Ru Cy2004

303562
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James m Catnn Tr CERTIFICATION # 21 4A
WELL CONTRACTOR COMPANY NAME Camps a Wel 1 R Piimp Co • Tnn PHONE #t7A) d5i_7122
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box); ResidentialtrMunicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATiOMA
Nearest Town: G L1
County { jh44Itn„)
(Sweet Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 4 M�Q
Address ) t 3 rt . �yK e KritiC k y $t
�,tre ou{p NcJ I ! 7 ,3
City Town State N Zip Code
Area cods Phone numbyy,, n
4. DATE DRILLED LI .cI, 01-1
5. TOTAL DEPTH: b S
6. DOES WELL REPLACE EXISTING WELL? YES] NO 0
7. STATIC WATER LEVEL Below Top of Casing: 3 FT.
(Use '4•' if Above Top of Casing)
8. TOP OF CASING IS i FT. Above Land Surfaces
`Top of casing terminated at/or below land surface requires a
variance in accordaeee with 15A NCAC 2C .011a.
9. YIELD (gpm): OU THO OF TEST D it
•10. WATER ZONES (depth): V�(J
11. DISINFECTION: Type rh 1 nri na Amount C.LA..ie
12. CASING:
Dep
From_ To.
From To Ft,
From To Ft.
13. GROUT: Depth Material
From p To 2 0 Ft.
Wall Thiclmess
Diameter or Weight/Ft. Material
Ft. 6 1 / 4
SDA21 PVC
Neat Ccmcnt
From To Ft. _
Method
Ha
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 trap
(check box)
DEPTH DRILLING J,O(i
Fra600escription
From T d
`„Ln 3 t7 g
LOCATION SKETclJ
Show direction and distance in miles from at leash
two State Roads or County Roads. Include the roa8
• r` an4 dead Dames.
num
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OTHIS RECORD HAS EEN PPROVIDED TO THE WELL OWNER
( L
444 led
1
SIGNATURE OF PERSt3N 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

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James car, Ca alp r Tr CERTIFICATION # 7 1 R 8
WELL CONTRACTOR COMPANY NAME Camp' S Wp11 R Primp_ ('n T n r PHONE #$7f3 451_7l22
STATE WELL CONSTRUCTION PERMIT$ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential B" Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT ON
Nearest Town: Wyk \u.0 County ci
(Street Name, Numbers, Community, Subdivision, Lot No., Zip
-Code)
s
j. OWNER: . AJt Ratrit.4,1&.
Address /r),..h S oift /J. Ye 1tt.tc-Ky St
(Street or Route .)
N / 3 / n6J 7
�Il
State Zip Code
Area code- Phone numbeh
4. DATE DRILLED "1•
5. TOTAL DEPTH. (p () ?
6. DOES WELL REPLACE EXISTING WELL? YEA p NO
7. STATIC WATER LEVEL Below Top of Casing: (( ))
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
`Top of cuing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 1C .0118.
9. YIELD(gpm): 5 MEIpp9FTEST kir
10. WATER ZONES (depth): bb �8 t
City or wo
UL'
11. DISINFECTION: Type rhl nrin P.
12. CASING:
Depth
Fromm_ To I u
From To
From To
13. GROUT: Depth
From_ To 2 0 Ft.
From To Ft.
Diameter
Ft.6 1/4
Ft.
Ft.
Amount
Wall Thickness
or Weight/Ft. Material
W9R21 PVC
Material Method
Neat Ccmcnt IIand
14. SCREEN: Depth Diareter
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
121 dge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box
DEPTH DRILLING LOG
From ' i gioADelpVion
flo tpu-s
vi
LOCATION SKETCIj
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
t,)
tosl
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 BEEN PROVIDED TO THE WELL OWNER
ayme _
SIGNATURE OF PERSO CONSTRUCTING THE WELL
Pi
l� 'is-D'
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

DCI) 'awn
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) N NfE (print) Jame Camp, J r - CERTIFICATION # 71 R R
WELL CONTRACTOR COMPANY NAME f'amp' c Wp11 R Pnmp Cn T n c PHONE #$7R) dS4-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial Cl Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELLLOCAT
Neare '('own:
County (?AZ
�&r 7`�n' tit J
(Sire Name, Numbers, C&nmunity, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
Nike- D; bed ie.5 �i -f RXP �✓,
(Street :,Route No.)
ol� /Ar6 'iA 30094
City or Town State Code
Zip
Area code- Phone numb Q ,` rr
4. DATE DRILLED 4
5. TOTAL DEPTH: MS
6. DOES WELL REPLACE EXISTING WELL? YE raj O
7. STATIC WATER LEVEL Below Top of Casing: 1( t/ FT.
(Use 'v." if Above Top of Casing)
8. TOP OF' CASING IS 1 FT. Above Land Surface*
'Top of casing terminated atlor below land surface requires ■
" • variance In accordgase with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST air
10. WATER ZONES (depth): bb
11. DISINFECTION: Type rh 1 nr i np Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From p ToyE 1 Ft.6 1 / 4 SDP.21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth
From O To 2 0 Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in in
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft
Material
Neat Cement
Method
Ha
Topographic/Land setting
Midge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILT.ING I.or
From�w nST� j?esgriptijyq
S `l G g s cit-clVtt.-A
J.00ATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the r
numbers and common road names.
01.0,
,&"
044)
16. REMARKS•
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCI LD IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS I.EEN PROVIDED TO THE WELL OWNER
5U
SIGNATURE OF PER$ CONSTRUCTING THE WELL ! DATE
2
N op
c.o.• )
C. n
Submit 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) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: BOSTIC
PEA RIDGE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JAMES MOODY
Address PEA RIDGE RD.
(Street or RouteNo.)
BOSTIC NC 28018
City or Town State Zip Code
(704) — 560-4007
Area Code Phone number
4. DATE DRILLED 10/06/04
5. TOTAL DEPTH: 67
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WA1ER LEVEL Below Top of Casing: 47 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 67 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 47 To 67 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
BUS. 74 E. FROM FOREST CITY. LEFT ON
BOSTIC/SUNSHINE. LEFT ON PEA RIDGE RD. IN
BOSTIC. LAST LOT ON RT. BEFORE ROBINSON
CREEK RD.
CD
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
SIGNATL OF 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
(17i"DlD / //) r - U

303848
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) 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: FOREST CITY
NEW JERUSALEM CH. RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: HARRY WALTON
Address 321 NEW JERUSALEM CH. RD.
(Street or Route No.)
FOREST CITY NC
City or Town State
(828) — 245-3151
Area Code Phone number
4. DATE DRILLED 10/08/04
5. TOTAL DEPTH: 50
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 35 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 6.9
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 50 Ft. 24" CEMENT
From _ To _ Ft. _
From _ To _ Ft. _
13. GROUT: Depth Material
From 0 To 20 Ft. CEMENT
From To _ Ft
14.SCREEN. Depth Diameter
From To
From To Ft
15. SAND/GRAVEL PACK:
Depth Size
From 35 To 50 Ft. 78M
From _ To _ Ft. _
Method
POURED
Slot Size Material
in. _ in.
in.
Material
GRAVEL
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
28043 Latitude/longitude source: ❑ GPS 0 Topographic map
Tap Code (check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #221 FROM RUTHERFORDTON. LEFT ON
NEW JERUSALEM CHURCH RD. (APPROX..3
MILES PAST HARRIS/HENRIETTA RD.) NEW
DRIVE APPROX..4 MILES ON LEFT IN FIELD.
(NEW DRIVE)
(I?
wGn....
N
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WELL
CON UUCTION STANDARDS,
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
9�iERSeV
� �* i�[/Q % 2 ,
IGNA O O ONSTRUCTING 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

303847
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Z Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: UNION MILLS
PINE TREE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JASON HOUSER
Address PINE TREE RD.
(Street or Route No.)
UNION MILLS NC 28167
City or Town State Zip Code
8(28) - 289-5888
Area Code Phone number
4. DATE DRILLED 10/12/04
5. TOTAL DEPTH: 57
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IZ
7. STATIC WATER LEVEL Below Top of Casing: 37 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 57 Ft. 24" CEMENT
From _ To _ Ft. _
From _ To _ Ft. _
13. GROUT: Depth Material
From 0 To 20 Ft. CEMENT
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _To_Ft_ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 37 To 57 Ft. 78M GRAVEL
From_ To_Ft. _
Method
POURED
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #221 N. FROM RUTHERFORDTON. RIGHT
ON HUDLOW RD. LEFT ON CONEY ISLAND RD.
RIGHT ON PINE TREE RD. LOT ON LEFT.
t or
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CON UCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAASBEEN PROVIDED TO THE WELL OWNER
rte,rss'
AN
A F PEC /'LAt
CING THE WELL 'rtD� //';
Submit 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

3038Q5
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 N Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: LAKE LURE
CHETAN WAY -LOT #14
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: DAVE MATTHEWS
Address CHETAN WAY
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
H8228) — 625-1190
Area Code Phone number
4. DATE DRILLED 10/01/04
5. TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO N
7. STATIC WATER LEVEL Below Top of Casing: 160 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
Zip Code)
11. DISINFECTION: Type CHLORYTE Amount 4.5
12. CASING: Wall Thickness
Depth Diameter or Weight/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. QUIICRETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ FL _ in. _ in.
From _ To _ FL _ in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From _ To _ Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #64/74A W. FROM RUTHERFORDTON.
RT. ON BILL'S CREEK RD. LEFT ON BUFFALO
SHOALS RD. RT. ON BUFFALO CREEK RD. RT. ON
YOUNGS MTN. RT. INTO BUFFALO CLIFFS ON
TATANKA TRAIL, RT. ON CHETAN WAY. LOT #14
ON RT. (ai DEAD END.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TIJAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/c-/` o7'
SIC IATUR't OF PERSO ONSTR CTING efr9--
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

zfsf
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quelity — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERPIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® MunicipaUPublic 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: RUTHERFORDTON
WILLOW LAKES -LOT #9
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JIM STILL
Address WILLOW LAKES
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
8(28) — 287-6860
Area Code Phone number
4. DATE DRILLED 10/20/04
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 245 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): 1/2 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 16.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 85 Ft 6-1/4" SDR21 PVC
From _ To _
From _To_Ft.
_ _
13. GROUT: Depth Material
From 0 To 20 Ft. QU KRETE
From _ To _ Ft
14.SCREEN: Depth Diameter
From _To_Ft.
_
From _To_Ft.
_
15. SAND/GRAVEL PACK:
Depth Size Material
Method
POURED
Slot Size Material
in. _ in.
in. in.
From _To_Ft
From To Ft
16. REMARKS:
Topographic/Land setting
❑ Ridge 0 Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 W. FROM RUTHERFORDTON. RT.
INTO WILLOW LAKES. LEFT AT CROSSROAD.
LOT AT DEAD END.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
l� eA6N TUR�� PE�Er�t—lf'/l_ /�!� /C t3 F()"
SI A OF SON 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

o
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERf1FICATION # 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 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: CLIFFSIDE County RUTH
OLD MILLS FARM LANE -LOT #22
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MIKE SHEW
Address OLD MILLS FARM LANE
(Street or Route No.)
CLIFFSIDE NC 28024
City or Town State Zip Code
(828) — 245-6357
Area Code Phone number
4. DATE DRILLED 10/26/04
5. TOTAL DEPTH: 285
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): 60 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 6.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 80 Ft 6-1/4" SDR.21 PVC
From To Ft. _
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft
16. REMARKS:
Topographic/Land setting
❑ Ridge 0 Slope 0 Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
BUS. 74 E. FROM ELLENBORO. RIGHT ON
HWY. #120. RIGHT INTO CLIFFSIDE ESTATES ON
SQUIRREL HOLLOW DR. RIGHT ON
SWEETWATER LANE. RIGHT ON HAZEL HURST.
TAKE THE NEXT RIGHT ONTO OLD MILLS FARM
LANE. LAST HOUSE ON RIGHT.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFI I
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
c- , D� '��j',� En--f o-_ /A -2 6 c CNA PERSONUCTIN� 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

WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Z MunicipallPublic ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: CLIFFSIDE County RUTH
OLD MILLS FARM LANE -LOT #23
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MACKIE LAWSON
Address OLD MILLS FARM LANE
(Street or Route No.)
CLIFFSIDE NC 28024
City or Town State Zip Code
(828) — 245-4070
Area Code Phone number
4. DATE DRILLED 10/26/04
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): 30 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To 70 Ft
From _ To _ Ft
From To _ Ft
13. GROUT: Depth
From 0 To 20 Ft
From To Ft
CHLORYTE Amount 7.5
Wall Thickness
Diameter or Weight/Ft Material
6-1/4" SDR.21 PVC
Material
. OUIKRETE
Method
POURED
14.SCREEN: Depth Diameter Slot Size Material
From To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To
From To Ft
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
BUS. 74 K FROM ELLENBORO. RIGHT ON
HWY. #120. RIGHT INTO CLIFFSIDE ESTATES ON
SQUIRREL HOLLOW DR. RIGHT ON
SWEETWATER LANE. RIGHT ON HAZEL HURST.
TAKE THE NEXT RIGHT ONTO OLD MILLS FARM
LANE. NEXT TO LAST HOUSE ON RIGHT. =-
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIONSTANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SI t 'A OF PERSON CONSTRUCTIN 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

ozs
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 ® MunicipalRublic ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
DARLINGTON RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: RICK HENSON
Address 1098 DARLINGTON RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
8(28) — 247-0376
Area Code Phone number
4. DATE DRILLED 10/28/04
5. TOTAL DEPTH: 365
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): 3 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 9.5
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. QU1'KRETE POURED
From _ To _ FI.
14.SCREEN: Depth Diameter Slot Size Material
in.
in.
From _ To _ Ft. _ in. _
From _ To _ Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #221 N. FROM RU IHP,RFORDTON. LEFT
ON DARLINGTON RD. RIGHT ON DRIVE AT
HOUSE #1100/1098.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
t1
SIG OF PERSON
,,s0- i 1?')— .,
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

303833
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: CASAR
JOHN QUEEN RD.
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: TIM COLE
Address 160 JOHN QUEEN RD.
(Street or Route No.)
CASAR NC 28020
City or Town State Zip Code
7(04) - 538-8697
Area Code Phone number
4. DATE DRILLED 10/12/04
5. TOTAL DEPTH: 185
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 60 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
, Zip Code)
11. DISINFECTION: Type CHLORYTE Amount 3.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 60 FL 6-1/4" SDR.21 PVC
From To Ft. _
From ^ To _ Ft.
13. GROUT: Depth Material Method
From <0 To 20 Ft. QUIRRETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft _ in. _ in.
From To _ Ft _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #226 N. FROM POLKVILLE. RIGHT ON
MORIAH SCHOOL RD. LEFT ON JOHN QUEEN RD.
1ST DRIVE ON RIGHT.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS UCTION STANDARDS, AND THAT A COOPPYQF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Fe J,rle'>`(fi+t-�lJTH
[17MG7J AO -A-2 0
S NATURE OF P RSON 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

From: Scott 8 Jo Ann To: Division of Water Quality
Date: 10/7/2004 Time: 10:25:08 PM Page 5 of 5
303118
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDU Al°NAME (print) SCUFF 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 Heal Pump Water lnjection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: FOREST CITY County RUTHERFORD
345 LEE RD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER WILKINS HOME CENTER
ADDRESS 1920 HWY 74A BYPASS
(Street or Route No.)
FOREST CITY NC
City or Town State
828-286-3647
Area Code - Phone Number
4. DATE DRILLED 9/15/04
5. TOTAL DEPTH 280
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing:
28043
Zip Code
YES ❑ NO ID
15 FE
(use "+" If Above Top of Casing)
8. TOP OF CASING IS 2 F7. Above Land Surface"
"Top Greasing terminated at/or below land inane regnbes a variance in
accordance with 15A NCAC 2C.0118
Topographic/Land setting
❑ Ridge 0 Slope 0 Valley ® Flat
Latitude/Longitude of well location
35.23.365 / 81.53.016
(degees/minutes/seconds)
Latitude/longitude source: ® GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 60 Clay
60 280 Consolidated Rock
9. YIELD (gpm): 5 METHOD OF TEST ARDM
10. WATER ZONES (depth): 250
ii. DISINFECTION: TYPE HYPOCHLORITE Amount 12 oa 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 74 Ft. 6 1/4 " SDR 21 PVC numbers and common road names. St,"
13. GROUT: O c_c
rs G
Depth Material Method fTrr'..
From 0 To 20 Ft. GRAVEL MIX GRAVITY 0 V3m
14. SCREEN I 7iQ
Depth Diameter Slot Size Material CO
om
From NA To Ft in. in. m+
a �'it-
15. SAND/GRAVl7. PACK:
O
Depth Size Material Pa i6
From NA To Ft. Cia NQ
tenCm"1
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND'FHAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
10/1 /04
Date
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section. 1636 Mail Service center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001

From: Scott & Jo Ann To: Division of Water Quality
Date: 10/7/2004 Time: 10:25:08 PM Page 4 of 5
30311??
(if applicable)
1. WELL USE (Check Applicable Box): Residential Ej
Recovery 0 Heat Pump Water Injection 0
2. WELL LOCATION:
Nearest town: LAKE LURE Conroy RUTHERFORD
LOT 55, COZY LANE, PEAKS AT LAKE LURE SUBDIVISION
(StreetName,Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER RIDGELINE DEVELOPMENT CORP.
ADDRESS 112 COCOPLUM CIRCLE.
(Strctl or Route No.)
ROYAL PALM BEACH
city u Towel
561-798-2729
Area Code - Phone Number
4. DATE DRILLED 9/11/04
FL
State
5. TOTAL DEPTH 180
6. DOES WEI3. REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(rise v- If Above. lop of Casutp)
8. TOP OF CASING IS 2 FT. Above Land Surface*
•Top of sump laminated Wor below land surface requires a variance in
accordance with 15A NCAC 2C.0118
v. YIELD (gran): 12 METHOD OF TEST ARDM
lo. WATER ZONES (depth): 170
11. DISINFECTION: TYPE
12. CASING:
33411
Zip Code
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)
Municipal ❑ Industrial 0 Agricultural ❑ Monitoring 0
Other 0 If Other, List Use:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley X❑ Flat
Latitude/Longitude of well location
35.24.475 / 82.10.736
(degrees/minutes/seconds)
Latitude/longitude source: ® GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 35 Clay
35 180 Consolidated Rock
Depth
From 0 To 45
13. GROUT:
HYPOCHLORITE Atnolmt 8
Wall Thickness
Diatnete or Weight/Ft Material
Ft 61/4" SDR21 PVC
Depth
From 0 To 20 Ft.
14. SCREEN
From
Depth
NA To
15. SAND/GRAVEL, PACK:
Depth
From NA To
16. REMARKS:
Ft.
Ft,
or
Diameter
Material Method
GRAVEL MIX GRAVITY
Slot Size Material
in.
Size Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road ; -
numbers and common road names. o C_,tc
o mI"
0 x-C
--I -orT1
1 p=
CO --IC7
rctrn
O....,
PZit
en
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.
10/1/04
Date
SIGN A Il1RE OF PERSON CONS 'Mlle! 'ING 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-I REV. 07/2001

From: Scott & Jo Ann To: Division of Water Quality
Date 10/7/2004 Time: 10.25:08 PM Page 3 of 5
303116
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 0 Municipal ❑ . Industrial 0 Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION: Topographic/Land setting
Nearest town: RUTHERFORDTON County RUTHERFORD ❑ Ridge 0 Slope 0 Valley ® Flat
112 BENNICK DR
(Street Name, Numbers, Community, Subdivision, Lot No, Zip Code)
3. OWNER HORTON HOME OF RUTHERFORDTON
ADDRESS 342 HWY 74 BYPASS
(So-ctt or Romc No.)
RUTHERFORDTON NC
City or Town State
828-287-3366
Area Code - Phone Number
4. DATE DRILLED 9/2/04
5. TOTAL DITTH 560
6. DOES WELL REPLACE EXISTING WELL
7. STATIC WATER LEVEI. Below Top of Casing:
28139
Zip Code
YES ❑ NO ID
500 FT.
(Use "a" If Above Top of Casio 1
8. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing lmnonied aoor below land surface minis es a vadmee br
accordance wide 15A NCAC 2C.0118
9. YIELD (gpm): 0 METHOD OF TEST ARDM
10. WATER ZONES (depth): NA
Latitude/Longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: El GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 80 Clay
80 560 Consolidated Rock
It DISINFECTION: TYPE HYPOCHLORITE Amount 6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 93 Ft- 6 1/4 " SDR 21 PVC
13. GROUT:
Depth
From 0 To 20 Ft.
14. SCREEN
oz
Material Method
GRAVEL MIX GRAVITY
Depth Diameter Slot Size Material
From NA To FI. in. in.
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.
15. SAND/GRAVEL PACK:
Depth Size Material
From NA To Ft.
16. REMARKs: DEEMED DRY WELL
PINEY KNOB
BENNICK
DR
200 YDS
3/8 lvf
CARPENTER RD
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.
10/1/04
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Dale
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001

From: Scott Gantt To: DENR Date: 1120/2004 Time: 10:20:28 AM
30458
Page 3 of 4
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 (Cheek Applicable Box) : Residential © Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: BOSTIC County RUTHF.RFORD
140 TONY RD BOSTIC
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER HORTON HOME OF RUTHERFORDTON
ADDRESS 342 HWY 74 BYPASS
(Street or Route No.)
RUTHERFORDTON
City or Town
828-287-3366
NC
State
Area Code - Phone Number
4. DATE DRILLED 10/18/04
5. TOTAL DEPTH 400
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing:
28139
Zip Code
YES ❑ NO El
70 FT.
(Use "+" If Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing totmmatcd at/or below land surface requires a vaiancc in
accordance with 15A NCAC 2C.0118
9. YIELD (gpm): 3 METHOD OF TEST ARDM
10. WAlLAt ZONES (depth): 350
Topogaphic/Land setting
❑ Ridge ❑ Slope ❑ Valley ® Flat
Latitude/Longitude of well location
35.27.712 / 81.48.571
(degrees/minutes/seconds)
Latitude/longitude source: ® GPS ❑ Topographic map
DEPTH
From To
DRILLING LOG
Formation Description
0 40 Clay
40 400
Consolidated Rock
DISINFECTION: TYPE HYPOCHLORITE Amount 15
12. CASING:
Depth
From 0 To
13. GROUT:
04
Wall Thickness
Diameter or Weight/Ft Material
50 FL 61/4" SDR21 PVC
Depth
From 0 To 20 Ft.
14. SCREEN
Depth Diameter Slot Size
From NA To Ft. in.
15. SAND/GRAVEL PACK:
Depth Sizc
From NA To Ft,
Material Method
GRAVEL MIX GRAVITY
16. REMARKS:
IR
Material
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. Cc'H
i h
�d
G —or"
N —
N oQ
f,-ant'
720
J'3
O rn
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
11/1/04
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-I REV. 07/2001

From: Scott Gantt To: DENR Date: 11/20/2004 Time: 10:20:28 AM
Page 1 of j.-5
304584
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GANTT CERTIFICATION # 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT #
(if applicable)
1. WELL USE (Check Applicable Box) : Residential
Recovery ❑ Heat Pump Water Injection ❑
2. WELL LOCATION:
Nearest town: RUTHERFORDTON
110 AUSTIN CIRCLE
ASSOCIATED WQ PERMIT#
(if applicable)
Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Other ❑ If Other, List Use:
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision Lot No.. Zip Code)
3. OWNER HORTON HOME OF RUTHERFORDTON
ADDRESS 342 HWY 74 BYPASS
(Socat or Route No.)
RUTHERFORDTON
City or Town
828-287-3366
NC
State
Area Code - Phone Number
4. DATE DRILLED 10/27/04
5. TOTAL DEPTH 200
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing:
YES ❑ NO
45 FI'.
(Us<"*" If Above Top of Casing)
s. TOP OF CASING IS 2 FT. Above Land Surface"
'Top of casing tearfvsated at/or below lad surface spores a vaiau< in
accordance with 15A NCAC 2C.0118
9. YIELD (gpm): 10 METHOD OF TEST ARDM
10. WATER ZONES (depth): 180
it. DISINFECTION: TYPE HYPOCHLORITE Amount 8
28139
Zip Code
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley El Flat
Latitude/Longitude of well location
35.26.080 / 82.02.093
(degrees/minutes/seconds)
LatitudeLongitude source: 0 GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 70 Clay
70 200 Consolidated Rock
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 80 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. .
Size
Ft,
Slot Size Material
in
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
;I.077
LO
—'ice
tTt�
2QocC
our)
0
Q`
--40
rt
C797-t
717
0 O
Ca 0
Fri
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.
11/1/04
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-I 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) I ames '•t- C a'"r. J r CERTIFICATION II 21 i8
WELL CONTRACTOR COMPANY NAME Camp' c Wal11 & Bumf, Cn T n r- PHONE e8%A) AS1_7322
STATE WELL CONSTRUCTION PERMIT* ASSOCIATED WQ PERMIT*
(if applicable)
(if applicable)
30486,8
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery O Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOt Turf�T'NN()-4)19it County WINIA
AUrr(- ttaaY
(Saint N Numbers, Comm .-S�ub�t No.. Zip Coda)
3. OWNER: fire k Ctk0i_
Address •c i&c 10l0
�t�-�- (steer or Row No.) O 1p
city or Town Sure 2ip Code
Ana Cede- Pboae number
4. DATE DRILLED L l 1 4 LAS. TOTAL DEPTH: Lk l�� i v YES 0 NO
6. DOES WELL REPLACE EXISTING WF1
7. STATIC WATER LEVEL Below Top of Casing: U b Ff.
(Use'*" If Above Top of Caries)
8. TOP OF CASING IS FT. Above Land Surface*
"Top of eu W terminated et/or below land surface requires a
' valance le ucerdeec with ISA NCAC 2C .On1L
9. YIELD (gpm): S Mt>T1i9D OF TEST air
10. WATER ZONES (depth). 55 000
11. DISINFECTION: Type rh1 nri na
12. CASING:
Depth'�'' f`•� Diameter
Froni_p— Tom= Ft. 4.
Amount
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
From_____ To Ft
From To Ft.
13. GROUT: Depth Material
Fromp To_-34_FL gloat Cement
From______ To Ft.
14. SCREEN: Depth Diameter
From To Fi. in.
From To Ft. in
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft
Method
Hand
Slot Size Materiel
in.
in.
Topographic/Land setting
Midge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(deancelmieuwfaeconds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DRILLING LOG
on Description
From To
n lid
�t "4 11 S Cumuli
LOCATION SKETQi
Show direction and distance in miles from at leant
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 I SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 9Q THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
�iS . CaM y . ;i--/<)-triq
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-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) Tames r.r Camp, Jr CERTIFICATION* 8
WELL CONTRACTOR COMPANY NAME Pamp' a Well & Pump (`G Trr- PHONE 11PRl-4CA-7222
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 ❑ If Other, List Use
2. WELL LOCATI
Nearest Tow}
CilKl)L !)pii AA Fp ., t
(Snore Name. Numbers, Community, Sub4rWoa. Lot No., Zip Code)
j � '1
3. OWNER: L{). &A 1-71.1i_CY5
Addresss Q © 11 c, t-(
llv' \ (Street or Route C )
ALA
City or Town Siam
cuniailaszi
jg
DPI.
Area code- Phone number
4. DATE DRILLED 1 • Qs; . Lc
5. TOTAL DEPTH: 3 R
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ci,
7. STATIC WATER LEVEL Below Top of Casing: 1 0 FT.
(Use Ntr if Above Top of Cuing)
B. TOP OF CASINO IS FT. Above Land Surface*
`Top of cuing terminated aior below land surface requires
variance la acceraaqAe with 1SA NCAC 2C .0119.
9. YIELD (gpm): S METHOD OF TEST
10. WATER ZONES (depth)' ?l cal
D
11. DISINFECTION: Type Ch 1 r,r 4 nc+ Amount L.0
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From_g_To E Ft.j/.4- aDR21
From To Ft
From To Ft.
13. GROUT: Depth Material Method
From_0___ To_20 Ft N—e. at-Gefitcnt 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
Material
PVC
Topographic/Land setting
!Midge ❑Slope 0Ya11ey ❑Flat
(cheek approp ' box)
Latitude/longitude of well location
(degneslmioutewacconds)
Latitude/longitude source:❑OPS❑Topographic nap
(cheek lox)
DEPTLI DRILLING LOCI
From To do De Lion
16. REMARKS:
LOCATION SKETCI(
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road tames.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
ana(' 11 -
SIGNATURE OF P
At
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 90 days. OW-1 REV. 07/2001

3l48.54
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION s .1 T a
WELL corrrRACroR(INDtvIDUAL)NAME (prim)lamas Cav`{', 7r- Rl �S't_7�22
WELL CONTRACTOR COMPANY NAME f'' amy a Wall R. Pomp C Tnr' PRONE $$2
STATE WELL CONSTRUCTION PERMITSASSOCIATED WQ PERMIT/(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential 83' 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\ON
N0a4z$ Town:
AO)) J�{
(Stow( Name. Nurbilya, Community, Subdivision Lot No.. Zip Code)
County (?. -tL k-q't ti
3. OWNER: A m- d /? 1
Address U l. A {y,Y/� � 9<.+J
(sewer Rouse No.)
y 1C Cayce/ Town Zip Code
(,a i Sr u \ - � � S
�] () �
Area coda- Pam/ [lumbar,
DATE DRILLED`
5. TOTAL DEPTH: :S U
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO a
7. STATIC WATER LEVEL Below Top of Casing: L\ () FT.
(Use 140' if Above Top of Cuing)
8. TOP OF CASING IS , t FT. Above Land Surface'
'Top of cuing termAated Wu below And surface requires a
' variance A aceordaace wtb ISA NCAC 2C .0116.
9. YIELD (gpm): 5 0 METHOD OF TEST n i r
10. WATER ZONES (depth): al O
11. DISINFECTION: Type ch 1 nr i n s Amount a
12. CASING: Wall Thickness
or Weight/Ft. Material
From p ToLi _ Ft, 6 1 / 4 SDR3-1 PVC
From To Ft
From To Ft.
13. GROUT: Depth Material
From_p To__24._Ft. Neat Content
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
Froin To Ft in.
15. SAND/GRAVEL PACK:
Depth Sire
Froth_ To Ft.
From To Ft
Depth Diameter
16. REMARKS -
Slot Size
in.
in.
Material
Topographic/Land setting
ittltdge °Slope °Valley DElat
(ebeolt appropriate box)
Latitude/longitude of well location
(degreulminuw/eseoada)
Latitude/longitude source:DOPP$D opographic map
(check box)
NTH pRILLTNG LOG
From To F,pnoagon Description
C/b CA.Jf
qb -OS (hnnud-'J
'
P`
© col)
2.
G -o`n
Pa
LOCATION SI ETCFL rn(2
Show direction and distance in miles from at kali
�;
r�-)
two State Roads or County Roads. Include the ad :?c�
numbers and common road names. -. o
-t
Aas
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH LSANCAC 2C. WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0{THIS RECORD HAS SEEN PROVIDED TOTHEWELL OWNER tt*1€ ( fin. fi-6`!l
CONSTRUCTING THE WELL / DATE
SIGNATURE OF P
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Pboae No. [phone], within 30 days. OW-1 REV. 07/2001

304853
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (priat) Jam as la__ Camp. Tr_
WELL CONTRACTOR COMPANY NAME ramp' c Wal 1 R Pilule L'n • Tnr
STATE WELL CONSTRUCTION PERMITd OCIATED WQ PERMITS
(if applicable) (if applicable)
CERTIFICATION N ) 1 1 8
PHONE e$7SR d 51.-'7322
1. WELL USE (Check Applicable Box): Residential()" Municipal/Public b Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION
Nearest Town:
(Street Nutt, N Don((,��Cotttmtmity, Subdivision, Ld No., Zip Coda)
3. OWNER: \A\pJ CC
Cotmty ______
Address 0 In t C
(Sae( or Rota No.)
VO4rn-t6 .rt- 11 V3
City Tow, Stun Zip Code
Ana code- Pitons number
4. DATE DRILLED 10 .a l • fi L�
5. TOTAL DEPTH: 1 11 S .
6. DOES WELL REPLACE EXISTING WELL? VS, ❑ N0 Dk
7. STATIC WATER LEVEL Below Top of Casing: .7 FT.
(Use 'Y" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Abovo Land Surfaces
'Top of edag terminated actor below lard surface nquires a
-variance la accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST air
10. WATER ZONES (depth): (":
11. DISINFECTION: Type rh1 nri ma Amount
12. CASING: WallThiclmess
Depth Diameter orWoigWlFt. Material
Froay_(L__To FL1.4 SDP21 PVC
From To Ft
From To Ft.
13. GROUT: Depth Material Method
From.._o_To_,Zg_Ft. Neat 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
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Vailcy ❑Flat
(check appropriate box)
Latitude/longitude of well location
(daandminuteahccoads)
Latitude/longitude source:❑GPS❑Topographic trap
(check boa)
DEPTH DRILLING J.On
From q 5 FFormationt Dekiriptlon
as -7 as cn.l(,Aa
J ()CATION IKETCld
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
w
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
cAPN
GNA RE °PIERSON CONSTRUCTING THE WELL
iV 1�09
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. OW-1 REV. 07/2001

f04842
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
James
WELL CONTRACTOR COMPANY NAME tamp' c Wc+11
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
Camp-, Jr CERTIFICATION# 7118
& ➢nm0 CrL,
ASSOCIATED WQ PERMIT#
Of applicable)
Tnr• PHONE #$7R) d5l-7322
1. WELL USE (Check Applicable Box): Residential 1iV'Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIQN:
Nearest Town:
(Street Name, Numbers, Community,Subdlvisiog,Lot No., Zip Code)
3. OWNER: Y' Ci
s
'
Address LSt l b 1.
(Suet[lx or /C Route No.)
City or Town State
Zip Code
Area code- Phone number
4. DATE DRILLED I . 0 Q L\
5. TOTAL DEPTH. C _
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ch.
7. STATIC WATER LEVEL Below Top of Casing: \ 0 ) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
• *Top of casing terminated at/or below land surface requires a
•variance in accordance with ISA NCAC 2C .0118.
9, YIELD (gpm): '.l METHOD OF TEST Sir
10. WATER ZONES (depth): 3 (o 6
11. DISINFECTION: Type ('h 1 nr i n P Amount Cite
12. CASING: Wall Thickness
Depth Diameter orWeight/Ft. Material
From____ To 2_Ft. 6 1/4 SDR21 PVC
From To Ft.
Fromm To Ft.
13. GROUT: Depth Material Method
From1-0-_To 20 Ft. Ncut Cement Hand
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From. To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From, To Ft.
From To Ft.
16. REMARKS:
_Topographic/Land setting
Midge ❑Slope ❑Valley ❑Flat
(cheek appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To otmatioRt De ripgQn
A
'43 Se S (MAItC
LOCATION SKETCH / L7
Show direction and distance in miles from at leas
two State Roads or County Roads. Include the rp d
numbers and common road names.
wolutio
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
GNATURE Ot)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-1 REV. 07/2001

WET T�i
North C :o:ina - Deaart:nent ofEnvironment :-. ..
CTION RECORD
30480
al Resod^^es - Division of Water Quality - Croundwater Section
WELL CONTR'aCT_O? (LN!DIY`..DLALI NAME (_o ��..—"'_._..'.'.'PIT r- Tr'
WELL CON PLACID =C:M?ANY :L�:. r�.-:'4_F. ' : rn rn
CERTD: ICATION 4 71 P R
!HONES 2Rl 4S1 7_322
STATE WELL CONSTRUCTION PERM"'# ASSOCIATED WQ PERYIZ '4
(if spoicab:e) • (if applicable)
IIIIIIIIIIMERMEIVEIt1. WELL USE (Check Applicable Sex) -,; ,entia_ 7.. Mar' rxi/Public CA Industrial 0 cc
Monitoring Re:o-•e-v C Kea ' c:„. ter Injer.ion _. Other ❑ If Other, _: U>e
2. WELL LOCATION
Nearest Tovm:U
U 1,A) C y `' o vv&
(Sine( Nzne, Ttroer,anm: S'ut Z -,
3.OWNER: 4f(LS
Address i .Z C 3 Ott Cl/ A�
(S¢eet or Ro-re No,)
ID —r tiNteh
City or Tewn Sate
( i-
Area code- Phone number
4. DATE DRILLED •7-l. U L�
5. TOTAL DEPTH: S 0
6. DOES WELL IDaS.T.11,1.0V
7. STATIC YSALEVEL Below TO of ...
31��3
1 .Topog:aphic✓Land setting
6CtLdge GSlope QVaBev 7Flat
Latin ng ;re of v_ . `acation
(degreeslminu.evseconds)
Latitude/longitude source COPSCTopographic map
DEPTH _ __ _ ."NG LOG
From 4 ';c - an De ription_.
`() 5oS
8. TOP OF CASING IS 1 FT ..c _ . - Lan:: sar`ace*
`Top of cuing iermLnat>c :stk. below land sari'sce requires a
r.rxnce ii.r.h.r.se with NCAC 7.0
lO.WATER ZnN d
CATION SKETCH
Show diectie;:..end distance in miles from at least
two State, Roads or County Roads. ln: rde the road
nt:rriers ar.i common 7oadoad na'es.
11. DISINFECTION: Type r b 1 n,- 4 Amour.;
12. CASINO: Wan Thicic:er.
Diameter
rrom• n cit 't=�_1_c_ -- -24
Prom To ..
From To _t.
13. GROtJ7 Depth iY;rv:
From :;=—�_--•---,''=.�G:
From
14. SCREEN: Depth Diameter
From
From To Ft.
15. SAND/GRAVEL PACK:
- From To Ft.
From '."n Ft.
Me tho,t
16. REIN/LARKS:
IDOHEREBY CE.'"_rYirIA.T c-..`,'31t+ _ ::T.RLC'..L.;. t\ACCOPDANCE 13ANC'02C,W.:.-
CONST-RIB:c10N J'i PVDt...a, AND THAT ' 201 7. 'al' T,'."RECORD HAS EENP' a?DED TO _..'rYE.::.., OWNER
SIGNATL.;. _._ PJ?_,C
C^NS.7.- :C'.'INC T:$ WELL
4 =4
Submit the origi . to the Division of Water }, C'-He'_ ;;,water Section, 1636 s,; Service CeFfet' - 2 iel4 NC
27699-1636 Phone No. (919) tT3-322 t, with!: (' oat,. Ta 7/-1 REV. C7/2001

3(0 48
WELL C SI-RUCTION T L
North Carolina - Oep,ra .nt o. Enrro.:ment and Nabzra_ Resources - Division of Wa'^r ('na.ity - Groundwater Section
WELL CONTRACTOR(LNDIV`D'JAL` N.A:.IE Corim` ramp - CE_RT:FICATION# 21 %,,3
WELL CONTRACTCP. CO:"ANY NAME f'a-rnt c r & D'Jmp rc.. Tnc
STATE WELL CONSTRUCTION PF,RRMllT#
Cif zpn..__c'e`
a g2H2-.. _ 7322
ASSCCIATED WQ P '' RAIIT# -"
(if applicable)
1. WELL, USE(Check A^_p icae Box): Residential ..'•aaicinai.JPcolic ❑ .._,,._.. __ '. ❑ Agricultural
Monitoring 0 Recovery 0 Heat Pump Water _r eotien a Other 0 If Other, List Use
2. WELL L OCATIOIIi:
Nearest ": owls
J�1A aA
(Sneer Nw:.e, '"_m
3. OWNER:
Adc-ess
route No.
Town t Qyt./IN
City or Tow
_etNe., Zip _ .ia)
Zip Cc J.e
( Area code- Phone norrber 1 n
4. DATE DRILLED I 0 02-0 "' L
5. TOTAL DEPTH: 1p 0 s
6. DOES WELL R?LAC: X:SI'NG WELL? YES T
7. STATIC WATER LEVEL Below Top cf Casir.p: 10 (Z_FT.
Use i.`Abov, Cat_:..;;
8. TOP OF CASINO IS 1 Fm. Fl.nr, :: . id Surface*
' 'Top of ter-.'nsced rlor be:ow:v. e arzx^ req.'
-variance's„ rc ewl .::.ChC J11',d.
9. YIELD (Rpm): lvILTHOD OE "'EST
10. WATER ZONES (death): 5L7 b
11. DISINFECTION: Type r'.. r n
12. CASING:
Dept ^,lain. er
Frotr, n To la C Ft. 6 i/
Amount Ll `t
'+aP_'; `--.;::vies^
or Weight/I .
S)E^ ^ C—
From_ To Ft.
SRC
13. vn� .: 2Dena Mete_ ='
From o To a n
From To
14. SCREEN: Depth Diarcet:: ct Siz
From To n.
From To _ .. .._.
15. SAND/CRAVEL
Depth Size Material
• From To Ft.
From To
16. R=*ft.RK
Topographic/Land setting
Madge OSlope a/alley °Flat
(check appropriate box)
Latitade/iongihide of well location .
(deg: ,es/minutes/second'
La' ^,d&iong: 7..:rce:CGPSC opcgraphic sap
(oheok box)
DR'L',ING LOG
07jf1$don Diej.s jlption
DEPTH
From
u
L CATION SKETCH
Show direction ::rid distance in miles from at least
two Late Roads ar County Roads. Include the road
numbers and uawoad narnes.
I DO HEREBY CERTIFY THAT THIS WELL WAS CO: S?..UCTED '_'.v' ACCORDANCE W,TH :5A NCAC 2C WELL
CONSTRUCTION NDAR.DS, AND THAT A CO: THIS RECORD HAS BEEN P.- IYIDED TO THE WELL C'WNER
.`0'.:TRLCTINGTILE WELL
ILlg. OLf
DATE
Submit the original to the Division of Water Quality, G c tnewater Section, 1636 Mail Service Center -Sleigh, NC
27699-1636 Phone No. [phone],withL•i3Cr..;,;s. - GW-1 REV. 07/2001

WET L CONSTRUCTION RECO2 D
North Carolina. - Department o£Environrrent Ord Natural Resources - Division of Water Creality - Cc. ..:cv+z*.es Section
484
WELL CONTRACTOR (INDIVIDUAL) NAME 'print)
TaTea -n7 r'.:mp, JL.
WELL CONTRACTOR CC'MPANY NAME c `v,F"
STATE WELL C.C,NSTRUCTION PERMIT# _
(if app?icable)
CERTIFICATION' u i 1 1 R
m r'n Tnr' PRONE If 9l4S3-7.322
SSOCIATED WQ PEP-MIT.4
(if applie ble,
1. WELL USE (Check Applicable Box): ResidentiL W Mw:ici_oa:,': ublic 0 Industrial 0 Agricultural 0
Monitoring C Recovery 0 :-:eat Pump Water Injection 0. Other. 0 If Other, List Use
2. WELL LOCATlp`N'
Nearest ,1-09 :1.{jKA `AAAA
JAACLL
(Stttet Name, Numbers, Community, lNe„, <:p Code)
3. OWNER:
Address i 1 i 4
nounty.
�LXFAA
VU'A It
Aid .n f 4.
ZAAJl;�1A�Y.�. „4Route
e ,.
(C2t) iY or &6 1 r a $ Zip Code
Area code- Phone number
4. DATE DRILLED 10- ky. oLl
5. TOTAL DEPTH: ) h S
6. DOES WELL REPLACE EXISTING WELL? Y . 0 NO A
7. ST.ATIC WATER T LEVEL ?elowTop of Casing: 0 FT
(list :.+"'fAbove Toss of Cn
8. TOP Or CASINO IS FT. Above Lana Surface"
*Top of easing terminated at/or below lane surface rewires a
-variance In accord:, •e with 1JANCAC,C °]L.
9. YIELD (gpm): a (1 METHOD OF TEST„
10. WATER ZONES (depth): 1.56
11. DIS2C.f'_._ -: 'T e '_..1 r.,- -
12. CASING:
Depth
Fromm To
From_
'Diameter
l
_. _.;c zziess
or Weight/Ft. Materia'.
cDF I. PVC
From To Ft.
13. GROUT: Depth Matei.ia1 Method
From C Te 20 Nc.z=en`_ ._end
From To Ft.
14. SCREEN: Depth ..in`neter Skit ".,... K:itte.-ia1
Fro:-. -. F+_.. in. _.
From To Ft. .. .. ...
15. SAND/GRAVELPACK:
Depth S;2c `vtatera'..
From To Ft.
From To Ft.
o&aPhic/L. sett:ag
❑Ridge 0S1ope 'Walley ❑Flat
(check appropriate box)
Latitude/longittide of well location
(degrtes/minutesi:ronds;
La' `aiJionii.Mde source:E0PS0Topographic map -.
(check box)
DRII,LING LOG
FRrme�tiPz{ Descriptt' or_ I
\`�.tli �XALt fAM+-7
DEPTH
From To
n Ug
yg 10 S
..CATION SKET. C i
SSow direct_L _ c Stancer. tm..es from at least
two State Roads I aunty Roads... the
numbers and commoad names.
16. REMARKS:
IDOHEREBY CERTIFY THAT MIS WELL WAS CONSTL CTED IN ATCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS SEES PROVIDED TO THE WEI L OWNER
kin
SIGN flT E
i4—\g-0y
SON CONSTRUCTINGTHE n.-vLL DATE
Submit the or g t . to the Division of Water Qt.ali y, oundwater Section, "575 Medi Service Center -Raleigh, NC
27699-16361''a0t No. (919) "39-3ew:i,'wIthia 30 rays. GWC REV. 07/2001
(.0
-o
etV

z048
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jame S hi— Camp, Tr- CERTIFICATION # 21 3fl
WELL CONTRACTOR COMPANY NAME Camps G Ldn11 & Pnmp Cry Tn(-• PHONE #$7R) d51-7122
STATE WELL CONSTRUCTION PERMITS _ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential I Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATTTTTT4O �y
NeasettTJo i l County . l t rYX?v.
(Street Name, Numbe s ^Communityjubdivision, Lot No., Zip Code) `'�i ° �'
3. OWNER: Pi) k
Address k i N 1
Street or Routc No.)
F(iw21 (31-1 yv C :25<ot1 3
City or Towo Q State Zip Code
Area code- Phone number
4. DATE DRIJ I Fr) I n tB • 0 t1
5. TOTAL DEPTH: IVO 6
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IY
7. STATIC WATER LEVEL Below Top of Casing: tj[7 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 aceordanfe with 15A NCAC 2C .0118.
9. YIELD (gpm): I METHOD OF TEST Aix
10. WATER ZONES (depth): 2.60
11. DISINFECTION: Type rh 1 n r i n a
12. CASING:
Depth Diameter
From# To__1 Ft. 6 1 / 4
From To Ft
From To Ft
13. GROUT: Depth
From___ To 20 Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From— To Ft
Amount
Wall Thickness
or Weight/Ft. Material
EDR,1 PVC
Material
Method
N at Cement Hand
Slot Sizc Material
in.
in.
16. REMARKS:
•
Topogr9pphic/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
Fromo Formatipn Desipt on
n 1 Q lln.C- arn�V lCa
Al
&41 fActiA--h
c
ars
n
�Q
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.
-9
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 PERVN 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
retol
-c) cc:i::

North Carob:.:: - Depa neat c:f
CONSTRUCTION RECORD
nv':mew; arc. ..:vti Resourr_s - Division of Water ?cual.iy • Groundwater Section
WELL CONTRACTOR (LNDIVL.:CAL)'-:.ME (prin) T2 m2�` "d
WELL CONTPACTOR COMPANY Neal,
STATE WELL CCSS T JCTION TZ'riiT#
(if applicable',
mD, J"-
CERTIFICATION # 2 1 i R
( 'n' R 'n'mr fan Tn,r' PHONE #>k7Rl C5'1_7322
SIESZIP
ASSOCIATED WQ PERMIT#
(if a-.licabie)
1. WELL USE (Check Applicable ;; :).: Residential 8' M':.aicipaVPublic O Industrial O Agricultural ❑
Monitoring ❑ Recovery 72 c -,at Pump Water Injection O Ocher O If Other, List Use
2. WELL LOCATION:
Neest Tow .:
hA.(
(Street Name, Numbers,
3. OWNER: ‘'o-N 4
Address P 5
Toy 7•gr'aphic/Land setting
Cs-= ' T DRidge DSiope DValley OF1at
(check appropriate box)
Comma";.y, Su"1ivisio , Let No., Zip Code)
Cc: orRoute No.)
\,l U�. ;;1 fl 9
_ "or, "r;wn Sate Zip Code
A reecode- Phone num;cr
4. DA"'c =' *:D (0• 1C4• O IV
5. TOTAL DEPTH' 3 b 5 _
6. DOES :i n REPLACE EXISTING WELL? YES f_ NO
7. STATIC WATER LEVEL Below Top of Casing: 5 0
(Ise "t" if Above Top of Casirpj
8. TOP OF CASING IS i FT..ti seve Land Surface
' *Top of casing terminated atlor below :and surface requires a
-variance in accordance with 13A
9. YIELD (phi): S METHOD OF TEST 7% r
10. WATER ZONES (depth): -L U
11. DISINFECTION: Type Ch
12. CASING: V(a2. Thicla:ess
Depth Diameter or Wc.g ort.
From To 40 Ft. g
From Ft
From To
13. GROUT: Dept_
From_0_,_ To a 0
From To
14. SCREEN: Depth
From To
From To
15. SAND/QP.AVE.r PACK:
Depth
To Ft.
From
From
16. REMARKS:
Ft.
Material
t
_...'i..reter Slot Size
Ft. in
Size
n.
Material
i.+thod
HarFr
vLate:ial
Latitudzilongitiide of well location
(d .roeshinuteslsecoad4)
Latitude/longitore source:OGPSOTopographic map
(check box)
;DRILLING LOG
FozmatiotpDet,
PF.PTN
From To
n
4 0_
d o , .cos Ut.41 UlAtn,t
LOCriTION S ETCH
Show direction and distance in =1es from at least
two State Roads or County Roads. Include the road
numbers ld common road names.
1 DO HEREBYCERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY Q� T1i:S RECCE: EAS BEEN P C'VIDED TO THE WELL OWNER.
NE
4PLI i v 4-41 t y2 r l— r " 0,j 7-
- IGNAT T .. OF PERSON CO_.•ST"UC NQ THE WILL DATE
Submit the oival to the Division of Water
r.'gQuality, Groundwater Section, 1636 Mail Service Center - Raleigh,NC
27699-1636 Phac,e No. )19) 733.3221, withir 7..0 days. GW-1 REV. 07/2001
;,Orn
(nr.rt
L.)
O
0

(142-6
305005
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
COVE SPRINGS RD.
(Street Name, Numbers, Community, Subdi
3. OWNER GEORGE RHODES
Address COVE SPRINGS RD.
(Street or RouteNo.)
RUTHERFORDTON N C 28139
City or Town State Zip Code
8(28) — 286-8090
Area Code Phone number
4. DATE DRILLED 11/01/04
5. TOTAL DEPTH: 58
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 43 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface;
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County RUTH
sion, Lot No., Zip Code)
11. DISINFECTION: Type CHLORYTE Amount 6.9
12. CASING: Wall Thickness
Depth Diameter or Weight/FL Material
From 0 To 58 Ft 24" CEMENT
From To
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 43 To 58 Ft. 78M GRAVEL
From To ____ Ft_
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #64/74A W. FROM RUTHERFORDTON.
RT. ON COVE RD. LEFT ON COVE SPRINGS. RD.
LEFT A FORK. 1sT DRIVE ON RT.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS CTION STANDARDS, AND THAT A COPY OFRECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE PE /i»LzZ
STRRTTING 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

05004
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use _
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
UPPER HUDLOW RD.
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: JOHN & TONYA MILLS
Address UPPER HUDLOW RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
8( ) — 288-3913
Area Code Phone number
4. DATE DRILLED 11/01/04
5. TOTAL DEPTH: 60
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 13
7. STATIC WATER LEVEL Below Top of Casing: 48 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated atior below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 12 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 5_52
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 60 Ft 24" CEMENT
From _To_Ft_
From _ To _ Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From _ To _ Ft.
14.SCREEN: Depth Diameter
From _To_Ft.
_
From _ To _ Ft.
15. SAND/GRAVEL PACK:
, Depth Size
From -48 To -0060 Ft 78M
From To_Ft. _
Slot Size Material
in. _ in.
in. in.
Material
GRAVEL
County RUTH
Zip Code)
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #64 E. FROM RUTHERORDTON. LEFT ON
HUDLOW RD. APPROX. 1/2 MILE ON RIGHT.
v
rn
n
N
CO
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
LUREflSaW'1'ttL 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
///rrl717/Q �'/ r

osID
305003
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: FOREST CITY County RUTH
790 OLD ROSS RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LAURIE JAX
Address 790 OLD ROSS RD.
(Street or Route No.)
FOREST CITY NC 28043
City or Town State Zip Code
(4) — 678-8637
Area Code Phone number
4. DATE DRILLED 11/08/04
5. TOTAL DEPTH: 62
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 42 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above 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 62 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 Slot Size
From _ To _ Ft. _ in. _
From _ To _ Ft.
15. SAND/GRAVEL PACK:
Depth Size
From 42 To 62 Ft. 78M
From To Ft
Method
POURED
16. REMARKS:
Material
in.
in.
Material
GRAVEL
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
FROM FOREST CITY.. GO DOWN HUDLOW RD.
LEFT ON OLD ROSS RD. 1 MILE ON LEFT. (790 ON
BOX)
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
fiZ/yti
SI ATURE F PE CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

304990
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 0 Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: BOSTIC County RUTH
PEA RIDGE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ROSALEE LONG
Address PEA RIDGE RD.
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code
(828) — 286-4661
Area Code Phone number
4. DATE DRILLED 11/18/04
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 4 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 7.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 85 Ft 6-1/4" SDR.21 PVC
From _ To _ Ft. _ _
From _ To _ Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. QUIKRETE
From To Ft
14.SCREEN: Depth Diameter
From _To_Ft.
_
From _To_Ft.
_
15. SAND/GRAVEL PACK:
Depth Size Material
From _To_Ft. _ _
From To_Ft. _ _
Method
POURED
Slot Size Material
in in.
in. in.
16. REMARKS:
Topographic/Land setting
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
FROM BOSTIC GO OUT PEA RIDGE RD. GO
PAST WHITESIDE RD. 3/4 MILE ON RIGHT.
0
rT1
00
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TfiAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
GNA
(I�G T/�/7LQL
OF PERSON CONSTRUcTHE 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

304988
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 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: BOSTIC County RUTH Topographic/Land setting
MTN. LOOKOUT DR. -LOT #36 ❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) (check appropriate box)
3. OWNER: HENRY KING Latitude/longitude of well location
Address MTN. LOOKOUT DR.
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code
8(28) — 245-5376
Area Code Phone number
4. DATE DRILLED 11/05/04
5. TOTAL DEPTH: 605 DRILLING LOG
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ® From To
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated atfor 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):
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
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" SD1L21 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:
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
BUS. 74 E. FROM FOREST CITY. LEFT ON
BOSTIC/SUNSHINE HWY. LEFT ON LUCKADOO
MTN. RD. LEFT ON FIRE TOWER RD. STAY
STRAIGHT ON FIRE TOWER INTO GOLDEN
VALLEY ESTATES. RT. ON MTN. LOOKOUT DR.
APPROX. 1-1/2 MILES ON LEFT. (LOT #36)
0
rn
0
N
m
N
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
CA— O'e 'n o- //- c — C t/
SIG ATURE OF PER N C SUMMING 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

304985
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERIINICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® MunicipallPublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: BOSTIC County RUTH
PEA RIDGE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JAMES HOOPER
Address PEA RIDGE RD.
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code
8( 28) — 289-0109
Area Code Phone number
4. DATE DRILLED 11/19/04
5. TOTAL DEPTH: 205
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): 15 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 4.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 90 Ft. 6-1/4" SDR.21 PVC
From _ To _ Ft.
From To _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
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: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
FROM BOSTIC. GO OUT PEA RIDGE RD. TURN
LEFT ON GRAVEL RD. BETWEEN TWO METAL
BUILDINGS. BEFORE KAY HOOPER'S BIG HOUSE.
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
Jn/ Q ,,
4�7Yi��F� t t�d1 U9-1.2 �.{�/7`� 7/( %i -n'i�� %1— / 5 1 K
SI NATURE OF PE ON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

305001
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERIIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH
MAPLE CREEK RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: GLORIA JACKSON
Address 1504 MAPLE CREEK RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
8(28) — 2884737
Area Code Phone number
4. DATE DRILLED 11/15/04
5. TOTAL DEPTH: 64
6. DOES WELT REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 44 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 64 Ft 24" CEMENT
From ____ To _____Ft ____
From ____ To _____Ft ____
13. GROUT: Depth Material
From 0 To 20 Ft. CEMENT
From _ To _ Ft.
14.SCREEN: Depth Diameter
From To _ Ft. _
From _ To Ft. _
15. SAND/GRAVEL PACK:
Depth Size
From 44 To 64 Ft 78M
From To Ft
16. REMARKS:
Method
POURED
Slot Size Material
in. _ in.
in in.
Material
GRAVEL
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
FROM HOSPITAL IN RUTHERFORDTON GO
DOWN HWY. #108W. RIGHT ON PIEDMONT RD.
LEFT ON MAPLE CREEK RD. 1sT DRIVE ON
RIGHT. (#1504)
Cr.
a
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPYOFTHIS RECORD HASBEENPROVIDED TO THE WELL OWNER
SIGNAT2J] �ER J' CaNSTR CTING THE WELL ���X 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) ROBIN MCNEELY CERI INICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
SIMS SAND PIT RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: HOWARD SIMS
Address 297 SIMS SAND PIT RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
8(28) — 287-3183
Area Code Phone number
4. DATE DRILLED 11/15/04
5. TOTAL DEPTH: 86
6. DOES WELL REPLACE EXISTING WELL? YES ® 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):
County RUTH
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 Material
From _ To _ Ft, _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 71 To 86 Ft. 78M GRAVEL
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 FROM RUTHERFORDTON. 4 MILES
FROM HOSPITAL. LEFT ON SIMS SAND PIT RD.
1/4 MILE ON LEFT. (297 ON MAILBOX)
0
0
r=1
Co
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS TION STANDARDS, AND THAT A COPY QF TIIISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIG ATURE F PE
CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

304998
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: FOREST CITY
DUNCAN RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: KEVIN HARRILL
Address DUNCAN RD.
(Street or Route No.)
FOREST CITY NC 28043
City or Town State Zip Code
8(28) - 245-9097
Area Code Phone number
4. DATE DRILLED 11/05/04
5. TOTAL DEPTH: 225
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 121
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated ator below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 6 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 50 Ft. 6-1/4" SDR21 PVC
From To FL_ _
From To Ft_ _
13. GROUT: Depth Material
From 0 To 20 Ft. OUHCRETE
From To Ft
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Method
POURED
16. REMARKS:
Material
Topographic/Land setting
❑ Ridge 0 Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or Calmly Roads. Include the road
number and common names
HWY. #221 S. FROM RUTHERFORDTON. RIGHT
ON JACK MCKINNEY RD. RIGHT AGAIN ON
JACK MCKINNEY RD. BEFORE RR CROSSING.
RIGHT ON DUNCAN RD. 4/10 MILE ON RIGHT,
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TF,4AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWal t
(---knergE OF PERSON CONSTRUCTTHE 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

3 0 49"
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 D Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: ELLENBORO
LISA DR.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JIM PARKER
Address 230 LISA DR
(Street or Route No.)
ELLENBORO NC 28040
City or Town State Zip Code
(704) — 692-2269
Area Code Phone number
4. DATE DRILLED 11/08/04
5. TOTAL DEPTH: 205
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): 6 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 4.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 35 Ft 6-1/4" SDR.21 PVC
From To Ft_
From To Ft _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIRRETE POURED
From To Ft
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _To_Ft.
_
From To Ft.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
FROM ELLENBORO.GOUP HOLLIS RD. LEFT
ON LISA DR LAST HOUSE ON LEFT AT DEAD
END.
16. REMARKS:
a
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFJ 1 rn
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNEe
nit() // - P- d
SIQ A ' r OF PEON CONSTRUCTING WELL DATE g
co
Submit 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

ak�tbon
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: LAKE LURE
SWEETBRIAR FARMS-LOT#51
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER• TOM SWEDISH
Address SWEETBRIAR FARMS
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
(727) — 743-8928
Area Code Phone number
4. DATE DRILLED 11/09/04
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IZ
7. STATIC WA 1'ER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface"
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 4 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 7.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 100 Ft. 6-1/4" SDR.21 PVC
From _ To
From To
Ft.
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.
Method
POURED
Slot Size Material
in. _ in.
in. in.
From To Ft
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #64/74 FROM RUTHERFORDTON. RIGHT
ON BILL'S CREEK RD RIGHT INTO SWEETBRIAR
RD. S. LEFT ON LONG RIDGE DR. LOT #51. DEAD
END ON LEFT.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL v
CONSTRUCTION STANDARDS, AND THAT A COPY
OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNERP
F PERSON CONSTRUCTING THE WELL DATE
t 0.
SIGN
Submit 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 Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: LAKE LURE
RAINBOW CIRCLE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: WAYNE KOHLER
Address 871 RAINBOW CIRCLE
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
S(28) — 625-7983
Area Code Phone number
4. DATE DRILLED 11/10/04
5. TOTAL DEPTH: 165
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IZ
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amour 3.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 115 Ft. 6-1/4" SDR21 PVC
County RUTH
From To Ft. _
From To Ft. _
13. GROUT: Depth Material
From 0 To 20 Ft.OUIQRETE
From To _ Ft.
14.SCREEN: Depth Diameter
From _ To _ Ft. _
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
Method
POURED
Slot Size Material
in. _ in.
in. in.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #64/74 FROM RUTHERFORDTON. RIGHT
INTO MAIN GATE AT RIVERBEND. CROSS
BRIDGE. LEFT ON RAINBOW CIRCLE. STAY
LEFT. CROSS DAM. STAY ON RAINBOW CIRCLE.
NEW TAN VINYL HOUSE ON RIGHT.
n
141
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL 0
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OW!. (
o--- y' 67lQ it - /C" c�
l SIG TURF 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
CO

asp
304993
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Qijlity — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING. LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
MTN. CREEK RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ROBERT HARPER
Address MTN. CREEK RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
8(- 28) — 894-2085
Area Code Phone number
4. DATE DRILLED 11/11/04
5. TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO EJ
7. STATIC WATER LEVEL Below Top of rasing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 6 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
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.OUHQIETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To _ Ft. _
From To Ft
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #221 N. FROM RUTHERFORDTON. LEFT
ON MOUNTAIN CREEK RD. APPROX. 2 MILES ON
RIGHT. (NEW CONSTRUCTION
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 tm)
CONSTRUCT
ING WELL DATE
SI NATURE OF PERSON
Submit 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
•
v

Nook COnMa • Depranont el Environment ard Mauna Rawrsees - Division of Water tunny • Groundwater Section
1a3tMMSMNHCrier-Ragh,N.C.m.t1s3iaorrn1nrado 2t
305528
WELL CONSTRUCTION RECORD WELL CONTRACTOR• 11-1-1 LabrPu nip se:- i c
WELL CONTRACTOR CERTIFICATION,: �1�5
STATE WELL CONSTRUCTION PERMIT,:
1. WELL USEaseat AppeeaN as* RaddenVS 1E17 Municipal ❑ Industrial ❑ AgeSural ❑ Moritorkip 0
knavery 0 Neel Pump Water Hendon ❑ Other ❑ u OIw, Use Use:
2. WEI . LOCATION: %Show.keldt W the Iodation below) arTr r 'Witt'WittNa 1Ten t WOW tJ}p n co,a ty:
i A"t Nenste.4 Ra
teed Name end Il seen. Oenevaraleart .*a.4Mpt and tat Na.)
3. OWNER Tarc I41lav a —De eraet:,
Addrew 1 -i
DRILLING LOG
Fowls TO
iI3P
Mew Tam seas Op cads
4. DATE DRILLED II-3o-oq
5. TOTAL DEPTH "),05
S. CUTTINGS COLLECTED YES ❑ NOria/
7. DCES WEII REPLACE EXISTING WELL? YES ❑ NO[T�
S. STATIC WATER LEVEL Oaks Top S Casing: No FT.
GM t' I Men 'rep N CSMhst
V. TOP OF CASING IS � Is" FT. Above Land Suttao.'
Top Snaky totaAMed oder blew Nei odes Does* a clones In now -
donee wit /.A RCAC AC.ella
10. YIELD (gpm): _.3,. _ METHOD OF TEST i r
11. WATER ZONES (dapfl: .V 4'O —
a Sabra; woo r nesdad use truttet k&
DEPTH
Forma» DeseripYat
R ukhe KorotOINULasetcw
k;, d o
12. CHLORINATION: Type Cat r
13. CASING: Ip i ' Gfon; p �.
Depth mast relegeW„girl
From '7o di' FL �'le" oL_
Ram- is FL
From To ---
4. GROUT:
Depth MaM.W MMhod
From 4w To ar FL `Ionia D%t. Your cl
Prom To FL
15. SCREEN:
Depth OMmetet Slot Siff ~el
From To Ft In. In.
From To FL In In.
From To R. In. h •
15. SANOIGRAVE. PACK:
D.$. SIs.
From To—FI.,
Ftom To FL.
17. REMARKS:
MaNwd
LQCATlQN SKETCH
(.5Mw Alroetlaa nod Adana born "flog too St100
Roods. or stir pep Siam* OW
100HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED INACCORDANCE MATH ISA NCACEC, WELL
CONSTRUCTION STANDARDS. AND THAT *COPY OF THIS RECORD SEEN PROVIDED 7O11E vat_ wisp_�. "1-e,--fre' // 5O OGL
SISNAMIoil FERIottVoNETRUCtP Is* nu.
son* song wane wow aloft Orornantw lame 14333 39 DIP
deal pEy. gel
FOR OFFICE USE ONLY
Gad Nu
Sold No.

Nonh Carolina • Dspweaent of EnveannwM and Natural Raaourea - Division 01 WON Quality • atoutsdwatw SKaoa
I IN MM SerNee Cater - RMIe N.C. 97SYF11176Awns (ata) 7334221
WELL CONSTRUCTION RECORD WELL CONTRACTOR•
WELL CONTRACTOR CERTWICATION 0:
STATE WELL CONSTRUCTION PERMITI:
A&F WELL DRILUNG
AND PUMP gtEisness 74 C
911 Hwy.
2 / inaa.247 7278 8
1. WELL USEkqtra Nee* asps Raeldential E Municipal 0 Indtnhlal 0 Agricultural 0 Monitoring 0
Recovery Ul Heat Pump Wear Injeoeon 0 Other C] It Other, Ust Use:
2. WELL LOCATION: (Shaw wretch of the )ocallon below) /�,`T. f ``� r�. 3 0 5 5 2 7
Newest Teas Alin - / coat 1P
12.40/JA.`r9 drladQ £flt& gago rr- ctire .-e
wdlearrare, af7,SSenAna tat Ot.) ORILLING LOGDEPTH
3. OWNER A � d Front To Fornaka DaserlOsn
WHIM /ye iaaee r, ti✓K
Allorinct/toCOS ease Mai DoCods
4, DATE DRILLED//" �T
5. TOTAL DEPTH /4 {
S. CUTI INO8 COLLECTED YES 0 NOE('
7. DOES WELL REPLACE EXISTING WELL? YES 0 NOE
S. STATIC WATER LEVEL Dutcw Top of Casino: lO FT.
, r. Ivnlie 11ISM TMNCa *
E. TOP OF CASING 1S / V FT. Above Land Wear
'Top of whop Ist*tssd elhv Sow land Mhos fasUW0 ■ mints lit wow -
deer silk ISA MAC e0.elts
10- YIELD (gp.n): ..C._ METHOD0OF TEST A; r
11. WATER ZONES (doper): -82
12. CHLORINATION: Type Air/ er Amount I addlaoSN soece to raided we baea o1 WWI
13. CASING: 70 / o, *--6.-
Depth 7/� / Disaster
Rentirot To FI.
From To FL
From —
1a. GROUP:
To FL
WS Dadaism
W�
[�j Depth ,, Mlperltll Itod
From _ _ To 9_FL&/=✓full` C FItd'
Frown To Fl
15. SCREEN:
Depth Olwnutir Slot Ski MAWS
From To - Ft . In. In.
From To FL_ In. In.
From To __.. FL_ In. — In. .
1S. SAND/GRAVELPACK:
Dept Site Material
From To Fl
Rom SIIINFPIPa To17. REMARKS:
t 00 HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA /CAC PC. WELL
CONSTRUCTION STANDARDS. MO THAT ACOPY OF THIS RECORD WAS SEEN PHOVWEO 10114E WELL WIER_
LOCAMJQN SKETCH
(Show Section and Stance Pant as teas:teo Ste r
Roads. or oho nn rstereoa Oral l; `.
<t/0/0.4;re
dnw/C
F t' 2 (; 2004
•
/-0
FOR OFFICE USE ONLY
Ord Ns
Serial No.
ME OF PERSON CONSTRUCleta ME WEUL Os-.3
SSE eAdn+loOWN aWas O.MFONund.MorWort t'wletill30 ays
cast WEY 1271

A&F WELL DRILLING
AND PUMP SERVICE, INC.
Myth Careen • DeparlMnt of Enbanmenl and Natural Rnoutess - OMalon el WON Quality • Utoundwalet Seehl Hwy. Business 74
11136 MaM WAN Cantor - RMIph, N.C. S7an-1a711-A+ona [phone] Bostic, NC 28018
828-247.1773
WELL CONSTRUCTION RECORD well CONTRACTOR:
WELL CONTRACTOR CERTIFICATION 0: 71 F3
STATE WELL CONSTRUCTION PERMITII:
1. WELL USEkaeSt ASH. as* Residential Municipal 0 Industrial [a Agrkukurrl 0 Manitorilp 0
Rnovety Heat Puna Water Inaction 0 Othr 0 1t Other. Usl Use:
Harem Tram/ n- t e Lyre Gown grd2. WELL LOCATION: pow Mulch of the location below) -r /
'/r � 00n re
Lerj3jAi/ecBefir / A Anne& Mai li ruleirc!/C
lend Nana al Sumba or SubAMabn and La( Na.) DRILLING LAG
3. OWNER .�i-y P J,, G Y, �/ y� From Ts
Marl /G9.S� f(I' iC2%�, (,/
er
Arey e ?7 -(
an ma IS
4. DATE DRILLED
5. TOTAL DEPTH
5. CUITMIOs COLLECTED YES 0 N0E(
7. DOES WELL REPLACE EXISTING Well YES ❑ NOaf
S. STATIC WATER LEVEL Below Tap ol Caring: /y FT.
tun••• IPam Ti►MCS*
S. TOP OF CASING 19 g FT. Above Land suSca'
in sr nun Mrwena ud sea Sow INS sSsot 1gWwa ■ ealeees M Scor
dance wet 1/A 11CAG SC .e11a
10.YIELD (gpII* t _METH000FTEST Air
1t. WATER ZONES (dam: 070
1E. CHLORINATION: Type rla r
13. CASING: , eter .z7 Pitt
Amount s'BZ
WNTddman
Depth / Olan er or Warn
From---To.-��
Fiftt. -- To f1..
From To—... FL
14. GROUT:
From p
From
15. SCREEN:
Depth Dlrrreier Slot Size Material
From To - Ft In In
From To __ FL— In. _ In.
From To ... FL_. In. In.
15. SANO/GRAVEL PACK:
Depth Size
From To FL _.----
from To FL.
17. REMARKS:
I WHEREBY CERTIFY THAT T119WELL WAS CONSTRUCTED INACCORDANCE WIWIISA 'CAC 2C.V/ELL
CONSTRUCTION STANDARDS, MO THAT ACOPY O 11p5 RECOOR?D HAS SEEN PROMO 70116 WELL OfEP-
•
et(4ef re —
dal
fhod
Af
To �a / FL f M ru>'V rH
To FL
Material
DEPTH
FonraSo' Daar+4 +
0
-'t
0
r
0
ti additional apace la needed use Wig form
LOCATIQN SKjTC$
(Shaw Section and tetra from at leastmy >>
Roads. or Ow elattnGe NOW/
/ C,F r/ t
FOR OFFICE USE ONLY
oaae Hu
CNArd Chi\
0
rn
0
CO
sio$ATUIEOF PERSON WNSTRUMING 1HQ WEtl Don
SLAM AWN aSund WSW Owq. DtswdsSui Seats YAW 39 ui1 6a•n ftY• 1211
Sa4d Na.

ct2
306093
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 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
POLK CO. LINE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ERNIE BAUTSTA
Address 1382 POLK COUNTY LINE RD.
(Street or RouteNo.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
aao — 288-1101
Area Code Phone number
4. DATE DRILLED 12/02/04
5. TOTAL DEPTH: 645
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): 12 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 18
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 70 Ft 6-1/4" SDR.21 PVC
From To _ Ft. _ _
From _ To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To Ft.
14.SCREEN: Depth Diameter
From To _ Ft. _
From To ____ Ft.
_
15. SAND/GRAVEL PACK:
Depth Size Material
From ____ To ___ Ft.
_
From _ To ____ Ft. ____
Slot Size Material
in. _ in.
itl 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 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 RUTHERFORDTON. GO DOWN HWY.
#108. RIGHT ON POLK CO. LINE RD. GO APPROX.
2 MILES. LEFT ON GRAVEL DR. RIGHT AT FORK
DEAD END. HOUSE 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
) �i�f/ ket . /.2
/J' SI NATURE OF PE ON CONSTRUCTING THE WELT 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

P(Q
306090
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, ATED WQ PERMIT # PHONE # [phone]
STATE WELL CONSTRUCTION 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 ❑ If Other, List Use _
2. WELL LOCATION:
Nearest Town: LAKE LURE
ISLAND CREEK RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JERRY CONDREY
Address ISLAND CREEK RD.
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
(828) - 453-8560
Area Code Phone number
4. DATE DRILLED 12/21/04
5. TOTAL DEPTH: 185
6. DOES WELL REPLACE EXISTING WELL? YES ® NO 0
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): 12 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 3.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 90 Ft 6-1/4" SDR.21 PVC
From_To_Ft
Ft.
_
Material Method
From_To__
13. GROUT: Depth
From 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 RUTH
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #64/74A W. FROM RUTHERFORDTON.
LEFT ON ISLAND CREEK RD. LOG CABIN ON
LEFT APPROX. 1 MILE.
T
rn
m
V
cn
0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/91-0C—wp ...aink-P_• ok 4-'67
SIGNATURE 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

Q5 306087
WELL CONSTRUCTION RECORD
North Carolina — Depanment of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERI'1ItICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MOORESBORO
HENRY JENKINS RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: TERRY ROBBINS
Address 900 HENRY JENKINS RD.
(Street or Route No.)
MOORESBORO NC 28114
City or Town State Zip CMr
(828-) — 657-5732
Area Code Phone number
4. DATE DRILLED 12/14/04
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO lig
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 4 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 7.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 40 Ft. 6-1/4" SDR.21 PVC
From _To_Ft_
From To Ft. _
13. GROUT: Depth Material 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
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #221A S. FROM CLIFFSIDE. RIGHT ON
ISLAND FORD RD. RIGHT ON HENRY JENIQNS
RD. BUILDING ON LEFT.
T
rn
CO
v
0
0
Cr)
0i
0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1.
County RUTH
` (C' `riL i / a - /V- Cy
NA URE 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

306084
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1.
WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
GROVES RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER PAGE GAMBLE
Address GROVES RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 223-4239
Area Code Phone number
4. DATE DRILLED 12/17/04
5. TOTAL DEPTH: 305
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 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): 5 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 7.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 40 Ft 6-1/4" SDR21 PVC
From ____To ____ Ft ____
From To Ft _
13. GROUT: Depth Material Method
From 0 To 20 Ft. OUIKRETE POURED
From To_Ft
14.SCREEN: Depth Diameter Slot Size Material
From To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From _____To ____ Ft ____
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #221 N. FROM RUTHERFORDTON. RIGHT
ON OAKE GROVE RD. LEFT AT STOP SIGN. STILL
OAK GROVE RD. LEFT ON GROVES RD. CROSS
BRIDGE. 13T HOUSE ON LEFT. USE 2Nn DRIVE ON
LEFT AFTER CROSSING BRIDGE.
c.)
1/40
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCPED 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 THE WET I DaTF /
Submit 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

306083
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural' []
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
ELLIOTT RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JAMES ARROWOOD
Address ELLIOTT RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 286-2784
Area Code Phone number
4. DATE DRILLED 12/21/04
5. TOTAL DEPTH: 605
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 1-112 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): 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 70 Ft. 6-1/4" SDR21 PVC
From _ To _ Ft. _
From _To_Ft_ _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To _ Ft
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _To_Ft
From To Ft.
County RUTH
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley, ❑ Flat
(check appropriate boi;) j`....
Latitude/longitude of well location
735
(degrees/minuteslseconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #221 N. FROM RUTHERFORDTON. LEFT
ON SCHOOLHOUSE RD. LEFT ON PAINTERS GAP
RD. LEFT ON PINEY KNOB RD. LEFT ON ELLIOTT
RD. 1ST DRIVE ON RIGHT.
T
m
m
0
0
01
c_
0
'D
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED O THE WELL OWNER
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

306082
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 El ; .:.
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use _ r-r
2. WELL LOCATION:
Nearest Town: CLIFFSIDE County RUTH
HIGH SHOALS CH. RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CHAD NEWTON
Address HIGH SHOALS CH. RD.
(Street or Route No.)
CLIFFSIDE NC 28024
City or Town State Zip Code
(828) — 453-7394
Area Code Phone number
4. DATE DRILLED 12/22/04
5. TOTAL DEPTH: 39
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 24 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 6.9
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 39 Ft 24" CEMENT
From _To_Ft_
From To Ft _
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT 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 24 To 39 Ft 78M GRAVEL
From To Ft
16. REMARKS:
rc
Topographic/Land sgfting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate kit) , i 4
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
FROM ELLENBORO GO DOWN RACE PATH
CH. RD. RIGHT ON HWY. 120. RIGHT ON HIGH
SHOALES CH. RD. CROSS 2"n BIDGE . 2ND DR. ON
LEFT.
m
m
Co
V
0
c-
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIISS RECORDHAS BEEN PROVIDED TO THE WELL OWNER
S GNA UVIRREE OF P CON TRUCTING THE WELL t / - — V
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

306060
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public ❑ Industrial 0 Agricultural Dr
, �r�
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use _ p fV 2r65
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH
HARDIN RD.
(Street Name, Numbers, Conununity, Subdivision, Lot No., Zip Code)
3. OWNER: RAMONA HALL
Address 223 HARDIN RD
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
8(28) - 286-3243
Area Code Phone number
4. DATE DRILLED 12/24/04
5. TOTAL DEPTH: 39
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 24 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To 39 Ft.
From _ To _ Ft
From _ To _ Ft
13. GROUT: Depth
From 0 To 20 Ft.
From To Ft
CHLORYTE Amount 6.9
Wall Thickness
Diameter or Weight/Ft Material
24" CEMENT
Material
CEMENT
Method
POURED
14.SCREEN: Depth Diameter Slot Size Material
in.
in.
From _ To _ Ft. _ in.
From _To_Ft._ itt
15. SAND/GRAVEL PACK:
Depth Size
From 24 To 39 Ft. 78M
From _ To _ Ft. _
Material
GRAVEL
Topograpluc/LancLsettnig
❑ Ridge ❑ Slope ❑ 1 t
(check appropriate box)- "
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #221 N. FROM RUTHERFORDTON. LEFT
ON HARDIN RD. LAST HOUSE ON LEFT (a,
DEADEND.
0
' J
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
reZZ 1
yl
SIGN OF O CONSTRUCTING WELLi ` 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

3061'71
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY CERTIFICATION # 2008
WELLCONTRACTOR COMPANY NAME BARKER CONSTRUCTION. INCJSARKER WELL & PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT# - - "
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: LAKE LURE County RUTHERFORD
BUZZARDS PLACE OFF OF BUFFALO SHOALS ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: RICHARD THOMPSON
Address 119 DEVINE STREET
(Street or Route No.)
STANLEY NC 28164
City or Town Stale Zip Code
( 704 )_ 588-0023
Area code- Phone number
4. DATE DRILLED DECEMBER 20, 2004
5. TOTAL DEPTH: 113
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "t" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface'
*Top of easing terminated at/or below land surface requires •
varince in secerdance with 1SA NCAC 2C .6119.
9. YIELD(gpm): 1'h METHOD OF TEST TIMED
10. WATER ZONES (depth):
11. DISINFECTION: Type aV PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 113 Ft. 61/8 SDR21 PVC
From To Ft.
From To Ft.
Topographic/Land setting
®Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitudeofwell location
(demo/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
13. GROUT: Depth Material Method
From 0 To 20 Ft. CONCRETE POURED
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft. in. in
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH N
Show direction and distance in miles from at leails
two State Roads or County Roads. Include the road
numbers and common roa names.
74' &adt , t,,ftiux, At
(darn an &� -a-c.o Smaw
6Wa.Lt - /�O � a-ca
01_0-4-- Art`
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
14-0•14,101,..ctot. wvn c,
lZ.— tz—Oty
SIGNATURE OF PERSON CONSTRUCTING THE WELL t DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD V
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY CERTIFICATION if 2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL 8 PUMP PRONE it [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use ... -
2. WELL LOCATION:
Nearest Town: LAKE LURE County RUTHERFORD
BILLS CREEK ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER JEFF PACE
Address PO BOX 763
(Street or Route No.)
FOREST CITY NC 28043
City or Town State Zip Code
( 828 )- 606-7309
Area code- Phone number
4. DATE DRILLED DECEMBER 23, 2004
5. TOTAL DEPTH: 205'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 131
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface
`Top of cuing terminated atfor below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 25 METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley KnFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLINGIrr,
From To Formation Description
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Diameter or Weight/Ft. Material
From 0 Ft. 61/8
From Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CONCRETE
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
SDR21 PVC
From
From
306168
c31
res
J
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.
San Cea4w to 1
744 &Nrf - cJ?a (2_ £-691-6
Method ` CALLA_
. n // _
POURED �J Ciu-L-TL /Cr(/
Ait attthz.&
Su/PIA ,dloa,ci-ti°oa.d.
Depth
To 48
To
To Ft.
To Ft.
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
wve
SIGNATURE OF PERSON CONSTRUCTING Tlx: WELL
UT 31-0Y
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

NonN•CerNMa • Dsp«wmnt W Snakeroot* «d Natural R.soun s • DMalan e1 Water Queety • Groundwater Section
1SSS Mal *Ma Ceti/ - RYatd4 N.C. 2711F1131•Phane (ofq 733.2221
WELL CONSTRUCTION RECORD WELL CONTRACTOR*
WELL CONTRACTOR CERTIFICATION S:
STATE WEU. CONSTRUCTION PERMIT!:
u9
305971
-riYC
1. WELL UEE1pwok Applicable Residential CI ❑ : AQrkuhurr<I ❑ MonllO,kftl�; IJ tira,
Recovery
LS
o Hest Pump Walor k 4stllon ❑ Oehler [J 1t Olhs , Ust Use:
2. WEU. LOCATION: (Show se of tho IocaUan below) /
Nen*Teen tare47 /°,r-y ran�u%�cE�,-,,ia�T°/
JAN 31 2016
IRs•eRsas as7etOwewly.wdutewbnand LelNo DRILLING LOG LQEPTH
3- OWNER r d4o e) 57,6 7 sr, toFocal Td Form�S ' 0.SCI Yon
Acid's* fenr,r� 4;-cA-4e/ 2 ,-, k
ON *aeon
4. DATE DRIU.EO 1
5. TOTAL DEPTH L /9
6. CUTTINQSCOLLECTED YES0 NOi
7. DOES WEU. REPLACE EXISTING WELL? YES NO©
S. STATIC WATER LEVEL Below Top of Casing: /25-" FT. U
P. TOP OF CASING IS / - Wee 'a' I Mai rep el cures n
FT. Above Land Swims''
'Tn ea easing Mrednated der below IS swine requires a Warm to neon
doneealal ISA NCAO ECJ/ a
10. YIELD (pp* METHOD OF TEST .5t •^ SJ
11. WATER ZONES (deplh):. 'ra) — LAs`
leas. 24iCod• •
12. CHLORINATION: Type Per Amount
13. CASING: ZZ'
WO Tt+dumee
Depth s Mims «WeI1Mn While
From To.7-.FL to
From -- To FL From To FT.
24. GROUT:
Depth Mat/del Method
From To AFL
From To FL
15. SCREEN:
Dept Dismally Slot SDI Material
From To Ft _.__ In. In.
From ._._To FL_ In. b.
From To FL_ M. in.
16. SAND/GRAVEL PACK:
Deals Eke Maledal
From To FL
S addkbnw space Is needed use bads Leon
LOCATION SKETCH
(Slaw deeelbn end Stance Nan v lees: two State
Roads. or whet nap Nina pow
zz6
c
From To FL
17. REMARKS:
100 HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITN ISA 1e0AC 2C. Y/ELL
CONSTRUCTION STANDARDS. AND THAT ACOPY 02tS RECORD WAS SEEN PROVIDED TO THE WEU.ON%ER f
-45
NONAUUREOF PERSON OpgTRUCTIND INS WELL DaIE
Subdtedds1*0k hnelwwr0.0.OrolFdralwSemen within 39 aye `wIFgr.IaTt
FOR OFFICE USE ONLY
Owdss
Seel ale.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -
WELL CONTRACTOR (INDIVIDUAL) NAME Division of Water Quality
(print) Q ty - ERGroundwater Section
WELL CONTRACTOR COMPANY NAME s CERTIFICATION 8 7 . 'i R
STATE WELL CONSTRUCTION PERMITp PHONE 8 $ � Rl�.� .I 2 i
ASSOCIATED WQ PERMIT'S
1. WELL USE (Check Applicable Box) Residential
Agricultural ❑
2. WELL LOCATIpN:
Neare T
(ifa licable)
(ifa ]icable)
8 0 Recovery esi ential �Munici 0 Heat Pump Water Injection 0 p Other1Industrial0 If Other,LiDe
CountyLifriA4J
(Street Name, N umber, Community, Subdivision, Lot No., Zip Code)
n•L _
3. OWNER:
Address
City or Town State
Area code- Phone monk{
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES
7. STATIC WATER LEVEL Below Top of Casing:
se if Above Top of Casing)
Zip Code
14. SCREEN: Depth
From______ To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
CASING IS
8. TOP OF (U .4..„
iFT. • *Top of casing terminated a lo r below land surface Above requires d a urfaCee
variance in accords ce with 15A NCAC 1C.0118.
9 YIELD (gpm): yL ME HOD OF TEST n ; 10. WATER ZONES (depth): —_
11. DISINFECTION: Type r,h I nr
12. CASING: — amount
Wall Thickness
From n Depth Diameter or Weight/Ft. Material
From To E�:�—a � 4 s9R31
From To Ft.
13. GROUT: Depth
Material Method
From_ Tom_ a,, _ ,
From To
Ft, Ft Ft.— `r. aze—
Diameter
Ft. in.
Ft. in.
Ft
Ft.
NO Et
FT.
Slot Size Material
in.
in.
Size Material
Topographic/Land setting
�Fliidge OSlope OValley OFlat
(check appropriate box)
Latitude/longitude of well location
Latitude/longitude sour a OGPSOTopographic map
(check box)
Fro DEPTH .IN DR .
—1_t-�__,1�p__ uAlQ
o F tio t D cri'on
LOCATIONS FT r l
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road numbers and common road names.
Uu
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 WELT, O
i . WNER
0
0
rl
SIGNATURE OF p i CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mail Servi a Cea er�
Raleigh,27699-1636 Phone No. [phone], within 30 days.Raleigh,NC
DA
GW-1 REV. 07/2001
3

2. WELL LOCAT
Nearest Town:
(Street Nam
3. OWNER:
Address
WELL CONSTRUCTION RECORD
North Carolina - Departtnent of Environment and Natural Resources - Division of Water
WELL CONTRACTOR (INDIVIDUAL) NAME (print Quality- Groundwater Section
WELL CONTRACTOR COMPANY NAME r CERTIFICATION vY 21 R
STATE WELL CONSTRUCTION PERMITS/ PHONE 8
(ifs licable) ASSOCIATED WQ PE .
(ifs linable)
1. WELL USE (Check Applicable Box): Residential Iji Monitoring 0 Recovery 0 Heat Pump Water Injection 0ip Other i0 If Other,c 0sList Use Agricultural 0
County
umbers, Community, Subdivision, Lot t- Code)
City or Town
Area code- Phone number
4. DATE DRILLED t .�.• 14 4
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ic1 NO ia. 7. STATIC WATER LEVEL Below Top of Casing: �_FT
8. TOP OF CASING IS (Use 4' if Above Top of Caving)
'Top of cuing terminated at/or below land surface Above Land res Surfaces
variance in accordanc with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST , ; .
10. WATER ZONES (depth):
11. DISINFECTION: Type rh 1 ram_ Amount _
12. CASING:
Wall Thickness
From n Dep Diameter or Weight/Ft. Material
To
From To Ft ° � 1-14.:'C—
From To Ft.
13. GROUT: Depth Material
Fron To_a.g.__Ft N^_ Method
From Tom Ftcent ate_
14. SCREEN: Depth Diameter To Ft Slot Size Material
in, in.
From
To Ft. in.
15. SAND/GRAVEL PACK: in.
From Depth Size Material
To Ft`
From To Ft
16. REMARKS:
Topographic/Land setting
ORidge OSlope OValley fit
(check appropriate box)
Latitude/Longittide of well location
Latitude/longitude (degrees/minutes/seconds)
map
(check box)
D PTH
From
DRILLIN r r nr,
Tj rQ o lion OW on
LO ATION > TCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the roa
numbers and common road names.
�.-pAl�,+ 1`N
I DO HEREBY CERTIFY THAT THIS WELL, WAS CONSTRUCI'1sD IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS )SEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF p i N CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mail Service Cen e-Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001
a7 R1— L4_53..„23 2 2
22‘
CuRii
305881
w

ati
County
(Street Name, N umhus, Community, S divisi
uhII L-t}N-o., Zip Cade)
3. OWNER: GiEw rt. Q.eaiet e
Address
North Carolina - Department ofEnviro 3 0 5" e 9
NoLL CONTRACTOR D(Iepartment
ofEnNAME ent and Natural Resources - Division of Water Quality
WELL CONTRACTOR COMPANY NAME (print) t Q ty -Groundwater Section
STATE WELL CONSTRUCTION PERhHTg CERTIFICATION p ? 1 aB
(ifa licable) PHONE d�iAl dr,1 322
OCIATED WQ PERhHTt1
1. WELL USE (Check Applicable Box): Ufa licable)
Monitoring 0 (Check
0 ) Residential 0 Municipal/Public 0
Recovery Industrial 0Heat Pump Water Injection 0 Other 0 If Other, List Use
Agricultural ❑
2. WELL LOCATION:
Nearest T
WELL CONSTRUCTION RECORD
Frorr_ Tom_ Ft. * ^ =terns Method
From To Ft.Knt--liC3i-
14. SCREEN: Depth
From__ To
To
15. SAND/GRAVEL, PACK:
Depth
From To
From To
16. REMARKS:
City or Towo
Alt& code- Phone number, g
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO t
7. STATIC WATER LEVEL Below Top of Casing: _ L_
8, TOP OF CASING IS (use '4" if Above Top of Casing)
_L. _ FT. Above Land Surface*
Top of casing terminated at/or below land surface requires a
variance la accordan with 15A NCAC 2C.0118.
9. YIELD (gpm);_
10. WATER ZONES (depth):�I OF TEST_ ate_
11. DISINFECTION: Type !'h 1 q
12. CASING: —�-- Amount
Wall Thiclmess
From�_Depth Diameter or Weight/Ft. Material
Fro Ft. c9Ra1
�_ To Ft.
From To Ft.
13. GROUT: Depth
Ma
Diameter
Ft. in.
Ft. in.
Ft
Ft,
Size
Slot Size
in.
in.
Material
Material
Topographic/Land setting
midge OSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
Latitude/longitude ource:❑GPSOTopographiemap
DEPTH (check box)
From
"-"----a`-1o n O(•
p01mIilats ati N r
I�jscriggion
17.2
CO ->
iv
LOCATION—C?I
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road numbers and common road names.
l0�
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 BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PE N CONSTRUCTINLGfTHE WELL / Submit the original to the Division of Water Quality, Groundwater SectionService Center -Raleigh, NC
1636 Mail S DATE
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001

305'789
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division"of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Oil /Y/ e /a ry/ / CERTIFICATION SA 77
WELL CONTRACTOR COMPANY NAMa ) wa-T•et We-1( 0r: I14I9 PRONE # tera -Otir0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 1E/ 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:
Jo � fs
(Strut Name.
umbcrs, Community, Subdivision, Lot No., Tip Code)
3. OWNER: Lir
tJ ,%ff /r C
Rrd.sh �� T��217047
City or Town State Zip Code
Mn code- Ptwne comber
4. DATE DRILLED / / -/(� 0
5. TOTAL DEPTH: �— p,j'
6. DOES WELL REPLACE EXISTING WE-LL/? YES 0 NO !
7. STATIC WATER LEVEL Below Top of Casing: (,5� FT.
8. TOP OF CASING IS %. S (Use -+'• if Above Top of Cal iog)
FT. Above Land Surface*
t1Top of casing terminated :War below land surface requires a
varlaat* m acwrdaa��,.,,ISA NCAC 2C .0118.
9. YIELD (gpnt): METHOD OF TEST /
10. WATER ZONES (depth):
It
County !` IAit%/��OY Q
Address De
« Route No.)
1 1. DISINFECTION: Type
I2. CASING:
Depth
From To 6 S
From To
From To
13. GROUT:_d Depth
From p To 20
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From / To Ft.
From To Ft.
16. REMARKS:
Amount /0 01.
Wall Thickness
DiTear or WeFt 5P,,e ight/Ft pu cal
Ft
Ft.
Ft.CO Material C
Met
c
Topo6�hic/Land setting.
0Ridge I Slope Malley Dflat
(� appropriate bmc)
Latitude/longitude of well location
L
(d#gtewminuhtvsoronds) a y,
Latitude/longitude sou rce:OGPSOTopographic map
(checkba�c)
DEPTH
From To
DRILLING LOG
Formation Description,__
t
LOCATION SKETCTI
Show direction and distance in miles from at least road
State Roads or County Roads. Include the
numbers and common ro.. names.
f•.-wcl,t
orket
t`L
81 /5 C/ee
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRULttD IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONS tRUCTION SSANDARDS, AND THAT A C�PY OF t S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF P a CONSTRUCTING THE WELL. DATE l / l /v O
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. (9I9) 733-3221, within 30 days.
GW-1 REV. 07/2001

From: Scott Gantt To: DENR
Date: 12/14/2004 Time: 6:48:32 PM Page 2 of 5
3056070
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) SCOTT GANTT CERTIFICATION # 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box) : Residential ❑ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Purnp Water Injection ❑ Other ❑ if Other, List Use:
2. WELL LOCATION: Topographic/Land setting
Nearest town: LAKE LURE County RUTHERFORD ❑ Ridge ❑ Slope ❑ Valley ❑ Flat
138 NEIGHBORLY DRIVE BUFFALO SHOALS RD Latitude/Longitude of well location
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code) 35.25.598 / 82.11.211
3. OWNER PAULA IRVING (deg,ees/minutes/seronds)
ADDRESS POB 828 Latitude/longitude source. CPS ❑ Topographicrmap
(Street or Ronu No.) DEPTH DRILLING LOG
HENDERSONVILLE NC 28793 From To Emulation Description
City or Town State Zip Code 0 85 Clay
828-696-0575
Area Code - Phone Number
4. DATE DRILLED 11/1/04
5. TOTAL DEPTH 140
6. DOES WELL REPLACE EXISTING WELL'
7. STATIC WATER LEVEL Below Top of Casing:
YES 0 NO El
55 FT.
(Osc - 1"If Above Top of Casing)
a. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a vvianet in
accordance with I5A NCAC 2C.0118
9. YIELD (gpm): 30 METHOD OF TEST ARDM
10. WATER ZONES (depth): 140
85 140 consolidated Rock
n. DISINFECTION: TYPE HYPOCHLORITE Amount 5 Oz LOCATION SKETCH
12. CASING: Wall Iltickness Show direction and distance in miles from at leasl0ri
Depth Diameter or Weight/Et. Material two State Roads or County Roads. Include the road
From 0 To 93 Ft 61/4" SDR 21 PVC numbers and common road names. J
13. GROUT:
Depth Material Method '
From 0 To 20 F1. GRAVEL MIX GRAVITY
14. SCREEN
Depth Diameter Slot Size Material
From NA To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From NA To Ft,
16. REMARKS:
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.
11/4/04
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 Gantt To: DENR
Date: 12/14/2004 Time: 6:48:32 PM Page 5 of 5
305610 (,(,72t
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GANTT CERTIFICATION # 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box) : Residential ❑ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: ELLENBORO County RUTHERFORD
1420 ELLEN/HENR RD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER HORTON HOME OF RUTHERFORDTON
ADDRESS 342 HWY 74 BYPASS
(Street or Route No.)
RUTHERFORDTON NC
City or Town State
828-287-3366
Area Code - Phone Number
4. DATE DRILLED 11/17/04
5. TOTALDEPTH 160
6. DOES WELL REPLACE EXISTNG WELL?
7. STATIC WATER LEVEL Below Top of Casing:
YES ❑ NO
60 FT.
(Use "4" lfAbove Top of Casing)
8. TOP OF CASING IS 2 FT. Above Laud Surface*
*Top of casing terminated atior below land surface requires a variance in
accordance with 15A NCAC 2C.0118
9. YIELD (gm): 20 METHOD OF TEST ARDM
M. WA ILK ZONES (depth): 155
u. DISINFECTION: TYPE HYPOCHLORITE Amount 6 oz LOCATION SKETCH
28139
Zip Code
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
Latitude/Longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
DEPTH DRILLING LOG --s:
From To Fcmmtion Description
0 45 Clay
45 160 Consolidated Rock
12. CASING: Wall Thickness Show direction and distance in miles from at least
Depth Diameter or Weight/Et. Material two State Roads or County Roads. Include the road
From 0 To 55 FL 6 1 /4 " SDR 21 PVC numbers and common road manes.
13. GROUT:
Depth Material Method
From 0 To 20 FI. GRAVEL MIX GRAVITY
14. SCREEN
From
Depth
NA To
Diameter Slot Size Material 4 LAKES SUB
FL in in.
r5. SAND/GRAVEL. PACK:
Depth Size Material
From NA To Ft,
16. REMARKS:
ELLEN/IIENR RD
1/4 va
US HWY 74
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.
12/1/04
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

1
SIGNATUR><IOF PERSON CONSTRUCTING THE WELL
lam"
30 303
WELL CONSTRICTION RECORD
North Carolina • Department of.Environment and Natt Rctourees - Divition of Water Quality • Groundwater Section •
WELL CON-rRACrO (NV MD UAL) NAME (prtaO
WEJ.L CONTRACTOR COMPANY NAME Cl no n RiVt r
STATE WELL CONSTRUCTION PERMITS
(if applicable)
WELL USE (Check Applicable Box): Residential 0 Municipal/Pjblic 0 Industrial ❑, Agricultural 0 •
-ac,Jt Smi f-h
e11t•PtAmo fn
ASSOCIATED WQ PERMITS
(if Applicable)
CERTDICATION r •
PHONE to inn (. 43-_12ao
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑Li,ther 0 If Other, List Use.
leswasi
2. WELL LOCATION` ` Topographic/Land setting .
Nearest Town tnko I CP— Counry�nr. (s1�br%erki❑Ridge G1ope ❑Valliy ❑Flat
11LA^ s 1orne1 mr.. (cheek appropriatebox)
(Sent Name, Numbers. Community. Subdivision, Lot
`N.o.,,,Vp Code) Latuh iw e �� eVac f 11 l Fation
u/�
3. OWNER: 'bo S4 4- e na.W yskVPr (derta/minuteshereedQ 7
Address 13z _/JAC LatitudeAongitudesouree:BBPS❑Topographiemap
p (Street or Rome No.) (cheek box)
' F n& s� 'II SC nna DEPTH DRILLING LOG
City or Town State .Zip Code From To Format' o}1 ace cription
(.yVta X39.- 51t9 C - 30
Ara code- Phone number 3 O - 41 it
4. DATE DRILLED /i—A. `O1 Ig -.32 r .
5. TOTAL DEPTH: 3 2 4
6. DOES WELL REPLACE EXISTING WELL? YES B14O ❑
7. STATIC WATER LEVEL Below Top ottasing: • fD FT.
(Uee' +" If Above Top of Crain)
8. TOP OF CASING IS / FT. Above Land Surfaces
'Top of cuing terminated suer below lend surface requlrea a
variance In accordance with ISA NCAC IC.011S.
9. YIELD (gpm): 1 METHOD_ OF TEST /ELR
10. WATER ZONES (depth): !CS r 39.gni
I1. DISINFECTION: Type HT/
12. CASING:
Depth Di ter
From_,/ To 3.»' Ft
From _ To 6 Q Ft.
• From_ To Ft.
13. GROUT: Depth • . Material •
F.rotn"(L_ To 1 n Ft. SAticar—&
From To Ft.
Amount
Wall Thickness
or We ght/Ft. Material
JPL/c,
i2✓L
Method
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. _ in
From To Ft. in. _ in.
' 15. SAND/GRAVEL PACK:
Depth Sire Mei ial
From . To Ft. f'
From To Ft.
16. REMARKS:
-TI
CO
'S
1
LOCATIONro
Show direction and distance in miles m £Geist
two State Roads or County Roads. Include gp road
numbers and common road names.
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED TN ACCORDANCE WITH I5A NCAC 2C. WELL
CONSTRUCTION STANDARDS. AND THAT A COPY OF TI�S RECO O HAS BEEN PROVIDED TO THE WELL OWNER
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Man Service canto -RalelgILNC
27699-1636 Phone No. [phone], within 30 days. _ GW1 REV. 07/2001
31*
OD

W3EC 29
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James w Ca nil, Jr CERTIFICATION #_2-Lj$
WELL CONTRACTOR COMPANY NAME Camp' m Well & Primp Cry Tnn PHONE #$2S 451_7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential V Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Neare_ s.Town:
County \CAI R Qw
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: TI TttLML.
Address 1} Dal to i 0 Yi
tt4' (Street or Rent
try or Towo Sta Zip Code
Area code- Phone number
1 l , 1
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WFI1? YES 0 NO IS
7. STATIC WATER LEVEL Below Top of Casing: .D () FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
Top of casing terminated atlor below land surface requires It
• -variance in accords a with 15A NCAC 2C .0118.
9. YIELD (gpm): p MEX1 OD OF TEST air
14. WATER ZONES (depth): _�,,
11. DISINFECTION: Type rh 1 nri
12. CASING:
Depth,
From 0 To
na Amount
Diane
Ft.6
From To Ftl
From_ To Ft.
13. GROUT: Depth
From 0 To 2 0 Ft.
From To Ft.
ter
/4
Wall Thickness
or Weight/Ft. Material
cD821 PVC
Material
Neat 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
Method
Hand
Slot Size Material
in.
in,
Ft.
Topographic/Land setting
!idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH pRILLHNG LOG
From T FormatioR Dicsc.fiption
1 (Ito. If t itt LAr�,
Gu)
Z
t1
Ott
O
LOCATION SKETCH[
Show direction and distance in miles from at (east
two State Roads or County Roads. Includeethe road
numbers and common road names.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL _y
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS pEEN PROVIDED TO THE WELL OWNER -'t
441 , rter M,,7n k -1 4, OS -
SIGNATURE OF PE CONSTRUCTING THE WELL / /� DATE
0
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC e r
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

306830
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J amac to f amp, Tr CERTIFICATION B 21 33
WELL CONTRACTOR COMPANY NAME ramp' c wnl l $ Pi imp Inn Tnn PRONE N$2Rl d5-i-7322
STATE WELL CONSTRUCTION PERMITB ASSOCIATED WQ PERMIT@
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential l'Municipai/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT O
Ne est Town: County
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Ve`
,F7,� `J._ i)
Address i-taae r
R1(S,veet pr Route No.) I C �7)
� P Y -rD Y Ci `{c0 Vt T`
City or Town State Zip Code
( ) , fl— 39,9
Area code- Phone number
4. DATE DRILLED t 0 - 0 L
5. TOTAL DEPTH: Q b S
6. DOES WELL REPLACE EXISTING WELL? YES, 0 NO
7. STATIC WATER LEVEL Below Top of Casing: C 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
`Top of casing terminated atlor below land surface requires a
--veziance in accordant, with 1SA NCAC 2C .0118.
9. YIELD (gpm): J METHOD OF TEST D i r
1Q. WATER ZONES (depth):
11. DISINFECTION: Type rh1 nri na
12. CASING:
Depth, Diameter
From O To J C) Ft 6 i/ 4
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From p To 30 Et. Neat Cement Hand
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in, in,
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope tWalley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes(seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From o Forpation Description
0 50
Amount 1c9.�„P
Wall Thickness
or Weight/Ft. Material
Q9g21 PVC
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.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS itBEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERS{3N 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 -

Co
306832
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James w Camp, Jr
WELL CONTRACTOR COMPANY NAME
ramp 's Wel1 R Piimp rrL Tnr
CERTIFICATION CMS
't R
PRONE #VA) dS1-7122
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 ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:
i� DJ'AA i.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 0fn .k k&) A AO Ak
Address C- PN vl 1 c-K f Y• 0
kt e r % ycroair e.) PJ L 413�
ounty LJ' t^ 0n
orewy ` D 5 t 6 Zip Code
Area code- Phonenumber
4. DATE DRILLED i - 3, CJ U
5. TOTAL DEPTH: .5U S
6. DOES WELL REPLACE EXISTING WELL? YE ❑ NO gi
7. STATIC WATER LEVEL Below Top of Casing: �0 U FT.
(Use '4" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of cuing terminated at/or below land surface requires a
' variance to accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TEST ai r
10. WATER ZONES (depth): 5 0 5
11. DISINFECTION: Type rh 1
12. CASING:
Depth
From 0 To E ()
From To
From To
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Ft.
Ft.
Ft.
nri na
Diameter
6 lit
Amount G 1,{)
Wall Thickness
or Weight/Ft. Material
DR21 PVC
Material
Ft. Neat Ccmcnt
Ft.
Diameter
Ft. in.
Ft. in.
Method
Hand
Slot Size Material
in.
in.
Depth Size Material
From To Ft
From To Ft.
ddgopographic/Land setting
e ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitride of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
FQrmationpesc'on
PEPTH
From To
(1 �b
50 5s
:t
CSI
JOCATION SKETFI-1
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 WFI 1 WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY Ol THIS RECORD HAS i3EBN PROVIDED TO THE WELL OWNER
1e4- , (ji. I- n
DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. - GW-1 REV. 07/2001 `�

c 306835
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 5 ramp, 7>_ CERTIFICATION # 21 18
WELL CONTRACTOR COMPANY NAME Camp' c Wa11 & Pump Cn_ Tnr PHONE 8t9A1 d51-7122
STATE WELL CONSTRUCTION PERMIT# _ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Er Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELLLOCAT •N
Nearest Town: County
I�t el(atOfipp— aters R
(Street Name, Numbers, Comm 'ty, Subdivision, Lot No., Zip Code)
3. OWNER: j�M _A Q
Address ,'S .{� to h i KD h t?w0. t/
(Street or Route 1l, .)
Freer S.G., a q 6,56
6Yit a e t 4- 5s9u4 8 Zip Code
Area code- Phone number
4. DATE DRILLED '11 2 (. 0 q
5. TOTAL DEPTH: 'l n S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO GA
7. STATIC WATER LEVEL Below Top of Casing: (a h 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 IC .0118.
9. YIELD (gpm): 5 METHOD OF TEST air
10. WATER ZONES (depth): 6 0
11. DISINFECTION: Type
12. CASING:
Depth
From_p_ To
From To Ft.
From To Ft.
13. GROUT: Depth
From_0____ To 2 0 Ft.
rh1 nri np Amount %f "'1
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 6 1 / 4 QDR.21 PVC
Material
Method
Neat Cement Hand
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
Slot Size Material
in.
in.
Size Material
opographic/Land setting
Ridge ❑Slope ❑Valley ❑Flat
(check. appropriate box)
Latitude/longitude of well location
(degreeslminutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check boa)
DEPTH DRILLING LOG
From To Formation nL?,escOstio¢-,
p `7 () A n. 11 V fp�VC
c—
on
C7
(J1
O
cr7
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.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCtbD IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HA9IEEN PROVIDED TO THE WELL OWNER
a4ria-
SIGNATURE OF PER$ CONSTRUCTING THE WELL jj `jj" 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. 07/200F

From: Scott Gantt To: DENR Date: 1/24/2005 Time: 6:20:06 PM
Page 1 of 3
306762
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) SCOTT GANTT CERTIFICATION # 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box) : Residential ❑ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: LAKE LURE
LOT 73 SWANS WAY RIVERBEND DEVELOPEMENT
County
RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER RIDOELINE DEVELOPMENT CORP.
ADDRESS 112 COCOPLUM CIRCLE
(Street or Route No.)
ROYAL PALM BEACH FL
City or Town State
561-798-2729
Area Code - Phone Number
4. DATE DRILLED 12/29/04
5. TOTAL DEPTH 300
33411
Zip Code
6. DOES WELL REPLACE EXISTING WELL, YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 85 FT
(Use"s^ If Above Top of Canny)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of easing terminated atlor below lend surface requires a variance in
accordance with 15A NCAC 2C.0118
9. YIELD (gpm): 7 METHOD OF TEST ARDM
10. WATER ZONES (depth):
Topographic/T,and setting
❑ Ridge ® Slope ❑ Valley ® Flat
Latitude/Longitude of well location
35.25.480 / 82.10.237
(degrees/minutes/seconds)
Latitude/longitude source: GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 65 Clay
65 300 Consolidated Rock
ii. DISINFECTION: TYPE HYPOCHLORITE Amount 11
12. CASING:
Depth
From 0 To
13. GROUT:
From 0
14. SCREEN
Wall Thickness
Diameter or Weight/Ft. Material
73 FL 61/4" SDR21 PVC
Depth
To 20 FL
Depth
From NA To
15. SAND/GRAVE[. PACK
Depth
NA To
From
16. REMARKS:
oz
Material Method
GRAVEL MIX GRAVITY
Diameter
Ft. in.
Ft,
Size
Slot Size
in.
Material
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the ro
numbers and common road names. r_
:v
<Jl
)73
;V
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.
1/15/05
Date
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001

From: Scott Gantt To: DENR Date: 1/2412005 Time: 6:20:06 PM
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 112584
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 ❑ Other ❑ if Other, List Use:
2. WELL LOCATION:
Nearest town: ELLENBORO
916 DUNCANS CREEK RD
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER ED HITT
ADDRESS 916 DUNCANS CREEK RD
(Street or Route No.)
ELLENBORO
City or Town
828-247-1068
NC
State
Area Code - Phone Number
4. DATE DRILLED 12/16/04
S. TOTAL DEPTH 200
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing:
28040
Zip Code
YES ❑ NO 13
110 Fr.
(Usc "z" If Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surfare"
'Top of casing terminated at/or below land surface requires a va imue in
accordance with 15A NCAC 2C.0118
9. YIELD (gpm): 3 METHOD OF TEST ARDM
10. WATER ZONES (depth): 180
Page 33 of 3 l
306763
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ® Flat
Latitude/Longitude of well location
35.27.493 / 81.43.205
(degrees/mimites/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 30 Clay
30 200 Consolidated Rock
IL DISINFECTION: TYPE HYPOCHI.ORITE Amount 7
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 45 Ft. 6 1/4 " SDR 21 PVC
13. GROUT:
Depth
From 0 To 20 F1.
14. SCREEN
Depth
From NA To
15. SAND/GRAVEL PACK:
Depth
From NA To
16. REMARKS:
Oz
Material Method
GRAVEL MIX GRAVITY
Diameter
Ft in.
Size
Ft,
Slot Size Material
in.
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
n
6_
ro
e
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.
1/15/05
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.
it,,1r,R A f
GW-I REV. 07/2001

cylt
307185
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nlyal Resources r �- D)v-isiioop of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
(print/Cie/en C/ /tXe9 Gies trp CERTIFICATION it 2-7
"
R
WELL CONTRACTOR COMPANY NAMhl,Sta)' C4W A -Weir W e"i (0 0: I 1 t ll d _____ PRONE x (80F16titi'0 'o
TTC STATE WELL CONSTRUCTION PERMASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential lil-Municipa1/Public ° Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI N: County Nearest Town: u 'e/ . o/
'6s � 2,1
(Street Name, Nonusers, Community, Subdivision, I.ot No, Zip Code)
3. OWNER: & yd
Addressess .I¢�J a) .p
nn Meet or Roue No.)
Crt.Ji7p r3-rf�LP �,C.
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED / 2 • /C2 " C> V.
5. TOTAL DEPTH: y 0 5 6. DOES WELL REPLACE EXISTING WELL? YES 0 NO LY
7. STATIC WATER LEVEL Below Top of Casing: 42O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS /• 77 r FT. Above Land Surface*
'lop of casing termh ated atlor below land surface requires a
variance to accordance with ISA NCAC 2C .011&
t !
9 YIELD (gpm): 5 METHOD OF TEST / M
10. WATER ZONES (depth):
dge
graphic/Land setting
°Slope °Valley Gnat(cheek appropriate bra)
Latitude/longitude of well location,
(degrees/miautestseconds)
Latitude/longitude source:°GPSDTopographic map
(check box)ILLI DEPTH pRNG LOG
From To Formation Description
11. DISINFECTION: Type (, G /y
12. CASING:
egda Sr Ft
From ep
From To Ft
From To
13. GROUT: Depth
From_ To Ld
From To
14. SCREEN: Depth
From / To
From To Ft.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From ' To FL
16. REMARKS:
I DO HEREBY CERTIFY THAT
CONSTR(ICFION STAND
12
SI
Wier
H
Amount / o or
Wall Thickness Mate
5or0f roc
Ft. // �
Ft eonnedi re JA9Gf w i*/x
Ft.
Diameter Slot Size Material
Ft in. in.
in.
r7
LOCATION SKETCIU
Show direction and distance in miles frgm oast
two State Roads or County l/include the mad
numbers and common road nama. CO/Ifby ftil
Size Material
S WELIt WAS CONSTRUtAED IN ACCORDANCE TH I5A NCAC 2C, WELL
T A COPOF THIS RECORD HAS BEEN P OVIDED TO THE WELL OWNER
/Z/r7—®r
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. G W-1 REV. 07/2001

307188
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N`'atural Resources/�-�7Div ion of Water Quality - Groundwater Section 7
WELL CONTRACTOR (INDIVIDUAL) NAME��1v� (.print) 1fOlM(I e /,J/7/(� CERTIFICGA.TIION#
WELL CONTRACTOR COMPANY NAMESdeer t4''T'EC (t ( 1J (t: I: A O PHONE # Iyr.glaqq'OCIBO
STATE WELL CONSTRUCTION PERMITS( ASSOCIATED WQ PERMIT#
of applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Q Municipai/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION-
N at Town:
County
woe /CAIha s Z.
(Street Name, Numbers, Commwity, Subdivision, Lot No., Tap Code)
e
rfrs
3. OWNER: %9E' Q DR
roG{ 0 ',rig
(Street or Route No.)
City or Town State Zip Code
( )-
Arcs code- Phone number
4. DATE DRILLED / 2- / 6 - t'l V
5. TOTAL DEPTH: / 'c7
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO kV
7. STATIC WATER LEVEL Below Top of Casing: yz. ' FT.
(Use"+" if Above Top of Casing)
8. TOP OF CASING IS /.J FT. Above Land Surfaces
'Top of casing tennisated at/or below land surface requires a
variance in accordancewith ISA NCAC 2C .0118. r .
9. YIELD (gpm):J _ METHOD OF TEST // /il e
10. WATER ZONES (depth): J 4t2
11. DISINFECTION: Type (ray- Amount
12. CASING:
Wall Thickness
ter orWeight/Ft al
From TDo /0 h Ft_ %%i 2(
Topographic/Land setting y
ORidge OSlope Malley gnat
(-Kck appropriate box)
LatitudeAongitude of well location
.TJ
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Formation Descripn
From To Ft.
From To Ft
13. GROUT: Depth Material
From To 7..s" Ftc°here� • e
From 111iii To Ft.
Depth
To
14. SCREEN:
From
From
15. SAND/G
Fro
From
Diameter Slot Size
Ft in.
To Ft. in. in.
VEL PACK
Depth Size Material
To Ft.
`16. REMARKS:
To Ft.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRU
CONSTRU (ZIO/N�ASTANDARDS, AND THAT ASyOPY OF
AP
�v`' SIGNATURE OF PERSON CONSTRUCTING THE WELL
DEPTH
From To
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.
IN ACCORDANCE WITH 1'5ANCAC 2C, WELL
RECORD HAS BEEN PROVIDED TO THE WET 1 OWNER
�z—ft o
-y
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

301552
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERIINICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
EMERALD LAKES -LOT #20
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: WENDY EDWARDS
Address EMERALD LAKES
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 288-3018
Area Code Phone number
4. DATE DRILLED 08/11/04
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 600 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 16.5
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
12. CASING:
Depth cif Diameter
From 0 To fi— Ft. 6-1/4"
From _ To _ Ft. _
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. QUH{RETE
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size
From To Ft in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Material
Method
POURED
Material
in.
in.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #221 N. FROM RUTHERFORDTON. LEFT
ON DARLINGTON RD. RIGHT ON CARPENTER
RD. LEFT INTO EMERALD LAKES ON EMERALD
PKWY. APPROX. 1/2 MILE ON RIGHT, (LOT #20)
o
402,
O 4
Ar
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
SNATUR'1; OF PERSON CONS
CTING THE LL DATE /
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 day5. GW-1 REV. 07/2001

301549
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quplity — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential r Municipal/Public ❑ Industrial 0 Agricultural
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: BOSTIC
PEA RIDGE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: GEORGE CASH
Address PEA RIDGE RD.
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code (828) — 245-1095
Area Code Phone number
4. DATE DRILLED 08/17/04
5. TOTAL DEPTH: 545
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 90 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 11=1/2 Ff. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 15
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 60 Ft.6-1/4" SDR.21 PVC
From _ To _ Ft.
From _To_Ft.
_
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
in. _ in.
ln. in.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
FROM BOSTIC. GO OUT PEA RIDGE RD.
APPROX. 1/2 MILE ON RIGHT. PAST ROBINSON
CREEK 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 H
AS BEEN PROVIDED TO THE WELL OWNER
N1UtteOFPE Q — D —/ %
SIGL
Submit 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

301548
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERFII'ICATION #3114
PHONE # B28) 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 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: LAKE LURE County RUTH
LAUREL LAKES PARKWAY -LOT #32
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: JONNA HARRIS
Address LAUREL LAKES PARKWAY
(Street or Route No.)
LAKE LURE NC
City or Town State
(704)— 756-7999
Area Code Phone number
4. DATE DRILLED 08/19/04
5. TOTAL DEPTH: 585
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 300 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 60 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 15.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 60 Ft. 6-1/4" SDR.21 PVC
From _To_Ft.
_
From _To_Ft.
_
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _To_Ft.
_
From _ To _ Ft.
28746
Zip Code
Zip Code)
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #64/74A FROM RUTH. RIGHT ON BILL'S
CREEK RD. LEFT ON LAUREL LAKES PARKWAY.
TOP OF HILL ON LEFT. (LOT #32)
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
S NA OF ERSON 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
6'-/9-6
DATE

301545
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 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: BOSTIC
DAISY LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LESLIE WATKINS
Address 204 DAISY LANE
(Street or Route No.)
BOSTIC N C 2818
City or Town State Zip Code
(828) — 247-0184
Area Code Phone number
4. DATE DRILLED 08/25/04
5. TOTAL DEPTH: 125
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 11/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 2.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 35 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: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
BUS. 74 E. FROM FOREST CITY. LEFT ON
BOSTIC/SUNSHINE HWY. RT. ON SALEM
CHURCH RD. LEFT ON DAISY LANE. 4TH DRIVE
ON RT.
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 S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�. /.. jj a^'�O & '� C /
� S GN�T RE1�F a 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

301543
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 #
(ff applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: BOSTIC
WHITESIDES RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CHARLIE BROOKS
Address 3590 WHITESIDES RD.
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code
(828) — 429-3976
Area Code Phone number
4. DATE DRILLED 08/03/04
5. TOTAL DEPTH: 44
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO (21
7. STATIC WATER LEVEL Below Top of Casing: 24 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 44 Ft. 24" CEMENT
From To Ft.
From To Ft. _
13. GROUT: Depth Material 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 24 To 44 Ft. 78M GRAVEL
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 ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
FROM BOSTIC GO OUT PEA RIDGE .RD. LEFT
ON WHITESIDES RD. LEFT ON GRAVEL DR
ACROSS FRO WILSON CHURCH. SINGLE WIDE
ON LEFT AT BOTTOM OF HILL
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONST1;ITCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
n (! a�THL�%�/17i )L - 3 .
SIGN TORE Oi(PERS a 4 S STRUCTING 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

301542
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERPIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
KAANAN DR,.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CHARLIE BROOKS
Address KAANAN DR
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 429-3976
Area Code Phone number
4. DATE DRILLED 08/03/04
5. TOTAL DEPTH: 37
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 25 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 12 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 5.52
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 37 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 25 To 37 Ft. 78M GRAVEL
From To Ft.
Method
POURED
Slot Size Material
in. _ in.
in. _ in.
Topograpbic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
FROM RUTHERFORDTON GO OUT ROCK RD.
RIGHT ON KAANAN DR. TAKE DIRT STREET TO
THE LEFT. MOBILE HOME SITE AT DEAD END
ON RIGHT.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�../
NAIL OF CONSTRUCTING TETE 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

301541
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 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 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: Topographic/Land setting
JONESTOWN Nearest Town: RD. County RUTH El Ridge 0 Slope El Valley 0 Flat
check a o riate box)
(Street Name, Numbers,Community, Subdivision, Lot No., Zip Code) Latitude/longitude of well location
3. OWNER: WALT TrOMAS
Address JONESTOWN RD. (degrees/minutes/seconds)
(Street or Route No.)
BOSTIC NC 28018 Latitude/longitude source: ❑ GPS ❑ Topographic map
City or Town State Zip Code (check box)DEPTH
(MO— 245-6896 From To
Area Code Phone number
4. DATE DRILLED 08/24/04 LOG
5. TOTAL DEPTH: 28 DRILLINGrom To
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 FI'. 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): 8 METHOD OF TEST STEEL TAPE number and common names
10. WATER ZONES (depth): BUS. 74 E. FROM FOREST CITY. LEFT ON
BOSTIC/SUNSHINE HWY. GO STRAIGHTACROSS
11. DISINFECTION: Type CHLORYTE Amount 3.2 AT GOOD OLE BOYS ONTO JONESTOWN RD.
12. CASING: Wall Thickness CROSS BRIDGE. APPROX. 300 YDS. ON RIGHT.
Depth Diameter or Weight/Ft. Material
From 0 To 28 Ft. 24" CEMENT
From _To_Ft.
_
From To Ft.
13. GROUT: Depth Material Method in, . Pic
From 0 To 20 Ft. CEMENT POURED v#F �L'
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material Se 7cOO�Y �Y
From _ To Ft. in. _ in.
From _ To _ Ft. _ in. _ in. eO C
15. SAND/GRAVEL PACK: *
Depth Size Material
From;2 d Toal Ft. 78M GRAVEL
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTR��UCTT1ON STANDARDS, AND THAT A COPY OF S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
f l� ram: 1 .1f rz o
2_ t VA
SIGNAT( OF P#ON CO STRUCTING 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
Date: 9/13/2004 Time: 6.40:20 PM
Page 7 of10
WELL CONSTRUCTION RECORD
North Carolina - Department .of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # 2584
WELL CONTRACTOR (INDIVID17A1.)NAME (print) SCOTT GATT N
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS 7
ASSOC IINC. A WQ PERMITNE # (704) 7#
(if applicable)
Municipal ❑
Industrial ❑ Agricultural 0 Monitoring
Other 0 If Other, List Use:
STATE WELL CONSTRUCTION FERMI
(if applicable)
1. WELL USE (Check Applicable Box)t Pump Water lential alot00
Recovery ❑
2. WELL LOCATION:
Nearest town: ELLENBORO
640 LEDFORD RD ELLENBORO
(Street Name. Numbers, Community. Subdivision. Lot No.. Zip Code)
3. OWNER HORTON HOME OF RUTHERFORDTON
ADDRESS 342 HW Y 74 BYPASS
(Street or Route No.)
RUTHERFORDTON
City or Town
828-287-3366
Area Code -Phone Number
4. DATE DRILLED 8/19/04
5. TOTAL DEPTH 290 YES 0 NO
6. DOES WELL REPLACE EXISTING WE LEI �
El
7. STATIC WATER LEVEL Below TOP of Casing:
65
(Use if Above Top of Ca
s. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing laminated at/or below land cache.. ,cgaw es a va,iar,ee
accordance with 15A NCAC 2C.0118
9 YIELD (gun): 12 METHOD OF TEST ARDM
to. WATER ZONES (depth): 285
o, LOCATION SKETCH
12. CASING: Wall
It DISINFECTION: TYPE HYPOCHLORITE A Wall
Thickness 12 Show direction and distance in miles from at least
T
301710
Topographic/Land setting
0 Ridge 0 Slope ❑ Valley ® Flat
Latitude/Longitude of well location
35.21.541 / 81 45.513
(degrees/minutes/seconds)
Latitudedongitude source: 0 GPS 0 Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 50 Clay
Consolidated Rock
Depth
From 0 To 62
13. GROUP:
NC
State
County RUTHERFORD
28139
Zip Code
50
290
Diameter or Weight/Fl Material two
State
t and admen n may Roads. oads. Include the road
Ft. 61/4" SDR 21 PVC tt
Depth
From 0 To 20 FL
14. SCREEN
Depth
From NA To
15. SAND/GRAVE. PACK:
Depth
From NA To
Material Method
GRAVEL MIX GRAVITY
Diane Slot Size Material
Ft. in in
Ft
Size Material
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THATA COPY OF THIS RECORD HAS BEEN PROVIDED 1'O THE WELL OWNER.
9/1/04
SIGNATURE OF PERSON CONS "I7tUCFIN GHIE 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.
IGW-i REV. 07/2001

From: Scott 8 Jo Mn To: Division of Water Quality
Date: 9/13/2004 Time: 6:40:20 PM
Page 6 of 10
30113`3
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - rro 71FaCATSeON #ction 2584
WELL CONTRACTOR (INDIVIDUAL) NAME (print) SCOTT GANTT
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # ONE WQ 4) 434MIT-7277
#
STATE WELL CONSTRUCTION PERMIT # (if ASSOCIATED
E
(if applicable) (if
Agricultural 0 Monitoring 0
1. WELL USE (Check Applicable
cable Box) : Residential El Municipal 0 Industrial
Recovery ❑ Heat Pump Water injection 0 Other 0 if Other, List Use:
Topographic/Land setting
2. WELL LOCATION: RideSloe Flat
Nearest town: ELLENBORO County RLITHERFORD 0 u 0 d ❑ Valley
Latitude/Longitude of well location
250 BROOKS RD EXT.
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER HEATHER WELLBORN
ADDRESS 250 BROOKS RD EXT
(Street or Route Ne.)
ELLENBORO
City or Town
828-287-4783
Area Code - Phone Number
4. DATE DRILLED 8/17/04
NC
State
S. TOTAL DIP'IH 120
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing:
30 FT.
(16c"1" If Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface"
slop of easing temrnuted at/or below land surface requbes a variance in
accordance with 15A NCAC 2C 0118
9. YIELD ( m). 10 MErItOD O1 i1ST ARDM
10. WATER ZONES (depth): 100
11. DISINFECTION: TYPE HYPOCHLORII'E Amount 6
12. CASING: Wall Thickness
or Weight/Ft. Material
SDR 21 PVC
Depth Diameter
From 0 To 43 Ft. 61/4"
is. GROUT:
From 0
Depth
To 20 Ft
14. SCREEN
Depth
From NA To
15. SAND/GRAVEL PACK:
Depth
From NA To
16. REMARKS:
28040
Zip Code
35.27.498 / 81.49.930
Latitude/longitude
DEPTH
From
0
(depees/nurwtes/seconds)
source: El GPS ❑ Topographic map
DRILLING LOG
To Folmatiorl Description
30 Clay
30
120 Consolidated Rock
Oz LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Material Method
GRAVEL MIX GRAVITY
Diameter
Ft in.
Ft.
Slot Size Material
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.
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
9/1/04
Date
GW-1 REV. 07/2001

From: Scott & Jo Ann To: Division of Water Quality
Date: 9/13/2004 Time: 6:40:20 PM Page 5 of 10
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - G(rroR undwater TFaCASSe0N ction # 2584
WELL CONTRACTOR (INDIVIDUAL) NAME (print) SCOTT GANTF
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC.PHONE
ASSOCIATED WQ PERMIT #
STATE WELL CONSTRUCTION PERMIT # (if plica
(if applicable) ❑ Agricultural 0 Monitoring-. ❑
le)
1. WELL USE (Check Applicable Box) : Residential ❑ Municipal D Industrial
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2 WELL LOCATION:
Nearest town: LAKE LURE
LOT 140 LAKERIDGE ST LAKE LURE
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
(degrees/minutes/seconds)
a. OWNER MODERN LIVING CONSTRUCTION
ADDRESS POB 694 Latitude/longitude source: 0 GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 103 Clay
(Street or Route No.)
LAKE LURE
city or Town
828-388-0477
NC
State
Area Code -Phone Number
4. DATE DRILLED 8/16/04
5. TOTAL DEPTH 120
6. DOES WELL REPLACE EXLSTING WELL? TES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" If Above Top of Casing)
8. TOP OF CASING IS 2 FL Above Land Surface"
°Top of easing terminated at1or below land surface requires a variance in
accordance with 15A NCAC 2C.0118
9. YIELD (gpm): 15 METHOD OF TEST ARDM
10. WATER ZONES (depth): 110
11. DISINFECTION: TYPE IIYPOCHLORITE Amount 4
12. CASING:
Depth
From 0 To 110
13. GROUT:
From 0
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 61/4" SDR21 PVC
Depth
To 20 Ft.
14. SCREEN
Depth
From NA To
15. SAND/GRAVEL PACK:
Depth
From NA To
16. REMARKS:
Ft.
Ft.
Zip Code
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley 0 Flat
Latitude/Longitude of well location
3525.430 / 82.11.607
103
120 Consolidated Rock
oe LOCATION SKETCH
Show direction and distance in miles from
two State Roads or County Roads. Include
numbers and common road names.
Diameter
Material Method
GRAVEL MIX GRAVITY
in.
Slot Size Material
in.
Size Material
at least
the road
t Pot
eiv
sr coos
' 4,
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.
9/4/04
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001

From: Scott & Jo Ann To: Division of Water Quality
Date: 9/13/2004 Time: 6-.40:20 PM Page 4 of 10
Wi r'
. WELL CONSTRUCTION RECORD 30 1 l' 3 7
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) SCOTT CANTT CERTIFICATION # 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT# - -
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box) Residential © Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring- ❑ _
Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, 1,ist Use:
2. WELL LOCATION: - Topographic/Land setting
Nearest own: RUFHERFORDTON ❑ Ridge 0 Slope 0 Valley ® Flat
211 FOREST TRAIL Latitude/Longitude of well location
35.21 014 / 31.59.262
County RUTHERFORD
(Street Name, Numbers, Community. Subdivision, Lot No,. Zip Code)
3. OWNER WILLIAM DOTSON (degrees/minutes/seconds)
ADDRESS 211 FOREST TRAIL Latitude/longitude source: El GPS 0 Topographic map
(Sent or Rome No.) DEPTH DRILLING LOG
RUTHERFORDTON NC 28139 From To Formation Description
City or Town Stale Zip CD& 0 80 Clay
828-287-7039
Area Code - Phone Number
4. DATE DRILLED 8/6/04
S. TOTAL DEPTH 300
6. DOES WELL REPLACE EXISTING WELL"
7. STATIC WATER LEVEL Below Top of ('asing:
YES NO
75 FT.
Qts< "v" If Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing I mauiated actor below land wi fese Ideas es a venium< in
accordance with 15A NCAC 2C 0118
9. YIELD (ppm). 7 METHOD OF TEST ARDM
to. WA TER ZONES (depth): 275
80 300 Consolidated Rock
ii, DISINFECTION: TYPE HYPOCHLORITE Amount 12 ez 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 80 Ft. 6 1/4 " SDR 21 PVC numbers and common road names.
U. GROUT:
Depth Material Method
From 0 To 20 Ft. GRAVEL MIX GRAVITY
14. SCREEN
Depth Diameter Slot Size Material
From NA To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From NA To FI.
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 '1'O THE WELL OWNER.
9/1/04
SIGNATURE OF PERSON CONSTRUC FLNG'I'HE WELL Date
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001

30204
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James la_ CaL , Jr CERTIFICATIONS n13R
WELL CONTRACTOR COMPANY NAME Camp' c Wa11 R Primp en Tnr PHONE S$9R1 dri-_7322
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential de-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:
NearestbTc
(Soeet Name. Numbers, Com
CU\ 3�
,Subdivision, Lot No., Zip Code)
3.' OWNER: S lNfWs. v \ 11 f��jl�t1�
Address II CbnclangiIle—i.lni1- I°I
(Street or Route No.)
CiCityorlowo Stale Zip Code
St/—i,( sine Ft 3ADSv
14-11 - (110
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: 0 S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Of
7. STATIC WATER LEVEL Below Top of Casing: 10 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of casing terminated atior below land surface requires a
variance in accord nee with 1SA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST p ; r
10. WATER ZONES (depth): 2- g(]
11. DISINFECTION: Type r h 1 n r i n a
12. CASING:
Depth Diameter
Frorn_g To 1 c Ft. 6 1 / 4r
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
Fromn_To '20 Et. Neat Cement Hand
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From, To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From_ To Ft
Amount C4 r..,e.
Wall Thickness
or Weight/Ft. Material
SDP?1 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 boa)
pRII LING I i ez
SMJ iVpt
nDe ri�on
DEPTH
From To
1S
IS 2 0IS ('fwin�
.vt
LOCATION SKETCH
Show direction and distance in miles from at left
two State Roads or County Roads. Include the Ad,
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 TH COPY OF THIS RECO HAS EEN P OVI TO THE WELL VOWNN�ER
DANry/TE
SIGNA
l.11
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

302042
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ja me S Catnf.r Jr CERTIFICATION 21 A
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT/
(if applicable)
Camp ta WP11
& Piimp Cn r Tnn PHONE #i07A1 d51_7122
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential ir 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: Newest nov(tt: CountySLIAL .tS
-Cvt-,Y)
(Street Name, Numbers, Communky, Subdivision, Lot No., Zip Code)
3. OWNER: k l
Address P O n A x
nr eet c )Raaq OW,
�, yea
City or Town Sate Zip Code
( }
Area code- Phone number
4. DATE DRILLED R • J-3 , n L`
5. TOTAL DEPTH: SOS .
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I*
7. STATIC WATER LEVEL Below Top of Casing: (7 6 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 accords c wltb 1SA NCAC 2C .0118.
9, YIELD (gpm): HQIZOF TEST kix_
10. WATER ZONES (depth): 1 (9-.5
r C4r
11. DISINFECTION: Type ('h1 nri rta
12. CASING:
Dep
From p To
From To Ft.
From To Ft.
13. GROUT: Depth Material
FrorfL_Q_To "20 Et- 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.
Amount C.1`_
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 6 t / 4 SnR 21
Slot Size
_ in.
in.
PVC
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Uri -at
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From _omatiUn Pc
e� e(Zhfioo S
i t) Sty S4A- (ktit tl
O
Kit
—rf
LOCATION SICETCI-I
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 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT ¢ DOPY OF THIS RECORD H4 BEEN PROI(r>pED TO THE WELL OWNER
a4lted- w.
SIGNATURE&F PERSON CONSTRUCT! G THE
q. q. 0 LI
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) JameS "L Canr, Jr CERTIFICATION# 711R
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERM1Tii
(if applicable)
('amp' C Wa11
& Primp Inn Tnc PRONE i8I7R1 d51_7322
ASSOCIATED WQ PERMITW
(if applicable)
1. WELL USE (Check Applicable Box): Residential IPrMunicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCAT N
Nearest Town: a � m��. r CountylAi gA.. .
p
(Street
Naira,INumbers, Community; Subdivision, Lot No., Zip Code)
3. OWNER:
Address
(Street or Route No.)
Qtl/ V c
City or Town State
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: 2 %
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ck
7. STATIC WATER LEVE Below Top of Casing: S 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): 1 rj MT OB OF TEST D i r
10. WATER ZONES (depth):
1d DLs
Zip Code
11. DISINFECTION: Type ['h 1 nr i n P
12. CASING:
Depth Diameter
From_ Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth
Fromp To 2 0 Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount eki,..e
Wall Thickness
or Weight/Ft.
SDR21
Material
PVC
Material Method
Neat Ccmcnt Hand
,Topographic/Land setting
M-Cdge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degree minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
pRILLING LOG
Fo tion Description
�5 7y t,o N 81 61 DI) IA)
From To &emu Y
r
-o
LOCATION SKETCH
Show direction and distance in miles from at leash
two State Roads or County Roads. Include the roiat
numbers and common road names.
tT
),4 tit' le d" kaPlIug1+u
() I C I) I E. A
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY THIS RECORD HAS BEEPROVIDED T,Q THE WELL OWNER,
q-9—o4
SIGNATURE OF PE
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
302043
pat,
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WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT.
(if applicable)
('amp' a J 11
Camp, Jr
R Pnmp ('n T n r-
ASSOCIATED WQ PERMIT.
(ifapplicable)
30204,
CERTIFICATION 8_211
PHONE iffi2R) AS1_7-22
1. WELL USE (Check Applicable Box): Residential ' Municipal/Public 0 Industrial 0 Agricultural Cl
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WSLLLOCAT N.'�^-���4
Nearest Town: yy.County ���L S
WA,...) \II pT
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 1 J C)J.IL.M,/.1
Address 3;2.hh YAinie/5 !I )
No.)
IA, t,u..bRoute w
t rtiryC 12-z\ tot)
City or Town State Zip Code
t` - as] R Saq
Area code- Phone numbyyyyyyyy
4. DATE DRILLED y - I q • 0 LA
5. TOTAL DEPTH: 0 �^ _
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: go 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 accords cc with ISA NCAC 2C .0118.
9. YIELD (gpm): g METHOD OF TEST
10. WATER ZONES (depth): t 2b .2-4 la
D it
11. DISINFECTION: Type r h 1 nr i n s Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From_q To SR Ft.6 1 /4 cn 21 PVC
From To Ft.
From______ To Ft.
Material
13. GROUT: Depth Material Method
From_ To .2 0 Ft.
Ncat Ccmcnt Hand
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Frorrl 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
�dgc °Slope °Valley °Flat
(check appropriate box)
Latitude/longitude of well location
(degnes/minutes/sernnae)
Latitude/longitude source:°GPS°Topographic map
(check box)
Pain
LOG
Dacron
DRILLING
__
From Tot ormatiionDyscr ._
t—i
n otr A
�L\ 3ns 111411.
LOCATION SKETCH 3
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. l ' p
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COP OF THIS RECORD HAS BEEN PROVIDE$ TO THE WELL OWNER
011 Ed_ lam.
SIGNATURE OF PUS ON CONSTRUCTING THE WEI4. / // 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

300'703
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James tat, Calnp, 7r- CERTIFICATION(' 71 3A
WELL CONTRACTOR COMPANY NAME ramp s Well & Pump f'rt Tnr PHONE A1 2tYR-7322
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT('
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential f]I Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 if Other, List Use
2. WELL LOCATIQ
Nearest Town: County
Lcf 7? e. A 1)eyAt es
(Street Name, Numbers, Community, Subdivision, Loft No., Zip Code)
3. OWNER: T me D. l7Gt�WGoi
Address [SDS N• Alen ile hr•
/► (Street or Roule No.)
Garner I? L . ?sal
City or Towo State Zip Code
Area code- Phone number A
4. DATE DRILLED -/ - 22 -04
5. TOTAL DEPTH: rjDS
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 6
7. STATIC WATER LEVEL Below Top of Casing: Abe, FT.
(Use "+ if Above Top of Casing)
8. TOP OF CASING 1S 1 FT. Above Land Surface*
'Top of cuing terminated at/or below land surface requires a
" variance in accordansa with 1SA NCAC 1C .0118.
9. YIELD (gpm): METHOD OF TEST air
10. WATER ZONES (depth): 6 f
11. DISINFECTION: Type Ph 1 nr i np Amount.p't Cue 5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From_ To .in Ft.6 1/4 eDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth
From n To 2 0 Ft.
From To Ft.
Material
Neat Cement
Method
Hand
14. SCREEN: Depth Diareter Slot Size Material
From To Ftin. in.
From_ To Ftin. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
qakidge ❑Slope DValley ❑Flat
(*heck appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longirude source:❑GPS❑Topographic map
(check box)
PEPTU DRILLING LOG
From To Formation Description
0% D t1;,t grade)
e' `705— (pits; Mated re rk
O
C om
r
of
J �a
i o
J OCATION SKETCIj terry
Show direction and distance in miles from at least Q rrt'r�
two State Roads or County Roads. Include the road cJ1 0
numbers and common road names. co.) %
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL / DATE
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mall Service Center\ }Weigh, j4 Np
27699-1636 Phone No. [phone], within 30 days. GW-1) jI 'V.t)/2'001

300702
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 Jr_
WELL CONTRACTOR COMPANY NAME !'amps a Wal 1 R Pump Ca
CERTIFICATION # 21 3 8
T n c PHONE #$2R1 d5"?_7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 MunicipabPublic 0 industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIOi / Nearest Town: ,-/1Ef47D✓D County Ra' kergrel
!DC? Era VIA s It7i)( Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: w, P1Aw1 MLktnslP
Address /0D7 Fifairt5 fIil1 RA
(Sweet or Route No.)
//evnborc IY C , $-D4D
City or Town Sus Zip Code
Area code- Phone number
4. DATE DRILLED 7'ez C —C dl
5. TOTAL DEPTH: 185 -
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ok
7. STATIC WATER LEVEL Below Top of Casing: ID 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 accord& with ISA NCAC 1C .0118.
9. YIELD (gpm): # i.:76 METHOD OF TEST air
10. WATER ZONES (depth): 6 `7
11. DISINFECTION: Type ('h 1 nr i na Amount ) cup
12. CASING: Wall Thickness
Depth
From_p_ To 53
From To Ft
From To Ft.
13. GROUT: Depth Material Method
From p To 20 Ft. N 0t 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.
Diameter or Weight/Ft. Material
Ft. 6 1 / 4 I>4421
PVC
16. REMARKS:
Topographic/Land setting
dge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreearminuteslseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILI DIG LOG
From To Formation Description
n c3 rlirf
53 185" Ccn5.911 e4 rock
Cz
O o
70
G "0, �
ri
J.00ATION SKETCH
'd
Show direction and distance in miles from at least rn
two State Roads or County Roads. Include the roar* crl
numbers and common road names.
C(kk Gr,✓e
Utu rc: � R
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC IED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS cIEEN PROVIDED TO THE WELL OWNER
Gbh WA-, Cady/ I�/1 . , -13 -IA
SIGNATURE OF PERSON CONSTRUCTING THE WELL - DATE
V
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail ServicaCenter-RaleiQfi hL
27699-1636 Phone No. [phone], within 30 days. '-GW-1 REV. 07/2001
to
CEP Ell /7 2,7q7

300152
828-429-4068
Area Code - Phone Number
4. DATE DRILLED 7/2/04
5. TOTAL DEPTH 280
6. DOES WELL REPLACE EXISTING WEI,I 7
7, STATIC WATER LEVEL Below lop of Casing'.
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 it Nll (704)
Q PERMIT)43-7277
STATE WELL CONSTRUCTION PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box)' Residential ❑ Municipal ❑ Industrial ❑ Agricultural 0 Monitoring ❑
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION: Topographic/Land setting
Nearest town: LAKE LURE County RUTHERFORD 0 Ridge 0 Slope 0 Valley ❑ Flat
LOT 218 RIVERBEND RESORT Latitude/Longitude of well location
35.25.892 / 82.09.842
(Street Name, Numbers. Community. Subdivision. Lot No,Zip Code)
3. OWNER BRIAN CONNOR
ADDRESS 373 DARK CORNER RD
(Street or Route No.) DEPTH DRILLING LOG
FOREST CITY NC 28043 From To Formation Description
City or Town Stale Zip Code 0 42 Clay
280 Consolidated Rock
YES 0 NO DI
210 ET
(Ilse "a' If Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface"
"Top of easing terminated al/or below land swface ravines a vain ce i1
aeeordmce with 15A NCAC 2C.0118
(degrces/minutes/seconds)
Latitude/longitude source: ® GPS ❑ Topographic map
42
9. YIELD (ppm): 10 METHOD OF TEST ARDM
to. WATER ZONES (depth): 260
ii. DISINFECTION: TYPE HYPOCHLORITE Amount 4 0z LOCATION SKETCH
12. CASING: Wall Thickness Show direction and distance in miles from at least
Depth Diameter or weighUFt. Material two State Roads or County Roads. Include the road
From 0 To 54 Ft. 61/4" SDR 21 PVC numbers and common road names. G
13. GROUT:0
O
Depth Material Method a • cz_
From 0 To 20 Ft GRAVEL MIX GRAVITY a C'
D. SCREEN s m
0.0
Depth Diameter Slot Size Material IV r..
y 0
From NA To Ft. in. in. Me ▪ '7.
15. SAND/GRAVEL PACK:m
• Ui2
Depth Size Material
0
From NA To Ft. N ti
CO 0
Z
16. REMARKS"
I DO HEREBY CERTIFY THAT THIS WEI.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.
SIGNATURE OF PERSON CONSTRUCTING THE WELL
8/ 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.
GW-1 REV. 07(2001

From: Scott & Jo Mn To: Division of Water quality Uate: 8n1/2004 lime: v:zu: au ism
rage o oto
300150
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) SCOTT GANTT CERTIFICATION # 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box) : Residential ❑ Municipal ❑ Industrial ❑ Agricultural 0 Monitoring ❑
Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use:
2. WELL LOCATION:
Nearest town: RUTHERFORDTON
LOT 12 PINE BRAE MANOR
Crnmry RUTHERF'ORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
Topographic/Land setting
0 Ridge 0 Slope ❑ Valley
Latitude/Longitude of well location
31.21.253 / 81.59.798
•
Flat
3. OWNER ALBERT McFALLS (degrees/minutes/seconds)
ADDRESS LOT 12 PINE BRAE MANOR Latitude/longitude source © GPS ❑ Topographic map
(Street or Route No.) DEPTH DRILLING LOG
RUTHERFORDTON NC 28139 Froni To Formation Description
City or Town State Zip Code 0 110 Clay
828-287-1532
Area Code - Phone Number
4. DATE DRILLED 7/5/04
5. TOTAL DEPTH 240
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing'.
YES ❑ NO EI
90 FT.
(Use "a" If Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing tnm&ntcd at/or below land surface rcqures a variance in
accordance with 15A NCAC 2C_0118
110
240 Consolidated Rock
9. YIELD (gpm): 8 SfECIIOD OF TEST ARDM
to. WAInt ZONES (depth): 230
is DISINFECTION: TYPE HYPOCHLORITE Amount 8 Oz LOCATION SKETCH
12. CASING: Wall Thickness Show direction and distance in miles from at least
Dept, Diameter or Weight/Ft. Material two State Roads or County Roads. Include the road
From 0 To 117 Ft. 61/4" SDR 21 PVC numbers and common road names. e
13. GROUT: t
Cs
Material Method G7
From 0 To 20 Ft. GRAVEI, AID( GRAVITY XS
GC'7 C
SCREEN14. SCREZ.
Depth Diameter Slot Site Material IV ern
>c
From NA To IN. in. in. ___
15. SAND/GRAVEL PACK'. _ fr.fr.°
oax
Depth Size Material �. �."0
From NA To Ft, N —I
CO 6
16. REMARKS:
1 DO HEREBY CERTIFY'I HA HIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
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. at i uzour i rile. c. u. w rrvi
300149
2. WELL LOCATION:
Nearest town: RUFIULRFORUTON
2631 ROCK RD
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOT GAN I CERTIFICATION #2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. FHNE # ONE WQ PERMIT #
STATE WELL CONSTRUCTION PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box) : Residential ❑ Municipal ❑ Industrial E Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use:
Topographic/Land setting
❑ Ridge 0 Slope 0 Valley E Flat
Latitude/Longitude of well location
35.26.641 / 81.56.352
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER HORTON HOME OF RUTHERFORDTON
ADDRESS 342 HWY 74 BYPASS
(Street or Route No.)
RUTHERFORDTON
City or Town
828-287-3366
Area Code - Phone Number
4. DATE DRILLED 7/6/04
NC
State
5. TOTALDEPTH 300
28139
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 121
7. STATIC WATER LEVEL Below Top of Casing: 50 F'L
(llsc "1" 1f Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated a✓or below loud surface requires a vaiame in
accordance with 15A NCAC 2C 0118
9. YIELD (Rpm) : 3 MEIMOD OF TES"r ARDM
to. WA I ER ZONES (depth): 290
(degrees/minutes/seconds)
• Latitude/longitude source: ® GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Fomlation Desrriplaon
0 65 Clay
65
300 Consolidated Rock
ii. DISINFECTION: TYPE HYPOCHLORFI'E Amount 12
12. CASING: Wall Thickness
Diameter or Weight/Ft. Material
73 Ft_ 61/4" SDR21 PVC
Depth
From 0 To
13. GROUT:
Depth
From 0 To
14. SCREEN
Depth
From NA To
From NA
oz LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Material Method
20 Ft. CRAVEI, MIX GRAVITY
15. SAND/GRAVEL PACK:
Depth
To
16. REMARKS:
Diameter
Ft. in.
FL
Size
Slot Size Material
in.
Material
0
PO
a
3C
CO
PO
I DO HEREBY CERTIFY'I HAlTHIS 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.
8/I/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.
nE
i
O
Cs
rn
OA
ern
IOC
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n
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IGW-1 REV. 07/2001

From: Scott & Jo Mn To: Division of Water Quality Date: till 1/LUu4 lime. d:tu: i u rtvi
etyc ui
300148
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 WQ PERMIT N7
STATE WELL CONSTRUCTION PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box) : Residential ❑ Municipal ❑ Industrial 0 Agricultural 0 Monitoring ❑
Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: LAKE LURE
LOT 272 WILDCAT RD RIVERBEND RESORT
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER RIDGELTNE DEVELOPMENT CORP. (degrees/minutes/seconds)
ADDRESS 112 COCOPLUM CIRCLE Latitude/longitude source: ® GPS ❑ Topographic map
DEPTH DRILLING LOG
33411 From To Formation Description
0 110 Clay
Topographic/Land setting
0 Ridge ❑ Slope 0 Valley ❑ Flat
Latitude/Longitude of well location
35.25.124 / 82.09.557
(Ricci or Rowc No.)
ROYAL PALM BEACH FL
City or Town State
561-798-2729
Area Code - Phone Number
4. DATE DRILLED 7/9/04
5. TOTAL DEPTH 280
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing:
YES ❑ NO
60 Fr.
(Csc' a' If above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
'Tap of caging tenmratcd at/or below land enrGee rcq,urco a variance in
aceordanee with 15A NCAC 2C.0118
9. YIELD (gpm): 15 METHOD OF TEST ARDM
to. WATER ZONES (depth): 210 270
Zip Code
110
280 Consolidated Rock
It. DISINFECTION: TYPE HYPOCHLORITE Amount 11 oa 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 120 Ft 61/4" SUR 21 PVC numbers and common road names.
G
II GROUT: O ZE
Depth
Material Method t 0
From 0 To 20 Ft GRAVEL MIX GRAVITY a x=
m
it SCREEN Q C
DWth Diameter Slot Size Material *rni
From NA To FI. in of a-.4..,,
mo
la. SAND/GRAVEL PACK: _ XIn1
Depth Size Material CO mac)
i7
From NA To Ma3
GAD
..2
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.
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.
OW.1 REV. 07/2001

la IV!
rrom: aeon s do Ann 10. uivision m vvarei uuanty
300146
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]
NE WQ PERMIT #
STATE WELL CONSTRUCTION PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box) : Residential ❑ Municipal ❑ Industrial ❑ Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION: Topographic/Land setting
Nearest town: CAROLEEN Comae, RUTHERFORD ❑ Ridge ❑ Slope 0 Valley II Flat
621 OLD MOORESBORO RD Latitude/Longitude of well location
35.16.389 / 81.46.388
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
J. OWNER JODY LEDFORD
ADDRESS 621 OLD MOORESBORO RD
(Street or Rout< No.)
ELLENBORO
City or Town
828-247-6269
Area Code - Phone Nnmher
4. DATE DRILLED 7/22/04
NC
State
5. TOTAL DEPTH 280
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing:
28040
Zip Code
YES ❑x NO ❑
60 Fr.
(Use "1" If Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
*Top of easing terminated aVor below land surface requires a variance in
accordance with I5A NC AC 2C 0118
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 112 Clay
112
120 Consolidated Rock
9. YIELD (gpm): 15 ME1I IUD OF TEST ARUM
10. WATER ZONES (depth): 270
11. DISINFECTION: TYPE HYPOCHLORITE Amount 11 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 120 Ft. 6 1/4 " SDR 21 PVC numbers and common road names. 0 0
CD
13. GROUT: G] —
Depth Material Method a 2::^'
0 ;
From 0 To 20 Ft. GRAVEL MIX GRAVITY 'n c —rn
_ of
s_
14. SCREEN N Scrn
Depth Diameter Slot Size Material p
-4-
1'r'1
From NA To Pt. in. in a :irp
15. SAND/GRAVEL PACK: 9 N z
n �
Depth Size Material N 0
From NA To Ft.Cal o Z
16. REMARKS:
I DO HEREBY CERTIFY THAT' IHIS 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.
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

rrom: Scott & Jo Mn To: Division of Water Quality
Date: 8/11/2004 Time: 9:20'10 PM
Page 8 of 8
2. WELL LOCATION:
Nearest town: RUTHERFORDTON
300145
North Carolina - Department of Environment,WELL CONSTRUCTION
and Natural
Division
of Water RECORD Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GANTT
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE [phone]CERCA277ON # 2584
STATE WELL CONSTRUCTION PERMIT #
(if applicable) ASSOCIATED WQ PERMIT #
1. WELL USE (Check Applicable Box) : Residential (if applicable)
Recovery© Municipal ❑ Industrial ❑ Agricultural ❑ Heat Pump Water Injection ❑ Other ❑ Monitoring ❑
❑ If Other, List Use:
19 DONNIE DR MAPLE CREEK RD
County RIITHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER HORTON HOME OF RUTHERFORDTON
ADDRESS 342 H W Y 74 d YPASS
(Street or ]tome No.)
RUTHERFORDTON
City or Town
828-287-3366
NC
State
28139
Zip Code
Area Code - Phone Number
4. DATE DRILLED 7/26/04
5. TOTAL DEPTH 150
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO m
7. STATIC WATER LEVEL Below Top of Casing. 65 FT
(Use" If Above Top of Casing)
8. TOP OF CASING IS 2 FT Above Land Surface*
*Top of casing terminated at/or below I,md smfaee requires a vadmec m
accordance with 15A NCAC 2C.0118
9. YIELD (gpm): 15 METHOD OF TEST
to. WA LER ZONES (depth): 190
11. DISINFECTION: TYPE
12. CASING:
HYPOCHI.ORITE
A RDM
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ® Flat
Latitude/Longitude of well location
35.24.008 / 82.02.903
(degrees/minuteslseconds)
Latitude/longitude source: ® GPS ❑ Topographic map
DEPTH
From
0
DRILLING LOG
To Formation Description
62 Clay
62
150 Consolidated Rock
Depth Diameter
From 0 To 70 FL 61/4"
13. GROUT:
Depth
From 0 To 20 Ft.
14. SCREEN
Depth
From NA To
15. SAND/GRAVEL PACK:
Depth
From NA To
16. REMARKS:
Amount 7
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Oz
Material Method
GRAVEL MIX GRAVITY
Diameter
Ft. in.
FI,
Size
Slot Size
in
Material
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
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.
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.
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IGW-1 REV. 07/2001I

N01103S M3lVMGNfONJOMO
3013301VNO10321 3111AS380011
292681
roOZ E g inr WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACMINI WIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL COISBUSTURI COMMI TIVIAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE W) titiftaJ&*4 MIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential D Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ® If Other, List Use STORE
2. WELL LOCATION:
Nearest Town: BOSTIC
BOSTIC/SUNSHINE HWY.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JEFF'S PLACE
Address 5301 BOSTIC/SUNSHINE HWY.
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code
(8) — 245-7001
Area Code Phone number
4. DATE DRILLED 01/12/04
5. TOTAL DEPTH: 50
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 50 Ft. 24" CEMENT
From _ To _ Ft. _
From _To_Ft.
_
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft _ in. _ in.
From _ To _ Ft __ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 30 To 50 Ft. 78M GRAVEL
From To _ Ft.
16. REMARKS:
County RUTH
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
BUS. 74 E. FROM FOREST CITY. LEFT ON
BOSTIC/SUNSHINE HWY. GO THRU BOSTIC.
WELL ON LEFT (& JEFF'S PLACE IN SUNSHINE.
r
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I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC fED IN ACCORDANCE WITH 15A NCAC 2C, WELL
COUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S GNA OF PE /ijizt
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

N01103S 2i31vMONn02lO-OMO
301ddO 1VN0103213TTIAS3MOOIN
tOOZ E a.in' 292682
WELL CONSTRUCTION RECORD
North Carolina — De ent of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRA V I j�,! �1, ) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL Cc���t �isr'}�( �� ^ NAME PITTMAN WELL BORING. LLC PHONE # [phone]
STATE t • N PERMIT # ASSOCIATED WQ PERMIT #
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: FOREST CITY
WHITESIDE RD.
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: PRISCILLA PRESCOTT
Address 1842 WHITESIDE RD.
(Street or Route No.)
FOREST CITY NC 28043
City or Town State Zip Code
(828) — 289-3922
Area Code Phone number
4. DATE DRILLED 01/21/04
5. TOTAL DEPTH: 54
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 34 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County RUTH
Zip Code)
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 54 Ft. 24" CEMENT
From To Ft. _
From _ To _ Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To Ft.
14.SCREEN: Depth Diameter
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From 34 To 54 Ft. 78M GRAVEL
From _ To _ Ft. _
Slot Size Material
in. _ in.
in. in.
16. REMARKS:
Topograpbic/Land setting
0 Ridge ❑ Slope 0 Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
BUS. 74 W. FROM FOREST CITY. RT. ON
HUDLOW RD. RT. ON WHITESIDE RD. 1ST HOUSE
ON LEFT.
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OFS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
C
S iNATURL OF PCONSTRUCTING THE WELL DATE
r�re� i - a' - o 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

N01103S a31vMONnoae—oMa
301dd010101038 3111AS32:10001
North Carolina - D
WELL
WELL
STATE WELL
(if applicable)
292676
b00Z £ Z l(lf WELL CONSTRUCTION RECORD
nt of Environment And Natural Resources - Division of Water Quality - Groundwater Section
BI)IVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
gait NAME PITTMANWELL BORING, LLC PHONE # [phone]
P!*ERMIT # _ 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 LOCATION:
Nearest Town: CAROLEEN
KELLY RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MARK HOLLIFIELD
Address KELLY RD.
(Street or Route No.)
CAROLEEN NC 28019
City or Town State Zip Code
(828) - 245-8127
Area Code Phone number
4. DATE DRILLED 01/12/04
5. TOTAL DEPTH: 225
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 7 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 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 RUTH
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #221A S. FROM FOREST CITY. APPROX.
1.5 - 2 MILES PAST KEY LARGO. RIGHT ON
KELLY RD. 4/10 MILE ON LEFT.
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16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
L-4 n
C SIGNAI OF PERSOCONSTRUCTIN THE WELL
/—/DATE 2-e5/
Submit 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

NO1133S 2I31`VMON11080-OM0
33I3301VN0103213111AS3}300IN
292677
•
b001 E g iflf WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTIM NDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL'e ` k' ^ `a'`• % . " 'I NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STAT)b,F'+�'T Y�It!i�' Sal, +,' PERMIT #_ ASSOCIATED WQPERMIT #
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential CO Municipal/Public ❑ Industrial 0 Agricultural
Monitoring ❑ Recovery D Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: LAKE LURE
COVE CREEK DR.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JOE VIOLA
Address COVE CREEK DR
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
(954) — 788-6882
Area Code Phone number
4. DATE DRILLED 01/07/04
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 16.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 70 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
❑ 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.M 64/74A W. FROM GREENHILL. RIGHT
ON COVE CREST DR LEFT ON COVE CREEK DR.
1/2 MILE ON LEFT.
-0
3
N
N
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC PhD IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND
THAT A COPY
l�l�lil OF�THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER
J )/.-- : %nYIQ /— 7 — 61/
SIGNATURE 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

NO1103S )331VMGNflO8O-oMO
30Idd01100103213111AS32300141
b00Z £ ti inr WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR I )IVIDUAL) NAME (print) DEAN SHEHAN CER11t1ICATION# 2160
WELL CONTRACT * `Jy ' i . AME PITTMAN WELL BORING. LLC PHONE # [phone]
STATE
, w iN r �� ; I # ASSOCIATED WQ PERMIT #
1, ../s�.r4e� (if applicable)
292678
1. WELL USE (Check Applicable Box): Residential ® MunicipalPublic 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: CAROLEEN
BYERS RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: STEVE SMART
Address BYERS RD.
(Street or Route No.)
CAROLEEN NC 28019
City or Town State Zip Code
8L M) - 657-5398
Area Code Phone number
4. DATE DRILLED 01/05/03
5. TOTAL DEPTH: 305
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): 13 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 130 Ft. 6-1/4" SDR.21 PVC
From__ To _ Ft. _
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. _
From To Ft.
16. REMARKS:
County RUTH
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
BY-PASS 74E. FROM FOREST CITY. EXIT RT.
ON HWY. #221A S. RT. ON KELLY RD. IN
CAROLEEN. LEFT ON BYERS RD. APPROX. 3/4
MILE. LEFT ON DRIVE W/BOX #391 ON IT. LEFT
A FORK 1ST DRIVE ON LEFT.
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I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS UCTION STAND S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNERJAL:,
/�J/y1 p JAI
SIGNATURE OF PERSON CONSTRTJCTING 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

N011333 831VMaN()O1:1O-OMG
331dd01VN0103213111AS3800111
29.2679
ton E Z 1(1C WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CO IVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELNAME PITTMAN WELL BORING. LLC PHONE # [phone]
STAPERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
N. WOODLEAF
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JASON & SHARMA PINKERTON
Address N. WOODLEAF
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) - 247-0055
Area Code Phone number
4. DATE DRILLED 01/05/04
5. TOTAL DEPTH: 50
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance hi accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
11. DISINFECTION: Type CIILORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 50 Ft. 24" CEMENT
From _To_Ft. _
From _ To _ Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To Ft. _ in. _ in.
From _ To _ Ft.
15. SAND/GRAVEL PACK:
Depth Size
From 30 To 50 Ft. 78M
From _ To _ Ft. _
County RUTH
Material
GRAVEL
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #221 S. FROM RUTHERFORDTON. TAKE
A LEFT ON NORTH WOODLEAF. (NORTH
WOODLEAF IS THE FIRST RD. ON LEFT AFTER
YU PASS MORRINGSTAR LAKE RD.) GO TO THE
END OF NORTH WOODLEAF. THE LOT IS ON THE
LEFT AT DEAD END. F
0
rnfrl
CO
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CON S2 UCTION STANDARDS, AND THAT A COPY OF S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
� O7
mATUREOF ER �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

N011333 2131b'MaNflO2io-OMO
301dd01VNOIO38 3l1IAS38001N
too? sz1nr
WELL CONSTRUCTION RECORD
North Caro
WEL
WEL
STATE WELL C
(if applicable)
ent of Environment And Natural Resources — Division of Water Quality — Groundwater Section
VIDUAL) NAME (print) ROBIN MCNEELY CERI JFICATION # 2567
NAME PTTTMAN WELL BORING, LLC PHONE # [phone]
PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable)
CAM
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: FOREST CITY
OLD ROSS RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DAVID BAYNARD, JR.
Address 380 OLD ROSS RD.
(Street or Route No.)
FOREST CITY NC 28043
City or Town State Zip Code
8(28) — 287-7043
Area Code Phone number
4. DATE DRILLED 01/08/04
5. TOTAL DEPTH: 70
6, DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 70 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 50 To 70 Ft. 78M GRAVEL
From _ To _ Ft.
Method
POURED
Slot Size Material
in.
in. in.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well 1ocation
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show dhection and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
BUS. 74 W. FROM FOREST CITY. RIGHT ON
HUDLOW RD. LEFT ON OLD ROSS RD. LAST
DRIVE ON LEFT BEFORE STOP SIGN. (380 ON
MAILBOX)
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I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
r C to
SIGNATURE F PERS
Fyn
UCTING THE WELL
CA—
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

NOI1.33S 2l31VMON(IO8&OOM0
3OIddO1VN0103U 311IAS3Z100141
292672
ton E v inr
WELL CONSTRUCTION RECORD
North Caroli(Ajttent of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WEI$308QPtdIRL 1VIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WEIBMIKeltiEkt3F6140gANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery _ ❑ Heat Pump Water Injection 0 Other ❑ if Other, List Use
2. WELL LOCATION:
Nearest Town. BOSTIC
ANGORA DR.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER JANE HUSK
Address ANGORA DR.
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code
7(04) - 481-1479
Area Code Phone number
4. DATE DRILLED 01/12/04
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 121
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 16.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 80 Ft. 6-1/4" SDR.21 PVC
From_ To _ Ft. _
From _ To _ Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From_ To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To Ft. T in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft. _
16. REMARKS:
County RUTH
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
BUS. 74 E. FROM FOREST CITY. LEFT ON
BOSTIC/SUNSHINE HWY. GO PAST SPUR
STATION IN SUNSHINE & LEFT ON ANGORA DR.
ASPHALT DRIVE 2/10 MILE ON RT.
0
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CW
0
0
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-40
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I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COP)' OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
7
Submit 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
`'
SIGI�IATURE OF PER ON CONSTRUCTING THE LL / S DATE

N011033 831VMONf102i0-DMO
30W01tlN01038 allIAS32i0011
tiooz s z 1111
WELL CONSTRUCTION RECORD
North Carol ' _ ' nt of Environment And Natural Resources — Division of Water Quality — Groundwater Section
9 t' .
WELL p s . h'a NDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
nN{riT ly s'*Gj s(Pa&IY NAME PITTMAN WELL BORING. LLC PHONE # [phone]
WELLl._ �,:
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: ELLENBORO
HOLLIS RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DANIELLE WITHROW
Address HOLLIS RD.
(Street or Route No.)
ELLENBORO NC
City or Town State
(828) — 453-8228
Area Code Phone number
4. DATE DRILLED 01/05/04
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ej
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9 YIELD (gpm): 6 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 140 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
From To Ft.
From _ To __ Ft. __
16. REMARKS:
Method
POURED
Slot Size Material
in. _ in
in. in.
Material
0
County RUTH Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
28040 Latitude/longitude source: ❑ GPS 0 Topographic map
Zip Code (check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HOLLIS RD. FROM ELLENBORO. 1ST DRIVE
ON LEFT PAST HINTON CREEK RD.
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I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
COUCTION STANDARI2S, AND THAT A COPY OFF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
I AfregePERSONC/�'lxU�fING�WE94/77� Ii0 DATE <
SIG
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

NO11038 a31HMONn0a0.-OM0
3DIdd0 TIN0103a 211IAS3a0OIN
292670
rood £ g lnr
WELL CONSTRUCTION RECORD
North illarttNeironment And Natural Resources — Division of Water Quality — Groundwater Section
WELL 01112]WJ)UAL) NAME (print) DEAN SHEHAN CERI IFTCATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: LAKE LURE
ROAD RUNNER CIRCLE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CHARLIE HOWELL
Address ROAD RUNNER CIRCLE
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
(321) — 861-9170
Area Code Phone number
4. DATE DRILLED 01/15/04
5. TOTAL DEPTH: 565
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 150 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 8 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 15.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 176 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. _ _
County RUTH
Method
POURED
Slot Size Material
in. _ in.
in. in.
Topographic/Land setting
0 Ridge ❑ Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #64/74A W. FROM RU 1'L hRFORDTON.
RT. ON BILL'S CREEK RD. RT. ON ROAD RUNNER
CIRCLE. GO TO DEAD END.
0
-11
m
CO
1
v
CJt
W
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS UCTION STANDARDS, AND THAT A nCOPP OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
i�c� C1711tiQ % / `5"-- to V
SIGNATURE OF PERSON CONSTRUCTING THE LL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

NO11038 i131VMONn08D-0MC
301id01VN0103213111AS321OOW
tooz E a inr 29?6FO
WELL CONSTRUCTION RECORD
North Carojr&AMBIAtment of Environment And Natural Resources — Division of Water Quality — Groundwater Section
�171.3901 RIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
W,t'(,3f4V���5l ANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: LAKE LURE
STONEYBROOK LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ROBERT FAULHABER
Address STONEYBROOK LANE
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
(828) — 625-9652
Area Code Phone number
4. DATE DRILLED 01/12/04
5. TOTAL DEPTH: 445
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): 12 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 12
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 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
From
To Ft.
To Ft.
16. REMARKS
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #64/74A W. FROM RUTHERFORDTON.
RT. ON BILL'S CREEK RD. LEFT ON CEDAR
CREEK RD. GO 4 MILES & RT. ON
STONEYBROOK LANE. DRIVE ON RIGHT AT
DEAD END.
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0
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I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC 1ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS UCTION STANDARDS, AND THAT T Q COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
9. qa
aGNATURE F PERSON CONSTRUCTING WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
30059
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Robert Miller CERTIFICATION p 2675
WELL CONTRACTOR COMPANY NAME SAEDACCO, Inc.
STATE WELL CONSTRUCTION PERMIT*/ ASSOCIATED WQ PERMIT*/
(if applicable) (if applicable)
PHONE * [phone]
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:rr��)
Nearest Town: r�6 er it County .44 esetato
Sp S, Ciro wJi\I St,
(Street Name, Numbers, Community, Subdiyision, Lot No Zip Code)
3. OWNER: 1.'0 ZN C S
Address S, 8roouJ!y
_ (Street or Route No) /
1�' y0, CT/ NO
Cit) or Toon State
Zip Code
Area code- Phone numb
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO'g
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use `+' if Above Top of Casing)
8. TOP OF CASING 1S G FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Tvpe
3-0'
Topographic/Land setting
❑Ridge ❑Slope ❑Valley *tat
(check appropriate box)
Latitude/longitude of well location
•
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
Fr To , Formation D cription
�N 5 e?
12. CASING:
Depth/ - From x To 69Ft.
From (3 To 'I/j' Ft.
From To Ft.
13, GROUT: Depth
to From 0 To 5 Ft.
‘.. From 0 To Leg' Ft.
14. SCREEN: Depth
From To
Amount
Wall Thickness
Darter or Weight/Ft. Material
G " S.rl tN7 f G
ten' I Method
0.EY jii'V4 J .0 m
Diameter Slot Size
Ft. in.
Ft, in.
in.
Material
From To in.
15. SAND/GRAVEL PACK:
Depth Size Material From To Ft. 29' ,; C ��
. _CND
From To Ft.
se
G c
Gn
O TA°
LOCATION SKETCH Nam'
Show direction and &stance in miles from at least C.
two State Roads or C runty Roads. Include the road 0 Z
numbers and comm., road names.
16. REMARKS: 2 BeN' N7 t Seal S6 -o J '
I DO HEREBY CERTIFY THAT THIS
CONSTRUCTION STANDARDS.
J
SIGNA
LL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
OPY OF THIS RECORD HAS BEEN PROVIDED TO E WELL OWNER
y.
RE OF PERSON
/‘-0072
NSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC - -
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Robert Miller
WELL CONTRACTOR COMPANY NAME SAEDACCO, Inc. PHONE N [phone]
300590
- Groundwater Section
CERTIFICATION N 2675
STATE WELL CONSTRUCTION PERMITN ASSOCIATED WQ PERMITN
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential D Municipal/Public O Industrial ❑ Agricultural ❑
Monitoring 12 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION; 1 C J�
Nearest Town: i0✓tS"]f/G, / County ofyev(or,J/
S 3 ` .C, CSYOQ. ithi,/ Se 1.
(Street Name. Numbers, Community, S bdtvision. Lot No., Zip Code)
3. OWNER: ,e..O S.lf f pCS
Address SY £ 8r02dL04y St.
(Street or Route No) /
f'Dr?s16,iy A/0
City or Town / State Zip Code
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: 40`
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO fg
7. STATIC WATER LEVEL Below Top of Casing: T' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 0 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): METHOD OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
13
14. SCREEN: Depth
From 9.4 ` To 4a'
From To
15. SAND/GRAVEL PACK:
Depth
From 2.3 To 40'
From To
From
From
Topographic/Land setting
❑Ridge ❑Slope ❑Valley lat
(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
0 40' TA/ S, Lt t ,41,Ga.
lc'cc-
6y0..=
0 �`G
P TA—
t y
i n
Depth Diameter
To ): Ft. a...
To
From To
Ft.
Ft.
Amount
LOCATION SKETCH
Show direction and distance in miles from at least
Wall Thickness y-two State Roadscr County Roads. Include thgg Ip�1214
or Weight/Ft. Material number and r(� nn rnnd name W /T
C0,1-. 40 �y ✓ N
GROUT: Depth " Mr Albaterial''T�
From c To �.I Ft. j-;�✓10
From To
Ft.
Method
fbut
Diameter Slot Size Material
Ft. a" in. , o t O in. ?VC/
Ft. in. in.
Size Material
t( t5414i
Ft.
16. REMARKS:
2.' CseNlo/v,fe Sea/ p'fo ;c3
J
02
MA"1 `t
d!'
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C. WELL
CONSTRUCTION STANDARDS. AND THATA.-C9PY OF THIS RECORD HAS BEEN PROVIDED TTHE WELL OWNER
SIGAY.4T6ktEror 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

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Robert Miller
WELL CONTRACTOR COMPANY NAME SAEDACCO, Inc.
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
300571
CERTIFICATION # 2675
PHONE # [phone]
I. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring M Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION; Nearest Town: r'O✓C,s rt
r/t�A County eAfINevFr])
S3 C. /?ro/3ef,
(Street Name, Numbers, Community, 566bdivision, Lot No., Zip Code)
3. OWNER: "De/ _7:4( rags
Address s.Y S, heroµJOY s'7`,
(Street or Route No.)
bore s", Gl , NCi
City or Town State Zip Code
Arca code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: WO'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO $
7. STATIC WATER LEVEL Below Top of Casing: �' FT.
(Usc "+" if Above Top of Casing)
8. TOP OF CASING IS 0 FT. Above Land Surface*
*Top of cuing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type Amount
12.
Topographic/Land setting.
Midge 0Slope ❑Valley flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Q 4O' TN S, t wAti,t%�
cisc+-
r rr r-
�
GT t� s
7lee Cn
LOCATION SKETCH
Show direction and distance in miles from at least O
CASING: W 0 Th k two State Roads County Roads. noluI d th ton/ O Z�
From To )-1 Ft. a4 Co,(, yo ✓ K
From To Ft.
Depth Diameter
a m ass }�- e
or Weight/Ft. MarerialG mtmhrra and rit. nn mad ,. arm a. w
From To Ft.
13. GROUT: Depth —.Material Method
From O To II Ft t�rttaub fij(,t
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From ' To 40. Ft. a" in , 0 tO in. ?UC'
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 2-3 To 40. Ft. '15 Sew' GG, SG�b
From To Ft. -�
16. REMARKS: 2.' C3eidwvft - -a/ 2,J 'to ,23 I g
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCg WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT Y OF THIS RECORD HAS BEEN PROVIDED T THE WELL OWNER
)
SI 0 PERSON CON UCTTNG 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
UL

WELL CONSTRUCTION RECORD
30059
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL. CONTRACTOR (INDIVpUAL) NAME (print) Robert Miller
WELL CONTRACTOR COMPANY NAME SAEDACCO, Inc.
STATE WELL CONSTRUCTION PERMIT$ ASSOCIATED WQ PERMIT$
(if applicable) (if applicable)
CERTIFICATION $ 2675
PHONE # [phone]
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring I Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION;
Nearest Town: rore.. f illy County of it trio&
G .L l�roadW4/3
(Street Name, Numbers, Community, Sddbdivtsion, Lot No., Zip Code)
3. OWNER: 0/ Sk Frp,
Address S.l S, tro
(Street or Route No.)
fore d C,1'y NO
City or Town State
( )-
wify yr,
Zip Code
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: WO'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO $
7. STATIC WATER LEVEL Below Top of Casing: %� FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 0 FT. Above Land Surface'
*Top of cuing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth):
I I. DISINFECTION: Type
Topographic/Land setting
❑Ridge ❑Slope OValley Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
"TV 5, t.t w/iH,cct,
DEPTH
From To
0 .40'
12. CASING:
Depth 1Diameter
From_ To 3
From To
From To
13. GROUT: Depth
From O To �1
From To
Ft.
Ft.
Ft.
Ft.
O
t cc,
Cry%
O YG
c^G
tr
LOCATION SKETCH ! n
Amount Show direction and distance in miles from at (east 0 'o
Wall Thickness two State Roads
or Weight/Ft Material numbers and r1
Cc'. 40
aterial
LGND
1Methhopod
[
1-4U Ii
14. SCREEN: Depth Diameter Slot Size Material
From �.. To 4Q' Ft. �„ in. rOt O in. 'PVC./
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From 2.3 To L(Q,
From To
b
County Roads. Include th read'
reO y�
(>f ad name 10 /y
Size Material
Ft. St L' Go— S4'uD
Ft. .._
M.0'1
16. REMARKS: 2, CeNfON,t Sea/ 2/ 'to .23 ' N
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCFy WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT�1CPY OF THIS RECORD HAS BEEN RROVIDED TQTHE WELL OWNER
'177-
SIGpM7VREe0F PERSON CON UCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Gro indwater Section, 1636 Mail Service Center - Raleigh, NC
GW-1 REV. 07/2001
27699-1636 Phone No. [phone], within 30 days.

300699
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James cY CaLnp, Jr CERTIFICATION)/ 71 3R
WELL CONTRACTOR COMPANY NAME ramp' G Wel 1 & Pump (`rL , Tnr PRONE )/S7R) d5'i— 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 0 if Other, List Use
2. WELL LOCAT1 N: (r 11 �J ("
Nearest Town: j iet'7CY (Dit County.t111'te✓7DV
75-1 Cc ✓e •
(Scree( Name, Numbers, Community, Subdivision, Lot No., Zip Code)
An alltat t I 5
'7 Cc ✓e
3. OWNER:
Address
RIAJke,%g_rrd`a yi)
City or Town State
i� e291 g41'1,
14C 2813q
Area code Phan: number /1
4. DATE DRILLED /- i -D
5. TOTAL DEPTH: 40 ¶i
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 4o
(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): /0 METHOD OF TEST air
10. WATER ZONES (depth): 34,5--
11. DISINFECTION: Type rh 1 n r i n a
12. CASING:
Depth
From p To 610
From To
From To
13. GROUT: Depth
From_ To 2 0
From To
Amount 1 cap
Wall Thickness
Diameter or Weight/Ft. Material
FL6 3/Q GDR31 PVC
Ft.
Ft.
Ft.
Material
Method
Neat Cclncnt Hand
Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft. ,%'2)'• l_!i; it /'J'i_/A
Slot Size Material
in.
in,
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Flat
(check appropriate box)
Latitude/longitude of well location
(degreeslminuteslseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
QRII LING J OG
Formation Description
A;rfi
DEPTH
From To
Cie
Cie Lib 5— c n'clidatet' ypck
t
O o
0n
Cm
—k �o
LOCATION SKETCH i o
Show direction and distance in miles from at least Z
two State Roads or County Roads. Include the road cn
numbers and common road names. hri
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 H EEN PROVIDED TO THE WELL OWNER
444 9_13-0''
SIGNATURE OF PERSQN CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,itGroundwater Section, 1636 Mail Service Center - Raleigh, NC !,,r
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2004-

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jamos cu r'amp Tr CERTIFICATIONY 21 RR
WELL CONTRACTOR COMPANY NAME ramp' c Wc11 R Pnmp C•Z Tnr PHONE ti i11 A51_7122
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: r II JJ
Nearest Town: RAter7r rrl III County(moo
r Name,
u �
. OWNER:
3
Address
Cc tvnd ry
ers, Community, Subdivision, Lot No., Zip Code)
,R-; tei W1Wife et, - t
loll N. MAi n St
��ii(Street or Route No.)
/TEn/Ie1ra NC
City or Towo Scale Zip Code
Area code- Phone number
4. DATE DRILLED 7
5. TOTAL DEPTH: 3C'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: I},S FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S t FT. Above Land Surface'
*I op of casing terminated atlor below land surface requires a
- variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): Ao METHOD OF TEST n ; r
10. WATER ZONES (depth): ,? 4 S
11. DISINFECTION: Type C'h 1 nr i nc
12. CASING:
Depth Diameter
From 6 1/4-
From To Ft.
From To Ft.
13. GROUT: Depth
From D To 2 p Ft.
From To Ft.
Amount . C ld 3
Wall Thickness
or Weight/Ft. Material
Q1 PVC
Material
Neat Ccmc.nt
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.
30011
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreea/minntes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check boa)
j1EPTH DRILLINCLOQ
From To Formation Description
615 rl i r f - Sand
qs 3es frrt4ofdafec rcd<
O
Grit
cc)
yarn
rm
LOCATION SKETCH S y
Show direction and distance in miles from at least p n�
two State Roads or County Roads. Include the road 0,
numbers and common road names. W Z
C� jYOYn h .I !`q
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
tt-11 � S —) 3 —o
SIGNATURE OF PERS. QN 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
Nminni r- rrn

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jamag c.r Camp Jr_ CERTIFICATION 21 3R
WELL CONTRACTOR COMPANY NAME ramps' ¢ Wa11 & Pump Inn Tnr PHONE #&2R) AC1 7322
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential i Municipal/Public 0 industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 if Other, List Use
2. WELL LOCAT19DI: /t
Nearest Town: —CfeSi Ct�
A94 Harrillif
(Street Name, Numbers, Community, Subdivi ton, Lot No., Zip Code)
3. OWNER: LyM h+I Rpt&
Address 07 nit
rest Ci77fwlkVC .)?Jlj3
cnY ° -c 5 — *7,12
Zip Code
*1e5
Area cads Phone number
4. DATE DRILLED I - sZ - C 4-
5. TOTAL DEPTH: -3 2 �
6. DOES WELL REPLACE EXISTING WELL? YES 5/NO 0
7. STATIC WATER LEVEL Below Top of Casing: 4.0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface'
'Top of casing terminated actor below land surface requires a
variance la accordance with 1SA NCAC 2C .Oils.
9. YIELD (gpm): f D MET OD OF TEST
10. WATER ZONES (depth): Sit
Air
11. DISINFECTION: Type rill i na Amount i% tap
12. CASING:
Depth..II -- Diameter
From___ To rt1 Ft.4z t / 4
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From p To 20 Ft. N at Cement 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
Frort>_ To Ft.
From To Ft.
Wall Thickness
or Weight/Ft. Material
DRa1 PVC
16. REMARKS:
300707
Topographic/Land setting
❑Ridge ❑Slope ❑Valley lat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DEPTH DRII LING LOCI
From To ,formation Description
n ito r\ et
4e -31_5- ('tH5o11A4tb. yr'L
0
072
C
OL
fC-1
l0
se
5 y
yOCATION SKETCI[ O n
Show direction and distance in miles from at least tJ% o
two State Roads or County Roads. Include the mad to, t
numbers and common road names.
> _ rr
_i.p.�
rxl'est Cif ,-
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service C2ht4n r
27699-1636 Phone No. [phone], within 30 days. I OW-1
1C7// OD7 (.)fit.

302932
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 ❑ MunicipaVPublic ❑ Industrial 0 Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: BOSTIC County RUTH
FREEWILL BAPTIST CHURCH RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DAN BIDDELL
Address 330 FREEWILL BAPTIST CHURCH RD.
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code
(828) — 248-2952
Area Code Phone number
4. DATE DRILLED 09/21/04
5. TOTAL DEPTH: 305
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): 12 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 7.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 60 Ft 6-1/4" SDR.21 PVC
From To Ft.
From _ Tg Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter Material
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Slot Size
in.
in.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
FROM BOSTIC GO OUT BOSTIC/SUNSHINE RD.
RIGHT ON SALEM CH. RD. RIGHT ON FREEWILL
BAPTIST CHURCH RD. 2 MILE ON LEFT. (330 ON
BOX)
• c�
o r'^n
CI 2:3
.-4 -0 rn
tCO Cr
-40
Inrn
p ZO
N c^ 0
N n
•
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTR CTION STANDARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIG OF P ON CONS CTING 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

30293
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: UNION MILLS
TIGHT TURN LOOP RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: RYAN HARRIS
Address TIGHT TURN LOOP RD.
(Street or Route No.)
UNION MILLS NC 28167
City or Town State Zip Code
(828) — 289-2008
Area Code Phone number
4. DATE DRILLED 09/29/04
5. TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IZ
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 75 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 4.5
12. CASING: Wall Thickness
Depth Diameter or Weigbt/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. 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.
County RUTH
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #221 N. FROM RUTHERFORDTON. LEFT
ON SCHOOLHOUSE RD. LEFT ON PAINTERS GAP
RD. RIGHT ON HEMPHILL RD. TAKE FIRST
PAVED RIGHT ONTO TIGHT TURN LOOP RD'410
MILE ON RIGHT. 0 ci-'CD
mr'
- M
too
t :°
a o
'era
t,' U3o
N ci
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
�ll L _ EZ % L cj
SI NA OF PERSON CONSTRUCTING I`}IE 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

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section G
WELL CONTRACTOR (INDIVIDUAL) NAME (print) t) R.+t S j4 e (tk,v A.) CERTIFICATION #
WELL CONTRACTOR COMPANYNAME VOL7R Wvll brn - PHONE # leic4
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
300'720
WELL USE (Check Applicable Box): Residential 12/Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: ! r'
Nearest Town:mitiSpC: � < County R,Ji-1.tiP.k�o►,
200 (n t _ini-' p Jst rbC{ e- FA -ark ak'72_c(ct
(Street Name, Numbek, Community,3ubdivision, t No., Zip Code)
3. OWNER: GI tt p R.-b6, _
Address Z D O i .t.' . S f-- d �S
(Street or PPbbutc No.)
City or ffpwn State Zip Code
Area code- Phone number
4. DATE DRILLED 0 Ps -Ai - -100
5. TOTAL DEPTH: 4 10' /
6. DOES WELL REPLACE EXISTING WELL? YES 0. NO lY'
7. STATIC WATER LEVEL Below Top of Casing: Z_i FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TESTA( ntn.)
10. WATER ZONES (depth):
11. DISINFECTION: Type C I9 It f Amount i l n apt/
12. CASING: Wall Thickness
/ Depth Diam er or Weight/Ft. Matt<rial
From I Pnv.-To 3 1 Ft. ✓(-
From To Ft.
From To
Ft.
Topographic/Land setting�
❑Ridge ❑Slope ❑Valley INFIat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map --
(check box) -__.
DEPTH pRILLII'tO LOG _.-__ __
From To f Formation Description
2 b -.D Vtat CAA7
13. GROUT: . Depth Material Method
Froml”P..,a -,XTo t n Ft. Ne.,A-L C,pMe A— Pct+fz; L'
From To Ft.
14. SCREEN: r1 Depth Diameter Slot Size Material
From iv/1-1-To Ft. in. - in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From Ai�,f--�-To Ft.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at feasts
two State Roads or County Roads. Include % roa% J,
numbers and common road names. G c
G2 a'-c
16. REMARKS: -CA. S--+1k 2% (HO' 5 Oh, cA .11--Cat w\. w,+1 t A .b n- ,to,k 4)e
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 �W)ELL OWNER
L-t �. E n l f� o -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

WELL CONSTRUCTION RECORD
300729
North Carolina - Department of Environment and
/Natural Resources - Division1of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) l./ L fZ j f'�(1,p & DA/.a � CERTIFICATIONpp�p 307
WELL CONTRACTOR COMPANY NAME tI Dvk IA)43.Ll L['\ i z 11.iN ( C PHONE M IGIO kC,
STATE WELL CONSTRUCTION PERMITS, ASSOCIATED WQ PERMIT/.
(if applicable) (if applicable)
1. WELL U$E (Check Applicable Box): Residential al 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:I{� f -'" \
Nearest Town:/• `` 1 l. Sp Pi N S County R+ west-004\
�o� w'spe &tti� Re FA w% - h
(Street Name, Numb drs, Community, Subdivisio , Lot No., Zip Code)
4 3. OWNER: LPG A%
(Street or Route No.)
Key - n:S
Area code- Phone number
4. DATE DRILLED D -lit} -' 4
Address P 0 c, -t 3 1
City or n S to
5. TOTAL DEPTH: 3C)D
6. DOES WELL REPLACE EXISTING WELL? YES 0. NO l /
7. STATIC WATER LEVEL Below Top of Casing: (Q °, 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 accordancewith/with ISA NCAC 2C .0118. 6
9. YIELD (gpm): METHOD OF TEST A, �. fi 1 O&i t
10. WATER ZONES (depth):
agnfiie,-RjtiS- DEPTH
Zip Code From To
D 30!
_]DI L1S/
11, ) 3n0/
11. DISINFECTION: Type Cam! t P A Amount 1 Zc rAi
12. CASING: Wall Thickness
Depth t Diameter or Weight/Ft. M terial
Froma'&ii To I. D Ft. (41JL .&� L.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From \,.pC..trA.To a.,D Ft. JAI c C.eatj
From To Ft.
14 SCREEN: Depth Diameter Slot Size
in. - in.
From "itPhTo Ft.
Method
tOOLtk)n,
From To Ft. in. in.
15. SAND/GRAVEL PACK:
A Depth
From, NI iI To Ft.
From To Ft. 16. REMARKS: LJV Ct4L1PC\ 1!j
'a kip pvInF/ Iavh.L
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
Size
Material
Material
Topographic/Land setting_�.�
❑Ridge ❑Slope ❑Valley Mat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map - (check box)
pRILLING LOG- - . -
Formation Description
�IKY
L vd .>r
LOCATION SKETCH
Show direction and distance in miles from at (east G
two State Roads or County Roads. Include the roado
numbers and common road names. t er p
0 L
y ,
no
Z
A A ,rtil. /
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
1,1,-z-1Alot -,l/aim_ +tom
Submit 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 4r Carp, Tr
WELL CONTRACTOR COMPANY NAME ('amp'
CERTIFICATION # 91 3 R
Wa11 & puma CrL • Tnr PRONE #&2R1 453-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential VMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
Lit
2. WELL LOCAT N: ty
Nearest Town: o}�
G'xt ft- \ )s,a„tU
(Street Name, Numbers, Community, Su division, Lot No., Zip Code)
3. OWNER: U o kn. W.LLD/I.( of
Address / Lv D ]2 LAco n i A S
11 ,�(.`Street or Route No.)
bc.T1A r>, F L 3‘72-ei—
0
City or Town State Zip Code
Area code- Phone numb
4. DATE DRILLED 1.4 "0 LS
5. TOTAL DEPTH: u 5
6. DOES WFT T REPLACE EXISTING WELL? YES Cl NO RJ
7. STATIC WATER LEVEL Below Top of Casing: fj0 FT.
(Use'+" if Above Top of Cuing)
8. TOP OF CASING IS t FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
•variance to accordanas with 1SA NCAC 2C .0118.
9. YIELD (gpm): MET OD-OFTEST 4,ir
10. WATER ZONES (depth): S
11. DISINFECTION: Type rh1nrina
12. CASING:
Depthr� Diameter
From o To U Q Ft. 6 1/ 4
From To Ft.
From______ To Ft.
13. GROUT: Depth_
From 9 To ^ Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
Froth To Ft.
From To Ft.
Amount Ct A.f
Wall Thickness
or Weight/Ft. Material
'BR-'1 PVC
Material
Ne-at
Method
Cement Hu —
Slot Size Material
in.
in.
Size Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrces/minutes/ser"ade)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From �To Fp(man'opDesq' [alp ion
Cab S c CA (�/N
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County R • • s. Include the road
numbers and common ra+d s.
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
OF PERS CONSTRUCTING THE WELL
r0—►C-0 LI
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 Envirorunent and Natural Resources - Division of Water Quality • Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James ri Caw Jr CERTIFICATION # 71 3R
WELLCONTRACtOR COMPANY NAME Ca mile Wm11 R Pnmp Crc, T n r PHONE#g49R) d51_7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
363565
1. WELL USE (Check Applicable Box): Residential Ia Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
crest Town:
U,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
County p,i2.CJPu,I..1, 9
3. OWNER: I t \kCJA&R
Address 6/ o y S 9
Luke L(NYP RnVlc
City or Town State Zip Code
( Area code- Phone numbest., !�
4. DATE DRILLED "1 • q. o
5. TOTAL DEPTH: 4 h `j
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO X7
7. STATIC WATER LEVEL Below Top of Casing: 1 fl n FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated atlor below land surface requires a
-variance in ■ecor n55g� with ISA NCAC 2C .0118.
9. YIELD (gpm): ,LU MEIHJD F TEST 4 i r
10. WATER. ZONES (depth):
2g46
11. DISINFECTION: Type ('h l nr i na
12. CASING:
Depth Diameter
From p To 1 () Ft. 6 1 / 4•
From To Ft.
From To Ft.
13. GROUT: Depth
From_o___ 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.
Amount t
Wall Thickness
or Weight/Ft. Material
RDP21 PVC
Material
N at Cement
Method
H.x rdd
Topographic/Land setting
Edge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation kescriptioa
C.prn
D 10
P_
O
LOCATION SKETCH
Show direction and distance in miles from at least N
two State Roads or County Roads. Include the road?
numbers d common road namy,. A 1 --o r'.-)
n t✓✓ I
C `
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC1hD IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, : a THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGH! T' OF PERS
Coipv 0- ICJJLI
CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. - GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James 47_ Camp, Jr
WELL CONTRACTOR COMPANY NAME ('amp' c Wa11 R Primp fin Tnr
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
303563
- Groundwater Section
CERTIFICATION # 91 111
PHONE 8117M 453-7-122
1. WELL USE (Check Applicable Box): Residential O- MunicipaUPublic 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
N twest Town:
j
(Street Name, i u'mbe-r, Cornn
! 3. OWNER:
Address 11203
kIL
signet or
Cary or 7rwn Stare Zip Code
Area code- Phone numb
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YESJJ NO I\
i(
FT,
.--``Topographic/Land setting
County '11& laltidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
7. STATIC WATER LEVEL Below To of Casing: g: 'V
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS 1 FT. Above Land Surfaces
`Top or casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 0 MrlieD OF TEST p i r
10. WATER ZONES (depth). `•[ J
11. DISINFECTION: Type f'h l nri n n Amount
12. CASING: Wall Thickness
Depth ma Diameter orWeight/Ft. Material
Frottt_o To_. OSI_ Ft 6 1/ 4 S DR 21 PVC
From To Ft.
From - To Ft.
13. GROUT: Depth Material Method
From 0 To 30 Ft. tipat ant Ha
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:
uni , Subdivision, Lot No., Zip Code)
ec t rce Co.
Route No.) Old N t P viftAc KV 5t
�� 3 7743 I
(degreeslminures/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING J.Ofi
Froom , lQ Rrma(io�Descrip[ion
' �.l nil
LOCATION SKETCH
Show direction and distance in miles from at leas
two State Roads or County Roads. Include the ro
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCLED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS VEEN PROVIDED TO THE WELL OWNER
. r -) -6/
SIGNATURE OF PERS N CONSTRUCTING THE WELL �� w
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
kit
RI

•
299955
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
MILLER CREEK COVE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BENSON HODGE
Address MILLER CREEK COVE
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 625-0475
Area Code Phone number
4. DATE DRILLED 03/23/04
5. TOTAL DEPTH: 47
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 131
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):
County RUTH
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.
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 27 To 47 Ft. 78M GRAVEL
From _ To _ Ft. _
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ slope ❑ Valley ❑ Plat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From
T�
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
MAPLE CREEK RD. FROM RUTHERFORDTON.
GO PAST ASPHALT PLANT. DRIVE ON LEFT JUST
BEFORE BRIDGE. MILLER CREEK COVE.
0
a
-D
.70
t
N
-D
W
0
N
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC 1ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS,DA�AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1i n� t� _ %nl.cL 6/
SIGNATURE O PERS C S 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

298953
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural ❑'
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH
KNOLLS DR - LOT #1
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JEFF & DEBORAH CANDLE
Address KNOLLS DR.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(864) — 814-0083
Area Code Phone number
4. DATE DRILLED 03/18/04
5. TOTAL DEPTH: 55
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IZ
7. STATIC WATER LEVEL Below Top of Casing: 35 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 55 Ft. 24" CEMENT
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CEMENT
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From 35 To 55 Ft. 78M GRAVEL
From To_Ft. ____
Method
POURED
in. _ in.
in. in.
16. REMARKS:
Topographic/Land setting
0 Ridge 0 Slope 0 Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
0
G7
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #221 S. FROM RUTHERFORDTON. RT. ON
HICKS GROVE RD. RT. ON MCABEE RD. RT. ON
OAKCREST. LEFT ON KNOLLS DR 1 ST DRIVE
ON LEFT.
0
-13
N
-D
0
N
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
o
�a
SIGNATURE PER CONSTRUCTING THE WELL
DATE
3-/09- 6/
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jan' eS ru Camp, Jr
298531
CERTIFICATION # 71 3 R
WELL CONTRACTOR COMPANY NAME ramp' c Wa11 R primp Cn Tnn PHONE #ffi7R) d53_7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential E Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use V V .
2. WELL LOCATIO
Neare
W AUcQ
County 'tut-J
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:I 0 N`
Address 4; C
Fl+.l t-4Aaw (Stree or Route No.)
s_c
City
er Town State
(Al — CM/
Zip Code
Area code- Phone number 1
4. DATE DRILLED A- y. 0 L
5. TOTAL DEPTH: 'A U S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
7. STATIC WATER LEVEL Below Top of Casing: b0 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 accordm ffetab 15A NCAC 2C .0118.
9. YIELD (gpm): oL S METHOD OF TEST
10. WATER ZONES (depth): 3 to S
a i L
11. DISINFECTION: Type Oh 1 n r i n
12. CASING:
Depth Diameter
From_ To Ft. 6
From To Ft.
From To Ft.
13. GROUT: Depth
From-0__ To 2 0 Ft.
From To Ft.
1/4
Amount 1 G.ue
Wall Thickness
or Weight/Ft. Material
Topographic/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)
DRILLING LOG
_ otAwtion Description
DEPTH
From To
n 0
%) `t l7 S CA -tut...*
1.
cp
0
3
a c2
LOCATION SKETCH
Show direction and distance in miles from
two State Roads or County Roads. Include
numbers andcommonroad names.
SDR21 PVC n
L
Material Method
Neat Ccmcnt Hand
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in,
15. SAND/GRAVEL PACK:
Depth Size Material
Froth To Ft.
From To Ft.
Slot Size Material
in.
in.
16. REMARKS:
q<
�21
t�east n o
e roag D'
IV rn�
r
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
^ v SIGNATURE OF PERSON CONSTRUCTING THE WELL
Wuuir
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)

29 27
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Tames TB/ Caine, Jr CERTIFICATION# 21 38
WELL CONTRACTOR COMPANY NAME ramp s Tani 1 R Pnmr Mn Tne PHONE I$➢81 4S 3_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 0 If Other, List Use
2. WELL LOCATION:Rd/I/ r
Nearest TownK e. : i-A L'County ✓
t.o1- 34 e'YILrY7 PA/S
(Street Name, NumbersCommunity, Su
/ubbd�division, Lot No., Zip Code)
3. OWNER: n-ke51 de naltdPYS
Address P 0 Ro X 5'/7
f Street or Lit -re L-Scr e Route () 2 0 4-6.
City ar Town State Zip Code
( Area code- Phone number ,I�
4. DATE DRILLED It a - D 7
5. TOTAL DEPTH: 6.14 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: J%0
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS t FT. Above Land Surface•
*Top of casing terminated at/or below land surface requires a
• variance In accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): , Z METHOD OF TEST a i r
10. WATER ZONES (depth): `t' ' S
1l. DISINFECTION: Type PM nrI nn
12. CASING:
Depth g Diameter
From 0 To I o O Ft. 6 1/ 4
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From_ To
From To
15. SAND/GRAVEL PACK:
Ft.
Ft.
Diameter
Ft. in.
Ft. in.
Amount I cap
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Material Method
Neat Cement Hand
Slot Size Material
in.
in.
Depth Size Material
From To Ft.
Frortt To Ft.
16. REMARKS:
dopographic/Land setting
ge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box),
DEPTH DRILLING LOG
From To
n I go
Igo 945
Formation Description
rr4ra lk!. r�"
Ylso/I aced rock
O
4-
c
a
n
E
De Cm
7O Cn
rn
zm
� n
LOCATION SKETCH >a A
Show direction and distance in miles from at list a V , --t,
two State Roads or County Roads. Include theftoad mci ZIA
ml
numbers and common road names.
siko
!D
O HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT,J- OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURFJQF PERSON CONSTRUCTING T
.3-Id -off
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

298525
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J ma s '& Cnrmft Jr
WELL CONTRACTOR COMPANY NAME f'AmpI c Win 11 & Primp en T n r
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 02 Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO j j y
Nearest Town: eY YO aunty (Ptll keY`}o Tel
jcciIn PYS &a/1
(Street Name, Numbers, Community,Subdivision, Lot No., Zip Code)
3. OWNER: «h e � I S Du tt!' a tt
Zip Code
Area code- Phone number ,
4. DATE DRILLED '55"- i — D `+
5. TOTAL DEPTH: ,SLR S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 60
(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): ,200 METHOD OF TEST air
10. WATER ZONES (depth): .200
Address 1135 ftuo y a2. I S
(Strp 11)avL Rout NN) C 2g 13'1
u e✓-�oY i
City or Town State
11. DISINFECTION: Type rib 1 nri nr' Amount I cap
12. CASING: Wall Thickness
or Weight/Ft. Material
Depth . Diameter
From et Tojej___ Ft. 6 1 / 4_
From To Et.
From To Ft.
13. GROUT: Depth Material Method
Frorn_a__To 20 Ft. Neat Cement Hand
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
�9F21 PVC
CERTIFICATION 8 2 1 4 A
PHONE# gI2R1 d51_7122
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Fla
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRTT LING LOG
Formation Description
(23 P-85 (AVtSo(ida_ e 1 C
DEPTH
From To
n G3
c
O -c
0
z c7J
c
t▪ D ▪ n
-c
0
LOCATION SKETCFt =�
Show direction and distance in miles from afliast cA t4
two State Roads or County Roads. Include ther-roacC
numbers and common road names. tT
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC1hD 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 CON CTIN THE WELL
-17 4
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

3. OWNER: IKX
298524
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 Vt Camp,.Tr CERTIFICATION 71 iA
WELL CONTRACTOR COMPANY NAME Camp' e; Wa11 & Pttmp r'n • Tnr PHONE #$7R1 d53-7322
STATE WELL. CONSTRUCTION PERMIIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Ifl Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELLLOCATIO
Ne st T �l L(
YE,) eta
(Stint Name, Numbers, Community. Subdivision.
Address ItelASut ci
USveeror RouCNoJ
County
Lot No., Zip Code)
..0 9 1 `t -)
City or Town State Zip Code
Area code- Phone number9 -, O 0
4. DATE DRILLED c
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YE 1 0 NO Di
7. STATIC WATER LEVEL Below Top of Casing: `i c) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
-variance In accordapcA with ISA NCAC 2C .0118.
9. YIELD (gpm): a U MF T1 OD OF TEST
10. WATER ZONES (depth): 1 ) 0
4J r
11. DISINFECTION: Type r h 1 n r I n p Amount (,( i4P
12. CASING: Wall Thickness
Depth. Diameter or Weight/Ft. Material
From�_To l �a Ft.6 1 / 4- 1.1114-31
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
Frorn_o_ To 20 Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
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 pRILLING LOG
From To Formation Description
11O Zt15 ), Unts-Ja
Neat Cement Hanis-
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
Ft.
Ft.
Size Material
r--I
a
LOCATION SKETCH
Show direction and distance in miles from at le%t
two State Roads or County Roads. Include the i
numbers + d e. .j on road names. I p
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 TH
NAT PERSON CONSTRUCTING THE WELL DATE.tei‘Aj")
Submit 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

298523
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ja mag c.i_ Camp, Jr CERTIFICATION # 21 9A
WELL CONTRACTOR COMPANY NAME ramp' q WEs11 & Pnmp Cn T n r PHONE #$2A) d5'i-7322
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential L)d Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
Nearest 2. WELL LOCATION:
�hP Yyzt ( ✓d opographicJLand setting
Town: L.A.X.C. J tV CountytA gc ❑Slope ❑Valley ❑Flat
lot 9Z -71te Pee,ks
(check appropriate box)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) Latitude/longitude of well location
3. OWNER: 4 /�C.5; d RA I I (lfe r5
Address b 130 X S4:9
G L(StreetureI�.t or Route J C- 02 g 9 4 � k�
City or Town State
Area code- Phone number
4. DATE DRILLED 3 - q - 04
5. TOTAL DEPTH: 5 D
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO X
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1, FT. Above Land Surface*
- _ `Top of casing terminated at/or below land surface requires a
variance in accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): /0 METHOD OF TEST &ir
10. WATER ZONES (depth): 9'75
11. DISINFECTION: Type rh 1 nri na Amount i /A cap
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From p To 3O Ft. 6 t / 4 cDg21 PVC
From To Ft.
From______ To Ft.
13. GROUT: Depth Material Method
From p To 20 Fi• N c t Cement Hs
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From_ To Ft. in in.
From To Ft. in. in.
Zip Code
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Size
Material
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To ,Formation D scription
3o ni/fSah
30 Dior GcX50lidet edjori,
-o ric
rn
a 0
LOCATION SKETCH -
Show direction and distance in miles from at least
two State Roads or Co ty Roads. Include the road
numbers and common names.
GA
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFr r
CONSTRUCTION STANDARDS, A THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SATURE OF PERSON CONSTRUCT!
3-17-a�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

3. OWNER:
Address
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James w
WELL CONTRACTOR COMPANY NAME Camp'
STATE WELL CONSTRUCTION PERMITS
(if applicable)
Camp, Jr.
R Pump f'rL
ASSOCIATED WQ PERMIT,/
(if applicable)
Wp11
Tnr
298522
CERTIFICATION,/ 21 "i R
PHONE,/$9R) ac3-7322
1. WELL USE (Check Applicable Box): Residential it Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELLLOCAT O ++��� yy��
Ne es Town: 1. A acza& CountY-1
Cu
(Street Name, Numbers, Community, Sub��sion, Lot No., Zip Code)
s
oa:
l F�P.1
(Sweet or Route No.)
AM C
A.Ir ,Y (At-
�t
C)Cryty T �n 1 State ,1 Zip Code
Area code- Phone number
4. DATE DRILLED 3'4-IS- O ("
5. TOTAL DEPTH: S 0 S
6. DOES WELL REPLACE EXISTING WELL? Y S 0 NO fl
7. STATIC WATER LEVEL Below Top of Casing: i S FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS 1 FT. Above Land Surface"
' *Top of casing terminated at/or below land surface requires a
-variance in accord ce with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST n 1 r
10. WATER ZONES (depth): y5U
11. DISINFECTION: Type cm l n r I n p
12. CASING:
Depth Diameter
From_a_ To 1 Q Ft. 6./ 4
From To Ft.
From_ To Ft.
13. GROUT: Depth
From__(_ To 2 0
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
Ft.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount i (1w
Wall Thickness
or Weight/Ft. Material
SDR2I PVC
Material Method
Neat Cement (land
Slot Size Material
in.
in.
16. REMARKS:
Topographic/Land setting
daCdge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To F rrmatipn Description
n ZO
CA-0.AJzi
).00ATION SKETCI-j
Show direction and distance in miles from at least-o
two State Roads or County Roads. Include the road
numbers and common ro names.
wAY 6+
lit,l'�2iY.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTND IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
G
krn r C
SIGNATURE OF PERSON CONSTRUCTING THE WELL
3 . i c. cry
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

298521
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ta min uL Camr 7r CERTIFICATION', 711R
WELL CONTRACTOR COMPANY NAME Ciampi WP.11 R pnmr f'n Tnr- PHONE #$7R) d51-7122
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT',
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WNELL LOCATl N:
9
Neazest own: 4 'L)r County RtL eY ✓
✓Pv eve its C K.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
li
3.OWNER: IOhit Ctee 6llSlklt
Address lla fi C/reit
(Street or Route No.)
City or Town State
�- 4-A— 3-50
Zip Code
Area code- Phone number
4. DATE DRILLED 3 "/ ok
5. TOTAL DEPTH: "'g0cr )�
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: /"r`,_
(Use "+" if Above Top o Casing)
8. TOP OF CASING IS i FT. Above Land Surface"
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): I METHOD OF TEST a ir
10. WATER ZONES (depth): I g5
11. DISINFECTION: Type rhl nri na Amount 1 Gt.tp
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From_q To I.3C Ft.6 1 / BR21 PVC
From To Ft
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. Neat Cement Ha
From To Ft.
14. SCREEN: Depth Diameter Slot Size Materiel
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Tope :npihic/Land setting '
❑Ridge EDSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation D scription
CDV(5Dlidate d rock
PEPT$
From To
13c t33S
0c
0
O O
y c�
m 72� Cn
—
rn L
a
LOCATION SKETCH a"
Show direction and distance in miles from at leasD, ' k
two State Roads or County Roads. Include the rtlad
numbers and common read napes., Q
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, Ate) THAT A COPY OIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S�;NATURE OgERSONc 0 ACTING 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

298519
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ja m s to Camp Jr CERTIFICATION # 711R
WELL CONTRACTOR COMPANY NAME f'.amp' a Wa11 & Pump rn Tnc PHONE #$7A) 4 S -7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential V Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: e. L iA Y e-
)0t /1 - /eaK6
(Street Name, Numbers, Community,
Subdivision, Lot No., Zip Code)
E
3. OWNER: -rl kf'S10e t'tkl)Ae rC
Address PP 1 n X ''i4'1
County RuIher'bYd
(Street or 7.oute No.)
%tiG %ure NLr ,2114t.
City or Town State Zip Code
( )- ash -aldo
Area code- Phone number
4. DATE DRILLED 3' Ns — D ti
5. TOTAL DEPTH: AD
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 181
7. STATIC WATER LEVEL Below Top of Casing: 2C 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 hi accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): :2 O METHOD OF TEST Air
10. WATER ZONES (depth): ) Sl'O
11. DISINFECTION: Type r h 1 n r i n p
12. CASING:
Depth Diameter
From n To *'D Ft. 6 1 /
From To Ft.
From - To Ft.
13. GROUT: Depth
From_p To 2 0 Ft.
From To Ft.
Amount 7a Ct4/1
Wall Thickness
or Weight/Ft. Material
e•DR31 PVC
Material
Neat Ccmcnt
Method
Hand
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
Froth To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
/ Topographic/Land setting I.
IRidge ❑Slope ❑Vallcy ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DEPTH RIM INGLOG
From To Formation Description
0 l;it? ayet de!
80 ?.D5 Cohsol;r,A-1p Yo/k
G
O
�m
c
C'=
G='
v,Q
•;›i
gym/
LOCATION SKETCH
Show direction and distance in miles from at leastr'.)
two State Roads or County Roads. Include the roads
numbers and common road names. 65-1
r
X Lir
19
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, ANR THAT A COPY OF THIS RECRRD HAS BEEbj PROVIDED TO THE WELL OWNER
j8.,o
Q,4_
•
!1
SIGNATURE OF PERSON CONSTRUCTING THJE 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.

From: Carolina Wet Dr4iers, Inc To: NC Dept cf Env. and Na Resour
Date: 3/10t2CC4 Time: 7:13:10 PM Facie 1 of 5
2981t0
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GANTT CERTIFICATION # 2?8-.
WELL CONTRACTOR CON:PANV NAME CAROLINA WELL DRILLERS. INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) �E applicable)
1. WELL USE (C e -.p9..cib!e Boai : Residential ❑ Municipal ❑ Industrial El Apiculture! El Mar,imt
Recovery ❑ Heat Pump Water Injection ❑ Other D If Other, List Use:
L WELL LOCATIC`.-
Nearest town: RLTHERFCRDTON
1042 GILMER EDA`VARDS RD
County RUTHERFORD
(Street Name, Numbos. Cneersmity. Subdisie:on Lot No,. Zip Code)
Topog-aphic!Lard settir.0
❑ Ridge ❑ Slope ❑ ti a' ey ��1 Fsr
Lai:.: de/Longitede of well lac-aio::
3 OWNER HORTON iICME OF RUTHERFORDTON (degrees/minutes/second, '
ADDRESS 342 HVIY 74 BYPASS Latirede lenaimde source: UPS [ Town';"- rt_
4.,:-...,.0o_eNo., - -. .. D GL:\CI L..G
RUT'HERFORDTQ': NC 28139 Froth To Form, -- -
Ciry or Tone Stale Zip Code 0 4o Cue.
828-287-3366 _„ 382
Area Code - Phone Nurser
4, DATE DRILLED 2r 224,04
5. TOTAL DEPTH 380
5. DOES WELL REPLACE EXIS T L\G WELL?
?
7 STATIC WATER LEVEL B m:' Top of Casio:
YES ❑ NO EL
60 FT.
5: _(cve. Top ofCasing)
8. TOP OF CASLNO IS 1 FT. Auntie Land Sadace*
'Top of easing tenninar d aoo: below iv.d su':a.e requires a vzrmnce in
accordance vnrh 1iA N(A -. _...
X)
X) Lni
1/4.—.4
9. YIELD (2pm): 12 :METHOD OF TEST ARDM w
"a'--i •'r-�
l0. WATER ZONES (depth,. 375 _
it. DISINFECTION. TYPE HYPOCHLOR1TE Amount 10 Oz LOCATION SKETCH Cr rn ^'-
m-
12. CASNG: C-I
Wall Thickness Show directie;- ts.d distance in miles Fora a:..:..it. --t
Depth Diameter or Weight/FL Material two State Roads or County Roads. Include tu: ?^::G,
From 0 To 49 Ft. 6 114'' SDR 21 PVC numbers are : TT -non road names.
U. GROUT:
Depth Material Method
From 0 -.. 20 rt GRAVEL MIX GRAVITY
11. SCREEN
Depth Dlaint:CT Slot Size Material
From NA To Ft. in. in
IS- SAND/GRAVEL PACK:
Depth Size Material
From NA To Ft,
15. REMARKS:
GILMER ED`.FA'.DS RD
0,AK SPEC.
1 DO HEREBY (Tail Y 1: TIIIS WELL WAS CONSTRUCTED IN ACCORDANCE 6 1 +Vu.AC 2C, WELL
CONSTRUCTIONS _ `V D ARDS, AND THATA COPY OF THIS RECORD HAS BEEN FROA11L1ED TO TEE WELL O 1 KE-
SIGNATI RE OF PERSON CONSTRUCTNO TIE WELL
2/26/0
Date
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service tenter - Raleigh, NC
27699-1636 Phone No. [phone]. within 30 days.

From: Carolina Well DrJlets, Inc To: NC Dept of Env. and Na Rescur
Date: 3/10/233; Time: 7:13:10 PM - _= 4 o'' E.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) SCOTT GANTT CERTIFICATION € 2_84
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION I'E_RMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
I. WELL USE (Cheer Appl cabin Box) : Residential ® Municipal ❑ Industrial E AE1CLitural ❑ \ leniccala_
Recovery D Heat Pump Water Injection ❑ Other ❑ If Other, List Us.
2- WELL LOCATION
Nearest town: LAKE LURE
MOUNTAIN WAY RE LOT 5
County RUTHERFORD
(Street Name, Numbers, Ccrnmunity, Subdivision, Lot No,. Zip Code)
3. OWNER MOUNTAIN WAY CONSTRUCTION
ADDRESS 721 vlOi. NTAIN WAY RD
(S3c.r o: Rock No )
LAKE LURE
City or Town
NC
State
28746
Zip Code
opog aphic/Lend se:ting
❑ kip ge ❑ Slope ❑ Valle,: r;71 trz-
Latitude/Longitude of well Iceation
35.28.833 / 82.06537
(deges/mlmxs'tecon1C
Latitude .10 jfdria source: ❑ GPS ❑Icooaraplize n zr
�_:-D PTH DE.ILLINGL:'G
From To Focnaa. C_";ri:{,.,
0 35 Clay
828-625-I446 85
Area Code - Phone Nmeiber
4. DATE DRILLED ^_r 19 04
5. TOTAL DEPTH 280
6. DOES WELLREPLACE EXISTING WELL? YES ❑ NO E
7. STATIC WATER LE`. L Beiow Top of Casing: 65
(Use "+" If Abeve Top of Casing)
S. TOP OF CASING IS 2 FT. Above Land Surface*
.1 op of casing tcrminatod .e o. 'oaiow land rurf a reoires a vvianec in
do:or:lance with 15A NCAC a'-0118
L. YIELD (gpm): 5 NED LOD OF TEST ARUM
10. WATER ZONES (depth;'. 275
u. DISINFECTION: TYPE HYPOCHLORITE Amount 7
t2. CASINO:
From 0 To 90 Ft.
13. GROUT:
From 0
14 SCREEN
From in.
Death
Depth.
To 20 FL
280 ConseLdsrn_^a: _
Wall Thickness
Diameter or Weight'[. Material
514" SDR21 PVC
Oz
Material Method
GRAVEL MIX GRAVITY
Depth
NA To
15. SAND/GRAVEL PACK:
Depth
From NA To
1r. REMARKS:
Diameter
Size
Slot Size Material
in.
Material
298168
LOCATION SKETCH
Show direction and distance in miles from s le to
two State Roams or Courry Roads. Inrh_de're r
numbers and coatmon road names. J
cn;
rn ;at
O
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WIPE I5A NCAC 20, WELL
CONSTRUCTION STANDARDS, AND THATA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNS .
2/25, 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.

From: Carolina Well Drillers, Inc To: NC Dept of Env. and Na Resour
Date: 3/10/2004 Time: 7:13:10 PM Face 5 of 5
298167
WELL CONSTRUCTION RECORD
North Carolina - Departr ant 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 ❑ Agricultural ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Newest town: RLTIERFCRDTON
618 T.AYLOR RD
Country RUTHERFORD
Topographic/L and setting
❑ Ridge ❑ Slope ❑ Va-.hv
Lea lade/Longitude of well lcoctia. i
(Street Name, Numbers. Community, Subdivision, Lot No,. Zip Code)
3. OWNER JASON AND PAULA DtiPREE (degreshninutes;secomll'
ADDRESS 157 RIRD ST Latitu : ong rode source: ❑ GPS ❑
(Sven or Route No.)
FOREST CITY
City or Town
DEPTH
NC 28043 From --- To Formatcoe Due ::4Tian
State Zip Code 0 70 Clay
828-245-6802 70 400 Cornolid£Rd Ro.:k
Area Code - Phone Number
4. DATE DRILLED 2 2 . 04
5. TOTAL DEPTH 400
6. DOES WELL REPLACE. Er?STRG WELL^.
7. STATIC WATER LEVEL 3eiow Top of Casing:
YES D NO -
80 FT.
g. TOP OF CASING IS
'Top of casing t nninaed a::
accordance with 15A NCAC
(Use "z" IFAbovc Top of Casing)
2 FT Above Land Surface'
End rorfvc requires a variance in
9 YIELD (gpm): MEfEOD OF TEST ARDM
10. WATER ZONES (thigh; 250 3o5
u. DISINFECTION: TYPE IIYPOCHLORITE Amount 12
t1. CASING: Wall Thickness
Depth Diameter or Weighv FL Material
From 0 To 77 R. 6114" SDR2I PVC
13. GROUT:
0:
(nd
O rn
LOCATION SKETCH a"5
Show direction Eisnd distance in miles from: zt!.en:r 3
two State Roads or COWIN'' Roads. Include Joe west
numbers and cc:nrnon road names.
Depth. Material Method
From 0 To 20 Ft. GRAVEL MIX GRAVITY III---
LLSCREEN
Depth Diameter Slot Size Material aA iNll 1
From NA To P_ in it
L. SAND/GRAVEL PA
LOR RD
Depth Sizz Matz -jai MAPLE CREEK RD
From NA To Ft.
to. REMARKS:
I DO HEREBY CER?1LY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1 `.A NCAC 2C, WELL •
CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
2/23104
SIGNATURE OF PERSON CONSTRUCTD G THE WELL Date
Submit the origin) to the Division of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.

297965
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 Tot: RUTHERFORDTON
HWY.#64 E.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: RONNIE BRADLEY
Address HWY. #64 E.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) - 287-2142
Area Code Phone number
4. DATE DRILLED 02/17/04
5. TOTAL DEPTH: 145
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 15A NCAC 2C .0118.
9. YIELD (gpm): 50 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 3
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 PVC
From
From _
13. GROUT:
From 0
From
14.SCREEN:
From
To 110 Ft. 6-1/4" SDR21
To Ft. _
To Ft. _
Depth Material
To 20 Ft. QUIKRETE
To Ft.
Depth Diameter
To _ Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size
To Ft.
To Ft.
From
From
16. REMARKS:
Method
POURED
Slot Size Material
in. _ in.
in.
Material
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #64 E. FROM RUTHERFORDTON. 1 MILE
ON LEFT AFTER YOU PASS PEA RIDGE RD.
-13
ry
CJ1
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cm
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C1
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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 4 COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
TCJKE An EA__ s��"( /i Q1 r? - / 7 - d `7'
SIG A OF PERSON CONSTRUCTING TEM 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

297963
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: FOREST CITY
LEE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JESSE BOONE
Address LEE RD.
(Street or Route No.)
FOREST CITY NC 28043
City or Town State Zip Code
(828) — 223-9764
Area Code Phone number
4. DATE DRILLED 02/25/04
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): 60 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 7.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 60 Ft. 6-1/4" SDR.21 PVC
From To Ft. _
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To _ Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ 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
GO OUT HUDLOW RD. FROM FOREST CITY.
CROSS THE BRIDGE & GO APPROX. 1 MILE.
RIGHT ON LEE RD. 9/10 MILE ON LEFT.
ZS :Z Wd Z— b`W 10
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crn
rn
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2
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS RUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PE ON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

297962
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING. LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
GRANDVIEW RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MITCHELL KIRKLAND
Address GRANDVIEW RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 287-9976
Area Code Phone number
4. DATE DRILLED 02/24/04
5. TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 121
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 4.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 90 Ft. 6-1/4" SDR21 PVC
From To Ft. _
From _____ To_Ft.
_
13. GROUT: Depth Material
From 0 To 20 Ft. QULKRETE
From To Ft.
14.SCREEN: Depth Diameter
From To Ft. _
From To Ft. _
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
POURED
Slot Size Material
in. _ in.
in. in.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/ongitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in stiles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 W. FROM RUTHERFORDTON. LEFT
ON UNION RD. RT. INTO GRANDVIEW RD. (2ND
PAVED RD.) LAST DRIVE ON LEFT.
Z S :Z Wd Z— dVW h0
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 1 — y 0/
SIGNATURE OF PERS 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

29'7861
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERIJFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
WIDD LAWING TRAIL
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: TOM STOVER
Address WIDD LAWING TRAIL
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 429-9174
Area Code Phone number
4. DATE DRILLED 02/23/04
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): 50 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 5.5
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
From 0 To 20 Ft. QUIKRETE
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To _ Ft. in. _ in.
From To Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
POURED
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 conunon names
HWY. #221 N. FROM RUTHERFORDTON. RT. ON
LAWING MILL RD. RT. ON WIDD LAWING TRAIL
STAY STRAIGHT AT END OF PAVEMENT. 1ST
DRIVE ON LEFT.
zS:Z Wd z-bitesh0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
,2-8-e-c— ` �rr� a a 3-6 sI
WELL DATE
SIGNATURE OF PERSOid CONSTRUCTING
Submit 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

2978r9
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
COVE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: NEAL BENNICK
Address 1094 COVE RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 287-3837
Area Code Phone number
4. DATE DRILLED 02/10/04
5. TOTAL DEPTH: 405
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 RUTH
11. DISINFECTION: Type CHLORYTE Amount 10.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 80 Ft. 6-1/4" SDR21 PVC
From _ To _ Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Lalitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #64/74A W. FROM RUTHERFORDTON.
RT. ON COVE RD. APPROX. 2 MILES ON RT.
c
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0
ern
yo
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G
z
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCIED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSO CONSTRUCTING THE WELL
?�., ,r-/6-Df
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

297858
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERI IFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1.
WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: BOSTIC
PEA RIDGE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BENSON FREEMAN
Address PEA RIDGE RD.
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code
(828) — 245-7388
Area Code Phone number
4. DATE DRILLED 02/23/04
5. TOTAL DEPTH: 305
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): 10 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 7.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 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
From To
15. SAND/GRAVEL
Depth
From _ To
From To
16. REMARKS:
Ft.
Ft.
PACK:
Size
Ft._
Ft.
in.
in.
Material
nL
in.
Topographic/Land setting
0 Ridge 0 Slope 0 Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) .....
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
BUS. 74 E. FROM FOREST CITY. LEFT ON
BOSTIC/SUNSHINE HWY. LEFT ON PEA RIDGE
RD. IN BOSTIC. APPROX. 4 MILES ON RT.
0
a
N
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1V
N
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC1ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS UCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE 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

297857
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: UNION MILLS
PINEY KNOB RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ALLISON GRISSOM
Address PINEY KNOB RD.
(Street or RouteNo.)
UNION MILLS NC 28167
City or Town State Zip Code
(828) — 289-5920
Area Code Phone number
4. DATE DRILLED 02/19/04
5. TOTAL DEPTH: 365
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 10 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
"Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 9
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 40 Ft. 6-1/4" SDR21 PVC
From _ To _ Ft. _
From _ To _ Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QULKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To Ft.
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/seconds)
Latitude/longitude source: 0 GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #221 N. FROM RUTHERFORDTON. LEFT
ON SCHOOLHOUSE D. LEFT ON PAINTERS GAP
RD. LEFT ON PINEY KNOB RD. 2/10 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
SIGNATURE OF PER ON ONSTRUCTING 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

297956
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: LAKE LURE
12 MILE POST
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JAMES HERZOG
Address LAKE HAVEN DR.
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
(828) — 429-4130
Area Code Phone number
4. DATE DRILLED 02/16/04
5. TOTAL DEPTH: 405
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 6 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 10.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 110 Ft. 6-1/4" SDR21 PVC
From To Ft. _
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
in.
in.
From _ To _ Ft. in. _
From _ To Ft. in. _
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. _
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge 0 Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #64/74 W. FROM RUTHERFORDTON.
LEFT INTO 12 MILE POST ONTO MCOWENBEN
PASS. GO APPROX. 1 MILL LEFT ON LAKE
HAVEN DR. APPROX. 2/10 MILE ON LEFT.
C.71
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSJ(tUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF ERSON CONSTRUCTING LL
DATE
U
Submit 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

297'351
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: LAKE LURE
BILL'S CREEK RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: GUNAR HARRIS
Address BILL'S CREEK RD.
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
(828) — 625-4570
Area Code Phone number
4. DATE DRILLED 02/04/04
5. TOTAL DEPTH: 245
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 80 Ft. 6-1/4" SDR21 PVC
From _ To _ Ft.
From _ To _ Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. QUIKRETE
From To Ft.
14.SCREEN: Depth Diameter
From _ To _ Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
POURED
Slot Size Material
in. _ in.
in. in.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #64/74A W. FROM RUTHRFORDTON. RT.
ON BILL'S CREEK RD. 1/4 MILE ON RT. PAST
ELLIJAY TRAIL. APPROX. 7 MILES FROM 64.74A.
0
a
N
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC PhD IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS AND THAT A C PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PE ON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mail Service Center— Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

297952
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
HUDLOW RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MARK CURRY
Address HUDLOW RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
8(28) — 289-8526
Area Code Phone number
4. DATE DRILLED 02/24/04
5. TOTAL DEPTH: 78
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 1 SA NCAC 2C .0118.
9. YIELD (gpm): 18 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 8.28
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 78 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 60 To 78 Ft. 78M GRAVEL
From _ To _ Ft. _
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #64 E, FROM RUTH. LEFT ON HUDLOW
RD. APPROX. 1-1/2 MILES ON RT. 1ST DRIVE PAST
#3450.
N
CJ1
N
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC1 ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CO l UCTION STANDARDS, AND THAT A COPY OF tt 1 S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
i" TORS i� .:i�n.o a �' D1
Si
SI NA OF P CON ' UCTING T� 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

297851
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: LAKE LURE
ISLAND CREEK RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JERRY CONDREY
Address ISLAND CREEK RD.
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
8( 28) — 453-8560
Area Code Phone number
4. DATE DRILLED 02/20/04
5. TOTAL DEPTH: 27
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 15A NCAC 2C .0118.
9. YIELD (gpm): 7 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 3
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 27 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 FL in. _ in.
in. in.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size
From 20 To 27 Ft. 78M
From To Ft.
16. REMARKS:
Material
GRAVEL
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. RIGHT ON
ISLAND CREEK RD. FIRST DRIVE ON RT. PAST
ENTRANCE INTO THE PEAKS.
N
r1
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS AND THAT A COPY F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�P � �i �r� o "c) o U f�
t/St2_tt
NAOF CONSTRUPCWELL
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

29'7850
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
3461 US HWY.64
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: JEFF DUNN
Address 3461 US HWY. 64
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 288-5629
Area Code Phone number
4. DATE DRILLED 02/20/04
5. TOTAL DEPTH: 82
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
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*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County RUTH
Zip Code)
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 82 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 62 To 82 Ft. 78M GRAVEL
From_ To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge 0 Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #64 E. FROM RUTHERFORDTON. DRIVE
ON LEFT JUST ABOUT 2/10 MILE BEFORE PEA
RIDGE RD.
0
N
-o
3
N
01
N
I DO HEREBY CERTIFY THAT TES 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 'ERSO
G 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

297949
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
ED THOMPSON RD.
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: JEFF ENSLEY
Address ED THOMPSON RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 429-2685
Area Code Phone number
4. DATE DRILLED 02/19/04
5. TOTAL DEPTH: 42
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 22 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County RUTH
Zip Code)
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/F[. Material
From 0 To 42 Ft. 24" CEMENT
From To Ft. _
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft CEMENT POURED
From To Ft.
14.SCREEN: Depth Diameter
From To _ Ft.
From To Ft. _
15. SAND/GRAVEL PACK:
Depth Size
From 22 To 42 Ft. 78M
From To Ft.
16. REMARKS:
Slot Size Material
in _ in.
in. in.
Material
GRAVEL
Topographic/Land setting
❑ Ridge ❑ Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #64 L FROM RUTH. RT. ON ED
THOMPSON RD. na, CAIN CREEK STORE. 2/10
MILE ON RT.
0
a
N
'9
cn
N
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC I ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
_�� ; % ja
` , d i �.�. �� ...� -/ g- o f/
SI NATURE F PE STRUCTING 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

297848
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: FOREST CITY
NORTH WOODLEAF RD.
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: DALE CAUSBY
Address NORTH WOODLEAF RD.
(Street or Route No.)
FOREST CITY NC 28043
City or Town State Zip Code
8(28) - 248-2024
Area Code Phone number
4. DATE DRILLED 02/17/04
5. TOTAL DEPTH: 49
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 29 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County RUTH
Zip Code)
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 49 Ft. 24" CEMENT
From To Ft. _
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft _ in. _ in.
From _ To _ Ft. _ in _ in.
15. SAND/GRAVEL PACK:
Depth Size
From 29 To 49 Ft. 78M
From To Ft.
16. REMARKS:
Material
GRAVEL
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. 3221 S. FROM RUTHERFORDTON. LEFT
ON NORTH WOODLEAF RD. 5TH DRIVE ON LEFT.
0
N
-o
N
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THI,,S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGWATURE F PE
iN
�i i�(0-7 rig e9 - 7 7 - U1/tSTRUCTING 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

297847
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: BOSTIC
S. MOUNTAIN RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CHRISTINE YOUNT
Address 321 S. MOUNTAIN RD.
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code
(828) - 245-5657
Area Code Phone number
4. DATE DRILLED 02/11/04
5. TOTAL DEPTH: 34
6. DOES WELL REPLACE EXISTING WELL? YES Z NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 22 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 12 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 5.52
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 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
From 22 To 34 Ft. 78M
From To Ft.
16. REMARKS:
Material
GRAVEL
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
BUS. 74 E. FROM FOREST CITY. LEFT ON
BOSTIC/SUNSHINE HWY. TO THRU BOSTIC. RT.
ON S. MOUNTAIN RD. BRICK HOUSE 3/4 MILE ON
LEFT. (321 ON BOX)
0
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I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
rJ SIGNATURE 0 PERS 0� //- U V S CTING THE WELLDATE
Submit 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

297845
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of' Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
CARPENTER RD.
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: KEVIN & DEBORAH STONE
Address CARPENTER RD.
(Street or RouteNo.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
8(28) - 287-3881
Area Code Phone number
4. DATE DRILLED 02/10/04
5. TOTAL DEPTH: 44
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 24 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County RUTH
Zip Code)
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING:
Depth Diameter
From 0 To 44 Ft. 24"
From To Ft.
From To Ft.
Wall Thickness
or Weight/Ft. Material
CEMENT
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 24 To 44 Ft. 78M GRAVEL
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #221 N. FROM RUTHERFORDTON. LEFT
ON DARLINGTON RD. RT. ON CARPENTER RD. 1-
1/2 MILES ON LEFT.
0
c
N
N
C/1
0)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCT JED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-711IGNO ON CONSTRUCTINGTHE WE DATE / 6 _ 6 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

297844
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: UNION MILLS
OWENS CHAPEL RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DARYL SIMS
Address OWENS CHAPEL RD.
(Street or Route No.)
UNION MILLS NC 28167
City or Town State Zip Code
(828) — 286-8939
Area Code Phone number
4. DATE DRILLED 02/04/04
5. TOTAL DEPTH: 66
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IZ
7. STATIC WATER LEVEL Below Top of Casing: 51 ET.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 6.9
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 66 Ft. 24" CEMENT
From To Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ im _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 51 To 66 Ft. 78M GRAVEL
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 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #221 N. FROM RUTHERFORDTON, RT. ON
OWENS CHAPEL RD. NEW DRIVE, 1 MILE ON RT.
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
���� p 1 _
er -ram L SIGNA OF P CO T G THE WEL��I��i D DATE
T
Submit 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
N.mh Co.! In.: - i)epu«.ncnl of en\ ironmcrn and Naiad)
Rcsourres • 'sir
\\ to 1. ( rl\ 1 tl \( ton (I\UI\IU( \t I \ \Mk. ,printl.....({1rtt `��.Y�/
tAtl_I t' UA,h V t _t Mt CUAIP1FV A1AI1. 1�Y.�y LOSS
\ \rl NI. I- L1. (O\\I RI CI)O\ 11:R31Il.
ta;n,li.
n540
298101
,on of Water Quality - Circundwater Nec.tior•,
LPI t(a\E, •�iir zz2„,
!Al FU\\ Q PER
.v APp'.:cAbltl
task::i. heck .\p; Iicnble Li;_\r. Reeldenl,al /Mtnu::pal PutHie 0 Industrial 0 ?gricultural
Ce.u-•+um C k:ce.o. \ 0 Heat Pump Wrier Inp.xuon C fhhcr +EI I' Othee, List Is Sc.__ ._._._._...__.__
o� z maeqe
. , 4, u. t, \: r.. C anu. Sur+V. ..^w Lo11:u. G•, C v•_•
OWN is; '!—rl3.V,)1^ ....._.
Qv\\1I\l 4/iCtg?39
Te ogaphis Land •etung
JRidgc aSl pe ❑\ ilI-y —efts:
1(112.ksPP r';,na: n r
Lautudell(tlgituda of ue11 location
1 dcgi t 1 t.„es Seb d. i
Lutdu.l .ItmgnudC lulu( C)( l SOTt,poltraph,c nun
ehe k bus,
Will LING 1..11t5
I titillation I.;e %I-Ipl:Orl
U FPTH
Fl on; ell
u Yi11D(gpoti ____Mh,HODOFTE _�_(0 4tlt__�x 1 � n T ! l _ � � Uy'
K
(;.\t. AT k.R ZONES depth, _Ls 0. Z ___ ._.. _......-, _....,
-- Shuw (';ration and dr'wn.r i1 rl tta1" 1: n'
' I I?ISi NI H� TIU\. Type—=l-$ � .Amount - - IN".! itLite Reads or ('u,n•) kolis. Ir;.lu.., 1 • r•.ud
Dora; I. amctc �r \6c�,ght''. 11rr'• 1; cumbt's Lei common Ina: r,auler.
E(,"1 Q i „ 'Y3 °1 14. PrI
: UN(>l. f' D pIh v!,::a tvtrh.,.
t. II)I \t DEPTH. L .&
6 DOES WELL REP LACE EXISTING N ELL" YES NO
i \C Al ER I.EVE'L. Below Top o1 Casing. __
`` 'L. se" tit Anon: cup or I *sing.
k 1(JP OF(:ASINC1 IS __. ..._1...._ i`I Aho,c Lan rt Sor%ce•
•1n•: to casing tcrmin aced ar'or blow ;sod su rfise requires •
II rIA nca In auo,ga'x non I!.1, ?C \C 2C 0118.
Iu Si P t I- NI Uertll D:.1;11:Icr S. -ze Alanes!!
Frain_-__ 1'e_-. 1:.-.. _... In. _... _._. in ._____....
S �\NI) (.RA': El. F'\\'Is: -_'___
D:;'n S .. \Ia1 rial
i r 1 .1. It ,
AL'.M.LS
I IS• Ilt.b'B'APIF_!il1FATHAT
'
1`•S ;i ,.l.I It)A'VIAND Ai
O
a
CO
a
I.3 —ter
i;S\\ELI \IvASCl.DSIkit I ED IN Al.(UROA\CE-tt ITH I!4 NI:\C '_C'. \\ELLa7 -6
-
ND THAT \ ('Ofi 1)r THIS ReCORD HAS 13e N PRO\ IDED I 0 I HE'\i EL_. UV. aZ
5- ci
.
•:I. •NA1 .. r.F !..le/ IIERSON L ONS 11(CC i INC.i\l: 'Ht. \\ LLL >At
-
Sub:ni( the original to the Pi\ rtlun or \\ Rler Qualit), Gruundaater Section, 16161Iai1 Senict ( coot Real
E egh, 2(Ili l
J699-11'An rI.on. Ni.•19191 �1'.32:1, wslhin 1G da\c.

From: Scott & Jo Ann To: Division of Water Quality Date: 7/21/2004 lime: 9:02:26 PM
Page 2 of 3
(if applicable)
1. WELL USE (Check Applicable Box) : Residential El
Recovery ❑ Heat Pump Water Injection 0
2. WELL LOCATION:
Nearest town: RUTHERFORDTON
1513 HWY 108
WELL CONSTRUCTION RECORD n J 9 4 �' 8
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) SCOTT CANTT
CERTIFICATION # 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable)
Municipal ❑ industrial ❑ Agricultural ❑
Other 0 If Other, List Use:
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER RICHARD ASHE
ADDRESS 1513 HWY 108
(Street or Route No.)
RUFHERFORDTON NC 28139
City or Town State Zip Code
828-287-9962
Area Code - Phone Number
4. DATE DRILLED 6/16/04
5. TOTAL DEPTH 340
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing:
YES X❑ NO ❑
15 FT
(Use "+" If Above Top ofCusing)
8. TOP OF CASING IS 2 FT. Above Land Surface"
'Top of casing terminated aUor below land surface regnba a variance in
accordance with 15A NCAC 2C.0118
9. YIFJ D (gpm): 8 METHOD OF TEST ARDM
10. WATER ZONES (depth): I I 0 320
Monitoring 0
Topographic/Land setting
❑ Ridge 0 Slope 0 Valley ❑ Flat
Latitude/Longitude of well location
35.20.960 / 82.00-142
(degrees/minutes/seconds)
Latitude/longitude source: ® GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 10 Clay
10 340 Consolidated Rock
u. DISINFECTION: TYPE HYPOCHLORITE Amount 15
12. CASING:
Depth
From 0 1'0
13. GROUT:
Depth
From 0 To
14. SCREEN
Wall Thickness
Diameter or Weight/Ft. Material
33 FL 6 1/4" SDR21 PVC
Of
Material Method
20 Ft. GRAVEL MIX GRAVITY
Depth
From NA To
15. SAND/GRAVEL PACK:
Depth
From NA To
16. REMARKS:
FL
Ft,
Diameter
Slot Size Material
in. in.
Size
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the ro
numbers and common road names.
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.
7/1/04
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.
OW-1 REV. 07/2001

3. OWNER:
Address It , tl6 hi -on ('irc jt
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTIUCTOR COMPANY NAME
James
(Th rn p' a Wpl l
t.,- Camp, Jr
R Pump Co_ ,
299411
CERTIFICATION N 7 1 3 fj
Tnr PHONE NN2'7R) 4 3-7.322
STATE WELL CONSTRUCTION PERh11TN ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential fl Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIOI111//
Nearest Town: { arxe LM Y e
Fo-f .?h The Pea <'s
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Poole -
County kaliterl t'd
(Street or Route No.)
Myrtle. Beat-k sL
Cid or Town State / Zip Code
dig )-
Area code- Phone number /
4. DATE DRILLED 6 'aZ�a
5. TOTAL DEPTH: 245-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 30 FT
(We "+'• if Above Top of Casing)
8. TOP OF CASING IS t FT. Above Land Surface'
*Top of casing terminated actor below land surface requires a
;variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): a 0 METHOD OF TEST n s
10. WATER ZONES (depth): I R 5
11. DISINFECTION: Type r h 1 nr i rim
22. CASING:
Depth Diameter
From___O_ To 4 i Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth
From__ To 2 0
' Fro
Amount f Cap
Wall Thickness
or Weight/Ft. Material
GDR21 PVC
Material
FL No ent
m 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
Iland
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)
DRILLING LOG
Formation Description
DEPTI-j
From To
45- qravirI -dirt
4S o245— ffin4Olirltziecl rock
rV
LOCATION SKETCH
Show direction and distance in miles from at least •
two State Roads or County Roads. Include the rot
numbers and common road names.
16. REMARKS•
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A 9PY OF THIS RECORD HAS BEEN PROVID :D TO THE WELL OWNER
( c7/1v1-64-- W .
SIGNATURE PERSON CONSTRUCTING THE
v.,
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
DATE

29 J !�
WELL CONSTRUCTION RECORD
North Carolina - Depar uuent of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ja me s w Camp Jr CERTIFICATION # 21 "iR
WELL CONTRACTOR COMPANY NAME C'amjt a Wal 1 R Piimp Cr Tnn PHONE # 7AR AS'i_7122
STATE WELL CONSTRUCTION PERMITd ASSOCIATED WQ PERMIT%
(iFapplicable) / (ifapplicable)
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. WELLLOCATO0� `I
NearestTown:&,tr �vY r YDK County
Ma1i)e vecC gci
(Stint Name, Ambers, Community, Subdivision, Lot No., Zip Code)
3. OWNER G 1'U(ce Bu/ lier5
Address Y 1 S1i'-1-
�7 ` i 1 VIZ
ar Route o.)
fterc
City or jown State Zip Code
( )- '?-36,i
Area code- Phone number 4. DATE DRILLED / n
- `d-04
5. TOTAL DEPTH: 5-0
�{
6. DOES WFr I REPLACE EXISTING WELL? YES 0 NO S°f
7. STATIC WATER LEVEL Below Top of Casing: /00 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface"
• *Top of casing terminated ardor below land surface requires a
variance in accordance with I5ANCAC 2C .0118.
9. YIELD (gpm): R METHOD OF TEST n ;
10. WATER ZONES (depth)• 2{05
11. DISINFECTION: Type rh l
12. CASING:
Depth
From_0___ To 10`)
From To
From To
13. GROUT: Depth
From p To 2 0
' 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.
nri na Amount I SCUP
Wall Thiclmess
Diameter or Weight/Ft. Material
Ft6 1/4
Ft
Ft.
Material Method
Plcut Ccmcnt Hand
DP-.21 PVC
Slot Size Material
in.
in.
Ft.
Topographic/Land setting
'dgc ❑Slope 0Va11ey ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude Source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
(lid-- cIa
(on5oh d d v
DEPTH
From 'To
0
Jo' SOS
r—
N —r
0
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road nines.
C�
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1 5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A PQIPY OF THIS RECORD HAS BEEN PROV1D TO THE WELL OWNER
SIGNATURE PERSON CONSTRUCTING THE
'4 tZ4tV aDATE
Submit 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
i;h

.!.99409
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
James
Caron, J-
CERTIFICATION I/ 2 1 1 R
WELL CONTRACTOR COMPANY' NAME (`amp' a Wp11 R Pnmp Co_ Tnr PHONE gffi9R1 451_7322
STATE WELL CONSTRUCTION PERMIT! ASSOCIATED WQ ?ERMITW
(if applicable) / (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 LOCAT1 N:(,� r
Nearest Town: athe r' TO It*IA- County i�iA r{�Fr' V
4/5-✓e(reeK�t•r��iL
(Street Name, Numbers, Communityy, Subdivision, Lot No., Zip Code)
3. OWNER: Alan- lA Yt_ & lei V JI
Address I.SI Erio-� -ICI(U,
(Street.
wtn'evJIe 5C
aZ9 4 b'3
City or Town Sac Zip Code
- F75-‘6 'o
Area code- Phone number
4. DATE DRILLED 7'S-0
5. TOTAL DEPTH: 1710 S
6. DOES WFI I REPLACE EXISTING WELL? YES- ❑ NO X
7. STATIC WATER LEVEL Below Top of Casing: t'O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS t FT. Above Land Surface"
`Top of casing terminated at/or below land surface requires a
variance In accordan •e with N ISA CAC 2C .0118.
9, YIELD (gpm): /0 METHOD OF TEST a ; r
10. WATER ZONES (depth): "--q6 -
11. DISINFECTION: Type t h 1 nr i np Amount
12. CASING: Wall Thickness
Diameter orWeight/Ft.
SDR21
Depth
From p To_6 Ft. 6 1 / 4
From To Ft.
From To Ft.
13, GROUT: Depth
Fromm To_20
' From To
Material
Topo phic/Land setting
❑Ridge lope ❑Valley ❑Flat
( eck appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From Tq Formatipn Description
• y 4va✓ef i%l'y
1(5o/ld a e recK
0
r—
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the r
Material nu beks`nand commonroad
PVC
Method
Ft. Noat Cement Hand
Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFI
CONSTRUCTION STANDARDS, AND THAT A9CQPgqY OF THIS RECORD HAS BEEN PROVID?D TO THE WELL OWNER
‘V yvAct— /AJ
SIGNATURE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
PERSON CONSTRUCTING THE DATE

WELL CONSTRUCTION RECORD
299406
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Tames '•' Caw pr Jr
WELL CONTRACTOR COMPANY NAME ('amp' c Wp11 R Ptlmp Cn Tnr
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITN
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 19liIndustrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 if Other, List Use
Nearest Town:
2. WELL LOCATION: I f Yl ('
J]'e L✓eCounty Rl e Y
T'Jcu r CreeK Rd.
(Suet( Name, Numbers, Community, Subdivision, Lot No., Zip Code)
I, Lo t of laKe ) 'Art
3. OWNER:
Address
l G fit X
(Street or Ito :e No.)
like Lave t�C— 2*^Iti4
DFPTH
City or Town Sate Zip Code From To
Area code- Phone number ' I
4. DATE DRILLED G - 4- 0 Y
5. TOTAL DEPTH: (p D
6. DOES WFi T REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: /.5 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of casing terminated atlor below land surface requires a
%variance In accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): 4tc METHOD OF TEST air
10. WATER ZONES (depth); .3 o C
54
11. DISINFECTION: Type rh1nrin.P .Amount Maps
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From n To 2eL Ft 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depthgn Material Method
Fromp Tom_ Ft.
From To Ft.
gDR.21 PVC
I9 at Ccmc.nt Hand
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
Front To Ft. in. in
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
CERTIFICATION S 21 18
PHONE Y i(t 2 Al d 5 1 — 7 3 2 2
Topo p'hic/Land setting
❑Ridgelope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrceslminureslscconds)
Latitude/longitude source:❑GPS❑Topographic,map
(check box)
DRILLING I.0V
Formation Description
LI A.!
sa LPor con sof1,dfed vock
0
JOCATION SK.ETCH
Show direction and distance in miles from atJ ast
two State Roads or County Roads. Include theroa4 r
numbers and common road names.
16. REMARKS:
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C WELL
CONSTRUCTION STANDARDS, AND THAT A RPY OF THIS RECORD HAS BEEN PROVED TO THE WELL OWNER
eZ/n4.&4— /iO. g 7 - I to - o 4-
SIGNATURE JF PERSON CONSTRUCTING THE DATE
Submit the original to the Division of Water Quality,
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001

299405
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James C n tor , ?r CERTIFICATION # 7 1 3 8
WELL CONTRACTOR COMPANY NAME f'ampIa Wall & Piimr I"rt T n r PHONE ag2Rl d 5-1 7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public CQ' industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
WELL LOCATIN:'/�('
Nearest Town: f4 ke LN✓e CounryRt4 {-% te✓foy
�SIct K(i CrepV k.A.
(Street None, Number, Community, Subdivision, Lot No., Zip Code)
3. OWNER: /c, u)rl o-(lane T are
Address / D o X .2 5-4;-
(Scree[ or Flo to No.)
/etke',etre /V C.-
City or Town State
( )-
Area code- Phone number
4. DATE DRILLED 0 3 o- o
Wcb
Zip Code
5. TOTAL DEPTH: 1/OS
6. DOES WFr i REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 9,0
(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 13A NCAC 2C .0118.
9. YIELD (gpm): 2S'" METHOD OF TEST n 1 r
10. WATER ZONES (depth): .3/7
11. DISINFECTION: Type C' h l n r i n p Amount
,12. CASING; Wall Thickness
Depth Diameter or Weight/Ft. Material
From o To CID Ft, 6 1 / 4 RD/2.71 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From_ To ._ Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Siza Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material - r
From To Ft. _._....,...__--
From To Ft.
16. REMARKS:
Neat Ccmcnt Hand
Topogiyphic/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 PRILLING LSO
From To Fo tionDescription
n
9. 6 410 cok(5b/i domed rock
iV
J.00ATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include thead
numbers and common road `names. (y 9-9
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A QPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
•
TUBE OF PERSON
%-l� D1-I-
CONSTRUCTING
SIGNA GTHE 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 REV. 07/2001

13. GROUT. Depth
WELL. CONSTRUCTION RECORD
299919
North Carolina - Department of Environment and Natural Resou Division of Water Quality - Groundwater Section
1M ELL r-ON fRAC'I OR (INDIVIDUAL) NAME (print) y� CERTI PIC ATIO\ 4 L`8
1 I.__i—.]-[LflR% PDDONE d LGt ZZ.3
ASSOCIATED \\'Q PERMIT'S
(ifapplicahlei
CON I R tiCI OR C'O\IPANY \AMk; ApP�� b
S 1 A IF \\ ka.l. L'O\3TRFC'a'ION PERMITS
i; fapplicab'.cl
WELL USE (Cheek Applicable Boxy Residential f Municipal/Pt:blie 0 Industrial 0 Agricultural O
Nlon torinu 0 Ricca%cry 0 Heat I`ump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT
Nearest Town
,Y Court }{%/-15�✓, z" s �0
g Ilia) Lh M Ll1/4i1 bts'7((
(Street tia',ne. Numbers. Community, Subdivision, Lot No. hip Code)
3. OWNER:] Pn AW (dt4 s
Addre s a hG X 33
L� r_i t pt Rront,kN(y,� 2t h c( (p
Cary or Tenn Stair J`l hip Code
t I -
Li
.Areacudc- Pbonc mother
4. DATE DRILLED -NI-0
5. TOTAL DEPTH: 405
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Helene Top of Casing: Wfl FT.
(Use "✓' if.A:%.ve Top of Casing)
3. TOP OF CASING IS A FT. Above Land Surfaces
'top of casing terminated at/or below land surface requires a
variance in accordance with I5A NC AC 2C' .01 I8. /i��
v, YIELD (gpm): _ CQ _ METHOD OF TESTA! I, K'1 Jr. &
10. WATER ZONES (depth): Z CP S
Topographic Land setting
ORidgc OSlope OValley
(check appropriate box;
Lalitudc'longitudz of well location
I degrees. tnmu tesiwconds I
Latitude/longitude source:OGPSOTOpographicmap,_ _.
(click box) _.
DEPTH
DRILLING LOCI
From To Formation D+scfipuon
LOCATION SKETCH t _.
I. DISINFECTION: Type Ld C_ Amount 2.. Show direction and distance in miles from of-t2ast -
12. CASING:
h rom e TO1�5 Et.
From To
Front To -
Maicrial Method
From To
From ToFt.
14. SCREEN: Depth Diameter Slot Size Matcria.
From To Ft. in. in.
From To Ft. in. in.
15. SAND.GRAVEL PACK.
Depth Size Material
Elora To Fl.
From Tu Ft
16. REMARKS:
Wall Thickness two State Roads or County Roads. Include th`voad -`-"�-
i numbers and common road names.
Depth Diameter or Weight Ft Materiel
Ft. — _I
rA r+1/412
I DO IIEREt3Y CERTIFY THAT TIIIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
('ONSTRCCTION . '. \DARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ors
SIGNATURE OF PERSON CONSTRUCTING THE WELL. DATE
Submit th original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center - Raleigh, NC
27699-I636 Phone No. [phone], within 30 dacs. (W-1 REV. 07 2 0 01

299946
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: FOREST CITY
HOLLY FOREST DR.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: TIM CARSWELL
Address HOLLY FOREST DR
(Street or Route No.)
FOREST CITY NC 28043
City or Town State Zip Code
(828) — 287-4770
Area Code Phone number
4. DATE DRILLED 07/09/04
5. TOTAL DEPTH: 405
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Eg
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 4 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
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" SDR.21 PVC
From To Ft. _
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUJKRETE 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 -I
(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. Includclhe road
number and common names
CLEGHORN MILL RD. FROM SHILOH. LEFT
ON HOLLY FOREST DR. 5TH 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
SIG A
OF P ON CONSTR CTING 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

299945
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 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: ELLENBORO
WALLS CHURCH RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BRIAN R. OGLESBY
Address WALLS CHURCH RD.
(Street or Route No.)
ELLENBORO NC 28040
City or Town State Zip Code
(828) —657-5045
Area Code Phone number
4. DATE DRILLED 07/08/04
5. TOTAL DEPTH: 225
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): 10 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 120 Ft. 6-1/4" SDR21 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
From To _ Ft _
From _To_Ft.
_
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To _ Ft. _
From To Ft.
Slot Size Material
in. _ in.
in. in.
16. REMARKS:
Topographic/Land setting
❑ 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 mile from at least
Two State Roads or County Roads. Include the road
number and common names
HOLLIS RD. FROM ELLENBORO. LEFT ON
WALLS CHURCH RD. NEW DRIVE 1 MILE ON RT.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUE 1 ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THA A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S NATURE 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

299943
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]
W
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED _ ( applicable) PERMIT #
(if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
BURGESS RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LORRAINE WHITSON
Address BURGESS RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) - 625-0422
Area Code Phone number
4. DATE DRILLED 07/07/04
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 4 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 7.5
12. CASING: Wall Thickness
or Weight/Ft. Material
SDR.21 PVC
Depth Diameter
From 0 To 120 Ft. 6-1/4"
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20
From To
14.SCREEN: Depth
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From To _ Ft. _
From To Ft.
16. REMARKS:
County RUTH
Material Method
Ft.OUIKRETE POURED
Ft.
Diameter Slot Size Material
in In.
in. in.
Topographic/Land setting
❑ Ridge 0 Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/sPronds) _.-.-
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 BURGESS RD. 2ND
DRIVE ON LEFT AFTER TURNING TO GRAVEL.
I DO HEREBY CERTIFY TIIAT 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
L4L-ecY S NA OF PERSON CONSTRUCTIN WELL
�, 7-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

299941
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: LAKE LURE
LAUREL LAKES
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JAMES PEEPLES
Address LAUREL LAKES
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
(843) — 884-5357
Area Code Phone number
4. DATE DRILLED 07/05/04
5. TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IZ
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 150 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
From To Ft. in. _
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To _ Ft. _
From To Ft.
16. REMARKS:
County RUTH
Material
in.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/ongitude source: ❑ GPS ❑ Topographicmap
(check box) 7 ---....
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles front atleast
Two State Roads or County Roads. Include the road -
number and connnon names
HWY. #64/74A W. FROM RUTHERFORDTON.
RIGHT ON BILL'S CREEK RD. LEFT INTO
LAUREL LAKES DEVELOPMENT„ APPROX. 1/2
MILE ON LEFT.
r.,
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
GNA
OF PERSON CON TRUCTRJG'T'HE WELL
1- 5"--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

299939
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: LAKE LURE County RUTH
BUFFALO CLIFFS -LOT #4
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DAVE MATTHEWS
Address BUFFALO CLIFFS
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
(828)- 625-1190
Area Code Phone number
4. DATE DRILLED 07/29/04
5. TOTAL DEPTH: 365
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): 5 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 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 _ 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 ❑Topogtap
(check box) -
DEPTH
From To
DRILLING LOG
From To
LOCATIONSKETCN: -d '
Show direction and distance in mil From at Ieas�
Two State Roads or County Roads. elude the'r3ad
number and common names
HWY. 64/74A W. FROM RUTHERFORDTON.
RIGHT ON BILL'S CREEK RD. LEFT ON BUFFALO
SHOALS RD. RIGHT ON BUFFALO CREEK RD.
RIFHT ON YOUNGS MTN. RD, RIGHT ON KENS
ROCK RD. RIGHT INTO BUFFALO CLIFFS ON
TATANKA TRAIL. APPROX. 1/4 MILE ON LEFT.
LOT #4
0
Ni
t1
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC 1ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIG
�, 9 Q1
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

299938
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERPIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: BOSTIC
MTN. OVERLOOK DR
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JACK RODWAY
Address 581 MTN. OVERLOOK DR.
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code
(239) — 267-7269
Area Code Phone number
4. DATE DRILLED 07/27/04
5. TOTAL DEPTH: 285
6. DOES WELL REPLACE EXISTING WELL? YES ❑ 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): 9 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 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. _ is _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ 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 t-
FROM BOSTIC. GO UP BOSTIC/SUNSHINE
HWY. LEFT ON LUCKADOO MTN. RD. LEFT ON
FIRETOWER RD. RIGHT ON AMELIA LANE. LEFT
ON MTN. LOOKOUT DR 1/10 MILE ON LEFT. (#581
ON POST) LOT #67
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCT ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
J / i I1,r.�/GL. 117A St .. % - 2 -7 - 0 �/
TURE OF PER 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

299936
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public D Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: BOSTIC
ROSA LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ED GURLEY
Address 151 ROSA LANE
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code
( ) — 245-6384
Area Code Phone number
4. DATE DRILLED 07/23/04
5. TOTAL DEPTH: 465
6. DOES WELL REPLACE EXISTING WELLS YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 45' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 8 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 12
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 80 Ft. 6-1/4" SDR.21 PVC
From To Ft. _
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From _ To _ Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge 0 Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location`
(degrees/minutes/seconds) ...
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETFH
Show direction and distance in mtleom at least
Two State Roads or County Roads. Include the road
number and common names
BUS. 74 E. FROM FOREST CITY. LEFT ON
BOSTIC/SUNSHINE HWY. LEFT ON HWY. #226 (a
GOOD OLE BOYS. LEFT ON GOLDEN VALLEY
CHURCH RD. ON DRIVE W/151 ON POST. 1ST
HOUSE 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
i
_) /1'
J A
SIG ATURE OF PER CONSTRUCTING THE WELL DATE
—� �--Ure
Submit 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

299933
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Qu` lity — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® MunicipalPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHRFORDTON County RUTH
MCOWENBEN PASS-12 MILE POST
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: STEVE & NANCY SMITH
Address 434 MCOWENBEN PASS
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 286-3018
Area Code Phone number
4. DATE DRILLED 07/16/04
5. TOTAL DEPTH: 205
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 I5A NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 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. QUIHRETE POURED
From _ To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
0 Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(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. Uncbrde the_road:-
number and common names
HWY. #64/74A W. FROM RUTHERFORDTON.
LEFT INTO 12 MILE POST. APPROX. 1-1/2 MILES
ON RT. (434 ON POST)
CM
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) nrerpsa>
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

299932
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: ELLENBORO
GETTYS RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MIKE GETTYS
Address GETTYS RD.
(Street or Route No.)
ELLENBORO NC 28040
City or Town State Zip Code
(828) - 453-0640
Area Code Phone number
4. DATE DRILLED 07/13/04
5. TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 4.5
12. CASING: Wall Thickness
Depth Diameter or Weight/FL 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. OUIKRETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ T9pograplvc map
(check box) - -
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. include the road
number and common names
FROM ELLENBORO. GO OUT HOLLIS RD. GO
TO THE DUMP. LEFT ON GETTYS RD. DIRVE
BEARS LEFT AT DEAD END.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
[am tREei -AZe .-�-►�1 \// ?
IGNA 11JRE OF PERSON C6NSTRUCTING THE WELL
�cr-rye. �J -/ 3- Cy
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

299930
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: FOREST CITY
JONES RADIATOR RD.
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: CHUCKPRESCOTT
Address JONES RADIATOR RD.
(Street or Route No.)
FOREST CITY NC 28043
City or Town State Zip Code
(SZS) — 287-0242
Area Code Phone number
4. DATE DRILLED 07/23/04
5. TOTAL DEPTH: 49
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 29 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County RUTH
Zip Code)
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From 0 To 49 Ft. 24"
From _ To _ Ft. _
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CEMENT
From To Ft.
Material
CEMENT
Method
POURED
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 29 To 49 Ft. 78M GRAVEL
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well lacaliotr-:_
(degrees/minutes/seconds) -
Latitude/longitude source: ❑ GPS ❑ Topographic map -
(check box) -
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETC H
Show direction and distance in miles from atIeast_-
Two State Roads or County Roads. Include the road
number and common names
FROM FOREST CITY. GO OUT HUDLOW RD.
LEFT ON WHITESIDES RD. LEFT ON JONES
RADIATOR RD. APPROX. 1/10 MILE ON LEFT.
t
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONST13LIGTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
OFSIGNA'FURECON ,i?I 53'RUC�� WELL DATE
3
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

299929
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: UNION MILLS County RUTH Topographic/Land setting
5716 HUDLOW RD. 0 Ridge 0 Slope ❑ Valley 0 Flat
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) (check appropriate box)
3. OWNER: MARY REYNOLDS Latitude/longitude of well location
Address 5716 HUDLOW RD. ______
(Street orRoute No.) (degrees/minutes/seconds)
UNION MILLS NC 28167 Latitude/longitude source: ❑ GPS 0 Topographic map
City or Town State Zip Code (check box)
(843) — 556-4418 DEPTH
Area Code Phone number From To
4. DATE DRILLED 07/14/04
5. TOTAL DEPTH: 82
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 64 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing teaninated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 18 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
11. DISINFECTION: T
12. CASING:
Depth
From 0 To 82
Diameter
Ft. 24"
From To Ft.
From To Ft.
CHLORYTE Amount 8.28
Wall Thickness
or Weight/Ft. Material
CEMENT
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To _ Ft.
14.SCREEN Depth Diameter Slot Size Material
From To Ft. in. in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 64 To 82 Ft. 78M GRAVEL
From To Ft.
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads., Include the road
number and common names
HWY. #221 N. FROM RUTHERFORDTON. RT. ON
HUDLOW RD. HOUSE ON LEFT AFTER GOING
PAST POST OFFICE.
r-;
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCI'ED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONS CTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE F PE�CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

From: Scott & Jo Ann To: Division of Water Quality
Date: 9/13/2004 Time: 6:40:20 PM Page 3 of 10
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) SCOTT GANTT CERTIFICATION # 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT Si ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box) : Residential ❑ Municipal 0 ]ndnstrial ❑ Agricultural ❑ Monitoring 0
Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: RUTHERFORDTON County RUTHERFORD
LOT 46 GREEN RIVER HIGHLANDS
(Street Name, Numbers, Community, Subdivision. Lot No,. Zip Code)
301736
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ® Flat
Lalitude/Longitude of well location
35.17.397 / 82.02.255
3. OWNER MICHELE PATENUADE (degrees/minutes/seconds)
ADDRESS LOT 46 GREENRIVER HIGHLANDS Latitude/longitude source: ❑ GPS ❑ Topographic map
(Street or Rome No.) DEPTH DRILLING LOG
RUTHERFORDTON NC 28139 From To Formation Description
City or Town State Zip Code 0 62 Clay
828-230-9764
Area Code - Phone Nmnber
4. DATEDRILLED 8/2/04
5. TOTAL DEPTH 300
6. DOES WELL REPLACE EXISTING WELL, YES ® NO ❑
7. STATIC WATER LEVEL. Below Top of Casing: 60 FT.
IU,e "+" If Above Top of CasPig)
8. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated tit/or below, land .nrface rapm ct a vufao,c in
accordance with 15A NCAC 2C 0111
9. YIELD (gpm): 8 METHOD OF TEST ARDM
to. WATEd. ZONES (depth): 75
62 300 Consolidated Rock
n. DISINFECTION: TYPE HYPOCHLORITE Amount 12
12. CASING: Wall lltickness
Depth Diameter or Weight/Ft. Material
From 0 To 70 FI. 6 1/4 " SDR 21 PVC
13. GROUT:
Oz
Depth Material Method
From 0 To 20 Ft. GRAVEL MIX GRAVITY
14. SCREEN
Depth
From NA To
Ft
Diameter
Slot Size Material
in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From NA To Ft,
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
9/ 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 8 Jo Ann To: Division of Water Quality
Date: 9/13/2004 Time: 6:40:20 PM Page 10 of 10
301
4'
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) SCOTT CANTT CERTIFICATION # 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT it ASSOCIATED WQ PERMIT it
(if applicable) (if applicable) ❑
1. WELL USE (Check Applie3blc Box) : Residential ❑ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring
Recovery 0 Heal Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION: Topographic/Land setting
Nearest town: LAKE LURE County RUTHERFORD ❑ Ridge 0 Slope ❑ Valley Z Flat
140 RAINBOW CIRCLE RIVERBEND RESORT Latitude/Longitude of well location
(Street Name, Numbers, Community, Subdivision. Lot No,. Zip Code) 3526.036 / 82.10.546
3. OWNER RIDGELINE DEVELOPMENT CORP. (degrees/minutes/seconds)
ADDRESS 112 COCOPLUM CIRCLE Latitude./longitude source: ® GPS 0 Topographic map
(Street or Rome No.) DEPTH DRILLING LOG
ROYAL PALM BEACH FL 33411 From To Formation Description
State Zip Code 0 90 Clay
City or Town
561-798-2729
Area Code - Phone Number
4. DATE DRILLED 8/30/04
5. TOTAL DEPTH 160
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WA BR LEVEL Below Top of Casing: 70 FT.
(fiat `-t" If Above Top of Casng)
8. TOP OF CASING IS 2 FT. Above Land Surfaces
*Top of easing terminated et/or below land mrfaec re/Or-et a variance in
accordance with 15A NCAC 2C.0118
90
120 Consolidated Rock
9. YIELD (lain): 20 METHOD OF TEST ARDM
10. WATER ZONES (depth): 110
n. DISINFECTION: TYPE HYPOCHLORITE Amount 4 oa 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 97 IT 6 1/4 " SUR 21 PVC numbers and common road names.
13. GROUT: Depth Material Method �iC<4PAamfr _:
From 0 To 20 Ft_ GRAVEL MIX GRAVITY �n 'p0�Fdet .) 14. SCREEN Vial t1/4/>QL
Depth Diameter Slot Size Material !'
From NA To Ft. in. is 45e, 4
15. SAND/GRAVEL PACK:
Depth Size Material
From NA To Pt,
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.
9/1/04
SIGNA'HIRE 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

301563
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
RICHARDSON CRK. LANE -LOT #11
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BOB & NANCY BOYER
Address RICHARDSON CRK. LANE
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) - 287-0733
Area Code Phone number
4. DATE DRILLED 08/03/04
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 RUTH
I I. 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
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.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #221 S. FROM RUTHERFORDTON. RT. ON
ARTHUR HENSON RD. LEFT ON RICHARDSON
CREEK LANE. 3/4 MILE ON RT. (LOT #11)
1Q icy
Slot Size Material
in. in
in. in.
Method
POURED
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
., Mrelk Q.- �- 3 /
SIGNATURE OF PERSON CONSTRUCTNG 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

301562
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'ItICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: BOSTIC
826 ARBRA MTN. WAY
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MAUREEN REDDELL
Address 826 ARBRA MTN. WAY
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code
(407) — 389-0742
Area Code Phone number
4. DATE DRILLED 08/06/04
5. TOTAL DEPTH: 545
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 15
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
0 To 120 Ft. 6-1/4" SDR.21 PVC
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.
From
From
County RUTH
Method
POURED
Slot Size Material
in. _ 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 map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
BUS. 74 E. FROM FOREST CITY. LEFT ON
BOSTIC/SUNSHINE HWY. LEFT ON TONEY RD.
LEFT ON WATERS RD. RIGHT ONTO YELLOW
TOP MTN. DR. LOT #29. 3RD CABIN 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
J
SIGNATURE OF PERSONCO
•
TRUCTING THE WELL
CrN42—>AD
C lr -Dt/
Submit 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

301555
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)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: LAKE LURE
RAINBOW RAPIDS RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BILL SOMMERS
Address RAINBOW RAPIDS RD.
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
(828) — 429-7490
Area Code Phone number
4. DATE DRILLED 08/25/04
5. TOTAL DEPTH: 185
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 RUTH
11. DISINFECTION: Type CHLORYTE Amount 3.5
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. QMICRETE
From _ To _ Ft.
14.SCREEN: Depth Diameter
From _ To _ Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To _ Ft. _
From To Ft.
Method
POURED
Slot Size Material
in. _ in.
in. in.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. 64/74A W. FROM RUTHERFORDTON.
RIGHT ON MCENTYRE RD. LEFT ON RAINBOW
RAPIDS RD. LEFT ON LILY MAE DR. 1ST LOT ON
RIGHT.
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
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

301554
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 El
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: ELLENBORO
WALLS CH. RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: PERRY WELLMAN
Address 330 WALLS CH. RD.
(Street or Route No.)
ELLENBORO NC 28040
City or Town State Zip Code
(828) — 245-8092
Area Code Phone number
4. DATE DRILLED 08/26/04
5. TOTAL DEPTH: 245
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 I5A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 180 Ft. 6-1/4" SDR.21 PVC
From To Ft. _
From _ To _ Ft. _
13. GROUT: Depth Material
From 0 To 20 Ft. QUIRRETE
From To _ Ft.
14.SCREEN: Depth Diameter Material
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To _ Ft.
From To Ft.
Method
POURED
Slot Size
in. _ in.
in. in.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS CTION STANDARDS, AND
��`THAT A�COPY OFFTTHIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
s� SIGNA OF PERS`QON CONSTRUCTING THE WELL
0 DATE ,? " 6 /
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
FROM ELLENBORO GO UP HOLLIS RD. LEFT
ON WALLS CH. RD. 3 MILES ON LEFT. (330 ON
MAILBOX)
Submit 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 CERI INICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
WEEKS RD.
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: CHUCK CUNNINGHAM
Address WEEKS RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
la)) - 247-0055
Area Code Phone number
4. DATE DRILLED 08/31/04
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
Zip Code)
11. DISINFECTION: Type CHLORYTE Amount 16.5
Wall Thickness
or Weight/Ft. Material
SDR.21 PVC
12. CASING:
Depth Diameter
From 0 To 80 Ft. 6-1/4"
From _ To _ Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. QUIKRETE
From To Ft.
14.SCREEN: Depth Diameter
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Method
POURED
Slot Size Material
in. _ in.
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. #221 S. FROM RUTHERFORDTON.
RIGHT ON POORS FORD RD. RIGHT ON
CLEGHORN MILL RD. LEFT ON WEEKS RD.
APPROX. 2/10 MILE ON RIGHT.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/i
L'r1 D.
IGNAOF PERSON CONSTC THEIWELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James w Camp, 3r
WELL CONTRACTOR COMPANY NAME rampc Wa11 R. Primp Crt Tnr
STATE WELL CONSTRUCTION PERMITS/— ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
CERTIFICATION if 21 38
PHONE#$7R) 451-7322
1. WELL USE (Check Applicable Box): Residential 1i 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: I C- County
(ao)AFtt Lit/)e ✓ t �7l
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: F✓!T tRC1S D1
Address )tY7/3 Ekvey L7r',
c�(S
Uv)o-,eeetn ktejCC' dig:
2.6
ity or Town. State Zip Code
)- 1Yo4-'iqa-763i
Area code- Phone number
4. DATE DRILLED / — a i<
5. TOTAL DEPTH: 6' 0 0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: qo FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS t FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordanecr,wttb 15A NCAC 2C .0118.
9. YIELD (gpm): ,? METHOD OF' TEST ;,; r
10. WATER ZONES (depth): 5 5-0
£Yc)
11. DISINFECTION: Type r h l n r i n e
12. CASING:
Depth i Diameter
From_ To Ft. 6 d / 4
From To Ft.
From To Ft.
13. GROUT: Depth
From_ n To 2 0 Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount (co-p
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Material Method
Noat Ccment IIand
Slot Size Material
in.
in.
16. REMARKS:
a'dTopographic/Land setting
ge ❑Slope ❑Va11ey OF
(check appropriate box)
Latitude/longitude of well locatio
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic hiap
(check box)
PEPTFj DRILLING USG
From To
LI- 2, G n
Forma on Desc 1ption
/ ilSo /�a Yt eik
F
•
c)
rn
n
n
..0 _r.s
LOCATION SKETCH c
Show direction and distance in miles from ataast C2m
two State Roads or County Roads. Include t4t6roadh=
numbers and common road names.
J z
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THPy1; A COPY OF THIS REl<ORD HM BEEN PRAVIDED TO THE WELL OWNER
SIGMA'
/.
OF PERSON CONSTRUCTING THE 1WEIAi 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 Camp Tr- CERTIFICATION 71 i8
WELL CONTRACTOR COMPANY NAME f amp' a We11 & pump co T n r
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT,/
(if applicable) (if applicable)
2'J 3-1.87
PHONE U$7R0 d53-7322
r
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: II
Nearest Town: 1-41.ke LAA County Its le11;1
(Street Name, Number, Community,
�Subdivision, Lot No., Zip Code)
3. OWNER: R9 t 13eaYJF&
So
Address 1 G•I IVn11-inghctm
(Street or gouge NO
Nel�rrre FF1-- 3,2-935
City or Town S to Zip Code
1)-;41-95g3
Area code- Phone number
4. DATE DRILLED / 15 - 0
5. TOTAL DEPTH: -J). S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Of
7. STATIC WATER LEVEL Below Top of Casing: 7() FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S 1 FT. Above Land Surface*
*Top of cuing terminated at/or below land surface requires a
variance In accorda a with 15A NCAC 2C .0118.
9. YIELD (gpm): MET OD DF TEST n i r
10. WATER ZONES (depth): ,''7
11. DISINFECTION: Type Ohl nri np Amount I Guff
12. CASING: Wall Thiclmess
or Weight/Ft. Material
SDR21 PVC
Depth Diameter
From__a_ To h Ft. 6 1 / 4
From______ To Ft.
Froth To Ft.
13. GROUT: Depth
From_ To 2 0 Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Material
N nt Ccmcnt
Method
H
/ Topographic/Land setting
dge ❑Slope ❑Valley ❑)tit
(check appropriate box) ' "
Latitude/longitude of well locatign
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topo piuc map __
(check box) ... I 1
DEPTH DRIJ LIN
From To Fo tion Descfiption
n 3.6- oir 5tvnt6
3cc n5o'll daleel rrC)<,
c
t-J
r
1
m
�rn
0
LOCATION SKETCH
Show direction and distance in miles from [fleas
two State Roads or County Roads. Include' roar'
a- -
r —
numbers and common road names.
'M 3At.'� ""Cv±44,.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND HAT A COPY OF T 11S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGs �1TURE OF PERSON CONSTRUCTI G THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James t•> Camp, Jr -
WELL CONTRACTOR COMPANY NAME ramp' G wa11 $ Pump en Tnc
203188
- Groundwater Section
CERTIFICATION # 21 18
PRONE #$?Al 451_7322
STATE WELL CONSTRUCTION PERMITM 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 LOCATIG3i:
Nearest Twn:
ftP n. C✓ee1C
ounty tAtlt PyPb ✓d
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: C)io»9 I Y 6OSC
Address 1Sc Z NI VL-norl lard
(Street or Route o.)
City or Town State Zip Code
(F).A)- 2 y 5-.2711
f1✓C.
Area code- Phone number
4. DATE DRILLED 9.- .4 • 0 =I
5. TOTAL DEPTH: %,, A 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 0 O
(Use '4" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9, YIELD (gpm): METHOD OF TEST air
10. WATER ZONES (depth): la'-O
11. DISINFECTION: Type r h l n r i n
12. CASING:
Depth Diameter
From_ To ry 7C Ft. 6 1 / 4
From______ To Ft.
From To Ft.
13. GROUT: Depth
From_ To 2 0 Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Wall Thickness two State
or Weight/Ft. Material numb
SDR21 PVC
Material Method
N at Cement ——
Slot Size Material
in.
in.
P. 1
Topographic/Land setting
❑RidgeSlope ❑Valley ❑Flat`
(check appropriate box)
Latitude/longitude of well location `
(degrees/minutes/seconds) I.'
Latitude/longitude source:❑GPS❑Topogra(}hic spy -
(check
box) II
DEPTH DRILLING be —
From �To Formation De
y
n /5- Gla 4-
77 I, _J c n44 i ei
ripVon
i(
r •_._ _. t
/
tr.) r�
>tJ
3 "to
LOCATION SKETCH IV cn•t
Amount 1,a. Gil 5 Show direction and distance in miles fromt.least,
ads or County Roads. Include.the rog
on road names.
tw (Ala CA
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TH46TjA COPY OF THIS REC,OfjtD HAS BEEN PROVIDED TO THE WELL OWNER
-04
tn.47 l ��
ONSTRUCTI
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
Cur

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jam in 5 TAr_ Ca mrr 7>_.
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ramp c Wall R pumr ('n
ASSOCIATED WQ PERMIT#
(if applicable)
31=a0
CERTIFICATION # 71 3 A
Tnr PHONE A) d51-7322
1. WELL USE (Check Applicable Box): Residential I/Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: 4)
Nearest Town: %K e L le County �v / hey- O d
Lef a 1 - Tie Pea (s
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 3ekt k)i 15-evA
Address On % /i zn / e tt Lfri. .
( treet or Route No.)
Asfaf,u Fk 34-7o5
_ City or Town State Zip Code
(% Z)- 5 9 4- - (2-902_
Area code- Phone number '1 /I
4. DATE DRILLED / — /3 -L'
5. TOTAL DEPTH: 6D5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: / 00
(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 a ; r
10. WATER ZONES (depth): S `% S
11. DISINFECTION: Type f'h 1 nri na Amount I Oup
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From p To lbo
From To
From To
13. GROUT: Depth
From p To 2 0
Ft. 6
Ft.
Ft.
Ft.
1/4 SDR21 PVC
Material
N Qt Cement
Method
Ha
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
l$kidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographi ai
(check box) rn
DEPTH
From To Fo tion Descri
/Leo sand, d ;it
/10 &,DC rarts 01Id rock
r
) I. 7
_
Gn
0
m
0
VC-
0
cs73
m
cm
_
.D -m
m0
—C 7
rl
rnz
LOCATION SKETCI'( 2
Show direction and distance in miles from at least o
two State Roads or County Roads. Include the road z
numbers and rammon road names.
at zl
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND Ti- AT A COPY OF THIS RECOUP HAS BEEN ROVIDED TO THE WELL OWNER
/;r1nwd . l.6(/)v -1G-D21
SIGNAJURE OF PERSON CONSTRUCTING Hi 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. OW-1 REV. 07/2001
Pet ,s

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jarn' s sa Camp, Jr.
WELLCONTRACTOR COMPANY NAME rampG WP11 & Pump Cr....,
CERTIFICATION # 2 1 3 R
TnC PHONE #678) 1 s3-7322
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 7 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 ,uu
Nearest 'own: O 5 I t e-- CountyRALey i `D f
/=7a/Jefrt )/alley rackrs — I-o18
(Street Name, Numbers, Comm((inity, Subdivision, Lot No.. Zip Code) n
3. OWNER: 0,t� e Y) >1 i
Address l . 09 L-yltl-Dry Ci'r le
(Street or Ro a No.)
l�l�e k Y C r< C, 34 I
City or Tow& State Zip Code
AP/1g -5741
Area code- Phone number II
4. DATE DRILLED - v `r
5. TOTAL DEPTH: Chi S .
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: o C All
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
• `Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): MET OD OF TEST air
10. WATER ZONES (depth): 'i 6 0
11.DISINFECTION: Type C.hlnrinp Amount I call
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To ?3 Ft. 6 1 f 4 SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
Fromm To 2 0 Ft.
From - To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topo phic/Land setting
❑Ridgelope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic
(check box)
map
r"
DEPTH PR II T ING LOG
From To Formation Description
1 SAn. A raUrL)
2215
_ POP600a ed to
O
T
rn
C77
D
LOCATION SKETCI-j v
Show direction and distance in miles from at leapt
two State Roads or County
numbers and common road names.
Neat Ccment II.a v
16. REMARKS:
Material
l%
r;ydow y
C�.
2931'78
0
0 0
=A
CC)
rn
zrn
CC
E_ rn
n
-10
✓ o
aidg-
0) 0
z
frk
e23I7c.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND HAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIG1 jATURE OF PERSON CONSTRU
/>-off
NG,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
a1

From: Carolina Wet Dnlla: s, Inc To: NC Dept of Env. and Na Reso r
Date: 211680C9 Time: 3:35:22 PM Fage 2 of 4
WELL CONSTRUCTION RECORD 293115
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Ground..vater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) SCOTT GANTT CERTIFICATION #2584
WELL CONTRAC TOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT 8
(if ap_;';_71)'t°.' if applicable)
1. WELL USE . Ap_a:cab:e Box): Residential ® Municipal ❑ Indeet i ai ❑ Awiculturai ❑ Mcncorhg ❑
Recover' ❑ Heat Purnp Water Injection ❑ Other ❑ If Ofaer, List L1se:
2 WELL LOCK 2DI.,
Nearest town: L- i<T. L:RE County RUTHERFORD
LAURAL LAKES LU: 74
(Street Name, Number). C, mar^^ t'. Subdivision, Lot No,. Zip Code)
3. OWNER RENAISSANCE BUILDERS
ADDRESS 152 E MAIN ST
FOREST CNN NC
city a sows State
828-247-4495
Area Code - Poore 'Nilo :oar
4. DATE DRILLED . 2:04
5. TOTALDEPPTii 233
25343
Zip Code
6. DOES WELL REPLACE EXISTENO WELL? YES ❑ NO D
1. STATIC WATER EV.77. Below Toy of Casing: 70 ET.
If.Above Top of Casing)
8. TOP OF CASINO L_ _ ... ASove Land Surface'
'Sop of ca.in_ tatnLmn1 ,L c. 1. .us.uc r8guir4s a vanauce .n
a..ordan, c' 4t 1... _. _ _. 21.11114
9_ YIELD lzpm::
10. WATER ZONP.S
230
NEMOD OF TEST ARDM
iopoceph.c Din.. stains
C Ridge ❑ Slope ❑ Galley 71 Fiat
La_;cde/Lor.itade ofv ail locaden
35.27.606: b_.0S.850
(clearers, niru[es:cconts)
Latina. lonnitude source: c<i CPS El To nooraphic map
0,c pm); DRILLING LOC
f_o.T. To Fcrmator. Cescrptiou
0 47 Ca,,
Consolidated Rock
✓ .
u
--.,
rn rm
CD C�
▪ -0
orn
J �m
!tom
u. DISINFECt10N• T`: PE HYPO/CHLORITE Amount 5
12. CASING: Wall Thickness
Ucnir. Diameter or WeightFt Matrial
From 0 To 52 Ft. 6 1/4 " SDR 21 PVC
13. GROLT
From 0
14. SCREEN
From NA To
ez LOCATION SKETCH q
Material Method
20 Ft. GRAVEL MIX GRAVITY
15. SAND/(GRAVEI. PAS
Deinh
From NA 'Co
16. REMARNS
Ft
Diameter
Slot Size Material
in in.
Size
Show directio41 and distance in miles from at least m
two Stare Roads or County Roads. Inciude the road t.J
numbers and common road nares. p
I DO HEREBY I1., -F. TEAT. THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH _SANfOAC 3C,ASELL
CONSTR1C91Li-:tiND.\RDS_ AND THATA COPY OR THIS RECORD HAS KEN ?RO fDf.D TO the 'WELT. t%NICTR.
214'04
`,J
SIGNATURE OF PERSON CONSIRUCTLNG TEL WELL cats
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service center- Raleigh. NC
27699-1636 Phone No. [phone], within 30 days.
GIN- I REV 07/2001

From: Carolina Well Dr.'.lera, ir.n To-. NC Dept of Env, and Na Reamer
Date: 2Y 3/2004 T:me: S'.3322 PM Page 3 of 4
293114
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 # 2534
WELL CONTR.`-.CTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE [phone]'7
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
b:e)
1. WELL USE (Chick — _Tp is eblc Box) : Residential
Recovery E Heat Pump Water Injection ❑
t. WELL LOCATION
Nearest town: LAKE LA R5
LOT 218 SWANS WAY" RI vERBEND RESORT
(n- applicable)
Municipal 0 Indus Aria: -sad LT Monitoring ❑
Other ❑ If Other, List Use
County RUTHERFORD
(Street Name, Nnm:ti n. C 3:na :y, S_,bdivision, Lot No,. Zip Code)
3. OWNER RIDGEL;i' E DEVELOPMENT CORP.
ADDRESS 1._ Ci_CC" LUM CIRCLE
ROYAL PALM EveRAL
City or Town
561-798-2729
FL
State
Area Code - Phone Nor, her
4, DATE DRILLED 1/7/04
5, TOTAL DEPTH
33411 Fr:
Zip Code 0
6, DOES WELL REPLACE ERESTING'WELL? YES ❑ NO E
7. STATIC WATER. L.'".' . ftelow Tot) of Casing: 90 P1.
w. *" If Above Top of Casing)
s. TOP OF CASING IS _ T. Above Land Surface*
`Top of easing tonninar.d a:r>r b:icw ivd;u^ssc rcquires a vadancc in
aecordancc with 15A \CA. 1C.O:-iS
9. YIELD (gpmr L METHOD OF TEST ARDM
to. WATERZONES p.epic): 150
Topem-aphic Land se:t ng
❑ Ridge ❑ Slope ❑'eane•, ❑ Fla:
Laitude/Lonmltude of well location
3525.479 : S1 10.376
('cress :aieutes'-econdi)
_sL rRorigitTDED s0u'ce. ❑ GPS a To c2xp ,rap
Ei1T1-1 DRILLING LOC
Ta -r,_., non Deearipcan
90 Clay
0 160 Consolidated Rock
u. DISINFECTION: T ''E f'YPOCIILORITE Amount
12. CASING.
From 0
13. GROUT:
From 0
14. SCREEN
O
1D cm
O<
3 C' LOCATrO\ S_CLTC.H >o
Shone of 1 IE: "1:67allcie in miles frora at lerst y 1/o
Gee_ K . r County Roads inoluie theroad;) cnz
W --t
fl 6
Z
Wall Thickness
Diameter or Weight/FL Material
0 Et 61/4" SDR21 PVC
Der',
To 20 Ft.
Material Method
GRAVEL MIX GRAVITY
De, ti: Diameter Slot Size Material
From NA To Ft in, in.
15. SAND/GRA\EL Y':'J-:
Size Matrial
From NA
16, REMARKS
I DO HEREBY Y RTir 1 THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH H r -A NCAC 2C, WELL
CONSTRUCTION .TAN) \RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED _D TO THE WELL O NER.
2,434
SIGNATURE OF PERSON CONSTRUCTNG Ti
Late
Submit the origa:a:irethe Division of Water Quality, Groundwater Section, 1636 Mail Sersico toter Raleigh, NC
27699-1636 Phonr'tc. (939) 73 3-3221, within 30 days.
GPr-! REV. 0 2 u1

2. w I:L[. LOCATION ,�(
Neal e tt Town- he I CountyyC1A`f�l.V ��ll
;Site:: N: fie. Numbers. cCC r imuniy, Subdivvi`i;_ion, Lot No . Yip Code)
3. OWNER: .6i� (. ( eA�"n'1P -
Addres5 t1 3bkcC2Vf��--
L etc Lacer Ne z 9 9 /GCo
1�, or'I'uwn State Zip Code
t I-
4m.. :nlc Phone number
4. DATE DRILLED I_ q
5
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural/Resources - Div on of ,Water Quality - Groundwater Sectioonn/
XX EI.I, CO\'111A('FOR ll\DIY IDt:AI.I NAME (print) j� ] 1�1_ L1 CERTIFICATION Nr/Ly1Q9 3 1 \\\ ,_(\ PliO\tip at C1t3Rfl3
W ELL C0\'I'R:1C OR(ONIY:\\l'2,%M:ra t
SI all w Et I. (O\s 1 RC 110\ I'ERMFin ASSOCDI'IED WQ PERMIT/
i iinppiirablc 1 Uf applicable)
293080
I. WELL USE (Check Applicable Boxl: Residential I�r NlunicipalPublic 0 Industrial 0 A_ricultural 0
NIon'itorine 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
r j Topographic/Land setting
2,a? Z(? 2i :Y ti� �L Il idgc ❑Slope Otebox) ❑Flat
(chink appropriate box)
•2-70 Latitude/longitude of well location
(clegrecs r io ices. second5)
Latitude longitude sounc:OGPS❑Topographic map
(check Kw)
DEPTH DRILLING LOG
From To Formation Description
5. TOTAL. DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES . N
STATIC WATER LEVEL Below Top of Casing: _Nu
FT.
(Use"'"irAhosc fop of Casing)
8. TOP OF CASINO IS L Pr. Above Land Surface%
'Top of casing terminated altor below land surface requires a
s ariance to accordance with 15A Si CAC 2C: .0118.
9. YIELD(gprnl: 1. METHOD OF TEST et I.entel_el
10. \VA TER ZONES (depth): 500
!I DISINFECTION. Type 1-ftICARA' Amount
I2. CASING: Wall, Thickness
�^A Depth Diameter or W'.ight:Ft. Material
From 0 To xoi_ FL_
From To Ft.
From To Ft.
13. GROUT. Depth ry Mate�ia} Method
From_ To Ft.
From. To Ft
14. SCR FEN: Depth Diameter Sint Size Material
From__---. To Ft. —__-in. in. From To Ft - in. in. _
15. SAND:GRAVEL PACK:
Depth Size Material
From _I o Et. _-- __----
From To Ft.
IC. RHNIARKS:
-0
O
T C)
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.
v it
c[Ycce-
.at-.d fk to fug [ • I
•-� • MMx
-
2
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WEL
CONSTRICT jlay ` ..'DA S. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-16 o Phone No. [phone], within 30 days. GW-I REV. 07(2001
` 1
J IJ.il
7 EI
WNERr

295380
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 BORINGG, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: UNION MILLS
PINE TREE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JASON HOUSER
Address PINE TREE RD.
(Street or Route No.)
UNION MILLS NC 28167
City or Town State Zip Code
(828) — 429-8588
Area Code Phone number
4. DATE DRILLED 05/24/04
5. TOTAL DEPTH: 28
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): 8 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 4
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 28 Ft. 24" CEMENT
From To Ft.
From To _ Ft. _
13. GROUT: Depth Material
From 0 To 20 Ft. CEMENT
From_ To _ Ft.
14.SCREEN: Depth Diameter
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From 20 To 28 Ft. 78M GRAVEL
From _ To _ Ft.
Method
POURED
Slot Size Material
in. _ in.
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 map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names _ _
FROM FOREST CITY GO UP HUDLOW RD.
THROUGH UNION MILLS. RIGHT ON CONEY
ISLAND RD. 1ST RIGHT ON PINE TREE RD. NEW
LOT 1/4 MILE ON LEFT.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC"1'I D IN ACCORDANCE WITH 15A NCAC 2C, WELL
COAISTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
r C`
i
SGNATURI� OF P)f3w3�1G CONSTRUCTING THE IDATh/
017
Submit 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

295379
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Qujlity - 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 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: BOSTIC
PEA RIDGE RD.
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: TODD ELLIS
Address PEA RIDGE RD.
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code
(8) - 289-8488
Area Code Phone number
4. DATE DRILLED 05/26/04
5. TOTAL DEPTH: 82
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
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*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County RUTH
Zip Code)
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.
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 62 To 82 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
BUS. 74 E. FROM FOREST CITY. LEFT ON
BOSTIC/SUNSHINE HWY. LEFT ON PEA RIDGE
RD. IN BOSTIC. APPROX. 2-1/2 MILES ON RT.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC IED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAN///DD�ARDSAND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
GNA IJ$E OF ���EEE N C STRUCTING WELL DATE /
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

295378
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH
MACKEY FREEMAN RD. (DEER RUM)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: STEVEN MORROW
Address MACKEY FREEMAN RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 245-6224
Area Code Phone number
4. DATE DRILLED 05/27/04
5. TOTAL DEPTH: 83
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 63 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above 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 83 Ft. 24" CEMENT
From To Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size
From 63 To 83 Ft. 78M
From To Ft.
Material
GRAVEL
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include-thenat
number and common names
HWY. #64 E. FROM RUTH. RT. ON MACKEY
FREEMAN RD. RT. INTO DEER RUN FARMS. 4TH
DRIVE ON LEFT. (LOT #17)
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
>a(/,77Le . ,A 7- (/
SI(�,NATURE t9F 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

295389
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 D Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
GREENRIVER HIGHLANDS LOT #116
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LINDA CAGLE
Address GREENRIVER HIGHLANDS -LOT #116
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
88443) — 332-6440
Area Code Phone number
4. DATE DRILLED 05/14/04
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): 1/2 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 19.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 50 Ft. 6-1/4" SDR21 PVC
From _ To _ Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To Ft. _
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ 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. RIGHT INTO GREENRIVER
HIGHLANDS ON RIVER CREST PARKWAY. LOT
#116.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A CC Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
LIF(/A
SIGNK•URE OF PERSON CONSTRUCTING THE WEL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

295390
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: FOREST CITY
HOGAN RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: RONNY SPICER
Address HOGAN RD.
(Street or Route No.)
FOREST CITY NC 28043
City or Town State Zip Code
(828) — 245-8367
Area Code Phone number
4. DATE DRILLED 05/12/04
5. TOTAL DEPTH: 325
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 RUTH
11. DISINFECTION: Type CHLORYTE Amount 8.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 70 Ft. 6-1/4" SDR.21 PVC
From To Ft. _
From _ To _ Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To _ Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #221 S. FROM RUTHERFORDTON. RT. ON
HOGAN RD. 2 MILES ON LEFT.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
OF PERSON CONSTR1ICTINGTH$ 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

295394
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)
WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
1162 GRASSY KNOB RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: GEORGE H. BUTLER
Address 1162 GRASSY KNOB RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 625-4436
Area Code Phone number
4. DATE DRILLED 05/05/04
5. TOTAL DEPTH: 305
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): 4 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 7.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 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
❑ Ridge ❑ Slope ❑ Valley ❑ Fiat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/sernds) ...._ .... _
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. RT. ON
GRASSY KNOB RD. 2.7 MILES. TURN LEFT AFTR
TWO APPLE ORCHARDS na, BLUE MAILBOX
W/#160 & NAME BRACKETT. STAY LEFT OF 1ST
HOUSE -LONG NARROW DRIVE. GO TO END.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC"1 ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS T tUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ON 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

295396
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING. LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH
MTN. CREEK RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CINDY COPE
Address MTN. CREEK RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
7( 04) - 434-2096
Area Code Phone number
4. DATE DRILLED 05/27/04
5. TOTAL DEPTH: 805
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface'
*Top of casing terminated abor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 22.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 60 Ft. 6-1/4"
From To Ft.
From To Ft. _
13. GROUT: Depth Material
From 0 To 20 Ft. QUIKRETE
From _ To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To _ Ft. _ in.
From _ To _ Ft _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To _ Ft.
From _ To _ Ft.
SD1C21 PVC
16. REMARKS:
Method
POURED
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #221 N. FROM RUTHERFORDTON. LEFT
ON MTN. CREEK RD. GRAVEL DRIVE APPROX. 2-
1/2 MILES ON RT.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS UCTIQN STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSOIQ CONSTRUCTING
167-A.0 , , s • a 7- C f`
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

295397
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: RUTHERFORDTON
MTN. CREEK RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CINDY COPE
Address MTN. CREEK RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(704) — 434-2096
Area Code Phone number
4. DATE DRILLED 05/24/04
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IZ
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 16.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 70 Ft. 6-1/4" SDR21 PVC
From To _ Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUHQRETE POURED
From _ To _ Ft.
14.SCREEN: Depth Diameter
From To _ Ft
From _ To _ Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. _
From To Ft.
Slot Size Material
in. in.
in. in.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutesheeonds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road -
number and common names
HWY. #221 N. FROM RUTHERFORDTON. LEFT
ON MTN. CREEK RD. GRAVEL DRIVE APPROX. 2-
1/2 MILES ON RT.
0
C-
-o
s
r
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TILE WELL OWNER
n7.->`4 �� �t-0) (4,77-,40 OK V- OK
SIGNATURE 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

295400
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 ® MunicipaVPublic ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
MTN. CREEK RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CINDY COPE
Address MTN. CREEK RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(704) — 434-2096
Area Code Phone number
4. DATE DRILLED 05/18/04
5. TOTAL DEPTH: 705
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 19.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 80 Ft. 6-1/4" 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:
County RUTH
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. #221 N. FROM RUTHERFORDTON. LEFT
ON MTN. CREEK RD. GO APPROX. 2-1/2 MILES &
RT. ON NEW GRAVEL DRIVE JUST PAST RED
HOUSE.
r -
J•
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS T TIO�I I$TANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
OF PERSON IYONSTRCTCTING 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

295101
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH
GREENRIVER HIGHLANDS -LOT #119
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: PALMER KAUFELT
Address GREENRIVER HIGHLANDS -LOT #119
(Street or Route No.)
RUTHERFORDTON
City or Town State
(8) — 286-4868
Area Code Phone number
4. DATE DRILLED 05/14/04
5. TOTAL DEPTH: 605
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 I5A NCAC 2C .0118.
9. YIELD (gpm): 1-1 1/2 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 16.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 40 Ft. 6-1/4" SDR.21 PVC
From To Ft. _
From _ To _ Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter
From To
From To Ft. _
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Slot Size Material
in. _ in.
in. in.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds),...
NC 28139 Latitude/longitude source: ❑ GPS ❑ Topographic map
Zip Code (check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #221 S. FROM RUTHERFORDTON RIGHT
ON COXE RD. RIGHT ON RIVERCREST PKWY.
RIGHT ON CROSS RIDGE DR. APPROX. 3/10 MILE
ON LEFT.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CO TJCTION STAND AR�2S, AND THAT A COPY OFJHTS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
,,& / 4 WCPX1V 7 J 3-' Y — IV
SIG 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

295402
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: LAKE LURE
BUFFALO CREEK RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: KENNY YOUNG'
Address BUFFALO CREEK RD.
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
(828) - 890-3559
Area Code Phone number
4. DATE DRILLED 05/12/04
5. TOTAL DEPTH: 165
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): 60 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To 40 Ft.
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 _ FL __
County RUTH
CHLORYTE Amount 3
Wall Thickness
Diameter or Weight/Ft. Material
6-1/4" SDR.21 PVC
16. REMARKS:
Method
POURED
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. #64/74 W. FROM RUTHERFORDTON.
RIGHT ON BILL'S CREEK RD. LEFT ON BUFFALO
SHOALS RD. RIGHT ON BUFFALO CREEK RD.
APPROX. 1/2 MILE ON RIGHT, AFTER PAVEMENT
ENDS. LOT ON CORNER OF BUFFALO CREEK RD.
AND POPLAR RD.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCT ED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONST�(CSTANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
) // � Ai,
mot,RE OF PERS(iN CONSTRUCTING TIC WELL
-/a - 0V
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

295403
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Q(y'lity — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION 4 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: ELLENBORO
NEWHOUSE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: WARREN BLAIR
Address 1890 NEWHOUSE RD.
(Street or Route No.)
ELLENBORO NC 28040
City or Town State Zip Code
(704) — 538-6778
Area Code Phone number
4. DATE DRILLED 05/11/04
5. TOTAL DEPTH: 385
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 I5A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 9.5
12. CASING:
Depth Diameter
From 0 To 40 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.
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 ❑ 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 read
number and common names
FROM 74 BUS. IN ELLENBORO GO UP NEW
HOUSE RD. LAST DRIVE ON RIGHT BEFORE YOU
GET TO ROBERT LUCKADOO'S GOAT FARM.
(#1890 ON FENCE POST)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY QF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
'-te (Mi_ �r - 4-- d
SIG ATURE OF PE ON 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

295405
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of' Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: ELLENBORO
NEWHOUSE RD.
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: WARREN BLAIR
Address 1890 NEWHOUSE RD.
(Street or Route No.)
ELLENBORO NC 28040
City or Town State Zip Code
(704) - 538-6778
Area Code Phone number
4. DATE DRILLED 05/07/04
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): 1 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From 0 To 40 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 RUTH
Zip Code)
CHLORYTE Amount 16.5
Wall Thickness
or Weight/Ft Material
SDR.21 PVC
Method
POURED
Slot Size Material
in. _ in.
in. in.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degreeshninutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
FROM 74 BUS. IN ELLENBORO GO UP NEW
HOUSE RD. LAST DRIVE ON RIGHT BEFORE YOU
GET TO ROBERT LUCKADOO'S GOAT FARM.
(#1890 ON FENCE POST)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUL I'ED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONS UCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�4-6'—y.LL� ,,, �� m �- 2 - dtz
SIG ATURE OF PE SON CONSTRUCTING THE WE L DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

295385
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 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: BOSTIC
BROOKS RD. EXT.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: WAYNE RAMSEY
Address BROOKS RD. EXT.
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code
8(28) — 289-5555
Area Code Phone number
4. DATE DRILLED 05/07/04
5. TOTAL DEPTH: 76
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 121
7. STATIC WATER LEVEL Below Top of Casing: 56 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 12 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 5.52
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 76 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 Slot Size
From To _ Ft. _ in.
From To _ Ft. _ in.
15. SAND/GRAVEL PACK:
Depth Size
From 56 To 76 Ft. 78M
From To Ft.
Method
POURED
16. REMARKS:
Material
in.
in.
Material
GRAVEL
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #64 E. FROM RUTHERFORDTON. RIGHT
ON PEA RIDGE RD. LEFT ON WHITESIDE RD.
LEFT ON BROOKS RD. RIGHT ON BROOKS RD.
EXT. 1/4 MILE ON LEFT.
ct
0
L
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRKCTION STANDARDS, AND THAT A COPY OF 1 SMECORD HAS BEEN PROVIDED TO THE WELL OWNER
Submit the original to the Division of Water Quality, Groundwater Sectieo,1636 Mail Service Center— Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

295386
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: BOSTIC County RUTH
WELLS MILL RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ED GALLANT
Address WELLS MILL RD.
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code
(401) - 781-4395
Area Code Phone number
4. DATE DRILLED 05/19/04
5. TOTAL DEPTH: 105
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 3
12. CASING: Wall Thickness
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. 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
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
BUS. 74 E. FROM FOREST CITY. LEFT ON
BOSTIC/SUNSHINE HWY. GO THRU BOSTIC. RT.
ON WELLS MILL RD. 1/2 MILE ON LEFT.
0
1
v
w
N
0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT T(ACOPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGN i lfF PERSON CONSTRUCTING THE LL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

29530
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)�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 ® 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: Topographic/Land and setting
WELLSNearest Town: RD. County RUTH 0 Ridge 0 Slope ❑ Valley 0 Flat
M, LL Numbers, (check appropriate box)
(StreetNName, LCommunity, Subdivision, Lot No., Zip Code) Latitude/longitude of well location
3. OWNER: ED GALLANT
Address WELLS MILL RD. (Street or Route No.) (degrees/minutes/seconds)
BOSTIC NC 28018 Latitude/longitude source: 0 GPS 0 Topograpllie map
City or Town State Zip Code (check box)
(401) — 781-0DEPTH
395 From To
Area Code Phone number
4. DATE DRILLED 05/18/04 DRILLING LOG
5. TOTAL DEPTH: 605 From To
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 11_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): 0 METHOD OF TEST ARD number and common names
10. WATER ZONES (depth): BUS. 74 E. FROM FOREST CITY. LEFT ON
BOSTIC/SUNSHINE HWY. GO THRU BOSTIC. RT.
11. DISINFECTION: Type CHLORYTE Amount 16.5 ON WELLS MILL RD. 1/2 MILE ON LEFT.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 30 Ft. 6-1/4" SDR.21 PVC
From To Ft.
From _To_Ft.
_
13. GROUT: Depth Material Method o
From 0 To 20 Ft.OUIKRETE POURED
r_
From To Ft.
En-
14.SCREEN: Depth Diameter Slot Size Material i
From _ To _ Ft. _ in. _ in.
From To Ft. in. _ in. J
15. SAND/GRAVEL PACK: —•-
Depth Size Material L..)From_ To Ft. .�
From To Ft. ^•
O
Cil
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT AACCOPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL/ OWNER
j,,e�Trr �i -.1"- /ij
AO
SIG F PE SON CONSTRUCTING YEE 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

295384
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 # ASSOCIA t Ell WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
NIX RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MELVIN LYNCH
Address 141 NIX RD.
(Street or RouteNo.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 289-2557
Area Code Phone number
4. DATE DRILLED 5/10/04
5. TOTAL DEPTH: 35
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): 15 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 6.9
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 35 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 Slot Size
From To Ft. in.
From _ To _ Ft. _ in.
15. SAND/GRAVEL PACK:
Depth Size
From 20 To 35 Ft. 78M
From To Ft.
Method
POURED
16. REMARKS:
Material
in.
in.
Material
GRAVEL
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map:
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #221 N. FROM RUTHERFORDTON. LEFT
ON SCHOOLHOUSE RD. IN GLLKEY. LEFT ON
PAINTERS GAP RD. LEFT ON NIX RD. 2ND DRIVE
ON LEFT.
0
Cl
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC PED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONTION STANDARDS, AND THAT A COPY OF THIS,,RECO2D HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSQt9tONSTR
Submit 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

295383
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: ELLENBORO
FORD RD.
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: DOMINICK BARIBERI
Address FORD RD.
(Street or Route No.)
ELLENBORO NC 28040
City or Town State Zip Code
(704) — 434-5100
Area Code Phone number
4. DATE DRILLED 05/11/04
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 RUTH
Zip Code)
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/FL Material
From 0 To 57 Ft. 24" CEMENT
From _ To _ Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 37 To 57 Ft. 78M GRAVEL
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HOLLIS RD. FROM ELLENBORO. RT. ON FORD
RD. 1/10 MILE ON RT.
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONST$LjCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIG AT[IRE OFERSON
"j in —A r 0 5 //^ O5
UCTING THE WELL 111 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 Driers, !no To: NC Dee: of E^ r. aoo \a Eaaov Jas. 6/32004 Erne: 8.42:24 PM
,,.1 Ei_',;?:\ iTRt,'C LION I4ECOR )
North Carolina - Lep,r'rent ctTr.', ira-r.dt st1 .21 F s uroes D1::si r 1eaLf iai:,a Crcudd ?`,::01
WELL CONTRACTOR(LND'V1llULL)rirt tt SC -OTT GAS-ft C'1R :'.'ICAI'IO z 2SIC
WELL CONTRACTOR CO\;PANN NA Olt Ca.,&0L,11,‘A WELL DAii:LERS INC. PlittNE c: [phone]
STATE WELL CONSTRUCTION PFRY:" -` ASSOCIATED Itt"Q PERMIT,
(ifapplic0b) A _ e _
I. WELL USE (Check Applicable B ,es e .lat rdctoz! '_I I testrial ❑ :r:1 t LJ o _ o i .
Recovery ❑ Heal o `Ater L i eLLIY: [_ CB:er h If CoIlet, List Use.
e. FVELI. LOCATION:
New'eo town: LAKE L'k:.
LOT 27 LAKE LURE PEAKS
Street Name. Numbers, Convinney, SuSJi•.ie:cr: :....
3 OWNER RENAISSANCE Di:IL!:I 5.
ADDRESS 152 E. MAIN Sf
(Smear rr..o,.,c t
FGRES f CITY
City or Town .. v
828-247-4395
Area Code - Phone Number
+. DATE DRILLED - i_3't1d
?. TOTAL DEPTH 220
6 DOES WELL REPLACE EXISTT:C WELD'
7 STATIC WATER LEVEL Below To:: of Coo:,
s TOP OF CASLNG IS
'Top of easing terminated avor anon land surface reopen: avv.m::ca
a..or1yne with tSANCAC 2C.:la
9. IIELD(_Rmy. 29— ...._.. J. ._
Io. WATFR ZONES (det:;-
u. DISINFECTION: TYPE I iYELY3iii..CRITE saiat —
r.CASING: —!.F
Depth
From 0 To 170
II. GROUT:
Depth
from 0 To 20
N. SCREEN
Depth
From NA To
G. SAND/GRAVEL FACE:
Depth
from NA To
16. R E1'.?RRS'.
DO HEREBYCEFSir't TAA1
CONSTRUCTION TIO? STANDARDS: :NIL
Submit the original to the itiviclort el X
27699-1636 PhoneNo. (919) 733-322'1, al
D P,
2SG-._ Snm __::
`0 C
MaImal
elotood
[do Start Roads o .. '. Roads. 0-
;orsand odds:our, EttoC YIETrItS.
V ZE I;:r'. TI l :. r.
Sect on. 163 ;1aail Service eenier C
293232

From: Cardir.3 Weti Deniers int To: NC. E.,-,?•A of Env. on.:1Nr. S000.t 2-ate. 618/2224 Thm.-2.: 8:42:24 FM
295229
',..V EL .:_.L,IZC_17C STRUCTION ItECORI?
North Carolina - Department of Errei CO( ni 2S.: RI-J. NCR:if li Re,sourees - Divis i et of Water Qiirlity - Groundwater aeiefieL
WELL CONTRACTOR (INDIVIDUAL; N.12.ii. i IE. il5V, SCOTT C ANTI CERTIFICATION # 16SI
WELL CONTRACTOR COMP ANt: NAI5I: 2 C &ROI_ 1:'CA WELL DRILLERS, INC. PHONE t4 [phone]
STATE %%ELL CONSTWECTION 1l:R75iIT 4 ASSOCAATED WO PERNIir (2 _____ ..... __
(if applicable.] (if imrlicalael
, , _ ..:
I WELT: i133' (TT:recto AppiicoblelThy) : A:PA:Jon:55 17, i.-illi.liP21 7 TilLuslLiFil r7_, :AL:Halal:mai 7 me,1;inss 2 7:
Recover.A 0 lit.al Prop iAl.Le: ire e.: Lea E: :alter [17
2 WL:LI, To2:Cr.,.T:02,-.: Yopowarfflic Lareil :ifal:La
1Reare,,! Ran i AKE: tkRy. C.7 :11.0 .' -.C: .1.7H 7,R pc r:!-) EA222_, x sicn.,
1,0T 35 LA Kir, 1.023F. PEAK., ',..-2.R7J2.2, I if:kJ:of:2 of aall :.-ralea
35.24 155' /512 I ] If 3
2 Ot.VRER RC' \ ROSSO-C.: kccgeo.31,:eitT
ADDRESS 2330 1 ERVI. Al '::
NORF- P'3,34- 312S From
24:, To,,- 3
Area Cod2 5,10
4 DAFEDRTI.E5
1QT.AI. DE ViN 260
DOES WELL REPLAC ERRI-RN3 0
STATIC 'N.ATER VEI help.: To:, of
? TOP OF '-7.SINC-'
`.122:121, 22.-C
R W. ATER '1,1,N2iS7271-.): 253
DISINFECI ION: IPE Ei'00.11,01.1 ni
12 CASINO:
From o To 1,52 : ' S1'.2 'VC
GROL, i
Dept
Horn 0 Tc 2C Y:
Dot.1 SIN :2 t I:aka!
Uoro NA 10
1! SAND 2112. EL P RiTis
Depth S
von, NA 10
It; RSA f ARKS
;IT
Elru.:v direction
;TIC).
ami ccrmvi 1333 r4-...-NLL,.
CD ;
C.—
r--
I DO Filth:St:I CEN'Ir7Y I L ‘.; A o. E .
.-0:,:STEL LI ON STA V2).`,R " a7CCF:21% Ri.:3 2: L -222 UE 0
-
1.3 72:1?3DNICL.P4CDN-17 ENS WEIL
Submit the origiml to the Diviskoit of 55 otor Cif a; SeAlott 1635 Sznic?.rontr - RaIeig;5, NC
27699-163b Phone No. (919) 733-32.7.2. :1 30 0

From. Carolina Weli:;r:l;ars, Inc co: PIC D
81812E34 Tr.>_'. 8.42'24 FM
?95230
%YEL . CONSTRUCTION STRUCTION RECORD
North Carolina - Department GI' Envranat en. it . Nattirsl P. e:ourees - Division of Water Qual:_c - Graionde,at_ _:ion
WELL CONTRACTOR (INDIVIDUAL) 1A!‘ •i' ((prinr, SCOTT GANTT CERTIFICATION ;--i 1:65.S
WELL CONTRACTOR COMPANY 1`•III CI-SIOLU A WELL DRILLERS, INC 'I(CiYE # (7t14) 434'177
STATE WELL CONSTRICTION TER "iT "ASSOCIATED.'Q PERMIT ri
if applicable) [Of _ ''rcable?
_
I. WELL USE(Cher' Apo,tcable Bo.:: -. r: I,`., _ I ipal o::csDrr L = _' e :T.a' _
Retcover; ❑ Heat ?'_ .t. :.[.: C. ':c: [11u l , List C _-
2_ WELL LOCATION.
;teach tons LAKE TURF.
LOT 2'2 RIVERBEND RFSCRT
(Street Nam:, Numbers. Corrmmn;ty, S.:hdirisoo, Lo:
�. OV,NER RIDG LEN r'. DESELOP_` OA- t.,,tc_
ADDIU:ss 112 COOOPLUM =IRCLE
'AERFCT.,
ROYAL PALM BF..A(`e
561-798-2721/42
Au: a Cede - PIiolw \hobo
a.DATIE DRILLED 5/6/01
!. TOTAL DEPTH 3DC
6. DOES WELL REPLACE EXISTDI;, WILL(
'.. STATIC WATER LEVELBelor To_ o_ C<.,u,,
u..md.m.< With : YANC'A(
lo. WATER. ZONES (^n)the 3G0
n. DISINFFCFION: TYPE. ((hrP0CHI.(3IT
12. LASING:
r9)n o
II GFDI. F.
tom 0
Depth
I'o 133
11. SCRIED
D,.)(h.
Fehr( NA. To
15. SAND:GRA/FL PACK:
Depth
Pmo; NA TO
99Oct:
C
l _.v_ of V r;i'.. .,_Grill
olI ?eC
h:J Staie `i' `.o __ Oor..lity 2o_0s h0(:Q V
11)0 HER ETC CEti I S Ti/Ar. .'
..:. .OF r5 V CON31T _:. WELL
Submit the original to the Division of l i'oto-r ;:a:i's, Corm::ir.:u): Section, 1636 M i Sztiice et.rr-r- RuIei
27699-163: "'Lane No. (9 9; 732.-2121, c, ::_::-�i;
VD
0

296231
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J. meS r'arnp, Jr- CERTIFICATION (f71 iR
WELL CONTRACTOR COMPANY NAME rampI s Wm11 & Pnrnp Y'n Tnr• PHONE #$7R) 4S1-7122
STATE WELL CONSTRUCTION PERMIT# ..ASSOCIATED WQ PERMIT# Of applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Ia—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
Ne est To
At
(Street Name, N ers, Community, Subdivision
3. OWNER: AA \-1.)
Address j� PAMbeau lOa✓KOal
r
I *net or tt/n C
C'LF No.) �i /I
k cYC (�
CountyC,(T jJ4rY 2
t No., Zip Code)
City or Tow,: t Staten 6 Li Zip Code
Area code- Phone number
4. DATE DRU I FD
5. TOTAL DEPTH: 3 0 S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: SO 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 accords cpp with ISA NCAC 2C .0118.
9. YIELD (gpm): 10 QD OF TEST 4i
10. WATER ZONES (depth): �5
11. DISINFECTION: Type rh 1 nri n
12. CASING:
Depth
From—o To4� Ft.6
From______ To Ft.
From To Ft.
13. GROUT: Depth
From_p_ To 2 0
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
Diameter
1/4
Amount V LAA.AQ
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Material
Et. Neat Cement
Ft.
Diameter
Ft. in.
Ft. in.
16. REMARKS:
Method
Hand
Slot Size Material
in.
in,
Size Material
Ft.
Ft.
Topographic/Land setting,
❑Ridge ❑Slope ❑Valley lerlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH PRILLINC'GInd _._ ___.._ _. -_
From To o tion D criptio
o
3os
f')
c
0
LOCATION SICETCI-( E n
Show direction and distance in miles from at least N
two State Roads or County Roads. Include the'ad
numbers and common road names. Ns
fV
I DO HEREBY CERTIFY THAT THIS WFI f WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HEEN PROVIDED TO THE WELL OWNER
ir_o-otb
SIGNATURE OF PERSCEN 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
N

Froit>, To
From To
13. GROUT: Depth
From_o To 2 0
296229
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, TY-- CERTIFICATION# 21 38
WELL CONTRACTOR COMPANY NAME ('amp[ a Win 11 & primp f rL Inr• PHONE N(g7Rl Li 732�--
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residentia1112'..-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 ON: p
Nearc Town: (j�� County
Ut ft-. v;,r` k, CS*ttes La l-Z6
(Street Name, Numbers, Communi[j, Subdivision, Lot No., Zip Code)
JJ
3. OWNER: V(IV, F Yl 2.
Address G0n c Ciro ctIA)
V(Baca[ or tine No.) 3 `I \ a Tc
Ci or ownlScate a r, ,, Zip Code
Area �q
o- Phone number
4. DATE DRILLED S —I n. D t
5. TOTAL DEPTH: S 0 S
6. DOES WELL REPLACE EXISTING WELL? Y E S 0 NO Fl
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
`Top of casing terminated at/or below land surface requires a
• - variance in accord ce with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST D it
•10. WATER. ZONES (depth): ll�j
11. DISINFECTION: Type rh 1 nr i rip
12. CASING:
Depth Diameter
From_ To \ ZFt. 6 / ri
Ft.
Ft.
Ft.
Amount "'^'i
Wall Thicloscss
or Weight/Ft. Material
c8g21 PVC
Material Method
Noat Ccmcnt IIand
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Slot Size Material
in.
in.
16. REMARKS:
Topographic/Land setting
6/gage OSlope DValley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box) _...
DEPTH PRILLTNG T.OG
From To Formation DescxQ,tion
0 Ate) 1 (J(
st a_ 60 5 AcA/ l
u
r
N
ti
LOCATION SKETCH
Show direction and distance in miles from at lie m -_
two State Roads or County Roads. Include thertVad
numbers and common road names.
JJ0`-1 iC
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCbD IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
Q� l9-oij
ayfi la
SIGNATURE OF PERSON CONSTRUCTING THE WETS. ✓
SO
Submit 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

296228
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jame e t.i ('amni J r- CERTIFICATION # 71 18
WELL CONTRACTOR COMPANY NAME Camp' c Wa11 R. Pinar ('n Inn PHONE #g9R1 453'-7';"Z'z -
STATE WELL CONSTRUCTION PERMIT# 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 ❑ Other 0 If Other, List Use
2. WELL LOCAT N.
Nearem�Town:
r, ` b T
Name, Numbers, Community, Subdivision, Lot No., Zip Code)
(S
3. OWNER: �L
Address y 1S`
(Sweet or Route No.)
t\,A MA N c
AVt�
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED - O
5. TOTAL DEPTH: i fY5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
7. STATIC WATER LEVEL Below Top of Casing: Cob FT.
(Use "+" if Above Top oteasing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of casing terminated atior below land surface requires a
variance In accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): .2,11 METHOD OF TEST air
10. WATER ZONES (depth): `has
11. DISINFECTION: Type r h 1 n r i n
Depth .
To
Diameter
Ft.6 1/4
Ft.
Ft.
Ft.
CounrykIW
12. CASING:
From
From To
From To
13. GROUT: Depth Material
Front.—p_To 20 N 3t Ccmcnt
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft, in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
gDR21 PVC
Method
hand
Slot Size Material
in.
in
TopographicfLand setting
Midge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographid map
(check box)
DEPTH DRILLING LOG
From To trmatioR Description
A Pis
111 o-A--4,
V
r-
3
N
c
c
c
r __
LOCATION SKETCH _C
Show direction and distance in miles from at legit
two State Roads or County Roads. Include the Mad
numbers and common road names.
16. REMARKS'
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUG fhD IN ACCORDANCE WITH I SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL/
aM1.0
DATE
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
r1

296227
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jamiss g ry Caryl Jr CERTIFICATION 117148
WELL CONTRACTOR CONIPANY NAME Camp) c Wa11 & Pomp f`n Tnr PHONE ti$781 4.51-7122
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITI ------
(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:
County
\I eCbc
(Street Nam , Numbee
rs, Community, Subdivision • Lot No., Zip Code)
3. OWNER: C�L.LI{� a
Address )r � v. Off? Ifi f_Acvi Jr' °AN 41
q (Street 1% (true No.) G u s-
1�.ti k0 A.t
City- nu or tas V Ztp Code
(�� 1,
Area code- Phone number
4. DATE DRIIIFD 04
5. TOTAL DEPTH: Oci
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO d
7. STATIC WATER LEVEL Below Top of Casing: SO FL
(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 accord sic with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST p i r
10. WATER ZONES (depth): t12 S
11. DISINFECTION: Type rh 1 nri na Amount LA
12. CASING: Wall Thickness
Depth.,Diameter orWeight/Ft.
From_a___ To 15 Ft 6 1 / 4 3DR21
From To Ft.
From To Ft.
13. GROUT: Depth
From o To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Material
PVC
Material Method
Ft. Ncxit Cement
Ft.
Diameter
Ft. in.
Ft. in.
Slot Size
in.
in.
Depth Size Material
Front To Ft.
Front To Ft.
16. REMARKS:
.,,-Topographic/Land setting
ID Ridge ❑Slope ❑Valley 0F1at
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH (check
LOG
From ,cTp Foutma` on Dc 'ption
$ 3 3 o..s C /r.1.
0
c
0
c
LOCATION SKETC14
Show direction and distance in miles from at Ieat 2 Fr
two State Roads or County Roads. Include therrgad
numbers and common road names. — o
=
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
DATE
444 d
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
�3

296240
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (printL Jarains Tel CamD, Jr- CERTIFICATION # 71 T$
WELL CONTRACTOR COMPANY NAME Camp' a Wa11 R Pinar ('n Tnn
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) - (if applicable)
PHONE #al7R) 453_7122
1. WELL USE (Check Applicable Box): Residential Lir 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,9N:
Nearest Town:
tkAivv>,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
,n "1 (t t, /vv,y4
Address -1 g
(Street or Route No.) n,)
City or Town Stale Zip Code
Area code- Phone numb
4. DATE DRILLED lk a U . 0
5. TOTAL DEPTH: '4 O S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IA]
7. STATIC WATER LEVEL Below Top of Casing: v i) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated atior below land surface requires a
. • variance In accordant with 1SA NCAC 1C .0118. r\
9. YIELD (gpm): METHQD OF TEST ;sir
10. WATER ZONES (depth). V t iv-kr .
Topographic/Land setting
❑Ridge ❑Slope ❑Valley (dfilat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box) i_...___._....
DEPTH DRILLING I1)(1
From Too. Eornation Description f
.Y .u.v„� S
1 1. DISINFECTION: Type ("hi nr i n s
12. CASING:
Depth,"Diameter
Fron _l__ To 1S Ft. 6 1 / 4
From_____To Ft.
From______ To Ft.
13, GROUT: Depth
Frortr_(1_ 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
Amount Cl.t
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Material
Ncat
Method
Cement IIand
From To
From To
Ft.
Ft.
Slot Size Material
in.
in.
Material
T.00ATION SKETCH
Show direction and distance in miles from at lfat
two State Roads or County Roads. Include the/toad
numbers and common road names.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WFT i WAS CONSTRUCIhD IN ACCORDANCE WITH 1 SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�y) G� i , C . 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

296237
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) .Tama 9 t.t
WELL CONTRACTOR COMPANY NAME Camp t
STATE WELL CONSTRUCTION PERMIT%
(if applicable)
win 11
Camp, Jr. CERTIFICATION If 211R
R Pnmr Cot
T n r-
ASSOCIATED WQ PERMIT%
(if applicable)
PHONE %817R) d 51-73.22.
1. WELL USE (Check Applicable Box): Residential C t4unicipal/Public 0 industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIOl�j
rest Toown:W A4t k it2 County
Ql,h C- q
(Street Name, Numbers, Common Subdivision, Lot No., Zip Code)
3. OWNER: CQ/)11‘..0 *goo
� L �J `
Address *700 C4 ✓s H /- n air r)d
(Sweet or Rout No.)
Clla/ [o t9 N c 4-aa6
City or Town State Zip Code
Area code- Phone nunbe
4. DATE DRILLED ' 2'. O L,
5. TOTAL DEPTH: 1 O S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: ( (3 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 IC .0118.
9. YIELD (gpm): S ME OD OF TJ S�T Sir
10. WATER ZONES (depth): 0j 0 1LL4,0
11. DISINFECTION: Type f'h 1
12. CASING:
Depth
From _ _pTo 11V Ft
From To Ft.
From To Ft.
13. GROUT: Depth Material
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
From To
From To
nri na
Diameter
6 1/4-
Amount a- LLCAP
Wall Thickness
or Weight/Ft. Material
SDP21 PVC
Method
Hand
Slot Size Material
in.
in.
Size Material
Ft.
Ft.
"-Topographic/Land setting `r
Midge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOCH
From To Fgrma6on ascription
o Lo
Go I, o S CA-ku 0-44\ A
T
LOCATION SKETCH( ry
Show direction and distance in miles from at leas?
two State Roads or County Roads. Include the toad
numbers and nomad names. •
e
t�
fV
IN)
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WFI 1 WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL / ' DATE
Submit 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

296236
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jamas co__ Ca'ttp, Jr CERTIFICATION 71 3R
WELL CONTRACTOR COMPANY NAME Camp' c Wa11 & Pomp C2 , Tnn PHONE N$7R) d53-7322
STATE WELL CONSTRUCTION PERMIT/4
(if applicable)
ASSOCIATEDWQ PERMIT% --_
(if applicable)
1. WELL USE (Check Applicable Box); Residential V Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION
N eu town
(Street Namc Numbers, Community, Subdivision, Lot No., Zip Code)
Topographic/Laad setting '
❑Ridge 112fglope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: / � 1l.lii (degrees/minutes/seconds)
Address 0 \Ai:A� Ut> 1�C.vY Latitude/longitude source:❑GPS❑Topographic map
(check box-)
DEPTH, (check
LOG _. __ - -
From To c�ormatiRRn DJf�S5crip(f}}'99❑
n u Z 3QnnaUg F (I(X
Lk D. O / J.ikili/U o
R County
of d \Al Cr twtpwc o.) V �3 �1
City or Tc o Stain ` Zip Code
ci
Area code- Phone number
4. DATE DRILLED IA- 2 i - O `I
5. TOTAL DEPTH: b s
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use''+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
. • variance In accordee with 15A NCAC 2C .0118.
9. YIELD (gpm):.1 it THOD OF TEST D i r
10. WATER ZONES (depth): `Q 0 k a u
11. DISINFECTION: Type rh 1 nr i na Amount
12. CASING: Wall Thickness
Depth A Diameter or Weight/Ft. Material
From'4- o ToL Ft.6 i/g cpp71 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From p To 20 Ft. Pleat 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.
LOCATION SKETCH N
Show direction and distance in miles from at least t
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WFi I WAS CONSTRUUIED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
6 y� la , C;. s as nil�
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

293.7?,9
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
PROVIDENCE WAY
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: RICK ROUTH
Address PROVIDENCE WAY
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 287-5035
Area Code Phone number
4. DATE DRILLED 04/14/04
5. TOTAL DEPTH: 125
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 40 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 3
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 90 Ft. 6-1/4" SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To FL _ in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS
Topographic/Land setting
❑ Ridge ❑ Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
FROM RUTHERFORDTON. LEFT ON MAPLE
CREEK RD. LEFT ON RIVER ROAD. LEFT ON
PROVIDENCE WAY. BEAR RIGHT (a, ALL FORKS.
HOUSE AT END OF ROAD.
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF ThjIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/! 1 1 T at /
SIGNATURE OF PERS CONSTRUCTING THE WELL
/V- 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

rrom: uarollna vvea unuers, Ino I G NL wept OT crv. anc Na P esoer
uate: 4l131LUu9 nme: e:4/:90 rrn 3'
294606
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Reaesaes - Division of Water Qaality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GANTT CERTIFICATION # 2531
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 Eos): Residential E municipal El Industrial ❑ Ag icuitural ❑ manitorur;
Recovery 0 Heat Pump Water Injection ❑ Otter L if Other, List Use:
2. WELL LOCATION:
Nearest town: RUTHERFORDTON
110 JOHN C. LOGAN RD
County RL:HERFORD
(Street Name, Numbers, Commurrry, Subdivision, Lot No,. Zip Code)
1 OWNER HORTO\ HOME OF RUTHERFORDTON (deaees/minuts/secord;)
ADDRESS 342 HWY 74 BYPASS Latitude/Iongitude source: © GPS ❑ Topcgraphia a.:y
(Sven or Roaa No) DEPTH DRtr' ING _1
RUTHERFORDTON NC 2�'!_9 From To Formation Dezerc zn
City or Town Stale L;p.:o.e 0 50 Clay
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley
LatitudelLongitude of wall location
35.25.698 / 81.54.218
828-287-3366
Area Code - Phone Number
1. DATE DRILLED 3/2000d
5. TOTAL DEPTH 340
6. DOES WELL REPLACE EXISTD.3 WELL? iES ❑ NO rr
7. STATIC WAIER LEVEL Below Top of Casing: 6:
(User "*" ifAbcvc To; of Casing)
S. TOP OF CASING IS 2 FT. Above Land Surface"
',Top of casing tmninatcd atior below land =ufzec requires a varianee n
accordance with 15A NCAC 2C.0118
9_ YIELD (gpm): 6
lo. WAIERZONES (depth)'.
u- DISINFECTION: TYPE
12. CASING,
Depth
From 0 To
D. GROUT:
Depth
50 343
Consolidated Rods
blr:lriOD OF TEST .ARDr:'
300 G,
HYPOCHLORI""E
?_no't 13
Cz LOCATION SKETCH
Wall Thies_ ss Show direction and distance in miles fron:
Diameter or Weighc1i'. :dateie: two State Roads or County Roads. Include
58 Ft. 61/4" SDR 21 PVC .13nbers and common road names.
Material \1e0':.oi
From 0 To 20 Ft. GRAVEL MIX GRAVITY
1J. SCREEN
From
Depth Diameter Slot Size N!ater:a'.
NA To Pc. sir.. _..
15_ SAND/GR.AVEL PACK:
Depth
From NA To
16. REMAR-KS:
Ft,
Size paretic:
O o
at leas C �,
the roct•
i
III 0
tp%
CR � P i
i
I DO HEREBY CERTIFY THAT THIS \\"ELL WAS CON STR'CC'. LD IN AC WITHI 15A NCAC 2u, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS PEEN PROVIDED TO THE WELL OWNER.
4,' 1704
SIGNATURE Or PERSON CON_:200IaNO THE WELL Date
Submit the original to the Division of Water Quality, Ground,hater Section, 1636 Mail Service center.-$aleigh, NC
27699-1636 Phone No. [phone], within 30 days.

From: Carolina Well Drillers, Inc To: NC Dept of Erv. and Na Resc.jr 0ece: 4!13,2004 Time: S:47:46 PM
29.1605
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Reso' aces - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT CANTT CERTIFICATION #2_34
WELL CONTRACTOR COMPANY NAME CAROLTNA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WO PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicsbls 6o: : Residential ❑ ...rioipa_ ['• Glaastrial E Avis-cultu ai ❑ ".i"
Recovery ❑ Heat Pump Water injection ❑ J_e_ ❑ If Other, List Use.
2. WELL LOCATION:
Nearest town: LAKE LURE Courn' R..1HGR7ORD
OTTER TRAIL LOT 9
(Street Name, Numbers, Commuri;y, Subdivision, Lot Co,. Zip Code)
Topographic/Land setting
❑ Ridge 0 Slope 0 Valley E
Latitude/Longitude of well locaton
35.31.1222 / 82.05.520
3 OWNER HORTON HOSE O; RuTHERFORDTON (deoreesminuterisecorde0
ADDRESS 342 HWl74 BYPASS Lattalejonktitude source: ❑ GPS G Topomepr_t stet -
(Ss ea or Route No.; DEPTH DRILLING LJ2
RLTHERFORDTON —:,._) From To Fa-atcn o: _
City or Town Steve 0 30 Clay
828-287-3366
Area Code - Phone Number
a. DATE DRILLED 3'17,01
5. TOTAL DEPTH 140
6- DOES WELL REPLACE EXISTO/3'/CLL? YES ❑ NC.
7. STATIC WATER LEVEL Below Top of Casino: 35 - -.
8 TOP OF CASING IS 2
'Sop of casing terminated aror oelow les
accordance with 15A NCAC 2C.0113
(Use "-" If Above Top of Casing)
=.Sem Land SU^rf
.-u sequins a visia:u: n
9. YIELD (Rpm): 15 METHOD OF TEST ARD'k!
to. WATER ZONES (depth): 130
30 140 Consolidate/. Rock
u. DISINFECTION: TYPE HYPOCHLORITE Amount
12. CASING: Wall TSieknes
Depth Diameter cr Weighs?;. Meeri el
From 0 To 29 Ft. 61,'i" SDR21 ?VC
13. GROUT:
From 0
Depth
To 20 Ft.
11 SCREEN
Depth
From NA To
15. SAND/GRAVEL PACK:
Depth
From NA To
lo. REMARKS:
Material ,\ nci
GRAVEL MIX GRAVITY
Diameter
in.
Size
Slot Size \late.
LOCATION SKETCH
Show dim /non and distance ir. milts from at least
two State Roads or County Roads. Include the road
niorbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED So. AC/i0RDANCE WITH 15A NCAC 20, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
4i 1;'04
SIGNATURE CIF PERSON CONST-RL•^T'_NG Ti-LE WELL Date
Submit the original to the Division of Water Quality, Groundwa:et Sect;an, 1636 Mail Service center - Raleigh, NC
27699-1636 I'hone No. [phone], mithi i 30 days.
FE-1-t._\-. ....-

From: Carolina We!I Drillers, Inc Tc: NC Dept of Env. and Na Rescar Datee.. 4'13:2004 Time: 8:47:46 PM
294604
WELL CONSTRUCTION RECORD
North Carolina -Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDLAL)N'AME (print) SCOTT G NIT CERTIFICATION # 25a1
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRICTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (,if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal '� 1n ustia1❑ Agrreu1ttra1 ❑ Monitor:,
Recovery ❑ Heat Pump Water Injection ❑ other ❑I If Other, List Use:
r. WELL LOCATION: Topographic/Land setting
Nearesttown: LAKE LURE Cony RiTEPERWPIO ❑ Ridge ❑ Slope ❑ Valley. ❑
BOL.AND RD TO NORSWAY TRAIL LOT 40 Latitude/Longi*Sde of wall location
(Street Name. Number, Community, Subdivision, Lot No, Zip Code) 35.29.267 / 82.06.007
3. OWNER HORTON HOME OF RliTHERFOPg,
DTON (deees'da) minutes id:onl
ADDRESS 342 HWY 74 BYPASS Lantude!longlcde source: © UPS El Topographao rc tp
DEPTH DR:L..I:G LOD
227::$ From To Formati.r:Des _:. _.
0 50 Clay
(Srcmr or Zoiae No.)
RLTHERFORDTON NC
City or Town State
828-287-3366
Area Code - Phone Number
4. DATE DRILLED 3/I0i0-i
5. TOTAL DEPTH 260
6. DOES WELL REPLACE EXISTNG WELL?
7. STATIC WATER LEVEL Below Top of Casing:
YES it N-
55 ...
a. TOP OF CASINO IS 2 FT. A9ove Land Surface.
*Tor ofemmg rermmated Sdor below livid a[:.:: rcavv-e; a vrianca in
accnrdoncc with ISA NCAC 2C.0118
9. YIELD (gm): 6 MPETHOD OF TEST ARDM
10. WATER ZONES (depth): SO 120 250
50 260 Coneolidatec R
tt. DISINFECTION: TYPE HYPOCHLORITE Amour.: 7 cz LOCATION SKETCH
12. CASING' Wall Thi:kneio Sho,v dceaeon and distance in miles from at le a t
Depth Diameter- or Weie,ilFc Mxxia_ ovo State Roads or County Roads. Include the roa,7
From 0 To : - a 6 101" SDR 21 PVC -iTbers and common road pianos
13, GROUT: Depth Material Memc.l O
From 0 To GRAVEL MIX GRAVITY C2. CI n
1. SCREEN
Depth Diameter Slot Size Moral 13 / S'-
�
From NA To r ir.. i"_ C. •.r.oS---
i ern .i
15. SAND/GRAVEL PACK: N
Depth Size Matcr,L
FmBorn(� NA To 't.
6
16. REMARKS
I DO HEREBY CERTIFY ILA THIS WE.L W">SCONS P.L ED TSA. ;< VCEt H 1SANCA ;G;ErL
CONSTRUCTION STANDARDS, AND THAT a COPY OF THIS RE CORD2 HAS SEEN PROVIDED TO THE WELL OM ER.
310/04
SIGNATURE OF PERSON CONSTRCCTLNG TIE WELL Date
CLZ-1 R-
Submit the original to the Division of Water Quality', >-rouadccntar 3ectlEn, 11236.^•Sail San ice center- Raleigh, NC.
27699-1636 Phone No [phone], within 30 days.

From: Carolina Well [tilers, Inc To: NC Dept of Env. and Na Rassar Date: 4/13:2004 Time: 8:47:48 PM
294603
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resource Dim : o . of Wakr Quality Groundwater Section
tion
WELL CONTRACTOR (INDIVIDUAL) NAME (print) SCOTT GANT, CERTIFICATION t. 256.i
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): Residenri l E:, `.— birici?Li Industrial ❑ Agicultural ❑ Nfonitor :1
1:.
❑ Heat Pump Water injection E :saber ❑ if Omar, List Use
2. WELL LOCATION:
Nearest [CAN:: LAKE LURE Ccung RJTH_ER
LOT 4 Al)FFALO CLIFFS
(Street Name, Numbers, Community, S::bdivizion. Lot NO, Zip Code
3. OWNER RENAISSANCE BUILDERS
ADDRESS 152 E. MAIN ST
(Saul or Route Na)
FOREST CITY
City or Town
828-247-4495
Area Code - Phone Number
4. DATE DRILLED 3/8:04
State
5. TOTAL DEFITI 220
6. DOES WELL REPLACE EXISTING 'KELL? YES D NO
7 STATIC WATER LEVEL Eeiox Top ri Casing: �5 '
(Tie 'TRAhoy, Too sine)
8. TOP OF CASING IS 2 `1. Above Land Surfrce'
'Top ofea.ing tamuuted at/or below l: .ur.e., rsyui , a .mimic ..
accordann with 15ANCAC 1C.0118
S. YIELD (gum): 6 rlETNNOD OE TEST AITDM
to. WATER ZONES (depd0: 250
Topographic/Land setting
E Ridge ❑ Slope ❑ Valle` �,=!
Latitude/Longitude of well location
35 28.43C i 82 10 840
(decrees/rr.Irstes,se ond_'
Latiudeiorgitli±de source: 0 UPS E Toncg-raphsz
DEPTH DRLLNG Front To To Fonnarrn De cr.r
0 45 Clay
45 230
Coasolida:cd Rix:.
u. DISINFECTION: TYPE IIYPOCHLORITE Amount
L. CASING: Wail T.ticire:t —
Depth Dianerer or Wetgh b. alat, ill
From 0 To 53 51!4 SDR2i PVC
13. GROUT:
Depth
From 0 To
14. SCREEN
Depth
From NA To
MMatenal b'ied,od
20 Ft. GRAVUL-NM:V C:CAVITh
15. S.AND; GRAVEL PACK:
Depth
From NA To
16. REMARKS:
Diameter
Ft.
Ft.
Sto:Size
Size vLteria:
LOCATION SKETCH
Show Direction and distance is mils from m at lea:
hco State Roads or Court/ Roads. Include road
numbers and corle-non road names.
O
- <'
�-t
U,`
,, tic,Ct:
"S in
o
ago -4
1 DO HEREBY CERTIFY THAT THIS WELL VOA COAsn :JC E IDANCE VI"- 15A _NC- 2i. WELL
CONSTRUCTION STANDARDS, AND THAT 1 A COPY G. THIS -TIC _ -._) HAS ESE •; PROVIDED IDED TO "r'-E WELL OWNER.
mil '%ice' 4/I/04
ST:NAT RE.:F Pie2.SeiN C0A3:' FL.-'!`ce- WELI. Date
3.l'.
Subunit the original to the Division of Water Quality, Ground:rater3 t:¢, 1535 Mali Seri ice center Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. -- ' - -

From: Carolina Well Drillers, Inc To NC Dept of Env. and Na Rescdr Cate: 4. 13/2034 Tire: 8:47:46 PM
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 e 2_8!
WELL CONTRACTOR COMPANY NAME CAROLINA WELL ^aLLL'tS INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT 0 __ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable) _
1. WELL USE (Check Applicable Box) Readential ❑ !�tricit E !! industrial❑ A&icrltwal [1 Vto _ irar_;r
Recovery ❑ Heat : u:ap Water Injection E Otter L ....r, , ,',ist Use:
WELL LOCATION:
Nearest town: LAKE LLB Comity RL
275 CHIPMONK TR!, RIVERBEND ACRES LAKE LURE
( Street Name, Numbers. Cornmurcy. Subdi:mon, Lot No.. Z!r Code)
294602
Topograph1JLand setti n_
❑ Ridge ❑ Slope ❑ Val:.:
Latitude/Longitude of well location
35,25.8121 82.10.0I0
3. OWNER LES HANSON (degueerrdnae=second,;
ADDRESS 275 CHIPMONKTRL Latinode4ongitude source: ❑ GPS L. Topographic rar
(S,ra¢ar Rase N0.) DEPTH DRIUIJNNGLO-
LAKE LURE NC From To Formatter Dm._ :,..
City or Town. -._:t 0 75 Clay.
863-640-8879 300 Consolidate;.Ro_
Area Code - Phone Ntuuber
4. DATE DRILLED 3/29104
5. T-DFAL DEPTH 300
6. DOES WELL REPLACE EXISTING WELL? YES 0 _w Er
7. STATIC WATER LEVEL. Below Fop of Casing: 30
!Es '—"it alma, ._
b. TOP OF CASLNG IS 2 FL Above Land Surface"
'Top ofem6:y unnunmd oitu: 61.ow Im.',... _.. , ,i.a.._...e.
accordance wi11SAN0.1.0 2C.0113
a YIELD (ppm): 10 2.T-EGO O TEST ARDM
to. WATER ZONES (depth): 283
it. DISINFECTION: TYPE HVPOCHLORITE Anon t 13
❑. CASING: Wall Thicr:ne_—__
Depth Diameter or WeiehvF:. tifsioi
From 0 To 80 Ft 6 tr4" SDR 21 PVC
13. GROUT:
Dept;•, Material .`._ =.,1
from 0 'I'a r CRAVES, MIX G3>_'v1TY
14. SCREEN
Depth Diameter Slot Size natal
From NA To
15. SAND/GRAVEL PACK:
Depth Size Mate:'ta:
From NA To -..
16. REMARKS:
LOCATION SKETCH
_..o:v direction and distance in miles from ai least c
Itto State Roads or County Roads.Include the
L re p
titt
—_cars and common road rues. CrrI
'
t
C
o rn
_ G
r�U
3 m
(./7r+�
�L% O
I DO HEREBY CERTIFY A: r,IS x c WAS rn S a-ISC I Ec. . CEGiTriISa NCA 2C WELL
CONSTRUCTION STANDARDS, AND rH "I A CC z J_ "'HIS 3 s--' 3 -y PRO x 1DED TO }I WELL O`e :F .
Jul `.�%`
SIGNATURE OF PI- ON .C1iI ST3UCT!N1! TIE WELL
4'1104
Submit the original to the Division of Water Quality, Grounuw-nlee Seoi:c,r, ;636 u;ail Service center- Raleigh, NC
27699-1636 Phone No. [phone], wirhha 39 days.

�71
WELL CONSTRUCTION RECORD
L4 y7 Liu-fac,
294800
North Carolina - Department of Environnntt and Natural Resources - Division of Water Quality - Grotmdwater Section
�g 24 3-054-; e < cnnncwnow •82 /SD
WELL CONTRACIOR(1ND/VIDUAL)NAME T
WELL CONTRACTOR COMPANY NAME .J Ji'�t c. t.iiis,'Vi Li\ Ny rime sf$ 7Z q-•Qaff
STATE WELL CO ETRI:CTION PERMIT,
.Iieable)
1. WELL USE (Check Applicable Box): Residential EIKAunicipaltPublic ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO• t
Nearest Town: County . iv
IL. £n +ttt&;v Ss
(Susi Name. Numbers, Commun,ity, `S-u-bdidivision, tot No- rep Code)
3. OWNER: !l J SVG Y�un.j Yo
Address \\ oi.( £ a 54
(Snot, a Rows No.)
5 Q,A A Lt C.- i t
City or Town State tip Lode
(� )_ Ices"--5 9c
Area cede. Phone weber
4. DATE DRILLED 7i 'z 7i " La'.
5. TOTAL DEPTH: 3 9 C-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Er
7. STATIC WATER LEVEL Below Top of Cagiert.° FT.
(Use" t"ifAMOWTap of Casing)
8. TOP OF CASING IS % FT. Above Lad Surface`
flap H easing LLtadarsed saSr bedew lei aria tsarina •
variance hi accordance with ISA NCAC ZC .pti
9. YIELD (gpm): 30 METHOD OF TEST AA Is<
to. WATER ZONES (depth): $ 0 _ors tn-+ Zee)
1 I. DISINFECTION: Type
12. CASING:
Depth Diameter
From To FL-
From O To /CF Ft 1 ' _
Fsom. 1 4 To //G Ft.
13. GROUf: Depth
From To
From_CL To Z 2 Ftate e / (-se
14. SCREEN: Depth OEndu StaiSire Material
From To FL it. is
Front.. To Ft is in.
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To Ft
16. REMARKS:
Materal Method
FL
Topographic/land setting
❑Ridge ['Slope ❑Valley Mkt
(ebeck approp,ute bolt)
Latitude/longitude of well location
(denedhvioutetlmeaonds)
Latitude/longitude source:❑GPSI3ropographic map
(check box)
DEPTH DRi1LINO LOQ
From To Formation Description
n-/Uv ,O:lc4>
/GO - 345
lei- _ e
-a' G
t
�1 -7
r,�
rn
LOCATION SKETCH �~
Amount Q 02 enR, Show direction and distance in miles from at IeaE1•) .
Wall Thit ness two Sate Roads or County Roads. Include We
o Wci$SR. math] numbers and common toad
6s'Z Z/
r Imo„
Pic
road —yy/Ae oil/
le 4,
ntir
I t44, ti S+ s jctl
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDS, AND THAT trOPY OF Tj1IS RECORD HAS BEEN PROVIDED TOME WELL OWNER
SIG
PERSON CONSTRUCTINGTHE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mad Service Center - Raleigh; NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

From: Carolina Well Drillers, Inc To: NC Dept of Env, and Na Resour
Date: 4/5;2004 Time. 10:0058 4te1 T>C4i, 1 of 2
2948G0
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundlaater Section
WEI,1, CONTRACTOR (INDIVIDUAL) NAME (print) SCO1T GANTT CERTIFICATION 4 25S4
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED \%(.2 PERMIT #
(if applicable) (if app iieable)
I. WELL USE (Check Applicable Beet : Residential ❑ Municipal ❑ Industrial ❑ Agicuhural ❑ �x2:,_
Recovery ❑ Heat Pump Water injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: Topographic/Land se
Nearesttomi: LAKE LURE Canty RUTHERFORD ❑ Ridge ❑ Slope vo_"
295 OLD MILL. RD LatitudelLongitade of wen iceatic; n
(Street Name, Numbers, Community_ Subitr !o , Lot No,. Zip Code) 35T7.006
J. OWNER TAMNi'1 CLARS (degaesarint i,zcc_s.
ADDRESS 295 OLD N ELL =R'D Lamnde/longitude soure 0 iiPS E
(sff:er,r x,.x: Noi DEPTH T_ _
Jre.,:_?N^L_;_:
LAKE LURE :2C 22745 From To
City er Town State Zip Code 0 55 nay
828-625-8237 55 320 Coraolidzi' 0 a'
Area Code - Phone N amber
J. DATE DRILLED 3:3`j4
5 TOTAL DEPTH :320
6. DOES WELL REPL.A.CE E X:S LC\G
7.S ACIC W.A'ERLh\T., Below Top a[L'si:g:
YES ❑ NO L
IfAbovc Top of Czhr
8. TOP OFCASLNG IS 2 RR.,b_1_ Land Smia:r'
'Top of caug tennee,ated _cot blow Tad. ,:mim e re:guc, a vaivmc
a_cord.sce with 15A NCAC 217.011s
9. YIELD (@pm): 4 METHOD OF TEST ARD34
10. WATER ZONES (depd0: 310
u. DISINFECTION: TYPE H` POCHLOuir Amount 12 Oz LOCATION SKETCH
12. CASING: Wail Thickness Show direction and distance i, tails `ion'in least G
Dann Dianerer or WeiAhuFa. Matari3 tv0 State Roads or County Roads. Incluth Ct_od :75-
a
From 0 To 61 EL 6 N4 SDR 2I PVC numbers and cornmor rcad nams. r
O. GROL"C - ^i
Depth Material Method 2- 7 C▪ -Er
From 0 To 20 Ft. LIRA\'EL MI}_ GRAVITY I o<
s_m
14. SCREEN :"-"iv
9' r'1 G
Depth Dirmeter Slot Sire Material ▪ wry,
From NA To 9t. u;. _.. -341 N=
rnz
0
15. SAINiaGRAbEL PACK: 0 —!
Depth Size Material 0 G
From NA To Ft.
16. RENLkRKS:
I DO HEREBY CERTIFY THAT THIS WELL WAD CONSTRUCTED IS ACCORDANCE WITH IDA NCAC 2C, WEi,L
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
4.104
SIGNATURE OF PERSON CONSTRUCTINCi TiLE WELL Date
Submit the origira! to the Division of Water Q_inity, Groundwater Section, 1636 Mai! Service center:-ta!ei;!z NC
27699-1636 Phone No. [phone], within 33 days.

293'737
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 0 MunicipallPublic ❑ Industrial ❑ Agricultural
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: ELLENBORO County RUTH
BEAMS MILL RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: EUGENE LEE
Address 570 BEAMS MILL RD.
(Street or Route No.)
ELLENBORO NC 28040
City or Town State Zip Code
(828) — 453-8683
Area Code Phone number
4. DATE DRILLED 04/16/04
5. TOTAL DEPTH: 345
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 1 SA NCAC 2C .0118.
9. YIELD (gpm): 100+ 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 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. in. _ in.
15. SAND/GRAVEL-PACK:
Depth Size Material
From
From
To Ft.
To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge 0 Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/second;:.
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in milep frorp at least
Two State Roads or County Roads. 1h''Elude the,load.
number and common names
BUS. 74 E. FROM ELLENBORO.
BEAMS MILL RD. 1 MILE ON RT. (#570 ON BOX)
0
N
0
Cr
rn.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONUCTION STANDARDS, AND THAT A COPYYOF THIS RECORD
HAS BEEN PROVIDED TO THE WELL OWNER
ATURE OF PERSON CONSTRUCTING THE WELL DAPS
Submit 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 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: CLIFFSIDE
CLIFFSIDE ESTATES
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: JOHN ARROWOOD
Address CLIFFSIDE ESTATES
(Street or Route No.)
CLIFFSIDE NC 28024
City or "[Own State Zip Code
(828) - 2874239
Area Code Phone number
4. DATE DRILLED 04/21/04
5. TOTAL DEPTH: 405
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 50 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
Zip Code)
11. DISINFECTION: Type CHLORYTE Amount 1.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
0 To 70 Ft. 6-1/4" SDR21 PVC
To _ Ft.
To
Depth Material Method
To 20 Ft. QUIKRETE POURED
To Ft.
Depth Diameter Slot Size Material
To Ft. in. in.
From
From
From
13. GROUT:
From 0
From
14. SCREEN:
From
From
To Ft. in. in.
15. SAND/GRAVEL-PACK:
From
From
Depth
To
To Ft.
16. REMARKS:
Size Material
Ft.
Topo ,raphic/Land setting
❑ Ridge 0 Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seeonds)r --- --- _ -"
Latitude/longitudc source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles rgtthlaLleast
Two State Roads or County Roads. In lTude the r ad
number and common names
HWY. #120 FROM CLIFFSIDE. LEFT INTO
CLIFFSIDE ESTATES. RT. ON HAZLEHURST. RT.
ON NEXT STREET (NO NASIE YET) 2/10 MILE ON
LEFT.
0
0
0.o
G
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION RUI TION STANDARDS, AND THAT A COPY OF T EBS KCI;UKll HAS BEEN PROVIDED TO THE WELL OWNER
.P—R/ V ge S-0 � c / —Q >/
SIGNATURE OF PERS N CONSTRUCTING TIME 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

293733
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 ® MunicipaVPublic 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: UNION MILLS County RUTH Topographic/Land setting
SEA ISLE DR. ❑ Ridge ❑ Slope 0 Valley ❑ Flat
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) (check appropriate box)
3. OWNER: KYLE FLACK Latitude/longitude of well
Address SEA ISLE DR.
(Street or Route No.)
UNION MILLS NC 28167
City or Town State Zip Code
(828) — 289-2226
Area Code Phone number
4. DATE DRILLED 04/23/04
5. TOTAL DEPTH: 505
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ej
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface"
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 13.5
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. QUHCRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To _ Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
in. _ in.
in. in.
From To Ft.
From To Ft.
16. REMARKS:
(degrees/minutes/secon r
Latitude/longitude source: 0 GPS .Telegraphic ma
(check box) '
DEPTH I` 1
From To
DRILLING LOG`_
From To
LOCATION SKETC34'
Show direction and distance in miles from at4tast,
Two State Roads or County Roads. hwlude the road
number and common names
HWY. #221 N. FROM RUTHERFORDTON. LEFT
ON SEA ISLE DR. APPROX. 1/2 MILE ON LEFT
c
0
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CON$ JC 1QN STANDARDS, AND THA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
0
CO�nfSTRir 2
SIGNA - OF PERSONWELL
c9 -
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

293731
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: LAKE LURE County RUTH
STONEY BROOKE LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JOE CARSON
Address STONEY BROOKE LANE
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
(828) — 223-4239
Area Code Phone number
4. DATE DRILLED 04/29/04
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): 8 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 130 Ft. 6-1/4" SDR.21 PVC
From To Ft.
From _ To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QULKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To Ft. in. _ in.
From To Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To Ft.
From To Ft.
Topographic/Land setting
❑ Ridge 0 Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconcs)
Latitude/longitude source: 0 GPS Q ToRographic ma
(check box)
DEPTH
From To ! -
DRILLING LOG
From To
LOCATION SKETCH.
Show direction and distance in miles from at
Two State Roads or County Roads. Include th
number and common names
HWY. #64/74A W. FROM RU 1'HLRFORDTON.
RT. ON BILL'S CREEK RD. LEFT ON CEDAR
CREEK RD. RT. ON STONEY BROOKE LANE.
0
r-
a
r =r_.
o r,
rn:.
rn�i V
r
0 CS
0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS JCTION STANDARDS, AND THAT A COPY Ojr TIJIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Ed;/
SIGN4IJRE OF PERSON
,) ! o_-• 51- a
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

c293'730
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 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH
GREEN RIVER HIGHLANDS -LOT #140
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JIM STEIN
Address GREENRIVER HIGHLANDS -LOT #140
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) - 286-4868
Area Code Phone number
4. DATE DRILLED 04/20/04
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): 3 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 80 Ft 6-1/4" SDR.21 PVC
From To Ft. _
From To _ Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To _ Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of
(degrees/minutes/ ndS---._.• - --..
Latitude/longitude source: ❑ GP '12Topographicl map
(check x3 `r-a DEPTH
From T'o
DRILLING Lt3G'
From f d
LOCATION SKETCH (
Show direction and distance itr miles from aiIsL 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 CTY. RIGHT ON
RIVER CREST PARKWAY. GO ABOUT 1 MILE.
RIGHT ON CROSS RIDGE DR GO ABOUT 1 MILE.
RIGHT ON VALLEY DR. 2/10 MILE ON LEFT. (#140)
--c
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/4
SIG ATURE OF PERSON CONSTRU G THE WELL DATE 74,0 tt. 07 4-
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

78-
72
WELL CONSTRUCTION RECORD 293
North Carolina — Department of Environment And Natural Resources — Division of Water Witty — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: BOSTIC
CHERRY RIDGE
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: BRIAN FLEETWOOD
Address CHERRY RIDGE
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code
(828) — 245-7811
Area Code Phone number
4. DATE DRILLED 04/26/04
5. TOTAL DEPTH: 345
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO EA
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 12 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
Zip Code)
11. DISINFECTION: Type CHLORYTE Amount 9
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 100 Ft.6-1/4" SDR21 PVC
From To Ft. _
From _ To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/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/sec
Latitude/longitude source: ❑ GPS ❑ Topogta iic ata
(checkbo )._, r. ,._�,
DEPTH f
From ''o;
DRILLING LOG...
From to
LOCATION SKE
Show direction and distance in
Two State Roads or County Roa
number and common names
BUS. 74 E. FROM FOREST CI
BOSTIC/SUNSHINE HWY. RT. ON SALEM
CHURCH RD. LEFT INTO CHERRY RIDGE
SUBDIVISION. RT. ON 1ST RD. & CTOSS DAM. 2/10
MILE ON RT.
Q
-7r
.0
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRJ jCTION STANDARDS, AND THAT A CQPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNF PERSON CONSTRU
TING TH ? ‘LL DATE
1i - 6 — 6
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

293724,
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 tEl Municipal/Public ❑ Industrial "❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: BOSTIC County RUTH
MAMIE HAMILTON RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ROBERT LAWSON
Address 170 MANIE HAMILTON RD.
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code
(82M) — 289-0162
Area Code Phone number
4. DATE DRILLED 04/01/04
5. TOTAL DEPTH: 87
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 67 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above 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 87 Ft. 24" CEMENT
From _ To _ Ft.
From To _ Ft.
13. GROUT: Depth
From 0 To 20 Ft.
From To Ft.
14.SCREEN: Depth Diameter
From To Ft.
From To _ Ft.
15. SAND/GRAVEL-PACK:
Depth Size
From 67 To 87 Ft. 78M
From To Ft.
Material
CEMENT
16. REMARKS:
Method
POURED
Slot Size Material
in. in.
in. in.
Material
GRAVEL
Topographic/Land setting
0 Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ jfopoiraphic map 1
(check box) JJ.:
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH"
Show direction and distance in miles from at
Two State Roads or County Roadsfi lude-themad--
number and common names
BUS. 74 E. FROM FOREST CITY. RT. ON
BOSTIC/SUNSHINE HWY. LEFT ON PEA RIDGE
RD. IN BOSTIC. RT. ON SANDY LEVEL CHURCH
RD. LEFT ON MAMIE HAMILTON RD. 3RD DRIVE
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
44-1r\-
GNATURE OF PERS SONS
$rn-,- 42-/ 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

293723
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quplity - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1 WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH Topographic/Land setting
BIG ISLAND RD. 0 Ridge 0 Slope 0 Valley ❑ Flat
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) (check appropriate box)
3. OWNER: EUGENE BYERS Latitude/longitude of well location
Address BIG ISLAND RD. t= _- "
(Street or RouteNo.) (degrees/minutes/ conds) r_._._,\__,;!
RUTHERFORDTONLO
NC 28139 Latitude/longitude source: 0 GP _-Topographie map,'
City or Town State Zip Code (check _.);
(828) - DEPTH
Area Code Phone number From
4. DATE DRILLED 04/02/04 1
5. TOTAL DEPTH: 44 DRILLING 1�G
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ® From I Sp
7. STATIC WATER LEVEL Below Top of Casing: 24 FT. ET( 1
(Use "+" if Above Top of Casing) r , -
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface* LOCATION SKEI'C ----_L
*Top of casing temrinated at/or below land surface requires a Show direction and distance 'n miles fr t(iafieasl t I
variance in accordance with 15A NCAC 2C .0118. Two State Roads or County R
9. YIELD (gpm): 20 METHOD OF 1 EST STEEL TAPE number and common names
10. WATER ZONES (depth): BIG ISLAND RD. FROM SHILOH. APPROX. 5
MILES ON RT.
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 44 Ft. 24" CEMENT
From To _ Ft. _
From _ To Ft.
13. GROUT: Depth Material 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 24 To 44 Ft. 78M GRAVEL
From To Ft.
0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS,ND7AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER/
/� N P �� �" a - 6�"
SI NA 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

293721
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERPIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
MACKEY FREEMAN RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ODEAN KEEVER
Address MACKEY FREEMAN RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 286-1311
Area Code Phone number
4. DATE DRILLED 04/28/04
5. TOTAL DEPTH: 37
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IZ
7. STATIC WATER LEVEL Below Top of Casing: 22 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 6.9
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 37 Ft. 24" CEMENT
From _ To _ Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From _ To _ Ft.
14.SCREEN: Depth Diameter
From To _ Ft.
From To _ Ft.
15. SAND/GRAVEL PACK:
Depth Size
From 22 To 37 Ft. 78M
From To Ft.
Slot Size Material
in. _ in.
in. in.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #64 E. FROM RUTH. RT. ON MACKEY
FREEMAN RD. APPROX. 2 MILES . RT. INTO DEER
RUN FARMS. 2/10 MILE ON LEFT.
r
•
I rl` N c.-
Material c
GRAVEL `
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WC1'H 15A NCAC 2C, WELL
CONSTRICTION STANDARDS, AND THAT A COPY F S RECORD HA BEEN PROVIDED TO THE WELL OWNER
1/4
5 NATURE PER ON 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 2 9 3 '7 20,
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: FOREST CITY
WHITESIDE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CHARLIE BROOKS
Address WHITESIDE RDL.
(Street or Route No.)
FOREST CITY NC 28043
City or Town State Zip Code
(828) - 429-3976
Area Code Phone number
4. DATE DRILLED 04/28/04
5. TOTAL DEPTH: 63
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 10
7. STATIC WATER LEVEL Below Top of Casing: 43 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 63 Ft. 24" __ CEMENT
From _ To _ Ft. _
From _ To _ Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. in.
From _ To _ Ft. in. _ in.
15. SAND/GRAVEL PACK:
Depth Size
From 43 To 63 Ft. 78M
From To Ft.
Material
GRAVEL
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
BUS. 74 E. FROM FOREST CITY. LEFT ON
BOSTIC/SUNSHINE HWY. LEFT ON PEA RIDGE
RD. IN BOSTIC. LEFT ON WHITESIDE RD. 1 MILE
ON LEFT.
'D
cr
2
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONS CTION STANDARDS, AND THAT A COPY OF S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SI A OF PE ONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jamas rr,
294450
Camp, Tr CERTIFICATION # 2 1 "2 A
WELL CONTRACTOR COMPANY NAME Camps c Win' 1 & Pump Co , Tnr PHONE #$2Al d53_7122
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
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:
k aa ( n
NearestttTown: JNO .r '•P-County C. _O.A_- Q.3
)N\ \\i1.A Pr. IAfnAt
(Stint Name, Numbers, Community, Subdivision,
Lot No., Zip:Code)
3. OWNER:.... \\ \ k-kiJL&2A%-
Address .2 \ L I (2179,!t & O 'J
(S` et a Roufe'No.)
lM,�+r� i�l ,
\NI\ ,n�\ 1. C %LSS
City or lqwn ufe`, - Zip Code
'1
Area coda Phone numbef
4. DATE DRILLED 3 - Z47014
5. TOTAL DEPTH: 0 S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO It
7. STATIC WATER LEVEL Below Top of Casing: U b FT
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS i FT. Above Land Surfaces
*Top of casing terminated odor below land surface requires a
•varlance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 5 0 METHOD OF TEST a ; r
10.WATER ZONES (depth) 0-5W
11. DISINFECTION: Type chi nri nR Amount I Cu..?
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From n To (.00 Ft. 6 1 / 4 g817-1 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
Frorn—p To 20 Ft. Neat Cement Hand
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting 1. ",
@kidge ❑Slope ❑Valley ❑Flat -
(check appropriate box) _
Latitude/longitude of well location
(degrees/minutes/seconds) •!
Latitude/longitude source:❑GPS❑Topographic Map:_t
(ebeck box) L
DEPTH pRILLING LOCII -,
From To Formation Descripti¢n
0 , 6 E1/ I
f.t, a 5— Auant.it
r
-n
LOCATION SKETCH
Show direction and distance in miles from at least-0
two State Roads or County Roads. Include the roa
numbers and common road names.
.D
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
nM r(' AJ t4 Li- 13 0 (4
OSIGNATUVW 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
Enid
Lin

294448
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ja ma s su
WELL CONTRACTOR COMPANY NAME t 1 1
STATE WELL CONSTRUCTION PERMIT?!
(if applicable)
Camp, Jr
CERTIFICATION p 21 3 R
Camp c Wa R Pttmp Cn Tnr PHONE H$7R) dc1_7322
ASSOCIATED WQ PERMITW
(if applicable)
1. WELL USE (Check Applicable Box): Residential 'Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Neatest Town: 1 _ _ -. County
k A A A.-01\ . S G/y._,. 1 a €10
(Street Name, Numbers, Community, Subdinsj u,- i Nd. ip Codes
/
3. OWNER: J`.J�' ' �� p^ tr 1 1 CJ (f D
Address CI 1A.,V�nrrn,QC) (sr�
VVU X) (Street or Route No.)
C r)C 5c15L
City or Town Ste Zip Code
Area code- Phone numb
4. DATE DRILLED ek aD n L1
5. TOTAL DEPTH: L\ S al
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO r
7. STATIC WATER LEVEL Below Top pf 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 accord. with 1SA NCAC 2C .0118.
9. YIELD (gpm): METHQIZpFTEST air
10. WATER ZONES (depth): j6 \66 j
11. DISINFECTION: Type rh 1 nri nP
12. CASING:
Depth Diameter
From f) To s() Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth
From q To 2 0 Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Amount \ l 2 . ,(-)
Wall Thickness
or Weight/Ft. Material
GBR21 PVC
Material
N at Cement
Method
Hsi
Slot Size Material
in.
in.
Size Material
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 DRILLING L
From To Fprmadon RC ription
Q
SD
C.
LOCATIONSKETC}
Show direction and distance in miles from at 1eas�
two State Roads or County Roads. Include the road
numbers and common road names. r
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CO STRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
' 2 i\nmAA C ,0,1\1\1 11. ) 3. 0 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
C

14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
WELL CONSTRUCTION RECORD
294447
North Carolina - Deparanent of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ja ma rr Camp, Tr CERTIFICATION# 71 38
WELL CONTRACTOR COMPANY NAME ('amps c Wa11 & Pnmr Cr1 , T n r• PHONE #$7R1 d 53_7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT%
—(i�plicable)
(ifap licable)
1. WELL USE (Check Applicable Box): Residential 0 MunicipallPublic 0 Industrial 0 Agricultural 1137
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI..
Nearest fTown: -D e 5 1 C i County -�-
wit nq �a r r 'ha Se /-fw-
(Street Name, NumbNumbed, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Ali/ RI(be✓±Stit
Address 7y0 HaYri; -- ffCY(✓tetra <A.
1YP5� 1S¢ectorAoutgNn) 2b t!3
-5
8 n
rwZip (g - try oT q �— l Tv g Code
Area code- Phone numbero •• rr
4. DATE DRILLED Li - ' n y-
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: to
(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): 5 METHOD OF TEST ai
10. WATER ZONES (depth): /
11. DISINFECTION: Type (h 1 n r i n p
12. CASING:
Depth Diameter
From 0 To 00 Ft. 6 1 / 4
From To Ft
From To Ft.
13. GROUT: Depth
From 0 To 2 0 Ft.
From To Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Amount f Cup
Wall Thickness
orWeight/Ft. Material
SDR21 PVC
Material Method
Not Cement Hand
Depth Size Material
From To Ft.
From To Ft
16. REMARKS:
1
Topoggwhic/Land setting
❑Ridge t[dSlope ❑Valley ❑Flat'
(cheek appropriate box)
Latitude/longitude of well location'
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topogra
(check box)
DEPTH U L
From To Formation Des
n (Do
100 3as
4
c.
.n
LOCATION SKETCFt
Show direction and distance in miles from at least
two State Roads or County Roads. Include the roadr.
numbers and common road mates. cn
0)
(- ) bo '
1 DO HEREBY CERTIFY THAT THIS WPi f 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
\PCNAj
-/ A R. U SIGNATURE OF PERSON CONSTRUCTING THE WELL �DA E (3 LS\
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
c
c=:
r—
ITE
51

29445.8
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
James Ta Camp, Jr
mp' c Wp1 1 & Pnmp r'n Tnr•
ASSOCIATED WQ PERMIT#
(if applicable)
CERTIFICATION # 21 18
PHONE #$2RI 4 S .7322
1. WELL USE (Check Applicable Box): Residential 'Municipal/Public 0 Industrial 0 Agricultural 0 Ir--
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use j - L
2. WELL LOCAT
Nearest T10 rn 1)Yr, t r..D County
' \),i % .i -7(re 1r.7J,,,
(Surem [ Nae, Number, Community, Subdivisio.i not No., Zip Code)
3. OWNER: , 1 ( 1 n� vt A
Address M Jet )1 � tom, S, 0
- (� (Street orRoute No.)
City or Town State Zip Code
Area code- Phone numbe(
4. DATE DRILLED '*
5. TOTAL DEPTH: 5-t1
6. DOES WELL REPLACE EXISTING WELL? YES Q-NO a
7. STATIC WATER LEVEL Below Top of Casing: \ 71 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 la accordance Itb 15A NCAC 2C .0118.
9. YIELD (gpm):r METH9D OF TEST j1 i
10. WATER ZONES (depth): y�U
11. DISINFECTION: Type rh 1 nri np
12. CASING:
(C77
Depth Diameter
From G To 1 Y'ri Ft. 6 1/ 4
From To Ft.
From To Ft.
13. GROUT: Depth
From_ To 2 0 Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
R8�21 PVC
Material
Plot Ccment
Method
Hand
?AA
(� Topographic/Land setting
Aidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
r
(deareeslminutes/seconds)
Latitude/longitude source:❑GPS❑Topograp#tc Qpp
(check box)
DRII LIN OG �_
Formation Descnption --
DEEM
From To
n
t� n
-DTI
o'er
oc
LOCATION SKETCI-L'�
Show direction and distance in miles from at Gistr
two State Roads or County Roads. Include the road
numbers and common road names.
tit
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�) � C,�a.n.�ye Kj . 3.
6 SIGN1\TURE 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

294457
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James w
WELL CONTRACTOR COMPANY NAME ramp t q lap.1 1
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
C.mr, Jr
R Pomp f rL
CERTIFICATION # 21 3 B
Tnr PHONE #$7R) dii-7322
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential e Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI9N ,,
Nearest Town: A .. " tilikr
C unty --(.A `-0
nc
(Street Name, Numbers, Community;Subdivision, Lot No., Zip Code)
3. OWNER: C4l(� '1�/(G1/1tJ►'..>!
Address I1 0 rt Qn� Ut_
(S t or Rouuro1'
City or Town State
Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 3
5. TOTAL DEPTH: V O
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ta
7. STATIC WATER LEVEL Below Top of Casing: (p 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 accords with 15A NCAC 2C .0118.
9. YIELD (gpm): j METHRD OF TEST air
10. WATER ZONES (depth): U..) -4 U-J.
11. DISINFECTION: Type ('h1 nri n.
12. CASING:
Dep Diameter
From__0-_ 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 Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount \ (A
Wall Thiclmess
or Weight/Ft. Material
cDR -a1 PVC
Material
N at Cctacnt
Method
Iland
Topographic/Land setting''
❑Ridge Dslope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location-
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Togo
(check box)
DEPTH a'ILL1N
From To
0 \Ob
10U Ls 1)
—a
0
rn
J-OCATION SKETCI-3 r
rn
Show direction and distance in miles from at Teat,' ¶,~
two State Roads or County Roads. Include the roypi o
numbers and common road names.
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 13, 0 �I
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

294456
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jame% at Camp, Jr CERTIFICATION# 2118
WELL CONTRACTOR COMPANY NAME ramp' c Wa11 & pump en Tnr PRONE %$7R' dc,1-7122
STATE WELL CONSTRUCTION PERMIT% ASSOCIATED WQ PERMIT%
(if applicable) (if applicable)
L-_
1. WELL USE (Check Applicable Box): Residential 13-""Municipal/Public 0 Indusnial 0 Agricultural 0 I -%:, r
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT[I
N arest Town: l `-P 1Al .S tpF.. county
�'1a1i'. A % LI\O
(Street Name, Numbers, Coml6unity, Subdivision, Lot No., Zip Code)
3. OWNER: /-2 • , )i 1.
Address \ ll Z ��'a t� O�
f n-0 4 it (SMueor Ro�uto No.)(N C
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED " "I . O `\
5. TOTAL DEPTH: S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: ( c- FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accord.(ea with I5A NCAC 2C .0118.
9. YIELD (gpm): f MET OD OF TEST
10. WATER ZONES (depth):
Ai r.
Topograpphic/Land setting f
❑Ridge 2Slope ❑Valley ±Iat
(check appropriate box)
Latitude/longitude of well loca on
(degrees/minutes/seconds) I:_
Latitude/longitude source:❑GPS❑Topo Op}iiC Lila p
(check box)
DEPTH DRIL
From To
0 C�.�
11. DISINFECTION: Type [' h i nr i na Amount (`P,(
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
12. CASING:
Depth ^ Diameter
From . o To k.0 1 Ft. 6 i/ 4
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From _q_To 20 Ft. N at 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:
(,4 _rill... J.
7 G
3- r
LOCATION SKETCH
Show direction and distance in miles from at lej1
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL QA
f/\ l yfk
'n n
S1G TURE OF ^PE ION 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

294455
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James w Camp, Jr
WELL CONTRACTOR COMPANY NAME Camp' S Wa11 & Pnmp f n Tnr•
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT'S
(if applicable) (if applicable)
CERTIFICATION # 21 1 A
PHONE #82R) 4S3-7.22
I. WELL USE (Check Applicable Box): Residential lr Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: ,j
NearestTp, S 1c�C,punly�.i).f�(v)r%+,^..<.,fl--
1 �CNv VoIu}
(Street Name, Numbers, Community, Sudivision, Lot No., Zip Code)
C1 n Pi ii,o
creel ortRoute No.)
is` C.
3. OWNER:
Address C
D
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED - \ Q . c)
5. TOTAL DEPTH: S n C
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: cd()
(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 .a118.
9. YIELD (gpm): S METHOD OF TEST
10. WATER ZONES (depth): S 0
Lir
11. DISINFECTION: Type (h 1 nr i n a
12. CASING:
Depth Diameter
From_ To�_ Ft. 6 1 / 4
From To Ft.
From______ To Ft.
13. GROUT: Depth
From__ To 2 0
From To
14. SCREEN: Depth
From To Ft. in
From To Ft. in
15. SAND/GRAVEL PACK:
Depth Size Material
Front To Ft.
From To Ft.
Ft.
Ft.
Diameter Slot Size Material
in.
in.
Material
Amount (Lk R
Wall Thickness
or Weight/Ft. Material
gDR.21 PVC
Neat Cement
Method
Hand
Topographic/Land setting' ,
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topogr
(check box)
DEPTH
From To
n 7n
7o So5
Formation�Description
C/4 ,(ir±
(an4ol i rda+ed rnrk
0
p r)
r_
-p r
? y,-
:� mac'.
LOCATION SKETCIj
Show direction and distance in miles from at leash
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCIED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED Ti THE WELL 01ij RR
) ft., nA.
Submit the original 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
SIGNA
CA. rc\N-e
OF PERSON CONSTRUCTING THE WELL
DATE
0

2966"'5
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Qyplity — 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: LAKE LURE
HUMMINGBIRD COVE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LOWRY PLEXICO
Address 218 HUMMINGBIRD COVE
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
8(03) — 781-5271
Area Code Phone number
4. DATE DRILLED 06/17/04
5. TOTAL DEPTH: 145
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): 50 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To 85 Ft.
From _ To Ft.
From To Ft.
County RUTH
CHLORYTE Amount 3
Wall Thickness
Diameter or Weight/Ft. Material
6-1/4" SDR21 PVC
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To _ Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C. WELL
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well Location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #64/74A W. FROM RUTHERFORDTON.
RIGHT ON BUFFALO SHOALS RD. APPROX. 3
MILES. LEFT ON RIDGE RD. RIGHT AT FORK.
STILL ON RIDGE RD. GO 1/8 MILE. RIGHT ON
HUMMINGBIRD COVE. 1/4 MILE ON RIGHT.
CON UCTION STAND S, AND THAT A COPY 0
SI NATURE OF PERS
THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-
N CONSTRUCTING THE WEL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

297522
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James w Camfs_, Tr CERTIFICATION # 211A
WELL CONTRACTOR COMPANY NAME ('mp' G Writ R Pimp rn Tnr PHONE #$2R) d51-7_322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential1,3'eMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT�i�r1N (j
Nearest T�o : County ` ,( s+n,rJt
eu,A,..t Ana
(Street Name, NSbers, Community, Subdivision, Lot No., Zip Code)
City or Town State
Area code- Phone number
4. DATE DRILLED —\ C • CikA
3. OWNER: VY II (tJyl l�`Ay� (degrees/minutes/seconds)
Address 2)l� l( jCP IAAatitude/longitude source:❑GPS❑Topographic map
1-�• , ( or Route No.) (check boa)
e�M )IV DEPTH 'MILLING LOG
From To Formatiop Description
.tti�.
Topographic/Land setting
t21dgc ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
5. TOTAL DEPTH: \t S
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO �.
7. STATIC WATER LEVEL Below Top of Casing: U 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 accordance with 1SA NCAC 2C .0118.
9, YIELD (gpm): \ 0 IA- METHOD OF TEST A i r
10. WATER ZONES (depth): \ ke (i
11. DISINFECTION: Type rhlnri na Amount CAf_e
Wall Thickness
or Weight/Ft. Material
e WO 1 PVC
12. CASING:
Depth Diameter
From p To 10 Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth Material
From_ To 2 0 Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Frolt1,__ To Ft in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
N at Cement
Method
IIand
16. REMARKS.
o
�0 41.•t-
v
J
LOCATION SKETc-j r_Aj
Show direction and distance in miles from at ast r "�
two State Roads or County Roads. Include the joadE'
numbersandcommon road names.
feSb�f1
0'
V iv
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 ERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

297521
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James m Camp, Tr CERTIFICATION0 21 38
WELL CONTRACTOR COMPANY NAME f Rmpt a Wa1 1 R, p„rnri en Tnr PHONE It67R1 453_73
STATE WELL CONSTRUCTION PERMIT# ��---
ASSOCIATED WQ pERM1T17
(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 LOCATI
Nearest II•
AAA County,6 1 A- —
(Sneed``, Numbers, Community,
^Subdivision, Lot No., Zip Code)
3. OWNER: W Q \ ,
Address VA)C
9,h rt�treet or Route No.)
Nc e_coyo\
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED S -r L'4 • (1 Lt
5. TOTAL DEPTH: X 6 S'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO CI,
7. STATIC WATER LEVEL Below Top of Casing: ti 5 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 accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TEST a i
10. WATER ZONES (depth): 0 V
11. DISINFECTION: Type rh 1 nri np
12. CASING:
Depth,Diameter
From p To S Ft. 6 1/ 4
From To Ft.
From To Ft.
13. GROUT: Depth Material
From__0___ To 30 Ft. DI at Cctncnt
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
Wall Thickness
or Weight/Ft. Material
Rnt')1 PVC
Method
Hand
Slot Size Material
in.
in.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope alley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) .
Latitude/longitude source:❑GPS❑Topographic tnap
(check box) —
PEPTIj FRILLING LOG
From To Fpption Deption
n 35
L in
LOCATION SKETCFI
Show direction and distance in miles from at Least . -
two State Roads or County Roads. Include the road
numbers and common road names.
co
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
SIGNA
OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

29'751 E
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J ma s rr Ca rrtp Jx. CERTIFICATION N 71 38
WELL CONTRACTOR COMPANY NAME ('am/'¢ Wa11 R Primp _en Tnn PHONE,/$2RR 453_7322
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT,/
(if applicable) (if applicable) — —_
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural V
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI� r I `f�
Nearest Town: 7�K`l h P rr•7G' ✓d +N County t l7 41 P ✓ IC ✓a
ClcfrK Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: !'I)I EL-K1el'
Address /(o 9 6 C (a dG IRA.
neat or Route No.)
{Z�'f iter rr) i7:P� C 028 /3
City or Town State / Zip Code
Area code- Phone number /
4. DATE DRILLED ,7(6' D `I-
5. TOTAL DEPTH:
6. DOES WF11 REPLACE EXISTING WELL? YES ❑ NO X
7. STATIC WATER LEVEL Below Top of Casing: An 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 accordancgg��wltb 1SA,/CAC 2C .0118.
9. YIELD (gpm)• oCs METHOD OF TEST air
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic trap
(check box)
DEPTH DRILLING LOG .
From To
Formation Description--
fiat S
5 6 5 ad n
Co nsol i,latect rock
11. DISINFECTION: Type r h 1 n r i n a
12. CASING:
Depth
From_p_ To 9.3
From To
From To
13. GROUT: Depth
From_0 _ 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.
Ft. 6
Ft
Ft.
Diameter
1/4
Amount l C.ILfI
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Material
N at Conant
0
r
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the &ii
numbers and common road names.
fzckcLuYe. 1/4/-
Method
Iland
� Qrk
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THATOPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNA
t W.
F PERSON CONSTRU
7
NG T
(
DATE
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Tames ur_ camp,Jr
WELL CONTRACTOR COMPANY NAME Camr' a Ida11 R Pump (-irk_ Tnr PHONE #,8if1) d53_7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERb1IT#
(i f applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential '4unicipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATISi
ergs[ own: it!. JJ -(; t.e,
County 'l..(Allk.J V19-
(Street Name, umbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: : a_A \\ p-CA21A
Address 1— f' t. W i i 1
y / E
oee[ or Route Nqq.
)fe royo IV i `/O4
Ciryor Town Stare Zip Code
Area code- Phone numb".
4. DATE DRILLED V ps
5. TOTAL DEPTH: VA S
6. DOES WFT T REPLACE EXISTING WELL? YE D NO 14
7. STATIC WATER LEVEL Below Top of Casing: tLd FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S 1 FT. Above Land Surface'
. "Top of casing terminated atier below land surface requires a
;variance In accorda with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth): I no
0l\
P it
11. DISINFECTION: Type r h 1 n r i n a
12. CASING:
Depth
From__ 0__To'&3
From To
From To
13. GROUT: Depth
Front__(__ To , Q
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:
Amount
Wall Thickness
Diameter orWeight/Ft. Material
Ft. 6 1 / 4 GDR.21
Ft.
Ft.
Ft.
CERTIFICATION # 2 1 3 f1
Topographic/Land setting
❑Ridge ❑Slope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DEPTH DRILLING LOG
From 3T5., tttion Description
dLt
297514
c
LOCATION SKETCH
Show direction and distance in [Hiles from at least; ='
two State Roads or County Roads. Include the rQ&
numbers and common road names.
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAND • ' a , AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
GNATURE OF RSON CON..
TRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
James Carnr, Jr
WELL CONTRACTOR COMPANY NAME ('amr' ¢ Wa11 E Pnmr r`n Tnn
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT/I
(if applicable)
(if applicable)
29'7509
CERTIFICATION N 2 1 3 f)
PHONE If 7A) AS3_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 Nearest est Town:
�c s c County Kw ljjher rd
14-if 72 &'i/ -rerr
Numbers, Communi Subdivision, Lo[Mo
3. Address.
d ER: in �JY n vI ()
Address �� Andy mint- Or,
(Street Name,., Zip Code)
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
(Street or Rotue No.)
ii er'svh 5 c-
try or Towo State Zip Code
(tsig
)
Area code- Phone number ,I
4. DATE DRILLED D Y
5. TOTAL DEPTH: 7o5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 6o
(Use "+" if Abovc 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): C METHOD OF TEST n t r
10.WATER ZONES (depth): f/N noi3Ort.
11. DISINFECTION: Type r
12. CASING:
Depth
From_0____ To C.c
From To
From To
13. GROUT: Depth
From n To 20
From To
14. SCREEN: Depth
From,_ To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
hlnrinn
Diameter
Ft.6 1/4
Ft.
Ft.
Material Method
Ft.
Ft.
Diameter
Ft. in.
Ft. in
Amount i � cup
Wall Thickness
or Weight/Ft. Material
GDa21 PVC
N at Cement Hand
Slot Sizc Material
in.
in
Size Material
Ft.
Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Va11cy ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
DEPTH DRILLING ox)
pRILLING LOG
From To Fprmati n D scriptjon__
/FS 765 Con's° it Atli,ri York
O
C"
LOCATION SKETCR
Show direction and distance in miles from at IeasslIn
two State Roads or County Roads. Include the raal
numbers and common road names. w
0
(A)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A C Y OF THIS RECORD HAS BEEN PROV ED TO THE WELL OWNER
ate-Gr t 6 , 6 /G-o{
SIGNATURE OF 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
r-
E.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jam As r4 Carrr, Tr CERTIFICATION# 7118
WELL CONTRACTOR COMPANY NAME ('a misR wa1 1 E Mimi-) r Tnr PHONE #$2RI 451_7 322
STATE WELL CONSTRUCTION PERMIT# SOCIATED WQ FERM1T#
(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 LOCATIO I/
Nearest Town: I-Ke / L( Ve County
-;Sod 64: ?LI f y.
(Street Name, Numbers, Community, Subdivisi n, Lot No., Zip Code)
3. OWNER:
;r
o n nSta-
Address /'7r�- / {lf Ye
L—/ a_ tjetorRomeN J
E I �u yP , C. � 8'7 46
try or Town State Zip Code
(/79l )- looms Sil
Area code- Phone number /
4. DATE DRILLED 4 —16 -D 4
5. TOTAL DEPTH:
6. DOES WFr r REPLA`C EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: r96
(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 accord& ce with 1SA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST D i r
10. WATER ZONES (depth): 45
11. DISINFECTION: Type (' h 1 nri n P
12. CASING:
Depth Diameter
From_a_ To D Ft. 6 1/ 4
From To Ft.
From To Ft.
13. GROUT: Depth
Fro111_0_ To 2 0 Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount 9, cup
Wall Thiclmess
or Weight/Ft. Material
eng.21 PVC
Material
N at Cement
Method
Iland
297506
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Flat
(check appropriate box)
Latitude/longitude of well location
(degrecs/minuteslseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formapion Description
n LID Sand 1 GI r, f
ifn iLf C cn1i<f)h afec rock.
LOCATION SKETCFj -g
Show direction and distance in miles from at 1e t"kI
two State Roads or County Roads. Include the road
numbers and common road names.
u re
Ifwy 6Y-74
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC IED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS
TRUCTION STANDARDS, AND THAT A COPY OF -.THIS RECORD HA$ BEE PROVIDED THE WELL OWNER
/ I /l/YI Z0d, �h�, y.1 —(4
SIGNATURE OF PE l,B N CONSTRUCTING THE WELL / / / DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
r
c

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From: Carolina Well Drillers. Inc To: NC Dept of Env. and Na Resour
Date: 7/7/2004 lime: 9:27:40 PM Page 1 of 1
296958
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 ❑X Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2- WELL LOCATION:
Nearest town: LAKE LURE
LOT 42 RIVERBEND RESORT LAKE LURE
County RUTHERFORD
(Street Name, Numbers, Conununity, Subdivision, Lot No,. Zip Code)
3. OWNER TERRY McGARVEY
ADDRESS 115 L.AURAL DR
(Street or Route No.)
LAKE LURE NC
City or Town Stale
Zip Code
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ® Flat
Latitude/Longitude of well location
35.25.621 / 82.09.577
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Fomlation Description
0 55 Clay
828-779-2264 55 400 Consolidated Rock
Area Code - Phone Number
4. DATE DRILLED 6/5/02
5. TOTAL DEPTH 400
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing:
YES ❑ NO El
178 FT.
(tlsc "+" I(Abavc Top creasing)
s. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated abor below land surface requires a variance in
no:Ai ee will] 15A NCAC 2C.0118
9. YIELD (gpm): 15 METHOD OF TEST ARDM
to. WATER ZONES (depth): 380
It. DISINFECTION: TYPE HYPOCHLORITE AnloNd 11 oz LOCATION SKETCH
O. CASING: Wall Thickness Show direction and distance in miles from at least
Dept, Diameter or Weight/Ft. Material two State Roads or County Roads. Include the road
From 0 To 62 Ft. 6 1/4 " SDR 21 PVC numbers and common road names.
13. GROUT:
Depth Nlaterial Method
From 0 To 20 Ft. GRAVEL MIX GRAVITY
14. SCREEN
Depth Deane er Slot Size Material
From NA To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From NA 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 OP THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
—
I
tm
7/1/94= _
Date
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-I REV. 07/2001'

29(3 92
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERI IFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1
WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: BOSTIC
105 ATLAS DR.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CINDY BERRYHILL
Address 105 ATLAS DR.
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code
(828) — 245-1536
Area Code Phone number
4. DATE DRILLED 06/01/04
5. TOTAL DEPTH: 72
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 52 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 72 Ft. 24" CEMENT
From _ To _ Ft. _
From _ To _ Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To FL in. _ in.
From _ To _ Ft. in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 52 To 72 Ft. 78M GRAVEL
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope D Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seronds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
BUS. 74 W. FROM FOREST CITY. RT. ON
HUDLOW RD. RT. ON WHITESIDE RD. LEFT ON
BROOKS RD. LEFT ON ATLAS DR. 1/10 MILE ON
LEFT.
_73
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC 1ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
OF PSIFS6N COI�'STRUCTING THE WELL DATE
IGNA
Submit 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

2967 90
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1 WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
ROCK RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ERVIN GREENE
Address ROCK RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) - 287-4958
Area Code Phone number
4. DATE DRILLED 06/21/04
5. TOTAL DEPTH: 35
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 15A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 6.9
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 35 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 Material
From _ To _ Ft.
From _ To _ Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From 20 To 35 Ft. 78M GRAVEL
From To Ft.
Method
POURED
Slot Size
in. in.
in. in.
Topographic/Land setting
0 Ridge ❑ Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) ---
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at (east
Two State Roads or County Roads. Include the road
number and common names
HWY. #64 E. FROM RUTHERFORDTON. LEFT
ON OSCAR JUSTICE RD. GO TO STOP SIGN.
RIGHT ON ROCK RD. 2/10 MILE ON RIGHT.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CON UCTION STANDARDS, AND THAT A COPY OF�THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNA 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

29r7
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH
RIVER RD. LOT #5
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: RON MAXWELL
Address RIVER RD. - LOT 5
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 749-2500
Area Code Phone nwnber
4. DATE DRILLED 06/15/04
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL'/ YES ❑ NO121
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface'
`Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 4 METHOD OF TEST ARD
10. WATER ZONES (depth):
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" SDR.21 PVC
From _ To _ Ft. _
From To _ Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QULKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To Ft. in in.
From To _ Ft. in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
0 Ridge ❑ Slope 0 Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names . .
HWY. #64/74A W. FROM RUTHERFORDTON.
LEFT ON MAPLE CREEK RD. RT. ON RIVER RD.
1/4 MILE ON RT.
iV
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC 1 ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIQN STAND S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
,
SIGIIIATURE 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

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water QUJiity - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC
WQ # PHONE # [phone]
I
STATE WELL CONSTRUCTION PERMIT # _ (if PERMITE)
(if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH
AIRPORT RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ROGER SMITH
Address AIRPORT RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) - 894-34422
Area Code Phone number
4. DATE DRILLED 06/28/04
5. TOTAL DEPTH: 645
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 2 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 60 Ft. 6-1/4" SDR.21 PVC
From To Ft.
From _To_Ft.
_
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To _ Ft.
From To Ft.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑'Topographic trap
(check box) - DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #64 E. FROM RUTH. LEFT ON OSCAR
JUSTICE RD. RT. ON AIRPORT RD. WELL AT
DEAD END.
0
J
w
w
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C. WELL
CONS 71 (CTION STANDARDS, AND''THAT
AC�OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
rpntc,
�2� SIGNATURE OF PERSON CONSTRU ING WELL~� DATE 6 — a P G, Sz
Submit 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 Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: LAKE LURE
JACKIE DR.-JERICHO WOODS
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JOE CARSON
Address JACKIE DR-JERICHO WOODS
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
(828) — 287-4239
Area Code Phone number
4. DATE DRILLED 06/28/04
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 16.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 80 Ft. 6-1/4" SDR.21 PVC
From _ To _ Ft. _
From _ To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUHCRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To Ft. in. _ 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/xi-fends)
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box) - ---
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in milesfrom-at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #64/74A W. FROM RUTHERFORDTON.
LEFT ON JERICHO LANE. STRAIGHT ON TYLER
TERRACE. RIGHT ON JACKIE DR. 1/10 MILE ON
RIGHT.
16. REMARKS:
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
SIGN F PERS N CONSTRUC G THE WEL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 2 9 ry 3
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: ELLENBORO County RUTH
NEW COVENANT WAY
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ROBBIE SMITH
Address NEW COVENANT WAY
(Street or Route No.)
ELLENBORO NC
City or Town State
(VI) — 980-3199
Area Code Phone number
4. DATE DRILLED 06/30/04
5. TOTAL DEPTH: 405
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO LE
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): 30 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: T
12. CASING:
Depth Diameter
From 0 To 150 Ft. 6-1/4"
From To Ft.
From _ To _ Ft. _
13. GROUT: Depth Material
From 0 To 20 Ft. QUH03ETE
From To Ft.
14.SCREEN: Depth Diameter
From _ To Ft.
From _ To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
CHLORYTE Amount 10.5
Wall Thickness
or Weight/Ft. Material
SDR.21 PVC
From
From
Method
POURED
Slot Size Material
in. _ in.
in. in.
To _ Ft.
To Ft.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds);, -_
28040 Latitude/longitude source: ❑ GPS ❑ Topotmphiv map
Zip Code (check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles frontat least
Two State Roads or County Roads. Include the road
number and common names
FROM ELLENBORO. GO UP HOLLIS RD. RIGHT
ON EVAN EDWARDS RD. LEFT ON NEW
COVENANT WAY. TAKE 1ST GRAVE RD. TO
LEFT. LEFT AT DEAD END.
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
(-4.—e, - 36 -0
SI A 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

299970
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERIINICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: HARRIS
HUNTER RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: KEVIN BOWYER
Address HUNTER RD.
(Street or Route No.)
HARRIS NC 28074
City or Town State Zip Code
(864) — 590-7019
Area Code Phone number
4. DATE DRILLED 03/18/04
5. TOTAL DEPTH: 425
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 90 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated aUor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 80 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 11.5
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 Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To _ Ft.
14.SCREEN: Depth Diameter
From To Ft_
From To Ft_
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To _ Ft.
Slot Size Material
in. _ in.
in. in.
16. REMARKS:
Topographic/Land setting
0 Ridge 0 Slope 0 Valley 0 Fla
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #221 S. FROM RUTHERFORDTON. RT. ON
JACK MCKINNEY RD. RT. ON WV THOMPSON
RD. RT. ON HUNTER RD. 2/10 MILE ON LEFT.
0
N
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIO)tIA • OF PERSON CONSTRUCTING WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEH. CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH
SOURWOOD RIDGE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: PHILLIP SHEHAN
Address 160 SOURWOOD RIDGE
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 286-2689
Area Code Phone number
4. DATE DRILLED 03/04/04
5. TOTAL DEPTH: 205
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): 9 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 4.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 40 Ft.6-L4" 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) i.-
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. LEFT
ON SCHOOLHOUSE RD. IN GH.KY. RT. ON
SOURWOOD RIDGE. 1 ST DRIVE ON RT.
0
IV
0
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I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THA 1n A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
A
�, -
S 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

299968
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: FOREST CITY
WHITESIDE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: KIM FREEMAN
Address WHITESIDE RD.
(Street or Route No.)
FOREST CITY NC 28043
City or Town State Zip Code
8L28)— 287-4239
Area Code Phone number
4. DATE DRILLED 03/02/04
5. TOTAL DEPTH: 245
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Eg
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 aUor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 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. _ is in.
From _ To _ Ft. _ in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
BUS. 74 W. FROM FOREST CITY. RT. ON
HUDLOW RD. RT. ON WHITESIDE RD. APPROX. 2
MILES ON RT.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SI
A��A OF PERSON CONSTRUCTING THE LL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

298965
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
WEEKS RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DARREN HONEYCUTT
Address WEEKS RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(864) - 461-8119
Area Code Phone number
4. DATE DRILLED 03/23/04
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 6 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 7.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 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
From To Ft. _
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Slot Size Material
in. _ in.
in. in.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
POORS FORD RD. FROM SHILOH. RT. ON
GRAY'S CREEK RD. RT. ON WEEKS RD. APPROX.
2/10 MILE ON LEFT.
c_
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-D0
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Fri
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0
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OFF�THIS
/RECORD HAS BEEN PROVIDED TO THE WELL OWNER
(//Jfi_ IGNA OF PERSON CddNSTRUCTING 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

298963
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® MunicipalPublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: UNION MILLS
NANNEYTOWN RD/
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: TOM PARSONS
Address 1119 NANNEYTOWN RD.
(Street or Route No.)
UNION MILLS NC 28167
City or Town State Zip Code
(828) - 243-1640
Area Code Phone number
4. DATE DRILLED 03/09/04
5. TOTAL DEPTH: 185
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): 30 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 3.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 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 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. #221 N. FROM RUTHERFORDTON. LEFT
ON NANNEYTOWN RD. 1 ST DRIVE ON LEFT
AFTER YOU PASS HORN MILLS RD. (BOX #1119)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC 1 ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
r-
2?/ < ii --��-. . 3- 2- o/
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

293962
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
GRASSY KNOB RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ROGER BELANGER
Address 1266 GRASSY KNOB RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 685-9225
Area Code Phone number
4. DATE DRILLED 03/05/04
5. TOTAL DEPTH: 205
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): 30 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 4.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 110 Ft. 6-1/4" 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:
County RUTH
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
cn
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic -map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #64/74A W. FROM RUTHERFORDTON.
LEFT ON ROCK SPRINGS CH. RD. RIGHT ON
GRASSY KNOB RD. 1/5 MILES ON RIGHT. (1266 ON
BOX)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIION STANDARDS, AND THAT A COPY
OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATUREAPE ON NSTRUCTING THE WELLDATE
`�nC2
Submit 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

299951
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
HAYNES RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: FRANKIE MILLIKEN
Address HAYNES RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
�) — 287-0388
Area Code Phone number
4. DATE DRILLED 03/23/04
5. TOTAL DEPTH: 170
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): 12 METHOD OF TEST ARD
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 3.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 150 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 ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
d)
LO
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #64/74A W. FROM RUTHERFORDTON.
RT. ON COVE RD. LEFT ON HAM CREEK RD.
CROSS INTO MCDOWELL CTY. HOUSE ON
CORNER OF HAM CREEK RD. & HAYNES RD.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS T )CTION STANDARDS
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE 07.1ARSON 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

(
99958
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
WOODLAND EST.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DERICKCLARK
Address WOODLAND EST.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
8( 28) — 287-4239
Area Code Phone number
4. DATE DRILLED 03/25/04
5. TOTAL DEPTH: 50
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 50 Ft. 24" CEMENT
From To Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To _ Ft in. in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 30 To 50 Ft. 78M GRAVEL
From To Ft.
c-
0
Topographic/Land setting co
❑ Ridge ❑ Slope ❑ Valley ❑ F1at - >
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Tipographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #221 S. FROM RUTHERFORDTON. RT. ON
POORS FORD RD. LEFT ON WOODLAND EST. 1/4
MILE ON LEFT.
w
0
IN)
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC rED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTR[JCTION STANDARDS, AND THAT A COPY OF THIS CORD HAS BEEN PROVIDED TO THE WELL OWNER
i
SIGNATURE 0 PERSONaNSTRUCTING 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