Ru CY2005

From:Scott Gantt To:Stephenie Wilson Date:8/1 512 0 0 5 Time:6:57:50 PM Page 1 of 4
3I5Q3) 4
WELL CONSTRUCTION RECORD D-0
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: RUTHERFORDTON County RUTHERFORD ❑Ridge ❑ Slope ❑ Valley ® Flat
3515 PAINTERS GAP RD Latitude/Longitude of well location
(Street Name,Numbers,Community,Subdivision,LotNo,Zip Code) 35.30.743/82,02,887
3.OWNER SETZER WELL CO (degrees/minutes/seconds)
ADDRESS Latitude/longitude source:®GPS❑Topographic map
(Street or Routa No.) DEPTH DRILLING LOG
SHELBY NC From To Formation Description
Cityor Town State Zip Code 0 30 Clay
704-434-6107 30 80 Consolidated Rock
Area Code-Phone Number
4.DATE DRILLED 7/27/05
5.TOTAL DEPTH 80
6.DOES WELL REPLACE EXISTING WELL? YES ❑ NO
T STATIC WATER LEVEL Below Top of Casing: 10 FL
Nse" -IfAbovc T000f CasmS)
S. TOP OF CASING IS 2 FT.Above Land Surface"
'Top of caring wouio tcd at/m blow land aufacc rcquaes a variant in
accordmcc with 15A NCAC 2C.0118
9. YIELD(gpm): 40 METHOD OF TEST ARDM
10,WATER ZONES(depth): 80
D.DISINFECTION:TYPE HYPOCHLORITE Amount 4 oa LOCATION SKETCH
12.CASING: wall Thickness Show direction and distance in miles from at least
Depth Diameter or weight/Ft. Material two State Roads or County Roads.Include the road
From 0 To 38 Ft 6 1/4" SDR 21 PVC numbers and common road names.
13.GROUT:
Depth Material Method
From 0 To 20 Ft GRAVEL MIX GRAVITY
14,SCREEN
Depth Diameter Slot Size Material ka
i7
From NA To FL in. intz-
15.SAND/GRAVEL PACK: .
Depth Size Material I
ION
i
From NA To Ft,
CJ
16.REMARKS: C!t
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
8/I/05
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
GW-I REV.0712001
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mao Service center-Raleigh,NC ---- --.._.
27699-1636 Phone No.[phone],Within 30 days. _ �,

WELL CONSTRUCTION RECORD l/
North Carolina Department of Environment and Natural Resources-Division of Water Quality"
(`a m n .7 r
WELL CONTRACTOR(INDIYIDUAL)NAME (Priat)��,ij,'^^�_ CERTIFICATION a-2-1-U
WELL CONTRACTOR COMPANY NAME tramp' s Well & pump Co.�PnoNE962S 451_7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ 'p
(if applicable) / (if applicabblele))
MENNEN
]. WELL USE(Check Applicable Box):Residential'o Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery El Heat Pump Water Injection❑ Other 11 If Other,List Use
2. WELL LOCA 10, - Topographic/Lan settin�
Nearest �d1 � CO�Ty- - edge ❑Sloe alley Flat
4 (chwk appropriate box)
(Street Name,t1Numbers,Commumly, ubdrvrsmn Lot No.,Zip Code)
Latitudellongitude of well location
3. OWNER: \ ' "4 \I1�,Ll AIL (degees/minutes/sewnds)
Address es 7C S'-I' LautudeAongitude source:f]GPSOTopographic map
(check box)
Street or Route Np.� DEPTH DRILLINGLOG
Lake �A✓e ���/ Y
City or Town state Zrp code Fm �T Fon non Description
Ares coda Phone num
4. DATE DRILLED � "
5. TOTAL DEPTH: ,
6. DOES WELL REPLACE EXISTING WELL? YE ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use"+"if Above Top of wing)
8. TOP OF CASING IS 1 FT.Above Land Surface* N
,Top of emaing terminated af/or bebw lied surface requim a N _
varianu in accordance with 15A NCAC 2C.0118,
9. YIELD(gpm): METHOD OF TEST_4 i r Ln
10.WATER ZONES(depth): k VD LOCATION SKETCH "s
Show direction and distance in miles from at leasY2
11. DISINFECTION:Type C lLar i n p Amount two State Roads or County Roads.Include the road
12. CASING: Wall Thickness numbers and common road names.
Depth Diameter or Weight/Ft. Material
From_To_SS­Ft. 6 1 /4 Sd r 1 - RV-C
From To Ft.
From To Ft. "
13. GROUT: Depth Material Method
From__p___To__2D_Ft. Neat Ce_mt-nt Hand
From To Ft-
14. SCREEN: Depth Diameter Slot Size Material.
From To Ft. in. _ in.
From To Ft. in. in.
614
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS C NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COP OPUS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
• SI A OF PERSON CONSTRUCTING THE WELL DATE v
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

WELL CONSTRUCTION RECORD l/
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELLCONTRACTOR(PIDI WIJAL)NAME (print)_y slR a Fr f`amn Tr CERTMCATION#_2_1-U
WELL CONTRACrORCOMPANYNAME EamP' s Well & PuMp Co _ Tnr_ PHONE # RSA e51_7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ le Yf
(if applicable) moomm (if applicable)
—
011111111111111111
1. WELL USE(Check ApplicableResidential
� tp Industrial ❑ Agricultural❑
Montoring❑ Recovery Heat Pump Water Injection OtherD IfOthrListUse
2. WELL LOCATION' Topogra�hic/Land setting
NrrestTown: CoantySj,� ORidge Utpe oVailey OFlat
\ Sl t\l. 0ti�s �L .� (check appropriate box)
(Street Name,Numbers,Commumty,Subdwismn,LotNo.,Zip Code) Latitude/longitude of well location
�• ,(� (degras/minutes/seconds)
3. Tddress
: ` Latitude/longitude source:DGPSOTopographic map
p (check box)
( !uteNo.) C �0 'I DEPTH DRILLING LOG
�C A From To Formation Description
City or Town State Zip Code
Area code-Phone i on' _.
4. DATE DRILLED X��:
5. TOTAL DEPTH: Doi ,�i -a
6. DOES WELL REPLACE EXISTING WELL? YES O NO up
7. STATIC WATER LEVEL Below Top of Casing: 1\0 n
(Use"+"if Above Top of Casing) r'7
8. TOP OF CASING IS 1 FT.Above Land Surface* tV _
'Top of casing terminated at/or below lend surface requires a tV
variance in new c with 15A NCAC 2C.01I& r••t 39
9. YIELD(gpm)rd _METHOD OF TEST_4 r Ln
10.WATER ZONES(depth): i OU LOCATION SKETCH
Show direction and distance in miles from at lean--+
11. DISINFECTION:Type Ch l>nr i na Amount two State Roads or County Roads.Include the road
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material numbers and Comm nro-ad�n es.
From rr_To�i�Ft. 6 1/4 Srl r 1 —p17C \ � ,U
From To Ft. 0
From To Ft. - W
13. GROUT: Depth Material Method
From___Q_To___2D_Ft. Neat Cement Rand
From Tc 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 Gvx.
From To Ft. Q�
From To Ft. �IAX.I QADil
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
SIGN N OF III. 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_I REV.09/2004

315288
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality"
WELL CONTRACTOR(INDIVIDUAL)NAME (print) amec W (`amnr x CERTIFICATION#-2-ua8
WELL CONTRACTOR COMPANY NAME Camp' s Well & Pumper, Inc_ PHONE # 62A d9, _ 22
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):ResidentiaiV Municipal/Public O Industrial❑ Agricultural❑ .
Monitoring❑ Recovery O Heat Pump Water Injection❑ Other O If Other,List Use
2. WELL LOCA ON• Topographic/Land setting
Nearest Town: v CountylUtJJble 4Rtudge ❑Slope OValley OFlat
r' ♦n 1 n .. (check appropriate box)
(Street Latitudellongitude of well location
,Numbers,Commumty,Subdivision,Lot No,Zip Code)
3. OWNER: (degiees/minutes/seconds)
Address Ay i it e Y Latitudeflongitude source:OGPSOTopogmphic map
�,{ (Sheet or Rp No.) _ (check box)
R K7 I(Q Ys r et d �h � C �S �3�) DEPTH DRILLING LOG
From
City or Town State Zip code TO F jlnation escription
( )- `117
Area code-Phone num
4. DATE DRILLED bV110.c. 0 S
5. TOTAL DEPTH: '
6. DOES WELL REPLACE EXISTING WELL? YES `NO CO C
7. STATIC WATER LEVEL Below Top of Casing:
.(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1 FT.Above Land Surface*
'Top of casing termhuted at(or below land surface requires a
variance in accord ce with 15A NCAC 2C.0118.
9. YIELD(gpm): _ME �� OF TEST4 i r
10.WATER ZONES(depth): LOCATION SKETCH ^s
Show direction and distance in miles from at least
12. CASING: Wall 11. DISINFECTION:Type Ch r�r i na Amount n s I two State Roads or County Roads.Include the road
Weigh Thickness
Dep Diameter or Weight/Ft. Material numbers and common road names.
From__To LFt. 6 1 /4 ;clr 1 pVr'
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From___Q _To__y.)_Ft. Neat rem_ent Hand
From - To Ft.
14. SCREEN: Depth Diameter Slot Size Material n r
From To Ft- in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft. ll
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN AC ORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SI A O ON ONSTRUCTAIGTHEWELL 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

01-1 31528 (;
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACPORONDIVIDUAL)NAME (print) amec W f`a m�Lr Jr CERTIFICATION 8-23- 8
wELLCONTRACPORCOMPANYNAME Uampt S Well & Pump CO- a Inn- PHONE 8
STATE WELL CONSTRUCTION PER?,M ASSOCIATED WQ PERNM
(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 LOCAT/I Topographic/Land setting
Nearest Town:} ^�- County ORidge ❑Slope ley OFlat
49-]l� (check appropriate box)
(Street Name,Numbcts,(;ommunity,Subdivision,Lot No.,Zip Code) LatitudeAongitude of well location
3. OWNER: 661z v� \Y (degreegmintaWseconds)
Address 7t7_1 - 1 " Latitude/longitude source:OGPSOTopographicmap
�y (S t of Route o.) (check box)
. , �e�ersh„ a rL 33710 _4cF b3 DEPTH DRILLING LOG
City or Town State Zip Code From To Forma6ot Descript'ipn
Ares code-Phone DEPTH:
numbr;
4. DATE .L1., —
5. TOTAL DEPTH:: �h s � S(U - .e_11 IAAAk --
6. DOES WELL REPLACE EXISTING WELL? YE ❑ NO Lj
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 N ti
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm):—.7 —M I! �L OF TEST_
10.WATER ZONES(depth): rS
LOCATION SKETCH
11. DISINFECTION:Type(`h I:n r i n o Amount
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_�9L Ft. 6 1 /¢ CA r 1 nvr
From TO Ft. 4. 1 n
From To Ft.
13. GROUT: Depth Material Method n.
From__Q_To__2i0L_Ft. Neat merit 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 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
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
GNATUREeyPER CONETRUCMG 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-I REV.09/2004

325285
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality"
WELL CONTRACTOR(INDIVIDUAL)NAME (print)� amPa W�f'am�}, .Tr CERTIFICATION p_Z.1_18
WELL CONTRACTOR COMPANY NAME Gamp' s Well & Pump co , Inc- PHONE # Q7A d&Z 22
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
if apPEcable) (if applicable)
1. WELL USE(Check Applicable Box):Residential❑ MunicipaUPublic❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery O Heat Pump Water Injection❑ Other O If Other,List Use
2. WELL LOCAT N: ` Topographic/Land setting
NearefjT wn: 6ouuntx_ rl M�/ Wdge ❑Slope OValley OFlat
(check appropriate box)
(Street Nano,,Numbers.Community,tSSu�bdivision,Lot No.,Zip Code) LatitudeQongitude of well location
3. OWNER: ` u k i Ptt-w+.rv�ttA a (degieeslminutestseconds)
Address o�9�0ol��:)ihe 6wli IZA Latitude/longitude source:OGPSOTopographic map
�(StrSet or Route N,q) (check box)
u PTV e d nI N c ). q DEPTH DRILLING LOG
City or Town State 1 Zip Code From To Formation Description
Area code-Phone ninths
4. DATE DRILLED I • y
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES O NO Cx
7. STATIC WATER LEVEL Below Top of Casing:k d 0 FT. r
(Use"+"if Above Top of Casing) N
8. TOP OF CASING IS 1 FT.Above Land Surface* (\3
-Top of easing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.011&
9. YIELD(gpm): ME OD OF TESTS jLn
.r
10.WATER ZONES(depth): 600
LOCATION SKETCH
11. DISINFECTION:Type h.I:.Dr i n P Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the mad
d'Q `
Depth Diameter or Weight/Ft. Material numbers and common road names.
From
__n_ _To Ft. 6 1 /4 Afir 1 PUC 1,
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From__D_To�p_Ft. Neat roament Hang_ ,Y� t� ,
From - TO Ft. V -rw.,.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. yC�
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. (� r
From To Ft. 's"' "
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRU STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
L4NATMOOPERSON 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

WELL CONSTRUCTION RECORD SS
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) Jameg W ramp Jr CERTIFICATION 9 24,18
wELLCONTRACrORCOMPANYNAME Camp' S Well & Pump Co- r Tnrr PHONE R 628 451_7122
STATE WELL CONSTRUCTION PERMrn ASSOCIATED WQ PERMIT0
(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/Lan setting
Nearest Town:�, * C6 !I C County fY oYJ_ ORidge ❑Slope L�SValley OFlat
�EA �('QQ C - (check appropriate box)
(Street Name,Numbers, nunity,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: YY (degree alminutes/seconds)
Address 5�[j_wit r Latitude/ongitude source:OGPSOTopographic map
1 (Street 9r Route No.) (check box)
IV C gQ 3 q DEPTH DRILLING LOG
City or Town State Zip code From To F rmation Description
U 0o
Area code-Phone number
4. DATE DRILLED �- -(`i.,S t�-() '�b 5 /'c h 5� P ✓ t_k
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YE ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: C n
(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 IV
variance in aceirdinff
with 15A NCAC 2C.011& (23
9. YIELD(gpm): METHOD OF TEST ql i r cn
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type Ch 1mr i n a Amoun Show direction and distance in miles from at least `
12. CASING: Wall Thickness two State Ro otmty Roads.Include the mad
Depth Diameter or Weight/Ft. Material numbers and names.
From�_To�G Ft. 6 1 /Q RAr 7I pvr
From To Ft.
From To Ft. -
13. GROUT: Depth Material Method
From_p_To__2_p_Ft. Neat- ment Hanel
From - To Ft.
14. SCREEN: Depth Diameter Slot Size Material XU'
From To Ft.—in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.-
Front—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
ivy ,, . r 8 16 _QS
0 SIGNATURE Q
q 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

31 ` Q q
J iJ tT�
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality-
WELL CONTRACPOR(INDWIDUAL)NAME (print) .TdmP_C W_ f`ampr Jr CERTIFICATION# 7�7R
wELLCONTRAcToRCOMPANYNAME Camp' s Well & Pump Co- , Tnr.- PHONE # a7A 451_7 22
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERNIM
ifapplicable) ifapplicable)
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 LOCATION: - Topographic/Land setting
Nearesst`Fown: 905tl C- County ('Y pYrl 6 idge ❑Slope OValkey []Flat
J A,yi kyit-t —L e I (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: OC2 Y( .5>y a l (degrees/minutes/seconds)
Address �'�k!409 VVyY(A Or Latitude/longitude source:OGPSOTopographic map
.{�- ueet o yjute No - (check box)
U R tl5 10. { '3Q9 Q(F DEPTH DRILLING LOG
Ia orT wn State Zip code From TO ormatio Description
- �33�- 4.3go 0 38
Area code-Phone number -
4. DATE DRILLEDV — O - OS
5. TOTAL DEPTH: 9+5
6. DOES WELL REPLACE EXISTING WELL? YES O NO
7. STATIC WATER LEVEL Below Top of Casing: I D(1
(Use"+"if Above Top of Casing) _
8. TOP OF CASING IS 1 FT.Above Land Surface'
`Top of casing termivated at/or below land surface requires a
variance in accordan a with 15A NCAC 2C.0118. C7 -
9. YIELD(gpm): SMETHOD OF TEST�L
10.WATER ZONES(depth):\.),V, yNyl,,,_ `''u nnpq ry
` LOCATION SKETCH o
11. DISINFECTION:Type h I:c r i rtP Amount Show direction and distance in miles fronM least,
12. CASING: Wall Thickness two State Roads or County Roads.Include the roam
Depth Diameter or Weight/Ft. Material numbers and common road names. -.:
From_ To �g Ft. 6 1 /¢ Srl r 1 nirr+
From To Ft. _
From TO Ft. -- - r.
13. GROUT: Depth Material Method
From__n_To--2jD_Ft. Neat Cement Hand P
From - TO Ft. `
VA
14. SCREEN: Depth Diameter Slot Size Material �\
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: N Oi X1 x
I DO HEMY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
A lvr/vim , t 9— 1l�_ '
GNATU[JRE RE OF 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-I REV.09/2004

0
315282
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELLCONTRACrOR(INDTVIDUAL)NAME (print) games W_ Camp, ,Iy-- CERTMCATION0 721 8
WELL CONTRACTOR COMPANY NAME Camp' s Weil & Pump Co- r Tnr,_ PHONE R7A 451_7 122
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) ifapplicable)
1. WELL USE(Check Applicable Box):Residential WMunicipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery O Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATIO Topographic/Land setting
Nearest Town: County
V -bRidge Slope OValley OFlat
\4D A LLa - (check appropriate box)
(street Name,Numbers,Community,S tNo.,Zip Code) Latitude/longitude of well location
3. OWNER( I o- �P 4 , nM 9n Ll C (degrees/minutes/seconds) - -
Address 'k l- N 2A.. 'wa 1 LatitudeAongitude source:OGPSOTopographic map
1�,,,� (S t or Route No. - (check box)
Sm.LY 712ils5) g 4�3 DEPTH DRILLING LOG
City or Town State Zip Code - Froma S Tos 9
F ation Description
Area codee c d-Phone noes -
4. DATE DRILLED d,• _.
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES O NO It _.
7. STATIC WATER LEVEL Below Top of Casing: 3 A FT. a 1
(Use"V'if Above Top of Casing)
8. TOP OF CASING IS 1 FT.Above Land Surface's
*Top of caning terminated at/or below land surface requires a _
variance iu accord pce with 15A NCAC 2C.011&
9. YIELD(gpm): a�(� METHOD OF TEST i r o
10.WATER ZONES(depth): nl]
LOCATION SKETCH
11. DISINFECTION:Type Ch.1;nr i n a Amount Show direction and distance in miles from at least a'
12. CASING: Wall Thickrea two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and c mmon road names.
From_p_To-6-5—Ft. 6 1 /¢ Sri r p�
From To Ft. W
From To Ft. -
13. GROUT: Depth 5 Material Method
From__IL_To Ft. Neat CPmant .
From Ft.De U�
14. SCREEN: Depth Diameter Slot Size Material �n
From To Ft. in. in. F4'
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material UW
From To Ft. .(JVTr _
From To Ft. `l
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
Q , �^� P,(X » C21 LMO �^ q. 0S
SIGNATUREOF 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

WELL CONS TR U CUT ION RECORD
North Carolina- Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
CERTIFICATION# t d
WELL CONTRACTOR(INDIVIDUAL)NAME (print)
,.i a c ow w \ PHONE * �fPL-SDS- .—zo LZ
♦VF,LL CONTRACTOR COMPANY NAME �� J
ASSOCIATED WQ PERMIT# _
SLATE WELL CONSTRUCTION PERMIT# (if applicable)
(if applicable) �/
I. WELL USE(Check Applicable Box): Residential El Municipal/Public ❑ Industrial ❑ Abmcultural❑ ,
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use __ _
2. WELL LOCATION:/ / '/ Topogir phic/Land setting
Nearest Town: laid /o��' County � 0' 9 ORidge "Slope ❑Valcy ❑Flat. _
(check appropriate boxI _
f4CKenzef om4; ' Latitude/lon itudeofv�7flocation
(Street Name-Numbers,Community.subdivision,Lot Na.Zip Code) g
(degrees/minutes/se:onds)
3. OWNER: C ^ Latitude/longitude source:OGP iOTopographic map
Address 3 f2ocxLaarx3 Vbotd (cbcrIAvx)
(Street or Route No.) DEPTH "DF ILLING LOG
Ar en N!L- Fo-mationDescrption
Coy or To-n State Ztp Code From To "
t7'T'7 9'tlt I �4 Qt.e� �1,.��..f
(a�a) —
Area code-Phone number
4. "DATE DRILLED
5. TOTAL DEPTH: — ,
ES ❑ NO
6. DOES WELL REPLACE EXISTING WELL? Y -- c
7. STATIC WATER LEVEL Below Top of Casing:_if FT. __may--T
(Use"+'if Above Top ofeasing) --.
S. TOP OF CASING IS 'N FT.Above Land Surface'
`Top of casing terminated at,,,below land surface requires a
•aHance in accordant'svitb 15A NCAC 2C.0118.
9. YIELD{gpm): `O METHOD OF TEST Ric,
10.WATER ZONES(depth): V LOCATION SKETCH
Amount Show direction and distance in mires from at least
11. DISINFECTION:Type >' .—_— two State Roads or County Roads. Include the road
12. CASING: Wall Thickness
Depth Diameter o�rnWcighUFt. Material numbers and common road names.
From�_Tov Ft--S�--- "�-
From - To Ft.
From To Ft. �^ �a U �� �"�� •
i3. GROUT: Depth Material Method
From To'AQ Ft. Wn-yk4 —
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. _----- gtZ:n7
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELLWAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
CONSTRUCTION STANDARDS;AND THAT A COPY O
SIGNATURE F PERSON TRUCTING THE WELL
DF,TE
,ANS
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Cents'REVgh,NC 1
,,<oo-t676 phone No.[phone],within 30 days.

_ \1'
> 8 � �
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality"
WELL.CQNTRA,70R(WDWMUAL)NAME (priest) Jame.^S W_ ramp, Jr CERTIFICATION# 21 a
::_._' _.__—___..._ __ .
WELL CONTRACTOR COMPANY NAME Camp' s Well & Pump Co- , Tnr•_ PHONE # A7A 45z_7z22
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) ,,, (if applicable)
0 1. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery [] Heat Pump Water Injection❑ Other O If Other,List Use
2. WELL LOCAT opographic/Land setting
Nearest Town: County Let dge ❑Slope OValley OFlat
(check appropriate box)
(StreetName, n
Numberrs m s,Comu'nit ,Slluubdivisionn Lot No.,,Zip Code) Latitude/longitude of well location '
3. OWNER: G.1I./tCb/1 ,,_t r-�l �L 'A' )J C' Y S (degrees/minutes/seconds)
Address - D o X TA q Latitude/longitude source:OGPSOTopogmphic map
(Street or Route No.)I C 6 (check box)
P j u Y e N DEPTH DRILLING LOG
City or Town State Zip Code From o Feormation Depscrip n
Area code-Phone numbe -
4. DATE DRILLED 2 S —�—,
S. TOTAL DEPTH: .I, %' U= g
6. DOES WELL REPLACE EXISTING WELL? Y It ES O NO
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* m .,
-Top of casing terminated atlor below land surface requires a
variance in accordan with 15A NCAC 2C.011&
9. YIELD(gpm):_ � METHOD OF TEST air r
10.WATER ZONES(depth): �)_?�U
LOCATION SKETCH ut
11. DISINFECTION:Type Ch 1 nr-i ne Amount 41
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. �(W�
From_To_�Ft. 6 1 /¢ Gr9T- 1 pirr
From To Ft.
From To Ft.
13. GROUT: Depth Material Method ----
From�_To _Ft. bleat Cement Hant3
From TO Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. \
From To7 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
(_�\ r �T/,iv, ()) Ew t I 1 (7
`S ATURE OF PEPS ON 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

"5..i._.
WELL CONSTRUCTION RECORD O 316 81
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONFRACfOR(INDIVIDUAL)NAME (print)_ .Tames W_ ramp, Jr CERTIFICATION# 9�7R
I ' j'l'F(LI.,CiQ ,I,'RACI'OR COMPANY NAME Camp' S Well 8 Pum® CO_ Inc_ PHONE # A7A, dr."2_7122
---_ ""- STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W Q PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential 8-.�Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Tow 41 Coun
(� b' 19Ridge ❑Slope ❑Valley ❑Flat
�Y'4�1tl (check appropriate box)
(Street Name,Numberc Cn,_„_,_mity Subdivision,Lot No.,Zip C e) Latitude/longitude of well location
3. OWNER:T (degrees/minutes/seconds)
Address & LatitudeAongitude source:❑GPS❑Topographic map
(Street or ute No.) (check box)
e n o g C)4 0 DEPTH DRILLING LOG
City or Town State Zip Code From �1To Fom]atI,on Descr lion
t
Area code-Phone number
4. DATE DRILLED
5. TOTAL DEPTH: G� cfud
,ry -
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: T. «t
(Use"+"if Above Top of Casing) -p
8. TOP OF CASING IS 1 FT.Above Land Surface•
-Top of casing terminated attor below land surface requires a -
vadance in accords ce with 15A NCAC 2C.011& -
9. YIELD(gpm): 4l, METHOD OF TESTS i r 01
01
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type Ch 1 Or 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 common road names.
From__To_':J�Ft. 6 1 /4 Sr3 r 21 PVC
From To Ft.
From To Ft. - -
13. GROUT: Depth Material Method
From__a_To__2j0L_Ft. Neat CemaIIt 14anr3
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
�.
From To Ft. in. in.
15. SAND/GRAVEL PACK: p
Depth Sim 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
n./ Ar, �,441 o q /S d S'
GNATURE OF,?ERSON CON TRUCTING 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-I REV.09/2004

WELL CONSTRUCTION RECORD 3fi g j
North Carolina Department of Environment and Natural Resources-Division of Water Quality"
WELL CONTRACTOR(INDIVIDUAL)NAME (print) Tam a W_ Camp, Jr CERTIFICATION q-2 -3$
WELL CONTRACTOR COMPANY NAME Camp' s We 11 & Pump CO_ , Tnn_ PHONE a $2g_q 1;'A_7-422
STATE WELL CONSTRUCTION PERMITH ASSOCIATED WQ PERMITN
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 LOCAT N: Topograoic/Land setting
NeaTe`a}4T� ,own: County Ridge ®•Slope OValley OFlat
--' PM^ �- (check appropriate box)
(Street Name,Numbers,Commu Inity Subdivision.Lot/No,zip Code) Latitude/longitude of well location
3. OWNER: I—e e �Y 1�E _ Ze X CCr'l ri a r' (degrees/minutes/seconds)
Address +ri 58 t7 t k rt RA . Latitude/longitude source:OGPSOTopographic map
(Str-tor Route No.) - (check box)
ttc LI ta/e o rl -5 C .: q 4 4 9 DEPTH DRILLING LOG
City or' own State Zip Code From To r do Desc ion
U 0
Area code-Phone number -
4. DATE DRILLED` ) O(�U� f)'Jy" --
5. TOTAL DEPTH: -"
6. DOES WELL REPLACE EXISTING WELL? YES P NO
7. STATIC WATER LEVEL Below Top of Casing: F C/)
(Use"+"if Above Top of Casing) -D
8. TOP OF CASING IS 1 FT.Above Land Surface* tv
-Top of casing terminated at/or below load surface requires a
variance in accordance with 15A NCAC 2C.0118. -
9. YIELD(gpm): () METHOD OF TEST Air
10.WATER ZONES(depth): U U
LOCATION SKETCH
11. DISINFECTION:Type Ch 1:or 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 common road names.
From_To Ft. 6 1 /4 SA r 91 pN7C
From To Ft.
From To Ft. -
13. GROUT: Depth Material Method
From__D_To_ _Ft. Neat Cemant Rand__
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material `
From To Ft. in. in.
From To Ft. in. in. 15
15. SAND/GRAVEL PACK: -
Depth Size Material
From To Ft. 1\ -
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
PC, p
SIGNATURE OF PERS 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

North Carolina Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
1536 Mau Service(.enter-Ralelgh,N.C. 27699-1638-Phone[phone]
VVFL ! CONSTRUCTION RECORD WELL CONTRACTOR: " °xAJvd L.A "VI
WELL CONTRACTOR CERTIFICATION # : 9�
STATE WELL CONSTRUCTION PERMIT #
NFLI- USE (Check Applicable Box): Residential Municipal El Industrial❑ Agricultural ❑ Monitcrinc❑
Recovery Heat Pump Water Injection Other❑ If Other, List Use:
'^dFll [ ")CATION (Show sketch of the location below) e�-
Nearest town rJ61.4"aso VAA4 Y County Ru?h zair/-L I'd J OW
/S�Y7,?Grs .T/ya+;.yAJ .��,iST �ei,�3'2D
a,nd Name and Numbers. Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
)`.VNFR 9cWAl d H. flojj%VJ61V From TO Formation Descrot,o
/
(Street or ou e O aryl/�bcnc Alid
Cny or Town State Zip Code
,. DATE DRILLED �16 - d
-4I DEPTH
'INGS COLLECTED YES Q NOM
FS 'VELL REPLACE EXISTING WELL? YES (-1 NO[Y](
i 'WATER LEVEL Below Top of Casing FT.
si (Use"✓'if above Top of Casing)
IF CASING IS « FT. Above Land Surface'
or .as,�q terminated atior below land surface requires a variance in actor
-f,ancr with FA NCAC C_p118 _
mot. ,Pm'r. /S_* METHOD OF TEST
W-FP ZONES (depth)
12 (:HLOP,INATION: Type Amount 4 If additional space is needed use back of form
CASING'. Wall Thickness
Depth Diameter or Weight/Ft. Material
to _70 Ft G X 7,G pt45,,%G LOCATION SKETCH
- To rt. (Showdirection and distance from at least two �'a•r
Roads. or other map reference poirts) --
�a ;Rf)UF
Depth Material Method
To Ft
To Ft
O
Depth Diameter Slot.Size Material _ -':1
__ to Ft in in W
^-- _ To Ft in In p
- _ To Ft in in LA �..s
`,J (;RAVEL PACK_ ,
- Depth Size .Material
m To Ft
r'or To Ft
'FMARKS
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 (- ��G-� + rC 9-/�- dS
Quad No. —� s
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Serial No. Submit original to Division of Water Quality. Groundwater Section within 30 days
GW 1 REV 1719r
24
i

e ?11,a U�anu o.atepneme wuson Date:9/29/2005 Time:5.57:52 PM Page 3 of 3
ovo
WELL CONSTRUCTION RECORD 1
North Carolina-Department of Environment,and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) SCOTT GANTT CERTIFICATION#2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS,INC. PHONE It(704)434-7277
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: RUTHERFORDTON Coumy RUTHERFORD ❑Ridge ❑ Slope ❑ Valley ® Flat
LOT 79 RIVER RIDGE SUB,COXE RD Latitude/Longitude of well location
(Street Name,Numbers,Conammily,Subdivision,Lot No,Zip Code) 35.17.462/81.58.616
a.OWNER TOM ARDITO (degrees/minmes/smonds)
ADDRESS LOT 79 RIVER RIDGE SUB,COXE RD Latitude/longitude source:®GPS❑Topographic map
(Street or Roble No.) DEPTH DRILLING LOG
RUTHERFORDTON NC 28139 From To Formation Description
City o Town State Zip Code 0 65 Clay
864-216-2584 65 160 Consolidated Rock
Area Code-Phone Number
4.DATE DRILLED 8/21/05
5.TOTAL DEPTH 160
6.DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7.STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use`+-IfAbovc Top of Casing)
8. TOP OF CASING IS 2 FT.Above Land Surface•
'Top of ease,tcrosmrtcd at/or below lead surface regaves a vviamcc as
accordance with 15A NCAC 2C.0118
9. YIELD(gpm): 10 METHOD OF TEST ARDM
10.WATER ZONES(depth): ISO
D.DISINFECTION:TYPE HYPOCHLORITE Amount 6 0= LOCATION SKETCH
12.CASING: Wall Thickness Show direction and distance in miles from at least
Depth Diameter m Weight/Ft. Material two State Roads or County Roads.Include the road
From o To 70 FL 6 1/4" SDR 21 PVC numbers and common road names.
U.GROUT:
Depth Material Method
From 0 To 20 Ft GRAVEL MIX GRAVITY rn U'
14.SCREEN —O
N mod:
Depth Diameter Slot Size Material
From NA To FL in. in.
CD a
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.
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 SecoUty1636Mai1Servkecenterz Rale%h(NC
27699-1636 Phone No.[phone],Within 30 days.

rrom:escort uantt to:Slepheme Wilson Date:9/29/2005 Time:5:57:52 PM Page 2 of 3
31 � � �' e
WELL CONSTRUCTION RECORD 00
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)
L WELL USE(Check Applicable Box): Residential ® Municipal ❑ Industrial❑ Agricultural ❑ Monitoring
Recovery ❑ Heat Pump Water Injection El Other El If Other,List Use: ❑
2.WELL LOCATION: Topographic/Land setting
Nearest town: LAKE LURE county RUTHERFORD ❑Ridge ❑ Slope ❑ Valley ® Flat
LOT 4 ON BUCK CT., DEER RUN SUBDIVISION Latitude/Longitude of well location
(Street Name,Numbers,Community,Subdivision.Lot No,Zip Code) 35.24-656/82-11-189
3.OWNER RIDGELINE DEVELOPMENT CORP. (degeesJmmutes/seconds)
ADDS 112 COCOPLUM CIRCLE Latitudegongimde source:®GPS❑Topographic map
(sued or Rowe No.) DEPTH DRILLING LOG
ROYAL PALM BEACH FL 33411 From To Formation Description
City or Town State Zip Code 0 60 Clay
561-798-2729 65 600 Consolidated Rock
Area Code-Phone Number
4.DATE DRILLED 8/18/05
5.TOTAL DEPTH 600
6.DOES WELL REPLACE EXISTING WELL? YES NO
7.STATIC WATER LEVEL Below Top of Casing: NA Fr.
(Use""tfAbovc Top of Casing)
8. TOP OF CASING IS 2 FT.Above Land Surface-
'Top of crsing iessnimted al/or below land awfsse""ores a variance in
accordancc with 15A NCAC 2C.0118
9. YIELD(gpm): 0 METHOD OF TEST ARDM
10.WATER ZONES(depth): NA
it.DISINFECTION:TYPE HYPOCHLORITE Amount 6 Ux 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 65 Ft. 6 1/4" SDR 21 PVC numbers and common road names.
13.GROUT: _
Depth Material Method
From 0 To 20 FL GRAVEL MIX GRAVITY fNTI
14.SCREEN -
N -
Depth Diameter Slot Size Material
From NA To FL in in. O
15.SAND/GRAVEL PACK: Cur
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.
9/1/05
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
GW-I REV.07/2001
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mall Service center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days.

rrom:=cm uann i o:biepnenie Wnson Date.9/29/2005 Time:5.57:52 PM Page 1 of 3
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment,and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) SCOTT GANTT CERTIFICATION#2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS,INC. PHONE#[phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I.WELL USE(Check Applicable Box): Residential ® Municipal ❑ Industrial❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2.WELL LOCATION: Topographic/Land setting
Nearest town: RUTHERFORDTON County RUTHERFORD ❑Ridge ❑ Slope ❑ Valley ® Flat
121 COMMON WEALTH LANE Latitude/Longitude of well location
(Street Name,Numbers,Community,Subdivision,Lot No,.Zip Code) 35,23.622/81,59,024
3.OWNER HORTON HOME OF RUTHERFORDTON (degees/mi rmes/seconds)
ADDRESS 342 HWY 74 BYPASS Latitude/longitude source:❑GPS❑Topographic map
(Str d or Romc No.) DEPTH DRILLING LOG
RUTHERFORDTON NC 28139 From To Formation Description
City or Town Stale Zip Code 0 55 Clay
828-287-3366 55 600 Consolidated Rock
Area Code-Phone Number
4,DATE DRILLED 8/25/05
5.TOTAL DEPTH 600
6.DOES WELL REPLACE EXISTING WELL? YES ❑ NO CI
7,STATIC WATER LEVEL Below Top of Casing: NA IT,
(Uae"-^If Above Top of Cum,)
8. TOP OF CASING IS 2 FT.Above Land Surface-
'Top ofcatu8 tmnmatcd a✓m bdow land swface requires a vaunce in
amordmm with 15A NCAC 2C.0118
9. YIELD(gpm): 0 METHOD OF TEST ARDM
10.WATER ZONES(depth): NA
11.DISINFECTION:TYPE HYPOCHLORITE Amount 5 0. LOCATION SKETCH
12.CASING: Wall Thickness Show direction and distance in miles from at least
Depth Diameter m Weight/Ft. Material two State Roads or County Roads.Include the road
From 0 To 60 PC 6 1/4" SDR 21 PVC numbers and common road names.
13.GROUT: "
Depth Material Method
rn0
From 0 70 20 Ft GRAVEL MIX GRAVITY tV -
14.SCREEN
lD
Depth Diameter Slot Size Matenal C3 .Y
From NA To FL in in.
15.SAND/GRAVEL PACK:
Depth Size Material
From NA To Ft,
16.REMARKS: DRY
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/L/05
SIGNATURE OF PERSON CONSTRUCTING THE WELL Dale
5W-1 REV.07/2001
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service center-Raleigh,NC--
276TE1636 Phone No.[phone],within 30 days. =•

ware:m2y11UU5 Time:5:57:52 PM
North Carolina-Department of Environment,and Natural SnTRUC D TIlvlsIOn ON o RE C ORD
WELL CONTRACTOR(INDIVIDUAL)NA an(print) SCOTT GANTT Quality-Groundw.
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS INC. PHONE(CERF
704TT43'
STATE WELL CONSTRUCTION PERMIT#
(if applicable) ASSOCIATED WQ PERn
1.WELL USE(Check Applicable Box): Residential ® Munici a] (if applicable)
Recovery ❑ Heat Pump Water Injection ❑ Otherp ❑ Industrial❑ Agricultural
❑ IfOther,List Use:
2.WELL LOCATION:
Nearest town: RUTHERFORDTON Topographic/Lan,
]21 COMMON WEALTH LANE Comity RUTHER� FO� ❑ e Rid
g ❑ Slope [
(Street Name,Numbers,Community,Subdivision,Lot No,.Zip Code) Latitude/Longitude oft
a.OWNER HORTON HOME OF RUTHERFORDTON 35.23.622/81
ADDRESS 342 HWY74 BYPASS (dewees/minute
(so-«t or xopto No.) Latitude/l(ngitude source:©GP;
RUTHERFORDTON NC DEPTH
City m Tow„ 28139 From To
SUte Zip Code
828-287-3366 0 55 Cla
Area Code-Phone Number 55 600 Col
4.DATE DRILLED 8/25/05
5.TOTAL DEPTH 600
6.DOES WELL REPLACE EXISTING WELL?
® _
7.STATIC WATER LEVEL Below Top of C YES ❑ NO
asing:
NA FT _
8. TOP OF CASING IS R1se ' IfAbovc Top of Casing)
2 FT.Above Land Sud'ace'
'Top of casing with 1SA 5A NledCAC 2 blow Imd smfacc r<gwsv a vvianm m eceordmce 2C 0118
9. YIELD(gpm): 0 MEIHOD OF TEST
ARDM
to.WATER ZONES(depth): NA —
u.DISINFECTION:TYPE HYPOCHLORiTE Amount 5 oz
12,CASING: —� LOCATI_ ON SKETCH
Wall Thickness Material
From 0 D Show direction and distance in miles fnDepth Diameter Orwell
TO 60 Ft 6 1/4° SDR 21 two State Roads or County Roads.Inch
13.GROUT— P�C numbers and common road names.
Depth Material
From 0 To Method
20 F[u.SCREEN GRAVEL MIX GRAVITY
Depth Diameter Slot Size
Material
From
NA To FL
n in,
I5.SAND/GRAVEL PACK;
Depth Size
From NA To Material
FI,
16.REMARKS: DRY
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 OWN]
SIGNATURE OF PERSON CONSTRUCTAIGTFIEWELL 9�1{OS
Submit the original to the Division of Water Quality,Groundwater Sectio Date
276"-1636 Phone No.[phone],within 30 days, n' �6 'tMail Sere Ce center Raleigh,NC,
i

.a
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:BAT CAVE County RUTH Topographic/Land setting
BALD MTN.CH.RD. ❑ Ridge ❑ Slope ❑ Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER: FRANK EVANS Latitude/longitude of well location
Address BALD MTN. CIL RD. _
(Street or Route No.) (degrees/minutes/seconds)
BAT CAVE NC 28710 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 28)—625-9529 DEPTH
Area Code Phone number From To
4.DATE DRILLED 09/13/05 _
5.TOTAL DEPTH: 805 DRILLING LOG
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 600 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): 1/2 METHOD OF TEST ARD number and common names
10.WATER ZONES(depth): HWY.#9 N.FROM BAT CAVE.RT.ON
IL DISINFECTION: Type CHLORYTE Amount 22.5 SHUMONT RD. RT.ON BALD MTN.CH RD.
12. CASING: Wall Thickness APPROX.3 MILES ON RT.
Depth Diameter or Weight/Ft Material
From 0 To 20 Ft 6-1/4" SDR21 PVC
From_To_Ft
From To_Ft_
13. GROU_Depth Material Method_
From 0 To 20 F[.OUII{RETE POURED c--r
From_To_Ft �I
14.SCREEN: Depth Diameter Slot Size Material m
From_To_Ft._ in in. o -
From_To_Ft_ in in. cn
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 UCTI N STANDARD 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(prim)RODNEY ROBBINS CERTIFICATION# 2785
WELL CONTRACTOR COMPANY NAME PrITMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural El
Monitorin gn
g El ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town:MOORESBORO County RUTH Topographic/Land setting
146 CEDAR VALLEY ❑ Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER CLIFF IRVIN Latitude/longitude of well location
Address 146 CEDAR VALLEY _
(Street or Route No.) (degreestminutestseconds)
MOORESBORO NC 28114 Latitudellongitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
7( 04)-434-7317 DEPTH
Area Code Phone number From To
4.DATE DRILLED 09/21/05
5.TOTAL DEPTH: 505 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 500 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.#221A S.FROM CLIFFSIDE.M RIGHT ON
ISLAND FORD RD.RIGHT ON FERRY RD.GO 3
11.DISINFECTION:Type CHLORYTE Amount 13.5 MILES.LEFT ON GROVER SCRUGGS RD.LEFT
Depth Diameter or Weight
12. CASING: Wall Th t/Ft Weight/Ft.
s Material ON LAKE RD.RIGHT ON CEDAR VALLEY.
From 0 To 35 Ft 6-1/4" SDR21 PVC
From_To_Ft_ _
From To Ft
T:13. GROU_Depth Material Method_
From 0 To 20 Ft.OUHQiETE POURED O
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material t
From_To_Ft_ in. in. - a'
From To Ft._ in. in. O
15. SAND/GRAVEL PACK:
Depth Size Material
rY
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
Ile -5—
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:ELLENBORO County RUTH Topographic/Land setting
128 VOLLEY RD. ❑ Ridge ❑ Slope ❑ Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:PAUL TECKLENBERG Latitude/longitude of well location
Address 128 VOLLEY RD. _
(Street or Route No.) (degrees/minutes/seconds)
ELLENBORO NC 28040 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8( ZS)—248-1589 DEPTH
Area Code Phone number From To
4. DATE DRILLED 09/28/05
5. TOTAL DEPTH: 305 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): 4 METHOD OF TEST ARD number and common names
10. WATER ZONES(depth): HOLLIS RD.FROM ELLENBORO.LEFT ON
11.DISINFECTION:Type CHLORYTE Amount 7.5 DUNCAN'S CREEK RD.LEFT ON MISSIONARY
12.CASING: Wall Thickness PLANTATION RD.RIGHT ON TOWERY TRACE.
RIGHT ON VOLLEY RD. 1 ST HOUSE ON RIGHT.
Depth Diameter or Weight/Ft. Material
From 0 To 80 Ft 6-1/4" SDR21 PVC
From_To_Ft.
From To_Ft. �t
13. GROT:U_Depth Mat_erial Method
From 0 To 20 Ft.OUHC2ETE POURED
From To_Ft o
14.SCREEN: Depth Diameter Slot Size Material Cn
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
J
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(prin()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:LAKE LURE County RUTH Topographic/Land setting
ST.JOHNS CH RD. ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:MATT BROOME Latitude/longitude of well location
Address ST.JOHNS CH.RD.
(Street or Route No.) (degrees/mmutes/seconds)
LAKE LURE NC 28746 Latitudellongitude source: ❑ CPS ❑Topographic map
City or Town State Zip Code (check box)
7( 04)—8244325 DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 09/21/05
5. TOTAL DEPTH: 185
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 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): 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 3.5 HWY.#64/74A W.FROM RUTHERFORDTON.
12. CASING: Wall Thickness RIGHT ON BELLS CREEK RD.RIGHT ON BIBLE
Depth Diameter or Weight/Ft. Material SCHOOL RD.STRIAGHT WHEN IT TURNS INTO
From 0 To 80 Ft 6-14" SDIL21 PVC ST.JOHNS CH.RD.AFTER IT TURNS INT ST.
From To_Ft_ JOHNS CIL RD.DRIVE IS APPR03L 1/2 MH E ON
From To_Ft._ RIGHT.
T:13. GROU_Depth Material Method
From 0 To 20 Ft OUBMTE POURED n
From_To Ft. r?
14.SCREEN: Depth Diameter Slot Size Material r
From_To_Ft._ in. in. a'
From_To_Ft._ in. in. G7
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
CON UCTION STANDARDS,AND THAT A COPY OF TH15 RECORD HAS BEEN PROVIDED TO THE WELL OWNER
i
G�
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

1 d r1 a} ?
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 El Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town: BOSTIC County RUTH Topographic/Land setting
GOLDEN VALLEY ❑Ridge ❑ Slope ❑Valley ❑Fiat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:TIM SWEATTE Latitude/longitude of well location
Address GOLDEN VALLEY
(Street or Route No.) (degrees/minmes✓seconds)
BOSTIC NC 28018 LatitudeAongitude source: ❑ GPS ❑Topographic map
City or Town state Zip Code (check box)
3( )—428-1510 DEPTH DRILLING LOG
Area Code Phone number From To From To
4. DATE DRILLED 09/30105 _
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118. 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 BOSTIC/SUNSHINE HWY.FROM BOSTIC.
12. CASING: Wall Thickness LEFT ON HWY.226 N.AT GOOD OLE BOYS.
Depth Diameter or Weight/Ft. Material LEFT ON 2 GOLDEN VALLEY CHRUCH RD.
From 0 To 40 Ft 6-1/4" SDR21 PVC RIGHT ON DIRT DRIVE WITH GREEN SIGN.
From_To_Ft_ TOP OF HILL
From To Ft.
T: _
13. GROU_Depth Material Method
From 0 To 20 Ft OUHCRETE POURED
From To Ft
r-)
14.SCREEN: Depth Diameter Slot Size Material +
From_To_Ft._ in. in.
From_To_Ft._ in. in. _
15. SAND/GRAVEL PACK: oto
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 TtIIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
GL
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 daya 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 ® Municipat/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water htjection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town: LAKE LURE County RUTH Topographic/Land setting
BOLAND RD, ❑Ridge ❑ Slope ❑Valley ❑ Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:HERB FETI'ELBERG Latitude/longitude of well location
Address BOLAND RD. _
(Street or Route No.) (degrees/minutes/seconds)
LAKE LURE NC 28746 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
L--)—_ DEPTH
Area Code Phone number From To
4.DATE DRILLED 09/07/05 _
5. TOTAL DEPTH: 81 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 61 FT. _
(Use`°+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface* 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.#64/74A W.FROM RUTHERFORDTON.
RT.ON BH.L'S CREEK RD.LEFT ON BOLAND RD.
11.DISINFECTION:Type CHLORYTE Amount 9.2 APPROX. 1-1/2 MILES ON LEFT.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 81 Ft. 24" CEMENT
From_To_Ft.
From To_Ft_
13. GRT:OU_Depth Material Method
From 0 To 20 Ft.CEMENT POURED o
From To FL a
14.SCREEN: Depth_ Diameter Slot Size Material
From_To_Ft._ in. in. Cn
From_To_Ft._ in. i CDn.
15. SAND/GRAVEL PACK:
Depth Size Material
From 61 To 81 FL 78M GRAVEL
From To FL
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
SIUNATURE O PERS NSTR 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) 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 Municipat/Public Ej Industrial ❑ Agricultural El
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town:HENRIETTA County RUTH Topographic/Land setting
CLOVERLEAF LANE ❑Ridge ❑ Slope ❑ Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:TOMMY SMITH Latitude/longitude of well location
Address CLOVERLEAF LANE _
(Street or Route No.) (degrees/mmutes/swonds)
HENRIETTA NC 28076 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
28)—245-2400 DEPTH
Area Code Phone number From To
4.DATE DRILLED 09/26/05 _
5.TOTAL DEPTH: 49 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 29 FT. _
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface* 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): FROM 6 POINTS GO DOWN HWY.120.RIGHT
11.DISINFECTION:Type CHLORYTE Amount 9.2 ON HIGHSHOALS RD.LEFT ON CLOVERLEAFLANE.1/10 MILE ON LEFT.
12. CASING: Watt Thickness
Depth Diameter or Weight/Ft Material
From 0 To 49 Ft 24" CEMENT
From_To_Ft.
From To_Ft CD_
13. GROUT_: Depth Material Method �a
From 0 To 20 Ft.CEMENT POURED
From_To Ft a'
14.SCREEN: Depth Diameter Slot Size Material can
From_To_Ft._ in. in.
From_To_Ft._ irr. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 29 To 49 FL 78M GRAVEL
From To Ft
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONS AUCTION STANDARDS,AND THAT A COPY OF CORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNA OF PE�§W 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

d.w 5TA7pQ
w^m"a
31681
_ RESIDENTIAL WELL CONSTRUCTION RECORD 1
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION#
1.WELL CONTRACTOR: f. DISINFECTION:Type Amount_
t� A ^� U. WATER ZONES(depth):
Well
Contractor(Individual)Name From S56 To
C N h es From To
�-`1�� fJ From To From To
Well Contractor Company Name t From To From To
STREET ADDRESS r��• � �p�V `1 �Q9 6. CASING: Thickness/
r)-O �� FromDToept - Ater WeWeillenal
City or Towwn St^atte ^ Zip Code From To FtFt
— .
Fran Tc Ft.
Area code- Phone number
2.WELL INFORMATION: 7. GROUT:
L� Depth Material Method
SITE WELL ID#(if applicable) FromSL To_aD Ft Q/Yr
From To Ft
STATE WELL PERMIT#(6 applicable) Fran To Ft.
DWQ or OTHER PERMIT#(if applicable) 8. SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply Fran Tc FL_in. _in,
ca
DATE DRILLED R - a' t) � Ffom Tc FL_in. _in,
^� From To Ft_in. _ in.
TIME COMPLETED 11 ' l� AM O PM ID,-
9. SANDIGRAVEL PACK:
3.WELL LOCATION:
Depth Size Material
CITY:r`�( �cnQ ` COU
N
TY Fran To Ft.
Fran To Ft.
Fran To Ft.
(S4ee[Name,Numbers,Canmunily,Subdivision,La No.,Parcel,Zip Code)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG i.
❑Slope ❑Valley ❑Flat ❑Ridge ❑Other From To Formation Descri ton
(check appropriate box) P
LATITUDE 6�-t- ate May be in degas, •--+�y>�-
� pf l minutes,seconds w
LONGITUDE 1/�J� S g V i in a decimal format d
N
Latitude/longitude source: ❑GPS ❑Topogaphic map(location of we9 must be shown on a USGS topo map and
attached to this form Ynot using GPS) N `'
4.WELL OWNERS '
OWNER'S NAME
C)
ST ET,ADD-RiESS S7
t oYf Mt1FY5 FL
City w Town State Zip Code -----�—
Area code- Phone number
S.WELL DETAILS: 11. REMARKS: -
a. TOTAL DEPTH: LL c�
b. DOES WELL REPLACE EXISTING WELL? rrYY�ES❑ NO E�
c. WATER LEVEL Below Top of Casing: Wo I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED INACCORDANCE WTM
iSA NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
ng) RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
(Use"+•If Above Top of Casi
d. TOP OF CASING IS 1_Fr.Above Land Sudace- =CERTIFitu
j•,�,
'Top of casing terminated aVw below land surface may require NTRACTOR DATE
a variance in accordance with 18A NCAC 2C.0118.e. YIELD(gpm): METHODOFTESTUCTING THE WELL
Submit the original to the Division of Water Quality Within 30 days. Attn:Information Mgt.,
1617 Mail Service Center-Raleigh,NC 27 6 9 9-1 61 7 Phone No.[phone] ext 568. Form GW-1a
Rev.7/05

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: UNION MILLS County RUTH Topographic/Land setting
WADE DR ❑Ridge ❑ Slope ❑ Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER: DAVID BIGGERSTAFF Latitude/longitude of well location
Address WADE DR.. _
(Street or Route No.) (degrees/minutes/seconds)
UNION MILLS NC 28167 Latitude/longitudc source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 28)-286-0526 DEPTH
Area Code Phone number From To
4.DATE DRILLED 08/24/05
5.TOTAL DEPTH: 77 DRILLING LOG
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 65 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface* LOCATION SKETCH
*Top of casing temtinated 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 STEEL TAPE number and common names
10.WATER ZONES(depth): HWY.#64 E. FROM RUTS LEFT ON HUDLOW
11.DISINFECTION:Type CHLORYTE Amount 5.52 RD.GO INTO UNION MILLS.RIGHT INTO
MAJESTIC OAKS ONTO BONNIE LANE. RIGHT
12. CASING: Wall Thickness
ON WADE DR 2 n HOUSE ON LEFT.
Depth Diameter or Weight/Ft. Material
From 0 To 77 Ft. 24" CEMENT
From_To_Ft._ N
rri
From_To_Ft._ -0
13. GROUT: Depth Material Method t z
From 0 To 20 Ft.CEMENT POURED tV
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 65 To 77 Ft. 78M GRAVEL
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 S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PPSON 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

tj
WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) ROBIN MCNEELY CERTIFICATION# 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town:BOSTIC County RUTH Topographic/Land setting
MOUNTAIN FOREST DR ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:JEFF ENSLEY Latitude/longitude of well location
Address MOUNTAIN FOREST DR _
(Street or Route No.) (degrees/mmutes/seconds)
BOSTIC NC 28018 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
(8�—429-2685 DEPTH
Area Code Phone number From To
4.DATE DRILLED 08/26/05 _
5.TOTAL DEPTH: 48 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 attar 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.#64 E.FROM RUTHERFORDTON.RIGHT
11.DISINFECTION:Type CHLORYTE Amount 9.2 ON CANE CREEK MNT.RD.RIGHT ON
12. CASING: Wall Thickness MOUNTAIN FOREST DR APPROX.1.8 MILES ON
LEFT.
Depth Diameter or Weight/Ft. Material
From 0 To 48 Ft 24" CEMENT
From_To Ft
From_To_Ft
13. GROUT: Depth Material Method cn
From 0 To 20 Ft.CEMENT POURED m
v —
From_To Ft i -
14.SCREEN: Depth Diameter Slot Size Material N
From To Ft. in. in. 0 2
From_To_Ft._ in.
cn
15. SAND/GRAVEL PACK:
Depth Size Material
From 28 To 48 Ft 78M GRAVEL
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, L
CON TI N STAND S, AND TI T A C PY ORD S BEE PROVIDED TO THE L O R
c
SIGNATURE OF P CONSTRUCTING DATE
Submit the origip4l to the Division of Water Quality,Groundwater Section,1636 Mail Servr$$��,��Inter—Raleigh,NC
27699-1636 Phpge No. [phone],within 30 days. Wk 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)
I. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town:BATCAVE County RUTHERFORD Topographic/Land setting
BALD MTN. CH.P.D. ❑ Ridge ❑ Slope ❑Valley ❑ Flat
(Sheet Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:FRANK EVANS Latitude/longitude of well location
Address BALD MTN. CH.RD. _
(Sheet or Route No.) (degrees/minutes/seconds)
BATCAVE NC 28710 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 28)-6258-9529 DEPTH
Area Code Phone number From To
4.DATE DRILLED 08/15/05
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): 10 METHOD OF TEST ARD number and common names
10. WATER ZONES(depth): HWY.#9 N.FROM BATCAVE.RIGHT ON
11. DISINFECTION:Type CHLORYTE Amount 16.5 SHUMONT RD.RIGHT ON BALD MTN.CH RD.
APPROX.3 MILES ON RIGHT.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 50 Ft. 6-1/4" SDR21 PVC
From_To_Ft
From_To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft.OUIKRETE POURED
From_To Ft. v t
14.SCREEN: Depth Diameter Slot Size Material v
From_To_Ft._ in in. ry
From_To_Ft._ in. in.
15. SAND/GRAVEL PACK: cC=)rr
Depth Size Material
From_To_FL_
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 RE RD HAS BEEN PROVIDED TO THE WELL OWNER
r —0-
--7%IGNATU1kE OF PERSON CONXRUCTING THE WELL ATE
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

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:BAT CAVE County RUTH Topographic/Land setting
BALD MTN,C$RD. ❑Ridge ❑ Slope ❑valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:FRANK EVANS Latitude/longitude of well location
Address BALD MTN,CH,RD«
(Street or Route No.) (degrees/minutes/seconds)
BAT CAVE NC 28710 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 28)-625-9529 DEPTH
Area Code Phone number From To
4. DATE DRILLED 08/17/05
5.TOTAL DEPTH: 605 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 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): 1/2 METHOD OF TEST ARD number and common names
10. WATER ZONES(depth): HWY.#9 N.FROM BAT CAVE.RT.ON
SHUMONT RD.RT.ON BALD MTN.CH.R> .
11.DISINFECTION:Type CHLORYTE Amount 16.5 APPROX.3 MILES ON RT.
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 rn
From 0 To 20 FL OUH{RETE POURED rn
From To—Ft.— i
14.SCREEN: Depth Diameter Slot Size Material r`3
From_To_ s i
Ft._ in. in. o
From_To_Ft._ in. L
15.SAND/GRAVEL PACK:
Depth Size Material
From_To Ft._
From To Ft
16.REMARKS:
I DO HEREBY CERTIFY TNAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONS CTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BREN PROVIDED TO THE WELL OWNER
]\//
NATURE OF PERSON CONSTRUCTING THE WELL DATE
Su4"the original to the Division dWitter Quality,Groundwater Srction,1636 Mail Service Center-Raleigh,NC
276"4636 Phone No. [phone],wig#130 days. GW-1 REV.07/2001

3g3
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 IRRIGATION
2. WELL LOCATION:
Nearest Town:BOSTIC County RUTH Topographic/Land setting
BOSTIC/SUNSHINE RD. ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:JONATHAN HOLLIFIELD Latitude/longitude of well location
Address BOSTIC/SUNSHINE RD. _
(Street or Route No.) (degrees/minutes/seconds)
BOSTIC NC 28018 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
(828)-289-7626 DEPTH
Area Code Phone number From To
4.DATE DRILLED 08/22/05
5.TOTAL DEPTH: 305 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 40 FT. _
(Use"+"ifAbove 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
vanance 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): FROM BOSTIC.GO OUT BOSTIC/SUNSHINE RD,
11. DISINFECTION:Type CHLORYTE Amount 7.5 NEW DRIVE ON LEFT.ACROSS FROM RAMSEY
RD.12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 80 Ft 6-1/4" SDR21 PVC
From To_Ft._ 3
From To_Ft_
13. GROUT: Depth Material Method rn
From 0 To 20 Ft.OUIKRETE POURED
From - To_Ft.
14.SCREEN: Depth Diameter Slot Size Material ry
From To Ft._ in. in. o
From_To Ft._ in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From_To_Ft._
From To Ft.
16.REMARKS:
I DLL HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
C]N$TRUCTION ST ARDS,AND THAT A COPY OF THI RECORD HAS BEEN PROVIDED TO THE WELL OWNER
JIM -��
GNA OF PERSON CONS UCTINGHE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

315612
WELL CONSTRUCTION RECORD"`'
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)RODNEY ROBBINS CERTIFICATION# 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: BOSTIC County RUTH Topographic/Land setting
452 LUCKADOO RD. ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:NORMAN MURRAY Latitude/longitude of well location
Address 452 LUCKADOO RD. _
(Street or Route No.) (degrees/mmutes/seconds)
BOSTIC NC 28018 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
JL8)-245-5200 DEPTH
Area Code Phone number From To
4.DATE DRILLED 08/23/05 _
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 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 Road or County Roads. Include the road
9.YIELD(gpm): 5 METHOD OF TEST ARD number and common names
10.WATER ZONES(depth): BUS.74 E.FROM FOREST CITY.LEFT ON
BOSTIC/SUNSHINE HWY.LEFT ON TONEY RD.IN
11.DISINFECTION:Type CHLORYTE Amount 10.5 ren
SUNSHINE. LEFT ON LUCKADOO RD. 2 DRIVE
12. CASING: Wall Thickness
ON LEFT.
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.OUHZRETE POURED rC i
ai
From To_Ft.
14.SCREEN: Depth Diameter Slot Size Material N ;?
From_To_FL_ in. in.
From_To_Ft._ in. in. rC
15. SAND/GRAVEL PACK:
Depth Size Material t
From_To_Ft_
From To Ft.
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUC STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
r`
3�-a
IGNA I URE 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(prim)RODNEY ROBBINS CERTIFICATION# 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ❑ Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: BOSTIC County RUTH Topographic/Land setting
LUCKADOO RD, ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:DONALD MURRAY Latitude/longitude of well location
Address I CKADOO RD. _
(Street or Route No.) (degrees/mmutes/seconds)
BOSTIC NC 28018 Latitudellongitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8(�—247-1144 DEPTH
Area Code Phone number From To
4. DATE DRILLED 08/24/05 _
5.TOTAL DEPTH: 305 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): 8 METHOD OF TEST ARD number and common names
10.WATER ZONES(depth): BUS.74 E.FROM FOREST CITY.LEFT ON
11.DISINFECTION:Type CHLORYTE Amount 7.5 BOSTIC/SUNSHINE RD.LEFT ON TONEY RD.INSUNSHINE.LEFT ON LUCKADOO RD.2 DRIVE
12. CASING: Wall Thickness ON RT.
Depth Diameter or Weight/Ft. Material
From 0 To 110 Ft. 6-1/4" SDIL21 PVC
From_To_Ft._
From_To_Ft_
13. GROUT: Depth Material Method
From 0 To 20 Ft.OUIKRETE POURED
From_To Ft. my
14.SCREEN: Depth Diameter Slot Size Material
N
From_To_Ft._ in. in.
From_To_Ft. in. in, o
D/15. SANGRAVEL PACK: CA
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 CeutW.V� NC
27699-1636 Phone No. [phone],within 30 days. GW-1 {��

V _ 9 f 5 6 8 U
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 PITTMAN WELL 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:BAT CAVE County RUTH Topographic/Land setting
BALD MTN.CH RD. ❑Ridge ❑ Slope ❑ Valley ❑ Flat
(Street Name,Numbs,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:FRANK EVANS Latitudellongitude of well location
Address BALD MTN.CH RD. _
(Street or Route No.) (degrees/minutes/seconds)
BAT CAVE NC 28710 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 28)-625-9529 DEPTH
Area Code Phone number From To
4.DATE DRILLED 08/27/05 _
5.TOTAL DEPTH: 605 DRILLING LOG
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 450 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): 1/2 METHOD OF TEST ARD number and common names
10.WATER ZONES(depth): HWY.#9N.FROM BAT CAVE.RT.ON
11.DISINFECTION:Type CHLORYTE Amount 16.5 SHUMONT RD.RT. ON BALD MTN.CH. RD.
APPROX. 3 MILES ON RT.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 20 Ft. 6-1/4" SDR.21 PVC
From_To_Ft
From_To_Ft.
13. GROUT: Depth Material Method cn
From 0 To 20 FL OUIKRETE POURED M
From_To_Ft
14.SCREEN: Depth Diameter Slot Size Material ni
From_To_Ft._ in in. p
From_To_Ft._ im. in. U
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 ITO TANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S
'�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

OJJ 315609
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)RODNEY ROBBINS CERTIFICATION# 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: LAKE LURE County RUTH Topographic/Land setting
454 SEARCY RD. ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:AMY HR L Latitude/longitude of well location
Address 454 SEARCY RD. _
(Street or Route No.) (degrees/minutes/seconds)
LAKE LURE NC 28746 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 28)-286-8326 DEPTH
Area Code Phone number From To
4. DATE DRILLED 08/29/05 _
5.TOTAL DEPTH: 265 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 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): 100 METHOD OF TEST ARD number and common names
10. WATER ZONES(depth): HWY.#64/74A W.FROM RUTHERFORDTON,
11.DISINFECTION:Type CHLORYTE Amount 6 RIGHT ON BELL'S CREEK RD.LEFT ON CEDAR
12. CASING: Wall Thickness
CREEK RD.LEFT ON SEARCY RD.
Depth Diameter or Weight/Ft. Material
From 0 To 70 Ft 6-1/4" SDR21 PVC
From To—Ft—
From To_Ft
13. GROUT: Depth Material Method _
From 0 To 20 Ft.OUH{RETE POURED N
From To_Ft_
14.SCREEN: Depth Diameter Slot Size Material
From_To_Ft._ in. in. 1v s
From_To_Ft._ in. in. o ry
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
CONS24UCTION STANDARDS,AND THAT A COPY OF WS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Lop�" ff'l'4 'Uz't�L �0�'7,2� F,'? P D
SIGNATURE OF PERSO CO STRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.0712001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)RODNEY ROBBINS CERTIFICATION# 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: FOREST CITY County RUTH Topographic/Land setting
STROUD MTN,TRW-LOT A ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:JIMMY HOOPER Latitude/longitude of well location
Address STROUD MTN.TRW-LOT A _
(Street or Route No.) (degrees/minutes/seconds)
FOREST CITY NC 28043 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8(�-4294671 DEPTH
Area Code Phone number From To
4.DATE DRILLED 08/30/05
5.TOTAL DEPTH: 305 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): 20 METHOD OF TEST ARD number and common names
10. WATER ZONES(depth): FROM SHILOH GO DOWN CLEGHORN RD.
11.DISINFECTION:Type CHLORYTE Amount 7.5 LEFT ON STROUD MTN.TRW.WELL AT DEAD
12.CASING: Wall Thickness END,LOT A.
Depth Diameter or Weight/Ft. Material
From 0 To 70 Ft 6-1/4" SDR21 PVC
From_To_Ft_
From_To—FL_
13. GROUT: Depth Material Method
From 0 To 20 Ft.OUHCRETE POURED
From To_Ft m -•.
14.SCREEN: Depth Diameter Slot Size Material n z
t
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 ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
e) v
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 ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town:FOREST CITY County RUTH Topographic/Land setting
STROUD MTN.TRW-LOT#B ❑Ridge ❑ Slope ❑ Valley ❑ Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:JIMMY HOOPER Latitude/longitude of well location
Address STROUD MTN.TRW-LOT#B
(Street or Route No.) (degrees/minutes/seconds)
FOREST CITY NC 28043 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
Ste)—4294671 DEPTH
Area Code Phone number From To
4.DATE DRILLED 08/31/05
5.TOTAL DEPTH: 425 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): 4 METHOD OF TEST ARD number and common names
10. WATER ZONES(depth): FROM SHILOH GO DOWN CLEGHORN RD.
11.DISINFECTION:Type CHLORYTE Amount 11 LEFT ON STROUD MTN.TRW.LOT B.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 100 Ft 6-1/4" SDR.21 PVC
From To Ft_ '
From To_Ft_
13. GROUT: Depth Material Method r*t
From 0 To 20 Ft.OUHQIETE POURED
t
From To_Ft. N
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
CONSTRUCTIO STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
- -D
IGNATURE OF PERSON CONS UCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

31 05
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 0 Mumcipat"lic El Industrial El Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town:BOSTIC County RUTH Topographic/Land setting
687 SALEM CHURCH RD. ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER: SCOTT STONE Latitude/longttude of well location
Address 687 SALEM CHURCH RD.
(Street or Route No.) (degrees/mmutes/seconds)
BOSTIC NC 28018 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
(828)-289-3495 DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 08/0/05 T
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-I/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): 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 3.5 FROM WASHBURN STORE GO OUT SALEM
12. CASING: Wall Thickness CHURCH RD.1 MILE ON LEFT.
Depth Diameter or Weight/Ft. Material
From 0 To 35 Ft.6-14" SDIL21 PVC
From_To_Ft_ _
From To_Ft
13. GROUT: Depth Material Method 5
From 0 To 20 Ft OU)BRETE POURED cn
From To Ft
14.SCREEN: Depth Diameter Slot Size Material
From_To_Ft._ in. in. N
From_To_Ft_ in. in. ro
15. SAND/GRAVEL PACK:
Depth Size Material e
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
Env, /GL,..1A . /�7�r�P g -/"d. S�
SIGNATURE OF PERSO CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.0712001

W 345604
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 El Muni�ci blic Industrial Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection LJ Other ❑ if Other,List Use
2. WELL LOCATION:
Nearest Town:BOSTIC County RUTH Topo a hic/Land setting
180 MANFORD DR ❑Ridge �,J Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER TRACY SHORT Latitude/longitude of well location
Address 180 MANFORD DR
(Street or Route No.) (degrees/minates/seconds)
BOSTIC NC 28018 Latitudellongitude source: ❑GPS ❑Topograpbic map
City or Town State Zip Code (check box)
8( 2j)-245-6769 DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED OSIOV05
5.TOTAL DEPTH: 205
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 10 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 Fr. Above Land Surface*
*Top of casing terminated Wor below land surface requires a
variance in accordance with 15A NCAC 2C.0118. LOCATION SKETCH
9.YIELD(gpm): 9 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 BUS.74 W.FROM FOREST CITY.LEFT ON
12. CASING: Wall Thickness BOSTIC/SUNSHINE HWY.LEFT ON TONEY RD.
Depth Diameter or Weight/Ft Material IN SUNSHINE.LEFT ON MANFORD DR HOUSE
From 0 To 70 Ft 6-14" SDPL21 PVC AT END OF DRIVE,
From_To Ft
From To Ft _
13.GROUT: Depth Material Method
From 0 To 20 Ft QUIKRETE POURED
From_To Ft_ _
14.SCREEM Depth Diameter Slot Size Material
From_To_Ft._ in. in. C/3
From_To_Ft. in. in. rn
15. SAND/GRAVEL PACK: '—
Depth Size Material
From_To Ft_ cC
From_To_Ft_
16.REMARKS: a
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTYJFTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCIING 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

00 315603
WELL CONSTRUCTION RECORD ��w___
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)45"662
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#_
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential 10 Municipai/Public 0 Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town: LAKE LURE County RUTH Topographic/Land setting
BILL'S CREEK RD. ❑Ridge ❑Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:TIMOTHY MURPHY Latitude/longitude of well location
Address BILL'S CREEK RD. _
(Street or Route No.) (degreestiamutes/seconds)
LAKE LURE NC 28746 Latitude/longitude source: ❑GPS ❑Topographic map
City or Town State Zip Code (check box)
( )—625-1056 DEPTH DRILLING LOG
Area Code Phone number From TO From To
4.DATE DRILLED 08/02/05
5.TOTAL DEPTH: 105
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): 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 2.5 FROM RUTH.GO UP HWY.#64/74.RIGHT ON
12.CASING: Wall Thiclmess BILL'S CREEK RD.1/4 MILE PAST BOLAND RD.
Depth Diameter or Weight/Ft Material ON RIGHT.NEW GRAVEL DR
From 0 To 45 Ft 6.14" SDR21 PVC
From_To_Ft_
From_To_Ft _
13.GROUT: Depth Material Method
From 0 To 20 Ft.OVEKRETE POURED ='y
From_To_Ft_
14.SCREEN: Depth Diameter Slot Size Material
From_To_Ft_ in. in
From_To Ft._ in. in. N
15. SAND/GRAVEL PACK:
Depth Size Material o
cn
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 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 daya 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 Z Municipal/Public El Industrial Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town:LAKE LURE County RUTH Topographic/Land setting
131 MTN.RIDGE DR ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER PAT GREEN Latitude/longitudc of well location
Address 131 MTN.RIDGE DR
(Street or Route No.) (degreestminutes/seconds)
LAKE LURE NC 28746 Latitude/longitude source: ❑GPS ❑Topographic map
City or Town State Zip Code (check box)
8(_28)-625-4525 DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 08103toS _
5.TOTAL DEPTH: 305
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use'Y'if Above Top of Casing)
8.TOP OF CASING IS 1-112 FT. Above Land Surface*
*Top of casing terminated atior below land surface requires a
variance in accordance with 15A NCAC 2C.0118. LOCATION SKETCH
9.YIELD(gpm):4 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 7.5 HWY.#64/74A W.FROM RFTN.ON BILL'S
12. CASING: Wall Thickness CREEK RD.LEFT ON CONNER RD.7/10 MILE.
Depth Diameter or Weight/Ft Material TURN RT.ON MOUNTAIN RIDGE DR 1 op
From 0 To 115 Ft.6-14" SDR21 PVC HOUSE ON LEFT.
From_To_Ft._
From To Ft _
13.GROUT: Depth Material Method
From 0 To 20 FL OUIKRETE POURED
From To Ft
14.SCREEN: Depth Diameter Slot Size Material rrri
From_To—Ft.— in. in.
From_To Ft._ in in. N
15. SAND/GRAVEL PACK:
Depth Size Material un
cn
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
3 S�
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

00 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 ® Municipat/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH Topographic/Land setting
BENNETT RD, ❑Ridge ❑ Slope ❑Valley ❑ Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER: STEVE DEZIO Latitude/longitude of well location
Address BENNETT RD, _
(Street or Route No.) (degrees/minutes/smonds)
RUTHERFORDTON NC 28139 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 28)-429-2751 DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 08/15/05 _
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 terminated at/or below land surface requires a LOCATION SKETCH
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 9 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.#221 N.FROM RUTHERFORDTON.
12. CASING: Wall Thickness LEFT ON DARLINGTON RD.RT.ON BENNETT
Depth Diameter or Weight/Ft Material RD. 1/2 MILE ON LEFT.
From 0 To 60 Ft. 6-14" SDR21 PVC
From_To Ft._ C/3
From_To Ft_ r
13. GROUT: Depth Material Method
From 0 To 20 FL OUEKRETE POURED ry
From To-FL— _
14.SCREEN: Depth Diameter Slot Size Material Lnn
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
�e-
> z Lr�, fb � ,) �A�
SIGNATURE OF PERSON C�TR ING 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 31 ,5598
WELL CONSTRUCTION RECORD w
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: LAKE LURE County RUTH Topographic/Land setting
BUFFALO SHOALS RD. ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER: MARSHALL SEAY Latitude/longitude of well location
Address BUFFALO SHOALS RD. _
(Street or Route No.) (degrees/minutes/seconds)
LAKE LURE NC 28746 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8864)—457-6198 DEPTH DRILLING LOG
Area Code Phone number From To From To
4. DATE DRILLED 08/17/05 _
5. TOTAL DEPTH: 385
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118. 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.#64/74A W.FROM RUTHERFORDTON.
12. CASING: Wall Thickness RT.ON BUFFALO SHOALS RD. 1 MILE ON
Depth Diameter or Weight/Ft Material LEFT.
From 0 To 60 Ft. 6-14" SDR21 PVC
From_To Ft_ Fa
From_To Ft _
13. GROUT: Depth Material Methodrn
N
From 0 To 20 Ft OUFKRETE POURED
From_To Ft
N
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
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 STANDARDS, AND THAT A COPY OFT
HIS 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

315597
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 N Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use—
2. WELL LOCATION:
Nearest Town: LAKE LURE County RUTH Topographic/Land setting
BUFFALO SHOALS RD. ❑Ridge ❑ Slope ❑ Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:JOHN MOORE Latitudellongitude of well location
Address BUFFALO SHOALS RD. _
(Street or Route No.) (degrees/mmutes/seconds)
LAKE LURE NC 28746 Latitude/longitude source: ❑GPS ❑Topographic map
City or Town State Zip Code (check box)
8�28)-625-1847 DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 08/18/05 —
5.TOTAL DEPTH: 305
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO N
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118. 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 7.5 HWY.#64/74A W. FROM RUTHERFORDTON.
12. CASING: Wall Thickness RIGHT ON BUFFALO SHOALS RD. GO ACROSS
Depth Diameter or Weight/Ft. Material DAM.APPROX. 2 MILES ON LEFT LOT#27.
From 0 To 65 Ft.6-14" SDR21 PVC
From_To_Ft_
From To_Ft._ Cn
13.GROUT: Depth Material Method rri
From 0 To 20 Ft OUHMTE POURED t
From To_Ft_ tv
14.SCREEN: Depth Diameter Slot Size Material p
From_To_Ft._ in. in. rn
From_To_Ft._ in. in. _
15. SAND/GRAVEL PACK: d
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
4, dp-
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

a 315596
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 ® MunicipaVPublic ❑ Industrial ❑ Agriculttual ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town:MOORESBORO County RUTH Topographic/Land setting
HENRY JENKINS RD. ❑Ridge ❑ Slope ❑ Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:AMBER JONES Latitude/longitude of well location
Address HENRY JENKINS RD,
(Street or Route No.) (degrees/minutes/seconds)
MOORESBORO NC 28114 Latitude/longitude source: ❑ GPS Li opographic map
City or Town State Zip Code (check box)
(_)—657-6169 DEPTH DRILLING LOG
Area Code Phone number From To From To
4. DATE DRILLED 08/22/05
5.TOTAL DEPTH: 605
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 605 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 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 HWY.#221A S.FROM CLIFFSHIE. RIGHT ON
12. CASING: Wall Thickness ISLAND FORD RD.RIGHT ON HENRY JENKINS
Depth Diameter or Weight/Ft Material RD.APPROX.3/4 MILE ON LEFT.BOX#5581
From 0 To 60 Ft. 6-14" SDR21 PVC
From_To_FL
From_To_Ft,
13. GROUT: Depth Material Method m
From 0 To 20 Ft.OUII{RETE POURED t
From To Ft._ ry
14.SCREEN: Depth Diameter Slot Size Material
0
From_To_Ft._ in. in. r.+t
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/17TUCTION STAN�, AND THAT A COPY OF THI RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON coNsTRucTTNG THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001
U

00 0 13
WELL CONSTRUCTION RECORD V�'
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)453-0662
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: MOORESBORO County RUTH Topographic/Land setting
HENRY JENKINS RD. ❑Ridge ❑ Slope ❑ Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:AMBER JONES Latitude/longitude of well location
Address HENRY JENKINS RD. _
(Street or Route No.) (degrees/minutes/seconds)
MOORESBORO NC 28114 Latitude/longitude source: ❑ GPS ❑ Topographic map
City or Town State Zip Code (check box)
8L2D-657-6169 DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 08/29/05
5.TOTAL DEPTH: 405
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118. 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 10.5 HWY.#221A S.FROM CLIFFSIDE.RIGHT ON
12. CASING: Wall Thickness ISLAND FORD RD.RIGHT ON HENRY JENKINS
Depth Diameter or Weight/Ft. Material RD.APPROX.314 MILE ON LEFT.LEFT AT
From 0 To 40 Ft. 6-1411 SDX21 PVC FORK IN DRIVE.
From_To_Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft.OUHCRETE POURED
From_To_Ft. _ Cn
14.SCREEN: Depth Diameter Slot Size Material rri
From_To_Ft._ in. in. r
From_To_Ft._ in. in. N
15. SAND/GRAVEL PACK: C3
Depth Size Material to
From To_Ft. _
From To FL
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
el-
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:Stephenie Wilson Dale:9/7/2005 Time:8:30:30 PM Page 5 of 5
Q3
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment,and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) SCOTTGANTT 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: RUTHERFORDTON County RLWHERFORD ❑Ridge ❑ Slope ❑ Valley © Flat
1524 HUDLOW RD Latitude/Longitude of well location
(Street Name,Numbers,Community,Subdivision,Lot No,Zip Code) 35,27.463/81.56.577
3.OWNER HORTON HOME OF RUTHERFORDTON (degrees/minutes/seconds)
ADDRESS 342 HWY 74 BYPASS Latitudellongihlde source:©GPS❑Topographic map
(Strew or Rome No.) DEPTH DRILLINGLOG
RUTHERFORDTON NC 28139 From To Formation Description
city orT. State Zip Code 0 55 Clay
828-287-3366 55 170 Consolidated Rock
Area Code-Phone Number
4.DATE DRILLED 8/6/05
5.TOTAL DEPTH 170
6.DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7.STATIC WATER LEVEL.Below Top of Casing: 70 FT.
(Oro"*"I(Above Top of Casing)
8. TOP OF CASING IS 2 FT.Above Land Surface-
-Top of cemug tam'auted ado,below land surface requires a variance in
aamrdmcc with 15A NCAC 2C.0118
9. YffFI (pm): 30 METHOD OF TEST ARDM
It.WATER ZONES(depth): 170
n.DISINFECTION:TYPE HYPOCHLORITE Amount 5 0: LOCATION SKETCH
12.CASING: wall Thickness Show direction and distance in miles from at least
Depth Diameter or Welght/Ft. Material two State Roads or County Roads.Include the road
From o To 62 Ft. 6 1/4" SDR 21 PVC numbers and common road names.
13,GROUT:
Depth Material Method
From 0 To 20 Ft. GRAVEL MIX GRAVITY
14.SCREEN
e'
Depth Diameter Slot Size Material
From NA To FL in. in. (n
15.SAND/GRAVEL PACK -cop
ra
Depth Sin Material
From NA To Ft,
� av
16.REMARKS: -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
9/1/05
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.

From:Scott Gantt To:Stephenie Wilson Date:3/20/2005 Time:5:44:50 PM Page 5 of 6
WELL CONSTRUCTION RECORD 309119
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: LAKE LURE County RUTHERFORD ❑Ridge ❑ Slope ❑ Valley ® Flat
5250 BILLS CREEK RD Latitude/Longitude of well location
(Street Name,Numbers,Community,Subdivision,Lot No,Zip Code) 35,28,988/82.07A27
3.OWNER GEORGE CORLEY (degrees/minutes/seconds)
ADDRESS 5250 BILLS CREEK RD Latitudedongitude source:®GPS❑Topographic map
(Strew or Router No.) DEPTH DRILLING LOG
RUTHERFORDTON NC 28139 From To Formation Descnption
City or Town State Zip Code 0 51 Clay
803-429-9870 51 180 Consolidated Rock
Area Code-Phone Number
4.DATE DRILLED 2/11/05
5.TOTAL DEPTH ISO
6.DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7.STATIC WATER LEVEL Below Top of Casing: 55 FL
(rise't If Above Top of Casino
8. TOP OF CASING IS 2 FT.Above Land Surfaces
'Top of caaing terminated at/or below Imd surface nquires a vim«In
a...odmeewa615ANCAC 2C.0118
9. YIELD(gpm): 6 METHOD OF TEST ARDM
10.WATER ZONES(depth): 170
u.DISINFECTION:TYPE HYPOCHLORITE Amount 6 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 o To 60 Ft. 6 1/4" SDR 21 PVC numbers and common road names.
13.GROUT:
Depth Material Method
From 0 To 20 FL GRAVEL MIX GRAVITY s
14.SCREEN E4
Depth Diameter Slot Size Material
From NA To FL 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 COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
2/15/05
SIGNATLIRE OF PERSON CONSTRUCTING THE WELL Dale
GW-1 REV.07l2001
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days.
x
I
t55

From:Scott Gantt To:Stephenie Wilson Date:3I20r2005 Time:5.44:50 PM Page 3 of 6
309117
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 ❑ Morutoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2.WELL LOCATION: Topographic/Land setting
Nearest town: FOREST CITY County RUTHERFORD ❑Ridge ❑ Slope ❑Valley ® Flat
415 COFFEY RD Latitude/Longitude of well location
(Street Name,Numbers,Community,Subdivision,LotNo,.Zip Code) 35-1 S 742181,50,209
3.OWNER HORTON HOME OF RUTHERFORDTON (degrees/minutes/seconds)
ADDRESS 342 HWY 74 BYPASS Latitude/longitude source:®GPS❑Topographic map
(Strcaor Rout,NoJ DEPTH DRILLING LOG
RUTHERFORDTON NC 28139 From To Formation Description
City or Town State Zip Code 0 50 Clay
828-287-3366 50 120 Consolidated Rack
Area Code-Phone Number
4.DATE DRILLED 2/4/05
5.TOTAL DEPTH 120
6.DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7.STATIC WATER LEVEL Below Top of Casing: 60 FT.
Was"*"IfAbovt Top of Casing)
8. TOP OF CASING IS 2 FT.Above Land Surface•
"Top of caseag tmninmcd at/ur below llmd swfacc rcqubts a vwimcc in
accordmcc with I5A NCAC 2C.0118
9. YiEI-D(gpni 12 METHOD OF TEST ARDM
10.WATER ZONES(depth): 110
it.DISINFECTION:TYPE HYPOCHLORITE Amount 5 W LOCATION SKETCH
12.CASING: Wall Thickness Show direction and distance in miles from at least
Depth Diameter or WeighvR, Material two State Roads or County Roads.Include the road
From 0 To 60 FL 6 1/4" SDR 21 PVC numbers and common road names.
D.GROUT:
Depth Material Method
From 0 To 20 Ft GRAVEL MIX GRAVITY =
14.SCREEN va
Depth Dlameta Slot Size Material
From NA To Ft in. in.
15.SAND/GRAVEL PACK:
Depth Size Material
From NA To Ft,
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
2/5/25
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.
ry
r�
ca -

From:Scott Gantt To:Stephanie Wilson Date:3/20/2005 Time:5:44:50 PM Page 2 of 6
WELL CONSTRUCTION RECORD 309116
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: RUTHERFORDTON County RUTHERFORD ❑Ridge ❑ Slope ❑Valley ® Flat
892 PLEASANT HILL CH.RD. RUTHERFORDTON Latitude/Longitude of well location
(Street Name,Numbers,Community,Subdivision,Lot No,Zip Code) 35.21205/82,01 440
3.OWNER DERRICK SMITH
(degrees/mmutes/seconds)
ADDRESS POD 1513 Latitude/longitude source:❑GPS❑Topographic map
sbrw or Rout.No.) DEPTH DRILLING LOG
RUTHERFORDTON NC 28139 From To Formation Description
City or Town State Zip Code 0 30 Clay
704-692-3591 30 180 Consolidated Rock
Area Code-Phone Number
4,DATE DRILLED 2/l/05
5.TOTAL DEPTH 180
6.DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7.STATIC WATER LEVEL Below Top of Casing: 35 FT.
plsc"a"IfAbove Top ofCasmg)
8. TOP OF CASING IS 2 FT.Above]and Surface-
'Topofeaeag� tad at/rbelow Imrd surtac.rcgimas...ian«v,
accord...with DA NCAC 2C.0118
9. YIELD(gprn): 6 METHOD OF TEST ARDM
10.WATER ZONES(depth): 170
ii.DISINFECTION:TYPE HYPOCHLORDE Amount 8 oa LOCATION SKETCH
12.CASING: Wall Thickness Show direction and distance 111 miles from at least
Depth Diameter or Weight/FL Material two State Roads or County Roads.Include the road
From 0 To 35 Ft. 61/4" SDR 21 PVC numbers and common road names.
13.GROUT:
Depth Material Method
From 0 To 20 FL GRAVEL MIX GRAVITY
a
14.SCREEN �
Depth Diameter Slot Size Material N
C
From NA To FL in in.
D.SANDIGRAVEL PACK: t:nl
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 O'Y"INER.
2/5/05
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.
- c—
cst

From:Scott Gantt To:Stephenie Wilson Date:3/20/2005 Time:5:44:50 PM Page 1 of 6
309115
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: RUTHERFORDTON County RUTHERFORD ❑Ridge ❑ Slope ❑ Valley ® Flat
215 CLARK RD Latitude/Longitude of well location
(Street Name,Numbers,Community,Subdivision,LotNo,Zip Code) 35.24.634/82,04,025
3.OWNER GRADY REYNOLDS (degrees/mimat seconds)
ADDRESS 215 CLARK RD Latitude/longitude source:®CPS❑Topographic map
(so-e<t or xoi¢<xo.) DEPTH DRILLING LOG
RUTHERFORDTON NC 28139 From To Formation Description
City or To. State Zip Code 0 145 Clay
828-288-0472 145 320 Consolidated Rock
Area Code-Phone Number
a.DATE DRILLED 2/18/05
5.TOTAL DEPTH 320
6.DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7.STATIC WATER LEVEL Below Top of Casing: 42 FL
(Use"+"IfAbov<Top of CasmJ
S. TOP OF CASING IS 2 FT.Above Land Surface-
'Top of eesu,tmninated WU below land swGc<r<gau<s a vasimc<in
accordmcew9h15ANCAC 2C0118
% YIELD(gpm): 3 METHOD OF TEST ARDM
10.WATER ZONES(depth): 300
11.DISINFECTION:TYPE HYPOCHLORITE Amount 14 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 156 Ft. 6 1/4" SDR 21 PVC numbers and common road names.
U.GROUT: b
Depth Material Method x
From 0 To 20 FL GRAVEL MIX GRAVITY A
14.SCREEN iV
Depth Dieneler Slot Sin Material
From NA To FL in. in C3
15.SAND/GRAVEL PACK: i3
Depth Size Material I,Mf
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.
t _
z� Gt�i
a
2i19ios 3)
SIGNATURE OF PERSON CONSTRUCTING T WELL Date
G*qF V.OD2001
IE
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service center-Raleigh,NC ;;T
27699-1636 Phone No.[phone],Within 30 days.
71 C:)
c- ,

309386
WELL CONSTRUCTION RECORD 47�/2,Sk-� 035—
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
-�
WELL CONTRACTOR(INDiVmUAL)NAME (print)
< �d", CERTIFICATION# �S
)
WELL CONTRACTOR COMPANY NAME r"< tV Q��"`� PHONE #Mla 32 • I—L%>
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
tf licable ifapplicable)
1. WELL USE(Check Applicable Box):Residential MunicipaVPublic❑ Industrial❑ Agricultural❑
Monitoring O Recovery ❑ Heat Pump Water Injection O Other O If Other,List Use
2. WELL LOCATION- y� /� TopographivIAnd setting
Nearest T� Cody, r�O� ORidge E3Slope []Valley OFlat
N� Gl-f4 bar -dh.a1.�J (check approprde box)
(StrectName,N��uca,,l e��t0.CommwiIN Sub div on,Us No, ip cad ) Latitudellongitude of well location
3. OWNER: eSL'LdCc Co. LLC (degmea/m�mnes/recends)
Address Latitude/longitudesource:OGPSOTopographicmap
suet or Rome No.) (check box)
_ t'���SOn✓ lit, (1)L a $701 a DEPTH DRILLING LOG
City or Town Store Zip Code From To Forman n Des ription
Area code-Phone tnmber r
4. DATE DRILLED 2 -10 -OS— r
/ 71at)r 5. TOTAL DEPTH: S - ;/�
6. DOES WELL REPLACE EXISTING WELL? YES O NO 1?9 VC-1- y
7. STATIC WATER LEVEL Below Top of Casing: y ) Fr.
(Use-+-if Above Top of Casing)
8. TOP OF CASING IS'+Z•S FT.Above Land Surfaces
-Top of rasing terasfasted Wor below land surface requires■
variance in accord with 15A NCAC 2C.0115
9. YIELD(gpm):(0 METHOD OF TEST R/#LU
10.WATER ZONES(depth): r
_ LOCATION SKETCH
11. DISINFECTION:Type Amotmt Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
or Wel t m�ers and common road names.
Fro To_12_1 Ft .J.1 ��nn o to
From_To Ft IdL
From - To FL
13. GROUT: DepW tMethod m�(` 1�Q
From-0—To�]_Ft. /7"Z*d a
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
From To Ft in. in.
From To FL in. in. n
15. SAND/GRAVEL PACK: o
Depth Size Material
From To Ft. I�
From To Ft. `
-
16. REMARKS: V'f
z-
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,W �
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATLyRE OF PERSON CONSTRUCTING THE WELL DATE No _
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-R9*h,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 RAV.b7/20M -

309385
WELL CONSTRUCTION RECORD 47&S 1Z89
North Carolina-Department of Environment and Natural Resources-(Division of Water Quality-Groundwater Section 7
WELL CONTRACTOR(INDIVIDUAL)NAME (Print) MAy� {/CIXM S' CERTIFICATION#
WELL CONTRACTOR COMPANY NAME MG�A"II [�/C�7&^.,P� PHONE # CTc?�132 .06
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential 6 MtmicipaWublic❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other 17 If Other,List Use
2. WELL LOCATION: Topogapltic/Langetting
Nearest Torw�D:� Co>mty� ❑Ridge ❑Slope Walley ❑Flat
$;Q. Ice C.N pnr L' rJ ✓r SPP_W V (check apgwr box)
(Suedxama Numbers.Community.Subdivision,LM No.,Zip Code)
Latitude longitude of well location
3. OWNER: LLL'CL V.i c t- CD . U-.0 (&-Fudmim twswon&)
Address —2-?>' (V. me- r St - Latitude/longitude source:❑GPS❑Topographic map
(Strcet ar Aoute No.) ( bm)
e!�crso.v �l r, roc �4 DEPTH D 11R T�IAG
or,
tip Code From
— To TZ r — Formation Desc iption
5 i d- r(O3 e
Am code-Phone n mber '82'- 34P"
4. DATE DRILLED 2-'
5. TOTAL DEPTH: e
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO L9
7. STATIC WATER LEVEL Below Top of Casing:
(Use"t"if Above Top f Casing) .
8. TOP OF CASING IS FT.Above Land Surface-
'Top of using terminated at/or below lead■arfaee requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm):�_METHOD OF TEST
10.WATER ZONES(depth): $— ...—
LOCATION SKETCH
11. DISINFECTION:Type NTff Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
-2 S Depth
FtDiampter$ orW t/Ft I f \ d common road fames. y
From
1
From_To Ft t l
From To Ft— /1 _
13. GROUT: Dep �M`t1O`� 9A*(40M r
From_To 0
From To Ft w
14. SCREEN: Depth Diameter Slot Size Material O
Frost To Ft in. ill. p
From To Ft ice. in. cA
15. SAND/GRAVEL PACK
Depth Size Material �l �'S ✓tc'� t IV ..
From To Ft. -
From To Ft.
16. REMARKS: kifftc/9 IWCA2,;L I�ACKt� e� W ✓OC� C��/�< l 9 i J
y
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
NIAy z-9-
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Ralelgly NC `
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.67/2001

309384
WELL CONSTRUCTION RECORD 4-7o51Z$al 33)
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) MI)-Tf den-c CERTIFICATION#2�-7
WELL CONTRACrOR COMPANY NAME MCC41I 9r6hW4T PHONE # ( 34h322'fsV6
STATE WELL CONSTRUCTION PERBEW ASSOCIATED WQ PERMIT#
(if applicable) (if applicable) _
1. WELL USE(Check Applicable Box):Residential VMunicipaUPublic❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
-n
2. WELL LOCATION: Topo� ic/Land setting —
Nearest Town:LX Gy County Midge L9Slope ❑Valleg- 01`lat
33 l&rzv Kockock su ✓i/, sr� Iaat�n (check stwopriare box)
;, .
(Sheet Name,N Community,Subdiviamn,Lot No,Z:ip ) Latitude/bngitude of well Ibation
3. OWNER: � 0.eSourc� CD. LLG
Address _33'1 N, MC,,' r Latitude/longitude smace:❑GPS❑TopoJmphicmap
ke��rsa vllG o�81Sa DEPTH (DRILLING LOG
ortown state tip Code From, To , Forma' nDe ription
(88� S 10-SQ.io3 �2 -53 0�u'
Meat code-Phone amber 63r— 1�-T (Al+trurik
4. DATE DRILLED Z- - T
5. TOTAL DEPTH:
6. DOES WELL REPLACIf EXISTING WELL? YES❑ NO Er
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'+"if Above Top of Cuing)
8. TOP OF CASING IS L Z,O FT.Above Land Surfaces
'Top of wing terminated actor below land surface requhu a
variance In accordance with 15A NCAC 2C.0113.
9. YIELD(gpm):_3Q METHOD?F TEST r
10.WATER ZONES(depth): 12S -- 30
LOCATION SKETCH
11. DISINFECTION:Type Amount Z 72 t Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
l Depth ssector5-a Ft A a wd UFtC ( nal �mm and common mad names.
��To From Al
Fromm-To Ft
From To FL
13. GROUT: Depth / Method to5 1J
From_Q_T; S _Ft_fi
From To Ft �u' OP �tCttc Yoe
14. SCREEN: Depth Diameter Slot Sim Material -- �- - /
From To Ft in. in. G'4 yd�1
From To Ft in. in.
15. SAND/GRAVEL PACK
Depth Sim Material , a
From To Ft. a n
From To Ft. ca
16. REMARKS: rn
C
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
#419k-2ao✓ 2--1�7-0,5-
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Rsleigb,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

309383
WELL CONSTRUCTION RECORD 4705l2-S'
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDWIDUAL)NAME (pria feF;t) MA H—Ej CERTIFICATION B�7
wELLCONTRA(.TORCOMPA"riAME U-' AI( Ata#Ar✓s PRONE a (-A
STATE WELL CONSTRUCTION PERMM ASSOCIATED WQ PERNTU -
(if applicable) - (if applicable)
1. WELL USE(Check Applicable Box):Residential lii,"Municipal/Pubuc❑ Industrial❑ Agricultural❑ `s
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use a
2. WELL LOCATION* TopogaphidLand setting
Nearest To .° L411� zul-e- C0untyQVkf4F-16 ❑Ridge ❑Slope ❑Valley S.IF)at ,
IT ZO Vt/ IPOC.F (check appmpxiate box) ^
(suet Name,N CoumuniM Subdivision,Lot No,Tip Code) LatitudeAongitude of well I.oC84on -,
3. OWNER: I-Cit1� R QI.fCe CL1 . LLC (depaslmimteduca�
Address -TM N• sr-'n S-t - Latitude/longitude source:❑GPS❑Topographic map
(Strator Route No.) (check box)' ---
)'W-r\<�{SSoA V. +\,t, roc g7`j a DEPTH DRILLING LOG
ChymTown State tip Code From. To a FormationDFwnption
Am code-Phone comber ,� (/•
4. DATE DRILLED -4' `0� .3 -
5. TOTAL DEPTH: '3 0 y _ 57r
6. DOES WELL REPLACE EXISTING WELL? YE$5 NO
7. STATIC WATER LEVEL Below Top of Casing: /S(J FT. t
2."S (Use^r^if Above Top of Cuing)
8. TOP OF CASING IS FT.Above Land Surfaces
'Top of easla8 terns sited x0or below land ur(aee requires a
Mina to accord with 1SA NCAC 2C.0118.
9. YIELD(gpm): as METHOD,0 TEST MdLt)
10.WATER ZONES(depth): /7�
_ LOCATION SKETCH
11. DISINFECTION:Type Amount 1` Show direction and distance in miles from at le
12. CASING: Wall Thickness two State Roads or County Roads.Include the r
o
or a t pumbers and common mad names. vvvv
Fromt241
.s �8 Z FL o�s ter 61
J f rN ffiG
From_To Ft
From To Ft
13. GROUT: Depth Material Method
From To Ft `
From To Ft
14. SCREEN: Depth Diameter Slot Size Material C
-
From To FL in. in &� ^ -
From To Ft in. in.
15. SAND/GRAVEL PACK: Oak
Depth Size material �}}��
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
os-
sioNATuRE OF PERSO ONSTRUCTIMG 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

309382
]) P 51y WELL CONSTRUCTION RECORD
North Carolina- Department of Environment and N +trat Re�ources- ivisionftf�f Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print / n� t/ CERTIFICATION��6�d
WELL CON'f RACTOR COMPANY NAME l( � � c+ PHONE #��✓'�'vP
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 LOCATI 57/, Topographic/Land setting
Nea tTown: 42 Cqunt // ❑Ridge ❑Slope ❑Valley ❑Flat
�toy lucAf Q C T (check appropriate box)
(Street Name, umbers,Community,Subdivis)on,Ka No.,Zip Code) Latitude/longitude of well location
3. OWNER: LAad 22S tkrce. ftmo ll 1 Lt-- (degrees/minules/seconds)
Address 7'3-1 IL Oil 11 �tTZ�2� Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
�_ _ ndierKnnH Ilp NL 711W. DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
AYE)- t5t
Area code-Phone number / _D r
4. DATE DRILLILL EDD > �
5. TOTAL DEPTH: - • ----
6. DOES WELL REPLACE EXISTING WELL? Y/�J,S�[/]-��1 O A_
7. STATIC WATER LEV L Below Top of Casing:/'«{--FT.
U '+"if Above Top of Casing)
8. TOP OF CASING l B� T. Above Land Surface* D
"Top of casing terminated at/or below land surface requires a
variance'n accords with 15A NCAC 2C.0118.
9. YIELD(gpm):��METH OF ST
10. WATER ZONES(depth): at
LOCATION SKETCH - ev
11. DISINFECTION: Type Amount Show direction and distance in miles from at least 25 - -
12. CASING: Wall Thickness two State Roads or County Roads. Include;the road —
—DTepth� . Di�me r or ght/Ft�. Material numbers and common road names.
From o ( Ft -
From To FL
From To Ft. f
13. GROUT Dep T tl7�n M to al It �^fJ ( �J 6
From - To Ft L
From To Ft.
14. SCREEN: Depth Diameter Slot Size erial j
From To Ft. in. in. W
From To Ft. in. in. O
15. SAND/GRAVEL PACK: O
Depth Size Material CA
From To Ft.—
From—To Ft.
16. REMARKS: ��/ �/�� ! ' t / ®V 1 ` Ut✓��'e�
I DO HEREBY CERTIFY THAT TH WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTR ION STAND LIS, HAT A Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIG ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-I REV.07/2001

309381
y WELL CONSTRUCTION RECORD a / 7
4 /P,�/W
North Carolina - Department of Environment and/yC'pt sou Dl/vrJs)ionpf Water Quality-Groundwater Secttiio(q
�/ CERTIFIC TIONdd��/,�r!
WELL CONTR.ACTOR(INDIVIDUAL)NAME (^^^' �
// .
WELL CO\"fR,tCTOR COMPANY NAME PHONE
fff+++---
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
L WELL USE (Check Applicable Box): ResidentialV-M'U'nicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ O�tyheerr❑ If Other, List Use
2. WELL LOCATI /��`� Topographic/Land setting
Neare T4own: h N e C wiry (/ e ❑Ridge ❑Slope ❑Valley ❑Flat
.-1 e 4C � 7 j" ,!Za v (check appropriate box)
(Street Na ne, Ambers,Community.Subdivision,Cot No.,2ip Code) Latitude/longitude of well location
3. OWNER cr)c, xi (degrees/minutes/seconds)
Address �3� fV�GC.�n S-LEXIct Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
� l�f-SYYJ; (1, NG o�g`�Oj a. DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
M )- sib-sato3
Area code-Phone number _ _ r '-
4. DATE DRILLED J
5. TOTAL DEPTH:
6. DOES WELL REPLAff EXISTING WELL? YE$ ❑_ NO
7. STATIC WATER LEVEL Below Top o£Casing: ./,!;t> 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 requireit a �.
variance in aecorit with 15A NCAC 2C.0118. _
9. YIELD (gpm):- _ ME HOD OF Ts4 —_
10. WATER ZONES(depth):
LOCATION SKETCH
I I. DISINFECTION:Type Amount Show direction and distance in miles from aS least a = -
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth' Di or t. ,�W r numbers and common road names.
From To Ft -
From To Ft.
From To Ft.
13. GROUT: .., Dept /� ethod
From _�To
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
f+�
From To Ft. in. in. C�
15. SAND/GRAVEL PACK: p
Depth Size Material CA
From To Ft.
Frotn To Ft _ m
16. REMARKS:
I DO HEREBY CERTIFY THAT THI WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTI STANDA S,A T AT A C Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
6
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

3 93g0
WELL CONSTRUCTION RECORD 47051299 I�-
North Carolina-Department of Environment and Natural 1R'4Hesources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR MDTVmUAL)NAME (Pr` t) r /• - ceded T- CERTIFICATION 0�7
WELL CONTRACTOR COMPANY NAME me org ag PHONE
STATE WELL CONSTRUCTION PERNM ASSOCIATED WQ PERM1Tk
(if applicable) / (if applicable) _
1. WELL USE(Check Applicable Box):Residential 9 Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: gaght d �
Nearest Town: '✓�— County +' ❑Rid;'09S]opo�pyalley ❑Flat
#14- rn&y koc L 5LJ . L/ (check appropriate box)
(Street Naaq 4webers,Commmity.Subdivision,Lot rap Code) Latitudc/longitude of well location
3. OWNER: �d. �.eSO(LrCV CO.
_ (,..(..�... _ (degmWmtmtteslreemds)
Address �3`) N M[ti:A Latitude/longitude source:OGPS❑Topographic map
'Street or Route No.) (check box)
1 rde�Sotu/.l\r N r o1$7n1 a P DRILLING LOG
City or Town Seat Zip Code From To Formati n De fcliption
,aqa -_sfo—satos a — m
Am coda•now amber
4. DATE DRILLED
5. TOTAL DEPTH: I
6. DOES WELL REPLACE EXISTING WELL? YES❑, NO Bel _
7. STATIC WATER LEVEL Below Top of Casing,--/���+A+-
(Use-+-if Above lop of CasmO i '
8. TOP OF CASING IS+1 t D FT.Above Land Surface -
*Top of easing teratoated War below land surface requires a � .
variance in accordance with 15A NCAC 2C.011&
9. YIELD(gpm): METHOD OF TEST
10.WATER ZONES(depth):
j OCATION SKETCH
11. DISINFECTION:Type Amount 4ib's Show direction and distance in miles from lit least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth� a tm %t numbers and common toad names.
From+l,D To Ft
From To FL
From To FL
13. GROUT: Depth i Material Mohqd LjD
From_To_ll.(Z FLCCOftht
From To Ft ajw14. SCREEN: Depth Diameter Slot Size Material �J bFrom To FLin. in. ry
From To FL ia. in.
15. SAND/GRAVEL PACK Depth Size Material C✓F�k��
�l e-
From To Ft.
From To Ft. tI`
16. REMARKS:
k- ' 6movuo Lit //0',
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Aft- S&ti- 2-2-U
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

34g3'79
WELL CONSTRUCTION RECORD-R470512 N 9
North Carolina-Department of Environment and'Na(tural Resources-Division of Water Quality-Groundwater Section pr-�7
WELL CONTRACTOR pD1VIDUAL)NAME (print) AAA Q �('�'K CERTIFICATION#2!FS—L
WELL CONTRACTOR COMPANY NAME i � C �"11 ✓aI Le✓- PRONE #
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) ifapplicable)
1. WELL USE(Check Applicable Box):Residential MmucipaUPublic❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water injection❑ Other❑ If Other,List Use
2. WELL LOCATIO Topo Land setting z
Nearest Town: Lk) Cotmty� ❑Ridge B�lope Malley ❑Flat '
(Street Name, berg,Comm mftY,Subaiviwu%tot No,ziipp Code) Latittrdellongituide of well location —
3. OWNER:_ Lard t eso a'Z=R CG. �1.0 (deeealm�m/aewads) 1
Address 3 �'l N, Ma_n St• LatitudcAongitude source:❑GPS❑Topographio map
`\ (Check box)
DEPTH DRILLING r.Or
City or Town cux Zip Code From T(1 i Formation De cription
Ara coda Phone manbw
4. DATE DRILLED 1 / -
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES NO
7. STATIC WATER LEVEL Below Top of Casing.
_ (Uu"+^if Above Top Casmg)
S. TOP OF CASING IS FT.Above Land Surface*
'Top of cadet;terattaxted aHor below land mrface requim a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): -METHOD OF TEST eki
10.WATER ZONES(depth): 'f}—
r nCATION 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 i or Weif t/Ft. numbgls common road names.
From._To.
by s(!
From To—Ft 1 A
From To Ft °Q A --__
13. GROUT: To t M�� Niethod /_ y-
From�Tc tyJS_Ft e�i fG7 � ���
To Ft—
From— ,bv��� C.! � /
14. SCREEN: Depth Diameter Slot Size Material K c
From To Ft in. in. CC
From Ft in. in.
15. SAND/GRAVEL
PACK:
Depth Size Material
From To Ft.
From To Ft. h
16. REMARKS (.(/T 4/15l/1�C�eTT ff r �rj`�fd �i� O r7D 7i�
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THATA COPY
YOOOFFTHIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
7,A Ole-7
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

309378
WELL CONSTRUCTION RECORD-M-10512S9 — !3
North Carolina-Department of Environment and Natural`,Resources-Division of Water Quality-Groundwater Sec'tiionnc
a
WELL CONTRACTOR(INDIVIDUAL)NAME WWI M A.IT uEe4ehl '' CERTIFICATION or
WELL CONTRACTOR COMPANY NAME �Q�CA-I 1 Ai�ws PHONE a L&A,-fa-1JDk
STATE WELL CONSTRUCTION PERMrrO ASSOCIATED wQ PERM IW
if Gcable) if icable
1. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial❑ Agriculnual❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
1.
2. WELL LOCATION; oglaphicJLand setting
Nearest Town: LA '-, L Countye� Sledge' ❑Slope ❑Valley ❑Flat
0-13 Grey k 'Subtly , (check appropriam box)
(Street Name.M=b=36 Community,subdivision,Lot No,Tap Code) Latitudeftlgitude of well location �� -
i
3. OWNER: Q
Cn r -r
L. (� fyC�i,SGe (depeWmim,mlaecanda) � � r',
Address 3 t\.), rf\G; n St-- LatitudeAtingitude source:❑GPS❑Topographie map -
(Street or Rodin No.) (chak box) _.. ..
enc�trSMV.(1r tvL � g14� DEPTH DRILLING LOG
CitymTown Sore ' Zip Code From, To Formation escription
Amu code-Phone number Z/ '
4. DATE DRILLED 1l 2' ve-
5. TOTAL DEPTH: -/
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO ff y7Q
7. STATIC WATER LEVEL Below Top of Casing: 70 FT• y 70
(Use"+'ifAbm Top of Cmmg)
8. TOP OF CASING IS +2.d FT.Above Land Surface-
*Top of easing terminated at/or below land surface requires a
variance In accordance with 1SA NCAC 2C.0118.
9. YIELD(gpm): 1-45 _METFJOD OF ST
10.WATER ZONES(depth): -
O LOCATION SKETCH
11. DISINFECTION:Type Amount Z Show direction and distance in miles from at least
12. CASING: Wall Thiclmess two State Roads or County Roads.Include the road
Depth r or Wd t/Ft a bens and common road names.
Fromb2.O To�_Ft� �{ a
From__To Ft
From To Ft a !cl» -4
13• From 0 GROUT: TO-1—FLepth M a MAW
bv;wll C 1 R6
From To Ft Y�7 /eC
14. SCREEN: Depth Diameter Slot Size Material � rr
From To Ft in. uL
From To Ft in. in. '
15. SAND/GRAVEL PACK: p�te- C
Depth Size Material
From To Ft. Y
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
&� Z4-� ii?-0-4:z-
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

309 37 7
WELL CONSTRUCTION RECORD4 47051 Z$j #: 1 Z
North Carolina-Department of Environment and Natural�Ri Cesouur^ces-Division of Water Quality-Groundwater Section
WELL CONTRACrOR(INDIVIDUAL)NAME (print) A•T7 AYtC CERTIFICATION*?= 7
WELL CONTRACTOR COMPANY NAME M ���11 StIA40� PHONE IF W)D4M1 -47-7 SLY.
STATE WELL CONSTRUCTION PERMIT#_ _ASSOCIATED WQ PERMIT#
if applicable) (if applicable) -
1. WELL USE(Check Applicable Box):Residential WMimicipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: TopogIvIlic/Iand setting Nearest Town: L4 Lu3 Connty� ❑Ridge ❑Slope Malley at
JjZ Gr',v a0 .S✓ e . (check apptoptiste boat)
(Sven,Name,Nuinbets,Commu uly,Subdivision,W No,zip Code) Latitude4ongitude of well location
3. OWNER: r�eS(>W'Lt is, PLC,
Address 33 LatitudcAongitude source:❑GPS❑Topographic map _
tSvcet ar Route No.) (choekbm)
DEPTH DRILLING LOG
pr Towe seen 73p Code From To/ Fotmati n De -ption
( _ S1�Phone EDD-Saro3 0 - 2S v r
4. DATEDRILLE ba -27-OS Z0 -ZT"
5. TOTAL DEPTH: a 24 '-L�I f
1 / ZVK- God
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO IB" dArk
7. STATIC WATER LEVEL Below Top of Casing: 4 t) FT.
tz, 0 (Use-+-if Above Top of Cuing)
8. TOP OF CASING IS FT.Above Land Surface'
'Top of casing terminated stlor below land surfm requires a
variance he ateordsoce with 15A NCAC 2C.0118.
9. YIELD(gpm): 2- METHOD OF TEST_
10.WATER ZONES(depth): Zwz
LOCATION SKETCH
11. DISINFECTION:Type MTN Amount / Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
lm 2•Q Tomah b '-
Diazoeter a Weight/FtG��members and common road names.
Fro Ft
From _To Ft
From To Ft.
13. GROUT: Depth rMaterialethod 1
From
14
From To Ft
14. SCREEN: Depth Diameter Slot Size Material - -
From To Ft m. in.
From To Ft in. in. Ca
15. SAND/GRAVEL PACK: N SYC �CCk
Depth Size Material C,reG Cn Iy
From To Ft. g�f�pl#L
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
Naloll- 19Z a, 2 7 0_c
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-I REV.07/2001

3093 `76
WELL CONSTRUCTION RECORD Q ?bS J?
North Carolina-Department of Environment and Nast ral Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (priatL M A- T_1 E � CERTIFICATION
WELL CONTRACTOR COMPANY NAME nje�a Z- PRONE # fxm 377•/1
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITq -
if licable if livable
1. WELL USE(Check Applicable Box):Residential Mumicipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: n Top099p]lic/Land setting -
Nearest Town: L ✓ CountyyLkey,91e2p ❑Ridge Mope Malley ❑Flat
Gm�o rr Sy A,; .-
,; (Shakvpropnftboa)
(Street Name,N, ^hers,Cam�lmvniry,Subdi,iaoo,Lot No.,Tip Code) Latitude longitude of well location
3. OWNER:_LCiSY�. itESb4IC,C CD . LLG ( yam)
Address _33rl tV . rr%w�r, St - Latitudellongitude source:❑GPS❑Topographic map
.(Surat or Route No.) (check bout)
� {SSD.�J Ilet rocag'7S 2. DEP1 DRILLING LOG
dy or Town 5.... Tip Code From To Formation Descri lion
A88f -_ P�_
Am undo-Rho LED'number
4. DATE DRILLED'
I^
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing:AFT.
(Use-+-if Above Top of Casing)
8. TOP OF CASING IS -42— FT.Above Land Surface*
'Top of casing terminated atfor below land surface requires a
variance in■ecordaaee with 1SA NCAC 2C.0118. `
9. YIELD(gpm): METROD OF TEST_ _
10.WATER ZONES(depth): --61—
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 I�i�ter tort/Ft nm hers and common road names.
From TO—Ft lo4/X
From Tc Ft
From To Ft �d A
13. GROUT: Depth 1 Method un A
From_ To�p�_Ft�L�
From To Ft
e
14. SCREEN: Depth Diameter Slot Size Material _
From To Ft ice. lit.
From To Ft in. in. SYl I� k-
15. SAND/GRAVEL PACK jD1 C yinDepth Size Material BJtTKte7
J�(Vj
From To Ft.
From To Ft.
16, REMARKS: C'�dt 1"
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
i - S_ Out—
SIGRATLU 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

309375
WELL CONSTRUCTION RECORD WOS�237 —�
North Carolina-Department of Environment and Na Res ourc Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVMUAL)NAME (priinntt) CERTIFICATION#
WELL CONTRACTOR COMPANY NAME -6,1I PHONE # 2-3271Z,2X
STATE WELL CONSTRUCTION PERMM ♦CCOCIATED 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 LOCATI N: � MRi ��hic/Land setting
Nearest own: ke L f County dge ❑Slope Malley ❑Flat
�lPr/ IDOL StidG it//�/UM (eheckappmPriatebox) -
(Sow Name, wrbers,Communtry,subdivision,Lot No,Tip Code) Latitudellonetude of well location,
3. OWNER: B)ESO-r-CL C n..fyn.4 Zir (depeeNmrmdeslseconds) _
Address _ 3 IV. rr-sc`n S-Uce+ Latitudellongitude source:❑GPS❑Topographic map
,($treat or Route No.) (check boa)
_ k t.aerso^�;11< Nc aV') ) DEPTH DRILLING LOG
Gar orTowri Sure3 Zip Cede From, �T3o Fomnuign De cription
�8fh Sib-Sa
Ara code.Phone number 73 —
4. DATE DRILLED '_
5. TOTAL DEPTH-,
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: So r FT.
(Use"+'if Above Top of Casing)
8. TOP OF CASING IS) a o FT.Above Land Surface'
'Top of easing terminated attor below land surface requires a —
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): $ METHOD OF TEST
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type N # Amount 3 165- Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth l Du peter or wei UFt numbers and common road names.
FromF2 0 To_3jLFt — 1199 GA Iv
From To FL
From To Ft
13. GROUT: Depth t serial Method
From_To Ft�t
From To Ft d a
14. SCREEN: Depth Diameter Slot Sian Material fir_
From To Ft in, in. w `Lrj
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Sian Material -. tl1 I�SdIb i✓,
From To Ft.
From To Ft.
16. REMARKS:
8y 'gyp
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 WALL,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 �j � �3 0 9 3 7 4
North Carolina- Department of Enviroi
nd N ra e our - i ipsion�iof•Water Quality-Groundwaterection
WELL CONTRACTOR(INDIVIDUAL)NAt) _ C-�/ CERTIF[C TION
WELL CONTRACTOR COMPANY NAME ;r— !PHONE >b��&
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(ifapplicable) (ifapplicable)
I. WELL USE(Check Applicable Box): Residential Municipal/Public❑ Industrial ❑ Agricultural ❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELLLOCATI Topographic/Land setting
Near tTo /n: Count ❑Ridge Mope ❑Valley ❑Flat
e G ,e (check appropriate box) -
(Street am N umbers,\\Coiinnmunity,Subdivision Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: +.L).) `C (\c—1-ZwrCL CD, LLC • (degrees/minutes/seconds) _
Address Ss N. ncc, n WrCE Latitude/longitude source:❑GPS❑Topographicmap
(Sweet or Route Na.) (check box)
en ItFSo1J I� tJ) av192 DEPTH DRILLING LOG
orTow, State Zip Code From To Formation Description
i, QCity
Area code-Phone number ZI
'(r
4. DATE DRILLED /JIf
5. TOTAL DEPTH:
6. DOES WELL REPLAft EXISTING WELL? YES ❑ NO l�
7. STATIC WATER LEVEL Below Top of Casing: � FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS ' FT. Above Land Surfacer
*Top of casing terminated at/or below land surface requires a
variance in accords with 15A NCAC 2C.0118.
9. YIELD(gpm): � MET OF TE T
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 iameter eight/ I. M terial numbers and common road names.
From T
From Tct Ft.—
From To Ft.
13. GROUT: Depth Material Method
From To FL
From ec De o Itj Ft
De f
14. SCREEN: Depth Diameter Slot Size Material U
From To Ft. in. in. ppN
From To Ft. in. in. Q
15. SAND/GRAVEL PACK: A
Depth Size Material
From To Ft.—
CD
From TO Ft. 9�p'w
16. REMARKS: � t
(� / oL ) �7
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION ST DARDS,AN 1 A COP'?, HIS RECORD HAS BEEN PROVIDED TO TH LL OWNER
os
SI ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 09373
North Carolina-Department of Environment and Normal Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (Pried) l=.h(I r I 1 S CERTIFICATION#aL52C
wELLCONTHACrORCOMPANYNAME VMILull bi&5 PHONE # (7110'1`)rt-A6
STATE WELL CONSTRUCTION PERMTr# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box):Residential 0--Uuoicipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat very Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: TopographicAmd setting -
Nearest Town: ( Ake Lu County P-ti ereir4 ❑Ridge ❑Slope ❑Valley ❑Flat = _
CN—cr-( rdrk 5", (check ahbox :i
aPPmPn )
(StlxtName,Number,Community,Subdivision,Lot No,Zip Code) LatitudeAtingitude of well location..
3. OWNER:��ClLr a ,Yf,.SC)w'et Cc, . L.l.L (degreealmtwdeslsxoods)
Address _339 /U. r� .,r) S-. Latitude/longitude source:❑GPS❑Topographic map
. E(Street or Rome No.) (cheek box)
l_ ender nV llr� ric DEPTH DRILLING LOG
City or Town State _ Zip Code From To Formation Description
(ns - S10-S a.lo3 — r`� - /3 6
Area code-Phone another 13 /le t I ✓e w t"rL�
4. DATE DRILLED_ ( ' OS 1 , i ti 2�,ey
5. TOTAL DEPTH: 5a O I t - ��,o t-
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO M'
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use"+-if Above Top of Casing)
8. TOP OF CASING IS—FT.Above Land Surface'
'Top of cedes terminated at/or below land surfam requires a
variance is aeoordauee with 15A NCAC 2C.0118.
9. YIELD(gpm): 6— METHOD OF TEST
10.WATER ZONES(depth): -;
LOCATION SKETCH
11. DISINFECTION:Type u Thl 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 Weightta Material numbers and common road names.
From-=&=-To Ft
From To FL
From To Ft a
13. GROUT: Depth tonal Method
From_To_�Ft wfnwxr,t to 1c o
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
From To Ft in. in. o
From To Ft in. in. Lam ,
15. SAND/GRAVEL PACK: Po
Depth Size Material
From To Ft. (e
From To Ft
16. REMARKS:_Pd J��P� (�lK//1 a lJ )ate -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C WELL
CONSTRUCTION ST S�J AND THAT A CO/�Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1t�7 ,, d'-,'
SIGNATURE 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. OW-1 REV.07/2001

ND
309372
WELL CONSTRUCTION RECO )Z8`7 l=%
North Carolina-Department of Environment and Natural ral Resources-Division of Water Quality-Groundwater Section
1
WELL CONTRACfOR(INDIVIDUAL)NAME (prinnt) 1y1�M}'yf�" C'LkA1 CERTIFICATION
WELLCONTRACIORCOMPANYNAME W-61kI I RrtH e•T PHONE # OgI269' J.-
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
if ►icable if icable
1. WELL USE(Check Applicable Box):Residential Mumcipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water hyection❑ Other❑ If Other,List Use
2. WELL LOCATIO Topographic/Land setting
Nearest Tow�n n jl)Y County, ❑Ridge ❑Slope ❑Valley at
G� il_ KDG �V, (checkrypmpriatebm)
(Strew Name,Nu6beM Commtmity,Subdivision,Lot No.,zip Code) Latitudellongihide of well location
3. OWNER: L a-,. L 9,, SO(zc* Co ,LV,
Address 3 ' to. fY t n S 4S�t E Latitude/longitude sou O PS❑Topographic map
`\ Areet pr Rowe No.) (cheek bm)
Zr S0r� V')lz, 6')L ag`l"I a DEPTH DRILLING LOG
g ,F"3 or foaa rue Tip Coda From To Formation Description
Am code-Phone--ber 4. DA DRILLEDI-/5'US- `rye a
5. TOTAL DEPTH:_7C0
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: WA FT.
(Use"+"if Above Top dfCuing)
8. TOP OF CASING IS 0 FT.Above Land Surface'
'Top of easing terminated at/or below lead surface requb u a
variance in aeeordance with 1SA NCAC 2C.011&
9. YIELD(gpm): -&- METHOD OF TEST u/
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
T oth h Ft� or Wei TL �f; numbers and common mad names.
Fronk.tb a G r�
Fromm_To Ft
From To FtrFSLI�-Woe--
13. GROUT:r� Depth 1M_�e�t�ho�d �VZ
Frot>L_To_1�FL NOC i.Iwf-�From To FL14. SCREEN: Depth Diameter Slot Size MaterialFrom To Ftin. in.From To Ft, in. in.
15. SAND/GRAVEL PACK Depth Size Material
FromTo Ft.FromTo Ft.
16. REMARKS:cyI CAS/e7T 1/ qrh4e skU izrG Gvl7irOc rl 0 `,J�D
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Al .- 4z-,tt /-m--Os
SIGNATURIS 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.072001

dwiw
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME —
�(print) U G1 yyke ,� Ca ✓• CERTIFICATION# a 13 b
WELL CONTRACTOR COMPANY NAME /�'I Y A 5 I A� d" p y wk 1 �G L Il G PHONE $! 0 )�9 3--�V z
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITS
if applicable) (if applicable) _
1. WELL USE(Check Applicable Box):Residential$,'Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCAT ON: ,, qp Topographic/Land setting
NeprgstT n: ltt.(�County�`✓' ddKidge ❑Slope ❑Valley ❑Flat
r (J (check appropriate box)
(Street Name,Numbers,Community,Subd..ston,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: Y Q M (degrees/minutes/seconds)
Address 121 e ✓ k-l-11e Latitude/longitude source:❑GPS❑Topographicmap
MJJa (Street or Route Np.) (check box)
)11 5Qd'i p & L ;�R 7 S6 DEPTH DRILLING LOG
Ci� _ st a Zip Code From To ormati D trip' n
U- a lit
Area code-Phone numbe,
4. DATE DRILLED Q
5. TOTAL DEPTH:
—� -
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing:V)--FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS�_FT.Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accords co With ISA NCAC 2C.0118.
9. YIELD(gpm): _METHOD OF TEST
10.WATER ZONES(depth): ` — LOCATION SKETCH
Show direction and distance in miles from at least
11. DISINFECTION:Type (� Amount 12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diareter or igh I. Mate 'al^ numbers and common road names.
From To 10 Ft. T 1 j� 1
From To Ft. S i`C
From To Ft.
13. GROUT• Depth. _ Material Method
From To a(� Ft.
From To Ft. .
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. _ in.
From To Ft. in. _ in. L '
15. SAND/GRAVEL PACK: i{" low V.�✓_
Depth Size Material
From To Ft.
From To Ft.
N �
Ul
16. REMARKS:
O
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE TH 15A NCAC 2C,WELL CA
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PR VIDED TO THE WELL OWNER
- So5
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE_
Submit the original to the Division of Water Quality,Attn: Information Management,1617.Nihal Srwlc�CNrter�
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. GW-1 REV.09/2004

WELL CONSTRUCTION RECORD
310566
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME nnt) - I '1e5 bj Ca CERTIFIcAC�ATCEIO'N1# r�I3B
WELL CONTRACTOR COMPANY NAME �'r ^^ ^ I/L F I1 ��it W1.1 L . T c. PHONE # P9
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential.10 Municipal/Public k/ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other O If Other,List Use
2. WELL LOCAT N dge O lope L d setting
Nearest Town: County pRidge ❑Slope alley OFlat
e.f &w i 14 d QG r c 5 S +r o wr o i d col (check appropriate box)
(Street Name,Numbers,uorniounity,
`�S,�u_7bdivi`sio'n,1L,ot No.,Zip Code) Latitudellongitude of well location
3. OWNERMAUM �UlI..A "A k (degrees/minutes/seconds)
Address Latitude/longitude source:EIGPSOTopographic map
I/ (Street or Rou No.) 7 0,1 (check box)
IC e " ✓P " 0 4� DEPTH DRILLING LOG
City or Town State Zip Code From TO o ation riptio
Area c de-Phone nuni M
4. DATE DRILLED 1 (1 t-rA 11) U �
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES IJ ( _ LA J
7. STATIC WATER LEVEL Below Top of Casing:nNO_FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS�_FT.Above Land Surface*
-Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): I. CD METHOD OF TEST CR X A
10.WATER ZONES(depth): U0 S LOCATION SKETCH
11. DISINFECTION:Type Amount llr Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
f, Depth_ DDiiauleter or i t/Ft. Ma_ teryal numbers and co(nmon road names.
From V To Ft.� ` 1hY
From To Ft.
From To Ft.
13. GROUT: Depth Mated - Ivf�thod
From_Q_To _Ft. z.��{1�Jc
From To Ft.
14. SCREEN: Depth Diameter lot Si Material
From To Ft.—in. in.
From To Ft. in. in. er1�j q. �ake [uve.
15. SAND/GRAVEL PACK: "l
Depth Size Material h n
From To Ft. U^')(_,�\' CAO
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELIN
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL 09MER
`f - It
SIGN TURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn: Information Management,1617 Miiii Sek_gicejCenter
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. GW-I REV.09/2004

WELL CONSTRUCTION RECORD
v 310565
North Carolina Department of Environment and Natural Resources-Division of water Quality g
WELL CONTRACTOR(INDIVInUAL)NAME (print) �.ecn2c-
CERTIFhC7ATIO'1N�WELL CONTRACTOR COMPANY NAME • PHONE # YS Z?A:
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box):Residential IP'Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery O Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCAT N• Topographic/Land setting
N estTown: County �idge ❑Slope OValley OFIat
(check appropriate box)
( treet Name,pNumbers,Cat mniTy,Sub",(Sbe�etorRoute
division,Lot No,Zip Code) Latitude/longitude of well location
3. OWNER: VI)�A �"," (degrees/minum,;/seconds)
Address Latitude/longitude source:OGPSOTopographicmap
(check box)
DEPTH DRILLING LOG
�) e ,V L � o te From o anon Descr' tion
iTy or Town - State Zip Code u
Area code- hone number t�
4. DATE DRILLED 3 , D-S,
5. TOTAL DEPTH: . D
6. DOES WELL REPLACE EXISTING WELL? YE —`
7. STATIC WATER LEVEL Below Top of Casing: ❑ NO
FT.
(Use"V'if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface•
"Top of casing terminated attor below land surface requires a
variance in accor a oe with 15A NCAC 2C.011&
9. YIELD(gpm): A METfflgiOF TEST.
10.WATER ZONES(depth): LOCATION SKETCH
Amount w direction and distance in miles from at least
11. DISINFECTION:Type — tw State Roads or County Roads.Include the road
12. CASING: Wall Thickness
D Di eter or gh t. Mate r nu ers and common road names.
o t\ (1 AA
From To Ft UT �1�F2It�X.r �-�
From To Ft.
From To Ft.
13. GROUT: Depth
atenal �` M rod
From To�o_u_Ft.
From To Ft.14. SCREEN: Depth Diameter Slot Size Material (� ,^ PAJ
From To Ft. in. in. 2N(If, WV _
From To Ft. in. in. �F..-5+f>,trDJ•
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. p.
104
From To Ft.
N P
16, REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL p
CONSTRUCTION STA ARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWAM-
�,
SIGNATURE OF PERSON CulySFRUCIING THE WELL
Submit the original to the Division of Water Quality,Attn:Information Management,:1617 Mail Service Center- !
�Grt
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. - MAY GA 1 309/2004

-- - -'-""""..... Date:5/9/2005 Time:4:57:12 PM
Page 8 of 8
WELL CONSTRUCTION RECORD 311186
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 CAROLINAL WELL DRILLERS INC.PHONE#[phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I.WELL USE(Check Applicable Box): Residential ® Municipal ❑ Industrial
Recovery ❑ Agricultural ❑ Monitoring ❑
❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
z.WELL LOCATION:
Nearest to Topographic/Land setting
town: —
LAKE LURE County RUTHERFORD
LOT 26 SWEET BRIAR FARMS ❑Ridge ❑ Slope ❑ Valley ® Flat
Latitude/Longitude of well location
(Street Name,Numbers,Corm mty,Subdivision,LotNo,.Zip Code) 35,28.831/8207/186
3.OWNER MICHAEL SKINNER
(degrees/minutes/seconds)
ADDRESS 1644 COXE RD Latitude/longitude source.®GPS❑Top 0
(so-rae w Ronls xo.) graphic map
RUTHERFORDTON DEPTH DRILLING LOG
NC 28139 From To
City or town Formation Description
State Zip Code 0 75 Clay
828-289-6363
Area Code-Phone Number 75 200 Consolidated Rock
n.DATE DRILLED 4/26/05
5.TOTAL DEPTH 200
6.DOES WELL REPLACE EXISTING WELL? YES NO
7.STATIC WATER LEVEL Below Top of Casing: 45 Fr
(Use"t"IfAbove Top of Caring)
8. TOP OF CASING IS 2 FT.Above Land Surface*
*Top 0fcesing taminalsd aUor bdow land wfae<regdv<s a venanae in
accordmce with 15A NCAC 2C.0118
9. YIELD(8pm): 12 METHOD OF TEST ARDM
10.WATER ZONES(depth): 190
--------------
It.DISINFECTION:TYPE HYPOCHLORITE Amount 8 0= LOCATION SKETCH
12.CASING: Wall Thickness
Show direction and distance in miles from at least
Depth Diameter or weight/Fl. Material two State Roads or County Roads.Include the road
From 0 To 84 Ft 6I/4" SDR 21 PVC
13.GROUT:
numbers and common road names.
-
Depth Material Method
From 0 To 20 Ft GRAVEL MIX GRAVITY
14.SCREEN a
A
Depth Diameter Slot Size Material -!'}
From NA To FL in. in W e
15.SAND/GRAVEL PACK:
'4
Depth Size Material Cil
From NA To Ft,
16.REMARKS: i
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.
5/1/05
SIGNATURE OF PERSON CONSTRUCTING THE WELL Dale
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service center-Raleigh,NC GW-1 REV.07/20 11
27699-1636 Phone No.[phone],within 30 days.

�n
J t .L z &F WELL DRILLING
AND PUMP SERVICE.I'!'_
Nrth Cwomm aMM •a�naE�w4en,neMudNaWrsflMapaeaa•Okukk�ofWWrQvaft OroundwaurSection911 Hwy. Busine_� '
lrateglt N.C.i7e4�te7l pftena(e19)783•3221 Bostic. NC ?0;
WELL CONSTRUCTION RECORD WELL CONTRACTOR: _
WELL CONTRACTOR CERTIFICATION it; Q 13 y
STATE WELL CONSTRUCTION PERMITe: _
1. WILL USE:J.�, °kApp kow t1e:) Fiaolde" MunI*ol 0 Industdd C7 AWkuhlrrai❑ Monitddnp O
ft"Cov"'y U Heim Pomp Water In K*n O Olher(j it os,e.ust Use:
z. WELL LOCATION:(Show MmIch of the waft"beber)
NeMesl Toms —6e9.Lrrc
Ntaad Naar rrl" e"&Owmapll.er aabdrloW aW Lvl Ns.) OflILUPif3 t.00 DEPTH -
S. OWNER - S/2 EeJcJ i0. 5 From To foeraAn O.awlimba<
Adana � sJo�i�u�s �A
ayerTaee awe
4. OATE ORILUW�
S. TOTAL DEPTH - �
6. CUTriNQS COI -ECTED YES Q NO[R
f. DOES WELL REPLACE EXISTING WELL? YES0 NOO
S. STATIC WATER LEVEL Selow Top of C=kW a FT; 1 t3
r, NsVelfte.sTooetCa"
4. TOP OF
CASINO 18 FF.AbWia LaW Sonc�e
'rop M aasMe""*"lvt Wsr bomw Net atwtaea rNuYaa■rarMna N acaor- 6_�'
Aeaa wph teA elcAtT eC.ttte � rj
10. YIELD(Vm): -_METHOD OF TEST Air w
i T. WATER ZONES jftM:--.--5'. o
12. CHLORINATION: Type �'` E AmotrrN n additW ewt:e N naW W w be$at Wm
13.CASINO: �O l
1Mal tlednaM LQgA=SKgM
mo
From-7n ,FL (C �..w�(„J� jL G (Sha"dU.dbn.nd mW ire ma pair f:rso suw
Roads,«eeanpapnterenGepelno 0/
From To FL qte
1t. GR01f1':
���� bWIh Maledat me
Fnm .CFI—To s90"—FL SQnd Mi X
Fr«w To 1%
1S. SCREEN:
Dam Ellmater slat Skit Metetiet / �;&
From To Ft.,...._ b1. Irl l
From To__F(
(p.V -
18. SANDA3RAVEL HACK: i
DepSI S(se MaNdM y� j
From To FL
From To FL
17. REMARKS
IDOHBRESYOERTWYTHATTI6S WELL WAS CONSTRUMD94 ACCORDANCE WITH t5A NCACPC.V/ELL
CONSTAVGTION STANOARO&AND THAT ACOFY OF THIS RECORD IUS OEEN FKMDEO TOT1K YrBLL ONxEP.-
FOR OFFICE USE ONLY r ���ad�� --
qw1 Ne: tpONJ1TURE0i PEA1ar DDNSTRUCTart t/1�r V/Etl�p•rE
= WbnilWOWNOMOmdWWrQMIIA OrovtdrNsrlow Wift39CWYS

DO
ts�".7ae�& owae Calmar M or ErwNa■neM a„d Nelural gatwuteee-06U100 01 velar CkW y.4roundwater Section 3 1 1 1 9 1
Ratea4 N.C.21mmI$3a-Alarw(eta)733.3221 A&F WELL DRILLING
WELL CONSTRUCTION RECORD WELL CONTRACTOR: AND PUMP SERVICE,INC.
WELL CONTRACTOR CEgT1FICATION jZ
Bostic, NC 28018
STATE WELL CONSTRUCTION PERMITf: 2S�d7 Ts
1. WELL USE APWaft,eal:Residential2�Munkipal❑ Industrial El Agricultural❑ Monhodnt❑
ftwwr7 Heat Fumy Wale►Mlee6on ❑ Other(� If Over.List Use:
2. WELL LOCATION.(Show ekebh of Vur Iticeton beloe�
M1aaeAddress"
arrow o/raw—w•rx anamI W) ORILLINQtAQ DEPTH
,- OWNER _ ,/1 r i>i� % 9�- <.,/ s� iron 70 FOma5n t>•■w4a6n
Elver Tent gre
4. GATE DRR.LEO
6. TOTAL DEPTH
6. CVTTMSCOLLECTED YESQ HOED-`
7. DOES WELL REPLACE EXISTING WELL? YES
NO �
6. STATIC WATER LEVEL.Sebw Top of Celtkg ) FT.
/ / m"BAbtma Top Mon"
B. TOP OF �
CASING tSL,,.� FT.Above Land Surface'
'TOP 91460ml Mw6W*d Ww twkw knd ewboa rtpuboo a wdM N nca08,
tense wab/eA NCAC iC Atte � ,�
t0. YIELD(qpn): C MEtH00 OF TEST� �'L �— __�
11.WATER IONES(depihj:,..,y2_4
12. CHLONINATION: Type .. ,airs— Atnounl M eddid"space b tAMW use beatq Irsm
13. CASINO:lgz� / ■ Q
Was Trio"" LOCATION SKETCH
_ l Depth t>t mow or Wo mlFl. MWdo (Show dMttta m arm doar""m ou km tm swe
from To LAbLt.FL ):/ Roede.or WMr MAP"I tremo P*kW
FL
From To FL
14. GROUT:
� �Depth Material Method l
From r4Z To _FL
F romTo Ft.
1S. SCREEN:
Depth Diameter Slot Ski MaterialFrom To:,._FI__ in, krFrom To__FL_, Im —in.From To fl._ In. —in.16. SANDSPAVEL PACK:
D" Ske Material
Flomoi
from To FL
17. REMARKS `l
100 HERESY CERTIFY TNAT TM WELL WAS CONSTRUCHO IN ACCORON CE WITH ISA HCAC IIC.YELL
CONSTRUCTION BTANDAROS,AND THAT A COPY OF TIES RECORD NAS BEEN PROWOEO to JK W61L Oat,ER_
R
FOR OFFICE USE ONLY
Owd tee: ,IONAlIaIEIlp PERBON CpNt1RUC1ep INS Y/m 0016
tttlbdleAdlW gDMllrnef Nhwr gwlq OrotaldeNrtenon>+dYlilt 70 Gsyt
ienrlw. oemW.12n .

311198 A&F WELL DRILLING
AND PUMP SERVICE,INC.
NaM CW460.Oapnsnnn of EmterawM and N R alurd .aoueaa•WOW 01 Wow Wa w-Uroundwmar Sec1IX 1 Hwy.business 74
*moo pMpComw-RdAftN.mVI 1636fhompts}7334211 Bostic,NO 28018
828.247.1773
WELL CONSTRUCTION RECORD WEU.CONTRACTOR: - --
WELL CONTRACTOR CERTIFICATION/: a 135
STATE WELL CONSTRUCTION PHRMiT#:
1. WILL UEE�aa1 MMkow a**Rdu1da 0E
od mmi*w 13 k"mw❑ Aodcomi❑ MowtmN❑
ftm�u Ned"Water In w0m p Olw p II Orror.uri u,.:
2. WELL LOCATION:(Show A"a1 ft beaS011 bebsq NNreNTernc �ii i r /5i&Qag>,n Couisy:-�f'n
.1 /�f:Foss✓
dhgq�a,p�e`m��Mi�b er iiAdMMOnand Lal Ns.) DRILLING LOG �DSPTH _
3. OWNERL;�J �S�r..t� �J LL �-rL. Fqm Ta Pom�San 0■�mMa+
Addtm
Gf/�G ISSN d I• C T ,
CyarTaea Mda apooda
♦. OATE diELLkb "--""—
S. TOTALOEPTN COUECTIMY��sp
S. OM V CUTTINML R ewlntr�wsL v v p Drop'
S STATIOWATERLEMOdmTopWCa.iy: 4,-.2 FT.
E. TOP OF CASWG L9 1 FT.Above Land Sudaoe` Y,
o �-
STOP dwe Meiwad aver kdaw lwd awsmisedwa■ead"Wimaaaor. `
saneewMl nAnollaus
to.ys"WmK =MUNOOOF TEST A I r
11.WATER ZONES(de ". b2 ,2
IL CILORINATM Type�l' ` E r A1IaaN S Wm"tMos h mWW use NO of brm
13.CASINO: 3a 1 ••�••��
SK
WAmew awwm wrTl+asaa MON phowdrisimbowladlsarl -ftm�sw
FMM knT0�70�2 1 FL.9 1114'_ . J.I fit= Rosds.arolMmePrtls�a>CeF I ..
Fmn To FL
From To_..FL
It.GROUT:
From b� p_To FL So hCI Ali i A hteT t
From To FL
15. 8CREEN: 7J`
From TG—FI— kL ____,kL
From Ta FL_ kL —in.
Fran To FL_ kL
IL&V4010RAYELPACK:
Oeplb ske Mab11M
From To FL�
From _... To FL�
17. REMARI(S:
IW"SRESYCBMFYYMTnUWELLWASCONSTA OMDIACCORDMIC WRHISA M C100-VAU
CONF RUC M STANDAM&ANDTNAT ACOPY OF TIES RECORD NAS SEEN PROVWEO TOTIE VML OMW
FOR O"ICE USEONLY r lL Z-f-4« Q
owaa S10NAtIIREOFFI'RSONOOIgI1N16T1N0I11EWELL o.zc
«�...�._ and Wipalemm"dwsw ooft el daftsmasWIN701ays
I1MrINe.

311197
North cereena.Mpwrnm of EnrGan,mn!srd Nahwd Raaoue•a•tNuHhm of Water QuaFy•Orow+dwNar Section
1070 MO aW40 Caner-Ral 4N N.C.2TaOFMVkFlmm(Oil)M-3421 p�.�A&F WELL DR LI.ING
WELL CONSTRUCTION RECORD WELL CONTRACTOR: )'JW �C
WELL CONTRACTOR CERTIFICATION O: �An+a ;1`7
STATE WELL CONSTRUCTION PERMIM @;' (2 -2471Z7.3
I.-
WELL USElp"ApNN.w Reap Raddor Md L3 Munkipst E Industrial❑ AyrleuAUral❑ Monitodng 0
Aecowry❑ Host Pump Water In)eelbn ❑ DOW[] It tmar.Ust Use:
2. WELL LOCATION:(ti�w sksah of the Mxrolan below) C _
Now"Tom �/Knet !V,!= , C
pleas Rain.rld�llu�M•rsdmnril/i�rr&*&A en.ntlLaNQ DRILLING LOG � QrPTH
a. OWNER �'P!_a —�Z� /����Sr a From TO FomisSOn Pmc*vm
AddtgO Q•/rs' /1 "[ iEl.l,,.1. /.1 d'
a4wToan sop 2ACada
4. DATE DRILLED ` QS
5. TOTAL DEPTH
S. CUT PINGS COLLECTED YES NO[]L'
7. DOES WELL REPLACE EXISTING WELL? YES 0 N00' R0
S. STATIC WATER LEVEL Seloer Top of CaeMg /f� FT.
it Was+'I Above Too @ICa" �
S. TOP OF CASM IS� _ FT.Abm Land Surface'
'M1F K•aahq h..An•1d offer 6d w Wd earloaa ro tt"s a rerNnw In aeoor- �
dailao N101 teA NOAC lC.Otlt
10. YIELD(ppr* METHOD OF TEST
11.WATERZ (dem:- -.K7--] cn
1 z. CMDAINATION: Type 2"' - % t t Anmrd s addkbW silos Is meded Ise batk or trim s
13. CASINO:
SKETCHLOCATION
WMTNWrM
Depth DU1mw or WMomin Material (Show dkeeft end dwfarme Mom e1 au:um 9u4
FMM T02,:.�Fl j� -- ,oaLLLL Roods.or oftr mmfOen) A P0110)
From To FL
From To Ft
It.GROUT:
Depth MafMW Memod
FFmm To ran To �� `
15. SCREEN:
049% DMatrater Slot shif Material ;
From —To—Ft— In. ML
From To FL_ In. —in }
I;MM _To FL_ In. _in
16. SANMRAVEL PACK: !Cr t k
Doplh Stan Material 1_
From TO Ft, .;/'
From To FL
17. REMARKS _-
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C.W1ELL
CONSTl UMM STANDARDS,AND THAT ACM OF INS RECORD K43 BEEN PPXMVEO TOM WELL ON"EF;.
FOR OFFICE USE ONLY
09MNa: i10NATMOF PERM COMSIRUC1H0v"IW LL
811MA eAdnll a OMalen etwew OuelMl:0ro1F1davar tlaap11eW1N 70 Gteys -;
Serial Na. SN•1 P�1:-1•`•T1

3 � A&F WELL DRILLING
NonnCare " W E Y AND PUMP SBERVIICE,INC.
an w�freesnsM and Nekrd Rtsaw"-OMskm e1 Wow Owr Omundwater SrCW Y
YAea; part ntWi ^K.C.47aN-ts76-p6oer(219)rM.Ml Bostic, NC 280 i8
CaMw 828•247-1773
WELL CONSTRUCTION RECORD WELLCONTRACTOR: -- -
WELL CONTRACTOR CERTIFICATION#: c2I- S4 _
Er
WELL CONSTRUCTION PERMIT#: _
I- WILL tiBE,?,j aw Appk toil:ResldsnW E,/MuntdPal[) InduStriai[] gyrkullural❑ MOn 10 ft❑
A"Ov"U Me01 Pump Water Iria lion ❑ Ogwr It OM1K.ul't Use:
2- WELL LOCATNXI:(Sipe akak.M►of RM WSWn baiowl
/yAf�iv'S
#astlllenwens%wreus.Orweadti.watkawwen mw Latex) DRILLING LOG DEPTH
s. OWNER rv;ee&A�44.!/gi�p,��;t7 c�,..� Fran To PomasnOe+c?w-t+
Adareae , iti-7! A? 5- 1
agwTeww amp ZIP Cede —
4. DATE Dt41LLED'K-2�;.
5. TOTAL DEPTH
S. CU171NGSCOLLECTED YESO NOM
7, DOES WELL RIPLACE tOUSnNQ WELL? YES❑ 140[5
•. STATIC WATER LEVEL 8alme Top of Cask,.- -
,,&2_FT `n
9. TOP OF CASH 13 I'to I1 FT.Mow Land Surtmew
wreP artsslne%"Wno%d a/w boww lend sedsa feqwm•ssrN"0e M _e
dsett wft ISA NCAC 80.01to scaon
10- YIELD(YPm): METHOD OF Te6r r` W
11. WATER ZONES(dap".-_ -n 2--4: ' o i
12- CHLOFMATiON: Type Anount a MMK%mw apace Is ne""use back of Pow
13.CASING: /
MAUM c/cgM
Dap!�'SC�I Womw orw*w . moo" {SMw recfknrfddalamYlrompMutnoslW
From TOs[� FL I s�� YG RoWs.wahx raarelannupo !
From Te FL
Flasn To FL
14. GROUT, fr
Fro n To_ii j_FL<�a M nc M,hire( !id
FC To FL j ((G�
15. SCREEN-
1 1
Depth Dwrnmler Sbt Ski Mate" r 1
Fmm TO.FI in. '...r_kt �•
Fmm To FL_ kL _in,
From To_..FL_ Im —in
19. SANDItiRAVELPACK:
0" Size Matedal
From To FL From To FL -
17. REMARKS:
I '
100HEREBYCERTIFYTHATINSWELLWASCONSTRUCTEDINA012MANCEW ITHISA NCACYC.v/ELL
CONSTAtJC"STANDARDS,ANDTHAT ACOPY OF THIS RECORD HAS SEEN PROVIDED TOTHE WELL ONSER, -
A
FOR OFFICE USE Ot11.Y clams 2Aaj4
OaadRc a10NAitIREOFFfcRSCHCOnSTAUC11Na1N�iv/ELL tM:E
..-- Submt4 WOW is00mylWaI QW41.Ww4ftPeon'FAtiIin70days
asaeitla. 6wht+ Y.12TI -

I Dll
Hants coteen..a 1 J
parrnant q ECM atd N■tutel Reaou¢ae•Walan et We1er O�aety•Gmundwatat Sectingt DR
ND PU WELL/aaa AW a«TIe.Cetttw-Ra1Nah N.C.II>iw/a3bPfwne(0191733.322i ILLING
911 MP SERVICE,1
WELL CONSTRUCTION RECORD WELL CONTRACTOR: "`) - F t; $ y °4 - C-
WELL CONTRACTOR CERTIFICATION a: 4: J , c828-247-17��
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE AppeafN MaJ:RaaldoMal0'"-iunklpal❑ Industrial[] AWICUllaral 13 MONIO V❑
wry Heat Pump Water 11460011 ❑ Oatar❑ It OEtar.Uri Use:
2. WELL LOCATION:(Show skalt:h of qte locallon be"
Nee■eNTotwl: /,Ll�s't/..i:�.� Caway;�'r/% E������
r-
PI■aa Nitta sod Qat mom.x end L■t wo.) DRILLING LOG DEPTH
,- OWNER f .t-0 /7�ivs o g6 F"m To FcwAjo 1 De■■tlpaw
Ad""
i `�lSiiirai1 -'
fterfem law- ZIP
,. OATEOii0.LE0 -,2 ` `',
5. TOTAL DEPTH r
<-s
S. CUTTMKiS COLLECTED YES E) NOc],—
7. DOES WELL REPLACE EXISTING WELL? YES❑ NOO—
S. STATIC WATER LEVEL Selow Top of Casktp'a:5-2-=Fr. _
IOae�•eMawTaFNCeaetN gc <
S. TOP OF CASM IS�y Fr.Above Land SurtacM
'rep of saatae 1etwompld over below ktd owl"o retptbee a vmkna In■aaw- - c
dame Took"A"CAC eC 1Is '�•
10. YIELD(opn* MOKOO OF TEST 4 —con
11.WATER ZONES(dappl):- h
12. CHLORIHATION: Typo ` Amount a addklorol apace In naodW use bad N krm
13. CASINO: 3 2 ;
wa lrAdnna LOCATION SKETCH
apth Mower or 1fifign 1. MtNdal (Show forecum wd crotame km at Nu:too Slaty
To FLU= r�Qc=� Roadsyw Nhar rAp rNrifMA poled)
Fromm To
Flom To Ft—
lit. GROUT: /fir 1 v
Depth Mate" meltwd n3
From 110;12' FL_ c,W.1a.
From To FL
15. SCREEN:
Depot Olrttater Slot Ski Material
From To Ft _ in. ._._...In
from To FL_ In. _In.
From To FL_ kL _in.
15. 8ANOR3RAVEL PACK:
aPw $&a Mate" � /f �� < f _ t;•r�
From To—FL
From To FL
s _ !
171. REMARKS:
i
IDOHERESY CERTIFY THAT THS WELL WAS CONSTRUCTED INACC/ORDANCEWRHISA H=2C.WELL
C"11INCTION STANDARDS.AND THAT A COPY OF THIS RECORD WS SEEN Itnom*TO THE WELL On\ER
FOR OFFICEU8@ONLY
OwINs: tgONAT1IREOF PER"CONSTRUCTION ImittWELL %t
..�..�� &Ana Wow10OMdena wow DO .GaFdmetubg*i%iY wcorys
Waal tee. Ya.r:PEY,'l:n -_=--=--

rrom:be=Uam I o:blephenie Wilson Date:5/9/2005 Time:4:57:12 PM ( , /\ Page 6 of 8
WELL CONSTRUCTION RECORD 31120
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 RUTHERFORD ❑Ridge ❑ Slope ❑ Valley ® Flat
815 NOLANDS WAY Latitude/Longitude of well location
(Street Name,Numbers,Community,Subdivision,LotNo,.Zip Code) 35.29A49/82,06.106
3.OWNER HORTON HOME OF RUTHERFORDTON (degrees/minutes/seconds)
ADDRESS 342 HW Y 74 BYPASS Latitude/longitude source:®GPS❑Topographic map
(Strcnorxoutc No.) DEPTH DRILLING LOG
RUPHERFORDTON NC 28139 From To Formation Description
City or Town State Zip Code 0 35 Clay
828-287-3366 35 200 Consolidated Rock
Area Code-Phone Number
4.DATE DRILLED 4/19/05
5.TOTAL DEPTH 200
7�
6.DOES WELL REPLACE EXISTING WELLY YES ❑ NO
7.STATIC WATER LEVEL Below Top of Casing: 55 Er. L,]
(Ora"+^1fAbovc Top of Caring)
1
8. TOP OF CASING IS 2 Ff.Above Land Surface-
'Top ofcasing termvmed aNw blow land swhce regiirw a variance in
accords c wid,15A NCAC 2C.0118
4
9. YIELD(gpm): 5 METHOD OF TEST ARDM
10.WATER ZONES(depth): 125
11.DISINFECTION:TYPE HYPOCHLORITE Amount 7 0= LOCATION SKETCH
12,CASING: wall Thickness Show direction and distance in miles from at least
Depth Diameter or Weight/FL Material two State Roads or County Roads.Include the road
From 0 7o 43 FL 6 1/4" SDR 21 PVC numbers and common road names.
13.GROUT: _-
—i
Depth Material Method
From 0 To 20 Ft GRAVEL MIX GRAVITY I
14.SCREEN .l
i
Depth Diameter Slot Size Material '1
From NA To FL in. in 'I
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.
5/1/05
SIGNATURE OF PERSON CONSTRUCTING THE WELL Dale
GW-]REV.07120011
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days.

rein.acoa Dann to:�stepnenie Wilson Date:5/9/2005 Time:4:57:12 PM Page 5 of
3112 0 4
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment,and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) SCOTT GANTT CERTIFICATION#2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS INC PHONE#[phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(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 RUTHERFORD ❑ Ridge ❑ Slope ❑ Valley ® Flat
LOT 34 SWEET BRIAR FARMS Latitude/Longitude of well location
(Street Name,Numbers,Cormmlruty,Subdivision,Lot No,.Zip Code) 35.28.781/82.0T073
3.OWNER MICHAEL SKINNER (degrees/minutes/seconds)
ADDRESS 1644 CORE RD Latitude/longitude source:®GPS❑Topographic map
(Stred or Route No.) DEPTH DRILLING LOG
RUTHERFORDTON NC 28139 From To Formation Description
City or Town State Zip Code p
ss clay
828-289-6363 85 200 Consolidated Rock
Area Code-Phone Number
4.DATE DRILLED 4/16/05
5.TOTAL DEPTH 200 r
C
6.DOES WELL REPLACE EXISTING WELL? YES ❑ NO ® ,s
7.STATIC WATER LEVEL Below Top of Casing: 90 FT.
Nsc-+^IfAbove Top of Casing)
a0
8. TOP OF CASING IS 2 FT.Above Land Surface-
*TV
'Top of cesmg krminakd at/orbelow lad avface mquises a vasia,oe in
aceordaae with 15A NCAC 2C 0118
9. YIELD(gpm): 8 MEIHOD OF TEST ARDM �*o1
la.WATER ZONES(depth): 190
il.DISINFECTION:TYPE HYPOCHLORITE Amount 6 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 90 Ft 6 1/4" SDR 21 PVC numbers and common road names. -
13.GROUT: �- --
Depth Material Method `•.-_. -,,—.. '
From 0 To 20 IT GRAVEL MIX GRAVITY - -
14.SCREEN - -
Depth Diameter Slot Size Material
From NA To Ft in. in
15.SAND/GRAVEL PACR: -
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.
5/1/05
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.

WELL CTION RECORD
310705 CONSTRU
North Carolina-DgmchomtofEnva and atmatRaoorc Division of WaterQoaidy-Gaoondw�r��9Q3
WELL CUNTaiACrOtt(II'IDIYIDUAIa NAa't� 2�2. t15 CERTIFICATION
W6I.L COMIEACt'ORCRmlANYNAmE Y:1 ViqokraoNs: 3 aac�-
a'rATSWSLLc0rwTxVCrWHIM llmC3 TSDWQPIt— Ta
d spolicablel rf
1. WELL USE(Cha kApphcable Bask Residential Mm icipaUPublic 0 IndasbW 0 AV icubmal❑
Momtormg 0 Recovery 0I/'' .�Ho�ot Pump WaterhVeectim 0p Othw 0 If Odm Listthe-
Z WELL> OCXoven setting
' E tuec- Comity L. l� tom.. � t
e S dlmk is� �Y
bwO
(SneCNsw Dyj m.Cmomk.Sdaddm.idNe.,LP Code) - L>bladd1m0Ide of weU laatim
3. o �(i � 9e.�- � r5 ( )
Address +fit f Latimde/la samce;OGPSQrepogtaphic map
(clumicWC, ag�q� DEPTHR�ILLWGLOG
City arTema Sur zipcade From To FasmalionDcautdoa
Areaeode-PIooea®ba al OGj �
4. DATE DRIU BD
5. TOTAL DEPTHti
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVELBdow Top ofCasir da O FT. n
(Ihe%4 VAbme TcporCn" �-
S. TOP OF CASING IS i FT.Above Land Surface*
'Top ofemlw teradaatal ethr blow lad arfire requins a
tMrrs f r5A NCAC 2C MIL t
9. YIELD(gpm): M D OFT T� r
10.WATERZONES(depth): �SbBr ��:L�—
LOCATION SKETCH
11. DISINFEMON:Type 'lam Am ud Show direction said distance in mfl a fi m at Ices[
12. CASING: Wall Tbir>a m two Slate Roads or County Rands.Isclode the road
Dismeoer orweightlFt Mammal a and cammam mad mores.
FronL_o To Ft
Fmm=To Ft 7 /
From_To Ft /1 p
13. GROUT: Depth M�eaat t �' C r
From To FtQanCYe c
Fraini__TO Ft
14. SCREEN: Depth Dismeler Slot Sim Mem®al
From_To Ft----iiL in.
FmnL_To Ft-----it im
15. SAND/GRAVELPACK
Depth Sin Material
From To Ft r
FrotIL _To Ft
16. REMARKS-
I DO HEREBY CERlIFYTBA WELL WAS CONmXucrFD IN ACCORDANCE WITH 15ANCAC 2C,WELL
CO ST ANDTBATACOPYOFTHISRECORDHASBEENPROVMMTOTHBWEMOWNER
S[Cd1A1VRE�PERSON CONSTRUc,nNGMIBWELL JDA7B
Smbmit the to the Dividen of water Quality,Gro®dwater Secben,106 Mail Service Ceder-RdeW NC
27699-Itt"i.6 Pbom No.p�M T&I-MI,within 3O days. GW-j REV-"i*1

0,
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 PTPTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH Topographic/Land setting
SPRING HH.L DR ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:WANDA DAVIS Latitudc/longitude of well location
Address SPRING HILL DR
(Street or Route No.) (degrees/minutes/seconds)
RUTHERFORDTON NC 28139 Latitude/Iongitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 28)—287-2376 DEPTH
Area Code Phone number From To
4.DATE DRILLED 04/04/05
5.TOTAL DEPTH: 605 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From TO
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use"V'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.0119. 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): HW.#108 W.FROM RUTHERFORDTON.RIGHT
ON PLEASANT HILL CH RD.LEFT ON PLEASANT
11.DISINFECTION:Type CHLORYTE Amount 16.5 HILL LOOP RD.LEFT ON SPRING HILL DR 6/10
12.CASING: Wall Thickness MILE ON LEFT.
Depth Diameter or Weight/Ft Material
From 0 To 120 Ft 64/4" SDR21 PVC
From_To_Ft
From To_Ft
T: _
13.GROU_Depth Material Method v
From 0 To 20 Ft.OUHMTE POURED —c
From_To_Ft.
Y
14.SCREEN: Depth Diameter Slot Size Material i
From To Ft._ in in. Oj E'
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

31 �: 4" 6
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 PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED PERMIT#
(if applicable) (if f 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: To luc/Land setting
Nearest Town: RUTHERFORDTON County RUTH Ridge ❑ Slope ❑Valle} ❑Flat
915 OLD STONECUTTER RD. _
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitu(check
appropriate
ppro ri of te ll location
3. OWNER:RICK COOPER
Address 915 STONECUTTER RD. (degrees/mmutes/seconds)
(Street or Route No.)
RUTHERFORDTON NC 28139 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
18J-287-0507 DEPTH
Area Code Phone number From To
4.DATE DRILLED 04/05/05
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 14/2 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): 15 METHOD OF TEST ARD number and common names
10.WATER ZONES (depth): BY-PASS 74 A E.FROM RUTHERFORDTON.
E3aT RT.ON OAKLAND RD.RT.ON POURS FORD
11.DISINFECTION:Type CHLORYTE Amount 4.5 RD.RT.ON OLD STONECUTTER RD.1/2 MILE ON
12. CASING: Wall Thickness RT.
Depth Diameter or Weight/Ft Material
From 0 To 120 Ft 6-1/4" SDR21 PVC
From_To_Ft
From To_Ft
T: _
13. GROU_Depth Material Method r
From 0 To 20 Ft.OUIKRETE POURED xr
From_To_Ft
14.SCREEN: Depth Diameter Slot Size Material
From_To_Ft._ in. _ in. w `
e
From_To_Ft._ in _ in p
15. SAND/GRAVEL PACK: u t
Depth Size Material I
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
SIGNATURE OF PERS N CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

31 , 487
WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)RODNEY ROBBINS CERTIFICATION# 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box): Residential ® MunicipaVPublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: UNION MlI LS County RUTH Topographic/Land setting
478 WIDD LAWING RD. ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER: TOM STOVER JR Latitude/longitude of well location
Address 478 WIDD LAWING RD
(degraes/
(Street or Route No.) I°lti°tes/sec°nds)
UNION MILLS NC 28167 Latitude/longitude source: ❑GPS ❑Topographic map
City or Town State Zip Code (check box)
8(�—429-7885 DEPTH
Area Code Phone number From To
4.DATE DRILLED 04/1V05
5.TOTAL DEPTH: 305 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 temmiated 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): 50 METHOD OF TEST ARD number and common names
10.WATER ZONES(depth): HWY.#221 N.FROM RUTHERFORDTON.GO
THROUGH GILKEY.RIGHT ON LAWING MILL
11.DISINFECTION:Type CHLORYTE Amount 7.5 RD.GO APPROX. 1/10 MILE.LEFT ON WIDD
12. CASING: Wall Thickness LAWING RD.DRIVE IS ON LEFT AT END OF
Depth Diameter or Weight/Ft. Material PAVEMENT.
From 0 To 80 Ft 6-1/4" SDR21 PVC
From_To_Ft
From To_Ft_ V
T:13.GROU Depth Material Method p
From 0 To 20 Ft.OUrKRETE POURED y
From_To Ft
14.SCREEN: Depth_ Diameter Slot Size Material W
From_To_Ft._ in in.
From_To_Ft._ in in. chit
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'>HIS 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

311486
WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)RODNEY ROBBINS CERTIFICATION# 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town: LAKE LURE County RUTH Topographic/Land setting
LAUREL LAKES ❑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 LAUREL LAKES
(Street or Route No.) (degreedminutes/seconds)
LAKE LURE NC 28746 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8( ZS)—4294239 DEPTH
Area Code Phone number From To
4.DATE DRILLED 04/12/05
5.TOTAL DEPTH: 285 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 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): 100 METHOD OF TEST ARD number and common names
10. WATER ZONES(depth): HWY.#64/74A W.FROM RUTHERFORDTON.
RIGHT ON RILL'S CREEK RD.LEFT AT LAUREL
11.DISINFECTION:Type CHLORYTE Amount 6.5 LAKE1 RIGH NAME UNKN T(RD„S. OWN)GO TO
12. CASING: Wall Thickness DEAD END.LOT IN CENTER OF CUL DE-SAC.
Depth Diameter or Weight/Ft Material
From 0 To 80 Ft 6-1/4" SDIL21 PVC
From_To_Ft
From To Ft y
13. GROU_Depth_ Mat_erial Method
From 0 To 20 Ft OUHCRETE POURED
From_To Ft
14.SCREEN: Depth Diameter Slot Size Material 1
From_To_Ft._ in. in. W
From_To_Ft._ in. in. O
15. SAND/GRAVEL PACK: 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
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

311434
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 ® Mtmicipal/Pnblic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town:FOREST CITY County RUTH Topographic/Land setting
204 S.OUAIL LANE ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:KEN WARREN Latitude/longitude of well location
Address 2014 S.OUAII LANE
(Street or Rome No.) (degrees/minutes/seconds)
FOREST CITY NC 28043 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 28)—289-9464 DEPTH
Area Code Phone number From To
4.DATE DRILLED 04/21/05
5.TOTAL DEPTH: 185 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 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 actor 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): 60 METHOD OF TEST ARD number and common names
10.WATER ZONES(depth): FROM FOREST CITY.LEFT AT BETHANY CH.
RD.AT KFC.LEFT ON DOGGETTE RD.RIGHT ON
11.DISINFECTION:Type CHLORYTE Amount 4.5 NORTH QUAIL RUN LEFT ON CHANDLER DR.
12. CASING: Wall Thickness RIGHT ON SOUTH QIJAH.LANE.2110 MILE ON
Depth Diameter or Weight/Ft. Material RIGHT.
From 0 To 70 Ft 6-1/4" SDR21 PVC
From To_Ft_
From To_Ft
T: _
13. GROU_Depth Material Method
From 0 To 20 Ft.OUIKRETE POURED i v
From To_Ft
14.SCREEN: Depth Diameter Slot Size Material _
From To_Ft._ in. in. w
From_To_F[._ in in. Ln
15. SAND/GRAVEL PACK: i
Depth Size Material -
i
From To_Ft_ -- -1
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

311482
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 RUTH TopographiaLand setting
BURT BLACKWELL P.D. ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:MARK HOLLHULD Latitude/longitude of well location
Address BURT BLACKWELL 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)—429-5555 DEPTH
Area Code Phone number From To
4.DATE DRILLED 04/2V05 _
5.TOTAL DEPTH: 245 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 60 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 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): 7 METHOD OF TEST ARD number and common names
10. WATER ZONES(depth): HWY.#9 N.FROM MILL SPRING.RIGHT ON
BURT BLACKWELL RD.AFTER THE PAVEMENT
11.DISINFECTION:Type CHLORYTE Amount 6 ENDS TAKE THE JsT LEFT AT FORK HOUSE IS AT
12.CASING: Wall Thickness DEAD END.
Depth Diameter or Weight/Ft Material
From 0 To 70 Ft 6-1/4" SDR21 PVC
From_To Ft_ 7 r
From To Ft._
13. GROUT:_Dep_th Material Method ce
From 0 To 20 Ft.OUHOlETE POURED i
From To_Ft. -` s
14.SCREEN: Depth Diameter Slot Size Material W
From_To_Ft._ in_ in. r
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 UCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL.OWNER
i
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Sectioa,1636 Matz Service Center—Raleigh,NC
27699-1636 Phone No. [phone],within 30days. GW-1 REV.07/2001

3111 " 0
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)RODNEY ROBBINS CERTIFICATION# 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#— ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use—
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH Topographic/Land setting
CONNER DR ❑Ridge ❑ Slope ❑valley ❑ Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER DON GREENE Latitude/longitude of well location
Address CONNER DR _
(Street or Route No.) (degrees(minutes/seconds)
RUTHERFORDTON NC 28139 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
(SZS)-286-1553 DEPTH
Area Code Phone number From To
4. DATE DRILLED 04/29/05
5.TOTAL DEPTH: 465 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'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): 10 METHOD OF TEST ARD number and common names
10. WATER ZONES(depth): HWY.#108 W.FROM RUTHERFORDTON.
11.DISINFECTION:Type CHLORYTE Amount 12 RIGHT ON PLEASANT HILL CH,.RD.LEFT ON
12. CASING: Wall Thickness PLEASANT HILL LOOP RD.LEFT ON CONNER
DR 1/10 MILE ON LEFT.
Depth Diameter or Weight/Ft Material
From 0 To 40 Ft 6-1/4" SDIL21 PVC
From_To_Ft
From To Ft
13. GROUT—: Depth Material Method
From 0 To 20 Ft OUHCRETE POURED
From_To_FL r3
W
14.SCREEN: Depth Diameter Slot Size Material ! 1 CD
_To_Ft._ in. in.
Lri
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
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTIN THE LL 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

31147 9
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) NEIL CRAFT CERTIFICATION# 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#— ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® MunicipaUPublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use—
2. WELL LOCATION:
Nearest Town: RUT fERFORDTON County RUTH TopographictLand setting
2840 JACK MCK"4MY RDJ ❑Ridge ❑ Slope ❑ Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER: RON PADGETT Latitude/longitude of well location
Address 2840 JACK MCKINNEY RD.
(Street or RouteNo.) (degreestramates/seconds)
RUTHERFORDTON NC 28139 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 28)-245-9418 DEPTH
Area Code Phone number From To
4. DATE DRILLED 04/07/05 _
5.TOTAL DEPTH: 325 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES® NO❑ From To
7. STATIC WATER LEVEL Below Top of Casing: 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 atlor below land surface requires a Show direction and distance m 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): HWY.#221 S.FROM RUTHERFORDTON.RIGHT
ON JACK MCKUVNEY RD.APPROX.1/2 MH..E ON
11.DISINFECTION:Type CHLORYTE Amount 8 RIGHT AFTER YOU PASS W.V.THOMPSON RD.
12. CASING: Wall Thickness (#2840 ON MAIL BOX)
Depth Diameter or Weight/Ft Material
From 0 To 100 Ft 6-1/4" SDR21 PVC
From_To—Ft
From To Ft. t
13.GROU_Depth_ Mat_erial Method a
r
From 0 To 20 Ft OUH{RETE POURED
From To_Ft "t
14.SCREEN: Depth Diameter Slot Size Material
W
From To_Ft._ in in. - - C
From_To_Ft.— irL in. Ira
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
SIGtfjkTURE OF PERSON CONSTRUCTING THE WELL DATE
Subask the original to the Division of Water Quality,Gro $er Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

311478
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) NE11L 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 ® MunicipaW&Iic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: LAKE LURE County RUTH Topographic/Land setting
JACKIE DR,JERICHO WOODS ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:DEBBIE DECOSTA Latitudellongitude of well location
Address JACKIE DR _
(Street or Route No.) (degrees/minutes/seconds)
LAKE LURE NC 28746 Latitude/longitade source: ❑GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 28)-287-7831 DEPTH
Area Code Phone number From To
4. DATE DRILLED 04/11/05
5.TOTAL DEPTH: 605 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES® NO❑ From To
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use`Y'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): 1 METHOD OF TEST ARD number and common names
10.WATER ZONES(depth): HWY.#64/74A W.FROM RUTHERFORDTON.
11.DISLNFECTION:Type CHLORYTE Amount 16.5 LEFT ON JERICHO LANE.STRAIGHT ON TYLER
TERRA .RIGHT ON JACKIE DR 1/10 MILE ON
12. CASING: Wall Thickness RIGHT.
Depth Diameter or Weight/Ft Material
From 0 To 95 Ft 6-1/4" SDR21 PVC
From_To_Ft.
From To _
13. GROU Dep_th Mat_erial Method
From 0 To 20 Ft.OUH BETE POURED
From_To_Ft 0
?3
14.SCREEN: Depth Diameter Slot Size Material
a
From—To—Ft.
To_Ft._ in. in.
From_To_FL_ in in.
15. SAND/GRAVEL PACK: w
Depth Size Material o
r
From_To_Ft._ ,i ILF1
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
SKMATURE 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

311476
WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) NEIL CRAFT CERTIFICATION# 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2, WELL LOCATION:
Nearest Town: LAKE LURE County RUTH Topographic/Land setting
HERMAN WILSON RD. ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:TEDDY MCDANIEL Latitude/longitude of well location
Address HERMAN WH SON PD.
(Street or Route No.) (degrees/minutestseconds)
LAKE LURE NC 28746 Latitude/longitude source: ❑GPS ❑Topographic map
City or Town State Zip Code (check box)
(828)—625-4701 DEPTH
Area Code Phone number From To
4.DATE DRILLED 04/19/05
5.TOTAL DEPTH: 605 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 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.#64/74A W. FROM RUTHERFORDTON.
RIGHT ON BILUS CREEK RD.LEFT ON BUFFALO
11.DISINFECTION:Type CHLORYTE Amount 16.5 CREEK RD.GO 1/4 MILE.RIGHT ON HERMAN
12.CASING: Wall Thickness WH,SON RD. LEFT AT FORK STRAIGHT AT END
Depth Diameter or Weight/Ft. Material OF PAVEMENT.ON DIRT GO 1110 MILE.LEFT
From 0 To 20 Ft.6-1/4" SDR21 PVC INTO GATE.
From To_Ft.
From To_Ft.
13. GROUT_: Depth Mat_erial Method j
From 0 To 20 Ft.OUEKRETE POURED S
From_To Ft. v
14.SCREEN: Depth_ Diameter Slot Size Material
From_To_Ft._ in. in. w
From_To_Ft._ in. in. 0
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
rp
o /
�rNAURE 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

311471
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:ELLENBORO County RUTH Topographic/Land setting
SALEM CHRUCH RD. ❑Ridge ❑ Slope ❑ Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER RICHARD GLOVER LatitudcAongitude of well location
Address SALEM CHURCH RD.
(Street or Route No.) (degrees/aunutestsecoods)
ELLENBORO NC 28040 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8�28)-429-3828 DEPTH
Area Code Phone number From To
4.DATE DRILLED 04/25/05 —
5.TOTAL DEPTH: 245 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 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): 150 METHOD OF TEST ARD number and common names
10.WATER ZONES(depth): HOLLIS RD.FROM ELLENBORO.LEFT ON
11.DISINFECTION:Type CHLORYTE Amount 6 SALEM CHURCH RD.1/2 MILE ON LEFT.
12.CASING: Wall Thicimess
Depth Diameter or Weight/Ft Material
From 0 To 95 Ft 6-1/4" SDR21 PVC
From—To—Ft— _
From To_Ft._
13. GROUT_: Depth Material Method
From 0 To 20 Ft.OUHCRETE POURED v
From To Ft. t
14.SCREEN: Depth Diameter Slot Size Material W
From To_Ft._ in. in. -1
From_To_Ft._ in. in. �
cn
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
SIGNATM 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 , 1
WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) NEIL CRAFT CERTIFICATION# 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town:LAKE LURE County RUTH Topographic/Land setting
GARDEN LANE ❑Ridge ❑ Slope ❑Valley ❑ Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER JOE WEBSTER Latitude/longitude of well location
Address GARDEN LANE
(Street or Route No.) (degrees/minutes/seconds)
LAKE LURE NC 28746 Latitudellongitude source: ❑GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 28)— 25-5244 DEPTH
Area Code Phone number From To
4.DATE DRILLED 04/28/05
5.TOTAL DEPTH: 605 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 200 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): 1 1/2 METHOD OF TEST ARD number and common names
10.WATER ZONES(depth): HWY.#9 N.FROM MILL SPRING.GO PAST THE
MARINA AT LAKE LURE.RIGHT ON BOYS CAMP
11.DISINFECTION:Type CHLORYTE Amount 16.5 RD.RIGHT ON GARDEN LANE. 3/10 MH.E ON
12.CASING: Wall Thickness RIGHT.
Depth Diameter or Weight/Ft Material
From 0 To 20 Ft 6-1/4" SDR21 PVC 4
From_To_Ft_
From To_Ft_
13. GROU_Depth Material Method -
From 0 To 20 R.OUHMETE POURED
From_To Ft c j
14.SCREEN: Depth Diameter Slot Size Material
From To_Ft._ in in. i �
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
�j)OF THIS RECORD HAS BEEN PROVIDED
`�TO THE WELL OWNER
S N F PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.0712001

3 1 , 40
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)
I. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ if Other,List Use
2. WELL LOCATION:
Nearest.Town:RUTHERFORDTON County RUTH Topographic/Land setting
HWY.#108 W. ❑Ridge ❑ Slope [-] Valley ❑Flat
(Street Name,Numbers,Community Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:BOB VAN BUSKIRK Latitudellongitude of well location
Address HWY.#108 W.
(Street or Route No.) (degrees/rmnotes/seconds)
RUTHERFORDTON NC 28139 Latitudellongitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
L8)—286-0038 DEPTH
Area Code Phone number From To
4. DATE DRILLED 04/0005
5.TOTAL DEPTH: 51 DRILLING LOG
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 31 FT.
(Use`°+,'if Above Top of Casing)
8.TOP OF CASING IS 1-112 FT. Above Land Surface* LOCATION SKETCH
*Top of casing tenanted 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): 20 METHOD OF TEST STEEL TAPE number and common names
10.WATER ZONES(depth): FROM RUTHERFORDTON.GO DOWN
HWY.#108 W.APPROX.1/2 MILE ON LEFT AFTER
11.DISINFECTION:Type CHLORYTE Amount 9.2 YOU CROSS BROAD RIVER
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 51 Ft 24" CEMENT
From_To_Ft._ t
From_To_Ft_ I - 4
13.GROUT: Depth Material Method ! y�
From 0 To 20 Ft.CEMENT POURED
From_To Ft
14.SCREEN: Depth_ Diameter Slot Size Material
CIO
From_To_Ft._ in. in. Ln r
From_To_Ft_ in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 31 To 51 Ft 78M GRAVEL j —
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 E 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.0712001

311468
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) ROBIN MCNEELY CERTIFICATION# 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#— ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use—
2. WELL LOCATION:
Nearest Town:RUTHERFORDTON County RUTH Topographic/Land setting
HWY.#108 W. ❑Ridge ❑ Slope ❑valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:BOB VAN BUSffiRK LatitudeAongitude of well location
Address HWY.#108 W.
(Street or Rome No.) (degrees/minutes/seconds)
RUTHERFORDTON NC 28139 Latitudellongitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8@ 8)-286-0038 DEPTH
Area Code Phone number From To
4.DATE DRILLED 04/04/05
5.TOTAL DEPTH: 51 DRILLING LOG
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 31 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): 20 METHOD OF TEST STEEL TAPE number and common names
10. WATER ZONES(depth): FROM RUTHERFORDTON.GO DOWN
HWY.#108 W.APPROX. 1/2 MULE ON LEFT AFTER
11.DISINFECTION:Type CHLORYTE Amount 9.2 YOU CROSS BROAD RIVER
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material A
From 0 To 51 Ft 24" CEMENT
From—To—Ft—
romToFt_ t_" . .a
_From_To_Ft_
13.GROUT: Depth Material Method
From 0 To 20 Ft.CEMENT POURED f A
From To Ft
14.SCREEN: Depth Diameter Slot Size Material IUl
From_To_Ft._ in. _ in. -
From_To_Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 31 To 51 Ft 78M
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 CORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PER7 CONSTMJCTING 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

312031
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural 1Resources-Division of Water Quality p
WELL CONTRACTOR(INDIVIDUAL)NAME
/I�print) Za9 y1'lP 5�I l_a yK ll CERTIFICATctION#
/
WELL CONTRACTOR COMPANY NAME- {�'(QS IA/E J V k Wl!I t c YI C PHONE # (9�ol gl J 3-�J�.2-z
STATE WELL CONSTRUCTION PERMIT# I- ASSOCIATED W Q PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential �'Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery O Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATI N• ty r� �p n Topographic/Landseceing
Ne/ar'�eist�Town: ' Coun i "�, ORidge ❑Slope OValley VP'lat
�\t0 MA k1t&_ 0 (check appropriate box)
(Street Name lumbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: (degrees/minutes/seconds)
Address Wn q&g I Latitude/longitude source:OGPSOTopographic map
a ' t eet or�R°�'w No.) (check box
-II i F_ JV C- '20 15 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
Area D Phone number, --
4. DATE DRILLED -
5. TOTAL DEPTH: •
6. DOES WELL REPLACE EXISTING WELL? YE NO (�
7. STATIC WATER LEVEL Below Top of Casing: FT. LAA3 d
(Use"+"if Above Top of Casing)
S. TOP OF CASING IS ` FT.Above Land Surface* N ,
-Top of casing terr thasted at/or below land surface requires a ,
variance in accordance with 15A NCAC 2C.011& LTN
9. YIELD(gpm): C1 METHOD OF TEST G).A
10.WATER ZONES(depth): 3 V
LOCATION SKETCH fy
11. DISINFECTION:Type Amount Show direction and distance in miles from at least eeaa44
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depc Di eter or (Weight/Ft. r 1 numbers and common road names.
From___
From To Ft.
From To Ft. - 1\• '�,
13. GROUT: Deptlkterial C� /'�
From To Ft.
From To Ft. �� O
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 - ---- -
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,Attn: Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004

� 12031
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACI'OR(INDIVIDUAL)NAME/{�print) '' n � CERTIFICAT # .�)3Y
WELL CONTRACTOR COMPANY NAME l,�t.fN,8S N.P ' V {ylp Q/tL PHONE # (g�pIO,N/A 75.3
STATE WELL CONSTRUCTION PERMIT# ASSO IATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential CVMunicipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery O Heat Pump Water Injection❑ Other 0 If Other,List Use
2. WELL LOCATI N: Topographic/Land setting
N�e'stT`ownp: AA,, County dge ❑Slope OValley OFlat
M AA!lA V0,k- t y (check appropriate box)
(Street Name Numbers,Comimunity(,�Subdivision,Lot No.,Zip Code) LatitudeAongitude of well location
3. OWNER: tt 1��� .1.— �V r Oki 'L (degmes/minutes/seconds)
Address 0 o X 1) LatitudeAongitude source:OGPSOTopographic map
k (Strcet or Royte No.) (check box)
C. LyZ N t �S� 6. DEPTH DRILLING LOG
City or Tom State Zip code From To Forman De 'p1]
�- $u (,
Area code-Phone number
4. DATE DRILLED
5. TOTAL DEPTH: T��,- •C
6. DOES WELL REPLACE EXISTING WELL? YES 0 NIV ❑
7. STATIC WATER LEVEL Below Top of Casing: ID T.
(Use"+"if Above Top of Casing) - U>
8. TOP OF CASING IS FT.Above Land Surface*
'Top of casing terminated attor below land surface requires a ell
variance in accords(4lce with 15A NCAC 2C.0115.
9. YIELD(gpm):_-: HOD OF TEST aA&
10.WATER ZONES(depth): S(e.S
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 DiatLeter or V igh(A't Mat ri 1 ` numbers and co mon road names.
From _To Ft. � d_
From To Ft.
From To Ft. --
13. GROUT: Depth Material Meth
From__To �Ft.I'1Cct'f Cervte nt- \G\itJ
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in, in. CUO
From To Ft. in. in. �,, n,
15. SAND/GRAVEL PACK: F WNW'
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 0 R
- 2,0 =K
SI(YATURE OF PEP SON 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
ji

3 12 0 x0
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality G
WELL CONTRACTOR(INDIVIDUAL)NAME {print) /ate M1' e5 . Caw CERTIFICATION#oZ .30
WELL CONTRACTOR COMPANY NAME A. 3 5 C'. $t - 0r PHONE #6ff
STATE WELL CONSTRUCTION PERMIT# ASSOCIATE WQ PERMrr#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residentially Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery O Heat Pump Water Injection❑ Other O If Other,List Use
2. WELL LOCAT N r �nq(� n 1 Topographic/Land setting
Nearest Town: ounty� ❑Ridge ❑Slope %21'alley OFlat
(check appropriate box)
(Street Name,Numbers,Community,,,SSubdivision,Lot No.,Zip Code) Latitudellongitude of well location
3. OWNER: P0,l 6 1AA' JlJ' (degrees/minutes/seconds)
Address P w e y�- V 2r Latitude/longitude source:OGPSOTopographic map
tree[lor o It I��( J� (check box)
dd DEPTH DRILLING LOG
City or Town State Zip Code From To l7na[ion escription
S-
Area code-Phone number -
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES O NO t(
7. STATIC WATER LEVEL Below Top of Casing: I-Il( T.
(Ilse"+"if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface* v
`Top ofcasing terminated aOr below land surface requires a t'9
variance in accordance with 15A NCAC 2C.0118. +'
9. YIELD(gpm):_1 (3 METHOD OF TEST
10.WATER ZONES(depth):— 200 LOCATION SKETCH
Un
11. DISINFECTION:Type VA X Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the Ion
Depth Diameter ei t/Ft. Material numbers and common road names.
FromS)_To_(pj Ft.-A4 E&
From TO Ft. `
From To Ft.
13. GROUT: Depth Material .} Method
From_To ) D_Ft. ol.Y�.3 -C e Yne r �la.vr _
From TO Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: p Q
Depth Size Material
From To Ft.—
From—To—Ft.
16. REMARKS: `d1�1 �JCI
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
i
Submit the original to the Division of Water Quality,Alto: Information Management,1617 Mail Service Center
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. -
GW-1 REV:"09/2004

WELL CONSTRUCTION RECORD 3 1 2 0 2 9
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVEDUAL)NAME (print)- O� n —f— CERTIFICATION#I13�'
WELL CONTRACTOR COMPANY NAME l)A YVt It,J �)I/L))'IA l / 11C PH ONE #egg
STATE WELL CONSTRUCTION PERMIT#. ASSOCIATEDT RMIT#
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 LOCAT Topographic/Land setting
Nearest Town: rl ,CountyLU Ridge []Slope ❑Valley ❑Flat
(check appropriate box)
(S at Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitudedongitude of well location
r
3. OWNER: ! Q, ,L de sours inutes/seSOT
Address 4 0 � Latitude/longitude source:❑GPS❑Topographic map
A''� q )
C Y1 1lIJR �)1 ) N C (check F/3 9 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
s RO r G la
Areacode-Phonenu b%,
4. DATE DRILLED
5. TOTAL DEPTH: k
6. DOES WELL REPLACE EXISTING WELL? Y U NO rP 1 ^
7. STATIC WATER LEVEL Below Top of Casing: FT.
1 (Use"+"if Above Top of Casing)
8. TOP OF CASING IS \ FT.Above Land Surface" p
"Top of casing terminated attor below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm):_ N METHOD OF TEST
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 rrDy Teter ocr Wne^igh,t/Ft to ' numbers and common road names.
From_To�6 Ft. &-�
From To Ft. OIt7
From To Ft.
13. GROUT: Depth Material l� ethod
From To A /' Ft.
From To Ft. ff
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: —�
Depth Size Material Ire""-
From To Ft.-
From—To—Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN CORDANCE WITH 15A NCAC 2C,WELL _
CONSTRUCTION STANDARDS, D THAT A COPY OF S RECO HAS BEEN PROVIDED TO THE WELL O R -
5- ,),a G.5'
SI ATURE OF PE ON CONSTRItTING 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

62
WELL CONSTRUCTION RECORD 3 12 0 8
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME/(g��nQ) IO, 13 E'5 /LIJ, cQ W/I�I)—�' CERTIFICATION k�l39
WELL CONTRACTOR COMPANY NAME rOL y✓(O S LL C'. �' �7 J�),( Yi'I(1 ( lI7! PHONE q
i
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITM
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential V Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCAT 0 : /'I'opographic/Land setting
NearestTown: �I County dge ❑Slope ❑Valley ❑Flat
�u% A 5 PA r fb K )--V— e/ (check appropriate box)
,(SGeet Name N be is,Cthionunity,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. C OWNresER: 0... y k r (degmes/minutes/seconds)
Adds A ri AZT/ Ar .t;CdLatitude/longitudesource:❑GPS❑Topographicmap
Strce or.Route No. (check box)
lA 13 DEPTH DRILLING LOG
City or Town State Zip Code From To F anon De ipfion
(� C) MI5
Area code-Phone num
4. DATE DRILLED
5. TOTAL DEPTH: S ��"�<Dss
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO A
7. STATIC WATER LEVEL Below Top of Casing: g�� FT. ^°3
(Use`V'if Above Top of Casing) -
8. TOP OF CASING IS FT.Above Land Surface• ="
*Top of casing terminated a r below land surface requires a 3>
variance in accord ce th 15A NCAC 2C.0118. _ U1 t�
9. YIELD(gpm) METHOD OF TEST CtkX '
10.WATER ZONES(depth): 1j
LOCATION SKETCH /r
11. DISINFECTION:Type Amount Show,direction and distance in miles from at least Q}'
12. CASING: Wall Thickness two State Roads or County Roads.Include the road �tll
Depth Di eter or Weight/Ft. ater' numbers and common road names.
From_To. Ft. (Z� `
From To Ft.
From To Ft.
13. GROUT: Depth Ma terial Metho
From To Ft. /Lea cc me4_ nailti
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material -
From TO Ft. in. in.
From To Ft. in. in. JJ
15. SAND/GRAVEL PACK:
Depth Size Material
From TO Ft.
From To Ft.
16. REMARKS:
LA
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN AC CE WrrH 15A NCAC 2 WELL
CONSTRUCTION STAND S,AND THAT A COP OF THIS RECO HAS BEEN PROVIDED TO THE LL
SIGNATU OF PERSON C STRUCTING THE WELL ATE P—0 5r
Submit the original to the Division of Water Quality,Attn: Information Management,1617 Service Center,''
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. —
GW-I REV:09/2004

WELL CONSTRUCTION RECORD 3 1 Q 1
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL) I NAME riot) v 5 W, C0. d CERTIFICATION# A f 3Fi
d
WELL CONTRACTOR COMPANY NAME �&I VI'I IIS E 1 AM4 O 1 , PHONE # e� 53— aj-
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 LOCAT N: Topographic/Land setting 3
Nearest wn: County Ridge ❑Slope OValley OFaM 'j
(check appropriate box) N `3
(Stneet4l4arne,Numbers,Conuoilinity,Subdivision,Lot No.,Zip Cade) Latitude/longitude of well location Cf� =<
3. OWNER: � (degrees/minutes/seconds)
Address 9- - Latitude/longitude source:DGPSOTopographic map,ryry
' ^ I(Street or Route No) (check
F y E_ '� C ��� DEPTH DRILLING LOG
City or Town State Zip Code From os oumation escription
Area acode-hon�ry
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YE Q NO l�
7. STATIC WATER LEVEL Below Top of Casing: U FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 35 FT.Above Land Surface* n"
*Top of casing terminated attor below land surface requires a jV----
variance in accordan a with 15A NCAC 2C.011&
9. YIELD(gpm):_ MET OD OF TEST CW,
10.WATER ZONES(depth): bo
LOCATION SKETC
11. DISINFECTION:Type Amount Show direction and distance in miles om at least
12. CASING: Wall Thickness two Stale Roads or County Roads.Incl de the road
Depth Die o et `t. en numbers and common road names.
From To��Ft. _
From To Ft.
From To Ft.
13. GROUT: DepdhMaterial Method
From_To Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material �V 1
From To Ft.
From To Ft. W
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STAND S,AND THAT A QgPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�C�O_.�s
SIGNAT OF PERSO CONSTRUCTING THE WELL DATE
Submit the original to the Division o at
Quality,Attn: Information Management,1617 Mail Service CTIter:-, -
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2001.
ry
O
c
cap
� i

312026
WELL CONSTRUCTION RECORD
North Carolina Department of Environmentand Natural Resources-Division of Water Quality-.
WELL CONTRACTOR(INDIVIDUAL)NAME mint) - lC 5 LA)• a CERTIFICATION# oZ)37
WELL CONTRACTOR COMPANY NAME 0. 5 e 1 PHONE # P(ca�) 53'
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMrr# - --:,
(if applicable) (if applicable) _
1. WELL USE(Check Applicable Box):Residential&YMunicipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other O If Other,List Use —
I
2. WELL LOCATION: ,� Topographic/Land setting
Neare own: J County��� �idge ❑Slope ❑Valley Offal:
- :[ho ` (check appropriate box) .
(StreaNName,Numbers,Con nurn S Lot NO.,Zip Code) LatltudeAongitude of well location < �
3. OWNER: (degrees/minutes/seconds)
Address O Latitude/longitude source:❑GPSOTopographic map - -
''� I lY ( trmt or Ro No.) , (check box)
TI Y CJY A ! ' ri. A� . . D 5�-1 t` 1, DEPTH DRILLING LOG
( City or Town State Zip Code ! �10�1Ss' From TO ormati De ript
Area code-Phone num O
4. DATE DRILLED �`yt
6. DOES WELL REPLACE EXISTING WELL? YES NO lb 4
7. STATIC WATER LEVEL Below Top of Casing: 4 U FT. - y
(Use"+"if Above Top of Casing) -..
8. TOP OF CASING IS FT.Above Land Surface' rn
-Top of casing tenoinated at/or below land surface requires a
variance in accor ec with 15A NCAC 2C.0118. '
9. YIELD(gpm): MET,{{��OD OF TEST C�Ate. r y
10.WATER ZONES(depth): l VIJ
LOCATIONS
11. DISINFECTION:Type Amount Show direction and distance n miles from at least
12. CASING: Wall Thickness two State Roads or County oads.Include the road
De Di eter o t t. Material numbers and common roa ames.
From 0 To Ft. �1
From To Ft.
From To Ft.
13. GROUT: Depth) atenal
From_ To�Ft.
From To Ft. [
Diameter Slot Size Material 14. SCREEN: Depth
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 COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
b- DS
SIGNf URE OF PER ON CONSTRUCTING THE WELL DATE
Submit the original to the Division Water Quality,Attn: Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD C 31 2
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME/,�,(print) e 5 WcL . 04 tK -�^ CERTIFICATION##-- ))318
WELL CONTRACTOR COMPANY NAME /_/W p k L f� 1 - Ef iYl11 L..,O, . TgcG PHONE 0 60 5 3-�.bZi2_=
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED
(if applicable) (if applicable) _-
1. WELL USE(Check Applicable Box):Residential tl^Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery O Heat Pump Water Injection❑ Other❑ If Other,List Use '
ram'
2. WELL LOCA 10 -
Topographic/Land setting I '^i
Nest CounTyZ IRMSe ❑Slope OValley OFiat_ � _
(check appropriate box)
(Street Name,Numbers,Community-$l bd,vi=i^^,Lot No.,Zip Code) Latitude/longitude of well location.
3. OWNER: 1 L"�~ (degrees/minutes/seconds)
Address P Ifn V1 Latitude/longitude source:OGPSOTopographic map -`" J1
(;SMt or Rou No.) y- (check box) `
e C✓ DEPTH DRILLING LOG
City or Town Zip Code From o rmatio es 'pti
G9.3- gY76 r, o
Area Bode-Phone number
4. DATE DRILLED s ' d(� � - oca
�
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 l Q
7. STATIC WATER LEVEL Below Top of Casing: FT. v
(Use"+"if Above Top o Casing)
8. TOP OF CASING IS FT.Above Land Surface*
-Top of casing terminated ado below land surface requires a Q�
variance in accordance with ISA NCAC 2C.0118. �'
9. YIELD(gpm):I ME�qT�eH�OD OF TEST Ct.-& Ln
10.WATER ZONES(depth): ;L.Jb 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
Dep Diameter orr�Wee' ht/Ft. at I numbers and common road names.
FromS�To t�Ft. (Q L air
From To Ft.
From To Ft.
13. GROUT: DeptlA - rJviateri� n thod
Fromom To u(,() Ft.
From To Ft. n
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Fte 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 ACCORDANC WITH 15A NCAC 2C,WELL
CONSTRUCTION ST NDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN ROVIDED TO THE WELL OWNER
o —D
SIGNAVRE OF PERSON PONSTRUCTING 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

308489
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 ® MunicipaUPublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: FOREST CITY County RUTH Topographic/Land setting
3590 WHErESIDE RD. ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER: CHARLIE BROOKS,SR Latitudellongitude of well location
Address 3590 WHITESIDE RD.
(Street or Route No.) (degrees/mmutes/seconds)
FOREST CITY NC 28139 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 28)-429-3976 DEPTH
Area Code Phone number From To
4.DATE DRILLED 02/23/05
5.TOTAL DEPTH: 66 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 51 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 Fr. 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): 15 METHOD OF TEST STEEL TAPE number and common names
10. WATER ZONES(depth): BUS.74 E. FROM FOREST CITY.LEFT ON
BOSTIC/SUNSHINE RD.LEFT ON PEA RIDGE RD.
It.DISINFECTION:Type CHLORYTE Amount 6.9 IN BOSTIC.LEFT ON WBTnSIDE RD.APPROX.
12. CASING: Wall Thickness 3/4 MILE ON LEFT.
Depth Diameter or Weight/Ft Material
From 0 To 66 Ft. 24" CEMENT
From_To_Ft_
From To Ft._ _
13. GROUT:-Depth— Material Method n
From 0 To 20 Ft.CEMENT POURED
From To_Ft
14.SCREEN: Depth Diameter Slot Size Material _ S
From_To_Ft._ in. in.
From To_FL_ is in.
15. SAND/GRAVEL PACK: r> O
cn
Depth Size Material
From 51 To 66 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
1
SIGNATURA OF PE ,,911 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

� 308499
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) NE11L CRAFT CERTIFICATION# 3114
WELL CONTRACTOR COMPANY NAME PTTTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Mumcipa"lic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH Topographic/Land setting
COUNCIL POINT ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:TOM STOVER Latitudellongitude of well location
Address COUNCIL POINT
(Street or Route No.) (degrees/minutes/seconds)
RUTHERFORDTON NC 28139 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 28)-429-9174 DEPTH
Area Code Phone number From To
4.DATE DRILLED 02/17/05
5.TOTAL DEPTH: 305 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface* 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): FROM RUTHERORDTON.GO DOWN HWY.
#108.RIGHT ON WILLOW LAKE DR RIGHT ON
11.DISINFECTION:Type CHLORYTE Amount 7.5 BAYBERRY DR LEFT ON OBSEVATION RIDGE.
12. CASING: Wall Thickness LEFT AT COUNCIL POINT.NEW HOUSE AT DEAD
Depth Diameter or Weight/Ft. Material END.
From 0 To 140 Ft 6-1/4" SDIL21 PVC
From_To_Ft.
From To Ft
13. GROUT_: Depth_ Mat_erial Method C7
From 0 To 20 Ft.QUIKRETE POURED A
From_To Ft.
14.SCREEN: Depth_ Diameter Slot Size Material
From_To_Ft._ in. in. C1�
From_To_Ft._ in. in. o #=
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 T COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
.._
14"—
SIGN4nNF,OrPERSON CONSTRUCTING LL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

J 30g49 '7
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) ROBIN MCNEELY CERTIFICATION# 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ®-Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH Topographic/Land setting
US HWY 64/74 W. ❑Ridge ❑ Slope ❑Valley ❑ Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:PAM ENSMINGER Latitude/longitude of well location
Address U.S.HWY.64/74 W.
(Street or Route No.) (degrees/minutes/seconds)
RUTHERFORDTON NC 28139 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
(8�-286-8736 DEPTH
Area Code Phone number From To
4.DATE DRILLED 02/07/05
5.TOTAL DEPTH: 57 DRILLING LOG
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 37 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface* 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): 20 METHOD OF TEST STEEL TAPE number and common names
10. WATER ZONES(depth): HWY.#64/74A W.FROM RUTHERFORDTON. 1sT
DRIVE ON RT.PAST GREEN HILL BAPTIST
11.DISINFECTION:Type CHLORYTE Amount 9.2 CHRUCH CEMETERY.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 57 Ft 24" CEMENT
From_To—Ft.—
From To_Ft
T: _
13. GROU_Depth Material Method
From 0 To 20 Ft.CEMENT POURED _
From ToEE _Ft.
14.SCRN: Depth Diameter Slot Size Material
From_To_Ft._ in. in.
From_To_Ft._ in in. Gn
15. SAND/GRAVEL PACK:
Depth Size Material
From 37 To 57 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
-� NQ iJ -
SIGNATURE OF PER ONS UCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

i
3p8 �96
WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) ROBIN MCNEELY CERTIFICATION# 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: FOREST CITY County RUTH Topographic/Land setting
SUNSET DR ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:SONNY BAILEY Latitude/longitude of well location
Address SUNSET DR
(Street or Route No.) (degrees/minutes/seconds)
FOREST CITY NC 28043 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 28)—245-0200 DEPTH
Area Code Phone number From To
4.DATE DRILLED 02/07/05 _
5.TOTAL DEPTH: 66 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 46 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 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 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.#74 W.RIGHT ON HWY.#221 N.LEFT ON
POORES FORD RD.RIGHT ON SUNSET DR DRIVE
11.DISINFECT'ION: Type CHLORYTE Amount 9.2 ON RIGHT AT DEAD END.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 66 Ft. 24" CEMENT
From_To_Ft_
From To_Ft.
T: _
13. GROU_Depth Material Method
From 0 To 20 Ft.CEMENT POURED vy
From To_Ft. ,
14.SCREEN: Depth Diameter Slot Size Material CA
From_To_Ft._ in. in. C3
From To_Ft._ in. in. Ln
15. SAND/GRAVEL PACK:
Depth Size Material
From 46 To 66 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 CTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
r (L
SIG ATURE O PERSON STRU G THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

308494
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 ® MunicipaVPublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: ELLENBORO County RUTH Topographic/Land setting
RIGHT PRONG RD. ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER: TROY DORSEY Latitude/longitude of well location
Address RIGHT PRONG RD. _
(Street or Route No.) (degrees/minutes/seconds)
ELLENBORO NC 28040 Latitude/longitudc source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 2D-287-4239 DEPTH
Area Code Phone number From To
4.DATE DRILLED 02/09*05 _
5.TOTAL DEPTH: 49 DRILLING LOG
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 29 FT. _
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1 1/2 FT. Above Land Surface* LOCATION SKETCH
*Top of casing teaninated 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): FROM ELLENBORO GO UP HOLLIS RD.RIGHT
11. DISINFECTION:Type CHLORYTE Amount 9.2 ON HOPEWELL RD.LEFT ON MT.OLIVETTE RD.
12.CASING: Wall Thickness RIGHT ON RIGHT PRONG RD. 1/2 MILE.NEW
DRIVE ON RIGHT.
Depth Diameter or Weight/Ft Material
From 0 To 49 Ft 24" CEMENT
From_To_Ft._
I
From_To_Ft
13.GROUT: Depth Material Method ut
From 0 To 20 Ft.CEMENT POURED S -
From_To Ft.
14.SCREEN: Depth Diameter Slot Size Material r
From To FL in. in. o
From_To_Ft._ in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 29 To 49 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
/ ^ SIGNATURE F PERS�i� ONSTR CTIN�THEL / DATE
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

30849
WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) ROBIN MCNEELY CERTIFICATION# 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH Topographic/Land setting
PETITE CT. ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER: RANDY TAVEVNIA Latitude/longitude of well location
Address PETITE CT.
(Street or Route No.) (degrees(minutes/seconds)
RUTHERFORDTON NC 28139 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8(�—248-2394 - DEPTH
Area Code Phone number From To
4.DATE DRILLED 02/10/05
5.TOTAL DEPTH: 64 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 44 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface* 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.#221 S. FROM RUTHERFORDTON.M
RIGHT ON JACK MCK NNEY RD.TURN RIGHT&
11.DISINFECTION:Type CHLORYTE Amount 9.2 GO OUT BY THE RACETRACK RIGHT W.V.
12. CASING: Wall Thickness THOMPSON RD.LEFT ON PETITE CT.APPROX.
Depth Diameter or Weight/Ft. Material 1/2 MILE ON LEFT.WHITE SINGLEWIDE BESIDE
From 0 To 64 Ft 24" CEMENT BLUE SCHOOL BUS.
From -To_Ft._ t
From_To_Ft_ j
13. GROUT: Depth Material Method Ez:
From 0 To 20 Ft.CEMENT POURED
From_To_Ft t
14.SCREEN: Depth Diameter Slot Size Material cp
From_To_Ft._ in. in. o
From To_Ft._ in. in. Cn
15. SAND/GRAVEL PACK:
Depth Size Material
From 44 To 64 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
SIGNATURE F PERSO� NSTRUCTTNG 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

308490
WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) ROBIN MCNEELY CERTIFICATION# 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH Topographic/Land setting
581 PEDMONT RD. ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:RICK ROBINSON Latitude/longitude of well location
Address 581 PEDMONT RD.
(Street or Route No.) (degrees/minutes/seconds)
RUTHERFORDTON NC 28139 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
U)—287-4723 DEPTH
Area Code Phone number From To
4.DATE DRILLED 02/16/05
5.TOTAL DEPTH: 50 DRILLING LOG
6. DOES WELL REPLACE EXISTING WELL? YES® NO❑ From To
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface; 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): FROM RUTHERFORDTON GO DOWN HWY.
#108.RIGHT ON PEDMONT RD. 2"o DRIVE ON
11.DISINFECTION:Type CHLORYTE Amount 9.2 LEFT.PAST NEW HOPE RD.
12.CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 50 Ft. 24" CEMENT
From_To Ft.
From_To_Ft.
13.GROUT: Depth Material Method y
From 0 To 20 Ft. CEMENT POURED r7
From To Ft.
14.SCREEN: Depth Diameter Slot Size MaterialFrom To_Ft._ is in. r, t
From To_Ft._ in. in. m
15. SAND/GRAVEL PACK: C3
Depth Size Material un 3
From 30 To 50 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 4&4" --2 - //- - /I �i'
�f
SIGNATURE OF,7SON 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 ® MunicipaUPublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: ELLENBORO County RUTH Topographic/Land setting
CRYSTAL CREEK LANE ❑ Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:WESTSIDE HOMES Latitude/longitude of well location
Address CRYSTAL CREEK LANE
(Street or Route No.) (degrees/minutes/seconds)
ELLENBORO NC 28040 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
7L04)—434-5100 DEPTH
Area Code Phone number From To
4. DATE DRILLED 02/17/05
5.TOTAL DEPTH: 43 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 25 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): 18 METHOD OF TEST STEEL TAPE number and common names
10.WATER ZONES(depth): FROM ELLENBORO GO DOWN
11.DISINFECTION:Tv
,pe CHLORYTE Amount 828 ELLENBORO/HENRIETTA RD.LEFT ON
MCCRAW RD.GO TO STOP SIGN.LEFT ON
12. CASING: Wall Thickness DOBBINSVILLE RD.RIGHT AGAIN ON MCCRAW
Depth Diameter or Weight/Ft Material RD.APPROX.3/10 MILE ON RIGHT.
From 0 To 43 Ft 24" CEMENT
From_To_Ft. 71
From To Ft.13. GROUT: —Material Method
From 0 To 20 Ft.CEMENT POURED :
From_To Ft
14.SCREEN: Depth Diameter Slot Size Material N
From_To_Ft._ in. in.
From_To_Ft._ in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 25 To 43 Ft 78M GRAVEL
From To Ft.
16.REMARKS:
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
SIGNATUREOF P CC TRUCTING THE WEI DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

I I V
Nefh C 6efdoeaCerlNr E MMM qd Nelurd Retouch.DMslon Of Wolof OuW1y.Groundwater Section 61 pp 7aea Reylplti N.O.Y10/F,17l4phone(afn 7 4221 c) U l7 3 4
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION F:
,_
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USB�a�Arolk"DO*Rosld@dd E,/mun,**I El immulu(] Agrriewturmi❑ M0,410 i V❑
hwomq U N081 PurfW WOW lNeeuw! ❑ Ovw p It OWm,u}t use:
z. WELL LOCATION.(Straw dtotch of as tMEM below)
Pk"Naate are learLate, of BAddekn end Let Ns) _DRILLING LAO DEPTH
S. OWNER ^)/ /llMff: t'
Addrogs nu - c From To Farrassr WeafMb+
F/ e
Heil,4 r� or
C1gaTom flat# NO 01019j^^+--
4. DATE DRILLED
S. TOTAL DDEMM "
6- CUTTINGS COLLECTED YESO NO
7. GOES WELL REPLACE iDlI8TIN0 WELL? YES o NOES-
6. STATN;WATERLEVELBdoerT o1
Op c"kW- ,IaEZ,_.FT.
WeawlAboveTepolcum
V. TOP OF CASING is / FT.Above LOW SUdWee
'rep of$going drfin@led ever blew low eels"rpebe a mkN on eeeoo-
deft@ Tom/fA NCAC sc Alt@ ..
M YIELD(glue); „ T M
11.WATER ZOM(dffp": ETHOD OF TEST
_ TROD
1 Z. CHLORINATION Type /mac Mpyfl tl eddiUaW epeg Y mW W we beck of lam
13. CASINO: yU f
wr tlede,.ee LOC&TTCIN..3KETCH
© Dapth Olen!@1er a WMWM Mom (Shaw dlredlon ow dotar"Item rd bag fag a"
Frere
To-�.FL l i` -_Ova' --1�3-c poetic.a Over pm reforms pool
Frain To Fl
From TO FL E R�
Ii. GROUT. rrc�2 /
From 7 TDO�FLJ"-Mrl ddL� /I thoO
From To FL V�� nm
15. SCREEN: mM
DOP61 Olretur StolSt:i MatOrGd 1 =o
Fran To Ft.....— In. mm
kl
From To FL__ In __b. a C-i=
Fran `� o-'
To FL_ b!. _.in. �
16. SAMINGRAVEL PACK: N =C
D" fto Malefic{ LA ML:�)
From To FL�
from To FL
17. REMARKS:
I DO HEREBY CERTWY THAT TINS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A MCAC 4C,Y/ELL
CONSTRUCTION STANDARDS.M 0 TMAT A COPY OF 7rS REC
ORD WAS SEEN FRMUEO 10 T1w WELL oA%ER_
E
OFFICEUSEOY6f }ItINATMOFI'ER}ONCONSTRIICTNn,11SVoM M'•E
-� O gdendwor011W1►t)roald.WrtOcpIYAINn7QGsy}ate. -- 6f.1/aY.!.`Tt

1L�1 A&F WELL DRILLING
'v cb J u cal VAND PUMP SERVICE,INC.
,.ere j D+Ow eNE^rfroroneMu+dNzkiratRwxw�ees_D +aWaNO
Msfauwq,Q/.WWWeterSocum 911 Hwy. Business 74
CCe�wN .w�+:N.am..+s36.rnw..n+rnraT-,YI Bostic, NC 28018
WELL CONSTRUCTION RECORD WELL CONTRACTOR: ,%f I, 828-247.1 ns
WELL CONTRACTOR CERTIFICATION 0. 1 _35
STATE WELL CONSTRUCTOR PERMIT!:
1. WILL USELLcmA A/MkeW jety peaMeMiaiff,mi*ow❑ Indumlal0 AgdCOUrai❑ Mardtodi 0
40com7u Meet Punp water k*cftn ❑ 0OW p K 01n..,Ust uee:
a WELL LOCATK k*.(snow @4W of the tocauonW0141
Neweel Torac�ll�n L s rc+ CQWW. AA r'Fn rrl
•• �r„�Zl+O a/A �
3. OWNER + �pe1e� r•w+�AsdManwdLatbl ORILUNGLOG DEPTH
' r Film To FaiwAMA Ona*gm
Adtd+rgt Lrsmn ram a ., �� —•
K Brn �+ 2SriiS%n
Dq wTaw, q jar
4. DATE DRILLED Qc�Z
S. TOTAL=PTH.z6z--
6. CUTTINGS tOLLEGTEb YES C3 NO
T. W63 WELL REPLACE EXI97M WELL? yFSp N0Q
6. STATIC WATER LEVEL 8ebw Top of Caft
6. TOP OF CASL4016 1'� FT.Ab LMW SUCws' =�
�L_.�_..._ FT.AOew feed Sunc�e•
'rwr me SWORN ewmwAftd WW tNMV k"ft d*"rNvenm a WNW w In nor- N I Asa Wee,sA+lcAc ec.n,e - - -
+D. YIELD(OPRO: -S METNOD OF TEST
11.WATER ZONES(dep": .3 -----
12. CNLORINATKNh Type TUu r A WXd jaAtlltloneiepmaMnesoedwMe;akmi
13.CASING:
L006M SSKETCH
0"0 M maw mWepan mom (Stew dreabn m6 dplame ftm oil bM Iw Stw
From±c PTO&&_FL I Q V4 " at _ VG Roede.er eo w poNtsl
From Te FL Q�
From To FL c�i1 2�
1s. GROUT: 3 mr^
m
th 0 m
Fran ",M To C' FL � �� co ov
From —TO FL ys z
1s. SCREEN: s -4�
DIM Diwneter Slat She MAW" 4^?
From Tam FI. In. JrL w coca
From To FL_ nL —In.
From To� FL._ k VL Q\ HoIO efc f
16. 84N=RAVEL PACK:
D"m Site Ma1aIe1
From To FL_
from To FL
1T. REMARKS:__ S e s z y
100 MERE6Y CMWY TNATTt6S WELL WASCONSTRUCTEO KI ACCORDANCE WtM ISA NCAC 2C.Y/EU,
CONSTRUCt"STANOAM&ANOTMAT A COPY OF RECORD NAj 6EEN PRMMO TO THE YrKjL D%NEF_
FOR OFFICE USE ONLY • u I �zw
O"d ft 6gNAT+InEa I IIsoNea+araucn►+a nls Witt axa
se�l+1.�►wrt>wranaw>vwoeRly6 le rw6r�nW"30e:rt
�+ro ��,.. OR,]MY.1271

1a7/ a61N ergeeaGrltsr ^R4^ .otM u.d N.had Maeuep
97EaFta3a.P s(919 Ghat¢e 0l WolofQVe -'3f*UWWel.r SKeon
RECORD
WELL CQNSTRUCTION I�azs1
WELL CONTRACTOR: t/ 307253
WELL CONTRACTOR CERTIFICATION I:STATE WELL CONSTRUCTION PfiRMR/:
t• WELL USE
+Y APppeekit sey:ROSIdWOM
Heat Pomp WAI.r�Y01 ❑ Offer l 0 kwi tdM❑ AyrkulWral❑ Monitorkg Q
2• WELL LOCATION: ❑ It Ovwr.Loss use:
Now"Towe lc ; P ft 10eUon beipW)
A OWNER w 7 Orfi°°'�0 WWLa►ro.I
ILLINO L O if DEPTH
we To Fonr4%npewfp*
�MTeee aIW ff
4. DATE DRILLED $Cad.
S. TOTAL DEPTH � S
7. D8 WESILCp COLLECTED YES(� NO
S. S7ATTC EL EPLACE EXISTING WELL?Q NO
1TiA LEVEL SdOn TOP of Caskg:
"T TOP 4",kwvdCASING FT�w TMelCalnvl ca
'T.r of as.lsa tarsAsyd spar SOrlaoe• '<
Mee.wghfµtlQAC aO.Nta aM aeAw rNuY..aaaNn.a la.coar.to. YIELD
11. WATER ZONE8��METHOD OF 7Esr�' �
t2. CHLORINATION: Type_-- ` iD=�_Amounl 1 J. CASING: j �S 11 etldaonN yece 6 nNded use Woc of tsm
Depth IN TNdmu
F _To. p _ PhowMream ard MM&ra��ggnosuw
F To,
Frprq FL— Rods.or r trap Maus pohY1
ti. GROUT: Tom R___ —
0
Depth v� 'u
Fmm Ma d,
Prom �_TO �F1 s hodw na i�ir.
1s_ SCREEN: Y 2Q y
DoM Okeneter Sal n. Sisi MalodM From To ti
frran To FLU_ in, k►. >_
18. SANVMRAVEL PACK in.
From D Size Malodw G®ve i001
Flom To_ Fk
1T. REMARKS;
t DO HERESY CERTIFY THAT TIES WELL WAS CONSTRUCTED IN
CONSTRUCTIONSTANDARKAMTMTACMOP �ORDANCe►NTNISA NCVjCIV/ELL
RECORD SEEN PKIIADED TO THE Y/UL Oe\ER
FOR OFFICE USE ONLY
agwltUgEar rERSON CprsTttUCt�THE Y/E1L
eurne ____,_�� aktwawNtlenslwaacssNl Grgr,dpy,E�on+rhHn7pcRys D':a
c,.1 pxv.12"

a3sr atl Via*m a Em "w"t Qnd III
Rwrytl N.0 mw+6394%ww(efp r3Ok6'*"I Qu*r*Y-amuncI 311wn
3221
WELL CONSTRUCTION RECORD 3 07254
• WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION e: /STATE WELL CONSTRUCTION PERMIT/:
1. WELL USE
+ak Rseldelltlal Mun
A&COVINY Hest Pump Waor krallon ❑ Oekarai❑I Dow.
❑ Ayrkuhurpl❑ Monilo ❑
2. Now"Tenwc WELL LOCATIOlIakebh of the baNwt below) ❑ .IJst Up: �
coiner
CR..atMNl.la.q pn`tyyt/er
3. OWNER �' + u.naldLatb) Fmm
Rm6w L00
T. Foro�Xon p..,dpa„
------------
amp
Gy a Ta.l
a. DATE DRILLED `�5 3lo
S. TOTAL DEPTH
T DpEg uS COpLLECTED Y&3[] N
S. STATIC WATER EXISTINQ of Yt
LEVEL SolCt►Top of Caehp; 642 FT. ,+
>t. TOP OF CASH IS ` W"V/Aan.rap M Caft W
grow M...I.E owmk" .d.Yw FT.Above Land Surface• 1
bne.MIA qA NCA6fC.e1f.maw Mad.wf.,o ryuY..■r.rNn..M k°Or-
10. YIELD GTPA+Y
11. WATER ZONES(dep" ST�4
'L CHLORINATION; Type
17. CASINO: 117 Maun1
S +wc.`n•.daw b.e.arum
F i 7 w or3 SKETC_u
DepYl
Fm -2 .—.To-�.Ft, (Shar pineuon rld da+.na from a ws:my sIw
To, FL— — dC.aofh.r
Fm m To— — ""p "ee p°ke'I
aepth
Fmm -e5l _ 70M-
To FL
Is. SCREEN: �---
From 1)"Ih Mmlor Sbl Ski MafMal `
From To=..._Ft h
T*,FL_._ LL --_h
From To FL_ _ h
It SANDMRAYELPACK: h. s
From .�.�DT h size I Ian y —
From
N
To FL
17. REMARKS: o
cz,
100 HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN r
COMMICT"STUDS.AND THAT ACOPY OF AOCOROANCE"TH ISA NCAC PC.WELL
S RE 0 HA9 SEEN PWADEO TO THE t/EiL OlA
FOR OFFICE USE ONLY
aORATUNE Ds PERSON 00t/STRUC m THE ELLe.
�,�, alal�«r�,wbokaallawu.,ow�Ir.rkaA,e«��„+,�,�n�ocsrr. a.:a
co-1 rgY.t.TI

119rNee�p�•d M E^ .M and Natural Re
"Ra+N#+4 N.R27gY-1 1pu-iei•tNvfalon et wlux Oua'M•0mundwaler section
WELL CONSTRUCTION RECORD
307255
WELL
CONTRACTOR: i Iy
WELL CONTRACTOR CERTIFICATION IV:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE� k
Aftwe+Y U N. RsaldantlN CJ Mun4al❑ laduatrtd❑R+nw Waldr Iri.oUon ❑ Olwr it Ayrkullural❑ Monllo&V❑
2• WELL LOCATION: ❑ .List Uae:
tNaN..a1 Tmvnc�s k�/ o►Ita►ocallon below)
.
_""---�-- awaay: o r O {
(Read Name Wad
E. OWNER �e 1p ww t a fro.) DR1Lt INO L00 c
Addraq ---�--�_ U.P___- 7H Y
LTo From To Fowwa*n pnc*gm
OlraTetet rY v�yt%
A, TEDRILLEO A°�•
b. TOTAL DEPTH
6. cvrn OSCOLLECTED 7. DOES WELL REPLACES E7t1YES
�O N0
•. STATIC WATER LEVEL qeIo*T0P WWELLT YES 0 NO
-.1/9 --Ff
f. TOP OF CASINO IS i Ivs•�•d Mew Too of Cabo
a...f e..ky .LZ'_ FT.Abom LWW Stnlaca•
Over done@ vft 1NA MAC aa.dl la kelow lead ewleea repdr.e a wrNnee 4 acaon07—
10..YIELD ��METHOD OF TEST �i. �/©
/t. WATERZONES(dgpN. f1� Y® iL
12. CHLORINATION: Tye p
12. CASINO: z� Amount
I addittond nP.p t.rr.dp cu.ta+a d r rm
�W NN,11�ieaN ..LQC97J�1 SKETCH
F --�--To..Lti FL� 1i) J',�, (9Aow rprk+b d+ C.
n and nena from ru I.0 reo Suu
— c cL. Row..of oMv MOP FINW Poke) 3
From
14 To— �— (AAAer
GROUT;
From �Pw alsdal e ,
-EL_ To ..�FLr.rc ?
IS. SCREEN:
u7
TO
Front
DomOlamelor Smfti Ma1.Aa1 CpJp
_ TG- Fl..,..._ In.
From FL in. In
In.
From To-_.�_ —_
18. 8ANW�ORAYEi PACK h In. ���Ll z
n
Wplt eke Malaid
From To F1
m
Flom -__. To FL
17. REMMKB: _ -
+00 MEREST CERTIFY THAT TIIB WELL WAS CONSTRUCTED
IN SA
CONSTRUOTM STANOARDS,AND THAT A COPY OF THIS CORD HAS '""Ce 1 "t �IC,WELL
FOR OFFICE USE ONLY �1OV10ED 7O 1tlE YrEli O"%Ep-
•"`OF
PERS01/ONSTRUC1N01NE V#M
#adar N.. �'n1�Io M*M of wow Oval,owla.ddr lkon$rim 70 coy$ o'sa
Coll/tY.1211

WELL CONSTRUCTION RECORD l
:V1
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) James to Camp, .7i CERTIFICATION# 71 3R
WELL CONTRACTOR COMPANY NAME ('Am c Wi 11 & PlImp Cn r Tnr PHONE #M2P) dS7_7722
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):ResidentialU"'-Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATIOT`tj: - L f, I Topog�p]uc/Land setting .
NeareSYt7To CountryY y�_�_.� ❑Ridge $Kfope ❑Valley ❑Flat
`7 /PE rfJc 5/aC: - (check appropriate box)
Subdivision,(street am e,�N—umbers,,Numbers, Lot No.,zip Code) Latitude/longitude of well location
3. OWNER:_ _ �.S t-i4 w11�1.G ems— (degrees/minutes/seconds)
Address 1 `i 4 5 C i "i u r� / . Latitude/longitude source:❑GPS❑Topographic map
( (check box)
S1 xt RouteN .) o . 3 DEPTH DRILLING LOG
ryTpw�C s tip Code From o 1 anon Descr pt� (t ,
jl_
Area coda Phonne.numb
4. DATE DRILLED `1 S
5. TOTAL DEPTH: ¢�
6. DOES WELL REPLACE EXISTING WELL? YE$ Q NO
7. STATIC WATER LEVEL Below Top of Casing: y FT.
(Use'+"if Above Top of Casing) in
8. TOP OF CASING IS I FT.Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordant with 15A NCAC 2C.0118.
9. YIELD(gpm): Ln
�ME I ODQF TEST A,
10.WATER ZONES(depth): lye SS
LOCATION SKETCH
11. DISINFECTION:Type rh 1 n,-i n A Amount Show direction and distance in miles from at least,f't
12. CASING: Wall Thickness two State Roads or County Roads.Include the aid
Depth II ,,-- Diameter or W eight/Ft. Material numbers and common road names.
Frotn_p_To —Ft.6 1 14 �c D R 21 per_ i
From To Ft. r
From - To Ft.
13. GROUT: Depth Material Method (.-
From-0 To 20 FL NPR47 V mRnt HaR,4--- (
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material 1' , �:':✓
From To Ft. in, in. �u
Front 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 I SA NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY O THIS RECORD HAS VEEN PROVIDED TO THE WELL OWNER v-
SIGNATURE OF PE CONSTRUCTING THE WELL DATE Cc)
e�>
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC o
27 69 9-163 6 Phone No.[phone],within 30 days. GW-I REV.07/200r-,

WELL CONSTRUCTION RECORD 3 C� 6 8% u
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)lam Ps to Camp, .7r CERTIFICATION# 71 aB
WELL CONTRACTOR COMPANY NAME j Ampl �_Wpl 1 & Pump_On r Tnr PHONE NA2M 45."3_7'i 22
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential tKMunicipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCAT OZ N:_ n Topographic/Land setting
Ne To�'w{ n: -i Coun,E (}Ridge ❑Slope ❑Valley ❑Flat
DS t ., `1-t� (check appropriate box)
(Street Name,Numbers,Ccmmmity,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
1
3. OWNER:---- -� �/ (degrecalminuteslseconds)
Address 1by COILA w h i N f- Sf, Latitude/longitude source:❑GPS❑Topographic trap
Street or ute No.) (check box)
S �eS✓t�/e C�- �Z� j DEPTH DRILLING LOG
try or T wn State Zip Code From To FDr7auon Description
DC - ���- I �j n x J
Area code-Phone number
4. DATE DRILLED -
5. TOTAL DEPTH: �p C
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Li!
7. STATIC WATER LEVEL Below Top of Casing: 6 D_FT. Z
(Use"V'if Above Top of Casing)
8. TOP OF CASING IS t FT.Above Land Surface"
*Top of casing terminated at/or below land surface requires■ O
•vwlaace in aceorda a with 15A NCAC 2C.0118.
9. YIELD(gpm):. L METHQD OF TESTSir
10.WATER ZONES(depth): i�0 —
LOCATION SKETCH
11. DISINFECTION:Type rh 1 n r i n p 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_q To—) Ft. 1; 1 /A $DRY �—
From To FL 1 . . ... _....._
From To Ft. _ ..___... _.. -
13. GROUT: Depth Material Method ^
From-0---Town Ft. r, eat 9e;R nt hIa:�—
From To FL
14. SCREEN: Depth Diameter Slot Size Material
From To Ft.____—in. m.
Front To Ft, in. in.
15. SAND/GRAVEL PACK:
Depth Size Material �� -
FronL To Ft. �
From To FL
16. REMARKS: 11
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PE CONSTRUCTING THE WELL DATE
(y,
Submit the original to 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 u _
e-rx

From:Scott Gantt To:Stephanie Wilson Date:2/21/2005 Time:12:57:44 PM ,i, Ii i Page 2 of 9
WELL CONSTRUCTION RECORD II T Y v 3 0 7 6 5 6
North Carolina-Department of Environment,and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) SCOTT GANTT CERTIFICATION#2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS,INC. PHONE#[phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I.WELL USE(Check Applicable Box)! Residential ® Municipal ❑ Industrial❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2.WELL LOCATION: Topographic/Land setting
Nearest town: FOREST CITY County RUTHERFORD ❑Ridge ❑ Slope ❑Valley ® Flat
HARRILL DAIRY RD Latitude/Longitude of well location
(StredName,Numbers,Conanunity,Subdivision,Lot No,Zip Code) 35,18.179/81,46.676
3.OWNER JERRY HALL (degreesfarmuteslseconds)
ADDRESS 1650 US HWY 221 N LatitudeAongitude source:®GPS❑Topographic map
(Stootor Romc No.) DEPTH DRILLING LOG
RUTHERFORDTON NC 28139 From To Formation Description
City or Town State Zip Code 0 40 Clay
828-287-4344 40 180 Consolidated Rock
Area Code-Phone Number
a.DATEDRILLED 1/25/05
5.TOTAL DEPTH 180 A
6.DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7.STATIC WATER LEVEL Below Top of Casing: 44 FT. -�
(Usn-."IfAbove Top ofCaaia, rn
8. TOP OF CASING IS 2 FT.Above Land Surface-
'Topofemia,t mind at/or blowlad surfice roquva a varianti
accordance wide 15A NCAC 2C.0118
I'
9. YIELD(gpm): 25 METHOD OF TEST ARDM
10.WATER ZONES(depth): 180
a
u.DISINFECTION:TYPE HYPOCHLORITE Amount 8 0. LOCATION SKETCH
12.CASING: Wall'Brickness Show direction and distance in miles from at least
Depth Diameter or Weighl Material two State Roads or County Roads.Include the road
From 0 To 50 Ft 6 1/4" SDR 21 PVC numbers and common road names.
13.GROUT:
Depth Material Medved
From 0 To 20 Ft. GRAVEL MIX GRAVITY
la.SCREEN
Depth Diameter Slot Sim Material
From NA To Ft in. in
15.SAND/GRAVEL PACK:
Depth Sim 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.
2/1/05
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
GW-1 REV.07/2001
Submit the original to the Division of Water Quality,Groundwater Seel 1636 Mali Service center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days.

From:Scott Gantt To:Stephanie Wilson Date:2/21/2005 Time.12:57:44 PM page 9 of 9
WELL CONSTRUCTION RECORD 3 0 7 6 6 3
North Carolina-Department of Environment,and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) SCOTTGANTT 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: HOLLIS County RUTHERFORD ❑Ridge [:] Slope [:] Valley ® Flat
1624 HOLLIS RD Latitude/Longitude of well location
(Street Name,Numbes,Community,Subdivision,LotNo,Zip Code) 35,22364 1 8L44,528
3.OWNER HORTON HOME OF RUTHERFORDTON (degees/minutes/seconds)
ADDRESS 342 HWY 74 BYPASS Lahtude/longitude source:®GPS❑Topographic map
(sbca orRowc No.) DEPTH DRILLING LOG
RUTHERFORDTON NC 28139 From To Formation Description
City or Town State Zip Code 0 95 Clay
828-287-3366 95 360 Consolidated Rock
Area Code-Phone Number
a.DATE DRILLED 1/25/05
5.TOTAL DEPTH 360
6.DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7.STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use"'IfAbovc Top of Casang) T
8. TOP OF CASING IS 2 FT.Above Land Surface' CS7
'Top of cast,tessnumt<d eV.,below Ind s ofine requha a vvi..c i. .�
accosdnce with 15ANCAC 2C.0118 rb
9. YIELD(Wm): 5 METHOD OF TEST ARDM C3
rn
Io.WATER ZONES(depth): 340
it.DISINFECTION:TYPE HYPOCHLORITE Amount IS o: LOCATION SKETCH .y I
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 105 Ft 6 1/4" SDR 21 PVC numbers and common road names.
13.GROUT:
Depth Material Method
From 0 To 20 FL GRAVEL MIX GRAVITY
14.SCREEN
Depth Diameter' Slot Size Material - -
From NA To FL in. im
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.
2/1/05
SIGNATURE OF PERSON CONSTRUCTING THE WELL Dale
GW-1 REV.07/2001
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service center-Raleigh,NC
27699-1636 Phone No.[phone],Within 30 days.

From:Scott Gantt To:Stephanie Wilson Date:2121/2005 Time:12:57:44 PM Page 8 of 9
NO
WELL CONSTRUCTION RECORD
307662
North Carolina-Department of Environment,and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) SCOTT GANTT CERTIFICATION#2594
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 RUTHERFORD ❑Ridge ❑ Slope ❑ Valley ® Flat
LOT 52 SWEET BRIAR FARMS Latitude/Longitude of well location
(Street Name,Numbers,Community,Subdivision,LotNo,.Zip Code) 35.28.671 192.07.011
3.OWNER MICHAEL SKINNER (degrees/minutes/seconds)
ADDRESS 1644 COXE RD Latitude/longitude source:®GPS❑Topographic map
(Strad or Route No.) DEPTH DRILLING LOG
RUTHERFORDTON NC 28139 From To Formation Description
city aTown State Zip Code 0 90 Clay
828-289-6363 90 220 Consolidated Rock
Area Code-Phone Number
4.DATE DRILLED 1/22/05
5.TOTAL DEPTH 220
6.DOES WELL REPLACE EXISTING WELL? YES NO ® lsr�je
7.STATIC WATER LEVEL Below Top of Casing: 30 FT. tp
r1
(rtt"1'I(Abova Top of Casing)
8. TOP OF CASING IS 2 FT.Above Land Surface-
'Top of casing tame pled wirer balow Land ewface ragimes a variance in
aeeorderne vide 15A NCAC 2C 0118 00
r�
9. YIELD(gym): 15 MEDiOD OF TEST ARDM C.J1
10.WATER ZONES(depth): 210
4
tt.DISINFECTION:TYPE HYPOCHLOAITE Amount 9 °= LOCATION SKETCH _
12.CASING: Wall Thickness Show direction and distance in miles from at least
Depth Diameter or Weight/Fl. Material two State Roads or County Roads.Include the road
From 0 To 100 FL 6 1/4" SDR 21 PVC numbers and common road names.
13.GROUT:
Depth Material Method
From 0 To 20 FL GRAVEL MIX GRAVITY
14.SCREEN
Depth Diameter Slot Size Material
From NA To FL in in
15.SAND/GRAVEL PACK:
Depth Size Material -
From NA To Ft,
id.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.
2/1/05
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
GW-1 REV.07/2001
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mall Service center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days.

From:Scott Gantt To:Stephanie Wilson Date:2/2112 0 0 5 Time: 12:57:44 PM r Page 7 of 9
307661
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: LAKE LURE County RUTHERFORD ❑Ridge ❑ Slope ❑Valley ® Flat
LOT 16 SWEET BRIAR FARMS Latitade/Longitude of well location
(Street Name,Numbers,Community,Subdivision,Lot No,Zip Code) 35.28.717/82.07.289
3.OWNER MICHAEL SKINNER (degrees/mhwtes/sttonds)
ADDRESS 1644 COXE RD Latitude/longitude source:®GPS❑Topographic map
(Strcetor Rootc No.) DEPTH DRILLING LOG
RUTHERFORDTON NC 28139 From To Formation Description
City or Teem State Zip Code 0 20 Clay
828-289-6363 20 340 Consolidated Rock
Area Code-Phone Number 1
4.DATE DRILLED 1/20/05
5.TOTAL DEPTH 340 1
6.DOES WELL REPLACE EXISTING WELL? YES Fl NO
7.STATIC WATER LEVEL Below Top of Casing: 80 FT. _ � 1
(Use"+"IfAbove Top of Casing) rn
8. TOP OF CASING IS 2 FT.Above Land Surfaces
"Top ofessmg t&rmbrrted aV.r Q Imd svrfaeo rcgwrcs a varimcc to
aeeosdmoe with 15A NCAC 2C.0118 0
9. YIELD(epm): 5 METHOD OF TEST ARDM y�
lo.WATER ZONES(depth): 320 Ln
11.DISINFECTION:TYPE HYPOCHLORITE Amount 12 Oa LOCATION SKETCH
12.CASING: Wall TTdckness Show direction and distance in miles from at least
Depth Diameter orweight/Ft Material two State Roads or County Roads.Include the road
From 0 To 35 Ft 6 1/4" SDR 21 PVC numbers and common road names.
13.GROUT:
Depth Material Method
From 0 To 20 Ft GRAVEL MIX GRAVITY
14.SCREEN
Depth Diameter Slot Sin Material
From NA To FL in in
15.SAND/GRAVEL PACK:
Depth Size Material
From NA To Ft,
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
2/l/05
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
GW-1 REV.0712001
Submit 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:Stephenie Wilson Date:2/21/2005 Time:12:57:44 PM � � Page 6 of 9
307660
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: LAKELURE County RUTHERFORD ❑Ridge ❑ Slope ❑ Valley ® Flat
LOT 27 SWEET BRIAR FARMS Latitude/Longitude of well location
(Street Name,Numbers,Community,Subdivision,Lot No,Zip Code) 35,28.782 192107,178
3.OWNER MICHAEL SKINNER (deggees/miutes/seconds)
ADDRESS 1644 COXE RD Latitude/longitude source:®GPS❑Topographic map
(stooA or Roux No.) DEPTH DRILLING LOG
RUTHERFORDTON NC 28139 From To Formation Description
City or Town State Zip Code 0 72 Clay
828-289-6363 72 500 Consolidated Rock
Area Code-Phone Number
4.DATE DRILLED I/17/05
5.TOTAL DEPTH Soo
6.DOES WELL REPLACE EXISTING WEILT YES ❑ NO ED
7.STATIC WATER LEVEL Below Top of Casing: 150 FT.
(Uzo"t^IfAbovz Top of Cum) �r1 9
S. TOP OF CASING IS 2 FT.Above Land Surface-
•Tov of cawig tumirutcdztlor blow lmducfzcc rcgwez a vufmcom W �
accordmcc with 15A NCAC 2C.0118
9. YIELD(gym): 3 METHOD OF TEST ARDM p
10.WATER ZONES(depth): 450
it.DISINFECTION: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 79 Ft 6 1/4" SDR 21 PVC numbers and common road names.
13.GROUT:
Depth Material Method
From 0 To 20 Ft GRAVEL MIX GRAVITY
14.SCREEN
Depth Diameer Slot Size Material
From NA To FL in in
15.SAND/GRAVEL PACK:
Depth Size Material
From NA To Ft,
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
2/1/05
SIGNATURE OF PERSON CONSTRUCTING THE WELL Dale
GW-1 REV.0712001
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mall Service center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days.

From:Scott Gantt To:Stephanie Wilson Date:221/2005 Time:12:57:44 PM Page 5 of 9
WELL CONSTRUCTION RECORD 3 0 7 6 5 9
North Carolina-Department of Environment,and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) SCOTT GANTT CERTIFICATION#2594
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 RUTHERFORD ®Ridge ❑ Slope ❑ Valley ❑ Flat
LOT 14 PEAKS AT LAKE LURE SUBDIVISION Lafimde/Longimde of well location
(Street Name,Numbers,Community,Subdivision,Lot No,.Zip Code) 35.24.281/82.10.942
3.OWNER VINCE PAVKOV CONSTRUCTION (degrees/minutes/seconds)
ADDRESS POB 67 LatitudeAongimde source:®GPS❑Topographic map
(Stred or ROW-No.) DEPTH DRILLING LOG
IRMO SC 29063 From To Formation Description
City or Town State Zip Code 0 140 Clay
803-407-0017 149 380 Consolidated Rock
Area Code-Phone Number
4.DATE DRILLED 1/10/05 '
s.TOTAL DEPTH 380
6.DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7.STATIC WATER LEVEL Below Top of Casing: 105 FT.
(U,.r"IAI,.TWof Casmo J
8. TOP OF CASING IS 2 FT.Above Land Surface- m { 1
-Top ofcaaoa tenn'vutcd er/or bcbw Id ewfacc rcquvca a vuience'u, ?^�
accordmcc wah 13A NCAC 2C.0118
*.r i
9. YIELD(gpm): 6 METHOD OF TEST ARDM rn
10.WATER ZONES(depth): 370 CIt
u.DISINFECTION:TYPE HYPOCHLORITE Amount 14 oz LOCATION SKETCH
12,CASING: Wall Thickness Show direction and distance in miles from at least 1
Depth Diameter orweight/Ft Material two State Roads or County Roads.Include the road
From 0 To 149 Ft 6 1/4" SDR 21 PVC numbers and common road names.
13.GROUT:
Depth Material Method
From 0 To 20 Ft GRAVEL MIX GRAVITY
14.SCREEN
Depth Diameter Slot Size Material
From NA To Ft in in
15.SAND/GRAVEL PACK: s:
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.
1119105
SIGNATURE OF PERSON CONSTRUCTING THE WELL Dale
GW-t REV.0712001
Suhm@ the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service center-Raleigh,NC
27699-1636 Phone No.[phone],Within 30 days.

308150
WELL CONSTRUCTION RECORD
North Carolina-Dcpattment of Environment and Natural Resources-/nDivision of Water Quality-Groundwater Section
1L 7
WELL CONTRACTOR(INDIVIDUAL)NAME (print) 9511/i/C GIMP CERTIFICATION#-2 !
WELL CONTRACTORCOMPANY NAMESr_ a x—ZAd&TeC I/1 /t s( tJ n: I1�/10 PRONE # (S2A� "�ygO
STATE WELL CONSTRUCTION PERMTTYi ASSOCIATED WQ PERMTT#
(if applicable) (if applicable)
FS/
I. WELL USE(Check Applicable Box):Residential MunicipaUPublic d Industrial 13 Agricultural 0
Monitoring❑ Recovery 0 Heat Pump Water Injection❑ Other 0 If Other,List Use
2. WELL LOCATION: ./n� / TopodLand setting
Nearest Town: 019 AI. � County iA F P pgiT lope OValley QFlat
12 14rtat.e c/ta!X'a su,6 :f> (oldappropria2box)
(Sneer Name,Numbers,Commuoi y.Subdivonim,lot No.,Zip Code) Latitude/longitude of well location -
3. OWNER: -S PDF CD�e (acg<exlmnua�ao�adc)
Address iV_T N,g�r_P c e 4s -9 Latitudet)ongitude source:EIGPS❑Topograpidc map
/ (Suet or Route No.) (Amok box)
Odd Spot r /v G 2 1� 7 5/ DEPTH DRILLING LOG
City or Town State tip Code From To Formation Description
Ara rode-Phone amber
4. DATE DRILLED-...
5. TOTAL DEPTH: /05' —
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO M"
7. STATIC WATER LEVEL Below Top of Casing:-J,_FT.
/ �- (User"+^if Above Tap of Casing)
8. TOP OF CASING IS5 FT.Above Land Surface" - 0
"Top of cuing terminated Wor below had surface requires a
variance to attudaua with ISA NCAC 2C.0IIL b �"
9. YIELD(gpm): r METHOD OF TEST/r'M
10. WATER ZONES(depth): o
LOCATION SKETCH
11. DISINFECTION:Type C Amount JU e 2 Show direction and distance in miles from at 1
12. CASING: Wall Thiclmess two State Roads or County Roads.Include the d
Fro nl�_Tq�q Ft al ZI numbers and common to names.
From To Ft 1 J
From To Ft P
13. OROUT- Depth Material Method ^ V
From To ZC2 Ft. 60C1'G C we / t•
From To Ft
14. SCREEN: Depth Disaster Slot Size Material
From To Ft. in. in.
From To Ft. tn. in.
15. SAND/GRAVEL PACK:
Depth Size Material C-7/
From Tc FL �� C
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C,WELL
CONSTRUCT'JOY STANDARDS,AND THATa
THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/-27 - tps�
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.(919)733-322L within 30 days. GW-1 REV.07/2001

307463
WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)RODNEY ROBBINS CERTIFICATION# 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ❑ Municipal/public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town:FOREST CITY County RUTH Topographic/Land setting
BEHELER RD. ❑Ridge ❑ Slope ❑ Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER: WADE FLACK Latitude/longitude of well location
Address 255 BEHELER RD. _
(Street or Route No.) (degrees/minutes/seconds)
FOREST CITY NC 28043 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 28)—287-2428 DEPTH
Area Code Phone number From To
4.DATE DRILLED O V07/05 _
5.TOTAL DEPTH: 245 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): 30 METHOD OF TEST ARD number and common names
10.WATER ZONES(depth): BY-PASS 74 E.FROM FOREST CITY.RT.ON
11.DISINFECTION:Type CHLORYTE Amount 6 BETHANY CHURCH RD.RT.ON PINEY KNOB RD.
12.CASING: Wall Thickness LEFT ON GRIFFIN RD.LEFT ON BEHELER RD.
Depth Diameter or Weight/Ft Material HOUSE ON LEFT AT DEAD-END.
From 0 To 30 Ft. 6-1/4" SDR21 PVC
From_To_Ft_ y
From ToFt_ CD =r
13.GRO :_Depot Material Method CA
From 0 To 20 Ft. OUH(RETE POURED y
From_To Ft A'
14.SCREEN: Depth_ Diameter Slot Size Material
From To_Ft._ in in.
From_To_Ft._ in. in.
15. SAND/GRAVEL PACK:
Depth Size Material a
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
CONS UC N STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
_ _ 7
SIG14ATURE OF PERS014 CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Seetion,1636 Mail Service Center—Raleigh,NC
27699406 Phone No. [phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD 307460
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)RODNEY ROBBINS CERTIFICATION# 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use—
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH Topographic/Land setting
STACEY P.D. ❑Ridge ❑ Slope ❑ valley ❑ Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER: TRENT BISHOP Latitude/longitude of well location
Address STACEY RD. _
(Street or Route No.) (degrees/minutes/seconds)
RUTHERFORDTON NC 28139 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
�)-248-1538 DEPTH
Area Code Phone number From TO
4.DATE DRILLED 01/13/05 _
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 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 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): 2 METHOD OF TEST ARD number and common names
10. WATER ZONES(depth): HWY.#221 S.FROM RUTHERFORDTON.RIGHT
11. DISINFECTION:Type CHLORYTE Amount 10.5 ON POORS FORD RD.CROSS RIVER LEFT ONMCMURRAY RD.APPROX.1 MILE.LEFT ON
12. CASING: Wall Thickness STACEY RD.GO 7/10 MILE.
Depth Diameter or Weight/Ft. Material
From 0 To 60 Ft. 6-1/4" SDR21 PVC
From_To_Ft
From To Ft._
13. GROT:U_Depth_ Material Method_ C:) P
From 0 To 20 Ft.OUHZRETE POURED ci
From_To_Ft
14.SCREEN: Depth Diameter Slot Size Material
From_TO_Ft._ in. in.
From_To_Ft.— in. in.
15. SAND/GRAVEL PACK: s _
Depth Size Material a c
From_To_Ft
From To Ft C�
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
a aa1ds d / _ / / 3 _ e'
SIGNATURE OF PE ON CONSTRUCTING DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

307459
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)RODNEY ROBBINS CERTIFICATION# 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: LAKE LURE County RUTH Topographic/Land setting
LURE LAKES-LOT#32 ❑ Ridge ❑ Slope ❑ Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER: KEVIN HATFIELD Latitude/longitude of well location
Address LURE LAKES _
(Street or Rome No.) (degreestminutes/seconds)
LAKE LURE NC 28746 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
(910)-977-3140 DEPTH
Area Code Phone number From To
4.DATE DRILLED 01/20/05 _
5.TOTAL DEPTH: 145 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): 30 METHOD OF TEST ARD number and common names
10.WATER ZONES (depth): HWY.#64/74 TO LAKE LURE. RIGHT ON BOYS
11.DISINFECTION:Type CHLORYTE Amount 3 CAMP RD.GO 1/6 MILES OR 18f PAVED DRIVE TO
RIGHT.PAST GARDEN LANE.STAY LEFT AT
12. CASING: Wall Thickness FORK.GO TO DEAD END.LOT ON RIGHT.LOT
Depth Diameter or Weight/Ft. Material #32.
From 0 To 70 Ft 6-1/41' SDIL21 PVC
From_To_Ft
From To_Ft._
13. GROT:U_Depth Material Method_
From 0 To 20 Ft.OUH{RETE POURED
From_To_Ft. ca - - -
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 7N ^ '`
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 CORD HAS BEEN PROVIDED TO THE WELL OWNER
�/CGNATUPE OF PERSON CO TING THE L DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.0712001

A iL'V
t✓
307479
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&&Iic ® Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town:BOSTIC County RUTH Topographic/Land setting
HWY.#226 ❑Ridge ❑ Slope ❑ Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:GOOD OLE BOYS Latitude/longitude of well location
Address HWY.#226 _
(Street or Route No.) (degreeshainmes/seconds)
BOSTIC NC 28018 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
L8)—245-6066 DEPTH
Area Code Phone number From To
4. DATE DRILLED 01/03/05
5.TOTAL DEPTH: 42 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES® NO❑ From To
7. STATIC WATER LEVEL Below Top of Casing: 22 FT. _
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS I-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): 20 METHOD OF TEST STEEL TAPE mmnber and common names
10. WATER ZONES(depth): BUS.74 E.FROM FOREST CITY.LEFT ON
11.DISINFECTION:Type CHLORYTE Amount 9.2 BOSTIC/SUNSHINE HWY.STORE ON CORNER OF
12. CASING: Wall Thickness BOSTIC/SUNSHINE HWY. &HWY.#226. g
Depth Diameter or Weight/Ft Material
From 0 To 42 Ft. 24" CEMENT a.
From_To_Ft._ t
From To Ft. �
13.GROU_T: Dep_th Mate_rial Method `?s'
From 0 To 20 Ft.CEMENT POURED _
From_To_Ft
14.SCREEN: Depth Diameter Slot Size Material a^`
From To_Ft._ in. in. 3
From_To_Ft._ in in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 22 To 42 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
`4 4a4_'a ira�.9f / - 3 d '4;—
SIGNATURB OF PERRN 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
307478
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) ROBIN MCNEELY CERTIFICATION# 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: ELLENBORO County RUTH Topographic/Land setting
MT.OLIVETTE RD. ❑Ridge ❑ Slope ❑ Valley ❑Flat
(Sheet Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER: MARK BARBER Latitude/longitude of well location
Address MT. OLIVETTE RD.
(Street or Route No.) (degrees/minutes/seconds)
ELLENOBRO NC 28040 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
S@28)-429-9130 DEPTH
Area Code Phone number From To
4.DATE DRILLED 01/05/05 _
5.TOTAL DEPTH: 37 DRILLING LOG
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 22 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface* 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): 15 METHOD OF TEST STEEL TAPE number and common names
10.WATER ZONES(depth): FROM ELLENBORO.GO UP HOLLIS RD.LEF
TON MT.OLIVETTE RD.2 MILES.NEW DRIVE ON
11.DISINFECTION:Type CHLORYTE Amount 6.9 LEFT.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 37 Ft 24" CEMENT
From_To_Ft_ n '-"-
From
T: To Ft
13. GROU_Depth_ Material Method t
From -0 To 20 Ft.CEMENT POURED -
From To_Ft.
14.SCREEN: Depth Diameter Slot Size Material 1.;From_To_Ft._ in. in. �J
From To_Ft._ in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 22 To 37 Ft 78M GRAVEL
From To Ft.
16.REMARKS:
I DO HEREBY CERTTFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Q �.P-fl feu ; �e s Gt7 / �L. ... —' D —
SI ATURE PERS STR TING T - S .
HE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

a)k"
307477
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) ROBIN MCNEELY CERTIFICATION# 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH Topographic/Land setting
CHRYSTAL LANE-LOT#2 ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER: THOMAS RABB Latitude/longitude of well location
Address CHRYSTAL LANE _
(Street or Route No.) (degrees/mmutes/seconds)
RUTHERFORDTON NC 28139 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8(_2D-245-7599 DEPTH
Area Code Phone number From To
4. DATE DRILLED 01/12/05 —
5.TOTAL DEPTH: 45 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 25 FT. —
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface* 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.#221 S.FROM RUTHERFORDTON.LEFT
11.DISINFECTION:Type CHLORYTE Amount 9.2 ON MORNINGSTAR LAKE RD.RIGHT ON
12. CASING: Wall Thickness CHRYSTAL LANE 2 LOT ON RIGHTY.
Depth Diameter or Weight/Ft Material o n
From 0 To 45 Ft 24" CEMENT --.I
From_To_FL
{t aJ
From To_Ft_ r
13.GROUT: Depth Material Method
From 0 To 20 Ft.CEMENT POURED
From_To_Ft -�
14.SCREEN: Depth Diameter Slot Size Material j
From_To_Ft._ in. in. v ""
�.;
From To_FL_ in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 25 To 45 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
Q -
SIG14ATURE OF PE 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

307476
WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) ROBIN MCNEELY CERTIFICATION# 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: BOSTIC County RUTH Topographic/Land setting
FREEWILL BAPTIST CIL RD. ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER: STEVE PADGETT LatitudeAongitude of well location
Address FREEWHL BAPTIST CH RD. _
(Street or Route No.) (degrees/minutes/seconds)
BOSTC NC 28018 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
7(�—538-8741 DEPTH
Area Code Phone number From To
4.DATE DRILLED 01/28/05
5.TOTAL DEPTH: 43 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 23 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): BUS.74 E.FROM FOREST CITY.LEFT ON
11.DISINFECTION:Type CBLORYTE Amount 9.2 BOSTIC/SUNSHINE HWY.RT.ON SALEM
12. CASING: Wall Thickness CHURCH RD.RT.ON FREEWILL BAPTIST CH.RD.
APPROX 3/4 MILE ON RIGHT.
Depth Diameter or Weight/Ft. Material
From 0 To 43 Ft 24" CEMENT
From_To_Ft
From To Ft. t f
13. GROU_Depth_ Mat_erial Method '
From 0 To 20 Ft. CEMENT POURED t -
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From_To_Ft_ in in.
From_To_Ft._ in. in. -
o -r
15. SAND/GRAVEL PACK: ry
Depth Size Material
From 23 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 OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OFYtSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,G:rerndwater Secro%1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No. [phone],within 30 days:_ GW-1 REV.07/2001

307475
WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) NEIL CRAFT CERTIFICATION# 3114
WELL CONTRACTOR COMPANY NAME PTTTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: LAKE LURE County RUTH Topographic/Land setting
117 LAUREL LAKES PKWY ❑Ridge ❑ Slope ❑ Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:ED PURCELL Latitude/longitude of well location
Address 117 LAUREL LAKES PKWY _
(Street or Route No.) (degrees/minutes/seconds)
LAKE LURE NC 28746 Latitude/longitude source: ❑GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 50)—277-2229 DEPTH
Area Code Phone number From To
4.DATE DRILLED 01/04/05
5.TOTAL DEPTH: 385 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES® NO❑ From To
7. STATIC WATER LEVEL Below Top of Casing: 120 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 11-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.#64/74A W.FROM RUTHERFORDTON.
RIGHT ON BILLS CREEK RD.LEFT INTO LAUREL
11.DISINFECTION:Type CHLORYTE Amount 9.5 LAKE DEVELOPMENT. 1 HOUSE ON LEFT.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material n ',
From 0 To 70 Ft,6-1/4" SDR21 PVC (-n "'
From_To_Ft_ m
From ToT: Ft "
13. GROU Dep_th Ma_terial Method `
From 0 To 20 Ft OUEKRETE POURED
From To_Ft
14.SCREEN: Depth Diameter Slot Size Material
From_To_Ft._ in. in. N
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 THA A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SWINATME OF ERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

z � 4r3
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:LAKE LURE County RUTH Topographic/Land setting
SOUTH POINTE LANE ❑Ridge ❑ Slope ❑ Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER: TERRY DUFFEY Latitude/longitude of well location
Address SOUTH POINTE LANE
(Street or Route No.) (degrees/minutes/seconds)
LAKE LURE NC 28746 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8(J—625-1997 DEPTH
Area Code Phone number From To
4.DATE DRILLED 01/10/05
5.TOTAL DEPTH: 350 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. Two State Roads or County Roads. Include the road
9. YIELD (gpm): 70 METHOD OF TEST ARD number and common names
10. WATER ZONES(depth): HWY.#64/74A W.FROM RUTHERFORDTON.
RIGHT AT FIRE STATION ONTO CHARLOTTE DR
11.DISINFECTION: Type CHLORYTE Amount 9 GO APPROX. 1/4 MILE.LEFT ON SOUTH POINTE
12. CASING: Wall Thickness LANE.WELL SITE IS AT CULL-DE-SAC.
Depth Diameter or Weight/Ft. Material
From 0 To 130 Ft 6-1/4" SDR21 PVC
From_To_Ft._
From_To_Ft._ i._�
13.GROUT: Depth Material Method cn {c
From 0 To 20 Ft.OUH{RETE POURED
n
From_To_FL - co
14.SCREEN: Depth Diameter Slot Size Material ='V
From_To_Ft._ in in. ,;-,j
From_To_Ft._ in in.
15. SAND/GRAVEL PAPK: a
Depth Size Material
From_To Ft._ vj
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 OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SfGNNFLJRE OF PERSON CONSTRUCTING THE WELL DATE
Submit the orlginaHo the Dimes Af Water Quality,Groundwater Section,1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No. (919}r3221,within 30 days. GW-1 REV.07/2001

J
307471
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 ® Mur icipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH Topographic/Land setting
ELLIOTT EXT.RD. ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER: CHARLIE BROOKS,JR. Latitude/longitude of well location
Address ELLIOTT EXT RD.
(Street or Route No.) (degrees/minutes/seconds)
RUTHERFORDTON NC 28139 Latitudellongitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
�)—429-3867 DEPTH
Area Code Phone number From To
4.DATE DRILLED 01/18/05
5.TOTAL DEPTH: 185 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 60 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/orat/o 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 ARD number and common names
10. WATER ZONES(depth): HWY.#64/74A W.FROM RUTHERFORDTON.
RT.ON COVE RD.RT.ON PARRIS RD.RT.ON
11.DISINFECTION:Type CHLORYTE Amount 3.5 ELLIOTT EXT.RD. 1/10 MILE 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_ Mat_erial Method m
From 0 To 20 Ft.01JIKRETE POURED
From_To Ft `�� --
14.SCREEN: Depth Diameter Slot Size Material L" e
From To_Ft._ in. in.
r + i
From_To_Ft._ in. in. c s
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
% y j"'P 6
SIG A OF PERSON CONSTRUCTING LL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

307470
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) NEIL CRAFT CERTIFICATION# 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town:RUTHERFORDTON County RUTH Topographic/Land setting
ELLIOTT EXT.RD. ❑Ridge ❑ Slope ❑ Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER: CHARLUr BROOKS,SR. Latitude/longitude of well location
Address ASHLEY RD.
(Street or Route No.) (degrees/minutes/seconds)
RUTHERFORDTON NC 28139 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 28)-429-3976 DEPTH
Area Code Phone number From To
4.DATE DRILLED 01/19/05
5.TOTAL DEPTH: 605 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 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): FROM GILKEY.GO OUT PAINTERS GAP RD.
LEFT ON PADGETT RD.RIGHT ON ASHLEY RD.
11.DISINFECTION:Type CHLORYTE Amount 16.5 1/2 MILE.GRAVEL DRIVE ON LEFT.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 50 Ft 6-1/4" SDIL21 PVC
From_To_Ft
From To Ft + y
13.GROU_Dep_th Mat_erial Method ?
From 0 To 20 Ft.OUH{RETE POURED mrn
From_To Ft 14.SCREEN: Depth Diameter Slot Size Material ? `-_'-
From_To_Ft._ in. in.
From_To_Ft._ in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From_To_Ft_
From To Ft.
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONS UCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
e
SIG MATURE 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

- J
307469
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) NEIL CRAFT CERTIFICATION# 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: LAKE LURE County RUTH Topographic/Land setting
SWEET BRIAR FARMS-LOT#4 ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER: GREG BELLINI Latitude/longitude of well location
Address SWEET BRIAR FARMS _
(Street or Route No.) (degrees/minutes/seconds)
LAKE LURE NC 28746 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
(828)-674-8974 DEPTH
Area Code Phone number From To
4.DATE DRILLED OV21/05
5.TOTAL DEPTH: 505 DRILLING LOG
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 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 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): 2 METHOD OF TEST ARD number and common names
10. WATER ZONES (depth): HWY.#64/74A W FROM RUTHERFORDTON.
11.DISINFECTION: Type CHLORYTE Amount 13.5 RIGHT ON BELLS CREEK RD.RIGHT INTO
1 . CASING: Wall Thickness SWEET BRIAR FARMS. 151 LOT ON LEFT.LOT#4.
Depth Diameter or Weight/FL Material
From 0 To 60 Ft.6-1/4" SDR21 PVC
From_To Ft.
From To_FL
13. GROUT: Depth Material Method 7 :,
From 0 To 20 Ft.OUHZRETE POURED
From_To Ft
14.SCREEN: Depth Diameter Slot Size Material `7 r '
From To_Ft._ is in.
From_To_Ft._ in. in.
15. SAND/GRAVEL PACK: s s
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 � � (.iJ�pa.K �/\✓/�g�Y�—�LI?viljL, /" ,� � - Ci . 'i
SlCg4ATURE 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

307468
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: LAKE LURE County RUTH Topographic/Land setting
SWEET BRIAR FARMS-LOT#10 ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER: GREG BELLINI Latitude/longitude of well location
Address SWEET BRIAR FARMS _
(Street or Route No.) (degrees/minutes/seconds)
LAKE LURE NC 28746 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (checkbox)
8( ZS)—674-8974 DEPTH
Area Code Phone number From To
4. DATE DRILLED 01/24/05
5. TOTAL DEPTH: 100 DRILLING LOG
6. DOES WELL REPLACE EXISTING WELL? YES❑ 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 Fr. Above Land Surface* LOCATION SKETCH
*Top of casing terminated at/orat/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): 15 METHOD OF TEST ARD number and common names
10. WATER ZONES(depth): HWY.#64/74A W.FROM RUTHERFORDTON.
11.DISINFECTION:Type CHLORYTE Amount1.5 RIGHT ON BILLS CREEK RD.RIGHT INTO
12. CASING: Wall Thickness SWEET BRIAR FARMS.GO TO 15TFORK LOT#10.
Depth Diameter or Weight/Ft Material _
From 0 To 60 Ft. 6-1/4" SDR21 PVC
From_To_Ft
From_To_Ft_ �� �.
13. GROU Depth Material Method t III'3 T:
From 0 To 20 Ft OUEKRETE POURED
From_To Ft
14.SCREEN: Depth_ Diameter Slot Size Material
From_To_Ft._ in in. ? `_v'
From_To_Ft._ in. in. v
15. SAND/GRAVEL PACK: t
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 T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SICKATURE OFPERSON 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

307467
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 ❑ Induustrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: LAKE LURE County RUTH Topographic/Land setting
SWEETBRIAR S.-LOT#31 ❑Ridge ❑ Slope ❑ Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:JOE PETRILLO Latitude/longitude of well location
Address SWEETBRIAR S. _
(Street or RouteNo.) (degrees/minutes/seconds)
LAKE LURE NC 28746 Latitudellongitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
5(�—6024399 DEPTH
Area Code Phone number From To
4.DATE DRILLED 01/25/05
5.TOTAL DEPTH: 365 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 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): 3 METHOD OF TEST ARD number and common names
10. WATER ZONES(depth): HWY.#64/74A W.FROM RUTHERFORDTON.
11.DISINFECTION:Type CHLORYTE Amount 9.5 RT. ON BILL'S CREEK RD.RT ON SWEETBRIAR S.
INTO SWEETBRIAR SUBDV.LOG CABIN APPROX.
12. CASING: Wall Thickness 3/4 MILE ON RT.(LOT#31)
Depth Diameter or Weight/Ft. Material
From 0 To 100 Ft 6-1/4" SDR21 PVC
From_To_Ft
From To Ft
T: _
13. GROU_Depth Material Method C3 s
From 0 To 20 Ft.OUII{RETE POURED f
From_ToFt.
14.SCREEN: Depth_ Diameter Slot Size Material
From_To_Ft._ in. in. s—
From_To_Ft_ in. in.
15. SAND/GRAVEL PACK: 72
Depth Size Material a
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 TRU(�TION STANDARDS,AND A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
BIGNAIURE 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

307466
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:UNION MILLS County RUTH Topographic/Land setting
1700 THERMAL CITY RD. ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:CARROLL COSTNER Latitude/longitude of well location
Address 1700 THERMAL CITY RD. _
(Street or Route No.) (degrms(mmutes/seconds)
UNION MILLS NC 28167 Latitude/longitude source: ❑ GPS El opographic map
City or Town State Zip Code (check box)
8(_28)-289-5314 DEPTH
Area Code Phone number From To
4.DATE DRILLED 01/04/05 _
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"+"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 sirface 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 ARD number and common names
10. WATER ZONES(depth): HWY.#221 N.FROM RUTHERFORDTON. LEFT
11.DISINFECTION: Type CHLORYTE Amount 4.5 ON NANNYTOWN RD.RIGHT ON THERMAL CITY
12.CASING: Wall Thickness
RD.6/10 MILE ON LEFT.
Depth Diameter or Weight/FL Material
From 0 To 90 FL 6-1/4" SDR.21 PVC
From_To_FL_
FromT: To_FL_
13.GROU_Depth Material Method
From 0 To 20 Ft.OUEKRETE POURED rn
a
From To_Ft.
14.SCREEN: Depth Diameter Slot Size Material
- c=
From To Ft. in in.
From_To—Ft._ is in.
15. SAND/GRAVEL PACK: _
Depth Size Material v
From_To_FL_
From To FL
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
i Lf
1117 SIGNATURE OF PE SON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

307465
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: UNION MH,LS County RUTH Topographic/Land setting
THERMAL CITY RD. ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:RODNEY BLEVINS Latitude/longitude of well location
Address THERMAL CITY RD. _
(Street or Route No.) (degrees/minutes/seconds)
UNION MILLS NC 28167 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
(g.28 —286-4727 DEPTH
Area Code Phone number From To
4.DATE DRILLED 01/04/05 _
5.TOTAL DEPTH: 305 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 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): 5 METHOD OF TEST ARD number and common names
10.WATER ZONES(depth): HWY.#221 N.FROM RUTHERFORDTON.LEFT
11.DISINFECTION:Type CHLORYTE Amount 7.5 ON NANNYTOWN RD.RIGHT ON THERMAL CITY
12. CASING: Wall Thickness
RD. 1 DR ON RIGHT PAST MIKES MTN.RD.
Depth Diameter or Weight/Ft Material
From 0 To 150 Ft 6-1/4" SDR21 PVC
From_To_Ft_ 7-1
From_To_Ft_
13. GROUT: Depth Material Method r: 1
From 0 To 20 Ft.QUH{RETE POURED
From_To_Ft
14.SCREEN: Depth Diameter Slot Size Material
From_To Ft._ in. in.
From_To_Ft._ in. in. - c
15. SAND/GRAVEL PACK: w
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 COP OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
, 6
SIGNATURE OF PE SON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.0712001

W 309806
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 ® MunicipaVPublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: FOREST CITY County RUTH Topographic/Land setting
827 OLD BALLPARK RD. ❑Ridge ❑ Slope ❑ valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:BECKTE EDWARDS Latitudellongitude of well location
Address 827 OLD BALLPARK RD.
(Street or Route No.) (degrees/minutes/seconds)
FOREST CITY NC 28043 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8g28)-286-4350 DEPTH
Area Code Phone number From To
4. DATE DRILLED 03/04/05 _
5.TOTAL DEPTH: 59 DRILLING LOG
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 39 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface* 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): BUS.74 W. FROM FOREST CITY.RT.ON
HUDLOW RD. LEFT ON OLD ROSS RD.RT. ON
11.DISINFECTION:Type CHLORYTE Amount 9.2 BALLPARK RD. DRIVE ON RT.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 59 Ft. 24" CEMENT
From To_Ft
From To_Ft_ - c7
13. GROUT:_Depth Material Method d
From 0 To 20 Ft.CEMENT POURED
From To Ft
14.SCREEN: Depth_ Diameter Slot Size Material
From_To_Ft._ is in. rc
From To_Ft._ in. in.
15. SAND/GRAVEL PACK: > v
Depth Size Material
From 39 To 59 Ft 78M GRAVE
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 QF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
- r / S�
SIGNATURE OF 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

Co 309807
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 ® MumicipaUPublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town:BOSTIC County RUTH Topographic/Land setting
621 SALEM CH.RD. ❑Ridge ❑ Slope ❑ Valley ❑Flat
(Sheet Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:JOHNNY HARRIS Latitude/longitude of well location
Address 621 SALEM CHRUCH RD. _
(Street or Route No.) (degreestminutes/seconds)
BOSTIC NC 28018 LatitudcAongitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 28)—245-5794 DEPTH
Area Code Phonenumber From TOE,
4.DATE DRILLED 03/07/05 _
5.TOTAL DEPTH: 46 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To ^"
7. STATIC WATER LEVEL Below Top of Casing: 31 FT. _
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface* 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): 15 METHOD OF TEST STEEL TAPE number and common names
10.WATER ZONES(depth): FROM WASHBURN STORE.GO OUT SALEM
11.DISINFECTION:Type CHLORYTE Amount 6.9 CH RD.1 MILE ON LEFT.(621 ON BOX)SINGLE
WIDE BEHIND BRICK HOUSE
12.CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 46 Ft 24" CEMENT
From_To_Ft
From To Ft._ _
13. GROU_Depth_ Material Method
From 0 To 20 Ft.CEMENT POURED o
From_To Ft u ;�
14.SCREEN: Depth_ Diameter Slot Size Material CD
From To_Ft._ is in. p
From_To_Ft._ in. in. N
15. SAND/GRAVEL PACK:
Depth Size Material
From 31 To 46 Ft 78M GRAVEL
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&IRRSON C 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

V'0 309805
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 ❑ Agricultuml ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use—
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH Topographic/Land setting
LITTLE FARM DR ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER: SPENCER WATSON Latitude/longitude of well location
Address LITTLE FARM DR _
(Street or Route No.) (degrees/minutesiseconds)
RUTHERFORDTON NC 28139 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
2(�-286-2861 DEPTH
Area Code Phone number From To
4. DATE DRILLED 03/07/05 _
5.TOTAL DEPTH: 64 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 44 FT. = �s
(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): FROM RUTHERFORDTON.GO DOWN HWY.
11.DISINFECTION:Type CHLORYTE Amount 9.2 #221 S.APPROX.4 MH ES.RIGHT ON LITTLE
12. CASING: Wall Thickness
FARM DR 15T DRIVE ON RIGHT.
Depth Diameter or Weight/Ft. Material
From 0 To 64 Ft 24" CEMENT
From_To_Ft
From_To_Ft
13. GROUT: Depth Material Method
From 0 To 20 Ft.CEMENT POURED
From_To_Ft
14.SCREEN: Depth Diameter Slot Size Material v
From_To_Ft._ in. in.
From_To_Ft. in in. t
Cfl
15. SAND/GRAVEL PACK: C
Depth Size Material Ln
From 44 To 64 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 UCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
r � 4�2L .F' - "
SIGNATURE OF PY 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

00 309803
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:UNION MILLS County RUTH Topographic/Land setting
HUDLOW 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 HUDLOW RD. _
(Street or Route No.) (degrees(minutes/seconds)
UNION MILLS NC 28167 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8(�-223-4243 DEPTH
Area Code Phone number From To -
4.DATE DRILLED 03/22/05
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 temunated 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.#221 N.FROM RUTHERFORDTON.RIGHT
11.DISINFECTION:Type CHLORYTE Amount 6.9 ON HUDLOW RD.APPROX.1 MII.E ON RIGHT
12. CASING: Wall Thickness NEW DRIVE ON RIGHT JUST PAST FORNEY RD.
Depth Diameter or Weight/Ft Material
From 0 To 70 Ft 24" CEMENT
From_To_Ft
From To Ft
T: T
13. GROU_Depth_ Material Method
From 0 To 20 Ft.CEMENT POURED
From_To_Ft
14.SCREEN: Depth Diameter Slot Size Material av IV
From_To_F[._ in in.
From_To_Ft.— in. in. t
15. SAND/GRAVEL PACK: CD
Depth Size Material C3�
From 55 To 70 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
SIGNATURE OF P> 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. s 309799
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#T828)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: RUTHERFORDTON County RUTH Topographic/Land setting
AIRPORT RD.-LOT#2 ❑Ridge ❑ Slope ❑ Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER: GRADY SMITH Latitude/longitude of well location
Address AHIPORT RD.-LOT#2 _
(Street or Route No.) (degreestinumtes/seconds)
RUTHERFORDTON NC 28139 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
(864)—578-3269 DEPTH
Area Code Phone number From To
4. DATE DRILLED 03/10/05 _
5.TOTAL DEPTH: 405 DRILLING LOG
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To -
7. STATIC WATER LEVEL Below Top of Casing: 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 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): 3 METHOD OF TEST ARD number and common names
10. WATER ZONES(depth): HWY.#9 S.FROM MILL SPRING.LEFT ON
12. DISINFECTION:Type CH CHESNEE RD.JUST BEFORE LAMBS GRILL.
LORYTE Amount 10.5 TURN RIGHT ON AIRPORT RD.2`m DRIVE ON
12. CASING: Wall Thickness LEFT.
Depth Diameter or Weight/Ft. Material
From 0 To 100 Ft 6-1/4" SDIL21 PVC
From_To_Ft.
From ToFt_ tppC
13. GROUT: Depth Material Method p
From 0 To 20 Ft.OUHOtETE POURED y
From To_Ft p n
14.SCREEN: Depth Diameter Slot Size Material r 3
From_To Ft._ in in. co
From_To_Ft._ in. in.
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 COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATUXE OF SON CONSTRUCTING THE'WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center—Ralcigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

bs 309798
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)
L WELL USE(Check Applicable Box): Residential 0 Municipal/Public D Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town:RUTHERFORDTON County RUTH Topographic/Land setting
BIG ISLAND RD. ❑Ridge ❑ Slope ❑ Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER: DERICK ELLER Latitude/longitude of well location
Address BIG ISLAND RD, _
(Street or Route No.) (degrees/minutes/seconds)
RUTHERFORDTON NC 28139 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8�8 —248-9131 DEPTH
Area Code Phone number From To
4.DATE DRILLED 03/15/05
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 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 ARD number and common names
10.WATER ZONES(depth): HWY.#221 S.FROM RUTHERFORDTON.L
11.DISINFECTION:Type CHLORYTE Amount 6.5 RIGHT ON JACK MCKIIQNEY RD.RIGHT W.V.
THOMPSON RD.RIGHT ON BIG ISLAND RD.
12. CASING: Wall Thickness APPROX. 2/10 MILE ON LEFT.
Depth Diameter or Weight/Ft. Material
From 0 To 120 Ft 6-1/4" SDIC21 PVC
From_To_Ft
From To Ft_
13. GROU_Depth Material Method C)
From 0 To 20 Ft.OUHZRETE POURED
From_To_Ft. �o K
14.SCREEN: Depth Diameter Slot Size Material '3
From_To_Ft._ in. in.
r 703
From_To_Ft_ in 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
CO CTION STANDARDS,AND THAT A COPY F THI RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNAOFRON COINWELL DATE
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

(�o 309797
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: UNION MILLS County RUTH Topographic/Land setting
270 HEMPHILL RD. ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER: TERRY HILL Latitude/longitude of well location
Address 270 HEMPHILL RD.
(Street or Route No.) (degrees/minutes/seconds)
UNION MILLS NC 28167 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
(828)-286-8040 DEPTH
Area Code Phone number From To
4. DATE DRILLED 03/15/05 _
5.TOTAL DEPTH: 185 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 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): 6 METHOD OF TEST ARD number and common names
10.WATER ZONES (depth): HWY.#221 N.FROM RUTHERFORDTON. LEFT
I I.DISINFECTION:Type CHLORYTE Amount 3.5 ON SCHOOLHOUSE RD.LEFT ON PAINTERS GAP
12. CASING: Wall Thickness RD.RIGHT ON HEMPHILL RD.APPROX. 1/4 MILE
Material
Depth Diameter or Weight/Ft ON LEFT ACROSS T&C AUTO REPAIR.
From 0 To 75 Ft 6-1/4" SDR21 PVC
From To_Ft
From To_Ft
T:13. GROU_Depth Material Method
From 0 To 20 Ft.OUHUM POURED a
From To FL -v t
14.SCREEN: Depth Diameter Slot Size Material
From_To_Ft._ in. in. ppn. i
From_To_Ft._ in.
15. SAND/GRAVEL PACK: C:)
Depth Size Material Ln
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
l S146NATME 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

0\1 3L? 9792
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 IQ Municipal/Public Ll Industrial El Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town:ELLENBORO County RUTH Topographic/Land setting
DYCUS RD. ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER: TV ECKARD Latitude/longitude of well location
Address DYCUS RD.
(Street or Route No.) (degrees/minutes/seconds)
ELLENBORO NC 28040 L.atitudetlongitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
(828)—453-9013 DEPTH
Area Code Phone number From To
4.DATE DRILLED 03/07/05
5. TOTAL DEPTH: 305 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Ilse"+"if Above Top of Casing) _
C_
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 OFFICE.GO OUT GLOVER RD.RIGHT
ON HOLLIS RD.RIGHT ON DYCUS RD.2/10 MILE
11.DISINFECTION:Type CHLORYTE Amount 7.5 ON RIGHT.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 90 Ft 6-1/4" SDR21 PVC
From To_Ft_ h
From_To Ft y.
13. GROUT: Depth_ Mat_erial Method v
From 0 To 20 Ft.Otfl%RETE POURED +
From_To_Ft co14.SCREEN: Depth Diameter Slot Size Material o
From To_Ft._ in in. N
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
zUC ION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PEPSONCONSTRUCTING 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

309i90
WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)RODNEY ROBBINS CERTIFICATION# 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® MunicipaUPublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: FOREST CITY County RUTH Topographialand setting
4251 S.US HWY.#221 ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER: GORDON SETZER Latitude/longitude of well location
Address 4251 S.US HWY.#221
(Street or Route No.) (degrees/minutes/seconds) _.
FOREST CITY NC 28043 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 28)—288-0809 DEPTH
Area Code Phone number From To
4.DATE DRILLED 03/14/05
5.TOTAL DEPTH: 505 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 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): 2 METHOD OF TEST ARD number and common names
10.WATER ZONES(depth): HWY.#221 S.FROM FOREST CITY.GO DOWN
THE HILL PAST TERRY CANTRELL'S STORE.
11.DISINFECTION:Type CHLORYTE Amount 13.5 STORAGE BUILDINGS ON LEFT.(4251)
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 100 Ft 6-1/4" SDR21 PVC
From To_Ft._
From To Ft
T:
13. GROU Depth_ Material Method ry
From 0 To 20 R.OUIKRETE POURED u
From_To_Ft rp
14.SCREEN: Depth Diameter Slot Size Material C3
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 S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON C014MUCTING 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

309789
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 PMMIAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH Topographic/Land setting
HOGAN RD. ❑Ridge ❑ Slope ❑ Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:STEVE GOWAN,JR. Latitude/longitude of well location
Address ROGAN P.D.
(Street or Route No.) (degrees/mmutes/seconds)
RUTHERFORDTON NC 28139 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
(Ij28)—289-8623 DEPTH
Area Code Phonenumber From To ...
4.DATE DRILLED 03/23/05
5.TOTAL DEPTH: 505 DRILLING LOG
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 Fr. 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(glint): 2 METHOD OF TEST ARD number and common names
10.WATER ZONES(depth): FROM RUTHERFORDTON GO DOWN HWY.
RIG
11.DISINFECTION:Type CHLORYTE Amount 13.5 R S. RIGHT ON HOGAN RD. ll2 MILE ON
RIGHT.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 90 Ft 6-1/4" SDR21 PVC
From_To_Ft
From To Ft_ t"
13. GROUT_: Depth_ Material Method
From 0 To 20 Ft.OUEKRETE POURED
From_To_FL m
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
CONSTRUCTION STANDARDS,AND THAT A CO/PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/l 7Z Z� � ,I- '9 -?- C�
s SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

U` 309787
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 PI'1'TMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH Topographic/Land setting
TWIN LEAF LANE ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:JIMMY HOOPER Latitude/longitude of well location
Address TWIN LEAF LANE
(Street or Route No.) (degrees/minutes/seconds)
RUTHERFORDTON NC 28139 Latitude/longitude source: ❑GPS ❑Topographic map
City or Town State Zip Code (check box)
L8)-4294671 DEPTH
Area Code Phone number From To -
4. DATE DRILLED 03/30/05 _
5. TOTAL DEPTH: 365 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 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 I SA 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.#221 N.FROM RUTHERFORDTON.GO A
COUPLE OF MH ES PAST RS CENTRAL ffiGH
11.DISINFECTION:Type CHLORYTE Amount 9 SCHOOL.LEFT ON TWIN LEAF LANE.GO 50
12. CASING: Wall Thickness YARDS.TAKE NEW DRIVE TO LEFT.
Depth Diameter or Weight/Ft Material
From 0 To 160 Ft 6-1/4" SDR21 PVC
From_To_Ft_
From_To_Ft_
13. GROUT: Depth Material Method
From 0 To 20 Ft OUH(RETE POURED
-n
From_To Ft
14.SCREEN: Depth_ Diameter Slot Size Material tb
From_To_Ft_ in in. �
From_To_Ft._ in
15. SAND/GRAVEL PACK: cft
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 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

00
� 314UO3
North CVONw•Depe/VneM Of ErrmirorwhtM vnd Nsiwsl Rrrsoweu.DWbkkn of Wdar Ousaty•Groundwater Section
t0,7s Mea lfarOke OsrMar-Rsidd4 N.O.27aaF1e�bPhoew p/aj 73,7.�21
WELL CONSTRUCTION RECORD WELL CONTRACTOR: ' °may
WELL CONTRACTOR CERTIFICATION S:
STATE WELL CONSTRUCTION PERMIT/:
1. WELL USE Jcmwo AppeNM Msk Rerdtmdr 2--1wniclpel E3 Inmotrlr❑ Ayrkuqurol❑ Monllo*v❑
Reaovegt p N..t Pump Warr Mooed O Outer❑ U Dowr.Ust use:
2. WELL LOCATION;(Shaw ekNoh Of d»kicallon below) r.t W s ! �' , �:
NesseslTenn: FO./i"r s rt Countf. � '_. —
D:P H
NMM11�nsold MrMU/s.Cemnaray.er a ld eeda+and tot No.) DRiILINQtAQ - Fom�.4t DssOApk^
g. OWNER .�.SZ1e From TO
AddrON !JR
At StF1dS�c?
CayMTasO am nFCsOe r
. DATE DRILLED 5
b. TOTAL DEPTH "'
S. CUTTINGS COLLECTED YES( NO[]'� —
7. DOES WELL REPLACE EXISTIP W"? YES ErNOO
S. STATIC WATER LEVEL SrOw TOP Of Casklp: �•
!. TOP OF CASING ISM_ FT.AbM LUM Surtaoe• N
vivo eraestm Hnaktoomi Wor kdow Will sv&"fNabes a vwWm la savor- `-" =f7f o
rsnaswak"ANOM20 NIS a,
10. YIELD Wpn*. 2 � METHOD OF TEST� �
11.WATER ZONES(dap":...o i• °
17. CHLORINATION: Typo .A AmWfd N eddkWW WscO Y ne*bd u"Wd of knn
13.CASING: )ham^2 10d�S
Was ttatlutess mom (Show dksoamt mm daalann Irom to Isss:nt0 Slrts
isntsur arwslptYF1.
FRMn� TO—Dep� O
z�' .FL f •r r ^'� ,: Roods.ar okrr Rm wlsrMGs 1*41
r
Flom-.TO FL
From To FL ra'
14.GROUT:
Depth Maledw memo
From TO �FL _ �t.n r s
Fran TO FL —
15. SCREEN: "
Depth Dimmier Slat Slsi Maledr
from TO`._Ft, In.
From TO_FL kL —�•
From TO__..FL_ -
1S. &MMGRAVELPACK: -
Depth eke MatWd x
From TO FLU—
from TO FL.,.-.-- ry,$
17. REMARKS:
I DO NERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCOROANCE WRH ISA WGAC 2C.Y/ELL
CONSTRUCTIM STANDARDS,AND THAT ACOPY OF Two raCORO K44 SEEN PROYIOEO TO THE Y/EtL Dn�'�
FOR OFFICE USE ONLY —� �' � a •f
FORicmw
a10NAirmDFpERaa+OOtgTR�f1C1a1O111E whltin706sy1
SAN*wondw lWklsnofwwrowMA4 r�R ce,lrkY.l•a
asA+IfO. �..r�

i 310002
Nonh Cw*Ma•Oepereram M Ewbwow o end Nalwal Resoueu-DFnelon e1 WMer Oueery•(I.Lff were(SecWn
ISM UW 9eevke CenWr-RWeW N.C.4TeYe-lGW4%one(9191 73T-aY21 A&F WELL DRILLING
WELL CONSTRUCTION RECORD WELL CONTRACTOR: . - L!�er- AN PdMp 63m,�Rv SE77C,
WELL CONTRACTOR CERTIFICATION 0: �"l ' "13Dstic, NC 2801 a
'STATE WELL CONSTRUCTION FERMITI: -'8Z6241773
I. WELL USE App wN o"p Residential E /munidpd❑ m&mtr d❑ AgrlWNura1❑ Mordlo p 0
Recovery 0 Hat Pump Waw irlecllon ❑ Olher 0 II Oowr.List Use:
2. WELL LOCATION:(Show e1uk1�4f ea loedhn below) r� "
NesrutTown: 7l ', z cz w) - L Cgpey:.c �.T.lF r 7 0z✓
NMdNene&Wokvrsw ,pinmwft.oreubdvtdmwW Lot W) DRILLING LOG - DEPTH -
8. OWN lo,)ez t Fmm 7e Fowa%nPosc wn
AN" ^aQ�c
6 �-
CeyerTehn Wow
ear. AP Go"
4. DATE ORILLEO` _
B. TOTAL DEPTH
S. CUTfINOSC0LLECTE0 YES❑ NO[� ro as
7. DOES WELL REPLACE EXISTINQ WELL? YES❑ NOE3-
8. STATIC WATER LEVEL Slaw Tap Of Ca4g: t T FT.
Ln
tua•a'1 AeeN Top M Ce" "^
9. TOP OF CASH iS_(4;I. / FT.Above land Sudece' it
'M1F of eeehao lwomo d ovw bw"low owAea fov*"a vwWew In eeaw-
"we webl.ARCACeC le
to. YIELD(9pn*. METNOOOFTEST,¢ •/,
11.WATER ZONES(depth);
12. CHLORINATION: Type Amounl If addlOonM.Pete la muted use bad M ken
13, CASINO: �`� � Goa/y2'" K
Depth DWrwter a WfWM MMdM (shwa'dkeellen erd dfum Dom a pee:aeo Sow
From To_=7 FL X':;k - —oz Pow!
From—To FL
From To FL d'Z
it.GROUT. a
Depth Maimead
From 0 Meswd (9
From To F1.
15. SCREEN: \ �(
Depth OWnelor Slot Ski Metedd 3
From —To—Ft
_ in. k1
From To�FL_ k. —in
From To_..FL_
/S. 8#JMRAYEI.PACK:
Depa FI 8ize. �-- maw"
From To
from To FL� , lors6
17. REMARKS:
1 CO NERE9Y CERTIFY THAT TMS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA tNCAC IC,Y/EU
CMTRVCpON STANOMM AND THAT A GOPY, OP TIES RECORD No BEEN PFMI)fO TOT11E YELL D`%%EP.
FOR OFFICE USE ONLY De:E
*AM Ift tp9NATUREOF PERSDNfDIreTRUC1e1f 1Xi 1nrELL
su6a+1eA�11iMOMIWaotweurOrrMRalasd"'rw tieeon•vWBlfllll70 ears
fee t,Ev.1:n
saAal lle.

fez A&F WELL DRILLING 1 J 1
AND PUMP SERVICE,INC.
t3mundwmar Sacuon 911 Hwy.Business 74
NenhCW*Mna.06OWWANOfEm4uwmMard" twefwaou'6a-OMala^e1WWrav�tY• Bostic, NC 28018
te3e MM aferwke CalMr-RdW4 N.M 2?fW/R76PAo w(9111)733.3221 828-247-1773
WELL CONSTRUCTION RECORD WM CONTRACTOR: . .
WELL CONTRACTOR CERTIFICATION 0:_�
.,/STATE WELL CONSTRUCTION PERMIT#:
I.- WELL USE ApRIkMMM/eMj RaMldsndMiL�J 1�M+MdWI[3 �UW© A9+�V(ri❑ Ma11ta*v o
PwA Recovery o most Pump water I*cftn E3 'Dow[] It Orr«,UMl Uu:
2. WELL LOCATION:(ShyNr 1111101011 Of"bugm Maw)
Nlwe Nwrw rwe N�nlaf.OMrtwwrdl7•er aiAd'AdOn MMdtel llo.) DRILLING Log DEPTH
3. OWNER zau I Fmm TO FomeSs�D
Addro" -------------
Clwr«Yews l> :4G
4. DATE DRR LED
S. TOTAL DEPTH
S. CUT7M103 COLLECTED YES Q NO� - --
7. DOES WELL REPLACE EXISTING WELL,? YES �� -
S. STATIC WATER LEM 8810erTop of Cwkw FT v <
luw•�•M MaaTeoN(.pMg1
Y. TOP OF CASING IS V 4" FT.M»w Land SYrbee'
Tq sr*wows 1wrw.MWed NNr I dewiwd ewleeerNWra••warNns Mseeoer-
e.ae.weenANCAcec.cln �}i f cn
1a- YIELD(am*: r2-METHOD OP TEST
m WATEA ZONES(deprlj:
m CHLORINATION: Type A�n1`- a aadx ,a WSW a nMMa.d use t a Irsre
13.CASING: �O ! 1I�AT t
w (Show dk'eNo"Mn6 ds+n,ro ran at Na+ M�v s1N.
Frem Oplt'�D 7 _ t ,� i GT tb�s.«wlwr nsep mwme,t�": R�
Front -To FL.•---
From 74— FL
1M1, GROUT:
Depth �Me�dw M.c,U,wd
From fS To 30-FL�31.1LS�J'i4ss- ISM----
Fr«w To FL Q
15.SCREEN; -
Depth DwOeter Sint Sits MAW"
Fran To Ft kl .--&L
From To—FL_ UL —i^•
Prom To FL— In. —- -•
IS. SANWPAVEL PACK:
Depth Site Maws �-
From To R mac"
From To FL
1T. REMARKS:
Igo HSREOYCERTWY THAT TMEWe"WASCONSTRUCTEDINACHEWtMISA "CAC2C.YIELL
CT
CONSTRUION STAiWMDS.AND THAT ACopy OFTNIS MCDRD M OEEN PROVIDED TOTNE Ylta l O"NFP-
�o
FOR OFFICEUSE0111Y �y pc RSpI/apNSTR11C1eAImaW§tt p..E
oweu.c a t�dov!WwrOMMtIr Awitnin�ouys
tie•1 tY•11271

sbgI 'I5
WELL CONSTRUCTION RECORD
Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
North Carolina- INDIVCERTIFICATION# 0 201
WELL CONTRACTOORR((INDIVIDUAL)NAME (print)RICHARD MCCRARY
BARKER CONSTRUCTION,INC.BARKER WELL&PUMP PHONE # [phone]
WELL CONTRACTOR COMPANY NAME pS$OCIATED WQ PERMIT#
STATE WELL CONSTRUCTION PERMIT# 1871 (if a pliable)
(if ap licable)
1. WELL USE(Check Applicable Box):Residential® Municipal/public❑ industrial❑ Agricultural❑ z'
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use _._..
2. WELL LOCATION: Topographic/Land setting
LAKE LURE county-RUTHERFORD ®Ridge ❑Slope ❑Valley ❑Flat
Nearest Town: (check appropriate box)
CUT AWAY ROAD Latitude/longitude of well location
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code)
(degresstminutes/seconds) -
3. OWNER ANDREW HART Latnude/longitude sotvice:❑GPS❑Topographic map
Address 60 BAIRD STREET (check box)
(Street or Rome No.) DEpfII DRB.LINGL.OG
ASHEVILLE NC 28801 To Formation Descriptiond
Zip code From
City or Town State P
8(-�- 777-6442
Area code-Phone number
4. DATE DRILLED FEBRUAR_ Y 23,2005— --_— -x�
5. TOTAL DEPTH: 22_5
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top ofCasing: 30 FT. _� O
(Use-+-if Above Top of Casing) —_
8. TOP OF CASING IS 1.33 FT.Above Land Surface
•Top of casing term raced at/or below land surface requires a
variance in are rdaam with 15A NCAC 2C.0118.
9. YIELD(gpm): 30 METHOD OF TEST TIMED
lO.WATER ZONES(depth): L—OC TTA H
BY PUMP----- Amount Show direction and distance in miles from at least
11. DISINFECTION:Type �Vatl Thickness two State Roads or Canty Roads.Include the road
12. CASING: numbers and c�tnm°D names'
DepthT0- Diameter or DR21 Ft. Material 51a-v ,� �,2 J
From 0 To 35 FL 6 1/8 SDR21 PVC � A /�'�-e,-�,, -�CIJ�7
From To Ft.
From To Ft. llliii �/, iGID
Material Method _/
13. From
TO-2-0
O Depth0 Ft.CONCRETE POURED �U -
From n
From To Ft. Q (. -
14. SCREEN: Depth Diameter. Slot Size Material
From
To FL in. in. �DL07')
From To F[. in. n•
15. SAND/GRAVEL PACK: s� Material N�
Depth
From To FL
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED O ACCORDANCE�I�SEROVIDED TO THE L O '
CONSTRUCTION STANDARDS,AND THAT
A COPY OF 05
SI NATURE OF PERS NCO S UCTING
LL ATE
Submit the original to the Division of Water Quality,Grotmdwa Section, Mail Service Center REV.07 2001
27699-1636 Phone No.[phone],within 30 days.

WELL CONSTRUCTION RECORD 308818
North Carolina Department of Environment and Natural Resources-Division of water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (Print) Jam Wcamp, .Tr_ CERTIFICATION 71 "tR
WELLCONTRACTORCOMPANVNAME ramn' Wel i R Pnmprn t Tnr PHONE # EI R4 3-7322
STATE WELL CONSTRUCTION PERMTIV ASSOCIATED WQ PERM1Tli
if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential O?Municipal/Public❑ Industrial ❑ Agricultural ❑
Monitoring❑ Recovery [] Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCA IO Topographic/Land setting
Nearest Tlow.nL:' ,M�aao,t.y�County�l� Lrkidge ❑Slope OValley OFlat
(check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitudellongitude of well location
3. OWNER: !'� (degrees/minutes/seconds)
Address ( D Latitude/longitude source:OGPSOTopographic map
-�--- ( tree[or Route No.) � _ (check box)
-J-r✓I I'IA -Fx 7 D(o „�. DEPTH DRILLING LOG
City or To State Zip Code From To Fo ation escript on
(�L't)- �74- - &�01 ll 7 3
Area wde-Phone num
4. DATE DRILLED 0 - _D
5. TOTAL DEPTH: 10
6. DOES WELL REPLACE EXISTING WELL? YES O NO
7. STATIC WATER LEVEL Below Top of Casing:�S T. -
(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.011S.
9. YIELD(gpm):�0 METHOD OF TEST Air
10.WATER ZONES(depth): J D(1
LOCATION SKETCH
11. DISINFECTION:Type Chlorine Amount UQ 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. 1M
From 0 To—IL-Ft. 6 1 /d SDR21 Pam_
From To Ft. 23
From To Ft. --
13. GROUT: Depth Material Method
From 0 To_2Q_Ft. Neat Cement Hand �q�J
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. y3a
K
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material -w
From To Ft. CA
-
From To Ft. r
16. REMARKS: -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER -
SIGNATURB OF PERSON C NSTRUCTING THE WELL DATE -
tV 1
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Cent_v-- co �-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. '
GW-1 REYA9/2004g = .
- r: ri-

WELL CONSTRUCTION RECORD q
North Carolina Department of Environment and Natural Resources-Division of Water Quality 308817
WELL CONTRACTORMQDIVIDUAL)NAME (print) 61am W. amp, ,Tr_ CERTIFICATION# 21 3A
WELL CONTRACTOR COMPANY NAME ralilgil S Wa11 R plImp r_p r Tnn_ PHONE # 62a453-7'I22
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
if applicable) (if applicable) _-
1. WELL USE(Check Applicable Box):Residential O Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery O Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCA ON _ Topogrphic/Land setting
NearestTowl • `'1�1 Z County ORidge ¢Slope OValley ❑Flat
(check appropriate box)
(Street Name,Numbers,CommumryQ,Subdivision,Lot No,Zip e) Latitude/longitude of well location
3. OWNER: 7 (degreesfminutes/seconds)
Address Latitude/longitude source:OGPSOTopographic map
. or Route ANf) (check box)
C 1F V g 5p D q 3 DEPTH DRILLING LOG
Cuy or Town S ! Zip Code From o FO atiOn I2escripti
0 �0
Area code-Phone nm
4. DATE DRILLED ' 3• r
5. TOTAL DEPTH: Jn qls
6. DOES WELL REPLACE EXISTING WELL? YES40 NO d
7. STATIC WATER LEVEL Below Top of Casing: U 0 T.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1 FT.Above Land Surface*
-Top of easing terminated allot below land surface requires a
Variance in accords cewith 15A NCAC 2C.011&
9. YIELD(gpm): METHOD OF TEST
10.WATER ZONES(depth): 3L 0 D 3 I&T —
LOCATION SKETCH
11. DISINFECTION:Type Chlorine Amount Show nection and distance in miles from at least
12. CASING: Wall Thickness two to Roads or County Roads.Include the roah
Depth Diameter or Weight/Ft. Material no rs and common road names.
From 0 To 40_Ft. 6 1 /4 SDR21 PVC ^ �W�" � =
From To Ft. C_ po'p a'
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/GRAVEI.PACK:
Depth Size Material
From To Ft.-
From.-To-Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN AC ORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER _
SIGNA RE OF PERSON CONSTRUCTING THE WELL DATE - CS
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. co c
GW-1 REV,Ct42004 c

WELL CONSTRUCTION RECORD 308814
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) names N Camp., Jr- CERTIFICATION# 2138
WELL CONTRACTOR COMPANY NAME ramp, s wa11 R Pump ra a Tnr PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# -- ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential 9'Mmicipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery O Heat Pump Water Injection❑ Other O If Other,List Use
2. WELL LOCA IO • Topographic/Land setting
Ne est ow2n: County .irt.q� ORidge ❑Slope OValley OFlat
Su Yl o pQ, LA - (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot
No.,Zip Code) Latitudeftongitude of well location
3. OWNER:�.Q I t \Ix l.tl£W (degrees/minutes/seconds)
Address U n 1C g�j q - _ Latitude longitude source:OGPSOTopographic map
_ Street or Route o.) (check box)
1/-A-ke ki�t-(e N C J�'�+�..(, DEPTH DRILLING LOG
City or T wn State Zip Code From To F anon Descriptio
C - �8G - ICU 0
Area code-Phone numbeall
4. DATE DRILLED • -1
5. TOTAL DEPTH: `FLU -
6. DOES WELL REPLACE EXISTING WELL? YES,Q NO
7. STATIC WATER LEVEL Below Top of Casing: 1 JT FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1 FT.Above Land Surface"
*Top of wing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm):�ME OD OF TEST Air
10.WATER ZONES(depth): `�g
LOCATION SKETCH
11. DISINFECTION:Type rhlorine 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 0 To �Ft. 6 1 /Q SDR21 PVC
From To Ft.
From To Ft. ` n
13. GROUT: Depth Material Method 3
From 0 To_2�Ft. Neat Cement Hand
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material _ r
From To Ft. in. in.
From To Ft. in. in. I
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. u
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
3 - S `
SIG TURF OF PERSON CONSTRUCTING THE WELL DATEL
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.M004 � ,

WELL CONSTRUCTION RECORD 1 308813
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (prinQ James W Camp_, .Tr_ CERTIFICATION# 138
WELL CONTRACTOR COMPANY NAME apt A WPI I W pump rn Inn PHONE # �6 134�2
SPATE WELL CONMUCTION PERMIT# - ASSOCIATED WQ PERMIT#
if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential Lr Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery O Heat Pump Water Injection❑ Other O If Other,List Use
2. WELL LOCA 0 1: pp Topographic/Land setting
N ares Tow\n`: County nny ORidge ®Slope OValley OFlat
"t� .)Q^��ti I r A LA4 (check appropriate box)
(Street Name,Numbers,Community, (u�bdivisiotn tNo.,zip Code) LatitudMongitude of well location
3. OWNER: lit 1ALl �IAI�A/fi AF. (degre&rninutes/seconds)
Address CC �CX 6—9 Latitude/longitude source:OGPSOTopographicmap
(Street or ute No.)
(check box)
� C ��"�e.'(�, DEPTH DRILLING LOG
try or Town Slate Zip Code From To Forrnati n Des iption
L' - 21 - 21 0 o jOU
Area code-Phone number QQ
4. DATE DRILLED
5. TOTAL DEPTH: �f)b t1 r`. GA-A
6. DOES WELL REPLACE EXISTING WELL? YES O NO
7. STATIC WATER LEVEL Below Top of Casing:ADO FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1 FT.Above Land Surface'
-Top of casing terminated agar below land surface requires a
variance in accord an with 15A NCAC 2C.0118.
9. YIELD(gpm): _METHOD OF TEST Air
10.WATER ZONES(depth): AU LOCATION SKETCH
11. DISINFECTION:Type rhlori 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 road names.
From 0 To - Ft. 6 1 /d SDR21 Pam_ -.C1ot-W
From To Ft.
From TO Ft.
13. GROUT: Depth Material Method �r
From 0 To_2DFt. Neat Cement Hand
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material -
From To Ft. in. in.
From To Ftw in. in.
15. SAND/GRAVEL PACK:
Depth Size Material C
From TO Ft.
From Tc Ft. a
16. REMARKS: - "
GJ
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 OWN - -
SIGN TURF OF PE ON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Cenfrr-"
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.�9/20040

WELL CONSTRUCTION RECORD 3 0 8 8 1 2
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (pdnt) Tames W CamELr TT_ CERTIFICATION#_21 'A
WELL CONTRACTORCOMPANY NAME rammg, b7a1 1 R Primp_!;pr Inc PRONE # B R 2
STATE WELL CONSTRUCTION PERMIT# - ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential%O/Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery O Heat Pump Water Injection❑ Other❑ If Other,List Use
2. NeELmLLOCA�IO � ,,p p TopograSphic/Land setting
Town CounTyp,, -4 DRidge Slope OValley OFlat
. (check appropriate box)
(Strcet Name,Numbers,Community, ubdry ,Lot��No.,Zrp Code) Latitude/longitude of well location
3. OWNER: Wel )E \ L% 1l\I (degrees/minutes/seconds)
Address q Latitude/longitude source:OGPSOTopographic map
(Street or Route No) (chi box)
�k, (_i,(1 r- h f(_ �r� (F; DEPTH DRILLING LOG
,,�arty or Town State Zip Code From To ormaf on De cr ption
Area coda Phone nun
4. DATE DRILLED� • U-
5. TOTAL DEPTH: -
6. DOES WELL REPLACE EXISTING WELL? YES O NO Ql
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): a 6 METHOD OF TEST Air
10.WATER ZONES(depth): to LOCATION SKETCH
11. DISINFECTION:Type Chlorine 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 0 To_qD_Ft. 6 1 /d SDR21 PVC
From To - Ft. U'
From To Ft.
13. GROUT: Depth Material Method Z W
From 0 To_Z_Ft. Neat Cement Hand
From To Ft. N
14. SCREEN: Depth Diameter Slot Size Material t5)
From To Ft. in. in.From To 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
/SIG A F PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Cent;?7 oo
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. —
GW-1 RE#.A9/20041
s,y

WELL CONSTRUCTION RECORD 308811
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME/jprint) � Ei �� (/�Lk-M � Y- CERTIFICATION# . "33
WELL CONTRACTOR COMPANY NAME l-a n"iJ S �U t I I V.1_ it M J . f YL( • PHONE # (g;7J)4 S 3 " 7 3 t
STATE WELL CONSTRUCTION PERMfDt ASSOCIATED WO PERMIT#
(if applicable) ,,,,/ (if applicable)
1. WELL USE(Check Applicable Box):Residential qr Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCAT O r )
Nearest Town: County lA. eY 7aYd dge D Topographic/Land OV setting__��l
Ridge ❑Slope []Valley 1pFla[
,:LUpel h.j4- 1,.Gf 5 (check appropriate box)
(Street Name,Numbers,Communi ,Subdivision,Lot No.,Zip Code) Latitudellongitude of well location --
co
3. OWNER: ReA e �Ul211 (degreestminutc.Vacconds)
Address D `/AI a r . Latitude/longitudesource:DGPSOTopographicmip
'/ (Street or ouie NoJ (check box) eat
V e Yll!E. � 1-- ,3 4 2 9 3 DEPTH DRILLING LOG
City or Town State Zip Code From o Eonration Des riptibn - --
L-) 3 A SaVt7
Area code-Phone number 2�Ori 50 t a YCC
4. DATE DRILLED ✓�' s .�
5. TOTAL DEPTH: 4 o S
6. DOES WELL REPLACE EXISTING WELL? YES 11 NO
7. STATIC WATER LEVEL Below Top of Casing:9FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS ( FT.Above Land Surface*
'Top of casing terminated atlor below land surface requires a
variance in accordance with 15A NCAC 2C.011&
9. YIELD(gpm): 5—METHOD OF TEST i r
10.WATER ZONES(depth): 3g0
LOCATION SKETCH
11. DISINFECTION:TypeL11_o l'1 iLE- Amount C a Shaw 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. S
From To 93 Ft..6�'4 5!)R21 PVc
From To Ft. tIV
From Ft.De
13. GROUT: Depth Material Me d Q
From To o20 Ft. (a Lure 5�aj
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: I
Depth Size Material
From To Ft.
From To Ft. +"
S
16. REMARKS: A
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STAND S,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
- 5-
SIGNATr OF PERSOICONSTRUCTING THE WELL DATE �I
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-I REV.09/2004

WELL CONSTRUCTION RECORD 4 Z 8 8 O C
North Carolina Department of Environment and Natural Resources-Division of Water Quality_
WELL CONTRACTOR(INDIVIDUAL)NAME (print) .Tam W dmPr .Tr CERTIFICATION# 21 3R
WELL CONTRACTOR COMPANY NAME Camp' a" Well P PUMP rn, r Inc PHONE N B B4S 4-7122
STATE WELL CONSTRUCTION PERMIT# - ASSOCIATED WQ PERMIT#
ifapplicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial❑ Agricultural ❑
Monitoring❑ Recovery D Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: 1 ,(,J / Topogr�phic/Land setting
Nearest ToWO/ ���f L.[.LYe County. K l�Lf'Y DYO DRidge ISSlope OValley CFlat
0(!G Y ✓P E K (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitudellongitude of well location
3. OWNER: /r I Gl.y k A'! E q iakc i 1_ (degrees/minutes/seconds)
Address aY Ue C K k d Latitude/longitude source:DGPSOTopographic map
(Street or Royte No.) )F?q (check box)
E i,(.y e N d DEPTH DRILLING LOG
City or Town State Zip Code From To Form lion Description
(---)- 0 7G19 —
Area code-Phone number -
4. DATE DRILLED 3-I -C S q'J —'�2 S Llc o 15r i alJ ✓c r
5. TOTAL DEPTH: �S
6. DOES WELL REPLACE EXISTING WELL? YES D NO
7. STATIC WATER LEVEL Below Top of Casing:�_FT.
(Use"-P'if Above Top of Casing)
8. TOP OF CASING IS 1 FT.Above Land Surface*
•Top of casing terminated■Nor below land surface requires a
variance in accordance with 15A NCAC 2C.01I&
9. YIELD(gpm): IO METHOD OF TEST Air
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type Chlorine Amount u Show direction and distance in miles from at least
12. CASING: Wall Thickness Itwo State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road n s.
From 0 To _Ft. Fi 1 /d SDR21 PVC x
From To Ft.
From To Ft. - kp
13. GROUT: Depth Material Method
From 0 To_Q Ft. Neat Cement Hand )f-
From To Ft.
14. SCREEN: Depth Diameter Slot She Material 0
From To Ft. in. in.D/ Q tD
From To Ft. in. _ in. f 1l f�5 CYfek N j
15. SANGRAVEL PACK: y�
Depth Size Material r �
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 S,AND THAT A CgPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
AAvi
5 os
SIGNATU OF PERSOIJ CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center,..J;
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. `Ij 11, Ii l'i Lti `
GW-1 REV.09/2004
MAR 2 8 n5

From:Scott Gantt To:Stepherre Nilson Date:9/7/2005 Tme:8,30:30 PM Page 4\of f 5
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment,and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) SCOTT GANTT CERTIFICATION#2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS,INC. PHONE#[phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box): Residential ® Municipal ❑ Industrial❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2.WELL LOCATION: Topographic/Land setting
Nearest town: RUTHERFORDTON County RUTHERFORD ❑Ridge ❑ Slope ❑ Valley ❑ Flat
415 LEWIS RD Latitude/Longitude of well location
(Street Name,Numbers,Community,Subdivision,Lot No,Zip Code) 15.25.974/82-00,150
3.OWNER HORTON HOME OF RUTHERFORDTON (degren'mirwtes/seconds)
ADDRESS 342 HW Y 74 BYPASS Latitude/longitude source:❑GPS❑Topographic map
(Sheet or Routc No.) DEPTH DRILLING LOG
RUTHERFORDTON NC 28139 From To Formation Dewnption
City or To-n State Zip Code 0 100 Clay
828-287-3366 100 260 Consolidated Rock
Area Code-Phone Number
4.DATE DRILLED 8/4/05
5.TOTAL DEPTH 260
6.DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7.STATIC WATER LEVEL.Below Top of Casing: 35 FT.
(Use w-If Above Top of Cum,)
8. TOP OF CASING IS 2 FT.Above Land Surface"
'Top of ceeie,ta.r,i otcd.Vor below Imd swfa«rcquira a vuim«in
accordame wth 15A NCAC 2C.D118
9. YIELD(gpm): 4 METHOD OF TEST ARDM
10.WATER ZONES(depth): 210
11.DISINFECTION:TYPE HYPOCHLORITE Amount 11 oa LOCATION SKETCH
12.CASING: Wall Thickness Show direction and distance in miles from at least
Depth Diameter orweighVFt. Material two State Roads or County Roads.Include the road
From 0 To 110 FL 6 1/4" SDR 21 PVC numbers and common road names.
D.GROUT:
Depth Material Method -
From O To 20 Ft. GRAVEL MIX GRAVITY _
14.SCREEN
Depth Diameter Slot Size Material --
From NA To FL in. in. Cn y
15.SAND/GRAVEL PACK
Depth Size Material
-.1
From NA To Ft,
O
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
9/1/05
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.

laT11 �,inAee m a Ei�lrxnenl a and N.Wrd B ware e ..-DM21ae el Wn.r W.Gty-amundwata SectionQQ
Coww-11WWp11,N.0.mwl63B4%wu pig)733.37Z1 ti J
WELL CONSTRUCTION RECORD WELLCONTRACTOR: -4-4 - AGc(l__(��
WELL CONTRACTOR CERTIFICATION I: / S
STATE WELL CONSTRUCTION PERMITI:
1. WELL USE ANiF LL ORI Lt G
ApPAeeMe Beth Ra,IdenrN L�J� Munkfpu�] UMuatrlal❑ Ay�iedprglpltAlI s!�s�
A@Cov"U !hied PUMP WaIW 1148CUvn El OIhw 13 it Oltw,Dal Use: 911 Hwy.8tJOS11C, NU usin s
2. WELL LOCATION;(Show t14o1Ch o11M tol:aron bolowj 828-247-17 313
MNe1Ae� e lWlyaatu0eddon.ne�.1Bo) DRiLLINQIOQ e- OWNER DcP_TH
/l�o, S wit ia- �� �
irpn Te Aft, Fwwa*n omc4oeon
�,
QyerTelel aide "'-
4. OATS DR'111.Eb
S. TOTAL DEPTH-
S. CUTTINGSCOLLECTED YESQ
7. DOES WELL HOL40E EXISTING WELL? YES NO[� N
S. STATIC WATER LEYEL Sabw Top of 9 4g �FT. -a
w"4'IAtomTeoWt:a" d -
,. TOP OF CASYNG ISZ i. FT.Above LOW Sudaoa• a
NeeeMdh�H4IC.Nahlowbnr.wfkerN�eerabneeNeeow- � ,
10- YIELD(Sm o.
METHOO OF TE67
11.WATER ZONES(dopSlj:__.j7
12. ChWRINATKft T r�G�s m-
YPu �' Amount M add4lanN rMee b needed w Wd W tam
13.CASINO: -, i
Wad TNdmea LOCATION 5KQ0
i- aP! . OIIInN10r er Wowm moo" (SAew Grecibn od didenoe ban o1 NNWeve Slap
From1 To�. —FL f— ;2 --, _ Roos.«oMw map fo m it P")
Frain To FL
F1Ur11 To FL � �-
sh q�
It. GROUT:
aPw , Malmw Mellow
Fran ToeZa_�FL A Q GPgAee-L(
From -To FL
IS. SCREEN:
00% D4amlor slat Slgi MatMat
From To' FI_ In. .41 9j
From to FL_ 4L —in.
From To FL_ 41. —in
18. SANMRAVEL PACK:
Doer► SW Mala1M
From To FL ��dd
17. REMARKS:
100 HERESY CERTIFY THAT TIES WELL WAS CONSTRLICTEO W E WITH ISA NCAC 2C.Y/ELL
CONSTRUCTION STANDARDS,AND THAT A DOPY OF INS RECORD INAS EN PROVIOEO TOT1E Y/E!1 oN'sER.
FOR OFFICE USE ONLY _f & s 1- o z
OaM Na $1131"A old PaRSO cmTBUCTR411INS V LL M TE
_ Subait«Odorto OM1 and W&W Ouft.0modaft lftw *in 79 6Ry$ -
,eAW

Nont Ceraena.OePoren bn am of Enwnwnl"Ndnrd Reaou "-DMalan of Wdor Querdy.Groundwater Seceon rt
tole MM lfI Ag Corder-RdWs,N.O.17f9F1e7e-Plwne(91917a1-]73 I
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Z-��` �
WELL CONTRACTOR CERTIFICATION#:
STATE WELL CONSTRUCTION PERMIT#:
A&F WELL DR G
1. WELL USE,.ata.,-��--�APOW14#BezM Rs"nVdO'1Mun4$1❑ Induebld[7 Aprkuhufal®D PWWflIf_ ,INC.
Pump Hecorery U Meet Pp Welor kt(eeNat ❑ CUM(3 if 01hK,Ltal Use: 911 Hwy.Business 74
z. WELL LOCATION:t611 M,akokh of the IMPon b#WA j 828-247-1773
Naf■#al leeea , '" F� ; �. �1 ` Counts---�� G.1��'`��'
NwrrdNwrOaraCamaWyer enetxtfval DRILLING LOG DEPTH
3. OWNER - ��� �'i i�/�� FROM To ForwA*n0ax+Wea
Ad*M ® s�
yy7� -�
W�I i9Na
4. DATE DRILLFA
5. TOTAL DEPTH6- CWMNOS COIMTEO YE
7. DOES WELL REPLACE EXIST# NOEY
O ELL?
YE
I_ r
S. STATE;WATER LEVEL anb►Top of Co6p: _-y,-�-, FT.
� f,�� Was�'#AeaeI"dCabw
f. TOP OF CASM lal..lz _' FT.Above LoW Su1bc#'
'Top of*wine twfalnob#ear bow 1wd eeAea fooabee■ewbea In of a
Aeee tAth teA NCAC>�Alto
10. YIELD(SPf* _.2._METHOD OF TEST; -.f t,
11.WATER ZONES(dW":
o
12. CHLORINATION: Type _/ %,
��;i- AflloarA � k addMbf W apace Is nadM two bd of krm
13. CASINO: �7 y ,
Wag TMfanne LOCATION SKETCH
Depth DWMW orwalge T. WHAM (Stow cksawnMdcotar"bonatbe%tom Min
From TO " RzT r< v Ada,a Gow map MwMee Patti)
Ffen To F
From Tie FL
14. GROUT:
Depth 7 M#add mood
From .L2"e—To .;2,4,LFL .-,;I
-
Frown To FL G 4 L
15. SCREEN: < /
gismo
t)"Ih Damear Sal Slzi Meladd 4
From __To FI__'__ In. ___,_Ir r..�_ F ,.•1 1
RMm To,FI_ kL _Yt
From —To_..,FL_ Im _IrL ,
1S. SANMRAYELPACIC V, v '�
Depth alto M#add
From To FL
From To FL — r
1T. REMARKS:
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH RSA HM 1C.YELL -
CONSTRUCTION STANDARDL AND THAT ACOPY OF TM RECORD HIS BEEN PROIOEO TO THE YlSiL 011,EF „
FOR OFFICE USE ONLY
DOWNS; SIONATUIEOFFERSONCW4TRU0INO) EWEtl W"E
titlYaftatfMwfaOMtltedwwrOuelq.Hrot#leeebf lbaon rAYIN 70 Cure � c.`
IIeAM1ie. ee.1PEr.,:n- . � G���,!

Nate CeraWra.OeFarenem N ErntrwwneM and Mtunu Resouiea•omolat of Wlear Ouaiy.OrouadwNp SKtIOn `.3 N
/ssa A1ae 1flenAee Center-Raa/h.N.C.IMMI 71-Flwna Pie)7=4221
WELL CONSTRUCTION RECORD WALLCONTRACTOR:
WELL CONTRACTOR 61ERTIFICATION 1: >
STATE WELL CONSTRUCTION PERMITS:
,.., 1 q A&FWELLORILLI
G
I. WELL USE�af AFp�"*RoWdmtlal Ea"' Muf I*w 0 InduoWd❑ AWiwkursi MD "fT'"' rf ®E,INC.
Agall"Iy a Host ftM Wank k4eallon ❑ Olhu It pyre(,LWt Uy: 911 wy. u ufess 74
2. WELL LOCATION-(Show 111{e of yte owdo r1 below) $28-247.1773
fleetoslTewtc . = F Conway
Sri. ".
Lowy/ or�den�to"s-) ORiLLIN(iL00 DEPTH
8. OWNER r6.11G ' 2i 7Addrion Flom Te FoaWmDampA
CaypTenn 61Ne
4. DATE DRILLED
6. TOTAL
DEPTH
6. CUTTMSCOLLECTED YESQ NOM-
1. GOES WELL REPLACE EXISTING WELL? YES ENO©
6. STATIC WATER LEVEL Ssloo Top of Cs*gp. , FT.
V. TOP OF CASH IS = FT.Moth LMM Sudws*
'FOP er males w..nlnreee alrw bdM Wa eetleae requires■volanae In maor-
dome wo Ish Ne"n0.9yo
10. YIELD Wn* —METH00 OF TEST r� .'"f
11.WATER ZONES(dflpElj: -��'
ILCHLORINATION: Typo�� � rr" MauM yaddNblW(pearnaWMwtndakrtn
13. CASING:
WSIlbkhmu LOCATION SKETCH
aPIh OWnew &wow^ Ma" (sh"olf AIM ww"arw$bon*I INC MP s"
From—:�To FL X — L_ �l'�- RoroYrrMwMformspoMu!
From To
From To FL
1�. GROUT: � •,�
Depth MalpW MNhod
From �'�' To r, FL,t -iv'c ias )t `"v
Frotw To FL
1S. SCREEN:
OepBt Dlsmear Slat Sizi MatfolM C3
From To - Ft— In. —K A v
Ff= To FL_ an. _In r �
From To FL_ in. _IrL X
18. $ANDMIRAWEL PACK: D�
0" Size Motellsl
from To R
From To FL —
17. REMARKS: /
190 INAESY CERTIFY THAT TIN WELL WAS CONSMICTEO IN ACCORDANCE WITH SSA NCAC JIC.VIELL --
CONS7RUCt1oN STANOARD8.AM THAT A M"OF 7115 RECORD MAS SEEN PROMO TOTIIE ML OANEI±_ _
FOR OFFICE USE ONLY C- so�r.
OaN Ns &VMPM OF FEp6ON CON>1RUCTINp 1NS WELL
tiubeAoAlYwloDMtlonawap t>v�.0aamrNerseapt whHn 70 Gsys ' '--

1es7i we,inAes G W_R a EmArop�.1 ud N.hwd R.20=08-DWlskin a wager Qu ily.ae$Kpon ) 5 2 `j
�> N.O.2Teee-te384% rge(etq M-3221
WELL CONSTRUCTION RECORD WELL CONTRACTOR: 4,7zZZ 46 .'/Z Z-±
WELL CONTRACTOR CifAfIFICATION
STATE WELL CONSTRUCTION PERmITeUSE-:PRO —
!
1. WELUSE-:PROApok"Next Ro*srNi 0' Mw ldpol❑ InIAtaUlai❑ AD&Wund[}NO LING
A§cOvw
82i-
ry O Hoot Puntp Water k4ectbn 09mr It 01ror.Ust Uss: 91 t Hwy s ,,.-E74 C.
2. WELL LOCATIM(Slaw ekebh 01 YN bceibn beloer) Best9icN NC 2ea18
� 247.1773
NNroA Tewnc 1 �✓/,..C-E cww.
lrbesnenrwMlawrlwrswwoT.or mad Lot ft) DRILLING LOG DEPTH
8. OWNEA f / i .r�, �¢ //'ram From ToAdftu fanr+SonOwar+kAbft
etco "'_
erTs.w1 ebb
4. GATE PftKA E-
5. TOTAL DEPTH,,i2 o 5'
S. CVTTS+IGS COLLECTED YES NO�
i. DOES WELL REPLACE EXISTI WELL? YES 0 NOZ3�-
,. STATIC WATER LE1rElL�Sabor Top of Csskg; FT.
V. TOP OF CASYiG 192- . ':. FT.ADon Land Slmisoe'
'FOP Of 4ROM lerwdmad$Vor bOm bnd mWosw rw pa*s a mien"b wewo.
resew wne WA IMM 20 ANte
10. YIELD(SPWI: w24—MOW90FTEST / ?�
11.WATER ZONES(deft
12. CHLORINATION: Typo — Mlounl p eddi2enM specs b needed lwle Wd a trm
13.CASING:
Wse TNdmwte LOQ6=SKETCH
Depth DW1Nbr "down mmedr (Shaw dlrFmmTqeeeen end�eonl s1lwu awo Swe
FL
Ffom� To��FL� a 1 /'6 ) r Ibeds'ar oerr rrap pleroace 1 117)
Fran To FL
1d. GROUT: •�Evd�
Wpth Maw" Method c
From, To4Lc-LFLaua2n' 44A^' -a
From To FL
15. SCREEN: cn
Dom Olerneler slot S12i Material \y M ry
From To.F1 In. kL
From To__FL_ kL _In. N
Fran To FL_ kL _IrL cn
16. SANO(GRAYEL PACK: A
0" Size Maledw
From To FL_ _.._._
from
17. REMARKS:
r,
100 HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE MM 18A NCAC IC.YiELL
CONSTRt1MM STANDARDS,AND THAT A COPT OF THIS OWLS SEEN PROWOEO TO THE WELL O HER_ --
FOR OFFICE U8E ONLY d d� o
0800Ism 01t1NAUMOP P9141 01304TRUCTM THE WELL 001.9
EubrltI*wamidomdWebrae*.ftwdwft saw rrWl ""Ys :-
Sarno. seay,EY.1.a j - ,

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 10 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town:RUTHERFORDTON County RUTH Topographic/Land setting
RIVERSIDE DR ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:LISA MOWERY Latitude/longitude of well location
Address RIVERSIDE DR
(Street or Route No.) (degrees/m ames/seconds)
RUTHERFORDTON NC 28139 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
(864)—316-0612 DEPTH
Area Code Phone number From To
4.DATE DRILLED 10/05/05 _
5.TOTAL DEPTH: 245 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 temrinated 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 ARD number and common names
10.WATER ZONES(depth): HWY.#221 S.FROM RUTHERFORDTON. RT.ON
1I.DISINFECTION:Type CHLORYTE Amount 6 COXE RD,GO PAST AMERICAN MATERIALS.
12. CASING: Wall Thickness LEFT ON JOHN WATSON RD.LEFT ON
Depth Diameter or Weight/Ft Material
RIVERSIDE DR 1/4 MILE ON RT.
From 0 To 80 Ft. 6-1/4" SDR21 PVC
From_To_Ft
From_To_Ft.
13. GROUT: Depth Material Method s
From 0 To 20 Ft OUHCRETE POURED o
From_To Ft
14.SCREEN: Depth Diameter Slot Size Material
From_To_Ft._ in. in.
From_To_Ft._ in. in. L
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
CONS CTION STANDARDS,AND THAT A COPY OF TjjI1S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
aaw��
16-
SIGNATURE OF PERSON CONSTRUCTING THE L DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

bco
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 PFII WELL BORING,LLC PHONE# i828)453-0662
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town:BAT CAVE County RUTH Topographic/Land setting
BALD MTN.CH.RD. ❑Ridge ❑ Slope ❑ valley ❑Flat
(Sheet Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER: FRANK EVANS Latitude/longitude of well location
Address BALD MTN.CH RD. _
(Street or Route No-) (degrees/minutes/seconds)
BAT CAVE NC 28710 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8l 28)—625-9529 DEPTH
Area Code Phone number From To
4. DATE DRILLED 10/01/05
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 N.FROM BAT CAVE.RT.ON
11.DISINFECTION:Type CHLORYTE Amount 22.5 SHUMONT RD,RT.ON BALD MTN.CH.RD.
12. CASING: Wall Thickness APPROX.3 MH.ES ON RT.
Depth Diameter or Weight/Ft. Material
From 0 To 40 Ft 6-1/4" SDR21 PVC
From_To_Ft._ 11
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
zr-
From_To_Ft_ in. in. N
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 F 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

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 0 MunicipaVPublic El Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use—
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH Topographic/Land setting
268 HOOPER RD. ❑Ridge ❑ Slope ❑valley ❑ Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:WADE LAUGHTER Latitudellongitude of well location
Address 268 HOOPER RD. _
(Street or Route No.) (degrees/minutes/seconds)
RUTHERFORDTON NC 28139 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8�)-245-7265 DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 10/12/05 —
5.TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 55 FT.
(Use'Y'ifAbove Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C-01I8. 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 SHH.OH GO DOWN BIG ISLAND RD.
12.CASING: Wall Thickness RIGHT ON DEWITT OWENS RD.RIGHT ON
Depth Diameter or Weight/Ft, Material HOOPER RD.HOUSE AT DEAD END.
From 0 To 55 Ft. 6-1/4" SDR27.6 PVC
From_To_Ft
From_To_Ft
13. GROUT: Depth Material Method
From 0 To 20 Ft.OUHCRETE POURED
.`9
From_To_Ft.
14.SCREEN: Depth Diameter Slot Size Material
From_To_Ft_ in. in. C
From_To_Ft.— M. in.
15. SAND/GRAVEL PACK: r
Depth Size Material o
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 RXCORD H7BEPROVIDED TO THE WELL OWNER
IGN OF ERS? ONSTRUCTING THE WELI DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

zS S �i A z
WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) ROBIN MCNEELY CERTIFICATION# 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH Topographic/Land setting
1818 DARK CORNER RD. ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:BOB WOCH Latitude/longitude of well location
Address 1818 DARK CORNER RD. _
(Sheet or Route No.) (degrees/minutes/seconds)
RUTHERFORDTON NC 28139 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8828)—248-2266 DEPTH
Area Code Phone number From To
4.DATE DRILLED 10/21/05 _
5.TOTAL DEPTH: 71 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES® NO❑ From To
7. STATIC WATER LEVEL Below Top of Casing: 53 FT. _
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface* 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): 18 METHOD OF TEST STEEL TAPE number and common names
10.WATER ZONES(depth): FROM SHH.OH GO DOWN BIG ISLAND RD.
RIGHT ON 2 DARK CORNER RD.APPROX. 1/4
11.DISINFECTION:Type CHLORYTE Amount 8.28 MH.E ON LEFT.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 71 Ft 24" CEMENT
From_To_Ft.
From_To_Ft.
13. GROUT: Depth Material Method j
From 0 To 20 Ft.CEMENT POURED Z
From_To Ft o
14.SCREEN: Depth Diameter Slot Size Material C
From_To_Ft._ in in.
From_To_Ft._ in. in. ^
15. SAND/GRAVEL PACK: CA
Depth Size Material
From 53 To 71 Ft. 78M GRAVEL
From To Ft.
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CO UCTION STANDARDS, AND THAT A COPY OF RECORD HAS BEEN PROVIDED TO THE WELL OWNER
n
SIGNATURE OF PETN 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
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 PITTMAN WELL BORING,LLC PHONE It f8281453-0662
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: LAKE LURE County RUTH Topograpluc/Land setting
119 AMYS RIDGE P.D. ❑Ridge ❑ Slope ❑Valley ❑ Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:WALTER&PEGGY OSTROSHI Latitude/longitude of well location
Address 119 AMYS RIDGE P.D. _
(Street or Route No.) (degreestminutestseconds)
LAKE LURE NC 28746 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
9( 41)—830-0774 DEPTH
Area Code Phone number From To
4.DATE DRILLED 10/24/05 _
5.TOTAL DEPTH: 285 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES® NO❑ From To
7. STATIC WATER LEVEL Below Top of Casing: 165 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.011& 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): FROM RUTHERFORDTON.GO UP HWY.#64/74.
11.DISINFECTION:Type CHLORYTE Amount 6.5 RIGHT ON BH.L'S CREEK RD.LEFT ONrm
12.CASING: Wall Thickness LEFT.
DR LEFT ON AMYS RIDGE.2 ON
LEFT.
Depth Diameter or Weight/Ft. Material
From 0 To 35 Ft 6-1/4" SDR27.6 PVC
From_To_Ft.
From_ToT: _ Mater
Ft._ _
13. GROU Depth ial Method
From 0 To 35 Ft OUH{RETE POUREDCD
".
From_To_Ft.
4
14.SCREEN: Depth Diameter Slot Size Material
From_To_Fr,_ is in. F
From_To_Ft._ in. in. C -
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 CORD HAS BEEN PROVIDED TO THE WELL OWNER
NA OF PERSON CO STRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

. 00 a! � �.
v b o _ _
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# t828)453-0662
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® MunicipaWtiblic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town:BAT CAVE County RUTH Topographic/Land setting
BALD MTN.CH RD. ❑Ridge ❑ Slope ❑ Valley ❑Flat
(Sheet Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER: FRANK EVANS Latitude/longitude of well location
Address BALD MTN,CH RD. _
(Sheet or Route No.) (degrees(minutes/seconds)
BAT CAVE NC 28710 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8(�8)—625-9529 DEPTH
Area Code Phone number From To
4.DATE DRILLED 10/20/05 _
5.TOTAL DEPTH: 405 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 0 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): 0 METHOD OF TEST ARD number and common names
10. WATER ZONES(depth): HWY.#9 N.FROM BAT CAVE.RT.ON
11.DISINFECTION:Type CHLORYTE Amount 10.5 SHUMONT RD. RT.ON BALD MTN.CH RD.APPROM 3 MILES ON RT.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 30 Ft. 6-V4" SDR27.6 PVC
From_To_Ft_ s
From_To_Ft. _
13. GROUT: Depth Material Method
Method z
From 0 To 20 Ft.OUH{RETE POURED o
From_To Ft =
14.SCREEN: Depth Diameter Slot Size Material
From_To_FL_ in. in.
From_To_FL_ in in. cn
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 TION ANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-�
NATURE OF PERSON CONSTRUCTING THE WELL. DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.0712001

eS
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 PITTMAN WELL 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:BAT CAVE County RUTH Topographic/Land setting
BALD MTN.CH RD. ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:FRANK EVANS Latitudellongitude of well location
Address BALD MTN.CH.RD. _
(Street or Route No.) (degrees/minutes/seconds)
BAT CAVE NC 28710 Latitudellongitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
(S28)—6258-9529 DEPTH
Area Code Phone number From To
4. DATE DRILLED 10/27/05 _
5. TOTAL DEPTH: 405 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 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 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): 0 METHOD OF TEST ARD number and common names
10.WATER ZONES(depth): HWY.#9 N.FROM BAT CAVE.RT.ON
11.DISINFECTION:Type CHLORYTE Amount 10.5 SHUMONT RD.RT.ON BALD MTN.C$RD.
12.CASING: Wall Thickness
APPROX.3 MILES ON RT.
Depth Diameter or Weight/Ft Material
From 0 To 20 Ft 6-1/4" SDR27.6 PVC
From_To_Ft.
_ c
From To_Ft _
13.GROU_Depth Material -Method
Method o
From 0 To 20 Ft.OUHO2ETE POURED
From_To_Ft
r
14.SCREEN: Depth Diameter Slot Size Material
From_To_Ft._ in in. C:)
cn
From_To_Ft._ m. 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
22Z=OPY OF RECORD HAS BEEN PROVIDED TO THE WELL OWNER
r�
SIGNATURE OF PERSON CONSTRUCTING THE WPLL DATE
Submit the original to the Division 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 x S
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 PM MAN 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:LAKE LURE County RUTH Topographic/Land setting
SWEETBRiAR N.-LOT#71 ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:MARSHALL SEAY Latitude/longitude of well location
Address SWEETBRIAR N.-LOT#71
(Street or Route No.) (degreestn inutes/seconds)
LAKE LURE NC 28746 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8(_64)—457-6198 DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 10/13/05
5.TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 200 FT.
(Use'Y'if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface"
`Top of casing terminated atior below land surface requires a
variance in accordance with 15A NCAC 2C.0118. 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 16.5 HWY.#64/74A W.FROM RUTHERFORDTON.
12. CASING: Wall Thickness RT.ON BH.L'S CREEK RD. LEFT ON
Depth Diameter or Weight/Ft. Material SWEETBRIAR N. STAY LEFT(a. FORK LOT#71
From 0 To 110 Ft. 6-1/4" SDR21 PVC ON RT.
From_To_Ft.
From To_Ft._ _
13. GROUT_: Depth Material Method y
From 0 To 20 Ft.OUIK"TE POURED ".
From_To Ft._
14.SCREEN: Depth_ Diameter Slot Sic Material C
From_To_Ft._ in. in. i
From_To_Ft._ in. in.
15. SAND/GRAVEL PACK: o
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 C Y F THIS REC RD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCITNGITIE WELL DATE
Submit the original to the Division 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)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:RUTHERFORDTON County RUTH Topographic/Land setting
ATCHLEY RD. ❑Ridge ❑ Slope ❑ Valley ❑ Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:BARBARA O'MEARA Latitude/longitude of well location
Address ATCHLEY RD. _
(Street or Route No.) (degrees/mmutes/seconds)
RUTHERFORDTON NC 28139 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
28D—429-3976 DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 10/06/05
5. TOTAL DEPTH: 385
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO Ej
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 atlor below land surface requires a
variance in accordance with 15A NCAC 2C.01I& 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 9.5 HWY.#221 N.FROM RUTHERFORDTON.
12. CASING: Wall Thickness LEFT ON PAINTERS GAP RD.LEFT ON
Depth Diameter or Weight/Ft Material PADGETTE RD.RT.ON ATCHLEY RD.GRAVEL
From 0 To 25 FL 6-1/4" SDR27.6 PVC DRIVE 1/2 MILE ON LEFT.
From_To_Ft.
From_To_Ft.
13. GROUT: Depth Material Method ;
From 0 To 20 Ft OUHCRETE POURED
From_To_Ft._ o
14.SCREEN: Depth Diameter Slot Size Material
From_To_Ft._ in. in.
From_To_Ft._ in in. _
15. SAND/GRAVEL PACK: o
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
v- G -es
SIGNA F PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

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:LAKE LURE County RUTH TopographicIlmd setting
SWEETBRIAR N. LOT#64 ❑Ridge ❑ Slope ❑ Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER: RICK WOOD Latitude/longitude of well location
Address SWEETBRiAR N.LOT#64(Street or Route No.) (degrees/mi u-tes/seconds)
LAKE LURE NC 28746 Latitude/longitude source: ❑GPS ❑Topographic map
City or Town State Zip Code (check box)
U-442-2000 DEPTH DRILLING LOG
Area Code Phone nunber From To From To
4.DATE DRILLED 10/04/05 _
5.TOTAL DEPTH: 365
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing tenninated at/or below land surface requires a LOCATION SKETCH
variance in accordance with 15A NCAC 2C.0118.
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 9 FROM RUTH GO UP HWY.#64/74A W.RIGHT
12. CASING: Wall Thickness ON BILL'S CREEK RD.LEFT INTO
Depth Diameter or Weight/Ft. Material SWEETBRIAR NORTH 1/2 MILE ON RIGHT.
From 0 To 130 Ft 6-1/4" SDR21 PVC LOT#64.
From To_Ft
From To Ft.
T:13. GROU Depth_ Material Method
From 0 To 20 Ft OUH(RETE POURED z c
0
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material i
From_To_Ft_ in. in. _
From To_Ft._ in. in. ro
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 STRUCTION STANDARDS, AND THAT OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ofo, ^ti D - 4
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)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: LAKE LURE County RUTH Topographic/Land setting
LAUREL LAKES-LOT#38 ❑Ridge ❑ Slope ❑ Valley ❑ Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER: NEAL BOTIE Latitudellongitude of well location
Address LAUREL LAKES-LOT#38
(Street or Route No.) (degrees/minutes/seconds)
LAKE LURE NC 28746 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
(828)—8914727 DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 10/01/05
5.TOTAL DEPTH: 505
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 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): 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 13.5 HWY.#64/74A W.FROM RUTHERFORDTON,
12. CASING: Wall Thickness RIGHT ON BH.L'S CREEK RD.LEFT ON
Depth Diameter or Weight/Ft Material LAUREL LAKES PKWY.APPROX.3/4 MILE ON
From 0 To 42 Ft 6-1/4" SDIL21 PVC LEFT.LOT#3&
From_To_Ft
From To Ft. "--4
13. GROUT: Depth Material Method
From 0 To 20 Ft OUIKRETE POURED mm
From_To_Ft._ o
14.SCREEN: Depth Diameter Slot Size Material t
From_To_Ft._ in. in. r
From_To_Ft._ in. in. o -
15. SAND/GRAVEL PACK: 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 CqPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE O PERSON CONSTRUCTING THE-WELL ATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

2ti
tiY
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 0 MumcipaVPublic ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water hrjechon ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: LAKE LURE County RUTH Topographic/Land setting
LAUREL LAKES-LOT#56 ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:MARSHALL SEAY Latitude/longitude of well location
Address LAUREL LAKES-LOT#56
(Street or Route No.) (degrees/minutes/seconds)
LAKE LURE NC 28746 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
L)-457-6198 DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 10/14/05
5.TOTAL DEPTH: 145
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): 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 3 IlWY.#64/74A W. FROM RUTH.RIGHT ON
12. CASING: Wall Tbickness BILL'S CREEK RD.LEFT INTO LAUREL LAKES.
Depth Diameter or Weight/Ft Material 1/2 MILE ON LEFT.LOT#56.
From 0 To 60 Ft 6-14" SDR21 PVC
From_To_Ft
From_To Ft.
13. GROUT: Depth Material Method o
From 0 To 20 Ft.OUHQIETE POURED
From To_Ft_ z-
14.SCREEN: Depth Diameter Slot Size Material _
From_To_Ft._ in. in. cn
From_To_Ft._ U' 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
S r1rONSTRucTlNG 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 M Mumcipal/Public LJ Industrial El Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town:LAKE LURE County RUTH Topographic/Land setting
SWEETBRIAR S.-LOT#35 ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:BOOTH CONSTRUCTION Latitude/longitude of well location
Address SWEETBRLAR SOUTH-LOT#3S
(Street or Route No.) (degreeshaimrtes/seconds)
LAKE LURE NC 28746 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
(828)-699-2730 DEPTH DRILLING LOG
Area Code Phone number From To From To
4. DATE DRILLED 10/14/05 —
5.TOTAL DEPTH: 345
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO ED
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 at/or below land surface requires a
variance in accordance with 15A NCAC 2C.Ol18. LOCATION SKETCH
9.YIELD(gpm): 150 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.#64/74A W.FROM RUTH RIGHT ON
12.CASING: Wall Thickness BH.L'S CREEK RD.RIGHT INTO SWEETBRIAR
Depth Diameter or Weight/Ft Material FARMS LEFT AT FORK ON SWEETBRIAR
From 0 To 45 Ft 6-14" SDR21 PVC FARMS RD. SOUTH.RIGHT ON FALLS CREEK
From_To_Ft_ RD. LIO MILE ON RIGHT.
From To Ft
T:
13.GROU_Depth Material Method k
From 0 To 20 Ft OUH(RETE POURED
From To_Ft_ o
14.SCREEN: Depth Diameter Slot Size Material
From_To_Ft_ in. in. '
From_To Ft._ in. in. sa
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
CONS UCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
0 -
SIGNATURE OF PERSON NSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Marl Service Center-Raleigh,NC
27699-1636 Phone No. (919)7333221,within 30 days. GW-1 REV.07/2001

From:Scott Gantt To:Stepheme Wilson Date:11/3/2005 lime:1U:19:1U PM Page 11 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 N 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS,INC.PHONE N(704)434-7277
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT N
(if applicable) (if applicable)
1.WELL USE(Check Applicable Box) Residential ® Municipal ❑ Industrial❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2.WELL LOCATION: Topographic/Land setting
Nearest town: LAKE LURE County RUTHERFORD ❑Ridge ❑ Slope ❑ Valley ® Flat
2451 GRASSEY KNOB RD Latitude/Longitude of well location
(Street Name,Numbers,Community,Subdivision,Lot No,Zip Code) 3523-972/82.10,884
3.OWNER FENDER CONST.CO. (degreea/mintues/seconds)
ADDRESS 2450 GRASSEY KNOB RD Latitude/longitude source.®GPS❑Topograpluc map
(Streit or Route No.) DEPTH DRILLING LOG
RUTHERFORDTON NC 28139 From To Formation Description
City Town State Zip Code 0 85 Clay
828-289-9399 85 120 Consolidated Rock
Area Code-Phone Number
4.DATE DRILLED 10/5/05
5.TOTAL DEPTH 120
6.DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7.STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use w"L Above Top ofCumi
s. TOP OF CASING IS 2 FT.Above Land Surface-
•Top ofcadng terminated Wor below land swfacc rrquim avaimec in
accordmccwithl5ANCAC 2C.0118
9. YIELD(gi m): 15 METHOD OF TEST ARDM
10.WATER ZONES(depth): 100
11.DISINFECTION:TYPE HYPOCHLORITE Amount 5 O= 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 91 FL 6 114" SDR 21 PVC ntunbers and cornmon road names.
13.GROUT: -
Depth Material Method
From 0 To 20 FL GRAVEL MIX GRAVITY t
14.SCREEN X71
Depth Diameter Slot Size Material O �—
Ul
From NA To FL in. in.
15.SAND/GRAVEL PACK:
Depth Size Material
From NA To Ft,
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
10/5/05
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 Gantt To:Stephanie Wilson Date:111312005 Time: 10:19:10 PM Page 12 of 13
A r,
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment,and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) SCOTT GANTT CERTIFICATION#2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS,INC.PHONE It(704)434-7277
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: RUTHERFORDTON County RUTHERFORD ❑Ridge ❑ Slope ❑ Valley ® Flat
215 MOONLIGHT LANE,HESTER MILL RD Latitude/Longitude of well location
(Street Name,Numbers,Community,Subdivision,Lot No,Zip Code) 35.15,670/81,57,547
3.OWNER PENASTAR HOMES (degrees/minutes/secunds)
ADDRESS POB 788 Latitude/longitude source: ®GPS❑Topographic map
(Strcctor R.W.No.) DEPTH DRILLING LOG
CHERRYVILLE NC 28021 From To Formation Dewnption
City or Tow,. State Zip Code 0 75 Clay
704-435-1257 75 260 Consolidated Rock
Area Code-Phone Number
4.DATE DRILLED 10/14/05
5.TOTAL DEPTH 260
6.DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7.STATIC WATER LEVEL Below Top of Casing: 85 FT.
(ua<•+^uAbo..Top orca.a�
8. TOP OF CASING IS 2 FT.Above Land Surface-
'17,or cuieg k.min.tcd.V.,below land surface r<gwres a vaunt.to
.....dote with 15A NCAC 2C.0118
9. YIELD(gpm): 10 METHOD OF TEST ARDM
to WATER ZONES(depth): 130
u.DISINFECTION:TYPE HYPOCHLORITE Amount 8 0. LOCATION SKETCH
n,CASING: Wall Thickness Show direction and distance in miles from at least
Depth Diametar orweight/Ft. Material two State Roads or County Roads.Include the road
From 0 To 80 Ft. 6 114" SDR 21 PVC numbers and common road names.
13.GROUT:
Depth Material Method
From 0 To 20 Ft. GRAVEL MIX GRAVITY
14.SCREEN
Depth Diameter Slot Size Material
From NA To Ft in. in
15.SAND/GRAVEL PACK:
Depth Size Material
From NA To Ft,
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
10/15/05
SIGNATURE OF PERSON CONSTRUCTING THE WELL Daze
GW-1 REV.0712001
Submit 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:Stephenie Wdson Date:11/3/2005 Time: 10:19:10 PM Page 3 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 It
(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
Neareat town: UNION MILLS County RUTHERFORD ❑Ridge ❑ Slope ❑ Valley © Flat
1524 CENEENIAL RD Latitude/Longitude of well location
(Street Name,Numbers,Community,Subdivision,Lot No,Zip Code) 35.28.250/81,55,467
9.OWNER ROBERTGUFFEY (degreestmmutu/seconds)
ADDRESS 1524 CENEINIAL RD Latitude/longitude source:®GPS❑Topographic map
otrcct or Routc No.) DEPTH DRILLING LOG
UNION MILLS NC 28167 From To Formation Description
City or To. State Zip Code 0 50 Clay
828-286-9793 50 500 Consolidated Rock
Area Code-Phone Number
a.DATE DRILLED 9/8/05
5.TOTAL DEPTH 500
6.DOES WELL REPLACE EXISTING WELL? YES ❑ NO EI
Z STATIC WATER LEVEL Below Top of Casing: 300 FT
(Use""If Above Top of Cuig)
8. TOP OF CASING IS 2 FT.Above Land Surface-
'Top of casing iemamtcd ac.r bdo v laud smfac<rcgimcs a vaunsn to
e...dance aiM 15A NCAC 2C.0119
9. YIELD(gam): 8 METHOD OF TEST ARDM
10.WATER ZONES(depth): 350
u.DISINFECTION:TYPE HYPOCHLORITE Amount 10 Oz LOCATION SKETCH
12.CASING: Wall Thickness Show direction and distance in Miles from at least
Depth Diameter or Weight/Ft. Material two State Roads or County Roads.Include the road
From 0 To 56 Ft 61/4" SDR21 PVC numbers and common road names.
u.GROUT:
z
Depth Material Method
From 0 To 20 FL GRAVEL MIX GRAVITY --
14.SCREEN O
Depth Diameter Slot Size Material �l
From NA To FL in. in. -
15.SAND/GRAVEL PACK: O
Cll
Depth Size Material From NA To Ft,
16.REMARKS:
I DO HER 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-RaledgiyNC
27699-1636 Phone No.[phone],Within 30 days.

From:Scott Gantt To:Stephenie Wilson Date:11/3/2005 Time:10:19:10 PM Page 4 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 town: LAKELURE county RUTHERFORD ❑Ridge ❑ Slope ❑ Valley © Flat
LOT 4 DEER RUN SUB. GRASSEY KNOB RD Latitude/Longitude ofwell location
(Street Name,Numbers,Community,Subdivision,Lot No,Zip Code) 35.24-638/82.09.145
3.OWNER RIDGELINE DEVELOPMENT CORP. (degrees/minau s/seconds)
ADDRESS 112 COCOPLUM CIRCLE Latitude/longitude source:®GPS❑Topographic map
(stri Roma Na.) DEPTH DRILLING LOG
ROYAL PALM BEACH FL 33411 From To Formation Description
CirywTown Stale Zip Code 0 60 Clay
561-798-2729 60 860 Consolidated Rock
Area Code-Phone Number
4.DATE DRILLED 9/13105
5.TOTALDEPTH 860
6.DOES WELL REPLACE EXISTING WELL? YES NO
7.STATIC WATER LEVEL Below Top of Casing: 800 FT
o,o 1[!Above Top of Caaing)
8. TOP OF CASING IS 2 FT.Above Land Surface"
'Top of casing tesminatrd at/or blow land swGce no,o a vananar in
aocordavice aiM 15A NCAC 2C.0118
9. YIELD(gpm): <1 METHOD OF TEST ARDM
10.WATER ZONES(depth): NA
u.DISINFECTION:TYPE HYPOCHLORITE Amount 10 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 o To 66 FL 6 1/4" SDR 21 PVC numbers and common road names.
13.GROUT:
Depth Material Method
From 0 To 20 FL GRAVEL MIX GRAVITY
14.SCREEN
Depth Diameter Slot Size Material
From NA To FL in. in.
Is.SAND/GRAVEL PACK:
Depth Size Material
From NA To Ft,
I&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� m
1011105
SIGNATURE OF PERSON CONSTRUCTING TBE WELL Date
GW-1 REV.07/2001
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mao Service center-Rate gh,NC -
27699-1636 Phone No.[phone],within 30 days.

From:Scott Gardt To:Stephenie Wilson Date: 11/3/2005 Time:10.19:10 PM Page 5 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)
L WELL USE(Check Applicable Box): Residential ® Municipal ❑ Industrial❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2.WELL LOCATION: Topographic/Land setting
Nearest town: LAKE LURE County RUTHERFORD ❑Ridge ❑ Slope ❑ Valley ❑x Flat
LOT 175,SANDPIPER ST. , RIVERBEND RESORT LatitudelLongitude of well location
(Street Name,Numbers,Community,Subdivision,Lot No,.Zip Code) 35.25.595/82,10,525
a.OWNER RIDGELIKE DEVELOPMENT CORP. (dcgrees/mimrtes/seronde)
ADDRESS 112 COCOPLUM CIRCLE LatitudeRongitude source:®GPS ❑Topographic map
(Strew or Rowe No.) DEPTH DRILLING LOG
ROYAL PALM BEACH FL 33411 From To Formation Description
City or Town State Zip Code 0 60 Clay
561-798-2729 60 260 Consolidated Rock
Area Code-Phone Number
4.DATE DRILLED 9/18/05
5.TOTALDEPTH 260
6.DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7.STATIC WATER LEVEL Below Top of Casing: 166 FT.
(Use-I-If Above Top ofC.n d
S. TOP OF CASING IS 2 FT.Above Land Surface-
'Top of caong tmninated at/r bdow land twfaee regwo a varinme in
a«ordance with 15A NCAC 2C.0118
9. YIELD(glum): 6 METHOD OF TEST ARDM
no.WATER ZONES(depth): 180
H.DISINFECTION:TYPE HYPOCHLORITE Amount 5 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 67 Ft 6 1/4" SDR 21 PVC numbers and common road names.
U.GROUT:
Depth Material Method
From 0 To 20 FL GRAVEL MIX GRAVITY '
14.SCREEN `^
Depth Diameter Slot Size Material r -s
From NA To FL in in. CD
{
15.SAND/GRAVEL PACK: t
Depth Size Material
O
From NA To F[, C.1T
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:Stepheme Wilson Date:11/3/2005 Time:10:19:10 PM Page 6 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 town: LAKE LURE County RUTHERFORD ❑Ridge ❑ Slope ❑ Valley ® Flat
820 BUFFALO CRK RD Latitude/Longitude of well location
(Street Name,Numbers,Connounily,Subdivision,LotNo,Zip Code) 35,29.693/82.10.544
a.OWNER MARK ELLINGWOOD (degrees/minuteoseconds)
ADDRESS 820 BUFFALO CRK RD LatitudeAongimde source.®GPS❑Topographic map
(Strcd or Rou[c No.) DEPTH DRILLING LOG
LAKE LURE NC From To Formation Description
City or To.va State Zip Code 0 70 Clay
828-337-9831 70 220 Consolidated Rock
Area Code-Phone Number
a.DATE DRILLED 9120/05
5.TOTAL DEPTH 220
6.DOES WELL REPLACE EXISTING WELL? YES I] NO
7.STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use'+'IfAbovc Top ofC2mg)
s. TOP OF CASING IS 2 FT.Above Land Surface-
•Top of...it it,krutinhd s✓or below Imd surface rcguvcs a vasimec in
amordxrce»ith MA NCAC 2C0118
9. YIELD(gym): 25 METHOD OF TEST ARDM
10.WATER ZONES(depth): 120
11.DISINFECTION:TYPE HYPOCHLORITE Amount 8 ox LOCATION SKETCH
12.CASING: Wall Thickness Show direction and distance in miles from at least
Depth Diameter or WeightTL Material two State Roads or County Roads.Include the road
From o To 80 FL 6 1/4" SDR 21 PVC numbers and common road names.
n.GROUT:
--i
Depth Material Method
From 0 To 20 FL GRAVEL MIX GRAVITY '
14.SCREEN C3
f�
Depth Diameter Slot Size Material C
1
From NA To FL in in ,97
15.SAND/GRAVEL PACK: CD
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.
10/1/05
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
GWA 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. - --

rrom:beet[uantt I o:bTepneme Wilson Date:11/srzuub I ime:1 u:1ea U PM Page/of 13
3 ' nra
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: LAKE LURE County RUTHERFORD [—]Ridge ❑ Slope ❑ Valley Q Flat
420 JUSTICE DR. Latitude/Longitude of well location
(Street Name,Numbers,Community,Subdivision,Lot No,Zip Code) 35.25.199/82,11,121
3.OWNER FENDER CONST.CO. (degreectrim ovseconds)
ADDRESS 2450 GRASSEY KNOB RD Latitude/longitude source: ®GPS❑Topographic map
(Strut or Ronk No.) DEPTH DRILLING LOG
RUT'HERFORDTON NC 28139 From To Formation Description
City or Town State Zip Code 0 65 Clay
828-28919399 65 540 Consolidated Rock
Area Code-Phone Number
4.DATEDRILLED 9/22/05
5.TOTAL DEPTH 540
6.DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7.STATIC WATER LEVEL Below Top of Casing: 200 FT
(Urc`'"1fAbovc Top of Cv,k,)
8. TOP OF CASING IS 2 FT.Above Land Surface-
-Top of care,taminwd a✓or bdow Hand s,v(acs rrqubes a van. in
ecoordmcc with 15A NCAC 2C.0118
9. YIELD(gym): 2 METHOD OF TEST ARDM
10.WATER ZONES(depth): 320
D.DISINFECTION:TYPE HYPOCHLORITE Amount 16 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 71 Fr 61/4" SDR21 PVC numbers and common road names.
13.GROUT *..?
Depth Material Method
From 0 To 20 Ft GRAVEL MIX GRAVITY O
C -7
14.SCREEN 1
Depth Diameter Slot Size Material
From NA To FL in in. 0
UT
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.
10/1/05
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
GW-1 REV.07/2001
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mall Service center-Raleigh,NC..
27699-1636 Phone No.[phone],within 30 days. -

rrom.acou oamt i o:aaepnerne vvnson wale:.i i/arzuuo nme. iu:i 7:w rwi rage Z oT I e
WELL CONSTRUCTION RECORD NO iJ t
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 Ptanp Water Injection ❑ Other ❑ If Other,List Use:
2.WELL LOCATION: Topographic/Land setting
Nearest town: RUTHERFORDTON County RUFHERFORD ❑Ridge ❑ Slope ❑ Valley ® Flat
WEEKS RD,SHILOH COMMUNITY Latitude/Longitude of well location
(Street Name,Numbers,Community,Subdivision,Lot No,Zip Code) 35,17.678/81.58.142
3.OWNER BRAIN CONNOR (degrees/minutmmonds)
ADDRESS 215 WEEKS RD LatitudeAongitude source:❑GPS❑Topographic map
(sce<torxome No.) DEPTH DRILLING LOG
RUTHERFORDTON NC 28139 From To Formation Description
City or Town State Zip Code 0 52 Clay
828-287-1520 52 400 Consolidated Rock
Area Code-Phone Number
4,DATE DRILLED 9/l/05
5.TOTAL DEPTH 400
6.DOES WELL REPLACE EXISTING WELL? YES NO
7,STATIC WATER LEVEL Below Top of Casing: 50 FT
(Use•+"IfAbov<Top of Cerm�
8. TOP OF CASING IS 2 FT.Above Land Surface-
•Top of eun,terminated atlor below llmrd surface rcgwres a variarc<m
a«ordmcc with 15A NCAC 2C.0118
9. YIELD(gpm): 2 MEFFIOD OF TEST ARDM
10.WATER ZONES(depth): 346
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
From 0 To 59 Ft 61/4" SDR 21 PVC numbers and common road names.
Lr.GROUT:
Depth _ Material Method
From 0 To 20 Ft GRAVEL MIX GRAVITY 0 ,
14.SCREEN
Depth Diameter Slot Size Material I _
From NA To FL in in. O
15.SAND/GRAVEL PACK: GJl
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.
10/1/05
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-RrpleigG,Nam... -- "'--- ' - `
27699-1636 Phone No.[phone],within 30 days.
i

ter eta
WELL CONSTRUCTION RECORD
North Carolina- Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section/
w' r t�
ELL CONTRACTOR(INDIVIDUAL)NAME (print) Gzf/Gty 'J lf� �4-)L CERTIFICATION# Zlt� a
V,I,Lt.CONTRACTOR COMPANY NAME C.F �_-LL. �tr _fA ty f PHONE Itf�1r'b) �Z y—S2Sy£J
STATE\YELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
11111
I. WELL USE(Check Applicable Box):Residential B' Municipal/Public❑ Industrial ❑ Agricultural ❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: I' n �" / opoglaphic/Land setting
Nearest Town:CA;r)R/C v 17 County RLIAer _1
Idge ❑Slope ❑Valley ❑FIaI
TU-�+ I (check appmpriatc box)
(Street Name Numbers,Community,,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: 12 LIL m f/z rQ S/t'ie,S (degrecs/mimnes7seconds)
Address 13�i'f CQ I= i-FtiC /.a Latitude/longitude source:❑GPS❑Topographic map
(Strett or Route No.) ty (check box)
m�•'1'tPC.PACAn�{ sof yGz DEPTH DRILLING LOG
(��;L�,�?,Chyof,rnu•n Stam Zip code From To Formation Description
(W)'_'y L,3 L
Area code-Phone numbe V_ 10
4. DATE DRILLED ' (e-D � bJ
5. TOTAL DEPTH: elO � 4I✓f
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: (a Q _FT. o
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface* —'
-Top of casing terminated atfur below land surface requires a CA
variance in accordance with I5A NCAC 2C.0118.
9. YIELD(gpm): jJ0 METHOD OF TEST f�k_o_ p
10. WATER ZONES(depth): i PJ
LOCATION SKETCH
11. DISINFECTION:Typc OI;'rNe Amount fYL Show direction and distance in miles from at least,
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Dia ter or Weight/Ft. map'al numbers and common road names.
Frorom 0 To��Ft. 6b) 0
From Tom � 195_
Fm G_To /nz Ft. -L
—l�t`�f,— glil � 4fi— gl
13. GROUT: Depth Material Method J
From To FL
From O To 2 Ft. 'r��/
14. SCREEN: Depth Diameter Slot 3izc Material _ L
From To Ft. in. in. VC
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material / J
From To FL
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUON 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 3erciceCenter-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.0712001

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STATE WELL CONSTRUCTION PERMf #:
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IT. REMARKS
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e a+r STATp W
Q RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION#
1.WELL CONTRACTOR: I /1 f. DISINFECTION:Type )a a Amount Cavj
0 T�ynes � ( Q WI IQ g. WATER ZONES(depth):
WellC�tractor.(Individual)Name I From——() To ZAo From To
Law( ` U)f11 �<rnn TYCc From To From To
Well Contractrir Company Name I� From To From To
STREET ADDRESS I v UC ( 7,q 6. CASING: Thickness/
9j II�� Depth ia� ter Weight Material
( EYLYJOYD C- � �01�0 FronQTo�Ft. Sr)TZaI yL
City or Town State Zip Code From To Ft. _
(��} ¢-�,,� —7� From To FL
Area code-Rhone number
2.WELL INFORMATION: 7. GROUT: Depth Material Met7od
From 60 To Av Ft. r7dGkre te. Yt ,t
SREWELLID#litapplicable) From To Ft.
STATE WELL PERMIT#(8 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.
�f q Fran To Ft.
_in. _ in.
DATE DRILLED I — ( ' cJ Fran To FL—in. _ in.
TIME COMPLETED , J I AM D PM#3--
9. SANDIGRAVEL PACK:
3.WELL LOCATION: I y1�'�, Depth Size Material
CITY: Sit Y(I Yl e- COUNTY Rlk V`ef�d From To Ft.
U)�p (] io 1� Fran To Ft.
(Sbe Name,Numbers,Cornrnunity,Subdivision,Lot No.,Parcel,Zip Code)
TgPOGRAPHIC I LAND SETTING: 10.DRILLING LOG
(dope Ovalley ❑Flat ❑Ridge ❑other From To Formation Description
(check appropriate box) [Maybe to de LATITUDE _ I_T j utes,secondsaLONGITUDEV'] ) ` 9 •)6q tti a decimal format
4 11risc I a e r�
Latitude/longitude source: drdPS ❑Topographic map -
(/ocabon of we#must be shown on a USGS topo map and
attached to this form Inot using GPS)
4.WELL OWNER .'
OWNER'S NAME �e5 �t' &I d21'S ,14
STREETADDRESS D 30Y �f t�
P YP_ L g' 7�(c
City a Tom State Zip Code
} p
Area code- Phone number
11. REMARKS:
S.WELL DETAILS:
a. TOTAL DEPTH: y
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO I�fv
c. WATER LEVEL Below To of Casing: // / ` I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
P g L Q FT. IM NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THATA COPY OF THIS
(Use"+•if 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 at/or below land surface may require SI TURE OF CERTIFIED W EL CONTRACTOR DATE
a variance in accordance With 15A NCAC 2C.0118.
e. YIELD(gpm): 0 METHOD OF TEST OL 1 r
PRINTED NAME OF.PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center-Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Form GW-la
Rev.7I05

e $AT( W
5 S RESIDENTIAL WELL CONSTRUCTION RECORD
'.� North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 12 139
1.WELL CONTRACTOR: ' f. DISINFECTION:Type (� cn n P. Amount LI
�J 0.OA 8.5 W 1 C-QVVL(� g. WATER ZONES(depth): I
Well Contractor(Individual)Name
From To�O From To
CtL�P5 ��.�' `7 Pbk M P Co . TVIC . From To From To
Well Contractor Company Name 't From To From—To—
STREET ADDRESS P 0r, 1�P)6 X `f 19 6. CASING: Thickness/
F-I I C'of C,YD (�J L 2 b D q 0 From Depth Diameter p Weight
eL_Q_To�D FL / �t
City or Town State Zip Code FromTo Ft.
y 4.53 _ 73-;z°2' From—To—Ft.—
Area code- Phone number
2.WELL INFORMATION:
7. GROUT: Depth Material Method
+ )�
SITE W ELL ID#(if applicable) From_To `LO Ft. e ert l 1141t
From To Ft.
STATE WELL PERMIT#(d applicable) From_To Ft.
DWQ or OTHER PERMIT#(if applicable) S. SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply IV From_To Ft.—in. _in.
DATE DRILLED 9- 17
From T
-0`J From To Ft—in. _in.
o Ft.—In. _in.
TIMECOMPLETED AM❑ PM
9. SANL)lGRAVEL PACK:
3.WELL LOCATION: + Depth Size Material
CITY: l � L-Ur� COUNTY tl.��QV� From To Ft.
Stti)eef C r IaY fa ��S From—To Ft—
C.K. I /Y From To Ft.
(Street Nama,Numbera, ammunity,Subdivision,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
[]Slope galley ❑Flat ❑Ridge ❑Other From To Formation Description
(check appropriate box)
LATITUDE 3 � I'7.44 ,� May be in degrees, �O L)qV I 5ay�
minutes,seconds or
LONGITUDE 0 CIL D � in a decimal format
Latitude/longitude source: V/OPS ❑Topographic map
(location of"I must be shown on a USGS topo map and
attached to this form I not us6g GPS) _
4.WELL OWNER _ ,y
OWNER'S NAME 0. e n
STREET ADDRESS e ees �r. n
City or Town State Zip Code
Area code- Phone number
11. REMARKS: `F
S.WELL DETAILS:
a. TOTAL DEPTH: �D j
b. DOES WELL REPLACE EXISTING WELL? YES❑ NOA
I COHERE BY CERTFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE Wlnl
c, WATER LEVEL Below Top of Casing:�FT, 15A NCAC2C.WELL CONSTRUCTION STANDARDS,AND TUTACOPY OF THIS
(Use-+•if Above Top of Casing) RECORD HAS BEEN PROVIDED TO THE WELL OWNER
d. TOP OF CASING IS_I FT.Above Land Surface' Aun,, � 1�� ��/J�G�
*Top of Casing terminated at/or belay land surface may require SI ATURE OF CERTIFIED WELL CONTRACTOR NTRACTOR "DATE
a variance in accordance With 15A NCAC 2C.0118.
e. YIELD(gpm):_ 2� O METHOD OF TEST 0.1 r
PRINTED NAME OF PERSON CON RUCTING 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.7/05

a„u.SrAlt- V v
RESIDENTIAL WELL CONSTRUCTION RECORD
" North Carolina Department of Environment and Natural Resources-Division of Water Quality Fi A,
WELL CONTRACTOR CERTIFICATION# 13 g -
1.WELL LCCO'NTRACTOR:1 I. DISINFECTION:Type Amount GL(
I/,{ x P 5 W. C4 VIA Q g• WATER ZONES(depth):
Well C7tractor(Individual)Name From To� From To
yyk4 wet I VI Q co I L y(c. From To From To
tracts Well Con Company Name p From To From To
STREET ADDRESS 0O X I S. CASING: Thickness/
`�11 �7 Depth// Di eter Weight at vial
f..f1. O YU IV C rX D D From_/L To_S�Ft. fir ( _ �G
City or Town nState Zip Code From To Ft.
(S3j{ _
±j.' - l5,� From To_Ft.
Area code- Phone number
2.WELL INFORMATION: 7. GROUT: Depth Material Method
Fram_D_7o_;?,C> Ft_4EXtCe TeK� (a [1
SITE WELL ID#(if applicable) From To Ft.
STATE WELL PERMIT#(il 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 -i - 1 -0! From To Ft.—in. _in.
TIME COMPLETED AM❑ PM IY
9. SANDIGRAVEL PACK:
3.WELL LOCATION: Depth Size Material
CITY: - Ll t r I' COUNTY I.Ct'l.e f✓ r� From To Ft.
�1- From To Ft.
SI�PC{ C1YIAf SN)eel�Y)AY K < S From Tc Ft.—
(St
reet Name,Numbers.Community.Subdivision Lot No.,Paroel,Zip Code)
TOPOGRAPHIC ILA SETTING: 10.DRILLING LOG
❑Slope []valley ` let ❑Ridge ❑Other From To Formation Description
(check appropriate box)
LATITUDE 3 t j May be in degrees,
`+ minutes,seconds or �� �G
LONGITUDEQXoZ" D ) cal ins decimal format
y(So Y Tz
Latitude/longitude source: ❑CPS ❑Topographic map lD0 " Ds 1/ Ae 0
(location of we0 must be shown on a USGS topo map and
attached to this form I not using GPS)
4.WELL OWNER r��7�, /n' `�
OWNER'S NAME Ca 0 Ka FYeCI S D lv 111S I•
STRE T ADDRESS 0 S U
o s J! ;�a l< �a
City or Town State Zip Code
Area code- Phone number
11. REMARKS:
S.WELL DETAILS:
r
a. TOTAL DEPTH: D.c
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO
1-3_6 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED INACCORDANCE WITHc. WATER LEVEL Below Top of Casing: FT. tsA NCAC 2C,WELL CONSTRUCTON STANDARDS,AND THAT A cow OF THIS
(Use•+-g 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 at/or below land surface may require SIG URE OF CERTIFIED W ELL ONTRACTOR DATE
a variance in accordance With 15A NCAC 2C.01 18.
e. YIELD(gpm): METHOD OF TEST A Y
PRIMED 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 276 9 9-1 61 7 Phone No.[phone] ext 568. Rev.7/05

d„a STATFo
RESIDENTIAL WELL CONSTRUCTION RECORD t ;
North Carolina Department of Environment and Natural Resources-Division of Water Quality
.. WELL CONTRACTOR CERTIFICATION#
1.WELL CONTRACTOR: f. DISINFECTION:Type Chlorjn� Amount L/.t
A me 5 4 1) �A i�A g. WATER ZONES(depth):
Well Contractor.(Indi"aLlal)Name From LO To d 0
From To
LA-M 4� e1Xl` (Q T ��(G, From To From To
Well Contractor Companlyn�Name �1 '` From To From To
STREET ADDRESS I BOX -7 ;�q 6. CASING: Thickness/
"" II Depth Dialmeter Weight Material
))e ktboro lV l . ?gb40 From L) To 40 Ft. /,— RAI F'✓C
City or Town State Zip Code From To Ft. _
' � -_ �,9j- � ��. From To Ft.
de- Phone numbs _
Area co
2.WELL INFORMATION: 7. GROUT: Depth Material ' �Melhod
SITE WELL ID From 0 To ,ZO Ft.f ftekYefe. ItQ
#(if applicable) From To Ft.
STATE WELL PERMIT#(a applicable) From Tc Ft.
DWQ or OTHER PERMIT#(if applicable) B. SCREEN: Depth Diameter Slat Size Material
WELL USE(Check Applicable Box): Residential Water Supply From To_Ft.—in. _ in.
DATE DRILLED q_.t 9-0S_ From To FL_in. _ in.
From To Ft.—In. _ in.
TIME COMPLETED 1 I: 30 AM V PM❑
9. SANDIGRAVEL PACK:
3.WELL LOCATION: (' II Depth Size Material
CITY: e COUNTY AC(' rj From To Ft.
II _ From To Ft
L- .
Ot u-c From To Ft.
(StreeyNarne,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code)
TO/POGRAPHIC/LAND SETTING: 10.DRILLING LOG
GYSIOpe ❑Valley ❑Flat ❑Ridge ❑Other From To
Formation Description
(check appropriate box)
LATITUDE 3 ,r Mi d
dr^9To � ma utbeinc + SQYI
LONGITUDE QgLr' qq. 136 LA) in a decimal format _
D OS a YOC
Latitude/longitude source: GPS ❑Topographic map ccoylSo
(Ideation of we#must be shown on a USGS topo map and
attached to this form snot using GPS)
4.WELL OWNER OWNER'S NAME L-ARC51 d e �>,ll f f✓,'
STREET ADDRESS 0 D X 5 9 O
1�t.kP Lure 7�l C, 2S'T 4 6
City or Town State Zip Code
r
f �
Area code- Phone number CJ1
11. REMARKS:
S.WELL DETAILS: -4
a. TOTAL DEPTH: ,3D.S `/
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO 61
c. WATER LEVEL Below Top of Casing: _FT/, ` I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
P15A NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
(flee"+'If Above Top of Casing) RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS�_FT.Above,Land Surface* `\ " A/ f _ �C
*Top of casing terminated allor below land surface may require SIGNATURE OF CERTIFIED WELL,�`r�Clb!CONTRACTOR DATE U
to-
a variance in accordance with 15A NCAC 2C.0118.
e. YIELD(gpm): METHODOFTEST Q) r PRINTED NAME OF PERSON CONST CTING THE W ELL
Submit the original to the Division of Water Quality Within 30 days. Attn: Information Mgt.,
1617 Mail Service Center-Raleigh,NC 27699-1617 Phone No.[phone] ext 566. j Form Rev.7/0505
- -�

a �
~ RESIDENTIAL WELL CONSTRUCTION RECORD 3
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# aC J
1.WELL CONTRACTOR: / I. DISINFECTION:Type C cyl Amount I (' Ca
WATER ZONES((1�eeppyyth):
WelICIntractor.(Individu I) iNam�eL /n/ �"' From To IT6 From To
Ca.wtBS Ve 1I �f Pytm �. 1 i1G. From To From To
Well Contrac or Company Name From To From To
STREETI ADDRESS BD X �,77 6. CASING:.n Thickness/
eLb 0 YI) �- oLA C`t From y DTot�Ft. Di�_�y r W I eight ale�al
City or Town State Zip Code From To Ft.
From To Ft.
Area code- Phone number
2.WELL INFORMATION: 7. GROUT: Depth Material .L M�1 hod
From To aO Ft. SCL&kYe1e 0.1LQ
SITE WELL ID#(itapplicable) From To Ft
STATE WELL PERMIT#(if applicable) From To Ft.
DWQ or OTHER PERMIT#(if applicable) 8. SCREEN: Depth Diameter Slot Size Material
From To_Ft._in.
WELL USE(Check Applicable pBox): Residential Water Supply From _ in.
R 1 a To Ft. _in.
DATE DRILLED 1 From To Ft._in. _in.
TIME COMPLETED I) 30 AMO PMO
9. SANDIGRAVEL PACK:
3.WELL LjjQC,AT ON: Depth Size Material
CITY:LC
�tt.�'I r /�`/ ✓t `TjCOUNTY V PI Y r.Jd. y From To Ft.
U '"ryiA-ter, CK . II OM450 Yt ��Q :�d I o� From To Ft.
(Street Name,Numbers,Community,Subdivisio ,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC!�Ar SETTING: 10.DRILLING LOG
❑Slope ❑valley Tlet ❑Ridge ❑Other From To Formation Description
(check appTTTTropriate box) -
LATITUDE 3 �" Ag.qL e a May be in degrees,
minutes,seconds or
LONGITUDE Ciil ` 41. gO II,1 in a decimal format
Latitude/longitude source: LgGPS ❑Topographic map SD rGl O(_
(location of well must be shown on a USGS topo map and
attached to this form ifnot using GPS)
4.WELL OWNER
OWNER'S NAME )44. D i. (.
STREET A'^PDRESS 6 e✓i c�tn �'e C-' '
StYllrqust'vte F1
City or Towd State Zip Code _
(Area code- Phone number
II. REMARKS: ---
5.WELL DETAILS, 7 r
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES❑ NOXI
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
c. WATER LEVEL Below Top of Casing:�_FT. 15A NCAC 2C,WELL CONSTRUCTION STANDARDS.AND THAT A COPY OF THIS
(Use"+-i1 Above Top of Casing) RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS 1 FT.Above Land Surface*
'Top of casing terminated atlor below land surface may require (TURE OF CERTIFIED WELL ONTRACTOR- , DATE J a variance in accordance With 15A NCAC 2C.0118. � (� p 1 ('t,
e. YIELD(gpm): ,J 0 METHOD OF TEST QA Y �1-y7�'0 e W \ hl
PRINTED NAME OF PERSON CONSTRUCTING THEW ELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form GW-1a
1617 Mail Service Center—Raleigh,NC 276 9 9-1 617 Phone No.[phone] ext 568. Rev.7105

R h (1 l n a
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# ,Z S
1.WELL CONTRACTOR, / A f. DISINFECTION:Type CVf le Amount ) 2.Ck
TWlP- 5 VV• L Q IYtr g. WATER ZONES(depth):
Well Co tractor(individual)Name From To-9 From To
( moL We /I V­ Pa it t u From To From Tc
Well Contractot Company Name From To From To
STREET ADDRESS b a 0X 6. CASING: Thickness/
ff 99 II -I Depth Dia eter Wei ht Material
)I.Y/D '✓O IVC �8e4o From 0 To )n19 FIZZ- 2I
pvc-
City Or'Town State Zip Code From To Ft.
,�� y 1,3 ` � �,`� From To FL
Area code-Phone number
2.WELL INFORMATION:
7. GROAT: Depth Material M hod
SITE WELL ID#(if applicable) From 0 To � Ft. m.kr e fe
From To Ft.
STATE WELL PERMIT#(if applicable) From To Ft.
DWQ or OTHER PERMIT#(if applicable) 1 8. SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply I{// From To Ft._in. _in.
Rn r� From To FL—in. —in.
DATE DRILLED From To Ft_in. _in.
TIME COMPLETED 3 O AM❑ PM IZ/
9. SAND/GRAVEL PACK:
3.WELL LOCATION: Depth Size Material
(( �� `
CITY: LLN IOV /v l I ) 116 COUNTY lL 1eY r From To Ft.From To Ft.
� n
1 `i'q u50r1 IQ)'
j4C IS� From To Ft.
(Street Naphe.Numbers,CoTmunabi,Subdivision,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC/LA D SETTING: 10.DRILLING LOG
❑Slope ❑Valley ❑Ridge OOther From To FormationDesciption
(check appropriate box) r1 I n h
�p .�� , ,f May e in degrees, V I-L�-
LATITUDE y1 � 3� minutes,seconds or _
LONGITUDE d 1 8 D- in a decimal format lob
LatitudeAongitudesource: ❑GPS ❑Topographicmap
(location of we9 must be shown on a USGS topo map and
attached to this form Mot using GPS)
4.WELL OWNER
OWNER'S NAME
ST�R ET ADDRES,,Sn 11 V X ~ n
I�(rni6 tYlil5 Nc, aglo
City or Town State Zip Code r
�)- O
Area code- Phone number _
11. REMARKS:
S.WELL DETAILS:
a. TOTAL DEPTH: ,
b. DOES WELL REPLACE EXISTING WELL? YES❑ NOY
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED INACCORDANCE WITH
C. WATER LEVEL BBIOW Top Of Casing: FT. 1SA NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
(Use"+-if Above Top of Casing) RECORD HAS BEEN PROVIDED TO THE WELL OWNER
d. TOP CASING IS 1 FT.Above Land Surface*
*Top
of casing terminated aVor below land surface may require 3RIEDNAME
E O CERTIFIED WELL�r6=0NT—RACT—OR DATE-
a variance in accordance with 15A NCAC 2C.01 18. 11 �e. YIELD(gpm): -a METHOD OF TEST_ L{.1✓ �A) �OF P.ER�ON CQh�STRUCTING THE.W E4L
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form�
1617 Mail Service Center-Raleigh,NC 27699-1617 Phone No.[phone] ext Gw-la
568. .6 i -Rev;
i

a S ATFo
1 <_ : S Vt 0, � � , , I
RESIDENTIAL WELL CONSTRUCTION RECORD z
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# J7 S
1.WELL CONTRACTOR: { //�• f. DISINFECTION:Type /' �cri n e Amount ca 1
t limc.� k) • l...A WlN g. WATER ZONES(depth):
r
Well Co(rytr,,ctor.(Inndividual) ame ,j �/J� /' ''� "ohn Q From To
l,-�C IN(U�! e�l y ! i.{('Vl n L , T. From To Frvn To
Well Contracts rorrpany(�Name 22 qG From To From To
STREET ADDRESS _ IY [JD x 1 6. CASING: Thicknessl
h /�( ryD y-`� Depth Diameter W h
IV tftt e{ial
rl,l1D Yc 1, DD From To �i3 FLU/`rr`/ae—
City or Town State Zip Code From To Ft.
)- _
q5; 0.- ?1j; Fran To Ft.
Area code- Phone numbs
2.WELL INFORMATION: 7. GROUT: Depth Material Mgthod
From_L_To�Ft. 5ACKYrfie '1AKtl
SITE WELL ID#(if applicable) From To Ft.
STATE WELL PERMIT#(ifapplicable) From To Ft.
DWQ or OTHER PERMIT#(if applicable) 8. SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water SuppW From To Ft._in. _ in.
DATE DRILLED 10 !3 -b 5 From To Ft._in. _ in.
/
TIME COMPLETED )I . 30 AM I PM❑ Fran To FL—in. _ in.
9. SAND/GRAVEL PACK:
3.WELL LOCATION: ,� Depth Size Material
CITY: l-a-he �uYE COUNTY 1P l�T� Fr0rn To Ft.
Q y' �'7 ! Fmm To Ft.
11 bars,C ��• RI'tVPr belt From To Ft.
—
TOPOGRAPHIC Name,Numbers,Canmunity, ubdiMsion_,Lot No.,Parcel,Zip Cotle)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
El Slope iaValley ❑Flat ❑Ridge ❑Other From o3 Fo anon Desc tbn
(check appropriate box)
/p o May be degree { —
LATITUDE 3 2 minutes,seconds or
LONGITUDE OB,;,o �it) in a decimal format 41
Latitude/longitude source: VGPS ❑Topographic map
(location of well must be shown on a USGS fopo map and
attached to this form lnot using GPS)
4.WELL OWNER
OWNER'S NAME
STRE T ADDRESS
�L2 FXL �L 3al,2 7 ^'
City or Town State Zip Code
Area code- Phone number _
11. REMARKS: -
5.WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO
c. WATER LEVEL Below Top of Casing: I WHEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE Wrol
OP g: FT. 15A NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
(Use-+-ifAbove Top of Casing) RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS I —FT.Above Land Surface' �n "DATE
11)
'Top of casing terminated aVa below land surface may require SIG TURE OF CERTIFIED WELL C NTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118.
e. YIELD(gpm):15L METHOD OF TEST 6t I)' -r-.
PR IN D NAME OF PERSON CONS RUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn:Information Mgt., Form Gw-la
1617 Mail Service Center-Raleigh,NC 276 9 9-1 61 7 Phone No.[phone] ext 568. ; Rev.7105

a,,.sratpv W"
.Py '�•�� dl .! f Y . 'l
% l:
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# I 0
1.WELL
�CONTRACTOR: /�1 f. DISINFECTION:Type 0 e_ Amount
1/kw e S 0• l.a nu g. WATER ZONES(depth):
Well Con �a rctor.(Individual)Name nn I_ From To \s a From To
lull.WQS tie I I �paw Yi'(L 'From To From To
Well Contractor Company Name From To From To
STREET ADDRESS P U IJQx 4..q 6. CASING: Thickness/
C Depth Diameter Weight Material
/— ley CYrt L ;?gDgD From D To__Ft. / I nt71) PIfG
��'� p r City or Town State Zip Code From To Ft. _
tL�fZL 4 G-7j —1 Ig a From—To—Ft.—
Area code- Phone number
2.WELL INFORMATION: 7. GROUT: Depth�7 Material Met7od
SITE WELL ID#(if applicable) From O To O Ft. SeTLKI ete kl&rll
From To Ft.
STATE WELL PERMIT#(il applicable) Fran To Ft.
DWQ or OTHER PERMIT#(if applicable) 8. SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply p/ From To Ft.—in. _ in.
From To Ft._in. _ in.
DATE DRILLED �`(�-- .'�i —D] / From To FL—in. _in.
TIME COMPLETED y" 30 AM❑ PM H
9. SANDIGRAVEL PACK:
3,WELL LOC//A�TIfO/N: i y1'al- 1 Depth Size Material
CITY: /"'b� � r—L�✓E COUNTY (.!_J VIe✓4✓Q From To Ft.
9 ''// r { J f )� '7 i From To Ft.
yoyk5)de 1�re 1 LDI z J 1115 X W� From
(Street Name,Numbers,Comm nity,6ubd�idsl n,Lot No.,Parcel,Zip Code) To Ft
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
❑Slope tKalley ❑Flat ❑Ridge ❑Other From CTo r p„Forma �plion
(check appropriate box) `� `\S \ tlA..L w
r f �4 May bc in degecs, b
LATITUDE minutes,=ends or
LONGITUDEDIZ 09-440 inadec"b"for"n
Latitude/longitude source: q&PS ❑Topographic map '
(location of we9 must be shown on a USGS topo map and
attached to this form 7not using GPS)
4.WELL OWNER
OWNER'S NAME ✓ SYnI
STREET ADDRESS Dto vdy ) I Iry
-i
City Town State Zip Code N
Area code- Phone number
11. REMARKS:
5.WELL DETAILS:
a. TOTAL DEPTH:_ A
b. DOES WELL REPLACE EXISTING WELLY YES❑ NO
e. WATER LEVEL Below Top of Casing: FT. 155AA tNicnc is WELL CONSTRUCTION STNONDSFY THAT THIS WELL WAS SAND THAT A CACCORDANCEPYO WIIH
(Use"+'if Above Top of Casing) RECORD HAS BEEN PROVIDEDTO THE WELL OWNER.
d. TOP OF CASING IS I FT.Above Land Surface-'Top of casing terminated aVor below land surface may require I MIA Lk
SI T RE OF CERTIFIED W LL C NTb R4CTOR DATE O�a variance in accordance vdth 15A NCAC 2C.0118.
e. YIELD(gpm): d METHOD OF TEST a.)r
PRINTED NAME OF PERSON CONS RUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn:Information Mgt., Fo m GW-1a
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Rev.

4
yd�swto
YX
RESIDENTIAL WELL CONSTRUCTION
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION#_ ;Z ) 9
1.WELL CONTRACTOR: , I. DISINFECTION:Type CLl o rl ne Amount,�Gu Q5
1--yo 5 k • �Q.{'VI 9. WATER ZONES(depth): r—
Well C/9��tractor.(indivifduall)Name
�,L I� //'1 _ From To USU FrOm To
("Q ( 4's oc a Y f U#'(o L 1� e From T° From To
Well Contract r Company Name /( p Fran To From To
STREETifI' ADDRESS U 13oX 7�1 S. CASING: Thickness/
G e ti 14( h'Di-G From U DToth. Diameter Weight ate al
Town
Ft_�� �d
City a Tavn State
Zip Code Fran To Ft�7�
( �jg I- — A From To Ft.
Area code- Phone number
2.WELL INFORMATION: 7. GROUT: Depth'� ,,,, Material MeeJthod
From © TooIIW Ft. 54.c_4e�e [LKj
SITE WELL ID#(if applicable) From To Ft
STATE WELL PERMIT#(a applicable) From To Ft.
DWQ or OTHER PERMIT#(if applicable) B. SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply' From To Ft._in. _ in.
�1 From To Ft—in. — in.
DATE DRILLED �U-I��DS Fran To Ft_in. in.
TIME COMPLETED 4:30 AM❑ PM Ij
- 9. SANDIGRAVEL PACK:
3.WELL LOCATION: y.� (� Depth Size Material
CITY: JUV15�1r1."Ie.- COUNTY AerrArJ From T° Ft.
From—�Su1M11Wir- � t tj l I_ac'`ako &VI 9j. From ToTo—Ft.
(Street Name,Nuhnbers.Community,Subdimaion_,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC I LAND SETTING* 10.DRILLING LOG
m DSlope ❑Valley ❑Flat xidge pother From To
Forman° escrip bn
(check appropriate box) e ,
q 4qq May e in degumcoeds ,
LATITUDE 3 �' minutes,seconds or
LONGITUDE D_f .III/'j in a decimal format �-�—
Latitude/longitude source: ❑GPS ❑Topographic map
(location of we#must be shown on a USGS topo map and
attached to this form Ynot using GPS) r
4.WELL OWNER t� /� I' J J7
OWNER'S NAME r A � IS/t'E(� �0-I 1,L cc)
STREET ADDRESS D ,5 5 L' 5bL to C
f the-XDYV L � 6D,>Z
City or Town I State Zip Code
Area code- Phone number
11. REMARKS:
S.WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES❑ NOf�
c. WATER LEVEL Below To of Casin _FT: I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WRH
P 9 15A NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THATA COPY OF THIS
(Use'+•ri Above Top
/Top of Casing) RECORD HAS BEEN PROVIDED TO THE WELL OWN
d. TOP OF CASING IS i FT.Above Land Surface' f1 i
'Top of casing terminated attor below land surface may require SI URE OF CERTIFIED W ELL ONTRACTOR DATE
a Variance in accordance with 15A NCAC 2C.0118. _
e. YIELD(gpm):_�METHOD OF TEST 4;r Q
PRINTED NAME OF,PER501,1 CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., I
1617 Mail Service Center—Raleigh,NC 27 6 9 9-1 61 7 Phone No.[phone] ext568, L Forrrl GW-la
Rev.7I05

_ RESIDENTIAL WELL CONSTRUCTION RECORD
" North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR f
CERTIFICATION#
1.WELL CONTRACTOR: `1 //�`�� f. DISINFECTION:Type C 0 'Np Amount
J4 w e S 0 . L �t h1 p g. WATER ZONES(depth):
Well Co actor,(individual)Name ,) From 7 To��6 From To
From To From To
Well Contract Company/Name {�7 —'(I From To From To
STREET ADDRESS 1' 0 Soo �f ago
6. CASING: Thickness/
I IeK oC Y9 NC- a.g04a From Depth D,iamgter Weight Mate
To�Ft. / %O V
City or Town State Zip Code From To Ft. --
( 91- 46 3 —?3 a 2-- Fran To Ft.
Area code- Phone number
2.WELL INFORMATION: 7. GROUT: Depth Material Method
Fran 0 To ;7D Ft et Ye C. _
SITE WELL ID#(If applicable) From To Ft.
STATE WELL PERMIT#(a 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.
'� -! os From To Ft.—in. in.
DATE DRILLED 77 From To Ft.—in. _in.
TIME COMPLETED 13 D AM O PM lkl
9. SAND/GRAVEL PACK:
3.WELL LOCATION: JI Depth Size Material
CITY: ,>1,LAS�41f— COUNTY ,l`�er CJ From To Ft.
.SuwtwUt L> t 5 L-ack kL MITI. Rd. From To Ft.
From To Ft.
(Street Name,Num ere,Ct dry,Subdivision_,La No.,Parcel,Zip Code)
TOPOGRAPHIC/LAND SE ING:
❑Slope ❑ F
Valley ❑Flat -Ridge ❑Other 106rn DRILLING LOG
rUlom �03 � Fonr�atio�De;grdptbn
(check appropriate box) _gin fY�U �:C
n Maybe in degrees,
LATITUDE /3�orL 1.5� minutes,seconds or
LONGITUDE I c 1 ; ' D W in a decimal format
"�n S �_
Latitude/longitude source: POPS ❑Topographic map
Qocation of we#must be shown on a USGS topo map and
attached to this form f not using GPSJ
4.WELL OWNER
OWNER'S NAME A-11 P .Yl` Co.
STRE T ADDRESS (/ e
i Cc D o
City o Town State Zip Code
Area code- Phone number -
11. REMARKS:
S.WELL DETAILS: }}
a. TOTAL DEPTH: J oS
to. DOES WELL REPLACE EXISTING WELL? YES❑ NOA
c. WATER LEVEL Beim TO of Casing:�FT. I DO HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
P g 1SA NCAC 2C,WELL CONSTRUCmON STANDARDS,AND THAT A COPY OF THIS
(Use"+'if Abova Top of Casing) RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS I FT.Above Land Surface* XpG�1 (A C��W ((I /(/ r 1 S
*Top of casing terminated at/or below land surface may require S RE OF CERTIFIED WELL CONTRACTOR �—V-DLAT-E�a variance in accordance With 15A NCAC 2C.0118.
e. YIELD(gpm): �/� METHOD OF TEST Air
PVTED NAME OF PERSON CONS RUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., J Fop GW-1a
1617 Mail Service Center—Raleigh,NC 27699.1617 Phone No.[phone] ext$68. 'Rev.7/05

V� 63, 'iAi C F' r
RESIDENTIAL WELL CONSTRUCTION RECORD
i
�.� North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# ;) is
I � ,7
1.WELL CONTRACTOR: //•I f. DISINFECTION:Type YIi Amount�+z cud
)a-W e 5 (�cl w)p g. WATER ZONES depth):
Well Contractor(Individual)Name /� / From To From To
Ca M05 oe II I /�4i yn( (_p, LC- From To From To—
Well Contractolf Company Name ,I ` From To From To
STREET ADDRESS 0,X Y�� 6. CASING: Thickness/
Depth Dia eter Iweiht Matgrialr1le n b ry g D D From To Ft.(
p V C
City a Town State Zip Code From To Ft.
(I � )- r53 ;z From To Ft.—
Area code- Phone number
7. GROUT: Depth Material ethod
2.WELL INFORMATION: From 19 To '* FL 15itG kre f l E 9J
SITE WELL ID#(if applicable) From To Ft.
STATE WELL PERMIT#(0 applicable) Fran To Ft.
DWO or OTHER PERMIT#(if applicable) 8. SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply❑ Fran To Ft—in. _ in.
��-.�`�"�7 From To Ft._in. in.
DATE DRILLED
—TI- Fran To Ft.—in. _ in.
TIMECOMPLETED 7 I5 AM PM rIJ'( 9, SANDIGRAVEL PACK:
3.WELL LOCCATI N: y. Depth Size Material
'f�CITY: IMte rr' yj�h COUNTY IkAet V Fran To Ft.
From To Ft.
Union )Zj From To Ft.
(Street Name,Numbers,Canmunity,Subdivision,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
❑Slope ❑Valley ❑Flat []Ridge OOther From To Formation Description
(check appropriate box)
LATITUDE 3 !Z q.IJO Mayteincondso deltrees,
� ) minutes,seconds or
LONGITUDE 01f .,g 11, in a decimal format -
I0n ,'SOS Corso ,rL ej rcc.
Latitude/longitude source: [k PS ❑Topographic map
(location of well must be shown on a USGS Icon,map and
attached to this form d not using GPS)
4.WELL OWNER
OWNER'S NAME 0 CD
STREET ADDRE S A i D
o c 139
City or Town Ste Zip Code
-74
Area code- Phone number -
11. REMARKS:
5.WELL DETAILS: D S -a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES IV/ NO❑
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED INACCORDANCE WrrN
c. WATER LEVEL Below Top of Casing: FT. 1SA NCAC YC,WELL CONSTRUCTION STANDARDS,AND THATA COPY OF THIS
(Use'+-8 Above Top of Casing) RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS I FT.Above Land Surtace• I U i K '�s
*Top of casing terminated at/or below land surface may require SI T RE OF CERTI D W L CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118.
e. YIELD(gpm): METHOD OF TEST—A,-� PRINTED NAME OF PEIRANISTRUETING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, r m GW
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. - F Eooi1 GV-1a

dµ STAI(o J�Lo
RESIDENTIAL WELL CONSTRUCTION RECORD c; j
" - North Carolina Department of Environment and Natural Resources-Division of Water Quality a
WELL CONTRACTOR CERTIFICATION#
1.WELL CONTRACTOR _ I. DISINFECTION:Type e o f. Amount CM
rzme 5 /(�/ Nl g. WATER ZONES(depth):
Well C 4tractor(individual)}Name r/� T From To�,5 From To
VVe '� If .y( C.. L From To From To
Well Contractoil Company Name I
Q From To From To
STREET ADDRESS r �� �DX 1 6. CASING: Thickness/
1I['K �D t!C Dept Di�rneter Weight Material
NC p o C 4 ci From _To SFt. Sp 2l Put
City or Town State Zip Code From To FL_
FrOln—Tom—Ft
Area code- Phone number
7. GROUT: Depth Material -{ 1� Metlhod
2.WELL INFORMATION:
From_Tc 0 O Ft. 5aCkfe 12. y10.
SITE WELL ID#(if applicable) From To Ft
STATE WELL PERMIT#(Il 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 FtL_in. _in.
DATE DRILLED q —ADC, —OJ From To FL_in. _in.
TIME COMPLETED I:00 AM❑ PM V
9. BANDIGRAVEL PACK:
3.WELL LOCATION: II Depth Size Material
CITY: 'a�Q. G.UVF. COUNTY bl e - � From TD Ft.
R
{ From To Ft.) tleYbevtd - 1�6 Raven )V Fran To Ft.
(Street Name,Numbers,Canmunity,Subdivision,Lot No.,Parcel.Zip Code)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
❑Slope ❑Valley ❑Flat ORidge ❑Other From To Formation Description
(check appropriate box)
77�� May be in degees,
LATITUDE 3 !2) n . f'C, minutes,seconds or
LONGITUDE DU
O )0 , in a decimal format
Latitude/longitude source: WB jPS ❑Topographic map(location of well must be shown on a USGS topo map and �T^
attached to this form Y not using GPS)
4.WELL OWNER OWNER'SNAME JDV nnv L AO
STREETADDR SS 7-,� *14 Or. P—ab11-e5�uYp 5C Zg0DL
City or Town j State Zip Code
Area code- Phone number
11. REMARKS:
5.WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES❑ NOX
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED INACCORDANCE Wr11
c. WATER LEVEL Below Top of Casing: (DA FT. ISA NCAC 2C.WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
(Use'+•0 Above Top of Casing) RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS I FT.Above Land Surface* A AN lb (.Q�.�.f�O
`Top of casing terminated at/or below land surface may require 5 RE OF CERTIFIED W EL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118, �� � ` 1
`
e. YIELD(gpm):�METHOD OF TEST 61..) f 6"C!L_v'II NOR
PRINTEED NAME OF PERSON C NSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form GW-la
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. "Rev,7/05

�6 C _ _
_ S RESIDENTIAL WELL CONSTRUCTION RECORD v Qy
North Carolina Department of Environment and Natural Resources-Division of Water Quality
.. WELL CONTRACTOR CERTIFICATION# 06C 3
1.WELL CONTRACTOR: f. DISINFECTION:Type C 1 oYr rl P Amount
/LCY'V1 P 5 �/. C�iL 1'V(/,1 g. WATER ZONES( epth):
Well C//o��ntractor.(Indlvidu I) fN(ame nn // From To From To
l % VVi ll 5 I�7e I I V P L YPl Co. I�r From To From To
Well ContractorCompanyrn�Name q From To From To
STREET ADDRESS 1 (r� ��O X t�� I 6. CASING: Thickness/
Kl Ie K boKy IV c "d "'t{O From D Depth
GU Ft. Di� eter WS1�iR2i M IrCN
�� �City or Town State Zip Code From_To Ft. _
(nb�t a >• 4 S3 - 9 31 From To Ft.
Area code Phone number
2.WELL INFORMATION: 7. GROUT: Depth Material Method
From 19 To d`G Ft. SacKl'ete ('1a K.a
SITE WELL ID#(if applicable) From To Ft.
STATE WELL PERMIT#(it 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 Fran To Ft._in. _ in.
From To Ft_in. _ in.
DATE DRILLED q-, C4 -/�5- 1/ From To Ft_in. _in.
TIME COMPLETED L j i '7G AM❑ PM[j
9. SAND/GRAVEL PACK:
3.WELL LOCATION: Depth Size Material
-o /�
CITY: 'KP 5 111� COUNTY IA (IY Y From To Ft.
FrmTL_To Ft.
o b)lA Dr, L4 S From To Ft.
(Sweet Name,Number Canmu ity,Subdivision,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
[_]Slope DValley ❑Flat pRidge ❑Other From To
Formation Description
(check appropriate box)
q Maybe in degees,
LATITUDE 3 S' I• D g minutes,sewnds or 11 L G 0.V S0.t1_
c - i -T,
LONGITUDE D in a decimal format
�� h S. I53 LL
ion �"R �5 CD95v I atr'd ✓ock
Latitude/longitudesowce: I,aGPS pTopographicmap
(Wation of we#must be shown on a USGS topo map and
attached to this f�io''r''m I not ulsingGPS)
4.WELL
OWNER OWNERS NAME 1- in (1 Jac- SnN
STREET ADDRESS _ h �D X 10 In -
t_�'ASlPtl 5C o'2,g1,41
City or TowTV State Zip Cade
Area code- Phone number p
11. REMARKS: cn
S.WELL DETAILS:
a. TOTAL DEPTH: !T ")
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO
c. WATER LEVEL Below TO of Casin : I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
P 9 FT. 15A NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
(Use'+•if Above Top of Casing) RECORD HAS BEEN PROVIDEDTO THE WELL OWNER.
d. TOP OF CASING IS m FT.Above land Surface* t \ d rn t n �� C „ � •1%•1)s
'Top of casing terminal with below land surface may require SIIVAA I URGE (OF CERTIFIED WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. v,�n[�
e. YIELD(gpm): METHOD OF TEST I Y t N � f.l 1w P
PRI TED NAME OF PFRSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn:Information Mgt.,
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Ram OWda
Rev.7105

wxrq
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 9 I -j p
1.WELL CONTRACTOR: f. DISINFECTION:Type G 1 GYI 2 Amount,-] ,
I Gf-me S � LO�YVI Q g. WATER ZONES(depth):
�Well o rtractor.(Individlu 1)NaIme �j �/)� f_ From - From To
.1 lM n$ v. If. 11 V 1r 1�{'I'1 p h lYl(' From To From To
Well Contractor Company Name q From To From To
STREET ADDRESS 0 Uf7) I 6. CASING: Thickness/
Dept {�i star �e^ighpt terial
Tit DYD C .�9040 From�To�Ft. 1 J� 1�
City or Town State Zip Code From To Ft.��"" _
( } "f- 3 � Fran To FL
Area code- P one number
2.WELL INFORMATION: 7. GROUT: Depth From�To�FLJQYf/Material/ Met od
Gl Y(�
SITE WELL ID#(if applicable) From To Ft.
STATE WELL PERMIT#(if 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. n. _ in.
r From To FL—in. _ in.
DATE DRILLED q')3 -y7 Fran To FL_in. _ in.
TIME COMPLETED 't'1" : 3 U AM El PM
9. SANDIGRAVEL PACK:
3.WELL LOCATION:II f Depth Sim Material
,(CITY: 5 n)ije COUNTY et l From To Ft.
-} II From To Ft.
�{ A(f Y5 Q Fran To Ft.
(Street Name.Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC I LANDS G: 10.DRILLING LOG
❑Slope CiValley ❑Flat IfRidge ❑Other From To Formation Description
(check appropriate box)
bc in
LATITUDE 3 ° � m wtes,seconds or q c �
LONGITUDE tLgL Q, & ii) in a decimal format q
Latitude/longitude source: BPS ❑Topographic map
(location of we#must be shown on a USGS topo map and
attached to this form ifnot using GPS)
4.WELL OWNER .,(.
OWNER'S NAME ra H k L I if�I SL'
STREET ADDRESS a-1y�eY 4 JR S
926fiL N L A 9 0 1 X -'
City or Town State Zip Code ry
`7
Area code- Phone number Cn
11. REMARKS:
5.WELL DETAILS:
a. TOTAL DEPTH:
la. DOES WELL REPLACE EXISTING WELL? YES❑ NO
DO HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED INACCORDANCE WITH
c. WATER LEVEL Below Top of Casing: I
_FT. SA NCAC 2C.WELL CONSTRUCTION STANDARDS,AND THATA COPY OF THIS
(Use'+•'fr Above Top of Casing) RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS I —FT.Above Land Surface• CU i K
•Top of casing terminated aUa below land surface may require SI A U E OF CERTIFIED W ELL ONTRACTOR - DATE a variance in accordance with 15A NCAC 2C.0116.
e. YIELD(gpm): METHOD OF TEST A)t°
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center-Raleigh,NC 276 9 9-1 61 7 Phone No.[phone] ext 568. Form GW.Ia
Rev.7/05

�p a w STA p W
%y r.uv,.ndlY I � 't
. .. Q RESIDENTIAL WELL CONSTRUCTION RECORD IJ °-
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2 ) 3 O P
1.WELL CONTRACTOR: I I f. DISINFECTION:Type C GY ✓IL Amount i 7= CiAy1
J e me S L1), l (A WI a 9. WATER ZONES(depth):
W ell ntractor/(individual Name Q From �b,�To 3 es From To
�-U (individual Name
PAW y �YLif. From To From To
Well L;ontrxtcbr Company NjJJm/e1 7 From To From To
STRE(EJ ADDRESS r v Box L�j4c��� 6. CASING: Thickness/
h'I L K bD Yf? ) C- A D qD From Depth I meter We ht te"al
�To 5A Ft. S l(G
c� �Cy ity w Town /, State Zip Code From To Ft. _
lI( ' D )- 'y - /.'1j a From—TO—Ft.—
Area code- Phone number
2.WELL INFORMATION: 7. GROUT: Depth Material I�"" M
From D To�D Ft 5aCKYete hd
SITE WELL ID#(if applicable) From To Ft
STATE WELL PERMIT#(if applicable) From Tc Ft.
DWQ or OTHER PERMIT#(if applicable) 8. SCREEN: Depth Diameter Slot Sin Material
WELL USE(Check Applicable Box): Residential Water Suppty From To Ft. in. _ in.
DATE DRILLED From To Ft._in. _in.
-1 ..,�rT-�C From To Ft.—in. _ in.
TIME COMPLETED AM D PM[r�
9. SANDIGRAVEL PACK:
3.WELL LOCATION: Depth Sipe Material
CITY: - U �/Vekl COUNTY 6 ill(t t' From To Ft.
I 1 From To Ft.
Sl.t 1`) L-lAL QDD t . From To Ft.
(street Name,Numbers.Community,Subdivsion,Lot No.,Parcel,Zip Code) -
TOPOGRAPHIC I LAND SET ING: 10.DRILLING LOG
❑Slope [:]Valley ❑Flat dge OOther From To
Formation Description
(check appropriate box) -
May be in degrees.
LATITUDE 3G- minutes,seconds or hR .50.7"t QYCP /
LONGITUDE dS�° 1, r] (.ir inadecimal format
(h v(SD ida tP YOG
Latitude/longitude source: ❑GPS ❑Topogaphic map
(location of well must be shown on a USGS topo map and
attached to this form anof using GPS) _
4.WELL OWNER T
OWNER'S NAME I L♦.tr-P Q fl`Vl Lk
�/
STREET ADDRESS
S(.ICS{L1J) � �e FL
City w Town State Zip Code
Area code- Phone number
11. REMARKS:
5.WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO
c. WATER LEVEL Below TO of Casing: _FT. I HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WID1
P 9 15A NCAC2C,WELL CONSTRUCTION STANDARDS,ANDTHATACOPY 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' I f1 �� t)
'Top of casing terminated ayor below)and surface may require SI T RE OF CERTIFIED W ELL CO DATE
TRACTOR a variance in accordance with 15A NCAC 2C.Ot 18.
e. YIELD(gpm): I f) METHOD OF TEST a 1ik
PRIN ED NA E OF PERSON C N RUCTING THE WA LL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Form GW-la
Rev.'7/05

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WELL CONTRACTOR CERTBNCATKNi h.� 7i -� S
STATE WELL CONSTRUCTION MAW#:�
I." WELL USE App *W*b*ftvww d2--Uxd*w 0 kWwbW ElAwkw ww❑ 0 D
hwftwr 0 Hod Fame WSW k*C*n ❑ Dow 0 u Odwrr Lm uw:
L WELL LOCAuft(Show*mm of"moft bwow)
c54
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7• OWNER ,A LF[I A I n ,1.o C e x: .2 s_l Pon To FwwdW Pw�+YM
AddoW a ,67
C�MTM111 �IY� � -
•. DATE DIIRLW.1
S. TOTAL DEPTH `
S. CuTTM10S CmucrED YWC3 NO
7. DOES WELL REPLACE B% Twd Wft14 Q NOM—
IL STATIC WATER LRYELOdowTep of Cwd W _ FT.
(Dw elAtmTopNCa"
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awc..IrarMeoetanxi
10. YRoLO bpmk l!Z_METHOD OF TW 12i^
11. WATER ZONES(dW"'.
1z. CM.OMATIOM Type Mawd NMBIMWomb amw6rli rr—gym
�<
13.CASINO 79 ( �TIONBKEICd3_ I
wwastl+drrxi i
a"& OInnM awdo : VANO ("wol -Mmelkwoolaow �z
Fmm Te FL— 1, w C36
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1A. OROVf: ca(�
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From KO To JW__FL e 11 X
From To FL U
15. scREENy
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Fom - To - Ft In. _&L
From ...__To FI._ bL
From To__FL_ Ni —Ir.
16. 8ANDGMVEL PACK:
OopS► Bite SAdmNI
From To FL
From To FL� cZ�
17. REIAARKS:
I OO NdRSSY CERRPYTNAT TMS WELL WA{CONSTRUCTED IN ACOORC94M WIN ISA W.JA 1C.YELL
CONSTIS mM STANDARDS.MV THAT ACOPY OF TMS MOORO NAS SEEN FRONDED 10M VIOLL OMSER.
FOR BFW USE ONL con
Sob�Aw�OiMOM�IwolwwrOrrIIRQNMiMrrMewn7rWn70Grri 04.1►BY.+:1I
3MmN4

WELL CONSTRUCTION RECORD ,_. 3 0 8 3 1 1
North Carolina Department of Environment and Natural(Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME/(�pfiat) J ' 1W • (�A CERTIFICATION � 13 9
WELL CONTRACTOR COMPANY NAME ( ,a �IS C' 11 `V ['V111/I 10, HONE N 6a ��3-732.7-
STATE WELL CONSTRUCTION PERMITN ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential tr-Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCAT N: Topographic/Land setting
Nearest Town: County )6idge 17Slope ❑Valley ❑Flat
(check appropriate box)
(Street Name,v,Numbers,Community ���i��1 r*/.of No.,Zip Code) Latitude/longitude of well location
3. OWNE MJ .A R:\c>IINA �.f•\ (degrees/minutes/seconds)
Address ( 1�4 Q al Latitude/longitude source:OGPS❑Topographic map
(Street or Route No J ' (check box)
C&AAA1A—Y1 DEPTH DRILLING LOG
City or T wn state Zip Code From o F ati Description
aLv-_ n
Area code-Phone number
4. DATE DRILLED -
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO [
7. STATIC WATER LEVEL Below Top of Casing: IOU T.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface* = r�
"Top of casing terminated attor below land surface requires a
variance in accordance with 15A NCAC 2C.011&
9. YIELD(gpm): 2 METHOD OF TEST CLA9I t
10.WATER ZONES(depth): S-
LOCATION SKETCH p
r
11. DISINFECTION:Type Amount A wA Show direction and distance in miles fromWleast
12. CASING: Wall Thickness two State Roads or County Roads.Include the roa
Depth t eter or Wei ht/Ft. Mat numbers and common road names.
From_To_I L_Ft.
From To Ft.
From TO Ft.
13. GROUT: De d �, Material thod �M
From To d-IY Ft. ; _ y?_Q,—
From To Ft. Yl P.dt C C me K}" "
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. a lj.
From To Ft. l�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 RECORD HAS BEEN PROVIDED TO THE WELL OWNER
(� A AAA C r1 n
SIONATURF OF 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'
MAR 21 MW
i

WELL CONSTRUCTION RECORD 3 4 8 3 0 8
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (sprint) .JT Wye> U)• C a rrl CERTIFICATION 0 oZ 138
WELL CONTRACTOR COMPANY NAME / 'I MA E V u LC Tvl C - PRONE it (g-��1 �I53--f
STATE WELL CONSTRUCTION PERMITtt ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential lEr Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery O Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOwn: 0� II Topographic/LandOV setting
Nearest Town: CounTy ^�/s ORidge Mope Walley ❑Flat
J-C Y lkA � - (check appropriate box)
(Street Name,Numbers,Commmunity, bdivision L Suot No.,Zip Code) Latitude/longitude of well location
3. OWNER:9\1,f _ Q 1 4-Q AMA_ (degrees/minutes/seconds)
Address [_�6 � /�13 CD — Latitude/longitude source:OGPSOTopographic map
(Street or Route No. (check box)
c ,�Cf DEPTH DRILLING LOG
City or Town State p Code From To F n ation Description
Area code-Phone number
4. DATE DRILLED - [cf- is
5. TOTAL DEPTH: (^
6. DOES WELL REPLACE EXISTING WELL? YES O NO
7. STATIC WATER LEVEL Below Top of Casing:_U_U_FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface* y
-Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118. t itf
9. YIELD(gpm): -2% METHOD OF TEST GLAT 00
10.WATER ZONES(depth): 1(1 [7
LOCATION SKETCH U]
11. DISINFECTION:Type IYA A Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Road or County Roads.Include the road
From Depth Diameter or Weigh t. Maternal numbers and c men road nart`t�e1�s.
To C
From To Ft. 5�� ({,V,"(1 (l//��""--�•
From To Ft. - t'
13. GROUT: Depth Material Methpd
From�To�Ft. ('p�PN� f{aM
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. d
From To Ft. in. in. I•
15. SAND/GRAVEL PACK:
Depth Size Material
From TO Ft.
From To Ft.
16. REMARKS: ��%C.l�-�`�`• ��--�
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THEWELL OWNER
oC
SIGNATURE qF 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
MAR 21 M
:1..

WELL CONSTRUCTION RECORD - 3 0 8 3 0 6
North Carolina Department of Environment and Natural Resources-Division of Water Quality ��1l
WELL CONTRACTOR(INDIVIDUAL)NAME (print) 5 �a CERTIFICATION t C��/-30 pp
WELL CONTRACTOR COMPANY NAME C'A W1 A 5 yl iA YR Ci`• C PHONE N t7 )
STATE WELL CONSTRUCTION PERMITq ASSOCIATED WQ PERMITH
(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 LOCAT N: � //�Topographic/Land setting
Neayre Town:.(I yt County A��k , J k5f idge ❑Slope ❑Valley ❑Flat
\lA t •?TCr ,1 tE (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: (degrees/minutes/seconds)
Address 1 3 2 Latitude/longitude source:❑GPS❑Topographic map
(Streete, oute No. (check box)
DEPTH DRILLING LOG
,d t City or To" e \State , Zip Code From - Fom ation Description
vs
A`DA c-,od'e-Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO �l
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use"+"if Above Top o Casing) ,,,I
8. TOP OF CASING IS FT.Above Land Surface*
'Top of casing terminated at/or below land surface requires a p
variance in accordan wdh 15A NCAC 2C.011&
9. YIELD(gpm): ('�—M THOD OF TEST QM CA
10.WATER ZONES(depth): � b
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at lea
12. CASING: Wall Thickness two State Roads or County Roads.Include the toad
Depth Diameter or Weli�gh'�t(/�Ft. Materi I numbers and common road names.
From To _ _ Ft. (1 V\ V
IV
From To Ft.—
From To Ft.
13. GROUT: Depth _Materialr Method ,n,Q
From_To�_Ft.
From TO Ft. Re01 Cwlevv'�
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
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,Attn: Information Management,1617 Mail Service Center.
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days - -
6W-1 REV.09/2004
MAR 21 2M
.0:.

312
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality"
WELL CONTRACTOR(INDIVIDUAL)NAME (print) "fames W ('amn J CERTIFICATION# 9�7a
WELL CONTRACTOR COMPANY NAME Campss Well & Piamp CO r Tnr_ PHONE 4 92 4SZ_7-322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. 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 LOCATION- Topogyaphic/Land setting
Nearest Town: C)K County k14AICY&J ORidge (J4Slo ppropOVallete j Flat
(Street ame,Numbers, mmunity,Subdivision,Lot No.,Zip Code) Latitudellongitude of well location
3. OWNER: �I_S-�Y,��`! Q�s/��PC (degreesfminutes/seconds)
Address I S I�P N N 1 NdYr+s� I A / Latitude/longitude source:OGPSOTopographic map
(check box)
(Street or Route )
f C �Oj c5 D _ DEPTH DRILLING LOG
City or Tovm State Zsp Code From To Formation Description
D 10 o d'•-T
Area code-Phone number �J
4. DATE DRILLED _) " 1 D D J�6 C'�n So l�i:& fd rc—c K
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES O NO
7. STATIC WATER LEVEL Below Top of Casing: �D T. c +�
I(Use'W'if Above Top of Casing) C
8. TOP OF CASING IS 1 FT.Above Land Surface* -
-Top of casing terminated atlor below land surface requires a J
variance in accordanr with 15A NCAC 2C.0118.
9. YIELD(gpm): D _METHOD OF TEST a i rN C
10.WATER ZONES(depth): - LOCATION SKETCH
Show direction and distance in miles from at*t
11. DISINFECTION:Type(•h 7 Or i n a Amount C two State Roads or County Roads.Include the road
12. CASING: Wall Thickness
Material numbers and common road names.
Depth Diameter or Weight/Ft.
From___D_To BD Ft. 6 1 /4 Sall-21 pt-Ck15ACAC
From To FtFrom To Ft.13. GROUT: Depth Material Method
From�_To�p._Ft. Nea ement- HnnAFrom To Ft14. SCREEN: Depth Diameter Slot Size MaterialFrom To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:Depth Size MaterialFromTo Ft.FromTo Ft.16. REMARKS:I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACC
CONSTRUCTION STANDARDS, D THAT A COPY THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/SI
GNATURE O PERSON CON RUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn:Informati it Service Center-
7m,F
n r, f f: 1-,
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. (i,� s - ,09/2004
Juri 2 7 2005
f_

WELL CONSTRUCTION RECORD O `
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print)� a mP4 W r'amp�_Jr CERTIFICATION# 9�"2R
WELL CONTRACTOR COMPANY NAME Camp s Well & Pumper, Tnc: _ PHONE # k7A dF'3_7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
if applicable) if applicable)
1111111
1. WELL USE(Check Applicable Box):Residential V Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery 0 Heat Pump Water Injection❑ Other 0 If Other,List Use
2. WELL LOCATIO : 1+ J Topographic/Land setting
Nearest Town: ( C! County tkj{ e' 4 ORidge ldSlope OValley []Flat
)i 10 1 -t IL-6 t (check appropriate box)
(Street ame,N'u-mnb'e'rs, ommunity,Subdivision,Ent No.,z'PCode) Latitude(longitude of well location
3. OWNER: 1 a /'Yt. �P GYP GO (degrees/minutes/seconds)
Address Latitude/longitude source:OGPSOTopographic map
(Street or Route No J J ( (check box)
DEPTH DRILLING LOG
City or Town Srate Zip Code From To Formation Description
t
Area code-Phone number s-
4. DATEDRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO lei
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* a
-Top of casing terminated atlor below land surface requires a
variance in accordance with 15A NCAC 2C.011& O
9. YIELD(gpm): METHOD OF TEST a_i r
10.WATER ZONES(depth): L LOCATION SKETCH
Show direction and distance in miles from at leas£
11. DISINFECTION:Type(-h i nP Amount two State Ro or County Roads.Include the road
12. CASING: Wall Thickness
Depth . Diameter or Weight/FtAMaterial
on road names.
From__To �� Ft. 6 1 /4 S.cir 1 � ��-
From To Ft.
From To Ft. -
13. GROUT: Depth Material
From_p_To2p_Ft. N a PmPrit—
From To Ft..
14. SCREEN: Depth Diameter Slot Size From To Ft. in. in.From To Ft. in. in.15. SAND/GRAVEL PACK:
Depth Size Materia
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 STA S,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
- DS
SIGNA OF PERSON 9ONSTRUCTING THE WELL DATE
v'
i
Submit the original to the Division of Water Quality,Attn:Informatiyn Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. r�} �^ �' I' i - .IT
(W�1IV.09/2004
{ �.� L. J U N 2 7 2'M5 �:

WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) Names W. Camp, .TrT CERTIFICATION4 21 3R
WELL CONTRACTOR COMPANY NAME Camp' c Wa1 1 F Pnmp C a Tnr - PRONE N 0 84 3-73 2
STATE WELL CONSTRUCTION PERMIT# - ASSOCIATED WQ PERMIT#
if a livable if a livable
1. WELL USE(Check Applicable Box):Residential 4 Municipal/Public❑- Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATI 14
nn Topographic/Land setting� ��
Nearest TTo rw'n: - County�145 ❑Ridge ❑Slope ❑Valley [Flat
[ i ule.J RA (check appropriate box)
(Street Name,,Numberi,Community,Subdivision,Lot No.,Zip Code) Latitudeilongitude of well location
3. OWNERJ (degrees/minutes/seconds)
Address i, - Latitude/longitude source:❑GPS❑Topographic map
F� ``(Street or ute o.) (check box)
G I I C'K170I'O I V C. g0 �0 DEPTH DRILLING LOG
City or Town State Zip Code - From To For{ ation Des iption
( � 0 S�
Area code-Phone number
4. DATE DRILLED -
5. TOTAL DEPTH: 1„�
6. DOES WELL REPLACE EXISTING WELL? YES dl'NO ❑
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Usc"V'if Above Top of Casing) Z .�
8. TOP OF CASING IS 1 FT.Above Land Surface"
•Top of easing terminated at/or below land surface requires a
variance in accordaAce with ISA NCAC 2C.011S. �3
9. YIELD(gpm): _METHOD OF TEST Air (J1
10.WATER ZONES(depth): 1411
- LOCATION SKETCH a'11
11. DISINFECTION:Type Chlorine 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 0 To� Ft. 6 1 /4 SDR21 PVC
From To Ft.
From To FL
13. GROUT: Depth Material Method
From 0 To_2_0_Ft. Neat Cement Hand
From To F[.
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. Iv
From To Ft. t"
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELLOWNER
Y—0
SI NATU OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn: Informs ulk nAgfnlerif,'1617 Mikil Sgiv F Eenter-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. =, _'_ i
i �� G LIREV.09/2004
I
J U N 2J LUJO
n 1J
1

North Carolina.Department of Environment and Natural Resources-Division of Wafer O,mlity-Gmundv+aler Saai,ln
1636 Mail Service Center-Raleigh,N.C.27699-1636 Phone[phone]
WELL CONSTRUCTION RECORD WELLC014TFIACIOFI: eal'Cta�� - �)emoeU ke Well Styr.
WELL CONTRACTOR CERTIFICATION a: C)15I
STATE WELL CONSTRUC1ION PERMITH:
1. WELL USE(Check Applicable oo.): Residonlial Municipal❑ Industrial❑ Agricultural f.toniloring ❑
(recovery❑ Heat Pump Water Injection ❑ Other If Other, Lin Use:
2. WELL LOCATION: (Show ske(c 1 of the location below) II
Nearest Town: Fc3feS� eU —County: � lw� Yi'UraJ C
y46V lam . a) __ N
(Road Name and Numbers,Community.or Subdivision and Lot No.) Dr11LLII IG LOG DEP N AO
3. OWNER 'DO u� %a Cd From To I om,a6cn 1)j=if,5cn
Address o r90 _);rfcmo:�=<A
r3
(Sueel"aiTloula Tlo. a20 5o
City or Town State Zip Code =L IQ'17 r�[7
4. DATE DRILLED 10'8'0 5- mo -
5. TOTAL DEPTH y DU
6. CUTTINGS COLLECTED YES(-1 NO j — ---
7. DOES WELL REPLACE EXISTING WELL? YES_ NO[
B. STATIC WATER LEVEL Below Top of Casing: FT.
(Use':Ir Above Top or Casing)
9. TOP OF CASING IS—_j_ FT.Above Left(] Surface'
'Top of casing terminated atior below land surface requires a variance In accor-
dance with 15A NCAC 2C.0118
10. YIELD(gpm): _METFIOD OF TESTA 12
11. WATER ZONES (depth):
Igo v _
12. CHLORINATION: Type Anloun!ram- II n(ditional space is needed u r bar g11F) rn L
13. CASING:
LOCAIIOL SI_[T_CII _-
Wall Thirknass
Depth Dlanneler or WoighUFt. phi 6 tonalv (Show direction and dis(nnco hom nt least I •a-I'll-
From
`C �.
From �� To � In •FI. Ronds,or other map relerr-ncp points I r^_
From To FI. {-
From To Ft.
14. GROUT: l'z
Depth Material Mellwd
From V To c'P.O Ft. eNow Y urn t --- -
From To Fl. _—_-
15. SCREEN:
Xor
Diameter Slot Size Material R 't-rart.�
From l _. In.
FromL_ In. In.
From _To ^Ft._
16. SAND/G AVEL PACK:
D Ill Sim Malelial
From Fl. ve
From To FL `�toae R
17. REMARKS:
DO HEREBY CERIIFY THAT THIS WELL WAS CONSTRUCTED IN ACCOnD.4NCE WITH 15A NCAC 2C,WELL L✓rr
CONSTRUCTION STANDARDS,AND I I IAT A COPY OF TTII11 /�E/C/ORD HA EIE/N�PROVIDED TO 1 HE NlFLL UN/NEN.
FOR OFFICE USE ONLY s.""z" L� �r `'� �J /+� --
QuadNo: SIGNATURE Or PERSON COrISTRUC11NGRIFWELL ()ATE
Submit aiginai to Division of Water Quality,Groundwater Section Wilhi it 30 days
$"dal No. G7/ 1 IIC`:. IL99

WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)DELBERT PITTMAN' CERTTFICATION#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 Municipai/Public Industrial El Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
7 WF.T.T.T.Or.ATTON-
Nearest Town:RUTHERFORDTON County RUTH Topographic/Land setting
JACIUE LANE-LOT#9 ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:ANTHONY KINDLE Latitude/longitude of well location
Address JACKIE LANE LOT#9
(Street or Route No.) (degrees/mmutes/seconds)
RUTHERFORDTON NC 28139 Iatitudencingitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
(229)—432-2823 DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 06/02105 _
5.TOTAL DEPTH: 605
6.DOES WELL REPLACE EXISTING WELL? YES® NO❑
7. STATIC WATER LEVEL Below Top of Casing: 140 FT.
([Ise"+"if Above Top of Casing)
8,TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface regnues a
varimrr in arrnrdsnry with 14A N(AC?C 011 R L'OCATTON 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
mrmher and mmmnn names
11.DISINFECTION:Type CHLORYTE Amount 16.5 HY.#64/74A W.FROM RUTHERFORDTON.
12.CASING: Wall Thickness GO PAST WHITESIDE STORE.LEFT ON JERICO
Depth Diameter or Weight/Ft Material LANE.(DIR1)GO RT.AT FORKS TO TOP OF
From 0 To 70 Ft 6-14" SDR21 PVC H[LL RT.ON JACKIELANEg1/10 MILE ON
From_To_Ft_ LEFT. r--
From To Ft
13. GROUT: Depth Material Method 1
From 0 To 20 Ft QUHMTE POURED rp
From To Ft
14.SCREEN: Depth Diameter Slot Size Material l
From_To_Ft_ in. _ in. 1 t;
From To Ft. in. in. g,
15. SAND/GRAVEL PACK:
Depth Size Material k
From To Ft L
From_To_Ft_ _
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CON,gRUCnON STANDARDS,AND THAT A COPY OF THI CORD HAS BEEN PROVIDED TO THE WELL OWNER
STrNATTIRF.OFPF'RCOWPONSTRTT('TTNf;THF,WFT.T. DATE.
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

* 3 1 "1 '1, " 9
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(Chock Applicable Box): Residential ® Municipal/Public Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town:ELLENBORO County RUTH Topographic/Land setting
331 PINEHURST DR ❑Ridge ❑ Slope ❑Valley ❑Flat
(Sreet Name,Numbers,Community,Subdivision,Lot No.,Zip Cade) (check appropriate box)
3.OWNER ROBERT MARTIN Latitude/longitude of well location
Address 331 PINEHURST DR. _
(Street or Route No.) (degreeyhnumes/seconds)
ELLENBORO NC 28M Latitude/longitude source: ❑GPS ❑Topographic map
City or Town State Zip Code (check box)
—248-1910 DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 06/07/05
5.TOTAL DEPTH: 195 —
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 Swhw*
*TOP of casing terminated Zatlor below land surface requires a
variance in accordance with 15A NCAC 2C.0118. LOCATION SKETCH
%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 mad
number and common names
11.DISINFECTION:Type CHLORYTE Amount 3.5 FROM ELLENBORO.GO UP BUS,74 W3.
12.CASING: Wall Thickness RIGHT ON OLD US 74.RIGHT ON PINEHURST
Depth Diameter or Weight t Material DR 1/2 MH E PAST CARPET BARN ON LEFT.
From 0 To 30 Ft.6-1411 SDX21 PVC
From_To_FL
From To Ft
13.GROUT: Depth Material Method
From 0 To 20 Ft OUHCRETE POURED
From To Ft j u�
14.SCREEN: Depth Diameter Slot Size Material G
From_To Ft_ in. in.
— r �
From_To Ft_ in. in. iJt
15. SAND/GRAVEL PACK:
Depth Size Material �t
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 STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL,OWNER
SIGNATURE OF PERSqR CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Maul Service Center—Rdeigb,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

31 'I'll '.
WELL CONSTRUCTION RECORD
North Carolima—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)DELBERT PFrFMAN- 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:BOSTIC County RUTH Topographic/Land setting
WATERS RD. ❑Ridge ❑Slope ❑Valley ❑Flat
(Stred Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER MARK HOLLHrIELD Latitudellongmide of well location
Address WATERS RD.
(Street or Route No.) (degrees/minutes/seconds)
BOSTIC NC 28018 Latitudellongitude source: ❑GPS ❑Topographic map
City or Town State Zip Code (check box)
(L —245-8127 DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 06/0M15
5.TOTAL DEPTH: 290
6.DOES WELL REPLACE EXISTING WELLY YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing. 40 FF.
(Use`+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0119. LOCATION SKETCH
9.YIELD(glint): 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 mad
number and common names
11.DISINFECTION:Type CHLORYTE Amount 7.5 BOSTIC/SUNSlI1rIE RD.FROM BOSTIC.LEFT
12.CASING: Wall Thickness ON SUNSHINE SCHOOL RD.IN SUNSHINE.
Depth Diameter or Weight/Ft Material LEFT'ON WATERS RD,
From 0 To 70 Ft 6-14" SDR21 PVC
From_To_Ft_
From_T: To_Ft 13. GROU Depth Material Method
From 0 To 20 Ft.OUHCRETE POURED G
From_To Ft t
14.SCREEN: Dep_th Diame_ter Slot Size Material Ln
From To_Ft._ in. in.
From r To_Ft_ in. in. S
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
COI)S�RUCTION STANDARDS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
AIM
t/ �r �
( Z E s
SIGNATURE OF PERSON CONSTRUCTING THE DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Marl Service Center—Raleigh,NC
27699-1636 gone No.[phone],within 30 days. GW-1 REV.07/2001

31 8i
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 El Municipal/Public El Industrial Lj Agricultural El
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town:LAKE LURE County,R TH Topographic/Land setting
190 N.CHASE LANE1 ❑Ridge ❑ Slope ❑Valley ❑Flat
(Stred Name,Numbers,Community,Subdivision,Lot No.,Zip Cade) (check appropriate box)
3.OWNER:KEITH RUSSELL Latitude/longitude of well location
Address 190 N.CHASE LANE
(Street or Route No.) (degreestii n tes/seconds)
LAKE LURE NC 2876 Latitude/longitude source: ❑GPS ❑Topographic map
City or Town State Zip Code (check box)
128)-778-21" DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 06/16/05 _
5.TOTAL DEPTH: 465
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 Surfaces
'Top of casing terminated atlor below land surface requires a
variance in accordance with 1SA NCAC 2C A118. 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 12 HWY.#64/74A W.FROM RUTHERFORDTON,
12.CASING: Wall Thickness RIGHT ON CALHOUN TRAIL.GO TO TOP OF
Depth Diameter or Weight/Ft Material HELL.STAY STRAIGHT ON N.CHASE LANE.
From 0 To 110 It 6.14" SDIL21 PVC RIGHT AT FORK.TAKE NEXT RIGHT.
From_To_It — - -From To Ft
13. GROUT:_Depth_ Material Method
From 0 To 20 FL OUHOtETE POURED
From_To Ft_
14.SCREEN: Depth__ Diameter Slot Size Material
From_To_Ft._ in. in. c�
From_To_Ft_ is in. r
15. SAND/GRAVEL PACK: r
Depth Size Material
From To_Ft_ O
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
- 5-
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 31 31 t 5
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#( M)453-0662
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:LAKE LURE County RUTH Topograpbioland setting
SWEETBRIAR N.-LOT#63 ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:JIM FORBES Latitudenongitude of well location
Address SWEETBRIAR N.-LOT#63
(Street or Route No.) (degrees/miindWseconds)
LAKE LURE NC 28746 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8J-243-5407 DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 06/22105 _
5.TOTAL DEPTH: 545
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 Wor below land surface requires a LOCATION SKETCH
variance in accordance with 15A NCAC 2C.0118.
9.YIELD(gpm):5 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.#64/74A W.FROM RUTHERFORDTON.
12.CASING: Wall Thickness RT.-ON BH.L'S CREEK RD.LEFT INTO
Depth Diameter or Weight/Ft. Material SWEETBRIAR N.1/2 MH.E ON LEFT.L LOT#63.
From 0 To 60 Ft 6.14" SDR21 PVC -- --- ----
From To_Ft_
From To Ft
13.GROUT: Depth Material Method r
From 0 To 20 Ft OUIIMTE POURED
From To Ft - '
14.SCREEN: Depth Diameter Slot Size Material
From_To_Ft._ in. in. G
r
From_To_Ft._ in, in. t
15. SAND/GRAVEL PACK: Ln
Depth Size Material of
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,A,ND THAT A COPY OF THI CORD HAS BEEN PROVIDED TO THE WELL OWNER
r
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

)p 3 13 ""�l I
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,EC PHONE#(S2g)453-0662
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
L WELL USE(Check Applicable Box): Residential El Municipal/Public N Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: LAKE LURE County RUTH TopographictLand setting
CEDAR CREEK RD, ❑Ridge ❑Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER BH L'S CREEK F.D.#2 Latitude/longmide of well location
Address CEDAR CREEK RD.
(Street or Route No.) (degreeshrmartes/swonds)
LAKE LURE NC 28746 Lantude/longitude source: ❑ GPS ❑ Topographic map
City or Town State Zip Code (check box)
SU)—625-9011 DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 06/23/05
5.TOTAL DEPTH: 205
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use"+"if Above Top of Casing)
S.TOP OF CASING IS 1-1/2 FT. Above Land Surfacer
•Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118. LOCATION SKETCH
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
I I.DISINFECTION:Type CHLORYTE Amount 4.5 HWY.#64/74A W.FROM RUTHERFORDTON.
12. CASING: Wall Thickness RT.ON BILL'S CREEK RD.LEFT ON CEDAR
Depth Diameter or Weight/Ft. Material CREEK RD.3/4 MILE ON RT.
From 0 To 75 Ft 6-14" SDIL21 PVC
From^To_Ft_
From To t F c
13.GROUT:_Depth_ Material Method
From 0 To 20 Ft QUHMTE POURED G r
From To Ft r' y
14.SCREEN. Depth Diameter Slot Size Material _
From To Ft._ in in.
From_To�—Ft._ in n.i �i
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,AN THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSO NSTR 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

C\JP 3
WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)RODNEY ROBBINS CERTIFICATION# 2785
WELL CONTRACTOR COMPANY NAME PrfTMAN WELL BORING.LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box): Residential ® Mumcipm ublic 13 Industrial 11 Agricultural El
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town:RUTHRFORDTON County RUTH Topographic/Land setting
HOPE DR ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:JOE CARSON LatitudcAongitude of well location
Address HOPE DR
(Street or Route No.) (degreeshninutedsecond.4)
RUTHERFORDTON NC 28139 Latitudellongitude son=: ❑GPS ❑Topographic map
City or Town State Zip Cade (check box)
—2874239 DEPTH
Area Code Phone number From To
4.DATE DRILLED 06/07/05
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 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): 2 METHOD OF TEST ARD number and common names
10. WATER ZONES(depth): HWY.#64/74A W.FROM RUTHERFORDTON.
11.DISINFECTION:T CHLORYTE Amount 16 5 LEFT ON MAPL CREEK RD.RIGHT INTO
Type PLEASANTVIEW SUBDV.ON HOPE DR 1/2 MILE
12. CASING: Wall Thickness ON RIGHT.
Depth Diameter or Weight/Ft Material
From 0 To 140 Ft 6-1/4" SDR21 PVC — -
i
From_To_FL_
From To t_F _ G
13.GROUT: Depth Material Method i r
From 0 To 20 Ft OUHMTE POURED
From_To Ft
14.SCREEN: Depth_ Diameter Slot Size Material
From_To_Ft_ in. in.
From_To_Ft_ in. in.
15.SAND/GRAVEL PACK:
Depth Size Material
From_TO_Ft.
_
From_To_Ft_
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
COJ�CT19NSTANDARDS,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 Marl 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# 2795
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ED MunicipaMblic 0 Industrial 0 Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH Topographic/Land setting
280 CAWMP RD. ❑Ridge ❑ Slope ❑ Valley ❑Fiat
(Sheet Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER: SCOTT SAMS Latitude/longitude of well location
Address 290 CAMP RD. _
(Sheet or Route No.) (degreeshninutes/seoonds)
RUTHERFORDTON NC 28139 Latitude/longitude source: ❑GPS El opographic map
City or Town State Zip Code (check box)
8( 28)—286-1126 DEPTH
Area Code Phone number From To
4.DATE DRILLED 06/23/05 _
5.TOTAL DEPTH: 225 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES® NO❑ From To
7. STATIC WATER LEVEL Below Top of Casing: 20 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): 50 METHOD OF TEST ARD number and common names
10.WATER ZONES(depth): HWY.#221 S.FROM RUTHERFORDTON.RT.ON
11.DISINFECTION:Type CHLORYTE Amount 5 COXE RD.RT.ON UNION RD.RT.ON CAMP RD.
APPROX. 112 MILE ON RT.
12. CASING: Wall Thickness y
Depth Diameter or Weight/Ft Material
From 0 To 45 Ft 6-114" SDIL21 PVC —
From_To_Ft_ --�1
From To Ft
13.GROUT: Depth Material Method II ,
From 0 To 20 Ft.OUHOLETE POURED j
From_To_Ft
14.SCREEN: Depth Diameter Slot Size Material -1
From_To_Ft_ in. in.
From To Ft_ in. in.
15. SAND/GRAVELPACK
Depth
Size Material —
From_To_Ft_
From To_Ft_ 7i
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL.
CO CTION STANDARDS,AND THAT A CO Y F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
—6
-5--
SIGNATURE OVPERSON 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.0712001

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# (=)-453-0662
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
L WELL USE(Check Applicable Box): Residential S MumcipaVPubhc LJ Industrial 11 Agrwtdtuml
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON county RUTH TopogrephicRaand setting
2169 W.V.THOMPSON RD. ❑Ridge ❑Slope Q Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:ANGEi A GH LIE LatitudeAongitude of well location
Address 2169 W.V.THOMPSON RD
(Sired or Race No.) (degroes/minutes/seconds)
RUTHERFORDTON NC 28139 Latitudeflongirude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
g2g —863-2468 DEPTH
Area Cade Phone number From To
4.DATE DRILLED 06/14/05 _
5.TOTAL DEPTH: 43 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of casing: 23 FT.
(Usc"+"if Abuvc Top of Casing)
X.TOP OF CASING IS 1-112 FT. Above Land Surface" LOCATION SKETCH
*Top of easing terminated at/or below land surface requires a Show direction and distance in miles from at least
variance in accordance uidr 15A NCAC 2C.0118. Two State Roads or County Roads. Include the road
9.YIELD(gprn): 20 METHOD OF TEST STEEL TAPE number and common nerves
10. WATER ZONES(depth): HWY.#221 S.FROM RUTHERFORDTON. RT.ON
11.DISINFECTION:Type CHLORYTE Amount 9.2 POORS FORD RD.LEFT ON MCCURRY RD.LEFP
ON W.V.THOMPSON RD. V4 MILE ON RT.
12.CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 43 Ft. 24" CEMENT
From_To_Ft.
_
FromT: To_Ft_
13.GROU_Depth Material Method r From 0 To 20 Ft.CEMENT POURED
From_To Ft I I cal
i4.SCREEN: Depth DiamGcr Slot Size Material
c::)
From_To_Ft_ in. in. i
From_To_Ft._ in. in. r j
15. SAND/GRAVEL PACK:
Depth Size Material
From 23 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
CANS ON STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ti
(5 7
SIGNATURE 10F PERSON C U G THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.0712001

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 Z Municipal/Public El Industrial Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2 WET J.T.0r.AlION-
Nearest Town: RUTHERFORDTON County RUTH Topographic/Land setting
BIG ISLAND RD. ❑Ridge ❑Slope ❑Valley ❑Flat
(Street Name,Nmnbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:WILLIAM WI SON Latitude/longitude of well location
Address BIG ISLAND RD. _
(Street or Route No.) (degrambimrtesJsemnds)
RUTHERFORDTON NC 28139 Latitude/longitude source: ❑GPS ❑Topographic map
City or Town State Zip Code (check box)
(864)-473-1688 DEPTH
Area Code Phone number From To
4. DATE DRILLED 06/14/05
5.TOTAL DEPTH: 70 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From TO
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface* LOCATION SKETCH
*Top of casing tenumted at/or below land surface requires a Chow dirertirm and distnnrr 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.LEFT ON CHESNEE RD.LEFT ON
11.DISINFECTION:Type CHLORYTE Amount 9.2 BIG ISLAND RD.APPROX.1/4 MILE ON RIGHT
19. CA RMG- Wall Thickness AFTER YOU CROSS BACK INTO NC.
Depth Diameter or Weight/Ft Material
From 0 To 70 Ft 24" CEMENT
From To Ft.
From_To_Ft - JI rG
13.GROUT: Depth Material Method f
From 0 To 20 Ft.CEMENT POURED
From_To Ft � o
14.SCREEN: Depth_ Diameter Slot Size Material
From TO Ft, in, in. 53
From To Ft_ in. in.
15. SAND/GRAVEL PACK: j` I
Depth Size Material
From 50 To 70 Ft 78M GRAVEL
From To Ft L_-
I
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONS7CTION STANDARDS, AND THAT A COPY OF THIS CORD HAS BEEN PROVIDED TO THE WELL OWNER
SIG ATURE O PERSO NSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

V' 4 4 12
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) Anttwny Bryant Smith CERTIFICATION N 2571
WELL CONTRACTOR COMPANY NAME Green River Well 6 Pump Company PHONE N ($41 60}1200
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W Q PERMITN
(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:gtah1 -64- 4to.�,Cotc+ty ut- ekr0'J ORidge IRSIope ❑Valley ❑Flat
'bM29+o r� K(l F -W r -F0 n UC_ b 139 (chock.ppropri.te box)
(Street Name,Nraubers,Community,Subdiviion.Lot No.,Zip ) Latitude longitude of well location
3s°ate' 3sAl 08; 06 13gLJ
3. OWNER:G)"n (degredminutehoeonde)
Address I Latitude/longitude sourceAWS❑Topographic map
is trget NO.) (check box)
.I.')�-�.L�YI nl r. a8► 3q DEPTH DRILLING LOG
cry�r Towa stain Zip Code From To F ati9n scription
Am coda Phone numbw8 _
4. DATEDRH.LED IP�It�'OJ" Q
5. TOTAL DEPTH: 305' — O r
6. DOES WELL REPLACE EXISTING WELL? YES O NO ❑
7. STATIC WATER LEVEL Below Top of Casing: /0 O FT.
(Use" "if Above Top of Casing) ._
8. TOP OF CASING IS FT.Above Land Surface*
-Top orcaring terminated atior below land surface requires a
variance in accordance with ISA NCAC 2C.011&
9. YIELD(gpm): (a 0 —METHOD OF TESTA i
10. WATER ZONES(depth): L!F
LOCATION SKETCH qq .'".
11. DISINFECTION:Type Amotm[ Show direction and distance in miles from at!•ast
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
7ool&F
a eter or Weight/Ft. Material numbers and common road names.
From Ft 27C vc- WFrom� t 21.C ✓G
From To F1
13. GROUT: Depth Material Metho
From Tom Ft RsErt/l1 M t oC t'-
From To Ft
14. SCREEN: Depth Diameter Slot Size Malarial
From To FLin. in.
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 CONSTRUCTED IN ACCORDANCE WITI 115A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT COPY OF THIS RECORD HAS BEEN PROVIDED'1'0 THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn: Lufermattoa-Mansgam-PT IG17 Nra Sit-Ace Centrr-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 dayp,
��....�,:i -- ---- --,•I W-1 REV.09t2004
_r ey "1r "
1
l

i
Nary c./.on.•o•w,�w a e r.�.M.�e N.w.a -wokp a wow auaM•cwopAw.,w sawn
ux wII TXI-=I
WELL CONSTRUCTION RECORD WIu CONTRACTOR:
WILL CONTRACTOR CIRTMACATION 5:
ETATI WSLL CONSTRUCTION PrmMITS•
1. WELL USE AM Sa8 ROdd�IMlti kwu*w❑ ft&*+,d❑ m dw"❑
hecomy fhSOM
Hod"WSW kOcftn❑ Otw❑ M OMr.4Mt UN:
S. WELL LOCATION:(E,owMnb of oro loc*W bOW4
NOOro>ATOw,c 2 . e
IE < r- CwuAI:.,G �sr� L��a(_
DRRIMLoa
DFVTH
AwllwrdllM�w. .�r�A/�Yln MN
s. OWNER - �— POW To F�OuolrA
r
4. DATE OPLLED
S. TOTAL OEPTN —�^- r
7. DOES WELL RIUR.ACG E>�TMNO WELL, YES 0NO S
S. STATIC WATER LEM Mbw TOP of Cadrm: •3 FL
pbo�9Afwo aCo,41
S. TOP OF CASIG ISM FT.Abwn Lwd&'I'Oo•
-top ,ose+ � wMr�N�aaf
--
m YIELD(w* 49 Z METHOD OF TEST,
i1.WATER ZONES(dWf
ILCHLORNATIOW Type 6.4,016',:�26=Nw MOAA1eIWoFwb,wNdwOotta+o�m
13.CASM/,/f/
a :.-...•
Dwo . arrow wow (SL/a
lMOMbolf�otYM
bnroo POW!
From..TO FL-
From To FL—
lot. (
GROUT: OWJ% MOIwW Mw+w •From TO a�FLFrom To FL N
DOOM, amOior SblMci mommFrom TO Ft Im ..,.�From To Ft._ kL —From To fl._ NA.TS. SANOl61MW3FACIL,DSFM, Sits Me""
From �
From _._... TO FL.
IT. REMIMKS:
,oONSRSSYCERTIFYTNATTNIYWE.I.WASOONSTIp1OMINA000FOMWIMTNISA WJZ1C•YAEIt
CONSTINCRM STANDMM AND TWIT ACOFY OF TEAS RECORD WLS SEMN PROMEO TDTNE'fML O*W
FOR OFFICE USE ONLY �'IftW gums "*WILL 0019
ans w .,y,,,IroMAs.Iww,o�Mo iw,amo,wTNn70uri rAv ,:n
pf,R[��IfJp','t. TF SECTION �
AONLV° �E Hf F"J��rl .1'=ti'v S

3 4 `+ 65
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
�g
WELL CONTRACTOR MMWIDUAL)NAME (Prim CERTIFICATION ftZZf
wELL CONTRACTOR COMPANY NAME S W rP i° W A)<e1 W e!/ ? ?U#W f4 ' PRONE s tStF)b y9=0'/1'O
STATE WELL CONSTRUCTION PERai1T♦f ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential& MtmicipaVPublic❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATI N:, r ,(� Topo c/Laud setting
N tTown e- County, /^ /� ❑Ridge POSlope ❑Valley 17FIat
77.3 3 7- t Pa s Z 7� (ehuk appeaprhse bra)
(Sheet Name,Numbm,Commlmay,Subdivniou,Lot N0.Tip Code) Latitudellongitude of well location
3. OWNER (dopedmimMdsamds)
Address Z OA I atih, cAongitude source:❑GPS❑Topographic map
�3ZJAf'%C1/tJ (s /l1G a ) Z$7$-8 DEPTH ( DRILLING LOG
-— City or Toga stag Tap Coat From To Formation Description
Area cods Phone aamber �y
4. DATE DRILLED 6 �7 -70 5�
5. TOTAL DEPTH: z.Y5' 17
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO B' - •i
7. STATIC WATER LEVEL Below Top of Casing:
(Use"+"if Above Top of Cuing)
8. TOP OF CASING IS /•S- FT.Above Law surface—
'Top of castes terminated Wor below had sorfma requim a
varhaee to atconteate wrtb ISA NCAC 2C A1IL 74 2,'
9. YIELD(gpm): le 0 METHOD OF TEST �0
10. WATER ZONES(depth): r+
LOCATION SKETCH �
11. DISINFECTION:Type C A�mt /D e�z Show direction and distance in tiles from at least j
12. CASING: Wall Thickness two State Roads or County Roads.Include the road'
Amp✓r a_glghr/Ft numbers and common road names.
F To O Ft SD 2 vL
From__To Ft
From—_To Ft
13. GROUT- Depth /�M�at�eri�a�l�/� Method
From ,�To��Ft� lv e-y- Mi x
From--To PL
14. SCREEN: Depth Diameter Slot Si= Material
From_To Ft in. in.
t
From To Ft in. in.
15. SANDIGRAVEL 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 PY OF RECORD HAS BEEN PROVIDED TO THE WELL OWNER
_asp
SIGNATURE OF PERSON CPRSTRt
uIgTEIEWppE(LL DATE
Submit the original to the Division of Water Quality,Groundwa See on,'fgb lo6dt-�W Ceot --Wc%h,NC
27699 1636 Phone Na(919)733 3221,within 30 days G�V-I REV.072001
GEf)I iiJ;r',+S^7P^ ,9F.CTp�N
.` ASncl'ii i [ fi�filurvel i(�pi^� f

V-1 31. 4910
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-%62
STATE WELL CONSTRUCTION PERMIT#— ASSOCIATED WQ PERMIT#_
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential N Municipal/Public ❑ Industrial Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use—
2. WELL LOCATION:
Nearest Town:LAKE LURE County RUTH Topographic/Land setting
SWEETBRIAR S.-LOT#82 ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:MARSHALL SEAY Latitude/longitude of well location
Address SWEETBRIAR S.-LOT#82
(Street or Route No.) (degrees/minutes/seconds)
LAKE LURE NC 28746 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
(K4)-457-61" DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 07/14/05 _
5.TOTAL DEPTH: 205 —
6.DOES WELL REPLACE EXISTING WELL? YES N NO❑
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use"+"if Above Top of Caging)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface•
*Top of casing terminated atior below land surface requires a
variance in accordance with 15A NCAC 2C.0118. LOCATION SKETCH
9.YIELD(gpm): 40 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.DISINFECITON:Type CHLORYTE Amount 4.5 HWY.#64/74A W.FROM RUTHERFORDTON.
12.CASING: Wall Thickness RT.ON BILLS CREEK RD.RT.INTO
Depth Diameter or Weight/Ft Material SWEETBRIAR S. STAY RT.(at FORK 1/2 MH E
From 0 To 55 Ft 6.14" SDR.21 PVC ON RT.(LOT#82)
From_To_Ft_ _
From To Ft _
13.GROUT: Depth Material Method
From 0 To 20 Ft OUMUTE POURED r;
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— —
i
16.REMARKS: TF
— i
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN A[CQQPDA'N ,WfTH 15A NCAC 2C; WELL
CONS N�UCTION STANDARDS, A THAT A COPY OF THIS CORD 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)DELBERT PITTMAN' CERTIFICATION#2159
WELL CONTRACTOR COMPANY NAME P_ITTMAN WELL BORING,LLC PHONE#(828)45M662
STATE WELL CONSTRUCTION PERMIT#— ASSOCIATED WQ PERMIT#_
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential 9 Municipal/Public Industrial Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ if Other,List Use_
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH Topographic/Land setting
RIVER RD. ❑Ridge ❑ Slope ❑Valley ❑Flat
(Sheet Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:RON JENKINS Latitude/longitude of well location
Address RIVER RD,
(Street or Route No.) (degrees/ntinutes/seconds)
RUTHERFORDTON NC 28139 Latitudellongitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 2581-289-7580 DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 07/21/05
5.TOTAL DEPTH: 445 `-
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface*
"Top of casing terminated 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
11.DISINFECTION:Type CHLORYTE Amount 12 FROM RUTH GO OUT MAPLE CREEK RD.
12.CASING: Wall Thickness LEFT ON RIVER RD. 1/2 MILE.NEW DRIVE ON
Depth Diameter or Weight/Ft. Material LEFT.
From 0 To 140 Ft 6.14" SDR21 PVC
From_To_Ft—
From_To Ft
13.GROUT: Depth Material —Method r
From 0 To 20 Ft OUIKRETE POURED
From_To_Ft r ^,
14.SCREEN: Depth Diameter Slot Size Material
From To_Ft. in. in. - - p
From—To_Ft— in. in. rn A.
15. SAND/GRAVEL PACK:
Depth Size Material
From_To_Ft_ —
From—To_Ft— —
i
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC-2C WELL
CONSTJIUCTION STANDARDS,ANU THAT A COPY OF THIS 4CORD HAS BEEN PROVIDED TO TILE WELL OWNER
SIGNATURE OF PERSON COKSTRUCTING 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

00 314904
WELL CONSTRUCTION RECORD V��` "�_
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 Fg—Mj53-0662
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#_
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential 0 Mumcipal/Public Industrial Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH Topographic/Land setting
GREENFIELD RIDGE ❑Ridge ❑ Slope ❑valley ❑Flat
(Street Name,Numbers,Cowmunity,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:JOE CARSON Latitude/longitude of well location
Address GREENFIELD RIDGE
(Street or Route No.) (degrees/mmutes/seconds)
RUTHERFORDTON NC 28139 Latitudellongitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
B( 28)-2874239 DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 07/25/05 _
5.TOTAL DEPTH: 505
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO ED
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use'Y'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
mmnber and common names
11.DISINFECTION:Type CHLORYTE Amount 13.5 FROM RUTH GO UP HWY.#64/74.LEFT ON
12. CASING: Wall Thickness GREENHILL FARM RD.LEFT ON GREENHII L
Depth Diameter or Weight/Ft. Material RIDGE RD, DRIVE ON LEFT.
From 0 To 80 Ft 6.14" SDR21 PVC
From_To Ft_ _
From_TO^r Ft _
13. GROUT: Depth Material Method
From 0 To 20 Ft OURMTE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. y,
From_To_Ft._ in. in. _
15. SAND/GRAVEL.PACK: G r
r
Depth Size Material w
From_To_Ft_ o
From_To Ft
e.a
16.REMARKS: 1
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CON UCTION STANDARDS,APp THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TEE 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

�l►Ny
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 R Municipal/Public Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town:RUTHERFORDTON County RUTH Topographic/Land setting
VS DALTON RD. ❑Ridge ❑ Slope ❑ Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER: TERRY DUFFY Latitude/longitude of well location
Address VS DALTON RD.
(Street or Route No.) (degreedmimrtes/seconds)
RUTHERFORDTON NC 28139 LatitudeRongitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 28)—625-1997 DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 07/27/05 _
5.TOTAL DEPTH: 385
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 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): 30 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
It.DISINFECTION:Type CHLORYTE Amount 9.5 HWY.#108 W.FROM COLUMBUS RIGHT ON
12. CASING: Wall Thickness COUNTY LINE RD.GO APPROX.1/4 MILE.
Depth Diameter or Weight/Ft. Material RIGHT ON VS DALTON RD.STRIAGHT AT
From 0 To 70 Ft 6-14" SDIL21 PVC DEAD END ON GRAVEL RD.NEW HOUSE ON
From_To_Ft_ TOP OF HILL.
From_To_Ft
13.GROUT: Depth Material Method
From 0 To 20 Ft OUHMETE POURED
From_To_Ft_
14.SCREEN: Depth Diameter Slot Size Material ^*?
From To_Ft._ in. in.
From_To_Ft._ in. in. i -#
15. SAND/GRAVEL PACK: r- -_ -
Depth Size Material
From_To_Ft_ cr
From_To_Ft_
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONS UCTI N STANDARDS,AND THAT A COPY OF THIS RECORD HAS-BEEN PROVIDED TO THE WELL OWNER
—e
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

Qs�' 31- 4902
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 0 Municipal/Public El Industrial El Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: CLIFFSIDE County RUTH Topographial and setting
254 HAZELHURST RD. ❑Ridge ❑Slope ❑Valley ❑Flat
(Sheet Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER,MIKE LEDSOM Latitudellongitude of well location
Address 254 HAZELHURST RD. _
(Sheet or Route No.) (degrees(mmutes/seconds)
CLIFFSIDE NC 28160 Latitude/longitude source: ❑GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 28)—657-0070 DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 07/28/05
5.TOTAL DEPTH: 525
6.DOES WELL REPLACE EXISTING WELL? YES® NO❑
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
([Jae"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated actor below land surface requires a
variance in accordance with 15A NCAC 2C.0118. 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 14 FROM CLIFFSIDE ON HWY.120.LEFT INTO
12. CASING: Wall Thickness CLIFFSIDE ESTATES.RT.ON SWEETWATER
Depth Diameter or Weight/Ft Material LANE.RT.ON HAZELHURST RD.(254 ON BOX)
From 0 To 60 Ft 6-14" SDR21 PVC
From_To_Ft_ ?
From�To_Ft
13.GROUT: Depth Material Method G "`
From 0 To 20 Ft OUIKRETE POURED :y
From To Ft
14.SCREEN: Depth Diameter Slot Size Material y
From_To_Ft._ in in. o
tit
From_To_Ft._ in. in.
15. 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
CONS CTION STANDARDS,AND THAT A COPY OF VHS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF Fht(N)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

30 0 14930 1
WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) ROBIN MCNEELY CERTIFICATION# 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING.LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential 0 Municipal/Public Industrial Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town:RUTHERFORDTON County RUTH Topographic/Land setting
4594 BIG ISLAND RD. ❑Ridge ❑ Slope ❑valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:DEWAYNE W LSON Latitude/longitude of well location
Address 4594 BIG ISLAND RD.
(Street or Route No.) (degreestminutes/seconds)
RUTHERFORDTON NC 28139 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8(64)—461-8256 DEPTH
Area Code Phone number From To
4.DATE DRILLED 07/13/05 _
5.TOTAL DEPTH: 46 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 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): FROM MILL SPRING.GO DOWN HWY.#9 S.
LEFT ON CHESNEE RD,GO ACROSS STAT LINE.
11.DISINFECTION:Type CHLORYTE Amount 4.6 LEFT ON BIG ISLAND R CROSS BACK INTO NC
12. CASING: Wall Thickness 2 .HOUSE ON LEFT.BOX#4590
Depth Diameter or Weight/Ft Material
From 0 To 46 Ft 24" CEMENT
From_To_Ft._
From_To_Ft_ _
13.GROUT: Depth Material Method
From 0 To 20 Ft.CEMENT POURED
From To_Ft '
14.SCREEN: Depth Diameter Slot Size Material
From_To_Ft^ in. in. C
From_To_Ft._ in. in. cr
15. SAND/GRAVEL PACK:
Depth Size Material
From 36 To 46 Ft 78M GRAVEL C
From_To_Ft_ -a
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONS ON STANDARDS,AND THAT A COPY OF THIS CORD HAS BEEN PROVIDED TO THE WELL OWNER
r — ? — '
SIGNATURE OF PERSO STR TING THE WELL IDATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

314899
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# f828)-453-0662
STATE WELL CONSTRUCTION PERMIT#— ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential S Municipal/Public Industrial Agricultural El
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ if Other,List Use—
2. WELL LOCATION:
Nearest Town:BOSTIC County RUTH Topographic/Land setting
WINNIERS RD. ❑Ridge ❑ Slope ❑Valley ❑Flat
(Sheet Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:RAY MCMAAAN Latitude/longitude of well location
Address WINNICRS RD,
(Street or Route No.) (degrees/minutes/seconds)
BOSTIC NC 28018 Latitudellongitude source: ❑GPS ❑Topographic map
City or Town State Zip Code (check box)
?J8 -734-1174 DEPTH
Area Code Phone number From To
4. DATE DRILLED 07/25/05 —
5.TOTAL DEPTH: 68 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 48 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 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): FROM BOSTIC GO OUT PEARIDGE RD.RIGHT
LEFT ON MAMMY
11.DISINFECTION:Type CHLORYTE Amount 9.2 ON SANDY SPRING RD. xo
12. CASING: Wall Thickness ON RD.RIGHTY ON WINNIES RD.3 DR ON LEF
Depth Diameter or Weight/Ft Material ON LEFT.
From 0 To 68 Ft. 24" CEMENT
From_To_Ft_ _
From_To_Ft_ _
13.GROUT: Depth Material Method
From 0 To 20 Ft.CEMENT POURED
From To Ft
14.SCREEN: Depth Diameter Slot Size Material
From—To_Ft- m. in. v
From To Ft. in in. - - G
15. SAND/GRAVEL PACK:
Depth Size Material i CD
From 48 To 68 Ft 78M GRAVEL L
From—To—Ft—
16,REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACC06AN CE WITH 15A NGi1C'7C;WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

489
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) ROBIN MCNEELY CERTIFICATION# 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential Z Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: ELLENBORO County RUTH Topographic/Land setting
EVAN EDWARDS RD, ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER: STEVE COX Latitudellongitude of well location
Address EVAN EDWARDS RD.
(Street or Route No.) (degrces/minoteslseconds)
ELLENBORO NC 28040 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
(82S)-648-9344 DEPTH
Area Code Phone number From TO
4.DATE DRILLED' 07/26/05 _
5.TOTAL DEPTH: 49 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 29 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface* 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.0119. 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): FROM ELLENBORO TAKE HOLLIS RD.RT.ON
11.DISINFECTION:Type CHLORYTE Amount 9.2 EVAN EDWARDS RD.4110 MILE ON RT,DIItT
12.CASING: Wall Thickness DRIVE JUST PAST NEW COVENT RD
Depth Diameter or Weight/Ft Material
From 0 To 49 Ft 24" CEMENT
From_To_Ft
From To_Ft_ _
13.GROUT_: Depth Material Method
From 0 To 20 Ft.CEMENT POURED a
From_To Ft
14.SCREEN: Depth_ Diameter Slot Size Material
From To_Ft._ in. in.
From To_Ft._ in. in. o ia
15.SAND/GRAVEL PACK: — - -
rr
Depth Size Material
From 29 To 49 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 WS RECORD HAS BEEN PROVIDED TO-'THE WELL OWNER
R f0
SIGNATURE OF PE O CO 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

V '
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 Z Municipal/Public Industrial Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town:ELLENBORO County RUTH Topographic/Land setting
GUNNS RD. ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:EDDIE LORD Latitude/longitudeofwell location
Address GUNNS RD.
(Street or Route No.) (degrees/minmes/seconds)
ELLENBORO NC 28040 Latitudellongitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
(LO4)-528-9515 DEPTH
Area Code Phone number From To
4.DATE DRILLED' 07/26105 _
5.TOTAL DEPTH: 58 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 38 FT. _
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface* LOCATION SKETCH
*Top of casing terminated at/or below land surface requires a Show direction and distance in miles from at least
variance in accordance with 15A NCAC 2C.0118. Two State Roads or County Roads. Include the road
9.YIELD(gpm): 20 METHOD OF TEST STEEL TAPE number and common names
10.WATER ZONES(depth): FROM ELLENBORO GO DOWN
11.DISINFECTION:Type CHZORYTE Amount 9.2 ELLENBORO/HENRIETTA RD,LEFT ON BUGGER
12. CASING: Wall Thicknnt HOLLOW RD.RIGHT ON GUNNS RD.APPROX. 1/4
MILE ON LEFT.
Depth Diameter or Weight/Ft Material
From 0 To 58 Ft 24" CEMENT
From_To_Ft.
_
From_To Ft
13. GROUT: Depth Material Method
From 0 To 20 Ft.CEMENT POURED
From To Ft
14.SCREEN: Depth Diameter Slot Size Material a
From_To_Ft._ in. in. -
From_To Ft._ in in.
15. SAND/GRAVEL PACK: �o
Depth Size Material
From 38 To 58 Ft 78M GRAVEL o
From_To_Ft
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC- X WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE
)WELL
AOWNER
SIGNATURE OF PSIGNA OF P N VONSTRUCTING 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

314, 896
WELL CONSTRUCTION RECORD lT�
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 El Agricultural El
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town:B STIC County RUTH TopographiclLand setting
ED THOMPSON RD, ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:JEFF ENSLEY Latitude/longitude of well location
Address ED THOMPSON RD.
(Street or Route No.) (degecs/mmutes/seconds)
BOSTIC NC 28018 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
(828)—429-2685 DEPTH
Area Code Phone number From To
4.DATE DRILLED 07/27/05 _
5.TOTAL DEPTH: 30 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): 10 METHOD OF TEST STEEL TAPE number and common names
10,WATER ZONES(depth): HWY.#64 E.FROM RUTH.RT.ON ED
THOMPSON RD OLD FARMHOUSE APPROX 1/2
11.DISINFECTION:Type CHLORYTE Amount 4.6 MILE ON RT.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 30 Ft 24" CEMENT
From_To_Ft� _
From_To_Ft_
13.GROUT: Depth Material Method v
From 0 To 20 Ft CEMENT POURED
From_To_Ft
14.SCREEN: Depth Diameter Slot Size Material _.__ w '
From_To_Ft_ in. in. CDFrom_To_FL_ in. in. ut ,,
15. SAND/GRAVEL PACK:
Depth Size Material
From 10 To 30 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 CORD HAS BEEN PROVIDED TO THE WELL OWNER
SI NA F PE C NSTR CTING TIIE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

44894
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 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 El Industrial El Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other,List Use_
2. WELL LOCATION:
Nearest Town:RUTHERFORDTON County RUTH Topographic(Land setting
WV THOMPSON RD ❑Ridge ❑ Slope ❑valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:RON COOK Latitude/longitude of well location
Address WV THOMPSON RD_ _
(Street or Route No.) (degrees/minutes/seconds)
RUTHERFORDTON NC 28139 Latitudellongitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 64)-472-9325 DEPTH
Area Code Phone number From To
4.DATE DRILLED 07/15/05
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 1-1/2 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 SHILOH GO DOWN POORS FORD RD.
W V
11.DISINFECTION:Type CHLORYTE Amount 7 LEFT ON MCMURRAY RD.LEFT ONTHOMPSON RD.1.4 MILES ON LEFT.
12.CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 150 Ft. 6-1/4" SDR21 PVC
From_To_Ft_
From_To_Ft_ _
13. GROUT: Depth Material Method v `'_
From 0 To 20 Ft.OUIKRETE POURED c�-r
From_To Ft i
14.SCREEN: Depth Diameter Slot Size Material
From_To_Ft_ in. in. o
From_To_Ft_ in. in. Ln
15. SAND/GRAVEL PACK: __ N
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 STANDARD AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
n y
Q
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# 2795
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE#[phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential 10 Muni
cipallP��blic Industrial Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH Topographic/Land setting
536 RADAR RD.. ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:RANDY TONEY LatitudeAtingitude of well location
Address RADAR RD.
(Street or Route No.) (degrces/miumes/seconds)
RUTHERFORDTON NC 28139 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check bar)
8( ZS)-287-7239 DEPTH
Area Code Phone number From To
4.DATE DRILLED 07/05/05 _
5.TOTAL DEPTH:365 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 60 Ff.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 Ff. 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.#9 S.LEFT ON CHESNEE RD.RIGHT ON
11.DISINFECTION:Type CHLORYTE Amount 9 RADAR RD.NEXT DRIVE ON RIGHT. BOX#536
12.CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 160 Ft 6-1/4" SDR21 PVC
From-To—Ft—
From p
TO Ft G
13.GROUT: Depth Material Method c
From 0 To 20 Ft.OUDMTE POURED �n .
From_To Ft o
14.SCREEN: Depth Diameter Slot Size Material , ___ Ln
From_To_Ft._ in. in.
From_To_Ft._ is in.
15. SAND/GRAVEL PACK:
Depth Size Material
From_To Ft
From_To_Ft_
_ E
i
16.REMARKS: r E
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTTRUCT10,N STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S=G�
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

f\�1 ►� 314888
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# (828)d53-0662
STATE WELL CONSTRUCTION PERMIT#^ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential 0 Municipal/Public 0 Industrial Agricultural El
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town:LAKE LURE County RUTH Topographic/Land setting
LAUREL LAKES-LOT#66 ❑Ridge ❑ Slope ❑valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:MIKE WILSON Latitude/longitude of well location
Address LAUREL LAKES-LOT#66
(Street or Route No.) (degrees/mira tes/seconds)
LAKE LURE NC 29746 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
9�4 —275-8513 DEPTH
Area Code Phone namber From To
4. DATE DRILLED 07/09/05
5.TOTAL DEPTH: 485 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface* 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): 2 METHOD OF TEST ARD number and common names
10.WATER ZONES(depth): HWY.#64/74A W. FROM RUTHERFORDTON.
11.DISINFECTION:Type CHLORYTE Amount 12.5 RIGHT ON BIWS CREEK RD.LEFT INTO
12.CASING: Wall Thickness � L LAKES.STAY LEFT.ONLY HOUSE ON
Depth Diameter or Weight/Ft Material LEFT.LOT#66.
From 0 To 110 Ft 6-1/4" SDIL21 PVC —
From To Ft_ yr
From^To Ft
13.GROUT: Depth Material Method r
From 0 To 20 Ft.OUHOtETE POURED
From To_Ft o
14.SCREEN: Depth Diameter Slot Size Material cn
From_To_Ft._ in in.
From_To_Ft_ in
15. SAND/GRAVEL PACK: — ----
Depth Size Material
i
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,-5"-
SIGNA OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

rn um,xvu rams i o.alepnerre vvuson Date:7/8/2005 Time:5:19:36 PM Page 3 of 5
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment,and Natural Resources-Division of Water Quality-Groundwater Section �' r
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)
L 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 RUTHERFORD ❑Ridge ❑ Slope ❑Valley ® Flat
LOT 166, GROUNDHOG CIRCLE, RIVERBEND SUB Latitude/Longitude of well location
(Street Name,Numbers,Community,Subdivision.Lot No,.Zip Code) 35,26.055/82,09.977
3.OWNER RIDGELINE DEVELOPMENT CORP. (degrees/minutes/seconds)
ADDRESS Y12 COCOPLUM CIRCLE Latitude/longitude source:®GPS❑Topographic map
(So-dor Route No.) DEPTH DRILLING LOG
ROYAL PALM BEACH FL 33411 From To Formation Description
city or Town State Zip Code 0 56 Clay
561-798-2729 56 280 Consolidated Rock
Area Code-Phone Number
4.DATE DRILLED 6/14/05
S.TOTAL DEPTH 280
6.DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7.STATIC WATER LEVEL Below Top of Casing: 73 FT.
(tie."t"IfAbov.Top ofCaem,)
8. TOP OF CASING IS 2 FT.Above Land Surface-
*Top of—ing I.rmtrat.d it/or below 1®d swfu.re,".ve i.,c to
atemdm..wa615A NCAC 2C 0118
9. YIELD(Rpm): 4 METHOD OF TEST ARDM
10.WATER ZONES(depth): 270
u.DISINFECTION:TYPE HYPOCHLORITE Amount 10 0. LOCATION SKETCH
12.CASING: wall Thickness Show direction and distance in miles from at least
Depth Diameter or WeighuFL Material two State Roads or County Roads.Include the road
From 0 To 66 Ft 6 1/4" SDR 21 PVC numbers and common road names.
13.GROUT
Depth Material Method I Y 10
From 0 To 20 Ft GRAVEL MIX GRAVITY �^�/�
14.SCREEN RY sl I 'ti
Depth Diameter Slot Size Material y Y `�� V _ rj
From NA To FL in in. J W
15.SAND/GRAVEL PACK: j O Y
Depth size Material
�� Ul
From NA To Ft,
-'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 RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
r� 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, 1636 Mail Service center-Raleigh,NC
27699-1636 Phone No.[phone],Within 30 days. -- -- ----- --.—
L:

rrom:t,cort ioarm i o:aiepneme wdson Date:7/8/2005 Time:5:19:36 PM nn Page 2 of 5
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment,and Natural Resources-Division of Water Quality-Groundwater Section ,9
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 cowry RUTHERFORD Ridge ❑ Slope ❑ Valley ® Flat
Ri e
LOT 17 SWEET BRIAR FARMS SUB. Latitude/Longitude of well location
(Street Name,Numbers,Community,Subdivision,LotNo,Zip Code) 38.28.799/82,07,308
9.OWNER MIKE COLBERT (deprees/mhurtes/seconds)
ADDRESS 5392 ORANGE BLVD Latitude/longitude source:®GPS❑Topographic map
(sired or Route No.) DEPTH DRILLING LOG
SANFORD FL 32771 From To Formation Description
City or T,oen State Zip Code 0 42 Clay
407-323-1977 42 220 Consolidated Rock
Area Code-Phone Number
4.DATE DRILLED 6/6/05
5.TOTAL DEPTH 220
6.DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7.STATIC WATER LEVEL Below Top of Casing: 70 FL
Oise w^IfAbove Top of Cuing)
8. TOP OF CASING IS 2 FT.Above Land Surface-
-TV of evmg tenninned ad.,bdow land sr6a rcguine o vanui.in
accordance with 15A NCAC 2C.01 18
9. YIELD(Rpm): 15 METHOD OF TEST ARDM
la.WATER ZONES(depth): 210
D.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 1/4" SDR 21 PVC numbers and common road names. s'S
la.GROUT:
Depth Material Method
From 0 To 20 Ft GRAVEL MIX GRAVITY
14.SCREEN
Depth Diameter Slot Size Material
From NA To Ft in. in. ,�� V Ul .sy�
15.SAND/GRAVEL PACK:
Depth Size Material .3
From NA To Ft. Y y
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.
7/7/OS
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
GW-1 REV.0712001
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days.

rrom:bcon carat i o:btepneme wuson Date:71&2005 Time:5:19:36 PM V Page 1 of 5
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
Nearesttown: RUTHERFORDTON County RUTHERFORD ❑Ridge ❑ Slope ❑ Valley ® Flat
2110 TONY RD Latitude/Longitude of well location
(Street Name,Numbers,Consim roily,Subdivision,Lot No,.Zip Code) 35.28.240181,41.469
3.OWNER HORTON HOME OF RUTHERFORDTON (degrees/mminci/seconds)
ADDRESS 342 HWY 74 BYPASS Latitude/longitude source:®GPS❑Topographic map
(strenor Rome No.) DEPTH DRILLING LOG
RUTHERFORDTON NC 28139 From To Formation Description
CityorTown State Zip Code 0 20 Clay
828-287-3366 20 140 Consolidated Rock
Area Code-Phone Number
4.DATE DRILLED 6/24/05
5.TOTAL DEPTH 140
6.DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7.STATIC WATER LEVEL Below Top ofCming: 20 FT.
(Usc"r-If Above Top of Casing)
8. TOP OF CASING IS 2 FT.Above Land Surface-
'Top of casing tammated atlor blow Ind serface requioes a varissuc in
aocordanee wiar IM NCAC 2C 0118
9. YIELD(gym): 10 METHOD OF TEST ARDM
to.WATER ZONES(depth): 130
I1.DISINFECTION:TYPE HYPOCHLORITE Amount 6 0= LOCATION SKETCH
12.CASING: Wall Thickness Show direction and distance in miles from at least
Depth Diameter or Welght/R. Material two State Roads or Comfy Roads.Include the road
From 0 To 27 FL 61/4" SDR 21 PVC numbers and common road names. F
13,GROUT: t'"g
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 C
15.SAND/GRAVEL PACK: \ \�� ;
Depth Size Material ) J
From NA To Ft,
A3` ./
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/l/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.
II '
ill

WELL CONSTRUCTION RECORD 314329
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) Tamea W f amP-r Jr CERTIFICATION#---21 3
WELL CONTRACTOR COMPANY NAME Camp' s Well & Pump Cc) Tric- PHONE # a24 491_7122
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1111111
1. WELL USE(Check Applicable Box):Residential dR'�Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery O Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATI N: \\ Topographic/Land setting
Nearest own: County 61 J' 9<idge ❑Slope OValley OFlat
t 'Tl� `� �j (check appropriate box)
(Stree`t ame,Numbers,Co unity(,,Subdivision,Lot No.,Zip Code) Latitudellongitude of well location
3. OWNER: , JA.✓ M
! V vt LA, (degreestminures/seconds)
Address V1 1 e.a d9 ✓ Ii-A ' I - Latitude/longitude source:OGPSOTopogmphic map
(Street or oute No.) (check box)
AQ X r Sp DEPTH DRILLING LOG
Ci or Town state Zip Code From To Fomat ion Dscription
(—)-
Area code-Phone number ••'�t _
4. DATE DRILLED `I • J.
5. TOTAL DEPTH: LA „C7 - !J tLA
6. DOES WELL REPLACE EXISTING WELL? YES P NO IY rss
7. STATIC WATER LEVEL Below Top of Casing: '4 0_FT. C
(Use"V'if Above Top of Casing) -rr�
8. TOP OF CASING IS 1 FT.Above Land Surface*
-Top of casing terminated atlor below land surface requires a
variance in accordance with 15A NCAC 2C.01l&
9. YIELD(gpm):1—METH029F TEST a i r —
10.WATER ZONES(depth): VA\
- LOCATION SKETCH
11. DISINFECTION:Type ChI on 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 WeighUFt. Material numbers and common road names.
From__To -)T Ft. 6 1 /4 Sdr 1 P V r
From To Ft. �}-
From To Ft. -- ur
13. GROUT: Depth Material Method � r��
From__Q__To_2_0___Ft. Neat Ce.aent- Hann
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 F[. V
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A C, OF THIS RECORD S BEEN PROVIDED TO THE WELL OWNER
Tl -05
SIGNATURE OF RSON CONS UC G THE LL DATE
Submit the original to the Division of Water Quality,Attn: Inforlrt4fig4 Manageineiit,15t7.-Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. -
GW-I REV.09/2004

01 314328
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVEDUAL)NAME (print) Tamea W ('ampyr Jr CERTIFICATION#_2_1_38
WELL CONTRACTOR COMPANY NAME Camp' s Well & Pump Cc) Tnr_ PHONE # R2A A52_7722
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential%R�Municipal/Public❑ Industrial O Agricultural❑
Monitoring❑ Recovery O Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCAT{QN: _ - ( Topographic/Land setting
Nearest own: `� County \ ORidge ❑Slope l plalley OFlat
16 (check appropriate box)
(Street Raine,Numbers,Conuntinny,subdivision,Lot N�o�.,(Zip
�Code) Latitude longitude of well location
3. OWNER:\1( S 1 `l1 lJ 1 l�' 11$SNX_lt..iJ` (deg`ces/minutes/sewnds)
Address �7f l�i�Xri Latitude/longitude source:OGPSOTopographicmap
II(Street or Route o.) (check box)
_)<C G.NY2- IV o�g ]�6 DEPTH DRILLING LOG
City or Town State Zip Code From ;o� Fo ation De cription -Ell
( ) ' vw
Area code-Phone number r� - ff,'
4. DATE DRILLED �2 • —� DY15c i a, 2 j�ec/c
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES O NO G
7. STATIC WATER LEVEL Below Top of Casing:_�A U FT. r—
(Use"+"if Above Top of Casing) r-
8. TOP OF CASING IS 1 FT.Above Land Surface* f V rF
-Top of casing terminated atlor below land surface requires a —e
variance in accordance with 15A NCAC 2C.0118. l7
9. YIELD(gpm):�0 METHOD OF TEST air
10.WATER ZONES(depth): —);)b LOCATION SKETCH
11. DISINFECTION:Type(`h 1_or i n e Amount Show direction and distance in miles from at leas
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
`
Depth Diameter or WeightfFt. Material numbers and common road names. �U
From___Q _To %A!�_Ft. 6 1 /4 Sdr 21 - PV-C
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From__(L_To2pFt. Neat C t-mPnt Hanr3
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS: _
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A CO OF THIS RECORD S BEEN PROVIDED TO THE WELL OWNER
' - -J S
SIGNATURE OF CONS UCTING THE LL DATE
Submit the original to the Division of Water uality,Attn: Information_Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-I REV.09/2004

WELL CONSTRUCTION RECORD ) 314325
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(1NDIVIDUAL)NAME (print) TamPS W
CERTIFICATION 9­2 1_3-8
WELL CONTRACTOR COMPANY NAME Camp' S Well & Pump CQ r Inc,_ PHONE # A2A 451_7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED pl PERMIT#
(if applicable) / (if applicc able)
I. WELL USE(Check Applicable Box):Residential ;r Municipal/Public❑ Industrial 0 Agricultural❑
Monitoring❑ Recovery O Heat Pump Water Injection❑ Other D If Other,List Use
2. WELL LOCAT N: Topo�J,jphic/Land setting
Nearer wn: County i "(p�' DRidge O61ope OValley []Flat
A r• O t � (check appropriate box)
=u b \ Latitude(lon itude of well location
(Street Name,Numbers,Community,Subdrvrswn,LotNo.,Zip Code) g
3. OWNER: JA �^� �` -ty 1 "�"`" (degrees/minutes/seconds)
i i 1 f� Latitude/longitude source:OGPSOTopographic map
Address
(S t r Roue N J (check box)
t
` C �/d�1�� DEPTH DRILLING LOG
fCity or Town t f brave Zip code From �To rmaf��QQn Description
Area code-Phone num
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YE$OUNO Ch
7. STATIC WATER LEVEL Below Top of Casing: �/
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1 FT.Above Land Surface' C
*Top of casing terminated attor below land surface requires afa
variance in accordau f�e with 15A NCAC 2C.011S.
9. YIELD(gpm t.�
): ME HOD
OFTEST i r r
10.WATER ZONES(depth): U - LOCATION SKETCH to ' `J
Show direction and distance in miles from at lease
11. DISINFECTION:Type C'lh I o r i n P Amount two State Roads or County Roads.Include the r'
12. CASING: Wall Thickness "w
Depth Diameter or Weight/Ft. Material
numbers and common road names.
From_To Ft. 6?/4 Sci r 1 P17C
From To Ft.
From To Ft. (� IV
13. GROUT: Depth Material Method t�/
From�_To__2..p_Ft. Neat Cement Hand
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. _ in.
From To Ft. in. _ in. r
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 COPY OF THIS RECO HAS BEEN PROVIDED TO THE WELL OWNER
7- 4-os
SIGNA F PERSON CO STRUCTING 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

WELL CONSTRUCTION RECORD �0 314324
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INIHVIDUAL)NAME (print) Tames k ('amp-, Jr CERTIFICATION#--2-1—M
WELL CONTRACTOR COMPANY NAME Camp' s Well & Pumper, Inc PRONE # R2A esz_�-xZZ
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential Lkr Municipal/Public❑ Industrial❑ Agricultural❑ _
Monitoring❑ Recovery O Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: 1 1 Topographic/Land setting .
Nearest IO` V.�9- County =,It.•r„�Ji ORidge ❑Slope OValley tat
i R .yp,Qy k/d, (check appropriate box)
(Street Name,Nunn rs Commu ubdivislon,Lot No.,Zip Code) Latitudellongitude of well location
3. OWNER: (degrees/minutesInconds)
Address O yo tine Latitude/longitude source:OGPSOTopographic map
Stree or geu No.) - (check box)
Moa✓es u vo ( C DEPTH DRILLING LOG
City or Town State Zip Code From
TTro-�—. Formation Description
(ea cod Ar e-Phone nuanbo,`��,111 ------ - (% [7 J�� l r -'i
4. DATE DRILLED
5. TOTAL DEPTH: Pr,N ScTe
6. DOES WELL REPLACE EXISTING WELL? YES O NO F�-=
7. STATIC WATER LEVEL Below Top of Casing: _FT. r
(Use"+"if Above Top of Cuing)
8. TOP OF CASING IS 1 FT.Above Land Surface*
-Top of wing terminated atlor below land surface requires a t7
variance in acmrdul a with 15A NCAC 2C.0118. Edi .,1
9. YIELD(gpm): dLkj
_METHOD OF TEST a i r
10.WATER ZONES(depth): �)-b0 Y
LOCATION SKETCH
11. DISINFECTION:Type('.fi 1-or i n e 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_To_5 Ft. 6 1 /4 grJr 1 - PVC S
From To Ft. nr�`
From To Ft. -- o�
13. GROUT: Depth Material Method
From_Q_To_20_Ft. Neat Cement Hand
From To Ft.
14. SCREEN: Depth Diameter Slot Sin Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material e^ , C- `,(�
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE 15A NCAC WELL
CONSTRUCTION STANDARDS,AND THA COPY OF THIS ORD HAS BEEN PROVID 0 THE WELL OWNER
SIGNA OF PE"ONSTRUCTR THE WELL DATE
Submit the original to the Division of Water Quality,Attn: Inforinift164-WhageRlent,1619 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD 314323
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDWIDUAL)NAME (prt CERTIFICATION#�7a
WELL CONTRACTOR COMPANY NAME Camp' s Well & Pump o r Inc-, _ PHONE # 62a a9z_-,322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
if livable if livable
1. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial O Agricultural❑
Monitoring❑ Recovery O Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATI N: -A n Topographic/Land setting
Nearest o U�-X�(/� County { vV---A Ridge []Slope OValley 0171at
\AA �-T'f (check appropriate box)
(StreetName,Nurn rs, ommunity, ubdivision Lot No,Zip Code) Latitude/longitude of well location
3. OWNER: (degrees/minutes/seconds)
Address 00 D4 Latitude/longitude source:OGPSOTopographicmap
(Sweet or Route No.) (check box)
1 I I �) �F 3 0 r. DEPTH DRILLING LOG
City or own State Zip Code From o F rmation Description
l�y'✓�J(_�1 98'] - lie��-
Area code-Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES O NO
7. STATIC WATER LEVEL Below Top of Casing:_LOU FT.
(Use'W'ifAbove Top of Casing) C •<
8. TOP OF CASING IS 1 FT.Above Land Surface's _
-Top of using terminated attor below land surface requires a _ Ei
variance in accords ce with 15A NCAC 2C.0118. r
9. YIELD(gpm): _METHOD OF TEST a i r
10.WATER ZONES(depth): LOCATION SKETCH r '
11. DISINFECTION:Type rh or i nP Amount Show direction and distance in miles from at le
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_To Ft. 6 1 /Q Rd, 21 PIT(-
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From�_To__2j)__Ft. Rea meat Hand
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material - '• , _/D
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 COPY OF THIS RE 6RD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNA OF PERSON ONSTRUCTIN 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
;- c

WELL CONSTRUCTION RECORD 314322
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) 3amPs W_ ramp, Jr CERTIFICATION#_21_3-8
WELL CONTRACTOR COMPANY NAME Camp' s Well & pump Co_ r Tnr- PHONE # Q7A 45Z_7J22
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: /� ,�jj� ���,pp ` Topographic/Land setting
Neare/stTown: e5 Cl'/ County hllhe Y� I Ridge []Slope OValley ❑Flat
L-o A j7F Jh0 U)7'b Q - (check appropriate box)
(Street Name,Nuurnbbe'rs,Qbnamunity,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: CJO ✓1 IYI,S (degrees/minutes/seconds)
Address Latitude/longitude source:OGPSOTopographic map
g�7 � 1 }(g.treet or Route No.) - (check box)
.Y�l u(JE AL 1 o A, rL 3 oZ.D.S DEPTH DRILLING LOG
City or Town State - Zip code From To Fo�ation Description
VSrl3q— II ro © (os di'y Li Ya)fl
Area code-Phone number ry ems `
4. DATE DRILLED 7-1a—G JD S ©`� %DA15oJi a e ✓o
5. TOTAL DEPTH: -
6. DOES WELL REPLACE EXISTING WELL? YES O NO J C
7. STATIC WATER LEVEL Below Top of Casing: qO T. r '
n� 01
(Use"+"if Above Top of Casing) _ ..
8. TOP OF CASING IS 1 FT.Above Land Surface•
-Top of casing terminated aVor below land surface requires a —
variance in accordance with 15A NCAC 2C.0118. Lrl
9. YIELD(gpm): 5' METHOD OF TEST a i r
10.WATER ZONES(depth): 3c40
LOCATION SKETCH
11. DISINFECTION:Type Ch 1 or i n P Amount I AShow direction and distance in miles from at
�((least
12. CASING: Wall Thickness two State Roads or Coun Roads.Include tgeroad
Depth Diameter or Weight/Ft. Material numbers and common roa names.
From___o_To�Ft. 6 1 /q SAr 71 pVC
From To Ft. ` I
From To Ft.
13. GROUT: Depth Material Method
From___0_Togp_Ft. Neat CemPT1t Hance_ I
From To Ft. I �✓. -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 r \
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 T A COPY OF THItECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNA OF PERnN CONSTRHtTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn: Informatiou'.Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-I REV.09/2004

WELL CONSTRUCTION RECORD 314321
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRAC'rOR(INDIVIDUAL)NAME (Print) lames W CERTIFICATION#_24-18 .._
WELL CONTRACTOR COMPANY NAME Camp' s Well & Pumo CO Tnrr_ PHONE # d27A 451_7322 '
ASSOCIATED WQ PERMIT# _
STATE WELL CONSTRUCTION PERMIT# (if applicable)
(if applicable)
1. WELL USE(Check Applicable Box):Residential o, Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring O Recovery O Heat Pump Water Injection❑ Other O If Other,List Use
2. WELL LOCATION: _ Topographic/Land settin
Nearest Town: tn. County v. ( Y ORidge ❑Slope OValley lat
(check appropriate box)
e,f ' - V✓ Latitudellongitude of well location
(Street Narnc,Numbers,Community,Subdrvrswn,Lot No.,Zip Code)
(degrees/minutes/seconds)
3. OWNER: Latitude/longitude source:OGPSOTopographic map. -
Address —�D 1 �X l7 S/q (check box)
(Street or Ron tJe�Njo.) DEPTH DRILLING LOG
14 Ke (,ixYE ' " L 20 /- From TO _. Formation Description
City or Town - Srate Zrp Code
(d A o-Phone number
4. DATE DRILLED ( � (D w In a e cl
5. TOTAL DEPTH: -c
WP-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO R
7. STATIC WATER LEVEL Below Top of Casing: r
(Use"+"if Above Top o asmg)
8. TOP OF CASING IS 1 FT.Above Land Surface* N
*Top of casing terminated;it,,below land surface requires a i®
variance in accordance with 15A NCAC ZC.011& p
9. YIELD(gpm):1_METHOD OF TEST-A t r -,.
10.WATER ZONES(depth): ZJL12 LOCATION SKETCH
Show direction and distance in miles from at leas
I1. DISINFECTION:Type f'h 1or i ne Amount� two State Roads or County Roads.Include the road
12. CASING: Wall Tightness d common road n
numbers an
Depth Diameter or Weight/Ft. Material i ames.
From_�_To �Ft. 6 1/4 $dr 1 PVC
From To Ft. _"-- J i
From To Ft.
S �f f��Y.!� ✓
13. GROUT: Depth Material Method
From_D_To9pFt. Neat Cement Hanr9
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. _ in.
From To Ft. in. is {�
15. SAND/GRAVEL PACK:
J t
Depth Size Material r V-
From To Ft.
From To Ft.
16. REMARKS: ty, .
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND IRA A COPY OF THIS CORD HAS BEEN PROVIDED TO THE WELL OWNER
.7-I9-o5
SIGNA OF PERSO CONSTRU ING 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

lam"" 314319
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality"
WELL CONTRACTOR(INDIVIDUAL)NAME (print) TdmPC w f amEL, Jr CERTIFICATIONS 7�Z8
WELL CONTRACTOR COMPANY NAME Camp' s weii & Pump Cc)_, Tnr_ PHONE a 62 d53 22
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT#
if applicable) (if applicable)
I. WELL USE(Check Applicable Box):Residential tp Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery O Heat Pump Water Injection❑ Other 0 If Other,List Use -:
2. WELL LOCAT N: - h r, � Topographic/Land setting !. _
Near tT con: Co `ty un dge ❑Slope OValley []Flat -
(check appropriate box)
(Street Name,Numbers,Community,Silbifivisian,Lot No.,Zip Code) Latitude/longitude of well location..
3. OWNER: D✓L Lo /7CSi (degms/minutes/seconds)
Address 434,0 2 �-aYna g - (check box) PoBmP P
LatitudeQon ttude source:OGPSOTo hic;ma
(Street or Route NP.)
Mnn tl VAA. 1—a w /V C, -2915 qi DEPTH DRILLING LOG
City or To n State Zip Code From T� OntlatiOn
Area code-Phone numbe
4. DATE DRILLED
5. TOTAL DEPTH: -'
6. DOES WELL REPLACE EXISTING WELL? YES` NO �
7. STATIC WATER LEVEL Below Top of Casing: 20 T. r—
(Use'Y'if Above Top of Casing) f V _
8. TOP OF CASING IS 1 FT.Above Land Surface's
-Top of casing terminated at/or below lend surface requires a
variance in accordance with 15A NCAC 2C.0118. c51
a r
9. YIELD(gpm):�_METHOD OF TESTS i r
10.WATER ZONES(depth): ��U LOCATION SKETCH
11. DISINFECTION:Type C I_nr 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 common road names.
From_0_To--ZU—Ft. 6 11 S.dr 1 - PVC
From To Ft. op3
From To Ft.
13. GROUT: Depth aterial Method
From___Q _To_2jp_Ft. N a -PmPnt HanA _
From To Ft. n
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in. F^� rGtJ
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 PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
OS
SIGNATURE PERSON CT STRUCTIN 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

mom cm4sm•D.v.rw.a of Mmbwn wni wA Ndvd 11"m".GMNan Of WOW Qu ft•QIwMW WMW SKtla"'" 4 4 v J
.as Mirew4wCyr-Rd@W Kr.V*MI9 4 wMptgT.C-=I
WELL CONSTRUCTION RECORD We"CONTMCTDR:
WELL CONTRACTORCRATIFICATION/: _ �rL� .—
STATE WELL CONETRtICTION FERMITP
A WELL D9�!U!�.(-.ING
1. WELL USE Appft*wMa ReoldrWd MunldpN❑ kWueMWQ A 91
eI�DRIN1idIMiEYJOE.INc.
ftwomY Hoa Funvwe)v k*om O Orw o a olm wt o 1 Hwy. 6usi�ess 7a
828-247-1773
s. WELL LOCATK wt(&Im a d*of me-m c No Wow)
NloM►MTtw�c�f�/) f�i l../�(/,r- Cw�9r: —� i
DfNLl NG LOG 0 H �-
�Iw�11w�dIM�MprwMM!•«euMAMrIMdl�M 11s.) _ ---
a. OWNER -Z"61-9-4 To FMnntpowr+�
t. DATE DRUM! ,
s. TOTAL DEPTH a ;'
s. cvrrms CCLL.ECYEO YEA❑ NO[]� ��----
7. DOES WELL REPLACE EI(IETING WELL
M Y rE8 No
i. STATICWATPA LEVEL bwTepaCean! FT. r
N...•�w«.T.raaw
!. TOP OF CASINO IS. ,z FT.AdWe laud SIMIeM'
Rw•yraAM%"*w%d AMMdw bwwd -wob"•wMwiwMen- -
dnw*wMM WA IMM=At"
iC. YMELO(w* a=._METHOD OF TEST /h= /.c, v
r
11.WATER Z011EE(MFsi�:.�� '.�'
m CHLOIINATM]It TYPO c '� Nppyle Medga"sp aYNoMmmebwAsfWm
13. CASINO: `�D, cO�vile� _
WaTtAdma
wrMlwaw mow phowpnak4+MdIrY^i+ srltl
FraM 7eM.J-S�.FL.4— ----/dac mmku rol w om I'wM�a
Flom- Te M
FMm To FL
lot. GROUT:
DIP* Mow" MWad L
Flom 4a To. -FL ngd&�� ?�- f 11" ��c e
From To FL
1s. scomum � 5�
040 amnow od Slti Mallow �
Fran %o Ft IIL �h
From To�FL— h —kL `� �7
Fran Te�_fi.�— YL —ti• h �
16. SMrOlO AVEI,PACKDopm maw"
Fran Te Fi k3' e'l r,�f
from To FL. .-------
17. REIIARtt&
ICONEIIE6YCERTwYDKTIM6WELLWA6COH$TIRL'MONACODROAN "TI419ANCAClC.WELL
CCNiT1RICRGR 6TANW!lD6.AfDTNAT A WPY OF T1M6(MECDRO NAs 6F.EN iYICNICEO TOTNE WELL Q>tbE�
FOR OFF)CE LIVE ONLYOF rEReCII O01gTIISC1els tit VML y;L
am ft
lMdlla

14462
NaM c•niN••WO�nw•a 6M4•Mw•A ww NN•d Aeaw.06"-mdam OR wow Qnw•a undww.Seabn
ISM MW ftf4m ow.-Mddlk MAL V6Wl=4FIm*p/sl r 3 Ml
WELL CONSTRUCTION RECORD WELLCONTMCTOR:
WSLL CONTRACTOR CSWTUgCATM t•:,� S
8TAT8 wM L CONSTRYCTION PwmlTh
1. WELL USE Anft M IN*ftW.IMLI�Mwd*W C3 VAI*W❑ t0 177
ftwo ry o Hm Puns WMM Y*ftn❑ Ol w[3 M Ow•t.L*UN: n•cONC. '
�VLV aRi 1 J
s. WELL LOCATXK(SAawakNoh o1 Wa beaf•n bNoV4
N•M^^rulTwwi s�-/3�.�1/-/' �t/h/ tNm�g;, �/�Y��'��/�A.1-�/fr✓ � '.
if '/J♦'iC J6tle�'"ff_ t�.C✓L_�� �.�As�i�l�c1'.tJ DEPTH -
pLrn.•.w ...erwrwwwlw.f -
�. OWNEfI Pon T• F••rtdr�Ondprs
AddMa
4. DATE DIVA Off= ..i..:._ S� .. . -.
S. TOTAL DEPTH � -
S. CUTrmsODUACTLW YES I�Ho
OE 7. D81IM L WEFLAKM EXIETN'�t# ax.?w-o HoEl
S. STATIC WATER LEVSL WOW Tap of CaYMlit FT,
pY•Y9A1•wTMMO•we1 '� ..
e. TOP OF CASIN018 -FT.Mow Laid SuAaaa' N e
'rN a aA�•M�MM��MM Yr•MY•i•ola•nl�•wrYst•Y•nr ``
a•e•,�IwwlroAoae.an o -=
IQ. YIELD(apnl} yL�.MP Tf10D OF TEST , c _ rilri 1 -3
11.WATER ZONES"w*
t2 CFSORSIATIOIk Typu�;1F'�r4 r AWAWd - aaddlYmlq•oaYiw/�dwb•daM�m
13. CAMft ,2G i
rAMOM ".w•larR Mary (Sbewgr••IYnwidMr�ofb�mMY•Ke�ofp•M
FL.(a. - +�-r.Y,/� IloadaaMw APaP+IWy
fyem Ti ft..
Fran Te
R ,<rA ^.
ta. CsR011T: Oapr, J NMoad t r
/Aa1nW '
Ftan To PL
1S. SCREEN:
Do& owmew am Sisi Maip1M
From To__FIT rL ----N A
From To__FL— h —W
From Te�.Fi— bL —b 1'l
1S. 8AN DMMVELPACK: h
Depl an Mdw1w 3
From To Fi. ,prelo a f
From Ta FL.__.�_
17. RENNAR%!ti
loo"gF11f8YCOMFYIMTTNISWIELLWAfICONSTRWMINACCOfM>AMWITHISA 11CA0l "t"
oofI8TR1ICIKINSTAM MOS,MVTHATACOFYOFTNlfif1EWWOfMSSEEIfPf10MI0E0TOlI1EY/CALCr`PF
A
FOR OFFICE US4ONL y;c
OwNfls N01IA/UIECFFiRIOMOONffmNOlM0Oli1t
SubuSuA/ndYObM�udWYMOafTII�Owd.YrM�n111MIN70Gf� W.�/EY.�:11
e••r11►

NMh C�g1Yr•WOrr+�r M en.Yrw�w�I end N�Ivd MaeuRM•CMdM e1 WOW 00OV•OMAWM W SK1bn
ImIsesale.c"Aw-Ado^M.c.s>ewsm-r .IeIQ?=2Ml 314469
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION
STATE VML CORSTRUCTWM PERMITI:
❑ YIdg*W❑ A&F WE-WtiAVLLING
1. WELL USE Appft"Mah Mlelcbel el❑ A VICE,INC.
MeoveeY Nod"WGWb*0m onwo NO11v.LMlLlee: 911Hwy, B�cin c174
ostic, NC 28018
828.247-1773
2. WELL LOCATIM(Show eluloh of me bCelen bobw)
Now" r
Nw..+Irew�. «eu�wlrr�wwtw-1 oRE.LmL00
a. OWNER
AOMWw `7 `` 0 Fww• n FrwMO�+YN"
l I �� �Xj/
c���T sue, o ei — pcoo
"�Ww'fi..I Srr wo.
4. OATG OFNLL19D2
e. TOTAL OERI4
e. ctmwoS v�WE p ►bC
7. DOES WELL PAPLACG MnaeX? Yes Q Now'
S. STATIC WATER LEYSLSebwToF d C"k FT.
IIIN 9•IA/eMTQ
e. TOP OF CAS Mi ISLZZ, FT.MNwe Lend Swleoo•
-Top of A
Miw�wle�MJ1NQAC eC » ;[ dl �c+.�
1a YIELa(EpIIa: METHOD OF TEST 1ac.__—Cre.--
».wATE(►mNEs(dwEl� � '-"s
12. CH MATII It TYFe 4:oZ:� —AMmd
D 1 e0a1ea1 q�ee r eMNe W b etel e,�
I& CAS ' ; � ��.6�e'— �et�7101� i SICffid�
raltlOmm one_o hm e11 m9"v S M
FNMwTe� LFi - G�-^/�-- Roede.aMrAYwIwMOePa�!
Ffom.. TO 11-
From To FL
lit.C+ROIII:
OoF1► Metwlel Msftd�
FNMA To --
15. SCREEIk °
Do& ok n w obt Slsi Mm"
From To�Ft..--.._ bl. -----b�
From To�FL_ h —In
From Tom K_ kL
1S. &AN016MYB.PACK
Dopm we maw"
From Te FL
From To FL.�-
17. REIIARI(
IOONEI1E8YfMARFYTMTMSWM.LWASCONSTRW INACWFA M M ISA MCAClC.Y/ELL
0OWnWi: M STANWJM AMD TMAT ACOFY OF TMEc RECORD MIN SEEN FWMW'T01Nt WELL Ort`[F
f .
FOR OFFICEUSEONLY aoluatllEOFF�1/osoaerwletllentWeu o•:t
OW Mw SnboSeAtndlopolbeetTl11w0�11kSNelldnleflson tTMiA70
swN.

Naa+cu.M.•O.o.+nwM a[wA+�.e..+l.ne NNva et.,omiw•oNlNen a war awalY•aw�.�ewwr salon �
tans Iln awtle.Cam�r-wdy�N.C.2►estwv4F�aee pfs)TSTJ2Zi J �-
WELL CONSTRUCTION RECORD WELLCONTRACTOR: 2v�/� G.�cli ,ram
W1a.L CONTRACTOR Ct liMCATION a: -21 S
8TATE WELL COMTRUCTWN PIMWra•
/. WELLUEE 11WIIeMNMthAeNda�M1/� 1�dPb❑ MM�MtrWQ A�AwINMaI❑ MWdlott+p❑
PAcoNY E!Heel"Welor ❑ Oere[] M omw-Lbt tba:
2. WELL LOCAMIM(Bliss aMebh of efe loce2on bNow)
H old
Fw.rMwrn+rpwR "araub/MMr� ,�%� `// ofniiNa tn00
DIFTH
AOdraM
moceft-
lab
,. DATE OIMLL M Y
5. TOTAL DEPTH
e. CUTTMM38OOLLEG YES E3 mom—
E
7. DOEB vMElt.REPLAa T 1►ES❑ NOE3"-
o. STATICWATRRLEVELBabsTepaCuing: FT.
V"elMmTgdGl" _
e. TOP OF CA9rM1 M, 'I FT.Move LWA Sletsaa'
'Iw a��tbelr+�nrta dNr bebw Moi rwMee wlrM��wMwNewa-
6aeetAThW11QAefeA�lfl�a'
10. YRiLD(ppaek �lrc.METl10O OF TEST!f, J'
i/.WATM ZOMU"op" 1;2!?5-r-!2 2 z'
ILCN1012NUft TYpaLla• E Mated Sadda "op"gbealodWbaloeerm
WIMUOMM
Depth Mary (stow go I odMeweroMmMirat:No811M -
Ffp11 TO , pL�+ — —,.Z�•^ �_. ReedRaN�M 11aPIMwM�Oe pow,
From.—To PL.—
From Ts ft
14.GROUT:
Depth Mob" Moll"
From To ,0-.1 FL `7-Q--- '
Peon To FL - dy
Is. SCFWLM
Depth Dhmeter sm Mti
From TG` Ft In
From To FL_ IR _MI r
Frain To FL— In. —IL- �y
/e. weisMVELPACK-
Depth eke Mabdd
From Ta FL
17. R612ARItM
IOOIIENEBrCERTIFYTNAT7MVN .1.WASCOI=TIRIDMINA000RDANCG MiNISA 110AC20.V drEi~
COr18TRUC1MBTAlID RMAIATNATAG0PYOFTHI/S't1ECOR0""SENTpRoVMMTOTNEW*L
FOR OpF10E USE ONLY
Oa MOIaTirl[OrNRS011CoegTIMIG1e16n[vl�Rl o�.[
SS4fAwf/iWbl>MAradMMMOsAROiMdwlrtMaeM1111MIIb�OG7<y2 414.I rev.UTI
Swala

NM n ewes".n 0-- 9 d amt nl mid NaYw m mos ho•mdomn et wow Queft•ammasecom `t
am ma o.ww c«r...Rdl%K N.C.vowiw&Ftm w pig)?mast
WELL CONSTRUCTION RECORD WMICONTMCTOR:
WBLL CONTRACTOR CERTMATION 1:, f 7S
STATE WELL comnRt cTm muff#:
t. WELLtME Ary1kMM"Raddw*d�d[3 m&mmdO d❑ Limi "❑
cortoY Ra Had""WONT k0tbn❑ Ora►❑ N Olha.Laot tiro
1. WELL LOCATIOnk(Blatt'andoh of S beolon bNoM /
NMwMTwwc..j '`/��' / o •4e aii/.� L-,,:c✓
DRUM LOG QFPTH -
l�ttmimmdnp"MM& tMm� gr wdLMMl
3. OWNER n `rO i F4 ram T» pmndr�o..mtMt+�
��M't► tt� wog -
A. OATEDRILLEo�;� ---
!. TOTAL DEPTH
G. curnws OMLE&ED va❑ �NO
f. oMv WKL RWFLACE E1081l�It#WEu U ®�
!. STATIC WATERLEVIL Moll TOP ofCMA 447 ,FT.
4!. FT.Above land 8wloeo'TOP OF 6A8lIO ISM,G,.
'tom M r��ImwtnMA a✓✓ww biMimd wfraal��vrwm�d�wsr
M�Me�wM MANQAata.olH
tO.TIELD IgI mx ALC.MUH000F TEST l
it.WATER>DONEB(dp>Itk � f
IL C1 U~TKK TYpr �;�1/ctGat� _AnaWd IIadOMklWtMaitllNMtlWMetdlvrM
M CAeIIKi: 1 f/ t
bYmew wlKttpolFt VAM+ a,rp,agb,,wd I l MNmnt«w.awos+t+l�o
Front 1eW, �' Roado.WWWOMMM fA
Flan-.—TO
Flom To Ft-
It.CPA".
DWyt Mob" IAo6►od
Froat , Yo f Fl 5� �F` AX
Fmm To FL
Is. SCREm
o"m ohnow Sbt Ski mow"
Ftae To—Ft.—.— Nt.
From To�FL— YL —k
Fttmn To._._ft _ Nt.
1!. &vcf R VMPACK 8w dM MaN
From DToopm FLU----
from To FL._-�-
1T. RE11AW«
t00NE11Eo�1fAtRTiYTMATTF�YVELLWAICONITRtiCTEOMIAL�ANCBWRI{1SA NCAClC.Y/Fll
CONVFAMM#T/1NWA&ANDTHATACOFYOFTM!RECORDNA IMFfjoMEOT0V4YrfLLCYAMF_
FOR OFFICE umn
OrMlltc wlanwEarwort�awrRuena»Ntt�t
„__ _, l�tl.AFwMtwlro.twwra+yoMar�drNw�twMin7oa*ri on.t Pet 12"

rrenn e.ww.OaprNwr a HaM1.rawrnl.na NaMwa Maws.+..aw m a war ouft•GmurAf~sqc*m (l OD 314 4 "
+ao MW e«vYa Cwdw-Rdaa►M.C.V*Wl"&"wr
WELL CONSTRUCTION RECORD WALLCOMTRAcTOR:
WALL CONTRACTOR CARTMATNNI d:
BTATE WELL CONATRjcTlm Muffs:
PRU-PUMP SFr)"
1. WELL UsE App"m a�news,Yl rrr Mur.�« MrdnUW❑ AWkuMur t t { p❑
Mcovwv Nod Pump WaIM k*wEdr+ ❑ 01hnr 0 N 01W.Lbt Uaa:
2. WELL LOCATK7K(Mow~of Ore badon CaaM ��-�F`•�� ✓
MvawMriorc
--i.(e'o e-.Jl e l o i-S�
a. PlaaaNw OFULU"ll LOU
mr wdw"&)
OWNS" Mpw�r . �- °
- — ram" »
Ad*"$
Dl► r wM � Cqa
0. DATE two LLEO `g
S. TOTAL DEEM
S. currms (� ploCr�
7. 00E8 WELL P A%ACE EXWiA10 wEu v vEs NQp�
S. 8TAVC WATEN LEVILOr+bwTOP d CeirO 7 FT.
„ �.•dAMwTgdQMM
V. TOP OF CASM ls.,Z' _ FT.Abovd lad Sloboa'
'fw at saaM ai Waaord vV*bdarr ------------
Ya/awirva raMMa a wlanaalaaaaar
daanvlwouMOAede�ona ( ?�
to rIELD(oP++rk � SE:TNOpoPTEST l�i�.. � -
i 1.WATER ZONES 04ft
JR.CHLORMATKft TYPv Amwird Nadel "speft Y+rMWI W SWAaWm
13.CABMO: O /Jov dc�
wrte�danr Dwpfh Mw� �I,a,.pr.alenanedwrridrawalYrewsY+r
F fivl T S '� fa PAOL%.erwworPerwvnoaPdQ
F 'prom- Te FL..
From To Ft
14. SHOUT: Dapw MWad
From ; To -24--)LFL r' /
Prom To
15. SCREEN: FL k\- d ar. %�, �- •..
DopOl DMmMer SYIski 1daYAN �A)
From To Fl b
From TO_.FL__ kL —h
From To h• —h o
18.&4mD MVEL PACK: 1
QaNr Saco
From Te FI. ._ --•-^-•
From To FI
17. REIEAISIS:
+00MMBYCFdMFYV MTTMBWKLWASCOKSTPWM*IACCORM CHWRKISA NACOO-WELL
COMETRtICRQM STANDARD41.AMO THAT ACOPY OF THIS IECOAO WLS IM FWWW 10Mc"'aL OrrEF v
FQR OFFICE.USB ON6Y NQIMR/sOl jp"- OQNSIRUCUIO Vw WILL COVE
OW Ns
bb�iwi/iWYOMAdwaMMNOrAaNMy"�rp111MIY170G1�d 04.+pal.+ill

From:Scott Gantt To:Stephenie Wilson Date:8/15/2005 Time:6:57:50 PM Page 4 of 4
� 15 0v7
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: LAKE LURE County RUTHERFORD ❑Ridge ❑ Slope ❑ Valley ® Flat
LOT 5A OTTER CREEK SUB FIBBER MCGEE LANE Latitude/Longitude of well location
(Street Name,Numbers,Community,Subdivision,Lot No,.Zip Code) 35,31.109/82.06A42
3.OWNER ZEITS CONSTRUCTION (degrees/minate0seconds)
ADDRESS Latitude/longitude source.®GPS❑Topographic map
(Steeetor Roble No.) DEPTH DRILLING LOG
LAKE LURE NC From To Formation Description
City or Town State Zip Code 0 70 Clay
70 ISO Consolidated Rock
Area Code-Phone Number
4.DATE DRILLED 7/26/05
5.TOTAL DEPTH 180
6.DOES WELL REPLACE EXISTING WEIL? YES ❑ NO
7.STATIC WATER LEVEL Below Top of Casing: 50 FT.
msc-+'IfAbovc Top of Casing)
8. TOP OF CASING IS 2 FT.Above Land Surface-
'Top of casing termauted War below land sevfece aques a variance in
aecordancc with 15A NCAC 2Co118
9. YIELD(Rpm): 8 METHOD OF TEST ARDM
10.WATER ZONES(depth): 140
u.DISINFECTION:TYPE HYPOCHLORITE Amount 8 oc LOCATION SKETCH
12.CASING: Wall Thickness Show direction and distance in miles from at least
Depth Diameter m Weight/FL Material two State Roads or County Roads.Include the road
From 0 To 77 Ft. 6 1/4" SDR 21 PVC numbers and common road names.
13.GROUT:
Depth Material Method `
From 0 To 20 Ft GRAVEL MIX GRAVITY
14.SCREEN
Depth Diameter Slot Sim Material
From NA To FL in. in. C r-
15.SAND/GRAVEL PACK: G) e-4
Depth Sim Material
From NA To Ft, t7
16.REMARKS: {{„{
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
8/1/05
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 Gantt To:Stephenie Wilson Date:8/1 512 0 0 5 Time:6:57:50 PM rnrn Page 3 of 4
00
WELL CONSTRUCTION RECORD 3 15 ® v 6
North Carolina-Department of Environment,and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) SCOTT GANTT CERTIFICATION#2584
WELL CONTRACTOR COMPANY NAME 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: RUTHERFORDTON County RUTHERFORD ❑Ridge ❑ Slope ❑ Valley ® Flat
215 DILL RD Latitude/Longitude of well location
(Stint Name,Numbers,Community,Subdivision,LotNo,.Zip Code) 35,15.832/81.54.692
3.OWNER PENASTAR HOMES (degreWminotes/seconds)
ADDRESS POB 788 Latimde/longitude source:®GPS❑Topographic map
(srrest or Rows No.) DEPTH DRILLING LOG
CHERRYVILLE NC 28021 From To Formation Description
City or Town State Zip Code 0 117 Clay
704-435-1257 117 140 Consolidated Rock
Area Code-Phone Number
4.DATE DRIT 1 7/22/05
5.TOTAL DEPTH 140
6.DOES WELL REPLACE EXISTING WELL? YES Fl NO
7.STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Usc' -IfAbovc Top of Caring)
s. TOP OF CASING IS 2 Ff.Above Land Surface"
*Top of casing temtmehd atlor bwnd swfacc ngidres a vanons in
accnrdanr. 615ANCAC 2C.0118
9. YrF[ (gpm): 10 METHOD OF TEST ARDM
to.WATER ZONES(depth): 130
It.DISINFECTION:TYPE HYPOCHLORITE Amount 5 ez LOCATION SKETCH
12.CASING: Wall Thickness Show direction and distance in miles from at least
Depth Diameter or weight/Ft Material two State Roads or County Roads.Include the road
From 0 To 124 Ft 6 114" SDR 21 PVC numbers and common road names.
13.GROUT:
Depth Material Method �r3
From 0 To 20 Ft GRAVEL MIX GRAVITY 0
14.SCREEN E�
a
Depth Diameter Slot Sim Material C e
From NA To FL in. in. :`94
15.SAND/GRAVEL PACK:
Depth Size Material C7
C.n
From NA To F[, }»
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
8/1/05
SIGNATURE OF PERSON CONSTRUCTING THE WELL Dale
GW-1 REV.07/2001
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mall Service center-:Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. -

From:Scott Gantt To:Stephanie Wilson Dale:8/1 512 0 0 5 Time:6:57:50 PM Page 2 of 4
G
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 k 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS,INC.PHONE N(704)434-7277
STATE WELL CONSTRUCTION PERMIT M 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 RUTHERFORD ❑Ridge ❑ Slope ❑ Valley ® Flat
1001 CAMP HILL RD Latitude/Longitude of well location
(Street Name,Numbers,Community,Subdivision,LotNo,.Zip Code) 35,25,153/82,12.688
3.OWNER JOHNNY WATKINS (degrees/minutes/seconds)
ADDRESS 1001 CAMP HILL RD LatitudcAongitude source:®GPS❑Topographic map
(Sued or Route No.) DEPTH DRILLING LOG
MILL SPRING NC From To Formation Description
City or Town State Zip Code 0 35 Clay
828-625-1311 35 300 Consolidated Rock
Area Code-Phone Number
C DATE DRILLED 7/8/05
5.TOTAL DEPTH 300
6.DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7.STATIC WATER LEVEL Below Top of Casing: 40 FT.
(nee"+^IfAbave Top of Caam,),
S. TOP OF CASING IS 2 FT.Above Land Surface-
'Top of earl tummmed at/or below Ind nv6ee requrte a vviance to
accordmcc with 15A NCAC 2C.0118
9. YTFI (Rpm): 5 METHOD OF TEST ARDM
lo.WATER ZONES(depth): 150
u.DISINFECTION:TYPE HYPOCHLORITE Amount 12 o', LOCATION SKETCH
12.CASING: wall Thickness Show direction and distance in miles from at least
Depth Diameter or Weil Material two State Roads or County Roads.Include the road
From 0 To 44 Ft 6 1/4" SDR 21 PVC numbers and common road names.
13.GROUT: -y
Depth Material Method CSC
From 0 To 20 Ft GRAVEL MIX GRAVITY
Is
w.SCREEN C
L7
Depth Diameter Slot Size Material
41
From NA To FL in in. .9
s<e
t5.SAND/GRAVEL PACK: - r0
Depth Size Material
From NA To 171. f
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH.I5A NCAC 2C,,WELL
CONSTRUCTION STANDARDS,AND THAT COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
8/1/05
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.

c A
RESIDENTIAL WELL CONSTRUCTION RECORD z� '
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2138
1.WELL CONTRACTOR: - t DISINFECTION:Type C}llOrine Amount 2.c u 5
James g. WATER ZONES(depth):
Wed ContractWIndiC ) me Fran T05 d From To
Camp' s Well & PUMD CO. Tnr• From To Fnu rom To
Well Coacta Company Name From To From - To
STREET ADDRESS P D BOX 429 S. CASING: Thicimess/
Ellenboro NC 2g0 F 0 Dep Diameter We�igght Material
enbo an State Front
To__Ft. 67 SD
lt21 PVC
City or Zip a From To Ft
( 828). 453-7322 From To Ft _
Area code- Phone number
2.WELL INFORMATION: 7. GROUT: Depth Material Method
From 0 To 20 Ft Sackrete Hand
SITE WELL ID OlappBeable) From To Ft.
STATE WELL PERMIT"applicable) From To Ft
DWQ or OTHER PERMIT#(If applicable) S. SCREEN: Depth Diameter . Slit Size .Material
WELL USE(Check Applicable Box): Residential Water Suppy From To Ft_ln. _ In.
DATE DRILLED �1 —a • �k- U7 U S From To Ft.,_Jn. _in.
From To Ft.,_in. ,in.
TIME COMPLETED V D[) AM D PM M-
9. SANDIGRAVEL PACK:
3.WELL LOCATION: Depth Size Material
CITY: LtF COUNTY Qd UW From_Ta Ft.
` Fran Tc Ft.
�al M M 4AX S3 from To Ft.
(Street Name,Numbers.Caneundy Sabdlgalo_n Lct No.,ParceL;ap Code)
TOPOGRAPHIC I LAND SETTING: 10.DRILLING LOG
0Slope DValey ❑Fiat Lkrl dge ❑Other From .To. omTafO�n Desc'p n
opri (y�
(check appropriate bold . 0 - Lk� N a , JF-
LATITUDE �_ S May minuttes,wc I.degas,
ords or
LONGITUDE•at\_ y9 1n1 w in a decimal knees
nc
Latitude/longitude source: OOPS OTopographic map
(bcafbn of we/must bo shown on a USGS(opo mep and
attached to this fort I not using GPS)
4.WELL OWNER
OWNER'S NAME
STREET ADDRESS
City or Town State Zip Cede -
n
�}
Area code- Phone number _
11. REMARKS:
5.WELLDETAILS:
a. TOTAL DEPTH: O S
b. DOES WELL REPLACE EXISTING WELL? YES O NO�
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
c. WATER LEVEL B,daN TopdCasing:,��FT, 115A NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THATACOPY OF THIS
(Use'+'9 Above Top of Casing) RECORD HAS BEEN PROVIDED TO THE WELL OWNER
d. TOP OF CASING IS 1 FT.Above Land Surface' C��0
Top of easing terminated aVor below land surface may require - SIG .LIRE OF CERTIFIED W ELL'COCTOR DATE
a valance In accordance with 15A NCAC 2C.01 18.
e. YIELD(gpm): —A, METHOD OF TE$T_Q&A__ James W. Camn
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 276994617 Phone No.[phone] ext 568. Rev.7105

3 - RD
ESIDENTML WELL CONSTRUCTION RECORD
LT 4 North Carolina Department of Environment and Natural Resources-Division of Water Quality
•�'"��� WELL CONTRACTOR CERTIFICATION# 213 8
1.WELL CONTRACTOR: I. DISINFECTION:Type chlorine Amount
James W Comp g• WATER ZONES(depth):
Well C.ontracta.(IndM4 Name Fran To 3 From To
Camp' S Well & Pump Co- Tnn_ From Tc Fran To
Weil Contractor Company Name Fran To Fran To
STREET ADDRESS P 0 BOX 429 S. CASING: Thickness/
Dept Dia(rieter WeMMoDht Material
Ellenboro NC 28040 Fran 0 To Ft 6a SDR21 PVC
City or Torn State Zip Cada Fran To Ft
( 828) 453-7322 From Tc Ft _
Area Code- Phone number
T. GROUT: Depth Material Method
2.WELL INFORMATION: Fray,0 To 20 Ft Sackrete Hand
SITEWELLID#laappacable) Fran Tc Ft.
STATE WELL PERMIT#(N applicable) From Tc Ft
DWQ or OTHER PERMIT#(#applicable) S. SCREEN: Depth Diameter Slot Size .Material
WELL USE-Cheek Applicable Box): Residential Water Supply U/ Fran To c Ft._in. _in..
( From To ,_Ft_la —In.
DATE DRILLED L L ` t . L7 S Fran To Ft_in. _in.
TIME COMPLETED - 3 I' AM O PM al�- 9. SANDIGRAVEL PACK:
3.WELL LOCATION: n( Depth size Material
��jj COUNTI'�'4% From To Ft.
CITY: \J From To Ft
(TIP l I Fmm TR_Ft .
(S atria,Numbers, nez SubdlNsion_Lo14o..Parcel; Code) . . -
TOPOGRAPHIC I LAND SETTING: 10.DRILLING LOG
❑Slope dilffey OFW ❑Ridge ❑Other From To. ortn 'on Der riptbn
(Cbedr approPdahk bo>n - . 0
May xNdegreea, .(
LATITUDE ;�L�tlll�l minutes.second,a
' in a docimal Intrat
LONG ITUD��� rt i� .�--�
Istitude•/�Iongitude source: bOPS OTopogaphic map
(atfe dd to#ds loan N awelmustbesfwsm LI GS topo mep and
4.WELL OWNER
OWNER'S N OWNER'S
NAME 4 19\1�fO pCA
STRIt g DRESS 1 • t)
131Jt ?.�y� c
City a Tavn Q Stara Zip coda
Area�cedee--Phone—number -
11. REMARKS:
6.WELL DETAILS:a. TOTAL DEPTH: 'A S
b. DOES WELL REPLACE EXISTING WELL? YES NO
100 HEREBY CERIIFYTNATTHM WELL WAS CONSTRUCIED N ACCORDANCE WITH
e. WATER LEVEL Bdow TOP of Casing: _FT, 15A NCAC 2C.WELL CONSTRUCTION STANDARDS.AND THATACOPY OF 7M
(USe"e B Above Top of Casing) RECORD HAS BEEN PROVIDED TO THE WELL OWNER [
d. TOP OF CASING IS 1 . FT.Above Land Surface' r 5
'rap of cuing terminated atlor below land surface may require SI ATUR E OF CERTIFIED L CONTRACTuR ' DATE
a VOWCO In accordance with 15A NCAC 2C.0118.
4METHODOFTEST James W. Camp
e. YIELD(gpm): PRIMED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30.days. Attn:Information Mgt., Fam GW1a
1617 Mail Service Center—Raleigh,NC 27699.1617 Phone No.[phone] ext 568. Rev.7t05

RESIDENTIAL WELLCONSTRVCTIONREcoRD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2138
1.WELL CONTRACTOR: I. DISINFECTION:Type chlorine Amount - CU
James W CamD g. WATER ZONES(depth):
Well Contracta.(Individuaq Name From To L From To
Camp' s Well & Pumper_ Tnc- From To From To
Well Contractor Company Name From To From - To
STREET ADDRESS P 0 BOX 429 S. CASING: Thickness/
Deplq D'aineter We ht Material
Ellenboro NC 28040 From 0 To lib Fl. 6a SDR21 PVC
City or Town - State Zip Code Fran To Ft
t 828)_ 453-7322 Fran To Ft
Area code- Phone number
7. GROUT: Depth Material Method
2.WELL INFORMATION: Fran 0 To 20 Ft Sackrete Hand
SITE WELL ID#(Ifapplimble) Fran To Ft
STATE WELL PERMIT#(0 applicable) Fran To FL
DWQ or OTHER PERMIT#(#applicable) 8. SCREEN: Depth Diameter - Slot Size -Material
WELL USE Check Applicable Box): Residential Water Supply�' Fran To Ft_in. _in..
( From To Ft._In. _in.
DATE DRILLED '1 • 2% i)S Fran To Ft._in _In.
TIME COMPLETED Vb(j - AM❑ PME1- 9, SANDIGRAVEL PACK:
3.WELL LOCATIN: Depth Size Material
Fran - To Ft.
CITY: p 0 COUNTY From To Ft.
VtA�tFA� �IJQ ��� Fran To Ft.
(Stree ame,Numbers,Community,Subdbislon,Lot No.,Parcel.Zip Code) - -
TOPOGRAPHIC I LAND SETTING: 10,DRILLING LOG
❑Slope VIey ❑FW ❑Ridge ❑Other From TO Formation De tion
(chock appropdata boz) . 0 . 1 1 0 CIAAA
r���[� ��� U [( May be in degrees,
IATrruDE 3a dL �J µ���1�5 minutes,seconds or
LONGRUDE O� �q—LQLW rnadecimal format
Latitude/longitude source: b6PS OTopographic map
(location of we#must be shown on a USGS topo map and -
attached to(his form I not using GPS)
4.WELL OWNER
OWNER'S NAME D:.4 �3'�P
STREET AD RESS < 1 .4
City or Town state Zip Code
( t•
Area code- Phone number 11. REMARKS:
S.WELL DETAILS:
a. TOTAL DEPTH,
Is. DOES WELL REPLACE EXISTING WELL? YESO NO
I DD HEREBY CFAIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WnH
e. WATER LEVEL Below Top of Casing:_�Q_FT, ISA NCAC 2c.WELL CONSTRUCTION STANDARDS.AND THATACOPYOF THIS-
(USe,+'O Above Top of Casing) RECORD HAS BEEN PRGJIDEDTO THE WELL OWNER j
d. TOP OF CASING IS 1 . Fr.Above Land Surface' ' !R b LT7
'Top of casing terminated atlor below land surface may require SI URE OF CERTIFIED WELL ELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. .
e• YIELD(gpm): _METHODOFTEST Dk1k James W. Camp -
PRINTED NAPi1E 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 276994617 Phone No.[phone] ext 568. Rev.7M5

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2138
1.WELL CONTRACTOR: I. DISINFECTION:Type Chlorine Amount 2 LT
James W. Camp g. WATER ZONES(depth):
Was Contractor(Individual)Name From To '400 From To
Camp' s Well & Pump Co. Inc- From To From To
Well Contractor Company Name From To From To
STREET ADDRESS P 0 BOX 429 6. CASING: ThlcWressl
Depth Dtajreter wort M Material
Ellenboro NC 28040
Fram 0 To�Fx 6, SD121 PVC
City or Torn - State Zip Code From To Fx _
( 828} 453-7322 Fram Tc_Ft_ _
Area code- Phone number
2.WELL INFORMATION: 7. GROUT: Depth Material Method
From 0 To 20 FL Sackrete Hand
SITE WELL ID Wit applicable) Fran To Fx
STATE WELL PERMITWsapplimble) Fran To FL
DWQ a OTHER PERMIT#(if applicable) S. SCREEN: Depth Diameter Slot Sire Materw
WELL USE(Check Applicable Box): _Residential Water Supply(P/ Fran To Ft_1n. _In.
r� Fran Tc Fx_in. _In.
DATE DRILLED �0 pit) rJ Fran Tc Ft_in. _In.
TIME COMPLETED •3 U AM❑ PM 0-
9. SANDIGRAVEL PACK:
3.WELL LOCATION: Depth Size MaterialFrom To Ft.
CITY: PL COUNTYRAL From Tc Ft.
ilk^MA �,A Ft.
(Street Name,Numbers,CommuNN�No.,Pascal,Zip Cale) _
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
❑SlopepVasey ❑Fld bl6ge ❑other From To. Formation Description
(check appropdatabox) . 0
o Maybe in degrees,
LATITUDE 3 .oZ38 minutes,secardsa
LONGfTUDE.U—C 41 b6 3 1 in a deamal fomut
Latitude/iongitude source: ❑OPS DTopographie map -
(location of well must be shown on a USGS topo map and
attached to this form rnot using GPS)
4.WELL OWNER
OWNER'S NAME r ,g "
STREET ADDRESS r
I-,A Ke C, .U7 44, G'
City or Town State Zip Code
Area code- Phone number
11. REMARKS:
5.WELL DETAILS:
a. TOTAL DEPTH: O S
lo. DOES WELL REPLACE EXISTING WELL? YES p NO ck
I DO HEREBY CEKMTHATTM WELL WAS CONMUC1ED IN ACCORDANCE YmH
c. WATER LEVEL Below Top of Casing: ISO FT, 15ANCAC 2C,WELL WNSTRUMIDN STANDARDS,AND THATA COPY OF THIS
(Use W 8 Above Top Of Casing) RECORD HAS BEEN PROVIDEDTO THE WELL OWNER
d. TOP OF CASING IS 1 . FT.Above Land Surface- /
. "fop of casing terminated atfor below land surface may require SI URE OF CERTIFIED WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118.
e. YIELD(gpm): METHOD OF TEST (Al.'A 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 GWda
1617 Mail Service Center-Raleigh,NC 27699-1617 Phone No.(919)733-T015 ext 566. . I Rev,7105

Z l
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2138
1.WELL CONTRACTOR: I. DISINFECTION:Type chlorine Amount I Cut s
James W Camp 9• WATER ZONES(�pde�p(th()�:
Well Contractor(Individual)Name From To�1L From To
Camp' S Well 11 Pump ro Tnc-_ From To Fran Te
Weil Contraela Company Name From To From To
STREET ADDRESS P 0 BOX 429 6. CASING: Thickness/
Dept D' o We
' ht Material
Ellenboro NC 28040 Fran 0 TDFL 6ret SD21 PVC
City a Tam Stale Zip Code Fran To Ft.
( 828> 453-7322 Fran To Ft
Area node• Phone number 7. GROUT: Depth Material Method
2.WELL INFORMATION: Fran 0 To 20 Ft Sackrete Hand
SITE WELL ID#(if applicable) Fran To Ft
STATE WELL PERMIT#Rappneable) From To Ft
DWQ or OTHER PERMIT#(B applicable) S. SCREEN: Depth Diameter Slot Size -Material
Fran To Ft_in. _in..
WELL USE(Check AtpplicabOle Bar): Residential Water Supply Frgp To Ft_Ia _In.
DATE DRILLED ` \ — i]' D S: From To FL_in. _in.
TIME COMPLETED 0 AM 0 PM I�- 9. SANDIGRAVEL PACK:
LOCATION: Depth Slur Material
1.WELL LOC
ATI � From To Ft.
CITY: �'n4.� .^r— COUNTY From To Ft
Cn .
u M , S B AJy� \ a`,( From To Ft
(Sheet Name,Numbers.tanmuNly,SubelNsb_n,La No.,Pa eel;.Zip Code) . . -
TOPOGRAPHIC I LAND SETTING: 10.DRIWNG LOG
Slope OValley ttFiat ❑Ridge ❑Other From To (� Fort Ln Desa�plbn
❑
(Cheek apprOPWR 1304 . 0 ' U6 �A.O�a a.tLM.t�1
May be in degw,
LATITUDE 3'S 3 LqL mmates,seconds or
LONGITUDEAa-- y_sZ.21� in a decimal fomut
LatitudcAongitude source: &MS OTopographic map
(location
ettati ed to of e#thi Must
m�no using shown on a U GS topo map and
4.WELL OWNER
OWNEWS NAME Q`&
STREET ADDRESS PO —Er ( 5 iD
j g kP I.UYC- IV c, A174U
City or Town Slate Zry Code n
( )-
Area code- Phone number 11. REMARKS:
S.WELL DETAILS:
a. TOTAL DEPTH: `1 5
It. DOES WELL REPLACE EXISTING WELL? YES p NO
(� IDO HEREBY CERIEYTHAT TFe$WELL WAS CONSIRUCIEDNACCORDANCE WITH
c. WATER LEVEL Below Top of Casing:, g FT, ISANCAC2C,WELL CONSTRUCTION STANDARDS,AND THATA COPY OF THIS
(Use-+•8 Above Top of Casing) RECORD HAS BEEN PROmw-rOTHE WELL OWNER
d. TOP OF CASING IS 1 FT.Above Land Surface- `(h()
'Top d casing teminaWd eVor bela+land surface may require S IATURE OF CERTIFIED W ELL C ,CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.01 18.
® METHOD OF James W. Crimp
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
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Rev.7105

y Ot SrArap V k', f �
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 213 8
1.WELL CONTRACTOR: f. DISINFECTION:Type Chlorine Amount a. tU m
James W amo g. WATER ZONES(depth):
Weil Contractor(Individuaq Name From_To_, From To
Camp' s Well & Pump Co- Tnc_ Fran Tc Fran To
Well Contracts Company N=0 From To From To
STREET ADDRESS P G BOX 429 - 6. CASING: Thickness/
Dep Diameter Wa Material
Ellenboro NC 28040 Fran 0 TL .Ft. 6a SDR21 PVC
City or Tam State Zip Cade Fran To FL
f 828)- 453-7322 Fran To FL
Area code- Phone number 7. GROUT: Depth Matettai Method
2.WELL INFORMATION: From To 20 FL Sackrete Hand
SITE WELL ID Of applicable) From To Ft
STATE WELL PERMIT#(rapplimble) Fran To FL
DWQ or OTHER PERMIT#(If applicable) S. SCREEN: Depth Diameter Slot Size -Material
From To Ft. n. _in..
WELL USE(Check Applicable Box): Residential Water Supply[J' Frorn To Ft._in. —In.
DATE DRILLED l�• ��1A' S From To FL_in• __in.
TIME COMPLETED _ AMO PMII,— g, SANDIGRAVEL PACK:
�.WELL LOC ION Depth Sim Material
From - To Ft.
COUNTY From To Ft.
A 1l/uX �A)[TL19t• From To Ft
(Street Name,Numbers.IX muruty SUR bdiNSla ,. No.,Parcel.Zip Code)
TOPOGRAPHIC I LAND SETTING: 10.DRILLING LOG
OS" ttKaa8ey OFlat ORldge ❑Other From tt1T111o11 Fonnatio D nptbn
(check appmielataboz) - - . 0 Yik 2fhh.0
R May be in seconds
LATITUDE _�ia-- miwtes,ueaWa
LONGITUDE•yQ -12L—.-ULW ineklaimal fonhhaz z.{.h..r. -r��
Iatitu de/longitude source: ❑GPS OTopographic map
(location of Wei must ba shown on a USGS topo map and
attached to this form i not using GPS)
4. OWNER OWN �Q�p>" T9M1
OWNER'S NAME .} ( e I vie
STREfLADDRESS 6 5 'P 6ayt M.
tILkKo aNaG .�
City or Twin Slate Zip Code .
(Area code- Phone number it. REMARKS: -
S.WELL DETAILS:
a. TOTAL DEPTH:_ _
b. DOES WELL REPLACE EXISTING WELL? YESO NO❑
I W HEREBY CERTIFYTHATIHIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
c. WATER LEVEL Below Top of Casing:(_FT. IeA NCAC 2C.WELL CONSTRUCTION STANDARDS,AND THAT ACOPY OF THIS.
(Use W If Above Top of Casing) RECORD HAS BEEN PROVDEDTOTHE WELL OWNER
d. TOP OF CASING IS 1 FT.Above Land Surface
'Top or Casing terminated evor below land surface may require 4mu
E OF CERTIFIED W EL I:ONT CTOR DATE
a variance In accordance with 15A NCAC 2C.0118.
METHOD OF TEST Q.•u 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., Fomh GW-1a
16117 Mail Service Center—Raleigh,NC 276994617 Phone No.[phone] BASS& Rev.7105

yFSGrEa
RESIDENTIAL WELL CONSTRUCTION RECORD 9 '
North Carolina Department of Environment and Natural Resources-Division of Water Quality t
WELL CONTRACTOR CERTIFICATION# 2138
1.WELL CONTRACTOR: I. DISINFECTION:Type chlorine Amount C'"itl 5
James W- Camp g. WATER ZONES(depth):
Well Contractor(individual)Name Fran To U50 From To
Camp' s Well & Pump Co. Inc--- From Tc Fran To
Well Contractor Company Name Fran Tc From - To
STREET ADDRESS P 0 BOX 429 - 6. CASING: Thickness/
Diameter Wei III Material
Ellenboro NC 28040 From 0 To Ft. 6a SDW21 PVC
City or Town - State Zip ode Fran To Ft _
( 828} 453-7322 Fran To Ft _
Area code. Phone number
7. GROUT: Depth Material Method
2.WELL INFORMATION: From 0 To 20 Ft Sackrete Hand
SITE WELL ID#of spplkable) from To FL
STATE WELL PERMIT#(Sapplicable) From To FL
DWO or OTHER PERMIT#(If applicable) - e. SCREEN: Depth Diameter Slot Size .Material
WELL USE(Check Applicable Box): Residential Water Supply Fran To FL—In. _in..
tt � From To Ft._in. —In.
t DATE DRILLED \ -`A-0 9 From To FL—in. _ in.
`
TIME COMPLETED 'A. -SIt AM❑ PMIR
9. SANDIGRAVEL PACK:
3.WELL LOCATION: Depth Sim Material
CITY: Ou I COUNTY ) From - To Ft.
From To Ft.
Ran To FL
(Streal Name,Numbers.Ocmmunl .SubdiMsWo.Lot No.,Pamel;.Zip Code)
TOPOGRAPHIC f LAND SETTING: 10.DRILLING LOG
'g,Slepe'T.IVaSey OFlat ORldge ❑Other From (To / foffnation Description
(check appmPdate box) 3 'I.I)
May be N degrees,
LATITUDE ,LJ' .Z ,'71 R minutes,seconds or
LONGrTUDEQQ2� �� •3io l� in a decimal format o 'S CC _
Latitude/iongitude source: OGPS oTopographic map
(locafbn of wen must be sham on a USGS topo map and
attached to this form Inot using GPS)
4.WELL OWNER -
OWNER'S NAME �D _
STREET ADDRESS IlIq 05 u�
City aTown i State Zip Code .D
Area code- Phone number
il. REMARKS:
S.WELL DETAILS:
a. TOTAL DEPTH: S
b. DOES WELL REPLACE EXISTING WELLY YES Q NOt
I DO HEREBY CERTIFYTHATTW WELL WAS CONSTRUCTED N ACCORDANCE WrTH
c. WATER LEVEL Below Top of Casing: U _FT. 1SA NCAC 2C.WELL CONSTRUCTION STANDARDS.AND THAT COPY OF TM$.
(Use`+'N Above Top of Casing) RECORD HAS BEEN PROVIDEDpD TO THE WELL OWNER.
d. TOP OF CASING IS 1 . FT.Above Land Surface` 0 f.f • I � (7
'Tap of casing terminated atfor below land surface may require SIG T RE OF CERTIFIED W ELI:CONT CTOR BATE
Aa
a valiance In accordance with 1SA NCAC 2C.011 S.
e. YIELD(gpm): r� METHOD OF TESTCQAA'� ames W. Camp
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn:Inforrnatlon Mgt., Form GW-1a
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. . Rev.7ro5

e.aSGrtu V_RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
•�' �• WELL CONTRACTOR CERTIFICATION# 2138
1.WELL CONTRACTOR: I. DISINFECTION:Type chlorine Amount
James W. Camp g. WATER ZONES(depth):
Well Contractor(Individual)Name Fran Tot b From To
Camp' S Well & Pump Co- T_nc- Fran To Fran To
Well Contractor Company Name Fran To Fran To
STREET ADDRESS P 0 BOX 429 6. CASING: Thlolmessl
DeP Diameter Weir Material
Ellenboro NC 28040 Fran 0 ro Ft 6a $DR21 PVC
City or Town State Zip Code From Tc Ft _
t 828>_ 453-7322 Fran To Ft _
Area code- Phone number
7. GROUT: Depth Material Method
2.WELL INFORMATION: FranL. 0 To 20 Ft Sackrete Hand
SITE WELL ID#(If applicabieI Fran Tc Ft
STATE WELL PERMIT#(0applicable) Fran To Ft
DWQ or OTHER PERMIT#(8 applicable) 8. SCREEN: Depth Diameter - Slot Size -Material
Fran T
WELL USE(Check Applicable Box): Residential Water Supply� Ft_ _ In.in. .
Fran To Ft._in. —In.
DATE DRILLED 1\- 3- 5 Fran To Ft_in. _In.
TIME COMPLETED V t1 `.3 U AMia" PM❑ 9. SANDIGRAVEL PACK:
3.WELL LOCATION: Deem Size Material
` Fran - To Ft.
CITY: t` COUNTY Fran To Ft
�,f,\ .
�ifYY�D QA a Fran To Ft.
iS WJ Name,Numbers.Community,Subdivision,Lot No..Parcel,ZIP Code)
TOPOGRAPHIC/LAND SETTING: 10.DRIWNG LOG
❑Slope pVaby ❑Flat ❑Ridge ❑Other From To oration i;CM) C
(Cloak appmpdata box) Mey be in de I kA= A/h..A
LATITUDE 3 S11'ee �'�. , 1�3p/�� mirwtes,accords a
LONGITUDE b y � in a decimal fanuu C) -A
LatitudeAongitude source: oGPS OTopographic map
(location of well must be shown on a USGS rope map and
attached to this form 7not using GPSI
4.WELL OWNERf p�
OWNER'S NAME�t„S,TfpfpdL_. T
STREET ADDRESS
/} -e•
,� AoL)
City m Town State Zip Code
t� l yag y3 o
Area code- Phone numbs -
11. REMARKS: �
5.WELL DETAILS: s�
a. TOTAL DEPTH: d.D
b. DOES WELL REPLACE EXISTING WELL? YESp NO CC
CC11{+i I DO HEREBY CERTIFY THATTMe WELL WAS CONSTRUCTED N ACCORDANCE WITH
c. WATER LEVEL Below Top of Casing: dV FT, 15A NCAC 2C.WELL CONSTRUCDDN STANDARDS,ANDTNATACOPY OF TIDS
(Use"+ O Above Top of Casing) RE^CORD HAS BEEN PROVIDFDTOTHE WELL OWNER
d. TOP OF CASING IS l FT.Above Land SurlaW
require
C�Y\� �E
`Tap of casing terminated eVor below lend surface may require - SI TORE OF CERTIFIED WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118.
e. YIELD(gpm): 5 U METHOD OFTEST—a.LA_ James W. Camp
PRINTED hiAAAE 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

�SUrEa
3 RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION If 2138
1.WELL CONTRACTOR: f. DISINFECTION:Type chlorine Amount ntns
James W. Camp g• WATER ZONES depth):
Well Contractor(Individual)Name Fran To From To _
Camp r S Well & Pump Co- Tn -_ Fran To From To
Well Contractor Company Name Fran Tc From To
STREET ADDRESS P O BOX 429 S. CASING: Thiknesal
Dep Diaineter Weight Material
Ellenboro NC 28040 From 0 To Ft. 6a SDR21 PVC
City a Town State Zip Code Fran To Ft. _
[ 828). 453-7322 Fran To Ft _
Area coda- Phone number
7. GROUT: Depth Material MOdlwd
2.WELL INFORMATION: FmnL 0 To 20 Ft Sackrete Hand
SITE WELL ID#0f applicable) Fran Tc Ft
STATE WELL PERMIT#(sapplicable) From . To Ft
DWQ a OTHER PERMIT#(0 applicable) B. SCREEN: Depth Diameter Slot Size .Material
WELL USE(CheckApplicable Box): Residential Water Supplyta� Fran To FL In. _In.
Fran To Ft.TIn. _In.
DATE DRILLED_Lk-- ®�• h From To FL_In. _in.
TIME COMPLETED j I. (lU AM IK PM❑ S. SANDIGRAVEL PACK:
S.WELL LOCATIO ,.�(� Depth Size Material
COUNTY- Fran To Ft.
CITY: Fran To Ft.
Fran To FL
(Street Name,Numbers.CoMmuffitif,SuMPASIo_n,La NO..PameOZip
TOPOGRAPHIC I LAND SETTING: 10.DRILLING LOG
❑Slope OValley ❑Flat tkKRige OOther Fro
Om ,iT`e S ,, ation, fescnpd,n
(check apprepdate box) May be in degrem y
LATITUDE -6_Jt-(Gn.Z minutes,secondta
LONGfTUDa g,3l •L a a W in a decimal tomcat -
Y\.
Latitude/longitude source: ❑GPS ❑Topographic map
(bcatbn of Wei must be shown on a USGS topo map and
attached to this form Inot using GPS)
4.WELL OWNER
OWNER'S NAME �f1✓H
STREET ADDRESS %.41Aa I '—
City or Town State Zip Code
( -). ,Ln -o2Su u
Area code- Phone number
11. REMARKS:
5.WELL DETAILS: ``11
a. TOTAL DEPTH: Y t) S
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO
�-/ I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED INOR ACCORDANCE WrrH
e. WATER LEVEL Below Tap of Casing: ZSt) FT, 15A NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THATACOPY OF THIS
(Use,+'g Above Top of Casing) RECORD HAS BEEN PROVDFDTO THE WELL OWNER I
d. 'top OF CASING IS 1 FT.Above Land Surface' �f T fN)J, U) G 1 11
'Tap of easing terminated et/or below land surface may require SIG TORE OF CERTIFIED WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. _
e. YIELD(gpm):. _METHOD OFTEST �\ 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-1a
1617 Mail Service Center-Raleigh,NC 276994617 Phone No.[phone] ext 568. Rey,7105

RESIDENTIAL WELL CONSTRVCrtON-RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
'Qwww�� WELL CONTRACTOR CERTIFICATION# 2138
1.WELL CONTRACTOR: f. DISINFECTION:TypetChlorine Amount_; -�t
James W- Camn 9. WATER ZONES(d L
Wei Contractor(Individual)Name Fran To From To
Camp' S Well & Pump CO. Tnc_ Fran To From Tc
Well CadrecI,Campanq Name Fran To Fran To
STREETADDRESS P O BOX 429 S. CASING: DI ThUrnwal
t Wee
6
Depalneta �IpM
Ellenboro NC 28040 From 0 To Ft a SDR2 Ma
1 PVCterial
City a Town State Zip Cork Fran To Ft
( 828> 453-7322 Fran Tc Ft _
Area code• Phone number
7. GROUT: Depth Material Method
2.WELL INFORMATION: From 0 To 20 Ft Saekrete Hand
SITE WELL ID#(N applic") From Tc Ft
STATE WELL PERMITit(sapplicable) Fran Tc Ft
DWQ or OTHER PERMIT#(If applicable) - 8. SCREEN: Depth Diameter - Slot Size .Msterlal
WELL USE(Check APpicable Box): Rissklential Water Supply v From T Ft. In. _In._
r�t [— From To Ft_in. _In.
DATE DRILLED (t • ,-L 1e• (7 J Fran To Ft_in. _in.
TIME COMPLETED 4.1)u AM O PM MY 9. SANDIGRAVEL PACK:
3.WELL LOCATION: ,pS� R Depth Size MataW
�{17f A j _ COUNTY )1 Vy,c. Y„ . From To Ft.
CITY: Fran To Ft.
Fran Tq Ft
(Stravt Name,Nur on.Canmurdty SubwNd wLot_No.,ParcN;.ZIP Code)
TOPOGRAPHIC/LAND SETTING: 10,DRILLING LOG
❑Skpe OVatey ❑Fiat fkidge ❑other _ From . .TO FDr((taOD
(Ciwdc q*mPdstab" May be In dw m 1
LATITUDEy`�h'13nN mirwta,Mwrds or
in a decimal tumret
LONGITUDE
Latitudellongitude source: ❑GPS OTopographic map
(location of walmust be shown On a USGS(opo map end
attached to thb form Ynot using GPS)
4,WELL OWNER
OWNER'S NAMEA I A AKr
STRE ADDRESS 11 Vl
City a Town F State Zip Cale
L
Area code- Phone number
11. REMARKS:
5.WELL DETAILS:
a. TOTAL DEPTH: ,l
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO ld,
I DD HEREBY CERTIFYTHATIHIS WELL WAS CONSTRUCTED N ACCORDANCE WfRI
e. WATER LEVEL Below TOP Of Casing:_jU _FT, 15A HCAC2C,WELL CONSTRUCTION STANDARDS.AND TMTACOPY OF.THIS-
(USe'Y.g Above.Top d Casing) (RECORD HAS BEEN PROVIDEDTO THE WELL OWNER
d. TOP OF CASING IS 1 FT.Above Land Surface M ) G N 1 AY LAM
1 Fa M
-TOp of easing WrInblated atror below land surface m@y require SleNkTURE OF CERTIFIED WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118.
e. YIELD(gpm): METHODOFTESTP James W. Ca
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the origihal to the Division of Water Quality within,30.days. Attn:information Mgt., Form GWta
1617 Mail Service Center—Raleigh,NC 2T699-1617 Phone No.(919)733-TO15 ext 668. Rev.7105

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NIP
WELL CONSTRUCTION RECORD I
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 PERMrr#— ASSOCIATED WQ PERMIT#_
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water hijection ❑ Other ❑ If Other,List Use
2. WELL LOCATION: —
Nearest Town: RUTHERFORDTON County RUTH Topographic/Land setting
1016 LOCUST RIDGE ❑ Ridge ❑ Slope ❑ Valley ❑Flat
(Sheet Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:EDWARD SELLIEN LatitudOongitude of well location
Address 1016 LOCUST RIDGE
(Street or Rome No.) (degrees/minutes/seconds)
RUTHERFORDTON NC 28139 Latitude/longitude source: ❑ GPS El opographic map
City or Town State Zip Code (check box)
(772)—287-5860 DEPTH DRILLING LOG
Area Code Phone number From To From To.
4. DATE DRILLED 12/01/05
5. TOTAL DEPTH: 305 —
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 11=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): 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 7.5 HWY.#64 FROM RFTN.RIGHT ON CAIN
12.CASING: Wall Thickness CREEK MTN.RD.RIGHT AT GATE ON MTN
Depth Diameter or Weight/Ft. Material FOREST RD.RIGHT ON LOCUST RIDGE.CROSS
From 0 To 85 Ft. 6-1/4" SDR21 PVC DAM. is PAVED DRIVE ON RIGHT.
From_To_Ft.
From T: To Ft._ _
13. GROU_Depth Material Method
From 0 To 20 Ft. OUHCRETE POURED
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: RECEIVED C
Depth Size Material
From To Ft. — �AN 3
From—To—Ft.— 20 D
16.REMARKS:— Asheville Regional Office
Aquifer Protection
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONS UCTION STANDARDS,AND THAT A COPY�q THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IGNATURE O ERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment And Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print)RODNEY ROBBINS CERTIFICATION# 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#— ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH Topographic/Land setting
2673 COVE RD, ❑Ridge ❑ Slope ❑ Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:ALAN BEKIEL Latitude/longitude of well location
Address 2673 COVE PD.
(Street or Route No.) (degrees/minutes(seconds)
RUTHERFORDTON NC 28139 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
5(_85)-492-1785 DEPTH
Area Code Phone number From To
4. DATE DRILLED 12/07/05
5.TOTAL DEPTH: 305 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.0118.9. YIELD(gpm): 5 METHOD OF TEST ARD Two State Roads or County Roads. Include the road
number and common names
10. WATER ZONES(depth): HWY,#64/74A W.FROM RUTHERFORDTON.
11.DISINFECTION:Type CHLORYTE Amount 7.5 RIGHT ON COVE RD.1 DRIVE ON LEFT PAST
12. CASING: Wall Thickness SHINGLE HOLLOW FHtE DEPT.
Depth Diameter or Weight/Ft, Material
From 0 To 70 Ft 6-114" SDR27.6 PVC
From_To_Ft.
From_To Ft
13. GROUT: Depth_ Material Method
From 0 To 20 Ft.OUIKRETE POURED
From_To_Ft
14.SCREEN: Depth Diameter Slot Size Material
From—To—Ft.— in. in.
From To Ft.— (n. — in. RECEIVEDFAsh�eville
15. SAND/GRAVEL PACK:
Depth Size Material
From TO—FL— 0 iu(S i
From To FL
16.REMARKS:
ional Office
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONS UC N STAND AND THAT A COPY F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
C�
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

5
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment And Natural Res
ourc
WELL CONTRACTOR(INDIVIDUAL)NAME es-Division of Water Quality-Groundwater Section
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING LLC ROBBINS
WELL # 2785
STATE WELL CONSTRUCTION PERMIT# PHONE# [phone]
ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
L WELL USE(Check Applicable Box): Residential ® Municipal/Public
Monitoring ❑ Industrial ❑ Agricultural Lig ❑ Recovery ❑ Heat Pump Water Injection ❑ OtherOther ❑ If Other,Lis[Use
2. WELL LOCATION: ---
Nearest Town: CLIFFSIDE County RUTH
HAZELHURST LANE Topographic/Land setting
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) ❑ Ridge El Slope ❑ Valley ❑Flat
3. OWNER:ROBERT WANTUCH (check appropriate box)
Address HAZELHURST LANE Latitude/longitude of well location
(Street or Route No.)
CLIFFSED NC 28160 (degrees/m nates/seconds)
City or T Zip Code own State Latitude/longitude source: ElGPS ❑Topographic map 828 (check box)-429-3718
Area Code Phone number DEPTH
4. DATE DRILLED 12/22/05 From To
5.TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO® DRILLING LOG
7. STATIC WATER LEVEL B P g Below To of Casing: 4 Ff. From To
0
(Use"+-if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FP. 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
FROM ELLENBORO. GO DOWN RACE PATH
11. DISINFECTION: Type CHLORYTE Amount 4.5 CH•�•RIGHT ON HWY.#120.RIGHT INTO
12. CASING: Wall Thickness CLIFFSIDE ESTATES.RIGHT ON SWEETWATER
Depth Diameter or Weight/Ft Material IDGHT ON HAZELHURST.NEXT TO LAST DRIVE
From 0 To 60 Ft 6-114" SDIL21 PVC ON LEFT.
From_To—
From FL_
From To
13. GROUT: Depth Material Method
From 0 To 20 Ft. OUIKRETE c_
From_To_Ft. POURED
14.SCREEN: Depth Diameter Slot Size Material T
From_To_Ft._ in. in. RECEIVED
From_To_Ft C73
in. in m
15. SAND/GRAVEL PACK:
Depth Size Material JAN 30 200B
From_To_Ft.
From_To—Ft._ Asheville Regional Office
16. REMARKS: A Uifer PrOteCtlOn
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CON CTI STANDARDS AND THAT A COPY F TIM RECORD HAS EN PROVIDED TO THE WELL OWNER
1-7
SIGNATURE OF PERSON ONSTRUCTING 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

r4
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 ElRecovery ❑ Heat Pump Water Injection ❑ Other [IIf Other,List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH To
CANE CREEK MTN.RD Pograpluc/Landsetting
(Street Name,Numbers,Community,Subdivision,Lot No.,Zipcode) El Ridge El Slope ❑ Valley ❑Flat
3. OWNER:JACK STINSON (check appropriate box)
Address CANE CREEK MTN.RD. Latitude/longitude of well location
(Street or Route No.) (degrees/minutes/seconds)
RUTHERFORDTON NC 28139
City or Town State Zip Code Latitude/longitude source: ElGPS El Topographic map
863 -467 4596 (check box)
Area Code Phone number DEPTH
4. DATE DRILLED 12/28/05 From To
5. TOTAL DEPTH: 225
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 atlor 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): 50 METHOD OF TEST ARD Two State Roads or County Roads. Include the road
10. WATER ZONES (depth): number and common names
HWY.#64 E. FROM RUTH.RT.ON CANE CREEK
11.DISINFECTION:Type CHLORYTE Amount 6.5 MTN.RD,NEW DRIV 1/2 MII E ON LEFT
12, CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 70 Ft. 6-1/4" SDR27.6 PVC From_To Ft_
From To_Ft
T: -
13. GROU Depth Material Method
From 0 To 20 Ft.QUIKRETE POURED CD
From To_Ft
14.SCRIT_N: Depth Diameter Slot Size Material
From—To Ft._ in. in
Fron`_T°—_Ft— in. — in.in. LLAsheville
ECEIVED
15. SAND/GRAVEL PACK:
Depth Size Material
From_To_Ft. JAN 30 2�06
From_To_Ft,_
16.REMARKS: Regional Office
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONS CTI STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON ONS UCTING THE WELL
DATE
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No. [phone],within 30 days
GW-1 REV.07/2001

From:Scott Gantt To:Stepheme Wilson Date:12/62005 Time:5:52:40 PM Page 1 of 2
WELL CONSTRUCTION RECORD �4
North Carolina-Department of Environment,and Natural Resources-Division of Water Quality-Groundwater Section 320535
WELL CONTRACTOR(INDIVIDUAL)NAME(print) SCOTT GANTT CERTIFICATION#2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS,INC.PHONE#[phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W Q 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 RUTHERFORD ❑Ridge ❑ Slope ❑ Valley ❑ Flat
PINEY CREEK RD, OFF BILLS CREEK RD,LAKE LURE Latlmdei,ongitude of well location
(Street Name,Numbers,Community,Subdivision,Lot No..Zip Code) 35.28 096/82,07,688
3.OWNER GEORGE MATHERSON (degrees/minutes/seconds)
ADDRESS 5347 Pine Ave Latitude/longitude source:❑GPS❑Topographic map
(Sven or Rout.No.) DEPTH DRILLING LOG
Orange Park FL 12003 From To Formation Description
Car or Town State Zip Code 0 80 Clay
904-269-8908 80 280 Consolidated Rock
Area Code-Phone Number
4.DATE DRILLED 11/23/05
5.TOTAL DEPTH 280
6.DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7.STATIC WATER LEVEL Below Top of Casing: 95 FT
(Use-I'If Above Top of Casing)
I. TOP OF CASING IS 2 FT.Above Land Surface-
-Top of easing terminated at/ur blow and surface requocs a vanann In
accordance with 15A NCAC 2C0118
9. YIELD(gpm): 15 METHOD OF TEST ARDM
10.WATER ZONES(depth): 210 260
ii.DISINFECTION:TYPE HYPOCHLORITE Amount 10 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 88 FL 6 1/4" SDR 21 PVC numbers and common road names.
13.GROUT:
Depth Material Method
From 0 To 20 FL GRAVEL MIX GRAVITY -
14.SCREEN n
Depth Diameter Slot Size Material
From NA To FL in. in. O
(It
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 COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
12/1/05
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
GW-t 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. - - - - -

Dec 06 05 08: 34p Carolina We 7044347212 p. l
WELL CONSTRUCTION RECORD 320534
North Carolina-Department of Emironment,and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(iNDIVIDUAL)NAME(print) SCOTTGANTT CERTIFICATION#2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS,INC.PHONE#[phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W Q PERMIT#
(it'applicahlc) (if applicable)
I. WELL USE;(Check AppliclbR tins): Residential M Municipal ❑ Industrial❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Beat Pump Water Injection ❑ Other ❑ If Other,List Use*
:.WELL I-OCATION: Topographic/Land setting
Nearrvt town: RUTHERFORMON Couniv RITrlIERPORD ❑ Ridge ❑ .Slope ❑Valley M Flat
PINKY MIN 12D L:dih{de/Longit aide of well location
(Saeet Nam.,Numlars,Community,Suhdivfsima Lot Na,.Zip CWd )
3 OWNER PENAS'rAR nomM s (dcgces'.mtd.Lecconds)
ADDRESS POB 788 LatitudrAongilude source:M GPS❑Topoo aphic map
1sn,a or lm'nc No) DF,11H DRILLING LOO
CH1'.RIiYVII.I.I:, NC 28021 Frnnl 1'o Fmtnation Description
Cilr nr Tawn Stow Ypc do 0 70 Clu
Y
704435-1257 70 ER Consolidated Rock
Area Code-Phone Numhct
4.DATE DRILLED 10/27/05
S.TOTAL DEPrII 90
L.DOES WELL REPLACE FXIS'rING N'EIAA YF,S ❑ NO
7.SI'M IC WA I'RR LEVEL Mow'I'op ol'Cavmy 42 Pr
x. 1011 Df CASING IS 2 M.Aho.- Land SurlSa"
"li,p.,rcoinI,i,I SA N(d('2CIII,u l:mJ snr(rupnmr.,.:vwmem
ac.urdanm wnL 15n AUC 2C.nl l x
Y. YIELD(CI...I): l0 nm na)DOF 11S'r ARDM
10.W-VIVR ZONES(dcp00: 90
D.DISINFEC"[ION: 1'YPF IIYPOCHLOR11 Amount 5 0% LOCHIION SKi FC[I
12.CASING: Wall 7fiiakness Show direction and distance in miles from at least
Depth Damdar ur Wcii;hdFL NWtc ul two State Roads or Count'Roads.Include the road
From 0 'ru 77 Ft. 6 1i4^ SDR 21 I'VC numbers and common road names. _
13.GRDII l': © '
Depth Material mah d ?2NC±� �17JitI `;�{� f_a1 n
from 0 '1'0 20 it. GRAVFLMIX GRAVIFY
14,SCR:FN F ex o
Ik pth Diamd" Slot Si, Malarial �J�,,J} �)y c�
F'ram NA T'o F1. in. m. r%"'Sic'" r� \ U,
_ v
IS S.AND'GRASEI.PACK:
Dc:p11+ Sin Nlnlalial
from NA To 1IL \ J
I6.REMARKS: ��✓� �7 l.I Nf PLC��Pi11/x//y
I DO I1E1013Y CERTIFY THAT II IIS WELL WAS CONSI RUCTED IN ACCORDANCE W'I"III I5A NCAC 2C, 14T.1.1.
CONSTRUCTION STANDARDS,AND 11IAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO 1111",WELL OWNP:R.
II/I/05
SI(;N..\TIWEOFPERAI)Nt'ONS7'RI4'TING1IIF11FLL D:nc
(i14-1 RIiP_Ot2o111
Submit die original to the Division of Water Qnahh.Groundwater Section, 1636 Mail Sen'ice center-Raleigh,NC
27699-1636 Phonc No.QIT1)733-3221,within 36 da)�s.

320622
�+ew►aca aew+a�pe,.,,.�+�sx►arse
WELL CONSTRUCT" RLCORD WKL CoxT 114114 . �c��%>�_�/I A- •i/. �
�COMR1ClOR( CAT1Dk f: [ -
NTATa W@LLC0k$TWJCTM vxvM#'
/.. 1MEt.i1lII apll�oaaea.geRniAoa�ei» Q M�MIdQ atLaNEu1eM�IQ
he I HedpwWwow C�-F_ Q 90004 LIML% ; AND PUMP SERVICE,INC.
x U
iMBLi + t k lI Hwy.�;,,�s�Bostic, NC 28018
82B•247=1773
i O1Nn11 K w[4wiiaT tEk1t OEM
ANC Fos Ts
Rai—
a. YWALOMML
N. Currm/caLLIL Vol YUO
r. nofsw+�c�c+ie�ou�T�l� r�
s art►T4cTldlYlllt l/��dwrfiv��'a�Y5 FIT.
as...arKMaa�la>te
mc"L pu r� � hawwe
Ww"Ida r LflCATILIteBKEit'ISlt
"peftw"WOM.-A pow
±F•1M1.-Ham..R., -...
1l C.tlfilT: 17
}
01111pilk Mew" MW"To FL
IW4
� ToIL scram
Oap6 plum r. alatBari VAN"
Fwe Tei1 in. &bL _Yllpeaty Ta Rt 1e1. __tt 7
tN aAip10lIIN� ma 2fFC
Ffm Ts I4
IT.RillllllKat
e�Dal ►VaRllrTlMrUNatIIIIALYM11i 0 A00000110E SM I M Ia.WW,V,—.0
CONiiIMJGTIOMIITIWQNNoa,N�Ri'rwr<Txt�FPt�it�'i�glOGat�Ftwkl�iMtOmteao€Trt�e.ow�E�
ane is NIaNT mw-oeNaoaaesaa�a�wat o.%E
#iMaAraDi6liM�aa►I�tarOw�6aarwrr lisp►vft 3g eat
48" ce we 60.1

320621 A&F WELL DRILLING
nA6armMna. AND PUMP SERVICE,INC.
No
t67{M W S eDapmw"CC0fflW W er ErwI-m" M and Na1iwH Re"U'64- w4w Oulft-Oroundweur 3sc4on911 Hwy.Business 74
AWIpi4 N.C.4TEM-tE3!•pheey PSI)r 7-S?T1 Bostic, NC 28018
�528-24'-17?3
WELL CONSTRUCTION RECORD WELL CONTRACTOR: =Gl�
WFLL CONTRACTOR CERTIFICATION r: a 1A
.�,/STATE WELL CONSTRUCTION PERRMIT#., _
1. WILL USE Appft w.su}R*Wvndd tt7 Muni*ol© kwustrw O Ag*A* rai 13 Momtodn 0
Aeoov" Heat PSS"Walt k4*c%n ❑ Odar 11 O31er,us'Use:
2. WELL LOCATION:(Show*om of ft� p�q below) a
Nomm Tom •e ! .rY- r CarxY —L4' w' olF�!', Ar-1
pwormbmmw whoiit.Orw **..�xd��A4�MM�pnNwim a) OMLLINGLOG DEPTH
e. OWNER - r/ L/�/` ,� '�L7 From To Forma D"WW"
Addrooe W'r o4 f/>rr /
,. DATE O"'LLEO
b. TOTAL OEPTH --
6. CUTTmS TED YES© N0ar—
7. DOES WELL REPLACE EKISTINO WELL? YES❑ NOET
S. STATIC WATER LEVEL Sdew Top of Coby: FT
!. TOP OF CASH IS � ' " FT.i M L&TA Sur •
Tmrr M���n/hm�ruMa Wmr rdme4ud mewlKm rNuw�•rWIN In a -
Nmee�rM11MANCACffi.H/}�
10. YIELD(Sp1ra Q,E METH00 OF TEST f4 %n
i t.WATER ZONES(dep":
12. CHLORINATION: Type r` Am(wM M edtllUoael Nuoe Y ntdrd w bed or rGcm
wMTNrrn.w ►QCA=-SKETCH cn
D _ ar WMc11VF` tabor.dlr.muon o,a mw rl rnn a I.. ! stw
Flom—�Te ,� 1 Rwds.aMhnmepr�+ss poln�!
From To FL..
From To FL
14.GROUT:
,
Jac-LFL Sr�r,"m'ix .�Ia!u!ed s� �
From �To rcra— '—�=c.�— � /
From To FL
Is. SCREEN:
D"Ih Dwneter Sb1 Ski MIIIvW
From _.:.To:_FI In. ..._._.Ir1
From —To FL_ r,. _K \� 1
From —To, FL In. _VL
IS. $ANDIGMYELPACK:
Dop81 Size Maw"
From To FL
.tile u % •-v
from To FL
17. REMARKS:
100 HERESY CERTWY THAT DU WELL WAS CONSTRUCTED MI ACCORDANCE WITH m HCAC M Y/ELL
C O ISTRUCRCN STANDARDS,AND THAT ACCOOPY OF TIES RECORD Hits SLIHI PRMOEO TOTK Vf%L 0"ER_
FOR OFFICE USE ONLY
aura aow+nxrEa�En� HCpNlp1UGTMililfrYlEU. w�%F
Subalat�nraDtiwnetwallerOurT�.Sad+o.rw6laaw lvkhh 7o uys
e«rf N.. 6N.1 rgy.12T1

x RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
.R �. WELL CONTRACTOR CERTIFICATION# 213 8
1.WELL CONTRACTOR: I. DISINFECTION:Type Chlorine Amount
James W. ramp g. WATER ZONES(depth):
Well Contractor(Individual)Name Fran To Fran To
Camp' S Well & Pump CO Tnc_ Fran To From To
W ell Contractor Company Name Fran To Fran To
STREET ADDRESS P 0 BOX 429 - 6. CASING: Thickness/
Depth DIa�eter Wt Material
Ellenboro NC 28040 Fran 0 Ta_4 Ft. 6 SIei h 21 PVC
City or Town State Zip Code Fran To FL
( B28y 453-7322 Fran To_FL
Area code- Phone number 7, GROUT: Depth Material Method
2.WELL INFORMATION: Ftom To 20 Ft, Sackrete Hand
SITE WELL ID#(it applicable) Fran To Ft.
STATE WELL PERMIT#(8 applicable) Fran To FL
DWQ a OTHER PERMIT#(If applicable) B. SCREEN: Depth Diameter - Slot Size Material
Fran To Ft._in. —tn..
WELL USE(Check Applicable Box): Residential Water Supply From To Ft. in. _In.
DATE DRILLED � 7' r� From To Ft. in. _in.
TIME COMPLETED . AM p Pm ay' g- SANDIGRAVEL PACK:
3.WELL LOCI ION: 'fI F Depth To Ft. size Material
Wjh �CITY: t D L COUNTY p ru From---To Ft.
w i t ID fi q From Tc FL
(Street Name,Nurnberg.GanmaNly,SubdM510n_,Lot No.,Parcel,Zip
YT OGRAPHIC/LAND SETTING: 10.DRILLING LOG
Slope ❑VaOey ❑Flat []Ridge ❑other From To Formation Description
(check appropriate box) 0 4,y —
Mey h in degrees, -
LATITUDE 7yli .�� �� �� minutes,xcondsa
LONGITUDE S . �;.�� in adeeimal format An ��
Pon 3
O r V e OC
Latitude/longitude source: ar6PS oTopographic map
(location of we#mustbe shown on a USGS topo map and
attached to this form#not using GPS)
4.WELL OWNER
OWNER'S NAME J//I Pill ��. �/�Y 4A;( k
STREET ADDRESS CU "1"J q DkIor-ClUlt-
St. 0 to tLd EL 2 �g '1'11
City or Town State Zip Code
Area tale- Phone number 11. REMARKS:
5.WELL DETAILS: r
a. TOTAL DEPTH: r� v
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO p
/ ` (WHEREBY CERTIFY 7HATTHI3 WELL WAS CONSTRUCTED NACCORDANCE Wmi
D. WATER LEVEL Below Top of Casing:__&!�__FT• 16A NCAC 2C.WELL CONSTRUCTION STANDARDS,AND TRATA COPY OF.THIS
(Use'i'If Above Top of Casing) REC BEEN PROVIDEDTO THE WELL OWNER.
d. TOP OF CASING 15 1 FT.Above Land Surface' . 0, J��O
'Top of casing terminated atlor below land surface may require SIGNATURE OF CERTIFIED W ELL CO RACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. V
�(Z_METHOD OF TEST&Ii-Y, James W. Camp
e. YIELD(gpm): D PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn:Information Mgt., Farr,GW-1a
1617 Mail Service Center—Raleigh,NC 27699.1617 Phone No.[phone] ext 568. . Rev.70

RESIDENTIAL WELL CONSTRUCTION RECORD/
North Carolina Department of Environment and Natural Resources-Division of Water Quality
•�"""�, WELL CONTRACTOR CERTIFICATION# 213 8
1.WELL CONTRACTOR: f. DISINFECTION:Type Chlorine Amount C"
James W. Camn g• WATER ZONES(depth):
Well Contractor(Individual)Name From To From To
Camp' s Well & Pump CO Inn- From To From To
Well Contractor Company Name From To From To
STREET ADDRESS P 0 BOX 429 6. CASING: Thickness/
Depth Diameter Wei ht Material
Ellenboro NC 28040 Fram 0 To�Ft. 64 SD�21 PVC
City or Town State Zip Code Fran To Ft. _
( 828} 453-7322 Fran To Ft. _
Area code Phone number 7. GROUT: Depth Material Method
2.WELL INFORMATION: From O To 20 FL Sackrete Hand
SITE WELL ID#(If applicable) Fmi To Ft
STATE WELL PERMIT#(aapplicable) Fran To Ft
DWQ a OTHER PERMIT#(if applicable) _ 9. SCREEN: Depth Diameter Slot Size Material
Fran To Ft._In. _in..
WELL USE(Check Applicable Box): Residentlat Water Supply❑ Fran To Ft._In. —In.
DATE DRILLED � '-v�0 425- From To Ft_1n. _in.
TIME COMPLETED I• IS AMO PMI/ 9. SANDIGRAVEL PACK:
3.WELL LOCATIO Depth Size M#edN
CITY: D5 G COUNTY LZ.IeY ra From To Ft.
From To Ft.
(S Name.Numbers,C munky.Subdivision,Lot No.,Parcel;Zip Code)
T OGRAPHIC/LAND SETTING: 10.DRILLING LOG
cope ❑Vaney ❑Flat ❑Ridge ❑Other From �Tio Fo atb1nDescrip90n
(check appropriate box) _/D
_ .�Q � � �f May fx in degree;
LATITUDE _.I_ 2 ` --511 t mirwta.seconds or p ��Z, '�1750) a 2 D
LONGRUDE
I �C, in a decimal format 7J�
Latitude/longitude source: LMciPS OTopographic map
flotation of we#must be shown on a USGS topo map and
attached to this form 1 not using GPS) 1
4.WELL OWNER
OWNER'S NAME
STREET ADDRESS
387 31� I3�
City or T n State Zip Code
Area code Phme number 11. REMARKS:
S.WELL DETAILS:
a. TOTAL DEPTH: `T V
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO�,
" I DO HEREBY CERTFYTHAT THIS WELL WAS CONUCTED INACCORDANCE WRH
c. WATER LEVEL Belcw Top of Casing: �_t STR FT, 15A NCAC 2C.WELL CONSTRUCMON STANDARDS,AND THATA COPY OF THIS
(Use'+'#Above Top of Casing) - REC11 9 PAS BEEN PROVIDED THE�LLOWNER /)L�
d. TOP OF CASING IS 1 Fr.Above Land Surface' - �L9 &
'Top of casing tenninated atior below land surface may require SIGNATURE OF CERTIFIED W ELL CO RACTOR DATE
a variance in wmdmce with 15A NCAC 2C.Oi 15. ,
rr//,�,, METHOD OF TEST Llllr �dmeS W. Camp
e. YIELD(gpm):_�+y�_ PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30.days. Attn:Information Mgt., Form GWla
1617 Mall Service Center-Raleigh,NC 2T6994617 Phone No.(919)T33-TOI S ext 668. Rev.7/05

~ RESIDENTIAL WELL CONSTRUCTION RECORD �p Q `9 `1
- North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2138
1.WELL CONTRACTOR: I. DISINFECTION:Type chlorine Amount L' A S
James W. Camp
g. WATER ZONES(depth):
Well Contractor.(InclMduai)Name From To From To
Camp' s Well & Pump Co Tnc-- From Tc From To
Well Contractor Company Name From Tc From To
STREET ADDRESS P 0 BOX 429 - 6. CASING: Thieknessl
Dep l�n
th Dieter Weig M Material
NC 28040 From 0 ToFt. SD1221 'PVC
City or Town State Zip Code From To Ft.
( 828� 453-7322 From To Ft.
Area code- Phone number 7, GROUT: Depth Material Method
2.WELL INFORMATION: From 0 To 20 Ft. Sackrete Hand
SITE WELL ID#(if applicable) From To Ft
STATE WELL PERMiT#(if applicable) From To Ft.
DWQ or OTHER PERMIT#(if applicable) S. SCREEN: Depth Diameter Slot Size Material
Fran To Ft._in. _in.
WELL USE(Check Applicable Box): Resldentiat W ater Supply❑ Fran To Ft^In. _In.
DATE DRILLED 9 L L`—1)12 From To Ft._in. —In.
TIME COMPLETED L�JO AM❑ PM
9. SANDIGRAVEL PACK:
3.WELL I-C AT ('� 7p jf, Depth Size Makdet
CITY: iA P/'ICY COUNTY LLther`W From To Ft.
/n� �7 J From To Ft.
I o. LI AP flt� ' From To Ft.
(Street Name,Numbers,Oanmumay,SubdMalon,Lot.No.,Parcel,21p Code) - -
T(1POGRAPHIC I LAND SETTING: 10.DRILLING LOG
Altiope OValley ❑Flat pRidge ❑Other From To f FOLmlation Description
11 (check apprOPdats box) .0 4'�, L(� f I
/� .�� � �� A� May h in degrees,
LATITUDE '_y.,_1 IL-. �L:.GJ�i• minutes,sewnds or ,f� i 0. P YC
LONGITUDE 3 .Z. D•7- /3�� t"'i inadecimel format �la , ' — .—( DI15o
�
fatitudeAongitude source: PS ❑Topographic map 7-1
((ocathn of"I must be shown on a USGS topo map and (.J
attached to this form 7 not using GPS)
4.WELL OWNER
OWNER'S NAME 1jAA a/y�k. Cam)✓
STREET A RESS G D K 1.0 Li
ler' d ti ,
City or Town State Zip Cade '
Area code- Phone number 11. REMARKS:
5.WELL DETAILS: �—
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YESV NO[I
I DO HEREBY CERTIFY THAT THIS WELL WAS GONSTRUCIED N ACCORDANCE WITH
C. WATER LEVEL Below Top of Casing: to FT, 15A NCAC 2C,WELL CONSIRUCTONSTANDARDS.OWNER.
INATACOPY OF THIS
(Use-+'R Above Top M Casing RECO BEEN PROVIDED TO THE WELLOWNER,
d. TOP OF CASING IS 1 . FT.Above Land Surface-
'Top of casing terminated at/or below land surface may require SIG MATURE OF CERTIFIED WELL CO TRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118.
METHODOFTEST a..lr' 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
11617 Mail Service Center—Raleigh,NC 27699.1617 Phone No.[phone] ext 568. . Rev.7105

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 2 CeA S
James W. Camp g• WATER ZONES(depth):
Well Contractor.(individual)Name Fran To From To
Camp' s Well & Pump Co Tnr- From To From To
Well Contractor Company Name From To Fran To
STREET ADDRESS P O BOX 429 6. CASING: Thickness/
. Depth Diameter Wei hl Material
Ellenboro NC 28040 Fran 0 To�-Ft. la SD�21 PVC
City a Tam State Ap Code Fran To FL
( 828)_ 453-7322 Fran To FL
Area code- Phone number 7. GROUT: Depth Material Method
2.WELL INFORMATION: Fran To 20 FL Sackrete -Hand
SITE WELL ID#(If applicable) From To FL
STATE WELL PERMrr#(R applicable) Fran To FL
DWQ or OTHER PERMIT#(if applicable) - B. SCREEN: Depth Diameter Slot Sim .Material
Fran Tc_Ft_in. _in.
WELL USE(Check Applicable Box): Residentiat W ater Supply Fmm Tc Ft. in. —In.
DATE DRILLED 1 9 C 5 From To FL_in. _In.
TIME COMPLETED AMO PM B. SANDIGRAVEL PACK:
3,WELL LOCATION: Depth Sim Material
I y(,'.� From To Ft.
CITY: l �nP 1L�VP_ -(C-OUNTY P I�7 F To Ft.
OgeeYP51 From To Ft. _
(Street Name,Numbers,cqnmunay,SumiNsim,La No.,Parcel,Zip Code)
TOPOGRA IC/LAND SETTING: 10.DRILLING LOG
1.
[]SlopearBy ❑Flat ❑Ridge ❑Other Foom Q -Formation S�Kspnptbn
(check appropriate box) Pa7ybe
in de u d
2 -1 _ &«o LATITUDE
, apg . imal
LONGITUDE
Latitude/longitude source: bTGPS OTopographie map
(location of war must be shown on a USGS topo map and 1
attached to this form Inot using GPS)
4.WELL OWNER 1 J
OWNER'S NAME AD IA u C a Y hL
STREET ADDRESS - d C P$
�Lxe G l LYe 6
City or Tam State Zip Code
Area ca�ode- Phone number 11. REMARKS:
S.WELL DETAILS: D
a. TOTAL DEPTH: \`
b. DOES WELL REPLACE EXISTING WELL? YES NO t4
X
DD,A� I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITHc. WATER LEVEL Below Top Of Casing:AFT. 15A NCAC 2C.WELL CONSTRUCTION STANDARDS.AND THATA COPY OF THIS
(Use + 'rf Above Top of Casing) RECORD HAS BEEN PROVIDEDTOTH/E W�ELLL OWNER.
d. TOP OF CASING IS 1 FT.Above Land Surface* (,,,LVJ'Vl.
'Top of casing terminated ally below land surface may require SIGNATURE OF CERTIFIED W ELL C RACTOR DATE
a variance in accordance with 15A NCAC 2C.0118.,
METHODOFTEST Q.f ✓ lames 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-la
1617 Mail Service Center-Raleigh,NC 276994617 Phone No.[phone] ext 568. Rev.7105

y.SUIFo ��
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources"Division of Water Quality
•�'""�' WELL CONTRACTOR CERTIFICATION# 213 8
1.WELL CONTRACTOR: t DISINFECTION:Type Chlorine Amount t• 'u
James W f'amD g. WATER ZONES(depth):
From To From To
Well Connactor.(Individuai)Name
Camp i S Well & Pump Co Tn(`_
W From To From To
ell Contract,Company Name Fran To From To
P 0 BOX 429 6. CASING: Thickness/
STREET ADDRESS Depth Dia)rteter Wei ht Matedai
Ellenboro NC 28040 From 0 To � Ft. 6a SD 21 PVC
CIIy orTown State Zip Code Fran To Ft.
( 828} 453-7322 Fran To Ft.
Area code- Phone number T. GROUT: Depth Material Method
2.WELL INFORMATION: From To 20 FL Sackrete Hand
SITE WELL ID#(if applicable) From To Ft.
STATE WELL PERMIT#(9 applicable) Fran To FL
DWO or OTHER PERMIT i if applicable) S. SCREEN: Depth Diameter Slot Size -Material
From To Ft. in. _In..
WELL USE(Check Applicable Box): Restdentiat W ater Supply IV/ Fmm To Ft. in. —in.
DATE DRILLED From To Ft_in. _In.
TIMECOMPLETED AM❑ PM❑ 9. SANDIGRAVEL PACK:
Depth SW Material
3.WELL LOCATION: From - To Ft.
CITY: /�1a I:P 1—k Ye COUNTY N �f f r� Fran To Ft.
IGq I ��AV CK ��• FranFt._To
(Street Nam bers.Ca
Name,Mini Subdivision,La NO.,Parcel,Zip Code) . . .. - -
TOPOGRAPHIC I LANDS tNG: 10.DRILLING LOG
From To Formation Description
❑Slope OValley ❑Fiat Ridge ❑Other .0 . S0.N.d
(check appropriate box) ]� May be in degree;
LATITUDE � ? 4' 7 °L" minutes,seconds, r' s30 r Y15 c I i r�a r,r k
in a decimal format 3—r
LONGITUDE g �� t�
Latitude/longitude source: I06PS ❑Topographic map "' -
(location of welf must be shown on a USGS topo map and I
attached to this form I not using GPS) W
4.WELL OWNER C � al
OWNER'S NAME JCo I ' !IIC
STi ET ADDRESS __��9__�}E O A Y
Me L UYp N g�4b
City or Tavn Stale Zip Code
Area axle- Phone number 11. REMARKS:
5.WELL DETAILS:
a. TOTAL DEPTH: C 5
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO❑
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
c. WATER LEVEL Below Top of Casing: FT, ISA WAC 2C,WELL CONSTRUCTION STANDARDS.AND THAT COPY OF THIS
(use +'i1 Above Top Of Casing) RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
1 t
FT.Above Land Surface'
d. TOP OF CASING IS --_lFI
'Top of casing terminated eVa belay land sudace may require SIGh�ly URE OF CERTIFIED W ELL CO RACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. James W. Camp
e. YIELD(gpm):�r da METHOD OF TEST I Y PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within,30 days. Attn:Information Mgt, Fo m GW-1a
1617 Mail Service Center-Raleigh,NC 2T6994617 Phone No.(919)T33-7015 ext 568. Rev.7105

diaSUlpo
�. ✓non � (� p ')
RESIDENTIAL WELL CONSTRUCTION RECORD '
North Carolina Department of Environment and Natural Resources-Division of Water Quality
•@"""�, WELL CONTRACTOR CERTIFICATION 2138
1.WELL CONTRACTOR: I. DISINFECTION:Typo Chlorine Amount
James W. Camp g. WATER ZONES(depth):
Well Contractor(individual)Name Fran To From To
Camp' s Well & Pump Co Tnc_ Frorr To From To
Well Contractor Company Name Fran To From To
STREETADDRESS P O BOX 429 6. CASING: Thickness/
Depth Diameter Wei ht Material
Ellenboro NC 28040 Fr 0 To �F=' 6a SD21 PVC
City or Town State Zip Code —
( 828)_ 453-7322 Fran To Ft. —
Area code- Phone number 7. GROUT: Depth Material Method
2.WELL INFORMATION: Fran 0 To 20 Ft. Sackrete Hand
SITE WELL ID#(If applicable) From To FL
STATE WELL PERMIT#(!applicable) From Tc FL
DWQ or OTHER PERMIT#(If applicable) S. SCREEN: Depth Diameter - Slot Size Material
From To FL in. _in..
WELL USE(Check Applicable Box): Residentiat Water Supplyv Fran To Ft._in. —In.
DATE DRILLED vCvZ-�`-� Fran Tc Ft. in. _in.
TIME COMPLETED_ AM❑ PM V S. SANDIGRAVEL PACK:
3.WELL LOCPAON. Depth Size Material
Fran To Ft.
CITY: iL COUNTY IA C&Y From To Ft.
From To Ft.
(Street ame,Numbem, unity,SubdlNaion,Lot No.,Pamel,Zp Code) -
TOPOGRAPHIC I LAND SE ING: 10.DRILLING LOG
p Slope OVOMey ❑Flat - Ridge ❑Other From IF
I FornlatiOn D BC[Iplbn
(check appropdale box) .0 � I 7S C!r5 l 5 a YI
rMaydbe in de®eea,LATITUDE (; ) ,seconds aC5-
B01 imal format -/^t'1S0 0.te _ Ya G.
LONGITUDEg
Latitudeflongitutde source: OPS ❑Topographic map
(IocatiDn of wet must be shown on a USGS topo map and
attached to this form Inot using GPS)
4.WELL OWNER y-- - l 1 i -
OWNER'S NAME \jZ-k e )15 F e to T
STR ET ADDRESS C
5 I A-
8 (.J
l ✓ d
City or Tarn State Zip Code
Area code- Phone number - 11. REMARKS:
5.WELL DETAILS:
a. TOTAL DEPTH: y,
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO Gf.
r, IDD HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED NACCORDANCE WnH
C. WATER LEVEL Below Top of Casing: qO FT. 15A NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF TWS
(Use W U Above Top of Casing) RECORD HAS BEEN PROVIDED TO THE
�WELL OWNFA r
d. TOP OF CASING IS 1 FT.Above Land Surface' ti�
. 'Top of casing terminated allor below land surface may require SIGNATURE OF CERTIFIED WELL q�NTRACTOR DATE
a variance in accordance with 15A NCAC 2C.01 18. It
_METHODOFTEST Q I r 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-la
1617 Mail Service Center-Raleigh,INC 27699.1617 Phone No.[phone] ext 568. Rev.7105

From:Scott Gantt To:Stephanie Wilson Date: 115/2006 Time:7:48:56 PM Iny Page'g2 of
6
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 W Q PERMIT#
(if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal (]f applicable)
RecoveryP ❑ Industrial❑ Agricultural ❑ Monitoring ❑
❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2.WELL LOCATION: Topographic/Land setting
Nearest town: LAKE LURE County RUTHERFORD ❑Ridge ❑ Slope ❑ Valley ® Flat
LOT 150,PHEASANT ST, RIVERBEND RESORTS Latitude/Longitude of well location
(Street Name,Numbrrs,Community,Subdivision,Lot No,.Zip Code) 35.25210/82/09/755
3.OWNER RIDGELINE DEVELOPMENT CORP. (degees/miwtes/seconds)
ADDRESS 112 COCOPLUM CIRCLE Latitudellongitucle source.©GPS❑Topographic map
(stree or Rowe No.) DEPTH DRILLINGLOG
ROYAL PALM BEACH FL 33411 From To Formation Description
City o Tower State Zip Code 0 65 Clay
561-798-2729 65 400 Consolidated Rock
Area Code-Phone Number
4_DATE DRILLED 12/29/05
5.TOTAL DEPTH 400
6.DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7,STATIC WATER LEVEL Below Top of Casing: 50 FT.
(/se"+"IlAWov Topof Casio,)
8. TOP OF CASING IS 2 FT.Above Land Surface-
-Top of ca®g tmnm od at/or hdo..w Imd swfaee rc4wez a vaimct in
a­ordmcc with 15A NCAC 2C 011s
9. YIELD(gpm): 5 METHOD OF TEST ARDM
10.WATER ZONES(depth): 210
It.DISINFECTION:TYPE HYPOCHLORITE Amount 16 0= LOCATION SKETCH
12.CASING: Wall Thickness Show direction and distance in miles from at least
Depth Diameter or weight/FL Material two State Roads or County Roads.Include the road
From o To 75 FL 6 1/4" SDR 21 PVC numbers and common road names.
L—
D.GROI7f: �
Depth Material Method
From 0 T9 20 FL GRAVEL MIX GRAVITY
14.SCREEN
Depth Diameter Sim Size Material t'.n
From NA To FL in in.
15.SAND/GRAVEL PACK: -
Depth Sin 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-]REV.07l2001
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days.

CY'
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 ® MunicipaVPublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ H Other,List Use
2. WELL LOCATION:
Nearest Town:LAVE LURE County RUTH Topographic/Land setting
120 PEARSON CIRCLE ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Commundy,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER: GREG BELLINI Latitude/longitude of well location
Address 120 PEARSON CIRCLE _
(Street or Route No.) (degrees/minutes/seconds)
LAKE LURE NC 28746 Latitude/longitude source: ❑ GPS ❑ Topographic map
City or Town State Zip Code (check box)
8�28)—674-8974 DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 11/22105
5.TOTAL DEPTH: 565
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 11=1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118. LOCATION SKETCH
9. YIELD(gpm): 5 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 15.5 HWY.#64/74A W.FROM RFTN.RIGHT ON
12. CASING: Wall Thickness BUFFALO SHOALS RD.RIGHT ON PEARSON
Depth Diameter or Weight/Ft Material CIRCLE. P1 LOT ON RIGHT.
From 0 To 45 Ft 6-1/4" SDR27.6 PVC
From_To_Ft
From To Ft _
13. GROUT: Depth Material Method
From 0 To 20 Ft. OUIKRETE POURED
From_To—Ft_
n
14.SCREEN: Depth Diameter Slot Size Material
From_To_Ft._ in. in. a`
From_To_Ft._ in. in. _
15. SAND/GRAVEL PACK: c�St
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 COP 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)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/Pubhc ❑ Industrial ❑ Agricultuml ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town:BOSTIC County RUTH Topographic/Land setting
SANDY LEVEL CHURCH RD. ❑ Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:JUDY BURNS Latitude/longitude of well location
Address SANDY LEVEL CHURCH RD.
(Street or Route No.) (degrees/mmutes/seconds)
BOSTIC NC 28018 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
L10)—744-8692 DEPTH DRILLING LOG
Area Code Phone number From To From To
4. DATE DRILLED 11/29/05
5.TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING\'YELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 10-20 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated atlor below land surface requires a
variance in accordance with 15A NCAC 2C.0118. LOCATION SKETCH
9.YIELD(gpm): 5 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 BOSTIC,GO OUT PEARIDGE RD.
12. CASING: Wall Thickness RIGHT ON SANDY LEVEL CHURCH RD.STAY
Depth Diameter or Weight/Ft Material LEFT ON SANDY LEVEL 113 MILE ON LEFT:
From 0 To 125 Ft 6-1/4" SDR21 PVC
From_To_Ft_
From_To_Ft.
_
13. GROUT: Depth Material Method Q,
From 0 To 20 Ft QUHMTE POURED
From_To_Ft_ s
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
CONSTRUCTION STANDARDS,AND THAT A OPY O THIS ORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THEVELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

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: LAKE LURE County RUTH Topographic/Land setting
LAKE LURE WASTE WATER TREATMENT PLANT ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER: TOWN OF LAKE LURE Latitude/longitude of well location
Address LAKE LURE WASTE WATER TREATMENT PLANT _
(Street or Route No.) (degrees/minutes/seconds)
LAKE LURE NC 28746 Latitudellongitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
(S28)—625-4696 DEPTH DRILLING LOG
Area Code Phone number From To From To
4,DATE DRILLED 11/30/05 _
5.TOTAL DEPTH: 185
6.DOES WELL REPLACE E)USTING 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): 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.#64/74A W.FROM
12. CASING: Wall Thickness RUTHERFORDTON.M P1 DRIVE ON RIGHT
Depth Diameter or Weight/Ft Material AFTER YOU PASS ISLAND CREEK RD.
From 0 To 45 Ft 6-1/4" SDR.21 PVC
From_To_Ft_
From_To Ft i
13. GROUT: Depth Material Method
From 0 To 20 Ft OUEKRETE POURED rr
From_To_Ft.
14.SCREEN: Depth Diameter Slot Size Material
From_To_Ft._ in. in.
From_To Ft._ in. in.
15. SAND/GRAVEL PA_CK:
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 STRUCTION 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

010
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:FOREST CITY County RUTH Topographic/Land setting
291 KITTEN TRAH. ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:JAMIE YELTON Latitude/longitude of well location
Address 291 KITTEN TRAIL _
(Street or Route No.) (degreestminates/seconds)
FOREST CITY NC 28043 Latitude/longitude source: ❑GPS ❑Topographic map
City or Town State Zip Code (check box)
7( 04)—4774247 DEPTH
Area Code Phone number From To
4.DATE DRILLED 11/07/05
5.TOTAL DEPTH: 185 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 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): 15 METHOD OF TEST ARD number and common names
10.WATER ZONES(depth): BUS.74 W.FROM FOREST CITY.RT.ON
11.DISINFECTION:Type CHLORYTE Amount 3.5 HUDLOW RD.LEFT ON WHITESIDE RD.APPROX.
12. CASING: Wall Thickness 1/4 MILE.LEFT ON KITTEN TRAIL.DRIVE GOES
Depth Diameter or Weight/Ft Material STRAIGHT AT DEAD END.
From 0 To 40 Ft 6-1/4" SDR27.6 PVC
From_To_Ft._ _
From_To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft.OUH{RETE POURED
From To_Ft.
14.SCREEN: Depth Diameter Slot Size Material
From_To_Ft._ in. in. O a
From_To_Ft._ m.
15. SAND/GRAVEL PACK: S
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 CTIO TANDARDS, AND THAT A COPY OF THI CORD HAS BEEN PROVIDED TO THE WELL OWNER
lJ J
IGNATURE OF PERSON CNSTRUCTING 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 PrrTMAN 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 2 Municipal/Public El Industrial ❑ Agricultural El
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town: LAKE LURE County RUTH Topographic/Land setting
BROOKSIDE FOREST-LOT#31 ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:NATURALTONE CUSTOM HOMES Latitude/longitude of well location
Address BROOKSIDE FOREST-LOT#31
(Street or Route No.) (degrees(minutes/seconds)
LAKE LURE NC 28746 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 28)—625-0933 DEPTH
Area Code Phone number From To
4.DATE DRILLED 11/11/05 _
5.TOTAL DEPTH: 585 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): 200+ METHOD OF TEST ARD number and common names
10. WATER ZONES(depth): HWY.#64/74A W.FROM RFTN.RIGHT ON
BILL'S CREEK RD.LEFT ON BROOKSIDE
I L DISINFECTION:Type CHLORYTE Amount 15.5 PARKWAY INTO BROOKSIDE FOREST SUBDV.
12.CASING: Wall Thickness RIGHT ON FREEMAN RIDGE.LOT#31 ON LEFT
Depth Diameter or Weight/Ft. Material AT TOP TO HILL.
From 0 To 70 Ft 6-1/4" SDR21 PVC
From_To_Ft_ _
From_To Ft _
13.GROUT: Depth Material Method
From 0 To 20 Ft.OUHOtETE POURED
From_To_Ft. .;
14.SCREEN: Depth Diameter Slot Size Material
From_To_Ft._ in in.
From_To_Ft_ in. in. � t
15. SAND/GRAVEL PACK: 3
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 TI STANDARDS,AND THAT A COPY OF S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING LL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

lam'
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 hijection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town:ELLE1BORO County RUTH Topographic/Land setting
211 GRANITE RD, ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER: TONE"TISDALE Latitude/longitude of well location
Address 211 GRANITE RD. _
(Street or Route No.) (degrees/mtinutes/seconds)
ELLENBORO NC 28040 Latitude/longitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8L)—453-0895 DEPTH
Area Code Phone number From To
4.DATE DRILLED 11/28/08
5.TOTAL DEPTH: 305 DRILLING LOG
6. DOES WELL REPLACE EXISTING WELL? YES® NO,n 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.0118.9. YIELD(gpm): 5 METHOD OF TEST ARD Two State Roads or County Roads. Include the road
number and common names
10. WATER ZONES(depth): FROM ELLENBORO.GO OUT PINEY MTN.CH
11.DISINFECTION:Type CHLORYTE Amount 7.5 RD.RIGHT ON OLD HOLLIS RD.LEFT ON
II
12. CASING: Wall Thickness GRANITE RD. 1/4 M E ON LEFT.211 ON
Depth Diameter or Weight/FL Material MAILBOX
From 0 To 35 Ft 6-1/4" SDR21 PVC
From_TO_Ft_ _
From To_Ft _
13. GROUT: Depth Material Method
From 0 To 20 Ft.OUIKRETE POURED
From_To_Ft
14.SCREEN: Depth Diameter Slot Size Material
From_To_Ft._ in. in. Q.
From_To_Ft._ in. in.
15. SAND/GRAVEL PACK: ut
Depth Size Material
From_To_FL_
From To FL
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTZUCnON STANDARDS,AND THAT A COPY F THIS RECORD HAS BEEN PROVIDED TO THE
/(WELL OWNER
-1 J j •�
SIGNATURE OF PERSON CONSTRUCTING THEVELL ' DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center—Raleigh,NC
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/2001

4
WELL CONSTRUCTION RECORD
North Carolina—Department of Environment And Natural Resources—Division of Water Quality—Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME(print) ROBIN MCNEELY CERTIFICATION# 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,LLC PHONE# [phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ if Other,List Use_
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH Topographic/Land setting
MIDDLE OAKS TRAII ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER: SCOTT BYERS Latitude/longitude of well location
Address MIDDLE OAKS TRAIL _
(Street or Route No.) (degrees/minutes/seconds)
RUTHERFORDTON NC 28139 Latitude/longitude source: ❑ CPS ❑Topographic map
City or Town State Zip Code (check box)
8l 1M—287-3551 DEPTH
Area Code Phone number From To
4.DATE DRILLED 11/02/05
5.TOTAL DEPTH: 32 DRILLING LOG
6.DOES WELL REPLACE EXISmG 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.0118.9. YIELD(gpm): 12 METHOD OF TEST STEEL TAPE Two State Roads or County Roads. Include the road
number and common names
10.WATER ZONES(depth): HWY.#64/74A W.FROM RUTHERFORDTON.GO
11.DISINFECTION: Type CHLORYTE Amount 9.2 PAST TOMMY'S BP.RIGHT ON MIDDLE OAKS
12. CASING: Wall Thickness TRAIL PASTURE ON RIGHT.
Depth Diameter or Weight/Ft. Material
From 0 To 32 Ft 24" CEMENT
From_To_Ft._ _
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft.CEMENT POURED
From_To_Ft ,
14.SCREEN: Depth Diameter Slot Size Material
From_To_Ft. in. in.
From_To_Ft._ in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 12 To 32 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 CTION STANDARDS,AND THAT A COPY OF S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1
' ec g
SIGNATURE OFP�VON 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 ® MunicipaVPublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town:ELLENBORO County RUTH Topographic/Land setting
160 DOBBINS RD. ❑Ridge ❑ Slope ❑ Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:DON JENKINS Latitude/longitude of well location
Address 160 DOBBINS P.D.
(Street or Route No.) (degrees/minutes/seconds)
ELLENBORO NC 28040 Latitude/longitude source: ❑ GPS ❑ Topographic map
City or Town State Zip Code (check box)
8L 8)-657-5230 DEPTH
Area Code Phone number From To
4.DATE DRILLED 11/03/05 _
5.TOTAL DEPTH: 42 DRILLING LOG
6.DOES WELL REPLACE EXISTING WELL? YES® NO❑ From To
7. STATIC WATER LEVEL Below Top of Casing: 32 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 requues 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): BY-PASS 74 E.FROM FOREST CITY.EXIT RT.
11.DISINFECTION:Type CHLORYTE Amount 4.6 ON HARRIS/HENRIETTA RD.LEFT ON DOBBINS
12.CASING: Wall Thickness RD.3f HOUSE ON RT.
Depth Diameter or Weight/Ft. Material
From 0 To 42 Ft 24" CEMENT
From_To—Ft._ _
From_To_Ft
13.GROUT: Depth Material Method o
From 0 To 20 Ft. CEMENT POURED
From_To_Ft
rn
14.SCREEN: Depth Diameter Slot Size Material
From_To_Ft._ in. in.
From_To_Ft._ in. in. On
15. SAND/GRAVEL PACK:
Depth Size Material
From 32 To 42 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
� C
-c s'
SIGNATME OF P ON CONSTRUCTING THE WELL- DATE
Submit the original to the Division of water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

00 '3 2a3 0
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 PITT 4AN WELL BORING,LLC PHONE#[phone]
STATE WELL CONSTRUCTION PERMIT#_ ASSOCIATED WQ PERMIT#_
(if applicable) (if applicable)
1. 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:
Nearest Town: RUTHERFORDTON County RUTH Topographic/Land setting
JERICHO LANE ❑Ridge ❑ Slope ❑Valley ❑Fiat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:JOE CARSON Latitude/longitude of well location
Address JERICHO LANE
(Street or Route No.) (degrees/minutesiseconds)
RUTHERFORDTON NC 28139 LatitudeAongitude source: ❑ GPS ❑Topographic map
City or Town State Zip Code (check box)
8(§ 8)—287-4239 DEPTH DRILLING LOG
Area Code Phone number From To From To
4. DATE DRILLED 11/02/05
5.TOTAL DEPTH: 185
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 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): 25 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.
WY #64/74 A W.FROM RUTHERFORDTON.
12.CASING: Wall Thickness LEFT ON JERICHO LANE IN GREENHILL.2/10
Depth Diameter or Weight/Ft Material MILE ON RT.
From 0 To 40 Ft 6-1/4" SDR21 PVC
From_To_Ft_
From To Ft. _
13.GROUT:_Depth Mat_erial Method �t
From 0 To 20 Ft OUIKRETE POURED
From_To_Ft._ a.
14.SCRfEN: 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
CONSTRUCTION STANDARDS,AND THAT A COP OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IGNATURE OtTFRSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center—RalelolvNCJ
27699-1636 Phone No. [phone],within 30 days. GW-1 REV.07/16011

0
2d3 ` 6
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 0 Municipal/Public El Industrial LJ Agricultural El
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use_
2. WELL LOCATION:
Nearest Town:BOSTIC County RUTH Topographic/Land setting
BIG ROCK RD.(LOT#90) ❑Ridge ❑ Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appmpriate box)
3.OWNER: MARTY WALKS Latitude/longitude of well location
Address BIG ROCK RD.
(Street or Route No.) (degreestminutes/seconds) _
BOSTIC NC 28018 Latitude/longitude source: ❑GPS ❑Topographic map
City or Town State Zip Cale (check box)
8( 2g)—288-3000 DEPTH DRILLING LOG
Area Cale Phone number From To From To
4.DATE DRILLED 11/03/05 _
5.TOTAL DEPTH: 465
6.DOES WELL REPLACE EXISTING)&TLL? YES❑ NO
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*
'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
I1.DISINFECTION:Type CHLORYTE Amount 12 BUS.74 E. FROM FOREST CITY.LEFT ON
12.CASING: Wall Thickness BOSTIC/SUNSHINE HWY.LEFT ON TONEY RD,
Depth Diameter or Weight/Ft. Material IN SUNSHINE.LEFT ON WATERS RD.RT.ON
From 0 To 135 Ft 6-1/4" SDR21 PVC ARBRA RD.INTO YELLOW TOP MTN.LEFT ON
From_To_FL_ BIG ROCK RD.PAVED DRIVE 1/4 MILE ON.;.
From_To_Ft. LEFT.
13.GROUT: Depth Material Method
From 0 To 20 Ft OUEMTE POURED n
From_To_Ft_
14.SCREEN: Depth Diameter Slot Size Material
From_To_Ft._ in in. _
From To Ft._ in in.
15. SAND/GRAVEL PACK:
Depth Size Material
From_To_Ft._
From_To_Ft_
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
COTASTRUCTION STANDARDS,AND THAT AYPPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATUREOF PERSON 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
I,`i` 144 2Qt�

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 MunicipaVPublic El Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: FOREST CITY County RUTH Topographic/Land setting
DARK CORNER RD. ❑Ridge ❑ Slope ❑Valley ❑Flat
(Sheet Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER JEFF BRADLEY LatitudeAcnigitude of well location
Address DARK CORNER RD. _
(Street or Route No.) (degreeshnmutes/seconds)
FOREST CITY NC 28043 Latitude/longitude source: ❑GPS ❑Topographic map
City or Town State Zip Code (check box)
8( 28)—245-1047 DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 11/04/05
5.TOTAL DEPTH: 145
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 LOCATION SKETCH
variance in accordance with 15A NCAC 2C.0118.
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 CEILORYTE Amount 3 BIG ISLAND RD.FROM SHILOH RT ON 1sT
12. CASING: Wall Thickness DARK CORNER RD.RT.ON LAST DRIVE
Depth Diameter or Weight/Ft Material BEFORE BRIDGE(APPROX.2 MILES)RT.ON 15F
From 0 To 40 Ft. 6-1/4" SDR21 PVC DRIVE
From_To_Ft
From To Ft. n
13.GROUT:_Depth Material Method n
From 0 To 20 Ft OUIKRETE POURED
From To Ft. _
14.SCREEN: Depth Diameter Slot Size Material O
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
1/ "v IGNATURE OFIPERSON 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)
I. WELL USE(Check Applicable Box): Residential 0 MumcipaVPublic El Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH Topographic/Land setting
1486 COOPERS GAP RD. ❑Ridge ❑ Slope ❑ Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3.OWNER:JEFF HIKES Latitude/longitude of well location
Address 1486 COOPERS GAP RD. _
(Street or Route No.) (degreestmimttes/seconds)
RUTHERFORDTON NC 28139 Latitude/Iongitude source: ❑GPS ❑Topographic map
City or Town State Zip Code (check box)
8L8 —288-0670 DEPTH DRILLING LOG
Area Code Phone number From To From To
4.DATE DRILLED 11/07/05 _
5.TOTAL DEPTH: 405
6.DOES WELL REPLACE EXISTING WELL? YES❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-1/2 FT. Above Land Surface•
*Top of casing terminated actor below land surface requires a
variance in accordance with 15A NCAC 2C.0118. LOCATION SKETCH
9.YIELD(gpm): 4 METHOD OF TEST ARD Show direction and distance in miles from at least
lo. WATER ZONES(depth):_ Two State Roads or County Roads. Include the road
number and common names
11.DISINFECTION:Type CHLORYT'E Amount 10.5 HWY.#64/74A W.FROM RUTHERFORDTON.
12. CASING: Wall Thickness LEFT ON COOPERS GAP RD.RIGHT ON DRIVE
Depth Diameter or Weight/Ft. Material (i4 BOX#1486.
From 0 To 80 Ft 6-114" SDR21 PVC
From_To_Ft_
From_To Ft_ _
13. GROUT: Depth Material Method O
From 0 To 20 Ft OUHOtETE POURED n
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
CON UCT10N STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�G
NATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center—Raleigh,NC i
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 PERMrr#_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ED MunicipattPublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH Topographic/Land setting
RUTHERFORD AH2PORT ❑Ridge ❑ Slope ❑ valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
3. OWNER:MELVIN HELPHREY LatitudeAongimde of well location
Address RUTHERFORD AIRPORT _
(Street or Route No.) (degrees/mimnes/seconds)
RUTHERFORDTON NC 28139 Latitude/longitude source: ❑ GPS ❑ Topographic map
City or Town State Zip Code (check box)
8( ZS)—654-9011 DEPTH
Area Code Phone number From To
4. DATE DRILLED 11/18/05 _
5. TOTAL DEPTH: 73 DRILLING LOG
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO® From To
7. STATIC WATER LEVEL Below Top of Casing: 53 FT. _
(Use"+"if Above Top of Casing)
8.TOP OF CASING IS 1-112 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 mad
9.YIELD(gpm): 20 METHOD OF TEST STEEL TAPE number and common names
10. WATER ZONES (depth): FROM RUTHERFORDTON.GO OUT HWY.#64
11.DISINFECTION:Type CHLORYTE Amount 9.2 E.LEFT ON OSCAR JUSTICE RD.RIGHT ON
12. CASING: Wall Thickness AIRPORT P.D.DEAD END.LAST HANGER ON
Depth Diameter or Weight/Ft Material RIGHT.
From 0 To 73 Ft 24" CEMENT
From_To_Ft
From_To Ft _
13.GROUT: Depth Material Method
From 0 To 20 Ft.CEMENT POURED
From_To_Ft
14.SCREEN: Depth Diameter Slot Size Material _.
From_To Ft._ in in. CD
From_To_Ft._ in. in. o
15. SAND/GRAVEL PACK: ut
Depth Size Material
From 53 To 73 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 CORD HAS BEEN PROVIDED TO THE WELL OWNER
SI NA OF PERSPOCONSTRUCTING 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

• - Rj�
ESIDENTTAL 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 1 R ca
James W- ramn g. WATER ZONES(depth):
Well Contractor-0ndividual)Name From To L4 D From To
Camp' s Well & Pumn�- Trs_— From ro From To
Well Contractor Company Name Fran To From To
STREETADDRESS P G BOX 429 S. CASING: Thlcpress/
Depth D or Wei ht Material
Ellenboro NC 28040 From 0 ro 38 Ft. 6 SDW21 PVC
City o Town - State lap Code Fran Tc Ft
( 8281 453-7322 Fran To Ft
Area code- Phone number
7. GROUT: Depth Material Method
2.WELL INFORMATION: Frain 0 To 20 Ft Sackrete Hand
SITE WELL ID#(If apple) From To Ft
STATE WELL PERMIT#(e appikable) Fran . To Ft
DWQ or OTHER PERMIT#(If applicable) 8. SCREEN: Depth Diameter Sict Sin .Material
WELL USE(Check Applicable Box): RAsklential Water Suppb❑ Fr
' Ff= To Ft._In. — In.
om To Ft. in. —In.
DATE DRILLED �02`a2�-D S ,.,// From To Ft.In. _^In.
TIME COMPLETED .� AM❑ PM0 9. SANDIGRAVEL PACK:
3.WELL LOCArTION: y'�/• Depth size Material
CITY: r ��>°ndoro COUNTY /lPY d F1°^'_ —To Ft
Fran To Ft.
From To Ft
(Street Name.NWIMa_n.CmanuNly,Subdivision,LU_No.,Pamet zlp Code) . . . .. .. .
TOPOGRAPHIC/LAP D SETTING: 10.DRILLING LOG
pSkrpe OVaBey tVPU ❑Ridge ❑Other From T Formation Description
(chock appropriate bob . 0 ' _ g c i ad 6,t
/ry.�J� May be I.ftwa,
LATITUDE _L 5 � ndm*,seconds or
LONGITUDE L� dgW ma decimal brand
LatitudeADngitude source: ❑GPS OTopographic map
(location orwelmustbe shown on a USGS fopo map and r—
attached to this form 7not uussig GPPS)) j
4,WELL OWNER N!l C'
OWNER'S NAME / LL
O
STREETADDRESS
Sheibit Z1 �g ►sa
City orTevm I State Zip Code
Area�wde Phone number
11. REMARKS:
S.WELL DETAILS: S
a. TOTAL DEPTH: J
Is. DOES WELL REPLACE EXISTING WELL? YES VNO O
rr 1 DO HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED INACCORDANCE Wmt
e. WATER LEVEL Below Top of Casing: CPS FT, MHCAC 2C,WELL CONSmUCHON STANDARDS,AND IMTACOPY OF THIS
(Use'+'I(Above Top Of Casing) RECORD HAS BEEN PROVIDED TOTHE WELL OWNER
0 d. TOP OF CASING IS 1 FT.Above Land Sutface� ' C
Top d casbg terminated at/or below land surface m@y require - SIG URE OF CERTIFIED WELL CONTIRACTOR DATE
a variance in accordance with 15A NCAC 2C.ONB James W. Camp
METHOD OF TEST f r /r
e. YIELD(gpm): d _ FRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submlt the original to the Division of Water Quality wlthin,30.days. Attn:I forma>p C E I V E D Form W-1a
1617 Mail S8NIC8 Center-Raleigh,NC Z76994617 Phone No.(919).733-7015 1 Kt 568. . Rev. 05
FEB 07 2006
ASheville Regional Office

RD
ESIDENTIAL WELL CONSTRUCTION RECORD v
North Carolina Department of Environment and Natural Resources-Division of Water Quality
mod. WELL CONTRACTOR CERTIFICATION# 2138
1.WELL CONTRACTOR: f. DISINFECTION:Type Chlorine Amount G`'t
James W GamD g. WATER ZONES(depth):
WeI1ConDaclor.(Ind'Nldual)Name Fran To Fran Tc
Camp' S Well & PumD� Tnn_ Fran To From To
Well Contractor Company Name Fran To Fran To
STREET ADDRESS P 0 BOX 429 6. CASING: Ttdcknessr
Depth Dlalneter WelaM Material
Ellenboro NC 28040 Fran 0 To •5� FL 6T SDR21 PVC
City xTown State Zip Code From Ta Ft.
t 828). 453-7322 From Tc FL
Area code- Phone number 7. GROUT: Depth Material Method
2.WELL INFORMATION: From 0 To 20 Ft Sackrete -Hand
SITE WELL ID#(N applicable) From To Ft
STATE WELL PERMIT#(a appilable) From . Tc FL
DWO or OTHER PERMIT#(if appBcabie) _ S. SCREEN: Depth Diameter Slot Size Material
From To Ft_ln. _In..
WELL USE(Cheek Applicable BOXY Residential Water Supply Fmrn To Ft_in. _in.
DATE DRILLED LA--",9—05 From To Ft_lm _in.
TIME COMPLETED 3 -/S AM O PM O 8. SANDIGRAVEL PACK:
3.WELL LOC7A,,TyyIO�N: ( Depth Sim Material
CITY: KU!/i t°/7oYd ldri COUNTY Y Y� Fro"'. To Ft
From To Ft
Pleas,z.t K/) L'Jj ./j From To Ft.
(Street Name.Nu_m". Commualty,SubdMalon,Lot No.,P..,.Zip Code) -
TOPOGRAPHIC I LAND SETTING: 10.DRI WNG LOG
ope pVatey OI•lat ❑RWge pother From To Formation De7�-'s1'ption
(checkepirmprlalebo� . 0 ' SaZ ��"a✓eli SAHQ
�L 1 14 AlMay be in dear, --
LATITUDE _3_ minutes,aewadea
dd aL° O(•'7/31Y) in a decimal briat PD)'(SD r e rnc�
LONGITUDES_
Iatitude/longitudesource: OOPS pTopogaphiemap
(locatioattachen of wa �beshownna S,GS topo map and
4.WELL OWNER
OWNER'S NAME l L°ii IIJ
STREET ADDRESS �
Y �
City or Town State Zip Code
Arm�code Phone number - 11. REMARKS:
5.WELL DETAILS:
a. TOTAL DEPTH.
b. DOES WELL REPLACE EXISTING WELL? YES Q NO --
I DO HEREBY CERTWyTHATTNS WELL WAS CONMRUCMD N ACCORDANCE WRH
c. WATER LEVEL Below Top of Casing: FT, 75A NCAC 2C.WELL CONSMWMN STANDARDS.ANDTHATACOPY pF THIS
(Use'+'9 Above Top of Casing) REORD HAS BEEN PROMEO,TOTHE WELL GINNER
d. TOP OF CASING 13 1 FT.Above Land Surface' D 6
•Top d cashg laminated atlor below land surface may Mquire SIGNATURE OF CERTIFIED W ELL CO CTOR DATE
a variance In accordance wfth 15A NCAC 2C.Otte. V
METHOD OF TEST ��r James W. Camp
e. YIELD(gpm): PRINTED NAME OF
Submit the original to the Division of Water Quality within 30.days. Attn:Inf at[On Mgt., Form GW to
1617 Mall Service Center-Raleigh,NC 27699-1617 Phone No.[phone] ext 568. FEB 072005 Rev.""
- Asheville Regional Offioe
Agurfer Protection

Lj�eea 5TA1Fa `\�� Tl c� V
H yyq
z RESIDENTIAL WELL.CONSTevCUON RECORD
North Cement Deportment of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 21 38
1.WELL CONTRACTOR: f. DISINFECTION:Type chlorine Amount �6
James W. Camp 9. WATER ZONES(depth):
Wen C.ontractor.(Individual)Name From To 3�Ib From To
Camp' S Well & Pump Co Tnc`_ Fran To From To
well ConUaclor Company Name Fran To From To
STREET ADDRESS P O BOX 429 S. CASING: Thiolmessl
Depth DI star We M Material
Ellenboro NC 28040 From 0 To SO Ft 6a SD 21 PVC
City or Town State Zip Code From Tc Ft _
( 828> 453-7322 Fran To Ft
Area code• Phone number 7. GROUT: Depth Material Method
2.WELL INFORMATION: Fran 0 To 20 Ft Sackrete Hand
SITE WELL ID#(II applicable) From To R
STATE WELL PERMIT#N appikabte) From_To Ft
DWO a OTHER PERMIT#(If applicable) _ S. SCREEN: Depth Diameter Slet Size Material
From To Ft in. _In._
WELL USE(Check Applicable Box): Residential Water Supply❑ Fes, To Ft.�in. —in.
DATE DRILLED I a • 2 g it S From To Ft_in. _in.
TIME COMPLETED AM❑ PM[P� 9. SANDIGRAVEL PACK:
J.WELL LOCH ION: Depth Size Material
rpr Fran To Ft.
CITY: COUNTY LdLddaJt Fran To Ft.
Fran_To Ft
IS Na .N a.CcMMu ubdivlsion,La No.,Parcel.$Code) .. - - -
TOPOGRAPHIC f LAND SETTING: 10.DRILLING LOG
❑Slaps DVdey OFM 13 @ge ❑Other From To. FormationDescdptbIt
(ohedrappropdatabox) . 0 � Sr-) (-ItAA
qrt 1 ,1 May beia�A
LATITUDE __ N�`}.�.(1�-Lt4- miwtes.aecadsa
in■dee1ma16rmat
LONGITUDE?A 091 1, r
Latitudeflongitude SOUrct: PePS oTopographic map
(attached to this fam Inot Using GPS)sibn of we,m ust be shown on a GS topo map end
r
4.WELL OWNER
OWNER'S NAME
STREET kDDRESS
City or Town State Zip Cede
Area code- Phone number 11. REMARKS: -
5.WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES D NO�
p� I DO HEREBY CERTIFY THATTIBS WELL WAS CONSRtUCMD N ACCORDANCE Wml
e. WATER LEVEL Below Top of Casing: j_FT, teA NCAC 2C,WELL CONSIRU(ftil STANONW-AND TNATA COPY OF.THIS
(Use + B Above Top of Casing) RECORD HAS BEEN PROVIDED TO THE WELL OWNER
d. TOP OF CASING IS 1 FT.Above Land Surface
:Tap or casing temdraded atfor below land surface may require 48IGTNE OF CERTIFI D W LL ON CTOR ` DATt
a variance In accordance with ISA NCAC 2C.011 B.
CC METHODOFTEST-0 James W. Cam
e. YIELD(gpm):y_ PRINTED NAME OF P7ASheville
VED
Submit the original to the Division of Water Quality wlthin;30.days. At
InfoForm OW-la
1617 Mail Service Center—Raleigh,NC 276994617 Phone No.(9191733-7015 ext 2006Rev.nos
nal uoffice
p'tfpr+

- RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division or Water Quality
WELL CONTRACTOR CERTIFICATION# 2138
1.WELL CONTRACTOR: 1. DISINFECTION:Type chlorine Amount_
James W. Camn g. WATER ZONES(depth):
Well Conbactor.(Ndlvidual)Name Fran To 1 U Frw To
Camp' S Well & PUMp Co, . Tnr•_ Fr= To From To
well Contractor Company Name Fran To From To
STREET ADDRESS P 0 BOX 429 S. CASING: Thickness/
Deptl* Diaieter Weight Material
Ellenboro NC 28040 From 0 Tc I+ _-FL 6a SDR21 PVC
City or Tom State Zip Code From To ` FL
( 828�. 453-7322 From To FL
Area coda Pho, number 7. GROUT: Depth Material Method
2.WELL INFORMATION: From 0 To 20 FL Sackrete Hand
SITE WELL ID#(If applicable) from To FL
STATE WELL PERMrr#(r applicable) Fran . To FL
DWQ or OTHER PERMIT#0f applicable) - 8. SCREEN: Depth Diameter Slot Size Material
cable Box): Rrisidentlal Water Supply❑ Fran To Ft. in. _In.
WELL USE(Check Appli Fran To Ft._in. —In.
DATE ORII r Fri �., 1� t�5 From To FL_in. _In.
TIMECOMPLETED IU AM PM®. 9. SANDIGRAVEL PACK:
3.WELL LOCATION: Depth Sim Malarial
From To FL
C COUNTY From To Pt.—
LA Q
From To FL__
(Shot Name,Number.Community.SubdiNsk LLd_No.,Paresl;ZIP Coda) -
TOPOGRAPHIC ILAND SETTING: 1D.DRILLING LOG
OSlope gVSre1,. ❑Flat ORldge ❑Other From _Tr7 (� �Formation ascription
(dwckapproPdatab?s) _L..d,.{ld �d)ffiLp
May be in degrees, .. —
LATITUDE ,;_ " minutar,seowdsor
in a decimal format
LONGITUDE,y�,� �q-i.�
LatitudcAongitwo source: pWS OTopographic map -
(���limb must
be shown on uses topo map and
L
4.WELL OWNER --
OWNER'S NAME - r
J
STREET ADDR SS big q, ,�
Oil
City ar}a+m ❑ State Zip Cod
Area code- Phone number 11. REMARKS:
S.WELL DETAILS:
a. TOTAL DEPTH' gh (n
b. DOES WELL REPLACE EXISTING WELL? YES13 NO�
I DD IEREBY CER IFy THAIM WELL WAS cONSTRUC7ED IN ACCORDANCE W1711
c. WATER LEVEL Below Top of Casing: 1 n FT. tsA NCAc 2c,WELL cottsmtjc InmSTANDARDS,ANDWTACOPYgETWS-
(Use,eVAboveTopofCasing) - RECORD NAS BEEN PROVIDEDTO THE WELL OWNER
d. TOP OF CASING IS 1 . FT.Above Lend Sudace• � j � \j 7 � j1 N'1AD
•Top d casYlg terminated av«belay land surface may require SI E OF CERT IED W E C TRACTOR DATE
a valiance in accordance with 15A NCAC 2C.011 B.
q METHOD OFTEST n � James W. Camp
e. YIELD(gpm).J-�-�— -Sd-° — PRINTED NAME OF. -
RECEIVED
Submit the original to the Division of Water Quality within,30.days. Attn:In nation Mgt., Form GV r4a
1617 Mail Service Center-Raleigh,NC 276994617 Phone No.(919),733-7016 a 568. FEB 07 2006 Rev.7ro
_Asheville Regional Office
Aqu'ffer Protection

sa�SGV(o V
raw
RESIDENTIAL VVELLCONSTRVCTIONRECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
ea WELL CONTRACTOR CERTIFICATION H 213 8
1.WELL CONTRACTOR: f. DISINFECTION:Type Chlorine Amount l I'L
James W. Camp g• WATER ZONES(d��ep�,tt,h)):
Well Contractor.(Individuaq Name From To_�0 From To
Camp' S Well & Pumn Co- T� Fran Tc From To
Well Cantrecta Company Name Fran To Fran - To
STREETADDRESS P 0 BOX 429 S. CASING: Thickmsl
DeplF D�i�Pieter Wei M Material
Ellenboro NC 28040 From 0 To %_Ft SD 21 PVC
City aTavn State Zip ode From To Ft _
( 8281 453-7322 Fmm To Ft
Area code- Phase number
T. GROtIT: Depth Material Method
2.WELL INFORMATION: Fran 0 To 20 FL Sackrete Hand
SITE WELL IDANawkable) Fran Tc Ft
STATE WELL PERMITe(Bapplicable) From . To Ft
DWQ or OTHER PERMIT#M applicable) 8. SCREEN: Depth Diameter Slot Size .Material
From To Ft_in. _ In._
WELL USE(Check Applicable Box): Residential Water Supply❑ Fmm To Ft. In. _in.
DATE DRILLED L a-• From To Ft_in. _In.
TIME COMPLETED-9 311 AM 9�- PM❑ 9. SAND/GRAVEL PACK:
3.WELL LOCATION: Depth Slze Material
(� p From To Ft.
CITY; t Q(1 COUNTY r .AL4.} From To Ft
n Q k a Fmm To Flt —
(Street Name.Nundwes, unity.SubdMti No.,ParoeL.ZIP Code) . . _
TOPOGRAPHIC I LAND SETTING: 10.DRILLING LOG
❑Slope W)/dw [3Fbt ❑Ridge ❑Other From //T^,++ �Formaypn DesrrrlpWn
(el,eck y,propAata b?q . 0 ' .¢f`1' CA, ..
g �� May be in degroes,
LATITUDE 3 La[`�� minutes.ucads or .(w!nn
LONGITUDE,_ 59. ILIQ inadecimalbmut — ti
Latitudeflongitude source: 01PPS OTopographic map
(location of welmustbe attached to b form/no shown GS lope,map end
sing GPS)
4.WELL OWNER -
OWNER'S NAME
STREET ADDRESS -
City or Town State Zip Code
Area code- Phone number 11. REMARKS:
5.WELL DETAILS: r 1�
a. TOTAL DEPTH: I`! S
b. DOES WELL REPLACE EXISTING WELL? YES p NO
1' I DO HEREBY CERTIFY VAT THIS WELL WAS CONSTRUCTED NACCORDANCE WITH
c. WATER LEVEL Below TOP of Casing: 0 1FT. ISA NCAC2C.WELL CDNs1Rt1Crm STANDARDS.ANDTHATACORY OF TO-
(usew KAbare Top Of Ceasing) RECORD HAS BEEN FROWIDFDTOTHE WELL OWNER
d. TOP OF CASING IS 1 FT.Above Lend Surface- �)
?Op of casyp taminated at/a below,land surface m@y[squire SI F CERTI ED W EL CTOR DATE
a valance in scoordwee wfth 15A NCAC 2C.011 a.
r/! James W.
e. YIELD(gpm): METHODOFTEST112- PRINTED NAME OF P RSON "FI - LL
Submit the origihal to the Division of Water Quality within 30.days. Attn:Info ation Mgt. Form GW-
1617 Mail Service Center—Raleigh,NC 2T6994617 Phone No.[phone] ext 6. . DEB 0 7 2006 Rev nos
Asheville Regional Office
A urfer Protection

RESIDENTIAL WELL CONSTRUCTION RECORD
North Camlina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2138
1.WELL CONTRACTOR: I. DISINFECTION:Type Chlorine Amount
James W. Camr) g. WATER ZONES(depth):
Wen Contracta.(Indtvkluaq Name From To L l From To
Camp' s Well & Pump CO. Tnn_ From To Fram To
Well Contractor Compalry Name From To From To
STREET ADDRESS P O BOX 429 6. CASING: Thblmessr
Depth D7 eter Wei M Matelot
Ellenboro NC 28040 From 0 col. FL 6�_ SD 21 PVC
City or Town State - Zip ode Fran To Ft
( 828>_ 453-7322 Fran To FL _
Area code- Phone number
7. GROUT: Depth Material Method
2.WELL INFORMATION: FmmL 0 To 20 Ft Sackrete -Hand
SITE WELL ID#Of applicable) Free Tc Ft
STATE WELL PERMIT#(e applicable) Fran Tc Ft
DWQ or OTHER PERMIT#(If applicable) S. SCREEN: Depth Diameter - Sbt Size .Material
WELL USE(Check Applicable Box): Residential Water Supply Cell' From To Ft_im _in..
nn � Flom To Ft.In. —In.
DATE DRILLED Fran Tc Ft_in. _in.
TIME COMPLETED. OU AMC] PM42" 9. SANDIGRAVEL PACK:
3.WELL LOCATIONW. fit' Size Material
CITY:Vuh 0, .,aklaty, _ COUNTY .LA From To Ft
From To Ft
(Street Name,Numbers,Community,Subdivision.Lot No.,PareaL.Zip Code)
TOPOGRAPHIC/LAND SETTING: - 10.DRILLING LOG
pskrpe bVatey p.FM pRldge ❑Otiter From To. Fortn^atbn Desch tic
(check eppmpiatabaq . 0 ' (1 •mn'V — '1
May be In degree,
LATITUDE minutes,seeds or --7�---
LONGITUDE , t.\ in a daimel former
Latitudepongitude source: oGPS OTopogcaphic map
(bcaffon of well must be sham on a USGS topo map and
attached to Itus form l not uskV GPS)
4.WELL OWNER !
OWNER'S NAME l0 gn.r A V1 'IM ---r
STRfF�JTADDRESS 0 C1
Tf-f'+N NC S i
fly or Town State Zip Code
Area code- Phone number -
11. REMARKS:
5.WELL DETAILS:
a. TOTAL DEPTH: Lli
b. DOES WELL REPLACE EXISTING WELL? YES(] NO�
I Do HEREBY CErmPYTHATTHIS WELL I
WAS CONSmum N Accorza CE wmi
c. WATER LEVEL Below Top of Casing: k Fr, I&A WAD 2C,WELL CONSTRUCTION STANDARDS.ANDTHATACOPY OF 7M
(Use'+'0Above TOP of Casing) RECORD HAS BEEN PROVIDED TO THE WELL OWNER
d. TOP OF CASING IS 1 FT.Above land Surface' /\�� lCA=
Of easing termlased allor below lard surface may require " T U s�� I T
a variance bI accordance with ISA NCAC 2C.0118. - SIrTURE OF CERTIFIED WELL CONTRACTOR DATE
_METHODOFTEST James O Cam
e. YIELD(gpm): �— PRINTED NAME OF
Submit the original to the Division of Water Quality within 30.days. Attn:Information Mgt., Form c -1a
1617 Mail Service Center—Raleigh,NC 276994617 Phone No.(919).733-7016 exi 668. FEB 0 7 2006 Rev.7ro
Asheville Regional Office
Aguifer Protection

- RESIDENTIAL WELL coNSTRVCfION-REcoRD
t ,
North Carolina Department of Environment and Natural Resources-Division of Water Quality ^y s
Rexn� WELL CONTRACTOR CERTngCATION# 2138
1.WELL CONTRACTOR: f. DISINFECTION:TyI»_Qb10rine Amount G s
James W. Camr) g. WATER ZONES(depth):
wen Contracta.pndivWuat)Nam8 From To Rom To
CampContractor' s Well & Pump Co. Tn From To From To
Well Company Name Fran To From To
STREETADDRESS P O BOX 429 S. CASING: Thickness/
Depth DWW�Inneter Wee�I�M Material
Ellenboro NC 28040 From 0 To�_Iet�_ SDR21 PVC
City or Tam State Zip ode Fran To Ft _
( 828l. 453-7322 Fran To Ft
Area code. Phone number
7. GROUT: Depth Material Method
2.WELL INFORMATION: Fran 0 Tc 20 Ft Sackrete -Hand
SITE WELL ID#(If applicable) FmT Tc FL
STATE WELL PERMITV applicable) Fran _ To FL
DWQ or OTHER PERMIT A(U applicable) 8. SCREEN: Depth Diameter $lot Size .Material
WELL USE(Check Appliceble Boor): Residential Water Supply❑ From To FL_1n. _ In.
,�1 ��' trrlll ��I�'' Fmn To FL In. _N.
DATE DRILLED 'd .� Fran Tc Ft_IR _In.
TIME COMPLETED O 0 AM0 PM$ S. SANDIGRAVEL PACK:
a.WELLL ATION: Depth Size Material
From To Ft.
CITY. CO.LUNTYs Fran To Ft
Cr ,poM „�,pA,t4I! .Cl 33 Fmn TR FLU_
(Street Name,Nu_mbeD, .Sub(HNsion,J.ol No.,Parcel,Lip Cotle)
TOPOGRAPHIC I LAND SETTING: 10.DRILLING LOG
❑slope oveeey 0Flat WRidge ❑Other From /T�o 1� .Fortngltbn Deapalptbn
(oheok apgopdataboAl . Q . l r �vG MiY
May be I.depem
LATRUOE ,$_ 3a`In (a minutes,seconds or
9 q � �/ in a decimal brmat I x
LONGITUDE_ �
Latitudellongitude source: 13OPS oTopographie map - —
(loeatbn of wet must be shown one USGS topo map and
attached to this tam snot using GPS) ,
4.WELL OWNER
OWNER'S NAME,(�l Ole 1fi L..Ofn..Y •-^
STRE ADDRESS ©�l �0
1S ri L ih0 C 4t �,T) �L tr
1 City or Townj Slate Zip Code
Arm�code Phone number - 11. REMARKS: -
6.WELL DETAILS: (1
a. TOTAL DEPTH. LA .A r
b. DOES WELL REPLACE EXISTING WELL? YES p NO lk
WATER LEVEL Below Top d Casing:__WI DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED NACCORDANCE WrrH
e. _FT. 15A NCAC 2C,WELL CONSTRUCTION STANDMDS,ANDTHATACO%OF.IM-
(Use*4'0 Abell TOP of Casing) RECORD HAS BEEN ORMWEDTOTHE WELL OWNER
d. TOP OF CASING M 1 FT.Aba+e Land Sudacri' _ q .0
'Top d casing temdnatad Or beioAl IerW aUCrf a TTI@y require S T RE O C wnFI D W E CONT CTOR DATE
a variance in
aaadenaf w1Un 15A NCAG 2C.0118. .
I � =at1qnMGt-,
e. YIELD(gpm):A _METHOD OF TEST ERSON LL
Submit the original to the Division of Water Quality withino atlon Mgt., Form GW 1a
1617 Mail Service Center—Raleigh,NC 2T699.1617 Phone No 68. FEB Q 7 1006 Rev.7105
Asheville Regional Office
u'Ifer Protection

RESIDENTL4 wsl l coNSTRTJCI7ON RECORD
North Carotin Depataamt oMovionment and Natural Resources.Division or Water Quality
WELL CONTRACTOR CERTIFICATION# a 1 IS
1.WELL CONTRACTOR: L DMINFECT10N:Ty 41'I �%trc motmt
J Q-rr,P R) Q B. WATER ZONES(daplh):
Wall Contractor(hd'mduaQ Name Frorn TO _
m t d -'Fl `A �� y�hol I Corneam bIr From To From TO
Well Contractor Compppany Naattne From To From To
STREET ADDRESS taf'J9 SI QQ-n . .ti S. CASING: TlNpptassy
I n N C ag al D Fmm_(�r°eptloFt k
CRY«town state zip Cociff
c7D11)- 5311-SS tS From To Ft
Area crate- Phone mtrrber
L WELL INFORMATION: 7. GRDUr. Depth /Material Method
SREWELL IDB(yappacabN) F._o_Tod_Ft L CYn14
From To Ft
STATE WELL PERMRiprWppaobte) Fran To Ft
DWQorOTHERPERMITNRappGcaW a SCREEM: Depth Diameter Sias Shy Material
W91 USE(Check Aptoeca/b/a Bmtl• Resides eal Water Supply Lg/ Fran To Ft,__in. __kL
DATE oRntint -OC mt
f ® CX JJ Fr To R.in. in.
From To Ft uL bL
TIME COMPLETED 'L•LUO AM O 'PMfj- —
9. SANDIGRAVEL PACK
3.WELL LOCATIDN: /� Depth Size Material
CRY: {� �`` '' COUNTY iZt,Tt,-,A,,cL F=T Tc FL
i�� �n:2 n� CA Ran Tc FL
(Street NOee.Nunbem.Cadda,ry,3tkiYMslaL La No..ft-K$Code)
TOPOGRAPHIC I LAND SETTING: 10.DRILLING LOG
OSfope O stay p OOOter From TO/ Fr>r n Description
LATITUDE 3 MAy be in degas, _ � ;
sneu ssecerdsa KoC•K
LONGITUDE__ ins drd®16rtwt '
Latitudeflongitude source: 00pS pTopogrephic maprsevi
C I 1 n
ltcaeor of wamug iw stmwn on a USGS$Wo map andLW—
a/Mahed ro Ida Xbfm 7nof usn9 GM
4.WELL OWNER (�
owNER's NAME C16-�t- L `W"1'i.l T A1-L� t
STREET ADDRESS jP�L�r� ('(_ e Iona I eCity or roam Stale Zip code er P u
f }
Area code- Phone nu nber
11. REMARKS:
S.WELL DETAILS: rz
a. TOTALDEPTIt 4qc
b. DOES WELL REPLACE EXISTING WELT..? YES❑ NOS
m WATER LEVEL SelowT of IDOr61® m Y CEFY7MTTM WELL WAS CONSFRUCTEp IN ACCORDANCE WITH
W S FT. 15A NCAC 20.W m
EIL CONSIRUOnON SIANONS,ANDTMTA COPY OFIXM
(the-+•IfAbrwe Top d Cg S9 RECORD RAS BEEN PROtm®TOTHEXWELL OWrMn
d. TOP p f c sING FT.Above real Staface• f { 'L��,its
?ap tas6tg aura below land surface may regtwe SIG RE OF CERTiFIm WELL N ACTOR DATE
a variance to accordance with 15A NCAC 2C.0716.
e. YIELD 19Pm): METHOD OF TEST PRINTED NAME OF PERSON CONSTFMCrING THE WELL
Submit the original to the Division of Water quality within 30 days. Attn:hformatfon Mgt,
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Fomt GW-la
Rev.7M5