Ru 2 CY2003

2693'71-
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1 WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery D Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
JOSHUA DR
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CHARLIE BROOKS
Address JOSHUA DR.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(8) — 286-3849
Area Code Phone number
4. DATE DRILLED 02/21/03
5. TOTAL DEPTH: 51
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO M
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. I5A NCAC 20 .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth): _
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 9.2
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 24" CEMENT
Ft. _
Ft.
Material Method
Ft. CEMENT POURED
Ft.
Diameter Slot Size Material
Ft in. in.
12. CASING:
Depth
From 0 To 51
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 31 To 51 Ft. 78M
From To Ft.
16. REMARKS:
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
cumber and common names
ROCK RD. FROM RUTH. APPROX. 5 MILES. RT.
ON JOSHUA DR. 3RD LOT ON RT.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
TerWSTR,I ICTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
NA OF P CONSTRUCTING THE WELL DATE
Submit the original to'ttt
27699-1636 Phone Nd. (919
e s ,-9 ,), /- O 3
ivision of Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC
733-3221, within 30 days. GW-1 REV. 07/2001

269370
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERr[h1CATION # 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
DAISY LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MARIE LOWERY
Address 156 DAISY LANE
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code
8( 28) — 248-1683
Area Code Phone number
4. DATE DRILLED 02/25/03
5. TOTAL DEPTH: 55
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 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 55 Ft. 24" CEMENT
From To _ Ft.
From To _ Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To Ft.
14.SCREEN: Depth Diameter
From To _ Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size
From 40 To 55 Ft. 78M
From To Ft.
16. REMARKS:
Slot Size Material
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
BUS. 74 E. FROM FOREST CITY. LEFT ON
BOSTIC/SUNSHINE HWY. RIGHT ON SALEM
CHURCH RD. LEFT ON DAISY LANE. APPROX.
2/10 MILE ON RIGHT.
r
rl
0
ERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
bOTRUCtIO1{S) S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
KTi
��ATT OF B> N 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

269369
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
LEWIS RD. LOT #8
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ROB FETTEROLF
Address LEWIS RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 286-0439
Area Code Phone number
4. DATE DRILLED 02/26/03
5. TOTAL DEPTH: 42
6. DOES WELL REPLACE EXISTING WELL? YES ❑ 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 .011 S.
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 42 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 22 To 42 Ft. 78M GRAVEL
Method
POURED
Slot Size Material
in in.
in. in.
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. #221 N. FROM RUTHERFORDTON. LEFT
ON MTN. CREEK RD. RT. ON LEWIS RD. CROSS
BRIDGE. 1/10 MILE ON RIGHT.
-o
w
rn
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
t,ONSTPI1rTInN STANnAPDS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1
SIGN)
Lj 'Submit the original to the DWI;
27.699-1636 Phone No. (9t9) 73
ASHEVILuE L-! CMCE
n !.
TURF PER
CONSTRUCTING THE WELL
lA>�-e-- - , ? (.2 d�
DATE
on of Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC
-3221, within 30 days. GW-1 REV. 07/2001

From: Scott Gantt To: Date: 3/6/2003 Time: 9:48:34 PM
Page 5 of 7
269703
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDWIDUAL)NAME (print) SCOTT GANTI 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: SPINDALE County
WINDY HII.I. SUBDIVISION LOT 2 CROWE DAIRY RD
RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER WILKINS HOME CENTER
ADDRESS 1920 H W Y 74 BYPASS
(Street or Route No.)
FOREST CITY
City or Town
828- 286-3647
Area Code - Phone Number
4. DATE DRILLED 2/4/03
NC
State
S. TOTAL DEPTH 300
6. DOES WEI if REPLACE! EXISTING WEI 1 7
7. STATIC WATER LEVEL Below Top of Casing:
(Lisa *" If Above Top of Coring)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of easing terminated ator below land surface requires a variance in
accordance with 15A NCAC 2C.0118
28043
Zip Code
YES ❑ NO EI
70 FT.
9. YIELD (gpm): 15 METHOD OF TEST
to. WA 1 ER ZONES (depth): 190
ARDM
Topographic/Land setting
❑ Ridge -❑ Slope ❑ Valley X Flat
Latitude/Longitude of well location
35.19.045 / 81.55.152
(degrees/minutes/seconds)
Latitude/longitude source: ® GPS ❑ Topographic map
DEPTH
Front
0
DRILLING LOG
To Formation Description
75 Clay
75 300 Consolidated Rock
u. DISINFECTION: TYPE HYPOCHLORITE Amount 7
12. CASING: Wall Thickness
Depth
From 0 To 80 Ft.
13. GROUT:
From 0
14. SCREEN
Depth
To 20 Ft
Depth
Froal NA To
to. SAND/GRAVEL PACK:
Depth
From NA To
16. REMARKS':
Diameter or Weigltl/Ft. Material
61/4" SDR21 PVC
oz LOCATION SKETCH
Show direction and distance in miles from at least
nvo State Roads or County Roads. Include the road
numbers and common road names.
Material Method
GRAVEL MIX GRAVITY
Diameter
Ft. in.
Ft,
Slot Sin Material
in.
Size Material
OAKLAND RD
Y HILL SUB
I I
5/10 Nil
CROWE DAIRY RD
O
CO
J
3
CO
co
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.
SIGNATURE OF PERSON CONSTRUCTING THE WELL
2/5/03
Date
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
276991 636PIrogc p... T/, within 30 (lays.
r-hl
GW-1 REV. 07/2001

From: Scott Gantt To:
Date: 3/6/2003 Tme: 9:48:34 PM Page 4 of 7
269'702
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 # [phone]
NE WQ PERMIT #
STATE WELL CONSTRUCTION PERMIT #
(if applicable)
1. WELL USE (Check Applicable Box) : Residential
Recovery ❑ Heat Pump Water Injection ❑
2. WELL LOCATION:
Nearest town: RUTHERFORDTON
245 PLEASANT HILL RD
(if applicable)
Municipal D Industrial ❑ Agricultural ❑ Monitoring ❑
Other ❑ If Other, List Use:
County RUTHERFORD
(Street Name. Numbers, Community, Subdivision, Lot No,Zip Code)
3. OWNER FRED PHILLIPS
ADDRESS 245 PLEASANT HILL RD
(Sirncl or Roma No.)
RUTHERFORDTON
City or Sown
828-241-4493
NC
State
Arca Code - Phone Number
4 DATE DRILLED 1/30/03
5. TOTAL DEPTH 280
Topographic/Land setting
❑ Ridge D Slope 0 Valley ® Flat
Latitude/Longitude of well location
35.19.912 / 82.00.757
(degrees/minutes/seconds)
Latitude/longitude source: ® GPS ❑ Topographic map
DEPTH DRILLING LOG
28139 From To Fomiahon Description
Zip Code 0 100 Clay
6. DOES WELL REPLACE EXISTING WELL? YES (] NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 65 FT.
(Use $" if Above Top of Casing)
8. TOP OF CASNG IS 2 FT. Above Land Surface*
"fop of casing terminated at'or below land surface requires a variance n
accordance with ISA NCAC 2C.0118
9. YIELD (gpm): 5 METHOD OF TEST ARDM
10- WATER ZONES (depth): 220
100
280 Consolidated Rock
u. DISINFECTION: TYPE HYPOCHLORITE Amount
12. CASING:
Depth
From 0 To 107
13. GROUT:
From 0
7
Wall Thickness
Diameter or Weight/Ft. Material
FL 61/4" SDR21 PVC
Depth
To 20 Ft.
la. SCREEN
Depth
From NA To
15. SAND/GRAVEL PACK:
Depth
From NA To
16. REMARKS:
or 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.
Diameter
Ft.
Ft,
Material Method
GRAVEL MIX GRAVITY
Slot Size Material
in.
Size Material
I-IWY 108
CO
CO
PLEASANT
HILL RD
5l mi
J
EZ
CO
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
2/1/03
to')
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service center- Raleigh, NC
-_. 27699-1634Phen= rithin 30 days.
r
GW-1 REV. 07/2001

From: Scott Gantt To: Date: 3/6/2003 Time: 9:48:34 PM
Page 3 of 7
269'701
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTI GANTI 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 0 Industrial ❑ Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: LAKE LURE
County
RIVERBEND RESORT LOT 214 HAWKS TERRACE
RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER HICKORY Nur DEVELOPEMENT CORPORATION
ADDRESS POB 65
(Street or Rout<Fo_)
LAKE LURE
City or Town
828-625-0866
NC
State
Area Code - Phone Number
4. DATE DRILLED 1/21/03
5. TOTAL DEPTH 150
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing:
Zip Code
YES ❑ NO E1
120 FT.
(Use "4" If Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface"
'Sop of easing terminated at/or below lard surface requires a vanmce in
aecordance with 15A NCAC 2C 0138
9- YIELD (gpm): 12 METHOD OF TEST ARDM
to. WATER ZONES (depth): 140
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley (ZI Flat
Latitude/Longitude of well location
3526.469 / 82.10.613
(degrees/minutes/seconds)
Latitude/longitude source: ® GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 5 Clay
5
150 Consolidated Rock
11. DISINFECTION: TYPE HYPOCHLORITE Amount 2
12. CASING.
Depth
From 0 To
13. GROUT:
Depth
From 0 To
14. SCREEN
Wall Thickness
Diameter or Weight/Ft. Material
20 FL 61/4" SDR 21 PVC
Oz
Material Method
20 Ft. GRAVEL MIX GRAVITY
Depth Diameter Slot Size Material
From NA To Ft. 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 road
numbers and common road names.
RIVERBEND SUB
O
HAWKS w
TERRAC
J
HWY 64/74
93
Cr)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
1/25/03
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.Yhono No (919) 733 3-iithin 30 days.
j
GW-1 REV, 07/2001

2'7038G
3. OWNER:
Address
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
Jamez m Camp, Sr.
WELL CONTRACTOR COMPANY NAME ramp' s ,Jp11 R. Pnmp rn Tnr-
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
CERTIFICATION M 2 1 3 R
(if applicable)
PHONE M$7R) 451-7322
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATI/OJN:
Nearest Town: I� t( if Y�L• J tilt) !t Coun
(FrLckr Iv,vf
(Street Name, Numbers, Community, Subdivision, Lot No
IRltricIC' N1asc,S
�Yec)l FEU)
Zip Code)
V77rkorti e
Di )ray
(Spat
or lite Nr .1��C�.J
City or To n State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED a / 3 " 0.3
5. TOTAL DEPTH: I) 2-.5-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 5'3
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): J METHOD OF TEST
10. WATER ZONES (depth): P10
Air
11. DISINFECTION: Type rh l n r i n a Amount 60 F) 5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To •. Ft. 6 1 / 4 gDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Methodm .x
FromTo 20 Ft. N t Cement hand
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From. To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
'dge ❑Slope [Walley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
j) DRILLING LOO
From To FormationDescription
afal viUeI. r61i7
Cr 4 S /'/>5 r I ckft f�DC
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 DQ-HEREBY CERT1FY THAT -I1 WELL WAS CONSTRUC Fi
1ED IN ACCORDANCE WITH 15A NCAC 2C, W1
CONSTRUCTION STANDARDS; THAT A COPY 0 THIS RECORD HAS EEN�PROVIDED TO THE WELL OWNER
�yi 1 d w , ( mot
SIGNATURE OF PER CONSTRUCTING THE WELL ✓ /n DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. (919) 733-32214 within 30 days. GW-1 REV. 07/2001

2703g
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James Id_ Cam[ir Jr
CERTIFICATION# 7 1 3 R
WELL CONTRACTOR COMPANY NAME ('amps q Wnl1 R. Pump ('rt, Tnr PHONE #l2R) d53-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential I Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water injection 0 Other 0 If Other, List Use
2. WELL LOCATIQN
Nearest Town: j" 1'l'6 lt) )y t County ( &YtbY
G T C`�4talA (.-{1 . Rri
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
/
3. OWNER: l Y is. rill IIAkU/)itY 1 ES
Address ,DD J-YV I Yl. )'7Y •
Cite Yv$le RffC)—
Ciry or Tu State Zip Code
( )-
Area code- Phone number
4. DATE DRIJ I FD — ICI' 1) 3
5 TOTAL DEPTH: en `;"
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: L 0
(Use "-? if Above Top of Casing)
FT. Above Land Surfaces
*Top of casing terminated actor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): :7 — METHOD OF TEST ai r
10. WATER ZONES (depth): ?) /70
11. DISINFECTION: Type rh 1 nr i na Amount I li, c s}1
Wall Thickness
or Weight/Ft. Material
wD14-2-1 PVC
8. TOP OF CASING IS 1
12. CASING:
Depth_Diameter
`
From 0 Tom}_ Ft. 6 1 / 4
From To Ft.
From - To Ft.
13. GROUT: Depth
From_0 To 20 Ft.
Material
Neat Ccmcnt
Method
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
From
16. REMARKS:
To Ft.
To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley f}7F'lat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box).
DEPTH DRILLING LOQ
From To Formation Description
n t'c- diftt
rl
J.00ATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
L
Gi^
j DO HEREBY CERTIF,Y f1THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFI 1
— --CONSTRUCTION STAND , AND THAT A COPY 0 THIS RECORD HAS (SEEN PROVIDED TO THE WELL OWNER
--) I SIGNATURE OF PER SCAN CONSTRUCTING THE WELL ✓ r� DATE
Submit the original. to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone N,®, (919) 73i-3221, within 30 days. GW-1 REV. 07/2001

27045E
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDW1DUAL) NAME (print)
JanhniS w Car^Ivr Jr.
WELL CONTRACTOR COMPANY NAME Campt c Wa1 1 R Pnmpt Cr" Tnc
STATE WELL CONSTRUCTION PERh11T# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
- Groundwater Section
CERTIFICATION # 21 18
PHONE #$2R1 dST_7122
1. WELL USE (Check Applicable Box): Residential 0/Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION ' j� y1i�.
Nearest T, wn' l-aKe �LC iC. c aunty Mite ite YDYr)
(Street Name, Nummben, Community, Subdivisknn, Lot No., Zip Code)
3.OWNER: 0/i(1JI�I ('OV151YL(C�OI(
Address / 75 ✓ urkg I> •
(Streetare or (V RoptoC ONo. 07g 16
lake f
City or Town State Zip Code
Area code- Phone number _
4. DATE DRILLED O D -7
5. TOTAL DEPTH: 4 a
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 6, S
(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 accordancp,with 15A NCAC 1C .0118.
9. YIELD (gpm): !/ O METHOD OF TEST ni r
10. WATER ZONES (depth): 35(i>
11. DISINFECTION: Type rh 1 nri ma Amount 2 c_o p
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From 0 To OC Ft 1 /`1 gDR21
From To Ft.
From To Ft.
13. GROUT: Depth Material
From_p To 20 Ft. N
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Material
PVC
16. REMARKS:
at
Cement
Method
H.a:r
Topographic/Land setting
t5 dge ❑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
0 loo graUE(ri
i o a 4as c l5c / t1» 1 rrck
J.00ATION SKETCH[
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
O c
W
LU'br-? ,aw
sue- fj?:,..,
� JT"
co
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC1hD IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 02 THIS RECORD HAS `SEEN PROVIDED TO THE WELL OWNER
�� i�• �3-1�-0,3
al`A("R LGW
i
ubmi original/to the a of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. (919) 71 2-, within 30 days. GW-1 REV. 07/2001
6e4i
ATURE OF PE CONSTRUCTING THE WELL 1 '4J DATE
`ICE

Topographic/Land setting
pI6dge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box).
TH DEPDRILLING LOG
From To Formation Description
O 74. CI Yf 6 rti e.
4 4 / SS CDI15d 1 /i i cit-e i B el<
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. ,
Size Material , _ ,._. Lab)
b)
To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCIED IN ACCORDANCE WITH 15A NCAC 2C, WFi T
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
1GNATURE OF PERSON CONSTRUCTING THE WELL / DATE
Submit the original to tp g sion of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 PhoneNo. (91 "'c221, within 30 days. GW-1 REV. 07/2001
270453
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J a m a 5 t. C a W p, Jr CERTIFICATION # 2 1 1 R
WELL CONTRACTOR COMPANY NAME C'amp' S Wa11 & Primp Cn_ Tnn PHONE #$9R1 451-7122
STATE WELL CONSTRUCTION PERMIT/4 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential fi Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: J 4< LILY e County gAtt, ),4
Y�
lcj 7 LituyeI Lakes
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: C / 1)I N tt
Address 3 L T 1.d h I fe ()a C L k
(Sweet Route No.)
Irnh NC Q703a
Ci or Town State Zip Code
( Area code- Phone number J
4. DATE DRILLED
5. TOTAL DEPTH: (9i'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO X
7. STATIC WATER LEVEL Below Top of Casing: -35 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 accordanipp with 15A NCAC 2C .0118.
9. YIELD (gpm): G-ti METHOD OF TEST air
10. WATER ZONES (depth): ! 6.50
11. DISINFECTION: Type rh 1 nri nP
12. CASING:
DepthDiameter
,
From 0 To %� Ft. 6 1 / 4 SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From_.p To 20 Ft. Neat Cement ILa
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
Front To
From
Amount 1 C 121)
Wall Thickness
or Weight/Ft. Material
Zt • i
o

282347
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 0 Recovery 0 Heat Ptunp Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
CANE CREEK RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: GREGBIFFLE
Address CANE CREEK RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(704) — 506-6640
Area Code Phone number
4. DATE DRILLED 10/22/03
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): 30 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 90 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
From To
From To
Size
Ft.
Ft.
County RUTH
Method
POURED
Slot Size Material
in. _ in.
in. in.
Material
Topographic/Land settin
❑ Ridge ❑ Slope ❑ Valley
(check appropriate box)
Latitude/longitude of well 1
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑
(check box)
DEPTH
From To
DRILLING LOG
From To
n
mac.
fl
o
c2
n
(2
raphic map
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 RUTHERFORDTON.RIGHT
AT CANE CREEK GROCERY ON ED THOMPSON
RD. LEFT ON CANE CREEK RD. 1/2 MILE ON
RIGHT. TRIPLE "B" RANCH SIGN A7`c:I/RIVE.
r:"?—
o -
cS
-o
CO
N
CO
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
) /C) 0-6 .
SIGNATURE PERSON CONSTRUCTING THEVELL 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

271549
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: UNION MILLS
PINEY KNOB RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MARVIN CRAIN
Address 957 PINEY KNOB RD.
(Street or Route No.)
UNION MILLS NC 28167
City or Town State Zip Code
(828) — 287-5222
Area Code Phone number
4. DATE DRILLED 03/27/03
5. TOTAL DEPTH: 80
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 65 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 M. accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST STEEL TAPE
10. WA 1 ER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 6.9
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
Ft. 24" CEMENT
Ft.
From 0 To 80
From To
From To Ft.
13. GROUT: Depth
From 0 To 20
From _ To
14.SCREEN: Depth
From To _ Ft.
From To Ft. _
15. SAND/GRAVEL PACK:
Depth Size
From 65 To 80 Ft. 78M
From To Ft.
16. REMARKS:
Material Method
Ft. CEMENT POURED
Ft.
Diameter Slot Size Material
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: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #221 N. FROM RUTHERFORDTON. LEFT
ON SCHOOLHOUSE RD. IN GILKEY. LEFT ON
PAINTERS GAP RD. LEFT ON PINEY KNOB RD. 2
MILES ON LEFT.
ry
ry
m
c-
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
C—ONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
n _
1
Submit the original to the'D v
27699-1636 Phone No. (919) 7
TURE bF PER SOIG'CONSTRUCTING THE WELL
�z nP , 3-,7 7- c) —3
DATE
ion of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001

271550
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERIIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring D Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
CAIN CREEK RD.
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: SAM FENDER
Address 2077 CAIN CREEK RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 288-5000
Area Code Phone number
4. DATE DRILLED 03/26/03
5. TOTAL DEPTH: 72
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 57 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
Zip Code)
11. DISINFECTION: Type CHLORYTE Amount 6.9
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 72 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 57 To 72 Ft. 78M GRAVEL
From To Ft.
16. REMARKS:
Topographic/Land setting
0 Ridge 0 Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 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
IIWY. #64 E. FROM RUTH. RT. ON ED
THOMPSON RD. LEFT ON CAIN CREEK RD. 1/4
MILE ON LEFT. (2077 ON BOX)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
(CONSTR THAT A COPY OFTHISS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
PER CONSTRUCTING THE WELL ' DATE
i
Submit the original to the Divisio of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
276 i9-1636 Phone No. (919) 733-321, within 30 days. GW-1 REV. 07/2001

271551
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERPIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH
THOMPSON LAKE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER WILLIAM BRAUN
Address 426 THOMPSON LAKE RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 287-3075
Area Code Phone number
4. DATE DRILLED 03/24/03
5. TOTAL DEPTH: 35
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO LEI
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
From 0 To 35 Ft.
From _ To _ Ft.
From _ To _ Ft.
13. GROUT: Depth
From 0 To 20 Ft.
From _ To _ Ft.
14.SCREEN Depth Diameter
From To FL
From _ To Ft.
15. SAND/GRAVEL PACK:
Depth Size
From 20 To 35 Ft. 78M
From To Ft.
CHLORYTE Amount 6.9
Wall Thickness
Diameter or Weight/Ft. Material
24" CEMENT
Material
CEMENT
16. REMARKS:
Method
POURED
Slot Size Material
in. _ in.
in. in.
Material
GRAVEL
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degreestminutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #64/74A W. FROM RUTHERFORDTON.
LEFT ON MAPLE CREEK RD. RIGHT ON RIVER
RT. RIGHT ON THOMPSON LAKE RD. APPROX.
3/4 MILE ON RIGHT. HOUSE AT LAKE.
I DO HEREBY CET
CONS T UCTIQN STAND
iLi L
Submit the original to the Divisi n of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27499-1636 Phone No. (919) 733- 221, within 30 days. GW-1 REV. 07/2001
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNERR/
SIGN' ' OF P N CONSTRUCTING THE WELL DATE

271555
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: BOSTIC
GOOD EARTH FARM DR.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: GLENN WELLS
Address 411 GOOD EARTH FARM DR
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code
(828) — 248-2709
Area Code Phone number
4. DATE DRILLED 03/04/03
5. TOTAL DEPTH: 67
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 57 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To 67 Ft.
From _ To Ft.
From To _ Ft.
13. GROUT: Depth
From 0 To 20 Ft.
From To Ft.
14.SCREEN: Depth
From To
From To
County RUTH
CHLORYTE Amount 4_6
Wall Thickness
Diameter or Weight/Ft. Material
24" CEMENT
Material
CEMENT
Method
POURED
Diameter Slot Size
Ft. in.
Ft_ in. in.
15. SAND/GRAVEL PACK:
Depth Size
From 57 To 67 Ft. 78M
From To Ft.
16. REMARKS:
Material
GRAVEL
Material
in.
Topographic/Land setting
0 Ridge ❑ Slope ❑ Valley D 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. RIGHT ON SALEM CH.
RD. RIGHT ON FREEWILL BAPTIST CH. RD.
RIGHT ON GOOD EARTH FARM DR. CROSS
CREEK AND TURN LEFT AT FORK co
c_ )
—o
N
c,
cal) c
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS UCTIQN, ST% S, AND THAT A CO/PYY/OFF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/Yi/ I! /
SI
1 `.
AA
RSON CONSTRUCTING THE
3- 62
DATE
Sp bmit the original to theDivision of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
2'7699-1636 Phone No. (919) 73; -3221, within 30 days. GW-1 REV. 07/2001

271556
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 D Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: BOSTIC
JOE BOSTIC RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JOHNNIE MALONEY
Address 822 JOE BOSTIC RD.
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code
(828) — 24-1806
Area Code Phone number
4. DATE DRILLED 03/03/03
5. TOTAL DEPTH: 50
6. DOES WELL REPLACE EXISTING WELL? YES ® NO 0
7. STATIC WATER LEVEL Below Top of Casing: 35 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): , 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 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.
From To _ Ft.
15. SAND/GRAVEL PACK:
Depth Size
From 35 To 50 Ft. 78M
From To Ft.
16. REMARKS:
in. in.
in. in.
Material
GRAVEL
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
BUS. 74 E. FROM FOREST CITY. LEFT ON
BOSTIC SUNSHINE RD. LEFT ON JOE BOSTIC RD.
4/10 MILE ON LEFT. (#822 ON BOX)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIQN-ST , AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-1
I
GNI
Submit the original to the Divis
27699-1636 Phone No. (919) 732
, 3 -3 - 0,3
OF P 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

2 7 1::a7
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 D Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: FOREST CITY
RICHARDSON CREEK LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DAVIT. SAVICK
Address 304 RICHARDSON CREEK LANE
(Street or Route No.)
FOREST CITY NC 28043
City or Town State Zip Code
(828) — 248-2317
Area Code Phone number
4. DATE DRILLED 03/28/03
5. TOTAL DEPTH: 305
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 I5A 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 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: 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. GO
PAST ROBBINS BRICK. RT. ON ARTHUR HENSON
RD. LEFT ON RICHARDSON CREEK LANE. 5/10
MILE ON RT. (LOT#10)
c.
c;
1 DO HEREBY CERT
CONSTRJ,I,CTION ST
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
N ING 7'I� WELL
SIG TURI OF PERSON CO STR UCT
DATE
Submit the original to the Di stun of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
7699-1636 Phone No. (919) 73-3221, within 30 days. GW-1 REV. 07/2001

271558
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERLIPICATION # 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 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MOORESBORO
DYSART RD,.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: EASTWOOD CONST„
Address DYSART RD
(Street or Route No.)
MOORESBORO NC 28114
City or Town State Zip Code
(704) — 473-7951
Area Code Phone number
4. DATE DRILLED 03/18/03
5. TOTAL DEPTH: 225
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): 15 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 70 Ft. 6-1/4" SDR21 PVC
From To Ft.
From _ To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To Ft in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
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. #221A S. FROM CLIFFSIDE. RT. ON HINES
RD. RT. ON DYSART RD. APPROX. 300 YDS. LEFT
INTO GATE. FOLLOW DRIVE AROUND TO RT.
WELL SITE APPROX. 800' ON RT.
From _ To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
[ CONSTRiI RECORD HAS BEEN PROVIDED TO THE WELL OWNER P.`�6I5i/-/S`)PtYhFSARDS, AND THAT A COPY OF THIS /J g
( SIG TURF F PERSON CONSTRUCTING THE L� L DATE
Submit the original to the Divisio 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 271550
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERI IFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: ELLENBORO
HATCHER RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DANIELLE WITHROW
Address 153 HATCHER RD.
(Street or Route No.)
ELLENBORO NC 28040
City or Town State Zip Code
(828) — 453-8228
Area Code Phone number
4. DATE DRILLED 03/17/03
5. TOTAL DEPTH: 345
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): 30 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 100 Ft. 6-1/4" SDR21 PVC
From To _ Ft. _
From To Ft _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
IDG
r qNs u TIoNLI 9
e
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
HOLLIS RD. FROM ELLENBORO. LEFT ON
HATCHER RD. 1ST HOUSE ON LEFT.
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY�OF THISHIISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
G[� r./�/� iGeC� _ - 7-3 -4. R
AT[)RP OF PERSON CONSTRUCTING T Fth WELL DATE
itthe original tathe Division of Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC
Gigs-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
ASHPv!I r,

2'71561
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 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH
HOOPER RD.
(Street Name, Numbers, Community, Subdivis
3. OWNER: WADE LAUGHTER
Address 268 HOOPER RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) - 245-7265
Area Code Phone number
4. DATE DRILLED 03/11/03
5. TOTAL DEPTH: 105
6. DOES WELL REPLACE EXISTING WELL? YES 0 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): 50 METHOD OF TEST ARD
10. WATER ZONES (depth):
on, Lot No., Zip Code)
11. DISINFECTION: Type CHLORYTE Amount 3
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 60 Ft. 6-1/4" SDR21 PVC
From To Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To _ Ft. in. _ in.
From _ To _ Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑ Ridge ❑ Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #221 S. FROM RUTHERFORDTON. RIGHT
ON POORS FORD RD. LEFT ON BIG ISLAND RD.
RIGHT ON DEWITT OWENS RD. RIGHT ON
HOOPER RD. HOUSE AT DEAD END./
16. REMARKS:
I DO. HEREBY-CERT
CONSTRUCTION STAND'
( �-P—n....-/2 � %l-Z�p� / (9 S — / — 3
Si. RE O/RSON CONSTRUCTING THE WE L DATE
1
Sujbmit the original to thejDivis n of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone NO. (979) 73*3221, within 30 days. GW-1 REV. 07/2001
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

271562
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)
LI
S
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: LAKE LURE
CEDAR CREEK RD.
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: BOB POHLMAN
Address 1475 CEDAR CREEK RD.
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
(828) — 288-8444
Area Code Phone number
4. DATE DRILLED 03/10/03
5. TOTAL DEPTH: 405
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): 7 METHOD OF TEST AR»
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 110 Ft. 6-1/4" SDR.21 PVC
Ft.
From To
From To
13. GROUT: Depth
From 0 To 20
From To
14.SCREEN: Depth
From _ To _ Ft.
From _ To _ Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
Ft.
Material
Ft. QUIKRETE
Ft.
Diameter Slot Size
in. _
in.
From To _ Ft.
From To _ Ft.
Method
POURED
Material
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
HWY. #64/74A W. FROM RUTHERFORDTON.
RT. ON BILL'S CREEK RD. LEFT ON CEDAR
CREEK RD. APPROX. 3/4 MILE ON LEFT PAST
CONNER RD. (BOX #1475)
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIUNST s, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
_
41
S bmit the original to the Divis
2t699-1636 Phone No. (949) 73
ci -- -3" / 0 - d -3
WWEE
OF PERSON CONSTRUCTING THE LL DATE
m of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
3221, within 30 days. GW-1 REV. 07/2001

271535
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1.
WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural
Monitoring 0 Recovery ❑ 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., Zip Code)
3. OWNER: ED YOUNGER
Address LAUREL MTN. ESTATES
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
(828) - 6254905
Area Code Phone number
4. DATE DRILLED 02/07/03
5. TOTAL DEPTH: 805
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO LSI
7. STATIC WATER LEVEL Below Top of Casing: 150 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 LEST 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 51 Ft. 8" 350 WALL GALV.
From To Ft. _
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft.OUIKRETE
From To Ft.
14.SCREEN: Depth Diameter
From To Ft.
Method
POURED
Slot Size Material
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. #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
r CONSTRUCTION STAND RnS�ANNDD THAT A COPY OF THIS RECORD
HAS BEEN PROVIDED TO THE WELL OWNER
r-,S I N}7 - OF PERSONC UCTIN' Cr THE WELL. DATE 7 `
L P _ jI
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
2t699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
I

271536
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
WINDY RIDGE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: GARY THRIFT
Address WINDY RIDGE
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(410) — 239-6485
Area Code Phone number
4. DATE DRILLED 03/31/03
5. TOTAL DEPTH: 405
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): 9 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
From To _ Ft
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To _ Ft.
16. REMARKS:
Slot Size Material
in. _ in.
in. in.
Topographic/Land setting
0 Ridge 0 Slope 0 Valley D 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 COOPERS GAP RD. RT. ON MOSS RD.
LEFT ON WINDY RIDGE. 4/10 MILE ON RT.
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
r CONSTRUCTION SiAND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/C r-rQ
TURE OF PERS
CONSTRUCTING THE WELL DATE
S bmit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
21699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

271537
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 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: BOSTIC
SALEM CHURCH RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: VANCE SISK
Address SALEM CHURCH RD.
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code
(828) - 245-0434
Area Code Phone number
4. DATE DRILLED 03/28/03
5. TOTAL DEPTH: 705
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 I SA NCAC 2C .0118.
9. YIELD (gpm): 7 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 19.5
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 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. RT. ON SALEM CH. RD.
2ND. LOT ON RIGHT PAST CHURCH.
0
W
,v
N
of
T DO HEREBY LERI-1F T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSrIRUCTION STANIT S, AND THAT A COPY OF THIS RECORD
HAS BEEN PROVIDED TO THE WELL OWNER
cJ��CiJ/�/i 3� C;
%h0Z1
SIG
i-Submit the original to the Di sion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
t,27699-1636 Phone No. (919) '33-3221, within 30 days. GW-1 REV. 07/2001

71r"
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERIIIICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
Of applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: UNION MILLS
OLD ORCHARD RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: FRED BARTLETT
Address OLD ORCHARD RD.
(Street or Route No.)
UNION MILLS NC 28167
City or Town State Zip Code
(803) — 796-9555
Area Code Phone number
4. DATE DRILLED 03/27/03
5. TOTAL DEPTH: 505
6. DOES WELL REPLACE EXISTING WELLS 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): 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 120 Ft. 6-1/4" SDR21 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:
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 GO UP HWY. #221 TURN LEFT ON
LIBERTY HILL CH. RD. RIGHT ON OLD
ORCHARD RD. GO TO END OF PAVEMENT ON
RIGHT. LOT #9.
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUUS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SI
L
Submit the original to the D vision of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
�-27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
;tom. ,3 -7-�
ATURE OF PERSON CONSTRUCTING TILE WELL DATE

272214
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James w
WELL CONTRACTOR COMPANY NAME
Camps C Wp11
Camp Jr CERTIFICATION # 714R
R Piimp en Tnr
PHONE b87A) drii-7 T22
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT10F1;
Nearest Town: 1,5fir- Coun
,24 —VO cir ih:t e y tSfAte
m6
(Sweet Name, Numbers, Community, Subdivision, LotoNo., Zip Code)
3. OWNER: / 170ACito
Address L vz' k y c k e rt b A ra er
��sscrect or R sute No.)
Cha r fo1Te N C, 28<2.
to
Dr.
City or Town State Zip Code
( /P't)- f7'7 �i — L.;
C f
Area code- Phone number
4. DATE DRILLED '-5 - 1 ti
5. TOTAL DEPTH: '7 O
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO X
7. STATIC WATER LEVEL Below Top of Casing: ,'20n FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S 1 FT. Above Land Surface*
'Top of casing terminated odor below land surface requires a
' -variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 1 METHOD OF TEST air
•10. WATER ZONES (depth): (4o
11. DISINFECTION: Type rh l n r i np Amount C (A10 S
12. CASING:
Depth
From 0 To (noL-
From To
From To
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size
Wall Thickness
Diameter or Weight/Ft. Material
Ft.6 1 f 4 q1R-21 PVC
Ft.
Ft.
Material Method
Ft• Neat Cement Hand
Ft.
Diameter Slot Size Material
in. in,
in. in.
From To
From To
16. REMARKS:
Ft.
Ft.
Material
Topographic/Land setting
Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check boxy
DRILLING LOG
Formation Description
DEPTH
From To
/
n J.
70c ('Cttso!dated ocl<
LOCATION SKETCFL
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
a
7, �l 1 r
f
I"fh, RQ,
- 7 L
Su mit the original to the D
276 d6t}P t (gli .
'slo
-3221
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WFI
THAT A COPY o. THIS RECORD HAS l3EEN PROVIDED TO THE WELL OWNER
ATURE OF PE
DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
within 30 days. GW-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 CERTIFICATION# 214fi
WELL CONTRACTOR COMPANY NAME Camps W,1 1 R. Pnmp (`rL Tnr• PHONE #$2R) d5"1-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
272213
1. WELL USE (Check Applicable Box): Residential fl Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATIO
Nearest Town: + L.lA..
Q u S r k C piiv‘c '€49
(Street —Name, nNumbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Q� Q C 2J
Address \ Zg f G 1z 6 U
\(Street or Rouct@ No.)
1», W
City or Town tale Zip Code
(1 -'SF s Q3L)
Area code- Phone numbe
4. DATE DRILLED .
5. TOTAL DEPTH: :IS, S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 4 0 FT,
(Use "1" if Above Top of Casing)
8. TOP OF CASING IS t FT. Above Land Surface"
•Top of cuing terminated at/or below land surface requires a
' *variance In accordanc with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST air
10. WATER ZONES (depth): )- -Q
i
Submit the original to they Divis
i 1699-163.6.Phone No_ (919)1733-3:
PL
11. DISINFECTION: Type rh 1 nr i n p Amount
12. CASING: Wall Thickness
or Weight/Ft. Material
Depth Diameter
From 0 To f., - Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From._0 To 20 Ft. N at 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.
SDR21 PVC
Slot Size Material
in.
in.
16. REMARKS:
.p4
County %..(,tXI pn
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 DRII I ING LOG
From To FormatioQ Denript n
n low
a
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.
1S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WEI I
THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
!
°NATURE OF PERSS CONSTRUCTING THE WELL �j) DATE
on of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001

273542
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM (print) .3 L in e 6 `i" . CaLh . ✓. p O CERTIFICATION WA( 3 g
WELL CONTRACTOR COMPANY NAME CAt%Kt/xi-Deli t Y)A mp l D. 1�Yl C . PHONE # .(Yogi) 453-2322,
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential FI Municipal/Public 0 industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI N: Nearest Tglim: eYFu11r70nCountyP M l
[NADA In Ra))n RC.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: Bc61h\l j_e Address kaivthr// knoir s Rd
-1.� tiff
(Sue?: or Route N .
77R iffv.-6(d °i'l NC .28131
City or Town State Zip Code
( )- :zst;r
Area code- Phone number
4. DATE DRILLED 4 - t Lf ' G 3
5. TOTAL DEPTH: i D`
Topographic/Land setting
IiRidge ❑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
lD SC claq - cliff
clC 5&5 r?risilAtttt I rcrk
6. DOES WELL REPLACE EXISTING WELL? YES 12/NO 0
7. STATIC WATER LEVEL Below Top of Casing: /71( 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 accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): .2 METHOD OF TEST ' I
10. WATER ZONES (depth): 4 cl0
11. DISINFECTION: Type
12. CASING:
Depth
From__ To X0
From To
From To
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth ... Size Material
From To Ft.
_Allth___ Amount 1 A Lugs
Wall Thickness
Di ter or Weight/Ft. Material
Ft. L sPRxl PVC
Ft.
Ft.
Material ..(_. MethQd
Ft.Ylea.t Cen1eIrc 1461.rvd
Ft.
Diameter Slot Size Material
Ft. in. in.
in.
From To Ft.
16. REMARKS.
LOCATION SKETCH zo
Show direction and distance in miles from aateas ~0
two State Roads or County Roads. Include roa,
numbers and common road names. r"
IV
wl i
r;
L6
).DO,IIERERYCERTIFY�THAT
tONFS'R1 ETI3NST.�
r-.If`I
Submit the original to the Dit
---27699-1636 Phone No. (919) 733
""HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WFI T
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IGNATURE OF PERSON CONSTRiTING THE WELL DATE
%-1,12-03
sion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
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) NAM5 (print) r,cv. m,,e.6 I�(�. CA/r'�t'�p CERTIFICATION
,1 it At 3g
WELL CONTRACTOR COMPANY NAME LGt ttp3 We I( v YUMQ (D. ITAC • PHONE it fg,, A 453-23,22
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: 7o 3 C County
1; ,0 lvdwlre awtl )51on f
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: RAY /e 5 5 e ill9( t
Address /, tb / • �Gi Wl r t' 111t ]nf l w r. 2 cl
(Soyet or Route P.0 0 1 No.)
�7cC� c lv C
City or To}vn State Zip Code
Area code- Phone number. ff
4. DATE DRILLED 't ' - o3
5. TOTAL DEPTH: 36
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO A
7. STATIC WATER LEVEL Below Top of Casing: c 5" FT. -e
(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
varlance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): .3 METHOD OF TEST et) Y
10. WATER ZONES (depth): .WJ D
11. DISINFECTION: Type + e- I el s
12. CASING:
Depth Diameter
From D To I-I0 Ft. 6 /144 ('/:c/r 10// I'% f fi
From To Ft.
From To Ft.
13. GROUT: Depth Material MethoQ1d
From 0 To 20 Ft./leaf Cement kekvva
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.
273541
Topographic/Land setting /
❑Ridge ❑Slope ❑Valley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH PRILLING LOG
From To Fopnation Desc ption
(� J 0 CJaV,- Satnt
PILO - 5 cen561/daJeii ynck
16. REMARKS:
Amount l/.a c tk f s
Wall Thickness
or Weight/Ft. Ma}enal
SJ�i221 yyC
LOCATION SKETCH fV
Show direction and distance in miles from at1l st
two State Roads or County Roads. Include th6e?oado
numbers and common road names.
�� I1ONS EITZTY
i,.I I
Submit the original totQe Di1
27699-f 636 Phone No, Oa) 733
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFI 1
AND T AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1
L.. GLyJ1l Gi% . (GL IJ� D-3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3221, within 30 days. GW-1 REV. 07/2001
J

273540
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM/F�!_ (print)�,.Jci m,ee 6 f�IA) LA wk p_, J r • CERTIFICATlIiON 8 Al 3 S
WELL CONTRACTOR COMPANY NAME CA rilfl$ De El V YIAvy (p. ILC PHONE q fP�d1 YS,3-�3a'�
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITS
(if applicable) (if (if applicable)
6�
1. WELL USE (Check Applicable Box): Residential MunicipalPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION _ v(_
NearestTown: )(.'`)// C CounNy(H1t't� �Zlcl
Hind Re.-72o)nett Vai
(Street Name, Numbers, Community, Subdivision, Lot No., Zip thode)
Ver v LL' I ko vkas
i 5 H1At'\1 Ri.
3. OWNER:
Address
(Street or Route No.)
�j D S I ( 1\ L Y (1)
City or Tow" State Zip Code
( )-.A245- Itisc
Area code- Phone number
4. DATE DRILLED 4 - t ' 03
5. TOTAL DEPTH: [ D 5 111 ttt
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing:
(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 ISA NCAC 2C .0118. R I Y
9. YIELD (gpm): ,12 C METHOD OF TEST
10. WATER ZONES (depth): j C
11. DISINFECTION: Type
12. CASING:
Depth
FromQ_ To 2G Ft.
From To Ft.
From To Ft.
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 Ft
he lIE'rs
Amount ,x C a r
Wall Thickness
Diameter or Weight/Ft. Material
16. REMARKS:
Material
Ft. neat Cement
Ft.
Diameter
Ft. in.
Ft, in.
Mcthild f�
Topographic/Lanft setting
❑Ridge ❑Slope Malley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude Source:❑GPS❑Topographic [nap
(check box).
DEPTH PRILLING LOG
From To Formation Description
t0 26 IDArn
SLO I G5 ryi(50 IvIcklPfl rock
Slot Size Material
in.
in.
Size Material
Ft
w
c
0
n_
Em
o.c
tJl t;rn
Z c
-0 m�
s a�
LOCATION SKETCH tv rn
Show direction and distance in miles from at Lst
two State Roads or County Roads. Include the road 2
numbers and common road names.
�rt tiw
Lct
orb
%)o5fJ
tc-SunS/I
@9N UcT1;N
ng
Submit the original to the
691,=143b-J'lrgne;N0. (919)
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THI RECORD HAS BEEN PROVIDED TO THE WELL OWNER
DATE
SIGNATURE OF PERSON ONSTRUCTING THE WELL
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
733-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM/F�!- (print) IT- (m es f�W • lA1's4 T17% CERTIFICATIONI�p A(.}3g
WELL CONTRACTOR COMPANY NAME LAWV Well t t'!A mp (m TYlC • PHONE# ',Mg) YS3-/3e12
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
273539
1. WELL USE (Check Applicable Box): Residential R Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIQN• rr )) 12Nearest Town: )emu iltY"FOr< an TU/i!'fi' ;YC
Marc in 51are
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Plc u g /11-c h le v
Address �• , C4 )I� I,a tk Ko o n Pc
(street or Ro ACC No.)
�)Irtrlale I\C 2g/60
City or Town State Zip Code
( )- :'�1iG 4 6 on
Area code- Phone number
4. DATE DRILLED I 3
5. TOTAL DEPTH: t1-0 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NOX
7. STATIC WATER LEVEL Below Top of Casing: '78 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): ,;Z METHOD OF TEST Gl) Y
10. WATER ZONES (depth): 9 0
11. DISINFECTION: Type / )t'
12. CASING:
Depth Diameter
From 0 To 5 5 Ft. / /Y
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To .D
From To
Amount I/- cups
Wall Thiclmess
or Weight/Ft. Material
5PR.21 P tic
Material At
Ft,
Cement
Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
kMethJ d
av
Slot Size Material
in.
in.
Size Material
TopogrSa�phic/Land setting
❑Ridge 113/Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreeslminutes/seconds)
Latitude/longitude source:❑GPS❑Topographic trap
(check box)
DRILLING LOG
Formation Description
Cla[yy ,)td £jra✓el
5-5"riCS ('r)/15oltdated rock
DEPTH
From To
d 55
c
O
S 4
-c
-t cm
CJ{
titrn
rt
=o
LOCATION SKETCH cnz
Show direction and distance in miles from at felts) c2)
two State Roads or County Roads. Include th ad
numbers and common road names. z
4.
11 SC41'1 1IVYS
J
THIS WELL WAS CONSTRUCIED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
GJ • (�'%-l1/� /lam.
SIGNATURE OF PERSON dONSTRUCTING THE WELL
/ -CS
DATE
I Submit the original to the tvision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
L 7699,- 6-rtA4 AF(1919) 7 3-3221, within 30 days. GW-1 REV. 07/2001
[ICE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM (print) .3R (m(e5 5�14 • CA \ P CERTIFICATION�IN 3 g
WELL CONTRACTOR COMPANY NAME W±
tpS-0C II RA frnp Co. 1�11c . PHONE # {jai 453-23
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
273532
1. WELL USE (Check Applicable Box): Residential itd Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearest Town:.(r5 L1'2 426112
IP Y
7�f K- urn ki'n Ceid-ct
(Street Name, Number , Com unity, Subdivision, Lot No., Zip Code)
3. OWNER: Z• T h.)11de5I Qes
Address ) O Rv X l i- 3=3
a
r-i (((Scree{{ or Route No.)
II\/U ,( Nerf0 1l;r (_ ' 31
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED f -
5. TOTAL DEPTH: .9-05
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 3b' 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 accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): j D METHOD OF TEST to I r^
10. WATER ZONES (depth): 1C1 C
11. DISINFECTION: Type pe c't Amount 34 Cap
•12. CASING:
Depth
From 0 To 1.2-
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
Wall Thickness
Diam ter or Weight/Ft. Material
Ft. (e CDR.Z1 -3 Pik -
Ft.
Ft.
Material Method
Ft. he(All Cement kavvd-
Ft.
Diameter Slot Size Material
Ft. in.
Ft. in.
STAND
tt-hnx
$*tpit the original tt the Dim
A.>-376StA-1636:phatlP Na-'I*1(9) 733
Size
Ft.
Ft.
in.
in.
Material
Topographic/Laan,d setting
❑Ridge ❑Slope IldValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH. DRILLING 1.0(1
From rTo Formation Description
/ 0 Z jOtt W dI/
7Z HOC CDIlG c!Iet to rock
Z
Tx.
c
O
m rn ..t c
0
>m
-✓1 O
\
LOCATION SKETCH s —0
Show direction and distance in miles from at 'past cn z
two State Roads or County Roads. Include thenirad n
numbers and common road names. IV o
z
/74 3
tc-
X
..IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WF1 1
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ra
Cc4v (A,
SIGNATURE OF P IRRSoN7 ONSTRUCTING THE WELL DATE
ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3221, within 30 days. GW-1 REV. 07/2001
1

From: Scott Gantt To:
Date: 5/15/2003 Time: 9:59:48 PM Page 6 of 6
273530
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GANTI 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:
= \VET,i. LOCATION:
>.ew est own: RUTHERFORDTON
81-1 RAINBOW RAPIDS RD
County RUTHERFORD
Street Name. Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER W ILKINS HOME CENTER
ADDRESS 1920 HW Y 74 BYPASS
(Suet' or Rome No.)
FOREST CL'I'Y NC
Town State
28043
Zip Code
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
Latitude/Longitude of well location
3526256 / 82.05.480
(degrees/minutes/seconds)
Latitude/longitude source: ® GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description.
0 70 Clay
828-280-3647 70 275 Consolidated Rock
.�., (l(lode - Phone Number
O. DA7F. DRILLED 412R/03
'I OTAL. DEPTH 275
6 DOES WELL REPLACE EXISTING WELL?
T. STATIC WAFER LEVEL Below Top of Casing:
YES ❑ NO 0
16 FT.
(Use"." IfAbova Top of Casing)
S. TOP OF CASING IS 2 FT. Above Land Surface*
ap a t asinq tows oul scar blow load surface requ'uco a vsnanaa ur
sic), .,u, w..b DA NOAC 2C.0118
4. `: D1.P V�mr 15 METHOD OF TEST ARDM
1 Ss.AI E:R ZONES (depth): 270
DISINFECTION: TYPE HYPOCHLORITE Amount 8 0s LOCATION SKETCH W
u CASING Wall Thickness Show direction and distance in miles from at leas
Depth Diameter or WeightfFt. Material two State Roads or County Roads. Include ttte road<
(enrr. ., To 78 Ft. 61/4" SDR21 PVC numbers and common road names.
Dept Material Method
To 20 Ft. GRAVEL MIX GRAVITY
I: SC:REES
Depth Diameter Slot Size Material
NA To FI. in. in.
I S. '{A ?ND GRAVEL PACK'.
Depth Size Material
Prone NA To Ft,
If. PEM ARKS
v
-J
- L'C HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CON ECU iCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
4/28/03
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
original to the Division of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
-1/37i Yftarte within 30 days.
9
GW-1 REV. 0- 2001

From Scott Gantt To.
Date: 5/15/2003 Time: 9'.59.48 PM Page 2 of
273526
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 #2=84
WE LI. CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1 \\'ELL USE (Check Applicable Box): Residential Z Municipal ❑ Industrial 0 Agricultural 0 Monitoring ❑
R.c-ocer ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2 WELL LOCATION:
Nearest town. ELLENHORO
215 DIXON RD 280,10
County RUrHERFORD
(Street Manx. Nurnberg, Community, Subdivision, Lot No,. Zip Code)
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley 0 Flat
Latitude/Longitude of well location
35.23.053 / 81.44.421
J. OWNER VVILKINS HOME CENTER (degrees/minutes/seconds)
ADDRESS 1920 HWY 74 BYPASS Latitudeilongitude source: ® GPS ❑ Topographic map
(seen or Route No.) DEPTH DRILLING LOG
FOREST CITY NC 28043 From To Formation Desenpiiou
c:. �r -low" State Zip Code 0 50 Clay
82S286 361_ 50 220 Consolidated Rock
Aron Cork - Phone Number
4. DATE DRILLED 5(2/03
TOTAL. DEPTH 220
6. DOES WELL REPLACE EXISTING WELL?
A DC V-' A' ER LEVEL Below Top of Casing:
YES ❑ NO
70 FT.
(Use "t" If Abovc Top of Casing)
4 'i CF' OF CASING IS 2 FT. Above Land Surface*
..,:; terminated anon beIow land surface requires a vaia ec in
see u-u.e with 1 sA NCAC 2E0118
9 'i IIn.1) t_eprn1 8 NO:IHOD OF TEST ARDM
10. WA 1112 ZUSE S (depth): 152 IRO
11 DISINFECTION. TYPE HYPOCHLORITE Amount 5 Oz
I CASING. Wall Thickness
Depth Diameter or Weight/Ft Material
To 57 Ft 61/4" SDR21 PVC
how 0
Depth Material Method
To ^-0 Ft. GRAVEI. MIX GRAVITY
SCREEN
Depth Diameter Slot Size Material
NA to
I `. S: _ND GP ea 1'EL PACK:
Depth Size Material
Fret¢ NA To Ft,
IS NP:1lenenS.
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.
7V'"1
eve Ct
m
orr_
Ql ten
Do
Sze
zrn
� m
y17
rn
_
G
i UU HIREBY CERTIFY 'THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CCSSTRUCFION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
-an-
5/3/03
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
Suhmil the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service center- Raleigh, NC
Ipne o. qi/}9173.3 vithin 30 days.
l,"�1 s
GW-1 REV. 0_.22001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM (print /J '0 0 CERTIFICATION ttri O 77
WELL CONTRACTOR COMPANY NAME I, � itRf;.,t�.t� N+N PHONE �t (Xdbl • �Y9-4 2)
STATE WELL CONSTRUCTION PERMIT# _ASSOCIATED WQ PERMIT'S
(if applicable)
(if applicable)
274141
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCAT
Neare;l,T'� Ifhs. sawunry �iv�•-
(Sweet Name, Num Cammonity, Subdiviaiou, Lot No., Tip Code)
3. OWNER:
Address it y
( "N c' ), ta5r7 3 9
Zip Code
City or
Area code- Phone Dumber A �j
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YE NO 107. STATIC WATER. LEVEL Below Top of Casing: V.2 FT.
�(Uae "v' if Above Top of Casing)
8. TOP OF CASING IS /.S FT. Above Land Surface'
'Top of wing terminated awor below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
•
9. YIELD (gpm)• METHOD OF TEST' 44.00
10. WATER. ZONES (depth): Z40/
infra ger)
�9
11. DISINFECTION: Type rare two State Roads or Co
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft t/,r�t��r,,,a1 numbers and commo
From�_To /vt2 Ft �it ref (/ 1'
From To Ft
From To Ft.
13. GROUT: Depth �rMaatteriall
From,i To-D _ Ft entlisr►/
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 )J/ 0 Z. Stow direction and di
16. REMARKS:
Topographic/Land setting
{PRidge ❑Slope ❑Valley ❑Flat
(check appropriate boa)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
PEPTH DRILLING LOG
From To Formation Description
c.) —
T rL2
LOCATION KETCH
einmiles
f
ty Roads. Inc
ad names.
D i�FRf?BY''CER • i ' yy � T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TH1E/WFI.T OWNER
- Raleigh, NC
l 4 SIGN/64711-1_t ICY/ OF PERSON CONSTRUCTINGTHE WELL Y+�ATE v/os
t—SubpdCtli o p to the ivision of Water Quality, Gronndwater Section,1636 Mail Service Center
GW-1 REV. 07/2001
ST4�-1836,Ehohealbl fa19 3-3221, within 30 days.

274091
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 Z Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: ELLENBORO
ROMEY CAMPBELL RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: FRED MCFARLAND
Address ROMEY CAMPBELL RD.
(Street or Route No.)
ELLENBORO NC 28040
City or Town State Zip Code
(828) - 245-0669
Area Code Phone number
4. DATE DRILLED 05/02/03
5. TOTAL DEPTH: 805
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 200 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 22.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To Ft. 6-1/4" SDR.21 PVC
From _ To _ Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QULKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ 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
HOLLIS RD. FROM ELLENBORO. LEFT ON
DUNCAN'S CREEK RD. RT. ON ROMEY
CAMPBELL RD. 1ST DRIVE ON LEFT.
O
W
L
La
-.a
w
r DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
r J ` I S, AND THATTHIS
'A COPY OF TS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
I$ T C IC�N S' 'AIQAIgP
- U -3
County RUTH
Submit the original to he D
ag699444krt8l4P, Id* (919)
ASHEVILLE REGIONAL OFFICE
ATURE OF PERSON CONSTRUCTING THE WELL DATE
vision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
733-3221, within 30 days. GW-1 REV. 07/2001

274089
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 PITPMAN 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
FIRST BROAD DRIVE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JOSEPH SUTPHIN
Address FIRST BROAD DRIVE
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code
(828) — 248-9646
Area Code Phone number
4. DATE DRILLED 05/15/03
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 7.5
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 ❑ 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. #226 S. FROM GOOD OLE BOgy,. R(iHT
ON FIRST BROAD DRIVE. 3/10 MILE OAS RIGHT.
c_
C c
w
rn
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC 1 ED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
rTh
SIG
ilI4u1;11nit the original to the Dillistd'n
276919-1636 Phone No. (919) 733-3.
C 1112; N
r° L.!!, ,,,ki;JAL 0,-li'F
OFERSON CONSTRUCTING THE
LL DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001

274088
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 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: ELLENBORO
PRICE CEMETERY RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ROGER WATTS
Address PRICE CEMETERY RD.
(Street or Route No.)
ELLENBORO NC 28040
City or Town State Zip Code
(828) — 245-3573
Area Code Phone number
4. DATE DRILLED 05/16/03
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 40 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 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
From To _ Ft. _
From To Ft. _
15. SAND/GRAVEL PACK:
Depth Size Material
From
From
Slot Size Material
in. _ in.
in. rri
To Ft.
To 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 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. LEFT ON
DUNCAN CREEK RD. RT. ON PRICE CEMETERY
RD. 1/4 MILE ON RT.
81 :C nd 6- Not CO
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
SAND T A COPYOF THISSRRECORD HAS BEEN PROVIDED TO THE WELL OWNER
F PERSON CONSTRUCTING THE'WELL
Submit the original to the D
2704-1634 Phone No.(919
�' R SECTION
C;JAL OFFICE
DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001

274087
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
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: CLIFFSIDE
GREEN ACRES RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JAMES SPLAWN
Address GREEN ACRES RD.
(Street or Route No.)
CLIFFSIDE NC 28024
City or Town State Zip Code
(828) — 288-7276
Area Code Phone number
4. DATE DRILLED 05/20/03
5. TOTAL DEPTH: 705
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 I5A NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 19.5
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
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.
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. #221A S. FROM CLIFFSIDE. GO JUST
PAST THE FIRE DEPT. TURN LEFT ON GREEN
ACRES RD. 2/10 MILE ON LEFT.
c0
_
rn
rf X
n
G
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
jQ S3 L CTION-STA1 D'ARDS,-AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
- lLL SIGNATLRE OF RSO CONSTRUCTING THE LL DATE
1Sub it the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
276 Phone; No (919)-733-3221, within 30 days. GW-1 REV. 07/2001
AS

274081
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: BOSTIC County RUTH
GOLDEN VALLEY ESTATES
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BILLY MCGAVOCK
Address GOLDEN VALLEY ESTATES
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code
(910) - 862-3551
Area Code Phone number
4. DATE DRILLED 05/01/03
5. TOTAL DEPTH: 445
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 400 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 12
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 60 Ft. 6-1/4" SDR21 PVC
From To _ Ft. _
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. QUIKRETE
From To Ft.
14.SCREEN: Depth Diameter
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
Method
POURED
Slot Size
in.
in.
Size Material
Ft.
Ft.
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
BUS. 74 E. FROM FROEST CITY. LEFT�ON
BOSTIC/SUNSHINE HWY. LEFT ON UICKADOO
MTN. RD. LEFT ON FIRE TOWER RI5:4IT.
FORK. APPROX. 1/5 MILES ON RT. (tQT #50 f..
t o
r
cn
..
c�
co
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
7
i I!
Submit the original to the Drvis i n of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
! 276994636_Phone No.-491f) 73 ' 3221, within 30 days. GW-1 REV. 07/2001
5—
WELL DATE
OF PERSON CONSTRUCTING

274030
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 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: LAKE LURE
RUTHERFORD ST.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: FRED SOLLARS
Address RUTHERFORD ST.
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
(_) -
Area Code Phone number
4. DATE DRILLED 05/02/03
5. TOTAL DEPTH: 345
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): 10 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 60 Ft. 6-1/4" SDR.21 PVC
Ft. _
Ft.
Material Method
Ft. QUIKRETE POURED
Ft.
Diameter Slot Size Material
From _ To
From To
13. GROUT: Depth
From 0 To 20
From To
14.SCREEN: Depth
From To _ Ft.
From _ To Ft.
15. SAND/GRAVEL PACK:
Depth
From To
From To
in. _ in.
in. in.
Size Material
Ft.
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
HWY. 64/74A W. FROM RUTHERFORDTON. RT.
ON BILL'S CREEK RD. LEFT ON BUFFALOrCREEK
RD. LEFT ON RALEIGH DR. A REDD I RrMLTY.
LEFT ON RU 1'HERFORD ST. 1ST D ON'LEFT.
Le
w
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
.5— - 6 3
DATE
Submit the original to t�e Di 'sion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
. 699- �#pbnq g_-J{1j19) ' 3-3221, within 30 days. GW-1 REV. 07/2001

274079
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
STALLINGS RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DOUG WALKER
Address STALLINGS RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 288-6876
Area Code Phone number
4. DATE DRILLED 05/14/03
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 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): 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
From 0 To 20
From To
14.SCREEN: Depth
From To Ft.
From To _ Ft.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Material Method
Ft. QUIKRETE POURED
Ft.
Diameter Slot Size Material
in. in.
in. in.
Material
Topographic/Land setting
❑ Ridge ❑ Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #64 E. FROM RUTH. LEFT ON STALLINGS
RD. (a, CAIN CREEK STORE. NEW DRIVE 3/4 MILE
ON LEFT.
O 0
i.
D 0
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-o
w
CO
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTutlrTrnN cT &UP*,. cs AND THAT A C�QPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SI
ii
Sti mit the original to the i
27 99-1636 Phone No. (919
/PERSON CONSTRUCTING G - 40-2rkLL DATE / V O ` R
L�
i s t n of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
733-0221, within 30 days. GW-1 REV. 07/2001
C FIG(

274076
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERI'IFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING. LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH Topographic/Land setting
STALLINGS RD. 0 Ridge 0 Slope ❑ Valley ❑ Flat
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) (check appropriate box)
3. OWNER: DOUG WALKER Latitude/longitude of well location
Address STALLINGS RD. (Street or Route No.) (degrees/minutes/seconds)
RUTHERFORDTON NC 28139 Latitude/longitude source: ❑ GPS ❑ Topographic map
City or Town State Zip Code (check box)
(828) — 288-6876 DEPTH
Area Code Phone number From To
4. DATE DRILLED 05/30/03
5. TOTAL DEPTH: 705
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 200 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): 2 METHOD OF TEST AR»
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 19.5
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. _
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
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
HWY. #64 E. FROM RUTH. LEFT ON STALLINGS
RD. (a) CAIN CREEK STORE. NEW DRjVE W/4 MILE
ON LEFT.
c
LD
v
cs)
II �DyyO HFRFBYN
CFRTTFV T
'1CNSc T19N1ST`
t /•
oc
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
3( -o_
OF PERSON CONSTRUCTING. WELL DATE
ubmit the original to t4 D'vi: ion of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
RhuME Noo(919) 7 -3221, within 30 days. GW-1 REV. 07/2001
PrHrviLi E "'_ CEHCE

274075
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NELL 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 0 Recovery ❑ 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
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 04/16/03
5. TOTAL DEPTH: 645
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
Zip Code)
11. DISINFECTION: Type CHLORYTE Amount 18
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 50 Ft. 6-1/4" SDR21 PVC
From To _ Ft. _
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter 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: 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. #64/74A 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.
`t�p[p the
�p
ASF'.I F+�= E '' '�"rf (91
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
OF PERSON CONSTRUCTING
WELL DATE
ivision of Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC
733-3221, within 30 days. GW-1 REV. 07/2001

274074
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Qu lity — 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 D Industrial D Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: LAKE LURE County RUTH
LAUAREL MTN. ESTATES LOT #9
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ED YOUNGER
Address LAUREL MIN. ESTATES (degrees/minutes/seconds)
(Street or Route No.)
LAKE LURE NC 28746 Latitude/longitude source: 0 GPS ❑ Topographic map
City or Town State Zip Code (check box)
(828) — 625-4905 DEPTH
Area Code Phone number From To
4. DATE DRILLED 04/17/03
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): 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 45 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 ❑ 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
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. 4/10 MILE ON LEFT.
rz
c
T 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
NATURE OF PERSON CONSTRUCTIN THE WELL
bUhnlif—the.or+ eithe r'vision of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
GYl kt(919 733-3221, within 30 days. GW-1 REV. 07/2001
ASHE/ILL..,.

274073
1
l)
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 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: LAKE LURE County RUTH
LAUAREL MTN. ESTATES LOT #33
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
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 04/22/03
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 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 25 Ft. 6-1/4" SDR.21 PVC
From To _ Ft. _
From To _ Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. QUIKRETE
From To Ft.
14.SCREEN: Depth Diameter Slot Size
From To _ Ft. in.
From To _ Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
Size
Ft.
Ft.
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. 5/10 MILE ON RT.
:£ Wd 6- Nil CO
07
0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S 'AI,D AND THAT
A COPY OF THIS RECORD HAS BEEN PROVIDED
TO THE WELL OWNER
a
OF PERSON CONSTRUCTING THE WELL DATE
Ii .,.i
�
Submit the original to the
276994¢36-@hut 7o:1
n of Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001

274072
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 D Industrial D 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
3. OWNER: L.B. BROWNING
Address 1523 MAPLE CREEK RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
88228) — 287-5870
Area Code Phone number
4. DATE DRILLED 05/12/03
5. TOTAL DEPTH: 41
6. DOES WELL REPLACE EXISTING WELLS YES I NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 21 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 41 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 21 To 41 Ft. 78M GRAVEL
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
MAPLE CREEK RD. FROM RUTHERFORDTON.
1ST DRIVE ON LEFT PAST PIEDMONT RD. (1523
ON BOX)
O
CO
L
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ram)
CO
c_
T 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
t1
N CONSTRUCTING THE WELL
DATE
Si ubmitthesri$$alto-the Di 'sion of Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC
27699-1to,)CY'J919) '33-3221, within 30 days. GW-1 REV. 07/2001
03

274071
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 D Agricultural
Monitoring 0 Recovery ❑ Heat Pump Water Injection D Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
JONAS RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: FRANCISCO PEREZ
Address 503 JONAS RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 245-0950
Area Code Phone number
4. DATE DRILLED 05/13/03
5. TOTAL DEPTH: 69
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
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): 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 69 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 49 To 69 Ft. 78M GRAVEL
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 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
ON JACK MCKINNEY RD. RT. ON JONAS RD.
APPROX. 1 MILE ON LEFT. YELLOW HOUSE
W/GREEN TRIM.
Wc
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0
(.4
OD
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECOQRD HAS BEEN PROVIDED TO THE WELL OWNER
Gz n� S"/ 3 -&
SIG i� r T< RE OF PERSON Cyt3 R'UCTING THE WELL DATE
II�� �...
Su6it the original to the Di ITC; of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27619-1636 Phone No.(919) 33-3�21, within 30 days. GW-1 REV. 07/2001
C, G
f^• r _ CFFCE

274 07
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
CANE CREEK RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: GLORIA ANDERSON
Address CANE CREEK RD.
(Street or Route No.)
RUTYHERFORDTON NC 28139
City or Town State Zip Code
(828) — 287-9114
Area Code Phone number
4. DATE DRILLED 05/28/03
5. TOTAL DEPTH: 36
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 21 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 36 Ft. 24" CEMENT
From To Ft.
From _ To _ Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
Ft.
From _ To
14.SCREEN: Depth Diameter Slot Size
From _ To Ft. _ in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From 21 To 36 Ft. 78M
From To Ft.
16. REMARKS:
in.
in.
Material
GRAVEL
Material
Topographic/Land setting
❑ Ridge 0 Slope 0 Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ 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 RUTHRFORDTON. RIGHT
ON ED THOMPSON RD. LEFT ON CANE CREEK
RD. 1 MILE ON LEFT. NEW LOG HOME. 1
c
'0
W
CO
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORDOHAS��BEENPROVIDEDTO THE WELL OWNER
ii���C/�O, _.fin , /C�C/t n.� — i-- ,3 12.- G,
SI IATKIRE'OF PE' A ' ONSTRUCTING THE WELL DATE
4J
Submit the original to the Di o ■ of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
276b9r163612hone No. [phone], within 30 days. GW-1 REV. 07/2001
cr�o�
JR-FOE

274069
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 D Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: ELLENBORO
MISSIONARY PLANTATION RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: MAX BURGIN
Address 300 MISSIONARY
(Street or Route No.
ELLENBORO NC
City or Town State
(704) — 434-9830
Area Code Phone number
4. DATE DRILLED 05/29/03
5. TOTAL DEPTH: 60
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 48 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):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 5_52
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 60 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 48 To 60 Ft. 78M GRAVEL
From To Ft.
Method
POURED
Slot Size Material
in. _ in.
in. in.
16. REMARKS:
Topographic/Land setting
❑ Ridge 0 Slope ❑ Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
PLANTATION RD.
(degrees/minutes/seconds)
28040 Latitude/longitude source: ❑ GPS ❑ Topographic map
Zip Code (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. RIGHT ON
HOLLIS RD. LEFT ON DUNCAN'S CREEK RD.
LEFT ON MISSIONARY PLANTATION RD. c
APPROX. 3/10 MILE ON RIGHT. ro
C._
c
w
cn
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
171)
1
'� SI
111/
`�ub it the original to the Dil o
27699-1636 Phone No.1919 33-31
U0"
( [LICE
Cn t - C- ol 5 - G-3
OF PE �CON TRUCTING THE WELL DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001

Tian 5.05,22 PM Page 7 ce 7
From. Scott Gantt To:Da;aDare:7l, /'_'"'2201
275731
WELL CONSTRUCTION RECORD
ixorth Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) SCOTT GANTT CERTIFICATION # 2=84
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
S LAIL WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
i. WELL. L SE (Check .Applicable Box): Residential E Municipal ❑ Index:Tie(❑ Agricultural ❑ Monitoring E
Recover- ❑ Heat Pump Water Injection ❑ Omer ❑ I`Cki: r, List use:
2 RTLL LOCATION:
Nca: est Run: RU I'HERFORDTON County RLi IHERFORD
1,0T19 FLI.IOT LANE GREEN RIVER HIGHLANDS SI(BDIVISION
(Straw Name Number- Corr munity. Subdivision_ Lot No, Zip Code)
3. OWNER D03G ILAF_LER
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
Latitude/Longitude of well location
35.17 387 / 82 02308
(degecs.'mintitcs'seconds)
) )Ri:0n LOT 16 ELLIOT LANE GREEN RIVER HIGIIL.ANDS :o dl '10 -gitude source: ❑ GPS ❑ Topographic map
S:-: BD1 t,'ISION
iSne,r ar Route No.)
IC idE: )ROION
Sri 381-9236
DEPTH DRILLING LOG
To Formation Description
State 0 90 Clew,
edea Code - Plans Ntuaber
0a z: RICHAED c:30,03
;.nr: Al. D::}'Cti :00
es .-.;E9 RTLL REPLACE ESIS T LNG IVELL'
YES ❑ t 0
-.....-i.viA da Lr EL Below Top of Casing: 45 FT.
(Use "m" If Above lop of C'asb,g)
$Ci: IS 7 ET. Above Land Surface'
,i net, blow land surface requires a variance in
2C0118
9.7.II2L17Lai nl: METHOD OF TEST ARDM
1r. WATER ZONES Cdcythd 380
400 Consolidated Rock
n. Di51CFF'. C':i0 TYPE HYPOCHLORITE Amount 11
Wall lltickneoo
LOCATION SKETCH O
She- :IireCtiOrt and distance in miles from at 1ea440
Detx:a Diameter or Weight/F:. 2.teterial ,; o Sroo Roar; or County Roads. Include tha
SDR 21 PV•O _-_:._..> and common road names.
Dept; Material 2ietherl
To 20 Ft. GRAVEL MIX GR DITY
14 Sr3$EEN
±scrlh Diameter Slot Size )Iaterial
i n..NA TO
Size v`I
tre-
7 rIF; S CiesR1HA THAT THIS WELL WAS CONSTRUCTED I FD IN ACCORDANCE, NCE, WITH I5A NCAC 2C, WELL
r.ONSTRI.TATON STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
6'27/03
SIGNATURE OF PERSON CON S'ili[._"'i;NCe 31-6 APFI.L Date
Salmi( the el ginat to the Division of Water Quality, Groundwater Section, =bit; lai`: Service center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-t REV, 07n001
G l
b CIION
nEr:ENMLE c NAL OFFICE

Morn. Scot: Gar.tt To:
Date: 7/Z2o:3 -Tr:-'. 6.C2.22 615 Page -
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 ONE WQ PERMI704) T77
#
STATE WELL r CONSTRUCTION PERMIT #
(if applicable) (if applicable)
1 eaTI.1 L St-;t neck Applicable Box) : Residential ❑ Minticipsd in?li Sial ❑ Agriculn1ral ❑ Monitoring ❑
2 reeyer; ❑ Heat Pump Water Injection❑ Other In If [',Ater, List list.
LOCATION:
tcnre RUTHERFORDTON Coumy RUTHERFORD
LOT 45 ELLIOT LANE GREEN RIVER HIGHLANDS SUBDIVISION
Name Samber5- Comrreenity, Subdivision, Lot No,. Zip Code)
1. OWNER MICHEI LE P:ATENAI'DE teeptees'minutesseconda)
u.:)crttr I.JT46 ELLIOT LANE GREEN RIVER HIGHLANDS Latitrdedoricirucle source,❑ GPS ❑ Topographic map
SCGDIViSION
DRILLING LOG
(3'.r.�aRLm<Na.) DEPTH 1H
;<_,—t r. ERrJRD70N NC SLi= c_� To Formation Desetipron
ctr. ,., rstate 0 90 Clay
93 620 Consolidated Rock
2757:30
Topographic/Land setting
E Riclge ❑ Slope ❑ Valley ❑ Flat
Latimde'Longimdc of well location
35. 17.387 82.02.308
25-230 s. _
Area Code - Pirorie N'urrber
�. D DE DRILLED 6 3606
c. TOTAL DEPTH 620
D1E3 \tFL L RF:':.. A.^E _EXISTING WELT.? YES ❑ NO _
-. 5 H0itL it Ai ER Lin ELBalmy Top of Casing: 65 FT.
(Use'+" IfAbovc Top of Cash,
OP OF CASLN-4 :S 2 FT- Above Land Surface*
• bnow land surface rcquircsavanm.ein
T'ILlT)‘21)!:F METHOD OF TEST ARDM
to.At.-1-"i 31335S td titlic 580
It DISINFECTION: TYPE HYPOCHLORITE Amount 1% of LOCATION SKETCH
Wall'rhicknese *now direction and distance in miles from at least
e. i:4si��e
?-ptii Diameter or Wel$v.rt. Maorird
[roar 96 Ft. 6114" SDR21 PVC
Material ]13:Iol
i [tarn To 30 Ft. GRAVEL MIX GRAVITY
t. SCR G: a —_-
D.rl: Diameter Slot Size iL^.t r:3.
Ft- i in
1)aaM Size ife:i i!
"room > 3 .o Ft.
DUG-LAT
7.",1 Stu;. roads or County Roads. Include the road
_inb 9cs and common road names. 0
a
C
r
CO
lA
0
'S THAT THIS WELL WAS CONSTRUCTED ':CL WITII I F.3 NC.AC 2C, WELL
ON SANDARDS, AND THAT A COPY OF THIS RECORD I IAS .I[cV O LDE0 TO TIIE WELL OWNER.
612703
SIGNATURE OF PERSON CONS -Ft, C FOO C3 ::C WELL, Date
Submit tij. Iji LtlUlie. livisiuS- ter Quality, Grounds aTer Section. 1636 Mail Service center- Raleigh, NC
r]N'7�)9,,1f36Phone,Ao. [phone],.�y- hin 30 days.
111
Iow-1 REV 0720L1

cord Scott Gant! To:
Date: 7/7/200'0 T.r : a.05:22 PM
27a'29
WELL CONSTRUCTION RECORD
North Carolina -Department of Environment, and Natural Resources Di eirienof Water Quality - Groundwater Section
WELL CO\TRACTOR (INDIVIDUAL) NAME (print) SCOTT GAMS CERTIFICATION #2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS. INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
Cif plicable) _ (if applicable)
t .. WELL USE (Check Applicable Box): Residential E \ inLap'_L E inSuslival❑ Agricultural E Monitoring
kecov iv ❑ Heat Pump Water Injection E Other iJ if C: er, List Use:
5 ELL LOCATION.
tc ELLENBORO County RutI112RFOP.D
1001 ROMF1' CAMPBELL RD
.,,get`:au,e Numb c, Con imuriity, Subdivision, Lot No. Zip Code,
1001 RONIEY CAMPBELL RD
iSirce: o, B.mte No.)
SORO
Topographic/Land setting
D Ridge ❑ Slope E Valley ❑ Flat
Latitude/Longitude of well location
3328.415/ 81.12.245
(demeeslnunutes'secondc)
.-_-lc longitude source: ❑x GPS ❑ Topographic map
DsprH DRILLING LOG
NC 228E1C .` To Formation Description
State Zip Code 0 100 Ciay
Area Code - Piione Nunber
[vATE DRILLED 6173 (03
600
001/5 5512i J. RFPL ACC. EXISTING WELL?
l:du' iA_ti ifi3 LEVEL Be!oa Top of Casing:
YES l0 NO -_
350
(Liss ' IfAbovc Top nfCiut^)
TOP t`d CA3w I3 2 FT. Above Land Surface
'f .., _ mtm.eact or'o, bclow I td ,rfa.c .euw., a.a.-tWuc ,n
IFIA) tops,::
NIR 1101) OF TEST ARDM
ZtiiNLS pthj: 450
100
600 Consolidated Rock
HYI'OCHLORITE Amount 8
Wall Thickness
Diameter or WeighrFc
106 Ft. 6 1/4" SDR 21 PVC
Depth
To 20 Ft GRAVEL MIX Gl'AVITY
Derr
R,
Material \ et1.od
Size
LOCATION SKETCH
directlon and distance in miles from at least
_ R o eds or County Roads. Include the road
.._aoe: s and common road names. CO
C
co
1.tU R t 73Y (0/17 EY THAT 'I'HIS WELL R AS CONSTRUC EED IA _ c :7Ct- le' H 15A NCAC 2C. WELL
'i)'IRi RLOGON STANDARDS, AND THAT A COPY OF THIS RECORD _ 17FilL PROVIDED TO THE WELL OWNER.
6;24/03
SIGNAr'c RE OF PERSON CONS' i 3': "' Date
S ulr,;tir :lm m9 i aI10 the Division of Water Quality, Groundwater Seciden, )630 \.ai'. S_rvice center - Raleigh,NC
in 30 days.
GW-1 REV 0712001

FForn' Scot Gantt To'.
Date- 7/7/2003 Time. 6'A5'.22 P71 Pay`-
2(5;'2:8
WELL CONSTRUCT ION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) SCOTT GANTA CERTIFICATION # 2584
WELL, CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE PE is E LL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable) (Cinch Applicable Box); Residential ❑ muu icipal LI iial D Agricultural ❑ Monitoring ❑
„tee, ;rn- ❑ Beat Rump Water Injection ❑ Other ❑ if Calue.. Iiet Use.
Y: e:LL LOCACIOA'.
•i.;,n¢ GERRIE—ETA Conrry RiDDLE .FOCI
, . - 11A3 NOES ir'.DGE RD
N,nrb cis Community. Sobdvisi on, Lot No, Zip Coda)
PSDDES BOB 36 LLAGE
....Gi:sS 612 HA.:SES RIDGE RD
.c. nr Rana No-)
r. Fisk
Topog_taphicLand setting
[' Ridge ❑ Slope ❑ Valley ❑ Flat
Lt tirude'Longitude of well location
35.14.479; 81.46.771
(deraes/mrtwtes seconds)
Latiwde.lonaitude source: (] GPS ❑ Topographic map
DEpig DRILLING LOG
NC _,,.. Jo Formation Description
Stare 3S Clay
I DATE DR.:L_.ht. 5 13:0;
I0 A!. DF0ili 240
0 65 )';EL[. REPLACE X!STING WELL? YES ❑
sfail,";•.''ii:R Ltn-' Beim. Top of Casing: 12 FT.
(Use If Abovc Tap of Casing)
i)P 0! \SIN._ IS v FT. Above Land Surface'
p of a _ tosooirrid at bc:cw Imd aufau requirco a valiance is
NLE1HOD OF TEST ARDM
230
240 Consolidated Rod:
i L''d1N .107 T1. PE IIYPOCHLORLFE Aznomn:
To 35
Depth
Ft,
tt
Wall Thickness
Diameter or wiciell t.. Natcii„l
61/4" SDR 21 PVC
Y'ateriat Method
GRAVEL MIX GRAVITY
Slot See llxiaiai
in.
sae
LOCATION SKETCH
Show erection and distance in miles from at least
Too Siate Roads or Count' Roads. Includ- th- roid°
n:nnbo_s end common road names. CO
C-
1
i—
a
-c,
_ t l TtiAT THIS WELL WAS C.0?,S 1C - N:G'•VtHISAV A.G. ,WELL
i ION STANDARDS, A.ND'.RDS, AND THAT a COPY OF THIS REGOR EEN PROVIDED TO TFIE WELL OWNER.
6 14 03
SIGVATLRE OF PERSON CO>S:AlieTBis GE WELL Date
Subrrst the original tot e Division of Water Quality, Groundwater Section, 1636 Mail Service center- Raleigh, NC
133-3221, within 30 days.
IGW-1 REV. 0%Cu61

From. Scott Gantt To: Date: 76L20:3 T05 22 PM
275727
WELL CONSTRUCTION RECORD
t-: Cz ` a Department of Environment, and Natural Resources DI e of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) SCOT"f GAN 1 . CERTIFICATION # 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS INC. PHONE # [phone]
ST 11 E WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(II applicable) (if applicable)
: tP EI. L LSE ;Cheek Applicable Box). Residential ❑ Municipal ❑ tndust*ial ❑ Agricultural ❑ Monitoring ❑
Recover' ❑ Heat Pump Water Injection ❑ Other ❑ if C:he-. 'Hat Lae:
vYPOL. LOCATION:
....,...:;o}:n: LAKE LURE
215 ?NTIOCH RD
Coup:} RUTHERFORD
ts,. erv.Cbmmunity. Subdivision, Lot No. Zip Code)
1toO- /TAIN WAY COAST
1.4i\ W.d1RD
Anita No.)
\HE:IRH
Topooraphic'Land setting_
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
Latitude'Longitude of well location
35.29.117 i 82.06.591
(demee>'minutes second;)
`aitu e:Ione:Ude source: 0 GPS ❑ Topographic map
DEPTH DRILLING LOG
NC Frcr. To Formaton Description
State 0 80 Clay
Arcs r_'ode
II 5 9'03
'. FILES REI: REPLACE EXISTENO WELL?
,..,T 1.1 ATES L.E.EEL Below Top of Casing:
YES ❑ NO E
__0 a..
('me `+" If above Top of Casin,i
s ._. sAituu33 n FT- Above Land Surface^
MLR _tp.D. 12 iTE'!<_OD OF TEST ARDyI
n:. t::oroe ZONES Ideptir 395
SJ
395 Cui:S00claled Rod.
UPNITI PION:TYPE. HYPOCHLORITE Amount 9
Mali Th:cnneas
Dianietn er r .-_ nt/Ft. �i: cant
Pt. 61/d" SDR 21 FV'C
Mat Hat Method
20 FI. GRAVEL AIL{ GRAVITY
DL;th Diameter Slot See NI
Fr il:.
D ;u; Size M mit!
Ni to
LOCATION SKETCH
.stet don and distance in miles front at least
tics nv C' , ri Roads. Include the road
: efi and ro❑upon road names. 0
CO
L
C
r-
1
CO
A
1
kip
W
VD
MO HERE _1' C ER Liz 1' THAT THIS WELL WAS CONSTRUCTED IN AC c 0A0'C E l- ITH 12A NCA.0 2C, 1AELL
` TIS'; R. -_ _IO`: STANDARDS, AND THATA COPY OF THIS RECORD HAS u1EN PROVIDED TO THE WELL OWNER.
6'1003
Date
SIGNT RE OF PERSON I DNSTRPOLINei TIES CELL.
Stibin ibc original to the Division of Water Quality, Groundwater Section. 1- _:it Service center - Raleigh, NC
21, within 30 days.
OW-i REV. O" 2001

SoRt
Cate 7/7/2223 Loaf! c J5'22 PM
275726
WELL CON STRLCTION RECORD
', o'rth Carolina Department of Environment, and Natural Resources - id,i oslori oER'rter Quality - Groundwater Section
U L'L.1, CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GAS E P CERTIFICATION # 2534
WEI L CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
SI. C 1 E \\ ELL CONSTRUCTION PERM/1.# ASSOCIATED W(2 PER 111#
df applicable) (if applicable)
L''Si.l'i cc7 d I r vb' Boy)'. Residential ❑ MungRoal eta -ail ❑ Agiculnnal ❑ Monitoring D
❑ clWavereat Pump arer injection ❑ C c i.b i Cse_
(LLE:NBORO
_. -i/'O GAP RD
Caunte RLTHERFORD
+..« '1:rate. Number. CT.tenunity. Subdivision, Lot No,. Zip Coder
Topo_^_:_:hic'Land setting
❑ Ridge ❑ Slope ❑ valley ❑ Fiat
LarrudeT.onthtnde of volt locafon
35 18 26S : 81 46 837
AcloFf. RORICAo HOME OF RLTHERFORDTON 11 +reefemum C:-seconds)
Lerrudalongimda source'. O GPS ❑ Topooraplur map
Isvcc,"c xo,:a No.T DEPTH DRILLING LOG
r'.i i0V AC je:39 -,z Foonation I` - ninon
State -r, ) Clay
74 BYPASS
o„e-.- mnbat
D2r:D D''Al LET, _
ALDEPTH 430
fnq F,.Il I, 1/I..Pt..A('11 I' XISTING AVFI.t
S i.1C'. �.IT!K LI IAra. BeIoia Top of Cseing'.
(TT, + IfAbovt Sop ofCas
FT. Above Land Sm{ace°
_ails« adtra , v odes ..:.,
•
l 01 ... S_S:'.._
YTS ❑ No ❑
60 1'r
Di-riOD OF TEST : ARDVI
.Fs( t1:. 420
Consolidated Rod:
C'. SINFECT10N'. TYPE II di .4aoimt It
WollP,cRncai
De(11! Diameter or WeighoR \. tans!
Ft 6 114 " SDR21 P"'<
Ft.
o=
\taler'.ai
Ft. CIRAVE.L 7d-\ GRAVITY
Slat e:ze
Size
LOCATION SKETCH
Imection and distance in mils from ar least
LV(' State Roads or Counina Roads. Include the road
FtrIZIIZZIHS and common a. rnfIIles. W
CO
C THIS WELT. WAS COESLP c 5 EPROVIDED
A I A 1, N: iC A EI
,SI -v S A z) RDS, AD IHAC 1 COPY US' 8 ._1JS- _ L�C. Cv IDEll TO THE A'/ELL OWL ER.
7703
Dose
Subr,:tt the original to the Division of Water Quality, Grount water Section. 1635 hail Service center - Raleigh, SC
121, within 3i) days.
(TV :-1 REV. -__
GROUO[i'AIATER SE' iION
ASHEVILI_E REP-IOi4^+I- PEFICE

275647
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 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 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 Town State Zip Code
(828) — 863-1301
Area Code Phone number
4. DATE DRILLED 06/02/03
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: _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): 7 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" 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 ❑ 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 S. FROM RUTHERFORDTON. RIGHT
ON COX RD. GO PAST THE CONCRETE PLANT.
LEFT ON JOHN WATSON RD. GO APPROX. 1-1/2
MILE AND TURN RIGHT ON CAPOZZI VINEYARD.
I DO HEREBY CERTIFY THAT
NSTRUCPON S1TAQ AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1 /0 e T)/UM . ` / - a -rI .3
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
SIGMA OF RSON CONSTRUCTING THE WELL DATE
' Submit the original to the Divisiob of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
k.
276994636 Phone No [phone], within 30 days. GW-1 REV. 07/2001
1

269375
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 to Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: ELLENBORO
HOLLIS RD.
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: DARRYL GETTYS
Address 3671 HOLLIS RD.
(Street or Route No.)
ELLENBORO NC 28040
City or Town State Zip Code
�04) — 735-0852
Area Code Phone number
4. DATE DRILLED 02/03/03
5. TOTAL DEPTH: 54
6. DOES WELL REPLACE EXISTING WELL? YES ® NO 0
7. STATIC WATER LEVEL Below Top of Casing: 36 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
, Zip Code)
11. DISINFECTION: Type CHLORYTE Amount 8.28
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 54 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 36 To 54 Ft. 78M GRAVEL
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
HOLLIS RD. FROM ELLENBORO. APPROX. 1/4
MILE ON LEFT PAST JACK MOORE MTN. RD.
(3671 ON BOX)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
N� W C/ e-- ,� - .3 - D J R
GTiIA�— OF O CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. (919) P33-3221, within 30 days. GW-1 REV. 07/2001

267964
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:RUTHERFORDTON
PINEY KNOB RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CHRIS DALE
Address PINEY KNOB RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 287-2381
Area Code Phone number
4. DATE DRILLED 01/09/03
5. TOTAL DEPTH: 51
6. DOES WELL REPLACE EXISTING WELL? YES ❑ 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 1 SA 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 51 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 31 To 51 Ft. 78M
From To Ft.
16. REMARKS:
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 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 N. FROM RUTHERFORDTON. LEFT
ON SCHOOLHOUSE RD. IN GILKY. LEFT ON
PAINTERS GAP RD. LEFT ON PINEY KNOB RD.
1ST DRIVE ON LEFT.
m Di
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY
�OFF`THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1- \ `� OF --(SON CONSTRUCTING HE WELL — DATE
Submit the original to the 1itvisitn of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. (919) 733.13221, within 30 days. GW-1 REV. 07/2001

267950
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 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: FOREST CITY
SULFUR SPRINGS CH. RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BYRON & BRIANA REID
Address SULFUR SPRINGS CH.RD.
(Street or Route No.)
FOREST CITY NC 28043
City or Town State Zip Code
(828) — 2454871
Area Code Phone number
4. DATE DRILLED 1/31/03
5. TOTAL DEPTH: 505
6. DOES WELL REPLACE EXISTING WELL? YES ® NO 0
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): 30 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" SDR21 PVC
From
From
13. GROUT: Method
From 0 POURED
From
14.SCREEN:
From To _ Ft.
From To _ Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
Depth Material
To 20 Ft. QUHCRETE
To _ Ft.
Depth Diameter Slot Size Material
in. _ in.
in. in.
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: ❑ 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. #221 S. FROM RUTHERFORDTON. GO
PAST JUVI COLES STORE AND RT. ON SULFUR
SPRINGS CH. RD. 1ST DRIVE ON LEFT PAST
ARTHUR HENSON RD.
0
16. REMARKS:
IDOFIFRFBY
tQNSTRUCTION STAND
j
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
OF PERSON CONSTRUCTING THE WELL
DATE
S4mit the original to thejivisi i n of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. (919) 733 t 221, within 30 days. GW-1 REV. 07/2001

267936
u
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
PHONE # [phone]
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC WQ PERMIT #
STATE WELL CONSTRUCTION PERMIT # _ ( applicable)
(if applicable)
1. WELL USE (Check Applicable ox): Reside
tial ®0 Municipal/Public Othbr ❑ If Industrial
ia1Li0seA���l 0
[ Pump Monitoring ❑ Recovery 0 Injection
2. WELL LOCATION: Topographic/Land and setting
Nearest Town: BOSTIC County RUTH ❑Ridge ❑c ❑Valley ❑Flat
WALKER DAIRY RD. Slope alle
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) Latitude/longitude(checkappropriate of bwelox)
location
3. OWNER: PAMELA DIXON
Address WALKER DAIRY RD. (degrees/minutes/seconds)
(Street or Route No.)
BOSTIC NC 28018 Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
828- City Town State Zip Code DEPTH
() 247-4475 From To
Area Code Phone number
4. DATE DRILLED 01/29/03 DRILLING LOG
DR
5. TOTAL DEPTH: 605 DRIL To
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL BelowTop of Cg Top of Ci
(Use "+"AbnCasing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 16.5
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. _ m.
15. SAND/GRAVEL PACK:
Depth Size Material
From To _ Ft.
From To _ Ft.
)I
r�
INATURE OF PERSON CONSTRUCTING
Submit the original to 1he Division of Water Quality, Groundwater Section, 1636 Mail ServiGW enter- Raleigh,
/e Oh NC
27699-1636 Phone-No.-r919) 733-3221, within 30 days.
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. #64 E. FROM RUTIIERFORDTON. RIGHT
ON PEA RIDGE RD. LEFT ON ANDREWS MILL RD.
LEFT ON ENGINEER RD. RIGHT ON WALKER
DAIRY RD. 1/10 MILE ON LEFT.
L.
01:Z kid 9- a33 CO
16. REMARKS:
LL
I DO HEREBY CERTIFY THATS THIS WELL AND THAT AACOS PY OF THIS CONSTRUCTED ORD HA BIN EEN PROVIDED TO THE WECE WITH 15A NCAC 2C, LL OWNER
��� �� iEVVEL �� DATE 7—
C 5

26'79GO
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: ELLENBORO
CAMPFIELD CHURCH RD.
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: RALPH JONES
Address 319 CAMPFIELD CHURCH RD.
(Street or Route No.)
ELLENBORO NC 28040
City or Town State Zip Code
(828) - 453-7719
Area Code Phone number
4. DATE DRILLED 1/28/03
5. TOTAL DEPTH: 62
6. DOES WELL REPLACE EXISTING WELL? YES ® NO 0
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): 12 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County RUTH
Zip Code)
11. DISINFECTION: Type CHLORYTE Amount 5.52
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 62 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
From To _ Ft. in.
From _ To Ft. in. _
15. SAND/GRAVEL PACK:
Depth Size
From 50 To 62 Ft. 78M
From To Ft.
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/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. LEFT ON
CAMPFIELD CHURCH RD. 3/4 MILE ON LEFT. (319
ON BOX)
O
0)
-*t
rn
co
rn
-D
rat
c
G
0
rn
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
G9NSTRIkCTIOri STANN AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELLOWNER
--ILY'`.'' ' "'o✓f�` `Ti.�,.., f/Pi�.fr�P /- .a rY- 0,3
OF P CONSTRUCTING THE WELL DATE
Jl/
Submit the original to the
276199-1636 Phone No. (-91_!
SI
vis'ot
733-Z
of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001

267937
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: BOSTIC
CHERRY RIDGE SUBDV.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BRAD WICKHAM
Address CHERRY RIDGE SUBDV.
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code
(828) - 286-2521
Area Code Phone number
4. DATE DRILLED 01/27/03
5. TOTAL DEPTH: 125
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing tenninated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 12 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 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.
15. SAND/GRAVEL PACK:
Depth Size Material
n. in.
From _ To _ Ft.
From To Ft.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
BUS. 74 E. FROM FORST CITY. LEFT ON
BOSTIC/SUNSHINE HWY. RT. ON SALEM
CHURCH RD. LEFT INTO CHERRY RIDGE. 1ST
KLOT ON LEFT.
01 :Z Wd 9- 83.E CO
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
1CONSTRUCTION STAND�5, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
+'CURE OF PERSONCONSTRUCTING-//A �f WELL - DATE 7 - G�
Submit the original to th
27699-1636 Phone No:;
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
9) 7: 3-3221, within 30 days. GW-1 REV. 07/2001

267938
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: UNION MILLS
OWENS CHAPEL RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JOHNNY FORNEY
Address 224 OWENS CHAPEL RD.
(Street or Route No.)
UNION MILLS NC 28167
City or Town State Zip Code
(828) — 286-0137
Area Code Phone number
4. DATE DRILLED 01/15/03
5. TOTAL DEPTH: 405
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A 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 100 Ft. 6-1/4" SDR.21 PVC
From _ To Ft.
From _ To _ Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(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. RIGHT
ON OWENS CHAPEL RD. 3RD DRIVE ON RIGHT.
v
fV
0
c
O
_=
rn
G
nn NFREBY CFRTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
-)1CONSTRUCTIQN S'TAN S, AND THAT�QA COPY OF THIS RECORDHASBEEN PROVIDED TO THE WELL OWNER
_ t / /. _it 's 1l /- .RD7/?fl%
ATURE OF PERSON CONSTRUCTING THE WELL
/- /5--
DATE
Submit the original to th Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. ( 19) 7: 3-3221, within 30 days. GW-1 REV. 07/2001

267952
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: LAKE LURE
MCDANIEL RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: RON DALTON
Address 361 MCDANIEL RD.
(Street or Route No.)
LAKE LURE NC 28146
City or Town State Zip Code
(828) — 625-1574
Area Code Phone number
4. DATE DRILLED 01/15/03'
5. TOTAL DEPTH: 145
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): 20 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
I I. DISINFECTION: Type CHLORYTE Amount 3
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 ❑ 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 MCDANIEL
RD. BROWN HOUSE ON LEFT.
0
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I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CQNSTRUCTION-STARDA Y3'a, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNA RE OF PERSON C STRUCTING THE WELL
11 L.
Submit the original to the Div sioof Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
276819-I636 Phone No. (919j-1733-3 21, within 30 days. GW-1 REV. 07/2001
DATE

267961
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 ❑ Maher, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
KINDLEWOOD DR.
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: RENE MICHAUD
Address 206 KINDLEWOOD DR
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 287-0349
Area Code Phone number
4. DATE DRILLED 01/15/03
5. TOTAL DEPTH: 54
6. DOES WELL REPLACE EXISTING WELL? YES ® NO 0
7. STATIC WATER LEVEL Below Top of Casing: 39 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County RUTH
Zip Code)
11. DISINFECTION: Type CHLORYTE Amount 6.9
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 54 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 39 To 54 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
LEFT ON EDWARDS ST. IN RUTHERFORDTON
(IN FRONT OF HOSPITAL). LEFT ON
KINDLEWOOD DR WELL AT DEAD-END.
CD
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I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
NS AND AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
II
Submit the original to the
27699-1636 Phone No. (91.
RE OF PER8DN C NSTRUCTING THE WELL (/7/)k-C'---• " / 5-- 6 J
DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001

267062
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: FOREST CITY
JAYNES RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: GERALD HANNA
Address JAYNES RD.
(Street or Route No.)
FOREST CITY NC 28043
City or Town State Zip Code
(828) — 245-6885
Area Code Phone number
4. DATE DRILLED 01/15/03
5. TOTAL DEPTH: 73
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 53 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 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 73 Ft. 24" CEMENT
From
From
To _ Ft.
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 53 To 73 Ft. 78M
From To Ft.
16. REMARKS:
Method
POURED
Slot Size Material
in. _ in.
in. in.
Material
GRAVEL
Topographic/Land setting
0 Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 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.
APPROX. 1 MILE AFTER GOING PAST ROBBINS
BRICK YARD. TURN LEFT ON JAYNES RD. DRIVE
GOES STRAIGHT AT DEAD-END. (NO BOX #)
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1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
NSTRUCTION STA -AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
2 L/1-1/ i l?i7C /' / S O3
11 i' l �r}t1J E OF PE CONSTRUCTINWELL DATE
Submit the original to the D isio of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. (919)`J733-3 21, within 30 days. GW-1 REV. 07/2001

267961
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 0 Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
TOM CAMP RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DANNY CAMP
Address 480 TOM CAMP RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 287-7187
Area Code Phone number
4. DATE DRILLED 01/13/03
5. TOTAL DEPTH: 41
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 21 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 41 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
21 To 41 Ft. 78M GRAVEL
To Ft.
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 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. RT. ON TOM CAMP RD. HOUSE ON
LEFT. (BOX #480)
0
111
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSnL cnas 7S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
TU OF PE NSTRUCTING THE WELL DATE
ThI
11:
r
Submit the original to the Divi ion of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

267939
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH
HUNTING DR.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CARLSON & FARMER
Address HUNTING DR.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 289-0207
Area Code Phone number
4. DATE DRILLED 01/10/03
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 I5A NCAC 2C .0118.
9. YIELD (gpm): 100 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 60 Ft. 6-1/4" SDR.21 PVC
From To Ft.
From _ To Ft.
13. GROUT: Depth
From 0 To 20
From To
14.SCREEN: Depth
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
Material Method
Ft. QUIKRETE POURED
Ft.
Diameter Slot Size Material
in. in.
in. in.
Material
Topographic/Land setting
❑ Ridge ❑ Slope 0 Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #64 E. FROM RUTH. LEFT ON HUNTING
DR. NEW DRIVE 1/4 MILE ON RT.
0
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I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
1 ONSTRUQTION STAND S, AND THAq A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/ d Q
Li L.1 T(5RE OF PERSON CONSTRUCTI THE WELL DATE
Submit the original to the pivision of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
2169Y 1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
J

267954
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 D
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: BOSTIC
CANE CREEK MTN. RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ANNA SANE
Address 1858 CANE CREEK MTN. RD.
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code
828) - 287-9226
Area Code Phone number
4. DATE DRILLED 01/09/03
5. TOTAL DEPTH: 305
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): 20 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 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 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. #64 E. FROM RUTHERFORDTON. RIGHT
ON CANE CREEK MTN. RD. GO 3.2 MILES. 2ND
GREEN GATE ON RIGHT.
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I DO HEREBY CERTIFY THAN; THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
NIIT[ON STANDiS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
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're>in n� -C n , .2 & 1/ A--,----- 4.--‘ lie/ 7�--/ / - 9 - 0 3
h li' S� TURE OF PE SON CONSTRUCTING THE L DATE
S bmit the original to the pivisik n of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
21699=1636 Phone No.,(919) 733�111113221, within 30 days. GW-1 REV. 07/2001

267956
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: ELLENBORO
GLOVER RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DELBERT PITTMAN
Address GLOVER RD.
(Street or Route No.)
ELLENBORO NC 28040
City or Town State Zip Code
(828) — 453-0662
Area Code Phone number
4. DATE DRILLED 01/08/03
5. TOTAL DEPTH: 285
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 6.5
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.
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.
From
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
HOLLIS RD. FROM ELLENBORO. LEFT ON
GLOVER RD. APPROX. 1/2 MILE ON RT. HOUSE
BEHIND SHOP ON HILL.
O
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0
1 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
ISIO TURE OF PERSON C STRUCTING THE WELL DATE
ubmit the original o th¢ llivt ion of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
99 1A36- Phone .No. (9119) 7?3-3221, within 30 days. GW-1 REV. 07/2001
ASP?.'......_.

267941
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 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: UNION MILLS
BILLS CREEK RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: WADE CONNER
Address 4231 BILLS CREEK RD.
(Street or Route No.)
UNION MILLS NC 28167
City or Town State Zip Code
(828) — 625-4969
Area Code Phone number
4. DATE DRILLED 01/08/03
5. TOTAL DEPTH: 405
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 I5A NCAC 2C .0118.
9. YIELD (gpm): 4 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 10.5
12. CASING:
From 0
Depth Diameter
To 50 Ft. 6-1/4"
To _ Ft.
To Ft.
Depth Material
To 20 Ft. QUIKRETE
To Ft.
Depth Diameter
To Ft.
To Ft.
From _
From
13. GROUT:
From 0
From
14.SCREEN:
From
From
Wall Thickness
or Weight/Ft. Material
SDR.21 PVC
15. SAND/GRAVEL PACK:
Depth
From _ To
From To Ft.
16. REMARKS:
Method
POURED
Slot Size
in.
in.
Size Material
Ft.
Material
in.
in.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #64/74A W. FROM RUTHERFORDTON.
RIGHT ON COVE RD. LEFT ON BILLS CREEK RD.
APPROX. 3/4 MILE ON RIGHT. (BOX #4231)
O1:Z Wd 9- 03d CO
§TR(1CT10N'STANDA
IG
SuILmit the original to the DJviSiot
27699-1636 Phone No. (919) 733-3
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
0EL% ram, /- t-- 6.3
RE OF PERSON CONSTRUCTING THE WELL DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001

267942
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 ® MunicipallPublic ❑ Industrial ❑ Agricultural
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
WINDY RIDGE DR
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JOHN LONG
Address WINDY RIDGE DR.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(/) — 247-3315
Area Code Phone number
4. DATE DRILLED 01/07/03
5. TOTAL DEPTH: 365
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ral
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 9.5
12. CASING:
From
From
From
13. GROUT:
From 0
From
I4.SCREEN:
From
From
Depth Diameter
0 To 40 Ft. 6-1/4"
To Ft.
To _ Ft.
Depth Material
To 20 Ft. QUIKRETE
To Ft.
Depth Diameter
To Ft.
To Ft.
15. SAND/GRAVEL PACK:
Depth Size
From To _ Ft. _
From To Ft.
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
16. REMARKS:
Method
POURED
Slot Size Material
in. _ in.
in. in.
Material
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.
LEFT ON COOPERS GAP RD. RT. ON MOSS RD.
LEFT ON WINDY RIDGE DR. APPROX. 1/2 MILE
ON RIGHT.
0 h pZ Wd 9- 9JJ CO
c
—
C
cn It
0
0
RUST ONi6Tk4Nta
2)6
Subtititthe-original to the I' •ision
2769a9116$6Phpne No. (919)r733-3
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH l5A NCAC 2C, WELL
ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
2_
E OF PERSON CONSTRUCTINGTHE WELL DATE
f Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
1, within 30 days. GW-1 REV. 07/2001

267957
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: RUTHERFORDTON
FARMINGTON LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JOE CARSON
Address FARMINGTON LANE
(Street or Route No.)
RUTHERFORDTON N C 28139
City or Town State Zip Code
(828) — 287-4239
Area Code Phone number
4. DATE DRILLED 01/07/03
5. TOTAL DEPTH: 405
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 10 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 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
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 E. FROM RUTH. CROSS CATHY'S
CREEK. APPROX. 3/4 MILE. LEFT ON
FARMINGTON LANE. NEW HOUSE AT TOP OF
HILL ON LEFT.
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
(11
_Jfi�
J i 0?
Submit the original to th Divi!
2t6994636-Phone:No. (919) 73
TURE OFL PERSON C NSTKCTING HE WELL DATE /
ion of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
5-3221, within 30 days. GW-1 REV. 07/2001

267968
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH
ARTHUR'S DR.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DONALD HINES
Address 63 ARTHUR'S DR.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 863-2715
Area Code Phone number
4. DATE DRILLED 01/07/S403
5. TOTAL DEPTH: 84
6. DOES WELL REPLACE EXISTING WELL? YES ® NO 0
7. STATIC WATER LEVEL Below Top of Casing: 66 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):
t 1. DISINFECTION: Type CHLORYTE Amount 8.28
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 84 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
CEMENT
From To Ft.
From To Ft. _
15. SAND/GRAVEL PACK:
Depth Size
From 66 To 84 Ft. 78M
From To Ft.
16. REMARKS:
in. in.
in. in.
Material
GRAVEL
Topographic/Land setting
❑ Ridge ❑ Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
NEW BY-PASS 74 W. FROM FOREST CITY. EXIT
ON PEA RIDGE RD. RT. AT STOPO SIGN. RT. ON
ARTHUR'S DR. HOUSE ON LEFT AT DEAD-END.
c
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
tIDA R38, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
r
11 i
1Su`imit the original to the Di
k,
276R9-1636Phone No. (919
tv�
OF PER CONSTRUCTING THE WELL DATE
isio of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
33-3 21, within 30 days. GW-1 REV. 07/2001

267969
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)
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
HWY. #226
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: D.C. BUMGARNER
Address 3018 NC HWY. #226
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code
(828) — 245-5134
Area Code Phone number
4. DATE DRILLED 01/06/03
5. TOTAL DEPTH: 78
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 58 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated al/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 9.2
Wall Thickness
or Weight/Ft. Material
CEMENT
12. CASING:
Depth
From 0 To 78
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 58 To 78 Ft. 78M
From _ To _ Ft.
Diameter
Ft. 24"
Ft.
Ft.
Material
Ft. CEMENT
Ft.
Diameter Slot Size
Ft. in. _
in.
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/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 POLKVILLE GO UP HWY. #226 N.
APPROX. 2 MILES ON RT. PAST GOOD OLE BOYS.
(3018 ON MAILBOX.)
11:Z Wd 9- UBJ CO
NTIWyCTION STAND
SI
Subrt the onginal 19 the 1Jivisio
2769Q 1636 Phone.No. (919) 733-3''
ASH_ ILI E
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
CONSTRUCTING THEWELL W� DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001

2679r8
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 ft 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 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH
WINDY RIDGE DR.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JOHN LONG
Address WINDY RIDGE DR.
(Street or Route No.)
RUTHERFORDTON N C 28139
City or Town State Zip Code
(828) — 247-3315
Area Code Phone number
4. DATE DRILLED 01/03/0303
5. TOTAL DEPTH: 705
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 I5A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 19.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 80 Ft. 6-1/4" SDR.21 PVC
From To _ Ft. _
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To Ft.
From To Ft.
16. REMARKS
Topographic/Land setting
❑ Ridge ❑ Slope 0 Valley 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.
LEFT ON COOPERS GAP RD. RT. ON MOSS RD.
LEFT ON WINDY RIDGE DR. APPROX. 1/2 MILE
ON RT.
0 -
W
1
m
CO
-D
iV
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
i NUNS 1 RUCTION STAN[ ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
l/34
J L.
ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
i27699-1636 Phone No. (19)133-3221, within 30 days. GW-1 REV. 07/2001

267949
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 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: UNION MILLS
FERGUSON RIDGE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: GENEVA MILLER
Address 671 FERGUSON RIDGE RD,
(Street or Route No.)
UNION MILLS NC 28167
City or Town State Zip Code
(828) — 286-1585
Area Code Phone number
4. DATE DRILLED 01/02/03
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): 40 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 160 Ft. 6-1/4" SDR.21 PVC
From _ To _ Ft. _
From _ To _ Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To Ft. in. _ in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From
From
To _ Ft.
To Ft.
16. REMARKS:
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
HW. #221 N. FROM RUTHERFORDTON. RT. ON
OWENS CHAPEL RD. RT. ON FERGUSON RIDGE
RD. 3/4 MOLE ON RT. (671 ON BOX)
0
-n
n
rn
p
t
v,
-o
tV
0
�Od-IEREBY CERTIFY TI{A4`'1'HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
g INSTRUCTION STANDS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
t� iD� � -- / ,Gl�- I //a /7;. R
= ` SI TIJRE OF PERSON CONSTRUCTING THE 'ELL DATE
Sutmit the original to the:Divisi 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

267943
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 ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: LAKE LURE
MOORELAND MTN. SHORES
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JOHN MOORE
Address MOORELAND MTN. SHORES
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
(828) — 625-1847
Area Code Phone number
4. DATE DRILLED 01/02/03
5. TOTAL DEPTH: 405
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): 50 METHOD OF TEST ARD
10. WATER ZONES (depth):
I
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 10.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 20 Ft. 6-1/4" SD1t21 PVC
From _ To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. QUIKRETE
From _ To _ Ft.
14.SCREEN: Depth Diameter
From To Ft.
From _ To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To Ft. _
From To Ft.
Method
POURED
Slot Size Material
in. in.
in. in.
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
HWY. #64/74A E. FROM LAKE LURE. LEFT ON
BILL'S CREEK RD. LEFT ON BUFFALO CREEK
RD. AT BILL'S CREEK STORE. GO PAST ROAD TO
FAIRFIELD ENTRANCE. APPROX. 1 MILE ON
LEFT. BUFFALO CREEK RD. TURNS INTO
BUFFALO SHOALS RD. ABOUT 1/2 MILE AFTER
FAIRFIELD ENTRANCE.
tO
CO
rn
m
p
I
c.
—o
N
0
16. REMARKS:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
q NSTRUCTION STANDA1 S1 AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/ ' a ' C _�
SIGN#' OF PERSON CONSTRUCTING THE LL DATE
Sub it the original to the D vision of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1536 Phone No. (919)'733-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
James vt Camp, ,Jr.
268615
CERTIFICATION # 2 1 3 R
WELL CONTRACTOR COMPANY NAME Camp. S WP 11 & Primp ('n Tnc PHONE #Al2R1 dC"3-7322
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�:1 1 %
Nearest Town: it, bin 1 County U�'-her-kY(
H;qlSdtcals PKA.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ill litt44 k
Address P t� (.j n X 214
(Street or Rowe No.)
HenYle4� I��lC t$076
Ciry or Town State Zip Code
( )-
Area coda Phone number
4. DATE DRILLED I (--) 3
5. TOTAL DEPTH: I S /
6. DOES WELL REPLACE EXISTING WELL? YES Q NO 0
7. STATIC WATER LEVEL Below Top of Casing: if 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): `�-b' METHOD OF TEST &ir
10. WATER ZONES (depth):
Topographic/Lan setting
❑Ridge ❑Slope Malley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
a;rt
tip I R ('evhDi Gated Yrf k
EP
From To
%
11. DISINFECTION: Type C'h 1 Sri na
12. CASING:
Depth Diameter
From 0 To_% Ft. 6 1 / 4
From______ To Ft.
From To Ft.
13. GROUT: Depth
Frorri_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.
Amount I-u/)
Wall Thickness
or Weight/Ft. Material
gDR-21 PVC
Material
Neat Cement
Method
Hand
Slot Size Material
in.
in,
Material
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
to O/esbpr^-
�ll�Y�ero,_
Hervr'ietra
-; A �t C
y
cnrc
•
NA C%113!Oc —• \+:nr
224 relf Crl<.d .
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFI r
S, AND THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
y61 i l�, / ,,Z- ID- cJ
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to tlte'D vision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. (9 9) 73-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James s ur Camr Tr- CERTIFICATION # 21 9R
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
Camp' s win' l
268616
R Pomp. Cry Inr PHONE $478) 4251-7122
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential tV Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT):QN:,t
Nearest To •i�-l.L,W , yr•- County'
eePS gyp
(Strut Name, Numters, Community, Subdivision, Lot No., Zip Code)
3. OWNER:DAAAA W 01
Address 5 /Cn1(� v 7C) F1ox �113
(C.l1�k XA I A cN�r —Route I) c • -g 3 Ct
City or To State Zip Code
(� a �C14 R
Area code- Phone number
4. DATE DRILLED (• a `.i- e) 3
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES I 'NO 0
7. STATIC WATER LEVEL Below Top of Casing: \ U 0 FT
(Use •'+•' if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): ,10 METHOD OF TEST p ir
10. WATER ZONES (depth). ( ks 0
11. DISINFECTION: Type chi Sri na Amount
Wall Thickness
or Weight/Ft. Material
cDR21 PVC
12. CASING:
Depth Diameter
From p To (0 O Ft 6 -1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth
From n To 2 p Ft.
Material
Pl at Ccmcnt
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From_ To Ft.
From To Ft.
Method
IIa
Slot Size Material
in.
in.
16. REMARKS:
1O� HEREBY CERTIFYTEiA-'i;i
"CONSTRUCTION STANDARDS)
1=4J1
j SIG
1 J
Sot f:tife original to the. Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27494634 Phbne Nos.(919) 7 within 30 days. GW-1 REV. 07/2001
Topographic/Land setting
❑Ridge ❑Slope Malley ❑Flat
(check appropriate box)
Latitudellongitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To F,rma(�Qn Description
it l �h
Lo a S r5t-b
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.
N
J
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY Of THIS RECORD HAS (SEEN PROVIDED TO THE WELL OWNER
ot-41
ATURE OF PERS N CONSTRUCTING THE WELL
,2-».p;
DATE

268620
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James L Carp p JL CERTIFICATION 21 38
WELL CONTRACTOR COMPANY NAME Camp' c Well & Pnrnp Cn Tnr PHONE #ffi?A) d5i-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential hf Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection O Other O If Other, List Use
2. WELL LOCATION: ``
Neare;;t Town: ..)pf n cla le County Rt('�1PI✓ 1 c rd
(1,401) Da, oiRd .
(Street Name, Numbers, CoMmunity, Subdivision, Lot No., Zip Code)
Nlihire d Gordol1
Address 4'eIO Plc{ r;
3. OWNER:
(Street or oute No.)
[',caber() C •8r&2JO
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED /%-�,�
5. TOTAL DEPTH: ,3."1,.'7
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 4,0
(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 accordanceslth 15A NCAC 2C .0118.
9. YIELD (gpm): J METHOD OF TEST 41 r
10. WATER ZONES (depth): 3 O 0
11. DISINFECTION: Type rh1 nri na
12. CASING:
Depth Diameter
From p To 675" Ft. 6 4/4
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 2 0 Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Amount ;Lc -at 5
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Material
Neat Cement
Method
Iland
Slot Size Material
in.
in.
From To Ft.
Topographic/Land setting
Ridge ❑Slope OValley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: OGPSOTopographic map
(check box)
DRILLING LOG
F rmatin Description
Clay (1;f1
P5 :,;<5- Consohdeded ro rK
ED PTH
From To
s
JOCATION SKETCH
Show direction and distance in miles om at least
two State Roads or County Roads. In ude t13e road
numbers and common road names. dep i nd:.ti c
Cy we SxTelhit=Vc
PGdI ✓y RA,
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY O THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
03
0
N f',�
N —+
—t O
GNATURE OF PERSCJN CONSTRUCTING THE WELL ✓ DATE
on of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
I, within 30 days. GW-1 REV. 07/2001
A

268621
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
J rn s Camp-, Jr
CERTIFICATION it7 1 9 R
WELL CONTRACTOR COMPANY NAME CampWel 1 R. Primp Cn Tne PHONE i $7Rl 4Sl-7 l22
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERh1IT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential V-Municipal/Public 0 industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT}{.)N:,
Nearest Town: ��,.1�11,1t�j'' Y-- County ZI.AtlI✓ ,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Nt V k»r4 n
4 Sty .i A 1L
ndr ,lf ` �Sp;et ar R�Ce No.) �q
lid fR' M^v '} 17t.
City or Town Stain Zip Code
( )-
Area code- Phone numbe
4. DATE DRILLED % `Z • 0
5. TOTAL DEPTH: t
6. DOES WELL REPLACE EXISTING WELL? YES ENO 0
7. STATIC WATER LEVEL Below Top of Casing: CPU 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 accordatice.twith 15A NCAC 2C .0118.
9. YIELD (gpm): U METHOD OF TEST D i zr
10. WATER ZONES (depth):
Topogra,Phic/Land setting
❑Ridge GlSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/miwteslseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From o on Description
f,1-ti S
11. DISINFECTION: Type rh 1 nr i n e
12. CASING:
II1 rCONSTRUCTION ST
Dep Diameter
From p To 11 Ft. 6 i J 4
From To Ft.
Froth To Ft.
13. GROUT: Depth Material Method
Frorng To 20 Ft. Neat Ccmc-nt Huila
Amount
Wall Thickness
or Weight/Ft. Material
SDR71 PVC
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.
AS
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or Co ty Roads. Include the road
number road names.
t o%
--
J
0o
THIS WELL WAS CONSTRUC IED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY 0 THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PE
a/k/
CONSTRUCTING THE WELL DATE
c•IO 63
(8tibniitthe origh%{ tgctpe Di ision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001

268624
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James ar- Carttp, Tr CERTIFICATION,/ 7138
WELL CONTRACTOR COMPANY NAME ('amp' s 1p7cnl 1 R Pomp ('ram In en PHONE ,/482S0 a .3-7322
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ PERMIT,/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Llf—/ Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: G-ttke ✓e County U ( e r
F5i lit
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 1=✓i r ri c E)1'(ar
Address /Y4 Na51/ �UA
fake 1.,.v
(Sweet A ute No.
e 1 74
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED / -) 0 - D 3
5. TOTAL DEPTH: (nc`i
6. DOES WELL REPLACE EXISTING WELL? YES M NO ❑
7. STATIC WATER LEVEL Below Top of Casing: AM FT.
(Use '4" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 4 METHOD OF TEST p y r
10. WATER ZONES (depth): 'i %U
11. DISINFECTION: Type chi nr i na
12. CASING:
Depth r - Diameter
From I To 6' 3 Ft 6 1/ 4
From To Ft.
From - To Ft.
13. GROUT:
From 0
From
14. SCREEN:
Depth
To 20
To
Depth
From To
From To
15. SAND/GRAVEL PACK:
Ft.
Ft.
Diameter
Ft. in
Ft. in.
Material
Amount h CLt/15
Wall Thiclmess
or Weight/Ft. Material
cng2j PVC
Method
Neat Cement Hand
Slot Size Material
in.
in.
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
:CERTIFY. T
r� iC"ON.�TRUCT(ON`SUMO
I t� - 1,
Submit the original to t)I4 Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
12-7699-i636It(groiNiii(49) 733-3
_
Topographic/Land setting
❑Ridge ❑Slope ❑Valley 63Flat
(check appropriate box)
Latitude/longittide of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH PRILL1NG LOG
From To Formation Description
61 veigi 5a Ad
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. 1
LoIL
k
Ils
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFT 1
AND THAT A COPY QI THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
aMle4
GNATURE OF PEV/4 CONSTRUCTING THE WELL
%0-03
DATE
21, within 30 days. GW-1 REV. 07/2001
Rtrkerr-

From: Scott Gantt To: Date: 2/13/2003 Time: 11:21:20 PM
Page 8 of 8
268612
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTC GANTT CERTIFICATION # 2584
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 wen RUTHERFORDTON County
LOT 49, 156 SASAFRAS DR RIVER RIDGE SUBDIVISION
(if applicable)
Municipal ❑ - Industrial 0 Agricultural 0 Monitoring 0
Other 0 If Other, List Use:
RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER BILL BOWE
ADDRESS 6338 Terra Rosa Circle
(Strad or Route No.)
Boynton Beach.
City or Town
561-635-6105
IL
State
Area Code - Phone Number
4. DATE DRILLED 1/15/03
5. TOTAL DEPTH 260
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 150 FT.
(Usa "+" IfAbove Top of Casing)
8. TOP OF CASLNG iS 2 FT. Above Land Surface*
"Top of meutg ,enn6,ated allor blow land surface rcquires a variance in
acenrdance with ISA NCAC 2C.0118
9. 'YIELD (gpm): 12 ME HOD OF TEST ARDM
10. WATER ZONES (depth): 250
33437
Zip Code
Topographic/Land setting
0 Ridge ❑ Slope 0 Valley ® Flat
Latitude/Longitude of well location
35,17259 / 81.59.171
(degrees/minutes/seconds)
Latitude/longitude source: ® GPS ❑ Topographic map
DEPTH
From
0
DRILLING LOG
To Formation Description
50 Clay
50 260 Consolidated Rock
u. DISINFECTION: TYPE IIYPOCHLORITE Amount 4
12. CASING. Wall Thickness
Depth Diameter or Wcight/Ft. Material
From 0 To 60 Ft. 6 1/4 " SDR 21 PVC
O. GROUT:
Depth
From 0 To 20 Ft.
14. SCREEN
Depth
From NA To
15. SAND/GRAVEL. PACK:
Depth
From NA To Ft,
16. REMARKS:
Oz
Material Method
GRAVEL MIX GRAVITY
Diameter
Ft. in.
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 road
numbers and common road names.
O
CO
SASAFRAS DR —r7
RIVER RIDGE
Li
COXE RD
N
Co
0
GJ
0
r
Fri
�1
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 IHE WELL Date
ter Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
thin 30 days.
GW-1 REV. 07/2001

From: Scott Gantt To:
Date: 2/13/2003 Time: 11:21:20 PM Page 7 of 8
268611
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 ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery D Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION.
Nearest town: RUTHERFORDTON
363 JAYNES RD
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision. Lot No . Zip Code)
3. OWNER WILKINS HOME CENTER
ADDRESS 1920 HWY 74 BYPASS
(Street or Route No.)
FOREST CITY NC
City or Town State
828-286-3647
Area Code - Phone Number
4. DATE DRILLED 1/13/03
S. TOTAL DEPTII 165
6. DOES WELL REPLACE EXISTING W EI.L?
7. STATIC WATER LEVEL Below Top of Casing:
28043
Zip Code
YES ❑ NO El
50 FT.
(4se "*" If Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface"
*Top ofcasu.g Iennulareal at/or below LIT surface requires a vana,ue 6t
accordance with 15A NCAC 2C.0118
9. YIELD ()win): 12 METHOD OF TEST ARDM
10. WATER ZONES (depth): 165
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ® Flat
Latitude/Longitude of well location
35.15.306 / 81.52.292
(degrees/minutes/seconds)
Latitude/longitude source: E GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 145 Clay
145 165 Consolidated Rock
D. DISINFECTION: TYPE HYPOCHLORITE Amount 4 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 the road
From 0 To 152 Ft. 61/4" SDR 21 PVC numbers and common road names.
13. GROUT'.
Depth Material Method
From 0 To 20 GRAVEL MIX GRAVITY
14. SCREEN Q
Depth Diameter Slot Size Material
Front NA To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material HWY 221
From NA To Ft,
16. REMARKS:
IMI
c
r7 _,
n
HP.RRI
O
CO
'T7
m
I DO HERFRY 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.
1/15/03
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
vithin 30 days.
GW-1 REV. 07/2001
LIRLILA _ -;ION
ASHEVILLE fiEc',:;i.'...L O!-FICE

From: Scott Gantt To: Date: 2/13/2003 Time
21:20 PM Page 6 of 8
268610
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDLIAL)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 ❑ Industrial Agricultural ❑ Monitoring ❑
Recovery, ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: Topographic/Land setting
Nearest town: LAKE LURE County RUTHERFORD
❑ Ridge ❑ Slope ❑ Valley © Flat
OLD GATE SUBDIVISION LOT 2 Latitude/Longitude of well location
(Street Name, Numbers, Community, Subdivision, Lot No, Zip Code) 35.26.242 / 82.09.376
3. OWNER ODOM AND ASSOCIATES (degrees/minutes/seconds)
ADDRESS 152 EAST MAIN ST Latitude/longitude source: ® CPS ❑ Topographic map
(Street or Rowe No.) DEPTH DRILLING LOG
FOREST CITY NC 28043 From To Formation Description
City or Te..n State Zip Code 0 85 Clay
828-247-4495 85 125 Consolidated Rock
Area Code - Phone Number
1. DATE DRILLED 1/11/03
5. TOTAL DEPTH 125
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing.
YES ❑ NO
50 F1.
(Usa "+" If Above Top of Casing)
s. TOP OF CASLG IS 2 ET. Above Land Surface"
*Top of easing terminated aAr below land srvfaee requires a variance 6,
accordm®c with 15A NCAC 2C.0118
9. YIELD (gpm): I O METHOD OF TEST ARUM
10. WATER ZONES (depth): 105
11. DISINFECTION: TYPE HYPOCHLORITE Amount 3 0z 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 the road°
From 0 To 85 Ft. 6 1 /4 " SDR 21 PVC numbers and common road names.
13. GROUT:
m
Depth Material Method CX7
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:
BILL'S CRK RD
HWY 64/74
c
n
;a nc
5'10
n
N
o
I DO IIEREBY 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.
1/15/03
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
IS' natives original to; the l3ivi ,son p! R er Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
888 r
I(I e 9Y-1S3fr PhoneNo:{419) 733-_3 u, bin 30 days.
I
i'u'i1
J
ACE -EI'iL L I, hrE
GW-1 REV. 07/2001

From: Scott Gantt To: Date: 2/13/2003 Time: 11:21:20 PM
Page 5 of 8
268609
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 ❑ Industrial ❑ Agricultural ❑ Monitoring
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: SIX POINTS
562 OLD MOORESBORO RD
County RUTHERFORD
(Street Name,Numbers, Community, Subdivision, Lot No,Zip Code)
3. OWNER WILKINS HOME CENTER
ADDRESS 1920 HWY 74 BYPASS
(Street or Route No.)
FOREST CITY NC
City or Town State
828-286-3647
Area Code - Phone Number
4. DATEDRILLED 1/10/03
5. TOTAL DEPTH 400
28043
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 63 FT.
(use t" If Above Top ofCasing)
8. TOP OF CASING IS 2 FT. Above Land Surface°
'Top of easuag terminated alor below land surface legumes a voltam<i in
accordance with I5A NCAC 2C0118
9. YIFA.D (gym)'. 3 I41EI14O1) OF TEST ARDM
10. WATER ZONES (depth):
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ® Flat
Latitude/Longitude of well location
35.16.637 / 81.46.016
(degrees/minutes/seconds)
Latitude/longitude source: ® GPS D Topographic map
DEPTH DRILLING LOG
From To Fomuation Description
0 68 • Clay
68 400 Consolidated Rock
DISINFECTION: TYPE HYPOCHLORITE Amount 11 n:
12. CASING: Wall Thickness
Depth Diameter or WeightfFt. Material
From 0 To 68 Ft. 6 1/4 " SDR 21 PVC
13. GROUT:
Depth Material Method
From 0 To 20 Ft. GRAVEL MIX GRAVITY
14. SCREEN
Depth Diameter Slot Size Material
From NA To R. 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 Stale Roads or County Roads. Include the road
numbers and common road names.
2/10 MI
OLD MOORESBORO
0
W
rn
i
c
b
rn_.
N:
-- n
McGRAW RDN
N p
T
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THATA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
Submit the on • inal to 1
7.;')j6994363�i Plly;te NO( (9)
il, ;in L -1
1 / 12/03
SIGNA LURE OF PERSON CONSTRUCTING THE WELL Date
Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh,NC
,within 30 days.
GW-1 REV. 07/2001

From: Scott Gantt To'.
Date: 2/13/2003 Time: 11:21:20 PM Page 4 of 8
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 ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery E Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: Topographic/Land setting
Nearest town: LAKE LURE County RUTHERFORD ❑ Ridge ❑ Slope ❑ Valley ❑ Flat
152 CALHOLN TRAIL Latitude/Longitude of well location
(Street Name, Numbers, Community, Subdivision, Lot No, Zip Code) 35.25.266 / 82.07.360
3. OWNER PEGGY HANES (degrees/minutes/seconds)
ADDRESS 748 CALHOUN TRAIL Latitude/longitude source: ® GPS ❑ Topographic map
(Street or Route No.) DEPTH DRILLING LOG
LAKE LURE NC 28'46 From To Formation Description
City or Tmmi State Zip Code 0 66 Clay
828-288-7005 66 140 Consolidated Rock
Area Code - Phone Number
4. DATE DRILLED 1/8/03
5. TOTAL DEPTH 140
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing. 53 FT.
(Use "+" If Above Top ofC
S. TOP OF CASING IS 2 Fr. Above Land Surface*
*Top of casing iemnmmed crier below land surface requires a variance in
accordance with 15A NCAC 2C.0113
sg)
9. YIELD (pm): 12 METHOD OF TEST ARDM
10. WATER ZONES (depth): 130
11. DISINFECTION: TYPE HYPOCHLORITE Amount 2 02 LOCATION SKETCH
12. CASING: Wall Thickness Show direction and distance in miles from at least
Depth
From 0 To
13. GROUT:
Diameter or Weight/Ft. Material two State Roads or County Roads. Include the road
72 Ft. 6 1/4" SDR 21 PVC numbers and common road names.
Depth Material Method
From 0 To 20 Ft GRAVEL MIX GRAVITY
14. SCREEN
Depth Diameter
From NA To Ft. in.
Slot Size Material
in
15_ SAND/GRAVEL PACK:
Depth Size Material
From NA To Ft,
16. REMARKS:
O
W
T1
IT]
CALHOUN TRAIL
idierr
CO
r"
HWY 64/74
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THATA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
1 / 10/03
SIGNATURE OF PERSON CONSTRUCTING IHE WELL Date
of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
21, within 30 days.
GW-I REV. 07/2001

From: Scott Gantt To: Date: 2/13/2003 Time
21:20 PM Page 3 at
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 D Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest fawn: RUFHERFORDTON
126 COVE CREEK RD
County RITFHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER WILKINS HOME CENTER
ADDRESS 1920 HWY 74 BYPASS
(Street or Route No.)
FOREST CITY
City or Town
828-286-3647
NC
Slate
Area Code - Phone Nmnbe
4. DATE DRILLED 1/7/03
S. TOTAL DEPTH 240
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing:
28043
Zip Code
YES NO El
35 FF.
(Use "." If Above Top of Coring)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of easing tenn6mted at/or below land surface requires a variance in
accordance with 15A NCAC 2C.0118
9. YIELD (pm): 6 METHOD OF TEST ARDM
10. WATER ZONES (depth): 220
11. DISINFECTION: TYPE HYPOCHLORITE Amount 7
12. CASING:
Depth
From 0 To
13. GROUT:
Depth
From 0 To
14. SCREEN
From
Depth
NA To
268607
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ® Flat
Latitude/Longitude of well location
35.25.690 / 82.06.449
(degrees/minutes/seconds)
Latitude/longitude source: ® GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 65 Clay
65 240 Consolidated Rock
Wall Thickness
Diameter or WeighUFt. Material
72 Ft. 6 1/4 " SDR 21 PVC
Oz
Material Method
20 Ft. GRAVEL MIX GRAVITY
l5- SAND/GRAVEL PACK:
Depth
From NA To
16. RENIARKS:
Diameter
Ft. in.
Ft,
Size
Slot Size
in.
Material
Material
LOCATION SKETCH
Show direction and distance in miles from at least t=
two State Roads or County Roads. Include the road CJ
number and common road names. '*1
w
rT7
COVE CREEK RD
HWY 64/74
;a
0:'
IV
N
ctt.
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.
1/14/03
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
within 30 days.
GW-1 REV. 07/2001

269392
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 ELLENBORO
HOLLIS RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DARRYL GETTYS
Address 3671 HOLLIS RD.
(Street or Route No.)
ELLENBORO NC 28040
City or Town State Zip Code
(704) — 735-0852
Area Code Phone number
4. DATE DRILLED 01/15/03
5. TOTAL DEPTH: 705
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 21
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. QUHOtETE POURED
From _ To Ft.
14.SCREEN Depth Diameter Slot Size Material
From To _ Ft.
From To _ Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
in. _ in.
in. in.
From _ To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HOLLIS RD. FROM ELLENBORO. APPROX. 1/4
MILE ON LEFT PAST JACK MOORE MTN. RD.
(3671 ON BOX)
0
ri
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
r -- r =? UCTIQN STEM RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
I `, 4, N
���%��C - / S 0 . R
ATURE OF P RSON CONSTRUCTING THE L DATE
Submit the original to the D. ision of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
27699-1636 Phone No, 919) 33-3221, within 30 days. GW-1 REV. 07/2001

269391
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 ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: LAKE LURE
STONEYBROOK LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ROBERT FAULHABER
Address STONEYBROOK LANE
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
(828) - 429-2685
Area Code Phone number
4. DATE DRILLED 02/04/03
5. TOTAL DEPTH: 445
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): 6 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 12
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 110 Ft. 6-1/4" SDR21 PVC
From _ To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
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
From To Ft.
From _ To Ft.
16. REMARKS:
in.
in.
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: ❑ 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 CEDAR
CREEK RD. GO 4 MILES & RT. ON
STONEYBROOK LANE. DRIVE ON LEFT AT
DEAD-END.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
i TIOriIT a ii�� S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
_ -7- 6._�
OF P RSON CONSTRUCTING THE WELL DATE
Submit the original to the Divi on of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phhou6 N6:13j)19) 73 -3221, within 30 days. GW-1 REV. 07/2001

r
269387
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: RUTHERFORDTON
JOSHUA DR.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CHARLIE BROOKS
Address JOSHUA DR.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 286-3849
Area Code Phone number
4. DATE DRILLED 02/21/03
5. TOTAL DEPTH: 405
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): 20 METHOD OF TEST ARD
10. WATER ZONES (depth):
c ess
Depth or Weight/Ft. Material
0 To 60 Ft.6-1/4" SDR.21 PVC
From _ To
From _ To
13. GROUT: Depth
From 0 To 20
From To
14.SCREEN: Depth
From To FL
From _ To _ Ft.
15. SAND/GRAVEL PACK:
Depth Size
From _ To Ft.
From To_Ft. _
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 10.5
12. CASING: Wall Thi kn
Diameter
From _
FL
Ft. _
Material Method
Ft. QUIKRETE POURED
Ft.
Diameter Slot Size Material
16. REMARKS:
in. _ in.
in. in
Material
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ['Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
ROCK RD. FROM RUTH. APPROX. 5 MILES, RT.
ON JOSHUA DR. 2ND LOT ON LEFT.
I DO HEREBY CERTIFY
T 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
Submit the original to thejDivis
276?36:phone Nil (9d9) 73
FSF�' iel;_4 JFICEE
o? - / - 6 -R
TUBE OF PE ON CONSTRUCTING HE WELL DATE
on of Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC
�3221, within 30 days. GW-1 REV. 07/2001

269386
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: CASAR
HWY. #226
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BETTY MOORE
Address 191 HWY. #226
(Street or Route No.)
CASAR NC 28020
City or Town State Zip Code
(828) —145-9567
Area Code Phone number
4. DATE DRILLED 02/24/03
5. TOTAL DEPTH: 405
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): 1-1/2 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 20 Ft. 6-1/4" SDR21 PVC
From To _ Ft.
From _ To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUHCRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From ____ To_Ft._ _
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley 0 Flat
(check appropriate box)
Latitude/longitude of well Location
(degrees/minutes/seconds)
Latitude/longitude source: 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. RT. ON HWY. #226 A
GOOD OLE BOYS. APPROX. 4 MILES ON RT.
r D HEREBY1.CER.T1ELDIAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
i rd U Tl�bl T ' r S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ATURE'OF PERSON CONSTRUCTTNb THE WELL
DATE
submit the original to th Division of Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC
276991636=Phone Noi(919) 733-3221, within 30 days. GW-1 REV. 07/2001
PE. '7:; '.FICE

269384
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERI IFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
I. 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: RUTHERFORDTON County RUTH
FOREST TRAIL DR. LOT #8
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ROBIN OLIVER
Address FOREST TRAIL DR
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 286-8274
Area Code Phone number
4. DATE DRILLED 02/18/03
5. TOTAL DEPTH: 505
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IZI
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 actor 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 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 Material Method
From 0 To 20 Ft. OUIKRETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To Ft. in. _ in.
From _ To _ Ft. _ in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. _
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 W. FROM RUTHERFORDTON. LEFT
ON UNION RD. GO APPROX. 1/4 MILE AND TURN
RIGHT ON FOREST MTN. TRAIL DR LAST LOT
ON RIGHT.
c
.-
0
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
iL
Submit the original to the
OF PERSO CONSTRUCTING
WELL DATE
2
n of Water Quality, Groundwater Section, 1636 Marl Service Center — Raleigh, NC
276�99-i636 Phone No. (91) 733j3221, within 30 days. GW-1 REV. 07/2001

From
13. GROUT:
Fr0L! 0
From
269383
WELL CONSTRUCTION RECORD
Nnrth Cnrnl inn -.. Dennrtment of Fnvirnnment And Nnt,,ml Recnnrrec flnricinn n( Wnter (hinlity _ (;rnnndtvater Serlinn
L
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATF WFI I (YINSTRIICTION PERMITA CSOC1AT_FD WO PERMIT#
(u applicable)
1. WELL USE (Check Applicable Box): Residential M Municipal/Public
r^ J —
iYlUliiiUamb LJ a-�cIV Y..a� j_j u_,:. Pump Water
�.;:-,-- I---
- Heat :,caaCa iiijG'.,iiUii Lj Other
2. WELL LOCATION:
Nearest Town: ELLENBORO Counts- RUTH
SKI- r--.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DAVID EMERY
Address 339 DUSKLE RD.
(Street or Route No.)
ELLENBORO Nr' 28040
city oTown State Zip Code
(828) — 453-0554
..a Code Phone milliFICT
4. DATE DRILLED 07/20/03
5. TOTAL DEPTH: 365
6 DOES WELL 1 REPLACE EXISTING WELL? YES f1v NO 0
7. STATIC WATER LEVLLBelow Top ofCasing: 40 FI.
(Use "1" 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 CIILORYTE Amount 9.5
12. CASING: Wall Thickness
Depth Diameter or Wcight/Ft. Material
From 0 To 80 Ft. 6-1/4" SDR.21 PVC
1 rom T o Fl.
To Ft.
Depth Material Method
To 24; Fi. (111;KRE;TE POURED
l'o Ft.
14.SCREEN: Depth Diameter Slot Size Material
r lllnl Fr, Pi. 1!!, ❑1.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
ievil! Site iitalenal
From 7'o Ft.
From To Ft.
16. REMARKS:
Industrial ❑ Aericii1l ir�1 rl
Other, ist Esc ..
Topographic Land setting
LJ :.uric Li :hope Li ValleyV L I Hat
(check appropriate box)
Latitude/longitude of well lotion
(degrees/minutes/seconds)
ialtud_nn-g.._dsource: rLJ vra -1 un b i
".'
"
(check box)
DEPTH
`'rUlii T
DRILLING LOG
From Tn
LOCATION SKETCH
Show direction and distance in mules from at least
Two State Roads or County' Roads. Include the road
nwuber and common naives
BUS. 74 W. FROM ELLENBORO. CROSS RR &
RIGHT ON BURNS RD. APPROX. 1 MILE ON LEFT.
c
0
1 DO HEREBY CERIIFI THAT THIS WELL WAS '.0xSTxuC1EL, 11V ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
pc T.,
,pnuni(t the eiiginal to • tiie. ti.
27699-1636 Phone No. (9919) 73
TURE OF PERSOL CONSTRUCTING THE WELL DATE
;on of Water Quality, a vtndwater Section, 1o36 Mail Service Ccntcr— Raleigh, NC
-3221, within 30 days. GW-i REV. 0712001

269382
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: LAKE LURE County RUTH
KINCADE DR. WELL A
(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
( 8) - 625-4905
Area Code Phone number
4. DATE DRILLED 12/18/02
5. TOTAL DEPTH: 605
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): 20 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 16.5
12. CASING: Wall Thickness
Depth or Weight/Ft. Material
From 0 To 51 250 STEEL
From To
From _ To
13. GROUT: Depth Material Method
From 0 To 51 Ft. CEMENT SLURRY
From _ To Ft.
14.SCREEN: Depth Diameter Slot Size
From To Ft. in.
From _ To _ Ft. _ in. _
15. SAND/GRAVEL PACK:
Depth Size
From _ To _ Ft. _
From To Ft.
16. REMARKS:8" DRIVE SHOE WELL PERMIT #WS01-00016
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C WELL
Diameter
Ft. 8"
Ft.
Ft.
Material
PRESSUR
Material
in.
in.
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. #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.
Cpm;IRlti'I �lt# �'1' IV S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/a - /07-Q
TURE OF PERSON CONSTRU TING THE WELL DATE
Submit the original to th D vision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
2-7699-K34-Phone No.; (9k9) 733-3221, within 30 days. GW-1 REV. 07/2001

269381
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 County RUTH
KINCADE DR. WELL B
(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 12/20/02
5. TOTAL DEPTH: 505
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount _ 13.5
12. CASING:
Depth Diameter
From 0 To 51 Ft. 8"
From To Ft
•
From To Ft.
Wall Thickness
or Weight/Ft. Material
350 GALV.
13. GROUT: Depth Material Method
From 0 To 51 Ft. CEMENT SLURRY PRESSUR
From _ To Ft
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
From
From
Depth
To
To
Sizc
Ft.
Ft.
Material
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
IIWY. #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.
16. REMARKS:8" DRIVE SHOE WELL PERMIT #WS01-00016
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
COITROcrr, ST S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SI A 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

269378
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 0 If Other, List Use
2 WELL LOCATION:
Nearest Town: BOSTIC
WALKER DAIRY RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MIKE WALKER
Address WALKER DAIRY RD.
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code
(828) — 223-1506
Area Code Phone number
4. DATE DRILLED 02/05/03
5. TOTAL DEPTH: 505
6. DOES WELL REPLACE EXISTING WELL? YES 0 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): 1-1/2 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To 60
From _ To
From To
Ft
Ft.
Ft.
County RUTH
CHLORYTE Amount 13.5
Wall Thickness
Diameter or Weight/Ft. Material
.6-1/4" SDR21 PVC
13. GROUT: Depth Material
From 0 To 20 Ft. QUIKRETE
From To _ Ft.
14.SCREEN: Depth Diameter
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From _ To _ Ft.
Method
POURED
Slot Size Material
in. _ in.
in. in.
16. REMARKS:
Topographic/Land setting
❑ Ridge 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. LEFT ON ANDREWS
MILL RD. RIGHT ON JOE BOSTIC RD. GO 1.3
MILES AND TURN LEFT ON WALKER DAIRY RD.
HIS DRIVE IS 1 MILE ON RIGHT IN PASTURE.
o
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
j i_Subrir`rt the original to the
27699-1636 Phone No. (919) 7
TURE OF PERSON CONSTRUCTING THE LL DATE
ion of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001

r-�
269374
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 ❑ Agricultural
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH
GILBOA CHURCH RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: WAN MAST
Address GILBOA CHURCH RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) - 429-9080
Area Code Phone number
4. DATE DRILLED 02/11/03
5. TOTAL DEPTH: 68
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IZ
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): 18 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From 0 To 68 Ft. 24"
From To Ft.
From _ To Ft. _
13. GROUT: Depth Material
From 0 To 20 Ft. CEMENT
From To Ft.
14.SCREEN: Depth Diameter
From To Ft.
From _ To _ Ft.
15. SAND/GRAVEL PACK:
Depth Size
From 50 To 68 Ft. 78M
From __ To _ Ft.
16. REMARKS:
CHLORYTE Amount 8.28
Wall Thickness
or Weight/Ft. Material
CEMENT
Method
POURED
Slot Size Material
in. in.
in.
Material
GRAVEL
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. #221 N. FROM RUTHERFORDTON. RT. ON
2ND GILBOA CHURCH RD. 1ST DRIVE ON RT.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC l`ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-a &T»
�- --ee
S-�1/r
Submit the original to theft?
27699-1636 Phone No. (919) 7
ATUR>`OF P
/Tne - //-
/ijA
UCTING THE WELL DATE
sion of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001

r
r
269373
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 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
BIG GUM COURT
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: WES CONNER
Address BIG GUM COURT
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(8) — 248-2000
Area Code Phone number
4. DATE DRILLED 02/13/03
5. TOTAL DEPTH: 76
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 56 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 76 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 56 To 76 Ft. 78M GRAVEL
From __ To _ Ft. __
16. REMARKS:
County RUTH
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. APPROX. 3
MILES, RT. ON BIG GUM COURT. 2/10 MILE ON
LEFT.
(tr•-e- , ;7 - /.? - 1),
ATURE PEW ONSTRUCTING TH�WELL DATE
Submit the original to Orb vision of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.GW-1 REV. 07/2001
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDAZDS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/�. 4,
t�

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)
269372
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: ELLENBORO County RUTH
SHIRES RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: SHANNON KEETER
Address SHIRES RD,
(Street or Route No.)
ELLENBORO NC 28040
City or Town State Zip Code
(828) — 245-3966
Area Code Phone number
4. DATE DRILLED 02/14/03
5. TOTAL DEPTH: 50
6. DOES WELL REPLACE EXISTING WELL" YES ❑ NO EA
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "t" 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. DISINFECT ION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 50 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
From _ To _ Ft. _ in. _
From To _ Fi. in.
15. SAND/GRAVEL PACK:
Depth Size
From 30 To 50 Ft. 78M
From To Ft.
CEMENT
16. REMARKS:
Material
in.
in.
Material
GRAVEL
Topographic/Land setting
❑ Ridge ❑ Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
BUS. 74 W. FROM ELLENBORO. RIGHT ON
PINEY MTN. CH. RD. RIGHT ON SHIRES RD. LAST
DRIVE ON RIGHT BEFORE ROBERT CH. RD. (NO
BOX #(
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONS TRJ TION STANDARDS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
v
SILT` ATURE O PERS C NSTRUCTING THE WELL
DATE
J
Submit the original to the furs on of Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC
27699-1636 Phone No. (91p) 73. -3221, within 30 days. GW-1 REV. 07/2001