Po CY2005

WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quay 1 A
eY
WELL CONTRACTOR(INDIVIDUAL)NAME (pri CERTIFICATION# 713A3
WELLCONTRACrORCOMEANYNAME ramp' C Wel 1 & Pump(,p_,_r Tnr PRONE a (g 84�2
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential❑ Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery O Heat Pump Water Injection❑ Other Other,List Use gT�n
2. WELL LOCATIO n Topographic/Land setting
Near` _ `est Town: CounTy i-(, ORidge []Slope OValley OFlat
1�1'a I (check appropriate box)
(Street Name,Numbers, ommunit ,Subdivision,Lot No.,Zip Code) LatitudeAongitude of well location
3. OWNER: Zs; JM t� LC. (degrees/minutes/seconds)
Address 0 i'X I J.5 Latitude/longitude source:OGPSOTopographic map
y (Street or Route No.) (check box)
5 )AY I c K y(YA j G o2q 7iG DEPTH DRILLING LOG
Ci or Town start Zip Code From T F tmation escription
(.1 0
Area code-Phone rarer",
4. DATE DRILLED S- o
5. TOTAL DEPTH: U Y
6. DOES WELL REPLACE EXISTING WELL? YES O NO I
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 accordance with 15A NCAC 2C.0118. _
9. YIELD(gpm): I nb�k- THOD OF TEST Air
10.WATER ZONES(depth): LOCATION SKETCH
1. DISINFECTION:Type Chlorine Amount Show direction and distance in miles from at least
1
1 . CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and c n road names.
From 0 To�Ft. 6 11 d SDR21 PVC -
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 ToFt. Neat Cement Hand
From TO Ft.
14. SCREEN: Depth Diameter Slot Size Material C�,f
From To Ft. in. _ in.
From TO Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Sim Material
From To Ft. -
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT TIES WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
3 -IS•
SIGNATURE F PERSON CONSTRUCTING THE WELL DATE co
co
C
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center:-. g `
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-I REV 09,/2004

309 � �� 0
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) NEE,CRAFT CERTIFICATION# 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town:MILL SPRING County POLK Topographic/Land setting
WATER MILL DR-LOT#5 ❑Ridge ❑ Slope ❑ Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:KETI'H RIMER Latitude/longitude of well location
Address WATER ME,L DR-LOT#5 _
(Street or Route No.) (degrees/mmutes/seconds)
MILL SPRING NC 28756 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 28)-674-7722 DEPTH
Area Code Phone number From To ..
4. DATE DRILLED 03/08/05 _
5.TOTAL DEPTH: 185 DRILLING LOG
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 50 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): 12 METHOD OF TEST ARD number and common names
10. WATER ZONES(depth): HWY.#9 S.FROM MILL SPRING.LEFT ON
11.DISINFECTION: Type CHLORYTE Amount 3.5 JOHN SHEHAN RD.RIGHT ON WATER MILL DR.
HOUSE AT CUIrDE-SAC.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 50 FL 6-1/4" SDR21 PVC
From_To_Ft-
From To FL
_T: _
13.GROU Depth Material Method Cy
From 0 To 20 Ft.OUH(RETE POURED O
From_To_Ft. v rY
14.SCREEN: Depth Diameter Slot Size Material n
From To_Ft— in. in. t
From_To_Ft in. in.
m
15. SAND/GRAVEL PACK: �
Depth Size Material
From_To_Ft_
From To Ft.
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIISS�R�EECORD HAS BEEN PROVIDED TO THE WELL OWNER
T MARE 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

North Carolina-Department of Environment and Natural Resources-Division of Walar ouality-Groundwater Section
1636 Mail Service Center.Raleigh,N.C.27699-1636-Phone [phone] 309125
WELL CONSTRUCTION RECORD WELLCONTRACTOR: W-2,0 N L .f WJ) - gut
WELL CONTRACTOR CERTIFICATION p:
STATE WELL CONSTRUCTION PERMITN: .�IQlla�l
1. WELL USE(check Applicable Box): Residential mr Municipal ❑ Industrial❑ Agncurtura Ln'oniro�rtn' ❑
Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use: g'
2. WELL LOCATION:(Show sketch of the location below) APR " 5
Nearest Town: C01o"ILAS County: `00)
so9& .. PA �� 'cickw R,�a. S Alu, tu. a n
(Roa �tl Name and Numbers,C
pommunity,or Subdivision and Lot No.) DRILLING l
3. OWNER COV►AJ 7LWdey- LOG
Address 33� AD From To ronnation Dcscrpllon
..... C�— d C7 r RCS C. G..
t eat o nute 3 a a
Lau.r cNs Sc. �O 644
C ty or 7o n State Zip Code - D ' 1pD B 14.tJt ,
4. DATE DRILLED 3- Id'OS gab, Ato
5. TOTAL DEPTH ZQ 0 Ib° Goer 6nw1 ,► taiw4�,6. CUTTINGS COLLECTED YES(—J NO[- —� —
7. DOES WELL REPLACE EXISTING WELL? YES NOQ
8. STATIC WATER LEVEL Below Top of Casing: A o FT.
(Use•✓IF Above Top or Casing) 3 {
9. TOP OF CASING IS•fI _ FT. Above Land Surface' -
•Top of casing terminated avor below land surface requires a variance In accor-
dance with 15A NCAC 2C.0118
10. YIELD(gpm): .20 METHOD OF TEST A 1 it --G— -.
11. WATER ZONES (depth):—At! Si Al. Ln
1$o N•• 1� c,P.•n
12. CHLORINATION: Type MAW, Amount
13. CASING: u If additional space Is needed use back of loan
De th wan Thickness LOCATION SKETCH
p Diameter or Weight/R. Malorial
From-- --_TO -Z_ Ft. L.'�k Pt/L (Show direction and distance from at least Iwo SIaLo
From Rua s,or other map reference points)
To FI.
From To FI. aka
14. GROUT:
Depth Material Method 4
From To aV Ft. 1aV•1DNf�'t•
From To FL
15. SCREEN:
D th Diameter Slot Sizo Material S'^
From To F In. _ in. N r4•
From To in. _ In. D1'p Maal4., d
From To__FL_ In. _ in. 'tit• �1+
16. SAND/GRAVEL PACK: i 1
Size Material c13 13 7`I a�
From To Ft. lt9n� �Z a/I' 4,z- 6e,
From
Ft.
17. REMARKS: �—
DO HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND MAT A COPY OF THIS RECORD
y�4f HAS BEEN PROVIDED TO THE WELL OWNER,
FOR OFFICE USE ONLY �L r�i e+ p � ?
Ouad No: SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water ouality,Groundwater Reclion within 30 days
Serfat No,
— -- — G71 I FIEV. I2)33

1 )
307464
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 ED
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town: TRYON County PO LK Topographic/Land setting
PINE MEADOWS LANE ❑ Ridge ❑ Slope ❑valley ❑ Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:BRUCE EDWARDS Latitudellongitude of well location
Address PINE MADOWS LANE _
(Street or Route No.) (degrees/minutes/seconds)
TRYON NC 28782 Lautude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
(S28)—8634338 DEPTH
Area Code Phone number From To
4. DATE DRILLED 01/06/05
5.TOTAL DEPTH: 405 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
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* 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): 3 METHOD OF TEST ARD number and common names
10.WATER ZONES(depth): HWY.#9 S.FROM SANDY PLAINS.LEFT ON
HORNE RD.LEFT ON S.GREENWAY DR GO
11.DISINFECTION:Type CHLORYTE Amount 10.5 APPROX. 1/2 MILE.LEFT ON PINE MEADOWS
12. CASING: Wall Thickness LANE. 1/4 MILE ON LEFT.
Depth Diameter or Weight/Ft. Material
From 0 To 90 Ft. 6-1/4" SDR21 PVC �� 35c l 2q cll°
From_To_Ft _ _
From TO Ft. fa�� r62° r{ 7O.�V _-n
13.GROUT: Depth Material Method ram'
From 0 To 20 Ft.OUIKRETE POURED
From_To_F[.
14.SCREEN: Depth Diameter Slot Size Material
From_To_Ft._ in, in. c
From_To_Ft._ m- in.
15. SAND/GRAVEL PACK: v
Depth Size Material
From_To Ft._ =
From To FL -
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 IMS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

307458
WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(prim)RODNEY ROBBINS CERTIFICATION# 2785
WELL CONTRACTOR COMPANY NAME PITT74AN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town:MILL SPRING County POLK Topographic/Land setting
HWY.#108 E. ❑Ridge ❑ Slope ❑ Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER: MAX CROWE Latitudc/longitudc of well location
Address HWY.#108 E.
(Street or Route No.) (degrees/minutes/seconds)
MILL SPRING NC 28156 Latitude/longimdc source: ❑ GPS ❑ Topographic map
City or Town State Zip Code (check box)
7( 70)—787-8984 DEPTH
Area Code Phone number From To
4.DATE DRILLED 01/27/05
5.TOTAL DEPTH: 805 DRILLING LOG
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
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* LOCATION SKETCH
*Top of casing ter atlor below land surface requires a Show direction and distance in miles from at least
variance in accordance with 15A NCAC 2C.0118.9. YIELD (gpm): 3 METHOD OF TEST ARD Two State Roads or County Roads. Include the road 10.WATER ZONES number and common names(depth): HWy,#108 E.FROMK COLUMBUS.GO
11.DISINFECTION:Type CHLORYTE Amount 22.5 APPROX. 1/4 MILE PAST PEA RIDGE RD.RIGHT
12.CASING: Wall Thickness INTO ORANGE GATE.
Depth Diameter or Weight/Ft Material ��{ 'tS il` 1-7,25°1Q
From 0 To 170 Ft. 6-1/4" SDR21 PVC
From_To_Ft_ _
From To Ft
_T: _
13. GROUT:—Depth Depth Material Method
From 0 To 20 Ft.QURMTE POURED
From_To_Ft,
14.SCREEN: Depth Diameter Slot Size Material
From_To_Ft._ in. in. a
From_To_Ft 15. SAND/GRAVEL PACK:
Depth Size Material
From To_Ft
From_To_Ft
16.REMARKS:
UN rf
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

OP
307462
WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)RODNEY ROBBINS CERTIFICATION# 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential Z Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK Topographic/Land setting
RED FOX RD. ❑Ridge ❑ Slope ❑ Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:MASTON HOMES Latitude/longitude of well location
Address RED FOX RD.
(Street or Route No.) (degrees/minutes/seconds)
COLUMBUS NC 28722 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
(S64)—457-3855 DEPTH
Area Code Phone number From To
4. DATE DRILLED 01/10/05
5.TOTAL DEPTH: 365 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO Z From To
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* LOCATION SKETCH
*Top of casing terminated atior below land surface requires a Show direction and distance in miles from at least
variance in accordance with 15A NCAC 2C.0118. Two State Roads or County Roads. Include the road
9.YIELD(gpm): 20 METHOD OF TEST ARD number and common names
10. WATER ZONES(depth): FROM COLUMBUS.GO OUT PENIEL RD.
RIGHT ON RED FOX.APPROX.6/10 MILE ON
11.DISINFECTION:Type CHLORYTE Amount 9 LEFT.
12. CASING: Wan Thickness
Depth Diameter or Weight/Ft. Material 1""J
From 0 To 160 Ft. 6-1/4" SDR21 PVC } 3� l3
cn
From_To_Ft. Wn� $Z`�j' 13•
From_To Ft._
13. GROUT: Dep_th Material Method
From 0 To 20 Ft.OUHZRETE POURED "
From_To Ft.
r=
14.SCREEN: Depth_ Diameter Slot Size Material
From_To_Ft._ in in.
From_To_Ft._ m. in.
15. SAND/GRAVEL PACK: c
Depth Size Material
From_To_Ft._
From To Ft. —
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIG OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Man Service Center—Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

308500
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: COLUMBUS County PO LK Topographic/Land setting
HWU.#108 L ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER: BILL LEDFORD Latitude/longitude of well location
Address HWY.#108 E.
(Street or Route No.) (degreestminutes/seconds)
COLUMBUS NC 28722 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 28)-894-8826 DEPTH
Area Code Phone number From To
4. DATE DRILLED 02/15/05
5.TOTAL DEPTH: 225 DRILLING LOG
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface* 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): 5 METHOD OF TEST ARD number and common names
10.WATER ZONES(depth): FROM COLUMBUS.GO UP HWY.#108 E.2ND
DRIVE ON LEFT PAST POLK COUNTY HIGH
11.DISINFECTION:Type CHLORYTE Amount 5 SCHOOL.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material Ih+ 3S° lkq' 1,23'N
From 0 To 120 Ft 6-1/4" SDR21 PVC ion� W wl S1.13""
From_To_Ft.
From_To Ft.
13. GROUT: Depth_ Mat_erial Method _ �3
From 0 To 20 Ft.QUH{RETE POURED
From_To Ft. a ,
14.SCREEN: Depth_ Diameter Slot Size Material ° co
From_To_Ft._ in. in. - d r-
From_To_Ft._ in. in. Vn
15. SAND/GRAVEL PACK: ,
Depth Size Material
From_To_Ft_
From To Ft
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
l_ 4 nir it ze4z' 2 . -�? / 5! - d S'
SIPNA:i URE OfTERSON CONSTRUCTINGTHE 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

308312
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (paint) ,J0. ,I CA W,1 CERTIFICCATIO/NI niay
11
WELL CONTRACTOR COMPANY NAME /d./n✓)5 L e�1 uT T1-t e. PHONE W
STATE WELL CONSTRUCTION PERMITp ASSOCIATED WQ PERMIT[!
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential Ll" Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery O Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION' p Topographic/Land setting
Nearest Town: County ` f> ❑Rid e d W g dope Walley OFlat
. \A)WNA JR e (check appropriate box)
(Street Name,Numbers,, Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
c
3. OWNER: ,;y �kG Ci1 h (degrees/minutes/seconds)
Address (5 LatitudMongitude source:OGPSOTopographic map
1 Str Route No.) (check box)
4Lc V- L. 24(9 2 DEPTH DRILLING LOG
City or Town Ste Zip Code From To _ F do escription
Area code-Phone number
4. DATE DRILLED a_ k) y
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO I!r
7. STATIC WATER LEVEL Below Top of Casing: 0 t T.
7
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1 FT.Above Land Surface' y
"Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.011&
9. YIELD(gpm): 0-0 METHOD OF TEST it 00
10.WATER ZONES(depth): I Y S
LOCATION SKETCHUl
11. DISINFECTION:Type Amount w2D— Show direction and distance in miles from at least
two State Roads or County Roads.Include the roa a
12. CASING: Wall Thickness ty "�
Depth Diatr'eter or�Weight/Ft. Matperi/y(I numbers and common roadQames.
From To �U a Ft. �/ r
From To Ft. s From To Ft.13. GROUT: Depth Material �y. Meth�o�]From To ,�.0 Ft. Meat C.t:men/ kAIFrom To Ft.
14. SCREEN: Depth Diameter Slot Size MaterialFrom To Ft. in. in.
From To Ft. in. in, Z15. SAND/GRAVEL PACK: 410 SI S�-44 "W
Depth Size Material
From To Ft. -
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDAN E WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATU F PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service CenteS-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. "
GW-1 REV.09/2004
MAR 21 2005

WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) Games W CamIL, 7T_ CERTIFICATION# 2138
WELL CONTRACTOR COMPANY NAME camp' , [Tall R Pttmn rn a Tnr PHONE # 6 84 2
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: ( Topographic/Land setting
Nearest Town: County \ ❑Ridge ❑Slope LtWalley OFlat
CM jA q N - (check appropriate box)
(Street Name,Ambers,Community,Subdivision,Lot No.,Zip Code) LatitudeAongitude of well location
3. OWNER: 1 Y/A l/l ri0 aA 4A.4 (degrees/minutes/seconds)
Address 1 5-o;L'1 4k /No Y / t t. Latitude/longitude source:❑GP$❑Topographic map
(S t or Route No.) 1 / �f q p (check box)
1 Yf a d' y.1 lie V � Ogoz I n DEPTH DRILLING LOG
City or Town - State Zip Code From To tmation D escription
U_ D �S F Area code-Phone number
4. DATE DRILLED—� ..
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES LYF10 ❑ .,
7. STATIC WATER LEVEL Below Top of Casing:�FT. G -�
(Use'W'if Above Top of asmg) Z'-
8. TOP OF CASING IS 1 FT.Above Land Surface"
"Top of casing termiaeted atlor below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): ( 1�M�THOD OF TEST Air
10.WATER ZONES(depth): (] - LOCATION SKETCH "
it. DISINFECTION:TypeL rhlOrine Amount CA f P Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names. �)
From 0 To 0 Ft. 6 1 /d SDR21 PVC
From To Ft. 5(
From To Ft.
13. GROUT: Depth Material Method
From 0 To_2_0 _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: r �3u r%J
Depth Size Material
From To Ft. —__ U to.,5 to it)rLV6.85Moi
From To Ft. 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
— — 6�
SIGNA OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn: InforM�fiop kau lgement,1617 Mail S rvace Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days 1— I
(I"rV1W.I REV.09/2004
1 7 ^��C

3-0 314
WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) ROBIN MCNEELY CERTIFICATION# 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential 0 Municipal/Public Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town:COLUMBUS County POLK Topophic/Land setting
GREEN FIELD FARMS El Ridge LJ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:HUBERT METCALF Latitude/longitude of well location
Address GREEN FIELD FARMS
(Street or Route No.) (degreedminutes/seconds)
COLUMBUS NC 28792 Latitudellongimde source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 28)—8634642 DEPTH
Area Code Phone number From To
4.DATE DRILLED 07/25/05 _
5.TOTAL DEPTH: 56 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 36 FT.
(Use"+"if Above Top of Casiag)
8.TOP OF CASING IS 1-V2 FT. Above Land Surface's LOCATION SKETCH
'Top of casing terminated at/or below land surface requires a Show direction and distance in miles from at least
variance in accordance with 15A NCAC 2C.0118. Two State Roads or County Roads. Include the road
9.YIELD(gpm): 20 METHOD OF TEST STEEL TAPE number and common names
10.WATER ZONES(depth): HWY.#9 S.FROM MILL SPRING.LEFT ON
11.DISINFECTION:Type CBZORYTE Amount 9.2 SANDY PLAINS RD. U4 MILE LEFT ON ASHLYN
12. CASING: Wall Thickness LANE.STAY LEFT. LOT AFTER CURVE ON
Depth Diameter or Weight/Ft Material LEFT.(LOT#5)
From 0 To 56 Ft 2411 CEMENT �tj 3S° (`S' M,git"N
From_To_Ft_ _
From To Ft 10�5 62ar}� 25,13 W
13.GROUT: Depth Material Method
From 0 To 20 Ft.CEMENT POURED
From_To,_^Ft
14.SCREEN: Depth Diameter Slot Size Material 7 _ W.
From_To_Ft_ in in.
From_To_Ft._ in. in. " - _ . . 1
15. SAND/GRAVEL PACK: G-)
Depth Size Material r
From 36 To 56 FL 79M GRAVEL
From_To_FL_ � ('
.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 OF THIS CORD HAS BEEN PROVIDED TO THE WELL OWNER
1 (2 S
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

0 314326
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) JameC W_ Camp, Jr CERTIFICATIONS 7�78
WELL CONTRACTOR COMPANY NAME Camp' s Well & Pump CO_ , Tnr, - PRONE # R7A 4,;1-7'222
STATE WELL CONSTRUCTION PERMM ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box):Residential d Municipal/Public❑ Industrial El Agricultural❑
Monitoring❑ Recovery O Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: - Topographic/Land setting
Near own: ountyxv CRidge eSlope OValley 0171at
,^ (check appropriate box)
(Street Name,Numbers,Community,Subdivision,LdrNo.,Zip Code) Latitude/longitude of well location
3. OWNER: AJILJL ��l'1In `JMA-{ (degrees/minutes/seconds)
Address D 30 X W,5 Latitude/longitude source:OGPSOTopographic map
} (S or Route No (check box)
S Lf Y I a K LC Ro �L DEPTH DRILLING LOG
Oi
ty or Town State Zip Code From o •mationD ription
�)
Ares code-Phone numbei n
4. DATE DRILLED lD ..t- 0 S Ei
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES O NO O
7. STATIC WATER LEVEL Below Top of Casing: Lk U T. - t=—;
C 'e
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1 FT.Above Land Surface* ro
_
-Top of casing terminated atlor below land snrfam regairea a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): JVOD OF TEST air �t
10.WATER ZONES(depth): cS �00
LOCATION SKETCH 7F1
11. DISINFECTION:Type rh Tor i na Amount Show direction and distance in miles from at leae
12. CASING: Wall Thickness two State Roads or County oads.Include the mad
Dep Diameter or Weight/Ft. Material numbers and common road ames. ^
From_To�Ft. 6 1 /4 ;fir 21 - PVC
From To Ft.
From To Ft. - r • /
13. GROUT: Depth Material Method
From__(_To__2_p_Ft. Neat Cement HAncj
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. _ in.
From To Ft. in. in.
IS. SAND/GRAVEL PACK:
Depth Size Material
From To FL <
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
19-0S
SIGNA UJKE OF PERSO CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn: Information-Management,-1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004

A'w 141 v o
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IMIMIGWMeat&err-Rdd^PLC.2Tewae&wane PIS)T -Ml
WELL CONSTRUCTION RECORD WSLLCONTRACTOR: "- 'G�� �Ac-il
WSLL CONTRACTOR CiRTIMATION e: '
STATS WILL CONSTRUCTION PrLRLW#:
■rate unILLINC
I. WIL.LUSE Appowm aapRaeWrdlY�MladNpel❑ kldlubW❑ ASrkulNPal❑ A� uslness74
Raaoraq 0 Hod Pump WNW k(acom ❑ Oew❑ U Odw,Lbt Use: T7 HWy.� uslnes�8 q
828-247.1773
2. WELL LOCATKWt(Sha►awloh el 80 baleen below)
NwwalTwwc .I., A
"� Nanr aNl�inara. anbdwra.dwtry , Of9LLNG LOG
i. OWNER , , 1(t�� ��/�`?f Pon T• Fonaf n PnOW"
AddroM 1 T
Q2�Z -
« a1a arr
♦. OATS ORILLEO
S. TOTAL DEPTH
S. CUYTINGS COLLECTED YES nom� '
T. DOES WELL WB%ACE WNWWGLL? VEB �
S. STATIC WATER LEVK%bwToP OfCwhM FT.
e i drd"'O'sAmmuplool"
9. TOP OF CASING IS I y j�_ FT.elbow Lend&~
'tw a anlaa w+awd aYw►rbMhnd rwMoelNlMa•wiwewta aar
1Q YIELD(gm* s9 METF
11.WATER Iomn(dePll&.zj�`,--
12. CMWINATKNt TypallL; E Alaomd vadmamlpaaab"good a*bodNbwm
12. CABNG: // y
Capes /� V SdaS�rLIY�+I -
_ ( arMukAIIPI VAN" (shewplaavaaaM�Mme161ar:fnaStaM
From �l FL ' �' -�— � Roed�.urorwr mup wlwNloa sob�u! 1 'S S' l l`31•s)ter,
Fmo1 TO rl- lo.,� qt° 1 ` 51,e7"w
From To Ft-
From -TTo�..L r FL a- _ a' --
a�� a6
From To FL._.__. 7 —
Opw DlrnN•r Slot Ski NMNAd [� C
Fran TO—Ft...-..— b< .._...bL i
From To_.FL— kL —kL r�9 R
From Te— Fi kL
15. 4114NDr6MM PACK:
Oeplh Site Mau"
Frew ­77 y l
from
17.
toOME11ESYCE1TWYTNATTMWELLWAICONSTRWMNACOOPWO14M1NRN934 WADZC.VALL
CONSTlKICt1GN STAnDAlIDS;ANDTHAT ACOPYtfFTNISRECOROIIA99Ed1 FRONDED TO11K r/EU-Oa�Ef
FOR OFFICE USE OHL y:t
awns 21ORAttP1LaNIR90N 11[Yre1L
Srb�SuA�WbCMIYreaMllNOuIMROmnd'�11rMorIMIMIM70E9� �.1►EY.1:11
eMrrlR

Nerve Cwerr-aypwrww+a 1 wd Ndvd meww6s-mAdm a wow Ootly•oiweawew 3wa' '(
a7.+ M*w4e.CeNe..RdW%N. VW*-I$X*bw�.r+q + a l �"-. .� 6 7
WELL CONSTRUCTION RECORD wELL cONTRACm:
WELL CONTRACTOR CERTMOCATION#: g0 i s
STATE WELL CONSTRUCTION PERMIT#:
AAQ�, �'` PUM S VI NC.
�� gE�t
1. WELL USE AWreMNaak Rnidw"Q �4N El MIduWW❑ AQAdlkur 1 Hr1�PFM9111Es+s44
Awerefy Hoot pwop Wow kisoMw 01w M aNr.Lb!U#r Bostic NC
7.1773
2. WELL LOCATION;(Slave aubh eI#w ba0, ImMow)
meMoelTew�c • * ° / Z Z.�6
rledNewe eeel+eelwe.pwweet�weddNwewel fats Na! OR0.LMIG LOG DEPTH -
3. OWNER ,4dZ)/L r
AftM
Cyw ww stw
+. DATE DRR.LEO
S. TOTAL DEPTH
6. Tw3cot, YESQ o
7. DOES rYEtd REPLACE ElU3TM E#w6u.9 YES Q moo---
S. 8TAT1C WATER LEVEL Sorts Top e>t Certtgi�—FT.
.I++��'#Newe dCMiel
!. TOP OF CAM4 IS a� FT.Abotfo LaM S&~
-lop NMINWM a euYeee Neaw-
OeeeewaeteANe"MA1I6 METTIOD�TEST�`y ri�nit cci)
11.WATER ZONES -,---- -
tz CHLORINATION: Typo C ••���-�=-AffawdrMellenlgNrizwNQw6�dalvm
13. CASINO .ors'`�`� a mwTOOI sly
valltdlwee erwdo
Odpw C NretYt (#MewtealeawdNtw+e##empteeewoSYM
Wnwe +
Feem to .-R-�— -�-�^ - Roo "Gitw WW"' e�0o FM01•
TO 111 ilk '��`231 d.7S'lN
From Te FL
1s.GROAT:
MtAlad
Fmm E _
Dow OMmeter SI#ISti MMMM 9 or�,•:� ui��
Foam To__Ft.,._._ tw ---
Felm TO__FL_ YL _kL
From To_.-FL
1s. SANDGRAVELPAM
D#pD EW mdww
Foam Ts FL.._--- LC .5
From To FL
17. RE11AlIKPw
+ooIERE@VC& IFYTNIITlmWELLWASCONSTMXMDMACCO WAWXMIRNISA OWIC.VML
COIISTRIIMMSTMOMILANDTNATACOPYOFT11116j OORDWLiMEN#PIIOYIOEO70TIlTcrrEtJ ON`Es
FOR OFFICE USE ONLY — 0019
ow#NO lgNAluilta F6llCSCCN#nSIC1r16nIt rArt
aa�Awt�tOfrOM�Me1wMrOrMRSlwrowl.leaee^wWa70 04.1 PSI.+.r
lepNe.

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: TRYON County POLK Topographic/Land setting
HOOPER CREEK RD. ❑Ridge ❑ Slope ❑ Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER ALICE PRINCE LatitudeRongitude of well location
Address HOOPER CREEK RD.
(Street or Route No.) (degrees/minutes/seconds)
TRYON NC 28782 Latitude/longitude source: ❑GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 64)-457-3855 DEPTH
Area Code Phone number From To
4. DATE DRILLED 09/22I05
5. TOTAL DEPTH: 205 DRILLING LOG
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
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' LOCATION SKETCH
'Top of casing temwuated attor below land surface requires a Show direction and distance in miles from at least
variance in accordance with 15A NCAC 2C.0118.9. YIELD(gpm): 15 METHOD OF TEST ARD Two State Roads or County Roads. Include flue road 10.WATER ZONES(depth): number and common namesFROM SANDY PLAINS GO DOWN HWY.#14.
11.DISINFECTION:Type CHLORYTE Amount 4.5 RIGHT ON RED FOX RD.RIGHT ON HOOPER
CREEK RD.APPRO ]-M
12.CASING: Wall Thickness X ILE ON LEFT
Depth Diameter or Weight/Ft Material
From 0 To 130 Ft 6-1/4" SDIL21 PVC
From_To_Ft. Ic t 35'IZ'�Il.tos'; ,.
From_To Ft._
13.GROUT: Depth Material Method— l� �2" S' S• F3" tn>
From 0 To 20 Ft.OUHCRETE POURED C:)
From_To_Ft
14.SCREEN: Depth Diameter Slot Size Material
From_To_Ft. in in. o
From To_Ft._ in in.
15. SAND/G_RAVEL PACK:
Depth Size Material
From_To_Ft._
From_To_Ft
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
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:Stepheme Wilson Date:1/5/2006 Time:7:48:56 PM Page 5 of 6
WELL CONSTRUCTION RECORD � ) I
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: Topographic/Land setting
Nearest town: LAKELURE county POLK ❑Ridge ❑ Slope ❑ Valley ® Flat
COYOTE PASS LANE,GRASSEY KNOB RD Latitude/Longitude of well location
(Street Name,Numbers,Community,Subdivision,Lot No,Zip Code) 35.24.255/92.10.184
3.OWNER TORTUGA MANAGEMENT (degrces/minutes/seconds)
ADDRESS Latitude/longitude source:®GPS❑Topographic map
(Street or Routs No.) DEPTH DRILLING LOG
ASHEVILLE NC From To Formation Description
City n Town State Zip Code 0 35 Clay
828-658-1915 35 220 Consolidated Rock
Area Code-Phone Number
4.DATE DRILLED 12/14/05
5.TOTAL DEPTH 220
6.DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7.STATIC WATER LEVEL Below Top of Casing: 92 FT.
(Use"✓'IfAbove Top of Casing)
8. TOP OF CASING IS 2 FT.Above Land Surface"
'Top of casing knnmated aUor blow Imd swfa«rcgwrec a va�arsac m
accordanac with 15ANCAC 2C.0118
9. YIELD(gpm): 20 METHOD OF TEST ARDM
10.WATER ZONES(depth): 218
u.DISINFECTION:TYPE HYPOCHLORITE Amount 6 0. LOCATION SKETCH
12.CASING: Wall Thickness Show direction and distance in miles from at least
Depth Diameter orweight/FL Material two State Roads or County Roads.Include the road
From 0 To 45 FL 6 1/4" SDR 21 PVC numbers and common road names.
13,GROUT:
Depth Material Method C_
From 0 To 20 FL GRAVEL MIX GRAVITY 7 -
14.SCREEN 1
Depth Diameter Slot Sin Material
From NA To FL in. in. C!)
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 OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
1/1/06
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
GW-1 REV.07/2001
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days.

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
W ELL CONTRACTOR(INDIVIDUAL)NAM (print)
CERTIFICATLOr N�#te�.7l��F/L�J/
WELL CONTRACTORCOMPANY NAME E a 4J11 LLC PHONE `�a�JA�cP7/aQ
STATE WELL CONSTRUCTION PERMIT#
(if applicable) ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE(Check Applicable Box):Residential e Municipal/Public ❑ Industrial ❑ Agricultural Cl
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELLLOms: N: Topographic/Land setting
Nearest Town: Counry f o��C pRidge ❑Slope ❑Valley ❑Flat
T �✓ (check appropriate box)
[Buret NameJJN��umbers,Communrry,Subdivision,Lot No.,Zip Code) L tirude/longirude,of well location
3. OWNER: .p� mg=r = V3'{a Lt,/7Y iroJ2°/o S/rt'
�-r-t
I (degmes/min nes/seconds)
.address /JU I!) Fi7-\N�r/. Ioi.Ja.
--3 r 1a Laritude/longirudesoorce:LAPS❑Topographic map
(Streeror lZop¢No.) (check box)
��ffo111U t I lG'.._ KC- QR'79 I DEPTH
Citytown State DRILLING LOG
or(o $7- y� zip Code m`f To Formation Description
d� s
: code-Phone numbCJ &r 70 ,
4. DATE DRILLED S 'Zf Of �o- 3or
5. TOTAL DEPTH: ?oJ-- I;Ltee.21
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO E!r
7. STATIC WATER LEVEL Below Top of Casing: L a FT.
(Use'Y'if Above Top of Casing)
8. TOP OF CASING IS � FT.Above Land Surface"
'Top of casing rerminared atior below land surface requires a
variance in accordance with 15A NCAC IC.al18.
9. YIELD (,pm):1_METHOD OF TEST2�r7lr/i V9
10. WATER ZONES (depdt): l�o '
LOCATION SKETCH
11. DISINFECTION:Type Ckdnr Amount IV _ Show direction and distance in miles from at least
12. CASING: - Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weighr/Ft. Material numbers and common road names.
From To 70 Ft. ,ter' <zWe
From - To FL I �c—1
From To FL_ q L
13. GROUT: Depth Material Method I .11, I
From�_To��Ft. /YC E E `.�i>Lr�,'„ra j.{�'1��`�U-"r�' » .-
From To Ft. 7�"-
19. SCREEN: Depth Diameter Slot Size Material t -q
From To FL in. in cn
From To Ft, ilL in. C3 -
15. SAND/GRAVEL PACK: c_n � +
Depth Size Material
From To - FL
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH IBA NCAC 2C,WELL
CONSTRUCTION SSTTAANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
i
Submit the original to the Division of Water Quality,Groundwater Section, - 1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001
,

R� .R
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Waror Quality-Groundwater Section�QJ
WELL CONTRACTOR(INOIVIDUAL)NAM (print) �QiA- CERTIFICATION#31Q
WELL CONTIIACroa COMPANY NAh1E�rU / F� 4/{�a j LL PHONE ARA 0'6.MJ/c
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if appl icable) (if Epp licitble)
1. WELL USE(Check Applicable Box):Residential 03 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION: ) Topographic/Land settin
Nearest Town: -ra ❑
n"'We- County �o�� g
CaV- A&/ Ridge ❑Slope ❑Valley ❑Fla[
(check appropriate box)t5veet Name,Numbers,Community,Subdivision,Lor No.,Zip l Code) Latitude/longitude of well location
�I /✓,7r�2z.G3Y'uorz�iG.3r1'
3. OWNER: S OLt� '•I � (degmes/minute seconds)
Address wt r La[i de/longitude source: GPS❑Topographic map
(Sreel or Route No.) —� (check box)
rdere SNut��r K C a-Sn9 DEPTH DRILLING LOG
Cry or Town State Zip Code From To FgZmation Description
�f
A code-Phone number 47-SZ .w�Sf��tC
4. DATE DRILLED .7-J -D r S l- tiryf
5. TOTAL DEPTH: r5h-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO hJ
7. STATIC WATER LEVEL Below Top of Casing: %DI FT
(Use"+"if Above Top of Caving)
8. TOP OF CASING IS FT.Above Land Surface"
•Top of casing rerminated at(or below land surface requires a
variance in accordance wirh 15A NCAC IC.0118.
9. YIELD(,pm): Z- IvIIJHOD OF TEST�yQt -&g
10.WATER ZONES(depth): f- l
LOCATION SKETCH
It. DISINFECTION:Type �'/o r oQ, Amount ZG fKSr Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material .numbers and common road names.
From To rL Ft. ,ic
From To Ft. Sr I6- r � J e—
From To—Ft. �oNUIIfp_ C
13. GROUT: Depth Material - Method I 'T
From- ,Q_To2_Ft. tyc E
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To FL—in. in. t� "
From To Ft. in. in.
15. SAND/GRAVEL PACK: .�
Depth P Size Material �
From To - Ft.
From To F[. O
16. REMARKS: -..
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STAAN/DARDS,.SND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUC_TING.THE WELL DATE
Submit the original to the Division of Water Quality;Groundwater Section, Y636 Mail,Service Center-Raleigh,NC
27699-1636 Phone No.[phone], within 30 days. - ( GW-1 REV.07/2001
i .

dasweo ��� A
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
Q°Wes• WELL CONTRACTOR CERTIFICATION# 2138
1.WELL CONTRACTOR: - f. DISINFECTION:Type Chlorine Amount I )�j C 0
James W. Camp g. WATER ZONES depth):
Well Contractor(Individual)Name Fran To, From To
Camp is Well & Pump Co- Tnn_ Fran To From To
Well Contractor Company Name Fran To Fran - To
STREET ADDRESS P 0 BOX 429 6. CASING: Thickmal
Dept�,,--,� Dlaitleter Weld Material
Ellenboro NC 28040 Fran 0 To�Ft. 6a SD2�21 PVC
City or Town State Zp ode From To FL _
( 828). 453-7322 Fro„ Tc FL
Area code- Phone numbs
7. GROUT: Depth Material Method
2.WELL INFORMATION: YY,/ Fran 0 To20 FL Sackrete Hand
SITE WELL ID#(If apptbable) &!K f n - [��i D'J`�i From To Ft.
STATE WELL PERMIT#0l applicable) Fran . To FL
DWQor OTHER PERMIT#(Ifapplicable) / 9. SCREEN: Depth Diameter Slot Size Material
WELL USE Check Applicable Box): Residential Water Supply la Fro T F n. _In._
( From To Ft.T_In. —In.
DATE DRILLED AD, (ti n fT From To Ft._In. —In.
TIME COMPLETED U AM PM U'Y 9. SANDIGRAVEL PACK:
3.WELL LOCATION: p Depth Size Materiel
COUNTY 1 C>- Fran To Ft.
CITY: From To Ft.
_ Fmm To FL
c„r.abdIlla,
(Street Name.NanbeP,Commurdly , d_No..Parcel,Zip Code) _ . . .. .
TOPOGRAPHIC I LAND SETTING: 10.DRILLING LOG
k6lipe pVWW OFlat ❑Ridge ❑Otlmr From T4Q, c-Fonn nDescription
(Check approp h"bofp . 0. 0 '
Maybe in degrees, .
LATITUDE 3s.. minutes,seconds or
,M'1 ,�!1 Q 1 l 9 in a dximal fomrt k S
LONGITUDE l��sl-J�.J_�.r61.J'1
Latitude/longitude source: ❑GPS pTopogaphic map
(bcatbn of wa/must be shown on a USGS topo map and
attached to this form I not using GPS)
4.WELLOWNER ER' NAME t-� I6
STREETDRESS U 9ox 1,15
I I, Y nq N C- X Jr O
City or Town 19-late Zip Code
Area code• Phone number
11. REMARKS:
S.WELL DETAILS: 11
A. TOTAL DEPTH:AQ
b. DOES WELL REPLACE EXISTING WELL? YES p NO
I DO HEREBY CERTIFYTMTTHIS WELL WAS CONSTRUCTED INACCDRDANCE WrrH
c. WATER LEVEL Below TopdCasing: _FT, 15A WM 2C,WELL CONSTRUCTION STANOMDS.AND THATACOPY OF THIS
(Use'+'BAbove Top of Casing) RECORD HAS BEEN PROVIDED TO THE WELL OWNER
d. TO an
.P OF CASING IS 1 FT.Above ld Surface' 2\ii M a i ' ,() bkm'D .
?op of casing terminated at/or below land surface may require SI RE OF CERTIFIED WFI I CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. .
e. YIELD(gpm): METHOD OF TEST�A7� James W. Camp
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30.days. Attn:Information Mgt., Farm GW-la
1617 Mail Service Center—Raleigh,NC 276994617 Phone No.(919).733-7015 ext 568. Rev.7105

J�yTABu n
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
•�'""�� WELL CONTRACTOR CERTIFICATION# 2138
1.WELL CONTRACTOR: f. DISINFECTION:Type chlorine Amount .,I ia
James W. Camp g. WATER ZONES( th):
Well Contractor(Individual)Name From To From To
Camp' s Well & Pump Co-o. Tn _ From To From To
Well Contractor Company Name Fran To From To
STREETADDRESS P O BOX 429 - S. CASING: Thickness/
Depth Diameter W ' M Material
Ellenboro NC 28010 Fran 0 r _&L _Ft. 6, SD�21 PVC
City or Town - State Zip Coda Fran To Ft
( 828). 453-7322 Frw To Ft _
Area code- Phone number
7. GROUT: Depth Material Method
2.WELL INFORMATION: From 0 To 20 FL Sackrete Hand
SITE WELL ID#(If applicable) Fran To Ft
STATE WELL PERMIT#(aapplicable) Fran To Ft
DWQ or OTHER PERMIT#(if applicable) 8. SCREEN: Depth Diameter Slot Size Material
} From Tc Ft In. _in..
WELL USE(Check Applicable Box): Residential Water Supply g Fran Tc Ft.Tin. —In.
DATE DRILLED 10 . 1 6• 0 S From To Ft_la ^in.
TIME COMPLETED V O U AM O PM%a,' B. SANDIGRAVEL PACK:
3.WELL LOCA ION: Depth Sim Material
F� To Ft.
CITY. �pC�OUNTY �tt Fran To FL
41N1A >Q11Pn RltnV� From To FL
(Street Name,Numbers, murky.Subdivision,Lot No.,Parcel;Lp Code)
TOPOGRAPHIC I LAND SETTING: ill.DRILLING LOG
[]Slope EfMay ❑Flat ❑Ridge ❑other From T1o. Form D�y�nptbIt
(check appropriate box) . 0 ' i]D S1�,a•Ct8taLgC
May be in degree,
LATITUDE _1640A6% minute;seconds or
LONGITUDE , �.(73 3 Id I in a decimal fomlet
IatitudcAongitude source: ❑GPS OTopographic map
(location of well must be shown on a USGS topo map and
attached to this form Inot us679 GPS)
4.WELL OWNER OWNER'S NAME yI.t.f. awopc.
STREET ADDRESS D BOX 4-I aS
4ArA_&6�fg 5C- ��1 os o
City or Town State Zip Cade
Area Code. Phone number 11, REMARKS:
5.WELL DETAILS: 1
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES Nkp
^ 100 HEREBY CERTIFYTIATTHIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
e. WATER LEVEL Below Top of Casing: d0 FT, 15A HCAC2C,WELL CONSTRUCTION STANDARDS,ANDTHATACOPY OF THIS•
(UBB'+'ff Above Top d Casing) - RECORD HAS BEEN PROVIDEDTOTHE WELL OWNER
d. TOP OF CASING IS 1 . FT.Above Land Surface' ') ) Q 0 Il b
'Top of casing terminated allor below land surface may require � TURE OF CERTIFIED �ELCCONTRACTOR DATE
a variance in accordance With 15A NCAC 2C.0118.
METHODOFTEST G1AJ� James W. Camp
e. YIELD(gpm): PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within,30,days. Attn:Information Mgt., -Form GW-ta
1617 Mail Service Center-Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Rev.7I05

RESIDENTIAL WELL CONSTRUCTION RECORD
•- North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 21 38
1.WELL CONTRACTOR: I. DISINFECTION:Type chlorine Amount I C up
James W. Camp g. WATER ZONES(depth):
Well Contractor(Individual)Name From To 300 - From To
Camp' s Well & Pump Co- Tnc_ From To From To
Well Contractor Company Name From To From - To
STREET ADDRESS P O BOX 429 S. CASING: Thickness)
Depth Diameter Wei ht Material
Ellenboro NC 28040 Fran 0 Tc qi Ft. 6a SD921 PVC
City or Torun State Zip Code From To Ft _
( 828)_ 453-7322 Fran Tc FL _
Area code- Phone number
7. GROUT: Depth Material Method
2.WELL INFORMATION: {�//�/�� II// nn From 0 To 20 FL Sackrete Hand
SITE WELL ID"fapptiable) AIR& • LDS 1`i 7( Fran To FL
STATE WELL PERMIT#(1 applicable) From To Ft.
DWQ or OTHER PERMIT#(d applicable) _ S. SCREEN: Depth Diameter Slot Size -Material
WELL USE(Check Applicable Box): REsidential Water Supply@^ From To Ft_in. In.
( ec From To Ft._in. _in.
DATE DRILLED tI 11. I S From To Ft.—in. _in.
TIME COMPLETED 3 OL) AMD PM2— S. SANDIGRAVEL PACK:
3.WELL L C ION: Depth Size Material
From - To Ft.
CITY: l` COUNTY 1 F� To Ft.
r.,l�nn `�AA ^ \ .rI".). L�3� Fran To Ft.
(Street Name.Numbara,community. I ,Lot No.,Parcel,ZIP Code)
TOPOGRAPHIC I LAND SETTING: 10.DRILLING LOG
❑Slope pValey M t ®Ridge ❑Other From To. Fornlatiot).j)escdptpn
(check appropriate b" A1ay in Al AA
LATITUDE hSyJ VKAIOi Nk mirwtes,xcads or
LONGITUDE��� 2 33`'i W inadeamal format I _ ,) A—!t AA•
Latitude/longitude source: ❑GPS oTopographic map
(location of wet must be shown on a USGS topo map and
attached to this thrm r not using GPS)
4.WELL OWNER -
OWNER'S NAME `--
STREET AD RESS S e.'�1 N -
�,
City or Town State Zip Code 01
Area code- Phone number
il. REMARKS:
5.WELL DETAILS: n
a. TOTAL DEPTH. of
b. DOES WELL REPLACE EXISTING WELL? YES p NO
r I DD HEREBY CERTIFY THAT THIS WELL WAS CONSIRUCIED IN ACCORDANCE WON
c. WATER LEVEL Below Top of Casing: -- FT. 15A HCAC 2C.WELL CONSTRUCTION STANDARDS.AHDTHATA COPY OF THIS
(Use•+•d Above Top of Casing) - RECORD HAS BEEN PROAgDFDTOTHE WELL OWNER
1 A d. TOP OF CASING IS FT.Above Land Surface' F
•Try of casing terminated allor below land surface may require SIG URE OF CERTIFIED WELLCONTRA TOR DATE
a valiance in accordance With 15A NCAC 2C.01 18.
e. YIELD(gpm): Is METHOD OF TEST CLM James W. Camp
•PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within,30 days. Attn:Information Mgt., Form GW-1a
1617 Mail Service Center-Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Rev.7105

I *
.,jam ,,.SurEo
"' +✓mow �, e_ A r, .. ,
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2138
1.WELL CONTRACTOR: t. DISINFECTION:Type chlorine Amount 11/;Z 6 VL
James W. Camp g. WATER ZONES(depth):
Well Contractor.(Indivldual)Name From To From To
Camp' s Well & Pump Co. Tnc_ From To From To
W ell Contractor Company Name From To From To
STREET ADDRESS P 0 BOX 429 S. CASING: Thkkrrassl
Depth Di at We hl Material
Ellenboro NC 28040 From 0 To _Ft. 6 SDr21 PVC
City or Town State Zip Code From To Ft. _
( 828} 453-7322 Fran To FL
Area code- Phone number
7. GROUT: Depth Material Method
2.WELL INFORMATION: From 0 Tc 20 Ft Sackrete Hand
SITE WELL ID#(if applicable) Fran To Ft
STATE WELL PERMIT#(e applicable) From . To Ft
DWQ or OTHER PERMIT#(8 applicable) 8. SCREEN: Depth Diameter - Slot Size .Material
Fran To Ft_ln. _In.
WELL USE(Check Applicable Box): Residential Water Supply Flom To Ft.T_in. in.
DATE DRILLED I • 1Q . 0 5 Fran To Ft_hL _In.
TIME COMPLETED 21. 0 AM❑ PM of
9. SANDIGRAVEL PACK:
3.WELL L�ONC,ATt N: Depth Size Material
CITY: 1Y1 COUNTY_2A_ From Depth
Ft.
p From To Ft.
jZp n \�AAM Fran Tq FL
(Street Name,Numbers.Community-�Nal La No.,Parcel,Zip Code) _
TOPOGRAPHIC I LAND SETTING: 10.DRILLING LOG
❑Slope &Patey ❑Flat ❑Ridge ❑other From To
F3nnetbn DesfC��rptbn
(check appropdata box) May be in degrees, ' 0 .
. I In Jt. ,�v..V
LATITUDE _Jaj�\-I IN t� minute,secaulsor
LONGITUDEQU- (A aq,% in a decimal format
Latitude/longitude source: bGPS ❑Topographic map -
(bcatbn of are/must be shown on a USGS fopo map and ---
attached to this form I not usng GPS)
4.WELL OWNER �>
OWNER'S NAME
STREET ADDRESS 7
T eac_h — 9,
City or Town state Zip Code
Area code- Phone number
11. REMARKS:
5.WELL DETAILS:
a. TOTAL DEPTH: 1 \j S
b. DOES WELL REPLACE EXISTING WELL? YES p NO[�
I DO HEREBY CERTFYTHATTHIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
c. WATER LEVEL Below Top of Casing: k _FT, 15A NCAC 2C.WELL CONSTRUCTION STANDARDS.ANDnwTA COPY OFTWs-
(Use"*'If Above Top ofCasing) RECORD HAS BEEN PROVIDED TO THE WELL OWNER
d. TOP OF CASING IS 1 FT.Above Land Surface- LL �_�,
Top of casing terminated allor below land surface may require SIGN R -F CERTIFIED WELL CONTRACTOR DATE
a variance In accordance with 15A NCAC 2C.0118.
METHODOFTEST Q.Ai. James W. Camp
e. YIELD(gpm):� PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn:Information Mgt., Form GW-1a
161T Mail Service Center—Raleigh,NC 27699-1617 Phone No.(919)733-TO15 ext 568. . i Rev.7/05

n 5
L<ESIDENTUL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION fi 213 8
1.WELL CONTRACTOR: f. DISINFECTION:Type chlorine Amount
James W Camp . WATER ZONES(depth): T i
III
Well Conlractor.(Individual)Name Frorn —& To From To
Camp' s Well & PttmD. Co Tnc- From To From To
Well Contractor Company Name From Tc From - To
STREET ADDRESS P 0 BOX 429 6. CASING; Thkimessl
Depth Diameter Weiam Material
Ellenboro NC 28040 From 0 To Ft. 6a SDR21 PVC
City or Town State Zip Code Fran To FL
( 828). 453-7322 From To FL
Area code• Phone number 7. GROUT: Depth Materiel Method
2.WELL INFORMATION: i�/ Ran 0 To 20 Ft Sackrete -Hand
§RE WELL IDM0rapplkable)JP//� Cu• r7 a Fran To Ft
STATE WELL PERMITM(Itapplkable) Fran To FL
DWQ or OTHER PERMIT rrpf applicants) 8. SCREEN: Depth Diameter Slot Size .Material
.✓ From To Ft._in. _In._
WELL USE(Check Altppecable Bo)): Residential Water Supply IV Fmm To Ft.^in. —In.
DATE DRILLED t l ^ I. 0 S Fran To FL_In. _In.
TIME COMPLETED 2 3 Q AM❑ PM IZ 8, SANDIGRAVEL PACK:
ON: Depth Size Material
3.WELL LOCAT
From To FL
kjZ
CITY; fC�O�UNTY Fratt To Ft.
GlT Vl C rriV (t D b IctY FMM__To Ft_^^_
IStreetISUeaI Nams. umbers munily,Subdivision.Lot No.,Parcel,7Jp Code) _ . . ..
TOPOGRAPHIC I LAND SETTING: 10.DRILLING LOG
OS" Valley OFlat ❑Ridge ❑Other From To. Formation esaiptbtln
(shack appropdatabox) . 0 ' `� `1 C I A A
p C ,,� May be in degrees,
E .
LATITUD �s1t�L, minutes.seconds
,,,.•� ,� in a decimal famat
LONGRUOE,��. �•.hJ-LJ`r -
LatitudeAongitude source: ❑GPS OTopographic map
(bca5on of wet must be sMwn on a USGS topo map and
attached to this lam I not UskV GPS)
4.WELL OWNER I nL
OWNER'S NAME m �J
C n EET ADDRESS /T g^� •�2 - - '"�+
City a Townes StatO Zip Code Q
Area code- Phone number 11. REMARKS:
5.WELL DETAILS:
a. TOTAL DEPTH: S
In. DOES WELL REPLACE EXISTING WELL? YES p NO
' 100 HEREBY CERTIFY THAT THIS WELL WAS OONSTRUC7ED IN ACCORDANCE Wml
e. WATER LEVEL Below Top of Casing: y. FTC ISANCAC=WEUCONSTRUd'nDNSTIWDARDs.ANDTmrACOPYOFTMS
(Use'4'If Abom Top of Casing) RECORD NAS BEEN PROvIDEDTOTHE WELL OWNER
d. TOP OF CASING IS 1 . FT.Above Land Surface• 4SIGRE )/1 ,y� (�fj`(y�p _ I.j1�Q'Top of easing laminated eUor below lend surface mtry roquiro OF CERTIFIED W—ELL C NTRACTOR DATE
a valance In accordance wfth 15A NCAC 2C.0118, .
Ca OF TEST �r A James W. Came
e. YIELD(gpm): PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within,30.days. Attn:Information Mgt., Form GW1a
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.(919).733-7015 ext 568. Rev.7105

N.um.a 'pTAS vv - �2t A r� e
.. RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION#
1.WELL CONTRACTOR: f. DISINFECTION:Type jl o 'I n e Amount
=J Gl Yyl e S �� (,!A f'Vl/� g. WATER ZONES(depth):
Well Co tractor EMS (/�� //I _ From 2"I. To ,"j6- From To
l-K�'I�S �e I I I IAynQ ( D TC. Fran To From To
Well Contractorl Company Name 1�, ') I From To From To
STREET ADDRESS 1 if) ✓OX CJ 6. CASING: Thickness/
�7
Depth la er Wei ht M to ial
C AFo4o From To��FI. � f
City or Town /State Zip Code From To Ft.
8 /. �,j - ( 9j.`-,� `�J Fran To Ft.
Area code- Phone number
2.WELL INFORMATION: 7. GROAT: Depth
h�T Material Method
From To oCO FL S0.G Ye t.y.o p(rl_8
SITE WELL ID#(if applicable) From To Ft.
STATE WELL PERMIT#(B applicable) From To Ft.
DWQ or OTHER PERMIT#(if applicable) 8. SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply(� From To Ft._in. _ in.
From To Ft._in. _ in.
DATE DRILLED /p -20'b f: From Tc FL-in. _ in.
TIME COMPLETED AM❑ PM to/
9. SANDIGRAVEL PACK:
3.WELL LO/C'IATION: rr' Depth Size Material
CITY: l _I]ILAw(fJ NS COUNTY ) From To Ft.
Sl� I/ t� Fran To_Ft.
i D hey 60c'h r e K;e If R . Fran TD Ft.
(Street Name,Nudlbers.Cammutiity,Subdivision,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC I LAND SETTING: 10.DRILLING LOG
❑Slope ❑Valley Vl'ilat [)Ridge ❑Other From To
Formation Description
(check appropriate box)
LATITUDE 3 1 mi to inde
O�n 3 N minutes,seconds r U '�D �Q K
LONGITUDEf?D' C. 94 ti/ ina decimal fomut
` D — oYi5o I e f'oc
Latitude/longitude source: I>tOPS ❑Topographic map
(location of welf must be shown on a USGS topo map and
attached to this form#not using GPS) I "`
"4
4.WELL OWNER C7(/J�OWNER'S NAME
STRET ADDRESS Io S WLI Q M fy v
i 11 Snyin4 L �d75-b `:
City or Town State Zip Code
Y
Area code- Phone number
11. REMARKS:
5.WELL DETAILS:
a. TOTAL DEPTH: OS i
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO Cl
c. WATER LEVEL Below To of Casing: ��11 I DO HEREBY CERTIFY THAT THIB WELL WAS CONSTRUCTED N ACCORDANCE WMH
P 9 8 FT. 15A NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THATA COPY OF THIS
(Use"+-d Above Top of Casing) RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS FT.Above Land Surface* (�(
'Top of casing terminated auor below land surface may require SI URE OF CERTIFI W ELL CONTRACTOR ! DATE.
a variance in accordance with 15A NCAC 2C.0118. /-••hA
e. YIELD(gpm): d METHOD OF TEST�1✓✓ ��)PPS .1 \ NA�
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form GW-1a
16117 Mail Service Center-Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Rev.7/05

From:bcon uann i o:atepneme Wilson Date:1IIMU06 Time: 10:19:10 PM sa Page 10 of 13
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: Topographic/Land setting
Nearest to.: MILL SPRING County POLK ❑Ridge ❑ Slope ❑ Valley ® Flat
2641 ABRAMS MOORE RD Latitude/Longitude of well location
(Street Name,Numbers,Community,Subdivision,Lot No,.Zip Code) 35.18,608/82,03.506
3.OWNER HORTON HOME OF RUTHERFORDTON (degrees/minmes)seconds)
ADDRESS 342 HWY 74 BYPASS LatitudeAongitude source.®GPS❑Topographic map
(shed or Rom.No.) DEPTH DRILLING LOG
RUTHERFORDTON NC 28139 From To Formation Description
City or Town State Zip Code 0 8 Clay
828-287-3366 8 155 Consolidated Rock
Area Code-Phone Number
4.DATE DRILLED 9/30/05
5.TOTALDEPTH 155
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 2 FT.Above Land Surface-
'Top orcasirg tarninated at/or below Imd swfaee r,uuc,a vvrimce in
.c,. ae with 15A NCAC 2C.0118
9. YIELD(Rpm): 15 ME/TIOD OF TEST ARDM
to.WATER ZONES(dWdi): 123 142
D.DISINFECTION:TYPE HYPOCHLORITE Amount 5 0. LOCATION SKETCH
12.CASING: Wall Thickness Show direction and distance ili miles from at least
Depth Diameter or weight/FL Material two State Roads or County Roads.Include the road - y
From 0 To 27 Ft 6 1/4" SDR 21 PVC numbers and common road names.
13.GROUT: ....
Depth Material Method CD
From 0 To 20 Ft. GRAVEL MIX GRAVITY i
14.SCREEN
Depth Diameter Slot Sim Material C:)
Ln
From NA To FL in in. -
15.SAND/GRAVEL PACK: ..,
Depth Size Material
From NA To FL
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.
1011105
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
GW-1 REV.07/2001
Submit 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.Scott Gantt To:Stephanie Wilson Date:9121 12 0 0 5 rime:4.21:22 PM Page 1 of 1
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❑ Agriculumil ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2.WELL LOCATION: Topographic/Land setting
Nearest town: MILL SPRING County POLK ❑Ridge ❑ Slope ❑ Valley ® Flat
15 DAY LILLY LANE Latitude/Longitude of well location
(Street Name,Numbers,Community,Subdivision,LotNo,.Zip Code) 35,15,070/82.07,817
3.OWNER HORTON HOME OF RUTHERFORDTON (degrces n ira tes/seconds)
ADDRESS 342 HW Y 74 BYPASS Latitude(longitude source:®GPS❑Topographic map
(st,ctor Rout,No.) DEPTH DRILLING LOG
RUTHERFORDTON NC 28139 From To Formation Description
City or Tewn State Zip Code 0 40 Clay
828-287-3366 40 210 Consolidated Rock
Area Code-Phone Number
a DATE DRILLED 8/12/05
s.TOTAL DEPTH 210
6.DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7,STATIC WATER LEVEL Below Top of Casing: 70 FT.
(nsc't IfAbuvc Top of Cash
8. TOP OF CASING IS 2 FT.Above Land Surface-
-I,ofcaiug U.km,d W.,blow land surfs«requires a vrriaac m
accordion with 15A NCAC 2C.0118
9. YIELD(gpm): 30 METHOD OF TEST ARDM
la.WATER ZONES(depth): 210
lr.DISINFECTION:TYPE HYPOCHLORITE Amount 7 0: 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 47 Ft. 6 I/4" SDR 21 PVC numbers and common road names.
13.GROUT:
Depth Material Method 1=*
From 0 To 20 Ft GRAVEL MIX GRAVITY ---_-- M
14.SCREEN
11.11, N
Depth Dianeter Slot Sim Material .,.�'1 c '- --� t C3 From
NA To FL in. in, _ I CD
Is.SAND/GRAVEL PACK 'P�.i , Irj 2005 �Ilr
Ln
Depth Size Material _
From NA To Ft,
ts.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,
9/1/05
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
GW-1 REV.07/2001
Submit 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:Scott Gant[ I o:blepheme Wilson Date:7/a/2005 Time:5:19:36 PM ^ Page 4 of 5
WELL CONSTRUCTION RECORD f r
North Carolina-Department of Environment,and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) SCOTT GANTT CERTIFICATION#2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS,INC.PHONE#[phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1.WELL USE(Check Applicable Box): Residential ® Municipal ❑ Industrial❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2.WELL LOCATION: Topographic/Land setting
Nearest town: MILL SPRING county POLK ❑Ridge ❑ Slope ❑ Valley ® Flat
1525 PEA RIDGE RD Latitude/Longitude of well location
(Street Name,Numbers,Community,Subdivision,Lot No,.Zip Code) 35,17,629/92.04,914
3.OWNER PAT SIUDA (degrees/minutes/smonds)
ADDRESS 1525 PEA RIDGE RD Latitude/longitude source:®GPS❑Topographic map
(Stredor Rout.No.) DEPTH DRILLING LOG
MILL SPRING NC From To Formation Description
City or Town State Zip Code 0 85 Clay
828-628-3215 85 400 Consolidated Rock
Area Code-Phone Number
4.DATE DRILLED 6/17/05
5.TOTAL DEPTH 400
6.DOES WELL REPLACE EXISTING WELL? YES NO
7,STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use-.-If Above Top ofCwirW
S. TOP OF CASING IS 2 FT.Above Land Surface-
'Top of casing tcrmirded at/or bdow lmd nrface requires a vaimee in
accordance with 15A NCAC 2C.0118
9. YIELD(Rpm): 5 METHOD OF TEST ARDM
10.WATER ZONES(depth): 380
it.DISINFECTION:TYPE HYPOCHLORITE Amount 16 or 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 '3
From o To 94 Ft. 6 1/4" SDR 21 PVC numbers and common road names.
1a.GROUT:
Depth Material Method
From 0 To 20 FL GRAVEL MIX GRAVITY G,�l .�J�7 r-' n
14.SCREEN
Depth Diameter Slot Size Material O
From NA To FL in. in. J (J7 ,
15.SAND/GRAVEL PACK "9
Depth Size Material
From NA To FL
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.
7/1/05
SIGNATURE OF PERSON CONSTRUCTING THE WELL Dale
GW-1 REV.07/2001
Submit the original to the Division of Water Quality,Groundwater Section, 16 $aleighi NC
27699-1636 Phone No.[phone],within 30 days.
I}i.
i
A AU('
I

From:Scott Gantt To:Stephanie Wilson Date:7/a/2005 Time:5:19:36 PM Page 5 of 5
V
WELL CONSTRUCTION RECORD s'
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: Topographic/Land setting
Nearest town: MILL SPRING County POLK ❑Ridge ❑ Slope ❑ Valley ® Flat
LOT 7 HORSE PATH LANE, PEA RIDGE RD Latitude/Longitude of well location
(StratName.Numbers,Commnuty,Subdivision,Lot No,Zip Code) 35,18.761/82,02,216
a.OWNER HORTON HOME OF RUTHERFORDTON (degrees numnes/seconds)
ADDRESS 342 HWY 74 BYPASS Latitude/longitude source:®GPS❑Topographic map
(St.d or Roatc No) DEPTH DRILLING LOG
RUTHERFORDTON NC 28139 From To Formation Description
City or Town State Zip Code 0 65 Clay
828-287-3366 65 400 Consolidated Rock
Area Code-Phone Number
4.DATE DRILLED 6/20/05
5.TOTAL DEPTH 400
6.DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7.STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use'+^IfAbovc Top of Curing)
S. TOP OF CASING IS 2 FT.Above Land Surface'
'Top of easing hrmir and eVor below 6d uwfaee nquves a vmun«in
accordance with 15A NCAC 2C.0118
9. YIHI.D(gam): 5 METHOD OF TEST ARDM
10.WATER ZONES(depth): 380
It.DISINFECHON:TYPE HYPOCHLORITE Amount 17 0= LOCATION SKETCH
12.CASING: Wall Thickness Show direction and distance in miles from at least
Depth Diameter or Weight/Ft. Material two State Roads or County Roads.Include the road
From 0 To 72 FL 6 1/4" SDR 21 PVC numbers and common road names.
13.GROUT:
Depth Material Method
From 0 To 20 Ft GRAVEL MIX GRAVITY `�I
14.SCREEN
Depth Diameter Slot Size Material
From NA To FL in. in. '// ---
N
15 SAND/GRAVEL PACK: q j mow+
Depth Size Material
From NA 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.
7/1/05
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
GW-I REV.07/2001
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. -- —;"-" -- -- - — -
r.
I

rrom:ocoa Dana i o:arepneme wnson uare:wwmuue lime:4:w:le rwi rage/oT t
co
3112 � �
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: Topographic/Land setting
Nearest town: MILL SPRING County POLK ❑Ridge ❑ Slope ❑ Valley ® Flat
662 ADEN GREENE RD, MILL SPRING,NC Latitude/Longitude of well location
(Street Name,Numbers,Community,Subdivision,Lot No,Zip Code) 35.22.345/82.09.582
a.OWNER RANDY SEIGFRIED (degrees/minutes/seconds)
ADDRESS 37 PANTHER LANE Latitudelongitude source.®GPS❑Topographic map
(so-cet or Raw.No.) DEPTH DRILLING LOG
MILL SPRING NC 28756 From To Formation Description
City or Town State Zip Code 0 25 Clay
828-625-9316 25 230 Consolidated Rock
Area Code-Phone Number
4.DATE DRILLED 4/20/05
5.TOTAL DEPTH 230
6.DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7.STATIC WATER LEVEL Below Top of Casing: 60 FT.
Y
(Ure"i"I1Above Top of Cuing) _
S. TOP OF CASING i8 2 FT.Above Land Surface•
•Top of carag tnmbuted W.,bd w Ind ewfacc rcquves a vanavae to
accordance with 15A NCAC 2C.0118 e.
9. YIELD(gpm): 12 METHOD OF TEST ARDM
10.WATER ZONES(depth): 225
n.DISINFECTION:TYPE HYPOCHLORITE Amount 9 ox 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 o To 34 Ft 6 1/4" SDR 21 PVC numbers and common road names. _
--
19.GROAT:
Depth Material Method J'.
From 0 To 20 Ft GRAVEL MIX GRAVITY
14.SCREEN
i
Depth Diameter Slot Sin Material ' --
From NA To Ft. in. is
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 OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
� ® 511105
SIGNATURE OF PERSON CONSTRUCTING THE WELL Dale
GW-I REV.07/2001
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days.

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment andaturpal Res u es- tvlsion of Water Quality-Groundwater Sects
WELL CONTRACTOR(INDIVIDUAL)NAME (pri (� A�/,E,X(��t CERTIFICATION -
WELL CONTRACTOR COMPANY NAME N ) fV I�`'t PHONE '
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ P
ifapplicable) if livable
1. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ if Other,List Use
2. WELL LOCA O Topo d setting
Nearest Town ur 1 CountyT Midge 19�Malley ❑Flat
(cheek appropriate box)
(Street Name,Nombem Cootunmity,Subdi i o%IM No,Zip Code) Il O III 1
3. OWNER: dilqmJ Utl.• (degaeVmimmeslsaotuis) W. oZ6d1g
Address Latitude/longitude source:❑GPS❑Topographic map
(Street or Rome No.) (cbwF bm)
DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
L�-
Am coda-Phone momb y ,3(x
U 4. DATE DRILLED
•/
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing:--C)--FT.
r. i (Use"+"if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface-
'Top of easing terminated at/or below land surface requires a
variance in accord agcq with 15A NCAC 2C.0118.
9. YIELD(gpm): V METHOD OF TEsiC�scZ L a_
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type Amount-1 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
D Ft Diameter or Weight/Ft Material numbers and common road names.
From =—
From_To Ft
From To Ft
13. GROUT: DcP Method
From To J Ft C
From To=FL t U. `i
14. SCREEN: Depth Diameter Slot Size Material
f!)
From To FL in. in. r1l
From To FL 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
CONSTR CTION STAND ,AND THAT A COPY OF THIS RECORD HAS BEEN PROVID19TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL '1cf,AITE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
2 76 9 9-1 63 6 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)�t-1-Qft tflft1��-`�y � -b CERTIFICATION#�
WELL CONTRACTOR COMPANY NAME GCern tl t t_pS W -�PR+t1i Sn -PHONE # ($e -1 aCP
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED wQ PERMIT# (_/P196-120`J
(if applicable) -/ (if applicable)
I. WELL USE(Check Applicable Box): Residential Q MunicipaVPublic❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: �U�K Topographic/Land setting
Nearest Town: I{/1'1141r�County /U� ❑Ridge ❑Slope (alley ❑Flat
(check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
05° tea' aaN o&2° ii aPw
3. OWNER: `i,Vf0A,1 J✓5 fJ�l (degms/minules/seconds)
Address FC (Iry 4Cy S-!6f Latitude longitude source:66PS❑Topographic map
(Street or Route Ne.) _ (cheek box)
�m S 1 I n ti L 7 5 DEPTH DRILLING LOG
o 'LCiry�m iro1.w, `1 scam Ziq code From To Fo non seription
ra
Area code-Phone number ti - <5/✓-Ir o' .1Z
4. DATE DRILLED - ,mac
5. TOTAL DEPTH: R N h iIt ti e)
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO 14"
7. STATIC WATER LEVEL Below Top of Casing: O' FT.
(Use","if Above Top of Casing)
8. TOP OF CASING IS It (Use
Above Land Surface• "
*Top of easing terminated attar below land surface requires a
rn
variance in accordance with 15A NCAC 2C.011& EO
9. YIELD(gpm): q_METHOD OF TEST i 2
10.WATER ZONES(depth):__,3_� S
c rCH
ft
] I. DISINFECTION:Type Amount �-( > miles fib at l
12. CASING: Wall Thickness ds.Include the d
Depth Diaryeter or Weight/Ft. Matc (y- les.
From l To AO Ft. 2/• C _Pv
From_
i05 Ft. 6_tz 1F19 s�
Fromi To 1 q6- FL 5�% I ey -$&r
13. GROUT: Depth Matenal Meth(
From To 2 V Ft. S JZOtP7 AVA 41_m'y? )C:w \ ��
From To Ft.
14, SCREEN: Depth Diameter Slot Size Material ly
m
From To Ft. in. in.
From To Ft. in. in. Y`
15. SAND/GRAVEL PACK: t)Q�
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS: -----
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STAND p/Ryp/�� AND THAT A COP 7JF THIS_ ORD HAS BEEN PROVIDED TO THE WELL OWtl$R -
SIG ATURE OF PERSON CONSTRUCTING THE WELL DATE -'
1w G-i
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Rakei%btC Qp _
27699-1636 Phone No.[phone],within 30 days. GW-I REV.,( /§001 =

309561
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Secti/o�n�''('�
WELL CONTRACTOR(INDIVIDUAL)NAME (print) Bfl I rNA.- t_7tYtstr\ ��� //////��ssss CERTIFICATIONNO) I
WELL CONTRACTOR COMPANY NAME 6- en�a Yr- Q"/ fFto�] PHONE N Baxl ldi3'Ia CD
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W11 Q PERMTTN
(ifapplicable) (ifapplicable)
1. WELL USE(Check Applicable Box):Residential C9'�Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Neraar�oest,�yTown: .5 J County PO/k p16dge ❑Slope ❑Valley ❑Flat
-11iiL.91r(16IQ 5;110dA NC 2 2�r 73 (check appropriate box)
(Sued Namq Numbers,Community,Subdinsion,Lot No.,Zip Code) Latitude longitude of well location
1 37 °?s oyAl 02rt°iS'N9iv
3. OWNER: R,an>d 1 I �o� �ON l (degrees/minuus/sermnds)
AddressAd Latitude/longitude source:BGPS❑Topographic map
(Sneet_a5 Route No. (check box)
�jyT 11fG j�.2�J',I DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
( 674 -.29, — - /o Rud Drat
Area code-Phone munber 1 - �Y'7
4. DATE DRILLED I --.Z '0�� r�,i- - D
5. TOTAL DEPTH: 7,171 _ 70y' I_
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO Q"
7. STATIC WATER LEVEL Below Top of Casing: /720' FT. f�
(Use","if Above Top of Casing)
8. TOP OF CASING IS ! FT.Above Land Surface•
'Top or naing terminated at/or below land surface requires a
variance in aecordao7 with 15A NCAC 2C.011& ('}
9. YIELD(gpm): /z METHOD OF TEST Al)?, �t -
10.WATER ZONES(depth): ,1 S'S 2 cn
LOCATION SKETCH t�
11. DISINFECTION:Type Amotmt Show direction and distance in miles from at it1A
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diam er or WeighUFt. Material numbers and c ,RL n road names.
From To��r FL p✓C
From�2 To-1 -Ft. fT6- i1G ��
From To Ft. �v /r
13. GROUT: Depth _ atenal Method
From_—_To .� 0 Ft. ltl<i j9t,- i11,f>t./D OR �R
From To Ft. O
14. SCREEN: Depth Diameter Slot Size Material to Ay/3r*- N
From To Ft.
in. in. a
From To Ft._in. in. �C
15. SAND/GRAVEL PACK:
Depth Size Material
From To FL
From 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 OPY�O 2S WE RD HAS BEEN PROVIDED TO THE WELL OWNER
u 1//����(( �/ � 7 `CJS
SIG ATURE OF PE ON CONSTRUCTING THE WELL DATE -
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC !
2 7 6 99-1 63 6 Phone No.[phone],within 30 days. GW-I REV.07/2001 --
�O

3
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of water Quality -Groundwater Section
s �� CERTIFICATION#Q5T
WELL CONTRACTOR(INDMDUAL)NAME (privO�LLIB tY]Rt lrs�3'I30D
�CNn��t1XC WQ-\` tMp Cif _PHONE 0 �—
WELL CONTRACTOR COMPANY NAME f— n ,✓
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMTTN IOva
(if applicable) —/ (if applicable)
7I. WELL USE(Check Applicable Box): Residential Er Mir»cipaVPubhc❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2, WELL LOCATION: Topographic/Land setting
Nearest Town: I County of [3Ridge ❑Slope []Valley ❑Flat
IS� e (check appropriate box)
Laitude/rylongit�u/de of w l 1 ation
(Sued Nam
c, (Numbers.Community,Subdivision,Tut No.,ZAP Code) '3 t`J 0'�n ��Z�S 'Z
J. OWNER:Jo-m('S I Wn _ (dcgr=s/minuAes/seconds)
Address n l nj n y0 0 � Latitude/longitude source:BZr`PS❑Topographic map
(cheek box)
_ ($ fR treat ooutc No.) /
'CQSt f'IG /OCJCI I L L( �2 f DEPTH DRILLING LOG
Ciry or Tow„ Stae Zip Code From To ���on scription
Area code-Phone numbs PD
4. DATE DRILLED $— 7� 0
5. TOTAL DEPTH: •�
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO R'
T STATIC WATER LEVEL Below Top of Casing: FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface'
`Top or using terminated atlor below land surfs"requires a
variance in acmrelanot with ISA NCAC 2C.0118. T :6
9. YIELD(gpm): _�_METHO,.(D OF TEST Cl�
10.WATER ZONES (depth): '/ A�l' LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from a leasij
12. CASING: Wall Thickness two State Roads or County Roads.Include Mai
Depth Di der or'WcighUFt. atcnal numbers and common road names.
From_Tom0 Ft. ,err'` 116
From To 102 Ill .It/ L VC,
From To Ft. k3
13. GROUT: Depth M Coal Method.
From..To A 0 Ft. S /- o
From To Ft. r Chi
14. SCREEN: Depth Diameter Slot Size Material
From To Ft.—in. in. S-
O
From To Ft.—in. _ in. —V
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To - Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION ST °ARDS,AN THAT�COPY'OW THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER 2
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Se don,1636 Mail Service Center Eh 20teRV 01
27699-1636 Phone No.[phone],wjthin 30 days.

WELL CONSTRUCTION RECORD
3095CI0
North Carolina-Department of Environment and Natural Resourcces-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print l BfllfllT>r- �lfYr1.116 IFI CERTCATION N.CPM
WELL CONTRACTOR COMPANY NAME QgAk M Lt PHONE N Q111 -I aCA
STATE WELL CONSTRUCTION PERMITN ASSOCIATED RQ PERMITN _/jl)POS DO O
if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ErlMunicipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATIO : Topographic/Land setting
Nearest �tl�q- County
I5-11 /HAvl�ea7 � 5�a/y , 'V 2 �.77 midge (check
❑Valley ❑Flat
�. appropriate box)
(Street Name,Num ,Commrmiry,Subdivision,Le No.,Zip Code) Latitude/1 gitude of well Doc lion
3. OWNER: M)[7c�r1 l 11D�Ix�b6nl 350/foyp/ o$z°/9�'fA.)
(degrees/mimaes/semnds)
Address l S N A Latitude/longitude source:MGPS❑Topographic map
(Saee[ar Route No.) (check box)
773 DEPTH DRILLING LOG
City or 7o State LP Code F FO f10O riper On
( - C�1`f- � S3 8� Cx t
Amu code-Phone number
4. DATE DRILLED-1
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES C<NO ❑ 5-
7. STATIC WATER LEVEL Below Top of Casing: 1 40 FT. "
(Use-+^if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance iu accord""with 15A NCAC 2C.0118
9. YIELD(gpm): _METHOD O�TEST A;R I
10.WATER ZONES(depth):
LOCATION SKETCH Q sm
11. DISINFECTION:Type Amami Show direction and distance in miles from aElgast
12. CASING: Wall Thickness two State Roads or Cotmty Roads.Include the road .
/ Depthl!,, D cter or WeighUFt. Material numbers and common road names.
From To?'�Ft.� �7 5_ _AyL -
From To��Ft. 21.5 I/C—
From To Ft.
13. GROUT: Depth Material M•Method
x
From O To�O Ft. $.FkREft>` Ad
From To Ft. OF
14. SCREEN: Depth Diameter Slot Size Material ^f�
From To Ft. in. _ in.
From To Ft. in. in fAAl
15. SAND/GRAVEL PACK: p
Depth Sim Material
From To Ft. Tt
From To Ft.
2
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 S RECORD HAS BEEN PROVIDED TO THEgWELL 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 J
27699-1636 Phone No.[phone],wjthin 30 dayL GW-I REV.07/2001 J -
N
s�-s

300557
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) -P]r1pry1- �fYv � CERTIFICATION M"a�,
�f; ' 430 L�Ap C-n
WELL CONTRACTOR COMPANY NAME (fin rIt pr rn � PHONE p ($2i)ld33-1a9p
STATE WELL CONSTRUCTION PERMITN wSSOC1ATED R'Q PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box): Residential C"Mtmicipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: nO
Nearest Town:. }{�((� S CI n I" Topographic/Land setting
{-�-Q, _Coumty ❑Ridge ape ❑Valley ❑Flat
6 7 (check appropriate box)
(Sheet Name,Numbers,Cordmunily,Subdivision,Lot No.,Zip Cod.) Latitude/longitude of we]1 location
3. OWNER: l t' fn S �7 1 i O87 i/�qw
(degrces/mines/min ums/seconds)
Address _ S i u n KK C Latitude/longitude sotrce:BGPS❑Topographic map
(S t r Route No.) (check box)
n r'{ 1 A Q l YPt P�t) G y DEPTH DRILLING I,OG
Cny or Town State Zip Code From To Formatipn cription
4--)- tJ— 1 D �J
Arca code-Phone numbs _ �O
4. DATE DRILLED z -/L -10'5
5. TOTAL DEPTH: % 05" W
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO f5r
7. STATIC WATER LEVEL Below Top of Casing:_ ! D FT_
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface"
'Top of neing terminated at/or bebw land surface requires a =1
variance in accordance ith 15A NCAC 2C.011 s. t
9. YIELD(gpm): I METHOD QETEST /1t'R r— '
10.WATER ZONES(depth):
LOCATION SKETCH
l 1. DISINFECTION:Type Amoumt Show direction and distance in miles from at least
12, CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diatpeler or Weight/Ft. Material numbers and common road names.
From_To Ft. _
From--5:�t-To _ Ft.
From To Ft. �r
13. GROUT: Depth Material Method
Fmm--C—To-2 Q Ft. 5R1<1?A/yz Ape f�
From To Ft.
14. GREEN:
F Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS D THAT A COPY TORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGfrnr URE OF PERSON CONSTRUCTING THE WELL DATE -
Srbntit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

&4 309553
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CCONTRACTOR(INDIVIDUAL)NAME (print) BfIIRr%A, 'ENn'A) CERTIFICATION#X�rL�(—��
11
WELL CONTRACTOR COMPANY NAME`((l��CLn lr il" WV_\` 4 "W0 7PHONE # R�l'Q,.�.-a:A"
ASSOCIATED w'Q PERMIT# fA I)) �Z'Z
STATE WELL CONSTRUCTION PERMIT# (if applicable)
(if applicable) (if
I. WELL USE(Check Applicable Box):Residential E Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use —
2. WELL LOCATION: t Topogra idLand setting
Nearest Town: W C'- 4'o County Qom- Midge lope OValley ❑Flat
(check appropriate box)
(Street Name,Numbers,Comm ity,Subdivision.Lot No.,Zip Code) {. L�1�ddcll?Wtµ� -I well lo C lti ra
/T♦1I_��I'i0.fiUnd 1�M'� ' (detpces/minuWss/V ds) 0
3. OWNER: .�nt t( C' �• ♦�G 1/1-S( 1�"
Address 1 ni &Sher-y i E tll Latitude/longitude source: PSOTopographic map
(Street or Roinc No.) (cheek box)
1 o to'Uys QytU it 1 C U k/)� DEPTH DRILLING LOG
City or Town State Zip Code From To Fotm, o escRputin
Area code-Phone number
4. DATE DRILLED 7`05 36 — !V
5. TOTAL DEPTH: 33 O
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO Ir
7. STATIC WATER LEVEL Below Top of Casing: 5 Q, FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface* Y
'Top of easing lermituaw atior below load surface requires a '0
t7 q
variance in accordance with 15A NCAC 2C.011&
9. YIELD(gpm):�_METHODQF TEST A t3 t
10.WATER ZONES(depth): �5
LOCATION SKETCH CD
11. DISINFECTION:Type Amount _ Show direction and distance in miles from at�ast
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth D' er or Weight/Ft. Material numbers and common road names.
From I To .3 O Ft. .4
From,?To�t0 Ft. 6 21.4 _&C
From To Ft.
13. GROUT: Depth � Material
� M�
Fmm To % O Ft. /— 1/
From To FL y
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in
From To Ft. in. in. _
15. SAND/GRAVEL PACK: J4 ` a
Depth Size Material W f11 01
Prom To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OIL'!SS RE HAS BEEN PROVIDED TO THE WELL OWNER
3` �' 05
SIGNA'KJFE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC. —GW-1 REV.07/2001
-
27699-1636 Phone No.[phone],within 30 days.
- c-
e
r

WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print)_ Bryant Smith CERTIFICATION H 2571
WELL C'ON'rRACTOR COMPANY NAME Green River Well&Pump Company PHO.7NE a [phone]
S I A I E WELL CONSTRUCTION PERMITk ASSOCIATED WQ PERAUTN
(if applicable) (if applicable)
I WELL USE(Check Applicable Box): Residential LA"Mur icipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring Cl Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
WELL LOCATION. opographic/Land setting
Nearest"T own. 5; d County_ ' �, �ge ❑Slope ❑Valley ❑Flat
OIF� cyc 5t 1 Unn (cheek appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longltu e of well location
35`'�y 1: 3y f9�t�/9 ry Dcv
i. OWNER J U I �. 1.l_J I Il t a/YI S (degrees/minulea/aeconds)
Address S5/ r7 C.1M FJ ir-, tY' Latitude/longitude source-211PS❑Topographic map
(Stree(or Route Nn.) (check box)
O'k 0-�k"L2tQ Al C ZS�t 7(7 DEPTH DRILLING LOG
City or Town 8 to Zip Code From TO Fonnatio egeription
r/o4 -�n�-�I (o( o — Id
.Srea code-Phone number 2r) j
4 DAI'EDRILLED
101 AL DEPTH: 3 N!t
o DOES WELL REPLACE EXISTING WELL? YES ❑ NO R-� -
7. S fA TIC WATER LEVEL Below Top of Casing: l 1D FT.
(Use"+"if Above Top of Casing)
S. "I'OP OF CASING IS_�_FT.Above Land Surface'
•lisp of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C 0118. _
9. YILD(gpm): METHOD OF TEST &)Z
10 WATER ZONES(depth): �Lf
LOCATION SKETCH
I I DISINFECTION. Type Amount Show direction and distance in miles from at least
11_. CASING Wall Thickness two State Roads or County Roads. Include the road
Depth Dla eter or Weight/Ft. Material numbers and common to*names 1
I ! To�FL ,/ ✓�
�DS�'r J/
ILroin -1 ::A Ft
1/ L
Prism To F[.
I+. GROUT Depth Material Method
Prom To 7 O Ft. 5,4k/a7lr-'atL IK,' CI`
From To Ft.
14 SCREEN: Depth Diameter Slot Size Material =� ,/ p, C
Prom "Co FL in. in.
From To FL in. in ;
15 SAND/GRAVEL PACK.
Depth Size Material L
ti` ,
From To Ft.
From To Ft. ZZ
10 REMARtcs- 0Z012�
pig
tx) HEREBY CERTIFY THAT THIS WELL WAS C STRUCTED IN ACCORDANCE WITH I 5A NCAC 2C, WELI.
CONS TRIJCTION STANDARDS,AND THAT A C OF THI ECORD HAS BEEN PROVIDED TO THE WELL OWNER
SI ATURE OF PERSON CONSI RUCTFNG"FEE WELL DA IT
Submit the original to the Division of Water Quality, Attn: Info,"atiion'-Management, 1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
;GW-I REV. 09/2004
Ili AN 9 2005

WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) Anthony Bryant Smith CERTIFICATION#2571
WELL CONTRACTOR COMPANY NAME Gratin River Wail&Pump Company PHONE a (820 6031200
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box):Residential B"'Mlmicipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topograpitic/Land setting
Nearest Town: SOJIAtCGL County P0I K, EMdge ❑Slope ❑Valley ❑Flat
L7i We, fbline. r`I—o- - Sn�wi al (chock rppropruw box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) LatiVe/longitude of well location
35 la r a N p$,;I,° al' 07cJ
3. OWNER: J�arn � SUSO.vr neon (dcgrm/minulwhocondr)
Address 3Y3q Wilmon-t- Ave_ Latitudellongitudesource:❑GPSOTopographicmap
(Street or Route No.) (chock box)
�a 4i-0n Ott IFS*/4 DEPTH DRILLING LOG
C ceTown Stara Zip Code From To Fo atio 'ption
Am code-Phone numbs r
4. DATE DRILLED I,2o IO S G
5. TOTAL DEPTH: 30 5
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO-B'
7. STATIC WATER LEVEL Below Top of Casing: 200 FT. 3
(Use"+"if Abovc Top of Cuing)
_ 8. TOP OF CASING IS I FT.Above Lard Surface• -
-Top of caning wenioated st/or below land surface requires• L
variance In aorordsoce with 1SA NCAC 2C.011& "
9. YIELD(gpm): _METHOD_QF TEST At r r
10. WATER ZANES(depth): LOCATION SKETCH
11. DISINFECTION:Type 1+-T-t-f Amount Show direction and distance in miles fromavleast 4
12. CASING: Wall Thickness two State Roads or County Roads. lmlude'dl roa C1
Depth Di etc' or Weight/Ft. Material numbers and common road names. p ,-ae�
From _To FL 2 7 r! &Z fso�t
From�To lOL Ft. 2/.C � `i 'StlF y�
From To Ft. MT
13. GROUT: Depth Matenial Method k
From © To-2 Ft. )K! jt ��Q
From TO Ft. f �1
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. !2 %fJ At/..
From To Ft. in. L_ ,��- y�
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS: Per i%
1 DO HEREBY CERTIFY THAT THIS WELL WAS CO STRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COP F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
e - 21 —Of
IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn: Info rNRAtiWLWaaagemcint1-1.61-7-Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
� --- GW-I REV.09R004
I ,

,E-• RESIDENTIAL WELL CONSTRUCTION RECORD
J • � � Noah Carolina Ucpertrnenl of environment and Natural Kcsourccs pIYlslon 1nl walcr Quabn
WELL CONTRACTOR CERTIFICATION 11 '-'S 7 I
1.WELL CONTRACTOR: u, I. DISINFECTION:Type mum Ao
-
1'yl Yqa&t J Yy11 tip`. g. WATER ZONES taeptnl
Well Cooltractor(Idividual)Name t From ' F To " �_ From To
6e_e-n ?tVPt' WOE o ?ll yk0 From To From To
Well Contractor Company Name ,�11 From To From To
STREET ADDRESS �U 130X J ly r 6. CASINO: Thickness
T Depth Diarrtater Weigh Malarial
COSt EiQt IOC KI K) C a IrY lC� From_ To 32 Ft_4_�_ lj,
City or Town State I^ Zip Code From_To Ft
( I. (�g3-)20U From To—Ft
At"code- Phone number
7. GROUT: Depth Malarial Memos
2.WELL INFORMATION: n
From To Z.Q Fl.
SITE WELL ID a(d appcePie) From To FI.
STATE WELL PERMITe(a appioede) From_To Ft
DWQ or OTHER PERMIT a(t appkaba) 8. SCREEN: Depth Drarnatuo SM Sae Material
From_To Ft._n _ n.
WELL LOSE(Chock Appl"ble Box): Resiclenbel Water Supply 091-�
_ From_To Ft_n n.
GATE DRILLED 9-►3 -o s / From_To FI_n n
TIME COMPLETED Z . 3 O AM, �PM 5�
9. SANDIORAVEL PACK:
7 WELL LOCATION:�,r Depth Size Material
CITY: 50-LAJAAr COUNTY TO I K- From To Ft
11 -n from To Ft.
10o Peace ITl
I 11S VYI d� From To Ft
(Street Name.Numbers,Communxy,SubdMwn.Lot No.,Parcel,Zip Code)
TOPOGRAPHIC I LAND SETTING. 10. DRILLING LOG
Ia"36'" ClVNley ❑Fat ORklp OOther From To F mnaU nJtleacriptam
(check appropnare box) [/x — l";? A (I
o I AI May be in degrm. �
LATITUDE �S �O minute,@ownsor 1� Z2
LONGITUDE LP C�'t (!.J mad@oanul format 3' `.t /f L4
LatitudeAonginate source: adFS OTopographic map -
(bcatarn of wet muat be awwn on a USGS lopo map and
anacbed to Ma Tomrr/not why GPS)
I
♦.WELL OWNER n -
OWNER'SNAME (Y�1�hei� t1\OYTIS --i
9-
STREET ADDRESS Po (� �
Ot- fJG Z�6 l 3 0
City or Town Sate Zip Code
I47s
At"rode- Phan number
11. REMARKS:
6.WELL DETAILS: I
a. TOTAL DEPTH: '--�5
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO E4- _.__-
IDO HEREBY CERTIFY T T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
c. WATER LEVEL Below Top of Casng. /DO FT_ RECORD 5 BEEN WELL
RRO L,ip n ELM AND THAT A XFY OF rNb
(Use's w I ADo Top d Coang) Q w�
ER
d. TOP OF CASINO IS I Fr.Above Land Surface- /-) -6O
Top of casing terminated atror below land surface may require SIGNATURE OFlCERTIFIED WELL CONTRACTOR DATE
a varanoa In atpordanw with 15A NCAC 2C.0118. �l( ,
M ETHOD OF TEST //-�y 1 r 1-r In �J
e. YIELD(ypm).� '�`-- PRTNTE0 NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days *tpn: I,ntormatlon MgL, _ Form Gw-1a
1617 Mall Service Center-Raleigh, NC 27699.1617 Phone No.(919)733 10Y5 ext 568. Rev 7105
I �

svr V
RESIDENTIAL WELLCONSTRUCTION RECORD
T -
�` North Carolina 1-kparVnent of Envimnmcnl and Natursl Kesources- Division of Water QuabN
111 �t n
WELL CONTRACTOR CERTMCATION III ! I
1.WELL/C+NTRACTOR: I. DISINFECTION:Type Amount
g. WATER ZONES(oaptn)
`J I iodual)Name r From gel& To ACJ From To
(f7re e-n ?tv Pr tAf Q�1 ? �Elykp From To From To
WWI Contractor Company Nartr From To From To
STREET ADDRESS GU T 6. CASINO: Tnicknesv
C / �-/ r1 / Depth m ter 7e MM tarot
r Q$} Y IQ f a 1 oC l0 From To 13. Ft.
City a Town State r Zip Code From To Ft
6 a 2 nuL_' Q 0 From To Ft.
Area cods- 1Pnw a number
7. GROUT: Depth Malarial Method
2.WELL INFORMATION: me From Q Tom FL -
SITE WELL IO Cif applkaba) From_To Ft.
STATE WELL PERMITII applicable) Fran_To F1
DWO a OTHER PERMIT a(/applicable) S. SCREEN: Depth Demeter Slot Size Material
. _ III
WELL USE(Clack Applicable Box): Residental Water From_To FL_n
er Supply❑ From_To Ft n _ in.
i
GATE DRILLED j �'�� ��) From_To Ft_n _ in
TIME COMPLETED AM O PM[5"
9. SANDIORAVEL PACK.
3.WELL LOCATION:
I � Depth See Material
CITY'. �-l.l..s 1.lJ.d'� COUNTY ��-�-r` From To Ft.
From To Ft.
N &A-ka"✓1I21 It)'f�0rne From To_Ft
(Street Name.Nurnows.Community.SubdiNtwn,Lot No..Parcel,Zip Code)
-OP!TOPOGRAPHIC I LAND SETTING: %DRILLING LOG
V 6ol OValloy DFat ❑Ridge 000ar From To mh bo scnption
(Uack appropriate lxa) 7
r May be in degas,
LATITUDE I minute,wends"
a a decnul format
LONGITUDf��' ' GLJ Q
Latitude/longitude source: ®BPS OTopograp)uc rnap LOD —l 30 may r.
(bcslcn of wet must be shown on a USGS topo map and /?✓)—d Z
attached to era ben r not usip GPS)
a.WELL OWNER
OWNER'SNAME C -
n
ST EET ADD ESS -raffuJailbr
6-2 S 7
C'hCor Town/ Q Slane de
( Zip Co
Area code- Phone number -
lt. REMARKS: -
6.WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES D NO B'
/,�< i(XI HEREBY CERTIFY That lrviS WELL WAS COrvSfRUCTEDw ACCORDANCEwnR
c. WATER LEVEL Below Top ofCamp: _FT. RECORD 5 aEE`L CONS`RCVDED "hO E wELSTANAW:RERD THAT A COPY OF THIS
✓(Use- M Above Top ofCasirp) `
d. TOP OF CASING IS d FT.Above Land Surf ace* e
-Top of casing terminated Won below land surface may require SIGNATURE F CE RT I FI E D W ELL CONTRACTOR DATE
a varanoe In accordance with 15A NCAC 2C.0118.
a. YIELD(gpm):�—METHOD OF TEST_ R y�¢.t9 t rN A► z,I K
PRINTED N E OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Ahn: Information MgL, Form GW-Is
1517 Mail Service Center-Raleigh, NC 27699.1617 Phone No.[phone] ezt 568. Rev.7105

0 z0310
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(prim)JEFF MELTON CERTIFICATION#3417
WELL CONTRACTOR COMPANY NAME PITTMAN WELL 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 El Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town: TRYON County POLK Topographic/Land setting
545 WHITE OAK LANE ❑Ridge ❑ Slope ❑valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:JOETTE WILLIAMS Latitude/longitude of well location
Address 545 WHITE OAK LANE _
(Street or Route No.) (degrees/minutes/seconds)
TRYON NC 28782 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
(8)-894-3762 DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 11/02/05 _
5.TOTAL DEPTH: 425
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® 14.'t 350 161 11��N
7. STATIC WATER LEVEL Below Top of Casing: 100 FT. Po
(Use"+"if Above Top of Casing) �J 8 Z J '�4�
8.TOP OF CASING IS 1-112 FT. Above Land Surface*
*Top of casing teiminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118. LOCATION SKETCH
9.YIELD(gpm): 20 METHOD OF TEST ARD Show direction and distance in miles from at least
10.WATER ZONES(depth):'_ Two State Roads or County Roads. Include the road
number and common names
I L DISINFECTION: Type CHLORYTE Amount 11 HWY.#9 S.FROM MILL SPRING.RIGHT ON
12. CASING: Wall Thickness HUGH CHAMPION RD.APPROX.314 MH E ON
Depth Diameter or Weight/Ft. Material LEFT.545 HOUSE#.
From 0 To 125 Ft 6-1/4" SDR21 PVC
From_To_Ft_
From To_Ft._
13.GROU_Depth Material Method n
From 0 To 20 Ft.OUH(RETE POURED
From_To Ft 14.SCREEN: Depth_ Diameter Slot Size Material O
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
CON TRUCTION STANDARDS,AND THAT A COPY F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

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 Municipal/Public Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK Topographic/Land setting
85 CAMEO DR
Street Nam ❑Ridge ❑ Slope ❑Valley ❑Flat
( e,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:PHILLIP GRIGG Latitudellongitude of well location
Address 85 CAMEO DR _
(Street or Route No.) (degrees/minutes/seconds)
COLUMBUS NC 28722 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 28 -817-0654 DEPTH
Area Code Phone number From TO
4.DATE DRILLED 11/08/05 _
5.TOTAL DEPTH: 805 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing:_0 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface* LOCATION SKETCH
*Top of casing terminated atlor 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): HWY.#9 S.FROM MH.L SPRING.RIGHT ON
11.DISINFECTION:Type CHLORYTE Amount 22.5 HWY.#14.LEFT ON JACKSON GROVE RD.RIGHT
ON CAMEO DR 1/10 MILE ON LEFT.
12. CASING: Wall Thickness
Depth Diameter or Weight/FL Material k 3 // 6-o 7 N
From 0 To 70 Ft. 6-1/4" SDR27.6 PVC
From_TO—Ft._ °^� $2° .6 q1 d�..
From_To_Ft._ r�
13. GROUT: Depth Material Method
From 0 To 20 Ft.OUHMTE POURED
From_To Ft
14.SCREEN: Depth Diameter Slot Size Material a
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
CONS O TANDARDS,AND THAT A COPY OF THIS CORD HAS BEEN PROVIDED TO THE WELL OWNER
!I li
NA OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)JEFF MELTON CERTIFICATION#3417
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE#[phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#_
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town: TRYON County POLK Topographic/Land setting
1959 SANDY PLAINS RD. ❑Ridge ❑ Slope ❑valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:MARGARET SECOR Latitude/longitude of well location
Address 1959 SANDY PLAINS P.D. _
(Street or Route No.) (degreeslminutes/seconds)
TRYON NC 28782 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
7( 047)—740-7395 DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 11/15/05
5.TOTAL DEPTH: 205
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO 0
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface'
*Top of casing terminated attor below land surface requires a
variance in accordance with 15A NCAC 2C.0118. LOCATION SKETCH
9.YIELD(gpm): 50 METHOD OF TEST ARD Show direction and distance in miles from at least
10. WATER ZONES(depth):_ Two State Roads or County Roads. Include the road
number and common names
11. DISINFECTION:Type CHLORYTE Amount 4.5 FROM MILL SPRING.HWY.#9 S.LEFT ON
12. CASING: Wall Thickness SANDY PLAINS RD.NEW GRAVEL DRIVE ON
Depth Diameter or Weight/Ft Material LEFT JUST PAST FOX HOUND CLUB.
From 0 To 70 Ft 6-114" SDK21 PVC
From_To_Ft_
From_To_Ft_ Ion,)
13. GROUT: Depth Material Method rm t.2
From 0 To 20 Ft ODUCRETE POURED �J
From_To_Ft_
14.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 FL
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS, AND THAT A COPYPY THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

P� ? 1. 3iJ5
WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)JEFF MELTON CERTIFICATION#3417
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE#[phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#—
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town:MILL SPRING County POLK Topographic/Land setting
4004 LAKE ADGER PKWY. ❑ Ridge ❑ Slope ❑Valley ❑ Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:JERRY JOHNSON Latitude/longitude of well location
Address 4004 LAKE ADGER PKWY. _
(Street or Route No.) (degrees/minutes/seconds)
MILL SPRING NC 28756 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
9( 19)—757-9262 DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 12/22(05 _
5.TOTAL DEPTH: 445
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO® iq k 3S` 0 '' 51. ZR (\J
7. STATIC WATER LEVEL Below Top of Casing: 40 FT. �y/
(Use"+"if Above Top of Casing) Io.,vJ 12' 13' 61t-Sl
8.TOP OF CASING IS 1-1/2 Fr. Above Land Surface*
*Top of casing terminated at/or below land surface requires a LOCATION SKETCH
variance in accordance with 15A NCAC 2C.0118.
9.YIELD(gpm): 3 METHOD OF TEST ARD Show direction and distance in miles from at least
10. WATER ZONES (depth):— Two State Roads or County Roads. Include the road
number and common names
11.DISINFECTION:Type CHLORYTE Amount 12 HWY.#9 N.FROM MH.L SPRIGNG. LEFT ON
12. CASING: Wall Thickness SILVER CREEK RD.RIGHT ON LAKE ADGER
Depth Diameter or Weight/FL Material PKWY.6/10 MILE ON LEFT.
From 0 To 85 Ft. 6-1/4" SDR21 PVC
From_To_FL
From To Ft.
T: _
13. GROU_Depth Material Method �—
From 0 To 20 Ft.OUHCRETE POURED
From_To_Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From—To—Ft._ in. = in. — RECEIVED
15. SAND/GRAVEL PACK:
Depth Size Material
From_TO—Ft.— JAN 30 2066
From_To_Ft.
16.REMARKS: Asheville Regional Office
A uifer Protection
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CON TRUCTION STANDARDS, AND THAT A COPY O THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)JEFF MELTON CERTIFICATION#3417
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE#[phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#_
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use—
2. WELL LOCATION:
Nearest Town: TRYON County POLK Topographic/Land setting
1863 CHESNEE RD. ❑Ridge ❑ Slope ❑ Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER: G.VANDEN BLACKWOOD Latitude/longitude of well location
Address 1863 CHESNEE RD,. _
(Street or Route No.) (degrees/minutes/seconds)
TRYON NC 28782 Latitudc/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8(28)-859-5858 DEPTH DRILLING LOG
Area Code Phone number From To From To
4. DATE DRILLED 12/12/05
5.TOTAL DEPTH: 205 —
6.DOES WELL REPLACE EXISTING WELL? YES® NO❑ } 35" i Z ' 41 4 6 P J
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use"+"if Above Top of Casing) �Z' 1' 17, )7-" i/J
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a LOCATION SKETCH
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 50 METHOD OF TEST ARD Show direction and distance in miles from at least
10. WATER ZONES(depth):_ Two State Roads or County Roads. Include the road
number and common names
11.DISINFECTION: Type CHLORYTE Amount 4.5 HWY.#9 S. FROM MILL SPRING.LEFT ON
12. CASING: Wall Thickness CHESNEE RD.BRICK HOUSE ON LEFT
Depth Diameter or Weight/Ft. Material STRAIGHT ACROSS FROM MELVIN HILL RD,
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. OUIKRETE POURED c_
From_To Ft _
14.SCREEN: Depth_ Diameter Slot Size Material -I
From_To_Ft._ in. in. "0
From To Ft. in. in.
15. SAND/GRAVEL PACK: l RECEIVED G
Depth Size Material
From—To—Ft._
From To—Ft— JAN 30 2006
16.REMARKS:— Asheville Regional Office
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN NC- C 2C,WELL
CONS UCTION STANDARDS, AND THAT A CO Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
2 ^Q
SIGNATURE PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water
WELL CONTRACTOR(INDIVIDUAL)NAME(print)RODNEY ROBBINS Qtty—Groundwater Section
WELL CONTRACTOR COMPANY NA PITTMAN WELL BORING LLC CERTIFICATION# 2785
STATE WELL CONSTRUCTION PERMIT# PHONE# [phone]
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
I. WELL USE(Check Applicable Box): Residential ® MunicipaUPublic ❑ Industrial
Monitoring ❑ Agricultural El ❑ Heat Pump Water Injection ❑ Other El If Other,List Use ❑
2. WELL LOCATION:
Nearest Town: TRYON County POLK
6601 PENIEL RD. Topographic/Land setting
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) ❑Ridge El Slope El Valley El Flat
3. OWNER:DON RAUSCH (check appropriate box)
Address 6601 PENIEL RD. Latitude/longitude of well location
(Street or Route No.) (degrces/minutes/seconds)
TRYON NC 28782 Latitude/longitude source: ❑ GPS ❑To
Crty or Town State Zip Code pographic map
9( 411 —779-3962 (check box)
Area Code Phone number DEPTH
4.DATE DRILLED 12/19/05 From To
5. TOTAL DEPTH: 245
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO® DRILLING LOG
7. STATIC WATER LEVEL Below Top g 0 of Casing: 6 FT. From To
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a LOCATION SKETCH
variance in accordance with 15A NCAC 2C.0118. Show direction and distance in miles from at least
9. YIELD(gpm): 20 METHOD OF TEST ARD Two State Roads or County Roads. Include the road
10. WATER ZONES(depth): number and common names
HWY.#9 S.FROM MILL SPRING.RIGHT ON
11.DISINFECTION:Type CHLORYTE Amount 6 PENIEL RD.3/4 MII E ON RIGHT BOX#6601)
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material ��+ 3S'i$ 2 oYr+N
From 0 To 140 Ft. 6-1/4" SDR21 PVC 10-� $Z� (0
From_To_Ft-_
From To Ft
13. GROT:U Depth Material Method
From 0 To 20 Ft.OUEKgETE POURED
From_To_Ft.
14.SCREEN: Depth Diameter Slot Size Material o
From_To_Ft._ in, in
From_To_Ft'_ in in RECEIVED
15. SAND/GRAVEL PACK:
Depth Size Material From To t JAN 3 0 2066
_F _
From_To_FL
Asheville Regional Office
16.REMARKS: Aquifer Protection
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONS UCTI STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNA OF PERSO ON TRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No. [phone],within 30 days.
GW-1 REV.07/2001

Na
WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)JEFF MELTON CERTIFICATION#3417
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE#[phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#_
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential E MunicipabPublic Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ if Other,List Use_
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK Topographic/Land setting
1322 RUtHAVEN DR. ❑Ridge ❑ Slope ❑Valley .❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
)
3. OWNER:RICK OUZTS Latitude/longitude of well location
Address 1322 RIXHAVEN DR _
(Street or Route No.) (degreeshninutes/seconds)
COLUMBUS NC 28722 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
(L43)—849-6878 DEPTH DRILLING LOG
Area Code Phone number From To From To
4. DATE DRILLED 10/19/05
5. TOTAL DEPTH: 305
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® ��} 3S' t 5^ 32,Z4 N
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use"+"if Above Top of Casing) 57..`}(< LJ
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118. LOCATION SKETCH
9.YIELD(gpm): 10 METHOD OF TEST ARD Show direction and distance in miles from at least
10. WATER ZONES(depth):_ Two State Roads or County Roads. Include the road
number and common names
11. DISINFECTION:Type CHLORYTE Amount 7.5 GO UP HOWARD GAP RD.CROSS I-26.LEFT
12. CASING: Wall Thickness INTO RDIHAVEN.APPROX.1.5 MILES ON
Depth Diameter or Weight/Ft. Material RIGHT.
From 0 To 120 Ft. 6-1/4" SDIL21 PVC
From_To_Ft
From_To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. OUHZRETE POURED
From_To_Ft.
14.SCREEN: Depth Diameter Slot Size Material r
From rt
_To_Ft._ in. in. o
From_To_Ft._ in. in.
15. SAND/GRAVEL PACK: �— q
Depth Size Material o
From_To_Ft._ cn
From To Ft.
. 5
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
n
Lbmit
610 SIG ATURE OF P ON ONSTRUCTING WELL DATE
the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

CL"
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)JEFF MELTON CERTIFICATION#3417
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE#[phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#_
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential 2 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK Topographic/Land setting
586 MORNING RIDE ❑Ridge ❑ Slope ❑ Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:URHO HUVONEN Latitude/longitude of well location
Address 586 MORNING RIDE _
(Street or Route No.) (degrees(minmes/seconds)
COLUMBUS NC 28722 Latitude/longitude source: ❑ GPS ❑ Topographic map
City or Town State Zip Code (check box)
8( 28)-894-6117 DEPTH DRILLING LOG
Area Code Phone number From To From To
4. DATE DRILLED 10/25105 _
5.TOTAL DEPTH: 605
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® f S' ( (, 3 S. 2°("�
7. STATIC WATER LEVEL Below Top of Casing: 0 FT. R 3
(Use"+"if Above Top of Casing) lu.') g2° l2' Sb. qw" LJ
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface"
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118. LOCATION SKETCH
9. YIELD(gpm): 0 METHOD OF TEST ARD Show direction and distance in miles from at least
10. WATER ZONES(depth):_ Two State Roads or County Roads. Include the road
number and common names
11.DISINFECTION:Type CHLORYTE Amount 16.5 FROM COLUMBUS GO OUT SKYUKA P.D.
12. CASING: Wall Thickness RIGHT ON HOUSTON RD LEFT ON WHITE OAK
Depth Diameter or Weight/Ft. Material MTN.RD.GO TO TOP OF MOUNTAIN.RIGHT
From 0 To 20 Ft. 6-1/4" SDR27.6 PVC ON MORNING RIDE.APPROM I MILE ON
From_To_Ft_ RIGHT.
From To Ft.
13. GROT:U_Depth Material Method
From 0 To 20 Ft QUHCRETE POURED t
From_To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From_To_Ft._ in. in. o
From_To_Ft._ in. in. - -
15. SAND/GRAVEL PACK: r
Depth Size Material cC
From_To Ft.
From To Ft.
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

21559
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)DELBERT PITTMAN- CERTIFICATION#2159
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE#[phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#_
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING County POLK Topographic/Land setting
2258 SILVER CREEK RD. ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:TOBY KAY Latitude/longitude of well location
Address 2258 SILVER CREEK RD. _
(Street or Route No.) (degrees/minutes/seconds)
MILL SPRING NC 28756 Latitudellongitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8(�-778-0647 DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 08/30/05 —
5.TOTAL DEPTH: 325
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO®
7. STATIC WATER LEVEL Below Top of Casing: 60 FT. f
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118. LOCATION SKETCH
9.YIELD(gpm): 50 METHOD OF TEST ARD Show direction and distance in miles from at least
10. WATER ZONES (depth):— Two State Roads or County Roads. Include the road
number and common names
11.DISINFECTION: Type CHLORYTE Amount 8 HWY.#9 N.FROM MILL SPRING.LEFT ON
12. CASING: Wall Thickness SILVER CREEK RD.NEXT DRIVE ON RIGHT
Depth Diameter or Weight/Ft. Material PAST GARRETT RD.
From 0 To 40 Ft.6-14" SDR21 PVC N
From_To Ft._ rn
From_To Ft
13. GROUT: Depth Material Method N -_
From 0 To 20 Ft. OUHKRETE POURED cm
From_To Ft._ _
ut t
14.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
CO TRUCTION 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

0 315601
WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natuml Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)DELBERT PITTMAN' CERTIFICATION#2159
WELL CONTRACTOR COMPANY NAME 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 MunicipaUPublic El Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town:MILL SPRING County POLK Topographic/Land setting
1354 BURGESS RD. ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:RICK MCINTOSH LatitudcAongitude of well location
Address 1354 BURGESS RD.
(Sheet or Route No.) (degrees/minutes/seconds)
MILL SPRING NC 28756 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8( ZS)—625-0551 DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 08/04/05
5.TOTAL DEPTH: 165
6,DOES WELL REPLACE EXISTING WELL? YES❑ NO® (.l- 35 Z3' 1i4 32'
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use"-P'if Above Top of Casing) 101" y` 1 14' -91 7 3" PJ
8,TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at(or below land surface requires a LOCATION SKETCH
variance in accordance with 15A NCAC 2C.0118.
9.YIELD(gpm): 75 METHOD OF TEST ARD Show direction and distance in miles from at least
10.WATER ZONES(depth):_ Two State Roads or County Roads. Include the road
number and common names
11.DISINFECTION:Type CHLORYTE Amount 3 HWY.#9 N.FROM MILL SPRING.LEFT ON
12. CASING: Wall Thickness COOPERS GAP RD.LEFT ON BURGESS RD.
Depth Diameter or Weight/Ft Material STRAIGHT ON GRAVEL TO THE DEAD END.
From 0 To 70 Ft 6-14" SDR21 PVC RIGHT ON DRIVE AT DEAD END.BOX#135,44)
From_To_Ft.
From_To_Ft
13. GROUT: Depth Material Method
FromFrom 0 To 20 Ft OUHMTE POURED
From To Ft
14.SCREEN: Depth Diameter Slot Size Material
From_To Ft._ in in. -0
From_To Ft._ in. in. _
15. SAND/GRAVEL PACK: N
Depth Size Material c:3
From To_Ft_
From_To_Ft_ _
16.REMARKS:
I DO 14EREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) ROBIN MCNEELY CERTIFICATION# 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential Z Municipal/Public Industrial Lj Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town:MILL SPRING County POLK Topograpluc/Land setting
45 POWELL RD, ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:FLOY L.ODELL Latitude/longitude of well location
Address 45 POWELL RD,
(Street or Route No.) (degrees/minutes/seconds)
MILL SPRING NC 28756 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
(828)—625-8913 DEPTH
Area Code Phone number From To
4. DATE DRILLED 09/30/05
5. TOTAL DEPTH: 60 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES® NO❑ From To
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* LOCATION SKETCH
*Top of casing terminated aVor below land surface requires a Show direction and distance in miles from at least
variance in accordance with 15A NCAC 2C.0118.9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE Two State Roads or County Roads. Include the road 10. WATER ZONES(depth): number and common namesHWY.#9 N.FROM MILL SPRING.RIGHT ON
11.DISINFECTION:Type CHLORYTE Amount 9.2 MCGUINN RD,RIGHT ON BIG LEVEL RD RIGHT
12. CASING: Wall Thickness ON SOUTH WILSON HILL RD.LEFT ON POWELL
Depth Diameter or Weight/Ft Material RD,1 DRIVE ON LEFT.
From 0 To 60 Ft. 24" CEMENT
From_To_FL_ _
From To Ft._ CDT:13. GROU_Depth Material Method
i
From 0 To 20 Ft CEMENT POURED rn
From_To_Ft
14.SCREEN: Depth Diameter Slot Size Material o
LJl
From_To_Ft._ in. in.
From_To Ft._ in in.
15. SAND/GRAVEL PACK:
Depth Size Material q t 3S�Zr r l)J.if IN
From 40 To 60 Ft. 78M GRAVEL —
From_To_Ft.
_
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
n
P_
S A F PE C NS CTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)DELBERT PITTMAW CERTIFICATION#2159
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE#[phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#_
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: TRYON County POLK Topographic/Land setting
11554COUNTRY CLUB RD. ❑Ridge ❑ Slope ❑ Valley ❑Flat
(Sheet Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:PETE MARKOVIC Latitude/longitude of well location
Address 1155 COUNTRY CLUB RD. _
(Street or Route No.) (degrees/mmutes/seconds)
TRYON NC 28782 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 28)—859-9787 DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 09/27/05
5.TOTAL DEPTH: 385
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO® 114
7. STATIC WATER LEVEL Below Top of Casing: 80 Ff. �v.� �?' is" 5 J, a Z" N
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a LOCATION SKETCH
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 7 METHOD OF TEST ARD Show direction and distance in miles from at least
10. WATER ZONES(depth):_ Two State Roads or County Roads. Include the road
number and common names
11.DISINFECTION:Type CHLORYTE Amount 9.5 HWY.#176 FROM TRYON. LEFT ON
12. CASING: Wall Thickness COUNTRY CLUB RD.CROSS RR TRACKS. 1s�
Depth Diameter or Weight/Ft. Material HOSE ON LEFT.
From 0 To 120 FL 6-14" SDIL21 PVC
From_To_Ft.
From_To—Ft. _
13. GROUT: Depth Material Method
From 0 To 20 FL OUH{RETE POURED o
From_To_Ft.
14.SCREEN: Depth Diameter Slot Size Material
From_To_Ft._ in. in. m
From_To_Ft._ in. in. _
15. SAND/GRAVEL PACK: c�it
Depth Size Material
From_To_Ft._ t
From To Ft.
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CO UCTION STANDARDS,ANI�THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON NSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)RODNEY ROBBINS CERTIFICATION# 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING.LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential Municipal/Public Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If other,List Use_
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK Topographic/Land setting
339 WILKERSON HOLLOW DR ❑Ridge ❑ Slope ❑Valley ❑Flat
(Sheet Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER: ROBERT B.DAVIS Latitude/longitude of well location
Address 339 WILKERSON HOLLOW DR
(Street or Route No.) (degrees/mmutes/seconds)
COLUMBUS NC 28722 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
L4)—304-8933 DEPTH
Area Code Phone number From To
4.DATE DRILLED 09/26/05
5.TOTAL DEPTH: 185 DRILLING LOG
6.DOES WELL REPLACE EMSTING WELL? YES❑ NO® From To
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* LOCATION SKITCH
*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.0118.9.YIELD(gpm): 30 METHOD OF TEST ARD ro
Two State Roads or County Roads. Include the ad
number and common names
10. WATER ZONES(depth): HWY,#9 S.FROM MH.L SPRING.RIGHT ON
11.DISINFECTION:Type CHLORYTE Amount 4.5 COLLINSVILLE RD. GO APPROX.2-1/2 MILES.
12. CASING: Wall Thickness LEFT ON WR KERSON HOLLOW DR LEFT AT
Depth Diameter or Weight/Ft. Material FORK APPROX.2/10 MILE ON LEFT.
From 0 To 80 Ft 6-1/4" SDR21 PVC
From_To_Ft
From_T: To_Ft
13.GROU Depth Material Method
From 0 To 20 Ft.OU1KRETE POURED
From_To_Ft. a
14.SCREEN: Depth Diameter Slot Size Material n{
From_To_Ft._ in. in. t
From_To_Ft._ im Q%
in. O
15. SAND/GRAVEL PACK:
Depth Size Material IAk. 35' /21 In• 23"l✓
From_To_Ft.
From_To_Ft_
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONS UCTION STANDARDS,AND THAT A COPY THIS RECORAHAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PEKSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)RODNEY ROBBINS CERTIFICATION# 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING County POLK Topographic/Land setting
470 N.PARK LANE ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:BOB JARVIS Latitude/longitude of well location
Address 470 N.PARK LANE _
(Street or Route No.) (degrees/minutes/seconds)
MILL SPRING NC 28756 Latitude/longitude source: ❑GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 28)-863-1314 DEPTH
Area Code Phone number From To
4.DATE DRILLED 09/14/05 _
5.TOTAL DEPTH: 285 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 60 FT. _
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-112 FT. Above Land Surface* LOCATION SKETCH
*Top of casing terminated attor 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): 7 METHOD OF TEST ARD number and common names
10. WATER ZONES(depth): HWY,#9 NN. FROM MILL SPRING.LEFT ON
11. DISINFECTION:Type CHLORYTE Amount 6.5 SILVER CREEK RD.RT.ON LAKE ADGER RD.RT.
ON PARKWAY NORTH.LEFT ON N.PARK LANE.
12. CASING: Wall Thickness HOUSE AT DEAD END OF CUL-DE-SAC.
Depth Diameter or Weight/Ft Material From 0 To 90 Ft 6-1/411 SDR21 PVC a f S50 yJ' 2-T
From To_FL
From To_Ft
T:13. GROU Depth Material Method
From 0 To 20 Ft.OUIKRETE POURED
From_To_Ft o
14.SCREEN: Depth Diameter Slot Size Material
From_To_Ft._ in. in.
From To_FL_ in. in. cn
15. SAND/GRAVEL PACK: o
Ln
Depth Size Material
From To_Ft._
From To Ft.
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
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

'314890
0S-6
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# 2795
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 0 Municipal/Public El Industrial Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town:TRYON County POLK Topographic/Land setting
1307 TURNER RD. ❑Ridge 0 Slope ❑Valley ❑Flat
(Street Name,Number.,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:EMILY TESKY Latitudellongitude of well location
Address 1307 TURNER RD, _
(Street or Route No.) (degrees/mmutes/seconds)
TRYON NC 28782 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (cheek box)
(H3j—569-7466 DEPTH
Area Code Phone number From To
4.DATE DRILLED 07/01/05
5.TOTAL DEPTH: 225 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 60 FT. _
(Use'W'if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface* LOCATION SKETCH
*Top of casing terminated at/or below land surface requires a Show direction and distance in miles from at least
variance in accordance with 15A NCAC 2C.0118. Two State Roads or County Roads. Include the road
9.YIELD(gpm): 20 METHOD OF TEST ARD number and common names
10.WATER ZONES(depth): HWY.#9 S.FROM MILL SPRING,LEFT ON
11.DISINFECTION:Type CHLORYTE Amount 5 TURNER RD.LAST DRIVE ON LEFT BEFORE THE
12. CASING: Wall Thickness VINEYARD.TURN BETWEEN OLD TRAILER AND
Depth Diameter or Weight/FL Material THEGRAPE VINES.STAY RIGHT.HOME SITE ON
LEFT.
From 0 To 100 Ft 6-1/4" SDR.21 PVC
From_To_Ft. ItiF 5SO ila' 171` %s
From To Ft
13.GROU_Depth Material Method > S' 38 03" vi �.
From 0 To 20 Ft.OUHMTE POURED cCi
From_To_FL
14.SCREEN: Depth Diameter Slot Size Material `D
From_To_Ft_ in. in
From To Ft._ is in.
F
15. SAND/GRAVEL PACK: —
Depth Size Material
From_To_Ft_
From To FL
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
SIG14ATURE 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

314891
WELL CONSTRUCTION RECORD D "
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)RODNEY ROBBINS CERTIFICATION# 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#— ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use—
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK Topographic/Land setting
SERPENTINE DR-LOT#64 ❑Ridge ❑ Slope ❑ Valley ❑Flat
(Sheet Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:FRANK MEDLIN Latitude/longitude of well location
Address SERPENTINE DR-LOT#64 _
(Street or Route No.) (degrees/minutes/seconds)
COLUMBUS NC 29722 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
7( 04)-578-6806 DEPT14
Area Code Phone number From To
C DATE DRILLED 07/21/05
5.TOTAL DEPTH: 265 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
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* 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): 50 METHOD OF TEST ARD number and common names
10.WATER ZONES(depth): FROM COLUMBUS.GO OUT SKYUKA RD.
RIGHT ON HOUSTON RD.LEFT ON WHTTE OAK
11.DISINFECTION:Type CHLORYTE Amount 6.5 MTN.RD.GO UP TO TOP OF MTN.LEFT AT
12. CASING: Wall Tbiclmess CONDOS.AFTER RD,TURNS TO DIRT.RIGHT ON
Depth Diameter or Weight/Ft Material SERPENTINE DR APPROX.2/10 MILE ON LEFT.
From 0 To 60 Ft 6-1/4" SDR21 PVC
From_To—Ft.
—
From To Ft C
far/ 35, IL' `fS'Fg" /J
fu,. 2� 13' "
13.GROUT:_Depth Material Method � � -9.11 vi o .,
From 0 To 20 Ft.OUEKRETE POURED t
From_To—Ft -?
14.SCREEN: Depth Diameter Slot Size Material _ o
From_To_Ft._ UL in. u
From To Ft_ is in. -
15. SAND/GRAVEL PACK:
Depth Size Material
From To_Ft_
From_To—Ft_ _
16.REMARKS: _
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
61-1
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

Vl �` "am " 31- 4895
WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME gima) IN MCNEELY CERTIFICATION# 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING.LLC PHONE# (828)•453-0662
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential M Municipal/Public ❑ Industrial El Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town:MILL SPRING County POLK Topographio Land setting
444 KING STEPP RD. ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:TOMMY BATES Latitude✓lorgitude of well location
Address 444 KING STEPP RD. _
(Street or Route No.) (degreedminutes/seconds)
MILL SPRING NC 28756 Latitudellongitude source: ❑GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 28)—388-1301 DEPTH
Area Code Phone number From To
4.DATE DRILLED 07/28/05 _
5.TOTAL DEPTH: 82 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing:AFT. _
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface* LOCATION SKETCH
*Top of casing terminated attor below land surface requires a Show direction and distance in miles from at least
variance in accordance with 15A NCAC 2C.0118. Two State Roads or County Roads. Include the road
9.YIELD(gpm): 20 METHOD OF TEST STEEL TAPE number and common names
10. WATER ZONES(depth): HWY.#9N.FROM MII.L SPRING.RIGHT ON
11.DISINFECTION:Type CHLORYTE Amount 9.2 GRASSY
II ON RIGHT.
RIGHT ON KING STEPP RD.
12.CASING: Wall Thickness 4/10
Depth Diameter or Weight/Ft Material dry+ 35' 23' IS x(�" t-J
From 0 To 82 Ft 24" CEMENT 1On) `6V II' 011M. S lnJ
From_To Ft_
From To Ft
13.GROU_T: Depth Material Method v231
From 0 To 20 Ft CEMENT POURED cCr
From_To Ft t
14.SCREEN: Depth_ Diameter Slot Size Material
From_To_Ft._ in. in. o
From_To Ft._ in. in.
15. SAND/GRAVEL PACK: y
Depth Size Material
From 62 To 82 Ft 78M GRAVEL
From To Ft
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF P 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 Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)DELBERT PITTMAN- CERTIFICATION#2159
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE#(828)453-W2
STATE WELL CONSTRUCTION PERMIT#— ASSOCIATED WQ PERMIT#_
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public Industrial El Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use—
2. WELL LOCATION:
Nearest Town: SALUDA County PO LK Topographic(Land setting
COUGAR LN.RIIivgAVEN-LOT#66 ❑Ridge ❑ Slope ❑Valley ❑Flat
(Sheet Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:DAVID ARNOLD Latitude/longitude of well location
Address COUGAR LANE
(Sheet or Route No.) (degrces/minutes/seconds)
SALUDA NC 28773 Latitude/longitude source: ❑ GPS ❑ Topographic map
City or Town State Zip Code (check box)
9(_04)—824-50140 DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 07/25/05
5.TOTAL DEPTH: 205 —
6.DOES WELL REPLACE EXISTING WELL? YES❑ NOIZ
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. LOCATION SKETCH
9.YIELD(gpm): 12 METHOD OF TEST ARD Show direction and distance in miles from at least
10.WATER ZONES(depth): _ Two State Roads or County Roads. Include the road
number and common names
11.DISINFECTION:Type CHLORYTE Amount 4.5 HWY.#108 W.FROM COLUMBUS.RT.ON
12.CASING: Wall Thiclmess OLD HOWARD GAP RD.RT.ON HOWARD GAP
Depth Diameter or Weight/Ft Material RD,GO TO TOP OF HILL,RT.ON INDIAN MTN.
From 0 To 30 Ft. 6-14" SDR21 PVC RD.CROSS OVER I-26.LEFT ON RMHAVEN DR
From To Ft_ AT INTERSECTION STAY RT.ON RICHAVEN
From—To�_—Ft DR RIGHT ON COUGAR LANE.LOT ON RT.AT
13.GROUT: Depth Material Method DEAD END,
From 0 To 20 Ft.4UHOtETE POURED
From_To_Ft. iA+. 35
14.SCREEN: Depth Diameter Slot Size Material [off
From To_Ft._ in. in.
From—_To_Ft. M. in. C
15.SAND/GRAVEL PACK:
Depth Size Material .o
From_To_Ft— o
From—To—Ft— Ln
16.REMARKS:
—
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED'TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mai(Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

0 `114911
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)DELBERT PITTMAN' CERTIFICATION#2159
WELL CONTRACTOR COMPANY NAME PITrMAN WELL BORING,LLC PHONE#[phone]
STATE WELL CONSTRUCTION PERMIT#— ASSOCIATED WQ PERMIT#
(if applicable) (if applicable) —
1. WELL USE(Check Applicable Box): Residential El Municipal/Public ® Industrial Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use—
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK Topographic/Land setting
413 GILBERT RD, ❑Ridge ❑ Slope ❑Valley ❑Flat
(Sheet Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER: GREEN CREEK WINERY Latitude/longitude of well location
Address 413 GILBERT RD. _
(Street or Route No.) (degrees/minutestseconds)
COLUMBUS NC 28722 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
2J8 —894-0528 DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 07/08/05 —
5.TOTAL DEPTH: 205
6.DOES WELL REPLACE EXISTING WELL? YES® NO❑
7. STATIC WATER LEVEL Below Top of Casing: 60 Fr.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 Fr. Above Land Surface*
*Top of casing terminated atJor below land surface requires a
variance in accordance with 15A NCAC 2C.0118. LOCATION SKETCH
9. YIELD(gpm): 60 METHOD OF TEST ARD Show direction and distance in miles from at least
10.WATER ZONES(depth):, Two State Roads or County Roads. Include the road
number and common names
11.DISINFECTION:Type CHLORYTE Amount 4.5 HWY.#9 S.FROM MILL SPRING.RIGHT ON
12.CASING: Wall Thickness LANDRUM RD.GO APPR03L I MILE.RIGHT ON
Depth Diameter or Weight/Ft Material GILBERT RD.WINERY IS 4/10 MILE ON LEFT.
From 0 To 110 Ft 6-14" SDR.21 PVC --
From To Ft
/7Y 3s' lr{ ' l&.r{7' N
From_To_Ft_ lad YZ° 6' (2.04" v/
13.GROUT: Depth Material —Method
From 0 To 20 Ft OUIKRETE POURED
From_To_Ft
14.SCREEN: Depth Diameter Slot Size Material `D
From_To—Ft.— in. in. - -C� '
From_To—Ft_ in. in. T
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
CON UCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON PONSTMCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)RODNEY ROBBINS CERTIFICATION# 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential 0 Mur icipal/Publlc Industrial Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town:MILL SPRING County POLK Topographic/Land setting
250 BURT BLACKWELL RD. ❑Ridge ❑ slope ❑valley ❑Flat
(Strad Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:RICHARD HOPKINS Latitude/longitude of well location
Address 250 BURT BLACKWELL RD,
(Street or Route No.) (degrees/minutes/seconds)
MH.L SPRING NC 28756 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
SL28)—894-8455 DEPTH
Area Code Phone number From To
4.DATE DR1LIM 06/30/05 _
5.TOTAL DEPTH: 405 DRILLING LOG
6,DOES WELL REPLACE EXISTING WELL? YES® NO❑ From To
7. STATIC WATER LEVEL Below Top of Casing: 60 FT. _
(Use"+-if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface' 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): 9 METHOD OF TEST ARD number and common names
10.WATER ZONES(depth): HWY.#9N FROM MULL SPRING.RIGHT ON
11.DISINFECTION:Type CHLORYTE Amount 10.5 BURT BLACKWELL RD 151 DRIVE ON RIGHT,
12.CASING: Wall Thickness 1,0- 3S° 11' 23,C 3' n/
Depth Diameter orWeight/Ft Material I �2` ic' 2(s,BS" Ljt
From 0 To 160 Ft 6-1/4" SDR21 PVC
From_ ,_To_Ft
From_To Ft
13.GROUT: Depth Material Method
From 0 To 20 FL OUDMETE POUREDLn
From_To_Ft
14.SCREEN. Depth Diameter Slot Size Material
From_To_FL— is in I
_ i I
From_To_Ft is in. -
15. SAND/GRAVEL PACK:
Depth Size Material
From_To_Ft_
From,To_Ft_ J -
16.REMARKS -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF 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

v— c) q�
WELL CONSTRUCTION RECORD Yl
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# t828)453-0662
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential N Mumct flc El Industrial El Agricultural El
Monitoring ❑ Recovery ❑ Heat Pump Water Injection Lj Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town:MILL SPRING County POLK Topographic/Land setting
90 HIDDEN ACKERS RD. ❑Ridge ❑ Slope ❑Valley ❑Flat
(Shed Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER TED FRANK Latitude/longitude of well location
Address 90 HIDDEN ACKERS RD.
(Street or Route No.) (degrees/minutes/seconds)
MILL SPRING NC 28756 Latitudellongitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 28)—625-9901 DEPTH
Area Code Phone number From To
4. DATE DRILLED 06/17/05
5.TOTAL DEPTH: 345 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES® NO❑ From To
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' LOCATION SKETCH
'Top of casing terminated attor 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): 6 METHOD OF TEST ARD number and common names
10. WATER ZONES(depth): HWY.#9 N.FROM MILL SPRING.RIGHT ON
11.DISINFECTION:Type CHLORYTE Amount 9 MCGUINN RD.RIGHT ON BIG LEVEL RIGHT ON
12. CASING: Wall Thickness SOUTH WILSON HHA.LEFT ON HIDDEN ACKERS
RD.2 No DRIVE ON RIGHT.
Depth Diameter or Weight/Ft Material
From 0 To 50 Ft IJK SDR21 PVC
From To_Ft _;
From_To Ft
13.GROU Depth Material Method I r T:
From 0 To 20 Ft OUHMTE POURED un
From_To_Ft
o
14.SCREEN: Depth Diameter Slot Size Material i tft
From_To_Ft_ in in.
From_To_Ft._ in. in.
15. SAND/GRAVEL PACK: - J
Depth Size MaterialFrom To Ft
From To Ft
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF TIESRECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)BODNEY BOBBINS CERTIFICATION# 2795
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]"2
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
L WELL USE(Check Applicable Box): Residential ® Municipal/Public Wustrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump water Injection ❑ other ❑ If Otis,List use_
2. WELL LOCATION:
Nearest Town:COLUMBUS County POLK Topographic/Land setting
431 PEULLIPS RD. ❑Ridge ❑Slope ❑valley ❑Flat
(Street Name,Numbers,Community,Sub(hvision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:CLAUDETTE ROBINSON Latitude/longitude of well location
Address 461 PHILLD'S RD.
(Street or Route No.) (degrees/minutedseconds)
COLUMBUS NC 28722 Latitude/longitude source: ❑GPS ❑Topographic map
City or Town State Zip Code (check box)
(�-863-4373 DEPTH
Area Code Phone numb From To
4.DATE DRILLED 004/05
5,TOTAL DEPTH: 305 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES® NO❑ From To
7.STATIC WATER LEVEL Below Tap of Casing: 60 FT.
(Use"+^if Above Top of Casing)
8.TOP OF CASING IS 1-112 FT. Above Land Surface* LOCATION SKETCH
'Top of casing terminated aUa below land surface requires a Show direction and distance in miles from at least
variance in accordance with 15A NCAC 2C.0119. Two State Roads or County Roads. Include the road
9.YIELD(gpm): 60 METHOD OF TEST ARD number and common names
10.WATER ZONES(depth): HWY.#9 S.FROM MILL SPRING.RIGHT ON
LE RD
11.DISINFECITON:Type CHLORYTE Amount 7.5 DRIVE O`N EFT. LEFT ON PHII LIl'S RD.3BD
12.CASING_ Wall Thickness 'x
Depth Diameter or Weight/Ft Material
From 0 To 140 Ft 6-1/4" SDIL21 PVC
From_To_Ft ` —_-- �4
From ToFt_ r_ "r ;
_ t
13.GROUT_: Depth_ Mateaal Method -� cri
From 0 To 20 Ft OUHCRETE POURED p
From_To_Ft
14.SCREEN: Depth Diameter Slot Size Material
From_To_Ft_ in. in.
From_To_Ft._ in. in.
15.SAND/GRAVEL PACK-
Depth Size Material Zak. S5 12 ZJ. f5�
From_To_Ft_ (�nT $2' S' `Sl.ji 7"Wi
From_To_Ft_
16,REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CON CTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
- - Ci
IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days GW-1 REV.07/2001

N*4h CWQ1m-DePanmae of EnvkeMMM"Nalmar Resouea•DMalan of WNar Cuesly•Oroundwatar Secoon 308350
I
au MAN SM109 Comer-RtIOW N.C.#7eeF/e3I Fhory(f 1a)733a321
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION e: �
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE Appage p set) Residential Munklpet❑ Industrial❑ AprkultUral❑ Monitorklp❑
Recovery 0 meet Pump Water k*wIl n ❑ Othn 0 It O#ror,List use.
Z. WELL LOCATION:(Show Ikek h 0(the bastion below)
NesreN Town f ba��, a
IRe"HMOedNwteara'OPMamb.er Bub&Asbn4"tmm X DRILLING LOG DEPTH
J. OWNER - Z)-� G�i J d s���9 h Fives To
faua�n Mawlp�n
Addren 33�' � � r
Os►erTMel Espy ZIP
4. OATE DRILLEO, j�
B. TOTAL DEPTH -_ `.3 g5Z=
6. CUTTM109 COLLECTED YES❑ NO�
7. DOES WELL REPLACE EXISTING W ELL7 YES NOEa" 3'A
S. STATIC WATER LEVEL Babes Top of Cukg: d FT. t m
i �1uea+•I Above Top M Cut"
B. TOP OF CASWG iS ,"FT.Above Land Surhm* S '
gTer er achy lerw4aete0 ever bel"Mtd serrae Iseukea a earbaoe In eeoat-
ne -� WC)doe weh OA"aftIC.e/1
10. YIELD(Spm): METHOD OF TEST
11.WATER ZONES(dapE1): ��^ a
Op
1 Z. CIILORINA Type Amotlnl — If addlilom!space Y needed use back of krm tV cr
13. CASINO: Cj c-
WM Tlednaa LOCA'11DN SK9MI
aped Dkffdi W Me mo (thaw dlredb an n d d riamo Iron ss;ae le rao Suit
From r' To -n r a�2 Fl. ,�yc- l B a ap Rosda, oNw m nivrome Polm)
Fromm Te FI Infi 35` ll (o•4 2 fJ
From To FL In II .-7S" W
14. GROUT:
Depth Material Method
From L4 To,,;LY _FL _-1,2c' "r -u �d
From To —FL
15. SCREEN:
Depth Olameter Slot Ski Material
From To__.Ft._,.— in. ._ _ kr �
From To.__FL_ h —In --
From To__R._ In. —in •� h, rr >
1S. SANDMIRAVELPACK: 1
Dap61 Site Material C
From To FL�
from To FL
17. REMARKS __.
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRWTEO IN ACCORDANCE WITH 154 HCAC sC.VrELI
CONSTRUCTION STANDARDS,AND THAT A COPY RECORD NAS BEEN PFAMDEO TO TK VML VA%EP
FOR OFFICE USE ONLY
0400 Na t11011ATtIREOF PERSON CON#TRUCTINO THE tmEt1 0a.E
&6dt1*0is comm d wow Ov*.coorom ier$004 r"7vCsys
6srN.. 64.1 y,FY.1271

308492
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
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ if Other,List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS County PO LK Topographic/Land setting
299 PRINCE RD. ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER: NORRIS HAWKINS Latitude/longitude of well location
Address 299 PRINCE RD.
(Street or Route No.) (degrees/minutes/seconds)
COLUMBUS NC 28722 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8(�-863-2421 DEPTH
Area Code Phone number From To
4.DATE DRILLED 02/11/05
5.TOTAL DEPTH: 31 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 21 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface* 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): 10 METHOD OF TEST STEEL TAPE number and common names
10.WATER ZONES(depth): HWY.#221 S. FROM RUTHERFORDTON.RIGHT
ON POORS FORD RD.GO TO STOP SIGN.
11.DISINFECTION:Type CHLORYTE Amount 4.6 STRAIGHT ACROSS ON PRINCE RD.1sT HOUSE
12.CASING: Wall Thickness ON LEFT.
Depth Diameter or Weight/Ft Material .JY`
From 0 To 31 Ft. 24" CEMENT ��( 35a If' 40.73 Ij
From To Ft
From_To_Ft.
_
13. GROUT: Depth Material Method
From 0 To 20 Ft.CEMENT POURED n a
From_To_Ft
14.SCREEN: Depth Diameter Slot Size Material t
From_To_Ft._ in. in. -•
From_To_Ft.— in. in.
15. SAND/GRAVEL PACK: LM
Depth Size Material
From 21 To 31 Ft 78M GRAVEL
From— To—Ft.—
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PEPrl 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

308434
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) NEEL CRAFT CERTIFICATION# 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town:MILL SPRING County POLK Topographic/Land setting
LAND O'LAKES-LOT 945 ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:JOE GAGNON Latitude/longitude of well location
Address LAND O'LAKES
(Street or Route No.) (degreeslminutes/seconds)
MILL SPRING NC 28756 LatitudeAongitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8E28)-696-9287 DEPTH
Area Code Phone number From To
4. DATE DRILLED 02/22/05
5.TOTAL DEPTH: 365 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-V2 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): 4 METHOD OF TEST ARD number and common names
10.WATER ZONES(depth): HWY.#108 E.FROM COLUMBUS.LEFT ON
HWY.#9 N.LEFT ON SILVER CREE RD. RIGHT ON
11.DISINFECTION:Type CHLORYTE Amount 9 BISHOP LANE.APPROX. 1/2 MILE ON LEFT.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 50 Ft 6-1/4" SDR.21 PVC
From_To_Ft
From_To Ft._
13. GROUT: Depth_ Material Method
From 0 To 20 Ft.QUIKRETE POURED nz:
From_To_Ft r v
14.SCREEN: Depth Diameter Slot Size Material 4
From_To_Ft._ in. in. co
From To_Ft.— in in. O
15. SAND/GRAVEL PACK: cn
Depth Size Material
From To_Ft-
From To Ft
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAAT'A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE Of PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-I REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDWIDUAL)NA1vIE (prin[)_,Tamr c to t��mE�t, JS CERTIFICATION# 71 U
WELL CONTRAC1'ORCOMPANYNAME faro[IG WA17 R. plImp (� r T PHONE #.%28) 1153_7-?22
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(it applicable) _ (if applicablcl -
�__.
1. WELL USE(Chick Applicable Box); Residential lP/Municipal./Public ❑ Industrial ❑ Agricultural ❑ -
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use - -
r. rLti
2. WELL LOCATION: - I D Topographic/Lan setting
Neatest Town: 5-� u. O�a. County__ ❑Ridge ❑Slope Galley ❑FTnt= r
�7UP �- L Love Rd.
(check appropriate box)
(Street Naznc,Numbars,Community,Subdivision,Lot No.,Zit,Code) Latitude/longitude of Well locatioT
3. OWNER:I _ (degrces/minutestseconds) J' �C
Address ih,D 4 �p �l N t Latitude/longitude source:❑GPS❑Topogtwgc trap r.-.�.
�- I (Sweet or Roue No.) (check box)
�G I IA(I A- �C DEPTH DRILLiN�rLOG
City or Town State Zip Code From To Formation Description
( )- D 30 Sun Ic Y�ck
Area codo-Phone number
4. DATE DRILLED '� � - l 3J rj a'l<d,il.: tej Vic k
5. TOTAL DEPTH:_ :342�]
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: l0
(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 1C.0118.
9. YIELD(am): r/ Iyy'/jOD OF TEST ,Air J�
10. WATER ZONES(depth): _ Y D '_,!)
LOCATION SKETCH
11. DISINFECTION:Type_(-h 1 n r i n a Amount C a Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the Fgad i'\
Depth Diameter or Weight/Ft. Material numbers and common road[tames. 4},\'`�
From--jaTo 30 Ft. 6 1 14 Zgl?,21 Fuld—
From_ To Ft.
From l o_-_Ft. F �'
13 GROUP. Depth Material Method
P(odr_p__T0_2{1___Ft_
3s 32. z
From To_ icl', f57`
14. SCR}?EN: Depth Oiarreter SlotSizo Material lu� �Z''lBt`i(v5 b✓
From Tu Fr in. in. 'Illy i'
Fr
ont, To Ft, in, in. (
15. SAND/GRAVEL PACK:
Depth Size Material 1 ,
From To Ft.
From To Ft. `]
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�o SIGNATURE OF PERSON CONSTRUCTING THE WELL ll ' I 0�
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27 69 9-163 6 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:MILL SPRING County POLK Topograpbic/Iand setting
476 EDGERTON RD, ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:JOHN PARON Latitude/longitude of well location
Address 476 EDGERTON RD.
(Street or Routs No.) (degrees/minutes/secends)
MILL SPRING NC 28756 Latitude/longitude source: ❑GPS ❑Topographic map
City or Town State Zip Code (checkbox) If .1S°2Z' 21. 33"N
8( 28)—696-4111 DEPTH $Z 9 r /c�•95 ' W
Area Code Phone number From To [on
4.DATE DRILLED 04/04/05
5.TOTAL DEPTH: 43 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 28 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface* LOCATION SKETCH
*Top of casing terminated atfor 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): 15 METHOD OF TEST STEEL TAPE number and common names
10.WATER ZONES (depth): Hwy.#9 N.FROM MILL SPRING.RIGHT ON
MCGUINN RD.LEFT ON EDGERTON RD.APPROX.
11.DISINFECTION:Type CHLORYTE Amount 6.9 1/2 MILE ON LEFT. (476 ON MAILBOX)TAKE
12.CASING: Wall Thickness DRIVE THAT GOES OFF TO THE LEFT.
Depth Diameter or Weight/FL Material
From 0 To 43 Ft 24" CEMENT
From_To_Ft_
From To Ft._
13.GROU_Dept_h Material Method i 3
From 0 To 20 Ft.CEMENT POURED
From_To Ft
14.SCREEN: Depth Diameter Slot Size Material ca
From_To_Ft._ in. in.
cn
From To_FL_ in in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 28 To 43 Ft 78M GRAVEL —
From To Ft
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY O THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SI GNATLUWRE OF WC IN CO TRUCTING THE WELL DATE
Submit the original to the Division of Wa i (fality,Groundwater Section, 1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No. [phone],w ft days. GW-1 REV.07/2001

3114 '7
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) NEIL CRAFT CERTIFICATION# 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public El Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If other,List Use
2. WELL LOCATION:
Nearest Town:MILL SPRING County POLK Topographic/Land setting
HORSE PATH SUBDV.LOT#7 ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:MATT BROWN Latitude/longitude of well location
Address HORSE PATH SUBDV.
(Street or Route No.) (degrees/minutes/seconds)
MILL SPRING NC 28756 Latitude/longimde source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
L8)-582-7411 DEPTH
Area Code Phone number From To
4. DATE DRILLED 04/29/05 _
5.TOTAL DEPTH: 805 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use'Y'if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface* LOCATION SKETCH
'Top of casing terminated at/or below land surface requires a Show direction and distance in miles from at least
variance in accordance with 15A NCAC 2C.0118. Two State Roads or County Roads. Include the road
9. YIELD(gpm): 0 METHOD OF TEST ARD number and common names
10.WATER ZONES(depth): HWY.#108 K FROM MH L SPRING.RIGHT ON
PEA RIDGE RD.GO 8/10 MILE LEFT INTO
11.DISINFECTION: Type CHLORYTE Amount 22.5 HORSEPATH DUBDIV.2110 MILE ON LEFT.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material -
From 0 To 40 Ft.6-1/4" SDR21 PVC 3So ��, {�
From_To_Ft_ t'F
From To Ft. jo. j 82' ` I U W
T: ` -
13. GROU_Depth_ Material Method
From 0 To 20 Ft.OUHCRETE POURED j v ct
From_To_Ft.
14.SCREEN: Depth Diameter Slot Size Material w
From_To_FL_ in in.
From_To_Ft._ in. in. ccn
15. SAND/GRAVEL PACK:
Depth Size Material
From_To_Ft
From To Ft
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT�k COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SANAWRE OF-PERSON CONSTRUCTIN041iE 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.0712001

3 4'77
WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(prim) 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 ® Muntcipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: TRYON County POLK Topographic/Land setting
1795 SANDY PLAINS RD. ❑Ridge El slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:MARGARET SECOR Latitude/longitude of well location
Address 1795 SANDY PLAINS RD.
(Street or Route No.) (degrees(minutes/seconds)
TRYON NC 28782 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
SL28)—863-1238 DEPTH
Area Code Phone number From To
4.DATE DRILLED 04/14/05
5.TOTAL DEPTH: 325 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES® NO❑ From To
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface* LOCATION SKETCH
*Top of casing terminated at/or below land surface requires a Show direction and distance in miles from at least
variance in accordance with 15A NCAC 2C.0118. Two State Roads or County Roads. Include the road
9.YIELD (gpm): 100 METHOD OF TEST ARD number and common names
10.WATER ZONES(depth): HWY.#9 S.FROM MH L SPRING.LEFT ON
SANDY PLAINS RD.1.6 MILES ON LEFT.
11.DISINFECTION:Type CHI RYTE Amount 5 ,
12. CASING: Wall Thickness IF+.
Depth Diameter orWeight/Ft. Material io �2' 3' �7•rFl" td
From 0 To 60 Ft,6-1/4" SDR21 PVC `i ci
,
From_To_Ft._ 0
From
T: To_Ft._ 3
13, GROU_Depth Material Method y
From 0 To 20 Ft.OUHQIETE POURED -_
From To Ft. t z
14.SCREEN: Depth_ Diameter Slot Size Material cJ
la
From To_Ft._ in in. �
From_To_Ft._ is in.
15. SAND/GRAVEL PACK:
Depth Size Material
From_To_Ft._
From To Ft.
16.REMARKS: _
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
'7 /1 ��.� Off'- 6
SIGRATUXE OF PERSON CONSTRUCTING TIM 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

311481
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 N MunicipaltPublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING County POLK Topographic/Land setting
3743 BIG LEVEL RD. ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:ROBERT DUPLER Latitude/longitude of well location
Address 3743 BIG LEVEL RD. _
(Street or Route No.) (degrees/minutes/seconds)
MILL SPRING NC 28756 Latitude/longitude source: ❑GPS ❑Topographic map
City or Town State Zip Code (check box)
8 —625-8824 DEPTH
Area Code Phone number From To
4.DATE DRILLED 04/25/05
5.TOTAL DEPTH: 385 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES N NO❑ From To
7. STATIC WATER LEVEL Below Top of Casing: 40 Fr.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface* LOCATION SKETCH
*Top of casing terminated atior 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 mad
9.YIELD(gpm): 15 METHOD OF TEST ARD number and common names
10. WATER ZONES(depth): HWY.#9 N.FROM MILL SPRING.RIGHT ON E.
11.DISINFECTION:T CHLORYTE Amount 9.5 MCGUINN RD.RIGHT ON BIG LEVEL RD.
Type APPROX. 1 1/2 MILE.RIGHT AT BOX#3743.
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. GROU_Depth_ Material Method
From 0 To 20 Ft.OIJUMTE POURED
From To_Ft i
14.SCREEN: Depth Diameter Slot Size Material W
From_To_Ft._ in. in.
From_To_Ft._ in in.
15. SAND/GRAVEL PACK: cn04
Depth Size Material itl} 35° .28 IJ - M
From To_Ft._ tons 7' 47.6Z" W
From To Ft
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
44
SIGNATURE OF PERSOMCONSTRUCTING 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

311
WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)RODNEY ROBBINS CERTIFICATION# 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK Topographic/I.and setting
688DAY DR ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER STEPHANIE EASLER LatimdcAongimde of well location
Address 688 DAY DR
(Street or Route No.) (degrees/minutes/seconds)
COLUMBUS NC 28722 Latitude/longitude source: ❑GPS ❑Topograpluc map
City or Town State Zip Code (check box)
L�—863-1284 DEPTH
Area Code Phone number From To
4.DATE DRILLED 04/14/05
5.TOTAL DEPTH: 365 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES® NO❑ From To
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' LOCATION SKETCH
*Top of casing terminated attor 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): 100 METHOD OF TEST ARD number and common names
10. WATER ZONES(depth): HWY.#9 S.FROM MILL SPRING.RIGHT ON
LANDRUM RD.RIGHT ON BURGUNDY LANE.
11.DISINFECTION:Type CHLORYTE Amount 9 LEFT ON DAY DR APPROX.1/2 MILE ON RIGHT.
12. CASING: Wall Thickness (688 ON MAIL BOX)
Depth Diameter or Weight/Ft. Material
From 0 To 170 Ft 6-1/4" SDR21 PVC --
From_To_Ft_ "
From To_Ft
T:
13. GROU_Depth Material Method
From 0 To 20 Ft.OUHOtETE POURED {
From_To Ft
14.SCREEN: Depth_ Diameter Slot Size Material
From_To_Ft._ in. in.
Cn
From To Ft._ in. in. En 4"
15. SAND/GRAVEL PACK: 3� 13` 58.37x
Depth Size Material
From_To_Ft
From To_Ft
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
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

3114�
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 ® MunicipalIPublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: SALUDA County PO LK Topographic/Land setting
BOBCAT TRA I LOT#23-RIXHAVEN ❑Ridge [-] Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:JERRY SIFFORD Latitude/longitude of well location
Address BOBCAT TRAIL-RIMAVEN
(Street or Route No.) (degreestminutes/seconds)
SALUDA NC 28773 Latitude/longitude source: ❑GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 43)—442-8981 DEPTH
Area Code Phone number From To
4. DATE DRILLED 04/06/05 _
5.TOTAL DEPTH: 365 DRILLING LOG
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface* 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): 30 METHOD OF TEST ARD number and common names
10. WATER ZONES(depth): HWY.#108 W.FROM COLUMBUS.RIGHT ON
OLD HOWARD GAP RD.RIGHT ON HOWARD GAP
11.DISINFECTION:Type CHLORYTE Amount 9.5 RD. RIGHT ON INDIAN MTN.RD.LEFT INTO
12.CASING: Wall Thickness RDCHAV N ON RDCHAVEN DR LEFT ON TABLE
Depth Diameter or Weight/Ft Material ROCK DR.LEFT ON BOBCAT TRIAL APPR03L 1/4
From 0 To 90 Ft 6-1/4" SDR21 PVC MILE ON LEFT.LOT#23
From_To_Ft_
From_To_FL
13.GROUT: Depth Material Method
From 0 To 20 Ft OUHCRETE POURED
From_To Ft
14.SCREEN: Depth_ Diameter Slot Size Material _ g
From_To_Ft._ in in.
From_To_FL_ in in. o
15. SAND/GRAVEL PACK: SS° /� 7"N c.n
Depth Size Material �°�
From To_Ft_ o.v� �Z" /it, 2S.9Z' 7
From To_Ft
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD 3 O 8 8 1 5
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACFOR(WDIVD)UAL)NAME (print) Tames W Compr .Tr_ CERTIFICATION# 21 3R
WELL CONTRACTOR COMPANY NAME ralapl a Wpl 1 & pttmp rn r TnC PHONE # �6 84�2
STATE WELL CONSTRUCTION PERMIT# -- ASSOCIATED W Q PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential DY Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery O Heat Pump Water Injection❑ Other D If Other,List Use
2. WELL LOCAT ONZ ( Topographic/Land setting
Nearest Tow : County yX,�t. ORidge YAope OValley []Flat
- ( eck appropriate box)
(Street Name,Numbers Coommality,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: (degrees/minutes/sewnds)
Address S 9_'l Latitudellongitude source:DGPSOTopographic map
(�(� ,(Street or Route d .) (check box)
5
..1111J DEPTH DRILLING LOG
city orTbwn State Zip Code From To F D nation Descrip' n
L—)_ 0 �i)
Area code-Phone numbe J�4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES O NOl
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use"V'if Above Top of Casing)
8. TOP OF CASING IS 1 FT.Above Land Surface*
"Top of casing terminated actor below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): \(I METHOD OF TEST Air
10.WATER ZONES(depth): �-I.{O LOCATION SKETCH
11. DISINFECTION:Type Chlor t ne Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common r�o�a�pames.
From 0 To 1D� Ft. 6 1 /4 SDR21 PVC 1'�J2' l0-�l�
From To Ft.
From To Ft. - Q 11 S IA "W
13. GROUT: Depth Material Method
From 0 To_2,0_Ft. Neat Cement Hand
From To Ft. •l
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material IJ
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL - -
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OVER
SI ATURE F PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. _ pp
GW-1 REV.09/2004
i

309998 A&F WELL DRILLING
AND PUMP SERVICE,INC.
Harth Caroms.D*prrr�maErnAmowmns dKa�lRe C i-MA'IO1OfWµHCAMW.Bss 74
raundwKaS��11 Hwy. BC 28018
7a2xMoMtlatrke Comm-RNNar,N.QYtElF1GM44r wp19)733-3221 Bo2i -247 28018
828-247-1773
WELL CONSTRUCTION RECORD WELLCONTRACTOR:
WELL CONTRACTOR CERTIFICATION f: -
STATE WALL CONSTRUCTION PERRMITO:-Tk�"f�`'7 --
1. WILL USE ApplkaMa tw.fI, W.W� MunmW© pWuarid Ll AW"Utid❑ Monllorrp❑
ftecomyo Heal Pump Water ktotw❑ Olhor[3 It Oder,UattHe:
2_ WELL LOCATIOtI (Show of the la aeon blow)
NoaraNTowrt�i /'-"' s CawY: B
pNMHMOw►Orrhwt�pemnWy,wa��Ar�I ardLaNv.) ORILLMGIOG DEPTH$. OWNER j7e&'I.IAY r %e3i i 7�.. .� TO farra:orrWs '
pgarTara► elMa
$Cody
4. t)ATE VAILLeD //'6
B. TOTAL DEPTH Z
B. CUTTMIGS GOI.IECl YES❑ NOD, —r
7. DOES WELL REPLACE FJUM40 WEu 9 YES�] NOQ
S. STATIC WATER LEVEL$4bw Top of Caskw 4',0 FT.
r �y:r pMd4'allraaio►NCtlaq) _ --�e---�-
s. TOP OF CASM ISJ--7..__ FT.AbM Lu d Sob N
'Fat M o.abra NrrrrrrrMa Wor►alerinra nrraea ragaK�■wrNnsr M aeoor-
ArrcawNrlaANCACne.atta
10. YIELD(Itpm1: METHOD OF TEST l r" — 7�
11.WATER ZONES(depth): -
12.CHLORINATION. Type ,(' T' ARWW x BMW"epee Y traadd use backa lcnrr
13.CASINO: i1-3 _MA
0 Wor " mile" tsMw dkeeft and d+�t ram 01 I"S:ao l3+aa
FmMlQP—To��j FL Q I/u -�vc-_ Roads.W 0ow mop mkm o Pow!
Float-..---To FL
From To�FL
ii.GROUT. —
Depth G Mabdd Mow .
From LQP—To _FL_ nn�9 jX _ Iwt 35` I 3k'Ng N s-
T..
From To F1
IS.SCREEN: n
Depth tHaraater Slot Sizi Mals"I
Flom To - Ft. _ in. �rt ..
From To FL— in. °O c-
From To FL— kL W -
t,1lr.L o
1a SANOftiRAlEt.PACK: - -
D"m Size Maw" G,
From To F1.-
From Ta FL- — -- 44 k J,e!/
17. REMARKS:
IDONLRESY CERTIFY TNATTMWH.L WAS CONSTRUCTE01MAOCOROANCE WITH ISA NCAC2C-VIELL
CONSTRUCTION ETANOARM AND THAT AC 3PY OFTta RECORD NOS BEEN PWMt)EO TOTNE yf%L CYANEF.-
FOR OFFICE USEONLY MONA- oFPgP-Wm%AmjnU lW1RFWftL Br:E
Orders �+10WAAftdW&W0eft-oWP rEWNOW$Tdlfh70Gsys
trra PEv.tzn
SO"era.

31 Q Q A&FWELLDRILU I
AND PUMP SERVICE, NC.
11 Hwy.Business 74
tsenh Cweam•tbpowoW t e1 EnWmftr*re wed Nehwd Rwwuex-DNMton of WOW Owr♦tr• "Ss`OO1a Bostic' NC 28018
loos ma SWAN Cemw-RMoId Km time-i 76 hww p1m Mmmt 828.2-47.1773
WELL CONSTRUCTION RECORD WELLCONTRACTOR:
WP.LL CONTRACTOR CERTIFICATION M_
,.,/MATE WELL CONSTRUCTION MAAITN: ,,Q 2
1.• WILL USE�.ot Applka ����LJ
u mmi*b© M"Wd❑ A9rfwNwd Elo�"O 0
Reoowry p Hod FIRM WSW Iftecown ❑ o9w o N okw.wt u..:
z WELLI.00At10N (W"adubh fftImUmWOO
oMetMrsneNsrew600tiwMiM•wSiASMMnwbtelNs) ORILLMQl00 - D°PTH
a OWNERR „ iTcG �, sloe Tofam as.A o.aeY►Yo+
AddtMS / _ T _o Esc �S
d ct S G '
wTaw anY "t
4. bAya opM "ff ;21-
S. TOTAL DEPTH
S. CUTTMNiS ODU ECTEO YEt3 Q NO(T� .,_
7. DOES WELL REPLACE 6XIS M WH U YES❑ NOQ — M
S. STATIC WATER LEM 0 11iYTOP OI COetnS _X:? FT. � -
PuewAawltepNCwsed p
s. TOP OF CASH IS P q" FT.MM Lmd StObW
'twers slneiwotowd stow bdwMelsate"mod"s vmkw Mom"
4wr;ewM OA NCACIGatts
III.YEW(wo. .�< METH00 OF TEST R i r
11.WATTZ0NU(dp/t):._;�-11 '/
IL CIE ORNfATN7N: Typo �rMOWM adNtlaal WsoO N^adsd�adN k�m
13.CA81NI1: r3�' • WCA�1(KMS912L
OY wrtdet+rw p w dh albnwiddleMUMRar
iesrra 'o
From:�_To /FL (,VL4" .�! Rube.eretMmoP P"'
From- To FL� MLO(Mc Ay
I
From To— FL
DIP6 , Ciii awMiX � a .
From �To 12c_ FL 1�
From To FL
1S. SCAEElt DOPE♦ VAMOrr SrlSki MMi Y
From • To`Ft .--
From To—FL— Mt.
IS.SMI MAV6.PAM' 3
DOpth SW Mde"
From
From To Fi.._--
1T.Rf:wIARKS: "
t 00 FIERHS1f t�IT�1f THAT7lpS WELL WAS CONSTAIIDTED W/1CCORWWCB WIM tSA ?O�TIS��OO�E�
�N$TRtICTtOlI i7ANDNWS.Atip THAT At�PY OF 11115 REt:ORO NAS SEEN PROVIDED � �'Z? S
a
FOR OFFICE ME ORLY y.E
DweME NDMAIUIWOiPERlDR001gito lNS �OCsYs
,,,_,.,,,_,r seee+twt�rwrt>IIIdIeNwwrOe�an �" �,,,►�v.,:n
3461 -

1 1 &
307474
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 ® Mumcipal/Pubhc ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK Topographic/Land setting
81 SMITH WALDROP RD. ElRidge El slope ElValley ElFlat
(Street Name,Numbers,Comrnn)ppurrity,Su ' 'sion,Lot No.,Zip Code) (check appropriate box)
3.OWNER: 6RT tX-Ot¢- Latitude/longitude of well location
Address 81 SMITH-WALDROP RD.
(Street or Route No.) (degrees/minutes/seconds)
COLUMBUS NC 28722 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 65)—604-2472 DEPTH
Area Code Phone number From To
4.DATE DRILLED 01/07/05
5.TOTAL DEPTH: 605 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface* 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.0I I& Two State Roads or County Roads. Include the road
9.YIELD (gpm): 1 METHOD OF TEST ARD number and common names
10. WATER ZONES(depth): HWU.#9 S.FROM MILL SPRING.M LEFT ON
FOX MTN.RD.JUST BEFORE CROSSING THE BY-
11.DISINFECTION:Type CHLORYTE Amount 16.5 PASS, TURN LEFT ON SMITH WALDROP RD.2
12. CASING: Wall Thickness HOUSE ON LEFT.YELLOW SIDED DOUBLE WIDE.
Depth Diameter or Weight/Ft. Material
From 0 To 60 Ft, 6-1/4" SDR21 PVC 144 'So Ib' (5.IS " TJ
From_To_Ft._ (� %Z" `T' 3+1 LJ
0
From_To_Ft _
13. GROUT: Depth Material Method a
From 0 To 20 Ft.OUHMTE POURED t =i
From_To Ft.
14.SCREEN: Depth_ Diameter Slot Size Material o r, Y
From_To_Ft._ in. in.
From_To_Ft._ in in.
15. SAND/GRAVEL PACK:
Depth Size Material
From_To_Ft.
From_To_Ft.
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

DkIl
WELL CONSTRUCTION RECORD
North Carolina-Department of Environmem and Natural Resources-Division of Water Quality-Groundwater Section o /
WELL CONTRACTOR(INDIVIDUAL)NAME (print)KENNETH MCCRARY CERTIFICATION#2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC.IBARKER WELL&PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box):Residential M MunicipaVPublic❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
-n
2. WELL LOCATION: Topogmphic(Landsetting ---
Nearest Town: SALUDA County POLK ®Ridge ❑Slope ❑Valley ❑Flat
GREENVILLE STREET (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location'-:
3. OWNER: RICHARD RAUSCHENBACH (degrees/minutes/semnds) '
Address 187 GREENVILLE STREET Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (cheek box)
SALUDA NC 28773 DEPTH DRILLING LOG --
Ci y or Town State zip Code From To Formation Description Ty 9
( 828)- 749-9698
Area code-Phone number r A -'A r l
4. DATE DRILLED JANUARY 11,2005 Ri L
5. TOTAL DEPTH: 705 'qtT
6. DOES WELL REPLACE EXISTING WELL? YES A NO M pp
7. STATIC WATER LEVEL Below Top of Casing: 605' FT. to Z
(Use"+"if Above Top of Casing) -0
8. TOP OF CASING IS 1.33 FT.Above Land Surface* p fl
*Top of using termloated atlor below land surface requires a x
variance in accordance with 15A NCAC 2C.0118, N`✓
9. YIELD(gpm): 3 METHOD OF TEST TIMED n
10.WATER ZONES(depth): LOCATION SKETCH
11. DISINFECFION:Type ev PUMP INSTALLER Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the rooadd._ ��
Depth Diameter or DR21 Ft. Material numbers and Vd common road a2 M„.K,�J2rlx�.�
From 0 To 74 Ft. 61/8 SDR21 PVC l�/dI ,�i.rf,-t.- /p uA-�
Fro To Ft
From To Ft An� AJ � O �
13. GROUT: Depth Material Method J (U- ,f tU d a_nd X0
From 0 To 20 Ft, CONCRETE POURED AO.lt, I I Ka-c ',/,,tnFrom To Ft. T 4lA.ur-e- ., ._J
14. SCREEN: Depth Diameter Slot Size Mater al �j ,�r,'iP(N�yo-t Lt%uti
From To Ft. in. in.
n. „„ „ . p„,iI /„, %L=�"1
From To Ft. in. in (7(,CAA•�1�6„LIiO(�i�. ,,/�
15. SAND/GRAVEL PACK: �,-Q�/1, ,`(J `�',
Depth Size Material
From To Ft. � > V 14' 0,C 3 • N
From To FL (v y 20 21 ' (I •ZI " IAA
nr�
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTINU THE bWLL DA IE—
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

zeb
North Carolina-Department of Environment and Natural Resources-Division of Water Quality.Groundwater Section 306758
1636 Mail Service Center.Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION#:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(check applicable Box): Residential IR Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other M If Other, List Use:
2. WELL LOCATION: Show sketch of 1e location below)
Nearest Town: _County:
(Road NaIR
Cc m unity,or S ivislon and t No.) DRILLING LOG DEPTH
3. OWNER From To Fom a1. nDesc p on
Address e
et or o. �y
City rTom State Zip Code
4. DATE DRILLED -Ica
5. TOTAL DEPTH e
6. CUTTINGS COLLECTED YES 0" NO[:]
7. DOES WELL REPLACE EXISTING WELL? YES n NO®
B. STATIC WATER LEVEL Below Top of Casing: 1 FT.
(Use'+'it Above Top of Casing(
9. TOP OF CASING IS�_ FT.Above Land Surface.
'Top of casing terminated atfor below land surface requires a variance In motor-
dance with 16A NCAC 2C.0118 � ;G
10. YIELD(gpm): T JA—M OD OF TES a 4
11. WATER ZONES(depth): � _TS�D -,-
12. CHLORINATION: Type 22(�Amount If additional space is needed use back of torm•' -
13. CASING:
Wall Thickness LOCATION SKETCH
Depth DDiiaaem�eter or WeighVFt. Material (Show direction and distance from at least two Stat
From l�TO _l/J' Ft. IWIi ;Q jai 02 '(_ Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From �_ To _a&_2 Ft. �-•�� ���¢
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material v
From —To—Ft— in. _ in. Texlke
From To_Ft._ in. _ in.
From To_Ft._ in. in.
16. SAND/GRAVEL PACK:
Depth Size Material From To Ft.
From To Ft. ,tmc*-P
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY /A p5—
Quad No: SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality,Groundwater Section Within 30 days
Serial No.
GW1 REV.72/99

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: TRYON County POLK Topographic/Land setting
HOOPER CREEK RD.-LOT#17 ❑ Ridge ❑ Slope ❑ Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:ALLAN BENNETT Latitude/longitude of well location
Address HOOPER CREEK RD.-LOT#17 _
(Street or Route No.) (degrees/minutes/seconds)
TRYON NC 28782 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
(S�—829-3707 DEPTH
Area Code Phone number From To
4. DATE DRILLED 09/16/05
5. TOTAL DEPTH: 205 DRILLING LOG
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 40 FT. _
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1-112 FT. Above Land Surface* LOCATION SKETCH
*Top of casing terminated attor 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): 15 METHOD OF TEST ARD number and common names
10. WATER ZONES(depth): HWY.#9S.FROM MILL SPRING.RIGHT ON
LANDRUM RD.RIGHT ON RED FOX RD.RIGHT
11.DISINFECTION:Type CHLORYTE Amount_ ^^rrw RD. 1.1 MILE ON RIGHT.
12. CASING: Wall Thicknc
Depth Diameter or Weight/Ft
From 0 To 130 Ft. 6-1/4" SDIL21
From_To_Ft._ Ca V1 k r�'
From_To_Ft._ o
13. GROUT: Depth Material Med
From 0 To 20 Ft. QUHCRETE I N� ,-Ou'✓a
From_To_Ft. '`�
14-SCREEN: Depth Diameter Slot Size o
From_To_Ft_ in _
cn
From_To_Ft._ 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 ACl,vn,.,. ._ 5A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON eONSTRUCTING 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

oit 314892
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 I@ MunicipaWublic El Industrial ❑ Agricultural El
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: TRYON County POLK Topographic/Und setting
269 LITTLE MTN.RD. ❑Ridge ❑ Slope ❑valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:PAUL BEH,ER Latitude/longitude of well location
Address 269 LITTLE MN.RD.
(Street or Route No.) (degrees/mmutes/secon ls)
TRYON NC 29782 Latitude/longitude source: ❑GPS ❑Topographic map
City or Town State Zip Code (check box)
@64)-863-5428 DEPTH
Area Code Phone number From To
4.DATE DRILLED 07/20/05 _
5.TOTAL DEPTH: 405 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 10 FT.
(Use`.+"if Above Top of Casing)
8.TOP OF CASING IS 14/2 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): 3 METHOD OF TEST ARD number and common names
10.WATER ZONES(depth): HWY.#9 S.FROM MH L SPRING.RIGHT ON
HUGH CHAMPION RD,RIGHT ON PENIEL RD.
11.DISINFECTION:Type CHLORYTE Amount 10.5 LEFT ON LITTLE MTN. RD. DRIVE ON LEFT.
12.CASING: Wan Thickness
Depth Diameter or Weight/Ft Material
From 0 To 40 Ft 6-1/4" SDR21 PVC
From_To_Ft_ v
From To Ft
T:
13.GROU_Depth Material Method
From 0 To 20 Ft.OUHMETE POURED r
�D
From_To Ft o
14.SCREEN: Depth Diameter Slot Size Material Ln „4
From_To_Ft_ in. in.
From_To_Ft
15. SAND/GRAVEL PACK: _
Depth Size Material
From_TO_Ft.
_
From_To_Ft T
16.REMARKS: - - -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED'TN ACCORDANCE WITH 13.Y NCAC 2C,WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
� -D S
S1 KnlsSTRUCTING 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)�nlltr t //C� KAD e(e S T/L CERTrnCAATION#17 S 2/
WELL CONTRACTOR COMPANY NAMES to Q LV�/ W/Q PCr PHONE # 1BZb1 67 q�O 7O
STATE WELL CONSTRUCTION PERMIT# 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
2. WELL LOCATION. Topographic/Land setting
Nearest Town: to county, Po/k ❑Ridge Effo ❑Valley ❑Flat
f�ls S'I fY hvfeE DR Z 7/7 (checkappropriateboa)
(SUM Comm I( wiry,subdi//viaioo�,/[a No.,Tap code) Latititde/longiwde of well location !
3. OWNER:Rf2 4 TPQat/ tAfJ7Ib/U (degreealmmuwslseconds)
Address /f S Y /bo Latitude/longitude source:❑GPS❑Tgpog_gphic map
(s or Route No.) (check boot)
___s ne 297/Z DEPTH _____GI _---
City mTown State tip code From To Formation Description - ---- -
Am cod Phone number
4. DATE DRILLED — 'G
5. TOTAL DEPTH-,
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO r:t
7. STATIC WATER LEVEL Below Top of Casing:
�q.q (Use"+^if Above Top of Casing)
8. TOP OF CASING IS—L-? FT.Above Land Surface• W
`Top of casing terudaated War below land surface requim a '
varlaow 1n aeeordaoce with 1SA NCAC 2C.011&
9. YIELD(gpm):_1L METHOD OF TEST M
10.WATER ZONES(depth): e�
LOCATION SKET�
11. DISINFECTION:Type C G Amount JL2 07 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the mad
Depth pimaeter ay t PU G numbers and common mad names.
Fro To��Ft(� Y5� S
From,To Ft
From Ft De
13. GROUT: Depth _ Material i mew
From "I Tom F[ ( t C E
From To Ft
14. SCREEN: Depth Diameter Slot Sim Material t
From To Ft m, in.
From To Ft in. in. S
15. SAND/GRAVEL PACK
Depth Sim Material
From ": To Ft.
From To Ft. of
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C,WELL
CONSTRUCTION STAND THAT A COPY OJ�HAS PROVIDED TO THE WELL OWNER
.(mot S
SIGNATURE OF PERSON CONSTRU THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality_
WELL CONfRACTOR(INDWEDUAL)NAME (print) JaMeS W. amp ,Tr_ CERTIFICATION# 713R
WELL CONTRACTOR COMPANY NAME Camp' c 'W421 I R PnmP ran _r Tnr• PHONE # 6 $�2
STATE WELL CONSTRUCTION PERMIT# - ASSOCIATED WQ PERMIT#
(if applicable) (if applicable) _
1. WELL USE(Check Applicable Box):Residential Ll"Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery O Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCAT N: Topophic/Land setting
Nearest Town: 'wCo11`mty Mdge Cope OValley DFlat
(check appropriate box)
(Street Name,,Numbers,Community,Subtlivision,Loft No.,Zip Code) Latituddlongitude of well location
3. OWNER: \ n 1K1 �,t l,{(y�JC'; (degrees/minutes/seconds)
Address p D oX S Latitude/longitude source:DGPSOTopographic map
(Street or R,oy�No.) (check box)
�AK� 1 uYe N ( �g 7 t� �i DEPTH DRILLING LOG
City or Town State Zip Code From To F nation Description
Area code-Phone number 0
4. DATE DRILLED
5. TOTAL DEPTH: q U S
6. DOES WELL REPLACE EXISTING WELL? YES O NO d
7. STATIC WATER LEVEL Below Top of Casing: U U T. n
(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 r7
variance In accords.fee with 15A NCAC 2C.0118.
9. YIELD(gpm): METHOD OF TEST Air
10.WATER ZONES(depth): 5
LOCATION SKETCH
11. DISINFECTION:Type chlorine Amount CIALP Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Dep Diameter or Weight/Ft. Material numbers and common road names.
From 0 To�Ft. 6 11 SDR21 PVC
From To Ft.
From To Ft. --
13. GROUT: Depth Material Method
From 0 To_2lLFt. Neat Cement Hand
From TO Ft. ,,,�
14. SCREEN: Depth Diameter Slot Size Material p„
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
CONS UCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
' 6 - 0 -IJS
IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
r— --- —,
Submit the original to the Division of Water Quality,Attn:Informall yrn I,l�fanag�en�16b711�i1��rvt�eK}eter-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW!1'RV.09/2004
'� 7 L' '1

WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality-
WELL CONTRACTOR(INDIVIDUAL)NAME (print) rr f'a m n .T r- CERTIFICATION k 71 3 R
WELL CONTRACTOR COMPANY NAME ramp' S Well R PUMP r r Trio PHONE P 612A�2
STATE WELL CONSTRUCTION PERM"# ASSOCIATED WQ PERMIT#
( (if applicable)
if applicable)
1. WELL USE(Check Applicable Box):Residential tY�Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery O Heat Pump Water Injection❑ Other O If Other,List Use
2. WELL LOCAT N: �1Q. Topographic/Land setting
Nearest Town: 'xCo}(rlty pJIU� ORidge �31ope Walley OFlat
(check appropriate box)
(Street Name,Numbers,commmity,SubUivision,Lot No,Zip Code) Latitudellongitude of well location
3. OWNER: (degrees/minutes/seconds)
Address 0 oX fi Latitude/longitude source:OGPSOTopographic map
u ,ee or Roy�(NoJ ^ n ^ J (check box)
N d�D -I b DEPTH DRILLING LOG
City or Town state Zip Code From To F t aation�Descriptton
Area code-Phone number
4. DATE DRILLED=� U S
5. TOTAL DEPTH:
6. DOES WELL REPLACE EYdSTBQG WELL? YES O NO �-
7. STATIC WATER LEVEL Below Top of Casing _U__FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1 FT.Above Land Surface7A
-Top of casing terminated eVor below land surface requires a C-2i
variance in amord!4"with 15A NCAC 2C.0118. ...�
9. YIELD(gpm): J MEETHOD OF TEST Air Y
10.WATER ZONES(depth): �y O LOCATION SKETCH
Show direction and distance in miles from at least
it. DISINFECTION:Type Chlorine Amount two State Roads or County Roads.Include the road
12. CASING: Wail Thickness numbers and common road names.
Delp Diameter or Weight/Ft. Material
From 0 To�Ft. 6 1 /d SDR21 PVC _
From To Ft.
From To Ft. -
13. GROUT: Depth Material Method
From 0 To 20 Ft. Neat Cement Hand
From To Ft. p,,
14. SCREEN: Depth Diameter Slot Size Material
From To Ft._in. in. .�
From To FL. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material L
From To Ft.
From To Ft. -
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONS UCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IGNATURE 0 PERSON CONSTRUCTING THE WELL DATE
1Vlsln�tg
Submit the original to the Division of Water Quality,Attn:Information ement;'1611➢.I�IA'is
bvic@T,,e e ;
et -
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. - GW-1 Vi(19/2004
'USN 2 7 2005 1.
i I 1

306757
North Carolina-Department of Environment and Natural Resources.Division of Water Quality-Groundwater Section
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION#:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential2 Municipal ❑ Industrial❑ Agricultural❑ Monitoring❑
Recovery❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATIOtJ;(Show sketch of the location below)
Nearest Town: County:l"�
c���
(RoadA ama and Numbe s,Co rpty,or Subdivision tl t No.) DRILLING LOG DEPTH
3. OWNER E From TOFoaration Description
Address
treat or o O.
Ciry own Slate Zip Code
4. DATE DRILLED
5. TOTAL DEPTH .
6. CUTTINGS COLLECTED YES ED' NOO
7. DOES WELL REPLACE EXISTING WELL? YES NO®
8. STATIC WATER LEVEL Below Top of Casing: 4 /�FT,
(Use':if Above Top of Casing)
9. TOP OF CASING IS�_ FT.Above Land Surface'
'Top of casing terminated atror below land surface requires a varlance In accor- C 11
dance with 15A NCAC 2C.0118 —
10. YIELD (gpm): _/ _ METHOD OF TEST "
11. WATER ZONES(depth):
12. CHLORINATION: Type Amount/To"
If additional space is needed use back of forGi=
13. CASING:
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two StaiF C
From TO-azL Ft. l/a on e _
Roads,or other map reference points)
From To Ft.
From To Ft. -19
14. GROUT:
Depth Material ethod
From D To r?e Ft. �
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
A
From —To— Ft— in. _in.
From To—Ft._ in. — in. Stu
From To—Ft._ in. — in.
�( n
16. SAND/GRAVEL PACK: No�er� c3
r
Depth Size Material
From 1fE�To Ft. #
From To Ft. �y
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No: SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Serial No. Submit original to Division of Water Quality,Groundwater Section Within 30 days
GW1 REV.12/99

3 (168
ap
' ' '. -Diviaian of Water Quality-Groundwater Secuon
w1Qa cattit►cit�` tatiull4 Tames—::^raul{a, Jr cPRTmcwnoN s 21.3B
WEILC0NTR&Cr0RC0WANYNAMEC' mg 14e11 X PUMP C'm r Tnr PHONE #A9M e5z_7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) _ (if applicable) -
1. WELL USE(Check Applicable Box):Residential r Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCAT N:, TopograplliclLan setting
Ne est own: ounry ❑Ridge ❑Slope alley ❑Flat
L,( ,px_ (check appropriate box)
(Sveet Name,Numbers,Community,Subdivision,Lot No.,Zip code) Latitude/longitdde of well location
3. OWNER: Y ' �X. wn- (degmedminuteslseconds)
Address Z Owl A1' Latitude/longitude source:❑GPS❑Topographic map
I cr e W NO.) DEPTH (cheett bob
C DRILLING LOG
City or Town sure tip Code From `;02 F Imatio Dec 'ption
Cam- �
Area code-Phone number
4. DATE DRILLED — ir) `J
5. TOTAL DEPTH: 4:�__T �I' 8
6. DOES WELL REPLACE EXISTING WELL? Y NO 'k
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use"P'if Above Top of Caning) L
8. TOP OF CASING IS 1 FT.Above Land Surface'
-Top of casing terminated stior below land surface requires a iV
variance In accordsn with 15A NCAC 2C.0118.
9. YIELD(gpm): ME HOD OF TEST; r 0
10. WATER ZONES (depth): (�
LOCATION SKETCH
11. DISINFECTION:Type Ch 1 =i n a Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft.. .Material numbers and co on road names.
From_n To 'a� Ft, C, 3 1¢ SD221 PVCr- u/µy
From To Ft.
From To Ft.
13. GROUT: Depth Material Method f
FronLp To--2q—Ft. rsea# Gef ant Henri 1!'
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in, in. v
From To Ft. in. in.
15, SAND/GRAVEL PACK:
Depth Size Material -
From To Ft ftAAA
From To Ft ,.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
Ds
SIGNATURE OF P N CONSTRUCTING THE WELL I lf DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No,[phone],within 30 days. GWd REV.0712001

3114'' `4
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) NEIL CRAFT CERTIFICATION# 3114
PHONE# [phone]
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC L
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ if Other,List Use
2. WELL LOCATION:
Nearest Town:MILL SPRING County PO LK Topographic/Land setting
SILVER RIDGE RD.-KIT#21 ❑Ridge ❑ Slope [I Valley [I Flat
(Street Name,Numbers,Community,Subdivision.Lot No.,Zip Code) (check appropriate box)
1 OWNER:MHCE&LAREN MESH Latitude/longitude of well location
Address SILVER RIDGE RD..-LOT#21 (degrees/mmuteslseconds)
(Street or Route No.)
MH.L SPRING NC 28756 Latitude/longitude source: Elk bo ❑Topographic map
(check box)
City or Town State Zip Code
DEPTH
9( -997-1207
From To
Area Code Phone number
4.DATE DRILLED 04/22t05
5.TOTAL DEPTH: 405 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 11=1/2 FT. Above Land Surface* LOCATION SKETCH
*Top of casing temrinated at/or below land surface requires a Show direction and distance in miles from at leas[
variance in accordance with 15A NCAC 2C.0118. Two State Roads or County Roads. Include the road
9.YIELD(gpm): 4 METHOD OF TEST ARD number and common names
10.WATER ZONES(depth): HWY.#9 N.FROM MILL SPRING.LEFT ON
SILVER CREEK RD.CROSS GREEN RIVER RIGHT
It.DISINFECTION:Type CHLORYTE Amount 10.5 ON LAKE ADGER RD.LEFT ON N.HIGHLAND RD.
12. CASING: Wall Thickness 1s RIGHT ONTO SII VER RIDGE RD.3/10 MII E
Depth Diameter or Weight/Ft Material ON LEFT.
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 R.OUIKRETE POURED 3C
From_To F[
pc
14.SCREEN: Depth_ Diameter Slot Size Material —
From_To_R._ in. in.
From_To_Ft._ in. in. CC=)
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
CONSTRUCTIONNSSl�RUCTION STANDARDS, AND T)IAT A COPY OF TIES RECORD 14A1S BEEN PROVIDED TO THE WELL OWNER
SIWATUKE OF PERSON CONSTRICTING CONSTROCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 MW Servlcc Center-Raleigh,NC
27 9-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

31101. 4
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and NaturalResourcces/-Division of Water Quality-Groundwater Section (/
WELL CONTRACTOR(INDIVIDUAL)NAME (prlatJ)9//&? C /�fl(Yl2a.S �IZ CERTII+ICppATION'#— /
WELL CONTRACTOR COMPANY NAME�I.t)rpLy l)7 /f/ (�( /�/'/ PRONE #
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box):Residential O--Municipal/Pubhc❑ Industrial❑ Agricultural❑ -
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCAT N: Topo d setting i
c N]/�ICs[s Town: e" County Polk
❑Ridge lope ❑Valley E�Flat
5`O I* ,y lyar46 d&e ,�nP/' N01 M (checkapww. boa); '
(Suet Name,Ni6obas,Community.Subdivlaes,10 l4o. T,p Code) Latitudelloagitude of well iQwtttln
3. OWNER:1) 4Nito O/UPa-1 ( ),
Address 4r LatitudcAongitude source:OGPS❑Topogrsphic map
(chwkbox)!,i
�/
K(A v'/'Y�ot"Q rrt� 72 7 k b ED PTI; DRA I;ING i _-
City or Town State zip Code From To Formation Description
L�
Area coda Phone aumba
4. DATE DRIIZED
5. TOTAL DEPTH: Z 5
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO 1�
7. STATIC WATER LEVEL Below Top of Casing: '>'J FT.
(Use-+"if Above
Top of Casio -;-,
S. TOP OF CASING IS FT.Above Land Surface' y-
'Top of cadug tenabated atlor below land surface requires a :.,t
vnisoce in accordance with ISA NCAC 2C.0118. W
9. YIELD(gpm): 16) —METHOD OF TEST /11"t`0
10.WATER ZONES(depth):
I OCATION SKF TCHLn
11. DISINFECTION:Type Amount /Q o Z Show direction and distance in miles from at leas4w,
12. CASING: ,� Ft- y/
Dra�pur Wall Thickness two State Roads or County Roads.Include the
From t4 or S/J2 Weight/Ft.
t (J numbers and common road names.
From_To�(�Ft e
From To Ft
13. OROLTT:_� Depth Material Method y e//
Fro To 270 Ft 041P le 10
From To Ft N L
14. SCREEN: Depth Diameter Slot Size Material U)
From To Ft in. in. f
Fro To Ft in. in.
15. SAND/G VELPACK.
Depth Size Material
From LTo—Ft. - C
From_LTo Ft. O
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS NSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C,WELL
CONS U ON STANDARDS, TACO OF THIS ORD HAS BEEN PROVIDED TO THE WELL OWNER
G`y
'SIGgATLIRE 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

r,
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
1636 Mail Service Center-Raleigh,N.C.27699-1636 Phone[phone] �e///l.e //
WELL CONSTRUCTION RECORD WELLCONTRACTOR: ✓ l��C _y✓��/W
WELL CONTRACTOR CERTIFICATION ff:
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE(Check Applicable 11o:): Residential Municipal❑
industrial❑ Agricultural❑ Monitoring
Recovery❑ Heal Pump Water Injection ❑ Other ❑ if Other, List Use:
2, WELL LOCATION: (Show sketch of the location below)`/
Nearest Town: County: -
_UEP_f Ii
(Road Name and Numbers.Community.or Subdivision and Lot No.) DRILLING LOG For*nalion Desf iplion
3. OWNER �QM1� U11301 fJ From To
o
Address 5� Lek Q-%.k 1a
'
0
-------TSoeet o oulo o.
*_'(40 }oa 1.5 v a-$139
City or Town Slate Zip Code too U. '✓` �,
4. DATE DRILLED 3'3' oS -)too, a5)„!
S. TOTALDEPTH o'140 -";L,o, 43y RAwe.� JrJa`Aa � '
6. CUTTINGS COLLECTED YES C] NO® .1 4a QDeJC
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO® �"dye
B. STATIC WATER LEVEL Below Top of Casing: q! FT.
(Use•:1(Above Top of Casing)
9. TOP OF CASING IS + I FT. ov Land Surface-
•Top of casing terminated avor beiow land surface requires a variance In accor-
dance with 15A NCAC 2C.0119
l D. YIELD(gpm): QL0_ METHOD OF TEST AIR -s m
11. WATER ZONES(depth):
12. CHLORINATION: Type 1J'�X_v Amount 1`I If additional space Is needed use back v!loan e —
13. CASING:
LOCATION SI_ETCH Ui
Wall Thickness
(Show direction and distance from at least two Slab
Depth Diameter or WeighYR. Material
From '}, To _3 I—Ft.- --�- PVc' t4- Roads,or other map referencepoinL^)
From To Ft. 3
From To Ft. r
14. GROUT:
Depth Malarial Method
From O To au Ft. ePOLDfae.
From To Ft.
15. SCREEN: 1 I
epth Diameter Slot Size Material
From To_FI In. _ in. by qss GRr!-r_Q. Fed ?A-
From
T
From o_Ft. in. _ In.
From —To_—Ft- In. _ in. ` d
16. SAND/GRAVEL PACK:
Depth Size Maleflal
From � Ft. ��
From Ft. —
17. REMARKS:
1 DO HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPYTpy HIS RECOR HAS BEEN PROVIDED TO THE WELL OYlNER.
2R OFFICE USE ONLY DATE
d No: SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit e,iginallo Division of Water Dustily,Groundwater Section Within 30 day' GIf 1fIf-V. 12199
Sgdal f1o.

North Carolina- Department of Environment and Natural Resources-Division of Water Oualily-Groundwater Section
1636 61ail Service Center-Raleigh,N.C.27699-1636-Phony(919)733-3221 71y,N Jell At 911
WELL CONSTRUCTION RECORD WELLCONTRACTOR: "� * ��K�� ��U`� {
WELL CONTRACTOR CERTIFICATION
STATE WELL CONSTRUCTION PERMIT#: -
1. WELL USE(Ctreck Applicable Box): ResldentialU Municipal El industrial❑ Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other It Other,List Use:
2. WELL LOCATION: (Show sketch of the location below) �1K �Qr P rj U�.N
Nearest Town: County:
(Road Name and Numbers,Community,or Subdivision and Lot No.) UfiILLING LOG _
DEPTH_
From To romalicn Descdplion
3. OWNER S0.M1[. �uaa1 J 92 0Co OCL,
Address
\ 63Awr e.�w �:s '{ 2o(k
Ky.-�hEriFL9l�Y0rlreet o5 (10 -v
City or Town Stxte Zip Code
4. DATE DRILLED 4' 3' 0IC too Alapr &fla-An (ty
S. TOTAL DEPTH 94 D „ 3� R9a k a row (lt�L.k.
R. CUTTINGS COLLECTED YES❑ NO®
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO®
8. STATIC WATER LEVEL Below Top of Caslflg: _y.-!� FT. ---
(Use'i It Above Top of Casing)
9. TOP OF CASING IS + I FT. ov Land Surface'
'Top or casing terminated aVorbelow land surface requires a variance In accor-
dance with 15A NCAC 2C.Otte r
10. YIELD(gpm): aO METHOD OF TEST R 1 R t
11. WATER ZONES(depth): — aMCI —
—4----
12. CHLORINATION: Type a'Y,� Arnounl I� - It additional space is needed use back ol�lorm i —
13. CASING: ,- CM
�KEI N
Wall T hickness
Depth Dia�m�e�l�or� or WeighuFt. Material (Show direction and distance Irom at least Iwo Stab
From }1 To 3-Ft.---�- �V L' Roads,or otter map reference paint
V
From To Ft. d
From To Fl. r
14. GROUT:
Depth Material �Me'thod � a
From O To au Ft. I ¢Q oor P. N
From To Ft. y
15. SCREEN:
epth Diameter Slot Size Material 1 .
From To_FI In. _in. wwBs r `Q-
From o_Ft._ in. _ In.
From _To Fl.__ In. In.
16. SANDJGRAVEL PACK:
Depth Size Ivlaledal v ?�---
Frommz..
Ft.
From Ft. — - z @73)
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, f ,
V.'ELL 00
CONSTRUCTION STANDARDS,AND THAT A COPY THIS RECOR HAS BEEN PROVIDED TO THE VJELL UWt
FOR OFFICE USE ONLYi
Quad No: SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit miglnal to Division of Water Quality.Groundwater Section Within 30 day6 01I.1 REV. I2197
godal No.

308578
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)RICHARD MCCRARY CERTIFICATION#2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION,INC./BARKER WELL&PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMrr#
(if applicable) (if applicable)
NONE
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: Topographic/Land setting Nearest Town: SALUDA County POLK ❑Ridge ❑Slope E]Valley ❑Flat
HWY.176 (check appropriate box) -
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude Of well location -
3. OWNER: STEVE BILLETER (degrees/minutes/seconds)
Address 640 E.HWY.176 Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
SALUDA NC 28773 DEPTH DRILLING LOG
City or Town State Zip Code From TO Formation Description
( 828 )- 749-9824
Area code-Phone number
4. DATE DRILLED FEBRUARY 18,2005
5. TOTAL DEPTH: 385'
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO IKI
7. STATIC WATER LEVEL Below Top of Casing: 4V FT,
(Use"+^if Above Top of Casing) —23
8. TOP OF CASING IS 1.33 FT.Above Land Surface'
-Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.011& S .e
9. YIELD(gpm): 4 METHOD OF TEST TIMED
10.WATER ZONES(depth): N '
LOCATION SKETCH
11. DISINFECTION:Type BY PUMP INSTALLER Amount Show direction and distance in miles from atd0ast
12. CASING: Wall Thickness two State Roads or County Roads.Include tkiload
Depth Diameter or Weight/FL Material numbers and common road names.
From 0 To 39' Ft. 6118 SDR21 PVC J,/�
From To Ft.
- From To Ft 176 1 ctw
13. GROUT: Depth Material Method yJ�
From 0 To 20' Ft, CONCRETE POURED Jk4_,1z
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From­To Ft. in. in.
15. SAWGRAVEL PACK:
Depth Size Material
FmiA To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, LL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THEW9CL OWVER
is fij—
IGNATURE OF PERSON CONSTRUC WELL EIATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

307472
WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(prim) NEIL CRAFT CERTIFICATION# 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: TRYON County POLK TopogmphicAmd setting
GREEN MEADOW LANE ❑Ridge ❑ Slope ❑ Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:JOHN&BETTY HELL Latitude/longitude of well location
Address GREEN MEADOW LANE
(Street or Route No.) (degrees/minutes/seconds)
TRYON NC 28782 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
(§L7)—0559 DEPTH
Area Code Phone number From To
4. DATE DRILLED 01/17/05 _
5.TOTAL DEPTH: 185 DRILLING LOG
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
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' LOCATION SKETCH
'Top of casing tenuinated at/or below land surface requires a Show direction and distance in miles from at least
variance in accordance with 15A NCAC 2C.0 11 S. Two State Roads or County Roads. Include the road
9. YIELD(gpm): 20 METHOD OF TEST ARD number and common names
10. WATER ZONES (depth): HWY.#9 S.FROM MH.L SPRING.RT.ON HWY.
#14.LEFT INTO GREENFIELD SUBDV.RT.ON
11.DISINFECTION:Type CHLORYTE Amount 3.5 GREEN MEADOW LANE.LOT AT END OF CUL DE
12. CASING: Wall Thickness SAC.
Depth Diameter or Weight/FL Material
From 0 To 70 Ft.6-1/4" SDR.21 PVC
From To_Ft._
From To FL �l
T:
13. GROU_Depth_ Mat_erial Method
From 0 To 20 Ft.OUH{RETE POURED
From To Ft.
w c�,
14.SCREEN: Depth_ Diameter Slot Size Material
From_To_Ft._ in in.
From_To_Ft._ in. in.
15. SAND/GRAVEL PACK:
Depth Size Material 1,14 35" m' is'*�j i
From To_Ft.
_ jgn� g'L' (g' ll•28"t�
From To Ft.
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION TANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIMATUAE OF PORSON 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

308491
WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) ROBIN MCNEELY CERTIFICATION# 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK Topographic/Land setting
WAGON LANE ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:TRAVIS PRICE Latitude/longitude of well location
Address WAGON LANE
(Street or Route No.) (degrces/minutesiseconds)
COLUMBUS NC 28722 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8(�—457-2614 H
Area Code Phone number I ++ To
4.DATE DRILLED 02/16/05
5.TOTAL DEPTH: 53 G LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® To
7. STATIC WATER LEVEL Below Top of Casing: 41 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface* 4 SKETCH
*Top of casing terminated at/or below land surface requires a ace 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): 12 METHOD OF TEST STEEL TAPE number and common names
10. WATER ZONES(depth): POORS FORD RD.FROM SHH,OH. RT.ON
GREEN RIVER CHRUCH PARSONAGE P.D.RT.ON
11.DISINFECTION:Type CHLORYTE Amount 5_52 WAGON LANE.STAY RIGHT AT FORKS.LEFT ON
12.CASING: Wall Thickness Isr DRIVE
Depth Diameter or Weight/Ft Material
From 0 To 53 Ft. 24" CEMENT i 350 14 40,53
From_To_Ft. h Vf 5lf' 12.f7"`J
From To_Ft._ �
13. GROUT:_Depth Material Method p
From 0 To 20 Ft.CEMENT POURED
From_To_FL co
14.SCREEN: Depth Diameter Slot Size Material
From_To_Ft._ in. in. N
From_To_Ft._ in. in. CA
15. SAND/GRAVEL PACK:
Depth Size Material
From 41 To 53 Ft. 78M GRAVEL
From To Ft
16,REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONS TION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
r
SIGNATURE OF PERSON T4STRUCTNG 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
WELL CONSTRUCTION RECORD 31681
North Cwolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (priut) L amec W_ ramp, J•r CERTIFICATION N_�$
WELL CONTRACTOR COMPANY NAME Camp' S Well & Pump CO- f Tnr PHONE # RSA 451_7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMrr#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential fi"Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery O Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: (J Topo ic/Land setting
Nearest Town: �d� County \ a%_& ORidge Mlope OValley OFlat
").A \.tAAAAJ.w - (check appropriate box)
(Street Name,Numbe nM Subdivision,Lot No.,Zip Code) LatitudeAongitude of well location
3. OWNER: SD--&1 k, (degreWnruntamiseconds) -
Address l 0ri- F la-f C. Latitude/longitude source:OGPSOTopographic map
I (Street or Route No.) _ (check box)
1 I( S,nYi nU NE C 05 L DEPTH DRILLING LOG
Ciry or 1'owo Sra ' Zip Code From To Fo anon Des.riptio
(� 0
Area code-Phone number
4. DATE DRILLED
5. TOTAL DEPTH: p
6. DOES WELL REPLACE EXISTING WELL? YES O NO lb,
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 O
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): METHOD OF TESTS i r '
10.WATER ZONES(depth):
:sa
LOCATION SKETCH
11. DISINFECTION:Type Ch ,C r i np Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From_p_To 10 SFt. 6 1 /4 Sr3r ➢1 PUC icit"
From To Ft.From To Ft.13. GROUT: Depth Material MethodFrom�_To�p_Ft. Neat emant HandFrom To Ft.
14. SCREEN: DepthDiamterSlot Size Material
From To Ft. in. in.
From To Ft. in. in.15. SAND/GRAVEL PACK:Depth Size MaterialFrom To Ft. � `"LZ.'
From To Ft. nil.
16. REMARKS:
V40-
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
/d- os
NIT A7URE OF PE N CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn: Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004

00 1- 4908
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)DELBERT P=AAN- CERTIFICATION#2159
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE#[phone]
STATE WELL CONSTRUCTION PERMIT#— ASSOCIATED WQ PERMIT#_
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential 0 Municipal/Public Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town: TRYON County POLK Topographiol and setting
FAIRWINDS DR ❑Ridge ❑ Slope ❑Valley ❑Flat
(Shed Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:THOMAS HOPKINS Latitude/longitude of well location
Address FAIRWINDS DR _
(Street or Route No.) (degrees/minutes/seconds)
TRYON NC 28782 Latitude/longitude source: ❑GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 28)-817-0760 DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 07/19/05
5.TOTAL DEPTH: 265 —
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 attor below land surface requires a
variance in accordance with 15A NCAC 2C.0118. LOCATION SKETCH
9.YIELD(gpm): 10 METHOD OF TEST ARD Show direction and distance in miles from at least
10.WATER ZONES(depth):_ Two State Roads or County Roads. Include the road
number and common names
11.DISINFECTION:Type CHLORYTE Amount 6 HWY.#9 S.FROM MILL SPRING.LEFT ON
12.CASING: Wall Thiclmess TURNER RD.LEFT ON FAIRWINDS DR 1/2
Depth Diameter or Weight/Ft Material MH.E ON RIGHT.
From 0 To 110 Ft 6-14" SDIL21 PVC RPProy
From_To_Ft,_ ��tk 35� K, S3.27 " n/
From To Ft S �f0 iys" tJ
13. GROUT_: Depth Material —Methodt y
11
From 0 To 20 Ft OUIKRETE POURED
From To Ft C $
14.SCREEN: Depth Diameter Slot Size Material c�
f:
From—To—Ft.^ in. in. �
From_To—Ft— in. — in.
15. SAND/GRAVEL PACK: cart
Depth Size Material
From—To_Ft_
From To Ft
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORI3A)+ICE wrnnm NCA_C 2C,WELL
CO UCTION STANDARDS,AND THAT A COPY OF TIM RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON NSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)RODNEY ROBBINS CERTIFICATION# 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK Topographic/Land setting
6505 S.NC 9 HWY. ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER: TIM&LYNDA CARR LatitudcAongitude of well location
Address 6505 S.NC 9 HWY. _
(Street or Route No.) (degrees/minutes/seconds)
COLUMBUS NC 28722 Latitude/longitude source: [l r-^" hic map
City or Town State Zip Code �y...
9( 04)-501-3063 I Cat
Area Code Phone number X
4.DATE DRILLED 09/19/05 ( '
5.TOTAL DEPTH: 405
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT. y
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface* Lk
*Top of casing terminated atlor below land surface requires a Show direction: _.,,c in miles from at least
variance in accordance with 15A NCAC 2C A 11 S. Two State Roads or County Roads. Include the road
9.YIELD(gpm): 8 METHOD OF TEST ARD number and common names
10. WATER ZONES(depth): HWY.#9S.FROM MILL SPRING.GO PAST DEVS
11.DISINFECTION:Type CHLORYTE Amount 10.5 AND THE STRIP MALL.NEXT FIELD ON LEFT AT
12. CASING: Wall Thickness END OF THE PARKING LOT.
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 o
From 0 To 20 Ft.OUH(RETE POURED nu
From_To_FL t
14.SCREEN. Depth Diameter Slot Size Material a'
From_To_Ft._ in. in. ,
From_To_Ft._ in. in. Ln
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
CONS ixUCTi0N SS TA N17DARDS,AiNM THAT A COPY OF TivS RECORD HAS BEEN PRO v UED TO THE WELL OWNER
r-�
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

l�D" - 14 999
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)DELBERT PITTMAN' CERTIFICATION#2159
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE#(828M53-0662
STATE WELL CONSTRUCTION PERMIT#, ASSOCIATED WQ PERMIT#_
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ED Municipal/Public Industrial Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town: TRYON County POLK Topographic/Land setting
SALEM WHIJAMS RD. ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Commundy,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:GEORGE DIMSDALE LatitudcAongitude of well location
Address SALEM WILLIAMS RD.
(Street or Route No.) (degreedminutes/seconds)
TRYON NC 28782 Latitude/Iongitude source: ❑GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 28-817-0440 DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 07/19/05
5.TOTAL DEPTH: 495
6.DOES WELL REPLACE EXISTING WELL? YES® NO❑
7. STATIC WATER LEVEL Below Top of Casing: 40 Fr.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casmg terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118. LOCATION SKETCH
9.YIELD(gpm): 3 METHOD OF TEST ARD Show direction and distance in miles from at least
10.WATER ZONES(depth):_ Two State Roads or County Roads. Include the road
number and common names
11.DISINFECTION:Type CHLORYTE Amount 12.5 FROM SHILOH GO DOWN POORS FORD RD.
12. CASING: Wall Thickness RIGHT ON E.GREENCREEK DR RIGHT ON
Depth Diameter or WeightTt Material SALEM WILLIAMS RD.1/2 MILE ON RIGHT.
From 0 To 80 Ft 6-14" SDR21 PVC HABITAT FOR HUMANITY SIGN IN THE
From_To_Ft_ FRONT YARD,
From To Ft .}
13.GROU_T: Depth Material Method
From 0 To 20 Ft OUIKRETE POURED 5
From_To Ft c
14.SCREEN: Depth Diameter Slot Size Material + ~'
From_To_Ft._ in. in.
From—To Ft in. in. C
15. SAND/GRAVEL—
PACK:
Depth Size Material .1
From_To_Ft
From To Ft
16.REMARKS:_
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACC0RDANCE-W1'M 15A NCAC 2C,IWELL
CONS CTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON C 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

R® ), ..
1 r u� .)
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDWIDUAL)NAME (print) games W- Camps Jr- CERTIFICATION# 913R
WELL CONTRACTOR COMPANY NAME Camp' S Wall R Pnmp rn r Tnr PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMTII!
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential &-�Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery O Heat Pump Water Injection❑ Other O If Other,List Use
2. WELL LOCATIO - (1{n Topographic/Land setting
Nearest Town: County (yt(- tb- ididge ❑Slope OValley []Flat
)r ( l1 yl• A I' K '=V'; 0 (check appropriate box)
(Street Name,N''umbers,Coninaunnity,(SSuubdivi�sio�n,„Lost No.,Zip Code) Latitude/longitude of well location
3. OWNER: (degrom/minutea/seconds)
Address -P O $o X (�S - Latitude/longitude source:OGPSOTopographic map
S .} (Street or Route No.) (check box)
DAY 1 Glt1 AYQ C- DEPTH DRILLING LOG
City or Town June . Zip Code From To Oralatl0 Description
(__)- 0 q
Area code-Phone numbe
4. DATE DRILLED -�� • S
5. TOTAL DEPTH: c6i-)S icl Sus —U�� 0
6. DOES WELL REPLACE EXISTING WELL? Y�O NO
7. STATIC WATER LEVEL Below Top of Casing: 0 T. L
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1 FT.Above Land Surface's
s
•Top of casing terminated at/or below lend surface requires a
variance in accords ce with ISA NCAC 2C.0118. 'J
9. YIELD(gpm): METHOD OF TEST Air o
10.WATER ZONES(depth): y 00
LOCATION SKETCH
11. DISINFECTION:Type Chlorine Amount Show direction and distance in miles from a le lt
12. CASING: Wall Thickness two State Roads or County Roads. lli (rea�
va
Depth Diameter or Weight/Ft. Material numbers and common road names
From 0 To A Ft. F 1 /d SDR21 PVC
From To Ft. 7,
From To Ft.
13. GROUT: Depth Material Method
From 0 To_2Q_Ft. Neat Cement Hand
From To Ft.
14. SCREEN: Depth Di ameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVELPACK:
Depth Size Material
From To Ft. <
From To Ft.
�Y 0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IGNATURE OF ERSON CONSTRUCTING THE WELL r�(,ff DATE
Submit the original to the Division of Water Quality,Attn: Information M >gF ,�'17 ii1$ervr4e _
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. v -r� 1'�
ft51 Jg004
LJ 1; JUN 2 7
I
A>

WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) JameS W. Camp, Jr CERTIFICATIONN 21 3R
WELL CONTRACTOR COMPANY NAME Camp' c Wa11 R Primp rn t Tnn PHONE p 6 a4 —7322
STATE WELL CONSTRUCTION PERhHTN ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):ResidentiallErIMunicipal/Public❑ Industrial ❑ Agricultural ❑
Monitoring❑ Recovery O Heat Pump Water Injection❑ Other O If Other,List Use
2. WELL LOCAT N: Topographic/Lan etting
Neare Town: County_ ORidge ❑Slope HValley ❑Flat
4 V (check appropriate box)
(Street Name,Numbers,Communityb a �di ismaq,Lot No.,Zip Code) Latitude/longitude of well location
c
3. 0WNER: I�/`(h 1J"U (degrees/minutes/seconds)
Address 0 l6e,K � I nl Latitude/longitude source:OGPSOTopographic map
treet or Route No.) (check box)
�/�d)`�0.Y lY`q 5 C- DEPTH DRILLING LOG
iry or Town - 5 - Zip Code - From To Formation Description
a,
Area code-Phone nun
4. DATE DRILLED - S - -
5. TOTAL DEPTH: S!A
6. DOES WELL REPLACE EXISTING WELL? YES O NO
7. STATIC WATER LEVEL Below Top of Casing:5_FT. W,
(Use"+"if Above Top of Casing)
g. TOP OF CASING IS 1 FT.Above Land Surface*
-Top of using terminated at/or below land surface requires a --1
variance in accordance with 15A NCAC 2C.01IS.
9. YIELD(gpm): I h METHOD OF TEST Air e
10.WATER ZONES(depth): SOo f_n
LOCATION SKETCH
11. DISINFECTION:Type Chlorine Amount ( .4 Show direction and distance in miles from at least (1 1
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common roadtimes.
From 0 Toakk Ft. 6 1 /4 SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To_ZQ_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. 1
From To Ft. �A
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARD , ND THAT A COPY THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IGNATURE O ERSON CON TRU TINE T, -DATE:
Submit the original to the Division of Water Quality,Attn:Inforoitipt`113anagemenf,1617 N1arfServigS.Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-I REV.09/2004

n 319 " i
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) names W. Camp, Jr_ CERTIFICATION# 213R
WELL CONTRACFORCOMPANY NAME ramp' S Wal 1 P. Pnmp_rn s Inc PHONE # 6 F14 3-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential OY Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery O Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: //Topographic/Land setting
Nearest Tow County— E4dge ❑Slope OValley OFlat
'M 1 Air. (1A t3 (check appropriate box)
(Street Name,Numbers,Community,Subdivi^'ot tNo.,Zip Code) Latitude/longitude of well location
3. OWNER: tom. (degrees/minutes/seconds)
Address D Latitude/longitude source:OGPSOTopographic map
{ —}- (Street or Route .) (check box)
)�AMMGLI U trL3G DEPTH DRILLING LOG
ity or own StatJe zip Code From To Fol nation D, �ription
(� o l i
Area coda Phone run �1
4. DATE DRILLED
5. TOTAL DEPTH: 5 e
6. DOES WELL REPLACE EXISTING WELL? Y. ❑ NO t t
7. STATIC WATER LEVEL Below Top of Casing: T. G
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1 FT.Above Land Surface* J
"Top of casing terminated at/or below land surface requires a .r
variance in accordance with 15A NCAC 2C.0118. ra
9. YIELD(gpm): &0 THODOFTEST Air
10.WATER ZONES(depth): I L V
LOCATION SKETCH 13
11. DISINFECTION:Type Chlorine Amount CAAX
Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names. lJ
From 0 To `�_Ft. 6 1 /4 SDR21 PVC
From To Ft. �-
From To Ft.
13. GROUT: Depth Material Method
From 0 To_0 Ft. Neat Cement Hand
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material lR�'
From To Ft. in. in.
From To Ft. in. in. � n�
15. SAND/GRAVEL PACK:
Depth Size Material
From TO Ft. ^r
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDA S,AND THAT A COPY THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE F PERSON CON RU E V -1 _ �DA1'E
Submit the original to the Division of Water Quality,Attn: Info !� "anagemen I61714Tail gervicO:Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days
I J�UN 1 /
GW-j REV.09/2004
t '
A:

�/— A.
2 A i
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) ,Tames W- rampt T r CERTIFICATION# 21 3 R
WELLCONTRACTORCOMPANYNAME remnr ex Wpl 1 R Pnmp Cn r Tnr PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
INS (if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential V Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery O Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: � Topographic/Land setting
Nearest T�Towyp: �CountyA ORidge [Wope Walley OFlat
0 . PA�eJCs rl d (check appropriate box)
(Street Name,Numbers,Community�Subdivision.Lot No.,Zip Code) LatitudMongitude of well location
3. OWNER: vAJ7+� ��/Nw,rp (s��L`'C. . (degrees/minutes/seconds)
Address �D }�o X 1 Latitude/longitude source:OGPSOTopographic map
Street or Route No.) - (check box)
.SLV rta 1'L�71.U`p SC_ DEPTH DRILLING LOG
City or Town S - Zip code From To Fo ation Descriptio
(fi G `� _
Area code--Phone number -
4. DATE DRILLED 6 - Ir BLS
5. TOTAL DEPTH: S t? - (o
6. DOES WELL REPLACE EXISTING WELL? YES O NO l
7. STATIC WATER LEVEL Below Top of Casing: 3 '__FT.
(Use'Y'if Above Top of Casing) -:
8. TOP OF CASING IS 1 FT.Above Land Surface*
"Top of casing terminated at/or below land surface requires a
variance in aceorda ce with 15A NCAC 2C.011&
9. YIELD(gpm): �a METHOD OFTEST Air
10.WATER ZONES(depth): q 10 O r-
LOCATION SKETCH
11. DISINFECTION:Type Chlorine Amount - Show direction and distance in miles from at leas[ t`T
12. CASING: Wall Thickness two State Roads or County Roads.Include the road -
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To Ft. 6 1 /Q SDR21 PVC
From To Ft.
From To Ft. Tim
13. GROUT: Depth Material MethodFrom 0 To��Ft. Neat Cement HandFrom To Ft.14. SCREEN: Depth Diameter Slot Size MaterialFrom TO Ft. in. in,m Fro 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
CON UCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNS
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,AtthCdtt�b at1'qp Mapagement,1617 Mail Service Center
� -
Raleigh,NC 27699-1617, Phone No.[phone],within 30'c�,y�<r -�--
i GW-1 REV.09/2004
I � j , ,
J U N 27

`� 309794
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 ® Mumcipal/Pubhc ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town:MILL SPRING County POLK Topographic/Land setting
HANNAH DR ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:BRIAN ROTHEMICH Latitudellongitude of well location
Address HANNAH DR.
(Street or Route No.) (degrees/minutes/seoonds)
MILL SPRING NC 28756 Latitude/longitude source: ❑ GPS ❑Topographic map
City m Town State Zip Code (check box)
4)—585-2347 DEPTH
Area Code Phone number From To
4.DATE DRILLED 03/29/05
5.TOTAL DEPTH: 285 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS I-V2 FT. Above Land Surface* LOCATION SKETCH
*Top of casing terminated at/or below land surface requires a Show direction and distance in miles from at least
variance in accordance with 15A NCAC 2C.0118. Two State Roads or County Roads. Include the road
9.YIELD(gpm): 20 METHOD OF TEST ARD number and common names
10. WATER ZONES(depth): HWy.#9 N.FROM MILL SPRING.LEFT ON
GARRETT RD.RIGHT ON GREEN HILLS RD.LEFT
11.DISINFECTION:Type CHLORYTE Amount 6.5 ON LAKE ADGER PARKWAY.RIGHT ON
12. CASING: Wall Thickness HANNAH DR APPROX..2 MILE ON RIGHT.
Depth Diameter or Weight/Ft. Material
From 0 To 70 Ft6-1/4" SDM21 PVC 'q Sq.Zic"
From_To_Ft_
From To to-,) K2o
fL� 10.�$91 _sA
T:13. GROU_Depth Material Method �
From 0 To 20 Ft.OUIKRETE POURED a
From_To_Ft. ;)a14.SCREEN: Depth Diameter Slot Size Material I
From_To_Ft._ in. in. co
From_To_Ft._ is in. O
15. SAND/GRAVEL PACK: Gn
Depth Size Material
From_To_Ft_
From_To_Ft.
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS, AND THAT A qOPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGN 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.0712001

VJ-NP 309796
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 ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION: —
Nearest Town: TRYON County PO LK Topographic/Land setting
HOOPER CREEK RD. ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:NORM BRANNON Latitudellongitude of well location
Address HOOPER CREEK RD.
(Street or Route No.) (degrees/minutes/seconds)
TRYON NC 28782 LatitudcAongitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8�28)-894-6313 DEPTH
Area Code Phone number From To
4.DATE DRILLED 03/21/05
5.TOTAL DEPTH: 285 DRILLING LOG
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use"+"if Above Top of Casing) —
8.TOP OF CASING IS 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.0118.9. YIELD(gpm): 5 METHOD OF TEST ARD Two State Roads or County Roads. Include the road 10. WATER ZONES (depth): number and common namesFROM COLUMBUS GO OUT PENIEL RD.RIGHT
11.DISINFECTION:Type CHLORYTE Amount 6.5 ON RED FOX RD.GO PAST COUNTRY CLUB AND
12. CASING: Wall Thiclmess TURN LEFT INTO HOOPER CREEK RD. GO
Depth Diameter or Weight/Ft. Material APPROX.3/4 MILE ON LEFT.
From 0 To 90 Ft.6-1/4" SDR21 PVC
From_To_Ft._
From To_Ft q-lr' w
T: t
13. GROU_Depth Material Method
From 0 To 20 Ft.QUH{RETE POURED 3"
From_To_Ft c^+
14.SCREEN: Depth Diameter Slot Size Material t
From_To Ft._ in in. 0
From To Ft in. in. C
15. SAND/GRAVEL PACK:
cn
Depth Size Material
From_To_Ft_
From To Ft
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIVNATURE 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

308501
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(prim) NEE,CRAFT CERTIFICATION# 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® MunicipaUPublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING County POLK TopographicAmd setting
4647 BIG LEVEL RD ❑Ridge ❑ Slope ❑ Valley ❑Flat
(Street Name,Numbers,Community Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:EDWIN&JUDY BAILEY Latitudeflongitude of well location
Address 4647 BIG LEVEL RD.
(Street or Route No.) (degrees/minutes/seconds)
MILL SPRING NC 28756 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 28)-625-0098 DEPTH
Area Code Phone number From To
4.DATE DRILLED 02/10/05 _
5. TOTAL DEPTH: 605 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use"+"ifAbove Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface* LOCATION SKETCH
*Top of casing terminated at/or below land surface requires a Show direction and distance in miles from at least
variance in accordance with 15A NCAC 2C.0118. Two State Roads or County Roads. Include the road
9. YIELD(gpm): 1 1/2 METHOD OF TEST ARD number and common names
10. WATER ZONES (depth): HWY.#9 N.FROM MILL SPRING.RIGHT ON
MCGUINN RD.RIGHT ON BIG LEVEL RD.
11.DISINFECTION:Type CHLORYTE Amount 16.5 APPROX. 1 1/12 MILES ON RIGHT.
12. CASING: Wall Thickness
Depth Diameter or Weight/FL Material
From 0 To 60 Ft.6-1/4" SDR21 PVC
From To_Ft.
From To Ft _
13. GROU_Depth Material —Method
Method
From 0 To 20 Ft.OUIKRETE POURED z 3
From_To Ft 14.SCREEN: Depth_ Diameter Slot Size Material r
From_To_Ft._ in. in. co
From_To_Ft._ in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From_To Ft._
From To Ft
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SI(JNATURE 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

�, 3os5o �
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) NEM 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:TRYON County PO LK Topographic/Land setting
1807 JOHN SHEHAN RD. ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:GLYNN&MARTHA TURK Latitude/longitude of well location
Address 1807 JOHN SHEHAN RD.
(Street or Route No.) (degrees/minutes/seconds)
TRYON NC 28782 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8828)-894-8389 DEPTH
Area Code Phone number From To
4.DATE DRILLED 02/08/05 _
5.TOTAL DEPTH: 450 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO N From To
7. STATIC WATER LEVEL Below Top of Casing: 90 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 Fp. Above Land Surface* LOCATION SKETCH
*Top of casing terminated attor below land surface requires a Show direction and distance in miles from at least
variance in accordance with 15A NCAC 2C.01 M Two State Roads or County Roads. Include the road
9.YIELD(gpm): 100 METHOD OF TEST ARD number and common names
10. WATER ZONES(depth): HWY.#9 S.FROM MILL SPRING.LEFT ON
JOHN SHEHAN RD. 1.8 MILES ON LEFT.
11.DISINFECTION:Type CHLORYTE Amount 12
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 70 Ft 6-1/4" SDR21 PVC
From_To_Ft_
From ToT: _Ft_
13. GROU Depth Material Method 2
From 0 To 20 Ft.OUIKRETE POURED n
From_To_Ft r
14.SCREEN: Depth Diameter Slot Size Material 8
From_To_Ft._ in. in. Ot
From_To_Ft._ in. in. �
15. SAND/GRAVEL PACK: tM
Depth Size Material
From_To_FL_
From To Ft.
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
'-
GN TUBE 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

F\
`�� 308503
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) NEE.CRAFT CERTIFICATION# 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#— ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use—
2. WELL LOCATION:
Nearest Town: SALUDA County PO LK Topographic/Land setting
SKYVIEW DR LOT#43(MILLER MTN.) ❑ Ridge ❑ Slope ❑ Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:CHARLES KLINGER Latitude/longitude of well location
Address SKYVIEW DR _
(Street or Roue No.) (degrees/minutes/seconds)
SALUDA NC 28773 Latitude/longitude source: ❑ GPS El opographic map
City or Town State Zip Code (check box)
(843)-559-6766 DEPTH
Area Code Phone number From To
4.DATE DRILLED 02/02/05 _
5.TOTAL DEPTH: 205 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 100 Fr. _
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 11=1/2 Fr. Above Land Surface* LOCATION SKETCH
*Top of casing terminated atlor 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): 40 METHOD OF TEST ARD number and common names
10. WATER ZONES (depth): HWY.#108 W.FROM COLUMBUS.RIGHT ON
11. DISINFECTION:Type CHLORYTE Amount 4.5 OLD HOWARD GAP RD.RIGHT ON HOWARD GAP
12. CASING: Wall Thickness RD.RT.ON INDIAN MTN.RD. STRAIGHT INTO
Depth Diameter or all Thickness
Material MILLER MTN.DEVELOPMENT. 1 LEFT ONTO
SKYVIEW DR LOT IS AT DEAD END-OFF THE
From 0 To 80 Ft 6-1/4" SDIL21 PVC CUL-DE-SAC.
From_To_Ft.From To Ft _
13. GROUT_: Depth_ Material Method Method (0 5 �,'1�'5Z,72"t-J
From 0 To 20 Ft.OUHZRETE POURED / n
From_To Ft. �O
14.SCREEN: Depth_ Diameter Slot Size Material
From To_Ft._ in. in.
From_To Ft.— in. in.
15. SAND/GRAVEL P_ACK: c�
Depth Size Material o
From To—Ft= Lit
To Ft.
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRU TION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
F
SIGNA O PMMON 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

308506
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 PERMrr#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK Topographic/Land setting
POORS FORD RD. ❑Ridge ❑ Slope ❑ Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:BRYA14 GOSNELL Latitude/longitude of well location
Address POORS FORD RD.
(Street or Route No.) (degrees/minutes/seconds)
COLUMBUS NC 28722 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8( ZS)—863-4576 DEPTH
Area Code Phone number From To
4. DATE DRILLED OV11105
5.TOTAL DEPTH: 485 DRILLING LOG
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7, STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface* 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): 30 METHOD OF TEST ARD number and common names
10. WATER ZONES(depth): FROM SHH,OH GO DOWN POORS FORD RD. 1sT
DR ON LEFT PAST STRAWBERRY LANE.
I1. DISINFECTION:Type CHLORYTE Amount 12.5
12. CASING: Wall Thickness /
Depth Diameter or Weight/Ft. Material �kk 35° �3 t 33•`E'2` A
From 0 To 140 Ft 6-1/4" SDR21 PVC �o "
From_To_Ft_
From ToT: _Ft_ rs
13. GROU Depth Material Method K7
From 0 To 20 Ft.OUIKRETE POURED
From To Ft v
14.SCREEN: Depth Diameter Slot Size Material
From_To_Ft._ in. in. co
From To_Ft._ in in.
15. SAND/GRAVEL PACK: c�Jt
Depth Size Material
From_To_Ft_
From To Ft
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
r�
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

r� 2 9 /J
t
North Carolina- Department of Environment and Natural Re sources-Division of Water Quality-Groundwater Section
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACIOil: S�e 1e ��" IA)w�le�� �� WG�� ScxY,
WELL CONTRACTOR CERTIFICATION if: 1
STATE WELL CONSTRUCIION PERMITH: Let OSO
1, WELL USE(check Applicable eox): Residential Municipal ❑ Indushial Agricultural U hioniloring ❑
Recovery❑ Heat Pump Water Injection ❑ Other 0 It Other,List Use:
2. WELL LOCATION: S1pow sketch of Ilia location below
Nearest Town: Ch 1 "b N& County:
C�„cssw�z eta . 1ZabbIY-SV
(Road Name and Walters,Conwtunlly,or Subdivision and Lot No.) DRILLING LOG DEPTI i
3. OWNER W 0.A�a(R I K&ta)r . From To ronnation Desuiphou
Address obbl.�Rt Cures 0 _ - iak 0' 6jnuvr elr~,
(street or ou a o. !a d ) 0 8 ' 6r1rTV'v` SG.v.u1
1R VA r4tA4•d r) c, - a g13� (o ts' - a2g, wzz 24(A
City or Town State zip code 2 00-al o k
4. DATE DRILLED 5'a5 - oS
5. TOTAL DEPTH r11 " - 2 eu
6. CUTTINGS COLLECTED YES❑ NO V —
7. DOES WELL REPLACE EXISTING WELL? YES NO --- n
B. STATIC WATER LEVEL Below Top of Casing: act FT.
(Use':It Above Top or Casing) [_ 3
9. TOP OF CASING ISM_ FT.Above Land Surface' z
'Top of easing terminated aUor below land surface requires a variance In accor-
dance with 16A NCAC 2C 0116
10, YIELD(gpm): 27L METHOD OF TEST 0,1 v- o
11. WATER ZONES(depth): o a 44
12. CHLORINATION: Type 14}14- Amount_141 93 ti odditional space Is nreded use back of town
13. CASING:
Waa,hicMncse UOCA1ICL, __ETCH
Depth Diameter or WeighuFl. Material (Show direction and distance from at I
From I Al To�_ Fl. (a �1 " Roads,or other map reference points)
From 60 To 168 Ft. U /2— -ems`= 3r'LVS , N F 3�
From To Fl.
14. GROUT: �"1 YiI c 0'r N c,"
.9
Depth Material Method
From O To 1" Ft.
From To Ft.
15. SCREEN:
pth Diameter Slot Size Material ,
From To Fl in. \JIJ r_:.: I
From T In. — lit,
From o_FI. In. _ in. r
16. SAND/GRAVEL PACK:
p Size Material _ c_
From Ft.
From To- Ft. w
17. REMARKS:
CD
CTI
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C.WE 4
CONSTRUCTION STANDARDS,AND 111AT A COPY OF TI I RECORDTIIAAS BEE14 PROVIDED TO 1 t1E WELL RqIf1Ef1
FOR OFFICE USE ONLY
Cited No: SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Subndl odgh,al to Division of Water Duality,Groundwater Section withirl 30 days
G111-1 BEV. 12M
Sedai No.

3 12 V 3' 4
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality-
WELL CONTRACTOR(INDIVIDUAL)NAME (print) GL ,�B11,S/l /t' CERTIFICATION#2137/
WELL CONTRACTOR COMPANY NAME /11)v(O S t'I)i 4 I"i(lyi/1 Ln. - ktr . PHONE #
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential l/ Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery O Heat Pump Water Injection❑ Other O If Other,List Use
2. WELL LOCATION Topo�gr3,rr,1hic/Land setting
Nearest Town: County ft4k DRidge 'ESlope OValley OFlat
19 S (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: (_04e y)j2 P_ 'b(l ulkA( r— (degrees/minutes/seconds)
Address .2`}6S NC Hwy I _ Latitude/longitude source:OGPSOTopographic map
(Street or Route No.) �— (check box)
,I ?\ C ,-2 DEPTH DRILLING LOG
City or Town State Zip Codes Fr6m To F nation scripit
Area code-Phone number 13
4. DATE DRILLED .�. - - 23
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 1i11-NO ❑
7. STATIC WATER LEVEL Below Top of Casing: bO T. y ,�
(Use"+"if Above Top of Casing)
C
8. TOP OF CASING IS FT.Above Land Surface* r+to
'Top of"sing terminated at/or below land surface requires a
variance in accordstcpe�with 15A NCAC 1C.01la. c
9. YIELD(gpm):_�-U-- H OF TEST t & o
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth� �` Direter o t/Ft. to ' numbers and common road names.
From Ft. 1p(- i2.SN pv
From To Ft.
From To Ft. Lat7 `6L°(ai 2j.5`d` Ld
13. GROUT: Depth n- aten Meted
From76_TO oL(. Ft. r a�.l'a-�
From To Ft.
14. 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 FL
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 ao-6
IGNATURE PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn: Information Management,1617 Mail Service Center-- -
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004 -
J

WELL CONSTRUCTION RECORD W 3 I 0 5 6 4
North Carolina Department of Environment and Natural Resources-Division of Water Quality p
/
WELL CONTRACTOR(INDIVIDUAL)NAME (print) —Iq rM e < )mac(,(M A If- CERTIFICATION#_�rQ
WELL CONTRACTOR COMPANY NAME I ALki)2 11 J 01CYK 0 ( s 1.- .. PHONE
STATE WELL CONSTRUCTION PERMITH ASSOCIATED WQ PERMITIi
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential UMunicipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery [] Heat Pump Water Injection 0 Other❑ If Other,List Use
2. WELL LOCATIIN 1 1 Ridopographic/Land setting
N ar tTown: County Inge ❑Slope OValley OFlat
1 (check appropriate box)
(Street Name,Numb,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER:S r. tym (degrees/minutes/seconds)
Address �rr ST a 1 W e F, Latitude/longitude source:OGPSOTopograpfiic map
,(Street or Route No.) (check box)
y ym N DEPTH DRILLING LOG
city or sown staill zip code FofInation Dttstiription
Area code-Phone number _
4. DATE DRILLED --
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO d '
7. STATIC WATER LEVEL Below Top of Casing:_Jo 0 FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface*
-Top of casing terminated aVor below land surface requires a
variance in accord c with 15A NCAC 2C.0119. /
9. YIELD(gpm): HOD OF TEST 0,C&
10.WATER ZONES depth): MT PS
LOCATION SKETCH lyj
11. DISINFECTION:Type Amount U At Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include a roa
Dep D_iareter or igh ; Ma ri numbers and common road names. ,
From To Ft. 9.,I\
From To Ft.
From To Ft.
13. GROUT, De atenal Metho
From�Too Ft.
From To Ft. rt ,Q p►d�{�-+•
14. SCREEN: Depth Diameter Slot Size Material n W^'�d'
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. ,,ao
From To Ft.
N
16. REMARKS: U7
CD
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL Ul
CONST CTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER A
CIA" a
- 18 05
SIGNATURE PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn: Information Management,1617 Mail SerYJiE Centee- p- ?
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
A`rCrW-hREV.09/20Q� i
;r,

ej U ey ey `� r A&F WELL DRILy3;:,
I AND PUMP SERVICE;
911 Hwy.Busrre:;.
ttenb ce"O".000mu m at vw*ditaent and Usk"ReMw;_-".Dma1p°e1 WNW Ouew•amurdwetar Sin Bostic,NC 28,"
1a3a Mae fv AH CorAw-Rr W%,N.C.4toWIS314 4wo(f 1n T33=t 828.247-177 ,
WELL CONSTRUCTION RECORD waLLcoNTRAcTOR: I IM
WEI,CONTRACTOR CRRTIRCATION P.
n c-ri i S
STATE WELL CONSTRUCTION PSRMITa:
Monllotirrp❑
--
1. WILL USE Ap pft"Z.POWs" Munidpel� htduaidat❑ A�{�itttal�
Recmrery 0 meet Pump water mean ❑ O1har 0 If OAhK,Lbt Uee:
2. WELL LOCATION:( tAceich 1n.10"Wn b*10w)
Nea�eNTowrc.Lfl ''� County:
DRILtANt3 L0t3 _ DC. H
p1aM Nrann eM Nnn�bare. .� at euWMaQn arld LalNa)$. OWNED FMn
Faman
Ad . . Wx+
11sCtf.�u mum aJ! __ —
lnlriMthr�c t ;Zyx O
pyarieret ttata npCaea
+. DATE OKILLE0 ..�• "" d_pS _
S. TOTAL DEPTH ..iy+` ------
6. CUT'TM1t3S COLLECTED YES
7. DOES WELL REPLACE EXISTING wrrLL? Yes-0ca
!. STATIC WATER I EYE Bob*Top Of Ceehp at
r ptN�•aAlre.aTeFMCetYe1 -.
V. TOP OF CASMK3 IS��'o �„ FT.MM lend SWIMW
■rraNnwMnceor- .1
'ralda�atne NnelnrMaeWtYalnwlwra ewleiatNaMa -
dome wab VIA RQACaCAla pj f�
10. YRELD fWq: �..-M �OF TEST C�
11.WATER ZONES(daPI14. —�—
12.CHLORINATION: Type ' �
f r AMUM IF arldiVa1N NO 4 rA"M ttsa 1'A d fi m
12.CASINO: ,y2 -LQQ&U i
WMTNdm " dkodbn ow ommme tram as bae:tno Bute
Qap81 DYrrrNer arW�elnw VG mwwraPOW!
FL r 11 1 �^ 1106ft a COW map
Fan --Te FL.. `•
From Te— R e?%i-.'L
14. GROUT: ANrs,
aP MaMriai kNStad.
From }�To -ku FI.6L� Mi G� czc Y4tlf4
Frew To FL
1S.SCREEN:
Daps► Diameter Slot Siti Metettal
From To Ft in.
From To FL_ I^
From To FL_ IR• ^--'
16. SANOMPAYELPACK:
Depth sire ,�/� y 7y
FMM To FL...------ —
From To FL_,.— �----- r�''
17. REMARKS: '=' n
1 DQ HERESY CERTMY 1NATTNIS WELL WAS CONSTRUCTED
INACCOFWINCEWtTF(15A NCX2C YlElt sr
MOVI UO"STANDARDS.AND THAT ACMOF Tm RECORD K43 SEEN PROVIDED TOTtd YrE��?
FOR OFFICE USE ONLY twE wt u 16ETE` o -
SIDNAllM1EOF PER3QN 7 R �IAft 30 GRYS
Oaaallrc ep�rrpkDFAtynellpWrOwr40rovdaMatMe"at
11aArrNe. -- � -

309804
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(prim) ROBIN MCNEELY CERTIFICATION# 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK Topographic/Land setting
COLLINSVILLE RD. ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER: CHARLES BENNETT Latitude/longitude of well location
Address COLLINSVILLE RD. _
(Street or Route No.) (degrees/minutes/seconds)
COLUMBUS NC 28722 Latitudellongitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8828)-8634409 DEPTH
Area Code Phone number From To -
4. DATE DRILLED 03/11/05 _
5.TOTAL DEPTH: 70 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 55 FT. _
(Use"+"if Above Top of Casing) _
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface* LOCATION SKETCH
*Top of casing terminated atlor 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): 15 METHOD OF TEST STEEL TAPE number and common names
10. WATER ZONES(depth): HWY.#9 S.FROM MH,L SPRING.RIGHT ON
COLLINSVILLE RD.GO 2.9 MILES.LEFT INTO
11.DISINFECTION:Type CHLORYTE Amount 6.9 BRIAR ROSE FARM.NEW DRIVE 1/10 MILE ON
12. CASING: Wall Thickness RIGHT.
Depth Diameter or Weight/Ft Material
From 0 To 70 Ft 24" CEMENT
From_To_Ft
From To Ft_
13. GROUT_: Depth Material Method
From 0 To 20 Ft.CEMENT POURED ao
From To Ft
1
14.SCREEN: Depth_ Diameter Slot Size Material coFrom_To Ft._ in in.
From To_Ft._ in. in. Ln
15. SAND/GRAVEL PACK:
Depth Size Material
From To_Ft. 78M GRAVEL
From To Ft
16.REMARKS:CUSTOMER BACK FILLED AROUND WELL. COULDN'T GROUT.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONS_TRVCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S--
SIUNATURELOF PE ON UCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
j7699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

Nosh Careens.DeVarnrtem a EnAm~q ettd Nalunl Resctwces-DlWlon of WNn Imerly,.Ofounciwala Section -? B --
IM MM ean4Ce CarNar-Ralafplt,N.C.47e11-If1.7rt-phone(911)73,7-=1
WELL CONSTRUCTION RECORD WELLCONTRACTOR: ` � ✓�/ ��:/�� �
WELL CONTRACTOR CERTIFICATION I
STATE WELL CONSTRUCTION PERMITI: O
- --- ...,/ -811 Hwy,Busipsi!74 C.
t. WVLL USE Apllpaaaa f ith RaeldantlatL�J Municip5l 0 IndU$Ulai❑ Agrkullural M %%W AtlMBp=80IS
paaovary HeatPufnp Water Injection ❑ Other(3 It Odtar.UstUse. 828-247-1773
I. WELL LOCATION:(Show sketch of the Wagon below)
Memel TOtw14
NlwrNwm and Nunsars.Comnaaalt,erauee d@nmd&MW) DMLLING LOG _ DEPTH
.3. OWNER Fwm Te Fwwa*n Oaw*lbt
AddtM
CtgrerTewn � ;2aP�da?
4. DATE GRILL
S. TOTALDEPTH -Ze Z
S. CUTTMIGS COLLECTED Y NO[� K
7, DOES WELL REPLACE EXISTIt�WELL? Y NOE]'
S. STATIC WATER LEVEL 8eaw Top of CaaMp: FT.
litift-vitAboveD. TOP OF CASING ISM FT.ADow Land SwfecM �
STOP er ashy aneenred War bow"Isad eerleee requim"a trwwa to ft O
Nttee wpt NiA NCAC ec.etae
to. YIELD(w": _MET OF TEST ��!L� l./
11. WATER ZONES(depth): 2 00
1 Z. CHLOfi1NAT10N: _ Typet Cry Alllourd If eddwonel apace Is nestled oast bad of lvwr
13. CASING: //Z
Wr7Mdmea• LOCAM SKETCH
Depth n
Ois"Ise orcWd1 M-0
tilli " (Show direction ard distance km al be%rev 8"
FfM To.L/Z.FL.6:Z �Kad- -ace feeds.or oust a"mlow4o lvoko!
From To FL
From To FL
14.GROUP:
Depth Me", M11111W I
From _0 To .=—FL Cdaa6b!l�
Flom To FL
15. SCREEN:
Depth Dlmmlar Sat Ski Matelot
A
From To Ft— In. _.__ IrL
From To FL_ In. _h
From To FL_ Im —in
1S, t31116NOMPAVELPACK:
Depth 8ise Meledtl 7 ti
From To FL --
c J L
from To FL
17. REMARKS:
100 HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE MATH I54 NCAC 4C.WELL
WISTRUCTIM STANDARDS.AND THAT ACM OF Tm CORD HAS SEEN PFMDEO TO1W INEa1 DANE 117
o
FOR OFFICE USE ONLY `S
Dow Na NW41FURE OF PERSON tONSiRUCTMD IMS VVIILL n ---_---
auba+t«pMt+aWahleeatwwr01fYA1 waneawrraacn+vkHn7oesri �[.--- J 1
Sa4al Na. 11n �-----.-_'._

i
WELL CONSTRUCTION RECORD J
North Carolina Department of Environment and Natural Resources-Division of water Quality
� ,ga CON!PRACTORI(1NDIVEDOAL)NAWIE (print) ameC W_ ('amFyr Jr CERTIFICATION# 213 8
]1LI$cdXt9JAcaORkiWAN'VNAME Camp' s Well & Pump C o Tnr PHONE # a7A d5 t 7322
STATE WELL CONSTRUCTINN PERhIIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential❑ Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring D Recovery D Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION• Topographic/Land setting
Nearest Town: County ORidge IVSlope DValley DFlat
1- �t A a a c e - (check appropriate box) -
(Street Name,Numbers,12onurainity,Subdivision,Lot No.,Zip Code) - Latitude/longitude of well location
S 3. OWNER: ^
IJL� P a (deg ees mina es seconds)
Address O 0 X -4-1 a SS L titude/longitude source:OGPSDTopographic map
�i [tree or Route No.) (check box)
SSA r I G Ai vt Y n C. ;,2�( D DEPTH DRILLING LOG
ity or Town Sisk Zip Code Fmmo� Fetiop Description
Area coda Phone number 1 7j ���
4. DATE DRILLED
5. TOTAL DEPTH: '•''" " -' ��4%�'M''-�
6. DOES WELL REPLACE EXISTING WELL? YU❑ NO U
7. STATIC WATER LEVEL Below Top of Casing: FT. m
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1 FT.Above Land Surface*
-Top of Ming terminated actor below land surface requires a r.) ^7
variance in accordalfie w� i1th 15A NCAC 2C.0118.
9. YIELD(gpm):�—ME�� TEST�ir n
10.WATER ZONES(depth): R
LOCATION SKETCH
11. DISINFECTION:Type Ch 1.nr i ne Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County oads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common roa na
From ..D_ _To�,_Ft. 6 1 L4 Srlr 21 PVC (p�
From To Ft.
From To Ft. --
13. GROUT: Depth Material Method
From---0_To__2.0__Ft. Neat Cement liana
From To Ft.
14, SCREEN: Depth Diameter Slot Size Material - �,,►-"�1(�,From - To Ft. in. in. t��CtlL"f�
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
CONSTR ON STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SICIATURF OF PER90N CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn: Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GWA REV.09/2004

A a �
WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)DELBERT PITTMAN- CERTIFICATION#2159
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE#[phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#_
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: TRYON County POLK Topographic/Land setting
HASFITZ TRAIL ❑Ridge ❑ Slope ❑ Valley ❑ Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:HASLAM Latitude/longitude of well location
Address HASFITZ TRAIL _
(Street or Route No.) (degreestminutes/seconds)
TRYON NC 28782 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 09/07/05 _
5.TOTAL DEPTH: 505
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated attor below land surface requires a
variance in accordance with 15A NCAC 2C.0118. LOCATION SKETCH
9.YIELD(gpm): 3 METHOD OF TEST ARD Show direction and distance in miles from at least
10. WATER ZONES(depth):_ Two State Roads or County Roads. Include the road
number and common names
11.DISINFECTION:Type CHLORYTE Amount 13.5 HWY.#9 S.FROM MILL SPRING.RT.ON
12. CASING: Wall Thickness HWY.#14.RT.ON GOLF COURSE RD.APPROX.
Depth Diameter or Weight/Ft Material 1.2 MH,ES,LEFT ON HASFITZ TRAIL. LOT IN
From 0 To 70 Ft. 6-14" SDR21 PVC FORK OF ROAD.
From To_Ft.
From To Ft _
13. GROU_Depth_ Mat_erial Method o
From 0 To 20 Ft. OUHCRETE POURED r
From_To Ft_ cT
14.SCREEN: Dep_th Diameter Slot 7Sc Material c7
From_To_Ft._ in. in. cr
From To_Ft._ 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
CO UCTION ST ARDS,AND THAT A COPY OF THIS ORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON C 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

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)DELBERT PITTMAN' CERTIFICATION#2159
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 0 MunicipaUPublic 0 Industrial 0 Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List U
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK Topographic/(and setting
WHITE OAK MTN.RA ❑Ridge ❑Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:JOHN EDNEY Latitude/longitude of well location
Address WHITE OAK MTN.RD.
(Street or Route No.) (degrees/minutes/seconds)
COLUMBUS NC 28722 LatitudeJlongitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 28)-817-0806 DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 09/20/05
5.TOTAL DEPTH: 425
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 Fr. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118. LOCATION SKETCH
9.YIELD(gpm): 10 METHOD OF TEST ARD Show direction and distance in miles from at least
10. WATER ZONES(depth):_ Two State Roads or County Roads. Include the road
number and common names
11.DISINFECTION:Type CHLORYTE Amount 11 FROM COLUMBUS.GO OUT SKYUKA RD.
12. CASING: Wall Thickness RIGHT ON HOUSTON RD.LEFT ON WHITE
Depth Diameter or Weight/Ft Material OAK MTN.RD.APPROX.2 MILES ON RIGHT
From 0 To 60 Ft 6.14" SDIL21 PVC
From_To_Ft
From To Ft
T: _
13.GROU_Depth Material Method
From 0 To 20 FL OUII BETE POURED -
From To Ft r
14.SCREEN: Depth Diameter Slot Size Material a`
From_To_Ft_ in. in, p
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
CONS CTION STANDARDS AND THAT A COPY OF THIS CORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSO 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

W
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)DELBERT PITTMAN- CERTIFICATION#2159
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE#[phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#_
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Pubhe U Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town:RUTHERFORDTON County POLK Topographic/Land setting
LYLES POND RD. ❑Ridge ❑ Slope ❑ Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:KEITH RUSSELL Latitudellongitude of well location
Address LYLES POND RD.
(Street or Route No.) (degrees/minutes/seconds)
RUTItERFORDTON NC 28139 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 28)—778-21" DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 09/22/05
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 te/mmated or below land surface requires a
variance in accordance with 15A NCAC 2C.0118. LOCATION SKETCH
9.YIELD(gpm): 6 METHOD OF TEST ARD Show direction and distance in miles from at least
10. WATER ZONES(depth):_ Two State Roads or County Roads. Include the road
number and common names
11.DISINFECTION:Type CHLORYTE Amount 7.5 FROM SHILOH GO DOWN POORS FORD RD.
12. CASING: Wall Thickness CROSS THE RIVER GO APPROX.1-1/2 TO 2
Depth Diameter or Weight/Ft. Material MILES.RIGHT ON LYLES POND RD.3 RD
From 0 To 100 Ft.6-14" SDIL21 PVC DRIVE ON RIGHT.
From_To_Ft_ _
From To Ft
T: _
13. GROU_Depth Material Method
From 0 To 20 Ft QUHQIETE POURED o
From_To Ft_ c�
14.SCREEN: Depth Diameter Slot Size Material
From_To_Ft._ in. in. a�
From_To_Ft._ in in. o
15. SAND/GRAVEL PACK: Un
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
CONS CTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
- �
LZZ
SIGNATURE OF PERSON CONSTRUCTING THE WELL r DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

co tJ 'J
WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)DELBERT PITTMAN% CERTIFICATION#2159
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE Ff2-- 53-0662
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#_
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential Z Municipal/Public ❑ Industrial ❑ Agricultural El
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ if Other,List Use_
2. WELL LOCATION:
Nearest Town:MILL SPRING County POLK Topographic/Land setting
BIG LEVEL RD. ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:JOE CARSON Latitude/longitude of well location
Address BIG LEVEL RD. _
(Street or Route No,) (degrees/minutes/seconds)
MILL SPRING NC 28756 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
S)—287-4239 DEPTH DRILLING LOG
Area Code Phone number From To From To
4. DATE DRILLED 09/24/05
5. TOTAL DEPTH: 805
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO Z
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 terminateN or below land surface requires a
variance in accordance with 15A NCAC 2C.0118. LOCATION SKETCH
9. YIELD(gpm): 0 METHOD OF TEST ARD Show direction and distance in miles from at least
10.WATER ZONES(depth):_ Two State Roads or County Roads. Include the road
number and common names
11.DISINFECTION:Type CHLORYTE Amount 22.5 HWY.#108 W.FROM RUTHERFORDTON.
12. CASING: Wall Thickness RIGHT ON BIG LEVEL RD.GO 8/10 MILE.
Depth Diameter or Weight/Ft. Material RIGHT ON GRAVEL DRIVE.LEFT AT FORK.
From 0 To 30 Ft. 6-14" SDR.21 PVC
From_To_Ft
From To_Ft._ _
13.GROU_T: Depth Material Method n
From 0 To 20 Ft OUIKRETE POURED
r
From To Ft m
14.SCREEN: Depth Diameter Slot Size Material o
From_To_Ft._ in in. Ln
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
CONS MON STANDARDS,AND THAT A COPY OF THIS RE RD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CO 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)DELBERT PITTMAN- CERTIFICATION#2159
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE#[phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#_
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public El Industrial El Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town:MILL SPRING County POLK Topographic/Land setting
BIG LEVEL RD. ❑Ridge ❑ Slope ❑ Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:AUGUST CONSTRUCTION Latitude/longitude of well location
Address BIG LEVEL RD. _
(Street or Route No.) (degreedminutes/seconds)
MILL SPRING NC 28756 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8( ZS)—894-5544 DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 09/26/05
5. TOTAL DEPTH: 305
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated attor below land surface requires a
variance in accordance with 15A NCAC 2C.0118. LOCATION SKETCH
9.YIELD(gpm): 10 METHOD OF TEST ARD Show direction and distance in miles from at least
10. WATER ZONES(depth):_ Two State Roads or County Roads. Include the road
number and common names
11.DISINFECTION:Type CHLORYTE Amount 7.5 HWY.#9 N.FROM MILL SPRING.RIGHT ON
12. CASING: Wall Thickness MCGUINN RD.RIGHT ON BIG LEVEL RD.GO
Depth Diameter or Weight/Ft. Material PAST LP GAS STORAGE TANK.DRIVE WILL BE
From 0 To 80 Ft 6-14" SDR21 PVC ON RIGHT.
From_To_Ft.
From To_Ft._
13. GROUT_: Depth Material Method
From 0 To 20 Ft OUEKRETE POURED r7
From To Ft._
14.SCREEN: Depth Diameter Slot Size Material
t
From To_Ft._ in. in. �
From To_Ft_ in. in. O
15. SAND/GRAVEL PACK: cP
Depth Size Material ="s
From_To_Ft.
From_To_Ft_ _
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 CORD HAS BEEN PROVIDED TO THE WELL OWNER
4 "
r
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.0712001

'v' V
WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)JEFF MELTON CERTIFICATION#3417
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE#[phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#_
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® MunicipaMblic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town:MILL SPRING County POLK Topographic/Land setting
HWY.#108 E. ❑Ridge ❑ Slope ❑valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:ROBERT CARNEY Latitude/longitude of well location
Address HWY.#108 E. _
(Street or Route No.) (degreestmmutes/seconds)
MILL SPRING NC 28756 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
L)—894-3442 DEPTH DRILLING LOG
Area Code Phone number From To From To
4. DATE DRILLED 09/28/05 _
5.TOTAL DEPTH: 345
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated attor below land surface requires a LOCATION SKETCH
variance in accordance with 15A NCAC 2C.0118.
9.YIELD (gpm): 15 METHOD OF TEST ARD Show direction and distance in miles from at least
10.WATER ZONES(depth):_ Two State Roads or County Roads. Include the road
number and common names
11.DISINFECTION:Type CHLORYTE Amount 9 HWY.#108 E.FROM MILL SPRING.CROSS
12. CASING: Wall Thickness GREEN RIVER BRIDGE.2 DRIVE ON RIGHT.
Depth Diameter or Weight/Ft Material
From 0 To 60 Ft 6-1/4" SDR21 PVC
From_To_Ft
From To Ft.
T:13.GROU_Depth_ Mat_erial Method
From 0 To 20 Ft OUHQtETE POURED o
From To_Ft. )
14.SCREEN: Depth Diame_ter Slot Size Material
From_To_Ft._ in. in.
From_To_Ft._ i11 in. o
15. SAND/GRAVEL PACK: ut
Depth Size Material
From_To_Ft.
From To Ft
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS, AND THAT A CO Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATUREeOF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) ROBIN MCNEELY CERTIFICATION# 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# i828)453-0662
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK Topographic/Land setting
HUGH CHAMPION RD. ❑Ridge ❑ Slope ❑ Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:WAYNE HORNE Latitude/longitude of well location
Address HUGH CHAMPION RD. _
(Street or Route No.) (degrees(atinutes/seconds)
COLUMBUS NC 28722 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
(864)-680-5555 DEPTH
Area Code Phone number From To
4.DATE DRILLED 09/01/05
5.TOTAL DEPTH: 40 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
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* LOCATION SKETCH
*Top of casing temunated at/or below land surface requires a Show direction and distance in miles from at least
variance in accordance with 15A NCAC 2C.0118. Two State Roads or County Roads. Include the road
9.YIELD(gpm): 20 METHOD OF TEST STEEL TAPE number and common names
10. WATER ZONES(depth): HWY.#9 S.FROM MILL SPRING.RIGHT ON
11.DISINFECTION:Type CHLORYTE Amount 9.2 HUGH CHAMPION RD.APPR03L 3/4 MILE ON
12. CASING: Wall Thickness RIGHT.
Depth Diameter or Weight/Ft. Material
From 0 To 40 Ft. 24" CEMENT
From To Ft._
From To_Ft._ _
13. GROUT:_Depth Material Method oC
From 0 To 20 Ft.CEMENT POURED —'
From_To_Ft. 3
m
14.SCREEN: Depth Diameter Slot Size Material .a
From To_Ft._ in. in. C:)
is
From_To_Ft._ in. in.
15. $AND/GRAVEL PACK:
Depth Size Material
From 20 To 40 Ft 78M GRAVEL
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTI STANDARDS,AND THAT A COPY OF RECORD HAS BEEN PROVIDED TO THE WELL OWNER
C
SIGNAYURE OF PE7N`C0KSTRI CTING WELL DATE
S the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
t36 Phone No. [phone],within 30 days. GW-1 REV.07/2001

G158
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 PERMrr#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: SALUDA County POLK Topographic/Land setting
HWY.#176 ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:GEORGE DERWORT Latitude/longitude of well location
Address HWY.#176 _
(Street or Route No.) (degrees(mmutes/seconds)
SALUDA NC 28773 Latitude/longitude source: ❑GPS ❑Topographic map
City or Town State Zip Code (check box)
(828)—749-2272 DEPTH
Area Code Phone number From To
4.DATE DRILLED 08/08/05 _
5.TOTAL DEPTH: 605 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
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* 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): 1 METHOD OF TEST ARD number and common names
10. WATER ZONES(depth): HWY.#176.FROM TRYON.M GO PAST THE 2
11.DISINFECTION:Type CHLORYTE Amount 16.5 BRIDGES. 1/10 MILE ON L>i'FT PAST OLD
ANTIQUE STORE ON RIGHT.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 56 Ft 6-114" SDR21 PVC
From_To_Ft
From_To_Ft_ N
13. GROUT: Depth Material Method r
From 0 To 20 Ft.QUHOIETE POURED
From_To_Ft ry
14.SCREEN: Depth Diameter Slot Size Material
0
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:
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 eONSTRUCTING 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.0,712p W,

D 6315614
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: SALUDA County POLK Topographic/Land setting
HWY.#176 ❑Ridge ❑ Slope ❑Valley ❑Flat
(Sheet Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER: GEORGE DERWORT Latitude/longitude of well location
Address HWY.#176 _
(Street or Route No.) (degrees/minmes/seconds)
SALUDA NC 28773 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
S( ZS)—749-2272 DEPTH
Area Code Phone number From To
4. DATE DRILLED 08/19/05
5.TOTAL DEPTH: 605 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use`Y'if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface* LOCATION SKETCH
*Top of casing terminated attor 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 ARD number and common names
10. WATER ZONES(depth): HWY.#176 FROM TRYON.GO PAST THE 2
11.DISINFECTION:Type CHLORYTE Amount 16.5 BRIDGES. 1110 MILE ON LEFT PAST OLD
ANTIQUE STORE ON RIGHT.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 60 Ft. 6-1/4" SDR21 PVC
From_To Ft._ _
From_To_Ft_ _
13.GROUT: Depth Material Method
From 0 To 20 Ft.OUH{RETE POURED rn
From_To_FL
14.SCREEN: Depth Diameter Slot Size Material r
From_To_Ft._ in. in. N -From_To_Ft._ in. in. o
15. SAND/GRAVEL PACK:
Depth Size Material
From_To_Ft._
From To FL
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
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

DO 13606
WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)DELBERT PITTMAN- CERTIFICATION#2159
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING LLC PHONE#[phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#_
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ❑ Municipal/Public ® Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town: TRYON County POLK Topographic/Land setting
SANDY PLAINS RD. ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:DAVID ODOM Latitude/longitude of well location
Address SANDY PLAINS RD.
(Street or Route No.) (degrees/rummes/seconds)
TRYON NC 28782 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 07/07/05 _
5. TOTAL DEPTH: 545
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. LOCATION SKETCH
9. YIELD(gpm): 235 METHOD OF TEST ARD Show direction and distance in miles from at least
10.WATER ZONES (depth):_ Two State Roads or County Roads. Include the road
number and common names
11.DISINFECTION:Type CHLORYTE Amount 15 HWY.#221 S. FROM RUTHERFORDTON. RT.
12. CASING: Wall Thickness ON CORE RD.2-1/2 MILES ON RT.AFTER COXE
Depth Diameter or Weight/Ft. Material RD. TURNS INTO SANDY PLAINS RD,
From 0 To 65 Ft. 8" 250 WALL STEEL
From To Ft.
From_To Ft.
13. GROUT: Depth Material Method
From 0 To 65 Ft. CONCRETE PRESSURE
From To Ft._ cn
14.SCREEN: Depth Diameter Slot Size Material 0
From_To_Ft._ in. in.
From To_Ft._ in. in. N 71
15. SAND/GRAVE_ L PACK CD
Depth Size Material Cn
From To Ft.
From To Ft. 3
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONS CTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL _ ._ DATE
Submit the original to the Division of Water Quality,Groundw#ter Section,1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

31 - 600
WELL CONSTRUCTION RECORD
North Carolina—Department of EmAtonment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)DELBERT PITTMAN- CERTIFICATION#2159
WELL CONTRACTOR COMPANY NAME 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 El Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water htjection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK Topographiedand setting
303 HAMILTON DR ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:MICHAEL BENTIVEGNA Latitude/longitude of well location
Address 303 HAMILTON DR
(Street or Route No.) (degrces(miumes/seconds)
COLUMBUS NC 28722 Latitude4ongitude source: ❑GPS ❑Topographic map
City or Town State Zip Code (check box)
8M—894-0390 DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 08/10/05
5.TOTAL DEPTH: 345
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118. LOCATION SKETCH
9.YIELD (gpm): 100 METHOD OF TEST ARD Show direction and distance in miles from at least
10.WATER ZONES(depth):_ Two State Roads or County Roads. Include the road
number and common names
11.DISINFECTION:Type CHLORYTE Amount 9 HWY.#9 S.FROM MILL SPRING.RT.ON
12.CASING: Wall Thickness PENIEL RD.LEFT ON RED FOX RD.RT.INTO
Depth Diameter or Weight/Ft Material EOUISTRIAN ESTATES DRIVE ON LEFT AT
From 0 To 130 FL 6-14" SDP-21 PVC END OF WHITE FENCE.
From_To_FL_
From To_Ft.
13. GROUT: Depth Material Method cn
From 0 To 20 Ft QUIKRETE POURED rnv
From_To_Ft_ ry
14.SCREEN: Depth Diameter Slot Size Material
From_To_Ft. in in. o
From_To Ft.T 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
CONS UCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
a2- a - -
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001
s

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)RODNEY ROBBINS CERTIFICATION# 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential 0 MunicipaUPublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town:MH L SPRING County POLK Topographic/Land setting
BIG LEVEL RD. ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER: CLAYTON HUDSON Latitude/longitude of well location
Address BIG LEVEL RD_
(Street or Route No.) (degrees/mmutes/seconds)
MH,L SPRING NC 28756 Latitude/longitude source: ❑ GPS El opographic map
City or Town State Zip Code (check box)
8(�-2874239 DEPTH
Area Code Phone number From To
4.DATE DRILLED 10/19/05
5. TOTAL DEPTH: 505 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use`•+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface* 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): HWY.#108 W.FROM RUTHERFORDTON.RT.
11.DISINFECTION:Type CHLORYTE Amount 13.5 ON BIG LEVEL RD.GO 8/10 MH E&RT.ON
12. CASING: Wall Thickness GRAVEL DRIVE LEFT AFORK FOLLOW NEW
Depth Diameter or Weight/Ft Material DRIVE'
From 0 To 22 Ft 6-114" SDR.21 PVC
From_To_Ft
From To Ft.
T: _
13. GROU_Depth Material Method
From 0 To 20 Ft OUHMTE POURED
From_To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From_To_Ft._ in. in. - o
From_To_Ft._ in in.
15. SAND/GRAVEL PACK:
Depth Size Material o
From_To_Ft._ cn
From To FL
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CON UCTI N STANDARDS,AND THAT A COPY OF WS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

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 It (828)-453-0662
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential 2 Municipal/Public El Industrial ❑ Agricultural El
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town:MH.L SPRING County POLK Topographic/Land setting
GIRL SCOUT CAMP RD. ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:SCOTT MELTON Latitude/longitude of well location
Address GHtL SCOUT CAMP RD.
(Street or Route No.) (degrees/minutes/seconds)
MILL SPRING NC 28756 Latitude/longitude source: ❑GPS ❑Topographic map
City or Town State Zip Code (check box)
9( 73)—5684033 DEPTH
Area Code Phone number From To
4.DATE DRILLED 10/17/05
5.TOTAL DEPTH: 305 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NON From To
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* LOCATION SKETCH
*Top of casing terminated atlor 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): 6 METHOD OF TEST ARD number and common names
10.WATER ZONES(depth): HWY.#9 N.FROM MH L SPRING.LEFT AT
12. CASING: Wall Thiclmess I.DISIN INGLE'S ON GIRL SCOUT CAMP RD.RIGHT ON
1FECTION:Type CHLORYTE Amount 7.5 NELON RD.APPROX. 1 MILE ON LEFT.
Depth Diameter or Weight/Ft Material
From 0 To 100 Ft 6-1/4" SDR21 PVC
From_To_Ft_ _
From_To_Ft
13.GROUT: Depth Material Method
From 0 To 20 Ft.OUIKRETE POURED =?
From_To_Ft
a
14.SCREEN: Depth Diameter Slot Size Material C
From_To_Ft._ in in. E
From_To_Ft._ in.
15. SAND/GRAVEL PACK: o M
Depth Size Material r.n
From_TO_Ft_
From To Ft
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

e i li
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# f828)453-0662
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:NML SPRING County POLK Topographic/Land setting
MANUS CHAPEL RD. ❑Ridge ❑ Slope ❑ Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER AUGUST CONSTRUCTION Latitude/longitude of well location
Address MAN US CHAPEL RD, _
(Street or Route No.) (degrees/minutes/seconds)
MILL SPRING NC 28756 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8L28)—894-5544 DEPTH
Area Code Phone number From To
4.DATE DRILLED 10/26/05
5.TOTAL DEPTH: 525 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface* 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): 40 METHOD OF TEST ARD number and common names
10.WATER ZONES(depth): GO DOWN THE BYPASS.GET OFF AT PEA
11.DISINFECTION:Type CHLORYTE Amount 13.5 RIDGE RD,TURN LEFT.THEN BACK RIGHT ON
12. CASING: Wall Thickness ABRAMS/MOORE RD.RIGHT AT STOP SIGN ON
Depth Diameter or WeihicknghttFt Material MANUS CHAPEL RD.GRAVEL DRIVE 1.2 MILES
From 0 Depth
70 Ft Diameter
SDR21 PVC ON RIGHT.FOLLOW LONG GRAVEL DRIVE.NEW
_ _ HOUSE SITE AT END.
From To Ft
From To_Ft._ _
13. GROU_Depth Material Method
From 0 To 20 Ft.OUHCRETE POURED
From_To_Ft.
14.SCREEN: Depth Diameter Slot Size Material
From_To_Ft._ in. in.
From_To Ft._ in in. CD15. SAND/GRAVEL P_ACK:
Depth Size Material -cr—
From_To_Ft._ o
From To Ft cn
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CO CTI STANDARDS,AND THAT A COPY OF S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
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

WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)JEFF MELTON CERTIFICATION#3417
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 El Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: TRYON County POLK Topographic/LaW setting
MCINTYRE RD. ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:BARRY JACKSON Latitude/longitude of well location
Address MCINTYRE RD. _
(Street or Route No.) (degrees/minutes/seconds)
TRYON NC 28782 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8�28)—863-2341 DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 10/27/05
5. TOTAL DEPTH: 605
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated attor below land surface requires a
variance in accordance with 15A NCAC 2C.0118. LOCATION SKETCH
9. YIELD(gpm): 2 METHOD OF TEST ARD Show direction and distance in miles from at least
10.WATER ZONES(depth):_ Two State Roads or County Roads. Include the road
number and common names
I I.DISINFECTION:Type CHLORYTE Amount 16.5 HWY.#9 S.FROM MILL SPRING.LEFT ON
12.CASING: Wall Thickness GREEN CREEK DR LEFT ON CORE RD.RIGHT
Depth Diameter or Weight/Ft. Material ON MCINTYRE RD. 3/4 MILE ON LEFT.
From 0 To 125 Ft. 6-1/4" SDR21 PVC
From_To_FL_ _
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 FL QUEKRETE POURED '
From_To_Ft.
14.SCREEN: Depth Diameter Slot Size Material __ o
From_To_Ft._ in. in. r
From_To Ft._ in in.
15. SAND/GRAVEL PACK: o
Depth Size Material cn
From_To_Ft._
From To FL
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
t
SIGNATURE OF RSON 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-i REV.07/2001

0,0
n r
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)JEFF MELTON CERTIFICATION#3417
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE#[phone]
STATE WELL CONSTRUCTION PERMIT#— ASSOCIATED WQ PERMIT#_
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use—
2. WELL LOCATION:
Nearest Town: SALUDA County POLK Topographic/Land setting
CHRISCOTT LANE ❑Ridge ❑ Slope ❑ Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:AUGUST CONSTRUCTION Latitude/longitude of well location
Address CHRISCOTT LANE _
(Street or Route No.) (degrees/mmutes/seconds)
SALUDA NC 28773 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8( LS -894-5544 DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 10/21/05 _
5.TOTAL DEPTH: 365
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 180 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 Fr. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118. LOCATION SKETCH
9.YIELD(gpm): 20 METHOD OF TEST ARD Show direction and distance in miles from at least
10.WATER ZONES(depth):— Two State Roads or County Roads. Include the road
number and common names
11.DISINFECTION:Type CHLORYTE Amount 9.5 HWY.#176 FROM TRYON.GOING INTO
12. CASING: Wall Thickness SALUDA.LEFT ON PEARSON FALLS RD,GO
Depth Diameter or Weight/Ft Material ALL THE WAY TO THE TUNNEL.AT
From 0 To 45 Ft. 6-1/4" SDR27.6 PVC ENTRANCE TO TUNNEL TURN LEFT ON
From_To_Ft_ CHRISCOTT LANE.GO 1/4 MILE.LEFT ON
From To_Ft._ DIRT DRIVE.GO 1/4 MILE RIGHT ON DIRT
T:13.GROU_Depth Material Method DRIVE.GO ALL THE WAY TO TOP OF HILL.
From 0 To 20 Ft OUH(RETE POURED
From To—Ft.
14.SCREEN: Depth Diameter Slot Size Material
From_To_Ft._ in in. _
From_To_Ft._ in in. C
15. SAND/GRAVEL PACK:
Depth Size Material r
From_To_Ft.
From—To—Ft— can
16.REMARKS:
-
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CON TRUCTION STANDARDS,AND THAT A COPY O S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PEASON CONSTRUCTING THE WELL DATE
ubmit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)JEFF MELTON CERTIFICATION#3417
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE#[phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#_
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential MunicipaMblic Industrial El Agricultural El
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town:TRYON County POLK Topographic/Land setting
HUGH CHAMPION RD. ❑Ridge ❑ Slope ❑ valley ❑Flat
(Sheet Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:BRIAN TAYLOR Latihrde/longitude of well location
Address HUGH CHAMPION RD.
(Street or Route No.) (degrees/minutes/seconds)
TRYON NC 28782 Latitude/longitude source: ❑GPS ❑Topographic map
City or Town State Zip Code (check box)
fto-894-8673 DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 10/18/05 _
5.TOTAL DEPTH: 605
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FF.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 Fr. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118. LOCATION SKETCH
9. YIELD(gpm): 1 METHOD OF TEST ARD Show direction and distance in miles from at least
10.WATER ZONES(depth):_ Two State Roads or County Roads. Include the road
number and common names
11.DISINFECTION:Type CHLORYTE Amount 16.5 FROM MML SPRING GO DOWN HWY.#9 S.
12. CASING: Wall Thickness RIGHT ON HUGH CHAMPION RD.DRIVE ON
Depth Diameter or Weight/Ft Material RIGHT APPROX. 1/4 MILEBEFORE THE END
From 0 To 90 Ft 6-1/4" SDR21 PVC OF HUGH CHAMPION RD.
From_To_Ft.
_ _
From To Ft _
13.GROUT: Depth Material Method
From 0 To 20 Ft OUEKRETE POURED l
<.a
From_To Ft
14.SCREEN: Depth Diameter Slot Size Material p`
From_To_Ft._ in in.
t
From_To_Ft._ is in. r
15. SAND/GRAVEL PACK:
Depth Size Material cC)it _
From_To_Ft
From To Ft
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/6 - o0- ;—
SIGNA OF PERSON CONSTRUCTING e 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)JEFF MELTON CERTIFICATION#3417
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING LLC PHONE#[phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#_
(if applicable) (if applicable)
L WELL USE(Check Applicable Box): Residential 13 Municipa"lic ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK Topographic/Land setting
SERPENTINE DR ❑Ridge ❑ Slope ❑ valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER: GARY TRAVER Latitude/longitude of well location
Address SERPENTINE DR _
(Street or Route No.) (degrees/minutes/seconds)
COLUMBUS NC 28722 Latitude/longitude source: ❑ GPS ❑ Topographic map
City or Town State Zip Code (check box)
8( ZS)-894-0397 DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 10/28/05 _
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 actor below land surface requires a LOCATION SKETCH
variance in accordance with 15A NCAC 2C.0118.
9.YIELD(gpm): 50 METHOD OF TEST ARD Show direction and distance in miles from at least
10.WATER ZONES(depth):_ Two State Roads or County Roads. Include the road
number and common names
11.DISINFECTION:Type CHLORYTE Amount 3.5 HWY.#108 W.FROM MILL SPRING.RIGHT
12.CASING: Wall Thickness ON HOUSTON RD.RIGHT ON WHITE OAK
Depth Diameter or Weight/Ft. Material MTN.RD.GO TO TOP OF MOUNTAIN.RIGHT
From 0 To 105 Ft 6-1/4" SDR21 PVC ON MORNING RIDE RD.LEFT ON SERPENTINE
From_To_Ft DR 1 HOUSE ON LEFT.
From To Ft _
13.GROUT: Depth Material Method
From 0 To 20 Ft OUH(RETE POURED
From_To Ft _
14.SCREEN: Depth Diameter Slot Size Material
From_To_Ft._ in in. _._.. -- z ",
From_To_Ft._ in in. Q3
15. SAND/GRAVEL PACK:
Depth Size Material
From_To_Ft._ C3
From—To—FL—
rom To Ft
Y
CA
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCEWITH I5A NCAC 2C,WELL
CO TRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
- Sf-
SIGNATURE OF PERSON CONSTRUCTING THE WELL C DATE
Submit the original to the Division 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 t
WELL CONTRACTOR(INDIVIDUAL)NAME(print)RODNEY ROBBINS CERTIFICATION#Groundwater Section
M
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#— ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: TRYON County POLK Topographic(Land setting
N.MCDADE RD.,BREEZY HILL SUBDV ❑Ridge ❑ Slope ❑ Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER: HUBERT METCALF Latitude/longitude of well location
Address N.MCDADE RD
(Street or Route No.) (degrees/minutes/seconds)
TRYON NC 28782 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 94)-899-4905 DEPTH
Area Code Phone number From To
4.DATE DRILLED 12/14/05
5. TOTAL DEPTH: DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
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* LOCATION SKETCH
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118. Show direction and distance in miles from at least
9.YIELD(gpm): 1 METHOD OF TEST ARD Two State Roads or County Roads. Include the road
10. WATER ZONES(depth): number and common names
HWY.#9 S.FROM MILL SPRING LEFT ON
11.DISINFECTION:Type CHLORYTE Amount 16.5 SANDY PLAINS RD.RIGHT ON FLOYD
12. CASING: Wall Thickness BLACKWELL RD.LEFT ON N MCDADE RD 1sT
Depth Diameter or Weight/Ft. Material DRIVE ON RIGHT.
From 0 To 110 Ft. 6-114" 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. i1L in.
From_To Ft. _ in. — in. RECEIVED
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft_ , ,
From—To—Ft._ J A N 3'0 r:ut:0
16.REMARKS: Asheville Regional Office
Aquifer Protection-
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONS UCTI STANDARDS,AND THAT A COPY OF TfflS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE J
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. GW-I REV.07/2001

N`l"" 3 9, 12 7 6
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)RODNEY ROBBINS CERTIFICATION# 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE#[phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK Topographic/Land setting
ADAWEHI LANE ❑Ridge ❑ Slope ❑ Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
Address ADAWEHI LANE
3. OWNER:RODNEY BOOTH (
Latitude/longitudehec of well location
(Street or Route No.) (degrees/minutes/seconds)
COLUMBUS NC 28722 Latitude/longitude source: ElGPS
OLT or Town p Code
State Zi ❑Topographic map
8( -863-1269 (check box)
Area Code Phone number DEPTH
4. DATE DRILLED 12/21/05 From To
5.TOTAL DEPTH: 605 DRILLING LOG
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
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* LOCATION SKETCH
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118. Show direction and distance in miles from at least
9. YIELD(gpm): 2 1/2 METHOD OF TEST ARD Two State Roads or County Roads. Include the road
10. WATER ZONES(depth): number and common names
HWY.#108 E.FROM COLUMBUS RIGHT ON
11.DISINFECTION: Type CHLORYTE Amount 16.5 FOX MTN.RD.RIGHT ON ADAWEHI LANE. I/10
12. CASING: Wall Thickness MILE ON RIGHT.
Depth Diameter or Weight/Ft. Material
From 0 To 120 Ft 6-1/4" SDR.21 PVC
From—To—Ft_
From To_Ft
Ft —_
13. GROUT: Depth Material Method
From 0 To 20 Ft.QUHOtETE POURED
From_To_Ft. 7
14.SCREEN: Depth Diameter Slot Size Material D
From_To Ft._ in. _ in. RECEIVE D
From—To—Ft._ in. in.
15. SAND/GRAVEL PACK:
Depth Size Material JAN 30 2006
From—To—Ft.
From—To—Ft._ Asheville Regional Office
16.REMARKS: Aquifer Protection
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CON§TR STANDARDS,AND THAT A COPY OF THI CORD HAS BEEN PROVIDED TO THE WELL OWNER
.1G✓
ti.
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

PF 3 ? 128 �
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) ROBIN MCNEELY CERTIFICATION# 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: TRYON County POLK Topographic/Land setting
N.MCDADE RD.,BREEZY HILL SUBV.LOT#6 ❑Ridge ❑ Slope ❑ Valley ❑ Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER: HUBERT METCALF Latitudellongitude of well location
Address N,MCDADE RD. _
(Street or Route No.) (degrees/minutestseconds)
TRYON NC 28782 Latitudellongitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
S( 28)-899-4905 DEPTH
Area Code Phone number From To
4.DATE DRILLED 12/21/05 _
5. TOTAL DEPTH: 61 DRILLING LOG
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 49 FT. _
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface* LOCATION SKETCH
*Top of casing terminated atlor 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): 12 METHOD OF TEST STEEL TAPE number and common names
10. WATER ZONES(depth): HWY.#9 S.FROM MILL SPRING.LEFT ON
11.DISINFECTION:Type CHLORYTE Amount 5.52 SANDY PLAINS RD.RT.ON FLOYD BLACKWELL
RIGHT. LOT#6.
LEFT ON 6. MCDADE RD. 1 DRIVE O
12. CASING: Wall Thickness RIGHT.
Depth Diameter or Weight/Ft. Material
From 0 To 61 Ft 24" CEMENT
From_To_Ft
From To Ft. _
13. GROUT: Depth Ma_terial Method
From 0 To 20 Ft.CEMENT POURED
From_To_Ft t
14.SCREEN: Depth Diameter Slot Size Material
From TO Ft. in. in.
From_—To_Ft.— in. — in. RECEIVED `°
15. SAND/GRAVEL PACK: c
Depth Size Material JAN 30 2006
From 49 To 61 Ft 78M GRAVEL
From_To—Ft._
Asheville Regional Office
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CO CTION STANDARDS,AND THAT A COP=TfH CO HAS BEEN PROVIDED TO THE WELL OWNER
/�IGNA OF N 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

; 1300
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)JEFF MELTON CERTIFICATION#3417
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE#[phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#_
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town: TRYON County POLK Topographic/Land setting
GOLF COURSE RD. ❑ Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:PAUL MULLETT Latitude/longitude of well location
Address GOLF COURSE RD. _
(Street or Route No.) - (degrees/minutes/seconds)
TRYON NC 28782 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 28)-817-1179 DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 12/20/05
5. TOTAL DEPTH: 525
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. LOCATION SKETCH
9. YIELD(gpm): 2 METHOD OF TEST ARD Show direction and distance in miles from at least
10. WATER ZONES(depth):_ Two State Roads or County Roads. Include the road
number and common names
11.DISINFECTION:Type CHLORYTE Amount 14 HWY.#9 S.FROM MILL SPRIN. RIGHT ON
12. CASING: Wall Thickness LANDRUM RD.RIGHT ON GOLF COURSE RD.
Depth Diameter or Weight/Ft Material APPROX. 1.5 MILES ON LEFT.
From 0 To 90 Ft. 6-1/4" SDIL21 PVC
From_To_Ft
From To Ft
T:
13. GROU_Depth_ Material Method
From 0 To 20 Ft OUEKRETE POURED
From_To Ft_
14.SCREEN: Dep_th Diameter Slot Si_ze Material
From_To_Ft._ in. in. o
From_To Ft._ in. in.
15. SAND/GRAVEL PACK: RECEIVED
Depth Size Material
From_To_Ft_ _ JAN 3 0 2006
From To Ft
16.REMARKS:_ Asheville Regional Office
A uifer Protection
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED TH DA NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT COPY OF THIS CORD 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

WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(prim) ROBIN MCNEELY CERTIFICATION# 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use—
2. WELL LOCATION:
Nearest Town: TRYON County POLK Topographic/Land setting
FAGAN RD. ❑Ridge ❑ Slope ❑ Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER: WAYNE HORNE Latitude/longitude of well location
Address FAGAN RD. _
(Street or Route No.) (degrees/mmutes/seconds)
TRYON NC 28782 Latitude/longitude source: ❑ GPS ❑ Topographic map
City or Town State Zip Code (check box)
8( 64)—680-5555 DEPTH
Area Code Phone number From To
4.DATE DRILLED 12/14/05
5. TOTAL DEPTH: 63 DRILLING LOG
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
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* LOCATION SKETCH
*Top of casing terminated attor below land surface requires a Show direction and distance in miles from at least
variance in accordance with 15A NCAC 2C.0118. Two State Roads or County Roads. Include the road
9. YIELD(gpm): 20 METHOD OF TEST STEEL TAPE number and common names
10.WATER ZONES (depth): HWY.#9 S.FROM MILL SPRING.LEFT ON
11.DISINFECTION: Type CHLORYTE Amount 9.2 CHESNEE RD.RIGHT ON FAGAN RD.APPROR. 1
12. CASING: Wall Thickness
2/10 MILE ON LEFT.
Depth Diameter or Weight/Ft Material
From 0 To 63 Ft 24" CEMENT
From_To_Ft._
From To Ft
T:13. GROU Depth_ Material —
erial Method
From 0 To 20 Ft.CEMENT POURED C-
From_To Ft.
14.SCREEN: Depth_ Diameter Slot Size Material
From_T Ft.— in. in. RECEIVED From_Too_Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material JAN 30 2006
From 43 To 63 Ft 78M GRAVEL
From—To—Ft— Asheville Regional Office
16.REMARKS: Aquifer Protection
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CON CTION STANDARDS, AND TACO Y O THIS CORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PER STR 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