. TOTAL DEPTH: 42
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
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): 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 42 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 22 To 42 Ft. 78M GRAVEL
From To Ft.
16. REMARKS:
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
HARRIS/HENRIETTA RD. FROM HENRIETTA.
LEFT ON HOG PEN BRANCH RD. RT. ON HENRY
JENKINS RD. GO STRAIGHT Aa, STOP gjGN.100
YARDS ON LEFT. w
o
—
t
w
tV
%.0
.0.
r._
c7
G
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 0 PE 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

284432
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J mp g la__ _ Caml' Jr CERTIFICATION# 71 3$
WELL CONTRACTOR COMPANY NAME CAME,' ¢ Wp11 R Pump Cn Inr PHONE #$7Fl dRi-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (ifapplicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public 0 Industrial 0 Agricultural 1e
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATJ.ON: 6
Nearest Town: !
Nq�Q,C
(Street Nadie, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: )/l,tIL
Address 1yt-k f X1 ,, r
i -1 ( eet or Routc.
O'
City-,�8i�
or To o tc0ci Zip Code
`t -
Area code- Phone number
4. DATE DRILLED i a • 2 (J- D
5. TOTAL DEPTH: (DC? S . . II,,tt
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 4!
7. STATIC WATER LEVEL Below Top pf Casing: ,2 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT.AboveLand 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 Air
10. WATER ZONES (depth): U D G
11. DISINFECTION: Type Ch 1 nr i np Amount aO
12. CASING:
Depth‘ Diameter
From p To . / S Ft. 6 1 / 4
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 Size Material
From To Ft.
From To Ft.
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
16. REMARKS:
p/j-� Topographic/Land setting
County M l -1 "" ❑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 J o3 Fprrmatti Description
O
r
-o
J,OCATION SKETCH o
Show direction and distance in miles from at 3easttr, A
two State Roads or County Roads. Include
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFI r
CONSTRUCTION STAND AR(D)
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�msr-1 U- 0LI
IGNATURE' PERSON 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

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James w Camf , Jr CERTIFICATION It 21 R8
WELL CONTRACTOR COMPANY NAME ('amp's Wel 1 R Pump Co T n r PHONE It 8123,14153
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# - - -
(if applicable) (if applicable)
284477
1. WELL USE (Check Applicable Box): Residential te-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: nor (\ j� (��--_� Topographic/Land setting
N est 7Tyn own�:� (AlJ�\Iw1 (}5— County ^ { L "❑Ridge — ope ❑Valley ❑Flat
\(�,`1. Nr/ 1.1�St(J7- (check appropriate box)
(Street Name, Numbers, CommunitySubdivision. Lot No., Zip Code) Latitude/longitude of well location
3. OWNER:
Address 11 ¶SC J N L
(Stre t or R_o a No.)
City or Town State
NN-
old
334�0
Zip Code
( )-
Area code- Phone number
4. DATE DRILLED l 2• I l L
5. TOTAL DEPTH:
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 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordpn,Fe with 15A NCAC 2C .0118.
9. YIELD (gpm): P t1U METHOD OF TEST 2jir
10. WATER ZONES (depth): \'()
11. DISINFECTION: Type C h 1 n r i n p
12. CASING:
Deptf-, Diameter
From _a_ To �I (1 Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth
From__ To 2 p Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From______To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Amount ` u1p
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Material
Neat Cement
Method
H.1
Slot Size Material
in.
in.
From To Ft.
From To Ft.
16. REMARKS:
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographikmap
(check box)
)7EPTH DRILLING LOG
From pTo tFo on Description
f 1() Y1.
CIO [& �r A✓ ev,. ,l
4✓
P
m
N o<
ri
LOCATION SKETCH w ^o
Show direction and distance in miles from at ast y=
two State Roads or County Roads. Include tleroat�"'A
numbers and common road names. O o
LocS
zry
72
acie
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC1BD IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONST. UCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
\ SIGNATURE IMF PERSON CONSTRUCTING THE WELL
f ` 10, 011
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

284476
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jamas sa Camp Jr CERTIFICATION #_2138
WELL CONTRACTOR COMPANY NAME r min q Win 11 R. Piimp Cn T n r PHONE #&7Rl 4Si_7122
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential OrMunicipal/Public 0 Industrial 0 Agricultural ❑:
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Neare own:
(S t Name, Numbers, Community., Subdivision, Lot No., Zip Code)
nn .� oo (n� pp Topographic/Land setting
County 2iz1\' A J1'k . , Midge ❑Slope ❑Valley ❑Flat.
(check appropriate box)
Latitude/longitude of well location
3. OWNER: `()9k Ci
Address () (r.CI
!� (Street or Route No.) �i O
Ciry r TTo'woo State C `ZZip Code
Area code- Phone number
4. DATE DRILLED i D- . 3. 0 3
5. TOTAL DEPTH: QO S -
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E
7. STATIC WATER LEVEL Below Top pf Casing: 10 0 FT.
- - (Use "+" if Above Top of Casing)
8. TOP OF CASING IS L FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordancA with 15A NCAC 2C .0118.
9. YIELD (gpm)' MET OD OF TEST 41 r
10. WATER ZONES (depth): Ll N: , a
11. DISINFECTION: Type rh l nri na
12. CASING:
Depth Diameter
Fro b_ L ToS Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth
From_ p To 20 Ft. Neat
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 ()DT
Wall Thickness
or Weight/Ft. Material
1 PVC
Material
Method
Cement IIand
Slot Size
in.
in.
Material
Material
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
DEPTH
From To
0 G
DRILLING LOG
Formation Description
13 `3 o S� Lt.Y
r
a �
L7
is - ▪ r- r'
rn
N
n
� o
LOCATION SKETCH s sr-,
Show direction and distance in miles from ast N
two State Roads or County Roads. Include tll8 roa€
numbers an common road names. O a
i
4L,A, TU`1'
LA ka
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC'iF.D IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
invm
SIGNATURE OF PERSON CONSTRUCTING THE WELL
D- %-b
ATE
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) James t•r- Camp, Jr_
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
CERTIFICATION # 21 3 R
Camp'S Wa11 & Pump Cn Tnr- PHONE #ffi2M 4Si-7322
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential Or Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCAT QN:
Neare$t Town: County
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: \ ` 0 QX
Address (...) v;� f "
(Su Gt, ou[e No.
- 1b4C . A11 \
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 0-2 3
5. TOTAL DEPTH: j-U S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO l`!!1
7. STATIC WATER LEVEL Below Top of Casing: 140 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 nce with 15A NCAC 2C .0118.
9. YIELD (gpm): (1 ME� `F�OD OF TEST A i r
10. WATER ZONES (depth): V'M)
11. DISINFECTION: Type C' h l nr i n a Amount' CL1e
12. CASING: Wall Thiclmess
or Weight/Ft. Material
SDR21 PVC
Depthc, Diameter
From 0 To O D 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:
Material Method
N "at Cement IIand
From Ft.
From Ft.
Depth Size
To
To
Slot Size Material
in.
in.
Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley l3Elat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic trap
(check box)
DRILLING LOG
Fok lion Description
DEPTH
From
n
LOC ION SKE
Show direction and distance in
two State Roads or Co . ' .ads. Include the ro d
numbers and.corr non road names.
L
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUUIED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
A rn CNN( � ► r O. O LI
` 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 Envirotunent and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ja mag vr_ Cam in Jr- CERTIFICATION# 211R
WELL CONTRACTOR COMPANY NAME ramp' s Wall & pttmis Cr) Tnr• PHONE #87R) 451 7322
284474
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential bMunicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest o
W lA r1 �F ED kty
G 0 Z
(Street Name, Numbers, Community�u(b�division, Lot No., Zip Code)
3.OWNER: tk
Address \` (^' Vt au V-k cQ
(S[rc [ r Route\t o.)C 9-2 t1
�11Vit\CAR V
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED 2 - u • 03
5. TOTAL DEPTH: S O S 6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO it,
7. STATIC WATER LEVEL Below Top of Casing: 1 O 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 accords with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST Air
10. WATER ZONES (depth): <55 0
( -Topol aphic/Land setting
rtr ^'r las. dge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
11. DISINFECTION: Type rh 1 nr i na
12. CASING:
Depth
From p To SS
From To
From To
13. GROUT: Depth
From ri To 2 0 Ft.
Diameter
Ft.6 1/4
Ft.
Ft.
Amount I. cwe
Wall Thiclmess
or Weight/Ft. Material
SDR21 PVC
Material
Neat Cement
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
Method
Ha
Slot Size Material
in.
in.
Size Material
Ft.
Ft.
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING
From 3o,
u
Formatipn Description
Q,iA%l
6s sos gut kk
d=
o
cam,
IV o C
LOCATION SKETCH ›o
Show direction and distance in miles from y eastm o
two State Roads or County Roads. Include the roag
numbers and common road names. w m
c1
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCIED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
O o
10
SIGNA .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

From: Carolina Well Dialers Inc To: NC Dept of Env. and Na Resour
Date: 1/14/2004 Time: 8:19:02 PM Page 2 of 6
WELL CONSTRUCTION RECORD28434
`)
North Carolina - Drpartment 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 #
fir applicable) (if applicable)
1. WELL USE (Chock Applicable Box) : Residential ® Municipal ❑ Industrial ❑ Agricultural ❑ ,Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use-.
2. WELL LOCATION:
Ner-est town: ... Ri DTON
ROPER LOOP RE
County RUTHERFORD
(Street Nhrne tninDa::
n e . Sub dic' Lot No, Zip Code)
Topographic/Lanrd 'setting
C - J Slope u Valley uJ Flat
-: omde/Longitlde of well Iecation
35 24.934 858 949
3 0,ANCR tiE'R 1.1 LANE (degrceerriccros'seconSai
ADDRESS ROPER LOOP
(::.a er Ronne No.)
RCTIIERFORDTON NC
city orTRkii State
828-287-7867
Ares Code - P eez
1. DATE DRILLED
5. TOTAL DEPTII
12/3 E03
'00
5. DOES WEILL REPLACE E`.ESTLNG WELLS YES ❑ NO
1. STATIC 4t'ATER LEVEL Eclo:vTop of Cosins: 65 Fr.
(use-*" IfAbove Top of Casing)
8. TOP OF CASING 1S 2 FT.. Above Land Surface*
'Top ofCaring icnne:ncio o: Ldaton,:ILA surface rcquGa a variance in
accerdnnre51tb 15.41 C1C 1 J.J115
9. YELD Crp:n7: 5 SIETMOD OF TEST ARDM
to -WATER 32(065 teo'- .. 120 350
28139
Zip Code
Lari_ccalongitude scarce: IJ—` GFS ❑ Topog ap h is map
DEPTH DRILLING LOG
FromTo Formation D.eecrtption
Ci 50 Clay
50 360 CcnS:4116tz:':Rock
1 DISINFECTION- ThEliii 'OCHLORITE Amman) 9 oat LOCATION SS_ETCH
C
I.. CASINO: Wall Thickness mad ills -nc'_.',_,.i i,1ar10
O
Asc. Diameter or Weight/Ft. Material two S % is or County Roads, Include the 1
Igor,: 0 To Ft. 61;4" SDR 21 PVC nilanC common road ;raTOS. b 0 Fri
D.GROUT: = Cn
Dapu. Material Method Gil Cr- on
Prom 0 T o Ft. GRAVEL MIX GRAVITY DC
▪ N
it SCREEN $ �C
rrl
Del; h. Diameter Slot Size Material
rn 2
m�
Fr9:T. NA To _,. m. in.�� Ci
D.-u!Size Material
From NA 1b Ft,
16. REMARKS:
I DO HERE 2Y (EY CI iE LYTI-II_AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE'l,TF 16A NC-C 2('. WELL
CONSTRUCTION STANDARDS, AND THATA COPY OF THIS RECORD MIS BEEN PF_OVIDED TO THE WELL OWNER.
27.
SIGNATURE OF PERSON CONSTRUCT1NO TE'D-6L. Dz:_
Submit the original to the Division. of Water Quality, Groundwater Section, 1636 Alai; Service writer - Raleigh, NC
27699-1636 Phon_ No. (919) 7333221, within 30 days.

From: Carolina Well D:9:
ic To: NC Dept of Env. and Na Resour Data: 1101.2024 Tice: 8:19:02 PM Page 3 of
284342
WELL CONSTRUCTION RECORD
North Carolina - Depanment of Environment, and Natural Resources - Division of \Hater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GANTF CERTIFICATION # 2534
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS. INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
/1f aocl:cshie)
I. WELL USE (Check ii.plEicabie Sox): Residential
Recovery ❑ Heat Pump Water Injection ❑
L. WELL LOCATION
Nearest town: ELLENBORO
416 SOCO GAP RI)
(f applicable)
Municipal ❑ inc ial ! Agricult:rzl ❑ .\Ic..om:a ❑
Other ❑ if Other, List List:
County RUTHERFORD
(Street Name. Nu nb_r-, Cs snL:city, Subdivision. Lot No,. Zip Code)
].OWNER WILKINS HOME CENTER
ADDRESS 1920 HWY. i_A BYPASS
PORESf CIT
cas 0, Town
828-286-36 7
NC
State
Area Code - Phone
4. DATE DRILLED 12 12103
5. TOTAL DEPTH
6. DOES BELL REPLACE EXISTING WELL?
7. STATIC WATER LE0NI. Below Top of Casing:
28043
Zip Code
YES Li NO El
45 FT.
MM.. "9" If Above Top of Casing)
a TOP OF CASINGS -:.Above Land S-,rfaae°
Top ofcouip eenumcE .vcs beta. bui surfzco requr, a Varian in
a.cardm,. with 15A NCAC 2CG::A
9 YIELD (genii'. 1>
ID. WATER ZONES (drt.th;:
u. DISINFECTION_ APE
r_. CASING'
Da
From 0
GROUP:
am 0
14. SCREEN
METHOD OF TFSI
110
ARDM
Topogaphic.'Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
Latimde/Lono rode of well location
35.18.269 81.17.228
[dogeeciu:tru: t cs iv: cot.d()
-r>imda source: E GPS ❑ Topographic crap
DEPTH DRILLING LOG
.._.____ To.. Formation _ _1;_Exica
83 Clay
140 ConeoLdate_ . poic
HYPOUHLORITE Avnoimt 3
Wall Thickness
Diemcer or Weight/Ft. Material
Ft 6 1;4SDR 21 PVC
Deptli
Frorn NA To
t'. SAMDGRAVFI. PACK'
Depth
From NA Tr
16 RE\UitKS'
Fr
oz
Material Method
Ft. GRAVEL MIX GRAVITY
Diameter Slot Size
Size
m
Material
Material
LOCATION SKETCH
Show r:.racacn and distance L*<miles from e`.'er.a
two l J a Or Count Roads. -include Erie [ s"
r_t :'_ n co=noroad n:_nss. A cm
cm
Z_
Or,
CI7 cm
Do
r�
m�
cnz
0
n
a
W
1 DO HEREBY CE0 0:
CONSTRUCTED, ST
RAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE V1T1-11i-T NCAC 2C, WELL
ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF PERSON CONSTRUCTING'Pr. WELL Date
Submit rive original t.5 tat Division of Water Quality, Groundwater Section, 1636 Mail Sun i=c:: center - Raleigh, NC
27699-1636Phone No. [phone], within 30 days.

From: Carolina Well Drillers Inc To: NC Dept of Env. and Na Resour
Date: 11-. 4/2004 Tree'. 6:16:02 PM Page 4 of 6
284341
WELL CONSTRUCTION RECORD
North Carolina - Departs:sira of Environment, and Natural Resources - Division of ! ater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) SCOIT GANTT CERTIFICATION # 2E84
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Clod: Applicable Box): Residential ® Municipal ❑ Lldustiial❑ Agricultural ❑ Moroori:tg ❑
Recovery ❑ Hear Pump Water Injection ❑ Other ❑ If Other, List Use:
1. WELL LOCAT I tss
Nearest totm_ LALL LURE
144 MOLASSES 900
County RUTHERFORD
(Street Name. Number, C a: anunLy, Subdivision, La; tic. Zip Code)
3. OWNER CHARITY CONNOR
ADDRESS 14d MOLASSES DR
UNION N!IiS NC
cis.or Town State
828-288-'019
28167
Zip Code
Area Code - Piror:e N;_11' -.
1. DATE DRILLED 1:...— 63
5. TOTALDEPTH ZSt.
5. DOES WILL REPLACE EX1STNG WELL? YES ❑ NO 0
7. STATIC WATERLF\ EL Eel ow Too of Casing: 60 FT.
(Usc "t" If About Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface"
"lop of caab,g Lc! "Wd suface requires a variance in
aecordanecw1ii1 AYC C
9. 1'IE.LD (aprr6'.
m. WATER ZONES
u. DISINFEC faCN
12. CASING.
Topegaphic!Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Fiat
L"-dimde,/Lon_eitude of sell Ioczdo
(degr eshmnute AeC31:Cs)
i,a0:uoalongitnile source: ❑ GPS ❑ Iopoamphic reap
DEPTH DRILLING LGG
:2(10 To Fomatioi. Description
Clay
380 Cansoida:ed Paz:
CJ!
..ilvtlOD 06"EST ARDM cri
>rn
150 "Jr_ ��
i4
i'_POCHLORITE Amount 10 0= LOCATION SKETCH Nrn
ril
Wall Thickness NUR, Iii ,_ echo,. and distance in miles from at least" c-8
Dre:b Diameter orWei Weight/Fr Material0
8 , r: o S '. R-eadi or County Roads. scrods thero;�— o
From 0 Ta 80 Ft 6 1/4 " SDR 21 PVC rt —1-sit and common road names. =
13. GROUT:
ggag
Prom 0
1. SCREEN
Four NA Tc,
15 SAND;GR 9\-L. Pe.
Depth
From NA To
11. RE\!ARKS
Material Method
20 Ft. GRAVEL MIX GRAVITY
Diameter
Size
Slot Size Material
in.
Material
OLD CONTERD 1.5_'.II
RIOT. =.22 ES R.DGE RD
CETEEE .
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANT F- F!ITH 1 5A NCAC 2C, WELL
CONSTR/ rG:.-:.ToTDANDS, AND THAT A COPY OF THIS RECORD HAS BEEN O?DED TO THE WELT OWNER.
TTET
1 2:17, 0"s
Dare I.
SIGNATURE OF PERSON CONSTRUCTLNO 'IRE WillIs
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Masi Service center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GET -1 I4V:.0 4001

From: Carolina Z,.t-ts ;; c To: NC Dept of Env. and Na Resour
I ',2009 T:mo 8:19:02 PM Page 5 o' c
284340
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) SCOTT GANTT CERTIcICATION#2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT#
app 1o:b1e) (if applicable)
1 WELL L F Ch;ck Applicable Box): Residential ® Municipal ❑ inl +, L Agricultural ❑ Marta,
Recovery 1-1Heat Rupp Water Injection D Other ❑ If Owe_, List Usa-.
2 WELL LOCATION.
Nearest town Ri HE County RUTHERFORD
LOT 59 GREEN RIVER H;GHLANDS SUBDIVISION
( Street Name. N ucnocrs. Ccirrnnrity, Subdivision, Lot No,. Zip Code)
Topographic'Lend setting
❑ Ridge ❑ Slope ❑ Valley ❑ Fiat
Latitude/Long, tude of well location
35.17.665 / 82 02.22 3
a_ OWNER DINO F_` e;TI (dewees/minctes'seconds)
ADDRESS 45d1 CACTUS .AVE ,.._...delon>itude soarce: N GPS ❑ Topogtaph.:c map
DEPTH DRILLING LOG
SAR.A Oi:-. FL 34231 Froo To For:iauon ascn:Con
clry or.cis. State Zip Code 0 40 Ciao
911-927-1507 4:3 1S0 Consolidated Rod
Area Code - Phone Ntuuher
J. DATE DRILLED 12,22103
5. TOTAL outrun Igo
6- DOES WELL REP CC F`.QSTNNG WELL?
7. STATIC WATER 1,F7,77'- field.v Top of Casing:
YES ❑ NO
25 FT
(Lie"f" If Above Top of Casing
8. TOP OF CASING IS 2 FT. .above Land Surface,
Top of caring ion:..:.nr:c ozo. ii214.6 load,urfxe r:gnu_; a vcrimccin
accordance with 1"A 19C.i_ _...i_-a
9. YIELD (gyro): 15 ELY1HOD OF TEST ARDM
10. WATER ZO`IES (u4126: ITS
u_ DISINFECTION: T`VPF H''POCHLORITE Amount 5 0z LOCATION SKETCH tr
12. CASING: Wall Thickness Show c. scion ant! distance in miles from at leV 0
Diameter or Weight/Ft. Material S _ s or Caddy ✓ Roads. include the icse. �m
From 0 Pt_ 6l'4" SDR21 PVC 1 !c., i eoa'n roannarnes, Z em
❑. GROI:T: 0 C
CJI : m
Material Method y0
From 0 "n Ft GRAVEL MIX GRAVITY .'� mp
SCREEN
7rn
tnz
Axh D�smG? meter Slot Size Material n
_ -i
From NA To FL in. in. C. O
Z
1,. SAND:GRAvEL PA.CI
Dszi.. Size Material
From N,
16. REMIFSS.
1 DO HEM d U!.GTI-Y_HAT THIS WELL WAS CONSTRUCTED IN ACCORDT:_IL3'_''H ISA N CAL, 2C-WELL
CONSTRUCTION STANDARDS, AND THATA COPY OF THIS RECORD HAS BEEN _OV-DUD TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING 0 i1:. tAcLL
Submit the orlginat to tl:e Division of Water Quality, Groundwater Section, 1636 Mall Service center - Raleigh, NC
27699-1636 Phanc \o. [phone], within 30 days.

From: Carolina Wei! Drire:_, Inc To: NC Dept of Env. and Na Resour
Date. 1/-', 412004 Tme: 8:19:02 PM Page 6 of 6
WELL CONSTRUCTION RECORD 284339
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) SCOTT GANTT CERTIFICATION # 2=54
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable)
1. WELL i SF (Cbcck. Appilcable Box) : Residential
Recovery ❑ Hea: Purnp Water Injection ❑
2 WELL LOCATtll.
Nearest tours 7 P.:SSE LURE
LOT 1 OLD GATE SUBDIVISION
(if applicable)
Municipal ❑ Tnci MI E Agriculntal ❑ Mon o:i..s ❑
Other El If Other, Lt;t Use.
County RUTHERFORD
(Street Name, Numbs:z, Cot:et:u:u:y, Subdiviaioa, Lot No,. Zip Code)
1. OWNER RENAISSANCE PLOILDERS
ADDRESS L52 E V,.ATN ST
(it... o. ro00 No.1
FOREST CITY NC
City or ti o.,,: State
828-247.-44,5
Area Code - Phone
1 DATEDRiLI.FD 122:29/03
s. TOTAL DEP TI 707,0
6. DOES WELL REPLACE EXISTING WELL?
28043
Zip Code
YES ElNO El
7 STATIC WATER LEVEL Erlow Top of Casing: 330 Fr.
Rue"r" If Above Top of Casing)
e. TOP OF CASING IS FT. Above Land Surface"
Fop of casing- u.�rz._-c ',quilts a vananccin
accordnnee e t NC/.0C
9 VELD (cpmp ?E_3OD OF TEST ARDM
(0. WATER ZO7CES (:lr:rq,: 330
Topoe:aphicLand setting
rE Ridge E Inw_ ❑ Valley 7; FI:at
Latitude Long rude of Well location
35.26.175 / 3 09.385
(degees ininutes/seconds)
Lann:ea.;ongitude source: Q GPS ❑ Topographic :nap
DEPTH DRILLING LOG
.i Formation De:on.-Mon
70 Clay
380 Consolidated
it. DISINFECTION` 1 YPE EYPOCHLORITE .Amount 4 Oz
r. CASING- Wall Thickness
D„.'.i Diarnete or Weight/FL Material
From 0 FL 61/4" SDR 21 PVC
13 GROUT:
Dan: Material Method
From 0 .. _0 Ft. GRAVEL MIX GRAVITY
u. SCREEN
Dent, Diarneter Slot Size Material
Front NA
15 SAND/GRAVEL PACK:
K:
Dinh Size Material
From NA To Pt,
:5. RE.LARKS.
T.00ATION SKETCH o O
Shovel;:eodor, and distance Ismiles from at leash 9m
Eve Sf.if Roais or County Roads Include the Las. a cb
rrl
mu;:bca a._1 ccnuncn road runes. 2 2�
i DO HEREERY CLk'_ THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE t, 15A NCAC 2C, WELL
CONSTRUCTION STA DARDS, AND THAT A COPY OF THIS RECORD HAS SEER: ,-C7010 Tilla TELL OWNER.
12:29,O3
SIGNATURE OF PERSON CONSTRUCTING TIE. WELL Datc
0?,2001
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.

283821
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEW 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: RUTHERFORDTON County RUTH
HOLLY FOREST DR.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JOE CARSON
Address HOLLY FOREST DR
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 287-4239
Area Code Phone number
4. DATE DRILLED 12/22/03
5. TOTAL DEPTH: 265
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ni
7. STATIC WATER LEVEL Below Top of Casing: 70 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): 6 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 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
To Ft.
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
14.SCREEN
From
From
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 frLm at least-
Two State Roads or County Roads. Include the road
number and common names
HWY. #221 S. FROM RUTHERFORDTON. RT. ON
POORS FORD RD. RT. ON CLEGHORN MILL RD.
LEFT ON HOLLY FOREST DR. 4TH DRIVE ON
LEFT.
C11
rV
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
SIGNA 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

283820
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CER I IF1CATION # 3114
WELL CONTRACTOR COMPANY NAME PTPTMAN 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: ELLENBORO County RUTH Topographic/Land setting
NEW COVENANT WAY ❑ Ridge 0 Slope ❑ Valley 0 Flat
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) (check appropriate box) ` ,___.,
3. OWNER: CLINT HENDRICKS Latitude/longitude of well location
Address NEW COVENANT WAY
(Street or Route No.) (degrees/minutes/seconds)-:-:: ,
ELLENBORO NC 28040 Latitude/longitude source: ❑ GPS 0 Topographic ma
City or Town State Zip Code (check box) i
(828) — 245-5814 DEPTH
Area Code Phone number From To
4. DATE DRILLED 12/22/03
5. TOTAL DEPTH: 145
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IZ
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 3
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 40 Ft. 6-1/4" SDIL21 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.
DRILLING LOG
From To
LOCATION SKETCHL
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HOLLIS RD. FROM ELLENBORO. RT. ON EVAN
EDWARDS RD. LEFT ON NEW COVENANT WAY.
1/2 MILE ON LEFT.
O
C-.
rem
a
O
CJt
c
0'
0
rri
cn c
m
0<
tic
Dc
rn
ma
ooz
nn
m�
-4
ti
Cr
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS,(Cc/(�S,AND�THAT A COPY OF THIS �RJE�j
CORD HAS BEEN PROVIDED TO THE WELL OWNER
IG A OF PERSON CONSTRUCTING THE WELL 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. GW-1 REV. 07/2001

283819
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 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH
GREEN RIVER HIGHLANDS -LOT #117
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: D.J. WILLIAMS
Address GREEN RIVER HIGHLANDS
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) - 286-4868
Area Code Phone number
4. DATE DRILLED 12/03/03
5. TOTAL DEPTH: 425
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): 60 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To 50 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
From _ To
From To Ft.
16. REMARKS:
Size Material
Ft.
CHLORYTE Amount 11
Wall Thickness
Diameter or Weight/Ft. Material
6-1/4" SDR.21 PVC
Material Method
POURED
Material
in.
in.
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 ❑ T4ppgrhphic map _F
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH I
Show direction and distance in miles fr9m at lea
Two State Roads or County Roads. Inchide-the'road-
number and common names
HWY. #221 S. FROM RUTHERFORDTON. RIGHT
ON COXE RD. RIGHT INTO GREEN RIVER
HIGHLANDS ONTO RIVER CREST PARKWAY.
APPROX. 1 MILE ON RIGHT. LOT #117.
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
A
ENN PROVIDED TO THE WELL OWNER
/L
� (cee ')— w2
SIGNA 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

283818
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: LAKE LURE County RUTH Topographic/Land setting
SUNSET COVE RD. ❑ Ridge 0 Slope 0 Valley 0 Flat
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) (check appropriate box)
3. OWNER: BII L SEYMOUR Latitude/longitude of well location --
LAKE COVE RD.
(Street or Route No.) (degrees/minutes/seconds) .. r_
LAKE LURE NC 28746 Latitude/longitude source: 0 GPS 0 Topographic map
City or Town State Zip Code (check box)
(864-) - 457-3855 DEPTH
Area Code Phone number From To
4. DATE DRILLED 12/02/03
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES ® NO 0
7. STATIC WATER LEVEL Below Top of Casing: 160 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 16.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 180 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.
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles fnm a leash''
Two State Roads or County Roads. Include the road- "-
number and common names
HWY. #64/74A E. FROM LAKE LURE. LEFT ON
BUFFALO SHOALS RD. LEFT ON SUNSET COVE
RD. 100' ON RT.
0
Cr1
N
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
/sr�'[7'-CTit i
- / a- - c a
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

283816
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 ❑ Agricultural
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH
CARSON FARM DR
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JOE CARSON
Address 132 CARSON FARM DR.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 287-7840
Area Code Phone number
4. DATE DRILLED 12/11/03
5. TOTAL DEPTH: 705 DRILLING LOG
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑ From To
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. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 19.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Et. Material
From 0 To 80 Ft. 6-1/4" SDIL21 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 nom at leas't'_
Two State Roads or County Roads. Ina -fide the road
number and common names
HWY. #108 W. FROM RUTHERFORDTON. LEFT
ON PLEASANT HILL RD. APPROX. 1/2 MILE. LEFT
ON CARSON FARM DR HOUSE AT DEAD-END.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
2
SIGNATURE OF PERSON CONSTRUCTING THE LL 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
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location— r
t_7
(degrees/minutes/seconds) �--
Latitudc/longitude source: ❑ GPS ❑ T(pagraphic map trot
(check box)
DEPTH 5=
From To

283813
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Qnality - 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 ® MunicipalPublic ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: ELLENBORO
BOSS MOORE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: TAMMY BENNETT
Address BOSS MOORE RD.
(Street or Route No.)
ELLENBORO NC 28040
City or Town State Zip Code
(828) - 657-4320
Area Code Phone number
4. DATE DRILLED 12/09/03
5. TOTAL DEPTH: 39
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 24 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 RUTH
11. DISINFECTION: Type CHLORYTE Amount 6.9
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 39 Ft. 24" CEMENT
From To
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 24 To 39 Ft. 78M
From To Ft.
16. REMARKS:
Method
POURED
Slot Size Material
in. in.
in. in.
Material
GRAVEL
Topographic/Land setting
❑ Ridge 0 Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) ^—_
Latitude/longitude source: 0 GPS ❑ Toppgmphic rtfai-
(check box) i'`,-
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
FROM ELLENBORO. GO DOWN
ELLENBORO/HENRIETTA RD. RIGHT ON BOSS
MOORE RD. 1ST DRIVE ON RIGHT.
0
a
N
a
0
to
tV
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDjARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ND
/tom. � " NAB✓` CONSTRUCTING
_f/�. '/G7 LL DATESIG9 U3
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

2838
2
WELL CONSTRUCTION RECORD 1
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 ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: HARRIS
HOGAN RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: PHILLIP SEARCY
Address HOGAN RD.
(Street or Route No.)
HARRIS NC
City or Town State
(828) — 245-4391
Area Code Phone number
4. DATE DRILLED 12/08/03
5. TOTAL DEPTH: 64
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 44 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 RUTH
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 64 Ft. 24" CEMENT
From To _ Ft. _
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
To Ft.
Depth Diameter Slot Size Material
To Ft. in. in.
in. in.
From
I4.SCREEN
From
From _ To _ Ft.
15. SAND/GRAVEL PACK:
Depth Size
From 44 To 64 Ft. 78M
From To Ft.
16. REMARKS:
Material
GRAVEL
Topographic/Land setting
❑ Ridge ❑ Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
28074 Latitude/longitude source: ❑ GPS ❑ Topographic snap:
Zip Code (check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles ftcitn a
Two State Roads or County Roads. Include the r)
number and common names
HWY. #221 S. FROM RUTHERFORDTON6RIGHT
ON HOGAN RD. APPROX. 2/10 MILE WI RIGHT.
07,
Z
A
3C
O
cn
1V
cC'
m
oc.
>C0
);:frc
rnCA :it
CArn
n
G
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
ert-e---- / K 13
SIGNATUREQ.V.-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

233409
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
James to Camp, Jr.
CERTIFICATION # 2 1 3 R
WELL CONTRACTORCOMPANY NAME ramp' s Well R Ptimp Co Inn PHONE #�7R) AS"1-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT/0r
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential W-Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring Cl Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCAT
NepSe-:�
C,X
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
(11 F Topographic/Land settin
County• V_ •(, w ❑Ridge ❑Slope ❑Valley zit
(check appropriate box) i `_-
Latitude/longitudeof well location',_`':
3. OWNER:'C1 St
Address _).1y ✓ \-,Uj
(Street or to N
City T n State Zip Code
,,��••��
lt'()-,`9 \ 5 C{
Area code- Phone number
4. DATE DRILLED S \ - V
5. TOTAL DEPTH:. O S
6. DOES WELL REPLACE EXISTING WELL? YE ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 0
(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): !i Q MET OD OF TEST n i
10. WATER ZONES (depth): l u
FT.
11. DISINFECTION: Type C'h 1 nr i na
12. CASING:
Depth.,Diameter
From 0 Too 5 Ft. 6 1/ 4
From To Ft.
From To Ft.
GROUT: Depth
From
0 To 2 0
From To
SCREEN: Depth
From To
From To
SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Ft.
Ft.
Material
Amount
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Neat Cement
Diameter
Ft. in.
Ft. in.
Method
H
Slot Size Material
in.
in.
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topograjfhec time ---_ .
(check box) q f
DEPTH DRILLING LOG
From To Formation D cn�tion
0 2� S fur 5 t((JI'v
LOCATION SKETCI-1
Show direction and distance in miles from at least.i
two State Roads or County Roads. Include 111e road-.
numbers and common road names.
0T1
-t to
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WET T
CONSTRUCTION STANDARD AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
PR - .?"UJl
TURE OF PEF,SpN CONSTRCTING 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
•
Gar

From To
From To
13. GROUT: Depth
From_0_ To , D
283408
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM (print)
J0. Ty
,eLS f�W LA/Y1v� p -`7T" CERTIFICATIONn# �(3 g
WELL CONTRACTOR COMPANY NAME a Ytl�$ el, V YU WI[I (U.r'r...l-Y1C PHONEpJda�(�]�'r'{-7 3.22--
r ,
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED WQ PERMITS
(if applicable)
1. WELL USE (Check Applicable Box): Residential b lunicipal/Public 0 Industrial 0 Agricultural I , 1
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest T
k) ` - 0e
(Streetame, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:A�q C� Ups..&
Address R Cn -2\ S. S
\` (Street or RoCte No.) a%
City or Town
S() -I L‘Lk�t
Zip Code
Area code- Phone numbgr
4. DATE DRILLED \ ` - `S ' 0
5. TOTAL DEPTH: L- Q Cr
6. DOES WELL REPLACE EXISTING WELL? YES ❑ O (
7. STATIC WATER LEVEL Below Top of Casing: 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 15A NCAC 2C .0118.
9. YIELD (gpm): \ UMETHOD OF TEST
10. WATER ZONES (depth): V
11. DISINFECTION: Type C V\
Amount C$J•,v0
12. CASING: Wall Thickness
Depth Diameter
From, D To 1 ('J
Ft
Ft.
qr4 eigg`t/Ft. ateDd
JJ 11\ �l. tl kA
Material Methgd
at CeY Ft.Ylellertl+- k1zt
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To
From To Ft.
Slot Size Material
in.
in.
16. REMARKS:
County c-t..lY.h4^
Topographic/Land settin
❑Ridge ❑Slope ❑Valley 4JP
(check appropriate box) j n
Latitude/longitude of well locatidn
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic
(check box)
DEPTH
From To
n Gn
PRILLING LOG
FormSion Description
Ar
'I kApkA
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
4)
0
1�7
2 L t�Sb U-USA �yC
1 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
f-d- /1). a4•v1y��� 1. -1b-05
SIQ TURE OF PERSON CONSTRUOTING4HHE WFT 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 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)
^` .3Rves f�l.J. �%r�vv�^,j r.
WELL CONTRACTOR COMPANY NAME /A Ttt LV 'W e I 1(vl t f'Ll mp ( ,111 c
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
283407
- Groundwater Section
CERTIFICATION # .A (/3 g
PHONE # f2d0) Y53- 1 3a2
1. WELL USE (Check Applicable Box): Residential (Y.-Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATON•
ICx �0
(Sine[ Name, Numbers, Community,(,,Sutbdidivision, Lot No,, Zip Code)
3. OWNER: (X � gy C4
Address .� 0 r) \ Sis L .-u (C—
r
\ (Sa t or Routo No.)
\kLa..11,4.VV C r�SS
City or Towo SwF_(AL 1 Zip Code
(apsd- ��(1 —
Area code- Phone number[t
4. DATE DRILLED (L \
5. TOTAL DEPTH: h'5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: \ FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ) 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 ��
10. WATER ZONES (depth): OU
11. DISINFECTION: Type (r
12. CASING:
Nare;SR'own: Ak 12.. J
Depth _ Diameter
From 0 To ID FL
o
From__To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. Pleat Ce'VY(eKt- kavJ
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in in.
Front To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth , Size Material
From To Ft."'
From To Ft.
County-IA.*�
Topographic/Land setting
dge ❑Slope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic tpap L_
(check box)
DEPTH
From (Tos
0
1 r
DRILLING LOOT
ion Description
(/
LOCATION SKETCH
Amount (k z,1c) Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
orWeight/Ft. rateriti, numbers and conunon road names.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFT T
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RBCORD HAS BEEN PROVIDED TO THE WELL OWNER
d1/2ri-224- /4).
\L v�
sic -re 't ATOM OF PERSON CONST VI tO HE 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) .Tames w Camp Tr
t
WELL CONTRACTOR COMPANY NAME ('a mP' s Wa11 R Pnmp C'rn Tnr
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
283406
- Groundwater Section
CERTIFICATION # 21 3 E3
PHONE #ffi2R) 4S4-7322
r
1. WELL USE (Check Applicable Box): Residential I�Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use I r.
2. WELL LOCATI N:
care own: ounry
(Sue Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: \ & &V O WI't* „ky _A
Address t7 A„Z\ S SET . s,o_c A
(Street Route No.)
.. A c \ \9,0o
(AZiry or Towu Su
- %SO . c L-\ Zip Code
)
Area coda- Phone numbir
4. DATE DRII I FD I, - rtc • U 3
5. TOTAL DEPTH• U 4 E
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: \ AO 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
` rariance in accords ea wltb ISA NCAC 2C .0118.
9. YIELD (gpm): (i METHOD F TEST pit
10. WATER ZONES (depth):
U. DISINFECTION: Type Chi nri na
12. CASING:
Depth
From icy To'SO Ft6 1/4
From To Ft
From To Ft.
13. GROUT: Depth
From o To 3 0 Ft
From To Ft.
Material
Nedt
Amount Li C.L4
Wall Thiclmess
Diameter or Weight/Ft. Material
ePa21 PVC
Method
Ccment Hand
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 ❑Fla
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic;
(check boa)
DEPTH,
From To
n ISU
\Sv 41q,S
LOCATION SKETCH
Show direction and distance in miles from at leas
two State Roads or County Roads, Include th oad
numbers and commons oad names.
�
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
(t-4/(( I", r
SIGNATURE OF PERSON CONSTRUCTING THE WF) 1 / 1/ 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
O
W
I -g-(3
0
tit
CS)
c
O

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
•CAS
k,eI( 2Ltmp CD. IC
ASSOCIATED WQ PERMIT#
(if applicable) (ifapplicable)
WELL CONTRACTOR (INDIVIDUAL) NAMJ (print)
WELL CONTRACTOR COMPANY NAME La Yrl(.S
STATE WELL CONSTRUCTION PERMIT#
.Tcivvtes IA)
283403
CERTIFICATION # AI .3 g
PHONE # (8aa 42' ! 3a'2
1. WELL USE (Check Applicable Box): Residential t7 Municipal/Public ❑ Industrial ❑ Agricultural t'
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI I /
Nearest T wn: �X l i3\ ; 1gtnty
�\C 11
(SS.,Numbers, .,Numbers, Cont unity, Subdivision, Lot No., Zip Code)
3. OWNER: i ((\\P '��',Y . C \-, OJ p j�
Address .t0 I -,NM V Ah.Mfi.(r Cj� (Yti
4r\ (Street or Route °.' S CN
(Cny or Tony Su[s_ 1 \orr Zip Code
St1Y V 5 3 — `lj
Area code- Phone numbgr,
4. DATE DRILLED l` -1 — O
5. TOTAL DEPTH: � l7 S
6. DOES WELL REPLACE EXISTING WELL? YE ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: LA U 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 accordan9c�e with 1SA NCAC 2C .0118.
9. YIELD (am): \ 1 TH21D OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To 1
From__To
From To
GROUT: Depth
From D To 2 D
Topograyhic/Land setting
❑Ridge (9S`lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING I.OQ
Fr� iT}l Fo�u• J`— Description
n ( ,� �/� LOCATION SKETCH
C. Amount `J..u(' Show direction and distance in miles from
Wall Thickness two State Roads or County Roads. Include
Diameter or Weight/Ft. i ' -A . Material r numbers and common road names.
Ft k3 is S4z T
Ft.
Ft.
Material Methopd
Ft neat Cew(evit kand
From To Ft.
SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in
SAND/GRAVEL PACK:
Depth ,.. Size
From To Ft.
From To Ft.
Slot Size Material
in.
in.
Material
ro
tile road
c-1;1
(.r1
rn
0.;
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 /O,F (THIS R,I:CORD HAS BEEN PROVIDED TO THE WELL OWNER
C , 7 /-2"
SIObIATURE OF PERSON CONSTRU IPIG/➢HE 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

283401
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMJ (print) .T0. VIAe.5 5�� • CA/1Wl p ^1/43 r. CERTIFICATION
11 # of 3 8
WELL CONTRACTOR COMPANY NAME lA Wlf1$ k)e �I V t'I.1 yyl (1 I D.11,.t-YlC PHONE # f2 45-3 3�2
STATE WELL CONSTRUCTION PERMIT# I ASSOCIATEDrWQ PERMITO
(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:
(Ssr_____!etharati, Numrs, Community, Subdivision, Lot No., Zip Code)
County %t.l .SLJ!,t,T
3. OWNER: U1
Address ) s-- xt�' l Jn
(Street omaNNo )
\I {M V1)AUN) 'IV C
City o Tew-) \StaJ\ Zip Code
�e- Phone numb
'`111
4. DATE DRILLED \ - \ M V 3
5. TOTAL DEPTH- l7 S
6. DOES WELL REPLACE EXISTING WELL? YES 1Q NO 0
7. STATIC WATER LEVEL Below Top of Casing: (i () FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ) 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 (3 A \
10. WATER ZONES (depth):
11. DISINFECTION: Type
Topowaaphic/Land setting
❑Ridge I�STope ❑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
d �00
Amount
12. CASING: Wall Thickness
Depth Diameter
From 0 To (�.) Ft. (J 7
From To Ft.
From To Ft.
13. GROUT:
From 0
i
LOCATION SKETCH i_
Show direction and distance in miles froat least
two State Roads or County Roads. Include the road
or eitt/Ft, t/ numbers and ommon road names. (t `
Depth Material
To .D Ft. Meal CCMen-
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth ... Size Material
Front To
Meth d
wcL tia
Slot Size Material
to
c Pt)
m �li
\IWu'-
�,�,
5 \_ UT c 1
CY
16. REMARKS: \'�''^ t�` t
From To Ft.
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFI
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS $CORD HAS BEEN PROVIDED TO THE WFI f OWNER
StylATURE OF PERSON TRDATE
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

277632
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
El
Monitoring 0 Recovery D Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: BOSTIC County RUTH
WATERS RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MAX TONEY
Address 990 WATERS RD.
(Street or Route No.) (degrees/minutes/seconds)
BOSTIC NC 28018 Latitude/longitude source: ❑ GPS ❑ Topographic map
City or Town State Zip Code (check box)
(828) - 245-8194 DEPTH
Area Code Phone number From To
4. DATE DRILLED 07/14/03
5. TOTAL DEPTH: 265
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 15A NCAC 2C .0118.
9. YIELD (gpm): 40 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 6
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 6-1/4" SDR.21 PVC
Ft.
Ft.
Material Method
Ft.OUH{RETE POURED
Ft.
Diameter Slot Size Material
Ft. _ in. _ in.
Ft. in. in.
12. CASING:
Depth
From 0 To 130
From To
From _ To
13. GROUT: Depth
From 0 To 20
From To
14.SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Size Material
From To
From _ To
Ft.
Ft.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
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
74 E. FROM FOREST CITY. LEFT ON
BOSTIC/SUNSHINE HWY. LEFT ON TONEY RD.
LEFT ON WATERS RD. 1 ST HOUSE ON LEFT.
0
CO
a
L
7
c3
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
teran
.S�
SIG ATURE OF PERSON CON TR?�CT1N(y TI LI« (1`.
1
Submit the original to the Division of Water Quality, Graz} dtater Section, 1636 Mail
27699-1636 Phone No. [phone], within 30 days. J
�- /V- a�
DATE
Center- Raleigh, NC
-1 REV. 07/2001

277631
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 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: BOSTIC
MTN. LOOKOUT DR.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BILL SMITH
Address 296 MTN. LOOKOUT DR.
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code
(336) — 838-9725
Area Code Phone number
4. DATE DRILLED 07/11/03
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 160 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 RUTH
11. DISINFECTION: Type CHLORYTE Amount 16.5
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
Method
POURED
Slot Size Material
in. _ in.
in. in.
From To Ft.
From To Ft.
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
BUS. 74 E. FROM FOREST CITY. LEFT ON
BOSTIC/SUNSHINE HWY. LEFT ON LUCKADOO
MTN. RD. LEFT ON FIRE TOWER RD. RT. ON
AMELIA LANE INTO GOLDEN VALLEY ESTATES.
RT. ON MTN. LOOKOUT DR. APPROX. 1 MILE ON
RT. LOT #41.
0
Co
c-�
0
tV
-C-
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
SIGNATURE OF CONS' IGUi
Submit the original to the Division of Water Quality, Grou
27699-1636 Phone No. [phone], within 30 days.
TING-WELL\p
IfMter Section, 1636 Mail Si
IIJ ffL
//7/n e, '7 - // -
DATE
Center — Raleigh, NC
-1 REV. 07/2001

277630
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 D Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: BOSTIC
CHERRY RIDGE SUBDV.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DEWAYNE & LISA MOORE
Address CHERRY RIDGE SUBDV.
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code
(803) — 782-5404
Area Code Phone number
4. DATE DRILLED 07/09/03
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): 20 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 4.5
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
From 0 To 20 Ft. QUIKRETE
From To Ft.
14. SCREEN: Depth Diameter
From To FL
From _ To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Method
POURED
Slot Size Material
in. 1n.
in. in.
From To Ft.
Topographic/Land setting
❑ Ridge ❑ Slope D 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
BUS. 74 E. FROM FOREST CITY. LEFT ON
BOSTIC/SUNSHINE HWY. RT. ON SALEM CH. RD.
LEFT INTO CHERRY RIDGE SUBDV. CROSS DAM.
BEAR LEFT. LOG HOME ON LEFT.
r.;=D
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
�SIGNA OF PERSON O awe Tim WELL f, DATE
Submit the original to the Division of Water Quality, Gripti ater Section, 1636 Mail $
27699-1636 Phone No. [phone], within 30 days. , li
I J L
tV
%- l`'-O ?
e Center — Raleigh, NC
W-1 REV. 07/2001

277629
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: BOSTIC
CHERRY RIDGE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BERRY PHLEGAR
Address CHERRY RIDGE
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code
(919) — 870-8802
Area Code Phone number
4. DATE DRILLED 07/08/03
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 1-112 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): 7 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 13.5
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. OUIKRETE POURED
From To Ft.
14.SCREEN: Dcpth 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 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 BOSTIC. GO OUT BOSTIC/SUNSHINE
HWY. RIGHT ON SALEM CH. RD. LEFT INTO
CHERRY RIDGE. TURN RIGHT. GO ACROSS DAM.
1/4 MILE. NEW DRIVE ON LEFT.
16. REMARKS:
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 PROVIDED TO THE WELL OWNER
a-s
J
SIG ATURE OF PERSO
Submit the original to the Division of Water Quality, Grid
27699-1636 Phone No. [phone], within 30 days.
ce Center —Raleigh, NC
GW-1 REV. 07/2001

SIG ATURE �(h'1,'."RUETiN9-TIf ,, ., DATE
.
Submit the original to the Division of Water Quality, Gr4rinifvater et ion, Marl
27699-1636 Phone No. [phone], within 30 days. fl E'
1 L.
277628
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 D Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: LAKE LURE
RUSTIC HOUSE LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: RICKY CONNER
Address 160 RUSTIC HOUSE LANE
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
(828) — 625-0605
Area Code Phone number
4. DATE DRILLED 07/09/03
5. TOTAL DEPTH: 45
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
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): 15 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth Diameter
CHLORYTE Amount 6.9
Wall Thickness
or Weight/Ft. Material
From 0 To 45 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 Slot Size
From To Ft. in. _
From _ To Ft. _ in.
15. SAND/GRAVEL PACK:
Depth Size
From 30 To 45 Ft. 78M
From To Ft.
CEMENT
Method
POURED
16. REMARKS:
Material
in.
in.
Material
GRAVEL
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/bngitude 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. #64/74A W. FROM RFTN. RIGHT ON
COVE RD. LEFT ON BILL'S CREEK RD. RIGHT ON
CONNER RD. GO APPROX. 3/4 MILE. LEFT ON
RUSTIC HOUSE LANE. 1/8 MILE ON RIGHT.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS, tECORD HAS BEEN PROVIDED TO THE WELL OWNER
GL
PERS
County RUTH
7 2-/?
Center — Raleigh, NC
W-1 REV. 07/2001

277627
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: RUTHERFORDTON
US HWY. #64
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LUCILLE HUTCHINS
Address 2233 US HWY. #64
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 248-7717
Area Code Phone numb_+
4. DATE DRILLED 07/07/03
5. TOTAL DEPTH: 55
6. DOES WELL REPLACE EXISTING WELL? ? YES D. NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 35 Ef.
(use"+"if Above Top of CziE"01 .)
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 RUTH
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 55 FL 24" CEMENT
Frnm Tr. Ft
From To Et.
13. GROUT: Depth Material Method
From 0 To 70 Ft. ertIFNT poutt 11
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
Front To Ft. in_ _ in.
From To Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size
From 35 To 55 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 In Topographic map
(check box)
DEPTH
Front To
DRILLING LOG
Fro... 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 E. FROM RUTH. WHITE HOUSE
APPROX. 8/10 MILE ON LEFT AFTER GOING PAST
HUDLOW RD.
Zh .z {Id B- 511V CO
c
t)^ ¶4FPFFt r"P_. T _ THAT ____. .,!. \VAS enNgTMIrTyn T J ArrOrtn"?CP WITH Nrlit C lC` vim T.
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SFa�
SIA OOF P N O STRUCTING THE WELL j �� DATE
Suhmit the ori•nna! to the Division of Water finality, G
27699-1636 Phone No. [phone], within 30 days. 11!
titer Section.-1-3(:; Mai F,e ice Center — Raleigh. NC
GW-1 REV. 07/2001
i
J

277625
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEE. 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: ELLENBORO
NEWHOUSE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DARRELL TONEY
Address NEWHOUSE RD.
(Street or Route No.)
ELLENBORO NC 28040
City or Town State Zip Code
(828) — 429-5249
Area Code Phone number
4. DATE DRILLED 07/30/03
5. TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
County RUTH
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: 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. 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
❑ 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 (east
Two State Roads or County Roads. Include the road
number and common names
FROM ELLENBORO GO UP NEWHOUSE RD.
NEW DRIVE ON LEFT. 1/2 MILE PAST WILKIEW
NURSERY.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TIJAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
(Ljilt ,-9-
GNA RE OF PERSON CONS WI, 1.11 W4L1 (—m,, DATE
Submit the original to the Division of Water Quality, Grot(r<aw4fer eraiiit, Mail Sa Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. 1 ' " 1 9J1i4 -1 REV. 07/2001

277624
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 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: BOSTIC
IDLEWILD DR LOT 65
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: VICKY ROBERTS
Address IDLEWILD DR.
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code
(864) — 461-4185
Area Code Phone number
4. DATE DRILLED 07/17/03
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 145 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 RUTH
11. DISINFECTION: Type CHLORYTE Amount 16.5
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.
15. SAND/GRAVEL PACK:
Depth
From To
From To Ft.
16. REMARKS:
Size Material
Ft.
Topographic/Land setting
❑ Ridge 0 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 miles from at least
Two State Roads or County Roads. Include the road
number and common names
BUS. 74 E. FROM FOREST CITY. LEFT ON
BOSTIC/SUNSHINE HWY. LEFT ON LUCKADOO
MTN. RD. LEFT ON FIRE TOWER RD. TO INTO
GOLDEN VALLEY ESTATES. RT. ON AMELIA
LANE. RT. ON MTN. LOOKOUT DR RT. ON
IDLEWILD DR. 1/4 MILE ON LEFT. (LOT #65)
--
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT t COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
( - TURF
NA OF PERSON CONSTRUCT1
Submit the original to the Division of Water Quality, Groundw$tjgr� ection,1636 Marl ervvic
27699-1636 Phone No. [phone], within 30 days. JI '' G
r— Raleigh, NC
V. 07/2001

277621
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/Publ
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other
2. WELL LOCATION:
Nearest Town: LAKE LURE County RUTH
HEMMINGWAY DRIVE.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER WALKE CONST.
Address HEMMINGWAY DRIVE.
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
(S28) - 288-3000
Area Code Phone number
4. DATE DRILLED 07/09/03
5. TOTAL DEPTH: 145
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ej
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): 20 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From 0 To 80 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
From To Ft.
From _ To Ft.
15. SAND/GRAVEL PACK:
CHLORYTE Amount 3
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Depth
From _ To
From To
16. REMARKS:
Method
POURED
Slot Size Material
in. in.
in. in.
Size Material
Ft.
Ft.
c ❑ Industrial 0 Agricultural 0
0 If Other, List Use
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 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 RUTH. 1-1/2 MILE PAST
HWY. #9. DRIVE ON RIGHT. HEMMINGWAY DR
1ST HOUSE ON RT.
0
CO
0
co
-o
N
r
N
-
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TIIAJ' A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SI A OF PERSON CONS
Submit the original to the Division of Water Quality, Grou
27699-1636 Phone No. [phone], within 30 days.
DATE
enter - Raleigh, NC
-1 REV. 07/2001

277620
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: LAKE LURE
RIDGECREST DRIVE -LOT #1
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: WALKE CONSTRUCTION
Address RIDGECREST DRIVE
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
(828) — 288-3000
Area Code Phone number
4. DATE DRILLED 07/08/03
5. TOTAL DEPTH: 205
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): 10 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CIILORYTE Amount 4.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 40 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.
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 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 RUTH. RT. ON BILL'S
CREEK RD. LEFT ON CEDAR CREEK RD. LEFT
ON RIDGECREST DR 2 MILES. NEW LOG HOUSE
ON RT.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCT ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�IGh�OF PERSON CONS
Submit the original to the Division of Water Quality, Groun
27699-1636 Phone No. [phone], within 30 days.
IL
IL
J-f- 0.9
LL DATE
'11:636S4i1 ServP
nter — Raleigh, NC
1 REV. 07/2001

277618
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 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: ELLENBORO
DOBBINS RD.
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: STEVEN BENNETT
Address 566 DOBBINS RD.
(Street or Route No.)
ELLENBORO NC 28040
City or Town State Zip Cod
(828) — 453-0883
Area Code Phone number
4. DATE DRILLED 07/08/03
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELLS YES D 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 I5A NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
Zip Code)
11. DISINFECTION: Type CHLORYTE Amount 7.5
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. 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
(degreesrminutes/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 ELLENBORO GO DOWN
ELLENBORO/HENRIETTA RD. LEFT ON DOBBINS
RD. APPROX. 1 MILE ON RIGHT. (BOX #566)
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
SI A OF PERSON GDATE
Submit the original to the Division of Water Quality, G
27699-1636 Phone No. [phone], within 30 days.
L
ion 1636114aili SpoOke Center — Raleigh, NC
W-1 REV. 07/2001
L.

277612
WELL CONSTRUCTION RECORD
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 IS) Municipal ❑ Industrial ErAgricultural ❑ Monitoring
Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use:
2. WELL LOCATION:
Nearest town: RUTHERFORDTON
LOT 5 COUNTRY MEADOWS ESTATES
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER WILKINS HOME CENTER
ADDRESS 1920 HWY 74A BYPASS
(Street or Route No.)
FOREST CITY
city or Town
828-286-3647
NC
State
Area Code - Phone Number
4. DATE DRILLED 7/8/03
5. TOTAL DEPTH 125
28043
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Eli
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" IfAboor Top of Cuing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated actor below land surface requires a variance in
accordance with 15A NCAC 2C.0118
9. YIELD(gpm): 10 METHOD OF TEST ARUM
t0- WATER ZONES (depth): 120
it DISINFECTION: TYPE HYPOCHLORITE Amount
12. CASING:
From 0
13. GROUT.
From 0
14. SCREEN
From
Depth
To 90
Diameter
Ft. 6 1/4 "
Depth
To 20 Ft.
Depth
NA To
15. SAND/GRAVEL PACK:
Depth
From NA To
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ® Flat
Latitude/Longitude of well location
35.15.597 / 81.55.939
(degrees/minutes/seconds)
Latitude/longitude source: ® GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Descripttion
0 80 Clay
80 125 Consolidated Rock
3 oa LOCATION SKETCH
Wall Thickness
or Weight/Et. Material
SDR21 PVC
Material Mettrod
GRAVEL MIX GRAVITY
Diameter
Ft. in
Ft.
Size
Slot Size
in.
Material
Material
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
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 OWNF,R.
8/1/03
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_ IWV 0712001

From
WELL CONSTRUCTION RECORD
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 ® Municipal Q Industrial Q Agricultural E Monitoring
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: LAKE LURE County RUTHERFORD
LOT 216 RIVERBEND ACRES
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER RIDGELINE DEVELOPEMENT CORP.
ADDRESS 112 COCOPLUM CIRCLE
(Street or Route No.)
ROYAL PALM BEACH
City or Town
561-798-2729
FL
State
Area Code - Phone Number
4. DATE DRILLED 7/14/03
5. TOTAL DEPTH 380
DOES WELL REPLACE EXISTING WELL?
. STATIC WATER LEVEL Below Top of Casing:
YES ❑ NO
55 FT
(Use "+" If Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated atlor below land surface requires a rsriance in
accordance with 15A NCAC 2C.0118
9. YIELD (gpm): 4
METHOD OF TEST ARDM
10. WATER ZONES (depth): 365
Zip Code
277611
Topographic/Landsetting
❑ Ridge ❑ Slope ❑ Valley ® Flat
Latitude/Longitude of well location
35.25274 / 82.09/513
(degrees/minutes/seconds)
Latitude/longitude source: ® GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 9 Clay
9
380 Consolidated Rock
11. DISINFECTION: TYPE HYPOCHLORITE Amount 10
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 21 Ft. 6 1/4 " SDR 21 PVC
13. GROUT:
Or
Depth Material Method
From 0 To 20 Ft GRAVEL MIX GRAVITY
14. SCREEN
Depth
From NA To
Diameter
Ft. in,
15. SAND/GRAVEL PACK:
Depth
NA To
16. REMARKS.
Ft,
Slot Size Material
in.
Size 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.
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-IBEEN PROVIDED•TE-THE WELL OWNER.
7/15/03-
Date
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. 07t2001

WELL CONSTRUCTION RECORD 277610
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 # ASSOCI'ATED- WQ PERIDigf#-
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box) : Residential ® Municipal Q • Industrial Q Agricultural Q Monitoring ❑
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION:
Nearest town: BOSTIC
7548 SUNSHINE HWY GOLDEN VALLEY
County RUTFIERFORD
Topographic/Land setting_
❑ Ridge ❑ Slope 0 Valley ® Flat
Latitude/Longitude of well location
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code) 35.30.824 / 81.45253
3. OWNER HORTON HOME OF RUTHERFORDTON (degrees/minutes/seconds)
ADDRESS 342 HWY 74 BYPASS Latitude/longitude source: ® GPS ❑ Topographic map
(Street or Route No.) DEPTH DRILLING LOG
RUTHERFORDTON NC 28139 From To Formation Descri{tttion
City or Town State Zip Code 0 90 Clay
828-287-3366 90 203 Consolidated Rock
Area Code - Phone Number
4. DATE DRILLED 7/29/03
5. TOTAL DEPTH 203
6_ DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing:
YES ❑ NO Egi
65 FT.
(Use "+" If Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
*Top of casing terminated actor below land surface requires a variance in
accordance with 15A NCAC 2C.0118
9. YIELD (gpm): I0 METHOD OF TEST ARDM
10. WATER ZONES (depth): 195
11. DISINFECTION: TYPE HYPOCHLORITE Amount 5 oz LOCATION SKETCH
12. CASING: Wall Thickness Show direction and distance in miles from at least
Depth Diameter or Weight/Ft. Material two State Roads or County Roads: Include thevad
From 0 To 98 Ft. 6 1/4 " SDR 21 PVC numbers and common road names.
13. GROUT:
Depth Material Method
From 0 To 20 Ft. GRAVEL MIX GRAVITY
14. SCREEN
Depth Diameter Slot Size Material
From NA To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From NA To Ft,
16. REMARKS:
0
CO
G
G7
O7
—u
b: r,
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 IHP. WELL OWNER.. E
•
7/30/03
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Date
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Ma'l Service center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 277609
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 PERMTP t
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box) : Residential ® Municipal. ❑ Industriat ❑ Agricultural a Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION.
Nearest town: BOSTIC
274 MELTON RD
County RUTHERFORD
Topographicitarrd'settitrg-
❑ Ridge ® Slope ❑ Valley ❑ Flat
Latitude/Longitude of well location
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER TERRY TINKEL (degrees/minutes/seconds)
ADDRESS 274 MELTON RD Latitude/longtude source: ❑ GPS ❑ Topographic map
(Street or Rome No.) DEPTH DRILLING LOG
BOSTIC NC 28018 From To Formation Descri ion
City or Town Slate Zip Code 0 60 Clay
860-739-4255 60 400 Consolidated Rock
Area Code - Phone Number
4. DATE DRILLED 7/24/03
5. TOTAL DEPTH 400
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 10 FT.
(Use "+" If Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of cuing terminated at/or below land surface requires a sariance in
accordance with 15A NCAC 2C.0I18
9. YIELD (gpm): 4 METHOD OF TEST ARDM
10. WATER ZONES (depth): 390
I.DISINFECTION: TYPE HYPOCHLORITE Amount 12
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 66 Ft. 61/4" SDR 21 PVC
13. GROUT:
Oz
Depth Material Method -
From 0 To 20 Ft. GRAVEL MIX GRAVITY
14. SCREEN
Depth Diameter Slot Size Material
From NA To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From NA To Ft,
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the read
numbers and common road names.
MILE.
MELTON RD
o
o
G7
JONESTOWN-RD
ITWY 226
IN)
W
c
y,
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C. WELL
CONSTRUCHON STANDARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
7/25/03
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. 0772001

WELL CONSTRUCTION RECORD
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 #
(if applicable)
I. WELL USE (Check Applicable Box) : Residential
Recovery ❑ Heat Pump Water Injection ❑
2. WELL LOCATION:
Nearest town: BOSTIC
LOT 5 FIRE TOWER RD GOLDEN VALLEY
277608
ASSOCIATED WQ PERMIT #
(if applicable)
Municipal Q Industrial Q Agricultural Q Monitoring
Other ❑ If Other, List Use:
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER WOODSTREAM CUSTOM BUILDERS, LLC
ADDRESS 643 E. HIDDEN MOUNTAIN LANE
(Street or Route No.)
CRUMPLER
City or Town
336-982-8880
NC
State
Area Code - Phone Number
4 DATE DRILLED 7/22/03
5. TOTAL DEPTH 222
28617
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ig
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(The "+" If Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
*Top of casing terminated atlor below land surface requires a aariance m
accordance with 15A NCAC 2C.0118
9. YIELD (gpm): 8 METHOD OF TEST ARDM
10. WATER ZONES (depth)'. 150
Topographic/Land setting
Ridge ❑ Slope ❑ Valley ® Flat
Latitude/Longitude of well location
35.30.380 / 81.49.135
(degrees/ninutes/seconds)
Latitude/longitude source: ® GPS ❑ Topographic map
DEPTH
From To
DRILLING LOG
Formation DescriRtion
0 60 Clay
60 222
Consolidated Rock
DISINFECTION: TYPE HYPOCHLORITE Amount 4
12. CASING'.
Depth
From 0 To 68
13. GROUT:
From 0
Diameter
Ft. 6 1/4 a
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Oz
Depth Material Method
To 20 Ft. GRAVEL MIX GRAVITY
14. SCREEN
Depth
From NA To
Diameter
Ft. in.
15. SAND/GRAVEL PACK:
Depth
From NA To
16. REMARKS:
Ft,
Size
Slot Size Material
in.
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the oad
numbers and common road names.
£h:? ddd 8-9111/E0
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-IIAS BEEN PROVIDED TO THE WELL OWNER.
7/24/f13
Date
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service center lRaleigh, NC
27699-1636 Phone No. [phone], within 30 days.
ra �
F
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 277607
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 # ASSOCIATEDWQ-PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box) : Residential ® Municipal E Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: RUTHERFORDTON
LOT 5 BLUEBELL COURT
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER HORTON HOME OF RUTHERFORDTON
ADDRESS 342 HWY 74 BYPASS
(Street or Route No.)
RUTHERFORDTON
City or Town
828-287-3366
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ® Flat
Latitude/Longitude of well location
35.16.216 / 81.57.155
(degrees/minules'seconds)
Latitude/longitude source: ® GPS ❑ Topographic map
DEPTH DRILLING LOG
NC 28139 From To Formation Descriition
State Zip Code 0 60 Clay
Area Code - Phone Number
4. DATE DRILLED 7/21/03
5. TOTAL DEPTH 220
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 30 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 surSce requires a am -lance in
accordance with 15A NCAC 2C.0118
9. YIELD (gpm): 20 METHOD OF TEST ARDM
10. WATER ZONES (depth): 215
60 220
u. DISINFECTION: TYPE HYPOCHLORITE Amount 6 oa
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 65 Ft. 6 1/4 " SDR 21 PVC numbers and common road names.
W
13. GROUT:
Depth Material Method v7
From 0 To 20 Ft. GRAVEL MIX GRAVITY
ca
14. SCREEN
Depth Diameter Slot Size Material
From NA To Ft. in in. tV
15. SAND/GRAVEL PACK: ,F—
Depth Size Material r_J
Consolidated Rock
LOCATION SKETCH
From NA To Ft,
16. REMARKS:
Show direction and distance in miles from at least
two State Roads or County Ruadr. include tht . oad
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 I HE WELL OWNER.
7/22/03
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Ma I Service center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001
l�.
J L Lei
_J
L1(/l. Ir tR SE Oi
Ac,:HEVELLE REb OFJAL OFFICE

WELL CONSTRUCTION RECORD n 7 7 A n 6
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 CAROIINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQPERNIIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal Q Industrial❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: LAKE LURE County RUTHERFORD
LOT 2 TANGLEWOOD DR
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER MOUNTAIN WAY CONST
ADDRESS 721 MOUNTAIN WAY RD
(Street or Route No.)
LAKE LURE
City or Town
828-625-1446
NC
State
Area Code - Phone Number
4. DATE DRILLED 7/15/03
5. TOTAL. DEPTH 314
6. DOES WELL REPLACE EXISTING WELL?
7, STATIC WATER LEVEL Below Top of Casing:
YES D NO
120 FT.
(Use "+" If Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
'Top ofeasing terminated actor below land surface regdnes a wiance in
accordance with 15A NCAC 2C.0118
9. YIELD (gpm): 25 METHOD OF TEST ARDM
10. WATER ZONES (depth): 310
II. DISINFECTION: TYPE HYPOCHLORITE Amount 6
Zip Code
Topographic/Land- setting
❑ Ridge ❑ Slope ❑ Valley ® Flat
Latitude/Longitude of well location
32.27.977 / 82.08.287
(degrees/minutes/seconds)
Latitude/longitude source: ® GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Descriiktion
0 70 Clay
70 314 Consolidated Rock
oz LOCATION SKETCH
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 78 Ft. 61/4" SDR 21 PVC
13. GROUT'.
Depth Material Method
From 0 To 20 Ft. GRAVEL MIX GRAVITY
14. SCREEN
Depth
From NA To
15. SAND/GRAVEL PACK'.
Depth
From NA To
16. REMARKS:
Diameter
Ft.
Ft,
Slot Size Material
in. in.
Size
Material
Show direction and distance in miles from at least
two State Roads or County Roads. Include the toad _
numbers and common road names.
CD
CA)
N
C)
r
-
0
1 DO FIERF.BY 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.
7/18/03
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
GROLFN!i, AVER SECTiON
ASHEVILLE I1EGiOi'J;;L OHHCE

WELL CONSTRUCTION RECORD
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
)434-7277 #
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED
applicable)
WQ PERMIT
(if applicable)
1. WELL USE (Check Applicable Box) : Residential ® Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery El Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION.
Nearest sown: LAKE LURE
LOT 26 LAKE LURE HIGHLANDS
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No, Zip Code)
3. OWNER HORTON HOME OF RUTHERFORDTON
ADDRESS 342 HWY 74 BYPASS
(Street or Route No.)
RUTHERFORDTON
City or Town
828-287-3366
Area Code - Phone Number
4. DATE DRILLED 7/17/03
NC
State
28139
Zip Code
5. TOTAL DEPTH 300
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Eg
7. STATIC WATER LEVEL Below Top of Casing: 30 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 15A NCAC 2C 0118
9. YIELD (gpm): 3 METHOD OF TEST
10. WATER ZONES (depth) 280
u. DISINFECTION: TYPE HYPOCHLORITE
12. CASING'.
Depth Diameter
From 0 To 29 Ft. 61/4"
13. GROUT:
From 0
Depth
To 20 Ft.
t4. SCREEN
Depth
From NA To
15. SAND/GRAVEL PACK:
Depth
From NA To
16. REMARKS:
ARDM
Amount 9
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Or
Material Method
GRAVEL MIX GRAVITY
Diameter
Ft. in.
Ft,
Size
Slot Size
m
Material
Material
277605
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ® Flat
Latitude/Longitude of well location
35.29.767 / 82.08.130
(degrees/minutes/seconds)
Latitude/longitude source: ® GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 8 Clay
8
300 Consolidated 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
0
GD
GD
CD
PO
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.
7/18/03
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. r --- —_—.
GW-1 REV. 0772001

275620
uL
GSbtiii'ID(ivigEflrppvivo? fhe Di
ASH 699b$fa:941AAISAfmE9)73:
y,oslt 6g
WELL CONSTRUCTION RECORD 1*47o_CiZi .
North Carolina - Department of Environment and Natural �R1e�sources - Division of Water Quality - Groundwater Section
R WELL CONTACTOR (INDIVIDUAL) NAME (print) M41+ aje4ir CERTIFICATION #24-5-7
M`Grll foil -lets
WELL CON'I RAC'rOR COMPANY NAME
SLATE WELL CONSTRUCTION PERMIT#
(if applicable)
PHONE # (7(j4) 39f' /SCC
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/PublicIndustrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ IC Other, List Use
2. WELL LOCATIONr::�
Nearest Town: C41fNtdri &«k P ounty e yf' 'J
Hi.) GOVA iaSY:n� 1pf.
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
(Street or Route No.)
C hi�ft�L� gunC,r, Nc, Ag ao
Zip Code
City or Town State
( )-
Arca code- Phone number
4. DATE DRILLED 6)-17.Q3
5. TOTAL DEPTH: IQcx)'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO (3"
7. STATIC WATER LEVEL Below Top of Casing: 56/ FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS +2.0 FT. Above Land Surface*
*Tup 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 t7/Lv-J
10. WATER ZONES (depth): 12i ' 2/..
C rr/
11. DISINFECTION: Type KY' Amount 4 AI
12. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Materi I
From y2.l) To I�\2 Ft. (�%�- ,lff fhc'i
From To Ft.
From To Ft.
13. GROUT: Depth MaterialL( Method
From Q To l02 Ft. fl 9 Cenie` T✓it"e
Ftonl 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 Ft.
To Ft.
Size Material
Topographic/Land setting
❑Ridge ❑Slope ❑Vallcyt
(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 — TS' Diet ekta:L-3.)
9C= 42r' t j4/./rei rat
47r- 43S1 pine rock
4 3 S'' Ob' talc. /rr 5/crri rrci
()VC - bvn' flak roc-k .
1.40' -- /poto ' dnik. ?veil YcYJ
LOCATION SKETCH
Show direction and distance in miles frontLat IeaS-f
two State Roads or County Roads. Includes e road-
s and common road names. r _-- -
4-
0
0
01
W
16. REMARKS: }I4Jy '74
D FIBC Ul2Tll''
CONSTRUCTION STA
d
Rq
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING TILE WELL
G, r/7° 03
DATE
'ISIOn of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
-3221, within 30 days. GW-I REV. 07/2001

267965
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 (Cheek Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: ELLENBORO
RALEIGH LEDBETTER RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LIBBY SEARS
Address 151 RALEIGH LEDBETTER RD.
(Street or Route No.)
ELLENBORO NC 28040
City or Town State Zip Code
(828) — 657-5812
Area Code Phone number
4. DATE DRILLED 01/09/03
5. TOTAL DEPTH: 43
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 25 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): 18 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 8.28
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 43 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 25 To 43 Ft. 78M GRAVEL
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
74 E. BY-PASS FROM FOREST CITY. EXIT ON
ELLENBORO/HENRIETTA RD. TURN RIGHT. GO
APPROX. 1/4 MILE. RIGHT ON RALEIGH
LEDBETTER RD. APPROX. 1/10 MILE ON Lek 1.
(#151 ON BOX) cvt
--tDE-HE-CERT1EYShIAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
' ) cONSTRUCTIONsTANI1A
ke
11- .- -A i7? I
J LiS19FjTATURL OF P
1 Sutunit the original to to Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
7699-1636 Phone No. (919) }133-3221, within 30 days. GW-1 REV. 07/2001
County RUTH
/ SI //�inG 7_� / -
N CONSTRUCTING THE WELL DATE
7- 6.R

279794
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 PHONE # [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 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
SANDY SPRINGS RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ELIZABETH SPIVEY
Address SANDY SPRINGS RD.
(Street or Route No.)
RUTHERFORDTON
City or Town State
(828) — 8634496
Area Code Phone number
4. DATE DRILLED 09/02/03
5. TOTAL DEPTH: 46
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
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 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 46 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 46 Ft. 78M GRAVEL
From _ To _ Ft. __
County RUTH
NC 28139
Zip Code
Topographic/Land setting
0 Ridge 0 Slope 0 Valley D Flat
(check appropriate box)
Latitude/longitude of well 1
r �
(degrees/minutes/secon
Latitude/longitude source: 0 GPS ❑iTo$QgraPhic map
(check box)
DEPTH
From To
DRILLING LOG
From To
0-1
LOCATION SKETC*"'
Show direction and distance in mil from at 1-7)
Two State Roads or County Roads. ¢dude die road
number and common names
POORS FORD RD. FROM SHILOH. LEFT ON
OLD CHESNEE RD. RT. ON SANDY SPRINGS RD.
DRIVE AT BOTTOM OF HILL ON LEFT. (1043 ON
BOX)
Frit
0
w
r7
0
w
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
DATE
[Fr
SIGNATURE OFPERS
NSTRUCTING 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

County RUTH
Submit the original to the Division of Water Quality, Groundwater
27699-1636 Phone No. [phone], within 30 days.
278697
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 El MunicipallPublic 0 Industrial ❑ Agricultural
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: ELLENBORO
DYCUS RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: HOWARD HOLLIFIELD
Address 147 DYCUS RD.
(Street or Route No.)
ELLENBORO N C 28040
City or Town State Zip Code
(828) — 453-7411
Area Code Phone number
4. DATE DRILLED 08/13/03
5. TOTAL DEPTH: 64
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 44 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 64 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 Sizc Material
From _ To _ Ft. _ in. in.
From _ To _ Ft. _ in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 44 To 64 Ft. 78M GRAVEL
From To Ft.
Topographic/Land setting
0 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
HOLLIS RD. FROM ELLENBORO, LEFT ON
DYCUS RD. 1-1/2 MILES ON RT. (147 ON BOX)
w
Cn
rn
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A CQPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNA O SON C • NSTRUCTINri TF1E WEL , DATE ',
I :. uh, 1636 Mail Service Cen ei h, NC
GW-1 7/2001
GROUNDWATER SECTION
ncucuniiF RFGIONAL OFFICE

273695
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
County RUTH
27699-1636 Phone No. [phone], within 30 days.
WELL USE (Check Applicable Box): Residential ® MunicipallPublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
KAANAN DR.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CHARILIE BROOKS
Address KAANAN DR.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 286-3849
Area Code Phone number
4. DATE DRILLED 08/14/03
5. TOTAL DEPTH: 39
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 24 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): 15 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 6.9
12. CASING: Wall Thickness
or Weight/Ft. Material
CEMENT
Depth Diameter
From 0 To 39 Ft. 24"
From To Ft
From To _ Ft. _
13. GROUT: Depth Material
From 0 To 20 Ft. CEMENT
From To Ft.
14.SCREEN: Depth
Method
POURED
Diameter Slot Size
From _ To Ft. in. _
From _ To Ft. _ in.
15. SAND/GRAVEL PACK:
Depth Size
From 24 To 39 Ft. 78M
From To Ft.
16. REMARKS:
Material
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
ROCK RD. FROM RUTH. APPROX. 5 MILES. RT.
ON KAANAN DR. LOT STRAIGHT AHEAD AT CUL-
DE-DAC.
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 PROVIDED TO THE WELL OWNER
?laTURE
D' j � � i? 1'-/V- o
O S11p TING THE WELL DATE
Submit the original to the Division of Water Quality, Gros Section, Mail Se eli 'Center — Raleigh,NC
-1 REV. 07/2001
GROONO'JVATEF SECTION
�, c PC ONAL OFFICE _

278694
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 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
KAANAN DR.
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: CHARILIE BROOKS
Address KAANAN DR
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 286-3849
Area Code Phone number
4. DATE DRILLED 08/14/03
5. TOTAL DEPTH: 50
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
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): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County RUTH
Zip Code)
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 50 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 30 To 50 Ft. 78M GRAVEL
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: 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
ROCK RD. FROM RUTH. APPROX. 5 MILES. RT.
ON KAANAN DR. LOT ON LEFT AT CUL-DE-SAC.
0
0
„r
ofl
or
bo
TT?a
C•1
NCI
rn
0
z
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRJICTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
tee
STATURE F PER flO CONS ' UCTING THE WELL
c7 us_ -/f/--d. 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. OW-1 REV. 07/2001

2'78693
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: RUTHERFORDTON
COVE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MIKE STOFER
Address 2684 COVE RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 286-4416
Area Code Phone number
4. DATE DRILLED 08/18/03
5. TOTAL DEPTH: 48
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
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): 18 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 8_28
12. CASING: Wall Thickness
Depth Diameter or Weight/FL Material
From 0 To 48 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 30 To 48 Ft. 78M GRAVEL
From To Ft.
Method
POURED
Slot Size Material
in. _ in.
in. in.
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 ❑ 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.
RT. ON COVE RD. 2ND DRIVE ON RT. PAST FIRE
DEPT. )ABOUT 7 MILES.
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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
C
GNA O
SI F
[t ON ONSTRUCTING
Submit the original to the Division of Water Quality, Groundwater S
27699-1636 Phone No. [phone], within 30 days.
D
�)�636 Mail Service Cente
It 1 ' GW-1 RE
igh, NC
001
GROUNE�'coFctnnial fFFICF

278692
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 ® MunicipalPublic ❑ Industrial ❑ Agricultural ❑
Monitoring D Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: BOSTIC
SALEM CHURCH RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: TIM BROOKS
Address SALEM CHURCH RD.
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code
(828) - 245-4316
Area Code Phone number
4. DATE DRILLED 08/19/03
5. TOTAL DEPTH: 35
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NOZ
7. STATIC WATER LEVEL Below Top of Casing: 23 FT.
(Use "+" if Above Top of Casing)
County RUTH
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 STEEL TAPE
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 5.52
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 35 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 23 To 35 Ft. 78M
From To Ft.
16. REMARKS:
Material
GRAVEL
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
BUS. 74 E. FROM FOREST CITY. LEFT ON
BOSTIC/SUNSHINE HWY. RT. ON SALEM
CHURCH RD. 2 ND. HOUSE ON RT. PAST
CEMETERY.
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
Lc,...)
SIG VATUPERSON CONSTRUCTING
Submit the original to the Division of Water Quality, Groundwater Sectio
27699-1636 Phone No. [phone], within 30 days.
PI
it
S Mail Service Center -
GW-1 REV.
DATE
,NC
GROUNDWATER newt:A I P RFCIC JAL OFFICE

278691
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) licable) (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: RUTHERFORDTON County RUTH
MOONLIGHT LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: SCOTT WATKINS
Address 214 MOONLIGHT LANE
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 289-9019
Area Code Phone number
4. DATE DRILLED 08/20/03
5. TOTAL DEPTH: 52
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 34 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): 18 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
I1. DISINFECTION: Type CHLORYTE Amount 8.28
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 52 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 34 To 52 Ft. 78M GRAVEL
From To Ft.
Method
POURED
Slot Size
in.
m. in.
Material
in.
Topographic/Land setting
0 Ridge 0 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
POORS FORD RD. FROM SHILOH. LEFT ON
HESTER MILL RD. RT. ON MOONLIGHT LANE. 1/2
MILE ON RT.
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16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC 1 ED IN ACCORDANCE WITH 15A NCAC 2C. WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
l
%1�Q��(/cam
SIG ATUR$ PERSON CONSTRUCTING THE
Submit the original to the Division of Water Quality, Groundwater Section, 163
27699-1636 Phone No. [phone], within 30 days.

278690
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 # 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: UNION MILLS
NAVAHO TRAIL
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LEONARD BELL
Address NAVAHO TRAIL
(Street or Route No.)
UNION MILLS NC 28716
City or Town State Zip Code
(828) — 749-3053
Area Code Phone number
4. DATE DRILLED 08/26/03
5. TOTAL DEPTH: 35
6. DOES WELL REPLACE EXISTING WELL? YES 0 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): 15 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From 0 To 35 Ft. 24"
Ft.
Ft.
From _ To _
From To
13. GROUT: Depth
From 0 To 20
From To
14.SCREEN: Depth
From To_
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size
From 15 To 35 Ft. 78M
From To Ft.
16. REMARKS:
County RUTH
CHLORYTE Amount 6.9
Wall Thickness
or Weight/Ft. Material
CEMENT
Material
Ft. CEMENT
Ft.
Diameter Slot Size Material
Ft.
Method
POURED
in. _ in.
in. in.
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. #221 N. FROM RUTHERFORDTON. LEFT
ON SCHOOLHOUSE RD. IN GILKEY. LEFT ON
PAINTERS GAP RD. LEFT ON BROOKS LAKE RD.
LEFT ON NAVAHO TRAIL. 1/4 MILE ON RT. (LOT
#17)
O
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FYI
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F
ill 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
F
v lz� o ��-G�
SIGIYATUREE OPERS NSTRUCTING T
s 1Y.7 1 t
Submit the original to the Division of Water Quality, Groundwater Sectic q -i''36 Mail Service Center — I1 jgh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV.:017/ 001
GROLLD ';i!i

278689
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quolity - 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 El Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: CAROLEEN County RUTH
BOSS MOORE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ROGER SHORT
Address 623 BOSS MOORE RD.
(Street or Route No.)
CAROLEEN NC 28019
City or Town State Zip Code
(828) - 245-8079
Area Code Phone number
4. DATE DRILLED 08/29/03
5. TOTAL DEPTH: 44
6. DOES WELL REPLACE EXISTING WELL? YES ® NO 0
7. STATIC WATER LEVEL Below Top of Casing: 24 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 44 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 24 To 44 Ft. 78M GRAVEL
From __ To _ Ft.
Method
POURED
Slot Size Material
in. _ in.
in. in.
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
BY-PASS 74 E. FROM FOREST CITY. EXIT RT.
ON HARRIS/HENRIETTA RD. RT. ON BOSS
MOORE RD. APPROX. 3/10 MILE ON RT. (623 ON
BOX)
16. REMARKS:
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 PE 9 CONSTRUCTING THE
Submit the original to the Division of Water Quality, Groundwater Section
27699-1636 Phone No. [phone], within 30 days.
n�
Mail Service Center -
GW-1 REV.
„� [ON
GaDL'Ivu',\r.i�R S�._r „iwn
,NC
1

278688
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]
W
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED _ ( PERMIT #
applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential ® MunicipallPublic 0 Industrial 0 Agricultural
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH
GREEN RIVER HIGHLANDS LOT #47
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ROB FETTEROLF
Address GREEN RIVER HIGHLANDS
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 286-0439
Area Code Phone number
4. DATE DRILLED 08/04/03
5. TOTAL DEPTH: 705
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 121
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): 2 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 110 Ft. 6-1/4" SDR21 PVC
Ft.
Ft.
From _ To
From _ To
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
0 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
.HWY. #221 S. FROM RUTHERFORDTON.
RIGHT INTO GREEN RIVER HIGHLANDS ONTO
RIVER CREST PARKWAY. GO APPROX. 3/4 MILE.
RIGHT ON ELLIOTT LANE. 3RD LOT ON RIGHT
)LOT #47)
-o
t
01
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC I ED 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
v_____43
SIGNATURE 0'5 PERSON CONSTRUCTIN Th a Lii- r id �U7°'
1
Submit the original to the Division of Water Quality, Groundwater Sect
27699-1636 Phone No. [phone], within 30 days.
636 Mail Service Center
GW-1 RE
igh, NC
001
L
(3R0(3
.TER `,ECHON

273687
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: UNION MILLS
LIBERTY HILL CHURCH RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ALLEN MCENTYRE
Address LIBERTY HILL CHURCH RD.
(Street or Route No.)
UNION MILLS NC 28163
City or Town State Zip Code
(828) — 287-9704
Area Code Phone number
4. DATE DRILLED 08/29/03
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): 1 METHOD OF TEST
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 16.5
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. 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 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. #221 N. FROM RUTHERFORDTON. LEFT
ON LIBERTY CHURCH RD. NEW DRIVE 2/10 MILE
ON RT.
0
0
rrl
so
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCOI dE'$ q nt 1'SA I CF 2C,_WELL
CONST UCTION STANDARDS, THAT A
DOPY OF THIS RECORD HAS
�BBEEN PROVIDED TO THE WELL OWNER
RSONTRUCTING THE WELL �� DATE / O
SIGNATURE
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

278682
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 ® Mu nicipalPublic 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: BOSTIC
DEPRIEST RD.
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: CURTIS POLLY
Address 928 DEPRIEST RD.
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code
(828)— 506-7475
Area Code Phone number
4. DATE DRILLED 08/15/03
5. TOTAL DEPTH: 405
6. DOES WELL REPLACE EXISTING WELL? YES ® NO 0
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):
County RUTH
, Zip Code)
11. DISINFECTION: Type CHLORYTE Amount 10.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 150 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
0 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
BUS. 74 E. FROM FOREST CITY. LEFT ON
BOSTIC/SUNSHINE HWY. GO THRU BOSTIC,
LEFT ON DEPRIEST RD. NEXT TO LAST HOUSE
ON RT.
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
,,. �%� r-,' - A 3
SIQ IA 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

WELL CONSTRUCTION RECORD 278681
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 ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: ELLENBORO
SUTTLES RD.
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: CHRIS MARTIN
Address 599 SUTTLES RD.
(Street or Route No.)
ELLENBORO NC 28040
City or Town State Zip Code
8( 28) — 247-4763
Area Code Phone number
4. DATE DRILLED 08/22/03
5. TOTAL DEPTH: 365
6. DOES WELL REPLACE EXISTING WELL? YES 0 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): 4 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
Zip Code)
11. DISINFECTION: Type CHLORYTE Amount 9.5
12. CASING: Wall Thickness
Depth Diameter or Weight/FL 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 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.
Topographic/Land setting
❑ 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
BUS. 74 E. FROM FOREST CITY. LEFT ON
BOSTIC/SUNSHINE HWY. GO THRU SUNSHINE &
RT. ON DUNCAN CREEK RD. LEFT ON APPLE
ORCHARD RD. RT. ON SUTTLES RD. 1 MII9r ON
LEFT. 3 o
mxx
—0
(V
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC 1 ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
itt_e
SIGN OF PERSON CONSTR CTING THE LL 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

?77484
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 # WSO1-00016 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: LAKE LURE County RUTHERFORD
APPLEVALLEY DRIVING RANGE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ED YOUNGER
Address WINESAP RD.
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
(828) — 625-4905
Area Code Phone number
4. DATE DRILLED 06/13/03
5. TOTAL DEPTH: 405
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): 22 METHOD OF TEST 24 PUMP
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 1 LB.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 63 Ft. 8" 350 WALL GALV.
From To _ Ft.
From _ To _ Ft.
13. GROUT: Depth Material Method
From 0 To 63 Ft. CEMENT SLURRY
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.
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 RUTH. HWY. 64/74. RIGHT ON BILL'S
CREEK RD. LEFT ON BUFFALO CREEK RD.
RIGHT ON AZALEA. 1/4 MILE ON RIBIT A`I'
DRIVING RANGE. co
c'>
0
iv
rs
LO
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
e NA/7,4,.A
IGNA PERSON CONSTRUCTINr THE wFt l
Submit the original to the Division of Water Quality, Gro a� fer section't 636 Mait Soy 4 Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. "
1 REV. 07/2001
is
JL
_ 6-/3-4-3
DATE

277483
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 # WSO1-00016 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: LAKE LURE County RUTHERFORD
APPLEVALLEY DRIVING RANGE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ED YOUNGER
Address WINESAP RD.
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
(828) — 6254905
Area Code Phone number
4. DATE DRILLED 06/11/03
5. TOTAL DEPTH: 805
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 temtinated at/or below land surface requires a
variance in accordance with 1 SA NCAC 2C .0118.
9. YIELD (gpm): 12 METHOD OF TEST 24 PUMP
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 1 LB.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 61 Ft. 8" 350 WALL GALV.
From To Ft.
From _ To _ Ft.
13. GROUT: Depth Material Method
From 0 To 61 Ft. CEMENT SLURRY
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 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
FROM RUTH. HWY. 64/74. RIGHT ON BILL'S
CREEK RD. LEFT ON BUFFALO CREEK RD.
RIGHT ON AZALEA. 1/4 MILE ON RIGHT AT
DRIVING RANGE.
w
-a
N
cn
0)
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 THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
'ter ./" ero-AS?�i
SIGNATUKE OF PERSON CONSTRU CTII G WELL DATE
Subm the636 Phone original to
the
Division
919) v33 32o1 Water
Quality,0 yGroundn\ aferSection, 1636 Mail Service Cn er — Raleigh, NC
V. 07/2001
�— ---
,-. c,. 10N
: �Iri

277644
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 D Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: ELLENBORO
ELLENBORO/HENRIETTA RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: AGNES M. EARLEY
Address 1862 ELLENBORO/HENRIETTA RD.
(Street or Route No.)
ELLENBORO NC 28040
City or Town State Zip Code
(828) — 657-9362
Area Code Phone number
4. DATE DRILLED 07/24/03
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): 8 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 6
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 Method
From 0 To 20 Ft. QUHCRETE 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:
in.
Topographic/Land setting
❑ 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
FROM ELLENBORO GO DOWN
ELLENBORO/HENRIETTA RD. LAST HOUSE ON
RIGHT BEFORE YOU GET TO WHERE THE RR
CROSSING USED TO BE. (1862 ON HOUSE BESIDE
THE DOOR)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PE SON CONSTRfJC`I'IiNG THE
II
Submit the original to the Division of Water Quality, Groundwat4 Section, 1636 Mail Senter — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. I I; j REV. 07/2001
—DATE

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)
277641
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: RUTHERFORDTON
JIM DOBBINS RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JOSEPH A. MONNO III
Address JIM DOBBINS RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
4( (4) — 257-1650
Area Code Phone number
4. DATE DRILLED 07/17/03
5. TOTAL DEPTH: 205
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): 20 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 4.5
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
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
POORS FORD RD. FROM SHILOH. RT. ON
GRAYS CREEK CHURCH RD. LEFT ON JIM
DOBBINS RD. ORANGE GATE ON LEFT 3/4 MILE
)SIGN-SHILOH PLANTATION)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CON(CTION STANDARDS, THAT
/1a.'
PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/?-71 1-' -- -
SIGNATURE OFON CONSTR CINGTHE LL ATE
Submit the original to the Division of Water Quality,Groun t� Yr Section,1636 Mail Servi rater — Raleigh, NC
�� f
27699-1636 Phone No. [phone], within 30 days. a i.i REV. 07/2001
J

2?7B36
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quillity — 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 ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
CAPOZZI VINEYARD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BOBBY CAPOZZI
Address 120 CAPOZZI VINEYARD
(Street or Route No.)
RUTHERFORDTON NC 28139
City or To State Zip Code
(828) — 863-1301
Area Code Phone number
4. DATE DRILLED 07/22/03
5. TOTAL DEPTH: 405
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): 12 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 10.5
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. 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.
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. #221 S. FROM RUTHERFORDTON. RT. ON
COXE RD. GO PAST CONCRETE PLANT & LEFT
ON JOHN WATSON RD. APPROX. 1-1/2 MILES,
TURN RT. ON CAPOZZI VINEYARD. NEW
HOMESITE AT TOP OF HILL.
ar
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS CTION STANDARDS, AND THAT A COPY
OFFTTIHIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�(�iZ�/7't�� *Th-> . %- 6 . S
NQ
SIGN P TURE OF PERSO1tI CONSTR e_ TE
Submit the original to the Division of Water Quality, Ground algirSection,16361HaISefv 44f ter— Raleigh, NC
I,
27699-1636 Phone No. [phone], within 30 days.
REV. 07/2001

277635
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 D Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH
CAPOZZI VINEYARD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BOBBY CAPOZZI
Address 120 CAPOZZI VINEYARD
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(S28) — 863-1301
Area Code Phone number
4. DATE DRILLED 07/18/03
5. TOTAL DEPTH: 805
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 tenninated 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 22.5
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 _ 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. #221 S, FROM RUTHERFORDTON. RT. ON
COXE RD. GO PAST CONCRETE PLANT & LEFT
ON JOHN WATSON RD. APPROX. 1-1/2 MILE TURN
RT. ON CAPOZZI VINEYARD. NEW HOMESITE AT
TOP OF HILL.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS CTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON/-&44
RUC("
Submit the original to the Division of Water Quality, Groundwakte tion,1636 Mail Service e r — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. 1 1 G 11 V. 07/2001
IJ
TIE WE
Ru.J
F,,

277634
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 D Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
GREYSTONE DR.
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: JOE CARSON
Address GREYSTONE DRIVE
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 287-4239
Area Code Phone number
4. DATE DRILLED 07/16/03
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): 2 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
Zip Code)
11. DISINFECTION: Type CHLORYTE Amount 13.5
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 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. #221 S. FROM RUTHERFORDTON.
APPROX. 3 MILES. LEFT ON GREYSTONE DR 150
YDS. ON RIGHT. NEW DRIVE.
0
w
loa
V�
CO
0
1y
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
COUCON STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SI NATURE OF PEkSO ONS
Submit the original to the Division of Water Quality, Grou
27699-1636 Phone No. [phone], within 30 days.
9-/4.-
enter — Raleigh, NC
-1 REV. 07/2001

277633
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 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHRFORDTON County RUTH
WILKINS FOREST SUBDV. EAST
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CARSWELL CONSTRUCTION
Address BENT TREE DR.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) - 894-3799
Area Code Phone number
4. DATE DRILLED 07/15/03
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): 5 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 7.5
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. QUIKRRETE 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 0 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. 64.74A W. FROM RUTHERFORDTON.
RIGHT ON BENT TREE DR. (WILKINS FOREST
EAST) 1ST DRIVE 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
irk 17 . J /�.// .. ) 'njnt0 7 - / 5-- G. -
�'URE OF PERSON P1S'FKUCTTN �d- DATE
SIGNA
Submit the original to the Division of Water Quality, Grjdttrid iterSection,1636 Mail, $Terrace Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. 1-1, I I 1 1GW-1 REV. 07/2001
LiL ;L`J

SIGNP:
,,iubmit the original to the Di n
27699-1636 Phone No. (919) 33-3:
L
275646
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 ❑ Agricultural
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: HARRIS
ROLLING HILL CIRCLE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JERRY JONES
Address 116 ROLLING HILL CIRCLE
(Street or Route No.)
HARRIS NC 28074
City or Town State Zip Code
(828) - 749-1513
Area Code Phone number
4. DATE DRILLED 06/09/03
5. TOTAL DEPTH: 505
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
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): 2 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 13.5
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
From 0 To 20
From To
14.SCREEN: Depth
From To
From _ To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Material
Ft. QULKRETE
FL
Method
POURED
Diameter Slot Size
FL in. in.
in. in.
Material
Topographic/Land setting
❑ Ridge 0 Slope ❑ 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. #221 S. FROM RFTN. RT. ON JACK
MCINNEY RD. LEFT ON Z. SIGMOND RD. RT. ON
ROLLING HILL CIRCLE. RT. ON DRIVE 1/4fl%IILE
ON RT.
r
0
0
N.)
N
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
i✓ e � 1 � 9-t.ik-o_ - 2
OF PERSON CONSTRUCTING THE LL DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001

275645
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 0 Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: ELLENBORO
HOLLIS RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MAX BURGIN
Address HOLLIS RD.
(Street or Route No.)
ELLENBORO NC 28040
City or Town State Zip Code
(704) — 434-9830
Area Code Phone number
4. DATE DRILLED 06/23/03
5. TOTAL DEPTH: 245
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
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 RUTH
11. DISINFECTION: Type CHLORYTE Amount 6
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 Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
in.
in.
From _ To _ Ft. in.
From To Ft in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge 0 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 miles from at least
Two State Roads or County Roads. Include the road
number and common names
HOLLIS RD. FROM ELLENBORO. 1 ST DRIVE
ON RT. PAST JACK MOORE MTN. RD.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
rctANS 1RUCTIONijSTATI)lARUSy ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNAOF PERSON CONSTRUCTING THE LL DATE
L
Subr$t the original to the DRrision of Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC
27699-3636 ellut;t<;SV6e ' 4133-3 21, within 30 days. GW-1 REV. 07/2001

275639
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 D Industrial D Agricultural D
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
US. HWY. 64/74
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MATTIE LOGAN
Address 3510 US HWY. 64/74
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) —
Area Code Phone number
4. DATE DRILLED 06/11/03
5. TOTAL DEPTH: 405
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO EZ
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 RUTH
11. DISINFECTION: Type CHLORYTE Amount 10.5
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
From To
From _ To _ Ft.
16. REMARKS:
Size Material
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. #64/74A W. FROM RUTHERFORDTON.
4TH DRIVE ON RT. PAST HAMILTON RD. (3510 ON
BOX)
0
0
c
c
r
0
0
rs
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
c
SF 0110N
TITRE OF PERSON CONSTRUCTING THE WELL DATE
e Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
19) i 33-3221, within 30 days. GW-1 REV. 07/2001

275638
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 ® MunicipalRublic 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
WIDD CAWING LANE
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: BRYAN SUMMERS
Address WIDD CAWING LANE
(Street or Route No.)
RUTHERFORDTON N C 28139
City or Town State Zip Code
(828) - 286-8155
Area Code Phone number
4. DATE DRILLED 06/12/03
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO DA
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 RUTH
Zip Code)
11. DISINFECTION: Type CHLORYTE Amount 16.5
12. CASING: Wall Thickness
Depth Diameter or Weight/FL Material
From 0 To 80 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.
Topographic/Land setting
❑ Ridge 0 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 miles from at Least
Two State Roads or County Roads. Include the road
number and common names
HWY. #221N. FROM RUTHERFORDTON. RT. ON
2ND CAWING MILL RD. APPROX. 1/4 MILE, LEFT
ON WIDD CAWING LANE. 1/4 MILE, NEW DRIVE
ON LEFT.
0
CO
c
c
r-
0
0
cn
N
c
=;
ex:
rn
0
From _ To _ Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAND DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
$ubdtit�ihe ot�igihal to t Iry
T¢7699-1636 Phone No. ( 19) 7:
GROUNDyvn.TEP SECi10N
ASHLVI-tr _. y`
TIME OF PERSON CONSTRUCTING THE WELL DATE
ion of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001

275637
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 El Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: BOSTIC
SALEM CHURCH RD.
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: JIM AYERS
Address SALEM CH. RD.
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code
(919) - 960-8819
Area Code Phone number
4. DATE DRILLED 06/18/03
5. TOTAL DEPTH: 705
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): 1/2 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
Zip Code)
11. DISINFECTION: Type CHLORYTE Amount 19.5
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
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.
Topographic/Land setting
0 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
BUS. 74 E. FROM FOREST CITY. LEFT ON
BOSTIC/SUNSHINE RD. RIGHT ON SALEM CH. RD.
1ST DRIVE ON RIGHT PAST THE CHURCH.
0
c.�
c
c
r-
0
0
cn
From To Ft.
16. REMARKS:
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
1
SIG/NA
i�
Submit the original to thelIDivis
21%99-1636 Phone No ) 73
GVH,JNPAI :ER SECTION
AS'E l CE
k7 / o ;3
TURE OF PERSON CONSTRUCTING THE WELL DATE
on of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
-3221, within 30 days. GW-1 REV. 07/2001

275636
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 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
WIDD LAWING LANE
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: BRYAN SUMMERS
Address WIDD LAWING LANE
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 286-8155
Area Code Phone number
4. DATE DRILLED 06/23/03
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): 60 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
Zip Code)
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
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 ❑ 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
IIWY.M #221 N. FROM RUTHERFORDTON. RT.
ON 2ND LAWING MILL RD. APPROX. 1/4 MILE,
LEFT ON WIDD LAWING LANE. 1/4 MILE, NEW
DRIVE ON LEFT.
c
0
Ca
c Et -
773.
r-
0
0
Cn
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
Snbmit the original- to the ton of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. (91 73 221, within 30 days. GW-1 REV. 07/2001
SIGN
OF PERSON CONSTRUCTING THE WELL DATE
GRC:. _ cr1 ON
PEE r - r ' �w.�

275635
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: LAKE LURE
ALLEN DR.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BROWN & BETTY THORNTON
Address 183 ALLEN DRIVE
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
(770) — 587-3449
Area Code Phone number
4. DATE DRILLED 06/24/03
5. TOTAL DEPTH: 145
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/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 60 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 3
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 70 Ft. 6-1/4" SDR.21 PVC
Ft.
Ft.
Material Method
Ft. QUIKRETE POURED
Ft.
Diameter Slot Size Material
in.
in.
From _ To
From To
13. GROUT: Depth
From 0 To 20
From To
14.SCREEN: Depth
From To _ Ft. in. _
From To _ Ft. 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. #64/74A W. FROM RUTHERFORDTON.
RIGHT ON BUFFALO SHOALS RD. APPROX. 2
MILES. LEFT ON THOMAS DR RIGHT ON ALLEN
DR APPROX. 1/4 MILE ON LEFT.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS r 11CTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
i
fr/r
URE OF PER
SON CONSTRUCTING THE WELL��J
S bmit the original to the btatsi n of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
21699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
($FQUfdCV,'hiER SEC !ON
AS -'I r' flCE

275634
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: BOSTIC
MTN. LOOKOUT DR.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BILL SMITH
Address 296 MTN. LOOKOUT DR.
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code
(336) — 838-9725
Area Code Phone number
4. DATE DRILLED 06/26/03
5. TOTAL DEPTH: 705
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 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 RUTH
11. DISINFECTION: Type CHLORYTE Amount 19.5
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. QUIKRETE
From To Ft.
I4.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.
16. REMARKS:
Method
POURED
Material
in.
in.
Topographic/Land setting
0 Ridge 0 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
BUS. 74 E. FROM FOREST CITY. LEFT ON
BOSTIC/SUNSHINE HWY. LEFT ON LUCKADOO
MTN. RD. LEFT ON FIRE TOWER RD. RT. ON
AMELIA LANE INTO GOLDEN VALLEY ESTATES.
RT. ON MTN. LOOKOUT DR APPROX. 1 MILE ON
RIGHT. LOT #41. o
CO
-
r=
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SI
r:_,J,i — U , , L.../
Supnit the original to the visi
27M9-1636 Phone No (91y) 733
GROUN0WATER SECTION
ASHEVLLE REGICL.AL OFFICE
OF PERSON CONSTRUCTING THE WELL
DATE
m of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
3221, within 30 days. GW-1 REV. 07/2001

275633
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 ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH
CROSS RIDGE DR LOT #78
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JIM STEIN
Address 470 CROSS RIDGE DR
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) - 697-5916
Area Code Phone number
4. DATE DRILLED 06/27/03
5. TOTAL DEPTH: 285
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 121
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): 30 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 6.5
12. CASING:
Depth Diameter
From 0 To 50 Ft. 6-1/4"
From _To_Ft.
_
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft.OULKRETE 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
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
From To Ft.
From To Ft.
16. REMARKS:
Industrial 0 Agricultural 0
If Other, List Use
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. CROSS INTO POLK CTY. RT. INTO
GREEN RIVER HIGHLANDS ONTO RIVER CREST
PARKWAY. RT, ON FRONT RIDGE RD. RT. ON
GOODWIN RD. RT. ON CROSS RIDGE DR. LOT #78
IS FIRST LOT ON RIGHT.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Sumivi
si
i it the original to the si
27G9A-uz6 Phere No (01) 733
GROUNDWATER SECTION
ASHEVIL'LE REGLON/'_ OFFICE
OF PERSON CONSTRUCTING THE WELL
ono- („ -6.3
DATE
m of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 27 5 6 31
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: RUTHERFORDTON
MAPLE CREEK RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ROGER PHILLIPS
Address 2382 MAPLE CREEK RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) - 287-5948
Area Code Phone number
4. DATE DRILLED 06/09/03
5. TOTAL DEPTH: 505
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): 3 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 13.5
12. CASING:
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. QUIKRETE
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
Wall Thickness
or Weight/Ft. Material
SDR.21 PVC
Method
POURED
From To Ft.
From To Ft.
16. REMARKS:
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
MAPLE CREEK RD. FROM RUTHERFORDTON.
GO PAST THOMPSON ASPHALT PLANT. DRIVE
ON RT. AFTER CROSSING BRIDGE.
O
CO
L
0
UG — 6 2(:,u3/st
1 THIS WELL WAS CONSTRUC 1 ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
' 1C / U, . 2 e ? . la % /�- 6
jjj [JJ1zRRgEE OF PERSON CONSTRUC G THE WELL DATE
Divis on of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
A'A?) 732-3221, within 30 days. GW-1 REV. 07/2001

l /
AUG - 6 2003
275628
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 El Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH
BROOKS LAKE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JIM BLANTON
Address BROOKS LAKE RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 247-0821
Area Code Phone number
4. DATE DRILLED 06/05/03
5. TOTAL DEPTH: 38
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 26 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 STEEL TAPE
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 5.52
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 38 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 26 To 38 Ft. 78M GRAVEL
From To Ft.
16. REMARKS:
Topographic/Land setting
El Ridge ❑ Slope El Valley El 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 N. FROM RUTHERFORDTON. LEFT
ON DARLINGTON RD. RIGHT ON BROOKS LAKE
RD. APPROX.1/2 MILE ON RIGHT. LOT IS ON THE
CORNER OF THE LAKE BESIDE THE DAM.
0
CO
0
O
cn
N
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
VAI . Et. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
U LS 1e/sc12. .� 1�i AvF P N CONSTRUCTING THE WE L DATE
S bmit the original to the 'mintof Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
2 ) 733,3221, within 30 days. GW-1 REV. 07/2001
UMBUittYV'VMCfeOLLef I
ASHEVILLE REGIONAL OFFICE

275627
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 ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
PATE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: EARL CROWDER SR.
Address 300 PATE RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 286-8820
Area Code Phone number
4. DATE DRILLED 06/06/03
5. TOTAL DEPTH: 61
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO EZI
7. STATIC WATER LEVEL Below Top of Casing: 41 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. WA I ER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 61 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 41
From
16. REMARKS:i
IILi_ H)
I DO HEREBY L`ER`t"(FY THAT THIS WELL p/AS�ONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, ANDTHAIt A C PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Elict�'
*ice— /„ —
G THE WELL DATE
11 t'
�o
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
FROM FOREST CITY. GO DOWN OAKLAND RD.
RIGHT ON POORS FORD RD. GO APPROX. 1/2
MILE. RIGHT ON PATE RD. 7TH HOUSE ON
RIGHT.
0
F
SIGNA ' •
ON CONSTRUCT
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

275626
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 ® MunicipalfPublic ❑ Industrial ❑ Agricultural
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MOORESBORO
SOURWOOD LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BRANDY MCCURRY
Address 156 SOURWOOD LANE
(Street or Route No.)
MOORESBORO NC 28714
City or Town State Zip Code
(828) — 453-8074
Area Code Phone number
4. DATE DRILLED 06/30/03
5. TOTAL DEPTH: 74
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 54 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 RUTH
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 74 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.
15. SAND/GRAVEL PACK:
Depth Size
From 54 To 74 Ft. 78M
From To Ft.
16. REMARKS:
in. In
Material
GRAVEL
Topographic/Land setting
❑ 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
BUS. 74 E. FROM ELLENBORO. RIGHT ON
HWY. 120. RIGHT ON GILESPIE RD. GO APPROX.
2/10 MILE. TURN LEFT ON SOURWOOD LANE.
TAN HOUSE WITH BLUE SHUTTERS ON RIGHT.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
rs< : / ,(c'->L . 6 - 3 0 - a 3
5 l IRE OF PE 13 CO TRUCTING THE WELL DATE
Submit the original to the Division
27699-1636 Phone No. (919) 733-3
'._ '^CON
OE
of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
Z21, 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) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # WSO1-00016 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 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: LAKE LURE County RUTHERFORD
APPLEVALLEY DRIVING RANGE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ED YOUNGER
Address WINESAP RD.
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
(828) — 625-4905
Area Code Phone number
4. DATE DRILLED 06/13/03
5. TOTAL DEPTH: 405
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): 22 METHOD OF TEST 24 PUMP
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 1 LB.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 63 Ft. 8" 350 WALL GALV.
From _ To _ Ft. _
From _ To _ Ft.
13. GROUT: Depth Material Method
From 0 To 63 Ft CEMENT SLURRY
From _ To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ is _ 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
FROM RUTH. HWY. 64/74. RIGHT ON BILL'S
CREEK RD. LEFT ON BUFFALO CREEK RD.
RIGHT ON AZALEA. 1/4 MILE ON RIGHT AT
DRIVING RANGE.
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
(V_�T�IE,C'�� i»x v l /3 6-3NA OF PERSON CONSTRUCTIN 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) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PTTTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # WSO1-00016 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 ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: LAKE LURE County RUTHERFORD
APPLEVALLEY DRIVING RANGE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ED YOUNGER
Address WINESAP RD.
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
(828) - 625-4905
Area Code Phone number
4. DATE DRILLED 06/11/03
5. TOTAL DEPTH: 805
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO EZI
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): 12 METHOD OF TEST 24 PUMP
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 1 LB.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 61 Ft. 8" 350 WALL GALV.
From To Ft. _
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 61 Ft CEMENT SLURRY
From To Ft.
14.SCREEN: Depth Diameter
From To FL_
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 ❑ 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
FROM RUTH. HWY. 64/74. RIGHT ON BILL'S
CREEK RD. LEFT ON BUFFALO CREEK RD.
RIGHT ON AZALEA. 1/4 MILE ON RIGHT AT
DRIVING RANGE.
n�r to11WI,7 ;�
AUG 11 2003 is
GROLI-c VATER SECT ON
—AC" L'LE C`E ICE
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
2 (1)Cel -(�r i'i%r�-xs�. l /i— v 3
SIGivATUI OF PERSON CONSTRUCTING rI� 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

From. Scott Gantt To'. Date: 6/11/2003 Time 11:07:18 PM
275009
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GANTT CERTIFICATION # 2584
11 ELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS. INC. PHONE # [phone]
S VA i E WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
i. WEI.1, USE (Check Applicable Box) : Residential ® Municipal ❑ Industrial ❑ Agricultural ❑ Efoncer:n
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
VCEI,1. LOCATION:
.owe:03rna`- RI'THERFORDTON
3:1; OW ENSBY R.D
County RUTHERFORD
.L a^. Nnux.?: amber., Comm malt y, Subdivision, Lot No,. Zip Code)
TopogaphicrLand setting
❑ Ridge ❑ Slope D Valley ❑'
Latitucle/l.ongitude of well location
35 26.604 . 82 03 023
;. OWNER JAMES ROACH (degrees minutes seconds)
AODR SS 509 OAti ENSBY RD Latitude✓1ongitude source: ❑ GPS ❑ Topographic. r.,i.
(sane; or Rome No.) DEPTH DRILLINGI.CS
RIM E RFORDTON NC 28139 From To Formation De zariL u
air., or Tenn State Zip Code 0 65 Clay
52A-28o-4850 65 180 Consolidated Roc)
Mew Code - Phone Number
r. D.-CE DRILLED 5 27'03
10PAL DIFPTH ISO
DOES WELL KEPL.ACE EXISIING WELL? YES ❑ N0
SILTIC WATER LEVEL Bow Top of Casing: 35 FT
(Ilse `t" If Above Top of Cming)
TEP OF CASING IS 2 FT. Above Land Surface*
• Iep 4.-.vi0 tu,vuwtnd onor blow land surface requires a valiance in
,.1:11.10.e or:hu0A]CAC 2C0115
'r In D igniz METHOD OF TEST ARDM
I^,. WATER ZONES (Acid:): 150
is D6iN FECTION:TYPE HYPOCHLORITE Amount 5
i. .at
Cr
oa LOCATION SKETCH
Wall Thickness Show direction and distance in miles from at least
Diameter or Weight/Ft. Material two State Roads or County Roads. Include the re:ai
70 FL 61/4 " SDR 21 PVC numbers and common road names.
I)5prh
b 0
Material Method
20 Et. GRAVEL MIX GRAVITY
I i. S-Si:F.N
Depth Diameter Slot Size Material
N:\ 1r3 Ft. in. in
t s.v'OCRAYL BACK.
Urrti, Size Material
Tz Ft,
ELM 31,145
DO IIERdBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C. \CELL
ONSTRF"CTIOX STANDARDS, AND THAT A COPY OF TTII1SRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF PERSON CONSTRUCTING THE WELL
6 11 '03
Date
.Submit the original to the Division of Water Quality, Groundwater Section, 1636 :Mail Service center - Raleigh, NC
,- 3}t 3221, within 30 days.
-- I;
r;
j, I
GROUP a,P,,;
iIPEEI,r LE

P:orc Scett Gann To Date: 6/11/2003 Time: i 1.07:16 PM
275008
WELL CONSTRUCTION RECORD
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. PHOONE WQ PERMIT 7277
STATE \\ ELL CONSTRUCTION PERMIT #
(! a pp licable) (if applicable)
L WE I ,I. SF f check Applicable Box): Residential 0 Municipal 0 industrial Agnouhural ❑ Mono(iin
rlecovzn ❑ Heat Pump Water Injection 0 Other 0 If Other, Lisi Use.
2 5VIDEL LOCATION:
Noe e¢ mv.n: LNION MILLS
2:"5 LIBERTY HILL CH RD
County RUTHERFORD
Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. oWAER ALV/N NANNY (degfeesiminutes second_)
:DDRESS 2'5 LIBERTY HILL CH RD Latitude longitude source: E GPS ❑ Topographic cap
ISn=a or Route No) DEPTH DRILLING ITNT
NPPN MILLS a NC 28167 From To Fennncon Dehrtruhn_
State tip Code 0 125 Clac
TopographicLand setting
❑ Ridge ❑ Slope ❑ Valley ❑ Fi=
Latitude Longitude of well location
35.28. 738. 81 52122
22S-23"-7652
N'ea Code - Pilot e Number
'AT:. DRILLED 5'26/03
0i-AI. isEETH 320
iraT8 BELL REPLACE EXISTING WELL?
. ,T1,C W.k LLR_ LEST:, 3eletc Top of Casing:
YES 0 NO ❑
65 FT.
(the "+" If Above Top of Casing)
._,,,, 2 FT. Above Land Surface'
.7O or be ow Lund surface requires a variance in
1C4C dCts118
--_..r; tcp..“
METHOD OF TEST ARDM
,::TIER ZONES (dentin. 120 260
125
320 Corcohdated Dad_
DIsICFECTION' TYPE HYPOCHLORITE Amount 8 m. LOCATION SKETCH
Wall Thickness Show direction and distance in miles from at le.:st
1)rylt: Diameter or Weight/Ft. Material two State Roads or County Roads_ include the rer.:i
... 133 Ft. 61/4" SDR 21 PVC numbers and common road mantes.
n �th Material Method
20 FL GRAVEL MIX GRAVIT\
Doe Diameter Slot Size Material
Ft. in. in.
`i.UD: OR,
Depth Size Material
C
IIFREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C. WELL
STRL:CTiOY STANDARDS, AND THAT A COPY OF' THIS RECORD HAS BEEN PROVIDED TO THE WELL OAVNER.
6.11:03
SIGNATURE OF PERSON CONSTRUCTING THE BELL
', ihnut the on^inid :r, the Division of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
72 99r1636Phont o. (919) 733L327T:N ibin 30 days.
Li
tl1
CAT FLEV

F roc,, Scott Gantt To: Date. 6/11/2003 Time_ 11'.07'.18 PM
275006
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
\VE LI,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#
(ilapplicable) (if applicable)
i WEILL I USE (Check Applicable Box) : Residential ® Municipal ❑ industrial ❑ Aedcultural ❑ NIonitorinc
Reecer y ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
!WELT LOCATION.
Ott clto's .. IPCION MILLS
co I iIUDLOW RD
County RUTHFRFORD
(Street Namc. Numbers, Community, Subdivision, Lot No,. Zip Code)
1.6vNER ROUND HILL CHURCH
sS 6611 hitVDLOAV RD
(StraC or Route No.)
_ P:ION MILL:S
68
NC
State
cd Cock -Phone Nu:nbe.
10:1'Hi DRILLED 5:15 03
5. f,ji AL DEPTH 260
61)LS :V EL:. REPLACE EXISTING WELL?
.>[ATI(' WATER LEVEL Below Top of Casing:
28167
Zip Code
YES Q NO 0
75 ET.
(rise "t" If Above Toy of Casing
Fr. Above Land Surface"
below AlIve,vfaee requires a variance in
IS;. NCAC:or 2G0118
nit) tedoty
m N. WATER cR ZONES :depth}:
I-HSIN F('TION: TYPE
DepTL
p
iLLTN
t)rr h
NA.o
Va
L`.i.ARICA
METHOD OF TEST
250
ARDM
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑the:
Latitude Longitude of well location
35 29.555 / 81.58.326
( deere ciminul wises and$
Latitude. lon_itude source: E GPS ❑ Topoisaplua melt
DEPTH
From To
141 Clay
DRILLING LU_
Forniaar,oi, Desc:y :
141
260 Consolidated Rock
HYPOCHLORITE Amount 6
18 Ft.
20 Ft.
K
Ft
Ft,
Wall Thickness
Diameter or Weight/Ft. Material
61/4" SDR2I PVC
oz LOCATION SKETCH
Show direction and distance in miles from at least
Diameter
Material Method
GRAVEL MIX GRAVITY
Slot Size Material
in. in.
Size Material
two State Roads or County Roads. Include the raid
numbers and common road names. O
W _
C
'.7t)1[ER r.61" CEP.TIES THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15_A NCAC 2C, WELL.
..%SIRUCT(ON STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
6711 03
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
Suhmil the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
pnrav{919) 7 a31221 within 30 days.

From Scott Gantt To: Date: 6/11/2003 T.rre: 11:07:18 PM
275005
WELL CONSTRUCTION RECORD
\orth Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOFF GA.NTT CERTIFICATION # 2554
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS. INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
of applicable)
I \\'ELL USE (Check Applicable Box) : Residential Q
Rc c vet ❑ Heat Pump Water Injection ❑
A"ELL LOCATION:
ca(own. FOREST CITY
\'EY BRIGHT LANE LOT2
(if applicable)
Municipal ❑ IndustrialAgricultural ❑ A4om`rn ui -1
Other ❑ If Other, List Use.
County RUEHERFORD
Ca rid Name. Number, Community, Subdivision, Lot No,Zip Code)
3 rdv :"ER HOI2TON HOMES OF RUTHERFORDTON
ADDRESS 312 HWY 71A. BY-PASS
9 i:! IERIORiji US NC
Stale
i.a:: Code - ?1Iou • N .m:bcr
I'+`.lE DRILLED 5. 13:03
TOTAL DEPTH 200
- DES WEI.I. REPLACE EXIST'L\'G WELL?
l I(' 4,A TER LEVEL Below Top of Casing:
28139
Zip Code
YES ❑ NO fl
60 FT.
(Us< `L" If Above Top of Caring)
e OOP OF CASLNG 1_S 2 FT. Above Land Surface*
6:g o<::uuwsl aro w land surface requires a variance in
c�. k. �n+a rmrr l 9d OC'.E 2CD118
3ETHOD OF TEST ARDM
120 IRO
TopographictLand setting
❑ Ridge ❑ Slope ❑ Valley ❑
Latitude/Longitude of tt ell locations
35,19.011. 81.53.T5i
(degrees:minutes eecocds)
I.arirudettoneimde source: ❑ CPS ❑ Topo_m"aphic 'OLE
DEPTH DRILLING LOC
From To formation Dos,cin....
0
90 Clay
90 200 Consolidated Frock
IIYPOCHLOREEE Amount 5
Wall Thickness
Diameter or Weight/Ft. Material
95 Ft. 61/4" SDR 21 PVC
20 Ft.
Ft,
Or
Material Method
GRAVEL MIX GRAVITY
Diameter Slot Size
Size
in
Material
Material
LOCATION SKETCH
Show direction and distance in mile from ar least
two State Roads or County Roads. Include the reed
number and common road names.
G
IN.)
O
LO
I [qa HFRE BY CERTIF 1' 1HAT THIS WELL WAS CONSTRUCTED PC ACCORDANCE WITFI 15A NCAC 2C, RFLL
,AvTR 3.S't:A'1DARDS, AND THAT A COPY OF THIS RECORD HAS*RI;E\ PROVIDED TO THE WFI.F. CW'\ER.
6 11 03
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Date
Submit the original to the Division o Water Quality, Groundwater Section, 1636 Mail Service center- Raleigh, NC
�_..\ ,Fo,', r •. t t,r: �, ,a,. , within 30 days.
GROUNDWATER SECTION
ASHEVILLE REGIGNL.L OEHICE

Scott Gantt To: Date: 6/11/2003 Time: 11:07:18 PM
275004
WELL CONSTRUCTION RECORD
<orU1 Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (1NDIVIDUAL)NAME (print) SCOTT GANTT CERTIFICATION # 2584
WIC LI, CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS INC. PHONE # [phone]
S FAIL R ELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
illapplicable) (if applicable)
i R'GLi. St (Check Applicable Box) Residential ® Municipal ❑ Industrial ❑ Agricultural ❑ Vol: t
Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
L LOCATION.
testoau. FOREST CITY
• County RUTHERFORD
VE BRIGHT LANE LOT 1
;Street Narne.boomers, Community. Subdivision. Lot No, Zip Code)
- OCR CON IIOMES OF RUTHERFORDTON
i:7RSS l_ HWY`4A BY-PASS
(Strca or Route No_)
—13 HP. FCYClilUY
NC
State
XI? a (Lode - Pion Number
.'\ L DRILLED 5.12/03
lrpf Al. DEPTH 263
G IFS 1Vpl.i. REPLACE EXISTING WELL?
.. _I Ic'\Vx rest L'Ort, Bela's Top of Casing
28139
Zip Code
YES ❑ NO I:
60 FI'.
(Uss'✓' IfAbovc Top of Casing)
v FT. Above Land Surface'
Leto^. I.l nvfass myths, a variance it
0.0111
:)LLD )Lpup. METHOD OF TEST ARDM
Is. AV.ATHR ZONES tdeputi: 195 260
Topographictand setting
❑ Riclge ❑ Slope ❑ Valley ❑ Mat
Latitude/Longitude of well location
35.19.009 81.53 477
(degees.minutes seconds)
Latitude. Longitude source: ❑ LJPS E -topographic _ r.; t:
DEPTH DRILLING LO:.'
From To Fortran -ion Doron:n: it
0 95 Clay
95 263 Consobdared R:
1:. DISINIEC PION: TT PE HYPOCHLORITE Amount 7
to :'-rs ooci Wall Thickness
Depth Diarneter or Weight/Ft. Material
102 FL 61/4" SDR 21 PVC
Ot LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the. roan.
II. 'alms and common road nm:ies.
Des;
20 It.
Diameter
Ft.
Material Method
GRAVEL MIX GRAVITY
Slot Size Material
_. i� tt Fl .ACn_
t Size Material
Ft,
cti
W
I i FRGRY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 13A NCAC 3C, WELL
S Rl. Cl1UASTANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWAER.
SIGNATURE OF PERSON CONSTRUCTING THE WELL
6 11
Date
at the original to the Division of Wa er Quality, Groundwater Section, 1636 Mail Service center- Raleigh. NC
99Er630Pl rit"Nop (919) 7 b-32R {y'i hin 30 days.
f _—IiI
1
if 1
03
GW1 REV P

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James r^t_ L'clm(, Tr
WELL CONTRACTOR COMPANY NAME f'amp' c WP1 1 R Ptirnp Cn Tnn
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
CERTIFICATION # 71 18
PRONE #$2R) 453_-322
ASSOCIATED WQ PERMIT#
(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:
NearestTown:�t Qyy0-t."4:.- County lit t3,4L
%2 �1(? (N4 v• U 0 Y
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: V. C GT tAte—
Address 3 :2-v) t Q e-Uu 1-cn-
(sweet or Route No.)
44%Qj k„ L4 N-r 2R019
City or owo A State Zip Code
Area coda Phone number,
4. DATE DRII I FD v. 3 U'- 0 3
5, TOTAL DEPTH: �R 5
6. DOES WELL REPLACE EXISTING WELL? YES Q'NO 0
7. STATIC WATER LEVEL Below Top of Casing: \o () FT,
(Use "+" if Above Top of Casing)
S. 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): t METHOD OF TEST
10. WATER ZONES (depth): el'` O
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From 0 To 0 Ft. 6 1/
From To Ft.
From To Ft.
13. GROUT:
From p
From
14. SCREEN:
Depth
To 20
To
eir
f'h1 nri na Amount
Wall Thickness
orWeight/Ft. Material
gDR21 PVC
Material
FL Neat Cement
Ft.
Depth Diameter
From To Ft. in
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
Method
Hand
Slot Size Material
in.
in.
16. REMARKS.
Lubnait-theor'igin-41
2t69911626P,Itone ln.',Olif i73
274711
Topographic/Land setting
['Ridge ;Mope ❑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 gormati2n Description
SSUpm
JOCATION SKETCH
Show direction and distance in miles from at least
L.--
two State Roads or County Roads. Include the gild o
numbers and common road names. _/ L
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY: THIS RECORD HiffiEEN PROVIDED TO THE WELL OWNER
/t — /c)._t3
OF PERS ' N CONSTRUCTING THE WELL / DATE
'on of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
21, 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) Jrn t^t_ Canr, Jr
WELL CONTRACTOR COMPANY NAME
Camr'G
274709
Groundwater Section
CERTIFICATION # 71 3 R
Wnl1 R Pomp en__ s TnC PHONE *O2R1 451-7122
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT*
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential tirMunicipal/Public O Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELLLOCAT ON. 'q
Barest Tom County�yl, .t•, i-
0uA0N a��i� `0 v
(Street Name, Numbers, Community,�„ Zip Code)
3. OWNER: \ VA erXS IQ 9, Ati,ki),
Address CI\ aan, `` Crt C3A.
(Sir t or Route Na)v-isu k c . OR 3
City or Town S Zip Code
( )-
Area code- Phone number,_
4. DATE DRILLED '
5. TOTAL DEPTH: E h 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO k 7. STATIC WATER LEVEL Below Top of Casing: 'o 0
(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 p1r_
10. WATER ZONES (depth): \uv et( Ann
11. DISINFECTION: Type rh 1 nri na Amount IA 6.-1.I.4
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From a To_gin Ft.6 i /4 eQR71 PVC
From To Ft.
From To Ft.
13. GROUT: Depth
Front—* To 2 0 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
To Ft.
To Ft.
Material
Neat Cemcnt
Method
Hand
From
From
Topographic/Land setting
I�R dge ❑Slope ❑Valley OF1at
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box) -
DRILLING LOG
Forryation Description
_
FromPTH o
0
go
`iU
LOCATION SKETCH
Show direction and distance in miles from at least Y
two State Roads or County Roads. Include tha d
numbers and common road names. '1
i lJ
LiWiszx
16. REMARKS:
WELL WAS CONSTRUL 1hD IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY 0 THIS RECORD HAS PROVIDED TO THE WELL OWNER
rGt4 G - i -o3
NATURE OF PERSON CONSTRUCTING THE WELL f DATE
original to the division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
36 ifhotie NiiQ9r91 733-32
I, 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) J m e s r+L C aft'L r Jr CERTIFICATION 21 "I8
WELL CONTRACTOR COMPANY NAME rampwin 11 & Pump Co Tnr PHONE #8}7R1 d53-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 6/ Municipa)/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: •L County
I
Nearest Town: : e bt Y e ue
C„ife- )s(K.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Kei i k CoYtVleY
Address coV(Y(Nr i?d
(Street or Route No.)
1,iILer Kai
City or Towo State I Zip Code
( )- l r /108
Area code- Phone number
4. DATE DRILLED 51 - b 3
5. TOTAL DEPTH: 1i Zt-i
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: I C 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�Ylth 15A NCAC IC .0118.
9. YIELD (gpm): b METHOD OF TEST air
10. WATER ZONES (depth): S D o
sd
11. DISINFECTION: Type rh 1 nri nP
12. CASING:
Depth Diameter
From 0 To 35- Ft. 6 t / 4
From To Ft.
From To Ft.
Amount CNp
Wall Thickness
or Weight/Ft. Material
QD.R.21 PVC
13. GROUT: Depth Material Method
From 0 To 20 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.
16. REMARKS•
274708
Topographic/Land setting
❑Ridge ❑Slope [Walley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check boxy
DEPTH DRILLING LOG
From To Formation Description
D 3S iiave I clay
f t;/.. 6oti5o/ida eci Yc
LOCATION SKETCH
Show direction and distance in miles from at least two State Roads or County Roads. Include thtsoad
numbers and common road names.
'.0
m
tV
J
O ie
EkillFft
TRUCT1ON STAND.
"T>'`NIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY 0THIS RECORD HBEEN PROVIDED TO THE WELL OWNER
i L
—%SIGNATURE OF PERS
4414e4.-
N CONSTRUCTING THE WELL
Submit-tileer-jgipatt Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
2$95$46361'hbne'Tiu: 9jii9) 733-3121, 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) 1T ame s t.r !'amp Jr CERTIFICATION# 21 R,8
WELL CONTRACTOR COMPANY NAME ramp t s wnl l R Pnmp In Tnn PHONE #82A) AS3-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT.
(if applicable)
(if applicable)
274704
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. Nearest Town: C$, WELLLOCATIC2 fl ^ ^.. o � Q Topographic/Landsetting
!Ridge ❑Slope ❑Valley OLF'rat
(check appropriate box)
Latitude/longitude of well location
1(vy,n,&a RArn-
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
"LAI \NI U 04
0 lTC4-a1 A �J y .
«Street or Route No.) Tt
,(L
City o own State I. Zip Code
^ h 5
a' v(,1
Area code- Phone number
4. DATE DRILLED $ • a.2, h
5. TOTAL DEPTH: ip S
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 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): 2,0 METHOD OF TEST p i r
10, WATER ZONES (depth): Z OU
11. DISINFECTION: Type rh 1 nri np Amount Lk L.,C
12. CASING: Wall Thickness
epth Diameter or Weight/Ft. Material
From p To q D Ft. 6 1/ 4 S-912.-221 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material
From__# To 20 Ft. N at Ccmcnt
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
Frorn_ To Ft.
From To Ft.
16. REMARKS:
FLLItahi
VFRUCTION STANDARDS,
Sub
2769R
Method
Hand
(degrees/minutes/seconds)
Latitude/longitude source: ❑GPS❑Topographic map
(check box) -
DEPTH DRILLING LOG
From To Fptmation7escription
(in J tUhti,
(in
4�YZ
Xj t t A.67nh,ti
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the rtsd
numbers and common road names. co
LL WAS CONSTRUCTED IN ACCORDANCE WITH 15A N
3s,,WFT
"HAT A COPY 0 THIS RECORD H EEN PROVIDED TO HE WELL. OWNER
( C
PTURE OF PERSON CONSTRUCTING THE WELL
DATE
Fr s'on of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
'19ILkiki221, within 30 days. GW-1 REV. 07/2001
lD
t,
rn
G
7
/20

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) .Tames
WELL CONTRACTOR COMPANY NAME Clamp s m WA11
STATE WELL CONSTRUCTION PERMIT/
(if applicable)
Camp, Tr CERTIFICATION# 213R
Piimp C Z
Tnr•
PHONE#817R1 d5'I-7122
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential ir-Municipa1Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATIQN:
Nearest Town. �{
County A-i?'
5 GJu
(Street Name, Numbers, Community, Subdivision, LotNo., Zip Code)
3. OWNER: CO-b.AA / (j 1C C1 t
(Street or Route Nu)
fl rjeLLA sc bYY
City or Town Stare Zip Code
(—)-
Area code- Phone number
4. DATE DRILLED . 2 \ 3
5. TOTAL DEPTH: lC 0 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: V .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 ith 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST a r
10, WATER ZONES (depth): -\ S O
11.DISINFECTION: Type rhlnrina Amount
Wall Thickness 'V
Address 31; 0.vel r ,tv
12. CASING:
Depth Diameter
From p To to J Ft. 6 1/ 4
From To Ft.
From _ To Ft.
13. GROUT: Depth Material
From o To 20 Ft. Neat
From To Ft.
14. SCREEN: Depth Diameter
Froth_ To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From. To Ft.
From To Ft.
or Weight/Ft. Material
eDR21 PVC
Method
CctRent Hand
Slot Size Material
in.
in.
16. REMARKS:
fie/teifgy�d- �ie Divi
4.7 914624Pha.ne,N0Offin733-3
Vital
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitudeof well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box).
DRILLING LOG
Formation Description
From To
(05lap' �Uln 1
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.
i L1/4}1n
\)5
IS WELL WAS CONSTRUCTED •RDANCE WITH 15ANCAC 2C, WELL
AND THAT A COPY OB THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
GZ�YG'1�
°NATURE OF PERS9N CONSTRUCTING THE WELL
DATE
ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001
ror
c
CO

WELL CONSTRUCTION RECORD
274699
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James t.t, Camg, Jr
WELL CONTRACTOR COMPANYNAME Camp c Wal 1 R Pnmp f n Tnr- PHONE #$S7Al dci 7322
ASSOCIATED WQ PERMIT#
(if applicable)
STATE WELL CONSTRUCTION PERMIT/
(if applicable)
CERTIFICATION" 71 18
1. WELL USE (Check Applicable Box): Residential fd7'MunicipaUPublic 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: `-{\
kJ)it II)A,(,..rlb:
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: \ (1-X LA.& 1
Address l $ k W t1 Q
County CRALONIII,
1 Lou 1 C'xJLset or Roalel C(SIS)
City or Towa Grate Zip Code
Area code- Phone number
4. DATE DRILLED S H 3 f)
5. TOTAL DEPTH: Li Q
6. DOES WELL REPLACE EXISTING WELL? YES 12140 0
7. STATIC WATER LEVEL Below Top of Casing: 4 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 1SA NCAC 2C .0118.
9. YIELD (gpm): & METHIIID OF TEST Ai r
10, WATER ZONES (depth): \ t m
11. DISINFECTION: Type rh 1 nri na
12. CASING:
Depth Diameter
From p To L\ Ft. 6 t / 4
From To Ft.
From To Ft.
13. GROUT: Depth
From_0_____ To 30 Ft.
From To Ft.
Amount 1 (,_,,�
Wall Thickness
or Weight/Ft. Material
DP21 PVC
Material
N at Ccment
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Method
Hand
Slot Size Material
in.
in,
From To Ft
Topographic/Land setting
❑Ridge ❑Slope ❑Valley 0Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutesiseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOO
From Tom-+ Formation Description
0 Q rJaClc� Cla.j
CIS y` co✓is,-))AEA roc I:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and pgmmon road names.
?6`
Ca)
C
_
lD r C =`
tV N
16. REMARKS:
IE pti,
Y R 1F THAT rilS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
STRUCTION STANDARD AN`- THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
h ATURE OF PERSON CONSTRUCTING THE WELL
Subt®lt ,_u,rnip4 ,75118 vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27A§94b9fifN6htenfifyllepl4g-3221 within 30 days. GW-1 REV. 07/2001
G -R-03
DATE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) JarnaS r+L Ca mkt, Jc CERTIFICATION Si 713R
WELL CONTRACTOR COMPANY NAME ('amp' a Wa11 R Primp C'n Tnn PHONE #$2R1 d 5'1_7122
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
274695
1. WELL USE (Check Applicable Box): Residential ErMunicipal/Public 0 Industrial O Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection O Other 0 If Other, List Use
2. WELL LOCAT O; Ni, p t�
Nearest Town: J. V.t ln,( Countys 1 ___
(Sweet Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:Ct) (t1x lit! [AA�C fi--
Address (— I. \ nX.AC � /LA 1 F-cY
City or Town State Zip Code
%,N)- (,25 42\ 2
Area code- Phone number,
4. DATE DRILLED —1 L U R
5. TOTAL DEPTH: U, O S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 141..
7. STATIC WATER LEVEL Below Top of Casing: (I 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 accordantesp'lth 15A NCAC 2C .0118.
9. YIELD(gpm): METHCDOFTEST Air
10, WATER ZONES (depth): \ /vaLhA.l
11. DISINFECTION: Type ('h 1 nri nP
12. CASING:
Depth
From p To
From To
From To
13. GROUT:
From p
Depth
To 20
Diameter
Ft.6 1/4
Ft.
Ft.
Ft.
Material
Nccit
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
From
From
Depth Size
To Ft.
To Ft
Amount
Wall Thickness
or Weight/Ft. Material
eDR-21 PVC
Method
Cement IIand
Slot Size Material
in.
in.
Material
Topographic/Land setting
InRidge OSlope OValley OFlat
(check appropriase box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:COPSOTopographic map
(check box) -
DEPTH 'DRILLING LOG
From To Formatior Descrip ❑
n \ Sl)
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the t2d
numbers and common road names. L
CZ
,n
S vim i WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WE_L
YD THAT A COPY 0THIS RECORD HAS BEEN PROVIDED TO THE WF(1 OWNER
�n 6-/ -03
N CONSTRUCTING THE WELLY / DATE
toRostkorwittictim (' Divis on of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
0151941636R9(81 ,Np.eifMg33-3221,within30days. GW-1 REV. 07/2001

274697
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# 7118
WELL CONTRACTOR COMPANY NAME ramp' ¢ Wa11 R Piimp C`n Tnr-
PHONE [phone] d'1-7322
STATE WELL CONSTRUCTION PERMIT/4 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential f Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nyarest own:
kttAk
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: N 4, Cd\N
Address k i% \ S,l-.t.J Lek.,
\AU'RX \ (Street or Router. No.) o25‘ 1 y 1�
a 1
Ir
City or Town State Zip Code
( Area code- Phone number
4. DATE DRILLED 6• 1 0. 0
5. TOTAL DEPTH: 0 6
6. DOES WELL REPLACE EXISTING WELL? YE$ 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 1,+ 0 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 15A NCAC 2C .0118.
9. YIELD (gpm): 6 METHOD OF TEST a i r
10, WATER ZONES (depth): 2- 0
11. DISINFECTION: Type ('h 1 nri np
12. CASING:
Depth Diameter
From__ To_ Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth
Material
Amount G A.4)
Wall Thickness
or Weight/Ft. Material
gBR71 PVC
From 0 To 20 Ft. N at 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.
Method
Hand
16 REMARKS
£HILT rLTfF
JNSTRUCTION STANDARD
AUG — 5 2103
County
Topographic/Land setting
❑Ridge t11241Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check brat).
DEPTH DRILLING LOG
From To FatioRDes ripri n
1ru
S 3e S )ll,1 LUIAAit
JOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include Qie road
numbers and common road names.
\-Se
NCLC:L.
N
Yv�1✓"'
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ND THAT A COPY 0 THIS RECORD HAS SEEN PROVIDED TO THE WELL OWNER
L(/I
anl G g D3
SIGNATURE OF PERSyN CONSTRUCTING THE WELL DATE
Su giMiAtgfhafoTali Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
1g8 t<k iliOA49f f CA1 within 30 days. OW-1 REV. 07/2001
\ 1»

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
CRmp's wall R Primp_ (`n Tnn
ASSOCIATED WQ rERMIT#
(if applicable)
WELL. CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
274696
CERTIFICATION 14_2118
PHONE#$7R) ACR-7322
1. WELL USE (Check Applicable Box): Residential IIY Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT O
Nearest Town: I.,_ VA t N
L A %, .. '.
County QA- ,1,G
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: � t S, .OA %L 1. i . O ,(11 , n
Address P. S 1 Cl
(Street or Route No.)
t r 'Li c ? SC-7 U 1,
City or Town State Zip Code
( Area coda- Phone number
4. DATE DRILLED S - \
5. TOTAL DEPTH: IA 0 S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO tal
7. STATIC WATER LEVEL Below Top of Casing: ) Li O 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 15A NCAC 2C .0118.
9. YIELD (gpm): 1 METHOD OF TEST n 1 ,-
10, WATER ZONES (depth): (' () (1
11. DISINFECTION: Type rh 1 Sri na
12. CASING:
Depth Diameter
From p To_l_a_ Ft. 6 1 / A
From To Ft.
From - To Ft.
13. GROUT: Depth Material Method
From_a_ To " 2 0 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.
Amount \ CA_A,p
Wall Thickness
or Weight/Ft. Material
eDR21 PVC
Ncat
Cement Hand
16. REMARKS:
I QERYEI{TIFY/TI�4T
fliSTRUCTION STANDARD:
H
A
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longinude of well location
(degrees/minutes/seconds)
Latitude/longitude source;❑GPS❑Topographic map
(check box}
DEPTH DRILLING LOG
From To Formatio Description
n G n S r,,,ti9
qu (Irk
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, WFI r
THAT A COPY 0THIS RECORD HASEEN PROVIDED TO THE WELL OWNER
mu; -5 7�f3 �� amla wD,�,�n� /., hz 03
SIGNATURE OF PERSON CONSTRUCTING THE WELL ✓ / DATE
Subs(,tilireE it laeGth®NDivisioa of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
278PtfbrtrelNUPtI9fIfjYF166-3221,within30days. GW-1 REV. 07/2001
0

From: Scott Gantt To:
Date: 558/2003 Time: 9'40:14 PM Page 7 of 8
272793
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTL 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 © Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
e WELL LOCATION:
Nearest town: LANDRUM
1540 LANDRUM RD
County RLITHERFORD
t S:rcet \:eme, Numbers, Community, Subdivision, Lot No, Zip Code)
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
Latitude/Longitude of well location
35.11.998 / 82.07.953
3. OWNER HORTON HOMES OF RUTHERFORDTON (degrees/minutesseconds)
ADDRESS 342 HWY 74A BY-PASS
(meet or Route No.)
RUTIIERFORD7ON NC
City or Town State
S28-287-3366
Area Code - Phone Number
1. DATE DRILLED 4/15/03
28139
Zip Code
Latitude/longitude source: E GPS ❑ Topographic wrap
DEPTH DRILLING LOG
From To Formation Descnpnon
0 75 Clay
75 82 Consolidated Rock
C
C O
6. DOES WELL REPLACE EXISTING WELL? YES El NO U = 0 _-
'. STATIC WATER LEVEL Below Top of Casing: 25 FT. Ors.',
--,.m
I ,7:jC
t9-___* rr
'Top of casing terminated m/or blow land surface requires a valiance in .`+O
accordance with 15A NCAC 3C.01r8 TM --f �
3C =O
rn
9. YIELD Lylnir. 10 METHOD OF TEST ARDM m 2
COmom.
in. WATER ZONES (depth): 250 n
D. DISINFECTION: TYPE HYPOCHLORITE Amount 9 oe LOCATION SKETCH o
Z
12 CASLNC: Wall Thickness Show direction and distance in miles from at least
Depth Diameter or Weight/Ft. Material two State Roads or County Roads. Include the road
I PJIII 0 To 82 Ft. 6 1/4 " SDR 21 PVC numbers and common road names.
5 TOTAL DEPTH 300
(Use "*" if Above Top of Casing)
%. TOP OF CASING IS 2 FT Above Land Surface'
13. GROUT:
Depth
From 0 To 20 Ft.
1. SCREEN
Material Method
GRAVEL MIX GRAVITY
Depth Diameter Slot Sire Alate'ial
From NA To Ft. in in.
L'. SANILGRAVF;1. PACK'
Depth Size Material
Fran NA To Ft,
to. RE\L\RKS'.
4 7/10 MI
LANDRUM RD
SC HWY 9
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITII 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
4/16103
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 Phonntin /919) 733-3221Lwithin 30 days.
' t)1—
GW-1 REV. 0 '2001

From: Scott Gantt To'.
Date: 5/8/2003 Time: 9.40:14 PM Page_ 6 of 8
272792
WELL CONSTRUCTION RECORD
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 Si
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box) : Residential El Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2 WELL LOCATION:
Nearest town: BOSTIC
201 FALLS LANE
County RUFHERFOR.D
;Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3 OWNER \VILKINS HOME CENTER
ADDRESS 1920 HWY 74 BYPASS
(Street or Route No.)
FOREST CITY NC
CM; or Train State
828-286-3647
Area Code - Phone Number
28043
Z; Code
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
Latitude/Longitude of well location
35.28.634 / 81.46.152
(degrees/minutes/seconds)
Latitude/longitude source: ® GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Deacaption
0 62 Clay
62 180 Consolidated Rock
C
!. DATE DRILLED 4/14/03 CD p
W
5. TOTAL DEPTH 180
• O
6. DOES WELL REPLACE EXISTING WELL? YES NO
A
-. STATIC WATER LEVEL Below Top of Casing: 55 FT. ▪ I —
G_
(Use "*" If Above' Top of Casing) k.0E rt
11._,
F TOP OF CASLNG IS 2 FT. Above Land Surface* Sr —t -,
'Top of cash,+, terminated odor blow land surface squires a variance in S �0
u.-o,v., cn,nfla 15A NCAC 2C.0118
CO m-,
1. YIELD (prn): 10 METHOD OF TEST ARDM
WATER ZONES (depth): 170
11 DISINFECTION: TYPE IIYPOCHLORITE Amount 4
L CP.SLVG. Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 70 FL 61/4" SDR 21 PVC
13. GROUT:
Depth
0z
Material Method
0 To 20 FL GRAVEL MIX GRAVITY
1 SCREE..:
Depth Diameter Slot Size Material
From NA To Ftin. in.
ty. SANi) iRAVli!. PACK:
Depth Size Material
Prom NA. To Ft,
16. REMARKS
-1
—1
0
T
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.
BOSTIC/
S UN SEIL\E
HIV,'
CAMPBELL SPRINGS RD
/2 MI
FALLS LANE
IIEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED EN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
4/15,'03
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
Submit the or ginal to the Division of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
27699-1636 Pane o (91y1 i -_
�..�,
r
GW-1 REV. 07.20Gp

From: Scott Gantt To'.
Date 5/8/2003 Time: 0 40.14 PM Page 4 of 6
272730
WELL CONSTRUCTION RECORD
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)
I. WELL USE (Check Applicable Box): Residential ❑ Municipal ❑ Industrial Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2_ WELL LOCATION:
Nearest town- RUTHERFORDTON
COUNTRY MEADOWS ESTATES LOT 3
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
s_ OWNt:R WILKINS IIOME CENTER
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ 'Flat
Latitude/Longitude of well location
35.15.619 / 81.55.907
(degrees/minutes/seconds)
ADDRESS 1920 HWY 74 BYPASS Latitude/longitude source: ® GPS ❑ Topographic Wrap
(Mott or Route No.) DEPTH DRILLING LOG
FOREST CITY NC 28043 From To Formation Description
City o, To.wn State Zip Code 0 94 Clay
828-286-3647 94 400 Consolidated Rock
.4r ea Code - Phone Ntmtber
J. DATE DRILLED 3/31/03
5. TOTAL DEPTH 400
6 DOES WELL REPLACE EXISTING WELL?
LSTATIC WATER LEVEL Below Top of Casing:
YES ❑ NC)
50 FT
(Use "z" If Above Top of Casin
P. TOP CIF' CASING IS 2 FT. Above Land Surface'
op of casing terminated odor below land surface requires a variance in
.aco:dmwc with 15,\ NCAC 2C0118
9. S LOL.D (glrn). 3 METHOD OF TEST ARDM
10. WATER ZONES (depth): 360
n. DISINFECTION: TYPE HYPOCHLORITE Amount II
12 C'AS I\ Li: Wall Thickness
Depth Diameter or WeighoEt. Material
Fiom 3 To 100 Ft. 61/4 " SDR 21 PVC
3 GROLI
F:on: 0
Depth
To 20 Ft.
1 SI.'16LLN
Or
Material . Method
GRAVEL MIX GRAVITY
Depth Diameter Slot Size Material
From NA To Ft. in. in.
t •.. S.'uND GRAVEL PACK'.
Depth Size MiteriN
Ti co NA To Ft,
lo. REMARKS.
0
Z ea."
1:3# Ern
LOCATION SKETCH
Show direction and distance in miles from at least C
two State Roads or County Roads. Include th-
numbers and common road names.
COUNTRY
MEADOWS
1/2 MI
DEWITT OMENS RD
BIG ISLAN1) RD
I DO I IEREBY 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.
3/31/03
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
275ifr 9 1636 Phone -No. (949J733-3221; withIw days.
CF cuil_,:,:1L6 SLCIION
AS LE I r .'/AL OFFICE
m

From: Scott Gantt To:
Date: 51E/2003 Time: 9:40:14 PM Page 2 of 8
(if applicable)
L WELL USE (Check Applicable Box) : Residential LI
Recovery ❑ Heat Pump Water Injection ❑
2. WELL ELL LOCATION:
Neareot town: LAKE LURE
654 ISLAND CREEK RD
2'72'i 88
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CON T RAC FOR (INDIVIDUAL)NAME (print) SCOTT GANTT CERTIFICATION # 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PIIONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable)
Murucipdi ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Other ❑ If Other, List Use:
County RUFIIERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,Zip Code)
3. O\VNLR HORTON HOME OF RUTHERFORDTON
ADDRESS 342 HWY 74A BY-PASS
(slreei or Rota< Na)
RI TTHERFORDTON
City or Town
828-287-3366
NC
State
Area Codo - Phone Number
a. DATE DRILLED 3/26103
e. TOTAL DEPTH 140
5. DOES `,FELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing:
28139
Zip Code
YES ❑ NO El
6 FT.
(Lsc "r" If Above Top of Casing)
3. TOP OF CASINO) IS 2 FT. Above Land Surface"
"Top of <mine tcnnlnama ator below land srnface regwres a variance in
as:a: de to with ISA NCAC 2C.0116
9 ` 1191,13 font. 12 METHOD OF TESLARDM
W 110I( ZONES (depth): 135
tl DISINI LC IION'. TYPE IIYPOCHLORITE Amount
12 CASLy0:
Prom 0
❑. GROUP.
From 0
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ 'Flat
Latitude/Longitude of well location
35.24.983 / 82.10.674
(degrees/minuteacseconds)
Latitude/longitude source: ® GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 30 Clay
30
140 Consolidated Rook
C
t.)
'S
b
O
�*n
A
4 Oz LOCATION SKETCH
Wall Thickness
)epHt Diameter or Weight/Ft. Material
To 38 Ft. 61/4" SDR 21 PVC
Deptii
To 20 Ft.
i SCREEN
Material Method
GRAVEL MIX GRAVITY
Depth Diameter Slot Size Material
From NA To Ft. in.
1' SAND RAVEL PACK'
Depth Size Material
Flora NA To Ft,
IS. REMARKS.
GO 7:
CO Cam')
Show direction and distance in miles from at least'
ONO State Roads or County Roads. Include the mad
numbers and common road names.
ISLAND CREEK RD
6/10MI
HWl 64 !4
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.
3/28/03
SIGNATURE OF PERSON CONSTRICTING THE WELL Date
Submit the original to the Division of Water Quality, Groundwater Section, 1636 :Mail Service center- Raleigh, NC
2 WW 63611GmeNO (91,9)-Z33i221,.3v_ithiin30 days.
ILi
L
GW-1 RE.A _ 0

WELL CONSTRUCTION RECORD 2 7 2 r7 8 7
North Carolina - Department of Environment and Natural Reso ces - Division o Water , Qua ' - Groundwater Sec p6n3=
� yy�� (,� n ` /1 �i�'�J'''�`(1'bibK CERTIFICATION A7
WELL CONTRACTOR (INDIVIDUAL) NAM,//E�� (ppr�rii(ntt)�)yyFrri /i� {��J • ♦``l PHONE # � Z�
WELL CONTRACTOR COMPANY NAME A rtitt(C'M4�itoCvit11. ]1i L
ASSOCIATED WQ PERMIT
STATE WELL CONSTRUCTION PERMITq (if applicable)
(i f appl icable)
I. WELL USE (Check Applicable Box): Residential Ill" Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
s--
WELL LOCATION: tt , r) opographic/Land setting
N wrest Town: 1 . e ) Idge ❑Slope ❑Valley ❑Flat
q n 1Cr -?. iei g_7e 6_.• Lkb L.uY .22 (check appropriate box)
(Street Name. Numbers, Communit , bdivision, Lot No., Zip Code) 2-11
Latitude/longitude of well location
(degrees/minutes/seconds)
3. OWNER: s0 6 5( 33 I � Latitude/longitude source:OGPS❑Topographicmap
Address P �% Lts-i (check box)
(Spector Route No.) 2:514-07 DRILLING LOG
N� DEPTH
La Cityor L41'-�J Zi Code From To Formation Description
or Town Stag P
(_)-
Area code- Phone number , r O
4. DATE DRILLED 3- �T
5. TOTAL DEPTH: ,72:)", 5 t
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO GI'
7. STATIC WATER LEVEL Below Top of Casing: -14-0 FT.
(Use"+" if Above Top of Casing)
8. TOP OF CASING IS , FT. Above Land Surface*
*Top of casing terminated atior below land surface requires a
variance In accordance with ISA NCAC 2C .0118. inr /�
•
9. YIELD (gpm): 160 METHOD OF TEST .1 G
r V•a41
10. WATER ZONES (depth): 3 CO5 L fl( AT1i ON SKETCH
)'� 14,4 Amount "L.Show direction and distance in miles from at least
11. DISINFECTION: Type Wall Thickness two State Roads or County Roads. Include the road
12. CASING: numbers and common road names.
Depth Diameter or Weight/Ft. Material ��
From CDTo~7 Ft. }-i U.h.-{ J i , ',,
From To Ft. n..CO I�'� tS`,3 o
From To Ft. � Z 8
13. GROUT: Depth Material Method��C�C'�t�'�,�rh
-G c
From To Ft.I 0 < _m
From To FI.
14. SCREEN: Depth Diameter Slot Sizc Material UD �ri
From To Ft. in. in. Jr m
From To Ft. in. in. m�
15. SAND/GRAVEL PACK: Material N -1
Depth Size F i
From To Ft.
From To Ft.
16. REMARKS:
FY THA THISWELL
AAACO OPY OF THIS RECORD HAS BEEN PROVED IN ACCORDANCE WITH 15A NCAC 2C, WELL
IDED VIDED TO THE WELL OWNER
g7ubmit the original to the f tuts
2769Y-1636 Phone No. (919�33-3:
GROLI._. IIUN
A--'EOLLE
I —
NATURE OF PERSON CONSTRUCTING THE WELL DATE
on of Water Quality, Groundwater Section, 1636 Mail Service Center' RREVgh, NC
21, within 30 days.

WELL CONSTRUCTION RECORD 2727 8 6
North Carolina - Department of Environment and Natural Reso ces - Division ro Wat r Qua(t Groundwater Sec too3�
/// S%SSS b1\ CERTIFICATION align,
WELL CON9'RAC'i'OR(INDIVIDUAL)NAME (prin[)IboYt�_ 1[9��er�
./�, tiePHONE N—
WELUCON"1'RACPOR COMPANY NAME Ti PHONE
n .u�L
ASSOCIATED WQ PERMIT
STATE WELL CONSTRUCTION PERMITp (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 f�Other 0 If Other, List Use
2. WELL LOCATION: r 1S-\ Lai Top lopesetting ❑Valley ❑Flat
L c-- Z �� 10 1 1. J d �'� j.,k{(/,,,, (check appropriate box)
(Street Name. Numbers, Community, Subdivision, Lot No., Zipk ode) ' lZ. -`I n-t Latitude/longitude of well location
g Y \ / ' I,r CW— j 654 C 6`C,ri� T] ) (degrees/minutes/seconds)
3. OWNER: Ik'� �RC� Latitude ongitude source:❑Gckbox) ographic map
Address (check box)
(Street or Route pt Z�rf�C DEPTH DRILLING LOG
�"� `� f✓t�Y�' (� e t From To Formation Description
City or Town State Zip Code
(—)-
Area code- Phone number- Z 5 —r+%
4. DATE DRILLED
5. TOTAL DEPTH: ZlD I
6. DOES WELL REPLACE EXISTING WELL'/ YES ❑ NO 0-
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use"+" if Above Top of Casing)
1
8. TOP OF CASING IS FT. Above Land Surface*
'Top of casing terminated atlor below land surface requires a
variance in accordan.tS wl h ISA NCAC 2C .0118.
9. YIELD (gpm): "-i METHOD OF TESTb.l r ��bili�h
10. WATER ZONES (depth): ( 00
I1. DISINFECTION: Type -Tab 14.4 Amount Z
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From_O L To 3-1 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth s Material Method
From To Ft.S��1� %,L-s(
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.
1 OCATIION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
'-(-tai 4-' C
O
W
L`dkQ iW� 3
{5>,,S (c &
N
4-
16. REMARKS:
11b HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
b��STRUCTION STANDARD '/( btHAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL
''
Suy pit the original to the Division
276994F614Pholtc(Yo4WP-3221,
AS ' ':icz
TURF OF PERSON CONSTRUCTING THE WELL DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center
I RREVgh, C
within 30 days.

272851
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 ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
HUNTING DR
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MARTY BRYSON
Address HUNTING DR
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) - 2874239
Area Code Phone number
4. DATE DRILLED 04/04/03
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):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 4.5
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 _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To FL 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 ❑ 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. #64 E. FROM RUTH. LEFT ON 2ND
HUNTING DR. 2/10 MILE ON RT.
0
1
-.J
N3
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE Wr t ISWELL _....
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVWED TO THE WELL OWNFIL.
iJ_ .0-47, C ---, (SLt �rc _�/—SIGNATURE OF PER CONSTRUCTING THE WELL 'DATE
i JSubmit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Serriice Center—.Raleigh1NC
27699-1636 Phone No. [phone], within 30 days. I GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 2 840
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERI IFICATION # 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 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: LAKE LURE
SUMMERFIELD LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: WALKE CONST.
Address SUMMERFIELD LANE
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
(828) — 288-3000
Area Code Phone number
4. DATE DRILLED 04/17/03
5. TOTAL DEPTH: 225
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 I5A NCAC 2C .0118.
9. YIELD (gpm): 12 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 90 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.
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. #64/74A W. FROM RUTHERFORDTON.
LEFT ON ROCK SPRINGS CHURCH RD. APPROX.
3/4 MILE ON LEFT PAST SHARP CURVE. LOT IN
CORNER OF ROCK SPRINGS CH. RD. & SUMMER
FIELD LANE.
Ch:Z Wd L-AVW£U
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS UCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIlil] D T99TFpWELL, OWNER
t air,,.,) C�a �— % o W(2i7/ � rt --7 =7J� 11 i
V! I
SIGNATURE OF PERSON CONSTRUCTING THE WELL ( t EE J
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 07/2004 -

2'72847
WELL CONSTRUCTION RECORD
Nnrth rarnlinn — Den;Trtment of PnvironTnnn/ Ann Nptm-,1114c<tirry.= Dwivirm ;It Watrr — tr-Irreinri# qrrir Seel:Inn
%)lt:Cii. (ON i RAI ;UK klINlJlV ILA JAL) NArvIht (prim) 1:414,AN 4.7 LK 2 Il'tt-fll ION # fro
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE 14/Fli I CONSFRI ICTInN PFRMIT # ccnr wn pppmiT #
(if applicabie) (if appiicable)
1 \A/Fi I T ICP (CI-120c Anntienhle Rnyli Preiriontini Thrinetree
L j keCO-Very LJ ieirt Fiinip Water I njeciion LJ kjirier Li ifUtfler, LiSi Use
2 WELL LOCATION.
Nenrest Tn‘yrt: DUTHFRP(IRDT/IN 4-rninty RiiT14 ce.ifitlo
. .
KOG IIOLI.OW DR. ; r _ lc;
Li Kiltigc op Li -..ancy L tar.
(Street i•iatne, Numbers 2, tratineact). Stihritvivete I :)t , 7ip Crkie) (check apprepriate ix
0119•ILIP: runic 1 ki14:SCIN 1 9t.nn1-il-mtiv1verht v, H. I ineirtion
AelCireite: 233 I- bait.
(Street or Route No (degrees/minutes/seconds)
RrTIIEREfIRrITtIN NiT
,cireck
(8/8) — 787-7812 TITPTI-T
4 DA 04:2Joia
5 TOTAI,DFPTH 1415
0"3:01 \Tic.'iT\ '931:-,11 '1 VL 117! KIC-1 fli
I:it A 1ft S% Lk 1_,LAI.L. liC10)-) op of Castile: ii; .
-6. I UV Of kiclIal.Nt...) 1-112 1 iivriGuI.1-riiii.1.3urfaccL
9. YIELD (mu): IOU METHOD OF TEST A RD
^ kto-pti, 2.
II. DISINFECTION: Type CHLORYTE Amount 2
2. CASING: Wall Thickness
i; 1.0 4i: H. i",-1 ire PVC
I Fon-.
1; 1:1-tt-tilT• 1)(7;0; NI;;;;T;;;;
DRILLING LOG
LOCATION SKETCH
Sinn% tiiicclion and distance 111 11111uS tt&jiti alt iedSi
Ihiffies
HWY. #221 N. FROM RUITHERFORDTON. LEFT
ON MTN. tTREEK RD. LEFT ON CASH RD. 112
1 2 t ' 03\ 3.0<00 HD! _____ Or,
v. ^r rvn !IS' 2)k 1,'C'l1t-Ninf,.
; iA ; A U;..)I r-tAa ULLfN r rvti'v icv Lit. UV,
( ,
1) 1S,LTP
H
SIGNATURE OF PERSON CONSTRUCTING THE WELL nivAm
I,
...... - • - • -
27fir.14.' Photto ?":3. 733 3221, wi:M•zt i-rt ,;=.„

27::84ti
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 ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: UNION MILLS
GROVES RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: THOMAS JOHNSON
Address 551 GROVES RD.
(Street or Route No.)
UNION MILLS NC 28167
City or Town State Zip Code
(828) - 287-4044
Area Code Phone number
4. DATE DRILLED 04/25/03
5. TOTAL DEPTH: 90
6. DOES WELL REPLACE EXISTING WELL? YES ® 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): 20 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 3
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. QUHKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. in. _ in.
From To _ FL _ 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. #64 E. FROM RUTH. LEFT ON HUDLOW
RD. LEFT ON ROCK RD. RT. ON GROVES RD. 3RD
HOUSE ON RIGHT. (BOX #551)
0
W
-o
3
iV
r
ca
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONNSTRUCTION STANDARDS, AND THAT A OPY OF THIS RECORD HAS BEEN PRO
SIGNATURE F 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

272815
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SIIEHAN 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 D Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection D Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
LANE RD.
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: ERIC BRADLEY
Address LANE RD.
(Street or Route No.)
RUTHERFORDTON N C 28139
City or Town State Zip Code
(828) — 625-8756
Area Code Phone number
4. DATE DRILLED 04/24/03
5. TOTAL DEPTH: 165
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): 20 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From 0 To 140 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
County RUTH
, Zip Code)
CHLORYTE Amount 3.5
Wall Thickness
or Weight/Ft. Material
SDR.21 PVC
Method
POURED
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:
Material
Topographic/Land setting
❑ Ridge 0 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. #221 N. FROM RUTHERFORDTON. LEFT
ON LANE RD. NEW LOT ON RT. AT DEAD-END.
-O
W
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE
11!AIT4CA:t 2 , iV L't
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN P_710 'I'b T14E4T/L
// II
en, %� � !�rie� 4/-of 4.
SIGNATURE O PERSON CONSTRUCTING THE LL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Sehice Center Raleigh, NC J
27699-1636 Phone No. [phone], within 30 days. GW-1 R*W 47/2001

272844
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Qmlity — 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)
L WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH
COUNTY LINE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JERRY LAWTER
Address COUNTY LINE RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
8( 28) - 625-2730
Area Code Phone number
4. DATE DRILLED 04/28/03
5. TOTAL DEPTH: 505
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 I5A NCAC 2C .0118.
9. YIELD (gpm): 20 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 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.
14.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To _ Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
in. in.
From To Ft.
Topographic/Land setting
0 Ridge 0 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. 64/74A W. FROM RUTHRFORDTON. LEFT
ON ROCK SPRINGS CH. RD. LEFT ON COUNTY
LINE RD. CHAIN LINK FENCE WITH GATE
APPROX. 2.5 MILES ON RIGHT.
£h:Z Nd L-INN£0
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC 1hD IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTFjUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Cehtbr—Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GWr1 REV. 07/2001
L t.),
('ThE

2728 43
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 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
OBSERVATION DR.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: TOM STOVER
Address OBSERVATION DR.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 287-5429
Area Code Phone number
4. DATE DRILLED 04/01/03
5. TOTAL DEPTH: 385
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): 4 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 9.5
12. CASING:
Depth
From 0 To 40
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
To
To
Frozn
From
16. REMARKS:
Diameter
Ft. 6-1/4"
Ft.
Ft.
Wall Thickness
or Weight/Ft. Material
SDR.21 PVC
Material Method
Ft. QUIKRETE POURED
Ft.
Diameter Slot Size Material
Ft. _ in. _ in.
Ft. _ in. in.
CK:
Size Material
Ft.
Ft.
Topographic/Land setting
❑ Ridge 0 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 miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 W. FROM RUTHERFORDTON. RT.
ON WILLOW LAKE DR- RT. ON BAYBERRY. LEFT
ON OBSERVATION DR 1/4 MILE ON LEFT. LOT
#33 Le
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE I j St -NC ^ [ 2C, .WEr r _
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PRO ! 1 TO L OWNS
SI NATURE OF PERSON CONSTRUCTING THE WELL : DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center _ Raleigh, NC l
GW-1 REV. 07/2001'
27699-1636 Phone No. [phone], within 30 days.

6 1 it 'J 'I 2
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 ® MunicipallPublic 0 Industrial ❑ Agricultural D
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
MACKIE FREEMAN RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: PHILLIP FREEMAN
Address MACKIE FREEMAN RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 429-2685
Area Code Phone number
4. DATE DRILLED 04/02/03
5. TOTAL DEPTH: 565
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO EJ
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): 10 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 15.5
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 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 0 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. #64 E. FROM RUTH. RT. ON MACKIE
FREEMAN RD. 2ND DRIVE ON LEFT.
0
w
tV
c
0
c_
cm
.,
o
m
12.o
rn
CAm
CA 2--
-a
0
z
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS THAT THAT A COPY OF THIS RECORD HAS BEEN PR/MIRED TO THE WELL OWNER.\'
ACHH-R.— / �//�� roc^— b
v �
SIGNATURE OF PERSON NSTRUCTING THE WELL 'DATE
Iull
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service enter — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-TtEV; 074Q01„

272841
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 0 Industrial ❑ Agricultural
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH
HWY. #64E.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: FRANKIE & KIM ROSE
Address HWY. 1464E.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 245-9701
Area Code Phone number
4. DATE DRILLED 04/04/03
5. TOTAL DEPTH: 705
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO NI
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 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 30 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 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:
Method
POURED
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. #64. FROM RUTHERFORDTON. 9/10
MILE ON RIGHT AFTER YOU PASS CENTENNIAL
RD.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCT ED IN ACCORDANCE WI
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PRO
5ANCAC2C WELL
11i0-THE WELI OWN
SIGNA URE OF PERSON CONSTRUCTING THE WELL ;
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service entear Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. G1 REy q //�0�i J
F

272810
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 ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH
BREEZE HILL DR
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JOE CARSON
Address BREEZE HILL DR.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 287-4239
Area Code Phone number
4. DATE DRILLED 04/15/03
5. TOTAL DEPTH: 605
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): 2 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" SDR21 PVC
From To _ Ft.
From _ To _ Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft.OUIKRETE 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
To _ Ft.
To Ft.
From
From
16. REMARKS
Topographic/Land setting
❑ Ridge El 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. #64 E. FROM RUTH. LEFT ON HUNTING
DR. GO TO TOP OF HILL & LEFT ON BREEZE
HILL DR 1ST DRIVE ON LEFT.
1V
F
W
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC.2Q, WEI 1
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN [E VI(EI1rrCI WELL b
/SIGNA ONCONSTRUCe WELL
I
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail ervic
27699-1636 Phone No. [phone], within 30 days. G
11/
Center — Raleigh, NC

27;:838
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 ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
64 HWY.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: FRANK STALLINGS
Address 461 US 64 HWY.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 287-3706
Area Code Phone number
4. DATE DRILLED 04/23/03
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 aUor 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 RUTH
11. DISINFECTION: Type CHLORYTE Amount 4.5
12. CASING:
Depth
From 0 To 140
From To
From To
13. GROUT: Depth
From 0 To 20
From To
14.SCREEN' Depth
From To
From To
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 6-1/4" SDR.21 PVC
Ft.
Ft.
Material Method
Ft. QUIKRETE POURED
Ft.
Diameter Slot Size Material
_ FL in. in.
Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size
From To _ Ft.
From To Ft.
16. REMARKS:
Material
Topographic/1 and 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. #64 E. FROM RUTH. APPROX. 1 MILE ON
LEFT.
0
Co,
.i"
C.J
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 PROVIDELLIlgTTI-IP WELL pWMIE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
'-
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ccntett Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REF '
g�lLt(p,r , 6EL11 IC
� , ' LLF t ,ii L IC

272836
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water QQmlity - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CER ILFICATION # 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 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: LAKE LURE
KINCADE DR.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ED ;YOUNGER
Address KINCADE DR
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
(828) - 625-4905
Area Code Phone number
4. DATE DRILLED 03/14/03
5. TOTAL DEPTH: 505
6. DOES WELL REPLACE EXISTING WELL'/ YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 505 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 RUTH
11. DISINFECTION: Type CHLORYTE Amount 13.5
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
From _ To
From To Ft.
16. REMARKS:
Size Material
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. #64/74A W. FROM RUTRERFORDTON.
RT. ON BILL'S CREEK RD. LEFT ON BUFFALO
CREEK RD. LEFT ON WHITNEY BLVD. RT. ON
KINCADE DR 1/2 MILE ON RT.
0
0
t
-o
NS
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 PROVIDE I7r -T)E
SI OF PERSON CONSTRUCTING WELL GNATURE
li
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service C
27699-1636 Phone No. [phone], within 30 days. GW-
Raleigh, NC
Q7L�001__ _
J

272834
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)
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: BOSTIC County RUTH
GOLDEN VALLEY ESTATES LOT #74
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CNP CONSTRUCTION
Address GOLDEN VALLEY ESTATES
(Street or Route No.)
BOSTIC NC 28139
City or Town State Zip Code
(866) - 808-3080
Area Code Phone number
4. DATE DRILLED 04/03/03
5. TOTAL DEPTH: 565
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IZI
7. STATIC WATER LEVEL Below Top of Casing: 500 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 I5A NCAC 2C .0118.
9. YIELD (gpm): 40 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To 30 Ft.
From _ To _ Ft.
From _ To _ Ft.
13. GROUT: Depth
From 0 To 20 Ft.
From To Ft.
I4.SCREEN: Depth
From _To_F
From To F
CHLORYTE Amount 15
Wall Thickness
Diameter or Weight/Ft. Material
6-1/4" SDR21 PVC
Material
OUJKRETE
Method
POURED
Diameter Slot Size Material
t. _ in. _ in.
L in. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
Material
Topographic/Land setting
0 Ridge 0 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
BUS. 74 E. FROM FOREST CITY. LEFT ON
BOSTIC/SUNSHINE HWY. LEFT ON LUCKADOO
MTN. RD. LEFT ON FIRE TOWER RD. RIGHT AT
FORK ON LOOKOUT DR. LEFT ON IDLEWILD DR
LOT #74 APPROX. 3/4 MILE ON RIGHT AT THE
TOP OF HILL.
-c- c ▪ a
1 0<
J r=
9 nr
s xo
N
• 0
r.3 o
z
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVID
�
S NA OF PERSON CONSTRUCTING THE WELL
"Ce� -
ypraffi WELL ±Wd`1E i fl
) 3-0iii
tS
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service ( enters- 42aleig1 1 L — J
27699-1636 Phone No. [phone], within 30 days. GW`Ij11 REVI, C� , ` EPi '1'

272832
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 D
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: LAKE LURE
LUREWOOD FOREST
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: TERRY DUFFY
Address LUREWOOD FOREST
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
(828) — 625-1997
Area Code Phone number
4. DATE DRILLED 04/29/03
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES 0 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 15A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
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" SDR21 PVC
From To _ Ft. _
From _ To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. QUHCRETE
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
in. _ in.
in. in.
16. REMARKS:
Material
Topographic/Land setting
0 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. #63/74A W. FROM RUTHERFORDTON.
RT. ON BOYS CAMP RD. IN LAKE LURE. RT. ON
CHAPEL POINT. LEFT ON LUREWOOD MANOR.
RT. ON LUREWOOD FOREST. LOT #15 ON LEFT
AT DEAD END.
Z1:3 Wd L- AVW CO
c
rJ
n-.
0r1
m
0
0
Nrn
conz
m�
c1
0
z
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PRO
lra'7_Q
SIGI4ATUREOFPE SON CONSTRUCTING THEWELL
N AC 2C, WELL
( ITFI W(✓LLiOWNEP; P,
,- 9-ate
D TE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service ICentei .Ii,�leigh, NC
27699-1636 Phone No. [phone], within 30 days. GIY-1 REV 0W2001 Y1

272831
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEW 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 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: LAKE LURE
LUREWOOD FOREST
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: TERRY DUFFY
Address LUREWOOD FOREST
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
(828) - 625-1997
Area Code Phone number
4. DATE DRILLED 04/29/03
5. TOTAL DEPTH: 145
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): 100 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To 40
From To
From To
13. GROUT: Depth
From 0 To 20
Ft.
Ft.
Ft.
Ft.
From To Ft.
County RUTH
, Zip Code)
CHLORYTE Amount 3
Wall Thickness
Diameter or Weight/Ft. Material
6-1/4" SDR.21 PVC
Material Method
QUIKRETE POURED
14.SCREEN: Depth Diameter Slot Size
From _ To Ft. in. _
From _ To _ Ft. in. _
15. SAND/GRAVEL PACK:
From
From
Depth
To
To
16. REMARKS:
Size Material
Ft.
Ft.
Material
in.
in.
Topographic/Land setting
❑ Ridge 0 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. #63/74A W. FROM RUTHERFORDTON.
RT. ON BOYS CAMP RD. IN LAKE LURE. RT. ON
CHAPEL POINT. LEFT ON LUREWOOD MANOR
RT. ON LUREWOOD FOREST. LOT #17 0V1T. AT
DEAD END. W
—c cm
o-c
r*t
m�
m
Z
N ma
IV o
z
J
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
AL7-iut,7;/
( SIGOF PERON CONSTRUCTING THE WELL
BATE
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

272830
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quplity — 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 [Si Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
CAMBY RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JOE HAWKINS
Address CAMBY RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(864) — 472-6827
Area Code Phone number
4. DATE DRILLED 04/30/03
5. TOTAL DEPTH: 525
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 500 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): 25 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 14
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
To 40 Ft. 6-1/4" SDR.21 PVC
To Ft.
To Ft.
Depth Material
To 20 Ft. QUHiRETE
To Ft.
Depth Diameter Slot Size
To Ft. in.
From To Ft. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 0
From
From
13. GROUT:
From 0
From
14. SCREEN:
From
From
From
To Ft.
To Ft.
16. REMARKS:
Method
POURED
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. #64/74A W. FROM RUTHERFORDTON.
RT. ON MCENTIRE RD. LEFT AT SHARP TURN ON
MCENTIRE RD. AGAIN. TAKE 1ST LEFT ONTO
CAMBY RD. APPROX. 4/10 MILE ON LEFT
o
S a
�t Cn
10 .�
>0
v n�
3
rn
n:r
N rya
n_
N a
x
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 PRO
t
GN TURE OF PERSON CONSTRUCTIN THE WELL
l
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service ¢enter; — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.

272822
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: ELLENBORO
TINEY RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: GERALDINE DAVIS
Address 808 TINEY RD.
(Street or Route No.)
ELLENBORO NC 28040
City or Town State Zip Code
(828) — 245-1713
Area Code Phone number
4. DATE DRILLED 04/23/03
5. TOTAL DEPTH: 45
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 25 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 RUTH
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 45 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
From 25 To 45 Ft. 78M
From _ To _ Ft.
16. REMARKS:
Method
POURED
Slot Size Material
in. in
in. in.
Material
GRAVEL
Topographic/Land setting
❑ Ridge D 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
BUS. 74 W. FROM ELLENBORO. RT. ON PINEY
MTN. CHURCH RD. LEFT ON TINEY RD. 2-1/2
MILES ON LEFT. (808 ON BOX)
O
(a
=C
v
J
-v
1V
rV
0
0
c)
rri
c r'
_m
o.<
.Ern
0
0
zz
tnx
m:a
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
SI ATURE 0F PER
IG (. r�� -Do_ %l T rTT
O STR G THE WELL ��� `- �� _
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service C Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-i . 07/2001
CuN 'WATER SECTION
AS:HEVILLE REGIONAL OFFICE

272819
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 El Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
PINEY KNOB RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JEFF JACKSON
Address PINEY KNOB RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 288-5661
Area Code Phone number
4. DATE DRILLED 04/30/03
5. TOTAL DEPTH: 34
6. DOES WELL REPLACE EXISIING WELL? YES ❑ NO
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 I5A NCAC 2C .0118.
9. YIELD (gpm): 12 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 5.52
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 34 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 22 To 34 Ft. 78M GRAVEL
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. 64.74A W. FROM RUTHERFORDTON.
RIGHT ON COVE RD. RIGHT ON PINEY KNOB RD,
1ST HOUSE ON LEFT PAST BOX #2050.
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 TTO/THE WELL OWNER
C GNAOF PON CONSTRUCTING THE WELL
I
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ce�Lir_ Ral4 Nf iJ
27699-1636 Phone No. [phone], within 30 days. GW-1IREV1 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
WELL CONTRACTOR COMPANY NAME Camyt G WP11 R Pnmp Ca Tnr
STATE WELL CONSTRUCTION PERh11T8 ASSOCIATED WQ PERMITS/
(if applicable) (if applicable)
276424
CERTIFICATLON /12 1 3 R
PHONE Nif)2M 453-7322
1. WELL USE (Check Applicable Box): Residential IP/)vlunicipalPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT, O ��
Nearest Town: County (.,( c)\Q „,„,_ _
c) Cn41�f �1�y
(Street Name, Numbers, Community, Subdivision .ot No...,, Zip Code)
3. OWNER:V\A 1,\At' p , '.`t'1c*.Q 2 7,] lQ
Address �(�( Qect orRoute mNo�q�
�A1i IW NW'`A 1 ( o2-25 1,R Cl
City or own State Zip Code
( )-
Area code- Phone numb:r
4. DATE DRILLED C - 11 l a
5. TOTAL DEPTH: ‘-‘1)
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 10
7. STATIC WATER LEVEL Below Top of Casing: Su 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): S METHOD OF TEST Sir
10. WATER ZONES (depth): �S(i
11. DISINFECTION: Type rh 1 nr i nt=
12. CASING:
Depth Diameter
From p To K%j' Ft.6 114
From To Ft.
From To Ft.
13. GROUT: Depth
From p 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 Material
From To Ft.
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
DR21 PVC
Material
Neat Cement
Method
Hand
Topograj�hic/Land setting
ORidge 2Slope OValley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
o 'o• Description
DEPTH
From To
95-
LOCATION SKETCH
Show direction and distance in miles from at least
two ate Roads or County Roads, Include the road,
numb s and common road names. -_
L
Slot Size \ -"'
in. O r-',
in,
r� rJ
16. REMARKS:
Material
,) I11OIHE*BYCERTIFYT ('HIS WELL WAS CONSTRUCIEDINACCORDANCE WITH 15ANCAC2C,WFI1
I �( 1 CONSTRUCTION STAND $AND THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
r11
j;, - ' SIGNATURE OF PERSCJN CONSTRUCTING THE WELL d DATE
I U
[submit the original to 4e Division of Water Quality, Groundwater Section,1636 Mail Service Center -Raleigh, NC
27699-16361'hona23o..[phone], within 30 days. GW-1 REV. 07/2001
iL F.I P Lis _. L.=RrF

276422
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Tames t.t camp p, Jr
WELL CONTRACTOR COMPANY NAME Camp, G WA11 R Pnmp C'n Tnn PHONE # 7R) 451-7 & izZ
STATE WELL CONSTRUCTION PERM]T# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
CERTIFICATION # 21 .18
1. WELL USE (Check Applicable Box): Residential Ed Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI
Nearest Town:
Dale Siyns . In left
(Street Name, Numbers, Community, Subdivision, ILot No., Zip Code)
3. OWNER: (� ry /,(J LL) cL y' Q S
Address j 4> PivtKwroci f?r.
( tct Routo No.)
12iAther c (c il'! � n Jai C, g 131
Ciry or Town State / Zip Code
( )-
auntyRU- I LeY fttY�
Area code- Phone number
4. DATE DRILLED Lo -04./ -D 3
5. TOTAL DEPTH: e 4 j
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IX
7. STATIC WATER LEVEL Below Top of Casing: /,, 1 PT.
(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 ith 15A NCAC 2C .0118.
9. YIELD (gpm)• S METHOD OF TEST p i -
10. WATER ZONES (depth): ' e 0
11. DISINFECTION: Type C'h 1 nr i nP
12. CASING:
Depth, i Diameter
From p To "7? Ft. z,_7 / 4
From To Ft.
From To Ft.
13. GROUT: Depth
From_ To 30 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.
Amount I /;), c.up5
Wall Thickness J
or Weight/Ft. Material
RDR.31 PVC
Material
N at Cement
Method
Hand
Topographic/Land setting 7�
ORidge ❑Slope ❑Valley 0Flat
(check appropriae box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic trap
(check box)
DEPTH DRILLING LOG
From To Formation Description
n 48 Cdcty , Sand
Lic 545 c'ortst)(dal-Qd 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.
t II
I n 4.a
16. REMARKS:
Material
-i Yf
7 Lf
Conic
p t/F
/Yn m5 Reel
1160 HEREBY CERTIFY THAT'Th114 WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C WFi r
COI`ISTRU TIONSTAPI:7ARDSI `n'IYwFh
II
THAT A COPY 0 THIS RECORD H EEN PROVIDED TO THE WFI 1 OWNER
„-- (L41 V-
I ATURE OF PERSON CONSTRUCTING THE WELL d /j DATE
Li
� v
Sublrltl the orjgtWattathe liivisio of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
' 27699-1636 Phone No. (919) T33-322 , within 30 days. GW-1 REV. 07/2001
7-11-D.3

276419
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
J2mes w. Camp, Jr CERTIFICATION 71 ii1
WELL CONTRACTORCOMPANY NAME ('amp' ¢ Wa11 R Ptrrnp Cr, Tnr PHONE #83?A) a'Y
STATE WELL, CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential - Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery O Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATIQNp
Nearest Town: A
(zr o/kJLi)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
3. OWNER:'-...? U§JQ
Address 1L4 \'( Q (^v
�)�� cot or Route NgE)
City or Town State �Al
( )-
3N le,
Zip Code
Area code- Phone numbep
4. DATE DRILLED 1
5. TOTAL DEPTH: y 0
-03
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: LI 0
(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- ME HOD OF TEST Si r
10. WATER ZONES (depth). 3 cop
11. DISINFECTION: Type rh 1 nri np Amount I (�
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From n__To \60- Ft.6 1/4 q nit 21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material
From q To 2 0 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.
Neat
Cement
16. REMARKS:
---
1 DO HEREBY CERTIFY THAT:T- SiWELL WAS CONSTRUCIED IN ACCORDANCE WITH 15A NCAC 2C WFi I
CONSTRUCTrONST4NDAR DS
Method
Hand
Topographic/Land setting
ORidge ❑Slope GJV'alley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From o FL�wormatiSn Description
3,-) LI o 5 02t,, .(.(tnL. t
J,OCATION SKETCH
7.7
Show direction and distance in miles from at St
two State Roads or County Roads Include theThad «,
numbers and common road names c_ ='
0
THAT A COPY 0 THIS RECORD HASEEN PROVIDED TO THE WELL OWNER
�8,�,71
-31U aSEI
ATURE OF PERN CONSTRUCTING THE WELL ✓ 7 DATE
SUbrilit the ongiaal 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

278189
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources,sI - Division of
Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMJ (print) .Ta. ' l es W CA Wk. p07. CERTIFICATION�}# AI S
WELL CONTRACTOR COMPANY NAME La »ip I.(�e 11 t Pin help 1 U.rJT�YI C . PHONE N (,Yabl 453-23r42
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential VMunicipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nsarest oWII:::
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER3.IA$sn hrr}U2er'-
1
County at Y, tin A%
Address GSi )
(Street or Route NS.)
City or Town State Zip Code
I ,)- — 1LbL
Area code- Phone number
4. DATE DRILLED -7 - l Q�
5. TOTAL DEPTH: `l
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO lia,
7. STATIC WATER LEVEL Below Top of Casing: I t FT.
(Use''+" if Above Top of Casing)
8. TOP OF CASING IS ) FT. Above Land Surface`
'Top orcasing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): ) METHOD OF TEST th
10. WATER ZONES (depth): \
11. DISINFECTION: Type C ). Amount (.f �A
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. M aerial
From 0 To kA Ft. 4 <� 1 A `1 \
From To Ft.
Ft.
From To
13. GROUT: Depth Material
Ftom 0 To ,20 Ft. heat Cewiertt
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.
Method
y\0. Kc1
16. REMARKS:
/ Topographic/Land setting
Ridge ❑Slope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH RILLING LOG
From ` To FFormation es 'ption
3 0
LOCATION SKETCH w o
Show direction and distance in miles from attest c
two State Roads or County Roads. Ini ude WO road' ^
numbers and comm(
on road names.
CD
W
\di
AP-
1 DO HEREBY CERTIFY THAT THIS WFl I WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS CORD HAS BEEN PROVIDED TO THE WM T OWNER
SIGWATURE OF PERSON CONS
Submit the original to the Division of Water Quality, Groun
27699-1636 Phone No. [phone], within 30 days.
- �:-=1t1 TE
hit
Section,Yb3S-Miuirservir b er - Raleigh, NC
i -1 REV. 07/2001
L Llf W
i_J
GROUNDWATER SECTION

278184
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James 1.1- Carvr, Tr CERTIFICATION# 71 3R
WELL CONTRACTOR COMPANY NAME ramp' q WP11 R Pttmp f`rL Tnr PHONE #a)7R) 451_7122
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential CIV_/ MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELLLOCATIKt1 -4, df K , e t
Nearest Town: j U 1 e V Y /c'N County u eY eV
Lot 35 / a A1ft l e Prst H u. l'j-A
(Street Name, Numbers, Community, Lot o. Zi Code) II tyP
3. OWNER: C41ay)e5 L.
Address UI43 3)ecry )r,l)oui Pi
!A� I5 Ci1(Street or YchVA
7Rou[e p/ %020 4
City or Town State Zip Code
Area code- Phone number
4.DATE DBE iED 7-/L-U3
5. TOTAL DEPTH: &DS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO k1
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "f" 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): 15 METHOD OF TEST a i r
10. WATER ZONES (depth): a'yo 5 fa
11. DISINFECTION: Type rh 1 nri na
12. CASING:
Depth Diameter
From p To Ian Ft. 6 1 / 4
From_ To Ft.
From _ To Ft.
13. GROUT: Depth
From p 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 Material
From To Ft.
From To Ft.
Amount IAA cups
Wall Thickness
or Weight/Ft. Material
SDP21 PVC
Material
Neat Cement
Method
Hand
Slot Size 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)
pFPTH DRILLING LOG
From To Formation Description
n lao clay dr'rj"
1 ao Goy ';otise II ria7e,ri 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 [tames. o
CO
c�
tV
c4 -'14A
t,
0
i.�
4?, f (.
O rnz
cam',
ry G
4, Le.'!
�\U
16. REMARKS.
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS PROVIDED TO THE WELL OWNER
ay/4ed /-2!-D5
S[GNATURE OF PERVN CONSTRUCTING THE WELL 1 DATE
. `l
Submit the original to the Division of Water Quality, Grogr�dtitar Se1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. r
it:donoR' 9W-1 REV. 07/2001
u V
L

278183
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division b*poff Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM$ (print) -3- vn e 6 f�14• `-a. T CERTIFICATION #ai.3e
WELL CONTRACTOR COMPANY NAME LA *TS�e 1I t YU Wtp I D.rrOTYIC . PHONE #InA `r53-13a'(
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential4unicipal/Public 0 industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT ON:
....a_
ar s Town .9?t g County t t✓yv^%
Utt
(Street Name, Numbers�ubdilvisiionc , Lot No., Zip Code)
3. OWNER: 0 p
Address a \ S � L`ii ,c �-lU\.P.l'�1mn
Ai.. (Strew tutu No.) oi go t
City or Towu SureZip Code
F ��s arm -
Area code- Phone number
4. DATE DRILLED t1
5. TOTAL DEPTH: �Uk
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO tia,
7. STATIC WATER LEVEL Below Top of Casing: I % 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 15A NCAC 2C .0118. r•� ���
9. YIELD (gpm): (3 METHOD OF TEST W\1�
10. WATER ZONES (depth): to au
11. DISINFECTION: Type C VJt
12. CASING:
Depth Diameter
From 0 To 9. U Ft. U Cif
From To Ft.
From To Ft.
13. GROUT: Depth
From O To ,2
From To
14. SCREEN: Depth
From To
From_ To
15. SAND/GRAVEL PACK:
Depth
From To
From To
Amount CA.t,C
Wall Thickness
or W i t/Ft.Material numbers and common road
s4v 21/4 1' xwu
Material Methpqd
Ft. heat Cemevrt Inaykd
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
16. REMARKS:
Size Material
Ft.
Ft.
// Topographic/Land setting
GlRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOCI
Fgfmatipn Description
DEPTH
From To
0 86
5SD
L
Aud
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
es.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC1ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS R,CORD HAS BEEN PROVIDED TO THE WELL OWNER
03
DATE
4.471-e.A1— /J L
SI ATURE OF PERSON CONSTRU 11 tl
Submit the original to the Division of Water Quality, C 1{ tcjriatei_Secdon,.1.636-Mall
27699-1636 Phone No. [phone], within 30 days. '-'{
Cb Center - Raleigh, NC
j GW-1 REV. 07/2001

278181
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM$ (print) .T4 VIA e5 "c" • Ca. WI . CERTIFICATlI�ON # "Jae
WELL CONTRACTOR COMPANY NAME LgHteS elf d- Pup I D. iT1C • PHONE # fad! 453-73a2
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Cr Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATk,ON:
L
T `"\-(),M.11
&eet Name, Numbers,tommunity, Subdivision, Lot No., Zip Code)
County 1UAX O.,kMv'
3. OWNER:n &Ai --
Address \k vld IQAN� S
(S
City or Town
( gf \ C
Area code- Phone number
4. DATE DRILLED L • aG U 3
5. TOTAL DEPTH: 'A b S
6. DOES WELL REPLACE EXISTING WELL? YESt-t10 0
7. STATIC WATER LEVEL Below Top of Casing: f/ f) 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): E METHOD OF TEST CLAN.
10. WATER ZONES (depth): % 0 0
11. DISINFECTION: Type (1 Q Amount V. ""V' /
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.Material\
FromQ_To �() Ft.� ,adx�4
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To ,0 Ft. heat Celt/lent klaJ
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.
eet or Route No.) 71oU
'NNVNC 2
Zip Code
16. REMARKS:
Topographic/Land setting
Tdge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING I.00{
F6rma3on Description
PEPTI-Z
From To
Qo
qo
Los
TION S
Show direction and distan
two Sta t1
numbers and common r
O r�
H w
o..s.Includefje oad.-
ad names.
❑
0H,Stuti fad'
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC1bD IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS CORD HAS BEEN PROVIDED TO THE WELL OWNER
. Grp.
SITURE OF PERSON CONtsalt slftrlY}-lli WEI;.L ATE
�er
SeeltWon,163b71iai S—e—S'C a ter -Raleigh, NC
Division of Water Quality, Grou
Submit the original to the Di
27699-1636 Phone No. [phone], within 30 days.
W-1 REV. 07/2001

278680
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 ® MunicipaUPublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH
JERICO LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LEE WALKE
Address JERICO LANE
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) - 286-3597
Area Code Phone number
4. DATE DRILLED 08/28/03
5. TOTAL DEPTH: 605
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/or below land surface requires a
variance in accordance with I SA NCAC 2C .0118.
9. YIELD (gpm): 1 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 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.
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. 64/74A W. FROM RUTHERFORDTON.
LEFT ON JERICO LANE. 3/10 MILE ON RTC LOT
#22. W
Vl errl rn
crn
¢
Do
-0
IV ,nz
ma
t "
0 o
Z
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
� �C� -'- ,-) 2-6 _ 3
SIG Tit OF PERSON CONSTRUCTING THE LL 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

278698
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 Z Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: UNION MILLS
OWENS CHAPEL RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JAMEL CONLEY
Address 458 OWENS CHAPEL RD.
(Street or Route No.)
UNION MILLS N C 28167
City or Town State Zip Code
(828) — 2874961
Area Code Phone number
4. DATE DRILLED 08/11/03
5. TOTAL DEPTH: 45
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 25 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 RUTH
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 45 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 25 To 45 Ft. 78M GRAVEL
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. #221 N. FROM RUTHERFORDTON. RT. ON
OWENS CHAPEL RD. APPROX. 1/2 MILE ON RT.
(458 ON SIGN AT DRIVE)
9'vZ lid 1- d3S CO
c
0
n�
on'
Zm
PG
>0
-4o
rrnn
rc*m
tz
r+m
C5
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS UCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
C Dom.
F PEIjS( CON
ce—// — 0
UCTWG THE WELL - DATE
Submit the original to the Division of Water Quality, r tuiik$vaierSeeti0e,-1636-Mai+
27699-1636 Phone No. [phone], within 30 days. ")
J LI
ce Center —Raleigh, NC
GW-1 REV. 07/2001

270873
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jam e
Cam, Jr
WELL CONTRACTOR COMPANY NAME ('ampc Wa11 R Primp Crt
CERTIFICATION # 71 "3 8
Tnc PHONE #82A) A5"I-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential EY Municipal/Public ❑ industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 - Other 0 If Other, List Use
2. WELL LOCATIio\N:
Neares To : r LIR/WI County
t 5- Ric1tarcdsttt (K.
(Sucet Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER 2NAMT •'Yv•sP4PP.-
Address t h cs U 5 & LI LL C>-
(Street or Route No.)
City or Town State Zip Code
(' 2�- 8q -35os
Topographic/Land setting
❑Ridge ❑Slope (29a11ey ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check bar)
DRILLING LOG
Otte on Description-_
Area code- Phone number 4. DATE DRILLED l - 2) . D l U C &Ara
5. TOTAL DEPTH: I 14
6. DOES WELL REPLACE EXISTING WELL? YEAS ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: A (7 FT
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
`Top of casing terminated atlor below land surface requires a
variance N accord& ce lib 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST 4;
10. WATER ZONES (depth): 19 0
11. DISINFECTION: Type ('h 1 nr i np
12. CASING:
Depth Diameter
From 0 To - S Ft. 6 1/ 4
From To Ft.
From To Ft.
13. GROUT: Depth
From—p To 20 Ft. Neat Ccmcnt
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From_ To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
SDR-11
Material
Slot Size
in.
in.
Material
Method
Iland
Material
From To Ft.
16. REMARKS:
7 AQ Y CERTIFY THAT T
CMS
S1
DEPTH
From To
n qS
r
N
JfCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
a1\
WFI 1 WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WFI I
THAT A COPY 0 THIS RECORD H;BEEN PROVIDED�TO THE WELL OWNER
fjAltURE OF PERS N CONSTRUCTING THE WELL / / DATE �_ I ()
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

270869
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James ru Camp, Jr_ CERTIFICATION # 21 3
WELL CONTRACTOR COMPANY NAME Camp' c Wa11 E Pinup ('n Tnr PHONE #$2R' 4'S —7322
STATE WELL CONSTRUCTION PERMT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential kr-Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: N
pabbinsvlll e omrn.
(Street Name, Numbers, Community, nSubdivision, Lot No Zip Code)
3. OWNERTP� ► l 5
Address (Q hl L ( 1
(Speer or Route No.)
C Alit., 14
County] tt j
)010
City or Town State Zip Code
(C(QSO- tc G 1 `% . 4
Area code-. Phone number
4. DATE DRILLED 0 3
5. TOTAL DEPTH: 5'4 S7
6. DOES WELL REPLACE EXISTING WELL? YES U NO Iftl
7. STATIC WATER. LEVEL Below Top of' Casing: LiFT.
(Use '4" 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): t METHOD OF TEST lr i r
10. WATER ZONES (depth): 3 0 0
11. DISINFECTION: Type rh 1
12. CASING:
Depth
From 0 To (QC' Ft.
From_ To Ft
From To Ft.
nri na Amount 2�,1.
Wall Thickness
Diameter or Weight/Ft. Material
6 1/4 SDR21 PVC
13. GROUT: Depth Material Method
Frorn n To 24 Ft. Ne-'t Cement Nand
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.
Slot Size
in.
in.
Material
Material
Topographic/Land setting
❑Ridge Q2`;lope. ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRIT,LING LOG
From To Forman Description
lo AA
tic' 3 4,I�'Y.,i
r.)
Lii
0
LOCATION SKETCH ry
Show direction and distance in miles from at Est
two State Roads or County Roads. Include the road
numbers and common road names.
IV
16. REMARKS: N
1 , Y CERTIFY THAT? THIS"
NS3dt(CTIbN STANDARDS, ANC
.. � SIGN
Submit the original to the Divisioh of
27b99-1636 Phone No. (9I9) 733.3221, with
WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFI r
T A COPY 0 THIS RECORD HAS EEN PROVIDED TOTHEWELL OWNER
CliYi'IP,d /wo ,�,,,,,'7
OF PERS N CONSTRUCTING THE WELL 7
:74-/6 • o3
DATE
ater Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
n 30 days. GW-1 REV. 07/2001

From: Scott Gantt To:
Date: 4/6/2003 Time: 10:48.52 PM Page 10 of 10
WELL CONSTRUCTION RECORD
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 WC) PERMIT #
(if applicable) Of applicable)
1. WELL USE (Check Applicable Box) : Residential ❑ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: LAKE LURE
LOT 190 PHEASANT ST. RIVEREND RESORT
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER ALAN TANNER
ADDRESS 112 COCOPLUM CIRCLE
(Street or Route No.)
ROYAL PALM REACH
City or Town
561-798-2729
FI.
State
Area Code - Phone Nmnber
4. DATE DRILLED 3/25/03
5. TOTAL DEPTH 220
6 DOES WILL REPLACE FXIS"PING WE1.1.7
7. STATIC WATER LEVEI. Below Top of Casing:
33411
Zip Code
YES ❑ NO D
60 P..I.
(Use`s" If Above Top of Casing
8. TOP OF CASLNG IS 2 FT. Above Land Surface's
`Top of ea ing tenni ned at/or below land surface requires a variance in
accordance with 15A NCAC 2C.0118
9. YIELD (pm): 8 METHOD OF TEST ARDM
to. WATER ZONES (depth): 160
it. DISINFECTION: TYPE HYPOCHLORITE Amount
12. C.ASLNG:
From 0
1s. GROUT
orn 0
Depth
To 63 Ft.
Depth
To 20 Ft.
14. SCREEN
Depth
From NA To
15. SAND/GRAVEL PACK:
Depth
From NA To
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
Latitude'Longitude of well location
35.25.254 ' 82.09.672
(degrees/minutes'attonds)
Latitude/longitude source. E GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Desetiption
0 55 Clay
55 220 Consolidated Rock
5
Wall Thickness
Diameter or Weight:Ft. Material
61/4" SDR21 PVC
or LOCATION SKETCH
Diameter
Ft.
Ft,
Material Method
GRAVEL MIX GRAVITY
in.
Size
Slot Size Matei
laterial
Show direction and distance in miles from at least
two State Roads or County Rends. Include the road
numbers and conunon road names_
O
W
L37831-
PHEASA\CST
HWY 64/74
BILL'S CREEK RD
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
Submit Otrorigtnafl flifl si
27699-1630 Phone No.'(919)733!t
3'26/03
SIGNATURE OF PERSON C'ONSTRUC'TINO TILE WELL
Date
ater Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
vithin 30 days.
GW-1 REV. 0- 2001

From: Scott Gantt To'.
Date: 4/6/2003 Time: 10:48:52 PM Page 8 of 10
271'762
WELL CONSTRUCTION RECORD
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)
I. WELL USE (Check Applicable Box) : Residential ❑ municipal D Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest torn: SPINDALE
621 CROWE DAIRY RD
County RUTHERFORD
(Street Name, Numbers. Community, Subdivision, Lot No.. Zip Code)
3. OWNER CHAD FARR
ADDRESS 621 CROWE DAIRY RD
(Smet or Route No.)
FOREST CITY NC
City or Town Slate
828-245-2709
Area Code - Phone Nurnber
4. DATE DRILLED 3/ 12/03
5. TOTAL DEPTH 220
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC W.AII-:R LEVEL. Below Top of Casing:
28043
Zip Code
YES ' NO El
55 FT.
(Use 1fAbmz Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface"
,Cop ofcauig imnumrtd at/or baow hind surface regimes a variance iu
accordance with 15A NCAC 2C0118
9. YIELD (gpm): 5 METHOD OF TEST ARDM
to. WATER ZONES (depth): 150
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑L Flat
Latitude; Longitude of well location
35.19.117 / 81.55.302
(degrees/minutes/seconds)
Latitude/longitude source: El GPS ❑ Topographic map
DEPTII DRILLING LOG
From To Formation Description
0 72 Clay
72 220 Consoidated Rock
t I. DISINFECTION: TYPE HYPOCHLORITE Amount 5 0: LOCATION SKETCH
12. CASING: Wall Thickness Show direction and distance in miles from at least
Depth Diametev or WeighUFt. Material two State Roads or County Roads. Include the road
From 0 To 80 Ft- 6 1/4 " SDR 21 PVC numbers and common road names. p
11 GROUT: W
Depth Material Method -0.
From 0 To 20 Ft. GRAVEL MIX GRAVITY ^�
14. SCREEN
Depth Diameter
From NA To Ft.
15, SANTD/GRAVEL PACK:
I I
Slot Size Material
in. in. 1 100 YDS
Depth Size Material
From NA To Ft,
16_ REMARKS:
CROWE DAIRY RD
BIJRCH HUTCHINS RD
J
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.
3.14/03
SIGNATURE OF PERSON CONSTRUCTLNG TILE WELL Date
Submit the original to the Division of Water Qual tv, Groundwater Section, 1636 Mail Service center - Raleigh, NC
27699-1636 PluiliiiNb(91?)731T-'3221, slituini3O cL
I-„ ✓7 Irr. ;1 .
GAV-I REV_ 07.2001

From: Scott Gantt To:
Date. 4/6/2003 Time: 10:48:52 PM Page 6 of 10
2717G{7
WELL CONSTRUCTION RECORD
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,W ELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box) : Residential ❑ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
s. WELL LOCATION:
Nearest town: RUTHERFORDTON
428 ELLIOT RD EXTENSION
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER JEFF LEE
ADDRESS 428 ELLIOT RD EXTENSION
(Street or Route No_)
RUTHERFORDTON
City or Toms
828-287-3972
NC
State
Area Code - Phone Number
4. DATE DRILLED 3/4/03
5. TOTAL DEPTH 200
28139
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES Q NO D
7. STATIC WATER LEVEL Below Top of Casing: 78 FT.
(Use "*" If Above Top of C
8. TOP OF CASING IS 2 FT. Above Land Surface"
'Top of casing tertninated atior below land surface requires a variance in
ascendance with 11A NCAC 20.0118
uis. )
9. YIELD (gpna). 7 METHOD OF TEST ARDM
10. WATER ZONES (depth): 150
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley NI Flat
Latinlde/Longinade of well location
35.27.156 / 82.03.145
(degrees/minutes seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
From
0
DEPTH
To
85
DRILLING LOG
Formation Description
Clay
85 200 Consolidated Rock
11. DISINFECTION: TYPE HYPOCHLORITE
12. CASING:
From 0
U. GROUT:
Depth
To 94 Ft.
Diameter
Amomrt 4 or
Wall Thickness
or Weiglil,FI. Material
SDR21 PVC
Depth
From 0 To 20 Ft.
14. SCREEN
Depth Diameter
From NA To FI. in.
1s. SAND/GRAVEL PACK:
Depth Size
From NA To Ft,
16. RENIARKS:
Material Nlethod
GRAVEL MIX GRAVITY
Slot Size Material
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
PARRIS RD
200 YDS
ELLIOT RL) ENT
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TIIIS RECORD HAS BEEN PROVIDED TO TILE WELL OWNER.
36rhonl2_No.'It91)))1733 32.
L.
3/8.03
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
r Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
in 30 days.
GW- I REV. 07/2001

From: Scott Gantt To: Date'. 4/6/2003 Time. 10'48'52 PM
271'759
Page 5 of 10
WELL CONSTRUJCTION RECORD
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 #
(if applicable)
1. WELL USE (Check Applicable Box) : Residential ❑ Municipal ❑ Industrial ❑ Monitoring ❑
Recovery D Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest tom: M.ARION
1000 OAKS SUBDIVISION LOT 2
Courtly MCDOWELL
(Street Name. Numbers. Community, Subdivision, Lot No. Zip Code)
3. OWNER HORION HOME S OF RUIHERFORDTON
ADDRESS 342 IIWY 74A BY-PASS
(Street or Ronne No.)
RUFHERFORDTON
City or Town
828-287-3366
NC
State
Area Code - Phone Number
4 DATE DRILLED 2/25/03
5. TOTAL DEPTH 220
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing
(Use T" If Above Top ofC
8. TOP OF CASING IS 2 FT. Above Land Surface"
'Top ofeasaeg terminated aeor below land surface requires a valiance in
accordance with 15A NCAC 26.0118
28139
Zip Code
YES ❑ NO CI
2 FT
9. YIELD (epm): 6 METHOD OF TEST ARDM
1o. WATER ZONES (depth): 210
n. DISINFECTION: TYPE HYPOCHLORITE Amonnt 7
12. CASING:
Depth Diameter
From 0 To 37 EL 61/4 "
13. GROUT:
ASSOCIATED WQ PERMIT #
(if applicable)
Agricultural ❑
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
Latitude/Longitude of well location
35.39.610/ 82.05.918
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Desenption
0 25 Clay
25 220 Consolidated Rock
Wall Thickness
or Weight/Ft. Material
SDR 21 PVC
oz
Depth Material Method
From 0 To 20 Pt. GRAVEL MIX GRAVITY
14. SCREEN
Depth
From NA To
15. SAND/GRAVEL PACK:
Depth
From NA To
16. REMARKS:
Diameter
Ft.
Size
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_
HWY 70
Slot Size Material
in. HENRY McCALL RD
Material
CO
c
OLD GRF,F.\+FF, —�
RD c J1 E
100i) OAKS SUB
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELI.
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
Sub
't271699 1f36 Efhong No,'419l13
3/4/03
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
Voter Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
within 30 days.
GW.I REV. 07/2001

From: Scott Gantt To: Date'. 4/6/2003 Time. 10.48:52 PM
Page 4 of 10
271758
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GANEF 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 ❑ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
z. WELL LOCATION:
Nearest town: LAKE LURE
LOT 297 WILDCAT BLVD. RIVERBEND ACRES
County RULHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER RIDGELINE DEVELOPMENT CORP
ADDRESS 112 COCOPLUM CIRCLE
(Sueet ar Rune No_)
ROYAL PALM BEACH
City or Town
561-798-2729
FL
State
Arca Code - Phone Number
4. DATE DRILLED 2/25/03
e. TOTAL DEPTH 220
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing:
33411
Zip Code
YES ❑ NO 0
80 FT.
R r "," if Above Top of Cain
8. TOP OF CASING IS 2 FT. Above Land Surface*
"Top of easing terminated at'or Wow land svface requires a variance in
acamdm,oe with ISA NCAC 2C 0118
9 YIELD (gpm): 15 M1IISI'HOD OF '!Esf
M. WATER ZONES (depth): 215
iI. DISINFECTION: TYPE
12. CASING:
ARUM
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley E Flat
Latitude/Longitude of well location
3525.160/ 82.09.518
(deioees/minutestseconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 40 Clay
40 220 Consolidated Rock
HYPOCFILORITE
Depth Diameter
From 0 To 47 Ft. 61/4"
IT GROUT:
Amount 5 0z LOCATION SKETCH
Wall Thickness Show direction and distance in miles from at least
or Weight'!'I. Material
SDR 21 PVC
Depth
From 0 To 20 D.
I1. SCREEN
Depth Diameter
From NA To Pt
Is. SAND/GRAVEL PACK:
Depth
From NA To Ft,
Size
Material
GRAVEL MIX
Method
GRAVITY
Slot Size Material
?Iaterial
i6_ REMARKS:
two Stale Roads or County Roads. Include the road
numbers and common road names.
WILDCAT RD
300 YDS
O
PHEASANT DR �.
CJ
H'V1 64/74
BILL'S CREEK RD
01
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WI -EH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER_
3,/1/03
SIX iTTithe{PTigi�ittl toQ th ivi bn a
2�A991y,63APhoJNd. (90) 7i3 , •
r
J
SIGNATURE OF PERSON CONSTRUCTING THE WELL Dale
r Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
lin 30 days.
GW-1 REV. 07.2001
Li
et

From: Scott Gantt To: Date: 4/62003 Time. 10.48.52 PM
Page 3 of 10
271757
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT CANTT CERTIFICATION # 2=84
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable)
1. WELL USE (Check Applicable Box) : Residential ❑
Recovery ❑ Heat Pump Water Injection ❑
2. WELL LOCATION:
Nearest town: LAKE LURE
LOT 274 WILDCAT BLVD. RIVERBEND ACRES
(if applicable)
Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring
Other ❑ If Other, List Use:
County RUTHERFORD
(Street Name. Numbers, Community. Subdivision. Lot No.. Zip Code)
3. OWNER RIDGET.INE DEVELOPMENT CORP
ADDRESS 112 COCOPLIIM CIRCLE
(Street or Route No.)
ROYAL PALM BEACH
Ciry or town
561-798-2'29
FL
State
Area Code - Phone Number
4. DATE DRILLED 2/21(03
5_ ToFAI. DEPTH 240
6. DOES WELL REPLACE EXISTNG WELL?
7. STATIC WATER LEVEL Below Top of Casing:
33111
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley El Flat
Latitude/Longitude of well location
35,25.148 / 82.09.510
(degrees/minutes/ seconds)
Latitude/longitude source: E GPS ❑ Topographic map
DEPTH DRILLING LOG
From --- To Formation Description
Zip Code 0
YES ❑ NO D
120 ET.
(Use `+" If Above Top of Casing)
s. TOP OF CASNG IS 2 FT. Above Land Surface'
'Tap of easing terminated Eor below land surfacercgnucs a variance in
accordance with 15A NCAC 2C.0I18
9. YIELD (gpm). 30 METHOD OF TEST ARDM
10. WATER ZONES (depth): 235
u. DISINFECTION: TYPE HYPOCHLORITE Amount 4
12. CASNG:
From 0
11 OR Ot fr.
Depth Diameter
To 55 FL 61/4"
Depth
From 0 To 20 FL
ILSCREEN
Depth
From NA To
15. SAND/GRAVEL PACK:
Depth
From NA To
16. REMARKS:
50 Clay
50 240 Consolidated Rock
Wall Thickness
or Weight/Ft. Material
SDK 21 PVC
O,.
Diameter
Ft.
Pt,
Size
Material Method
GRAVEL MIX GRAVITY
Slot Size Material
Material
LOCATION SKFTCH
Show direction and distance in miles from at least
two State Roads or County Roadls. Include the road C
numbers and common road) names.
WILDCAT RD
300 YDS
J
PHEASANTDR
co
HWY 64.74
BILL'S CREEK RD
01
c)242
G
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WLTH 15A NCAC 2C, AVELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
Sttbrfilt tl{gari tIal tt tl\PiDiviisio4
2'00-i6.36131 b-N0, O14)Ti].
L-
3 1/03
SIGNATURE OF PERSON CONSTRUCTING THE. WELL Date
ter Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
thin 30 days.
GW-1 RE1'. 07,2001

From: Scott Gantt To:
Date: 4/6/2003 Time: 10:48:52 PM Page 2 of 10
271 56
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GAN'IT CERTIFICATION #2=84
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 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: RUTIIERFORDTON
LOT 79 COVE CREEK RD
County RUTIIERFORD
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER WILKINS HONIE CENTER
ADDRESS 1920 HWY 74 BYPASS
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
Latitude 'Longitude of well location
35.25.662 / 82.06.584
(degrees/minutes/seconds)
Latitude/longitude source: ❑ CiPS ❑ Topographic mop
(snaior Rome No) DEPTH DRILLING LOG
FOREST CITY NC 28043 From To Formation Description
City or Town State Zip Code 0 60 Clay
828- 286-3647
Area Code - Phone Nrunber
4 DATE DRILLED 2/19/03
5. TOTAL DEPTH 220
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing:
YES ❑ N0
70 FT.
(Use "+" IFAbavc Top of Casing)
B. TOP OF CASING IS 2 FT. Above Land Surface'
*Top of casing tenninaied ado* bdow Iv,d surface require* a vaia,a m
accmdanac with ISA NCAC 22C.0118
9. YIELD (gpm): 8 METHOD OF TEST ARDM
10_ WATER ZONES (depth): 156
60 220 Consolidated Rock
W
v
11. DISINFECTION: TYPE IIYPOCIILORITE Amount 5
12. CASING: Wall Thickness
Depth Diameter or Weight'FL Material
From 0 To 68 F1 61/d" SDR 21 PVC
13. GROUT:
From 0
Depth
To 20 FI.
14. SCREEN
Or
Material Method
GRAVEL MIX GRAVITY
Depth Diameter Slot Sire Material
From NA To Ft. in. in.
15. SAND/GRAVEL PAC'Ii:
Depth Size Material
From NA To Et.
16. RENLARES''
LUCANION SKETCH
Show direction and distance in miles from at least 3
two State Roads or County Roads. Include the roads
numbers and common road names.
MI
COVE CREEK RD
H't\ 7 64'74
J
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RFCORD HAS REEN PROVIDED TO THE WELL OWNER.
3'19'03
En
SIGNATURE OF PERSON CONSTRUCTLNG THE WELL Date
er Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
9+3,6301Plio*aN'oil(911NJ 7.53-;32 },xnilfin 30 days.
f•
—
GW-1 RF„"�0-t2CEd

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: LAKE LURE
BUFFALO CREEK RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip
3. OWNER: ROBERT D. MILLER
Address 1939 BUFFALO CREEK RD.
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
(828)- 625-9218
Area Code Phone number
4. DATE DRILLED 03/24/03
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES ® NO 0
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): 8 METHOD OF TEST ARD
10. WATER ZONES (depth):
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
From 0 To 20 Ft. QUIKRETE
From _ To _ Ft.
I4.SCREEN: Depth
From _ To
From To
County RUTH
Code)
Method
POURED
Diameter Slot Size
Ft. _ in. _
Ft. _ in. _
15. SAND/GRAVEL PACK:
Depth
From _ To
From To
16. REMARKS:
Size Material
Ft.
Ft.
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: ❑ 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. #64/74A W. FROM RUTHERFORDTON.
RT. ON BILL'S CREEK RD. LEFT ON BUFFALO
CREEK RD. RT. ON BUFFALO CREEK & OVER
BRIDGE PAST COUNTRY CLUB. APPROX. 3
MILES ON LEFT (1939 ON BOX -RED A -FRAME
HOUSE) _
CO
CO
:- o
UD
N
N
O )
0
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
i coN Rt T1f bN „STANDAR\AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
L'T>�Z� C.
3/� V/h,3
SIGMA OF PE SON CONSTRUCTING THE WE
i
Subinit the original to the Divisio of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. (919) 733-3 21, within 30 days. GW-1 REV. 07/2001
DATE

From 0
From
From
13. GROUT:
From 0
From _
14.SCREEN:
From To _ FL _
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size
From To _ Ft. _
From To Ft.
16. REMARKS:
271543
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: MOORESBORO
GOLDEN EAGLE DR.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LARRY DALJEV
Address GOLDEN EAGLE DR.
(Street or Route No.)
MOORESBORO NC 28114
City or Town State Zip Code
(828) — 248-1812
Area Code Phone number
4. DATE DRILLED 03/31/03
5. TOTAL DEPTH: 425
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): 25 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 11
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
To 50 Ft. 6-1/4" SDR.21 PVC
To Ft.
To FL
Depth Material
To 20 Ft.OUIKRETE
To _ Ft.
Depth Diameter Slot Size
in.
in.
Material
Method
POURED
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
BY-PASS 74 E. FROM FOREST CITY. EXIT RT.
ON HARRIS/ELLENBORO/HENRIETTA RD. LEFT
ON DOBBINSVILLE RD. GO APPROX. 2/10 MILE
ON GOLDEN EAGLE DR. LOT 6 & 8, 3/10 MILE ON
RIGHT.
o
w
-n ;__
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS CTION STAND, AND THAT�A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/Ora.—r•—; - 3 /— l3�
SIGNAL OF PERSON CONSTRUCTING THE` E LL DATE
L
Sullnit the original to the Divisio
276 1636 Phone No. (9191733-;
of Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001

'11a41
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERIIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PTTTMAN 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: BOSTIC
WATERS RD.
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: ANGIE & CHUCK WILSON
Address WATERS RD.
(Street or RouteNo.)
BOSTIC NC 28018
City or Town State Zip Code
(828) — 245-8194
Area Code Phone number
4. DATE DRILLED 03/12/03
5. TOTAL DEPTH: 245
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
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): 12 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
, Zip Code)
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.
From To Ft.
16. REMARKS:
Topographic/Land setting
0 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
BUS. 74 E. FROM FOREST CITY. LEFT ON
BOSTIC/SUNSHINE HWY. LEFT ON TONEY RD.
LEFT ON WATERS RD. 1ST DRIVE ON RIGHT.
0
G)
—o
77-3
—o
N
rr
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
'COzir J CTION STANDAR ,SND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
4 ' ���,C'
SIGNAOF PERSON CONSTRUCTING THE LL
Subthit the original to the Division
276994636 Phone No. (919)' 33-3:
..3-/cR-0 3
DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC
21, 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) 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)
271547
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: LAKE LURE
KINCADE DR.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ED YOUNGER
Address KINCADE DR.
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
(828) — 6254905
Area Code Phone number
4. DATE DRILLED 02/22/03
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 305 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 I5A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 7.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 40 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 Material
From _ To _ Ft. _ in. _ in.
From To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To _ Ft.
From To Ft.
County RUTH
16. REMARKS:
Method
POURED
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 ❑ 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.
RT. ON BILL'S CREEK RD. LEFT ON BUFFALO
CREEK RD. LEFT ON WHITNEY BLVD. RT. ON
KINCADE DR 1/4 MILE ON LEFT.
0
w
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
COMST1?-IIL IUN arA AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-- i�-?./ram /9 a /�.
SIf1�9A-URE OF PERSON CONSTRUCTING WELL DATE
Submit the original to the Divisi n of Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC
27699-1636 Phone No. (919) 733 221, 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) NEIL CRAFT CERI IHICATION # 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: LAKE LURE1 County RUTH
LAUREL MTN. ESTATES LOT #17
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: ED YOUNGER
Address LAUREL MTN. ESTATES
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
(828) — 625-4905
Area Code Phone number
4. DATE DRILLED 02/21/03
5. TOTAL DEPTH: 245
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 12)
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 LEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: TyI
12. CASING:
Depth
From 0 To 56
From To
From
13. GROUT:
From 0
From
14.SCREEN:
From
From
Zip Code)
e CHLORYTE Amount 6
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 8" 350 WALL GALV.
Ft.
To Ft. _
Depth Material
To 20 Ft. QUIKRETE
To Ft.
Depth Diameter Slot Size
To _ Ft. in.
To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From _ To Ft. _
From To Ft.
16. REMARKS:
Material
Method
POURED
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. #64/74A W. FROM RUTHERFORDTON.
RT. ON BILL'S CREEK RD. LEFT ON BUFFALO
CREEK RD. LEFT ON WHITNEY BLVD. RT. ON
LAUREL MTN. ESTATES. LOT #17, 7/10 MILE ON
LEFT.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
RUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
:II ���2����Cf�/ C.7zJYIp_� d /— 6
SISNA1" O ERSONCONSTRUCTING WELL DATE
SuMnit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
2769p-1636 Phone No. (919) 733-3 21, within 30 days. GW-1 REV. 07/2001