Po CY2004

29'99, 1
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING County POLK
1710 WHITESIDES RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BILLY PRITCHARD
Address 1710 WHITESIDES RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 894-8346
Area Code Phone number
4. DATE DRILLED 07/27/04
5. TOTAL DEPTH: 125
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 6 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 2.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 25 Ft. 6-1/4" SDR.21 PVC
Ft. _
Ft.
From To
From _ To
13. GROUT: Depth
From 0 To 20
From To
14.SCREEN: Depth
From To
From _ To
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Material Method
Ft. QUIKRETE POURED
Ft.
Diameter Slot Size Material
Ft. in.
Ft. in.
in.
in.
Topographic/Land setting
0 Ridge 0 Slope ❑ Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS 0-Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. tnclude.the-road --
number and common names
HWY. #108 E. FROM MILL SPRING. RIGHT ON
PEA RIDGE RD. RIGHT ON WHITESIDES RD. GO
APPROX. 1 MILE ON LEFT. (BOX #1710)
cn
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
GN OF PERSON CONSTR ING THE WELL ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

299952
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERIIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING County POLK
SALEM TURN - LAND O'LAKES
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: GORDON BALSER
Address SALEM TURN
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
8(_28) — 698-2794
Area Code Phone number
4. DATE DRILLED 07/26/04
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IZ
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 4 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 7.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 120 Ft. 6-1/4" SDR.21 PVC
From _ To Ft. _
From To _ Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To _ Ft.
14.SCREEN: Depth Diameter
From To _ Ft. _
From _ To _ Ft. _
15. SAND/GRAVEL PACK:
Depth Size Material
Slot Size Material
in. _ in.
in. in.
From _ To
From To
16. REMARKS:
Ft.
Ft.
Topographic/Land setting
0 Ridge 0 Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) Latitude/longitude source: 0 GPS ❑ Topographic map
(check box) ---...
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 FROM MILL SPRING. LEFT ON
SILVER CREEK RD. RIGHT ON BISHOP RD. LEFT
ON TWIN DR. GO TO END. LOT ON RIGHT.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER HA
GF SIGN R PERS 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
�� , ��/rrA11 , 2 - ,7 6 - ��

299951
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 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
SMITH RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CHRISTOPHER METCALF
Address SMITH RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
( ) — 894-0270
Area Code Phone number
4. DATE DRILLED 07/23/04
5. TOTAL DEPTH: 505
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 13.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 100 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
To Ft.
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. #108 E. FROM COLUMBUS. RIGHT ON
FOX MTN. RD. CROSS BRIDGE. LEFT ON SMISTH
RD. 2ND DOUBLEWIDE ON LEFT.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
HIV TURE'D� - 9- a 3- o 1
SIG A OF P RSON CONSTRUCTING THE L DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 2 3ti
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 D Agricultural D
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON
GOLF COURSE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: WAYNE HAGAR
Address GOLF COURSE RD.
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
8( 28)-691-9898
Area Code Phone number
4. DATE DRILLED 07/22/04
5. TOTAL DEPTH: 365
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): 6 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 9
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 135 Ft. 6-1/4" SDR21 PVC
From _ To _ Ft.
From To _ Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. in. in.
From _ To Ft. _ in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To _ Ft. _
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge 0 Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographiemap
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road:
number and common names
HWY. #9 S. FROM MILL SPRING. BEN
LANDRUM RD. RT. ON GOLF COURSE RD.
APPROX. 1 MILE ON RT.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SI NAT RE 0 RSON CONSTRUCTING THE WELL
i-a 2- (1Y
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

2999/1:0
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON County POLK Topographic/Land setting
PENIEL RD. 0 Ridge ❑ Slope 0 Valley ❑ Flat
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) (check appropriate box)
3. OWNER: NICK MARBERT Latitude/longitude of well location
Address PENIEL RD. _—
(Street or Route No.) (degrees/minutes/seconds)
TRYON NC 28782 Latitude/longitude source: ❑ GPS ❑ Topographic map-, -
City or Town State Zip Code (check box)
(828) — 863-4141 DEPTH
Area Code Phone number From To
4. DATE DRILLED 07/20/04
5. TOTAL DEPTH: 205
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): 40 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 4.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 120 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:
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. RT. ON
PENIEL RD. 3/10 MILE ON RT. HOUSE AT DEAD
END.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCT IED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGN OF ERSO
r r/7/tQ
ONCTING THE�W'EL`L
-
aZ.Q a�
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

290947
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: SALUDA
CHARLESTON RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CARLYLE WEST'
Address CHARLESTON RD.
(Street or Route No.)
SALUDA NC 28773
City or Town State Zip Code
(843) — 688-5453
Area Code Phone number
4. DATE DRILLED 07/15/04
5. TOTAL DEPTH: 225
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
"Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 12 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 60 Ft. 6-1/4" SDR.21 PVC
From To Ft. _
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUH{RETE POURED
From _ To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS El Topographic map
(check box) r _
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH j G
Show direction and distance in miles frbnrat least --
Two State Roads or County Roads. !, Include the road
number and common names
HWY. #176 W. FROM TRYON. 1ST ROAD ON
RIGHT, PAST BEAR CREEK G THROUGH GATE.
1ST HOUSE ON LEFT.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A CO Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNAT PERS N CONSTRU G 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

299942
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 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON
380 MT. VERNON DR.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MAY H. COCHRAN
Address 380 MT. VERNON DR.
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
8(28) — 894-0327
Area Code Phone number
4. DATE DRILLED 07/06/04
5. TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 7 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 4.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 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.
Topographic/Land setting
0 Ridge ❑ Slope ❑ Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS 0 Topographic map -
(check box) --. _...-__-. -_-_l _.
DEPTH -
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in mite§ from at least -
Two State Roads or County Roads. Include the road
number and common names
FROM COLUMBUS. GO OUT PENIEL RD.
RIGHT ON RED FOX RD. GO 2/10 MILE PAST
HUNTING OUNTRY RD. RIGHT ON MT. VERNON
DR. HOUSE AT DEAD END.
0
7
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCI'ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT AzCOPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SI A"I R OF PERSON TRUCTING THE ,/(A--€14
' 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

299940
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON
MEADOW CREST
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DEAN CULBRETH
Address MEADOW CREST
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(828) - 894-2574
Area Code Phone number
4. DATE DRILLED 07/30/04
5. TOTAL DEPTH: 205
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): 15 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 4.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 90 Ft. 6-1/4" SDR21 PVC
From To _ Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. OUIKRETE POURED
From _ To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. in.
From _ To Ft. _ in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From
From
To Ft.
To Ft.
16. REMARKS:
Topographic/Land setting
0 Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)- — -.--
Latitude/longitude source: ❑ GPS 0 ToPogmPltTc_ 7pl?` -
(check box) a „_. _
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles front at least
Two State Roads or County Roads. IAciude the road -
number and common names
BY-PASS 74 E. FROM COLUMUS. RIGHT ON
PEA RIDGE RD. RIGHT ON SANDY PLAINS RD.
CROSS BRIDGE. LEFT ON MEADOW CREST.
RIGHT AT FORK. APPROX. 1/4 MILE ON LEFT.
N
U7
c,
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONS • UCCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
e-14,A- 7d SA,„_ /� 7: -f , 2 — 3 Zs - O
IGNATURE 0 ER N CONSTRUCTING WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

299937
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quolity — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1.
WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
SMITH RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BARRY LOWMAN
Address 1048 SMITH RD.
(Street or Route No.)
COLUMBUS NC
City or Town State
(828) — 894-0527
Area Code Phone number
4. DATE DRILLED 07/26/04
5. TOTAL DEPTH: 105
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
28722
Zip Code
11. DISINFECTION: Type CHLORYTE Amount 2
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. 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 0 Slope ❑ Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS 0 Topographic map,
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH ,
Show direction and distance in mils from at least --
Two State Roads or County Roads. _e:road
number and common names
HWY, #108 E. FROM COLUMBUS. RIGHT ON
FOX MTN. RD. LEFT ON SMITH RD. HOUSE ON
RIGHT AFTER PAVEMENT ENDS.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSUCTION STANDARDS, AND THAT A COPY OF
THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
NATURE OF PE SON CONSTRUCTING TH6 WECL DATE
7- 2 -0'
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

299935
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1
WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK
169 STONEYBROOK LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: RICHARD PATTERSON
Address 169 STONEYBROOK LANE
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 692-5806
Area Code Phone number
4. DATE DRILLED 07/22/04
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 50 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 150 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
0 Ridge 0 Slope 0 Valley 0 Flat
(check appropriate box)
Latitude/longitude of well•locatien-
(degrees/minutes/secgnds),..
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box) •
DEPTH
From To
DRILLING LOG
From To
LOCATION SKE EH
Show direction and distance in tiiiles from at least_.
Two State Roads or County Roads. Include the road -
number and common names
WALKER ST. FROM COLUMBUS RT. ON
PENIEL RD. RT. ON GOLDEN RD LEFT ON
STONEYBROOK WAY. 1/10 MILE ON LEFT.
:-3
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
I�.�- �/T irY�
IGNATtJRE OF PERSON C NSTRUCTING THE WELL c DATE
a. a
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

299934
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERI IFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON
CHESNEE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: RANDY LAUGHTER
Address CHESNEE RD.
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(828) — 248-2497
Area Code Phone number
4. DATE DRILLED 07/20/04
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 1 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 16.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft_ Material
From 0 To 120 Ft. 6-1/4" SDR21 PVC
From To Ft.
From _ To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
0 Ridge 0 Slope 0 Valley ❑ 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 POORS FORD RD. RIGHT ON CHESNEE RD.
1ST LOT ON RIGHT AFTER "INTEGRATIVE
MEDICINE CLINIC"
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
%
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

299931
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial D Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON
2799 BILL COLLINS RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: HOWARD HARRISON
Address 2799 BILL COLLINS RD.
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(828) — 894-3174
Area Code Phone number
4. DATE DRILLED 07/07/04
5. TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 6 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 4.5
12. CASING: Wall Thickness
Depth Diameter or Weight/FL Material
From 0 To 90 Ft. 6-1/4" SDR.21 PVC
From To Ft. _
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QU KRETE POURED
To _ Ft.
Depth Diameter Slot Size Material
To Ft. in. _ in.
in. in.
From
14.SCREEN:
From
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To _ Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographie-map
(check box) -
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles cram at leapt
Two State Roads or County Roads. Include the road_
number and common names
HWY. #9 S. FROM MILL SPRING. RT. ON HUGH
CHAMPION RD. GO TO END & RT. ON BILL
COLLINS RD. APPROX. 3/10 MILE ON RT.
SIGNA RE OF PERSO CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

299928
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'1HCATION # 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 ® Municipat/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON County POLK
ASHLYN LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: RICHARD SEIDLER
Address ASHLYN LANE
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(864) — 4944933
Area Code Phone number
4. DATE DRILLED 07/13/04
5. TOTAL DEPTH: 86
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 71 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9 YIELD (gpm): 15 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 6.9
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 86 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 71 To 86 Ft. 78M
From To Ft.
16. REMARKS:
Material
in.
in.
Material
GRAVEL
Topographic/Land setting
0 Ridge 0 Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)_
Latitude/longitudesource: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include -the road
number and common names
HWY. #9 S. FROM MILL SPRING. LEFT ON
SANDY PLAINS RD. LEFT ON ASHLYN LANE.
HOUSE ON LEFT AT DEAD END.
o
c.J
N
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS UCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
.�,� J 1-8,
� a� r '7 (3 - 6/
SIG ATUPE VI ONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

301564
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CER11t'ICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
MCGUINN RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JEREMIAH CARSWELL
Address 420 MCGUINN RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 894-8203
Area Code Phone number
4. DATE DRILLED 08/03/04
5. TOTAL DEPTH: 465
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): 7 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 12
12. CASING: Wall Thickness
Depth Diameter or Weight/FL Material
From 0 To 90 Ft. 6-1/4" SDR.21 PVC
From To_Ft. _ _
From _ To _ Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ 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 ❑ Topogaphic.map .
(check box) _=
DEPTH
From To
DRILLING LOG
From To
co
rn
—1
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. GO TO SUNNY
MTN. FISH CAMP. LEFT ON MCGUINN RD.
APPROX. 1/2 MILE ON RIGHT.
t
seb
O�
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
pa'.-LGin'._ ?--?-6/
^" OF PERSO CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

301561
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) Of applicable)
1.
WELL USE (Check Applicable Box): Residential ® MunicipaUPublic ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
TOBACCO RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ELIZABETH LYDA
Address TOBACCO RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) - 625-0418
Area Code Phone numbs
4. DATE DRILLED 08/09/04
5. TOTAL DEPTH: 365
6. DOES WELL REPLACE EIUS I ING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use if Above Top of Casing
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 9
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 70 Ft. 6-1/4" SDR.21 PVC
From _ To Ft.
From _ To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Et. QUHCRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ FL _ in.
From _ To _ Ft. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To FL
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge 0 Slope 0 Valley ❑ Flat
(check appiopiiate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. RIGHT ON
MCGUINN RD. GO 1/4 MILE. RIGHT ON A. LYNCH
RD. TAKE 1ST RIGHT ON TOBACCO RD. 300
YARDS ON LEFT.
tot
Selo �O7FC�04,
1 DO HEREBY C
CONSTAUCTIQj
ez
RTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
STANDARDS, AND THAT A COPY Y OFF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ER
Wi 6- 9- L
SIGN
GNATT rp urE. De -of -nu i. cyre-`a
Submit the original to the Division of Water (.'silty, Groundwater Sir ion, 1636 M_ I Service: Cenrer -Raleigh, NC
276RQ 1636 P:. ,,, (e ,..1 3221. within 3n, _ G 1 _ .,...

3015GO
WELL CONSTRUCTION RECORD
North Carolina — Depaitnent of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING County POLK
SYLVAN LANE -LOT #1 LAKE ADGER
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: PHIL DRESSENDOFER
Address SYLVAN LANE
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 894-6136
Area Code Phone number
4. DATE DRILLED 08/11/04
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): 50 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: T
12. CASING:
Depth Diameter
From 0 To 50 Ft. 6-1/4"
From To Ft.
From To Ft
13. GROUT: Depth Material
From 0 To 20 Ft. QUIKRETE
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size
From _ To _ Ft. _ in.
From _ To _ Ft. _ in. _
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
CHLORYTE Amount 7.5
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
16. REMARKS:
Method
POURED
Material
in.
in.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at (east
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. LEFT ON
GARRETT RD. RIGHT ON GREEN HILLS RD. LEFT
ON LAKE ADGER PARKWAY. LEFT ON SYLVAN
LANE. 1/4 MILE ON RIGHT.
Om to
A
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 N PROVIDED TO THE WELL OWNER
_e (o . P // — l�<L
SIGN: TURE OF PERSON •NSTRUCTING THE WE L DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

301553
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: COOPERS GAP County POLK
NORTH HIGHI.ANDVIEW DR -LAKE ADGER
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: RON & ILEANA WOOD
Address NORTH HIGITLANDVIEW DR.
(Street or Route No.)
COOPERS GAP NC 28756
City or Town State Zip Code
(864) — 313-3513
Area Code Phone number
4. DATE DRILLED 08/18/04
5. TOTAL DEPTH: 505
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 atlor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 8 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 13.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 180 Ft. 6-1/4" SDR21 PVC
From _ To _ Ft. _
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in.
From _ To _ Ft. _ in. _ 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 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
FROM MILL SPRING. GO OUT SILVER CREEK
RD. RIGHT ON LAKE ADGER RD. LEFT ON
NORTH HIGHLANDVIEW DR. APPROX. 1/2 MILE
ON RIGHT. (LOT #6)
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 P RSON CONSTRUCTING THE LL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

301557
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERIIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING., LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ® MunicipalPublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
HWY. #9S.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: GREG BELLINI
Address HWY. #9 S.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 674-8974
Area Code Phone number
4. DATE DRILLED 08/23/04
5. TOTAL DEPTH: 345
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-112 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 50 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 9
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 110 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: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. NEW GRAVEL
DRIVE ON RT. 1/2 MILE BEFORE S.C. STATE LINE.
rart
taea
CO APO
e9 %
PR
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CON RUCTJQN STANDARDS. AND THAT A COPY O THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/)no 3 r
SIG ATURE OF PERS 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

301556
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING County POLK Topographic/Land setting
WATER MILL DR. ❑ Ridge 0 Slope 0 Valley 0 Flat
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) (check appropriate box)
3. OWNER: RON WORD Latitude/longitude of well location
Address 381 WATER MILL DR
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(817) — 929-0989
Area Code Phone number
4. DATE DRILLED 08/24/04
5. TOTAL DEPTH: 185
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): 50 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 3.5
Wall Thickness
or Weight/Ft Material
SDR21 PVC
12. CASING:
From 0
From _
From _
13. GROUT:
From 0
From
14.SCREEN:
From
From
Depth Diameter
To 40 Ft. 6-1/4"
To Ft.
To Ft.
Depth Material Method
To 20 Ft. OUIKRETE POURED
To Ft.
Depth Diameter
To Ft.
To Ft.
Slot Size Material
in _ in.
In in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To ______ Ft.
_
From To Ft.
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 E. FROM MILL SPRING. RIGHT ON
PEA RIDGE RD. CROSS BY-PASS. TURN RIGHT ON
JOHN SHEHAN RD. LEFT ON WATER MILL DR.
LEFT AT FORK. SHOP ON LEFT.
ar
der 0
crs co
*o
moo v
' � '
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUL 1 LD IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PER
— o --n-er
ON CONSTRUCTING THE WE DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

301543
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 Purnp Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: SALUDA
STONE WATER LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: EARL HORNBECK
Address 138 STONE WATER LANE
(Street or Route No.)
SALUDA NC 28773
City or Town State Zip Code
(828) — 894-3254
Area Code Phone number
4. DATE DRILLED 08/26/04
5. TOTAL DEPTH: 265
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 100 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 100 Ft. 6-1/4" SDR.21 PVC
From To Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIICRETE 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. #9 N. FROM MILL SPRING. LEFT ON
SILVER CREEK RD. LEFT ON HOLBERTS COVE
RD. GO 2.6 MILES. LEFT ON STONE WATER
LANE. RIGHT 1ST FORK.
9QG/R�cF/` /
Sep R It �6y'Q/on,
ueoof
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S NA OF PERSON CONSTRUCTING WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

3015411
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CER1IFTCATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK
WINDING CREEK LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JIM SMITH
Address 72 WINDING CREEK LANE
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
8(64) — 457-7442
Area Code Phone number
4. DATE DRILLED 08/09/04 N
5. TOTAL DEPTH: 245
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 11=1/2 FT. Above Land Surface*
*Top of casing terminated aUor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 6
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. OUIKRETE
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) .'C
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles fromat least
Two State Roads or County Roads. Include the road
number and common names
FROM COLUMBUS. GO OUT PENIEL RD. LEFT
ON SMITH DAIRY RD. GO APPROX. 3/4 MILE.
LEFT ON HUNTVIEW LANE. GO TO STOP SIGN.
LEFT ON WINDING CREEK LANE. 1ST LOT ON
LEFT.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, ANC THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
`keg
lleiZATURE OF PERSON CONSTRUCTING THE WELL
:-
DAT
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

301510
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 D Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
TURNING LEAF
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JAMES LEDFORD
Address TURNING LEAF
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) - 894-3733
Area Code Phone number
4. DATE DRILLED 08/27/04
5. TOTAL DEPTH: 31
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
valiance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 11 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 5_06
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 31 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 20 To 31 Ft. 78M GRAVEL
From _ To _ Ft.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. RIGHT ON
GRASSY KNOB RD. RIGHT ON TURNING LEAF
LANE. AT SHARP CURVE GO STRAIGHT ON DIRT
DRIVE. GO TO BOTTOM OF HILL.
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
N
S�NATURE F PER e v CO UCTING THE WELL
i/,rl�- ,�-� 2-65/
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

301802
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (pilot) KENNETH MCCRARY CERTIFICATION # 2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT(' 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORD County POLK
SWEETWATER POINT SD - SUNLIGHT PATCH RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Tap Code)
3. OWNER: WOODY FOX
Address 1328 GREENWOOD CLIFF
(Street or Route No.)
CHARLOTTE NC 28204
City or Town State Zip Code
( 704 )_ 335-0904
Area code- Phone number
4. DATE DRILLED AUGUST 9, 2004
5. TOTAL DEPTH: 255
6. DOES WELL REPLACE EXISTING WELL? YES O NO
7. STATIC WATER LEVEL Below Top of Casing: 10 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
"Top of casing terminated atlor below land surface require a
varlance in accordance with 15A NCAC 2C .0l1&
9. YIELD (gpm): 10 METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Land setting
°Ridge ®Slope °Valley °Flat
(check appropriate box)
Latitude/longitude of well location
(degreestminutes/seconds)
Latitude/longitude source:OGPSOTopographic map.
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 41 Ft. 61/8 SDR21
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CONCRETE POURED
From To Ft.
14. SCREEN: Depth
From To Ft. in. m.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
�f q4i�t ��2o
F
44
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road�oa�/names. fear
PVC tb-14- Y7L £ tth _tde._
232cLizta de %gat a_
d ii,,tZP,(0 Cc la to fajt CL
el& Ode s ectcek !P�[��"''�'��/.""""3rz. ./10
&LW Q/Kat Za 0. r tfLr i/i/D
Diameter Slot Size Material r{a finkrallt P ,.
Orb 4c cyLt fztt,ed oZdt-4 D1
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WFI.1
CONSTRUCTION STANDARDS, ANDLL OWNER
THAT HATAT A RECORD HAS BEEN OVIDED TO THE 07
DATE
SIGNATURE OF PERSON CONSTRUCTING TIB? WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

(Stint Name, Numbers, Community,'tubdivisio\n, Lot No., Zip Code)
3.'OWNER: e t\icj'iaV-
Address -->! P
.T
rK`p ++,—a{d veer or Route No.) C. Zip Code d �T /
S 1 J
Area code- Phan. nuinber J p
4. DATE DRILLED C{ r • k
5. TOTAL DEPTH: iiOS
6. DOES WFT T REPLACE EXISTING WELL? YES� 0 NO El,
7. STATIC WATER LEVEL Below Top of Casing: to O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S t FT. Above Land Surfaces
• 'Top of casing terminated actor below land surface requires a
-,variance In accordance with 1SA NCAC 2C .0118.
9. YIELD(gpm): \ DVic METHOD OF TEST Dir
10. WATER ZONES (depth): %q 0
11. DISINFECTION: Type r h 1 nr i n P
12. CASING:
Depth , Diameter
From__o To I) 5— Ft.6 1 4
From To Ft.
From To Ft
13. GROUT: Depth
From -0
From To Ft.
To- •20
Ft.
Amount
Wall Thickness
or Weight/Ft. Material
GPR�1 PVC
Material
Method
N at Cement Hand
14. SCREEN: Depth Diameter
From To Ft in.
From To Ft in.
15. SAND/GRAVEL PACK:
Depth Size Material
Slot Size Material
in.
in.
From To Ft.
From To Ft
16. REMARKS.
(degrees/minutes/seconds)
jy 1 s1 • Latitude/longitude source:❑GPS❑Topographic trap
232) L,tmmer Z)•1,
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Tamna Camp, Jr_
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
C'ampI c WP11
302041
CERTIFICATION # 2 1 3 R
R Pnmp r'n Tnc PHONE #a'7Al IlCi1 7322
ASSOCIATED WQ PERMITP
(if explicable)
1. WELL USE (Check Applicable Box): Residential Ilnunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 if Other, List Use - -
2. WELL LOCATIQN:
Nearest Town:
County PA.
Topo phicJLand setting
❑Ridge 11Slope ❑Valley ❑Flat.
(check appropriate box)
Latitude/longitude of well location
DEPTH
From To
57
(check box)
DRILLING LOG
Formation Description
c�a,f
j o ns&Udt ceA rock
O
tv
i
--a
LOCATION SKETCH
Show direction and distance in miles from at le st
two State Roads or County Roads. Include the oad..--
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THPyT"A\COPY OF THIS RECO HAS EEN PROV TO THE WELL OWNER
DATE
SIGNATURt/OF PERSON CONSTRUCTING THE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
3007G5
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RICHARD MCCRARY
CERTIFICATION # 2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL 8 PUMP pAONE ,/ [phone]
STATE WELL CONSTRUCTION PERMIT,/ 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential I Municipal/Public O Industrial O Agricultural O
Monitoring O Recovery O Heat Pump Water Injection O Other O If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK
FOX MOUNTAIN ROAD, YESHUA LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: TIM AND VICKI CONNOR
Address 240 EAST HILLTOP DRIVE
(Street or Route No.)
SALUDA NC 28773
City or Town
( 828 )_ 749-9580
Area code- Phone number
4. DATE DRILLED JULY 28, 2004
State
5. TOTAL DEPTH: 205'
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES O NO El
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface`
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ®Slope OValley OFIat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude sotrce:OGPSOTopographic map
(check box)
DEPTH DRILLING 1 LYi
From To Formation Description
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness Z
Ca 0
gr s ter^
1. rr
t.T
Q% y0
En 0
r
Depth Diameter or Weight/Ft. Material-tj�,(///� // _ />
From 0 To 99 Ft. 61(8 SDR21 PVC A/4__ k O From To Ft. �J ////
From To Ft. /08 eaff' .4) Q tn.
13. GROUT: Depth Material Method chi. na . _ .- taro £ j7 / `i
From 0 To 20 Ft. CONCRETE POUREDOLLU!!"u- II, d/�.��-"
From To Ft. -q �j/(wt_
14. SCREEN: Depth Diameter Slot Size Material / ��� //__ /pp �� 4Lct
From To Ft. in. in. (Ct-/(,2_. 2`U q/u-(.-C-
From To Ft. in. in. ��������nn (/
15. SAND/GRAVEL PACK: «w""
Depth Size Material
From To Ft.
From To Ft.
LOCATION SKETCH W
Show direction and distance in miles from at leas
two State Roads or County Roads. Include the road)
numbers and common road names.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS I€EN PROVJDED TO THE WELL OWNER
a �yfFP
SI NATURE OF P
CONS-TRUCLxN0
Submit the original to the Division of Water Quality, Groundwater
27699-1636 Phone No. [phone], within 30 days.
THE WEL
°Y
DATE
on, 1636 Mail Service Center - Raleigh, NC
GW-1 REV. 07/2001

300701
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) .Ta ma g ht. Camp, TT CERTIFICATION. ?1 38
WELL CONTRACTOR COMPANY NAME ('a mpt a Wa11 & Primp On_ Tnc PHONE.$7Al d51_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: II
Nearest Town:_u4tn.County #1�o� 1 K
L-ttf no' &&een R;dev )4-iyk)Anai
(Sweet Name, Numbers, Community, Subdivision, Lot No., Zip Code),
3. OWNER: Tr !V £ &t yt
Ne Komi11),Q 75
City or Town Sta
c°Lb gip_ 4R�1
Area code- Phone numbern
4. DATE DRILLED "7- / 9 - 0 Li
5. TOTAL DEPTH: 4 p 5
6. DOES WELL REPLACEEXISTING WELL? YES 0 NO F
7. STATIC WATER LEVEL Below Top of Casing: /DC
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface•
*Top of casing terminated actor below land surface requires a
. ' variance la accordance with ISA NCAC 1C .0118.
9. YIELD (gpm): ID METHOD OF TEST D it
10. WATER ZONES (depth): b-
Address o jar-hen/1re (i rr je
(Sweet or Roue No,)
Zip Code
11. DISINFECTION: Type Ohl nr i ❑ie
12. CASING:
Depth Diameter
From p To l f) Ft. 6 1 / 4-
From To Ft.
From To Ft.
13. GROUT: Depth
From_0___ To 2 0 Ft.
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Ft.
Diameter
Ft. in.
Ft. in,
Amount Ci-Lp
Wall Thickness
or Weight/Ft. Material
eDR_21 PVC
Material
Neat Cet:Lent
Method
Hand
Slot Size Material
in.
in.
Depth Size Material
From To Ft
From To Ft.
16. REMARKS: Piat't / axe
Topo laic/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutWseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check boa)
DEPTH DRILLING LOCz
From To Formation Description
n tan dirf
tic S een'5oltdaled rock
3:"o
LOCATION SKETCF( S n
Show direction and distance in miles from at least o �e
two State Roads or County Roads. Include the road
numbers and common road nacre
r
jr"✓
/<: :
r
¶r%err:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERS(7N CONSTRUCTING THE WELL / DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service pfe�n�tefj',_Ralpigh,INC 1,'
27699-1636 Phone No. [phone], within 30 days. ,faW1T gP,rV704/30.01
i
;-i ; UEP �/ (!hil

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Tames tit_ Camp, Jr- CERTIFICATION 71 18
300700
WELL CONTRACTOR COMPANY NAME ('amp' c WP11 R Pnmp Cry Tnr PHONE #$7R1 A51-7'122
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) - / (if applicable)
1. WELL USE (Check Applicable Box): Residential QV
M un i c i p al/P u b 1 i c 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT
Nearest Town: County
Lsf 113-ree�Lgkder�} t'ati AIAA 5
(Street Name, Numbers, Community, Subdivision, No., Zip Code)
3. OWNER: POaq!AS jt lrk'eevCY- 1
Address lD73D (,yi0' TrYace East
(7r&dII (Su�feta Route No,
ew+oVC 1_. 3 cz5J
City or Town Scam Zip Code
y`-3bSS
Area code- Phone number
4. DATE DRILLED % �9 �4
5. TOTAL DEPTH: `I 4.5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO X
7. STATIC WATER LEVEL Below Top of Casing: 60 FT,
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance in accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): foot METHOD OF TEST D i r
10. WATER ZONES (depth):
11. DISINFECTION: Type rhlnri nP Amount 1/1 Cdj)
Wail Thickness
or Weight/Ft. Material
SDR21 PVC
12. CASING:
Depth Diameter
From p To Ft. 6 . / G
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From p To 20 Ft. pleat 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 Sizc Material
From To Ft.
From To Ft.
Topo phic/Land setting
❑Ridge mSlope ❑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
n a3 Ai f clay
a3 44' f'nvtsclidated rock
g
?.
"r
rn
pG
LOCATION SKETCH
Show direction and distance in miles from at leas
two State Roads or County Roads. Include the roa15
numbers and common road names.
r
tit
1
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WTI I WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
G-41 teA wI M�n
SIGNATURE OF PERSON CONSTRUCTING THE WELL /
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
-

r
300151
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GAN'IT CERTIFICATION # 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRIJCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box) : Residential ❑ Municipal ❑ Industrial ❑ Agricultural 0 Monitoring ❑
Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: MILL SPRING
County POLK
LOT 6 BUCK BRANCH RD DEER MEADOWS SUBDIVISION
(Street Name, Numbers, Community. Subdivision, Lot No.. Zip Code)
3. OWNER HORTON HOME OF RLI THERFORDTON
ADDRESS 342 HWY74 BYPASS
(Shed ur Rome No_)
RUTHERFORDTON
City or Town
828-287-3366
NC
State
Area Code - Phone Number
4. DATE DRILLED 7/27/04
5. TOTAL DEPTH 560
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ® Flat
Latitude/Longitude of well location
35.18.223 / 82.05.993
(degrees/minutes/seconds)
Latitude/longitude source: ® GPS ❑ Topographic map
DEPTH DRILLING LOG
28139 From To Formation Description
Zip Code 0 50 Clay
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO LI
7. STATIC WATER LEVEL Below Top of Casing: 200 FT
(Use "+^ If Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance m
accordance with 15A NCAC 2C.0118
9. YIELD (Rpm): 3 METHOD OF TEST ARDM
to. WA IER ZONES (depth): 540
50 560 Consolidated Rock
n. DISINFECTION: TYPE IIYPOCIILORITE Amount 17
12. CASING: Wall Thickness
Depth Diameter or Weight/FL Material
From 0 To 62 Ft. 61/4" SDR 21 PVC
u. GROUT:
From 0
14. SCREEN
Oz
Depth Material Method
To 20 Ft. GRAVEL MIX GRAVITY
Depth
From NA To
15. SAND/GRAVEL PACK:
Depth
From NA To
16. REMARKS:
Diameter
Slot Size Material
FI. in. in
Ft,
Size Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
s
co
t"f
Cwi
c
C3
-.. Fa1
oc
sra
ran
0
fn
tat
n
r
O
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.
8/1/04
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Date
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001

From: Scott & Jo Ann To: Division of Water Quality uate: co 1/2Uu4 lime: 9:4u:-iu rni
rape uu
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 D
Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use:
2. WELL LOCATION:
Nearest town: MILL SPRING Cmmty POLK
LOT 18 TWIN DR LAURAL LAKES
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER HORTON HOME OF RUTHERFORDTON
ADDRESS 342 HWY74 BYPASS
(Street or Route No.)
RUTHERFORDTON
City or Town
828-287-3366
NC
State
Area Code - Phone Number
4. DATEDRILLED 7/14/04
5. TOTAL DEPTH 300
28139
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 45 EL
(Inc' *" If Above Top of eating)
8. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of -casing terminated at/or below land surface requires a variance in
accordance with 15ANCAC 2C.0118
9. YIELD (gpm): 10 METIIOD OF TEST ARDM
lo. WATER ZONES (depth): 280
300147
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley Flat
Latitude/Longitude of well location
35.19.155 / 82.13.313
(degrees/minutes/seconds)
Latitude/longitude source: ® GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Fomlatiou Description
0 120 Clay
120 300 Consolidated Rock
u. DISINFECTION: TYPE HYPOCHLORITE Amomrt 12
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 130 Ft. 61/4" SDR 21 PVC
13. GROUT:
From 0
14. SCREEN
oz
Depth Material Method
To 20 Ft. GRAVEL MIX GRAVITY
Depth
From NA To
15. SAND/GRAVEL PACK:
Depth
From NA To
16. REMARKS:
Diameter
Ft in.
Size
Ft,
Slot Size Material
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the roan
numbers and common road names. a
G7
iV
a
IV
c.3
I DO HEREBY CERTIF'Y't'HA'I PHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TIIIS RECORD IIAS BEEN PROVIDED TO THE WELL OWNER.
8/1/04
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Date
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001

300153
North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR• _ �� �y-C>�
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): ResidentiallL Municipal ❑ Industrial 0 Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION- (Show sketch of the location below) /
Nearest Town. /,�s a �e< ounty: --41
(RoadName and Numbers, CCyrvn Ay, or Subdivision and Lot No.) DRILLING LOG
3. OWNER �./%l Xi
Address 5117 dim!/ e/
(Street or Rou No.)
Cir Town State
4. DATE DRILLED --Li: ,/
5. TOTAL DEPTH `Yd.")
6. CUTTINGS COLLECTED YES NO❑
7. DOES WELL REPLACE EXISTING WELL? YES NO. ]
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'+' it Above Top of Casing)
9. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated aVor below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 'e
From
0
7O
"
/7-
To
7-'
/77
Zip Code
METHOD OF TEST Are
11. WATER ZONES (depth)• �/t ,776.27"
12. CHLORINATION: Type C',1i6. Win, Amount 4,1.-44l
13. CASING: '
Wall Thickness
Depth Diameter or Weight/Ft,
From /..T To /77 Ft 44/ l/.) S27-tvg/
From To Ft
From To Ft
14. GROUT:
From G
Material
Depth Material tYfethod
To G' Ft # /%.rare ze-:e
From To Ft
15. SCREEN:
17 pth
From /V To
From To Ft
From _ To Ft
16. SAND/GRAVEL PACK:
Depth
y/ From To Ft.
From To Ft.
17. REMARKS: ,45- —444/r[';..f /f/ �`r / �%J �.1=/e5Oa'
Diameter Slot Size Material
Ft _ in _ in
in in
in in
Size Material
DEPTH
Formation Description
t ',
J`o-Jlre
13. on
al z
*#`'
ac
rnf
1C. in
4
f
If additional space is needed use back of forrrf? nr
—11
LOCATION SKETCH Crs' s
(Show direction and distance from at least two State
Roads, or other map reference points)
C.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
' SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW1 REV. 12/99
FOR OFFICE USE ONLY
Quad No:
Serial No.

N011338 131b'MON(TO2if-OMU
331d301VNOIO38 3111AS3MOOI1
rooz v inr 292,675
WELL CONSTRUCTION RECORD
North Carolina — DefflAi@faffnvironment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CON IOSIZI $II MIL NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONVAWYMACiP-A19 SIANffi PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection D Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
COUNTY LINE RD.-NORTH
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JERRY HODGE
Address COUNTY LINE RD.-NORTH
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) - 429-2685
Area Code Phone number
4. DATE DRILLED 01/08/04 N
5. TOTAL DEPTH: 365
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): 3 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 9.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
To 90 Ft. 6-1/4" SDR21 PVC
From 0
From _
From _
13. GROUT:
From 0
From
14.SCREEN:
From
To Ft. _
To Ft. _
Depth Material
To 20 Ft. QUIKRETE
To Ft.
Depth Diameter
To Ft.
Method
POURED
Slot Size
in.
From in.
in. _
15. SAND/GRAVEL PACK:
Depth Size Material
From To _ Ft.
From To Ft.
16. REMARKS:
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
IIWY. #108 W. FROM RUTHERFORDTON. RT.
ON COUNTY LINE RD.-NORTH. APPROX. 3 MILES
ON LEFT (ii BOX #2911.
ZS :Z bid I— 933 h0
0
0
0
ern
crn
cm
0
Sm
y0
m�
m
cnz
m=
--1
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
6
SIG ATURE 0F 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

N011038 ?131VMONn021J-DMO
3013301VNOI O3213111AS3210001
rooz s g inr
292674
WELL CONSTRUCTION RECORD
North Car. 4r !AI:i. ' I ent of Environment And Natural Resources — Division of Water Quality — Groundwater Section
a, , a i it o•t,.•7Y1, 0" VIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
W1l1N3ttlallaAntORIGANY NAME PITI'MAN WELL BORING. LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIA 1 ED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
N. HIGHLAND RD LOT #15
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER BRIAN GILLEN
Address N. HIGHLAND
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 894-0496
Area Code Phone number
4. DATE DRILLED 01/07/04
5. TOTAL DEPTH: 525
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 160 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 4 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
, Zip Code)
11. DISINFECTION: Type CHLORYTE Amount 14
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 100 Ft. 6-1/4" SDR21 PVC
From _To_Ft. _
From _ To _ Ft. _ —
13. GROUT: Depth Material
From 0 To 20 Ft. QUIKRETE
From To _ Ft.
14.SCREEN Depth Diameter
From _To_Ft.
_
From _To_Ft_
15. SAND/GRAVEL PACK:
Depth Size Material
From_ To_Ft. _
From _ To _ Ft. _
Method
POURED
Slot Size Material
in. _ in.
in. iit
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. LEFT ON
SILVER CREEK RD. LEFT ON N. HIGHLAND RD.
4/10 MILE ON RT.
CS :Z bid h— 83310
0
0
c
Cert
cm
O<
Do
ma
rn
N�
c4
0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS UCTION STANDARDS, AND THA A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SI NATU1OF ERSON CONSTRUCTING WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

NO110381131VMONnONO-OMO
3013d01VN0103e13111AS3800W
tioo2 E ti lnc
292673
WELL CONSTRUCTION RECORD
North Carolina epierapt of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL UAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL obintlatettiPaikaPiatIlY 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 0 Industrial 0 Agricultural ❑
Monitoring ❑ 'Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON
ARLEDGE DR
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: SHERRY ARLEDGE
Address ARLEDGE DR.
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(828) — 894-3920
Area Code Phone number
4. DATE DRILLED 01/14/04
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): 5 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 10.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 180 Ft 6-1/4" SDR.21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From _0 To 20 Ft. QUIKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From To_Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. RIGHT ON
HUGH CHAMPION RD, RIGHT ON ARLEDGE DR.
APPROX. 1/4 MILE ON RIGHT.
0
t
-*1
rn
Q
1
r
IV
C!t
W
0
0
�rn
rn
c)
�m
O<
Sc
:r.)• 0
rel
cn
rn�
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 SSS RECORDD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSO CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James yr Camp, Tr CERTIFICATION* 7138
WELL CONTRACTOR COMPANY NAME Camp' c Wo11 & Pomp Cn. Tnr PHONE ff$7A) 453_7322
STATE WELL CONSTRUCTION PERMIT* ASSOCIATED WQ PERMIT*
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential f"Municipal/Public 0 industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO 1
Nearest Town: (S✓Y irt4 Countyle
,S44 1,, Y(i'Fe Oak Dr.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: c &v kJ Ikf 11 let
Address -D/II MavIry Dr,
(Street or Route No.)
')0014;1 SC ZgzID
City or Town State Zip Code
(WPS)- 7Ia - a 03 8
Arta code- Phone number /y •'
4. DATE DRILLED /-24-Dy
5. TOTAL DEPTH: 4 D S
6. DOES WELL REPLACE EXISTING WELL? YES 6d" NO ❑
7. STATIC WATER LEVEL Below Top of Casing: LI-0 FT
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S .1 FT. Above Land Surface*
Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 4 METHOD OF TEST D it
10. WATER ZONES (depth): 3 So
11. DISINFECTION: Type rh l m r i n
12. CASING:
Depth
From it To l)7
From To
From To
Amount VA cap
Wall Thickness
Diameter or Weight/Ft. Material
Ft 6
Ft.
Ft.
eDR.21 PVC
13. GROUT: Depth Material Method
From p To 20 Ft. N at Ccmcnt Hand
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in, in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft
30071 r)
Topo phic/Land setting
❑Ridge lope ❑Valley OFlat
(ebeck appropriate box)
Latitude/longitude of well location
(degree&minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To formation Description
p IIS rdirt stµnd,99�aye/
I 15 4o5- L'ph5ojid&fed'i'ork,
s 9en
Gecru
(. O �
J4c
ye,
/
LOCATION SKETCHS NA
Show direction and distance in miles from at least C
two State Roads or County Roads. Include the road eft ,
numbers and common road names. W 2
r
X
0
1 �/✓% **' 0 k
r
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL i
1
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center '-Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
STATE WELL CONSTRUCTION PERMITW SOCIATED WQ PERMITH
(if applicable) (if applicable)
30071'1
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (1NDMDUAL) NAME (print) 1 me Q 41 Camp J c CERTIFICATION s 2 1 3 R
WELL CONTRACTOR COMPANY NAME r mpI S Wall & Primp en Tnr- PHONE B&'%A) 4S'1-7122
1. WELL USE (Check Applicable Box); Residential Ly" 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:
Neare 5 County
eLIKitt arK - j ociroul Mci:e
(Sheet Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: TI'vt Srncfk 4550c.
Address
trttt or Route o.)
5-f(rtan um
try or Town State Zip Code
Area code- Phone number II II
4. DATE DRILLED -D Y
5. TOTAL DEPTH: N Ci
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO gk
7. STATIC WATER LEVEL Below Top of Casing: 20
(Use '4" if Above Top of Casing)
8. TOP OF CASING IS i FT. Above Land Surface.
*Top of casing terminated at/or below land surface requires a
variance in accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): !OC T METHOD OF TEST p ti-
le. WATER ZONES (depth): �i �5 0
11. DISINFECTION: Type C' h 1 n r i n a
12. CASING:
Depth Diameter
From r) To do Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth
From_a____ To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK.:
Material
Amount f CLtp
Wall Thiclaess
or Weight/Ft. Material
eDR21 PVC
Method
Ft. Ncat Cement Hand
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft, in. in.
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS•
Topogr�'a�PPhic/Land setting
❑Ridge Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(dcgreedminutesiseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
QRILLING LOri
Fprmatiog Delscription
From�To
D
rack
P
0 en
cyfn
LOCATION SKETCH 9°
Show direction and distance in miles from at least 9 141
c
two State Roads or County Roads. Include the road i rt�
numbers and common road names. I eX t, A : p c
✓; s -1 r =
17 el.
(.7rfCr <)kf--
F-V) +/. R
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WEL.
CONSTRUCTION STANDARDS, AND THAT A COPY 0(; THIS RECORD HAS j3EE P OVIDED TO THE WELL OWNER
1 �. -13 —0
SIGNATURE OF PERSQN CONSTRUCTING THE WELL / DATE -
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James *Y Carp, jr CERTIFICATION Y 71 3R
WELL CONTRACTOR COMPANY NAME ramp' c Wall R. Primp Cm Tnr PHONE Y$9R) ASi_7322
STATE WELL CONSTRUCTION PERMITY ASSOCIATED WQ PERMITY
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential l?X/ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 if Other, List Use
2. WELL LOCATION: �'�/
Nearest Town: (I S 1 Y"1 Iv County
t`) ill: /�Y�<- iv.'
nul Mckc-e
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
-Tin Jiin i A53 L
Address P L / ( X L UR7
/ 44Sneer or Row; No.)
rooL1Iv)QQ 5C o2957L
dity or Town 54ue Zip Code
( )-
Arra code- Phone number
4. DATE DRILLED
Li
5. TOTAL DEPTH: ,CZ,5 `>
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 14(
7. STATIC WATER LEVEL Below Top of Casing: Z' FT.
(Use "t" if Above Top of Casing)
8. TOP OF CASING 1S 1 FT. Above Land Surface"
*Top of cuing terminated atlor below land surface requires a
• axiaoce in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): / cc -t METHOD OF TEST a ; r
10. WATER ZONES (depth): 2 v
11. DISINFECTION: Type chi nri rim
12. CASING:
Depth Diameter
From o To .2 Ft. 6 1 / 4
From To Ft
From To Ft.
13. GROUT: Depth
From_ To 20
From To
Amount 1 c t,�l
Wall Thickness
or Weight/Ft. Material
RDQ-21 PVC
Material Method
14. SCREEN: Depth Slot Size Material
From To in.
From To in.
15. SAND/GRAVEL PACK: CrFE Iti riofY
Depth Size Material
From To Ft.
From To Ft.
300713
Topo phic/Land setting
❑Ridge 12Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees(m ioinesre. nnds)
Latitude/longitude source:❑GPS❑Topographic map
(check boa)
DEPTU DRILLING Len
From To Fprmation Description
c 7 (y J11 r
rp,1-5rli lt_�i ro L
J ()CATION SKETCH
Show direction and distance in miles from at le
two State Roads or County Roads. Include the r
numbers and common road names.
16. REMARKS:
Ft. N ,zt Ccmcnt Ha
Ft.
Diameter
Ft.
Ft.
in.
in.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A C00 OF THIS RECORD HAS BEEN PROVIDTO THE WELL OWNER
/G 4/11,1.�1- L'(," • /L1��+
ON CONSTRUCTING THE
q
SIGNATURE OF
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
DATE
hick'ff
kd

3. OWNER:
Address
STATE WELL CONSTRUCTION PERMIT"
aoplioabl el
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDI\TDUAL) NAME (print) Tames .0 Camp Jr CERTIFICATION " 7 1 i A
WELL CONTRACTOR COMPANY NAME ('amps! S Wn 11 R. Primp rn Tn(-
ASSOCIATED WQ PERMIT"
(if applicable)
300'712
PHONE"E2R) AST_7322
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Yln� ountyc P7
Nearest To /t`I ) 6)
ftc(icw' ``Ir Kef
(Street Name, Number, Community, Subdivision, Lot No., Zip Code)
9 Ol i y 45 DC .
/ i5tx Yl 25"
(Street or Rome No.)
_/ .i/ Ar U SE �92�r
City or Town Olei
Cityc Zip Code
( Area code- Phone number
4. DATE DRILLED I ' C
5. TOTAL DEPTH: .L'
6. DOES WFI I REPLACE EXISTING WELL? YES 0 NO A
7. STATIC WATER LEVEL Below Top of Casing: (2c FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S 1 FT. Above Land Surface`
flop of casing terminated at/or below land surface requires a
-Wholes in accordance with ISA NCAC 2C .0118.
9. YIELD (Rpm): METHOD OF TEST nix
10. WATER ZONES (depth): IL-
11. DISINFECTION: Type f h l n r i nF
12. CASING:
Depth Diameter
From_a___ To "nt Ft.6 t /a_
From To Ft.
From To Ft.
13. GROUT: Depth
Front_ To 2 0 Ft.
From To Ft.
14. SCREEN: Depth Diameter
Frorn To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To
From To
Material
Wont
16. REMARKS:
Ft.
Ft.
Amount 14 Cu�
Wall Thickness
or Weight/Ft. Material
RDR21 PVC
Method
Cement Hand
Slot Size Material
in.
in.
Material
142'tPc r e w Nt Kee RA -
Topo hic/Land setting
ORidge lope OValley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Rc
7 r- rcrs4-,darcd feck
o
P
Gs
G Cr^
C's
,�► yc0
LOCATION SKETCH S M'
Show direction and distance in miles from at least
CA
two State Roads or County Roads, Include the road W y
numbers and common road names. +1Lake La fe
✓E n
,,c f
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED TN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
c?/{i ,e1- ,. / •L 7141
SIGNATURE pF PERSON CONSTRUCTING THE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone Nu. [phone], within 30 days. GW-1 REV. 07/2001
g-)6
DATE

300710
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Tames w Cain p, ?r CERTIFICATION 21 ill
WELL CONTRACTOR COMPANY NAME r'amr' G Wa11 2, Pi Piimr (`Tnr• PHONE al d52_7322
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential (!J Municipal/Public 0 industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 if Other, List Use
2. WELL LOCATI0)j1 jj
Nearg�t Town: LO &4t't_b t•(S Coun
- J;
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Cade)
3. OWNER: ( h1t BrcAie
Address aai l Lan e_
a//�� f tFStreet or Route o,)
ItmhuS C—
iry or Town State Zip Code
(�6 )- in — 3
Area code- Phone number
4. DATE DRILLED cI ' 6
5. TOTAL DEPTH: LR S y
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO la
7. STATIC WATER LEVEL Below Top of Casing: /7O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of casing terminated aUor below land surface requires a
variance In accord& with 1SA NCAC 2C .0118.
9. YIELD (gpm): MEJ OOD OF TEST p y r
10. WATER ZONES (depth): iy(--
i
11. DISINFECTION: Type Ohl nri np Amount t/a0.4.0
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
12. CASING:
DepthA, Diameter
From n To '/ 7 Ft. 6 1/ 4
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
Fronn_ o To 20 Ft. Plot Ccnicnt 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:
Dcpth Sizc Material
From To Ft.
From To Ft.
)'orn
16. REMARKS:
two State Roads or County Roads. Include the road O
numbers and common road names. rfi
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 HASEEN PROVIDED TO THE WELL OWNER
a a-n',n .
SIGNATURE OF PERSON CONSTRUCTING THE WELL > DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center • Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
g-
Topo cJLand setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
PEPTH QRILI ING LOG
From TQ tjF�orma lion Description
(rtY
Consolidated rock
0 O
c7 c-
4.44
n 2 G
• fr`s
• -70
J ()CATION SKETCH rn
tin
Show direction and distance in miles from at least i IP
n
Z

WELL CONSTRUCTION RECORD
North Carolina - Deparunent of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
Jam se to Camis Jr_ CEHTIFICATIONp 71 38 WELL CONTRACTOR COMPANY NAME Camps c WE'11 & primp n &
f`n TnPHONE 87A) d51-7122
STATE WELL CONSTRUCTION PERMITS
(if applicable) ASSOCIATED PERMITH
(if applicableicab]e)
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 LOCA ]
Nearest Town: VC11— Coun
%cf 137 peen RiJere
(Street None, Numbers, Community, Subdivision, Lot No.
3. OWNER: Keit c i �/
Address 137 G-reert Ki ver' N;ghlands
4veet pr Route No.) J
atiter rdtoA C .28139
)- /Din—(objp
Area code- Phone number
4. DATEDRIJIFD �_ ,?) 704
5. TOTAL DEPTH: .SD 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: a/2 FT.
(Use'4" if Above Top of Casing)
8. TOP OF CASING 1S t FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires ■
variance In accordance with ISA NCAC 1C .0118.
9. YIELD (gpm): .2..D METHOD OF TEST air
10. WATER ZONES (depth): c '1c
City or Town State 1 Zip Code
Code)
11. DISINFECTION: Type rh 1 nr i na Amount Ua C 4p
12. CASING:
Depth Diameter
From_a_ To 42- Ft. 6 1 / 4
From To Ft.
From To Ft.
Wall Thickness
or WeighUFt. Material
SDR21 PVC
13. GROUT: Depth Material Method
From p To 20 Ft. Neat Cement Hand
From To Ft.
14. SCREEN: Depth Diameter Slot Size Matcrial
From , To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topo hie/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)
DRILLING LOG
Formatiopp Description
Airi Ha y
eo cdd+FA rr.,ic
DEPTH
From To
n 6Z_
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Ryais.Include the road
numbers and common roaditamesY
Y
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCIED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS pEEN PROVIDED TO THE WELL OWNER
it
SIGNATURE OF PERS N CONSTRUCTING/ 1.3 .d
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-I REV. 07/2001
g
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cc.) y G
4rn
,O
rn
? rP
O
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1\�

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 8o 06y
302893
- Groundwater Section
WELL CONTRACTOR COMPANY NAME FL /YososvS Welt A/tlt/�/q; Cry,
CERTIFICATION # 0 a 75
PHONE ga 68'3 - frry
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential (Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 if Other, List Use
2. WELL LOCATION: Nearest Town: ►1'1/t/(S fQ/4 /I9 p County TOi
4
(e Ktvz 4' sier /reek RY
(Street Name, umbers, Community, Subdivision, Lot No., Zip Code)
3 OWNER:SOtueylern Showcase HOGS112 a)frgi cz)
Address 5413 Asheville NtUI�
(Sneer or Rowe No.)
N€yy(ersfmuille JVC a874)
City or Town State Zip Code
(tt)-coin-2Sn
Area code- Phone number
4. DATE DRILLED 57}7#y
5. TOTAL DEPTH: ST
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: ),[) FT.
( Use "+" it' Above Toil Fr Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
"Top o1 casing terminated atior below land surface requires a
variance in accordance with 15A NCAC IC .0118. n
9. YIELD (gprri): 2, METHOD OFTEST1-lirrliny/45
10. WATER ZONES (depth): 3 ye r
Topogr�ic/Land setting
❑Ridge EiSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of we location
/Il-sr° /SaeaS WifliA //,0z'
(degrees/minutes/ onds)
Latitude/longitude source: PS❑Topographic map
(check box)
DRILLING LOG
Formation Description
//In I'
DEPTH
From To
o — 97
Q7 - ,CO2 Pr
/D7\— 1{os
11. DISINFECTION: Type fra,6te )55
12. CASING:
Depth Diameter
From A To an Fr 6, AS ahhia2 PUc 5p/C4l
From To Ft
From To Ft
13. GROUT: Depth Material Merhod
From 0 To 7,4 Ft. eancrijt Po UNA(i
From To Ft. l
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ftin. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Amount //0
Wall Thickness
or Weight/Ft. Material numbers and common road names.
Silver CO:. Rd.
Mills Spring,Mc
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTIONSTANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Na
SIGNAT
RE OF PERSON CONSTRUCTING THE WELL DATE
O Cr'l
t' - nrr
r-r m
n tiG
arn
2,10
cp oC
LOCATION SKETCH
9 nth
Show direction and distance in miles from at past �
two State Roads or County Roads. Include th4ad t
0.0
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. (919) 733-322], within 30 days. GW-1 REV. 07/2001
(IA
ry

WELL CONSTRUCTION RECORD
North Carolina - Depanment of Environment and Natural Resources - Division of Water Quality - Groundwater Section
Per/5
WELL CONTIUCTOR(INDIVIDUAL) NAME (print) IJO L6y t
302876
CERTIFICATION # 20& 8
WELL CONTRACTOR COMPANY NAME PC /Y,)f On/ r W e /( nn/I/I/at)0 Ca , PHONE gra) 6%3 - 99Y9
STATE WELL CONSTRUCTION PERMIT# ��// ASSOCIATED WQ PERMIT#
(inapplicable) (ifapplicable)
—/
1. WELL USE (Check Applicable Box): Residential a Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ if Other, List Use
2. WELL LOCATION:
Nearest Town: eSt lDda County PO (k
Pri tnDlr/ii, /twt
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Be 11 LO kt I VII rttr
Address Tao o Mat✓4 r[ir znsp Rd
(Street or Route No.)
SR lecAl t_ h e - 8 773
Ciry or Town State Zip Code
hM8)- 4 fla -aS88
Area code- Phone number
4. DATE DRILLED -S 4/
5. TOTAL DEPTH: 3 $ S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IV
7. STATIC WATER LEVEL Below Top of Casing: ¥& FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING 1S / FT. Above Land Surface*
`Top of casing terminated actor below land surface requires a
variance in accordance with 15A NCAC 2C .0118. pp
9. YIELD (gpm): METHOD OF TEST11/r i)(1774,
10. WATER ZONES (depth): /X
Topogra hic/Land setting
❑Ridge 3Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
Nat nt.e0Vu�gd•/9,Cm'
(degrees/ tine�s/onds)
Latitudeilongitude source: at PS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 — 79' Ater
7f' - 71
7 — 38S
11. DISINFECTION: Type
12. CASING:
Depth
From__l To 77
From To
From To
13. GROUT: Depth
From 0 To V)
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Fr.
t6. REMARKS:
Diameter
Ft. lyric
Ft.
Ft.
Ft.
Ft.
Diameter
Ft. in.
Ft. in.
L
YA.
tr n
o
tn-- L
_s 'Om
0
LOCATION SKETCH
Amount _ !dp , Show direction and distance in miles from at leacip
Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft. Material numbers and common road names.
6,11I PuLAngAI
Material
�nncrtjt
Method
Pa Jrtiny
Slot Size Material
in.
in.
Size Material
%r. -e r d d h p (a we.,
�� l4 d- r ems_
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
SIGNAT RE OF PERSON CONSTRUCTING THE WELL
CO
Lo
0
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - $aleig , NC
27699-1636 Phone No. [phone], within 30 days. GW-I I V1:,0,7/4001!I

applicable)
WE IJCTION
Division of Water QualitDepanment y - Groundwater � a
) CLRTIFICATIOY9
North Carolina - TOR (INDIVIDUAL)
of Environment `nt Natural Resources - PHONE
ls
WELL CONTRACTOR (1ND1VAN ALA NAME (p
WELL CONTRACTOR COMPANY NAME'1 able)
STATE
CORD
WELL CON9TR Section
ASSOCIATED WQ PERMITS
(if applicable)
WELL CONSTRUCTION PERM
Agricultural ❑
(f appMunicipal/Public ❑ Industrial 0
Residential Injection 0 Other 0 If Other, List Uses -----
WELL USE (Check Applicable Box): Water
n Heat PumpTopogr Ic/Land setting
❑Ridge Slope ❑Va11ey ❑Flat
(check appropriate box)
f well locinon
Latitude/longitude
Zip Code
6. EX ��_FT.
6. DOES WELL REPLACEof Casing: of casing)
7. STATIC WATER LEVEL BelowTop
se , if Above Top
•
FT. Above Land Surface*
3. TOP OF
CASING na �- requires a
terminated actor below land surface
*Top a of casing ag
variance in accordance with l5A NCAC
METHOD
9. YIELD (gPtn): ��-- ^ �
10. WATER ZONES (depth). _ /� y�
11. DISINFECTION: TYpe—lam""
12. CASING: Depth Diameter
Ft.-
From_11--7o Ft._�
From --__To
From Depth Mmeri ,
13. GROUT'
Et.
From_(i— To_
From_--
14. SCREEN' Depth
From To_
From To-
15. SAND/GRAVEL PACK: Size
Depth
Ft.
From_---TToo Ft.__
From �—
S
Ft
Diameter slot Site
ll. in.
Fr. in. _
Ft. n.
Material
Recovery
Monitoring ❑
2. WELL LOCATION: I County
Nearest �..-0 n
Code)
Numbers, Co[mnoniry, Subdivision, Lot No., Zip
(Street N
3. OWNER:
Address
Cry or To
8-1 )- '1
Area code- Phone number y
4. DATE DRILLED f
TOTAL DEPTHNG WELL'S
YES 0 NO
(degrees/In
Latitudeilongitude source:
DEPTH
From To
c.mta.
OF TEST
Amount _fit
Wall Thickness Material
or Weight/Ft. M
pits -sue`
al Method
Material
o
conds)
pS❑T'opographic map
(check box) GLGG
DRILL
Formation Description
lanc�i.�
p G-:f
0= o
Show direction and distance in miles from at I t rol
two State Roads or County Roads. Include the �d 20
on road names. • rrct-
numbers and comet ▪ 0
r —
S1lvev Creek Road
5princ3[ nC
SANCAC 2C WELL THIS
Cr.)
rn
16. REMARKS: ACCORDANCE WITH 1 WELL OWNER
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE
l DO HEREBY CERTIFY THAT WELL WAS CONSTRUCTED IN
CONSTRUCTION STANDARDS.. AND
GN AT RE OF eCeriierRaleigh, NC
PERSON
CONSTRUCTING THE WELL
SI 1636 Mail Serwc
Submit the original to the Division of Water Quality, Groundwater Section,
GW-I REV:07l2001
276994636 Phone No. [phone], within 30 days. 2
yZ o
ATE

w
Topogr3piticiLand setting
/ ORidge Slope OValley ❑Flat
/ t ffey N£ (check appropriate box)
(Street Name, t um hers, Cot umry, vision, Lot No., Zip Code)
SoLati u e/I nngitude of well location
/ r- &MIN( La✓� /,(`5Ln� ern) N �� ' o >o7a'
3. OWNER: L-Aw'ic.4G! noWUA68 degrees/minu±f�onds)
Address 5413 A51)v vi 1 lE }}W Latitude/longitude source: La GPSOTopographic map
(Sager or Route No.) (check box)
evdlPXsInv1IIC. RC, ;- /9'Il DEPTH DRILLING LOG
From To Formation Description
(M)-On-2.$83 p - Y9 all.t
Area code- Phone number Y9 SY Ror k
4. DATE DRILLED 6/a.40" S Y — 305 (y/taw.ltG
5. TOTAL DEPTH: 30.5 /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Q
7. STATIC WATER LEVEL Below Top of Casing: VD FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
*Top ofeasing terminated avor below land surface requires a
variance in accordance with (5.A NCAC 2C.0118. t
9. YIELD (gpm): 3 METH $ 9 OF TESTRI/kdiny�s-t�
10. WATER ZONES (depth): ��
LOCATION SKETCH rr1�D p ri
11. DISINFECTION: Type Nek '$ Amount 810 i Show direction and distance in miles from at Igast t1V
12 CASING: Wall Thickness two State Roads or County Roads. Include the IV a:a
Depth Diameter or Weight/Ft. Material numbers and common road names. i
From_0_To SY Ft. (, JS 2t6,iXS ��_<n&aj
z'J
From To Ft. �
13. GROUT: Depth Material Method relic' LOAC, ,•,-:::::-,i
1 �+
302818
WELL CONSTRUCTION RECORD
North Carolina - Depanment of Environment and Natural Resources Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) IS O lob/ W , PG ! 5 CERTIFICATION # IX a 25
WELL CONTRACTOR COMPANY NAME Fr yosoNT W e L( 1VV ///A/ Cry . PHONE gaYl6t3 - 99PI
STATE WELL CONSTRUCTION PERMIT# �/ ASSOCIATED WQ PERMIT#
(ifapplicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential LT Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: rr
Nearest Town: Ybi/gb So!i County
I(u/b tli
Ciry or Town State Zip Code
From To Ft.
A /k
r From 0 To v) Ft. tone rejt Po04A mill'
y� % J cn !
From To FL y 1' I 1 I I N r i n9 1 f1C i `,
14. SCREEN: Depth Diameter Slot Size Material i — t
From To Ft. in. in. co
From To Ftin. in.
15. SAND/GRAVEL PACK: _r-ll
Depth Size Material
From To Ft.
From To Ft.
I6. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
i
SIGNATORE OF PERSON CONSTRUCTING THE WELL
6pz/o9
ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -'Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

3p3
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) jam a s ut, Cair p, jr CERTIFICATION # 713R
PRONE#$7R1 AS3-7322
WELL. CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
ramp' a Wa11 R Pump
Tnr-
1. WELL USE (Check Applicable Box): ResidentialerMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION.
Nearest Town
County Pt
trL_o r z fyr, �fdc
(Sweet Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER/OD4Ik,&1*.i.oftosti,
Address D X 5
La-ke (5 torRoute No.)` /� s9^,J
u Y e /v /
City or Town State
Zip Code
Area coda Phone numbjjj�{{.,, �`
4. DATE DRILLED u(• 11 1
A
5. TOTAL DEPTH: g.s
6. DOES WELL REPLACE EXISTING WELL? YE��NO 47. STATIC WATER LEVEL Below Top of Casing: ,
(Use "t" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
_ *Top of casing terminated at/or below land surface requires a
*variance in accordages with 15A NCAC 1C .0118.
9. YIELD (gpm): IWn MET OD OF TEST air
10. WATER ZONES (depth): \'d)
11. DISINFECTION: Type ("hi nr i n a Amount
12. CASING:
Depth Diameter or Weight/Ft.
From__ To Z Ft. 6 1 / 4
From To Ft
From To Ft.
13. GROUT: Depth Material Method
Front_p To 2 0 Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Site.
Front To Ft.
From To Ft.
CLue
Wall Thickness
eDR. 21
Material
PVC
Topographic/Land setting
midge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH PRII.I.INGLOG
From I rTq Formation f�Tkescrptio¢
Neat Cemcnt Hand
Material
LOCATION SKETCIi
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS: -„
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WELL N
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
,{ N\PMA fl /CI • 0 u
ATURE OF P ON CONS CTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
303566
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) TamnS m Camp Tr CERTIFICATION CLUB
WELL CONTRACTOR COMPANY NAME ramp' R Wa11 R Pump Cn Tnr
STATE WELL CONSTRUCTION PERMIT$ ASSOCIATED WQ PERMIT#
(if applicable) • (if applicable)
1. WELL USE (Check Applicable Box): Residentialer Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
PHONE #gi7R) d57_7322
WELL LOCATN:
Nearest T wn:, J��t1ypN� & &)
(Street Name, Numbers, Communi , Subdivision, Lot No., Zip Code)
3. OWNER: 1 f
Address j � Sox fl4
County
(Steecj or Route No.)
IY WI O 3 C 29-0 � .S
City or owo State Zip Code
63- r7g -67z3
Area code- Phone number
4. DATE
LLED
5. TOTAL DEPTH: kip (1 (1�{
6. DOES WELL REPLACE EXISTING WELL? YE ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 01% FT.
(Use'4" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Move Land Surfaces
`Top of casing terminated at/or below land surface requires a
-variance In accordappe with ISA NCAC 2C .0118.
9. YIELD (gpm): Al METH p NEST n; r
10. WATER ZONES (depth): b V'O
11. DISINFECTION: Type r h l n r
12. CASING:
Depth Diameter
From p To •S-t7 Ft. 6 1 / 4
From To Ft,
From To Ft.
13. GROUT: Depth
From_0__ To 2 0 Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK
Depth Size.
From To Ft.
From To Ft.
Amount 2. U t'
Wall Thickness
or Weight/Ft. Material
gDR.21 PVC
Material
N at Cement
16. REMARKS:
Slot Size
in.
in
Material
Topographic/Land setting
Pgidge ❑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 Fgrmaugp DeiCtion
0 �-t7llM.V
SO ions (.11.41s
LOCATION SKETCH (�
Show direction and distance in miles from at le st"
two State Roads or County Roads. Include the Toad
numbers and common road names.
1 DO HEREBY CERTIFY THAT THIS WFr r 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
Acbis SIC�,p414TURE OF PEON CO STRUCTING THE WELL
tO-Is-oy
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
w

03564
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Tames W_ Camp, Jr CERTIFICATION # 21 RR
WELL CONTRACTOR COMPANY NAME ramp' q Wa11 R Primp ('n Tnr PHONE #$7R) 451_7322
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 ❑ If Other, List Use
2. WELL LOCATION:
�
ear t Town:',t�(�A1 County
(I V\ Q.4 4DA � ..2`
(Street Name, Numbers, Community, Subdivision,`Lot No., Zip Code)
3. OWNER: 5yaj/e V I et its 5
Address 5.72 ,T o t'Lk Lf tt V4.n 1 n,
/K(! Ye r r n S 3ectie No.),
N C o2S(/ 39
City or Town State Zip Code
Area code- Phone numb
4. DATE DRILLED 3, 1. U y
5. TOTAL DEPTH: S
6. DOES WELL REPLACE EXISTING WELL', YES 0 NO It]
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use '4" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surfaces
• *Top of casing terminated atlor below land surface requires a
•variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): I 0 METHOD. OF TEST
10. WATER ZONES (depth): \ (i
Lir
11. DISINFECTION: Type eh 1 or in a
12. CASING:
Depth Diameter
From__0___ To 20 Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth Material
From o To 30 Ft. N at Cement
From To Ft.
Amount CA Mr
Wall Thickness
or Weight/Ft. Material
SDD1 PVC
Method
IIand
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 I3Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH PRILLING LOG
From •f F,Qtmatign Descrip l net
LOCATION SKETCH
Show direction and distance in miles from at lealP
two State Roads or County Roads. Include the rorit
numbers and common road names. N
Fs0
cuhm? O-tk
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACC e ' a ANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION ST a ' aS, AND THAT A COPY OF THIS RECORD AS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE a PECSPN=RUCTING THE WELL
I(- is- C>'
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. - GW-1 REV. 07/2001

mono
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ja m cis (.r Camp J>r CERTIFICATION Y 71 18
Tnr PHONE #67R) 451-7322
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
R Pnmr C2 ,
ASSOCIATED WQ PERMIT#
(if applicable)
ramp's
wall
1. WELL USE (Check Applicable Box): Residentialia Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCA ON:
N est Town.
\QPAn
(Street Name, Numbers, / Community, Sub
3. OWNER: f(e51tlt
Address ////P o RpX 5'
£t-Ke >! ureor%JC_)
.Co ty
MA
ion, Lot No., Zip Code)eD
I /de - (�✓ 1 S 14-14-
(904
City or Town Suite Zip Code
Area code -Phone numb
4. DATE DRILLED
5. TOTAL DEPTH:
ac -OL(
bE,
6. DOES WELL REPLACE EXISTING WELL? YEA cia NO 0
7. STATIC WATER LEVEL Below Top of Casing: X U FT,
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): S ME iQD TEST air
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope Geralley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING I.OQ
From To �� ation Dpperippti
FLU ' 4SCAAIAA
11. DISINFECTION: Type (MI n r i na Amount c,AJ. ,)
12. CASING: Wall Thickness
Depth, • Diameter or Weight/Ft. Material
From p To G0 Ft.6 1/4 SDR21 PVC
From To Ft.
From_ - To Ft.
13. GROUT: Depth Material Method
Fronl__0.-_To 30 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 Size Material
From To Ft.
From To Ft
16. REMARKS:
LOCATION SKETCI-j
Show direction and distance in miles from at lee
two State Roads or County Roads. Include the raad (?',
rn:
numbers and common road names.2-1
r_
rr'4t.
c>
a:5
•
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY O THIS RECORD HAS pEEN PROVIDED TOTHEWELL OWNER
ayfr/ cwr 'f,,,,yn �n .
SIGNATURE OF PE CONSTRUCTING THE WELL ✓ /A DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
N
•
r

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,/ 21 iR
WELL CONTRACTOR COMPANY NAME ramp' q Win 11 R Piimp Cn. Tnr PHONE ,/$2R) dS'3_7322
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ PERMIT,/
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residentialyd' Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCH" ONa
Nearest Town: 4. N County Pet. 4 .
(Street Name, Numbers Community, Subdivision, Lot No., Zip Cod )
3. OWNER: 0belf I1
Address e R o X 301
K S (Screw AreNo.) oig5_4 g
O 5
(Nti-tY
oc:I'o S Zip Code
Area code -Phone numb
4. DATE DRILLED Q �
5. TOTAL DEPTH: ti S (so `''
6. DOES WELL REPLACE EXISTING WELL? YE NO
7. STATIC WATER LEVEL Below Top of Casing: . U FT.
8. TOP OF CASING IS (Use "+" if Above Top of Casing)
1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 1C .0118.
9. YIELD (gpm): f U MATTQD OF TEST tSr
10. WATER ZONES(depth). J
11. DISINFECTION: Type r h 1 nr i rip. Amount it W
12. CASING: Wall Thickness
Depth Diameter orWeight/Ft. Material
From Q To 1'Z Ft.6 1 / 4 QDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From p To 20 Et. Pleat Ccment Hand
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope th'0•alley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DELTA DRILLING LOG
From To ormatioDDespriptty
g
(Xf
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common ro r s.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/r YVtI�l.[
JIG ATURE OF P$RSON CONS UCTING 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. OW-1 REV. 07/2001
n

From: Scott & Jo Ann To: Division of Water Quality
Date: 10/27/2004 Time: 8:07:40 PM Page 3 of 1
G� 303679
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 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION:
Nearest town: COLUMBUS Couob POLK
LOT 9 GREEN HILLS RD. LAKE ADGER / GREEN RIVER SUBDIVISION
(StreetName, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OVVNER THOMAS CALTON
ADDRESS 210 Sycamore Ln
(Street or Ronk No.)
Rutherfordton NC
City or Town Slate
28139
Zip Code
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley 0 Flat
Lafitude/Longitude of well location
35.19.601 / 82.11.602
(degrccs/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic map
DEPTH DRILLING LOG
From To
0
Formation Description
65 Clay
828-287-3766 65 720 Consolidated Rock
Area Code - Phone Number
4. DATE DRILLED 9/24/04
5. TOTALDEPTH 720
6. DOES WELL REPLACE EXISTING W ELCt
7. STATIC WATER LEVEL Below Top of Casing:
VhS ❑ NO Q
550 Ff.
(1Jsa +" If Above Top ofcasirpj
8. TOP OF CASING IS 2 Fr. Above Land Surface'
'Top ofossi ng tamivatcd aVor below land surface requva a variance in
accordance with 15A NCAC 2C.0118
9. YIELD (Wm): 1/2 METHOD OF TEST ARUM
10. WATER ZONES (depth): 250
it. DISINFECTION: TYPE HYPOCHLORITE Amount 12
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 72 Ft. 6 1/4 " SUR 21 PVC numbers and common road names. G
O M
13. GROUT: y'— =^tn
rt
Depth Material Method CO �`.0
From 0 To 20 Ft. GRAVEL MIX GRAVITY --t -Va
14. SCREEN D'aCD p1Q
Depth Diameter Slot Size Material fr1)
From NA To Ft. in in. - _t)
15. SAND/GRAVEL PACK: 0
Depth Size Material N rnCD
From NA To Ft, C Cs
16. REMARKS:
1 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.
10/1/04
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001

zoZ84t
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
4560 HWY. #108
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MARK CULBRETH
Address 4560 HWY. #108
(Street or RouteNo.)
MILL SPRING NC 28756
City or Town State Zip Code
S( 28) — 894-2518
Area Code Phone number
4. DATE DRILLED 10/13/04
5. TOTAL DEPTH: 34
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 14 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 6_44
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 34 Ft. 24" CEMENT
From To Ft. _
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. in.
15. SAND/GRAVEL PACK:
Depth Size
14 To 34 Ft. 78M
To Ft.
From
From
16. REMARKS:
Material
GRAVEL
Topographic/Land setting
❑ Ridge 0 Slope 0 Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at (east
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 E. FROM MILL SPRING. DOUBLE
WIDE APPROX.1/4 MILE ON RIGHT.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1 l_r,
s SI NATURER CONS UCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) Of applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
KEITH LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ROBIN CHOQUETTE
Address 81 KEITH LANE
(Street or Route No.)
COLUMBUS, NC 28722
City or Town State Zip Code
8(_28) - 894-5947
Area Code Phone number
4. DATE DRILLED 10/07/04
5. TOTAL DEPTH: 245
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Nj
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 4.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 90 Ft. 6-1/4" SDR.21 PVC
From To Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft QUIKRETE POURED
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To _ Ft _ in.
From _ To _ Ft. _ in. _
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
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. #108 E. FROM COLUMBUS. RIGHT ON
FOX MTN. RD. LEFT ON SMITH RD. TO APPROX.
1/2 MILE. TURN LEFT ON KEITH LANE. 1/10 MILE
ON LEFT.
From To _ Ft. _
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC 1 ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
i7.7V1.> /f) - i uyt
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 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 ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: SALUDA
WEST FORK CREEK RD.
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: WALLY PACE
Address 1521 WEST FORK CREEK RD.
(Street or Route No.)
SALUDA NC 28773
City or Town State Zip Code
(828) — 674-9077
Area Code Phone number
4. DATE DRILLED 10/13/04
5. TOTAL DEPTH: 165
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
Zip Code)
11. DISINFECTION: Type CHLORYTE Amount 3.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 85 Ft. 6-1/4" SDR21 PVC
From To Ft.. _
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. OUCRETE POURED
From To Ft.
14.SCREEN• Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _To_Ft_ in. is
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topograpbic/Land setting
❑ 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. #176 W. FROM TRYON TO SALUDA. IN
TOWN TURN LEFT ON MOUNTAIN PAGE RD.
CROSS RR TRACKS. GO APPROX. 1.5 MILES.
LEFT ON OLD MTN. PAGE RD. LEFT ON MTN.
PAGE RD. AGAIN AT SS. LEFT ON MINE MTN. RD.
LEFT ON WEST FORK CREEK RD. APPROX. 3/10
MILE ON RIGHT GRAVEL DRIVE.
OCD
-o
w
w
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIG /TURN OF PE
ON CONSTRUCTING THE LL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK
140 CHRISTOPHER RD. SCRIVENS HILL
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: SCOTT STATLER
Address 140 CHRISTOPHER RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) - 859-2890
Area Code Phone number
4. DATE DRILLED 10/20/04
5. TOTAL DEPTH: 365
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 6 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 9
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 120 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: Diameter Slot Size Material
From Ft. in _ in.
in. in.
Depth
To
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To _ Ft. _
From To Ft
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 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. #108 W. FROM COLUMBUS. LEFT ON
CAPPS RD. RT. ON GUNNING RD. LEFT ON
SCRIVEN HILL RD. LEFT AT 1sT ROAD. FIRST
DRIVE ON RIGHT.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTgUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
TURE F PERSON C NSTR CTIN THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

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 IF 'CATION # 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 ry Municipal/Public 0 industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
HONEYHILL COVE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: ROBERT PENFOLD
Address HONEYHILL COVE
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
Area Code Phone number
4. DATE DRILLED 10/08/04
5. TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Zj
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 12 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 4.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 80 Ft. 6-1/4" SDR.21 PVC
From To Ft.
From _ To _ 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.
County POLK
Topographic/Land setting
0 Ridge ❑ Slope ❑ Valley D Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. RT. ON HUGH
CHAMPION RD. RT. ON PENIEL RD. RT. ON BILL
HOLBERT RD. TAKE LEFT FORK INTO
HONEYHILL COVE. 1ST DRIVE ON LEFT.
CD
O
•
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS CTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/t) ',f'- U
DATE
SIGN OF PERS CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

303834
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK
GOLF COURSE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: PAUL MULLETT
Address 1572 GOLF COURSE RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) - 817-1179
Area Code Phone number
4. DATE DRILLED 10/11/04
5. TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 4.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 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 _ is
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 appmopuate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. RIGHT ON
LANDRUM RD. RIGHT ON GOLF COURSE RD.
APPROX. 2 MILES ON LEFT.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRJTIONSTANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
."(SIGNA OF PERSO CONSTRUCTING THE WELL
O a9 /o /l- 6
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

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- MILL SPRING
232 WILD HAVEN WAY
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CURTIS ROWE
Address 232 WILD HAVEN WAY
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
8(28) — 863-4253
Area Code Phone number
4. DATE DRILLED 10/19/04
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): 6 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CIH.ORYTE Amount 7.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 60 Ft 6-1/4" SDR.21 PVC
From _ To _ Ft. _ _
From _To_Ft.
_ _
13. GROUT: Depth Material
From 0 To 20 Ft. OUIKRETE
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size
From _ To _ Ft. _ in. _
From _ To _ Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To _ Ft. _
From _To_Ft. _
16. REMARKS:
Method
POURED
Material
in.
in.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. LEFT ON
GARRETT RD. RIGHT ON GREENBILLS DR LEFT
ON LAKE ADGER PARKWAY. JUST BEFORE
COVERED BRIDGE. TURN RIGHT ON WILD
HAVEN WAY. APPROX. 1/2 MILE ON RIGHT.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
s J e1 i . 9dc4,57) �� '4 �. ' -a te /D - O 9 - e f'
SIGNATURE OF PERSON CON UCTING 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

zozszi
From._ To _ Ft. in. _
From To Ft. in. _
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
16. REMARKS:
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 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON County POLK
COLLINSVILLE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: WAYNE HORNE
Address COLLINSVILLE RD.
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
8( 64) — 680-5555
Area Code Phone number
4. DATE DRILLED 10/22/04
5. TOTAL DEPTH: 485
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO EZ
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 12.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 140 Ft 6-1/4" SDR21 PVC
From To Ft
From _To_Ft_ _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
in.
in.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. RIGHT ON
COLLINSVILLE RD. 4/10 MILE ON RIGHT. NEW
DRIVE.
r _r
5")
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
A)2 — ,U_ -i7. _ / i - a - c �
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

fiV
1 303830
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
BURGUNDY LANE
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: BRENT SEAGLE
Address 167 BURGUNDY LANE
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 863-224
Area Code Phone number
4. DATE DRILLED 10/29/04
5. TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 60 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
Zip Code)
11. DISINFECTION: Type CHLORYTE Amount 4.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 70 Ft. 6-1/4" 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: 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. #9S. FROM MILL SPRING. RT. ON
LANDRUM RD. RT. ON BURGUNDY LANE. 1ST LOT
ON LEFT.
CD
G cc'
0
r- ter,
o rn,,
t,,,)
4) U2c
C,
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
NATURE OF PERSON CO
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 3 0 3 1 5
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR.
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential IN Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: L'OL Um6I/S/ -etc County. /49,Z,
///1/Y /41'
(Road Name and Numbers. Community. or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER From To Formation Description
D' /7'
Address
C. ai Street or outs No.)
,rterz
City or Town State Zip Code
4. DATE DRILLED 9"oa%4i
5. TOTAL DEPTH -;41)
6. CUTTINGS COLLECTED YES jar NO❑
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO®
8. STATIC WATER LEVEL Below Top of Casing: if„? FT.
(Use'*' it Above Top of Casing)
9. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .p11a
10. YIELD (gpm). LD METHOD OF TEST - 2
11. WATER ZONES (depth). C4 C% /,ld0'
/7'
yp ' ia'
12. CHLORINATION: Type 4•14�-2< Amount "levre' If additional space is needed use back of form Y�
13. CASING: Cr-
LOCATION SKETCH .C.tr&..
Wall Thickness 0t3
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two Stat>� -.0'8
From 11-4-7To y/ - Ft 6X' oD 5 'ai -i/C Roads, or other map reference points) 1 'o0 G
From To Ft. n• �' '
From To Ft S o O
14. GROUT: tpo
s�
• n
Depth Material Method
From O To do Ft j/ 1�- zr
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From — To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
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.
fra
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
FOR OFFICE USE ONLY
Quad No:
Serial No.
GW-1 REV. 12/99

WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Clayton Bigham
WELL CONTRACTOR COMPANY NAME Lee & Sims Drilling Services, Inc. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# Polk County Permit 40039 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
CERTIFICATION # 2320
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Hendersonville
Lot#8, Rixhaven Drive
County Polk
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Frederick Wood
Address 2206 Evergreen Dr.
(Street or Route No.)
Hendersonville NC 28792
City or Town State Zip Code
(828 } 697-2403
Area code- Phone number
4. DATE DRILLED 11/12/2004
5. TOTAL DEPTH: 515
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: 55 FT.
(Use "+"if Above Top of Casing)
8. TOP OF CASING IS 1.5 FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with l5A NCAC 2C .011&
9. YIELD (gpm): 2.5 METHOD OF TEST Air Purge
10. WATER ZONES (depth): 200', 250'
11. DISINFECTION: Type Ca Hypochlorite
12. CASING:
Depth Diameter
From 0 To 69 Ft. 6.25
Amount 8 oz.
Wall Thickness
or Weight/Ft. Material
.25* PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. Neat Cement
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From N/A To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From N/A To Ft.
From To Ft.
Method
Tremie
Topographic/Land setting
®Ridge ❑Slope ❑Valley, ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreea/minutea/aeconda)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 5 Red Clay
5 64 Silt
64 69 PWR
69 515 Bedrock
LOCATION SKETCH
Show direction and distance in miles from at tst
two State Roads or County Roads. Include the road
,JOtrm"
numbers and common road names.
Material 50/
/14
-24
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
)
SIGNATURE 0
ce_
ERSON CONSTRUCTING THE WELL DAT
Submit the original to the Division of Water Quality, Attn: Information Management, 1617 Mail Service Center -
Raleigh, NC 27699-1617, Phone No. [phone], within 30 days.
GW-1 REV. 09/2004

From: Scott Gantt To: DENR
Date: 11/20/2004 Time: 10:20:28 AM Page 2 of 4
304585
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 WO PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box) : Residential ❑ Municipal ❑ Industrial ❑ Agicuhural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: LAKE LURE County POLK
213 TURNING LEAF LANE
(Street Name, Numbers, Community, Subdivision. Lot No,. Zip Code)
3. OWNER HORTON HOME OF RUTHERFORDTON
ADDRESS 342 H W Y 74 BYPASS
(Sired or Sonic No.)
RUTHERFORDTON NC
City or 'Town State
828-287-3366
Area Code - Phone Number
4. DATEDRILLED 10/14/04
5. TOTAL DEPTH 180
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 55 FT.
(rise"," If Above Top of -Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
°Top of casing terminated at/or below land surface requires a vorimcc in
accordance with 15A NCAC 2C.0118
9. YIELD (gpm): 8 METHOD OF TEST ARUM
to. WATER ZONES (depth): 170
28139
Zip Code
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
Latitude/Longitude of well location
35.23.295/ 82.10753
(demeeslminutcs/seconds)
Latitude/longitude sourcc: 0 GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 110 Clay
110 180 Consolidated Rock
it DISINFECTION: TYPE HYPOCHLORITE Amount 6 on LOCATION SKETCH
12. CASING: Wall 'Thickness Show direction and distance in miles from al least
Depth Diameter or Weight/Ft. Material two State Roads or Cotmty Roads. Include the road -.
From 0 To 119 Ft. 61/4" SDR21 PVC numbers and common road names.
13. GROUT:
Depth
epth Material Method
From 0 To 20 FL GRAVEL MIX GRAVITY
14. SCREEN N)
N c3
Depth Diameter Slot Size Material crlITT
CZ
From NA To FL in. in. --�''
15. SAND/GRAVEL PACK: t-9 C%0
Depth Size Material 0 C.nce
r)
From NA To Ft, ,
16. REMARKS:
I DO HEREBY CERTIFY TI1AT PHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
11/1104
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
lames 'L Camp, Jr
WELL CONTRACTOR COMPANY NAME Camp' a Wal 1 R Primp Cr. Tnr
STATE WELL CONSTRUCTION PERMLTI ASSOCIATED WQ PERMITI
(if applicable) (if applicable)
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
CERTIFICATION s 21 ' 8
PHONE e$7A) d43_7322
1. WELL USE (Check Applicable Box): Residential 0 MunicipaUPublc ❑ Industrial 0 Agricultural 0
Monitoring Cl Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATIAN pp pp
Nearest Town: WA.1 nn A Gn� RnY County {'✓�
CJ 4 M (ZAt„\k/ to
(sum Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: yy\./UTOL b/v,
Address i-j 0 +it Lavitt tiro,
n?t._,iA
Poi (in), , R) 13 '7
City or Iowa Stag Zip Code
(3,5i)- L.Z1- Hal
Arta code. Phone non
4. DATE DRILLED 1 I - I O.
5. TOTAL DEPTH: R. t7 S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IA
7. STATIC WATER LEVEL Below Top of Casing: \5- (? ET.
(Use "✓•" if Above Top of Casing)
8. TOP OP CASING IS 1 FT. Above Land Surfaces
• - , *Top of easing terminaud atlor below lead surface esquires •
-varlaaa la mordent with ISA NCAC 1C .0118.
9. YIELD (gpm): 1 5 METHODQF TEST „a it
10. WATER ZONES (depth); 2 t4 5
11. DISINFECTION: Type r h 1 or i n e Amount
12. CASING: Will Thiclmess
Depth Diameter or Weight/Pt. Material
From 0 To La ELF 1 / 4SDP.24 DVC
From To Ft.
From To. Ft
13. GROUT: Depth
From p To�.0_ Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From_ To Ft. in. in.
From To Ft. in. in
15. SAND/GRAVEL PACK:
Depth Sit. Material
From To Ft.
From To Ft.
16. REMARKS'
Material
Neat Cement
Method
Topographic/Lend setting
❑Ridge ❑Slope ❑Valley ❑F1at
(cluck appropriate box)
Latitude/longitude of well location
(desraedmtauraahnoondr)
Latitude/longitude source:❑GPS❑Topographic map
@bock bat)
DEPTH pRII LING LOQ
From „To,, Fol bon Description
{1 I..
0; 3 G(-4 & S,)
7 OCN'ION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
ko-um SAD
0
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
SIGNAT-it QF PERSOt CONSTRUCT)NG THE WELL
1 (.Or. elf
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Man Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. OW-1 REV. 07/2001

tel'Ctit
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Oroutrdwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ja meg
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT/
(if applicable)
lc- Conic , Tr
ramp c Wa11 R Pump rn
_ASSOCIATED WQ PERMIT/
(if applicable)
Inc
CERTIFICATION / 2 1 3 R
PHONE /$7R1 4. - 322
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION nn
Nearest Town: Qn$1, Itelli County,'f)
C .1 tr, OkiiX ' (QM
(Street Name, Number, Community, ub5 divivm, Lot No., Zip Code)
3. OWNER: -t(I-brjj.k -s (f`Jfl-
Address ..).i\ :) t3 z:A Uu 14.
C.4A (sent_ -� Na.) cai 3 L
LytyorTow Stye GI Zip Code
Area code- Phone awnber
4. DATE DRILLED 1 N • 0 jl
5. TOTAL DEPTH: 0 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 N4 ❑
7. STATIC WATER LEVEL Below Top of Casing: a-0 FT.
(Use w" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
•Top or easing terminated atlor below load surface requires s
•varlamp la sewrd co with 1SA NCAC 1C .0114.
9. YIELD (gpm)'(} OD OF TEST
10. WATER ZONES (depth): 0
err
11. DISINFECTION: Type C h 1 n r i n a
12. CASINO:
Depth Diametu
From 0 To 2-D Ft. 6 3 /
From To FL
From To Ft.
13. GROUT: Depth
From$ _ To_2_ Ft.
From To Ft.
Amount LI1Le
Wall Thickness
or Weight/Ft. Material
rDR21 PVC
Mau:rid
Neat CC(ncnt
Method
Hand
14. SCREEN: Depth Diameter Slot Size Material
From To Ft in in.
From To Ft. in. in
15. SAND/GRAVEL PACK
Depth Sias Material
From To Ft
From To Ft.
16. REMARKS-
Topographic/Land setting
❑Ridge ❑Slope ❑Flat
(ebscic appropriate boa)
Latitude/longitude of well location
(dagreedmiautWaacon4 )
Latitude/longitude source:OGPS❑Topographic map
(clack boa)
pRII LINO 1.0
From To
n6
Cogtnah'o1151"
2n Zos CI L
:.t
-*.jn
LOCATION SKETCIj ca 7-)
'
Show direction and distance in miles from at leasto Trill.`?
two State Roads or Co i S =-)
W>h' Roads, ]nelude the road � .s ;..
numbers and common road names. c.r y
C frt
.D ,;-->
1 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
TUBE O 'ERSON C STRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Sectlon,1636 Mali Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. OW-1 REV. 07/2001

"o
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J a In Ps to Camp Ir- CERTIFICATION# 711 PI
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
Camp' a WP11 R Primp en Tnc PHONE #$7R) d51-7322
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential de7Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 IF Other, List Use
2. WELL LOCATION:
N ar st Tow:CLASIIM
County `'
Street Name Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: S ,
Address .3-1 v 0 ( A tk Q
p1 (Street or Amite No.)
City or fowAdtwe State Zip Code
Area code- Phone number
4. DATE DRILLED 11 • 014
5. TOTAL DEPTH: a. S
6. DOES WELL REPLACE EXISTING WELL? YES.❑ NO 31.
7. STATIC WATER LEVEL Below Top of Casing: to it FT.
(Usc'cr" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface"
*Top of casing terminated at/or below land surface requires a
variance in accords ce with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST a i r
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
Froat_p_.C2. To _Ft.
From To Ft.
Froze( To Ft.
13. GROUT: Depth
Frorri_.p.__ To 2
.2b(1
Ch 1 nri na Amount
Wall Thickness
Diameter orWeight/Ft. Material
6 1/4 Q814-'1 PVC
Material
• Neat
Cement
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Method
Hand
Slot Size
in.
in.
Material
Topographic/Land setting
citidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH QRI�!LQLING LOG
From To rinatm Drys r Wi n
TLin(5 L2S J�Lt
LOCATION SKETCIi
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road n4mes.
1 DO HEREBY CERTIFY THAT THIS WFI I WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Afn SiGMATURE OO F PER N CONSTRUCTING THE WELL I DATE v
SZ:Z kid DC NH 10
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. OW-1 REV. 07/2001
r=

�rw
North Carolina - Departrnent of Environment and Natural Resources - Division of Water Quality • Groundwater Section
1636 Mail Service Center - Flaleigh, N.C. 27699.1636-Phone [phone]
WELL CONSTRUCTION RECORD
306333
WELL CONTRACTOR- Ue--/vd Leo- ki II St?V.C-2S
WELL CONTRACTOR CERTIFICATION #: ai
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable 13ox): ResldentiaLU Municipal ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injection ❑ Other El If Other, List Use:
Agricultural ❑ Monitoring ❑
2. WELL LOCATIOy (how skgtch of the location below) {)�'
Nearest Town: o/ZOt tA-5 County rC
?,?° /3of s
(Road Name and Numbers, Coerrpunity, oir Subdivision and Lot No.) DRILLING LOG
3. OWNER .-re-rNa.. lir�e' is From To
Address 7f70 Poors ND rof
ez_4( r a 1$ueel or Ro/u5No.) �t
4. DATE DRILLED
5. TOTAL DEPTI-( 3 D 0
6. CUTTINGS COLLECTED YES LJ NO
7. DOES WELL REPLACE EXISTING WELL? YES ( I NOT]
8. STATIC WATER LEVEL Below Top of Casing: 33 FT.
2 g/39 •-• - y--
City or Town State - Zip Code
1-rf-os � — 33
PeI
(Use'' II Above lop of Casing)
9. TOP OF CASING IS 11 S FT. Above Land Surface'
*Top of casing terminated aVor below land surface requires a variance In accor-
dance with 15A NCAC 2C .01111
10. YIELD (gpm): 7 METHOD OF TESTA '
11. WATER ZONES (depth).
�- 60
7/- 30'D
DEPTH
Formation Description
Red (1/0-•
/T
prN 7423
Sb 7f .brow ✓moo Cs/k
6'. it rent L<
12. CHLORINATION: Type If-�%/^I Amount S-02
13. CASING:
Wall thickness
Depth Diameter or Weight/FL Material
O
From To 71 Ft 6 Yg P UC
From To Ft
From To FI
14. GROUT:
Depth Material Methgd
From 0 To 2% FI E-Z 8e_&/ Trena, c
From
15. SCREEN:
II additional space is needed use back.gf form IV
Ur-Td!
-at—
LOCATION SKETCF-P
(Show direction and distance from at leas( J,wo1Statee C'"'t
Roads, or other map reference pointsj: - • fd! •
To Ft r
r�y
Depth Diameter Slot Size Material
From To Ft in in
From To FI in. In
From To FI In. In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
r
I DO FIEREBY 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.
FOR OFFICE USE ONLY �'c"^^---- t>,..;�c- ✓vC /-• S-OGy
ouad No: SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE/
Submit original to Division of Water Ouatity, Gmu d ter Section within 30 days
r4,1171 No.
0(/-I fIEV. 12193

Q
304984
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'1FICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIA I'ED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON
SANDY PLAINS RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: PAT & ALLEN CARRON
Address 1212 SANDY PLAINS RD.
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(828) — 863-2149
Area Code Phone number
4. DATE DRILLED 11/22/04
5. TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WELL? YES ® NO 0
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 4.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 140 Ft. 6-1/4" SDR.21 PVC
From To Ft. _
From____ To ____Ft ____ _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To _ Ft
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS-
Topographic/Land setting
0 Ridge 0 Slope 0 Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. LEFT ON
SANDY PLAINS RD. 1.2 MILES ON RIGHT. (1212 ON
ROCK BESIDE DRIVE)
0
0
c-�
N
Co
V
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS UCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
0 //-
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

304999
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: COLUMBUS
SERPENTINE DR.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: STEWART GWINN
Address 357 SERPENTINE DR.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
8(� — 894-2207
Area Code Phone number
4. DATE DRILLED 11/04/04
5. TOTAL DEPTH: 505
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=4/2 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 POLK
11. DISINFECTION: Type CHLORYTE Amount 13.5
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.OUDQRETE 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
HOUSTON RD. FROM COLUMBUS. LEFT ON
SKYUKA RD. RT. ON SKYUKA MTN. DR GO TO
TOP OF MTN. & LEFT ON SERPENTINE DR. 1/4
MILE ON LEFT.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
dT G�
S GN P$ N CONSTRUCTING THE WELL DATE 4/
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING. LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential tEl Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
SUNSET RIDGE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: TONY WALDROP
Address #2 SUNSET RIDGE RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 894-5080
Area Code Phone number
4. DATE DRILLED 11/02/04
5. TOTAL DEPTH: 705
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 11_1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 19.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 35 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.
From_ To_Ft. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _To_Ft_
From _ To _ Ft. _
Method
POURED
16. REMARKS:
in.
in.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 FROM COLUMBUS. GO OUT
SKYUKA RD. RIGHT ON HOUSTON RD. LEFT ON
WHITE OAK MTN. RD. GO TO TOP OF
MOUNTAIN. TURN LEFT AND GO BY THE
CONDOS. STAY STRAIGHT ON DIRT ROAD. LEFT
ON SUNSET RIDGE RD. ON LEFT BEFORE CUL-
DE-SAC.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT &NflUCTaELL
OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNR
//1 � �� py�1/ ( /,S.J".':!d']1LI1Zk:CGl_(JAT OF PERDATE co
V
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mail Service Center— Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

306092
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 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County POLK
GREEN RIVER HIGHLANDS -LOT #136
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CHARLES BRACKETT
Address GREEN RIVER HIGHLANDS
(Street or RouteNo.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
8(28) — 429-7490
Area Code Phone number
4. DATE DRILLED 12/07/04
5. TOTAL DEPTH: 505
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 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 110 Ft 6-1/4" SDR21 PVC
From _To_Ft. _ _
From To Ft _
13. GROUT: Depth Material Method
From 0 To 20 Ft.OULKRETE POURED
From To FL
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #221 S. FROM RUTHERFORDTON. RIGHT
ON COXE RD. GO INTO POLK CO. RIGHT ON
RIVER CREST PARKWAY. RIGHT ON CROSS
RIDGE RD. LOT ON RIGHT. BEFORE CUL-DE-SAC.
(LOT #136j
V
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
- ? - n
SIGNkTURE 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

306089
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CER11FTCATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: LAKE LURE
515 HWY. #9 N.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JAY GULIANO
Address 515 HWY. #9 N.
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
(866) — 867-7687
Area Code Phone number
4. DATE DRILLED 12/23/04
5. TOTAL DEPTH: 265
6. DOES WELL REPLACE EXISTING WELL? YES ® NO 0
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 100 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 6.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 150 Ft 6-1/4" SDR.21 PVC
From To
From _____To ____ Ft ____ _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From ____ To ____Ft. ____ in. in.
From To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge 0 Slope 0 Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. HOUSE ON
RIGHT IN CORNER OF HWY. #9 & ISLAND CREEK
RD.
T
m
CO
0
tca,
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNA OF PERSON ONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

306088
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERl'1FICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Z Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
PEA RIDGE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DAVID RUSSELL
Address 4066 PEA RIDGE RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 863-4806
Area Code Phone number
4. DATE DRILLED 12/13/04
5. TOTAL DEPTH: 465
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
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): 100 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 12.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 90 Ft. 6-1/4" SDR21 PVC
From To Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 E. FROM MILL SPRING. RIGHT ON
PEA RIDGE RD. CROSS OVER THE BY-PASS. RED
BUILDING ON RIGHT.
T
m
CO
v
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
42
TV OIL PERSON CO i -- TRUCTING7/7 .s / .Z DATE WELL - (%
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

306086
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PTTTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON County POLK
HUNTERS RIDGE -LOT #18
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER MIKE STONE
Address HUNTERS RIDGE
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(864) — 457-3855
Area Code Phone number
4. DATE DRILLED 12/16/04
5. TOTAL DEPTH: 45
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 5 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 100 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 1.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 35 FL 6-1/4" SDR21 PVC
From To Ft. _
From To Ft_ _
13. GROUT: Depth Material
From 0 To 20 Ft. QUIKRETE
From To Ft
14.SCREEN: Depth Diameter Slot Size
From To _ Ft. in.
From _ To _ Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
16. REMARKS:
Method
POURED
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 ❑ 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 Rnads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. RIGHT ON
HUGH CHAMPION RD. RIGHT ON PENIEL RD.
LEFT ON HENDERSON RD. GO ALMOST TO STOP
SIGN, RIGHT ON HUNTERS TRAIL 1ST RIGHT
THEN 1/10 MILE ON RIGHT.
0
c_
ca
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
/1 i7 /il
1-7 —/ — o/.
SON
SIG OF CONSTRUCTING 11ifi WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - WELL CONTRACTOR (INDIVIDUAL) Division of Water Quality
WELL CONTRACTOR COMPANY L) NAMEE (print) ' Q ty - Groundwater CATr Section
STATE WELL CONSTRUCTION PERMITp CERTIFICATION p 2 1 3B
(ifa licable) PHONE p�9R) d53 7Z22
OCIATED WQ PERMITp
('f a icable)
1 • WELL USE (Check Applicable Box): Residential l
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Otherpal/Publt0 If Other0 r,sListU❑se Agricultural
2. WELL LOCATION:
Nearest Town;
City or Tow
(---)___Slam D--= .. Code
Area coda Phone number
4. DATE DRILLED I�11Oa
5. TOTAL DEPTH:�(��
6. DOES WELL REPLACE EXISTING WELL? YES
7. STATIC WATER LEVEL Below Top of Casing: _i U NO T..
8, TOP OF (Use "+" if Above Top of Casing)
CASING IS i
'Top of casing terminated at/or below land surfs a Above
Land Surface*
variance in accords a with 15A NCACT2C .0118.
10. WATER9. YIELD ZONES
METRO F TEST__ n„ir—_. -•-
(depth): 1�
11. DISINFECTION: Type fah 7
12. CASING:
Depth Diameter
FroFrom__nn_ To_S Ft.
Too Ft
From .
13. GROUT: Ft.
Depth Material From To
-
Fron_ Tom_ Ft. a,,
Ft. =went•— .Aei---
14. SCREEN:
From Depth Diameter
From______ To Ft in. Material
Front__ To Ft.
15, SAND/GRAVEL PACK: 1A'
From Depth Size Material
To Ft.
From
To Ft.
16. REMARKS: —'—
Amount_
Wall Tluclmess
or Weight/Ft. Material
enR21 _ nv
Slot Size
in.
in.
Method
Topographic/Land setting
ORidge @Slope OValley OF1at
(check appropriate box)
Latitude/longitude of well location
(degreea/mnwtesheconds)
Latitude/longitude source:OGPSOTopographic map
DEPTH (check box)
From DRIi 7.IN (2Q
n v To ation escrip 'on
0
CATION Frga
Show direction and distance in miles from at It
two State Roads or County Roads. Include the itpgd
numbers and common road names.
W
ee
1211
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORD
CONSTRUCTION STANDARDS EEN P WITH I5APROVIDED
O THACE
2C, WELL
AND THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WEi,i, OWNER
SIGNATURE OF PE • p CONSTRUCTING THE WELL f S -
DA
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mail Servi e C nter�
27699-1636 Phone No. [phone], within 30 days.
Raleigh, NC
GW-1 REV. 07/2001
7.7

ORD
305878
E WELL CONSTRUCTION PERMIT.
(ifa licable) ASSOCIATED WQ pERM1TN
(ifa licable)
I. WELL USE (Check Applicable Box): Residential Municipal/PMonitoring 0 Recovery 0 Heat Pump Water Injection El Othuert0 If Other,Industr
II Agricultural 0
e 2. WELL LOCATIQN:
Nearest Town:
City or Town Stain
Zip Code
Dep
Fromm To
From To
From To Ft.
13. GROUT: DepthMaterial From To
Method
Ft.—
Ft.
14. SCREEN: Depth Diameter
Front__To Ft. Material
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: !1 t1 _
6. DOES WELL REPLACE EXISTING WELL? YES, ONO a
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS
e Lad
*Top of casing terminated at/or below lasurface vrequires asurfacee
variance in accordance with 1SA NCAC 2C .0118.
9 YIELD (gpm): -- �SZ ME H D OF TEST n ; r 10. WATER ZONES (depth): $5
11. DISINFECTION: Type l 7 r
12. CASING: —rsup__Amount Ci,A
Wall Thickness
Diameter or Weight/Ft. .Material
Ft.4- ¢DR.221 ncrn
Ft.
From To in.
in,
15. SAND/GRAVEL PACK:
From Depth Ft. Size Material
From To
Ft. _
16. REMARKS:
Slot Size
in.
in.
M- / Topographic/Land and setting
idge OSlope °Valley OFlat
(check appropriate box)
Latitude/longitude of well location
Latitude/longitude source OGPSDTopographic'map
(check box)
DEE ILL
From To Fo tion De criptio �
O
0
tV
v
LOCATIO_ N 5
•
Show direction and distance in miles from at Ida st
two State Roads or County Roads. Include the road numbers and common road names.
ti
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
SIGNATURE OF p r N CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mail Service C nterE- Ralei
DA
27699-1636 Phone No. [phone], within 30 days.
-Raleigh NC
GW-1 REV. 07/2001
-IS-o
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -
Quality ua
WELL CONTRACTOR (INDIVIDUAL) NAME Division of Water li
(print -Groundwater Section
WELL CONTRACTOR COMPANY NAME CERTIFICATION Y 1 "3 R
STAT
PHONE d81281a7322
LL.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)Jam�
c m r+.. 7
WELL CONTRACTOR COMPANY NAME C L CERTIFICATION # 9 1 4 A
STATE WELL CONSTRUCTION PERMIT#
Gial 1 P r T PHONE #$7A1 dS4_ -
(if a licable) ASSOCIATED WQ PERMIT#
(ifa icable) - ---
I. WELL USE (Check Applicable Box): Residential tMunici al/Public 0 Industrial Agri
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 P Other 0 If Other, List Use cultural ❑ - -
2. WELL LOCAT N.
Near t Town: - - .. Coun
(Street Name, Numbers, Community, Subdi
3. OWNER
Address
City or To
Area code Phone number q
4. DATE DRILLED . el .� r O LI
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: U 0 FT.
8. TOP OF CASING IS (Use "+" if Above Top of Casing)
1 FT. Above Land Surfaces
*Top of casing terminated atior below land surface requires a
variance In accorditafe with ISA NCAC 2C .0118.
9. YIELD (gpm): y ME7HHOp OF' TEST a ; .
10. WATER ZONES (depth); S
11. DISINFECTION: Typ
12. CASING:
From�_D o a3
From To
From To
13. GROUT: Depth
FronL-g__ To 2 0
From To
14. SCREEN: Depth
From To
Front_____To
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
e
—
Wall Thiclmess
Diameter or Weight/Ft. Material
Ft.4
Ft.
Ft._
'DR-21 y
Material Method
Ft. N at CetRent____
Ft.�_
Diameter Slot Size Material
Ftin. in.
Ft. in. in.
Ft.
Ft.
Size Material
I DO HEREEy CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
a
Sot!
Topogphic/Land setting
Midge ®Slope ❑Valley CFlat
(cheek appropriate box)
Latitude/longitude of well location
Latitude/longitude source:❑GPS❑T---- • i
c map
(check box)
DEPTH DRI .IN Inn
FroFrO=T Fo tionDescription
n
Q
rat
LOCATION SKETCH
Show direction and distance in miles from at leash.)
two State Roads or County Roads. Include the roat-
numbers and common road names, rT
SIGNATURE OF PE. # CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -
27699-1636 Phone No. [phone], within 30 days. - Raleigh, NC
GW-1 REV. 07/2001
DATE
kvitLIALmi
l2,-1S--o
i6

30588
North Carolina - Department of Environment and Natural Resources - Division of Water
WELL WELL CONTRACTOR (INDIVIDUAL) NAME (print Q tY ^ Groundwater r Section
WELL CONTRACTOR COMPANY NAME CERTIFICATION Y 1 4 R
STATE WELL CONSTRUCTION PERMITY PHONE Y ig Al-Iti 2 Z
(ifa licable) SOCIATED WQ pERMITY
(ifa icable)
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 LOCATI N. ���
Ne st Town) County
(Street Name, N
3. OWNER:
Address
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YESp O�' NO Iik
7. STATIC WATER LEVEL Below Top of Casing:--a-IL__FT
(Use "+" if Above Top of Casing) 8. TOP OF CASING IS
*Top of casing terminated at/or below land surface requiresd Surface*
variance In accordan a with ISA NCAC 2C .0118.
9. YIELD (gpm): et METHOD F TEST n ; ,.
10. WATER ZONES (depth): lt.(
11. DISINFECTION: Type rl lr�- Amount
12. CASING:
Wall Thickness
From n Depth Diameter or Weight/Ft. Material
From To� Ft s--= �4- e DR -)1 _aver_
From To Ft
13. GROUT: Depth Material
Front _ To Method
_2g_Ft. Neat Ce.R-nt--rz_
From To Ft.
14. SCREEN: Depth Diameter
From Slot Size Material
From__ Ft. in.
From To in.
Ft
15. SAND/GRAVEL PACK: m in.
From Depth Size Material
To Ft.
From To Ft
16. REMARKS:
WELL CONSTRUCTION RECORD
Route Na)
A1c
City or a n te Zip Code
Ares code- Phone number
4. DATE DRILLED It 15 . 0 Lk
/ Topographic/Land setting
WRidge °Slope °Valley °Flat
(cheek appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) "
Latitude/longitude ource:DGPSOTopographic map
(check box)
DIEM
From o Fo 6onD gcription
DRI IN r OG
LO ATION S Frcj
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
�Q a ea-
0
0
rn
tv
ca
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
SIGNATURE OF P Y CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service
27699-1636 Phone No. [phone], within 30 days.
DATE
Center -Raleigh, NC
GW-I REV. 07/2001
r

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) JameS w Camp, Tr CERTIFICATION# 71 38
WELL CONTRACTOR COMPANY NAME ('amp' s Well & Ptimp en T n n PHONE 8$7R) 4rY 7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
306831
1. WELL USE (Check Applicable Box): Residential W Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIO
Nearest Town:
(Street Name,
County Put).
C
bars, Community, Subdiv�ision. Int No., Zip Code)
3. OWNER: i1(`t..A— SG CA0 ,.`. C
Address (- RCCc a f IM r' Y d
aeet or Route No.
/V.i i prh1a KT& ,;.?75G
A - or cegw+ _ /rat4l Zip Code
n
Area code- Phone number
4. DATE DRILLED 1 D• & O` 0
5. TOTAL DEPTH: (0 0
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO t
7. STATIC WATER LEVEL Below Top of Casing: el 0 FT.
(Use 'Y." if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
• -variance In accords ce with 1SA NCAC 2C .0118.
9. YIELD (gpm)- METHOD OF TEST 4; r
10. WATER ZONES (depth). 4)
11. DISINFECTION: Type rh 1 nr i ma
12. CASING:
Depth Diameter
From 0 To at Ft. 6 t/ 4
From To Ft.
From To
13. GROUT: Depth
Front p To 20
From To
Ft
Material Method
Ft Neat Cement Hand \ h
Ft. ` ei
Amount 1 (`IA,�
Wall Thickness
or Weight/Ft. Material
cDR01 PVC
Topographic/Land setting
(112ICfdge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
pEPTFj DRILLING LOG
From o 5 E.o-ation ascription
m1 .r�
61) Sdi ln,f-4)
off
LOCATION SKETCTj
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
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:
Ytl.,
1 \ 1
0 fej.44 )CJ inj
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
%lid rr�, r , 1, _, .04
SIGNATURE OF PER$ 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
a
3

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # 7 1 3 A
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jams r.L Cam( Jr-
ramrs' a Wp11 R Primp en T n r PHONE #8,7A') d53-7322
ASSOCIATED WQ PERMIT#
Of applicable)
30036
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential L/'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 Top
County
D 1 gl 9C-E I D g
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: \ 7b^ \A) 'W n `
Address f cY+&oX ).35-12
(Street or Route No.)
�1��(en5 5 C (2g6DI— 1353
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED `� • �-� U
5. TOTAL DEPTH: \ Q s
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 151.
7. STATIC WATER LEVEL Below Top of Casing: 16 FT.
(Use '+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface`
*Top of casing terminated atlor below land surface requires ■
variance in accords et with ISA NCAC 2C .0118.
9. YIELD (gpm): () METHOD OF TEST air
10. WATER ZONES (depth): la 0
11. DISINFECTION: Type ('h 1 nr i np
12. CASING:
Depth
From_ To 0
From To
From To Ft.
13. GROUT: Depth
From 0 To 2 0
From To
14. SCREEN: Depth
From To Ft in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
16. REMARKS:
Amount /
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 6 1 / 4 SDR-2.1 PVC
Material
FL Neat Cement
Ft.
Diameter
Topographic/Lan etting
❑Ridge ❑Slope alley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreedminutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From o Formation Dept
n `l) S.Ao k...�
Method
Hand
Slot Size Material
in.
in.
Ft.
t7t
JOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
i1 v-c
I DO HEREBY CERTIFY THAT THIS WFr i WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 00> THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PER 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

WELL CONSTRUCTION RECORD 3 0 6 8 3 9
North Carolina - Department of Environment and Natural Resources
WELL CONTRACTOR (INDIVIDUAL) NAME Division of Water Quality - Groundwater Section
(print
WELL CONTRACTOR COMPANY NAME i CERTIFICATION 8 2 7 "2 R
STATE WELL CONSTRUCTION PERMITB PHONE 8 13122 Z
(if a licable) OCIATED WQ pN
(ifs licable)ERMIT
1. WELL USE (Check Applicable Box): Residential be-Municipal/Public 0 Industrial ❑
Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT ON
Nearest T . wn:
(Street Name, N
3. OWNER:
Address
City or Town State Zip Code
County_
unity, Subdivision, Lot No., tip Code)
From Depth Diameter
0 To Ft._F i / 4
From To Ft.
From To Ft
13. GROUT: Depth Material
m_ Ft._ n 4 Method
From
From _o___ ToTo Ft.�' en to
14. SCREEN: Depth Diameter
Slot Size Maoris)
From To Ft Sl
in. in.
From
To Ft. in.
15. SAND/GRAVEL PACK: in.
From Ft.
Depth Size Material
To
From To Ft.
16. REMARKS:
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: FT
8. TOP OF CASING IS (Use "+ if Above Top of Casing)
*Top of casing terminated atfor below land surface Above equires a u[face'+
variance in accordance with 1SA NCAC 1C .0118.
9. YIELD (gpm): _ALL_ 2vTHOD OF TEST n ; ,.
10. WATER ZONES (depth): sit ()
11. DISINFECTION: Type f'h 1__ _ Amount
12. CASING:
Wall Thickn
or Weight/Ft. Material
Qr wfl nOn
Topographic/Land setting
❑Ridge DSlope Walley ❑FIgt
(check appropriate box) 'es
Latitude/longitude of well location=
fr
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topograpg ma
(check
From o Orman n D n
on
DRIr L_ ING O(-
LOCATIONS ETCH
Show direction and distance in miles from at krri
ilt
two State Roads or County Roads. Include the
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
r,
SIGNATURE OF PE • i N CONSTRUCTING THE WELL
r
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mail Service Cen e--
27699-1636 Phone No. [phone], within 30 days.
Raleigh, NC
GW-1 REV. 07/2001
d

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James '•r Camp, Jr
2 93Pi
CERTIFICATION # 7 1 3 R
WELL CONTRACTOR COMPANY NAME ramp'c Wm11 & Primp Co Tnc PRONE#ffi7R) 4C1-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT,.
(if applicable) (if applicable) r
1. WELL USE (Check Applicable Box): Residential QV Municipal/Public 0 Industrial 0 Agricultural 0
C_.)
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use i tr'
2. WELL LOCATION.
Neste tToyer: • 3✓U _ County i G JK
�'iq{t1ayt I-�('w'l_ f i 3 - R;porh
(Street e, Numbers, Community, Subdivision, Lot -No., Zip Code)
3. OWNER: tel I/: !1 eo wJ e ( it; I
Address I QDL? .I tires 3wt±J1 RA
(Street or oute No.)
(.0ittiwdbt,cs NC ,297,za
,city or Town State Zip Code
(7e/ 17-D3e
Area code- Phone number 1'
4. DATE DRILLED - 4 -0 4
5. TOTAL DEPTH: 5 0 5 .
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires •
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): „-'CD METHOD OF TEST A i r
10. WATER ZONES (depth): I 11
11. DISINFECTION: Type r h 1 n r i n p
12. CASING:
Depth _ Diameter
From_o To 7b Ft. 6 t / 4
From To Ft.
From To Ft.
13. GROUT: Depth
From_p To 20 Ft. Neat Cement
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Amount I Cu p
Wall Thickness
or Weight/Ft. Material
S.DP21 PVC
Material
Method
IIand
Slot Size Material
in.
in.
From To Ft.
16. REMARKS:
Topographic/Land setting I
63/Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) i -..
Latitude/longitude source:❑GPS❑Topograph mat_
(check box)
PEPTit DRILLING L(;
From To FQrmation Descn bon
n 7ti Cla, . 54.nd
'15-'305 C°cnslydrdT-A rock
r
o
s1
0<
DO
"-V -fit'
LOCATION SKETCH en
rns
Show direction and distance in miles from at mast cmi
two State Roads or County Roads. Include thFoad'-t
numbers and common road names.
Is
LP
L
1 DO HEREBY CERTIFY THAT THIS WELL. WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVID TO THE WELL OWNER
1/.
(2.41'IP4- k) • CQ.-�Vt. 1 —/L —D t/
SIGNATURE OF PERSON CONSTRUCTING THE / 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

2931,)0
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
James ur.. Camp, Tr.
CERTIFICATION # 21 3 R
WELL CONTRACTOR COMPANY NAME ramp' S Wall & Pump en TnC PHONE #87R) AC9-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION•1
Nearest Town: Al III v i d q County o 1 k
si RI dare - LAKE Edged - 1; - Harris
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
n� �, (in r
,� owe oY5
IK00 -Tckn 5mAk. KA
3. OWNER:
Address
n (Street or {route No.)
l c I bL..t5 Ni C )8907.
City or Tgwo State Zip Code
(Q;g4)- 11.-DCM
Area code- Phone number
4. DATE DRILLED 3 ' 0 4
5. TOTAL DEPTH: 3S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO X
7. STATIC WATER LEVEL Below Top of Casing: 5 i5 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 •
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): l7 0 METHOD OF TEST air
10. WATER ZONES (depth):
11. DISINFECTION: Type r h 1 nr i n a
12. CASING:
Depth a Diameter
From_ To "5 -3 Ft. 6 1 /
From To Ft.
From To Ft.
13. GROUT: Depth
From_ p To 2 0 Ft.
Amount i u p
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Material
Neat Cement
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
Ha d
Slot Size
in.
in.
Material
16. REMARKS:
Topographic/Land setting
CaRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topograph? -
(check box)
DRILLING LOGE
Formation Deiscription
R:If
93 .315 (Er14cl/riate d tcck
DEPTH
From To
n 23
t
—n '
rn m
0
rn
LOCATION SKETCIi — nz
Show di ction and distance in miles from avast
two State Roads or County Roads. Include ttiW oati
numbers an common road names.
e
PC, de
v
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 BEPROVIDED TO THE WELL OWNER
6�rvl.ed
SIGN A OF PERSON CONSTRUCTII/IG Tl
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
102

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James ter_ Ca rip, Jr. CERTIFICATION a 7118
WELL CONTRACTOR COMPANY NAME Camp' c WPM R Primp rn Tnn PHONE 4(g7R) 41-7322
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT'S
(if applicable) (if applicable)
293191
1. WELL USE (Check Applicable Box): Residential l Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO A } (/
Nearest Town: / t (1) 1 CJ fl y i Y( County c l f�
7-%P eV( r✓e ,' lK1 it)an - Lot G�
(Street Name, Numbers, Community Subdivision, Lot No., Zip Code)
3. OWNER: k c 5C &;AI ) J eYS
Address P C 130 X 54
(Street or Route Nitl C �7[I
f�
t u re %—Gt-%
City or Town State Zip Codc
(022)_ ? - f
Area code- Phone number
4. DATE DRII.T.FD /",a --a
5. TOTAL DEPTH: / ?5
6. DOES WELL REPLACE EXISTING WELL/ YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: ,aD 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): /00 METHOD OF TEST p i1<
10. WATER ZONES (depth). 14
11. DISINFECTION: Type r h 1 n r i rip Amount ` 3&' l Cr
Wall Thickness
Diameter or Weight/Ft. Material
Ft..c 1/4
12. CASING:
Depth
From_p—._To �---/
From To
From To
13. GROUT: Depth Material Method
Fromm To 20 Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
eDR21 PVC
N at Cement Hared
16. REMARKS:
Ft
Ft.
Topographic/Land setting ,
❑Ridge ❑Slope Malley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTII DRILLING LOG
From To Formation Descripliou
Ss �tNd
7 (eit5olidaferl tk.
n
CO e
QC
LOCATION SKETCH `L if -
Show direction and distance in miles fromili. leasr+a
two State Roads or County Roads. Include a rog`�'
numbers and common road names. ^? n
.c_ c�
Cl
u
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND T COPY OF THIS RECORD HAS BEEN ROVIDED TO THE WELL OWNER
SIGNA OF PERSON CONSTRUCTING HE' LL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

i
L.a'I^*
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James to Camp, Jr CERTIFICATION # 7118
WELL CONTRACTOR COMPANY NAME ramps a Wa11 $ Piimp en_ Tnc PHONE Si$7R) d54-7922
STATE WELL CONSTRUCTION PERMIT'S ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ild 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: N� II •D po Yl9 Co'uIn�ty
l-ot7t teen rMMI/el(/7t'e[(hlark s
(
(Street Name, Numbers, Community, Subdivision, Lot Nei., Zip Code)
3. OWNER: i Ke VI -Fo
Address I36IS S-fai•wt4c/d Dr.
tree[ "RN
r Route No.
liter IS Kg f"e 1` N 33 4 4-
City 9r Tow& State
(5)E))-'/53 —A199 Zip Code
Area code- Phone number
4. DATE DRILLED / -) 3 -o 4
5. TOTAL DEPTH: 3 25 ,�S°/
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I
7. STATIC WATER LEVEL Below Top of Casing: 4 b 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 accordan,9awlth 15A NCAC 2C .0118.
9. YIELD (gpm): h METHOD OF TEST n ; >
10. WATER ZONES (depth): 3 6
11. DISINFECTION: Type r h 1 n r i n p
12. CASING:
Depth Diameter
From ei To LC Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth
From# To 2 0 Ft.
Amount I c u P
Wall Thickness
or Weight/Ft. Material
SDR_'I PVC
Material
N at Ccmcnt
Topo laic/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) --
Latitude/longitude source:❑GPS❑Topographic map
(check box) I....
DEPTH DRILLING LOG f
From To fFormationDescriptio
(1 (� Ir�lt-clot
(A S cuts, I cia fe 4 rn/k
Method
Hu
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
0
0
• t.r�
xm
CO cm
O<
w -n
0
m�
LOCATION SKETCI-j V12
Show direction and distance in miles from mast rr'i
two State Roads or County Roads. II cl e tie road+
numbers and common road nanJesr z
(.oye Pcl,
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUUIhD IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING HE WE4 . DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James vL Ca nip, Tr. CERTIFICATION 71 38
WELL CONTRACTOR COMPANY NAME ('amp' et wall 8, Piimp Cn. Tnc PHONE #$7R) d53-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
203193
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION
Nearest T )vn:
(-AC it is c bl
(Street Name, Numbers, Community, Subdivision, Lot No., Zip
Code)
3. OWNER: r t(/ ) �l 5 �Rc tiv1 D i I
Address «D t o X 4 4 I
County U y' J K
(Street or oute No.)
s�lIV.C1A N . u773
try or To n State Zip Code
( 'i4 - 2,2:7 it
Area code- Phone number i ' I
4. DATE DRILLED a 7 I D
5. TOTAL DEPTH: 4 S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO A
7. STATIC WATER LEVEL Below Top of Casing: g 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with 1SA NCAC 2C .0I18.
9. YIELD (gpm): /7 METHOD OF TEST air
10. WATER ZONES (depth): 40 U
11. DISINFECTION: Type ('h1 nrl n
12. CASING:
Depthhh Diameter
From_p To Ft. 6 1 / 4
From To Ft.
From. To Ft.
13. GROUT: Depth
From_q—To 20 Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
I
Amount V/ (-up
Wall Thickness
or Weight/Ft. Material
n&.21 PVC
Material
Neat Cement
16. REMARKS:
Topographic/Land setting
'dge ❑Slope ❑Valley ❑Fla
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topograp yµ 11h2 _
(check box)
DEPTH DRILLING LOG
From To
7 �7
Formation Description
dirt yynr�/1
(nn5c 'bred rock
c
0
T
rn
0
G I
Cr"
t-'
m
cm
lD :cc rn
'9 f\
LOCATION SKETCI-j r0i
Show direction and distance in miles fromtje0leask't
two State Roads or County Roads. Include the roard
numbers and common road names. CO z
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUL-ihD IN ACCORDANCE WITH 15A NCAC 2C WELL
CONSTRUCTION STANDARDS, AND THAT A COP OF THIS RECORD) HAS BE N PROVID TO THE WELL OWNER
z . t.ea_ LcJ • C t'1na 2 — / b - 6q
SIGNATURE OF P ON CONSTRUCTING THE WELL / DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

2U3184
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J am a s r3 Camp., Jr CERTIFICATION# 21 3A
WELL CONTRACTOR COMPANYNAE ramp' a W11 R Mimi) ('n Tnr PHONE agt➢R) 4r 3-7322 Ma
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential II Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Near tst T ti / , , n� County
�rP n / 1
(Street Name, Numbers, Community, division, Lot No., Zip Code)
3. OWNER: MAX a X l l e Yt 61ieG�
-
Address ��recn Five✓ ITJ h Ic\rv-Is
(Street or Royle No.)
pp
(A)Uwth,.(S NC--
ry or Town State Zip Code
(9 In- 974'— 37“
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLA E E ISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS T FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance lib 1SA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth): l f-g
air
11. DISINFECTION: Type r h 1 n r i n a Amount / r U!�
12. CASING: Wall Thickness f%
Depth Diameter or Weight/Ft. Material
From p To $.5 Ft. 6 1. / 4
From To Ft.
From To Ft.
13. GROUT: Depth
From_p To 2 0 Ft.
From To Ft.
14. SCREEN: Depth Diameter 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.
SDR2I PVC
Material
Neat Ccment
Method
Hand
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley
(check appropriate box)
Latitude/longitude of well location,
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topogrlte(map7 -_____
(check box) ) 1
PT DEH DRILLING LOG 11.
From o Formation Description
(MIso)tciafed tack.
c
0 0
c�
CO m
cm
11J tm
).00ATION SKETCH = vrrl
Show direction and distance in miles from At;Yeastr`",it
two State Roads or County Roads. Include the roa
numbers and common road names. Co
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS CORD.)FIAS BEEN PROVIDED TO THE WELL OWNER
rAv(.P.1- 1J• (44 ���- a -i —el
SIGN TURE OF PERSON CONSTRUCTING T DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

2031'79
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jarnps w Camp, Jr- CERTIFICATION# 211A
WELL CONTRACTOR COMPANY NAME Camp' c Wp1 1 R Pomp en Tnr PHONE "a2A) d51-7122
STATE WELL CONSTRUCTION PERMIT" ASSOCIATED WQ PERMIT"
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: Nearest Town n'C ! SJ Y i vtici County 0r I h
hike Ay v l k'vi2 next S,k'e, (K.
(Street Name, Numbers, Commdnity, Subdivision, Lot No., Zip Code)
3. OWNER: LaVeSt 1F .3 ; Ife
Address P 0 go X b 4 a
( uect or Route No.)
L-&Yc LRYE NJ L 2 ')t
City or Town State Zip Code
(429)- -2)4o
Area code- Phone number i ' I
4. DATE DRILLED I _ ' - O
5. TOTAL DEPTH: 9-0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: e
(Use "t" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
• *Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 4- 5- METHOD OF TEST
10. WATER ZONES (depth): 15O
ai r
IL DISINFECTION: Type ('hl nri np
12. CASING:
Depth Diameter
From_,D_ To 63- Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth
From_" To 2 0 Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
Amount I c Mp
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Material
Not Ccmcnt
From —___To Ft. in,
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
H.i
Slot Size Material
in.
in.
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 ):papL___ ______.
(check box) 1
DEPTH DRILLING I.Oh
From To Formation Description
r(� tic 5a a1 a✓a Jet c 1
45 y-Os7 /4'-N5e3h riate At rc,rk
0
0
• • I
CO
to
s
0
m
Zrn
oc
>rn
0
0
�m
LOCATION SKETCIt ry PIM
Show direction and distance in miles from at -bast
two State Roads or County Roads. Include taloa
numbers and common road names.
SI�J'f
cK•R,
1 DO HEREBY CERTIFY THAT THIS WFI i WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARD$, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
I GNATOFC
SIGNATURE OF PERSON CONSTRU NG THE WELL DATE L�
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
1-00

295299
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'IHCATION # 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 0 Municipal/Public 0 Industrial ❑ Agricultural
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
JACKSON GROVE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JANE GALLAGHER
Address 1855 JACKSON GROVE RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 894-2607
Area Code Phone number
4. DATE DRILLED 05/19/04
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 121
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 ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 16.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
0 To 70 Ft. 6-1/4" SDR21 PVC
To Ft.
To Ft. _
Depth Material
To 20 Ft. QUIKRETE
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To Ft.
From _ To _ Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From
From
From
13. GROUT:
From 0
Method
POURED
ire in.
in. In.
16. REMARKS:
Topographic/Land setting
0 Ridge 0 Slope 0 Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds),
Latitude/longitude source: 0 GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9S. FROM MILL SPRING. RT. ON HWY.
#14. LEFT ON JACKSON GROVE RD. HOUSE 2
MILES ON LEFY. (1855 ON BOX)
c—
J
-o
N
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CON,SIUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
22 ,E /%S&t /9TURE OF PERSONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

2957.98
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial D Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
LAKE ADGER-LOT G2/45
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JAMES MILLER
Address LAKE ADGER-LOT G2/45
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) - 684-1468
Area Code Phone number
4. DATE DRILLED 05/21/04
5. TOTAL DEPTH: 605
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): 3 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 16.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 90 Ft. 6-1/4" SDR21 PVC
From To Ft. _
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To _ Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) -
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. LEFT ON SILVER CREEIfIID.
RIGHT ON LAKE ADGER RD. RIGHT ON
PARKWAY NORTH. GO 1.2 MILES. LEFT ON
NORTH PARK LANE. PAVED DRIVE ON RIGHT AT
CUL-DE-SAC. o
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS UCTIO TANDARDS THAT A COPY OF THI RECORD HAS BEEN P`RRjOVVIIrDED TO THE WELL OWNER
SIGNAOF PERSONHE 1 DATE / y T(�JRE RSO COCOS UCTING WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

295"95
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
MILL SHOALS DR.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: AVERY WIGGINS
Address MILL SHOALS DR.
(Street or RouteNo.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) - 685-8928
Area Code Phone number
4. DATE DRILLED 05/28/04
5. TOTAL DEPTH: 505
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9 YIELD (gpm): _ METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 13.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 70 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/seronds)
Latitude/Iongitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. LEFT ON
COOPERS GAP RD. RT. ON MILL SHOALS DR. RT.
ON 2ND GRAVEL DR. ON LEFT AT DEAD END.
-o
W
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTLtUCTION STANDARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSO ONS UCTING 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

295393
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEE. CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
HICKORY GROVE CH. RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BOB BAILEY
Address 493 HICKORY GROVE CH. RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(404) — 219-9106
Area Code Phone number
4. DATE DRILLED 05/07/04
5. TOTAL DEPTH: 705
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 1 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 19.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 90 Ft. 6-1/4" SDR21 PVC
From To Ft.
From _ To _ Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft.OUH{RETE POURED
From _ To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the. road
number and common names
HWY. #9 S. FROM MILL SPRING. RIGHT ON
LANDRUM RD. LEFT ON HICKORY GROVE CH.
RD. APPROX. 1/2 MILE ON LEFT. (493 ON
MAILBOX)
0
r"
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT h COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
J- sa- - 7 - a
SIGAJ�1TURE OF PERSON CONSTRUCTING WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

295392
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 # (828}453 0662
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: Topographic/Land and setting
Nearest Town: COLUMBUS County POLK 0 Ridge ElSlope 0 Valley 0 Flat
SMITH RD. riate lox
(Street Name, Numbers,Community,, Subdivision, Lot No., Zip Code) 'Latitude/longitude
ae/longittuude of well location -. ..
3. OWNER: MACK HENSON
Address 428 SMITH RD. (Street or Route No.) (degrees/minutes/seconds)
COLUMBUS NC 28722 Latitude/longitude source: 0 GPS ❑ Topographic map
City or Town State Zip Code (check box)
(828) - 894-5977 DEPTH
Area Code Phone number From To
4. DATE DRILLED 05/10/04 DRILLING LOG
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ® From To
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface; LOCATION SKETCH
'Top of casing terminated at/or below land surface requires a Show direction and distance in miles front at least
variance in accordance with 15A NCAC 2C .0118. Two State Roads or County Roads. Include`tlter0dd_
9. YIELD (gpm): 1 METHOD OF TEST ARD number and common names
10. WATER ZONES (depth): HWY. #108 E. FROM COLUMBUS. RT. ON FOX
MTN. RD. CROSS BY-PASS & LEFT ON SMITH RD.
11. DISINFECTION: Type CHLORYTE Amount 16.5 3/10 MILE ON RT.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 30 Ft 6-1/4" SDR.21 PVC
From To Ft.
From _To_Ft. cp _
13. GROUT: Depth Material Method o
From 0 To 20 Ft. OUIKRETE POURED G
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material1
From _ To _ Ft. _ in. _ in.
From _ To _ Ft _ in. _ in. _v
15. SAND/GRAVEL PACK: in _.
Depth Size Material (-9r r' ..:-
From To Ft. - r
N o
From To_Ft. __
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
rci A r.- rr`` • A - T /
SIG ATURE OF PERSON CONSTRUCTING WELL ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

295391
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING. LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
WATER MILL DR.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MITCH STOTT
Address 308 WATER MILL DR/
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 894-2364
Area Code Phone number
4. DATE DRILLED 05/11/04
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): 12 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 10.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 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
To _ Ft,
To Ft.
From
From
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seronds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. 74 BY-PASS
EAST. GET OFF AND TURN RIGHT ON PEA RIDGE
RD. RIGHT ON JOHN SHEHAN R.D GO 1/4 MILE.
LEFT ON WATER MILL DR APPROX. 1/2 MILE ON
RIGHT.
0
G
J
-13
r
N
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCI ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGN. UR$ OP 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

295388
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: COLUMBUS
3111 SKYUKA MTN. RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BOB WILSON
Address 3111 SKYKUKA MTN. RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(8) — 284-5729
Area Code Phone number
4. DATE DRILLED 05/17/04
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 140 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 4 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 7.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 80 Ft. 6-1/4" SDR21 PVC
From To Ft. _
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _To_FL_ in. _ in.
From _To_Ft_ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HOUSTON RD. FROM COLUMBUS. LEFT ON
SKYUKA MTN. RD. 3 MILES ON RT.
c
r
J
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A CQPY OF THIS RECQRD HAS BEEN PROVIDED TO THE WELL OWNER
j2 ( ld ' n %L ' rli,�cz s /7 'D
F PERS N CONSTRUCTING THE WE DATE
SIGNA
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Centcr — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

295382
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1.
WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON County POLK
FAGAN RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: WAYNE HORNE
Address FAGAN RD.
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(864) — 680-5555
Area Code Phone number
4. DATE DRILLED 05/18/04
5. TOTAL DEPTH: 71
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 51 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 71 Ft. 24" CEMENT
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To Ft in. _ in.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size
From 51 To 71 Ft. 78M
From To Ft.
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 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles front at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. LEFT ON
CHESNEE HWY. RIGHT ON FAGAN RD. 1/10 MILE
ON LEFT.
0
ca
r
N
n
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS '13l' ION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE I F PERS" •
U/G -
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

From: Carolina Well D lte s, Inc To NC Deat cr Ea0. sat ros Eassor dace: 6/12004 Time: a 2.24 E4l
295234
L CCiiie ST Mt IL, ITO.A RECORD
North Carolina - Department of Er. nt: per: -.. r ! . -al Resources ll v;.,i:. i of Water Quality tirciscishiraior SsatiC :
WELL CONTRACTOR (INDIVIDUAL) :- tur:::r: SC:OTT CANTT CERiTI?IC 1 c I%25E-;
WELL CONTRACTOR COMPANY N '31 C?21)LINA WELL DRILLERS, INC. PHONE s (704) 434- 72'7
STATE WELL CONSTRUCTION PEIC-t'T a ASSOCIATED V Q PERMIT :0 _____ -_
(if applicable) , ii iica:,ic',
D
i. WELL U SE (( heck Apt o;o Hari : 'r _pal P „at:a ial = -.-.
Recover' ❑ Hoar Purr :r1t ea (__ Geer ❑ T sta i.ist Use:
z. WELL LOCATION.
New at iuwa. ?vIiLL SPRING •
47 SILVER SPUR LANE
(Street Narne, Numbers. Community, Subaivis:c
3 OW'.''ER CIIRIS OWENIIY
ADDRESS POD a ..a entdt 'I eit`ar9 >C [" r'• I
(St cr..r dojo Na./
(ILL EPPING
cry: ow
828-625-299S
Area Code - Phone N::;abz:
4 DATE DRILLED _.27/01
+. TOTAL DEPT`: 400
6. DOHS WELL REPLACE EX!STiNG VI: Et
7. SIACIC WATER LEVEL Eeiou To;, ofl'.rd at:
8 TOE' OF CASING IS % :i_.,.......-
'Top oicuilyt. �:I6:mc$ aroro .
n.ortun.e with 15A NCAC -.. XI Li
O.}IELD(Am). 3
lo. WATER ZONES (ae{;hl:
it. DISINFECTION: TYPE HYPOCHLOR;TS
1 :'.. CASING:
Depth L vreur _ tifltc'ia:
From 0 To 100 Ft.
13. GROUT.
Dept?,
From 0 To 20
I1 StEEEN
Depth
From NA To
u. SAND/GRAVEL PACK:
Depth
Dom NA To
Is. REMARKS
I DO HEREBY CEP:
CONS"iR( TtON Si S
ITCC
altSor
Maiteloi
Front
LCC _'iIC.
d.'Seono: a :E hsiaa7s
c Set_ Roads on County Road) teal
/-:ba:s arc coonaan road ._-.-,.
; H G✓FFFI
di lid PERSONCONS1Rr;C'i N:.: TiE WELL
Submit the original to the Divisioa olAalet c,..i.,, t,:aatiiia.atacrS2cHGn, 1635 Mail Service Cana( tTT!;:i.. NC.
27699-1636 Phone No. [phone], 'cci i
O
C_
AD

From: Carolina Well Dr"ers, Inc To NC Clip: „Ero 6/8/2s .a 3 42.24 PM
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and P:zsal Resc`sees - Dicison of Water QGaL y -
WELL CONTRACTOR (INDIVIDLctL) ti 3'rin (mint` SCOTT CANT r
WELL CONTRACT OR COMF_A.N'e CA7JLL4.y. WELL DRILLERS INC. PHON-L
STATE WELL CONS1R1 C P:i\r- In .:SSGCIAI-i:
`tY
1. \VEI, I, USE (Check Apptickblz nosi: ,�.•.-ufl .- I -C : Li iawcial `I
Recovery ❑ He rc_,e r ----- �[! -1 Der L_i .. , List Use:
AVELI. LOCATION`:
Ncoest town: MILL SPRING
LOT 96 GREEN RIVER ILGHi ANDS
r
(Slree- Nat'l:, Number, CCmr:r•crry. Sc6w;ly..
]. OWNER MICHAE, SKINNER
ADDRESS 373 33EE C ST
RI-rHER ORDEON
City orio-..n _. _ _: Ccre
828-289-6393
.Area Code - Phone Number
J DATE:DRILLED ` 10/0d
< TOTAL Darn; i80
6. DOES WELL REPLACE EXISTING WELL? [7 LC IQ
7 STATIC WATER LEVEL LCe: :: Toy o` C E.zl: g.
S. TOP OF CASLNC 1S 2
'Top of cming Iaminaad acor b.kv. i nd,r:L: nG.
iccerdama with Ln NCAC 2C ril)n
9. YIELD (spin', 18 A3C-fii5 '--;
10. WATER ZONES (JeptC 150
49.J^3J.
Groundwater Se37i01
CERTI IC-.Ti-O,`;
L
Frcen
0
10
n. DISINFECTION. TYPE HYPOCNLl,iIc "moasr 6
1'_. CASLNG: I �_
DeK h
It OTT: 0 Tn
It. at:Oli r.__ __..
Dept
Franc 0 To 20 Et
IJ. SCREEN
Depth
Prom Sti fo
15 S.A::i i0R V GL' •:.� ;i.
Depth
Rnm NA To
1s. REMARKS:
1.-nnorhis et- ' _ Boris:
Lumen
.:13t31 al
cf
State Roaclic C
I DO HEREBY CERTIFI TFIAY THIS
cONSTRCCT[ON STANDARDS, ` _ Y4'
\ACC SDA`E WITH lo±0
LJ.'_D f_ a - PROVIDED __ '3E
La, 3N CONSTIELE2JSii TREE WELL
Submit the original to the Divie or of
27699-1636 PhoneSo. (919) 73a-32?1, Wit
L
LO
0

29rr.n
WELL CONSTRUCTION RECORD
tits
North Carolina - Department of Environment and Njrgl l Resources - Jvysiontof Water Quality - Groundwater Sectio
WELL CONTRACTOR (INDIVIDUAL) NAME (pr.
\\ ELT. CONTRACTOR COMPANY NAME
STATE \\ EI.L CONSTRUCTION PERMITN ASSOCIATED \VQ PERMIT/
1 if applicable)
(i[applicable)
CERTIFICATION gti/t�r
PIIONEa iZ•24/ 37I/$i'&
1. WELL USE (Check Applicable Box): Residential 0 Municipal./Public Industrial ❑ Aericultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI
�y, Nearest Town: POP'ii 7 County
11 TDB 1b1Y11711tYM f ([trvYatts fi^') -, NC•
(Succl Na ae. Num )ers, Community, 'ubtli vision, Lot No.t`
, Zip Cwle)
3. OWNER: et, pi Cdv_Cvr
Address .4.) [akrtbpLLSt S+ree+
CD) 9M) jeer )r R \nte od
City or Town State Zip Code
ZVd122
( )-
Area code- Phone number
4. DATE DRILLED 3 ���� .
5. TOTAL DEPTH: ern'. /
6. DOES WELL REPLACE EXISTING WELL? YES C(J�44O e
7. STATIC WATER LEVEL Below Top of Casing: AA ET.
% (Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at or below laud surface requires
variance in accords i ith I5A NCAC 2C .0118.
9. YIELD (elm* NIET.H OP TES
10. WATER ZONES (depth): / 59 f2/r7) a,
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic clap
(check box)
DRILLING LOG
11. DISINFECTION: Type
12. CASING:
Depth r[- Dia
From (/ To if, Ft._.(
From To Ft.
From To Et.
13. GROUT://., Depth%%
_�j
From[L.To ("✓'Ft
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
•D//k
Amount
Wall Thickness
UE`8y�
Slot Size Material
in.
in.
16. REMARKS:
DEPTH
From To
Formation Description
( L
c ci
z
LOCATION SKETCH `!,
Show direction and distance in miles from ❑T(east =-'c)
two State Roads or County Roads. Include tirroacC:^t
numbers and common road names. enrt-
. r'
eN 10613OR7&'%//$
?eiQitof a/c, //5
fre4/1 %' g,j PST
I DO HEREBY CERTIFY TIIAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15? NCAC 2C, WELL
CONSTRUCTION STa.NDARDS, AND TFth / COPYY f'THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
e3/ 6'C11
BLz
tE 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. C;W-1 REV. 07/2001

296232
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J mog sf rj Tr CERTIFICATION if 2 1
WELL CONTRACTOR COMPANY NAME Camp c Wel 1 R Pnmp en Tnr PRONE #$2R) 4Si— 7 i22
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential i'Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT
Neare t Town:
In
(Sweet Name,
Numbers, Community, Subdivision, •t No., Zip
Cooddee)))7,.
3. OWNER: Ali ¶ co— J W
Address „I-C1 0-tTi r� ( —
p(Sixect orNJJ1/4 RoutejJo.) M61 OR.
Ui It11•n�-�—l-�� C%C l�
City or Town Sdhe Zip Code
( ICI 0 131.
Area code- Phone number
4. DATE DRILLED - :14 -
5. TOTAL DEPTH: O S
6. DOES WELL REPLACE EXISTING WELL? YE 0 NO L71
7. STATIC WATER LEVEL Below Top of Casing: U 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 ISA NCAC 2C .0118.
9. YIELD (gpm): S METHOD OF TEST kir
10. WATER ZONES (depth): Lk In
4
11. DISINFECTION: Type rh 1 nr i n n Amount
12. CASING: Wall Thickness
Depth Diameter orWeight/Ft. Material
From p To Depth,,, F16 1/4 RDR21 PVC
From To Ft.
From _ To Ft.
13. GROUT: Depth Material
Fronl_,p To 20 Ft. Neat Cement
From To Ft.
14. SCREEN: Depth Diameter Slot She
From To Ft. in.
Froin To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Method
Hand
Material
in.
in.
Material
Topo :phic/Land setting
❑Ridge &Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING Ch?1
From To c� mmaanon Descriptiotp
n q 5 LA.A Si "WA S(
F
v
LOCATION SKETCH o
Show direction and distance in miles from at let
two State Roads or County Roads. Include the pyd
numbers and common road names.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WFf I WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS (SEEN PROVIDED TO THE WELL OWNER
1' lq-off
DATE
SIGNATURE OF PE
N CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

296226
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # 7 1 3 6
WELL CONTRACTOR COMPANY NAME ('amp' a Wa11 R Pnmp C'n Tnr PHONE 8$71:11 454 7122
STATE WELL CONSTRUCTION PERMITN ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J ants Cam pr Jr
1. WELL USE (Check Applicable Box): Residential ♦a' Municipal/Public 0 industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATLON:
Neare t Town:
LD R y fl (u din Ay uQ 1r J
(Street Name, Numbers, Community, Subdivision, Lot Igo., Zip Code)
3. OWNER: ``
Address
v.-County
true[ w R u[ No.
lai k n1t)
5 /.+✓ra4 Lo✓(l
95(7 )/
City or Town State Zip Code
r 2)- 676 -g706
Area code- Phone number
4. DATE DRILLED 5 -1 a 01
5. TOTAL DEPTH: Lk. O 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO II\
7. STATIC WATER LEVEL Below Top of Casing: tD 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 10 M%T OD OF TEST p ; r
•10. WATER ZONES (depth): U S
11. DISINFECTION: Type rh
12. CASING:
Depth
From 0 To 11it)
From_ To
From To
13. GROUT: Depth
From To 2 0
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Diameter
Ft. 6 1 / 4-
Ft.
Ft.
16. REMARKS:
Ft.
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
lnrina Amount
Wall Thickness
or Weight/Ft. Material
�r.R21 PVC
Material Method
Neat Ccmcnt Hand
Size Material
Topographic/Land setting
DRidge @Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check bor)
DEPTH DRILLING LOCI
From To Fo tion escripicoii
0 10 D(1) Y\-, tl
110 o LADS— Cutt
O
4-
a
j.00ATION SKETCH tv
Show direction and distance in miles from at last
two State oads or County Roads, Include the road
numbers r d common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUL IED IN ACCORDANCE WITH 15ANCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
0
n _
r' C
c,
SIGNATURE OF PERSCIN 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

88/28/2882 16:17 919-71E-0580
NCDE*NR/WATER OUPL
PAGE 01/81
($•treat Nemo. Numkn:.Cc in �'l� /� ZipCode)
3. OWNER: iv' - 1-_r,_ , S/ o e ! 7`.S
Address
296194
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
W EIL CONTRACTOR ;IN DEVIDCAL) NAME (pr4otLa "Rff IGAT10!1 42 7 a 9
WELL COV?RACIOt COMPANY NAME //P/ 't `agh�#(C3 E;4
STATE WELL CON STRLCTION PERMIT#
(if apoi:cable)
ASSQCIATI D WQ PERMIT** MR r-tC C--
if epplieab1e
1 WELL. USE (Check Applicable Box). R.esidentia! yd' :Mtmicipal/Public Q Industrial G Agrieultt:ral ❑
Monitoring Recovery 0 Heat Pump Water Injection 0 Other❑ if Other, ListUsC
2. WELL.,LOCATION!
�tr tw
Nearest Ount k�''
so Cr
nm9mr, eShcvi4JY�. IA[:`e.,
(Sim; or AMA, No..
City or Town Saw Zip Coca
^).
Aron code hoes mart: - g
c O
5. TOTAL DEPTH' % C
6. DOES WELL REPLACE EXISTING WELL? YESr_ D,�' N O 11r
.. STATIC WATER LEVEL Below Top of Casing, l —FT.
Lse" A•• it Atovt Top of Covina)
S TOP OF CASING IS FT. Abote Lard Surfs::'
'Top or easing tetmio ed utior below Wad aortae, reclaims a
vorianw to accordy`t ty r•�• 6C IC .011ar- fO�
9. YIELD (gprr''): 'tea•" S M }9 0 EST ,l /
I0. WATER ZONES (depth): a.- V -
a DATE DRILLED 4 `r t-4 4' O 4-
Topoy aphiclend sating
❑Ridge 0Slope [Walley ❑Flu
(cbcck nppnprtnk ;al)
La.itudeflongitudc of v.'ell location
(denim** i m teal w: a ade)
Latimduilonuitude Sount:DGPSOTopograpnio map
Wank an)
DEPTH DRILL:NG LOG
From To Formation Description
5 LOCATION SKETCIi
11. DISINFECI10 "DIGtClelr,Q etcht4r.t r 01 C Sno x' direction and distant: in milts .from 144:
hickness (aL"
Itwo State Roads or County Roads Include . tooad
lit CASLtiG �Cr' W 2! Tb q ad m s
Dept;
From (7 To
From To
rot oral ^bi Fvl : axnzl nos :.ks art Comrne)j0 m _
q ,�jRa2!
From To Ft. vfeLhod
13. GROUT' Dcrth Mater,L! �J
From V To� „-O FL l c Me
From To Ft.
14. SCREEN' Depth Diameter S.ot Size Material
Peon To Ft in, 'n.
Front. To Ft. in. _— in
15. SAND/GRAVEL PACK'
Depth Size Material
Frorr Q i O Ft.
From N 0 To Ft.
16. REMARKS:
C.)
N
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, ANDTHA,T OPY OF THIS RECORD HAS BEEN PROVIDED TOTI-MWNEK
�0
$IGNATUR= ERSON CONSTRUCTING THE WELL DATE
Submit the urig'al to the Division of Water Qualit), Groundwater Section, 1636 Mail Service Cae+a=r • RaWg.-t, 9C
2769p-1636 FhPtie No. (9t9) 733-3111, within 30 stays.
Gyp-1 REV. 07 ^_001

WELL CONSTRUCTION RECORD
296241
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James tv f' am(', jr �13$
CERTIFICATION #
WELL CONTRACTOR COMPANY NAME Camp' c Wel 1 g Pnmr Co_ Tnr•
PHONE #$7.81 Ac1_7322
STATE WELL CONSTRUCTION PERh1IT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential ire-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 PN
Nest Town:
LA-01 \ A A.kn
(Street Name Numbers, Community, Subdi sion, Lot No., Zip Code)
nUN 3. OWNER: Y N
Address �D.yY ! 'tLiaYtvyKdi •
neeto1Rga'[eNn.) 3a Sov✓entto1/6
City or Town State Zip Code
L)-
Area code- Phone flambe
4. DATE DRILLED
-1G 0 L\
5. TOTAL DEPTH: .,14 S
6. DOES WELL REPLACE EXISTING WELL? YES9 R.NO
7. STATIC WATER LEVEL Below Top of Casing: p5 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
`Top of casing terminated st/or below land surface requires a
' • variance In accordaARce,�,with 15A NCAC 2C .0118.
9. YIELD (gpm): /-l1 M(H•QD OF TEST p 1L
10. WATER ZONES (depth):
"Topographic/Land setting I.
Midge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map - -
(check box)
DEPTH QRII LING T.O(.
From To° lion Description
w�Q
11. DISINFECTION: Type C'h l nri nn
12. CASING:
Dept¢, Diameter
From 0 To 1 Ft. 6 t / 4_
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20 Ft• N at
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From_ To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount C(.(.e
Wall Thickness
or Weight/Ft. Material
QDR21 PVC
Material
Method
Cement Hair..
Slot Size Material
in.
in.
16. REMARKS:
r-.
'
▪ _r
IV p1
:r.
y
r1�
- cn=
Show direction and distance in miles from at
two State Roads or County Roads. Include the road
numbers and common road names.
T.00ATION SKETCH
q2
1 DO HEREBY CERTIFY THAT THIS WFI I WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
a44ta l , ( ,wr,,A, S J9-o4
SIGNATURE OF PE CONSTRUCTING 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

296235
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ja maS W Cap p Jr CERTIFICATION# 21 3A
PHONE 2 Al d 51 112.2
WELL CONTRACTOR COMPANY NAME
Camp' S t,7P11 & Pnmp rry
Tnr•
STATE WELL CONSTRUCTION PERhIITN ASSOCIATED WQ PERMIT#
(if applicable) - ..
(if applicable)
1. WELL USE (Check Applicable Box): Residential tr.Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCA
Ne es� t Town: -
(Street Name, Numbers, Community, Subdf ' ion, Lot No., Zip Code)
3. OWNER: I�/ j'V1 a �
Address trot 90 GP, f♦
N.
Coun
}-(Svcgt a Route No, ry v(—hP Y`-o V(�`D 11 C- r�0l3
City or Town State Zip Code
Area code- Phone numb
4. DATE DRILLED li Zq C -k
r
5. TOTAL DEPTH: lk
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO o.
7. STATIC WATER LEVEL Below Top of Casing: 1, 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 accordan Se'I ISA NCAC 2C .0118.
9. YIELD (gpm): —4 O OF TEST ai _
10. WATER ZONES (depth): `1
11. DISINFECTION: Type rh 1 nr i n P Amount ' (..U.t(
12. CASING: Wall Thickness
Deptl}a Diameter orWeight/Ft. Material
From _ _pTo }>5 y Ft. 6 1 / 4- SDR21 PVC
From To Ft.
From - To Ft.
13. GROUT: Depth
From_Q To 2 0 Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Material
Neat Cement
Method
Hand
16. REMARKS:
Topoo�gra_phic/Land setting ''
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From X `-\ F inaisica nDesfpti�
r_.
LOCATION SKETCH
Show direction and distance in miles from at le3R
two State Roads or County Roads. Include the Fold
rn-r_
rn _z
numbers and common road ry
r-
c
CIO
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5ANCAC 2C, WELL
EEN PROVIDED TO THE WFI I OWNER
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS
SIGNATURE OF PER$tIN CONSTRUCTING THE WELL i 'f 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

296233
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jamns to, Camp, Jr
CERTIFICATION $ 2 1 18
WELL CONTRACTOR COMPANY NAME (Thmp' a Wn11 & pimp CrL Tnr PRONE #t2A) 451-7'322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential iEr Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION; h
Nearest Town: t r\^ R
frn M 9 1 u
(StreetName, Numbers, Community, Subdivisi
3. OWNER7 LANA-
Address () O 1-3oX CI (2S
S
County
, LotLo�No., Zip Code)
�. —.
(Street or Route No.)
Ian b AYo S a 9.3DS
Zip Code
Area code- Phone numb r
4. DATE DRILLED • 2X- 0 Ck
5. TOTAL DEPTH: 2 O
6. DOES WELL REPLACE EXISTING WELL? YE NO 0
7. STATIC WATER LEVEL Below Top of Casing: 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 1n accordance with 15A NCAC 2C .0118.
9. YIELD (pm): METHQD OF TEST
10. WATER ZONES (depth): Q U
air
11. DISINFECTION: Type rh 1 nri na
12. CASING:
Depth _ Diameter
From p To :-/LS Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
Fromm To_ Ft.
—�No-.n C m-��„ent Hand
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft in. in
From To Ft. in. in.
Amount
Wall Thickness
or Weight/Ft.
c gg,31
15. SAND/GRAVEL PACK:
Depth
Frottl, To Ft.
From To Ft.
Size
Material
Material
PVC
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 DRILLINSLOG
From To o matioVDe riptitpg
a ns Cuth.„-ti
.c-
0
c
c,
c. "
.�
LOCATION SKETCK
Show direction and distance in miles from at least. m
two State Roads or County Roads. Include the road �'
p cn
numbers and common road names. rn ;:
tV ,i
tV c
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC IhD IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY O THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
G�IG'1Ed
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

293741
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
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(ifapplicable) licable) (if applicable)
PHONE # [phone]R
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON County POLK
MEADOWCREST RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JIM WALTERS
Address 55 MEADOWCREST RD.
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(828) — 817-3738
Area Code Phone number
4. DATE DRILLED 04/03/04
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 1 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 50 Ft. 6-1/4" SDR.21 PVC
From To Ft.
From To _ Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
14.SCREEN• Depth Diameter Slot Size Material
From To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
c.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(checkappropriate )• a o riate box).
of well location
9 � ---
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS �To'pogia iicmap
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9S. FROM MILL SPRING. LEFT ON
SANDY PLAINS RD. APPROX. 5 MILES, RT. ON
MEADOWCREST DR NEW DRIVE ON LEFT NEXT
TO 29 MEADOWCREST.
0
iv
0
0
CD
-12
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
p
GNA OF PERSON C STRUCTTNG THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

2`�74u � y
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water QWlity - 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) Of applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON County POLK
HORNE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: TIM ARLEDGE
Address 483 HORNE RD.
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(828) - 863-4536
Area Code Phone number
4. DATE DRILLED 04/06/04
5. TOTAL DEPTH: 705
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 100+ 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 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 - r
El Ridge ❑ Slope 0 Valley 0 Flat„,..,
(check appropriate box)',
Latitude/longitude of well locatidn
(degrees/minutes/seconds) -
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box) """--{{ --
DEPTH 4 ---
From To --
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at (east
Two State Roads or County Roads. Include the road
number and common names
HWY. #95. FROM MILL SPRING. APPROX. 1/4
MILE ON LEFT PAST MCDADES GARAGE. TURN
LEFT ON HORNE RD. 1ST DRIVE ON LEFT PAST
GREENWAY DR SINGLE WIDE AT TOP OF HILL.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF T IS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
RE OF PERSO CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

294623
llorth Carolina • Department 01 6rvirorunenl and tlalural Iloanoreea - pivhinn of Water Ounlily - GInundnnlnr
163G Mail Service Center • Ralelgh, N.C. 27699.1636 Phon° [phone] `/ J /
WELL CONSTRUCTION RECORD WELLCONTRACT011: il :ee, /1�Lf n'--thizviell �[Y Ale
WELL CO?!IMC1CHI CPU 1IrICATIONII: of/i
STALE WELL COI1S1111JC1ion PERMIIft:
1, W ELL USE (Check AppilcahIo homy Resldenliol
Munlclpal I._J Indu^hint I J
nocovery ❑ Nenl Pump Walor In)ecllon ❑ Other ❑ II Ulliol, 1.Isl Uye'.
2. WELL LOCATION: (Slow skotcli ol II to I0Cnlioll below)
Nearest Town: Cy) H rnb t S County:
' Comae L, .
Woad Name end N m ors", C�onan oily, or Subdivision and Lol Ilo.)
3. OWNER �Itint&YL �Q-}U
Address I D.0(cvst, 0_ ,I.4
(Slroei or flou417101
COI urnbNS
City or Town Slate
4. DATE DRILLED 9-7-' Ott
5. TOTAL DEPTH •3cD
6. CUTTINGS COLI.ECTED YES I_I I1OJ �I
7 DOES WELL REPLACE EXISIING WELL? YES NO
Zip Code
6. STATIC WATER LEVEL Below Top of Casing: _Sp_ FT.
(Use'.' II Above lop ol Casing)
9. TOP OF CASING IS ( FT. Above Lnrid Sullaco'
'Top of casing terminated atfor below land aortae° require. ° variance In accor-
dance with 15A MAC 2C.0ai0
10. YIELD (gpin)t la METHOD Or TEST A 1R
11. WATER ZONES (depth): r}t 0 - 1 U s
12. CHLORINATION: Typo 0+14 Anounl )) 065 •
13. CASING:
Agricullul: l I_ -I I.hmil-nillq I_J
t lrin_L-lll' LUG
-runeTo Innn.lir•n (,•:•lir.i
RQc1 Qku- vie
(3� e-h-t___--- __ _'io
_B�ap! d a SOJt.�_-�Rauh jU-�Cl
ryoUWt(00
0-1u-) � . ' WU
1Jv _
e,ne.A1 keyk /vie - (/0
89oc)c I-c/.LL--var.
wall 1h1 *llrla
�y
Del)gl Dlanwlrr or WeiUIIVI I. Material
From it° To is rt.—Wig__— _P�-�=
From Zip' To 41 FI (g1t� Pvc-
From To FI.
14. GROUT:
Depth Mato dal Method
From O To 8-° rt 1"3atvoeor i , _ ?ncssun
From To FI
15. SC EN:
Depth Dlmnolor Slol SI76 Molt -Idol
From _ To rt In. _ In. --
From To
FI In. -- In 1_rw c
Flom To FI tn.— III
16, SAND/GRAVEL PACK:
Depth Site Material
Frorn To Ft
Frorn To rt.
17. REMARKS:
1 DO I IEREOY CER I IFY 111AT 11115 WELL WAS CONSTRUCTED IN ACCORDANCE INITI 115A IICAC 2CC. wt:t.l.
CONSTRUCTION STANDARDS, AND MAT A COPY OF 11115 CORD HAS ! PR VIDEO TO 11 fE \'lNU OWN :II
FOn OFFICE USE ONLY I pnl
Cod No: IJ SI rIA1UWE or PERSON cOrns!rlwcrlrlo 111F.. MU.
Division 01 Water Dllalily, Groundnalor Section wll)Ott 3r) (ny 1 (,,, l.1 I I E l7 17
r.,.i.11 n SuI"lI odp1
II ndditional space I; nnednl nsn rrt?k 04Apj
— C/3?
1_0.cm UiI-;tla l l..
(Slow direction and distance how al 'pall V»%laln
Rolla, or other reap relelnllie pond �) hly'
w•
bats\
Siva
• S
• S
t
Tat
at

From: Carolina Well Drillers, Inc To: NC Dept of Env. and Na Resour
Date: 4/5/2004 Time: 10:00:58 FM rzge 2 of 2
294861
WELL CONSTRUCTION RECORD
North Carolina - Department o[Envirorment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) SCOTT GANTT CERTIFICATION ._': 25_4
WELL CONTRACTOR COMPANY NA'.\IF CAROLINA WEId, DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box) : Residential ❑ Municipal ❑ Industtial ❑ Auiculmral ❑ Moi to^' '_
Recovery ❑ Heat Pump Water injection E Other ❑ If Other, List Use:
L WELL LOCATION:
Nearest low::: MILL SPRING
Cowes POLK
LOT 1 OSTINE CREEK TRAIL LAKE ADGER ESTATES
(Street Name, Numbers, Corrununity, Subdivision, Lot No,. Zip Coat)
3.O\VNER RIDGELINE DEVELOPMENT CORP. (degrees minutes eCori;
ADDRESS 112 COCOPLUM CIRCLE Latitude/longitude source: El GPS ❑ Toccer..plia F.4.
(ssr :sra,e o.No.) DEPTH DST.— _
vhi L._)
ROYAL PALM BEACH FL 33411 From To
CJry or Town Sate Zip Code 0 45 Clay
Topogaphic; Land setting
❑ Ridge ❑ Slope ❑ 6'
Lanmdeto git]:ie of w 1 is r:i.rl
3519.826. S2.12.467
561-798-2729 45 183 Ow:scadan:-P.
.Area Code - Phone Number
4. DATE DRILLED 3. i'04
,. TOTAL DEPTH 180
6 DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing
YES ❑ NO fl
4S FT
Rise -*•' Ir?bove Tcp of Cast.
8. TOP OF CASING IS 2 FI. Above Land Swface'
*Top of caeing terminated at or beecw
accordance xith 15A NCAC' '_C..Giis
9. YIELD i gpm): _0 3,EiPOD OF TEST
to. WATER ZONES (depth): 175
ARDV
it DISINFECTION: TYPE HYPOCHLORITE Amo.u.i 6 0- LOCATION SKETCH
12. CASING: Wall Tnicknesa
Depth Dune[, orWeigheTt. Afao ial two State Roads or County Roads. IncinrL the ret l C
From 0 To 53 Et. 6 1/4 " SDP, 21 PVC numbers and common road namas. cp o
L
13. GROUT: 317'--0 �, T,
Depth Material Method I) c_�--,
From 0 To 20 Ft. GRAVEL MIX GRAVITY 1 `o .0
Xm
14. SCREEN Cn
--I--
r• rn0
J T70
n
O --1
p o
Depth ...::rider
From NA To Ft.
IS. SAND/GRAVEL PACK
Depth Sire
From NA To Ft.
16. REMARKS:
Slot Size Ma....al
%ta::sal
Show direction and disa1ee in mules frog: at lis-t
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, : ELL
CONSTRUCTION STANDARDS, ANDTHAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL O ?:E.
SIG`"_ATUREE OF PERSON CONSTRUCTNG THE WELL
4' 1 04
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.

293738
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CER I. 1FICATION # 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 D Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: SALUDA
ARCHER RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: FOSTER ARCHER
Address 60 ARCHER RD.
(Street or Route No.)
SALUDA NC 28773
City or Town State Zip Code
(828) — 749-2732
Area Code Phone number
4. DATE DRILLED 04/15/04
5. TOTAL DEPTH: 265
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): 15 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 6.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 60 Ft. 6-1/4" SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QULKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To
From To Ft. in.
15. SAND/GRAVEL-PACK:
From
From
Depth
To
To Ft.
16. REMARKS:
Ft. in. in.
in.
Size Material
Ft.
Topographic/Land setting
0 Ridge 0 Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) -;_
Latitude/longitude source: ❑ GPS ❑''opogrraphic map 1 Li
DEPTH 1C (check box)
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles
Two State Roads or County Roads. In
number and common names
HWY. #176 W. FROM TRYON. LEFT ON
CABBAGE PATCH RD. RT. ON FROST DR RT. (a
SUGAR SHACK SIGN. RT. ON 1ST DRIVE ON LEFT.
0
3
v
0
c.
o%
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARD , AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIG ATURE OF PERSO CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 293736
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
3453 JOHN WATSON RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ROGER SMITH
Address 3453 JOHN WATSON RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) - 288-1797
Area Code Phone number
4. DATE DRILLED 04/20/04
5. TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IZI
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):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 4.5
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
From 0 To 20 Ft. QUIKRETE
From To Ft.
14.SCREEN: Depth Diameter Slot S
From To _ Ft. in.
From To Ft. in.
15. SAND/GRAVEL-PACK:
Depth Size Material
Method
POURED
ze Material
in.
From _ To Ft.
From To Ft.
16. REMARKS:
in.
Topographic/Land setting
0 Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/second-)
Latitude/longitude source: ❑ GPS Topographicntap-
(check box) (-
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH -
Show direction and distance in mil roan at-1easL
Two State Roads or County Roads. tclude thdr% W -
number and common names
HWY. #221 S. FROM RUTHERFORDTON. RIGHT
ON POORS FORD RD. RIGHT ON KEN MILLER
RD. LEFT ON JOHN WATSON RD. APPROX. 1
MILE ON RIGHT.
0
T
0
TT
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY O THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/4%
SIG$4ATURE OF PE ON CONSTRUCTING THE WELL
74->zrts- 3a a d - O
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

2.937-3
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) Of applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON
STRAWBERRY RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CIIESTER TALLY
Address STRAWBERRY RD.
(Street or Route No)
TRYON NC 28782
City or Town State Zip Code
(704) — 852-9577
Area Code Phone number
4. DATE DRILLED 04/20/04
5. TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO EZ
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 4.5
12. CASING: Wall Thickness
Depth Diameter or Wcight/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. 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/ntinutes/seco
Latitude/longitude source: ❑ GPS
(check box)
DEPTH
From TOIL;
DRILLING LOG I r,
From To I.- 7.
-
LOCATION SKETCH
Show direction and distance in mi es from aril
Two State Roads or County Roads. Include th'
number and common names
HWY. #221 S. FROM RUTHERFORDTON. RIGHT
ON POORS FORD RD. GO INTO POLK COUNTY.
TURN LEFT ON STRAEBERRY RD. 1/4 MILE ON
LEFT.
T??egr�plric mmp
0
.c
=-c
rJ
r
0
0
9J
C>
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
moo-�
SIGIIiATURE 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

fi f
'93732
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERI IFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON
COUNTRY CLUB RD.
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: CHAD HUNTSINGER
Address 272 COUNTRY CLUB RD.
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(828) - 859-6333
Area Code Phone number
4. DATE DRILLED 04/28/04
5. TOTAL DEPTH: 465
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 POLK
Zip Code)
11. DISINFECTION: Type CHLORYTE Amount 12.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 170 Ft. 6-1/4" SDR.21 PVC
From_ To Ft.
From To _ Ft. _
13. GROUT: Depth Material
From 0 To 20 Ft.OUIKRETE
From To _ Ft.
14.SCREEN: Depth Diameter
From To Ft
From To Ft.
15. SAND/GRAVEL-PACK:
Depth Size Material
Method
POURED
Slot Size Material
in. _ in.
in.
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: 0 GPS ❑ n T6pographie-ap
(check box)
DEPTH
From To
DRILLING LOG
From To
•Jt
u'.r
Two State Roads or County Roads Include #Ire-reacL=- '_
number and common names
LOCATION SKETCH
Show direction and distance in miles fFdih_at least
HWY. #176 E. FROM TRYON. LEFT -ON
COUNTRY CLUB RD. 2ND DRIVE ON RIGHT. (#272)
O
r
-a
N
0
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIW STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER A
SIGNA/I'(IRE OF PERSOIG 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

293729,
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Z Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
GREENFIELDS-LOT #5
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BILL HILL
Address GREENFIELDS-LOT #5
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(864) — 266-7425
Area Code Phone number
4. DATE DRILLED 04/23/04
5. TOTAL DEPTH: 505
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 1 SA NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 13.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 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.
From To _ Ft. _ in.
15. SAND/GRAVEL-PACK:
Depth Size Material
From _ To Ft.
From To Ft.
16. REMARKS:
in.
in.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/second )
Latitude/longitude source: ❑ GPS Wop.grap5iic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETC
Show direction and distance in miles from at
Two State Roads or County Roads. Include th
number and common names
HWY. #9 S. FROM MILL SPRING. RIGHT ON
LANDRUM RD. LEFT INTO GREENFIELDS. TAKE
1ST ROAD TO RIGHT. 2ND LOT ON LEFT (LOT #5)
0
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS f,((UCTION STANDARDS, AND T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
f
OF PERSON al �UCTINNGG TFIE 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

292,7 7
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1.
WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
BISHOP LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BARNEY BISHOP
Address 388 BISHOP LANE
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) - 894-0613
Area Code Phone number
4. DATE DRILLED 04/28/04
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO EZ
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 7.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 40 Ft.6-1/4" SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To _ Ft.
From To Ft.
15. SAND/GRAVEL PACK:
From
From
Depth
To
To Ft.
16. REMARKS:
in. in.
Ln. in.
Size Material
Ft.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) c..- _...__..
Latitude/longitude source: 0 GPS ❑ Topographic map ,'
(check box) ..._.,
DEPTH
From To LET -
DRILLING LOG
From To
�uu
LOCATION SKETCH 1 I��.
Show direction and distance in miles om Mena
Two State Roads or County Roads. Inc ude the ro4d _ t
number and common names II
HWY. #9 N. FROM MILL SPRING. LEFT ON
SILVER CREEK RD. RIGHT ON BISHOP LANE
(LAND OF LAKES) GO THROUGH THE FIRST
CROSSROADS. 1ST DOUBLE WIDE ON RIGHT.
0
2
0
0
0
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
( ,-1/0 �, �ti ��r[-1E bvEih�r\Q - 7' o? �' d y
SIG ATURE F PE ON CONSTRUCTING LL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

293126
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 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
RED FOX RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JAMES MCNAMARA
Address 2290 RED FOX RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 894-5423
Area Code Phone number
4. DATE DRILLED 04/30/04
5. TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 50 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From 0 To 70 Ft. 6-1/4"
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. QUIKRETE
From To Ft.
14.SCREEN: Depth Diameter
From To Ft.
From To Ft
15. SAND/GRAVEL"PACK:
Depth Size Material
From To Ft.
County POLK
CHLORYTE Amount 4.5
Wall Thickness
or Weight/Ft. Material
SDR.21 PVC
Method
POURED
Slot Size
in. _ in_
in. in.
From To Ft.
16. REMARKS:
Material
Topographic/Land setting
0 Ridge 0 Slope 0 Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)-------
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in mile 4014 at least
Two State Roads or County Roads. elude the Toil__-
number and common names
HWY. #9 S. FROM MILL SPRING. RT. 0
#14. RT. ON RED FOX RD. 1-1/2 MILES ON LEFT.
(2290 ON BOX)
J
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCIED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND T A
COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
l � SIG
E" ON CONSTRUCTING 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
i�r�v. 4 30- d;

2937-25
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: MILL SPRING
WHITE PINE LANE
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: LUIS GUERRERO
Address WHITE PINE LANE
(Street or Route No.)
MILL SPRING NC
City or Town State
(828) — 223-6693
Area Code Phone number
4. DATE DRILLED 04/01/04
5. TOTAL DEPTH: 57
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 37 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County POLK
Zip Code)
28756
Zip Code
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 57 Ft. 24" CEMENT
From To Ft.
From _ To _ Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CEMENT
From To Ft.
14.SCREEN: Depth Diameter
From To _ Ft. _
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From 37 To 57 Ft. 78M GRAVEL
From To Ft.
Method
POURED
Slot Size Material
in. _ in.
in. in.
16. REMARKS:
Latitude/long
Topographic/Land setting
❑ Ridge 0 Slope ❑ Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/sec nds) r- -
tude source: ❑ GPS I❑ Topographic map
(checkboxr
DEPTH
From To
DRILLING Lop "
From Ta'
LOCATION SKE—CH
Show direction and distance in Hiles t'reimafleast'
Two State Roads or County Roada. Includell,be i_oad.;
number and common names
HWY. #9 N. FROM MILL SPRING. RIGHT ON
GRASSY KNOB RD. GO APPROX. 1 MILE. RIGHT
ON WHITE PINE LANE. LOT ON LEFT AT DEAD
END.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRJCTJIIONSTANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Q
SIGN'ARE OF PER
UCTING THE WELL ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

293722
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]
W
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED (if aPERMIT #
applicable)
Of 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 Ton COLUMBUS
FLOYD BLACKWELL RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: HUBERT METCALF
Address FLOYD BLACKWELL RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 8994905
Area Code Phone number
4. DATE DRILLED 04/08/04
5. TOTAL DEPTH: 34
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 14 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 6.44
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 34 Ft. 24" CEMENT
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size
From To Ft. in.
From To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 20 To 34 Ft. 78M GRAVEL
Material
in.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/secondsl
Latitude/longitude source: ❑ GPS [f] Topographic map
(check box)
DEPTH
From To, I' t
DRILLING LOG
From Td
-1
LOCATION SKETCH- ..
Show direction and distance in i$sij'om at least
Two State Roads or County RoadsInclnde Toad-
number and common names
HWY. #9 S. FROM MILL SP
SANDY PLAINS RD. RT. ON FLOYD BLACKWELL
RD. APPROX. 3 MILES ON RT.
From To __ Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CQN RUCTION STANDARDS, AND THAT A COPY OF S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
CA. CAA / SiGNATUR� OF PER CONSTRUCT THE'WELL � DATE �I
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

294452
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jam e S t•r Camp, Jr
CERTIFICATION p 21 4 R
WELL CONTRACTOR COMPANY NAME Camp. a Wail & Pimp ('n Tnr- PHONE 1 82R) 4S1-7322
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ PERMIT,/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIO
Nearest Town.
LeLKe er 6r4
(Street Name, Numbers, Cithmunity, Subdivision, Lot No., Zip Code)
3. OWNER: �b -A?hY� S�e11leyt5
Address
/✓I;)!
City or
County PC' 1 k
Topohic/Land setting
❑Ridge 15lope ❑Valley ❑Flat
(c eck appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
d�a Pi PM er (-cc 1- mrt 4 . 3p Latitude/longitude source:❑GPS❑Topographic Snap
(street or Route 11o.) -J /�(nt}tt e ✓ L-n • (check box)
511111
N
C at cg PEPTIC pRILLING LOG
Tow d Slue Zip Code From To Formation Description
( )-
Area code- Phone number
4. DATE DRILLED T —
n
4s
el7✓t, 9ralnl
5-0 ecti5o ,dare vO(.k
5. TOTAL DEPTH: 5-0 5 yyy
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: /7
(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 .O118.
9. YIELD (gpm): •95 METHOD OF TEST 4. i r
10. WATER ZONES (depth): q g C
11. DISINFECTION: Type Chi nr i n.
12. CASING:
Depth Diameter
From To ' ' Ft. 6 ] /
From To Ft.
From To Ft.
13. GROUT: Depth Material
Frorn p To 2 0 Ft.
From To Ft.
14. SCREEN: Depth Diameter
From_ To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Amount tYA ✓c11
Wall Thickness
or Weight/Ft. Material
RBR21 PVC
Neat Cement
Method
Hand
Slot Size Material
in.
in.
From To Ft.
From To Ft.
0
0 O
c C',.
Ire
N..:
.773 c r
▪ 1,'`,=
LOCATION SKETCI-1
Show direction and distance in miles from at least(3 �`:
two State Roads or County Roads. Include the roadN r ,c
numbers and common road names. .' 0
r G
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
l
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

29.451
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James '•' Cain l', Jr CERTIFICATION # 21 38
WELL CONTRACTOR COMPANY NAME Camp' c We11 & Pimp Cn Tnc PHONE #$7R) d5R-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 1 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: Si. I 'tide,- / rCounty Po f
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: >irSol u 0. K e a �4Thi
Address r 0 E nI( '700
Sf [y)'(/4p0.(Str}ecyt or Route No.)2 g /77 3
6 )ryo/Town State Yl - l4lyl �v�6 Zip Code
Area code- Phone number
4. DATE DRILLED Si J - 6 1
5. TOTAL DEPTH• 4E C
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: /1D FT.
(Use "-r 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): /D METHOD OF TEST a i r
10. WATER ZONES (depth): 8>
11. DISINFECTION: Type ['hl nri nP. Amount / Gap
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From_0____ To Ft.6 1 /4 QDR.21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From p To 20 Ft. N at Ccmcnt Hand
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Front_ To Ft. in in.
From To Ft. in in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
J Topographic/Land setting
47Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographicjnap v
(check box)
DRILLINGr LOG -1
Formation Des notionl'--------- -
SRII�iY
C�12so'idatrd rock
-3 I
ird'
DEPTH
From To
R4
0
i
LOCATION SKETCij
Show direction and distance in miles from at least '7
two State Roads or County Roads. Include the roar -
numbers and common road names.
tfi
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
(v.M hI Iu-
/ SIGNATURE OF PRSON 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
ETU

2944/19
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James tar Camp, Tr CERTIFICATION # 21 "1R
WELL CONTRACTOR COMPANY NAME Camrt a Wel1 R Piimp CrL Inc PHONE #S7A) 4Si'-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT,/
(if applicable) (ifap livable)
1. WELL USE (Check Applicable Box): Residential EYMunicipal/Public ❑ Industrial ❑ Agricultural ❑ n
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI((y
Nearest Town' . A A, County
�/1✓ a* -4-�- rc b .. V.a2w 4-3,V..t,..l_
(Street Name, Numbers, Canm , Subdivision, Lot No., Zip Code)
3. OWNER: I) a Y`-- Y� 0
Address .Q h\ t A n A i{ CA \PA V \JA-
C: (� }(Street or Route No.)
,2t1tret�JC
City or Town State Zip Code
Area code- Phone numb*.
4. DATE DRILLED \
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO d
7. STATIC WATER LEVEL Below Top of Casing: to 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surfaces
`Top of casing terminated at/or below land surface requires a
*variance In accordan a with ISA NCAC 1C .0118.
9. YIELD (gpm): S�Q METHOD OF TEST air
10. WATER ZONES (depth): \ (n
11. DISINFECTION: Type rh 1 nri np Amount
12. CASING: Wall Thickness
DepDiameter orWeight/Ft. Material
From (l To \nl) Ft. 6 1 / 4 GDR.21
From To Ft.
From To Ft.
13. GROUT: Depth
Front_,/ To 2 0 Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in in.
in. in.
From To Ft.
15. SAND/GRAVEL PACK: ( Irrr
Depth Size Material 1 b
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 m'ap
(check box) ---
pEPTI-1 FRILLING LpG
From To Formation Desc
tJIJ t�
1 o t1 \, `c; S
0
O o
LOCATION SKETCli
Show direction and distance in miles from at least -o
two State Roads or County Roads. Include the road?
numbers and common road names. WA
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
�9 TnA At Arcv
3 SIGNATUZE 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
t Z

294454
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James '.r C mp, Jr -
WELL CONTRACTOR COMPANY NAME Campt a We11 & Pump en_ Tnc PHONE 8817R) 451-7122
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
CERTIFICATION p 21 R R
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential "MunicipaUPublic 0 Industrial 0 Agricultural ❑ ' - r---
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI PO
Nearest Town: i it S C 1 rt� C'' ppltaryry ISO)
P-et 75 Green RI Jtv thgll lends
Subdivision,
(Street Name, Numbers, Community, Lot o. Zi -p Code)
3. OWNER: JYii. , c �V11 YC _
Address 37/0 Did 1`11 i heIA<F cifc C
i %f l33 it- I Li-
(bib- 7°14
) -5525 FF
(S eet or Route No.)
) - ,
City or Town' State Zip Code
Area code- Phone number
4. DATE DRILLED Qt
5. TOTAL DEPTH: I- O S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO X
7. STATIC WATER LEVEL Below Top of Casing: 4'O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface•
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 4 METHOD OF TEST p i r
10. WATER ZONES (depth): S
11. DISINFECTION: Type ('h 1 nri na Amount 1 carp
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From_(] To ha- Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth Material
From p To 20 Ft.
From To Ft.
SDR21 PVC
Neat Cement
Method
Hand
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topo hic✓Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map -
(check box)
DEPTH DRILLING L ('r
From To Fprmation Descnption
0 rl-z alas? , 5 rAy; el
7..t ifo5 Cat4olidattd vt ,r k
G
O
=-O
LOCATION SKETCH t%.*?
Show direction and distance in miles from at leaf
two State Roads or County Roads. Include the r t6 d
numbers and common roartnames.
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.
Cart .l
SIGNA'
n )' eTh
t ` �- I.)
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

297523
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 s
Camp, Jr
CERTIFICATION 8 21 3 A
WELL CONTRACTOR COMPANY NAME ramp' S Well g Pump Cn Tnr• PHONE #817R) 4 " -7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential r Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: \�
Nearest Town: i\Ak A ) �S^ tL
Q AAn-t.� County
Cne�.M �AAALA 61.Afi
(Street Name, Numbers, Community, Subdivisiop Lot No., Zip Code)
Topographic/Land setting
❑Ridge lfhpe ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER; - McV&LJ— (degrees/minutes/seconds)
Address 'ric le1eI r� Latitude/longitude source:❑GPS❑Topographicnlap
J (Street or RouteNo.) (check box)
MUI J�r�hri NC o-22L74 DRILLINGt .—__-
City r Tow/ state Zip Code ):.Ormatipn scri
( )- S'C, - II0(a 0 'A�V/r,�i
Vn
Area code- Phone number
4. DATE DRILLED S - 2S • 0L4
5. TOTAL DEPTH: S 0 5-
6. DOES WELL REPLACE EXISTING WELL? YES 02'NO 0
7. STATIC WATER LEVEL Below Top of Casing: CCU FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accord nce with 15A NCAC 2C .0118.
9. YIELD (gpm): S METHOD OF TEST D i 2r
10. WATER ZONES (depth): *Us C
11. DISINFECTION: Type r h 1 nr i n p Amount
12. CASING: Wall Thickness
Dept] Diameter or Weight/Ft.
From 0 To 1-J Ft. 6 1 / 4 c r).R 21
Froth__ To Ft.
From, To Ft.
Material
PVC
13. GROUT: Depth Material Method
Frond To 20 Ft. N at Cement Hand
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
DEPTH
From To
) 3 S(1 S— °Litt CAA ,a
LOCATION SKETCFI
Show direction and distance in miles from atast
two State Roads or County Roads. Include the joads,, -.
numbers gttd commop road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRULIED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
NATURE • 9 PERSON CONSTRUCTING THE WELL
L- I 3Lt
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR(INDIVIDUAL) NAME (print) Tam ms to._ Ca»t(,_, Jr CERTIFICATION 0 71 3R
WELL CONTRACTOR COMPANY NAME ramp' a Wm11 R Pnmr Cr-) T n r PHONE a&7R1 dS3_7322-
STATE WELL CONSTRUCTION PERMITN ASSOCIATED WQ PERMITW
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential gat/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: i_. c I to Iv\ IJ „ l5 _Cosity V' a IC
R o SKyuKu K
(Street Name, Numbers. Communi II Subdivision, Lot No., Zip Code)
3.OWNER: 205e h PAInwler
Address 3/71{ Sru ih Ai lart i c
(S t or RoPto No.)
((Vmnn { brick �L .Z I2
try or Town State I Zip Code
gRe)- Y`2 -/)oo
Area code -Phone number
4. DATE DRILLED 0Z), i
5. TOTAL DEPTH: 41057
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO l(
7. STATIC WATER LEVEL Below Top of Casing: ?r0 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
yarlance In accordancea ith 15ANCAC 2C .0118.
9. YIELD (gpm): 13 METHODpOF TEST air
10. WATER ZONES (depth): C (v 5-
11. DISINFECTION: Type rh 1 nri na
12. CASING:
Depth
From p To b3
From To
From To
13. GROUT: Depth
From_0___ To 2 0
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
To
To
Diameter
Ft.6 1/4
Ft.
Ft.
Material
ant
Ft.
Diameter
Ft. in.
Ft. in.
Topo c✓Land setting
❑Ridge lope ❑Vallcy ❑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 Descrip q'on
n 63 drive l / ScAxrl
/log- Ce lsnJir♦Ate A rock
LOCATION SKETCH L.
Amount / cad +U / I Show direction and distance in miles from at least
Wall Thickness / / two State Ro or County Roads. Include the roads
or Weight/Ft. Material numbersoad names.
GDR71 PVC
From Ft.
From Ft.
16. REMARKS:
Method
IIand
Slot Size Material
in.
in,
Size Material
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
one- GO. Cam /�] /��"_� / - / 4 - v l
SIGNA yY.F PERSON CONSTRUCTING THEaDATE
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
ras
297520
c
v
t'v
ALL

297517
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Janteis u r'arp p, Jr CERTIFICATION # 21 4R
WELL CONTRACTOR COMPANY NAME (Tamp' S Wa11 R Pump !'n Tnn PHONE #ffi7R1 454_7122
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Cr Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT €N:
Ne est Town:
(Street Name, Numbers, CommunitySubdivision, Lot No., Zip Code)
3. OWNER: Qn tv. Ll1J.
Address \ D `'I ' '� 11IS .
(Street tow
b
liry or Town Stale Zip Code
Area code- Phone number
4. DATE DRINTFD L\
5. TOTAL DEPTH: UC
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO III
7. STATIC WATER LEVEL Below Top of Casing: Q. 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 accordii��nc w ISA NCAC 2C .0118.
9. YIELD (gpm): f[\S METHOD OF TEST p jx
10. WATER ZONES (depth): IOU
11. DISINFECTION: Type ('h1 nri nn
12. CASING:
Dep Diameter
From p To Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth
From_0___ To 2 0 Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
Amount
Wall Thickness
or Weight/Ft. Material
S1-112,.21 PVC
Material
Neat Cement
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
IIand
Slot Size Material
in.
in.
16. REMARKS:
Topographic/L`an4 setting
ORidge ❑Slope Malley OFlat
(check appropriate box)
Latitude/longitude of well location
(degreesiminures/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From Too ,dtFo on Description
03 S YA
r
J.00ATION SKETCH L c,,
Show direction and distance in miles from at least -
two State Roads or County Roads. Include the r68d1
numbers and common road names. = -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY O THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERS, QN CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
297516
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
Wp11 R
Carp, Jt
Pumas Pn
Tnr•
CERTIFICATION # 21 18
PHONE #${7Al dSl_7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential I7J Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO :
Nearest Town: n /UW( btl6
64 /�-elite' Rd
(Street Nume, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Da cart l y
Address (C, efrt r e I Fa
(Street or Ro a No.)
COItlfr(hu6 a
County PO '/�.
try or wn / sr3 Zip Code
Area cede- Phone number
4. DATE DRILLED LJ — a8 -L'
5. TOTAL DEPTH: Co c
6. DOES WF) I REPLACE EXISTING WELL? YES O NO �S
7. STATIC WATER LEVEL Below Top of Casing: /0 0
(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): METHOD OF TEST kir
10. WATER ZONES (depth): y-ti C
11. DISINFECTION: Type f'h 1 nr i n p Amount j CU
12. CASING: Wall Thickness
Depth "" f� Diameter or Weight/Ft. Material
From 0 To iDy- Ft.6 1 /Q cnR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From p To 20 FL Neat Cement Hand
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: - duly
Depth Size Material
From To Ft. on
From To Ft. /
16. REMARKS:
two State Roads or Co ly'Rohds.
numbers and commotti oad names.
ecTlie
!`CY
CA Peale,
Topographic/Land setting
ORidge ❑Slope DValley Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: OGPSOTopographic pwp
(check box)
DEPTH PRILLING LOG
From To � F don Description
,Dr/ct
l o(1 lc05- ( 6f/Led vor
LOCATION SKETC1j —
Show direction and distance in miles from at leash
elude the read
GJ
0
rV
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECOfs:D HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE PERSON CONSTRUCTING THE
-/G-U'/
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

297515
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ja mag ur Cantr, Jrr CERTIFICATION # 71 4R
WELL CONTRACTOR COMPANY NAME ramp' S WP11 R Primp Ong Tnr- PHONE #g2Rl A I_7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable. (if applicable)
1. WELL USE (Check Applicable Box): Residential I tunicipal/Public ❑ industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT ON:
barest own
(Street Name, Numbers, Community, Subdivision,
3. OWNER AD S
Address 74 k{ o
CI(sae?' or Route No.)
t�)r1/Jac iVc
County P fkXJ�
Lot No., Zip Code)
re i/e'ci
Ctry or ow State Zip Code
Area code- Phone numbef
4. DATE DRILLED 19- t
5. TOTAL DEPTH: S
6. DOES WELL REPLACE EXISTING WELL? YES 14NO ❑
7. STATIC WATER LEVEL Below Top of Casing: v 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 accordaince with 1SA NCAC 2C .0118.
9. YIELD (gpm): 1 u METHOD OF TEST k i r
10. WATER ZONES (depth):
11. DISINFECTION: Type rh 1 nri na
12. CASING:
Depth Diameter
From p To k V1 Ft 6 1/ 4
From To Ft.
From To Ft.
13. GROUT: Depth
From_a_ To 2 0 Ft.
From To Ft.
Amount
Wall Thicimess
or Weight/Ft. Material
eDR.21 PVC
Material
N at Cement
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Slot Size Material
in.
in.
16. REMARKS•
Topographic/Land setting
[Ledge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic ipap;,__
(check box)
DEPTH DRILLING LOG
From To Forman Descnptio
n t 1 l �d. F� _
rV
w
0
LOCATION SKETCli
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common ro . . names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFI
CONSTRUCTION STANDARDS, AND THAT A COPY O THIS RECORD HAS IEEN PROVIDED TO THE WFI 1 OWNER
GLY61g ,
SIGNATURE OF PERSyN 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

297508
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James .., Camp+, Jr
WELL CONTRACTORCOMPANY NAME ramp' c Wa11 R Primp Cn Tnr PHONE #832R) d54_7322
STATE WELL CONSTRUCTION PERMIT?! ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
CERTIFICATION # 21 R R
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI
Nearest Tcwn
(Suter Name, Numh}.r;, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address V. 0 a
aeet or fir . Nc. aq a ti
Zip Code
7 R1a(- klta G1,
County \ ,1)e_
Area code- Phone number
4. DATE DRILLED I • U t4
5. TOTAL DEPTH: a \j
6. DOES WFI 1 REPLACE EXISTING WELL? YES 0 NO th
7. STATIC WATER LEVEL Below Top of Casing: % FT
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
`Top of casing terminated atfor below land surface requires a
•variance In actor ce with ISA NCAC 2C .0118.
9. YIELD (gpm): Q_ MFGTH 5 OF TEST a 1 r
10. WATER ZONES (depth): JJ
11. DISINFECTION: Type r h l n r i n a
12. CASING:
Dep Diameter
From p To Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
FrormLr_To 20 Ft. Plcut Cement
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
S-DP21 PVC
Topographi4ang.setting
❑Ridge ❑Slope YdValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box) _
DEPTH J3RILL ING LOG
From To grmation D scripti
n Xb bxl).,.,,
gb ,, ko Gu1.L.
w
0
o
LOCATION SKETCH
Show direction and distance in mil s from at lea
two State • • • • - o • • . • elude the road
numbers and common road names
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUL1lD IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION S BARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNA
c
OFLIVEINSO CONSTRUCTING THE WF) I
1O irQ'1
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

297641
V1 E L (ON 'IRUC I ON R1CQ�lt
at of V. WI (Jualµy
r,, . J.1'%n.n. II ri ! n.,,rnrn:N N.tj ,aluul P.' 4Th.:> :i... n �a.l 1 -
,.I:,r trl. quint, ALAI"i'1/4.- (
:uNn.ul\tu.,l,•.\.u'v I_t�n
.NSW. t\, I I)%%Q or limns
,. .,, vllr :.r%.I N.(1/1.♦1'!.N♦IIU __..
... •at Ii ahlr
>c(Ialh Lft
^' It2Lnit,at la
N<SiC:n�..al Vu'u.:r•;.., i'.,1,,'.: 0 - • ....
,. + r fl ..A \...,: 171i Ur C' .... f 1;F.... Li$ ..
0 MCYt romp \\ Y,a lr,, :Inn;'.: t :�. a.-� ' .,
/[[ tr; land ,c!un
...�,( ��/��. v 01.1';l.S OF la
ulr(c "�ICOl
: h w.; rY �). u(m
LYulydc II nl(t..vd,• ul a€l. Iu.Y -
i.kgrar. ...e.,. A,. r.,.
'](,Lynn fupoe, aids:
L••
• ..Ie unfit. Vet SC, till
. �. rl�..P ����� (•. JLLnI\:�
5'15 Q -,-mod.. 5e5-....
T.' .. Sun.'. I \:. ('
414-moo 44, --7d..
5(wd. -
5 VI-0
pot:, NCu RF.i'LALF E X1STINC' N k LL
•-i, .hR Lt\r:i den•w Tan. .,! ♦a,.lS Cr I?
o ,4f1 O T„
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• •
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r.\.l.l IC .ttll.
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'I I)hi\t ( F..il')\ P Ayr".n.k•+o..
.-�(� h• '.I.. ...
F,
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It
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cri
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LSLcilLt • ,!ILiLt.!. N o
+,., ,n.. r ' 1' ;.. ••
<.,r:clian and � t �
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1':, ',IICIi C,A '.
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.Il \�.M 11 ((k.'_1 µ%.Sit'i?\I Nl-1 11'.1. IN. At _b—�
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mac: bun. rh\A ♦1 o11. t,,.• 1 tl1 ``I, Af'\'t .r l,ll
:.y..,ol., 1'nou. •
N�, � )lu, ^1 t 12:1. wtlinra 1G Ant..

297630
H'FLL C O'�STRUC'1lOti RECORD
\..lot i.• V,, pi., - Jcpen,e. nI 14 F n.,nmrncriI sod Naltutjj11 �Rc.c ul, cs ' A'/
\\ PA I. l ON I I< it 1 VK (INUI11U1. Al r N tMl. :print) ... r��1(r•�1`et_i_. /
•-t Ll. L .'i)\,h11 :OK CU\IPI.1 N]tll. ApOSi �'�`r Rk\
,, 1+1 1`1t.i.(U\lIN1 1;I1i1N t'!.N • _.__
"At : t hi s. Np;,1.c:01le bet'. Neste. m al
15yU11Y
_ vt c ,'.:!) 0 Hcal 1)01111, uicr Ins •ctit,I; U2 t
fItA")3�tS Lb' ..
3.(s.. i e,I CO tG .lL
3 (s -r4 . `C. Y O_oL _ _Let M..
I _ — —
,iara V ir.,:r
i li 1 IY.I I. f•L .4i _�
il)1 1 .,,prFH ... .. _
t, UUL:, \\ LLI. RFYL.ALE EXISTING L` WI LNh SO `IO _...-._..
>T '.i lt. N,Yi h'.R 1. t. A'kl heir:). Ton c f' hu (.
t i..«"• r1Alba: fop o(inrnQ
N I I (IF 1 ASINII , ( ..... k1,.: UM; Sterac:$
• y t.I, aainll lrtl(at(I ator n.low hold rfart, retiuiresk _�. ..LV
♦ar ¢a )n att .rdan. .r •n 1. %•NC ♦C IC n11N. %�� y /1 ( U✓ l _—
u iPl l) (poi' 41/--1 4)�pi' TF.',1' ]..yk�- ScI Srl-.._ .. _._ c
it 'r \ R R1'.1:Ntdepthl _ _._ _ _____ \:?S.L..LS.I.I
• I qL�` 0 a pount ShJw I c1iaa an dig iot 1 ,.
I I II\I `Ft•(: TI ),\ iypt_ r� •,\ Si.. Tn,ktio., la , ,i.t.. Roads of l „oa Rna.s. It • 0..._• ,
`:Nti I..tunhtrt :i!,4 ;er;rno;'. IV:1.: ri1tl)e r.
rl; Iaf; '1grtrlcr OP N:.ght F V-. t .i ,r
of B‘cao Cc Lam
on of V1 414r 1.)J.1110,
,1UN4.1 YE R"no
.u>P':cabltt
'I Cundwecer ie' nor'
Cl R 1 Lk IC�n1IUN
'7$
I'.d'•li: 0 in!u%ir„ri ❑ >cncuhur.t! L
;loci U l )thxr. Lt5• t '.. _ ._.-_ .. _ .. .
Topographic Ladd 'cuing.
gRlayc O51opi' OA ail:) UFI..
,ppr,;.,,ait n.,r
Laluudc'I: ngltud., u! ell IC . aIIVn
a1Ju.i:, ,y„ndc nolu cc licirSO'Ibpatnaph.r n,.1'
I H
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III •IL:\ rh!. •r,\iL
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H4,WHA1.A 44iCUN.NIKtl 1Fl:i\At( ilIJA\t L'A If H 14 `•(\i 2I. t\II.•
AND nAl\I(lr1t)r IYINRhitIKl)IIAS filch!. 11N0\if1FU 10 INC \L`. ` —'.
r I �JLLi V..
,. il)', 1 UN`.IHI.I
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NJIOIttI the UCI F.:IgI It: the P1111 h111 DI �\AI<r �Uil l)(1. la rllUnrjN altr 1t•i llu n. Iyty Na,l ]. r1 i:r (nt'r - !tali hl
]:S'00-/t ,l'bun.N•,., +1'1r ..I43121. wllhin 1G tl:.11.
.n: 1

296791
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: TRYON
CARRIAGE ROW1
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: ARLINE, CARTWRIGHT
Address 236 CARRIAGE ROW
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(828) - 859-2210
Area Code Phone number
4. DATE DRILLED 06/09/04
5. TOTAL DEPTH: 48
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 28 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County POLK
Zip Code)
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 48 Ft. 24" CEMENT
From To _ Ft. _
From _ To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From _ To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. _ in.
From _ To Ft. _ in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 28 To 48 Ft. 78M GRAVEL
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds). - -- _
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. RT. ON HUG11
CHAMPION RD. RT. ON PENIEL RD. LEFT ON
HENDERSON RD. LEFT ON RED FOX RD. ON
HUNTING COUNTRY RD. RT. ON CARRIAGE
ROW. APPROX. 3/4 MILE & LEFT (M BOX #236.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
J � /
c �Y� f 0 - 7' 6 21
SIGNATURE F PER ON TRUCTING THE WELL (( DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

296780
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
HIGIH,ANDVIEW LANE -LOT #20
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: GREGG BELLINI
Address HIGHLAND VIEW LANE
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 674-8974
Area Code Phone number
4. DATE DRILLED 06/18/04
5. TOTAL DEPTH: 245
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO EI
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 6
12. CASING:
Dcpth Diameter
From 0 To 140 Ft. 6-1/4"
From To _ Ft. _
From _ To _ Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. QUIKRETE
From To Ft.
Wall Thickness
or Weight/Ft. Material
SDR.21 PVC
14.SCREEN Depth Diameter
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Method
POURED
Slot Size Material
in. _ in.
in. in.
From To Ft.
Topographic/Land setting
❑ Ridge 0 Slope ❑ Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) _.. _.
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. LEFT ON
SILVER CREEK RD. RIGHT ON LAKE ADGER RD.
GO PAST MARINA. LEFT ON HIGHLAND VIEW
LANE. APPROX. 2/10 MILE ON LEFT.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
(i'rn,ra to -/ It 07
GNATlURE OF PERSO CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD Groundwater Section
North Carolina - Department of Environment And Natural Resources - Division of Water Quality -
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERIIFICATI PHONE #[phone]
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town- MILL SPRING County POLK ❑Ridge 0 Slope 0 Valley ❑Flat
HWY. Name108,
N. (check appropriate box)
(Street G.S.ENGLEs, Community, Subdivision, Lot No., Zip Code) Latitude/longitudef well location
3. OWNER: G..
Address HWY. #108 E. (degrees/minutes/seconds)
(Street or Route No.)
MILL SPRING NC 28756 Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
City or Town State Zip Code DEPTH
(828) — 894-6559 From To
Area Code Phone number
4. DATE DRILLED 06/21/04 DRILLING LOG
5. TOTAL DEPTH: 305 DR DRTo
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): 8 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To 80 Ft.
From _ To _ Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20 Ft
From To
14.SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
CHLORYTE Amount 7.5
Wall Thickness
Diameter or Weight/Ft. Material
6-1/4" SDR.21 PVC
Material Method
.OUIKRETE POURED
Ft.
Diameter Slot Size
_ Ft. in. _—
Ft. in.
From To _ Ft.
Material
in.
in.
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 E. FROM MILL SPRING. HOUSE ON
LEFT 1/4 MILE BEFORE PEA RIDGE RD.
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
�� niflin il�i) /
SIGNATURE OF PERSON COJNSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME 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 Pinup Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING County POLK
BIG LEVEL RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: RICHARD BRADLEY
Address BIG LEVEL RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 625-2458
Area Code Phone number
4. DATE DRILLED 06/04/04
5. TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 12 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 4.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 30 Ft. 6-1/4" SDR.21 PVC
From _ To Ft. _
From To _ Ft. _
13. GROUT: Depth Material
From 0 To 20 Ft. QUIKRETE
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To Ft. _ in. _ in.
From To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
Method
POURED
From To _ Ft.
From To Ft.
Topographic/Land setting
❑ Ridge 0 Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degreeshninutes/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 atleast
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. RIGHT ON E.
MCGUINN RD. GO TO STOP SIGN. RIGHT ON BIG
LEVEL RD. APPROX. 3/10 MILE ON LEFT.
CO
w
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS RUCTION STANDARDS,
OP S is ( RECORD
' BEEN PROVIDED THEL OWNER (n n
PERSON CONSTRU
THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - ICATIOGro 311ater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT PHONE # (828) d53-0662
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLCED WQ PERMIT #
STATE WELL CONSTRUCTION PERMIT # _ Elfapplicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential ® MunicipalPublic 0 Industrial 0 Agricultural
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK
JACKSON GROVE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JANE GALLAGHER
Address 1855 JACKSON GROVE RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) - 894-2607
Area Code Phone number
4. DATE DRILLED 06/08/04
5. TOTAL DEPTH: 665
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 140 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 100 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 18
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 90 Ft. 6-1/4" SDR.21 PVC
From To Ft.
From _To_Ft.
_
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft _ in. in.
From To _ Ft. _ in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To Ft.
From To _ Ft.
Topographic/Land setting
0 Ridge 0 Slope 0 Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) - _...._...
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box) - -
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. RT. ON HWY.
#14. LEFT ON JACKSON GROVE RD. HOUSE IS 2
MILES ON LEFT.
0
;v
,y
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THfT A COPY OF THIS ORD HAS BEEN PROVIDED TO THE WELL OWNER
4-
SIVNATt4RE OF PERSON CONSTRUCTING WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center
e REV. 0 leigh NC
27699-1636 Phone No. [phone], within 30 days.

2967 ;'5
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 #PHONE # [phone]
3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
I. 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: Topographic/Land settingNearest Town: COLUMBUS County POLK 0 Ridge 0 Slope ❑ Valley 0 Flat
PHILLIPSName, Nu (check appropriate box)
(StreetNNumbers, Community, Subdivision, Lot No., Zip Code) Latitude/longitudef well location
3. OWNER: ANDREW FOSTER
Address 1047 PHILLIPS RD. (Street or Route No.) (degrees/minutes/seconds)..
m hie irua
COLUMBUS NC 28722 Latitude/longitude source: ❑ GPS ❑:Topog p p
(check box) __
City or Town State Zip Code DEPTH
(828) — 863-2552 From To
Area Code Phone number
4. DATE DRILLED 06/11/04 DRILLING LOG
5. TOTAL DEPTH: 405 DRDRIL To
6. DOES WELL REPLACE EXISTING WELL? YES 0 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 15A NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To 140 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 _ F
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
CHLORYTE Amount 1
Wall Thickness
Diameter or Weight/Ft. Material
6-1/4" SDR21 PVC
Material
QUIICRETE
0.5
Method
POURED
Diameter Slot Size Material
Ft. _ in. _ in.
t in. in.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
nHWYumber and common names
#9 S. FROM MILL SPRING! RT:ON "-"
COLLINSVILLE RD. LEFT ON PHILLIPS RD.
0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS UCTION STANDARDS AND THAT COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�o—//—r;�
DATE
SIG ATUI(E OF PERSON CONSTRUCTING WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001

296773
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CER IIFICATION #3114
PHONE # (S28) 453-0662
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: MILL SPRING County POLK pogmP
OWL HOLLOW RD. 0 Ridge 0 Slope ❑ Valley 0 Flat
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) (check appropriate box)
3. OWNER: CHRIS OGLES Latitude/longitude of well location
Address 1323 OWL HOLLOW RD. (Street or Route No.) (degrees/minutes/seconds)
MILL SPRING NC 28756 Latitude/longitude source: 0 GPS ❑ Topographic map
City or Town State Zip Code (check box) (828) — 625-2565 DEPTH
Area Code Phone number From To
4. DATE DRILLED 06/17/04
5. TOTAL DEPTH: 405
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 4 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 10.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 40 Ft. 6-1/4" SDR21 PVC
From To Ft.
From To _ Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth 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. #9 N. FROM MILL SPRING. APPROX 5
MILES. LEFT ON LAUGHTER RD. RIGHT -ON -OWL -
HOLLOW RD. 1ST DRIVE ON LEFT.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SI
XO--,t rr �/ r'/ri 2 �n 7 - (�
A 0 ERSON COwjSTRI1CTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Se GW a REV. 0aleenter — igh NC
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 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 ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON
WESTMORELAND TRAIL
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ELIZABETH WINKEL
Address 118 WESTMORELAND TRAIL
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(828) — 894-5612
Area Code Phone number
4. DATE DRILLED 06/22/04
5. TOTAL DEPTH: 405
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):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 10.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 120 Ft. 6-1/4" SDR.21 PVC
From _ To Ft _
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To Ft. in. in.
15. SAND/GRAVELPACK:
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
WALKER ST. FROM COLUMBUS. RT. ON _..
PENIEL RD RT. ON GOLDEN RD. LEFT ON
WESTMORELAND TRAIL. 1ST DRIVE ON RT.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS,STyAND
THAT �1 COPY OF THIS RECORRDD HAS BEEN PROVIDED TO THE WELL OWNER
l ' I 'ERSON ON /,t . � TYIE �o - , A - 11 ( i
SIG �A OF PERSON CON UCTIN 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

29F771
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'1FICATION #3114
PHONE # (828)�53-0662
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® MunicipallPublic ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK
OLD HWY. #19
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: TRAVIS REDD
Address 815 OLD HWY. #19
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
8(64) — 457-3165
Area Code Phone number
4. DATE DRILLED 06/23/04
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 12 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To 70
From To
From To
13. GROUT: Depth
From 0 To 20
From To
Ft
CHLORYTE Amount 7.5
Wall Thickness
Diameter or Weight/Ft. Material
.6-1/4" SDR21 PVC
Ft.
Ft.
Material Method
Ft. QUIKRETE POURED
_ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From _ To _ Ft.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) "
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box) _. I
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in mikes from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 W. FROM COLUMBUS. LEFT AT KFC
ON OLD HWY. #19. APPROX. 1 MILE. TURN LEFT
ON DRIVE AT BOX #815. LEFT AT FORK. LEFT
ACROSS THE CREEK FOLLOW DRIVE TO TOP
OF HILL.
r,
CA
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIONSTANDARDS,
AND THAT ! f./ �(f COPY OF F CORD HAS BEEN PROVIDED TOTHE a WELL OWNER
��/lI o " 3- 0Y/
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

298879
/_llt 5 vaa4'
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Jyatmai
WELL CONTRACTOR (INDIVIDUAL) NAME (p i
\\'ELL CONTRACTOR COMPAN'V NAME
STATE \\'ELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# '.
(if applicable)
(if applicable)
2
esour s - Division Water Quality - Groundwater Secti
_he,� 1/ 1 CERTIFICATION �j�
—171 C PHONE #222�/ 3/ 7/
WELL USE (Check Applicable Box): Residential O Municipal/Public IP-" Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
WELL LOCATI
Nearest Town: L A* County
111,0,� we Comnmun
(Street N me, N
fibers, C�ommmuunity. Subdivision,
1�
3. OWNER: / nJ efi it✓/7
Address
C�f o) eeiorR p .)
i
� V.
City or Town State
( )-
Zip Code
Areacode-Phone RILL umber --� ,1 / //
4. DATE DRILLED J 4,
5. TOTAL DEPTH: ()�7
6. DOES WELL REPLACE EXISTING WELL? a
7. STATIC WATER LEVEL Below Top of Casing: YES/pp 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 accordant with 15.A NCAC 2C .0118.
9. YIELD (gpm): b MET D O EST
10. WATER ZONES (depth): /g/e
I1
12. CASING:
DISINFECTION: Type
Depth
From D Top S Ft.
From To — Ft.
From To Ft.
13. GROUT: Depth
From To Ft.
From To
Depth
Diamete
ttt-f Cf1MnuC C&UJV\huJ, JJG
bdivision, Lot ., Zip Code)
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSOTopographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
--rn
fV sm
LOCATION SKETCH
nT
Amount Show direction and distance in miles frond
Wall Thickness two State Roads or County Roads. IncludRti e r
or Weight/Ft Mate ial numbers and common road names.
ems
Material
Ft.
14. SCREEN: Diameter
From To Ft. in.
From To Ft. in.
co
51 . r of neth
Method
!'Ply seh o/ A'/r7
cookini %l%aj 2z7 jPen,-
I III 6f 71
Slot Size Material
in.
in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIOJ STANDARpS, AI9THJ.T A COPY Of THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
2 Li-/JJ Y- 2s-27 2/
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
af
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

WPC/NM WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N tral Resrurce Div
\\'ELL CO\TR:\C7 OR (INDIVIDUAL) NAME °V�i t)
05
WELL CONTRACTOR COYIPANY NAME
517E ssss3
n of Water • uality - Groundwater Section
CERTIFICATION t�2a
PHONE # 7^` 377/SO4
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public lei Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATI1
Nearest Town: (�
U%%/w.5 Count
Y
HIto Ip$, rnm ftli Tt.r Lolt�n JtNf
-
(Street Name, Numbers. Community, Subdivi
ion, Lot No., Zip Code)
3. OWNER- Pill? en oiv r'
Address t-IO COUr-FheU Str-et
C(D/D4? Street
pRoute o.)
yc-. uiza
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLA EXISTING WELL? YEA P0 p�
7. r STATIC A R rnLEVEAL Below Top of Casing: �p of
FT.
5 e/'`�ieU (Use "+"ifAboveTop of Casing)
8. OP F A ING IS FT. Above Land Surface*
*Top of casing terminated aUor below land surface requires a
variance in accordance th 15A NCAC 2C .0118.
9. YIELD (gpm): V ME :9 O�/TTEST
l0. WATER ZONES (depth): �(/ ii/
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topoggraphic map
(check box)
DRILLING; LOG--. —
Formation Description
DEPTH
From To
on
cm
Z_
I O ,
V �m
>o
LOCATION SKETCH ^ rm+l
11 DISINFECTION: Type Amount Show direction and distance in miles fromgleaga
12. CASING:
,r. Depth
From li To G 7 Ft. i
From To Ft.
From To Ft.
13. GROUT: Depth
From To Ft.
Wall Thickness two State Roads or County Roads. Includtithe ro2
ter o eight'Ft. Mate ial numbers and common road names. N
Zil Sloe z oIC) Pala)
Cryvivt' fre 122 M, edit
5 C,ha ! gA j ec. T f/c%L
ei/( 5//M/y
Material Method
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:
fi /led1R5>)rc/< rT N; no 1- 7ef
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDYDS, AND THIP.Tf A COTY,F THIS RECO HAS BEEN PROVIDED TO THE WELL OWNER
/21a HAS 3- /y- �Z/
•SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

298886
5/c237
North Caro ma - Department of Environment and N real esource
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CO\'IRACIOIt COMPANY NAIVE
STATE WELL CONSTRUCTION PERMIT#
(if appl icable)
WELL CONSTRUCTION RECORD
thge
-JDivisi f Water Quality - Groundwater Section
CERTIFICATION
5PHONE #
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIO
Nearest Town: /// /�zy County
fa rn e r R-D L1 CP
(Street Name, Numbers. Community, Subdivision, Lo o., Zip Code)
3. OWNER:�� M//(fH /. / 1
Address I ar ieu - nee f r
( Slq;et orRoute N 1
6?e,rw l-e- SG Zei(00I
City or Towel.Sufi
Zip Code
(8q)- (AD- — Hir5O
Area code- Phone number -
4. DATE DRILLED -
5. TOTAL DEPTH: e/J%j'e
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL elow Top of Casin
(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 require
variance in accorde with 15A NCAC 2C .0118.
9, YIELD (gpm): �J(L0 M HOD OF EST
10. WATER ZONES (depth):
11. DISINFECTION: Type
12, CASING:
Depth
From To
From To F
From To Ft.
13, GROUT:., Dept' I t
From .) Top 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)
DRILLING UOG----"�-
Formation Description
DEPTH
From To
O n
LOCATION SKETCH Srn
Amount Show direction and distance in miles front at leo^t
to
Wall Thickness two State Roads or County Roads. Inclufb>the oqa�
roEL lgaterjttltt t� numbers and common road /es. m o
i� 75�� id
S/, I & �/I %l er-
t/2/dJeUT
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
Material
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To//�/ 11 Ft. n/y- n
16. REMARKS: Patti V Je/v/ jth d e t
I DO HEREBY CERTIFY TH:
CONSTRUCTION STANDA
p9A Nt/e'L 4
T THIS WELL WA O STRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
S, AND TIjPT A f ' OF THItECORD HAS BEEN PROVIDED TO THE WELL OWNER
.3/a-0g
SIC NATURE 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

tiiP S1,737 WELL CONSTRUCTION RECORD ��l/f 7 — 1
North Carolina - OR(INDIVI (INDIVIDUAL) NAME
N Resourees i io a[er Quality - Gr CERTIFIndwaterCATION
Sec
WELL CONTRACTOR (INDIVIDUAL) N:UIE (print) 7 J• e CE RTIFICATIO\
\YELL CONTR.\CFOR CONIP.ANY NAME I job yi PHONE
STATE \\ ELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT/
l if appl icable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ❑ MunicipaliPublic Itd' Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Fleat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCA:R / /
Nearest Town'11//���� � 5 � County
Palmer (Load,
(Street Name. Numbers. Com/muniitty. Subdivision, Lot No.. Zip Code)
3. OWNERJ J/.Ci 9i \ gS �I 5 4 /eat
Address L{ 1
(Street or Route o.)
rPQ0u11Q 50 , igloo
Zip Code
(py)- Una `ft0SU
City or Town State
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)
DRILLING LOG
Formation Description
DEPTH
From To
Area code- Phone number ©�
4. DATE DRILLED - -/ /
5. TOTAL DEPTH: e/I�T%%'e de-4
6. DOES WELL REPLAC EXISTING WELL? YES DI NO Its
7. STATIC WATER LEVEL Below Top of Casing: 17 FT.
/5q,# pJ'e (//N (Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accords with ISA NCAC 2C .0118.
9. YIELD (gpm): P M THOlD OF TEST
10. WATER ZONES (depth): ld0/ P 35, ad4
11. DISINFECTION: Type
12. CASING:
Amount i. 1.
Wall Thickness
Depth { Diam' er or Wp' ht/Ft.
From v To �l Ft. s �
From To Ft.
From To Ft.
13. GROUT: Depth r t' I )
From e/ To ,f Ft. t p
From To
14. SCREEN: Depth
From To Ft.
From To Ft.
I5. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16.
Ft.
Diameter
in.
In.
Slot Size
in.
in.
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
l/ l5 jD617re'•
aT
Material
iP(pot
te K `rn
rjyh1s G'/ e�cprri
1 0�
IV Sr.)
i. mo
^m
(2rN2
m�
a
CO —r
N•) 8
REMARKS: fig66/ pcx/D 859, i/wei TOr3 DOW Cr" 8 %oIgo
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, Af D HAT_A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
is„ -.04
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

293967
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 # ($28)=453-0662
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
LAKE ADGER RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: PAM LAUGHTER
Address 558 LAKE ADGER RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 625-8156
Area Code Phone number
4. DATE DRILLED 03/29/04
5. TOTAL DEPTH: 345
6. DOES WELL REPLACE EXISTING WELL? YES ® NO 0
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 6 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 9
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 100 Ft. 6-1/4" SDR.21 PVC
From To Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To Ft. in _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
0 Ridge ❑ Slope ❑ Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. LEFT ON
COOPERS GAP RD. LEFT ON LAKE ADGER RD.
2ND. ROAD ON RIGHT AFTER THE BRIDGE.
0
N
cr.'?
0
N
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC PED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS AND THAT A COPY/OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
nmP , 3 - c:32 i'- v,
SIGN TURE OF PERSO CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

?93966
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
LANDRUM RD. (HWY. #14)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: GIST & JUDY FARR
Address LANRUM RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(504) — 897-6704
Area Code Phone number
4. DATE DRILLED 03/26/04
5. TOTAL DEPTH: 545
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): 100 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 15
12. CASING: Wall Thickness
Depth Diameter or Weight/FL Material
From 0 To 130 Ft. 6-1/4" SDR.21 PVC
From To Ft. _
From _____ To_Ft.
_ _
13. GROUT: Depth Material
From 0 To 20 Ft. QUIKRETE
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To _ Ft. _ in
From _ To _ Ft. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
POURED
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box) ..
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. RT. ON HWY.
#14. W MILES ON LEFT.
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.
S GNATURE OF P ON CONSTRUCTING THE WE DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

293964
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Qulity — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785 - -
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING County POLK
BISHOP LANE - LAND O'LAKES
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DAN R. SCHMIDT
Address BISHOP LANE
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(386) — 822-9857
Area Code Phone number
4. DATE DRILLED 03/17/04
5. TOTAL DEPTH: 505
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): 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 120 Ft. 6-1/4" SDR.21 PVC
From To Ft. _
From _ To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
I4.SCREEN: Depth Diameter Slot Size Material
From _ To Ft. in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
0 Ridge 0 Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) . ---
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. LEFT ON
SLIVER CREEK RD. RT. ON BISHOP LANE INTO
LAND O'LAKES. APPROX. 1 MILE ON LEFT. NEW
DRIVE UP THE HILL.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC IED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT
A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
9n SIGNATURE OF ERSON CONSTRUCTING THE 4 DATE
3— /� — UY
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

298960
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CER11hICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
HENRY RUFF RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: THOMAS WILSON
Address 868 HENRY RUFF RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 625-8162
Area Code Phone number
4. DATE DRILLED 03/18/04
5. TOTAL DEPTH: 605
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): 4 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 16.5
12. CASING: Wall Thickness
Depth Diameter or Weight/FL Material
From 0 To 100 Ft. 6-1/4" SDR21 PVC
From To Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
14.SCREEN Depth Diameter Slot Size Material
From _ To _ Ft. _ in. in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth 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
c)
CO
CD C
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. LEFT ON
COOPERS GAP RD. LEFT ON LAKE ADGER RD.
LEFT ON HENRY RUFF RD. HOUSE AT DEAD
END.
0 -0-
-o �m
o ;zm
7J .==cam
rn
r7
"rm
C.) <n z
rn
O 2
N G
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
u=

293959
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 # (S28)-453-0662
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ElG-3 j
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use G
2. WELL LOCATION: m i
Nearest Town: COLUMBUS County POLK Topographic/Land setting 1 cc
HWY. #9 S. ❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) (check appropriate box) 3. OWNER: FRANK SYLVESTER Latitude/longitude of well location
Address HWY. #9 S.
(Street or Route No.) (degrees/minutes/seconds)
COLUMBUS NC 28722 Latitude/longitude source: ❑ GPS ❑ Top`ogmphib map
City or Town State Zip Code (check box)
(—)- DEPTH
Area Code Phone number From To
4. DATE DRILLED 03/30/04
5. TOTAL DEPTH: 82 DRILLING LOG
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ® From To
7. STATIC WATER LEVEL Below Top of Casing: 62 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface* LOCATION SKETCH
*Top of casing terminated at/or below land surface requires a Show direction and distance in miles from at least
variance in accordance with 15A NCAC 2C .0118. Two State Roads or County Roads. Include the road
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE number and common names
10. WATER ZONES (depth): HWY. #9S. FROM MILL SPRING. 1 ThLE )N RT.
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 82 Ft. 24" CEMENT
From To Ft. _
Rom _ 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 62 To 82 Ft. 78M GRAVEL
From To Ft.
16. REMARKS:
PAST MCDOWELL RD.
- ▪ 0m
a rn
Hi 01
0
o
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCT hD IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPYOF
THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
r Lao � yCd iU_.L.1/� .!tier - , 3 - 3 0
SIGNATURE 0 PERSO NSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

299956
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY (.ET21'1FICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # ; (828)-453-0662
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 c5
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: co
Nearest Town: MILL SPRING County POLK Topographic/Land setting _ ,
RUFF ACRES LANE 0 Ridge ❑ Slope 0 Valley 0 Flat
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) (check appropriate box)
3. OWNER: MARGIE CASE Latitude/longitude of well location
Address RUFF ACRES LANE
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 894-8097
Area Code Phone number
4. DATE DRILLED 03/24/04
5. TOTAL DEPTH: 47
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 27 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 47 Ft. 24" CEMENT
From To Ft. _
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To Ft.
I4.SCREEN: Depth Diameter Slot Size Material
From To Ft in. in.
From _ To _ Ft _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 27 To 47 Ft. 78M GRAVEL
From _ To _ Ft.
16. REMARKS:
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ 'f bp'ogm 1iic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING ABOUT 3/4
MILE . RIGHT ON RUFF ACRES LANE. 1/10 MILE
ON RIGHT.
ZO :£ Odd Z— ddV i0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
(;irk 0_ .3 y- U /
SIG ATURE O PERSONZONSTRUCFING 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

298954
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
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ Industrial ❑ Agricultural ❑'
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ® If Other, List Use IRRIGATION r-
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK
GOLF COURSE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: WALLACE HUGHES
Address 2301 GOLF COURSE RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 7784275
Area Code Phone number
4. DATE DRILLED 03/17/04
5. TOTAL DEPTH: 81
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO EI
7. STATIC WATER LEVEL Below Top of Casing: 61 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 81 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 61 To 81 Ft. 78M GRAVEL
From To Ft.
n
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box) •
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. RT. ON
LANDRUM RD. RT. ON GOLF COURSE RD.
APPROX. 2/10 MILE ON RIGHT.
ZO :C Wd Z— ddV h0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE 0 PERS C NSTRUCTING THE WELL
t
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
298s
North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) .Tames t'r- Carpp, tv'
WELL CONTRACTOR COMPANY NAME ramp a (dial 1 & Primp !'n Tnr
CERTIFICATION # 71 I A
PHONE #$7A) d5-4_7122
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential NI/Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI N I/
Nearest To 1 SQ v i (V1 County O
lie A tr
(Street Name, Numbers, Com
ity, Subdivision, Lot No., Zip Code)
3. OWNER: ii1)GJ)1e Rko ie5
Address i // M i / l e ✓ Rd . La vt e
5tLStreet or Route No.)
Ld61/4- NC
``��'C'ityor Town State Zip Code
(7�N)- -'fiae
Area code- Phone number
4. DATE DRILLED I - I cf ` 04'
5. TOTAL DEPTH: `D O S A6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: L. 5-
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
• `Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST Lix
10. WATER ZONES (depth): `f St'D
11. DISINFECTION: Type Chl nri na
12. CASING:
Depth
From 0 To /0O
From To
From To
13. GROUT: Depth
From 0 To 20
Diameter
Ft. 6 1 / 4
Ft.
Ft.
Ft.
Amount / cup
Wall Thickness
orWeight/Ft. Material
SDR21 PVC
Material Method
N cit Cement Ha
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
Slot Size Material
in.
in.
Material
opographic/Land setting
'dge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
PEPTIC DRILLING LOG
From To Formation Description
tt /.%O
)ao tics Zriatl,,htted icfk
� o
}
_T
cFri
c G
r.
� r"o
LOCATION SKETCH
Show direction and distance in miles from Vleast
two State Roads or County Roads. Include& road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFf 1
CONSTRUCTION STANDARDS, AND THAT A.6QPY OF THIS RECORD HAS BEEN PRO)1DED TO THE WELL OWNER
4 --1g a `�
..44.4tt eA—
SIGNATURE OF PERSON CONSTRUCTING THE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
DATE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ja meS m Camp Tr CERTIFICATION# 21 R8
WELL CONTRACTOR COMPANY NAME ('amps Well $ Pump Cm Tnr PHONE #$2R) d51-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
298a3Q
1. WELL USE (Check Applicable Box): Residential V Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI ;QN w1 I
Nearest Town: TAN± Lite le ToKCounry��POIk
Lo' (4j alYerrt Rit)ey �tglit laKis
(Street Name, Numbers, Community, Subdivision, Lot No., ZipP.dQode)
1' 3. OWNER: Pete r /-C 10 h .1-
Address I'i 1 6reert_ RIl/r✓ l Hqh s
(Street or Route I9o.)
Colunthmsi NC
City or Town State Zip Code
c9�L) a.2g -5't51
Area code- Phone number
4. DATE DRILLED ) S - 6 L
an(
5. TOTAL DEPTH: /� O S _
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: ( 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 •
variance In accordancect'itb 15A NCAC 2C .0118.
9. YIELD (gpm): `z METHOD OF TEST air
10. WATER ZONES (depth): 8 D
11. DISINFECTION: Type C.h 1 nri na Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From 0 To Ft. 6 1/ 4 'Z RR..) 1
From To Ft.
From_ To Ft.
13. GROUT: Depth
Fromm_ To 2 0
From To
14. SCREEN: Depth Slot Size Material
From To in.
From To in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Material
PVC
Material Method
N ;Zt Ccmcnt
Ft.
Ft.
Diameter
Ft. in.
Ft. in.
Topographic/Lan ettin'g
❑Ridge ❑Slope alley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
PEPTE DRILLING LOG
From To Forrnaatio(1 Description
So Sccnd/ dl'r7
ho LIDS GonsoGldal} erl1
Yo[.k
c
0
J.00ATION SKETCI-U r ttri
Show direction and distance in miles from itleasf,?
two State Roads or County Roads. Include4kt ma
numbers and common road names.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THATZA COPY OF THIS RECORD HAS BEEN PROOMIDED TO THE WELL OWNER
A4-rue.._ hi . Ca�� iLll 3-12 —6 4
SIGNATWW OF PERSON CONSTRUCTING THE 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

298529
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ja mms IQ_ Ca mr Jr CERTIFICATION #71 iA
WELL CONTRACTOR COMPANY NAME t'amDI a Wa11 $ Pump Co Tnr PHONE #a7R) 4c 1_7322
ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
STATE WELL CONSTRUCTION PERMIT#
1. WELL USE (Check Applicable Box): Residential LMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION/'
Nearest Town: l v r r v10 Cot.n K° / I_
Rider i-dr.l^- Ls&ke Adger
(Street Name, Numbers, Community, Subdivision, Lot No.)Zip Code)
Topographic/Land setting
❑Ridge ❑Slope ❑Valley l lat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: J i1A1 `I A 55D c . (degrees/minutes/seconds)
Address Q O as X 1- IDS Latitude/longitude source:❑GPS❑Topographic map
(See or Roue No.) (check box)
5eArfartr u rq 5 , C ��3 a 5 DEPTHPRILLING LOG
City dTown State J r Zip Code
Area code- Phone number n n r,l
4. DATE DRILLED ( a0l
5. TOTAL DEPTH: - /) 6
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: tji 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): 5 0 METHOD OF TEST n 1 r
10. WATER ZONES (depth): %O
11. DISINFECTION: Type r h l n r i n a
12. CASING:
Depth Diameter
From p To n Ft. 6 1/
From To Ft.
From______ To Ft.
13. GROUT: Depth
From__#_ To 2 0 Ft.
Amount I c up
Wall Thickness
orWeight/Ft. Material
GDR21 PVC
Material
N at Cement
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
Hand
Slot Size Material
in.
in,
From So) �tmatjozT,e ption
3 .0 5- a/ GutM-tik
MINO
tra
LOCATION SKETCH
Show direction and distance in miles from at led
two State Roads or County Roads. Include the rCU
nu bers and common road s. al
S,t9.zAIIR
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A CQPY OF THIS RECORD HAS BE) N PROVIDED TO THE WELL OWNER
SIGNATURE OF
A,J)1e4
ERSON CONSTRUCTING THE
3-17-eq-
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. OW-1 REV. 07/2001
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298528
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James ut Camp, Jr-_ CERTIFICATION d 211R
WELL CONTRACTOR COMPANY NAME f'Amp' a WP11 R _Pimp Co 7 TnC• PHONE a(89R) d54-7322
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential IW Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION P p \ \
Nearest Town: County
ru4 t&b.- 5;3\
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: r1/(AAPit, G� s ya
Address ?sa\ Q.twA ' tr
�(S,tint or Route No.)
/vnn tJL
City or Town State Zip Code
RA)- scav( -\-1 0
Area code- Phone number
4. DATE DRILLED .1.- • al- 014
5. TOTAL DEPTH: - 1S
6. DOES WELL REPLACE EXISTING WELL? YES LtYNO ❑
7. STATIC WATER LEVEL Below Top of Casing: I FT.
(Use "r" if Above Top of Casing)
8. TOP OF CASING IS t FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): r5O METHOD OF TEST 8jr_
10. WATER ZONES (depth): 1(a ()
11. DISINFECTION: Type f' h 1 nr i n a Amount 1 �d
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
1/4 gBR21 PVC
From_q To Ft.6
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From_a_. To 20 Ft. N at Ccmcnt Hand
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
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)
DRILLING LOG
Fo�on Description
nlnl'
PEPTI(
From To
n
0 0
0
q
=o
LOCATION SKETCI-j IV ma
Show direction and distance in miles from -lease
two State Roads or County Roads. Include OTT roai
numbers • d c. • t on road names.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
3-1l. 0 LI
sioNATURE OF PERSON CONSTRUCTING THE WFI f 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

298520
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jams. ry
WELL CONTRACTOR COMPANY NAME 4' amp' R Wa11
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
Camp, Jr
CERTIFICATION M 7 1 18
R Pump Cn Tnc PHONE#E7R) LI59_7322
ASSOCIATED WQ PERMIT/
(if applicable)
1. WELL USE (Check Applicable Box): Residential D 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: ! 'till ✓ t Vl t County
5R5htih
(Street Name, N ers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MAC pKA
Address IDS Saktedo-1%ipv! Co
1,A)- Co II (sue,mitt bor aoute No)c t 66I
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED .3' 13 — D 7
5. TOTAL DEPTH: '5-0 1-7
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: Co
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated atter below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9, YIELD (gpm): 5 METOD OF TEST n i r
10. WATER ZONES (depth): 4- ' D
11. DISINFECTION: Type ('h l nr i n a Amount I/,a cup
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From___p__To IIC Ft.6 1/4- SDR21 PVC
From To Ft.
From. To Ft.
13. GROUT: Depth Material Method
From__o To 20 Et. N at Cement Hand
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Lan setting
Midge ❑Slope alley ❑Flat
(check appropnate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DEPTH j>RILLING LOG
From To Formation Description
n I I S dirt, c et
III, Soy Ceiti Dlidattd rotk.
LOCATION SKETC$
Show direction and distance in miles front at 1eas3
two State Roads or County Roads. Include the rciaS
numbers and common road names.
r
6v
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
�Q.47I. 4 u)- C.4
SIGNATURE OF PERSON CONS�'RUCT�I0 THE WELL
3-1s--DPI
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

From: Carolina Well Drillers, Inc To: NC Deot cf Env. and Na Resour
Date: 3/10/2004 Time: 7:13:10 PM Pace 3 of 5
298169.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quzlity - 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) (e applicable) _
1. WELL USE (Check Applicable Box): Residential E Municipal ❑ Industrial Agieultural ❑ 1: ,it7z '_.
Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Otter, List Use
r- WELL LOCATION. '-opographic!LPnd setting
Nearest town: L.\KL LURE County POLK ❑'. c u Slope ❑Valle'; 1''....
PINE RIDGE SUB LOT 4 , , aToideKonirlirade of well lcc_ ion
(Street Name, Numbers, Community, Subdivision. Lot No,. Zip Code) 35.24.216 i 87.09.7888
i. OWNER RIDGELFNF DEVELOPMENT CORP. (degieehninutesrsmou5=)
ADDRESS 112 COLPLUMCIRCLE Latitudedongitude source: ❑ GPS ❑ ` eco,TapL c nor
(s-:r.or Font: Nod DEPTH Dar._llbriLrI
ROYAL PALM BEACH FL 33411 From To Focrat.n DP 27111" 21-1
City or Toni State Zip Code 0 30 Clap
561-798-2729 30 390 Corer/dared Roza:
Area Code- Phone NMI
4. DATE. DRILLED
s. TOTAL DEPTH
1:04
6. DOES WELL REPLACE EX:STL\G `BELL?
7. STATIC WAIGR LEVEL Belau Top ofCaeirr_:
YES ❑ NO El
75 FT.
e. TOP OF CASING IS
'Top of easing terminated ao'or
accordance with 15A NCA,
iric+" If Abave Top of Caung)
7 FT. Above Land Surface*
ace land :LL face regdw a vaeanec m
9. YIELD (gpm): 8 6:ETHOD OF TEST ARDM
to. WATER ZONES (dery 3S0
u. DISINFECTION: TYPE HtPOCHLORiTE Amount 10 Oz
12. CASING: Wall Thickness
Depth - Diarr:eter or Weight/FL Material
From 0 To 36 Ft 61!4" SDR21 PVC
li. GROUT:
Depth Materai Method
From 0 To 10 GRAVEL MIX GRAVITY
14. SCREEN
Depth
From NA To
D:antwer
Itt.
Slot Size Material
15. SAW/GRAVEL PACK:
Depth Size Material
From NA To F'1,
IG. RESIARRS:
m
1— — G
LOCATION SKETCH — Cirri
'lC
Show direeccn rind distance in miles from at'ea,t. —in
0
two State Roads or County Roach. Inel,de in._ roams ,-,1
numbers and common road names. CO rncisi
z � • n
ti
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2
o p
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I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IV ACCORDANCE WISH ITA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
2.113704
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
OW -I RT.V u'�

297966
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 ICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Z Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other List Use
2. WELL LOCATION:
Nearest Town: TRYON
PENIEL RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: HUBERT MCENTYRE
Address PENIEL RD.
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(828) — 894-8853
Area Code Phone number
4. DATE DRILLED 02/23/04
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 7.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 180 Ft. 6-1/4" SDR21 PVC
From To Ft. _
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. RT. ON
PENIEL RD. APPROX. 5 MILES ON RT. (ACROSS
FROM BOX #3344)
0
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I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC I ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
--/- a. f4, a - a 3 - o
SIG2IATURL OF PERSON CONSTRUCTING WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

297864
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 9 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
SILVER RIDGE RD.-LOT #22
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: PHILLIP DRESSENDOFER
Address SILVER RIDGE RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(8) - 894-6136
Area Code Phone number
4. DATE DRILLED 02/13/04
5. TOTAL DEPTH: 385
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO EZ
7. STATIC WATER LEVEL Below Top of Casing: 140 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 9.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 140 Ft. 6-1/4" SDR.21 PVC
From To Ft. _
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft.OUIKRETE POURED
From To _ Ft.
14.SCREEN: Depth
From _ To
From To
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Diameter Slot Size
Ft. _ in.
FL in. in.
16. REMARKS:
Material
in.
Topographic/Land setting
❑ Ridge ❑ Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. LEFT ON
SILVER CREEK RD. CROSS GREEN RIVER THEN
RIGHY ON LAKE ADGER RD. GO APPROX. 1/4
MILE THEN LEFT ON NORTH HIGHLANDS RD.
TAKE FIRST RIGHT ONTO SILVER RIDGE RD.
4/10 MILE ON LEFT. LOT #22.
O
3
a.
N
co
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS UCTION STANDARDS, AND A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
(7i—t'
0 SI OF PERSON C UTR CT� DATE - d e/
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

29 9F0
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
RIXHAVEN-LOT 373
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BILL KEMPER
Address RIXHAVEN
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(164) — 234-9434
Area Code Phone number
4. DATE DRILLED 02/19/04
5. TOTAL DEPTH: 705
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): 2 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CRLORYTE Amount 19.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 150 Ft. 6-1/4" SDR.21 PVC
From To Ft. _
From To _ Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft.ODIKRETE POURED
From To Ft.
I4.SCREEN: Depth Diameter Slot Size Material
From _ To Ft. _ in. _ in.
From _ To Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To _ Ft. _
From To Ft.
16. REMARKS:
Topographic/Land setting
0 Ridge 0 Slope 0 Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 W. FROM COLUMBUS. RT. ON
HOWARD GAP RD. RT. AT STOP SIGN & CROSS
OVER 1-26. LEFT INTO RIXHAVEN. 1-1/2 MILES
ON RT.
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I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTJ.I4TION STANDARDS, AND THAT A COPY Olj THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
TGNATLLRE PERSON ON�� � DATE
o cx9- � 9 - O)/
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERIIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
BISHOP LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DEAN TOLZMAN
Address 386 BISHOP LANE
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 698-9331
Area Code Phone number
4. DATE DRILLED 02/09/04
5. TOTAL DEPTH: 245
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 12 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 6
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. 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
HWY. #9 N. FROM MILL SPRING. LEFT ON
SILVER CREEK RD. GO TO LAND 0 LAKES. 1ST
ENTRANCE. TURN RIGHT ON BISHOP LANE.
NEW DRIVE 3/10 MILE ON RIGHT.
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I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
COjSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE dFERSONONSTRUCTING TI WELL DATE ` (, V
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONS1'RUCTION RECORD
North 1 al o.u1.l - Gcp40117ent rr Ern ironincnt and Natural Rcsuwccs - Div n or Water Quality - Groundwater Section
tt F111 I)♦1It. tC lek 1 I\UIv1U1 AI.!\ %%1F.(print/__ 1��( ,13
��«-`-�- i-�l>� _.... CFPTIFIf.A7117h(a���(��JCC_/J��
•
N t.� `, =ill!- 1 .3
. .L�11st'Q PHONE M �Z.� Zz
It tII \ti.I I.( U V'. I lit ( lip \1'10011in.- _ J
_.. __...._.'1S.SOCI:\'I"V:U\\ PF.RMI'rp __
nt upl`Lcehler Q __.. _....__.___
__ .- � t.raFPL:ablel
1\ .LI SE ii Ii k \p plicabl. Lioxl. Residential Sturlcipal'i 'ublic ❑ Industrial ❑ A ricultural 0
oat IIn;; C: Recovers' O Hcat Ptr-.np Water Injection O (lthm 0 I( Gthvr. Lisi List
SS H.L. LOCAT
Nea:cot Town Dj \ram �� ��C 7upugrap n:Land setuf;g
�_ -L�. L� ('our,lyy-% o ❑Ridge s 0Valley ''OFlat
1 CC.1- . ^t�t•lti_ Zp ln_ ;check Jftl'ttrrolloNu,
.S ;t' \,:roc. \d-rhtrs. (or"nr,'r'y, Subdl vii ton. Lot M� t Code r
alitudc'longuude ofwell location
LI.I (t tkt(Il1R(. t l\IPA\\ \.t'U-fiepapSIt((1AS I t
x '.richer
J, DAlt DRILL L ED_�.--
TOTAL DEPT}t'_ '
DC)l:S WELL REPLACE EJ(1S1lNG WELL.' YES 0 NO
' ST AI IC WATER LEVIiL Re1ow Top of Casing: in _FT . --'__ _
11 ILlc"•" r Abosa cop of( &sing)
F.. TOP' Or' CASING IS L F'r. Above Land Surface• _.__..-.—
•Thp of casing Ierminated atfor below land surlier rtqutres a-----------
rariancc to accordance with 15.A \('AC 2C .0110. /1
YIELD !cprni: .—..J.._._..__. METHOD OF TEST _ t. (riii—ibi )
'U. WA TER. ?ONES (depth):_._,— --
298696
I tlegrece nu r,..'a.seconde�
Lulilud: 1 nt:dude soul. - DGE'SOTopegrephtc map
neck box)
DEFT ! DEILLINC LOG
From Tn Fnrntali on Description
tt ____ _ _ _ LOC'ATJQN SKETCH
! I DISINFECTION. Type Ai1\Q.. _ Amount jr --_- Show direction and distance in miles liu:n at least
12 C:\S:NG- \Val! Thickness two State Road; or Counly Roads. Include the roe d
�1
Depth / N D:ameter or W'e:uhl Ft 4laten;d numhers add common roar .:iaaJmes.
From 0 _ "rn VP,' l F; u I O O
i'rom ..__._ 'I o _ Ft.
_ -'�j
D. pth
rnnn To FI -1- t. 0 p
1 SC kl FN i.. tr Diatn rer S.vSic Mat r-1 ��y 6 cceQ
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✓
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arn
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i(' RI\I IkKs': — �'L
N2
te rrt
! I)O Ht Rh lei lEIt11rY THAT THIS WELL WAS Ct )NSTRI.CIED IN ACCORDA\( E WT[hl isA-NCA(' 2C. WELL N -1
l l),\S FRI VIT KOS. � D THA'T,A COr\' OF }HIS RECuRD HAS FLEE\ PROVIDED TO'IHE W ELL OWNEWT o
c- 2•2_0_0 I Z
1 S ,\\t):URA \'EL PACK: _.
U-r�i Sze Materla)
Frurr it. Fi
SI(INA-Witt (JI- rtl(SOT ( O'\STItLCTI,.G 7HL' WF'.LL DA1L
Submit the original to the Dis ision or Water QuaIiI , Ground, &ter Section. 1b36 Mail Sentcr ("enter - Raleigh. 1(:
27644-Io3b Phone \o. (919i 733-3221, within 30 data.
CAV-I REV. 07.2(10i

TDiapigter or Ft. t numbers and common road names,
Ft. a , 1 Y�' Mi.5 Oen Aa09-/-mil
Ft.
4p0- //o'fW% we // 7. =
De th �J t al et od
De /47Ft. T % %
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
4`05 n7
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nat 1 urc s - D sion of Water Quality - Groundwater Sectio
WELL CONTRACTOR (INDIVIDUAL) NAME (print ¢ , - 'lret/i /1 CERTIFIC' TION
WELL CONIRACTOR COMPANY NAME DJ Pre PHONE
STATE WELL CONSTRUCTION PERNIITN
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public cii' Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
3.
4
5
6
7
Nearest T ;f
d
(Street Name, N nfo, Community, Subdivipe*sion Lot No., Zip Code)
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
OWNER: �Ireptlettal
� �� C.� (degrees/minutes/seconds)
Address' S ttZ11X% Latitude/longitude source:❑GPS❑Topographic map
(Street or RoNo) (check box)
DEPTH DRILLING LOG
Oreenvtl LQ 54 2gllo01
iN or Town State Zip Code
fit)-1d'Ia -U('SD
DATE DRILLED / c D l
Area code- Phone number
TOTAL DEPTH:
%oao cfale d L�
DOES WELL REPLACE EXISTING WELL? YES ❑.DIG
STATIC WATER LEVEL Below Top of Casing:/ FT.
( Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires
variance in accordapp v 15A NCAC 2C .0118.
9. YIELD (gpm): / METHOD 0 TES
10.WATERZONES(depth): abp ao0, 3 O,435
14- 5 o, 1,7 S J
11. DISINFECTION: Type if[ /I Amount 1 ��1J.
12, CASING: Wall Thickness
Depth'
From 0 To /
From To
From To Ft.
13. GROUT:
From 0 To
From
/ yo loop
leer
Fo /alio' Des. ieti'.n
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
ire/
£�frie Z of 6�fip� S
To Ft. /
Slot Size Material Gte 5UQ-d/» O
Ft. in. in. F'
14. SCREEN: Depth Diameter
From To
C
From To Ft. in. in. �:°
73 en
t o<
03 t o
✓c
't7 ri
-1 �m
Z
N ma
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL al
CTh4d
STRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
l# 'Tes/. *'; r 7a7 " filled 8 7, , /PRP " 15-,04
^O�TRIjj1�! THE WELL DATE
.�
Submit the original o the Division of Voter Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 ['hone No. [phone], within 30 days. GW-1 REV. 07/2001
0
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1051237
North Carolina - Department of Environment and N
WELL CONTRACTOR (INDIVIDUAL) NAME (p7jrtt)
WELL CONTRACTOR COMPANY NAME 1/1
WELL CONSTRUCTION RECORD
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
297918
r
S A 7)
eso r es - ivision,o�ff �Water Quality - G SA
ataatteeerr Section
{
CE
» Z�/!/Ci PHONEf#IF(i'11 /r Z
ASSOCIATED WQ PERMIT#
(if applicable)
WELL USE (Check Applicable Box): Residential ❑ Municipal/Public Iir<clustrial ❑ Agricultural ❑
Nionitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI
Near -t Town: V v_/' oun
3.
Address in `1 rri Q no) s ciAik 2,no
Street of Routd H4)'1
CIity n nw, N� 21-f1toI
City or Tow Start
(Street Nan/umbers, JbeCommunity , ubJivtsion, Lot
JNo.,, Zip Code
DWNERq^".4/1/ fA/5 0
Zip Code
814)-to(19- `i11,50
Area code- Phone number
4. DATE DRILLED
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)
DRILLING LOG
Formation Description
DEPTH
From To
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING L? Y ❑ NO 0---"-----
7. STATIC WATER LEVEL Below Top of Casing: / 77 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
variance in accordan vith 15A NCAC 2C .0118.
9. YIELD (gpm):�_ M -T D OF-ST
10. WATER ZONES (depth):
11. DISINFECTION: Type /S// Amount
12. CASING: Wall Thickness
Dept n Di er or ,�yh7�Ft. ate ial
From To %_S Ft. y i .ja"
From To Ft. \. _
From To Ft it D 4t eJi 0
hud 6
Me AlY_•7
-IX'illiNnownne
13. GROUT Top / UyS ytvi�e / /I NeelFrom To/� F %L� �✓✓L/C� ft//Q/)75 L�eeK F//f
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
1/&)0/l5 JegTed 47
om To Ft.
14. SCREEN: Depth Diameter Slot Size Material -r— O
From To Ft. in. in. - 3 o �
From To Ft. in. in. cm
15. SAND/GRAVEL PACK: I t.-n
CJ
Depth Size Material -;n
y o
From To Ft. n,
c
From To Ft _.
3 =
C11
LL rWAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
�HA77��PY- -THIS RECORD HAS BELL PROVIDED TO Ci THWELL�WNERS
16. REMARKS
1 DO HEREBY CERTIFY THAT THIS W
CONSTRUCTIOI 3)[AN DARD
AND
SIGNATURE OF PERSON CONSTRUCTING THE \V
LL
DATE
—1
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

297919
iwvs 1)3 I
No th Carolina Department of Environment and N. ralfsou
WELL CONTRACTOR (INDIVIDUAL) NAME (prjnt
W'ELI. CONTRACTOR COMPANY NAME 7/(J
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
WELL CONSTRUCTION RECORD
P��Yse
a Mes'vision of Quality - round1water ction e
/, PHONE /4N TId
ASSOCIATED WQ PERMIT'S
(if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOC.ATI / C
Nearest Town: J
Pa (rrme Y P-o del
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER m/hf/9� .�8t^iQ4L L Owe
Address S f� r L11 SirGee t✓ 'rt. 200
(Street or Route o.)
CreenOat c[.
CountyfPlk
City or Town State Zip Code
( )- 1.,ei - u(050
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: it (C? N5/
6. DOES WELL REPLACE EXISTING W L? YES 0 NCI ❑'
7. STATIC WATER LEVEL Below Top of Casing: /0/ FT.
(Use "+" i f 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 _ �f.
variance in accorda we stth IS METHOD OFNCAC 2C aTE a(
9. YIELD (gp ):� _
10. WATER ZONES (depth): 3Uf) _ost)
11. DISINFECTION: Type
12
CASING:
From
From
From
D
13. GROUT: Depth `%
From To !( Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
0 0
LOCATION SKETCH S 9m
Amount Show direction and distance in miles from; leagc>
Wall Thickness two State Roads or County Roads. Include the rt>
numbers and common road names. W >0
Dc th Di er or f j�lF[- eJi �rn
To ��7 Ft. ( .//.I�( / z
To Ft.
To Ft.
/ %�- d Pj
� z
//ci eel
16. REMARKS:
AAil( Sprint
Prtn, prvje`
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, DTHAT A OPTHIS. ORD HAS B EN,aROVIDED TO THE WELL OWNER
L/SIGN PTUREv1OOF PERSON CONSTRUCTING THEWELLDATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 da)s. GW-I REV. 07/2001

2. WELL Town: •. y / j)
Neare.��sTown: / � � Count n
•net hid Crepes ,undlvts!co
(Street Name, umbers. Community, Subdivision, Lot No., Zip Code)
3. OWNER: /// u/'c9T 1—fin9,165 (�/6�\
(Street or Route No.)
Address Ilrl rn nlo9 +. c‘cti}e, 9-oo
4/a5W7
WELL CONSTRUCTION RECORD
914
North Carolina - Department of Environment and N r �1(1 esou s -}J( /J�issiion of Wa er Quality - Groundwater Section /)
WELL CONTRACTOR (INDIVIDUAL) NAME (pri t / ,� / ` `� � PHECERTIFICATION (/
\\'EI.L CON1 R:\CTOR COMPANY NAME [ — ��* 85
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential 0 Municipal/Public L7 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
S1
GreentT t9_ pu,
City or Town Stale Zip Code
( )-
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTI$IG WELL? Y ❑ 0 ®'
7. STATIC WATER LEVEL Below Top of Casin�.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ax FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires
variance in accordan wi h ISA NCAC 2C .0118. I/2
9. YIELD (gpm): THOD O aj�j ST
10.WATERZONES(depth): p�d7D� p1QQ�
I I. DISINFECTION: Type
12. CASING:
De t Di er
From To Ft.
From To Ft.
From To Ft.
13. GROUT:hDepth
From v To
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To
From
ount
Wall Thickness
or / t. qIe
Topographic/Land setting
DRidge ❑Slope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
cr)al �y �,rye
Ft O Methgd
/ //eap1 P
Slot Size Material
in.
i11.
Size Material
Ft.
To Ft.
DEPTH
From To
tin
.7A1 A
4,3fl
Ifli r!�%s:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
3 '°m
Cm
1 C l
CJm
T+c
-0 -i ce
m
3 am
N
N m�
16. REMARKS: /9hibd/ t15P T97Jde To/noon 6 te2/,a ro . 1 DO HEREBY CERTIFY THAT THIS WELL \VAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION ST RDS, AND\' A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
a
�,
SIC,
�r15 Ida 1/ lS
� J, Air ;
Its°x0' -me
T
�f pJ eC
0101
leer kJ) 011/4107-P4
ATURE 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. (919) 733-322I, within 30 days. GW-I REV. 07/2001

299413
North Carolina - Deparunent of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) TamAs (sr Camp, Jr CERTIFICATIONN 21 "I8
WELL CONTRACTOR COMPANY NAME Lamp' s Wn11 R. Pomp Cr) Tyr PHONE if$S2R1 451 —7372 __..
STATE WELL CONSTRUCTION PERMIT?! ASSOCIATED WQ PERMITN
(ifapplicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 1 Municipal/Public 0 industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
WELL CONSTRUCTION RECORD
2. WELL LOCAT).QN:-
Nearest TownYCI t County I O1 K
1—D7` R;'ler )'b'et k v d s
(Street Name, Numbers, Community, Subdivision, Lot NO, Zip Code)
3. OWNER: 0. ke 11 gUI I Ide✓t
Address POR D X 5-4- 9
(Sneer or Route No.)
Lvre (N C AS 746
City or Town Stare Zip Code
O
Area code- Phone number
4. DATE DRILLED 7" —15
5. TOTAL DEPTH: 3 D 5-
6. DOES WFI I REPLACE EXISTING WELL? YES. 0 NO
7. STATIC WATER LEVEL Below Top of Casing: LC
(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
ryariance In accordance with 15A NCAC IC .0118.
9. YIELD (gpm): ao METHOD OF TEST air
10. WATER ZONES (depth): / 5
11. DISINFECTION: Type r h 1 n r i TIP
12. CASING:
Depth Diameter
From_a____ To 9 5 Ft. 6 1/ 4
From To Ft.
From To Ft.
Amount I Gap
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
13. GROUT: Depth Material Method
FrortL0_To 20 FL Neat Cement Hand
' From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Slot Size Material
in
in.
16. REMARKS:
Topogpfhic/Land setting
❑Ridge fl'Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(del/Trees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
99-- dirt
415" 305 lbns1lida'I-ed yak
0
0
LOCATION SKETCI-j
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRIR tiD IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A )PY OF THIS RECORD HAS BEEN PROVIID TO THE WELL OWNER
t
et:/k lfl— /A)
SIGNATURE AF PERSON CONSTRUCTING THE
�-14 -0S
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME tamp' s talal l R Pnmr Cc( Jnr
299407
CERTIFICATION if 21 3 fi
PHONE # 7R) Il53-7322
STATE WELL CONSTRUCTION PERMITM ASSOCIATED WQ PERMITq
(if applicable)
(ifapplieable)
1. WELL USE (Check Applicable Box): Residential V MunicipaUPublie ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI N: '/
Nearest Town: Atie Pea vc e CountyffPo I K
J-o± /Oq Gre en gt vet Iticitf vv
(Stint Name, Numbers, Community, Subdivision-1Lo( No., Zip Code)
3. OWNER: Da uc Pearce
Address GiL 4�tt s-r. 11-it '7
Sweet or Route No.)
&nil& Sus.
Try or own Stare -
tare Zip Code
T
-9b9-04o2i{
Area code- Phone number
4. DATE DRILLED % -2.'04
5. TOTAL DEPTH: 370
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: Sri
(Use "+" if Above Top of Casing)
8, TOP OF CASING IS 1 FT. Above Land Surfaces
'Top of easing terminated actor below land surface requires a
'varianee In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /00 METHOD OF TEST a 1
10. WATER ZONES (depth):
TopophicJLaad setting
❑Ridge IUSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑OPS❑Topographic map
(check box)
DRILLING LOG
Fqr Jmation Description --- --
el
dvin oli cla e4 Keck
DEPTIj
From To
144' A7r
11. DISINFECTION: Type is h 1 nr i n a Amount i Cct/)
,12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From__ To _Ft.6 1/4 SDR21
From To Ft.
From To Ft.
13. GROUT: Depth
From_p_ To 2 0
Ft.
Material
Neat Cement
From To Ft.
14. SCREEN: Depth Diameter Slot Size . Material
Frorn To Ft in. in
From To Ft, in. in,
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Material
PVC
Method
Iland
16. REMARKS:
L
J.00ATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the' ad
numbers and common road names.
JGH
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A CJPY OF THIS RECORD HAS BEEN PROVIID D TO THE WELL OWNER
SIGNATURE PERSON CONSTRUCTING THE W tILL" /� DATE
VVVVVV ✓... ,
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